utmost care is required in the treatment of these cases if the illness is to be conducted to a favourable issue. Our endeavours must be directed to quiet irritation ; to prevent the occurrence of fresh catarrh ; to reduce peristaltic action, so that the healing of the ulcers may not be interfered with ; to support the strength of the patient, and to fur ther cicatrisation by suitable medication.
The child should be kept in bed in a well-ventilated room, and his belly should be protected by a broad layer of cotton-wool confined by a suitable bandage. All discharges and soiled linen should be at once removed, and every means be employed to keep the air of the room fresh and pure. The diet must be regulated so as to convey nourishment with out supplying material for fermentation. As long as catarrh persists, fer mentable food is to be avoided ; and even when the diarrhoea has been arrested, the capacity for digesting such a diet still continues small. Milk must be positively forbidden ; and starchy matters can only be taken, if at all, in very small quantity. An infant must 'be fed with weak veal or chicken-broth and barley-water in equal proportions ; whey, plain, or if the child be feeble, made with sherry (white wine whey), and cream ; yolk of egg beaten up with whey or veal-broth ; and Mellin's food dissolved in either broth or whey, and mixed with barley-water. The meals must be small and frequent ; and it is advisable to make constant changes, so as to furnish a sufficient variety. If the purging be severe, no more than one tablespoonful, or even less, can be given at one meal ; and all food must be given cold.
After the age of eighteen months, raw mutton or beef forms a very val uable remedy. This should be prepared as directed in the treatment of chronic diarrhoea, and may be eaten plain or diffused through broth or jelly. Uncooked meat so prepared is very nutritious and digestible ; and even if not completely digested, the residue appears to be perfectly unini tating to the bowels. Still, it is well immediately before the meal to give a dose of pepsin (gr. iij.-v.) dissolved in a few drops of dilute hydrochloric acid, in order to aid the process of digestion. If the child be between the ages of one and a half and two years, and the purging be severe, little other food besides the raw meat, meat-jelly, and broth should be allowed for a few days, until the violence of the catarrh is reduced. Afterwards, or in older children at first, yolk of egg, well-boiled cauliflower or Spanish onion pressed through a fine sieve, and thin well-toasted bread may be al lowed. In some of these cases, where the power of digesting starch seems reduced to a minimum, a good substitute for bread is the malted child's biscuit made by Messrs. Hill & Sons of Bishopsgate Street. If these are objected to, a loaf may be baked expressly for the child in which a pro portion of finely-ground fresh malt is introduced—one part of malt to two parts of flour. It is well, also, in addition, to give a spoonful of Hoff's ex tract of malt directly after the meal. When the intestinal catarrh has been arrested, milk may be returned to, but should be given cautiously. In most cases, it is the curd of the milk which is digested with such diffi culty ; and I have found the pancreatised inilk prepared with Benger's pancreatic solution, as directed elsewhere (see page 606), to be well borne when ordinary milk could not be taken. In other cases, skimmed milk seems to agree better than milk from which the cream has not been re moved. Whatever be the age of the child, so long as he is taking milk a careful watch must be kept upon the digestive process ; and any sign of flatulence or acidity, and especially any return of the purging, should be a signal for reducing the quantity of the milk, or even for omitting it for a time altogether from the diet. If the child is weakly, or appears to be ex hausted by the purging, stimulants must be given as required. White
wine whey for infants, and brandy-and-egg mixture for children of all ages, are the most valuable.
With regard to medicines :—As long as there is purging, astringents with opium are indicated. It is well in these cases not to rely too much upon one form of remedy, for we shall often be forced to make frequent changes in the prescription in order to guide the disease to a favourable ending. If the stools consist of the homogeneous, pasty liquid matter which has been described, nitrate of silver is pre-eminently useful. One eighth to one-fifth of a grain should be combined with a few drops of di lute nitric acid, and one or two drops of laudanum, in water sweetened with glycerine. This close can be given three times a day. If from tenes mus, pain in the right iliac fossa, or the appearance of bright blood in the stools, there is reason to believe the large bowel to be the seat of the le sion, internal administration of the drug may be supplemented by the use of the salt locally. For a child two years of age, the lower bowel should be first cleared out by a copious injection of tepid water, and afterwards two grains of the nitrate dissolved in four ounces of water must be thrown up the bowel through a long tube. If tenesmus is urgent, five drops of laudanum may be added to the medicated injection ; or, after the return of the nitrate, the laudanum, mixed with half an ounce of thin warm starch, may be thrown into the bowel. The astringent injection can be repeated for three or four nights in succession, and can then be given only on alternate nights, if the symptoms still persist. Instead of the silver salt, sulphate of copper (half a grain to the ounce of water) may be used for the injection, and is often of service. This treatment by injections is useful not only by ap plying the astringent directly to the affected part, but also by clearing away hardened lumps of ftcal matter, which are very apt to be retained and keep up irritation even wimp the stools generally are loose and frequent.
Another useful remedy is the extract of hmematoxylon. Three to five grains may be combined with one or two drops of laudanum, and two to four drops of ipecacuanha wine in the compound chalk mixture, and given three times in the day. A combinatiot of the extracts of hmematoxylon and rhatany (gr. iij. of each) is often found of signal efficacy if the purging is obstinate ; or gallic acid (gr. ij.-v.), with a few drops of aromatic sul phuric acid, may be used. Opium should be always added to the astrin gent, whatever this may be, in order to reduce irritability of the mucous membrane, and quiet peristaltic movement. Sometimes we find cases, which have resisted all other treatment, yield to bismuth given in large doses.. For a child of two years old, fifteen grains of the carbonate of bismutlr may be given with five grains of the aromatic chalk powder, every four hours ; and a few doses of this combination is followed by really sur prising improvement in many cases. If thought desirable, a drop of laudanum may be added to each alternate dose of this remedy, or a small injection of starch and opium may be given every night.
When purging has been arrested, the healing of the ulcers may be pro moted by perfect rest, and the administration of the pernitrate of iron iij.-v.) with laudanum crq, in a teaspoonful of water sweetened with glycerine ; or quinine may be given with pepsin and strychnia, as recom mended during convalescence from inflammatory diarrhoea. For a con siderable time it will be necessary to pay strict attention to the diet, and limit the quantity of farinaceous and saccharine foods ; and long after convalescence is established, the child should continue to wear a flannel bandage round the belly as a necessary part of his dress.