'When the combination of a water diet with irrigation does not suffice to empty the intestine of the accumulated fermenting masses, we have recourse to purgatives. Of these calomel has for a long time been the favorite, because, besides having laxative power, it has been considered an antiseptic, and to have an action increasing the flow of bile and the secretion of the intestinal wall. Not only is there little foundation for this view, but through Tissier's researches we have learned of an undesirable effect of the drug, eonsisting in pathologic alteration of tlw intestinal flora. This has strengthened me in my aversion to calomel, although I have never belonged among its sup porters. It can be prescribed in purgative closes, .03 gram (1 grain) up to 3 months, 0.1 gram (11 grains) frotu 3-12 months, divided in two doses. It is insoluble, and must be mixed with some vehicle, or pow dered and given in SP0011 with some fluid. It ean also be given in smaller divided doses, .005 gram grain) every hour, or .01 gram (4 grain) every two hours till a total amount of ,0-1-.05 gram (1 grain) has been taken. In every ease one should stop giving it when the characteristic loose leek-green movements have appeared, the color of which is due largely to the formation of sulphide of mercury in the feces t8choen-I.adniewski).
The same effect ean be obtained in an absolutely safe and effective way by the use of other purgatives, of which I can recommend castor oil, in teaspoonful closes, or 'Infers powder (magnesia with rhubarb), as much as can be held on the point of a knife, or CureHa's powder, (compound licorice powder) in the same dose, or a mixture of equal parts of hydromel infantum and fluid extract of rhubarb, a teaspoonful every one or two hours till effective. One should stop giving the purgatives when loose stools containing no milk-residue have been established, whieh usually takes place with an abundant passage of gas.
One of the most tormenting symptoms is the cofie, whieh often prevents the child from resting by day or night, and which proves very painful for the family. Usually the colic can be allayed by removal of the cause, through emptying the intestinal canal of its abnormal contents, and quieting it. Frequently however it is necessary, when colic is the prominent symptotn, or when it outlasts the other symptoms, to proceed against it directly, in order to procure at least a temporary quieting and thus to allow the infant a few hours' sleep. Often it is sufficient to bring about the passage of intestinal gas or some feces, simply to introduce and withdraw an intestinal sound or empty syringe, or to insert a glycerin suppository. Applications to the abdomen in the fortn of warm compresses, chamomile bags, flaxseed poultices, or properly formed thermophor plates are also often of temporary service.
Also one tnay employ massage of the abdomen, with the hand moist ened in warm oil, grasping the abdomen with the fingers in eonstantly widening eireles from the navel outward, and finally moving along the course of the large intestine, to press out the gases in this way, The internal. administration of caraway water (ay. earininativa 30-.10 Gm. (one ounce) with aq. 70-60 Gm. (two ounces) a teaspoonful every two hours), or of chamomile and fennel tea is usually but slightly effee tive. If there are great pain, frequent repetition of the attaeks and almost total loss of sleep, we can use chloral, either by mouth or by rectum, as has recently been recommended by Epstein and Czerny-Keller.
Chloral is given in solution, 0.5 Gm. 0'1 gr.) to 100 c.c. (3 oz.) of water ,one half per cent. solution), one teaspoonful every one or two hours, or half a grain of chloral in 50 c.c. of water (7)„, grains in 14 ounces) can be injected as an enema. As to bromide preparations, I have never seen a noticeable effect. Opitun, which is widely recommended tEsche rich, Fenwick, Filatow, Jaquet, Soltmann, et al.) can be given either by mouth, one or two drops of tinct. opii simplieis (P. G.) in a 100 gram solution, a teaspoonful every two hours, till quieting occurs or it can be Oven by rectum, one or two drops of tincture of opium to the enema, not oftener than once a clay. It has this drawback, that it has a con stipating action, and consequently after its temporary effect it has a tendency toward increasing the attacks of colic. Also we must take into consideration the intolerance toward even the smallest doses of opium which is often found, especially in very young children, and which manifests its effects in severe symptoms of poisoning. Recently, in consideration of the remarkable effect of morphine in intestinal colic, I have ordered it in especially obstinate cases. I give muriate of morphine .001 gram with aq. 100. (-,‘ grain with ounces of water), and a saccharin tablet, a teaspoonful every two hours till quieting occurs. It has a less marked constipating action, and I have seen a good result without any injurious action.
With marked sour fermentation in the stomach, recognized by the pungent odor of the vomitus and the sour belching, mild alkalies per form good service, such as sodium benzoate, or magnesium benzoate in 3 or 1 per cent. solution, or small doses of sodium bicarbonate, as much a, can be held on the point of a small knife, after each feeding. When the stomach washing has shown marked retardation of digestion, one can give some hydrochloric acid and pepsin before each meal. For example, Soltmann's formula can be used: pepsin 1.0 Gm. (15 gr.), acid hydrochlor. gtt. x, aq. destill. 100.0 c.c. (3i oz.), saccharin tablet, one teaspoonful before each meal.