In some cases of intractable diarrhoea suppression of milk from the dietary proves curative. Regurgitations and vomiting are frequent in such cases. The motions are foetid, liquid, or putty-like; much more frequent by day than by night. The liver is swollen and sensitive to touch; there is progressive emacia tion, the cachexia deepens, and the infant is in great danger. Milk does not suit all digestions. It is, above all, necessary that the secretion of pepsin should be normal, and even irreproachable milk should undergo all the necessary meta morphosis to cause it to be absorbed by the organism. B. Saint-Philippe (Indian Med. Record, July 19, '99).
Methods that have been found most successful in 6S2 cases of summer dial. rhrea in dispensary and hospital service, as well as in private practice, with but •1 deaths. Most diarrhwas occur under two years of age. At this time the child's diet consists mainly of milk. As soon as the diarrhwa begins all milk must be stopped. This is true no mat ter what its source,—mother's milk, guaranteed cows' milk, dairy milk, or grocery milk,—all alike must be stopped completely and at once. It does no good to pasteurize or to boil or to modify the milk in any manner. It must simply be stopped. If the child be nursing there must be no food for twenty-four hours. Then nursing may be tried, but if it show any tendency to cause the diarrhoea to persist even breast-milk must be stopped and sub stitutes employed. If the child be on a mixed diet consisting mainly of milk, all the cows' milk must be stopped at once. It may be necessary to stop for days, even for weeks. The writer has seen a ease in which only after five months could the use of milk be resumed. The substitute foods should consist mainly of carbohydrates. A tablespoonful of barley flour or of rice, cooked ill a pint of water, should be given in quantities about equal to the amount of milk taken before; this for a child under one year of age. For older children more of the carbohydrates may be employed and the feeding mixture may be dextrinized. Such food is not pleasant, because of the sameness of its taste. To give a variety of savor, chicken-, mutton-, or beef- broth in small quantities may be added. Beef-juice may also be added at times, but sparingly and only with the idea of making the food tasty, not with the idea of adding to its nutritional qualities. The free use of brandy and
whisky, which is sometimes advised be cause children are in a weakened condi tion, is not advisable. They rather add to the lack of resistive vitality and do not increase the store of vital force, as is sometimes taught. The use of egg albumin dissolved in water used to be a favorite recommendation. This com pound is not, however, as suitable in cases of gastro-enterie disturbance as are carbohydrates. Bacteria can be cul tivated on egg-water, while the fer mentation set up by carbohydrates is rather unfavorable to the growth, es pecially of the pathogenic bacteria. The use of certain of the proteid-sparers has been suggested. The three classes of foods that come under this head are gelatin. fats, and carbohydrates. The fats are distasteful, and hence cannot be used for any length of time. The end products of gelatin when digested are very similar to those of milk, and hence they would probably prove as unsuit able for the disturbed gastrointestinal tract. Carbohydrates are therefore the indicated food-products. The by-prod ucts of carbohydrate digestion are mainly excreted through the limps. This saves the intestines considerable. irritation. C. G. Kerley (Proceedings New York Acad. of Med.; Med. News, June 7, 1902).
In the majority of instances, however,. it is wiser to secure at the outset by means of medicine a thorough evacuation of the bowels, ridding them in this way of any fermenting material. To accom plish this we may make use of either castor-oil or calomel, both of which act promptly and with little irritant effect on the mucous membrane. Of the for mer a full dose may be given in any con venient way. Should there be much gastric irritation, as shown by a tendency to retch or vomit, the latter is preferable, and may be given in small to grain, at short intervals—until a de tided effect is obtained. Afterward, if necessary, one of the preparations of muth may be given with each feeding, for a few days.
Slight purge should be given to begin with. If this fails, enemata of starch water with from half a drop to a drop of laudanum may be administered, and repeated two or three times a day if nec essary. Internally, bismuth or astrin gents are to be used. M. A. F. Plicque (Pratt., Oct., '96).