Study of the blood of three cases. The number of red cells is diminished; the total number of white cells is some times augmented and sometimes normal. The lymphocytes are always aug mented; the inononuelears always di minished; the polynuclears and poly morphonuelears are sometimes aug mented and sometimes normal. The cosinophiles are absent or normal. Nu cleated red cells were observed twice. D'Orlandi (Revue Men. des Mal. de l'Enfance, July, '99).
Prognosis.—Few diseases have a worse prognosis. The higher the rectal tem perature, the younger the infant, the hot ter the weather, and the more unhygi enic the surroundings, the more hopeless is the case. Rotch considers the disease to be, to some extent, self-limited, and thinks that, if the infant survive the first three days, a crisis comes and the prognosis improves.
Prognosis of cholera infantum is very unfavorable, especially when the child is artificially fed, and the mortality reaches very commonly 95 or 97 per cent. In naturally-fed children the death-rate is low, In eases where the brain is early affected, with coma or convulsions pres ent, the prognosis is bad. H. N. Potter (Annals of Gynec. and Ped., Apr., '93).
Treatment.—Regarding the disorder as a toxic condition due to the absorption of a poison from the alimentary canal, our first efforts must be directed to clear ing out this tract as promptly and thor oughly as possible. For this purpose a few grains of calomel combined with sodium bicarbonate should be given in divided doses. As soon as practicable, the stomach should be thoroughly washed out with a tepid weak solution of sodium bicarbonate (1/2 drachm to the pint). Following this the whole tract of the colon should be irrigated with a saline solution (1 drachm of sodium chlo ride to the pint). To insure passage of the solution into the higher portions of the colon, the hips of the infant must be well elevated., and the tube passed well up into the bowel, due attention being paid to its curve. The solution should be allowed to run into the gut in a gentle steady stream from a fountain-syringe placed at a height not exceeding two or three feet. Its passage upward may be favored by a gentle massage along the course of the bowel. The temperature
of the irrigating fluid (from 85° F. to 105° P.) will be determined by the con dition of the patient and the degree of pyrexia.
The use of antiseptic solutions for ir rigating is, in our opinion, not to be recommended. To be in any degree ef fectual they must have a moderate strength, and then there is always danger of poisonous absorption. The irrigations should be repeated during the earlier hours of the attack. In the meantime, only stimulants and ice or iced water in small quantities should be allowed by the mouth. No form of nourishment should be permitted during the first twenty-four hours. The digestive func tions of the stomach and duodenum must be in complete abeyance, and any food administered will either be at once re jected by the stomach, increasing its hy permic condition, or, if retained, will go on to fermentation.
No food of any kind and no drugs given. Boiled water at the ordinary tem perathre, 3 '/, ounces every hour for at least twenty-four hours and hypodermic injections of l '/, to 6 drachms, aceording to age, every five hours, of a solution of Sterilized (not distilled) water, 10 omices.
t'onimon salt, 37 grains.
C'itrate or benzoate of caffeine, 12 These injeetions should be given slowly. In addition, warm baths (95° F.) twice or four times in the twenty four hours should be given. each bath lasting from five to ten minutes. Wash ing out the stomach and intestines, though useful in other forms of infantile diarrlwea, may give rise in choleraic diar rhcea to convulsions or eollapse. In con valescence, if the (Harrill-an persists, calo mel or subnitrate of bismuth may be given. Not any satisfactory results ob tained with salol, betol, benzonaphthol, lactic acid. tannin, or opium. Marfan (La Med. Moderne, .Iiine 15. '97).
To counteract the depressing action of the poison, and to prevent the paretic condition of the intestinal vasomotor sys tem, an hypodermic injection of mor phine combined with atropine is probably our best remedy. Holt recommends for an infant 1 year old an initial dose of not more than / loo grain of morphine and 1/8o, grain of atropine. This may be repeated in an hour, if the desired sed ative action is not obtained.