The course of these cases is generally downward. Exacerbations and relapses are easily excited. Only the few recover completely, and in these convalescence is always slow. The fatal result is fre quently hastened by some intercurrent disease.
Diagnosis.—Like the preceding, this form of inflammatory diarrhcea is to be distinguished from intussusception. It is important to remember that with in tussusception, although we may have vomiting, bloody stools, and tenesmus, we have no pyrexia. Later on, the absence of faecal matter in what passes from the bowel, the tenesmus, the tympanites, the stercoraceous vomiting, and the slowly rising temperature complete a picture quite different from that of an ileocolitis. Typhoid fever, as we have before men tioned, very rarely presents itself in an infant.
A diagnosis of the presence of ulcera tion is to be made from the whole char acter of the case, rather than from any one special symptom. Where mucous stools persist for several weeks with only moderate fever, but with distinct wasting and loss of strength, a condition of ulcer ation is more than probable.
Prognosis.—The prognosis must be greatly dependent on the vitality and strength of the infant, upon the hygienic and dietetic conditions that can be se cured, upon the severity of the attack, and upon the season of the year. Deli cate Infants under unhygienic conditions generally succumb early. Continuous high fever, the presence of a large amount of blood in the evacuations, se vere nervous disturbances, and symptoms indicative of extreme feebleness of the circulation are always to be regarded as unfavorable.
Treatment.—The same measures are to be employed at the outset in this group of cases as in the preceding. Milk and all milk-foods are to be forbidden. A full dose of castor-oil or an effective dose of calomel is to be promptly adminis tered, and followed within a few hours by copious irrigations of the colon with tepid saline solution (sodium chloride, 1 ounce; water, 1 gallon). The compress over the abdomen, which we have already advised as an excellent sedative, should also be applied. After the second or third irrigation of the intestines, should painful straining persist, a small quan tity (5ii-5iv) of a thin starch solution, to which from 1 to 3 drops of tincture of opium, according to the age of the in fant, has been added, should be gently thrown into the rectum, with the object of moderating excessive peristalsis and lessening tenesmus. These opiate injec tions may be repeated, if necessary, once or twice daily. Should the stools contain a large amount of blood, rectal injections of hot water, 106° F., to which a small
amount of fluid extract of hamamelis has been added, may be administered for ten or fifteen minutes at a time, allowing the fluid to escape without hindrance. Tan nic-acid and weak nitrate-of-silver solu tions have both been recommended for use in this acute stage. We consider them of more advantage after the acute symptoms have, to some extent, subsided.
Internally, during the first few days of the acute stage a mixture containing castor-oil, in from 3- to 10-minim closes, associated with ipecac, and small doses of an opiate given at intervals of two or three hours, is strongly recommended by M. Elerzarian (N. Y. Med. Jour., No. 1029, p. 270, '98).
Eudoxin successfully used in the treat ment of 63 eases of infantile diarrhoea. Of these, 2 died: 1 patient with acute dysentery, seen on the tenth day, and 1 patient, aged 9 months, with acute ileo colitis. Recoveries took place: .33 in 24 hours; 12 in 2 days; 2 in 3 days, and 6 in 4 days. The dose for infants is 2 to 3 grains; for children of 5 to 10 years, 3 to 5 grains. Blech (N. Y. Med. dour., July S, '99).
Tincture of iodine, also praised by Croscb and Stahan, highly recommended. It may be administered as follows':— 11 Tincture of iodine, 5 to 15 drops. Distilled water, 5 ounces.
Syrup, 6 drachms.
A teaspoonful every two hours.
This should be preceded by a purgative dose of castor-oil or of calomel. Speedy results are obtained. Cattaneo (Pediat ria, Oct., '99).
The solution ordinarily chosen for rec tal irrigation is the normal salt solution prepared by adding 1 teaspoonful of com mon table-salt to the pint of water and using from 1 to 2 quarts at each irriga tion, which is given as follows: A fount ain-syringe and a soft-rubber catheter of medium size are used. To prevent the curling of the catheter upon itself, its tip should be immersed in oil and intro duced a short distance into the bowel, when water should be allowed to flow, thereby dilating the bowel and facili tating the entrance of the catheter. When the bowel is well distended by the solution, as evidenced by a return-flow. or upon examining the abdomen and finding it tense, the catheter should he detached from the syringe and left in place to permit the escape of water. In the same way medication can be directly applied to the highly inflamed membrane. The bowel should first he cleansed by the normal salt solution be fore using any medication locally. Loach (Memphis Med. Monthly, Jan., 1900).