Older children may take skimmed milk, raw sc.r.a.ped beef, junket, and coddled white of egg or raw egg, bread crumbs, toasted, or zwieback.

A rectal enema must be given every twenty-four hours if the bowels have not moved. If constipation is the habit a laxative should be given; the aromatic fluid extract of cascara sagrada or magnesia are suitable. At least one free movement every day is essential to success.

Colon irrigations are only to be used when there is a rise of temperature, irrespective of whether the bowels have moved or not.

When convalescence is established these children should be given a maximum of fresh air and should be treated as recommended in cases of malnutrition.

SUMMER DIARRHEA

As the name implies, this is the form of diarrhea that is so common, especially in cities, in summer. It is always preceded by some milder condition which paves the way for the more serious diarrhea. Acute indigestion is, as a general rule, the forerunner of cholera infantum.

The influence of hot weather must always be kept in mind as the underlying factor which no doubt conduces to gastro-intestinal disease of infancy and childhood. The depression incident to a spell of hot and possibly humid weather tends to interfere with the digestive process of babies and children. When this function is carried on imperfectly, the strength and vitality of the child fails, and if immediate steps are not taken to check the process, diarrhea makes its appearance. If these children are improperly fed, or if their surroundings are not sanitary; if they are not getting fresh air enough, or if they suffer because of lack of attention, and have at the same time a little indigestion, it is only a step further to develop a full-fledged cholera infantum.

The outcome of any case of summer diarrhea is questionable. It is not safe to make any promise. An apparently mild attack may prove quickly fatal. Much depends upon the previous history of the child. If it has been a strong, healthy child it has a very good chance if treated energetically and correctly. If it has previously suffered from bad nutrition, is not robust, has had trouble with its stomach, etc., the chances are against it.

The one lesson to be learned by all mothers is, as stated above, to act quickly; to be on the watch all through the summer months for any trouble with the baby's stomach or bowels. It is much easier to treat and cure a little trouble than to battle against an established gastro-enteric intoxication. Overfeeding and indiscriminate feeding must be religiously avoided,--they are the two most prolific causes of stomach and intestinal troubles in childhood.

Symptoms.--The onset is sudden and p.r.o.nounced. The child begins to vomit and continues vomiting and retching persistently. The bowels are loose, and large, watery, greenish stools are frequent. The prostration is very marked, the child looks seriously sick, respiration is quick and shallow, the eyes sunken, the skin becomes ashen gray in color, and the pulse is soft and very rapid. The fever may be very high or it may remain low. The low febrile cases are the worst.

If taken in hand quickly and if the treatment is energetic and if the child reacts, the case may go rapidly on to recovery and the child be wholly well in a few days; or it may not react, but be overwhelmed by the poison and sink and die in twenty-four hours.

Treatment.--In the treatment of cholera infantum it must not be forgotten that the dangerous element is the poisoning of the system that is constantly going on. It is difficult for the non-medical mind to estimate the importance of this element. It is, of course, caused by the bacteria present in the gastro-intestinal ca.n.a.l. There are numberless millions of bacteria in the normal healthy bowel. A very large percentage of those germs are good for us, are there for a beneficent purpose, and can and do protect us from other germs which occasionally find their way into the bowel and whose purpose is not a peaceful one.

When the bowel condition changes, as during an attack of summer diarrhea, it is invaded by mult.i.tudes of evil-intentioned germs. These germs find conditions in the diseased bowel exceedingly favorable to them, so they begin work in an active, energetic way. The result of their activity is highly poisonous, and, as the good germs are virtually out of business and are consequently not working in our interest, we are absolutely in the hands of the enemy. There is soon manufactured, by these invading germs, enough poison to poison the entire system of the child. It is this feature that we must combat in summer diarrhea.

It is absolutely essential to keep these cases as much in the open fresh air as possible. No matter how sick they may be, this rule must be observed. Light clothing is advisable.

If it is a city child that is affected and it does not show decided improvement in three or four days, it should, if possible, be sent to the country. There is always distinct danger of a relapse in every case, so the little victim should be given a change of air as soon as convalescence permits. The seash.o.r.e is preferable to the mountains in all intestinal cases.

In the care of these patients cleanliness is an important factor and counts much in the ultimate cure. The child, as well as the clothing, should be kept scrupulously clean. Napkins as soon as soiled should be removed and put into a disinfecting solution. The b.u.t.tocks should be well powdered after each movement to prevent sores developing.

Feeding must be stopped at once. No food of any kind should be given for at least twenty-four hours, or until the tendency to vomit subsides. The thirst must be allayed, however, so we give frequently small quant.i.ties of thin barley water or alb.u.men water or cold boiled water. If these are vomited we must stop giving them altogether for twenty-four hours. If the fever is high and the skin dry, the child should be given a cool pack, 85 to 90 F., which can be moistened every half hour with water at this temperature; this will often control the fever satisfactorily.

Hot-water bottles should be placed at the feet if they are cold.

If, on the other hand, the fever is very low (below normal), the child's circulation poor, the skin blue and cold, a hot-water bath at 108 F., for five minutes (rubbing the surface of the body while in the bath), will be of very great service. The bath may be repeated at half-hour intervals.

If the patient is a breast-fed infant it can be allowed to nurse after the twenty-four-hour rest. The length of time it is permitted to stay at the breast should be about one-quarter of the time it was allowed before the attack began. If it does not vomit, the nursing can be repeated every four hours. As the case progresses toward recovery the interval between feedings can be shortened. Care, however, must be taken not to shorten the interval too rapidly.

If the patient is artificially fed and is not over four months old, a subst.i.tute for the milk must be found. The best subst.i.tutes are rice or barley water, either plain or dextrinized, the malted foods, chicken or beef broths, liquid peptonoids or bovinine. Water (boiled and cooled) may be allowed at all times if not vomited.

Older children are treated in the same way. All food is withheld while there is any vomiting. When vomiting stops begin with small quant.i.ties of beef broth, or chicken, or veal broth. Later k.u.myss or matzoon can be tried, and finally thin gruels made with milk.

If vomiting persists the stomach must be washed out; this can be done by giving the infant or child a large drink of cool boiled water. This will be immediately vomited and it will clean the stomach at the same time.

The stomach-pump may be used to better advantage. One washing is usually sufficient. The vomiting will stop after the stomach has been washed out and the patient may then be given, frequently, small quant.i.ties of cold alb.u.men water or barley water.

The bowel should be thoroughly cleaned out at the beginning of every summer diarrhea. Castor oil or calomel are the two best cathartics for this purpose. If the stomach is not upset use castor oil. If the stomach is upset use calomel; one-fourth of a grain every hour for eight doses will be sufficient. Give enough, however,--there is no danger at the beginning of the attack of too free movements of the bowel. Whatever cathartic is given, it should produce green, watery stools.

Irrigation of the bowel is an exceedingly effective way of cleaning out the poison-laden large intestine. It should be done in every instance unless the movements are watery and of such frequency as to render irrigation unnecessary. Once or twice daily will be sufficient in even the worst cases. The irrigation should be given at the temperature of 100 F, and should be the normal saline solution; a long rectal tube is used to give the irrigation.

SUMMARY:--

1st. Cholera infantum is one of the most dangerous, one of the most treacherous, and one of the quickest acting diseases of childhood.

2nd. Don't temporize, don't delay, don't regard lightly any diarrhea during the summer time.

3rd. Give a large dose of castor oil and withhold all nourishment until the doctor sees the little patient in every case of diarrhea during the warm weather.

4th. Keep the child in a cool, quiet place and don't handle or annoy it.

5th. Follow, your doctor's directions implicitly. The fight may be short, sharp, and decisive. Don't pave the way for regrets afterward. Do everything while you have the chance.

COLIC

Colic is a common condition in infancy. Very few children escape more or less colic during the first few months of life. It does not seem to injure permanently some infants; they go on growing according to standard, eat and sleep, and seem contented and happy despite occasional severe attacks of colic. Other children suffer seriously; the degree of indigestion is considerable, and the nutrition of the child is interfered with.

Colic is much more frequent in bottle-fed infants than in those fed on breast milk. Cow's milk, no matter how skillfully it is prepared for their use, is at best an unsuitable diet and taxes the digestive ability of robust children. It is quite natural for an infant whose digestive organs are not strong to develop colic and intestinal indigestion if put on artificial food. Any condition that causes indigestion may likewise cause colic. Those children who are always overfeeding,--taking too much milk, too strong milk, or who are fed irregularly,--are the colicky babies.

Constipation is frequently a.s.sociated with colic and may be the actual cause. A daily movement of the bowel does not necessarily mean that the bowels are emptying themselves satisfactorily. Despite the daily movement, there may be considerable fecal matter left in the bowel which undergoes decomposition. This results in the evolution of large quant.i.ties of gas and severe attacks of colic. Indigestion is very often caused by conditions which effect the stability of the child's nervous organism; such conditions are fright, anger, fatigue, exhaustion, excitement.

The origin of the colic in breast-fed children is very often caused by some nervous condition of the mother that affects her milk. Constipation in the mother may cause colic in the child.

Symptoms.--A baby having an attack of colic will cry loudly from time to time and whine during the interval; it will pull up its legs and bear down. Its abdomen is tense and hard and distended with gas. With the expulsion of the gas the pain ceases and the child falls asleep. If the attack is very severe the prostration and exhaustion is marked; the feet are cold and the body is bathed in perspiration.

If the colic is constant the child may be fretful and restless most of the time, being seemingly comfortable for only an hour or two in the twenty-four.

In older children who cry because of severe pain in the abdomen the possibility of appendicitis must not be forgotten.

Treatment.--Find out the cause of the colic if possible. If the cause is located in the mother, the remedy naturally must affect her.

Regulation of her bowel, restriction of her diet, and proper exercise, may be sufficient to effect a cure of the colic in the infant.

The object of treatment is to help the child get rid of the gas. The best and quickest means to effect this is to apply ma.s.sage or give a rectal injection. An injection of two ounces of cold water in which a half or one teaspoonful of glycerine has been put, will act quickly. Dry heat applied to the abdomen in the form of the hot-water bottle or woolen cloths will aid in the expulsion of the gas. The feet should be kept warm.

In cases of habitual colic in breast-fed babies the cause may be in the quality of the mother's milk. It should be examined and if found too strong should be diluted. This can be done by giving the child an ounce of plain boiled water or barley water before each feeding. If the child gets an ounce of liquid before each feeding he will not want as much of the breast milk; so we shall have the same total quant.i.ty, but a reduced quality, which may cure the colic at once.

It is necessary, in order to cure colic, that the bowels move every day in a satisfactory manner. If any aid is needed, milk of magnesia is the best laxative. It may be given in teaspoonful doses in water previous to a feeding. Aromatic cascara sagrada in from ten to thirty-drop doses is a very good laxative, if a stronger remedy is needed.

To relieve the acute attack, three drops of Hoffman's anodyne may be given in two teaspoonfuls of warm water and repeated in ten-minute intervals until relieved, to a baby under one year of age. From five to ten drops of gin, given in three teaspoonfuls of warm water, and repeated in fifteen minutes, is also satisfactory and harmless. A very good remedy which may be used with the above for quick relief, and to stop the child from crying, is the following: Fold a piece of flannel cloth (two thicknesses) the size of the baby's abdomen; wring out of very hot water and drop ten drops of turpentine over the surface,--at different spots,--of the flannel and lay on abdomen,--turpentine side next skin. Cover this with another piece of flannel,--two or three thicknesses, that has been dry-heated and allow to remain in place for about ten minutes.

Colic, as a rule, disappears completely about the third month.

APPENDICITIS

Appendicitis is mentioned here merely to acquaint mothers with its prominent symptoms.

When a child has what seems to be an attack of indigestion, but complains of pain and tenderness in the abdomen, vomits, and develops a fever, and is constipated, appendicitis may be suspected.