of the stomach in early life is a derangement of common occur rence. It is met with in two forms—a febrile and a non-febrile variety. A. first attack renders .the gastric mucous membrane more susceptible than before, and predisposes to a second : on this account, the disorder is frequently found to recur repeatedly in the same subject, and serious in terference with the child's nutrition may be the consequence. Catarrh of the stomach, unaccompanied by fever, is perhaps the commonest derange ment to which children are exposed. It is a perpetual danger to hand-fed babies, and forms, indeed, the chief obstacle to the successful rearing of infants. The disorder as met with in early infancy has been already de scribed (see Infantile Atrophy). The present chapter treats only of catarrh as it affects older children, after the period of infancy has passed by.
childhood, the mucous membrane is especially liable to be affected by chills, but the " cold " does not always show itself in the form of sore-throat or cough. A gastric or intestinal disorder is a famil iar consequence of exposure to changes of temperature, and to this cause most cases of the derangement can be attributed. A child who has suf fered from many such attacks, often acquires an extraordinary susceptibility to alternations of temperature; and the most trifling chill will be sufficient to induce a return of his complaint. In such children, the mere going out with cold feet into raw, clamp air, is a common cause of a fresh attack. In sufficient clothing is sometimes the sole cause of the derangement. Chil dren whose parents have a foolish objection to flannel, often suffer greatly from continued catarrhs. I have known cases where complete loss of ap petite and persistent wasting resulted from this deficiency, and ceased at once when proper measures were taken to protect the child's body from the cold.
Certain constitutional states predispose the child to be readily affected by chills. In rickets, a susceptibility to catarrh is a marked feature of the disease. Pulmonary and gastric catarrhs are of constant occurrence in such subjects, and if the disease be present in a severe form, may lead to a rap-.
idly fatal issue. Scrofulous children, again, are very prone to suffer from catarrhal disorders, and gastric derangement in therm is very common from this cause. There is one peculiarity of gastric catarrh, as it occurs in scrof ulous subjects, which is of importance. It is that the complaint is almost invariably accompanied with fever. In such children, the recurring attacks of pyrexia, lasting from a few days to a week, which are often complained of, are cases of the febrile variety of acute gastric catarrh.
During the second dentition, the trifling febrile disturbance which is excited by the passage of the tooth through the gum, may render the child very susceptible to chills, and attacks of gastric catarrh at this time are very common.
Besides exposure to cold, irritation of the mucous membrane by un suitable food may be a source of catarrh. In infants, as has been already described, this is the cause to which the derangement can be most com monly attributed. In older children, also, gastric catarrh may be pro duced by similar means, and may be set up by excess of rich sauces, fruit, or sweets. As in the case of a chill, the susceptibility to suffer from these causes may be increased by temporary or constitutional states. During the evolution of a tooth, food Which would be readily digested at another time, is often found to disagree.
.11Iorbid mucous membrane, the seat of catarrh, is injected in spots, and a layer of tough mucus covers its surface. In the stomach the mucous surface is often found softened ; but this condition, which, under the name of gelatinous softening, or gastro-malacia, was at one time re garded as a pathological feature of great importance, and the cause of the symptoms which had been observed during life, is now admitted to be a mere post-mortem change which has no practical significance. The gastric membrane is thickened, and exhibits patches of redness. The stomach often contains much mucus, and not unfrequently fermenting food.