COMO on, appearances the causes of which a.re not yet entirely clear.* The entire nature of the child is changed. The alteration in its ex pression, which has already been mentioned, soon not only accompanies the nausea preceding vomiting, or the pain attending evacuation, but becomes permanent as a result of the persistent intestinal discomfort. Epstein, a fine observer of such things, gives the following description. "The appearance of content disappears, even in sleep, the features become more shrivelled and more pointed, the glance becomes weaker, the corners of the mouth more drawn back, and the expression of the face becomes more set anti pinched." Sleep, which normally collies on after feeding with evident com fort, either fails to appear at all, or lacks its normal depth and quiet. The slightest noise makes the child wide awake, and eVCII without such disturbances it suddenly starts convulsively, works its lips, arms and legs in an unaccustomed way, in short, does not obtain proper rest. The face has become notably paler, the rosy tint of the skin which after the hyperainia of the first few days appears as a sign of health, being replaced by a slight anatinia. Macules and papules of light or dark red color appear on the face, either singly, in groups, or as a diffuse erythema. The genital region is frequently the seat of processes vary ing from simple reddening of the skin to hard infiltrated and super ficially ulcerated or even deeper eczema, which can extend down to the knees, or up to the middle of the back. The abdomen, which in normal infants is scarcely distended, and does not reach altove the level of the thorax, now appears distended by gas, with tense skin. On applying the hand to the abdomen, the movement of the intestines is telt, and occasionally, with a loud noise, sour-smelling or foul gas comes out of the anus, and is frequently accompanied by little spurts of feces. The discomfort of the waking or sleeping infant is increased by attacks of colic, which cause severe crying, in which the face becomes dark red, and the features distorted with pain. The legs are drawn up, or kicked back and forth continuously, thus causing reddening or excoria tion of the heels. These symptoms continue until the passage of gas,
or a. movement of the bowels, which squirts out for some distance, procures quiet for a time.
The mouth, which in the beginning of the symptoms presents a slight reddening, shows in their further course a catarrhal swelling. The tongue shows a velvety coat, which becomes thicker near the base. In very young children a. growth of thrush quickly appears which covers the inner surface of the lips, the gums, the mucous membrane of the cheeks, and the palate and pharynx with larger or smaller, isolated or confluent, deposits of a white or yellowish color, which stand out sharply from the reddened and somewhat swollen mucosa. There is usually no fever, at most a brief initial rise of temperature.
As to the weight curve, in the beginning it shows a more inter rupted course instead of the normal steady increase. Periods of sta tionary weight alternate with occasional sudden increase bey-ond the normal rate of growth. Later the weight curve becomes kvel, or slowly inclines downward. This beconies manifest in the appearance of the child. Its superficial fat and the musculature feel more flabby, its movements lose their vigor, and the skin loses its color.
I have already- said that these symptoms of overfeeding frequently subside of themselves, because on the one hand a strengthening of the child's digestive power collies on, which makes it sufficiently- developed to meet the increased demands, and because, on the other hand, a regulation of the amount of milk provided by the mother or nurse occurs, veltich limits the quantity' of food given. But one must not count too much upon this spontaneous subsidence, because, although these disturbances are innocent as a whole, and quickly and easily allayed by proper treatment, still the boundary lines which. separate them from the severer affections of the gastro-enteric tract are shift ing. Furthermore there is the danger of secondary infection, against which the normal course of digestion guarantees a relative immunity, but to which children thus injured by overfeeding are easily liable.