Inv,estigators who have been studying diagnostic procedures and standards for judging the healing or development of early rickets in infants have coniniented on the difficulty of making accurate judgments when these must be based upon the physical findings, roentgenological examinations, the serum calcium and serum phosphorus determinations. W e have previously cited' our belief that, through the determination of the serum phosphatase, we have a more accurate means of recognizing the early development of the disease. In this we simply agree with other investigators"? and offer additional supporting evidence. However, with our interest in this abnormal state in the infant, we were struck by the lack of any considerable data defining the gzorwzal serum phosphatase for the infant in the first year of life. The data of Jeans and Steams* show that the plasma phosphatase, which is low at birth, rises abruptly to a maximum during the first month, maintains this peak only a short time, and then falls rather rapidly during the second or third month, gradually declining through the remainder of the year, although the phosphatase level remains higher than that found in older age groups.Our data, based on 630 observations made upon infants during the first year of life, do not entirely coincide with those of Jeans and Stearns but we feel that they represent a good sampling of population of this age for this section of the country. Part of the patients, differentiated as "Harper Babies", upon whom 390 observations were made, were born at Harper Hospital and were followed in our outpatient clinic. They received adequate amounts of milk, vitamin D
A concentrate that would retain the virtues of cod liver oil and at the same time permit the giving of a small dose of the substance would be welcomed by infants, parents and physicians alike. Clouse,1 in an extensive treatise on vitamin D, passed over the use of concentrates with the statement that generally cod liver oil can be given, or. if there is need of a concentrate, viosterol should be used. Physicians in private practice do not feel that concentrates can be treated in such casual fashion. One sees too many infants in whom definite rickets develops in spite of the fact that adequate doses of cod liver oil have been prescribed. Babies do not all take cod liver oil willingly in teaspoonful doses, and some do not tolerate the fat in the quantities used if cod liver oil is given. There is, also, more than a groundless suspicion that these infants do not actually receive the amount of cod liver oil advised.Data are accumulating which tend to show, further, that viosterol is not the equivalent of cod liver oil, quantitatively or qualitatively. My experience 2 has been that a group of infants receiving 1,250 units of vitamin D in the form of viosterol was no more protected against rickets than an untreated control group, while a group getting approxi¬ mately the same dose (1,400 units, Oslo) of vitamin D in cod liver oil was protected in 95 per cent of cases. De Sanctis and Craig3 a little later published a similar study which showed that from 1,400 to 1,700 units of vitamin D given as cod liver oil prevented rickets in 97 per cent of the cases studied, while viosterol 100 D in doses of 3,000 rat units daily prevented rickets in only 77 per cent. De Sanctis and Craig cited their own experience to show that rickets develops in from 25 to 30 per cent of infants not receiving antirachitic agents.
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