Image from page 794 of "The diseases of infants and children" (1919)
Publisher: Philadelphia, London, W.B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons
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a constant or troublesome symptom unlessthe disease is complicated by gastric indigestion. The abdomen is usuallydistended by gas and there is frequent colic if constipation is present, butless often so if diarrhea. The appetite is generally good and sometimeslarge; the tongue varies; there is often irregular fever alternating with nor-mal or low temperature, or there may be more constant elevation, butonly when symptoms of constitutional intoxication develop. The urinemay show the presence of the acetone bodies and an increased output ofnitrogen in the form of ammonia, but this is not always the case. Insome patients there arises an intolerance for cows milk in any form,its administration being followed by an exacerbation of the symptoms,including vomiting, diarrhea, fever, and sometimes cutaneous eruptionsand evidence of a disturbed nervous state. The chief symptom, however, is -persistent increasing malnutrition,with all the symptoms already described under the heading of infantile
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Fig. 252.—Chronic Intestinal Indigestion.Child of 3j^ months, in the Childrens Hospital of Philadelphia. Great wasting; mod-erate fever; bowels loose; failure to improve under any treatment; death. atrophy (pp. 612 and 698). The children gradually waste more and more,and suffer from low temperature, feeble circulation, anemia, and in-creasing debility. They are usually constantly fretful in the early stageand often apathetic later. During this condition of malnutrition no verypositive evidences of indigestion may be discoverable. Yet diminishingthe amount of food of these infants may increase the rapid loss of weight,while increasing the amount may have the same effect, often with attacksof autointoxication of a dangerous nature. Course and Prognosis.—The course of the disease is very variableand the duration uncertain. At best it is long-continuetl and lasts formonths before recovery is assured. In some instances the loss of weightis constant and extreme (Fig. 252). In others the
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