1102

appears about the third or fourth month in casesof hyperemesis; indeed the paralysis may be mis-taken for inanition as the result of uncontrollablevomiting.

DIETARY SURVEYS.

THE direct experimental method has recentlybeen applied with good effect to the science ofnutrition, animals and less frequently groups ofhuman subjects being employed to test the effectof variable dietetic factors on development andliability to disease. But another method of

investigation is sometimes employed, consistingof a careful survey of the food actually consumedby selected groups of individuals over a definiteperiod. If the subjects of such surveys are

apparently normal healthy individuals it is assumedthat the diets observed are more or less adequate.Moreover, it is possible from such studies to gainsome information about the amounts of variousfood components habitually consumed by membersof various classes of society, and by comparingthese amounts with figures obtained in the labora-tory for the food requirements of normal healthysubjects it may be possible to gauge roughly theprevalence of any marked degree of under-nutritionin a given section of society. CATHCART and hisco-workers have been engaged in a series of surveysof this type, and have just published the resultsof their inquiry into the diet of families in Cardiffand Reading.! The inquiry was limited to working-class families, and comprised a total of about370 individuals in each town. As in their previousstudy, carried out at St. Andrews, they found theaverage daily caloric value of the diets rangedfairly close to the accepted figure of 3000, andthe amount of fat consumed was in both instancesdistinctly higher than the generally acceptedaverage-namely, 113°6 g. in Cardiff and 100’8 g.in Reading. Special interest is attached to theanalysis of the poorest diets. The mean value in8 families in Cardiff and 12 in Reading wasless than 2500 calories, and in three instances wasless than 1800. It was found that this shortageof food was not occasioned solely by the smallnessof the income, but arose partly through the improvi-dence or incapacity of one or the other parent.It appears that with very restricted incomesa distinctly smaller proportion of the weeklywages is devoted to the buying of food in theseEnglish towns than in Scottish towns, which factis largely accounted for by the higher rents paid inthe English towns. Special attention was devotedto the physique of the children belonging to thefamilies under observation. It did not appearthat any serious degree of malnutrition existed

among them, although the numbers examined weretoo few for any decided opinion to be formed on thispoint.The practical use to which dietary surveys can

be put is illustrated by a circular recently issued1 Studies in Nutrition. An Inquiry into the Diet of Families

in Cardiff and Reading. By E. P. Cathcart and A. M. T.Murray. Med. Res. Council Spec. Rep. Ser. No. 165. 1932.H.M. Stationery Office. Pp. 28. 6d.

by the United States Department of Agricultureregarding midday meals for pre-school-children.2The object of the circular is to suggest suitablemenus for young children attending day nurseriesand nursery schools. The menus are carefullyconstructed so that they furnish approximatelythe same amounts of the main food constituentsand the same total energy value. These standardquantities were arrived at after a considerationof reliable surveys of the diets of normal healthyyoung children brought up in private familieswith varying incomes. Some of the main findingsof four such surveys are reproduced in the presentreport. The mean energy value of diets of childrenaged 2 to 3 years varied in the different surveysbetween 1200 and 1400 calories; of those aged3 to 4 between 1330 and 1500 calories ; and of thoseaged 4 to 5 between 1430 and 1720 calories. Insome of these surveys the intake of calcium,phosphorus, and iron was estimated as well as

that of protein, fat, and carbohydrate, but thequantities of these mineral elements allowed inthe proposed dietaries are based rather on previouslypublished individual metabolism experiments thanon the results of such surveys. Attention has been

paid to the vitamin content of the diets, and freeuse is made of milk, eggs, salads, fresh vegetables,and cod-liver oil. The general plan of the schemeis to provide at the nursery school one-half of theestimated daily requirement of protein, phosphorus,and total energy, and rather more than one-halfof the calcium and iron needed. The averagecost of the raw materials for meals constructedfrom the proposed menus and actually served atone particular institution worked out at 17 cents(82d. at par) per child per day during the first halfof 1930, individual menus costing from 11 centsto 25 cents (5. to 18. 02d.). These figures arecertainly very much higher than some recentlyquoted in the report 3 of, the Advisory Committeeon Nutrition, as representing the actual expenditureon children’s food allowed by certain of the publicauthorities in Great Britain. From a qualitativepoint of view the recommendations of this com-mittee agree well with those of the compilers of theAmerican report.

A NEW PITUITARY SYNDROME.

TUMOURS of the pituitary gland have alwaysexcited great interest because of the widespreaddisturbance that they produce both in the endocrinesystem and in other parts of the body. Withfew exceptions they are adenomas arising in theanterior lobe, a structure which is composed ofthree types of cell, chromophobe, acidophilegranular, and basophile granular cells. Of theseonly chromophobe and acidophile cells havehitherto been encountered in tumours. Adenomas

composed wholly or mainly of cells resemblingacidophile cells of the normal gland are associated

2 Midday Meals for Pre-school-children in Day Nurseries andNursery Schools. By M. E. Sweeny and C. Chatfield. UnitedStates Dept. of Agriculture Circular No. 203. 1932. Pp. 45.10 cents.

3 See THE LANCET, April 9th, p. 782.