Digestive disturbances (anorexia, flatulence, gripes, indigestion, trapped wind, constipation and diarrhea) constitute a significant segment of pediatric illnesses. This is more true of the newborn than infants and older children. It is particularly important that the digestive system should function normally for the metabolic processes of growth and development in the newborn. It has been estimated that as many as 60% of children in India suffer from digestive disturbances and delayed growth and development. A significant number also suffer from malnutrition due, probably, to non-availability of protein-rich food.

Though the digestive system of the newborn is normally adequate for this task, the rapid rate of growth and proportionately high requirements of nutrition at this stage of life coupled with the immaturity of digestive functions, enhance the proneness to digestive disturbances.

Many drugs (stomachics, gripe waters, carminative mixtures, sodium bicarbonate and such other remedies) have been used in the past for bringing about a quick amelioration from dyspepsia and flatulence. Though these drugs relieved dyspepsia and flatulence temporarily, they failed to produce a more marked and lasting relief.

It is in this particular context that Bonnisan scores a point over all others in not only correcting the indigestion, helping assimilation and utilization of food but also possessing the advantage of being an anabolic agent and a hepatic stimulant.

The results of our clinical trials in newborns tally with those of many workers in the field. Dhurandhar⁴ (1973) studied 100 cases and reported remarkable control of flatulence and distension and improvement in appetite, digestion and gain in weight, Indira Bai⁶ et al (1973) in a controlled study of 200 cases has reported similar findings. Koti and Mehta⁷ (1974) studied 138 cases which included 15 premature babies. They noted marked improvement in all the cases. Rangwala and Anjaneyulu⁹ (1974) studied 100 cases and reported significant and excellent improvement. Shirole¹⁰ et al (1974) in their study of 135 cases have reported excellent results with Bonnisan.

We have been particularly impressed by the effect of Bonnisan on chronic, non-specific (non-bacterial) and non-parasitic diarrheas in infants and children. In our trials therefore, we have two sections:

Section I - Trials with Bonnisan in newborn infants and

Section II - Bonnisan in chronic non-bacterial and non-parasitic diarrhea in infants and children.

Section I

Bonnisan in Newborns

Newborns and infants at age of 2-4 days delivered in R.M. Hospital, Thanjavur in Post-natal ward were selected (after excluding infants with congenital anomalies).

Each mother was handed over one bottle of Bonnisan at the time of her discharge with instructions to start Bonnisan from the 12-14th day of birth of the baby, and to report by the 20-21st day to the Pediatric out-patient for follow-up.

They were followed up for a period of 3 months at intervals of 2 weeks each.

The response to Bonnisan therapy was noted at the end of 3 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks and 12 weeks of age, i.e., 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks and 10 weeks after starting the drug.

Dose advised:

¼ tsp. t.i.d. up to 2 months.

½ tsp. t.i.d. after 2 months.

Appetite was assessed by the baby's satisfaction after feeds, duration of undisturbed sleep, time lag between feeds and the mother's observations.

Digestive function was rated by

— crying due to colic or restlessness

— belching

— flatulence

— consistency, color and frequency of stools

— cheerfulness of the infant

General Health was assessed by the well-being and cheerfulness of the infant as observed by the parents and the doctor.

Bowel Action: Number of motions was regular, as expected with breast-fed babies.

General Health: All babies were seen to thrive normally.

(Vomiting was noted in only 3 cases in 5-6th week).

Weight gain was observed as shown in the Table above.

Thirty-eight in-patient newborns who were on Bonnisan up to the end of 12 weeks were observed. Bonnisan was definitely helpful in these infants in promoting good appetite, maintaining a good level of digestion, normal bowel status and freedom from digestive disturbances. There was a uniform and sustained weight gain in the infants.

Bonnisan maintains a status of good health especially in relevance to gastrointestinal system, promotes sustained weight gain and improves well-being because of good appetite and digestion.

Section II

Bonnisan in chronic Non-Bacterial and Non-Parasitic Diarrhea in infants and Children

Infants with diarrhea and digestive disturbances who after repeated stool examination, showed no positive findings were selected, as also those who were not improving with the routine O.P.D. symptomatic treatment.

The local people in this study are of poor socio-economic status having unfounded fears of offering supplementary feeds to infants. This often leads to malnutrition. These children are given only diluted milk even up to the age of 1-2 years. No cereal food is added to routine diet until the age of 1 year. No non-vegetarian food or curds or vegetables are given to infants below the age of 1-1½ years.

Those babies who are weaned from their mothers' milk usually go into clinical protein-calorie malnutrition status. The process of diarrhea starts and persists in these children. A vicious cycle is thus set up: diarrhea — malnutrition and more diarrhea. The total number of cases registered was 42.

Out-patient infants attending the O.P. Department, R.M. Hospital and Thanjavur Medical College Hospital, Thanjavur were taken up for the study.

Cases were examined, weight checked and diet advice given on registration. Cases were instructed to continue to attend the O.P. Treatment was as usual and they were in addition asked to give Bonnisan.

The patients were reviewed once in 7-10 days for assessment.

1. Reduction in the number of motions; consistency, color and frequency of stools.

2. Disappearance of irritability.

3. Improvement in appetite.

4. Acceptance and tolerance of new foods hitherto not tolerated (e.g. cereals etc.).

5. Reduction in the size of abdomen (as seen by both mother and doctor).

6. Relief of abdominal pain.

7. General outlook and disposition.

8. Increase in weight.

9. Disappearance of flatulence.

10. Improvement in digestion.

The period of Bonnisan administration was for 3-4 weeks only, along with routine O.P. treatment (Supportive and symptomatic treatment).

Weight gain was variable (depending on the age of cases and the initial low weight).

All cases showed positive improvement at the end of 4 weeks.

Cases were drawn from the lower and middle income group. They were on insufficient diet and had chronic diarrheas off and on and low body weight.

Bonnisan was added as an adjuvant to symptomatic treatment of these cases receiving out-patient treatment. The response observed was significant with control of non-specific diarrhea in 34. The acceptance, toleration of new food (cereal etc.) was noteworthy. There was weight gain in all cases though the rate of weight gain was variable.

Most encouraging and gratifying results of improvement in appetite, digestion and control of loose motions were noted from the 2nd week after the commencement of Bonnisan.

Except in 8 cases, the control of diarrhea was nearly complete by the 4th week, along with general improvement in children. There were 9 babies among the 42 cases with protein caloric malnutrition and one case had congenital cyanotic heart disease and one case was receiving treatment for primary complex.

The addition of Bonnisan to the routine treatment in cases of chronic diarrhea of nonspecific etiology associated with food taboos and insufficient food helps in controlling and arresting the diarrhea and also improving the status of general condition in these cases. The response to Bonnisan was remarkable because of the presence of Liv.52 ingredients in the formula which probably aids in correction of the digestive system and also helps as an anabolic agent.

We thank The Himalaya Drug Company, Bombay for providing the opportunity for the trial and also for liberal supplies of Bonnisan. We thank Dr. M. Narayana, M.S., D.M.E., for permitting us to publish this article.

We are also thankful to Dr. D. Bhoopathy, M.D., Principal, Thanjavur Medical College Hospital and Dr. D.S. Desakavalan, M.S., D.L.O., and Dr. M.A. Mallick, M.D., the Superintendent, R.M. Hospital and TMC Hospital respectively for the use of hospital records