The prodromal stages of a food intoxication may be well marked into stages of considerable length, as indicated above. Again, they may follow one another so rapidly that the child is first seen in the midst of a well-developed intoxication, and only upon careful inquiry will the history of a previous disorder be elicited. It is evident that any number of combinations can precede the actual culminating intoxication, and that this itself may be gradual or come on like an explosion in uremia. Commonly, to a previous digestive or other disorder that has not seemed at all alarming, there is suddenly added the evidence of an intoxication brought on by an increase of food, especially the fat or the sugar, to a point beyond the limit of tolerance. The child now looks sick; its eyes are heavy, half closed, often fixed and unmoving. It looks drowsy, stuporous, "dopey," is hard to rouse, and may even become comatose. If at all severe, the baby seems in collapse. We have here for the first time a continuous fever, the temperature rising to 101° to 105° F. or more, depending upon the previous condition of the infant and the degree of dietetic abuse. The respiration is peculiarly altered. The breathing is rapid, deep, and pauseless. This may be barely discernible, or the child may literally pant for breath. The loss in weight is rapid and continuous, many times as great as that of starvation alone. Diarrhea, with dyspeptic stools, is the rule. This reaches its maximum degree in cholera infantum, where the bowel movements are simply spurts of foul turbid water, that is forcibly ejected every few minutes. In certain cases the severity of the intoxication seems to paralyze the intestinal movements, and even cathartics and enemas are unavailing for a time. The liver is often enlarged, in certain severe cases advancing steadily till it reaches the umbilicus (Walls), and causes the upper part of the abdomen to protrude. There is present a moderate leucocytosis, 20,000 to 50,000; there is sugar (lactose and galactose) and albumin and casts in the urine. The appetite is usually lost completely; in milder cases the baby drinks water eagerly, in the severest cases it will not even swallow it if put in its mouth.

The paradoxical reaction is here most convincing. The tolerance for food is zero. To continue the food that has caused it is dangerous in the extreme. The child is in a state of "metabolic bankruptcy"(Finkelstein), and even the smallest amount of fat or sugar acts as a toxin or poison, as can easily be demonstrated in any case. The sugar is probably the real intoxicating agent, while the fat is the important factor in the prodromal stages. The tolerance for protein, both casein and albumin, still remains unchanged. Even human milk, with its abundance of fat and sugar, is no longer tolerated, as we might expect.

These intoxications occur not only as the final picture of a series of metabolic disturbances caused by overfeeding, but likewise arise in the course of any general infection, such as typhoid, or pneumonia, or ileo-colitis, or of any general disturbance such as nephritis, that affects the whole organism to such a degree that the administration of a sufficient amount of food, especially one rich in fat and sugar, will call out an intoxication. The clinical picture of the intoxication is the same in all conditions. The possible bearing of this upon the toxemias of typhoid and other infections is evident. In typhoid in young children we have repeatedly seen the toxic symptoms disappear as rapidly as in the simple food intoxications, when the fat and sugar were withdrawn from the food. The exact nature of the toxins is not known.

These food intoxications occur most frequently during the hot months of July and August, as we might expect. The child's general condition is lowered by the depressing heat, and its ability to handle food correspondingly lessened. Commonly the baby gets the same amount of food whether the weather is hot or cold. It naturally requires much less food to maintain its animal heat in an atmosphere of 85° or 90° F. than in one much cooler. Consequently it is relatively overfed by getting the same amount of food. Diarrhea has been produced in guinea pigs by simulating this condition by heating the room in which they were kept (Maurel). It is certainly hard to explain, on a bacterial basis that is so commonly accepted, why these conditions should arise when sterile food is given and why they should occur more frequently in summer, even though the food is sterile, or even human milk. In cases carefully fed and kept cool there is little more danger of intoxications during the summer than during the winter. The food should be materially lessened during hot weather.