GASTRO-INTESTINAL DISEASES OF OLDER CHILDREN This originates from the ingestion of too large a quantity of nour ishment or from eating indigestible food. Occurrences of this kind are observed particularly at the fruit season, after a change in the accustomed eharacter of the food, and especially in holiday seasons, or in hospitals at the conelusicm of the visiting days.
The symptoms begin, as a rule, suddenly, or are introduced by a short prodromal stage whieh is characterized by headache, restless sleep, haggard appearance and the loss of appetite. Shortly after, fever sets in, which often is high, 40° C. (104° F.) and over; the child begins to vomit, complains of feeling bad, with headache and dizzi ness and is constipated. On examination, the patient gives the impres sion of being very ill; the tongue is swollen, its dorsum thickly furred, the breath is sour, the abdomen appears somewhat distended, partic ularly in its upper half. The urine is voided sparingly and is often thick in consistency, or has a reddish precipitate. A convulsion may mark the onset, and, in other ways, the cerebral cortex may appear involved, for, after going to bed, the children toss restle.ssly about, cry out in their sleep, gnash with their teeth, and sometimes also show anomalies of respiration and of pulse. ;Variations in intensity and arrhythmia.) The duration of the trouble is, for the most part, very short; after two or three days the improvement generally becomes rapid; more seldom, the condition is more protracted and lasts, with variations in the fever, which usually is lower in the morning, during a week or even longer.
The diagnosis is not always easy. Where impairment in the digestive powier is present, particularly in those critical periods above mentioned, the condition is, as a rule, promptly recognized; especially4 when it comes on quickly during health and reaches its height in a few hours, leading to severe disturbance of the general condition, with a thick deposit on the tongue and similar symptoms. There are, how
ever, cases commencing with convulsions, particularly in nervous children, which give the impression of beginning meningitis. Moreover the gastric form of influenza produces similar symptoms; still, the fart of a prevailing epidemic, the absence of any digestive indiscretion and the simultaneous occunence of catarrhal influenza in the family, and finally, the later involvement of brothers and sisters will generally set one on the right track. The separation, also, of such a condition from typhoid fever, particularly when it concerns a somewhat prolonged form of illness, is occasionally' rather difficult, especially as the bacterio logical examination of the dejecta and the serum reaction with the blood yield no positive results during the first days. The acute febrile onset, accompanied by vomiting and malaise, of the acute exantheinata will indeed for a short. time make one doubtful, but only for a few- days, since the eruption and the characteristic changes in the mucous mem brane of the pharynx and mouth soon clear up the situation.
The treatment is fairly simple: emptying the stomach and intes tine with absolute restriction of diet and the use of a purgative; later, in cases of continued vomiting and fever, gastric lavage and careful return to the usual nourishment soon bring about prompt healing. As a laxative, I prefer calomel, which, these cases, is well retained, and, according to the age of the patient, is given in from .01-.04 Gm. (1;--1- gr.) every two hours until the appearance of green stools; castor oil (in soup or coffee. 1 to 2 tablespoonfuls); or, a mixture of rhubarb, manna and senna 1coinpound infusion) in suitable proportions. When a high fever and intense cerebral phenomena are present, cold packs applied to the trunk are beneficial; a warm bath given in the evening will favorably influence the night's rest.