786 W. McKIM MARRIOTT 



urine as an indication that acidosis does in fact occur in these infants and 

 Czerny and Keller have suggested that the low grade acidosis thus brought 

 about is a factor in the causation of symptoms. This theory does not 

 rest on a very firm foundation as a high ammonia coefficient is not neces- 

 sarily an indication of acidosis. The more reliable methods for the de- 

 tection of acidosis have failed to demonstrate that it is present. Further- 

 more, the symptoms are not those of acidosis and the administration of 

 alkali fails to benefit the condition. 



Whether or not acidosis occurs/the fact remains that there is a loss 

 of mineral matter from the body and this may very well be an important 

 factor in interfering with normal processes of growth for we know that 

 inorganic material is an essential constituent of the body cells and fluids. 

 If loss of mineral by the bowel were the cause of the symptoms observed 

 one might suppose that the administration of inorganic salts in proper 

 amounts would be the logical treatment. Some efforts have been made 

 to treat these infants by the administration of salts by mouth but the re- 

 sults have not been satisfactory. It should be pointed out in this con- 

 nection that even though there is a sufficient intake of mineral matter by 

 mouth, absorption is not assured. The salt content of cow's milk is 

 much greater than that of human but, as has been mentioned, the feeding 

 of cow's milk results in a negative balance of certain mineral constituents. 



One view of the pathogenesis of the condition under consideration 

 is that of Benjamin, who believes that an excess of protein is the" chief 

 factor. He has shown that long continued feeding of a large amount of 

 protein leads to the retention of a great, deal of nitrogen without a cor- 

 responding gain in weight of the infant. This he interprets as evidence 

 that overfeeding with protein leads to an abnormal composition of the 

 body and thus interferes with the normal processes of growth and repair. 

 Benjamin's hypothesis is in interesting contrast to the prevailing modern 

 view that protein is relatively harmless. Holt and Levine have observed 

 an irregular weight curve and a considerable rise in body temperature 

 following the addition of considerable amounts of sodium caseinate to 

 the food of infants. This they attribute to a toxic action of protein split 

 products. Hoobler has observed serious symptoms ending in stupor 

 following the feeding of a high protein diet to an infant. A diet such as 

 cow's milk which contains a considerable amount of protein leads to a dis- 

 tinct change in the bacterial flora of the large intestine. It is a mooted 

 question whether or not the change in the flora has an influence on meta- 

 bolic processes. Porter, Morris and Meyer and Bessau present evidences 

 for the belief that the changes in the flora are an important factor in 

 causing a disturbance of the nutrition. Tanaka on increasing the casein 

 of the diet three- or fourfold found a poorer retention of nitrogen than 

 when smaller amounts of protein were fed and also poor absorption 

 and retention of calcium and of phosphorus. Howland and Stolte, on the 



