CHOLERA MORBUS. 



503 



not show that the milk has become sour, but that the gastric juice has 

 acted normally on it, and curdled the casein; when the vomited milk 

 is not curdled, it shows that there is an abnormal secretion in the stom- 

 ach, and this must excite the suspicion of gastric catarrh. Soon after 

 the vomiting, or even at the same time, the passages from the bowels 

 become abnormal, or there may be no vomiting, and the appearance 

 of the passages may form the sole symptom of gastric catarrh. The 

 evacuations consist of a very acid, green or greenish-yellow fluid, con- 

 taining more or less firm lumps ; they remind us of the changes that 

 the milk undergoes after standing for some time out of the body, and 

 show that the gastric juice has not even digested it enough to cause 

 its sudden coagulation. The vomiting and purging, which are usually 

 preceded by restlessness of the child, by crying and drawing the legs 

 up toward the belly, occur more or less frequently ; the evacuations 

 often change their color and consistence. In many cases, the vomiting 

 ceases after a few days, the undigested milk disappears from the evac- 

 uations, the children improve and pick up ; but in other cases, from time 

 to time, quantities of acid milk, partly unchanged, partly curdled and 

 mixed with mucus, are vomited ; the purging increases, the evacuations 

 become thin, liquid, and very free ; at first they are bright yellow or 

 green, but at last almost white. Some yellow or greenish flocculi swim 

 in the colorless fluid ; these remain on the diaper, while the fluid partly 

 filters through, partly leaves large, damp, discolored spots in it. Even 

 now both the smell and reaction of the evacuations are acid. Occasion- 

 ally the appearance of the dejections changes suddenly, without our 

 being able to say why ; they become dark brown or clayey, and softer 

 masses of disagreeable smell are evacuated in large quantities. These 

 severer forms of acute gastric and intestinal catarrh reduce the child rap- 

 idly ; its face falls and is contracted with pain, it may even become wrin- 

 kled in a few days, the eyes are usually half opened and deep set, the lips 

 as well as the hands and feet are often bluish, the rest of the body, es- 

 pecially the back, is mottled. The temperature is uneven, the trunk, 

 especially the belly, is burning hot, while the face and limbs are cool. 

 From the diminution of cerebral pressure the fontanelles become de- 

 pressed, occasionally even the frontal and occipital bones sink slightly 

 below the parietal bones, the movements of the children become sluggish, 

 even nursing troubles them ; they let go of the breast, but eagerly drink 

 water when it is offered to them. The cries of pain which usually pre- 

 cede the evacuations gradually change to weak whimpering ; in the 

 interval the child lies half asleep. As the exhaustion increases, many 

 die ; occasionally, shortly before death, convulsions (hydrocephaloid) 

 and other symptoms of anaemia of the brain appear. When the disease 

 runs a favorable course, the evacuations gradually become fewer and 



