Volume 1 — AN ACCOUNT INTO THE CAUSE AND CURE OF THE CHOLERA INFANTUM.

By this name I mean to designate a disease, called, in Philadelphia, the “vomiting and purging of children.” From the regularity of its appearance in the summer months, it is likewise known by the name of “the disease of the season.” It prevails in most of the large towns of the United States. It is distinguished in Charleston, in South Carolina, by the name of “the April and May disease,” from making its first appearance in those two months. It seldom appears in Philadelphia till the middle of June, or the beginning of July, and generally continues till near the middle of September. Its frequency and danger are always in proportion to the heat of the weather. It affects children from the first or second week after their birth, till they are two years old. It sometimes begins with a diarrhœa, which continues for several days without any other symptom of indisposition; but it more frequently comes on with a violent vomiting and purging, and a high fever. The matter discharged from the stomach and bowels is generally yellow or green, but the stools are sometimes slimy and bloody, without any tincture of bile. In some instances they are nearly as limpid as water. Worms are frequently discharged in each kind of the stools that has been described. The children, in this stage of the disease, appear to suffer a good deal of pain. They draw up their feet, and are never easy in one posture. The pulse is quick and weak. The head is unusually warm, while the extremities retain their natural heat, or incline to be cold. The fever is of the remitting kind, and discovers evident exacerbations, especially in the evenings. The disease affects the head so much, as in some instances to produce symptoms not only of delirium, but of mania, insomuch that the children throw their heads backwards and forwards, and sometimes make attempts to scratch, and to bite their parents, nurses, and even themselves. A swelling frequently occurs in the abdomen, and in the face and limbs. An intense thirst attends every stage of the disease. The eyes appear languid and hollow, and the children generally sleep with them half closed. Such is the insensibility of the system in some instances in this disease, that flies have been seen to alight upon the eyes when open, without exciting a motion in the eyelids to remove them. Sometimes the vomiting continues without the purging, but more generally the purging continues without the vomiting, through the whole course of the disease. The stools are frequently large, and extremely fœtid, but in some instances they are without smell, and resemble drinks and aliment which have been taken into the body. The disease is sometimes fatal in a few days. I once saw it carry off a child in four and twenty hours. Its duration is varied by the season of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence, and disposes it to a favourable termination. It often continues, with occasional variations in its appearance, for six weeks or two months. Where the disease has been of long continuance, the approach of death is gradual, and attended by a number of distressing symptoms. An emaciation of the body to such a degree, as that the bones come through the skin, livid spots, a singultus, convulsions, a strongly marked hippocratic countenance, and a sore mouth, generally precede the fatal termination of this disease. Few children ever recover, after the last symptoms which have been mentioned make their appearance.

This disease has been ascribed to several causes; of each of which I shall take notice in order.

I. It has been attributed to dentition. To refute this opinion, it will be necessary to observe, that it appears only in one season of the year. Dentition, I acknowledge, sometimes aggravates it; hence we find it is most severe in that period of life, when the greatest number of teeth make their appearance, which is generally about the 10th month. I think I have observed more children to die of this disease at that age, than at any other.

II. Worms have likewise been suspected of being the cause of this disease. To this opinion, I object the uncertainty of worms ever producing an idiopathic fever, and the improbability of their combining in such a manner as to produce an annual epidemic disease of any kind. But further, we often see the disease in all its force, before that age, in which worms usually produce diseases; we likewise often see it resist the most powerful anthelmintic medicines; and, lastly, it appears from dissection, where the disease has proved fatal, that not a single worm has been discovered in the bowels. It is true, worms are in some instances discharged in this disease, but they are frequently discharged in greater numbers in the hydrocephalus internus, and in the small-pox, and yet who will assert either of those diseases to be produced by worms.

III. The summer fruits have been accused of producing this disease. To this opinion I object, that the disease is but little known in country places, where children eat much more fruit than in cities. As far as I have observed, I am disposed to believe, that the moderate use of ripe fruits, rather tends to prevent, than to induce the disease.

From the discharge of bile which generally introduces the disease, from the remissions and exacerbations of the fever which accompanies it, and from its occurring nearly in the same season with the cholera and remitting fever in adults, I am disposed to consider it as a modification of the same diseases. Its appearance earlier in the season than the cholera and remitting fever in adults, must be ascribed to the constitutions of children being more predisposed from weakness to be acted upon, by the remote causes which produce those diseases.

I shall now mention the remedies which are proper and useful in this disease.

I. The first indication of cure is to evacuate the bile from the stomach and bowels. This should be done by gentle doses of ipecacuanha, or tartar emetic. The vomits should be repeated occasionally, if indicated, in every stage of the disease. The bowels should be opened by means of calomel, manna, castor oil, or magnesia. I have generally found rhubarb improper for this purpose, while the stomach was in a very irritable state. In those cases, where there is reason to believe that the offending contents of the primæ viæ have been discharged by nature (which is often the case), the emetics and purges should by no means be given; but, instead of them, recourse must be had to

II. Opiates. A few drops of liquid laudanum, combined in a testaceous julep, with peppermint or cinnamon-water, seldom fail of composing the stomach and bowels. In some instances, this medicine alone subdues the disease in two or three days; but where it does not prove so successful, it produces a remission of pain, and of other distressing symptoms, in every stage of the disease.

III. Demulcent and diluting drinks have an agreeable effect in this disease. Mint and mallow teas, or a tea made of blackberry roots infused in cold water, together with a decoction of the shavings of hartshorn and gum arabic with cinnamon, should all be given in their turns for this purpose.

IV. Glysters made of flaxseed tea, or of mutton broth, or of starch dissolved in water, with a few drops of liquid laudanum in them, give ease, and produce other useful effects.

V. Plasters of Venice treacle applied to the region of the stomach, and flannels dipped in infusions of bitter and aromatic herbs in warm spirits, or Madeira wine, and applied to the region of the abdomen, often afford considerable relief.

VI. As soon as the more violent symptoms of the disease are composed, tonic and cordial medicines should be given. The bark in decoction, or in substance (where it can be retained in that form), mixed with a little nutmeg, often produces the most salutary effects. Port wine or claret mixed with water are likewise proper in this stage of the disease. After the disease has continued for some time, we often see an appetite suddenly awakened for articles of diet of a stimulating nature. I have seen many children recover from being gratified in an inclination to eat salted fish, and the different kinds of salted meat. In some instances they discover an appetite for butter, and the richest gravies of roasted meats, and eat them with obvious relief to all their symptoms. I once saw a child of sixteen months old, perfectly restored, from the lowest stage of this disease, by eating large quantities of rancid English cheese, and drinking two or three glasses of port wine every day. She would in no instance eat bread with the cheese, nor taste the wine, if it was mixed with water.

We sometimes see relief given by the use of the warm bath, in cases of obstinate pain. The bath is more effectual, if warm wine is used, instead of water.

I have had but few opportunities of trying the effects of cold water applied to the body in this disease; but from the benefit which attended its use in the cases in which it was prescribed, I am disposed to believe that it would do great service, could we overcome the prejudices which subsist in the minds of parents against it.

After all that has been said in favour of the remedies that have been mentioned, I am sorry to add, that I have very often seen them all administered without effect. My principal dependence, therefore, for many years, has been placed upon

VII. Country air. Out of many hundred children whom I have sent into the country, in every stage of this disease, I have lost but three; two of whom were sent, contrary to my advice, into that unhealthy part of the neighbourhood of Philadelphia called the Neck, which lies between the city and the conflux of the rivers Delaware and Schuylkill. I have seen one cure performed by this remedy, after convulsions had taken place. To derive the utmost benefit from the country air, children should be carried out on horseback, or in a carriage, every day; and they should be exposed to the open air as much as possible in fair weather, in the day time. Where the convenience of the constant benefit of country air cannot be obtained, I have seen evident advantages from taking children out of the city once or twice a day. It is extremely agreeable to see the little sufferers revive as soon as they escape from the city air, and inspire the pure air of the country.

I shall conclude this inquiry, by recommending the following methods of preventing this disease, all of which have been found by experience to be useful.

1. The daily use of the cold bath.

2. A faithful and attentive accommodation of the dresses of children, to the state and changes of the air.

3. A moderate quantity of salted meat taken occasionally in those months in which this disease usually prevails. It is perhaps in part from the daily use of salted meat in diet, that the children of country people escape this disease.

4. The use of sound old wine in the summer months. From a tea-spoon-full, to half a wine glass full, according to the age of the child, may be given every day. It is remarkable, that the children of persons in easy circumstances, who sip occasionally with their parents the remains of a glass of wine after dinner, are much less subject to this disease, than the children of poor people, who are without the benefit of that article of diet.

5. Cleanliness, both with respect to the skin and clothing of children. Perhaps the neglect of this direction may be another reason why the children of the poor, are most subject to this disease.

6. The removal of children into the country before the approach of warm weather. This advice is peculiarly necessary during the whole period of dentition. I have never known but one instance of a child being affected by this disease, who had been carried into the country in order to avoid it.

I have only to add to the above observations, that since the prevalence of the yellow fever in Philadelphia after the year 1793, the cholera infantum has assumed symptoms of such malignity, as to require bleeding to cure it. In some cases, two and three bleedings were necessary for that purpose.