After a few days, the earlier in proportion to the profuseness of the drain, the child falls into a state of profound depression, with quick, feeble pulse, and rapid, shallow breathing. The eyes are hollow, the purple lids close incompletely, and the face, especially round the mouth, is livid. The fontanelle is deeply depressed. The tongue often gets dry and brown, and thrush may appear upon the cheeks and lips. Often, although the hands and feet feel cold, the internal temperature of the body is very high. A ther mometer placed in the rectum will sometimes mark 107°, or even higher, although the child's general appearance is that of. collapse. Thus, a little boy, aged nine months, had suffered from diarrhoea for a week, and was occasionally sick. When seen the motions were light coloured, watery, and offensive. His temperature (in the rectum) was 105.6° ; pulse, 176 ; respirations, 64. On the following morning the temperature was 103° ; but in the evening it rose to 107.8°, and the child died a few hours afterwards. Just before death the thermometer marked 106°. Another infant, ten months old, had diarrhcea for about a fortnight, the bowels acting five, six, or seven times in the clay. At this time the temperature was normal. It then be gan to rise, and for a few clays varied between 101° and 102°. Then it rose rapidly to 107.4', and the child died with all the signs of collapse. In neither of these cases was permission obtained to make examination of the body, but no complication could be discovered during life to account for the elevation of temperature.
When the catarrh is seated in the larger bowel, especially if it affects principally the descending colon and rectum, the symptoms are more dys enteric in character. Indeed, this form of inflammatory diarrhoea is often improperly spoken of as "dysentery." The infant usually cries before the passage of a stool from griping pains in the belly ; and the evacuations are discharged with great effort and Straining. Often the bowel prolapses, and the motions contain streaks or drops of red blood. The stools themselves consist of slimy matter from admixture with mucus, and lumps of coagu lated mucus can be distinctly perceived in the fmcal matter. Sometimes the straining continues for a considerable time after the passage of the motion, and the prolapsed bowel protrudes like a bright crimson ball from the anus. Often it can be returned only with great difficulty, and when replaced is shot out again directly by the straining. In this form the stools may be as numerous as when the small intestine is affected, the vomiting as distressing, and the prostrating effect upon the system of the constant purging quite as pronounced. Indeed, if the tenesmus is urgent and the protrusion of the inflamed bowel almost constant, the case is very likely to end fatally.
If the derangement be complicated with parenchymatous nephritis, the signs of general collapse, into which the infant in fatal cases almost invaria bly sinks, are diversified by others pointing to the kidney. According to
Kjellberg's description of such cases the tongue is dry, the skin upon the abdomen is cool and dry, and its elasticity is completely lost, so that when pinched up it remains wrinkled, lying in loose folds ; the legs are stretched out and stiff, often oedematous ; the urine is very scanty, albu minous, and deposits a sediment containing epithelial and hyaline casts and small round cells. The child vomits occasionally, sometimes shrieks out, and may be convulsed. In the very acute cases the infant is restless, with a very rapid pulse and hot skin. He flexes his thighs on his belly, and al though drowsy and stupid, screams at times with pain, and appears to feel acutely the slightest touch upon his body.
In the more protracted cases the infant often falls into a comatose state, which from its resemblance to the third stage of meningitis has been called " spurious hydrocephalus." The child lies in a drowsy condition, from which, however, he can at first be roused. His eyelids are half closed ; the pupils are sluggish and may be unequal ; the pulse is rapid, and often intermittent ; the breathing is irregular and sometimes sighing ; the fontanelle is deeply depressed ; the features are pinched and sharp ; and the complexion is livid or even lead-coloured. The temperature taken in the rectum is subnormal. While in this state the stools—small, wa tery, and often greenish—may continue, and be passet involuntarily ; or the purging may cease, but without being followed by any signs of im provement. Unless energetic measures of stimulation are adopted, the child continues in the same state for twelve or twenty-four hours, or even several days, growing weaker and weaker, and death may be preceded by a slight convulsive seizure.
Spurious hydrocephalus may be the consequence merely of sluggish circulation through the brain of impoverished blood. Often, however, it appears to be owing to the occurrence of thrombosis in the cerebral sinuses. Parrot has suggested that it may be sometimes due to ummic poisoning from deficient renal secretion.
When the disease occurs after the age of infancy, the child is usually able to resist the exhausting effects of the diarrhoea for a longer period than is possible at the earlier age ; but he rapidly loses flesh and strength, and if the purging is severe and is accompanied by vomiting, the features soon look pinched, the eyes get hollow, and the expression is haggard and distressed. Unless the lower bowel is affected, pain in the belly is usually insignificant ; but if the descending colon is the seat of the derangement, there is much tenesmus and griping pain, and the bowel may prolapse. The temperature in these cases is usually moderately elevated during the earlier period of the attack, but often falls to a lower level than that of health when the purging has produced much depression of strength.