Our society today is so complex that most women--and men, too, for that matter--do not know where their efforts for its simplification could be applied. The technological revolution with its rapid urbanization and other social dislocations has been hard enough upon men, but it has disrupted the lives of women far more drastically. Accelerated by wars both hot and cold, this revolution has shattered the old social structure, undermined the family, and weakened traditional moral standards. At the same time economic forces have drawn some twenty million women into the labor market and the professions. Most women work of necessity, many because they are especially talented. But the force of our economic maelstrom is such that few people can resist being drawn into it. It has now come to the point where many married women work and neglect their children because they feel they must have a paid job in order to hold the respect of the community. As a result, homemaking has become depreciated. It is one thing if women work because they must help support the family and other dependents or because they have a special contribution to make to society. It is quite another thing--it is socially undesirable--if society forces the mother to take a job in order that she may respect herself and gain the respect of others. No wonder that the average stay-at-home housewife is confused. She is no longer sure what society expects of her. Women have gained an unparalleled freedom in American only to sacrifice it to the rat race for success--and success in our country, alas, means financial success.
There are other bitter heritages with which the middle-aged woman has to contend. The feminist influence taught women to see themselves as rivals of men rather than as partners of a common endeavor, whether on the job or in the home. I concede that the early feminists had so many legal, political, and economic disadvantages to combat, and most males were so stupid in their opposition to progress in these areas, that hostility between the sexes was difficult to avoid. As a result, we have many worried, restless, immature females who complain bitterly that there are not enough women in the United Nations, the government, and diplomacy. Others actually rebel against the inescapable fact that they are women.
Dangerous as this dissatisfaction with their own womanhood may be to women's psychology, it is not more insidious than the reaction now in full swing which tempts women to be nothing but females. The preoccupation with glamor so prevalent in America today is the pernicious result. No self-respecting woman--or man for that matter--should neglect outward appearances; but too great a preoccupation with it is a sign of a superficial attitude toward life.
Yet our women have long had the greatest freedom to lead courageous, individualistic lives, for our institutions have been friendlier to them than those of any other nation. But many lack the self-discipline needed to ration that most precious of all things, time. Psychologists will tell you that many of them clutter up their lives with trivialities, that they actually welcome distraction because they lack clear-cut, worth-while objectives and therefore do not develop the will-power to organize their time and use their leisure for more continuity of thought and action.
Much of this lack of discipline results, I believe, from the attitude toward marriage entertained by many American women. When they get their man they feel the goal of life has been achieved and renounce further ambitions for self-development. As a result, the sheer ignorance of American women is appalling. In our country, where women have had the same opportunities for education as men, this is inexcusable. George Gallup has given me figures which prove that American men are not too well informed on current events, but the record of the women in every test is far lower.
Wednesday, October 17, 2007
Creation and Education
Education is of course learning something. More importantly, it is becoming something. Although knowledge is needed for education, an educated person is not the same as a man who has knowledge. An educated person is one who is at work on his enlargement. If we learn things that become parts of us, if we make efforts to develop our own particular understanding of life and of the order of life's goods, it is education we are doing. A person is something that it takes time to make; there is on everyone an invisible sign, "Work in progress"; and the considered effort to get along with the work is education.
Thought of in this way, education is not as common as one might suppose. The institutions that we call "educational" are engaged only now and then in the development, in children and young people, of understanding of the order of life's goods. Schools and universities provide care of the young, offer recreation and pleasant associations, teach many useful skills from reading and writing to surgery and the preparation of legal briefs, and occasionally, desirably, indispensably educate.
So much of life goes just to keep things running, to police action, to bolstering the dikes against catastrophe. In our national life we have small freedom to decide how to spend the income of our immense national wealth. Most of it is firmly committed to paying for past wars and to trying to protect ourselves from or in future wars. In the schools we have got ourselves into a situation where we have only limited freedom to educate. You will see a schoolroom with fifty children and one teacher; the teacher uses most of her energies in keeping some kind of order. In a high school or college, also, much that goes on is merely custodial. Part of the budget goes to keeping the young people out of trouble and reasonably happy. If parents feel sure that this much is being accomplished, they are thankful and content.
If an occasional adult turns to the task of making himself grow in understanding of the order of life's goods by way of books and reasonable discussion, he meets a world and often a neighborhood that are unfavorable to his effort. Time and the will for education are in short supply. There are the pressures of immediate circumstance; there are work, entertainment, and the enjoyment of life in other ways. There are the innumerable problems of personal and public life. Many people today are passive or pessimistic; the tone of much public life is harsh and threatening; the danger of war by indiscriminate slaughter continues.
Nor is there much encouragement for education by adults, of themselves, in the examples and expectations that we encounter in our communities. What appears in most current print or broadcasting is for the most part irrelevant or ignoble. And one's neighbors are not likely to expect one to start work on one's own development through the pursuit of learning. Education, being a growth of the self, is in nature endless and hardly begins in the schools, but there is a widespread mistaken idea that all that sort of thing is over in school and college. Thoughtful people, who read a good many books, are today sometimes looked upon as a little queer, possibly as dangerous. The pursuit of learning by grown men and women is not very popular.
I state these difficulties so that we may take them into account in judging the worth of what I say here about what education is and how it goes on in men and women. No doubt I have overemphasized them. To the peasant of India wanting to learn just to read and write, America is vastly fortunate. Compared with other peoples, we are blessed with unusual material provision for such education as we may want to undertake. Where else is the working day so short? Where else have people such means to enjoy books, travel, and time to think?
In the very general sense of becoming something, everybody gets educated; everybody becomes something in the course of his life. The questions are, How good or bad a something? And, who decides what I become?
To meet the necessity of becoming something or other as one grows up and grows old, there are at least four distinguishable possibilities. The first way is no longer open to us; it was the way in which, in primitive societies, education was brought about merely through living the expected life. Taught by the example and the simple instruction of those around him, the American Indian or the African tribesman arrived at such wisdom as he needed in his well-integrated and largely stable world.
Creation, not always connected closely with education, is an experience that all may have. Sara, age three, creates a song by changing one word of a song her mother sings her. Now she sings a song that is "her very own." The Pueblo Indian potter varies one line of a traditional volute and knows herself an artist. I read today of an American who devotes his life to improving the effectiveness of the handles we grasp on the tools we use. Such creations are narrow, but they provide the sense of being a creator.
Greater creations may be achieved not only by the professional artists or scholars but by other people who are carrying on some private study for the joy it gives them. That part of the Maya hieroglyphic writing known as the Supplementary Series was deciphered by an American chemical engineer in the course of the journeys by train that he took in connection with his business. The glyphs had been for years a puzzle to specialists. The ancient Mediterranean script known as Linear B, written by the Greeks of Crete and Asia Minor, was recently made readable by the efforts of a young English architect.
The great creations of art and science and scholarship no doubt contribute to the education of those who achieve them and also provide works and ideas which become materials for the education of others. The coming to understand something--to understand it in that degree and kind which makes the thing learned a part of one's mind and self--is a creation, too. In this case the thing made is more private and personal. It is never wholly so. Education is an exchange in which each learner helps build the other as he builds himself.
Learning that educates includes an element of invention. In anthropology we speak of a process called "stimulus diffusion." Peoples learn. from other peoples not only by imitating one another but also by observing one another and then doing something in a different way that reaches the same end. After Chinese porcelain had been coming to Europe for almost two centuries, European potters, stimulated by the beauty of the Chinese product, set themselves the task of finding a way to make it and succeeded. In the early nineteenth century a Cherokee Indian, who was entirely without schooling or knowledge of English, was impressed by the white man's writing and was stimulated to invent, single-handed, a syllabary. He had not grasped the alphabetic principle, but the example of writing that he saw and only partly understood was enough to cause him to invent. It seems to me that my own experience as a teacher might provide examples of learning by stimulus diffusion.
Thought of in this way, education is not as common as one might suppose. The institutions that we call "educational" are engaged only now and then in the development, in children and young people, of understanding of the order of life's goods. Schools and universities provide care of the young, offer recreation and pleasant associations, teach many useful skills from reading and writing to surgery and the preparation of legal briefs, and occasionally, desirably, indispensably educate.
So much of life goes just to keep things running, to police action, to bolstering the dikes against catastrophe. In our national life we have small freedom to decide how to spend the income of our immense national wealth. Most of it is firmly committed to paying for past wars and to trying to protect ourselves from or in future wars. In the schools we have got ourselves into a situation where we have only limited freedom to educate. You will see a schoolroom with fifty children and one teacher; the teacher uses most of her energies in keeping some kind of order. In a high school or college, also, much that goes on is merely custodial. Part of the budget goes to keeping the young people out of trouble and reasonably happy. If parents feel sure that this much is being accomplished, they are thankful and content.
If an occasional adult turns to the task of making himself grow in understanding of the order of life's goods by way of books and reasonable discussion, he meets a world and often a neighborhood that are unfavorable to his effort. Time and the will for education are in short supply. There are the pressures of immediate circumstance; there are work, entertainment, and the enjoyment of life in other ways. There are the innumerable problems of personal and public life. Many people today are passive or pessimistic; the tone of much public life is harsh and threatening; the danger of war by indiscriminate slaughter continues.
Nor is there much encouragement for education by adults, of themselves, in the examples and expectations that we encounter in our communities. What appears in most current print or broadcasting is for the most part irrelevant or ignoble. And one's neighbors are not likely to expect one to start work on one's own development through the pursuit of learning. Education, being a growth of the self, is in nature endless and hardly begins in the schools, but there is a widespread mistaken idea that all that sort of thing is over in school and college. Thoughtful people, who read a good many books, are today sometimes looked upon as a little queer, possibly as dangerous. The pursuit of learning by grown men and women is not very popular.
I state these difficulties so that we may take them into account in judging the worth of what I say here about what education is and how it goes on in men and women. No doubt I have overemphasized them. To the peasant of India wanting to learn just to read and write, America is vastly fortunate. Compared with other peoples, we are blessed with unusual material provision for such education as we may want to undertake. Where else is the working day so short? Where else have people such means to enjoy books, travel, and time to think?
In the very general sense of becoming something, everybody gets educated; everybody becomes something in the course of his life. The questions are, How good or bad a something? And, who decides what I become?
To meet the necessity of becoming something or other as one grows up and grows old, there are at least four distinguishable possibilities. The first way is no longer open to us; it was the way in which, in primitive societies, education was brought about merely through living the expected life. Taught by the example and the simple instruction of those around him, the American Indian or the African tribesman arrived at such wisdom as he needed in his well-integrated and largely stable world.
Creation, not always connected closely with education, is an experience that all may have. Sara, age three, creates a song by changing one word of a song her mother sings her. Now she sings a song that is "her very own." The Pueblo Indian potter varies one line of a traditional volute and knows herself an artist. I read today of an American who devotes his life to improving the effectiveness of the handles we grasp on the tools we use. Such creations are narrow, but they provide the sense of being a creator.
Greater creations may be achieved not only by the professional artists or scholars but by other people who are carrying on some private study for the joy it gives them. That part of the Maya hieroglyphic writing known as the Supplementary Series was deciphered by an American chemical engineer in the course of the journeys by train that he took in connection with his business. The glyphs had been for years a puzzle to specialists. The ancient Mediterranean script known as Linear B, written by the Greeks of Crete and Asia Minor, was recently made readable by the efforts of a young English architect.
The great creations of art and science and scholarship no doubt contribute to the education of those who achieve them and also provide works and ideas which become materials for the education of others. The coming to understand something--to understand it in that degree and kind which makes the thing learned a part of one's mind and self--is a creation, too. In this case the thing made is more private and personal. It is never wholly so. Education is an exchange in which each learner helps build the other as he builds himself.
Learning that educates includes an element of invention. In anthropology we speak of a process called "stimulus diffusion." Peoples learn. from other peoples not only by imitating one another but also by observing one another and then doing something in a different way that reaches the same end. After Chinese porcelain had been coming to Europe for almost two centuries, European potters, stimulated by the beauty of the Chinese product, set themselves the task of finding a way to make it and succeeded. In the early nineteenth century a Cherokee Indian, who was entirely without schooling or knowledge of English, was impressed by the white man's writing and was stimulated to invent, single-handed, a syllabary. He had not grasped the alphabetic principle, but the example of writing that he saw and only partly understood was enough to cause him to invent. It seems to me that my own experience as a teacher might provide examples of learning by stimulus diffusion.
Can Retirement Satisfy?
As our technology has become more efficient, fewer workers have been needed to do the work of the country, even though standards of living were rising and people were consuming more goods and services. When the depression of the thirties brought unemployment, the older workers were discharged first, and the Social Security Act was passed to give these people an income. Then World War II brought full employment and kept older workers on the job but did not modify the expectation that had been built up especially in big business and industry and in government and civil service--the expectation of compulsory retirement at a fixed age, usually 65.
Retirement is a new way of life. The elderly man who has filled his day with eight or ten hours of work must find new ways of living these eight or ten hours daily. His wife must also learn new living patterns, with her husband at home much more of the time. The person at retirement must learn to do without the things that his work has brought him; and his work has brought him more than his weekly or monthly pay.
For some people retirement is a goal toward which they have been working. It is the culmination of years of hope, sacrifice, and planning. For others it is a trap, a piece of bad luck for which they are unprepared. What retirement means to a person depends partly on what his work has meant to him. If he can get the satisfactions out of retirement that he formerly got out of work, or if he can get new and greater satisfactions in retirement than he got in his work, then retirement is a boon to him.
What does retirement mean in the life-cycle? Is it merely a narrow band of years coming at the end of a full life and ending in death, or is it a broad stretch of opportunity to enjoy one's self, to do things one always wanted to do?
In either case retirement is a new way of life and carries some problems with it. There are problems of leaving work--of finishing things off, of breaking off sharply or tapering off slowly, of deciding whether to look for another job or a part-time job. Then there are the greater problems of entering the new life. These problems consist of learning how to manage on a reduced income, how to use more leisure time, and how to get new satisfactions to replace the ones that went with work.
The economic cost of retirement to the nation will grow as the proportion of older people grows, unless we revise our retirement policies. For the individual there is sure to be some cost to retirement, if only the loss of the income which he has been earning. In addition, most people get other satisfactions from their work, and retirement means the loss of these satisfactions unless they can find other ways of gaining similar satisfactions.
As the time comes when work is not a necessity for the whole of adult life, older people are most affected by the change in significance of work. The primary function of work as the means of securing income is beginning to lose its significance for older people. Less frequently does the veteran of forty years of work say, "I have to work to eat. How can a workingman retire?" A pension can answer that question for him. He has earned the opportunity to retire and to live for ten or fifteen years of comparatively good health free from work if he wants to.
If work had only the function of earning a living and this function was discharged for life by the age of 65, everyone should welcome retirement at that age. But other essential functions of life are included in work. If these functions and the satisfactions they bring are lost by retirement, then retirement is an undiluted tragedy for a man.
The problem of retirement is to secure the extra-economic values that work brings and to secure them through play or leisure-time activity. Can this problem be solved? Can play have the same functions as work? Can play provide the satisfactions to older people that they formerly got out of work?
In Western society, work is by cultural definition sharply set off as the enemy of pleasure, love, consumption of goods, and almost every sort of freedom. Work is a task defined and required of one by other people. This historical cultural definition of work is not valid for many of the workers. They have found other and more pleasurable meanings in their work.
Let us consider the extra-economic meanings of work and inquire whether leisure-time activity, play, or recreation also have similar meanings, and, if so, how the meanings of work can be realized in leisure.
Being with other people, making friends and having friendly relations with people, is one of the principal meanings of work to people in all the occupations we have studied. This function is also served by clubs, churches, recreation agencies, and a variety of formal and informal associations in the person's nonwork life. The pattern already exists; the problem is to fill the void created by loss of work associations in nonwork life.
Retirement is a new way of life. The elderly man who has filled his day with eight or ten hours of work must find new ways of living these eight or ten hours daily. His wife must also learn new living patterns, with her husband at home much more of the time. The person at retirement must learn to do without the things that his work has brought him; and his work has brought him more than his weekly or monthly pay.
For some people retirement is a goal toward which they have been working. It is the culmination of years of hope, sacrifice, and planning. For others it is a trap, a piece of bad luck for which they are unprepared. What retirement means to a person depends partly on what his work has meant to him. If he can get the satisfactions out of retirement that he formerly got out of work, or if he can get new and greater satisfactions in retirement than he got in his work, then retirement is a boon to him.
What does retirement mean in the life-cycle? Is it merely a narrow band of years coming at the end of a full life and ending in death, or is it a broad stretch of opportunity to enjoy one's self, to do things one always wanted to do?
In either case retirement is a new way of life and carries some problems with it. There are problems of leaving work--of finishing things off, of breaking off sharply or tapering off slowly, of deciding whether to look for another job or a part-time job. Then there are the greater problems of entering the new life. These problems consist of learning how to manage on a reduced income, how to use more leisure time, and how to get new satisfactions to replace the ones that went with work.
The economic cost of retirement to the nation will grow as the proportion of older people grows, unless we revise our retirement policies. For the individual there is sure to be some cost to retirement, if only the loss of the income which he has been earning. In addition, most people get other satisfactions from their work, and retirement means the loss of these satisfactions unless they can find other ways of gaining similar satisfactions.
As the time comes when work is not a necessity for the whole of adult life, older people are most affected by the change in significance of work. The primary function of work as the means of securing income is beginning to lose its significance for older people. Less frequently does the veteran of forty years of work say, "I have to work to eat. How can a workingman retire?" A pension can answer that question for him. He has earned the opportunity to retire and to live for ten or fifteen years of comparatively good health free from work if he wants to.
If work had only the function of earning a living and this function was discharged for life by the age of 65, everyone should welcome retirement at that age. But other essential functions of life are included in work. If these functions and the satisfactions they bring are lost by retirement, then retirement is an undiluted tragedy for a man.
The problem of retirement is to secure the extra-economic values that work brings and to secure them through play or leisure-time activity. Can this problem be solved? Can play have the same functions as work? Can play provide the satisfactions to older people that they formerly got out of work?
In Western society, work is by cultural definition sharply set off as the enemy of pleasure, love, consumption of goods, and almost every sort of freedom. Work is a task defined and required of one by other people. This historical cultural definition of work is not valid for many of the workers. They have found other and more pleasurable meanings in their work.
Let us consider the extra-economic meanings of work and inquire whether leisure-time activity, play, or recreation also have similar meanings, and, if so, how the meanings of work can be realized in leisure.
Being with other people, making friends and having friendly relations with people, is one of the principal meanings of work to people in all the occupations we have studied. This function is also served by clubs, churches, recreation agencies, and a variety of formal and informal associations in the person's nonwork life. The pattern already exists; the problem is to fill the void created by loss of work associations in nonwork life.
To Retire or Not
The majority of younger executives said that they would want to leave their companies at normal retirement age. Most of them expressed the feeling, "I'll welcome retirement; just give me the chance to get away from this business pressure." Only a small proportion of these men added the cautionary proviso, "If I have enough money." The fact that twice as many said they would prefer less rigorous company assignments as said they would want to remain on a full-time basis is also an indication of an expressed desire to lessen business pressures. The "similar" or "different" work they said they wanted for post-retirement activity was usually described in no more than general terms. On the other hand, hobbies and recreational-cultural activities were mentional enthusiastically and definitely as occupations. This enthusiasm was somewhat less pronounced among those who looked forward to public-service assignments.
In contrast, the majority of older executives wanted to continue with their companies because the alternative of retirement simply did not seem so attractive to them. Realization of the personal satisfactions they obtained in business was impressed on this group as they contemplated leaving their companies; the disadvantages of pressure all but disappeared from their minds. They placed new importance on the business and social recognition provided by their jobs. There was anticipation of a loss of prestige and standing inherent in a change. This feeling was especially true among those executives who had achieved their job ambitions relatively late in their business lives. It seemed more prevalent, also, among men who had no more than a vague idea of their post-retirement programs. Over-all, the executives who said they wanted to continue with their companies looked with disfavor on "retirement from" and lacked a concept of "retirement to."
In contrast, the majority of older executives wanted to continue with their companies because the alternative of retirement simply did not seem so attractive to them. Realization of the personal satisfactions they obtained in business was impressed on this group as they contemplated leaving their companies; the disadvantages of pressure all but disappeared from their minds. They placed new importance on the business and social recognition provided by their jobs. There was anticipation of a loss of prestige and standing inherent in a change. This feeling was especially true among those executives who had achieved their job ambitions relatively late in their business lives. It seemed more prevalent, also, among men who had no more than a vague idea of their post-retirement programs. Over-all, the executives who said they wanted to continue with their companies looked with disfavor on "retirement from" and lacked a concept of "retirement to."
Wednesday, October 10, 2007
High blood pressure complications
High blood pressure sometimes produces headaches, spots before the eyes, dizzy spells, or nose bleeds, but these symptoms are not major concerns. However, high blood pressure that persists over a period of years accelerates arteriosclerosis, which can be serious because it is a major predisposition to stroke, heart attack, kidney disease, poor circulation in the legs, and heart failure. In response to a long period of high pressure, the heart gradually increases in size as it attempts to do heavier-than-normal work. Eventually the workload becomes too great, pressure cannot be maintained, the heart fails, the lungs become congested, and breathing becomes difficult. Thus, the complications of high blood pressure are much more serious problems than the pressure itself.
High blood pressure causes
Whether young or old, each of us experiences changes in blood pressure throughout the day. It is usually lower at night when we sleep and higher during waking hours. Psychological stress can temporarily increase the pressure, although even a relaxed person in a quiet room may experience increased or decreased pressure for no obvious reason. Blood pressure also varies considerably among different individuals, tending to vary more widely in younger than in older people. This may reflect older persons' greater experience in coping with the contingencies of day-to-day living.
In addition to momentary fluctuations, the average blood pressure over a period of time also varies from one individual to another. It is this average pressure that physicians seek to determine and understand by measuring blood pressure several times during a single visit and again on successive visits, comparing readings to obtain an average. After the age of 40, systolic pressures of 140 or less are normal, pressures of 140 to 159 are considered borderline, and pressures exceeding 160 may signal an abnormality, especially if sustained over a period of time. At these ages, diastolic pressures under 90 are normal, pressures of 90 to 95 are borderline, and pressures greater than 95 are considered abnormal, indicating a need for further evaluation.
For the most part, psychological influences on blood pressure are transitory. Only rarely does psychological stress sustain an elevated pressure, the pressure usually dropping when the source of stress is removed. Excess salt, or sodium, is a more common cause of elevated pressure. Sodium apparently gets into arterioles, increases their contraction, and causes constriction.
Although the association is poorly understood, overweight also significantly contributes to high blood pressure. However, it is clear that when weight raises the blood pressure, reducing the weight also lowers the pressure.
Heredity is the principal contributor to the most common type of high blood pressure, known as essential or familial hypertension, which affects almost 90 percent of all people with excessive diastolic pressure. For this reason, a family history of high blood pressure is significant. This problem often first appears in middle life, but minor elevations in pressure during youth may give early clues. However, the mechanisms by which genes affect blood pressure are unknown.
Evaluation of high blood pressure usually includes a study of the kidneys because kidney disease is frequently associated with pressure problems. While this form of high pressure differs from essential hypertension, the essential type can damage the kidneys. In some cases it is difficult to determine whether high pressure preceded kidney disease, or vice versa.
In rare instances, mostly in young people, tumors of the adrenal gland cause high blood pressure. The possibility must be considered, but is usually quickly ruled out.
In addition to momentary fluctuations, the average blood pressure over a period of time also varies from one individual to another. It is this average pressure that physicians seek to determine and understand by measuring blood pressure several times during a single visit and again on successive visits, comparing readings to obtain an average. After the age of 40, systolic pressures of 140 or less are normal, pressures of 140 to 159 are considered borderline, and pressures exceeding 160 may signal an abnormality, especially if sustained over a period of time. At these ages, diastolic pressures under 90 are normal, pressures of 90 to 95 are borderline, and pressures greater than 95 are considered abnormal, indicating a need for further evaluation.
For the most part, psychological influences on blood pressure are transitory. Only rarely does psychological stress sustain an elevated pressure, the pressure usually dropping when the source of stress is removed. Excess salt, or sodium, is a more common cause of elevated pressure. Sodium apparently gets into arterioles, increases their contraction, and causes constriction.
Although the association is poorly understood, overweight also significantly contributes to high blood pressure. However, it is clear that when weight raises the blood pressure, reducing the weight also lowers the pressure.
Heredity is the principal contributor to the most common type of high blood pressure, known as essential or familial hypertension, which affects almost 90 percent of all people with excessive diastolic pressure. For this reason, a family history of high blood pressure is significant. This problem often first appears in middle life, but minor elevations in pressure during youth may give early clues. However, the mechanisms by which genes affect blood pressure are unknown.
Evaluation of high blood pressure usually includes a study of the kidneys because kidney disease is frequently associated with pressure problems. While this form of high pressure differs from essential hypertension, the essential type can damage the kidneys. In some cases it is difficult to determine whether high pressure preceded kidney disease, or vice versa.
In rare instances, mostly in young people, tumors of the adrenal gland cause high blood pressure. The possibility must be considered, but is usually quickly ruled out.
Diastolic blood pressure
Diastolic blood pressure is controlled primarily by the tiny arteries at the end of the innumerable branches of the arterial tree in the muscles, skin, brain, and other parts of the body. These tiny arteries, or arterioles, contract and expand in response to muscle activity in the arterial wall. The muscles are controlled in turn by the autonomic nervous system, influenced by the amount of salt in the muscle. When the arterial muscles are relaxed and the arterioles are open, blood rushes into the arterial system as the heart pumps and out through the arterioles into the veins. Between heart beats, the pressure falls to the lower diastolic pressure. If systolic pressure is low, diastolic pressure will be correspondingly lower.
The inelastic large arteries of the older person with high systolic pressure tend to contribute to high diastolic pressure even if the small arterioles are clear because the pressure doesn't have enough time to fall to a normal low level before the next heart beat raises it again. Thus, an older individual may have a systolic pressure of 160 and a diastolic pressure of 90, yet have completely normal arterioles.
The inelastic large arteries of the older person with high systolic pressure tend to contribute to high diastolic pressure even if the small arterioles are clear because the pressure doesn't have enough time to fall to a normal low level before the next heart beat raises it again. Thus, an older individual may have a systolic pressure of 160 and a diastolic pressure of 90, yet have completely normal arterioles.
Systolic blood pressure
Systolic blood pressure is related to the strength of the heart muscle as it pushes blood into the arterial system, and more importantly, to the elasticity of the arteries -- their ability to expand and contract with changes in pressure. Thus, if the arteries are flexible and give easily as the heart beats, systolic pressure will not be excessively high. This is characteristic of young persons who often have a systolic pressure of 110, or even less. Such low pressure is not clinically significant. A medical school teacher may remark that the only thing to do for such individuals is to offer congratulations.
As we grow older, the blood vessel walls tend to stiffen, and arteriosclerosis (hardening of the arteries) may aggravate the normal loss of elasticity. Loss of elasticity causes a higher systolic pressure as the heart tries to force a normal amount of blood into the unyielding arteries. After the age of 55, systolic pressure tends to be higher, and a pressure of 150 to 160 is not unusual due solely to the normal loss of elasticity in aging tissues.
As we grow older, the blood vessel walls tend to stiffen, and arteriosclerosis (hardening of the arteries) may aggravate the normal loss of elasticity. Loss of elasticity causes a higher systolic pressure as the heart tries to force a normal amount of blood into the unyielding arteries. After the age of 55, systolic pressure tends to be higher, and a pressure of 150 to 160 is not unusual due solely to the normal loss of elasticity in aging tissues.
High Blood Pressure
High blood pressure by itself is not a serious problem. However, its secondary effects -- prolonged exposure of the heart, brain, kidneys, and blood vessels to high pressure -- are serious threats to well-being. Fortunately, harm can be minimized by lowering the blood pressure with drugs prescribed by a physician. But effective control requires full awareness of the condition and the aims of therapy. Because treatment may involve some side effects, the hypertensive must learn to deal with them. If necessary, the physician can usually modify the drug program to reduce troublesome reactions, so that therapy need not interfere with the normal enjoyment of life.
The term "blood pressure" refers to the pressure in the large arteries of the arms and legs. The measured pressure in millimeters of mercury is expressed in two numbers, the first always higher than the second. The first number is the peak (systolic) pressure reached when the heart muscles fully contract. When the heart relaxes, the pressure falls to a low point, the diastolic pressure, preceding the next heartbeat. This is indicated by the second number. Thus, a reading of 130/80 means a systolic pressure of 130 and a diastolic pressure of 80 millimeters of mercury.
The term "blood pressure" refers to the pressure in the large arteries of the arms and legs. The measured pressure in millimeters of mercury is expressed in two numbers, the first always higher than the second. The first number is the peak (systolic) pressure reached when the heart muscles fully contract. When the heart relaxes, the pressure falls to a low point, the diastolic pressure, preceding the next heartbeat. This is indicated by the second number. Thus, a reading of 130/80 means a systolic pressure of 130 and a diastolic pressure of 80 millimeters of mercury.
Influence of food on metabolism
With the youngest children it was not possible to obtain ideal conditions for measuring the basal metabolism, i. e., complete muscular repose and with no food in the alimentary tract, or the "post-absorptive" condition. With adults the post-absorptive condition is usually not secured until 12 hours after an ordinary meal and the maximum increase following a protein-rich meal may be as high as 40 to 50 per cent for a short time, with its effect possibly continued even longer than 12 hours. With the children observed in this study, excessively large meals were not the rule, the last meal before the observations with the respiration apparatus being purposely considerably reduced.
A careful control of the muscular activity was secured through graphic records. With the youngest children, and especially the infants, however, it was not possible to obtain the required degree of muscular repose when there was no food in the stomach, because the want of food caused restlessness and frequently crying. In recognition of this difficulty, it was necessary to compromise by supplying as small an amount of food as would produce comfort and consequent muscular repose. This amount of food, even though small, inevitably influenced the metabolism. When older children were studied, it was possible to postpone the observations after a meal for a longer period of time, even for 4 or 5 hours. Accordingly, in the subsequent analysis of the metabolism data for the children of various ages, it must be remembered that as the age of the children increases the influence of the ingestion of food decreases correspondingly. The basal metabolism of children under 2 years of age can thus be compared with that of older children only on the distinct understanding that the values for the basal metabolism for the younger children are higher than they normally would be, owing to the influence of food.
The quantitative measurement of the influence of the ingestion of food upon the metabolism of infants should be given special study, such as has been done for adults in a previous publication from this laboratory. Certain more or less fragmentary evidence has, however, been accumulated in the present research with children, in part by design and in part by accident. With several of the children, a prolonged series of observations was made after food had been taken, some of these continuing 9 or 10 hours without interruption. The results of these observations give some information as to the possible influence of food. Here again we find a difficulty in interpretation in that the somewhat subtle influence of food is profoundly affected by a change in the activity; hence only periods of comparable muscular activity, or preferably muscular repose, can legitimately be used to determine the influence of food upon the metabolism. That is, it must be assured that the increase in the metabolism after food is not due to muscular activity before assuming it is due to the stimulus of food.
A careful control of the muscular activity was secured through graphic records. With the youngest children, and especially the infants, however, it was not possible to obtain the required degree of muscular repose when there was no food in the stomach, because the want of food caused restlessness and frequently crying. In recognition of this difficulty, it was necessary to compromise by supplying as small an amount of food as would produce comfort and consequent muscular repose. This amount of food, even though small, inevitably influenced the metabolism. When older children were studied, it was possible to postpone the observations after a meal for a longer period of time, even for 4 or 5 hours. Accordingly, in the subsequent analysis of the metabolism data for the children of various ages, it must be remembered that as the age of the children increases the influence of the ingestion of food decreases correspondingly. The basal metabolism of children under 2 years of age can thus be compared with that of older children only on the distinct understanding that the values for the basal metabolism for the younger children are higher than they normally would be, owing to the influence of food.
The quantitative measurement of the influence of the ingestion of food upon the metabolism of infants should be given special study, such as has been done for adults in a previous publication from this laboratory. Certain more or less fragmentary evidence has, however, been accumulated in the present research with children, in part by design and in part by accident. With several of the children, a prolonged series of observations was made after food had been taken, some of these continuing 9 or 10 hours without interruption. The results of these observations give some information as to the possible influence of food. Here again we find a difficulty in interpretation in that the somewhat subtle influence of food is profoundly affected by a change in the activity; hence only periods of comparable muscular activity, or preferably muscular repose, can legitimately be used to determine the influence of food upon the metabolism. That is, it must be assured that the increase in the metabolism after food is not due to muscular activity before assuming it is due to the stimulus of food.
Rectal Temperature
Any physiological study of body temperature, to be of true scientific value, must deal with temperatures taken deep in the body trunk. The extraneous factors of exercise, mouth-breathing, and the effect of previously taken foods so greatly vitiate all measurements of the buccal temperature that they have little, if any, value except for demonstrating the absence of fever. It has been the custom of many clinicians to take the temperature of young children in the axilla or in the groin. These records, aside from likewise showing the presence or absence of fever, have no physiological value, for it has been found that even when these cavities are well-closed a very considerable period of time is required to raise their temperature to that approximating the interior of the body.
The rectal temperature was measured primarily to demonstrate the absence of any febrile condition, since the presence of fever would of course preclude further observations with the child in this abnormal state. Every reasonable effort was made to have these measurements meet the exactions of scientific accuracy, but as ordinary clinical mercury thermometers were used, even though well-tested, and there were changes in the personnel of the assistants from time to time, as well as possibilities of difference in the depth of insertion of the thermometer bulb, we may not look upon these observations as a refined physiological study of changes in body temperature of children.
It is to be regretted that a study of the diurnal rhythm of the rectal temperature of children of various ages could not have been included in the research, but this was impracticable. To use occasional observations of rectal temperature as a basis for determining the physiological temperature of children is open to serious question, since the well-known influences of activity, ingestion of food, and sleep make such measurements liable to gross variability. When one considers that the normal range in temperature is but 2° or 3° F:, it will be seen that if a study of the body temperature is to be made with strict scientific accuracy, a much more sensitive measurement should be used than that employed in this research. But as the measurements were all made with the child inside a chamber, lying quietly on a comfortable bed, we believe that although the method was admittedly defective, the conditions were essentially comparable and the values may legitimately be used for drawing conclusions.
The rectal temperature was usually recorded, at least with the younger children, just before and just after each respiration experiment. Several hundred observations of the body temperature of these children were thus obtained. The values for boys range from 97.1° F., the very low value for the two boys averaging 5 years of age, to a maximum of 99.52 F. in the group of six boys for 1½ years. During the first month or two of life the temperatures for boys are somewhat low, but with evidence of a tendency to rise thereafter, the maximum continuing for approximately two or three years. Subsequently the figures incline to run below rather than above 99° F., and after 10 years all values are 98.8° F. or under. Special attention has already been called to the extraordinarily low value of 97.1° F. for the two boys 5 years of age, which must not be looked upon as characteristic of that age.
The rectal temperature was measured primarily to demonstrate the absence of any febrile condition, since the presence of fever would of course preclude further observations with the child in this abnormal state. Every reasonable effort was made to have these measurements meet the exactions of scientific accuracy, but as ordinary clinical mercury thermometers were used, even though well-tested, and there were changes in the personnel of the assistants from time to time, as well as possibilities of difference in the depth of insertion of the thermometer bulb, we may not look upon these observations as a refined physiological study of changes in body temperature of children.
It is to be regretted that a study of the diurnal rhythm of the rectal temperature of children of various ages could not have been included in the research, but this was impracticable. To use occasional observations of rectal temperature as a basis for determining the physiological temperature of children is open to serious question, since the well-known influences of activity, ingestion of food, and sleep make such measurements liable to gross variability. When one considers that the normal range in temperature is but 2° or 3° F:, it will be seen that if a study of the body temperature is to be made with strict scientific accuracy, a much more sensitive measurement should be used than that employed in this research. But as the measurements were all made with the child inside a chamber, lying quietly on a comfortable bed, we believe that although the method was admittedly defective, the conditions were essentially comparable and the values may legitimately be used for drawing conclusions.
The rectal temperature was usually recorded, at least with the younger children, just before and just after each respiration experiment. Several hundred observations of the body temperature of these children were thus obtained. The values for boys range from 97.1° F., the very low value for the two boys averaging 5 years of age, to a maximum of 99.52 F. in the group of six boys for 1½ years. During the first month or two of life the temperatures for boys are somewhat low, but with evidence of a tendency to rise thereafter, the maximum continuing for approximately two or three years. Subsequently the figures incline to run below rather than above 99° F., and after 10 years all values are 98.8° F. or under. Special attention has already been called to the extraordinarily low value of 97.1° F. for the two boys 5 years of age, which must not be looked upon as characteristic of that age.
Sex and minumum pulse-rate
The intimate relation between pulse-rate and metabolism, shown with the same individual in the large majority of observations in this laboratory, makes a careful examination of pulse-rate with respect to sex of special importance. The analysis of data for the basal metabolism of men and women has shown that women as a class have a lower metabolism than men, not only per individual, but per unit of weight. On the other hand, the pulse-rate of women as a class was shown to be higher than that of men, as measurements for 90 women and 121 men in our series gave an average of 68.67 for women and 61.26 for men. These differences are substantiated by the fact that with men three different groups of 28, 116, and 50 men showed average pulse-rates of 62.5, 61.3, and 61.3, respectively. Two groups of women, one of 68 and the other of 22, showed pulse-rates of 69.1 and 67.3, respectively. In other words, it seems thoroughly established that the women as a class have a pulse-rate somewhat higher than men, in spite of the fact that their metabolism is distinctly lower. This supplies very clear evidence that while pulse-rate and heat production may be closely correlated in the same individual, in groups of individuals the pulse-rate may vary enormously and "average" pulse-rate may have little, if any, connection with "average" heat production.
Since the pulse-rates of men and women show a difference, it becomes extremely important, in studying our groups of children, to note at what point, if any, there is a definite change in the pulse-rate, and further comparisons of values for males and females will be of special interest in this connection. Such comparison may be made from the pulse-rate data for boys and girls in table 20, which gives an opportunity of noting the differentiation, if any, due to sex. To this end, wherever values for both boys and girls are recorded at the same age, the higher of the two values has been italicized. Thus, for children I day old, 29 boys gave an average minimum pulse-rate of 113, while 21 girls had a pulse-rate of 110. On the next day the conditions for very nearly the same number of boys as girls were reversed, the girls showing a pulse-rate 4 beats higher than the boys.
Pursuing this method of analysis for the entire group of data in table 20, and passing over those ages for which records are available for only one of the two sexes, we find that at 11 age-periods the boys have a higher pulse-rate than the girls of the same age, while at 15 age-periods the girls have a higher pulse-rate than boys of like age. On this basis, therefore, it would appear that the pulse-rate of the girls was, on the whole, somewhat higher than that of boys. The italicized figures in the table show no great regularity in the appearance of these high values with either sex. The most consistent record is that from 1½ months to 10 months, the only ages at which the girls are not higher being that of 4 months, and again of 5 months, when the average pulse-rate for both sexes is the same. After 10 months the italicized figures indicate but little regularity as to sex.
On the whole, the picture can not be said to speak pronouncedly for a higher pulse-rate with girls than with boys. In making this general conclusion, however, it is important to note that the data under consideration are at best somewhat meager, although they may be relied upon as far as they go. But many observations of the minimum resting pulse-rate of boys and girls are necessary before final conclusions can be drawn, for obviously the pulse-rate at other ages should be studied and supplementary data should be obtained for the higher ages included in our observations.
Since the pulse-rates of men and women show a difference, it becomes extremely important, in studying our groups of children, to note at what point, if any, there is a definite change in the pulse-rate, and further comparisons of values for males and females will be of special interest in this connection. Such comparison may be made from the pulse-rate data for boys and girls in table 20, which gives an opportunity of noting the differentiation, if any, due to sex. To this end, wherever values for both boys and girls are recorded at the same age, the higher of the two values has been italicized. Thus, for children I day old, 29 boys gave an average minimum pulse-rate of 113, while 21 girls had a pulse-rate of 110. On the next day the conditions for very nearly the same number of boys as girls were reversed, the girls showing a pulse-rate 4 beats higher than the boys.
Pursuing this method of analysis for the entire group of data in table 20, and passing over those ages for which records are available for only one of the two sexes, we find that at 11 age-periods the boys have a higher pulse-rate than the girls of the same age, while at 15 age-periods the girls have a higher pulse-rate than boys of like age. On this basis, therefore, it would appear that the pulse-rate of the girls was, on the whole, somewhat higher than that of boys. The italicized figures in the table show no great regularity in the appearance of these high values with either sex. The most consistent record is that from 1½ months to 10 months, the only ages at which the girls are not higher being that of 4 months, and again of 5 months, when the average pulse-rate for both sexes is the same. After 10 months the italicized figures indicate but little regularity as to sex.
On the whole, the picture can not be said to speak pronouncedly for a higher pulse-rate with girls than with boys. In making this general conclusion, however, it is important to note that the data under consideration are at best somewhat meager, although they may be relied upon as far as they go. But many observations of the minimum resting pulse-rate of boys and girls are necessary before final conclusions can be drawn, for obviously the pulse-rate at other ages should be studied and supplementary data should be obtained for the higher ages included in our observations.
Average pulse-rate of children
The second important factor to which our data contribute is the average pulse-rate of children of the same age, both as to its absolute value and as to the deviation therefrom which can be expected for children in repose. With boys, one of the most extensive series numerically that we have for any age represented is that for the group 7 months old, in which the basal pulse-rate for the 13 boys ranged from 107 to 127. The average for this group is found to be 117. It is clear, therefore, that it is only with a great deal of reserve that one may speak of the pulse-rate of a boy of 7 months as being 117. Even wider differences are observed with the 4 boys of 20 months, the lowest being 92 and the highest 127, with an average of 111.
From the foregoing discussion of the considerable variation to be found with an individual in the earlier years, one would naturally expect similar large differences between groups of older children of the same age. Thus, for the 7 boys 7 years of age, the lowest is 74 and the highest 99. With the 5 boys 9 years of age, the lowest record is 71 and the highest 86, while the 9 boys 11 years of age show a maximum difference in their basal pulse-rates of 22 beats.
With girls, one of the largest groups at the earlier ages is that for 6 months, but the pulse-rates for these 8 girls range only from 118 to 132, with an average of 124. This approach to uniformity, which is much closer than that noted for boys, does not by any means hold for all ages, since at 16 and 18 months differences amounting to 40 and 32 beats, respectively, are observed. Bearing in mind the irregularities seen in the careful examination of the data for these several age-groups, we may average these pulse data and attempt to portray the general trend of the minimum or basal pulse-rate of boys and girls from birth to 13 years of age. In so doing we have left out of the averaging all age-ranges represented by less than three individuals.
The average values shown for boys indicate a reasonably constant pulse-rate for the first 14 months of life, ranging from 113 to 125, if we exclude the first 5 days, and from 105 to 125 if these earlier values are included. Thereafter the picture is a gradual decrease, persisting throughout the second and much of the third year. The data between 3 and 6 years are lacking. During this period there has been a very considerable fall, the tendency to a decrease continuing subsequent to 7 years. The lowest value is 69 at the age of 12 years. With girls, the averages show that after the first 11 days there is a distinct tendency for a rise in pulse-rate, the return to the rate of the first week not taking place until shortly after the end of the first year. There is then a continued decrease, the lowest record being 74 at the age of 7 years.
From the foregoing discussion of the considerable variation to be found with an individual in the earlier years, one would naturally expect similar large differences between groups of older children of the same age. Thus, for the 7 boys 7 years of age, the lowest is 74 and the highest 99. With the 5 boys 9 years of age, the lowest record is 71 and the highest 86, while the 9 boys 11 years of age show a maximum difference in their basal pulse-rates of 22 beats.
With girls, one of the largest groups at the earlier ages is that for 6 months, but the pulse-rates for these 8 girls range only from 118 to 132, with an average of 124. This approach to uniformity, which is much closer than that noted for boys, does not by any means hold for all ages, since at 16 and 18 months differences amounting to 40 and 32 beats, respectively, are observed. Bearing in mind the irregularities seen in the careful examination of the data for these several age-groups, we may average these pulse data and attempt to portray the general trend of the minimum or basal pulse-rate of boys and girls from birth to 13 years of age. In so doing we have left out of the averaging all age-ranges represented by less than three individuals.
The average values shown for boys indicate a reasonably constant pulse-rate for the first 14 months of life, ranging from 113 to 125, if we exclude the first 5 days, and from 105 to 125 if these earlier values are included. Thereafter the picture is a gradual decrease, persisting throughout the second and much of the third year. The data between 3 and 6 years are lacking. During this period there has been a very considerable fall, the tendency to a decrease continuing subsequent to 7 years. The lowest value is 69 at the age of 12 years. With girls, the averages show that after the first 11 days there is a distinct tendency for a rise in pulse-rate, the return to the rate of the first week not taking place until shortly after the end of the first year. There is then a continued decrease, the lowest record being 74 at the age of 7 years.
Normal pulse-rates for children
One of the most striking indices of apparent changes in metabolic activity, induced either by muscular activity or by febrile conditions, is the pulse-rate. In our earlier treatment of the physiology of normal infants, 1 we laid special emphasis upon the importance of knowing the fluctuations in the activity as exhibited by the kymograph record of the movements of the crib and particularly upon the relationships between this curve for activity and both the pulse-rate and the metabolism.
Before the study of new-born infants, our observations on children were so scattered and represented so few normal subjects that we were unable to record normal pulse-rates for children of various ages. With the new-born infants, however, this was perfectly feasible, and in the report of that study, 2 data were recorded giving the average pulse-rate for the first 8 days after birth as 112 on the first day, and for the 7 subsequent days 114, 116, 116, 116, 122, 119, and 126, respectively. These average values were obtained from a considerable number of counts for different children. Those for the first day after birth represented 50 new-born infants, but on the later days the number of subjects was less, particularly on the seventh and eighth days.
In our report of the observations on the few normal subjects, made in the first study of the gaseous metabolism of infants, 1 we were primarily interested in such alterations in the pulse-rate of an individual infant as were due to changes in activity and not in the alterations due to changes in age. Accordingly, in this earlier study the period of observation did not exceed 30 to 45 days, except with a single infant. In the accumulation of our new data, however, special stress was laid upon the trend of the pulse-rate as the age increased. This could be studied advantageously in those series of observations in which the metabolism of the same child was studied over periods of 4 months or more, and in a few cases 3½ years. Finally, with the older children, the unusually advantageous conditions under which the data were obtained make it seem desirable for us to record the pulse-rates and deduce therefrom average values which might be expected from children under quiet conditions.
Even the earliest observers noted that the pulse-rate of infants was very difficult to obtain and varied under different circumstances. The great difficulties in securing accurate records can perhaps be no better expressed than by quoting from the earliest report that we have found in English of observations on the pulse-rate of children. Publishing in 1694, Walter Harris of London stated:
"But the Pulses of Children are naturally, or upon every little Alteration, do become so swift and frequent, that they always seem somewhat Feverish. Moreover, they are for the most part, so chagreen and froward, that not keeping their Wrest one moment in the same posture, do not suffer their Pulse to be touched. Lastly, there are so many things that do accelerate or otherways change their Pulses, that Sentiments taken thence should prove very uncertain, if not altogether false."
In the interesting book of Benjamin Waterhouse 2 we find a quotation from a paper read in 1768 at the Royal College of Physicians in London by the venerable Dr. Heberden:
"The pulse of children under two years old should be felt when they are asleep; for their pulses are greatly quickened by every new sensation, and the occasions of these are perpetually happening to them while they are awake. The pulse then of a healthy infant asleep on the day of its birth, is between 130 and 140 in one minute; and the mean rate for the first month is 120, for, during this time, the artery often beats as frequently as it does the first day, and I have never found it beat slower than 108. During the first year the limits may be fixed at 108 and 120. For the second year at 90 and 108. For the third year at 80 and 100. The same will very nearly serve for the fourth, fifth, and sixth years. In the seventh year the pulsations will be sometimes so few as 72, though generally more; and therefore, except only that they are more easily quickened by illness, or any other cause, they will differ but little from the healthy pulse of an adult, the range of which is from a little below 60 to a little above 80. It must be remembered, that the pulse becomes more frequent, by ten or twelve in a minute after a full meal."
No further evidence as to the difficulties of making these physiological records is necessary. Perhaps the best confirmation of this evidence is the fact that so little is now known regarding the quiet resting pulse of children. On looking over the literature on the normal pulse-rate of children, it is at once obvious that very little interest has been taken in the subject and few accurate counts have been made which take into consideration all the factors which modify the normal rate of the heart. It has been the custom of practically all writers to report minimum and maximum pulse-rates and to follow what seems to us the very confusing and entirely irrational procedure of averaging these and reporting the result as the average pulse-rate. A summation of our data shows that any pulse-rate above the minimum is profoundly affected by the degree of activity; therefore, little, if any, value can be placed upon observations of pulse-rate other than those obtained with the child in repose. It is of importance to know to what extent maximum pulse may develop during paroxysms of crying and with such activity as a child may exhibit when lying in bed, but for all normal purposes such records have but little, if any, scientific value.
The younger the infant the greater is the difficulty of obtaining the pulse-rate. With older children the element of apprehension should not be entirely disregarded. If this apprehension is not present to any great degree, the special precautions necessary for small children will not be required for the older individuals. Our measurements were all made while the child was inside a hermetically sealed chamber, and the routine was invariable for all children studied.
Before the study of new-born infants, our observations on children were so scattered and represented so few normal subjects that we were unable to record normal pulse-rates for children of various ages. With the new-born infants, however, this was perfectly feasible, and in the report of that study, 2 data were recorded giving the average pulse-rate for the first 8 days after birth as 112 on the first day, and for the 7 subsequent days 114, 116, 116, 116, 122, 119, and 126, respectively. These average values were obtained from a considerable number of counts for different children. Those for the first day after birth represented 50 new-born infants, but on the later days the number of subjects was less, particularly on the seventh and eighth days.
In our report of the observations on the few normal subjects, made in the first study of the gaseous metabolism of infants, 1 we were primarily interested in such alterations in the pulse-rate of an individual infant as were due to changes in activity and not in the alterations due to changes in age. Accordingly, in this earlier study the period of observation did not exceed 30 to 45 days, except with a single infant. In the accumulation of our new data, however, special stress was laid upon the trend of the pulse-rate as the age increased. This could be studied advantageously in those series of observations in which the metabolism of the same child was studied over periods of 4 months or more, and in a few cases 3½ years. Finally, with the older children, the unusually advantageous conditions under which the data were obtained make it seem desirable for us to record the pulse-rates and deduce therefrom average values which might be expected from children under quiet conditions.
Even the earliest observers noted that the pulse-rate of infants was very difficult to obtain and varied under different circumstances. The great difficulties in securing accurate records can perhaps be no better expressed than by quoting from the earliest report that we have found in English of observations on the pulse-rate of children. Publishing in 1694, Walter Harris of London stated:
"But the Pulses of Children are naturally, or upon every little Alteration, do become so swift and frequent, that they always seem somewhat Feverish. Moreover, they are for the most part, so chagreen and froward, that not keeping their Wrest one moment in the same posture, do not suffer their Pulse to be touched. Lastly, there are so many things that do accelerate or otherways change their Pulses, that Sentiments taken thence should prove very uncertain, if not altogether false."
In the interesting book of Benjamin Waterhouse 2 we find a quotation from a paper read in 1768 at the Royal College of Physicians in London by the venerable Dr. Heberden:
"The pulse of children under two years old should be felt when they are asleep; for their pulses are greatly quickened by every new sensation, and the occasions of these are perpetually happening to them while they are awake. The pulse then of a healthy infant asleep on the day of its birth, is between 130 and 140 in one minute; and the mean rate for the first month is 120, for, during this time, the artery often beats as frequently as it does the first day, and I have never found it beat slower than 108. During the first year the limits may be fixed at 108 and 120. For the second year at 90 and 108. For the third year at 80 and 100. The same will very nearly serve for the fourth, fifth, and sixth years. In the seventh year the pulsations will be sometimes so few as 72, though generally more; and therefore, except only that they are more easily quickened by illness, or any other cause, they will differ but little from the healthy pulse of an adult, the range of which is from a little below 60 to a little above 80. It must be remembered, that the pulse becomes more frequent, by ten or twelve in a minute after a full meal."
No further evidence as to the difficulties of making these physiological records is necessary. Perhaps the best confirmation of this evidence is the fact that so little is now known regarding the quiet resting pulse of children. On looking over the literature on the normal pulse-rate of children, it is at once obvious that very little interest has been taken in the subject and few accurate counts have been made which take into consideration all the factors which modify the normal rate of the heart. It has been the custom of practically all writers to report minimum and maximum pulse-rates and to follow what seems to us the very confusing and entirely irrational procedure of averaging these and reporting the result as the average pulse-rate. A summation of our data shows that any pulse-rate above the minimum is profoundly affected by the degree of activity; therefore, little, if any, value can be placed upon observations of pulse-rate other than those obtained with the child in repose. It is of importance to know to what extent maximum pulse may develop during paroxysms of crying and with such activity as a child may exhibit when lying in bed, but for all normal purposes such records have but little, if any, scientific value.
The younger the infant the greater is the difficulty of obtaining the pulse-rate. With older children the element of apprehension should not be entirely disregarded. If this apprehension is not present to any great degree, the special precautions necessary for small children will not be required for the older individuals. Our measurements were all made while the child was inside a hermetically sealed chamber, and the routine was invariable for all children studied.
Relationship between height and weight
From the foregoing discussion it is obvious that an index of the state of nutrition based on the relationships of height to age and weight to age is subject to very considerable error, because although a child may be of normally short stature with an accompanying small bodyweight, due to racial characteristics, on the basis of age he would be considered to be both underheight and underweight. If the short stature is due to racial characteristics and not to deficiency in the growth-promoting factors in the diet, the child may still be considered normal, indeed may be considered ideal. Before this condition can be established, however, a far greater study of the height-weight ratio of children of normally short parents should be made, and in considering the average mixed population of American schools the element of racial characteristics must not be overlooked.
Having shown that neither an average height for age nor an average weight for age is best suited for an index of nutritional state, since the height may be accompanied by varying weights and vice versa, it is clear that as an index of the best proportional distribution of flesh to skeleton the relationship between height and weight is most satisfactory. For a child of a given height a definite weight is productive of a fullness of development and addition of flesh that may be termed ideal. When the child has too little flesh it is very obvious, and likewise when it has too much flesh. The problem then arises as to what is the best proportion between weight and height for children. Should children be somewhat light in build or distinctly overweight, as judged by the popular conception of underweight and overweight when applied to children? Referring again to our private-school data, we find that although these children are heavier and taller than other series of normal children at the same age, when the height and weight are compared they are on the whole somewhat thinner for their height than are our normal laboratory children selected for this study. On the basis only of weight referred to height, therefore, it would appear as if our laboratory children had somewhat the advantage over the group of private-school children, i. e., so far as proportion is concerned. It still remains a fact, however, that had our laboratory children been given the advantages of private-school children, namely, outdoor life, better medical care, operative treatment if needed, and better diet, particularly with regard to growthpromoting factors, the skeletal growth would probably have been greater than actually noted.
The question is a serious one, then, as to whether we should consider a child of a certain age who has a large proportion of flesh for his height a better nourished child than one of the same age who is taller and at the same time heavier, but in whom the proportion between weight and height is not so great as with the shorter child. This question leads us to a consideration of the importance of the diet factors which play a rôle in growth. No one would seek for abnormal rapidity in the growth of children. In the normal development of the child growth proceeds with a considerable degree of regularity and, on the average, at a certain rate of rapidity. When children, however, are subjected to ideal outdoor life, with plenty of food and excellent medical care, they do grow -- in skeletal form, at least, as well as in total weight -- at a somewhat greater rate than otherwise. Is this desirable or not? Everything points to the desirability of this condition, and yet on close analysis it is seen that these private-school children do not have the proportion of weight to height found with the group of laboratory children selected for our measurements. Which, therefore, of the two factors is the most important in the process of growth, height or weight? The striking difference between the private-school children and our laboratory children is the greater height and correspondingly greater weight of the former, although the weight is in all probability simply a natural concomitant of the height. The fact that the obviously ideal conditions of private-school life result in this increased growth would seem to be prima facie evidence of its desirability. On the other hand, we must consider for a moment the relationship between weight and height which has resulted, with our laboratory children at least, in a better proportionment -- that is, these children are somewhat heavier for a given height than are the private-school children.
The underweight child is a great care to nutritional experts, and so the greatest stress is laid upon the question of underweight, and apparently little, if any, attention is given to underheight. We have pointed out that underheight may be due to erroneous dietary conditions, although in many instances such conditions are perhaps entirely unsuspected. But the chief attention of all dietitians and pediatricians is given to the underweight of the child; hence, the stress laid upon the larger proportion of weight for height. The desirability of advocating this proportion is well substantiated by the importance ascribed to the relationship between weight and height in the best and recent studies of vital statistics. These statistics show clearly that longevity is better favored in youthful adults, particularly under 30 years of age, if there is a certain degree of overweight; that is, that those youths over the average weight usually have a somewhat better expectancy of life. Beyond the age of 35 years statistics show that a weight somewhat under the average insures a better life expectancy. If during the period of early adult age, longevity is favored by having the weight somewhat above the average, it seems a reasonable conclusion that this same condition must be advantageous for children. Consequently we believe that during the entire period of growth the weight should, if possible, be somewhat over the average and should approach the ideal as indicated by the weight for ages of our privateschool children. Indeed, it seems logical to assume that if the privateschool children had been supplied with a larger amount of food, so that they could have put on more flesh and had a proportion of weight to height more nearly in accord with that found with our laboratory children, they would have presented an even more ideal picture. Apparently they were slightly underweight for their height, while our laboratory children, selected from by no means as good an environment, showed a somewhat better proportion of weight to heightbetter when judged on the basis that excess weight is advantageous during the period of growth. For these reasons we believe that all curves which represent a so-called normal, either for height or for weight, are drawn at too low a level, and instead of using the average for normal, as is commonly done, a value perceptibly higher than the average should be striven for in establishing any standards to represent the ideal rates of growth in height and weight for the various ages.
Having shown that neither an average height for age nor an average weight for age is best suited for an index of nutritional state, since the height may be accompanied by varying weights and vice versa, it is clear that as an index of the best proportional distribution of flesh to skeleton the relationship between height and weight is most satisfactory. For a child of a given height a definite weight is productive of a fullness of development and addition of flesh that may be termed ideal. When the child has too little flesh it is very obvious, and likewise when it has too much flesh. The problem then arises as to what is the best proportion between weight and height for children. Should children be somewhat light in build or distinctly overweight, as judged by the popular conception of underweight and overweight when applied to children? Referring again to our private-school data, we find that although these children are heavier and taller than other series of normal children at the same age, when the height and weight are compared they are on the whole somewhat thinner for their height than are our normal laboratory children selected for this study. On the basis only of weight referred to height, therefore, it would appear as if our laboratory children had somewhat the advantage over the group of private-school children, i. e., so far as proportion is concerned. It still remains a fact, however, that had our laboratory children been given the advantages of private-school children, namely, outdoor life, better medical care, operative treatment if needed, and better diet, particularly with regard to growthpromoting factors, the skeletal growth would probably have been greater than actually noted.
The question is a serious one, then, as to whether we should consider a child of a certain age who has a large proportion of flesh for his height a better nourished child than one of the same age who is taller and at the same time heavier, but in whom the proportion between weight and height is not so great as with the shorter child. This question leads us to a consideration of the importance of the diet factors which play a rôle in growth. No one would seek for abnormal rapidity in the growth of children. In the normal development of the child growth proceeds with a considerable degree of regularity and, on the average, at a certain rate of rapidity. When children, however, are subjected to ideal outdoor life, with plenty of food and excellent medical care, they do grow -- in skeletal form, at least, as well as in total weight -- at a somewhat greater rate than otherwise. Is this desirable or not? Everything points to the desirability of this condition, and yet on close analysis it is seen that these private-school children do not have the proportion of weight to height found with the group of laboratory children selected for our measurements. Which, therefore, of the two factors is the most important in the process of growth, height or weight? The striking difference between the private-school children and our laboratory children is the greater height and correspondingly greater weight of the former, although the weight is in all probability simply a natural concomitant of the height. The fact that the obviously ideal conditions of private-school life result in this increased growth would seem to be prima facie evidence of its desirability. On the other hand, we must consider for a moment the relationship between weight and height which has resulted, with our laboratory children at least, in a better proportionment -- that is, these children are somewhat heavier for a given height than are the private-school children.
The underweight child is a great care to nutritional experts, and so the greatest stress is laid upon the question of underweight, and apparently little, if any, attention is given to underheight. We have pointed out that underheight may be due to erroneous dietary conditions, although in many instances such conditions are perhaps entirely unsuspected. But the chief attention of all dietitians and pediatricians is given to the underweight of the child; hence, the stress laid upon the larger proportion of weight for height. The desirability of advocating this proportion is well substantiated by the importance ascribed to the relationship between weight and height in the best and recent studies of vital statistics. These statistics show clearly that longevity is better favored in youthful adults, particularly under 30 years of age, if there is a certain degree of overweight; that is, that those youths over the average weight usually have a somewhat better expectancy of life. Beyond the age of 35 years statistics show that a weight somewhat under the average insures a better life expectancy. If during the period of early adult age, longevity is favored by having the weight somewhat above the average, it seems a reasonable conclusion that this same condition must be advantageous for children. Consequently we believe that during the entire period of growth the weight should, if possible, be somewhat over the average and should approach the ideal as indicated by the weight for ages of our privateschool children. Indeed, it seems logical to assume that if the privateschool children had been supplied with a larger amount of food, so that they could have put on more flesh and had a proportion of weight to height more nearly in accord with that found with our laboratory children, they would have presented an even more ideal picture. Apparently they were slightly underweight for their height, while our laboratory children, selected from by no means as good an environment, showed a somewhat better proportion of weight to heightbetter when judged on the basis that excess weight is advantageous during the period of growth. For these reasons we believe that all curves which represent a so-called normal, either for height or for weight, are drawn at too low a level, and instead of using the average for normal, as is commonly done, a value perceptibly higher than the average should be striven for in establishing any standards to represent the ideal rates of growth in height and weight for the various ages.
Normal body-weight
The emphasis laid upon the relationship between height and age is far overshadowed by that laid upon the relationship between body-weight and age. A child of a certain age is commonly supposed to have a certain weight, and if below this weight is considered an underweight child. As in the case of height, average weight is invariably taken as the normal weight. Normal tables or average tables have been prepared, and almost every writer combines several of the earlier series and obtains his own individual normal which he uses for his study. The very fact that this divergence and uncertainty exist in the minds of all students of the physiology of childhood shows that there has been an unwritten hesitation to accept as normal many of these values. We believe that with children certainly we should no longer consider the average as normal. With adults there are a large number of overweight individuals to compensate for the number of underweight individuals, so that the average value for body-weight represents a median line with approximately the same proportion of overweights as underweights. With children the situation is quite the reverse. The number of overweight children, even using the erroneous term "normal" when applied to the average, are much fewer than the number of underweights. On standing in front of any of our public schools and noting the condition of the children running out at the end of a day's session, one may see at a glance that the obviously overweight children are very few indeed, while those who are obviously underweight usually pass by more rapidly than they can be counted. On this ground, therefore, to take an average value for children seems wholly erroneous.
If a child is seemingly underweight for a given age, this may be due in part to his short stature -- possibly a racial characteristic -- or may be due to a deficiency in the growth-promoting factors in the diet. In other words, underweight may be simply a concurrent factor with short stature, or, if the height is up to the average and the child is still noticeably underweight, this condition may be due distinctly to an insufficient caloric intake. This latter is the more probable and more common situation. If we refer again to our data for privateschool children, we will recall that at all ages they were measurably heavier for their age than were the other normal series that we have reported, both our own laboratory series and the earlier standard series. As we pointed out, however, their greater weight is in large part due to their greater height. Still, the fact that outdoor environment, better medical attention, and probably better dietetic conditions have produced a larger and better conditioned child than the ordinary, especially in our public schools, is a factor that must not be overlooked.
So-called "normal weight" is not normal, but is merely average. We believe that our ideal figures, as represented in our curves for private-school children, more truly represent the normal and that pediatricians should strive for the higher weight for age as exhibited by our private-school children rather than for the average weight for age, although here again we clearly recognize the differences in nationality in mixed groups, such as those being studied in any of the public schools, and the probably purer strain of nationality in our private schools.
If a child is seemingly underweight for a given age, this may be due in part to his short stature -- possibly a racial characteristic -- or may be due to a deficiency in the growth-promoting factors in the diet. In other words, underweight may be simply a concurrent factor with short stature, or, if the height is up to the average and the child is still noticeably underweight, this condition may be due distinctly to an insufficient caloric intake. This latter is the more probable and more common situation. If we refer again to our data for privateschool children, we will recall that at all ages they were measurably heavier for their age than were the other normal series that we have reported, both our own laboratory series and the earlier standard series. As we pointed out, however, their greater weight is in large part due to their greater height. Still, the fact that outdoor environment, better medical attention, and probably better dietetic conditions have produced a larger and better conditioned child than the ordinary, especially in our public schools, is a factor that must not be overlooked.
So-called "normal weight" is not normal, but is merely average. We believe that our ideal figures, as represented in our curves for private-school children, more truly represent the normal and that pediatricians should strive for the higher weight for age as exhibited by our private-school children rather than for the average weight for age, although here again we clearly recognize the differences in nationality in mixed groups, such as those being studied in any of the public schools, and the probably purer strain of nationality in our private schools.
Normal height
In the first place, what is the normal height of the child? With adults there is no such thing as normal height. The ranges of height with men and with women are very extended indeed. We form definite opinions as to whether a man is especially short or especially tall, but no one would care to state the normal height for man. The average height for a man is commonly given as 170 cm., but it is granted that there are very wide variations from this average height. With adults, then, the difference between normal and average is clearly recognized, but the average is taken as normal. Thus, the heights of a large group of individuals representing the general run of the population are measured and averaged, and this average value is considered as the normal value. We contend that this procedure is entirely erroneous when applied to children, although it is regularly employed and is a basis of most of the tables and charts in current use. 
With children there should be, or at least there is properly supposed to be, a reasonably definite height for an age. It has been stated earlier in our discussion that age, weight, and height are rather closely correlated with children, in contradistinction to the situation with adults. As children grow older they increase in height and weight approximately in the same degree. It has been repeatedly shown that racial characteristics appear very prominently in height. Our American population is by no means of a pure strain, and a group of children from a large public school, especially in our big cities, may represent a large percentage of foreign blood. Under these conditions an average figure may certainly be obtained, but we believe it is not justifiable to consider this average figure as normal. From the consideration of the charts in which our private-school data were plotted (figs. 4 and 6), it is clear that the private-school children on the whole are considerably taller for their age than are our laboratory children, or, indeed, the extensive series we quote from other writers. In other words, it seems evident that the conditions obtaining with the children of private schools in eastern Massachusetts produce a greater skeletal growth, as indicated by the height. On this basis, all of these private-school children are supernormal; in other words, they are certainly above the average, and the question immediately arises, "Is the average to be considered as normal?"
If one objects to the values found with the private-school children as normal values, no exception can be taken to the expression "ideal value." Hence one should compare the height and weight of a child not with the average or the fictitious normal, but with the ideal, which is unquestionably represented more nearly by our data from private schools. We wish here especially to emphasize the difference between average, normal, and ideal. When a child is short for his age this instantly indicates one of two things. In the first place, the child may be the offspring of a race of people or of parents of normally short stature; secondly, there may be a serious deficiency in the growth-producing factors in the diet. This deficiency in growthproducing factors is to be sharply distinguished from the caloric content of the diet, for it has been shown, with animals at least, that when they are maintained upon a diet of constant caloric value during the active period of growth, skeletal growth is made at the expense of the addition of tissue.
We should no longer, then, compare the height of our children to the average and call this normal. The fact that a group of 800 privateschool children may attain a height for age considerably above that of the average or so-called "normal" can be taken only as an index of the fact that this average represents children living under conditions which do not produce the best growth. In any educational campaign for the promotion of child welfare it is important to lay special stress upon those conditions favoring the largest skeletal growth. Consequently we believe that all previous charts indicating height for age are not ideal and represent simply a group of the population that has been stunted, in part at least, by abnormal living conditions and perhaps deficient dietary constituents. In laying down this thesis we are, of course, open to the criticisms that our private-school children were less contaminated by racial commingling and that the shorter statured people did not send their children to these private schools -- in other words, that our private-school children represent the more purely typical American or Anglo-Saxon type. To a certain extent this is probably true, but we are not in a position to throw definite light upon this subject. We think it highly improbable, however, that this explanation completely accounts for the greater height of this group of children. For an estimate of the ideal height of children we believe, therefore, that one should rely not upon the so-called "normal" curve, but more nearly upon an ideal curve which is measurably higher than a normal or average commonly given. On this basis many analyses of the measurements of children which indicate that the children are above normal height simply mean that the normal level is arbitrarily adjusted at too low a point. Nutrition experts and pediatricians must hold this important relationship clearly in mind and not be content with the statement that a child is of average height when the possibilities of greater skeletal growth are presented by better living conditions, medical treatment, and general care.
With children there should be, or at least there is properly supposed to be, a reasonably definite height for an age. It has been stated earlier in our discussion that age, weight, and height are rather closely correlated with children, in contradistinction to the situation with adults. As children grow older they increase in height and weight approximately in the same degree. It has been repeatedly shown that racial characteristics appear very prominently in height. Our American population is by no means of a pure strain, and a group of children from a large public school, especially in our big cities, may represent a large percentage of foreign blood. Under these conditions an average figure may certainly be obtained, but we believe it is not justifiable to consider this average figure as normal. From the consideration of the charts in which our private-school data were plotted (figs. 4 and 6), it is clear that the private-school children on the whole are considerably taller for their age than are our laboratory children, or, indeed, the extensive series we quote from other writers. In other words, it seems evident that the conditions obtaining with the children of private schools in eastern Massachusetts produce a greater skeletal growth, as indicated by the height. On this basis, all of these private-school children are supernormal; in other words, they are certainly above the average, and the question immediately arises, "Is the average to be considered as normal?"If one objects to the values found with the private-school children as normal values, no exception can be taken to the expression "ideal value." Hence one should compare the height and weight of a child not with the average or the fictitious normal, but with the ideal, which is unquestionably represented more nearly by our data from private schools. We wish here especially to emphasize the difference between average, normal, and ideal. When a child is short for his age this instantly indicates one of two things. In the first place, the child may be the offspring of a race of people or of parents of normally short stature; secondly, there may be a serious deficiency in the growth-producing factors in the diet. This deficiency in growthproducing factors is to be sharply distinguished from the caloric content of the diet, for it has been shown, with animals at least, that when they are maintained upon a diet of constant caloric value during the active period of growth, skeletal growth is made at the expense of the addition of tissue.
We should no longer, then, compare the height of our children to the average and call this normal. The fact that a group of 800 privateschool children may attain a height for age considerably above that of the average or so-called "normal" can be taken only as an index of the fact that this average represents children living under conditions which do not produce the best growth. In any educational campaign for the promotion of child welfare it is important to lay special stress upon those conditions favoring the largest skeletal growth. Consequently we believe that all previous charts indicating height for age are not ideal and represent simply a group of the population that has been stunted, in part at least, by abnormal living conditions and perhaps deficient dietary constituents. In laying down this thesis we are, of course, open to the criticisms that our private-school children were less contaminated by racial commingling and that the shorter statured people did not send their children to these private schools -- in other words, that our private-school children represent the more purely typical American or Anglo-Saxon type. To a certain extent this is probably true, but we are not in a position to throw definite light upon this subject. We think it highly improbable, however, that this explanation completely accounts for the greater height of this group of children. For an estimate of the ideal height of children we believe, therefore, that one should rely not upon the so-called "normal" curve, but more nearly upon an ideal curve which is measurably higher than a normal or average commonly given. On this basis many analyses of the measurements of children which indicate that the children are above normal height simply mean that the normal level is arbitrarily adjusted at too low a point. Nutrition experts and pediatricians must hold this important relationship clearly in mind and not be content with the statement that a child is of average height when the possibilities of greater skeletal growth are presented by better living conditions, medical treatment, and general care.
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