290 INFECTIONS OF THE DIGESTIVE TRACT 



gation in order to avoid as far as possible putrefactive 

 decompositions in the large intestine. A great deal of 

 rest is necessary for these children and they should not 

 be permitted to play or walk to the point of fatigue. 

 Patients of the class under consideration often do badly 

 in cold weather, probably because they cannot afford 

 the caloric loss to which they are then subjected. Where 

 this is the case a period of residence in a mild winter 

 climate is helpful. Improvement is sometimes so slow 

 that every one concerned with the case may become dis- 

 couraged, but it is certain that a high degree of improve- 

 ment can occur even after several years of extremely 

 slow progress. I have several times known this to be 

 the case. In order to secure this improvement, however, 

 it is impossible to make concessions in regard to diet, and 

 the policy of largely excluding carbohydrates must be 

 enforced. It cannot be denied that even in those cases 

 where the best results are obtained there is commonly 

 a retardation in growth which is still manifest at the 

 time of puberty. Moreover, there is no doubt that per- 

 sons who have suffered from the conditions under consid- 

 eration during the period of childhood become especially 

 susceptible to intestinal disorders in later years and sel- 

 dom attain robust health. There are probably many 

 persons in the community whose digestive derangements 

 date from early life, and in many of these cases the less 

 pronounced forms of the type of chronic intestinal indi- 

 gestion which has just been described have doubtless 

 constituted the foundation of invalidism in adult life. 



