ACUTE GASTRIC CATARRH. 507 



moderate sufferings of the patient do not justify the use of an emetic, 

 we should give a carbonate of one of the alkalies. The most used is 

 the bicarbonate of soda, in doses of gr. v-x, in powder or solution ; if 

 we wish to employ it in the popular form of mineral water, we should 

 first assure ourselves that the water furnished actually contains bicar- 

 bonate of soda, and does not simply consist of carbonic acid and 

 water. 



In spite of numerous evacuations upward and downward, small 

 amounts of the decomposing substances not unfrequently remain in the 

 stomach. The alkalies prescribed can neutralize the acids already 

 formed, it is true, but they cannot entirely arrest the process of decom- 

 position and the formation of new acid products. The substances re- 

 maining in the stomach and undergoing decomposition transfer their 

 chemical action to the fresh and unspoiled food, and render the most 

 harmless food injurious and even dangerous for the gastric mucous 

 membrane of children, in whom this state most frequently occurs. In 

 such cases it is necessary to arrest the decomposition of the contents 

 of the stomach remaining after the vomiting and purging. It is diffi- 

 cult to fulfil this indication, and all the skill of the physician often fails 

 in the attempt. If we recognize the abnormal decomposition of the 

 contents of the stomach and intestines as the most frequent cause of 

 infantile diarrhoea, we can at least understand the unfortunate results 

 of its treatment, which we cannot do if we regard the gastric and in- 

 testinal catarrh as the sole disease. Even outside of the body, as is 

 well known, it is often difficult to arrest a fermentation or other de- 

 composition that has once begun. But the means that answer for this, 

 outside of the body, cannot always be used in it. We cannot perfectly 

 dry the contents of the stomach or keep them at so high or so low a 

 temperature as to arrest decomposition ; and certain substances that 

 prevent fermentation are poisonous to the organism. But, if we regard 

 the numerous remedies (often exactly opposite in their other qualities) 

 which physicians employ in the diarrhaea and vomiting of children, with 

 or without clear ideas of the reasons for so doing, and which are some- 

 times unmistakably serviceable, we find that they are such substances 

 as are used outside of the organism for arresting fermentation and 

 other decompositions. The remedies most frequently given in infantile 

 diarrhoea are carbonates of the alkalies; mineral acids, particularly 

 muriatic ; metallic salts, especially calomel and nitrate of- silver ; also 

 hannin, creasote, and nux vomica. Possibly part of these, such as the 

 nitrate of silver and tannin, have, at the same time, a favorable effect 

 on the irritated mucous membrane of the stomach and intestines, by 

 their astringent action on the hypersemia. But the greater part of 

 these remedies, especially the one most used, calomel, cannot be said 



