(b) Diarrhœa is a derangement of the stools in which they loose their semi-solid, pap-like consistence and become watery liquid alone, or watery liquid in which indigested particles of food and fecal matter remain suspended. The quantity of alvine matter that is evacuated greatly exceeds that which passes in the normal state. The stools have an alkaline or acrid nature which irritates and often inflames the anus and the surrounding integument. “The normal form of the infantile feces in the first year of life is the pappy; the color is yellow like that of the yolk of egg; the smell is feebly acid, never putrid, and only in children who are fed upon a meat diet as repulsively pungent as in the adult; in later years they are no longer distinguished from the adult.”
The passages of diarrhœa may be simply softer, but yellowish and increased in quantity, or they may be bright yellow and so watery as to squeeze out from the anus as from a syringe and soak through diapers and bedclothes, or the stools may be green, or bilious, and slimy. When children teethe they often have a diarrhœa for several days; this intestinal derangement has no connection with improper feeding, yet it requires to be watched lest it become serious and uncontrollable. There is still another kind of diarrhœa which is foamy and contains large quantities of mucus and little or no coloring matter. For the different varieties one and the same remedy will answer, and that which I here submit has never disappointed my expectation:—
| Take: | Subnitrate of Bismuth | 1 dram |
| Powdered Kino | 16 grains | |
| Rubbed thoroughly with Glycerine | 1 dram | |
| Paregoric. | 2 drams | |
| Chalk Mixture, sufficient to make | 2 ounces |
Shake the mixture thoroughly before using, and the dose can be regulated between ten drops for an infant to a teaspoonful for a child three or four years old.
(c) Dysentery or Flux is an inflammation of the mucous membrane of the large intestine, or colon, extending down to the rectum. Children under one year of age are not as liable to this affection as those who are older, and it is during their first dentition that the affection shows itself. In hot summer months, at the season of unripe fruits, the disease often becomes epidemic. The loss of strength and flesh is very rapid, and when children do not perish during the first few days of their sickness, they may succumb later when the disease has assumed a chronic form. Dysentery is extremely liable to become complicated with pneumonia, anæmia, pyæmia, perforations and strictures of the intestines, jaundice and abscess of the liver, and in proportion that these complications become developed life becomes seriously threatened. The symptoms of dysentery are striking and can hardly be mistaken for anything else. There is always pain over the abdomen, but on touching the abdomen near the navel and over the course of the colon the pain is greater than elsewhere.
Tenesmus is a characteristic symptom of dysentery. This is a straining sensation as if the bowels wanted to move, yet notwithstanding the violent bearing down, only a little mucus often streaked with pus or blood is discharged. The straining causes the lower folds of the rectum to protrude, and this portion of the bowel presents a livid red color; the sufferer is tormented a great deal by this fruitless bearing down, and the bowels should be anointed with pure zinc ointment and returned. The stools of the child are characteristic of this disease. Every passage contains glairy mucus formed into lumps resembling granules of boiled starch, streaked with blood and associated with a creamy looking substance which is purulent matter. If the disease has progressed to the formation of ulcers the evacuations become grayish red or assume a dirty ashen color, and the odor is putrescent. Portions of the mucous membrane slough off and large quantities of pus are discharged from the ulcerating surfaces so that the stools present sometimes nothing but purulent and bloody matter.
The treatment for this disease must be prompt and directed to the point; reliance must not be placed upon one single remedy, but a combination of expedients must be resorted to.
The greatest annoyance and source of pain is the straining and tenesmus, and to relieve this steps must at once be taken. There is hardly any use to give injections for this purpose for the irritable condition of the rectum makes it impossible for the child to retain them long enough to do any good. Use suppositories instead, and if need be, retain them by holding a soft compress of cloth over the anus, for ten to fifteen minutes until they are dissolved. For example, to a child one year old I employ the following suppository:—
| Take: | Laudanum | 1 drop |
| Cocaine | 1/30 grain | |
| Bismuth Subnitrate | 10 grains | |
| Cocoa Butter | 10 grains |
Make into one long suppository and roll in powdered bismuth, dip it first into oil or vaseline and insert into the rectum every three or four hours until the soreness and straining have subsided. If the child is not very sensitive nor very ill an injection of a teaspoonful of boiled liquid starch to which a few drops of laudanum have been added, may be used instead and as often as may be necessary. Cold drinks aggravate the pains, therefore give everything warm.