PATHOLOGY OF METABOLISM IN INFANCY 801 



it occurs often as the result of prolonged diarrhea brought about by over- 

 feeding is essentially a condition resulting from an insufficient amount 

 of food available for building up body tissue. 



During the stage of development of athrepsia, all of the evidence points 

 to the fact that there is a breakdown of body tissue. This destruction 

 of body substance is not confined to the solid portions of the organism 

 but affects the blood as well. There are a diminution in blood protein, 

 a destruction of blood corpuscles, and a decrease in the total blood volume 

 (Marriott (c), Utheim(a)). Diminution in blood volume has the same ef- 

 fect in these infants as diminution of blood volume brought about in any 

 other manner. There is a diminished blood flow (Utheim(a)) at least in 

 the peripheral portions of the body. The flow of blood through the internal 

 organs has not been measured so that we do not know if it is decreased 

 in amount or not. It would seem likely that a decreased flow of blood 

 occurs throughout the body, and if this were true one would expect a 

 lowering of the functional capacity of all parts of the body. 



There is considerable evidence that the functional capacity of the 

 body is lowered, and furthermore, when the blood volume is increased there- 

 is a return of normal function. 



The treatment of the condition of athrepsia based on the known changes 

 in metabolism is to supply a food containing all of the essentials necessary 

 for building up body tissue and one which will at the same time have 

 a sufficient caloric value to cover the rather high energy demands. 

 Furthermore such food must be one which can be digested and absorbed 

 by an infant whose gastro-intestinal tract is functionally weak. 



The capacity of these infants to utilize food may be increased by 

 methods which restore the blood volume to normal. For this reason trans- 

 fusion is a valuable preliminary in any form of treatment. ' Unfortunate- 

 ly, the blood volume even when restored to normal by transfusion often 

 fails to be maintained and for this reason repeated transfusions may be 

 necessary. A substitute for blood which is of some value is a solution 

 of glucose and gum acacia (Marriott (c)). Such a solution supplies a cer- 

 tain amount of food and tends to maintain blood volume. 



Infants, and especially athreptic infants, are able to digest a larger 

 amount of food if given in the form of breast milk than in any of the 

 prepared mixtures of cow's milk. Furthermore, breast milk supplies all 

 of the essential elements necessary for building up the body. When breast 

 milk is not available some form of artificially soured cow's milk is the 

 most valuable food. The infants are usually able to take a larger amount 

 of acidified cow's milk than of sweet cow's milk. It is an advantage to 

 these infants if a large amount of sugar can be fed, as this supplies a 

 readily utilizable form of energy and tends to spare protein destruction. 

 Larger amounts of dextrin and maltose may be fed than of some of the 

 other sugars. Sugar may also be given intravenously in the form of a 



