In all cases of severe intestinal catarrh, a careful watch should be kept over the temperature, and any great increase in the bodily heat should be at once reduced by tepid bathing. In tropical climates, the treatment of inflammatory diarrhea by baths has been found very successful. A point of great practical importance in applying this method, is to remember the depressing effect of the illness, and to be careful that the application of cold is not carried to the point of inducing prostration. The more weakly the child, the more careful should we be so to regulate our measures, as to avoid a shock to the system which might be too severe to awaken any responsive re action. The use of the bath at once reduces the temperature, and even in cases which eventually prove fatal, its immediate effect is often encouraging.
A little girl, aged twelve months, with twelve teeth, was seized with se vere diarrhea. The stools were buff-coloured and watery, without lumps, and were passed very frequently in the day. After about a week, the de jections became frothy, and had a dark 'green tint. There was much tenes mus, and the bowel sometimes prolapsed. On an average, there were about fifteen stools in the twenty-four hours. The child was very weak, and had no appetite, but was thirsty. She never vomited.
When first seen on the twelfth day of the purging, the tongue was red, with some fur on the dorsum. The skin was inelastic. The abdomen was distended, but unless the child strained, the parietes were flaccid, and there was no tenderness. The eyes were hollow, the mouth livid, and the nasal line was well marked. The fontanelle was depressed. The temperature was 103.4°.
The child was ordered to be fed with veal-broth and barley-water in equal proportions, and to take as medicine, powders of bismuth and aro matic chalk. After each motion she was bathed in cold water. After six of these baths, each of which had greatly reduced the temperature, the bodily heat remained normal, the stools were reduced to three in the twenty-four hours, and the child's appearance was much improved. She looked brighter, the eyes were less hollow, and there was less lividity about the lips. The stools were green and slimy, and were evacuated with straining. Unfortunately, after a few days of this improvement, although there was no increase in the diarrhea, the child seemed to sink from ex haustion, and died on the nineteenth day of the illness.
In this and similar cases, the child was placed in cold water, and bathed for a minute or two with a sponge. When the child is very weak, it is ad visable to make use of water warmed to the temperature of 70°, and to bathe him in this water for a few minutes, or until sufficient evidence of reduced temperature is obtained. Afterwards, he should be placed between blankets in his cot, with a hot bottle to his feet. A stimulant is usually required after the bath ; and may be given with advantage, also, when the child is taken out of his cot to be placed in the water.
The above measures are all of great importance, and constitute in them selves the main treatment of the disease. The use of drugs, although often of signal service in the conduct of the case, cannot be expected to lead to any good result unless the other matters have been first attended to.
If the case is seen early, it is well to begin the medicinal treatment with a gentle laxative, such as castor-oil, or rhubarb and soda. Afterwards, if the temperature is only moderately elevated, not passing above 100° in the rectum, the aperient should be followed by an astringent mixttue containing opium. For a child of six months old, two grains of the extract of haema toxylon may be combined with five drops of the tincture of catechu, and half a drop of laudanum in a chalk mixture, and given every six hours in the day and night. If the case resist this treatment, it usually goes on, and appears to be little influenced by astringents, however ingeniously they may and combined. The cases we meet with in children's hos pitals, have usually been treated with a variety of the ordinary binding rem edies, but the diarrhoea continues apparently unaffected by changes in the physic. After seeing many of these cases, we are led to rely less upon the pharmacopoeia than upon attention to diet and the other means by which the disorder may be controlled. Of astringent remedies I prefer the ex tracts of hmmatoxylon (gr. ij.—v.) , and rhatany (gr. ij.—v.) , or the tincture of catechu ( lit v.—x.), to gallic acid, sulphuric acid, and lead. In my hands, dilute sulphuric acid has appeared to be almost inert unless given in a fair ly concentrated form ; gallic acid is often disappointing as a cure for dim- rhcea, and lead I believe to be inadmissible for infants, as it has seemed to me to be not unfrequently a cause of convulsions.