SECONDARY GASTRO-ENTERTC DISTURBANCES. SEPTIC INFECTION WITH G ASTRO-INTESTINAL SYMPTOMS.
It still remains for me to discuss very briefly the gastro-intestinal disturbances developing in connection with other diseases of infancy, and appearing as complicating symptoms often of a se.rere character, and also the gastro-enteric sy-mptoms forming the clinical manifesto, tion of a general septic infection. The infantile intestine, on account of its marked irritability, reacts easily to diseases located in other organs, especially' if such diseases are of an infectious nature and run a febrile course. For example it is a known fact that influenza in early life is often marked lyy severe gastro-intestinal symptoms, the proper inter pretation of which encounters difficulties. Frequently, only the addi tional presence of rhiniti.s, the spreading of influenza] diseases in the family or among the inmates of the sick-room, and the prevalence of an epidemic puts us on the right track. The same is true of febrile catarrhs of the respiratory tract, such as rhinitis, angina, and bronchitis, which cause involvement of the gastro-intestinal canal either through the action of absorbed toxines, or through direct extension of the process, or through the swallowing of the secretions. Such eases are charac terized lyy the appearance of frequent movements containing mucus, and often of mucous vomiting, the latter symptom especially being an indication for stomach washing. In the sante way the different acute infectious diseases of early life, such as diphtheria, measles, scarlet fever, German measles and whooping-cough, are often accom panied by vomiting and diarrhoea, which have an unfavorable influence on their course. Also when the reaction does not appear as the direct result of the infection of the body, secondary disease of the gastro enteric tract may come on as a result of the anorexia and weakness of digestive power accompanying these diseases, in combination with too abundant feeding. This retards convalescence and if it is very promi
nent, may eventually' assume threatening proportions. The feeding of children with a febrile infectious disease should be carefully adjusted to the weakened function of their intestine, with long intervals between the feedings and reduction in the amount given each time. What trivial influences may cause severe disturbance of digestion is shown by the appearance of such symptoms after relatively slight surgical opera tions, or after strapping children down in the beds devised for the collec tion of urine and feces in metabolism experiments, or after shutting them up in the respiration apparatus (Epstein, Bendix, Rubner-Heub ner). This leads us naturally to those cases which are apparently gastro-enteric affections, but which are. really the clinical manifestations of a septic infection finding its entrance to the body in an entirely- differ ent place. This is not the place to consider these interesting forms of diseases and their diagnostic importance. I refer the reader to my article on this condition in the "Traite des maladies de Flinfance," in which are explained the reasons for my introducing the term "Sepsis with gastro intestinal symptoms" for this condition, a term which in my opinion characterizes the nature of the process with sufficient definiteness. I will only mention here that even with the most accurate clinical observation it is often impossible to reach the right diagnosis with cer tainty, and this is only attained by autopsy and thorough histologic examination. I do not deny the possibility of a general septic infec tion originating in the intestinal canal itself, hut I declare this to be an occurrence exceedingly rare in breast-fed children, and to be hitherto unsupported by reliable observation.