In simple diarrhoea the indications are to first remove by purgatives the irri tating and decomposing contents of the intestines. This is best done by giving calomel in small doses—say, grain— frequently repeated or by a full dose of castor-oil.
The second indication is to withhold food which would be likely to undergo fermentation and add to the existing toxaemia. Milk and other foods should be absolutely prohibited. The child should be allowed to take pure water quite freely. Barley-water, to which a little white of egg or sugar has been added, may be given, and, later, whey may also be given.
Third. if ptomaines are thought to be present in the lower bowel it would be well to irrigate after each movement of the bowels, using a warm normal salt solution (1 drachm to 1 quart), about 1 pint at a time.
Finally, such drugs as retard fermen tation: e.g., bismuth subnit., gr. x. every two or three hours; or soda benzoate in 4-grain doses in water every two hours. J. Lewis Smith (Pediatrics. July. '96).
Salicylate of bismuth given in fifty cases of diarrhoea in infants under two years of age, with only two deaths. The following formula is recommended:— Bismuthi salieylici, 24 grains. Gummi arabici, 1 drachm.
Sacch. albi, 1 'A drachms.
Terendo adde aq. dest.. 2 ounces.
Fiat lac, thin adde aq. dest., 4 ounces.
M. D. S.: The bottle to be kept in cold water or ice, and to be shaken well before use. One or two teaspoonfuls three to six times daily. In cases of offensive diarrhwa the administration should be preceded by a dose of castor oil. In acute eases the remedy is useless, but in all of a week's standing or longer its effects are excellent. Mikhnevitch (Med. Oboz.; Indian Lancet, Aug. 1, In a severe case of summer diarrhoea the first indication is to wash out the stomach, remove fermenting material, and prevent the absorption of toxic ma terials from the gastro-intestinal tract. This lavage need not be repeated. The intestines should be washed out fre quently, however. It removes peccant
material; it stimulates peristalsis, which also helps to remove undesirable irri tating substances, and it supplies water to the infant: a very useful measure, since it is well known that the child is water-starved. A stiff rubber rectal tube, such as used for adults, may be used without fear. Too much pressure should not be employed, however, in forcing water into the intestine, as it is possible to burst them. The irrigator should not be placed more than one foot above the patient. It is a good plan to try to leave considerable water in the intestine when the irrigation is con cluded. About a pint of normal salt so lution should be employed. Koplik (Med. News, July 15, '99).
Of one hundred and seventy-one chil dren suffering from diarrhoea or dysentery who were treated with tannalbin, only two died. Large doses give the best re sults. As much as 45 grains daily may be given without the slightest inconven ience. Waedemou (Annal. de la Soc. de Med. de Gand, lxxvii, p. 271, '99).
Inflammatory Diarrhceas.—The two groups of inflammatory diarrhceas in clude almost all the cases of infantile diarrhoea met with during the summer months. They are very closely allied in their etiology, and although the intes tinal lesions in the one are comparatively slight, while the symptoms of local in flammation in the other become promi nent, in both we have to deal with marked constitutional disturbance. All that we have said in reference to the in fluence of age, of season, and of mode of feeding is equally true of both groups. The symptoms and course of these two varieties of the disease differ in impor tant particulars. We have already re ferred to their pathology; we cannot but feel, however, that there is still much that is obscure, and later investigations may prove the bacteriological relations of the two classes are even closer than at the present they appear.