. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. hat the disease has become estab-lished without ha-\-ing attracted the notice of the parents. In children of five years of age the symptoms are more marked. TUBERCULOSIS 419 The child may have an attack of \omiting and diarrhea and appar-ently recover; after a few weeks, during which there are irritability,loss of appetite, and progressive emaciation, the child no longer desiresto be up and about, but lies quiet in its crib, with its head in a charac-teristic rigid position. It develops st
. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. hat the disease has become estab-lished without ha-\-ing attracted the notice of the parents. In children of five years of age the symptoms are more marked. TUBERCULOSIS 419 The child may have an attack of \omiting and diarrhea and appar-ently recover; after a few weeks, during which there are irritability,loss of appetite, and progressive emaciation, the child no longer desiresto be up and about, but lies quiet in its crib, with its head in a charac-teristic rigid position. It develops strabismus, becomes soporose, andcries out at night. This cry is sometimes piercing in character, and isthe cause of much concern to the mother. When the symptoms ofcerebral pressure are fully developed, the picture is in the majorityof cases much the same. The infant after the first convulsion lies ina soporose or comatose condition. The eyes are open and there is avacant stare; the sclera may be apparent above the cornea; the fontan-elle if still open is tense and bulging, and there may be horizontal. Fio. 94.—Babinskis reflex. Tuberculous meiiingitis:aged seven years. stage of facial palsies. Boy, nystagmus. The infant cries if disturbed, or may be indifferent to itssurroundings. The pupils may be imequal in size and react to one case which I observed the pressure sej-mptoms were infant lay on its back with rigid neck and arched back (opisthot-onos), and emitted a piercing cry at intervals. At each cry thepupils became successively dilated and contracted (hippus). I haveseen this phenomenon in two cases of tuberculous meningitis. Opis-thotonos may be present, and the retraction of the head may relaxat inter\als, the muscles of the back being lax. In some cases thereis apparently no rigidity of the neck. As a rule there are no convul-sions. As the infant or child lies quietly in its crib the inspirationsduring the stage of cerebral pressure may be very ir
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