Chronic Ileo-colitis fellows the acute variety. Cases which are unusually severe or which have been badly managed are likely to become chronic. A child suffering from this disease presents the following picture: The patient is emaciated, the abdomen is usually enlarged with gas, the feet are cold, the circulation of the blood is poor, the fever is low or absent altogether except when the child is having a relapse, when it jumps up suddenly. The bowels are loose and contain mucus, frequently in large quantities. The mucus may stop for a few days; then it appears again with a rise of temperature accompanied with loose stools with foul odor. These children are exceedingly nervous and irritable and are very poor sleepers.
Parents should be told it will be impossible to effect a rapid cure of these cases. It often takes months to get them started on the safe road. The slightest mistake or change in the weather will upset the progress of the cure and it will be necessary to begin all over again. The entire hope of cure rests with the mother. She must be faithful, patient, and must carry out the physician's instructions implicitly. The management consists in diet, change of climate, and such other treatment as the physician finds necessary in each individual case.
Treatment.—In children under one year of age the only hope is breast milk, which must be given in small quantities. They do not do well on any starch food for a considerable period.
Where breast milk is not available the whites of two or three eggs may be given daily. They may be beaten up and given in skimmed milk, or in plain water with a little salt added. Zwieback or bread crumbs may be given in small quantities. They should be fed at four-hour intervals.
Older children may take skimmed milk, raw scraped 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.