In some cases a curious condition of the tongue is noticed. On the dorsum are seen rounded or oval patches, which appear to consist in a re moval of the epithelial covering. The surface of the patches is distinctly depressed, and the colour is that of the dorsum generally. The edges are circumscribed and irregular. The number of these patches is usually three or four. They may be seated on the dorsum or on the edges of the tongue. At times, small rounded ulcers (aphth) and red elevated papilla are seen at the tip of the tongue in addition to the depressed patches on the dorsum. If aphtlne are not present, there is no pain or soreness.
Symptoms such as the above show a high degree of digestive derange ment, aggravated by an unsuitable dietary, and are almost invariably the consequence of repeated attacks of catarrh of the stomach. Under such circumstances, nutrition is interfered with, the child wastes perceptibly, and the apprehensions of the parents are carried to a high degree. When, on the other hand, the indisposition is only occasional, and the symptoms are not severe, little attention is excited. The child is supposed to be a bilious subject, and unless the attacks become so frequent as to cause an evident diminution in bulk, or some new symptom is noticed which excites the alarm of the friends, medical advice is considered unnecessary.
In cases where, owing to the mildness or infrequency of the attacks of gastric derangement, general nutrition has not suffered, the occurrence of fainting fits may induce the parents to apply for medical assistance. At tacks of syncope, more or less complete, are not uncommon in these cases. Naturally enough, they give rise to great anxiety, especially if conjoined with palpitations and flatulent pains about the chest. They are then con sidered to be symptomatic of heart disease. Thus, a little girl, aged eleven years and a half," fainted for the first time six years ago. She has since fainted on five different occasions. At these times she has always been noticed to be dull and languid, with a poor appetite, but otherwise has seemed to be well. Is subject to sharp pains in the left hypochon cilium, under the influence of which her face will become ghastly white. She sleeps badly, talking and moaning, and often lies awake at night. Has never suffered from worms ; bowels are confined. Has sometimes a sallow complexion." This young lady, who was a well-grown, well-nourished girl, with perfectly sound organs, soon lost all her symptoms under suitable treatment.
In some cases, the non-febrile form of the complaint is accompanied by more serious symptoms. There may be severe pain in the epigastrium, violent headache, and distressing retching and vomiting, first of food and afterwards of bilious or watery fluid. Such attacks are usually soon over. They are commonly produced by the introduction of some irritant into the stomach, and cease soon after the complete ejection of the offending mat ters from the body. For some days afterwards the child is languid, his digestion weak, and vomiting is easily excited.
In children of eight or nine years of age or upwards, the dyspepsia in duced by repeated attacks of gastric catarrh may give rise to more or less severe pain after food, a tendency to vomit, pyrosis, and other symptoms such as accompany the derangement in the adult. These symptoms are seldom met with except in children who are habitually over-fed, or are in dulged with rich sauces and highly-spiced and stimulating food. They usually quickly subside under a change of diet.
Diagnosis.—The febrile form of acute gastric catarrh often presents some difficulty in the diagnosis, for the symptoms are frequently indefinite, and the case may be mistaken for one of far more serious disease. Such cases have been confounded with cases of acute tuberculosis, and they often present a strong likeness to the mild form of enteric fever. The prin cipal points upon which the diagnosis is founded will be best illustrated by the narration of the following case seen in consultation with Dr. G :fflher.
A little girl, aged seven years, of a strumous disposition, had been deli cate and subject to occasional failure of appetite for some months. For about a week she had been feverish, the bodily temperature rising some times as high as Fahr. Her appetite had been completely lost, but she had not suffered from sickness. The bowels, at first sluggish, had been somewhat relaxed for two days, the motions passed being moderate in quan tity, but loose, rather offensive, and bright yellow in colour. She had oc casionally complained of abdominal pains. During the whole time of her illness the child had snuffled slightly, and at first her throat had been a little sore, but there had been no cough. She had complained sometimes of frontal headache, but had not been delirious.