162 E. Kerpel-Fronius 



Kerpel-Fronius, E., Varga, F., Vonoczky, J. and Kun, K. (1951). 



Helv. paediat. Acta, 6, 377. 

 Keys, A., Brozek, J., Henschel, A., Mickelsen, O., and Taylor, 



H. L. (1950). The Biology of Human Starvation. Minneapolis: 



Minnesota Press. 

 McCance, R. a. (1951). Spec. Rep. Ser. med. Res. Court. (Lond.), 



no. 275. 

 McCance, R. A., and Widdowson, E. M. (1957). Brit. med. Bull., 13, 3. 

 Varga, F. (1957). Personal communication. 



DISCUSSION 



Davson : Has the subject of size per se been considered as opposed to 

 immaturity? The pulse rate of the baby was mentioned as being faster 

 than that of the adult and the reasons for it were based on the im- 

 maturity of the organism, whereas one finds that small adult animals 

 have very fast pulse rates. The rabbit pulse, for instance, is well into the 

 hundreds and the mouse pulse is even faster. 



Young : I do not think it has been suggested that the pulse rate is high 

 because of immaturity : it is high because of the high metabolic rate in 

 relation to the other constants, and in order to keep up the cardiac output. 



Adolph : The effect of body size on functions such as pulse rate and 

 respiration rate varies considerably in any one species. Among various 

 species of adults it is very definite because you can get a wide range of 

 body sizes and can calculate what the average difference of function is. 

 In one species, the rat, the breathing rate is almost constant with age, 

 whereas the ventilation varies enormously with age, and even relative 

 to body size it varies somewhat with age. The pulse rate varies in accor- 

 dance with body size only after the age of weaning, and I should say 

 that none of the body size rules apply uncomplicatedly during infancy. 

 There are other factors, and perhaps the factor of metabolic peculiarities 

 is one of them. 



McCance : Would anyone with paediatric experience like to comment 

 on the metabolic rate in pyloric stenosis? 



Young : Prof. Kerpel-Fronius only quoted the example of the meta- 

 bolic rate in pyloric stenosis because dehydration is so likely to occur in 

 that condition, where the baby is also malnourished. Dr. Varga has 

 studied a series of malnourished cases in which he showed that the meta- 

 bolic rate and the oxygen uptake were low. 



Talbot: Could the results shown in Fig. 2. (p. 156) be explained on 

 the basis of starvation with hypoproteinaemia? As in the nephrotic 

 patient, hypoproteinaemia tends to result in hypovolaemia. This in turn 

 leads to sodium and water retention and to a tendency to the formation 

 of extracellular oedema. It is thought that these reactions represent an 

 attempt on the part of the body to restore vascular volume to a satis- 

 factory level. 



Young : When this infant became dehydrated he still had a relatively 

 high volume of extracellular fluid as a percentage of body weight, but 



