The vegetable astringents, although they have been largely employed in the treatment of this as well as other forms of infantile diarrhoea, are, I think, much less frequently prescribed than formerly. I have entirely discarded them, since they are apt to be vomited and have not proved efficient in my practice. As a substitute for them the subnitrate of bismuth has come into use, and in much larger doses than were formerly employed. While it aids in checking the diarrhoea, it is an efficient antiemetic and antiseptic. It should be prescribed in ten or twelve grains for an infant of twelve months; larger doses produce no ill effect, for its action is almost entirely local and soothing to the inflamed surface with which it comes in contact. It undergoes a chemical change in the stomach and intestines, becoming black, being converted into the bismuth sulphide, and it causes dark stools. Rarely it gives rise in the infant to the well-known garlicky odor, like that occasionally observed in adult patients, and which Squibb thinks may be due to tellurium accidentally associated with the bismuth in its natural state. For those cases in which the symptoms are chiefly due to colitis, and the stools contain blood with a large proportion of mucus, it has been customary to prescribe laudanum or some other form of opium with castor oil. I prefer, however, the bismuth and opium for such cases as are more decidedly dysenteric, as well as for cases of the usual form of intestinal catarrh. In ordering bismuth in these large doses it is important that a pure article be dispensed.

The following are convenient and useful formulæ for a child of one year:

Rx.Tinct. opii deodorat.minim xvj;
Bismuth. subnitrat.drachm ij;
Syrupi,fluidrachm ij;
Misturæ cretæ,fluidrachm xiv. Misce.

Shake thoroughly and give one teaspoonful every two to four hours.

Rx.Tinct. opii deodorat.minim xvj;
Bismuth. subnitrat.drachm ij;
Syrupi,fluidounce ss;
Aq. cinnamomi,fluidounce iss. Misce.

Shake bottle; give one teaspoonful every two to four hours.

Rx.Bismuth. subnitrat.drachm ij;
Pulv. cret. comp. c. opio,drachm ss. Misce.

Divid in Chart No. X. Dose, one powder every three hours.

Rx.Bismuth. subnitrat.drachm ij;
Pulv. ipecac. comp.gr. ix. Misce.

Divid in Chart No. XII. Dose, one powder every three hours.