It is important to know early, by continued control of thc weight, temperature, and stools, when such conditions set in, so that they may be confined to their local stage.
The best results are undoubtedly obtained by giving the child, before changing the diet, for the first twelve to twenty-four hours, mud. diluted remedies, such as tea sweetened with saccharin, physiological salt solution, etc. These may be given ad libitei in.
When vomiting is the chief symptom, washing out the stomach will often give results so that it is not necessary to resort to medicine. Flush ing the bowels with non-irritating fluids is also useful in removingirritatiom 3. Alinwntary Intoxication.—tio far the questions dealt with have been the results of the quantity and the composition of the food, and the effects were remedied by reducing the amount. or changing the quality of the food. The studies to be undertaken now are those which through a eontinuation of the harmful nourishing processes have assumed a form beyond the disorders of the intestines, causing disturbances of assimilation with consequent great danger to the life of the patient.
Formerly this group was considered according to the most prominent symptoms as acute gastro-enteritis, acute entero-catarrh, cholera infantum, etc. The observations of Finkelstein and Czerny-Keller have directed attention toward the general condition of the patient, the changes in the other organs and metabolic disturbances without regard for the local condition.
It. must be conceded that alimentary intoxication, as well as ali mentary decomposition which is considered later, is not primary but is secondary to disorders of balance and dyspepsia. This being a continua tion of such disorders, it is not uncommon to overlook he earliest symp toms, and it is therefore important to thoroughly study conditions in all unnaturally nourished babie.s so that a remedy may be applied in dine.
Symploms.—By alimentary intoxication we mean a condition re sulting from t.he poisonous effects on the system of food which has not been disposed of properly or properly digested.
Finkelstein directs our attention to nine different symptoms which though subject. to great change are always present.
I. L066 of consciousness.
2. Peculiar changes in respiration (so-called "large" breathing).
3. Alimentary glycosuria.
4. Fever.
5. Collapse.
6. Gastro-intestinal symptoms in form of diarrhcea and voniiting.
7. Albuminuria and cylinduria.
S. Loss of weight.
9. Leucocytosis.
The loss of consciousness presents variable pictures. In the less severe cases the patient is sleepy, his attention is attracted with diffi culty, his face is pale and expressionless. In the more severe cases the child lies relaxed with the eyes partly open, the cornea is dull and lustre less, his attention is attracted only with great difficulty' and then only temporarily, the child takes no notice of his dearest friends and he never smiles. The whole picture is typical of this disorder. As the condition develops there is coma, lack of expression, relaxation of the extremities, thin pointed nose, and a peculiar bluish-gray color of the skin,—a picture which shows the danger at once to the experienced. When disturbed the child rises with outstretched arms and with a wild expression, only to fall back into its former comatose condition.
The breathing shows a characteristic type in the mild cases. Without pause the single excursion deepens, the rhythm accelerates, and there is a remarkable gasp for air, which is surprising because of the negative findings in the lungs (dyspncea sine materia). (Finkelstein compares this breathing to that of hunted game.) Alimentary glyrosuria is an early symptom sometimes appearing before the clinical symptoms and for this reason is of diagnostic impor tance. The sugar of the nourishment is not consumed (this nieans all sugar) but is taken up unchanged from the intestines. This of course lasts only while a sugar diet is used. Its constant and early appearance even in mild forms makes it of great importance.
Fever.—Its intensity depends on the severity of the sickness. It may vary front normal temperature to a hyperpyrexia. It may be regular or fluctuating, with the appearance of coma due to the intoxica tion; there is, with the appearance of collapse, a sudden fall of the tem perature.