Summer diarrhoea is exceedingly fatal among infants in hot weather in densely populated localities, and they require very careful feeding for this disease. Intractable cases are prolonged for several weeks, with more or less vomiting, diarrhoeal mucous stools, fever, and meteorism, and a variety of complications supervene.

Prevention

Entero-colitis is a subacute milk infection, resembling the acute form, cholera infantum, but it is less violent, although much more prevalent. It is produced by toxins developed by the activity of bacteria in the food, and it is therefore to a large extent preventable, and most easily so by exclusive breast nursing.

The preventive treatment for weanlings in nurseries where there are several children consists in absolute cleanliness and antisepsis, and the nurse must be made to realise the necessity of disinfecting diapers and her own hands at once, and she must never handle either food or food utensils with soiled hands, for by neglect of these simple precautions the germs are passed on from one child to another. When cow's milk is used in hot weather it should be Pasteurised unless absolutely fresh and clean.

Dietetic Treatment

As a preliminary to dietetic treatment the alimentary canal should be evacuated of all irritant material. The stomach should be washed out through a funnel, a (No. 10) soft rubber catheter, hot water (1020 F.) being used, to which salt is added (a teaspoonful to the quart). The colon should be similarly irrigated with hot salt solution. If the child is still nursing, and the mother's milk is found to disagree, a wet nurse should be secured whenever possible. If the child is fairly strong and well nourished at the commencement, it is best to withhold all food for several hours, and merely give a little barley water or some equally bland beverage. In any event it is best to abandon milk and its preparations entirely for two or three days. In this manner the intestinal germs which are causing the mischief are starved out or replaced by others which are comparatively innocuous.

There are many cases of enteritis in children in which milk wholly disagrees, even when Pasteurised or pancreatinised, apparently because the casein is not properly digested in the stomach, and in such cases the casein should be prevented from passing through the alimentary canal in tough and irritating coagulae.

Fresh meat broths (beef, mutton, or veal), pressed-meat juice, and egg-albumen solution with ten to thirty drops of diluted whisky or good brandy, are to be given in lieu of all milk. Children a year or more old may have gruels of arrowroot, barley, or rice, but commercial baby foods and patented meat extracts should be omitted. A mixture of cream and water is sometimes well borne.

It is important to give nourishment in very moderate quantity, one or two teaspoonfuls at a time, to prevent overfilling of the stomach. For older children a little scraped beef may be prescribed three times a day; and they may be allowed to drink whey.

After several days, but not until the symptoms have well-nigh disappeared, a very gradual return to milk is permissible.

In those cases in which children lose all appetite or infants persistently refuse to take the bottle, the prognosis is extremely unfavourable, and recourse must be had to rectal feeding and stimulation.

In every protracted case an exact record should be kept of the quantity of food taken, and no general report should be accepted from the nurse that the child is simply "feeding well." Frequent weighing and comparison with the amount of food ingested, combined with personal observation of the stools, are the best guides for the physician to follow in regulating the diet, and they should never be neglected.

During convalescence older children should be carefully watched to see that they do not surreptitiously, or through ignorance of their nurses, obtain unwholesome food. Such articles as potatoes, tomatoes, and other fresh vegetables, coarse cereals, like oatmeal, wheaten grits, and corn-meal, must be forbidden, as well as fruits. Holt has seen a fatal issue from eating a few raisins.