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Metabolism and Nutrition During the First Year of Life

physiology, time, artificial, numerous, heat, childhood and feeding

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METABOLISM AND NUTRITION DURING THE FIRST YEAR OF LIFE A thorough foundation in physiology is especially indicated in pediatrics. The great progress of the natural sciences and of medicine within the last decade has considerably advanced our knowl edge of the life of the normal healthy human organism. Each step of this progress leads to new questions and opens up new problems. Neverthe less, we affirm with satisfaction that thanks to the labor of many inves tigators during the past thirty years, numerous problems have found a :sufficiently exact explanation, and this is especially true in the physiology of childhood. It must be acknowledged that some of these problems had been worked out much earlier. We need only recall the very important investigations of Quetelet concerning the growth of man.* But for a surprisingly long time knowledge on most important subjects—particu larly the nutrition and metabolism of children--was sadly deficient.

Allix, a Frenchman, contributed the first work on the physiology of infancy. The first observations on the quantity and character of the food were recorded by Forster, a pupil of Volt. But Vierordt, of Ger many, is the real founder of the physiology of childhood. He published in 1S77 for the first time, in Gerhardt's Handbuch dcr Kinderkrank hciten, a physiology comprising the entire period of childhood. To him we owe the very important knowledge of the surface of the body at different periods of life; and he was the first to It the determination of a metab olism equilibrium in the child and to calculate the absolute and relative expenditure of heat. For the latter, lie found 130 calories per kilogram in an infant five months of age, and 91 calories in a child of a year and a half. These figures are not far removed from the real values. Lavoisier calculated the intake and expenditure of heat in the adult, and he regarded the production of animal heat as due to the formation of carbonic acid and water in the body. Boussaignault, Liebig, Dumas, and others tried to determine the heat produced from the difference *Queielet stir hornme, Paris, 1835.

364 between the amount of carbon and hvdrogen introduced into the body and the amount eliminated in urine and feces within 21 hours. They calculated that the adult requires 2 lInt calories per diem, a figure which approaches the yalnes which I)espretz previously obtained on the basis of direct calorimetric measurements. A complete understanding of the

transmutation of energy could not be obtained before the discovery of the law of the conservation of energy ( R. Maier). Camerer (the elder), lleubner, and Hubner deserve the credit of introducing the nse of this law in the physiology of childhood. Despite the approximate correct ness of his calculations, the explanation which Vierordt deduced from Iris results is not quite right, as we will show later on. We have to mention here the numerous observations and investigations of Camerer (the elder) concerning the metabolism from the time of birth to the end of the time of growth, and in regard to the growth in length and weight. With Soldner he made investigations into the chemical composition of human milk. The contributions of Rugger the balance of energy, and the exact metabolism experiments which lie conducted in conjunction with fleubner and other investigators, were of great im portance. Valuable observations in regard to nutrition and metabolism were reported from obstetrical departments, while the numerous publica tions of former times from children's hospitals treated more of patho logical conditions.

The reason which Camerer (the elder) gave in Do)1 to explain the unsatisfactory result of artificial infant feeding shows how insignificant our knowledge was only a short while ago in regard to one of the most important points in practice. Ile deemed it necessary. in order to estab lish artificial feeding on any other than a rather crude empirical basis, to obtain clear information as to the infant's physiological requirement of water, proteids„ fats, sugar, and salts, and as to the utilization of a normal food by the healthy infant. The problems of artificial feeding could be formulated in a really scientific manner, and rational methods of artificial feeding he instituted, only when such examinations had been made on a certain number of infants. The line of investigation has 110W been carried out in its essential points, and we are indebted to numerous researches of practicing physicians and patient investigators. Among the number of German authors who have contributed to the accom plishment of this task, the names of Biedert. Czerny, Escherich, Keller, Pfaundler, and Schlossmann should be mentioned.

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