One of the first indications of a gastro-intestinal catarrh is the child's lack of appetite. This symptom, however, is often over-shadowed by its excessive thirst, under cover of which the food may all be ingested. The abdomen then becomes distended and tender, and the child draws its legs up, and cries or moans constantly in a most pitiful manner. .At first the stools are merely increased in number, but show little change in appearance. Later, however, they become curdled and green, are mixed with mucus, and have a foul odour ; finally, they become fluid, and are then passed with a great deal of gas. A small number of children survive the first attack and get we:I ; but the majority develop a chronic catarrh from which they may suffer for prolonged periods before recovery takes place. Death may result from progressive emaciation, and from the effects of the toxic materials produced in the intestine. Sometimes the thin, foul, mucous stools may alternate with apparently normal evacuations. Aside from the character of the stools, the most noteworthy symptom of intestinal catarrh is the marked emaciation which takes place. All the fatty tissue is lost, so that the poor little mite gradually gets the appearance of a skeleton covered with skin. Boils frequently develop, and also bed-sores, in the region of the buttocks, the genitals, or the heels. The voice of the constantly crying, restless and sleepless child becomes more and more hoarse, and finally is nothing hut an indistinct moan, which in most cases is stilled by death.
In the treatment of an infant ill with gastrointestinal catarrh it is extremely important to follow the advice of a physician. The food. which also serves as medicine, must be prepared with the greatest care and pre caution, with regard to its character as well as to its cleanliness, and no heed should he given to advice tendered by any other person than the physician. The excessive thirst may he relieved by bland drinks, and the best of these is boiled water, to which may he added a teaspoonful of granulated sugar to every pint, or a thin infusion of black tea. The tea is prepared by pouring a pint of boiling water over a teaspoonful of tea, straining after two minutes, and then sweetening with a lump of sugar. This may be taken warm or cold. The sick children must he kept in a clean bed, and soiled linen should he immediately replaced, for in this way bed-sores and furuncles may best be avoided, or, if already present, may be prevented from becoming worse. The soiled napkins should be kept for the inspection of the physician, so that he may note the character and progress of the disease. The most important prophylactic measure is to provide pure milk from a well-conducted dairy ; and then to observe scrupulous cleanliness with regard to the body of the child and all objects with which it comes in contact. In older children
the course of the disease does not vary greatly from that observed in adults.
Intestinal Haemorrhage.—The significance of this condition varies according to the locality from which the bleeding proceeds. Blood which flows from the anus may be derived not only from various portions of the intestine, but also from the stomach. Its colour and composition vary with the extent of intestine which it has to traverse before it reaches the exterior of the body. The hmmoglobin is disintegrated by the intestine, wherefore the blood loses its red colour ; and if it comes from the stomach or from the upper portions of the small gut, it is quite black hen it reaches the antis, and gives the stools a very dark and tarry appearance. Blood from the colon remains more or less mixed with the intestinal contents, without losing its distinctive red tint, so that it renders the stools reddish-brown or chocolate-coloured. In doubtful cases, the admixture of blood in the stools may be detected only by chemical analysis. Even very old, black blood, in which the red blood corpuscles can no longer be recognised by microscopical examination, may be diagnosed with absolute certainty by chemical tests \vhich reveal the presence of the colouring matter, the hemoglobin. Bright red blood can come only from the lower segments of the intestinal canal, particularly the rectum, in which case it does not become mixed with the fecal matter, but is deposited on the outside of the mass. These variations in the colour of blood passed with the stools are of great importance in determining the site of the lllemorrhage.
The most frequent cause of bleeding from the intestinal canal is the presence of piles, or H.ENORRIMIDS (Which see). Rectal haemorrhages may be due also to catarrhs or ulcers of the mucous membrane of the rectum, but in such cases blood passed is much less in amount, and is always mixed with mucus. Rectal bleeding is not uncommonly the first sign of cancer of this portion of the gut ; and the condition is very often neglected because it is believed to be due to 1Kemorrhoids. Continued intestinal hemorrhages, however slight, always require a careful examination of the rectum. Ulcers or tumours in the colon may likewise give rise to intestinal hemorrhage, and the appearance of this symptom may often serve as the first indication of their presence. In these cases the bleeding occurs because the Nvalls of the blood-vessels which traverse the sloughing growth become involved in the process of destruction, and consequently rupture. Bleeding due to ulcers or tumours can be stopped only by curing the ulcerative conditions, or by removing the tumours.