on several characteristics of the mother and child which might be listed among these factors was collected at the Nutrition Clinic of the Philadelphia Lying-In Hospital and included parity of the infant, maternal age, length of gestation, mother's pregravid weight status, and mother's height. The analysis to be presented in this report examines the relationship between these variables and the size of the infants at birth as measured by weight, chest circumference, crown-sole length, crown-rump length, rump-sole length, hip breadth, and head circumference. The analysis is based on the observations on 1,466 singleton infants whose mothers attended the Clinic during the period 1947-1952, and includes 75 babies weighing less than 5.5 Ibs. at birth who were therefore classified as premature. The white

THE Nutrition Study carried on at the Pennsylvania Hos­ pital from 1947 to 1952 was designed to investigate the effect of the addition of protein and vitamin supple­ ments to the diets of pregnant women upon the outcome of their pregnancy and upon the physical status of their infants. The previous reports from the Study have dealt primarily with the first of these two questions, and it is with the second, the relationship between supplementation of the maternal diet and the physical status of the baby, that this report is concerned. Under the plan of the study, women coming to the Clinic of the Hospital during the first 16 weeks of pregnancy were re­ ferred to the Nutrition Clinic. There they were assigned to one of four groups, on a random basis controlled for race, age, and gravida. One group was designated as the control and was given no nutritional supplement, a second group was given vitamins only, the third group a protein supplement only, and the fourth group was given both vitamins and the protein sup­ plement.4 Uniform diet instructions were given to the women

HE weight and size at birth of babies born to obese mothers is of clinical importance because the overweight patient has an increased likelihood of a long labor and difficult delivery which may be complicated further by a large baby. Consequently, limitation of fetal growth frequently is attempted through severe restriction of prenatal weight gain. Implicit in such a procedure is the belief that prenatal weight gain has a significant effect on the size of the baby and that the low intake of food required to restrict weight gain has no unfavorable effects on the mother or her baby. Records of obese patients who attended the Nutrition Research Clinic at the Philadelphia Lying-In Hospital from 1947 through 1952, afford data relevant to the problem of birth size and its relation to prenatal weight gain and also on potential benefits to the patient and her baby of a high level of intake of essential nutrients. The population and procedures of the Nutrition Research Clinic will be described briefly. All prenatal patients registering at the Philadelphia LyingIn Hospital were referred to the Nutrition Research Clinic if estimated gestation was not more than sixteen weeks, if the patient was married, and if there was no indication of serious chronic disease or syphilis,2 unless the patient refused to attend clinic in the afternoon. With these exceptions, the patients are

THAT there is an intimate relationship between the nu­ tritional status of a mother and her well-being during pregnancy as well as that of her baby would scarcely be questioned today. Nevertheless, health supervision in pre­ natal clinics rarely includes any individual teaching of mothers concerning dietary requirements during pregnancy. No per­ sonnel is provided in hospitals for this service, and physicians give attention to the diet of a patient chiefly after toxic symp­ toms or excess weight gain are noted. The potential value of diet education for mothers in preventing complications of preg­ nancy and infant loss has been recognized by many public health workers, but programs for integrating such a service into hospital prenatal clinics have not been developed. In 1947 the Nutrition Committee of the Bronx Council of Social Welfare became interested in the problem of teaching nutrition to patients in prenatal clinics in City Hospitals in New York and enlisted the cooperation of Morrisania City Hospital2 for a maternal nutrition demonstration. It seemed desirable to evaluate the results of the demonstration, and a pilot experiment was planned with advice from the technical staff of the Milbank Memorial Fund. The Community Serv­ ice Society of New York made it possible to conduct the project by furnishing a nutritionist and a nurse who took the diet his­ tories and gave nutrition instruction to patients.3 This experiment in diet education was undertaken with two

Evaluation of Diagnostic Signs and Therapeutic Tests for Nutritional Deficiency States Dorothy G. Wiehl CopyRight https://doi.org/10.2105/AJPH.41.8_Pt_2.69 Published Online: October 03, 2011

T 1 HIS is the concluding paper on the Study of the Nutritional Status of Aircraft Workers in Southern California. It is a summary of the whole Study and discusses the results in the context of related studies and their objectives. The immediate impetus to the undertaking of the Study came from the call for maximum production in the war effort. In the years preceding the National Emergency and the War the general public had become increasingly interested in nutrition, especially in the question of the value of vitamin supplements. A few employers were convinced that production was improved by improving the nutrition of their workers. In most cases this opinion was an interpretation of the results of tests, without controls, of supplementing the diets of workers with vitamin concentrates. There were no adequate studies of the nutritional status of the workers before and after a vitamin supplement was used, nor of precisely what was gained by its use. In most industrial groups in the United States there is probably relatively little severe or acute nutritional deficiency. At the time of the declaration of the National Emergency in I941 the effects of improving the diet of such a population on health, working calThe Study of the nutrition of aircraft workers in California was sponsored by the Nutrition Committee (R. A. Millikan, Chairman), appointed by the Board of Supervisors of the County of Los Angeles, California, and the Committee on the Nutrition of Industrial Workers of the National Research Council. The Study was supported in part by the sponsors and by the following: the California Institute of Technology, The Lockheed Aircraft Corporation, the Milbank Memorial Fund, the War Production Board, and the Work Projects Administration (Project No. 12372). Support was also received from the California Fruit Growers Exchange, the Gelatin Products Corporation, Hoffman-LaRoche, Inc., Merck and Company, the National Oil Products Company, the Research Corporation, E. R. Squibb and Sons, and the Vita-Food Corporation. s California Institute of Technology, Pasadena. 8 Milbank Memorial Fund, New York.

'This Study of the nutrition of aircraft workers in California was sponsored by the Nutrition Committee (R. A. Millikan, Chairman), appointed by the Board of of Supervisors of the County of Los Angeles, California, and the Committee on the Nutrition of Industrial Workers of the National Research Council. The Study was supported in part by the sponsors and by the following: the California Institute of Technology, The Lockheed Aircraft Corporation, the Milbank Memorial Fund, the War Production Board, and the Work Projects Administration (Project No. 12372). Support was also received from the California Fruit Growers Exchange, the Gelatin Products Corporation, Hoffman-La Roche, Inc., Merck and Company, the National Oil Products Company, the Research Corporation, E. R. Squibb and Sons, and the VitaFood Corporation. Dr. L. de Merre participated in this work; we take this occasion to thank him. 2California Institute of Technology, Pasadena. 'Milbank Memorial Fund, New York. At the second examination H. Borsook made the physical examinations, biomicroscopic examinations of the tongue and conjunctivae; J. W. Dubnoff made the biomicroscopic examinations for corneal vascularization; and G. W. Keighley conducted the tests for vibratory sensibility. At the first examination the physical examinations were made by Elmer Alpert and E. D. Kremers; biomicroscopic examinations on the eyes by Elmer Alpert, H. Borsook and J. W. Dubnoff. Miss B. T. Woodberry performed the hematological work at the first examination and Elizabeth B. Goolden at the second. The ascorbic acid measurements were made by G. H. Palmer at the first examination and by Josephine G. Williams at the second. Dorothy G. Wiehl supervised and participated in the analysis of all the data, as well as in planning the Study.