In children at the breast, the derangement is usually quickly remedied by the administration two or three times a day of a few grains of bicarbon ate of soda, and half a drop of the tincture of nux vornica, in a teaspoonful of some aromatic water. In infants artificially fed, the disorder is not so easily cured, and a complete change in the diet will be required. The pancreatised milk is very useful in these eases, and in conjunction with the alkaline mixture just referred to, will often quickly restore the digestive organs to a healthy condition. If this do not succeed, it will be necessary to stop all milk-food for a day or two. The youngest infants bear a tem porary deprivation of milk exceedingly well ; and when, as in the derange ment spoken of, the symptoms are the direct consequence of fermentation and acidity, a withdrawal of the fermentable material is followed by im mediate and striking improvement. Even in the most obstinate and pro tracted cases of gastric derangement in young babies, the withholding of milk-food, combined with proper measures to support the strength and maintain the heat of the body, will be generally successful in restoring the infant to health. The same treatment is of equal service in cases of severe acute gastric catarrh in hand-fed babies.
Some time ago I was asked to see an infant two months old, whom I found suffering from acute gastric catarrh, and in a state of great exhaustion. She had been brought up by hand, and was being fed upon milk and bar ley-water in equal proportions. This she vomited as soon as it had been swallowed, bringing it up curdled and intensely acid. There was a sour smell from the breath, and although the disease had only lasted a few days, the eyes were hollow, the face looked pinched, the fontanelle was deeply depressed, and she lay motionless on the nurse's lap with her eyes half closed. Her hands and feet were cold to the touch and looked purple. For a day or two her bowels had been much relaxed. She was taking small closes of lead and opium to check the diarrhoea, but each dose was returned almost immediately. The child was ordered to be kept warm and perfectly quiet. A week mustard poultice was applied for an hour to the epigastrium. The milk was stopped, and the child was fed with weak veal broth and thin barley-water mixed together in equal proportions, and given cold at inter vals with a teaspoon. A few drops of brandy were also given occasionally, as seemed desirable. As a result of this treatment, the vomiting stopped at once, and the child when seen three days afterwards was found to be greatly improved. The breath had lost its sour smell, the face was no longer pinched, the eyes were not hollow, the fontanelle was net depressed, and when asleep the child closed her eyelids. The motions were still rather watery, although the number was natural. The medicine and diet were continued for a few days longer, and the child was soon well.
The most important part of the treatment in this case was the substitu tion of veal broth for milk. Directly the supply of fermentable matter was stopped, fermentation ceased, acid was no longer formed, and the digestive organs returned to a healthy condition. Here the derangement was acute. In the following case the complaint was chronic, the inability to digest cow's milk having extended over a lengthened period.
A little girl, ten months of age, very thin and weakly-looking, had been weaned at the age of eight months. Since that time she had been unable
to digest milk, vomiting it at once whenever it was given to her. For nearly two months, therefore, she had been fed on two dessert-spoonfuls of farinaceous food made with water into a thick cream, and given every two hours with a spoon. She -refused to take it from a bottle. Twice a day the food was made with beef-tea instead of with water. After a meal the child often vomited, but when this happened she was immediately fed again. The result of such a diet was to be expected. The child, although ten months old, could not sit up. She was becoming rapidly thinner. She slept very little, crying and whining the greater part of the night. She was said to show no signs of abdominal pain, but the bowels acted three times a clay, and the motions were relaxed and horribly offensive. The feet were almost always cold.
Such a case, which is far from being an uncommon one, is readily treated, however severe may be the vomiting, by restricting the diet to equal parts of weak veal broth and thin barley-water, given cold in small quantities at a time ; by warmth to the belly and extremities ; by perfect quiet, and by suitable remedies. The best sedative is liq. arsenicalis—half a drop for the dose—given with a few grains of bicarbonate of soda in some aromatic water. It may be sweetened with spirits of chloroform. After a few clays of such treatment, the power of digesting milk usually returns. But at first it should be given sparingly, either pancreatised, or freely diluted with barley-water, and only once or twice in the day. If the inability to digest milk continue, the case must be treated as described under the head of Chronic Diarrhoea (see page 640).
It may be necessary to begin the treatment by a dose of castor-oil, or rhubarb and soda, to clear away undigested food from the bowels. If the child is very weak, white wine whey is very useful. This may be sucked from a feeding-bottle, or given with a syringe-feeder, and the infant, if feeble, may take it in large quantities. Alternate meals of this whey, and of weak veal broth diluted with an equal proportion of thin barley-water, forms a very suitable diet for such cases. Meliin's food, dissolved in thin barley-water, or plain whey and barley-water, is also very useful ; and a dessert-spoonful of fresh cream, shaken up with a teacupful of plain or white wine whey, is a very valuable resource in obstinate cases.
For the treatment of constipation, colic, looseness of the bowels, thrush, and the other accidents attendant upon improper feeding and general mis management, the reader is referred to the chapters treating of these special subjects. In conclusion, it may again be remarked that success in the arti ficial feeding of infants depends, in the first place, upon the selection of a suitable diet ; and in the second, upon extreme watchfulness to detect the earliest signs of indigestion and acidity, and to make the necessary changes in the food which have been indicated above. Action must be prompt, for delay is often fatal. A food must be changed directly it ceases to agree, and any symptom of indigestion must be met at once with a suitable remedy. A derangement which in the beginning might have been arrested without difficulty soon assumes serious proportions, and if allowed to con tinue, will quickly bring a weakly infant to the grave.