The destructive process is most intense in the lower part of the colon and in the rectum ; but the inflammation may involve the whole colon, and even pass the ilio-cmcal valve into the lower part of the ilium. If the child survive, cicatrisation may occur. A fibrinous exudation is thrown out on the floor of the ulcer, and becomes gradually organised.
Lesions may be found iu other organs. The mesenteric glands may be swollen, the abdominal organs may be congested, and abscess of the liver may occur. In a little girl, aged three years and a half, who died in St. Bartholomew's Hospital under the care of Dr. Andrew, two abscesses were found in the liver. The child had never lived out of England, but had suffered for two months from an attack of dysentery, succeeding to prolonged diarrhoea of ten months' duration. One of the abscesses was situated in the right lobe, and was as large as an orange. The second, no larger than a filbert, occupied the left lobe. In the neighbourhood of the abscesses the structure of the liver was healthy. The whole of the large intestine was extensively ulcerated.
The chronic form of dysentery is not always the consequence of un healed ulcers. Still, in many cases ulceration is present. In advanced cases the intestinal tube may be atrophied, with complete disappearance of its glandular structures, and extreme thinness of its coats. In a less ad vanced.stage, the areolar tissue, and even all the coats of the bowel, may be greatly thickened.
Symptoms.—The illness begins with slight fever, loss of appetite, and sometimes nausea. The child complains of uneasiness in his belly of a colicky character, but his sufferings do not seem to be very severe. Then a sudden feeling of tenesmus urges him to evacuate the bowels, and the contents of the rectum are discharged, more or less coated with tenacious mucus. The passage of the motion, however, produces little or no relief. The desire quickly returns, so that the child almost constantly requires the stool, and sits straining with extreme violence. Nothing, however, is voided but offensive mucus, with occasional minute scybala. The mu cus may be streaked or mixed more or less intimately with blood. In bad cases, it resembles a rose-coloured jelly. All this time the griping
continues. The child often screams with pain, and may be found resting on his knees in his bed, with his head buried in the pillow. Still, there is little or no tenderness of the belly. The face is pale, with a distressed expression. The child cannot sleep. His tongue is white, and his skin dry. He seldom complains much of thirst, but eats little, either from loss of appetite, or from the increase of abdominal pain, which he soon finds is provoked by the taking of food. Sometimes, for the first few days, the stools may continue to be feculent. Then, as the griping pains and te nesmus increase, the dejections become more scanty and frequent, and consist of fecal matter mixed with gelatinous mucus.
The disease does not always begin thus mildly. It may be ushered in by a severe rigor, or an attack of convulsions, with high fever, distressing griping pains, and almost constant tenesmus. There is burning pain at the anus, and the child, if permitted, will remain, as long as his strength allows, almost constantly seated on the night-stool. As in cases of acute inflammatory diarrhoea, the straining may induce prolapse of the rectum. The mucus passed from the bowels is bloody almost from the first ; and sometimes pure blood, bright or dark and clotted, may be evacuated. However it may have begun, if the disease last beyond a week without improvement, slangily matter begins to be discharged from the bowels. The stools, instead of consisting merely of offensive bloody mucus, begin to contain dark-coloured, shreddy matter, mixed with reddish, dirty water. The odour of these stools is intolerably foetid, and grows more and more insupportable. The particles of slough generally get larger in successive dejections, and sometimes cylindrical portions of dead and putrefying mucous membrane may be discharged unbroken. It is comparatively seldom, however, that this stage is reached in the case of a child. The disease is so exhausting a one that death usually takes place before much sloughing of mucous membrane has had time to occur. Sloughing is rarely found in children under twelve years of age.