No. 3127: July 15, 1931 A REPORT ON THE HEALTH AND NUTRITION OF MEXICANS LIVING IN TEXAS By JET C. WINTERS Associate Professor of H ome Econom ics The University of Texas Bureau of Research in the Social Sciences Study No. 2 PUULISHED BY T HE U IVERSITY OF TEXAS AUSTIN Additional copies of this publication may be procured from the University Publications, The University o.r Texas, Austin, Texas THE UNIVERSITY OF TEXAS BULLETIN No. 3127: July 15, 1931 A REPORT ON THE HEALTH AND NUTRITION OF MEXICANS LIVING IN TEXAS By JET C. WINTERS AHoclate Profeuor of Home EconomJce The Unlveralty of Texas BCREAU OF RESEARCH IN THE SOCIAL SCIENCES STUDY NO. 2 PUBUIHBD BY THB UNIVERSITY POUR TIMBS A MONTH, AND BNTBRBD AS SBCOND·CLASS MATTBll ~TTHB POSTOPPICB AT AUSTIN, TBXAS, UNDBll THB ACT OP AUGUST U, 1912 The benefit• of education and of uaeful knowled.e, •enerally diffuaed throush a community, are HHntial to the preservation of a free •overn• ment. Sam Houston Cultivated mind ia the •uardian reniua of Democracy, and while suided and controlled by virtue, the noblest attribute of man. It ia the only dictator that fr-men acknowleclse, and the only aecurit'y which freemen deaire. Mirabeau B. Lamar CONTENTS PART I (The Mexican Family) . . Page Plan of lnvesugat1on..._... _ ...._...................... _..... -..-----·-------·-----· 9 Adequacy of Diet -······-····-····-··--····················--------····-··-···---··············-····16 Economy of Diet -·····-·············-·····-···--·-·······-····-----······---·--···----·-·-···--·29 Relation of Diet to Health ···--·············--·····--··-·--·-··-----··--·-····-···-···-···33 Appendix ·····-·-·-·--·-··--··-----··-·-·--·----·-··-··---------------------·-··37 PART II (The Mexican Infant and Pre-School Child) Plan of Investigation ···-··········-···-·················------------------···-············-····49 Results of Study of Pre-Natal Care and Early Feeding ------·-------··-···-·-···51 Study of Pre-School Child ····----------···-·········-·------------···········-·····53 Compari90ll of Nutrition of Mexican, Negro, and American Children ............ 66 Relation of Diet to Health of Mexican Pre-School Children --····-···-······--·68 Appendix ···-··········---·--···-··--·-·······-····--·--------------------------79 TABLES FOR PART I Page I. Double Scale for Calculating the Energy and the Protein and Mineral Needs of a Family ·······-······--------------·····-···-····-14 II. Adequacy of Diets of Sixty-five Mexican Families on the Basis of Two Different Standards ---····-····--·--··-----···-··-·····---16 III. Average Food Value per Man per Day of Four Groups of Amer· ican Dietaries, Grouped according to Cost ···-··········-·········-······--20 IV. Average Food Value per Man per Day of Four Groups of Mex­ican Dietaries, Grouped according to Family Income ···-····-··-·······20 V. Percentage of American and Mexican Diets Inadequate in the Various Food Factors. Based on Ninety-two American and Sixty-five Mexican Dietaries ···-····-····-----······---········----21 VI. Foods Appearing in Sixty-five Mexican Diets During a Period ()f One Week, Number of Diets in which Each Appeared, and Amount of Those Foods Appearing in More than One-fourth of the Diets ···-····-····-···-·····-··········-····-····----------·-····-·······-22 VII. Suggested Percentage Distribution of Calories for an Adequate Family Diet -·····-·························-··········-·-----···--···-··········-····27 VIII. Percentage Distribution of Calories in Groups of Mexican Families ----------·--··--------···-------·····--··-··-····--·27 IX. Percentage Distribution of Total Food Cost and of Nutrients in 224 American Dietaries ·······-·····-···-···---------·····-·-··-·····-······--.29 X. Percentage Distribution of Total Food Cost and of Nutrients in Sixty-five Mexican Dietaries ···············--------------------····-----29 XI. Percentage of Americans and Mexicans Dying in State of Texas from Diseues Related to Diet ···-···-····-···-···-··--·-·······--·-----35 XII. The Cost and the Percentage Adequacy of Diets of Sixty-five Mexican Families Arranged According to Income Groups and Expreteed on Buis of (1) Individual Standard and (2) Haw­ ley Standard ----------------------------------37 4 Contents XIII. Distribution of Cost and Nutrients for One Week in Sixty-five Mexican Dietaries, Arranged According to Income Groups .......... 41 XIV. Percentage Distribution of Cost and Nutrients for One Week in Five Groups of Mexican Dietaries, Arranged According to Income Groups ..............................----------.. ------------------------------------------------43 XV. Distribution of Cost and Nutrients for One Week in Forty Mex­ican Dietaries-Mixed Incomes ............................................................ 44 XVI. Percentage Distribution of Cost and Nutrients for One Week in Forty Mexican Dietaries-Mixed Incomes ............... ________________________--45 XVII. Distribution of Cost and Nutrients for One Week in Sixty-five Mexican Dietaries ------------------·-----···--·····-········-----------------------····--··-45 XVIII. Percentage Distribution of Cost and Nutrients for One Week in Sixty-five Mexican Dietaries ··---------------------------------------------------------------46 TABLES FOR PART II Page I. Calorie Requirement of Pre-School Children ........................................53 II. Average Daily Intake of Calories, Protein, Calcium, Phosphorus, and Iron of Mexican Pre-School Children -·------·-----..------------------------54 III. Calories-Frequency of Percentage Deviation from Standards (Given in Percentages) ---------------------------------------------------------------------55 IV. Protein-Frequency of Percentage Deviation from Standards. (Given in Percentages) --------------------------------------------------------------------56 V. Minerals-F.requency of Percentage Deviation from Standards. (Given in Percentages) --------------------------------------------------------------56 VI. Comparison of Adequacy of Diets of Mexican Families and of Mexican Pre-School Children --·---····-····-·····--····-------··--······-------------59 VII. Number of Mea1s in Which Certain Types of Food Occurred ............ 60 VIII. Average Daily Milk Intake of Mexican Pre-School Children ________..62 IX. Percentage of American, Negro, and Mexican Children Below Standard Dietary Requirements ---------------------------.. .......... ............. 66 X. Percentage Freque-ncy c;f Inadequate Factors in Diets of Amer­ ican, Negro, and Mexican Children ______________...._________________ .._____________ 67 XI. Heights of Mexican and American Pre-School Children ....................69 XII. Summary of Physical Examination Findings of a Group of Mex­ican Pr~School Children. (Results in Percentage) _______________________ 71 XIII. Summary of Physical Examination Findings of a Group of Mex­ ican Pre-School Children, by Age Groups (Results in Per· centage) -------..---------------------------------------------------------------------------------------73 XIV. Average Daily Intake of Seventy-five Mexican Pre-School Children ....79 XV. Percentage of Deviation from Standard in Diet of .Mexican Pre­school Children -·-------------------------·------------------------------------------------------85 XVI. Deviation from Standard Weight of Mexican Pre-School Chldren ...... 91 FOREWORD This investigation was made possible by a grant from the Bureau of Research in the Social Sciences of The Uni­versity of Texas. It could not have been carried out without the cooperation of many persons. The interest of Mexican people in the project was secured chiefly through the efforts of Misses Kathleen and Aurora Gonzales, public-school teachers in San Antonio, Texas; Miss Della Wright, secre­tary of the International Institute of Austin, Texas; and Mrs. Gaile Burkhart, City Health Nurse of Austin. The collection and much of the compilation of data were done by Miss Mary Goldman and Mrs. Helene P. Smith, trained nutritionists. Several students in the classes in nutrition also assisted in the compilation of data. To all of these and, most of all, to the Mexican families who so cheerfully per­mitted a study of their dietary habits I wish to express my sincere appreciation. A typed copy of the results of this investigation, con­taining the calculations for the individual families of the nutritive requirements and nutritive value of food con­sumed, is filed in the library of The University of Texas for reference. JET C. WINTERS. The University of Texas. PART I THE MEXICAN FAMILY PLAN OF INVESTIGATION AS AN OUTCOME of many investigations concerning the relationship of food to physiological well-being certain dietary standards have been established, and more or less definite failure in physiological efficiency has been shown to follow any great deviation from these. Among people living on a very low economic level these standards are apt to be flagrantly violated. Consequently, a study of the food intake of such a people, particularly when com­bined with a knowledge of their physical condition, should yield data of much interest to those concerned with the problems of nutrition and should afford an excellent oppor­tunity for testing the validity of dietary standards. It was, then, with the idea of determining what deficiencies were characteristic of Mexican diet and of discovering possible relationships between these deficiencies and physical con­ditions that this study of the diet of typical groups of Mexi­can families living in Texas was undertaken. Texas has a considerable Mexican population. In 1930 it was estimated to be about 820,000, or 14 per cent of the total State population.1 Many of these Mexicans work on farms or in section gangs on the railroad, but numbers of them live in segregated districts of towns and cities. It is with urban Mexicans that this investigation is concerned. They are, on the whole, unskilled workers and belong to the lowest wage-earning group. Their dietary habits have undoubtedly been modified by their contact with Ameri­cans and by a different kind of food supply, but they cling, to some extent, to the diet which they followed in Mexico. None of the families studied had lived in Texas less than eight years. Many had been there twenty or twenty-five years, and a few "always." Extent of study.-Material was gathered in two Texas cities, San Antonio and Austin. San Antonio is one of the large cities of Texas, with a population of some 250,000, 1Manuel, H. T., The Education of Me:.r:ican and Spanish-Speaking Children in Te:.r:I Nutrition, Third Edition. Since this table is based on edible food material, it was necessary in cases where "as purchased" and "edible" por­tions differed materially (bananas, watermelon, cantaloupe, etc.) to use tables giving protein and mineral values in terms of hundred calorie portions.2 For certain widely-used Mexican foods no data are available. This is true of masa, tortillas, canned chili, and sweet bread. Mas.a is made from whole corn grains soaked in lime water, boiled, washed, and ground, this process resulting in a dough which may be rolled or patted quite thin and cut or shaped into round pieces about the size of an ordinary salad plate. These, fried or baked, are called tortillas. Masa may be bought and made into tortillas by the housewife, or the tortillas may be bought either from a factory where they are made by running masa through hot rollers, or from Mexican ~Sherman, H. C., Chemistry o.f Food and Nutrition. Table 19. families who make a business of supplying them, often cooking them directly over a charcoal furnace. In order to estimate the food value of masa and tortillas, the moisture content was determined and from this the actual amount of ground corn in the product estimated. Pan dulce, or sweet bread, is a name applied by the Mexicans to bakery products made by the addition of fat and sugar to ordinary bread dough. Additional calories were estimated from the amount of sugar and fat added, and protein and mineral content were based on ordinary bread figures. Canned chili, used in only a few instances, was frozen, and the meat, beans, and fat separated and weighed. Nutritive value was estimated from figures obtained in this way. Only the cheapest cuts of meat, usually stew meat containing large amounts of waste material, were purchased. For this reason the food-value figures for meat are low. Standards used in calculating nutritive requirements.­ The discrepancies among the various dietary standards in use at the present time have been so adequately discussed by Hawley in her bulletin entitled Dietary Scales and Standards for Measuring a Famuy's Nutritive Needs3 that it seems unnecessary to review the subject here. In view of these discrepancies, it was thought best to use two dif­ferent standards in determining the adequacy of diets. Con­sequently, the dietary requirements were estimated by (1) the "individual method" and (2) the Hawley method. In the first method individual requirements for each member of the family were estimated, and the sum of these was considered the requirement for the family as a whole. Three thousand calories were taken as representing the energy requirement of the adult man at moderately active muscular work and 2,700 that of the adult woman. All per­sons over fifteen years of age were considered adults. The requirement was increased by 10 per cent for occupations demanding unusual energy output. These are the usual standards for adults of average activity, and it is possible, 3United States Department of Agriculture, Technical Bulletin No. 8. since Mexicans are smaller than Americans, that they are somewhat high. The average height of a group of twenty­five Mexican men selected at random was 5 feet, 5V2 inches. The average weight was 147 pounds. A similar group of women had an average height of 5 feet, 2 inches, and an average weight of 125 pounds. Since these figures are not greatly below the American average, and since the food bought was of such poor quality that there was probably more than average waste, it was thought that these stand­ards were not excessively high. There is the possibility, however, that the calorie deficiency is somewhat exagger­ated because of the use of too high a standard. It is regretted that requirements were not based on actual weights, but these would have been difficult to obtain. Chil­dren's calorie requirements were based on the tables of Gillett, the mid-point in the given range being used. The protein needs of the family were considered met if the protein supplied as much as 10 per cent of the calories. Mineral requirements for adults were taken to be .69 gm. calcium, 1.32 gms. phosphorus, and .015 gm. iron daily for every person over fifteen years of age. Children under fif­teen were counted as requiring one gram each of phos­t>horus and calcium daily.• The iron standard for children was varied according to the calorie requirement, .0005 gm. for each 100 calories.5 For lactating mothers (represented by children under one year of age) , the calorie requirement was increased 20 per cent, the calcium 75 per cent, phos­phorus 20 per cent, and iron 17 per cent. These increases are based on suggestions by Rose. e In Hawley's method of estimating nutritive needs, the family is reduced to "man units" on the basis of the fol­lowing table, which provides separate units for energy and protein-minerals.7 •Sherman, H. C., Chemistrv of Food and Nutrition, Third Edition, p. 542. 1926. 5Rose, M. S., LabQTatory Handbook for Dietetics, p. 27. 1929. e&ose, Feeding the Family, Third Edition, p. 119. THawley, Dietary Scales and Standards /QT Measuring A Family's Nutritive Needs. United States Department of Agriculture. Tech­nical Bulletin No. 8. TABLE I DOUBLE SCALE FOR CALCULATING THE ENERGY AND THE PROTEIN AND MINERAL NEEDS OF A FAMILY* Age of Protein~Mineral Individual Dearee of Ener11 Scalet Scalet (Yean) Activity Male Female Male Female Over 60 ____________Moderately active_____ 0.9 0.7 0.9 0.7 Over 60 -------------------Sedentary ------------.8 .6 .8 .6 18 to 60 --------------------Active --------------------------1.2 .9 1.1 .9 Do ______________________ Moderately active_________ 1.0 .8 1.0 .8 Do _________________Sedentary --------------.8 .7 1.0 .8 15 to 17 _____________________Moderately active_____ 1.1 .9 1.5 1.0 .8 1.3 13 to 14 --------------------------------­ 10 to 14 ----------------" --------------------­ .9 1.3 10 to 12 -------------------" ------------------------­ .8 1.2 .6 .6 1.0 1.0 6 to 9 -----------------------------------------­Under 6 ----------------" ---------------------­ .4 .4 .8 .8 •The 1t1odard for each nutrient 11 ba1r.d on food H eaten and indicates the nu.tritlve need of a moderately active man eeveoty kilo1rama in weiaht. tl.O = 3,000 calorlea. ;l.0=67 1m1. protein, 1.3 pa. phoophorua, .68 1m. calcium, and .012 1m. Iron. Comparing the results of estimating requirements according to the two methods, it will be found that there is no great difference in calories. The protein, phosphorus, and iron figures are higher and the calcium figures lower when estimated by the Hawley method. Consequently, when the two standards are applied to inadequate diets, the inadequacy will appear greater in protein, phosphorus, and iron, and less in calcium, when the Hawley rather than the "individual standard" is used. In the following tables and discussions the "individual standard" is referred to as Standard I and the Hawley standard as Standard II. Cost standards.-For the purpose of reducing cost to a "per-man-per-day" basis, the United States Department of Labor scale was used. The scale follows: !\fan --------------------------------------------------------------··-------------1.00 Woman ----------------------------------------------------------------------------------------------.90 Children 11-14 yrs·--------------------··-----·------·-----·-···------·--·--·--···--·--------------.90 Children 7-10 yrs·-----·-------------------------------------·-------------·-------------·-.75 Children 4--6 yrs.·---------·------------------·------------------------------------------------------.40 Children 1-3 yrs...----------------·-··--·----------------------------------------------·------------.15 This rating has been so generally employed, particularly for the purpose of estimating cost of food per day per per­son, that it was thought best to use it here in order that these results might be compared with those of other studies. A careful study of prices at the time this investigation was made showed that 40 cents per day per person might rea­sonably be considered the minimum amount for which adequate nutrition could be provided. Accordingly, this amount is used as the standard in discussing the economy of the Mexican diet. ADEQUACY OF DIETS Calorie, protein, and mineral adequacy.-Table XII, in the Appendix to Part I, gives the cost and percentage ade­quacy in five food factors of sixty-five Mexican diets calculated according to two different standards as explained above. These may be roughly summarized as follows :8 Percentage Percenh1ge of Diets of Diet• Inadequate Inadequate Requirementa According to Accordinr to Standard I Standard II Calories ----------------····-··-··· 54 --·---··--······--··-·---------··-·-·---···-·-·--·---·-----·----··---55 Protein -----·--··---·-----··-·-··-29 ---------------------------------------------·------------------------43 Calcium ------------·-------------94 -------------------------------·---------------------------·----------81 Phosphorus -------------------54 -----·---------------------------------------------------------------76 Iron ---·----------------------------51 -----------------------------------·----------------------------------84 Amount spent.________________ 81 ---------------------------------------------------------------------81 These data may also be summarized in table form as follows: TABLE II ADEQUACY OF DIETS OF SIXTY-FIVE MEXICAN FAMILIES ON THE BASIS OF Two STANDARDS AS EXPLAINED IN TEXT No. of No. of No. of No. of Fam· Fam· Fam-Fam­iliee ilie1 iliea iliee with with with below 95-100 75-95 50-75 so Per Per Per Per Per Per Per Per Cent Cent Cent Cent Cent Cent Cent Cent Ade-of Ade-of Ade-of Ade-of quacy Total quacy Total quacy Total quacy Total Calories I.______ __________________ 30 Standard 46 19 29 14 22 2 3 IL ___ ___________ __ _____ ___ 29 Standard 45 17 26 14 22 5 7 Protein I._________________________ 46 Standard 71 14 22 5 7 0 0 IL_______________ . ____ 37 Standard 57 10 16 15 23 3 4 Calcium Standard I ·--------------------· 4 Standard II__ __________ ___________ 12 Phosphorus Standard I -----------------­30 Standard IL__ _____ __ ____ _________ _ 16 Iron Standard L .. ·----·---------------·· 32 Standard 11________ ______________ __ __ 10 6 19 46 24 49 16 11 16 15 25 19 24 17 24 23 39 30 36 28 26 17 18 13 24 43 40 26 28 20 38 22 11 3 6 1 7 34 17 4 9 1 10 890-100 per cent adequacy has been counted "adequate." From this table it will be seen that 1. According to Standard I, calorie estimations show: 46 per cent of diets adequate. 29 per cent of diets at least three-fourths adequate. 22 per cent of diets one-half to three-fourths adequate. 3 per cent of diets less than one-half adequate. Protein estimations show: 71 per cent of diets adequate. 22 per cent of diets at least three-fourths adequate. 7 per cent of diets one-half to three.fourths adequate. 0 per cent of diets less than one·half adequate. Calcium estimations show: 6 per cent of diets adequate. 17 per cent of diets at least three.fourths adequate. 43 per cent of diets from one-half to three-fourths adequate. 34 per cent of diets less than one·half adequate. Phosphorus estimations show: 46 per cent of diets adequate. 23 per cent of diets at le.ast three-fourths adequate. 26 per cent of diets one-half to three-fourths adequate. 4 per cent of diets less than one-half adequate. Iron estimations show: 49 per cent of diets adequate. 30 per cent of diets at least three-fourths adequate. 20 per cent of diets from one-half to three-fourths adequate. 1 per cent of diets less than one·half adequate. 2. According to Standard II, calorie estimations show: 45 per cent of diets adequate. 26 per cent of diets at least three-fourths adequate. 22 per cent of diets from one·half to three-fourths adequate. 7 per cent of diets less than one·half adequate. Protein estimations show: 57 per cent of diets adequate. 16 per cent of diets at least three.fourths adequate. 23 per cent of diets from one·half to three-fourths adequate. 4 per cent of diets less than one-half adequate. Calcium estimations show: 19 per cent of diets adequate. 24 per cent of diets at least three-fourths adequate. 40 per cent of diets from one·half to three.fourths adequate. 17 per cent of diets less than one·half adequate. Phosphorus estimations show: 24 per cent of diets adequate. 39 per cent of diets at least three-fourths adequate. 28 per cent of diets from one-half to three-fourths adequate. 9 per cent of diets less than one-half adequate. Iron estimations show: 16 per cent of diets adequate. 36 per cent of diet~ at least three-fourths adequate. 38 per cent of diets from one-half to three-fourths adequate. 10 per cent of diets less than one-half adequate. It is evident that somewhat different conclusions as to the adequacy of Mexican diets will be reached according to the standard used. Employing the Hawley standards, min­eral deficiencies are much more marked than calorie or protein deficiency, while only calcium deficiency exceeds calorie when the "individual method" is used. By either method the figures for calories vary only slightly, and devia­tion from standard is less for protein than for any other factor. Another way of envisaging dietary deficiencies is to con­sider diets in relation to the number of deficiencies which they show. Thus, according to Standard I: 7 per cent of the diets are adequate in all five factors. 27 per cent of the diets are inadequate in only one factor. 15 per cent of the diets are inadequate in two factors. 10 per cent of the diets are inadequate in three factors. 15 per cent of the diets are inadequate in four factors. 26 per cent of the diets are inadequate in all five factors. Average number of factors inadequate, 2.8 Using Standard II: 10 per cent of the diets are adequate in all five factors. 6 per cent of the diets are inadequate in only one factor. 6 per cent of the diets are inadequate in two factors. 20 per cent of the diets are inadequate in three factors. 21 per cent of the diets are inadequate in four factors. 37 per cent of the diets are inadequate in all five factors. Average number of factors inadequate, 3.4. By either standard outstanding deficiencies in the Mexi­can diet are apparent. If the sixty-five families studied may be taken as representative of the Mexican population, then it may be said that more than 50 per cent of the Mexicans are living on deficient diets and at least 25 per cent on diets that are only one-half to three-fourths adequate. It may be said, also, that the most outstanding deficiency is in calcium, and the least deficiency in protein. Comparison of the adequacy of Mexican and American Diets.-The standard "per-man-per-day" intakes for five food factors have been computed by Sherman to be as follows: Energy ·-··-···-····-··················································-··-······-·· 3,000 calories Protein --···························-··--··········-······-···------·-··· 75 gms. Phosphorus ·······················-······-······-··········-········-·-······ 1.32 gms. Calcium ············---·······························-·············-·-········· .69 gm. Iron ·········-···················-·······-··-····-··········-····-··-·--··-·· .015 gm. As a result of data from 224 typical American families, Sherman gives the following average food values on the per-man-per-day basis :9 Energy -········------····----·········--·········-------3,256 calories Protein ·-····-··········--··-··---··--····-·········-·····-············-106 gms. Phosphorus --··-----·····-··-·--····--····-····················-1.63 gms. Calcium ··-------·-·····-·····-·--··-··········-··--·-··---.74 gm. Iron -··--····-··----------····-········-··-···-·····-··--·-·-.017 gm. Similar figures for sixty-five Mexican dietaries are :10 Energy ---·-··--····-··----···--·-····-······-··---···--2,665 calories Protein -····-··-··········--····-···-·············-····-····-············-86 gms. Phosphorus ····---··-··--······································-··---·· 1.35 gms. Calcium -··--·-· ·-······-·-··-··-··-················-·····---.64 gm. Iron ··········--·········-·····--·····-····-···-·-····························-··-.015 gm. Concerning the average food values for the American families, Sherman says: . . . It will be seen that the freely chosen dietaries contained a liberal surplus of protein and a fair supply of phosphorus and iron but scarcely more than is actually necessary of calories or calcium. Correspondingly we find that the num­ber of individual family dietaries actually deficient in calcium and calories is high enough to cause serious concern while the cases of deficiency of phosphorus or iron were considerably less frequent and there were few, if any, cases showing an actual deficiency of protein.11 The Mexican figures show a considerably lower average than the American in ail five food factors. However, the vsherman, Chemistry of Food and Nutrition, Third Edition, p. 552. 10For reducing to per man per day, the United States Bureau of Labor Scale was used in order to obtain figures comparable to Sher­man's. If Hawley units are used, quite different results are obtained. 11sherman, Chemistry of Food and Nutrition, Third Edition, p. 552. averages are as much or more than the standard in every­thing but calories and calcium. Evidently the difference in the two diets is in amount and not in kind. From a dietary study based oil ninety-two typical Ameri­can families, Sherman and Gillett evolve the following table :12 TABLE III AVERAGE FooD VALUE PER MAN PER DAY OF FouR GROUPS OF AMERICAN DIETARIES GROUPED AccoRDING TO CosT Pro· Pho•· Cal· Iron Group Coot Cal· tein photUI cium Milli· (cento) orie1 Gram1 Grams Gram1 grams I ----------------------·----------19.2 2,043 78 1.14 .51 12.l ___________________________.._______ II 28.2 2,665 91 1.39 .64 14.9 III -----------------------------------34.7 3,106 109 1.60 .72 17.7 IV --------------------------------49.4 3,889 126 1.95 1.01 20.6 The table below gives the average of the four income groups studied in San Antonio. It is not exactly comparable to the table of Gillett, but serves to show that, for the same amount of money, the Mexicans secured approximately the same amounts of protein, calories, phosphorus, calcium, and iron as the Americans. The difference in price of food in 1917 and 1930 has not been considered. TABLE IV AVERAGE FooD VALUE PER MAN PER DAY OF FoUR GROUPS OF MEXICAN DIETARIES GROUPED ACCORDING TO FAMILY INCOME Pro-Pho•· Col· Iron Group Coat tein cium Cal-phoru1 Milli­(cent•) orie• Grama Cram1 Grams 1ram1 I --------------------------24 2,320 77 1.32 .53 14 __..____________________ II 29 2,572 83 1.31 .57 13 III -------------------------------27 3,090 87 1.42 .61 15IV ---------------------------·-32 2,740 89 1.44 .73 14 In the same study the percentage of American diets inadequate in the various food factors is given. These may be compared with the inadequacy tables on page 16 of this study, but, again, the two are not strictly comparable, as they are not computed in exactly the same way. 12Sherman and Gillett, Adequacy and Econorrvy of Some City Die­taries. 1917. TABLE V PEacEl'ITACE or AlllEllICAN AND MExlCAN DIETS INADEQUATE IN THE vAlllOUS Fooo FAcrOttS. &sm ON N1NETY·TWO AMERICAN AND Sa:TY·hVE MEXICAN DIETARIES Mexican Me:dcan American Standard I Standard II Calories -----54 55 - ---------59 Protein 13 29 43 Calcium ---53 81 -----94 Phoephorua . 49 54 76 Iron --------41 51 84 All of these figures serve to show that the Texas-Mexican diet is not, on the whole, as adequate as the American diet; that the same type of deficiencies exist in the Mexican as in the American diet, and that the differences are hardly as great as might be expected in the face of differences in economic conditions and in the general level of intelligence. Vitamin adequacy.-Since there is no way of making a quantitative estimation of the vitamin content of diets, perhaps the best data on which to base an opinion of general vitamin adequacy are the kinds and amounts of foods used. The following table gives a list of food appearing in the dietaries, the number of families using each food, and the amount used per week per family for those foods which appear on any considerable number of diets. From this table it appears that the Mexican diet contains beans, cereals (largely white flour, white rice, and whole corn), and lard in large amounts. Meat, eggs, milk, and cheese are used frequently, but in small amounts. Tomatoes, potatoes, and onions are the most widely used vegetables. Fruit plays a very small part in the diets, but bananas and oranges appear on almost a third of them. Sugar is practically the only sweet used. Coffee is bought regardless of economic status. TABLE VI FOODS APPEARING IN S!XTY· FIVE MEXICAN DIETS DURING A PERIOD OF ONE WEEK, NUMBER OF DIETS IN WHICH EACH APPEARED, AND AMOUNT OF THOSE FooDs APPEARING ON MoRE THAN ONE·FOURTH OF THE DIETS Food Fruits i~~l:: "("d;i~~i)"--::=:=::::::::::::=:::=::::==~-=~:--===:=:= Bananas ··--------------·-------·---------------------------------·-· Cantaloupe -·····--·-······-·-----------------·-------------------­Cherries -·····----------------··········-···-·····--------···········­Grapes ·····------·-------·················--------------------------­Lemons ---·-----·-···············-------------·-··-··------­Oranges ------------------------------------···--------------------------· Peaches ------------·---------·-·····--·-····-----··········-··-··· Peaches (canned) ----------··----··-·········-····················· Pineapple (canned) -----------------------------··-········-···-· Plums ----------------·······----------·····-···-····----------··-·······­Prunes ·················-----··················-----------------------·-··· Raisins -------····--·--------·················-····-------·-------·· Watermelon --------------···············-····--·-----------·-··­ Vegetables Beans (green) -------·········-------··------------·····----------­Beets ·-·-··-·--·----------·---------·--·····---------····-·--···· Cabbage ----------··········---··-··············---·----------------­ Carrots ------------------------···---·----------------················ Cauliflower ----·-------·---------···---------------······ Celery ---------------···---------------. Corn ------------------·-····-···············-----·--·--·-········· Corn (canned) --------···-··----······--------------·------··· Cucumbers ----------·············-·········--·-········--·-------·-· Egg plant ------------------------····---··---·-·-··········-··· Lettuce -----------············-----··········-----------------·-----··· Onions ······----·-···--·····---······-····-·----------·---------·· Peas -------------------··---···-----·--------·······-----··-·---··------· Potatoes ----------------------------·····················-····-········· Pumpkin ----------------------···········-·········-·······-·-··--·-· Spinach ---···---------·--····-·····-----···---------------------­Squash ----------····--···--··-·············--········-·········-------···· Sweet potatoes --······-···················-·····--··----·-··········· Tomatoes -----------··············--··----------------------·-···········-­ Legumes Beans (dried) ------------·-·········-····-------------------------­ Cereals and Cereal Products Bread (white) -----------------------------------·-·······-----------­Cakes ---------------------·········---···-----------------·····-·--····----·· Corn meal -····-·--·····-·-···-····-------·············-·····----------····· Corn flakes ··-----·-······························----------·-·············· Crackers ·····-·············--·-·----····-·----·-······----------------------···· ~a basis of number of families u1ing and not of enlire croup. Number Families Uaina: Food l~ 29 6 1 3 4 29 10 9 1 4 2 3 15 4 6 18 5 2 1 10 7 4 1 8 50 7 59 12 3 3 7 59 62 45 6 3 2 22 Avera1e Amount Per Week Per Family• Ibo. 3.24 2.97 2.34 6.16 4.46 5.56 5.91 .50 TABLE Vl-(Continued) Fooos APPEARING IN S1XTY· FIVE MEXICAN D1ETS DURING A PERIOD OF ONE Wu1:, NUMBER OF DIETS IN WHICH EACH APPEARED, AND AMOUNT OF THOSE FOODS APPEARING ON MORE THAN 0NE·FOURTH OF THE DIETS A veraa:e Number Amount Familiea Per Week Food Uain1 Per Family• Food lbt. Cream of wheat ······-···············-··········-····-··-············ 6 Farina -····-····--··-·····--···············-···-··--··-···-·-·· 2 Flour (white) -·················· ·-···-··········-·-··-···-··-··· so 16.29 Macaroni ·-·--··-···--·-·········-·············-····-·-·-········· 22 .93 Masa ····----··---··---·······-····-····--··------­36 8.37 Oatmeal ···----·---··-·-···-·-···········--···-··----­16 2.48 Rice ····-···--··-········-·-··················-····-·--··--···-···· 47 2.38 Spaghetti --·····--··-··-··-········-···-·····-··-----· 2 Sweet bread ····-·····-··········-····-····-··········--·--··· 44 6.50 Tapioca -··-·····-·-··············-························-··-··--· 1 Tortillas ---··--··········-············-···--······----22 4.56 Vermicelli -··---···········--····-····--···-·-··-----28 .98 Meat and Meat Substitutes Bacon -·----·--····-····-····-··-··················--·--26 1.36 Brains ······-··--·-··---····-·······-·-·-·-····-·--·----· 1 Cheese ···-----------··········-········-· 41 1.00 Chicken -·--···-----····-··-·--····-····-·--·---5 Corned beef ··--·-·····-·····-··········-·······-·-·-·--2 Eggs --···· ··-----·-··--··-··-····-····------59 24 eggs Fish ( fresh) _··--··-·········-··-····-·-·-··········-·--·--2 Fish ftakes ····--····---·······-··-····-····-····-··-··-·--1 Liver ··-·------··---···········-·-·-·-·····-··--·--3 Meat (beef) ···--·-····-····························-····-·--·--58 4.18 Oysters --····---············-···-····················-··--·--· 1 Salmon -·-··-·-------··-·············-·········-·--··--4 Sardines -···-····-·····-·-··-·····················-····-···----4 Sausage ···-·-----··--·····-···--···········--·····--· 24 1.61 Tripe -·---···--·--·····················-·······-··--··--1 Weiner& ··-··---··----····················-·-···--····-···--1 Milk ··-··-·-····--·-··-·············-·······-·····-·--·-62 10.7 qt&. Fats 3.97 Butter -···--····-······-···················-············-····-···--58 .76 Oil ····-····-···············......... ·············-·········-·····-···--·-2 Lard ··--·-··--··--·-·-··················-·······-···-·-···-59 Sweets Sugar ···-·--······-····························-··-········-···----61 5.21 Syrup ··-······-···············-··········-···················-···---2 Jam and jelly -········-·······················-··········-··-··---· 4 Candy ······-··-··-················································--·-··· l Molasses -·--·-···················· · ··················-··········-·-···· 2 .Mi!!Cellaneous Coffee -····-·--··-·· ..·······························-···-··············· 60 1.68 Tea ········--······-··-···--·----·---······--···--···--····-···----··---···-··· l •Qa buit or numbH of famiHH Utin& and not o( rntire lfOUp. TABLE Vl-(Continued) FooDs APPEARING IN S1xTY-FIVE MEXICAN DIETS DURING A PERIOD OF ONE WEEK, NUMBER OF DIETS IN WHICH EACH APPEARED, AND AMOUNT OF THOSE FooDs APPEARING ON MoRE THAN ONE-FOURTH OF THE DIETS Averaae Number Amount Familie1 Per Week Food U1in1 Per Family• Food Ibo. Canned soup --······-----···········-··-···--------·-··········-··-····· 2 Pecans ------------------·······································-···········-··· 1 Cream .................. ···-------···-··········-·····-·······-····---·····-· .... 1 Pickles --··-------------------------------------------------------···-····----2 Pie --------------···----···-···············-------·-···--··--------------·······-··-1 Chili (canned) ················-···-···-··········-········-----------14 Jello -·········--······-···--·-·········-·-----------------------------------------2 Ice cream ------·····----·-···························-----·-···----··-··· 2 Chocolate --------------···········-···············----·-··········-·········· 1 Cocoa ·····-····-------·-·········-···········-·········---------···--·-·········· 1 Noodles ··········-·-···········------················----------------········· 1 Mayonnaise -······-···--··········---·················-----····----····-·· 1 Peppers ---------------------·····--------------------------------··············-65 •On bui1 of number of famiHea using and not of entire group. Vitamin A.-Milk, butter, eggs, leafy vegetables, and glandular meats are usually depended upon as sources of this vitamin. While milk appears on all but three of the diets, it is used in very small amounts. In the two lower­income groups of the San Antonio study the average amount of milk bought was only a little more than a quart a day per family. These two groups comprise fifty adults and seventy-nine children. The amount of milk purchased during the week was 143 quarts. If all the milk were given to the children, it would average only about one-fourth quart, or one cup, per day. Since in Part II of this study, which is concerned with the food intake of pre-school Mexi­can children, it was found that the average amount of milk taken was nearly one and one-half cups, it seems a safe guess that the custom in these Mexican families is to give the milk to the younger children and let the older ones do without. In the higher-income groups a little more than one and a half quarts per day per family was purchased. This group contained fifty-eight adults and eighty-two chil­dren. The amount of milk purchased was 230.5 quarts, an average of .4 quart per day per child. In the Austin group there is approximately the same average amount of milk per child as in the two higher-income groups of the San Antonio study. This group comprises seventy-two adults and 110 children. The amount of milk bought was 290.5 quarts. There seems to be a tendency to purchase a quart of milk a day per family, regardless of the number of chil­dren. Twenty-four of the sixty-five families bought six to eight quarts per week. Only thirteen families bought more than two quarts. The amount of milk used is certainly too small to furnish sufficient Vitamin A. Butter appears in only 30 per cent of the lower-income diets and is bought in very small amounts, an average of a little more than one­fourth pound per week per family. In the higher-income group butter appears on 70 per cent of the diets, but again it is used in very small amounts, one-half pound per week per family. Eggs are widely used, but there is a great deal of variation in the number bought. In the two lower-income groups in San Antonio fifteen eggs per week per family were used and in the two higher-income groups, twenty-five per week per family. The Austin group used an average of thirty-two eggs per week per family. This is interesting in view of the fact that the Austin study was made in the winter, when eggs were expensive, and the San Antonio study in summer, when eggs were cheap. Of the fruits that are popular with the Mexican, only bananas, and of the vegetables only tomatoes, are good sources of A. On the whole, it seems quite probable that the Mexican diet does not furnish enough of this vitamin to promote the best physiological efficiency. Vitamin B.-The increasing use of milled cereals in place of the whole-grain corn, so universally used by the Mexican in his home country, may be cutting down his Vitamin B supply to a dangerous extent. Only 10 to 12 per cent of the calories obtained from cereals came from the whole-grain varieties. The Mexican never buys graham or wholewheat flour or brown rice. This growing tendency to substitute milled cereals for whole grains is shown by the fact that while forty-five of the sixty-five families studied used white bread and fifty white flour, only twenty-two used tortillas and thirty-six masa. It is also shown by the large amounts of white flour and white-flour products used in comparison to the small amount of corn products. White-flour "tor­tillas" (most of the white flour is used in making these) are being substituted to a large extent for corn tortillas, a prac­tice much to be regretted from the standpoint of mineral as well as vitamin supply. In diets in which more than 40 per cent of the calorie intake comes from cereals, it is especially desirable that the cereals used carry their full quota of min­erals and vitamins. To offset the possible B deficiency, there is the fact that beans, potatoes, and tomatoes are exten­sively used. There seems to be less danger of a B than of an A deficiency. Vitamin C.-In spite of the small amounts of fresh fruits and vegetables used, the wide use of tomatoes, an extremely rich source of C, and the use of large amounts of potatoes, a fair source, make a deficiency in this vitamin less prob­able than in either A or B. Vitamin D.-Through all the summer and the greater part of the winter Mexican children, wearing very few clothes, play in the sunshine. Plenty of D may be supplied in this way, in spite of the pigmentation of the skin which might be expected to prevent the greatest profit from the ultra-violet rays of the sun. Cod-liver oil or Viosterol therapy is practically unknown. Vitamin G.-Not a great deal is known as yet concern­ing the distribution of this vitamin. Milk and meat are said to be good sources, but the Mexican diet supplies little of either of these foods. Cereals have been found to supply very little G, and beans, once thought to be efficient in pre­venting pellagra, were found, on experiment,18 to be ineffective. On the basis of our present knowledge, the Mexican would seem to be very poorly insured in regard to Vitamin G. Comparison of Mexican food intake with dietary plans.­ It is interesting to compare the Mexican diet with dietary 13Goldberger, U. S. Public Health Reports, Vol. 40, p. 2. 1925. plans outlined by various authorities. Rose14 suggests the following as a working plan for the construction of an ade­quate diet for a family of two adults and three children: TABLE VII SUGGESTED PERCENTAGE DISTRIBUTION OF CALORIES FOR AN ADEQUATE FAMILY DIET Pe-r Ceot of Total C1lorie1 from Each Clu1 of Food Eno. Chee1e, Meat, Ve1e• and ~vol table1 Other ol Cert>al and Flooh Income Crain• Milk Fruit• Fata Su1ar Food Low -------------------·--·-----35 25 I2 I2 10 6 Moderate ------------25 25 I7 15 10 8 High -----------------------20 25 20 15 IO 10 From Tables XIV, XVI, XVIII, in the Appendix to Part I, giving the percentage distribution of cost and nutrients in Mexican families, a summary table may be made for comparison with the above. Figures for the forty San Antonio families, the twenty-five Austin families, and the group as a whole show the following distribution: TABLE VIII PERCENTAGE DISTRIBUTION OF CALORIES IN GROUPS OF MEXICAN FAMILIES Per Cent of Total Calorie• from Eaoh ClaN ol Fnod Veae· Milk tableo• Eno Cereal and and and Grains Cht'ete Fruita Fat• Su1ar Mt'at1 San Antonio -----------43 7 I5 18 IO 7 Austin ···-·-·---------------43 9 I2 16 IO 10 Total group__ _ _______________ 43 8 I4 I7 IO 8 The most outstanding difference in the Mexican distribu­tion and that suggested by Rose lies in the percentage of total calories obtained from milk. Rose postulates that for an adequate diet in a family with three small children 25 per cent of the calories should come from milk. The Mexi­can families with an average of about 4.5 small children get probably 6 to 8 per cent of their calories from milk. a&ose, Laboratory Handbook for Dietetics, Third Edition, p. 31. (Figures in the table include cheese.) Other differences in the Mexican distribution and that suggested by Rose are the larger percentage of calories from cereals and the slightly larger percentage from fats. It is also important to point out that much more than half of the calories from vegetables and fruits come from dried beans. In considering the results of these differences in distribution, it should be stated that: 1. Diets in which too large a percentage of calories are drawn from cereals are apt to be deficient in calcium and Vitamin A. 2. Milk has been shown to be very definitely connected with calcium adequacy, and it is also an excellent source of A. 3. Diets in which too large a proportion of calories is drawn from cereals and too small a proportion from milk would almost certainly be deficient in calcium and Vita­min A. Moreover, one looks in vain for foods that might off set the tendency toward these deficiencies. Butter and eggs are used in amounts much too small to supplement for A. The large amount of beans used makes the calcium defi­ciency less than it would otherwise be but cannot make up for the small amount of milk. Another plan for an adequate diet consists of suggestions as to the apportionment of the food budget. Perhaps one of the best known is that suggested by the Food Adminis­tration: One-fifth, more or less, for vegetables and fruit. One-fifth, or more, for milk and cheese. One-fifth, or less, for meats, fish, and eggs. One-fifth, or more, for bread and cereals. One-fifth, or less, for fats, sugar, and other groceries and food adjuncts. The Mexicans spend only about one-eighth of their food money for milk and cheese, nearly one-fourth for meat and eggs, nearly one-fourth for cereals, and about one-fifth for the other two classes. Both in regard to the percentage of the budget spent for milk and in the calories obtained from milk, Mexican diets are far below these standards. ECONOMY OF DIET THIS economy of diet phase of the study was designed to reveal the relative importance of economic conditions and of poor food selection in determining the inadequacy of the Mexican diet. Sherman gives the following table which permits a comparison between the percentage expenditures for the different types of food and the returns from each in terms of calories, protein, calcium, phos­phorus, and iron in the case of a series of 224 American family dietaries. TABLE IX PERCENTAGE DISTRIBUTION OF TOTAL FOOD COST AND OF NUTRIENTS IN 224 AMERICAN D1ETARIES15 Pro• Cal· Cal· Pho•· Food tein Ori M cium phoru• Iron Coit Meat and fish...._____ 35.34 18.99 3.86 26.36 30.37 32.19 Egge ---------------­---­---­4.M Milk and cheese__ ____ ll.56 Butter and fats_____ ___ .31 1.77 8.08 10.32 3.64 55.76 .73 4.02 20.61 .32 6.25 5.11 .33 5.47 10.59 9.55 Grain products.__ _____ 37.25 38.20 15.67 30.27 25.87 18.29 Sugar and molaaeea.. .14 10.06 1.81 .20 1.80 4.57 Vegetables ----------· 9.55 9.05 14.87 15.58 26.42 10.55 Fruit -.---------­--­----­---­.78 2.W 3.15 1.82 3.29 5.31 Nute -----­-----­-­·-­-.ll .14 .o7 .13 .09 .15 Food adjuncts..._ ..... .32 .40 .44 .69 .47 3.33 Total --········-···----100.00 100.00 100.00 100.00 100.00 100.00 A similar table for sixty-five typical Mexican dietaries is given below:18 TABLE X PERCENTAGE D1sTRmt:TION OF TOTAL FooD COST AND OF NUTRIENTS IN SIXTY·FIVE MEXICAN DIETARIES Pro· Cal· Cal· Phoe· Food lll" iD oril"8 cium pborue Iron Cost 6.27 1.87 14.44 14.79 18.01 Beane (dried>----···· 16.38 8.12 15.63 21.89 30.51 4.90 Grain products.. _______ 40.67 42.96 12.09 29.85 27.11 20.95 Milk and cheese.____ 12.17 7.82 57.63 21.09 4.70 14.70 Sweets .87 9.85 .34 .03 .45 4.81 Meat ···············-···-···· 18.99 __.._ ______ ________ Fata 1.28 17.39 .31 .53 .34 7.93 Eggs 5.02 1.86 3.51 4.44 7.21 6.60 --------------------·-­ Fruits and vegetables 4.01 5.44 8.49 7.58 14.91 14.97 Miscellaneous ---------.57 .25 .11 .18 .08 .44 Accessories ----------6.66 ________ _100.00 Total 100.00 100.00 100.00 100.00 100.00 t 5Sherman, Clt.emi8try of Food and Nutrition, Third Edition, p. 555. teTables XIII and XIV in the Appendix give this information ac­cording to income groups. With the exception of the percentage spent for meat, the cost distribution of the Mexican dietaries is not unlike that of the American. In spite of the small amount of milk used, if these two tables are representative, the Mexican actually spends a greater percentage of his food money for milk and cheese than the American. Beans were made a sepa­rate item for the Mexicans because used in such large quan­tities. It is interesting to note that they give the best nutritive return for the money invested in them of all the various classes of food; i.e., the percentage of protein, calories, and minerals is much larger in comparison to the percentage of food money spent than is the case in any other type of food. All kinds of dried beans, frijoles, are used by Mexicans, but their favorite is a small brown, mot­tled bean called the "pinto." In regard to the American dietaries, Sherman states: Such investigations of the data of actual dietary studies, supplemented by laboratory experimentation both upon human and animal subjects, have now made it quite clear that the average or typical American food budget can be easily improved by giving greater prominence to milk, vege­tables, and fruit, the money needed for this being obtained if necessary by reducing the expenditure for meats and sweets.11 Since the Mexican spends a smaller percentage of money for meat, uses larger amounts of beans, which apparently give the best nutritive return of all the foods, and spends a somewhat larger percentage for milk than the American, it would seem that his food selection is better than that of the American. As has been explained, it had been estimated that 40 cents per day per person, using the United States Bureau of Labor figures for reducing families to man units, was the minimum amount on which an adequate diet could be provided at the time this study was made. On this basis, it will be found (Table XII, in the Appendix to Part I, gives the cost per day per person for each family) that, 17Sherman, H. C., Chemistry of Food and Nutrition, Third Edition, p. 558. In the two lower-income groups in San Antonio: 10 per cent spent enough money to secure adequate food. 35 per cent spent at least three-founhs enough to secure adequate food. 30 per cent spent from one-half to three-fourths enough to secure adequate food. 25 per cent spent less than one-half enough to secure adequate food. In the two higher-income groups in San Antonio: 30 per cent spent enough money to secure adequate food. 20 per cent spent at least three-fourths enough to secure adequate food. 30 per cent spent from one-half to three-fourths enough to secure adequate food. 20 per cent spent less than one-half enough to secure ai:lequate food. In the Austin study: 16 per cent spent enough money to secure adequate food. 24 per cent spent at least three-founhs enough to secure adequate food. 40 per cent spent from one-half to three.fourths enough to secure adequate food. 20 per cent spent less than one-half enough to secure adequate food. In the group as a whole: 18 per cent spent enough money to secure adequate food. 26 per cent spent at least three-fourths enough to secure adequate food. 34 per cent Ppent from one·half to three-fourths enough to secure adequate food. 22 per cent spent less than one-half enough to secure adequate food. It is evident that economic conditions are chiefly respon­sible for the lack of proper nutrition among the Mexicans. The fact that 18 per cent of the families spend enough money to obtain adequate food and only 7 per cent (page 18) secure a completely adequate diet indicates poor food selection, but when it is shown that at least 40 per cent of the diets are adequate in everything but calcium (page 37), the indications are reversed. Certainly some improvement of the diet may be made by better selection, but not much can be accomplished until economic conditions permit the spending of more money for food. Looking toward the betterment of the Mexican diet, the following recommendations are made: 1. The wide use of beans, potatoes, tomatoes, and onions is to be highly commended. 2. The use of milled cereals, particularly the substitu­tion of ftour for corn tortillas, is to be discouraged. 3. The use of milk, especially canned or dried, is to be encouraged. Lack of refrigeration and unsanitary condi­tions in the home, as well as a tendency to buy the poorest grade possible, leave one in doubt as to the wisdom of advising the use of fresh milk. 4. A wider use of the cheaper leafy vegetables is strongly advisable. An attempt should be made to intro­duce dishes made from raw cabbage, whkh is very cheap and obtainable throughout the year. 5. Molasses is cheap and, used to replace part of the sugar, would enhance the iron content of the diet. 6. Money spent for coffee should be invested in food. Too large a proportion of the food money is spent for materials, principally coffee and peppers, having no nutri­tive value. 7. The use of less fried and less highly-seasoned food would result in better digestion. RELATION OF DIET TO HEALTH THE Mexican diet has been found to be: ( 1) Low in calories. (2) Somewhat inadequate in protein. (3) Low in minerals, particularly calcium. (4) Low in vitamins, especially A. What disastrous physiological results might be expected to accompany these deficiencies? From the calorie inade­quacy it is reasonable to conclude that the percentage of underweight will be large. An emaciated, cadaverous people might be anticipated. There seem to be no statistics on the amount of underweight among Mexican adults, but various investigations of the weight of school children show their percentage of underweight is about the same as for American children. In a study in Austin which included 309 children of various ages, 35 per cent of the children were underweight.18 In another Texas investigation19 which included approximately 1,400 children from seven to twenty-one years of age 32 per cent of underweight was found. These figures are no higher than those reported for American children. Since calcium inadequacy is so outstanding, it is logical to look for physical results of this deficiency. Present-day literature on the subject, however, does not make very clear what physical effects are to be expected from a low calcium intake, unaccompanied, as in this case it may be presumed to be, by Vitamin D deficiency. Insufficient lime is said to bring about osteoporosis, a disorder of the bone closely allied with, but not marked by the clinical symptoms of, rickets. The extent of osteoporosis can be discovered only by the X-ray. Aub20 has shown that the bone tra­beculae act as a storehouse for calcium and that calcium may be withdrawn from the trabeculae in case of an l&Report of the Austin City Health Officer, Dr. Eugene Chimene. 1930. 1&Report of Dr. H. T. Manuel. Brownsville Schools. 1928. 20Aub, J. C., Harvey Lectures 1928-29, p. 151. increased demand or a period of low intake and replaced, when the demand is decreased or the intake increased, without harm to the bony structure. Mexicans, however, suffer from a constantly low intake. It would seem that Mexican women, particularly, should furnish an example of what happens when the body is insufficiently supplied with calcium, since, in addition to the low intake, they undergo the great drain on calcium resources brought about by many pregnancies and lactation periods. Thus, there is a constant withdrawal of calcium with very little oppor­tunity for replacement. As many as ten children during a period of twelve to fifteen years is not an unusual record for Mexican women. As a rule the tenth child is nursed quite as successfully as the first, but it would be interesting to know something about the calcium content of the milk at this time. As far as can be ascertained without actual statistics, Mexican women, although far from being the toothless hags that might be expected under the circum­stance, do have considerable dental trouble during the time of pregnancy and lactation. Whether this is greater or less than among American women, who have fewer chil­dren and larger calicum intake, it would be impossible to say, as the question is complicated by the fact that Ameri­can women are more apt to have satisfactory dental care, while in the case of Mexican women only serious trouble receives attention. In examining the records for the past four years of three Mexican clinics in San Antonio, nine cases of osteomalacia were found. This is rather surpris­ing in view of the rarity of the disease in this country. Osteomalacia is usually ascribed to a Vitamin D, rather than calcium, deficiency, but the latter may be a contrib­uting factor. On the whole, the amount of physiological disturbance that can be traced to low calcium intake seems to be less than would be expected as a result of the marked deficiency shown by the dietary study. It may be that the amount of calcium necessary for physiological well-being, in the presence of a plentiful supply of Vitamin D, is much lower than the standard in present use. This standard was determined before the interrelationship between calcium metabolism and Vitamin D was discovered. It may be that there are physiological results which this very inadequate study fails to bring out. In any event, the question is inter­esting and important enough to deserve closer study. Cer­tain it is that Mexicans exist on much less calcium than is commonly thought to be necessary for physiological well­being and on less than is supplied by the ordinary American dietary, which itself is more likely to be low in calcium than in any other food factor. The lower resistance of Mexicans, compared to Ameri­cans, to certain diseases is well known. The table below is taken from the data of the State Department of Health and shows the percentage of Mexicans and Americans dying in the State of Texas during 1928 and 1929 from diseases that are more or less definitely connected with diet. TABLE XI PERCENTAGE OF MEXICANS AND AMERICANS DYING IN STATE OF TEXAS FROM DISEASES RELATED TO DIET You 1928 Year 1929 Dt.eaee American1 Mealcan1 Amerlcan1 Medcan1 Digestive eyatem, total 9.50 18..20 9.10 15.20 Liver .93 .70 1.30 .66 Diarrhea (under 2 yn.) _____ 2.80 12.00 2.20 9.90 Di~h~. (over 2 yn.) ______ 1.30 2.30 .99 2.01 Penton1t1s ------------------1.50 .65 1.10 .61 Intestinal obstruction______________ .98 .42 1.08 .49 Appendicitis --------------.97 1.10 Kidney -------------------5.80 2.20 5.50 2.50 Anemias -----------.36 .20 .28 .13 Respiratory system, total_________ 18.40 27.20 18.90 27.60 Pneumonia ---------·------6.70 8.02 7.37 8.10 Diphtheria -----------------------.98 .59 .93 .46 Tuberculosis of lungs____________ 5.70 11.60 5.60 12.40 Rickets ------------------------------.01 .02 .01 .02 Scurvy -----------------------.002 .01 .002 .02 Pellagra -----------------·-1.40 .71 1.20 1.05 Bone disea8e8, total___ __________ .09 .04 .06 .04 It is seen that the percentage of Mexicans dying from digestive disorders is almost twice as great as that of Americans. On analyzing the situation, however, the differ­ence is found to be almost entirely accounted for by the large percentage of children under two years of age dying of diarrhea. It is impossible to say how much of this diarrhea is due to food and how much to infection, but it is probable that the greater amount is due to infection from bad food rather than to the kind or amount of food. The large percentage of deaths from diarrhea is borne out by figures from the San Antonio Health Department which show 16 to 18 per cent of Mexican deaths in that city during the years 1927, 1928, and 1929 due to diarrhea. The table shows also that a much larger percentage of Mexicans than Ameri­cans die from respiratory disorders. This fact is largely accounted for by the greater death rate from tuberculosis that is prevalent among the Mexicans. Every physician who has worked among Mexicans has emphasized their great susceptibility to this disease. The lowered resist­ance to infection is undoubtedly due partly to unsanitary living conditions and crowded quarters, but it may, to almost as great an extent, be due to the low vitamin con­tent of the diet, and particularly to insufficient Vitamin A. The typical food deficiency diseases do not appear to be much, if any, more prevalent among the Mexicans than among Americans. In three San Antonio clinics, where the clientele is largely Mexican, there were recorded in the last four years fourteen cases of rickets, six cases of scurvy, thirty-five of pellagra, and nine of osteomalacia. APPENDIX TO PART I TABLE XII THE COST AND THE PERCENTAGE ADEQUACY OF D1ETS OF S1XTY·FIVE MEXICAN FAMILIES ARRANGED ACCORDING TO INCOME GROUPS AND EXPRESSED ON THE BASIS OF (1) INDIVIDUAL STANDARD AND (2) HAWLEY STANDARD 1. Lowest Income Group-San Antonio Coit Per Day Porcenta1e Adequacy Per Cal· Pro· Cal· Phoa· Per· Family otla toin cium. pboru1 Iron IOD No. 1-(1) 100+ 100+ 93 100+ 100+ .41 -(2) 100+ 100+ 100+ 100+ 88 No. 2-(1) ___ 70 32 87 .24 100+ 81 -(2)____ 56 62 69 44 67 No. 3---(l) 51 70 30 59 78 .19 -(2) 46 49 45 53 50 No. 4-(1) 66 100+ 51 98 100+ .20 -(2) 59 75 59 76 75 ~(l)_____ 51 91 100 .21 -(2) 76 77 67 85 82 No. 77 82 No. 6-(1) 96 100+ 50 100+ 100+ .32 -(2) ____ 95 100+ 65 100+ 100+ No. 7-(1) 55 67 23 60 70 .17 -(2) 54 52 27 47 49 8-(1) _____ .10 No. 49 57 29 48 70 -(2) 43 47 34 40 50 No. 9-(1) 100+ 100+ 56 87 91 .28 -(2)____ 100+ 100+ 64 i.> 75 No.10-(1) ____ 96 100+ 59 96 100+ .32 -(2) ___ 82 100+ 63 79 78 2. Low Income Group-San Antonio 1-(1) 100+ 100+ 86 100+ 100+ .41 No. -(2) ____ 100+ 100+ 100 100+ 100+ No. 2-(1) ____ 69 82 40 67 78 .20 -(2)._____ 65 60 50 66 56 100+ 100+ .37 No. 3---( 1) --------85 100+ 57 -(2) 79 95 76 97 86 4-(1) ____ 70 100 100 .30 No. 100+ 100 -(2)____ 100+ 100+ 79 97 78 ~(l)____ 100 88 100 100 .31 No. 98 -(2) 91 100 96 100 99 TABLE XIl-(Continued) THE CosT AND THE PERCENTAGE ADEQUACY OF DIETS OF S1XTY·FlVE MEXICAN FAMILIES ARRANGED ACCORDING TO INCOME GROUPS AND EXPRESSED ON THE BASIS OF (1) INDIVlDUAL STANDARD AND (2) HAWLEY STANDARD Coot Per Day Pen:enta1e Ad.equacy Per Family No. 6--(1) ____ -(2) _______ Cal· orie1 47 43 Pro· tein 51 43 Cal· cium 21 26 Pho1° phoru1 42 35 Iron 45 34 Per• IOD .12 No. 7-0L.-(2) ______ 100 97 100 97 43 62 87 80 100 98 .28 No. 8-(l) _______ -(2) _____ 71 66 86 70 37 68 64 50 71 52 .16 No. 9-(1) ------­-(2)_________ 100+ 100+ 100+ 100+ 76 93 100+ 95 100+ 87 .25 No. 10-(1) _________ . -(2) ________ 81 83 100 100 67 75 100 90 95 78 .32 3. Medium Income Group-San Antonio No. 1-(1) ______ -(2) _____ 79 75 73 62 31 35 65 52 69 51 .15 No. 2-(1) _____ -(2) ____ 87 88 100 100 39 50 81 75 92 79 .17 No. 3-(l) ______ -(2)________ 100 100 89 81 44 61 62 62 71 59 .20 No. 4---(1) _____ -(2) _________ 100 100 100 100 51 68 100 93 100 95 .40 No. 5-(l) ------­-(2) ______ 100 100 100 100 71 96 100 100 100 100 .36 No. 6--(l) _____ -(2) _____ 100 100 100 100 80 97 100 100 100 100 .39 No. 7-(l) ______ -(2) ______ 100 100 100 100 100 100 100 100 100 100 .39 No. 8-(l) _____ -(2) ______ 56 55 61 50 33 37 63 47 74 53 .16 No. 9-(l) ______ -(2) _________ 75 72 78 67 32 39 70 58 79 55 .19 No.10-(l) ____ -(2) _______ 86 85 100 100 64 70 92 80 95 76 .27 No. 100 100 80 100 93 4. Highest Income Group-San Antonio 1-(l)______ .31 -(2) _______ 98 100+ 85 88 65 2-(l) _________ No. 99 100 71 100 100 .41 -(2) _________ 91 100 89 95 93 TABLE XIl-(Continued) THE CosT AND THE PERCENTAGE ADEQUACY OF DIETS OF SIXTY·FIVE MEXICAN FAMILIES ARJtANGED ACCORDING TO INCOME GROUPS AND EXPRESSED ON THE BASIS OF (1) INDIVIDUAL STANDARD AND (2) HAWLEY STANDARD Coit P.r D1y Percentaae Adequacy Per Cal­ Pro• C.I· Phoo· Pot· F1mil1 No. 3--(l) ____ -(2) ______ orlea 100 100 tein 100 100 cium 100 100 phorue 100 100 Iron 100 100 100 .44 No. 4-(1) ___ -(2)_____ 100 100 79 67 67 79 93 85 90 75 .30 No. 5-(1) ·----­-(2)..______ 100 100 100 100 74 92 100 84 100 81 .32 No. 6-(l)____..__ -(2) _______ 77 76 100 83 57 73 79 70 90 67 .27 No. 7-(1) ··----·-­-(2).._______ 100 100 100 100 76 91 100 87 96 80 .39 No. 8-'1 )______ -(2)_____ 67 67 83 80 45 50 89 80 77 70 .25 No. 9-(l)_______ -(2) .._______ 97 99 100 100 55 65 86 84 100 83 .20 No.l~(l)________ 83 100 80 100 91 .28 -(2)··---·-­ 82 100 88 92 92 5. Mixed Income Group-Austin No. 1-(l)________ -(2)_____ 65 58 77 63 16 23 46 41 6b 47 .11 No. 2-(l)______ -(2)________ 73 66 76 58 35 53 58 51 65 43 .17 No. 3--(1) ____ 76 84 37 53 57 .19 -(2)____ 71 66 50 47 39 No. 4-(l)______ 100 100 25 57 81 .16 -(2) ····------·­ 99 92 35 51 58 No. 5-(1) -·--··---­-(2)...·--·-··-··· 44 44 75 73 38 46 69 63 89 70 .16 No. 6-(1) .... _.___-(2)________ 51 47 77 63 55 60 66 54 64 45 .21 No. 7-(1)_..___ -(2)_________ 66 60 87 68 55 73 70 63 72 50 .21 No. 8-(1) --···----­-(2) _______ 83 81 100+ 84 59 83 74 68 75 55 .21 No. 9-(l) ________ -(2)_____ 87 86 100+ 95 41 58 70 69 85 68 .25 No.1~(1).... -..-----­-(2) __________ 100 100 100 100 45 57 80 69 89 61 .21 The Univer&ity of Texa.s Bulletin TABLE XIl-(Continued) THE Cost AND THE PERCENTAGE ADEQUACY OF DIETS OF S1XTY·FIVE MEXICAN FAMILIES ARRANGED ACCORDING TO INCOME GROUPS AND EXPRESSED ON THE BASIS OF (1) INDIVIDUAL STANDARD AND (2) HAWLEY STANDARD Coit Per Day Percenta1e Adequacy Per Cal- Pro· Cal· Phot· Per• Family orie1 tein cium phorut Iron 100 No. 11-(1) -------------­-(2) -------­--­ 81 76 100 91 64 77 100 87 100 74 .33 No. 12-(1) _______________ -(2) __________________ 81 80 97 97 58 81 70 73 64 55 .30 No. 13-(1) _____________ -(2) ______________ __. 100 100 100 100 70 94 96 78 98 65 .30 No.14-(1) ..........______-(2) __________________ 100 100 100 100 82 100 100 100 100 99+ .52 No. 15-(1) ______________ -(2) ______ _________ 81 79 100 100 59 67 100 88 100 82 .30 No. 16-(1) ___________ -(2) ______ ________ 100 100 100 96 42 60 76 67 82 58 .32 No.17-(1) _____ _____ -(2) _________ 71 70 100+ 84 73 90 91 77 88 66 .28 No.18-(1) _________ -(2) ________ _ ____ 100 100 100 100 80 100 100 100 100 100 .37 No.19-(1) ___________ -(2) __________ 75 75 82 73 56 66 88 76 59 48 .21 No. 20-(1) ________ ______ -(2) ____ ___ ___________ 100 100 100 100 81 100 100 100 100 89 .43 No. 21-(1 >---------·---­-(2) --------------­-- 89 86 100 92 98 100 100 100 91 77 .29 No. 22-(1) ____ ____________ 100 100 53 95 99 .45 -(2)--------------­ 100 100 73 82 67 No. 23-(1).._______ -(2) __________ 88 87 100 100 64 75 80 75 95 80 .45 No. 24-(1) __ __ _______ -(2) ______________ 88 71 100 95 64 71 100 85 100 87 .24 No. 25-(1 >---·------­-(2) --------------­ 100 100 100 100 96 100 100 88 100 82 .50 TABLE XIII DISTaulVTION OF COST AND NVTRIENTS FOR ONE WEES: IN S1XTY·FIVE MEXICAN FAMWES Aeu.NcED AccoRDINC To INCOME GeouPS (1) Laredo Corral--Lowest Income-IO Families Pro-C.I· C.1-Phoo-Food teia oriea ciu.m pborut hon Cott G..,. c,,.,. c...... c...... Meat 5,027 51,050 2.971 59.971 .6319 15.05 Beans 6,965 107,229 49.563 145.849 2.1669 6.80 Cereals____ 9,536 319,729 21.555 126.427 1.1430 19.07 Milk and cheese___ 2,557 49,600 90.138 68.945 .1664 8.76 Sweets 16 86,700 4.26 Fata 8 115,139 4.20 Eggs_______ 592 6,808 3.036 8.280 .1380 2.35 Fruit and vegetables_ 874 31,223 10.050 27.561 .6792 7.76 Acceuories_______ -----------8.20 25,575 767,478 177.313 437.033 4.9254 76.45 (2) Hernandez Corral-Second Income Group-10 Families Pro-C.I· Cal-Phoo· Food teia. oriea cium pboru1 lroa. Cott c.... Gnu. r;,,,,_ Gnu. MeaL------····-·--6,632 55,457 4.470 80.871 .8331 18.36 Beans....----------5,151 79,018 36.658 107.915 l.6037 4.97 Cereals_______ 11,762 386,122 26.277 133.885 1.2476 19.77 Milk and cheese..___ 3,041 60,950 107.745 83.761 .1066 11.32 Sweets..--------····· 81,627 --------3.59 Fata__________ 97 176,834 .795 3.286 .0209 7.42 Eu•---------·----1,396 16,058 7.161 19.530 .3255 5.90 Fruit and vegetables__ 1,074 45,333 17.526 31.476 .6577 12.67 Accessories_____ _ _ ---------5.66 29,153 901,399 200.632 460.724 4.7951 89.66 (3) South Frio Street-Third Income Group-10 Families Pro-C.I· C.I· Pboo· Food teio orie• cium pbonlt Iron Coit c.... c.... c.... c.... 3,923 35,855 2.627 46.801 .4743 11.00 Meat ·····-----·-----··-· Beans.. ___________ __ 6,556 100,487 46.646 137.295 2.0400 6.08 Cereals.....·-·--·----14,824 486,551 33.051 177.184 I.6637 25.18 Milk and cheese_______ 2,960 57,575 103.959 80.010 .1910 10.23 Sweets._ _ ________ ll 119,982 .957 .200 .0331 4.47 Fats ····-----------.·····-61 216,460 .475 l.856 .0096 9.25 Eggs...·--·-········-···--·-·---l,174 13,468 6.006 16.380 .2730 4.43 Fruit and vegetables ·---1,418 56,754 21.814 41.839 .8088 17.13 Accessories _____ __ 6.94 30,927 1,087,132 215.535 501.565 5.4935 94.71 TABLE XIII-(Continued) DISTRIBUTION OF COST AND NUTRIENTS FOR ONE WEEK IN S!XTY·FIVE MEXICAN FAMILIES ARRANGED AccoRDJNG TO INCOME GROUPS (4) South Leona Street-Highest Income Group-10 Families Pro· Cal-Cal· Pbo1· Food tein oriel cium phoru1 Iron Coot Cnu. Cnu. Cm1. Cm1. 8,568 78,648 5.598 102.040 1.1095 25.94 MeaL... ·-···-·-·-············· Beans....-------------··­ 4,555 70,627 34.209 96.445 1.4384 4.41 Cereals ...... --..------15,095 484,297 33.870 181.091 1.6716 25.04 Milk and cheese ..... -------5,283 106,219 188.529 145.352 .3664 19.79 Sweets ... _............______.. 65 112,035 2.871 .600 .0993 4.90 Fats .............. ----------158 202,693 1.398 4.696 .0338 10.95 Eggs ........ --------------------2,105 24,071 11.005 29.922 .4963 8.39 Fruit and vegetables ...... 2,046 86,128 35.888 56.690 1.0587 25.55 Miscellaneous....... _.____ 174 7,070 .773 1.063 .0040 1.65 Accessories ....................... -------------------9.76 38,049 1,171,788 314.141 617,899 6.2780 136.38 (5) Austin Group-Mixed lncomes-25 Families Pro· Cal· Cal­ Pho1­ Food tein orie1 cium phoru1 Iron Coot Cm.s. Gms. Gma. Cnu. Meat___________________________ Beans.___________,,_____________ Cereals___________________ 14,725 10,317 32,028 176,361 157,085 1,043,159 13.211 74.035 71.699 175.676 216.881 342.415 1.9163 3.0162 3.3814 47.53 9.83 48.07 Milk and cheese ............. Sweets..____________ ,,_____ Fats ............ _ .......... ______ ll,074 1,696 2,308 221,299 223,407 390,132 398.458 1.443 2.161 301.140 .292 7.233 .7500 .0196 .0500 46.09 14.27 20.09 Eggs .................................. 5,024 57,794 26.861 69.098 1.1909 22.14 Fruit and vegetables ..... 2,797 125,125 45.630 86,855 1.7416 34.74 Miscellaneous ............. -. Accessories ...................... 1,004 8,612 ---------------­ .947 4.834 ____________ ..__ .0246 1.24 13.07 80,973 2,402,974 634.445 1,204.424 12.0906 257.07 TABLE XIV PERCENTAGE DISTRIBUTION OF COST AND NUTRIENTS FOR ONE WEEK IN FIVE GROUPS OF MEXICAN DIETARIES ARRANGED ACCORDING TO INCOME GROUPS (1) Laredo Corral-Lowest Income Group-10 Families Pro· Cal· Cal­ Pbo1• Food tein oriee r:ium phoru1 Iron Coot MeaL-----··---------­ 19.70 6.66 1.68 13.70 12.80 19.66 Beans..Cereals_________________ Milk and cheese_____________ Sweets.____________ 27.21 37.25 10.01 .06 13.90 41.60 6.46 11.30 27.95 12.15 50.81 33.34 28.95 15.77 44.00 23.21 3.38 8.90 24.96 11.48 5.58 Fats .03 15.10 5.48 Eggs.·-----·------------­Fruit and vegetables_____ 2.31 3.42 .91 4.07 1.72 5.69 1.89 6.35 2.80 13.81 3.06 10.16 Accessories .... ·-------------· 10.72 Total..________ 100.00 100.00 100.00 100.00 100.00 100.00 (2) Hernandez Corral-Second Income Group-10 Families Pro· Cal· Cal-Pho1­Food tein orie1 cium phlln&I Iron Coit 22.59 6.15 2.24 17.55 17.35 20.45 Meat---·-----------------­ 17.73 8.77 18.29 23.42 33.50 5.54 Beans ----·--·-·-----·-----------­Cereals······--·---···---··-----------­ 40.42 42.80 13.10 29.05 25.95 22.03 Milk and cheese. ----·-·-------I'0.45 6.76 53.63 18.18 2.21 12.65 Sweets·----·----·-··--·------------­ 9.07 4.01 Fats--------------·----·------------­ .33 19.62 .40 .71 .44 8.29 Eggs ...... ----·-------------------------------4.79 J.78 3.58 4.25 6.80 6.58 Fruit and vegetables --------------3.69 5.04 8.76 6.84 13.75 14.13 Accessories. _______________ 6.32 Total...________________________ 100.00 100.00 100.00 100.00 100.00 100.00 (3) South Frio Street-Third Income Group-JO FamilieJ Pro. C•l· c.1. PhM· Food teia orie• clum pborut Iron Co•t 12.69 3.32 1.22 9.30 8.62 11.62 Beans---------------------·----------­ Meat ........... ---------------------------·­ 21.11 9.25 21.66 27.40 37.22 6.42 Cereals ---------------------------­ 48.02 14.71 15.35 35.30 30.39 26.60 Milk and cheese______________ 9.55 5.29 48.20 16.00 3.48 10.80 Sweets_______________________________ .04 11.04 .44 .04 .60 4.71 Fats.. ---------·------------------­ .20 19.93 .22 .37 .02 9.76 Eggs__________________ ________________ 3.81 1.24 2.76 3.27 4.97 4.67 Fruit and vegetables----------------4.59 5.23 10.15 8.32 14.70 18.10 Accessories____________________ 7.32 Total..__________________ 100.00 100.00 100.00 100.00 100.00 100.00 TABLE XIV-(Continued) PERCENTAGE D1sTRmUT10N OF CosT AND NUTRIENTS FOR ONE WEEK IN FIVE GROUPS OF MEXICAN DIETARIES ARRANGED ACCORDINC TO INCOME GROUPS (4) South Leona Street-Highest lncom~ Group-10 Families Pro. c..1. Cal-Pho1· Iron Food tein oriee cium phoru• Cott Meat_··-········---------------22.53 .6.71 1.78 16.53 17.68 19.02 Beans........-------------------· 11.99 6.03 10.90 15.60 22.93 3.23 Cereals......---------------------39.65 41.35 10.78 29.29 26.62 18.36 Milk and cheese___ _ _ _ ____ 13.90 9.06 60.00 23.52 5.84 14.51 Sweets·-------------------··· .17 9.56 .91 .10 1.58 3.59 Fats·------·--·--·---------------.38 17.29 .45 .76 .54 8.03 Eggs.......·--·-··--······-·------------··· 5.54 2.05 3.50 4.84 7.91 6.15 Fruit and vegetables._____________ 5.38 7.35 11.42 9.18 16.84 18.75 Miscellaneous·--··------·---····· .46 .60 .25 .17 .06 1.20 Accessories_____ _ _ __ _ ____ 7.13 Total.._____________ _ ______ 100.00 100.00 100.00 100.00 100.00 100.00 (5) Austin Group-Mixed lncomes-25 Families Pro· Cal-Cal· Phoa• Food tein ories cium phoru1 Iron Cott Meat________ ____ 18.18 7.31 2.08 14.58 15.85 18.49 Beans_____________________ 12.74 6.59 11.66 18.01 24.94 3.82 Cereals______ _ ________ 39.55 43.23 11.30 28.42 27.96 18.67 Milk and cheese_________ _ 13.67 9.17 62.80 25.02 6.18 17.94 Sweets_______________ 2.09 9.69 .22 .15 5.55 Fats_____ _____ _____ 2.85 16.16 .15 .20 7.81 Eggs_ _______________________ 6.24 2.39 4.23 5.73 9.85 8.61 Fruit and vegetables_______ 3.45 7.19 14.40 5.18 7.21 13.52 Miscellaneous___ ________ 1.24 .31 .49 Accessories_______________ 5.09 Total..________________ 100.00 100.00 100.00 100.00 100.00 100.00 TABLE XV DISTRIBUTION OF COST AND NUTRIENTS FOR ONE WEEK IN FORTY MEXICAN DIETARIES-MIXED INCOMES-SAN ANTONIO (Totals for Groups 1-4 in Table XIII) Pro· Cal-Cal· Phoa•Food tein orie1 clum phoru1 Iron Cott Gnu. Gnu. G11u. Gm.s. Meat_ _____________ 24,150 221,010 15.666 289.683 3.0488 70.35 Beans________ ___ 23,227 357,361 167.076 487.504 7.2490 22.26 Cereals.......________ 51,217 1,676,699 114.753 618.587 5.7259 89.06 Milk and cheese__ _ 13,841 274,344 490.371 378.068 .8304 50.10 Sweets__________ 92 400,314 3.828 .800 .1324 17.22 Fats__ _ _________ _ 324 711,126 2.668 9.838 .0643 31.82 Eggs____ ___________ 5,267 60,405 27.208 74.112 1.2328 21.07 Fruit and vegetables 5,412 219,438 85.278 157.566 3.2044 63.11Miscellaneous________ 174 7,070 .773 1.063 .0040 1.65 Accessories__ __ ________ ------------------ - -30.56 Total..._______ 123,704 3,927,797 907.621 2,017.221 21.4920 397.20 TABLE XVI PEBCENTACE D1sTJUBUTION OF CosT AND NUTRIENTS FOR ONE WEEK IN FORTY MEXICAN DrETARIES-MIXED INCOMES-SAN ANTONIO (Totals for Groups 1-4 in Table XIV) Pro· Cal-Cal-Pbot· r-i tein orie1 cium phorut Iron Coot c..... c..... c...... Gms. 19.51 5.62 1.73 14.36 14.20 17.68 Bean•--------·-18.80 9.12 18.41 24.16 33.68 5.60 Cereal•---------·---41.39 42.70 12.64 30.70 26.63 22.42 Meat ... ----····--··---··········­ Milk and cheese_____________ 11.20 6.98 54.08 18.75 3.86 12.61 Sweet•---------·-.07 10.18 .42 .04 .62 4.33 Fata_______________ .26 18.10 .29 .49 .30 8.01 Egg•.--··----······---····--4.26 1.53 3.00 3.67 5.74 5.30 Fruit and vegetables.·-····---·· 4.38 5.58 9.40 7.79 14.90 15.89 Miacellaneoua__________ .14 .18 .01 .05 .02 .41 Acceaaories_______ 7.75 100.00 100.00 100.00 100.00 100.00 100.00 Total·····---··-····--··--··--­TABLE XVII DISTRIBUTION OF COST AND NUTRIENTS FOR ONE WEEK IN SIXTY·FIVE MEXICAN DIETARIES (Total from Table XIII) Food Pro­teiD Cal· oriet Cal­cium Ph°"­pboru1 Iron Coat c... Cm1. c..... c..... Meat___________ 38,875 397,371 28.877 465.359 4.9651 117.88 Beans ···--·-·----­Cereals ... ----·-······· Milk and cheese_____Sweets ____________ 33,544 83,245 24,915 1,788 514,446 2,719,858 495,643 623,751 241.111 186.452 888.829 5.271 704.385 961.002 679.208 1.092 10.2652 9.1073 1.5804 .1520 32.09 137.13 96.19 31.49 Fat•----------·-······ Ew-----···-------···· Fruit and vegetables Miscellaneous ........... 2,632 10,291 8,209 1,178 1,101,258 118,199 344,563 15,682 4.829 54.069 130.908 1.720 17.071 143.210 244.421 5.897 .1143 2.4237 4.9460 .0286 51.91 43.21 97.85 2.89 Acceaaories ............... ··--········ ···­ ................ -----------·--­ 43.63 -----­ Total._______________ 204,677 6,330,771 1,542.066 3,221.645 33.5826 654.27 TABLE XVIII PERCENTAGE DISTRIBUTION OF COST AND NUTRIENTS FOR ONE WEEK IN S1XTY•FIVE MEXICAN DIETARIES Pro- Cal· Cal· Pho1· Food tein orie1 cium phoru1 Iron Coit Gm.1 . Gm.1. c...... Grr.;. MeaL..___ 18.99 6.27 1.87 14.44 14.79 18.01 Beans...·-------·----· Cereals__________________ 16.38 40.67 8.12 42.96 15.63 12.09 21.89 29.85 30.51 27.11 4.90 20.95 Milk and cheese________ . Sweets_____________ 12.17 .87 7.82 9.85 57.63 .34 21.09 .03 4.70 .4.'i 14.70 4.81 Fats..·-··----~---·----·· 1.28 17.39 .31 .53 .34 7.93 Eggs..·-···--··········--···--·--·····-·· Fruit and vegetables ····--·····-· Miscellaneous...._____________ 5.02 4.01 .57 1.86 5.44 .25 3.51 8.49 .11 4.44 7.58 .18 7.21 14.91 .08 6.60 14.97 .44 Accessories·-----·----·--­ Total.._________________________ 100.00 100.00 100.00 100.00 100.00 100.00 PART II THE MEXICAN INFANT AND PRE-SCHOOL CHILD PLAN OF INVESTIGATION J: WAS originally planned to devote the second part of this study to the diet of the Mexican child. Upon finding that an elaborate comparative study of the diet and physi­cal status of American, Mexican, and Negro school children of Texas was already under way,t it was decided to limit this investigation to the Mexican infant and pre-school child. Extent of study.-Data on the feeding of infants and children up to two years of age were obtained from seventy­six mothers, fifty in San Antonio and twenty-six in Austin. This material concerned 266 children, an average of 3.5 children per family, and included, as well as actual feeding regimes, information on the prenatal care of the mother, her care during confinement, and the general health of the children. In order to obtain accurate information on the food intake of the pre-school child, actual dietaries were kept for seventy-five children from two to five years of age. Each dietary covered a period of one week. Method of obtaining data.-The material on the feeding of infants, together with the related data referred to above, was obtained by visits to the families and interviews with the mothers. A copy of the blank used for recording the information will be found in the Appendix to Part II. In Austin the investigator, Helene P. Smith, accompanied the city health nurse on her visits and obtained the informa­tion, while in San Antonio the mothers were interviewed by a teacher in the Mexican schools, Aurora Gonzales, who was thoroughly familiar with Mexican habits and well acquainted with the objects and methods of the investiga­tion. These same investigators collected the dietary records for the older children. Considerable difficulty was experienced in securing accu­rate dietary records for the two to five-year-old children. tThis study is under the supervision of Jessie Whitacre of the Agricultural and Mechanical College of Texas. In order to get a sample of a normal Mexican child's food intake under average home conditions, it is obviously neces­sary to obtain the assistance of the mothers. It required a great deal of explanation and persuasion to get these mothers to help in keeping the food-intake records, and constant supervision was necessary. The family was visited every day to see that the record had been kept, and ques­tions were asked to make sure that nothing had been omitted. It was also difficult to get an accurate idea of the amount of food eaten by the child. A sample of the form on which dietary records were kept is included in the Appendix. The mothers were instructed: 1. To record exactly what the child ate, and not what he was served. 2. To record carefully the amount eaten in cups, spoon­fuls, etc. 3. To indicate size of portion, if food could not be meas­ured. 4. To note method of preparation of food. 5. To record accurately sugar and cream used on cereals, butter on bread, etc. 6. To make the record immediately after the meal. By various means the cooperation of mothers was obtained, and, with the careful supervision exercised, it is believed the records are as accurate as it is possible to get. Calculation of data.-For dietary calculations, Rose, Laboratory Handbook for Dietetics, Third Edition, and Tables on Nutritive Values of FoO'd, compiled by nutrition classes under the direction of the author at The Univer­sity of Texas were used. RESULTS OF STUDY OF PRENATAL CARE AND EARLY FEEDING SINCE the diet and health of the mother before the birth of the child are important factors in the child's nutri­tion, an inquiry was made into the diet and health of Mexi­can women during pregnancy. It was found that Mexican mothers never follow any particular dietary regime before childbirth. When it is remembered that much stress is laid on the importance of a plentiful supply of minerals and vitamins for the expectant mother and that the diet of Mexicans is deficient in these factors, and particularly deficient in calcium, the mineral whose importance at this time has been most emphasized, it would seem that Mexi­can diets are not well adapted to the production and rearing of healthy children. In only 2.4 per cent of 266 pregnancies is the health of the mother reported bad, while in 84.5 per cent it is said to be good and in 13.1 per cent fair. Ignorant midwives are commonly employed by Mexican mothers at the time of childbirth, but there is a growing tendency to employ a physician. In 60 per cent of 266 births midwives were in attendance; in 35.7 per cent physi­cians were employed ; and in 4.2 per cent neighbors or rela­tives were depended upon. In spite of lack of care and sanitation at the time of childbirth, there seems to be no great loss of life either of mother or child, though there is considerable suffering from infections. There were seven cases of premature births, one case in which instruments were necessary, and no stillbirths reported in the survey. On the whole, the mothers are apparently very sturdy, and it is not uncommon for tl:lem to be up and back at part of their daily work in three days after childbirth. It is interesting that in spite of a low mineral, low vita­min diet, Mexican women are usually able to nurse their many children successfully. They probably wean them at a later age than is common with American women, as is shown by the following table: AGE OF WEANING Cases 6 months -----------------------------------------------------10 9 months ------------------------------------41 12 months --------------------------------------------------51 15 months -----------------------------------------------------------------54 18 months -----------------------------------------------37 21 months -----------------------------------------18 2 years -------------------------------·-------------------------------------------23 2~years ---------------------------------------------------19 3 years ---------------------------------------------1 3-4 years -------------------------------------------------------------------------------12 Eighty-five per cent of the children were entirely breast­fed, while 7.2 per cent were partly, and 7.5 per cent entirely bottle-fed. The common practice is to breast-feed the child as long as he will take it and the supply holds out. A few mothers, 18 per cent, follow some sort of feeding schedule, but most of them, 82 per cent, feed the child whenever he is hungry or whenever he cries. When bottle­feeding is necessary, sweetened condensed milk, usually diluted with water and often not even warmed, is almost invariably used. Solid food is generally a part of the diet at about six months of age, and at twelve months the children are eating everything the family eats. Cereals are rather widely used for younger children, but the use of green vegetables is decidedly limited. Vegetables, to Mexicans, mean beans and fried potatoes. A popular food combina­tion consists of frijoles, fried potatoes, tortillas, and coffee. The practice of giving coffee, more or less diluted with milk, to infants and children is very common. Cod-liver oil therapy is unknown except in a few cases where physicians have given samples to mothers. About 19 per cent of the mothers give orange juice to infants, but with no regularity. Tomato juice is not used as such, but, since canned tomatoes are in general use, the older children must get a certain amount. On the whole, the feeding regime of infants and young children falls far short of the ideal advocated by modern pediatricians. STUDY OF PRE-SCHOOL CHILD Standards used in calculating nutritive requirements of pre-school children.-Not a great deal of material on the nutritive requirements of children is available. A survey of the literature on food requirements of the pre-school child has recently been made by Eppright2 and by Sweeny.8 Since some discrepancy exists between the standards set up by various investigators, particularly in regard to calo­ries and protein, the two most widely used have been selected for use in this study. These are, for calories, those of Gillett and Holt and are as follows: TABLE I CALORIE REQUIREMENT OF PRE·SCHOOL CHILDREN According to Gillett' A ccordinlJ to HoltG Per Pound Per Kllorrem Ace Cirlo Boye Cirl1 Boye Cirl1 Boye 2-3 yrs. ---------980-1,280 1,000-1,300 43 42 94 93 3-4 yrs. ____________l,060-1,360 1,100-1,400 40 40 87 80 4-5 yrs. ________.l,140-1,440 1,200-1,500 37 38 82 84 For protein requirement, the standards most widely used are based on the body weight or on the calorie require­ment. Accordingly, the following have been selected: Standard A-Two to three grams per kilogram of body weight, based on normal weight. Standard B-Ten to 15 per cent of the calorie require­ment, based on requirement for normal weight. The mineral standards are the same as those used in Part I of this study : Calcium-One gram per day. Phosphorus-One gram per day. Iron-Five ten-thousandths of a gram per 100 calories of standard calorie requirement. 2Eppright, E. S., A Dutary Stud11 of White and Negro Pre-School Cmldren. Thesis. The University of Texa1. 1930. &Merrill-Palmer Standards of Ph11sical and Mental Growth, p. 5. •Gillett, Lucy H., Food Allowancea for Health11 Children, p. 8. Bulletin of Association for Improving the Condition of the Poor. GHolt, L. E., Food, Health, and Growth, p. 84, The Macmillan Co. 1922. Calorie, protein, and mineral adequacy.-In order to get figures that may be used for comparison with the above standards, it is first necessary to estimate the daily calorie, protein, and mineral intake for each child and to obtain the average for the week. Table XIV, in the Appendix to Part II, gives the average intake in each of the above fac­tors arranged according to age and sex of the seventy-five children studied. Table II, following below, is a summary of Table XIV, and gives the averages for the different age and sex groups. TABLE II AVERAGE DAILY INTAKE OF CALORIES, PROTEIN, CALCIUM, PHOSPHORUS, AND IRON FOR MEXICAN PRE-SCHOOL CHILDREN Pro· Cal· Pho1­Cal· tein cium phoru1 Iron orie1 gram& 1ramJ iramJ gram.t 2-3 years: 'Boys 34.57 .6224 .9489 .00512 ·················-···············l,041 Girls 867 31.51 .5199 .9913 .00480 --------------------·· ------­ 3-4 years: Boys 34.91 .6103 .8407 .00615 --············-··--············1,071 Girls ..................................1,042 36.44 .5280 .9531 .00489 4-5 years: Boys ..................................1,051! 37.30 .4868 .8509 .00538 Girls ----------------------------------772 .5095 .7560 .00434 32.02 For comparison with the Gillett calorie standards the average calorie intake of each child is taken as "within range," "above range," or "below range," "above range" meaning above the highest figure of Gillett, and "below range," below the lowest figure. For comparison with the Holt calorie standard the average calorie intake of each child per unit of body weight is obtained and the per­centage variation from the Holt standard estimated. Pro­tein intakes have been estimated both on the basis of body weight and of percentage of calorie intake. Table XV, in the Appendix to Part II, gives the variations from the two calorie and protein standards and from the mineral stand­ards for each of the seventy-five children studied. In order to compare roughly the results of the two calorie standards, "within range" of the Gillett standard and +10 to -10 per cent from the average of the Holt figures may be considered equivalent, while more than 10 per cent below or above the Holt standard may be taken as equivalent to "below range" or "above range" on the Gillett standard. Table III, below, is arranged on this basis. Although there is considerable variation within the different groups when compared according to the two standards, the percentage of adequacy and inadequacy is the same for the group as a whole. TABLE III CALORIES-FREQUENCY OF PERCENTAGE DEVIATION FROM STANDARDS (Given in Percentages) Holt and Fales Standard Gillett Standard -10 Per Cent Below to Above -10 + 10 +10 Per Per Per Below Within Above Cueo Cent Cent Cent Ran1e Rance Ran1e 2-3 years: Boys .................... 15 39.6 33.7 26.4 46.0 33.7 19.8 Girls .................... 5 80.0 0.0 20.0 80.0 0.0 20.0 3-4 years: Boys 5 60.0 40.0 0.0 60.0 20.0 20.0 -·················· Girls 41.6 41.6 16.6 50.0 33.2 16.6 ······-··········12 4-5 years: Boys. ··············-····19 78.6 16.0 5.0 73.6 21.0 5.3 Girls .................... 19 89.6 10.4 0.0 84.0 16.0 0.0 Total .............. 75 66.6 22.6 10.6 66.6 22.6 10.6 Concerning the adequacy in calories of the diet of Mexi­can pre-school children it may be said that two-thirds of the group have calorie intakes definitely below the require­ment, that a larger percentage of boys than girls have inadequate intakes, and that a much higher percentage of the four-year-old group than of the other groups are below the standard. By consulting Table XV, it will be seen that for the individual child adequacy according to one standard does not always mean adequacy according to the other. In considering adequacy in protein according to Stand­ard A, diets are considered adequate that provide two to three grams per kilogram of body weight. Using Standard B, diets are taken to be adequate if the protein provides 10 to 15 per cent of the calorie requirement. Table IV gives the percentage deviation from the two standards. TABLE IV PROTEIN-FREQUENCY OF PERCENTAGE DEVIATION FROM STANDARDS (Given in Percentages) Standard A Standard B Below Within AboYe Within 10 1~15 15 Below 2-3 Above Per Per Per Cun 2 cm•· ID'•· 31m1. Cent Cent Cent 2-3 years: Boys __________15 0.0 60.0 40.0 20.0 60.0 20.0 Girls -----------5 0.0 80.0 20.0 40.0 40.0 20.0 3-4 years: Boys -------5 40.0 40.0 20.0 40.0 60.0 0.0 Girls _______12 8.3 58.3 33.3 25.0 50.0 25.0 4-5 years : Boys ____________19 20.8 68.0 lQ.4 32.2 62.5 5.2 Girls _________________19 37.0 63.0 0.0 37.0 63.0 0.0 Total ______75 18.6 62.6 18.6 30.6 58.6 10.6 Thus it will be seen that with the exception of three to four-year-old boys, a group very inadequately represented, the percentage below Standard A is not large, excepting the four to five-year-old group. Moreover, the percentage under standard for the group as a whole is only 18.6 per cent as compared with 66.6 per cent for calories. It is ap­parent that Standard B is higher than Standard A. Mineral intakes are compared directly with the mineral standards. The following table gives the frequency of per­centage deviation from standards for calcium, phosphorus, and iron. TABLE V MINERALS-FREQUENCY OF PERCENTAGE DEVIATION FROM STANDARDS (Given in Percentages) Below 100 90-100 80-90 70-30 60-70 5~ 50 Per !'er r.r Per Per Per Per Cent Cent Cent Cent Cent Cent Cent No. Ade-Ade· Ade-Ade-Ade-Ade· Ade· c.-qa•te quite qaate qaate quate quate quate Calcium 2-3 years: _ ___15 Boys 6.6 0.0 13.3 13.3 26.6 13.3 26.6 Girls -----5 0.0 0.0 o.o 0.0 20.0 40.0 40.0 TABLE V-(Continued) MJN~FUQUENCY OF PERCENTAGE DEVIATION FROM STANDARDS (Given in Percentages) Below 100 9(1-100 80-90 7IHIO 60-70 50-60 so Per Per Per Per Per Per Per c..t Cent Cent Cent Cent Cent Cent No. Ade· Ade-Ade-Ade-Ade-Ade• Ade· ea-qute quate quite quate quate quate quate 3-4 years: Boys ----5 0.0 0.0 20.0 20.0 20.0 0.0 40.0 Girls __12 8.3 0.0 8.3 0.0 8.3 8.3 66.6 ~years: ___19 Boys 0.0 0.0 0.0 16.0 16.0 16.0 52.0 Girls _____19 5.3 0.0 10.6 5.3 10.6 16.0 52.0 Total ____75 4.0 0.0 8.0 9.3 16.0 14.6 48.0 Phosphoru.$ 2-3 years: ____15 Boys 20.0 13.3 26.6 20.0 13.3 0.0 6.6 Girls ---5 20.0 20.0 0.0 20.0 20.0 20.0 0.0 3-4 years: Boys 20.0 20.0 0.0 40.0 20.0 0.0 0.0 --·--·--5 Girls __12 33.3 0.0 25.0 16.6 16.6 8.3 0.0 ~years: ______19 Boys 32.0 16.0 16.0 5.0 26.0 0.0 5.0 Girls ________ 19 10.5 16.0 21.0 10.5 16.0 10.5 16.0 Total __75 22.7 13.3 18.7 16.0 16.7 5.3 6.7 Iron 2-3 years: ______15 Boys 33.3 13.3 26.6 6.6 13.3 6.6 0.0 Girls _____ 5 20.0 0.0 20.0 0.0 40.0 20.0 0.0 3-4 years: Boys 40.0 20.0 20.0 0.0 0.0 20.0 0.0 ··-·--5 Girls ___12 25.0 16.6 8.3 16.6 16.6 16.6 0.0 ~years: ___19 Boys 21.0 10.5 10.5 15.7 26.3 10.5 5.4 Girls _____19 0.0 15.7 10.0 21.0 15.7 15.7 21.0 Total _____75 20.0 13.3 14.6 13.3 18.6 13.3 6.7 Again, as in the study of the Mexican families, the cal­cium deficiency is outstanding. Only 4 per cent of the diets provide an adequate amount of calcium, while 48 per cent are more than 50 per cent deficient. As is the case with calories, the diets of the older group are more deficient in calcium than those of the younger, only about one-fourth of the two-year-old group being more than 50 per cent deficient, while more than one-half of the diets of the four-year-old group show this amount of inadequacy. Roughly speaking, it may be said that about one-fourth of the two-year-old group and approximately one-half of the three and four-year-old group are receiving diets which supply less than half the calcium requirement. The phos­phorus deficiency is much less drastic than that of calcium, since more than one-third6 of the diets are adequate in this factor and only 6.7 per cent as much as 50 per cent inde­quate. Moreover, the tendency toward marked deficiency in the diets of the older children is not so obvious. The deficiencies in iron closely parallel those of phosphorus. Again, one-third of the diets are adequate, and approxi­mately the same small percentage more than 50 per cent inadequate, but the in-between figures indicate that the iron deficiency is somewhat more marked than that of phosphorus. On the whole, the mineral deficiencies are outstanding, at least two-thirds of the diets being from 10 to 50 per cent deficient in all three minerals. The calcium inadequacy is by far the greatest, since almost two-thirds of the diets are 40 per cent or more below the standard requirement for this element. In order to compare the adequacy of the diets of the Mexican pre-school children with the adequacy of the diets of Mexican families as a whole, as discussed in Part I, Table VI has been arranged. In this table the Holt stand­ard has been used for calories, and two to three grams per kilogram of body weight for protein. It is probably fairer to compare these results with Standard I than Standard II, as used for families, since mineral standards are on the same basis. •Less than 10 per cent inadequacy is ignored, as explained in Part I. TABLE VI Comparison of Adequacy of Diets of Mexican Families and of Mexican Pre-School Children Leu Than 9!;-100 Por Cent 7:;..95 Por Cont 5 .... 75 Por Cont SO Per Ct.nt Adequate Adequate Adequate Adequate Por Por Por Por Por Por Por Per Cent Cent Cent Cent Cent Cent Cent Cent of of of of of of of of Fami· Chil-Fami.. Chil-Fami.. Chi!-Fami· Chi!­litt dren Hu dren lice dren }i('I dren Calories 24 29 32 22 37 3 7 Protein ·········-----····-··-··--71 84 22 9 7 5 0 2 Calcium 6 4 17 11 43 37 34 ·-····-····-···-················46 --·---·---------·--------48 ··········--············46 Phosphorus 24 24 44 26 25 4 7 Iron -------------------------49 27 30 30 20 36 l 7 From this table it is evident that the same kind of defi­ciencies are characteristic of the diet of the pre-school child as of the family as a whole. Mineral deficiencies are greater in the child's diet than the family diet, and calorie deficiency is much more marked. Only the protein needs seem to be somewhat better supplied in the case of the children. For purposes of comparison it may be said that: 46 per cent of the family diets provide adequate calories. 24 per cent of the children's diets provide adequate calories. 71 per cent of the family diets provide adequate protein. 84 per cent of the children's diets provide adequate protein. 6 per cent of the family diets provide adequate calcium. 3 per cent of the children's diets provide adequate calcium. 46 per cent of the family diets provide adequate phosphorus. 24 per cent of the children's diets provide adequate phosphorus. 49 per cent of the family diets provide adequate iron. 27 per cent of the children's diets provide adequate iron. Apparently the younger Mexican children are not even as adequately fed as the study of family dietaries would lead one to expect. They are evidently not receiving their share of the nutrients available. Considering the children's diets in relation to the number of deficiencies which they show, it was found that: 4 per cent of the diets are adequate in all five factors. I 7 pt'r cent of the diets are inadequate in only one factor. I I per cent of the iliets are inadequate in two factors. 20 per cent of the diets are inadequate in three factors. 32 per cent of the diets are inadequate in four factors. I6 per cent of the diets are inadequate in all five factors. Average number of factors inadequate: 3,4. A similar table for families as a whole shows, according to Standard (1) :r 7 per cent of the diets adequate in all five factors. 27 per cent of the diets inadequatein only one factor. 15 per cent of the diets inadequate in two factors. 10 per cent of the diets inadequate in three factors. 32 per cent of the diets inadequate in four factors. 26 per cent of the diets inadequate in five factors. Average number of factors inadequate: 2.8. This comparison again brings out the greater inadequacy of the children's diets. It is probable that the calorie defi­ciency accounts for the iron, phosphorus, and protein defi­ciencies, and that, had the calorie requirement been met, the only outstanding deficiency would have been that of calcium. Vitamin content of diets.-Since vitamin adequacy can best be judged on the basis of the kind and amount of food in the diets, a table showing the number of times different types of food appeared on the dietaries was compiled. Sev­enty-five dietaries for a period of one week each represent a total of 1,575 meals. The table below shows the number of times each food was served during the period of a week, or in the 1,575 meals: TABLE VII NUMBER OF MEALS IN WHICH CERTAIN TYPES OF Fooo OCCURRED Milk --------------------------------·-----------------------------------------888 Beans (dried) -------------------------------------------------------432 Cereals --------------------------------------------------------430 Rice ------------------------------------------------------------------­Oatmeal ---------------------------------------·----------------------------------------­ Macaroni, spaghetti, vermicelli_______________________________________ Post Toasties----------------------------------------------------------------------­ Cream of Wheat.--------------------------------------------------------------­ Corn Flakes------------------------------------------------------------­ Pufled Rice·------------------------------------------------------------------­ Breads -------------------------------------------------------------------------1,332 White flour products (bread and tortillas)-----------------------------764 Corn tortillas----------------------------------------------- -396 Corn bread-­ -------­-----------------------------------­------­----­ 15 Sweet bread, rolls, etc·­-----------------------­--­-------­--------­ 74 Brown bread------­-----------------­----­-------­-------­ 1 1 Part I of this etudy. TABLE Vll-(Continued) NUMBER OF MEALS nr WmCH CaTAIN TYPES or Fooo OccURRED Rye bread__________________________ 2 Whole wheat bread______________________________ 1 Griddle cakes______________________________________ 2 Biscuit ----------------------------------------------36 Soda cracken, Saltines-----------------------------------41 Meats --------------------------------------------------258 Beef (steak. hamburger, ground loaf, hash, balls, chili) ________ Pork (roast, chops>------------------------------------------------­Sausage -------------------------------------------­ Bacon ----------------------­ Ham -------------------------------------------------­ Mutton ------------------------------­ Veal -------------------------------------------------­ Fish -----------------------------------------------­Liver ----· -----­Potatoes (sweet and hish>---------------------------214 Eggs----------------------143 Butter ---------------------------211 Pastries and sweets __________________________________ _ 139 Cookies --------------------------------------­ Sil Candy ------------------------------------------­58 Cake --------------------------------------­ 15 Pie (apple, lemon>---------------------------------8 Mexican foods·---------------------------------------------23 Enchilada ---------------------------------------------­Tamales ----------------------------------------------------­Chili ---------------------------------------------------------------­ Fruits --------------------------------------------------­ 337 Fresh­ ~:!~~-;-a-;g;-juice_-=:=::::=::::::::=::=::::=::=======::==::::=:::: Bananas ------------------------------------------------------­Grapefruit ----------------------------------------------------­ Dried-­Prunes ------­ Canned- Peaches ------------------------------------------------------------------------------­Pineapple --------------------------------------------------------------------­Pears ------------------------------------------------·-----------------------­ Vegetables ------···--·-·---·-------------------·-------·----------------------186 Fresh- Cabbage ------------------------------------·------------···-----------------­ Spinach -----------------------------·--------------------------­ Tomatoes ----·---··---------·-·-----·------·----------------------------­Mustard and turnip greens ·-·-------···-··--------·----------------------­Water cress ----------------------·---------------------------­ Lettuce --------------------·----------·--------------------­ Carrots -----------------------------------·---------­ Beets ----------------------­Beans ------------­Onions --------------------------·-------­ TABLE Vll-(Continued) NUMBER OF MEALS IN WHICH CERTAIN TYPES OF FOOD OCCURRED Canned- Corn ------------------------------------------------------------------------------------------------­Peas ----------------------------------------·-------------------------------------------------------­Tomatoes ----------------------------------------------------------------------------------­ Other foods seldom used- Cottage cheese...--------------------------------------------------------------------------------­Peanut butter __ ---·--------------------·------·---------------------------------------------------­Doughnuts -------···--· ··-·----·----------·--------------------·------------------------------------­Molasses -·----···-·--------·--· ---··--·--·----------------·------------------------------------------­Nuts --------------·---·····------------·--·------·---------------------------------------------------------­Popcorn ---------·---· ·---·-------···· --··------·------------------------------------------------------­Jelly ----------------··-·--·-··---------------------------------------------------------------------­ Although milk is included in considerably more than half of the meals served, the average amounts used (shown in the table below) are not large. TABLE VIII AVERAGE DAILY MILK INTAKE OF MEXICAN PRE-SCHOOL CHILDREN Age Amount in Cups Two to three years-Boys ------------------·-------------------------------------------------1.66 Girls ---------------------------------------------------------------------1.38 Three to four years- Boys -------------·-------------------------------------------------------1.72 Girls ------------------------------------------------------------------------1.25 Four to five years-Boys ----·---··----·---------------------·-------------------------------------1.11 Girls --····-··-··--·---------------·---··-----·---------·----------·---------·-1.55 Average ------·-·--·----·--·---------·----·-------------------------·---1.44 Practically no milk is used in cooking. It is served plain, on cereals, and in cocoa, chocolate, and coffee. All but two of the seventy-five children had milk in some form during the seven-day period. Eleven in each city drank plain milk, five in San Antonio had milk only in coffee, and forty-eight children in the two cities drank it both plain and in coffee. Milk intake figures show that only one child took the standard one quart a day, 29 per cent of the chil­dren had as much as a pint a day, 34 per cent had a cup a day, 30 per cent had less than a cup, and 2.6 per cent had none. The few children who get fresh fruit are given it con­ sistently. Orange juice occurs in only three dietaries. Green vegetables are used even less than fruits. They occur in thirty-seven meals, but twenty-six of these are on one diet. Almost no spinach is used, ten of the sixteen times that it occurred being in one diet. The study was made during the time fresh spinach was on the market. Nineteen children in the two cities had neither fruits nor green vegetables during the entire week, and there were as many more that had them only once during this time. Fortunately, canned tomatoes are widely used, and canned vegetable soup is a favorite dish. Cereal and cereal products appear on the diets fre­ quently and in large amounts. A meal often consists of beans and bread. The tendency to substitute milled cereal products for the whole grain is shown here as in the study of the family dietaries. Whole grain products (corn tor­ tillas, rye bread, and whole wheat bread) appeared at only 400 of the meals served, while white flour products appeared on 932. Of the cereals used, oatmeal is fairly popular, but it appears much less often than rice and macaroni. Beans are used extensively in the diets, appearing almost often enough to represent once a day for six days a week for every child. Although large amounts of potatoes are consumed by many of the children, they appear in only half as many meals as beans. Frying is the favorite method of cooking potatoes, but they are served baked, boiled, mashed, and as potato chips. Butter was served in 211 meals, but it appears ten to fifteen times on one diet and is used in very few dietaries. The majority of the children get no butter or, if any, only a very small amount. While eggs do not appear on the children's dietaries as often as the family diets indicate, yet they occur on an average twice a week for each child and are usually served fried. Meat occurs often enough to represent a serving approx­imately three times a week for each child. Beef is the most widely used meat; ham and mutton appear fairly often; liver is listed only once during the entire study. About 75 per cent of the children in the two cities drink coffee, the amount consumed per day varying from one to four cups. Milk is usually added, and at first it was thought that rather large amounts of milk must be consumed in this way. Calculations, however, showed that probably not more than .1 to .2 cups were used in this manner. There is a surprising lack of Mexican dishes, such as tamales, enchiladas, and chili, in the children's dietaries. These are used for Sundays and holidays as a special treat. The tendency to serve rich, concentrated foods, high in fat and highly seasoned, is shown in their meats, gravies, soups, and combination dishes of rice, meat, and tomatoes. Many kinds of peppers are bought and are freely used. On the whole, vitamin deficiencies of the diets of the children are similar to those of the family. Too little milk, butter, eggs, and leafy vegetables are used to supply the requisite amount of Vitamin A. Although the substitution of milled for whole cereals has cut down on the supply of Vitamin B, it is possible that this element is still fairly well supplied by the large amounts of beans, potatoes, and tomatoes used. The use of large amounts of tomatoes and potatoes makes a deficiency of Vitamin C less probable than of either A or B. The amount of Vitamin D is ques­tionable, but the children live largely out of doors in a semi-tropical climate. Whether or not sufficient amounts of Vitamin D are obtained can best be settled by an exam­ination into the extent to which signs of rickets are pres­ent among Mexican children. This will be discussed later. On the basis of our present knowledge of the distribution of Vitamin G, the children's diets appear to be decidedly deficient in this factor. The diet of the Mexican pre-school child presents quite a contrast to that which has been pro­posed as the result of much practical and experimental experience. This prescribes that the pre-school child's diet should be built around whole-wheat bread, butter, milk, green vegetables, cereals, fruits, eggs, liver, and potatoes and that special precautions must be taken to supply Vita­mins C and D by using orange or tomato juice and cod-liver oil or Viosterol. The Mexican pre-school child subsists largely on beans, potatoes, cereals, and coffee. Luckily, he has plenty of sunshine, and the natural fondness for toma­toes is a fortunate one. COMPARISON OF NUTRITION OF MEXICAN CHIL­DREN WITH THAT OF AMERICAN AND NEGRO CHILDREN A STUDY of the nutrition of American and Negro chil­ dren has been made by Eppright.8 Her investigation included a group of fifty American and fifty Negro children selected at random in Austin, Texas. Comparing the fig­ures obtained from the Mexican study with those of Eppright, it was found that-­ 1. The calorie intake of the Mexican children was defi­nitely lower than that of the American children and some­what lower than that of the Negroes. 2. The average protein intake was below that of both the American and Negro group. 3. Calcium intake was markedly lower than that of the American group but only slightly lower than that of the Negro group. 4. Phosphorus and iron intakes did not vary greatly from those of the other groups, the phosphorus intake being somewhat higher than that of the American group and lower than that of the Negro and the iron intake slightly lower than that of either of the other groups. Table IX shows the percentage in each group below the standard requirement. TABLE IX PERCENTAGE or AMERICAN, NEGRO, AND MEXICAN CHILDREN BELOW STANDARD DIETARY REQUIREMENTS Calorlea More Protein Than Below Below 10 Per More Than 2 11111. 10 Per Cent 10 Per Cent Per Kilo· Cent of Below Below sram Calorie Holt Below Standard1 of Bally Require· Stand· Giiiett Phoo· Weicht ment ard Ranp Calcium pboru1 lroD American __ 20 26 52 32 so 38 so Negroes __ 26 26 62 40 90 74 32 Mexican __ 18 31 66 66 96 64 66 8Eppright, E. S., A Dietary Stud11 of White and Negro Pre-School Children. Thesis. The University of Texas. 1930. These figures show a much more deficient diet for the Mexican group than for either the American or Negro. The greater deficiency of the Mexican diet is also shown by figures relative to the number of inadequate factors (Table X). TABLE X PuCENTACE FREQUENCY OF INADEQUATE FACTORS IN DIETS OF AMERICAN, NECRO, AND MEXICAN CHILDREN Nnmber or laad.,.....te American• Necroeo Mesican1 Facton Per Cent Per Ceat Per Cent 0 ----------30 IO 4 1 --------------22 14 17 14 11 2 --------------32 3 --------10 14 20 4 --------12 10 32 5 ------12 20 16 ___ 100 Total 100 100 Average Number of Inadequate Factors Americans ------------------------1.8 per person Negroe1 ---------------------2.6 per person Mexicans ---------------------------3.4 per person The results of this dietary study show that the nutri­tion of the Mexican pre-school child is poor both in comparison to dietary standards and in comparison to that of both American and Negro pre-school children. The outstanding deficiencies are those of calories, calcium, and Vitamins A and G. RELATION OF DIET TO HEALTH OF MEXICAN PRE-SCHOOL CHILDREN SINCE the calorie intake of the Mexican pre-school child is very low, both in comparison with the standard and with the intake of American and Negro children of like age, a large percentage of underweight might be expected. Contrary to this expectation, however, only three children in the group of seventy-five (4 per cent) were more than 7 per cent underweight. Moreover, 32 per cent of the group were more than 7 per cent overweight. In similar groups of American and Negro children, 6 per cent and 34 per cent, respectively, of underweight had been found. The most inadequate diet seemed to have resulted in the least percentage of underweight. These findings were so surprising and so at variance with what had been found in groups of Mexican school children that it was decided to see if this small percentage of underweight was typical of a larger group of children. It was thought desirable, also, to get further data on the physical condition of the Mexican pre-school child. A group of approximately two hundred Mexican pre-school children living in San Antonio were given physical examinations by Doctor Edith Bonnet of that city. Of this group 33 per cent were 7 per cent or more underweight, but only 13 per cent were more than 10 per cent underweight and only 8 per cent more than 7 per cent overweight (Table XII). Whatever the explana­tion of the small percentage of underweight found in the dietary group, it apparently is not typical. However, 17 per cent of the American children admitted to the Univer­sity Nursery School in Austin were found to be under­weight, so that the 6 per cent of underweight found by Eppright cannot be considered typical either. No data are available for a large Negro group. The question of under­weight cannot be settled until more accurate data are available. The average height of Mexican children is apparently considerably below that of American children as given by various investigators. Table XI gives the range in height for pre-school children given by Merrill-Palmer, by Bald­win, and by the Children's Bureau, and, for comparative purposes, the average of the different age groups of Mexi­can children. The number of children examined was too small for computing a range, but it will be seen that the average height of the various Mexican groups is below the smallest figure in the American range. TABLE XI HEIGHTS OF MExJCAN AND AMERICAN PRE-ScHOOL CHILDREN (Heights in inches) Merrill-Palmer 2-3 Year Range 34.6--37.6 3-4 Year Range 37.6-40.4 4-5 Year Range 40.4-42.9 Merrill·Palmer 2-3 Year Range M.2-37.1 3-4 Year Range 37.1-40.2 4-5 Year Range 40.2-42.5 American Borw Baldwin 33.8-36.9 36.9-39.3 39.3-41.9 American Girl• a.Idwila 33.1-36.4 36.4-39.3 39.3-41.5 Chlldnna'1 Bureau 33.6-36.6 36.6-39.2 39.2-41.6 Chlldrea'• Bureau 33.1-36.2 36.2-38.9 38.9-41.4 Medcan Boy1 2-3 Year Average 33.6 (Group of 29) 3-4 Year Average 36.4 (Group of 34) 4-5 Year Average 39.0 (Group of 32) Mes.icao Cirle 2-3 Year Average 32.9 (Group of 28) 3-4 Year Average 36.3 (Group of 29) 4-5 Year Average 38.4 (Group of 46) The physical examination findings are summed up in Table XII, which gives the results for the group as a whole, and in Table XIII, which gives figures for the various age groups. These data may be interpreted, in part at least, in terms of dietary deficiencies. A large percentage of the group shows the various posture defects that have been ascribed to undernutrition. In a group of such very young children 41 per cent of children with decayed teeth seems large. No data on teeth are available for a large group of Texas-American children, but a survey of Kansas pre­school children made by Rypin' shows that of 1,197 chil­dren 27.2 per cent had dental caries, which averaged over one tooth for each mouth examined and almost four decayed teeth for each carious mouth, and that of the teeth erupted 6.3 per cent were carious. An analysis of the data on Mexican children shows an average of 1.2 decayed teeth for each mouth examined and 3 decayed teeth for each of the carious mouths. Of the teeth erupted, 7 per cent were carious. If comparison between these two groups is valid, it shows a larger percentage of bad teeth in the Mexican group. Low intake of calcium and of Vitamins C and D have been definitely connected with dental decay. Although the examinations were made in midsummer, there is a large percentage of nose discharges. Lack of Vitamin A may be a causative factor. The question of rickets in Mexican children is a disputed one. Many physicians who have worked with Mexican chil­dren state that rickets does not exist among them. The examining physician for the present group found that only 15 per cent showed no evidence of rickets, while 66 per cent showed at least two signs of this disorder. However, since bow-legs, knock-knees, and flat feet are not consid­ered as definitely indicative of rickets, it may be pointed out that about 19 per cent of the group showed signs of rickets other than these abnormalities. Only 7 per cent of the American children admitted to the University Nursery School showed definite signs of rickets. Surveying the tables for differences in age groups, it will be found that the percentages of underweight in the four to five-year-old group is 42, while for the younger groups it is about 25. This accords with our finding that the diet of the older children is more deficient than that of the younger. Moreover, there is an increased number of poor postures in the older group, more decayed teeth, and more signs of rickets. In general physical condition, 58 per cent of the two-to-three-year group, 38 per cent of the three-to-four-year group, and 24 per cent of the four-to­five-year-old group were marked "good." The number of 9Quoted from Mccollum and Simmonds, Ne~r Knowledge of Nu­trition. Fourth Edition. 1929. children in "good" physical condition decreases alarmingly in the older group. Not a great deal of difference is appar­ent in the figures on boys and girls. Boys, apparently, are more subject to rickets than girls, as 9.5 per cent of the boys and 21.3 per cent of the girls showed no signs. It is to be regretted that figures for American and Negro children of like age are not available. From observation and from conversations with physicians and nurses it would seem that the Mexican pre-school child is not markedly inferior physically to the American pre-school child. The death rate of Mexican children under two years of age is exceedingly high, and it may be that only the sturdiest survive, while the weaker American children are not so apt to die early in life but do bring down the general average of the physical condition of the pre-school chil­dren. Comparative statistics, however, are needed to prove or disprove this idea. It is generally conceded that Mexican children have a lower resistance than American children to infections, particularly t>f the respiratory type. It must be admitted, also, that they are considerably more exposed to infections of every type, so that it is impossible to know to what extent this lowered resistance is due to diet alone. TABLE XII SUMMARY OF PHYSICAL EXAMINATION FINDINGS OF A GaouP or MEXICAN PRE-ScHooL CHILDREN-95 BoYS, 103 G1RLS (Results in percentage) II'ei1ht 7 Per Cent 10 Per Cent 7 Per Cent or More or More or More Under­ Under­ Over­ Normal wei,bt wei&bt wei,bt Boys..·-­--·­··­·-­-----53.2 Girls ­--·­····­-------· 64.3 35.l 30.6 15.9 9.9 11.7 4.9 Total ···-­-----------­ 58.9 32.8 12.8 8.2 Expression Sli1b1 Marked Alert Fa1l1ued Cln:1­ Clrelea Boys ________ _ _ _ 88.4 11.6 60.0 25.2 Girls ·---­----·--····-·-·­ 88.3 11.6 52-4 34.9 Total ·-·-··---­--­---­ 88.3 12.l 56.l 30.3 TABLE XIl-(Continued) SUMMARY OF PHYSICAL EXAMI NATION FINDINGS OF A GROUP OF MEXICAN PRE-SCHOOL CHILDREN-95 BOYS, 103 GIRLS Posture E:11uer· Protrudln1 atod Spinal Protrudin1 Flat Forward Sbouldon Cunea Abdomen Feet Head Boys____________ 62.l 31.5 86.3 32.6 81.l Girls...·---···-·-··--66.0 32.0 77.6 29.l 79.6 'l'otaL_.__ _ _ __. 64.6 31.8 81.8 30.8 80.3 Posture Excellent Good Poor Bad Boys---------·--·---0 55.8 41.l 3.1 Girls....--------------------· O 57.2 37.8 4.8 Total.........._________. O 57.0 39.4 4.0 Tonsils Cervical Glanda lfyportropbied Inflamed Palpable Boys_, ___________ _ ____________ 83.2 18.9 89.5 Girls......-----------·····---·· 91.2 24.2 85.4 Total....____________ ·------·---87.3 21.7 87.3 Teeth Decayed Poor Occlu1lon Boys______,,________________..,,,............._ 34.7 12.6 Girls_____ __ _________________ 47.5 9.7 Total.___...._____ ----------------------41.4 11.l Flesh Mu1cle Tone Amount of Fat Good Fair Flabby Sufliclont Little Mucb Boys.....-----------12.6 68.4 18.9 74.8 24.2 1.0 Girls......-------·-------------14.5 55.3 30.l 72.8 26.2 .9 Total...__ _______________.. 13.6 61.6 24.7 74.2 25.2 1.0 Skin Special Sen101 Nooe Eye Good Anemic Dlochar10 Diocbarp Boys__ __________ _____ 91.7 8.4 42.l 3.2 Girls·---------------·--·-93.2 6.8 40.8 3.8 Total..........__ ______ 92.9 7.5 41.4 3.5 Signs of Rickets Knock­Knee1 Bow· Le11 Enlar1ed Wri1ta Enlar1od Ank.lea Harri­100'1 Groove DoprouodEn1i£onn Bo1ee1 Boys .......... 65.3 4.2 14.7 4.2 32.6 43.l 14.7 Girls ---·-­ 48.5 2.9 22.3 .9 21.3 33.0 6.8 Total -------­56.5 3.5 18.7 2.5 26.8 37.9 10.6 Signs of Rickeu Boys___ _____ ___ No Sisn ___ 9.5 OnoSip 27.4 Two Slp1 36.8 Three Sip• 23.l Four Si•n• 3.2 Girls...·----·-·-­··-----­21.3Total...._...._______ _ 15.6 34.9 31.3 27.l 32.3 16.5 19.6 .9 2.0 TABLE Xll-(Continued) SutUllARY OF PHYSICAL EXAMINATION FINDINCS OF A GROUP OF MEXICAN Plt&·SCHOOL CHILDREN-95 Boys, 103 GIRLS Habits lrre1ular Too Much Too Little Poor Bowel Cryln1 Sloop Appetite Movement Boys......________ ___ 26.3 13.7 20.0 11.5 Girls ···--··-····-······--··· 25.2 8.7 18.4 13.6 Total..___________ 25.7 11.l 19.l 12.6 General Physical Condition E•celleat Good Fair Poor Boys________ 1.1 33.7 44.2 21.l Girls____________ 1.9 42.7 25.2 30.l Total..____ _____ ___ 1.5 38.2 34.8 25.7 TABLE XIII SUMMARY OF PHYSICAL EXAMINATION flNDINCS OF A GROUP OF MEXICAN PRE·SCHOOL CHILDREN (Results in percentage) Two-to-Three-Year Group-29 Boys, 28 Girls Weight 7 Per Coat 10 Per Cent 7 Per Cent or Moro or More or More Under· Under· Over· Normal Weicht weicht wel1ht Boys_ ____________ _ 51.7 27.6 20.7 20.7 Girls.·----····-······ ____ 64.3 32.l 7.1 3.6 Total..._____ _ _____ _ _ 57.9 29.8 14.1 12.3 Expression Slicht Marked Alert Fatl1ued Clrcloa Clre lea Boys._ ________ 86.2 13.8 65.5 17.2 Girls.·-----·--···----92.8 7.2 57.1 32.1 Total..___________ 89.5 10.5 61.4 24.5 Posture Eu11or­Protrudinc ated Spinal Protrudio1 Flat Forward Sbouldera Curvff Abdomen Feet Head Boys..·--·-····-···----····· 34.5 17.2 82.8 51.7 79.3 Girls...·-··-····--····-····· 39.3 32.l 92.a 32.l 75.0 Total...·-····------·-· 36.8 24.5 87.7 42.1 77.2 Posture Eacelleat Good Poor Bad Boys......_____________ 0 79.4 17.2 3.4 Girls...·--·-······-···--····· 0 60.7 35.7 3.6 Total.........------·--···· 0 70.2 26.3 3.5 Tonsils Cervical Glanda lfrpertropbled laftamed Palpable Boys............_______ --······· 82.8 6.9 79.3 Girls...·----···-----············ 82.l 14.2 75.0 Total...·-··----·---······-···· 82.5 10.5 77.2 TABLE XIIl-(Continued) SUMMARY OF PHYSICAL EXAMINATION FINDINGS OF A GROUP OF MEXICAN PRE-SCHOOL CHILDREN Teeth Decayed Poor Occlusion 6.9 Girls ......... ·-····--····································-··---· 10.7 Boys..... ·-····----··--································ 20. 7 7.1 Total ...... -------·-------···--·---·--··--·-------·---15.8 7.0 Flesh Mu1cle Tone Amount of Fat Too Too Good Fair Flabby Sufficient Little Much Boys ........ ----··-··--·-·····---10.3 75.9 13.8 79.4 17.2 3.4 Girls............................ __ 21.4 42.8 35.7 64.3 32.1 3.6 Total.............................. 15.8 59.6 24.6 71.9 24.6 3.5 Skin Special Sen1e1 Nooe Eye Good Anemic Dlocharre Dl1charr• Boys..·----·-····----·-·-· 93.l 6.9 48.3 6.9 Girls ............................... 92.8 7.2 57.1 3.6 Total.............................. 93.0 7.0 52.6 5.3 Signs of Rickets Harri· Knock· Bow· Enlarged Enlar1ed 1on 11 Depre11ed Knee1 Le11 Wri1t1 Ankle1 Groove En1llorm Boaoe1 Boys ........ 62.1 6.9 31.0 13.8 34.5 31.0 10.3 Girls -·-·-39.3 0 25.0 0 25 21.4 17.8 Total ---50.9 3.5 28.l 7.0 29.8 26.3 14.1 Signs of Rickets No One Two Three Four Sirn Sip Sl1n1 Si1n1 51101 Boys ......... ------·---·---20.7 17.2 34.6 24.1 3.4 Girls ········------·---------·· 28.5 28.5 35.9 7.1 0 Total·-----····----------· 24.6 22.8 35.0 15.8 1.8 Habits lrreaular Too Much Too Little Poor Bowel Cryin1 Sleep Appetite Movement Boys .............. -----------·· 31.0 10.3 10.3 3.4 Girls ................_________ ____ 28.5 14.3 10.7 10.7 Total ····--··----------·---···--· 29.8 12.2 10.5 7.0 General Physical Condition Excellent Good Fair Poor Boys ...... _ ....................... 0 48.3 44.8 6.9 Girls ............................... 3.6 64.3 10.7 21.4 Total ............................ 1.7 56.3 28.0 14.0 TABLE Xlll-(Continued) SUMMAllY OF PHYSICAL EXAMINATION FINDINGS OF A GROUP OF MEXICAN PRE-SCHOOL CHILDREN Three-to-Four-Year Group-34 Boys, 29 Girls Ireight 7 Por Cent 10 Per Cent 7 Per Cent or More or More or More Undf'r· Under­Over• Normal Wf'i1bt weiaht wol1ht Boya________ 60.6 27.2 9.1 12.l Girls._____________ 75.8 20.8 13.8 3.4 TolaL________ 67.7 24.2 11.3 8.1 Expression Sli1ht Marked Alon Fati111ed Circ!.. Clrcloo Boys____________ 82.4 17.6 52.9 32.3 Girl•---------------93.l 6.9 37.9 48.3 TotaL__________ 87.3 12.7 46.0 39.6 Posture Exa11er· Protrudin1 ated Spinal Protrudin1 Flat Forward Shouldero Curvee Abdomen Feet Head Boya _____________ 55.8 29.4 91.2 32.3 79.4 Girl•------------62.1 24.1 93.l 34.5 82.8 Total_____________ 58.7 26.9 92.1 33.3 80.9 Posture E:sce11ent Good Poor Bad Boys___________ 0 47.1 50.0 2.9 Girls_______________ 0 62.1 37.9 0 Total.__________0 53.9 44.4 1.6 Tonsils Co"lcal Claad1 lfyportrophied lnftamed PalpableBoys___________________________ 79.4 23.5 91.l Girls-------------------------86.2 24.l 89.6 Total ----------------------------82.5 23.8 90.5 Teeth Deeayed Poor Occlu1lon Boys------------------------·-----------------------26.4 8.8 Girls----------------------------------------------------48.3 3.4 TotaL____ __ ________ -----------------------------36.5 6.3 Flesh Muecle Tone Amount of Fat Too Too Good Fair Flabby Sulicleat Little Much 8.8 70.6 20.6 88.2 11.7 0 Girls ------------------­ Boys --------------------­ 10.3 62.l 27.6 75.8 24.1 0 Total ------------------9.5 66.7 23.8 82.5 17.4 0 TABLE XIII-(Continued) SUMMARY OF PHYSICAL EXAMINATION FINDINGS OF A GROUP OF MEXICAN PRE-SCHOOL CHILDREN Skin Special Sen1e1 No1e Eye Good Anemic Di1Char1e Diacharce Boys..---·-·····----------91.l 8.8 44.1 2.1 Girls...·--·-------------···---86.2 13.8 34.5 3.4 Total..........____________ 88.9 11.1 39.7 3.2 Signs of Rickets Harri­Knock-Bow-Enlar1ed Enlar1ed aon 'a Depreued Knee1 Le11 Wri1t1 Anklet Groove Enaiform Douet Boys ---------70.6 2.9 8.8 0 41.2 29.4 14.7 Girls ····-···· 62.1 3.4 31.0 3.4 17.2 37.9 0 Total ·-----·-· 66.7 3.2 19.1 1.6 30.1 33.3 7.9 Signs of Rickets No One Two Three Four Si1n Sign Sian• Si1n1 Siano Boys.--------·--------· 8.8 32.3 41.2 11.7 5.8 Girls__________________ 17.2 31.0 24.1 24.1 3.4 Total..._ _ _______ 12.7 31.7 33.3 17.4 4.8 Habits lrrep)ar Too Much Too Little Poor Bowel Cryin1 Sleep Appetite Movement Boys________________ ___ 29.4 11.7 14.7 17.6 Girls__________________ 20.6 6.9 24.1 20.7 Total.........._____ ____ 25.4 9.5 19.0 19.0 General Physical Condition EepreMed Ka..,. Les• Wri1t1 AnIr.lea Groove En1iform Bo- Boys ----62.5 3.1 6.3 0 21.9 68.8 18.8 Girls ----4.5.7 4.3 15.2 0 37.0 4.3 21.7 Total ---52.6 3.8 11.5 0 21.8' 50.0 10.3 TABLE XIII-(Continued) SUMMARY OF PHYSICAL EXAMINATION FINDINGS OF A GROUP OF MUICAN PRE·SCHOOL CHILDR&N Sisns of Rickets No One Two Throe Four Si1n Sien Sip• Si1n1 Sip• Boys...·---·--·----·-··--O 31.3 34.4 34.4 0 Girls......·-·-··--·--·--·--··· 19.6 41.3 21.7 17.4 0 TotaL.......___________ 11.5 37.2 26.9 24.3 0 Habits Irresul1r Too Much Too IJttle Poor Bowel Cryin1 Sleep Appetite Movement Boys___________________ 18.8 18.8 34.4 12.5 Girls___________ ---·-----··· 26.l 6.5 19.6 10.9 Total...______________ 23.l 11.5 25.6 11.5 General Physical Condition Excollont Good Fair Poor Boys..____________ 0 18.8 46.9 34.4 Girls_______________ 2.2 28.3 30.4 39.l Total...______________ 1.3 24.3 37.2 37.2 TABLE XIV AVEllACE DAILY INTAKE OF SEVENTY·FIVE MEXICAN PRE-SCHOOL CHILDREN Two-year Boys Ace YMn We(alu, Heicf>t, Proteia. Calelum, Phoophol'Do, u.. ud Pounde l11eh.. Calorln Cram1 Cram1 Cr.mi Gram• > M-tha Austin­ A2._________________________ 2--0 27 32.5 l,4n 52.06 1.0850 2.1761 .00809 A3.__________________________________ 2--0 34 34.0 1,231 32.65 .6597 .7801 .00505 ~ AS..._____________ 2-1 30 34.5 841 30.10 .8407 .7710 .00787 0 A6 ---------------------2-2 25 32.0 1,357 34.04 .3456 1.0435 .00658 A7____________________ ­ 2-2 33 34.0 1,048 41.lS .6250 .7889 .00482 x A9___________________________________ 2-10 29 32.5 1,457 42.21 .8264 .9347 .00556 Average ·----------------------------29.7 33.2 1,235 38.70 .7304 1.0824 .00633 d San Antonio- SAL_________________ ""O 2-2 25 30.5 974 32.46 .6538 .8304 .00398 SA3. ______ ____________________ 2-4 26 31.0 1,096 37.78 .7886 .8727 .00449 > SA4_____________________ 2-4 29 35.0 785 29.93 .6730 .8761 .00334 ::0 SAS ----------------------------------------· 2-5 28 34.0 795 26.37 .3188 .6371 .00343 -l SA6 -----------------·------------·-----------· 2-5 32 30.0 1,175 37.34 .5439 1.6796 .00506 SA7..--. -·--··-·----------·---· ----·--------2·-6 30 34.0 584 24.33 .4053 .6220 .00437 ­ - SA8 ·-----------------·------------2--6 35 33.0 780 25.58 .2529 .4866 .00368 SAlO____________________________ 2-9 30 33.0 1,118 34.43 .5899 .8099 .00484 SAIL____________ 2-10 33 36.0 907 38.13 .7271 .9247 .00569 Average ---------------29.8 32.9 913 31.82 .5504 .8599 .00432 Total-15 cases, average_ --29.7 33.0 1,041 34.57 .6224 .9489 .00512 ~ TABLE XIV-(Continued) AVERAGE DAILY INTAKE OF SEVENTY·Fl\'E MEXICAN PRE-SCHOOL CHILDREN ~ ;:,­ (\ Two-year Girls ~ Age Yean and Montlu Weight, Pouode Height, lnche1 Calories Protein, Grams Calcium, Grams Phosphorus, Grams Iron, Grams ;::s... e (\... "'...- Austin-Al-----·····­----------·--·-···-----··­A4-----··-···-·-·----·----------··-····-·­AB ---·--·----------------­-------------­ 2---0 2-1 2 -5 26 28 20 34.5 32.0 33.5 842 1,313 822 34.19 43.90 26.96 .5480 .5550 .6684 .7863 1.9827 .6726 .00504 .00872 .00326 ~ ()-~ (\ ~ Average------·----------····-­ -----­ 24.7 33.3 992 35.01 .5905 1.1472 .00567 e San Antonio­SA2______________ SA9________ ____ Average___________________ 2-2 2-7 ----­ 25 30 27.5 31.0 36.0 33.5 518 842 680 21.33 31.18 26.25 .4056 .4228 .4142 .5806 .9344 .7575 .00284 .00416 .00350 ~--(\-... ;::s Total-5 cases, average ___ -­ 25.8 33.4 867 31.51 .5199 .9913 .00480 ::z:: "' Q;:;­ TABLE XIV-(Continued) ~ AVERAGE DAILY INTAKE OF SEVENTY· Fl\'E MEXICAN PRE·SCHOOL CHILDREN l Three-year Boy1 ~ A1• Yeara and Month• Weisht, Pound• Hei1ht, lnchee Calorle1 Pro1ein. Gram a Calcium, Cram1 Phoephoru1, Gram• lroa, Gram• ... =.·Q';:s Austin­ ()- Al2 ···-······--­----­····­······ ··· ······· .. ·-­ 3-6 36 40.0 855 29.32 .8310 .7541 .00861 Al4......--········--·-·­····-···.. ···.. ······ Al6...-----------­-------------·················· 3--10 3--11 36 30 39.5 37.5 1,581 831 39.00 29.67 .3739 .6104 l.1761 .6198 .00790 .00367 ~ "' ~ ~· Average ---·..·­····-·-----­--­-······· San Antonio-­SA12 ·----····-·----­------------­--­---­-· SA 13·­---·-·····­·········--····­--­--·········· -·---­3-3 3-4 34 25 36 39.0 34.0 36.0 1,089 1,100 988 32.66 39.08 37.51 .6051 .7836 .4528 .8500 .9309 .7227 .00673 .00526 .00529 Qg: t'-­;;·....;:s ~ Average ··--·­....... _ ............... ...... ---···­ 30.5 35.0 1,044 38.29 .6132 .8268 .00528 .... ;:I Total-5 cases, avora10 ..... ... -----­ 32.6 37.4 1,071 34.91 .6103 .8407 .00615 ""'3 ~ e co ...... ~ TABLE XIV-(Continued) AVERAGE DAILY hTAKE OF SEVENTY-FIVE MEXICAN PRE-SCHOOL CHILDREN Three-year Girls Age Years ond '\\'eight. Pounds Height. lnche1 Calorie• Protein, Gram1 Calcium, Gram• Phoepboru1, Grams Iron, Grama ~ Mootbs "' Austin-AlO ____________________________ Al}_______________________ A13 ·--­-----­------------------·­Al5____________________ __ _______ __ 3--0 3-2 3-10 3-11 25 30 30 27 33.25 33.50 36.50 35.00 l,ll9 928 1,106 1,043 40.85 36.85 30.28 40.64 .5270 .3274 .3696 .4W5 1.9679 .7738 .6485 .7593 .00752 .00444 .00417 .00532 ~ ;:s c· "'.., ...... ;::.· '< Average -------------····---··········­ -----­-- 28 34.-50 1,049 37.15 .4161 1.0374 .00536 ~ San Antonio­SA14 _____________ ··­···-·-------·-----· SAIS__ ____________________________________ 3-6 3--0 35 40 34.00 39.00 1,418 825 52.44 24.09 .8875 .3181 l.1389 .5526 .00622 .00352 ~ "' ! SA16 -------------------------------· SA17 _________________ SAIS __________________ 3-7 3-8 3-8 32 26 33 34.00 34.50 34.00 888 1,075 667 32.28 32.02 26.05 .6405 .3707 .3839 .8233 .8270 .6594 .00416 .00432 .00339 b:I ~-~ SA19.--------------------------· SA20 -·····-···-----------------­-------------­SA2l ___ __________________________ 3-10 3--10 3-ll 33 32 32 36.00 32.50 38.00 1,449 804 1,183 51.28 26.45 44.09 l.1913 .4655 .4144 1.3179 .8339 1.1351 .00647 .0'.>317 .00596 ;;· Average ­---------------­ -­ 33 35.2 1,038 36.09 .5840 .9110 .00465 Total--12 cases, aYerage ___ ---­ 31.2 35.0 l ,042 36.44 .5280 .9531 .00489 TABLE XIV-(Continued) An:R Act; D.on hTAKt: o•· St:n::'iTY·Fl\'t: Mt:xlcA:o< PRt:-ScHooL CHILDRES Four-year Boys Ausrin­A21 A22 A23 . A25 ---· . ­ A&e '\'ran •nd Moath1 4---3 4-­3 .i 4 4--6 "'"i11ht. Pou nd• 35 36 33 40 Hei1h1. Inch~• 40.0 40.0 39.0 43.5 Calorl"' 1,075 1,300 602 1,305 ProlrJn, Cram• 33.19 35.42 14.80 57.72 Calciurn. Gram• .5733 .3745 .1669 .7459 Phottphoru•, Gram" 1.0118 1.0772 .4168 .9954 Iron, Gram• .00621 ,(}3665 .00220 .01021 ::z:: ~ 1:1-.. ~ 1:1 :::s Q.. <: $::.... Average .. .______ ___ ___ ,,_ ....._. __ _____ San Anlonio-­SA2.3 __ . ...____ ____ -----­-·-·· ··· ···· SA27 _ --.. ----· ..... ... .. ... ............. SA28 .. .. .. .. ................ ..... ----­---------­S:\31 ---·­-··------------.. ·-­·----.. -----.. ·---­S:\34 __ ____ .. ___ -­--------­----------­____ .. __ _ SA35 __ _ ----­-.. --......... ............. ........... SA36 _____ _·----·----------·-­----------­--·· ­-------­SA37 ______________ ___ _.. __ __ __ ,, __ __ __ __ ________ SA39 _____ .... ____ ______ .... . .. SA40 .......... .............. SA41 ..... ....... ....... _ -· · ·-· ·· SA44 _ .. . _ ------­.. .. SA45 .......................... --------------­-­-----­SA49 .-..--­-----·-­----------......_____ _____ ..____ _ SA50 ­--­-·----·------------·--------------· -----·­4---1 4---2 4---.3 4--3 4---6 4----6 4-6 4 -6 4---8 4 -8 4---8 4---11 4--II 4---11 5--0 36 33 38 35 33 39 37 40 38 39 37 38 33 40 45 50 40.6 36.0 38.5 39.0 37.0 40.0 38.0 39.0 39.0 37.0 37.5 36.0 45.0 39.5 45.0 42.0 1,070 1,414 842 1.082 1.085 1,115 731 939 844 94S 1,086 985 1,013 896 1,317 1,531 35.28 49.36 27.99 44.52 36.20 35.40 29.72 35.42 36.06 4I.6:l 35.68 3.~.86 39 87 28.50 42.57 50.91 .4651 .6-181 .3670 .5443 .4134 .7002 .:~882 .2412 .3506 .6628 .5876 .3746 .6222 .3691 .3729 .7483 .8753 .9869 .6603 1.0424 .8S88 .8681 .6808 .6892 .7377 .9279 .8428 .6952 .9125 .6082 l.1296 1.0270 .00632 .00633 .00404 .0)672 .00498 .00421 .00·375 .00518 .00512 .OJ36'J .005.')3 .00420 .0047.'l .00422 .004'37 .0098J ~· c· ;:s c-~ ~ ~ ;::;· 1:1 :::s "' ~ ;:;·... :::s ~ ... ;:s ""3.,. ~ ~ "' Average ------------------------------­ -------­ 38.3 39.0 1,055 37.84 .4927 .8445 .00512 Toral-19 cases, average ____ __ ------­ 37.8 39.5 1,058 37.30 .4868 .8509 .00538 00 w TABLE XIV-(Continued) ~ AVERAGE DAILY INTAKE OF SEVENTY-FIVE MEXICAN PRE-SCHOOL CHILDREN Age Yeart Weight. Four-year Height, Girls Protein, Calcium. Photphoru•, Iron, and Pounds Inches Calories Grams Grams Grams Grams Months Austin­ Al7................................ ··················-­Al8 ·---·--·-------·---------·--·--····-····-­··-· 4-0 4-0 32 39 39.25 42.00 1,412 1,151 48.99 47.76 .9968 .8082 1.4024 .9392 .00644 .00554 ~ ;:,-­"' Al9..·-··-·--·-·-----------· ···----·-··-----···· 4-1 30 39.50 1,233 35.05 .6241 .7631 .00486 ~ A20----------···----·--------·----····­· A24 --­--·-··--·-·--···---------·----·--·-·-······­Average_____ __ _ _ ____ ___ ______________ 4-2 4-6 ---­ 31 36 33.6 36.50 42.00 39.80 877 894 1,113 2-3.07 36.94 38.36 .1763 .5749 .6360 .6748 .8000 .9159 .00410 .00533 .00525 ;::i... c "' ... "' ~· San Antonio­SA22 ·············----------------------···--······· 4-0 34 34.00 759 27.84 .5971 .6980 .00286 0- SA24­·-·-·--·-·--···-------·---------------···­-SA25 -··-···-------· ·· ····--············-·----··--­SA.26 ·----­---·----------­--­-----------·--·--­SA29.________________________ ______ ______ SA30_________________ 4-1 4-2 4-2 4-3 4-3 40 38 35 49 56 40.00 39.00 38.50 39.00 44.00 795 699 885 612 1,042 38.11 32.81 31.92 20.74 40.33 .3455 .3188 .3979 .4084 .8645 .8853 .9109 .7198 .4849 1.0048 .00593 .00421 .00491 .00226 .00398 ~ "' ~ Q... t:tl;::- SA32 -·---­--·---­----·­------··--····­SA33________ _______ _ _______ _______ SA38 ··------·--·-------·-·---------------­ 4-4 4-5 4-8 40 51 36 39.00 40.00 40.00 903 519 721 38.93 17.79 24.76 .7305 .2580 .4880 .9174 .3426 .8145 .00621 .00266 .00273 a;;· SA42 ----·-----------·------------····--··-··-­ 4-9 36 40.00 912 31.61 .4655 .6845 .00413 SA43_____ ·-­-------------·-­·--­ 4-11 30 36.25 474 18.63 .2189 .4102 .00279 SA46 ..­ --------·---------------­ 4-11 35 38.00 754 28.05 .3595 .5403 .00411 SA41--------------------·-··--· 4-11 39 40.00 1,077 39.81 .5340 .8173 .00547 SA48 ··--········-··­----­---------­ 4-11 42 43.00 664 25.35 .5134 .5541 .00385 Average ···----------------·--­--­ ---­ 40 39.30 772 29.05 .4643 .6917 .00401 Total-19 cases, average____ -­ 38.3 39.4 862 32.02 .5095 .7560 .00434 TABLE XV ::i:: PERCENTAGE DEVIATION FROM STANDARDS JN DIET OF MEXICAN PRE-SCHOOL CHILDREN Two-year Boye ~ Protein l Ace lc>-15 2-3 Calorie• Yuro Per Cenl CRmt Hoh :<:and of Calorie Per Kilo and Miaeral1 E Mon1h1 Jnuke S1anclard Fat.. Gillen Calcium, Phoopboruo, Iron, Slanclard Standard Sunclard Gram• Gram• Cram• a. Austin­ s· A2.·--··-··-·------·---------·-----··--····-2-0 +27 +47 +3S.O -13.0 + 8 +117 +48 ;:s A3 ···-··-------····--·-··-·----·----------------2-0 Within Within + 8.S Within -34 -22 -IO ~ -16 -23 +44 A6.·----·----------------·-···-------------2-2 Within Within +29.0 -4.3 -66 + 4 +25 ~ AS.. ·--------------------····--------2-1 Within Within -22.0 -lS.O -lS A 1------------------·····-----------------2-2 Within +11 -7.S Within -38 -22 A 9-----------------·---·-·----------------2-10 + 3.2 +ls +33.0 -12.0 -18 -7 + 1.8 §· San Antonio-i! SAl -------·---·-----------2-2 Within + 3.2 + .8 -2.6 -3S -17 -17 t'-i ... -10 SA3.·----------------------------·--2-4 Within + 12.0 + 8.7 Within -22 -13 ~ ... -45 SA4 ...... ----·····-------·---------··-----------···· 2-4 Within Within -3S.O -21.0 -33 -13 ~ 2-S -7.3 Within -29.0 -20.0 -69 -37 -39 SA6 ................................................... 2-5 + 7.8 +24.0 +27.0 Within -46 + 67 + 9.S ;:s SA7 ................ ················-····-····--·-·· 2-6 -14.0 Within -48.0 -41.0 -60 -38 -22 SAS ···----·-···----------------2--0 -6.S Within -28.0 -22.0 -7s -S2 ~ SAS ·························-······················ ... -32 ~ SAIO...______ -11 2-9 Within Within + 2.3 Within -42 -20 SAIL_______ e 2-10 Within Within -30.0 -9.3 -28 -8 -12 ~ ~ TABLE :XV-(Continued) PERCENTAGE DEVIATIOl'f FIOM STANDARDS IN DIET OF MEXICAN PBE-ScHOOL C&ILDllEN ~ Three-year Boys Protein ~ ... Ac• m-ts 2-3 Calorieo c Yearw Per Cent Gnnu Bolt ... and of Calorie Per Kilo aad llinetab .. ~ Moatha latab Standard Falea CilJeu Calcium. Ph-lionu, Iron, i:.· Standard Standard Standard Grama Gnm1 Gnm1 ~ Al2 Austin­ ____________ ~ ~ -18 -IO -40.0 -22 -17 -25 +19.0 "'i Al4 3-10 Within Within + 9.7 +12 -63 + 17 + 9.7 Al6 3-11 -12 -I -37.0 -24 -39 -39 -44.0 fi San Antonio­ -~ SA12 3-3 Within + 6.2 + 1.8 Within -22 -7 -2.5 SA13 3-4 Within Within -20.0 -u -55 -28 -15.0 ­ ~ s· TABLE XV-(C.Ontinued) PuCEl'ITACE DEVIATION FROM STANDAllDS IN DIET OF MEXICAN Plll:-ScHOOL CHILDREN Four-year Boys t Protein Ap ll>-15 H Calorieo Y•n Per Caal c;;-Bola aad of Calorie Pet Do .... Miunla l Moa1.. lalalt• lkaUanl FU. Clllelt Calelam, Ph-llorua, Iron, Standard Standard Staaclanl c....... c....... Cnm1 Austin­ A2l.____________________________ 4-3 -u Within -21.0 -HI -43 + 1 -9.2 f• A.22 --------------------4-3 Withia Within -4.9 Within -63 + 7 -2.7 A23________________________ 4-4 -55.0 -53 -5'J) -49 -84 -59 -66.0 A25___________________ 4-6 Within + 3.4 -16.0 Within -26 -1 +31.0 .a. San Antonio-it SA23_______________ 4-1 +11 +17.0 +20.0 Within -36 -2 + 7.4 SA27_____ 4-2 -10 -6.6 -32.0 -29.0 -64 -34 -35.0 SA28___ 4-3 Within Within -18.0 -9.8 -46 + 4 + 1.05 1· SA3l____ 4-3 Within Within -10.0 -9.5 -59 -15 -18.0 SA34_____ 4-6 Within Within -18.0 -7.0 -30 -14 -38.0 t°"' SA35_____ 4-6 -5.1 Within -41.0 -39.0 -62 -32 -40.0 e· SA36..-----------------4-6 Within Within -28.0 -21.0 -76 -32 -22.0 ~­SA37--------·-·-·--------------4-6 Within Wilkin -36.0 -29.0 -65 -27 -23.0 s· SA39..·-·-··--·-------------· 4-8 Within Within -22.0 -21.0 -34 -8 -39.0 SA40_____ 4-8 Within Within -13.0 -9.5 -42 -16 -11.8 SA4l______ ~ 4-8 Within Within -16.0 -17.0 -63 -31 -28.0 SA44_____ 4-11 -6.7 -2.4 -40.0 -15.0 -38 -9 -44.0 ! SA45_____ 4-11 -16.0 -9.8 -32.0 -25.0 -64 -40 -36.0 SA49.. 4-12 Within Within -22.0 Within ---63 + 12 -48.0 SASO 4-12 Within Within + 3.3 + 2.0 -26 + 2 +24.0 CD ~ ~ TABLE XV-(Continued) ~ PERCENTAGE DEVIATION FROM STANDARDS IN DIET OF MEXICAN PRE·SCHOOL CHILDREN Two-year Girls ~ :.;· .,. Protein Ac• 1~15 Z-3 Calorie• ...... Yean Per Cent Grama Holt :::.· and of Calorie Per Kilo and Minerala Montb1 Intake Standard Fal.. Gillett Calcium, Pb-borna, lroa, 0 Standard Standard Standard Gram• Grama Grama Austin--~ ""i Al_ ___ ___________ 2--0 Within Within -32.0 -14.0 -46 -22 -19.0 "' A4 .. 2-·l +13.0 +34 +27.0 + 2.5 -45 + 98 +69".0 I A8 2-5 -3.0 Within -26.0 -16.0 -34 -33 -40.0 t:tl I: San Antonio­ ;­ - -6() SA2 2-2 -13.0 Within -47.0 -47.0 -42 -42.0 .... - SA9 ·· --2-7 -3.4 Within -34.0 -14.0 -58 -7 -35.0 ;:I TABLE XV-(Continued) t PERCENTAGE DEVIATION FROM STANDARDS IN DIET or MEXICAN PRE-SceooL Cell.DBEN Three-year Girls l Protela Ace lC.--15 H Calorlea Yean Per Cent Gnm1 Bolt and of Calorie Per Imo and Mlnenlo j Monlh1 latalte Standard Falee Gillett Caleham, Ph-horut, Iron, Standard Standard Standard Gnm1 Cramt Gnm1 ;:s Austin- AlO_____________________ ~ 3--0 + 4.6 + 15.0 + 7.5 Within -48 + 96 +44 All ______ 3--2 Within Within -14.0 -12.0 -68 -23 -11 AIL______________ 3-10 ~ -2.5 Within -10.0 Within -64 -36 -32 AlS ------3-11 Within + .3 -10.0 -1.6 -56 -25 -8.2 1· San Antonio­ SA14 ---------------3-6 +29.0 +42.0 +31.0 + 4.2 -12 + 13 +15 ~ ... SAIS-----------------------------------3-6 -29.0 -22.0 -39.0 --22.0 -69 -45 -48 c SAI6 -------------··-----------------------··-· 3--7 Within Within -17.0 -16.0 -36 -18 -22 s· SA 17.--------·--------·-···--····-··-··---·----3-8 Within Within -7.3 Within -63 -18 -25 Oii SAIS..________________________________________ 3-9 -6.9 Within -40.0 -37.0 -62 -35 -29 s· SAI9__________________________ 3-10 +13.0 +25.0 +29.0 + 6.5 + 19 + 31 + 7.8 i ~ SA20__ _ ____________________________ 3-10 Within Within -25.0 -24.0 -54 -17 -41 SA21 --------------------------------3-11 Within Within -10.0 Within -59 + 13 -9.6 ~ 8 TABLE XV-(Continued) PERCENTAGE DEVIATION FROM STANDARDS IN DIET OF MEXICAN PRE-ScHOOL CHILDREN Four-year Girls Protein ,.. ll>-15 2-3 Caloriea Yeara Per Cent Graiu Bolt ond or Calerie Per .l'.llo aad Minerala Montbt Intake Standard Fote. Gillett Calcium, Pboopborut, Iron, ~ Standard Standard Standard Crama Grama Gnat Austin­ Al7._______ 4--0 Within Within + 6.0 Within -1 + 40 -3.3 Ala _____________ 4--0 Within Within -~.o Within -:M) -7 -22.0 f.. Al9 ______ 4--1 Within Within -7.4 Within -38 -24 -27.0 l· A~ 4--2 -19 -17 -23.0 -23 -83 -33 -28.0 ~ A24 4--6 Within Within -19.0 -21 -4.3 -:M> -3.9 0 San Antonio-­ SA22________________ 4--0 Within Within -2.6.0 -33 -41 -31 -44.0 SA24_______________ 4--1 Within Within -40.0 -30 -66 -12 -10.0 I SA25 4--2 Within Within -44.0 -38 -69 -9 -33.0 SA26____ 4--2 Within Within -27.0 -22 -61 -29 -19.0 I'. SA29. 4--3 -34 -32 -51.C -46 -60 -52 -64.0 ~ SA30 _ 4--3 Within Within -31.0 -8.5 -14 + 0.48 -47.0 I· SA32 -----------4--4 Within Within -28.0 -~ -27 -9 -1.2 SA33 _____________ 4--5 -47 -45 -61.0 -54 -75 -66 -60.0 SA38 ____ 4--8 -27 -24 -45.0 -36 -52 -19 -59.0 SA42 --4--9 Within Within -31.0 -~ -54 -32 -37.0 SA43_________ 4--11 -34 -33 -58.0 -58 -79 -59 -51.0 SA46._____________ 4--11 -8.1 -6.3 -38.0 -33 -65 -46 -30.9 SA4L. 4--11 Within Within -19.0 -5.5 -47 -19 -17.0 SA48. 4--11 -31 -30 -55.0 -41 -49 -45 -47.o TABLE XVI DEV1Ano.N FROM STANDARD WEICHT oF MEXICAN PRE-ScHooL CliILDREN-GROl' P OF 198 Two-year Girls Wel1ht, Ac• Heiaht Pound1 months._________________ 32 38.3 26 months___ ____________ 32 33.3 32.2 months___________ 24 31.7 23.7 months________________ 32 31.7 22 months ______________ 34 32 23 26 months----------------·--. 31 22 26 months.......................... 33.5 23.2 months______ _____________ 26 33.8 24 31 months----·--------------33.2 24 30 month11..........--------------32.4 22.2 27 months.·-------------------33.l 25 months._____ __________________ 28 31.6 22.4 months_____________ ____ 32 35.8 25.8 33 months.·-------------------33.7 26.6 24 months ·----------------32.2 24.8 33 month•---------------33.5 25.5 months......_. ___________ 33 36.2 30.2 months _____________ 31 32.7 24.2 26 months ..---------------34 26.2 26 months ---------------------32.5 25.2 27 months --------------32.9 24.5 months....._____________ 24 30 21.5 months.____ _____________ 33 35 26.5 months______________ 30 32.4 20 30 month•----------------33.2 23.5 months______ 30 32.8 24.6 31 months..---------------30.7 20.7 Three to Four-year Girls 44 months 36.8 25.5 45 months---------38.l 35 months_______ 38 36.7 28.1 46 months·---------------------39.5 30.2 36 months..------------------38.2 34.3 45 months------·------------37.2 32 41 month11 ......--------·-----·· 35 28 42 month•----------------·· 36.4 27 36 months-----------------36.5 28 40 months ---------------------36 28 36 month•-------------------32.2 24.5 45 months-------·-----·--· 37.8 32.7 47 months ..--------------·-------36.4 26.1 38 months -----·--·-----------32 22 46 months ----------------···--· 38.5 32.5 42 months -----------------·----35.5 30.7 36 months -----------·-----32.9 24.2 39 months -----------------·----·-34.4 26.6 42 months ·----·----······-·-·--38.2 31 45 months ----------------------37.5 33 months___________ 37 35.2 29.2 Standard Wei1bt, Pounda 25 25 24 24 25 23 25 26 25 24 25 23 30 26 24 26 30 25 26 24 25 21 29 24 25 25 23 30 33 31 34 33 31 29 30 30 30 25 33 30 25 33 29 25 27 33 31 29 Variation Percenta1e + 4 +28.8 ± 0 8.3 8 4.3 7.2 7.6 4 7.5 ± 0 ± 0 -14 ± 0 ± 0 ± 0 ± 0 ± 0 ± 0 + 5 ± 0 ± 0 8.6 -16.6 -6 ± 0 -10 -15 + 6 + 4 + 3.2 -9.4 -11.1 -3.8 -10 6.6 -6.6 ± 0 ± 0 -13 -12 ± 0 + 6 ± 0 ± 0 6 6.4 ± 0 TABLE XVl-(Continued) DEVIATION FROM STANDARD WEIGHT OF MEXICAN Pu·ScHOOL CHILDREN-GROUP OF 198 Standard Wel1ht, Wel1ht, Variation A1e Heisht Pound1 Pound• PercOlltal• months __________________ 42 34 29.2 27 + 8.1 months______________ __ _ 45 36.4 39.5 30 ± 0 months______________________ 42 38 31.3 33 ± 0 months_______________________ 45 38.4 32.2 33 ± 0 months__________________ 44 35.6 28.2 29 ± 0 months____________________ 43 36.3 29.2 30 ± 0 Four to Five-year Girls months________________ _____ __ 48 36.5 28 30 -6.6 months________________ ____ 56 39.5 33.8 34 ± 0 months _______________________ so 37 28 31 -9.6 months_________________________ 60 42.3 35.l 39 -10 months_____ _____ ______________ 49 40.2 32 36 -11.l months______________________ 57 35.8 28.5 31 8 months ______________________ 54 36 28 31 9.6 months ________________________ 49 35.5 29.5 29 ± 0 months_________________________ 51 38 30.7 33 -7 months_____________________ 48 35.5 27.5 29 -5.1 months______________ _________ 53 37 35 31 +13 months__________ ________ 57 40.8 35.1 37 -5.1 months__________________ 54 38.3 28.1 33 -11.8 months_____________ _ ___ 56 35.3 28.5 29 ± 0 months _______ ______________ 54 40.5 36.2 36 ± 0 months______________ 60 38.7 32 34 6 months________________________ so 39.5 32.5 34 4.1 months______________________ 54 40.5 33.5 36 7 months_____________________ 55 36.5 months ________________ _ _______ 50 40.7 33.7 37 -9 54 months------------------------40.7 34.4 37 -7 months _ _____________________ 49 37.7 33.3 33 ± 0 59 ...--------·----------41.7 43.6 39 + 11.7 months ___ __ ___________________ so 53 months ..--------------·----39 31 36 -14 months ______________ _ ___ 50 37.5 31.7 31 ± 0 Two to Three·year Boys months_ ________________ 24 30.7 24.8 23 + 7.8 24 months ..-----------------------33 27.5 26 + 5.7 months ______________ ___ ______ 28 31.6 22.8 24 5 months _____________________ 31 35.2 31.7 29 9.3 24 months ------------------------· 32.2 22.2 25 -11.2 29 months..------------------------31.l 22.6 25 9.6 + months _______________________ 31 35.4 31.7 29 9.3 + months__ ___________ _________ 30 34.6 27 27 ± 0 months____________________ 33 34.5 29 27 7.4 + months_____________ _____ 29 34.7 26.7 27 ± 0 months _ ________________ 30 32.7 27.1 26 + 4.2 33 months-----------------33.2 22.3 26 -14.2 months______________________ 33 34.8 29 35 -17.1 months__________________ 30 34 27 27 ± 0 months___________ 33 34 26 27 -3.7 TABLE XVl-(Continued) DEVIATION FROM STANDARD WEIGHT OF MEXICAN PRE-ScHOOL CHILDREN-GROUP OF 198 Standard Weicht, Ac• Hei1h1 Pound• months__________ 25 32 21.5 months______________ 30 34 26.7 months__________ ________ 27 32.8 months__________________ 29 36.5 31 months_____________________ 31 41 28.5 months_____________ 34 33.5 25.5 31 months..---------------35.8 29 months______________ 32 30.5 20.5 months_____ 30 33.7 24.6 months__________ 33 34.5 28.5 months______ 25 33.4 28 months________ 27 36.2 32 Three to Four-year Boys months_______ months_________ 37 34.7 26.2 38 40 32.1 months______ 43 37.5 32.7 mQnths________ 45 36.5 31.5 months_______ 42 32.5 23.5 months________ 46 38.5 30.5 months_________ 39 32.8 23.5 months_____________ 43 34.8 29 months___________ 47 36.5 33.5 36 months_···--·-······ 31.7 23.7 months..__________ 42 39.5 35 months______________ 45 39.5 35.7 months_______________ 36 35.2 31.5 months___________ 36 40 39.5 36 months......·---·--·--· 34.5 29.2 months_____________ 44 38.5 33.2 months____________ 45 36 30.7 41 months 38.2 32.5 months_______ 38 36.2 30.7 months_____________ 38 37.5 34 months____________ 37 36 28.2 36 35 29.5 months___________ -···· 45 months_____........ 36.5 33.l 43 months....._____ ··---·······-35.8 26.5 months__________________ 43 37.5 28.5 36 months---------···-· 34 27.l Four to Five-year Boys months______________ 53 35.7 28.7 months________ 60 41.8 33.7 months____________ 48 38.8 32.5 57 months 36.5 30 months_________ 50 36.4 28.2 months_.________ 57 39.2 29 lllonths_________ 54 41 33 months_______ 55 37.7 28.3 52 months 37.2 33 Wei1ht, Pound1 25 27 31 38 26 31 22 27 27 26 31 29 36 32 31 24 33 26 29 31 25 35 35 29 36 27 33 31 33 31 32 31 29 31 32 32 27 31 39 35 31 31 35 38 34 32 Variation Percenta1e -14 :!: 0 :!: 0 -25 :!: 0 6.4 6.8 8.8 + 5.5 + 7.6 + 3.2 -9.5 -10.8 ± 0 ± 0 ± 0 7.5 9.6 :!: 0 + 8 -5.2 ± 0 ± 0 + 8.6 + 9.7 + 8.1 ± 0 ± 0 ± 0 :!: 0 + 6.2 -9 ± 0 + 6.8 -17.1 -10.9 :!: .0 -7.4 -13.5 -7.1 -3.2 -9 -17.l -13.l -16.7 + 3.1 TABLE XVl-(Continued) DEVIATION FROM STANDARD WEIGHT OF MEXICAN fu·ScHOOL CHILDREN-GROUP or 198 St111dard Wel1ht, Welpt, VarlatlOD A10 Hel1ht Powada Pounda Percenta1e 54 months__ ___________ 39.3 35.l 35 ::t: 0 48 months__________ 40.5 36 36 ::t: 0 54 months____________ 38 33.5 34 ::t: 0 50 months_____________ 38 30 33 -9 58 months___________ 36.7 28 32 -12.5 59 months__________ 42.5 36.l 39 7.4 50 months_______________ 39.3 33.7 35 4 60 months________________ 42.2 41 39 + 5.1 50 months_______________ 37.6 30.7 32 4 57 months..-----------------37 31 32 3.1 57 months__________ 40.2 36.7 36 ::t: 0 53 months.----·------------39 32.5 35 7.1 51 months___________________ 38 30 33 9.1 48 months__________ 39.5 30.7 35 -12.3 58 months______ ______ 41 35 38 7.9 48 months_____________ 40 38.5 36 + 754 months__ _____________ 41.7 36.3 39 -7 BLANK FOR RECORDING GENERAL DATA Name ---------------------------------Date -----------------------­Address _________________Date of birth________________ 1. Prenatal care ---------------------------------------­Health of mother during pregnancy ----------------------------------------­ Diet -------------------------------­Physician consult.eel ------------------------­ 2. Birth --------------------------­Full time or premature -----­Normal or abnormal-----------------------­ 8. Feeding during first year --------­ Breast ----------------------------­Bottle: type of mixture -------------------­Supplements -----------------------­ Cod liver oil Tomato juice ---------­Cereal_________ vegetables ___________ meat_________ Regularity of feeding ------------­Appetite --------------­Age of weaning --------------------------------___ 4. Feeding after first year ---------------------------------­Milk Food dislikes -----------­Cereals ----------------Meat -----------------­Fruits Candy -------------------­Vegetables -------------------Cod liver oil-----------­ Appetite ----------------------Tomato or orange juice-------­ 5. General health ----------------------------------------------------------­Colds ---------------­Other infections ---------------------------------------------------------­Teeth --------------------------------------Tonsils ----------------------------------­ 6. Data from physical examination -------------------------------------------------------------­ 7. General comments BLANK FOR RECORDING FOOD CONSUMPTION OF PRE-SCHOOL CHILDREN A Dietary Stwl.11 Name ---------------------------------------------Date of birth----------------­Date ------------------------------------------Height ---------------------­Weight ------------------------­ Directions for Keeping Dietary 1. Put down what child actually eats. 2. Measure in cup or tablespoon. 3. Abbreviations: c=cup; T =tablespoon; t =teaspoon. Day BREAKFAST DINNER Food Amount Food Amount SUPPER BETWEEN MEALS Food Amount Food Amount COMMENTS INDEX Aceuraey, or data, 11 Adequacy: Calorl.,, protein, mineral, 19-21, 64 comp&rt.on, Mexican and American dim, 1&-21 American dleta compared with Mexican, 19-21 nutrition of children, 66-67 weill'ht of children, 68 heelth of children, 70 Aub, bone trabeculae study or, 88 Austin, aourc" of data, 9-10 Baldwin, ranll'e In h..ill'ht, 69 Bananas, vitamin adequacy of, 21 Baths, facillt1"8 for, 10 Beans vitamin adequacy, 21 in preventlq pelJacra, 26 u Vitamin B, 26 use of, 80 for children, 68 Beef, for children, 64 Bone 1tudy of trabeculae, 88 atorehoua" for calcium, 83-84 Bonnet. Dr. Edith, 68 Bottl.,.feedlq, percentall'e of, 62 Bowlep, 70 Bread, 11..e Graham, Ry.,, White, Whole Whfft bread Breut-f.....Uq, per-c..atall'e of, 62 Budll'et. food, 28 Bureau of Labor, U.S., 80 Burkhart, M". Gaile, 6 Butta u Vitamin A, 24 weekly consumption, 26 for childnn, 61, 66 Calcium, outatandinll' deficiency of, 88-86, 67 Calculation, of data. 11-12, 60 Calorie requlrem..ata, 61 adequacy, 6MO Intake, 68 di11trlbutlon, 27 Cerealo vitamin adequacy, 21 u Vitamin B, 26-26 u Vitamin G, 26 defldency, Calcium, Vitamin A 28 for children, 62, 62-418, 65 ' Ch-. vkamln adequaey of, 21 Childbirth, 11 ChUdnn number under fifteen, 10 requlrementa, 18, 68 g:::ra·· Bureau, 611 no data on content, 11-12 In children'• diet. 64 Chocolate, for children, 62 Cocoa, for children, 62 Cod-llv"r oil th"rapy rare, 26, 112 for children, 66 Coffee vitamin adequacy. 21 for children, 112, 62, 84 Comparative atatlati-86 Disease reeulta of deficiency, 88-86 resistance to, 86-86 Diatribution, of calories, 27 Economic Conditions, relative Impor­tance of, 29 Economy of diet, 29-82 Efficiency, phyalolOll'lcal, 9 Esrll'• vitamin adequacy. 21 weekly conaumntlon, 25 for children, 68, 65 Enchiladas. In children's diet, 64 Epprlll'ht. study of Alllerlcan and Nerrro children, 66 Examination, physical, 69 Expenditure distribution amonll' foodo, 28 compared with retu?'tla, 29 Extent, of study, 9-10, 49 Flat-f..et_ 70 Flour. «e, Graham, White, Whole Wheat Flour Food Administration, budll'et of, 28 FrlJolea, 80, 52 Fruit vitamin ~uacy, 21 for children. 68, 66 Gillet, standard for calorie requlr.,_ ment, Ill, 118 Goldman, Mary, II, 10 Gon,..lea, Aurora, II, 49 Gonzalea, Kathleen, II, 10 Graham Flour, lack of, 25 Grain producta, 68 Hablto, modified dietary, 9 Ham, for children, 64 Hawl.,y, Dietary Scalee and Standards, 12-14 Health, relaUd to diet In children, 88-78 Hell!'ht Mexican adults, 18 children, 68-69 98 INDEX Holt, standard of requirementa, 118, 118 Improvement. recommendation In diet, 81, 64-66 Income, ranire of, 10 Individual Method of Determinlnir Ade­quacy of Dieta, 12-11 Infante, prenatal eare, feedlna, 61-112 Infections, expoaure to, 70 Instruction, to mothers, 60 International Institute, 6, 11 Inventory, of food, 10 Iron, deficiency in, 68 Knock-knees, 70 Laboratory Handbook, Rose, 11, 50 Lactation period, drain on calcium, a• Lime, bone diseases from lack of, 88 Liver, for children, 6•, 66 Living conditions, 10 Macaroni, for children, 81 Man-units, In Hawley method, 18 Maaa no data on content. 11-12 number families usinir, 26-28 Meat food value, 12 vitamin adequacy, Ill as Vitamin A, 24 as Vitamin G, 26 for children, 6• Kerrill-Palmer, ranae In helaht, 69 Method of obtalnlns data, 10-11, •MO of determining adequacy of dletl, lll-16 Midwives, employment of, Ill Milk vitamin adequacy, 21 as Vitamin A, 24, 28 dally consumption, 2'-26 aa Vitamin G, 26 condensed for babies, 62 for children, 62, 66 Milk, mother's, calcium content, 84 Milled Cereals, substitution of, 26 Mineral requirements of adults, 18 adequacy, U-60 deficiencies, 68 Minimum, coet for adequate nutrition, 15 Mutton, for children, 6' Neirro com\)ariaon, children and Mexican, 66-67 welirht of children, 68 health of children, 70 Noee Dlacharirea, 70 Number, famlllea studied, 10-11 Oatmeal, for children, 68 Occupation, of Mexicans, 9 Onions, vitamin adequacy, 21 Oranires, vitamin adequacy, 21 Orange Juice for Infants, H for children, 68, 66 O.teomalacla, number of eaaea, 8', 86 OateoPoroels, 88 Overwelirht, of children, 68 Pan Dulce, ne Sweet Bread Pellairra theory of prevention, 26 number of eaaea, 86 Peppen, tor children, 6' Period, covered by study, 11 Phoephorua Deficiency. 118 Physicians, employment of, Ill Phyaloloirlcal results of deftcleney, 88-88 Pinto beans, 80 Population, Mexican• In Texas, 9 Poeture, 69-70 Potatoes vitamin adequacy, 21 aa Vitamin B, ll6 aa Vitamin C, 26 food for children, 62, 68, 611 Pretrnancydrain on calcium, 84 no dietary retrlme, 61-112 Premature Births, e&al'9 reported, Ill Prenatal care, 49, 61-112 Protein needs of family, 18 requirement standards, 68 adequacy, 6'-60 Recommendations, tor Improvement, 81--32 Residence, length of, 9 Resistance, to disease, 86-86 Respiratory dlaeue, 86 Requirements calorie, of children, 18 nutritive, 58 Rice lack of brown, ll5 for children, 68 Ricketa not oeteoPoroeis, 88 number of eaaea, 88 disputed question, 70 Rose Laboratory Handbook, 11, 50 workins plan for adequate diet, ll7 Rye Bread, for children, 68 Rypln, survey of Kansas children, 611 San Antonio, source of data, 9-10 San Antonio Health Department, 86 Scurvy, number of caa•, 86 Selection, need tor better, 81 Sherman concernlnir American food values, 19 comparison, expenditure and return, 29 Improvement of food buclsat. 80 Smith, Mrs. Helene P .. 6, 49 Solid food, In babies' diet. l5ll Spinach, for children, 68 Standards dietary, 9 nutritive requlrementa, 12-11 me.aurlnir requirements, 68 State Department of Health, 86 Students, work of, 6 Substitution, milled for whole sraln, 88 Suirar, vitamin adequacy, 21 Supervision, necessity of, 50 Sweet bread, no data on content of, 11-12 Tabl• of Nutritive Values of Food, 110 Tamai•, In children's diet, 64 Teeth, condition of, 69-70 Tomatoes vitamin adequacy, 21 as Vitamin B, 26 aa Vitamin C, 26 for children, 68 Tomato J ulce for Infante, 62 tor children, 611 Tortlllaa no data on content, 11-12 number families u1in1r, 25-26 for children, 112, 88 Tuben:uloel1, irreater death rate, 86 Underweilrht. aa, 88 Unl...nley Nunery School, 68, 70 Unaldlled worken, 9 Value, method of ftndlnir nntritlve, 12 Variatlons, from calorie and proteln etandarda, M Ventablee u Vitamin A. 24 for children, 52, 68, 615 Vesetable Soup, for children, 6S VU.t.rol therapy rare, 16 for children, 115 Vlalt8, dally, 10 Vitamin adequaey, 21-28 Vitamin A adequacy, 2'-215 raaon for deftciency, 28 In children'• dleta, 14 connection with noae diaeharsee, 70 Vitamin B adequacy, 215-26 In children'• dleta, 6' Vitamin C adequacy, 26 in children'• diets, 64, 65 connection with dental decay, 70 Vitamin D adequacy, 26 preeumed deftciency, SS in children'• diets, 64, 65 connection with dental decay, 70 Vitamin G, adequacy of, 26 Wute, no calculation of, 1~11 Weanin11, aire of, 51-52 Weitrht of Mexican men, lS of children, as. 68 White bread, uee of, 25-26 White flour uee of, 25-26 for children, 63 Whole Wheat bread, for children, 68, 615 Whole Wheat flour, lack of, 215 Wriirht, Della. 15, 11