When the cause cannot be traced to the condition of the mother's milk, it will, in general, be found to result from the injudicious overloading of the infant's stomach with some kind of pap or panadaarticles which are invariably injurious, even when, from a deficient supply of milk on the part of the mother, additional aliment is required. In addition to the proper regulation of the infant's diet, the functions of the skin should be promoted by the daily use of the warm bath, followed by gentle friction of the surface. When the weather will permit, the child should be carried into the open air daily. Riding short distances in an open carriage, or sailing in a boat, when practicable, will invariably be found advantageous. The body should be preserved of a proper and equable temperature, by appropriate clothing, and by rooms sufficiently heated in winter, and well ventilated in summer. Medicine of any kind will seldom be required. When considerable nausea and retching occur without free vomiting, it may, however, be proper to unload the stomach by a gentle emetic. If considerable acidity of the stomach exists, a dose of calcined magnesia may be given. If the bowels are constipated, a dose of equal parts of magnesia and rhubarb; if diarrhoea be present, the simple cretaceous mixture, or what we prefer, prepared chalk, combined with small doses of ipecacuanha, will be proper. Dr. Kuhn preferred, in all cases of acidity affecting the alimentary canal of children, and unattended with inflammation, the aqua ammonia, to either the magnesia or carbonate of lime. He prescribed it in the following formula: R.-Aq. puræ, Ziij. Gum. acacia, ij. Aq. cinnamom. simpl. vel, Aquæ ammoniæ, mxlviij.-lxxx. A teaspoonful to be given every one, two, or three hours, according to circumstances. When the infant is troubled with severe griping pains, the warm bath, frictions with some anodyne liniment, followed by warm fomentations to the abdomen, and the use of the aqua ammonia as directed by Dr. Kuhn, will be found in many cases to afford prompt relief. The remedy from which we have seen the best effects to result in the colic of children from indigestion, is a combination of magnesia, extract of hyoscyamus, calomel, and ipecacuhana. In some cases, a few drops of aq. camphora, or of the ethereal solution of camphor, will promptly allay the colicky pain. Three to five drops of spirits of turpentine, mixed with a little sweetened water, and repeated in the course of an hour, will, also, often produce a decidedly favorable effect. 1 R.-Magnesiæ calc. Dijss. ad 3j. Calomel. gr. iij.-M. f. chart. No. One to be given every two or three hours. 2 R.-Camphoræ, 3j. Solve in The Add thirty drops of this solution to one When, however, the pain is very intense, and is not promptly allayed by the remedies already enumerated, a dose of the camphorated tincture of opium, adapted to the age of the child, may be given, in a little sweetened aniseed water, or it may be administered in the form of enema combined with thin starch. Great caution should, however, be observed in the employment of opiate enemata in the affections of infants-neither to resort to them unnecessarily, nor to repeat them too often. The opiate should be, also, in small doses, and its effects carefully watched, as very minute doses of either the simple or the camphorated tincture of opium have, even when injected into the rectum, not unfrequently proved fatal to infants. In cases of indigestion attended with frequent and copious discharges from the bowels, it will, occasionally, be prudent to administer some slight astringent. The tincture of kino will, in general, very promptly suspend the diarrhoea; it may be given in combination with the cretaceous mixture. In cases of indigestion from too early weaning, when practicable, the infant should be reapplied to the breast, or, if this cannot be effected, it should be confined entirely to milk and water, sweetened with loaf sugar, as directed in our section on the diet of infants. The indigestion occurring at the period of weaning is usually very readily managed by a proper attention to diet, the warm bath, daily exercise in the open air, when the weather will permit, and the removal of any symptom of unusual severity that may occur by the remedies already detailed. In the indigestion of older children, it will be proper, in most cases, to administer an emetic of ipecacuanha, followed, if the bowels are much disturbed, by a moderate dose of magnesia and rhubarb. After which, a proper regulation of the diet, as well in regard to quality as to quantity, will, in general, very speedily remove every unpleasant symptom, and restore the regularity and activity of the digestive function. Confining the patient, for a short time, to a milk and farinaceous diet alone, or with the occasional use of plain meat broths, with the addition of rice or crackers, will be proper. All species of pastry and confectionery, crude and acescent fruits, and flatulent vegetables, should be strictly proscribed. Every case of indigestion occurring in children should be carefully scrutinized and cautiously watched, and if any symptom indi cative of the occurrence of even a slight degree of inflammation in any part of the gastro-intestinal mucous membrane be detected-such as the skin becoming dry and parched, the tongue red at its edges and extremity, and coated on its upper surface with a whitish mucus; or increased heat of the epigastrium, with tenderness or pain upon pressure, leeches and fomentations to the abdomen, with cool mucilaginous drinks internally, will be demanded. In protracted cases, with entire suspension of the function of the stomach-the food and drinks passing through the bowels without change almost as soon as they are taken-but little can in general be done to prevent a fatal result. In some cases much benefit, however, has resulted from the use of a cold infusion of bark, with the addition of a few drops of hydrochloric acid; or of the tincture of the sesquichloride of iron, or chalybeate wine in small doses-one or two drops of the first, and from three to six of the latter, in a teaspoonful of water. We have occasionally seen good effects result from the tartrate of iron, combined with hyoscyamus and acetate of lead. R.-Ext. hyoscyami, gr. vj. ad viij. Tart. ferri, gr. xxiv. ad xxxvj. Acetat. plumbi, gr. xij.—M. f. chart. No. xij. Friction along the spine with the weak liniment of ammonia, repeated daily, and frequent exposure to the open air, by riding in a carriage, will, in general, be found useful. The diet should consist exclusively of beef-tea or milk, with the addition of rice flour or arrowroot. What would be the effect of tannin, or of the pure sulphate of alumina in these cases, we are not prepared to saynever having had an opportunity of making a trial of them. In that form of infantile indigestion in which softening of the stomach is most likely to occur, trial may be made of the hydrochloride of iron, which appears to have frequently succeeded in restoring the healthy functions of the stomach, in the hands of Pommer, Hergt, Camerer, Droste, and others. 2. Gastritis. Inflammation of the Stomach. Inflammation of the mucous coat of the stomach is of more frequent occurrence during infancy and childhood than is generally supposed. It varies in degree, in different cases, from a slight erythematic inflammation, confined to a small portion of the gastric mucous membrane, and attended by symptoms so obscure as to cause its existence, in its earlier stages, to be entirely overlooked; to an intense inflammation of the greater part of the stomach and bowels, accompanied by symptoms of a very decided and violent character. and rapidly producing disorganization of the tissues in which it is seated. It is seldom that the stomach is alone affected; in the great majority of instances, the inflammation extending to the duodenum, and the other small intestines. The leading symptoms of gastritis in the infant are retching or vomiting; increased heat and tension of the epigastrium; shrinking and painful cries when this part is compressed; an expression of countenance indicative of distress; a dry, parched skin; redness of the point and edges of the tongue; a coating of white mucus over its surface, through which the enlarged and florid papillæ protrude; great restlessness; a small and contracted pulse, often greatly increased in frequency; augmented thirst, and generally aversion from food. These symptoms vary in intensity, in different cases, and are often complicated with others, arising from disease of adjoining or remote organs, by which the gastritis has been preceded, or which became developed simultaneously with, or subsequently to its occur rence. The most constant symptoms are, frequent vomiting, heat, tension, and pain upon pressure of the epigastrium, and an expression of countenance indicative of suffering. The vomiting is most liable to occur upon any drink or food being taken into the stomach, which is almost immediately rejected. The vomiting is occasionally attended with considerable retching, and is evidently, in severe cases, a cause of much suffering to the patient. The matters vomited are the food and drinks taken, or a thick, ropy, or frothy mucus, often mixed with yellow or greenish bilious matter; brownish or dark brown, and even bloody discharges are occasionally observed. The matters vomited are not unfrequently decidedly acid. Some degree of heat and tension of the epigastrium is seldom absent. These symptoms are at first generally slight; but when the inflammation of the stomach is fully established, and of any degree of intensity, the heat and tension of the abdomen are usually very considerable; the heat of this part, in many cases, being the more marked, from the temperature of the surface generally not being augmented, while that of the lower extremities is perhaps reduced. The tenderness of the epigastrium may be detected only upon pressure; by the patient starting and moaning, or crying out with the peculiar acute tone belonging to the cry from pain; or it may be to such an extent as to render the slightest touch a source of suffering, and to cause the patient to lie upon his back, with his knees drawn up. In these cases, the countenance, as well as the restlessness and constant cries of the infant, indicate the severity of its suffering. When the child is old enough to express his feelings, he, in general, complains of a burning pain in the stomach. When the gastric pain is severe, respiration is short and quick, and performed, almost exclusively, by the ribs. Diarrhoea is commonly present; the matters discharged from the bowels being at first fecal, but, subsequently, similar to those ejected by vomiting. Gastritis is occasionally, however, attended with constipation. The disease is often, especially in young infants, unattended, throughout, with any degree of febrile excitement. Occasionally, however, there is considerable fever, with a hot and burning skin, quick and frequent pulse, and delirium, or a tendency to coma. In general, the febrile symptoms are remittent, with exacerbations toward evening or even later. Gastritis may terminate in resolution, ulceration, or gangrene, or in softening of the gastric mucous membrane, or of the whole of the coats of the stomach, causing a perforation of the organ. In violent cases, great prostration of strength, attended with profuse perspiration about the head and face, subsequently extending over the greater part of the body, hiccough, cold extremities, a sinking of the pulse, and often convulsions, early occur, and are, generally, speedily followed by death. The disease may become chronic, and continue for a length of time, with occasional vomiting-some degree of tenderness and tension of the epigastrium-irregular appetite-occasional diarrhoea, alternating with costiveness-a dry and harsh condition of the surface— febrile symptoms of a remittent character-and progressive emaciation. White softening of the stomach, with perforation, may occur in these cases; or, the brain may become affected, and effusion in that organ take place; or, tubercles becoming developed in the lungs, the patient may die with all the symptoms of tubercular phthisis. The causes of gastritis in children are, either irritating substances -improper or deteriorated articles of food, or some acrid or poisonous matter-introduced into the stomach; cold and moisture applied to some portion of the surface; sudden alternations of temperature; the sudden suppression of cutaneous eruptions, or of the discharge from ulcerations behind the ears. In many cases, particularly in young infants, the inflammation of the stomach is preceded by an attack of stomatitis; in others, the stomatitis occurs in the course of the gastritis. The disease would appear to prevail, occasionally, as an epidemic. Inflammation of the stomach, however, rarely occurs in children as a primary affection; in the great majority of cases, it becomes developed in the course of other diseases. The appearances observed after death are, injection and redness, with thickening, or a softened condition of the mucous membrane of the stomach. The redness may consist in simple injection of the blood vessels, and present an arborescent arrangement: this occurs chiefly in the slighter cases of the disease. When the inflammation is more intense, the redness is more or less diffuse; or it occurs in patches of a greater or less extent, or in irregular striæ, which follow, generally, the course of the corrugations of the stomach, or in numerous, closely approximated red points. (Billard.) The stomach often contains a quantity of thick, tenacious mucus. The papillæ, |