AIMS OF MODERN PEDIATRICS 481 



still undeveloped in spite of the high development of organic chemis- 

 try. The subjects of chemic investigation are especially the excreta 

 of the body, the urine and the feces. The study of urine has for a long 

 time, at least in early infancy, been improperly neglected on account 

 of the difficulty in collecting it. Thanks to Kjelberg's suggestion the 

 catheter is now more frequently used for the collection of urine, 

 especially in girls, while in boys we use the Raudnitz urinal. As 

 a result unexpected frequency and variety of albumin, in the study of 

 which Heubner has done especial service. Also the presence of other 

 substances useful in diagnosis; the substances shown by Ehrlich's 

 diazo reaction, acetone, diacetic acid, etc., were found in children of 

 all ages. As regards the morphologic elements, not considering the 

 very great frequency of blood and tube casts, we will only mention 

 the presence of bladder and kidney epithelium, as well as of bacteria 

 (generally colon bacilli), as an expression of infection of the urinary 

 tract occurring especially often in girls. The use of the centrifuge in 

 all these examinations is very advantageous. Another very promis- 

 ing method is the freezing-point determination, introduced into 

 clinical medicine by Koran yi; it has been used repeatedly in pedia- 

 trics, in the study of the milk as well as the urine. 



The collection of the stools is much easier than of the urine, at 

 least in nurslings; they also offer much more favorable opportuni- 

 ties for diagnosis and analysis than do the stools of adults. While in 

 the latter it is a mass of stinking putrefaction, composed of a third of 

 bacteria, in the nursling, the stool on account of the much shorter 

 intestinal tract is comparable to that obtained from a fistula of the 

 small intestine and shows, like the contents of the small intestine, 

 acid reaction, no putrefaction, and comparatively few bacteria; food 

 constituents if found in it at all are found in relatively slightly altered 

 condition. Another factor which considerably increases the diagnos- 

 tic importance of the nursling's stool is the similarity or at least 

 very limited variation in the character of the food, whereby the 

 determination of a normal stool in respect to color, amount, and 

 chemic composition is rendered possible. For this reason the chemic 

 analysis of the stools of infants, especially those partaking of breast 

 milk, was undertaken comparatively early (Wegscheider). The com- 

 position of the bacterial flora was studied by me, by Booker, and 

 more lately by Tissier, who points with right to the importance of the 

 anaerobes. Thanks to these conditions we are able to determine 

 the pathologic changes in the digestive process of nurslings by chemic 

 and bacteriologic examination of their stools much earlier and more 

 exactly, and even to make the clinical diagnosis in a not inconsider- 

 able number of cases. 



The investigation of these excreta gains much in importance 

 because their analysis enables us to gain an insight into the meta- 



