814 FRANCIS H. McCRUDDEN 



merely descriptive classification, and not attempting to find any relation- 

 ship between their cases and the laboratory cases of stunted growth. The 

 first type of infantilism in which an attempt was made to study the meta- 

 bolic changes with any degree of thoroughness is the so-called "Intestinal 

 Infantilism" first described by Herter in 1908. This form of infant- 

 . ilism occurs in childhood, and is characterized by periods of disturbance 

 of nutrition with loss of weight, alternating with periods of normal nutri- 

 tion and gain of weight ; it finally ends in a state of arrest of development 

 in which it is almost impossible to bring about increase of weight. There 

 are marked abdominal distention, a moderate grade of anemia ; there are 

 symptoms of rickets, and a rapid onset of physical and mental fatigue. 

 Diarrhea, or at least looseness of the bowels, is frequent ; and the stools are 

 often fatty and foul. The appetite and thirst are excessive. The urine is 

 frequently increased in quantity, and shows a rise in the ethereal sulphates, 

 indican, phenol, and oxy-acids. There is a change in the intestinal 

 flora a reversion to the flora of the infantile type. 



Herter described five cases which he had thoroughly studied and re- 

 ferred to five others that he had seen. Freeman described four cases. 

 Three cases described by Schultz and others by Huebner fit into this 

 category. 



The intestinal symptoms seemed so definitely a part of the disease in 

 this form of infantilism that metabolic changes seemed probable and were 

 accordingly sought for by McCrudden (McCrudden (a), also McCrudden 

 and Lusk). 



Preliminary studies showed that the urine is low in nitrogen; the 

 amount excreted, calculated per one square meter body surface, averages 

 less than the starvation value (McCrudden and Fales). The feces are 

 very bulky and contain much nitrogen. The creatinin coefficient is low 

 (McCrudden (a)) and acetone is occasionally found in the urine. These, 

 and certain other features indicating faulty nutrition and poor absorption, 

 suggested that partial starvation might be a factor in the condition. 

 Studies were accordingly made of the nitrogen and sulphur distribution 

 in the urine. 



Under normal conditions more than 80 per cent of the total nitrogen of 

 the urine is present as urea nitrogen, and about the same proportion of 

 the total sulphur as inorganic sulphates. The amount of other nitrogenous 

 and sulphur compounds is low. In starvation and on a low protein diet, 

 the absolute amount of urea and inorganic sulphur falls ; the fraction of 

 the total nitrogen as urea nitrogen and of the total sulphur as inorganic 

 sulphur diminishes. The absolute amounts of nitrogen in the form of- 

 uric acid, creatinin, ammonia, and amino acids, and of sulphur in the 

 form of ethereal sulphates and neutral sulphur remain nearly constant; 

 the proportion of the total nitrogen and sulphur in these forms increases. 

 Examination of the distribution of nitrogen and sulphur among the differ- 



