diarrhoea (severe intestinal catarrh or entero-colitis) is a much more serious disorder than the preceding. The purging may be severe from the first, or may begin as a mild looseness of the bowels, which quickly becomes more violent, and is accompanied by very evident impairment of the strength and interference with the general nutrition of the patient. In feeble children and infants it is often rapidly fatal, and even robust sub jects may die collapsed after a few days. In some cases it passes into a chronic stage, and if not fatal to life, may reduce the child to a state of ex treme emaciation and weakness.
Causation.—The causes which have been enumerated as giving rise to the simple form of diarrhoea may also induce the more serious variety of intestinal catarrh. The severity of the process excited by these agencies is probably often dependent upon constitutional tendency, or upon some special state of the system prevailing in the child at the time of the attack.
Chilling of the surface and improper feeding are, no doubt, answerable for many of these cases. Besides these, the drinking of contaminated water, or the effluvium from decaying organic matter given out by the putrefying refuse of large cities is, no doubt, a frequent cause of the preva lence of severe and often fatal diarrhoea during the summer months. Not unfrequently several of these causes are found in operation at the same tune. If an infant born of poor parents, and living in a badly drained and crowded house, be fed in hot weather from an ill-cleaned and sour-smelling bottle, it may be considered certain that acute inflammatory diarrhoea of a violent character will very shortly follow. In bottle-fed infants, indeed, the disease is especially common, and is answerable for a large part of the mortality which occurs in cities during the first twelve months of life.
Severe inflammatory diarrlicea, appears to be almost confined to large towns ; and the mortality from this cause is greatest during the months of July, August, and September. According to Dr. G. B. Longstaff it is not
so much heat alone, as heat combined with drought that gives its virulence to the disease ; for the mortality is greatest in years with hot, dry summers, least in years when the summers are cold and wet. This observer regards the complaint as a communicable zymotic affection, and attributes its ori gin to a locally bred miasma from the soil or sewer-air. It seems, indeed, likely that in many of the more serious cases of acute inflammatory diar rhoea there may be a strong septic element in the illness. Certainly we often find a degree of nervous prostration quite out of proportion to the amount of purging. Indeed, a state of exhaustion may continue after the diarrhoea has been arrested, and end in death, although days have passed without any excessive looseness of the bowels having been noticed.
of the child, as might be expected, favours the occurrence of inflammatory diarrhoea ; but there are certain diseases which are commonly accompanied by catarrh of the bowel. Thus in typhoid fever diarrhoea is a frequent symptom ; and in measles and scarlatina pargiug may form a very serious complication. Again, causes which promote congestion of the portal system, such as cirrhosis of the liver, and diseases of the heart and lungs, which impede the passage of the blobd from the right side of the heart to the left, and therefore interfere with the whole venous circulation, may also help to determine the derangement.
Morbid Anatomy.—The catarrh of the intestine is seldom general, usu ally it is very partial, and is limited to the large intestine and jejunum. On opening the bowel we find the lining membrane coated at the inflamed part with a layer of thick. mucus containing detached epithelial scales. The mucous membrane itself is reddened, and often thickened, and its solitary glands and the glands of Peyer's patches are swollen so as to project above the surface. Sometimes the mesenteric glands are a little swollen.