tion, he has directed cow's milk to be given, either diluted, pure, or combined with gelatine, changing it occasionally for chicken water, and, when the child is especially eager for animal food, and has suffered much from debility, beef tea, or a piece of fat meat, according to the instincts of the child. These last mentioned articles and even salted meats, Dr. Stewart considers to be especially beneficial in the more advanced forms of cholera infantum and during convalescence.

When the discharges from the bowels are thin, small in quantity, dark colored, and highly offensive, with flatulence and a tendency to a tympanitic condition of the abdomen; or when frequent griping pains are experienced, we have derived the best effects from the use of the turpentine mixture, as directed in the treatment of chronic diarrhoea. When great irritability of the bowels is present, we usually direct the addition to the turpentine mixture of 3iij. tinct. kino, or catechu, and the same proportion of the camphorated tincture of opium.

In chronic cases of cholera infantum, with acrid, offensive, and dark-colored discharges, much advantage will often be derived from the use of pulverized charcoal: we have usually administered it in combination with powdered rhubarb, ipecacuanha, and extract of hyoscyamus.

B.-Tartrat. ferri, gr. xl.
Aq. puræ, 3ij.

Syrup. zingiber. 3ss.-M.

Dose, 20 to 40 drops every three hours.

R.-Carbon. ligni, 3j. to 3ij.
Rhei, ij.

Ipecacuanhæ, gr. iv. ad xij.

Ext. hyoscyami, gr. xij.-M. f. ch.
No. xij.

One to be given every 3 or 4 hours.

When, by a judicious treatment, the disease has been entirely removed, the full restoration of the patient's strength, and the prevention of a relapse are only to be insured by the influence of a cool and pure atmosphere, a mild unirritating diet, and the most scrupulous cleanliness of his person and clothing.

4. Prolapsus Ani.

A prolapsus, or protrusion of the mucous membrane of the rectum or of the rectum itself, is a frequent consequence of long continued diarrhoea in children. It may, however, result from the irritation of worms, or from costiveness, and we have occasionally met with it where the only cause appeared to be a relaxed condition of the sphincter ani; the prolapsus occurring, not only every time the patient had an evacuation from his bowels, but even when he continued for any length of time in the erect posture.

In slight cases, a very small portion of the mucous membrane is protruded beyond the anus, with a sense of bearing down and smarting, that continues until the protruded membrane is returned, which may take place either spontaneously, or upon the slightest pressure being made upon it. În other cases, a considerable portion of the mucous membrane is protruded, in the form of a small, coiled, pyramidal tumor, of a bright red color, and is with difficulty returned

being firmly embraced by the sphincter. If it be allowed to remain protruded for any length of time, the tumor becomes more and more swollen, of a darker red or even purple hue, and inflammation, terminating in ulceration or sloughing of the protruded portion may rapidly take place. Occasionally, a considerable portion of the rectum may become prolapsed, and if allowed to inflame, can no longer be reduced, but subjects the patient to much inconvenience and suffering; disturbing his digestion, and finally causing his death from the impaired nutrition and long-continued irritation it gives rise to. The prolapsus may, occasionally, be the result of an invagination of the upper portion of the rectum, or even of a portion of the colon. In these cases the prognosis is generally unfavorable, though cases are on record, in which the invaginated portion has become separated, and discharged per anum.

Children are peculiarly disposed to prolapsus of the anus, from the greater mobility of the intestine, its less extensive connections from the imperfect development of the neighboring organs, the slighter curvature of the sacrum, and the perfect mobility of the os coccyx; as well as from the general laxity of all the tissues, and the deficient resistant powers at this period of life.

In the generality of cases, if the prolapsus is attended to on its first occurrence, its reduction is seldom attended with much difficulty. The child being placed upon his back, gentle pressure is to be applied upon the protruded portion of intestine with the thumbs or forefingers, previously smeared with fresh lard or dipped in sweet oil, the pressure being made in such a direction as shall tend to return the tumor within the sphincter. Or the forefinger may be introduced into the gut, in order to remove the resistance of the sphincter, when gentle, well-directed pressure will generally cause the protruded intestine to pass within it. The utmost care should be taken to effect the return, every time, and as soon after the prolapsus occurs as possible.

If the patient is affected with a disposition to bear down subsequent to the return of the intestine, an anodyne enema, composed of a small portion of laudanum and three grains of acetate of lead, intimately combined with a little thin mucilage, should be adminis tered. Proper means are of course to be pursued for the removal of the cause by which the prolapsus is produced.

If the prolapsed portion of intestine should become swollen or · inflamed, it will be proper to apply to it cold water, or a solution of acetate of lead, or a few leeches, previously to any attempt being made to reduce it.

When the prolapsus is the result of violent straining, incident to a costive state of the bowels, some gentle laxative, as ripe fruit stewed in molasses, or rye mush and molasses, should be given daily, and the child caused to evacuate his bowels in an erect posture.

Washing the anus daily with cold water, or suddenly dipping the nates in cold water, night and morning, has been recommended as a means of preventing the recurrence of the prolapsus, and when there is nothing to forbid its employment, it may be practised, per

haps, with advantage. But it will not be proper in delicate children, in those in whom there is a predisposition to catarrhal affections, or who are in a state of exhaustion, from long-continued diarrhoea, or other disease. In such cases, however, astringent washes and injections of a tepid warmth will often produce a beneficial effect.

B.-Quercus cort. contus. 3j.

Aquæ puræ, Oij.
Coque ad Oj.

The decoction of oak bark may be used alone, or with the addition of half a drachm of alum; or a solution of alum alone may be used, in the proportion of ten grains to the ounce of water. A decoction of galls, with or without the addition of alum, is preferred by some practitioners.

When the prolapsus continues, for any length of time, to recur at short intervals; the sphincter becomes, finally, so much relaxed, that the intestine comes down, often to a considerable extent, upon the patient making the slightest exertion, or even assuming an erect posture. In such cases, the intestine must be retained by a soft compress, applied upon the anus, and supported by a T bandage. By this means, and the use of astringent injections, and a proper attention to the state of the bowels, a radical cure may often be effected. Should the prolapsus continue still to recur, notwithstanding the employment of these means for a reasonable length of time, the propriety of an operation should be considered. The nature of the operation will depend, in a great measure, upon the particular circumstances of each case:-whether the removal of a portion of the projecting folds of the skin, at the verge of the anus, as prac tised by Dupuytren-the excision of the circular fold of loose skin around the anus, with a portion of the mucous membrane of the rectum, as recommended by Hey and Macfarlane; or the application of the actual cautery to the margin of the anus, as recommended by Mr. Benjamin Phillips, and said to have been practised by him on a child of three years of age, with complete success.

It has been recommended that children subject to prolapsus ani should be made to sit on a hard, flat-bottomed stool or chair, without arms, and of such a height that their feet may not touch the ground.

5.-Polypus of the Rectum.

The attention of the profession was a few years since directed, by Dr. Stolz, of Strasburg, to the occurrence of polypous tumors within the rectum of children. Polypus, in this situation, had previously been very generally overlooked, it being probably mistaken for a prolapsus ani, to which it bears a very close resemblance. It is somewhat remarkable, that it should have escaped the notice of almost every modern writer on the diseases of children. Although of no very frequent occurrence, it is, nevertheless, much more so than physicians would appear to be aware. Several instances have fallen under our notice. They were generally presented to us as cases of prolapsus ani, but, upon a careful and minute examination-a neg

lect of which, in such instances would be unpardonable-we have never found the least difficulty in detecting the true character of the complaint.

Polypus of the rectum is most generally met with in children under ten years of age.

In its commencement, polypus of the rectum in children is marked by few symptoms indicative of its presence. After it has attained some size, however, there is, most commonly, an exudation, or even a flow of blood from the anus, with some degree of tenesmus. The fecal matters are commonly stained, sometimes bathed in and sof tened by pure blood, without any admixture of mucus.

As the polypous tumor increases in size, the little patient usually becomes troubled, at intervals, with a repeated, often ineffectual, desire to evacuate the bowels, generally attended with considerable straining. Sooner or later, and finally, every time the straining recurs, a red, smooth tumor is protruded from the anus-varying in size, in different cases, from that of a cherry to that of a large hickory nut.

The tumor is, usually, of a bright or dark red color, but often white, or of a dirty yellow. It is, in most cases, thickly covered with a tenacious, bloody mucus. When of a dark red or purple hue, it is apt to bleed freely, especially when handled or irritated. Protruded beyond the anus, the tumor is found situated in the centre of the anus, and entirely without the sphincter, appearing at first view as if it were attached, all around, to the end of the anus. On passing the finger into the rectum, a slender pedicle is found to proceed from the base of the tumor to a short distance within the gut, on the inner surface of which it is attached. In some cases, in consequence of the shortness of the pedicle, or from its being attached very high up, the polypus does not protrude. Its presence then can only be detected by the introduction of the finger, or by the speculum ani.

When the polypus is of considerable size, the straining efforts to evacuate the bowels are often very violent, and attended, sometimes,. with considerable pain and often with the discharge of more or less. blood. The little patient is usually affected with loss of appetite, paleness of complexion, and emaciation.

When the polypus is finally protruded, it is found to be surrounded by a slight eversion of the lower portion of the rectum. In one of the cases that came under our notice, the tumor, which was of a large size, separated, and came away spontaneously; the hemorrhage which followed was very slight, and soon ceased, without the necessity of a resort to even a compress. In other cases, the tumors were readily removed by ligatures-in the application of which there is not the least difficulty-without the occurrence of any severe or un-toward symptom.

In consequence of the readiness with which these polypi become spontaneously detached, when they have attained a certain size, it is probable that they have been present in many cases without being, detected-producing frequent bloody discharges, which, after the

trial of various remedies for their arrest without success, have suddenly ceased in consequence of the spontaneous separation of the

tumor.

Authors are not agreed upon the nature of these growths. Some consider them of a fibro-cellular structure-others, on the contrary, believe them to be always of a mucous texture. Stolz supposes that in many cases they are the result of frequently repeated prolapsus ani, a portion of mucous membrane, incarcerated within the ring of the sphincter, becoming congested, swollen, and, after a certain period, pediculated. Such may, perhaps, be in some cases, the manner in which the polypus is generated, but there are many exceptions. Polypus of the rectum has repeatedly been observed in subjects who had never suffered from prolapsus ani; while, again, in some instances, the insertion of the pedicle is too high up within the rectum to admit of the polypus being produced in the manner supposed by Dr. Stolz. Guersent has usually found these polypi to consist of a mucous sheath borrowed from the mucous membrane of the rectum, enveloping a spongy texture.

In the number of L'Expérience for June, 1843, Dr. Gigon has related the history of six cases of polypus of the rectum in young children, three of which were under his own care, and three under that of his colleague, Dr. Brun.

The polypi in these cases were fleshy, of a red color, resembling a large cherry deprived of its epidermis, and with a bleeding surface. They were suspended by a narrow pedicle or stalk. When cut in pieces they were found to be fleshy, of variable consistence, but usually having about the firmness of a portion of liver. To the naked eye they presented no appearance of vessels or fibres. In one case, by the aid of the microscope, some traces of vascularity were discovered; while in another, in which the polypus had existed for a long period, a well marked fibrous disposition was detected.

The pedicles were membranous, smooth, soft, and of a grayish color. They were insensible, and had but little firmness. In one case the pedicle broke upon the application of the ligature, and in another was ruptured during the passage of hardened feces.

The pedicles were implanted within the anus, at a distance vary. ing from a few lines to two inches or more. The rupture of the pedicle was seldom attended with hemorrhage, which would, at first sight, seem to prove that the polypi were not vascular, and that the discharge of blood which so often accompanies the disease, comes from the rectum, in consequence of the irritation attendant upon the presence of the polypus. In one instance, however, after applying a ligature the discharge of blood ceased, notwithstanding the continued presence of the tumor in the rectum; in another, the excision of the pedicle was followed by severe hemorrhage, showing, conclusively, that it is to the vessels which traverse the pedicle that the sanguineous exudations and hemorrhages, by which these polypi are so commonly attended, are due.

According to Dr. Gigon, the diseases with which the polypus of