804 W. McKIM MAKKIOTT 



characteristic eye condition and many from marked edema. Prompt re- 

 covery occurred on the addition of whole milk and cod liver oil to the 

 dietary without any alterations in the amount of carbohydrate given. 

 In a group of older children fed on partially skimmed milk and on oleo- 

 margarine in place of butter the development of xerophthalmia and 

 edema occurred. The xerophthalmia cleared quickly on adding a small 

 amount of cod liver oil. In these cases there was sufficient fat in the diet 

 but an insufficiency of the essential "fat soluble A." As the condition im- 

 proved after this was added in the form of cod liver oil, the evidence points 

 most strongly to the fact that deficiency of this accessory foodstuff is 

 the important factor in bringing about the condition. Bloch believes 

 from his observations that the occurrence of severe nutritional edema 

 is more frequent in individuals who have been deprived of all fat than in 

 those who receive some fat even though it may be such fat as margarine 

 which does not contain the "fat soluble A". Harden and Zilva have repro- 

 duced the condition in a monkey by feeding a diet deficient in "fat soluble 

 A" and in protein. 



A deficiency of protein alone in the diet results in a failure to gain 

 in weight at the normal rate. Anemia of a secondary type is likely to 

 develop. The minimum protein requirement of infants is about one and 

 one-half grams per kilogram of body weight per day, but the majority of 

 infants maintain their nutrition better when as much as two and one- 

 half or three grams of protein per kilogram of body weight per day is 

 fed. Proteins deficient in such amino acids as trypophane, lysin and 

 cystin are of less value from the nutritional standpoint than proteins con- 

 taining amino acids in which the relative proportions approach that in 

 body protein. Proteins which are entirely lacking in one or more of 

 the essential amino acids have a nutritional value comparable to carbo- 

 hydrate. Such incomplete proteins fail entirely to supply the body's pro- 

 tein demands. Lactalbumen is a protein containing all of the essential 

 amino acids in proportions which are better suited for the nutritional re- 

 quirements of the infant than has any other known protein. Casein 

 is relatively deficient in some amino acids, notably cystin, and is con- 

 sequently of less value in nutrition, that is to say, a larger amount of 

 casein must be fed to accomplish the same nutritional result as when 

 lactalbumen is fed (Osborne and Mendel (/)). An infant fed on cow's milk 

 with its relatively high casein and low lactalbumen content, therefore, 

 requires more protein than one fed on breast milk in which the protein 

 is largely lactalbumen. 



A deficiency of carbohydrate in the diet of an infant or young child 

 may result in those disturbances of the metabolism that have been de- 

 scribed previously in considering the effects of a diet containing a rela- 

 tive excess of protein and fat. Without a fair amount of carbohydrate 

 there is usually a failure to gain in weight, less storage of nitrogen, or, in 



