which may be done without inconvenience, as I have previously given an example. The child should be kept in a mild temperature, sheltered against cold and damp, and the greatest attention paid to cleanliness. After знаний And each evacuation it should be washed with a sponge moistened with cauli ness Show tepid water, the linen should be changed, so that the contact of the evacuations may not irritate and redden the skin. The thighs and buttocks should then be powdered with the usual bee blod skin powder, or the powder of lycopodium, perfumed with the essential oils of cloves, benzoin, &c. Erved Regulat Although less agreeable than the first, the powder of lycopodium is infinitely superior to it, from the fact that it perfectly carries out the intention for which it is employed. The water glides over the skin which is covered by it, as it would over a varnished cloth. The child should be entirely restricted to the milk of the nurse, diet who should be enjoined to give it the breast less frequently. diet should not extend beyond this. In this case this demi-privation may be remedied by recommending the use of a slight decoction of starch, groats, quince seeds, rice flavoured by orange flower, or by Cataplas administering a small quantity of powdered gum in milk. The Small cataplasms should be applied on the stomach, either simple, applud or sprinkled with some drops of laudanum, and enemata of about four ounces at most of the decoction of linseed, bran, quince seeds, or starch administered. For my part, I prefer enemata of less quantity and composed of about three table spoonfuls of liquid, decoction of starch or any other, to which one or two drops of laudanum are added. These enemata may be repeated twice a day. At a more advanced period the following antispasmodic draught may be administered, the results of which are very successful : Hufeland fulfilled a similar indication by giving the powder of which the following is the formula: Carbonate of magnesia, crab's eyes, scraped hartshorn, mistletoe, valerian root-of each equal parts. To make a powder; as much as will cover the point of a knife to be given once or twice a day. In some cases, and especially where the breath is acid, the stools very green, and the preceding means have not proved efficacious, a more active and slightly perturbative medication must be employed. About one ounce of the syrup of ipecacuanha may be given fasting, Stomach or what is still better, ipecacuanha powder in the dose of about three CRC grains in an ounce of simple syrup. Calcined magnesia in the dose of about three grains is also of service, or the use of the following mixture-the formula of which is to be found in Hufeland: Shake and give one teaspoonful every hour. In some cases when the diarrhoea succeeds constipation, slight purgatives must be employed, such as: Syrup of violets Oil of sweet almonds Or the syrup of chicory in the dose of one ounce; calomel in dose of less than a grain, &c. It is seldom that it is necessary to make use of all these means or to be obliged to have recourse to rhatanhy, monesia, tannin, and other astringents, of which we shall speak when on the subject of inflammatory diarrhoea. Simple change of regimen is sufficient to calm most of the cases of spasmodic and catarrhal diarrhoea. They only resist when a new element is present to complicate the irritation of the bowels and when the disease is changed into a true entero-colitis. This disease then presents itself with entirely different symptoms and necessitates the employment of new remedies, the detail of which will naturally find its place at the end of the following chapter, which will have inflammatory diarrhoea for its subject. APHORISMS. 258. The diarrhoea which is very common amongst children at the breast is often independent of inflammation and other material lesions of the intestine. 259. Diarrhoea is a flux which often results from cold, the moral impressions of the child, its imperfect hygiene, over-feeding, carelessness and moral impressions of the nurse, &c. 260. Diarrhoea is often sympathetic of the buccal irritation caused by teething. 261. Diarrhoea is often observed amongst children nourished by the feeding bottle. 262. An abundant or scanty milk, if it is concentrated, always produces diarrhoea. 263. The yellowish homogeneous diarrhoea is generally of little importance. 264. The yellowish diarrhoea, becoming green on exposure to the air under the influence of the reaction of the urine, is unimportant. 265. The yellowish green diarrhoea, or that sprinkled with specks of curd, indicates a considerable irritation of the intestine. 266. Abundant serous diarrhoea is always an unfavourable phenomenon. 267. The sanguinolent diarrhoea and intestinal hæmorrhage are very serious. 268. Gentle, progressive diarrhoea, not very considerable and unattended with fever, is not a serious disease. 269. A febrile diarrhoea, lasting some time, announces entero-colitis. 270. Choleriform diarrhoea announces an acute entero-colitis of the highest importance. 271. Catarrhal, spasmodic diarrhoea, is usually very quickly cured. 272. Diarrhoea leads to enlarged belly amongst children. 273. Catarrhal diarrhoea sometimes engenders inflammation of the intestines. 274. It is a great prejudice to keep up the diarrhoea of dentition. 275. Every diarrhoea of any extent should be immediately treated by the medicines susceptible of curing it. 276. In order to cure diarrhoea it is often sufficient to change the nurse, or to regulate the hours of lactation by increasing the interval between them. 277. The nurse may be changed several times until one has been found who suits the wants of the child. 278. Children to whom solid food is prematurely given, and who have diarrhoea from this circumstance, recover as soon as they are nourished on milk. 279. Catarrhal diarrhoea is cured by baths, and by astringents and opiates administered internally. CHAPTER II. ON INFLAMMATORY DIARRHEA OR ENTERO-COLITIS. Inflammatory diarrhoea is connected in the most intimate manner with the anatomical alterations of the mucous membrane of the small and large intestine. On this account we shall describe it under the Cue & it. name of entero-colitis, so that there can be no doubt as to the precise Sursin seat of the disease. Entero-colitis is one of the most formidable diseases of children at the breast; it is the most frequent of all those that are observed at гмий this age. It presents itself with a remarkable character of unity, able his which is lost at the end of the second year. It then becomes more and more rare, and its form changes in proportion as the period of Eceses e weaning is distanced. children allie chew 2s24s old. Slab ph in large 458 SPECIAL PATHOLOGY OF INFANCY. [Part III. Entero-colitis is, then, a disease which is nearly confined to children of the tenderest age. The principal elements of this disease have their seat in the large intestine, and by extension, in the termination of the small intestine, an inverse disposition to that which is observed in typhoid fever, where, as it is well known, the alterations are situate in the ileum extending into the large intestine. The antithesis is Jutest, & complete. The detail of the pathological anatomy justifies this assertion. 2 PATHOLOGICAL ANATOMY. Changes in the large intestine. Amongst the children whose history and I have compiled, otherwise made perfect by post mortem inspection, I have been enabled to discover constant change in the large intestine, extending from one of its extremities to the other. In the greater number of cases, this change is confined to the mucous membrane, in others, it extends to the submucous cellular tissue, and, in a small number of cases, it involves all the tunics of the large intestine. This viscus is usually contracted and narrowed in consequence of users is the mass of the muscular coat. In its interior the mucous membrane is thrown into a great number of folds, the summit of which, being constantly irritated by the passage of excremental matters, often exhibits traces of inflammation. This membrane presents a colour which varies from a pale rose to a very bright pink. This colour is due to the presence of a very rich capillary net-work, which assumes two very remarkable dispositions. In one case it covers the whole surface of the mucous membrane; the twigs, anastomosing to infinity, are here her and there interrupted by small, whitish, projecting bodies, depressed Mm is spasm Throseghen Luving in the centre, which form more or less apparent spots, according to the subjects. These are the mucous crypts of the hypertrophied hi, intestine, the interior of which is filled by a small quantity of greyish mucus, which becomes emptied on pressure. In the other case, the redness exists at the summit of the folds of which we have spoken. It presents itself under the form of red lines, irregularly disposed, like the folds, in the direction of the length of the colon, or more obliquely, so as to intersect each other, and to form lozenge shaped spaces and irregular parallelograms. In these places, erosion soon takes place, the tissue disappears, ulceration is established, both prominent in its form, and sinuous us, Cov like the folds which it surmounts. Cerotion inny tran These ulcerations are usually very narrow, superficial, and easily overlooked. The edges are a little reddened, not at all swollen, and the base preserves its harmony of colour with the adjoining membrane. A close examination by a good light is necessary in order to be assured of their existence. Other ulcerations exist in the intervals of the folds of the mucous membrane. These are also difficult to make out, and contrast with Eers may the surrounding surfaces by their slightly inflamed border. They are very small, very superficial, nearly circular. They are placed at the be found situation of the muciparous crypts (solitary glands), and appear to be formed at their expense. If the disease dates from a more distant su all period, a great number of these have already had the time to become Circular, cicatrized, and there is simply remarked a slight depression on the surface of the mucous membrane, without any change of colour having in outting remained. .M. The thickening of the mucous membrane is very difficult to prove if it is not considerable. In children who die rapidly, without having lost much of their plumpness, the mucous membrane preserves an appreciable thickness. On the other hand, it is much thinned and appears no longer to exist in those who, having fallen into a thund state of marasmus, die slowly, and are reduced to a fearful state of emaciation. Nevertheless, but by exception, there are subjects in whom this membrane is evidently swollen. The density of the mucous membrane is rapidly changed in enterocolitis. It sometimes resists the traction employed on it, but more ay J frequently it is impossible to raise it in a layer. It detaches itself by ftened small fragments, so great is the softening. We have always remarked these cases coincide with a very vivid redness of the membrane. They now Solitary With these changes, we may always observe the abnormal development of the solitary glands of the intestine, which, in the ordinary anatomical condition, easily escape observation, and present themselves under the form of isolated points of extreme smallness. appear under the form of granulations of from .08 to 12 inch in lary diameter, but slightly projecting, and situate in the thickness or beneath the mucous membrane. Each of these crypts is pierced by a small opening, through which the mucus escapes. This opening is frequently dilated; the edges are pale and flattened; more often the dilatation results from the ulceration of the tissues, as we have previously shown in mentioning the creatrices which remain on the mucous membrane. These ulcerations are recognized by the redness and the swelling of the circumference, not very evident modifications, but which may be easily appreciated by an attentive observer. The layer of cellular tissue, which separates the muscular mucous tunics, rarely participates in the anatomical modifications of the acute variety. Its texture is always altered in chronic entero-colitis. The lesions which it presents are tolerably constant, being confined to simple thickening in the acute form, and to a semi-transparent, sometimes very thick, induration in the chronic variety. The thickening of the submucous layer, developed in acute entero-colitis, never exceeds are Cell, 14, |