810 W. McKIM MARRIOTT 



infant to gain satisfactorily despite an abundant intake of food. Such 

 infants as do gain in weight are flabby and pale. There is a tendency 

 to a catarrhal condition of the skin and mucous membranes. This is 

 manifested especially as eczema, intertrigo, rhinopharyngitis, otitis media, 

 bronchitis and gastro-intestinal disturbances. General hyperplasia of the 

 lymphoid tissues throughout the body occurs. There is a lessened re- 

 sistance to infection. - 



There is considerable difference of opinion as to whether or not the 

 exudative diathesis is in reality a definite clinical entity. The mani- 

 festations are so varied that it is quite possible a number of entirely dif- 

 ferent conditions of diverse etiology have been included. Czerny's idea 

 seems to have received more general acceptance in Europe than in this 

 country. 



In the discussion of metabolism in the condition, it would seem best to 

 consider only the changes occurring in those cases with manifest eczema 

 as it is only in this group that any significant alterations in metabolism 

 have been observed. 



Steinitz and Weigert found that infants with eczema were unable to 

 absorb fat to the same extent as normal infants. Czerny has considered 

 this finding of importance as showing an intolerance on the part of the 

 infant for fat. No significant changes in the nitrogen and carbohydrate 

 metabolism have been observed, although in some cases of eczema a 

 definite hypersensitiveness to foreign proteins has been observed 

 (Schloss(6), Blackfan). 



The most constant and marked features of the metabolism of eczema- 

 tous infants are alterations in the water and mineral salt balance. Lust 

 (a) and Lederer found at times a considerably increased water content of 

 the blood of eczematous patients as compared with the normal infant. 

 Most characteristic was a tendency to wide and rapidly occurring fluctu- 

 ations in the water content. The variations in the amounts of water re- 

 tained in the body seem to be dependent upon alterations in mineral metab- 

 olism. Thus Freund(c?) found infants with eczema showed a much 

 greater retention of sodium chlorid than normal infants given the same 

 diet. The retention of sodium chlorid was coincident with rapid gain in 

 weight due undoubtedly to simultaneous water retention. L. F. Meyer(c) 

 found during periods of underfeeding of eczematous patients a much 

 greater output of mineral salts than was observed in the case of normal 

 infants on the same diet. This finding, together with those of Freund, 

 suggests a very labile salt metabolism of the eczematous infant. Salts are 

 readily retained and as readily excreted. Bruck studying a number of 

 cases of eczema found little or no change in the mineral metabolism. It 

 is possible that eczema is a disease of diverse etiology and that its mani- 

 festations are not always the same. 



The treatment of the condition has not been any too satisfactory. In 



