re attacked by this fearful
disease. The antecedents are extremely peculiar and manifold. Even two
or three weeks before the outbreak of the real sickness, emaciation
takes place from which the face is strangely enough entirely exempt, so
that children, when dressed show no signs of a change. Attentive mothers
and nurses, however, regularly notice the same and especially the
appearance of the ribs causes no little anxiety. With this a slight
pallor of the face is associated and a peculiar lustre of the eyes. The
children lose their former feeling of gayety and activity. They sleep
more than usual, withdraw from their favorite game, they become grumbly
and shy toward their surroundings and cry for the slightest reason. It
also is very peculiar that they avoid trying their former little tricks,
such as climbing up on chairs, opening of door bolts that are almost out
of their reach, they even will not try to look through a latticed window
and asked to do so, decidedly refuse. Boys, that would not stand
anything from their associates, that fought and wrestled as long as
their strength permitted it, sneak away cowardly and crying from such
attacks. Other children again become extraordinarily tender-hearted and
affectionate, they hug their parents continually and can hardly console
themselves when they leave them.

In the case of older children that have already learnt something,
teachers notice unusual inattention and indifference, committing to
memory comes harder than usual and what is finally learnt is recited in
an awkward and stammering way. The children sleep unusually much and
often by day; on the other hand their sleep at night is less sound and
is interrupted by horrid dreams, frequent turning over in the bed and
frequent clamorous outcries.

The appetite is lessened, and often a craving is noticed for stimulating
food of which, however, little is eaten. Thirst is not increased. Urinal
secretion is somewhat diminished and the urine is characterized by a
brick-colored precipitate. The stool is rather costive, especially with
larger children; but diarrhoea may attend this disease. The latter is
principally the case with small children that are in the stage of first
teething.

Headache is rarely felt and hardly ever complained of even by larger
children; dizziness and unsteady walking is frequently observed. The
children quite often complain of stomach-ache, which is very much
increased by pressure on the abdomen.