This is the most severe and fatal of the acute intestinal diarrheas of infants. It is characterized by excessive vomiting and purging. The stools are thin, watery, and often copious, rapidly causing great prostration and even collapse.

The indications for treatment are to remove the cause of intoxication, to restore to the child the water lost by vomiting and purging, and to maintain the patient's strength. The cause of cholera infantum is the same as of the summer diarrhea of infants. That tyrotoxicon can cause it is well understood, but that all cases have a common origin has not yet been determined. Possibly, in some instances, an unusually virulent condition of micro-organisms normally found in the intestines gives rise to the syndrome.

To cleanse the digestive tract, recourse must be had to lavage of the stomach and colon with sterile water. If the child is in a condition of collapse, stomach-washing may be injudicious, but flushing of the colon with hot sterile salt solution is of great value. All food should be withheld, only sterilized water being given by the stomach. It is most grateful when it is cold. The flushing of the colon must be repeated frequently, three or four times and sometimes oftener during the first days of the illness. This helps to cleanse the intestine and to restore by absorption to the blood some of the fluid that has been lost, to soothe the intestine, and to warm the little patient's body.

When the loss of fluid has been excessive and cannot be replaced by natural channels because of frequent vomiting, water must be administered subcutaneously. A solution of seven parts of common salt in 1000 is to be preferred for this injection. It must be made sterile and injected with antiseptic precautions.

Food should be withheld until improvement in the gastrointestinal symptoms is manifest. It is often difficult to restrain parents and nurses from feeding a child too soon. It is best to wait twelve or fifteen hours after vomiting has ceased before beginning to give food. At first a teaspoonful of rice-water or albumen water should be given every half-hour. If this is well borne, it may be given in larger amounts at a time. Later, small doses of diluted milk may be given, or, better, of peptonized milk or modified milk, such as has just been recommended in enterocolitis. Many prefer to give weak broths for a day or two before they try milk; but all food should be given at first in quantities of a teaspoonful at frequent intervals. There is danger of giving too much while the digestive organs are weak and incapable of much functional activity. As in other forms of diarrhea, the change to a varied diet must be made very gradually.

That this disease may best be treated amid pure, fresh air, and that every precaution must be taken to maintain cleanliness of the child is self-evident. The same advice as to change of air applies to these cases as to those of enterocolitis.