Finally, we have to allude to medicinal enemata (e.g., decoction of garlic for the removal of intestinal parasites); the smaller enemata (starch solution) for quieting the inflamed mucous membrane; and the stimulating enemata (vinegar, 1 to •1 Of the various methods of treatment by introducing substances through the skin into the tissues, only the subject of subcutaneous infusion deserves a few words at this point, as the use of drugs by hypo dermic injection is sufficiently well known. ;subcutaneous infusion may be very useful in the first place. in replenishing the tissue fluids lost through exhausting vomiting and diarrhwa or severe hientorrhage; and, in the second place, in septic) and toxic conditions, by causing greater drainage through the tissues. It is only necessary to use it oppor tunely and with sufficient frequency—even two or three times daily. In pediatric practice, the principal indication for this procedure is in cases of diarrhcea and vomiting, when the absorptive powers of the intestines have been lost. and the decrease of the normal tension of the skin indicates the danger of the drying out of the tissues. Instead of all the complicated solutions, it is only necessary to prepare a salt solu tion (six or eight Gin. about one heaping teaspoonful—of table salt to one litre—one quart of water), and to boil it for ten minutes. For in jecting the fluid, one of the larger syringes is used, such as is commonly employed for the injection of serum, and which is usually at hand. The injection is accomplished by refilling the cylinder repeatedly without removing the needle from the tissues. The large syringes which are connected with a cannula by means of a rubber tubing are much better. It is also possible to introduce fluid under the skin by using a length of rubber tubing which has been carefully boiled, one end being attached to a needle and the other to a funnel. Only 30 to 50 c.c. (S to 14 drams) in infants, and 50 to IWO c.c. (14 to 2S drams) in older children, can be introduced at one point. If necessary, however, the infusion may he made at a number of points. During the infusion the needle is slowly advanced and must always have its point free in the subcutaneous tissue. The preferred location for the infusion is the region below the clavicle, or the sidle of the abdomen. Local reaction can readily he prevented by the sterilization of the instrument and the skin, and by closure of the puncture with plaster, or cotton and collodion.
Rica/int/ is also occasionally indicated in childhood. Its action is sometimes very rapid in but less often will it help to overcome the danger of death in conditions of extreme cyanosis (c.)).. pneumonia. cardiac weakness) by relieving the circulation. As a rule, however, it should be practiced only in the latter half of childhood. SO to 120 Gin. (3 to 4 ounces) of blood being drawn. An elastic band or a wet gauze bandage is wound rather tightly around the pendant arm, so that the peripheral veins become distended. After making a small incision through the disinfected skin, a vein in the bend of the elbow is opened for a distance of about -1 cm. in the direction of the course of the vessel, and the blood is allowed to flow into a receptacle whose capacity is ap proximately known. After removal of the bandage the. Heeding ceases
spontaneously, so that only a small antiseptic compress is required at the point of incision. Occasionally, it is possible to puncture a fully distended vein through the skin by means of a good sized cannula.
Blood-letting by means of wet cups. in the vicinity of a diseased organ, is also to be chosen only in the ease of older children (particu larly in inflammation of the lungs and pleura); whereas dry cupping may be employed in younger children. A wet cup draws up about 3 to 5 Gin. (.15 to 75 minims) of blood. Each cup is taken directly out of warm water and its opening is held over an alcohol flame, and then, before it has become too it is quickly and firmly pressed upon the skin. To remove the cup, the skin at its margin is pressed down, when the entrance of air into the cup releases it. Instead of wet cups, leeches may he used. Puncture of the spinal canal, which is of value not only for diagnostic but for therapeutic purposes, will be considered elsewhere.
Hydrotherapy (including balneotherapy).—Most of the diseases of childhood arc favorably influenced by the use of water applied in any way. Only in certain diseases of the newborn, and in some skin and surgical affections, are there any contraindications. Like any other remedy, when misused, water may become harmful, and it is often used only to supplement some other form of treatment. If, therefore, hydro therapy cannot be considered as a separate method of treatment, as distinguished from the rest of the subject of therapeutics, it neverthe less enjoys the particular advantage of careful scientific elaboration and a readily controlled action rendering possible the most delicate graduations and changes in the application of its various procedures. This advantage, however, is of value only where the action of every prescription is watched by the physician himself, and the procedure is modified according to necessity and to the result obtained, which latter depends upon the individuality of the patient and the course of the disease.
Water, acting upon the body surface, affects the nerves, vessels. and tissues. The behavior of the blood vessels, influenced directly or reflexly through the nervous system, is particularly important in so far as the primary effect of the treatment is followed by a secondary action (really in a direction opposite to that of the first), which affects their state of contraction. 11lost of the procedures produce their best results only when this opposite condition, the reaction, takes place promptly and markedly. During the application of the water treatment, aside from local changes in the amount of blood in the vessels, there will also be an opposite action (revulsion) upon the distribution of the blood in the underlying tissues or in the tissues of other parts of the body. It is therefore, possible, directly or indirectly, to influence the quantity of blood in a given area, increasing or diminishing it, and thereby its nutrition and function. Procedures which include a considerable portion of the body surface, acting through the circulation, have a inure powerful influence, even affecting general metabolism.