In the earliest stage there appears to be special in the symptoms themselves to indicate that the disease is anything more than an ordinary attack of severe intestinal catarrh. Afterwards, when the affection has become more fully developed, the characteristic fcetor of the dejections at once reveals the nature of the illness. Intussusception of the bowel is also marked by the passage of blood-stained, non-feculent mucus, combined with great straining and severe colicky pain. The distin guishing points between the two diseases are elsewhere described (see page 674).
Prognosis.—The danger of the case is in proportion not only to the severity of the attack, but also to the time at which the patient comes under observation. Dysentery is a disease in which early treatment is of the utmost importance. If the child be seen during the first few days, or even before the end of the first week, he will probably recover under judicious treatment. Absence of severe depression of strength and spirits, placidity of expression, and a fair pulse are all signs of favourable import ; and an early return of feculence in the stools, if combined with a diminu tion in the colicky pains and tenesmus, may be taken as an indication of ap proaching convalescence. On the contrary, early prostration, a haggard facies, a feeble, frequent pulse, great restlessness, hiccough, a dry tongue, a gangrenous odour from the stools, and, especially, delirium—all these symptoms should occasion the utmost anxiety.
If, after the cessation of the ordinary dysenteric symptoms, the child remain prostrate and stupid, lying in a drowsy state with eyes only par tially closed, his pupils sluggish, his breathing irregular or of the Cheyne Stokes type, we should fear the occurrence of cranial thrombosis.
Treatment.—If the child is seen early, he should be put into a bath of the temperature of 95°, and be kept there for ten minutes, or a less time if he feel faint. He should be then put into bed with hot fomentations to his belly, and take a draught composed of castor-oil in conjunction with rhubarb and laudanum, in some aromatic water. This combination is believed to have originated with the late Dr. John Scott, examining physi cian to the H. E. I. Company. It was kindly communicated to me by Dr. Chevers, who, in his own large Indian experience, has been accustomed to rely greatly upon this remedy if given sufficiently early in the disease. To a child of ten years of age the draught may be given in the following proportions : If after this draught the bowels act more than twice in the next twelve hours, an enema containing ten drops of laudanum in half an ounce of starch- or gum-water, may be thrown up the bowel. In the case of children,
opium should be used with especial care, on account of the early prostra tion which is so apt. to occur in this disease. If given at the first, its use should not be continued too long. Dr. Morehead speaks warningly against a too prolonged use of opium, which he says makes the dejection pasty and scanty, and is injurious to favourable progress.
If the practitioner fear the use of opium by the mouth, ipecacuanha is as useful a remedy in the young subject as it is in the adult. Six grains may be given to a child ten years of age ; two, three, or four grains to a younger child. The dose must be mixed with as little, fluid as possible, and is to be repeated every day at sufficient intervals for the child to be able to take nourishment ; for the ipecacuanha must not be given until two hours have elapsed after food. Usually, twelve hours may be per mitted to pass between successive doses of the drug. The diet should consist of meat-broths, thickened, if necessary, with boiled sago or arrow root ; and of boiled milk diluted with barley-water, and alkalinised with a few drops of the saccharated solution of lime. The child must be kept as quiet as possible in his bed, and painful tenesmus must be treated with injections of opium and starch, and by hot applications to the belly and anus. All through the acute stage the child should be rigidly confined to his bed. The air of his room should be kept pure by open windows and the proper use of disinfectants ; and all excreta should be disinfected be fore removal from the sick-chamber.
If the case is seen early, or is of a comparatively mild character, the above treatment will be usually effectual in checking its further develop ment. In the very severe cases, or those which are seen after the end of the first week, when gangrenous sloughs are being passed, the belly should be covered, as in the former case, with hot applications or turpentine stupes. Ipecacuanha should be then given in one full dose (gr. vj.--viij. to a child of ten years of age), and the quantity can be repeated in eight or ten hours. If thought advisable, a few drops of laudanum can be given half an hour before the ipecacuanha. After taking the latter the child should be kept perfectly quiet, and must take no food or fluid. If he be very thirsty, however, he may be allowed to suck small lumps of ice. Dr. Maclean speaks very highly of the value of the remedy so administered. According to this physician, the straining and colic subside, the blood and slime disappear from the stools and are replaced by feculent matter, the skin becomes moist, and the patient falls into a quiet sleep.