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INCREASED GROWTH-RATES IN CHILDREN
1327
probit fitting) of 13-35 years. Furthermore, the Edinburgh children are lighter and shorter than London children at all ages from 5 to 14 and perhaps later (the sampling of
Annotations INCREASED GROWTH-RATES IN CHILDREN
suspect). The differquite, considerable-roughly about 1 inch in height and 1 lb. in weight. It may be that London children are more mature than Edinburgh ones ; or perhaps the final adult size is greater in London. Only studies of bone-age could distinguish these alternatives. However this may be, both the London and Edinburgh reports give further evidence that this trend is a real one. Choirmasters, we understand, were not in doubt, for they have for some time been finding it increasingly difficult to get enough soprano choirboys. both studies at older ages becomes ences
ONE of the most consistent and astonishing biological trends of our time is the tendency to reach physical maturity earlier and earlier : children, it seems, are getting older every year. The age at first menstruation is the criterion of maturity which has been most thoroughly investigated, and the results of these studies, discussed in detail recently by Tanner,l leave no doubt that the age of menarche has advanced quite regularly in Western Europe and America for the last hundred years at the almost spectacular rate of four to six months per decade. The average age of menarche in Norway, for example, was about 17.0 in 1850 ; in 1950 it was 13.5, the same as in England at that time. The maturing process has accelerated at all ages, so that by the age of 5 children today are already much bigger than they The Swedish data were, say, twenty-five years ago. quoted by Tanner show that school-children measured in 1938 were the same size as children eighteen months older in 1883. American, Scandinavian, and British data all give secular trends of very similar magnitude-about 1-5 cm. and 1 lb. per decade at ages 5 to 7, increasing to about 2 cm. and 3 lb. per decade during adolescence. The trend is still, it seems, in full swing, and the latest contribution to its study comes from the records of the London County Council.2 This is a report of the heights and weights of a sample of 20,000 children aged 5 to 16, measured in 1954 ; these figures are compared with the corresponding ones for 1948 and show increases precisely consistent with the previous trend. The L.C.C. do admirably to plan a series of cross-section surveys of this sort from time to time, but they would be more valuable if the methods used were more in line with the newer standards of technique, as illustrated, for example, in the studies of Krogman.3 In the L.C.C. survey, children were weighed in " ordinary indoor clothing but without footwear," but no indication is given of the weight of the clothes -though the weights were recorded to the nearest 0.1 kg. This procedure is justified on the grounds that this was what was done in 1948, and comparison with those results was the objective ; but it would perhaps have been better to measure a sample of the children clothed and unclothed so that the change from one etchnique to another could have been made with accuracy. Heights were also measured, but in what way is not stated ; the height-scales attached to most weighing machines are grossly inaccurate and never as satisfactory as the old book-on-the-head-standing-against-tbe-wall
technique. The L.C.C. investigators also asked the girls whether had started to menstruate or not, but they did not treat the resulting data by the method of probits so as to obtain a valid figure for the average age of menarche. The figure they give, which is the age by which half of the girls interrogated had reached menarche, is 12.9 years, but this rather underestimates the mean, since the sample lacks an adequate number of those aged 15 and 16, and there were no older girls, some of whom must constitute the older end of the non-menstruating group. Nevertheless, the true average figure can scarcely be more than 13-25 years, and this figure receives some support from the very careful and extensive study of children’s measurements recently reported by Provis and Ellis.44 In a random sample of Edinburgh children of all social classes, they found a mean menarche age (by
they
1. 2.
Tanner, J. M. Growth at Adolescence. Oxford, 1955. Report on the Heights and Weights of School Pupils in the County of London in 1954. London County Council, 1955. 3. Krogman, W. M. Monogr. Soc. Res. Child Develpm. 1950, 13,
no. 3. 4. Provis, H. S., Ellis R. W. B.
Arch. Dis. Childh. 1955,
30, 328.
are
IDIOPATHIC HYPERCALCÆMIA IN 1952 Lightwood drew attention 12 to a disease of infants in which failure to thrive, vomiting, constipation, and bypotonia are associated with a raised serumcalcium level. The prognosis is fairly good, and it seems that these cases of " idiopathic hypercalcsemia " should be distinguished3 from a more grave condition, described by Fanconi et al.,4 in which serum-calcium is also raised, but in addition there is mental retardation, a particular facies, and osteosclerosis. In both conditions the mechanism by which the serum-calcium rises is obscure, but the resemblance between the milder disease and intoxication with vitamin D5 was soon apparent.6 Even the usual intake of vitamin D may be well above the ideal level ; the optimum has been placed as low as 500 i.u. daily,7 and artificially fed infants can easily be given too much in fortified foods and cod-liver oil. The response to vitamin D and the need for it probably do vary widely from oversensitivity8 to resistance.9 Furthermore, artificially fed infants may be getting a lot of calcium, because the cow’s milk contains four times as much calcium as breast-milk. Bonham Carter and his colleagues 10 have recently published observations, begun in 1952, which greatly help our understanding of the idiopathic hypercalcaemia of Lightwood. They studied a nine-month-old boy in whom the diagnosis was first suspected when a loud systolic murmur was heard. These murmurs have been heard in the more severe disease described by Fanconi et al .,4 but it is clear that they may be present in the milder disease as well. Calcification of the valve cusps 11 has been given as an explanation. Bonham Carter et al. felt justified in finding out whether vitamin D did in fact influence the boy’s condition-a matter of importance in deciding his subsequent treatment. For ten days, at a time when his disease was in remission, he was given 10,000 i.u. daily of vitamin D, and this made him worse. Although 10,000 units is a large dose for a child without rickets, one would not expect it to produce any ill effects in a normal child. They then gave him a constant diet containing very little vitamin D, and varied the calcium content of the diet from none at all to 610 mg. daily. On the calcium-free diet the plasma-calcium fell to normal and the boy’s symptoms rapidly diminished ; others have made the same observation.12 On the diet containing calcium the plasma-calcium rose again and the symptoms returned. The boy absorbed an abnormally large propor1. Payne, W. W., Lightwood, R. Arch. Dis. Childh. 1952, 27, 302. 2. Lightwood, R. Arch. franç. Pédiat. 1953, 10, 190. 3. Lightwood, R., Stapleton, T. Lancet, 1953, ii, 255. 4. Fanconi, G., Girardet, P., Schlesinger, B., Butler, N., Black, J. Helr. pœdiat. acta, 1952, 7, 314. 5. Fanconi, G., de Chastonay, E. Ibid, 1950, 5, suppl. 5. 6. See Lancet, 1954, ii, 127. 7. Woodcock, R. H. Ibid, p. 243. 8. Thatcher, L. Ibid, 1936, i, 20. 9. Jonxis, J. H. P. Helv. pœdiat. acta, 1955, 10, 245. 10. Bonham Carter, R. E., Dent, C. E., Fowler, D. I., Harper, C. M. Arch. Dis. Childh. 1955, 30, 399. 11. Helv. pœdiat. acta, 1955, 10, 149. 12. Ferguson, A. W., McGowan, G. K. Lancet, 1954, i, 1272 ; Ibid, 1954, ii, 817.
probit fitting) of 13-35 years. Furthermore, the Edinburgh children are lighter and shorter than London children at all ages from 5 to 14 and perhaps later (the sampling of
Annotations INCREASED GROWTH-RATES IN CHILDREN
suspect). The differquite, considerable-roughly about 1 inch in height and 1 lb. in weight. It may be that London children are more mature than Edinburgh ones ; or perhaps the final adult size is greater in London. Only studies of bone-age could distinguish these alternatives. However this may be, both the London and Edinburgh reports give further evidence that this trend is a real one. Choirmasters, we understand, were not in doubt, for they have for some time been finding it increasingly difficult to get enough soprano choirboys. both studies at older ages becomes ences
ONE of the most consistent and astonishing biological trends of our time is the tendency to reach physical maturity earlier and earlier : children, it seems, are getting older every year. The age at first menstruation is the criterion of maturity which has been most thoroughly investigated, and the results of these studies, discussed in detail recently by Tanner,l leave no doubt that the age of menarche has advanced quite regularly in Western Europe and America for the last hundred years at the almost spectacular rate of four to six months per decade. The average age of menarche in Norway, for example, was about 17.0 in 1850 ; in 1950 it was 13.5, the same as in England at that time. The maturing process has accelerated at all ages, so that by the age of 5 children today are already much bigger than they The Swedish data were, say, twenty-five years ago. quoted by Tanner show that school-children measured in 1938 were the same size as children eighteen months older in 1883. American, Scandinavian, and British data all give secular trends of very similar magnitude-about 1-5 cm. and 1 lb. per decade at ages 5 to 7, increasing to about 2 cm. and 3 lb. per decade during adolescence. The trend is still, it seems, in full swing, and the latest contribution to its study comes from the records of the London County Council.2 This is a report of the heights and weights of a sample of 20,000 children aged 5 to 16, measured in 1954 ; these figures are compared with the corresponding ones for 1948 and show increases precisely consistent with the previous trend. The L.C.C. do admirably to plan a series of cross-section surveys of this sort from time to time, but they would be more valuable if the methods used were more in line with the newer standards of technique, as illustrated, for example, in the studies of Krogman.3 In the L.C.C. survey, children were weighed in " ordinary indoor clothing but without footwear," but no indication is given of the weight of the clothes -though the weights were recorded to the nearest 0.1 kg. This procedure is justified on the grounds that this was what was done in 1948, and comparison with those results was the objective ; but it would perhaps have been better to measure a sample of the children clothed and unclothed so that the change from one etchnique to another could have been made with accuracy. Heights were also measured, but in what way is not stated ; the height-scales attached to most weighing machines are grossly inaccurate and never as satisfactory as the old book-on-the-head-standing-against-tbe-wall
technique. The L.C.C. investigators also asked the girls whether had started to menstruate or not, but they did not treat the resulting data by the method of probits so as to obtain a valid figure for the average age of menarche. The figure they give, which is the age by which half of the girls interrogated had reached menarche, is 12.9 years, but this rather underestimates the mean, since the sample lacks an adequate number of those aged 15 and 16, and there were no older girls, some of whom must constitute the older end of the non-menstruating group. Nevertheless, the true average figure can scarcely be more than 13-25 years, and this figure receives some support from the very careful and extensive study of children’s measurements recently reported by Provis and Ellis.44 In a random sample of Edinburgh children of all social classes, they found a mean menarche age (by
they
1. 2.
Tanner, J. M. Growth at Adolescence. Oxford, 1955. Report on the Heights and Weights of School Pupils in the County of London in 1954. London County Council, 1955. 3. Krogman, W. M. Monogr. Soc. Res. Child Develpm. 1950, 13,
no. 3. 4. Provis, H. S., Ellis R. W. B.
Arch. Dis. Childh. 1955,
30, 328.
are
IDIOPATHIC HYPERCALCÆMIA IN 1952 Lightwood drew attention 12 to a disease of infants in which failure to thrive, vomiting, constipation, and bypotonia are associated with a raised serumcalcium level. The prognosis is fairly good, and it seems that these cases of " idiopathic hypercalcsemia " should be distinguished3 from a more grave condition, described by Fanconi et al.,4 in which serum-calcium is also raised, but in addition there is mental retardation, a particular facies, and osteosclerosis. In both conditions the mechanism by which the serum-calcium rises is obscure, but the resemblance between the milder disease and intoxication with vitamin D5 was soon apparent.6 Even the usual intake of vitamin D may be well above the ideal level ; the optimum has been placed as low as 500 i.u. daily,7 and artificially fed infants can easily be given too much in fortified foods and cod-liver oil. The response to vitamin D and the need for it probably do vary widely from oversensitivity8 to resistance.9 Furthermore, artificially fed infants may be getting a lot of calcium, because the cow’s milk contains four times as much calcium as breast-milk. Bonham Carter and his colleagues 10 have recently published observations, begun in 1952, which greatly help our understanding of the idiopathic hypercalcaemia of Lightwood. They studied a nine-month-old boy in whom the diagnosis was first suspected when a loud systolic murmur was heard. These murmurs have been heard in the more severe disease described by Fanconi et al .,4 but it is clear that they may be present in the milder disease as well. Calcification of the valve cusps 11 has been given as an explanation. Bonham Carter et al. felt justified in finding out whether vitamin D did in fact influence the boy’s condition-a matter of importance in deciding his subsequent treatment. For ten days, at a time when his disease was in remission, he was given 10,000 i.u. daily of vitamin D, and this made him worse. Although 10,000 units is a large dose for a child without rickets, one would not expect it to produce any ill effects in a normal child. They then gave him a constant diet containing very little vitamin D, and varied the calcium content of the diet from none at all to 610 mg. daily. On the calcium-free diet the plasma-calcium fell to normal and the boy’s symptoms rapidly diminished ; others have made the same observation.12 On the diet containing calcium the plasma-calcium rose again and the symptoms returned. The boy absorbed an abnormally large propor1. Payne, W. W., Lightwood, R. Arch. Dis. Childh. 1952, 27, 302. 2. Lightwood, R. Arch. franç. Pédiat. 1953, 10, 190. 3. Lightwood, R., Stapleton, T. Lancet, 1953, ii, 255. 4. Fanconi, G., Girardet, P., Schlesinger, B., Butler, N., Black, J. Helr. pœdiat. acta, 1952, 7, 314. 5. Fanconi, G., de Chastonay, E. Ibid, 1950, 5, suppl. 5. 6. See Lancet, 1954, ii, 127. 7. Woodcock, R. H. Ibid, p. 243. 8. Thatcher, L. Ibid, 1936, i, 20. 9. Jonxis, J. H. P. Helv. pœdiat. acta, 1955, 10, 245. 10. Bonham Carter, R. E., Dent, C. E., Fowler, D. I., Harper, C. M. Arch. Dis. Childh. 1955, 30, 399. 11. Helv. pœdiat. acta, 1955, 10, 149. 12. Ferguson, A. W., McGowan, G. K. Lancet, 1954, i, 1272 ; Ibid, 1954, ii, 817.