In cases which resist the ordinary astringents, the old prescription of dilute nitric acid with opium is often of special value. For a child of six months old, two drops of the dilute acid, with half a drop of tinct. opii, may be combined with a quarter of a drop of tinct. capsici, or two of tinct. zingiberis, and given in a teaspoonful of water sweetened with glycerine, three times a day. When the diarrhoea is accompanied by a high temper ature, astringents are seldom of much service until the pyrexia has subsided. In these serious cases, the temperature must first be reduced by cool or tepid bathing ; and for medicine, the child may take a few drops of castor oil (Tit, iij.—vj., according to his age), with one or two drops of laudanum, several times in the day. Another remedy, from which the best results some times follow, is ipecacuanha. The value of ipecacuanha in small and re peated doses in the bowel complaints of children, has long been known. Certainly, there are few drugs which have a more striking effect upon the mucous membrane of the intestine. The dose of ipecacuanha should always be combined with an aromatic. One-tenth or one-eighth of a grain may be given with a few grains of aromatic chalk powder in mucilage every three or four hours. Even in these small doses, the remedy may sometimes ex ercise a depressing effect upon the system ; it is well, therefore, to combine with each dose a few drops of chloric ether or sal volatile. Another form in which the remedy may be administered is the time-honoured combination of Dover's powder with mercury and chalk. I have known obstinate cases of inflammatory diarrhoea, which had resisted other methods of treatment, to yield quickly to small and repeated doses of this compound powder., To a child of six months old, I order a quarter of a grain of each (Dover's pow-, der and gray powder) every three hours. Ipecacuanha is also useful in somewhat larger doses, so as to produce a slight emetic action. Given in quantities of half a grain or a grain to a child of six months old twice in the clay, it will often produce vomiting without much retching ; and if the stools have been previously pasty and sour-smelling, will cause a very rapid improvement in their character. When the lower bowel is affected, and there is great tenesmus, ipecacuanha is especially indicated. In such cases, it may be administered suspended in thin starch (gr. v. to ij.) as an injec, Lion twice a day. The castor-oil and opium mixture is also useful where the lower bowel is the seat of catarrh, and has great influence in allaying the, pain and tenesmus. One-eighth of a grain of powdered ipecacuanha may be usefully combined with this mixture. If the stomach is very irri table, and the diarrhoea is accompanied by excessive vomiting, ipecacuanha is of the utmost service. This drug, although an emetic in large doses, in feeble doses is a sedative ; and if given very frequently in small quantities, has a very striking influence in improving the condition of the patient. In fact, fully to exhibit the value of this remedy, we should select a case in which the vomiting is frequent and the tenesmus distressing, and give one or two drops of ipecacuanba wine in half a teaspoonful of water regularly every hour. Antimony, which has a similar action to ipecacuanha, is also useful in like cases. Two drops of the wine, combined with half a drop of opium, and two or three of tincture of ginger, form a very satisfactory rem edy given every four or six hours. In all cases where the lower bowel is inflamed, an injection of tinet. opli in thin warm starch tat iij.—v. to S ss.) is most useful in relieving the tenesmus and checking the purging. It may be administered every night. Dr. Tyson recommends chloral to be used in the same way, and prescribes half a drachm of the chloral hydrate to two ounces of thin starch. Of this, one drachm is to be used at a time. A drug which is often useful when other astringents fail, is bismuth ; but to be efficacious, the dose of this drug must be large. For a child of six months old, it will be useless to give a smaller quantity than ten grains every four hours. I usually combine the bismuth with a few grains of the aromatic
chalk powder, and have often met with very good results from this remedy.
Directly a reduction in the temperature and an increase in the ence of the stools show that the first acute violence of the disease is sub siding, astringent remedies are called for, and the case must be treated as already described.
If the lower bowel is acutely inflamed, and prolapses as a crimson ball which cannot be returned, or is replaced with great difficulty, the protrud ed gut should be first foinented with warm water ; next, half an ounce of thin, warm starch, containing four drops of laudanum and five grains of powdered ipecacuanha, should be thrown up the rectum ; lastly, a thick poultice of boiled starch should be applied over the fundament. The enema may be repeated twice a day, but the fomentation and poultice should be renewed after each action of the bowels. If prolapsus occur later, as a consequence of relaxation of the sphincter and irritability of the mucous membrane at the lower part of the rectum, the bowel should be re turned by pressure with the oiled finger, and if necessary may be retained in place by a pad. Astringent and tonic remedies internally, such as per nitrate of iron and nux vomica (for a child of six months old : liq. ferri per nitratis, rq iij. ; tinct. nucis.vomicfe, 111 a ; aquam ad., 3 j. ; to be taken three times a day), and enemata of infusion of rhatany after each protrusion, will usually quickly put an end to the prolapse. Ordinary cases of pro lapsus ani in children, the consequence of repeated catarrhs of the lower bowel, without any great frequency or urgency in the dejections, may be readily cured in most cases by the application of an efficient flannel binder to the belly. The occurrence of fresh catarrhs being thus prevented, the relaxed mucous membrane soon recovers its tone.
In cases where the symptoms known as "spurious hydrocephalus " are noticed, or in any case where signs of prostration are visible, the child should be placed for ten minutes in a warm mustard bath, and should be afterwards wrapped in flannel, with hot bottles to his sides and against his feet. The brandy-and-egg mixture can then be given every hour or half hour in doses of one teaspoonful, or if the patient be a young infant white wine whey may be used instead. In all cases of inflammatory diarrhoea, the quantity of food to be taken at one time must be carefully regulated according to the strength of the child. If the purging be severe, and espe cially if it be accompanied by distressing vomiting, liquid food should be given in quantities of one spoonful every half hour. Sometimes more than one teaspoonful can be borne at one time.
In the chronic form of inflammatory diarrhoea, the treatment consists mainly in a careful regulation of the food. Milk in such a case is an irri tant poison which must be strictly forbidden ; and starches are digested with difficulty, and must be very sparingly allowed.
In the insidious beginning of the disorder, when large pasty stools are being pasSed, the child, if an infant, should be fed with weak veal-broth and barley-water in equal proportions ; whey with cream ; the yolk of one egg beaten up with broth or whey ; and Mellin's food mixed with whey or barley-water. The meals should be frequently varied during the day, and the quantity allowed must be strictly proportioned to the infant's powers of. digestion. For medicine, lie may take a powder of rhubarb (gr.
and aromatic chalk (gr. iij.-v.) every night for three nights ; and in the day, a mixture composed of half a drop or a drop of laudanum with four or five grains of the bicarbonate of soda in some aromatic water. If the stools still continue pasty in character, although reduced in quantity, a couple of grains of pepsin may be given two or three times a day in water and gly cerine, before food. In such young children, if the derangement have not passed beyond this early stage, it is usually readily arrested by this means. The infant should be warmly clothed, with a flannel bandage round his belly, and should be taken out frequently into the open air.