PATHOLOGY OF METABOLISM IN INFANCY 793 



of base by the bowel. He overlooked the fact that there was a greater loss 

 of the acid elements. 



The loss of calcium and of phosphoric acid is, according to all ob- 

 servers, hardly increased above the normal and the balance of these ele- 

 ments is usually positive even in very severe diarrhea. This is in marked 

 contrast to the findings in cases of constipation with soap stools previously 

 described. The difference is probably due to the favorable effect of an 

 acid reaction of the contents of the lower intestine on calcium and phos- 

 phate absorption. *. 



The loss of water in the diarrheal stools is more marked than that 

 of any other constituent, the amount lost in this way may be as much as 

 fifteen times as great as under normal conditions (Jundell). This loss 

 of water is such as to threaten the water reserve of the body and, as will 

 be seen later, is an important factor in bringing about deep-seated changes 

 in the intermediary metabolism. 



The urine of these infants is markedly diminished in volume even to the 

 point of almost complete anuria. Such urine as is passed is highly con- 

 centrated and may contain as much or more total nitrogen in a very small 

 volume as is contained in the entire 24-hour urine of a normal infant. The 

 excretion of organic nitrogen by way of the urine and bowel not infrequent- 

 ly exceeds the nitrogen intake so that an actual negative nitrogen balance 

 is the result. The nitrogen partition in the urine differs from that in 

 health ; the most striding changes are an excess of ammonia and of amino 

 acid nitrogen. Albumin is generally present in moderate amounts. Modi- 

 gliani, Lust(c), and Schloss and Worthen(&) have brought forward evi- 

 dence to prove that the protein of the urine is, in part, food protein and 

 which must therefore have passed unchanged through the intestinal wall. 



Acetone bodies may occur in the urine in small amounts but the quan- 

 tities are no greater than in the urine of normal infants during a period 

 of underfeeding. 



A reducing substance is present in the urine in almost all severe cases. 

 Langstein and Steinitz, and Meyer (&) supposed this substance to be lactose 

 which had passed unchanged through the intestinal wall into the blood 

 and, as it could not be utilized in the body, was excreted in the urine. 

 Schloss has, however, shown that these investigators based their conclusions 

 on faulty chemical methods. He found the reducing substance of the urine 

 to be invariably glucose or glucose with traces of lactose and galactose. 



Mineral excretion by way of the urine differs from that during health. 

 There is less excretion of sodium, potassium and chlorids than in the 

 normal urine (Meyer (6) ) and this in some measure compensates for the in- 

 creased excretion by way of the bowel, but not completely so for the bal- 

 ance of these elements is usually negative. The excretion of calcium and 

 of phosphorus is, if anything, slightly less than normal. 



The blood of infants suffering from the severe end results of diar- 



