INFLAMMATORY DIARRHEAS IN WHICH THE SYMPTOMS OF A TOXIC SYSTEMIC INFECTION ARE PREDOMINANT-ACUTE GASTRO - ENTERIC INFECTION - ACUTE GASTROINTESTINAL CATARRH.
Symptoms.—As we might be led to almost expect, when we consider the various ways and the varying numbers and characters in which these toxin producing bacteria make their entrance into the alimentary tract and the varying conditions under which their develop ment may take place in the stomach and intestines, the mode of onset of this dis ease is very variable. Frequently it is gradual; the symptoms may present little except their persistence to dis tinguish them from those produced by indigestion. The infant may be fretful, show occasional signs of colic, be restless at night, and slightly feverish; and asso ciated with these disturbances may be some looseness of the bowels. As the disease progresses the symptoms increase in severity; the motions become fre quent, thin in character, and of a varying color, and of a sour, or more generally of an offensive odor; pyrexia increases; the pulse becomes quick and weak; and pain becomes a marked feature, interfering with rest and sleep. At other times the onset is sudden, frequently with severe gastric disturbance, high fever, and sometimes alarming nervous symptoms.
In these cases vomiting is one of the earliest symptoms, and may continue in the most persistent manner; the tem perature may be very high, 104° to 105°, but generally falls one or two degrees after diarrhoea sets in; twitching of the limbs, great restlessness, and sometimes delirium, or even convulsions, may usher in the attack. When the disease is well established, the symptoms become very characteristic; the infant is restless, cry ing frequently; the face is pale and its features somewhat pinched; the eyes sunken; the tongue coated in the centre, but with tip and edges red and dry; thirst is pronounced, but fluids are fre quently vomited shortly after they are taken; the abdomen is generally, but not always, distended. Often we may dis tinguish through the thin abdominal wall special dilatation of the stomach or small or large bowel; the skin gradually assumes a dry harsh feeling, while the subcutaneous tissues waste rapidly; the temperature varies from 102° F. in the
morning to 103° F. or more in the even ing, and the quick and feeble pulse indi cates great exhaustion.
While the stools may at first contain some undigested matter, this soon in great part ceases, and they become of a greenish, greenish-yellow, or brown color, and of an offensive odor, and are asso ciated with a large amount of flatus. Little useful diagnostic information can be gained from their appearance, but we may generally consider that frequent and watery stools indicate a severe attack. The reaction is in the beginning always acid, but in the more severe cases be comes neutral or even alkaline. Lesage says that a relation generally exists be tween the character of the reaction and the degree of infection. Under the microscope the stools are seen to contain undigested food, epithelial cells, few if any leucocytes, and numerous bacteria, among which bacilli predominate. Vomiting at the first may be violent and persistent, but, as the case progresses, the tendency for it is to subside. Pain to a greater or less extent is always present. In the earlier days it is a prominent feature; while later on, perhaps owing to general exhaustion, the infant appears to suffer less acutely. Exacerbations may be noticed shortly before each evacua tion. The presence of abdominal tender ness is generally a difficult matter to ascertain.
With these local symptoms the indica tions of a toxic infection of the system are not wanting; the temperature re mains moderately high, 101° to 103° F., with a tendency to rise in the evening and fall again toward morning; the pulse is quick, and may become weak and in termittent; emaciation goes on rapidly; with a greatly increased loss of fluid in the alvine evacuations, the urine becomes scanty and high-colored, and contains a large amount of indican. As the disease progresses to an unfavorable termination, the general prostration increases, the ex tremities become cold, slightly cyanosed, and sometimes oedematous, and the slightly-swelled eyelids only half-close over the deep-sunken eyes; the fonta nelle, if still open, is much depressed; the infant ceases to cry, and death closes the scene generally in a very quiet manner.