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For many decades, it has been well known that sickle cell anemia is due to the homozygous inheritance of a hemoglobin variant (hemoglobin S) rather than hemoglobin A in the red cells. Sickle cell a...

A study of the problem of organic precursors of the hematin part of hemoglobin shows that no attention has been directed toward the possible relation of vitamines therein, whether this be as a direct precursor, or as involved in the use of such possible precursors as chlorophyll.The problem was to determine whether rats could be rendered anemic by the absence of one or more vitamines in a synthetic diet and whether phaophytin, obtained from chlorophyll, functions as a hemoglobin precursor in anemic rats, however this anemia may have been brought about. Rats kept upon such diets were systematically followed as to weight, blood hemoglobin and red blood cell count. The tentative conclusions arrived at as applied to rats are the following:1. Synthetic rations containing 18 per cent casein and deficient in Vitamines A, B and E do not produce anemia but do produce an unusually high hemoglobin content.2. Phaophytin may not be substituted for any one of the Vitamins A, B, or E.3. Casein at a 10 per cent level pro...

of the Tyler-Smith County Health Department had anemia that we felt concern. We wondered whether poor nutrition or hookworm, which was once common in this part of Texas, could be responsible for the prevalence of low hemoglobin. Stool specimens we collected were negative for hookworm. A study of food habits was more revealing. Not only did we lear a great deal about the diet habits of our patients, but we also learned to be far more practical in the way we taught nutrition to them. We started our study of eating habits by recording the food intake of 28 women with a hemoglobin of less than 70 percent. Their eating habits were poor; so we reviewed our findings with a nutrition consultant from a neighboring county. We then decided to survey the eating habits of 100 clinic patients selected without regard to their hemoglobin level. We wanted to know what nutrients the women were getting, which foods supplied them, and how to go about helping them improve their diets. The study of the dietary habits of pregnant women in Iowa made by Jeans, Smith, and Steams helped us design our study (1). We collected one-day food histories from 100 patients. In the beginning we took three

To determine the utility of chronic subcutaneous Desferal (SCDF) therapy (Rx) in the prevention of cardiac disease in patients with thalassemia major who began treatment after the age of 10, we evaluated 36 patients; all of whom were started on SCDF when they were 10 years of age or older and had no pre-existing cardiac disease (defined as clinical congestive heart failure or abnormal left ventricular function). There were 17 compliant patients (mean age 12.3 years at onset of Rx) who used SCDF at least 5 days a week; 8-12 hours each day. Nineteen patients were noncompliant (mean age 16.6 years), they used SCDF periodically. In the group of compliant patients, the mean number of years on Desferal Rx was 4.8 years, in the noncompliant group, 4.0 years. All patients have been on a hypertransfusion regimen (maintaining a hemoglobin of 11%), at least since they began SCDF. Only one patient in the compliant group developed cardiac disease (at age 11) and she died of congestive heart failure at age 18. In contrast, 12 in the noncompliant group developed cardiac disease. Two of these patients have died. The mean age of development of cardiac disease in the noncompliant patients was 20.3 years ± 4.2 years. Therefore, the lack of cardiac complications in the compliant group suggests that compliance with SCDF Rx may reduce the risk of cardiac disease in older patients.

Pneumococcal infections generally occur sporadically. 1 Household contacts of a patient with pneumococcal disease are considered to be at no risk of acquiring secondary infection. This is a report of two siblings who had invasive pneumococcal disease two days apart. Report of Cases .—Case1.—A 4-year-old black girl was admitted to an outlying hospital with a history of persistent fever for three days. On the day of admission she complained of a headache and had a brief generalized seizure. Physical examination on admission showed a lethargic, disoriented child. Her temperature was 40.3 °C; BP, 90/68 mm Hg; apical heart rate, 104 beats per minute; and respirations, 40/min. Her neck was stiff and her deep-tendon reflexes were depressed. Laboratory data disclosed a hemoglobin level of 9.8 mg/dL and a WBC count of 17,000/cu mm, with 29% polymorphonuclear leukocytes, 61% band forms, 8% lymphocytes, and 2% monocytes. Hemoglobin electrophoresis showed heterozygous

In Reply .—Dr Smith would have preferred that our differential diagnosis of the proposita deal more extensively with β + vs β° thalassemia and the difference in their clinical presentation. We point out that the differential diagnostic process for newborns differs from that appropriate for the symptomatic child in that there is no clinical history. The differential diagnosis is that of a hemoglobin composition, not that of a clinical course. The hemoglobin composition of the proposita described (principally Hb S without Hb A) automatically excludes sickle-β + thalassemia, and therefore it was not discussed. As explained in the third paragraph of the "Comment" section, it is sickle-β thalassemia that must be distinguished from sickle cell anemia because in both there is no synthesis of Hb A. Drs Grover and Wethers claim that, in the family described, "neither confirmatory testing nor family studies were obtained appropriately." Regarding confirmatory testing, as the article states

PLASMAPHERESIS for hyperviscosity syndrome of Waldenstrom's macroglobulinemia has become standard treatment since the first report by Skoog and Adams 1 in 1959. Their patient received a 15-day course of plasmapheresis in November 1957. This is a tardy report of a case of Waldenstrom's macroglobulinemia treated by plasmapheresis at the University of Minnesota Hospitals in September 1956, twenty-four years ago. Report of a Case A 63-year-old man was admitted to the hospital on Aug 23, 1956, with a chief complaint of progressive deterioration of vision. He was unable to recognize persons or objects. He also complained of progressive dyspnea on exertion, recurrent chills and fever for several years, bruising, and gingival bleeding. Anemia had been present for five years. On physical examination, there was splenomegaly and cardiomegaly. Changes noted on funduscopic examination consisted of hemorrhages, exudates, and noticeable venous distention. Abnormalities in laboratory results included a hemoglobin level of 6.1 g/dL

To the Editor.— The article by de la Riva et al, entitled "Acute Massive Intestinal Bleeding Caused by Hookworm" (1981;246:68), called to mind the presentation that I made to the joint meeting of the Argentine and Paraguayan Surgical Societies in 1968 of seven cases of severe gastrointestinal hemorrhage owing to a heavy infestation of hookworms. These seven cases were encountered at the Baptist Hospital in Asuncion, Paraguay, where I was then serving as chief of the surgical service. The first patient treated was a 2-year-old child who was admitted with a hemoglobin level of 2 g/dL and multiple bowel movements of blood that varied from black to bright red. Sigmoidoscopy and barium enema results were normal. Examination of the fecal material for parasites showed innumerable eggs of the parasite Ancylostoma . Eight blood transfusions were given that only temporarily improved the child's condition. An abdominal exploration showed edema and inflammation of

School age children in Chile receive 30g of biscuits each day through a national food supplementation program. Wheat flour biscuits were fortified with 4,6 and 8% of a hemoglobin concentrate obtained from cattle blood. The 4% and 6% fortified biscuits were considered acceptable for consumption and did not show unfavorable changes after storage for 6 months at room temperature or 40°C. Bioavailability of the heme-iron was studied isotopically in 15 children preparing biscuits with radioactive hemoglobin obtained from a 55Fe-injected calf. Each child received 30g of biscuits containing 5.5mg of heme-iron and 2.1 uCi of 55Fe on day 1 and a solution of ferrous ascorbate (2mg iron, 0.7 uCi 59Fe) on day 2. Absorption was calculated from the circulating radioactivity on day 15 according to Eakins and Erown. Geometric mean absorption of the fortification iron was 19.7% with a heme-iron/ferrous ascorbate absorption ratio of 0.65. Fortification of biscuits with hemoglobin appears as a promising way of providing children with bioavailable iron.

In Cooley's anemia, maintenance of a hemoglobin level≥9.5 g/dl prevents anoxia and suppresses endogenous erythropolesis. Eight patients have been maintained on this transfusion regimer, since initial diagnosis, for 3 to 13 years. The patients have maintained excellent health and have been able to live normal lives, including school sports. Hepato-splenomegaly has been contained to a modest level; hyperspienism has not developed. Cardiac size and function have been normal; however, echo-cardiography revealed increased left ventricular wall thickness in children older than 8 years, suggesting increased Fe depostion. All children have received test doses of I.M. Desferrioxamine-B 20 mg/Kg 15-16 times each year. The results indicate that in the youngest children, 20% of the transfused Fe, and in the oldest children, 50%, could be eliminated by dally I.M. Injections. Recently, the same dose of Desferrioxamine-B has been administered by intravenous or subcutaneous infusion overnight. By these routes, the excretion of Fe has increased fourfold in the youngest, and twice in 1he oldest children. Thus, children with Cooley's anemia may be kept in excellent health by this transfusion regimen, and the iror overload prevented by daily subcutaneous chelation therapy at home. This should result in increased longevity.

• A 20-year-old black man with known sickle cell anemia was admitted to the hospital with the signs and symptoms of right middle lobe pneumonia. Because of a hemoglobin value of 3.9 g/dL, he received a transfusion of 3 units of packed erythrocytes. Seven days later, hypertension, headache, and one grand mal seizure occurred. Evaluation of his condition gave normal findings. Similar events, some terminating in cerebral hemorrhage and death, have been reported in patients with hemolytic anemia after they received multiple transfusions. To our knowledge, this patient represents the first adult with sickle cell anemia who had this syndrome. Prompt antihypertensive therapy may have been of benefit. ( Arch Intern Med 1984;144:607-608)

To the physician, for whom it has become a practical diagnostic necessity, the reports of the Wassermann reaction have presented great vagueness and inaccuracy.It has been the custom to call the reaction "negative" or "positive," and if positive, "very weak," "weak," "medium," "strong," or "very strong." Such terminology, by its own nature, makes for inexactitude, which is anything but desirable, to say nothing of being unscientific. The human mind cannot grapple with adjectives. It needs figures. Completely to grasp variations of a color-scheme or quantitative gradations, we must obtain our impressions numerically. The terms are from zero to one hundred. No one would think of writing a hemoglobin estimate as pale pink, pink, red, dark-red, crimson, etc. We have determined what intensity of color in hemoglobin represents 100 per cent., and we have readjusted our conception of weaker concentrations accordingly. A similar, if not homologous, method would be

To the Editor:— I have had a patient with acute agranulocytosis with a fatal outcome that was caused, in all probability, by the use of chlorpromazine (Thorazine). The fulminating onset, typical clinical picture, and short duration of the illness were closely observed and recorded. The clinical picture was similar to agranulocytosis, sometimes observed following administration of aminopyrine. A 62-year-old woman was admitted to the hospital with a diagnosis of presenile brain disease in February, 1953. The physical examination did not reveal any abnormalities at the time of her admission. Laboratory findings were as follows: urine: no albumin, no sugar, sediment in normal ranges. Complete blood study showed 5,100,000 red blood cells per cubic millimeter, 8,400 white blood cells per cubic millimeter, and a hemoglobin level of 12 gm. per 100 cc. Kahn test was negative. Chest x-ray did not reveal any abnormalities of the heart or lungs. After admission, the

Dr. Donald L. Stone: This upper-gastrointestinal series is that of a 46-year-old white woman who had experienced some occasional epigastric discomfort for one year, and more recently had been noted to be somewhat pale. She had lost 5 lb (2.3 kg) over the two months prior to this examination. Laboratory data included a guaiac test of the stool which was 2 + and a hemoglobin level of 10.2 gm/100 cc. Discussion Dr. Laurence L. Robbins: Is the fluoroscopist here? Dr. Willard Perry: I examined this patient and found a large radiolucent filling defect in the antral portion of the stomach (Fig 1,left). It seemed to vary in size and shape with peristaltic activity (Fig 1,right). It appeared to be on a stalk, but it did not prolapse into the duodenum. I thought a gastric polyp was the most likely diagnosis, although I also suggested a lipoma because of the

On 13 patients, 22 ischemic skin ulcers which had resisted a variety of therapeutic agents were treated with ordinary gold leaf. Three coexisting lesions served as controls. After initial cleansing and debridement, the ulcers were wetted with 95% alcohol, covered with four to eight layers of gold leaf, and protective dressings were applied; this procedure was repeated every 48 hours. A venous-stasis lesion decreased in size 86% in one month, and a diabetic ulcer showed 44% improvement in 11 days. Twenty decubitus ulcers decreased an average of 62%, and three coexisting control ulcers increased in size an average of 96%. Deterrents to successful treatment include a hemoglobin value below 12 gm/100 cc, excessive friction, undermining of ulcer edges, ringing of the lesion with scar tissue, and copious purulent discharge. No adverse reactions to gold leaf were observed.

To the Editor:— In cases of poisoning in infants, it is generally conceded that the exact amount of the toxic substance ingested is open to question. The mother was somewhat vague as to the exact amount of aspirin given this infant. As stated in the article, the salicylate level before the first exchange was 35 mg.%, fell to 29 mg.% thereafter, and to 23 mg.% only after the second transfusion. Intravenous fluid therapy consisted of 5% dextrose solution in distilled water and a whole blood transfusion. No alkali was given so that this perhaps was not an iatrogenic acid-base imbalance, as suggested by Drs. Oski and Salitsky. The whole blood transfusion was given in an attempt to buffer the acid-base relationship and also because of a mild anemia (a hemoglobin level of 10 Gm.% despite the dehydration), the cause of which was not ascertained. It was my impression that the

Two additional patients with thalassemia minor and ankle ulcers are reported, bringing the total number reported to ten. A genealogic study of the thalassemic trait in their family was traced. From a review of the literature it appears that all previous patients with thalassemia and leg ulcers had thalassemia minor. The composite affected patient is a 26-year-old Italian-decended woman with splenomegaly and a hemoglobin of about 8 gm/100 ml. The pathogenesis of the ulcers is nonspecific. Treatment is that of a stasis ulcer.

Lambert1has recently called attention to pregnancy as a "condition in which the dire effects of hookworm disease are dramatized most vividly" and calls attention to the number of deaths annually of mother or child or both as a result of hookworm disease occurring in Fiji. Darling,2working in the same region some years ago, found that the average hemogloblin estimation for pregnant women was 15 per cent lower than that for the general population. In Paraguay, I have found a hemoglobin percentage of 64.4 for the general population (2,491 examinations), whereas the average for pregnant women (thirty-nine examinations) is but 51, which represents a loss of 13.4 per cent. In campaigns for the treatment of hookworm disease in tropical countries, where fecundity begins early and birth control is unknown, the pregnant woman has formed a large part of that group, "not treated for medical reasons," and has

In 1913 Fernau et al. (1) reported slight transitory "polymorphonucleosis" within the first 2 days after intravenous injections of polonium in 5 rabbits with doses ranging from the equivalent of 1 uc/kg to 5 uc/kg. This was followed by moderately marked depression of leukocyte count by the 15th to 18th days after injection, with partial recovery by the 50th day. A rabbit receiving 10.4 uc/kg intravenously revealed a decline in leukocyte count to half the preinjection value by the 15th day. In a rabbit receiving 39 ,uc/kg there was a rapid decline of leukocyte count to 1000 by the 8th day, with marked increase in percentage of polymorphonuclear leukocytes at 4 and 6 days. No changes were observed in erythrocyte counts in any of these rabbits. In 1925 Lacassagne et al. (2) reported changes in circulating blood in 5 rabbits injected with polonium at various dosage levels and by various routes. In 1 rabbit, after an intraperitoneal dose of 151 uc/kg, the leukocyte count fell rapidly to zero by the 9th day, polymorphonuclear leukocytes showed an initial relative increase in number and then disappeared by the 7th day, the platelet count was decreased, and the erythrocyte count fell slightly before death on the 11th day. In 2 rabbits receiving intravenous injections of about 100 pc/kg these authors noted transient leukocytosis followed by depression of leukocyte count to low levels by the 15th day, which persisted with only partial recovery during a period of 2 months. In 1 rabbit receiving a total subcutaneous dose of 37 Ac/kg in eight daily fractions the leukocyte count dropped gradually to 2100 by the 5th day after the last injection, than gradually returned to normal, the erythrocyte count was constant. One rabbit receiving 27 ci/kg intravenously showed an essentially similar but more rapid leukocyte count depression, a slight reduction of platelet count, and a rise in erythrocyte count after 1 week, associated with a hemoglobin value 90 % of normal. Casarett (3, 4) in 1948 and 1952 reported changes in circulating blood of Wistar

This case report is presented because of its rarity, the extensive osteomyelitic lesion, and the difficulty encountered in establishing the diagnosis early in the disease. REPORT OF CASE S. F., a 27-month-old Negro boy, was admitted to Jackson Memorial Hospital on Sept. 14, 1954, with the chief complaint of fever and swelling of the right elbow of three days' duration. The patient was first seen at Jackson Memorial Hospital seven days prior to admission, with a two-day history of fever and intermittent pain in all four extremities. Examination at this time revealed a well-developed, well-nourished, Negro boy, having a rectal temperature of 99 F and no significant physical findings. Laboratory studies showed a hemoglobin of 9.4 gm. per 100 cc. (capillary blood) and 12 nucleated RBC's per 100 RBC's, and the sickling preparation demonstrated 85% sickling. The diagnosis of sickle-cell crisis was made, and the patient was treated symptomatically. He

It is traditional to consider the well built, strong, plethoric, overweight person as a candidate for apoplexy or heart disease. Because of the lack of recorded observations to support this clinical impression, a study of the erythrocyte counts and hemoglobin contents of a series of proved cases of coronary thrombosis was made. A study of 58 cases in which there was either autopsy evidence or a series of electrocardiographic tracings typical of coronary thrombosis has revealed that only 8 per cent of the patients had an erythrocyte count of less than 4,500,000 per cubic millimeter and that only 11 per cent had a hemoglobin content of less than 13.0 Gm. There were 36 men, with a mean erythrocyte count of 5,090,000 per cubic millimeter, and 22 women, with a mean erythrocyte count of 4,850,000 per cubic millimeter. Six per cent of the men and 13.5 per cent of the

of maternity patients. This special afternoon gives the nurse an opportunity to explain the clinic routine to the new patient and it gives the patient an opportunity to discuss her problems without feeling that she is being rushed. I met Maxine when she came to the health clinic for her first visit. She was approximately four months pregnant and weighed 146 pounds-six pounds above her normal weight. She was pale and she looked tired. Since Maxine had had a Wassermann test, a urinalysis, and a hemoglobin test, I looked on her record for the reports. I noted that the Wassermann was negative, the urinalysis normal, but her hemoglobin was only 60 per cent. In discussing Maxine's diet with her I discovered that it was low in calcium, phosphorous, iron, and all the vitamins except vitamin C. I told her about the importance of these food elements and urged her to drink at least a quart of milk each day, as it is important for the baby's bones and teeth. I knew that fresh milk was expensive so I suggested that she use powdered skim milk which is just as nourishing, yet lower in calories. The cost of the powdered milk is approximately eight cents a quart, whereas fresh milk is 27 cents a quart. When the powdered milk is mixed and chilled, it tastes like fresh milk. Flavoring may be used to make it more palatable or it may be "hidden" in prepared dishes. Maxine seemed very pleased to hear about this much cheaper but wholesome product and promised that she would try it. Although milk is very important during pregnancy, I also explained the value of other foods-lean meat, especially liver, fresh vegetables, fruits, and whole grain cereals. I suggested that she avoid starchy, sweet, and greasy foods to prevent a too rapid gain in weight. Maxine told me that at times she was bothered by constipation. I explained that this was not uncommon, and could be corrected. Usually, simple steps will do this, such as drinking fluids and eating plenty of fruit and vegetables. I also told her to practice regular habits and to follow a routine of light exercises. The clinic has some illustrated booklets which show how the baby grows inside the uterus. Maxine was interested and while she looked at the pictures I stressed the fact that the

To the Editor.— Since the report of Goodwin et al 1 in 1950 of painless hematuria associated with sickle cell hemoglobinopathy, numerous reports have confirmed the phenomenon in both sickle cell (SS) trait and SS disease. Gunnels and Grim 2 have reported painless hematuria in A/D hemoglobinopathy. We have previously reported a case of recurrent painless hematuria in a patient with hemoglobin C trait. 3 The present report concerns a child with painless hematuria who had β-thalassemia trait associated with silent gall stones. A 5-year-old black American child was found on routine preschool examination to have significant microscopic hematuria. Complete urological evaluation revealed no abnormality but x-ray films showed radiopaque gall stones. Results of hematological evaluation included a hemoglobin level of 10.8 gm/100 ml, normal bilirubin level, and normal reticulocyte count. Hemoglobin electrophoresis however revealed an A 2 hemoglobin value of 4.3%. Analysis of the parents revealed normal hematograms for both

Introduction Necrosis of hepatic cells may occur during severe infections, 2,6-9 after exposure to certain chemical agents, 1,2,6,7 and occasionally in association with alterations in the peripheral or hepatic circulations. 3-6,10-12 Massive necrosis of the left lobe of the liver occurred in a patient with S-A hemoglobin during the course of a Gram-negative septicemia secondary to pyelonephritis occurring pre- and postpartum. The course of the patient is described here because: Biopsy material obtained during the acute and healing stages demonstrated changes compatible with hepatic infarction; this degree of hepatic destruction with subsequent survival is unusual, and our patient made a complete recovery from what appeared to all who saw her to be a moribund state. Report of a Case A 17-year-old Negro woman was first seen in late June, 1961, during the seventh month of her first pregnancy with fever, nausea, vomiting, jaundice, clay-colored stools, and dark urine for 4-6

IN 1912, Kilinger first described Actinobacillus actinomycetemcomitans as a bacterial organism occurring in close association with active cases of actinomycosis. Thjotta and Sydves in 1951 reported the first case of human infection in which this organism was the sole infecting agent. 1 King and Tatum have reported cultural and serological studies on A actinomycetemcomitans identified from blood cultures in 27 instances, but the sources of infection were not described. 2 A review of the literature has failed to reveal a case of A actinomycetemcomitans endocarditis. It is our purpose to present such a case with bacteriologic and pathologic material and to reemphasize the similarity of this organism to Hemophilus aphrophilus . Report of Case A 57-year-old Negro (0-14521) was admitted to the Ann Arbor Veterans Administration Hospital on June 11, 1964. Four months earlier he had begun experiencing fatigue, weakness, fever, and nocturnal diaphoresis. Hospitalization elsewhere revealed a hemoglobin level of

A case report of a woman who developed a positive sickle cell test a nd an A-S pattern with less than 2% hemoglobin F (hemoglobin electrophoresis) while taking the oral contraceptive Ovulen (1 mg ethynodiol diacetate and .1 mg mestranol) is presented. Since 8.5% of American Negroes have sickle cell trait it is suggested that a sickle cell test and a hemoglobin electrophoresis be performed before prescribing an oral contraceptive for a Negro patient. An alternative contraceptive method is suggested if sickling or hemoglobin S is found.

Mattie A., aged 38, was admitted to Mercy Hall Cancer Hospital on March 9, 1945. She had been operated on at Woman's Hospital by Dr. W. E. Johnston in July 1941. Dr. Johnston, Dr. Don M. Beaver and Dr. Frances Ford supplied the notes from the latter hospital admission. Prior to her admission to Woman's Hospital the patient had complained of pain and tenderness underneath the right costal margin for one year and of jaundice for two weeks. She had weighed 90 pounds (40.8 Kg.) and had a hemoglobin content of 60 per cent and a red blood cell count of 3,250,000. At abdominal exploration on July 25, 1941, the head of the pancreas had been found to be the size of a large plum, round and hard. The gallbladder had been distended and the common duct dilated. There had been no evidence of disease of the gallbladder. Cholecystogastrostomy had

The red cell organic phosphate 2, 3-diphosphoglycerate (DPG) has been shown to bind to adult hemoglobin and decrease its affinity for oxygen while it has little effect on altering the oxygen equilibrium curve of fetal hemoglobin. Sequential studies of the P50 (partial pressure of oxygen at which hemoglobin is 50% saturated), fetal hemoglobin and red cell DPG were performed in 31 term and 28 premature infants. In term infants the P50 averaged 19.4 mm Hg on day 1; 20.6 on day 5; 26.6 at 3–4 months amd 28.0 at 6 months (normal adults 27.5=0.8). The initial P50 of the premature infants was lower and its change with age more gradual. The P50 did not correlate precisely with the percent fetal hemoglobin alone or the DPG alone but correlated significantly with the product of the percent adult hemoglobin times the DPG content (‘functioning DPG fraction’). Calculations indicate that the term infants at age 3 months with a hemoglobin of 11.0 g% is delivering more oxygen to his tissues at a mean venous PO2 of 40 mm Hg than is the newborn with a hemoglobin of 17.0 g%. sick infants were found to have low P50's and DPG levels. Infants given either simple or exchange transfusions of fresh adult blood showed an increased ‘functioning DPG fraction’, a shift of the oxygen equilibrium curve to the right and their oxygen unloading capacity reached that of a 6-month infant. Such treatment appears useful in the sick infant because it facilitates peripheral oxygen delivery to the tissues.

In a series of analyses previously made in this laboratory normal values for the copper and iron contents of the whole blood of adults were established. 1 It was shown that while the average values for copper were practically the same, irrespective of sex, values for iron and hemoglobin were appreciably lower for women, so that separate standards of hemoglobin values for men and for women were advocated. In a more recent report 2 values were established for copper, iron and hemoglobin for normal children, ranging from new-born infants to children of 15 years. The results in this series exhibited no sex variations, but the values fluctuated greatly with changes in age, especially in the first year of life. It was suggested that for greater reliability in clinical interpretation a hemoglobin curve is preferable to a single standard for children. The present study was undertaken to complete the series of