The number of investigations of the exact acidity, that is, the hydrogen ion concentration, of infants' stools reported in the literature are comparatively few. When the possible importance of the relation of the acidity of the stools to the general condition of the infant, the rate of growth, the presence of fermentative diarrhea, parenteral infections and many other conditions are considered, it is rather surprising that so few determinations have been reported. The only results which we have been able to find have been recorded in the German literature.
The studies reported in this paper were undertaken in consequence of some clinical and chemical observations made by us on the condition of chronic intestinal indigestion, particularly in relation to treatment with special high protein diets.1 It seemed desirable to attempt to explain certain apparently contradictory phenomena, and if possible to formulate a rational explanation of the successful use of extremely high protein diets in overcoming this condition.The first question that comes to mind concerns the well-known characteristics of the typical feces, namely, mushy consistency, often acid reaction, suggesting abnormal fermentative activity in the intestinal tract, but accompanied almost invariably by a markedly putrefactive odor. How are the symptoms of two antagonistic forms of bacterial activity to be accounted for? That a fermentative condition prevails is supported by the abdominal distension characteristic of the condition, and by the exaggeration of symptoms when more carbohydrate is added to the diet. That putrefactive activities are also concerned seems to have been indicated by Herter's 2 findings of indolic and phenolic sub¬ stances in the urine and of aromatic oxyacids in the feces in chronic intestinal indigestion. Other questions arise in connection with the type of food used to bring about improvement. A high protein diet would naturally tend to overcome the excessive fermentation, but why at the same time does it not encourage the putrefactive processes? Further, the importance of the ingestion of large amounts of a specific organism, namely, Streptococcus lacticus (Micrococcus ovalis) in the
Since the appearance of Czerny and Kleinschmidt's article in the Jahrbuch f\l=u"\r Kinderheilkunde for 1918, describing their new butter\x=req-\ flour mixture for infants and their experience in its use, many contributions on the subject have appeared in the German periodicals, particularly the Jahrbuch f\l=u"\r Kinderheilkunde and the Zeitschrift f\l =u"\r Kinderheilkunde. The only extensive articles in English are those by Crozer Griffith 1 and by Graeme Mitchell.2 All, with the exception of one each by Stolte 3 and Zielaskowski,4 are mainly clinical discussions and report no metabolism observations. Most of these writers give their experience with feeding from twenty to fifty children on this food for varying lengths of time. For the type of children for whom it is indicated there is almost unanimous agreement that the use of the C-K butter-flour mixture brings about rapid and uniform weight gain, improvement in color of the skin and in turgor, deposition of subcutaneous fat, tendency to sleep well, and a generally happy disposition.The stools resemble those of breast fed infants and like them contain a large percent of fat.Many clinicians recommend its exclusive use for very young, pre¬ mature or very small infants when artificially fed. Czerny and Kleinschmidt consider that prematures under 1,700 gm. in weight should receive part breast milk. Several others think that young weakly infants should have butter-flour mixture supplemented by breast milk.One author claims to get better results with the butter-flour mixture for children over six months of age than for those under. Some report success in using it for infants who are vomiting, especially infants of the neuropathic type. There is general agreement, however, that in certain cases of eczema its use is indicated, here again with neuropathic children, while in other cases of eczema the condition is aggravated by feeding with butter-flour mixture. Several consider it adapted for
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