785 



The passage of "soap stools" by an infant may be perfectly compatible 

 with normal growth and development. In fact, most infants fed on 

 cow's milk modifications pass stools which partake more or less of this 

 character. Other infants, however, maintain a stationary weight even 

 with abundant food intake and present the symptoms already enumerated. 

 It is this class which is particularly considered here. One of the most 

 obvious explanations of the failure to gain weight is that despite a suffi- 

 cient food intake there is such a great loss of mineral by way of the 

 bowel that, insufficient food is absorbed. Metabolic studies by Freund(&) 

 (c) and by Bahrdt have shown that although the stools contain considerable 

 amounts of soaps the loss of fat in this way is small compared with the 

 amount absorbed. The absorption of fat is usually over 90 per cent of 

 the intake, and even in the most severe cases studied by him Bahrdt found 

 the fat absorption to be 81.9 per cent. The loss of fat in the form of 

 unabsorbed soap is entirely insufficient to explain the symptoms. If this 

 loss of fat were the underlying cause of the condition the addition of a 

 relatively small amount of fat to the diet should compensate for the loss 

 by way of the stools, but practical experience has shown that the addition 

 of more fat to the diet tends to aggravate the symptoms even when the 

 total amount of fat absorbed is actually increased by this means. It is, of 

 course, possible that altered conditions in the gastro-intestinal tract may 

 interfere with the absorption of the essential fat soluble accessory food 

 substance (vitamine, a fat soluble A"), but there is as yet no experimental 

 proof that such is the case. The amount of protein and of carbohydrate 

 lost in the stools is negligible. 



The mineral metabolism shows very considerable alterations from the 

 normal. The soap stools contain fairly large amounts of calcium and 

 magnesium, larger in fact than can be accounted for by the combination 

 with fatty acids in the form of soaps (Bahrdt). This excess of calcium 

 and magnesium is combined in the form of insoluble dibasic phosphates 

 the combination being favored by an alkaline condition in the gastro- 

 intestinal tract. The amount of calcium and magnesium lost in this way 

 may approximate the amount taken in with the food and in some in- 

 stances exceed it, so that an actual negative balance of calcium and mag- 

 nesium occurs (Birk, Kothberg, Bahrdt). In some instances, especially 

 when large amounts of fat have been fed, there is also a negative sodium 

 and potassium balance (Steinitz) although such a negative balance of the- 

 alkalies is not so likely to occur in these infants as in those who are suf- 

 fering from diarrhea. The loss of sodium and potassium salts by the 

 bowel is usually the result of increased secretion of the intestinal juices 

 which have been incompletely reabsorbed. It is conceivable that the 

 amount of base lost in this way could exceed the amount of acid excreted 

 and thus lead to a depletion of the reserve alkali of the body, that is to 

 say, acidosis. Steinitz has considered the high ammonia coefficient of the 



