DIARRHCEA IN OLDER CHILDREN The increased resistance of the digestive organs in children, in their second year, is shown by the fact that disturbances of nutrition are localized in the intestine and produce symptoms which indicate that a definite portion of the alimentary tract is particularly or exclusively involved. The onset of these ailments is much less acute; they yield more readily to treatment, while severe affections of this nature, which threaten life and involve the whole organism in sympathy, seldom occur. Most frequently a transition of the disease process from the stomach to the small intestine is observed, 60 it seems proper to unite in a common chapter the consideration of Catarrh of the Small Intestine and Vomiting and Diarrhma.
Etiology.—Acute catarrh of the small intestine occurs generally as a result of marked indiscretions in diet, also after the ingestion of food digested with difficulty or of doubtful quality, after overfeeding, or sudden variations in diet, such, for example, as occur in going from home to boarding-house cooking. Moreover, climatic influences play a part, as a stay on the sea-coast or at high altitudes, as do also other factors such as the use of unaccustomed products for food, the character of the drinking water and similar causes. The illness begins as a rule with fever, the height of which indicates the intensity of the digestive disturbance; at the same time there are symptoms of marked irritation of the nervous system, particularly in young and highly-strung chil dren. Even convulsive attacks, often of great violence and long dura tion, may occur, but generally with the appearance of diarriunal stools the fever quickly falls and the nervous irritation subsides. General malaise, dry mucous membranes, a tongue coated gray particularly at the base, headaches and loss of appetite are the usual accompanying symptoms. Exceptionally, colicky pains are present with rumbling noises in the abdomen preceding every evacuation, and rather numer ous stools are passed containing light colored, often undigested, food particles, and such indigestible residues as fruit seeds, hulls of vege tables, etc. The movements leave the anus noisily and with a dis
charge of gas as though squirted from a syringe. Often the child has not time to use a vessel. The number of evacuations usually varies between two to three and eight to ten in twenty-four hours. They( follow shortly after meals, are definitely fluid, often interspersed with yellow or whitish partieles and have for the most part a fecal odor. Only in prolonged cases, which have received no adequate treatment, do the stools become colorless, odorless and more frequent. At the same time, the child emaciates rapidly, becomes pale, loses sleep, voids sparingly a thick urine rich in salts, and suffers from distressing thirst.
The treatment of acute catarrh of the small intestine is relatively simple and generally successful. Only by the greatest neglect of all suitable measures of relief does the condition become dangerously severe, or lead to a chronic disturbance of digestion. If children about two years of age are afflicted, a strict diet in the form of weak, sweetened tea for twelve to twenty-four hours, a hot pack to the abdomen, and an astringent medicine are prescribed. For example, a thin mucilage, 1 Gm. (15 gr.) to 100 c.c. (3 oz.) water may be given containing zinc sulphate 0.1 Gm. (1.5 gr.), extract opii 0.02 Gm. (1 gr.) and syrup althem 10 Gm. (2 dr.), teaspoonful every two hours (for a child at the end of its second year); or, extract Iffernatoxylin 5 Gna. (It (Ir.) to 100 c.c. (3 oz.) water, tinct. cateehu 3 Gm. (45 gr.), tinct. opii 20 to 25 drops, syrup cinnamomi 15 Gm. (t oz.); a teaspoon ful every two hours; or, extract columbo 2.5 to 3.5 Gm. (t to 1 dr.) to 100 c.c. (3 oz.) water with tinct. opii 20 to 25 drops in equal doses, tannigen 0.25 to 0.4 Gm. (4 to 6 gr.) three times a day; tannal bin in equal doses or in the form of tannalbin chocolate, bismuthose, and similar preparations.