INFLAMMATORY DIARRHCEA IIv WHICH IN ADDITION TO THE SYSTEMIC INFEC TION THE SYMPTOMS OF AN ACUTE LOCAL INFLAMMATION HAVE A PROMI NENT PART—ACUTE ILEOCOLITIS (MOLT).
Symptoms.—The symptoms in this form of disease generally commence abruptly, and for the first few days closely resemble those of the preceding form. The vomiting, however, is not generally persistent: the temperature, although high at the onset, soon falls, and remains about 102° F., and the mo tions are of a greenish or greenish-yellow color and very frequent. After two or three days the discharges assume a more characteristic appearance. They become small in amount, are of a grass-green or brown color; contain a large quantity of mucus; a variable amount of blood; and are passed with much pain and straining. Such stools may either have a compara tively slight odor, or a distinctly putrid and offensive one. Under the micro scope, undigested material, epithelial cells, pus-corpuscles, and streptococci, with other forms of bacteria, are seen.
The abdomen may now show signs of slight distension; tenderness on pressure may be elicited along the course of the colon, and the urine, if collected, may show the presence of a small amount of albumin. As the disease progresses the severe straining frequently leads to a dis tinct prolapse of the bowel.
If proper measures have been em ployed, the severity of the symptoms generally begins to subside toward the end of the first week. The motions now diminish in frequency: they no longer show signs of blood; pain and tenesmus lessen, and the mucus decreases in amount. In many cases, however, re covery is slow, and relapses on the slight est indiscretion are liable to take place. Much care is necessary lest the inflamma tory process go on to ulceration.
The persistence for two or three weeks of brown mucous stools with moderate pyrexia, and a failing nutrition are, ac cording to Holt, indicative that ulcera tion has taken place.
In the more recent form the tempera ture remains steadily high; the motions arc very frequent and contain much blood; and the infant quickly falls into a typhoid state in which stupor, delirium, or convulsions are liable to occur. If the
case survive, the symptoms may moder ate; but prostration is extreme, and some pulmonary or cerebral complication is apt to turn the scale on the wrong side. Some ulceration is almost always present in these cases, retarding recovery for for many weeks. A long period, during which careful dietetic and medicinal measures must be faithfully employed, may still reappear before complete res toration to health is secured.
The membranous type if the disease is fortunately of rare occurrence. In this form the symptoms are of an alarming character from the very outset. Not only do the stools contain much blood and mucus, but an examination of these under water may reveal numerous shreds, and sometimes large patches of pseudo membrane. Pronounced nervous symp toms, such as stupor or convulsions, may at the onset mark the symptoms of local inflammation. These cases run a severe course, typhoid symptoms develop early, and recovery is comparatively rare.
In some cases which for the first two or three weeks have shown symptoms of gastro-enteric infection rather than of local inflammation, owing either to the feeble constitution of the infant or to the intensity and duration of the local irri tation, a follicular ulceration develops, and symptoms of local inflammation make their appearance. The motions now become small, slimy, and, to a variable extent, tinged with blood; their color is most frequently of a dark green or brown, and their odor usually offensive. Pain at this stage, though present, is no longer so prominent a feature as during the earlier stages of the disease; pyrexia is only moderate; the motions are not very frequent, but the strength of the infant gradually fails, and the general emaciation becomes very noticeable. Under the microscope the stools are seen to contain epithelial cells in large num bers, numerous leucocytes, and strepto cocci associated with bacilli.