CHOLERA INFANTUM:
AND ITS SEQUELAE.
CONVULSIONS,
DIARRHEAA AND D YSENTER Y.
By WM. 0. RICHAK DSON, M. D.,
ST. LOUIS, Missouri,
Editor of the Obstetrical Department of the A merican Observer, late Professor of Gynaecology
in the Homceopathic Medical College of Missouri, Member of the
Western Academy of Homoeopathy, etc., etc.
DETROIT, MICHIGAN:
PTBLISHED AT LODGE'S HOMCEOPATHIC PHARMACY,
1874.



TO THE SUFFERING INFANTS.
To whom I devoutly and sincerely hope it may be of benefit, I most
reverently dedicate this humble effort in their behalf.
WM. C. RICHARDSON.


Published at office American Observer,
Detroit, Michigan.



PREFACE.


It has long been a matter of regret to me that Homceopathic Medical Literature, was so entirely devoid of any special treatise on a disease so universal and frequently met with
as CHOLERA INFANTUM.
Even the text-books on diseases of children are singularly
indefinite and unsatisfactory on this important subject; the
only source of really practical information we have, is scattered throughout the various periodical publications of the
last decade; it is but a comparatively small number of physicians that do or can possess all the journals, and even if they
did the difficulty, all are so well acquainted with, of finding
at once what one wants in the midst of so much foreign matter, is so great as to make this source of information almost
inaccessible to the busy practitioner.
For the above reasons, I offer to the profession this little
work on Cholera Infantum, and its most frequent sequele.Through its pages I recommend only that which by a large
experience, I have found to be the most satisfactory manner
of treatment-offering only that which I believe or know to
be good. With a firm belief in the immutable law of similia,
and owing allegiance to no sect, I disclaim now and forever
any quarrels with the adherents either of crude or infinitesmal
medication.
THE AUTHOR.
No. 3236 North loth Street,
ST. Louis, Missouri.



CHOLERA INFANTUM.


No physician, I believe, will dispute me when I make the
as it may seem the astonishing assertion, that one-third of all
deaths occurring among children under three years of age,
are caused by cholera infantum and its sequele.
Among the people it is customary to designate every case
of bowel disease occurring to children, whether it be an indigestion, inflammation, or any one of the other numerous intestinal disorders that childhood is peculiarly liable to, as summer complaint, and physicians, unfortunately have fallen into
the same general error, only desiring to appear less vulgar and
more mystical in their expression, they make use of such
high sounding, technical, and as their imagination leads them
to believe, more comprehensive appellations of cholera infantum, tabes-mesenterica, marasmus, &c., which if anything, are
far less appropriate in a majority of instances, than grandmother's simple, and to a partial extent expressive designation
of summer complaint.
Now, what are we to understand by the appellation of cholera infantum?  Simply nothing more or less than what is expressed-cholera of infants, and not by any means a diarrhcea,
dysentery, uraemia, or as some would have us believe, gastromalacia! My intention in thus particularly trying to impress upon the mind of the profession what cholera infantum
is not; (farther on I shall endeavor to show clearly what it is.)
is my honest conviction, that did physicians give more attention to the diagnosis of infantile disease, the treatment of
this class of maladies would accordingly become more rational
and less routine than it now lamentably is, and consequently
the little innocents would have the benefit of properly selected



CHOLERA INFANTUM.


9


decay, to decompose, to pass back again into their original
simple elements, from which the life-power drew them by its
organizing force. During the process of decay, many substances become volatilized and float about in the air as gases.
These gases when breathed or absorbed by the skin, become
detrimental to health in various ways, depending on their
quality and quantity. They may disturb the healthy equilibrium of the air, either by diminishing its free oxygen, by forming new compounds with some of its elements, or by simply
mingling with it a foreign substance. Heat and moisture hasten the processes of decomposition and volatilization; hence,
it is that the air in cities is much less pure in summer than in
winter.
The poisonous qualities of decaying substances cannot be
measured by the amount of odor they emit. The vulgar notion prevails that a decaying substance cannot be detrimental unless it stinks. It should be borne in mind that the most
deadly atmospheric poisons produce no perceptible impression
on the senses. Their presence is only known by their toxical
action on the system. In fact, those substances that emit an
odor give off their particles in so gross a form that they seem
to deteriorate the air, either by simply diluting it so that the
same volume contains less life sustaining element, or by uniting with its oxygen and thus generating carbonic acid and
other detrimental compounds; while more deadly miasmas
and contagions are so attenuated as to pervade the air without
disturbing its elements, as electricity pervades gross matter.Air soon becomes unhealthy by stagnation even as water
does.
Children kept in-doors during the winter, in dark, overheated, ill-ventilated rooms, die by the heats of summer. It is
my opinion that one of the chief causes of cholera infantum
in our cities during the summer months originates in the bad
management of children during the winter. This bad management consists in keeping them too much confined in ill
ventilated, over-heated and frequently foul rooms. By this
treatment they become so enervated that the heats of sum2



CHOLERA INFANTUM.


II


vated parents, who are not possessed of vital force enough to
sustain their own crumbling organisms, much less furnish the
vital animus upon which infants are principally sustained during the first year or two of their existence, and it is among
this class of scrofulous, rachitic children that cholera infantum if not so liable to attack, as those first described as being poorly nourished, is more fatal and tedious to.treat.
Cholera infantum, owing to the irritated and excitable condition of the whole system during that most critical era of a
child-life, is peculiarly obnoxious to children during the period
of dentition. In fact, it is safe to say, that it numbers threefourths or more of all its victims from among children between the ages of nine months and two years, or in other
words-the period of dentition. It is especially liable to attack those who are in the least constitutionally predisposed
directly after weaning.
In nursing children, a return of the menses will not unfrequently act as an exciting cause; mental agitation, improprieties in diet, purgative medicines, etc., are exciting causes,
acting through the maternal parent.
Having thus very briefly referred to some of the most principal conditions favorable to the causation and development
of cholera infantum, I shall at once pass to the symptoms.
SYMPTOMS.
The child is, to all appearances in the majority of cases,well
up to almost the moment of attack; in this differing from the
epidemic cholera of adults, in the absence of the premonitory
diarrhoea or cholerine which usually precedes Asiatic cholera,
and resembling more closely the cholera morbus of older persons in the suddenness, of invasion,and also in the endemic rather than the epidemic character of its prevalence. This,however,
is not invariably the case, for sometimes the disease is preceded by uneasiness and general malaise, but taken all in all, by
far the greatest number of cases are without any well defined
symptoms of premonition.
The child suddenly commences to vomit and purges copi



12


CHOLERA INFANTUM.


onsly without any seeming effort or pain, the surface of the
whole body is all at once overspread by a peculiar waxen palor;
the extremities become cold and clammy, with the exception
however, of the head which is usually hot, as is also the abdominal surface, and occasionally the face may remain flushed; the eyes are sunken in the head and encircled by dark
rings; the breathing is short and hurried, and the breath
seems cold, in this regard resembling adult cholera; the face
is flushed and shriveled; the nose becomes more pointed;--
the whole muscular system is greatly relaxed; there is a complete lack of energy on the part of the child, so much so that
it will not change its position except to take water, or toss or
roll about in a listless, aimless, despairing manner. The pulse
is peculiarly unstable or intermittent, sometimes it may be
full and bounding, at others quick and wirey, or again it
will become very feeble and almost imperceptible, but it is
always invariably rapid and never, in the last moments even,
becomes slow. There may nevertheless be an evening exacerbation, but on the following morning it will be found that
if the beats are not quite so frequent as on the preceding evening, they are still of greater frequency than they were twentyfour hours previous. There is great thirst, in fact it is insatiable and one of the most strongly marked characteristics of the
disease, if attempts to satisfy it are made, as is usually the
case by perniciously administering frequent and copious
draughts of cold water or any other diluent of whatever nature, the vomiting is greatly faci-litated and made to become
almost incessant, causing no gagging or effort on the part of
child. Food, unless it be in a liquid form is utterly refused.T"he vomiting at first consists of curdled milk or any other
food that may happen to be in the stomach at the time of attack, or that may be given to allay thirst during the progress
of the disease, afterwards it consists of slimy froth, smelling
sour and sometimes being tinctured with bilious matter, every
thing is ejected and nothing assimilated.
The purging is also copious, accompanying and sometimes
even preceding the vomiting,the evacuations at first being large



16


CHOLERA INFANTUM.


Now, arguing a priori, what is more reasonable than to infer that if the natural channels of outlet 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? For my part I am satisfied and think it cannot appear
but plausible to others, that the fluid under consideration finds
its way to the spinal and cranial cavities where its presence
acting as any other foreign secretion would produces irritation,
compression,and finally convulsions! Even in many cases where
the secretions are not diverted or arrested, the quantity poured
out is so great that it not only keeps up the vomiting and
purging, but also finds its way into the cavities containing
the great nerve centres, producing irritation and convulsions
result.
In support of this theory I may be permitted to adduce
the fact, that a great many cases of infantile paralysis occur immediately after an attack of cholera infantum, especially where the disease has been accompanied or followed by
convulsions. The paralysis manifests itself directly after the
cessation of the convulsions-the modus operandi being thus:
the brain and spinal cord have, as it were become accustomed
to the excitement and irritation of the enveloping deposit that
aroused them to such a state of convulsive activity, and now
suffer only the constant but not increasing (since the disease
spends its active force in a short time) pressure from the unnatural secretion, or rather excretion that surrounds them and
occasions an incapacity to perform the proper functioins of
their office, hence the paralysis.
It may not be amiss here to suggest, that children who are
characterized by the possession of large heads, and who have
a constitutional tendency leading toward the development of
hydrocephalus may, and in all probability do often have convulsions and even paralysis arising from the deposition in the



20


CHOLERA INFANTUM.


workings of the mouth; cold hands and feet. I know from
analogy that I have a case of approaching collapse."  *  *
As up to the present writing I have not been able to make
any post-mortem examinations of children who have died suddenly during an attack of convulsions resulting from cholera
infantum or the sudden checking up of the discharges I
can only bring to bear in this line the researches of many
eminent pathologists who have found almost invariably in
cases of death from the disease under consideration, that a
deposit of seral fluid occupied the cranial and spinal cavities,
surrounding and even occasionally infiltrating the brain and
spinal cord.
The microscope has most satisfactorily and beautifully
shown the shriveled condition of the red corpuscles of the
blood, which with many other points useless to mention, could
be brought forward to prove the great drainage of serum that
takes place. Post-mortems have also shown that the villous
coat of the intestines is raw and denuded, sometimes the denudation being only in patches, in others the whole surface is
involved; the glands of Peyer and the solitary glands are
softened, or even in many instances ulcerated perforations
have occasionally been found, and in fact, the whole structure
of the intestines is softened and in an almost disintegrating
condition; this is in those sub-acute lingering, and above all
relapsing cases, especially true of the stomach and spleen,and
has given rise amo'ng many physicians, and some of eminence
even, to the erroneous supposition that the disease was caused
by gastromalacia (softening of the stomach.)
PROGNOSIS.
Cholera infantum, owing to bad management on the part
of parents and nurses, and a faulty system of therapeutics,
has always been a disease greatly dreaded as well by the
profession, as the laity. At the present time, however, in the
light of a greatly improved system of therapeutics, and a better knowledge of hygiene and dietetic rules, I do not hesitate
to venture my belief that the mortality may be reduced at
least one-half.]



CHOLERA TNPANTUM.


21


THERAPEUTICS.
For convenience and a better understanding of the subject I
shall divide the treatment of cholera infantum and its sequelae into several sections, beginning with the cholera proper as manifested by violent and active condition of the disease
in its earlier stages, and under this head will also consider
the subacute and relapsing forms of the same. Secondly, I
shall take up for consideration the convulsions, together with
the resulting paralysis; and finally, the chronic diarrhcea and
dysentery, or so called summer complaint, will be therapeutically displayed.
I wish right here to distinctly impress upon the mind of
the reader, that in considering the treatment of this disease I
shall not advance any fanciful theories, or air any strange, newfangled remedies, simply for the sake of offering as a discovery something new; this more especially since I believe firmly
that the disease, where there is no unfavorable constitutional
tendencies, is perfectly amenable in nearly every instance, to
well proven remedies.
If I should have the good fortune, and I hope I shall, to offer anything in the shape of remedies that the profession are
not acquainted with, all may be perfectly assured, that it shall
only be such means as have been thoroughly tested in numerous cases, and found by a large experience to be the best
adapted, in the majority of cases, to the condition for which
they are recommended.
These remarks I do not offer, as indeed it may appear, in a
spirit of egotism, but for the reason that every physician in
general practice as well as myself, have found in consulting
works on medical subjects, remedial means lauded to the skies,
which no one would question might have been of great service
in one, or even several isolated cases, but nevertheless, in a
majority of cases were worse than useless.
Now, what is the result of such recklessness and indiscriminate praise on the part of medical authors in behalf of their
favorite hobbies?  In reply to the question I will say, that
physicians in busy practice are caused to lose a great deal of



CHOLERA INFANTUM.


25


China Officinalis. This remedy is often of great benefit in
cases, where the evacuations are brownish, mixed with undigested food; the symptoms are aggravated by eating, and
are worse at night; great debility, emaciation and cedematous condition of the extremities, rumbling and distended abdomen, with watery eructations and insatiable hunger and
thirst.
Chamomilla Vulgaris is indicated when the diarrhoea is
characterized by watery, bilious, greenish yellow, slimy discharges, nausea and bilious vomiting, absence of hunger, very
little thirst; the child is restless, and is relieved by being carried about.
Ferrum Meetallicum. Iron is called for when there exists a
nightly diarrhcea, peculiar to the early painless evacuation of
watery liehteric stools, distended abdomen without flatulence
great emaciation, pale bloodless appearance of the surface,
canine hunger alternating with loss of appetite..Mercurius. The soluble or black oxide of Mercury is a
grand remedy in cases that are characterised by frothy watery stools tinged with blood, and when the stools look and
smell like rotten eggs, the discharges are always accompanied
by great tenesmus, and there is extreme languor and trembling, with cold perspirations.
Rhubarb. The stools are large, consisting of a slimy liquid
smelling sour and having the appearance of being fermented,
occasional vomiting, pale face, severe colic, great restlessness,
and drawing up of the legs, accompanied by screaming.
ADJUVANS.
Cold. Cold water, or indeed in some instances even ice applied to the head and abdominal surface are very grateful, and
materially aid in controlling the vomiting and tendency toward convulsions.
I have also found, perhaps greater benefit derived by keeping cloths wet in a mixture of equal parts of brandy and icewater, constantly on the head and abdomen, changing as often
as they become hot and dry, When the surface is cold,shriv4



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CHOLERA INFANTUM.


seen the slightest ill, much less fatal results, that could in any
way possibly be attributed to such a course of medication.Nevertheless there are occasionally cases found in which such
doses, or in fact the medicines under discussion in any dose,
however minute, would be contra-indicated. I refer to those
cases where the circulation is sluggish or impeded, or where
there evidently exists cardiac lesion, in which instances it
would be criminal to make such a prescription.
TOPICAL APPLICATIONS.
Warm. Usually before the physician has time to arrive at
a patient he has been called upon to treat for convulsions, the
little sufferer will have been immersed in hot water, had hot
fomentations applied to the abdominal region, hot cloths to
the head, sinapisms to the nape of the neck, &c., &c. Now
this, perhaps is all well enough, or I would say hot applications do no harm, and may even afford temporary relief during the spasmodic paroxysm, by relaxing the muscular system, and thereby reducing to a certain extent the spasm and
rigidity; but as a means of preventing the recurrence of convulsions, has no beneficial result whatever.
Cold. When we take into consideration the fact, that the
kind of convulsions we are discussing,usually arise from a hyperaemic condition, or an effusion of serum into the cranial
and spinal cavities, it will at once be perceived that cold and
stimulating applications in the treatment are not only appropriate, but quite indispensable.
I usually direct pounded ice to be placed between folds of
oiled silk, or in a bladder, and if neither are convenient between folds of flannel, and placed directly over the region of
the brain and spinal cord, and on top of this folded towels or
napkins to prevent soiling the clothes or bedding, or if this
from any peculiarities of the case or surroundings, is found
objectionable, the mixture of brandy or whiskey and ice water, as previously recommended under another head, may be
applied to the same regions, and will answer the purpose quite
as well.



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CHOLERA INFANTUM.


which it may remain after the direct cause has ceased to
exist.
In such cases great benefit will be derived from the judicious administration, according to the idiosyncrasies of the individual patient we have under treatment, of such remedies
as the following:Aluminum Metallicum-when the paralysis is confined to
the lower extremities, and the seat of the effusion has evidently been in the spinal column.
Arnica Montana-in cases where the paralysis is general
rather than local, and the exudation has occurred in both the
cranial and spinal cavities.
Belladonna, or A tropine-will be found of great service in
hemiplegia, where the enfused liquid has been confined to
the cranium.
Cocculus Indicus-will be found useful in paraplegia occuring in debilitated nervous patients, and where the circulation
is impeded or sluggish, giving rise to cedema.
Dulcamara-is an excellent remedy in paralysis of the extremities upper or lower which are not devoid of sensation,
but the circulation is so interfered with as to occasion a peculiar icy coldness.
Gelseminum-is indicated in complete paralysis, or rather
where the muscles seem to have only lost power of contraction at the will of the patient, there being no loss of sensation or the slightest change in temperature.
Nux Vomica-this remedy will be found useful in cases of
paralysis that are incomplete-that is, where the power of
motion at will is not totally gone, but very much impeded by
painful twitchings, and spasmodic contractions occur whenever the affected part is exercised.
Phosphorus-where the trouble is confined to the extremities, upper or lower, and originates from pressure on the spinal cord.
Plumbum Metallicum-complete paralysis, together with
general atrophy.
Secale Cornutum-in emaciated subjects, if the paralysis si
accompanied by a constant tendency to spasms.



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CHOLERA INFANTUM.


"To manage a case of disease successsfully, will often tax
all the powers of a young physician, as well as one who has
years of experience, and 'grown gray in his profession.' Before giving any advice as to the medicines necessary, we wish
to say that, where it occurs in large cities, a change of air for
the child is advisable. If circumstances allow, it is well to
send the patient to some northern climate, where the heat is
not excessive. We prefer the seashore, mountain air, or near
some lake, where the surroundings are pleasant and agreeable.
This change will save the lives of a great many children, but
in most cases, in ordinary practice, it is impracticable, as the
means of the parties will not allow them to go away with
their children.
MEDICINES. For the diarrhoea, if without fever, and the
passages are undigested, alternation with watery stools, with
nausea, furred tongue, and the attack has come on after a
constipation, Antimonium crudum 3rd, may be given. Evacuations frothy, painless, but worse after eating, China 2nd.Evacuations smell sour, breath sour, dentition retarded, abdomen bloated, child emaciated, and othe remedies have perhaps failed, Calc. carb. 2nd, In some cases where the stools
were chalky, with no appearance of bile in them, especially in
infant artificially reared, children who seem subject to frequent attacks of bowel complaint, we have given a trituration
of Phosphate of Soda "I-5, in doses of from one to ten grains
three times a day. In the diarrhcea accompanying whooping
cough, in cases where the children are greatly emaciated and
digestion was impaired. it has many times!proved a very valuable medicine. We call the attention of our professional brethren to this remedy, and one of the principal indications of its
use is where the bowel complaint has been induced from the
want of a requisite variety of food.
Where the stools are serous, watery, sometimes involuntary
with great pain, Oleum Crotonis. Compare also, with the last
named, Elaterium. Yellowish, profuse stool, Jalapa 2nd;vomiting and nausea, Ipecac 2nd, Pulsatilla 3rd, or Arsenic.
30th; vomiting and nausea, with very fcetid stools, child sinking, Kreosote Ist attenuation. This is a very important and
effective remedy, useful (I may say sometimes specific) in
chronic dysentery. Evacuation slimy, with straining, gums
sensitive and swollen, child sweats much, and has aggravations at night, one of the following preparations of Mercury
may be selected: Mercurius sol. 2nd, or Merc. dulcis 2nd.other remedies, such as Acid Phosph., Acid Sulphuric, Podo