Study of experimental ketogenesis and some other dietary states in view of the personality effects of endocrine function

PDF

Download

Open document

Flip pages

Download a page range

Download transcript

Copy asset link

Request this asset

Request accessible transcript

Transcript (if available)

Content A STÜDÏ OF EXPERIMEHTAIi KETOGEUESIS A H D SO M E OÎHBH DIETARY STATES IE VIEW OP THE PERS0HA1ITÏ EPPBCTS OP BEDOORIHE POTCTIOE à A T hesis P resen ted to th e F a c u lty o f th e D iv isio n o f Psychology U n iv e rsity o f Southern C a lifo rn ia In P a r t i a l F u lfillm e n t o f th e R equirem ents f o r th e Degree M aster o f A rts in Psychology ^7 C harles Bruce M itc h e ll June 1957 UMI Number: EP63889 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Oisseftatfflf! PVblisMng UMI EP63889 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 This the sis y written by ..............C H A RLES BRUCE MITCHELL............. 1 9 ^ 9 & ■ under the direction of Als Faculty Com m ittee, and approved by all its rrbembers, has been * presented to and accepted by the Council on Graduate S tudy and Research in partial julfill- ment of the requirements for the degree of M ASTER OF ARTS Secretary Date Jun e,,...1 9 3 7 .......... Facility Committee Chairmàn A CK HO W LEBÔ BM M TS Deep g r a titu d e i s owed th e ex p erim en tal s u h je c te whose i n t e r e s t and sportsm anship made t h i s in v e s tig a tio n p o s s ib le ; and th e D epartm ent o f B iochem istry i s to be thanked fo r p a r a l l e l i n g th e b eh av io r stu d y in k e to g e n e sis w ith biochem ical d eterm in atio n s* TABLE OF COIÎTMTS CHAPTER PACE I . THE PROBLEM................... 1 The o b je c t of the stu d y . . . . . . . . . . 2 The p lan o f ex p erim en tatio n ..................... 2 O rg an izatio n o f th e t h e s i s . . . . . . . . . 5 I I . THE PRESEHT K N O W L E D G E OF TOTRITIOH-OTDOGRIirE- BEHAVIOR IHTERRELATIOHSHIPS . . . . . . . . . 8 The need fo r e n d o c rin o lo g ic a l re se a rc h in psychology 8 The th y ro id . . . . . . . . . . . . . . . . . 11 Io d in e as p ro p h y lax is . . . . . . . . . . . . . 13 Meats and calcium a s causes o f d y sfu n ctio n . . . 15 D istu rb in g e f f e c ts o f o th e r foods and o f inanition 16 C retin ism p re v e n tio n w ith Io d in e . . . . . . . . i s The p a ra th y ro id s . . . . . . . . . . . . . . 18 R e la tio n to nervousness ... ....... 18 Comparison w ith v ita m in D . . . . . . . . . . . 19 The p i t u i t a r y . . . . . . . . . . . . . . 21 R e la tio n to v ita m in B in glycém ie fu n c tio n . . . 22 The gonads and t h e i r e f f e c t s on b e h a v io r * . . « • 22 A b o litio n o f t e s t i c u l a r hormone in av itam in o sis B 23 The thymus and p in e a l . . . . . . . . . . . 23 The a d re n a ls . . . . . . . . . . . . . . . . . . . 24 E pinephrine and glycem ia in em otion . . . . . . 25 i l CHAPTER PAGE C ortex a s re g u la to r o f sodium -pot a ss ium balance 25 V itam in C in c o rte x 26 G a stric fu n c tio n and neurology in p e rn ic io u s miemia 27 In s u lin in carb o h y d rate m etabolism # « « « * • * • 3 1 E ffe c t on p e r s o n a litie s o f undernourished norm als 34 Cure f o r dem entia praecox . . . . . . . . . 37 E ffe c t o f an tian em ic m a te ria l on n erv e changes . . 39 I I I . Tj^TS USED........................................................................ 42 Grip endurance . . . . . . . . . . . . . . . 42 Push-up e x e rc is e . . . . . . . . . . . . 45 T hree-dim ensional tap p in g . . . . . . ... 47 The Humm-Wadsworth Temperament S cale ..... . 50 The O tis T ests o f M ental A b ility . . . . . . . 5 1 IV . A PRELIMINARY INVESTIGATION OF BEHAVIOR IN VARIOUS NUTRITIONAL STATES . . . . . . . . . . . . 52 Thyroxin a d m in is tra tio n to two norm al in d iv id u a ls . 5 2 R e su lts . . . . . . .................. . . . . . . . . . 54 P e rs o n a lity e f f e c ts o f raw meat d le to th e ra p y . . . 55 R e su lts . . . . . . . . . . . . . . . . . 58 L iv e r e x tr a c t in a case o f p e rio d ic m elan ch o lia. . 60 R e su lts . . . . . . . . . . . . . . . . 62 M assive g ly c in e in g e s tio n . . . . . . . . . . 62 R e su lts . . . . . . . . . . . . . . . . 64 ^ s s i v e e th y l a lc o h o l In g e stio n . . . . . . . . . 66 R e su lts . . . . . . . . . . . . . . . . . . . . 69 I l l CHAPTER PAGE T . BEHAVIOR IN KETOGENESIS.......................... 72 The o b je c t o f t h i s phase o f th e In v e s tig a tio n . . 73 The ex p erim en tal tech n iq u e . . . . . . . . . . . . 73 S u b je c ts . ...................... 73 C ontrol procedure . . . . . . . . . . . . . . . 76 E xperim ental regim e . . . . . . . . . . . . . . 77 The k eto g en ic d i e t ..................... 79 D ie ta ry a d ju n c ts . . . . . . . . . . . . . . 80 The q u a lita tiv e r e s u l t s . . . . . . . . . . . 81 R eaction to b lo o d -g iv in g . . . . . . . . . . . . 81 G lycogenolysis a c c e le ra te d by em otion . . . . . 84 A norexia . . . . . . . . . . . . . . . . . . . . 88 S u b je c tiv e f a tig u e 88 R e tra c tio n o f F ie ld o f co n scio u sn ess . . . . . . 89 A m ativeness 90 The q u a n tita tiv e r e s u l t s . . . . . . . . . . 91 E ffe c ts on m ental fu n c tio n s , a t t i t u d e s , and m uscular endurance 91 V I. ST O M A H Y A N D CONCLUSIONS . . . . . . . . . . . . . . 97 Summary . . . . . . . . . . . . . . . . 97 C onclusions . . . . . . 99 BIBLIOGRAPHY . . . . ................................................................................101 APPENDIK . . . . . . ............................................. . . . . . . . 106 LIST OP TABLES A N D LISTS TABLE PAGE I . D ata on two norm al s u b je c ts b e fo re and a f t e r th y ro x in In g e s tio n . . • • 53 I I . D ata on s u b je c t b e fo re and a f t e r raw meat d le to - th era p y in c o l i t i s g ra v is 61 I I I . D ata on two s u b je c ts b e fo re and a f t e r prolonged g ly c in e in g e s tio n . , . . . . . . . . . . . . . . . 63 . . ' I ' ■ ' ' ‘ IV . R e su lts o f t e s t s made b e fo re and a f t e r a lc o h o l in g e s tio n . . . . . . . . . . . . . .. • 71 V. Q u a n tita tiv e fin d in g s in a k eto g en ic regim e . . • * 92-95 LIST I . D ie ta ry a d ju n c ts used as p ro p h y la x is a g a in s t de f ic ie n c ie s in th e k e to g e n ic d i e t . . . . . . . . . . 8 3 LIST OF GRAPHS G R A PH PAGE I* C hronological course o f a c e to n u ria and g rip fa tig u e in th re e s u b je c ts . . . . . . . ...................... 9 6 CHAPTER I THE PRO BLEM P sy c h o lo g ists have given r e l a t i v e l y l i t t l e con s id e r a tio n to th e in te r r e la tio n s h ip s betw een n u t r i t i o n , th e e n d o c rin e s, and b e h a v io r. Human b eh av io r in n u t r i t io n a l d istu rb a n c e s w ith t h e i r accompanying end o crin e d y sfu n c tio n s and p e r s o n a lity im balance has rem ained alm ost e n t i r e ly in th e p ro v in ce o f th e p h y s ic ia n . The p r a c tic in g p h y sic ia n u s u a lly la c k s th e tim e , equipm ent, and tr a in in g f o r o b jec tiv e p sy e h o lo g ic a l in v e s tig a tio n . The r e s u l t has been th e accum ulation in th e c l i n i c a l l i t e r a t u r e o f a mass o f Im p re s s io n s . An example o f extrem e im pressionism in th e m edical f r a t e r n i t y i s th a t o f Berman.^ T ypical i s h is sta te m e n t t h a t h y p o p itu ita rism "su p p lie s th e second and t h i r d o ffe n d e rs i n th e Ju v e n ile c o u r ts ." N e v e rth e le ss--th o u g h Berman does n o t w ait fo r s c i e n t i f i c p ro o f—much t h a t he has w r itte n may be p ro p h e tic . Under th e c a p tio n "Food and V itam ins—Raw M a te ria ls f o r th e Endocrine G lands," h e s t a t e s : ^ %erman, L o u is, The Glands R eg u latin g P e rs o n a lity (New York: The M acm illan '<Sompany, lé S s ) , 0 4 i pp. ^ As quoted by R obinson, W. J . , Our M ysterious L ife G lands. . . In c lu d in g th e V itam ins (New York: B agenics Pub lis h in g CoEgbany, W m ) , p . iè& . A h o s t o f re s e a rc h e s , exp erim en tal o b se rv a tio n s in an im als, and s tu d ie s o f human b ein g s now demon s t r a t e th a t w hatever a f f e c ts th e endocrine glands d e le te r io u s lg o r fa v o ra b ly , a f f e c t s c h a ra c te r and p e rso n a lity .® The o b je c t o f th e s tu d y . That B erm an's statem en t i s n e a re r prophesy th an f a c t w i l l appear from th e survey o f th e more s c i e n t i f i c l i t e r a t u r e in t h i s f i e l d re p o rte d in C hapter I I . Only b eg in n in g s have been made in d em o n stratin g th e t r i p l e c o r r e la tio n which Berman dogm atizes, and th e o b je c t o f th e p re s e n t stu d y has been to c o n trib u te to th e n a sc e n t u n d e rsta n d in g o f th e r e l a t i o n between th e n u t r i t io n and be h a v io r o f humans. S p e c if ic a lly , t h i s in v e s tig a tio n has attem pted to a s c e r ta in w hether a stu d y o f th e p e r s o n a lity a s p e c ts o f a number o f d ie ta r y s t a t e s w ill uncover s u ffic ie n t fo u n d a tio n in th e l i f e s c ie n c e s f o r a s e p a ra te sc ie n c e o f n u t r i t i o n a l psychology. Such a s c ie n c e , i f j u s t if i e d in th e p re s e n t s t a t e o f toow ledge, should prove a u s e fu l guide to th e p r a c tic a b le d is c ip lin e s o f m edicine and e d u c a tio n . I t s v alu e m ight in c re a s e w ith th e devlopm ent o f s p e c ia liz e d te c h n iq u es accompanying dem arcation as a s e p a ra te scien ce* The p la n o f e x p e rim e n ta tio n . The ex p erim en tal approach was w ith f u l l view o f th e p ro b ab le in s e p a r a b ility o f th re e ty p es o f phenomena: n u t r i t i o n a l , en d o crin e, and b e h a v io ra l. ^ Berman, L o u is, Food and C h a ra c te r (B oston: Houghton M ifflin Company, 1932), pp . 93-94. 3 As th e stu d y p ro g re sse d , t h i s in s e p a r a b ility became more e v i dent# D ire c t o b s e rv a tio n , how ever, was p r in c ip a lly lim ite d to n u t r i t io n and b e h a v io r. The en d o crin e stu d y , in th e m ain, was approached by a p p ly in g th e law o f c a u s a lity to th e b io ch em istry and p h y sio lo g y o f th e s u b je c ts . The p la n follow ed was th a t o f o b serv in g b e h a v io r in s e v e ra l ty p e s o f abnormal food o r hormone in g e s tio n f o r com p a ris o n w ith o b serv ab le p sy c h o lo g ic a l and biochem ical phenom ena in th e a c id o s is ty p ic a l o f s ta r v a tio n and d ia b e te s which i s known as k e to s is . The ty p es o f abnormal n u t r i t io n a l s ta t e s stu d ie d were th o se o f (1) Thyroxin a d m in is tra tio n to two norw mal in d iv id u a ls , (2) Raw meat d le to th e ra p y , (3) M assive ln« g e s tio n o f l i v e r e x tr a c t, (4) The consum ption o f la rg e amounts o f g ly cin e over a p erio d o f weeks, (6) M assive in g e s tio n o f e th y l a lc o h o l, and (6) K etogenesis in norm al men and women. A ll o f t h is ex p e rim e n ta tio n was done under m edical su p er v is io n whenever th e procedure was more th an a s l i g h t d ie ta r y d e v ia tio n . To keep some o f th e f a c to r s o f in d iv id u a l v a r ia tio n c o n s ta n t, d if f e r e n t experim ents were perform ed w ith th e same s u b je c ts when p o s s ib le . W ith growing r e a l iz a ti o n o f th e lim ita tio n s o f norm al humans as la b o ra to ry an im als, th e re was an in c re a s in g tendency a s th e study p ro g ressed to co n fin e in v e s tig a tio n to m eaningful fu n c tio n s such as g e n e ra l in te llig e n c e and big-m uscle endurance. 4 Thus th e re r e s u lte d some fin d in g s o f p o s s ib le s ig n ific a n c e where o b je c tiv e b eh av io r s tu d ie s had n o t p re v io u sly been made, as in th e k e to s is o f norm al women su b je c te d e x p e ri m en ta lly to a k eto g en ic d ie t# Terms used# The tendency o f w orkers in psychology to c re a te u n e s s e n tia l term in o lo g y i s d e c rie d . T h erefo re , in th e p re se n t r e p o r t, an attem p t has been made to use only th o se term s a lre a d y enjoying g e n e ra l s c i e n t i f i c acceptance# This has seemed p o s s ib le o f accom plishm ent w ith n e g lig ib le c irc u m lo cu tio n ; and a g lo s s a ry has been appended to re n d e r th e re p o rt more u n d ersta n d ab le to s tu d e n ts in a l l fie ld s # Some e lu c id a tio n o f th e concept o f f a tig u e , however, may be h e lp f u l. Watson has ca p tio n ed w ith " ’F atigue* Not a S e rv ic e a b le C onception in Psychology**^ a d is c u s s io n in which he b e lie s th e fa tig u e concept n ih ilis m o f h is t i t l e by advo- 5 e a tin g stu d y o f th e curve o f w ork. Dodge h as more s e n s ib ly suggested th a t d is tin c ti o n be made betw een fa tig u e and r e l a tiv e f a tig u e , acco rd in g to th e c a u sa l f a c to r s u n d erly in g th e work decrem ent# In s p ite o f th e s e e a rly and such c u rre n t m isg iv in g s W atson, J . B ., Psychology From th e S tan d p o in t o f a B e h a v io rist (P h ila d e lp h ia : ^ .B . S ip p in c o tt Company, 1924TT p . é69 ^ Dodge, R ., "The Laws o f R e la tiv e F a tig u e ," P sy ch o lo g ical Review. 24:89-113, 1917. as th a t m an ifested in th e " p s e n d o - s c ie n tif ie ” e p ith e t o f Edward S. R obinson, fa tig u e rem ains a u s e fu l concept where th e c o n te x t g iv es i t s c i e n t i f i c a l l y a c c u ra te meaning—as in 7 th e re c e n t re p o rt o f N eil W arren on overcom pensatory p r i o r i t y o f movement in fa tig u e d fin g e rs# In th e p re s e n t r e p o r t, th e term " f a tig u e " i s used w ith o u t q u a lif ic a tio n where i t i s d esire d to convey d e s c r ip tiv e ly what is p o p u la rly known as " th a t t i r e d f e e lin g ," and o h a ra o te r- 0 ized by E n g lish as W e a rin e s s ." Where more p re c is io n i s n eces s a ry , the p ro p e r q u a lify in g word o r p h rase i s used* The p h ra se , " f a tig u e in d e x ," i s u s e fu l as a s t a t i s t i c a l e x p re ssio n . In t h i s work, i t s meaning i s ex p lain ed f o r each s p e c if ic a p p lic a tio n . In dynamometric d e te rm in a tio n s , th e convention o f W hipple^ i s used; b u t th e form ula and e x p la n a tio n a re g iv en . O rg an izatio n o f th is r e p o r t. A fte r p o in tin g out th e r e s p o n s ib ility o f psychology in n u tr itio n a l- e n d o c r in e re s e a rc h . ^ R obinson, E .S ., "Work o f th e In te g ra te d O rganism ," C hapter 12, p p .679-580 o f A Handbook o f G eneral E xperim ental PsycholoCT. M urchison, C a rl, e d ito r (W o rcester,M ass.: C lark U n iv e rsity P re s s , 1934). ^ W arren, N e il, "The E ffe c t o f F a tig u e on P r i o r i ty o f B ila te r a l Manual M ovements," P sy ch o lo g ic a l B u lle tin .32:547.1935 ® E n g lish , H .B ., A S tu d e n t's D ic tio n a ry o f P sy ch o lo g ical Terms. (Yellow S p rin g s,O h io ; The A ntioch P re s 8% T9&8]J o W hipple, G.M., Manual o f M ental and P h y sic a l T e s ts . P a rt I (B altim o re: Warwick and York, 1924T, P . 119. 6 t h i s re p o rt a tte m p ts in C hapter I I a b r i e f c r i t i c a l review o f th e l i t e r a t u r e r e la ti n g to th e problem g e n e ra lly , to g e th e r w ith th a t b e a rin g s p e c if ic a l ly on th o se n u t r i t io n a l s ta te s in v e s tig a te d in t h i s stu d y . The t e s t i n g in s tru m e n ta ria and methods used in t h i s in v e s tig a tio n are th en d esc rib ed in C hapter I I , and th o se n u t r i t io n a l s t a t e s where o p p o rtu n ity was la c k in g f o r stu d y beyond t h a t s u f f i c ie n t f o r g ro ss com parison are re p o rte d upon in C hapter IV. The stu d y o f k e to g e n e sis occupies C hapter V, w h ile th e fin d in g s in th e v a rio u s s t a t e s a re summarized com p a r a tiv e ly in C hapter V I. An an n o tated b ib lio g ra p h y and a g lo s s a ry com plete th e work# CHAPTER I I THE PRESENT K N O W LED G E OP NUTRITION-ENDOCRÎNE-BEHAYIOR INTERRELATIONSHIPS The endocrine re se a rc h d u ty o f psychology to p s y c h ia try # R e g re tta b ly , most accep ted p s y c h ia tr is ts have d ev iated f a r from th e s c i e n t i f i c ap p ro ach . P erhaps th is i s because i t i s easy to th e o riz e g lib ly about a m etap h y sical "m ind.” Very re c e n tly an occurence w idely p u b lic iz e d by th e p re s s has emphasized t h i s shortcom ing o f p s y c h ia try . A h y s te r ic a l woman, M rs. Helen W ills Love, lap sed in to a coma in an e f f o r t to escape im p o sitio n o f sen ten ce a f t e r h e r con v ic tio n o f second degree m urder f o r th e k i l l i n g o f h e r s e c r e t husband in r e t a l i a t i o n f o r h is O ed ip u s-lik e b e h a v io r. P h y sic ia n s and p s y c h ia tr is ts a tte n d in g th e woman were re p o rte d ^ a s b ein g f iv e in number, t h e i r names w ell known in p s y c h ia tr ic c i r c l e s . Even allo w in g f o r custom ary in a c c u ra c ie s o f th e p r e s s , th e re p o rte d consensus o f t h i s presum ably re p r e s e n ta tiv e group i s alarm in g . The c o n d itio n was diagnosed a s a d is s o c ia tio n s im ila r to s h e ll-s h o c k , which seems p la u s ib le , b u t a d ir e c t q u o ta tio n from The Los A ngeles Times in d ic a te s where p s y c h ia tric th o u g h t w ent from th e re ^ D ispatch in th e Los A ngeles Tim es, Blaroh 16, 1937, p a r t I , p . 3* ^ D ispatch in th e Los Angeles Times, March 17, 1937, p a r t I I , p . 1 -2 . 8 [jPhe p s y c h ia tr is t^ ) sa id she could n o t be th e v ic tim o f se lf-h y p n o sis# H er c o n d itio n was d e sc rib e d a s som ething l i k e s h e l l shock. Her con scio u s mind h a s d e se rte d h e r, le a v in g o n ly th e su b conscious mind fu n c tio n in g . The remedy, s c ie n t i s t s s a id , i s l i k e tr e a tin g a b o il deep down in th e sy s - stem . I t i s n e c e ssa ry to p e n e tra te th e subconscious (siq] mind and d ra in from i t th e h o rro r shock which s p l i t th e c o n sc io u sn e ss, j u s t lik e pus i s d rain ed from a b o i l . The f i r s t r e a c tio n o f a p s y c h o lo g ic a lly tra in e d re a d e r would be to a s c rib e th e above q u o ta tio n to j o u r n a l i s t ic b lu n d er in g . T his cannot re a so n a b ly be done, how ever, f o r a p r i o r des p a tc h r e la te d a re p o rt made by one o f th e p s y c h ia tr is ts to th e j a i l p h y sic ia n : The re p o rt added th a t th e con scio u s mind stream i s s p l i t by p re ssu re from th e unconscious mind; t h a t th e con scio u s mind i s mow under tre a tm e n t and th a t th e m ental v e i l w ill l i f t g ra d u a lly . The r e p o r t added th a t th e woman’s c o n d itio n w ill n o t n e c e s s a r ily prove f a t a l . ^ I f r é p e r t o r i a i m isq u o ta tio n were re sp o n s ib le f o r th e e a r l i e r o f th e above d is p a tc h e s , i t seems th a t any p sy c h ia t r i s t fo llo w in g b e h a v io r is t o r any o th e r th an m etap h y sical m ethodology would have c u r ta ile d p b u lic a tio n o f th e l a t e r des p a tc h by th re a te n in g th e new spaper w ith a s u i t . This did n o t o c c u r, and th e n a tu r a l in fe re n c e i s th a t b o th examples o f p sy c h o a n a ly tic co n fu sio n were a s re p o rte d • Since t h i s a p p a re n tly re p re s e n ts th e s t a t e o f b ew il derm ent o f p s y c h i a tr i s t s who as m edical s tu d e n ts must have ^ Tim es, op. c i t . , March, 16, 1937. 9 learn ed c o n sid e ra b le o f p h y sio lo g y , i t su g g ests th a t th e b ranch o f p hysiology known as endocrinology must rem ain too uncharted f o r s u b s ta n tia l in c lu s io n in th e c u r r ic u la o f m ed ical s c h o o ls. Such, a t l e a s t , seems to be th e o p in io n o f Raymond D. F o sd ick , p re s id e n t o f th e R o c k e fe lle r F oundation. Q u a lifie d to speak by having su p erv ised th e pouring o f two m illio n s o f d o lla r s in to m ental hygiene re s e a rc h , he c h a ra c te riz e s th e c o n tro l o f hormone s e c r e tio n as th e o n ly method which seems a t a l l prom is in g in th e p re v e n tio n and c o rre c tio n o f p e r s o n a lity d istu rb a n c e s He adds w ith r e g r e t th a t m edical knowledge o f en docrinology i s in a "fragm entary s t a t e I t th e re fo re behooves psychology to encompass a more in te n s iv e stu d y o f th e glands i f e f f e c tiv e aid i s to be given p r a c tic in g p s y c h ia try . Such stu d y m ight f a l l p r in c ip a lly in th e p ro v in ce o f a n u t r i t i o n a l psychology, i f b a s is f o r such a psychology e x i s t s . For a tim e , much o f th e a id th e p sy c h o lo g ist can give th e p s y c h i a tr is t w ill be in th e form o f p ro v is io n a l w orking th e o r ie s ; b u t even such u n s u b s ta n tia te d th e o r iz a tio n a s th a t o f Berman® i s o f more v alu e th an p sy c h o a n a ly tic th e o ry . Psycho a n a ly s is i s m etap h y sical in bein g based e n t ir e l y on unobserv a b le c r e a tio n s assumed to e x is t because o f an u n c r it i c a l ^ F o sd ick , R .D ., a s quoted in e d i t o r i a l , "M ental H yg ien e,” Los A ngeles Tim es. A p ril £5, 1937. ® Berman, L o u is, The Glands Reg u la tin g P e rs o n a lity (New York: The M acm illan Company, 1928) , 341 pp. 10 a p p lic a tio n o f th e law o f c a u s a lity ; w hile even th e most ex trem e e n d o c rin o lo g ic a l th e o ry a tte m p ts to work w ith observable e n t i t i e s , though th e o b se rv a tio n may be lim ite d to au to p sy o f ex p erim en tal a n im als. T his need fo r d ir e c tin g p s y c h ia tr ic thought away from m etaphysics and in to sc ie n c e was re c e n tly expressed by th e p re s id e n t o f th e R o c k e fe lle r F oundation when he d esc rib ed th e tre a tm e n t o f m ental d is o rd e rs a s ” . . ♦ th e most backw ard, th e m ost needed and p o t e n ti a ll y f r u i t f u l f ie l d in m edicine to d a y .”® That some p sy c h o lo g ists have accepted t h i s re s p o n s i b i l i t y in a p r a c t ic a l manner i s evidenced by th e v ery re c e n t work o f W enrlck and a few o th e r s . O ther p sy c h o lo g ic a l ap proaches th an th e anim al ex p e rim e n ta tio n o f W enrlck m ight be through c o r r e la tio n s o f ty p es o f b e h a v io r w ith o rg an ic fin d in g s o f th e surgeons on o p e ra tio n o r au to p sy , o r w ith d isco v e r ie s o f th e bioch em ical la b o ra to ry . W ith t h i s tren d in view , th e p re s e n t in v e s tig a tio n was conducted alw ays w ith a view to endocrine fu n c tio n in n u t r i t i o n a l a l t e r a t i o n s . To la y th e p ro p e r background, a review must be made o f th e a s p e c ts o f en docrinology and n u t r i t i o n b e a rin g on t h e b eh a v io r s tu d ie s which a re th e essen ce o f th e problem . ^ F o sd ick , R .D ., Loo, c i t . 7 W enrlck, J .E ., "A F u rth e r Study o f P a r t i a l Suprarena- lectom y upon th e L earning o f th e,W h ite Rat in a W ater Ife z e ,” The Jo u rn a l o f Com parative Psychology, Z Z II:0 , December,1936, pp . 421-27. 1 1 The th y r o id . S ince th e in co m p letely understood l i n k age betw een th e en d o crin es and p e r s o n a lity has been w e ll covered in th e p sy c h o lo g ic a l l i t e r a t u r e , t h i s c h a p te r review s th e psycho^ lo g ic a l ly l e s s known l i t e r a t u r e c o r r e la tin g n u t r i t i o n and th e e n d o c rin e s. Reviews o f th e sc a n t ty p ic a lly p sy c h o lo g ic a l l i t e r a tu r e d e a lin g w ith th e d ie ta r y s t a t e s e x p e rim e n ta lly stu d ie d a re d e fe rre d t i l l th e c h a p te rs which re p o r t th e experim en tal phases o f th e in v e s tig a tio n . P a r t i c u l a r l y f o r use in re a d in g th e p re se n t c h a p te r, th e r e f o r e , a b r i e f g lo s s a ry has been p laced in th e appen d ix . In e v a lu a tin g t h i s rev iew , th e u n s e ttle d s t a t e o f en d o c rin o lo g ic a l knowledge should be borne c o n s ta n tly in m ind. L ite r a tu r e in t h i s f i e l d w hich i s a few months old may be p r in c ip a lly o f h i s t o r i c a l i n t e r e s t . A thorough c r itiq u e would presuppose an u n d erstan d in g o f biochem ical nuanoes beyond th e scope o f th e p re se n t r e s e a rc h . The o b je c t o f t h i s review was sim ply to stu d y th e e n d o c rin o lo g ic a l l i t e r a t u r e fo r p o s s ib le p a th s o f p sy c h o lo g ic a l in v e s tig a tio n w ith a view p a r ti c u la r ly to n u t r i t i o n a l c o n d itio n s . The th y ro id i s th e l a r g e s t and b e s t known o f th e endo c rin e g la n d s, and i t s co n n ectio n w ith b o th b e h a v io r and n u t r i tio n i s based on s c i e n t i f i c a l l y sound o b se rv a tio n o f thousands 8 o f o a se s. ® G insburg, Solomon, "P re v e n tio n and Treatm ent o f G o ite r," H ygeia. X I I I :10, O ctober, 1936, pp. 950-53 12 S ince th e l i t e r a t u r e on t h i s gland i s so volum inous, t h i s re p o r t can o n ly review th e m ost s a l i e n t p o in ts # The th y ro id i s a tw o-lohed gland w eighing about an ounce and i s s itu a te d in th e f r o n t o f th e n e c k . I t i s h e a v ie r in th e fem ale th a n in th e m ale, gmd bee omes en larg ed and con g ested d u rin g sex u al in te r c o u r s e . T his f a c t le d th e a n c ie n ts to m easure a wommi’s neck when in doubt about h e r a c t i v i t i e s o f th e p re v io u s n ig h t. The t e s t , however, i s u n r e lia b le , s in c e th e th y ro id a ls o e n la rg e s d u rin g m en stru a tio n and pregnancy. L ike th e o th e r e n d o c rin e s, th e th y ro id s e c re te s a h o r mone d i r e c tly in to th e blood stream w ith o u t b e n e f it o f a d u c t. T his f a c u lty d i f f e r e n t i a t e s a l l th e en d o crin es from such d u ct g lands as th e s a liv a r y o r sw eat g la n d s, o r th e k id n e y s. Thus a r e th e en d o crin es a ls o c a lle d th e d u c tle s s g lan d s to ^ f u r th e r d is tin g u is h them from th e d u ct glands which pour only in to body c a v itie s o r onto th e s u rfa c e o f th e s k in . F urtherm ore, on ly th e p ro d u c ts o f th e en d o crin e o r d u c tle s s glands a re d ig n ifie d w ith th e name hormone. T hyroxin, th e th y ro id hormone, i s an o rg an ic compound c o n s is tin g la r g e ly o f io d in e . I t a c ts d i r e c t l y on th e m etab olism o f th e c e l l s and n o t through th e in te rm e d ia tio n o f th e c e n tr a l o r autonom ic nervous sy stem s.^ But i t a ls o in flu e n c e s s p e c if ic a lly th e c o n d u c tiv ity o f th e b r a in . ^ R obinson, W. J . , Our M ysterious L ife G lands. (Hew York: Eugenios P u b lish in g Company, 19S 4), p . Ï 6 . Berman, 0£ . c i t . . p . 200. 1 3 A d istu rb e d b eh av io r and c o n d itio n o f food u t i l i z a tio n i s seen in c h ild re n who s u f f e r from c re tin is m and in a d u lts who have myxedema. Both o f th e se c o n d itio n s a re due to hyp o th y ro id ism , o r u n d e r-fu n c tio n in g o f th e th y ro id . The v ic tim s have an appearance o f fla b b y and puffed f a tn e s s , which i s r e a lly causëd by d is te n tio n o f the t is s u e s w ith se m i-so lid mucus. Io d in e in d rin k in g w ater has been used f o r prophy l a c t i c p u rposes where c re tin is m o r myxedema i s endem ic, o r ty p ic a l o f th e re g io n . Some su ccess has fo llo w ed , b u t many c a se s o f c re tin is m seem to be h e r e d ita r y . P o s s ib ly preven tiv e a d m in is tra tio n o f Io d in e should have been begun a g enera tio n o r so e a r l i e r , f o r in some re g io n s fo u r p e r cen t^ ^ o f th e p o p u la tio n i s s t i l l composed o f p i t i f u l l i t t l e c r e t i n s . Regions where c re tin is m i s p a r ti c u l a r ly endemic a re c e r ta in m ountainous p a r ts o f S w itzerlan d a n d .A u s tria . There many o f th e b a b ie s a re born w ith th e th y ro id a b se n t or v e s t i g i a l . These endemic c r e tin s d i f f e r somewhat from th e ab norm al c h ild re n known a s c r e t in s to m edical and p sy c h o lo g ic a l c l i n i c s in th e U nited S ta te s . D r. Beaupre g iv es t h i s v iv id d e s c rip tio n o f an endemic c r e t in : RCblnson,'W .J., op. c i t . , p . 20 14 I see a head o f unusual form and s iz e , a sq u at b lo a te d f ig u r e , a s tu p id lo o k , b le a re d , hollow and heavy ey es, th ic k , p ro je c tin g e y e lid s , and f l a t n o se. H is fa c e is a lead e n hue, h is sk in d i r t y , fla b b y , covered w ith e ru p tio n s , and h is th ic k tongue p ro tru d e s beyond h is m o ist l iv id l i p s ; h is m outh, a l ways open and f u l l o f s a liv a , shows h is decaying t e e th . H is c h e st i s narrow , h is back cu rv ed , h is b re a th a s th m a tic , h is lim bs s h o r t, weak, m isshapen. He i s knock-kneed, and h is f e e t a re f l a t . The la rg e head droops l i s t l e s s l y on th e c h e s t, and th e abdomen i s lik e a b ag. Some o f th e above c h a r a c t e r is ti c s a re th o se o f th e Mongol, a ls o ; b u t th e Mongol i s too ty p ic a l to f o o l th e tra in e d o b se rv e r. O ther d y sfu n c tio n s o f th e th y ro id are h y p e rth y ro id ism , w ith i t s accompanying ele v a te d m etabolism and nervous n e ss; and th e ty p ic a l exophthalm ic o r "pop-eyed" g o i te r . A more n e a rly benign d is o rd e r o f the th y ro id i s sim ple g o i te r . This i s m erely an enlargem ent o f th e g lan d . I t i s u s u a lly ch ro n ic and ap p ears both endem ically and s p o ra d ic a lly in th e U nited S ta te s . The cause i s in v a ria b ly a la c k of io d in e . Such sim ple g o ite r g iv es few symptoms, u n le ss th e re i s p re ssu re a g a in s t the tra c h e a (w in d p ip e). Io d in e i s used b o th in p re v e n tio n and c u re . The dangers o f u nsupervised io d in e usage to o th e r form s o f th y ro id d y sfu n c tio n has been po in ted out by many i n t e r n i s t s . ^ Robinson, W .J., Our M ysterious L ife Glands . . In c lu d in g th e V itam ins (New York: Eugenics P u b lish in g Com pany, 193 4 ), p . ^5. 15 D iet n o ta b ly a f f e c t s b o th th e s tr u c tu r e and th e chem i s t r y o f th e th y ro id . I t has been in d is p u ta b ly shown th a t io d in e fed to p reg n an t women i s q u ic k ly sto re d in th e f e t a l th y ro id . This forms a co n v in cin g argum ent f o r p re v e n tiv e mass io d in e th e ra p y in endem ically e r e t in ic a r e a s . Even in d iv id u a lly , i t would seem b e t t e r to r i s k th e in d u c tio n o f th y ro to x ic o s is in a p reg n an t woman th a t to have h e r b rin g in to th e world a c r e tin — f o r , in s p ite o f th e b r i l l i a n t r e s u l t s from th y ro x in adm inis t r a t i o n to c r e t i n s , th e se u n fo rtu n a te s cannot o fte n be e le vated above h ig h -g ra d e m o ro n ity . E x p erim en tally , Sudersnatch^® long ago d isco v ered th a t sm all amounts o f th y ro id fed to ta d p o le s causes a much a c c e le r a te d m etam orphosis. This t e s t rem ains th e most s e n s itiv e f o r th e th y ro id hormone. O ther forms o f io d in e h a ste n m etam orphosis, b u t n o t to so g re a t an e x te n t. An analogy to t h i s a c c e le ra te d m etam orphosis m ight apply to s t r u c t u r a l (and th e u s u a lly accompanying b eh av io r) changes in humans. P u b erty praecox m ight be an exam ple. The p a r t th a t calcium p la y s in g o ite r developm ent i s n o t u n d ersto o d , alth o u g h th e re c e n t ex p erim en tal work o f Thomp sons^ and many o th e rs w orking in d ep en d e n tly has ab u n d an tly ® G udersnatch, J .B ., American Jo u rn a l o f Anatomy, 15: 431, (1917) , as quoted in G landular PE yslology and"^Ttierapy, M orris F ish b e in , E d ito r ( Chicago: American M edical A s s o c ia tio n , 1935), A c r i t i c a l review o f t h i s symposium forms th e b a s is f o r much o f th e rem ainder o f t h i s c h a p te r. 14 Thompson, J . , "In flu e n c e o f th e In ta k e o f Calcium on th e Thyroid Gland o f th e A lbino R a t," A rchives o f P ath o lo g y , 16:211, A ugust, 1933. 16 confirm ed o ld e r g eo lo g ic and chem ical s tu d ie s in e s ta b lis h in g th e f a c t th a t an e x c e ssiv e in ta k e o f calcium in c re a s e s th e g o ite r g e n io - e f f e c t o f given (u s u a lly ra c h lto g e n ic ) d i e t s . L e st th e a b so lu te v e g e ta ria n s a p p ro p ria te b ia s e d ly th e se g o ite rg e n ic in d ic tm e n ts o f meat and th e ca lc iu m -b e arin g m ilk , a tte n tio n i s a ls o in v ite d to s im ila r experim ents w ith e d ib le p la n ts . Chesney and Webster^® have re p o rte d t h a t a d i e t c o n s is tin g s o le ly o f cabbage o fte n produced g o ite r in 1 A r a b b i t s . M arine and c o lla b o ra to r s have many tim es re fe rr e d to th e freq u en cy w ith w hich th y ro id h y p e rp la s ia develops in p re p u b e ra l r a b b its on a d ie t o f a l f a l f a hay and o a ts . In f a ir n e s s i t must be p o in ted out th a t th e re a re h ere g o ite r genic se a so n a l and s o i l v a r ia tio n s , th a t cabbage and a l f a l f a have h ig h calcium and low phosphorus c o n te n ts , and th a t a l i t t l e io d in e ad m in iste red c o n c u rre n tly t o t a l l y p re v e n ts g o ite r . The experim ents o f Baumann and Hunt^*^ dem onstrated th a t th e th y ro id s e c re tio n i s n e c e ssa ry f o r th e s p e c if ic dy namic a c tio n o f fo o d s. In th y ro id ecto m ized r a b b its t h i s spe c i f i c dynamic a c tio n d isa p p e a rs a f t e r about s ix ty - f iv e days. I t can be re s to re d by fe e d in g w ith d e s s ic a te d th y ro id . ^® M arine, D avid, G lan d u lar P hysiology and ( Chicago : American M edical A s s o c ia tio n , 1935), S b a p te r 23CÎI, p ; 349. • i b i a . 17 Baumann, E . J a n d H unt, L o u ise, "R e la tio n o f Thyroid S e c re tio n to S p e c ific Dynamic A c tio n ,” Jo u rn a l o f B io lo g ic O hem lstry, 64:709, J u ly , 1925. 1 7 I n a n itio n (e x h au stio n from la c k o f food) b rin g s about In v o lu tio n o f th e th y ro id , i . e . , a d ecrease in th e s iz e o f th e e p i t h e l i a l c e l l s , a d ecrease in th e blood supply, and an In c re a se in th e c o llo id and in th e io d in e s to r e — evidence o f decreased fu n c tio n a l a c t i v i t y . T his f a c t has been re p e a te d ly shown by au to p sy ; b u t th e p re s e n t e x p e rim e n ta tio n , in which norm al hu mans were su b je c te d to lim ite d s ta r v a tio n , f a ile d to e l i c i t d e f in i t e l y o b serv a b le in d ic a tio n s o f changes in th y ro id fu n c tio n . A bsolute f a s tin g was b r i e f , how ever. S ince hormones and v ita m in e s b o th a c t c a t a l y t i c a l l y , and o fte n seem to have c e r ta in e f f e c ts in common, th e re has long been in v e s tig a tio n o f t h e i r p o s s ib le c o r r e la tio n s . C om paratively e a r ly in v ita m in h is to r y , Dutcher^® showed th y ro x in to have an t i n e u r i t ic p r o p e r tie s in av ian n u t r i t i o n . For a b r i e f w h ile i t was even co nsidered th a t th e two m ight be i d e n t i c a l . A c tu a lly , th e re i s no evidence t h a t a v ita m in d e f i c ien c y p la y s any prim ary r o le in th e e tio lo g y o f th y ro id dys fu n c tio n . There i s some ev id en ce, how ever, t h a t d e f ic ie n c ie s o f v ita m in B complex^^ and v ita m in 0 a re c o n trib u tin g f a c to r s . R a d io - a c tiv itie s o f su b stan ce s d isso lv e d in w ater have a ls o been p o s ite d as c a u sa l f a c to r s , b u t no d e f in ite c o rre la tio n :; has been e s ta b lis h e d . Harrow, Benjam in, Glands in H ea lth and D ise a se , (Hew York: E .P . D utton and Company, 1928), p . 218. S u re, B a rn e tt, and Sm ith. M.E.'i "H yperthyroidism and n u t r i t io n ; V itam in B and T hyro x in ," Jo u rn a l o f n u t r i t i o n . 7:647^ May, 1934. 18 There i s no d o u h t, how ever, th a t a d e fic ie n c y o f io dine has been amply dem onstrated as a cause o f th y ro id d y s fu n c tio n . The p a r a th y ro id s . The p a ra th y ro id s a re fo u r sm all g lan d s s itu a te d , two on each s id e , behind th e lo b es o f th e th y ro id g lan d . T h eir fu n c tio n i s q u ite d if f e r e n t from th a t o f th e th y ro id . The p a ra th y ro id s c o n tro l calcium m etabolism . Hence th ey govern, w ith v ita m in D, th e calcium -phosphorus r a t i o in bon es, blood serum , and t i s s u e s . A p a ra th y ro id d e fic ie n c y may cause extrem e nervous n e s s , even te ta n y w ith c o n v u lsio n s. T his i s due to th e d i r e c t r e la ti o n o f blood serum calciu m to th e e x c i t a b i l i t y o f n e r vous and m uscle t i s s u e s . N inety p e r c e n t o f co n v u lsio n s in c h ild re n under two y e a rs a re thought to be due to t h i s f a c t . The s e v e ra l re aso n ab ly p ric e d conm iereial p re p a ra tio n s o f p a ra th y ro id e x tr a c t on th e m arket a re e f f e c tiv e in c o n tro llin g any degree o f te ta n y . P erh a p s, to o , some m ild ly ir a s e a b le p e r s o n a litie s could be Improved by a d m in is tra tio n o f t h i s % hormone. S ince some o f th e ex p e rim e n ta tio n re p o rte d in C hapter I I I was in flu e n c e d by th e f a c t th a t b o th th e p a ra th y ro id h o r mone and v ita m in D govern th e caleium ^phosphorus m etabolism , i t may be o f i n t e r e s t to d i f f e r e n t i a t e th e p h y sio lo g ic e f f e c ts o f th e two in d e t a i l . 19 The p h y sio lo g ic e f f e c ts o f p a ra th y ro id hormone (para- g o thormone) a re : 1 . To r a is e th e blood calcium and low er th e phosphorus. 2 . P o s s ib ly to in c re a s e th e io n iz e d ,calcium in th e b lo o d . 3 . To in c re a s e calcium and phosphorus ex-^ c r e tio n in th e u r in e . 4 . To o b ta in th e calcium f o r t h i s in cre ased demand e ith e r from a la rg e amount o f in g e ste d calcium o r from th e s to r e s in th e bone. Untoward e f f e c ts from ex cess dosage may be: 1 . The kidney i s damaged and, p o s s ib ly as a r e s u l t , 2 . Blood phosphorus r i s e s and 3 . N itrogenous w astes accum ulate in th e body f l u i d s . 4 . Abnormal d e p o s its o f calcium s a l t s occur in s o f t t i s s u e s . 5 . B ecause o f th e la rg e e x c re tio n o f calcium and phosphorus in th e u r in e , kidney sto n e s a re formed . 6 . O s te i t is fib ro s a c y s tic a develops in bones, w ith an in c re a s e in a c t i v i t y o f o s te o c la s ts , and u s u a lly o f o s te o b la s ts . R e su lt: g e n e ra liz e d o s te o p o ro s is , c y s ts , and g ia n t c e l l tum ors. 2 l Cantarow say s th a t th e s e untoward e f f e c t s a re only Aub, J .G ., "P a ra th y ro id Hormone T herapy," C hapter ZXV o f G lan d u lar P hysiology and Therapy, (C hicago: American M edical A s s o c ia tio n , 19S&J. Cantarow , A ., Calcium M etabolism and Calcium Therapy, (Lea and F e rb ig e r, 1^&2). 20 rem ote p o s s i b i l i t i e s in th e th e ra p e u tic use o f th e hormone. Hose o f them a re a ls o p o s s ib le in v ita m in D overdosage. V io s te ro l (v ita m in D c o n c e n tra te ) when given in la rg e am ounts, e x e rts much th e same e f f e c ts on th e body as p a ra th y ro id hormone. I t r a is e s th e calcium le v e l in blood and ex c r e ta . I t d i f f e r s from p a ra th y ro id e x t r a c t , how ever, in a l so in c re a s in g the a b s o rp tio n o f calcium from th e i n t e s t i n a l t r a c t . O ther ad vantages o f v ita m in D a re th e in d e f in ite m aintenance o f th e se e f f e c t s , and th e e ffe c tiv e n e s s o f o r a l a d m in is tr a tio n . T h e re fo re , i t i s o fte n p re fe ra b le to sub s t i t u t e v ita m in D f o r p a ra th y ro id e x tr a c t . This i s p a r tic u l a r l y tr u e when prolonged a d m in is tra tio n i s needed. V itam in D has d isad v an tag e s to o , how ever. P a ra th y ro id e x tr a c t ta k e s a few ho u rs to e s ta b lis h i t s e f f e c t; v ita m in D ta k e s d ay s. T h erefo re i t i s o f much le s s use in a te t a n ic em ergency. Then, to o , th e e f f e c t s o f an overdosage o f v ita m in D l a s t a long tim e . A hypercalcem ia induced by v ita m in D overdosage l a s t s f o r two weeks o r lo n g e r, so th a t the accompanying n au se a, la c k o f a p p e tite and o th e r more 22 s e rio u s s ig n s a re p ro lo n g ed . W ith p a ra th y ro id e x tr a c t such symptoms would n o t l a s t lo n g e r th an a day. 22 Aub, J.C ê op. P i t . . p . 381. 81 The p i t u i t a r y . The p i t u i t a r y , ab o u t th e s iz e o f a C a lifo rn ia pea (10 g ra in s) and s itu a te d a t th e base o f th e s k u ll in a bony s tr u c tu r e c a lle d th e s e l l a tu r c ic a , i s perhaps th e most complex gland in th e human economy. I t e la b o ra te s a number o f horm ones, some o f th e known ones o f th e a n te r io r p a r t o f the p i t u i t a r y alo n e b ein g a growth horm one, a sex hormone, and a m ilk producing hormone c a lle d P r o la c tin . The p o s te r io r lo b e o f th e p i t u i t a r y s e c re te s s e v e ra l hormones a ls o . One o f th e s e , p i t u i t r i n , h a s a s p e c if ic and pow erful e f f e c t in in d u cin g c o n tra c tio n s o f th e u te r u s , p a r t i c u l a r l y th e p reg n an t u te r u s . Of p o s s ib le fu tu re I n t e r e s t to n u t r i t i o n i s t s i s th e a s y e t t e n ta tiv e b e l i e f th a t th e amino a c id h i s t id i n e i s th e b a s is o f pituitrin.23 A nother p i t u i t a r y horm one, p l t r e s s l n , e le v a te s th e blood p re ss u re te m p o ra rily and i s used f o r th is purpose in some su rg e ry . I t a ls o r e lie v e s th e e x c e ssiv e u r in a tio n o f d ia b e te s in s ip id u s . The in te rm e d ia te s tr u c tu r e o f th e p i t u i t a r y a lso se c r e te s a hormone, in te rm e d in . I t , to o , i s used in tr e a ti n g d ia b e te s in s ip id u s . V arious im balances o f th e se p i t u i t a r y hormones may cause g ia n tism , dw arfism , acrom egaly, g e n ito -o b e s ity d is e a s e (w ith m ental d u lln e s s ) , Simmond's d is e a s e (a decided c a c h e x ia ), o r la w re n c e -B ie d l d is e a s e (o b e s ity w ith b lin d n e ss o f v a ry in g B reed , Lorena M ., ^ e Human M achine, (B oston: The S tr a tf o r d Company, 19 3 4 ), p . SS. 28 deg rees su g g e stiv e o f A -a v ita m ln o sis). I t i s only sin c e 1927 th a t th e p i t u i t a r y gland has been d isco v ered to be such a sto reh o u se o f hormones* In a d d itio n to th e hormones a lre a d y m entioned above i t i s r e s p o n sib le fo r a d ia b e to g e n ic , a th y r o tr o p ic , an a d re n o tro p io , a p a r a th y ro tro p ic , a la c to g e n ic , a chromoto p h o ro tro p ic , an e s tro g e n ic , and a gonadotropic su b sta n c e . In s p ite o f t h i s com plexity and th e newness o f th e re s e a rc h , some f a c ts o f i n t e r e s t to a te n ta tiv e n u t r i t i o n a l psychology have a lre a d y been e l i c i t e d . W hile norm al dogs show marked hyperglycem ia ( ex cess blood sugar) when k e p t on a v ita m in B d e f ic ie n t d i e t , no such r i s e in blood su g ar occurs 24 in dogs from whom th e p i t u i t a r y glands have been removed. V arious o f th e p i t u i t a r y hormones a re connected w ith carb o h y d rate m etabolism . Among them i s a s p e c if ic a lly k e to - g en ic hormone, a f a c t o f p a r t i c u l a r i n t e r e s t to th e p re se n t stu d y o f k e to s is . The gonads. The gonads, which in th e male a re t e s t i c l e s and in th e fem ale o v a r ie s , a re im p o rtan t c o n tr o lle r s o f s tr u c tu r e and b e h a v io r, but a re n o t e s s e n tia l to l i f e . In f a c t , c a s tr a tio n o f m ales a f t e r p u b e rty does n o t n e c e s s a r ily r e s t r i c t se x u a l d e s ire o r p o t e n c e . In fe m ales, c a s tr a tio n B ra ie r , B ., "Be ra p p o rt carbone ax o te dans l ’a v i tam inose des ch ien s h y p o p h y so p riv es." Compte, re n d . Soc. de M o l. 108: 607-08, O cto b er, 1931. guoted by C o llip T JTBT "M a b e to genlc S u b stan ce", p . 93, C hapter V II, G landular P hysiology and Therapy, op. c i t . R obinson, W .J., op. c i t . . p . 126., 23 invokes a prem ature m enopause, b u t o fte n w ith in c re a s e o f sex u al lib id o and p le a s u re in c o itu s* A ccording to Moore, hormone s e c r e tio n by th e t e s t i c l e i s a ffe c te d by n u t r i t i o n a l c o n d itio n s . A d i e t de f i c i e n t in v ita m in B re d u c e s, o r a b o lis h e s , hormone s e c re tio n in ra ts * R e s tr ic tio n o f th e d ie t to in a n itio n le v e l s , b u t w ith an e x c e ssiv e supply o f v ita m in B produces th e same e ffe c t* I t i s b e lie v e d t h a t th e a n te r io r p i t u i t a r y i s th e r e a l c e n te r o f in ju r y , sin c e th e t e s t i c l e s o f such v ita m in B -fre e o r in a n itio n an im als respond to in je c tio n s o f hypo p h y sea l e x tr a c ts and prom ptly s e c r e te la rg e amounts o f t e s t i s hormone. F u rth e r evidence I s th e f a c t th a t th e hypophyses o f v ita m in B -fre e and in a n itio n anim als have low ered c a p a c ity to s tim u la te th e gonads o f immature a n i- _ 26 mais* The thymus* The thym us, s itu a te d betw een th e upper p a r t o f th e sternum ( f l a t bone o f th e b r e a s t) and th e tra c h e a , i s a tem porary g la n d . I t i s u s e fu l in developm ent, b u t n o r m ally n e a rly a tro p h ic in ad u lth o o d . L i t t l e i s known o f i t and i t s co n n ectio n w ith n u t r i t i o n , ex cep t th a t i f th e thymus a tro p h ie s to o e a r ly , th e c h ild m atures too soon— g e n e ra lly , s e x u a lly , and u s u a lly in m ental p ro cesses* Moore, C .R ., " T e s tis Hormone," G landular P hysiology and T herapy. op. c i t ; C hapter X V III, p . 267* 24 The P in e a l* The p in e a l i s a sm all re d d ish gland weigh in g o n ly about 2 g rain s* I t may be a v e s tig e o f a th ir d eye found in g r e a te r developm ent in p re s e n t low er form s such as amphioxus* There i s no knowledge o f i t s connection w ith nu t r i t i o n , and th e re i s even some doubt ab o u ts i t s having an end o crin e fu n ctio n * I t i s p o s s ib le , however, t h a t i t may account f o r h y p e rg e n ita lism . Berman has r a th e r f a n t a s t i c a l l y suggested th a t th e e a r l i e r m a tu ra tio n o f so u th ern p eo p les may be due to th e e f f e c ts o f th e sun b e a tin g do%n upon th e h ead s—and, h en c e, th e p in e a l g la n d s, of th e se p e o p le s. The a d re n a ls* The a d re n a ls , a ls o c a lle d su p ra re n a is because o f t h e i r lo c a tio n s over th e k id n e y s, a re two sm all glands ab o u t an inch lo n g and tw o ^ ten th s o f an in ch in th ic k n e s s . They weigh about two grams each* The m edulla o f th e a d re n a l e la b o ra te s e p in e p h rin e , which i s so im portant in f e a r and anger because o f i t s q u ick ening o f th e m etabolism and c ir c u la tio n long enough to meet c ris e s * I t s e f f e c t on carb o h y d rate m etabolism , and on w ith draw al o f glycogen from th e l i v e r and o th e r d e p o ts, i s q u ic k , s tro n g , and tra n s ie n t* T his f a c t was e v id e n t in th e blood su g ar s tu d ie s o f th e p re s e n t in v e s tig a tio n , when S u b ject C c o lla p s e d • 25 P7 M eGarrison found in an ea rly stu d y th a t th e a d re n a l g lan d s o f p o ly n e u ritic b ird s a re much enlarged and th a t th e a d re n a l c o n te n t i s in c re a s e d , w hile th e en d o crin es d eg en erate and tend to d isa p p e a r w ith p ro g re ss o f the d e fic ie n c y d isease* This stim u la te d f u r th e r re s e a rc h and c h a r a c t e r is t ic d iffe re n c e s have been e l i c it e d in a d re n a l s tr u c tu r e and fu n c tio n on de- 28 f ic ie n c ie s o f p r o te in , f a t , and v itam in A, B, o r C intak e* The a d r e n a ls , no d o u b t, a re an a c tiv e two-way co n n ect in g li n k betw een b e h a v io r and n u t r i t i o n . Though th e re i s n o t y e t b a s is f o r th e statem en t o f Berman^^ t h a t th e a d re n a ls regu l a t e b ra in grow th, th e re i s evidence o f t h e i r in flu e n c e on th e developm ent o f th e sex g la n d s, and upon th e to n e o f th e sex glan d s a f t e r adolescence* The c o rte x o f th e a d re n a l i s much more im p o rtan t to l i f e . I t p r o te c ts a g a in s t d e h y d ra tio n , e x h a u stio n , and dys fu n c tio n o f sodium m etabolism * I t s d e fic ie n c y , i f m arked, r e s u l t s in A ddison’s d is e a s e —u s u a lly f a t a l u n le s s c o rte x h o r mone ( c o r tin ) i s ad m in istered * Huge q u a n titie s o f th e sodium c o n ta in in g R ubin-E rick s o lu tio n alo n e w ill p ro lo n g l i f e * Usu a l l y th e hormone and th e s o lu tio n a re used c o n c u rren tly * Harrow, B enjam in, Glands in H ealth and D isease. (New York: E*P. D utton and Company, 1922), p . 10. Berman, L o u is, Food and C h a ra c te r (B oston: Houghton M ifflin Company, 1 9 3 2 ), p . 90* 29 Ib id * , p . 117* 26 A lthough H uhin-Z rick s o lu tio n c a r r ie s c h lo rin e and s e v e ra l m e ta llic io n s o th e r th an sodium , th e sodium io n i s thought to he th e p r in c ip a l th e ra p e u tic agent* A d e fic ie n c y o f c o r tin causes an undue potassium r e te n tio n . The a d re n a l c o rte x hormone may th en he thought o f as c o n tr o llin g th e sodium -potassium b alan ce in much th e same manner th a t p a ra th y ro id e x tr a c t c o n tro ls th e calcium - phosphorus balance* A nother m a tte r o f i n t e r e s t co ncerning th e a d re n a ls has been m entioned by R* W * T ru e s d a ll. Much o f th e c o rte x c o n s is ts o f v ita m in 0; b u t C i t r i n , th e new v ita m in d isc o v e ry which ife s a s s o c ia te d w ith v ita m in C in i t s th e ra p e u tic e f f e c ts and in i t s occurence in lemon ju ic e , i s n o t a component o f th e a d re n a l cortex* The r o le o f th e a d re n a l c o rte x hormone in sodium - potassium m etabolism zaakes th e hormone alm ost a d a ily n ec es s i t y to s u f f e r e r s from A ddison’s d isease* The expense o f t h i s tre a tm e n t amounts to $1,000 to $1,600 f o r th e hormone alone* I t may th u s be seen th a t many s u f f e r e r s n o t w e ll o f f f in a n c ia lly m ust d ie . M assive doses o f s a l t may p ro lo n g t h e i r l i f e i f used w ith sm a lle r doses o f c o r ti n , b u t th e y s t i l l suc cumb w ith alarm in g prom ptness. T heir b eh av io r i s ty p ic a lly d e f e a tis t* From th e s o c ia l p sy c h o lo g ic a l v ie w p o in t, p r a c tic a l 87 s y n th e s is o f th e a d re n a l c o rte x hormone would rank w ith th e d is c o v e rie s o f in s u lin and l i v e r th e re b y . A ro u te f o r a v o id in g th e expense o f t h i s e x tr a c t has been t r i e d in a d m in is tra tio n o f th e raw gland o r e x tr a c tiv e s by m outh. Only some m ild c a ses have been b e n e f itte d .^ ^ G a stric F u n ctio n in P e rn ic io u s Anemia and B eh av io ral •Z'\ C o r r e la te s . A ccording to West th e re i s an alm ost u n iv e rs a l r e la tio n s h ip o f a c h y lia g a s tr ic a to A ddison’ s anemia and to su b acu te combine d e g e n e ra tio n o f th e s p in a l c o rd . F u rth e r m ore, th e a c h y lia p reced es c l i n i c a l symptoms and p e r s i s t s a f t e r o th erw ise e f f e c tiv e l i v e r therapy# C a stle ^ ^ has shown th a t g a s tr ic d ig e s tio n l i b e r a t e s a n t i - anemic m a te ria l from c e r ta in fo o d s tu ffs which b e fo re d ig e s tio n had no an tian em ic p r o p e r tie s . H is c la s s ic experim ent c o n s is te d in fe e d in g a p a tie n t s u f f e r in g w ith p e rn ic io u s anemia a h a l f pound (226 (ks.) o f r a r e ham burger s te a k each m orning, and 200cc. o f fre s h norm al g a s tr ic ju ic e (human) each evening f o r te n d ay s. Under t h i s regim en, th e re was no blood re sp o n se . F or th e n e x t te n day p e rio d th e s te a k and g a s t r i c ju ic e were fed to g e th e r. A r i s e in r e tic u lo c y te s and blood count fo llo w ed . ^ G rollm an, A rth u r, The A d re n als# (B altim o re: W illiam s and W ilk in s, 1936), 410 p p . The p h y s io lo g ic a l d is c u s s io n o f t h i s s e c tio n i s based on W est, Rand o lp h , "A ntisnem ic M a te ria l o f l i v e r and Stom ach", C hapter X X X ^ pp#451-66 o f G landular P hysio lo g y and Therapy, op » d i t C a s tle , W.B., and lo c k e , E .A ., "O b serv atio n s on th e E tio lo g ie R e la tio n s h ip o f A chylia G a stric a to P e rn ic io u s Anemiq" Jo u rn a l o f C lin ic a l I n v e s tig a tio n , 6 :2 , A ugust, 1928. 88 analogous to t h a t d escrib ed f o r l i v e r feeding* The re a c tio n o f th e g a s t r i c ju ic e w ith th e b e e f s te a k may a ls o be c a r r ie d o u t In v i t r o by in c u b a tio n in s l i g h t l y a c id s o lu tio n , and p o s itiv e re sp o n se s fo llo w when th e r e s u ltin g p ro d u ct i s ad m in iste re d o r a lly to p a tie n ts # In th e e a r l i e s t experim ents a normal in d iv id u a l a te 850 Gm. o f s te a k and re g u rg ita te d i t a f t e r a s h o rt tim e; th e p ro d u ct was th e n a d m in iste re d by stom ach tube# The f a c t o r in b e e fs te a k was c a lle d th e e x tr in s ic fa c to r# Lack o f th e l a t t e r has been d e f in i t e l y shown to be th e cause o f A ddison’s anem ia, and th e term in o lo g y o f th e f a c to r s has been r e ta in e d . The i n t r i n s i c f a c to r i s th erm o lab le: h e a tin g to 70 deg rees C en tig rad e co m p letely in a c tiv a te s it# I t i s presum ably an enzyme, b u t experim ents c a rrie d out by s u b s titu tin g v a rio u s p re p a ra tio n s o f p e p sin and re n n in f o r f r e s h g a s tr ic ju ic e have y ie ld e d n e g a tiv e r e s u lts # C a stle ^ ^ has shown th a t g a s tr ic a c id it y and th e in t r i n s i c f a c to r a re n o t n e c e s s a r ily c o r re la te s * Cases o f t r o p i c a l sprue w ith norm al stomach acid v a lu e s may p re s e n t an anemia S tr a u s s , M.B. , and C a s tle , W.B*, "The N ature o f th e E x trin s ic F a c to r o f th e D eficien cy S ta te in P e rn ic io u s Anemia and in R elated M acrocytic A nem ias," New England Jo u rn a l o f M edicine. 207:55, Ju ly 24, 1932; L a n c e t. 2 :1 1 1 , Ju ly 16, 1932# 29 t h a t responds to l i v e r , w hile e ld e r ly in d iv id u a ls have ac h - lo rh y d ria b u t no anem ia. Acid g a s tr ic ju ic e from an anemic p a tie n t w ith s p ru e , when mixed w ith m eat and fed to a p a t i e n t w ith A ddison’s anem ia, f a ile d to induce a r e tic u lo c y te re sp o n se , w hile a o h lo rh y d ric g a s tr ic ju ic e from an e ld e r ly nonanemie in d iv id u a l co n tain ed th e i n t r i n s i c f a c to r by th e same t e s t . A tte n tio n h as been c a lle d by many i n t e r n i s t s to th e dim inished q u a n tity o f g a s tr ic ju ic e s e c re te d in p e rn ic io u s anem ia. A t o t a l o f 1600 G O . h as been c o lle c te d from f iv e p a tie n ts o v er a p erio d o f e ig h t w eeks. T h is, when in cu b ated w ith meat and fed to a p a t i e n t , was follow ed by a f a i r r i s e in r e ti c u lo c y t e s . The e x t r in s ic f a c to r i s o f more i n t e r e s t to p r a c t ic a l n u t r i t i o n i s t s . I t has been s tu d ie d by S tra u s s and C a stle who s u b s titu te d v a rio u s su b sta n c e s fo r th e b e e fs te a k o f t h e i r o r ig in a l ea^erim ent and d ig e ste d them w ith norm al g a s t r i c j u i c e s . By t h i s method th e e x tr i n s i c f a c to r has been found to be a b se n t from c a s e in , g lu te n , n u c le o p ro te in from h en ’s b lo o d , and n u c le ic a c id o f y e a s t and o f anim al o r ig in . Washed b e e f m uscle p r o te in c o n ta in s m oderate am ounts, and sp le e n p u lp s and m utolyzed y e a s t la r g e amounts o f th e e x tr in s ic f a c t o r . S trausq M. B ., and C a s tle , W. B ., "The N ature o f th e E x trin s ic F a c to r o f th e D eficien cy S ta te in P e m io lo u s Anemia and in R elated M acrocytic A nem ias," New England J o u rn a l o f M edicine, 207:65, J u ly 24, 1962; to n c e ? . 2 : l l i V ^ u ly i6 ,"T 9 g 2 . 30 The f a r th e r o b s e rv a tio n s th a t th e e x tr in s ic f a c to r in y e a s t was n o t d estro y e d by au to s la v in g and was s o lu b le in 80 p e r c e n t a lc o h o l le d to th e su g g e stio n th a t i t m ight be id e n t ic a l w ith o r c lo s e ly a l l i e d to v ita m in 0 . T his proved to be a n o th e r ease o f co n fu sin g a v ita m in w ith a n o th e r su b - 35 s ta n c e , f o r L assen , and numerous o th e r s , have f a ile d to o b ta in re sp o n se s on fe e d in g v a rio u s so u rces o f v ita m in G and g a s tr ic ju ic e to p a tie n ts h av in g p e rn ic io u s anem ia. F u rth e r m ore, p o ten t l i v e r m a te ria l h as been p u r if ie d t i l l f r e e from t h i s v i t a m i n , w i t h o u t lo s s o f p o ten cy . That th e au to ly zed y e a s t p re p a ra tio n Cvegex) o r ^mar m ite ) c o n ta in s th e e x t r in s ic f a c to r has been shown in many ways, n o ta b ly by W ills® ^ in h i s work on tr o p ic a l m acro cy tic anem ias. In th e se anem ias, th e i n t r i n s i c f a c to r i s presum a b ly p re s e n t and th e e x tr in s ic f a c to r la c k in g in th e d i e t . W ills re c e iv e d no resp o n se from a lk a lin e au to clav ed vegex, v ita m in B2 from egg w h ite , n o r from v ita m in s B1 and B4. I t i s , th e r e f o r e , th e consensus t h a t v ita m in B2 and th e e x tr in s ic L assen , H .C .A ., and L assen, H .K ., "Y east o r V itam in B2 as E x trin s ic F a c to r in T reatm ent o f P e rn ic io u s A nem ia," American Jo u rn a l o f th e M edical S c ie n c e s. 188:461, O cto b e r,1934. B rand, E ., W est, R andolph, and S tucky, O .J ., "V itam in G P otency o f P u rifie d L iv e r P re p a ra tio n s ," P ro ceed in g s o f th e S o c ie ty o f E xperim ental B iology and Med 1 o in e . 30Vl382, TSae ,1933 W ills , L . , "A Case o f P e rn ic io u s Anemia T reated w ith V itam in BE from Egg W h ite," L a n c e t. 1 :1 2 8 6 , June 17, 1933. "The N ature o f th e H em atopoietic F a c to r in M arm ite," i b id . 1 :1 2 8 3 , June 17, 1933. SI f a c to r a r e n o t i d e n t i c a l . Some o b s e rv e rs , how ever, have found b o th p re s e n t in egg w h ite , f a i l i n g to confirm th e work o f W ills . A lthough th e s e a n t i anemic f a c to r s a re n o t o f th e v ita m in B complex, i t i s p ro b ab le th a t th e y p la y a p a r t in th e complex p ic tu r e o f p e lla g r a . S p ies has re p o rte d c l i n i c a l Improvement fo llo w in g maximal doses o f p a r e n te r a l l i v e r e x tr a c t in p e lla g r a . Such improvement in c lu d e s abatem ent o f th e m ental d is tu rb a n c e . O a s tr o - in te s tin a l m alabsorption^® such as th a t o f d ia rrh e a o r i n t e s t i n a l o b s tr u c tio n , may i n t e r f e r e w ith th e p ro p e r a b s o rp tio n o f an tian em ic m a te r ia l. F u rth eim o re, i t s s to ra g e in th e l i v e r may be im paired in c i r r h o s i s . Secondary anem ias o f th e ty p e s th a t y ie ld to ir o n have been shown by Murphy®® to y ie ld more ra p id ly i f p a r e n te r a l l i v e r e x tr a c t i s a ls o given a t w eekly i n t e r v a l s . A n o v el e f f e c t in secondary anemia i s re p o rte d in C hapter IV. I n s u l i n : in te r n a l s e c r e tio n o f th e p a n c re a s. The h o r mone in s u lin i s s e c re te d in to th e blood stream by th e c e l l s in th e p an c reas known as th e is la n d s o f L angherans, o r, more m odem ly, th e p a n c re a tic i s l e t s . T his hormone l im its th e p erc e n ta g e o f , su g ar in th e b lo o d , and has become in d is p e n s ib le S tr a u s s , M .B., "The Role o f th e G a stro -In te stin c L l T ra c t in C o n d itio n in g D eficien cy D is e a s e ,” Jo u rn a l o f th e Amer ic a n M edical A s s o c ia tio n , 1 0 3 :1 , J u ly 7, 19^4. Murphy, W .P., "T reatm ent o f Secondary Anemia, W ith s p e c ia l R eference to Use o f D iver E x tra c t Inti*am ùscularly, ” A rchives o f I n te r n a l M edicine, 51:656, May, 1933. 32 in the control of dishetes. There a re f iv e o th e r hormones which I n te r f e r e w ith th e a c tio n o f in s u lin , e i t h e r by producing hyperglycem ia o r hypoglycem ia. They a re e p in e p h rin e , c o r tin , th y ro x in e , pos t e r i o r p i t u i t a r y e x tr a c t, and th e d ia b e to g e n ic su b stan ce o f th e a n te r io r p i t u i t a r y . O ther su b sta n c e s which may i n t e r f e r e ?d.th in s u lin a c tio n a r e : c e r ta in enzymes, some o f which may be in th e b lo o d ; th e r e a c tio n s o f ti s s u e s ( a c id o s is combats in s u lin a c ti o n ) ; th e to x ic p ro d u c ts and c e r ta in o th e r e f f e c ts o f in f e c tio n s ; and a n e s th e tic s . F o rtu n a te ly th e se enem ies o f th e d ia b e tic a re u s u a lly c o n tro lle d by a d ju s tin g th e dosage o f i n s u l i n , o r by o th e r m easures. There i s a tend ency to a s c rib e a l l c a se s o f spon taneous hypoglycem ia to h y p e rin s u lln ism , b u t t h i s i s n o t j u s t i f i e d . O ther cau ses may b e: (1) l i v e r in ju r y , (2) dé f ic ie n c e s such a s o f a n t e r io r p i t u i t a r y s e c r e tio n o r ë d re n a l m a lfu n c tio n , (3) a k e to g e n ic d i e t . The most a c tiv e form o f i n s u lin i s th a t o b tain ed in th e c r y s t a l l i n e form , and i s composed o f numerous amino a c id s ( c y s tin e , ty r o s in e , a r g in in e , h i s t i d i n e , ly s in e , le u c in e , glutam ic acid, p r o lin e and p h e n y la la n in e ). I t g iv e s â l l th e ty p ic a l p ro te in t e s t s . That th e a c tiv e m a te ria l i s m erely 33 absorbed on th e c r y s t a ll i n e p r o te in i s u n l i k e l y . T h e c r y s t a ls a re p ro b ab ly th e s a l t o f In s u lin w ith a m etal such a s zin c o r cadmium. The av erag e dose tak en i s about 30 u n i ts , and a s a r e s u l t f o r one d ia b e tic c h ild who su rv iv ed te n y e a rs fo rm e rly p erh ap s a thousand su rv iv e to d a y . The amount o f ca rb o h y d rate which one u n it o f I n s u lin w ill m e ta b o liz e v a r ie s . In g e n e ra l i t i s 1 o r E gm ,or p e r haps 3 to 6 . Newburg even sy as 7 , b u t t h i s i s an extrem e p o s itio n . I t i s r e a l ly im p o ssib le to say d e f i n i t e l y , because th e p a n c re a tic f I n te r n a l s e c re to ry a c t i v i t y o f n e ith e r norm al n o r d ia b e tic humans i s known. As to a d m in is tr a tio n , th e n e e d le rem ains th e only p r a c tic a l r o u te . A ccording to J o s lin ,^ ^ symptoms o f an overdose o f in s u lin , f o r p r a c t ic a l p u rp o se s, a re id e n t ic a l w ith th o se r e s u ltin g from a f a l l in th e p e rc e n ta g e o f sugar in th e blood below norm al. Such symptoms a re o fte n re p o rte d to develop when th e blood su g ar is a t norm al le v e l o r even above. J o s l i n doubts t h i s , b u t adm its t h a t sudden f a l l i n g o f th e blood su g ar S c o tt, D .A ., " C r y s ta llin e I n s u lin " , B ioch em istry J . 88:1592, 1934, a s quoted by B e s t, C .H ., C hapter ZXVII, G landular P hysiology and T herapy, o p . c i t . J o s lin , E. P ., " I n s u lin T h erap y ," C hapter ZXVIÎI, o f G landular P hysio lo g y and Therapy, op. c i t . 54 from h ig h le v e ls to le v e ls o n ly s l i g h t l y below 0 .1 0 p e r ce n t (ICO mg. p e r hundred cu b ic c e n tim e te rs o f blood) causes symp toms th a t would n ev er be f e l t when th e same glycém ie p ercen ta g e i s approached l e s s a b r u p tly . In th e p re s e n t s tu d y , a glycém ie p erc e n ta g e o f 0.044 produced no n o tic e a b le d i s t r e s s , b u t t h i s fig u re was based upon a new method o f a n a ly s is which g iv e s low er f ig u r e s th an o ld e r m ethods. I n s u lin in n o n d la b e tlc s t a t e s . T hin, un d ern o u rish ed in d iv id u a ls whose em aciatio n i s due to poor a p p e tite can be helped to ta k e more food by th e use o f i n s u l in . The p r a c tic e o f u sin g in s u lin in n o n d ia b e tie p a tie n ts to in c re a s e w eight began in 1923, and was soon adopted f o r n o n d ia b e tie tu b e rc u lo u s c a s e s . The mode o f such a c tio n i s n o t e n t i r e ly c l e a r . In s u lin i s only one o f many f a c to r s in flu e n c in g a p p e tite and n u t r i t i o n , and y e t a l l p a tie n ts w ith tu b e rc u lo s is r e a c t to i t s use in th e same way. F . M. A llen adv ised b eg in n in g w ith 5 u n its th re e tim es a day and in c re a s in g to 40 u n its th re e tim es a d ay . The p r o te c tio n a g a in s t shock depends n o t so much on la rg e q u a n titie s o f ca rb o h y d ra te s as on th e re p e a te d a d m in is tra tio n o f such sm all amounts as 10 gm. ^2 fjie " tru e blood su g ar" v a lu e s th u s o b tain ed a re 10-20 mgms. lo w er, a s ex p lain ed a t th e co n c lu sio n o f C hapter I I I , p . 52. 35 O c c a sio n a lly much l a r g e r do ses o f in s u lin were g iv e n . I n d iv id u a liz a tio n o f th e dosage should he em phasized, e s p e c ia lly in eases in which tu b e rc u lo s is o f th e a d re n a ls o f l i v e r i s p r e s e n t. In such ca ses dangerous hypoglycem ia may o c c u r. Gains in w eight o f 60 pounds (27 Kg.) o r more in a few months to g e th e r w ith improvement in s tre n g th and " s p i r i t s " fre q u e n tly a re r e p o rte d and a re sa id to be m aintained a f t e r in s u lin i s sto p p ed . However, a l l w r ite r s ag ree th a t I n s u lin i s an a d ju n c t and I s n o t to be s u b s titu te d f o r any o f th e r e g u la r forms o f tre a tm e n t f o r tu b e r c u lo s is . R enal g ly c o s u ria should n o t be tr e a te d w ith i n s u l in . The fundam ental c h a r a c t e r is t i c o f r e n a l g ly c o s u ria I s th e con s ta n t o ccu rren ce o f g ly c o s u ria even w ith a norm al blood su g a r, ir r e s p e c tiv e o f th e amount o f ca rb o h y d rate in g e s te d . B ehavior a b n o rm a litie s a re n e a rly alw ays m a n ife st in u n d e r n u tr itio n . That m inor p e r s o n a lity d is tu rb a n c e s accompany even m ild u n d e r n u tr itio n has been shown by th e p re s e n t i n v e s t i g a tio n . The erg o g rap h , re p e a te d kymograph re c o rd in g s o f m ental b lo c k in g s , th e g rip dynamometer, a s te a d in e s s t e s t e r , and v a rie d in te llig e n c e t e s t s , were among th e in s tru m e n ta ria u s e fu l in e l i c i t i n g th e s e re sp o n se s. Where u n d e m u tr itio n e x i s t s in norm al p erso n s in th e fa c e o f adequate ac cess to p ro p e rly balan ced fo o d , ex p e rien ce 36 has shown th e e f f e c tiv e n e s s o f en d ocrinology to cope w ith th e s i t u a t i o n , i n s u l in i s used in much th e same way in which i t i s used to c o n tro l d ia b e te s . Gains in w eight o f 60 pounds o r more in a few months to g e th e r w ith improvement in " s tr e n g th and s p i r i t s " fre q u e n tly a re re p o rte d and a re sa id to be m aintained a f t e r in s u lin i s sto p p ed . On the o th e r extrem e, th e re i s grouped under th e t i t l e o f h y p e rin su lism an in c re a s in g number o f c a se s o f "hunger" d is e a s e (S e a le H a rris ) o r spontaneous hypoglycem ia.^® The symptoms o f hunger, n e rv o u sn e ss, sw eatin g , f a i n t i n g , , e p ile p tifo rm co n v u lsio n s and u n co n scio u sn ess—u s u a lly r e lie v e d by food o r by d e x tro se giv en in tra v e n o u s ly —a re due to hypoglycem ia, w hether i t s cause i s tr u l y o v e rs e c re tio n o f in s u lin o r, a s In some in s ta n c e s , a d is e a s e o f th e l i v e r o f a d r e n a ls . The v a r ie ty o f nervous and m ental symptoms, a s w e ll as th e abdom inal symptoms, makes th e c o n d itio n an im p o rtan t one f o r d i e t i c i a n , i n t e r n i s t , and p s y c h o lo g ist a lik e to b e a r in mind# I t must be remembered, a ls o , th a t hypoglycem ia may oc- cu r in c e r ta in ty p es o f h e p a tic d is e a s e s , in d is e a s e s o f th e ? p i t u i t a r y , th y ro id and a d re n a l glands ( e s p e c ia lly in A ddison’s d is e a s e ) ; and H a rris u rg e s th e stu d y o f a l l o th e r p o s s ib le 43 J o s lin , E .P . G landular P hysiology and T herapy. (C hicago: American M edical A s s o c ia tio n , l9 S o ), p . 437. Much o f th e m a te ria l in th e c lo s in g pages o f t h i s c h a p te r i s ta k e n from t h i s symposium. 37 oauses o f hypoglycem ia b e fo re th e d iag n o sis i s made o f h y p e r- in su lism in e p i l e p t i c p a t i e n t s . The d i a ^ o s i s may be made te n t a t i v e l y from th e c l i n i c a l symptoms, and from th e r e l i e f o f m ild symptoms by fre q u e n t ca rb o h y d rate fe ed in g and a h ig h f a t d i e t . Blood su g ar v a lu e s below 0 .0 6 p e r c e n t fo llo w in g a d e x tro se to le ra n c e t e s t should be w atched, e s p e c ia lly s in c e in some c a se s e p ile p tifo rm s e iz u r e s have occurred when th e blood su g ar f e l l to 0 .0 6 p e r c e n t. Such a tta c k s may be produced by g iv in g t e s t doses o f in s u lin , b u t t h i s proced u re I s n o t a d v is e d . The stu d y o f k e to g e n e sis re p o rte d in C hapter T su g g ests o th e r f a c to r s o p e ra tin g in t h i s s o -c a lle d hypoglycem ia syndrome. One s u b je c t in th e experim ent re p o rte d in C hapter V showed by a new a n a ly tic tech n iq u e a blood su g ar o f 44 mgm/lOO c c ., a n o th e r o f 54 mgm./lOO c c . w ith o u t marked b eh av io r d is tu rb a n c e s . A nother developm ent o f I n t e r e s t which may be f i t t i n g l y m entioned h e re i s th e r e c e n tly re p o rte d su cc ess in t r e a t i n g de m entia p raeeo x w ith i n s u lin . I t must be em phasized t h a t t h i s i s a shock tre a tm e n t and i s n o t to be confused w ith th e u su a l 44a p h y sio lo g ic u ses o f i n s u l in . Qa8t r o - l n t e s t i n a l hormones » M edical sc ie n c e has been in c re a s in g ly occupied o f l a t e w ith th e r e a l iz a t i o n th a t many o f Giving " tru e blood sugar" v a lu e s 10-20 mgms. low er th a n o ld e r m ethods, as ex p lain ed under th e l a s t to p ic in Chap* t e r I I I , p . 52. W ort18, Jo sep h , " I n s u lin in S o h iso p h re n ia ," (C ol le c te d a h s tra o t) The Jo u rn a l o f Eervous and M ental D is e a se , 1 8 5 :5 , p p . 588-593T^1ay, 1957. 38 th e o rd in a ry d u et glan d s a ls o have en docrine fu n c tio n s ♦ • . th a t i s , th e y s e c re te horm ones. There a re a number o f th e se du al fu n c tio n organs in th e d ig e s tiv e t r a c t . T h eir s e c r e ta i ons a re c a lle d th e g a s t r o - i n t e s t l n a l horm ones. The stomach s e c r e te s a hormone known a s ^ s t r i h . Among o th e r f u n c tio n s , i t i s th o u g h t to a c t by way o f a hum oral ro u te to prom ote th e s e c re tio n s o f g a s tr ic ju ic e fo llo w in g In g e s tio n o f a m eal. The f r a c tio n o f l i v e r th a t c o n ta in s th e a n ti- p e r n ic io u s su b stan ce I s a lso r ic h in g a s tr ic s e c re ta g o g ic p o ten cy . H istam ine a c ts l i k e th e s e horm ones, b u t much more power f u l l y in e x c itin g ac id g a s t r ic s e c r e tio n . By d i f f e r e n t i a t i n g be tween tru e and f a ls e a n a c id ity upon p a r e n te r a l a d m in is tr a tio n , i t d e te c ts in c ip ie n t p e rn ic io u s anemia even b e fo re th e p ro drom al e f f e c ts on th e c e n tr a l nervous system a re m a n ife s t. In th e i n t e s t i n e th e re a re e la b o ra te d th e hormones s e c r e t in , c h o le c y s to k in in (s tim u lu s f o r g a ll- g la d d e r c o n tra c t i o n ) , and p o s s ib ly a g a s t r o - i n t e s t i n a l m otor hormone (aug m enting m o tility ) . N e ith e r g a s tr in n o r any o f th e s e have been found as y e t th e r a p e u tic a lly u s e f u l, b u t t h e i r d is tu rb a n c e may e x p la in much o f th e " d y sp e p tic " p e r s o n a lity . A ntianem ic m a te ria l o f l i v e r and stom ach. The changes in th e n erv o u s system in p e rn ic io u s anem ia, ac co rd in g to 39 Westf® a re In d ic a te d by th e c l i n i c a l c o u rse . There i s a m yelin sh e a th d e g e n e ra tio n , a f f e c tin g c h ie f ly th e d o rs a l colm m s and pyram idal t r a c t s o f th e s p in a l c o rd , and to a l e s s e r e x te n t th e w h ite m a tte r o f th e b ra in and p e r ip e h ra l n e rv e s . H is to lo g ic s tu d ie s o f th e nervous system fo llo w in g th e e f f e c tiv e th e ra p y have n o t been re p o rte d , b u t a l l in d ic a tio n s a re th a t w ith adequate amounts o f l i v e r th e p ro g re ss o f th e le s io n s i s a r r e s t e d , and a g rad u al improvement in b eh a v i o r ta k e s p la c e o ver a p e rio d o f months o r even y ea rs West^"^ e m p h a tic a lly s t a t e s t h a t th e m ost im p o rtan t p o in t in tr e a tin g p a ti e n ts w ith s p in a l cord involvem ent i s th e m aintenance o f th e blood a t o r above norm al l e v e l s . Even w ith th e red blood co u n t a s h ig h as fo u r m illio n o r b e t t e r th e devblop* ment o f cord le s io n s has been o bserved; w hile w ith red c e l l s a t f iv e m illio n o r b e t t e r no le s io n s d ev e lo p . West b e lie v e s th a t t h i s acco u n ts f o r th e d is c re p a n c ie s in th e l i t e r a t u r e review ed W est. Randolph. G lan d u lar P h ysiology and Therapy, op. c i t . . C hapter XXX. B aker, B .M .J r., B o r d le y ,J ., III, and Longcope,W .T. "The E ffe c t o f L iv e r Therapy on th e N e u ro lo g ic a l M a n ife s ta tio n s o f P e rn ic io u s Anem ia," American Jo u rn a l o f th e M edical S cien ces 1 8 4 :1 , J u ly , 1932. M inot, 6 .R . , and ÔasîTe," W .B., ’*'The Adequate T reatm ent o f Anem ia," A nnals o f I n te r n a l M edicine. 5 :1 6 9 , A ugust, 1931. Ü ngley, G.C., "The ¥reaTment o f Subacute Combined Dégénéra* t i o n ," P ro ceed in g s o f th e Royal S o c ie ty o f M edicine. 27:779, A p ril, 1934, a s quo$Fd lay W est, Randolph, op. c i t . . Ch. XXX. W est, R andolph, op. c i t . , p . 464. 40 48 by F o u te , who found th a t v ita m in B was i n e r t in th e t r e a t ment o f cord le s i o n s . Very sev ere c a se s— o h a o te riz e d by bed s o re s , p a r a l y s is , and b la d d e r involvem ent—may respond to adequate p a r e n te r a l l i v e r th e ra p y . The b e h a v io ra l resp o n se h ere i s s t r i k i n g . The somewhat p re v a le n t b e l i e f th a t le s io n s o f th e p e r ip h e ra l n e rv e s may im prove w h ile s p in a l cord le s io n s do n o t, i s ch allen g ed by th e d isap p ea ran ce o f th e B abinski r e f le x and a t a x i a . The resp o n se o f th e g a s t r o - in t e s t i n a l t r a c t to l i v e r th e ra p y i s even more com plete th an i s th e n e u ro lo g ic a l and be h a v io r re sp o n se . T his ten d s to a s u b je c tiv e improvement ex ceeding somewhat th e n e u ro lo g ic a l b e n e f i t . S u b ject A. M., as re p o rte d in th e n e x t c h a p te r, was fre e d o f d i s t r e s s f u l m enstru a tio n by p a r e n te r a l l i v e r a d m in is tr a tio n . Accompanying t h i s was r e l i e f from a p e r io d ic m e la n c h o lia . T his review as a r e f e r e n c e . The l i t e r a t u r e review ed in t h i s c h a p te r was p r in c ip a lly th a t p s y c h o lo g ic a lly le s s known ty p e c o r r e la tin g n u t r i t i o n and th e e n d o c rin e s. The b e h a v io r c o r r e la te s were m entioned b r i e f l y . The v a lu e to psychology o f ^6 F o u ts, P . J . , "V itam in B In tra v e n o u sly f o r th e t r e a t ment o f n e u ro lo g ic a l changes in p e rn ic io u s an e m ia,” J . In d ia n a M .A., 2 6 :4 8 , O cto b er, 1932. 41 th e kind o f l i t e r a t u r e re se a rc h h ere in a lim ite d manner exem p l i f i e d l i e s in i t s com parative n o v e lty h u t u n d en iab le im portance to p sy c h o lo g ic a l s tu d y . More g e n e ra l a tte n tio n o f s tu d e n ts o f b e h a v io r to t h i s type o f l i t e r a t u r e w ill make a v a ila b le to psy chology th e v a s t amount o f c l i n i c a l and b io ch em ical in v e s tig a tio n d a ily seek in g f o r more d e f in i t e knowledge o f th e n u t r i t i o n - en d o crin e r e la tio n s h ip . Of th e t r i p l e c o r r e la tio n o f t h i s r e la tio n s h ip w ith be h a v io r, th e ex p erim en tal p a r t o f t h i s in v e s tig a tio n sought to o b ta in more d e f in i t e knowledge th a n th e l i t e r a t u r e o f f e r s . The l i t e r a t u r e review ed in t h i s c h a p te r, how ever, w il l serv e as a background f o r e v a lu a tio n o f th e ex p e rim e n ta l fin d in g s . Ref eren ces to t h i s l i t e r a t u r e w ill be made re p e a te d ly . CHAPTER I I I TESTS USED Grrip endttranee# The g rip span o f a Smedley dynanom eter was s e t to th e optimum span f o r each s u b je c t. The s e t t i n g was determ ined a f t e r s e v e ra l n o n -e o n se o u tlv e t r i a l s f o r each indi-» v ld u a l, and was used in sub seq u en t t e s t s . T his d e te rm in a tio n o f th e optimum span a ls o re v e a le d , a s a c o n tr o l, th e maximum g rip o f each s u b je c t in a l l o f th e e x p e rim e n ta tio n in which g rip was t e s t e d . Hence any s h irk in g o f i n i t i a l e f f o r t in subsequent endurance t e s t s could be d e te c te d . For th e t e s t th e s u b je c t was se a te d a t a ta b l e , h is r ig h t forearm r e s tin g co m fo rtab ly th e re o n , and ap p ro x im ately p erp en d icu l a r to th e f r o n ta l p la n e o f h i s body. The dynamometer was grasped in th e r ig h t hand, w ith th e d i a l and p o in te r in a v e r t i c a l p la n e in approxim ate p ro lo n g a tio n o f th e fo rearm . The s u b je c t was in s tru c te d to g rip w ith maximum e f f o r t when he was " s e t" and to keep th e p o in te r a t as h ig h a re a d in g a s he could t i l l to ld to s to p . As th e p o in te r began to move, th e ex p erim en ter d ire c te d "go" to an a s s i s t a n t . The a s s i s t a n t h eld a watch In h is hand and a t th e end o f each f iv e second i n t e r v a l from re c e p tio n o f th e instruc*^ tio n "g o ," he issu e d th e o rd e r "mark»" The ex p e rim e n te r k e p t h is eyes on th e two-way moving p o in te r and a t each Issu an c e o f th e o rd e r "mark" from th e a s s i s t a n t , he v is u a liz e d th e re a d in g o f th e p o in te r and reco rd ed i t in ample tim e to lo o k up and a g a in 4 5 f i x on th e p o in te r b e fo re re c e iv in g th e o rd e r "mark" a t th e end o f th e subsequent fiv e -se c o n d i n t e r v a l . Upon th e tw e lfth re c o rd in g , ( a f t e r th e la p s e o f s ix ty se c o n d s), th e s u b je c t was d ire c te d to " s to p " and allow ed to c o lla p s e over th e t a b l e . The re a d in g o f th e one-way moving p o in te r was th en noted to o b ta in th e maximum g r ip . The o th e r elem ent o f th e r e s u l t s was a f a tig u e in d ex found from th e form ula suggested by W hipple,^ XS r - r* r where X i s th e g rip endurance index o f f a tig u e , r th e mean o f th e f i r s t fo u r re a d in g s , and r* th e mean o f th e l a s t fo u r re a d in g s . T his I s a lo g ic a l c o n v e n tio n , sin c e a zero index would in d ic a te no f a tig u e , o r p e r f e c t endurance; w h ile an index o f u n ity would in d ic a te i n f i n i t e f a tig u e o r no endurance based on th e c r i t e r i o n o f g rip rem aining d u rin g th e l a s t tw enty seconds o f th e m inute i n t e r v a l . T his g rip endurance t e s t was planned to o b ta in m axi mal perform ance by e l i c i t i n g s u b je c t resp o n se as a c o m p e titiv e f e a t and a s a showing o f sp o rtsm an sh ip . Every e f f o r t was made to d iv o rc e th e t e s t from r e s t r i c t i o n s which m ight c h a ra c te r iz e a la b o r a to r y s i t u a t i o n . Yet th e method was s u f f i c i e n t l y a c c u ra te ^ W hipple, G r. M ., l^ n u a l o f M ental and P h y sic a l T ests (B altim o re: Warwick and York, l92?T , p . l l 9 . 44 to d e te c t a p p re c ia b le v a r ia tio n s in t h i s ty p e o f endurance, and i t had th e d i s t i n c t advantage o f a d m in is tra tio n in th e l iv in g q u a r te rs o f th e su b je c ts# There have been many argum ents a s to th e r e l a ti v e m e rits o f sp rin g as compared w ith w eight lo a d in g in th e stu d y o f m uscular fa tig u e # T his argum ent has extended to th e r e l a tiv e c a p a c ity o f a m uscle w orking by is o m e tric v e rsu s is o to n ic c o n tra c tio n s ; and to th e p o s s ib lity o f is o l a t in g a s in g ly work in g m u scle. These c o n s id e ra tio n s may be o f im portance in p u re ly la b o ra to r y re s e a rc h , b u t th e y have l i t t l e b e a rin g on a p r a c tic a l stu d y o f f a tig u e . I f th e sta te m e n t o f Watson th a t "W hatever th e organism d o e s, i t does as a w h o l e , n e e d s q u a li f i c a t i o n , i t i s n e v e rth e le s s u n d en iab ly tr u e th a t any m otor a c t i s done n o t w ith a s in g le m uscle b u t w ith a group o f m tm oles. There would seem, th e n , to be p r a c t ic a l im portance in th e stu d y o f a re a so n a b ly e x h a u stin g fu n c tio n o f th e many m uscles Involved in g rip p in g . F urtherm ore— i f "work decrem ent" i s to be d efin ed a f t e r th e a c cepted co n cep tio n ex p ressed in th e words o f Robinson® a s "That lo s s in e f f ic ie n c y which i s ty p ic a lly produced by prolonged and co n tin u o u s perform ance o f a s e t t a s k ," — th e n th e t e s t o f g rip endurance a s o u tlin e d ap p ears p a r t i c u l a r ly m ean in g fu l. B a ts o n , J .B ., Psychology from th e S tan d p o in t o f a B e h a v io ris t (P h ila d e lp h ia : J .B . h ip p in c o tt Company, 1924.) ®Robinson, E .S ., "The Work o f th e In te g ra te d O rganism ," Handbook o f G eneral E xperim ental PsycholORV. M urchison, C a rl, M i t o r (W o rcester, M ass.; C lark U n iv e rs ity P r e s s , 1 9 3 4 ),XKI:5 7 9 . 45 As W hipple h as sa id in s u g g e stin g th e t e s t o f which t h i s i s a m o d ific a tio n , i t seems p o s s ib le . • .t o se c u re v a lu a b le r e s u l t s f o r com parative p u rp o se s. • .b y th e use o f sim p le r a p p a ra tu s and l e s s rig o ro u s te c h n iq u e . . • For t h i s re aso n th e t e s t i s suggested a s a p r a c t ic a l s u b s t itu t e f o r th e more cumbersome and com plicated e rg o g ra p h .4 Push-up e x e r c is e . To ex ecu te p u sh -u p s. th e s u b je c t a s sumed a prone p o s itio n , h is v e n tr a l s u rfa c e in c o n ta c t w ith the f lo o r . Each hand was placed palm downward und er th e co rresp o n d in g s h o u ld e r. The fin g e r s were h eld to g e th e r , and p a r a l l e l to th e lo n g itu d in a l a x is o f th e body. From t h i s p o s itio n , th e s u b je c t extended h i s arms w ith o u t a l t e r i n g th e placem ent o f h is hands o r th e s t r a i g h t d is p o s i tio n o f to r s o and l e g s . The r e s u l t was a m otion o f th e body, upon th e to e s as a fu lcru m , to a p o s itio n form ing an an g le o f about t h i r t y d eg rees w ith th e f lo o r . In t h i s p o s itio n o f m axi mum d isp la c e m e n t, th e palms o f th e hands and th e d i s t a l ends o f th e g r e a te r to e s (o r th e f r o n t s u rfa c e o f th e shoes) su p p o rted th e r e s t o f th e body. Ho p a r ts o th e r th an th e hands and to e s touched th e f l o o r . This upward movement o f th e e x e rc is e was done in ap p ro x im ately two seco n d s, o r to a count o f fo u r . ^ W hipple, G.M., Manual o f M ental and P h y sic a l T e s ts . (B altim o re: Warwick and York, 1924TT pp. 1 Ï5 -Ï1 6 . 46 The concluding p a r t o f th e e x e rc is e was a downward movement, re tu rn in g th e body to I t s I n i t i a l prone p o s itio n on th e f l o o r . T his p o rtio n o f th e e x e rc is e was a ls o done in ap p ro x im ately two seco n d s, o r fo u r c o u n ts. Push-up endurance. Push-up endurance was co n sid ered to be th e t o t a l number o f th e s e e x e rc is e s perform ed w ith o u t a p p re c ia b le r e s t o r a l t e r a t i o n o f rhythm by a s u b je c t m otivated to maximal e f f o r t . The push-up e x e rc is e was chosen because o f i t s m eaningfulness in q u a n tita tiv e ly in d ic a tin g f a tig u e r e s u l t ing from fu n c tio n o f b ig m u scles, in c lu d in g th e much used t r i ceps b r a c h i a l is . I t has th e f u r th e r ad v an tag e, o f c o u rse , o f re q u ir in g no a p p a ra tu s . Hence i t could be a d m in iste red to th e s u b je c ts when in t h e i r q u a r te rs and in in fo rm al a t t i r e . Thus was a f u r th e r detachm ent from th e la b o ra to r y s it u a tio n o b ta in e d . This e x e rc is e has a f a r t h e r advantage which was in d ic a te d in a p re lim in a ry stu d y . There i s no a p p re c ia b le f lu c tu a tio n in th e t o t a l number o f th e s e e x e rc is e s which a p ro p e rly m o tiv ated s u b je c t w i l l do w ith c o n d itio n s k e p t even ro u g h ly c o n s ta n t. F our young men, whose mean push-up endurance was re p re se n te d by 21 o f th e e x e r c is e s , were re q u ire d to each ex ecu te in sequences ap p ro ach in g t h e i r endurance l i m i t s 60 o f th e se e x e rc is e s each m orning b e fo re a r is in g and each evening b e fo re r e t i r i n g . The r e s u l t o f th r e e months o f t h i s regim e was a mean In c re a se in 47 push-up endurance o f 1 1 . The g r e a te s t v a r ia ti o n o f any in d iv id u a l sc o re from th e s u b j e c t 's mean f o r any week was 5 . This co n c ep tio n o f endurance i s th e r e f o r e v a lu a b le in com paring th e perform ance o f a given in d iv id u a l under d i f f e r e n t c o n d itio n s , and i t i s so used in t h i s in v e s tig a tio n . C o n tro l o f movement. A l e s s m eaningful t e s t used in t h i s in v e s tig a tio n was a m o d ific a tio n o f a "co n tro l o f move ment" t e s t used a t Columbia U n iv e r s ity . More p ro p e rly i t m ight be c a lle d a th re e -d im e n sio n a l ta p p in g t e s t , sin c e a d ire c te d t r a n s l a t o r y movement was added to th e s in g le -p la n e c u r v ilin e a r m otion o f key ta p p in g . The s u b je c t was su p p lied w ith c o o rd in a te p ap er marked w ith one c e n tim e te r s q u a re s . Each h u n d red th sq u are was o u t lin e d more h e a v ily th a t th e in te rv e n in g s q u a re s . The s u b je c t was su p p lie d w ith a p e n c il and to ld to make a d o t in each sq u are as r a p id ly as p o s s ib le . Where sim ply th e r a te o f th ree-d im en s io n a l ta p p in g was d e s ire d ,h e was to ld to sto p a t th e f i r s t h e a v ily o u tlin e d sq u a re . By tim in g h is i n i t i a l and f i n a l ta p s th e r a t e f o r th e hundred ta p s was a s c e r ta in e d . T hree-d im en sio n al ta p p in g fa tig u e in d e x . Where a f a tig u e index was d e s ire in th e th re e -d im e n sio n a l ta p p in g t e s t , th e s u b je c t was to ld to c o n tin u e making th e d o ts a t maximum speed through th e th ir d h e a v ily o u tlin e d sq u a re . He was re lie v e d o f some r e s p o n s i b il ity o f o r ie n ta tio n by b ein g to ld th a t th e 48 ex p erim en ter would watch h is o p e ra tio n and t e l l him when to s to p . The f a tig u e index was th en o b tain ed by s u b tr a c tin g th e r e c ip r o c a l o f th e tim e in seconds f o r th e l a s t hundred ta p s from th e r e c ip r o c a l o f th e tim e in seconds f o r th e f i r s t hundred ta p s , and d iv id in g th e rem ainder by th e r e c ip ro c a l o f th e tim e in seconds f o r th e f i r s t hundred ta p s . This m ath em atical p ro cedure keeps th e method analogous to t h a t recommended by W hipple and h e re in b e fo re d esc rib ed in c o n n e ctio n w ith th e g rip endurance fa tig u e in d e x . The p ro c e ss i s re p re se n te d by th e fo llo w in g f o r m ula: 1 1 z= T - T' T o r where X i s th e d e s ire d index o f f a tig u e , t th e tim e in seconds f o r th e f i r s t hundred ta p s , and t ' th e tim e in seconds f o r th e l a s t hundred ta p s . S te a d in e ss T e s t. As a t e s t o f s te a d in e s s , a m o d ific a tio n o f th e method suggested by Whipple® was u se d . A m e ta llic p l a t e , s e t a t an an g le o f f o r ty f iv e d e g re e s, and bored w ith a s e r ie s o f h o le s whose d iam eters were 32, 20, 16, 13, 11, 10, 9, 8, and 7 s ix ty - f o u r th s o f an in c h , r e s p e c tiv e ly , was u sed . When ® W hipple, G.M., op. c i t . , p. 166-167 49 a p o in te r w hich th e s u b je c t m anipulated touched th e p e rip h e ry o f a h o le , an e l e c t r i c c i r c u i t a c tu a tin g a co u n ter was c lo s e d . The c o u n te r in d ic a te d th e tim e o f c o n ta c t in one-hundred-and- tw e n tie th s o f a second. The s u b je c t was in s tr u c te d to hold th e n e e d le in th e manner p re s c rib e d by W hipple,® and to p la c e th e n eed le in th e h o le in w hich he was te s te d and to hold i t th e re w ith th e l e a s t p o s s ib le c o n ta c t w ith th e p e rip h e ry fo r a p erio d o f 16 seco n d s. The p re c a u tio n s f o r m a in ta in in g c o n sta n t f a c to r s o f s e a tin g a s d e ta ile d by Struthers*^ were fo llo w e d . The r e s u l t s were expressed in t o t a l tim e o f In v o lu n ta ry c o n ta c t w ith th e boundary o f a g iv en h o le du rin g th e f i f t e e n second i n t e r v a l . Key ta p p in g . The r a te o f ta p p in g a te le g ra p h key f o r f iv e second in te r v a ls was determ ined by means o f an e l e c t r i c c o u n te r. To determ ine an index o f f a tig u e f o r t h i s much- s tu d ie d b u t r a th e r m eaningless v o lu n ta ry m otor a b i l i t y , an a s s i s t a n t o p e ra tin g a sto p w atch gave th e o rd e r "mark" a t th e end o f each fiv e second in te r v a l to d ir e c t th e ex p erim en ter in re a d in g an e l e c t r i c c o u n te r. Upon th e c o n c lu sio n o f a m inute ® W hipple, G.M., l o o . c i t . ^ S tr u th e r s , A .B ., F u n c tio n a l P e r io d ic ity and E f f ic ie n c y . D o cto ral D is s e r ta tio n (The Û n iv e rs ity o f Southern C a lif o r n i, 1936), p p. 116-116. 50 o f t h i s p ro c e d u re , th e s u b je c t was to ld to cease ta p p in g . An index o f fa tig u e f o r com paring a given s u b je c t 's perform ance under d if f e r e n t c o n d itio n s was th en o b tain ed by ap p ly in g th e form ula given under g rip endurance. The H U m m -Wadsworth Temperament Scale.® W ith f u l l r e a l iz a t i o n th a t a l l y a r d s tic k s o f p e r s o n a lity a re in th e ex p e rim e n ta l s ta g e , th e HummrWadsworth Temperament S cale was used p u re ly to compare some s u b je c tiv e a s p e c ts o f a given p e r s o n a lity under v a ry in g n u t r i t i o n a l c o n d itio n s . This i s n o t, o f c o u rse , th e use f o r which t h i s s c a le was i n i t i a l l y in te n d e d . R esearch would move v e ry slo w ly , how e v e r, i f in stru m e n ts o f in v e s tig a tio n were n ev er p u t to new u s e s . I f t h i s s c a le can be used even e x p e rim e n ta lly as an a n a ly s is o f p e r s o n a lity , i t s method o f s ta n d a r d iz a tio n and many component q u e s tio n s c e r t a i n ly j u s t i f y i t s use as an e x p e ri m ental in v e n to ry o f a t t i t u d e s under d if f e r e n t c o n d itio n s w ith re a so n a b ly wide s e p a ra tio n in tim e . The r e s u l t s o f a p p ly in g t h is tem peram ent s c a le were expressed in two w ays. The o b tain ed " p r o f ile s " o r graphs o f te n d e n c ie s were compared g r o s s ly . Then an a n a ly s is o f answ ers g iven d i f f e r e n t l y under d if f e r e n t n u t r i t i o n a l c o n d itio n s was made by com paring m agnitudes o f in d iv id u a l sco re com ponents. ® P ublish ed by a u th o rs (Los A ngeles: D oncaster G. Humm, 661 H. Parkman Avenue, 1934). 61 These r e s u l t s ap p ear in th e c h a p te rs devoted to th e stu d y o f th e v a rio u s n u t r i t i o n a l s t a t e s . The O tis T e sts o f M ental A b i li ty . Thorough s ta n d a r d i z a tio n , h ig h c o r r e la tio n w ith o th e r c r i t e r i a o f in te llig e n c e , e x is te n c e o f s e v e ra l form s w ith h ig h c o r r e la tio n and known p ra c t i c e e f f e c t betw een th e form s^—a l l th e se f a c to r s c o n trib u te d to th e s e le c tio n o f th e O tis t e s t s f o r com parison o f m ental a b i l i t y in th e d if f e r e n t d ie ta r y and en d o crin e s t a t e s i n v e s t i gated in t h i s s tu d y . The O tis t e s t s used were th o se o f th e H igher Exam ination: Forms A, B, C, and D. The th irty -m in u te tim e l i m i t was adhered t o , because o f i t s g r e a te r r e l i a b i l i t y . B iochem ical T e s ts . The method used to determ ine blood su g ar c o n c e n tra tio n s i s th e o n ly d e t a i l o f chem ical a n a ly s is which n e c e s s ita te s e x p la n a tio n f o r an u n d e rsta n d in g o f th e be h a v io r s tu d y . The most r e c e n tly accep ted m ethodology grouped 10 under th e "Sm ogyi-Shaeffer-H artm ann" d e s ig n a tio n was u sed . This tech n iq u e has c o n s is te n tly g iv en " tr u e blood su g ar" v a lu e s 10-20 mgms. low er th a n th o se o f th e o ld e r methods upon which th e l i t e r a t u r e review ed in C hapter I I i s b a se d . ® "O tis S e lf-A d m in iste rin g T e sts o f M ental A b ility ," Manual o f D ire c tio n s and Key (Y onkers, Hew York: World Book cTompany, 1928), pp . sT Ï 2 . Hawk and Bergrem . A P r a c tic a l P h y s io lo g ic a l C hem istry. (P h ila d e lp h ie :P. B la k isto n ) . C H A P T E R IV A PRELIMIHARY IHVESTIGATIOH OF BEHAVIOR IH VARIOUS HUTHITIOHAL STATES As a p re lim in a ry e x p lo ra tio n in to th e p o s s i b i l i t i e s o f a sc ie n c e o f n u t r i t i o n a l psychology, a number o f c o n d itio n s o f abnorm al food o r homrone in g e s tio n in humans was stu d ied * The p r in c ip a l o b je c tiv e o f t h i s phase o f th e in v e s tig a tio n was th e g a in in g o f b e h a v io r d a ta f o r com parison w ith th e d a ta re p o rte d in th e c h a p te r on k e to s is # I . THYROXIH ADMIHISTRATIOH TO T W O HORM Al IHBIVIBUAIiS P ro c e d u re . B asal m e ta b o lic r a te s o f a m ale and a f e male s u b je c t w ith norm al th y ro id g lands on p a lp it a t io n were ob ta in e d . C o n tro l t e s t s were th e n given b o th s u b je c ts as fo llo w s: th e O tis T est o f M ental A b ility , Form A, was ad m in iste re d w ith a 30 m inute tim e l i m i t ; g rip endurance was d eterm ined; th e th re e -d im e n sio n a l tap p in g , r a te was observed; "push-up" endurance was s tu d ie d ; and th e average o f th e noon and evening p u lse r a te s f o r th r e e days was n o te d . IThen th e mean p u lse r a te o f a s u b je c t had in c re a se d a t l e a s t e ig h t and n o t more th an s ix te e n p u ls a tio n s , th e above-named t e s t s were re p e a te d . 53 TABLE I D A TA O H T W O N O R M A L SUBJECTS BEFORE A N D AFTER THYROXIN INGESTION S u b ject A. M. B efore A fte r sex . . . . . . . . F. Age . . . . . . . . 28 D aily dosage o f th y ro x in . . . . . . 1 g r . No. of days on th y ro x in . . . . . . . . 6 B asal m e tab o lic r a t e . . . . . . . . . . -12 Mean p u lse r a t e . . . . . 74 89 I . Q. on O tis , Forms A and B . . . . . . 114 121 G rip endurance. F a tig u e Index . . • • • • .333 .380 Push-up e x e rc is e s perform ed .. . . . . 3 2 T h ree-d im en sio n al ta p p in g , seconds f o r f i r s t 100 ta p s 30 26 T h ree-d im en sio n al ta p p in g , f a tig u e index . . . . . . .186 .151 Time f o r Humm-Wadsworth t e s t . . . 45 30 (M inutes to com plete) S u b je c t C. J . B efore A fte r 30 -10 66 127 .389 15 25 .294 35 1 gr, 8 74 132 .403 14 24 .240 26 54 R esul'tg and o o n o la sio n s. The r e s u l t s a re shown in Table I . These d a ta in d ic a te f o r th e se two s u b je c ts some In d iv id u a l v a r ia ti o n s , b u t as tre n d s common to th e two ap peared a quick en in g o f m otor and m ental a c t i v i t y and an a c tu a l d ec rease in big-m usole endurance in e x h a u stin g e x e r c is e s . The in c re a s e in th e f a tig u e In d ic e s found in t h i s lim ite d stu d y i s a t v a ria n c e w ith much t h a t i s found in t e x t books o f m edicine and p h y sio lo g y , p a r t i c u l a r l y in view o f th e "low -norm al" b a s a l m etab o lic r a t e s h e re found b e fo re th y ro x in a d m in is tr a tio n . These r a te s a re dependable, s in c e th e y a re th e av erag es o f c lo s e ly a g re e in g d e te rm in a tio n s made under c a r e f u lly c o n tro lle d c o n d itio n s a t th e S h elto n C lin ic , Los A ngeles. What th e s e te x tb o o k s overlo o k i s th e f a c t t h a t many c a se s o f low ered m etabolism o ccu r in norm al in d iv id u a ls w ith out any d isc o v e ra b le c a u se , and w ith o u t any im pairm ent o f h e a lth . F u rth erm o re, th e r e a re en d o crin e d e p re ssa n ts o f m etabolism o th e r th a n h y p o th y ro id ism —n o ta b ly , s u p ra re n a l and hypophyseal de f ic ie n c y . T his fin d in g o f th e in e ff ic a o y o f th y ro id as an a n t i d ote to b ig-m uscle fa tig u e in s u b je c ts w ith o u t th y ro id d y sfu n c t io n b u t w ith low b a s a l m e ta b o lic r a te s i s in agreem ent w ith a stu d y o f H u rx th al in which 28 p a tie n ts w ith norm al th y ro id glands on p a l p i t a t i o n were given d e s s ie a te d th y ro id in doses o f 1 to 2 55 g ra in s d a lly "w ith o u t b e n e f it in m ost c a s e s . T hat th e q u ick en in g o f m otor and m ental a c t i v i t y found in th e p re s e n t s tu d y may be due to an in c re a se d i r r i t a b i l i t y , p o s s ib ly from a toxem ia, seems p o s s ib le in view o f re c e n t l i t e r - 2 a t u r e . I I . PERSONALITY EFFECTS OP R A W M EA T DIBTOTHERAPY O H ONE CASE S u b je c t. A fo rm e rly ro b u s t young man had s u ffe re d from a sev ere c h ro n ic u lc e r a tiv e c o l i t i s f o r f iv e y e a r s . A ll o f th e accep ted foim s o f th e ra p y in c lu d in g e x te n siv e c o u rse s o f serums and v a c c in e s d ire c te d a t th e s o -c a lle d Bar g e n 's D ip lo s tre p to - coceus had been t r ie d w ith o u t b e n e f i t. O c c a sio n a lly , w ith o u t tre a tm e n t o r w ith in s ig n if ic a n t tre a tm e n t, a spontaneous r e m issio n would o c c u r. These re m issio n s would o n ly l a s t a few w eeks, and even d u rin g re m issio n c o n s id e ra b le mucus and oc c a s io n a l blood was p re s e n t in th e s to o ls . Any d e v ia tio n from a r ig id lo w -re s id u e , h ig h -v ita m in d i e t would cause a r e la p s e . Even w ith adherence to t h i s d i e t e t i c regim en, re v e rs io n to th e a c tiv e phase o f th e d ise a s e would occur a f t e r a s h o rt p e rio d . An o u tsta n d in g c h a r a c t e r i s t i c o f th e s u b j e c t 's d is eased s t a t e was f a tig u e . He found i t n e c e ssa ry to spend most ^ H u rx th a l, L. M ., "Blood C h o le ste ro l and H ypom etabolism ," A rchives o f I n te r n a l M edicine, June, 1934. ® G insburg, S ., "Masked 'H y p e rth y ro id is m '" , H ygeia»13M 2, December, 1935. 56 o f h ie tim e in bed even d u rin g re m is s io n s . He could engage in none o f th e a t h l e t i c a c t i v i t i e s in which he fo rm e rly to o k p a rt# W ith th e c h r o n ie ity o f h i s d is e a s e , th e s u b je c t de veloped a number o f p e r s o n a lity d is tu rb a n c e s . H is p r o f i l e on th e Humm-Wadsworth was o f th e manic d e p re ssiv e ty p e , w ith th e d e p re s siv e phase asc en d en t and th e norm al component a minus tw o. He developed an a n x ie ty s t a t e and a b a e te rlo p h o b ia . I t was n o tic e d , how ever, th a t h is s u b je c tiv e s t a t e was b e t t e r when he a te f o r a few days m eals composed alm ost en t i r e l y o f le a n lamb o r b e e f . He adm itted t h a t h is i n t e s t i n a l symptoms were m ild e r d u rin g such tim e s, b u t he was imbued w ith id e a s o f harm to h is a lre a d y fe e b le h e a lth which he th ought m ight r e s u l t from a d ie t composed to o h e a v ily o f m eat. T e n ta tiv e p ro c e d u re . For two weeks a l l a r t i c l e s were e lim in a te d from th e s u b j e c t 's d i e t ex cep t b u t t e r , p la in a g a r, and le a n r o a s t lam b. H is d ia rr h e a d isap p ea red alm ost e n ti r e ly ; b u t p u s, b lo o d , and mucus were s t i l l p re s e n t in h is s t o o l s . H is s u b je c tiv e s t a t e improved somewhat; b u t h is f a tig u e was n o t helped g r e a tly , and he w o rried a g re a t d e a l o v er th e calcium and v ita m in d e fic ie n c y in h is d i e t . He was allow ed to r e tu r n to h is form er regim en, and th e i n t e s t i n a l symptoms w ith in a few days re tu rn e d to t h e i r form er m agnitude. Accompanying t h i s was a deepened d e p re s s io n . 57 Improved p ro c e d u re . Means were th e n d ev ised to sup p ly th e calcium and v ita m in d e f ic ie n c ie s in th e form er d ie t w ith o u t th e in tro d u c tio n o f i r r i t a t i n g f a c t o r s . To in s u re r e te n tio n o f ample am ounts o f th e h e a t- la b il e v ita m in s in th e m eat, a ro a st-m e a t therm om eter o f th e ty p e w hich can be in s e rte d in to th e i n t e r i o r o f a c u t o f meat was o b ta in e d . The therm om eter was th e n th o ro u g h ly c a lib r a te d w ith an a c c u ra te in stru m e n t. The m eat component o f th e s u b j e c t's d ie t was lim ite d to th e le a n , c o n n e c tiv e -tis s u e f r e e , p o rtio n s o f le g s o f lam b. T his meat was p re p ared by cooking w ith o u t s e a rin g in an oven a t from 250 to SCO d eg rees F a re n h e lt u n t i l th e i n t e r i o r o f th e m e a t,a s in d ic a te d by th e ro a st-m e a t therm om eter was a t 130 d eg rees F a re n h e it. Thus th e meat w as, in e f f e c t , p a s te u r iz e d . I t was ren d ered b a c te r io lo g ic a lly and p a r a s i t i l o g i c a l l y s a f e , w ith o u t c o a g u la tin g th e p r o te in o r unduly d e s tro y in g th e h e a t- l a b i l e v ita m in s . In o rd e r to in s u re a g a in s t a t h e o r e tic a l d e fic ie n c y o f v ita m in s and calcium e x p re ssin g i t s e l f as an a c t u a l i t y w ith th e co n tin u an ce o f t h i s d i e t o ver a long p e r io d , some a c c e s s o rie s were in clu d ed in th e d ie t* These a ls o had an im m ediate s a lu - to r y e f f e c t on th e m orale o f th e s u b je c t in d is p e llin g h is f e a r s o f an in ad eq u a te d i e t . 58 F in a lly , th e s u b j e c t's t o t a l d a ily in ta k e o f food was th e fo llo w in g : 1 . Roughly o n e -h a lf le g o f th e p re p ared raw lam b. 2 . A heaping te a sp o o n fu l o f a g a r in w ater w ith each m eal. 3 . Four onces o f b u t t e r . 4 . S ix th in s l i c e s o f m o d erately to a s te d b re a d . 5 . Three minims o f h a liv e r o i l (one c a p s u le ). 6 . Four and o n e -h a lf ounces o f G erber’ s s tra in e d p e a s . 7 . F i f t y m illig ra m s o f c e v ita m ic a c id a t each m eal. 8 . 700 u n its o f v ita m in B n w ith 170 u n its o f v ita m in G in th e form o f 10 c o t o f S quibb’s v ita m in B and G syrup (se e fo o tn o te ).® R e s u lts . S u b je c tiv e improvement began alm ost a t once, and a f t e r te n days on t h i s regim en th e s u b je c t’s I n t e s t i n a l c o n d itio n changed from t h a t m an ifested by a b loody, m uco-puru l e n t d ia rrh e a to a c o n d itio n in which o n ly p e r f e c tly norm al s to o ls were e x c re te d and w ith norm al fre q u e n c y . A fte r two weeks o f t h i s d i e t , th e s u b je c t re tu rn e d to th o ro u g h ly cooked meat and th e a d d itio n o f a m oderate amount o f I T E xpressed in Ghase-Sherman and Sherman u n i t s , re sp e c t i v e l y . T his item was re p la c e d by p u re V itam in B absorbed on B la c k 's re a g e n t when th e Squibb syrup was so changed d u rin g re c e n t weeks as to induce a l l e r g i c r e a c tio n s . 59 b lan d no re sid u e c a rb o h y d ra te . The norm al s to o ls co n tin u ed ; b u t th e s u b j e c t 's a f f e c tiv e to n e , which had a t f i r s t o u t s trip p e d th e p u re ly p h y s ic a lly m an ifested phase o f im prove m ent, seemed to la g behind th e h e a lin g o f th e lo c a l l e s i o n . A fte r ab o u t th re e weeks o f th e more norm al and cooked- meat d i e t th e r e was a g ra d u a l r e tu r n o f i n t e s t i n a l symptoms, in c lu d in g th e p assag e o f pus and blood w ith th e s t o o l s . The cooked m eat d i e t could n o t be in d ic te d e x c lu s iv e ly , however; because c o n c u rre n tly en v iro n m en tal f a c to r s had caused a Moder a te em otional u p s e t. F o rtu n a te ly f o r th e s c i e n t i f i c i n v e s t i g a tio n , how ever, th e am o tio n al u p se t c o n tin u e d . I t s c a u sa l f a c to r s co n tin u ed and even in c re a se d in p o ten cy . In s p ite o f t h i s , th e i n t e s t i n a l c o n d itio n was c o rre c te d in th re e days by a r e tu r n to th e raw m eat d i e t . D uring th e s ix months which have elap sed s in c e th a t tim e , th e s u b je c t h as con tin u ed e s s e n t i a l l y on th e raw meat d i e t , w ith th e o c c a sio n a l a d d itio n .o f a few lo w -carb o h y d rate foods o f in a p p re c ia b le re s id u e such as soy-bean m ilk g e la tin e and p a s te u riz e d eg g s. H is s to o ls rem ain p e r f e c tly norm al ex c e p t when a d ie ta r y debauch cau ses th e appearance o f a m oderate amount o f m ucus. At such tim es he r e tu r n s more s t r i c t l y to th e raw meat d i e t and th e s to o ls prom ptly become norm al a g a in . W ith t h i s knowledge o f h is c o n tro l o v er any rem nants o f h is d is e a s e , th e e n tir e o u tlo o k o f th e s u b je c t has changed. 60 He has resumed many a c t i v i t i e s , in c lu d in g th e s u c c e s s fu l r e tu rn to h is c o lle g e w ork. The o b je c tiv e c r i t e r i a o f h is b e h a v io r improvement a re shown in Table I I . I I I . LIVER EXTRACT IN A CASE OF PERIODIC MELANCHOLIA An example o f an unusual p sy ch ic e f f e c t o f l i v e r ex t r a c t seems w orthy o f in c lu s io n in t h i s s tu d y , a lth o u g h th e re p o rt m ust be p r in c ip a lly d e s c r ip tiv e because o f th e p a u c ity o f q u a n tita tiv e d a ta in h e re n t in th e a c c id e n ta l d isc o v e ry o f th e e f f e c t . S u b je c t. An o th e rw ise norm al young n u llip a r a had s u ffe re d sin c e p u b e rty w ith extrem e abdom inal p a in a t each m en stru al flo w . F or th e p a s t few y e a r s , o r s in c e h e r l a t e te e n s , t h i s p h y s ic a l d i s t r e s s had been accompanied by an a g i ta te d d e p re ssiv e b e h a v io r o b se rv a b le to a l l h e r a s s o c ia te s and resem b lin g t h a t o f in v o lu tio n a l m elan ch o lia ex cep t in d u ra tio n P ro c e d u re . For a secondary anem ia, a p h y sic ia n had p re s c rib e d l i v e r e x t r a c t . By c o in cid en c e she re c e iv e d h e r f i r s t dose o f S ee. o f th e c o n c e n tra te d e x tr a c t p a re n te r a l l y upon a day b e fo re h e r m e n stru a l flow s t a r t e d . She was de lig h te d to ex p e rien ce h e r f i r s t m en stru al p e rio d w ith o u t ab dom inal d i s t r e s s . Her a f f e c tiv e s t a t e was in decided c o n tr a s t to th e u s u a l d e p re s s io n . In f a c t , i t was d is tu r b in g ly n e a r th e m anic. On a Humm-Wadsworth Temperament s c a le she showed a c l e a r l y dom inating manic com ponent. 61 T A B L E II D A TA O N SUBJECT BEFORE A N D AFTER R A W M EA T DIETOTHEHAPY IN COLITIS GRAVIS BEFORE AFTER Sex . . . . . . . é M # Age . . . . . . . . 29 D a ily -in g e 31 io n o f raw m eat 3 l b s . B asal m e ta b o lic r a t e . . . -1 8 -11 Average No. o f s to o ls p e r day . . . . . . . 9 2 N ature o f s to o ls . . . . . b lo o d y , norm al ffiuco-purulent P e r c e n tile ra n k . Army A lpha .... .. . 80 f o r c o lle g e group P e r c e n tile ra n k , O tis # . Push-up endurance. No. o f e x e r c is e s perform ed . . 5 G rip endurance, f a tig u e in d ex . . . . . . . . .831 Three d im en sio n al ta p p in g , seconds f o r 1 s t 100 ta p s # 25 Three d im en sio n al ta p p in g , f a tig u e in d ex . . . . . . .360 Humm-Wadsworth Temperament p r o f i l e , ty p e «• • • •. m a n ic -d e p re ssiv e I n te r v a l betw een s t u d i e s , ' m onths . . . . . . . . 6 W eight ....................... 145 145 97 f o r c o lle g e group 16 .390 26 .251 norm al-m anic 62 These r e s u l t s were re p e a te d c o n s is te n tly f o r th re e m onths. F o rtu n a te ly she had been co n sid ered and abandoned as an ex p e rim e n ta l su b je c t, in th e phase o f t h i s in v e s tig a tio n concerned w ith k e t o s i s . T h e re fo re , some o b je c tiv e d a ta were a v a ila b le , and she consented a s a f u r th e r c o n tro l p ro cedure to r e f r a i n from ta k in g -th e l i v e r e x tr a c t d u rin g one m e n stru a l p e r io d . A ll o f th e form er syndrome r e tu r n e d , so f o r th e p a s t two m e n stru a l p e rio d s she has resumed th e use o f l i v e r e x tr a c t and w ith a l l o f i t s form er e f f ic a c y . O b je c tiv e ly , she showed in a d d itio n to th e tem pera ment s c a le fin d in g s m entioned, a re d u c tio n o f th e mean g rip f a tig u e in d ic e s ta k e n co m p arativ e ly d u rin g m e n stru a l p e rio d s w ith o u t and w ith th e l i v e r e x tr a c t from .500 to .3 3 3 . IV . MASSIVE GLYCINE INGESTION T h erap eu tic u s e s . G ly cin e, o th e rw ise known a s g ly c o - c o l l o r am in o acetic a c i d , i s one o f th e n u t r i t i o n a l l y n o n - e s s e n tia l amino a c id s . I t o cc u rs in anhydrous g e la tin e in th e u s u a l p ro p o rtio n o f tw e n ty -fiv e p e r c e n t. A ccording to Beard and B a m e s,^ Duchneen, E rb , and F r ie d re ic h w orking in d ep e n d en tly had as e a r ly as 1861 re p o rte d d e f in it e s t r u c t u r a l ^ B eard, E .G ., and B arn es, B roda, "The In flu e n c e o f F eeding P r o te in s , a m in o -a c id s, and r e la te d su b sta n c e s upon c r e a tin e - c r e a tin in e m e ta b o lism ,” Jo u rn a l o f B io lo g ic a l Chem- i s t r y , 9 4 :4 9 , November, 1931. 63 changes in m uscular d y s tro p h ie s . This i s in o p p o s itio n to any view t h a t a h y p o th e tic a l a l t e r a t i o n in th e nerv e supp ly a t th e m yoneural ju n c tio n i s to blam e. T his argum ent i s o f i n t e r e s t to th e p re s e n t stu d y because o f th e in v e s tig a tio n o f f a tig u e common to th e v a r i ous n u t r i t i o n a l s t a t e s considered# R ecent c l i n i c a l develop m ents have su g g ested an o b je c tiv e d e te rm in a tio n o f th e v a l i d i t y o f th e d istu rb e d m uscular m etabolism c o n c e p t. Such an in v e s tig a tio n would c e n te r around th e use o f g ly c in e in n o n -s p e c ific f a tig u e re p o rte d w ith such unanimous fa v o r by W ild e r, Boothby, Beard and B arnes, and Bench. ® In a d d itio n to th e use o f g ly c in e in th e o u tr ig h t m uscular d y s tro p h ie s w ith d ram atic su c c e ss, th e se i n t e r n i s t s unanim ously r e p o rt b e n e f it in a l l c a se s o f sim ple f a t i g a b i l i t y and th a t even norm al c o n tro ls ta k in g as much as S grams a day o f th e com pound can "go f u r th e r and do more."® P ro c e d u re . To t e s t th e v a l i d i t y o f th e s e re p o rts w ith o b je c tiv e t e s t s , two s u b je c ts w ith th e h ig h e s t f a tig u e in d ic e s in th e o th e r s tu d ie s o f t h i s in v e s tig a tio n were se le c te d . In rough p ro p o rtio n to t h e i r w e ig h ts, th e male and W ild e r, R.M ., G eneral D isc u ssio n . P ro c . S ta f f M eet. , Mayo C lin ic , 9 :6 0 6 , O ctober 3 , 1934; Boothby, W.W. , *'?Ke C lin ic a l E f f e c t o f G lycine in P ro g re s s iv e M uscular D ystrophy, in Simple F a t i g a b i l i t y , and on Normal C o n tro ls ," P ro ceed in g s S t a f f M eeting. Mayo C lin ic . 9:600; Beard and B am es. op. cilF. ; tfench, y . È . , "A C o n sid e ra tio n o f M uscular P ain and F atig u e w ith a N ote on G ly c in e ," P ro ceed in g s S t a f f M eeting. Mayo C lin ic , 9 :6 0 3 , O ctober 3 , 1934, ms quôted in S q u itb "Memoranda (1 9 3 7 ). ® W ild er, R.M ., lo o , o l t . 64 fem ale s u b je c ts took th re e and two grams o f g ly e in e r e s p e c tiv e ly w ith ev ery m eal f o r a p e rio d o f s ix w eeks. The compound i s very, p a la ta b le and th e male to o k h i s dosage d isso lv e d in w ater* The fem ale s u b je c t to o k h e r dosage in wine a s a r u l e , b u t o cc a sio n a l l y in w a te r o r f r u i t j u i c e s . The amount o f w ine, when taken, was l e s s th an two ounces. O b je c tiv e enduran ce, sim ple m otor, i n t e lli g e n c e , and s o -c a lle d " p e rs o n a lity " t e s t s were ad m in iste red to th e sub j e c t s w ith r e p e titio n s to o b ta in dependable means b o th b e fo re and f o r a few days a t th e end o f th e p e rio d o f g ly c in e in g e s t i o n . R e s u lts . The t e s t s given and th e r e s u l t s o b tain ed a re shown in Table I I I . There was no s ig n if ic a n t improvement in g rip en d u ran ce, push-up endurance, th re e -d im e n sio n a l ta p p in g enduran ce, o r in th e a g g re g a te o f M ental fu n c tio n s te s te d in sta n d a rd in te llig e n c e t e s t s . There was an Improvement in a f f e c tiv e to n e o r "m orale" in d ic a te d by one tem perament s c a le . The w eight g ain no ted by B e a r d i n s im ila r s u b je c ts was n o t o b serv e d . C o n clu sio n . The p re s e n t tendency o f many p r a c t it i o n e r s to a d m in is te r g ly e in e u n iv e r s a lly to th e "w eary and heavy la d e n " i s in c a p a b le o f o b je c tiv e j u s t i f i c a t i o n . ^ B ea rd , H .H ., l o c . c i t . 65 T A B L E III D A TA O H T W O SUBJECTS BEFORE A N D AFTER PROLONGED GLYCINE INGESTION S u b ject A S u b ject B B efore A fte r B efore A fte r Sex P . M. Age .................................................. 28 31 G lycine in g e s te d d a i ly . Grams 6 9 G rip f a tig u e in d ex •••• •• .333 .312 .391 .416 Push-up enduran ce. No. o f e x e rc is e s perform ed • • • • 3 3 14 15 T h ree-d im en sio n al ta p p in g , seconds f o r 1 s t 100 ta p s . . . 31 29 26 24 T h ree-d im en sio n al ta p p in g , f a tig u e in d ex . . . . . . . .192 .179 .172 .151 Humm-Wadsworth Tempérament P r o f i l e , ty p e . . . . . . A u tis tic Norm al- M anic-. Normal- Normal Manic D epres- Manic s iv e I . Q. on O tis T e st . . . . . . 116 119 128 130 W eight, l b s . . . . . . . . . . 112 110 152 148 66 Y. MASSIVE ETHYL A LCOH OL INGESTION Much o f th e l i t e r a t u r e on b e h a v io r a f t e r a lc o h o l in g e s tio n i s so p a r tis a n as to be v a lu e le s s . Watson attem p ted to s e p a ra te th e u n eq u iv o cal d ata and a rriv e d a t th e fo llo w in g i n t e r p r e ta ti o n o f th e n o n -p a rtis a n consensus: 1 . There i s a wide range o f in d iv id u a l v a r ia t io n in th e a b i l i t y o f d i f f e r e n t people to consume a lc o h o l w ith o u t showing i t s e f f e c t on t h e i r curve o f w ork. The amount may v a ry from 20 e c . to 40 c e . o f a b s o lu te a lc o h o l (a veryVmueh h e a v ie r dose th an i s u s u a lly tak en f o r p u re ly s o c ia l p u rp o s e s )• 2. The e f f e c t o f a lc o h o l upon a l l r e f le x e s when any i s noted i s d e p re s s in g . T his has been confirm ed by many in v e s tig a to r s w orking upon th e p a t e l l a r r e f l e x , r e f le x eye movements and o th e r s . IBut o th e r in - o v e s tig a to r s have re p o rte d some q u ick en in g o f r e f l e x e s ^ 3 . The e f f e c t o f a lc o h o l when ta k e n in la r g e quan t i t i e s on th e amount and q u a lity o f m uscular work which can be done i s d e le te r io u s , acco rd in g to most o b s e rv e rs . Some hold th a t th e bad e f f e c t upon m uscular v/ork can be observed f o r many h o u rs a f t e r th e a lc o h o l h as been con sumed . . .W ith a l a r g e r dose o f 40 c c . , th e re was e v i- d en èér— in one c a s e , a t l e a s t — o f an in c re a s e in th e amount o f work under th e in flu e n c e o f th e su b sta n c e ; b u t th e in c re a s e was u n c e rta in and In c o n s ta n t, and th e p o s s i b i l i t y cannot be excluded th a t i t was due to d is tu r b in g f a c t o r s . W ith la r g e r d o s e s ... a decided f a l l i n g o f f in th e amount o f work w ith a dose o f 80 grammes. The e f f e c t upon language fu n c tio n s i s n o t c l e a r . g They a re undoubtedly l e s s a ffe c te d th a n a re manual h a b it s . In th e sen se th a t i s cap ab le o f o x id a tio n and h e a t pro-?- 8 S p e id e l, C arl C ., "Changes in Nerve F ib e rs L uring A lco h o lic I n to x ic a tio n and Recovery" S c ie n t if ic M onthly, Feb ru a ry , 1937, pp. 178-185. 9 W atson, J .B ., P sychology from th e S tandpoiit o f a B e h a v io ris t (P h ila d e lp h ia : J .B . L ip p in c o tt Ôompany, 1924T ,p. 381 67 d u c tio n In th e body, e th y l a lc o h o l I s a fo o d . B enedict^^ s t a t e s th a t 72 grams o f a lc o h o l can be o x id iz e d by a human in a day, and i t was w ith a view to a p p re c ia b ly exceeding t h i s amount th a t th e dosage o f two s u b je c ts in t h i s experla m ent was s e t a t 100 grams# The e n t ir e s t a tu s o f a lc o h o l as a fo o d , how ever, has 1 1 been ch a llen g e d by Sy in an e x c e lle n t re c e n t review o f p r in c i p a l l y p h y s io lo g ic a l and c l i n i c a l l i t e r a t u r e on th e su b je c t# I n th e fa c e o f th e f a c t th a t a lc o h o l w i ll p h y s io lo g ic a lly produce 97 p e r c e n t o f th e h e a t w hich i s im p arted by th e same amount o f su g ar o r s ta r c h , he s t a t e s th a t a lc o h o l i s prob a b ly n o t a food sin c e i t i s d e f i n i t e l y known n o t to p a r t i c i p a te in th e fo rm a tio n o f new body tis s u e s # F u rth erm o re, he adds ^ h a t i t i s ex trem ely d o u b tfu l w hether th e h e a t energy o f a lc o h o l i s c o n v e rtib le in to m uscular a c t i v i t y . I t was upon t h i s a s p e c t, p a r t i c u l a r l y , w hich t h i s experim ent hoped to throw some l i g h t . I In th e com parison o f b e h a v io r in alc o h o lism w ith th a t o f k e to s is ro p o rte d in C hapter 7 , some b io ch em ical c o n sid éra^ tlo n s a re o f in te r e s t# E th y l a lc o h o l h as been found c l i n i c a l l y B e n e d ic t, P .C .. I n d u s t r i a l and E n g in eerin g C hem istry (1 9 2 5 ), p . 423. ------------------------------------------ ----------- Sy, A .P ., "A lcohol and i t s E f f e c t on Man," C onsum er's R esearch B u lle tin , I I I (new s e r i e s ) : 5, pp . 20-23, Jan u a ry ,19 Sherman, H .C ., C hem istry o f Food and N u tr itio n . (New York : The M acm illan Company, 1933), p . 6^9* 68 to be k e t o ly t lc in many c a se s o f d ia b e te s* R ecen tly S hapiro^^ e x p e rim e n ta lly c o rro b o ra te d th e c l i n i c a l im p ressio n s and a ls o found th a t t h i s k e t o ly t lc a c tio n o f a lc o h o l i s p ro b a b ly due to i t s s tim u la tin g e f f e c t on th e o x id a tio n o f p r o te in , and n o t to any h y p o th e tic a l g ly c o g e n e tic a c tio n o f th e a lc o h o l. P ro ce d u re. In th e f i r s t phase o f th e ex p e rim e n t, th e p la n was to g iv e a m ale and a fem ale s u b je c t d o ses o f a lc o h o l p ro p o rtio n a l to t h e i r su rfa c e a re a b u t in each case in ex cess o f th e q u a n tity .s ta te d by B enedict as b e in g o x id iz a b le . A fte r d rin k in g h e r d o sag e, how ever, th e young woman s u b je c t seemed u n a ffe c te d even e a r ly t h i r t y m inutes l a t e r . She i n s i s te d t h a t she would l i k e to d rin k th e same amount as th e m ale s u b je c t so as to g iv e th e stu d y more s o c ia l s ig n if ic a n c e , arg u in g th a t i t was n o t custom ary to a llo c a te c o c k ta il c o n te n t on a s u rfa c e a re a b a s i s . Her re a so n in g seemed p la u s ib le and h e r c o n d itio n seemed to j u s t i f y i t , so b o th s u b je c ts e v e n tu a lly consumed 100 grams in th e co u rse o f an h o u r. S in c e , ac co rd in g to Em erson^^, th e e f f e c t s of an a lc o h o lic beverage re a c h a maximum about an hour and a h a l f a f t e r in g e s tio n , th e t e s t i n g was s ta r t e d 45 m inutes a f t e r com pletion 13 S h a p iro , In e z , D o cto ral D is s e r ta tio n in B ioch em istry G raduate School o f th e U n iv e rs ity o f S outhern d a l l f o m i a (Ï9 6 6 ) p p • 134 -6 . ., Em erson, Haven, A lcohol and Man, (New York: The M acm illan Company, 1 9 3 3 ). 69 o f th e d rin k in g , o r about an hour and a h a lf a f t e r th e bulk o f th e a lc o h o l was consumed* The a lc o h o l had been mixed w ith tw ice i t s volume o f f r u i t ju ic e , and th e re were no g a s t r i c u p s e ts . The t e s t s were s t a r te d w ith b o th s u b je c ts in ap p ar e n tly good c o n d itio n , and w ith e q u ilib riu m u n a f fe c te d . The e q u ilib riu m t e s t s was th e sim ple one used in p h y s i c a l exam inations f o r Naval A v ia tio n . The s u b je c t sim ply sto o d cn one f o o t, b lin d fo ld e d , o r w ith th e eyes c lo s e d . The non su p p o rt in g le g was b e n t in to a r i g h t an g le a t th e knee and i t s knee was h e ld c lo s e ly a g a in s t th e o th e r Im ee. In t h i s experim ent th e s u b je c ts were re q u ire d to atte m p t sta n d in g i n t h i s p o s itio n f o r s ix ty second p e rio d s a t each t e s t i n g . I f th e y f e l l o r re q u ire d su p p o rt p r io r to th e end o f th e s ix ty second i n t e r v a l , th e num b e r o f seconds b e fo re f a i l u r e was re co rd ed as in T able IV . A fte r t h i s b r i e f e q u ilib riu m t e s t , th é o rd e r o f t e s t i n g was as fo llo w s : The O tis T e s t, 30 m inute li m i t The g rip endurance t e s t The second e q u ilib riu m t e s t The e n t i r e p rocedure was re p e a te d in a n o th e r lo c a le w ith two o th e r s e x - d if f e r e n tia te d s u b je c ts , ex cep t t h a t in th e second case th e a lc o h o l d o sa g e r3 were th e l e s s e r ones shown in ^ -A< Table IV, where th e d e ta ile d r e s u l t s a re a ls o l i s t e d . R e s u lts » As may be seen from th e t a b l e , th e women were 70 a f f e c te d in a l l a s p e c ts more th an th e men# There was a de c re a s e in th e o b ta in e d I.Q .* s o f a l l s u b je c ts as w e ll as a common d is tu rb a n c e o f e q u ilib riu m ; b u t b o th e f f e c t s were g r e a te r in th e fe m a le s. The men showed no s ig n if ic a n t de c re a se in m uscular endurance, w hile th e wcmen d id . In th e more m assive ddsage t h i s m ight be e x p la in a b le on a su rfa c e a re a o r w eight b a s i s , as w e ll as on a b a s is o f enurem ent r e s u ltin g from th e m ale s u b je c t's having been a b a rte n d e r f o r a p r o tr a c te d p e rio d . 71 T A B L E IV RESULTS O F TESTS BEFORE A N D AFTER A LCO HOL INGESTION^ S u b je c t B S u b je c t E B efore A fte r B efore A fte r Sex . . . . . . . . . . F . M. W eight. . . . . . . . . . . 120 160 Age ....................... 25 24 E th y l a lc o h o l in g e s te d . . 100 100 gms. gms. G rip f a tig u e index . . . . .366 .485 .313 .339 I* Q. on O tis T e sts . . . . 114 92 119^ 108 E q u ilib riu m , seconds o f b a la n c e . . . . . . . . . 60 31 60 42 S u b je c t G S u b je c t F B efore A fte r B efore A fte r Sex . . . . . . . . . . . . F . M. W eight. . . . . . . . . . . 110 150 Age . ........................... 26 29 E th y l a lc o h o l in g e s te d . « 30 50 gras. gras. G rip , f a tig u e in d ex . . . . .^312 .390 . 378 .360 I . Q. on O tis T e sts . . . . 122 114 - 127 122 E q u ilib riu m , seconds o f b alan c e . . . . . . . . 60 54 "B efore" o r c o n tro l t e s t s were made a t tim es removed from a lc o h o lic in g e s tio n by a t l e a s t 72 h o u rs, ex cep t where o th e rw ise in d ic a te d . b ^ T his c o n tro l t e s t was g iv en im m ediately b e fo re th e e x p e ri m ental a lc o h o l In g e s tio n , hence th e p r a c tic e e f f e c t was a t a maximum. T his p r a c tic e e f f e c t f o r c o n se c u tiv e -d a y t e s t s i s fo u r p o in ts . CHAPTER V BEHAVIOR IN KETOGENESIS The b io ch em ical stu d y o f k e to s is h as reach ed a d i s c rim in a tin g ly q u a n tita tiv e b a s is d u rin g th e p a s t decade p r in c ip a lly th ro u g h th e e f f o r t s o f Deuel and h is a s s o c ia te s . No ta b le among th e work o f th e l a t t e r h as been th a t o f B u tts ,^ who developed a m ethod o f a c h ie v in g k e to s is in r a t s and th e re b y c o rro b o ra te d h is e a r l i e r fin d in g s made in a s s o c ia tio n w ith ■ ■ n - , i Q I Deuel and G ulick on th e r e l a t i v e k e t o l y t l c p o ten cy o f d i f f e r e n t s u g a rs . D uring th e l a s t m entioned stu d y , in w hich he was one I o f th e s u b je c ts . B u tts found th a t on a p ro lo n g ed n o -carbohy d r a te d i e t o f 1800 c a lo r ie s d a ily , c o n sid e ra b le la s s itu d e was f e l t a lth o u g h h e a lth was p re se rv e d even when th e regim en was p rolonged f o r w eeks. In a n o th e r study^ a pronounced sex u al v a r ia tio n was found in th e k e to s is o f f a s t i n g . Not only were th e aceto n e b o d ies e x c re te d th re e o r fo u r tim es as g r e a t in th e case o f fe m a le s, b u t th e im p ressio n was c le a r th a t sub je c tiv e d is tu rb a n c e s were much g r e a te r . D euel s t a te s th a t B u tts , J . S . , D o c to ra l D is s e r ta tio n in B ioéhem is t r y , g ra d u a te School o f th e W nïvers i t y o f S outhern C a ïïf o r n ia , 1933, Jo u rn a l o f B io lo g ic a l C hem istry, 105 :8 7 -9 6 , A p r il, 1934. ^ D euel, H .J ., G u lick , M., and B u tts , J ; S . , "The Com p a r a tiv e K e to ly tic A ction o f G lucose, G a la c to se , F ru c to s e , and S u cro se," Jo u rn a l o f B io lo g ic a l C hem istry, 9 2 :XXIII (1 9 3 2 ),p . 333 —— — —— — D euel, H .J ., J r . G u lick , M arg a ret, "The Sexual V a ri a tio n in S ta rv a tio n K e to s is ,” Jo u rn a l o f B io lo g ic a l C hem istry, 7 6 :2 5 , 1932. ' ^ 73 "Many women became so i l l th a t th e y were bedded." In s ta r v a tio n , o f c o u rse , th e r e a re many f a c to r s cap a b le o f a f f e c tin g b e h a v io r w hich a re in a d d itio n to th e k e to s is and i t s u s u a l co n co m itan t, hypoglycem ia, hunger c o n tra c tio n s o f th e stom ach, q u ic k ly m a n ife ste d v ita m in C d e f ic ie n c ie s , and th e m etabolism o f endogenous p r o te in m ight be m entioned. A lthough some p r in c ip a lly d e s c r ip tiv e r e p o r ts on th e Î b e h a v io r o f in d iv id u a ls who f o r one re a so n o r a n o th e r were f a s t in g have been made, th e re have been no r e p o r ts o f o b je c tiv e b e h a v io r s tu d ie s where a k e to s is waq induced w ith o u t d is tu r b in g f a c to r s in a d d itio n to th e p u re ly k e to g e n ic o n es. \ ■ The o b je c t o f t h i s stu d y . In th e phase o f in v e s tig a t io n re p o rte d in t h i s c h a p te r, an e f f o r t was made to stu d y ob j e c t i v e l y any p e r s o n a lity d is tu rb a n c e s m a n ife ste d by b e h a v io r a l t e r a t i o n s in s u b je c ts o f b o th sex es who were su b je c te d to k e to g e n e s is w h ile f a c to r s d e trim e n ta l to t h e i r h e a lth w ere c a r e f u lly e lim in a te d . The o b je c t was to a s c e r ta in what a f f e c t k e t o s is , p e r s e , has upon b e h a v io r, and to compare th a t e f f e c t w ith th o se e l i c i t e d in th e n u t r i t i o n a l s t a t e s re p o rte d upon in th e p re v io u s c h a p te rs . I . THE EXPERIMENTAL TECHNIQUE r S u b je c ts , i Four m atu re, norm al, and ro b u s t su b je e tsr p a r ti c i p a t e d in th e ex p e rim e n t. Three a re young womenaand one 74 i s a young man. In th e ta b u la te d r e s u l t s th e y a re r e f e r r e d to as S u b je c ts A, B, G » and D. In th e d e s c r ip tiv e p o rtio n s o f th e r e p o r t , how ever, an e f f o r t has been made to c l a r i f y in te g r a te d p e r s o n a lity co n c ep tio n s by a s s ig n in g each s u b je c t a r a c i a l l y c o r r e c t name b eg in n in g w ith h is o r h e r de s ig n a to r y l e t t e r . S u b je c t A, Ana, i s an a t t r a c t i v e young woman o f Cas t i l i a n appearance and o f C a s tilia n and German a n c e s try . Her age i s 24, h e r h e ig h t f iv e f e e t s ix snô. a h a l f in c h e s , and h e r w eight b e fo re th e experim ent was 134 pounds; She en gages in dancing and o th e r r e c r e a tio n s c h a r a c t e r i s t i c o f a p e rso n a b le and s o c ia lly in c lin e d young la d y . She i s u n m arried , b u t a d d ic te d to fre q u e n t and tr a n s ie n t " c ru s h e s ." Her a s s o c i a te s c r e d it h e r w ith o c c a sio n a l d i c t a t o r i a l n e s s . As a l e s s n o tic e a b le c h a r a c t e r is t i c she has a deep r e l i g i o s i t y and an accompanying av erso n f o r conduct n o t in harmony w ith th e m oral d i c t a t e s o f h e r ch u rch . Her I .Q ., a s m easured by O tis T e s ts , i s 120. Her custom ary Humm-Wadsworth p r o f i l e i s dom inated by th r e e p lu s-tw o com ponents—norm al, m anic, and p a ra n o id . S u b ject B, B lanche, i s a blond young la d y o f 25, gen e r a l l y conceded to be b e a u tif u l. Her h e ig h t i s f iv e f e e t fo u r and a h a l f in c h e s , and h e r w eight b e fo re th e experim ent was 119 pounds. She le a d s a v ery a c tiv e s o c ia l l i f e , and does n o t seem to p re se rv e one gentlem an f r ie n d to th e e x c lu sio n o f o th e r s . 75 She a ls o h as o c c a sio n a l " c ru s h e s ," w hich she i s more backward in e x p re ssin g th a n Ana* She i s an ex trem ely ev e n -n a tu re d i p erso n who m ight co n c eiv ab ly be presum ed upon—an im p ressio n n o t c o n c lu siv e because in c o n tr a s t to h e r u s u a lly la c k a d a is i c a l m anner, she o fte n " g r i t s h e r te e th " and snaps in to g r u e l lin g a c t i v i t y w ith s te r n i n t e n s i t y . In th e e x p e rim e n ta tio n she was th e m ost c o n s is te n tly c o o p e ra tiv e s u b je c t. Her O tis I.Q . i s 114. Her custom ary Humm-Wadsworth p r o f i l e i s dom in a te d by p lu s-tw o manic and a u t i s t i c com ponents. S u b je c t C, C a lv in , i s a v ig o ro u s a th l e te o f 24. He i s f iv e f e e t te n and a h a l f in c h e s in h e ig h t, and h is w eight sin c e th e experim ent h as been 164 pounds. He ach iev ed th e 't . l a s t Olympic Game te a m -s e le c tio n f i n a l s in some tra c k e v e n ts . He i s a v e ry w e ll lik e d young man and engages in a g r e a t d e a l o f s o c ia l a c t i v i t y w ith v a r ie d young women com panions. H is O tis I.% . i s 120 in th e fa c e o f a r e l a t i v e l y low s c h o la s tic re c o rd d u rin g h is u n d erg rad u ate c o lle g e y e a r s . H is Humm- Wadsworth p r o f i l e shows dom ination by p lu s - th r e e manic and p lu s-tw o h y s te ro id com ponents. S u b je c t D, D e lic ia , i s an a t r r a c t i v e r e c e n tly m arrie d woman o f 1 8 . Her h e ig h t i s f iv e f e e t th re e in c h e s and h e r w eight 112 pounds. E n th u s ia s tic a lly , and w ith h e r h u sb a n d 's c o n se n t, she jo in e d th e experim ent when i t was n e a rly com pleted. W ith eq u al enthusiasm she dropped o u t a t th e end' o f th e second d ay . D ata upon h e r a re lim ite d . 76 Control Procedure. To obtain controls and to select s u ita b le fu n c tio n s f o r stu d y , th e s u b je c ts underw ent v a rio u s b e h a v io r t e s t s f o r a few days p red ed in g th e ex p e rim e n ta l r e gim e. Some o f th e t e s t s proved to#^ irk s p % f o r in c lu s io n in prolonged ex p e rim e n ta l r o u ti n e ; and some, such as re a c tio n tim e in s e le c tin g from two s tim u li, showed v a r ia tio n s too( g re a t u n d er norm al c o n d itio n s . ^ / . M ention o f t e s t s w hich were t r i e d and d is c a rd e d i s p ro b a b ly o f i n t e r e s t to th e t o t a l p i c tu r e . Among t h e : f i r s t r e je c te d was p a t e l l a r r e f l e x stu d y . A fte r s e v e ra l d eterm in a tio n s w ith th e Ruhl-M usgrave a p p a ra tu s , th e fem ale s u b je c ts o b je c te d to th e la b o ra to r y s p e c ta to r s and to so re n e ss o f t h e i r k n e e s. S tu d ie s o f m en tal b lo c k in g were made, b u t e a r ly in th e experim ent i t was found t h a t when th e kymograph had been s e t up and th e s u b je c ts ta k e n from t h e i r o th e r a c t i v i t i e s , i t was d i f f i c u l t to p re se rv e s u b je c t c o o p e ra tio n in what seemed to them a r a th e r m ean in g less t e s t . A fte r she had developed a k e t o s i s . Ana would in te r p o la te rem arks such a s "T his i s dumb” among h e r te d io u s adding and s u b tr a c tin g o f th e d i g i t s w ith w hich she was c o n fro n te d . Much th e same re a c tio n r e s u lte d w ith e a r ly erg o g rap h ic s tu d ie s , w ith t e s t o f r e a c tio n tim e and w ith k e y -ta p p in g —in f a c t w ith a l l t e s t s w herein i t was n e c e ss a ry to re p e a te d ly p la c e th e s u b je c ts in a la b o r a to r y environm ent. In a Kohs 77 Block D esign T e st g iv en in th e c l i n i c b e fo re s p e c ta to r s . Ana showed a m en tal age o f 11, w hereas h e r I.Q . on in te llig e n c e t e s t s i s 120. I n t e s t s in th e la b o r a to r y , C alv in and Ana n e v e rth e l e s s u s u a lly co o p e rated w ith g o o d -n atu red rem o n stran ces w h ile B lanche p re se rv e d h e r ev en ly p le a s a n t accom odativeness; b u t a few t e s t s w hich co u ld be g iv en in li v in g q u a r te rs seemed a c tu a lly more m eaningful and were re c e iv e d w ith c o n s is te n t i n t e r e s t and e a g er c o o p e ra tio n . Hence some n o n -la b o ra to ry t e s t s were s e le c te d f o r p r in c ip a l s tu d y . They were g rip en d u ran ce, push-up endurance, th re e -d im e n sio n a l ta p p in g and ta p p in g f a ti g u e , O tis I n t e l l i gence t e s t s , and th e Humm-Wadsworth Temperament S c a le . A ll o f th e s e o b s e rv a tio n a l in stru m e n ts a re d e s c rib e d in C hapter I I I . ^ ! r v E x p erim en tal reg im e. Each m orning b e fo re b re a k fa s t th e s u b je c ts were w eighed. A d d itio n a l b e f o re -b r e a k fa s t ro u t in e was th e g rip endurance t e s t , th e th re e -d im e n sio n a l ta p p in g t e s t , and—on some d ay s—th e g iv in g o f blood specim ens f o r sugar d e te rm in a tio n s . C alvin took push-up endurance t e s t s a t t h i s tim e , b u t Ana took h e rs b e fo re r e t i r i n g . " T h is v a r ia tio n was a m a tte r o f in d iv id u a l p re fe re n c e , hence i t was p e rm itte d . The tw e n ty -fo u r hour u r in e c o lle c tio n o f each was a ls o com p le te d w ith th e f i r s t u r in a tio n upon a r i s i n g . T his m a tte r o f th e c o lle c tio n o f u r in e from norm al 78 women h as been a stum bling clo ck in many in v e s tig a tio n s where a l l o f th e u rin e voided f o r a p r o tr a c te d p e rio d was n e c e s s a ry to th e stu d y . The an ato m ical d i f f i c u l t i e s o f th e fem ale in t h i s m a tte r were tak en in to acco u n t in th e p re s e n t in v e s tig a tio n and th e women s u b je c ts were su p p lie d w ith m echanical a id s w hich made p o s s ib le th e p ro c u rin g o f com plete tw e n ty -fo u r specim ens o ver a p e rio d o f s e v e ra l days w h ile th e women went about norm al a c t i v i t i e s . The c o lle c tio n o f u rin e began tw e n ty -fo u r h o u rs be fo r e th e s t a r t of th e e x p e rim e n ta l d ie ta r y r o u tin e . T his f i r s t specim en ap p ears as th e c o n tro l specim en in th e ta b le s and re p r e s e n ts th e u rin e o f th e s u b je c ts w h ile on t h e i r custom ary m ixed d i e t . That o f S u b je c t B, B lanche, m ight be s l i g h t l y a - ty p ic a l in t h a t she consumed a s l i g h t amount o f a lc o h o l d u rin g th e p e r io d . A fte r th e l a s t p a rta k in g o f t h e i r custom ary fo o d , th e th re e s u b je c ts Ana, B lanche, and C a lv in , f a s te d f o r a p p ro x i m ately f o r t y h o u rs. D uring t h i s p e rio d from t h e i r l a s t re g u l a r supper u n t i l a d elay ed b re a k fa s t th e second day fo llo w in g , th e y re c e iv e d no food b u t were allow ed to d rin k a s much un sw eetened and uncream ed te a o r c o ffe e as th e y d e s ir e d . T his was a co n c essio n to th e s u b je c ts in th e fa c e o f, th e known stim u l a t i n g e f f e c t o f c a f f e in e . A fte r some in c re a s e d u rin g f a s t i n g , th e in g e s tio n o f c o ffe e d u rin g th e rem ainder o f th e e x p e ri ment was n o t in ex cess o f th e s u b je c ts ' h a b itu a l d a ily in ta k e . 79 E s s e n ti a l ly , th e s u b je c ts pursu ed t h e i r custom ary a c t i v i t i e s d u rin g th e f a s t , C alv in w alking h is u s u a l d a ily two m ile s and su p e rv is in g a p layground f o r s e v e ra l h o u rs . On th e second m orning o f th e f a s t , tw e n ty -fo u r hour u rin e c o lle c tio n s were ag a in com pleted and blo o d specim ens were ta k e n f o r sugar d e te rm in a tio n s . These f a s ti n g specim ens ap p ear in th e ta b le s in th e "2nd" day colum n. B efore b re a k in g th e f a s t , and a f t e r th e com pletion o f f o r t y h o u rs w ith o u t fo o d , O tis t e s t s o f m ental a b i l i t y were a d m in iste re d in a d d itio n to th e ro u tin e ones o f g r ip and ta p p in g f a tig u e . The f a s t was broken w ith th e f i r s t m eal o f th e k e to g en ic d i e t . The n a tu re o f t h i s d i e t i s d e ta ile d in th e n e x t p a ra g ra p h . In a d d itio n to th e b e f o re -b r e a k fa s t r o u tin e —which was much th e same th ro u g h o u t th e experim ent ex cep t t h a t an O tis t e s t was a d m in iste re d a g a in o n ly a t th e h e ig h t o f k e t o s i s , and th e b lood specim ens were n o t ta k e n r e g u la r ly — g rip f a tig u e d e te rm in a tio n s were u s u a lly made ag a in b e fo re lu n c h , as were ta p p in g f a tig u e t e s t s . The k e to g e n ic d i e t . For c o n tin u in g th e developm ent o f th e k e to s is th e re was u sed a c a rb o h y d ra te ffre e d i e t o f 1500 c a lo r ie s d a ily f o r each o f th e women and 2000 c a lo r ie s d a ily f o r th e man. The fo o d s allow ed were eg g s, w hipping cream , unsw eetened g e la tin e , and any k in d o f m eat ex cep t glycogen d e p o ts . The v a r i e t i e s and r e l a t i v e p ro p o rtio n s o f th e s e foods were as th e s u b je c ts w ish ed . The ex p erim en ter took th e o rd e rs 80 o f th e s u b je c ts and p urchased and d e liv e re d a l l o f th e food w hich was p e rm itte d in th e e a tin g q u a r te rs o f th e s u b je c ts . The d ie ta r y a d ju n c ts l i s t e d u n d er th e n e x t h ead in g were added. The h o n e sty o f th e s u b je c ts was beyond q u e s tio n , b u t f o r tu n a te ly f o r th e s c i e n t i f i c a p p r a is a l o f th e s u b je c ts ' m otives f o r ad h e ren ce , a p e c u lia r co n cep tio n a ro se among them . The b e l i e f came to be unanimous th a t any d e v ia tio n from th e regim en would r e f l e c t i t s e l f im m ediately and d is c rim in â t o r i l y in th e b io ch em ical f in d in g s . . D ie ta ry a d ju n c ts . When th e .fo o d i s p r a c t i c a l l y devoid o f v itam in C, sev e re scu rv y dev elo p s in a g u in ea p ig in two w eeks, and in man in about two m onths. . Long b e fo re m a n ife s t scurvy a p p e a rs, how éver, th e re ; * ‘ i s a p e rio d o f i l l h e a lth , symptoms o f w hich in c lu d e " lo s s o f é n è rg y ."^ Because man does n o t s y n th e s iz e v ita m in C—n o r does , . i, ' • ' he s to r e i t ex c ep t in v e ry s li g h t amount in th e a d re n a l c o rte x — t t & I a d a ily in ta k e o f v ita m in G i s morp im port p u t to man th a n th a t t / : : ! , ■ ' '' ' : ' o f th e o th e r v ita m in s , which a r e .s to r e d more a b u n d a n tly . S in c e — ex cep t in th e a d re n a l C ortex—a p p re c ia b le n a tu r a l . ■ _ - t ' ( so u rces o f v ita m in 0 alw ays c o e x is t w ith so u rce s o f c a rb o h y d ra te , s p e c ia l a tt e n ti o n m ust be g iv en to su p p ly in g v ita m in C to humans ^ Sherman, H .C ., C hem istry o f Food and N u tr itio n (New York: The M acm illan Company, 1 9 3 3 ;, p . 4È0. c Plim m er, R .H .A ., Food, H e a lth , and V itam ins (New Y ork: Longmans, G reen, and Company, 1 9 ^ 2 ), pp. 143. 81 on a c a rb o h y d ra te -fre e d i e t . One p o s s ib le means o f doing t h i s would be by having th e s u b je c ts e a t la r g e q u a n titie s o f f r e s h ly k i l l e d raw meat in th e hope t h a t s u f f i c i e n t v ita m in C m ight e x is t th e r e in in some form such as an accompaniment o f th e d i s t r i b u t e d a d re n a l c o rte x horm one. T his i s , o f c o u rse , n o t u su a l l y f e a s ib le in k e to g e n e s is . In p re v io u s e x p e rim e n ta l k e to g e n e s is , l e t t u c e has been u s e d . T his food h as th e d isa d v a n ta g e s o f a th r e e p e r c e n t c a rb o h y d ra te c o n te n t and o f r e q u ir in g th re e q u a r te rs o f a pound to g iv e th e v ita m in C e q u iv a le n t o f one and o n e -h a lf ounces o f orange ju ic e o r 25 m illig ra m s o f ce v ita m ic a c id —th e u s u a l minimum p ro p h y la c tic d o se . F o rtu n a te ly , w ith th e i d e n t i f i c a t i o n o f v ita m in C as th e h ex u ro n ic a c id known a s c e v ita m ic a c id , t h i s v ita m in may now be o b ta in e d in pure form a t a r e l a t i v e l y low p r ic e . T h is, and o th e r d ie ta r y a d ju n c ts which were in c lu d e d in th e d i e t o f th e s u b je c ts , a re l i s t e d in L i s t I . I I . THE QUALITATIVE RESULTS The ex p e rim e n ta l regim e fre q u e n tly seemed to be th e cause o f w holly u nexpected beh av io r^ some o f w hich w ill be re p o rte d d e s c r ip tiv e ly along w ith th e q u a l it a t iv e tre a tm e n t o f some more p r e d ic ta b le e f f e c t s . R eactio n to b lo o d -g iv in g . S ince th e c a p il la r y method was n o t co n sid e re d s u f f i c i e n t l y a c c u ra te f o r th e blood su g ar d e te rm in a tio n s , i t was n e c e ssa ry in th e s e d e te rm in a tio n s to 82 p ie r c e a v e in and draw an a p p re c ia b le volume (10 c c . ) o f blood.® S ince none o f th e s u b je c ts had ev e r g iv en a b^ood specim en b e f o re , n o r had th e y sp en t any a p p re c ia b le tim e in a h o s p ita l o r c l i n i c a l la b o ra to r y environm ent, t h e i r r e a c tio n s were o f i n t e r e s t . C a lv in , th e m ale s u b je c t, e a r ly showed a tendency tow ard r a t i o n a l i z a t i o n f o r th e purpose o f a v o id in g th e venous p u n c tu re s . A p p aren tly w ith u t t e r u n co n scio u sn ess o f h is m o tiv a tio n , he would in a l l good f a i t h manage to be l a t e f o r appointm ents w ith th e te c n h ic ia n . The fem ale s u b je c ts showed no such ten d en cy , b u t an o b s e rv a tio n o f th e ta k in g o f blood specim ens a f t e r th e f o r t y - ho u r f a s t made sympathy w ith C alvin e a sy . W hile h is v e in s were more e a s ily a c c e s s ib le th an B la n c h e 's , he o b v io u sly s u f fe re d in te n s e ly because o f some m inor v a r ia tio n in p e r s o n a lity . The appearance o f b lo o d has no e f f e c t on him; b u t e i t h e r b e cause o f a m ild ph o b ia o r aA a c c e n tu a te d mechanism f o r s e l f - p r e s e r v a tio n , he had to co e rce h im se lf f o r c e f u lly to subm it to a p ie rc in g o f h i s in teg u m en t. In g iv in g th e p ro lo n g e d -fa s t in g specim en, hé tu rn e d v e ry p a le , b u t su b m itted b ra v e ly . A fte r th e n e e d le had been! w ith draw n, he f e l l to th e f l o o r b u t would l e t no one su p p o rt him . He s ta te d b lu n tly , " I'm n o t f a in ti n g ," a f t e r w hich he rem ained ® R esearch T ech n ician H.D. Blundèn made m ost o f th e s e d e te rm in a tio n s , u n d er th e d ir e c tio n o f D r. J . S . B u tts . 83 LIST I DIETARY ADJUNCTS USED AS PROPHYLAXIS AGAINST DEFICIENCIES IN KETOGENESIS Calcium g lu c o n a te In th e average q u a n tity o f 3 grams p e r day p e r s u b je c t was serv ed in sac c h a rin -sw e e te n e d g e la tin e o r suspended in whipped cream . C evitam ic a c id . 50 m illig ra m s p e r p erso n p e r d ay , was d is s o lv e d in c o f f e e , t e a , o r sa c c h a rin -sw e e te n e d g e la t i n e . H a liv e r o i l . 3 minims p e r day p e r s u b je c t, was su p p lie d in creçm . Maple syrup in a b o t t l e w ith e a s ily -b ro k e n s e a l was a v a ila b le f o r any p o s s ib ly -o c c u rrin g hypoglycem ic em ergency.^ P la in a g a r, P arke-D avis or.. L i l l y 's , was a v a ila b le c o n s ta n tly f o r any s u b je c ts f e e lin g th e need o f i n t e s t i n a l b u lk .^ VegeX; a c a rb o h y d ra te -fre e c o n c e n tra te o f v ita m in s B and G, was ta k e n w ith m eat o r as b r o th . At l e a s t 600 Chase-Sherm an u n i ts o f v ita m in B were su p p lie d each s u b je c t d a ily in t h i s m anner. ^ A v a ila b le , b u t were n o t u se d . 84 on th e f l o o r on hands and knees much l i k e a boxer who has been alm ost knocked o u t. A fte r about two m in u te s, he d ecid ed th a t he needed some f r e s h a i r and went to th e back p o rch , where he s a t f o r a w h ile b e fo re r e tu r n in g to h is own apartm ent* Ana and B lanche w itn e sse d t h i s , b u t seemed l i t t l e a f f e c te d when th e y soon t h e r e a f t e r gave t h e i r blood specim ens, B lanche g r i t t e d h e r t e e t h , b u t w atched w h ile h e r v e in was punc tu r e d , Then she tu rn e d away as th e b lo o d was b ein g withdrawn* Ana w atched in te r e s t e d l y and conversed w ith th e te c h n ic ia n d u r in g th e whole p ro c e ss w h ile i t was b ein g en acted on h e r s e l f , a lth o u g h h e r v e in s were more d i f f i c u l t o f lo c a tio n and punc t u r e . G ly co g en o ly sis a c c e le ra te d by em otion. C a lv in 's r e a c tio n , s u b s ta n tia te d by th e blood su g ar fin d in g o f 166 mgms. p e r 100 c c . in s p ite o f h i s im m ediately p re c e d in g f a s t o f f o r ty h o u rs, g iv e s alm ost in whole C annon's p ic tu r e o f a d re n a l h y p e r - a c tiv ity o f em otional origin.*^ In p la in evidence were th e c r i t e r i a o f ra p id p u ls e , wide p u p ils , sw eatin g ; and th e h ig h glycém ie p e rc e n ta g e n o te d . A fte r h av in g s te e le d h im se lf f o r th e o rd e a l u n t i l i t was o v er, th e re was th e r e a c tio n o f w eakness a fte rw a rd s w hich h as been d e s c rib e d . Twenty m in u tes l a t e r , how ever, he re tu rn e d ^ Cannon, W .B., B odily Changes in P a in ; Hunger, F e a r. and Rage (Now Y ork: A ppleton and Com pan^ pp. x iv and 404; , M clver, M.A. and B lis s , S.W ., "A Sym pathetic and A drenal Mechanism f o r M o b iliz in g Sugar in H ypoglycem ia," American Jo u rn a l o f P h y sio lo g y . 69:46-66 (1924) 85 f o r b r e a k f a s t in good s p i r i t s and w ith ■unimpaired a p p e tite f o r th e c a rb o h y d ra te -fre e m eal. H is index o f g rip f a tig u e , tak en j u s t b e fo re th e m eal, was tw enty p e r c e n t h ig h e r th a n h is c o n tro l mean. T his g iv e s h is f a tig u e curve in Graph I a d e c e p tiv e e a r ly p eak . The o ccu rren ce i l l u s t r a t e s , how ever, some o f th e e n d o c rin e -n u tritio n a l-e m o tio n a l c o r r e la tio n d i s cussed in th e l i t e r a t u r e review ed in C hapter I I I . C alv in showed h is sportsm an sh ip by t o t a l la c k o f r e sentm ent over th e comment on h i s re a c tio n ,a n d by su b m ittin g to a subsequent venous p u n ctu re w ith o u t th e form er r a t i o n a l i z in g e f f o r t s to av o id i t . Towards t h i s l a s t p u n ctu re he m ani f e s te d no a p p re c ia b le em otional r e a c tio n , and th e glycém ie p e rc e n ta g e was found to be in th e norm al range f o r f a s t i n g . The f a c to r s w hich seemed most l i k e l y to have e f f e c te d t h i s change, eithei* s in g ly o r in com bination w ere; th e change from p ro lo n g ed f a s t in g to a k e to g e n ic d i e t , th e change from a m ale to a fem ale te c h n ic ia n , p o s s ib le v a r ia tio n s in th e p u n ctu rè te c h n iq u e , a b re a c tio n in .the p re v a le n t d is c u s s io n ai>out tî^e m a tte r, a n d /o r a spontaneous in h ib ijtio n o f th e em otional r e s pon se. Of p o s s ib le i n t e r e s t to th e t o t a l p ic tu r e o f G a lv in 's r e a c tio n i s th e c o n s is te n t showing o f a p lu s-tw o h y s te ro id . com ponent in h i s Humm-Wadsworth p r o f i l e . T his component i s dom- I I in a te d , b o th in h i s c o n tro l t e s t s and in k e to g e n e s is , by a p lu s - th r e e manic com ponent. N orm ally, he shows no o th e r stro n g com ponents; b u t in k e to g e n e s is th e h y s te ro id component 86 i s e q u a lle d by a d e p re s s iv e com ponent. I t m ust be em phasized t h a t th e Humm-Wadsworth S cale i s u sed in t h i s in v e s tig a tio n p u ely f o r com parative in v e n to rie s o f a g iv en s u b j e c t 's a t t i tu d e s under d i f f e r e n t c o n d itio n s , and w ith no re g a rd f o r th e S c a le 's a b s o lu te v a l i d i t y as a " P e r s o n a lity Q u o tie n t." H y s te ric a l w eeping. On th e f o u r th day o f th e e x p e ri m en tal reg im e, th e e x p e rim e n te r a r riv e d a t th e q u a r te rs o f Ana and B lanche as th e y and C alv in were to g e th e r com pleting a k e to g e n ic m eal w ith a d e s e r t o f sac ch ar in - swe e t ened, syn t h e t i c a l l y fla v o re d g e la tin e in w hich was d is s o lv e d calcium g lu c o n a te and ce v itam ic a c id . The g e la tin e was topped w ith whipped cream in w hich was m ixed some h a liv e r o i l . The group, in c lu d in g Ana, seemed in a good mood. "T h is i s sad s t u f f , " C alv in rem arked, r e f e r r i n g to th e d e s s e r t w hich had been p re p ared f o r them . There w ere, how ever, no s e rio u s co m p lain ts a s th e s u b je c ts gave t h e i r acco u n ts o f th e d a y 's a c t i v i t i e s . Ana th en r a th e r l i g h t l y rem arked th a t she had a con f e s s io n to make; she had e a te n "som ething cooked w ith f l o u r ," b u t th e way i t was cooked sh e d i d n 't b e lie v e th e c a rb o h y d rate in v o lv ed amounted to a n y th in g . B efore w a itin g to h e a r th a t h e r d e r e l ic ti o n c o n s is te d in e a tin g one p ie c e o f ch ick en f r i e d c r is p in la r d to w hich a h a l f teaspoon o f flo u r had been added, th e ex p e rim e n te r c ru d e ly reprim anded h e r f o r " r a tio n a liz in g th e c a rb o h y d rate o u t o f f l o u r ." "T hat makes me m ad," Ana s a id r a th e r q u ie tly and l e f t 87 th e room c ry in g . She lo ck ed h e r s e l f in a n o th e r room, and th e e x p e rim e n te r's a p o lo g ie s and im p o rtu n ât io n s were n o t h eed ed . B lanche, who had long been A na's roommate, s ta te d d e f i n i t e l y t h a t in y e a rs o f c lo s e o b s e rv a tio n she had n ev er seen s im ila r b e h a v io r in Ana. F u rth erm o re, th e 'p re su m p tio n t h a t t h i s m ild h y s te r ia was r e la te d to th e k e to g e n ic regim e becomes p a r t i c u l a r l y s tro n g in view o f A n a's blood g lu co se c o n c e n tra tio n th a t m orning bhaving been 44 mgm./lOO c c .—a glycém ie c o n c e n tra tio n ro u g h ly h a l f th e norm al mean f a s tin g 8 ( p r e -b re a k fa s t) l e v e l . J o s lin s t a t e s , as was in d ic a te d in th e l i t e r a t u r e review ed in C hapter I I , t h a t glycém ie concen t r a t i o n s below 60 mgms. should be w atched, and th a t in some e a se s e p ile p tifo rm s e iz u re s have o c c u rre d when th e concen t r a t i o n was a t 5Ô mgms./ICO c c . J o s l i n 's f ig u r e s , how ever, m ust re c e iv e a m inus c o r re c tio n o f from 10 to 20 mgms. f o r p u rp o ses o f com parison w ith th e r e s u l t s : o f th e newer method o f d e te rm in a tio n u sed in th e p re s e n t stu d y .^ Ana d id n o t show to any e x te n t th e hypoglycem ic symp toms a s s o c ia te d w ith in s u lin shock in d ia b e tic s and w hich a re re p o rte d in th e l i t e r a t u r e review ed in C hapter I I . The l a t t e r syndrome p ro b a b ly has cau ses beyond a low glycém ie c o n c e n tra t i o n . ® J o s li n , B .P ., G lan d u lar P h y sio lo g y and % e ra p y (C hicago; American M edical A s s o c ia tio n , 1935) p . èsY. ^ As e x p la in e d under th e l a s t to p ic in C hapter I I I . 88 I t was n e v e rth e le s s d ec id e d to remove Ana from th e e x p e rim e n ta l reg im en . t/Upon in te rv ie w in g h e r a few h o u rs a f t e r h e r h y s t e r i c a l o u tb u rs t, she q u ite g o o d -n a tu re d ly r e s i s t e d t h i s d e c is io n . She gam ely i n s i s t e d on s ta y in g w ith th e ex p e rim e n ta l r o u tin e . She was l e f t v /ith th e ad v ice th a t she should w ithdraw from th e stu d y as a s u b je c t and th a t th e in v e s tig a tio n would n o t s u f f e r by h e r so d o in g . In s p ite o f t h i s she seemed to h a te to w ithdraw . The fo llo w in g day she a te one p ie c e o f t o a s t (40 c a lo r ie s o f c a r b o h y d ra te ), b u t i n s i s te d th a t she burned i t u n t i l she co u ld have ab so rb ed no c a rb o h y d ra te . In th e fo llo w in g days she g ra d u a lly re tu rn e d to a norm al d i e t , as in d ic a te d in T able V I. A n o rex ia. B lanche and Ana b o th e a r ly developed a d i s i n t e r e s t in fo o d , b u t t h a t o f Ana was r a th e r q u a l if i e d . She s ta te d t h a t she th o u g h t c o n tin u a lly o f c a rb o h y d rate fo o d s, C a lv in , in keep in g w ith th e sex v a r ia tio n w hich m a n ife ste d i t s e l f in th e a c e to n u ria , r e ta in e d a good a p p e tite . S u b je c tiv e f a ti g u e . "That t i r e d f e e lin g " was a con s ta n t fin d in g in th e th re e s u b je c ts a f t e r an ap p re d ia b le k e to s is had d ev elo p ed . They could n e v e rth e le s s r a l l y and do n e a r ly a s w e ll, b u t r a r e ly q u ite as w e ll, on o b je c tiv e endurance t e s t s as on t h e i r c o n tro l endurance t e s t s . C alvin e le c te d to e x p la in t h i s by say in g t h a t he "dragged around" a l l d ay , n o t w astin g any en erg y , and when co n fro n te d w ith a n e c e s s ity to p erform he 89 could do i t p r e tt y w ell* W hether any e x h a u stin g o f a lk a lin e re s e rv e o r any o th e r phenomenon would have a lt e r e d t h i s p ic tu r e w ith co n tin u an ce o f th e k e to g e n ic d i e t over lo n g p e rio d s i s n o t known* B lanche, on th e s ix th day o f th e regim e, began to lo s e much o f h e r s u b je c tiv e f a tig u e in s p ite o f a c o n tin u ed h ig h k e to s is * She co n tin u ed to f e e l n o rm ally e n e rg e tic th ro u g h tth e n e x t s ix days she rem ained on a c a rb o h y d ra te -fre e d i e t . There was some r e tu r n o f s u b je c tiv e -energy in th e o th e r two s u b je c ts w h ile k e to s is rem ained, a ls o . T his su g g e sts an h a b itu a tio n or a d a p ta tio n , w hich i s borne o u t by th e o b je c tiv e t e s t s . D uring t h e i r p e rio d s o f maximum f a tig u e , a l l s u b je c ts m entioned b ein g ex trem ely t i r e d upon clim b in g s t a i r s . B lanche, p a r t i c u l a r l y , com plained o f som ething resem b lin g cramps in th e m uscles o f h e r le g s on t h i s and o th e r e x e r c is e — som etim es sim ply w ith t h a t o f s ta n d in g . R e tra c tio n o f F ie ld o f C onsciousn e s s . A bsent-m indedness seemed to be u n u su a lly p re v a le n t d u rin g th e p e rio d o f maximum k e t o s i s . Blanche and C a lv in , p a r t i c u l a r l y , re p o rte d in s ta n c e s o f unaccustom ed f o r g e tf u ln e s s . C alvin re p o rte d t h a t , f o r th e f i r s t tim e in y e a rs o f playground s u p e rv is io n , he had w alked th e e n t i r e m ile to h i s playground o n ly to f in d t h a t he had l e f t th e n e c e ss a ry lo c k e r keys and w h is tle a t h is ap a rtm e n t. In s p ite o f t h i s , th e s u b je c ts seemed to have no d i f f i c u l t y in r a ll y in g t h e i r m en tal f a c u l t i e s f o r th e accom plishm ent o f ta s k s 90 such as in te llig e n c e t e s t s . D uring h i s l a s t day o r two o f th e reg im e, C alvin re p o rte d th a t h i s "mind seemed c le a r e r " and th a t he was g e n e ra lly more re la x e d . He re p o rte d "w in n in g f i f t e e n bucks from some tough poker p la y e r s ." A m ativeness# F o lk lo re and e s o te r ic l i t e r a t u r e a re f i l l e d w ith re fe re n c e s to th e a p h ro d is ia c e f f e c t o f a h ig h - m eat d i e t . The s u b je c ts in t h i s experim ent were n o t q u e stio n e d in t h i s m a tte r , b u t t h e i r b e h a v io r gave a r a th e r c le a r sug g e s tio n o f changes in a m a tiv e n e ss. C alv in v o lu n te e re d th e in fo rm a tio n th a t d u rin g th e ex p e rim e n ta l regim e he was f r e e from any sex u al d e s i r e , in d i s t i n c t c o n tr a s t to h is u s u a l c o n d itio n o f awaking each m orning w ith an e r e c tio n and a stro n g sex d r iv e . W hile on th e h ig h -m eat d i e t he had no e r e c tio n s o r n o c tu rn a l e m issio n s, and h is days were Apent in a h e te r o -s e x u a l s o c ie ty w ith o u t e s tr u a tlo n on h is p a r t . Sex d r iv e , p e r s e , was n o t d is c u s s e d w ith th e two c h a ste young women who were th e fem ale s u b je c ts . T h eir b e h a v io r, how ever, was in some c o n tr a s t to th a t o f C a lv in . Dur in g th e e x p e rim e n ta tio n th e y b o th s u s ta in e d r a th e r " s p i r i t u a l " cru sh e s on a young s c i e n t i s t who was a d v is in g th e ex p e rim e n te r. He was t h e i r alm ost c o n sta n t to p ic o f c o n v e rs a tio n , even in th e p resen ce o f th e young men w ith whom th e y were c o n c u rre n tly en gaged in s o c ia l a c t i v i t y . 9 1 T his b e h a v io r, how ever, d id n o t seem to in d ic a te a sex u a l v a r ia tio n from th e la c k o f am ativ en ess of C a lv in . I t seemed, r a t h e r , to have had i t s in c ip ie n c e i n th e em otional i n s t a b i l i t y w hich c h a ra c te r iz e d th e i n i t i a l k e t o s i s . I I I . QUANTITATIVE RESULTS The q u a n tita tiv e r e s u l t s of th e b eh a v io r and b io chem ical stu d y a re ex p ressed in T able V and Graph I . From th e s e i t w il l be seen th a t 1 . There i s no a p p re c ia b le c o r r e la tio n betw een blood su g ar d e te rm in a tio n s and g rip endurance t e s t s made o n ly a few m in u tes a p a rt# The endur ance i s p erh ap s a fu n c tio n o f glycogen s to ra g e and g ly c o g e n o ly s is . 2 . G eneral in te llig e n c e as m a n ife ste d on O tis t e s t s i s in s i g n i f ic a n t l y a f f e c te d by th e k e to g en ic d i e t o r b r i e f f a s t i n g . 3 . There i s a ten d en cy to d e p re s siv e and h y s te ro id in c re a s e s in Humm-Wadsworth Temperament S cale com p o n e n ts. 4 . G e n e ra lly , a h ig h g rip f a tig u e accom panies an in c re a s e in th e p o s itiv e r a t é o f change o f th e ace to n u ria * b u t when t h i s r a te rem ains c o n s ta n t o r becomes n é g a tiv e , g r ip f a tig u e f a l l s t i l l s ta b i liz e d a t o r n e a r c o n tro l l e v e l s . D uring g r e a te r p a r ts o f th e c u rv e s, th e re i s su g g e stio n th a t f a tig u e i s a fu n c tio n o f à p a r t i a l f i r s t d e r iv a tiv e o f th e curve o f a c e to n u ria . p C O * H © O W o o p I> C M O • to $ to I I I - p C O o G -P 4 3 C O is o CO N ( â c 4 r4 0 1 « 4 r4 to <4 Pk r4 < f * 4 iH <4 pt| H o > <4 P4 3 <4 H C O to 5 ! # H to to # o fcO to o o C l % > g : I to H o > to < M O C O C O 3 I G > g g E g o - * § # § o to fH 8 r4 # to to C M ÎU C M C M C M O + 4 * s C M M S H C M r-l* 4 - # ' M 4 4 © !« U P i © * d a 9 o a P M ■s 4 3 G d 4 3 W © © j o I 4 4 O * 3 o i l § 6 © © 4 3 U # # » © 43 © « G •rt « d o © © © b O f4 O 4 4 4 3 I © g' 4 ^ II & I O •H u 4 3 © © P i •H O * d •H * d g®* g o •H »H 4 3 P i O ■ 3 o • • * • # • # • • • # • » * • • • • • * • • # # • • • P Q © © jq • • # • H • • • . • « • • • # ^ P P © -r! # • « • • « • o* • • • p # « • # • • • © # • X © • * k # § * ♦ P N © ,© © k» #' • • # © •H © • 6 1 • O .H © r a » d o © 3 # * • * d 2 « * # © © © © © I © G © © d • • . # § * H g > © © © * H • a? © 0iH AM © 4 3 © O © o .© © © © •H 0 P 8 o o • • * A P i O P P •d © • © • f c c o * H © © © G) © © © H P © G bo * # # © p § ) 0 •H 4 4 © X p M P o h < % * P o 4 3 © rd P d P © © r4 • P # 3 4 4 © H © to P i © © © © © n 4 O o P © P i 4 4 © 044 a © © o •H * d © © © O 0 v4 1 o © o ^ © o p • r- » W P © o • A A f© © A © c © © •9 X •r t © o s % 4 Pi © • p Q B * d r 4 © •H © © O 4 4 1 — 1 w © 0 O P o o © © © o A to C O < 4 O m B C Î J £4 o A o ^ O 44 * d o © 44 « H 4 4 • H r4 r4 © © u g*E © * d _ © an « © © • • © «■g # « \4 3 O * H •H G § © © 4 3 © •H I b O © © P S • © > ■P © © o > •• *H «H <j * d P rO a © v4 O P © O © g js © « H C M G > PÎ © O fH « © O • • © aê s o * © p j « t 4 © ♦ O ft© è B P W tH * * * P 44 **©o © > © © o w a p © o d Pi o © G i ^ 3 % ^ C Î 3 I O E 4 a a i S > a lO I I * 1 I < D J © a n g w 3 o o p © o p © « o p 5 « © • G M * d P P i © A A M C5 - • I H . o » d p M â © A : A rH > • rH O M © Pi E 4 p 0 P < © © 0 E 4 rH 0 G H ’ i O B4 < C A • ( 3^ © p © A lO r H A A r4 C O r4 A M fH A A H A rH A A fH 3 A A »H A rH 8 A A rH P 0 © T - » 1 g • 4» 0 1 B g . ♦ to to to o % > § g A H § A A A G ) A O ^ o > O O A rH A A A A § S g A C M • # * • • • * * • • * • • • B • • • • • • * # • X o* © # © * * X t # \ • • © •H 0 3 » *d 1 © © • d © • •H g> 5 © © •H # A © © P i O © & • 0 "H O bOO •H 44 •H P 4 © 0 O P bO • 0 44 ©rH © P 0 Pi • d \ 44 0 O 0 •H X bO p © O • A A iH © o a •H A © © O 44 rH w Pi © A < O A W A E H © O © g s lg §i © . H rH C A rH C M C M rH H - + 4" G? M I © P ê p © p f : M l 111 A o fe: © E 4 4 4 O © A P m a 4 4 © © A © f© •H f i & •H a © • H K I P i © © Pi © I I O o > a o 'm pH to irH to g a to o A 4 8 rH G > O # rH '"j* rH a > to ^ O A A W rH P lO # o p 5 o s rH o > o > O to C M § O # * S s C 5 O E 4 5 A § I H a I p I I p w H I 0 •H §> 1 I O P 0 .A 4 O P . s p © © 4 4 0 •H A O ÎS O o p 0 0 •r -> 1 G) to iH O) A rH rH a rH A t - O • • • • • B ♦ • • » c r * • © • ^ • © .« •d © © s 0 ®S A • * © 0 0 •H 0 « H 9 © 044 P 0 0 fl 0 0 p © iH 0 0 0 4 4 < 0 C M £ - < D to fH I A rH ® 5 H to O A A p H 0> 0) 0 A rH A • • A • • # * • • • • • • g X *d 0 % 0 « H 0 *d 0 © 0 0 0 0 •H & © © 0 •H 0 Ü 0 P •d f4 A © 0 0 •H 44 0 X P 0 © 60 A 4-, a A A a •H A © • U © 0 0 A E 4 AÎ2Î S rH 5 3 fH O f M * d I © p § A ACM C M + f 4- îBtd A ACM rH + 4. 4 . 0 E 4 44 o 0 A A 44 0 0 A *d c îj o M S E 4 A A o > I O P 0 A 4 E H < o M O M A P > C Î 5 P © © © M M rH 4i A A m R <4 H Ê H A g <4 A # * M E H . # * ‘ :< # * A • # S ■ 3 1 I © P 0 A A A C M rH rH A A C M rH rH P 0 0 1 © s s G O * © • g # ' *d © © • 0 R 0 •H © P i • © r» O 0 H » U o P © 0 © bO •H O fcOO •ri P, © 0 O P 0 4 i ©rH © 0 Pi 44 O 0 p © O • A 0 O à •H O A rH Q) Pi <4 O m B C Î3 g 0 •H P < 2 « •H I 0 O © § 0 © Pi rH II 0 r . 0 O P k % cÿ M •d 0 0 © P ê p , g 0 0 0rH gW © B ü 0 -* A P © _ P 0 P III 8 S'S A 0 rH a E4 4, O 0 b O © A P © U • r t 4 , 0 0 m © »d •H f i ACETONURIA, GRAM S PER SQUARE METER o > PQ M O M O M H n Q O CO o o CO iS 8 § o o t r » - I T * jg IHDEX OF GRIP FATIGUIT C H A P T E R VI SU M M A R Y A N D CONCLUSIONS To e v a lu a te th e f e a s i b i l i t y of a p o s tu la te d sc ie n c e o f n u t r i t i o n a l p sychology, an I n v e s tig a tio n o f b e h a v io r In a number o f n u t r i t i o n a l s t a t e s was undertaken* The component s tu d ie s ranged from a few h o u rs o b se rv a tio n o f fo u r s u b je c ts In a lc o h o lism to a stu d y o f fo u r s u b je c ts In k e to g e n e s is extended in d iv id u a lly from two days to two weeks* Summary o f r e s u l t s * W ithin th e in d ic a te d l i m i t s o f e x p e rim e n ta tio n , th e fo llo w in g fin d in g s were n o te d : 1* A d m in is tra tio n o f th y ro x in to two norm al s u b je c ts was fo llo w ed by a . A q u ick en in g o f p u lse r a t e and o f m otor and m en tal a c t i v i t y . b* An a c tu a l d e c re a se in b ig m uscle endurance in e x h a u stin g e x e rc is e s . c# An in c re a s e d i r r i t a b i l i t y . 2* Raw m eat d ie to th e ra p y in a case o f c h ro n ic u lc e r a t i v e c o l i t i s was fo llo w ed by a . Cure o f th e d is e a s e , b . V a s tly im proved perform ance on endurance t e s t s , c* Change o f tem peram ent from m a n ic -d e p re ssiv e to norm al. d* S eventeen p e r c e n t improvement in p e r c e n tile ra n k in c o lle g e group on in te llig e n c e t e s t s . 98 3 . L iv e r th e ra p y in a case o f p e r io d ic m elan ch o lia p reced ed a# R e lie f from d e p re ss io n and a l l p h y s ic a l d i s t r e s s 4m M assive in g e s tio n o f g ly c in e by two norm al b u t e a s ily fa tig u e d s u b je c ts o ver a p e rio d o f s ix weeks was fo llo w ed by a . No s ig n if ic a n t e f f e c t s upon thorough study# 5 , M assive e th y l a lc o h o l in g e s tio n by fo u r s u b je c ts was fo llo w ed by a . A g r e a t d e c re a se in o b ta in e d in te llig e n c e q u o tie n ts . b# A s ig n if ic a n t d e c re a se in m u scu lar endurance o f th e women s u b je c ts , w hich in th e one s u b je c t common to b o th exp erim en ts was n o t a s g r e a t a s h e r maximum e n d u ra n c e -lo ss in k e t o s i s , c . No s i g n if ic a n t d e c re a se in m u scu lar endurance in th e m ale s u b je c ts # d . Some d is tu rb a n c e o f e q u ilib riu m , w hich was g r e a te r in th e fe m a le s . 6# In th e k e to g e n e s is o f th r e e fem ale and one m ale s u b je c t th e re was observed a# The r e p o r tin g o f a number o f marked in d iv id u a l s u b je c tiv e changes* b* F req u en t e x p re ssio n s o f a f e e lin g o f f a tig u e by a l l s u b je c ts # c« C o n siste n t m a n ife s ta tio n s o f a r e tr a c t e d f i e l d o f c o n sc io u sn e ss. d* L essened em otional s t a b i l i t y i n a l l s u b je c ts , w hich was m a n ife ste d in one fem ale s u b je c t by un accustom ed w eeping, and in th e m ale by c o lla p s e fo llo w in g a n o n - i n i t i a l venous p u n c tu re # 99 e . No s ig n i f i c a n t change in o b ta in e d in te llig e n c e q u o tie n ts . f • In th e Htuum-Wadsworth Temperament S cale u sed s o le ly f o r com parative p u rp o se s, a pronounced in c re a s e in d e p re s s iv e and h y s te ro id components over th e c o n tro l t e s t s . g . T h at, i n g e n e ra l, when th e re v/as an in c re a s e in th e p o s itiv e r a t e o f change o f th e a c e to n u ria , g rip f a tig u e sta y e d a t r e l a t i v e l y h ig h le v e l s ; b u t when th e f i r s t d e r iv a tiv e o f th e curve o f a c e to n u ria rem ained c o n s ta n t o r became n e g a tiv e , th e re was a f a l l in g r i p f a tig u e t o s t a b i l i z e n e a r c o n tr o l le v e ls . g e n e ra l c o n c lu sio n . A review o f th e r e le v a n t l i t e r a t u r e and th e r e s u l t s o f t h i s in v e s tig a tio n su g g est t h a t b a s is emd J u s t i f i c a t i o n e x i s t f o r a d iv is io n o f la b o r w ith in th e l i f e sc ie n c e s to c r e a te a s e p a ra te sc ie n c e o f n u t r i t i o n a l p sy ch o lo g y . .BIBLIOGRAPHY 101 A. Books B a m e tt, S u re, The V itam ins in H e a lth and D is e a s e . New Y ork; C entury Company, 1933. 66 p p . #615.2 P728a a t U n iv e rs ity B ranch p u b lic l i b r a r y . Berman, L o u is, The G lands R e g u latin g P e r s o n a lity . New York; The Macmillfiôi Company,' 1928. 341 p p . S tim u la tin g and p ro p h e tic , b u t f i l l e d w ith s c i e n t i f i c a l l y u n w arran ted assu m p tio n s. A v a ila b le a t campus l i b r a r y . Berman, L o u is, Food and C h a ra c te r. New York ; Houghton M if f lin Company, 1*^357 3 Ï8 pp. B rud, L orena M ., The Human M achine. B oston: The S tr a tf o r d Company, 1934. TÔÏ p p ♦ C antarow , Abraham, Calcium Met a b o l i t and C a lc iy a T herapy. P h ila d e lp h ia ; t e a and P 'e rb ig e r, 1S30. 19$ p p . Much in fo rm a tio n on th e p a r a th y ro id s , m o stly o f m ed ical i n t e r e s t . C o llie r ; Oxford M ed icin e. Not review ed ex cep t as quoted in A.M.A. symposium. F a n tu s, B ern ard , Yearbook o f G eneral T h e ra p e u tic s . 1034. C hicago; Y ear Book P u t! l a s e r s , ^ 9 S4* 4é2 p p . C ontains in i t s s h o rt s e c tio n b ;? ie f, w e ll docum ented d is c u s s io n o f en d o c rih o lp g y , in c lu d in g some e x p e rim e n ta l fin d in g s on D -d e fic ie n c y h y p e rp a ra th ro id i sm. P is h b e in , M o rris, e d i t o r . G lan d u lar P h y sio lo g y and T herapy. A Symposium. Chicago ; American M edicaï As s o c i a t io n , 1935. 521 pp . ■ R easonably up to d a te ex p e rim e n ta l and c l i n i c a l f in d in g s , many of them o f i n t e r e s t to p s y c h o lo g is ts . On th e re s e rv e d bopk s h e lf o f th e campus m ed ical l i b r a r y . P o ld e s, Eugene, A New Approach to D ie té tic Therapy in E p ilep sy . E tc . B oston; ^ i c n a r S ^ . B adger, Ï9'à3. 434 pp. Gould, G. M .. 40.000 M edical W ords. P h ila d e lp h ia ; P . B la c k is te n ’s Son and C ^ p a n y , ï93o • A u s e f u l p o ck et m ed ical d ic tio n a r y . 102 G roilm an, A rth u r, The A d re n a ls. B altim o re : W illiam s and W ilk in s, 1936. 4ÏÔ p p . . ~ Harrow, Benjam in, G lands in H e a lth and D is e a se . New York: E . P. D utton and compahy, ÏÔ 32. Sound, b u t r a th e r out-m oded. A v a ila b le a t campus l i b r a r y . Hawk and Bergrem, A P r a c tic a l P h y s io lo g ic a l C hem istry. P h ila d elp h ia :* " P . B la c k lsto n e s Èon and Company. 468 pp. M urchison, C a rl, e d i to r , A Handbook o f G eneral E xperim en tal P sychology. W orohesTer, M a s s a c ^ s e tts : C lark IJ n iv e rs ity P re s s , 1934. 1200 p p . C ontains two e x c e lle n t c h a p te rs r e l a t i n g to en d o crin o lo g y : "The N euro-hum oral B a sis o f Em otional R eactio n s" ( P h i l lip Bard) and "The E x p re ssio n of Émotion" (C arney L a n d is ). A v a ila b le a t campus l i b r a r y . Plim m er, R. H. A ., Pood, H e a lth . V itam in s. New York : Longmans, Green and Company, lÔ 3ë. 143 pp . Some n o v e lly p r a c t i c a l p r e s e n ta tio n s by an Ib ig lis h a u th o r. .2 P728a a t U n iv e r s ity Branch p u b lic l i b r a r y . R obinson, W. J . , Our M y sterio u s L ife Glands (w ith a t r e a t i s e on v ita m in s ) • Sew York : Eugeni c s S u b ii sh in g Company, 1934. 291 p p . In s p ite o f th e t i t l e , t h i s book p re s e n ts a c o r r e c tly s c i e n t i f i c surv ey o f en d o crin o lo g y in p o p u la r s t y l e . Con t a in s a g lo s s a ry . S h e llin g , D. H .. The P a ra th y ro id s in H ea lth and D is e a se . S t. L o u is; C. V. Mosby, Ï9 3 ë . 335 pp. B. P e rio d ic a l A r tic le s B aker, B. M., J r .," T h e E f f e c t o f L iv e r The. apy on th e N e u ro lo g ic a l M a n ife s ta tio n s o f P e rn ic io u s Anemia," ' American Jo u rn a l o f # ie M edical S c ie n c e s. 184;1 , J u ly , 1932. Baumann, E . J . , and H unt, L o u ise . " R e la tio n o f T h y ro id S e c re tio n to S p e c ific Dynamic A c tio n ," Jo u rn a l of B io lo g ic a l C heidistry, 6 4 :7 0 9 , J u ly , 1925. :----------------------------------- -------- 103 Brown, W. L ., "E n d o crin es and M ental D is o rd e rs ," P r a c ti t io n e r , 1 3 7 :1 -1 3 , J u ly , 1936. C r ile , C#, "P o ly g la n d u la r D isease (and A drenal D e n e rv a tio n )," Jo u rn a l o f th e M edical S o c ie ty o f New J e rs e y . 33:336 -41, June, 1936. de C andia, 8 . , "Two New Forms o f E ndocrine Nanism: P a ra th y ro id Nanism and P rec o cio u s m atronism o f P ende," ^ d o c r in o lo g y G ynecology, and O b s te tr ic s , 1 :2 9 3 -6 , A p r il, Ï9 3 ê , de S a n c tis , A. G ., and C ra ig , J . D ., Jo u rn a l o f American M edical A s s o c ia tio n . December, 1934. D rey er, I r v in g , and Reed, C. I . , "The T reatm ent o f A r t h r i t i s w ith M assive Doses o f V itam in D," A rchives o f P h y sic a l T herapy, X-Ray, Radium XVI (S eptem ber, X95d), 6 3 7 -4 4 # G ran t, G. A ., "The E f f e c t o f P r o la c tin on L a c to se S ^cithesis by th e Mammary G land," B io ch em istry J o u rn a l, XXX:10, 0 31-35. (^insburg, Solomon, " P re v e n tio n and T reatm ent o f Toxic G o ite r," H ygeia. 1 3 :1 0 , O ctober, 1935, p p . 950r53, - — , " P re v e n tio n and T reatm ent o f G o ite r," H ygeia, 1 3 :1 1 . November, 1935, p p . 1040-43. "Masked ’H y p erth ro id ism ’ o r T h y ro to x ic o s is ," H ygeia. 1 3 :1 2 , December, 1935, p p . 1114-16. The above th re e a r t i c l e s a re e n lig h te n in g e x p o s itio n s w r itte n f o r la y r e a d e r s . A v a ila b le in alm ost any l i b r a r y . H aussay, B .A ., " R e la tio n s Between P a ra th y ro id s , H ypophysis, and P a n c re a s," New England Jo u rn a l o f M edicine. 214:1133-36, June 4 , 1933. Johnson, A .S .. "D u c tle ss G lands, Pormen o f Body." H ygeia. 1 4 :638- 641, J u ly , 1936. An e x c e lle n t and up to d a te d is c u s s io n f o r la y r e a d e r s . L eM essu rier, D .H ., " S ite o f A ctio n o f C a ffe in e as R e s p ira to ry S tim u la n t," Jo u rn a l o f Pharm acology and E xp erim en tal Therapy 57 :4 5 8 -6 3 , A ugust, 1536. L eonard, S .L ., "H ypophysis, th y ro id , gonad r e la ti o n s h i p ," P ro ce ed in g s o f th e S o c ie ty o f E xp erim en tal B iology and M edicine 34:599-600, Ju n e, 1936. 104 S p e ld e l, C arl C*, "Changes in Nerve F ib e rs d u rin g A lco h o lic I n to x ic a tio n and R ecovery," S c i e n t i f i c M onthly, F ebru a r y , 1937, pp . 178-185. Sy, Â .P ., "A lcohol and i t s E f f e c t on Man," Consumer’s R esearch B u lle tin , I I I (new s e r i e s ) : 5 , p p . 20-25, Jan u a ry , Ï 937• XJngley, G .C ., "The T reatm ent o f Subacute Combined D e g e n e ra tio n ," P ro ceed in g s o f th e Royal S o c ie ty o f M edicine, 27':779, A p r il, 1934. W arren, N e ll, "The E f f e c ts o f F a tig u e on P r i o r i t y o f B i la te r a l Manual M ovements," P sy c h o lo g ic a l B u lle tin , 3 2:547, 1935. W ild er, R.M ., and H ow ell, L .P ., " E tio lo g y and D iag n o sis in Hy- p e rp a ra th y ro id is m ," J o u r n a l. o f th e American M edical Asso c i a t i o n , CVI:6, p p . 4 2 7 - 3 1 , l^ b r u a r y 3 , 1 9 3 6 . R ep o rts on c l i n i c a l D -d efi c i ency h y p e rp a ra th y ro id ism . W ild er, H ig g in s, and S h eard , A nnals o f I n te r n a l M edicine, V II: 1059, M arch, 1934. R ep o rts on e x p e rim e n ta lly induced D -d e fic ie n c y h y p e rp a ra th y ro id is m . W o rtis, Jo sep h , C o lle c te d A b s tra c t; " I n s u lin in S c h iz o p h re n ia ," The J o u rn a l of Nervous and M ental D ise a se , 8 5 :5 .p p . 581- 3 ^ 5 ,'M â y rï'937.---------------------------------------------^ APPENDIX 106 GLOSSARÏ^ A breaction# "T alk in g i t o u t" as a menas o f em o tio n al r e le a s e . A c e to n u ria . The o ccu rren ce o f k eto n e b o d ie s in th e u r in e . Acromegaly* A d is e a s e o f th e p i t u i t a r y g lan d ca u sin g abnorm al enlargem ent o f th e bones o f th e h ead , fa c e and e x tr e m itie s . A cu te. D eveloping su d d en ly . Having a s h o rt c o u rse . A ddison’s D ise a se . A d is e a s e o f th e a d re n a ls ca u sin g g re a t w eakness, abnorm ally bronzed s k in , anem ia, and—i f u n tr e a te d w ith a d re n a l c o rte x hormone—d e a th . Adenoma. Tumor o f a g la n d . A dipose. P a tty . A dolescen ce. The p e rio d betw een p u b e rty and m a tu rity . A d re n a l. The s u p ra re n a l c a p su le o r g la n d . In mammals, one n o rm ally o ccu rs over each k id n e y . A d re n a lin . O b so lescen t term f o r th e a c tiv e p r in c ip le o f th e a d re n a l g la n d , e p in e p h rin . A dren in . O b so lescen t term synonymous w ith a d r e n a lin . Anemia* A d e fic ie n c y o f blood 6r o f th e re d c e l l s in th e b lo o d . A d e f ic ie n c y o f hem oglobin o r o f re d blood c e l l s , o r b o th . A n te rio r P i t u i t a r y . The f r o n t p a r t o f th e p i t u i t a r y g la n d . Synonymous w ith p r e - p i t u i t a r y and a n t e - p i t u i t a r y . A n t i - r a c h i ti c . Any su b stan ce w hich p re v e n ts o r c u re s r i c k e t s . A trophy. S h rin k in g o r d im in u tio n in s i z e . A u t i s t ic . "O f a p e r s o n a lity te n d in g to p re o c c u p a tio n w ith dreams and f a n ta s ie s and o th e r re m in a tio n s a t th e expense o f i n t e r e s t i n e x te r n a l ev en ts.." (E n g lish ) The so u rc e s f o r t h i s g lo s s a ry were p r i n c ip a ll y Gould, G.M., 40,000 M edical Words (P h ila d e lp h ia : P. B la k is to h ’s Son and Company, i95o} and R obinson, W * J . Our M y sterio u s L ife Glands; (New York: E ugenics P u b lis h in g Company, 1934) . 107 A vitam in o sis* Any d is e a s e o r c o n d itio n caused by a la c k o f v itam in s* B B actek^iology. The sc ie n c e d e a lin g w ith m icroorganism s* B asal M etabolism * The m e ta b o lic r a t a t r e s t , c a lc u la te d from th e consum ption o f oxygen* Basedow’ s D ise a se , r Synonymous w ith Exophthalm ic G o ite r. B e r i- b e r i . P o ly n e u r itis , o r m u ltip le n e u r itis * B r ig h t’s D isease* N e p h r itis o r in fla m a tio n o f th e k id n e y s . C C achexia. Any sev ere c o n s titu tio n a l d is e a s e w ith em ac ia tio n and e x h a u stio n . , C a lc if e r o l. C r y s ta llin e v ita m in D. C a lc if ic a tio n . The d é p o s itio n o f lim e s a l t s in th e t i s s u e s , c a l c i f i c a t i o n o f th e b o n es. C a lo rie . The amount o f h e a t re q u ire d to r a is e th e te m p e ra tu re o f one k ilo g ram o f w ater one d eg ree C e n tig ra d e . The u n it i s a p p lie d to th e f u e l v a lu e o f foods* C a rd ia c . P e rta in in g to th e h e a r t . C a r ie s . U lc e ra tio n s o f th e bones an d cteeth * C a s tr a tio n . E x cisio n o f th e gonads ( t e s t i c l e s o r o v a r ie s ) . C atam enia. M e n stru a tio n . C e re b ro -s p in a l. P e rta in in g to th e b r a in and th e s p in e . C ervix* The neck o f th e womb. C h ro n ic. Slow ly d ev elo p in g and lo n g c o n tin u e d . Antonym o f a c u te . C o llo id . A s e m i-s o lid , n o n - c r y s ta llin e su b sta n c e . C o n g e n ita l. E x is tin g from b ir th * C o n v u lsio n . A v io le n t in v o lu n ta ry m uscular spasm . Corpus luteum * A y e llo w ish mass in th e ovary m arking th e s i t e o f a ru p tu re d g r a a f ia n f o l l i c l e . 108 C o rtex . The o u te r la y e r o r " rin d " o f an o rg an . C o rtin . A name uaecL In soîiie q u a r te rs to d e s ig n a te th e hormone from th e c o rte x o f th e a d re n a l g la n d . C r e tin . A p erso n a f f l i c t e d w ith c r e tin is m . ■ ? C re tin ism . A d is e a s e o f th e th y ro id glàhc^^càusing v a ry in g d e g re e s and com bination o f m ental d e f ic ie n c y and dw arfed som atic developm ent. C y st. A membranous sac c o n ta in in g f l u f d . D D e fic ie n c y D ise a se . D isease caused by i n s u f f i c i e n t v ita m in s o r elem ents in th e fo o d . D iab e te s (D ia b e te s M e llitu s ) . A d is e a s e c h a ra c te r iz e d by an e x c e ssiv e blood sugar and a volum inous flow o f s u g a r-c o n ta in in g u r in e . D iab e te s I n s ip id u s . A d is e a s e c h a ra c te riz e d by e x c e ssiv e t h i r s t , and th e p a ssin g o f enormous amounts o f u rin e c o n ta in in g no sugar* D uct. A sm all tu b e o r c a n a l c a rry in g o f f th e s e c r e tio n from a g la n d . D u c tle ss g la n d s . E ndocrine g la n d s, g lan d s w ith an in te r n a l s e c r e tio n . Dwarfism . The c o n d itio n o f s tu n te d grow th. D y sfu n c tio n . F a u lty a c t i v i t y . Abnormal o r m orbid fu n c tio n . D ysm enorrhea. P a in fu l and d i f f i c u l t m e n s tru a tio n . D y s p itü ità ris m . D iso rd ered a c t i v i t y o r fu n c tio n o f th e p i t d l t a r y g la n d . D ystrophy. F a u lty grow th. _ ^ , _ _ _ _ _ - ^ -ectom y. A s u f f ix s ig n ify in g e x c is io n o r rem oval o f an o r g a n , i . e . , th y ro id ecto m y . Edema. S w ellin g due to accum ulation o f serum in c e l l u l a r t i s s u e . E n d e m ic .P r e s e n t more o f l e s s c o n s ta n tly in a l o c a l i t y . I s in c o n tr a s t to ep id em ic. Endocrine* Having an i n t e r n a l s e c re tio n * 109 Endogenous* O rig in a tin g w ith in th e body, w ith o u t th e n e c e s s ity o f in v a s io n . D iab e te s i s an endogenous d is e a s e . Enzyme* An u n o rg an ized fe rm e n t. L ife i s th o u g h t to be n e c e ssa ry f o r th e s y n th e s is o f e n z ^ e s . E p in e p h rin e . The hormone s e c re te d by th e m edulla o f th e a d re n a l g la n d . L ess m odefnly c a lle d a d r e n a lin o r a d r e n in . E p ip h y sis* 1* The p in e a l body. 2 . The e x tre m ity o f a lo n g b o n e. E p ith e liu m . The co v erin g o f th e s k in and mucous mem branes. I t i s c e llu la r * E rogenous. P ro d u c tiv e o f sex u a l excitem ent* E ro ticism * S exual d e s ir e , u s u a lly i n a m orbid sense* E s t r i n . The f o l l i c u l a r hormone w hich produces "h e a t" in anim als* E stru s* S exual ex citem en t in th e fem ale a n im a l. The p e rio d o f " h e a t" . E tio lo g y * Study o f th e cau ses o f d is e a s e . E x o c rin e . Having an e x te r n a l s e c re tio n * Exogenous. O rig in a tin g o u ts id e th e body. M easles i s an exogenous d is e a s e . E xophthalm ia. Abnormal p ro tu s io n o f th e eyes* P F erm ent. A su b stan ce w hich, in sm all am ounts, i s ca p ab le o f pro d u cin g changes in o rg a n ic su b sta n c e s w ith o u t i t s e l f u n d er going much o r any change. Some ferm en ts a r e m erely c a t a l y s t s . O thers a re o rganism s, l i k e y e a s t. F e tu s . The c h ild in th e womb from th e t h i r d to th e end o f th e n in th m onth. P r io r to th e t h i r d m onth, embryo i s th e c o r r e c t term* G G a s tric J u ic e . T % ie d ig e s tiv e ju ic e s e c re te d by th e stom ach. G e n ita ls . The re p ro d u c tiv e o rg a n s, more c u sto m a rily th e ex t e r n a l ones* G land. An org an , o r a g g re g a tio n o f c e l l s , p o s se ssin g th e s p e c ia l fu n c tio n o f m an u factu rin g s p e c ia l f l u i d s o r s e c r e tio n s . 110 Glucose* A m onosaccharide* The sim ple form of sugar w hich e x is t s in th e blood* Glycemia* Th#' c o n c e n tra tio n o f su g ar in th e blood* , -i. ^ . t ' • ' r- ■ * j j ' . . ■ . . - • - ■ Glycogen* A p o ly s a c c h a rid e . "Animal sta rc h * " A c a rb o h y d rate s to re d in anim al t i s s u e s , p a r t i o u l a r l y ’th e l i v e r . I t i s c o n v e rtib le in to b lo o d su g ar a s needed* G ly co g e n o ly sis* C onversion o f g lycogen in to b lood su g a r. G lycogenic* P roducing g ly co g en . G ly c o su ria . Sugar in th e u rin e * G o ite r. ^Ah enlargem ent o f th e th y ro id g la n d , in th e f r o n t o f th e n eck . Gonads* The~sex glands* J G ra a fia n F o l l i c l e . The m ature f o l l i c l e * A s p h e r ic a l v e s ic le in th e o u ts id e la y e r o f th e o v a ry . I t c o n ta in s an ovule (egg) and l i q u id under p r e s s u r e . I t e v e n tu a lly b u r s ts , cau sin g o v u la tio n . G raves D ise a se . Exophthalm ic G oiter* H H e te ro se x u a l. S e x u a lly norm al o r a t t r a c te d to th e o p p o site sex* Hormone. A chemi c a l sub sta n c e whi eh, produced in one p a r t o r o rg an , p a ssé s in to th e b lo o d stream , s tim u la tin g o th e r organs to a c tiv ity * The s e c r e tio n s o f th e en d o crin e g lan d s a re o r c o n ta in hormones* H y p er-. P r e f ix m eaning above, m ore, h ig h e r : H y p e rth y ro id is m - e x c e ssiv e fu n c tio n o f th e th ^ o l d * H i^ e rc a lc e m ia . An ex c ess o f calcium in th e b lo o d . H ^ e r f u n c tlo n . E x cessiv e fu n c tio n o r a c tiv ity * H y p e rg è n ità lism . Abnormal grow th o r developm ent o f th e g e n ita l o rg a n s. H ^ e rth y ro id is m . E x ce ssiv e a c t i v i t y o r s e c re tio n o f th e th y ro id * H ypo-. P re fix meaning u n d e r, l e s s , below ; H ypothyroidism — dim ished fu n c tio n o r s e c r e tio n o f th e th y ro id * I l l Hypoglycemia* I n s u f f i c i e n t blood s u g a r. H ypothyroidism . D im inished fu n c tio n o r s e c r e tio n o f th e th y ro id # I In tra m u s c u la r. W ithin o r in to a m u scle. L L e sio n . Any wound, d is e a s e d sp o t, any m orbid change i n th e s tr u c tu r e o f a ti s s u e or an o rg a n . M M a la ise . A f e e lin g o f u n e a s in e s s , a s l i g h t i l l n e s s , d is c o m fo rt. M a lfu n c tio n . To fu n c tio n ab norm ally, or abnorm al fu n c tio n . M enorrhea. M onthly flow o r m e n s tru a tio n . M etab o lism .' The p ro c e ss o f c o h v e rtih g fo o d , d rin k and oxygen in to li v in g t i s s u e s and b u rn in g up th e t i s s u e s i n th e p ro c e s s of l i v i n g . Thé c o n s tru c tiv e and d e s tr u c tiv e changes w hich go on in l iv in g o rganism s. M yasthenia G ra v is. Grave e x h a u stio n and d e g e n e ra tio n o f th e - m u scles. Myxedemaé A d is e a s e marked by h ard edema o r sw e llin g o f th e fa c e , d ry n e ss o f th e h a i r , d u lln e s s and a p a th y o f th e in t e l l e c t . The cause i s a d e fic ie n c y o f th y ro id s e c r e tio n . ¥ N e u r itis . Inflam m ation o f a n e rv e . 0 O steo m alacia. A m orbid s o fte n in g o f bone. P P a n c re a s. Goihmbn name— sw eetb read . A g lan d in th e abdomen w hich s e c r e te s i n s u l in and p a n c r e a tin . P a r e n te r a l. I n some way o th e r th an bÿ th e d ig e s tiv e t r a c t ; f o r in s ta n c e by in tra v e n o u s i n j e c ti o n . P e lla g r a . A sk in d is e a s e due to la c k o f c e r ta i n v ita m in s in th e fo o d . 112 P e rn ic io u s Anemia* Very se v e re anem ia w ith ty p ic a l accom pani m ents* P sy ch o an aly sis* A system o f p s y c h ia try founded by P ro fe s s o r Sigmund Freud which c o n s is ts in c a r e f u l stu d y in g o f th e m en tal c o n d itio n o f a p a tie n t by a n a ly z in g h is dreams and com paring h i s s u b je c tiv e and o b je c tiv e symptoms* P uberty# The p e rio d a t w hich a boy o r g i r l becomes s e x u a lly m a tu re * P u ru le n t. Having th e c h a ra c te r o f p u s, c o n ta in in g pus* R R ic k e ts . A lso c a lle d R a c h itis* A c o n s titu tio n a l d is e a s e o f c h ild h o o d , c h a ra c te r iz e d by s o fte n in g o f th e b o n es, m al n u t r i t i o n , sw eating and h y p e rs e n s itiv e n e s s when to u ch ed . S a c c h a rin . A sweet su b stan ce from c o a l - t a r , used a s a sub s t i t u t e f o r sugar* S curvy. A d is e a s e marked by sp o n g in ess and b le e d in g o f th e gums, in a n itio n , w eakness, edema, e t c . Caused by a de f ic ie n c y o f V itam in C in th e food* S e c r e tio n . The p ro c e ss o f m an u factu rin g and p o u rin g o u t c e r ta i n f l u i d s ; a ls o a p p lie d to th e f l u i d s so se c re te d * Syndrome. The sum o f a l l sig n s and symptoms b elo n g in g to a c e r ta in d ise a se * S y n th e s is . The fo rm a tio n o f a compound by u n itin g i t s elem ents* T Thyroxin* The hormone o r a c tiv e p r in c ip le o f th e th y ro id gland* Can now be p re p a re d a r t i f i c i a l l y * Trachea* The w indpipe; th e tu b e ex ten d in g from th e la ry n x to th e b fo n c h ia l tubes* U U lc e ra tio n . The p ro c e ss o f u l c e r f o m a tio n 113 V itam in s. P e c u lia r su b sta n c e s found in c e r ta in foods w hich a re n e c e ssa ry f o r norm al developm ent o f th e young and th e main ten an c e o f h e a lt h . A 3-so s p e lle d V itam in es. X ero p h th alm ia. A d ry inflam m ation o f th e ey e, so th a t no te a r s can be shed, w ith fo rm a tio n o f u l c e r s .

Asset Metadata

Creator Mitchell, Charles Bruce (author)

Core Title Study of experimental ketogenesis and some other dietary states in view of the personality effects of endocrine function

Contributor Digitized by ProQuest (provenance)

Degree Master of Arts

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Biological Sciences,OAI-PMH Harvest,Psychology

Format application/pdf (imt)

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c39-36143

Unique identifier UC11310676

Identifier EP63889.pdf (filename),usctheses-c39-36143 (legacy record id)

Legacy Identifier EP63889.pdf

Dmrecord 36143

Document Type Thesis

Format application/pdf (imt)

Rights Mitchell, C. B.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA

Linked assets

University of Southern California Dissertations and Theses