The non-febrile form of the disease may be recognised without difficulty. Frequently-recurring attacks of indigestion, a tendency to acidity and flat ulence, restlessness and irritability after indulgence in sweets and other forms of fermentable food, are almost invariably the consequence of gastric catarrh. The complaint is so common a one that it should be always sus pected in children who are habitually pale, thin, and nervous, with a sallow complexion, and who are subject periodically to fits of irritability and ill temper. Continued loss of appetite from this cause often excites appre hensions that the child is becoming consumptive. The real cause of his wasting may, hoewver, be detected by noticing that the chest, on examina tion, shows no sign of disease ; that his expression, although occasionally wearied, as after exertion or before going to bed, is not habitually distressed, and that the evening temperature is normal. On inquiry, too, it will be found that the wasting is not a constant feature, but that the child is better and worse, sometimes appearing to be almost well and to gain flesh ; at others, being languid, moping, and sallow-looking when indigestion is excited by a fresh attack of catarrh.
Treatment. —Whether the gastric catarrh assumes the febrile or the non febrile form, its treatment is the same. Our object is, firstly, to put a stop to the existing derangement, and, secondly, to adopt such measures as will prevent its recurrence.
To cure the existing catarrh, we must do our best to remove all sources of irritation which may be keeping up the disorder. The acrid mucus, a. free secretion of which is one of the ordinary phenomena of the catarrhal state, is a constant source of fermentation and acidity. It very quickly in duces an acid change in the more fermentable articles of food. Therefore, if the stomach be oppressed by sour matters, shown by uneasiness at the epigastrium, a sour smell from the breath, and a feeling of nausea, im mediate benefit will be derived from an emetic dose of ipecacuanha wine. Afterwards, a draught composed of tincture of nux vomica (fitj.-iij.), with bicarbonate of soda (gr. iv.-vi.), in water sweetened with spirits of chloro form, taken two or three times a day, will soon restore the gastric mucous membrane to a healthy condition. Strong purgatives are to be avoided, but as there is usually constipation in these cases, an occasional mild ape rient will be required, such as compound liquorice powder or castor-oil. If there be fever which does not subside after the action of the emetic, the child may be allowed to take fluids from time to time in moderate quanti ties. The best are unsweetened barley-water, flavoured, if desired, with orange-flower-water, and fresh whey.
During the treatment, as long as any signs of acidity of the stomach persist, care should be taken to exclude from the diet all matters capable of favouring the tendency to fermentation of food ; and even for some time afterwards, readily fermentable substances, such as starches and sweets, should be taken sparingly, lest the derangement be encouraged to return. At first, nothing should be allowed but freshly-made broths, with dry toast, and when milk is once more permitted, it must be guarded with a fourth part of lime-water, or with saccharated solution of lime, in the proportion of twenty drops to the teacupful. While the derangement continues, no fruit, cake, sweets, light puddings, or potatoes should be permitted. When the appetite begins to return, a little fish, chicken, or mutton may be al lowed, but the child must not be pressed to eat ; indeed, until his diges tive power be completely restored, the utmost care must be taken not to overload the stomach with food.
The above measures will effect a considerable improvement in the con dition of the child, but at this point the treatment may be said only to have begun. The patient is in a weakly state from successive attacks of gastric catarrh. We have therefore to adopt measures to strengthen the diges tive power, and take such precautions as will insure him against a relapse.
To give tone to the stomach and strengthen digestive power, prepara tions of iron are required. It is a common practice in such cases to admin ister the preparation of the phosphates of iron and lime known as "Par rish's chemical food." This syrup is a very favourite remedy with mothers, who, misled; perhaps, by the name, give it largely, and with the worst results. Theoretically, no doubt, it is an active tonic, but practically it is highly per nicious. The reason is that the syrup in which the phosphates are dissolved supplies material for fermentation, and each close is soon followed by acid ity and flatulence, so that the medicine really aggravates the mischief it is intended to allay. better plan is to give the dialysed iron, or, if there be any tendency to acidity remaining, the ammonio-citrate, with a few grains of bicarbonate of soda, sweetened with spirits of chloroform. After a time a change may be made to the solution of strychnia, with the per chloride or pernitrate of iron, given directly after food. All this time, the quantity of fermentable material taken at meals much be restricted, as al ready recommended. During the same time, a mild aperient should be given every few days, whether it seems to be required or not, to insure proper relief to the bowels, and prevent the retention of any excess of mucous secretion.