Morbid Anatomy.—In cases of death from infantile atrophy, the tissues are found excessively wasted, and there is complete absence of adipose tissue from the body. The general pathological appearances are such as have been already described as common to cases of thrush (see page 572).
Symptoms.—When a child at the breast depends for his support upon a scanty supply of poor milk, he suffers no pain, but wastes persistently. The infant is peevish from hunger, and at times cries violently. For the same reason he sleeps little, and at night is very troublesome. In the day time he often lies quietly sucking his fingers until they are raw. His fon tanelle is level or depressed ; his skin is moist ; his bowels are confined ; the motions scanty and often almost solid. He soon becomes pale and flabby, and does not grow. If the milk, although poor and watery, is abun dant, the child frequently requires the breast. He sleeps much, and often is found asleep with the nipple still in his mouth. This, indeed, is a common sign of watery milk. If noticed in a child who is not thriving, but in whom no positive derangement can be discovered, measures should at once be taken to change the nurse, or supplement the breast-milk by a suitable diet.
In hand-fed babies, infantile atrophy is often seen in its most extreme degree. A child fed with unsuitable food is not only starved, but is kept in a state of continual distress ; so that we find persistent wasting com bined with symptoms more or less striking of gastric and intestinal dis turbance.
The loss of flesh is noticed from the very beginning. Its rapidity de pends partly upon the kind of food chosen ; partly upon the natural strength of the child, and his capacity for extracting nourishment from his unwholesome diet. A puny infant, fed with large quantities of arrow root, or other equally inappropriate food, wastes very rapidly, and at the end of two or three months, if he lives so long, may actually appear to have made no advance in size or in strength since his birth. Such an in fant i,s pale and miserably thin, his skin is dry, and has a faint yellow tint ; his eyes are hollow ; his cheek-bones project ; his lips are livid, and their slightest movement shows a deep furrow encircling the corners of the mouth; his expression is uneasy and languid; his feet and hands are habit ually cold, and he whines and cries fretfully for hours together. These
children often have a. ravenous appetite for food, and will swallow greedily whatever is offered to them. The meal, however, produces merely a tem porary relief, and as soon as the griping pains to which it gives rise make themselves felt, the child's wailings are renewed. The abdominal pains excited by the indigestible nature of his food are often very severe. The infant may become quite stiff and rigid from his suffering, and scream with white, drawn face and staring eyes until exhausted. Sometimes the griping gives rise to a convulsive fit, although this is rare, but the irrita tion of the bowels, and acidity, not =frequently excite signs of nervous irritation ; we notice sudden starts and twitches, a slight squint, a pecu liar rotation of the eyeball upwards, and contractions of the fingers and toes.
Eruptions on the skin, such as strophulus and urticaria, are common ; and in the later stage of the illness, aphthm or thrush may appear in the mouth.
The state of the bowels varies. It is probably dependent upon the de gree to which the mucous membrane is irritated by the child's unsuitable diet. If this irritation be only moderate, the bowels are usually confined. The infant is restless, and may be noticed to be feverish at night. His tongue is coated with a thick white fur. He is evidently in a state of great discomfort, for his temper is peevish and fretful, his movements are uneasy and jerking, and he occasionally breaks out into piercing cries, drawing up his knees and twisting about his body under the influence of abdominal pain. At night the griping is especially violent ; the child scarcely sleeps at all, or if he be quiet for a moment in uneasy sleep, he soon starts up again, screaming with a fresh attack of pain. The motions are scanty and rare. The bowels sometimes remain confined for twenty four hours or longer, and when they are at last relieved, hard, clay-col oured balls, tinged with green mucus, are expelled with great effort and straining. These balls consist of hard curd and farinaceous matter. A full dose of castor-oil, which clears away the curd, allays the symptoms for a time ; but usually, if the same diet be persisted in without any change, they return in a day or two, and the child is in the same distress as before.