Holt's Diseases of infancy and childhood : a textbook for the use of students and practitioners / by the late L. Emmett Holt and John Howland.

  • Luther Emmett Holt
Date:
[1936]
Catalogue details

Licence: Public Domain Mark

Credit: Holt's Diseases of infancy and childhood : a textbook for the use of students and practitioners / by the late L. Emmett Holt and John Howland. Source: Wellcome Collection.

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    but progressive; frequent stools, which have no constant or striking character¬ istics. They are usually thin, yellow or greenish in color, often containing no mucus or blood. Occasionally for a day the stools may be almost normal in appear¬ ance. In number they average five or six a day, but often for days only two or three. Outside of a hospital where autopsies are regularly made, these cases are often overlooked and considered as obscure pneumonia, tuberculosis, septicemia, typhoid, etc. The duration of severe dysentery is usually from a few hours to several weeks. The duration of the most rapidly fatal case we have seen was only eighteen hours. We have seen one child recover after thirty-eight days of continuous fever. The Fig. 197.—Temperature Chart in Fatal Case of Dysentery. Infant fourteen months old, Babies’ Hospital. Symptoms for the first two weeks obscure. Intestinal symptoms for the last two weeks only, never very severe; stools four to six daily, geerally green, thin, with much mucus at times, and once or twice traces of blood. Autopsy: Membranous dysentery involving entire colon; catarrhal enteritis. usual duration of acute symptoms is ten to twenty days. Death usually occurs when the symptoms are at their height, the children apparently being overwhelmed by the severity of the disease; or, the acute stage having been survived, they suc¬ cumb to exhaustion or to some intercurrent infection such as pneumonia. It is probable that almost every case of the severity described terminates fatally when it occurs in a young infant. In older children the disease is usually milder and the prognosis is much better as to life, but in them the acute attack may be followed by a prolonged convalescence or by persistent intestinal disturbances. Some cases of chronic intestinal indigestion (celiac disease) apparently owe their origin to an attack of dysentery. Chronic Ulcerative Colitis.—In institutional practice and occasionally with very poorly nourished infants a type of dysentery is seen which is marked more by its chronicity than by its severity. The patient has often had several previous attacks of diarrhea or a prolonged subacute attack. The onset is usually not abrupt and the fever does not remain high. Toward the close, even of fatal cases, it may be hardly above normal. Vomiting is not a feature of these cases, though it may be easily excited by injudicious feeding. The stools are seldom very frequent but contain large quantities of mucus. Blood is not usually present. The failure in nutrition and steady loss in weight are very constant in these cases. As emaciation goes on, the skin hangs in loose folds on the thighs; it be¬ comes dry and scaly and loses its elasticity, and occasionally small petechial spots