The influence of suggestion also has a broad field of activity. whereas hypnosis but rarely comes into play (e.g., in the more severe cases of somnambulism). Many disorders may be made transitory in a similar manner, by preventing them, from the very beginning, from being strongly emphasized, and by thereby obviating the fixation of the disease conception. Even pronounced hysterical symptoms, such as uncontrollable vomiting, convulsions, etc., often disappear in a Yen' short time if the patient is removed from his usual surroundings and his complaints are ignored, and in this manner the vicious circle of unconscious disease concepts is broken and repressed. Active sug gestion often requires positive exhortation (by which the child is caused to concentrate his attention by gazing fixedly at the physician). An impressive manipulation which apparently or actually cooperates in the removal of the symptoms of disease is of greater assistance, such as medicaments, electric current, massage, passive and active exercises, etc. suggestive therapy will be used the inure, the more carefully the physician takes into account the psychical aspect of all diseases, of \vhich chronic constipation, which has been found to have autosuggestion as a basis, may be taken as an example. And finally, the psychical influence has its share in the successes of many varied methods of treatment (e.y., sojourn in the country, baths, sanatoria, etc.). without the phy sician or those around the child being always conscious of the fact. Association with children of the same age, the sense of new impressions, and change in routine and in the demands made upon it. improve the temper, give new impulse to the will, and bring about a change in the tone of all the functions which, if maintained within proper limits, may be of great therapeutic value.
Physical Treatment.—The physical methods of treatment in pedi atrics are so highly thought of because of the simplicity with which they are carried out, and the certainty of their success, that there is even a tendency to ignore on their account the treatment of the etiolog ical factors. The simplicity of these methods sometimes leads to for getfulness of the fact that they may produce local or constitutional injury when used collectively, and particularly when frequently repeated. It is therefore impossible to regulate these procedures according to a fixed rule. The digestive tract, at its upper and lower portions, is most frequently subjected to mechanical treatment, stomach lavage and gavage, procedures for emptying the bowels, and rectal feeding.
Laraye of the stomach may be used fbr removing harmful gastric contents in poisoning, or after the ingestion of indigestible food, and again for the removal of pathological contents (mucus, excess of hydro chloric acid, feces in stercoraceous vomiting). The most frequent clin ical indication for this procedure is vomiting. But it would be an error to consider gastric layage only as a method of assisting spontaneous evac uations of stomach contents, inasmuch as, by distending the walls of the stomach, it acts as a sedative and stops the vomiting. Hence it follows that an indication for lavage exists even when there can no longer be any possible suspicion of further retention of irritating contents in the stomach. It is, however, frequently possible in these cases to allay the vomiting by the much more simple procedure of administering a proper diet.
For gastric lavage a soft or semi-soft catheter should be used (Nela ton or silk-woven catheter), which should be connected by means of a short glass tube to a piece of rubber tubing about the length of the child; at the end of the rubber tubing there should be a funnel to facili tate the pouring in of the fluid for washing. The catheter should have the largest possible calibre (for infants, No. XV). The infant is then well wrapped (because the bowels are usually evacuated during the course of the lavage), the arms being included in the wrapping. The child is taken upon the lap of the nurse or the physician, and a second person pours the fluid, and allows it to flow in and out. If the physi cian holds the child, after having protected himself with an apron, he lays the child upon his lap, and with his right hand introduces the cath eter, which he holds in place, using his left hand to hold the infant, whose head must be toward the left and depressed. This method recom mends itself, as in practice there is frequently a lack of assistance. In older children the nurse must hold the child, holding the legs between her knees, grasping the hands with her right hand, and with her left against the child's forehead pressing the head against her breast. The physician then introduces the tube, at the same time keeping the mouth open with a mouth gag, rubber wedge, or cork if necessary, which he steadies while another person allows the water to flow in and out. The water should contain a small quantity of table salt or Carlsbad salt, or, if it is desired to use a disinfectant, boracic acid; be lukewarm, and be slowly introduced, the height of the funnel regulating the rapid ity of the flow; it is emptied by siphon action. This should be re peated until the water returns clear. As it is possible that stomach con tents may he retained out of reach of the flow of water, it is necessary to change the direction of the tube and to withdraw it if it conies in contact with the wall of the stomach; if blood or mucous membrane appears in the water, for safety, the tube should be at once withdrawn, and the procedure be discontinued.
Instead of this method for washing the stomach of the infant, that recommended by Escherich may be employed. It consists of a gradu ated bottle with a wide neck, haying a capacity of about 400 c.c. (1 pint). This is closed with a rubber cork, having two small openings. Through one of these passes a glass tube which reaches to the bottom of the bottle, and through the other passes a shorter one; to the former is attached the stomach tube, and to the latter a short piece of rubber tubing. After introducing the stomach tube, the contents of the stomach may be evacuated into the bottle if desired, and then be subjected to exam ination. The cork is then withdrawn from the bottle, which is replaced by one containing fluid for washing the stomach. By blowing through the tube connected with the short glass rod, the fluid is forced into the stomach and is returned into the bottle by the pressure of the abdom inal wall. This procedure is repeated with changed cleansing fluid as often as necessary. This method makes it possible to judge more accu rately the pressure and the quantity than can be clone in using the tube and funnel.