795 



that the increased permeability of the gastrointestinal tract is brought 

 about by irritant acids. They explained the fact that severe symptoms are 

 not so likely to occur following diarrhea in breast fed infants, despite the 

 high lactose content of breast milk, on the basis that the whey of breast 

 milk tends to protect the intestinal mucosa from the harmful effects 

 of acid. The whey of cow's milk is supposed to injure the mucosa and 

 make it more permeable and more susceptible to the action of acids. They 

 considered the altered mineral metabolism also as a result of lactose in- 

 toxication, on the supposition that the sugar alters the permeability of 

 the cells of the body thus disturbing the normal salt distribution. It is 

 also claimed by the adherents of the Finkelstein school that the whey 

 salts of cow's milk exert an influence on the mineral metabolism. The 

 great water loss from the body is considered secondary to salt loss. The 

 fever is explained on the basis of a specific pyrogenic action of lactose and 

 of mineral salts. The acidosis they do not satisfactorily explain, but Fink- 

 elstein^) suggests that it may be due in part to abnormal production of 

 acids from sugar in the intermediary metabolism and in part to a loss of 

 alkali. 



Finkelstein and his colleagues have based their theories on the ob- 

 served fact that the feeding of an excess of cow's milk or of cow's milk 

 whey to an infant suffering from diarrhea leads to an increase in all of 

 the symptoms. That lactose enters the circulation is claimed by Lang- 

 stein and Steinitz and by Meyer (c) but, as previously pointed out, Sehloss 

 has been unable to confirm this fact. That lactose and an excess of sodium 

 chlorid circulating in the body is capable of doing harm is claimed by 

 the adherents of this school on the basis of the experimental work of 

 Finkelstein and his assistants who observed serious symptoms following 

 the intravenous, administration of lactose. Allen (a), Helmholz, Rosenthal 

 (a) and Balcar, Sansum and Woodyat have, on the other hand, been unable 

 to show any specific toxic effect of either lactose or sodium chlorid when 

 injected into the circulation in any but overwhelming amounts and in con- 

 centrated solution. The discussion of the possible harmful effects of sugar 

 and salt introduced parenterally has been chiefly concerned with whether 

 or not fever is produced. Even if it were, it is only one symptom of severe 

 diarrhea. There is no evidence that either the clinical picture or the char- 

 acteristic changes in metabolism can be brought about by the administra- 

 tion of any amount of lactose or sodium chlorid. 



The idea of the harmful effect of cow's milk whey is based on some 

 experiments of L. F. Meyer (a) who fed infants on mixtures of cow's milk 

 whey with the curds of breast milk and then changed the feeding to one 

 prepared from the whey of breast milk with the curds of cow's milk. He 

 claimed on the basis of a very limited number of experiments, that infants 

 recovering from diarrhea, when fed on breast milk whey with cow's milk 

 curds, progressed favorably whereas when fed on cow's milk whey with 



