CHOLERA INFANTUM.

BY S. J. SMITH, M. D., of Cambridge, N. Y.

This is a disease of very frequent occurrence in this country, and one requiring great skill and judgment to conduct to a successful termination. It has proved to be one of the most fatal of diseases. "One-third of all deaths occurring among children under three years of age being caused by cholera infantum and its sequelae." It usually occurs during the second summer, or the period of first dentition, but may occur any time previous to the third year. "The disease may terminate fatally during the first twenty-four hours, or may continue. for three or four days, the child recovering or gradually passing into the chronic form."

Causes. Some have supposed dentition to be the cause, but statistics show that it more frequently occurs previous to dentition than after it. Again," we would expect to find the disease only in cases of dental irritation, whereas we find it in children who have no teeth, who are not cutting teeth at the time the disease commences, who have all their deciduous teeth except the four last molars, or when showing no swelling, tenderness or irritation of the gums." It occurs during the months of May, June, July and August, and, in severe cases, may last until cool weather. "A continuous high temperature always increases the severity of the disease, while a cool, moist atmosphere gives relief."

Symptoms. Cholera infantum is usually preceded by feculent diarrhoea, which gives but little uneasiness, continuing for two or three days. Suddenly, we have prostration, frequent discharges from the bowels and vomiting; or the child suddenly commences to vomit and purge copiously, seemingly without effort or pain. Thirst is very intense, the child desiring water, which, if given, is immediately rejected by the stomach. In some cases the skin is hard and dry, and the pulse hard and increased in frequency; in others, the skin is soft and doughy, the extremities cold and the pulse feeble and frequent. "The pulse is peculiarly unstable, or intermittent; sometimes it may be full and bounding, at others quick and wiry, or again, it will become very feeble and almost imperceptible; but is always invariably rapid, and never, in the last moments even, becomes slow." As the disease advances the desire for drink increases, the evacuations. from the bowels are more frequent, and the little sufferer becomes extremely emaciated. The discharges vary in character, sometimes yellowish, with more or less stringy mucus mixed with them, showing disease of the mucous follicles; at other times they are greenish, have a sour smell; at others, clayey or almost white rarely of a dark color. These evacuations are extremely putrid, acrid, and sour-smell

ing. The matter evacuated sticks to the diapers like mucilage; after a time there may be considerable tenesmus, the little sufferer drawing up the feet and legs, as if cramped, at each evacuation. The abdomen inay be tympanitic, hot, and excessively sensitive to the touch.

There is usually a partial and sometimes a complete suppression of urine, and that which is voided is thick, turbid, and shows traces of albumen. There is generally great irritability of the nervous system, the little patient is restless and uneasy, never satisfied, always changing its position, rolling and tossing about, placing its hands frequently on the head, and moaning in a piteous manner. After a time this uneasiness is superseded by a kind of somnolent stupor, or, in other words, a collapse which is disturbed by frequent starts and tremors, that may even, and often do, amount to convulsions. The patient may readily be aroused from this comatose condition, and consciousness is always found to be unimpaired, which is not the case in hydrocephalus, and is a diagnostic point of great importance. Occasionally the brain is affected. We may have congestion' indicated by the continual moving of the head from side to side, sleeping with the eyes open, rolling the eyeballs upward. When the pupils do not contract upon exposure to light there is congestion with effusion. We often have determination of blood to the head, throbbing of the carotids, contraction of the pupils, with great restlessness.

Pathology.-Dr. J. M. Scudder says: "It is not easy to say what the exact pathology of this disease is. In one case it seems to be almost wholly an irritation of the gastro-intestinal mucous membrane; in another it is an atomic condition, and a failure of power to digest food; in still another the intestinal lesion seems to be secondary and depends upon a want of assimilation, and nutritive power; and in others the lesion is principally of the nervous system. I conclude from all this that the lesion is primarily one of the sympathetic system of nerves which govern all the processes of vegetative life." (Dis. of Children, 228.)

Diagnosis." The acute attack is readily recognized; the sudden appearance of nausea and vomiting, with diarrhea; the great prostration and intense thirst. The chronic form is recognized by its slow accession and the same nausea and vomiting, the intense thirst, the persistent diarrhoea, and the impairment of digestion and nutrition, as marked by the rapidly wasting tissues.

Prognosis is usually favorable if there are no brain symptoms; if the latter exist the mortality is large.

Treatment. In treating this disease each case requires individual study and treatment appropriate to itself. Be careful not to check the discharges from the bowels suddenly. "If the vomiting and purging are arrested by the administration of any drugs the action of which is to fly up, if the expression is admissible, the alimentary canal, thus preventing the excreta from finding a natural outlet, and causing them to seek some other place of deposit, the result will almost invariably be convulsions. Now, arguing a priori what is more reasonable than to infer that if the natural channels, or out

let, for this excretion, if I am permitted so to designate it, be dammed up, which stoppage of flux, no one, I think, will venture to say, arrests the process.of seral drainage from the blood, but on the contrary, we believe it goes on and seeks some other place or cavity of deposit than the alimentary canal, which has been forcibly denied it. The question now is, where will it find a place of lodgment. I am satisfied that the fluid finds its way to the spinal and cranial cavities, where it produces irritation, compression and convulsions." (W. C. Richardson, M. D.)

Aconite and Ipecac are much used in alternation. The pulse frequent, quick in stroke, tissues somewhat pinched, tongue pinched and red, or but little changed. Aconite is appropriate when the child has a flushed face, hot head and abdomen, fierce thirst, with symptoms of great febrile excitement.

B Tr. Aconiti, rad. gtts. ij. ad iv.

Aquæ

3 iv.

Sig. Teaspoonful once in one-half hour to one hour.

Ipecac is indicated by sudden paroxysm of great nausea and loathing. In vomiting, should it occur, and is very scant, consisting of mucus and bilious matters, mixed with ingesta, with diarrhoeic evacuations of greenish yellow, slimy, limpid matter, smelling sour, give

B Tr. Ipecac, gtts. v ad viij.
Aquæ

Sig. Teaspoonful once an hour.

3 iv.

"Veratrum Album is appropriate if the attack should be ushered in suddenly by large watery discharges from the bowels, immediately followed by copious vomiting, without seeming effort; cold, clammy surface, great and sudden prostration following the profuse evacuation; very great sensitiveness and pain in the abdominal region; great anguish, indicated by moving and tossing about; tendency to spasms, especially indicated if the attack comes on early in the morning." (Richardson.)

Nux Vomica. Face pallid, eyes dull, tongue full; sallow yellowishness of skin; abdomen tumid, persistent nausea and some abdominal pain.

Rhus Tox. "We occasionally find a case of cholera infantum in which irritation of the nervous centers is a dangerous complication. The symptoms are contraction of the tissues about the eyes, which are sometimes slightly injected; evident pain in the forehead, manifested by uneasy movements and raising the hand to the head; cold feet and hands; face flushed, left side; tongue pointed, red at tip; short stroke of the pulse. Very frequently the attention will be first called to the trouble by the sharp cry of the child." (Scudder.) B Tr. Rhus., gtts. ij. Aquæ 3 iv.

Teaspoonful once an hour.

Argenti Nitras. - "Frequent discharges, with evident implication of the brain; eyes bright and moist; great restlessness; marked increase of the temperature of the head, and sometimes of the trunk ; hands cold.

Colocynth.

Greenish stools, with severe colic pains. Tenesmus.

B Colocynth, gtt. j.

Aquæ, Az iv. M.

Teaspoonful once an hour.

Euphorbia Hypericifolia. - Used on general principles; chronic cases. The most prominent symptoms are "vomiting and diarrhoea, associated with fever of a remittent character, and great emaciation." "Camphor in cases where all other remedies have failed, and when collapse is imminent, or has taken place, will prove highly efficacious, recalling life, as it were, at the last moment." (Dr. Richardson.)

B Tr. Camphor, gtt. x.
Water,
fl 3 iv.

Teaspoonful every twenty minutes.

Salicylic acid. I think this will be found a valuable aid in some cases. "In all cases where fermentive changes occur in the alimentary canal it acts more efficiently than any other antiseptic substance, as it can be administered in large doses." In case the child is "brought up on the bottle" the addition of a little acid to the milk will serve a good purpose, preventing the milk souring. The "Quinine inunction "should not be overlooked. The following remedies will prove of value in some cases: Rhubarb, Bismuth, Oxide of Zinc, Podophyllin, Phosphoric acid. "Coffee, as an article of diet as well as a medicine, is highly useful in the summer complaints of children." Liebig's food, cows' milk, condensed milk, beef tea, chicken broth or Arrow root are useful where the child cannot nurse. To quench the thirst give small pieces of ice, or tie a piece of ice in a cloth and give it to the child to suck. Dr. Richardson says: "I have found in ice cold lemonade, made very sour with the juice of fresh lemons, and slightly sweetened with clarified sugar, a means that not only is a great boon to the little sufferer but also a most excellent remedy for the vomiting. Give one teaspoonful at a time; it may be given every ten or fifteen minutes. In nursing children it should not be given either directly before or after nursing.'

TRANSACTIONS OF THE SARATOGA DISTRICT SOCIETY.

The Saratoga District Eclectic Medical Society held its annual meeting at Saratoga Springs, on Tuesday, June 20, 1876.

The session opened at 10.30 A. M., N. Bedortha, M. D., President, in the chair. The Secretary read the minutes of the former annual meeting in September last. Approved.

The Treasurer's report was read and adopted.

Visiting physicians were invited to a seat. Invitation accepted by Dr. Bostwick of New York, and Dr. Gage of Saratoga.

A communication was received from J. E. Danelson, M. D., Secretary of the State society, which was ordered on file.

Propositions for a fellowship in this society were received from Drs. O. C. Gage and S. S. Carter. Referred to Drs. Pease, Quackenbush and Hamilton, as Censors.

Article 2 of the Constitution was amended by making the office of Treasurer separate from that of Secretary.

Article 5 of the Constitution was amended, fixing the time of the annual meeting on the first Thursday of June, at ten A. M.

Drs. Pease, Quackenbush and Henry were appointed a committee to nominate officers for the ensuing year. The committee made a report which was laid on the table until the afternoon session.

D. H. Hanks, M. D., read an essay on epilepsy. It was received and placed on file. Remarks upon this disease were made by Drs. Bostwick and Quackenbush.

Dr. Quackenbush presented a case of chronic cystitis successfully treated.

Dr. Mattocks, of Troy, made remarks on the use of acids or alkalies in certain inflammatory and typhoid conditions.

A recess was ordered until two P. M., at which hour the society was called to order.

The Censors reported that they had examined Drs. Gage and Carter, and finding them worthy and duly qualified, recommended them for election as fellows of the society.

The balloting resulted in their unanimous election.

The report of the nominating committee was taken from the table, and on balloting for officers, the following were elected: President, N. Bedortha, M. D.; Vice-President, G. W. King, M. D.; Secretary, H. L. Grose, M. D.; Treasurer, R. Hamilton, M. D.; Censors, H. Pease, T. W. Quackenbush, R. Hamilton.

Resolved, That we adopt the recommendation of the State society requiring the new members to be furnished with an annual State certificate.

Received a communication from Dr. Neef, of Albany, with reference to consolidation. Appointed H. L. Grose, M. D., R. Hamilton,