Fever is not generally attendant, but the same may be present.

The symptoms just described, separately or collectively, gradually
increase; the children finally take to their bed and now the _real
cerebral affection_ developes.

Now the principal symptoms are: vomiting, constipation, slow pulse,
irregular abrupt breathing, increased temperature of the skin,
contracted abdomen, headache, great excitement alternating with
drowsiness, beginning decrease of reason, and deranged ability of moving
the limbs.

As regards _vomiting_, this is almost a continuous symptom and generally
appears in the earlier stages. But the duration of vomiting is very
different. Some children vomit only for one or more days and not all
they have eaten, while others vomit continuously from the beginning of
the disease till they are relieved by death, and no food can be found
that is not thrown up shortly after its being eaten. In this connection
it is a peculiar fact that vomiting will not recur if it has once ceased
for twenty-four hours.

Very important for the recognition of the disease is the manner of
vomiting. For a child suffering from a spoiled stomach will be troubled
with nausea, belching, choking and cold sweat long before it is forced
to vomit, while children with acute hydrocephalus will throw up without
any previous symptoms of that kind, just as though they filled the mouth
with water and spit it out again. Vomiting is facilitated when children
are raised or placed on their side. It ceases for the time the stomach
is empty, but as soon as fluid or even solid food is taken in it will be
cast out at once without causing any particular distress or
inconvenience to the child. Gall is very rarely mixed with the vomit.

A second and nearly as constant a symptom is _constipation_ from which
nearly three-fourths of the diseased children suffer. As a rule
cathartics have no effect and are generally thrown out through the
mouth. This constipation will not last till the end, for a few pappy
stools appear later on whether purgatives are administered or not.
Violent diarrhoea resulting from intestinal tuberculosis may be
discontinued at the beginning of acute hydrocephalus. But the later
stools will again be thin and of cadaverous odor.

During the latter stages of the disease children will often _fail to
pass urine_ for twenty-four hours, so that the physician is obliged to
draw it off with a catheter.

The appetite does not disappea