The excretion of sulphur in infants and in older children has been made the subject of special study by Freund, whose investigations show that the quantity of total sulphur elimination is in direct ratio to the albumin transformation. Freund found, for the sulphuric acid, values of 0.1365: 0.2171: 0.1159 Gm. This was in breast-fed babies, while in those fed on the bottle, the quantity wab 0.5030 Gm. The absolute quantities of ethereal sulphuric acid were very small, ranging between 0.0091 and 0.0162 Gm. per day. Ponticaccia found values of 1-2 Gm. per day for the total sulphuric acid in healthy older children upon mixed diet, the absolute quantity of ethyl sulphuric acid being in almost every experiment 0.1 Gm.
The elimination of ethyl sulphuric acid is believed to be a measure of the amount of intestinal decomposition, but it must be emphasized that it is of value only so far as the appearance of great quantities of ethyl sulphurie acid indicate an excessive intestinal decomposition, whereas the reverse is not true, since its excretion is affected by many conditions, such as albumin intake, albtunin-loss, resorption, etc., which cannot be accurately estimated.
Phenol excretion also is effected by the decomposition in the intes tines. F. Meyer has shown that it is less in breast-fed than in bottle-fed babies. He found that in a nursling of six months the daily excretion amounted to 5.S7 mg.; in one of ten weeks it was 2.507 mg.; and in the bottle-fed the excretion was eonsiderably higher,about 13.2S mg. per day.
The excretion of indican, derived from indol, has been frequently investigated. Friedrichller, in spite of contrary statements by other writers, even now defends the opinion that indol does not arise from the breaking up of albumin in the tissues, but results exclusively from albuminoid decomposition in the bowel, of the intensity of which it, is a measure. This accounts for the fact that the reaction for indican in the urine is almost invariably negative in healthy breast-fed babies, while it is generally positive in the bottle-fed (Senator, Hochsinger, Zamfiresco). Momidlowski has shown that the excretion of indican is increased in almost every child ill with gastro-intestinal disorder, and that the more severe the intestinal disturbance the greater will be the quantity of intlican. In older children, upon a mixed diet, the behavior of indi can is the same as in adults. The contention of Hochsinger and Kahane, who maintained that the proportion of indican is abnormally large in tuberculosis, and that it was of diagnostic value in the young, may be considered to be refuted, as may also the observation of A. Mayer that
indican is not excretecl by atrophic infants, since von Starck affirms that he found' increased excretion of indoxyl-sulphuric acid in children suffering from school anwinia.
There have been recorded in the literature some instances of indi guria, with the appearance in freshly voided urine of indigo red.
Urobiltin and ['rob ilinogen. —These arc chiefly formed in the intes tinal tract, where they result from the decomposition of biliruhin, the billiary coloring matter. But they may also be formed outside the intes tines, as for instance in blood extravasations.
According to Giarre, urobilin is completely absent from the urine of nurslings, while it is sometimes found in the bottle-fed. According to statements in the literature, urobilin is often present in the urine of scarlet fever patients, while it is absent in cases of diphtheria. Book man, who tested these statements in Heubner's Clinic, was led to diff erent conclusions. ITe studied especially the excretion of urobilinogen in infancy, and arrived at the following conclusions:* The urine of breast-fed infants contains no urobilinogen: that of artificially nourished babies almost always does. Urobilinogen will be found in increased quantity in the urine of infants suffering from intestinal affections, especially in cases where the stools are white (Langstein).
Older children excrete urobilinogen upon a mixed diet in varying amount. Infantile diseases, attended by Memorrhages, occasionally show increase of urobilinogen. This is true also of paroxysmal Memo globinuria. In accordance with the observations of Otto Neubauer, Bookman found that urobilinogen disappears from the urine in cases of obstructive jaundice, if the obstruction of the gall-duct is complete, but that it reappears as soon as the bile once more flows into the intes tine. To this degree, Ehrlich's reaction with dirnethyl-amido-benzal dehyd is of prognostic and diagnostic value in the jaundice of the young.
The Acetone Bodies.—Acetone, diacetic acid, and oxybutyric acid are formed in cases of inanition, and wherever the carbohydrate metab olism is disturbed. Children are more inclined (Langstein and L. F. Meyer) to acetonuria than adults, and not inconsiderable quantities may be found even in the mildest febrile diseases if they are accompanied by inanition. It is not possible to attribute to this any differential diagnostic importance (L. F. Meyer), and furthermore it gives no idea of the nature of the disease.