After the intestines have become quiet, diluted milk is given, hest added to the tea; later cereal waters, and then slowly, with co»stant regard to the condition of the tongue, the previous normal diet is again resumed. It is advisable to continue the medication referred to for a half to a whole day after the complete cessation of the diarrhcea, as other wise it may readily return. It goes without saying that these children, in the time immediately following, need especial supervision in the careful choice of the kind and quantity of their food, protection from taking cold, etc. In older patients, those somewhat more than three years of age, a liquid dict is sufficient (one consisting of thoroughly boiled cow's milk with addition of cocoa if desired, cereal coffee, etc., cereal decoctions, flour soups, fresh soft boiled eggs), together with the astringent medication already- referred to, bring about in a short time a tranquil condition of the intestines, and shortly afterwards formed stools. One should wait for movements of this character before passing tO solid diet, which then should be in the form of gruels (from bar ley, rice, oatmeal), light farinaceous foods (puddings, omelette), finely hashed white meat (chicken, squab, veal, etc.).
Not infrequently, the condition described in the previous section as gastric indigestion terminates in catarrh of the small intestine, in which ease the characteristic diarrhoea follows the symptoms of the affection first mentioned. Its treatment should be conducted along similar lint,.
Moreover, vomiting and diarrhoea setting in at the same time or one immediately following the other, that is a true attack of diarrhoea with vomiting (gastro-enteritis, dyspeptic diarrhom of the American writers), is not an unusual affection in ehildren over two years of age, hut it rarely reaches a severe grade or assumes a cholera-like character. In the simple forms of this nAalady an initial gastric lavage is of much service: however, this procedure which is so simple in the ease of infants is not so pleasant in older children, who must be held firmly by suitable assistants. The phy.sician's fingers should be protected from the child's teeth by a metal covering. When violent gastro-intestinal symp toms, accompanied by great loss of tissue fluids and marked involve ment of the whole organism are present, tbe therapeutie procedures advised in cholera-like vomiting and diartheea may be employed.
Chronic disturbance, of digcPtion, in later childhood, have their beginnings usually in infaney. since they arise either fron) malnutrition at that period, or occur in eonsequcnce of a residual weakness of diges tion following trifling injuries to the gastro-intestinal tract. Such chil dren are exceedingly backward in bodily development; their dentition is delayed, they have more or less anasmia, their appetite is very variable and marked by capricious and perverse tendencies 1.such as the eating of chalk, dirt from the ground, etc.), their stools are at times consti pated, at times diarrhceal, their tongue is always more or less coated and the abdomen distended, the region of the stomach being partic ularly prominent.
Thc treatment of this condition requires much patience: the most important factors are simple and not extended meals, only three a dayi separated by five hour intervals, a mixed diet, on the menu of which a large place should be given to special carbohydrates in the form of gruels and the vegetables, in finely divided form, which stimulate peristalsis (such as suitably prepared yellow beets, carrots, spinach, Brussels sprouts, pur6e of potatoes, ete.). Meat is allowed in small quantities1
(1 to 2 tablespoons daily) hashed, or only at one meal, and milk (and here the chief stress is to be laid) must be restrieted as far as practicable, and it should be entirely withheld as a drink giN-en with the meals. Climatic therapy is of value, sueh as a stay in a country region having a mild temperature, at the sea-shore, or among mountains of moderate elevation, provided that at these places food of proper quality and suitably prepared ean be furnished. All excessive exereise should be, avoided and the patient should remain as long as possible in the open air.
When antemia is a pronounced symptom, the use of one of the numerous iron preparations will doubtless prove a valuable aid in the treatment.
(d) CATARRH OF THE LARGE INTESTINE IN OLDER CHILDREN This affection can appear in acute or chronic form, since the transi tion of the first into the latter may occur, as well as acute exacerbations of chronic colitis. The disease begins primarily as a localized affection of the mucous membrane of the large intestine, and remains limited to this portion, or forms only the first stage of an ascending inflammation involving the whole intestinal tract; or, again, it may be the final stage of an inflammation passing from the stomach to the small intestine. Moreover it may also have a light or severe, coinplicated or uncompli cated, course, and out of it all results a considerable variety in the disease picture, the most marked types of which will be here presented.
Etiology.—The condition is brought about in the last analysis by indiscretions in the diet, particularly in the too free use of meat in pieces not sufficiently divided, or in giving meat too early; again, a condition of constipation is set up, after a too long continued diet of sterilized milk (Guinon). Later on, diarrffica accompanied by a slight elevation of temperature appears with small frequent stools containing mucus and accompanied by tenesmus. The children, who are for the most part anternic, show no particular loss in appetite and no especial disturbance of their general condition. The skin surrounding the anus is slightly reddened with superficial maceration, and one can make out, 011 separating the gluteal folds, a painful contraction of the sphincter ani, and transparent or light green mucus can be seen welling out of the anus. The discharge in the napkin, or in the vessel, in some cases, has an offensive or even fetid odor, and contains fecal material in the form of small solid brown particles which adhere a gelatinous-like mass; later, it may be composed of only thick gray or green mueus, with fine flecks of blood or a diffuse tinge of blood, the evacuation of which pro duces pain and intense straining, so that the children cannot be removed from the vessel where even after painful straining, only a few drops of urine are pressed out.. Notwithstanding the fact that the number of these (frogs' spawn-like) stools, may reach twenty to thirty in twenty four hours, the child is not particularly emaciated by them and does not give the impression of being very ill. The anwmia, which has been present for some time, becomes more pronounced because of the con siderable mixture of blood in the movements. In addition to the char acteristic stools from the rectum, a fecal evacuation, coming from the upper portion of the intestinal tract, is occasionally observed after a purge or a high irrigation.