286 INFECTIONS OF THE DIGESTIVE TRACT 



improvement is very slow, and slight errors in diet are 

 followed by prompt reappearance of flatulence and per- 

 haps diarrhoea. Fats and proteids are well tolerated. 



A feature in this form of chronic excessive intestinal 

 putrefaction is the readiness with which fatigue comes 

 on. A child of six or eight years of age will show fatigue 

 after a very short walk and will manifest a want of in- 

 terest in exercise and play. There is in fact a state of 

 chronic fatigue, which I attribute to the absorption of 

 putrefactive products. If the trouble comes on during 

 infancy, there may be considerable delay in the develop- 

 ment of the ability of the child to stand and walk without 

 support, and a child of five or six years or over may be 

 unable to go upstairs except by a kind of creeping 

 motion. A certain emotional irritability is common in 

 these children. As a rule they are not much retarded 

 mentally except in so far as they have missed opportuni- 

 ties for conventional learning. On the contrary, one not 

 infrequently is struck by the contrast between the sharp 

 wits of these children and their physical retardation. 



The ethereal sulphates are regularly increased in the 

 urine in cases of the kind under consideration, that is to 

 say, there is not merely a relative increase of the ethereal 

 as compared with the preformed sulphates, but usually 

 also an actual excess in the absolute amount of the 

 ethereal sulphates. The proportion of ethereal to pre- 

 formed sulphates may be one to seven, or one to five, 

 or even one to four. It can usually be shown that the 

 stools contain considerable quantities of indol and phenol. 



A noteworthy peculiarity of these cases is the presence 



