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IRON REQUIREMENTS IN NUTRITION.
942 it has been recognised, since Dr. R. W. LOVETT introduced what has been called the Vermont plan, that the management of the arthritic requires a minimum of hospital care and a maximum of after-care. In Massachusetts there is a movement afoot to provide for the 145,000 arthritics in the State a system by which instruction and care is given in the homes after patients have been seen in the clinic.2 The total amount of crippling, it is believed, has already been reduced by effort of this kind.
IRON REQUIREMENTS IN NUTRITION. GREAT interest has for many years been shown by students of nutrition in the methods by which iron is obtained by the organism for the purpose of elaborating haemoglobin. Two problems in particular have engaged their attention-namely, the amount of iron that should be regularly supplied and the chemical form in which it should be presented to ensure adequate utilisation. It may be remembered that for many years the question was debated whether simple inorganic salts or more complicated organic compounds Modern investigawere the normal source of iron. tions have shown repeatedly that simple iron - salts can be effectively utilised, although it seems equally clear that organically bound iron is a satisfactory source and indeed probably forms the greater part of the necessary supply of the average individual. The only available test of the adequacy of the iron supply for a given individual at present is his capacity for maintenance of a normal concentration of haemoglobin or for producing regeneration of haemoglobin when this has been reduced from any cause below the normal level; and we are now coming to realise that this capacity depends on other factors besides the quantity of iron supplied and the chemical form in which it is exhibited-for instance the simultaneous supply of copper and possibly other mineral elements. Such facts as these have emerged from studies of nutritional anaemia, a condition experimentally produced in young animals by exclusive diets of milk which has long been known to be relatively deficient in iron. It is true that some doubts have been cast from time to time on the assumption that milk is necessarily deficient in iron, and not long ago ScoTT and ERF 3 claimed to have shown that young rats could be successfully reared with normal concentrations of haemoglobin if they were fed exclusively on raw milk from selected cows which were given special diets containing a salt mixture which included iron and copper. Such results, if substantiated, would not invalidate the results of previous experiments on nutritional anaemia and we may therefore consider it proved
complicate the problem of the normal minimum requirement. Some approximation to this quantity may be obtained by measuring the intake and output of iron by healthy individuals on a good mixed diet which is not likely to be iron
deficient in any known food constitutents, and measurements of this kind have indicated that. 10 mg. a day is the average requirement for an adult, For young children it has been calculated that about 0-5 mg. a day should be allowed per kilo of body-weight. If such calculations have a interest it is important that the iron practical content of common foods should be known, and many series of chemical analyses have been published in recent years which deal with this point. A recent report on the iron content of vegetables and fruits has been published in America.44 The list of articles examined is comprehensive and the results are summarised by classifying them as poor, fair, good, and excellent sources of iron, the criteria being respectively iron contents of less than 0-0004 per cent., between 0-0004 and 0-00079 per cent., between 0-0008 and 0-00159 per cent.. and more than 0-0016 per cent. The last group contains kale, parsley, peas, spinach, turnip tops, and water-cress ; the first contains apples, pears, peaches, pineapples, and melons. Most of the vegetables eaten in this country are entered under the " fair " or good ,. headings and it is interesting to find potatoes classed as a good source of iron. These results confirm the accepted view that vegetables, and "
particularly leafy vegetables source
can
be
an
important
of iron in mixed diets.
A SURVEY OF HOSPITAL PRACTICE.
SINCE their origin in mediaeval days as refuges for the sick poor, in alliance, loose or close, with the Crown and the Church, the hospitals in this country have undergone a wide expansion of function ; and now that their activities have come to include the treatment of those who are not destitute but who can afford to pay a fee, sometimes equalling or even exceeding their cost of maintenance, we have a fundamental change in their position towards society. The January issue of N08okomeion, in a survey of the scope of hospitals in various countries, shows that this expansion of hospital service is not confined to England alone, and in a series of closely written articles sets out the hospital systems in a number of European countries, and in Turkey, the United States, Australia, and Canada. In France the position resembles that found in England; even before the war, hospitals were opening their doors to middle-class patients wishing to make use of the equipment and skilled treatment available there. The hospitals here, moreover, are becoming centres of preventive and sanitary that the quantitative iron requirements of an more and more there is increasing collaboration and individual are not fixed and unalterable, but medicine, the public health services of between them and are liable to vary with the supply of other elements the country. Attached, for example, to the hosin the diet. This consideration must tend to pitals of the Assistance Publique are centres for 2 New Eng. Jour. Med., Feb. 25th, p. 392. 3 Scott, E., and Erf, L. A.: Ann. Proc. Internat. Assoc. Dairy and Milk Inspectors, 1931.
4 Stiebling, H. K.: 1932, United States Dept. of Agriculture, Circular No. 205.
IRON REQUIREMENTS IN NUTRITION. GREAT interest has for many years been shown by students of nutrition in the methods by which iron is obtained by the organism for the purpose of elaborating haemoglobin. Two problems in particular have engaged their attention-namely, the amount of iron that should be regularly supplied and the chemical form in which it should be presented to ensure adequate utilisation. It may be remembered that for many years the question was debated whether simple inorganic salts or more complicated organic compounds Modern investigawere the normal source of iron. tions have shown repeatedly that simple iron - salts can be effectively utilised, although it seems equally clear that organically bound iron is a satisfactory source and indeed probably forms the greater part of the necessary supply of the average individual. The only available test of the adequacy of the iron supply for a given individual at present is his capacity for maintenance of a normal concentration of haemoglobin or for producing regeneration of haemoglobin when this has been reduced from any cause below the normal level; and we are now coming to realise that this capacity depends on other factors besides the quantity of iron supplied and the chemical form in which it is exhibited-for instance the simultaneous supply of copper and possibly other mineral elements. Such facts as these have emerged from studies of nutritional anaemia, a condition experimentally produced in young animals by exclusive diets of milk which has long been known to be relatively deficient in iron. It is true that some doubts have been cast from time to time on the assumption that milk is necessarily deficient in iron, and not long ago ScoTT and ERF 3 claimed to have shown that young rats could be successfully reared with normal concentrations of haemoglobin if they were fed exclusively on raw milk from selected cows which were given special diets containing a salt mixture which included iron and copper. Such results, if substantiated, would not invalidate the results of previous experiments on nutritional anaemia and we may therefore consider it proved
complicate the problem of the normal minimum requirement. Some approximation to this quantity may be obtained by measuring the intake and output of iron by healthy individuals on a good mixed diet which is not likely to be iron
deficient in any known food constitutents, and measurements of this kind have indicated that. 10 mg. a day is the average requirement for an adult, For young children it has been calculated that about 0-5 mg. a day should be allowed per kilo of body-weight. If such calculations have a interest it is important that the iron practical content of common foods should be known, and many series of chemical analyses have been published in recent years which deal with this point. A recent report on the iron content of vegetables and fruits has been published in America.44 The list of articles examined is comprehensive and the results are summarised by classifying them as poor, fair, good, and excellent sources of iron, the criteria being respectively iron contents of less than 0-0004 per cent., between 0-0004 and 0-00079 per cent., between 0-0008 and 0-00159 per cent.. and more than 0-0016 per cent. The last group contains kale, parsley, peas, spinach, turnip tops, and water-cress ; the first contains apples, pears, peaches, pineapples, and melons. Most of the vegetables eaten in this country are entered under the " fair " or good ,. headings and it is interesting to find potatoes classed as a good source of iron. These results confirm the accepted view that vegetables, and "
particularly leafy vegetables source
can
be
an
important
of iron in mixed diets.
A SURVEY OF HOSPITAL PRACTICE.
SINCE their origin in mediaeval days as refuges for the sick poor, in alliance, loose or close, with the Crown and the Church, the hospitals in this country have undergone a wide expansion of function ; and now that their activities have come to include the treatment of those who are not destitute but who can afford to pay a fee, sometimes equalling or even exceeding their cost of maintenance, we have a fundamental change in their position towards society. The January issue of N08okomeion, in a survey of the scope of hospitals in various countries, shows that this expansion of hospital service is not confined to England alone, and in a series of closely written articles sets out the hospital systems in a number of European countries, and in Turkey, the United States, Australia, and Canada. In France the position resembles that found in England; even before the war, hospitals were opening their doors to middle-class patients wishing to make use of the equipment and skilled treatment available there. The hospitals here, moreover, are becoming centres of preventive and sanitary that the quantitative iron requirements of an more and more there is increasing collaboration and individual are not fixed and unalterable, but medicine, the public health services of between them and are liable to vary with the supply of other elements the country. Attached, for example, to the hosin the diet. This consideration must tend to pitals of the Assistance Publique are centres for 2 New Eng. Jour. Med., Feb. 25th, p. 392. 3 Scott, E., and Erf, L. A.: Ann. Proc. Internat. Assoc. Dairy and Milk Inspectors, 1931.
4 Stiebling, H. K.: 1932, United States Dept. of Agriculture, Circular No. 205.