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stools, time and milk

CHOLERA INFANTUM.—The so-called summer-diarrhcea, an affliction which carries away many children in their first year of life. It prevails at any time from May to October, but most frequently during July and August. Excessive heat and high humidity are factors favouring its development. Artificially nourished infants are particularly prone to the disease, which is unquestionably dependent on changes which the heat produces in the milk. Among the immediate causes may be mentioned the presence of pathogenic bacteria in milk which is not handled in a cleanly manner, ferments which are present in the fodder fed to the cows, overfeeding with milk which con tains too much albumin, and too early feeding with gruels. In many cases with complicating dysentery, a specific bacterial flora is present, the Bacillus shiga being one of the most common representatives.

The children may be very restless before any definite symptoms of the disease appear. They cry pitifully, and constantly draw up their legs over the abdomen, which is distended and tender to the touch. After a time the stools become green, or consist of mucus streaked with green. In other

cases the initial symptoms may be eructations and vomiting. The stools then increase in frequency, and are thin, green, like rice-water, or mixed with mucus. If not already present, vomiting follows. If nothing is done for these children, they become rapidly weaker from this continued diarrhcea ; the cry becomes hoarse and moaning, the eyes sink in, the nose becomes pointed, the fingers cold and blue, the skin dry, and a series of convulsions may bring about a fatal ending. If these symptoms appear in a child previously well and having normal stools, no time should be lost in summon ing a physician. In the meanwhile all nourishment must be stopped, and the intense thirst may be satisfied with a little boiled water or weak tea. If an irrigator is at hand it is to give the child several enemas of lukewarm water. In every case, the soiled napkins should be saved for the physician's inspection, so that he may note the character of the stools.