A very common symptom is a loud, plaintive outcry, that is repeated at longer or shorter intervals. Children often cry out at partly regular intervals during a whole night; these cries are always accompanied by a loud sigh. These symptoms of excitement being extremely tormenting and depressing for the sympathizing relatives, fortunately last no longer than 6–8 days at the most, and are succeeded by a deep stupor.
If the children have once become unconscious, they do not recover again as a rule but remain so until death; delirium and stupor may alternate with each other in certain cases, but the former process is by far the most frequent.
Convulsions appear only in the later stages. At first the interval between the attacks are long, often as many as three or four days intervene. Commonly however they come much oftener and may in some cases last for hours. All extremities are affected by these convulsions, the eyes become red, are rolled in every direction and turning way up are fixed so that nothing but the whites is visible. After several minutes, often after two or three hours, these general convulsions subside, the children, now very pale, drop into a deep sleep and their general condition appears much reduced.
Different muscular groups especially those of the face are subject to local cramps. The upper lip may become distorted, convulsive smiles have been observed, also peculiar sucking motions. The children point their lips and flatten them again, sometimes for hours in succession.
In the latter stages a squinting of one or both eyes may be noticed but this may again disappear.
Grinding of the teeth is another very peculiar symptom which is well-known and feared by experienced nurses. The arms are subject to various motions, at times sweeping automaton like, then again convulsive contractions, sometimes trembling of the muscles, at others a throbbing of the tendons. Many patients put their hands to their sexual organs and make motions tending to onanism.
The legs are not subject to cramps as much as the arms; they are mostly bent and drawn up in a half paralyzed condition.
The muscles of the neck and back are very much contracted and most children, when raised or laid on their side, bend the head far back.
In most children an extreme sensibility at being touched is observed. They may be handled with the greatest possible care and lifted most tenderly, a slight pressure on the head, body or hands in changing their position will be violently resisted with obvious expressions of pain. In the latter stages this extreme sensibility gives way to insensibility.
Then the children may be pinched and poked, they may be turned and moved from one side to the other without any consideration, they will not resist and only give expression to the remaining sensibility by a low whimper. The lack of sensibility may be especially marked in the eyes; these can be touched with the fingers, without causing a closing of the lids.