3. The hypertonic form is similar to the atrophic. There is emacia tion, the skin is withered, aside from this the body musculature becomes tense and drawn, and this condition at its height has been likened to a doll's appearance. The arms and legs are bowed, lying close to the trunk.
The vertebral column is stifT or there is lordosis.
In certain high-grade cases there is tetany and an inclination toward eclarnpsia. Such children may die suddenly.
This form (described first by Gregor) of severe irritability of the musculature is rare and may, accompany the other types.
The prognosis of the sitnple atrophic form is good.
The atrophy eeases on withdrawing the Hour and substituting milk (breast milk is the best). The prognosis of the other forms is grave, because of the more rapid loss of the salt content of the body.
important indication IA to stop the flour and to substitute milk. Some children quickly- regain the lost ground even when they have serious disturbances (specially- loss in weight) when a change of nourishment is made. Rietschel in the beginning gives small amounts of breast milk (200 to 300 Cm.), increasing it gradually ftS the condition improves. Such ehiklren improve slowly after two or three weeks.
The introduction of cow's milk must be with even more caution. Rietsehel advises a tablespoonful on the first day, l00 to 200 Gin. on the next, and then gives 200 to 300 Cdn. daily for the next few days.
In such cases a trial may be made with mixtures rich in fat. Raw milk has given good results. Rietschel relieves the suffering from the reduction in the amount of milk by diluting the skim milk with tea or water. Buttermilk and malt soup are contraindicated, because of their high carbohydrate content.
(c) By Bacterial Infection of the aecurate insight, which the studies of the pathology of metabolism in the diseases of infants due to disorders of nutrition have furnished, has been the means of lessening the importance of the attention paid to the germ content of COW'8 Milk. Its over-estimation has already been emphasized. One will naturally understand however the importanee of the cleanest possible milk for infants' consumption, and often the reason of disturbances when due to milk supply will be sought for in wrong directions. The question
often arises as to the eonnection between the sickness and the taking of unclean milk. The studies in this direction are not very great, and if we exact proof for this connection, the circle for suck observation narrows itself still further. To complete the proof of the connection the presum able cause should be found in the milk and in the stools am! should be recognized as not originating from the normal intestinal flora or other scattered micro-organisms.
It appears from the work of recent years to be established, with constantly greater certainty, that in the causation of acute and chronic gastro-intestinal infections, which occur as a result of taking bacterially contaminated milk, streptoeocci play- an important part. Lesage and Thiercolin, Nobeeourt, Escherich and his pupils Finkelstein and others, as also in more recent years Petouseliky, Kriebel, and Briinig, mention the frequency of finding streptocoeci in the stools of artifieially nourished infants with gastro-intestinal diseases, and their demonstration in badly kept cow's milk, in which they gain entrance front inflammatory pro cesses in the udders of the animals, from the dirt of the stable, manure, hair of animals, ete. They can, aS have been shown by the observations of Escherich and Jehle, form the only exciting cause. This being the case, there is produced the clinical picture of a severe disease localized pri marily in the large intestine, which either ascends from there and leads to general symptoms or produces general infection through the blood and lymph channels by breaking through the intestinal wall. There are many mucous or muco-purulent and bloody stools which contain, as pre dominating micro-organisms, the gram staining cocci in long chains or in little groups and in clumps.
Fever and prostration usher in this disease. Convulsions follow, and increase of the intestinal symptoms, the appearance of algidity, and collapse may terminate the scene in a very short time.