794 W. McKIM MARRIOTT 



rhea is markedly altered in composition. It is concentrated by water loss 

 (Reiss, Salge, Schloss). There is an increase in the specific gravity, the 

 index of refraction is high and the protein content markedly increased. 

 Thus a normal infant at 6 months of age should have a hlood protein of 

 about 6 per cent, an infant suffering from severe diarrhea may have over 

 9 per cent protein. The total dried residue is high, the viscosity is greater 

 than normal. The osmotic pressure and electrical conductivity are in- 

 creased which is evidence of a concentration of mineral salts as well as 

 of colloids. The urea and total non-protein nitrogen content of the serum 

 is high, the increase being greater than could be accounted for merely by 

 blood concentration (Schloss). That this increase is due to a functional 

 renal insufficiency is further shown by the high Ambard coefficient and re- 

 duced phenolphthalein excretion (Schloss). The inorganic phosphate of 

 the serum is sometimes high (Howland and Marriott (a)) and there is oc- 

 casionally hyperglycemia (Mogwitz). The hydrogen ion concentration of 

 the serum is increased, that is to say, the serum is more acid than normal, 

 the reserve alkalinity is decreased and the carbon dioxid combining capac- 

 ity low. There is a low O 2 combining capacity of the hemoglobin (How- 

 land and Marriott (a)). These findings are all positive evidences of the oc- 

 currence of acidosis. The acetone bodies of the blood may be moderately 

 increased but no more than in the case of well infants undergoing partial 

 starvation and not sufficiently increased to account for the severe degree 

 of acidosis often present (Moore). 



The cellular count and hemoglobin content of the blood obtained from 

 the capillaries by puncture of the skin is distinctly higher (20 per cent 

 or more) than of blood taken from the veins ( Marriott (c) ). This discrep- 

 ancy is to be explained on the basis of arteriolar constriction with a dam- 

 ming back of corpuscles on the capillary side. 



The alveolar air of infants with severe symptoms following diarrhea 

 often has a low carbon dioxid tension. This is additional evidence of 

 acidosis (Howland and Marriott (a), Schloss, Yllpo). 



Functional alterations in the circulatory system occur. There is ap- 

 parently incomplete diastolic filling of the heart as shown by fluoroscopic 

 examination (Czerny (&')). The peripheral circulation is greatly di- 

 minished, the volume of blood passing through an extremity being often 

 less than one-tenth of the normal amount (Utheim(a)). A considerable 

 degree of fever is a frequent occurrence. 



There has been much discussion as to the exact manner in which the 

 diarrhea brings about the profound chemical and physiological variations 

 from the normal which have been recounted above. 



Finkelstein(a)(&) and Langstein and Meyer(c) attributed the symp- 

 toms to a poisoning of the body by sugar, especially lactose, which they be- 

 lieved passes through the injured intestinal wall and thus enters the circu- 

 lation without first having been split into monosaccharids. They believed 



