Book Review Therapeutics of Dry Hot Air . By Clarence Edward Skinner, M.D., LL.D. Third edition. Thoroughly revised to date. Hammond, Indiana: Frank S. Betz Company. 1914
Boston Medical and Surgical Journal
In answer to Dr. Percy, I will say that we did see carbohydrate, or signs of carbohydrate indigestion in the course of some of these cases, but whenever it occurred we could relieve it very easily, but the fat indigestion we could not relieve so easily. Also there is a large series of cases that came into the hospital which were diagnosed as carbohydrate indigestion only. They gave the symptoms of acid irritating stools, gas, green movements and vomiting, but they were very easily relieved and
... asily relieved and soon discharged. In those cases when we gave moderate amounts of carbohydrates we did not see signs of carbohydrate indigestion after they entered the hospital. The only time we saw it was when we attempted to experiment by increasing the amount of carbohydrates. Dr. Gale's question: A certain number of cases were on maltose preceding a "blow-up," with an increasing amount of fat in their stools; fully as many cases in the series showed fat "blow-ups" on maltose as on lactose. Possibly we had more on maltose. The maltose seemed not so much of use in preventing the "blow-ups," but it allowed us to obtain a gain in weight with a small amount of fat. It nourished the baby better, but did not increase the fat tolerance. Dr. Porter's question: I am by no means convinced myself from our evidence that the cow's milk salts do not play an important rôle in these cases. In fact, we entered the investigation rather in the hope of obtaining evidence to that effect. The method of using precipitated casein and alternating with whole milk protein is a rather crude one, anyway. What we would like to do if we had enough breast-milk would be to repeat the experiment of using human milk fat with cows' milk, whey and vice versa. It seems to me it would give very definite evidence as to the rôle of the salts. All we were able to conclude was that wo did not get the advantage from feeding tho precipitated casein and diminishing the salts that we expected to get when we began the investigation. There were certainly cases in the series which did better on precipitated cesein, but there were others which did not. Dr. Talbot has spoken about estimating the amount of fat as soaps in the stools. I do not believe that our method is an accurate one at all, but we are endeavoring to adopt a standardized method which we will transmit from house officer to house officer. The method is simply to take a definitely measured portion of the stool and mix it with Sudan III and acetic acid, boiling, and then estimating the results by the concentration of the globules. This is a very crude method, and although we have what we call a sliding scale, yet the evidence of the actual amount of fat as shown in this way does not amount to very much-it is either a soap stool or it is not. The importance of maintaining a balance between the fat, carbohydrates and protein I quite agree with. You have got to keep the balance more or less constant or some form of indigestion will surely follow. Dr. Talbot asked whether they were all cases of fat indigestion or whether some of them might not have been carbohydrate indigestion. I might say that we did not classify them as to what was the possible primary condition. We classified as carbohydrate indigestion those which did not show fat indigestion, cases showing symptoms of carbohydrate indigestion which were relieved when the carbohydrates were cut down or changed. The other eases which showed fat in the stools we classified as fat indigestion without reserve. The only evidence which I have on that point was obtained from looking over all the histories, which we went into as carefully as possible. This frequently suggested carbohydrate overfeeding, and it was on that basis that I suggested that the carbohydrate fermentation seemed to be a very possible primary cause, and I think that the relationship between fat and carbohydrate indigestion is very close, just as Dr. number of additional case reports, several new illustrations, and a number of technical details. This third edition has been largely rewritten so as to embody and conform with recent advances in knowledge, and contains a new chapter on the incandescent electric light as a local therapeutic agent. It is illustrated with 40 text-cuts. It has the merits and defects of its original, and, in the words of our previous review, ' ' cannot be called a judicial statement of the uses and limitations of this mode of treatment." Modern Medicine.