T98 W. McKIM MARRIOTT 



is necessary to administer large amounts of fluid by every possible means. 

 The administration of fluid intraperitoneally (Blackfan and Maxey) is 

 one of'the most effective means of insuring the absorption of large amounts 

 of fluid without overtaxing the circulation. On account of the loss of 

 mineral material from the body the injected fluid should contain not only 

 sodium chlorid but also other salts. A modified Ringer's solution or di- 

 luted sea water is a satisfactory injection fluid. 



The administration of hypertonic glucose solutions intravenously tends 

 to promote the absorption of fluid from the gastro-intestinal tract or from 

 the peritoneum and acts as a diuretic; furthermore, it supplies a certain 

 amount of nourishment during the period when food by mouth is with- 

 held. 



Metabolic Disturbances Due to an Insufficient 

 Intake of Food 



Fortunately, relatively few infants suffering from diarrhea develop 

 the severe nutritional disturbances just described. In almost all there 

 is a temporary failure to gain or a moderate loss of weight, due most prob- 

 ably to the decreased amount of food material actually taken in and ab- 

 sorbed from the intestinal tract. With a cessation of the diarrhea and the 

 resumption of the normal food intake the loss is often quickly regained. 

 If, however, the diarrhea is prolonged even though not sufficiently severe 

 to lead to the disturbances described, there may result a very consid- 

 erable loss of weight and a train of well marked clinical symptoms. The 

 infant seems to waste away, the subcutaneous fat disappears and, in ex- 

 treme cases, the skin becomes paper thin, gray in color and hangs in 

 loose folds. The ribs and facial bones are prominent, the eyes sunken. 

 The muscular tone is poor and the infant's cry is weak. The pulse is 

 small, often slow, and occasionally irregular. The heart sounds are feeble. 

 The temperature tends to be below normal. There is a lowered resistance 

 to infections of all kinds and as a result furunculosis, otitis media, bron- 

 chitis and pyelitis are of frequent occurrence. These infants are ap- 

 parently always hungry and when fed amounts of food suitable for normal 

 infants of the same age they are likely to vomit and develop very severe 

 diarrhea. Even breast milk cannot be taken in more than small amounts. 

 Once the condition is developed recovery is extremely slow even though 

 the infant may later develop the capacity for considerable amounts of food 

 as far as the gastro-intestinal tract is concerned. 



The condition has been described under various names such as "ma- 

 rasmus", "pedatrophy", "dekomposition", "wasting disease", or "ath- 

 repgia". The last-named term, first applied by Parrot, is accurately de- 

 scriptive of the condition. 



