The stools are very watery and offensive, usually dark in colour, and if much milk is being taken, may contain lumps of curd. Sometimes, espe cially in very hot weather, they may be yellow or green from excessive secretion of bile. The urine is comparatively scanty and high-coloured. According to Nothnagel, if the small intestine is the seat of catarrh, the ex cretion of indican is in excess. When death takes place it is usually by asthenia ; but spurious hydrocephalus is uncommon after the period of in fancy has passed, and, according to Kjellberg, kidney complication after that age is equally rare.
At ages the symptoms of prostration come on earlier and are more pronounced if the child is already reduced in strength when the attack begins, and therefore inflammatory diarrhoea occurring as a secondary complication in a child worn and wasted by previous illness is an exces sively serious derangement.
The chronic form of intestinal catarrh is a very obstinate and dangerous disorder, and unless treated judiciously is almost certain to end fatally. It may succeed directly to an acute attack, or may begin insidiously. If it occur as a sequel of the acute variety, the stools gradually become fewer and the more urgent symptoms subside. The child, however, does not re gain flesh or strength, but remains feeble and pallid. His bowels act three or four times a day, and the evacuations consist of thin, dark, offensive fluid, or of equally offensive pasty matter and mucus.
The insidious beginning of the chronic disorder is very common. If detected early and treated with judgment, it is readily arrested ; but if it continue unchecked, it becomes a confirmed derangement and is much more difficult of cure. Still, even in bad cases the disorder may be usually guided to a successful issue if proper measures are adopted.
A child of eighteen months or two years of age is noticed to be looking pale, and his flesh is found to be flabby. Then he shows less than his usual pleasure at being on his legs, and if the power of walking have been only lately acquired, often refuses altogether to put his feet to the ground. These symptoms occasion great perplexity to the attendants, for the child's appetite continues good—often unusually keen—and his bowels are regu larly relieved. On inquiry it will be found that the motions are more nu merous than natural, often three or four in the day ; that they are large, offensive, and sour-smelling,' and that in appearance they resemble a mass of soft putty. If only one or two stools occur in the day, they are often curiously copious ; and the mother will declare that the quantity of food consumed by the child, considerable as it may be, is quite insufficient to account for the enormous amount of matter passed from the bowels.
For weeks, perhaps, these symptoms go on unchanged. The wasting continues, and all power of digesting what is swallowed seems to be lost. Occasionally for two or three days together the bowels are relaxed, the stools being frothy and sour-smelling, or thin and dark-coloured like dirty water ; but the diarrhea soon ceases and the motions again become large, soft, and pasty, as they were before. The attacks of acute catarrh repeat edly return, the intervals between them grow shorter, and eventually the looseness becomes a confirmed condition. Often, however, a considerable time may elapse before this stage is arrived at. The child for months may remain pale and listless, with curious alternations of voracity in feeding and disgust for nourishment of every kind. He is not feverish but sweats copiously. There is no actual diarrhcea, perhaps even no increased fre quency of stool. No pain is complained of. The mother will say that she cannot think what is the matter with the child, but that he is wasting away.
When the diarrhcea becomes persistent, the stools vary in character from time to time. In any case, they have an intolerable stench ; and may be dark coloured and watery ; or thicker, but still fluid, like thin paste ; or may consist of green matter, like chopped spinach, diffused through a dark brown liquid. If they show a shreddy deposit, mived with small black clots of blood, ulceration of the bowels may be confidently predicated, even al though no tenderness of the abdomen can be detected.
The wasting now proceeds rapidly. The child gets hollow-eyed, wrinkled, and old-looking. His belly swells from flatulent distention. His limbs often become oedematous. He is excessively feeble, and lies quite motion less, taking little notice of anything. His appetite may be good, even at this stage, but often it is capricious or altogether lost. The water is diminished in quantity, if the purging is severe, and may contain from time to time, a little uric acid sand. Eventually, the child sinks into a state of exhaustion, and dies from asthenia, or is carried off by an attack of inflammation of the lung. All the symptoms which have been described as spurious hydro cephalus, may be noticed before death, and the diarrhcea may quite cease during the last few days of the illness.