Foreign Title :
Die Ruhr der Kindern in Russisch-Polen.
In September 1915 a dysentery epidemic occurred in Russian Poland affecting the civil population. In the course of five weeks 28 cases were met with chiefly in children, as the following analysis shows: -[img 2T8190.tif] The disease is endemic in this country. Its greater incidence in the early years of life finds an analogy in the case of measles. In our country mothers look upon measles as an unavoidable illness for almost every child, one attack conferring immunity in most cases for a lifetime. In Poland it is the same with dysentery. The mothers think that everyone must sooner or later fall a victim to the disease and the sooner it is over the better. No measures therefore are taken to avoid infection and it is a common sight to see several children playing round the cost of an infected child, in fact coming into the closest contact with it. The people consider that one attack protects the individual against further trouble. In addition they say that there is more danger to adults than to children, a fact which the author's experience seems to confirm. Certain points of difference mark the course of dysentery in children. In the first place the haemorrhagic stage is shorter. During October and November 1914 the cases occurring amongst soldiers and civilian adults were serious in comparison with those seen amongst the children. Prodromal or initial symptoms, appearing some time before the passing of blood, are common but are seldom found in adults. Vomiting, rigors, abdominal disturbances and headache are often seen prior to typical stools. The haemorrhagic period usually lasts from five to seven days. The number of stools is excessive-five, six, and even twelve in an hour. Genuine symptoms of intoxication are only seen in the initial stage. Not only the large gut but the whole digestive tract becomes involved. When the blood disappears from the motions the child does not become convalescent as is usual with grown-up people but enters upon a new stage the symptoms of which are determined by the extent of damage to the digestive system. Four children in their first year, watched throughout the course of the disease, could tolerate no other food than their mother's milk. All of them suffered from meteorism. There was a tendency in all to exhibit a subfebrile temperature. While the temperature during the haemorrhagic stage was normal or subnormal, in the next stage it varied between 37.50 and 38° C. If breast-fed the child was usually well in from one to two weeks after the disappearance of blood from the stools. As regards treatment, breast-feeding was chiefly relied upon. Sucklings received no medicinal treatment. In the case of older children opium was of great use for counteracting the painful tenesmus of the acute stage. Purges were never used. E. E. A.
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