PATHOLOGY OF METABOLISM IN INFANCY 789 



and the infant loses weight. The loss in weight may, in severe cases, 

 amount to as much as 10 or 15 per cent of the total body weight in a 

 single day. Vomiting and diarrhea are constant symptoms. In severe 

 cases the whole appearance of the infant changes. The features become 

 sharpened, the eyes sunken and fixed in a far-away stare or are turned 

 upwards under the half closed lids. The skin, especially over the fore- 

 head, is likely to assume a slate gray color. Over the body it hangs in 

 loose folds, it is dry and has lost its elasticity so that it may be picked up 

 into ridges which remain an appreciable interval before flattening. The 

 lips and tongue are dry and parched, the mouth is held partly open. The 

 infant is at first 'irritable and restless, later the psyche becomes clouded 

 and he lapses into a state of coma. The respirations are deeper than 

 normal, often of the air-hunger type. The pulse is small, sometimes almost 

 imperceptible, often rapid and irregular. The hands and feet are cold 

 although the rectal temperature is almost invariably elevated. The urine 

 is scanty, highly concentrated and may contain traces of albumin and a 

 substance capable of reducing Fehling's solution. The blood is thick, 

 does not flow easily and when centrifuged separates a relatively small 

 amount of serum. Some degree of leucocytosis is often present. 



In all infants the symptoms are not so severe. The diarrhea is less 

 marked and the extremely toxic manifestations do not occur. The clinical 

 picture has been described under various names such as "acute gastro-in- 

 testinal digestion", "sugar indigestion", "fermentative diarrhea" or "dys- 

 pepsia". These terms are usually applied to the milder forms of the dis- 

 turbance. To the more severe forms with toxic symptoms such names as 

 "cholera infantum", "acute gastro-intestinal intoxication", "toxicosis", 

 "alimentary intoxication", "anhydremic intoxication" are applied. 



The diarrhea of these infants may be brought about by overfeeding 

 with any food element, but an excess of carbohydrate is by far the most 

 frequent cause. An excess of fat may in itself lead to diarrhea but is more 

 likely to do so when considerable amounts of sugar are given at the same 

 time. Protein is rarely given in sufficiently large amounts to cause 

 diarrhea. There is considerable difference of opinion as to how an excess 

 of food brings about diarrhea. The view most generally held has been 

 that the increased peristalsis is the result of intestinal irritation by 

 organic acids, produced by the bacterial decomposition of carbohydrates 

 and fat. The clinical basis for this view is the fact that the diarrheal 

 stools are usually acid and that an excess of sugar or fat, substances which 

 on bacterial decomposition give rise to acids, are particularly likely to 

 lead to diarrhea. Before considering the possible bacterial decomposition 

 products of food, it is well to point out that any sugar in sufficiently con- 

 centrated solution is capable of setting up intestinal peristalsis purely 

 by its "salt" action and that this is probably the explanation of some of 

 the diarrheas resulting after the administration of hypertonic sugar solu- 



