As a consequence of the profuse drain both from the stomach and bowels, the patient's body wastes and dwindles with a rapidity which is surprising. After only as few hours, the eyes grow hollow and the nose sharp, the cheeks fall in, and all the features look pinched and draWn. If previously well nourished, the child's flesh loses all elasticity, and feels soft and doughy to the'touch. The abdominal parietes are flaccid and sometimes shrunken. The skin is inelastic. Owing to the loss of water, the thirst is extreme. The child, if he can speak, asks constantly for drink. If an in fant, he fixes his eyes upon any cup or vessel containing fluid, sucks his lips, and whines in a manner which is sufficiently expressive. In most cases, however, anything which may be swallowed is immediately returned.
The urine is excessively scanty, and if the diarrhoea is profuse, may seem to be almost suppressed. The tongue may be clean, or covered with a thin fur. Towards the end of the disease it is often dry and brown. The pulse is rapid and very feeble. It often reaches 150, but is regular in rhythm. The temperature is generally high. The heat of the surface may be nat ural, or even sub-normal, and often the extremities feel cold to the hand ; but a thermometer placed in the rectum registers a high level, the mercury rising to 104°, 105°, or even a point still more elevated. The child is ex cessively restless. As long as he has strength to do so, he moves his arms and legs uneasily, and whimpers or cries feebly. Often he draws up the corners of his mouth as if to cry, but no sound is heard. He sleeps little, but lies in a drowsy state with eyelids only partially closed. The fontanelle is deeply hollowed, and in extreme cases, owing to the shrinking of the brain from abstraction of water, the bones of the skull can be felt to over lap.
In a very short time, unless some amendment occur, the child passes into a state of collapse. He lies perfectly quiet, as if dosing. His eyes are only half closed ; lris features are sharp, and his face livid and old looking. The vomiting usually ceases at this stage, but the diarrhoea gen erally continues, although with diminished violence. The coma becomes more and more complete ; the conjunctivEe cease to show any sign of sen sitiveness, and the child dies quietly, or in a faint convulsion.
In the comparatively rare cases which terminate favourably, the first sign of improvement usually noticed is a fall in the temperature ; the next a cessation of the vomiting, so that fluids can be retained upon the stomach. Then the stools begin to present a better appearance. The serous discharge becomes again tinged with ffflcal matter, and the craving for drink is less noticeable. The diarrhoea may then cease, or thin feculent stools may con tinue to be passed in small quantity for some clays. In other cases the im provement in the stools is the earliest sign of amendment, and the vomiting continues for a time, even after the purging has ceased.
The duration of the illness is terribly brief. Often it may be measured by hours. Always at the end of the fourth or fifth day, the patient is either dead, or is evidently advancing towards convalescence. Death may take place in five or six hours from the first onset. In other cases the child survives for a longer period. Usually he dies in the course of the third day.
Diagnosis.—There is no difficulty about the detection of the disorder. The uncontrollable vomiting and diarrhoea, the intense thirst, the rapid shrinking of the tissues, the copious serous stools, the scanty secretion of urine, and the early collapse—all these form a group of symptoms which is very characteristic, and, indeed, can hardly be mistaken.
Prognosis.—When the disease is established, the prospect of recovery is faint. Early cessation of the vomiting is a favourable sign, and any re turn of feculent matter in the stools allows room for hope, however unfa vourable the general condition of the child may appear. Also, a fall in the internal temperature, although the symptoms may not have visibly im proved, is a sign of amendment which is not to be disregarded. If the child sink into a state of collapse, he almost invariably dies. At any rate, I have never known an infant to recover from such a condition. Indeed, in any case, during the first few months of life, the ratio of recoveries is excessively small.
Treatment.—On account of the persistent vomiting, which is one of the marked symptoms of the complaint, attempts to supply nourishment and support the strength of the child against the exhausting and continuous drain from which he is suffering, often meet with little success. Indeed, as long as the vomiting is frequent and distressing, and the purging severe, it is better to abandon all attempts to introduce food into the stomach. We should content ourselves with allowing the child to drink as much iced water as he shows an inclination to swallow ; for stinting of liquid in these cases has been shown to be not only cruel, but injudicious. .As soon as any diminution in the vomiting allows us to hope that food may be retained, we may begin by giving a teaspoonful of white wine whey (iced), and repeating this quantity every twenty minutes or half hour. If this be vomited, a less quantity should be given ; but if this, too, be re jected, it is better to postpone, for the time, any further attempts to sup ply nourishment and return to the iced water. If the stomach can retain the whey, the child may be allowed to take it in considerable quantities, sucking it through the bottle like any ordinary food. If after a few hours there is no sign of sickness, a dessertspoonful of cream may be shaken up in the bottleful of whey. Milk in any shape, even breast-milk, must be strictly forbidden in these cases.