Whilst cutting teeth, young children are more than usually prone to looseness of the bowels. In such cases, the relaxation is popularly ascribed directly to the process of dentition, and the child is said to " cut his teeth with diarrhoea." There is, however, no doubt that the teething process is concerned in -the derangement only indirectly. During dentition, a child is often feverish, and pyrexia from any cause reduces the resisting power of the body, and renders it sensitive in an unusual degree to changes of tem perature. In one case, the catarrh fastens upon the bowels, in another upon the stomach, in a third upon the lungs, according to the varying suscepti bility of the organs ; and strictly speaking, the child suffers not because he is teething, but because he is feverish.
Although looseness of the bowels from the above-mentioned causes is usually transient and trifling, it is liable at any time to become severe and even dangerous. An intestinal catarrh, unless quickly arrested, is apt to extend and grow violent, especially in weakly subjects ; and an attack of diarrhoea begins mildly enough, may suddenly change its character and assume very serious proportions.
3Iorbid Anatomy.—As the derangement is not in itself of much mo ment, few opportunities of an examination of the intestine are afforded. Such, however, occasionally occur when the derangement has been present in a young child who is feeble and ailing from some more serious affection. In such cases, the mucous membrane may appear to be quite healthy, and if here and there a certain amount of arborescent redness is discovered, this is in all probability a post-mortem change. Occasionally, an excess of slimy mucus may be found coating the lining membrane over a greater or less extent of surface.
Symptoms.—In infants, the mild intestinal catarrh which constitutes the non-inflammatory form of diarrhoea usually occurs suddenly. Sometimes it is preceded for some hours by slight griping pains, nausea, or even vom iting, a furred peevishness, and other signs of discom fort ; and occasionally, if a very indigestible substance has been swallowed, by some fever. In a short time, a profuse discharge of thin feculent matter takes place from the bowel, and the pyrexia, if it bad been present, sub sides at once. At first, the evacuations are frecal, and contain lumps of un digested food. They have often an offensive sour smell, and may be frothy from evident fermentation. Usually, the early fcal stools are succeeded by thinner, or slimy dejections, showing an excess of mucus, and tinted of a green colour. If the catarrh affect exclusively the lower part
of the larger bowel, there is much mucus and perhaps streaks of blood from straining. In the first few hours the stools are usually frequent, but after wards they become rarer, and five or six seldom more—are passed in the course of the twenty-four hours. They are more numerous in the day than in the night, and are excited by liquid food, especially if this be taken warm and in large quantities at a time. The belly is not swollen or tender, and the motions after the first are usually voided without pain. If frequent, they have a noticeable effect upon the nutrition of the child. He looks pale, and his flesh quickly becomes soft and flabby to the touch, although to the eye the body may not appear to be wasted. A thermometer placed in the rec tum shows no increase of temperature. The duration of the derangement varies from twenty-four hours to two or even three days. If it exceed this period, it often passes into the more serious variety described in the next chapter.
If the diarrhcea be clue to a chill, other signs of catarrh may usually be detected. The child snuffles from slight coryza, or coughs from a trifling cold on the chest.
After the age of infancy, the symptoms present little variety from those just described. The child may complain of discomfort in the belly, but preserves his spirits, often his appetite, and will not allow that he is ill. He is usually thirsty, and his tongue is furred, but his general health, and even his nutrition, seem to suffer little, if at all, from the looseness of his bowels.
In children of five or six years of age and upwards a form of looseness of the bowels called "lienteric diarrhoea" is common. This derangement consists in an exaggeration of the normal peristaltic movement, which ap pears to be at once excited by the taking of food. In these cases, the latter part of a meal is accompanied by an uneasy sensation in the belly which soon becomes a griping pain, and is quickly followed by an urgent desire to evacuate the bowels. Often the child has to hurry away from the table, and the motions are found to consist almost entirely of undigested food and mucus. act in this manner after each meal, and often also in the morning before breakfast. The abdominal pain may be com plained of at other times without being followed by a stool. The tongue is slightly furred, or is clean, red, and irritable-looking. If this looseness continue for several weeks, as it often does, it causes considerable impair ment of nutrition.