Cholera infantum

“ Cholera Infantum, or summer complaint, is a disease peculiar to the warm season, and more prevalent in cities, and among those children who do not nurse at the breast. It is characterized by great irritability of the stomach, and persistent vomiting and purging, the discharges from the bowels being copious and watery, and sometimes containing specks of curd, yellowish-green matter, and mucus. The limbs of the little sufferer are usually drawn up, indicating pain in the bowels, and there is great prostration with cold extremities. ”

“ In cholera infantum the gastro-intestinal symptoms always take the precedence, and are, except in advanced cases, always more prominent than other symptoms. It does not commence as by a stroke like coup de soleil, but it comes on more gradually, though rapidly, and it often supervenes upon a diarrhoea or some error of diet. In the commencement of cholera infantum the infant is not apt to be drowsy, and it is often wide awake and restless from the thirst. ”

“ In the treatment of this disease as it affects young children (Cholera Infantum) , most reliance is to be placed on the administration of chalk and the use of starch enemata. In their case opium in any form cannot be safely employed.
Malignant Cholera (synonyms, Asiatic Cholera, Indian Cholera, Epidemic Cholera, Algide Cholera) is one of the most severe and fatal diseases. In describing the symptoms it is customary to divide them into three stages, but it must be noted that these do not always present themselves in so distinct a form as to be capable of separate recognition. ”

“ Summer diarrhea of children, also called cholera infantum, occurs as an epidemic in almost all large cities during the hottest days of summer. The disease is largely fatal, especially during the first hot month, because the most susceptible and tender children are the first affected. It is due to the absorption into the systems of these children of the toxins formed during the putrefying of milk in the stomachs and bowels of the little sufferers. Clean, pure sweet milk, free from bacteria should be used to prevent the occurrence of this disease. ”

“ It is obvious, from what has been stated in the foregoing pages, that cholera infantum is the form of this malady which involves greatest danger. Except in such cases there is sufficient forewarning of a fatal result, for if death occur it is after a lingering sickness, with fluctuations and gradual loss of flesh and strength. Patients often recover from a state of great prostration and emaciation, provided that no fatal complications arise. ”

“ Cholera infantum attacks only those children who have been raised without breast-milk, those who have been weaned too early or too hastily, or those to whom, on account of the failure of the mother's milk, other foods have been injudiciously administered. ”

“ Cholera infantum requires similar treatment to that which is proper for the ordinary form of the summer diarrhoea, but there is no disease, unless it is pseudo-membranous croup, in which early and appropriate treatment is more urgently required, since the tendency is to rapid sinking and death. As early as possible, therefore, proper instructions should be given in regard to the feeding, and for an infant between the ages of eight and twelve months either one of the above prescriptions should be given or the following ”

“ I have often compared our endeavours to cure cholera infantum, while these causes remain, to an attempt to relieve inflammation in a part, while a thorn is sticking in the flesh. We may resort to bleeding and leeching; we may restrict our patient to the lowest diet, and the most perfect rest; we may employ all those remedies, which are ordinarily best calculated to reduce inflammation: but so long as the thorn continues in the wound, our efforts will be fruitless. Thus it is with cholera. We may obviate the more violent symptoms ”

“ The passage of curds in the stool is a danger signal indicating overfeeding and should be heeded immediately. If it is not, the chances for a ease of cholera infantum, especially in warm weather, are great. Cholera infantum is due to overfeeding, or the use of inferior milk, or both. It is a form of milk poisoning, in which the bowels are very irritable. As a matter of self-protection they throw out a large quantity of serum, which soon depletes the system of the poor little sufferer, and death too often claims another young life. ”

“ The diarrhœal diseases, comprising infantile diarrhœa, cholera infantum, inflammation of the bowels, dysentery, and some others. These are the cause of at least one fourth of the entire infant mortality the world over; while in America cholera infantum alone is responsible for nearly or quite one fifth. ”

“ If cholera infantum makes its appearance the baby is given its best chance to live if feeding is stopped immediately, warm water given whenever desired, but not too large quantities at a time. Give no cathartics, for they irritate an already seriously disturbed mucous membrane, but give a small enema of blood-warm water once or twice a day. Keep the baby comfortable, seeing that the feet and abdomen are kept warm, but give plenty of fresh air. ”

“ Attending upon this or even sometimes preceding it, or rapidly succeeding upon it, is the extreme muscular prostration and great depression of the respiratory functions; there is generally more or less griping pain and restlessness, and a rapid appearance of all the symptoms of collapse, coldness of the surface and tongue, feeble rapid pulse, and partial or total loss of voice. Cholera infantum proper, lasts but a few hours—hardly a few days—when it ends in recovery, death, or inflammatory disease of some portion of the intestinal tract ”

“ On the other hand, should you have to wait even three or four hours for a physician begin one of the treatments below until he comes; you may save the child's life by doing so. Cholera infantum and pneumonia claim so many of our little ones each year, and in many cases snatch them away within a few hours of the first noticeable symptoms that we must advise you to call a physician as soon as you suspect it is serious. Cases vary and only a trained eye can detect the little symptoms and changes that may weigh in the balance the life of baby. ”

“ The great office-workers do not contribute largely to our mortality statistics, but we will derive great comfort as we proceed, in finding 277that the figures of these common men are stupendously significant—that the bullet and bayonet are in the aggregate little less important than the epaulette and the gold lace.” He supposed that in the large majority of cases reported as cholera infantum that the choleraic feature was present at some time during the illness, though very likely not at or very near the time of death. ”

“ If these children are improperly fed, or if their surroundings are not sanitary; if they are not getting fresh air enough, or if they suffer because of lack of attention, and have at the same time a little indigestion, it is only a step further to develop a full-fledged cholera infantum.
The outcome of any case of summer diarrhea is questionable. It is not safe to make any promise. An apparently mild attack may prove quickly fatal. Much depends upon the previous history of the child. If it has been a strong, healthy child it has a very good chance if treated energetically and correctly. ”

“ If it be true, as it is believed to be, that they are affected by cholera in a degree scarcely, if at all, exceeding that of persons in the same social condition otherwise employed, the fact would appear to furnish a strong general argument against the contagious nature of the disease. ”

“ Before such admission can be held necessary, it must be shown that the disease which attacked the nurse was not derived from places outside the Hospital, which he was allowed to visit, or from the cause diffused in the air of the neighbourhood, in less or greater concentration, and manifesting its powers relatively to the degree of concentration, and the force of pre-disposing co-operating agents.
It would be unsafe to assert that cholera can never, under any circumstances become contagious ”

“ This is not unfrequently the case on board some of our emigrant ships, when hundreds of human [p.36] beings are stowed away between decks without the means of efficient ventilation, disinfection, or other mode of expelling the noxious principle. Though the germ of disease may be ever on board, it does not vegetate and come forth and rapidly acquire its activity, vigor and power, unless the localizing influence vivify, foster and nurture its development. This is fully confirmed by the recent arrival of two steamers with cholera on board. ”

“ A cheerful home with a small tract of land in the country, with wholesome food and water, is worth more to preserve health and life, than a house in a crowded city with luxuries and twenty rooms to let. That bad air is not the sole cause of infantile cholera, I will mention an incident in proof. While travelling through some of the thinly-settled districts of the British Provinces during the prevalence of cholera in the autumn of 1865, I noticed that most of the children suffering from the disease were those of parents whose circumstances would not warrant the comforts of life. ”

“ In New York, it has been observed that they have enjoyed no greater immunity than the whites, and the natives of India, whose constitution much resembles that of the negro, were more liable to cholera than Europeans. There is ample grounds for fearing that the disease will be productive of terrible mortality among the slaves of the southern states, and proper measures of hygiene should be promptly adopted; and on the very first symptoms of derangement of the digestive organs, remedial measures immediately resorted to. ”

“ The only effect of its communication in the pits would be, that the men and boys in a family would have the cholera a day or two earlier than the women and children; and if a special inquiry were made on this point, this would probably be found to be the case. It has often been said that, if cholera were a communicable disease, women ought to suffer in much greater numbers than the men, as they are employed in nursing the sick. ”

“ It is a great mistake to conclude that infants will have cholera if weaned early, or if they are to be artificially nursed. The fear comes from persons having been so educated within the last half century.
All kinds of preparations are advertised and eagerly sought for baby diet; as if the internal organs of babes were entirely different from what they were before, and must needs be supplied with something more supernatural than those of the adult. The symptoms of cholera are by no means uniform. ”

“ I will not pretend to say, which is the first cause of Cholera, nor do I think we shall arrive at that knowledge till the analysis of the atmosphere is carried to infinitely greater perfection than it is at present; till we are able to separate the principles of small-pox, plague, and intermittent fever from the air we breathe, and bottle them up as we do oxygen, nitrogen, and carbonic acid gas. I consider cholera essentially a disease of secretion, of immoderate secretion of serum from the skin and the intestines. ”

“ I know not of any visitation so much to be dreaded as epidemic fever; it is worse than the plague, for it lasts throughout all seasons. Cholera may seem more frightful, but it is in reality less destructive. It terminates rapidly in death, or in as rapid recovery. Its visitation, too, is short, and it leaves those who recover unimpaired in health and strength. ”

“ In the Minden, hospital ship at Hong Kong, in 1843, when periodic fever and flux were prevalent and highly fatal, a man, convalescing from an attack of the latter, was suddenly seized with unquestionable symptoms of cholera, which ran its destructive course in a few hours. ”

“ Care must be taken by the authorities and by the community to take measures for the treatment of the sick. But the difficult point in the prevention of cholera is the predisposition in time and place. It is no use urging, as the contagionists do, that we can not change the nature of the soil. One of the established facts concerning epidemics of cholera is the tendency of the disease to rage in those quarters where the greatest filth prevails. All towns which have been provided with good drainage and water-supply have lost their susceptibility to cholera. ”

“ It is this multiplication, and the disturbance which attaches to it, that in each case constitutes the disease and destroys life. Of this fact the circumstantial evidence is abundant and conclusive, and may account in part for the violence of the disease in its first irruption in any particular locality. [p.47] The vomiting, purging, and cramps are now generally considered as secondary and non-essential phenomena, for numerous cases of cholera have occurred in every section where it has prevailed in its more violent and malignant form without exhibiting these symptoms. ”

“ As far as they go, they harmonize with a long-prevalent opinion that the cholera poison consists of certain microscopic germs, which, on being received into the bowels, propagate their kind and destroy the epithelium. It is believed by some that these bodies are products of the rice-plant on the banks of the Ganges, and that, having once originated the disease, the germs contained in the discharges become mixed with water or are borne upon the wind, and enter the system of new victims, who, in their turn, disseminate the plague. ”

“ The eggs of the tape-worm must undoubtedly pass down the sewers into the Thames, but it by no means follows that everybody who drinks a glass of the water should swallow one of the eggs. As regards the morbid matter of cholera, many other circumstances, besides the quantity of it which is present in a river at different periods of the epidemic, must influence the chances of its being swallowed, such as its remaining in a butt or other vessel till it is decomposed or devoured by animalcules, or its merely settling to the bottom and remaining there. ”