50 METABOLISM AND GROWTH FROM BIRTH TO PUBERTY. 



He also notes that "as the favorability of the environment decreases, 

 the proportion of medical care extended to the children, as indicated 

 by the percentage of removed adenoids, also decreases, while the degree 

 of medical neglect, as indicated by the percentage of infected and 

 unoperated adenoids, undergoes a parallel increase." 



Food and physical surroundings are not entirely responsible for 

 under-growth. It has been shown that physical defects play a large 

 part in preventing the normal growth and nourishment of children, 

 even under good dietetic and hygienic conditions. Carious and 

 infected teeth and enlarged and infected tonsils and adenoids are the 

 most common physical defects responsible for under-growth and 

 under-nourishment. 



Exercise. Ordinarily it is considered that the effect of exercise is 

 almost immediately compensated by an increased food consumption, 

 as commonly experienced in the ravenous appetities of vigorously 

 exercising children, yet it may frequently happen that an underfed 

 child automatically restricts his energy expended in work or play to a 

 lower level, in order to provide for growth. In other words, a child 

 that is undernourished can not supply the energy for vigorous exer- 

 cise, since he needs this energy first for growth, and he will auto- 

 matically cut down his activity and thus conserve energy. On the 

 other hand, a child may be led, in the excitement of competition with 

 his playmates, to excessive exercise. In this case the child (although 

 furnished with a considerable amount of food) grows in height in 

 other words, the skeletal growth continues but he does not gain in 

 weight. The lack of growth in weight in this instance is due to 

 excessive exercise and to the fact that extra food has not been added 

 to compensate the increased muscular activity. If such a child is 

 made to take regular rest periods during the day, he will commence to 

 gain weight on a normal diet without an increase in the quantity of 

 food. 



The value of rest in conserving the energy of children has been most 

 tragically illustrated in the recent experiences of German mothers in 

 the war, as reported by Leonard Hill: 1 



"The mothers of Germany kept their war-starved children most of the 

 day in bed, letting them get up at 11 a. m. and go to bed at 4 p. m. Thus 

 they husbanded the national life, taught by scientific experience that 

 growth will make good when the war is over and food supplies become 

 ample." 



We thus see that the amount of food and exercise together play a 

 very important part in the final resultant growth, and that while the 

 quantity of food affects the general state of nutrition, it is not the sole 

 cause for undernutrition. If the caloric intake is not sufficient to 



1 Hill, The science of ventilation and open-air treatment, part i, Special Report Series No. 32, 

 Medical Research Committee, London, 1919, p. 79. 



