Symutoms.—Attacks of gastric catarrh may or may not be accompanied by elevation of temperature. The severe acute attack, with high fever, is the less common, and is limited, or nearly so, to the subjects of struma. The subacute, non-febrile gastric derangement is much more often met with. It is milder in character and more quickly subsides : indeed, from the slightness of the symptoms by which it is accompanied, the attack may pass almost unnoticed, or be spoken of as "liver" or "biliousness." In the acute febrile form, the child feels chilly, or even shivers, and then becomes very feverish, the temperature rising, perhaps, in the evening of the first day or two, to 104°. The patient complains of no pain, but is languid and irritable. He has a sallow complexion, and looks dark under the eyes, but his.general expression is placid, and unless the child is tired by exercise, there is none of the pinched, haggard aspect which is so com mon in cases of really serious illness. The appetite is lost, and there is some thirst. The tongue is usually furred on the dorsum, but may be clean and red at the tip and edges. Vomiting is not common, but may occur, although it is rarely distressing. If the catarrh affect the intestinal mucous membrane as well as that of the stomach, there is some diarrhoea ; otherwise the bowels are confined. Purging, if present, may be accom panied by some pain in the belly, but this, as a rule is insignificant. At night the child is often restless, and is disturbed by dreams from which he may wake in great terror. During the day, if the catarrh is severe, he is generally drowsy, and sits or lies about without wishing to join in the sports of his companions. While the attack lasts, nutrition is in abeyance, and the flesh and strength manifestly suffer. After a week or ten days, the pyrexia, which had been gradually subsiding, disappears ; the appe tite and spirits return, and the patient is convalescent.
Often the gastric catarrh is accompanied by symptoms pointing to a similar condition of other tracts of mucous membrane. The child may suf fer slightly from catarrh of the nose ; the throat may be a little sore ; the eyes may be weak and distressed by a strong light, or there may be slight cough. Even if the fever is high, delirium is not common, but there is oc casionally some frontal headache. If the catarrh pass along the duodenum to the common bile duct, a mild jaundice is noticed.
In many cases, an attack such as the above passes off, and the child does not suffer again from a similar illness. Often, however, the catarrh, instead of occurring in one solitary instance, returns repeatedly at short intervals. Cases of recurring gastric catarrh of greater or less severity are far from uncommon ; and these attacks, if the intervals between them are short, may exercise a very injurious influence upon the health and general development of the patient. Children, the subjects of such catarrhs, become pale and thin, for their nutrition is being constantly interrupted. By its influence upon appetite and digestion, the catarrh checks for a time the introduction of nourishment into the system, and nutrition is hardly restored on the cessation of the attack when a return of the derangement suspends it again as before. In this way the child may become an almost constant sufferer
from disordered stomach, and his continued ill health and persistent wast ing excite the gravest apprehensions amongst his relatives. Such cases are often supposed to be cases of consumption ; and, indeed, if there be any inherited chest weakness, long-continued interference with nutrition, such as is produced by a frequent recurrence of these attacks, may go far to en courage the tendency to phthisis.
In the non febrile variety, the symptoms are much less striking, for, py rexia being absent, the spirits are less depressed and the patient utters no complaint. Most children suffer at times from what is called " biliousness." For two or three days together they lose their appetite, mope and lie about, have a dull, pasty or sallow complexion, and look dark under the eyes. At night they sleep badly, and they are restless and irritable in the clay. These symptoms are produced by a temporary catarrh of the stomach which in terferes for the time with the digestion of food, but passing off, leaves no ill consequences behind. When, however, the attacks are frequent, tion is weak, even in the intervals of comparative health, and nutrition be comes seriously impaired. Such children complain often of flatulent pains in the sides, and may be subject to attacks of syncope from pressure up wards of the distended stomach against the heart. Their bowels are usually costive. The appetite varies greatly. Sometimes it is excessively keen ; at others it is poor and capricious. In many cases, indeed, the child seems to have no appetite at all, and the greatest difficulty is experienced in mak ing him swallow his food.
These symptoms may be greatly aggravated by an unsuitable dietary. If a child who suffers from the condition described be supplied with an ex cess of fermentable food, such as potatoes, puddings, jams, and sweet cakes, he is kept in a state of chronic acid dyspepsia which is a source of constant discomfort to himself and anxiety to his friends. The whole system being full of acid generated by fermenting food, the child is wayward and cross in temper, and excessively fidgety and restless. His speech is often hesi tating, and he may stammer in his talk. His muscles are irritable and twitch easily, so that he winks his eyes and distorts in nervous fashion the corners of his mouth. The so-called nervous habits of children often owe their origin to this derangement.
Sickness is not a common symptom in these cases, for gastric catarrh is by no means always accompanied by irritability of stomach. Sometimes, however, the child at rare intervals brings up a large quantity of sour-smell ing fluid and mucus. Frontal headache, more or less severe, is rarely ab sent, and oftentimes the pain is distressing. The wearing periodical head aches of children are not uncommonly owing to this cause. The urine is noticed from time to time to be thick with lithates ; and, in rare cases, quan tities of fine uric acid sand are passed, precipitated by the free acid with which the urine is charged. .