Page:Transactions of the Provincial Medical and Surgical Association, volume 1.djvu/108

 only in the first place, but terminating, eventually, in incurable organic derangement; it is in the cellars and dirty alleys of a crowded city, that such examples are to be found, and it is in these that infant mortality attains its maximum. Of a large proportion of these little sufferers, it may be said that they die without medical aid; and of many more, that the disease has made incurable inroads, before it becomes the subject of medical treatment. The child is already in a state of marasmus. At first there is some functional derangement of the alimentary canal; the intestinal discharges are too frequent, perhaps, and in process of time, assume a chyliferous appearance. Nor is the disease confined to the bowels, but the mesentery and peritoneum, lining the parietes of the abdomen, share in the affection, and the belly is tumefied and tense. The surface of the abdomen is often tender to the touch, and there is frequent deep-seated lancinating pain within its cavity. Should these symptoms not subside under proper treatment, a rapid increase of the emaciation ensues, and the evening accession of fever is more severe, and in some instances, towards the conclusion, the little patient becomes comatose. This is a form of disease that has doubtless occurred to every practitioner. But in some instances, along with many of the above symptoms, there is cough, with chronic diarrhoea, followed by a febrile and marcescent state; and some structural derangement of the lungs is superadded to the abdominal mischief. From the appearances on dissection, of some such cases, one might suppose that the germs of tubercles are sometimes born with us, for in one such dissection