PATHOLOGY OF METABOLISM IN INFANCY 783 



of disturbances based upon symptom complexes have been described in 

 great detail, but many authors have contented themselves with these de- 

 scriptions and have dismissed the subject of the underlying pathology 

 of metabolism with a few brief statements to the effect that the child's 

 "tolerance" for food has been exceeded and that the symptoms are the re- 

 sult. Others state that the intermediary metabolism is deranged by an 

 excess of food so that poisons are produced in the body but fail to state 

 how the course of metabolism is changed or what is the nature of the 

 hypothetical poisons. 



Czerny was one of the first to attempt classification of the metabolic 

 disturbances of infancy which result from an excessive intake of food. 

 Under the name of "milchnahrschaden" he described the clinical picture 

 resulting from an overfeeding of milk, especially cow's milk. The same 

 clinical picture has been described by other authors under different names 

 such as "fat constipation," "fettnahrschaden," "bilanzstorung," "chronic 

 fat indigestion," etc. The symptoms may be of all degrees of severity. 

 Almost any artificially fed infant may be said to show the symptoms to 

 a greater or less degree. When the condition is well marked the infant's 

 weight remains at a standstill or even decreases. The skin loses its normal 

 elasticity and becomes pale and waxy in appearance. The muscular tone is 

 poor. The infant becomes fretful and restless. The temperature fluc- 

 tuates somewhat although rarely more than 2F. except in the presence 

 of complications. Resistance to infection is lowered so that rhinopharyn- 

 gitis, otitis media, pyelitis and skin infections are liable to occur. The spit- 

 ting up of small amounts of food after each feeding is frequently ob- 

 served. The stools are ordinarily few in number and are putty-like in 

 consistency, light gray in color and alkaline in reaction. The char- 

 acter of the stools is due to the fact that they contain a much larger per- 

 centage of calcium and magnesium soaps than do normal stools (Freund 

 (&)(c), also Holt, Courtney and Fales(c)). The urine contains no al- 

 bumin or casts and is essentially normal in character except for a some- 

 what increased ammonia coefficient. There are no gross or microscopical 

 changes in any of the organs. 



The pathogenesis of the condition is not always the same, and it would 

 appear from metabolic studies and from clinical observation that more 

 than one factor may be responsible. An excess of fat or protein in the 

 food, an insufficient amount of carbohydrate or an improper mineral salt 

 intake have all been considered as factors involved in bringing about 

 the condition. 



Inasmuch as "soap stools" are characteristically present and as clinical 

 improvement frequently occurs coincident with alteration in the type of 

 the stools, attention has been directed particularly to the chemical com- 

 position of these stools and to the mechanism of their formation and the 

 metabolic changes in the body which are the result. 



