1 B.-Calomel. Ipecacuanhæ, ãã gr. ij. Ext. hyoscyami, gr. iv.—vj. Acetat. plumbi, gr. viij.—xij.-M. f. pill No. xij. One to be given every three hours. Blisters to the abdomen will often be found advantageous, especially in protracted cases; they should be kept on a few hours, and followed by a bread and milk poultice. In very acute cases, warm sinapised pediluvia, or sinapisms to the extremities, will generally be productive of good effects. In chronic cases, the warm bath, blisters to the abdomen, the internal exhibition of calomel, ipecacuanha, and extract of hyoscyamus, in combination, with the addition, when diarrhoea is present, of the acetate of lead; and when the discharges are thin and offensive, the use of turpentine, are the means from which the greatest amount of relief will be obtained. The diet should be mild, unirritating, and taken in small quantities, at properly regulated periods. Plain chicken water, arrowroot, tapioca, and milk, or beef-tea, will, in most cases, be proper articles of food-producing but little irritation, and supporting the patient's strength, which, in cases of chronic enteritis, is very apt to be greatly prostrated. By some practitioners, it is considered beneficial to dress the blisters upon the abdomen. with mercurial ointment, or to apply this by friction over the abdominal surface in cases where blisters have not been applied. When a state of convalescence has been procured, the skin becoming soft and moist, the tongue clean, the stools more regular and natural in appearance, with a disappearance of the tenderness and tumefaction of the abdomen, and a return of the natural appetite, the administration of some light tonic will, in general, be found beneficial-more rapidly restoring the patient's strength, and rendering a relapse less liable to occur. 9. Colitis. Inflammation of the large Intestine. Dysentery. Inflammation of the large intestine seldom occurs independently of some degree of inflammation of the small intestine, and it is occasionally accompanied with more or less gastro-enteritis. It is distinguished from ordinary enteritis, chiefly, by frequent small discharges from the bowels of mucus, generally mixed with more or less blood, and accompanied with severe tormina and tenesmus. In children, dysentery generally commences with the symptoms of simple diarrhoea, the discharges being at first feculent, but soon becoming serous, with an admixture of blood. There is often tension of the abdomen, with pain or tenderness upon pressure along the course of the colon. The skin is generally dry and hot, and, in children of a year old and upwards, distinct febrile. reaction, having evening exacerbations, is often present, with redness of the tongue and increased thirst. Nausea and vomiting are occasionally observed, but are seldom frequent or severe unless the stomach is the seat of some degree of inflammation. The discharges from the bowels become, at an early period of the disease, very frequent, but small in quantity, and composed entirely of a little bloody mucus. They are generally preceded by more or less tenesmus, and attended and followed by tormina. There is seldom any appearance of feculent matter in the stools, though occasionally it is passed in hardened masses, of various sizes, with blood and mucus. If the disease is not arrested, the anus becomes red, hot, and exceedingly painful-the abdomen hot, swollen, and tympanitic; it is often affected with severe pain, or is excessively sore to the touch. The surface of the body becomes cool, and the extremities cold; the discharges from the bowels become dark-colored and offensive; great prostration of strength ensues, and the patient exhibits all the symptoms of chronic intestinal disease. The mouth often becomes covered with aphthæ, which also occasionally appear about the verge of the anus. Colitis may in its more intense forms terminate in death at an early period, but in general it runs a protracted course, and the pa tient sinks finally from extreme prostration; or a state of coma ensues, and death is preceded by symptoms of encephalic effusion. The appearances upon dissection differ in nothing from those that occur in cases of enteritis, excepting in the seat. The mucous membrane of the colon and rectum are studded with red elevated patches or striæ, and with friability or softening of the tissue, at the part where they are situated. The surface of the colon and rectum are occasionally covered with filaments, varying in size, of a curd-like appearance. Enlargement, inflammation, and ulceration of the muciparous glands and follicles are very commonly met with; gangrenous ulceration is occasionally present, and, in chronic cases especially, thickening, with a dark purple or slate color, of the mucous membrane of the colon or rectum, in patches of greater or less extent. Dr. Crampton has observed, in cases of children who died of dys enteric symptoms, the mucous membrane of the intestines, in many places, to be highly vascular, and covered with granulations of a yellow, or dirty yellow color, as if from a coating of wax; in several, ulcerations had taken place; these ulcers were disposed in patches, with well-defined edges. In cases that terminated favorably, a quantity of yellowish, branny scales, were seen floating in the discharges from the bowels, like minute portions of wax from honeycomb Dr. Mayne, in his account of an epidemic of dysentery which prevailed in Dublin (Dublin Quart. Jour. of Med. Science, vol. vii., 1849), states that in the majority of cases where the death occurred within three weeks from the commencement of the attack, the morbid ap pearances were confined to the large intestine, pervading its entire tract, but most decidedly marked at its lower portion. There was also an undue degree of vascularity of the peritoneum covering the diseased portion of the canal. The absorbent glands along the same part were congested and enlarged. The walls of the intestine were thickened and indurated, while its mucous coat varied in color from a bright red to green or purple, and was, in some cases, covered with a bran-like exudation, in others ulcerated. The ulcers were sometimes small and isolated, in others superficial and extensive, and in a third variety, large, irregular, ragged, and penetrating. The small intestines were generally healthy. The liver, in some cases, was much congested. Colitis would appear, in the majority of cases, to be the result of sudden transitions of atmospheric temperature, particularly the sudden change from warm and dry, to cold and damp weather. It is most prevalent during the latter part of summer, or the commencement of autumn, when the days are hot, but the nights chilly and damp. It is apt to prove endemic in unhealthy localities, especially those favorable to the production of intermittent and remittent fevers, and often prevails epidemically with fevers of a catarrhal character. A few days of cool, rainy weather, occurring in the summer, will often cause the prevailing bowel complaints of children to assume a dysenteric character. It may, also, be produced by the same causes which give rise to inflammation in other portions of the alimentary canal. In the treatment of colitis, the same general directions are applicable as in the other intestinal inflammations. All solid, stimulat-, ing, and indigestible food should be avoided. The patient may be allowed mild mucilaginous drinks; but even with these he should not be allowed to overload his stomach. The free use of fresh buttermilk has been found advantageous in many cases. The warm bath and warm fomentations or cataplasms to the abdomen, are equally beneficial, as in cases of enteritis. The patient should be kept at perfect rest in a recumbent posture, and not allowed to rise every time he feels an inclination to evacuate his bowels; nor should he be permitted to sit for a long period, ineffectually straining, when, probably, only a drop or two of bloody mucus is discharged. Leeches should be applied, along the course of the colon, in numbers proportioned to the violence of the disease, and the strength and age of the patient, and repeated, if, after their first application, the symptoms remain without considerable abatement. By some practitioners leeches are directed to be applied to the verge of the anus. Occasionally, this will be found to produce a very favorable impression upon the symptoms of the case; but, as a general rule, we cannot recommend the application of leeches to this part in children, having occasionally found the hemorrhage produced by them to continue for some time after their removal, and to be with difficulty controlled. In cases in which symptoms of gastritis are present, leeches should be applied to the epigastrium. In robust children, over one year of age, when the disease is accompanied by symptoms of any degree of intensity, blood may be taken from the arm. In regard to the use of internal remedies, there exists a very great diversity of opinion among practitioners. To the common practice of giving small and repeated doses of castor oil, either with or without an addition of laudanum, we are decidedly opposed; we have seen much injury result from it, and cannot understand the principles upon which the treatment is founded. From the administration of small doses of calomel, in combination with ipecacuanha, we have derived the best effects, and believe that a small portion of extract of hyoscyamus, agreeably to the plan pursued by many of the German physicians, forms an admirable addition.' The relief derived from this combination is often prompt and considerable, while a favorable change is produced, in a very short time, in the character of the discharges. IR.-Calomel. gr. iv. ad xij. Ipecacuanhæ, gr. iij.-iv. Ext. hyoscyami, gr. iv.—vj. Cretæ ppt. gr. xxxvj.—M. f. pulv. No. xij. When there is much tenderness of the abdomen, great relief will often be obtained from the use of the warm bath, followed by warm fomentations or the application of a soft emollient poultice. In protracted cases, the application of a blister over the abdomen, as directed in enteritis, we have repeatedly seen productive of very beneficial results. Injections into the rectum, of a solution of acetate of lead, with or without laudanum, are calculated to allay the tormina and tenesmus, and may be repeated with advantage. We must recollect, however, that much caution is to be observed in the use of opium and its preparations, in the form of enemata, in the diseases of children. Experience early taught us, that very small portions of laudanum thrown into the rectum, will often produce a degree of narcotism which would be scarcely anticipated from a similar quantity given by the mouth; the same fact has been noticed by other practitioners. From an early period in the attack we are in the habit of giving every three hours the acetate of lead, in the dose of one grain, combined with from one to two or three grains of Dover's powder, according to the age of the patient and the urgency of the symptoms, and we have seldom been disappointed in the prompt relief which the patient experiences from the use of this prescription. The nitrate of silver, in from a sixth to a quarter of a grain doses, made into a pill with extract of gentian, and repeated every two or three hours, will often be found to produce prompt relief after the more acute symptoms of the disease have been subdued. If symptoms of exhaustion occur, stimulants will be needed, but much judgment is requisite as to the time when they should be commenced. No definite rule, as Dr. West remarks, can be laid down. "Each case must be treated for itself, and to be treated successfully it must be watched most closely. The necessity for stimu lants may arise suddenly, or the need for their administration may be but temporary, while the infant's state in the morning affords in severe cases no sure criterion to judge what its state will be at night." "About half a drachm of brandy given every two or three hours to a child of a year old, in a quantity of a few drops at a time, mixed with the cold milk and water, or the thin arrowroot with which it is fed, will often have the effect of arresting the sickness as well as of rallying the sunken energies of the system." When the brandy occasions pain in the stomach or nausea, Dr. West recommends the substitution of the compound tincture of bark, or the aromatic spirits of ammonia, or the two together, mixed with milk and sufficiently sweetened. When the child is weaned, instead of farinaceous articles of diet, or even milk, which latter often disagrees with the stomach, the child should be nourished on strong animal broths, given in small quantities at a time, at short intervals. In chronic cases of colitis, the same treatment is applicable as in chronic diarrhoea. The spirits of turpentine will, in such cases, be often found a very valuable remedy. During convalescence, more especially from the more protracted and chronic forms of the disease, the vegetable astringents will be found advantageous, in restoring tone to the intestines, and facili tating the recovery of the patient's strength. In an epidemic of dysentery that occurred among children, in Washington County, New York, an infusion in milk of white oak bark, blackberry root, and yarrow, with the addition of sugar,' was found, according to Dr. Cogswell, to be productive of the best effects. The persesquinitrate of iron is also spoken of by Williams and others as a useful remedy, in the dysentery of children. 1 R.-Cort. querci alb. Rad. rub. villosi, aa 3ss. A dessertspoonful to be given frequently. CHAPTER VI. PERITONITIS-INFLAMMATION OF THE PERITONEUM. INFLAMMATION of the peritoneum may occur in children even at the earliest period subsequent to birth. In still-born infants, as well as in those who have died a few hours after birth, so frequently have there been detected redness and opacity of the peritoneum, with serous or puriform effusion; a coating of coagulable lymph, either in the form of flocculi or membranous shreds; adhesions between the intestinal convolutions and other abdominal viscera, some slight and recent, and others very firm and apparently of long continuance; and tubercular granulations of the peritoneum, that we would perhaps be warranted in including peritonitis among the most common and fatal of the diseases to which the foetus in utero or the child immediately after birth is liable. In its acute form peritonitis is by no means a very frequent disease in children. It may, however, occur either as a primary affec tion, or, as is more frequently the case, it may become developed in |