PATHOLOGY OF -METABOLISM IN INFANCY 79T 



to Balcar, Sansum and Woodyatt, to an insufficient water reserve. Straub 

 (a) has shown experimentally that desiccation of the body results in 

 severe disturbances of the metabolism, chief among which are a negative 

 nitrogen and mineral salt balance. 



It is thus seen that there is direct experimental evidence that a water 

 deficit in the body can account for the entire picture presented by these 

 infants, who, following severe diarrhea, have lapsed into a toxic-like con- 

 dition with grave disturbances of the metabolism and who are known 

 to have a greatly diminished water content of the body. In the light of 

 our present knowledge it seems more reasonable to assume that water loss 

 is the important factor in these infants and that the harmful effect of 

 an excess of food especially of sugar is due to the fact that it leads to 

 an increase in the diarrhea and consequently to the water loss from the 

 body. 



Exactly the same clinical and metabolic picture is presented by in- 

 fants who are not suffering from diarrhea but who have become desiccated 

 by insufficient fluid intake (Marriott(c) ), excessive vomiting, or increased 

 loss of water due to high external temperature (Ilietschel(&) ). 



When the condition of desiccation of the body or "anhydremia" has 

 existed for any length of time such serious injury to the body cells takes 

 place that recovery may be impossible even if the lost water is restored. 

 If, however, in the case of diarrhea, the water loss can be checked soon 

 enough and sufficient water and mineral matter supplied to the body, 

 recovery may be expected. 



If all food is withheld for a period and water alone given the upper 

 intestinal tract becomes relatively bacteria free. No demands are made 

 upon the secretory glands, there is nothing to irritate the intestine and 

 to stimulate peristalsis, absorption of water is improved. After a period 

 cf fasting of from 12 to 24 hours a small amount of food can usually be 

 taken without harm. The foods which arc least likely to increase the diar- 

 rhea are those which contain relatively little fermentable sugar. Foods 

 which contain very little fat are less likely to cause a continuance of the 

 diarrhea than those from which the fat has been removed, for example, 

 skimmed milk. Protein is well tolerated and, if anything, tends to cause 

 a cessation of the diarrhea. The whey of cow's milk is considered harm- 

 ful by Finkelstein who makes use of a preparation containing very little 

 whey, namely, protein milk. Morse and Talbot, on the other hand, on 

 the basis of their experience state that whey is as likely to agree as any 

 other form of artificial food. Milk which has been artificially soured by 

 lactic acid producing organisms is very well tolerated, this is probably 

 due to its low "buffer" value, its freedom from bacteria, other than the 

 harmless lactic acid organisms, and the finely divided form of its casein. 



The water deficit of the tissues of these infants is great and must be 

 made up at the earliest possible moment. In order to accomplish this it 



