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PRACTICE OF MEDICINE. 



Diagnosis^— \n infantile remittent fever, the cerebral symptoms 

 do not appear until near the close of the disease,- in hydrocephalus, 

 they invariably occur before the end of the first week, and often- 

 trnies sooner. The acceleration of the pulse, the remissions and the 

 diarrhoea, which are always constant symptoms of infantile remittent 

 fever, will serve to distinguish it from acute hydrocephalus, in which 

 the bowels are always constipated from the commencement of the 

 disease, and the pulse occasionally slow. 



Chronic form of remittent. — This form either makes its approach 

 insidiously or follows the acute. The child wastes, the abdomen 

 enlarges, the breath is offensive, and the strength fails. The tongue 

 is white or loaded, but moist, and has often a strawberry-like appear- 

 ance; the bowels are generally costive, and the evacuations are 

 always unhealthy. The pulse is usually about 100 in the day, but 

 rises to 140 in the evening. There is generally one exacerbation 

 in the twenty-four hours, and it seldom appears before evening, 

 lasting until morning, and terminating in sweats. If the disease be 

 not removed, tympanitic distention of the abdomen, emaciation, 

 harsh discoloration of the skin, enlarged mesenteric glands, chronic 

 diarrhoea, and lientery, supervene. 



This affection is liable to be mistaken for chronic inflammation 

 of the pia mater in children. 



Treatment.— \i the affection be acute, and the child strong, leeches 

 should be applied to the epigastrium, calomel and lames' powder 

 ought to be given at night, and a mild aperient draught in the 

 morning. If the bowels are not evacuated by these means, an enema 

 should be given ; equal parts of castor oil and oil of turpentine in 

 water-gruel form the best enema in these cases. The calomel and 

 James' powder should be repeated every night, or on alternate 

 nights ; and a purgative mixture be given in the morning. When 

 the evacuations have been improved by these means, mild tonics 

 may be employed ; of these, the infusions of cinchona, cascarilla, 

 and of valerian, form the best ; stimulating liniments, and other 

 counter-irritants, should be applied to the abdomen. The foot-hath, 

 some mustard flour being added to the water, will be found useful at 

 bed -time. Small doses of sulphate of quinine may be exhibited ; 

 and if the disease assume the adynamic form, small d^oses o^ chlorate 

 of potass, in an infusion of valeria?i or of cinchona may be given 

 with advantage. Change of air, especially to a dry and elevated 

 situation, should be recommended. Warm clothing, frictions of the 

 surface, and light, but nourishing diet, are also very beneficial. 

 During the complaint, farinacea, and weak broth, are the most 

 suitable food. Where the disease has produced mesenteric obstruc- 

 tion, small doses of iodide of potassium may be exhibited. When 

 convalescence is established, the iodid. ferri will be found a useful 

 tonic. 



