If the inflammation have passed into a chronic stage it is dark gray or dirty red in colour, and the enlarged follicles can be seen as small, pearly pro jections. In some cases patches of false membrane are seen on the surface, especially in the large intestine. The mucous membrane then has the ap pearance of being sprinkled over with bran. The little patches consist of exuded lymph containing epithelial scales. They vary in size and shape, and usually occupy the summits of the ridges of the mucous membrane.
If the catarrhal process has lasted long or been very serious we often find ulcerations. These are usually seen in the large intestine, especially towards the lower part, and in the lower part of the ilium. The ulcers are seated at the follicles and result from suppuration and ulceration starting from the interior. They are at first circular but may extend their edges ir regularly. Not rarely we find intussusceptions of the bowel. These usually occupy the small intestine, and several may be present at the same time. They are evidently produced immediately before death, for the invaginated portions can be readily drawn out and show no sign of congestion or swell ing.
In many cases of severe intestinal catarrh the liver is fatty. Another frequent complication, according to Kjellberg, is parenchymatous nephritiS. This physician states that in 143 cases of fatal intestinal catarrh he found kidney disease in no less than G7. It is more common in infants than in older children, and is often partial, attacking only a portion of the cortical substance.
Symptoms,—The symptoms of acute inflammatory diarrhma vary to some extent according to the age of the child. As a rule, if the purging be profuse the drain upon the system causes symptoms of depression, which come on earlier and are more severe in infancy than at a later period of childhood. Moreover, in infancy the intestinal disorder is apt to be accom panied by symptoms dependent upon parenchymatous nephritis ; and this complication is not so often seen after the period of the first dentition has come to an end. The derangement will, therefore, be first described as it affects infants, and afterwards as it is met with in older children.
In infants inflammatory diarrhoea usually begins like the milder form, with symptoms of discomfort about the belly and some looseness of the bowels ; but the purging soon becomes more severe. If there be any gas
tric catarrh, the child often vomits ; and both the matter ejected from the stomach and that discharged from the bowels is acid and sour-smelling. The stools at first contain much curd and undigested food, but rapidly change their character and become thin and watery. They are brownish or greenish in colour, and give out a most offensive odour. Unless the lower bowel be affected there is little mucus visible to the eye, and the stools are passed without straining or signs of pain in the belly. In number they vary from six or seven to fifteen or twenty, or even more, in the twenty-four hours. Their character is found to change from time to time, partly according to the frequency of their passage. Thus, if they follow rapidly upon one an other they usually consist of dark-coloured watery fluid, which deposits thick feculent matter on standing. If separated by a longer interval, they become thicker and more distinctly fcal, and may contain small lumps of curd. Often they vary in character, and are at different times light and pasty, or frothy and dark, or green and very liquid. They are almost always very offensive. Under the microscope Dr. Lewis Smith has detected undigested particles of casein, fibres of meat, crystalline formations, epithelial cells— single or arranged in clusters—mucus, and sometimes blood. According to Nothnagel, of Jena, mucus, invisible to the naked eye, but perceptible under the microscope, indicates a catarrh of the smaller bowel.
The general symptoms are very severe. The infant rapidly wastes, and becomes so weak that he cannot sit up. His eyes get hollow; his face is very pale ; the nasal line encircling the corners of his mouth becomes deepened into a distinct wrinkle, and erythematous redness appears upon the buttocks and inner parts of the thighs from the irritation of the dis charges ; the skin is dry, and the amount of urine is greatly diminished. Often the tongue is quite clean and red, although less moist than in health, and there is great thirst. If there ,is much gastric catarrh, the tongue may be furred upon the dorsum, and vomiting is often a distressing symptom. The pulse is rapid and feeble. The temperature varies. Sometimes it re mains unaltered or may even be subnormal ; in other cases it reaches to 102° or 103°, rising and falling irregularly, but never dropping to the level of health.