Stomach Affections of the Mouth

bowel, time, blood, child, belly, obstruction and material

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Laudanum ought never to be used.

Intestinal Obstruction as it occurs in chil dren is in the form of intussusception, in which one part of the bowel slips into another part, as one part of the finger of a glove may be made to slip into the neighbouring part. It is met with in infancy and early childhood, the male child being more liable to it .thanthe female. It is occasioned by irregular action of the bowels, sometimes set up by improper food, by the presence of worms, or by diarrhoea. It is very liable to be misunderstood, the ill ness being taken for an attack of colic or diarrhoea, for though proper motions are not passed, a bloody discharge is.

The symptoms arise suddenly with severe pain, which may cause convulsions. Vomiting soon occurs, and the vomit is often streaked with blood and in a short time becomes smelling of fcecal matters. Blood is frequently passed in the stools. On examining the belly the mass of obstructed bowel may be detected as a sausage-like swelling. The child may die in a few days of shock or exhaustion.

If the parent or nurse waits till the symp toms quite clearly indicate the nature of the ailment, all chance of saving the child's life is probably gone. Now the first motion after obstruction has occurred is likely to be of material lying in the lower bowel, material quite unaffected by what has occurred above. Any motion containing blood, or black because of altered blood, will not be passed for some time, perhaps a considerable time after the obstruction has taken place. For a similar reason the first vomit is likely to be of merely watery material and partly digested food, and the suspicious vomit,which is chocolate-coloured or coffee-like because of admixture with altered blood, and foul because of containing hews, is not likely to occur for some time. Motions and vomit of such character, in an infant, following sometime after the child has suddenly become ill with pain in the belly, very clearly indicate what has occurred; but by this time it is too late to do anything with much chance of success.

A group of symptoms, much slighter than these, if associated, justify the fear of obstruc tion and prompt action to overcome it. That group of symptoms is as follows :— (1) Sudden pain in the belly in an infant or young child, indicated by the child suddenly crying out, squirming, and kicking.

(2) Equally sudden pallor of countenance, often the skin of the whole body be comes pale; and the paleness is intense and persistent, and is due to the nervous shock caused by the pinching of the bowel.

(3) Vomiting, which persists if food is given.

(4) Rapid pulse, not associated with a high temperature.

The temperature, which should be taken in the bowel, is at first likely to be depressed by the shock ; nevertheless the pulse is quick and thready. After some hours the temperature is likely to rise, though it may not rise more than one or two degrees; the pulse becomes still faster; nevertheless the pallor of face and akin remains.

If, with this group of symptoms, some tender ness can be made out over a limited area of the belly, the probability of obstruction is great. In the absence of a doctor, the olive-oil should be injected, as stated below, and gentle pressure on the outlet of the bowel made to help retain it while the belly is gently manipulated, the operator's hand being soft and well warmed.

The treatment must be prompt. Vomiting of material from the bowel, and the discharge of blood, should lead to help being instantly obtained. Purgative medicines do harm. The mother or nurse may, by means of an enema syringe, inject into the bowel, slowly and care fully, pure olive-oil slightly warmed. This may be done up to 10 ounces in the hope of releasing the obstruction by filling the bowel, and so causing it to slip up out of its unnatural position. If the oil is expelled from the bowel, a second 10 ounces may be injected within half an hour.

Costiveness.—It must be noticed that some children are costive by habit, and have motion only once in two or three days. It must also be remembered that frequent dosing with medicine is itself productive of costiveness, and is otherwise injurious. Medicines should therefore be avoided as much as possible, and reliance placed on proper dieting and on train ing the child to regular habits—to train it to seek relief at, as nearly as possible, the same time every day, say after breakfast.

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