Lactic acid, recommended by llaymn and Lesage for green diar rhma, I could not get the children to take in the quantity recommended by these authors (15-20 gram q oz.) a day) and saw no results from smaller amounts.
When the iliarrluna is very !narked, it can be combated by bis muth preparations (bismuth subnitrate or salicylate in 2-1 per cent. emulsion with mucilage of acacia) or by tanningen, tannalbin, bis inutose, etc.., but one must not forget to warn the family of the resulting dark color of the movements, otherwise much anxiety may result.
Thrush usually becomes less marked with improvement of the digestive symptoms, and therefore should never form the sole condi tion requiring treatment. Still, local treatment of thrush is often not unpardonable. For this I prefer a corrosive sublimate solution, 1 to 5000, which is painted on every two hours. Epstein recommends a 5 per cent. sodium borate solution, Escherich recommends the boric acid "comforter," for which proceeding I cannot be enthusiastic, as it restores to honor a nuisance banished with difficulty from the nursery. At all events, in any method of treating thrush every brisk proceeding should be avoided, and the removal of the mycelium should be under taken in the most careful wrty, with a good light and under control by the eye.
Intertriginous eczema requires in the first place the greatest atten tion On the part of those in charge of the child, frequent changing of the diapers, the avoidance of the use of diapers which have become wet and have been simply dried without washing, together with delicate cleansing of the anal region with cotton and vaseline to prevent mechan ical injury. The treatment should in the first place be directed to the digestive disturbances, since their alleviation deprives the movements of their power of irritating the skin, and is frequently sufficient in milder processes to bring about spontaneous cure. If this does not occttr, local treatment must be trhal. In a purely erythematous form gly cerite of tannin in 5-10 per cent. solution is best. Strips of cotton are soaked in it, squeezed out, applied, and changed after every movement or urination. 01(1 diapers should be used, as the solution stains the linen. Or a powder may be used, for example acid salicylic .25 Gm. (4 gr.), amyli, zinci oxid. aa 15.0 Gm. (-1 dr.). In forms with exudation, the parts are bandaged with Lassar paste (acid salicylate 0.1 to 0.2 Gm.
0.1-3 gr.) amyli, zinei oxid. aa. 10.0 Gm. (21 dr.), vaseline 20.0 Gm. (5 dr.) 15I. ft. pasta), which is smeared on with the clean finger, and then thickly strewn with rice flour. In younger infants, less salicylic acid should be used, on account of its irritative action. When the crusts formed by this paste get cracked, fresh paste and po»-cler are applied. With marked infiltration of the skin poultiees are used, with either lead water, or dilute aluminum acetate solution [alum 5.0 Grn. (1 dr.), plurnbi acetat. 25:0 Gm. (6 dr.), aq. destill. 1000 Gm. (1 quart) ]. Bathing is always to be stopped in intertriginous eczema, because it has been found empirically that the process is thus more quickly cured.
B. From Insufficient form of disease is much less common than the one just considered. Its cause is insufficiency of the nurse's milk, and its recognition is of importance, because it points to the only efficient method of treatment. Its recognition is however not wholly easy, since the condition is often confused with emaciation due to some other cause.
We have no reliable method of measuring the milk content of the female breast, and are therefore compelled to depend upon the in formation gained by weighing the child before and after nursing. Often we can convince ourselves that breasts, which are apparently poorly developed, in which we feel only a little glandular tissue, and which yield on pressure only meagre drops of milk, are nevertheless quite sufficient for the needs of the infant, because it drinks enough and gains weight. On the other hand, an apparently full breast can yield too little food material, on account of overdevelopment of the fatty tissue at the expense of the secreting parenchyma. This condition bas been called "hypogalaktie" iMarfan), and primary and secondary " hypugalaktie" have been differentiated, according to whether lactation is insufficient from the outset or whether after a temporarily sufficient production of milk, it begins prematurely to dry up. But care must be taken in making this diagnosis, all the more in the case of nursing by the mother, especially if a primipara, for not infrequently they have difficulty at the beginning, but with sufficient perseverance they are able to nurse successfully.