In older children, if the derangement have persisted for a considerable time, digestion and nutrition are less easily restored. The same plan must be adopted of forbidding milk, and greatly restricting the quantity of starchy food. The child should take the yolk of an egg for his breakfast, with a slice or two of thin, well-toasted bread and fresh butter. For dinner, the lean of an under-done mutton-chop, with well-boiled cauliflower, and fried bread crumbs. For his evening meal, strong broth, meat-jelly, or meat-es sence. It is best, in obstinate cases, to accustom the child to take malt bis cuits, or malted rusks, instead of ordinary bread and toast, as the former are much more readily digested. Sometimes the pancreatic emulsion seems to be beneficial, but apart from the disagreeable taste of this preparation, which renders it exceedingly unpleasant to the patient, it often causes nausea and discomfort, and has to be discontinued. Pepsin (gr. iij.-v.) is, however, very useful, and the extract of malt often proves a valuable aid to digestion. Still, maltine must be given with caution, as, if it, contain excess of glucose, it may encourage looseness of the bowels.
I have found raw meat of immense service in cases where the stools continue pasty and offensive in spite of the most careful regulation of the diet. It is prepared by mincing a piece of raw rump-steak or mutton-chop, pounding it finely in a mortar, and then straining through a fine sieve. Meat so prepared may be eaten as it is, or diffused through meat-broth or meat-jelly, or spread upon bread and butter. It may be taken in large quan tities. If possible, the child should be induced to swallow from a quarter to half a pound in the course of the day. Before each meal of raw meat, a dose of pepsin should be administered. Children soon take a liking for this food. At first it is only partially digested, and the decomposing resi due.gives a most offensive smell to the stools ; but after a few clays, es pecially if pepsin be taken, the meat ceases to be visible in the motions. By the above measures, strictly carried out, the most obstinate cases can be arrested. The child rapidly regains flesh and strength, and after a time his power of digesting milk and starch Very careful watching, however, is required in order to carry the illness to a successful issue. The stools must be inspected every day, and any sign of looseness, offensiveness, or hyper-secretion of mucus will require to be promptly attended to. Of fensiveness of the motions is doe to the presence in them of undigested and decomposing food. This is often the consequence of abnormal briskness of peristaltic action, which forces the contents of the bowel too rapidly along ; or it may be due to mere weakness of digestive power. In the first case, one
drop of laudanum should be given three times a day to quiet exaggerated peristaltic action. In the second, the diet must be revised, especially in the matter of farinaceous food, and no starch unguarded by malt should be al lowed to be taken. Excess of mucus may usually be quickly moderated by the castor-oil and opium mixture previously recommended, or by a drops (v.-x.) of liq. hydrargyri perchloridi, given every two or three hours. during the day. Slight looseness of the bowels is readily arrested by nightly doses of powdered rhubarb (gr. iij.-v.) and aromatic chalk-powde• (gr. v.-viij.) ; or the latter may be given with a drop of laudanum, and ten or fifteen of tinct. catechu, three or four times in the day. The flannel binder in all these cases is as important for older children as it is for infants, and should be fitted closely to the abdomen, as already directed.
If, when the child is first seen, the derangement has become a confirmed diarrhoea, the above plan of treatment, as regards diet, must still be the same. The belly should be covered with cotton wadding under a flannel binder, and the child should be strictly confined to two rooms. The purg ing must be controlled by hmmatoxylon, rhatany, and opium, given several times in the day in the doses recommended on a previous page ; and if the motions are sour-smelling, a few grains of aromatic chalk may be added. If the purging is obstinate, especially if ulceration of the bowels is sus pected, nitrate of silver is a most valuable remedy. It is suitable to both infants and older children, and should be given with dilute nitric acid and tinct. opii in glycerine. • For a child of six months old, one-eighth of a grain may be administered every four hours. For an older child, the quantity of the nitrate may be increased to one-fifth or one-fourth of a grain. The treatment of severe cases when ulceration of the bowel is present, is fully considered in another place (see page 666).
The raw meat diet is very useful in obstinate cases, and, if the diarrhoea. be copious, should form the staple of the child's nourishment. Stimulants. will usually be required, and should consist of the brandy-and-egg mixture given as of ten and in such quantities as may seem necessary.
When the purging has been arrested, the case must be treated as de scribed for the early insidious form of the complaint. Afterwards, quinine and iron may be given, and the child should be sent, if possible, into a bra cing air. A valuable tonic in these cases is the following, suitable for a child of three years old :— Cod-liver oil is alsO a useful remedy, and should never be neglected in obstinate cases.