At all ages, the case is more serious if the temperature is high than if it be only moderately elevated. Also, great frequency in the stools ; vio lent vomiting ; early collapse ; unusual drowsiness or stupor ; stertorous breathing ; convulsions, or other sign of cerebral complication, and any sudden marked increase in the pyrexia—all these are signs of very serious import. On the contrary, a fall in the rectal temperature is of good omen. If the internal heat of the body be found to have become normal, we may entertain hopes of improvement, although the general symptoms appear to have undergone no change.
In the chronic form, the prognosis is also more serious in children under the age of two years. Another very important matter is the per sistence of the diarrhcea. If the purging is a confirmed derangement, our chances of success are much fewer than if intervals occur, however short, in which the stools are merely soft and pasty without being relaxed. If ulceration of the bowels has occurred, we should look forward to the ter mination of the illness with very serious apprehension (see Ulceration of the Bowels).
Treatment.—In all cases of severe diarrhcea in the child, especially in the infant, our first care should be to place the patient at once upon a suit able diet. This subject is of the first importance ; for it is indispensable to improvement that all food be withheld which is capable of fermenting and giving rise to acidity. Our object is to furnish the child with a diet which will supply nourishment to the system without leaving an undigested residue to irritate the bowels, and so aggravate the derangement we are endeavouring to cure. Milk, in particular, must be prohibited unless the patient be an infant at the breast. If he be suckled, it will sometimes be. found that restricting the child entirely to his mother's breast is followed by improvement. Often, however, even this diet will not agree, and other means will have to be adopted. A hand-fed baby must be fed with whey and cream, or whey and barley-water in equal proportions, or with weak veal or chicken tea diluted with whey or barley-water. The food should be given cold, and in small quantities at a time. If the child is weakly, and in any case if he show signs of becoming exhausted, white wine whey is of great service. This must be given cold in suitable quantities at regu lar intervals. Thus, a feeble infant will take a tablespoonful every hour with advantage at first. Afterwards, as the need for stimulation grows less
pressing, other foods may be alternated with the white wine whey ; or this may be given only two or three times in the day.
Kornniss has been used largely in these cases, and sometimes appears to agree. My own experience of this food, however, has not been quite satis factory. In giving koumiss to a young child, the gas should be first ex pelled by pouring the fluid several times from one vessel to another. The quantity allowed to be taken at each meal must be proportioned to the se verity of the purging. If this be insignificant, the child may take the whole contents of feeding-bottle. If, on the contrary, the looseness be frequent and exhausting, koumiss, like other fluids, must be given sparingly, and the quantity taken on each occasion must be very carefully restricted. The addition of Mellin's food to any of the first-named fluids is useful, and in most cases answers well.
Older children should be fed, while the temperature is high and the purging severe, with plain whey, barley-water, and weak veal or chicken broths, given in small quantities ;_ or if the strength is failing, with the wine whey, or brandy-and-egg mixture, and strong meat essence. When the first violence of the disease has abated, the patient may begin to take but it should be well-diluted with barley-water to insure fine division of the curd, and be alkalinised by the addition of the saccharated solution of lime, fifteen or twenty drops to the teacupful. Whatever be the age of the' patient, any sign of exhaustion must be combated by energetic stimu lation. Brandy must be given internally, and the skin must be irritated by warm mustard baths.
After regulation of the diet, the next matter is to see that the belly is kept warm. The whole abdomen should be covered with a thick layer of cotton wadding, and this must be kept in place by a broad flannel binder. If there is any tendency to coldness of the feet, they must be warmed by a hot bottle.
,Pfirity of the air is another point which is not to be neglected. The window should be opened—care being of course taken that the child is not exposed to draught—and a free circulation of air through the room can be insured by a small lamp placed in the fire-grate. Few persons should be allowed in the sick room ; and all soiled linen should be removed at once to another part of the house.