The abdomen usually becomes distended as the disease progresses, and there is often some tenderness on pressure over the colon. The weakness now becomes very great. The child lies back with a pinched, haggard face, sleeps little, and is very restless. His hands and feet are apt be cold, although the internal temperature is high. He is thirsty, but cares little for food. He may be troubled with vomiting. His water is scanty and high-coloured ; sometimes it is passed very frequently, but retention of urine is apt to occur, and require the use of a catheter. His tongue, very furred on the dorsum, becomes red at the tip and edges, and often dry.
In favourable cases the distressing symptoms gradually subside. The temperature becomes normal ; the tenesmus grows less and less, and dis appears ; the stools lose their blood and contain much grayish mucus ; they begin again to show signs of feculent matter ; the insupportable dysenteric odour diminishes ; the tongue cleans, and the appetite and spirits improve.
In fatal cases the abdomen is distended ; the pulse is very rapid and feeble ; the prostration is extreme ; the face is dusky and haggard ; the ex tremities are cold ; the child grows delirious, or sinks into a state of stupor, in which he dies. Towards the end paralysis of the sphincter may occur, so that the outlet of the rectum is seen wide and gaping. In exceptional cases oedema of the lower extremities is noticed ; and Dr. S. C. Busey states that this is sometimes associated with discolonration of the skin of the feet and legs.
A certain variety in the symptoms can be noticed in different cases.
The tenesmus is distressing in proportion to the degree to which the rec tum may be implicated. If, as may happen, this part of the colon is only slightly involved, the straining may be insignificant, or even altogether ab sent. In such a case the dejections are more feculent, and contain altered bile mingled with the mucus and blood. The number of the stools is very variable. There may be from two or three to ten or twelve, or even more, in the hour. In the latter case, even if the quantity of mucus discharged on each occasion be scanty, the whole amount passed in the day and night may be very considerable. The temperature is elevated. The mercury in the evening is often found to rise to 102° or 103°, but sinks in the morn ing to below 100°.
If the child die, death usually takes place from exhaustion, the patient being worn out by pain, want of sleep, and the profuse discharge of a highly albuminous fluid from the bowels. Sometimes, however, the fatal termination may be reached in a different manner. The disease may appear to take a favourable turn, and the dysenteric symptoms may have even subsided, when the child is suddenly seized with convulsions, then sinks into a state of coma, and dies in a few hours. Dr. S. C. Busey has connected these cases with thrombosis of the cranial sinuses—a complica tion which is always to be feared in the infant, when his strength is pro foundly impaired by exhausting disease.
After the subsidence of the acute symptoms, dysentery often passes into a chronic stage. The child remains pale and thin, and continues to lose flesh. His bowels are open several times in the day, and the motions, which consist of scybala and fleshy-looking lumps, are passed with strain ing. His tongue tends to be dry, and is often glazed, or is fissured with transverse cracks. He complains of frequent pains in the belly of a colicky character, and these are usually excited by taking food. The child is habitually thirsty, and is sometimes feverish at night. Such cases may go on for months, or in older children for years. Even in the most favour able cases, convalescence is usually slow, the bowels being costive and troublesome for a considerable time after the disease is at an end. The colon often remains torpid, while the irritability of the rectum continues ; so that, although the apparent need of evacuation is urgent, and the straining distressing, small stools consisting of scybala embedded in mucus are alone discharged.
Diagnosis.—As long as the stools continue to be feculent, the inflam matory process may be judged to be as yet in an early stage. Afterwards, when gelatinous mucus, clear or blood-stained, is passed unmixed with true feeces, or containing merely hard small scybala, we may conclude that the inflamed area is still limited to the rectum and the lower part of the colon. If later, when the tenesmus and griping pains are severe, 'the mucus is again contaminated with thin feculent matter, it is probable that the inflammation has extended higher and has involved the upper part of the colon, and, perhaps, a portion of the ilium.