Sometimes the motions are frothy, speaking of rapid fermentative processes going on in the bowel. In all of these cases feeding should be stopped for 6 or 12 hours, castor-oil should be given in repeated small doses, as suggested for simple diarrhoea. When the stools are clay-like, grain of calomel may be given and repeated every 12 hours, instead of castor-oil, and the slightly saline water given freely by the mouth, as the child is usually thirsty and the mouth dry. If there is much exhaustion a few drops of whisky or brandy may be given with the saline water. Besides these steps, it would be well to wash. out the bowel. For this purpose tepid water should be used, iu every pint (2 tumblers) of which a small tea-spoonful of table-salt has been dissolved. This water should have first been boiled and then kept in a per fectly clean vessel, protected from dust, till cool enough for the purpose. It should be injected by means of an enema syringe which has previously been soaked in boiling water containing a tea-spoonful of soda to every pint. The rubber tube, supplied for going over the bone-end of the enema delivery-tube, should be put on, having become thoroughly soft by soaking in boiling water, and being oiled with clean pure olive-oil. Care should be taken that there is no in the enema, the tube should, with a spiral movement, be gently passed up into the bowel as far as it will go, and the water very gently injected. The child is best lying on the nurse's knee, the nurse being pro tected by a rubber sheet over the knees, dipping into a small child's bath. A warmed towel is placed on the rubber, on which the child rests. The person injecting the water sits at the side on a low chair or stool, not directly in front of the child, lest a spurt of water from the bowel be shot over him.
If the water be slowly injected, if care be taken that its outflow from the bowel is not hindered, there can be no danger in using several pints of water; that is to say, pint or so would be injected, then allowed to escape, then another I pint injected and allowed to escape, and so on, till the water returned unsoiled.
After 6 or 12 hours, feeding would be re sumed; but it would in such chronic cases probably be best resumed with egg - water. This is made by stirring the white only of one egg in two tumblers of cold boiled water. The egg is not whisked, only broken up in the water by means of a fork or spoon. It is then strained through cloth and very slightly sweetened. The whole of this quantity may be used in 2 hours, being given in frequent spoonfuls.
Improvement being maintained, " milk mix ture" may gradually be added to the egg-water ill a way similar to that described for the addi tion of "milk mixture" and saline water in simple diarrhoea.
The only medicine other than castor-oil or calomel which may be given by unqualified persons is the carbonate or salicylate of bis muth, which may be given in 5-grain doses from four to eight times in 24 hours, according to the age of the child.
In some cases, after 24 hours of the white-of egg drink before milk is resumed, it is well to wait other 24 hours and to give the white of-egg drink and a weak chicken or mutton broth turn about.
Summer Diarrhoea of Children (Cholera infantum) differs from the preceding forms of diarrhoea in that it is due to an actual form of poisoning, the poison or toxin that plays the mischief being produced by the activity of living organisms which have gained entrance to the milk.
It prevails in summer and hot weather, and is the cause of the high mortality of infants in cities and pool, overcrowded districts, where unsanitary conditions abound.
The attack is usually sudden, vomiting and purging setting in together. The vomit is at first of the partly-digested milk, and then of bile-stained mucus; the motions are at first of undigested food, but they soon become watery and very abundant, and colourless. The loss of water from the body is so great that the child soon becomes greatly exhausted, hollow eyed, pale as death, and rapidly emaciated. The temperature rises, the pulse is weak and thready ; the child is very restless, and thirsty; its breathing is hurried; and it may become convulsed or stuporous.
Treatment, to have the least chance of suc cess, must be rapid and energetic. The child is suffering from the effects of a poison intro duced in milk, and irritating both stomach and bowels. Therefore to give no more of the material that may contain the poison, and to wash out, so far as possible, what has been already given, are the obvious things to try to do.
Feeding with milk must therefore be com pletely stopped. The bowels must be washed out with water, as directed on p. 603.
If the stomach could also be washed out with the saline water, it ought to be done; but in the absence of a qualified person this could not be done.
If the stomach cannot be washed out, small doses of calomel (k grain) should be given and repeated every 4 hours for 24 hours. If castor-oil could be retained, it would be good to begin with one` or two tea-spoonfuls, and thereafter to give the first of the repeated doses of calomel. Ice - cold boiled water, with the slight addition of salt (see p. 602), and with the addition of whisky or brandy if necessary, should be the only thing given by the mouth for the first 24 hours. The white-of-egg water, made with boiled water which has been cooled, should follow, the saline water being continued, with stimulant if necessary. After other 24 hours, warm, weak meat or chicken broth may be tried.
Artificial foods and meat extracts must not be used.
Finally a cautious return to milk food, as directed on p. 603, is made, the utmost care being exercised in the preparation of " the milk mixture" and its preservation from contami nation. If, at the outset, the temperature runs high, an ice-cap to the head may be advisable, and cold sponging, with friction to the limbs. On the other hand, when a pinched and livid skin suggest collapse of the child, a warm bath to restore the circulation may be the beat remedy—a bath of a temperature of 100°.