Benger's, Nestle's and Mellin's Foods are very suitable, and Meigs' Milk Cream—which for an infant 6 months old may be made by mixing pure fresh milk 3, cream ri, lime water i, sugar of milk k, and boiled water 2 parts—is an excellent food when cow's milk must be used. The lime water may be replaced by a solution of bicarbonate of soda (3 grs. to each oz.) if constipation follows. Wright recommends the addition of zo grs. Citrate of Soda to each pint of cow's milk, and Variot states that this drug has a specific action in the vomiting of infancy.
Summer Diarrlima is a different form of the irritative type of diarrhoea, and to which the term " septic " has been also applied; it occurs in young children and sometimes in infants. Here also the milk—generally cow's milk—is at fault, and there can be little doubt that the irritant is a microbe or ferment which secretes a highly poisonous principle, causing profuse and frequent liquid motions, so that severe cases sometimes are described as Cholera Infantum. The affection is rarely met with in breast-fed infants, and the contamination of the milk has been regarded as the result of infection of the liquid by the introduction of such microbes as Bacillus coli, pvocyaneus, streptococci, &c., which are believed to be carried readily by the house-fly.
t is unfortunate that these names are used in different senses by different writers; thus irritative diarrhoea is often called inflammatory. The irritative diarrhoea caused by curds of milk in infants is sometimes spoken of as simple or dyspeptic diarrhwa, but if it passes on into entero colitis it becomes an inflammatory diarrhoea.
The immediate withdrawal of the milk diet and the copious adminis tration of ice or iced water with a purgative is the first step in treatment, after which any of the previously mentioned foods, prepared fresh every time, or sterilised cow's milk may be given, provided it is clear that prior to the attack there was no evacuation of the firm, dry, putty-like masses before described. Castor Oil is the safest purgative in these cases; the following old-fashioned combination is an excellent one, and a child one year old may get a powder twice a day: R Pulv. Rhei gr. iss.
Sodce Bicarb. gr. iv.
Pulv. Cinnamomi gr. j. Misce.
Fiat Pulvis.
Sterilisation of the milk is a reliable prophylactic; the milk can be best sterilised by being heated upon a water-bath in small bottles for 15 minutes, and all tubes and bottles soaked in a strong solution of Boric Acid. There is no doubt that tuberculous disease is communicated often through the milk of cows with tubercular deposits in the mammary gland, and it is a wise measure to always sterilise the milk of bottle-fed children where there is any doubt about the purity of it, or of the health of the animal supplying it.
Chalk Mixture or Bismuth may be prescribed safely as a routine, and the following is suitable for a child of i to 2 years when the diarrhoea continues after the diet has been made right; a child 4 years old may have the amount of bismuth doubled and the tincture of camphor trebled.
. Bismuthi Carbonalis gr. xlv.
Tincturre Camphorce Co. 5j.
Clycerini 5ss.
Mucilaginis Recentis Aqua' Chloroformi ad Siij. Misce.
Fiat mistura. Sigma.—" A teaspoonful to be administered after each loose motion." • Intestinal antiseptics constitute the ideal treatment for this form of diarrhoea, but unfortunately an intestinal antiseptic in the true sense of the word is as yet unknown. Salol, Naphthaline, Beta-naphthol, Resorcin, Creosote, Iodide and Perchloride of Mercury, Salicylates, Aspirin, and perhaps one hundred more antiseptics have been lauded from time to time. but by common consent their local antiseptic action is considered to be useless as regards the lower part of the intestinal tube. The only reliable drug of this class is Calomel, which may be given even to young infants in doses of I gr. every hour for 6 to 8 hours with a little sugar; it may be combined with tor gr. doses of Naphthol. This treat ment is highly successful in checking the foul green motions of most forms of septic diarrhoea occurring in childhood. Illingworth gives small doses of the Biniodide of Mercury dissolved in Iodide of Potassium combined with Chloral.
In the more severe degree of irritative diarrhoea known as Cholera Infantum (probably identical with the Cholera Nostras of adults), the intestinal symptoms are combined with grave constitutional disturbance arising from the absorption of the toxins produced in the intestine which induce high fever, rapid shrinking of the skin and subcutaneous tissues, and the development of collapse and the hydrocephaloid state: the Calo mel treatment is the best routine. Hyperpyrexia must be treated by cold sponging or the cold pack, and the tendency towards acidosis or collapse met by rectal flushing with warm saline Solution and Alcoholic stimu lants. Where vomiting is continuous, a liberal supply of pure water may be permitted to wash out the stomach, or this organ may be irrigated through a rubber catheter with a weak solution of Permanganate of Potassium. Strychnine should be given hypodermically gr.) and Saline Solution injected slowly into the subcutaneous tissue.