Chemical Examination of the Feces of Infants and Children after Gastroenterostomy

FRITZ B. TALBOT
1909 Boston Medical and Surgical Journal  
crease of internal pressure would tend to break the adhesions and re-establish the normal posterior horn. Might not such straining on the adhesions give rise to pain or other symptoms? 6. That the calcarine fissure and the cerebellum, which modify so much the shape of the posterior horn, are developing rapidly about the time of the appearance of convulsions in infants is an interesting coincidence, especially taken in consideration with the case briefly mentioned in this paper. 7. The large
more » ... r. 7. The large proportion of anomalies in the posterior horns of brains from institutions is significant. 8. In all cases the ventricle should extend far into the occipital lobe, and traces of its having been there at one time during development are always to be found. 9. The relationship of the optic radiation and other structures to the posterior horn are important facts for consideration in connection with the causes of temporary scotoma and migraine, and possibly other conditions. The following investigation was undertaken, at the suggestion of Dr. Charles L. Scudder, upon specimens obtained from cases operated upon by him and upon other material collected from a wide territory. The object of this study was primarily to determine whether or not gastroenterostomy, performed on babies with benign pyloric stenosis, modified the digestion of fat, starch and protein. It was hoped that accurate data of the amounts and quality of the food could be obtained. The patients, however, were not under the writer's control, and it thus was impossible to make this a metabolism experiment. The parents or physicians in charge of the patients were requested to collect all the stools, free from urine, passed during a period of three days. There was no attempt to mark off the beginning and end of the three days with carmine. The specimens were placed in glass jars and sent to the writer by express, some of them arriving the next day, and the most distant one taking five days. They were all collected during the cold weather of the winter of 1908-1909, and were, therefore, chilled or frozen when received. They were thawed out, thoroughly mixed up, and examined microscopically for muscle fibers, connective tissue, starch and fat. Muscle and connective tissue were looked for in an unstained cover glass specimen, and starch in a specimen stained by Lugol's solution. The estimation of fat under the microscope will not be recorded, because the chemical examinations recorded in the accompanying table give accurate figures. The character but not the quantity of the food during the three days was known in all but two instances. These were two five-months-old babies which were probably fed on milk in some form. The diets of Case 3 and Case a included all kinds of meat, and Case e and Case 2 chicken only. None of the stools from these contained an excess of muscle fiber or connective tissue. All but Case 6 and Case / took starch in some form, and none of the stools showed starch either by the macroscopic or microscopic test with Lugol's solution. Cases 1, / and 4 were said to be " constipated, but otherwise well." The rest were reported " perfectly well." In spite of the fact that the data were not as accurate as could be wished, because the patients were not under the writer's control, because the quantities of the food components were not recorded, and because the urine was separated from the feces by untrained observers, the stools were dried down and examined chemically for fats and nitrogen, according to a modification of Fr. Miiller's method, described in the Boston Medical and Surgical Journal, June 11, 1908, page 906. The work of Camerer, Hartmann, Escherich and Rubner shows that the quantity and quality of the food ingested may cause wide variations in the amounts of feces excreted. The weights of the stools of these patients after gastro-enterostomy when compared with these figures all come within the normal limits. In comparing the total weight of stools passed per day with those for corresponding ages collected by Schmidt and Strassburger, the results do not show a great variation from the normal. The percentage of nitrogen is also influenced by the quality of the food given. According to Biedert, it varies from 4.23% of the dried stool in bottle-fed babies to 5.28% of the dried stool in breast-fed babies. The percentages are somewhat higher on the average adult diet, ranging from 5 to 8%. If these figures are representative of all normal conditions, the percentages of nitrogen in the above table are within the variations of the normal. Three only approach the highest limit. It is safe to say, therefore, that none of these specimens show a marked increase in the amount of protein excreted. Cases c, 1 and d contained a higher percentage of total fat in the dry stool than would be expected in normal children of the same age. The others were well under the normal limits. According to Fr. Müller, 75% of this fat should be split into fatty acids and soaps, or, in other words, less than 25% of the total fat of the dried stool should be in the form of neutral fat. Cases 6, /, o, 4, e, a and d were very close to or within this arbitrary limit of 25% of neutral fat; on the other hand, Cases c and 3 were considerably above
doi:10.1056/nejm190911251612204 fatcat:rdduugryqned7gi4443l2jnyqi