INFECTIONS OF THE DIGESTIVE TRACT 285 



extremely obstinate form of digestive derangement, mani- 

 festing itself in a distinct retardation of growth (usually 

 without much mental retardation), in distension of the 

 abdomen by gas, flatulence, intolerance of carbohydrates, 

 and voluminous, light-colored, usually gray and fatty 

 stools containing much gas. In many of these children 

 there is excessive sweating of the head. I have studied 

 with considerable care several children corresponding to 

 this clinical type (most of them patients of Professor L. E. 

 Holt, who has in every way aided me in the effort to 

 learn something about the underlying conditions present 

 in this striking derangement). It was found that it is 

 a characteristic in these cases that the urine contains 

 a large amount of indican and usually an excessive 

 amount of phenol. The phenol may amount to more 

 than one hundred milligrams in twenty-four hours, in the 

 urine from a child not more than three or four years of 

 age. The Ehrlich aldehyde reaction of the urine may or 

 may not be excessive. After a long period of careful diet- 

 ing in which carbohydrates are very much restricted the 

 indican may disappear from the urine in such cases 

 although the patients show but little gain in weight or 

 strength. This falling off in indican of the urine is to 

 be regarded as a favorable indication and often precedes 

 by many months more obvious clinical indications of 

 recovery. In some instances, however, there occurs a 

 slow gain in strength and in weight and in the ability 

 to digest carbohydrate food despite the fact that the 

 improvement in the excretion of indican and phenol is 

 only slight. Under the most favorable circumstances 



