Prognosis.—In every attack of inflam matory diarrhoea the prognosis must be greatly dependent upon our securing from the outset fair hygienic conditions, and the strict observance of such dietetic rules as may be laid down. In no dis ease is the prognosis more affected by a faulty hygiene or by an imprudent diet ary. In infants suffering from chronic dyspeptic troubles, or in those whose nu trition is seriously impaired, the progno sis must always be grave. During the heat of summer an attack of inflamma tory diarrhoea is of much more serious import than one occurring during the cooler months of the year. In the course of an attack a decrease in the tempera ture and in the frequency of the stools are favorable symptoms, especially when associated with an improvement in the general appearance, an increase in the amount of urine, and perhaps an in creased desire for food. On the other hand, a higher temperature, more fre quent and more watery movements, a more anxious expression on the features, increasing insensibility of the pupils, sighing and irregular respiration, a feeble and intermittent pulse, suppression of the urine, and the onset of nervous symp toms must all be regarded as of grave significance.
Treatment—Regarding this disorder as due to an intoxication of the system, either induced suddenly by an absorption from the intestinal tract of toxins in large amount, or coming on gradually, owing to the development in the intes tinal canal of pathogenic bacteria with a subsequent absorption of toxins, our first efforts should be directed to securing as promptly and as effectually as possible the clearing out of the intestinal tract. This we endeavor to effect by means of promptly acting purgatives, and by lav age of the stomach and large intestines; the small intestines, unless by means of purgatives, we are apparently unable to reach.
At the same time we endeavor to limit the development of bacteria by stopping for several days absolutely all milk food, in which we know they are able to de velop very rapidly; a sterile water only should be allowed as a drink for the first twenty-four hours. During the early days no astringent or drug which would tend to check peristalsis, at this period to be regarded as salutary in character, is to be given. For the evacuation of the intestinal tract two drugs especially com mend themselves, on account of their promptness and of the very slight amount of irritation which they induce. These are castor-oil and calomel.
Castor-oil is of much value if it can be retained in the stomach. A full dose, 1 or 2 drachms, may be given in any con venient way. In many cases there is too great irritability of the stomach for us to attempt the administration of this somewhat nauseous drug, and we can with advantage have recourse to calomel, which acts not only as a purgative, but also as an intestinal antiseptic. This
drug may be given either in one full pur gative dose, or in a series of small doses repeated at short intervals. Lesage recommends that if the onset is with high fever, a foul-smelling but not abundant diarrhcea, and a considerable amount of tympanites, a dose of about 1 grain, for an infant of three months, 2 grains for an infant under one year, and 3 grains for an infant over that age, should be administered, mixed with a little sugar in a powder. In those cases where the fever is only moderate, where the abdomen is soft and not distended, and the diarrhcea is copious, small doses of about V, grain may be given every one or two hours, for six or twelve doses. Other purgatives have been employed, but, in our opinion, they are not so satis factory.
Should vomiting persist, a careful lavage of the stomach will often at this period of the disease prove of much value, not only removing fermenting material and toxins, but having a direct action on the gastric mucous membrane. This lavage can easily be accomplished by means of a few feet of rubber tubing, to which is attached at one end a soft rubber catheter, number 15 or 1S Eng lish (No. 30 Charriere), and to the other a small glass funnel. The fluid used may be either sterile water or nor mal saline solution, 7 per 1000. Its temperature should be about 100° F.
Three or 4 ounces should be intro duced at a time and allowed to escape. This should be repeated until the water returns clear.
Water is one of the poorest media for the development of bacteria which it is safe to introduce into the stomach. If a child is given from 10 to 12 ounces of sterilized water daily vomiting will cease at once, diarrlicea will soon disappear, and the temperature will fall so that in a relatively short time milk can again be given. Absolutely no medicine will be required. Most brilliant results ob tained from this simple treatment of infantile diarrhoea. Mongour (Corres. f. Schweizer Aerzte, Apr., .9S).
When the summer disease of infancy is established, no matter whether the in fant is breast-fed or bottle-fed, milk must be stopped for at least twenty four to forty-eight hours.
A thorough cleansing of the gastro intestinal canal from the mouth to the anus must be insisted upon.
One of the best medications is: 1 or 2 teaspoonfuls of castor-oil, followed in two or three hours by:— 13. Magnes. sulphat., Syr. rhei arom., Aquae fceniculi, of each, q. s. ac cording to age.