INTESTINAL CATARRH. 573 



during their second year from chronic catarrh of the intestines. In 

 babies put out to board, chronic intestinal catarrh usually appears 

 earlier and runs its course quicker. The mother of such a child, which 

 has previously been healthy and plump, and whose appearance was 

 the best recommendation for the fitness of the mother as a nurse, often 

 takes a position as wet nurse even six or eight weeks after her confine- 

 ment. The child is given over to some old woman, who feeds him 

 with bad milk and spoiled pap, and, to prevent his crying too much, 

 gives him a sugar teat or crust of bread during the intervals between 

 meals. Diarrhoea soon occurs, emaciation goes on rapidly, and soon 

 becomes extreme; fat and muscles disappear, the child becomes 

 wrinkled, and looks like a little old woman ; his flabby skin flaps 

 about him like a loose pair of trousers ; there are excoriations about 

 the anus, and the oral mucous membrane is covered with thrush depos- 

 it. While the child which the nurse suckles flourishes, her own child 

 usually wastes away and dies in the third or fourth month. In large 

 cities, women who gain a living by taking children to board bury three 

 or four, or even more, every year. Even in these cases, on autopsy, 

 nothing is usually found but the signs of excessive wasting, and the 

 slight remains of chronic intestinal catarrh. The latter may be consid 

 ered, in the diarrhoea ablactatorum, as a series of daily returning acute 

 catarrhs, which are daily excited by the passage of undigested and 

 decomposed ingesta into the intestines. 



We shall next speak of the most frequent form of the severe ca- 

 tarrhal inflammations that lead to ulceration of the mucous membrane, 

 and not unfrequently of the entire wall of the intestine, viz., typhlitis , 

 or, as it is usually called, typhlitis stercoralis. Sometimes there are 

 premonitory symptoms, before attaining the stage of severe inflam- 

 mation, that we call typhlitis ; collections of faeces in the caecum and as- 

 cending colon cause repeated attacks of colic and catarrh ; so that from 

 time to time the patient complains of stomach-ache, and has alternate 

 constipation and diarrhoea. In other cases there are no premonitions, 

 and even the first retention of faeces in the caecum or ascending colon 

 leads to severe inflammation and ulceration of the wall of the intestine. 

 When this occurs, the muscular coat loses its power of contraction, and 

 fchere is almost as great obstruction to the advance of the contents of 

 the intestines as there is in constriction or adhesions of the bowels. 

 Mucous or bloody mucous masses, the result of catarrh in the lower 

 portion of the rectum, are passed, but there is no proper defecation. 

 The contents of the small intestine cannot pass downward, hence are 

 driven upward by the contractions of the intestinal muscles ; there are 

 So-called anti-peristaltic movements. The contents of the small intes- 



