When diarrhea occurs, it must be checked as rapidly as possible, for the exhaustion it induces in a child already enfeebled is extreme. The following rules will be found useful in these cases, and in the acute diarrhoeas of children generally. If the tongue is furred white or yellow, the skin hot, the belly hard, and the motions green and slimy, with much straining and griping pain, give an aperient of rhubarb and soda, or castor oil, followed by a mixture containing magnesia with an aromatic : B. Magnesiæ, 3j; Mucilag. acaciæ, āā 3ss; Aquæ carui, ad 3iij. M. 3ij ter die. If the tongue is furred white or yellow, skin hot, the belly soft, the motions pale, frothy, and sour-smelling, without straining, give a mixture containing chalk, catechu, and aromatic confection. If the tongue is clean and smooth, and the motions dark, watery, and stinking, with straining, give opium. If the diarrhoea continues, acetate of lead may be added :— B. Plumbi acetatis, gr. xvj; Acidi acetici dil., Tinct. opii, aa mvj ; Syrupi simplicis, 3ss; Aquæ, 3jss. M. 3j ter die. If, in spite of this, the diarrhoea still goes on, the treatment recommended under the head of chronic diarrhoea must be resorted to. When either of these complications (diarrhoea or catarrh) are present, the diet must be at once altered to suit the temporarily reduced power of digestion. The treatment of convulsions and laryngismus stridulus is included in the treatment of the general disease of which TREATMENT OF CONVULSIONS. 129 they form such common complications. By removing the rickety condition the tendency to convulsions also disappears. During the actual presence of these attacks, Dr. Gee* recommends the bromide of potassium or ammonium to be given in four-grain doses three or four times a day to a child of one year old, and to be continued for a week or two after the fits have subsided. The presence of a large head in combination with convulsive attacks often gives rise to a suspicion that the fits are due to hydrocephalus, and very active treatment is resorted to, often with the most disastrous results. Rickety children will not bear lowering measures at any time, and to reduce the strength while convulsions are actually present is only to increase the number and the intensity of the fits. * Saint Bartholomew's Hospital Reports, vol. iii., 1867, p. 103. K CHAPTER V. CONGENITAL SYPHILIS. CONGENITAL SYPHILIS.-Appearance of first symptoms-Before birth-At birth-After birth-Snuffling-Necrosis of nasal bones-Eruptions on skin—Seat—Varieties — Scaly patches - Ecthymatous pustules — Papules - Tubercular spots - Ulcers Mucous patches Cracks and fissures-Complexion-Cry-Openness of fontanelle-Influence of the disease on general nutrition-Affections of internal organs-HairLocal peritonitis—Spleen-Delayed Symptoms-Syphilitic teeth. Diagnosis. By general symptoms-By history-By examination of other children of the same family. Causes. Transmission of taint from father-From mother-Mother seldom escapes if father affected-Colles' law-Other modes of infection. Prognosis. From observation of parents-Of Child-Importance of considering the intensity of the general cachexia-Importance of certain special symptoms. Frevention. Treatment.—Two objects-Treatment to be begun early-Remarks on the non-mercurial treatment-Treatment by mercuryDifferent preparations--External applications-Ointment-Mercurial baths-Improve general Nutrition-Diet-Peculiarities of the milk in syphilitic mothers-Other foods-Cod's liver oil-Warmth-Cleanliness-Treatment of vomiting and diarrhoea-Local applications— Tonics. CONGENITAL SYPHILIS may manifest its presence in the child at three different periods,-viz., before birth, at birth, or after birth. If before birth, it occurs usually from the fifth to the seventh month of intra-uterine life. The child dies, and is born dead before the proper time. This disease is so common a cause of miscarriage that when labour has repeatedly occurred prematurely our suspicions should always be excited, and we should make inquiries as to the previous health of the parents, so that by the proper treatment of one or both, the lives of succeeding children may be preserved. If at birth, the symptoms are usually very severe. The OUTBREAK OF SYMPTOMS. 131 child, although born alive, is emaciated, and looks shrivelled. He snuffles and cries hoarsely. A few hours after birth, an eruption of pemphigus appears, situated principally on the palms of the hands and the soles of the feet. The bullæ become filled with a semi-purulent liquid, and burst, leaving angry-looking sores. Spots of inflammation, with abscesses, are scattered through the thymus gland and through the lungs. The liver is indurated. The infant may linger on for a few days, or weeks, but these cases almost always prove fatal. Although appearing at birth, the symptoms are not, however, always so marked as those described. The amount of flesh may be considerable, and the lesions of the internal organs may not be present. In such cases the child may recover, but the prognosis is exceedingly unfavourable. If after birth, the child is born apparently healthy. He is often plump, seems strong, and presents no symptoms by which even the most practised eye can detect the disease lurking in his system. Sometimes, however, although offering no distinct symptoms of disease, there is yet a something which seems to hint at the approaching outbreak. The face is rather old-looking; the skin inelastic and unnaturally pale; the complexion dull and wanting in transparence. After a time, varying from two weeks to six or seven months, although rarely after the end of the third month, symptoms of the disease begin to be noticed. The outbreak of the symptoms may be determined by some febrile attack, as one of the exanthemata, the eruption of which subsiding leaves the syphilitic rash in its place. In almost all cases the first sign of the disease is snuffling. The mother in the beginning attributes little importance to this symptom, and indeed does not usually mention it unless questioned specially upon the point, when she replies that the child has "had a cold" for a few days. Soon the mucous membrane lining the air-passages becomes more swollen, but even then there is not much snuffling so long as the child breathes through his mouth. When, however, he takes the breast, his difficulty of breathing through the nose becomes at once apparent. Each inspiration is accompanied by a slight snore, and as the obstruction becomes more decided he can only suck at short intervals, desisting frequently and lying with the nipple in his half-open mouth, so as to obtain a supply of air before making another effort to draw out the milk. Occasionally he snorts violently as if in an attempt to clear away some obstruction, and this often causes serious alarm to the mother, who will complain that the child seems as if he were going to be suffocated when he takes the breast." 66 After a time there appears from the nostrils a slight watery discharge, which may be tinged with blood. It is seldom profuse at first, and is often merely enough to give a glistening appearance to the openings of the nares. Gradually, however, it becomes more abundant, and acquires consistence, so that it forms crusts which block up the nasal apertures, and still further impede the passage of the air. The discharge is intensely irritating, and scalds the parts with which it comes into contact, producing cracks and little ulcerations about the nostrils and upper lip, which become encrusted with minute scabs. Diday, however, believes these external cracks and ulcers to be due to mucous patches, and to be independent of the discharge: the discharge itself he attributes to mucous patches developed on the Schneiderian membrane. In severe cases the ulceration thus set up within the nose may perforate the septum nasi, or lay bare the nasal bones which may become necrosed in consequence of the exposure. Fragments of these bones are sometimes found in the crusts thrown off. The bones may also become loosened and sink down, so *On Syphilis in New-born Children, by P. Diday, New. Syd. Soc. |