This disease is most frequently due to errors in diet; the mother’s
milk may be altered in quantity or quality from taking improper food;
the child may be over-nursed, or the foods given in place of the
mother’s milk are at fault. Too often a filthy bottle is the cause. The
predisposing causes are dentition and extreme heat; and these, combined
with constitutional weakness, bad hygiene and a weak spine, diminish
the resisting power of the infant. Hence, in artificially fed children
of the poorer classes, this disease is very prevalent.
=Pathologically=, there is catarrhal swelling of the mucosa of both the
small and large intestines. The amount of mucus is increased, and there
is more or less involvement of all the lymphoid tissue. The submucous
membrane is often infiltrated. If there is much inflammation ulcers may
occur.
=Symptoms.=—The child may seem to be in its usual health, with
slight restlessness at night and an increased number of stools.
This restlessness may be due to nausea and colicky pain. The stools
are copious and offensive, containing undigested food and curds. In
children over two years old these attacks may follow the eating of
unripe food or drinking tainted milk. In other cases the onset may
be sudden with vomiting, purging, and griping pains. The fever may
rise rapidly to 103 or 104 degrees or more, sometimes followed by
convulsions. The stools become more numerous—there may be twenty in the
twenty-four hours—gray or green in color, and sometimes containing much
mucus, rarely blood.
=Diagnosis.=—The sudden onset and the character of the stools, which
never have a watery, serous character, distinguish this from cholera
infantum. And the small amount of mucus which the stools contain
distinguishes them from those of ileo-colitis. This form often precedes
the onset of specific fevers.
=Prognosis.=—Among the better classes this is generally favorable,
but among the weak, half-starved children of the poor it is often
unfavorable, especially in hot weather.
=Treatment.=—The child should be clad warmly, kept absolutely clean
and given a change of diet and air if possible, with frequent baths.
Sterilized milk should be given at regular intervals; or if the
diarrhea continues, beef juice and egg albumin instead. The bowels
should be thoroughly cleansed by injections. The spine should be
thoroughly treated through the lower dorsal and lumbar regions, and if
the abdomen is not sensitive, a light treatment to the bowels directly
will aid recovery. Frequently it will be found that the muscles of the
neck and upper dorsals are considerably contracted, especially where
the child has fever and is very restless.
For =acute intestinal indigestion= Ruhrah gives the following dietetic
treatment: “Withhold all food for the first twenty-four hours, except
a little albumin water. This is best given in small doses at not too
great intervals. Plain boiled water may be used instead. Very weak tea
to which a little red wine has been added may be given if the child
is weak. On the second day the albumin or barley water may be given
with the addition of weak strained broth, and on the third day malted
milk may be added to the list. After four or five days cow’s milk
diluted and boiled or peptonized may be tried. It is best mixed with a
farinaceous gruel or with malted milk to start with. It may be given
every other feeding for a day or two if it agrees, and the former
feeding gradually resumed.
“In nursing infants withhold the breast twenty-four hours and feed as
above. After that the breast may be given once for a few minutes and
the feeding pieced out with albumin- or barley water. If it agrees the
breast may be given for three or four feedings, every other feeding
followed by albumin- or barley water. On the following day the breast
may be given at each feeding. The time of nursing should be increased
gradually until the child is back on its old schedule.”