Causes

This ailment differs from simple diarrhea by more frequent defecation and stools containing streaks of blood and mucus. The child generally has more or less fever; at times a constantly high temperature, at other times a normal temperature. Micro-organisms are the common cause of this disease. The bacillus dysenteriae of Shiga, is the cause of many cases and of most epidemics, but other bacteria frequently are causes of the same symptoms. Children are especially liable to be attacked during their second year, after they have partly or wholly left the breast, particularly in the summer season, when their food is more easily spoiled or contaminated by the growth of microorganisms than at any other time. The heat of summer also makes the children less resistant, as is frequently shown by their rapid recovery when they are taken to the fresh air of the country, seaside, or lakeside. The ill effects of life in overcrowded buildings, and hot rooms, badly ventilated and dirty, are too well known to need amplification. In the first year of life infants are least liable to the disease if breast fed. When one that is bottle fed develops it, a change to the breast milk of the wet-nurse often effects a cure. The influence of hot weather in increasing the number of microbes in milk is readily understood. Moreover, the corollary is self evident that to prevent this disease milk must be handled so as to exclude bacteria from it as completely as possible. The utmost care must be taken with bootle-fed babies to maintain pure and fresh air about them and to insure absolute cleanliness of all vessels and utensils that come in contact with the milk to be given as food, as well as of the food itself. Sterilized or Pasteurized milk is often a prophylactic of value.

Treatment

When the disease makes its onset, the intestinal canal should be promptly cleansed by a laxative such as calomel, or, often better still, by castor oil. For twenty-four or forty-eight hours, sterilized water only should be given or a little rice-water or arrow-root, tapioca, or sago cooked with water. When given to older children, these drinks may be flavored with nutmeg, cloves, or cinnamon. This food should be sterile and fed from bottles or dishes scrupulously clean. In most cases it is necessary to abandon the use of milk for at least two or three days - often for a longer time. During this time it is best to give very little food - not more than a tablespoonful or two every one or two hours. Besides the rice or other farinaceous waters just mentioned, a little beef-tea or veal or mutton broth may be given. Egg-albumen stirred into water also may be used. Children one or two years old can take the cereal waters best, and after the first days, a somewhat thicker gruel.

As a rule, milk cannot be tolerated, often because the casein in it is not well digested. Many times a modified milk will obviate this difficulty. The protein in it should be reduced to 2 or 1 per cent, or less. It is also best to lessen somewhat the percentage of fat and sugar. When improvement begins and it seems necessary to give more nourishing food, a modified milk containing 3 per cent, of fat, 4 or 5 of sugar, and 2 or 3 of protein may be employed. The mixture should be made slightly alkaline by the addition of lime-water. As digestion becomes well established the ingredients of the milk may be made to approach nearer and nearer to the normal proportion of cow's milk or mother's milk to which the child has been accustomed.

There are also numerous patients who cannot tolerate the fats but who can digest casein. Skim milk and butter milk often prove to be especially adapted to their needs. It is probable that the presence of micro-organisms in excessively large numbers in cream is the cause of the enteritis in many cases or at least aggravates it. Skim milk containing relatively so small a number is therefore less harmful and buttermilk full of the lactic acid ferment checks the growth of other organisms. Although these bacteriologic phenomena account for the harmfulness to many individuals of milk rich in fat there are others in whom the ability to digest fat is lessened.

Flushing the colon with sterile water is of great importance. It should be done once or twice daily, and in some cases even oftener. A large quantity of water should be used so that the colon will be well cleansed, at least in the lower parts.

It is a help to give such children a change of air, especially to get them upon the water, where fresh, clean, invigorating air will blow over them. Anodynes, antiseptics, astringents, and stimulants have their place in the treatment, but will surely fail unless hygienic and dietetic rules also are followed.