• TABLE OF CONTENTS
HIDE
 Title Page
 Credits
 Introduction
 Composition of the blood
 Function of the red cells
 Causes of anemia
 Classification of the anemias
 Nutritional anemia in Florida
 Iron requirement
 Curative measures
 Summary
 Literature cited






Group Title: Bulletin - University of Florida. Agricultural Experiment Stations ; No. 328
Title: Nutritional anemia and its prevention
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00027212/00001
 Material Information
Title: Nutritional anemia and its prevention
Series Title: Bulletin University of Florida. Agricultural Experiment Station
Physical Description: 12 : ; 23 cm.
Language: English
Creator: Abbott, O. D ( Ouida Davis ), b. 1892
Ahmann, Chester F ( Chester Frederick ), b. 1897
Publisher: University of Florida Agricultural Experiment Station
Place of Publication: Gainesville Fla
Publication Date: 1938
 Subjects
Subject: Iron deficiency anemia   ( lcsh )
Iron deficiency anemia -- Prevention   ( lcsh )
Iron deficiency anemia in children   ( lcsh )
Iron deficiency anemia in children -- Prevention   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Bibliography: Bibliography: p. 12.
Statement of Responsibility: by Ouida Davis Abbott and Chester F. Ahmann.
General Note: Cover title.
Funding: Bulletin (University of Florida. Agricultural Experiment Station)
 Record Information
Bibliographic ID: UF00027212
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 000924556
oclc - 18214255
notis - AEN5183

Table of Contents
    Title Page
        Page 1
    Credits
        Page 2
    Introduction
        Page 3
    Composition of the blood
        Page 4
    Function of the red cells
        Page 4
    Causes of anemia
        Page 5
    Classification of the anemias
        Page 6
    Nutritional anemia in Florida
        Page 7
    Iron requirement
        Page 8
        Page 9
        Page 10
    Curative measures
        Page 11
    Summary
        Page 12
    Literature cited
        Page 12
Full Text


November, 1938


UNIVERSITY OF FLORIDA
AGRICULTURAL EXPERIMENT STATION
GAINESVILLE, FLORIDA
WILMON NEWELL, Director









NUTRITIONAL ANEMIA


AND ITS PREVENTION




By

OUIDA DAVIS ABBOTT and CHESTER F. AHMANN


Bulletins will be sent free to Florida residents upon request to
AGRICULTURAL EXPERIMENT STATION
GAINESVILLE, FLORIDA


Bulletin 328








EXECUTIVE STAFF

John J. Tigert, M.A., LL.D., President of
the University
Wilmon Newell, D.Sc., Director
Harold Mowry, M.S.A., Asst. Dir., Research
J. Francis Cooper, M.S.A., Editor
Jefferson Thomas, Assistant Editor
Clyde Beale, A.B.J., Assistant Editor
Ida Keeling Cresap, Librarian
Ruby Newhall, Administrative Manager
K. H. Graham, Business Manager
Rachel McQuarrie, Accountant

MAIN STATION, GAINESVILLE
AGRONOMY
W. E. Stokes, M.S., Agronomist'
W. A. Leukel, Ph.D., Agronomist
G. E. Ritchey, M.S., Associate2
Fred H. Hull, Ph.D., Associate
W. A. Carver, Ph.D., Associate
John P. Camp, M.S., Assistant
Roy E. Blaser, M.S., Assistant
ANIMAL HUSBANDRY
A. L. Shealy, D.V.M., Animal Husbandman'
R. B. Becker, Ph.D., Dairy Husbandman
L. M. Thurston, Ph.D., Dairy Technologist
W. M. Neal, Ph.D., Asso. in An. Nutrition
D. A. Sanders, D.V.M., Veterinarian
M. W. Emmel, D.V.M., Veterinarian
N. R. Mehrhof, M.Agr., Poultry Husbandman
O. W. Anderson, M.S., Asst. Poultry Husb.
W. G. Kirk, Ph.D., Asst. An. Husbandman
R. M. Crown, B.S.A., Asst. An. Husbandman
P. T. Dix Arnold, M.S.A., Assistant Dairy
Husbandman
L. L. Rusoff, M.S., Asst. in An. Nutritions

CHEMISTRY AND SOILS
R. V. Allison, Ph.D., Chemist'
R. M. Barnette, Ph.D., Chemist
F. B. Smith, Ph.D., Soils Chemist
C. E. Bell, Ph.D., Associate
R. B. French, Ph.D., Associate
H. W. Winsor, B.S.A., Assistant
J. Russell Henderson, M.S.A., Assistant
L. W. Gaddum, Ph.D., Biochemist
L. H. Rogers, M.A., Spectroscopic Analyst'
Richard A. Carrigan, B.S., Asst. Chemist
ECONOMICS, AGRICULTURAL
C. V. Noble, Ph.D., Agricultural Economist'
Bruce McKinley, A.B., B.S.A., Associate
Zach Savage, M.S.A., Associate
A. H. Spurlock, M.S.A., Assistant
ECONOMICS, HOME
Ouida Davis Abbott, Ph.D., Specialist'
Ruth Overstreet, R.N., Assistant
ENTOMOLOGY
J. R. Watson, A.M., Entomologist'
A. N. Tissot, Ph.D., Associate
H. E. Bratley, M.S.A., Assistant
HORTICULTURE
G. H. Blackmon, M.S.A., Horticulturist'
A. L. Stahl, Ph.D.. Associate
F. S. Jamison, Ph.D., Truck Horticulturist
R. J. Wilmot, M.S.A., Specialist, Fumigation
Research
R. D. Dickey. B.S.A., Assistant Horticulturist
J. Carlton Cain, B.S.A., Asst. Horticulturist
Victor F. Nettles, M.S.A., Asst. Hort.
PLANT PATHOLOGY
W. B. Tisdale, Ph.D., Plant Pathologist'
George F. Weber, Ph.D., Plant Pathologist
R. K. Voorhees, M.S., Assistant8
Erdman West, M.S., Mycologist
Lillian E. Arnold, M.S., Assistant Botanist


BOARD OF CONTROL

R. P. Terry, Chairman, Miami
Thomas W. Bryant, Lakeland
W. M. Palmer, Ocala
H. P. Adair, Jacksonville
Chas. P. Helfenstein, Live Oak
J. T. Diamond, Secretary, Tallahassee

BRANCH STATIONS

NORTH FLORIDA STATION, QUINCY
L. 0. Gratz, Ph.D., Plant Pathologist in
Charge
R. R. Kincaid, Ph.D., Asso. Plant Pathologist
J. D. Warner, M.S., Agronomist
Jesse Reeves, Farm Superintendent
CITRUS STATION, LAKE ALFRED
A. F. Camp, Ph.D., Horticulturist in Charge
John H. Jefferies, Superintendent
Michael Peech, Ph.D., Soils Chemist
B. R. Fudge, Ph.D., Associate Chemist
W. L. Thompson, B.S., Asst. Entomologist
W. W. Lawless, B.S., Asst. Horticulturist
EVERGLADES STATION, BELLE GLADE
J. R. Neller, Ph.D., Biochemist in Charge
J. W. Wilson, Sc.D., Entomologist
F. D. Stevens, B.S., Sugarcane Agronomist
Thomas Bregger, Ph.D., Sugarcane
Physiologist
Jos. R. Beckenbach, Ph.D., Asso. Horticul.
Frederick Boyd, Ph.D., Asst. Agronomist
G. R. Townsend, Ph.D., Associate Plant Path.
R. W. Kidder, B.S., Asst. Animal Husbandman
W. T. Foresee, Ph.D., Asst. Chemist
B. S. Clayton, B.S.C.E., Drainage Engineer'
SUB-TROPICAL STATION, HOMESTEAD
W. M. Fifleld, M.S., Asst. Horticulturist
S. J. Lynch, B.S.A., Asst. Horticulturist
Geo. D. Ruehle, Ph.D., Asso. Plant Pathologist
W. CENTRAL FLA. STA., BROOKSVILLE
W. F. Ward, M.S., Asst. An. Husbandman
in Charge2

FIELD STATIONS
Leesburg
M. N. Walker, Ph.D., Plant Pathologist in
Charge
K. W. Loucks, M.S., Asst. Plant Pathologist
C. C. Goff, M.S., Assistant Entomologist
Plant City
A. N. Brooks, Ph.D., Plant Pathologist
R. N. Lobdell, M.S., Asst. Entomologist
Cocoa
A. S. Rhoads, Ph.D., Plant Pathologist
Hastings
A. H. Eddins, Ph.D., Plant Pathologist
Monticello
Samuel O. Hill, B.S., Asst. Entomologist2
Bradenton
David G. Kelbert, Asst. Plant Pathologist
Sanford
R. W. Ruprecht, Ph.D., Chemist in Charge,
Celery Investigations
W. B. Shippy, Ph.D., Asso. Plant Pathologist
Lakeland
E. S. Ellison, Meteorologist2
B. H. Moore, A.B., Asst. Meteorologist'

'Head of Department.
'In cooperation with U.S.D.A.
'On leave.








NUTRITIONAL ANEMIA

AND ITS PREVENTION

By OUIDA DAVIS ABBOTT and CHESTER F. AHMANNL

INTRODUCTION
One of the most common nutritional deficiency diseases is
anemia, a disease in which the oxygen-carrying capacity of the
blood is reduced. It is not limited to any country, particular
race, nor to any group or class of society; it is found in every
state and section of the country.
It might at first be believed that the people comprising the
lowest income class, those actually suffering from hunger, would
have anemia and that the wealthy, having plenty, would be en-
tirely free from it. Such is not the case.
According to incomes the population may be divided into
four groups. In the lowest group are those who are hungry,
but due to aid from various state and social agencies the num-
ber of these is decreasing. Supervision and selection of foods
by trained nutritionists are giving to many in this group a
more nearly balanced diet than is obtainable by the group
immediately above it. This second group is a much larger one,
estimated to cover between 10 and 25 percent of the popula-
tion. The people in this group can afford enough to prevent
hunger, but very often the diet is of a quality now known to
afford little protection against malnutrition. On the next plane
up, measured by income, is another group which earns enough
to secure an adequate diet, provided the earnings are spent in
accord with the newer ideas of what constitutes a balanced and
protective diet. Unfortunately, many incomes in this group
are spent unwisely. For this reason a large number of these
families fall into the class of the undernourished. At the top,
measured by incomes, are the rich. But even here anemia is
present.
Heretofore, an anemia condition has been regarded as rela-
tively unimportant, but experiments conducted by the authors
show that when this condition develops in young animals the
heart, liver, spleen, ovary, and to a lesser degree, the other
organs are injured; and this injury is not fully repaired after
'Chester F. Ahmann, M.D., Ph.D., consulting physician; formerly physi-
ologist, Home Economics Department, Florida Agricultural Experiment
Station.






Florida Agricultural Experiment Station


recovery. In an earlier study Ahmann and his associates (1)2
pointed out that 20 percent of the children in five representative
counties in the state had heart defects. The high incidence of
heart defects in middle life suggests that an enlarged and weak-
ened heart brought on by severe anemia in childhood might
contribute to this condition. From a study of a large number
of children Mackay (4) found that anemia retarded the rate
of growth and markedly lowered the resistance to infectious
diseases.
Because of the high incidence of anemia and the insidious
nature of the effects, there should be a more general under-
standing of its causes and prevention.

COMPOSITION OF THE BLOOD
Before considering anemia it will be necessary to touch upon
the composition of the blood and to define certain terms which
will be used in this discussion. The blood is composed of a
liquid portion, the plasma, and various solids, the cells. There
are three distinct classes of cells or corpuscles suspended in the
plasma: the red and white corpuscles, and the platelets. The
problem of anemia is concerned primarily with the red cells.
In the male there are about 5,000,000 red cells in a cubic milli-
meter of blood; in the female, 4,500,000. The striking feature
of this cell is its content of hemoglobin, which gives to the
blood its characteristic red color.
In building normal body cells of any type, proteins, fats,
carbohydrates, vitamins, and mineral salts are necessary. But
in building red blood cells two additional substances must be
supplied to the marrow of the flat bones, especially to the ribs,
skull, and vertebrae, where the formation of the red cells takes
place. The substances are iron, which is necessary for hemo-
globin, and an extract from the liver and other organs, which
is necessary for the maturation of the cells. With adequate
amounts of these substances the marrow functions at a con-
stant rate of speed and new cells are formed to take the place
of the ones destroyed each day.

FUNCTION OF THE RED CELLS
Hemoglobin is an iron-protein compound that has the prop-
erty of combining with oxygen. The body tissues must be
supplied with many times as much oxygen as can be carried
'Italic figures in parentheses refer to "Literature Cited" in the back
of this bulletin.






Florida Agricultural Experiment Station


recovery. In an earlier study Ahmann and his associates (1)2
pointed out that 20 percent of the children in five representative
counties in the state had heart defects. The high incidence of
heart defects in middle life suggests that an enlarged and weak-
ened heart brought on by severe anemia in childhood might
contribute to this condition. From a study of a large number
of children Mackay (4) found that anemia retarded the rate
of growth and markedly lowered the resistance to infectious
diseases.
Because of the high incidence of anemia and the insidious
nature of the effects, there should be a more general under-
standing of its causes and prevention.

COMPOSITION OF THE BLOOD
Before considering anemia it will be necessary to touch upon
the composition of the blood and to define certain terms which
will be used in this discussion. The blood is composed of a
liquid portion, the plasma, and various solids, the cells. There
are three distinct classes of cells or corpuscles suspended in the
plasma: the red and white corpuscles, and the platelets. The
problem of anemia is concerned primarily with the red cells.
In the male there are about 5,000,000 red cells in a cubic milli-
meter of blood; in the female, 4,500,000. The striking feature
of this cell is its content of hemoglobin, which gives to the
blood its characteristic red color.
In building normal body cells of any type, proteins, fats,
carbohydrates, vitamins, and mineral salts are necessary. But
in building red blood cells two additional substances must be
supplied to the marrow of the flat bones, especially to the ribs,
skull, and vertebrae, where the formation of the red cells takes
place. The substances are iron, which is necessary for hemo-
globin, and an extract from the liver and other organs, which
is necessary for the maturation of the cells. With adequate
amounts of these substances the marrow functions at a con-
stant rate of speed and new cells are formed to take the place
of the ones destroyed each day.

FUNCTION OF THE RED CELLS
Hemoglobin is an iron-protein compound that has the prop-
erty of combining with oxygen. The body tissues must be
supplied with many times as much oxygen as can be carried
'Italic figures in parentheses refer to "Literature Cited" in the back
of this bulletin.







Nutritional Anemia and Its Prevention


in solution in the plasma; and the hemoglobin normally present
in the red cells (15 to 16 gms. per 100 cc. of blood) by chemically
combining with oxygen increases the carrying capacity of the
blood 100 times. The red cells may be thought of as hemoglobin
containers, and the hemoglobin as an oxygen carrier. These
cells become filled with oxygen in the lungs, and the circulating
blood distributes this oxygen to the tissue cells of the body in
exchange for carbon dioxide which constantly accumulates in
the tissues. Thus, the red cells are constantly making round
trips from the lungs to the tissues. The life span of each red
cell is about 30 days, after which it undergoes fragmentation.
During this process hemoglobin is set free and is broken up
into globin and hematin. Hematin loses its iron and is changed
into bile pigments. About 15 percent of the iron is excreted
and the remainder is returned to the bone marrow to be used
again.
agan CAUSES OF ANEMIA

The term "anemia" is applied to any deficiency in the quantity
or quality of blood as manifested by a reduction in the number
of red cells, in the amount of hemoglobin, or in both. There is
some difference of opinion as to the degree of hemoglobin re-
duction necessary to characterize a condition as anemic. Most
authorities agree that out of a standardized 100 percent hemo-
globin, values much below 85 percent are subnormal, and that
values below 70 percent indicate an anemic condition. But
Davies (2) is of the opinion that any hemoglobin value below
75 percent should be regarded as pathologic. Several factors
operating singly or together may bring about a disturbance in
the normal balance between destruction and regeneration of red
cells and hemoglobin. A deficit in any one of the cell-building
materials or such general factors as exhaustion, infection,
malignancy, poisons, or a mechanical measure such as hemor-
rhage, may disturb the balance.
However, the usual cause of the disturbance may be traced to
a lack of the liver principle necessary for the maturation of the
cells, or iron necessary for hemoglobin formation. A deficit in
these substances leads first to qualitative defects and, in time,
to quantitative defects in red cell formation. In the absence of
the liver principle the blood shows a reduction in the number
of cells, but the cells are large and contain more hemoglobin
than normal cells. The blood picture of an early or mild iron
deficiency is a normal red count with reduced hemoglobin. In
severe or chronic iron deficiency the cells become smaller and






Florida Agricultural Experiment Station


fewer and the hemoglobin is still further reduced. With a re-
duction in the hemoglobin or in the number of red cells the
oxygen-carrying capacity of the blood is likewise reduced. For
example, blood containing only one-half the normal amount of
hemoglobin can carry only one-half the normal amount of
oxygen. In order to supply the tissues with the necessary
oxygen the cells must make more trips from the lungs to the
tissues, so the less hemoglobin there is present in the blood
the faster the heart action must be, and the faster the heart
rate the greater is the strain put upon it.
While it is not within the scope of this paper to enter into
a technical discussion of the anemias, it seems desirable to
mention the basis for classification and to indicate briefly the
characteristics of the anemias prevalent in Florida.

CLASSIFICATION OF THE ANEMIAS
There are two classifications of the anemias. The first of
these is based especially on the size and hemoglobin content
of the red cells. On the basis of size these cells are classified
as normal, large, or small (normocytic, macrocytic, micro-
cytic); on the basis of hemoglobin content as normal, increased,
or decreased (normochromic, hyperchromic, and hypochromic).
This information provides the data for the classification of the
anemias according to the blood picture.
The second classification is based on the cause of the anemia-
that is, whether it is due to increased blood loss, as in acute
hemorrhage or infections, or to decreased blood formation
brought on by depression of the bone marrow or by deficiencies
in substances necessary for the formation of red cells. This
classification is known as the clinical classification. In making
a diagnosis the information obtained from both the classifica-
tions is correlated. For example, in the anemia caused by a
mild iron deficiency there is no reduction in the size of the
red cells, but the hemoglobin is reduced. With a severe or pro-
longed iron deficiency there is a further decrease in hemoglobin
and the mean size of the cell becomes smaller. Because of the
reduction in hemoglobin, anemia due to an iron deficiency is
classified as hypochromic. Anemia of childhood, simple anemia
of pregnancy, and chlorosis are types of hypochromic anemia. If
the anemia is due to a deficiency of the liver principle, it is char-
acterized chiefly by deficient formation of red cells. These cells
are reduced in number and vary greatly in size and shape. Many
of them are very large (macrocytes), others are normal in






Nutritional Anemia and Its Prevention


size, while a few are very small (microcytes). Although the
cells may be markedly reduced in number they are well filled
with hemoglobin. The anemias included in this group are: per-
nicious anemia, and the anemias of pellagra and sprue.

NUTRITIONAL ANEMIA IN FLORIDA
In the study of nutritional anemia in Florida the blood of
approximately 5,000 rural children and 100 pregnant women
was examined. All of the children were attending school and
considered able to participate in the daily program. In no case
was there evidence of acute infections. The blood picture showed
that 40 percent of them were definitely anemic. Of those who
were anemic more than three-fourths had hemoglobin values
from 50 to 70 percent, while their red cell count remained
normal. This is the blood picture characteristic of hypochromic
anemia due to an early or mild iron deficiency. However, the
blood picture of the remainder of the anemic children showed
that the red cells had become fewer and smaller and the hemo-
globin values ranged from 20 to 50 percent. Such a condition
indicated a severe or chronic iron deficiency. That an iron de-
ficiency was the cause of the anemia was demonstrated by giv-
ing iron to 200 severely anemic children. In from three to five
weeks the hemoglobin values of the treated children had in-
creased enough to be considered normal. Many of these children
had hookworms and enlarged tonsils, and a few had had malaria.
But in spite of these infections the hemoglobin values were
restored when iron was given. Investigations on the degree
of hookworm infection showed that many children were infected
with a moderate number of hookworms. It was found that a
well nourished child thus parasitized had little change in hemo-
globin; however, when a poorly nourished child had the same
number of worms the hemoglobin reached dangerously low
levels. The same observations were made on children with
malaria. A well nourished child was able to withstand malaria
for a short time with very little decrease in hemoglobin, but
when one poorly nourished contracted malaria there was a rapid
decrease. Apparently most of the general symptoms of the
patient with hookworm are due to anemia. The pallor, the
marked weakness, the excessive fatigue, the loss of appetite,
and edema are due for the most part to anemia. Rhoads and
his associates (5) were able to prevent anemia in cases highly
infected with hookworm by administration of iron, later sub-






Florida Agricultural Experiment Station


stituted by an iron-rich diet. Thus, it is evident from these
observations that children infected with parasites should at all
times be supplied with diets high in iron.
In blood studies of rural white women during pregnancy it
was found that 80 percent of them were anemic. In most cases
the condition was due solely to a lack of iron, in others to dis-
turbances of gastric acidity which hindered absorption. But
often dietary and gastric deficiencies were associated, and it
was not uncommon to find still other factors which aggravated
the condition. Among these the most outstanding were: the
early age at which child-bearing began, the great number of
pregnancies and miscarriages, the lack of pre-natal and post-
natal care, and the general state of nutrition at the beginning
of and during pregnancy. The junior author has observed cases
where child-bearing began at 16 to 17 years of age and con-
tinued to the menopause. Often there was neither pre-natal
nor post-natal care-the only time the doctor visited the mother
was at delivery.
The hemoglobin values of many of these women were already
at low levels and the increasing demand on the part of the
developing fetus for iron produced an anemia of severe degree.
In simple iron deficiency the hemoglobin values ranged from
50 to 60 percent. However, when other factors were contrib-
uting, values as low as 35 percent were found. But, regardless
of the many contributing factors, routine iron treatment, sup-
plemented with hydrochloric acid when indicated, raised the
hemoglobin and at the time of delivery all the women had
hemoglobin values within the normal range.

IRON REQUIREMENT
While it is recognized that several factors operating singly
or together may contribute to the lowering of the hemoglobin
of school children and pregnant women in Florida, the fact
remains that the administration of large doses of iron quickly
restores the hemoglobin to normal levels. Apparently there
are several causes for iron deficiency. Among these are the
high carbohydrate diets necessitated by poverty or custom, the
limitations of a small farm's products, intensive cultivation of
cash crops, and ignorance of food values. In individual cases
whims and food fancies or gastro-intestinal symptoms may bring
about a chronic deficiency. Kracke and Garver (3), in sum-
marizing the current ideas concerning the causes of iron de-






Nutritional Anemia and Its Prevention


ficiency in childhood, mention anemia in the pregnant mother
as one of the predisposing factors that is well understood. It
has been observed frequently that a child born of an anemic
mother often has a small iron reserve and develops some degree
of anemia before the iron-carrying foods are supplied.
According to Sherman (6) "a daily allowance of 10 milli-
grams of iron in a diet otherwise adequate should suffice for
the maintenance of equilibrium in an average man under normal
conditions; but, until the conditions which determine a larger
metabolism are more clearly defined, it would seem desirable
to set a higher standard, perhaps 15 milligrams of food iron
per man per day." However, in planning the family dietary
increased allowance should be made to meet the demands of
the pregnant and lactating mother and the extraordinary re-
quirements of the growing child. The child probably needs
more iron than the adult, but it is still impossible to state in
quantitative terms what the daily allowance should be. How-
ever, at all times a child's diet should be sufficiently high in
iron to provide not only for maintenance, but also for the in-
creasing blood supply needed during growth. It should be em-
phasized that the daily allowance for both adults and children
are those recommended for average individuals under normal
conditions, But during infections, when there is an increased
destruction of blood and perhaps poor absorption, the require-
ment is increased, and this increase is determined by the length
and severity of the infection.
Food is, of course, the most important means of preventing
anemia. But if the diet is to be effective, foods high in iron
must be included therein. This means that the diet must be
planned in a definite way and not left to chance or to circum-
stance.
In calculating the iron content of a mixed diet it may be
said that it is roughly proportional to the protein, for these
two constituents tend to run parallel. A diet which includes
a liberal allowance of protein foods will nearly always contain
sufficient iron to prevent anemia.
Eating habits of rural people, particularly those having the
lower incomes, are determined primarily by the foods that are
produced on the farm or are easily and cheaply procured. As
these foods are used continuously an appetite for them is grad-
ually built up and once this habit is formed it is not subject
to sudden change. Ahmann and his associates (1) in the study
of the diets of 2,100 rural school children found that only 1.2






Florida Agricultural Experiment Station


percent of them had commendable diets-that is, diets capable
of meeting the body needs. Likewise, the number in the ade-
quate group was small, amounting to only 23.4 percent. Almost
twice this number, 45.7 percent, had diets which were highly
questionable; 29.9 percent had diets which were plainly incap-
able of supplying the necessary nutrients, and of this group
1.4 percent had diets classified as distinctly deficient. The iron
content of sample diets that were considered questionable was
estimated at 8 milligrams. If all the iron were available, and
all of it absorbed and utilized, these diets furnished even less
than the minimum requirement.
In a study of the food items making up these diets it was
found that on many farms pork, sweet potatoes, rice, grits, and
cornmeal-all low in iron-constituted the main articles of diet;
while the foods high in iron such as beef, eggs, leafy and dried
vegetables, and dried fruits were used in relatively small quan-
tities. Among the most potent foods used for hemoglobin re-
generation are beef and especially its "extra carcass" parts,
liver, heart, spleen, and kidneys. Yet in a survey of the dis-
tribution of family living from the farm, the Department of
Agricultural Economics, Florida Agricultural Experiment Sta-
tion3 found that of the 213 farms studied, only 7 contributed
beef. Further dietary studies by the authors showed that beef
was used in negligible amounts by rural families in nine coun-
ties in the state.
Eggs, one of the best sources of iron, were found to be avail-
able in some quantity on approximately 98 percent of the farms.
However, eggs were about the only source of income for the
farm women so that in many homes their use in quantity was
limited to a relatively short time in the spring when they were
plentiful and prices low.
Some kinds of garden produce were furnished on all farms
during a part of the year, but unfortunately, the year-round
garden was the exception rather than the rule. Lettuce, toma-
toes, string beans, and mustard and turnip greens were used
for only a few months, whereas cabbage and collards were used
for a longer period. In the amounts consumed, only the green
leafy vegetables, string beans, field peas and tomatoes furnish
sufficient iron to be considered good dietary sources. Whole
grains, dried peas and beans, all high in iron, were used spar-
ingly or not at all. The same was true of dried fruits.
'Unpublished data.






Nutritional Anemia and Its Prevention


Improvements in methods of production, transportation, stor-
age and distribution have made available a great variety of
foods, but the consumer with a limited budget often buys un-
wisely. The rural woman may have little information to guide
her in buying. Often she buys the attractive, the highly ad-
vertised food, or she buys the food for which an appetite has
been created. On the other hand, the budget may be so low
that only the cheapest can be bought. A study of the food
bought by families living in the general farming section showed
that such staples as sugar, coffee, bread, rice, grits, tea and
condiments were the usual purchases; these are known to be
low in iron.
CURATIVE MEASURES
Once a deficiency of iron has led to anemia it is almost im-
possible to cure it by diet. Iron in some form must be given.
The administration of suitable preparations and adequate
amounts of iron is the recognized treatment for all types of
anemia due to reduction of hemoglobin. According to Kracke
and Garver (3) the value of iron has been recognized for more
than a hundred years, but only since the necessity for large
doses has been stressed has the importance of iron therapy
been fully appreciated. Because of the possible factors in-
fluencing its absorption it is necessary to give large doses. The
quantity required represents at least 20 times the normal
absorption.
In regard to the relative curative values of the different
preparations of iron, inorganic is superior to organic. Ferrous
salts are preferable to ferric, a smaller dose being required to
give the same hemoglobin regeneration. The iron should be
given in divided doses, preferably with or just after meals.
The admixture with foods gives a wide distribution over con-
siderable absorptive surface and the dilution obviates irritation
in the stomach.
In the treatment of anemic school children and pregnant
women the cheap and effective ferric ammonium citrate has
been used in daily doses at the rate of 45 grains per day, 15
grains in three doses after each meal. As in other medication
the requirement varies with the patient and should be given
under a prescription of a physician. It should be emphasized
that when the hemoglobin rises during the administration of-
iron it will fall again when it is discontinued unless the diet
is adequate.






Florida Agricultural Experiment Station


Because of the recognition of the relationship of the diet to
disease a radical change in buying and diet planning is taking
place in some families and could no doubt be speeded up and
generally popularized. The public now has at its disposal a
body of knowledge which will, if it is sufficiently widespread
and used, help families to choose foods best suited to their
needs. The effects of anemia are so insidious that diets ade-
quate in iron must be planned and not left to chance. In most
cases this means a redistribution of the present food budget,
and this without omitting any article generally used. By the
mere shifting of relative proportions of the different food con-
stituents the diet can be made adequate. The cost of neglect-
ing such measures is seen in rearing children on diets now
known to be definitely harmful to their mental and physical
development, in malnourished women continuing to bear mal-
nourished babies, and in the persistence of avoidable ill health.
Scientific evidence points to the fact that the health and effi-
ciency of the family is largely determined by the everyday
choice of food.
SUMMARY
The most outstanding cause of anemia among school children
and pregnant women in the state is the lack of iron in the diet.
The iron requirement of an average man under normal condi-
tions was set at 15 milligrams of food iron per day, but chil-
dren and pregnant and nursing women require more.
Nutritional anemia is prevented by the use of foods high in
iron, but when the hemoglobin falls to anemic levels the ad-
ministration of iron salts becomes necessary.
Iron salts should be given under a doctor's prescription.

LITERATURE CITED
1. AHMANN, C. F., O. D. ABBOTT, and GEORGIA WESTOVER. A nutritional
study of the white school children in five representative counties of
Florida. Fla. Agr. Exp. Sta. Bul. 216. 1930.
2. DAVIES, DANIEL T. Anemia in pregnancy. Practitioner, 134: 290-297.
1934.
3. KRACKE, RoY R., and HORTENSE GARVER. Diseases of the blood and
atlas of hematology, pp. 195, 278. J. B. Lippincott Co. 1937.
4. MACKAY, H. M. M. Normal hemoglobin level during the first year of
life. Arch. Dis. Chil. 8: 221-225. 1933.
5. RHOADS, C. P., W. B. CASTLE, G. C. PAYNE, and H. A. LAWSON. Hook-
worm anemia: etiology and treatment with special reference to iron.
Am. Jour. Hyg. 20: 291-306. 1934.
6. SHERMAN, H. C. Chemistry of food and nutrition. 4th Ed. p. 320.
The Macmillan Co. 1935.






Florida Agricultural Experiment Station


Because of the recognition of the relationship of the diet to
disease a radical change in buying and diet planning is taking
place in some families and could no doubt be speeded up and
generally popularized. The public now has at its disposal a
body of knowledge which will, if it is sufficiently widespread
and used, help families to choose foods best suited to their
needs. The effects of anemia are so insidious that diets ade-
quate in iron must be planned and not left to chance. In most
cases this means a redistribution of the present food budget,
and this without omitting any article generally used. By the
mere shifting of relative proportions of the different food con-
stituents the diet can be made adequate. The cost of neglect-
ing such measures is seen in rearing children on diets now
known to be definitely harmful to their mental and physical
development, in malnourished women continuing to bear mal-
nourished babies, and in the persistence of avoidable ill health.
Scientific evidence points to the fact that the health and effi-
ciency of the family is largely determined by the everyday
choice of food.
SUMMARY
The most outstanding cause of anemia among school children
and pregnant women in the state is the lack of iron in the diet.
The iron requirement of an average man under normal condi-
tions was set at 15 milligrams of food iron per day, but chil-
dren and pregnant and nursing women require more.
Nutritional anemia is prevented by the use of foods high in
iron, but when the hemoglobin falls to anemic levels the ad-
ministration of iron salts becomes necessary.
Iron salts should be given under a doctor's prescription.

LITERATURE CITED
1. AHMANN, C. F., O. D. ABBOTT, and GEORGIA WESTOVER. A nutritional
study of the white school children in five representative counties of
Florida. Fla. Agr. Exp. Sta. Bul. 216. 1930.
2. DAVIES, DANIEL T. Anemia in pregnancy. Practitioner, 134: 290-297.
1934.
3. KRACKE, RoY R., and HORTENSE GARVER. Diseases of the blood and
atlas of hematology, pp. 195, 278. J. B. Lippincott Co. 1937.
4. MACKAY, H. M. M. Normal hemoglobin level during the first year of
life. Arch. Dis. Chil. 8: 221-225. 1933.
5. RHOADS, C. P., W. B. CASTLE, G. C. PAYNE, and H. A. LAWSON. Hook-
worm anemia: etiology and treatment with special reference to iron.
Am. Jour. Hyg. 20: 291-306. 1934.
6. SHERMAN, H. C. Chemistry of food and nutrition. 4th Ed. p. 320.
The Macmillan Co. 1935.




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