In almost all cases of infantile atrophy, the ordinary uniform course of the derangement is interrupted by intercurrent attacks of vomiting and diarrhcea. These attacks not only greatly increase the rapidity of the wasting, but, if of great severity, may bring the illness abruptly to an end.
Troublesome vomiting in a young baby, the consequence of gastric catarrh, is a very serious ailment. All food swallowed is instantly re turned, and clear fluid, like water, or bile-stained mucus, is occasionally ejected. The vomited matters, and even the breath of the child, have an offensive, sour smell. The belly is swollen and often seems tender; the hands and feet are'very difficult to keep warm; the eyes grow quickly hol low; the lids close imperfectly; the complexion is sallow or half jaundiced, and the fontanelle is deeply depressed. At first the tongue is thickly furred, later it is apt to have a red, glazed appearance: The child is very fretful. He soon becomes too weak to cry loudly, but whimpers feebly to himself in a pitiful way, and scarcely seems to sleep at all. If no diarrhoea complicate the ailment, the bowels are confined, and the patient often seems to be disturbed by flatulence, for he draws up his legs uneasily with a troubled grimace. If treatment do not succeed in checking the disorder, the vomiting continues, and is excited by the least movement. The complexion becomes earthy, the hands and feet grow purple, and the temperature in the rectum may fall as low as 96° or 97°. At this period, thrush usually appears in the mouth, and death may be preceded by symptoms of spurious hydrocephalus.
Steady, persistent vomiting such as has been described, is less common than are shorter attacks of sickness accompanied by diarrhoea. These are apt to occur in children at an early period of the atrophy, and must be looked upon as an eflOrt of nature to relieve the alimentary canal of its unwholesome burden. It is only at a later period of the illness that they are apt to become obstinate, and when thus confirmed, the ailment is very difficult to overcome. A chronic diarrhoea, such as is elsewhere described (see page 633), often arises in the course of infantile atrophy, and, if not treated judiciously, determines a fatal issue to the illness. In most cases, indeed, death is the consequence of a persistent looseness of the bowels which nothing will arrest. But, in an infant reduced to a weakly state by
a long course of improper food, any acute ailment, however apparently trifling it may be, will often prove fatal. A new symptom occurring at a late period of atrophy is therefore to be regarded with very serious ap prehension.
Diagnosis.—A state of extreme emaciation may be present in the infant as a result of other causes than injudicious management and unwholesome feeding. Infants, the subjects of inherited syphilis, are often excessively puny and feeble, and acute tuberculosis may attack a child of a few months old and gravely impair the nutrition of the patient.
In the first case, the symptoms induced by the syphilitic poison are sufficiently distinct. The child snuffles and cries hoarsely. His skin is dry, wrinkled, and of the colour of old parchment. It is sprinkled over with the characteristic coppery or rust-coloured spots, and the buttocks and perinum, often, also, the genitals and upper parts of the thighs, are the colour of the lean of ham. Mucous tubercles are probably to be discovered at the margin of the anus and the lips. The corners of the mouth are fissured, and the nostrils red-looking and excoriated. The bridge of the nose is flattened, and an examination of the belly will probably detect enlargement of the spleen. None of these symptoms are to be found in simple infantile atrophy. The earthy tint of the face and body sometimes resulting from chronic digestive trouble is very different from the parch ment-like hue of the inherited disease ; strophulus, arising from the same cause, can hardly be mistaken for the coppery spots of syphilis ; and hoarse ness, snuffling, and the other symptoms which have been enumerated, are never the consequence of weakness and wasting, however profound.
In acute tuberculosis, the temperature is elevated, and a thermometer in the rectum will be found to mark 100° or 101° in the evening. In in fantile atrophy, there is no pyrexia ; on the contrary, the bodily heat is usually lower than in health. Moreover, in the former disease, the child coughs, and even if the lungs are not the seat of pneumonia, a clicking rhonchus will be discovered here and there about the chest. In tuber culosis, too, a slight amount of oedema of the legs is almost invariably present in the infant.