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THE PHYSIOLOGY OF THE NEW-BORN INFANT 
 
 CHARACTER AND AMOUNT OF THE 
 KATABOLISM 
 
 BY 
 
 FRANCIS G. BENEDICT 
 
 AND 
 
 FRITZ B. TALBOT 
 
 ' 
 
 
 * 
 
 WASHINGTON, D. C. V 
 
 PUBLISHED BY THE CARNEGIE INSTITUTION OF WASHINGTON 
 1915 
 
<? 
 
 SiOLOGY 
 
 IBRARY 
 
 G 
 
 CARNEGIE INSTITUTION OF WASHINGTON 
 PUBLICATION No. 233 
 
 
 PRESS OF GIBSON BROTHERS, INC. 
 WASHINGTON, D. C. 
 
PREFACE. 
 
 The investigation on new-born infants reported herewith is a natural 
 outcome of the attempt of this laboratory during the last four years to 
 secure adequate information regarding the normal metabolism of 
 infants preparatory to a contemplated study of pathological conditions, 
 for until normal data are available an intelligent interpretation of the 
 data from pathological cases is impossible. 
 
 The observations have been made by Miss Alice Johnson, whose 
 skillful technique and experience in studies of infant metabolism have 
 contributed greatly to the research. To the trustees and especially to 
 the superintendent of the Massachusetts General Hospital we wish to 
 express our thanks for the facilities offered to us in the prosecution 
 of this study. Through the kindness of the trustees and staff of the 
 Boston Lying-in Hospital, a large number of new-born infants were 
 made available for this research. The majority of the infants used in 
 these observations came from this institution. Much credit is also 
 due the nurses of the hospital for their active interest and cooperation, 
 which materially assisted in the successful outcome of the research. 
 
 NUTRITION LABORATORY OF THE 
 
 CARNEGIE INSTITUTION OF WASHINGTON, 
 
 Boston, Massachusetts, July 31, 1915. 
 
 353768 
 
CONTENTS. 
 
 PAGE 
 
 Introduction 7 
 
 Embryonic conditions 7 
 
 Post-natal conditions 8 
 
 Loss in body-weight 9 
 
 Earlier researches with new-born infants 12 
 
 Observations by Hasselbalch 15 
 
 Purpose and plan of the research 38 
 
 Apparatus and tests for accuracy 38 
 
 Method of computation 39 
 
 Care of the new-born infant 41 
 
 Statistics of the observations 43 
 
 Discussion of results 80 
 
 Character of the katabolism 80 
 
 Respiratory quotient during the first 24 hours of life . . 80 
 
 Respiratory quotient during the first week of life 89 
 
 Influence of body- weight upon the respiratory quotient 91 
 
 General conclusions as to character of katabolism of new-born infants .... 92 
 
 Basal katabolism 94 
 
 Total minimum heat-production per 24 hours 97 
 
 Minimum heat-output per kilogram of body-weight per 24 hours 98 
 
 Minimum heat-output per square meter per 24 hours 99 
 
 Influence of age upon the katabolism 102 
 
 Influence of age upon the heat-production in the first day 103 
 
 Influence of age upon the heat-production from the second to the 
 
 seventh day 105 
 
 Influence of length upon the basal katabolism 106 
 
 Influence of activity upon the basal katabolism Ill 
 
 Pulse-rate 113 
 
 Physiological needs vs. supply 117 
 
 The conservation of energy 118 
 
 Body temperature 118 
 
 Methods for reducing the energy loss 121 
 
 The energy intake 122 
 
 Probable 24-hour energy requirement of a new-born infant for maintenance . 126 
 
 ILLUSTRATIONS. 
 
 FIG. 1. Respiratory quotients of infants found at times during the first 24 hours. . 88 
 
 2. Respiratory quotient of infants in first 24 hours referred to total body- 
 
 weight 91 
 
 3. Respiratory quotient of infants in first 24 hours referred to body-weight 
 
 per unit of length of infant 91 
 
 4. Minimum heat-production of new-born infants per 24 hours referred to the 
 
 body- weight 97 
 
 5. Minimum heat-production of new-born infants per kilogram per 24 hours 
 
 referred to the body-weight 99 
 
 6. Minimum heat-production of new-born infants per square meter of body- 
 
 surface per 24 hours referred to the body-weight 101 
 
 7. Minimum heat-production of new-born infants per 24 hours referred to age . . 103 
 
 8. Minimum heat-production of new-born infants per kilogram of body-weight 
 
 per 24 hours referred to age 104 
 
 9. Minimum heat-production of new-born infants per square meter of body- 
 
 surface per 24 hours referred to age 105 
 
 10. Minimum heat-production of new-born infants per square meter per 24 
 hours computed per centimeter of length for infants between l\ and 
 
 Gdaysold 107 
 
 4 
 
THE PHYSIOLOGY OF THE NEW-BORN INFANT 
 
 CHARACTEK AND AMOUNT OF THE KATABOLISM 
 
 BY 
 FRANCIS G. BENEDICT AND FRITZ B. TALBOT 
 
INTRODUCTION. 
 
 In our observations on the gaseous metabolism of infants, which were 
 begun over three years ago, we have been impressed by the fact that 
 while observations on three or four infants would admit of conjectures 
 which might subsequently be in part verified by multiplication of data, 
 yet of themselves they could necessarily have very little conclusive 
 value. Accordingly, as it is the purpose of this laboratory to secure 
 sufficient data to eliminate, so far as possible, the personal equation, 
 we frankly stated in our earlier publication 1 that we were still occupied 
 in " overcoming the paucity of results obtained with normal infants," 
 and similar statements were made with regard to the new-born infants. 
 Our observations of new-born infants were begun in the latter part of 
 1913 and were freely discussed with the investigators working in the 
 same field. There seems to have been a disposition on the part of some 
 investigators to relieve us of the responsibility of interpreting certain of 
 our results; consequently, we present here our complete data in regard 
 to the character and amount of the metabolism of 105 new-born infants, 
 74 of which were studied within 24 hours of birth. 
 
 EMBRYONIC CONDITIONS. 
 
 Although the interest of the embryologist in the prenatal develop- 
 ment of the infant begins at the moment of conception, it is not until 
 the fetus has reached a considerably advanced stage of development 
 that an intelligent interest can be taken in its metabolism. Histological 
 studies show that the composition of the embryo is not materially dif- 
 ferent from that of the adult organism. Food is carried to the placenta 
 by the blood of the mother and we have no reason to believe that there 
 is in the prenatal life any marked difference between the mother and 
 the fetus in the character of the katabolism. On the other hand, 
 histological studies 2 do show that there is in the embryo a relatively 
 large proportion of glycogen. While this is shown microscopically, 
 it has not as yet received verification by chemical analysis. At the 
 present time, therefore, the common belief in a large supply of glycogen 
 in the embryo is based solely upon histological studies, made almost 
 entirely on animals, and it is well known that the results of histological 
 
 Benedict and Talbot, Am. Journ. Diseases of Children, 1914, 8, p. 43. 
 
 2 Gierke, Lubarsch-Ostertag's Ergeb. Jahrb., 1907, 11 (2), p. 880. Also, Lubarsch, Virchow's 
 Archiv, 1906, 183, p. 188. Most of the work has been done on animals, with the single exception 
 of that by Lubarsch. Lubarsch examined a 9-weeks human embryo and a 4 to 5 months human 
 fetus, and concluded that the amount of glycogen varied with the age and the species. The 
 muscles contain a considerable amount of glycogen even in the embryo, while glycogen is 
 only deposited in the liver in later embryonic life. Mendel and Leaven worth (Am. Journ. Physiol. , 
 1907-8, 20, p. 117) add to Gierke's extended review of the literature on the subject. 
 
* 
 
 80 ll^H^J^I^y^OF THE NEW-BORN INFANT. 
 
 studies and chemical analyses do not necessarily agree. 1 It is gener- 
 ally considered, however, that the fetus has a larger supply of glycogen 
 in proportion to its weight than has the mother. If, as we believe, 
 the character of the combustion is determined in large measure by the 
 character of the available food-supply, it is not inconceivable that there 
 may be a larger combustion of glycogen and a specific fetal katabolism. 
 On the other hand, the oxygen and food are obtained from the blood of 
 the mother, and while the fetus may be glycogen-rich, the liver of the 
 mother is likewise glycogen-rich, and hence it may be unreasonable to 
 expect a specific gaseous metabolism of the embryo in the pre-natal state. 
 It is hardly probable that with our present technique we can ration- 
 ally interpret the character of the katabolism of the fetus by measuring 
 the gaseous metabolism of the mother and the child before the birth of 
 the child, and the mother alone after delivery, for as the metabolism 
 of the mother is very much greater than that of the child, a differential 
 method is liable to very great error. 
 
 POST-NATAL CONDITIONS. 
 
 As soon as the child is born all of the conditions are changed. Prior 
 to birth the fetus is living on a rich food-supply which is brought by the 
 maternal blood. Immediately after birth this supply is cut off and no 
 food is thus derived from the mother. The infant then begins to 
 starve, that is, to draw upon its reserve body-material until the mother's 
 breasts secrete enough food to supply its demands. We may properly 
 ask, what is this reserve and how does it influence the character as 
 well as the totality of the katabolism? The amount of the material 
 burned we know is determined in large part by the muscular activity 
 of the infant, but since now the infant must live (for the first hours, at 
 least) solely upon its own body-reserve, the character of the material 
 available for combustion and the character of the material actually 
 burned present a new interest. 
 
 No mammal mother is so completely incapacitated for carrying out 
 the duties necessary to protect and nourish her young during the first 
 few days after parturition as is civilized woman. On the first day after 
 birth, the mother is usually absolutely dependent upon the ministra- 
 tions of others. The infant must likewise share this dependency upon 
 others. Even the natural food-supply of the parturient mother is extra- 
 ordinarily small, for the total fuel value of the colostrum is insufficient 
 during the first few days, even under the most favorable circumstances. 2 
 
 We may question, then, is the new-born child automatically adjusted 
 to this state of affairs? Is the body-supply sufficiently liberal to pro- 
 vide for the draft upon it, and have we really, therefore, a self-contained 
 little engine? What are the infant's needs for the first few days? 
 
 'Rusk, Proc. Soc. Exp. Biol. and Med., 1912, 10, p. 21. 
 2 See page 122. 
 
INTRODUCTION. 9 
 
 First, the infant must keep up its vitality. In the prenatal condition 
 it has been in a moist, warm medium, with no loss of heat by radiation 
 or by the vaporization of water. By birth it is suddenly thrust into 
 a much less moist and often cold environment. It is currently believed 
 that this change is in some way actually beneficial, since it acts as a 
 stimulus to the vital activities of the infant. But immediately after 
 birth the child is required to make up for the heat lost by radiation, 
 which is considerable, and for that used in the vaporization of water 
 from the body-surface. In the few days subsequent to the birth the 
 infant's heat-regulating mechanism is extremely imperfect. It is first 
 called into play as soon as the child is delivered. A bath is usually 
 given shortly after the delivery, which, with its attendant exposure 
 of the body, unquestionably increases the heat loss. There is, however, 
 almost invariably an increased heat-production as the result of muscular 
 activity and frequently loud, vigorous crying. 
 
 We may classify the new-born infant's needs under two gross cate- 
 gories: first, the need for maintenance, and second, the need for 
 growth. Since, in our discussion, we are interested for the most part 
 in the consideration of the metabolism during the first week of life, we 
 may properly at this time omit consideration of the question of growth 
 and confine ourselves exclusively to the maintenance requirements. The 
 question, then, is : Can the infant in the first week of life obtain sufficient 
 nourishment from its mother, even a normal mother, to maintain its 
 vital activities without loss of body-substance? An examination of the 
 records of body-weight will be of interest in this connection, for a loss 
 in weight, if any, may be considered a crude index of the infant's needs. 
 
 LOSS IN BODY-WEIGHT. 
 
 Shortly after birth there is normally a very considerable loss in body- 
 weight. The average duration of this loss in weight is 2 to 3 days, the 
 length of time depending upon when the mother's milk-supply is suf- 
 ficiently established to provide the infant with enough nourishment for 
 its needs. If an infant continues to lose weight after the fourth day 
 the cause must be pathological. As may naturally be expected, the 
 time and amount of the secretion of the breast-milk are the principal 
 factors in determining the amount of weight lost. The loss of weight 
 varies according to different investigators, but usually lies between 
 150 and 300 grams, 1 with an extreme high figure of 700 grams. 2 A loss 
 of even 400 to 500 grams has been observed with infants which have 
 shown no pathological disturbance at the time or later. In general, 
 the smaller the baby is at birth, the greater will be the relative propor- 
 tion of the weight lost, the usual proportion being between 6 and 9 per 
 
 Von Reuss, Die Krankheiten des Neugeborenen, Berlin, 1914, p. 2. 
 
 2 Czerny and Keller, Des Kindes Ernahrung, Ernahrungsstorungen und Ernahrungstherapie, 
 Leipsic and Vienna, 1906, 1, p. 554. 
 
10 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 cent of the birth-weight. Trepper 1 has concluded that the percentage 
 loss was greatest with weak, undeveloped infants, least with those of 
 average weight, increasing again, not only absolutely but relatively, 
 with large infants because of the greater trauma during birth. 
 
 But the loss in body-weight of the new-born infant may not be taken 
 as an index of its physiological needs for nourishment, as an analysis 
 of the character of this loss in weight shows us that there are two 
 distinct causes: (1) mechanical and (2) physiological. 
 
 Within a few hours after birth the infant passes urine and meconium 
 and at times regurgitates allantoic fluid from the stomach. No one of 
 these can be said to represent a loss due to the physiological disintegra- 
 tion of body-substance, but they should all be classified under the head 
 of mechanical loss. 
 
 Subsequently there is a loss of body-material or body-reserve which 
 should be considered as definitely disintegrative. When a previously 
 nourished organism is subjected to complete inanition or withdrawal 
 of food, there is in all cases a marked loss in weight during the first 
 period of the fast, and as the fast progresses the loss becomes consider- 
 ably less per unit of time. This is strikingly noted in experiments with 
 fasting animals, and, indeed, in those with man, and receives a logical 
 explanation in view of modern studies which show that there is an excess- 
 ive water-loss during the earlier stages of inanition. Exactly the same 
 conditions may be said to exist in the case of new-born infants. Before 
 birth the infant was in a moist environment and the body was therefore 
 surcharged with water. A not inconsiderable amount of this may be 
 lost very shortly after birth through vaporization from the skin and 
 lungs, particularly when active crying takes place. This water should 
 be considered as preformed water existing in the body. 
 
 But the most important physiological loss is that due to the actual 
 oxidation of body-substance as a result of metabolism. With the first 
 moment after delivery and as soon as the lungs have become filled with 
 air, the infant begins to oxidize body-substance, this material being 
 chiefly fat, with some protein and some carbohydrate. This material 
 is carried off in the form of carbon dioxide and of oxidized organic 
 hydrogen, and thus contributes its quota to the physiological loss. 
 
 Since the loss of meconium, allantoic fluid, and urine, and even of 
 preformed water, is not accompanied by energy transformations and 
 the liberation of heat, we may estimate the true physiological loss by 
 determining the energy loss either directly or, what is more practicable, 
 by the indirect method of measuring the carbon-dioxide output and the 
 oxygen consumption. 
 
 Although it is a popular conception that the new-born infant has a 
 very much larger metabolism than has the adult, evidence that we 
 
 lr Trepper, Ueber die Gewichtsabnahme der Neugeborenen, Inaug. Diss., Giessen, 1913. 
 
INTRODUCTION. 11 
 
 have already published 1 in discussing an entirely different subject, 
 namely, the metabolism per square meter of body-surface, shows that 
 new-born infants have a relatively low heat-production per square meter 
 of body-surface. The calorific needs for these infants may therefore 
 be legitimately considered as extraordinarily low. If we compute the 
 calories required for a new-born infant on the basis of the experiments 
 previously published by us, we find that the daily heat-output of a 
 quiet, resting new-born infant of approximately 3.76 kilograms cor- 
 responds to the oxidation of about 17 grams of fat. Since the total 
 loss in weight during the first few days is 200 to 300 grams, it can be 
 seen that only a small proportion of this loss can consist of organized 
 body- tissue, such as fat. Even if the entire energy output were derived 
 from the combustion of carbohydrate, the amount katabolized, i. e. } 
 approximately 40 grams, or about twice the amount corresponding to 
 the katabolism of fat, would still be too small to account for this loss 
 in body-weight. The relatively small amounts of protein katabolized 
 may properly be disregarded in discussing this phase of the total 
 metabolism. Hence the only other alternative we deal with here is 
 the loss of a large amount of water. 
 
 In the foregoing considerations, however, the assumption is made 
 that the infant is undergoing complete starvation. As a matter of fact, 
 a certain, although admittedly deficient, amount of nourishment is 
 obtained from the small amount of colostrum available. This would, 
 in part at least, tend to retard any physiological loss in weight and a 
 consideration of this fact only accentuates the contention that the loss 
 in weight, per se, can not be an accurate index of the food require- 
 ment of the new-born infant. 
 
 Benedict and Talbot, Carnegie Inst. Wash, Pub. No. 201, 1914, p. 157; also, Am. Journ. 
 Diseases of Children, 1914, 8, p. 1. 
 
12 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 EARLIER RESEARCHES WITH NEW-BORN INFANTS. 
 
 Considering the marked physiological loss in weight during the 
 first week of life, the rapidly changing character of the nourishment, and 
 the supposed imperfect heat regulation of the new-born infant, together 
 with the fact that all human beings must pass through the experiences 
 of this period, it is surprising that so little evidence regarding both the 
 character and the amount of human metabolism during the first week of 
 life is available. There are almost no reliable observations on the 
 character of the katabolism and the majority of observations on the 
 amount of metabolism are, in the light of present-day technique, 
 seriously vitiated by the fact that, at the time the researches were 
 made, the importance of complete muscular repose on the part of the 
 infants was but imperfectly realized. 
 
 OBSERVATIONS BY MENSI. 
 
 Although Forster, 1 in 1877 studied the carbon-dioxide output of an 
 infant 14 and 60 days after birth, and 10 years later Langlois 2 studied 
 the heat-production of an infant 15 days old, it was not until the research 
 of Mensi 3 in 1894 that we find any observations on the gaseous metab- 
 olism or heat-production of infants during the first week of life. 
 
 As a matter of fact, Mensi' s infants were all somewhat under the 
 normal weight of a new-born infant, and while the oxygen consumed per 
 kilogram per minute, as reported by Mensi, appears to be reasonably 
 uniform, the extraordinarily low respiratory quotients noted by him 
 still leave the experimental procedure somewhat in doubt. The appa- 
 ratus used by Mensi has, so far as we know, never been described. 
 After a number of efforts we have finally been able, through the kind- 
 ness of Professor G. Fano of Florence and Professor Herlitzka of Turin, 
 
 , Amtlicher Bericht der 50. Versammlung deutsch. Naturforscher u. Aerzte in Munchen, 
 Munich, 1877, p. 355. Supplementary data regarding these two observations were given in a per- 
 sonal communication to Professor Magnus-Levy and published by him in the Archiv f . Anat. u. 
 Physiol., 1889, Suppbnd., p. 314. According to Professor Forster, the data were obtained on a 
 girl, ' ' bei ziemlicher Ruhe." Although the infant was older than those included in our own study, 
 we consider the material of sufficient importance to give the following tabular data, which were 
 published by Magnus-Levy regarding Forster's observations: 
 
 
 
 Carbon 
 
 Carbon dioxide 
 
 Carbon 
 
 Carbon dioxide 
 
 Age. 
 
 Weight. 
 
 dioxide 
 eliminated 
 
 eliminated per 
 kilogram per 
 
 dioxide 
 eliminated 
 
 eliminated per 
 kilogram per 
 
 
 
 per hour. 
 
 hour. 
 
 per minute. 
 
 minute. 
 
 days. 
 
 kilos. 
 
 gm. 
 
 gm. 
 
 c.c. 
 
 c.c. 
 
 14 
 
 2.70 
 
 2.52 
 
 0.93 
 
 21.40 
 
 7.89 
 
 60 
 
 3.78 
 
 3.68 
 
 0.97 
 
 31.07 
 
 8.22 
 
 2 Langlois, Journ. de 1'Anat. et de Physiol., 1887, 23, p. 400. Langlois' observation on an infant 
 15 days old was only incidental and, in view of the known errors of the calorimeter employed, the 
 values can have only an historic interest. 
 
 3 Mensi, Giorn. d. R. Accad. di Med. di Torino, 1894, 57, p. 301. An abstract of Mensi's obser- 
 vations was given in our earlier publication. See Benedict and Talbot, Carnegie Inst. Wash. 
 Pub. No. 201, 1914, p. 14. 
 
EARLIER RESEARCHES WITH NEW-BORN INFANTS. 13 
 
 to secure information from Mensi regarding the apparatus and the 
 technique used in the observations. The infant was placed under a 
 bell in which air was circulated. The carbon-dioxide output was deter- 
 mined by barium hydroxide, while the oxygen consumption was found 
 by measuring the amount used from a flask of known capacity in replac- 
 ing the oxygen consumed by the infant. The principle of the apparatus 
 appears to be essentially that of Regnault and Reiset. 
 
 OBSERVATIONS BY SCHERER. 
 
 Perhaps no research on the gaseous metabolism of infants is more 
 frequently cited as being the earliest and of the greatest significance 
 than is that of Scherer 1 in the laboratory of Professor Mares in Prague. 
 As pointed out in our earlier consideration of these experiments, 2 the 
 extraordinarily low respiratory quotients found by the investigator 
 lead one to doubt the accuracy of the determination of the gaseous 
 metabolism. In the latter part of his article, Scherer discusses the 
 protocols of one experiment, which he gives in detail, and points out 
 the fact that Mares considered that the increase in the nitrogen of 
 the air inside the chamber should be taken as an indication of the accu- 
 racy of the experiment, since the smaller the nitrogen accumulation, 
 the more accurate is the experiment. 
 
 Unusual attention was paid in the Prague laboratory to the possi- 
 bilities of leaks into or out of the respiration system, and the earlier 
 work in Pfliiger's laboratory was keenly criticized by Mares 3 in the 
 original description of his apparatus for studying the metabolism of 
 animals during hibernation. In this Bohemian monograph Mares 
 devotes several pages to a discussion of the possibilities of error due 
 to leaks, to the accumulation of nitrogen, and to the role the nitrogen 
 may play in the total metabolism, and gives a number of arguments 
 for and against the belief that free nitrogen rises from protein disin- 
 tegration. It is surprising, therefore, to find that Scherer assumed 
 the percentage composition of the compressed oxygen used by him 
 to be that determined by an old analysis. This point can best be 
 considered in connection with the keen criticism of Scherer ? s experi- 
 ments by Hasselbalch in the excellent paper which will be presented 
 somewhat later in this report. 
 
 Scherer made 55 experiments in the spring and summer and 30 
 experiments in the winter, each experiment being about 2 hours long. 
 A considerable number of these experiments were with infants 7 days 
 old or under, namely, 24 experiments in the summer and 7 experiments 
 in the winter. It is most unfortunate that at this period in the develop- 
 ment of the respiration apparatus in the Prague laboratory control 
 
 T Jahrb. f. Kinderheilk., 1896, N. F., 43, p. 471. 
 2 Benedict and Talbot, Carnegie Inst. Wash. Pub. No. 201, 1914, p. 14. 
 3 Mares, Arch, bohemes de med., 1889, 2, p. 458. 
 
14 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 tests were not made with burning alcohol. Although such tests are 
 cited in the reports of later investigations in this laboratory, Scherer 
 gives no description of control tests made by him. 
 
 OBSERVATIONS BY BABAK. 
 
 The next research on this subject published from the Prague labora- 
 tory was that of Babdk, 1 which appeared in Bohemian in 1901 and in a 
 somewhat abridged form in German in 1902. Babdk's investigations 
 dealt primarily with the study of the heat regulation, the Bohemian 
 paper being prefaced by an extended consideration of theoretical 
 points involved in the discussion of the chemical and physical heat 
 regulation; evidently this was the whole trend of his discussion and his 
 experimental research, his interest in the gaseous metabolism of new- 
 born infants being only secondary. 
 
 Babdk used a respiration apparatus of the Regnault-Reiset type, 
 which was, indeed, the apparatus originally employed by Scherer but 
 later somewhat modified by the attachment of calorimetric devices 
 on the d'Arsonval principle. The control tests, which were made by 
 the burning of alcohol, are reported to give an accuracy of 2 per cent 
 within theory for the oxygen consumption and 6 per cent within theory 
 for the carbon-dioxide production. This large error in the carbon 
 dioxide is, we believe, unique with the Regnault-Reiset type of respira- 
 tion apparatus, for with all of the apparatus that we have thus far 
 investigated we have found that the determinations of the carbon 
 dioxide are usually extraordinarily exact, practically all of the errors 
 falling upon the oxygen. Since no protocols are given by Babdk, 
 either in the German paper or in the Bohemian paper, further intelli- 
 gent discussion of the technique is impossible. In all 63 experiments 
 were made with 7 infants, ranging in age from 1 to 8 days. No records 
 were published for these infants of the degree of activity or of the pulse- 
 rate. We can not, therefore, compare the total metabolism as measured 
 by this type of apparatus with the results of modern researches. 
 
 As the alcohol control tests of Babdk's calorimeter never showed an 
 extraordinarily high degree of accuracy, and as Babdk's problem was 
 simply to determine the temperature regulation of the new-born 
 infant, it is not surprising that in the German article he gives but 
 a few words to the discussion of the respiratory quotient, only making 
 the statement that, like Scherer, he found the respiratory quotient 
 
 ^abak, Rozp. C. Akad. Cisafe Frantiska Josef a, Tfida II, Rodnik X, 6fslo I, 1901, and Archiv 
 f . d. ges. Physiol., 1902, 89, p. 154. The reference to the German publication of Babdk's researches 
 was inadvertently omitted from our two previous communications. (See Benedict and Talbot, 
 Carnegie Inst. Wash. Pub. No. 201, 1914, and Am. Journ. Diseases of Children, 1914, 8, p. 1.) 
 At the time the literature was being assembled we were awaiting a complete translation of the 
 original Bohemian article, and as this could not be finished prior to publication it was not inserted. 
 The absence of the German reference was clearly an omission. At this point we would like to 
 state that the Bohemian article has been translated by Miss B. Haderbolets, the Bohemian trans- 
 lator of the Nutrition Laboratory, and a copy is on file in the laboratory. 
 
OBSERVATIONS BY HASSELBALCH. 15 
 
 to be somewhat lower in winter than in summer. In the Bohemian 
 article we find a somewhat more extended discussion of his results, 
 inasmuch as Babak points out that the respiratory quotient does not 
 show regularity, this being largely due to variations in the carbon- 
 dioxide determinations. The majority of the low values for the 
 respiratory quotients were found during the low temperature of winter, 
 and Babak concludes that since similar observations were obtained 
 with rabbits he can corroborate the discovery of Scherer that in winter 
 assimilation is greater than disassimilation, or that anabolism is greater 
 than katabolism. 
 
 OBSERVATIONS BY HASSELBALCH. 
 
 In 1904 Hasselbalch, 1 publishing in a remote place, presented a most 
 interesting paper on respiration experiments with new-born infants. 
 At the time of going to press with our earlier publication, this Danish 
 contribution was in process of translation, and hence it was not then 
 cited by us. Upon the completion of the translation, for which it is 
 a pleasure to thank Miss Alice Johnson, of the Nutrition Laboratory 
 staff, and Dr. M. N. Smith-Petersen, of the Peter Bent Brigham 
 Hospital, we are so impressed with the accuracy of the technique and 
 the clear-cut conception of Hasselbalch' s conclusions that we feel it is 
 incumbent upon us to make this material available to readers in other 
 than Danish, and hence it is here reprinted. We wish to express our 
 thanks to Professor Hasselbalch for his kindness in looking over the 
 manuscript and making some slight alterations in the phraseology of 
 the translation. 
 
 Hasselbalch, Respirationsfors^g paa nyf0dte B0rn, Bibliotek for Laeger, Copenhagen, 1904, 
 8, p. 219. 
 
16 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 RESPIRATION EXPERIMENTS WITH NEW-BORN INFANTS. 
 BY K. A. HASSELBALCH. 
 
 The desirability of carrying out total metabolism experiments on 
 healthy and sick infants with a view to obtaining information regarding 
 the adequate nourishment of the infant is very evident. So long as it 
 is not an established fact how the healthy and normally-nourished infant 
 utilizes the fat and carbohydrate of milk, so long every therapeutic treat- 
 ment of the fatal conditions in pedatrophia is absolutely guesswork, and 
 so long the composition of the countless strength-giving foods for 
 artificially nourishing infants is based on the roughest empiricism by 
 observing the changes, if any, in the curve of the body-weight. 
 
 While the present paper does not report experiments on total metabo- 
 lism, a study of the respiratory exchange of the new-born infant is also 
 of considerable interest. In the first place, the amount of the respira- 
 tory exchange, because of its considerable excess over the nitrogen 
 exchange, may be used as an expression of the amount of the total 
 metabolism, and in the second place the respiratory quotient throws 
 light on the substances oxidized in a given period of time. 
 
 It is generally believed that a young individual has a greater metabo- 
 lism, per kilogram of body- weight than the adult, because of its greater 
 surface in relation to its body-weight and because it is growing. I shall 
 not enter into a discussion of the rather contestable "law of surface 
 area" which is the subject of so much dispute. My experiments 
 can not be used to support such a discussion successfully, for it is 
 rather difficult with young children to represent fairly the same external 
 and internal experimental conditions as are represented by other inves- 
 tigators in their respiration experiments with adults. In one respect 
 only can my experiments give enlightenment, that is, as to the influence 
 of exercise on the amount of the metabolism. From experiments 
 during which the infant slept quietly I have obtained material whereby 
 I could form my own point of view in regard to the dogma concerning 
 the relatively large metabolism of the infant. If it is possible from the 
 experiments to come to an approximate conclusion concerning the 
 amount of the metabolism of the new-born sleeping infant, this conclu- 
 sion has a special interest as bearing directly on the fetal life. In the 
 embryonic condition it is well known that the metabolism per unit of 
 body-weight is as great as with the grown individual of the same species. 
 
 The respiratory quotient, obtained as soon as possible after birth, 
 gives information as to the approximate composition of the new-born 
 infant's fuel material and permits an assumption as to its composition 
 in the embryonic state. The breast-fed infant and the infant that 
 directly after birth has been given the spoonful of cane-sugar solution 
 traditional in Denmark 1 give the experimenter some idea of the time 
 
 *The following information regarding this practice is kindly supplied by Hasselbalch in a 
 personal communication: "The midwife gives the child a teaspoonful or two of a weak cane-sugar 
 solution (strength of solution quite accidental) after the child is washed and before it is put to bed. 
 We suppose the reason to be that the child should not be starving until the mother has milk enough 
 for it. Generally the administration of cane-sugar is not repeated, as the role of the midwife is 
 now over and the nurse's work begins." 
 
OBSERVATIONS BY HASSELBALCH. 17 
 
 required for the absorption and oxidation of the three nutrients in the 
 food the protein, fat, and carbohydrate. 
 
 The only complete respiration experiments on new-born infants 
 known to me were undertaken first at Prague under the direction of 
 Mares by Scherer 1 and Babak. 2 The experiments of Babak on the respi- 
 ratory exchange are only a link in the investigation of the new-born 
 infant's heat regulation. The surprising result of both these investi- 
 gators' experiments is this, that not only after birth, but even with 
 infants several weeks old, an unusually low respiratory quotient was 
 found. Scherer reports 55 summer experiments with respiratory 
 quotients ranging from 0.567 to 0.898; in 27 instances the quotients 
 are under 0.70, a quotient which, for the grown individual, is the lowest 
 imaginable, at least for rather long periods of time. His 30 winter 
 experiments show but one quotient over 0.70; the lowest is 0.493, the 
 highest 0.717. Babak's experiments generally show a higher quotient, 
 but 0.51 is not uncommon with him. 
 
 To explain these low quotients, which are ordinarily found only with 
 hibernating animals, Scherer has to resort to the explanation generally 
 assumed for these animals, i. e., an incomplete burning of food material, 
 whereby the oxygen taken in does not leave the organism in its entirety 
 as carbon dioxide, but to some extent is stored up in the form of unstable 
 compounds. Scherer, in attempting to explain the significance of this 
 saving of oxygen in infancy, refers to the " excess of anabolism over 
 katabolism"; but this conclusion does not hold true. In the fetal life, 
 then, one must also expect low quotients, lower than with the free oxi- 
 dation of the embryo's food material. But the chicken embryo burns 
 fat and has a fat quotient, 0.71 ; the guinea-pig embryo has a carbo- 
 hydrate quotient 3 of 1.00. The snake embryo has a mixed quotient, 
 about 0.85, while with the silk-worm embryo 4 the respiration takes 
 place with a diminution of both fat and carbohydrate, which naturally 
 would result in a quotient between 0.7 and 1.0. 
 
 The hypothesis presented by Farkas, 5 partly in reference to the fat 
 quotient with the bird embryo and partly in reference to Scherer's and 
 Babak's low quotients with new-born infants, "wahrend der embryo- 
 nalen Entwicklung und in den ersten Stunden des Lebens iiberwiegend 
 Fett verbrannt wird," may be disputed. The different animal classes 
 can not be expected to nourish their embryos with the same material; 
 that they do not do this has already been mentioned, and Farkas him- 
 self brings forward a new example to demonstrate this point. 
 
 In view of the doubtful respiratory quotients found by Scherer and 
 Babak, we must reject in advance Scherer's second conclusion concern- 
 ing the amount of the respiratory exchange. Eighty-five experiments 
 are mentioned, not with the same child, but with different children at 
 different times. From this material, without taking into consideration 
 the child's condition during the experiment, such as movements, crying, 
 
 Scherer, Jahrb. f. Kinderheilk., 1896, N. F., 43, p. 471. 
 
 2 Babak, Archiv f. d. ges. Physiol., 1902, 89, p. 154. 
 
 3 Bohr, Vidensk. Selsk. Forh., 1900. 
 
 4 Farkas, Archiv f. d. ges. Physiol., 1903, 98, p. 490. 'Farkas, loc. cit. t p. 517. 
 
18 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 digestion, etc., Scherer and Babdk draw the following quite unjusti- 
 fiable conclusion: "Die Kohlensaureproduction und der Sauerstoff- 
 verbrauch shaken beim Neugeborenen etwas in den ersten Stunden 
 nach der Geburt bis ung. zur neunten Stunde," etc. If a new-born 
 infant kicks and cries soon after birth, is afterwards quiet and sleeps 
 almost to the ninth hour, then wakes and is laid at the breast, the results 
 obtained would nearly agree with the quotation given above, but other- 
 wise not. Speck, 1 a well-trained subject for physiological experiments, 
 tripled his respiratory exchange by doing considerable work with one 
 arm. So great is the influence of muscular contractions upon metabo- 
 lism that the arrangement of a schedule like the one indicated above is 
 rather a waste of time. 
 
 Scherer and Babdk have worked with the same respiration apparatus. 
 That their results agree quite well, therefore, is but natural. If their 
 results are incorrect, as I must assume after carrying out my own experi- 
 ments, this can not be due to the inaccuracy of their methods (although 
 the limit of error of 6 per cent for carbon dioxide is quite large, the res- 
 piratory quotient can in a given instance vary from 0.65 to 0.60), but 
 must have its reason in a systematic error. I refer to Scherer's descrip- 
 tion of his experiments, from which it is clear that in the closed respiration 
 apparatus after the experiment there may be found an increase of 541 
 C.c. beyond the calculated nitrogen quantity; the oxygen consumed is 
 replaced from an oxygen bomb; the oxygen introduced into the chamber 
 is not analyzed for its purity, but is assumed from " Hoppe-Seyler's 
 analysis" of the same manufacture to contain 4 per cent nitrogen; if, 
 in reality, it contains over four times as much (which is perhaps 
 unreasonable but always possible), this would explain the finding of 
 541 c.c. of nitrogen in excess. If on this basis a correction is made 
 in the above case, the quotient rises from 0.63 to 0.73. 
 
 I do not dare insist that this explanation is very probable; from the 
 account of the experiment, however, I find no other. At any rate, I 
 may say that a method with such large sources of error is too crude to be 
 compared with mine, which has given especially accurate results in the 
 hands of numerous investigators. My method of experimentation is 
 given herewith: 
 
 The atmospheric air from outside is drawn through a water gas-meter, and from there 
 through a large spiral lead pipe, where it is warmed to the experimental temperature. The 
 infant lies naked in a 15-liter respiration chamber, which is placed within a couveuse. The air 
 is sent into one end of the respiration chamber at the top, passes out below at the opposite 
 end, and through a flask where the moisture of the expired air and the perspiration is con- 
 densed. After this the air-current is passed into a simple sampling apparatus, consisting of 
 a mercury receptacle closed with three-way taps, from which the mercury can run out in a 
 thin stream during an experiment. By this means almost continuous samples of the air- 
 current, each with a volume of 70 c.c., may be obtained; 50 c.c. of the sample are used immedi- 
 ately for an analysis in a Pettersson apparatus (with potassium pyrogallate). The air is 
 sucked over the child by means of a water-suction pump; the speed, which is sufficiently even 
 for our purpose, with variations never over 3 per cent, is regulated according to the percent- 
 age of carbon dioxide one desires in the respiration chamber. The samples of air are not 
 taken until the infant has remained in the air-current so long that we can assume a uniform 
 composition, i. e., when three times its own volume of air has been passed out of the respira- 
 
 , Physiologic des menschlichen Athmens, Leipsic, 1892, p. 82. 
 
OBSERVATIONS BY HASSELBALCH. 19 
 
 tion chamber, after at least 12 to 15 minutes or longer, according to circumstances. The 
 atmospheric air is analyzed either on the day of the experiment, or, in case of evening 
 and night experiments, the following morning. (The occasionally rather insignificant vari- 
 ations in the composition of the atmosphere during the experiments is without influence 
 on the results, so that now and then an atmospheric analysis is omitted. I have then made 
 my calculations, using the preceding day's analysis.) From the percentage composition of 
 the air before and after it passes into the chamber the respiratory quotient is estimated 
 (with a small reduction based on the supposition that the nitrogen does not take part in the 
 respiratory exchange) and from the quantity of air which has circulated in the respiration 
 chamber during the experiment and which has been determined by the gas-meter, the abso- 
 lute amount of the metabolism is calculated, with a reduction for pressure and temperature. 
 
 The temperature during the experiment as recorded by a thermometer inside the respira- 
 tion chamber, fastened firmly to the under side of the glass top or ceiling of the chamber, 
 varies during the experiment between 31 and 35 C. The intention was to supply perfect 
 physiological conditions for the infants. Since, as a rule, they had been submitted to the 
 customary bath and had a particularly low temperature previous to the experiment, the body 
 temperature rose sometimes several degrees, but never above normal. This rise in tempera- 
 ture occurred almost entirely during the 15 minutes that preceded the experiment proper, 
 so that the temperature of the child (see in tables the last figures under " Body temperature") 
 can be considered as nearly constant during the experiment. 
 
 The degree of humidity in the air is also physiological, since the inspired air, saturated 
 with moisture at the temperature of the gas-meter (15 to 20 C.), is afterwards warmed to 
 about 32 C. before it is inspired. The duration of an experiment is from 22 to 24 minutes 
 for each single determination. As regards the accuracy of the method, even if the greatest 
 possible errors in analyses are made (according to numerous double determinations of the 
 atmospheric air), this could alter the respiratory quotient only 1 or 2 in the third decimal 
 place. The weights of the children can not be counted on to give a greater accuracy than 
 = fc 25 grams; partly for this reason and partly because the limit of error for the reading of the 
 gas-meter is ^0.5 per cent, the error in the determination of the amount of the metabolism 
 per kilogram of body-weight and per hour may be counted as = fc 2 per cent of the reported 
 value. 
 
 When we consider that the respiratory quotient of the guinea-pig 
 embryo is about 1.0, even when that of the mother animal is consider- 
 ably lower, it is natural to expect that the new-born infant, which is 
 born with a greater or less store of glycogen in its liver, would live exclu- 
 sively at the expense of this supply in the first hours of its life and 
 accordingly give a carbohydrate quotient. This should be all the more 
 true, the shorter the interval between the birth of the child and the 
 beginning of the experiment. 
 
 From table 1, in which 6 respiration experiments with new-born 
 infants weighing over 3,000 grams are arranged chronologically, it is 
 evident that the relationship is not quite so simple. The youngest 
 infant, which was 45 minutes old at the beginning of the experiment, 
 and one of the two oldest, which was 2 hours old, show quotients of 
 approximately 1.0, but in experiments 3, 8, and 7 a mixed exchange 
 takes place, in which carbohydrates are chiefly concerned; in experi- 
 ment 12 we find a pure albumin quotient, which can also originate from 
 the burning of much fat and few carbohydrates. 
 
 If we now examine table 1 more closely, we see quickly that the sub- 
 ject of experiment 2, with a pure carbohydrate quotient, is recorded as 
 "fat and strong"; its weight is also striking in comparison with its 
 length (3,650 grams to 51 cm.). Although in experiment 9 no general 
 impressions of the infant's condition are recorded, it is obvious from the 
 weight and height that this was also a particularly well-nourished 
 
20 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 child. At the other extreme is the infant in experiment 12, who, with 
 a very low quotient, is heavy, but with a disproportionate length and 
 consequently thin. If, then, having the condition of nourishment in 
 mind, we examine the remaining experiments, it appears for the present 
 as if the better nourished the infant is the nearer to 1 is the respiratory 
 quotient of the new-born fasting infant in the first hours after birth. We 
 will discuss later the possible influence of the other experimental 
 conditions on the quotient. If these values are correct the period of 
 time after birth affects the results in such a manner that with the 
 same infant in two consecutive determinations the quotient falls from 
 experiment to experiment. 
 
 TABLE I. 1 
 
 
 
 
 
 
 
 
 
 Carbon- 
 
 
 
 
 
 
 
 
 
 
 dioxide 
 
 
 Experi- 
 ment 
 No. 
 
 Sex. 
 
 Body- 
 weight. 
 
 Height. 
 
 Age. 
 
 Temperature 
 of air in 
 apparatus. 
 
 Body-tempera- 
 ture (rectal). 
 
 Carbon- 
 dioxide 
 in air of 
 cham- 
 
 elimina- 
 tion per 
 kilogram 
 per hour 
 
 Respir- 
 atory 
 quo- 
 
 tiont 
 
 
 
 
 
 
 
 
 ber. 
 
 at C. 
 
 tlclll'. 
 
 
 
 
 
 
 
 
 
 and 760 
 
 
 
 
 
 
 
 
 
 
 mm. 
 
 
 
 
 gin. 
 
 cm. 
 
 hr. m. 
 
 C. 
 
 C. 
 
 p.ct. 
 
 c.c. 
 
 
 29 
 
 F. 
 
 3,750 
 
 51 
 
 45 
 
 34 . 0-35 . 
 
 
 0.873 
 
 333 
 
 0.970 
 
 8 3 
 
 M. 
 
 3,100 
 
 51 
 
 1 30 
 
 34.3-35.0 
 
 32.8-35.2 
 
 .669 
 
 481 
 
 .868 
 
 4 8 
 
 F. 
 
 3,950 
 
 54 
 
 1 30 
 
 33.5-33.8 
 
 -36.0 
 
 .613 
 
 270 
 
 .862 
 
 6 12 
 
 F. 
 
 4,000 
 
 54 
 
 1 30 
 
 34 . 0-34 . 
 
 
 .989 
 
 399 
 
 .794 
 
 2 
 
 F. 
 
 3,650 
 
 51 
 
 2 .. 
 
 34.5-35.0 
 
 33.4- 
 
 .909 
 
 422 
 
 1.012 
 
 7 7 
 
 M. 
 
 3,200 
 
 50 
 
 2 . . 
 
 32.0-32.0 
 
 
 .749 
 
 457 
 
 .909 
 
 
 
 
 
 
 
 
 
 
 
 *In this and the following tables only the experimental conditions which might be supposed to 
 have interest are quoted. Therefore, the figures for the air analyses and the percentage 
 of oxygen in the respiration chamber are not given. The latter, according to carbon- 
 dioxide percentage, would be about 20 per cent. 
 
 No food; during whole experiment very quiet; slept the latter half of experiment. 
 
 *No food; bath, crying and kicking for about a minute; otherwise contented, sucking or half 
 asleep; thin. 
 
 4 No food; quiet, now and then sucking; otherwise without movements during whole experiment; 
 no crying. 
 
 6 No food; rather restless, hungry; now and then crying; see No. 22, table 4. 
 
 No food; during most of the experiment quiet and contented, now and then sleeping; cried 
 about one-half minute; fat and strong. 
 
 7 No food ; rather quiet, now and then kicking and trembling as if cold ; no crying. 
 
 In table 2 three pairs of experiments are reported, the subjects 
 being fairly well-nourished infants, in all cases examined so soon after 
 birth that the quotient still points towards a predominance of carbo- 
 hydrate combustion. Table 2 shows that in all three instances the 
 quotient fell considerably in the course of the hour between the first 
 and the second division of the experiment, changing from a little above 
 to a little under 0.9. 
 
 I made here the curious observation, which has been partly expressed 
 in the remarks in the last column of the table : When a new-born fasting 
 infant begins to show signs of hunger, we can be sure that its quotient 
 is lower than 0.9; according to this indicating symptom the time for the 
 beginning of the second half of the experiment is adjusted, and hunger 
 
OBSERVATIONS BY HASSELBALCH. 
 
 21 
 
 signs have appeared not only in these 3 experiments, but in about 10 
 instances where I have made observations on the fasting new-born 
 infant. The child 7 s customary sign of hunger, sucking its fingers or its 
 hand, can most certainly be misunderstood, but not by a skilled obser- 
 ver. There is a considerable difference in the playful manner in which 
 a satisfied and well-nourished infant temporarily sucks its fingers for 
 lack of any other pastime, and the energy in a hungry child's strong 
 sucking, which is either frequently interrupted by angry crying or is 
 constant and hopeful. 
 
 The rule which is brought out by table 1, i. e., that the respiratory 
 quotient is nearer 1.00 the better the condition of the infants, is not 
 contradicted by table 2. The child in experiments 19 and 20 with the 
 fairly normal weight of 3,600 grams and the unusual length of 54 cm. 
 had a very marked birth swelling at the crown of the head; its real 
 length was barely over 51 cm.; and it is inaccurately recorded in the 
 remarks accompanying the table "good condition." 
 
 Table 2 brings out a second point: The respiratory quotients are 
 nearer 1 the sooner after birth the infant is experimented upon. 
 
 TABLE 2. 
 
 
 
 
 
 
 
 
 
 Carbon- 
 
 
 
 
 
 
 
 
 
 
 dioxide 
 
 
 Experi- 
 ment 
 No. 
 
 Sex. 
 
 Body- 
 weight. 
 
 Height. 
 
 Age. 
 
 Temperature 
 of air in 
 apparatus. 
 
 Body-tempera- 
 ture (rectal). 
 
 Carbon 
 dioxide 
 in air of 
 cham- 
 
 elimina- 
 tion per 
 kilogram 
 per hour 
 
 Respir- 
 atory 
 quo- 
 
 
 
 
 
 
 
 
 ber. 
 
 at C. 
 
 tient. 
 
 
 
 
 
 
 
 
 
 and 760 
 
 
 
 
 
 
 
 
 
 
 mm. 
 
 
 
 
 gm. 
 
 ra. 
 
 hr. m. 
 
 c. 
 
 C. 
 
 p. ct. 
 
 c.c. 
 
 
 2 18 
 
 }M. 
 
 3,400 
 
 52 
 
 \ 30 
 
 1 1 45 
 
 34.3-34.0 
 34.5-34.5 
 
 36.2- 
 -37.3 
 
 0.678 
 .568 
 
 344 
 275 
 
 0.933 
 
 .854 
 
 3 13 
 
 i 
 
 
 
 \ 45 
 
 34.2-34.8 
 
 36.8- 
 
 1.332 
 
 488 
 
 .921 
 
 4 14 
 
 >M, 
 
 4,500 
 
 53 
 
 1 1 45 
 
 33.5-33.5 
 
 -37.4 
 
 .775 
 
 300 
 
 .808 
 
 6 19 
 20 
 
 }M. 
 
 3,600 
 
 54 
 
 f 1 30 
 \ 2 30 
 
 33.5-33.3 
 32.5-32.5 
 
 33.9-35.2 
 35.2-35.8 
 
 .605 
 .490 
 
 400 
 306 
 
 .921 
 .849 
 
 : No food; no bath; wide awake; quite contented; no crying. 
 
 2 Hungry and sleepy in last two- thirds of experiment ; frequently sleeping, constantly awakened; 
 
 no crying. 
 
 3 No food; no bath; awake and contented. 
 4 Sleeping quietly during nearly the whole experiment. 
 6 No food; bath; good condition; considerable birth swelling; lively and contented; later hungry 
 
 and somewhat sleepy. 
 'Stupid; fell asleep now and then, but awake most of the time; cried 1 minute; at the last lively. 
 
 A well-nourished infant, born at full term, has a store of carbohydrate 
 which it lives on either exclusively or largely in the first hours of its 
 life; gradually this store (which consequently can not be especially 
 large) is used up, and this leads to an increase in the oxidation of the 
 other elements. 
 
 In table 3 five experiments are given with 4 under-weight, prema- 
 turely-born infants. The experiments indicate that such infants show 
 signs of being very poorly nourished, in that their carbohydrate store 
 is very quickly spent. But if the infant is experimented upon soon 
 
22 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 enough after birth (as in experiments 10 and 11, in which the infant 
 was placed in the respiration chamber immediately after tying the navel 
 cord) we see clearly that here also we have to deal with the consump- 
 tion of a store of carbohydrate, which causes the organism to burn 
 other materials in addition. 
 
 In experiment 6 the quotient, even within an hour after birth, is 0.766. 
 Experiment 11 serves well for comparison. In this experiment an 
 infant of the same length, but weighing 200 grams more, shows a quo- 
 tient of 0.897 an hour after birth. If experiments 10 and 11 are com- 
 pared, we find in the case of prematurely-born children, also, the same 
 influence of condition of nutrition and of interval of time after birth 
 upon the quotient as with those born at full term. 
 
 TABLE 3. 
 
 
 
 
 
 
 
 
 
 Carbon- 
 
 
 
 
 
 
 
 
 
 
 dioxide 
 
 
 Experi- 
 ment 
 No. 
 
 Sex. 
 
 Body- 
 weight. 
 
 Height. 
 
 Age. 
 
 Temperature 
 of air in 
 apparatus. 
 
 Body-tempera- 
 ture (rectal). 
 
 Carbon 
 dioxide 
 in air of 
 cham- 
 
 elimina- 
 tion per 
 kilogram 
 per hour 
 
 Respir- 
 atory 
 quo- 
 
 tiont 
 
 
 
 
 
 
 
 
 ber. 
 
 at C. 
 
 ulClllr. 
 
 
 
 
 
 
 
 
 
 and 760 
 
 
 
 
 
 
 
 
 
 
 mm. 
 
 
 
 
 gm. 
 
 cm. 
 
 hr. m. 
 
 C. 
 
 C. 
 
 p. ct. 
 
 c.c. 
 
 
 *6 
 
 M. 
 
 2,550 
 
 47 
 
 I .. 
 
 33.0-33.5 
 
 
 
 0.524 
 
 339 
 
 0.766 
 
 5 
 
 F. 
 
 1,825 
 
 44 
 
 2 .. 
 
 34.5-34.5 
 
 33.4-35.8 
 
 .392 
 
 273 
 
 .871 
 
 4 
 
 M. 
 
 2,700 
 
 50 
 
 1 30 
 
 -33 
 
 33.1-35.0 
 
 .729 
 
 464 
 
 .858 
 
 no 
 
 11 
 
 }M. 
 
 2,750 
 
 47 
 
 d' 5 
 
 35.3-35.2 
 35 . 2-35 . 1 
 
 36.5- 
 -37.8 
 
 .561 
 .521 
 
 462 
 420 
 
 .912 
 .897 
 
 *No food; quietly sleeping or sucking during the whole experiment. 
 
 *No food; bath; sleeping; respirations irregular, very few movements; artificial delivery; more 
 than 1 month premature; died day following. 
 
 No food; lively in first half of experiment, sleeping in last half; born less than 1 month prema- 
 turely. 
 
 4 No food; no bath; born 3 weeks before time; crying about one-third of the time. 
 
 6 Quieter; crying about one-fourth of the time. 
 
 The infant in experiment 5, although very poorly nourished, has a 
 somewhat high quotient of 0.871, 2 hours after instrumental delivery. 
 The fact that this child when 2 hours old still had a large quantity of 
 carbohydrate to draw from is presumably due to the unusually low 
 metabolism. This experiment is important; it is a case of premature 
 interruption of pregnancy of more than a month before the end of the 
 full term. The prematurely-born infant, therefore, shows the same 
 respiratory quotient as the full-term child, indicating that it is con- 
 suming the remainder of its carbohydrate supply. It is an obvious 
 supposition that during the fetal life in mammals, with a physiological 
 nourishment by the mother, there are always sufficient carbohydrates at 
 hand, so that the respiratory exchange takes place normally with an exclu- 
 sive metabolism of carbohydrates. 
 
 This supposition of mine is well supported by literature. The fact 
 that the fetal tissues contain large quantities of glycogen, which steadily 
 dimmish during growth (always excepting the liver, in which more and 
 
OBSERVATIONS BY HASSELBALCH. 23 
 
 more glycogen is stored) , and the fact that the invertin 1 from the mucous 
 membrane of the small intestine provides the fetus with a ferment for 
 the eventual katabolism of this glycogen, are both arguments that 
 point towards the important r61e of the carbohydrate in the economy 
 of the fetus. Charrin and Guillemonat 2 find more glycogen in the liver 
 of the pregnant guinea-pig than in the non-pregnant; and this is true 
 both during inanition and during a rich carbohydrate feeding. In preg- 
 nant guinea-pigs this signifies, then, either an increased impulse towards 
 preparing glycogen from its food material or, in case of need, from its 
 own body elements. Furthermore, as already mentioned, Bohr has 
 definitely shown that the respiratory quotient of the guinea-pig's 
 embryo is 1.0, without reference to the fact that the respiratory quo- 
 tient of the mother may be lower.' 
 
 It may have been noticed that in most of the previous experiments 
 the percentage of carbon dioxide in the respiration chamber was quite 
 high, most frequently between 0.5 and 1.0 per cent. This was done in 
 order that the unavoidable errors in the analyses would have less effect 
 upon the results. That it is not this fairly high percentage of carbon 
 dioxide which has caused the difference between my results and those 
 of Scherer and Babdk is evident from the fact that these scientists have 
 worked with approximately the same percentage of carbon dioxide in 
 the respiration chamber. 
 
 In the double experiments in table 2 the metabolism, i. e., the carbon 
 dioxide per kilogram and per hour, in the second half of the experiment 
 is in every instance considerably less than in the first half of the experi- 
 ment. This smaller metabolism, which was a result of the infant's 
 sleepiness in the later period, has no modifying influence on the size 
 of the quotient. The decreasing lung ventilation at the beginning of 
 sleep could well be thought in the first minutes 3 to be followed by a 
 slight drop in the quotient (if the relationship in this regard is the same 
 as in adults, which is not proved), but in the course of the 23 minutes 
 of the experiment in every case such an effect was soon compensated 
 for. The experimental period is after all so long that we can judge 
 of the nature of the oxidized material from the quotient without fearing 
 to be misled by the influence of lung ventilation or work. 
 
 If we wish to be convinced that the quotients quoted above are 
 not affected systematically (and therefore are unaffected) by work done 
 during the experiment (crying, kicking, etc.) we need only to compare 
 experiments like 2 and 9 in table 1 on the one hand and 3 and 8 in table 
 1, and 5 in table 3, on the other. The comparison between 3 and 8 is 
 especially convincing; in 3 there is twice as great a metabolism as in 8, 
 due to the difference in muscular activity, but the same quotient is 
 found with both. 
 
 That the percentage of carbon dioxide in the atmosphere about the 
 infant can not be considered to have an effect upon the quotient has 
 already been quite definitely settled for adults by Speck's 4 experiments. 
 In his experiments the same percentage of carbon dioxide as that used 
 
 , Zeitschr. f. Biol., 1895, 32. 
 2 Charrin and Guillemonat, Compt. rend, de la HOC. de biol., 1900. 
 3 Speck, Physiologic des menschlichen Athmens, Leipsic, 1892, p. 16. 4 Speck, loc. cit., p. 133. 
 
24 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 in these experiments is shown to bring about a decrease in the oxygen 
 intake, and a consequent increase in the respiratory quotient, only 
 when the oxygen percentage in the atmosphere is at the same time 
 very low (i. e., 8 per cent against 20 per cent in my experiments). This 
 fact is strikingly demonstrated by a comparison of 12 and 2 in table 1 
 (with the same percentage of carbon dioxide and extreme difference 
 between quotients) and a comparison of 13 in table 2 and 5 in table 3 
 (with an extreme difference between the percentage of carbon dioxide 
 and approximately the same quotient). 
 
 As regards the amount of the metabolism in the above experiments it 
 seems impossible for me to conclude anything else from the tables than 
 that the activity of the infant is the chief determining factor, and that 
 the influence of other conditions, such as the condition of nourishment, 
 age, etc., is not demonstrated, at least by my method of experimenta- 
 tion. The influence of activity is overwhelming and is observed 
 regularly in the double experiments in table 2, and 10 and 11 in table 3, 
 in which the child in the second experiment is always either drowsy or 
 asleep. In the single experiments, also, we find a striking parallelism 
 between the amount of the metabolism recorded and the intensity of 
 the activity. It is naturally quite difficult to judge of and to express 
 in words the degree of strength with which the infant has contracted 
 its muscles in the course of 23 minutes. In the experimental pairs 17- 
 18 and 19-20 (table 2) I have repeatedly awakened the infants in the 
 second experiment by rapping loudly on the cover of the respiration 
 chamber. The purpose was to keep the activity and thereby the 
 metabolism artificially at the same level as in the first experiment. 
 Although the infants reacted to every rap with severe general contrac- 
 tion of the muscles, the drowsiness throughout the entire period has 
 been the determining factor; the metabolism in experiments 19 and 20 
 fell 25 per cent. 
 
 Even though it is difficult to determine the work which the different 
 children have done during the experiment and therefore difficult to 
 arrive at a numerical expression for the effect of work on the amount 
 of the metabolism, it is easy to convince one's self of the absolute 
 absence of visible contractions. When such a condition has prevailed 
 throughout the 23 minutes of the experiment we find a very low metabo- 
 lism value from 270 to 300 c.c. carbon dioxide per kilogram and per 
 hour. Such figures are found both for infants overweight (3,950 grams in 
 experiment 8 of table 1, etc.) and for infants underweight (1,825 grams in 
 experiment 5 of table 3, etc.). After due reflection this is not surprising. 
 The heat regulation of a new-born infant 1 is very poorly developed. 
 Even if it were not poorly developed, the temperature during the 
 experiment is so regulated that the question of the feeble heat regula- 
 tion of the child is eliminated as far as possible. Thus every experi- 
 mental condition which would produce a smaller metabolism per unit 
 of weight in the large infant with a relatively small surface than in 
 the smaller infant with a relatively large surface is eliminated. But 
 there is cause for reflection in the fact that a figure like 270 c.c. for the 
 
 'Babdk, Archiv f. d. ges. Physiol., 1902, 89, p. 154. 
 
OBSERVATIONS BY HASSELBALCH. 25 
 
 carbon dioxide per kilogram and per hour for a new-born infant is not 
 essentially higher than the corresponding figure for a grown individual 
 in absolute repose. 
 
 There is reason to investigate whether the different temperatures of 
 the children experimented upon have had an effect upon the difference 
 in the amount of the metabolism. As previously mentioned, a fairly 
 accurate value for the infant's temperature during the experiment is 
 the last figure in the column headed " Body-temperature" in the tables. 
 Recorded in this way, the infants' body-temperatures during the experi- 
 ments do not show large differences, and these are in all instances 
 plainly not parallel with the differences in the amount of the metabo- 
 lism; I emphasize experiment 3, table 1 (temp. 35.2, metabolism 481), 
 in comparison with experiment 8-, table 1 (36.0, 270) ; experiment 5, 
 table 3 (35.8, 273) with experiment 4, table 3 (35.0, 464), etc. More- 
 over, it is sufficiently well known that strong and continuous crying can 
 raise an infant's temperature about 0.5. As crying is followed by a 
 rise in metabolism, a certain degree of parallelism between the infant's 
 temperature and the figure for the metabolism was expected. 
 
 As regards the low temperatures after the birth-bath, they are for 
 full-term and strong infants obviously considerably lower than is 
 considered the rule. Vierordt 1 reports a temperature fall on account 
 of birth and birth-bath at an average of 1 C; a fall of 1.7 C. " comes 
 very rarely," but with delicate infants it may amount to even 4.7 C. 
 
 In my experiments the normal children in experiments 3 and 2 in 
 table 1 show in one-half hour and 2 hours after birth a temperature 
 which is 4 C. or more below normal. When no bath after birth was 
 given prior to the experiment, the cooling-off after birth has been fol- 
 lowed by a fall in temperature of about 1 C. (experiments 17 and 13 in 
 table 2 and experiment 10 in table 3). I would not dispute the fact 
 that the tepid birth-bath is in all cases a very important means of 
 reflexly starting the respirations, but I consider it very possible that 
 the cooling off brought about by the bath can be carried too far, and if 
 special arrangements have not been made for effectively warming the 
 child after the bath, the cooling effect can be of too long duration. 
 
 How is the respiratory metabolism of the new-born infant altered 
 under the influence of food, as well with respect to the quotient as to 
 the amount of the metabolism? When a hungry individual is put 
 on a nearly exclusive carbohydrate diet, 2 his respiratory quotient 
 reaches 1 about an hour after the first meal. In the course of an hour, 
 therefore, the absorption and combustion of the carbohydrates in the 
 different organs is in full operation. If we make an experiment similar 
 to this with fat, the quotient shows that the time for the combustion 
 of fat is considerably longer, i. e., about 3 hours after eating; something 
 similar is true of proteids. Carbohydrates, therefore, are for grown 
 individuals the food element most easily and most quickly consumed. 
 This agrees very well with the fact that Mosso found with dogs an 
 increase in temperature of about 1 C. an hour after taking 1 to 2 grams 
 
 l Vierordt, Physiol. d. Kindesalters, 1877, pp. 152-154. 
 
 2 Speck, Physiologic des menschlichen Athmens, Leipsic, 1892, p. 35; Magnus-Levy, Archiv f. d. 
 ges. Physiol., 1894, 55, p. 1. 
 
26 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 of cane sugar per kilogram of the dog's body-weight. From the records 
 of the body-temperature of the dog during and after a meal, consisting 
 of cane sugar or of isodynamic quantities of bread, Mosso concludes 
 that about an hour after taking the sugar is all absorbed, small quanti- 
 ties being used entirely for the formation of heat and larger deposits 
 being used in part for the same purpose and in part stored for future 
 consumption. Bread is utilized in the same way, but more slowly, 
 since it takes longer before the other food elements in the bread are 
 oxidized. The bread as a whole, therefore, can not develop a heat 
 influence so suddenly as can isodynamic quantities of sugar. 
 
 TABLE 4. 
 
 
 
 
 
 
 
 
 
 Carbon- 
 
 
 
 
 
 
 
 
 
 
 dioxide 
 
 
 Experi- 
 ment 
 No. 
 
 Sex. 
 
 Body- 
 weight. 
 
 Height. 
 
 Age. 
 
 Temperature 
 of air in 
 apparatus. 
 
 Body-tempera- 
 ture (rectal). 
 
 Carbon 
 dioxide 
 in air of 
 cham- 
 
 elimina- 
 tion per 
 kilogram 
 per hour 
 
 Respir- 
 atory 
 quo- 
 
 tipnt 
 
 
 
 
 
 
 
 
 ber. 
 
 at C. 
 
 tieiiu. 
 
 
 
 
 
 
 
 
 
 and 760 
 
 
 
 
 
 
 
 
 
 
 mm. 
 
 
 
 
 Q7ft>* 
 
 cm. 
 
 d.hr. 
 
 C. 
 
 C. 
 
 p.ct. 
 
 c.c. 
 
 
 1 25 
 
 M. 
 
 3,600 
 
 
 5 .. 
 
 33.0-33.0 
 
 36.5-37.0 
 
 1.148 
 
 510 
 
 0.930 
 
 222 
 
 F. 
 
 4,100 
 
 54 
 
 5 .. 
 
 31 -31 
 
 36.0-36.8 
 
 1.133 
 
 487 
 
 .916 
 
 321 
 
 M. 
 
 3,250 
 
 52 
 
 2 . . 
 
 32.0-32.0 
 
 35.2-36.8 
 
 .851 
 
 478 
 
 .799 
 
 <24 
 
 M. 
 
 3,400 
 
 52 
 
 5 . . 
 
 32.3-32.7 
 
 35.4-36.6 
 
 .743 
 
 395 
 
 .807 
 
 6 15 
 16 
 
 }. 
 
 1,900 
 
 
 5 .. 
 
 J33.5-33.8 
 \33.4-33.7 
 
 
 .260 
 .373 
 
 205 
 235 
 
 .770 
 .806 
 
 28 
 
 M. 
 
 3,000 
 
 50 
 
 .. 15 
 
 32.5-32.5 
 
 37.0-37.0 
 
 .707 
 
 482 
 
 .849 
 
 7 30 
 
 F. 
 
 2,950 
 
 
 1 . . 
 
 31.8-32.5 
 
 36.8-37.0 
 
 .894 
 
 642 
 
 .872 
 
 23 
 
 F. 
 
 2,550 
 
 
 . . 15 
 
 32.0-32.0 
 
 34.4-34.6 
 
 .449 
 
 283 
 
 .691 
 
 breast-fed 1 hour before experiment; cried somewhat for about 8 minutes; passage of urine and 
 feces; during the last 5 minutes asleep. See experiment 27, table 5. 
 
 2 Breast-fed; same as subject in experiment 12, table 1; breast-fed 1 hour previously; awake and 
 satisfied. 
 
 Same as subject in 17 and 18 in table 2; slight jaundice; breast-fed 2 hours previous to experi- 
 ment; cried 3 minutes; awake and lively, sucking its fingers. 
 
 4 Breast-fed 2 hours and again just before experiment; asleep or drowsy; only a few movements; 
 no signs of hunger. 
 
 Incubator infant; weighed at birth 1,950 grams; takes to the breast poorly; is put to the breast 
 every 2 hours; last time just previous to experiment; fast asleep. This applies to 
 experiment 16 as well. 
 
 Bottle and breast; last meal 3 hours and again just previous to experiment; awake and lively. 
 See experiment 29, table 5. 
 
 'Breast; last meal 3 hours and again just before experiment; violently crying more than two- 
 thirds of the time; rest of the time in light sleep. See experiment 31, table 5. 
 
 8 Breast; born 2 to 3 weeks prematurely; breast-fed altogether 2 times, 5 hours before and again 
 just before experiment; took to breast well; absolutely quiet, half and wholly asleep. 
 
 An individual on a liberal mixed diet does not show variations in the 
 respiratory quotient which would suggest a selective choice of the 
 different foodstuffs. For instance, he does not have an hour after a 
 meal a respiratory quotient of 1 , 2 hours after a quotient of 0.8, and 3 
 hours after 0.7, but would, at any time selected, have a quotient which 
 varies but little from 0.88, for example. The reason for this is that the 
 nourishment is plentiful, or, in other words, that there is in the circu- 
 lation almost the same mixture of all three chief nutrients or their 
 
OBSERVATIONS BY HASSELBALCH. 27 
 
 intermediate metabolism products. Meals, which as a rule follow so 
 quickly after each other that the fat and albumin absorption in the 
 course of a day does not cease at all, can therefore not have any recog- 
 nizable influence on the quotient. The evident conclusion is that if 
 a meal (having constant composition) causes variations in the quotient 
 of the above-mentioned character, it must mean that the nourishment 
 is insufficient. I am not certain whether experiments favor this con- 
 clusion, but I do not doubt that the supposition is true in the case of 
 the adult. 
 
 The meal affects the amount of the metabolism in such a way that 
 the activity of the muscles and of the glands, caused by the ingestion of 
 the food, increases the respiratory metabolism about 10 per cent. 
 If we consider table 4, in which the experiments are arranged according 
 to the time which has elapsed after the last meal, there seems to be 
 little doubt concerning the effect of the meal on the respiratory quo- 
 tient. In the two experiments (25 and 22) which began an hour after 
 the meal, the middle of the experiment corresponding to 1 J hours after 
 the meal (intervals which are important in carbohydrate metabolism), 
 high quotients are found, namely, 0.930 and 0.916. These quotients 
 point towards a predominant carbohydrate metabolism. In experi- 
 ment 21 the meal was given 2 hours previous and the quotient is 0.799. 
 Almost the same quotient was found in experiment 24 (0.807). Pre- 
 vious to this experiment the child had not been fed for 2 hours, but was 
 put to the breast just before the experiment began. The preceding 
 meal may, therefore, be considered as having increased the metabolism 
 but not as having changed the quotient, because at the end of the exper- 
 iment only 38 minutes had elapsed since the meal (15 plus 23 minutes). 
 The metabolism during the experiment was the metabolism of the ele- 
 ments from the previous meal. The exact correspondence between 
 the quotients in these two experiments also seems to indicate that 
 the metabolism of the food given just before experiment 24 did not 
 begin during the experimental period. 
 
 Experiments 15 and 16, with a 5-day-old incubator child for subject, 
 are interesting because they point towards the time when the metabo- 
 lism of a meal begins; they were conducted at 1-hour intervals. The 
 child received its last meal 2 hours before experiment 15, and therefore 
 in this experiment has a quotient of 0.770 (approximately the same as 
 the quotient in 21 and 24). With experiment 16, however, the child 
 had its last meal an hour previous to the beginning of the experimental 
 period; we therefore find an increased quotient, i. e., 0.806. 
 
 In experiments 28 and 30, both with infants fed at the breast 3 hours 
 previous to and again just before the experiment, quotients of 0.849 
 and 0.872 were obtained, which again show fair uniformity. These 
 quotients are considerably lower than those obtained one-half hour 
 after the meal, but higher than those obtained 2 to 2| hours after. 
 This may be only accidental, but it is impossible to decide concerning 
 this point. If we determine the metabolism 5 hours after the meal, 
 as in experimejit 23, the quotient is found to be 0.691, indicating the 
 katabolism of fat. 
 
28 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 It is quite clear to me that in investigating these circumstances it 
 would have been experimentally more correct to have used the same 
 instead of different infants. The material for the investigations, how- 
 ever, was collected for another purpose. Nevertheless the dependence 
 of the respiratory quotient upon the interval of time elapsing after 
 the last meal is shown in table 4, and in such a striking manner that 
 there can hardly be any other interpretation. 
 
 There is, however, no doubt about one point. Even though the 
 composition of the food of the infant is much more constant than that 
 of the adult, the respiratory quotient of the infant varies continually 
 with the meals, so that it is highest about If hours afterwards (during 
 this period the metabolism of lactose is chiefly going on) , and very low 
 about 5 hours after, when the lactose from the last meal had been 
 used up. I would not insist that this is definitely in favor of more 
 frequent feeding than the ordinary 5 feedings during the course of the 
 day, but it certainly deserves some consideration. 
 
 On the other hand, it is possible that it might be harmful to the infant 
 if the meals were so near together that the respiratory quotient remained 
 constant throughout the day. In any case the problem is interesting 
 and deserves a more thorough investigation, especially in the case of the 
 same child throughout a rather long interval of time, with varying 
 frequency of feeding with the same quantity of food and under constant 
 control of the weight curve. 
 
 Table 4 does not give any new information concerning the amount 
 of the metabolism. The influence of activity is also quite apparent 
 here. The premature incubator infant in experiments 15 and 16, 
 which was practically motionless during the experiments, has a metabo- 
 lism even lower than that found in the experiments with infants 
 immediately after birth; it is interesting to note that the metabolism 
 rises in the second experiment (both the carbon dioxide produced and 
 the oxygen consumed), because this is supposedly to be interpreted in 
 the same manner as the rise of the quotient in experiment 16. The 
 work of digestion is greater hi experiment 16 than in experiment 15. 
 At any rate, it was impossible to recognize a difference in the muscular 
 activity of the infant in the two experiments, as the child was lying 
 relaxed and asleep. The quotients for the infants spoken of as " lively 
 and content" are somewhat higher than those of similar cases in tables 
 1, 2, and 3; but it is also striking how much more energy is displayed 
 by the child a few days old than by the new-born infant, exhausted 
 after birth. 
 
 In experiment 30 we find an enormous metabolism, 642 c.c. of carbon 
 dioxide per kilogram and per hour; but in this case we observe that the 
 child was " violently crying more than two-thirds of the time." Evi- 
 dently we can not overestimate the increased metabolism due to the 
 incessant crying of feeble infants. 
 
 Experiment 27 (not given in the tables) illustrates the effect of crying 
 on the amount of the metabolism. By moderately lowering the tem- 
 perature (which caused a drop in the body-temperature of 0.4 C.) we 
 succeeded in making the child cry very violently for about 17 min- 
 
OBSERVATIONS BY HASSELBALCH. 29 
 
 utes. The experiment was made with the same male infant as experi- 
 ment 25 in table 4, the weight of the child being 3,600 grams and the 
 age 6 days. It was breast-fed. The temperature of the apparatus 
 was 25 to 26 C.; the body-temperature of the infant was 37.0 to 
 36.6 C. The percentage of carbon dioxide in the air of the chamber 
 was 1.534; the carbon-dioxide elimination per kilogram per hour, 
 reduced to C. and 760 mm., was 764 c.c. and the respiratory quotient 
 0.897. The child was crying violently three-quarters of the experi- 
 mental period and was evidently cold. In the middle of the experi- 
 ment there was a quiet period with a little sobbing. It would be 
 erroneous to consider the great increase in metabolism (compare 
 experiment 25, table 4) in this experiment a result of the child's 
 " chemical heat regulation" brought about by a cold reflex. 1 The 
 infant would have reacted to any other equally powerful irritant with as 
 severe crying and with equally high metabolism. 
 
 Even if the previous experiments leave no doubt that the carbo- 
 hydrates of the food play the same r61e in the infant's nutrition as in 
 that of adults, namely, that of the most accessible food elements and 
 consequently most quickly consumed for heat production, and even if 
 the results in table 4 are most easily interpreted on the supposition 
 that the absorption and metabolism of carbohydrates reach their 
 climax 1 to If hours after the meal, further experimental evidence is 
 still needed of the correctness of this hypothesis. With this purpose 
 in mind three infants were put on a diet so arranged that meats were 
 given between their regular feedings. These meals consisted of 4 to 5 
 grams of grape or milk sugar dissolved in a little water. 
 
 In experiment 29 of table 5 the respiration experiment commences 3 
 hours after the milk meal and about If hours after the lactose meal. 
 The quotient is 1.0. In experiment 26, in which the grape-sugar was 
 given 4 hours and again one-half hour previous to the experiment 
 (breast-feeding between the two feedings about 2 hours previous to the 
 experiment), it is seen that the quotient 0.869 does not point towards 
 an exclusive carbohydrate metabolism. In the course of the half 
 hour the absorption of the administered grape-sugar has not taken place. 
 Finally, in experiment 31, undertaken about 3f hours after the last 
 milk meal and about 2f hours after the last grape-sugar feeding, the 
 quotient is 0.845, an index that the metabolism of the 4 grams of grape- 
 sugar has to a great extent taken place as quickly as 2\ hours after admin- 
 istration. 
 
 This result corresponds strikingly with those obtained by Speck and 
 Magnus-Levy with adults (my discussion of the results in table 4 were 
 based on the results obtained by these two authors), and with Mosso's 
 demonstration of a temperature rise of 1 C. in the case of a starving 
 dog, about an hour after the ingestion of an amount of sugar correspond- 
 ing to that used in these experiments. It is thus clear that the custom 
 of feeding sugar-water immediately after the birth-bath rests upon a 
 
 (Archiv f. d. ges. PhysioL, 1902, 89, p. 166) interprets a rise in metabolism from 332 
 c.c. to 579 c.c. carbon dioxide as a sign of an "auffallige Thatigkeit der chemischen Regulation," 
 without giving information about the child's behavior in the two cases. 
 
30 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 very sound principle. Of all the elements of nutrition sugar is digested 
 by the infant the most quickly and the most easily, and doubtless 
 causes a rise in temperature very much to be desired, because of the 
 cooling-off at birth and during the birth-bath. 
 
 Experiment 1 of table 5 is an experiment which should illustrate 
 this utilization of sugar, but there are some objections. In the first 
 place, it was not wise to select a period 3 hours after birth for feeding 
 with sugar; in the second place, it will always be difficult to demonstrate 
 in respiration experiments the utilization of sugar at such a period, for 
 even without sugar the quotient at this period is close to 1.0. But a 
 direct demonstration of this point is unnecessary. The fact that the 
 small intestine of the fetus contains invertin shows that it is equipped 
 for the digestion of carbohydrates, and therefore favors the supposition 
 that the new-born infant should be able to digest cane-sugar without 
 difficulty immediately after birth. 
 
 TABLE 5. 
 
 
 
 
 
 
 
 
 
 Carbon- 
 
 
 
 
 
 
 
 
 
 
 dioxide 
 
 
 Experi- 
 ment 
 No. 
 
 Sex. 
 
 Body- 
 weight. 
 
 Height. 
 
 Age. 
 
 Temperature 
 of air in 
 apparatus. 
 
 Body-tempera- 
 ture (rectal). 
 
 Carbon 
 dioxide 
 in air of 
 cham- 
 
 elimina- 
 tion per 
 kilogram 
 per hour 
 
 Respir- 
 atory 
 quo- 
 
 4 i ri i + 
 
 
 
 
 
 
 
 
 ber. 
 
 at C. 
 
 nent. 
 
 
 
 
 
 
 
 
 
 and 760 
 
 
 
 
 
 
 
 
 
 
 mm. 
 
 
 
 
 QW:. 
 
 cm. 
 
 d. hr. 
 
 C. 
 
 C. 
 
 p. ct. 
 
 c.c. 
 
 
 1 2Q 
 
 M. 
 
 2,950 
 
 50 
 
 2 .. 
 
 31.8-32.1 
 
 36.4-36.5 
 
 0.806 
 
 617 
 
 1.027 
 
 *26 
 
 F. 
 
 2,450 
 
 
 2 . . 
 
 31.8-32.1 
 
 36.0-35.7 
 
 .553 
 
 370 
 
 .869 
 
 '31 
 
 F. 
 
 2,950 
 
 
 2 .. 
 
 31.0-31.3 
 
 36.3-36.7 
 
 .511 
 
 343 
 
 .845 
 
 <1 
 
 F. 
 
 3,700 
 
 51 
 
 .. 3 
 
 33.5-35.0 
 
 34.2-35.4 
 
 1.291 
 
 500 
 
 .902 
 
 1 Bottle and breast; same as subject of experiment 28 in table 4; in last 24 hours between the 
 
 meal- times fed with 5x4 grams milk-sugar, last time l hours before experiment. Crying 
 
 violently for 4 minutes, afterwards half or wholly asleep. 
 2 Breast; same as subject of experiment 23 in table 4; in last 36 hours 5x5 grams grape-sugar, 
 
 last 4 hours and hour before experiment; sleeping or dozing; now and then vigorous 
 
 movements. 
 Breast; same as subject of experiment 30 in table 4; in the last 24 hours 5x4 grams grape-sugar; 
 
 last feeding 2\ hours before experiment; half or wholly asleep. 
 4 Sugar-water at birth; bath; crying about one-half of the time; otherwise restless, kicking, and 
 
 perspiring. 
 
 It would be unreasonable to dispute the fact that mother's milk is 
 the ideal nourishment for the infant. It is well to note, however, that 
 the infant must be born at full term and be healthy. With premature 
 infants and infants with intestinal catarrh or other digestive ailments, 
 which result in diarrhea and rapid loss of weight, it is quite a different 
 matter. 
 
 Recent investigators in this line tend more towards localizing the 
 logical cause of digestive diseases in those organs in which the final 
 katabolism of the food elements takes place, instead of in the mucous 
 membrane of the digestive tract and the accessory digestive glands; 
 indeed, there are many points which favor a pathological retarded 
 development of the oxidative functions of the liver tissues. 
 
OBSERVATIONS BY HASSELBALCH. 31 
 
 Meinhard Pfaundler 1 has shown in an interesting paper that an 
 infant, and especially an infant weakened from some illness, is unable to 
 oxidize the fat and albumin in the nourishment as completely as the adult, 
 and he has shown by experiments that this is due to some extent 
 to the small oxidative power of the liver tissue. 
 
 Carbohydrates receive a prominent place as that constituent in milk 
 which is most easily and most completely oxidized under all conditions, 
 and which is therefore an important element in the feeding of the 
 infant, whose fat and albumin digestion is supposedly overworked. 
 In such cases the mother's milk is not the ideal food, for its contents of 
 fat and albumin (which can not be digested and whose products of 
 decomposition may do harm in the intestine) are altogether too large 
 and cause the child in reality to starve. 
 
 In reviewing the extensive amount of literature on artificial feeding 
 of atrophic infants, it is evident that the composition which has had 
 the best results, Keller's malt soup (a modified Liebig soup), points 
 towards feeding largely with easily digested carbohydrates (maltose). 
 With this kind of feeding the formerly atonic and poorly-nourished 
 infant thrives and the disease is, as a rule, cured at one stroke. If, 
 therefore, it is demonstrated that mother's milk is not the most favor- 
 able nourishment in all pathological cases, it is well, bearing the previ- 
 ous results in mind, not to take it for granted that mother's milk is 
 indicated in the case of the premature infant, but to consider whether 
 feeding with relatively large amounts of carbohydrates would not be 
 preferable. 
 
 CONCLUSIONS. 
 
 I. The well-nourished infant, born at full term, has a store of carbo- 
 hydrates (glycogen) in its organs, which is spent in the course 
 of a few hours. 
 
 II. The metabolism of a poorly-nourished and premature infant 
 depends chiefly on the oxidation of carbohydrates during the 
 first hours of life. 
 
 III. There is every reason to suppose that the metabolism of the 
 
 normal, well-nourished human fetus consists of the oxidation 
 of carbohydrates. 
 
 IV. When the infant is fed with mother's milk, the respiratory metab- 
 
 olism shows a mixed quotient, which varies with the meals 
 in such a way as to indicate that milk sugar is the element 
 most quickly burned, that is, about 1 hours after the meal. 
 This fact is confirmed by experiments. 
 
 V. The amount of the infant's metabolism is to a very large extent 
 dependent upon muscular contractions. At 32 C. and with 
 least possible work, the metabolism per kilogram is hardly 
 greater than that of the adult at absolute rest. 
 
 VI. The relative ease with which carbohydrates are digested favors 
 their extensive use in cases where the ability to digest the 
 other constituents of human milk is decreased. 
 
 Meinhard Pfaundler, Jahrb. f. Kinderheilk., 1901, 54, p. 247. See also here a large amount of 
 literature on the subject. 
 
32 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 DISCUSSION OF HASSELBALCH'S RESEARCH. 
 
 We consider it peculiarly unfortunate that in our two earlier publica- 
 tions reference to Hasselbalch's research and to his striking conclusions 
 was inadvertently omitted, and although at that time we were unable 
 to comment intelligently upon the results or make a satisfactory 
 abstract of them, since there were some difficulties in the translation, 
 nevertheless it would have been desirable to call attention earlier to 
 the existence of this wholly remarkable piece of research upon infant 
 metabolism. Although the study was made 11 years ago, the same 
 degree of care and nicety of technique which has characterized Hassel- 
 balch's subsequent observations is apparent in this research. It is 
 obvious that we have here for the first time quantitative measurements 
 of the gaseous metabolism of infants by a study of the carbon-dioxide 
 increment and oxygen deficit in the ventilating current of air. It is an 
 interesting fact, which should certainly be pointed out, that the appa- 
 ratus used by Hasselbalch for this study embodied the same principle 
 as the Jaquet 1 apparatus, and, indeed, both forms of apparatus were 
 described in the same year, thus proving independent simultaneous 
 development. 
 
 Of particular importance in studying the respiratory exchange is a 
 special appreciation of the significance of the difficulties of determining 
 the oxygen in any gaseous mixture, even in ordinary atmospheric air. 
 Researches in the Nutrition Laboratory have shown that the external 
 air is of absolutely constant composition, irrespective of seasons, wind 
 direction, weather conditions, barometric pressure, and altitude. 2 
 Consequently it can be assumed that any gas-analysis apparatus which 
 fails to give constant values for the oxygen content of the atmospheric 
 air may be considered on this a priori evidence as being an inaccurate 
 apparatus, or the technique is at fault. 
 
 It is, furthermore, obvious that the greater the carbon-dioxide incre- 
 ment and the greater the oxygen deficit in the ventilating current of air, 
 the less the analytical errors will influence the calculation of the respira- 
 tory quotient. It has been frequently pointed out that those using 
 the Jaquet method are too often inclined so to adjust the ventilating 
 air-current as to have a minimum carbon-dioxide increase and an 
 equivalent oxygen deficit. When this carbon-dioxide increment is 
 less than 0.5 per cent, analytical errors play a great r61e not only in the 
 calculation of the respiratory quotient, but likewise to a certain extent 
 in the calculation of the total metabolism. Since the analytical errors 
 in the determination of the carbon dioxide are very much less than those 
 in determining oxygen, this may not of necessity be a serious matter. 
 On the other hand, the exact determination of oxygen necessitates the 
 skill of the best trained analyst and an especially accurate gas-analysis 
 apparatus with a carefully controlled technique. When the oxygen 
 
 1 Jaquet, Verhandl. d. Naturforsch. Gesellsch. in Basel, 1904, 15, p. 252. 
 Benedict, Carnegie Inst. Wash. Pub. No. 166, 1912. 
 
EARLIER RESEARCHES WITH NEW-BORN INFANTS. 33 
 
 deficit is less than 0.7 per cent, analytical errors of plus or minus 0.03 
 per cent (which are not at all infrequent) will have a very considerable 
 influence upon the computations of the respiratory quotient. 
 
 The air analyses published by most users of the Jaquet apparatus 
 have shown discrepancies in the oxygen content of external air which 
 lead one to suspect analytical errors. We note with interest, however, 
 Hasselbalch's statement regarding his own experience in analytical 
 analysis, which indicates that he found very insignificant variations 
 in the composition of the atmosphere. Thus we may properly infer 
 an especially careful analytical procedure. But of more significance 
 is the fact that Hasselbalch's published results show us that his carbon- 
 dioxide increment was frequently 1 per cent or even 1.5 per cent. It 
 is clear that Hasselbalch's analytical data are probably as accurate 
 as any determinations thus far made of the carbon-dioxide increment 
 and the oxygen deficit in an open-circuit respiration apparatus, and we 
 may have an unusual degree of confidence in his values. 
 
 The number of infants studied by Hasselbalch was too few to obtain 
 definite physiological constants, and although he reports 31 experi- 
 mental periods on 20 infants, and as a result of his accurate technique 
 was able to make deductions from them, it is obvious that a problem 
 so important as the metabolism during the first week of life demands 
 not simply confirmation but further elaboration of data. We shall 
 have occasion, in discussing our own results subsequently, to refer to 
 the sharply drawn conclusions reported by Hasselbalch. 
 
 OBSERVATIONS BY WEISS. 
 
 In 1908 G. Weiss, 1 employing a type of respiration apparatus which 
 was entirely different from those previously used for studying infant 
 metabolism, made a most interesting series of observations on new-born 
 infants, in which both the carbon-dioxide output and oxygen intake 
 were studied. Twelve new-born infants were observed, ranging in 
 age from 1 to 11 days. His apparatus consisted of a metal chamber 
 supplied with a window and a thermometer, and having a capacity of 
 60 liters. The infant was hermetically sealed in this chamber and 
 remained there for approximately an hour. The air in the chamber was 
 then thoroughly mixed by an electric fan and a sample taken for analy- 
 sis. This method of studying the gaseous exchange was employed 
 by Chauveau and Kaufmann and used with especial success by Laulanie*. 
 The carbon-dioxide increment in the chamber and the oxygen deficit 
 could be readily computed from the results of the analysis and data 
 obtained as to the total oxygen absorption and carbon-dioxide produc- 
 tion of the infant. 
 
 The author points out that with new-born infants the carbon-dioxide 
 excretion is two, three, or sometimes four times greater per kilogram of 
 body-weight than it is with the adult. He found, for example, that the 
 carbon dioxide excreted varied from 1,064 c.c. to 337 c.c. per kilogram 
 
 1 G. Weiss, Bui. de 1'Acad. M6d., 1908, 60, 3d ser., p. 458. 
 
34 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 per hour, while the values for the oxygen consumed varied from 1,248 
 to 404 c.c. per hour. He also states that he found the respiratory 
 quotient to be generally much higher than the results obtained by 
 Scherer. Basing his discussion upon the law of surface area, Weiss 
 concludes that the metabolism is proportional to the cube root of the 
 square of the weight. We give here his argument in full. His result* 
 are given in tables 6 and 7. 
 
 La consommation de divers sujets de m&ne espece, et les phe"nomenes qui 
 Paccompagnent, en particulier _Pintensite des ^changes respiratoires, doit 
 done etre proportionnelle a ^P 2 , et en rapportant cette consommation i 
 
 Punite de poids, on obtient = = , que je designerai par a. 
 
 Si done tous les sujets se trouvaient dans lesmemes conditions d'utilisation 
 d'oxygene, ils devraient, par kilogramme, faire une consommation propor- 
 tionnelle a a. En designant Poxygene absorbe* par kilogramme-heure par Q, 
 
 serait constant, quelle que soit la taille du sujet. En suivant les variations 
 a 
 
 de , on a reellement Pindication d'une utilisation surabondante ou defec- 
 a 
 
 tueuse de Poxygene; c'est pourquoi ce rapport peut etre designe" par le nom 
 d'indice d'oxygenation. Get indice d'oxyge*nation est en somme le rapport 
 de ce qu'un sujet prend reellement d'oxygene a ce qu'il devrait prendre nor- 
 malement pour sa taille. 
 
 En appliquant cette formule a Padulte pendant le cycle de vingt-quatre 
 heures, P etant exprime en kilos et Q en litres, on obtient un indice voisin de 
 Pimite*; 0.99 a 1.03, pour Phomme variant de 60 a 70 kilogrammes. 
 
 Voyons maintenant ce que Pon trouve chez le nourrisson. 
 
 J'ai calcuie les indices correspondant a mes di verses determinations chez 
 le nouveau-ne'; les r^sultats sont reported dans la Table II. On ne constate 
 plus alors cet e*cart considerable entre le nourrisson et Padulte. 
 
 Dans les premiers jours apr&s la naissance, Pindice d'oxyg^nation est un 
 peu inferieur a la normale, mais il se releve ensuite et ne la de"passe guere; chez 
 un seul sujet particulierement beau il s'est e*leye* a 1.5 et meme 1.8. Mes 
 mesures ne comprennent pas les premieres heures, il y a la une lacune a combler. 
 
 Mais si, chez les enfants que Pon peut qualifier de normaux, c'est-a-dire 
 qui augmentent regulierement de poids, Pindice d'oxyg^nation prend une 
 valeur un peu supe*rieure a Punite, chez les d^biles Sieve's a la couveuse il 
 est franchement au-dessous, il est au voisinage de 0.5 et ne se releve pas; 
 c'est la un point qui me parait important et qu'il y a lieu d'examiner de plus 
 pr&s au moyen de nouvelles experiences. 
 
 Peut-etre devrais-je ni'arr^ter ici et me contender des constatations que 
 j'ai faites; mais il y a lieu de se demander a quoi tiennent les differences 
 d'indice que j'ai relevees. 
 
 Je ne voudrais pas sortir des limites de la physiologic normale et penetrer 
 sur un terrain peu sur pour moi; cependant je tiens a faire une remarque 
 qui peut orienter les recherches a entreprendre. 
 
 Jusque dans ces derniers temps, et confonnement ^, la theorie de Lavoisier, 
 la question de Pabsorption d'oxygene par les e*tres vivants etait, sans restric- 
 tion aucune, intimement liee a la production de Penergie utilisee par les ani- 
 maux. 
 
 Dans cet ordre d'idees on aurait pu se demander si certains enfants ne 
 s'oxygenent pas plus que d'autres parce que, etant plus robustes, ils s'agitent 
 et depensent davantage. 
 
EARLIER RESEARCHES W 
 
 fra 
 
 NEW-BORN INFANTS. 
 
 35 
 
 Mais cette explication ne peut pas nous contenter; on a vu en effet plus haut 
 que les robustes Femportent sur les debiles meme alors que les premiers dorment 
 au repos complet et que les seconds s'agitent. En dehors de 1'influence de Fagi- 
 tation, il faut chercher une autre cause a la variation de 1'indice d'oxyge*nation. 
 
 Au cours de recherches que je poursuis depuis plusieurs anne"es, et dont 
 j'ai public quelques resultats a la Societe de Biologic, j'ai montre que non 
 seulement, comme on le savait, certains animaux pouvaient yivre un certain 
 temps a Fabri de Pair, y produisant du travail avec elimination d'acide car- 
 bonique, mais que cette production de travail ne se faisait pas aux de*pens de 
 provisions d'oxygene tiroes anterieurement de F atmosphere. 
 
 Le muscle peut travailler sans intervention de Foxygene de Fair. Celui-ci 
 ne semble intervenir que pour eViter Fencombrement de Forganisme par des 
 de*chets et produits toxiques. Autrement dit, Foxygene est un e"purateur. 
 
 II se peut qu'il y ait lieu de rapprocher ce role epurateur de Foxygene des 
 bonnes conditions de developpement des enfants robustes, tandis qu'il est 
 insuffisant chez les debiles. 
 
 TABLE 6. 1 
 
 Nos. 
 
 Age. 
 
 Poids. 
 
 CO 2 
 
 2 
 
 R.Q. 
 
 Remarques. 
 
 I. 9 BON fiTAT. 
 
 1 
 2 
 3 
 
 4 
 5 
 
 6 
 
 7 
 
 5 e jour. 
 
 3.120 
 
 0.960 
 0.887 
 0.975 
 1.064 
 0.922 
 0.884 
 0.556 
 
 1.067 
 0.935 
 1.023 
 1.248 
 0.971 
 0.912 
 0.598 
 
 0.90 
 0.95 
 0.95 
 0.90 
 0.95 
 0.97 
 0.93 
 
 22. Vient de teter. Cris frequents. 
 22 . 5. Cris frequents. 
 23 . 5. Cris frequents. 
 24. Cris frequents. 
 21. Tete il y a 2 h. 30. Cris frequents. 
 21.5. Vient de teter. 
 21.5. Repos complet. 
 
 
 
 
 
 8e jour. 
 
 3.370 
 
 
 
 II. rf 1 BON &TAT. 
 
 8 
 9 
 10 
 11 
 12 
 13 
 14 
 15 
 16 
 
 17 
 
 2 e jour. 
 
 3.300 
 
 0.403 
 0.530 
 0.604 
 0.613 
 0.701 
 0.753 
 0.659 
 0.756 
 0.815 
 
 0.837 
 
 0.498 
 0.631 
 0.695 
 0.730 
 0.779 
 0.801 
 0.701 
 0.796 
 0.886 
 
 0.854 
 
 0.81 
 0.84 
 0.87 
 0.84 
 0.90 
 0.94 
 0.94 
 0.95 
 0.92 
 
 0.98 
 
 21. Aucune tetee encore. Sommeil. 
 21.5. Quelques cris. 
 21. Vient de teter. Sommeil. 
 Sommeil. 
 22. Vient de teter. Repos et sommeil. 
 23. Sommeil. 
 23.5. Vient de teter. Sommeil. 
 26. Cris, puis sommeil. 
 24. Vient de teter. Cris. Demi-som- 
 meil. 
 24 . 5. Demi-sommeil. 
 
 4e jour. 
 
 3 270 
 
 7 e jour. 
 
 3.420 
 
 9 e jour. 
 
 3.520 
 
 lie jour. 
 
 3.620 
 
 
 
 III. 9 BON fiTAT. 
 
 18 
 19 
 20 
 21 
 22 
 23 
 24 
 
 25 
 
 2 jour. 
 
 3.570 
 
 0.403 
 0.413 
 0.407 
 0.525 
 0.629 
 0.596 
 0.696 
 
 0.589 
 
 0.504 
 0.504 
 0.509 
 0.610 
 0.732 
 0.678 
 0.757 
 
 0.685 
 
 0.80 
 0.82 
 0.80 
 0.86 
 0.86 
 0.88 
 0.92 
 
 0.86 
 
 24. Vient de teter. Sommeil. 
 25. Sommeil. 
 23. Vient de teter. Sommeil. 
 25 . 5. Cris et sommeil. 
 24 . 5. Vient de teter. Cris et sommeil. 
 26. Cris et sommeil. 
 22. Pas tete ce matin. Sommeil. Re- 
 veil. Cris. 
 22. Tetee. Sommeil. 
 
 4e jour. 
 
 3.600 
 
 6e jour. 
 
 3.710 
 
 9 e jour. 
 
 3.860 
 
 
 
 IV. $ BON fiTAT. 
 
 26 
 27 
 28 
 29 
 
 2e jour. 
 
 3.050 
 
 0.469 
 0.579 
 0.479 
 0.451 
 
 0.579 
 0.697 
 0.614 
 0.609 
 
 0.81 
 0.83 
 0.78 
 0.74 
 
 22 . 5. Aucune tetee encore. Sommeil. 
 24. Reveil et pleurs. 
 23. Vient de teter. Sommeil. 
 24. Sommeil. 
 
 4 e jour. 
 
 2.780 
 
 
 
 x Table I in the Weiss article. 
 
36 PHYSIOLOGY OF THE NEW-BOKN INFANT. 
 
 TABLE 6 1 Continued. 
 
 Nos. 
 
 Age. 
 
 Poids. 
 
 C0 2 
 
 2 
 
 R. Q. 
 
 Remarques. 
 
 2 V. cf JUMEAU DfiBILE A LA COUVEUSE. 
 
 30 
 31 
 32 
 33 
 
 4e jour. 
 6e jour. 
 9e jour. 
 11 jour. 
 
 1.570 
 1.530 
 1.470 
 1.480 
 
 0.443 
 0.337 
 0.408 
 0.364 
 
 0.554 
 0.481 
 0.517 
 0.444 
 
 0.80 
 0.70 
 0.79 
 0.82 
 
 23 . 5. Legere agitation et sommeil. 
 24 . 5. Sommeil. 
 25. L6gere agitation et sommeil. 
 23 . 5. Sommeil leger avec frequents mouve- 
 ments. 
 
 VI. d* BON 6TAT. 
 
 34 
 35 
 
 2 jour. 
 5 e jour. 
 
 3.070 
 2.900 
 
 0.403 
 0.401 
 
 0.492 
 0.521 
 
 0.82 
 0.77 
 
 24 . 5. Pas tete ce matin. Sommeil. 
 26. Vient de teter. Sommeil. 
 
 VII. d* BON fiTAT. 
 
 36 
 37 
 
 38 
 39 
 
 40 
 
 2e jour. 
 4 jour. 
 
 7 e jour. 
 9e jour. 
 
 lie jour. 
 
 2.470 
 2.250 
 
 2.320 
 2.370 
 
 2.430 
 
 0.406 
 0.551 
 
 0.556 
 0.565 
 
 0.685 
 
 0.556 
 0.771 
 
 0.670 
 0.698 
 
 0.753 
 
 0.73 
 0.72 
 
 0.83 
 0.81 
 
 0.91 
 
 24 . 5. Aucune tetee encore. Sommeil leger . 
 25.5. Petite tetee le matin. Demi-som- 
 meil. 
 23. Vient de teter. Sommeil. 
 23. Tete il y a trois heures. Quelques 
 cris. Sommeil. 
 21. Quelques pleurs. Sommeil. 
 
 VIII. 9 Nfi A 8 MOIS. DfiBILE. COUVEUSE. 
 
 41 
 42 
 43 
 
 4 jour. 
 6e jour. 
 8 e jour. 
 
 1.860 
 1.850 
 1.790 
 
 0.425 
 0.349 
 0.514 
 
 0.518 
 0.459 
 0.591 
 
 0.82 
 0.76 
 0.87 
 
 23 . 5. Cris la moitiS du temps. 
 25. Quelques pleurs. Sommeil. 
 23 . 5. Sommeil et cris. 
 
 IX. 9 BON fiTAT. 
 
 44 
 45 
 46 
 47 
 
 ler jour. 
 3 jour. 
 5 e jour. 
 10 6 jour. 
 
 3.200 
 3.000 
 3.030 
 3.150 
 
 0.342 
 0.341 
 0.555 
 0.638 
 
 0.433 
 0.421 
 0.646 
 0.701 
 
 0.79 
 0.81 
 0.86 
 0.91 
 
 26. Sommeil continu. 
 27. Vient de teter. Sommeil continu. 
 27. Quelques cris. Sommeil. 
 23 . 5. Quelques cris. Sommeil. 
 
 X. d" BON fiTAT. 
 
 48 
 
 49 
 50 
 51 
 
 l er jour. 
 
 4e jour. 
 6e jour. 
 8 e jour. 
 
 3.700 
 
 3.450 
 3.530 
 3.550 
 
 0.404 
 
 0.447 
 0.545 
 0.664 
 
 0.481 
 
 0.552 
 0.641 
 0.772 
 
 0.84 
 
 0.81 
 0.85 
 0.86 
 
 25.5. Aucune tetee encore. Sommeil un 
 peu agite. 
 23. Vient de teter. Sommeil. 
 23 . 5. Vient de teter. Demi-sommeil. 
 23. Vient de teter. Cris frequents. 
 
 XL <? BON fiTAT. 
 
 52 
 
 53 
 54 
 
 2 e jour. 
 
 4e jour. 
 6 e jour. 
 
 3.600 
 
 3.450 
 3.550 
 
 0.543 
 
 0.521 
 0.625 
 
 0.647 
 
 0.606 
 0.680 
 
 0.84 
 
 0.86 
 0.92 
 
 23. Vient de teter. Reveil tranquille. 
 Quelques cris. 
 23. Vient de teter. Sommeil. 
 24.5. Vient de teter. Vagissements et 
 sommeil. 
 
 6 XII. d* DfiBILE A LA COUVEUSE. 
 
 55 
 56 
 57 
 
 58 
 
 59 
 
 ler jour. 
 3e jour. 
 5 e jour. 
 8e jour. 
 
 10 jour. 
 
 1.950 
 1.800 
 1.800 
 1.790 
 
 1.820 
 
 0.327 
 0.381 
 0.351 
 0.465 
 
 0.512 
 
 0.404 
 0.465 
 0.423 
 0.495 
 
 0.539 
 
 0.81 
 0.82 
 0.83 
 0.94 
 
 0.95 
 
 26. Aucune tetee encore. Sommeil. 
 26. Quelques mouvements. Sommeil. 
 26 . 5. Sommeil. 
 24. Vient de teter. Sommeil et quelques 
 cris. 
 23.5. Vient de teter. Demi-sommeil et 
 reveil. 
 
 I in the Weiss article. 
 *La mere n'ayant pas assez de lait, cet enfant recevait en supplement sept repas de 30 grammes 
 
 de lait sterilised Dernier repas trois heures avant 1'experience. 
 *La mere n'a pas permis la continuation des mesures. 
 4 L' enfant tetait environ deux heures avant 1'experience. 
 5 Jusqu'au huitieme jour, cet enfant, trop faible pour teter, prenait au bol, toutes les deux heures, 
 
 10 grammes de lait provenant de la mere les deux premiers jours, puis les jours suivants 30 
 
 grammes toutes les 2 h. 30 min. 
 
EARLIER RESEARCHES WITH NEW-BORN INFANTS. 
 TABLE 7. Indices d'oxygenation. 1 
 
 37 
 
 Robustes. 
 
 Debiles. 
 
 I 2 
 
 II 
 
 III 
 
 IV 
 
 VI 
 
 VII 
 
 IX 
 
 X 
 
 XI 
 
 V 
 
 VIII 
 
 XII 
 
 .574 
 
 0.742 
 
 0.771 
 
 0.840 
 
 0.718 
 
 0.751 
 
 0.639 
 
 0.745 
 
 0.993 
 
 0.642 
 
 0.637 
 
 0.503 
 
 .380 
 
 0.940 
 
 0.771 
 
 1.011 
 
 0.742 
 
 1.010 
 
 0.606 
 
 0.836 
 
 0.918 
 
 0.552 
 
 0.562 
 
 0.565 
 
 .509 
 
 
 .051 
 
 0.779 
 
 0.863 
 
 
 
 0.888 
 
 0.937 
 
 0.974 
 
 1.037 
 
 0.584 
 
 0.715 
 
 0.514 
 
 .841 
 
 
 .084 
 
 0.933 
 
 0.856 
 
 
 
 0.932 
 
 1.030 
 
 1.177 
 
 
 
 0.506 
 
 " 
 
 0.599 
 
 .465 
 
 
 .176 
 
 1.134 
 
 
 
 
 
 1.013 
 
 
 
 
 
 
 
 
 
 
 0.657 
 
 .368 
 
 
 .210 
 
 1.051 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 " 
 
 0.897 
 
 
 .066 
 
 1.189 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 11 
 
 " 
 
 
 .210 
 
 1.075 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 " 
 
 " 
 
 
 .360 
 
 " 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 " 
 
 
 
 .311 
 
 " 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 II in the Weiss article. 
 2 Les nombres de la premiere colonne (I) ne commencent pas aux premiers jours apres 
 la naissance. 
 
 It is obvious that the results recently reported from this laboratory 
 on the heat-output of atrophic infants confirm the observations of 
 Weiss, but the existence of abnormalities in the nature of the oxidative 
 processes is hardly essential to explain these differences. The varia- 
 tions in body composition and the variations in cellular and muscular 
 activity fully account for all differences in the amounts of oxygen 
 consumed. 
 
 OBSERVATIONS BY BIRK AND EDELSTEIN. 
 
 Using the Pettenkofer-Voit respiration apparatus in the Kaiserin 
 Auguste Victoria-Haus in Charlottenburg, Birk and Edelstein 1 in 1910 
 studied the total carbon-dioxide output of a healthy new-born infant 
 weighing 3,200 grams and 50 cm. long, during the first 3 days of post- 
 natal life. As the authors themselves recognize, the lack of data 
 regarding the oxygen consumption makes it impossible to use the results 
 for discussing the character of the katabolism during the first days of 
 life. The absence of a quantitative measurement of the muscular 
 activity likewise makes it difficult to compare their results with data 
 obtained in researches in which the muscular activity was observed. 
 
 OBSERVATIONS BY CARPENTER AND MURLIN. 
 
 Employing the differential method, Carpenter and Murlin 2 made 
 observations with the bed respiration calorimeter in the Nutrition 
 Laboratory on pregnant women before and after delivery. By deduct- 
 ing the metabolism of the mother after delivery from that of the mother 
 and child, an attempt was made to estimate the total metabolism of 
 the new-born infant. It is obvious that the difficulties inherent in a 
 differential method of this type make the results of little value for direct 
 comparison with data obtained with new-born infants. 
 
 and Edelstein, Monatsschr. f. Kinderheilk., 1910, 9, p. 505. 
 2 Carpenter and Murlin, Archives Internal Med., 1911, 7, p. 184. 
 
38 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 OBSERVATIONS BY BAILEY AND MURLIN. 
 
 In an earlier publication of our work, in which we specifically con- 
 sidered the influence of the age of an infant upon the metabolism 
 per square meter of body-surface, we computed the average values for 
 9 new-born infants ranging in age from 3 hours to 14 days. 1 These 
 results were presented solely for the purpose of discussing the heat 
 production per square meter of body-surface in connection with similar 
 measurements obtained with a large number of atrophic as well as 
 normal infants. Subsequently Bailey and Murlin 2 discussed the 
 energy requirements of new-born infants, chiefly upon the basis of our 
 values, supplemented by their own fragmentary data. It is unneces- 
 sary here to enter into a discussion of their results, for in the light of the 
 researches of Hasselbalch, their investigation can hardly be looked upon 
 as more than a substantiation of the earlier research. 
 
 PURPOSE AND PLAN OF THE RESEARCH. 
 
 The incomplete nature of all of the earlier work with new-born 
 infants and, indeed, of most of the recent studies, the lack of apprecia- 
 tion of the significance of muscular repose during the determination of 
 the total metabolism, and the usually imperfect technique for the 
 measurement of the oxygen consumption, with the consequent liability 
 to error in the estimation of the respiratory quotient, have led us to 
 believe that an extended study of a large number of new-born infants, 
 in which the metabolism during the first week of post-natal life should 
 be definitely established, was not only justifiable, but that the results 
 would be of great significance. 
 
 APPARATUS AND TESTS FOR ACCURACY. 
 
 The respiration apparatus which was described in our previous 
 reports of studies on infant metabolism 3 and which has been installed 
 at the Massachusetts General Hospital since January 1913, was 
 employed for the measurement of the respiratory exchange of infants 
 during the first week after birth. The tightness of the apparatus was 
 tested each day to demonstrate the absence of any leakage of air which 
 might affect the oxygen measurements. In addition check tests were 
 frequently made in which the respiratory quotient of alcohol was used 
 as an index of accuracy. In consequence we are confident that the appa- 
 ratus was absolutely tight throughout the whole series of observations. 
 
 We wish, however, distinctly to disclaim absolute accuracy for all 
 of the individual respiratory quotients, for with a series of observa- 
 tions including approximately 1,000 periods and extending over 18 
 months, it is impossible to insure absolute accuracy for the individual 
 
 Benedict and Talbot, Am. Journ. Diseases of Children, 1914, 8, p. 1, tables 13 and 15. 
 *Bailey and Murlin, Am. Journ. Obstetrics, 1915, 71, p. 526. 
 
 Benedict and Talbot, Carnegie Inst. Wash. Pub. 201, 1914, p. 32; also Benedict and Talbot, 
 Am. Journ. Diseases of Children, 1914, 8, p. 21. 
 
PURPOSE AND PLAN OF RESEARCH. 39 
 
 periods of observation. That at times inconceivably low respiratory 
 quotients are found among the data is not surprising. The difficulties 
 of determining accurately the exact temperature of the air in the appa- 
 ratus, particularly when the infant is restless, needs no special emphasis. 
 Similarly, the equalization of humidity throughout the chamber with no 
 specific ventilation other than that supplied by the air-current likewise 
 presents technical difficulties. The results as a whole are, we believe, 
 accurate and may be accepted without question. It seems fitting, 
 therefore, to present the data exactly as recorded, even though occa- 
 sionally there may be anomalous differences in the values, rather than 
 to attempt an arbitrary selection which might favor our interpretation 
 of the results. While we have given our data completely, without 
 selection and without reservation, the fact should be emphasized that 
 individual quotients must not be interpreted as significant. It was 
 our purpose to collect such a large mass of results that the general 
 picture of both the character and the amount of the metabolism during 
 the first week of post-natal life would be perfectly defined and clear. 
 
 METHOD OF COMPUTATION. 
 
 The details of the experimental routine and of the technique may be 
 found in the publication describing our earlier study. 1 As it appears 
 to be difficult for certain writers to understand the method of comput- 
 ing the results obtained in observations of this character, it seems desir- 
 able to describe our method of calculation somewhat more fully than 
 has previously been done. 
 
 In the determination of the respiratory exchange by an apparatus of 
 the type we employed, it is obvious that the carbon-dioxide output in 
 short periods may be determined more exactly than the oxygen intake. 
 The residual amount of carbon dioxide in the chamber remains constant 
 from period to period, the mechanism supplying the purified air being 
 so adjusted as to replace the air in the chamber some 15 times during 
 a 30-minute period. On the other hand, the determination of the 
 oxygen consumption involves the calculation of the volume of air 
 residual in the chamber at the end of each period. This calculation 
 requires an exact knowledge of the average temperature and the degree 
 of humidity of the air at the end of each period of measurement. As 
 has already been pointed out, the determination of these factors 
 presents great technical difficulties. Since the longer the period of 
 measurement the less the errors influence the results, it has been our 
 custom to measure the carbon dioxide in 30-minute periods, with, so 
 far as possible, complete muscular repose on the part of the infant, and 
 to calculate the oxygen intake only once for the entire time that the 
 child remains in the respiration chamber. It may reasonably be 
 assumed that differences in the muscular activity, especially with the 
 
 Benedict and Talbot, Carnegie Inst. Wash. Pub. No. 201, 1914, p. 31. 
 
40 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 new-born infant, will not cause a marked difference in the character 
 of the katabolism so that when a comparison is made of the carbon- 
 dioxide production and the oxygen consumption for the entire period 
 of observation, i.e., If to 2 hours, the result may be fairly considered as 
 representing the average respiratory quotient for that period. If 
 in this time there is a 30-minute period of complete muscular repose 
 during which the carbon-dioxide output has been measured, the heat- 
 output may be computed for this minimum period by the method of 
 indirect calorimetry, i. e., by multiplying the carbon-dioxide production 
 for the 30-minute period by the calorific equivalent of carbon dioxide 
 for the respiratory quotient prevailing during the entire period of 1^ 
 to 2 hours. 
 
 The heat output for the entire period of observation may be obtained 
 not only by using the carbon-dioxide production for that period, but 
 may also be secured by multiplying the oxygen consumption by the 
 calorific equivalent of oxygen for the respiratory quotient during the 
 period of observation. In view of the technical difficulties of meas- 
 uring the oxygen consumption, however, this factor may not properly 
 be used for calculating the heat-output for the minimum period. 1 
 
 It may be argued that the assumption of a representative respiratory 
 quotient for the entire period of observation for use in computing the 
 heat-output during the minimum period may lead to error, since there 
 may be a slight, normal fall in the respiratory quotient (particularly 
 if the observation is preceded by nursing), this fall being due to the fact 
 that the carbohydrate of milk probably burns more rapidly than the 
 fat and the protein. It is fair to assume, however, that the error caused 
 by the use of this average respiratory quotient in the formula for indi- 
 rectly computing the heat-output from the carbon-dioxide production 
 for a 30-minute period is certainly no greater and is probably less than 
 that involved in the direct measurement of the oxygen consumption 
 with its attendant temperature and barometric measurements at the 
 beginning and end of the period. In our research we desired not only to 
 determine the character of the katabolism, but also, if possible, to deter- 
 mine the minimum basal metabolism. Since this was usually deter- 
 minable only in 30-minute periods, the method of computation just 
 outlined was applied to these experiments. 
 
 x lt should be said that the proper thermometer, barometer, psychrometer, spirometer, and meter 
 readings were recorded at the end of every period. Calculations based upon these showed for the 
 most part good agreement in each period between the heat indirectly calculated from the carbon- 
 dioxide output and the average respiratory quotient and that calculated from the oxygen consump- 
 tion and the average respiratory quotient. This fact has been cited in discussing the maximum 
 heat-output (see table 18, p. 113). Nevertheless, as each absolute value for the oxygen determina- 
 tion may possibly be subject to the errors previously cited, the values for the heat-output in this 
 publication, except in table 18, have been calculated from the carbon-dioxide determinations, 
 using the calorific value of carbon dioxide corresponding to the average respiratory quotient for 
 the entire sojourn inside the chamber. 
 
PURPOSE AND PLAN OF RESEARCH. 41 
 
 CARE OF THE NEW-BORN INFANT. 
 
 The general routine followed at the Boston Lying-in Hospital for 
 the care of infants during and after delivery is as follows : 
 
 The infant is delivered in the "case room" of the hospital. This 
 room is kept at a temperature of 80 to 84 F. Ordinarily, after the 
 baby is delivered, it is held up by the feet in order to drain the mucus 
 from its mouth and throat. About one out of five babies is patted on 
 the back to make it cry and in this way to expand the lungs. The cord 
 is then cut, tied with two ligatures, and sterile dressings applied. 
 These dressings consist of two sterile sponges, one of which is put 
 around the cord and the other over the cord. The dressings are 
 held in place by a gauze band placed over them. The infant is laid 
 in a crib on its right side, with a blanket so folded about it as to cover 
 the entire body, and with the feet slightly elevated, so that the mucus 
 may continue to drain from the mouth. A tin heater, with a tempera- 
 ture of about 100 F. and covered with Canton flannel, is then put at 
 the baby's back at such distance that a hand can be placed between the 
 heater and the body of the infant. The baby is left in the crib for 1J 
 to 2 hours after birth, while the nurse is caring for the mother. As 
 soon as the nurse is free, the baby is bathed in cotton-seed oil. The 
 temperature of the oil is not known, but the nurse says that it is "kept 
 warm" and is probably the same temperature as that of the room 
 (80 to 84 F.) or a little warmer. After the oil-bath, the infant is 
 powdered with castile soap and washed in sterile water, the temperature 
 of the bath being about 100 F. The exposure to the air is in all about 
 15 minutes, this including the oiling, bathing, and weighing. 
 
 The infant is next taken to the "ward room," which has a tempera- 
 ture of 68 to 74 F., and put in its crib, where it remains until it is 
 nursed. It is first put to the breast 8 hours after birth and subsequently 
 every 6 hours during the first 24 hours, the nursing period being 3 to 
 4 minutes. Some babies take hold of the nipple and nurse immedi- 
 ately, while others are lazy and have to be urged by the attendant. 
 During the second day the baby is put to the breast every 4 hours and 
 is left there 3 to 4 minutes. In the third 24 hours, the baby is nursed 
 every 2 hours during the day and every 4 hours during the night, 
 thus making, in all, 10 feedings. When the milk secretion is once 
 established, i. e., when "the milk comes in," the baby is left at the 
 breast 10 minutes at each feeding. 
 
 This routine was varied somewhat when the infants were taken to 
 the respiration apparatus within an hour of birth. An extra nurse 
 took the baby after delivery and oiled, bathed, and dressed it as pre- 
 viously described. It was then wrapped in two or three blankets, 
 the number varying with the weather. The blankets were drawn up so 
 as to form a hood almost entirely covering the infant's head and the 
 baby was then carried in the nurse's arms from the Lying-in Hospital to 
 
42 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 the Massachusetts General Hospital. The distance between the front 
 doors of these two hospitals is 177 paces and not more than 2 or 3 
 minutes are required to go from one building to the other. On reaching 
 the observation room, the baby was placed in the respiration chamber. 
 When the measurements of the respiratory exchange were completed, 
 the baby was weighed and measured and then returned immediately 
 to the Lying-in Hospital. 
 
 The routine followed for one infant which was studied shortly after 
 birth is shown by the notes given below and is fairly typical of the 
 routine used for the infants studied under these circumstances. 
 
 Baby R. (No. 94), negro Born at 2 h 12 m p. m., April 28, 1915. Low for- 
 ceps case. Message received at the observation room at 2 h 20 m p. m. Baby 
 received in the case room at 2 h 27 m p. m. It had been exposed at birth 3 to 
 4 minutes. This exposure was less than usual, as the mother had a hemor- 
 rhage and required immediate attention. The cord was therefore simply 
 clamped. Usually the baby lies in the physician's lap 6 to 8 minutes before 
 the cord is cut. The infant was also exposed about 5 minutes shortly after 
 birth while it was being immersed in water of a temperature of 100 to 105 F., 
 and wrapped in warm blankets with heaters. At 2 h 30 m p. m. it was exposed 
 for 3 or 4 minutes when the cord was ligated and cut. The infant was then 
 weighed, oiled, and the length measured, this requiring 5 minutes. The cord 
 was dressed, the band applied, and the baby dressed in the period of 5 minutes. 
 A bonnet and small coat were put on the infant, which was also wrapped in 
 two large blankets. The nurse and baby left the Lying-in Hospital about 
 2 h 55 m p. m. and arrived in the observation room in the Massachusetts General 
 Hospital at 3 p. m., where a study was made of the respiratory exchange. 
 
STATISTICS OF OBSERVATIONS. 43 
 
 STATISTICS OF THE OBSERVATIONS. 
 
 The clinical statistics of the 105 infants studied hi this research 
 are given in table 8, with full data regarding birth. 
 
 The results of the observations on the gaseous exchange of the same 
 infants are given in chronological order in table 9. The infants 
 included in this research are referred to throughout by numbers, but 
 in the first column of this table the initials have also been given for 
 such of the infants as were included in the previous report. 1 The 
 sex and the dates of the individual observations are given in the next 
 two columns. The length of the infant in centimeters, also the age and 
 weight for each observation, are given in succeeding columns, and the 
 actual length of each period from which the per hour figures are calcu- 
 lated is given under " Duration of period." The data for the prelim- 
 inary periods, i. e., the carbon dioxide produced per hour and the pulse- 
 rate, are shown by the first values given for each observation. These 
 values were not used in calculating the respiratory quotient for the whole 
 observation, only those in brackets (if more than one period was used) 
 being included in this calculation. The heat-production per 24 hours 
 is given on the three bases of total heat-production and heat-production 
 per kilogram of body-weight and per square meter of body-surface. 
 The pulse-rate is an average value for the several counts made during 
 each period. The data for the rectal temperature represent the records 
 made at the beginning and end of the observations. Prior to November 
 1914 the body-temperature was recorded about 30 minutes before the 
 measurement of the metabolism began. After November 1914 the 
 record was made approximately 3 minutes before the beginning of 
 the preliminary period of observation; this was always the routine 
 with the very young infants in the later observations. Temperature 
 records were usually taken within 5 minutes after the end of the 
 observation and always within 10 minutes. The data regarding the 
 feeding show the time between the taking of food and the beginning 
 of the metabolism measurements, also the kind and composition of the 
 food. Nearly all of the infants were normal, but a few were patho- 
 logical cases, these being indicated in the notes accompanying the table. 
 
 Benedict and Talbot, Am. Journ. Diseases of Children, 1914, 8, p. 1, tables 13 and 15. 
 
44 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 TABLE 8. Clinical statistics of infants. 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 Date of 
 birth. 
 
 Birth. 
 
 Term. 
 
 Delivery. 
 
 Birth-weight. 
 
 Length. 
 
 1 
 
 2 
 3 
 4 
 5 
 6 
 7 
 8 
 9 
 10 
 11 
 12 
 13 
 14 
 15 
 16 
 17 
 18 
 19 
 20 
 21 
 22 
 23 
 24 
 25 
 26 
 27 
 28 
 29 
 30 
 31 
 32 
 33 
 34 
 35 
 
 36 
 37 
 38 
 39 
 40 
 41 
 42 
 43 
 44 
 45 
 46 
 47 
 48 
 49 
 50 
 51 
 
 M. 
 
 F. 
 M. 
 F. 
 M. 
 M. 
 M. 
 M. 
 F. 
 M. 
 M. 
 F. 
 F. 
 M. 
 M. 
 F. 
 F. 
 M. 
 M. 
 F. 
 F. 
 F. 
 F. 
 M. 
 M. 
 F. 
 M. 
 F. 
 F. 
 M. 
 M. 
 M. 
 M. 
 F. 
 F. 
 
 M. 
 F. 
 F. 
 F. 
 F. 
 M. 
 F. 
 F. 
 F. 
 F. 
 M. 
 M. 
 F. 
 F. 
 F. 
 M. 
 
 1913 
 Dec. 3 
 
 1914 
 Jan. 8 
 Mar. 16 
 Mar. 22 
 Mar. 30 
 Mar. 31 
 ...do.... 
 Apr. 6 
 Apr. 9 
 Apr. 11 
 Apr. 15 
 Apr. 18 
 Apr. 21 
 Apr. 27 
 May 3 
 May 5 
 May 11 
 ...do 
 
 Primiparous. . . 
 
 Multiparous. . 
 Primiparous. . . 
 Multiparous. . 
 do 
 do 
 Primiparous. . . 
 
 Full term... 
 
 do 
 do 
 do 
 do 
 do 
 
 Csesarian sec- 
 tion. 
 
 Normal 
 
 Ibs. oz. 
 
 *8 5* 
 8 14 
 7 15 
 8 6 
 10 2 
 g 
 
 kilo* 
 1 3.13 
 
 2 3.79 
 4.03 
 3.60 
 3.81 
 4.59 
 3.63 
 3.63 
 4.41 
 3.63 
 4.07 
 3.95 
 4 3.37 
 4.22 
 3.77 
 4.11 
 3.67 
 3.18 
 3.57 
 3.86 
 3.15 
 2.86 
 3.69 
 2.35 
 3.40 
 3.63 
 3.86 
 3.73 
 3.63 
 3.57 
 3.70 
 3.60 
 4.11 
 3.26 
 4.82 
 
 3.52 
 2.49 
 4.20 
 2.95 
 2.92 
 3.91 
 4.25 
 3.94 
 3.57 
 2.66 
 3.83 
 4.05 
 4.82 
 2.92 
 3.09 
 4.03 
 
 cm. 
 52 
 
 53 
 52 
 46.5 
 52.5 
 52 
 51.5 
 51 
 51 
 52 
 52 
 52.5 
 50 
 51 
 50 
 53 
 52.5 
 50.5 
 53 
 52 
 50 
 49 
 50.5 
 43 
 51.5 
 50 
 52 
 50.5 
 50 
 51 
 53.5 
 47.5 
 52 
 50.5 
 54 
 
 53 
 46.5 
 51.5 
 50 
 49.5 
 51.5 
 54 
 50 
 51 
 46.5 
 51.5 
 52 
 54.5 
 47.5 
 48.5 
 52.5 
 
 do 
 do 
 Low forceps. . . 
 Normal 
 
 do 
 
 Multiparous. . 
 do 
 
 ..do.. 
 do . . 
 
 do 
 do . . . 
 
 8 .. 
 9 Hi 
 
 8 . . 
 
 Primiparous. . . 
 
 do 
 
 do 
 
 Multiparous. . 
 do 
 Primiparous. . . 
 Multiparous. . 
 Primiparous. . . 
 Multiparous. . 
 
 do 
 do 
 do 
 do 
 do 
 . ..do. 
 
 do 
 do 
 do 
 do 
 do 
 do 
 
 8 15i 
 8 Hi 
 
 4 7 7 
 
 9 5 
 8 5 
 9 1 
 8 li 
 
 7 14 
 8 8 
 6 15 
 6 5 
 8 2 
 5 3 
 7 8 
 8 .. 
 8 8 
 8 3i 
 8 .. 
 7 14 
 8 2i 
 7 15 
 9 1 
 7 3 
 10 10 
 
 7 12 
 5 8 
 9 4 
 6 8 
 6 7 
 8 10 
 9 6 
 8 11 
 7 14 
 5 14 
 8 7 
 8 15 
 10 10 
 6 7 
 6 13 
 8 14 
 
 . ..do 
 
 do... . 
 
 . . do. . . . 
 
 .. ..do 
 
 do 
 
 . ..do. . . . 
 
 May 17 
 May 24 
 ...do.... 
 May 31 
 ...do.... 
 June 7 
 ...do 
 
 do 
 do 
 do 
 do 
 Primiparous. . . 
 do 
 ..do 
 
 do 
 do 
 do 
 do 
 do 
 Premature 6 . 
 Full term . . 
 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 
 June 6 
 June 15 
 June 17 
 June 24 
 ...do.... 
 Oct. 15 
 Oct. 19 
 Oct. 23 
 Oct. 24 
 Oct. 29 
 
 Nov. 1 
 Nov. 3 
 Nov. 9 
 ..do . 
 
 Multiparous. . 
 do 
 do 
 do 
 Primiparous. . . 
 Multiparous. . 
 Primiparous. . . 
 Multiparous. . 
 
 do 
 do 
 do 
 do 
 do 
 do 
 do. . . 
 
 do 
 do 
 do 
 do 
 do 
 do 
 Low forceps. . . 
 Normal 
 do 
 
 do... . 
 
 ..do 
 
 do 
 
 do 
 
 do 
 
 Caesarian sec- 
 tion. 
 Low forceps. . . 
 Normal 
 do 
 do 
 
 Primiparous. . . 
 do 
 Multiparous . . 
 do 
 
 ..do.. 
 do?.... 
 do 
 . ..do... . 
 
 Nov. 11 
 Nov. 16 
 ...do 
 
 do 
 do 
 Primiparous. . . 
 Multiparous . . 
 
 do?.... 
 do 8 .... 
 do 
 do .. . 
 
 do 
 do 
 do 
 do 
 
 ...do.... 
 Nov. 19 
 Nov. 22 
 Nov. 27 
 Nov. 30 
 Dec. 6 
 Dec. 8 
 Dec. 13 
 Dec. 14 
 
 do 
 
 do 7 
 
 do 
 
 Primiparous. . . 
 do 
 Multiparous. . 
 .do 
 
 do?.... 
 do 
 do 
 do 
 
 do 
 Low forceps... 
 Normal 
 
 Low forceps. . . 
 Normal 
 
 do 
 do 
 do 
 
 do 
 do 
 do 
 
 do 
 do 
 
 x Not birth-weight but weight obtained on the third day. 
 Height obtained after 6 days. 6 Between 7 and 8 months. 
 
 Toxemia of pregnancy. "Congenital heart. 
 
 4 Weight obtained after 25 hours. 'Syphilis. 
 
STATISTICS OF OBSERVATIONS. 
 
 45 
 
 TABLE 8 Clinical statistics of infants Continued. 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 Date of 
 birth. 
 
 Birth. 
 
 Term. 
 
 Delivery. 
 
 Birth-weight. 
 
 Length. 
 
 52 
 53 
 54 
 
 55 
 56 
 
 57 
 58 
 59 
 60 
 61 
 62 
 63 
 64 
 65 
 66 
 67 
 68 
 69 
 70 
 71 
 72 
 
 73 
 74 
 75 
 76 
 77 
 78 
 79 
 80 
 81 
 82 
 83 
 84 
 85 
 86 
 87 
 88 
 89 
 90 
 91 
 92 
 93 
 294 
 95 
 96 
 97 
 98 
 99 
 100 
 101 
 102 
 103 
 104 
 105 
 
 F. 
 M. 
 M. 
 
 M. 
 M. 
 M. 
 F. 
 F. 
 M. 
 M. 
 M. 
 F. 
 F. 
 F. 
 M. 
 M. 
 M. 
 M. 
 M. 
 M. 
 M. 
 
 M. 
 M. 
 
 M. 
 M. 
 F. 
 M. 
 F. 
 M. 
 F. 
 M. 
 M. 
 F. 
 M. 
 F. 
 M. 
 F. 
 M. 
 M. 
 F. 
 F. 
 M. 
 M. 
 F. 
 F. 
 F. 
 F. 
 M. 
 M. 
 M. 
 M. 
 F. 
 M. 
 M. 
 
 1914. 
 Dec. 20 
 Dec. 27 
 Dec. 30 
 1915 
 Jan. 3 
 Jan. 2 
 Jan. 7 
 Jan. 11 
 Jan. 14 
 Jan. 13 
 Jan. 20 
 Jan. 25 
 Feb. 2 
 Feb. 4 
 Feb. 7 
 Feb. 9 
 Feb. 12 
 Feb. 15 
 Feb. 17 
 Feb. 22 
 Feb. 21 
 Feb. 26 
 
 Mar. 3 
 Mar. 7 
 ...do.. .. 
 Mar. 10 
 Mar. 12 
 Mar. 15 
 Mar. 16 
 Mar. 19 
 Mar. 22 
 Mar. 23 
 Mar. 24 
 Mar. 26 
 ...do 
 
 Multiparous. . 
 Primiparous. . . 
 do 
 
 Multiparous. . 
 
 Full term... 
 do 
 do 
 
 do 
 
 Normal 
 
 Ibs. oz. 
 8 2 
 
 7 li 
 
 17 7 
 
 8 5 
 7 6 
 8 13 
 7 .. 
 8 14 
 9 2 
 7 3 
 7 11 
 6 3 
 7 7 
 5 14 
 7 6 
 11 .. 
 5 7 
 8 2 
 8 10 
 9 2 
 7 11 
 
 8 .. 
 8 7 
 6 6 
 7 2 
 8 10 
 5 7| 
 9 2 
 7 10 
 7 4 
 6 \ 
 8 3| 
 9 1 
 7 14 
 7 5 
 8 11 
 5 13 
 7 3 
 7 6 
 7 5| 
 8 5| 
 7 12* 
 7 1 
 6 4 
 7 8 
 6 7* 
 6 5 
 8 3 
 10 4 
 8 9 
 6 3* 
 7 4 
 7 5 
 7 6 
 
 kilos. 
 3.69 
 3.22 
 ^.SS 
 
 3.77 
 3.36 
 4.00 
 3.18 
 4.03 
 4.14 
 3.26 
 3.49 
 2.81 
 3.37 
 2.66 
 3.35 
 4.99 
 2.48 
 3.69 
 3.93 
 4.14 
 3.49 
 
 3.63 
 3.83 
 2.89 
 3.23 
 3.91 
 4 2.48 
 4.14 
 3.47 
 3.29 
 2.74 
 3.73 
 4.11 
 3.57 
 3.32 
 3.94 
 2.64 
 3.26 
 3.35 
 3.33 
 3.78 
 3.53 
 3.20 
 2.84 
 3.40 
 2.93 
 2.86 
 3.71 
 4.65 
 3.88 
 2.82 
 3.29 
 3.32 
 3.35 
 
 cm. 
 50 
 47.5 
 50 
 
 50 
 51.5 
 54 
 49 
 52 
 52 
 49.5 
 49.5 
 47.5 
 48 
 49 
 51 
 54 
 46 
 50 
 51 
 53.5 
 50.5 
 
 50 
 52 
 47.5 
 50 
 53 
 47 
 52.5 
 51.5 
 50 
 49 
 52 
 54 
 52 
 51 
 51 
 47.5 
 49.5 
 50 
 49.5 
 51 
 50.5 
 50 
 46.5 
 51.5 
 48 
 47.5 
 51.5 
 54 
 51.5 
 47.5 
 49 
 51 
 50.5 
 
 do 
 do 
 
 do. . . 
 
 Primiparous. . . 
 
 do 
 
 do 
 
 Multiparous. . 
 Primiparous. . . 
 Multiparous. . 
 do 
 Primiparous. . . 
 do 
 Multiparous. . 
 do 
 Primiparous. . . 
 do 
 Multiparous. . 
 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 do 
 .do . . 
 
 Primiparous. . . 
 Multiparous. . 
 
 do 
 . ..do 
 
 Low forceps. . . 
 Normal 
 
 Primiparous. . . 
 do 
 
 . .do. . 
 
 ..do . . . 
 
 . ..do. 
 
 do 
 
 Multiparous. . 
 
 . ..do. . 
 
 Caesarian sec- 
 tion. 
 Normal 
 do 
 
 Primiparous. . . 
 do 
 
 ..do.. 
 do 3 .... 
 
 Multiparous. . 
 do 
 
 do 
 do 
 
 do 
 do 
 
 Primiparous. . . 
 Multiparous. . 
 do 
 Primiparous. . . 
 Multiparous. . 
 Primiparous. . . 
 do 
 
 do 
 do 
 do 
 do 
 do 
 do 
 
 do? 
 do....... 
 do 
 do 
 do 
 . ..do . ... 
 
 . ..do... . 
 
 . ..do 
 
 Multiparous. . 
 do 
 
 do 
 do 
 
 do 
 do 
 
 Mar. 30 
 Mar. 31 
 Apr. 2 
 Apr. 20 
 Apr. 19 
 Apr. 22 
 Apr. 24 
 Apr. 27 
 Apr. 28 
 May 1 
 May 3 
 May 6 
 May 7 
 May 11 
 May 13 
 May 17 
 May 19 
 May 21 
 May 24 
 May 26 
 
 do 
 do 
 Primiparous. . . 
 Multiparous. . 
 Primiparous. . . 
 
 do 
 do 
 do 
 do 
 .do. . 
 
 do 
 do 
 Low forceps... 
 Normal ... . 
 
 ..do 
 
 Multiparous. . 
 .do 
 
 ..do. .. 
 
 do 
 
 do 
 
 .do 
 
 .do 
 
 do 
 
 Low forceps . . . 
 do 
 
 Primiparous. . . 
 
 do 
 
 Multiparous 
 
 do 
 
 Normal 
 
 Primiparous. . . 
 do 
 
 do 
 do 
 
 Low forceps . . . 
 do 
 
 do 
 
 do 
 
 Normal 
 do 
 do 
 do 
 do 
 do 
 
 Multiparous. . 
 do 
 do 
 Primiparous. . . 
 Multiparous. . 
 
 do 
 do 
 do 
 do 
 .do. . 
 
 Primiparous. . . 
 
 do 
 
 do 
 
 Multiparous. . 
 
 do. ... 
 
 do 
 
 
 
 
 : Weight obtained after 6* hours. 
 2 Negro. 
 
 3 Postpartum eclampsia. 
 4 Weight obtained after 11 hours. 
 
46 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 - 
 
 Q 
 
 
 -UOI113AJ8S 
 
 -qo jo pug 
 
 O -^ 
 
 tJ to 
 
 CO CO 
 
 O I-H 
 
 ts.' i>! 
 
 CO CO 
 
 uorjBA 
 -jasqo jo 
 
 SuiuutSeg 
 
 CO CO 
 
 CO O5 O 
 
 
 -d 3 
 . 
 
 
 
 w 
 
 CO iQ I s - 00 
 
 I s * ^5 ^j ^ 
 
 CO 00 * 00 l"^ 
 
 g : 
 
 COCO "0 b- 
 
 S 
 
 00 
 CO 
 
 I. 
 
 O5 
 
 I 
 
 I! 
 
 o 
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 OS O *'< 
 
 b- oo co c6 
 
 CO CO CO CO 
 
 co b- 
 
 CO CO 
 
 CO b- rH CO 
 
 : 2 
 
 
 _OQ 
 
 I 6 
 I* 
 
 y 
 
 Tt 
 rH 
 
 A ei 
 
 a s 
 
STATISTICS OF OBSERVATIONS. 
 
 47 
 
 d 
 
 1 
 
 1 
 
 1 
 
 1 
 1 
 . 
 
 Colostrum. 
 
 fColostrum; sterile water 4 min- 
 \ utes before the observation. 
 
 fColostrum ; breast-milk commenc- 
 l ing. 
 
 More breast-milk. 
 Breast-milk. 
 
 f Sterile water 2 minutes before the 
 \ observation. 
 
 f Partly colostrum; sterile water 1 
 \ hour before the observation. 
 
 d 
 
 0) 
 
 'Si 
 1 
 
 c3 
 ^ 
 O 
 
 ! 
 
 
 
 1 
 l 
 
 fColostrum; sterile water 5 min- 
 \ utes before the observation. 
 
 fColostrum; sterile water 9 min- 
 \ utes before the observation. 
 
 fBreast-milk; sterile water 2 min- 
 \ utes before the observation. 
 
 Breast-milk. 
 
 The ages here given are at the beginning of the period of observation. For 3 Died subsequently of congenital syphilis and jaundice, 
 infants over 2 days old, the age is given to the nearest half day. 4 Axillary temperature. 
 Calculated from the weight of carbon dioxide produced during the period. 5 Results with this subject have been previously published. (See Benedict 
 The preliminary periods for all days are omitted in computing the and Talbot, Am. Journ. Diseases of Children, 1914, 8, pp. 38-39.) 
 minimum metabolism. See table 12, page 95. 6 Intracranial hemorrhage found at operation on April 12, 1914. 
 
 
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 : g : 
 
 rH rH 
 
 
 ^ 
 
 
 CO 
 
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 CO 
 
 rH 
 
 CO 
 
 CO 
 
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 CO "^ t* 
 
 t^ CO CO 
 CO CO CO 
 
 CO 
 
 CO 
 
 CO 
 
 
 
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 CO 
 
 CO 
 
 CO 
 
 CO 
 CO 
 
 O OS 
 
 rH 
 
 CO 
 
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 ^H 
 
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 ^ 
 
 CO 
 
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 CO CO CO 
 
 CO 
 
 N, 
 
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 CO 
 
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 c3 
 
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 lO GO b 
 rH O O 
 
 
 
 rH rH CO OS CO rH 
 CO CO rH rH rH rH 
 
 
 rH 
 
 ^ O 
 
 CO O 
 
 CO O 
 
 t> ^ O 00 tfD *fl 
 
 |> CO b *H C^ *C 
 
 II 
 
 CO CO 
 CO rH 
 
 l>- 1> 
 
 II 
 
 11 
 
 i-4 
 
 jgiiii 
 
 * ; 
 
 S3 
 
 951 
 
 -- ;-- ;sa 
 
 3 
 
 S9 
 
 S3 
 
 ss 
 
 00 O 
 
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 t^ rH -^ CO 
 
 Tj( IO ^ Tjl 
 
 s; 
 
 38 
 
 05 T< 
 
 CO CO 
 
 SS :3 :gg 
 
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 CO CO 
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 ^-^-< ^^ v_^_ 
 
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 8 
 
 
 
 
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 CO GO 00 
 
 > 
 
 ^^SScSS 
 
 ^00*COCOrHOCO^ 
 
 CO CO OS 
 
 OS rH O 
 
 CO CO CO 
 
 rH CO CO rH rH 
 
 COrHrHCOCOCqCOCOCO 
 
 CO CO rH 
 
 CO CO CO 
 
 ^ CO CO CO CO CO 
 
 CO CO <tf 
 
 CO CO CO CO (N CO 
 
 OcOCOCOCOCOrHCOO^COGO-^COCOT^lO 
 COT^rHCOCOCOCOCOCOeOCOrHCOCOrHCOCO 
 
 GOOtrHCOlOCOXCOlOTt<Tj* 
 rH CO CO CO CO CO CO CO CO rH CO CO 
 
 rH Tj< OS 
 CO CO <N 
 
 CO CO -^ t>- CO CO 
 CO CO CO rH CO CO 
 
 CO 
 
 
 
 CO 
 
 CO 
 
 CO CO CO 
 
 a 
 
 CO 
 
 
 
 CO 
 
 s 
 
 5 
 
 CO 
 CO 
 
 !) 8 
 
 
 
 
 
 CO 
 
 CO 
 
 rH 
 
 rH 
 
 CO CO CO 
 
 rH rH rH 
 
 CO TH >O 
 
 ^ 
 
 rH 
 
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 rH 
 
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 CO Th 
 
 * 
 
 
 1 
 
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 >0 
 
 
 
 
 I j 
 
 8 
 li 
 
 1 
 
 1 
 
 co I s * oo 
 
 w w w 
 
 1 1 1 
 
 m m i4 
 
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 rH 
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 rH 
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 | 
 
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 < 
 
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 4 4 
 
 i XX 
 
 ** 
 
 6 
 
 
 
 -- 
 
 ^b 
 
 
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48 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 * 
 
 
 
 i 
 
 PQ 
 
 8-go 
 
 ^ - o 
 
 1 i 
 
 MIIM 
 
 8 
 
 -qo jo png 
 
 CO CO 
 
 CCCC 
 
 COCO 
 
 -aasqo jo 
 
 I 
 
 If i 
 
 8 o 
 
 if 
 
 -ra -be 
 
 . 
 tS 
 
 r 
 
 ure.i3 
 
 ^i 
 
 e 
 
 ? 
 
 fH rH CO ^^ ^ 00 
 -O5C<I 'OOW -COCO 
 
 CO CO O "H * I s * t^ 
 
 t^ I s * I s * O 
 
 1>O T-I > i 
 JS- t^ * I s * t^ 
 
 OilNiO CO ^ O i-t -OOO5 -CNi-i -rt(Oi -COO -lOCO -CO 
 10 t^ U5 10 <* * CO I> O O rj< rJH rf T}< Tt* O 
 
 OS CO O> rH GO rH 
 
 CN 0} ?5 ?5 ' JH 12 
 
 COt-l -COIN 
 
 iO-<* 
 OOCO 
 
 k 
 
 o 
 
 CO -IN 
 
 Tf^cOtN 
 
 
 'SrH 
 
 
 OrHr-tTf<(N 
 Tt<CO<NOlO 
 
 9 
 
 
 
STATISTICS OF OBSERVATIONS. 
 
 49 
 
 i! 
 
 11 
 
 9** 1 1 
 
 Si 1 1 1 5 
 
 i .s 
 
 s o *o 
 tt fc 
 
 1 a 1 
 
 | a a a | a | 
 
 reviously published. (See Benedict 
 ases of Children, 1914, 8, pp. 38-39). 
 ents obtained in the three preceding 
 iting the heat values on this day. 
 
 CO CO CO 
 
 OOO O 
 CO CO CO CO 
 
 rH -^ rH rH 
 
 ** S 
 
 I^lf 
 
 | g.g 
 
 O O CO OS O 
 CO CO CO CO CO 
 
 O W OS O OS d O* 
 
 CO CO CO CO CO CO CO 
 
 ^^8 
 
 ill! 
 
 b- b- <N OS OS 
 
 CO CO I s * CO CO 
 
 CO 00 CO CO 
 
 OS <N <N <N b OS CO 
 
 "* i 
 
 So O^-P 
 
 2^~I 
 
 SSSS3SS&S52S88 
 
 OSOOO^COOOCOOOSOrHCOXOCOrHtt<rHOOrH^lCC<ICOO 
 
 ^+3 H 
 
 111! 
 
 b- lO 00 CM rH CO CO 00 O 
 OOO 0000 00 O rH W O 
 b-CD CO O b- b- 00 b b- 
 
 CO b00 -rHb tO O NU5 rHC^JCO bOOCD -b-COrH 
 rH* T-T r-T 
 
 <fl g-o 
 
 1 s 
 
 I S 
 
 3$ 3% :3S :S3 3 
 
 00 XO-iOlO 3!^ OSC^ rHb-CO C^lOCO-iOC^O 
 rH 
 
 e 3 t 4 
 
 SS 8 :8S :S S 
 
 M OCO'OOOO OOb- Ob COiOC<l OS-^CO-rt<COiO 
 
 
 H^ ^^ ^> -~^ --v 
 
 _, v__, v_^^ v_^_. * * v ^ , ^-^ - v_^ - 
 
 o ^.S 
 43 -0 -C -g 
 
 CO 00 b- CO 
 
 D ^O CO 00 CO I s * ^* 
 D l> . b- b- 00 b- 00 
 
 3 5 
 
 ^^ ft a 
 
 rt Q) H 
 
 ( ( ', ^ , j , ', ' 
 
 1, '_ -^ =s '^^ ' m ^ =S ' ' ' " * '. ' 
 
 1131 
 
 CNO-*O(NrHOOOlOrHO<NOTf 
 
 rHOOS-*CD<NOiOC<CD"3<NC<b- 
 
 b-<M<NTt<rHTHCOCO-^lOOb-b-OSCOCOTtl^OOSCOCOCO<NO5 
 <NOCOrHCDCOCOCOTj<COOOCOC<rHOSCOrHrHOSOOOOOIOOSOS 
 
 M ti a '~ 
 
 o a3 *C -- . 
 
 (N(NrHCO<N(N<N<N<N<N<N<NTlH(N 
 
 COCO<N<N<N<N<NCO<N<N<N<N(NCOrHCOCO<NCOrHrH<N<NrH^ 
 
 il^s? 
 
 OSOrHCDO<Nb-rHrHCOOCOOS<N 
 rH CO CO rH CO CO CO CO CO W CO CO rH CO 
 
 COOOOb-rHC<l'c^CO 1 ^00OC<JOSC<jTj<OrHOCOCObOOrH 
 CO CO CO CO rH CO CO C 1 ^ CO CO rH CO CO rH CO ^ CO C^ ^ CO CO rH CO CO CO 
 
 l^'8i | 
 
 &soa 
 
 IIISs 
 
 b- 00 <N b- O 
 
 CO OS b- O 
 
 b" rH t b b- O OS 
 
 rH iH rH rH CO <N rH 
 
 .^ D, 
 
 1* A |l 
 
 CO Tt< 
 
 
 |88 
 
 CNJ CO CO 
 
 rH 
 
 M rH <N CO 
 
 rH 
 Tt< IO CO b- rH N CO 
 
 a ^^^ s 
 
 9 2 *OQ 
 
 |^s 
 
 ' 2 'S ^ fl 
 
 m W 3 J3 S 
 
 8 : 
 
 i : : g ! : 
 
 Hill 
 ssife! 
 
 Tjt 1C CD b- rH 
 rH rH rH rH W 
 
 B, & ^, 
 
 ** S. pi S. S. pi, ** 
 
 5 1 f a 2 
 
 fl o J.g | 
 
 lllll 
 
 2 all 
 
 
 
 |3|| 
 
 1 
 
 PH PR 
 
 oo fn 'S H " 
 
 5^ 
 
 <N CO 
 
 rH rH 
 
 o J 
 ? 
 
50 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 10 N 
 
 I* 
 
 
 
 
 .9 -813 t o 
 
 N f i 1 8 * 
 
 .O H W 
 
 . 
 
 2 
 
 rH CO 
 
 -qo jo pug 
 
 00 CO 
 
 CO CO 
 
 ^ 
 
 CO 
 
 (Q 
 
 CO 
 
 -jasqo jo 
 
 O> 
 
 
 rHrHCOrHOOrHOrHCOCO 
 
 3 ^ n 
 ^^ fa 
 
 2-2 
 
 A 8'OT 
 
 'J8TVBSSl r j) 
 
 -OJt3[ 
 
 00 O 
 t^ CO 
 
 I s * 00 
 
 CO i-H 
 
 00 O 
 O O 
 
 00 10 CO CO 0> 
 
 00 
 CO 
 
 l> CO t IO 
 
 COl> 
 
 rt<CO 
 l>00 
 
 1 * -O5> 
 
 oo 
 
 OOrH 
 
 1>O 
 l>l> 
 
 COt> 
 
 ! I 
 
 O 
 00 
 
 rHCOCOOirHOOCOOCOrH 
 lOCOOJCOCOrHCOOCOiO 
 
 
 ci 
 
 * 
 
 iO O 
 
 O5 OO 
 
 CO CO 
 
 CO 
 
 CO 
 
 t -^ co 
 
 I> l^ t 
 
 CO CO Co' 
 
 - 
 
 CO CO 
 
 rH rH 
 
 CO <* 
 
 s s 
 
 
 
STATISTICS OF OBSERVATIONS. 
 
 51 
 
 1 
 
 ? 6 6 
 S P Q 
 
 M 
 
 5 ^ 
 
 of o o 1 1 1 
 
 O PQ PQ O 
 
 dioxide produced during the period 
 all days are omitted in computing 
 3ee table 12, page 95. 
 
 O O 
 
 CO CO CO 
 
 rH rH rH rH rH CO 
 
 H h 
 | . 
 
 si! 
 
 CO <N l> 
 
 CO CO CO 
 
 OS CM CM O CM ^ CO 
 
 CO CO CO CO CO CO CO 
 
 o & 
 ifcj 
 
 t> t> CO 
 
 b- O OS O O O CO 
 
 111 
 
 s era 
 
 <NO><NOO^THOOOiCO 
 <Ni-H<NCOCO<N<N(NrH<N 
 
 rHrH^lO^CMrHlOOOiOOSb-rHOSCOCMCMlOrHOSOSlOOOCOOS 
 
 !?1 
 
 
 
 '^'^ 
 
 ill ;|1 ilS ; 
 
 IO OS OS rH CD b* b CM OS rH CO *O b OS ^ O rH IO *O rH 
 CO rH CO 00 b* b CO b b* b* 00 b* b* rH CO CM O b b b* 
 
 r2 
 
 rH Tj< CO CO 00 IO 
 iO IO b ^f ^ ^t 1 
 
 rHIO -Tt*CMCDO -OOCO b-COrH COCO -COCOO -CMb-00 
 T^b- '^lO'^'O '^lO^ ^*OO ^b- -^b-b 'iO^l^< 
 
 S 
 
 CO OS CO IO b- CO 
 
 IO OO 00 rH 00 O CO O OS 00 O O 00 O b rH CO 00 b* b 
 
 
 v-^-- -^- ^_- 
 
 
 
 CM >O -CO 
 
 Tf- o -CO O CO O -CO 
 
 S "S 
 
 o d 
 
 b *O 00 CO CO CO CO *O ^ O 
 
 CMCMOOOOb-OOTj<cOCDCOOCOOOOOSCMCO-*b-OrHOOOO 
 rti^cDCOCO^cOiOrHCDtOCMCOb-COOOcOiOb-iOcOiMCM^CMCO 
 
 sa 
 
 CMCMCMCOCOCMCMCMCMCM 
 
 CM ^ CM CM CM CM CM CO CM CM CM CO CM CM CQ CO CM ^ CO CM ^ ^ CM CM CM CM 
 
 ll 
 
 2S3828g2S8S 
 
 b* CO b* rH O CO O O O O O CM O O tO CO rH O CO tO CO O CM rH CO CO 
 C^COrHCOCOCMCO^WCOCOCMCOCO^lOCOCOrHCM^ICOCMCOCOCO 
 
 fed 
 
 a 
 
 8-6 
 
 b CO b 
 
 cO CD *O 
 
 CO CO CO 
 
 O rH 00 rH b- O CO 
 CO rH O OS OS O CO 
 
 co -^ * co co TJ< co 
 
 f-a 
 
 a 
 
 CM CM CM 
 
 i t rH rH 
 
 CO TjH O 
 
 CM CO CO CM CM CM 10 
 rH rH rH rH rH rH rH 
 
 b- rH CM CO >O 
 
 II 
 
 : : : 
 
 >O 
 
 CO * CM 
 
 
 ^1 
 
 03 CM 
 
 2 ft 
 
 b- 00 OS 
 
 B? b 
 
 c 
 
 s s s 
 
 rH CO b- CO OS rH C<J 
 i-l rH rH 
 
 II I | | | | 
 
 S 
 
 ij 
 
 8 3 
 
 
 PR PH' 
 
 IsS 
 
 jfMT3 
 
 -" 
 
 CO b* 
 
 rH TH 
 
 i 
 
 9 
 
 S 
 
52 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 B 
 
 
 I I 
 
 
 
 PQ 
 
 & 
 
 1 
 
 O 
 
 ^ 
 
 24 
 
 K 
 
 (zjM^ 8'01 
 'janBSS 
 ra -bs 
 
 ^ 
 
 e 
 
 "2 
 
 
 O rH CO O3 
 rH 00 00 b 
 
 CM 
 
 CD i> 
 
 CM b- CO 00 O rH 
 CM * <N O O3 O 
 N CM CO (N rH CM 
 
 CO CM b- * CO rH O3 
 
 00 b- b- CO CO CO -CO 
 
 rH T}< rH b- rH 
 
 IO IO *O *O ^O 
 
 03 00 b- rH 
 
 : 
 
 'EL Jk -^ 
 
 l! II 
 
 : 8 
 
 i a M 
 
 65|^ 
 
 lOCMrHOOOOb-b-OOCOrHb-OCO 
 'rOCMWTttCOCMCMCMC^COCMCMCMCMCMCMCMrHrHCMrHrHrHrHfNrHCMrH 
 
 
 ^b-CMOOOb-'co'oOrHCo'^rHrHb. 
 grHCOCOCMCOCMCOCOCOCOCOCOCOrH 
 
 OOCMOOOCDCOCO0-* 
 rHCOCOrHCOCOCMCOCO 
 
 * 
 
 CO CO CM 
 
 CM CD 
 
 03 00 
 
 CM CM 
 
 a &-v e 
 a&1 g 
 
 t 
 
 
 
 3 3 3 
 
STATISTICS OF OBSERVATIONS. 
 
 53 
 
 Do. 
 
 (No food; would not take sterile 
 water about 1 hour before the 
 observation. 
 
 Colostrum. 
 Breast-milk. 
 
 6 6 2 d o 
 Q P Q Q 
 
 
 
 M 6 
 
 dioxide produced during the period, 
 all days are omitted in computing 
 See table 12, page 95. 
 
 rH 
 
 TH CO rH 
 
 rH rH CO 
 
 a ^ 
 l^fl 
 
 CO O O5 CO 
 CO CO CO CO 
 
 b- O CO O5 O 
 
 CO b- CO b- 00 
 CO CO CO CO CO 
 
 CO CO CO 
 
 ill 
 
 O5 rH b- O 
 
 CD l> CO b- 
 
 CO CO CO CO 
 
 (N O CO 00 05 
 
 !> CO I s * 
 
 ^.s s 
 
 in 
 
 TrHOOOOCO<NCOOOCMOrHOOOO 
 O O O O CM CM i 1 O rH rH O5 O rH 
 
 COCOCOO5rHCOrHrHO5OCOTHC<JO5b- 
 OOO5OrHC<lrHi-(O(N<N(NCO(N<N 
 
 t* ^H GO O^ CO rH Oi ^ CO Oi 
 
 l a 
 
 *- 2 <u 
 
 T3 U ^ 
 
 CM CD O5 *00t> rH rH 00 T 
 
 OCOO rH O O O O5 00 
 iO *O CO OO CO ' CO CO CO 00 
 
 :g| i :8! igg :Si 
 
 rH IO GO CO *O i-H ^ 
 
 co H ^*3 
 
 1 
 
 b- O5 TH CO O TH ^f GO rH 
 
 CO O5 rH O^ O5 CO * 00 ^H Oi I s * 
 
 o^ io^o *^^ -^10 -10^0 
 
 ;-- ;--^ ;ss 
 
 " 
 
 :Srn^ :gS :8 :8 
 
 l>* CO * t^ t> 00 !> t^ GO O O 
 
 :$ :i5 :S5 
 
 rt 
 
 . ^ . ^_, ^_, ^_^ 
 
 
 ^^ - , ^^ 
 
 1- 
 
 00 CM TH -CD 
 b- -00 -00 -00 
 
 : 8 : 8 : : F: : f: 
 
 00 00 4 s * 
 
 
 ' . > ' ( 
 
 - / _^_^ % / _^^ > i 
 
 l . r _^^ 
 
 ^ s 
 
 O5COTflCOI>COrHOCMCMOCOO5 
 
 COC<|i-irHiObOOb-COOO<NOOb-CD 
 COiOCOb->OOCOeO<NOCOTt<Tt*b-CO 
 
 C^\ O rH CO CO CO O4 CO Cb O 
 
 3| 
 
 rHrHrHrH<NW<NCN<N<N<N<N<N 
 
 <N<N<N<NNN<N<N<NW<N<M<N<N<N 
 
 <N<N(N(N(M(N<N(NrH(N 
 
 ll 
 
 Tt<rH(NCOrHrHOrHCOrHb-C<|rH 
 rHTHTHCOCMCOCOCMCOTHrHCOCO 
 
 O5rHC<'-lrHrHCDCOCOCOb-lOCOCO < * 
 (NCOeO<NCOCOC<ICOT}<T^cOCOrt<COCO 
 
 O5 ^ CO O5 00 O O CO ^t* CO 
 rH CO CO rH CO CO CO rH CO CO 
 
 ia 
 ft 
 
 I* 
 
 TH b- CM b- 
 
 00 rH 10 CO 
 CM CO* CO CO 
 
 C<J CO b- CO O 
 
 CO CO CO CO CO 
 
 3 S o 
 co co' co 
 
 *' S 
 
 ! 
 
 CM CM 
 
 b- rH TH 
 
 CO CO <N 
 iO CO it (M 
 
 HIM 
 
 Cl (N O 
 rH rH CM 
 
 CO TH 
 
 ^2 
 
 : 8 : : 
 
 : : S 
 
 
 
 !i 
 
 8S CM 
 P fe 
 
 00 00 O5 rH 
 rH rH rH (N 
 
 1 S 1 1 
 
 1 1 1 1 1 
 
 00 OS 10 
 CM CM CM 
 
 re given ai 
 infants ovc 
 
 s 
 
 fe 
 
 fc 
 
 5SSJ 
 
 M^-O 
 
 
 
 i 
 
 rH 
 
 <N 
 
 1 
 
 1 
 
54 
 
 PHYSIOLOGY OF THE NEW-BOKN INFANT. 
 
 B 
 
 I & 
 
 B 
 
 a M) JL 
 's 
 
 t 
 
 -qo jo pug 
 
 8 
 
 -jasqo jo 
 
 CD 
 
 co 
 
 W 5 
 
 g'OI 
 
 t 
 
 t 
 
 1 ; : 
 
 05 CO 10 rH 
 rH <N rH (N 
 
 .GOCOOlOO5COCOCOt-O5COCOTt<T^OlOt-O5rHtN.OCOOOrH 
 glOCOt^COt^t-COpOOSC^COCOOOCOOOiOlOC^OOGOCOOO 1 * 
 
 1 rH rH rH <N C<l O} 
 
 atl 
 
 .giOlOOOC^t><NlO<NCOCOCOCOCOCOCOCOTjHGOOOrHOO 
 S(NCOCOC<ICOCO<NCOCOC<ICOCO(NCOCO<NCOCOrH-^CO 
 
 OOrHOOt>-rHrHOOOO 
 
 CO CO CO CO CO O 
 i-H CO CO CO rH <* 
 
 3 S 
 
 (N (N 
 
STATISTICS OF OBSERVATIONS. 
 
 55 
 
 Colostrum. 
 
 Do. 
 
 (Breasts beginning to fill; cried 
 throughout observation, as if 
 very hungry. 
 
 1 * 8 
 
 axilla 
 
 2 o o *o 
 
 & 
 
 Breasts filling. 
 
 *The ages here given are at the beginning of the period of observation. "Calculated from the weight of carbon dioxide produced during the period. 
 For infants over 2 days old the age is given to the nearest half The preliminary periods for all days are omitted in computing 
 day. the minimum metabolism. See table 12, page 95. 
 3 Died subsequently of inanition. 
 
 . . jC * * * " * ^ ^ 
 
 o 
 
 b- 
 
 co 
 
 05 rH 
 CO CO 
 
 CO 00 b- Tf< O5 O5 00 
 
 CO CD CD *O CD CD CO 
 CO CO CO CO CO CO CO 
 
 05 
 
 CO 
 
 CO 
 
 05 
 
 1 
 
 * t 
 
 b- 00 00 CO O5 CO CO 
 CO CD CO CO CD CD CO 
 
 rH 
 
 , > 
 
 CO * 00 CO rH 
 1-H (N rH (N O 
 
 O5 O TtH O CO O * 
 rH CO CO CO <N TfH (M 
 
 iOOO-*CDb-<NOO<MO5^iOTt<b-<Nb-OOi-HrHiOOb-O5TtHb".O 
 
 
 ;isi; 
 
 b- CD 05 ^ O 
 
 l 1 rH l-H O5 ^ 
 00 C^l O5 CO rH 
 
 Tt<iOO5 IO 00 -COb-rH Tfi CO -COCO -COOOrH -COO5 
 CO &O b- -COO b- O5 rH CO IO rH rH 00 Tf CO CO b- 
 00 00 b- t> C5 l> rH_00 t < ^ b- b- b- b- 00 t> 00 
 
 :gl 
 
 oo ic -^ 
 
 iO ^f ^O 
 
 O rH C-l rH b- 
 
 iO 00 CO CD b- 
 
 b* 00 CO C^ rH C*l rH IO ^ ^O * O5 O5 ^ C^ O5 rH rH 
 O*OiO -lOCO iOCO'O -COCO 'T^Ttl -iOiOO -OCO 
 
 %% 
 
 ' ?5 rH rH 
 
 O5 O5 rH rH CD 
 rH (M (N O* W 
 
 CD rH CO C^ CO ^ ^O CO O5 CO CO CO O C^l GO O CO 
 O5 O 00 00 rH GO OO O5 b 00 CO CO 00 b O5 ' b* O 
 
 ;^o 
 
 ' ^ ' - '-^ ^-^-s ' . . <N . 
 
 
 05 
 
 CO CD 
 CO b- 
 
 s ;s : z :fc ;B ; g ; e 
 
 : ^ 
 
 CO * O CO TJH 
 (N 00 (N CO CO 
 
 CO rH <N CO IO rH <N 
 b- rH rH 00 b- O 00 
 
 OOTtiO5rHX'*(NOO5 1 ^COTt<Ob-'<^Tt<b-cOlOO5lOt>.rH 
 CDb-Tt*(NTpO5O5l>rHCOeOOrH(N(N<McOCO(NOTt<(Mb- 
 
 w^o 
 
 <N<N<N<N<N<N^ro<N<NCO<N<N^<NM<N<N<N<^^ 
 
 HP 
 
 N CO CO O5 O5 
 N CO CO <N rH 
 
 * v " 
 
 5 
 
 CO 
 
 O O (N CO CO CO CO 
 
 CO CO CO CO CO CO rH CO ^ CO C^ Tfl CD C^ CO CO C^ CO CO CO C^l CO CO 
 
 rH IO <N 
 
 <N CO CO 
 
 SCO 
 "# 
 
 CO CO 
 
 CD (N <N iO b- CO iO 
 
 TjH IO O CO CO CO CO 
 
 CO CO CO <N CO CO CO 
 
 CO 
 
 00 
 rH 
 
 rH rH 
 
 (N CO 
 
 (N (N C<J O CO 00 <M l 
 
 ^ IO CO rH Cq 
 
 (N 
 
 rH 
 
 CO 
 
 g 
 
 
 10 
 
 
 rH 
 
 -S 
 
 N CO 
 
 ^ IO CO 00 00 O5 O 
 
 rH 
 V S> Q> G> <Q 0} n) 
 
 
 
 "-S -3 t-j Hj t-s r^ ^ 
 
 rH 
 rH 
 
 9) 
 
 d 
 
 ^ 2 S 
 
 9 8 
 
56 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 
 I 
 
 I 
 
 
 
 Q' & 
 
 & 
 
 
 - 
 
 . 
 
 qo 
 
 -aasqo jo 
 
 SumuiSog 
 
 00 b- 
 
 s $ 
 
 So 
 
 I If I 
 
 1&. 
 
 Ill 
 
 if 
 
 8-01 
 8Fi) 
 ta 'be .raj 
 
 i 
 
 i 
 
 i 
 
 O5 O> 
 
 8 :gS 
 
 .-i fr o g 
 
 O> CD 
 
 S :S 
 
 CO CO CO <N (N 
 
 OS CO tO rH O 
 
 g 
 
 CO O 
 00 l> 
 
 : 3 
 
 S-S^Sg.9 
 
 a a 5? a o 
 
 >%%% 
 
 II 
 
 ^3^C^S8?r^^^?5 
 
 CC O '~ 
 
 CO CO CO 
 
 SS* 
 
 - a 
 
 CM CO tO 
 
 X 
 
 
 
 Io 
 
 r 
 
STATISTICS OF OBSERVATIONS. 
 
 a 
 
 4 
 ion 
 
 the 
 
 Colostrum 
 utes bef 
 
 <5 a | I 
 
 & & 
 
 Tji(NrHCOOOCOt>OOCOOiOCNCOrHO>COOOOO5lN.C^OJ'^COO5 
 CMCOCOCttrHrHrHrHNrHIMCqrHCMrHrHrHrHOOrHeOCMOO 
 
 Sl 
 
 "# O5 00 
 
 00 rH 
 
 O 
 
 T}< 
 
 8 
 
 o co 
 
 t> CO 
 
 JO CO 
 
 t^ * rH 
 U3 O CO 
 
 CO CO 
 
 8 S 
 
 iS8^S^2 
 
 CO CO *O ^ ^ ^ O ^O ^ ^^ ^ GO 
 fH CM ^ Cb O Os O) O) O CO O CO 
 
 rH CO - rH -l 
 
 iH (M (M iH i- 
 
 ^ct^^lfg^^^^cl^i^t^^^g^^^^^^c5c^iS^g 
 
 s s 
 
 CO CO 
 
 s 
 
 8 
 
58 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 
 .5 
 
 > 
 
 to 
 
 
 begi 
 
 B 
 
 & 
 
 fB 
 \ 
 
 Breast-milk; 
 two days pre 
 
 CO . O 
 
 -8-2 
 
 tem- 
 re. 
 
 tal 
 
 -qo jo pug 
 
 CO CO CO 
 
 -aasqo jo 
 
 CO CO 
 
 
 CD Oi l^* *O CD ^ !> C^ C^ Oi *O !> CO O 00 CO CO 00 l>* 00 *O Tj* 1 s ** 00 *O O ^H 
 ^Oi^C^C^C^Oi^OC5O-Hi-H'-<C^i-HrHi-HC ; l-Hi-HC^C^C^i-Hi-Hi--t 
 
 fi 
 
 Heat prod 
 (computed 
 24 hour 
 
 X 8-OT 
 
 m 
 
 2 *' 
 
 COCO -CMOO -OtO -O5^ -COO -bl^ 
 CO t* I s - 00 CD t> CD CO CD tO CO CD 
 
 i-iCO -r-iTt< -COCO -COOO -COtO -OOCO -tOi-i -t^t* 
 CDOO ^'^ -tO-^ -TjlcD -CDOO -tOt* -tOcD --^CO 
 
 o'B 
 
 O 'rt ti C3 
 
 ^ &2 
 
 *C^(N(NC<li-ii-iC<|i-ii^iHrM(NC<l(NC^C<l(N<NCOC<tN<NrHi-<C<Ji--(i-iC4C^(N 
 
 A "5*8 
 
 II 
 
 O t>- Tt< X O5 
 T}< <N CO CO f-i 
 
 * 
 
 a z- 
 
 4- 
 
 cococococococococo 
 
 i-l OJ CO 
 
 O 
 
 1C 
 
 I* 
 
 * -J 
 
 5 o S 
 
 n 
 
STATISTICS OF OBSERVATIONS. 
 
 59 
 
 B 
 
 a 
 
 s 
 
 1 ! 
 
 B 
 
 s 
 
 B 
 
 o o 
 co co 
 
 8 
 
 8 
 
 CO O rH rH 00 CO CO 
 
 CO CO CO 
 
 b- b- 
 
 CO CO 
 
 CD 
 CO 
 
 OOOOCOtOcOOOOCO<NO<NOrHU3O^OOtOb-OOb-OOb-rHOOOSb-COOO5OS 
 
 ^COCOCOCO^^^rHrHrH<NC<ICq(NCO(NCOCOCOOrH(NOrHrHOOOC^rHrH 
 
 COO 'tO b- rH IO to '00 00 CD b- OS 
 
 OSGO O O Tfl -rHO N C<l rH tO rH 
 
 CD CD CD b* tO * b b CD b CO CD CO 
 
 00<N -COCO TJH 00 -rJHOO 
 rHOO -r^OS -CO 1 * -<N(M 
 
 <N O 
 
 tO tO 
 
 ^ :^13 :5J : 
 
 S 
 
 CO CO TJ4 OS CD 
 
 00 00 CD -CD b- 
 
 rH CO 
 
 CO b- rH 
 
 b- b- b 
 
 COOOCOCOOOOCOCOCOOOOOSCOlO<NOS<N 
 b* CO CO CO rH CO rH CD ^ rH CO ^ O b* C^ ^ rH 
 
 OlTH(NC<|(NC^<N(NC<JC^(NrHrHC<l<N 
 
 * 10 
 <N <N 
 
 QO^J 05 CO rH CO 00 
 
 CQ ^T CQ CO CO _CO Cv 
 
 CO O CO ^ T^ 
 TfH Tt< CO CO CO 
 
 CO CO CO 
 
 CO CO CO 
 
 o 
 
 CO CO 
 
 3 
 
PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 I 
 
 Do. 
 Do. 
 
 3 
 
 o o o 
 
 CO CO CO 
 
 o 
 
 CO 
 
 -qo p pug 
 
 l> 
 
 CO 
 
 'UOI^BA 
 
 -jasqo jo 
 
 OS (N O CO CO W 
 
 r-t rH iH <N i-l iH 
 
 1| S 
 
 wl 
 
 A 8'OT 
 nOTs 
 -ra -bs 
 
 ^ 
 
 
 
 CO I** lO rH O 
 CO CO 00 OS I s * 
 
 CO CD X CO 
 
 C^ W5 
 
 ^ 
 
 *O 
 
 OOO -CO -COI> 
 
 -COQO 
 
 -IOO 
 
 8 : 
 
 O CO O5 -OS 
 t>. t^ CO t^. 
 
 . ON lO CN CO 
 
 rH >0 Tj< rH 
 
 1 CO N CN CO CM <M C<) 
 
 
 * 
 
 ^ 3 CO CO ^ 
 
 <N (N CM CN <N 
 
 CO CO <N CN <N OS 
 
 1-1 <M CO ^ 
 
 s l 
 
 I 
 
 d 
 
 s 
 
STATISTICS OF OBSERVATIONS. 
 
 61 
 
 Colostrum and breast-milk. 
 
 1 I 
 
 c 1 
 
 
 
 Breast-milk. 
 Do. 
 
 o* 6 
 P P 
 
 Colostrum. 
 
 [Colostrum; high temperature due 
 \ to hunger. 
 
 Breast-milk. 
 Do. 
 
 1 
 
 O 
 
 S5 
 
 f the respiratory quotients obtained 
 ubject. 
 >llowing day because of high tem- 
 
 orrhagic disease of the new-born. 
 
 o 
 
 CO 
 
 : 8 
 
 i i 
 
 8 8 
 
 CO CO CO CO 
 
 . 
 
 <=>"< & 
 
 il^l^ 
 
 >^ a.-g ^ 
 
 CM 
 
 00 
 CO 
 
 00 O5 
 
 CO b^ 
 
 CO CO 
 
 05 O 
 
 CO CO 
 
 ^ T^ CO ^ 
 
 CO CO CO CO 
 
 
 
 8 
 
 c8 'g O d -^ 
 
 ilfll 
 
 sla^S 
 
 i 
 
 CO CO 
 
 CO b- 
 
 b-' CO 
 
 CO CO 
 
 CO O 
 CO CO 
 
 CO CO CO b- 
 
 b- 00 b- CO 
 
 CO CO CO CO 
 
 b- 
 | 
 
 1|3|^' 
 -5 ^3 
 
 a d 2 
 
 ^ CO tO 
 
 CO CO 10 00 CM JO 
 O rH O rH rH W 00 
 
 30 O CO CO CO b* 00 
 
 Tt* CO CO b- O5 
 
 (N CO CO CO O 
 
 rCOOOO5b-CMtOCMCOCOC<> 
 rHrHtOtOrHrHT^OOrH 
 
 rH b- rH 
 O O O 
 
 ^lltf 
 
 
 
 
 
 
 
 O O M ft > 
 
 CO b 
 
 co b- 
 
 b- b- 
 
 CO to CO CO CO 
 
 ;;ii; 
 
 OS ^ bt 
 to CO b- 
 
 CO C 1 ^ rH tO CO O O 
 ' rH^ T-* 
 
 CO CM 
 
 . l| 1^5 
 
 II 525 
 
 1 ,o S 
 
 :5S 
 
 OO 00 CO O5 rH 
 ^ CO Tt^ to tO 
 
 to b- O O 
 
 to to to to 
 
 "* b- -CO 
 
 Tp Ttf O 
 
 to to O ^ 00 ^ to 
 
 CO * 
 CO CO 
 
 P ? 9 
 
 'SoS 
 
 CO tO rH O5 
 
 Tt< rH CO CO CO 
 
 w -b;^ 
 
 CM CO CO 
 
 33 ' ' 'S3 
 
 O5 rH 
 CO CO 
 
 
 , , 
 
 
 ^^_, ^^ 
 
 
 ^ ^ ^ ^ 
 
 ^_, 
 
 5 ^I 
 
 '^3 T3 'C -i 3 
 
 CO 
 CO 
 
 05 00 
 
 O -to 
 
 O CO 
 O5 00 
 
 CD $ g J: 
 
 to 
 
 ^8 JI fe 53 
 t,^ ^g 
 
 
 V -* s ie--5 
 
 '^ * N '^-^-N ' 
 
 
 / '^-x ' "r-^^ > 'r-^ > 
 
 ^^_^ 
 
 Jill 
 
 Tj< rH tO 
 
 b- CM CO 
 
 CO (N CO (M b- to CO 
 b- O5 to 00 O rH 00 
 
 CO tO <N O b- b- CO 
 00 b- 00 rH b- b- (N 
 
 CO 00 00 CO C^ 
 00 O5 b- <N O 
 
 COO5COO5T^O5T^O5b-lO 
 OOCOCOrHO5b-rHrHb-00 
 
 tO b- tO 
 
 (N rH O 
 
 tsD fl 
 
 ss-c^ . 
 
 (N <M <N 
 
 rH rH rH rH CM CM rH 
 
 rH rH i-H (N rH rH (N 
 
 rH j-4 CM <M (N 
 
 rHrHCO-^rHrHCOCMrHrH 
 
 (N CM W 
 
 gj-il* 
 
 to tO Tj< 
 CO CO CO 
 
 O5 tO 00 CO O5 CO 00 
 <M CO CO CO CM CO CO 
 
 b- CO O O O5 IO rH 
 
 CO CO Th CO CO CO CC 
 
 Hto 
 b- b- b- to 00 
 
 CO CO CM CO (M 
 
 H|P rt| 
 
 CO < *COTt<COTtlCOCO'^CO 
 
 (M CO CO 
 
 CO CO CO 
 
 llli! 
 
 co d T3 . 
 ,d S o M <M 
 
 rH 
 
 CO 
 
 g s 
 
 rH (N 
 CO b- 
 
 ?2 S 
 
 CO CO 10 rH 
 00 b- b- 00 
 
 (N CM <N CM 
 
 05 
 CO 
 
 3 gj g 03 rH 
 
 & ft B 
 
 itlll 
 
 <N 
 
 00 00 
 rH 
 
 <N CO 
 
 ^ to 
 
 CO (N (M (N 
 
 rH rH rH 
 rH (M CO IO 
 
 * 
 
 lllgl 
 K|* d 
 
 Q S 05 M 
 
 
 I 
 
 
 i i 
 
 IO 
 
 to 
 
 tO 
 
 rd 8 ga 
 
 -I'S| 
 
 :ss a i 
 
 .. M >j g 
 
 *, 
 
 05 
 
 rH CM 
 
 CO Tfl 
 
 (N CO -^ CO 
 
 CO 
 
 s S 1 1 a 
 
 i? B rt d 
 
 53 
 
 1 1 
 
 1 1 
 
 1 1 
 
 & f-* 
 
 > > > > 
 
 1 1 1 1 
 
 o 
 SZ5 
 
 QQ 2 ^ 
 t> -*a ^3 d d 
 
 finl 
 
 
 ft 
 
 
 
 ^ 
 
 g 
 
 *l|jj 
 
 m PR H "5 
 
 
 - 
 
 
 
 S 
 
 rH 
 
 ! 1 
 
 g 5 
 
62 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 a 
 
 o S 
 
 1 I 
 
 8 
 
 tal 
 
 -qo jo pug 
 
 -jssqo jo 
 8uiuui3ag 
 
 CO 
 
 is 
 
 ggg 
 
 ted) 
 
 mpu 
 24 ho 
 
 m -bs 
 
 -OH 3 ! 
 
 II 
 
 o 
 
 ^ 
 
 ^co 
 
 00 t> 
 
 
 JJ 
 
 I* 
 
 O5 O CO 00 IO ^ CO 
 l> <N C<J (N rH rH * 
 
 rH rH rH <N CO CO 
 
 CO CO CO CO 
 
 COCO^COCOCOCOCOCOCOCOCOCOCOCOr^^COCO 
 
 pip 
 
 b CO CO *O 
 
 00 O O O 
 
 CO CO ^ ^ 
 
 CO CO CO 
 
 
STATISTICS OF OBSERVATIONS. 
 
 63 
 
 [Colostrum; sterile water 4 min- 
 \ utes before the observation. 
 
 Breast-milk. 
 
 >M 
 
 . 
 
 [Colostrum; regurgitating in mid- 
 \ die of preliminary period. 
 
 Colostrum and breast-milk. 
 
 No food or water. 
 
 Do. 
 Colostrum. 
 
 & \ a 
 
 6 6 
 
 Q Q 
 
 The ages here given are at the beginning of the period of observation. Calculated from the weight of carbon dioxide produced during the period. 
 For infants over 2 days old the age is given to the nearest half The preliminary periods for all days are omitted in computing 
 day. the minimum metabolism. See table 12, page 95. 
 *Minutes. 
 
 CO 
 
 8 
 
 
 iO 
 
 8 
 
 
 : i 
 
 ooo 
 
 CO CO CO 
 rH 
 
 o o 
 
 CO CO 
 
 CO 
 
 b- 
 
 CO 
 
 
 
 b- 
 
 CO 
 
 
 
 8 
 
 o 
 
 H 
 
 CO 
 % 
 
 rH OS 
 
 CO CO 
 
 1> 1> CO 
 
 CO CO CO 
 
 CO O 
 CO CO 
 
 o 
 
 
 b- 
 
 % 
 
 b- 
 
 00 
 CO 
 
 co 
 
 CO 
 CO 
 
 -> > 
 
 rH 
 
 CD 
 
 CO 
 
 O <M 
 
 , / A > 
 
 rH CO CO 
 i * / * / * \i 
 
 CO b- 
 
 _ A w f, % 
 
 OS rH O >0 
 
 OJ rH rH rH 
 
 %$ 
 
 g 
 
 8S22 
 
 s 
 
 8 
 
 CO rH 00 CO iO <N 
 CO (M <N rH <N rH 
 
 C^ d rH O b* O C^ CO OS rH 
 COrHrHCOOrHOOOrH 
 
 10 CO ; 000 
 rH rH CO CO IO 
 
 
 CO CM 
 . ^0 . 
 
 || : 
 
 O CO 
 C^ OS 
 
 o *o 
 
 OS CO 
 iO OS 
 
 Sc$ 
 
 CO CO 
 
 b- CO 
 
 rH rH OS 
 
 b- 00 rH 00 rH <M 
 * rH CO cO CO rH OS 
 CO b- b- b- CO CO 
 
 00 00 CO OS 
 
 :$r? : 
 
 3S : 
 
 $3 
 
 :$$ : 
 
 OS rH 
 
 rH iO 
 
 :33 
 
 OS O <M O 
 
 CO rH rH >O 
 
 :38 :S?S :3S : 
 
 b- b- rH CO 
 
 rH rH O O 
 
 
 :^3 : 
 
 (N b- 
 
 cO CO 
 
 %% 
 
 :rn : 
 
 %% 
 
 rH rH 
 
 os co 
 
 OS >O C<l 00 
 rH O iO b- 
 
 CD iO 00 <N - O <N 
 *O 00 I s * t^* *O CD 
 
 rH <M rH OS 
 
 CO CO 00 CO 
 
 , , 
 
 ^_^_, 
 
 >_^ 
 
 ^^_, 
 
 , , 
 
 , , 
 
 ^^_^ ^^_^ 
 
 ^^_, , , ,_^, 
 
 ^- v -' ^-^ 
 
 
 
 * 
 
 CO 
 
 rH 
 
 rH 
 
 00 
 
 : g : fc 
 
 S3 ? ' 
 
 00 b- t> 
 
 2 : 3 
 
 V-.L '^-, ',_^ '^_, V-^-a V- > \ -^ ', -^ V^-, j , ',-~-^ ', 
 
 S883 
 
 b- rH (N rH CO 
 
 rH rH rH CO 
 
 rH rH rH iO 
 O CO rH OS 
 
 00 <M O OS O 
 
 IO CO OS IO rH 
 
 OS <N OS IO rH IO 
 
 rH 00 00 <N O CO 
 
 COb-b-iOCOOCOrHOO<N 
 
 (NrHlOOSIMrHrHOOOSlO 
 
 00 OS b- CO <N 
 <N (N 00 O CO 
 
 
 <N<N<N<MrHrHOJ<N<N 
 
 (N(M(N<N(N(N<NrHrH(NcN(N<M(NCO 
 
 CO CO CO CO 
 
 CO b- O b- OS 
 CO CO CO TH CO 
 
 iO (M (N 00 CO rH 
 CO rH rH (N rH rH 
 
 COrHrHiOOO<NOO 
 cqrHCOCOrHrHCOrHrH 
 
 OOCOrHCOrHCO(Mb-COO 
 
 rH CO CO rH CO CO CO rH CO rH 
 
 CO CO CO CO CO 
 
 CO 
 
 00 
 
 rH 
 
 CO 
 
 CO 
 CO 
 
 $ 
 
 (N 
 
 IM 
 
 8 
 
 CO 
 
 CO 
 
 $ 
 
 CO CO 
 
 CO O 
 
 "*. . 
 
 CO CO 
 
 <N 
 
 rH 
 
 H| 
 
 He* 
 
 rH 
 
 00 
 
 rH 
 
 rH CO rH 
 
 10 CO 
 
 o >o .... 
 
 rH O ' 
 
 rH 
 
 <N 
 
 i 
 
 5 
 
 1 
 
 a 
 
 a 
 
 b- 
 
 b- 00 
 
 <N (N 
 
 00 O rH 
 
 <N CO 
 
 <N CO 
 
 
 
 
 
 fc 
 
 1 
 
 O 
 
 J5 fc 
 
 III 
 
 fe ^d 
 
 , - , 
 
64 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 l 
 
 
 l 
 
 fl 
 
 CO t-i 
 
 
 J 
 
 g 
 
 2 
 
 -qo jo pug 
 
 'UOI^BA 
 
 -aasqo jo 
 8utuut8ag 
 
 CN <N CO 1-1 (M H 
 
 W 
 
 -TO -bs 
 
 g 
 
 S :S3 
 
 C35 * CO -( 
 
 CO 
 
 O 
 
 O -OiO 
 t^* 00 I s * 
 
 COOS-CO 
 OOU2-OO 
 
 O 
 IO 
 
 S 
 
 CO^ 
 I s * t^ 
 
 U3 
 CO 
 
 u 
 
 S "s 
 
 ssqssqgois2^Sci^^^i^^^cigssg 
 
 fH<NCMi-HCM(NTHfHrHC^i-l 
 
 4*4 4 
 
 -- a 
 
 CO CO CO CO CO 
 
 jt-3-.a 
 
 <N <M (N CO 
 
 ^H rH (N CN 
 
 (N CO * U5 ^H 
 
 i s 
 
 1* 
 
 c c 
 
 9 9 
 
 Q Q 
 
STATISTICS OF OBSERVATIONS. 
 
 65 
 
 . 
 
 S 
 
 O 
 
 Colostrum and breast-milk. 
 
 1 & & I 1 
 
 c3 O,O 
 [_, O O 
 
 00 
 
 & 
 
 /Colostrum; breasts beginning to 
 \ fill. 
 
 Breast-milk. 
 
 dioxide produced during the period, 
 all days are omitted in computing 
 See table 12, page 95. 
 
 8 
 
 CO CO 
 
 01 
 
 CO CO CO * * 
 CO CO 
 
 s 
 
 i 
 
 a j* 
 o ,0 
 
 " S 
 ^1| 
 
 OS 
 
 00 CO CO 
 
 t^ 
 
 "^ t>* Ci 00 t>* 
 
 o 
 
 O "^ 
 
 -2 aj 
 
 CO 
 co 
 
 co b- i> 
 
 CO CO CO 
 
 CO 
 
 CO 
 
 !> CD t"* CD CD 
 
 CO CO CO CO CO 
 
 co 
 
 c^ 
 
 Ml ^ 
 
 |&s 
 
 ^ 
 
 O CO <N 
 
 
 
 rH t. 05 rH (N 
 
 ^ 
 
 CO Tt< 
 
 ^.s a 
 
 rS S 3 
 
 CO 
 
 CO CO CO 
 
 CO 
 
 CO CO CO CO CO 
 
 CO 
 
 CO CO 
 
 S 8 
 
 s 2 '3 
 
 Ol CO 01 
 
 O<NrHbCDCDOrHt^-l 
 CO CO CO CD *O *O Tft CO ^ CS 
 
 CO l> 
 
 *- 
 
 T}<OOTHtOrHTt<tOTfTtlTtlOSOOOO5 
 OlOrHOrHrHOSrHrHOSOOOlOOS 
 
 32 
 
 ^Sr^ 
 
 l' g 
 
 ^ 2 <D 
 
 
 
 
 
 
 
 'SH^ . 
 
 Ol CO 
 Ol Ol 
 
 C1 rH 05 CO rH b- 
 rt< OS b- 00 OS 00 
 CO CO b b b* b 
 
 36 
 
 CO rH CO I s - O CO * O ^ OS 
 
 O O CO to to Ol O CO OS 
 1>I> -t^CO -COCO !> -I>iO 
 
 O CO 
 OS 00 
 CO CO 
 
 CO OS CO CO 
 
 co co * co 
 
 fs oo 
 
 i I 
 
 o d 
 
 
 
 
 
 
 
 ~* .H 
 
 c3 k-t 
 
 5*! 
 
 O CO 00 OS b- b- 
 
 10 b- 
 
 tO to 
 
 :gS3 :S^ :^^ :S :^5 
 
 CO CO 
 
 CO to CO to 
 
 o S 
 
 
 
 
 
 
 
 
 :3 
 
 rH IO Ol Tf l> CO 
 CO OS 0* 05 CO CO 
 
 01 OS 
 
 tO to 
 
 OlrH -OOO1 -Olt^ -Ol -lOrH 
 
 r^rt< --^CO -COO1 --^ -OOtO 
 
 OS 00 
 CO CO 
 
 t> IO CO rH 
 
 tO CO 00 J> 
 
 
 ,__, 
 
 --^ -^- -^- 
 
 ^z 
 
 ^_, ^__^ v_^_, V__^ 
 
 v_^_, 
 
 ^_, ^^ 
 
 d -3 
 
 13 
 
 OS 
 
 O1 -CO -00 
 
 to 
 
 00 -00 -OS -CO CO 
 
 . ^ 
 
 r| o 
 
 03 ^ 
 > w 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 O fH 
 
 , 
 
 r-^- -s ^- x , * 
 
 / * 
 
 / . / ^ * / ^i ^^-^ 
 
 , , 
 
 , , , , 
 
 t r> q^ 
 
 to ^ co 
 o t> b- 
 
 OtOb-COrHrHCO^TtllO 
 
 ss 
 
 ^T^<NCDOOcDt>OOi-HCOCD^iOi-H 
 C^ 1 s * t"* ^H Oi t>- O5 !> i> Oi 00 CO CO O 
 
 Ol O 00 
 
 rH rH O 
 
 tO Tt< tO OS CO 
 OS O CO Tj< CO 
 
 fl 
 
 o^ 
 
 CO 0* 01 
 
 COOIOICOCOCOCOOIOIOI 
 
 rH <N 
 
 
 01 01 01 
 
 01 rH <N 01 01 01 
 
 1o 
 
 IO t> 00 
 
 co co co 
 
 OS^iO^tOOOOcOCOOl 
 CO CO CO CO CO T^ 01 CO CO CO 
 
 00 O 
 
 co co 
 
 cococooicocooicococscoiococo 
 
 01 CD 00 
 CO CO Ol 
 
 Ol CO Ol rH -^1 (M 
 
 * co co co co co 
 
 Id 
 
 a ^ 
 j*i 
 
 rH 
 
 01 OS 01 
 
 00 
 
 Ol Ol tO to 01 
 
 00 
 
 S! 3! 
 
 5 ; 
 
 
 *tf Tj< Ol 
 
 
 
 Ol Ol Ol Ol CO 
 
 CO 
 
 co co 
 
 cj 
 
 IO 
 
 00 
 CO 
 
 * 
 
 CO 00 
 
 HIM 
 rH 
 
 CO CO 
 
 rH 
 Ol CO * rH 
 
 CO 
 rH 
 
 rH 
 
 Ol 
 
 rH' 
 
 Ol ^ 
 
 fi 
 
 ii 
 
 j 
 
 to 
 
 
 to tO 
 
 
 : ] 
 
 SL 
 
 !* 
 
 ^01 
 
 <JJ M 
 
 rH 
 
 01 ^ GO 
 
 OS 
 
 rH 01 T* 10 
 
 CO 
 
 t- 00 
 
 
 
 
 
 
 
 rH rH 
 
 S a> 
 
 Q 
 
 d 5 o 
 
 SjP.jp 
 
 Q 
 
 Q P Q Q Q 
 
 
 p 
 
 8 
 
 p p 
 
 > a 
 
 '5c^ 
 
 <B fl 
 
 
 ^ 
 
 
 2 
 
 
 
 III 
 
 
 -, 
 
 
 O rH 
 
 *o *o 
 
 
 
 e 
 
 S . 
 
66 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 n. 
 
 Ill 
 If 
 
 S'OI 
 aatvessiq) 
 ra -bs jta 
 
 ~ - 
 a - 
 
 (>-< -t^ 
 -Ot> -lO 
 
 ^- . 10 CO 
 
 -OO5 -O3<N -0000 -OiOi -^H 
 CO Tf CO Tt< -^ 10 -COCO -O 
 
 1 : 
 
 t 'O- -Ot> -C^ 
 
 CO -COCO -lOiO -CO 
 
 OO5 -3<N -OOO -COCO 
 O ^ O rj< CO -^ Tt< * 
 
 OOr^ -<MCO 
 
 SPA* 
 
 8 -8 S 
 P? 2 *^ 
 
 10 -CM -O -i-t 
 
 co -oo -b- -b 
 
 i-t -CO 
 
 -O 
 
 -a> 
 
 
 T*cO-O>COCOl N CO<^C s J 
 liCO ^ CO 0^-00 CO CO CO 
 
 "^CO CO CO CO COCOW CO CO CO 
 
 CN CO 
 
 CO CO CN 
 
 
 
 
 
 
 
 1 
 
 s 
 
 A 
 
STATISTICS OF OBSERVATIONS. 
 
 * 
 1 2 1 6 66-* 
 1 1 1 Q Q P 1 
 
 M u & 
 
 Colostrum. 
 
 /Colostrum; breasts beginning to 
 1 fill. 
 
 Breast-milk. 
 
 [Breast-milk ; sterile water 4 min- 
 \ utes before the observation. 
 
 Colostrum. 
 
 a 
 
 
 o o o o 
 co co co co 
 
 g 
 
 CO 
 
 rH rH 
 
 s 
 
 CO 
 
 
 (N rH O CO 
 CO CO CO CO CO CO 
 
 rH CO 
 
 O (N 
 
 
 
 CO 
 
 
 CO CO 
 
 CO CO 
 
 CO 
 
 CO 
 
 rH CO b- b- O CD (N 
 
 b- CD CO CO b- CD CD 
 
 cp cp co co cp cp cp 
 
 CO 01 
 b- CD 
 
 co co 
 . ( 
 
 l> O 
 
 CD l> 
 
 CO CO 
 
 rH 
 
 ss 
 
 I * \r 
 
 o 
 
 j 
 
 
 COCOOlCOCOlOOCDrHClOOO-^rHOlrHOCOfNCNlO 
 rH rH O C^C^C^OlC^'^rHC^IrH CO CO rH CO Tt* CO rH O rH 
 
 SOI O O O O 
 Ol Tt< rH CO (N 
 
 rH CO O CO Tf 
 <N rH rH TJH 10 
 
 O b- CM -* 
 
 (N rH rH 
 
 
 
 00 
 
 o 
 
 
 . q Q} . -^ >, . Qj rJH CO O * Tj< O CO b- CM ^O 
 Olb- CO't l b OiOb- rH b- -GCTtt -rHCO 
 CO CD CO CD CD b* CO CO b- CO b* b CO CO 
 
 IO rH rH iO 
 
 00 <N Ol <N 
 *O O t> Ol 
 
 rH 
 
 0} l> Js, 2 
 
 CO CO CO "# 
 
 i-T rH 
 
 ^ CO 
 
 i 
 
 1 
 
 :$3 : S 3 :9 33$ '-SI ;SS :SS 
 
 Ol Ol * CO C^ 
 
 CD IO rH CO 
 
 >O b- 
 
 >o 
 
 b- 
 
 *CC^ 'O5(N 'C^l -Oit^-O 'OO *COiO -<O<N 
 
 10 ^o "^ *-o *o ^o ^H ^o co *o r^ co *o co 
 
 rH CD Ol rH 
 'rH M '2J 
 
 b* CO CO ^* 
 
 01 * 
 
 CO Tt< 
 
 S 
 
 01 
 
 co 
 
 ^_^_, ,__, . ^ . ^_, ^^ ^^ 
 
 
 cz^ ^^ 
 
 , , 
 
 s 
 
 , ' 
 
 CO CO CO T-H to CO O 
 
 00 rH 
 
 t- b- 
 
 : : S 
 
 . CO 
 
 ^ 
 b 
 
 1 
 
 ' r -^~ , ' ', ' " " , V-2=2 ' > ' '*-*-* ' ' ' ' > 
 
 T)HCOClTtHiOOl(MCOOOCOCOb-OOOliOiO'*<NCOrHOO 
 COOOiiOOlOlCOO100COOO^<NrHb-iOTt*OlOlOi 
 
 iOOOOliOTf^OOC<lCDO'<tfOOdOlb-rHGO 
 -HCOC<><NCOb-OCO<N<Nb-OOCOGOOOOib-t>- 
 
 C^<NrH(NrHrH(NrH(NC^CNC<J(N(N(N<NC<JC<>CNrHrH 
 
 N rH CO C<l W CM 
 
 <N <M (N CO ^ rt< 
 
 
 
 
 rHO^t^b-^^INOlCO-'^COcNCOrHrHrtiCo'cD'cOCO 
 CNCOCOCOCOCO<N^<NCOCOCOCOCOCOCOCOCOCOCOCO 
 
 CD "40*00 O 
 O CO CO CO (N CO 
 v / , . 
 
 CO CO CO CO C^ C^ CO CO CO CO CO 
 
 >0 
 CO 
 
 ' 
 
 O J O O Cj O CO O 
 CO CO CO CO CO CO CO 
 
 Ol O 
 O O 
 
 CO CO 
 
 S b? 
 
 CO CO 
 
 8 
 
 CO 
 
 S 
 
 
 <N CO oT 
 
 rH rH 
 
 CO CO r}< 10 CO 
 
 01 
 
 rH C^l 
 
 (N 
 rH 
 
 * 10 
 
 to 
 
 rH 
 
 
 
 rH 
 rH 
 
 
 i s I I i i I I 
 
 (N * iO CO b- 00 b- 
 
 a G d d dad 
 
 oj 08 o3 03 99 
 
 l-S -3 -3 ^-S ~9 H, (-9 
 
 CO 01 
 
 4 4 
 
 rH CM 
 rH rH 
 
 1 1 
 
 rH 
 
 rH 
 
 1 
 
 rH 
 I 
 
 
 s s s ^ 
 
 8 S - 6 S 
 
68 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 B 
 
 B 
 
 ilk. 
 
 B 
 
 -qojo pug 
 
 . o 
 
 J 
 
 CO 
 
 -aasqo jo 
 
 CO CO 
 
 Illl 
 
 OCOCDO)OrHOiCOt>.C^(MOC<IO<NCOCOOOO5rHOrHTtlOO500O5lC 
 rHrHOC>JrHCOrHOrHCOCO<NCOCO-*<NrHrHrHCq(NOC<(NrHC<|C^rH 
 
 Heat produced 
 (computed) per 
 24 hours. 
 
 ra *bs 
 
 3 i 
 
 CO 
 
 t^ 
 
 GO 
 
 2 
 
 rH O 
 rH rH 
 
 CO CO 
 
 rH Tj< <M t^ rH 1C 
 <N (M <N rH t^ CO 
 
 ill 
 
 ^ rH rH d <N rH (N (N rH (N CO (N (N (N <N (N <N 
 
 8 
 
 I 
 
 ojcococo 
 
 rH^i-H(Nt^CDOOO(NrHOCDCDOI> 
 CO CO CO CO CO CO ^ CO "^ CO ^* CO CO CO CO 
 
 I- 
 
 t3 CO rH 
 
 
 00 fl r. 
 
 "6 w 
 
STATISTICS OF OBSERVATIONS. 
 
 6 
 
 Q 
 
 ? 6 6 66 
 S Q Q P Q 
 
 c3 O 
 
 6 
 
 Breast-milk. 
 No food or water. 
 
 Colostrum. 
 
 oi o 
 -3 
 
 PQ o 
 
 8 
 
 o o o o o 
 
 CO CO CO CO CO 
 10 f 
 
 TH 
 
 i 
 
 % % : 
 
 CO 
 
 CD 
 
 co 
 
 t^. a i> TH oo co 
 
 i> CO CO cO CO 4 s * 
 
 CO CO CO CO CO CO 
 
 O CO 
 
 b CO 
 
 CO CO 
 
 CO 
 
 co 
 
 O O CO 
 t> !> O 
 
 
 CO 
 
 f- CO l> TH 00 00 
 
 co co co co co co 
 
 l> CD 
 
 co co 
 
 | 
 
 TH OS O 
 
 b- CO t> 
 
 CO CO CO 
 
 rH 
 
 OOCOCOOsOrH<NTH'O<NCO<NCO<NCOCOOCb-CO 
 
 O CO b- rH CO t> 
 
 (N b- CO rH 
 W rH O rH 
 
 b-(NCDb-THlOCDCO 
 (N(NCO(NCOOO<M 
 
 
 
 
 
 
 :i 
 
 TH 00 t^ ' OS TH GO O b* ^O OS OS OS O 
 
 TH b- 00 CD 
 OS TH l> (N 
 
 O CO 
 00 b- 
 
 11 ; ill 
 
 
 rH 
 
 
 
 
 00 
 
 10 -bo -<NIO -O<N -rHt* -coco -coco 
 
 TH CD O CO 
 O O TH CO 
 
 :^S : 
 
 rH O 00 ^ O I s * 
 
 iO iO TH TH TH 
 
 
 
 
 
 
 :S 
 
 CO *O *O CO CO rH t> GO CO CD CD GO O 
 TH iO TH -COTH -COCO -<MTH -CMfN -OrH 
 
 W <N CO (N 
 
 :^2 : 
 
 b- 10 CO O b- OS 
 
 ^_ 
 
 _- -J!' v,^ -^- ^^ -^ ^Z 
 
 ^-^ ^-^ 
 
 ^^ 
 
 ^-^ v___, v_^_^ 
 
 
 
 
 
 
 b 
 
 2 -CO -b^ -00 -CO -b- -t- 
 
 b- -CO 
 
 b- 
 
 CD b- b- 
 
 , ' 
 
 _^ ^_ t l > 
 
 4 v 
 
 ^_ t 
 
 ^^ / > ',-^-> 
 
 OS CO 
 (N 
 
 IOTHOOOTHCOCOC<JTHCDCD>O>OTHTHTHTHCO 
 OSTHO3O(Nb-COCDOOOS(MOb-OSCDCOOOCOCO 
 
 X> O iO O CO O 
 3S CO CO TH CO b- 
 
 CO O OS CO 
 
 CO rH OS rH 
 
 Ob-COCOTHTHCOb- 
 COb-lOOOSCOCOOS 
 
 N (N 
 
 THTHTHCOC<>THTHNrHrHC<|rHrHrHTHTHTHi IrH 
 
 H rH rH (N rH rH 
 
 (N (N rH (N 
 
 THrH<NC<IrHrHrHrH 
 
 CM CO 
 
 COCOCO<MCOCOCOCOCOCO<NCOCO<NTHCO<NCOTH 
 
 N T? CO N W CO 
 
 f 2 fc S 
 
 CO ^T* CO C^ 
 
 HH 
 
 COTH(NCOCOCOTHCO 
 
 CO 
 
 (N CN (N IO CO CO 
 CO CO CO C^J C^l CQ 
 
 <N 1> 
 
 CO CO 
 
 <N CO 
 
 8 
 
 CO 
 
 O) C4 CO 
 <N CO CN 
 
 00 
 
 TH 
 
 CO TH iO TH CO 
 
 CO 
 
 >0 
 
 rH rH 
 
 j 
 
 :::**:: 
 
 : 9 
 
 i 
 
 i i 9 
 
 
 
 00 O CO ^ &O 
 
 (N CS| CO 
 
 CO TH 
 
 
 
 CO 00 00 
 
 q 
 
 1 
 
 1 J 1 J I 1 
 
 ^ 3 r? rH PH PH 
 
 1 1 
 
 p^ 
 
 CD V V 
 
 PH PH PH 
 
 
 PH 
 
 h 
 
 
 PH 
 
 
 s 
 
 S 
 
 
 5 
 
70 
 
 PHYSIOLOGY OF THE NEW-BOKN INFANT. 
 
 
 & 
 
 & 6 
 
 1 
 
 l tem 
 ture. 
 
 -qo jo pug 
 
 
 
 CO CO 
 
 -aasqo jo 
 
 sis 
 
 rHOrHCOCOCOC(NCO 
 
 tN<NOOO<NrH<NCO 
 
 ced 
 
 u 
 ) per 
 
 Heat p 
 (compu 
 24 h 
 
 ra -bs 
 
 1 
 
 b 00 CO C^ 
 
 CO CO N rH 
 
 05-OOt^ rH l>. 05 CO rH 
 
 IO CO l^ rH rH 
 
 CO rH (N (N -CO 
 
 :3 : 
 
 u 
 
 : fc 
 
 00 -00 
 
 tN * 04 CO 
 
 U5 CO rH O 
 
 (N tN CO CO 
 
 2 S 
 
 SI 
 
 1 
 
 A 
 I 
 
 I 6 
 
 r 
 
 o ** 
 
 J5 
 
 "Z 
 
 
STATISTICS OF OBSERVATIONS. 
 
 jj 
 
 ^5 
 
 | | 
 H3 . rt 
 
 # . 2 d a d 
 
 iljllxiil 
 
 6o ^o 
 
 Colostrum. 
 
 f Colostrum and breast-milk; 
 \ breasts filling. 
 
 Breasts filled. 
 
 Colostrum. 
 
 o o o * o o o o 
 
 CO CO CO CO CO CO CO 
 CO TH 
 
 CO 
 
 ^ 
 
 ,noosT-!t^t>i>.c<it" 
 
 t^tN."co't^cDCOCOt-CO 
 CO CO CO CO CO CO CO 
 
 O co O 
 co co co 
 
 oo 
 
 cd 
 
 CO 
 
 COOOt>-t^C<ll><NTH 
 
 CO CO CO CO CO CO CO CO CO 
 
 t O O 
 
 CO I s * I s * 
 
 CO CO CO 
 
 T-l 
 
 g5g5^TH^2888?532^i2S8Ta28S^^ 
 
 2 3 2 S 2 fe 2 8 
 
 322 
 
 
 
 
 TH 
 
 I p ill :||. 
 
 i:g 
 
 ^ CO O(N i(C "* 'S 'OcO -O5 -OiH COS t^- 
 
 t*** 00 ^ CD *O GO 00 
 
 T^ CO ^ * Tf Tf ' Tf t^- 
 
 !9 :S^J 
 
 :22:g %% 25S :88 :S :S5! S^ S 
 
 O 00 O CO iO iO O 
 
 TH T-l 
 O t^ 
 
 
 
 _^ , , 
 
 t^-C^ C^ O I s - 00 OS 00 C! 
 I s * 00 I s * t** * CO CO * f** CO t* 
 
 3 ^ co <y> 
 h co t* 
 
 : 8 
 
 _^ __^ ^ ^ ' ' ' f -^-^ ' , , ' r-^ 
 
 ^ -, % ' f _^^ , ^_ 
 
 =3 Ic^a 
 
 COtHOO(NCOTHOSCN'THTH(Nt^OTHTt<t^Ttib.iCT^cOOSOCO 
 TjHCOt>OSt^OOkCOCOOOOTi<Tj<CO(M^(M-*COOS(MOOiCOSO 
 
 St>-CC<MTj<CO<NO5COT}< 
 COi iOSi i O O TH e<) CO 
 
 O CO <N -** 
 TH CO 1C 1-1 
 
 C<INC^C^<NC^iHC$THTH<N<NTH!HTHTHiHC^WTHC<liHTHC<l<N 
 
 <N<NCOTHCO<N<N<N<NCO 
 
 (N <N <N N 
 
 OSTj<cOCSCOTH^OS^t^cOI>O5THTH<NCTt<COC<jTHCOTtfO(N 
 NCOCOINCOCOCOCOCOtNC^COIN^lCCOCOCOCOCOT^COCONCO 
 
 O CO CO CO O CO CO LQ O CO 
 <N<N<NCQCO<NCOCO<Ni-i 
 
 S8*S 
 
 COCTHCOCOTHC<JlCt^ 
 COCOCOTHTHi llCCOCO 
 
 TtiTjH<N<N<N<NCOCOCO 
 
 8 
 
 CO CO CO 
 
 8 
 
 co 
 
 N TH(MN(Nt>-I>tM 
 
 TH TH TH TH TH TH 
 
 CO-*TH<NCO'* TH(M 
 
 CO ; 
 
 i-t (M CO 
 
 (M 
 
 5? : 
 
 i-l 
 
 c 
 
 8 
 
 iCOCOh-OOOSb-OOOS 
 
 *S"o"o"o"'w'S'ffl 
 
 
 
 e* N w 
 
 
 
 (D 05 0) 
 fo (X4 fe 
 
 5 
 
 a a 
 
 s 
 
 s 
 
 9 - 8 
 
 e 
 
 B 
 
72 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 a 
 
 B 
 
 Breasts fiUed a 
 before this o 
 
 CO JS 
 
 f t^t w 
 
 tt 
 
 p, 
 
 UOrj'BAJOS 
 
 -qo jo 
 
 o> oo 
 
 S S 
 
 'UOtJ'BA 
 
 -aasqo jo 
 
 d ^ 
 
 
 % 
 
 CO -4< 
 
 s s 
 
 as 
 
 28 
 
 CN H 2 H 05 
 
 |R 
 
 11 
 
 s 
 
 -ui -bs 
 
 O5 O5 I s * CO t^- ^* CO C4 ^ 
 i-H -t^CO -OOlO -OICO -t-ICO 
 
 CO CO ^O O 
 
 CO Tt< Tf lO 
 
 1-1 CO <N CO 
 <N 10 00 rj< 
 
 1-H T-l O 
 
 -H C CO 
 
 l 
 
 : g 
 
 i-t(NCOOt'b''-tO'-H 
 <NCCCO<NO5<NT}<OOCO 
 
 'COCO<NCOCO(N<Ni-H 
 
 01 - <N (N ! IH i-i 
 
 11 
 
 *gCO<NCOCO<MCOCO 
 
 l CO i-H M< Tj< i ( 
 
 <N CO CO CO r}< TJ< 
 
 2 2 S 
 
 
 
 2 S 
 
 05 ^j 
 -g 
 
 
 d 
 
 i* 
 
STATISTICS OF OBSERVATIONS. 
 
 73 
 
 Breast-milk and colostrum. 
 
 Breast-milk. 
 Colostrum. 
 
 I* 
 
 ill 
 ^ ||i 
 
 ! i Itil i 
 
 d a a 5 !! B| 5 
 
 g T5 ro ^ o gj? TJ 
 o o 43 X o <u < - o 
 w O O tn co t 1 Oj^ojcco 
 *** fn ,3 O rj ^^ 
 50 O'o'o 0-- i 'o0 
 ^ 5? ^ m ^ 0^ 52; 
 
 e table 10, p. 81. 
 btained during the entire period of 
 i computing the heat-production. 
 
 " 
 
 o 
 
 o o o o 
 
 CO " CO CO CO 
 CO CO 
 
 g O.B 
 
 "^1 
 -g -I 3 
 
 rH 
 b- 
 
 co 
 
 b- b- 
 
 CO CD 
 CO CO 
 
 rHO500<NOOrH O COOS 
 b-COCOb-COb^ b- b-CO 
 
 cocococococo co coco 
 
 III 
 
 o 
 
 CO 
 
 d d 
 
 CO CO 
 
 * * \f 
 
 00 O O O CO 09 O5 COO 
 
 cocococococo co coco 
 
 'ill 
 III 
 
 H S fl8 
 
 ^ CO O5 OC 
 
 2228 
 
 MCOtOO<Nb-O5COb-'*Tt<rHb-COOOCO<NCOO5COrHlOb-b--^COlO-* 
 ^COfNOOMrHrHrH^rHCOfNC^rHrHOrHrHO^'^COCvlCOCOCNlCNlrH 
 
 ^ | 
 
 
 
 
 *l 
 
 iO CO 
 
 O5 CO 
 
 CO b- 
 
 iO O CO O5 
 b- IO 00 rj< 
 b- b- iO CO 
 
 O -COO -rHO5 -Tt^b- -TflrH -T^O -b-COOi b -lOO -OOCO 
 
 rH -O>O -b-b- -COCO -O5^ -COO5 ->OT^C<I -CO -COOO -COCO 
 00 -COiO -OO -COb- -COb- -bCD -CDOC<I -b- 'C5b- -b-b- 
 
 |S 
 
 K 2 
 
 -G 
 
 ;ss ; 
 
 00 CO rH CO 
 iO iO "tf *& 
 
 : S ;S9 ;SS ]99 ; ]99 :%%$ |8 ;SS ;S3 
 
 ^H 
 
 b- O 
 
 iO O O rt< 
 
 to 10 co "# 
 
 O -rHO -lO^O -b-O5 -b-00 -OOb- -OCOO5 -b- -rHOO -b-CO 
 
 d K*J*^ r? 
 
 ^: 
 
 -^- v-^- 
 
 C^ ^-^ ^-^ ^ ' ^r=: * " ^ " - - ^2 
 
 03 .3 
 '43 T3 'G -S 
 
 : g : 
 
 O CO 
 
 :3 : g : g : S : g : g : :g : J2 : fc 
 
 mi 
 
 ,_^^ 
 
 ,- -> '_c^=i 
 
 '_C~=3 L==3 L=3 Lci3 L=3 ' ' L==J L^3 
 
 ^^^8 
 
 00 CO b^ Tf 
 
 rH Tt< CO O C5 
 
 O 05 iO b- 00 
 
 OOOOCOCOT^OOcOrHCOb-COr^-<tiTl<C<J<NrHb-O5COCOOOOCOiOCOC^ 
 
 S SP d 
 
 *-. c3 g "^ 
 
 a 'S -o ^ 
 
 ,_! ,_( rH CO 
 
 <NrH<NrHrH 
 
 NCOrHrHrHCOWNNC<l<NN^^<N(NCO<N<NrHCOCO<NCOW(NWCC l C< 1 
 
 gJ-SfiS 
 
 SSS2 
 
 -^ 'V . . 
 
 H| iH|W iH| 
 
 rHTt<C^Tt<Tj<<NCOCOC^COCOC^COCOCO^ 
 
 ls|l| 
 
 O S T3 4) > 
 
 S S 2 S2 
 
 ^ 
 
 O5 CO 
 CO rH 
 
 CO CO 
 
 CO 00 ^ t>* O CO l> tv Oi 
 
 CO ^ i* O5 00 00 ^ CO C^ 
 
 COCO-^COCOCO CO COCO 
 
 "l-sH 
 
 .IS'iZ^ 
 
 CO 
 
 CO CO 
 
 CO rH CO CO (N rH -CO 
 
 lll'ai 
 
 CO 
 
 CO 
 
 rH CO CO 
 
 111- 8 a 
 
 ., 3 "s a 
 
 
 : S 
 
 CO b- CO rH O 
 
 O * 10 O -10 
 
 S oa ^a 
 
 5 ^^.s-g 
 
 Hi!l 
 
 05 
 
 O rH 
 
 eoiocob-ooo5 05 coco 
 
 S lild 
 
 JI t> fl a 
 
 1 
 
 1 1 
 
 O3o3o3o3o3o3 c3 Se3 
 
 ssssss % ss 
 
 l^^ag 
 
 Ssfil 
 
 g 3 1 *1 
 
 
 S 
 
 fe g fe ^ fe- 
 
 ^ 
 
 
 g 
 
 bj" 00 O5 O rH 
 
 1 1 
 
 6 1 S> 
 
74 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 
 i 
 
 1 S 
 
 * 
 
 s s 1 
 1 1 1 
 
 113 
 
 Breast-milk. 
 No food or water. 
 
 f 
 
 
 S : : 8 
 
 -' CO 
 
 : 
 
 I 
 
 $ | -qo jo pug 
 
 CN CO 
 
 o CD !** t^" 
 
 CO CO CO 
 
 -M O 
 
 t>! o 
 
 co co 
 
 1 
 
 UOT^A 
 
 Q, -jasqo jo 
 
 t^ CD CO 
 
 i i i 
 
 ^ 
 
 mi 
 
 SS833$SS3gS82S 
 
 ?8S28g88885: 
 
 
 <j a ^ 
 
 
 
 I 
 
 | ^ -m -to x> d 
 
 O O5 ^ O5 IS- t^ *"H CO ^O O5 C^l I s " OO O5 
 ^ -t^OOrt<Tj( t^t-i(N'-(<NcOOi ^b-CD 
 
 CO <N Tt< TH C> O <-H 00 
 (MOO O <M CD iO CO CO 
 t> l> 10 iO CD 00 t"* *O *O 
 
 V 
 
 111 -onT^ad 
 
 ^ -iCCOt^OO 00-ii-ii-i<NiOcO -OOCOCD 
 
 00 C^ CN C^ O *O 00 CO CO 
 
 1 
 
 11 N wu 
 
 'TS O5-iCOCO Tt<OiCiOiOCD^f -OcOiO 
 
 O Tj< CO CO CO l> GO GO O 
 COO CO CO CO <N O ^ O 
 
 
 
 
 
 
 
 ||o^ 
 
 :[essi iisss^ ; s 
 
 CO COCOOCOCOiOl^. 
 
 b- -t.oooooooot>.t>. 
 
 
 
 a^M 
 
 o 
 
 ^^ 
 
 'I 
 
 A 6 A S it *i 
 
 oJOO-oS^X^ 
 
 g88888S8oi 
 
 JCOT^CTSCQi-tCOCJOfMrtt 
 5COW5000000WOt^OO 
 
 & 
 
 "O 43 
 
 'a^^^^^^^c^^^^ttttc^^,^ 
 
 *<NC<J(Ni-t-lC<ICOCNCNC^ 
 
 ; 
 
 11! 
 
 |^S88S8888S6^S8SS 
 
 5(NiCCOiCOiOC55C<|U300 
 l-^CO-icOiO^-OCDiO>O 
 
 i 
 
 ^ ^ 'S "^ 
 
 _j ff r 
 
 CN CO CO 
 
 (>. 
 
 CO Tf 
 
 i 
 
 
 
 3 
 
 111] 
 
 < ^ S* N 
 
 He* 
 
 l-H 
 
 CD 
 
 ^ 
 
 1 
 
 8 5 8 
 
 ': * 
 
 
 1 
 
 =S I i 
 
 CO S 
 
 a a 
 
 
 1 
 
 s s 
 
 ^ 
 
 
 If 
 
 s s 
 
 SB 
 
STATISTICS OP OBSERVATIONS. 
 
 f Colostrum and breast-milk; 
 \ mostly breast-milk. 
 
 1 
 
 s 
 
 o 
 
 1 
 
 X 
 
 ill 1 
 
 o 2 o -| 
 K & fc 
 
 No food. 
 No food. 
 
 Colostrum. 
 
 /Colostrum and breast-milk; 
 \ breasts beginning to fill. 
 
 J The ages here given are at the beginning of the period of observation. 3 For the age from period to period, see table 10, p. 81. 
 For infants over 2 days old the age is given to the nearest half day. 4 The average respiratory quotient obtained during the entire period of 
 Calculated from the weight of carbon dioxide produced during the period. observation has been used in computing the heat-production. 
 The preliminary periods for all days are omitted in computing 
 the minimum metabolism. See table 12, page 95. 
 
 CO IO rH 
 
 05 
 
 05 
 
 8 
 
 CO l> rH 04 
 
 CD b- 05 rH 
 
 CD CO CO 1> 
 CO CO CO CO 
 
 
 
 / * N 
 
 CO 
 CO 
 
 , * < 
 
 CO b- CO rH 
 
 10 co co t^ 
 
 CO CO CO CO 
 
 rH 1>- 00 t^ 1 * 
 
 CO CO CO CO 
 
 SrH IO 
 04 rH 
 
 82g 
 
 rH CO CO ^ !> 00 CO to 04 to ^ rH to CO O CO t** ^ CD 
 
 O O rH O O5 O5 rH rH CO ^ O4 04 CM T^ rH rH rH rH O 
 
 b-iOCOb-iOOCMtOOOOSCO 
 
 C5O5rHOrHO4rHrHr-IO4O4 
 
 
 to CO 
 00 CO 
 
 : 
 
 rt^OS -COO5 O5''tflOOCOTflt>"00 -OOOtO 
 O4O4 -COrH rtlO4O'* | GOOOO -00004 
 tOCO -t>t^ tOt^OCDtOcDO5 -COCOt^ 
 
 !>. 00 O5 C4 t^ CO to O 
 COCO to iO -tOCO -t>CO 
 
 :S9 
 
 10 rH 
 
 COCO -CMrH COt^cOO400Orfi -T^lcOOO 
 CO-* -toto COrt*CO-^COT}<cO -T}<T^rt< . 
 
 CO b- 00 O5 -rHlO rH b- 
 
 : 
 
 :3 
 
 O^ -O5CO rHCOOSCOOCO^tl -COOO5 
 O4Tfi -tOto T^OOtOCOtOiOtO -COI>I> 
 
 :^ :fc :2?$ 
 
 
 : o 
 
 ; eg 
 
 
 tO rf< -CO -tO 
 
 rH 
 
 33 
 
 tO O5 O 
 
 CO rH 
 
 rHiOCOCOiOi-HtOCOrHOOCMCOl>OOO500O5CO 
 
 OOlOOOOOO5O5COOt>.l>.^rHO4l^OO5OrHO4 
 
 b O5 IT** O5 CO rH CO CO O to O5 
 
 iOiOO5tOCO04cOGOO4OOO 
 
 040404 
 
 C4 (M 04 
 
 rHi-lrHO4rHrHCO<NO4COCMC'4O4COCOrHO4<T404 
 
 rHrH04rHrHCOrHrH04(NrH 
 
 * ' 
 
 * y < 
 
 OOO4rHOOOO4'^lO<NrHTHOrHOl>-^T}H'rH' 
 
 CO-*Tj<O4r^CO(NCOiOCOcOCOcO < ^04COCOCOCM 
 
 OSOOTttOOb-lOOO^COlO 
 CO Tfl C4 CO CO rH CO CO O4 CO CO 
 
 CO 
 
 O4 
 
 to 
 
 CO 
 
 04 CO ^ 04 
 CO O O5 t> 
 
 CO CO CO CO 
 
 C4 * O4 CO 
 
 CO O4 rH O 
 
 04 CO CO CO 
 
 CO 
 
 05 
 
 *> 04 rH ,0 
 
 CO rH 
 
 CO b- CO O4 
 rH 
 
 r- 1 04 
 
 
 
 s 
 
 S : 5 
 
 tO to 
 b- O5 
 
 1 
 
 co 
 
 CM 
 
 si 
 
 O 04 rH rH 
 CO CO 
 
 1 1 1 i 
 * ^ s < 
 
 <N 04 04 
 
 ft 0, 0, ft 
 
 
 s 
 
 ^ ^ 
 
 ti Jg' 
 
 
 s 
 
 S - So 
 
 oo o 
 oo oo 
 
76 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 Heat produced 
 (computed) per 
 24 hours. 
 
 (!il A 8'01 
 janrass 
 ra -bs 
 
 rH CO 
 IO ^ 
 00 b 
 
 rH O CN CO Oi 
 b- CO IO Tf* ^ 
 
 S 
 
 8 
 
 rH b. 
 
 O CO 
 
 |M 
 
 rH(NOOCNrHiO^Oib-b-OOOOb-OOb-O5OO<NO5COb--^ 
 T^Oi^COCNO>OCNb-b-OOCOb-OOCOOO(NCOOiOO5b-CO 
 
 'COCN(NO^CNCNCNC<lrHC^CNrHrHrHrHrHTHCNrH(N(NrH(NrHC<J(N<NCOCO<N 
 
 I 
 
 8 
 
 
 I I 
 
 Id 
 
STATISTICS OF OBSERVATIONS. 
 
 77 
 
 1 1 
 
 s s a 
 
 1 ill "8 
 1 1 J j 5 
 
 o o "3 o o 
 55 55 55 55 
 
 hour was required for its resuscita- 
 
 je table 10, p. 81. 
 btained during the entire period ol 
 i computing the heat-production, 
 utes. 
 
 T* 
 
 g s u -s a 
 
 * - -P -0 
 
 T3 a a> S 
 
 O O w * 
 
 w "6 * " 
 
 1 8. S a 
 
 00 <N t>. CO OS 
 
 3*2 
 
 Nlii 
 
 GO CO -I CO <N 
 
 C*O CO CO CO CO 
 
 l^ll 
 H -|| 
 
 ^^c^^^^2^^^?5^^^^^S^^^2^^g5^^S^2g^c5cB^ 
 
 , 2 fc 
 
 llsll 
 
 
 tJ *> o3 fc 
 
 rH T ( 
 
 ^ l 
 1 II 1 
 
 :SS5SSS JS^S^RS^ :gg :3g338S8 SS83fe3 
 
 fLi pE< EH 
 
 iQ O CD *O !> I s * O O *O CD C^ CO *O O5 CO C^ ' *O O I s * C^ O CO Oi CO O CO ^ O O5 CO 
 
 fl >T3 fl 1 
 
 ,* ^^^ .au.^^-.-,-, Us> o 1 o ieu , usi o 
 
 .2 * .2 : 
 
 OOl>b-OOt>t^.OO t>OOOObOSOOt- l>- XOOGOOOb-OOOS OSOOOSOOOOCOCO 
 
 5 53 , 
 
 fcj | 
 
 ' i ' 
 
 ll" 
 
 ^SSSo?Sc5^2S^^g^S&^Scit:^ggSSo^gt28 
 
 M fl 
 
 "o <u 'C ^ 
 
 2 s ^ 10 
 
 CO(N^CNC^rHr^(NCO(NC^THC<lCO(NN(N(NCONTHrHrHTHrH^(N<NHrH^H^^^N 
 
 1 S^S^ 
 
 t!!*o <M n o <M o es ^^ H|e ' 
 
 S^'SI I 
 ft B , 
 
 UJ rj -Q <U . 
 
 ^3 o *H <N 
 
 co 
 
 iO O OS ^ CO 
 
 co' * ^ N . 
 
 CO CM <N CO 
 
 :!&:: 
 Hl 
 
 CO CD Oi 00 
 
 *: *: *: *: 
 
 gs^^l 
 
 tC^ C M 
 -M 
 
 ^2-s^ a 
 
 s s i s 
 
 43 o> o ^3 
 
 *I*11 
 
 os^ 3 -g a^ 
 
 g^>>! 
 
 c5 c^ M 
 S, a ft 
 
 B 1 f J J 
 
 o ^ .S S 
 
 p*jil 
 "*a1U 
 
 Jo o ft '3 
 
 S S fe h 
 
 Jiii 
 
 8 - | S 8 
 
 bC c3 
 
 J 
 
 ^ 5 
 
78 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 
 . = 
 
 3 
 
 -qo jo pag 
 
 -aasqo jo 
 
 vy KT t/j 
 
 ill 
 
 
 
 i-H C^ T^ i~< CO CO I s * CO CD O5 
 OOdi-<OCO*Hi-c<NCO 
 
 A '01 
 ntjss 
 -ra -be 
 
 CDiOkOWJ'OCDO 
 
 t>.rHT^O5 t-H fl b- N 
 
 ^J 
 
 e 
 
 W -S 
 
 1 ; 
 
 O t^ O5 O 
 
 CO (N 00 O5 
 
 g o- 
 
 X 00 00 00 00 00 00 
 
 : cj ' 
 
 ^StSSo 
 
 > c<i ,4 ^H' ,4 ^H 
 
 CO<Nt-iCO<N(N(NCO 
 
 ill 
 
 fil 
 
 FH O d CO CO O5 O O) CO CO CO CO O 
 COCOt>CO(N*OCO*Ot>-COiOiOi-i 
 
 S 
 
 58 
 
 
 
STATISTICS OF OBSERVATIONS. 
 
 79 
 
 111 
 
 t c; ^ 
 
 ooo 
 fc ^ ^ 
 
 No food. 
 
 1 
 
 
 & 
 
 ee table 10, p. 81. 
 btained during the entire period oi 
 i computing the heat -production, 
 
 
 
 
 -a +3 -o 
 
 3-8] 
 33 
 
 o, o d 
 
 co co co 
 
 CO 
 
 CO 
 CO 
 
 ftj 
 
 111 
 
 *& b- O 
 
 CO O CD 
 
 co co co 
 
 CD 
 CO 
 
 i 
 
 i 
 
 g^^^^^22J232833^^^^^S^S^ 
 
 Tj<COb-CO<NiOOOO3 
 
 sssssss 
 
 **"* CO (3 
 
 
 
 
 M c3 ^ 
 03 aJ 02 
 
 <MCOrt*rt<CD(NCD -rJICDGOb-OOb-CN -rfiOGOO3^00O 
 <MrH(MOO5OO rHCOO5rHOlOO5 -OOb-O5O5lOOiO 
 CDb-bOTt<COCO -CDiOT^iOb-CDb- COiOb-COCOO5GO 
 
 CO O5 GO O5 O5 rH 
 CO IO O5 GO CO 00 
 
 O b- b- CO <N CO rH 
 CO "tf O b- rH CO O3 
 
 O CD b- iO CO b- O 
 
 ^ CD .S 
 O -d g 
 
 rHbb-COC<IO3O -lOOSCDOOtOOOOO -b-OiOCMOCOOs 
 rflrt<Tj<cOCOCOTt* ^COCOCOiO'^lO rtlTflOCO^COlO 
 
 O5 <N * Tt< CO O 
 CO CO CO CO 10 TF 
 
 gssssgs 
 
 *& * 
 
 GO rH Tf4 GO CD CO "^ * b* rH CO b b- CD ^ CO O C^ ^O O5 b- *O 
 iOGOOO(N(M>OiO -CMrHOOiOCOCD -lOCOOOOT^OOJ 
 
 O3 iO -^ (M CO CO 
 
 CN O rH rH b- CO 
 
 sssssss 
 
 d >>T3 M 
 
 ^^.^^.^^^ ., ^.^^^^^.^ 
 
 
 
 ,0 03 _0 
 
 O5OTt<(MrHCOCO -COO<NOOOOOrH -O300rHlOrHCOO 
 
 GOOOOOOOOOOO -OOOOOOb-OOXCO -COb-OSOOOOOOOO 
 
 <N O CO O5 CO <N 
 O3 CO O5 GO GO 00 
 
 CO O5 O5 <N rH CN (N 
 
 00 00 CO CO GO CO GO 
 
 o3 <U p, 
 
 ^ 
 
 
 
 J ^"5 
 
 ^^^iSs^^^S332S^2^fegii2gS 
 
 b O *O 00 ^O GO IO rH 
 rH O5 *O CD CO *O O5 C^ 
 
 O (N CO O CN rH T^ 
 
 GO rH CO O5 O * O 
 
 SlI* 3 
 
 COC<JC^<NrHrH(NC<)CvlrHrHrHrHCNrHC<>eOCNrHCNC<l<NCN(N 
 
 CNrHrHrHrHIMrHCN 
 
 rH (M CN rH (N CM CN 
 
 "o CD T3 ^ ^ 
 
 OCOOXCOOOrHb-OOrf<O3rHrHCOrHCOrHrHOOOCOrf<OOO5 
 
 NcOCOCOiOOCDO<NCDiOCOCOb-COOCOCOCOtOCDCOOO 
 
 3S S gi8S 
 
 CO CO GO CO rH rH O 
 CO iO CO CD CO CO 
 
 lllis 
 
 CO d CO 
 
 
 
 CO 
 
 b- 
 
 CO 
 
 Sill 
 
 b- rH O 
 * * 
 
 n* 
 
 ? 
 
 nil 1 
 
 2-s a 
 
 tO *O 
 
 H t* O 
 
 iO * * 
 
 S 
 
 o 
 
 8 
 
 rd S 1 3 
 
 ^ "'!! 
 
 t> O ^H 
 
 i4 iH (N 
 
 ft ft ft 
 
 s s s 
 
 & 
 
 a 
 
 S 
 ft 
 
 jjjjfj 
 
 s s ^ 
 
 s 
 
 a 
 
 lllSl 
 
 2 i 2 
 
 2 
 
 1 
 
 J 1 
 
80 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 DISCUSSION OF RESULTS. 
 
 The data we have accumulated in this study of new-born infants 
 permit a reasonably complete discussion of several phases of infant 
 katabolism, particularly the character and the amount of the katabo- 
 lism and the physiological needs of infants during the first week after 
 
 birth. 
 
 CHARACTER OF THE KATABOLISM. 
 
 Though previous observations with adults and animals give us no rea- 
 son to expect any particular kind of katabolism with new-born infants, 
 except that which may be due to the character of the food-supply and 
 possibly to muscular work as in severe crying, nevertheless since it is 
 commonly believed that there is an excess of glycogen in the body of 
 the new-born infant, it is necessary to examine carefully the character 
 of the katabolism during the first week, if not, indeed, during the first 
 hours of life. Such a study will give evidence as to the probable gly- 
 cogen content of the body, or, more specifically, the availability of the 
 glycogen content for supplying the needs of the body in the absence 
 of the ingestion of food. 
 
 It was possible to determine the respiratory exchange of the infants 
 by means of the respiration apparatus, and from these data to calculate 
 the respiratory quotient for practically all of our observations. As has 
 already been pointed out in our description of the technique, the 
 greatest errors are liable to appear in the determination of the oxygen 
 consumption, as this requires an exact knowledge of the temperature, 
 humidity, and barometric pressure inside the chamber. Since this 
 error may be minimized by measuring the oxygen consumption in 
 long periods, it has been our custom to determine the oxygen consump- 
 tion for the entire time that the infant was inside the chamber, sub- 
 dividing the observations into periods upon the basis of the carbon- 
 dioxide measurements. In certain observations these periods were 
 made long enough to obtain fairly accurate respiratory quotients for 
 the individual periods. This is particularly the case with the infants 
 studied immediately after birth. Our data are therefore sufficiently 
 extended to permit us to discuss the respiratory quotient of the new- 
 born infant during the first week of life and particularly during the 
 first 24 hours following birth. 
 
 RESPIRATORY QUOTIENT DURING THE FIRST 24 HOURS OF LIFE. 
 
 The greater part of our evidence in regard to the respiratory quotient 
 during the first 24 hours of life was obtained in those observations 
 which were specifically designed to study this question, namely, those 
 in which the infants were observed almost immediately after birth. 
 The periods were for the most part 1 hour long and therefore may rea- 
 sonably be expected to give satisfactory determinations of the oxygen 
 consumption. The results are given in abstract in table 10. 
 
CHARACTEE OF THE KATABOLISM. 
 
 81 
 
 TABLE 10. Respiratory quotients of infants during early hours after birth. 
 
 
 
 
 
 
 Relative 
 
 
 
 
 
 
 Relative 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 Age at 
 begin- 
 ning of 
 period. 
 
 Respi- 
 ratory 
 quo- 
 tient. 1 
 
 Car- 
 bon 
 diox- 
 ide per 
 hour. 
 
 activity 2 
 estimated 
 from kymo- 
 graph records. 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 Age at 
 begin- 
 ning of 
 period. 
 
 Respi- 
 ratory 
 quo- 
 tient. 1 
 
 Car- 
 bon 
 diox- 
 ide per 
 hour. 
 
 activity 2 
 estimated 
 from Kymo- 
 graph records. 
 
 Obs. 
 
 Obs. 
 
 Obs. 
 
 Obs. 
 
 
 
 
 
 
 I. 
 
 II. 
 
 
 
 
 
 
 I. 
 
 II. 
 
 
 
 h. m. 
 
 
 Qvn. 
 
 
 
 
 
 h. m. 
 
 
 gm. 
 
 
 
 80 
 
 M. 
 
 2 . . 
 
 0.75 
 
 2.14 
 
 B ' 
 
 B 
 
 95 
 
 F. 
 
 4 15 
 
 0.83 
 
 1.71 
 
 B 
 
 B 
 
 
 
 3 . . 
 
 .78 
 
 1.76 
 
 A 
 
 A 
 
 
 
 5 15 
 
 .70 
 
 1.41 
 
 A 
 
 A 
 
 
 
 4 . . 
 
 .90 
 
 3.99 
 
 D 
 
 C 
 
 
 
 6 15 
 
 .84 
 
 1.58 
 
 B 
 
 B 
 
 
 
 6 .. 
 
 3 .78 
 
 2.39 
 
 C 
 
 B 
 
 
 
 7 15 
 
 [.93] 
 
 2.09 
 
 E 
 
 D 
 
 82 
 
 M. 
 
 3 .. 
 
 .76 
 
 1.28 
 
 A 
 
 A 
 
 96 
 
 F. 
 
 1 15 
 
 .93 
 
 .87 
 
 F 
 
 D 
 
 
 
 4 15 
 
 .78 
 
 1.60 
 
 B 
 
 B 
 
 
 
 2 15 
 
 .85 
 
 .75 
 
 D 
 
 C 
 
 
 
 5 15 
 
 .83 
 
 1.75 
 
 B 
 
 B 
 
 
 
 3 30 
 
 .91 
 
 .65 
 
 A 
 
 A 
 
 
 
 6 15 
 
 .80 
 
 1.77 
 
 C 
 
 B 
 
 
 
 4 30 
 
 .89 
 
 .95 
 
 C 
 
 B 
 
 83 
 
 M. 
 
 2 30 
 
 .80 
 
 2.06 
 
 A 
 
 A 
 
 
 
 5 30 
 
 .80 
 
 .75 
 
 A 
 
 A 
 
 
 
 3 30 
 
 .90 
 
 2.21 
 
 A 
 
 A 
 
 
 
 6 30 
 
 .86 
 
 .88 
 
 B 
 
 B 
 
 
 
 4 30 
 
 .83 
 
 2.22 
 
 B 
 
 B 
 
 
 
 7 30 
 
 .86 
 
 .09 
 
 E 
 
 E 
 
 
 
 5 30 
 
 .83 
 
 2.20 
 
 C 
 
 C 
 
 97 
 
 F. 
 
 2 . . 
 
 .85 
 
 .82 
 
 F 
 
 F 
 
 
 
 6 30 
 
 .85 
 
 2.24 
 
 B 
 
 B 
 
 
 
 3 .. 
 
 .84 
 
 .75 
 
 E 
 
 E 
 
 
 
 7 30 
 
 .79 
 
 2.39 
 
 D 
 
 D 
 
 
 
 4 . . 
 
 .82 
 
 .58 
 
 A 
 
 A 
 
 
 
 8 30 
 
 [.99] 
 
 3.55 
 
 E 
 
 E 
 
 
 
 5 .. 
 
 .87 
 
 .61 
 
 B 
 
 B 
 
 84 
 
 F. 
 
 2 . . 
 
 .76 
 
 1.82 
 
 B 
 
 A 
 
 
 
 6 . . 
 
 .87 
 
 .65 
 
 D 
 
 E 
 
 
 
 3 .. 
 
 .83 
 
 1.81 
 
 A 
 
 A 
 
 
 
 7 .. 
 
 .86 
 
 .84 
 
 C 
 
 D 
 
 
 
 4 . . 
 
 .80 
 
 2.26 
 
 D 
 
 C 
 
 
 
 8 .. 
 
 .86 
 
 .80 
 
 C 
 
 C 
 
 
 
 5 . . 
 
 .86 
 
 3.09 
 
 F 
 
 D 
 
 98 
 
 F. 
 
 2 . . 
 
 0.77 
 
 .33 
 
 D 
 
 C 
 
 
 
 6 .. 
 
 .83 
 
 2.70 
 
 E 
 
 C 
 
 
 
 3 .. 
 
 .90 
 
 .93 
 
 F 
 
 D 
 
 
 
 7 .. 
 
 .75 
 
 2.02 
 
 C 
 
 B 
 
 
 
 4 . . 
 
 .90 
 
 .22 
 
 E 
 
 E 
 
 
 
 8 .. 
 
 .77 
 
 2.04 
 
 C 
 
 B 
 
 
 
 5 .. 
 
 .74 
 
 .50 
 
 C 
 
 B 
 
 87 
 
 M. 
 
 1 30 
 
 .79 
 
 2.06 
 
 A 
 
 A 
 
 
 
 6 .. 
 
 .74 
 
 .37 
 
 B 
 
 A 
 
 
 
 2 45 
 
 [1.05] 
 
 2.71 
 
 D 
 
 C 
 
 
 
 7 .. 
 
 .79 
 
 .38 
 
 A 
 
 A 
 
 
 
 3 30 
 
 [-90] 
 
 3.78 
 
 F 
 
 D 
 
 
 
 8 15 
 
 .85 
 
 .50 
 
 B 
 
 A 
 
 
 
 4 45 
 
 .81 
 
 2.42 
 
 B 
 
 B 
 
 99 
 
 M. 
 
 1 30 
 
 .79 
 
 2.09 
 
 B 
 
 B 
 
 
 
 5 45 
 
 .76 
 
 2.18 
 
 A 
 
 A 
 
 
 
 2 30 
 
 .83 
 
 1.78 
 
 A 
 
 A 
 
 
 
 6 45 
 
 .84 
 
 2.27 
 
 C 
 
 B 
 
 
 
 3 30 
 
 .93 
 
 3.09 
 
 D 
 
 C 
 
 
 
 7 45 
 
 [-96] 
 
 3.70 
 
 E 
 
 D 
 
 
 
 4 30 
 
 .90 
 
 2.33 
 
 C 
 
 B 
 
 93 
 
 M. 
 
 1 
 
 .83 
 
 2.69 
 
 F 
 
 F 
 
 
 
 6 . . 
 
 .83 
 
 2.00 
 
 A 
 
 A 
 
 
 
 2 .. 
 
 .77 
 
 1.86 
 
 D 
 
 C 
 
 
 
 7 .. 
 
 .89 
 
 2.81 
 
 D 
 
 D 
 
 
 
 3 .. 
 
 .79 
 
 2.01 
 
 C 
 
 D 
 
 
 
 7 45 
 
 .87 
 
 3.25 
 
 E 
 
 E 
 
 
 
 4 .. 
 
 .87 
 
 2.69 
 
 E 
 
 E 
 
 100 
 
 M. 
 
 1 15 
 
 .90 
 
 3.47 
 
 D 
 
 E 
 
 
 
 5 .. 
 
 .76 
 
 1.89 
 
 B 
 
 A 
 
 
 
 2 15 
 
 .98 
 
 3.43 
 
 D 
 
 F 
 
 
 
 6 . . 
 
 .77 
 
 1.89 
 
 A 
 
 A 
 
 
 
 3 15 
 
 1.00 
 
 4.36 
 
 E 
 
 G 
 
 
 
 7 . . 
 
 .86 
 
 2.07 
 
 B 
 
 B 
 
 
 
 4 15 
 
 .85 
 
 2.86 
 
 C 
 
 D 
 
 94 
 
 M. 
 
 1 15 
 
 .76 
 
 2.09 
 
 C 
 
 D 
 
 
 
 5 15 
 
 .87 
 
 2.96 
 
 A 
 
 B 
 
 
 
 2 15 
 
 .87 
 
 2.16 
 
 D 
 
 D 
 
 
 
 6 15 
 
 .91 
 
 2.81 
 
 A 
 
 A 
 
 
 
 3 15 
 
 .81 
 
 1.89 
 
 A 
 
 A 
 
 
 
 7 15 
 
 .82 
 
 3.12 
 
 B 
 
 C 
 
 
 
 4 15 
 
 .75 
 
 2.12 
 
 C 
 
 B 
 
 101 
 
 M. 
 
 1 15 
 
 .89 
 
 2.34 
 
 C 
 
 C 
 
 
 
 5 15 
 
 [-96] 
 
 3.24 
 
 F 
 
 E 
 
 
 
 2 15 
 
 1.00 
 
 2.69 
 
 F 
 
 E 
 
 
 
 6 15 
 
 .80 
 
 2.29 
 
 C 
 
 C 
 
 
 
 3 15 
 
 .94 
 
 2.73 
 
 E 
 
 E 
 
 
 
 7 15 
 
 .79 
 
 2.07 
 
 B 
 
 B 
 
 
 
 4 15 
 
 .82 
 
 1.90 
 
 B 
 
 B 
 
 95 
 
 F. 
 
 1 15 
 
 .89 
 
 1.90 
 
 D 
 
 C 
 
 
 
 5 15 
 
 .81 
 
 1.87 
 
 A 
 
 A 
 
 
 
 2 15 
 
 .80 
 
 1.54 
 
 C 
 
 B 
 
 
 
 6 15 
 
 .88 
 
 2.27 
 
 D 
 
 D 
 
 
 
 3 15 
 
 .84 
 
 1.65 
 
 B 
 
 B 
 
 
 
 7 15 
 
 .86 
 
 2.29 
 
 D 
 
 D 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Duration of periods about 1 hour in practically all cases. 
 
 J The designations here used indicate only that the activity in one period is greater or less than in 
 
 the other periods, the letter A being applied to the period of least activity in each case. 
 
 The designations are not comparable for the different subjects. 
 8 This quotient was obtained following an interval in which the cover of the chamber was 
 
 removed to give the baby a small amount of sterile water and after a second preliminary 
 
 period. 
 
82 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 TABLE 10. Respiratory quotients of infants during early hours after birth Continued. 
 
 
 
 
 
 
 Relative 
 
 
 
 
 
 
 Relative 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 Age at 
 begin- 
 ning of 
 period. 
 
 Respi- 
 ratory 
 quo- 
 tient. 1 
 
 Car- 
 bon 
 diox- 
 ide per 
 hour. 
 
 activity 2 
 estimated 
 from kymo- 
 graph records. 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 Age at 
 begin- 
 ning of 
 period. 
 
 Respi- 
 ratory 
 quo- 
 tient. 1 
 
 Car- 
 bon 
 diox- 
 ide per 
 hour. 
 
 activity 2 
 estimated 
 from kymo- 
 graph records. 
 
 Obs. 
 
 Obs. 
 
 Obs. 
 
 Obs. 
 
 
 
 
 
 
 I. 
 
 II. 
 
 
 
 
 
 
 I. 
 
 II. 
 
 
 
 h. m. 
 
 
 gm. 
 
 
 
 
 
 h. m. 
 
 
 gm. 
 
 
 
 102 
 
 M. 
 
 2 15 
 
 0.83 
 
 1.76 
 
 D 
 
 C 
 
 104 
 
 M. 
 
 1 45 
 
 0.92 
 
 1.90 
 
 D 
 
 C 
 
 
 
 3 15 
 
 .80 
 
 1.55 
 
 C 
 
 C 
 
 
 
 2 45 
 
 .85 
 
 1.55 
 
 B 
 
 A 
 
 
 
 4 15 
 
 .82 
 
 1.43 
 
 A 
 
 A 
 
 
 
 3 45 
 
 .96 
 
 1.68 
 
 A 
 
 A 
 
 
 
 5 15 
 
 .78 
 
 1.49 
 
 B 
 
 B 
 
 
 
 5 .. 
 
 .89 
 
 1.65 
 
 C 
 
 B 
 
 
 
 6 15 
 
 .88 
 
 2.19 
 
 E 
 
 D 
 
 
 
 6 .. 
 
 .88 
 
 2.58 
 
 E 
 
 D 
 
 
 
 7 30 
 
 .80 
 
 1.89 
 
 D 
 
 C 
 
 
 
 7 .. 
 
 .82 
 
 1.95 
 
 C 
 
 C 
 
 
 
 8 30 
 
 .81 
 
 2.28 
 
 F 
 
 E 
 
 105 
 
 M. 
 
 3 15 
 
 .83 
 
 1.85 
 
 A 
 
 A 
 
 103 
 
 F. 
 
 1 15 
 
 .89 
 
 2.25 
 
 A 
 
 A 
 
 
 
 4 30 
 
 .89 
 
 2.12 
 
 E 
 
 D 
 
 
 
 2 15 
 
 .78 
 
 1.87 
 
 A 
 
 B 
 
 
 
 5 30 
 
 .89 
 
 2.33 
 
 D 
 
 E 
 
 
 
 3 15 
 
 .91 
 
 2.63 
 
 D 
 
 D 
 
 
 
 6 30 
 
 .82 
 
 1.90 
 
 A 
 
 A 
 
 
 
 4 15 
 
 .85 
 
 2.96 
 
 E 
 
 D 
 
 
 
 7 30 
 
 .81 
 
 2.02 
 
 C 
 
 B 
 
 
 
 5 15 
 
 .81 
 
 2.15 
 
 B 
 
 C 
 
 
 
 8 30 
 
 .82 
 
 2.41 
 
 D 
 
 E 
 
 
 
 6 15 
 
 .88 
 
 2.99 
 
 D 
 
 D 
 
 
 
 9 30 
 
 .82 
 
 2.04 
 
 C 
 
 C 
 
 
 
 7 15 
 
 .85 
 
 2.82 
 
 C 
 
 D 
 
 
 
 
 
 
 
 
 1 Duration of periods about 1 hour in practically all cases. 
 
 2 The designations here used indicate only that the activity in one period is greater or less than in 
 
 the other periods, the letter A being applied to the period of least activity in each case. 
 
 The designations are not comparable for the different subjects. 
 
 When we examine the individual quotients for each day, we find 
 that at times there are great fluctuations, as, for instance, in the case of 
 subject 83, in which there was an increase in the last period from 0.79 
 to 0.99. Since the infant had had no previous nourishment and was 
 without food during the whole time that it lay in the respiration 
 chamber, it is of course inconceivable that after 8J hours of fasting 
 subsequent to birth there should have been this qualitative alteration 
 to a metabolism which would be indicative of pure carbohydrate com- 
 bustion. On several other days similar abnormal respiratory quotients 
 are found, these being indicated in the table by brackets. These 
 brackets are not used to differentiate sharply between the correct and 
 incorrect quotients, but merely to point out the most strikingly defective 
 quotients. 
 
 There may be two reasons for these defective quotients. In the 
 first place, they may be due to excessive carbon-dioxide excretion, 
 unaccompanied by a corresponding increase in the oxygen absorption, 
 or they may be due to a defect in the measurement of the oxygen, 
 particularly of the residual oxygen inside the chamber. If we examine 
 the values given in this table for the total carbon-dioxide production, 
 we find that at times there are very great increases. Thus, with 
 infant No. 80, there was an increase of over 100 per cent in the carbon- 
 dioxide production from the second to the third period of the observa- 
 tion, this being accompanied by an increase of 0.12 in the respiratory 
 
CHARACTER OF THE KATABOLISM. 83 
 
 quotient. With practically all of the quotients which are inclosed in 
 brackets we find very great increases in the carbon-dioxide production 
 over that of the preceding period; hence we may ascribe at least a 
 portion of this change in the quotient to an excess carbon-dioxide 
 excretion. It is not impossible that a certain amount of the carbon 
 dioxide thus excreted may be due to actual over-ventilation of the 
 lungs of the infant, produced by excessive crying; this can not, how- 
 ever, account for the entire increase. 
 
 For a partial explanation of these variations in the carbon-dioxide 
 production, we may with profit examine the kymograph records accom- 
 panying each period. It is impracticable to publish all of the records 
 obtained in this series of observations; accordingly two skilled observers 
 have examined them independently and have indicated the relative 
 activity by ascribing a letter to each individual period. This classi- 
 fication is not intended as a comparison of the activity of one infant 
 with another, nor do the letters designate arbitrary degrees of muscular 
 repose. They apply only to the activity of each infant by itself and 
 show the muscular repose of the individual periods as related to that 
 of the other periods, A being used to designate the greatest degree of 
 muscular repose. If there are two periods in an observation when the 
 muscular repose is of exactly the same degree, they are given the same 
 letter. (See infant No. 82.) The estimations made by Observer I 
 and Observer II never differ more than one unit in classification and 
 usually they are identical. It will be seen that in practically all of the 
 instances in which abnormally high quotients were found, there was 
 a great increase in the activity as shown by the kymograph record. 
 While a variation in the degree of muscular repose is not always 
 accompanied by a variation in the respiratory quotient, nevertheless 
 this is true in the majority of cases. 
 
 In view of these considerations, we must accept with reserve the 
 respiratory quotients which do not lie within reasonable limits of the 
 average quotient for the day. If the infant organism were surcharged 
 with glycogen we would normally expect to find a high respiratory 
 quotient shortly after birth, with a gradual decrease throughout the 
 day. A critical examination of all of the values in table 10 shows 
 a distinct, though slight, tendency for the quotient to fall off during 
 the day; on the other hand, the initial quotients are not extremely high, 
 being for the most part considerably less than 0.90. We may there- 
 fore properly conclude that while the quotients have a tendency to 
 decrease as the period of inanition lengthens, since the quotients are 
 rarely as high as 0.90, even when obvious technical errors are eliminated, 
 we can not infer that the katabolism is chiefly that of carbohydrate 
 during the observation period. 
 
 According to the table of Zuntz and Schumburg, a non-protein 
 respirato^ quotient of 0.90 corresponds to a combustion in which 
 66 per cent of the total energy is derived from carbohydrate and 34 
 
84 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 per cent from fat. While with these infants we have not been able 
 to secure a non-protein respiratory quotient, we may safely disregard 
 this fact and assume that a quotient of 0.90 with these infants cor- 
 responds to a katabolism in which approximately two-thirds of the 
 maintenance metabolism is derived from carbohydrate. 
 
 To obtain the average respiratory quotient for these infants on the 
 first day of life, we may best examine the values given in table 11, 
 in which all of the respiratory quotients on the first day have been 
 brought together and averaged. We find that the average respiratory 
 quotient for 74 infants on the first day of life was 0.80, a value materi- 
 ally lower than the quotient of 0.90 occasionally appearing in the first 
 few hours of life. This value of 0.80 represents a fasting value not 
 widely different from that observed during the first 24 hours with fasting 
 man, a previous publication from this laboratory showing that the aver- 
 age respiratory quotient in 14 experiments with 10 men was 0.79 on the 
 first day. 1 
 
 Benedict, Carnegie Inst. Wash. Pub. No. 77, 1907, p. 451. 
 
CHARACTER OP THE KATABOLISM. 
 
 85 
 
 -i> 
 
 -00 
 
 CO O 
 >l> CO 
 
 S&T^" 
 II M 
 
 4 
 
 s 
 
 i> co j 
 
 t^ ^ CO 
 
 CO CO CO 
 
 3i 
 2| 
 
 m 
 
 5 : 
 
 t> t>- O O -COIN 
 r-l -0p -CO GO 10 
 
 Tt< -COTji -CO -(NCO 
 
 O C<J l> <N 
 
 O O CO CO 
 
 CO CO CO CO 
 
 II 
 
 S :J:2 : :898889 
 
 TjJ -COCO -(NCOCOCOfNCO 
 
 &%% : 
 
 CO CO CO 
 
 O5 -<N 
 
 o -t>- 
 
 iO"tfO<NOCCOl>O<Ni-HiOCO 
 
 * # ++ * -M-* at 
 
 CO GO GO CO 
 * * * 
 
 T}<COCOCOCOCO!NCOCOCO<NCO -COCOCO -COCO 
 
 COt>.lOCO -t>-lOCOO(NO 1>GO'HCO 
 
 CO t>. CO CO t^. t^ CO t*. . l> .CO t l> l> CO 
 
 *'*'*.* * * * * 
 
 . CO 
 
 *2 
 
 O-^t^b- -OOCOTHOr-l -r}HGO<NO 
 COTt<COCO COCOCOCOCOlN -COlNlNCO 
 
 -CO -COCOCOCO 
 
 03 Q 1 - 
 
 ^ ' ' 
 
 CO CO CO ^ * CO ^ CO CO CO CO CO ^ CO CO CO CO C^l CN CO CO CO CO CO CO 
 
 B 
 
 fe 
 
 * : : : 
 
 * -CO 
 -CO -O 
 
 COCO 1 ^ -CO 
 
 (M l> 
 
 * "^ CO ^ CO CO CO CO CO 
 
PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 
 
 T3 
 
 B 
 
 5 
 
 5 
 
 
 
 * 
 
 5 : 
 
 : : : :g ::::::::: 
 
 H UJ 
 
 b- CO 
 
 CO rt< 
 
 I 
 
 Mil 
 
 bt X 
 
 C* U3 CO r-l 
 
 x x oO x 
 
 
 
 r-i *O "t O b- -00 -O 0> "* O <* 05 05 "5 CO -I O -I <N rf X b- 
 X X O O5 b- -b- -O5 -X -b. -b-b-b-b- '00^ 'O . 00 . ^ '^^^ ' . 
 O -H- ' I ** I * I I * I ' " 4 ' 
 
 II 
 
 !^? 
 
 CO CO CO CO Tt . M <N 
 
 CO -CCCOTjlN -COCO 
 
 05 03 
 r-t CO 
 
 CC CO 
 
 O O C* O iO 
 
 cc ' PO N cc ec 
 
 b-b-b-b- 
 
 b-b- -b-O 
 
 O ++*+ 
 
 * 
 
 O-^O -Oi -C<>kC -CO -OifNOiN -TtO5 -O -O3 -O -b-b- '^Oi 
 ^ CO t> CD -CO b- b- -O CO <N CO b- X "3 W r-l -OS <N CC "Op 
 
 COCC^IN -CCM -CO -CC 
 
 CO<N -(NfO 
 
 -CCr^CC -U5COO^ OOiO < ^ -Xb-X --lOCD<N -r-t -i-H b-b- < tXC<Jb. 
 
 -Xb-b- -b-Ob-X -Xb-b-b- -b-OCO -b-b-b-b- -b- -b- -b-Ob-Ob-b- 
 
 o * '*'*'' -^*' ' *' #' *' ' ' *' *' ' #' *' ' ' *' ' *' * 
 
 'COOCO OSi-l'-HOO - 
 . -C005W -COb-Ob- 
 
 COb-C<J -rJ<r-4bC<l -C -b- -Oib-OOWOO 
 rHCOb- -C050XM -10 .D<NCVDOJtCO 
 
 CO CO W CO CO CO 
 
 ^ : : 
 
 i-i -O^HCO b-'-l'<tOO5<NiMXkOOOCDCC-t OiCOlN'-iiOC^OOOO 
 
 ^ -osb-oo oOb-eo^ujccT^b.b-o^r-ieo -iooooob-ciioolco 
 
 ?0<N<N CCWCO<NCOCC'<t(M<NCOeOMCO 
 
 CO(NCOCO(MCOC10C)(MCO 
 
 :S 
 
 c> 
 
 -U5OOiO5 -iCW -OiCO^THiCOO -CO -COCO -O5O -OOO - 
 b- X b- OS b- b- 00 b- 00 b- 00 b- 00 b- -Ob- 00 b- 
 
 51 
 
 I 
 
 * !2 
 
 COOO'O -rH^ b.<CCOrHiO<N -<N -XU3 -O0 -COCO -b-^Oi 
 COr^CIOl O5 Oi IOOXW31OO3 -X -CO-* 'O ' 'C^CO -CCOi-i 
 
 ^^c^rt^(N -coco eo w eo w ^ w -co -coco -coco -eoro -w^jcvj 
 
 ^ O O 
 3 o> 
 ** 
 
CHAKACTER OF THE KATABOLISM. 
 
 87 
 
 CO 
 b- 00 iO 
 
 ^ CD 
 
 b- rH 
 
 CO '' CO CO 
 
 i 
 
 CO 
 
 o 
 
 b- OS CO ?3 IO CO IO O 00 U3 
 
 CO b- 00 
 
 . ** 
 
 O OS CO b- CO 00 
 
 Tt< CO 00 CO O i-l CO 
 
 coco -co N -coco co -co 
 
 B 
 
 . * * * *#** ...... 
 
 00 b- CO <N O O T|< -OS TH -00<N -IN -OS 
 
 iH CO CO Oi CM CO CO -CO b- -OO5 -O -00 
 
 tNCOCOCOCOCO <N---CO----CO'-'-COC1-CO'<M CO 
 
 rMNOOTH -COOO -00 -<N -O -COCOCO 
 
 00 b CO b b b* b* CO b* b b* b b* 
 
 'a'.'.'.''.'.'.''.'.'.''.''*' 
 
 tt i-H 10 CO TH CO b- b- <N <N b- H 
 
 CDCOCOCO -rHcOCD -OS -T^ -b -tHOW 
 
 CO 
 CO COCO -COCOC^THCOCOC<ICOTHeOCOCO<NCOCOCOCOCOCOC<ICOCNC^COTtfCOCSJCOCOCO CO 
 
 2? 
 
 g 
 
 . "o 
 
 I ^ S *a S'd'ea Sis S is s ^ 13 i i "a is 8 8 8 8 "a ' 
 
 O'-i<NCO'*iOCOb.XOlO'-<<NCOTt*iOCDb-OOC5O-i(NCOT}<U^ 
 OOOOOOOOXaOOOOOOOOOO5O5O5OiO5O5O5O5O5C5OOOOOO 
 
88 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 Some of the infants obtained a certain amount of colostrum prior 
 to the measurement of the metabolism; they were therefore not in 
 all cases in the post-absorptive condition when the metabolism was 
 measured. Most of the infants, however, were in the post-absorptive 
 condition during the observations and the average value obtained for 
 the respiratory quotient, i. e., 0.80, may very properly be compared 
 with the average respiratory quotient of 0.79 which was previously cited 
 for 10 men on the first day of their fast. This comparison of itself 
 would therefore lead one to conclude that there was not an excessive 
 deposit of glycogen in the bodies of new-born children, for according to 
 the table of Zuntz and Schumburg, a respiratory quotient of 0.79 corre- 
 sponds to a metabolism in which approximately one-third of the energy 
 comes from carbohydrate and two-thirds from fat. 
 
 i.oo 
 
 .95 
 
 .90 
 
 .3S 
 
 .80 
 
 .75 
 
 .70 
 
 16 
 
 18 
 
 20 
 
 22 
 
 24 
 
 2 4 6 8 10 12 14 
 
 Age in Hours 
 FIG. 1. Respiratory quotients of infants found at various times during the first 24 hours. 
 
 The trend of the respiratory quotient during the first 24 hours after 
 birth may perhaps best be shown graphical^. We have therefore 
 plotted from table 10 all of the individual respiratory quotients obtained 
 during the first day, with the exception of the bracketed values, and 
 have supplemented these with the average values from table 11 for the 
 infants whose respiratory exchange was not studied in short periods in 
 the first 24 hours. The values on this chart (see fig. 1) show that 
 during the first 24 hours of life there was a slight, though definitely 
 observable, decrease in the respiratory quotient as time progressed. 
 Although this was not sufficiently characteristic to justify its represen- 
 tation by a curve, when we compare the quotients above and below 
 0.80, we find that up to the eighth hour the greater number lie above 
 0.80, while subsequent to the tenth hour the larger proportion lie below 
 this value. 
 
CHARACTER OF THE KATABOLISM. 89 
 
 RESPIRATORY QUOTIENT DURING THE FIRST WEEK OF LIFE. 
 
 Table 11 also shows the respiratory quotients obtained for each day 
 up to the eighth day inclusive, the interval between successive daily quo- 
 tients being approximately 24 hours. The time when the breast-milk 
 appeared is designated by an asterisk (*) and when the milk was suffi- 
 cient in amount by the designation (J). Evidence that the infant was 
 clearly gaining weight was the criterion used in placing the designation 
 (t) . In the case of certain infants who were 3 or more days old when 
 the first observations were made, no designations have been placed on 
 the respiratory quotients, since apparently the breast-milk was already 
 established. Furthermore, when there was an interval of more than 
 36 hours between observations, either of the designations may have 
 been omitted. When there was no gain in weight, even if breast-milk 
 was recorded, it evidently was not sufficient; the designation (J) was 
 therefore omitted. All weights are without clothing. 
 
 If we study the variations in the respiratory quotient found with the 
 new-born infants during the first week of life as shown in table 11, 
 we note a distinct tendency for the quotient to decrease after the first 
 day, reaching the lowest average of 0.73 on the third day. Thereafter 
 there was a tendency for the respiratory quotient to increase and on the 
 last 3 days the average was not far from 0.81. The average value 
 found with 74 infants on the first day was 0.80; with 64 infants on the 
 second day, 0.74; with 62 infants on the third day, 0.73; with 51 infants 
 on the fourth day, 0.75; with 41 infants on the fifth day, 0.79; with 22 
 infants on the sixth day, 0.82; with 15 infants on the seventh day, 0.81 ; 
 and with 9 infants on the eighth day, 0.80. It is quite obvious that 
 some factor entering into the nourishment of the infant produced a 
 change in the metabolism which raised the average respiratory quotient 
 from a minimum of 0.73 on the third day of life to 0.81 at the end of the 
 first week. 
 
 According to the table of Zuntz and Schumburg, if we assume that 
 these are non-protein respiratory quotients, 0.73 would correspond to 
 a metabolism in which somewhat less than 10 per cent of the energy 
 was derived from carbohydrate and the remainder from fat, while a 
 quotient of 0.81 would correspond to a metabolism in which one-third 
 of the energy was the result of a carbohydrate combustion and two- 
 thirds was derived from a fat combustion. It is thus obvious that the 
 infant between the third and seventh days secured a supply of carbo- 
 hydrate which was not drawn from the body-material. This could be 
 derived only from the nourishment taken, usually in the mother's milk. 
 
 The profound influence of the mother's milk upon the character of 
 the katabolism is shown by the fact that the time when the milk began 
 to appear in the mother's breasts, as indicated by the asterisk (*), 
 almost invariably coincides with the increase in the respiratory quo- 
 tient. On the first day of life the infant is subsisting upon the moder- 
 
90 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 ate amount of glycogen in the body at birth. On the second, third, 
 and fourth days the colostrum is entirely insufficient to supply the 
 needed energy; on the fifth day the milk flow is usually estab- 
 lished and subsequently the respiratory quotient is not far from 0.81, 
 indicating a katabolism in which somewhat over one-third of the 
 energy is derived from carbohydrate. This quotient is not far from that 
 found with normal individuals. Thus, in the study made by Benedict, 
 Emmes, Roth, and Smith, 1 in which 157 individuals (89 men and 68 
 women) subsisting upon a mixed diet were studied, the post-absorptive 
 katabolism showed a respiratory quotient of 0.81. Comparing this 
 average value with the respiratory quotients found with the new-born 
 infants, we may properly infer that the infant at birth has not an exces- 
 sive supply of glycogen in the tissues. We may further conclude that 
 the glycogen supply is somewhat rapidly exhausted on the first day and 
 it is not until the supply of milk from the mother's breasts is established 
 that we find a respiratory quotient indicating a considerable combustion 
 of carbohydrate. 
 
 Further light is thrown upon this subject by a consideration of the 
 changes in body-weight during the first week. While it is practically 
 a routine in all hospitals to record the birth-weight of infants, it is 
 a well-known fact that in many instances the record may represent 
 the weight either before or after the meconium is passed, and that the 
 true physiological weight is not known. It is rarely that weights are 
 obtained from day to day, so that comparisons can be made and the 
 curve studied. As was stated in a previous section, there is at first a 
 distinct normal loss in body-weight with a subsequent rise; our obser- 
 vations, the results of which are given in table 11, have in consequence 
 a peculiar significance in this connection. 
 
 The average body-weight for the first 7 days of life was as follows: 
 On the first day, with 74 subjects, 3.48 kg.; on the second day, with 
 64 subjects, 3.41 kg.; on the third day, with 62 subjects, 3.32 kg.; 
 on the fourth day, with 51 subjects, 3.34 kg.; on the fifth day, with 
 41 subjects, 3.43 kg.; on the sixth day, with 22 subjects, 3.51 kg.; 
 and on the seventh day, with 15 subjects, 3.54 kg. These figures are 
 not wholly comparable, as the weights were not obtained for the same 
 individuals during the whole period. Computations were made, 
 however, of the body-weight of 44 infants for both the first and second 
 days; these show that the body-weight for the first day was 3.61 kg. 
 and for the second day, 3.44 kg. There was therefore a loss of weight 
 during the first day of 170 grams. It is also clear that there was a 
 further distinct loss on the second and third days, which was followed 
 by an increase in the later days. It should be stated that during the 
 first few days the small amount of food taken would have relatively but 
 little effect upon the body-weight, although the sterile water, which was 
 
 Benedict, Emmes, Roth, and Smith, Journ. Biol. Chem., 1914, 18, p. 139. 
 
CHARACTER OF THE KATABOLISM. 
 
 91 
 
 frequently given, would naturally tend to increase the weight some- 
 what. On the other hand, the 170 grams of body- weight lost on the 
 first day can not in any way be considered as being a loss of either 
 flesh or fat, but, as was pointed out in a preceding section, was doubtless 
 due in large part to a loss of water from the body. 
 
 It was noted that the establishment of the flow of milk was, as a rule, 
 coincident with an increase in the respiratory quotient. Here again we 
 find in considering the records of the body-weight that this factor also 
 tends to increase at the time that the milk-flow is established. In 
 general, therefore, after the first day the infant loses weight while the 
 food-supply is insufficient, particularly in carbohydrate, and increases 
 in weight when the milk-supply is established. 
 
 INFLUENCE OF BODY-WEIGHT UPON THE RESPIRATORY QUOTIENT. 
 
 Since it was possible that the store of glycogen in the body of the 
 infant might vary considerably with variations in the size and nourish- 
 ment, the respiratory quotients were compared with the body-weights 
 of the infants. This comparison is shown in figure 2, in which the 
 actual body-weights of the infants during the first 24 hours are plotted 
 
 1.00 
 |.90 
 
 ' 8 
 1 
 
 |.70 
 
 6 2 
 Fi 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 :. 
 
 
 
 
 > : 
 
 
 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 * ff 
 
 . 
 
 . 
 
 * . 
 
 . 
 
 ' 
 
 
 
 
 
 
 * 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 30 2.50 2.70 2.90 3.10 3.30 3.50 3.70 3.90 4.10 4.30 4.50 4.70 4.90 5. 
 Body Weight. Kilos. 
 
 G. 2. Respiratory quotient of infants in first 24 hours referred to total body-weight. 
 
 against the respiratory quotients obtained for the same period. A 
 careful examination of the chart shows no tendency toward a variation 
 in the average quotient as the weight varies. We must therefore infer 
 that the respiratory quotient is independent of the weight. 
 
 I.UU 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 . * 
 
 - 
 
 . 
 
 
 
 
 
 
 
 
 S 
 
 * TQ 
 
 * ' 
 
 
 
 
 V 
 
 '" 
 
 
 ' . 
 
 ' 
 
 
 
 
 
 
 
 
 
 .60 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 .082 .085 
 
 .052 .055 .058 .0.61 .064- .067 .070 .073 .076 .079 
 
 Body Weight per Cm. of Length. Kilo. 
 
 FIG. 3. Respiratory quotient of infants in first 24 hours referred to body-weight per 
 
 unit of length of infant. 
 
 .094 
 
92 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 Since, however, infants of approximately the same weight but of 
 varying length may differ in the degree of nourishment, the relationship 
 between the weight and the length of the infants may be of significance 
 hi this connection; the weight per unit of length may thus be a better 
 basis for comparison than the actual weight. The values have there- 
 fore been compared on this basis in figure 3, in which the respiratory 
 quotients have been plotted against the weight per unit of length. 
 Using the average respiratory quotient of 0.80 as a base-line, we find 
 no distinct tendency toward a grouping of the values. Such differences 
 as may be apparent are not sufficiently striking to allow us to make any 
 other deduction than that the respiratory quotient appears to be abso- 
 lutely independent of the weight and the state of nutrition. Unfortu- 
 nately our hospital and other data do not provide definite information 
 regarding the degree of nutrition of the mothers. No relationship can 
 therefore be established between the nature of the katabolism of the 
 new-born inf ant in the first few hours after birth and the state of nutri- 
 tion of the mother. 
 
 GENERAL CONCLUSIONS AS TO CHARACTER OF KATABOLISM 
 OF NEW-BORN INFANTS. 
 
 From the results obtained in our experiments we are unable to verify 
 Hasselbalch's conclusion that the metabolism of the new-born infant 
 in the first few hours is chiefly of carbohydrate material. It is true 
 that in practically none of our observations were we able to secure data 
 so soon after birth as did Hasselbalch. Thus, while he frequently 
 records observations beginning 30 to 45 minutes after birth and, indeed, 
 in one instance 15 minutes after birth, our values were rarely obtained 
 in observations less than an hour after birth, and for the most part 
 they were 2 or more hours after birth. On the other hand, the time 
 relations in our observations are fully comparable to the fragmentary 
 data published by Bailey and Murlin, since in only two of their cases 
 were observations made as early as 6 hours after birth, and there was 
 but one period in each case. 
 
 If we examine the data published by Hasselbalch, particularly the 
 values given in table 2 (see page 21), we find that a great decrease 
 in the respiratory quotient is accompanied by a very large decrease in 
 the total katabolism as indicated by the carbon-dioxide production. 
 Thus in his observation No. 17 the carbon-dioxide production per kilo- 
 gram per hour was 344 c.c. and the respiratory quotient was 0.933, 
 while the next period showed a carbon-dioxide production per kilogram 
 per hour of only 275 c.c. and a respiratory quotient of 0.854. A similar 
 relationship between the variations in the metabolism as indicated by 
 
CHARACTER OF THE KATABOLISM. 93 
 
 the carbon-dioxide production and the respiratory quotient is shown in 
 observations Nos. 13-14 and 19-20. 
 
 It will be remembered that in our consideration of the values in table 
 10 (see page 81), a like increase in the metabolism was found to accom- 
 pany the abnormal increase in the respiratory quotient and that the 
 conclusion was drawn that this increase was in part due to the muscular 
 activity of the infant, and specifically to the excess carbon-dioxide 
 produced in crying. The notes accompanying Hasselbalch's protocols 
 specify that the infant was not crying; nevertheless we know too little at 
 present regarding the ventilation of the lungs of new-born infants not to 
 assume that there may certainly have been a distinctly excessive ventila- 
 tion, with an accompanying increase in the carbon-dioxide excretion. 
 We have here, then, an actual increase in the katabolism of considerable 
 magnitude, with the high probability of there being somewhat more car- 
 bon dioxide produced than oxygen consumed, the difference being suffi- 
 cient to cause a corresponding variation in the respiratory quotient. 
 
 The fact that in a large number of our observations of long duration 
 these abnormally high quotients appear not only in the first hours, but, 
 later, lends considerable strength to this supposition. We are inclined 
 to believe, therefore, that Hasselbalch's conclusion that the higher 
 respiratory quotients are obtained in those observations which are 
 nearest to the birth is due not to the larger proportion of the glycogen 
 taking part in the combustion, but to an increase in the carbon-dioxide 
 excretion, owing to a disturbance in the mechanics of respiration. 
 
 On the first day of life there is a gradual decrease in the respiratory 
 quotient which is fully comparable to that experienced with any fasting 
 organism in which the initial supply of glycogen is fairly liberal. On 
 the other hand, the quotients found shortly after birth and the level 
 to which they fall on the first day are not such as to justify the conclu- 
 sion that there is an excessive glycogen storage in the body of the new- 
 born infant. On the second and subsequent days the- respiratory 
 quotients decrease, indicating a somewhat rapid depletion of glycogen 
 until the quotient of 0.73 is reached, this being similar to the metabo- 
 lism of fasting animals. When the milk-flow is fully established, and 
 the body is in consequence supplied more liberally with carbohydrate 
 material, the average respiratory quotient increases until at the end 
 of the first week it is 0.81. 
 
 No obvious relationship between the respiratory quotient and the 
 size and condition of nourishment can be found from the data obtained. 
 As information is lacking in regard to the degree of nourishment of the 
 mothers, no study can be made of the relationship between the respira- 
 tory quotient and this factor. 
 
94 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 BASAL KATABOLISM. 
 
 Direct measurements of the heat-production are only possible with 
 extremely complicated and expensive calorimetric devices. Thus 
 far no one has successfully completed such measurements with infants 
 save Rowland. 1 As it was impracticable to make direct measure- 
 ments of the heat-output in our study of the metabolism of new-born 
 infants, we were obliged to content ourselves with the indirect method 
 of computing the energy from the carbon-dioxide elimination and 
 the oxygen consumption. Fortunately the interesting research of 
 Rowland has shown that this method of determining the energy out- 
 put gives results of a high degree of accuracy. On the other hand, 
 it is impossible to compare the results obtained with an infant in 
 half-hour or hour periods at different times of the day unless there was 
 like extraneous muscular activity in the periods compared. It is 
 much less possible to compare the results obtained with different infants 
 without an assurance of complete muscular repose during the time 
 of the observations. From the beginning of our research we have laid 
 emphasis upon graphic records of the degree of muscular repose, and we 
 are glad to note that this is now bearing fruit in that practically all 
 experimenters are to-day of one mind regarding the absolute necessity 
 of using periods of minimum activity for comparison. 
 
 Even in so extended a series of observations as is reported here, we 
 were not able with all of the infants to secure periods of absolutely 
 minimum muscular activity. A critical examination of all the kymo- 
 graph records was made independently by two skilled observers and 
 periods of practically minimum activity were selected wherever it was 
 possible. In the selection of these periods, however, actual minimum 
 heat values were sought; a careful inspection was therefore made of 
 the heat-production as computed from the carbon dioxide observed. 
 Minimum values were secured for 94 out of the 105 infants. These 
 results have been averaged and are given in table 12. It was rarely 
 necessary to make use of a minimum value obtained from but one period 
 in the series of observations with an infant. These periods of minimum 
 activity and heat-production may be found with comparative ease by 
 referring to the statistical table (see pages 46 to 79). 
 
 lowland, Proc. Soc. Exp. Biol. and Med., 1911, 8, p. 63; Hoppe-Seyler's Zeitschr. f. Physiol. 
 Chem., 1911, 74, p. 1; Trans. 15th Int. Congress on Hygiene and Demography, Washington, 
 1913, 2, p. 438. 
 
BASAL KATABOLISM. 
 
 95 
 
 TABLE 12. Minimum heat-production of new-born infants. 
 
 
 
 
 
 
 
 
 Heat produced (computed) 
 
 
 
 
 
 
 Average 
 
 
 per 24 hours. 
 
 
 
 Body- 
 
 
 
 rectal tem- 
 
 
 
 
 Per square meter 
 
 Sub- 
 ject 
 
 XT 
 
 Sex. 
 
 weight 
 with- 
 out 
 
 Length. 
 
 Age. 
 
 perature. 
 
 Pulse- 
 rate. 
 
 
 Per 
 
 (Lissauer, 
 10.3 X/W2). 
 
 No. 
 
 
 cloth- 
 
 
 
 
 
 
 Total. 
 
 kilo- 
 
 
 Per 
 
 
 
 ing. 
 
 
 
 
 
 
 
 gram. 
 
 
 
 
 
 
 
 
 Cent. 
 
 Fahr. 
 
 
 
 
 Total. 
 
 centi- 
 
 
 
 
 
 
 
 
 
 
 
 
 meter of 
 
 i 
 
 
 
 
 
 
 
 
 
 
 length. 1 
 
 
 
 kg. 
 
 cm. 
 
 
 
 
 
 cal. 
 
 cal. 
 
 cal. 
 
 cal. 
 
 2 
 
 F. 
 
 3.80 
 
 53 
 
 6| days 
 
 36.8 
 
 98.2 
 
 99 
 
 152 
 
 40 
 
 606 
 
 11.4 
 
 3 
 
 M. 
 
 3.63 
 
 52 
 
 2 days 
 
 37.0 
 
 98.6 
 
 97 
 
 166 
 
 46 
 
 685 
 
 13.2 
 
 4 
 
 F. 
 
 3.28 
 
 46.5 
 
 2 days 
 
 37.2 
 
 99.0 
 
 105 
 
 139 
 
 43 
 
 612 
 
 13.2 
 
 5 
 
 M. 
 
 3.82 
 
 52.5 
 
 7 hrs. 
 
 36.9 
 
 98.4 
 
 112 
 
 137 
 
 36 
 
 544 
 
 
 6 
 
 M. 
 
 4.32 
 
 52 
 
 3 days 
 
 37.0 
 
 98.6 
 
 116 
 
 191 
 
 44 
 
 697 
 
 13A 
 
 8 
 
 M. 
 
 3.48 
 
 51 
 
 2 days 
 
 36.8 
 
 98.3 
 
 117 
 
 160 
 
 45 
 
 673 
 
 13.2 
 
 9 
 
 F. 
 
 4.04 
 
 51 
 
 2 days 
 
 37.3 
 
 99.2 
 
 109 
 
 178 
 
 44 
 
 677 
 
 13.3 
 
 10 
 
 M. 
 
 3.45 
 
 52 
 
 2 days 
 
 36.8 
 
 98.2 
 
 116 
 
 162 
 
 48 
 
 694 
 
 13.3 
 
 12 
 
 F. 
 
 4.17 
 
 52.5 
 
 5 days 
 
 37.0 
 
 98.6 
 
 112 
 
 171 
 
 41 
 
 639 
 
 12.2 
 
 13 
 
 F. 
 
 3.25 
 
 50 
 
 2 days 
 
 37.1 
 
 98.7 
 
 113 
 
 138 
 
 43 
 
 612 
 
 12.2 
 
 15 
 
 M. 
 
 3.64 
 
 50 
 
 4 days 
 
 37.0 
 
 98.6 
 
 122 
 
 162 
 
 44 
 
 665 
 
 13.3 
 
 16 
 
 F. 
 
 4.03 
 
 53 
 
 2| days 
 
 37.1 
 
 98.8 
 
 113 
 
 175 
 
 44 
 
 670 
 
 12.6 
 
 17 
 
 F. 
 
 3.66 
 
 52.5 
 
 15 hrs. 
 
 36.8 
 
 98.3 
 
 118 
 
 174 
 
 48 
 
 713 
 
 
 18 
 
 M. 
 
 2.84 
 
 50.5 
 
 7 days 
 
 36.6 
 
 97.9 
 
 105 
 
 108 
 
 38 
 
 519 
 
 10.3 
 
 19 
 
 M. 
 
 3.50 
 
 53 
 
 1^ days 
 
 36.9 
 
 98.5 
 
 114 
 
 155 
 
 44 
 
 653 
 
 12.3 
 
 20 
 
 F. 
 
 3.54 
 
 52 
 
 3| days 
 
 36.8 
 
 98.3 
 
 110 
 
 153 
 
 43 
 
 638 
 
 12.3 
 
 21 
 
 F. 
 
 2.92 
 
 50 
 
 2 days 
 
 36.9 
 
 98.4 
 
 121 
 
 136 
 
 47 
 
 645 
 
 12.9 
 
 22 
 
 F. 
 
 2.72 
 
 49 
 
 1\ days 
 
 36.8 
 
 98.2 
 
 114 
 
 128 
 
 47 
 
 635 
 
 13.0 
 
 25 
 
 M. 
 
 3.32 
 
 51.5 
 
 4 days 
 
 36.9 
 
 98.5 
 
 123 
 
 158 
 
 47 
 
 686 
 
 13.3 
 
 26 
 
 F. 
 
 3.46 
 
 50 
 
 5 days 
 
 37.2 
 
 98.9 
 
 113 
 
 151 
 
 44 
 
 645 
 
 12.9 
 
 27 
 
 M. 
 
 3.58 
 
 52 
 
 4 days 
 
 37.1 
 
 98.8 
 
 111 
 
 169 
 
 48 
 
 703 
 
 13.5 
 
 29 
 
 F. 
 
 3.37 
 
 50 
 
 2^ days 
 
 37.4 
 
 99.3 
 
 112 
 
 150 
 
 45 
 
 652 
 
 13.0 
 
 30 
 
 M. 
 
 3.33 
 
 51 
 
 2 days 
 
 37.1 
 
 98.7 
 
 114 
 
 144 
 
 43 
 
 623 
 
 12.2 
 
 31 
 
 M. 
 
 3.56 
 
 53.5 
 
 4 days 
 
 37.1 
 
 98.7 
 
 117 
 
 158 
 
 45 
 
 662 
 
 12.4 
 
 32 
 
 M. 
 
 3.42 
 
 47.5 
 
 2| days 
 
 36.9 
 
 98.5 
 
 116 
 
 140 
 
 41 
 
 604 
 
 12.7 
 
 33 
 
 M. 
 
 3.73 
 
 52 
 
 5 days 
 
 37.1 
 
 98.7 
 
 129 
 
 153 
 
 41 
 
 617 
 
 11.9 
 
 34 
 
 F. 
 
 2.90 
 
 50.5 
 
 2 days 
 
 37.2 
 
 98.9 
 
 115 
 
 134 
 
 47 
 
 638 
 
 12.6 
 
 35 
 
 F. 
 
 4.33 
 
 54 
 
 4 days 
 
 37.2 
 
 98.9 
 
 109 
 
 175 
 
 41 
 
 640 
 
 11.9 
 
 36 
 
 M. 
 
 3.33 
 
 53 
 
 21 hrs. 
 
 37.6 
 
 99.6 
 
 129 
 
 154 
 
 46 
 
 670 
 
 
 37 
 
 F. 
 
 2.49 
 
 46.5 
 
 13 hrs. 
 
 36.8 
 
 98.3 
 
 119 
 
 99 
 
 40 
 
 522 
 
 
 38 
 
 F. 
 
 3.90 
 
 51.5 
 
 \\ days 
 
 37.4 
 
 99.3 
 
 127 
 
 156 
 
 40 
 
 610 
 
 ii.8 
 
 39 
 
 F. 
 
 2.95 
 
 50 
 
 9 hrs. 
 
 36.5 
 
 97.7 
 
 105 
 
 113 
 
 38 
 
 533 
 
 
 40 
 
 F. 
 
 2.78 
 
 49.5 
 
 4| days 
 
 37.4 
 
 99.4 
 
 111 
 
 134 
 
 48 
 
 655 
 
 i3i2 
 
 42 
 
 F. 
 
 3.95 
 
 54 
 
 3 days 
 
 37.2 
 
 98.9 
 
 113 
 
 176 
 
 45 
 
 684 
 
 12.7 
 
 43 
 
 F. 
 
 3.62 
 
 50 
 
 2 days 
 
 37.6 
 
 99.6 
 
 119 
 
 165 
 
 46 
 
 682 
 
 13.6 
 
 44 
 
 F. 
 
 3.57 
 
 51 
 
 2 hrs. 
 
 36.9 
 
 98.4 
 
 103 
 
 136 
 
 38 
 
 567 
 
 
 45 
 
 F. 
 
 2.56 
 
 46.5 
 
 1 day 
 
 36.6 
 
 97.9 
 
 110 
 
 107 
 
 43 
 
 558 
 
 
 46 
 
 M. 
 
 3.83 
 
 51.5 
 
 5 hrs. 
 
 37.2 
 
 99.0 
 
 126 
 
 152 
 
 40 
 
 603 
 
 
 47 
 
 M. 
 
 3.51 
 
 52 
 
 5 hrs. 
 
 37.5 
 
 99.5 
 
 107 
 
 143 
 
 41 
 
 601 
 
 
 48 
 
 F. 
 
 4.52 
 
 54.5 
 
 6 days 
 
 36.9 
 
 98.4 
 
 132 
 
 188 
 
 42 
 
 667 
 
 12.2 
 
 49 
 
 F. 
 
 2.75 
 
 47.5 
 
 4 days 
 
 36.9 
 
 98.5 
 
 114 
 
 130 
 
 47 
 
 638 
 
 13.4 
 
 50 
 
 F. 
 
 2.75 
 
 48.5 
 
 1 day 
 
 36.4 
 
 97.6 
 
 89? 
 
 142 
 
 52 
 
 700 
 
 
 51 
 
 M. 
 
 3.73 
 
 52.5 
 
 2 days 
 
 36.9 
 
 98.5 
 
 96 
 
 154 
 
 42 
 
 623 
 
 11.9 
 
 52 
 
 F. 
 
 3.54 
 
 50 
 
 2? days 
 
 37.2 
 
 99.0 
 
 114 
 
 138 
 
 39 
 
 579 
 
 11.6 
 
 53 
 
 M. 
 
 2.87 
 
 47.5 
 
 2 days 
 
 37.7 
 
 99.9 
 
 126 
 
 143 
 
 50 
 
 684 
 
 14.4 
 
 54 
 
 M. 
 
 3.31 
 
 50 
 
 \\ days 
 
 37.1 
 
 98.7 
 
 106 
 
 129 
 
 39 
 
 563 
 
 11.3 
 
 55 
 
 M. 
 
 3.45 
 
 50 
 
 16 hrs. 
 
 36.9 
 
 98.4 
 
 124 
 
 151 
 
 44 
 
 641 
 
 
 56 
 
 M. 
 
 3.19 
 
 51.5 
 
 4 days 
 
 36.9 
 
 98.4 
 
 121 
 
 150 
 
 47 
 
 669 
 
 13.0 
 
 57 
 
 M. 
 
 3.75 
 
 54 
 
 22 hrs. 
 
 36.9 
 
 98.5 
 
 105 
 
 153 
 
 40 
 
 611 
 
 
 Computed only for infants of ages between 1| and 6 days inclusive. See fig. 10, p. 107. 
 
96 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 TABLE 12. Minimum heat-production of new-born infants Continued. 
 
 
 
 
 
 Age. 
 
 
 
 Heat produced (computed) 
 
 
 
 
 
 Average 
 
 
 per 24 hours. 
 
 Sub- 
 ject 
 
 "NTn 
 
 Sex. 
 
 Body- 
 weight 
 with- 
 out 
 
 Length. 
 
 rectal tem- 
 perature. 
 
 Pulse- 
 rate. 
 
 
 Per 
 
 Per square meter 
 (Lissauer 
 10.3 v'w*). 
 
 l^i O. 
 
 
 cloth- 
 
 
 
 
 
 Total. 
 
 kilo- 
 
 
 Per 
 
 
 
 ing. 
 
 
 
 
 
 
 gram. 
 
 
 
 
 
 
 
 Cent. 
 
 Fahr. 
 
 
 
 
 Total. 
 
 centi- 
 
 
 
 
 
 
 
 
 
 
 
 meter of 
 
 
 
 
 
 
 
 
 
 
 
 length. 1 
 
 
 
 kg. 
 
 cm. 
 
 
 
 
 
 
 cal. 
 
 cal. 
 
 cal. 
 
 cal. 
 
 58 
 
 F. 
 
 3.01 
 
 49 
 
 1 
 
 day 
 
 37.2 
 
 98.9 
 
 Ill 
 
 139 
 
 46 
 
 647 
 
 
 59 
 
 F. 
 
 3.60 
 
 52 
 
 IT 
 
 days 
 
 37.1 
 
 98.8 
 
 112 
 
 150 
 
 42 
 
 621 
 
 11.3 
 
 60 
 
 M. 
 
 3.60 
 
 52 
 
 4 
 
 days 
 
 37.0 
 
 98.6 
 
 117 
 
 149 
 
 42 
 
 617 
 
 11.9 
 
 61 
 
 M. 
 
 3.26 
 
 49.5 
 
 21 
 
 ^hrs. 
 
 36.6 
 
 97.8 
 
 121 
 
 123 
 
 38 
 
 542 
 
 
 62 
 
 M. 
 
 3.30 
 
 49.5 
 
 3 
 
 days 
 
 36.8 
 
 98.3 
 
 116 
 
 134 
 
 41 
 
 588 
 
 11.9 
 
 63 
 
 F. 
 
 2.37 
 
 47.5 
 
 3 
 
 days 
 
 37.2 
 
 98.9 
 
 125 
 
 109 
 
 46 
 
 596 
 
 12.5 
 
 64 
 
 F. 
 
 3.37 
 
 48 
 
 7 
 
 hrs. 
 
 36.7 
 
 98.1 
 
 98 
 
 128 
 
 38 
 
 552 
 
 
 65 
 
 F. 
 
 2.63 
 
 49 
 
 2 
 
 days 
 
 36.8 
 
 98.2 
 
 116 
 
 127 ; 48 
 
 644 
 
 13.1 
 
 66 
 
 M. 
 
 3.19 
 
 51 
 
 14 
 
 hrs. 
 
 36.3 
 
 97.4 
 
 103 
 
 122 1 38 
 
 543 
 
 
 67 
 
 M. 
 
 4.74 
 
 54 
 
 3 
 
 days 
 
 37.1 
 
 98.7 
 
 122 193 . 41 
 
 669 
 
 12^4 
 
 68 
 
 M. 
 
 2.12 
 
 46 
 
 4 
 
 days 
 
 36.8 
 
 98.3 
 
 113 
 
 103 48 
 
 604 
 
 13.1 
 
 69 
 
 M. 
 
 3.44 
 
 50 
 
 19 
 
 hrs. 
 
 36.9 
 
 98.5 
 
 110 
 
 142 ! 42 
 
 609 
 
 
 70 
 
 M. 
 
 3.56 
 
 51 
 
 2 
 
 days 
 
 36.9 
 
 98.5 
 
 109 
 
 153 
 
 43 
 
 640 
 
 12.5 
 
 71 
 
 M. 
 
 3.96 
 
 53.5 
 
 3 
 
 days 
 
 36.8 
 
 98.2 
 
 106 
 
 172 
 
 44 
 
 667 
 
 12.5 
 
 72 
 
 M. 
 
 3.29 
 
 50.5 
 
 2\ 
 
 days 
 
 36.7 
 
 98.0 
 
 110 
 
 157 
 
 48 
 
 687 
 
 13.6 
 
 73 
 
 M. 
 
 3.63 
 
 50 
 
 7 
 
 hrs. 
 
 36.8 
 
 98.2 
 
 106 
 
 164 
 
 45 
 
 673 
 
 
 74 
 
 M. 
 
 3.63 
 
 52 
 
 2 
 
 days 
 
 36.8 
 
 98.3 
 
 94 
 
 156 
 
 43 
 
 640 
 
 12^3 
 
 75 
 
 M. 
 
 2.65 
 
 47.5 
 
 U 
 
 days 
 
 36.6 
 
 97.9 
 
 100 
 
 132 
 
 50 
 
 664 
 
 14.0 
 
 76 
 
 M. 
 
 3.16 
 
 50 
 
 13 
 
 hrs. 
 
 36.7 
 
 98.0 
 
 101 
 
 137 
 
 44 
 
 618 
 
 
 78 
 
 M. 
 
 2.48 
 
 47 
 
 12 
 
 hrs. 
 
 36.4 
 
 97.6 
 
 101 
 
 109 
 
 44 
 
 577 
 
 
 79 
 
 F. 
 
 4.14 
 
 52.5 
 
 4 
 
 hrs. 
 
 36.9 
 
 98.4 
 
 116 
 
 153 
 
 37 
 
 575 
 
 
 80 
 
 M. 
 
 3.47 
 
 51.5 
 
 3 
 
 hrs. 
 
 36.4 
 
 97.6 
 
 109 
 
 128 
 
 37 
 
 542 
 
 
 81 
 
 F. 
 
 3.29 
 
 50 
 
 4 
 
 hrs. 
 
 36.9 
 
 98.4 
 
 114 
 
 167 
 
 51 
 
 732 
 
 
 82 
 
 M. 
 
 2.74 
 
 49 
 
 3 
 
 hrs. 
 
 36.4 
 
 97.6 
 
 101 
 
 95 
 
 35 
 
 470 
 
 
 83 
 
 M. 
 
 3.73 
 
 52 
 
 3 
 
 hrs. 
 
 37.2 
 
 99.0 
 
 131 
 
 148 
 
 40 
 
 597 
 
 
 84 
 
 F. 
 
 4.11 
 
 54 
 
 21 
 
 hrs. 
 
 36.5 
 
 97.7 
 
 109 
 
 133 
 
 32 
 
 504 
 
 
 85 
 
 M. 
 
 3.52 
 
 52 
 
 9 
 
 hrs. 
 
 36.8 
 
 98.2 
 
 109 i 144 41 
 
 605 
 
 
 86 
 
 F. 
 
 3.32 
 
 51 
 
 6 
 
 hrs. 
 
 36.6 
 
 97.8 
 
 103 120 36 
 
 524 
 
 
 87 
 
 M. 
 
 3.94 
 
 51 
 
 3^ 
 
 hrs. 
 
 37.3 
 
 99.2 
 
 118 146 
 
 37 
 
 567 
 
 
 88 
 
 F. 
 
 2.62 
 
 47.5 
 
 9 
 
 hrs. 
 
 36.8 
 
 98.3 
 
 96 122 47 
 
 623 
 
 
 89 
 
 M. 
 
 3.24 
 
 49.5 
 
 8 
 
 hrs. 
 
 36.7 
 
 98.0 
 
 107 124 38 
 
 549 
 
 
 90 
 
 M. 
 
 3.00 
 
 50 
 
 21 
 
 days 
 
 36.8 
 
 98.2 
 
 86 
 
 138 46 
 
 641 
 
 12.S 
 
 91 
 
 F. 
 
 3.33 
 
 49.5 
 
 13 
 
 hrs. 
 
 37.4 
 
 99.4 
 
 113 
 
 140 
 
 42 
 
 609 
 
 
 92 
 
 F. 
 
 3.78 
 
 51 
 
 4 
 
 hrs. 
 
 36.6 
 
 97.8 
 
 112 
 
 157 
 
 42 
 
 628 
 
 
 93 
 
 M. 
 
 3.53 
 
 50.5 
 
 4 
 
 hrs. 
 
 36.8 
 
 98.2 
 
 127 
 
 136 
 
 39 
 
 573 
 
 
 94 
 
 M. 
 
 3.20 
 
 50 
 
 3i 
 
 hrs. 
 
 36.8 
 
 98.2 
 
 117 
 
 136 
 
 43 
 
 607 
 
 
 95 
 
 F. 
 
 2.84 
 
 46.5 
 
 5^ 
 
 hrs. 
 
 36.2 
 
 97.1 
 
 123 
 
 100 
 
 35 
 
 483 
 
 
 96 
 
 F. 
 
 3.23 
 
 51.5 
 
 3i 
 
 hrs. 
 
 36.6 
 
 97.8 
 
 99 
 
 113 
 
 35 
 
 502 
 
 
 97 
 
 F. 
 
 2.82 
 
 48 
 
 4i 
 
 hrs. 
 
 36.1 
 
 96.9 
 
 113 
 
 112 
 
 40 
 
 542 
 
 
 98 
 
 F. 
 
 2.86 
 
 47.5 
 
 5 
 
 hrs. 
 
 36.2 
 
 97.1 
 
 102 
 
 98 
 
 35 
 
 471 
 
 
 99 
 
 M. 
 
 3.58 
 
 51.5 
 
 2 \ 
 
 hrs. 
 
 36.9 
 
 98.4 
 
 103 
 
 122 
 
 34 
 
 508 
 
 
 100 
 
 M. 
 
 4.65 
 
 54 
 
 
 hrs. 
 
 37.1 
 
 98.8 
 
 130 
 
 186 
 
 40 
 
 648 
 
 
 101 
 
 M. 
 
 3.88 
 
 51.5 
 
 5J 
 
 hrs. 
 
 36.7 
 
 98.0 
 
 109 
 
 126 
 
 32 
 
 496 
 
 
 103 
 
 F. 
 
 3.29 
 
 49 
 
 2\ hrs. 
 
 37.5 
 
 99.5 
 
 125 
 
 130 
 
 40 
 
 570 
 
 
 104 
 
 M. 
 
 3.32 
 
 51 
 
 3 
 
 hrs. 
 
 36.4 
 
 97.6 
 
 107 
 
 105 
 
 32 
 
 459 
 
 
 Average of 
 
 
 
 
 
 
 
 
 
 
 
 94 sub- 
 
 
 
 
 
 
 
 
 
 
 
 
 jects. . . 
 
 3.40 
 
 50.5 
 
 2 
 
 days 
 
 36.9 
 
 98.4 
 
 112 
 
 143 
 
 42 
 
 612 
 
 
 Computed only for infants of ages between \\ and 6 days inclusive. See fig. 10, p. 107. 
 
BASAL KATABOLISM. 
 
 97 
 
 In table 12 the minimum metabolism is expressed first as the total 
 heat-production in 24 hours; second, as the heat-output per kilogram 
 of body-weight per 24 hours ; and third, as the heat-output per square 
 meter of body-surface per 24 hours. To explain these values further 
 we have added the records for the body-weight without clothing, the 
 length, the age, the average rectal temperature, and the pulse-rate for 
 the periods of observation included in this table. 
 
 TOTAL MINIMUM HEAT-PRODUCTION PER 24 HOURS. 
 
 It will be seen that on the basis of the total minimum heat-production 
 per 24 hours new-born infants may range from 193 calories found with 
 subject 67 to a minimum of 95 calories found with subject 82. With 
 so large a number of values as are given in table 12 it is difficult to 
 discover any direct relationship between the body-weight and the total 
 heat-output. The results have therefore been represented graphically 
 in figure 4, in which the total heat-output per 24 hours has been 
 
 4.7 
 
 4.4 
 
 4.1 
 
 I 3.8 
 
 3,5 
 
 3.2 
 2.9 
 2.6 
 2.3 
 2.0 
 
 ^ 
 
 90 100 110 120 130 140 150 160 170 180 190 200 
 
 Calories per 24 Hours 
 
 FIG. 4. Minimum heat-production of new-born infants per 24 hours referred to 
 
 the body-weight. 
 
 plotted against the actual body-weight of the individual infants at the 
 time the metabolism was measured. The approximate average value 
 is indicated in the chart by a heavy black line. As a matter of fact, 
 this line represents a value of 42 calories per kilogram of body-weight 
 per 24 hours. 
 
98 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 Although one would expect with a large number of normal new-born 
 infants to find a tendency towards constancy in the minimum metabo- 
 lism, this chart shows clearly that there is no such constancy, for while 
 in general there is a rough relationship between the total body-weight 
 and the total minimum metabolism, in that for the most part the 
 infants with the larger body-weight have the larger metabolism, yet 
 wide deviations from the average value are found. 
 
 Recently it has been the custom among some writers on metabolism 
 to consider a plus or minus metabolism of 10 per cent as a possible nor- 
 mal fluctuation. Although the arbitrary selection of this range seems 
 questionable and we are unable to see what particular value the indi- 
 vidual normal figures may have when the variation may admittedly 
 be =*= 10 per cent, we have indicated these limits on the chart by light 
 lines above and below the heavier line showing the average value. 
 Even under these circumstances we find that a large number of the 
 plotted figures lie outside of the supposedly acceptable limits of varia- 
 tion, for 13 points are above the upper light line and at least 17 
 points below the lower light line; in other words, some 30 values lie 
 outside of the 10 per cent limits of variation. Perhaps the most 
 striking illustration of this fact is that of an infant weighing 4.1 kilo- 
 grams and having a total heat-output per 24 hours of 133 calories. 
 While the majority of the results obtained were well within the 10 
 per cent limits, yet, as our observations were made with new-born 
 infants, presumably healthy organisms, which should be perfectly com- 
 parable, it is somewhat surprising that variations are found as large as 
 and, indeed, much larger than =*= 10 per cent. 
 
 MINIMUM HEAT-OUTPUT PER KILOGRAM OF BODY-WEIGHT 
 PER 24 HOURS. 
 
 The highest value for the minimum heat-production in this series 
 of observations was secured with infant No. 67, who had a body- weight 
 of 4.74 kg., this being the largest body- weight of any of the infants; 
 the lowest minimum heat-production was found with infant No. 82, 
 whose body-weight was only 2.74 kg., although some of the infants 
 had an even smaller body-weight than this. It is obvious, therefore, 
 that body-weight plays an important r61e in the amount of the katabo- 
 lism and the heat-production per unit of weight must be considered. 
 The values for the heat-production per kilogram of body-weight given 
 in table 12 vary from 52 calories per kilogram with infant No. 50 to 32 
 calories per kilogram with infants Nos. 84, 101, and 104. It is thus 
 clear that, even per kilogram of body-weight, healthy new-born infants 
 may vary widely in their energy output. 
 
 Here again the general trend may be more easily seen in the form of 
 a chart, and the values are therefore given on this basis in figure 5, 
 which shows very clearly the wide variations in the values. Prac- 
 tically no approximation to regularity is apparent, although a con- 
 
BASAL KATABOLISM. 
 
 siderable number of the points lie within 10 per cent of the average 
 value of 42 calories. If we draw lines at 38 and 46 to represent these 
 limits of variation, we find that 13 values lie outside of the limits on the 
 one side and 18 values on the other, there being in all some 33 per cent 
 of the total number outside of the limits of variation. To indicate a 
 true average value for a living organism on the basis of weight alone 
 appears, therefore, to be extremely difficult, for even with these normal 
 new-born infants, which are presumably more directly comparable 
 than any other class of human beings, we still find wide variations. 
 
 4.7 
 
 4.4 
 4.1 
 
 1 3.8 
 k 
 
 fa- 5 
 lu 
 
 2.9 
 2.6 
 2.3 
 
 2 '3 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 f 
 
 
 
 
 
 
 
 
 
 . 
 
 . 
 
 
 
 
 
 
 
 
 . 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 s 
 
 
 
 
 
 
 : 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 2 34 36 38 40 42 44 45 48 50 5, 
 
 Calories per Kilo, per 24 Hours 
 
 FIG. 5. Minimum heat-production of new-born infants per kilogram per 24 
 hours referred to the body-weight. 
 
 MINIMUM HEAT-OUTPUT PER SQUARE METER PER 24 HOURS. 
 
 Since the cube root of the square of the body-weight represents the 
 general law of growth, and since physiologists, basing their belief upon 
 the observations of Bergmann, 1 Rubner, 2 and Richet, 3 have been 
 inclined to ascribe a particular significance to the relationship between 
 the body-surface and the metabolism, the results computed on the 
 basis of the heat-output per square meter of body-surface per 24 hours 
 have been included in table 12. In our earlier publication 4 it was 
 
 Bergmann and Leuckart, Anatomisch-physiol. Uebersicht des Thierreichs, Stuttgart, 1852, 
 p. 272. See also, Bergmann, Ueber die Verhaltnisse der Warmeokonomie der Thiere zu ihrer 
 Grosse, Gottingen, 1848, p. 9. 
 
 2 Rubner, Zeitschr. f. Biol., 1883, 19, p. 545. 
 
 3 Richet, Archives de Physiol. norm, et path., 1885, 15, 3d ser., p. 237. 
 
 'Benedict and Talbot, Carnegie Inst. Wash. Pub. No. 201, 1914, p. 166; Benedict and Talbot, 
 Am. Journ. Diseases of Children, 1914, 8, p. 48. 
 
100 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 shown that one of the greatest factors influencing thermogenesis, i. e., 
 the active mass of protoplasmic tissue, probably develops according 
 to the general fundamental law of growth as expressed by the cube 
 root of the square of the body- weight. We feel wholly justified, there- 
 fore, in attempting to study the heat-production of these infants on 
 the empirical basis of the heat-output per square meter of body-surface 
 per 24 hours. 
 
 The actual measurement of the body-surface of these infants was 
 impossible, as the methods used by Meeh and Lissauer were precluded 
 and no other method giving accurate results was available. At the 
 moment of writing a method which promises well, namely, the Du 
 Bois formula, makes it not at all impossible that body-measurements 
 may be practicable in future investigation of this type. As the data 
 regarding the body-surface of these infants could not be obtained by 
 means of actual measurement, we employed in our calculations the for- 
 mula of Lissauer, in which the constant 10.3 is multiplied by the cube 
 root of the square of the body-weight. 
 
 The results thus obtained show that the average minimum heat- 
 production per square meter of body-surface for the 94 infants was 612 
 calories per square meter per 24 hours. The largest minimum value 
 was 732 calories with infant No. 81 and the smallest 459 calories with 
 infant No. 104. Even on this basis, which is supposed to equalize not 
 only all animals of similar species but also animals of different species, 
 we do not find comparable values for these infants throughout the 
 whole series. 
 
 For a better visualization of the values for the heat-output com- 
 puted on this basis and given in table 12, the minimum heat-production 
 per square meter of body-surface per 24 hours has been plotted against 
 the body-weight. (See fig. 6.) Here also we find very wide deviations 
 from the average value of 612 calories. Using again, for the purpose of 
 discussion, the hypothetical limits of =*= 10 per cent, i. e., 675 calories and 
 550 calories, respectively, we find that there are 18 values which are 
 more than 10 per cent below the average value and 13 over 10 per 
 cent above the average value. Thus in practically one-third of our 
 observations the results obtained vary more than =*= 10 per cent from 
 the average value. 
 
 In considering the results obtained with our infants and graphically 
 shown in figure 6, it is of particular interest to refer to the previous 
 conception regarding the heat-production per square meter of body- 
 surface of infants. Although infants have rarely been studied in the 
 first week of post-natal life, the prevailing opinion of physiologists has 
 been that very small and very young animals have proportionally a 
 much larger heat-production than has the adult organism. From the 
 review of the earlier literature given in our first report 1 it will be seen 
 
 Benedict and Talbot, Carnegie Inst. Wash. Pub. No. 201, 1914, p. 11; also, Am. Journ. 
 Diseases of Children, 1914, 8, p. 3 and 43. 
 
BASAL K AT ABOLISH. 
 
 101 
 
 that the general belief was that infants produced not far from 1,000 
 calories per square meter of body-surface in common with that sup- 
 posedly produced by other living organisms. The first considerable 
 reduction in this figure is noted in the writings of Schlossmann and 
 Murschhauser, 1 in which they point out that the basal value is 866 
 calories per square meter. That this compares favorably with values 
 obtained upon man is shown by Schlossmann and Murschhauser in an 
 interesting way from the results of a single period selected from one of 
 the earlier experiments of Atwater and his associates, in which a heat- 
 production of 828 calories per square meter was observed. 
 
 4.7 
 4.4 
 4.1 
 3.8 
 3.5 
 3.2 
 2.9 
 2.6 
 2.3 
 
 2 -2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 
 
 
 
 
 
 
 . 
 
 
 
 * * 
 
 
 
 
 
 
 
 ' . 
 
 
 
 , 
 
 * 
 
 - 
 
 
 
 
 - 
 
 . 
 
 
 
 
 
 
 
 
 
 . 
 
 . 
 
 
 
 
 
 
 
 
 
 
 . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 50 480 500 520 540 560 580 600 620 640 660 680 700 720 74 
 Calories per Sq. Meter per 24 Hours 
 
 FIG. 6. Minimum heat-production of new-born infants per square meter of body-surface 
 per 24 hours referred to the body-weight. 
 
 We may then say that up to the present time the general opinion 
 has been that young infants had a larger metabolism than adults, that 
 such measurements as were made previous to the observations of Schloss- 
 mann and Murschhauser ascribe to the infant a heat-production of 
 1,000 calories per square meter of body-surface, and that the figure of 
 Schlossmann and Murschhauser reduces this value to 866 calories per 
 square meter of body-surface. It is of further interest that this value 
 of 866 calories per square meter was obtained and reported by Schloss- 
 mann and Murschhauser in full recognition of the significance of com- 
 plete muscular repose during the observations, as is evidenced by their 
 painstaking ocular notations of the degree of muscular repose which 
 were made by^a specially trained assistant. 
 
 Schlossmann and Murschhauser, Biochem. Zeitschr., 1910, 26, p. 32. 
 
102 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 By reference to table 12, it will be seen that the vahie of 866 calories 
 is over 100 calories higher than the higVM value there recorded, for 
 only 3 observations are above 700 calories per square meter of body- 
 surface, these being obtained with infants 17, 27, and 81, who had a 
 heat-production per square meter of 713, 703, and 732 calories, respec- 
 tively. The average minimum heat-production of 612 calories per 
 square meter is 254 calories less than the minimum figure of Schloss- 
 rnann and Murschhauser. 
 
 Perhaps no better illustration than this can be found of the difficul- 
 ties of securing accurate information regarding the probable trend 
 of the metabolism of any group of individuals, in which one case 
 that was carefully and continuously studied gave a value of 866 calories 
 per square nieter of body-surface, and a later research, in which 100 
 or more cases were studied, gave results very much lower, no value 
 being secured within essentially 130 calories of the minimum obtained 
 by the previous investigators. The cause for this discrepancy may 
 readily be found, we believe, in the inherent difficulties in obtaining 
 metabolism measurements when the experimental periods 
 
 must of necessity be of several hours duration, as was the cam with 
 Schlossmann and Murschhauser. Had these observers been able to 
 measure the metabolism of their infant in selected half-hour periods, 
 we have no doubt that their value of 866 calories would have been 
 materially reduced. 
 
 The value of 866 calories reported by Schlossmann and Murschhauser 
 was not obtained with a new-born infant, but at the time their observa- 
 tions were published it was the general impression among pediatricians 
 that the metabolism of the new-born infant would be even higher per 
 unit of surface than that of an infant several months old. Accordingly, 
 the difference between our average minimum value of 612 calories and 
 the minimum value of Schlossmann and Murschhauser of 866 calories 
 per square meter of body-surface is, to say the least, most striking. 
 
 It should likewise be borne in mind that it is unpractical to use here for 
 comparison the heat-production per square meter per 24 hours recorded 
 for the infants studied in our previous research, 1 for these latter include 
 a large number of atrophic infants whose metabolism is admittedly 
 above normal. Although our material is slowly accumulating for an 
 estimation of the metabolism of perfectly normal infants from the time 
 of birth to the age of 2 years, we are not yet in a position to draw con- 
 clusions that will necessarily withstand subsequent addition of data: we 
 prefer, therefore, to defer the making of general deductions until later. 
 
 INFLUENCE OF AGE UPON THE KATABOUSM. 
 
 A general inspection of the values given in table 12 indicates that in 
 the first week of life there is some connection between the age and the 
 
 ^Benedict and Talbot. Carnegie lust. Wash. Pub. N<x 301. 1914: aba. Am. Jouru.. 
 of Children. 1914. & p- 1. 
 
BASAL KATABOLISM. 
 
 103 
 
 total katabolism. Although little in the nature of such a relationship 
 may be expected in the first hours after birth, for during the first 24 
 hours of life there must certainly be a profound readjustment of the 
 organism as a result of the radical change hi environment, yet in order 
 that a study may be made of this possible relationship, three charts 
 have been plotted in which the total heat-production per 24 hours, the 
 heat-production per kilogram of body-weight, and the heat-production 
 per square meter of body-surface have been plotted against the age, 
 the minimum figures given in table 12 being used hi all cases. (See 
 figures 7, 8, and 9.) 
 
 IXTLtnCMCE OF AOB CPOM TUB HEAT-PR00UCT10W IV THE FlB0T DAT. 
 
 The total heat-production and the age hi days at the time of measure- 
 ment are compared hi figure 7, from which it will be seen that there is a 
 general tendency for the low values for the heat-production to occur 
 
 I 
 
 90 100 HO 120 130 140 ISO 160 170 180 190 200 
 Cabrfet ftr 24 HIM* 
 
 Fn. 7. Minimum beat-producikm of new-born infanta per 24 bourn referred to af*, 
 
 on the first day of life. The chart does not take into consideration the 
 differences hi body-weight, but this is done hi figure 8, hi which the 
 heat-production per kilogram of body-weight per 24 hours is plotted 
 against the age. In figure 8, also, we find that nearly all of the low 
 values, such as those under 40 calories per kilogram per 24 hours, 
 appear on the first day, even when the weight of the infant is taken 
 into account. 
 
 This tendency is shown even more strikingly in figure 9, in which 
 the heat-production per square meter of body-surface per 24 hours is 
 plotted against the age, for all but 4 of the values below 600 calories 
 are found on the first day. It is likewise of interest to note that the 
 two highest values obtained with our infants for the heat-production 
 per square meter of body-surface per 24 hours were also found on this 
 
104 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 day. In an attempt to study the heat-production more closely, the 
 chart has been so plotted as to show the values obtained on each half 
 day. We find but little difference between the first and last halves of 
 the first day, however, as the number of observations in the second 12 
 hours of life were relatively few. As a matter of fact, all values below 
 520 calories per square meter of body-surface were obtained inside of 
 the first 12 hours of life. 
 
 From figures 7, 8, and 9, therefore, it is evident that in our problem 
 of studying the metabolism of infants during the first week of post- 
 natal life we have two distinct phases to consider: (1) the metabolism 
 on the first day of birth, and (2) the metabolism on the remaining 5 or 
 6 days of the first week. While all of the charts thus far studied 
 
 1-3 
 
 2 
 1 
 
 32 34 
 
 36 
 
 38 40 42 44 46 
 Calories per Kilo, per 24 Hours 
 
 48 
 
 50 52 
 
 Fio. 8. Minimum heat-production of new-born infants per kilogram of 
 body-weight per 24 hours referred to age. 
 
 indicate clearly that there is no approximation to uniformity shown 
 in the metabolism of new-born infants during the first week of life, the 
 analysis just made shows that a large part, if not indeed the greater 
 part, of the extreme values found in our observations may be attributed 
 to the measurements obtained during the first 24 hours of life. Hence 
 our general conclusion with regard to the metabolism of new-born 
 infants holds true, particularly for the first day of life, namely, that 
 there is no relationship between the total metabolism and either the 
 body-weight or the body-surface. We have to consider, therefore, if, 
 after eliminating the first day of post-natal life, in which there is 
 admittedly a profound physiological readjustment inside the organism, 
 any tendency towards uniformity may be noted in the remaining days 
 of the week. 
 
BASAL KATABOLISM. 
 
 105 
 
 INFLUENCE OF AGE ON THE HEAT-PRODUCTION FROM THE SECOND TO THE SEVENTH DAY. 
 
 With a number of infants experiments were made practically every 
 day during the first week of life. While it was not possible to obtain 
 values showing the minimum metabolism for all of these infants on 
 the succeeding days of the week, we have been able to collect data for 
 a considerable number of the infants for the first 8 days of life which 
 show an approximately minimum metabolism. As for the first 5 days 
 of the week the data were obtained from 35 to 56 subjects, and even on 
 
 64 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 z 
 
 6 
 
 1 
 
 5 
 
 ! 
 
 4 
 
 | 
 
 *i 
 
 t 
 
 3 
 
 22 
 
 z 
 
 i 
 1 
 A 
 
 4 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ,. 
 
 
 
 
 
 
 
 
 
 
 
 ... 
 
 
 
 * * 
 
 : 
 
 :" 
 
 . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 60 480 500 520 540 560 580 600 620 640 660 680 700 720 74 
 
 Calories per Sq. Meter per 24 Hours 
 
 FIG. 9. Minimum heat-production of new-born infants per square meter of body-surface 
 per 24 hours referred to age. 
 
 the last 3 days from 6 to 16 subjects, we may fairly say that they are 
 distinctly comparable. While these values do not represent the actual 
 minimum metabolism, they probably do show, in general, the basal 
 metabolism; they are therefore compared in table 13, in which are 
 given: first, the number of subjects averaged for each day, and second, 
 the average heat-production per square meter of body-surface per 24 
 hours for the successive days. 
 
106 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 Even these approximately minimum metabolism values show a heat- 
 production per square meter of body-surface which is considerably 
 lower on the first day than on the other days of the week. After the 
 first day the values remain essentially constant at 660 or 670 calories 
 until the eighth day, the values for 6 subjects on this last day averaging 
 702 calories. 
 
 TABLE 13. Approximate basal metabolism of 
 infants during first 8 days after birth. 
 
 
 
 Average heat- 
 
 Age. 
 
 No. of 
 subjects. 
 
 production (com- 
 puted) per square 
 
 
 
 meter per 24 hours. 
 
 days. 
 
 
 cat. 
 
 1 
 
 56 
 
 592 
 
 2 
 
 47 
 
 661 
 
 3 
 
 49 
 
 676 
 
 4 
 
 46 
 
 677 
 
 5 
 
 35 
 
 659 
 
 6 
 
 16 
 
 689 
 
 7 
 
 8 
 
 652 
 
 8 
 
 6 
 
 702 
 
 If we turn again to figure 9, in which the absolutely minimum values 
 are shown, we find that there is a distinct tendency for the minimum 
 values for the days subsequent to the first day of life to group about a 
 vertical line corresponding to an average of approximately 640 calories 
 per square meter. If the limits of variation used with the other charts 
 are applied, it will be seen that practically all of the data for the last 6 
 days lie between 580 and 700 calories per square meter of body-surface, 
 the single exception being that of the 7-day-old infant No. 18, with the 
 extraordinarily low heat-production per square meter of 519 calories. 
 Aside from this particular case, therefore, all of the plotted values sub- 
 sequent to the first day of life lie inside of the =*= 10 per cent variation 
 from the average value of approximately 640 calories. If the plus or 
 minus variation of 10 per cent is accepted as approximating a physio- 
 logical law, we may consider this a verification of the fact that after the 
 first 24 hours the heat-production of new-born infants during the first 
 week of lif e is approximately 640 calories per square meter of body-sur- 
 face, all values lying inside the limits of 10 per cent of this average. 
 
 INFLUENCE OF LENGTH UPON THE BASAL KATABOLISM. 
 
 In our study a large number of plots were made in an attempt to 
 establish some relationship between the metabolism, the body-surface, 
 length, weight, age, and even pulse-rate and body-temperature, as it 
 was believed that the data obtained in the research were sufficiently 
 extensive to justify a thorough search for a mathematical relationship 
 between the measured factors. In a close examination of the original 
 draft of figure 9, on which were noted the lengths of the infants repre- 
 
BASAL KATABOLISM. 
 
 107 
 
 sented by each point, it was observed that there was a distinct tendency 
 for the shorter infants to have a lower heat-production per square meter 
 of body-surface than the heat-production of the longer infants, and 
 this apparent influence of the length upon the values led us to study 
 the problem critically. The heat-production per square meter of body- 
 surface per 24 hours was therefore divided by the total length of the 
 infant an admittedly somewhat empirical procedure and the result- 
 ing values were plotted in a chart which is shown in figure 10. Owing 
 to the profound disturbances in heat regulation and the variation in 
 the heat-production values on the first day, only those subjects between 
 If and 6 days of age are included in this chart. Even with these 
 omissions we have the results from 48 infants which are strictly com- 
 parable. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 * - 
 
 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 .E 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ... 
 
 t t 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 1 1.0 
 
 14.5 
 
 11.5 2.0 125 t '3-0 
 
 Cals. per Sq. Meter per 24 Hrs. per Cm. of Length 
 
 FIG. 10. Minimum heat-production of new-born infants per square meter per 24 hours, 
 computed per centimeter of length for infants between 1^ and 6 days old. The 
 arrow indicates 12.65 calories. 
 
 Nearly all of the points shown in this chart lie between 11.9 calories 
 and 13.4 calories, there being but 3 points below 11.9 calories and only 
 5 points above 13.4 calories. The 40 points which lie between these 
 values show an average heat-production of 12.65 calories per square 
 meter of body-surface per centimeter of length. The plus or minus 
 variation from this value is, accordingly, about 6 per cent for the 40 
 infants. It is' clear, therefore, that in the 5 days following the first 24 
 hours of post-natal life, we have a close approximation to constancy 
 in the metabolism of these new-born infants, for while we may reason- 
 
108 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 ably question values varying 10 per cent, a uniformity in values with 
 variations of only 6 per cent, with but a few striking exceptions, is at 
 least worthy of serious consideration. 
 
 From these observations we have derived a formula, cal. = ZX 12.65, 
 which takes into consideration both the length and the body-surface 
 and believe that it is possible to compute the minimum heat-production 
 of infants per 24 hours and per square meter of body-surface by multi- 
 plying the length I by the constant 12.65, this constant representing 
 the average calories per square meter per 24 hours per centimeter of 
 length as found from actual observations made with this group of 
 infants from If to 6 days old, inclusive. Thus our formula becomes: 
 
 Total cal. = ZX12.65Xl0.3^wt 2 
 
 The heat-production for the 48 infants shown in figure 10 has been 
 computed by means of this formula and the results are compared in 
 table 14 with the heat-production as determined by indirect calorimetry 
 from the gaseous metabolism. The plus or minus differences between 
 the two values are, for the most part, well inside of 6 per cent, the 
 widest variations being in the case of infants Nos. 53 and 54, with 
 differences of 11.9 per cent and +12.4 per cent, respectively. Aside 
 from infant No. 75, with a variation of 10.6 per cent, practically no 
 other values are found which vary over 7 per cent from the value 
 determined by indirect calorimetry. We believe, therefore, that we 
 are justified in presenting this formula as a reasonably accurate means 
 of computing the minimum heat-production of infants from If to 6 
 days old. 
 
 It is of course not unlikely that, with the progress of the interesting 
 researches of Du Bois on the measurement of body-surface, the Lissauer 
 constant may have to be discarded. As the body-surface is simply 
 an empirical index of the law of growth, we would strongly emphasize 
 our belief in the advisability of securing the most exact measurements; 
 at the same time we would further express our disapproval of any con- 
 ception of a causal relationship between body-surface and heat-produc- 
 tion. As an aid to pediatricians, however, we have computed various 
 data which may be used for obtaining the minimum metabolism of 
 new-born infants. In table 15 the body-surface is given for weights 
 ranging from 2 to 5 kg., as computed with the Lissauer formula. Since, 
 as brought out in the previous discussion, the heat-production per 
 square meter of body-surface becomes a function of length times a 
 constant, we have also computed the theoretical heat-production per 
 square meter per 24 hours for infants varying in length from 45 to 55 
 cm., using the constant of 12.65 found in our observations. These 
 values are given in table 16. Consequently, to find the total minimum 
 heat-production per 24 hours for any infant, which is of especial value 
 to the pediatrician as indicating a basal value, one has but to multiply 
 
BASAL KATABOLISM. 
 
 109 
 
 TABLE 14. Comparison of minimum heat-production computed by different methods. 
 (Infants l\to 6 days old.) 
 
 
 
 
 
 Heat produced per 24 hours. 
 
 Sub- 
 ject 
 No. 
 
 Length. 
 
 Body- 
 weight 
 without 
 clothing. 
 
 Surface 
 (Lis- 
 sauer) . 
 
 A 
 
 By formula 
 (length X 
 
 B 
 
 By indirect 
 
 Difference. 
 
 C 
 
 D 
 
 
 
 
 
 12.65X 
 surface) - 1 
 
 calorimetry. 2 
 
 Amount 
 (A -B). 
 
 Per cent 
 
 cxioo 
 
 B 
 
 
 cm. 
 
 kg. 
 
 sq. m. 
 
 cal 
 
 cal. 
 
 cal. 
 
 
 3 
 
 52 
 
 3.63 
 
 0.243 
 
 160 
 
 166 
 
 - 6 
 
 - 3.6 
 
 4 
 
 46.5 
 
 3.28 
 
 .227 
 
 133 
 
 139 
 
 - 6 
 
 - 4.3 
 
 6 
 
 52 
 
 4.32 
 
 .273 
 
 180 
 
 191 
 
 -11 
 
 - 5.8 
 
 8 
 
 51 
 
 3.48 
 
 .236 
 
 152 
 
 160 
 
 - 8 
 
 - 5.0 
 
 9 
 
 51 
 
 4.04 
 
 .262 
 
 169 
 
 178 
 
 - 9 
 
 - 5.1 
 
 10 
 
 52 
 
 3.45 
 
 .235 
 
 155 
 
 162 
 
 - 7 
 
 - 4.3 
 
 12 
 
 52.5 
 
 4.17 
 
 .267 
 
 177 
 
 171 
 
 + 6 
 
 + 3.5 
 
 13 
 
 50 
 
 3.25 
 
 .226 
 
 143 
 
 138 
 
 + 5 
 
 + 3.6 
 
 15 
 
 50 
 
 3.64 
 
 .243 
 
 154 
 
 162 
 
 - 8 
 
 - 4.9 
 
 16 
 
 53 
 
 4.03 
 
 .261 
 
 175 
 
 175 
 
 
 
 
 
 19 
 
 53 
 
 3.50 
 
 .237 
 
 159 
 
 155 
 
 + 4 
 
 + 2.6 
 
 20 
 
 52 
 
 3.54 
 
 .239 
 
 157 
 
 153 
 
 + 4 
 
 + 2.6 
 
 21 
 
 50 
 
 2.92 
 
 .211 
 
 134 
 
 136 
 
 - 2 
 
 - 1.5 
 
 22 
 
 49 
 
 2.72 
 
 .201 
 
 125 
 
 128 
 
 - 3 
 
 - 2.3 
 
 25 
 
 51.5 
 
 3.32 
 
 .229 
 
 149 
 
 158 
 
 - 9 
 
 - 5.7 
 
 26 
 
 50 
 
 3.46 
 
 .235 
 
 149 
 
 151 
 
 - 2 
 
 - 1.3 
 
 27 
 
 52 
 
 3.58 
 
 .240 
 
 158 
 
 169 
 
 -11 
 
 - 6.5 
 
 29 
 
 50 
 
 3.37 
 
 .232 
 
 147 
 
 150 
 
 - 3 
 
 - 2.0 
 
 30 
 
 51 
 
 3.33 
 
 .230 
 
 148 
 
 144 
 
 + 4 
 
 + 2.8 
 
 31 
 
 53.5 
 
 3.56 
 
 .239 
 
 162 
 
 158 
 
 + 4 
 
 + 2.5 
 
 32 
 
 47.5 
 
 3.42 
 
 .234 
 
 141 
 
 140 
 
 + 1 
 
 + 0.7 
 
 33 
 
 52 
 
 3.73 
 
 .248 
 
 163 
 
 153 
 
 + 10 
 
 + 6.5 
 
 34 
 
 50.5 
 
 2.90 
 
 .210 
 
 134 
 
 134 
 
 
 
 
 
 35 
 
 54 
 
 4.33 
 
 .274 
 
 187 
 
 175 
 
 +12 
 
 + 6.9 
 
 38 
 
 51.5 
 
 3.90 
 
 .255 
 
 166 
 
 156 
 
 + 10 
 
 + 6.4 
 
 40 
 
 49.5 
 
 2.78 
 
 .204 
 
 128 
 
 134 
 
 - 6 
 
 - 4.5 
 
 42 
 
 54 
 
 3.95 
 
 .257 
 
 176 
 
 176 
 
 
 
 
 
 43 
 
 50 
 
 3.62 
 
 .242 
 
 153 
 
 165 
 
 -12 
 
 - 7.3 
 
 48 
 
 54.5 
 
 4.52 
 
 .282 
 
 194 
 
 188 
 
 + 6 
 
 + 3.2 
 
 49 
 
 47.5 
 
 2.75 
 
 .202 
 
 121 
 
 130 
 
 Q 
 t7 
 
 - 6.9 
 
 51 
 
 52.5 
 
 3.73 
 
 .248 
 
 165 
 
 154 
 
 +11 
 
 + 7.1 
 
 52 
 
 50 
 
 3.54 
 
 .239 
 
 151 
 
 138 
 
 + 13 
 
 + 9.4 
 
 53 
 
 47.5 
 
 2.87 
 
 .209 
 
 126 
 
 143 
 
 -17 
 
 -11.9 
 
 54 
 
 50 
 
 3.31 
 
 .229 
 
 145 
 
 129 
 
 +16 
 
 + 12.4 
 
 56 
 
 51.5 
 
 3.19 
 
 .224 
 
 146 
 
 150 
 
 - 4 
 
 - 2.7 
 
 59 
 
 52 
 
 3.60 
 
 .241 
 
 159 
 
 150 
 
 + 9 
 
 + 6 
 
 60 
 
 52 
 
 3.60 
 
 .241 
 
 159 
 
 149 
 
 +10 
 
 + 6.7 
 
 62 
 
 49.5 
 
 3.30 
 
 .228 
 
 143 
 
 134 
 
 + 9 
 
 + 6.7 
 
 63 
 
 47.5 
 
 2.37 
 
 .183 
 
 110 
 
 109 
 
 + 1 
 
 + 0.9 
 
 65 
 
 49 
 
 2.63 
 
 .197 
 
 122 
 
 127 
 
 5 
 
 - 3.9 
 
 67 
 
 54 
 
 4.74 
 
 .291 
 
 199 
 
 193 
 
 + 6 
 
 + 3.1 
 
 68 
 
 46 
 
 2.12 
 
 .170 
 
 99 
 
 103 
 
 - 4 
 
 - 3.9 
 
 70 
 
 51 
 
 3.56 
 
 .239 
 
 154 
 
 153 
 
 + 1 
 
 + 0.7 
 
 71 
 
 53.5 
 
 3.96 
 
 .258 
 
 175 
 
 172 
 
 + 3 
 
 + 1.7 
 
 72 
 
 50.5 
 
 3.29 
 
 .228 
 
 146 
 
 157 
 
 -11 
 
 - 7.0 
 
 74 
 
 52 
 
 3.63 
 
 .243 
 
 160 
 
 156 
 
 + 4 
 
 + 2.6 
 
 75 
 
 47.5 
 
 2.65 
 
 .197 
 
 118 
 
 132 
 
 -14 
 
 -10.6 
 
 90 
 
 50 
 
 3.00 
 
 .214 
 
 135 
 
 138 
 
 - 3 
 
 - 2.2 
 
 iSee fig. 10, p. 107, and table 16, p. 110. 2 See table 12 p. 95. 
 
110 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 the values given in table 16 by the surface area as indicated in table 15. 
 The^minimum basal metabolism thus found will lie for the most part 
 within a 6 per cent limit, only a few instances being found outside of 
 this and these rarely varying more than 10 per cent from the average 
 value. 
 
 TABLE 15. Body-surface computed from the Lissauer formula (10.3 
 
 Body- 
 weight. 
 
 Body- 
 surface. 
 
 Body- 
 weight. 
 
 Body- 
 surface. 
 
 Body- 
 weight. 
 
 Body- 
 surface. 
 
 Body- 
 weight. 
 
 Body- 
 surface. 
 
 kg. 
 
 sq. m. 
 
 kg. 
 
 sq. m. 
 
 kg. 
 
 sq. m. 
 
 kg. 
 
 sq. m. 
 
 2.00 
 
 0.163 
 
 2.80 
 
 0.205 
 
 3.55 
 
 0.239 
 
 4.30 
 
 0.272 
 
 2.05 
 
 .166 
 
 2.85 
 
 .207 
 
 3.60 
 
 .241 
 
 4.35 
 
 .274 
 
 2.10 
 
 .169 
 
 2.90 
 
 .210 
 
 3.65 
 
 .244 
 
 4.40 
 
 .277 
 
 2.15 
 
 .172 
 
 2.95 
 
 .212 
 
 3.70 
 
 .246 
 
 4.45 
 
 .279 
 
 2.20 
 
 .174 
 
 3.00 
 
 .214 
 
 3.75 
 
 .249 
 
 4.50 
 
 .281 
 
 2.25 
 
 .177 
 
 3.05 
 
 .217 
 
 3.80 
 
 .251 
 
 4.55 
 
 .283 
 
 2.30 
 
 .179 
 
 3.10 
 
 .219 
 
 3.85 
 
 .253 
 
 4.60 
 
 .285 
 
 2.35 
 
 .182 
 
 3.15 
 
 .222 
 
 3.90 
 
 .255 
 
 4.65 
 
 .287 
 
 2.40 
 
 .184 
 
 3.20 
 
 .224 
 
 3.95 
 
 .257 
 
 4.70 
 
 .289 
 
 2.45 
 
 .187 
 
 3.25 
 
 .226 
 
 4.00 
 
 .260 
 
 4.75 
 
 .291 
 
 2.50 
 
 .190 
 
 3.30 
 
 .228 
 
 4.05 
 
 .262 
 
 4.80 
 
 .293 
 
 2.55 
 
 .192 
 
 3.35 
 
 .231 
 
 4.10 
 
 .264 
 
 4.85 
 
 .295 
 
 2.60 
 
 .195 
 
 3.40 
 
 .233 
 
 4.15 
 
 .266 
 
 4.90 
 
 .297 
 
 2.65 
 
 .197 
 
 3.45 
 
 .235 
 
 4.20 
 
 .268 
 
 4.95 
 
 .299 
 
 2.70 
 
 .200 
 
 3.50 
 
 .237 
 
 4.25 
 
 .270 
 
 5.00 
 
 .301 
 
 2.75 
 
 .202 
 
 
 
 
 
 
 
 TABLE 16. Heat values (per sq. meter per 24 hrs.) computed for 
 varying lengths. (Infants 1\ to 6 days old, inclusive.) 
 
 Length. 
 
 Length X 
 constant 
 (12.65) . l 
 
 Length. 
 
 Length X 
 constant 
 (12.65) - 1 
 
 Length. 
 
 Length X 
 constant 
 (12.65). 1 
 
 cm. 
 
 col. 
 
 cm. 
 
 cal. 
 
 cm. 
 
 cal. 
 
 45.0 
 
 569 
 
 48.5 
 
 614 
 
 52.0 
 
 658 
 
 45.5 
 
 576 
 
 49.0 
 
 620 
 
 52.5 
 
 664 
 
 46.0 
 
 582 
 
 49.5 
 
 626 
 
 53.0 
 
 670 
 
 46.5 
 
 588 
 
 50.0 
 
 633 
 
 53.5 
 
 677 
 
 47.0 
 
 595 
 
 50.5 
 
 639 
 
 54.0 
 
 683 
 
 47.5 
 
 601 
 
 51.0 
 
 645 
 
 54.5 
 
 689 
 
 48.0 
 
 607 
 
 51.5 
 
 651 
 
 55.0 
 
 696 
 
 *See fig. 10, page 107. 
 
 It should further be emphasized that in the foregoing discussion we 
 have been dealing specifically with the minimum basal metabolism, 
 and that this would not, except in extremely rare instances, correspond 
 to the total 24-hour heat-production of an infant living in a private 
 hospital ward or the home nursery. The influence of feeding and mus- 
 cular activity would obviously be superimposed upon these minimum 
 values, but we believe that we are correct in saying that this is the first 
 time we have information which may be considered as founded upon 
 sufficiently extensive data to give us a true basal value for the minimum 
 
BASAL KATABOLISM. Ill 
 
 metabolism of new-born infants. The problem now before us is to 
 determine approximately the influence of the various superimposed 
 factors which make up a day of ordinary activity. 
 
 INFLUENCE OF ACTIVITY UPON THE BASAL KATABOLISM. 
 
 As has already been pointed out, the minimum metabolism values 
 recorded in this report indicate only the metabolism when. the infants 
 studied were in a condition of practically complete muscular repose. 
 As a matter of fact, infants are not in complete muscular repose during 
 the entire first week of life, and there are periods in which the activity 
 varies from a general restlessness and movement of the limbs to 
 paroxysms of severe crying. The probable maximum values for the 
 metabolism are therefore of interest. The maximum values observed 
 with 93 of our infants, i. e., the values found in the periods when the 
 maximum respiratory exchange took place, are given in table 17 and are 
 there compared with the minimum values previously recorded in table 
 12. The percentage increase found in the maximum periods as com- 
 pared with the minimum periods is also given in table 17. It should be 
 borne in mind that the values given in table 17 are not the highest values 
 possible as a result of muscular activity, but are the highest that were 
 observed for the individual infants in our study. It is probable, 
 however, that the 211 per cent increase shown by one of the infants 
 represents approximately the possible maximum. 
 
 Before the measurements of the respiratory exchange were begun 
 most of the infants were naturally somewhat active as a result of bath- 
 ing and dressing and their transportation from the hospital to the obser- 
 vation room. A considerable proportion of the maximum values were 
 therefore found in the preliminary periods of the observations, but a 
 large number of these values were also obtained in other periods. 
 With a few infants the increase shown in the maximum period was 
 hardly 4 per cent, but the average for the 93 subjects shows an 
 increase of 65 per cent in the maximum heat-production as compared 
 with the minimum. In some instances this average difference was very 
 greatly increased. Thus, values over 100 per cent were found in 10 
 instances, the highest value being that of infant No. 89, with which 
 an increase of 211 per cent was found in the maximum period. On 
 the other hand, a large majority of the subjects showed an increase of 
 only 40 to 80 per cent above the minimum. 
 
 Since other writers have reported a very much smaller increment in 
 the basal metabolism as a result of crying and muscular activity, a 
 close analysis of our figures is essential. A possible criticism may be 
 raised that these computations were based entirely upon the carbon- 
 dioxide output, making due allowance for the variations in the respira- 
 tory quotients in computing the calories produced. We have there- 
 fore recomputed the increment in metabolism for a considerable number 
 
112 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 TABLE 17. Maximum and minimum heat-production in observations on new-born infanti 
 
 Subject 
 No. 
 
 Pulse-rate. 
 
 Heat produced 
 (computed) per 
 24 hours. 
 
 Subject 
 No. 
 
 Pulse-rate. 
 
 Heat produced 
 (computed) per 
 24 hours. 
 
 Max 
 per- 
 iod. 
 
 Min 
 per- 
 iods. 1 
 
 Max 
 
 Min. 1 
 
 Increase, 
 maximum 
 over 
 minimum 
 
 Max 
 per- 
 iod. 
 
 Min 
 per- 
 iods. 1 
 
 Max. 
 
 Min. 1 
 
 Increase, 
 maximum 
 over 
 minimum 
 
 2 
 
 107 
 135 
 113 
 128 
 160 
 162 
 103 
 101 
 130 
 135 
 131 
 139 
 126 
 110 
 118 
 129 
 126 
 139 
 135 
 124 
 119 
 139 
 125 
 127 
 115 
 140 
 135 
 123 
 138 
 117 
 123 
 133 
 134 
 135 
 131 
 122 
 158 
 119 
 181 
 140 
 94 
 120 
 138 
 160 
 112 
 126 
 141 
 154 
 
 99 
 97 
 105 
 112 
 116 
 117 
 109 
 116 
 112 
 113 
 122 
 113 
 118 
 105 
 114 
 110 
 121 
 114 
 123 
 113 
 111 
 112 
 114 
 117 
 116 
 129 
 115 
 109 
 129 
 119 
 127 
 105 
 113 
 119 
 103 
 110 
 126 
 107 
 132 
 114 
 89 
 96 
 114 
 126 
 106 
 124 
 121 
 105 
 
 cat. 
 2 195 
 2 305 
 2221 
 2242 
 381 
 267 
 2 243 
 2227 
 2 249 
 352 
 286 
 312 
 323 
 2 200 
 205 
 209 
 2 217 
 2 303 
 233 
 269 
 2 237 
 326 
 2 195 
 2 218 
 2 193 
 2 225 
 200 
 2 244 
 2 220 
 2 134 
 2 225 
 2 198 
 2244 
 2 244 
 225 
 2 157 
 239 
 2 249 
 2 515 
 2 226 
 2 147 
 2 264 
 209 
 315 
 2 223 
 2 194 
 2 209 
 345 
 
 cal. 
 152 
 166 
 139 
 137 
 191 
 160 
 178 
 162 
 171 
 138 
 162 
 175 
 174 
 108 
 155 
 153 
 136 
 128 
 158 
 151 
 169 
 150 
 144 
 158 
 140 
 153 
 134 
 175 
 154 
 99 
 156 
 113 
 176 
 165 
 136 
 107 
 152 
 143 
 188 
 130 
 142 
 154 
 138 
 143 
 129 
 151 
 150 
 153 
 
 p.ct. 
 28 
 84 
 59 
 77 
 99 
 67 
 37 
 40 
 46 
 155 
 77 
 78 
 86 
 85 
 32 
 37 
 60 
 137 
 47 
 78 
 40 
 117 
 35 
 38 
 38 
 47 
 49 
 39 
 43 
 35 
 44 
 75 
 39 
 48 
 65 
 47 
 57 
 74 
 174 
 74 
 4 
 71 
 51 
 120 
 73 
 28 
 39 
 125 
 
 58 
 
 120 
 132 
 142 
 119 
 146 
 113 
 122 
 129 
 136 
 135 
 141 
 124 
 125 
 119 
 110 
 162 
 118 
 118 
 110 
 125 
 127 
 146 
 126 
 106 
 138 
 139 
 102 
 104 
 145 
 106 
 162 
 92 
 115 
 136 
 146 
 135 
 142 
 120 
 117 
 123 
 124 
 134 
 158 
 123 
 135 
 
 Ill 
 112 
 117 
 121 
 116 
 125 
 98 
 116 
 103 
 122 
 113 
 110 
 109 
 106 
 110 
 106 
 94 
 100 
 101 
 101 
 116 
 109 
 114 
 101 
 131 
 109 
 109 
 103 
 118 
 96 
 107 
 86 
 113 
 112 
 127 
 117 
 123 
 99 
 113 
 102 
 103 
 130 
 109 
 125 
 107 
 
 cal. 
 2 180 
 2 271 
 213 
 2 136 
 2 363 
 2 185 
 2 193 
 2 166 
 2 205 
 2 283 
 185 
 2 222 
 270 
 2 255 
 2 210 
 248 
 2 225 
 2 185 
 2 193 
 2 153 
 2 257 
 290 
 2 196 
 131 
 2 332 
 227 
 2 169 
 2 231 
 259 
 2 172 
 386 
 2 181 
 2 199 
 2 240 
 2 239 
 2 237 
 2 176 
 2 174 
 2 178 
 160 
 2 228 
 2 295 
 2 251 
 2 215 
 176 
 
 cal. 
 139 
 150 
 149 
 123 
 134 
 109 
 128 
 127 
 122 
 193 
 103 
 142 
 153 
 172 
 157 
 164 
 156 
 132 
 137 
 109 
 153 
 128 
 167 
 95 
 148 
 133 
 144 
 120 
 146 
 122 
 124 
 138 
 140 
 157 
 136 
 136 
 100 
 113 
 112 
 98 
 122 
 186 
 126 
 130 
 105 
 
 p.ct. 
 29 
 81 
 43 
 11 
 171 
 70 
 51 
 31 
 68 
 47 
 80 
 56 
 76 
 48 
 34 
 51 
 44 
 40 
 41 
 40 
 68 
 127 
 17 
 38 
 124 
 71 
 17 
 93 
 77 
 41 
 211 
 31 
 42 
 53 
 76 
 74 
 76 
 54 
 59 
 63 
 87 
 59 
 99 
 65 
 68 
 
 3 
 
 59 ... 
 
 4 
 
 60 
 
 5 
 
 61 
 62 
 63 
 
 6 
 
 8 
 9 
 
 64 
 
 10 
 12 
 
 65 
 
 66 
 
 13 
 
 67 
 
 15 
 
 68 
 
 16 
 
 69 
 
 17 
 
 70 
 
 18 
 
 71 
 
 19 
 
 72 
 
 20 
 21 
 22 ... 
 
 73 
 
 74 
 75 
 
 25 
 
 76 
 
 26 
 
 78 
 79 
 80 
 
 27 
 
 29 
 
 30 
 31 
 32 
 33 
 34 
 
 81 
 82 
 83 . . 
 
 84 
 
 85 
 86 
 87 
 
 35 
 
 36 
 37 
 
 88 
 89 
 90 
 
 38 
 
 39 
 
 42 
 43 . . 
 
 91.. . . 
 
 92 
 
 44 
 
 93 
 
 45 
 
 94 
 
 46 
 
 95 
 
 47 
 
 96 
 
 48 
 
 97 . . 
 
 49 
 
 98 
 
 50 
 
 99 
 
 51 
 
 100 
 
 52 
 
 101 
 103 
 
 53 
 54 
 
 EC 
 
 104 
 
 
 56 
 
 Average of 
 93 subjects 
 
 129 
 
 112 
 
 234 
 
 143 
 
 65 
 
 57 
 
 l See table 12, p. 95. 
 
 2 Maximum calculated from the carbon dioxide produced during a preliminary period for which 
 the respiratory quotient was not determined. 
 
BASAL KATABOLISM. 
 
 113 
 
 of the infants who showed a large increase in the heat-production 
 during the maximum period, using the oxygen consumption as a basis 
 of calculation. These are compared in table 18 with the values pre- 
 viously calculated from the carbon-dioxide production. As will be 
 seen by reference to this table, the values found upon this basis vary 
 but slightly from those computed from the carbon-dioxide production. 
 For example, the large increment of 211 per cent shown by infant No. 
 89 in the maximum period on the basis of the carbon-dioxide production 
 becomes 219 per cent when the calculation is made on the basis of the 
 oxygen consumption, while with infant No. 13 the increment of 155 
 per cent becomes 137 per cent on the basis of the oxygen consumption. 
 All of the other computations lie distinctly inside these limits. 
 
 TABLE 18. Periods of maximum heat-production computed 
 from the oxygen consumption. 
 
 
 
 
 
 Increase of maximum 
 
 
 
 
 Heat 
 
 over minimum. 
 
 Sub- 
 
 Dura- 
 
 Oxygen 
 
 produced 
 
 
 
 
 ject 
 No. 
 
 tion of 
 period. 
 
 con- 
 sumed. 
 
 (com- 
 puted) per 
 24 hours. 
 
 Computed 
 from 
 
 Computed 
 from 
 carbon 
 
 
 
 
 
 oxygen. 1 
 
 dioxide. 2 
 
 
 min. 
 
 liters. 
 
 cal: 
 
 p.ct. 
 
 p.ct. 
 
 6 
 
 29 
 
 1.46 
 
 341 
 
 79 
 
 99 
 
 13 
 
 31 
 
 1.45 
 
 327 
 
 137 
 
 155 
 
 15 
 
 33 
 
 1.33 
 
 289 
 
 78 
 
 77 
 
 16 
 
 43 
 
 1.87 
 
 308 
 
 76 
 
 78 
 
 26 
 
 26 
 
 .96 
 
 258 
 
 71 
 
 78 
 
 29 
 
 24 
 
 1.14 
 
 331 
 
 121 
 
 117 
 
 57 
 
 25 
 
 1.19 
 
 332 
 
 117 
 
 125 
 
 68 
 
 37 
 
 1.01 
 
 187 
 
 82 
 
 80 
 
 80 
 
 62 
 
 2.34 
 
 262 
 
 105 
 
 127 
 
 87 
 
 62 
 
 2.21 
 
 251 
 
 72 
 
 77 
 
 89 
 
 27 
 
 1.55 
 
 395 
 
 219 
 
 211 
 
 x The average respiratory quotient for the observation was 
 used in the computation as was done in computing 
 the values in table 17. 
 
 2 See table 17. 
 
 In view of this comparison, we may therefore have every confidence 
 in the values given in table 17, and fairly conclude that with the aver- 
 age infant the metabolism may, on the average, be increased approxi- 
 mately 65 per cent above the minimum value, with the possibility of an 
 increase of 200 per cent, or even more when there is extreme restlessness 
 and crying. 
 
 PULSE-RATE. 
 
 It has been clearly demonstrated in previous researches in this labora- 
 tory that the pulse-rate is one of the best indices of the internal mus- 
 cular activity or degree of cellular stimulus, and this fact was taken 
 into consideration in selecting the minimum metabolism periods. In 
 the earlier investigation the relationship between the pulse-rate and 
 
114 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 the metabolism was specifically studied, 1 but in the research on the 
 metabolism of new-born infants, the recording of the pulse-rate was 
 only incidental to the measurements of the metabolism and a special 
 assistant was not assigned to this routine; the method of taking the 
 records was therefore somewhat defective. Nevertheless, from 6 to 8 
 observations were made during each 30-minute period and a sufficient 
 number of periods were used in averaging to give reasonable assurance 
 of the validity of the average values obtained. A study of the pulse- 
 records is therefore desirable. 
 
 The observations of the pulse-rate in the previous research showed 
 the very wide variations which may reasonably be expected to occur 
 in a short period. The infants studied at that time included only a 
 few new-born infants, yet the records obtained in the later research 
 show the same striking changes in the pulse-rate that were found with 
 the older infants. This may be seen in table 17, 2 in which the average 
 pulse-rates for the periods of minimum metabolism are given and com- 
 pared with those for the periods of maximum metabolism. It should 
 be borne in mind that these values do not represent the minimum or 
 maximum pulse-records, but only the average pulse-rates for those 
 periods in which the minimum or maximum metabolism was found for 
 the individual infants. The comparison of the values obtained in 
 these periods has a special interest in our study of the minimum and 
 maximum metabolism of new-born infants. 
 
 The values for the pulse-rate during the periods of minimum metab- 
 olism ranged from 86 for infant No. 90 to 132 for infant No. 48, the 
 average for the 93 subjects being 112. When we examine the average 
 values for the periods of maximum metabolism, certain anomalous 
 values are apparent, but usually the pulse-rate for the minimum period 
 was distinctly lower than that found during the maximum period, the 
 average value for the maximum period being 129, or 17 beats higher 
 than the average value for the minimum periods. Very great differ- 
 ences are, however, frequently found between the highest and lowest 
 values. For instance, with infant No. 6 the pulse-rate for the maximum 
 period was 160 and for the minimum period 116, and with infant No. 8 
 the averages were 162 and 117 respectively. With infant No. 73 a still 
 greater difference was found, the values being 162 for the maximum 
 and 106 for the minimum; essentially the same values were found for 
 infant No. 89, with whom the metabolism increased 211 per cent. We 
 may say with perfect propriety, therefore, that in general with new-born 
 infants the pulse-rate increases with the metabolism, but we do not 
 find so close an approximation to the mathematical relationship 
 between the increment in the pulse-rate and the metabolism as was 
 observed with the fasting man recently studied in this laboratory. 3 
 
 Benedict and Talbot, Carnegie Inst. Wash. Pub. No. 201, 1915, p. 130. 
 
 'See page 112. 3 Benedict, Carnegie Inat. Wash. Pub. No. 203, 1915, p. 350. 
 
BASAL KATABOLISM. 
 
 115 
 
 TABLE 19. Pulse-rate of infants during periods of approximately minimum heat-production 
 
 in first 8 days after birth. 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 First 
 day. 
 
 Second 
 day. 
 
 Third 
 day. 
 
 Fourth 
 day. 
 
 Fifth 
 day. 
 
 Sixth 
 day. 
 
 Seventh 
 day. 
 
 Eighth 
 day. 
 
 2 
 3 
 4 
 5 
 6 
 8 
 9 
 10 
 12 
 13 
 15 
 16 
 17 
 18 
 19 
 20 
 21 
 22 
 25 
 26 
 27 
 29 
 30 
 31 
 32 
 33 
 34 
 35 
 36 
 37 
 38 
 39 
 40 
 42 
 43 
 44 
 45 
 46 
 47 
 48 
 49 
 50 
 51 
 52 
 53 
 54 
 55 
 56 
 57 
 58 
 59 
 60 
 61 
 62 
 63 
 64 
 65 
 66 
 67 
 
 Female 
 
 
 
 
 
 103 
 114 
 
 117 
 
 120 
 
 103 
 
 i28 
 
 95 
 
 Male 
 
 
 95 
 101 
 103 
 
 99 
 108 
 
 13G 
 144 
 109 
 117 
 
 113 
 125 
 107 
 
 107 
 
 114 
 127 
 
 112 
 119 
 
 121 
 129 
 
 104 
 113 
 
 123 
 115 
 108 
 110 
 119 
 115 
 120 
 117 
 116 
 107 
 105 
 
 ill 
 122 
 123 
 
 Female 
 Male 
 
 112 
 
 Male 
 
 Male 
 
 111 
 
 115 
 
 118 
 
 ioe 
 
 113 
 113 
 110 
 
 Female 
 
 Male . . 
 
 Female 
 
 Female 
 Male 
 
 121 
 
 119 
 121 
 
 
 121 
 
 Female 
 Female 
 
 Male 
 
 109 
 96 
 109 
 120 
 
 124 
 105 
 
 117 
 118 
 125 
 131 
 107 
 
 111 
 
 123 
 129 
 106 
 
 138 
 138 
 119 
 
 105 
 
 124 
 113 
 
 136 
 110 
 
 123 
 
 148 
 114 
 
 Male 
 
 116 
 110 
 116 
 
 114 
 121 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 
 
 Female 
 
 
 
 Male . . . 
 
 
 117 
 113 
 125 
 
 121 
 127 
 
 117 
 112 
 137 
 
 iis 
 
 134 
 130 
 138 
 115 
 89 
 114 
 124 
 
 116 
 113 
 102 
 
 116 
 111 
 
 Female . . . . f . . 
 
 
 Male 
 Male 
 Male 
 Male 
 Female 
 Female 
 Male 
 Female 
 Female 
 Female 
 
 128 
 
 129 
 119 
 125 
 105 
 
 130 
 132 
 122 
 
 123 
 119 
 112 
 
 107 
 
 115 
 111 
 
 120 
 
 115 
 115 
 
 114 
 
 124 
 124 
 125 
 124 
 
 109 
 
 
 
 Female 
 
 Female 
 
 120 
 
 103 
 99 
 122 
 107 
 
 Female 
 Female 
 
 Female 
 
 Male 
 
 109 
 105 
 132 
 113 
 
 106 
 122 
 131 
 114 
 
 114 
 136 
 132 
 
 
 156 
 
 Male 
 
 Female 
 
 Female 
 
 
 Female 
 
 
 Male 
 
 99 
 
 93 
 110 
 126 
 120 
 
 108 
 
 129 
 126 
 118 
 125 
 137 
 124 
 
 108 
 115 
 
 114 
 126 
 113 
 
 111 
 111 
 
 
 
 
 Female 
 
 Male 
 
 
 Male 
 
 101 
 124 
 
 106 
 
 99 
 107 
 115 
 
 122 
 118 
 112 
 112 
 126 
 119 
 126 
 
 Male 
 Male 
 
 119 
 119 
 
 119 
 
 
 
 Male 
 Female 
 Female 
 Male 
 Male 
 
 109 
 115 
 
 121 
 118 
 
 117 
 
 120 
 
 
 
 Male 
 
 114 
 125 
 
 121 
 131 
 125 
 
 115 
 110 
 131 
 
 
 
 
 Female 
 
 Female 
 
 98 
 106 
 103 
 
 Female ~". 
 Male 
 
 134 
 115 
 
 
 
 
 Male 
 
 
 
116 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 TABLE 19. Pulse-rate of infants during periods of approximately minimum heat-production 
 in first 8 days after birth Continued. 
 
 Sub- 
 ject 
 No. 
 
 Sex. 
 
 First 
 day. 
 
 Second 
 day. 
 
 Third 
 day. 
 
 Fourth 
 day. 
 
 Fifth 
 day. 
 
 Sixth 
 day. 
 
 Seventh 
 day. 
 
 Eighth 
 day. 
 
 68 
 69 
 
 Male 
 Male 
 
 iii 
 
 109 
 
 112 
 
 115 
 
 109 
 
 
 
 
 70 
 
 Male 
 
 
 107 
 
 100 
 
 111 
 
 
 
 
 
 71 
 
 Male 
 
 
 
 111 
 
 
 100 
 
 
 
 
 72 
 
 Male 
 
 
 
 110 
 
 
 
 
 
 
 73 
 
 Male 
 
 106 
 
 131 
 
 131 
 
 121 
 
 
 
 
 
 74 
 
 Male 
 
 
 94 
 
 
 
 
 
 
 
 75 
 
 Male 
 
 
 100 
 
 113 
 
 115 
 
 
 
 
 
 76 
 
 Male 
 
 101 
 
 
 
 
 
 
 
 
 78 
 
 Male 
 
 101 
 
 
 
 
 
 
 
 
 79 
 
 Female 
 
 116 
 
 124 
 
 127 
 
 106 
 
 
 
 
 
 80 
 
 Male 
 
 109 
 
 
 
 124 
 
 
 
 
 
 81 
 
 Female 
 
 114 
 
 
 
 
 
 
 
 
 82 
 
 Male 
 
 101 
 
 
 
 
 
 
 
 
 83 
 
 Male . . 
 
 131 
 
 122 
 
 
 
 
 
 133 
 
 
 84 
 
 Female 
 
 109 
 
 
 115 
 
 
 
 
 
 
 85 
 
 Male 
 
 109 
 
 
 
 
 
 
 
 
 86 
 
 Female 
 
 103 
 
 
 
 98 
 
 
 
 
 
 87 
 
 Male 
 
 118 
 
 113 
 
 
 
 
 
 
 
 88 
 
 Female 
 
 96 
 
 
 
 
 
 
 
 
 89 
 
 Male 
 
 107 
 
 112 
 
 123 
 
 129 
 
 
 
 
 
 90 
 
 Male 
 
 116 
 
 88 
 
 82 
 
 
 
 
 
 
 91 
 
 Female 
 
 113 
 
 105 
 
 
 
 
 
 
 
 92 
 
 Female . . 
 
 112 
 
 
 112 
 
 
 
 
 
 
 93 
 
 Male 
 
 127 
 
 
 
 
 
 
 
 
 94 
 
 Male 
 
 117 
 
 
 118 
 
 
 
 
 
 
 95 
 
 Female 
 
 123 
 
 
 
 
 
 
 
 
 96 
 
 Female 
 
 99 
 
 
 
 
 
 
 
 
 97 
 
 Female 
 
 113 
 
 
 
 
 
 
 
 
 98 
 
 Female 
 
 102 
 
 
 
 
 
 
 
 
 99 
 
 Male 
 
 103 
 
 
 
 
 
 
 
 
 100 
 
 Male 
 
 130 
 
 
 
 
 
 
 
 
 101 
 
 Male 
 
 109 
 
 
 
 
 
 
 
 
 103 
 
 Female ... ... 
 
 125 
 
 
 
 
 
 
 
 
 104 
 
 Male 
 
 107 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Average 
 
 112 
 
 114 
 
 116 
 
 116 
 
 116 
 
 122 
 
 119 
 
 126 
 
 
 
 
 
 
 
 
 
 
 
 This discussion of the pulse-rate of new-born infants has thus far 
 dealt with the average pulse-records during the periods with either 
 maximum or minimum metabolism, irrespective of the age of the 
 infant, which varied from 1 to 7 days. Since a study of the probable 
 trend of the pulse-rate of infants during the first week of life may be 
 of particular significance, we have gathered together in table 19 the 
 pulse-rate prevailing during the periods which were selected for the 
 comparison from day to day of the minimum heat-production. (See 
 table 13.) The metabolism in these periods can be considered abso- 
 lutely minimum in but relatively few instances, but the values do repre- 
 sent the best which could be obtained from the data available for the 
 first 8 days of life. The lowest average pulse-rate, i. e., 112, was found 
 on the first day of life. For the next 4 days the pulse-rate remained 
 
PHYSIOLOGICAL NEEDS VS. SUPPLY. 117 
 
 essentially constant, being 114 for the second day and 116 for the three 
 following days. At the end of the week there was a distinct increase, 
 the pulse for the sixth, seventh, and eighth days averaging 122, 119, and 
 126, respectively. 
 
 While we would again emphasize the fact that these pulse-rate obser- 
 vations were wholly incidental to the studies of the metabolism, yet 
 our previous experience has led us to be so cautious in our selection of 
 average values and of minimum values that we may say with confidence 
 that these figures represent the average minimum values for the pulse- 
 rate of a considerable number of new-born infants during the first 8 
 days of life. The fact that the low pulse-rate for the first day is coinci- 
 dental with a low average body-temperature and heat-production is only 
 what would naturally be expected in view of the results obtained in 
 our previous researches and bears out the theory that the best indices 
 of internal muscular activity or internal cellular activity are the pulse- 
 rate and the body-temperature. Under normal conditions fluctua- 
 tions in the body-temperature are not so great as to define sharply the 
 relationship between the body-temperature and the metabolism, except 
 when there is a febrile temperature. With the supercooling of these 
 infants, however, the low pulse-rate and its attendant low metabolism 
 and low temperature are strikingly in accord. 
 
 PHYSIOLOGICAL NEEDS VS. SUPPLY. 
 
 As a result of this study of the metabolism of the new-born infant, 
 certain fundamental values may be considered as definitely established, 
 namely, the basal energy requirements of the new-born infant for the 
 5 days following the first 24 hours of life. Our calculations of the mini- 
 mum metabolism, upon which we base our discussion almost exclusively, 
 show a remarkable degree of uniformity in these values. From the 
 tables recording the minimum and maximum metabolism, data may be 
 obtained for also computing the approximate energy requirements of the 
 new-born child during a day of varied activity. The maximum values 
 have been shown to vary enormously in individual cases, but the results 
 of the whole series average 65 per cent above the basal metabolism. 1 
 
 In estimating such requirements we are dealing only with the problem 
 of maintenance, assuming that during the first week we may disregard 
 the requirements for actual growth (at least for the purposes of dis- 
 cus^ion). Hence the primal consideration may be stated to be: Is the 
 normal food-supply of the new-born infant during the first week suffi- 
 cient for maintenance, disregarding any needs for growth? As the 
 evidence that we have accumulated may have a certain directly prac- 
 tical value in this connection, the energy output and its quantitative 
 relations to the energy intake may very properly be considered. Prac- 
 tical experience, particularly in regard to the noticeable loss in weight 
 
 l See p. 112. 
 
118 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 and the apparent scant supply of colostrum, leads us to expect, a 
 priori, that there is a lack of balance between intake and output. To 
 attempt any readjustment demands either (1) a reduction of the energy 
 output or (2) a more adequate food-supply, or a combination of both 
 factors. 
 
 THE CONSERVATION OF ENERGY. 
 
 The energy output depends largely upon the heat-regulation of the 
 body. The values previously presented have indicated that this heat- 
 regulation is very imperfect during the first day after birth, since both 
 minimum and maximum values for the basal metabolism per unit of 
 weight or surface area are noted on this day. 1 Important supple- 
 mentary evidence as to a greatly disturbed heat-regulation may be 
 found in a study of the body-temperature of these infants, for body- 
 temperature is the resultant of thermogenesis and thermolysis, and if 
 the latter prevails, there is a falling temperature. The well-known 
 factors influencing body-temperature in the adult, such as muscular 
 activity and exposure to a temperature environment differing greatly 
 from that of the body, are immediately recognized as factors entering 
 into the early life of the new-born infant, thus making a consideration 
 of the fluctuations in the body-temperature imperative in any adequate 
 discussion of the problem of heat-regulation in the body of the new- 
 born infant. 
 
 BODY-TEMPERATURE. 
 
 The body-temperature of these infants was recorded in practically 
 all instances just before and just after the observation of the respira- 
 tory exchange, and the data obtained are given with the other statistical 
 data in table 9. 2 In many of the observations on the first day after 
 birth, the body-temperature rose while the infant was inside the respi- 
 ration chamber. It would appear, therefore, that the effect of the 
 labor, the bath, and the exposure incident thereto was to lower the 
 temperature below normal. High temperatures were rarely noted with 
 any of the infants, but occasionally very low records were obtained 
 when there had been undue exposure, such as in the bath given before 
 the observation of the respiratory exchange. The low temperature due 
 to this previous exposure persisted for some time, but the temperature 
 gradually attained the normal height for an infant of this age. 
 
 In order that a more definite comparison may be made of the body- 
 temperature records during the first day after birth with those obtained 
 in the days following, the average rectal temperature of our infants for 
 each of the first 8 days is given in table 20. To study more closely 
 the temperature for the first day, we give also the records obtained with 
 infants studied before they were 12 hours old and those studied between 
 the twelfth and twenty-fourth hours. On the day of birth 48 infants 
 
 ^ee figures 7, 8, and 9, pp. 103, 104, and 105. 2 See pages 46 to 79. 
 
PHYSIOLOGICAL NEEDS VS. SUPPLY. 
 
 119 
 
 had an average rectal temperature during the first 12 hours of 36.7 C. 
 (98.1 F.) and during the last 12 hours 26 infants had an average tem- 
 perature of 36.9 C. (98.4 F.). The average rectal temperature for 
 the infants studied on the first day after birth was 36.8 C. (98.2 F.), 
 on the second day 37.1 C. (98.8 F.), on the third day 37.2 C. (99.0 
 F.), on the fourth day 37.0 C. (98.6 F.), and on the fifth day 36.9 C. 
 (98.5 F.). While admittedly the records for the sixth, seventh, and 
 eighth days were obtained with relatively few infants, the average 
 results approximate those for the days immediately preceding, being 
 37.0 C. (98.6 F.). It is perfectly clear from these data, therefore, 
 that the average rectal temperature of infants on the first day after 
 birth is at least 0.3 C. (0.6 F.) lower than on the second day. This 
 observation, taken in connection with the fact that the infants during 
 the first 12 hours had a slightly lower temperature than those studied 
 during the last 12 hours, would imply that the temperature gradually 
 increased from the first to the third day, and, indeed, even during the 
 first day, or that it was lowered during the first day by the bath. 
 
 TABLE 20. Average rectal temperature of infants during first 8 days after birth. 
 
 Age. 
 
 No. of 
 subjects. 
 
 Average temperature. 
 
 Age. 
 
 No. of 
 
 subjects. 
 
 Average temperature. 
 
 
 
 8 C. 
 
 F. 
 
 
 
 C. 
 
 F. 
 
 1 to 12 hrs. . 
 
 48 
 
 36.7 
 
 98.1 
 
 4 days. . . . 
 
 51 
 
 37.0 
 
 98.6 
 
 12 to 24 hrs.. 
 
 26 
 
 36.9 
 
 98.4 
 
 5 days .... 
 
 41 
 
 36.9 
 
 98.5 
 
 1 day 
 
 74 
 
 36.8 
 
 98.2 
 
 6 days .... 
 
 22 
 
 37.0 
 
 98.6 
 
 2 days 
 
 65 
 
 37.1 
 
 98.8 
 
 7 days .... 
 
 16 
 
 36.9 
 
 98.5 
 
 3 days 
 
 62 
 
 37.2 
 
 99.0 
 
 8 days .... 
 
 9 
 
 37.1 
 
 98.8 
 
 With one infant the rectal temperature was recorded at short inter- 
 vals for about 5 hours, beginning 1 hour after birth. Oiling and a 
 bath preceded the observations in the respiration chamber. During 
 this preliminary care the child was inadvertently subjected in the 
 hospital to a longer exposure than usual and the temperature of the 
 room was also lower than had been customary. 1 The records of the 
 rectal temperature are given in table 21, those while the infant was in 
 the respiration chamber beginning with 4 h 56 m p. m. While the rectal 
 temperatures were being taken in the chamber there was necessarily 
 the same slight exposure which is customary when such temperature 
 records are made in the hospital, but great care was taken to keep the 
 infant well wrapped up at these times. 
 
 From the records in table 21 it will be seen that the rectal tempera- 
 ture rose steadily and somewhat rapidly throughout the entire period. 
 It is not possible, however, to average these values with the tempera- 
 ture records^ obtained with the other infants, for in the majority of 
 
 J The temperature of the room was 71 F., while usually it is 80 F. or more. 
 
120 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 cases the exposure during the bath was less than in this particular 
 instance. On the other hand, the exposure after birth was probably 
 much less with our infants than is usual in ordinary hospital practice 
 or in caring for the new-born child in the home. Accordingly we may 
 fairly conclude that when the infant is bathed in the usual way the 
 temperature during the first 24 hours is distinctly subnormal. 
 
 That the environmental temperature plays a very great role in its 
 effect upon the body-temperature, particularly during the first day of 
 life, is also shown in certain of Hasselbalch's studies, in which the 
 recorded temperatures are frequently extraordinarily low. Thus in 
 table 1 he gives rectal temperatures as low as 32.8 C. and 33.4 C., while 
 in table 3 he gives two temperatures of 33.4 C. and 33.1 C. 1 
 
 TABLE 21. Rectal temperature of an infant taken at frequent intervals during early hours 
 
 after birth. 
 
 Time. 
 
 Rectal temperature. 
 
 Time. 
 
 Rectal temperature. 
 
 May 14, 1915: 
 4 h 06 m p. m. 1 . 
 
 C. 
 37.0 
 37.0 
 36.4 
 35.2 
 35.2 
 35.4 
 35.7 
 
 F. 
 
 98.6 
 98.6 
 97.6 
 95.4 
 95.4 
 95.8 
 96.2 
 
 May 14, 1915 con. 
 6 h 44 m p. m 
 7 09 p. m 
 
 C. 
 36.0 
 36.0 
 36.3 
 36.3 
 36.4 
 36.4 
 
 F. 
 96.8 
 96.8 
 97.4 
 97.4 
 97.6 
 97.6 
 
 4 17 p. m 
 4 46 p. m. (?) . . 
 4 56 p m 2 
 
 7 34 p. m 
 
 7 59 p m 
 
 5 23 p. m 
 
 8 25 p. m 
 
 5 49 p. m 
 6 17 p. m 
 
 8 50 p. m 
 
 
 of birth 4 h Ol m p. m. Bath (oiled first and then bathed in water at 102 F.) given 
 
 between 4 h 20 p. m. and 4 h 45 m p. m.; temperature of room 71 F. 
 2 Placed in the respiration chamber at 4 h 56 m p. m. 
 
 The observations made with our infants indicate that there is a dis- 
 tinct correlation between the body-temperature of the infant and the 
 total metabolism, for on the days with low body-temperature the total 
 metabolism was likewise low. Indeed, in some instances when the 
 records of the temperature distinctly indicated a supercooling, the 
 advisability of using certain of the data has been questioned. Since 
 it is seldom that we find these low temperatures other than on the first 
 day after birth, it is highly probable that they are due solely to the 
 exposure incidental to the birth, the subsequent bath, and other special 
 details of the care of a new-born infant. It is of peculiar significance, 
 therefore, that on the first day, when the low temperatures predominate, 
 we find likewise a somewhat lower metabolism per kilogram of body- 
 weight and per square meter of body-surface than on the subsequent 
 days, thus bearing out the contention that the metabolism is con- 
 siderably affected by the body-temperature. 
 
 When we make a critical analysis of Hasselbalch's figures, however, 
 we find it impossible to determine precisely the influence of the body- 
 temperature upon the metabolism, for we have no evidence as to the 
 
 ^ee pages 20 and 22. It should be stated here that Hasselbalch calls attention to the possible 
 errors in these observations. 
 
PHYSIOLOGICAL NEEDS VS. SUPPLY. 121 
 
 exact degree of the muscular repose of the infant. It is not improbable 
 that the chilling effect of too low a temperature and exposure during a 
 bath may produce shivering and, indeed, crying, as the child attempts 
 temperature regulation by increased muscular activity. The low 
 metabolism induced by the low temperature may therefore be more 
 than compensated by an increase in the metabolism due to the efforts 
 of the infant to maintain the temperature by muscular movements. 
 
 Since the metabolism is so profoundly affected by the influence of 
 various factors upon the body-temperature, it would appear logical 
 that some means should be found for compensating for the defective 
 temperature regulation of the new-born infant a deficiency frequently 
 resulting in a disturbed katabolism. 
 
 METHODS FOR REDUCING THE ENERGY Loss. 
 
 Various methods for preventing an excess energy output during the 
 first days of an infant's life are used in ordinary practice. Every good 
 nurse, whether trained or untrained, knows that an infant must be 
 kept warm and comfortable and does everything in her power to make 
 him so, thus instinctively conserving the energy. Excess katabolism 
 is, for the most part, due to muscular activity. At birth the infant 
 emerges from warm surroundings in which the temperature was 37 C. 
 (98.6 F.) into air which is many degrees colder, presumably 26.7 C. 
 (80 F.); the shock of the cold air causes him to cry. This crying, 
 however, is necessary for his future welfare, as it expands his lungs with 
 air and prepares them for their future work. The preliminary fit of 
 crying comes naturally to most infants and is usually induced with 
 others. 
 
 After this fit of crying every legitimate effort should be made, espe- 
 cially during the first days of life, to reduce the muscular activity to a 
 minimum, and thus prevent a waste of energy. The more time the 
 infant spends in quiet sleep, the less will be the katabolism. When a 
 healthy, new-born baby is awake, crying, and active, it is usually 
 uncomfortable and it cries from an instinct of self-preservation. This 
 discomfort may be due to chilling, improperly adjusted clothing, wet or 
 soiled diapers, too high a temperature of the hot-water bottles, hunger, 
 indigestion, or a few pathological processes. 1 The infant should be made 
 comfortable by attention to such minor details as dry diapers, a comfort- 
 able bed, protection from glaring sunlight, and similar precautions. 
 
 When too low a temperature environment produces chilling, the 
 infant instinctively attempts to raise the body-temperature by physical 
 activity and thus compensate for the loss of heat. For energy con- 
 servation a warm environment is imperatively necessary and all undue 
 exposure must be avoided. Since there must in consequence be more 
 
 this monograph deals only with the normal, healthy infant, it is not necessary to speak 
 further of the possible diseases which may cause an infant to cry. 
 
122 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 or less exposure and a lowering of the body-temperature in bathing the 
 infant, especially in a room of ordinary temperature, there is good 
 reason for believing that the bath should be omitted on the first day 
 and the infant should be simply oiled. This precaution may be espe- 
 cially applicable in the case of poorly-nourished, weak, or premature 
 infants. The baby should also be kept warm with artificial heat, hot- 
 water bottles commonly being used. With the infants in our observa- 
 tions a warm environment was produced inside the respiration chamber 
 by raising the temperature of the water-jacket surrounding it. The 
 fact that the body-temperature rose in many of the observations with 
 the respiration chamber, especially on the first day, would indicate 
 that the conditions were favorable for conserving the energy output 
 during the first hours after birth, when the heat regulation of the body 
 was markedly imperfect. 
 
 Yet another reason for the excess muscular activity during these 
 first days of an infant's life may be the actual need of food, for certain 
 muscular movements are always associated with hunger. The methods 
 for supplying this need are, however, more properly discussed in con- 
 nection with the quantitative relations of the energy intake. 
 
 THE ENERGY INTAKE. 
 
 The results obtained in our study of the new-born infant show that 
 the energy requirements during the first week of life are by no means 
 small. While these requirements are not so large per kilogram of 
 body-weight and per square meter of body-surface as has been com- 
 monly supposed, nevertheless there is a considerable draft upon body- 
 material, at least during the early days of an infant's life, and it is not 
 true that the body has a superabundant supply of glycogen available 
 for this excessive draft upon its material. As has already been noted, 1 
 while there is a moderate amount of glycogen present in the body of 
 an infant, this can be rapidly depleted and essentially fasting quotients 
 found after 24 hours. This is especially the case if the infant attempts 
 by muscular activity to increase the body-temperature. While on the 
 first day, at least, the muscular activity would not probably be suffi- 
 cient to compensate for the low temperature, it would tend to deplete 
 the moderate store of glycogen, thus producing a condition approaching 
 complete inanition, with the possibility of developing an acidosis. It 
 would appear, therefore, that nature has made no unusual provision 
 for supplying a quickly available fuel asset in the form of body glycogen. 
 
 Furthermore, the normal supply of food-material from the breast 
 of the civilized, parturient woman during the first few days of the 
 infant's life is admittedly much less than is actually needed for mainte- 
 nance. The colostrum and the milk during the first week or ten days 
 following the birth of the child have been analyzed by a number of 
 
 J See pages 84 and 88. 
 
PHYSIOLOGICAL NEEDS VS. SUPPLY. 
 
 123 
 
 investigators, these including Pfeiffer, 1 V. and J. Adriance, 2 Camerer 
 and Soldner, 3 Czerny and Keller, 4 and Langstein, Rott and Edelstein. 5 
 Bailey and Murlin 6 also report the results of analyses made by Gep- 
 hart. The values reported by Czerny and Keller are given in table 22 
 and those of Gephart in table 23. The energy values per liter of human 
 milk as reported by Langstein, Rott, and Edelstein for the first 7 days 
 after birth are as follows : 
 
 First day 1 . 500 calories per c.c. 
 
 Second day 1 . 100 
 
 Third day 800 
 
 Fourth day 750 
 
 Fifth day 700 
 
 Sixth day 675 
 
 Seventh day 650 
 
 TABLE 22. Variations in percentage composition of woman's milk (Czerny and Keller}. 
 
 
 Fat, 
 
 Sugar. 
 
 Protein. 1 
 
 Ash. 
 
 Solids. 
 
 Pfeiffer 
 
 p.ct. 
 0.758 to 9.053 
 27 46 
 
 p.ct. 
 4.224 to 7.65 
 5.9 7.8 
 
 p.ct. 
 1.049 to 3.04 
 .9 1.3 
 
 p.ct. 
 0.104 to 0.446 
 
 p. ct. 
 8.23 to 15.559 
 
 V. and J. Adriance . ... 
 
 1.31 7.61 
 
 5.35 7.95 
 
 .23 2.60 
 
 .09 .28 
 
 9.19 15.31 
 
 Guiraud 
 
 1.75 6.18 
 
 6.7 7.7 
 
 .85 1.4 
 
 .10 .27 
 
 11.2 16.3 
 
 Camerer and Soldner. . . . 
 Schlossmann 
 
 1.27 5.77 
 1 65 9.46 
 
 5.35 7.52 
 5.2 10.90 
 
 .824 1.87 
 .56 3.4 
 
 .11 .36 
 
 9.41 14.11 
 
 
 
 
 
 
 
 1 Nitrogen times 6.25. 
 TABLE 23. Results of analysis of colostrum (Gephart). 
 
 Day. 
 
 Protein. 
 
 Fat. 
 
 Carbo- 
 hydrate. 
 
 Heat values per c.c. 
 
 Bomb 
 calo- 
 rimeter. 
 
 Physio- 
 logical 
 heat 
 value. 
 
 Second 
 
 p.ct. 
 2.56 
 2.63 
 1.79 
 2.06 
 2.63 
 
 p.ct. 
 2.60 
 3.47 
 1.25 
 5.45 
 2.06 
 
 p.ct. 
 7.75 
 5.37 
 8.68 
 7.04 
 7.44 
 
 cat. 
 0.667 
 .685 
 .561 
 .903 
 .636 
 
 col. 
 0.626 
 .643 
 .532 
 .870 
 .594 
 
 Third 
 
 Average.. 
 
 2.3 
 
 2.9 
 
 7.1 
 
 .677 
 
 .653 
 
 The amount of human milk secreted by healthy mothers depends 
 upon the demands of the infants, thus varying with the weight and 
 strength of the child. That it also varies in primiparse and multipart 
 
 Pfeiffer, Jahrb. f. Kinderheilk., 1883, 20, p. 365. 
 *V. and J. Adriance, Archives of Pediatrics, 1897, 14, p. 22. 
 'Camerer and Soldner, Zeitschr. f. Biol., 1898, 36, p. 277. 
 
 4 Czerny and Keller, Des Kindes Ernahrung, Ernahrungsstorungen und Ernahrungstherapie, 
 Leipsic and Vienna, 1906, p. 412-417. 
 
 6 Langstein, Rott and Edelstein, Festschrift z. Heubner, Berlin, 1913, p. 405. 
 Bailey and Murlin, Am. Journ. of Obstetrics, 1915, 71, p. 526. 
 
124 
 
 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 is shown by Cramer's 1 values given in table 24. It is obvious that an 
 amount of milk which would be normal for one infant would be abnor- 
 mal for another, and for this reason average figures as to the amount 
 secreted only give a general idea of what an average infant might take 
 and can not be applied to abnormally strong or weak infants. Von 
 Reuss 2 has collected the estimations made by a number of investigators 
 as to the amount of milk secreted per day by the mothers of infants of 
 different weights; these are given in table 25. The amount of milk 
 taken by the infant during the day was obtained by weighing the mother 
 or the infant before and after nursing. This method is obviously 
 liable to great error, especially when the small amounts of the first few 
 days are to be considered. 
 
 TABLE 24. Amounts of colostrum and of human milk secreted per 24 hours in primiparoe and 
 
 multipart (Cramer). 
 
 [All values in grams.] 
 
 
 1st 
 day. 
 
 2d 
 day. 
 
 3d 
 day. 
 
 4th 
 day. 
 
 5th 
 
 day. 
 
 6th 
 day. 
 
 7th 
 day. 
 
 8th 
 day. 
 
 9th 
 
 day. 
 
 10th 
 day. 
 
 9 babies of primiparse; av. birth 
 wt. 3,290 gm . . . 
 
 4 
 
 78 
 
 183 
 
 199 
 
 236 
 
 299 
 
 303 
 
 274 
 
 362 
 
 384 
 
 7 babies of multiparae; av. birth 
 wt. 3,348 gm 
 
 6 
 
 129 
 
 238 
 
 324 
 
 344 
 
 324 
 
 361 
 
 365 
 
 384 
 
 415 
 
 
 
 
 
 
 
 
 
 
 
 
 TABLE 25. Estimation of the daily secretion of colostrum and of human milk (von Reuss). 
 
 [All values in grams.] 
 
 Author. 
 
 No. 
 of 
 cases. 
 
 Birth-weight. 
 
 1st 
 day. 
 
 2d 
 day. 
 
 3d 
 day. 
 
 4th 
 day. 
 
 5th 
 
 day. 
 
 6th 
 day. 
 
 7th 
 day. 
 
 8th 
 day. 
 
 9th 
 
 day. 
 
 10th 
 day. 
 
 Kruger, 1875 
 Reusing, 1895 
 
 W. Camerer 
 Denecke, 1880. .. 
 Baumm and Illner 
 Cramer, 1901 
 Feer, 1902 
 
 10 
 6 
 
 11 
 10 
 
 5 
 7 
 10 
 16 
 3 
 18 
 75 
 25 
 
 3,060 
 (2,220-3,650) 
 3,126 
 
 12-15 
 38.3 
 
 17 
 44 
 20 
 2.5 
 
 4 
 
 17 
 
 19 
 56.7 
 
 96 
 120.8 
 
 91 
 135 
 75 
 10.89 
 50 
 22.5 
 91 
 13 
 90 
 197.8 
 54 
 
 192 
 176.6 
 
 193 
 192 
 80 
 89.49 
 177 
 79.9 
 190 
 190 
 193 
 296.8 
 173 
 
 234 
 220 
 
 309 
 266 
 155 
 192.6 
 315 
 175.5 
 302 
 370 
 260 
 371.5 
 263 
 
 363 
 
 271.5 
 
 352 
 
 352 
 218 
 226 
 456 
 217.6 
 348 
 460 
 339 
 431 
 327 
 
 441 
 296.6 
 
 391 
 365 
 233 
 246 
 549 
 242.5 
 381 
 440 
 402 
 462.8 
 354 
 
 501 
 297 
 
 467 
 383 
 
 518 
 333 
 
 621 
 
 648 
 
 
 
 411 
 
 
 
 
 
 311 
 
 552 
 281.8 
 450 
 483 
 415 
 455.3 
 362 
 
 567 
 
 562 
 
 603 
 
 3,528 
 3,403 
 
 Aronstamm, 1903. 
 Beuthhner, 1902.. 
 Klemm, 1907 
 Jaschke, 1909 
 Opitz, 1911 
 von Reuss 
 
 476 
 
 
 
 3,091 
 2,700-3,416 
 3,000-3,500 
 2,800-4,000 
 
 
 
 470 
 485.1 
 390 
 
 467.6 
 
 
 
 
 
 From the data in the foregoing tables it is seen that even under the 
 most favorable conditions the total amount of available energy in the 
 colostrum which the child receives from the mother's breast during 
 the first few days is wholly insufficient to supply the energy needs, even 
 when we consider only the basal metabolism. Still less does this scant 
 
 Cramer, Klin. Beitrag z. Frage der kunstlichen Ernahrung des Neugeborenen. Inaug. Diss., 
 Breslau, 1896. Cited by Czerny and Keller, Des Kindes Ernahrung, Ernahrungsstorungen und 
 Ernahrungstherapie. Leipsic and Vienna, 1906, 1, p. 356. 
 
 Von Reuss, Die Krankheiten des Neugeborenen. Berlin, 1914, p. 90. 
 
PHYSIOLOGICAL NEEDS VS. SUPPLY. 125 
 
 fuel-supply serve for the probable increment above basal metabolism 
 caused by the restlessness, crying, and varied muscular activity of the 
 infant throughout the day. It is thus seen that the struggle for 
 existence and the struggle for food begin simultaneously with the new- 
 born infant. Since the food-supply is so obviously insufficient, we 
 may ask why nature does not provide more liberally during the first 
 few days. It is a most striking fact that only human mothers and 
 new-born infants are so entirely dependent upon the care of others. 
 The relationship between this fact and the development of civilization 
 is most interesting and leads one to ask if this scant food-supply is a 
 natural consequence of civilization. 
 
 We may, furthermore, consider whether, in the absence of a suffi- 
 cient natural food-supply to compensate for the energy outgo, it is 
 desirable to supplement the normal supply of colostrum with other 
 food-material until the milk is available in the mother's breast. Pro- 
 vision of material for growth may, without danger to the child's welfare, 
 be delayed for one week until plenty of milk is supplied by the mother. 
 Since this would practically be partial inanition, we may reason from 
 the analogy of the prolonged fasting experiment recently reported 1 
 that the infant may draw upon its own body-reserve for a considerable 
 period of time. 
 
 On the other hand, a delay in the maintenance supply of food suffi- 
 cient to force the infant to subsist upon its own body-reserves may not 
 be without actual detriment. Usually a healthy, well-nourished infant 
 has at birth considerable fat, and, as shown by our study of the respira- 
 tory quotient, a moderate supply of glycogen. It is a well-known fact, 
 however, that even with adults during fasting, particularly when there 
 is a deficiency of carbohydrate available for combustion, an acidosis 
 rapidly develops. This is strikingly shown with fasting adults and 
 with adults fed on a carbohydrate-free diet, 2 and has, indeed, been 
 frequently observed with young children. 3 Is this acidosis dangerous, 
 and if so, how can it be combated? From our experience with adults, 
 apparently the best method of combating acidosis is to feed carbo- 
 hydrate material. If, therefore, supplemental feeding is necessary, it 
 would seem on general principles that the food-material most easily 
 digested and most readily absorbed for oxidation would be a soluble 
 carbohydrate. The carbohydrate possessing these qualities in the 
 greatest degree is dextrose, as it requires no hydrating ferment to 
 convert it into the blood sugar. 
 
 If the infant is to be fed, we may again emphasize the fact that a 
 knowledge of the energy requirement for the first week is most impor- 
 tant. Those in charge of the child at this time should therefore have 
 
 ^Benedict, Carnegie Inst. Wash. Pub. No. 203, 1915. 
 Benedict and Joslin, Carnegie Inst. Wash. Pub. No. 176, 1912, p. 125. 
 
 3 Schlossmann and Murschhauser, Biochem. Zeitschr., 1913, 56, p. 355; see also, Murschhauser, 
 Boston Med. and Surg. Journ., 1914, 171, p. 185. 
 
126 PHYSIOLOGY OF THE NEW-BORN INFANT. 
 
 practical experience in supplemental feeding, for a disturbance of the 
 digestion in the first few days after birth is most harmful and may 
 even prove fatal. In discussing this point, Morse and Talbot 1 say: 
 "It is very important, when beginning to feed a new-born baby, not 
 to give it too much food or too strong a food. There is no time in a 
 baby's life in which it is so easy to disturb the digestion or at which 
 it is so difficult to correct the disturbance, if it is once caused. " 
 
 PROBABLE 24-HOUR ENERGY REQUIREMENT OF A NEW-BORN INFANT FOR 
 
 MAINTENANCE. 
 
 From a practical standpoint, therefore, we should know not merely 
 the basal metabolism of the infant during the first week of life, but the 
 probable average metabolism. This would include the superimposed 
 metabolism due to varied muscular activity during the day, the infant 
 when studied in the respiration chamber being quiet and with but 
 little, if any, muscular activity. In discussing the results of our 
 research we have laid special emphasis upon the maximum activity, 
 which we have found to vary from the minimum by 4 to 211 per cent, 
 with an average variation of 65 per cent. 2 To form a conception of 
 the true increase above the basal metabolism, an estimate of the general 
 activity of the infant throughout the day is essential. An estimate of 
 the period of time in which the child has been asleep, awake, or crying 
 may be obtained from the report of the nurse, if the infant is in the 
 hospital, or from some responsible member of the family, if in the 
 home. It is even possible that some simple form of recording crib, 
 with graphic attachment, 3 may be used to indicate the degree of mus- 
 cular activity as a help in forming an estimate of the amount of food 
 necessary for the total 24-hour energy requirement. 
 
 Without taking into consideration the question of growth (and in 
 the first week of the child's life, this may be neglected) we may assume 
 that for infants from If to 6 days old the basal energy requirement is 
 44 calories per kilogram of body- weight or 12.65 calories per square 
 meter of body-surface per unit of length. Some 10 per cent for the 
 portion rejected as fecal material should be added to this amount, thus 
 making the minimum food requirement approximately 48 calories per 
 kilogram of body-weight. The indefinite but rarely minimum amount 
 of activity of the infant throughout the day would further increase the 
 energy requirement. This may be estimated as about one-half of 
 the average maximum metabolism found in our observations, or 30 
 per cent, which would give an increase of 14 calories. The daily energy 
 requirement, including both the maintenance metabolism and the metab- 
 olism due to activity, would therefore be approximately 62 calories per 
 kilogram per 24 hours this estimate making absolutely no provision 
 for growth. 
 
 ^orse and Talbot, The nutrition and feeding of infants. New York, 1915, p. 125. 
 , 2 See table 17, p. 112. 
 "Benedict and Talbot, Carnegie Inst. Wash. Pub. No. 201, 1915, p. 60. 
 

 
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