802 W. McKIM MARRIOTT 



10 per cent glucose solution and considerable amounts may be given 

 intraperitoneally in the form of an isotonic glucose solution, or glucose 

 saline mixture. Athreptic infants show a curious behavior in their re- 

 actions to food. Many of them will maintain a constant weight, for quite 

 a long period and then with no change in the food or surroundings slowly 

 begin to gain. This period of repair seems to be a period during which 

 some necessary change in the physiology of the body is taking place. 

 Experiments on animals -in which the condition of athrepsia was dupli- 

 cated suggest that the period of repair may be a period during which the 

 blood volume is being restored to normal (Utheim(a)). 



Disturbances Due to Insufficiency of Certain Elements 



in the Diet 



When an infant or older child is fed on a diet which is sufficient to 

 supply the energy demand but which is lacking in protein and fat very 

 characteristic symptoms and disturbances of the metabolism are likely 

 to result. 



The condition was well described by Czerny under the name of "mehl- 

 nahrschaden" or "starch nutritional disturbance." As edema is one 

 of the striking features of the condition, it is sometimes referred to as 

 "nutritional edema" or "war edema." The condition is seen in infants 

 who have been fed for prolonged periods on a food composed largely of 

 cereals, or cereal gruels, or sugar with very little milk, or with merely 

 skimmed milk added. Such poorly balanced feeding may be given on 

 account of inability to obtain milk due to failure of the supply or to 

 poverty of the parents. Sometimes such a diet is used to correct a diar- 

 rhea and is kept up for long periods of time for fear that a return to a 

 normal diet would result in a recurrence of the diarrhea. Infants with 

 hypertrophic stenosis of the pylorus are occasionally fed on thick cereal 

 mixtures containing very little milk in order to prevent vomiting. Under 

 war conditions, the supply of milk and other foods is often reduced so 

 that the diet of children may be composed almost entirely of starches. 



The use of proprietary infant foods by ignorant parents on the as- 

 sumption that these foods, which are largely carbohydrate, are good sub- 

 stitutes for milk is frequently responsible for the development of the con- 

 dition. The very severe types of nutritional edema with accompanying 

 symptoms are not so frequent in this country as they are in Europe. A 

 mild degree of the disturbance is, however, quite frequent and is seen 

 especially in infants who have been fed for long periods of time on one 

 of the sweetened condensed milks. Sweetened condensed milk is a food 

 which contains a very high proportion of sugar with relatively little pro- 

 tein and fat and cannot be so diluted as to give an adequate amount of 



