I used to give a lecture to medical students on one of the scourges of children’s health, acute gastroenteritis or diarrhoeal disease. I composed and sang a few songs to add interest to the educational experience. Here are a few of them.

How to make oral rehydration solution to prevent a baby or child becoming dehydrated from acute gastroenteritis and to treat them if they are dehydrated. The tune is ‘A spoonful of sugar’ from Mary Poppins.

Before the fontanelle’s depressed

And the skin turgor’s not the best

And mucous membranes are distinctly dry

Please don’t get into a tizz

For the solution simply is

A litre jar of clean and cool water

And…. eight…

Teaspoons of sugar and a half a one of salt

A half a one of salt, a half a one of salt

Just 8 teaspoons of sugar and a half a one of salt:

Oral Rehydration Fluid.

If baby starts to dehydrate

As shown by rapid loss of weight,

Or signs of dryness now are plain to see,

To prevent a major boob

Insert a nasogastric tube

In this you slip the fluid you will drip

Like…. eight…

Teaspoons of sugar and a half a one of salt

A half a one of salt, a half a one of salt

Just 8 teaspoons of sugar and a half a one of salt: Oral Rehydration Fluid.

But, I asked, why do children get diarrhoea in the first place? The answer is not about the microbes. It is something more fundamental. This song is sung to Bill Sykes’ song from Lionel Bart’s ‘Oliver!’.

How does diarrhoea get them?

Their guts, how does it upset them?

How does the grim reaper net them?

Is it infection? — Not just!

That’s merely the common pathway.

It don’t even travel halfway

To the Cause. It’s the bizarre way

Nations are structured. — Not Just.

Think of female education.

Running water, sanitation,

Food supplies and cheap child spacing.

How are things ordered? — Not just.

Companies that push the bottle

Not concerned with what’ll be

Caused by milk contamination

Bears examination, please.

If we really want prevention

It must be our first intention

To aim our health intervention

At all injustice. — We must!

And what kills and maims children who get severe diarrhoea? A song from the film Casablanca ‘As time goes by’ gives the answer:

You must remember this:

What makes it dangerous

And makes the children die?

A fundamental thing of life:

They get so dry.

It’s still the same old story,

They’re far from hunky-dory

(A fact you can’t deny)

As water leaves the little babes,

They get so dry.

And how is diarrhoea experienced by an anxious mother. i tried to illustrate the physiology of the signs of dehydration through the eyes of a desperate mother. Rather inappropriately the tune is ‘Food, glorious food.’ again from Oliver!

Stool, copious stool

Fresh, liquid and squirty

I’m losing my cool

Each nappy is dirty.

Each bottle I give to him

Sets the cycle in motion

As the milk goes down into him

Out comes an ocean.

Stool copious stool

My baby is thirsty

Am I a big fool?

Milk’s making him worse. He

Needs to drink but I really think

That’s not the right tool – oh

Stool, numberless stool, unending stool

Watery stool.

And things just get worse

Stool copious stool

My baby was crying,

Now he seems so weak

I think he is dying.

Everything I have given him

He either rejected

Or if he did swallow it

It was ejected.

Stool copious stool

Just look at his eyes now

They’re sunken and bleak,

Eyelids hardly rise now.

Tongue’s dry and a sighing cry

Life can be so cruel – oh

Stool, life-sapping stool,

merciless stool, Murderous stool

I reminded students that there are almost no medicines that consistently work to mitigate acute diarrhoea and that many are dangerous. ‘The answer is fluid’, using the tune of ‘How do you solve a problem like Maria’ from Rodgers and Hammerstein’s ‘The Sound of Music’.

How do you solve the problem diarrhoea?

How do you get the fluid balance right?

How do you stop it coming from his rear?

The fact is you’ll cop it if you try to stop it

You can’t.

Many’s the thing that you would like to give him

Antibiotic, pectin or some such

But try as you may, I say

There really is just one way:

Fluid replacement for a time and much

For when all’s been said and done the fact remains that

Diarrhoea’s a self-limiting disease.

When it’s with you it’s a mess

As it slithers down your dress

Crappy nappy, child’s unhappy so am I.

All that washing to be done.

Got to dry it. There’s no sun

And you feel so helpless and you want to cry.

Every time you give a drink

Out will come another stink

Baby’s squalling, it’s appalling, can’t I die?

How do you solve the problem diarrhoea?

What do you teach this mother under stress?

What is the answer? What’s the panacea?

You don’t need a druid, the answer is fluid

and lots.

Do not be tempted to dispense Lomotil.

Drugs such as this are dangerous because

The output of stool may drop but

It’s still being lost in the gut.

Do not be tempted to clutch for any straws ’cause

When all’s been said and done the fact remains that

Diarrhoea’s a self-limiting disease.