792 W. McKIM MARRIOTT 



well-balanced food is of necessity slowly digested and absorbed, the un~ 

 absorbed residue may serve as a culture medium for bacteria. When 

 the secretions of the stomach and intestines are decreased from any cause, 

 digestion and absorption of food is slow and bacterial growth especially 

 favored on account of lack of the antiseptic action of the secretions. Salle 

 has shown that in hot weather the gastric juice in infants may be appreci- 

 ably lessened in volume and in content of hydrochloric acid and ferments. 

 Carlson has observed a distinct diminution of the gastric juice in the pres- 

 ence of fever. From these facts we have an explanation of the greater fre- 

 quency of diarrhea during the summer months and its frequent occurrence 

 in infants suffering- from fever even though, the fever be of parenteral 

 origin. Diarrhea, however brought about, may, if sufficiently prolonged 

 or severe, lead to grave disturbances of the metabolism. These disturb- 

 ances are largely the result of an excessive loss of material by way of the 

 bowel. The researches of Jundell, and of Holt, Courtney and Fales(a) 

 have shown the magnitude and character of this loss. The results obtained 

 by these various workers are essentially in accord. The diarrheal stools 

 contain considerable amounts of nitrogenous material which is in part un- 

 absorbed protein and in part secretion from the irritated intestinal tract. 

 The protein loss in the stools may be two or three times as great as that 

 in health. The loss of fat is even greater, this being mostly in the form 

 of neutral fat and fatty acids together with small amounts of alkali or 

 alkali earth soaps. In severe diarrhea as much as 87 per cent of the fat 

 taken in may be lost in the stools (Jundell). Such amounts of sugar as 

 may reach the lower intestinal tract are completely broken up by bacteria 

 and only the end products, organic acids, appear in the stools. The amount 

 of sugar actually absorbed is undoubtedly greatly diminished in diarrhea, 

 but, as it is impossible to determine by analysis of the stools just how 

 much has been destroyed by bacteria, the total absorption cannot be ac- 

 curately calculated. If the infant is receiving starch considerable amounts 

 may appear unchanged in the stools. 



As to the loss of certain other organic constituents of the food such 

 as the vitamines, bile pigments and salts we have no accurate information. 

 It would seem practically certain that a loss of each of these substances by 

 way of the bowel must occur during severe diarrhea. 



The total mineral loss by the bowel is very great and often exceeds 

 the intake. In this loss sodium, potassium, magnesium and chlorids are 

 chiefly concerned (Jundell ; Holt, Courtney and Fales(a) ; Steinitz). The 

 balance of each of these elements is negative in the severe diarrheas but 

 the loss of the chlorin ion is proportionately greater than that of either 

 sodium or potassium (Holt, Courtney and Fales(a)) so that the end result 

 is a loss of acid rather than of alkali by the bowel. Steinitz on the basis 

 of the negative sodium and potassium balances suggested that infants with 

 diarrhea were suffering from a "relative acidosis" as a result of the loss 



