- i* I
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CHOLERA


INFANTUM:


AND ITS SEQUELAE
CONVULSIONS,
DIARRFICEA AND 1 YSENTER Y.
By WX. 0     PUICHARDSON, X, f.,
ST. LOUIS, Missourxi.
Editor of the Obstetrical Department of the A mnerican Observer, Professor of Diseases of
Women and Children in the Homecopathic Medical College of Missouri,
Member of the Western Academy of Homoeopathy, etc., etc.
DETROIT:
PUBLISHED AT "AMERICAN OBSERVER" OFFICE.
1876.










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




6


CHOLERA INFANTUM.


and appropriate remedies-the frightful and seemingly unaccountably large mortality list would be greatly diminished;
parents would be doubly grateful to the physician who gave
the same careful attention to their babes that he did to
the older but no more esteemed members of their family,
and physicians themselves would feel a deep, though perhaps inexpressible consciousness of satisfaction on not being
called upon so frequently to sign mortuary certificates.Right here I cannot forbear quoting from Dr. J. W. Thrailkill's most admirable little "Essay on the Cause of Infant
Mortality,"-he says:" The physician occupies a peculiarly responsible position in
society; one that is not well understood nor appreciated.The patient sins against nature by disobeying the organic
laws-those laws established by the Creator for the regulation
and government of this physical existence. After the sin has
been committed, and the patient feels the infliction of the
penalty (that is the disease,) coming on him, the physician is
sent for to reprieve him from the punishment. The physician
thus becomes the mediator between the sinner and the offended law, and offers as a propitiation for the sins of his patient
the means which bounteous heaven has so munificently bestowed for the purpose, in the shape of remedies. Hence, the
true physician is the servant of the Divine Master, interpreting His will in the great book of nature before us, and dispensing out his blessings to many an unworthy sinner. But
in the case of the child the parents are morally responsible
for the sins committed against nature's laws, although the penalties fall upon it alone. The physician in thus assuming the
functions of an interpreter of nature and a dispenser of her
blessings, often takes into his hands the reins of life and
death, and should feel the high order of the responsibilities
resting upon him."
From the extreme susceptibility of the infant constitution
to the action of both disease and medicine, the responsibility
of the physician is much greater in treating this class of patients than it is in the treatment of adults. The life-power of




CHOLERA INFANTUM.


7


the infant, compared to that of the adult, is as a candle to a
blazing furnace. The one may be blown out by a blast which
would but serve to increase the other's heat. Hence the necessity of treating these little beings with the greatest circumspection and the mildest and gentlest medicines. The physician may fire away at his adult patients with all the artillery
of the apothecary shop, day after day, and week after week,
and nature will finally come off victorious, and restore the patient in spite of the disease and the treatment, and the physician will get all the glory of the victory. A little anecdote
will illustrate the practice of some physicians admirably.
Two men were riding together along the road, one a little in
advance of the other; the foremost man rode under a swinging limb of a tree; as he did so, he caught it, and pulling it
after him as far as he could, then letting it go, it flew back and
knocked the hindmost man from his horse. He got up, badly
hurt, thanked his companion, and told him that if he had not
held that limb as long as he did it would have killed him.
Just so do many physicians get the credit of saving their
patients lives by almost killing them. However much undeserved reputation physicans may gain by such practice among
adults, it proves a blighting ruin to little children. Even those
it does not send to the grave, often have implanted in their
very vitals the seeds of some lasting infirmity."
CAUSES.
Cholera infantum is similar to the cholera morbus of adults,
inasmuch as it is like the latter, usually most prevalent in an
endemic form during the warm season, and especially during
hot damp weather, and is precipitated by impure vegetables
any indigestive or irritating substances partaken of by the
nursing mother or the child itself.
Whether cholera infantum, cholera morbus, or even epidemic
cholera be dependent on atmospheric spores, germs, or an inadequate supply of ozone in the air, will not be discussed here,
especially since there has been so great a variety of opinions
on the subject in scientific circles and as we have no positive




8


CHOLERA INFANTUM.


proofs pro or con; it may, however, en passant, be remarked,
that it is a fact well known and admitted by every observant practitioner, that at least the two former disorders, whatever the immediate or exciting cause may be, are invariably
found to occur in greater frequency during those seasons that
are characterized by frequent showers of rain followed by hot
sunshine, or in other words, seasons that are peculiarly well
qualified for their favorableness to rapid vegetable decomposition.
Among the remote causes of cholera infantum, it may be
well to mention violations of respiratory laws; this may appear a little far-fetched, but as farther on I shall satisfactorily I believe, show that the disease under consideration is
dependent on a decomposition or a disintegration rather, if you
will, of the blood, it will be very easy to comprehend how an
impure atmosphere inhaled into the lungs, the purifying chambers of the blood can lead to cholera infantum. We all know
that physicians in crowded cities where the air is necessarily
injurious, after failing to cure cases of this disease, invariably
and almost always with good results, send the little sufferers
to the country,where it is nothing but the pure air, and perhaps
a change of diet that effects a cure that no amount of medication could do.
I shall again quote from Thrailkill-" Most persons (and he
might add physicians) have a vague idea that it is unhealthy,
especially for children, to breathe an impure air; but very few
know anything more about the matter than this. What constitutes pure air and the purpose it subserves in sustaining life,
and also what constitutes foul or impure air and the sources
that give rise to this and the evils it engenders to health, the
vast majority of the people are about as ignorant of as 'the
man in the moon.'
The chief sources of impure air in cities are animal and
vegetable substances in a state of decomposition, and the unhealthy qualities which the air acquires by its stagnation in
confined places. All organic substances, that is everything of
vegetable or animal origin, as soon as life is extinct begins to




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




IO


CHOLERA INFANTUM.


summer destroy them by this terrible disease. That it is not
the action of the solar heat alone that produces this disease is
evidenced, by the fact, that it is actually less prevalent in the
south than in the north. There is actually less mortality from
cholera infantum in the cities of Charleston and New Orleans
than in New' York, Philadelphia and St. Louis-the winters
being so mild in the South that children are not kept confined
in-doors so constantly, nor for so great a length of time as
they are during the winters at the North. Therefore they are
able, in the former situation to withstand even a greater heat
with less mortality from the disease."
Cholera infantum attacks in preference usually, first,children
that are characterized by being large, fat, and to all appearances the very ones that one would think should escape itindeed, their constitution and health to all outward appearance is excellent; but they are really far from being in a
healthy condition, for their seeming robustness is in the highest degree artificial, and the result of a systematic swill feeding, whether it be from nourishing them with milk obtained
from cows that are fed on brewery slops, as is done by all, or
nearly all dairymen in our large cities, and their vicinity,
or by the mother allowing herself to be argued into the equally pernicious belief that lager-beer, the refined slop of the
brewery, will increase the amount and improve the quality of
the secretions of the lacteal glands.
I say, the mother permits herself to be argued into this belief, advisedly, for her natural taste instinctively, in nearly every instance leads her to abhor the (to her) vile stuff; and it is
only after long perseverance and great effort to overcome natural disinclination, in most cases, that she can accustom herself to drink it at all. Beer may be well enough in its proper
place, but experience and analysis have satisfactorily proven
beyond a doubt, that its place is not the stomach of the nursing mother. Thus we see that large, artificially nourished
children furnish the most numerous victims to this disease.
Among children peculiarly predisposed to cholera infantum,
we find secondly, children that are born of diseased and ener



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




CHOLERA INFANTUM.


13


and in composition and appearance dependent on the contents
of the bowels at the time of attack, but the discharges soon
become less in quantity but more frequent, the matter changing to a slimy or frothy, dirty white or gray color, intermingled with green-are extremely putrid, acrid and sour smelling, the matter evacuated sticks to the diaper 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.  There may also sometimes be frequent discharges of very offensive and foetid flatulence; the abdomen
may be tympanitic, hot and excessively sensitive to the touch.
There usually is a partially and sometimes a complete suppression of urine, and that which may be voided is thick, turbid, and shows traces of albumen. This has led some authors
to erroneously confound the disease with uraemia. This condition may be of twenty-four hours duration and generallyjis
accompanied by considerable restlessness, which the little sufferer manifests by its rolling and tossing about, placing the
hands frequently on the head and moaning in a manner most
piteous to see or hear; 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 little patient may readily be aroused from this comotose condition
and consciousness is always found to be unimpaired; which
is not the case in hydrocephalus, and is a diagnostic point of
great importance.
The above comprises the usual symptoms and course of the
disease; there are, however, many cases to be met with in
which the malady assumes a sub-acute form, and all the
above enumerated symptoms in a less violent though none
the less dangerous form, are continued throughout a period of
several days or even weeks-again there is a great liability to
frequent relapses.
If death does not take place during the first onslaught of
the disease, as is indeed too often the case where there is debilitated or pampered constitution for it to work on, or under




t4


CHOLERA INFANTUM.


mismanagement and heroic treatment; the disorder may now
subside into a rapid convalescence and the return to health will.
be as speedy and sudden as was the occurrence of the attack
Again it very frequently happens that the vomiting gradually
ceases, the nervous system recovers slowly from the shock, the
child rallies and regains partially its former strength, but a debilitating diarrhcea or dysentery remains to run a subacute
course and finally if not properly treated becomes chronic,
which condition is casually and quite appropriately designated
as marasmus or summer complaint. This diarrhoea, or dysentery as the case may be, is very telling on the frail and immature little body, causing it to waste away rapidly, and taken
altogether it is perhaps one of the most annoying difficulties
peculiar to childhood that the physician is called upon to deal
with.
Taking into consideration the fact that it is so familiar
to every physician in general practice, I shall not attempt to
enter into the protean characteristics so peculiar to it, but
shall satisfy myself by giving some of the most frequently
met with and prominent symptoms. In nine cases out of ten
it is occasioned by irritation of the whole alimentary canal,
caused either by the use of astringent or other injudicious
remedies employed to abort the disease in its earlier stages.
This irritable condition is often neglected and fostered by
improper diet and bad medication until inflammation and
ulceration of the intestines has taken place, which soon puts an
end to the little sufferer.
Gastromalacia or softening of the stomach, another almost
irremedial difficulty may and often does result from the same
cause. The alvine evacuations are capricious as regards frequency and varied in character, sometimes being diarrhceic, at
others markedly dysenteric; the child is very irritable, fretful,
languid or drowsy-like; the appetite is also capricious, there
being sometimes almost a complete absence of any desire to
partake of any food, again there will be canine hunger; the
abdomen is puffed, hot and sensitive to the touch; the head,
especially the occipital region is hot, there is a constant, some



CHOLERA INFANTUM.


IS5


times however, intermittent feverish condition, cold extremities and great emaciation.
CONVULSIONS.
During the acute form of cholera infantum as before stated,
convulsions are frequently met with and often they will be
found very violent and intractable to ordinary treatment; this
is especially true if the disease should be diverted from its
natural course during the earlier stages of its progress by
means of violence, that is in other words-if the vomiting
and purging are arrested by the administration of any drugs
the action of which is to plug 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. The consideration of this phase of the disease lead
us to its
PATHOLOGY.
Now I have a theory in regard to these convulsions, which
if correct, and admitted so to be, will I most confidently believe prevent every physician from attempting to stop suddenly the evacuation peculiar to this disease.
To begin, let us first consider what the evacuations of the
cholera infantum consist of, surely not of any food or drink
partaken of by the child, for this is all expelled in the earliest
stages by the first three or four discharges, but notwithstanding this the flux still goes on, and that too even if water and all
other kinds of drink or food are entirely withheld, but ot
course their frequent liberal administration which is usually
permitted greatly increases the quantity discharged.
It is I believe, almost universally acknowledged that the
so called rice-water evacuations of Asiatic cholera and sometime cholera morbus after a time are composed principally
of serum from the blood, which owing to the loss of nerve
force and power of contractility in the vessels, coupled with a
general relaxation of the whole vascular system, is poured out
or we might say, drained off very rapidly. This is likewise
true of cholera infantum.




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




CHOLERA INFANTUM.


cerebral and spinal cavities of the fluid under consideration,
without the occurrence of any more violent symptoms such as
vomiting, purging, &c., of cholera, there being only slight intestinal irritation coupled with looseness of the bowels to indicate the character of the disorder.
I may here appropriately perhaps state, as not altogether
foreign to our subject and partially confirmatory to the theory
advanced, that during the prevalence in St. Louis throughout
the winter and spring of 1873, of the terrible epidemic of cerebro-spinal meningitis, I observed in numerous cases of that
disease that there occurred a copious deposit of seral fluid,
in the synovial sacs enclosing the knee and elbow-joints,
which was doubtless occasioned by the meningeal inflammation having been extended to these membranous sacs which are
well known to be closely related in structural formation to the
membranes which were the original seat of the inflammation.
I also remarked that where this, as it might with propriety be
designated vicarious deposit took place the patients almost
invariably recovered from the attack, and that too without
any symptoms of the paralysis that, as is so well known, frequently accompanies the convalesence following this disease,
which paralysis beyond a doubt is occasioned by a copious
deposit of fluid in the cerebral and spinal cavities as a result
of the meningeal inflammation.
I could enumerate, did I deem it necessary so to do, in support of this theory, several cases of cholera infantum accompanied or followed by convulsions that very evidently were the
result of an exudation; however I shall confine myself to
the narration of one very strikingly characteristic and typical
case which occurred in my practice during the summer of
1873.
At 6 o'clock on the evening of June 26th I was summoned
in haste to see the child of Mr. J. C. The babe was aged 18
months, and had previous to the present attack enjoyed ordinary good health; there were however some indications of
a scrofulous diathesis, it had not been weaned, but was given
3




18


CHOLERA INFANTUM.


in addition to the breast food from the table. I was informed that the child had been attacked early that morning
with violent vomiting and purging. It being some three miles
or more from my residence to where the family were located,
and as there was no messenger to be found, (her husband being absent) the mother in her fright and emergency called in
an "old school" practitioner who happened to reside in an adjoining block.
Now let us see what "old regular" proceeds to do, nothing
more or less than to administer some powders that I on examination found to consist of Opium, Calomel and Camphor?
Now for the result of this most admirable prescription. The
cholera as manifested by vomiting and purging was almost
instantly arrested, and I suppose our regular friend thought
he had made a beautiful cure; but.alas for regular triumph!
in less than three hours time from the stopping of the vomiting and purging, convulsions of a most violent nature set in"regular" now says that the disease has gone to the child's
head, which among homceopaths as well as regulars is always
the excuse when this grave complication results-it satisfies
parents you know, and besides it is strictly speaking true; but
how does it come to go to the head? In this case as in many
others, it was forcibly driven there by the medicines.
On my arrival I found the child in an almost continuous
state of convulsions, the intermission between each convulsion being only an interval of about two minutes and-a-half
during which there was a partial return to consciousness, then
a return to violent convulsions which lasted during a period of
from five to ten minutes. This condition had already existed
several hours, and I at once informed the mother that I had
but little hope of benefiting or saving the little sufferer, but
nevertheless I prescribed with the view in end, to quiet the
convulsive state and bringing about a restoration of the alvine
evacuations.
On returning to see my patient the following morning, June
27th, I was happily surprised to find that my prescription had




CHOLERA INFANTUM.


19


very fortunately and opportunely effected the result that
had been desired-i. e., the convulsions had been banished on
a return of free evacuations from the bowels. Nor was this all
the change I discovered; in addition there existed, as might
have been anticipated, complete paralysis of te entire right
side including the face. Now what caused this paralysis? I
think I can without fear of contradiction answer, that it was
simply pressure of the fluid (that had been diverted from its
natural channels of exit) upon the great nerve centres. I now
leave the case by stating that after some three months treatment the patient was discharged cured of its paralysis and in
general good health.
This is not an imaginary or isolated case, and with the exception of the paralysis, but one of many, that as before stated, did I deem it necessary in support of my theory, I could
cite,as doubtless could almost any physician in active practice.
Where convulsions do not directly supervene from this copious exudation of serum, after a time another condition occurs
that gives rise to grave cerebral symptoms. I cannot better
describe this condition than by quoting from Dr. 0. P. Baer in
Medical Investigator, vol. ix., page 374. He says:
"I look upon the head troubles as simply symptomatic,
arising in consequence of the great drainage of serum from the
blood, thus leaving the crassamentum in excess, and in consequence of one sixth of the whole volume of blood of the person circulating through the head, the crassamentum must necessarily be great in excess.  This contains all the carbon,
fibrin, albumen; hence the great tendency to coagulation by
overcoming the weakened force of the cerebral vessels. Venous action is tardy; veins look blue; serum is nearly gone.
The child is anaemic-bled to death as it weie, by excessive
alvine discharges.  The whole system is blanched, just as
complete as a case of cholera Asiatica. And if you ever had
a bad case of collapsed cholera to recover, the patient being
intelligent will tell you of the numerous head symptoms.Now analogy teaches us, or should teach us many things that
nothing else will or can. I see my babe lie with its little eyes
half-open when in sleep; its cerebellum, and indeed the whole
base of the brain unnaturally warm, with tossing of the head
from side to side; fontanels sunken, with moans and constant




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




22


CHOLERA INFANTUtM.


precious and valuable time by being led to try them; and the
innocent patients, alas! too often lose their lives, victims to a
very foolish and vain-glorious effort of some medical penny-aliner to distinguish himself by offering something new, however worthless it may be.
I do not, by any means say this to deter any one from making discovery of new remedies and methods of treatment, but
on the contrary believe in encouraging new discoveries, with
the proviso, however, that they be well proven before they are
offered to the world as infallible. Let us by all means confine
ourselves to old and well-proven remedies, unless we have the
evidence of some honest man, that the remedy offered has
been proven in numerous well attested cases of the disease for
which it is recommended, and not, as is too frequently the
case, in one or two exhibitions where it may be very doubtful
whether nature or the remedy effected the relief. Without
further preliminary remarks, other than to say that I shall
only give brief characteristic indications for the administration of each drug, I shall now proceed to the treatment of
Cholera Infantum.
REMEDIES.
Veratrum Album is, perhaps, in a majority of cases, the
first remedy to be called into requisition. It is especially indicated if the attack should be ushered in very suddenly by
large watery discharges from the bowels, immediately followed by copious vomiting without seeming effort; cold, clammy
surface, great and sudden prostration following immediately
upon the extraordinary profuse evacuation.
Very great sensitiveness and pain in the abdominal region;
great anguish is indicated by the moaning and tossing about
of the little patient; tendency to spasms, painful contractions
of the soles of the feet and palms of the hands; and finally,
I may say, that the most marked characteristic of Veratrum
is the attack comes on early in the morning.
Tartar Emetic is, in cases of sudden invasion, next to Veratrum, the best remedy. Its most marked indications arealmost incessant and profuse vomiting, accompanied by a




CHOLERA INFANTUM.


23


short dry cough, rattling in the throat, apparent constriction
of the pharynx, labored breathing, cold hands and feet, great
pallor; child is drowsy, does not like to be disturbed, and does
not seem at all thirsty.
A senicum Album is called for in those cases where there is
violent gagging and vomiting, which, however, is not very copious-of watery, bilious, slimy, greenish-brown, or black matter; the lips are blue, cold and shriveled; the breath is cold,
nose pointed, sunken cheeks; cold, dry, shriveled and bluish
skin all over the body; pulse tremulous and intermittent;small watery evacuations accompanied by very painful burning
tenesmus, and burning thirst, which nevertheless is quenched by
very few drops only to return in a few moments as bad as before
drinking.
Ipecacuanha is also indicated by sudden paroxysms of great
nausea and loathing; but vomiting, if it should occur, is very
scant, consisting of mucus and bilious matters mixed with
ingesta, diarrhoeic evacuations of greenish yellow, slimy lumpy matter, smelling sour, and having the appearance of being
fermented; face puffed, distorted, red and hot, blue margins
around the eyes, paroxysms of suffocative spasmodic cough,
during which the face becomes blue and the body rigid, panting breath and nervous twitching.
Cuprum metallicum. Copper is an excellent remedy where
there is a tendency to convulsions from the very outset, and
where the vomiting and retching are violent and seem to arise
from  abdominal spasms; the child is very irritable and
screams violently with anger on the slightest provocation.
Tabacum. Tobacco is an excellent remedy in those cases
of cholera infantum, where there is icy coldness of the extremities, with hot abdominal surface, and the little sufferer
does not seem satisfied until atll the covering is removed, and the
abdomen is exposed to the cold air, which seems to mitigate the
vomiting and nausea, that are always incited by motion;deathly pallor of the face, and cold viscid sweat.
Aconitum Radix. If in the earlier stages of the attack the
child has a flushed face, hot head and abdomen, fierce thirst,




24


CHOLERA INFANTUM.


together with symptoms of great general febrile excitement I
have almost invariably found beautiful results to follow the
administration of frequently repeated doses of root tincture
of Aconite, given in the following manner:Mix ten drops of the tincture in ten tablespoonful of cold
water,administering a teaspoonful dose every 15 or 20 minutes,
until the febrile excitement is controlled, after which some
one of the previously mentioned remedies, may be called into
requisition.
Camphora. In cases where all other remedies have failed,
and where collapse is imminent, or has already taken place,
tincture of Camphor prepared and administered in the same
manner as Aconite as above recommended, will prove highly
efficacious, recalling life as it were at the last moment.
With the exception of Aconite and Camphor, which according to my experience should always be given and prepared as
in the manner above described, I have purposely avoided recommending any potency or mode of preparation, leaving it to
each practitioner to give the remedies in such manner as his
own judgment or experience may dictate, and this I do simply because I believe the remedies if given to the individual
indications of each will do good in any potency or manner that they may be exhibited. However, it may not be
amiss to state, that I have preferences for the second and
third attenuations, and believe they should be administered
at intervals of not less than half-an-hour.
The remedies above mentioned are those that by experience
I have found most beneficial in the majority of cases; to be
sure there are many others, yet I think that nearly every curable case of cholera infantum may be brought to a successful
issue by a persevering and judicious application of their
virtues.
In those cases of sub-acute, lingering and recurring cholera
infantum, where all the marked symptoms of the disease are
present but in a mitigated or less %iolent form, I have found
in addition to the remedies already referred to, the following
to be of great utility:



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




26


CHOLERA INFANTUM.


Sled, and collapse evidently approaching, active friction with
camphorated oil is exceedingly beneficial.
Diet. If the child is not weaned, the breast-milk, in the
manner directed farther on, is the best and only food admissible; but in case the child has been weaned, only light farinaceous articles of diet, such as fresh soda crackers, together
with ripe acidulous fruits in season, such as orange, blackberries, and baked apples, should be permitted.
Beef Tea. Where there is a great prostration, it is advisable to give occasionally a teaspoonful of freshly prepared
beef tea.
Water, and in fact all liquids, except lemonade, which I
shall notice farther on, should be most strenuously prohibited,
for the simple reason, that free drinking is surely followed by
the immediate ejection through emesis of the liquid swallowed, and thus it will be seen, that by repeated libations the
vomiting will not only be greatly facilitated, but even when it
has ceased, will be caused to recur.
It may really seem,as in almost any other instance, it would
be cruel to thus deny the little innocent the satisfaction of
quenching its thirst, but it is only done that we may be
able to save its life, and it usually will not in the majority of
cases, especially if the parents or nurse are possessed of ordinary intelligence, be difficult to convince them of the necessity and judiciousness of this denial. I am fully convinced
that nature does not usually make capricious and unnecessary
demands; but here is an instance where, if the natural inclinations are permitted to enjoy their gratification, fatal results
are very apt to be the consequence.
In the prohibition of liquids I am forced to include, in case
of nursing infants the administration of the breast except at
intervals of three or four hours, and then the child must not
be allowed to nurse to satiety, but only for a few minutes, at
most not more than three or four at a time. The expediency
of this is readily seen when we take into consideration how
very little, if indeed any in many cases, of the milk can be
assimilated, owing to the relaxed and inactive, or rather if yon
will, revulsive action of the absorbents.




CHOLERA INFANTUM.


27


Blackberry Syrup, or cordial diluted with water, is often an
excellent auxiliary in the treatment of this malady.
Lemonade. Notwithstanding what has been said against
the granting of indiscriminate permission to drink adhlibitum
in cholera infantum, 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, whose thirst seems to consume him,
but also a most excellent remedy for the vomiting itself, and
one that sometimes when all others have failed, will put a stop
to the emesis and very materially aid to restore the deranged
system to harmony and tranquillity.
It should, however, as I have before stated, be made so as
to contain a large proportion of juice from the fresh fruit, and
never under any condition given in quantities greater than a
teaspoonful at one time, which amount, however, may be given at very short intervals, say every five or ten minutes, if the
patient should desire it frequently.
It is not advisable in case of nursing children to give lemonade either directly before or after nursing, since there would
be a probability of the milk being curdled in the stomach
thereby. Its free administration does not interfere unfavorably with the action of any of the remedies previously recommended, on the contrary, it seems to assist the proper assimilation of their remedial virtues.
CONVULSIONS.
Since violent convulsions so frequently accompany or follow directly upon the cessation of the active stages of the disease,I shall at once proceed to their therapeutic consideration.
Before giving a list of the remedies especially called for
in convulsions accompanying cholera infantum, it may not be
amiss to state that where there exists only tremors, spasmodic
contractions of the extremities, great irritability, nervous excitement, and sometimes even well defined spasms of an internal or abdominal character,the medicines previously recommended under another heading are frequently all sufficient to
quell the excited nervous manifestations. This is pre-emi



28


CHOLERA INPANTUM.


nently true in the cases requiring such medicines as Ipecac,
Cuprum, Aconite, Camphor, and Chamomilla.
There are, however, many cases of cholera infantum, in
which the cerebral symptoms are not only well marked and
characteristic, but even predominate over the gastric or abdominal. In such cases I have found the following remedies
are most efficacious.
Belladonna. This is the remedy where there is general convulsive contraction and rigidity of the whole body, upper and
lower extremities, dark red flushes alternating with pallor, hot
burning fever, alternating with chilliness and cold surface,
dilated pupils, great thirst, but attempts to drink result in
precipitating the spasm, involuntary evacuations from the
bowels during the spasm, sleeplessness and restless tossing
about between the paroxysms.
Hyosciamus. For clonic spasms, bloatedness and bluish
color of the face, foam at the mouth, protrusion of the eyes,
convulsions are unilateral, loss of consciousness, involuntary
emissions of urine, deep comatose sleep with sterterous breathing, during the interval between the spasms, and a general
hyperemic condition.
Nur Vomica. Clonic and tonic spasms, convulsive starts,
twitching and spasmodic contractions of the muscles about
the eyes, lips and extremities, somnolence,involuntary screams,
opisthotonos and tetanic constriction of the jaws. Sometimes
when this remedy appears to be plainly indicated but does
seem to act promptly enough its near relative,
Ignatia Amara, will, on being exhibited give highly satisfactory results.
Opium. Deep and comatose sleep, spasms are more violent
in the extremities, particularly the upper, clenching of the
hands, and entire loss of consciousness.
Stramonium. Hiccough, distortion of the face which causes a dull stupid good natured expression, red face, hot surface, sterterous breathing, violently delirous, opisthotonos, convulsive tossing about of the extremities, and suppression of
the urine that sometimes amounts to uroemia.




CHOLERA INFANTUM.


29


Valeriana oficinalis, is indicated where there is great nervous irritation, trembling, twitching and spasmodic contractions of the extremities, violent colic and abdominal spasms.
Veratrum viride is the remedy where the child is anamic,
and there is great arterial excitement, hot surface and opisthotonos.
Zincum metallicum, Apis mellifica, Platinum and Stannum,
are remedies that are peculiarly adapted to those cases of convulsions, or rather nervous irritability, that we so often meet
with in sub-acute and recurring cases of cholera infantum,
and also especially in those cases where there is seemingly a
congenital predisposition to hydrocephaloid diseases. Digitalis purpura, is also in those cases where there is a tendency
to hydrocephalus, a most excellent remedy.
And finally, in those cases where the cerebral disturbance
is late in making its appearance, and the subject has had time
to waste away and become anamic, or in those cases where
there is evidently neither hyperaemia or a deposit of serum
to occasion the brain symptoms, but on the contrary they
arise from a general drainage of serum from the blood, and
such cases do occur as previously stated-then such medicines
as Calcarea carbonica,Carbo vegetabilis, Nux moschata, Podophyllum, Rhus toxicodendron and Sulphur,will prove of incalculable benefit, giving directly curative results.
The above are the principal curative medicines that will be
ca!led for in nearly all cases of convulsions accompanying
cholera infantum. I wish to say, however, that they cannot
be expected to always act " beautifully," "immediately,"
" like a charm," &c., &c., as many of our over sanguine theorists, and even some of our faithful physicians in actual practice would have us believe. "A little faith goes a great
way."
On the contrary,they most frequently will be found slow,but
if given with due perseverance are very sure eventually to give
relief, and we need not be at all surprised when we consider
the exciting cause of the cerebral disturbance under consideration. But, the question is naturally asked-is there no
means to overcome and quiet this frightful display of convul



3O


CHOLERA INFANTUM.


sions that spreads such terror and consternation in the family
and friends of the little sufferer? I say very positively, yes!
and this brings us to the consideration of
PALLIATIVE TREATMENT.
All physicians know, when called upon to treat a case of infantile convulsions, whether it be accompanying the active
stage of cholera infantum, or arising from any other known
cause whatever, that the family and friends of the little patient, in their fright and agitated condition, look for him to do
something, and that immediately, to re!ieve the little sufferer;
now under the circumstances what does he propose to do? is
he going to tell the anguished parents and distressed friends
that eagerly surround and wait upon him with such great expectancy, that they must exercise patience for a time, till the
appropriate curative medicine shall have time to act, a period
that in the majority of cases will be extended at least calculation to several hours? I say most emphatically, no! and
why? simply because if he does make such an answer, he will
in all probability, and that with good reasons too, be dismissed
and some other less conservative aid called in to take charge
of the case.
But on the other hand, if he says to the afflicted parents
with an air of sincerity and candor-be calm, your child shall
be relieved, and the convulsions will be quieted within an hour
at farthest, the result will be altogether different-in fact, if I
am permitted the simile,it will be like "pouring oil on troubled
waters," harmony and order will spring up in place of the supreme confusion which has pervaded all the surroundings, and
this alone is almost sufficient to justify such a positive assertion, and the doctor's orders will be unfalteringly complied with
and carried out to the very letter faithfully and understandingly, for the simple reason, that every one will be impressed,
through the physician's plainly manifest confidence in himself,
that he evidently knows what he is about, and means exactly
what he says!
Will the physician be justified and borne out by the results
in making such a positive assertion? I unhesitatingly answer,




CHOLERA INFANTUM.


31


with the risk of being assailed by theoretical critics, who are
too conservative to make use of the means themselves, that he
most certainly will; and this I say because an extensive experience in the treatment of convulsions, has taught me that
in nine cases out of ten,the prediction will prove true-that is,
if the plan of treatment recommended is faithfully carried
out. Moreover, I affirm without hesitation, and notwithstanding the protest of theoretical croakers, that no evil after effects
whatever will result; but to the contrary, the way will be
paved and made clear, so to speak, for the better action of the
curative medicines previously recommended.
The palliative, and I might say not unfrequently curative
treatment upon which the above remarks are based, without
discussion or theorizing as to mode of action,etc., etc.,is briefly as follows:1W3 Choral hydrate.
Potass bromide,    -         -  -  -      3i.
Aqua pura.
Syrup aurant cort.,  -         -   -  -  a i.
M.
Of this mixture a teaspoonful is to be administered every
fifteen minutes, or as often as the interval between the convulsions will permit, and to be discontinued (but may be repeated
occasionally, say every three or four hours, should the tendency to active convulsions not at once disappear) as soon as
the convulsions have been quieted, which as before stated, in
nine cases out of ten, will be within the space of an hour, a
few minutes more or less. During this time the little patient
will have taken four or five doses of the mixture, each dose
containing about three or three-fourths grains each of Chloral
hydrate and Potass. Bromide, making in all within the period
of an hour, a maximum, say of 18 grains each.
Now, at first sight, I am willing to admit, this may appear
rather heroic, but notwithstanding the hue and cry that has
been raised in medical circles about the ill-effects of large
doses of the medicines under consideration, I have in a very
extensive experience in the treatment of convulsions, never




32


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.




CHOLERA INFANTUM.


33


Pieces of ice may also be introduced into the rectum, and
owing to the close proximity of this organ to the place where
the spinal column ends, and the large nerves that supply the
lower extremity, take their exit from the spinal column, will
act perhaps, in this way more promptly, than when applied
externally.
PARALYSIS.
Infantile paralysis resulting from and in complication with
cholera infantum, is not nearly so rare an affection as one
would be led to believe from a consideration of the literature
bearing on this subject. The reason that medical authors are
so evasive of, and prone not to dilate on these cases is perhaps, the fact so well known, that unfortunately physicians
gain very little reputation in treating them.
The paralysis peculiar to cholera infantum usually makes its
appearance very suddenly, either during or immediately superceding the convulsive stage, but sometimes does not appear
or several days after the violent and acute symptoms have
subsided, and finally may occur where there has been no convulsions or other marked indications of cerebral disturbance.
It is in a majority of cases directly dependent on the compression of the brain or spinal cord, which compression is exercised by the effusion of fluid into the cavities containing
these organs, as has previously been shown under another
heading.
It may be of, from several hours to as many months duration-may be partial or complete-may affect one side, upper
or lower extremities, one or several organs may be involved,
as the tongue, eye, etc., or the whole muscular system may be
included in the attack, and it is not to any very flattering extent amenable to any known method of treatment, but does
not necessarily lead to fatal results, and will, in the majority of
cases, if left to nature, and no unfavorable complications occurring, eventually disappear, when the exciting cause, i. e.,
the effusion, has been removed: however, there are cases in
5




34


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.




CHOLERA INFANTUM.


35


Stannum-is the remedy in hemiplegia when the paralyzed
parts are constantly moist from perspiration.
There are other remedies that will be found useful in paralysis, but I will not take up time and space in giving their
characteristic indications, especially since they are so familiar
to all practitioners who pay any attention to Materia Medica.
I refer to snch medicines as AEsculus hip., A nacardium, A rsenicum, Baryta Carb., Causticum, China, Cuprum, Ferrum, Ignatia, Graphites, Oleander, Rhus tox, Stramonium and Zincum.
LOCAL TREATMENT OF PARALYSIS.
Electricity. This agent is, according to my experience, one
of the best available means in our possession, for the treatment of paralysis. This the more so since it can so advantageously be called into requisition conjointly with any of the
medicines that may be indicated. In reference to mode of
application, I cannot do better than to quote from "Braithwaite's Retrospect," Part LXVIII., page 73, as follows:" In the 'essential paralysis' of infancy and childhood electrization may be of considerable use if employed before the
muscular tissue is too much degenerated. In this form of
infantile paralysis the affection comes on suddenly, the faradocontractility of the muscles is more or less diminished; they
waste, and their tissues undergo the fatty degeneration;and they are affected by secondary contractions. Not rarely
it will be found that when the affected muscles answer but little or not at all the faradic current, they will respond to a
slowly interrupted voltaic current, and are even more than
normally sensitive to it."
" The good that electrization can do here is to improve and
to preserve the nutrition of the muscles, and so prevent wasting, degeneration and contraction; and in some cases even
more than this may be done, for even if the affection of the
cord can be cured, the peripheral electrical treatment may
forward the cure. Where there is still response to faradism
this form of electricity is the best to use. Care being of
course taken not to frighten or pain the child. Where the irritability to the interrupted voltaic current is increased, it will
be best to treat the case at first with this current. In a little
time it will be found that the reaction to the faradic current is
restored and that the excitability to the interrupted voltaic




36


CHOLERA INFANTUM.


current lessens; then faradization only may be employed.The disease is generally a tedious one, and the treatment must
be continued for a very long time-for months, or years even.
but so long as there is any response to electrization there is a
hope of benefit."
Dr. Radcliff says, 'if the paralyzed muscles retain their
electro-contractility and sensibility, and so show that they
have not passed into that state of fatty degeneration into
which they always tend to pass eventually, there appears to
be scarcely any limit to the time in which improvement, and
even recovery is possible'."
Bathing. Great benefit may be derived from a judicious
application, as the peculiarity of the case may demand, of hot
or cold baths, or hot and cold shower baths may be given in
rapid alternation, after which the surface is to be briskly rubbed, till perfectly dry, with rough towels (not too rough, however, since the delicate integument might be destroyed, or injured, and the devitalized condition of the organ might not
admit of prompt healing, which is a complication to be
avoided) and afterwards enveloped in soft flannel.
The Wet Pack-is also sometimes of great utility in the
treatment of this form of infantile paralysis, aud may often
be employed with splendid results, especially in the earlier
stages of the difficulty.
Embrocations-of camphorated oil, or what is better a glycerole of Camphor, will frequently be found beneficial, or
the paralyzed parts may be enveloped in soft woollen wraps,
that have been previously saturated in the camphorated oil
or glycerine.
Dry Friction and Animal Magnetism-may also be employed with success-and finally, it is always advisable to
keep the paralyzed parts constantly warm by means of soft
woollen coverings.
SUMMER COMPLAINT.
I shall now finally direct the attention of my readers to the
therapeutic consideration of that hydra-headed condition, the
most prominent features of which are diarrhoea, dysentery,and
emaciation; and which (as has been previously stated) may
quite appropriately be designated under the above heading,
i. e.-summer complaint.




CHOLERA INFANTUM.


37


Without entering into a detail of the symptoms peculiar to
this condition, I shall at one proceed to its therapeutics.
REMEDIES.
Where there is a tendency to diarrhoea, and when this is the
predominant feature of the disease the following remedies will
be found to usually fulfil all the requirements of the case.
Antomonium crudum. Is indicated in cases of watery diarrhoea, with deranged stomach; white coated tongue, loss of
appetite, eructations and nausea.
Bryonia alba. When the diarrhoea is aggravated by cold
drinks, or by anger and chagrin.
Calcarea carbonica. In cases where the diarrhoea has assumed the chronic form, and is especially suitable to children
that are emaciated and scrofulous; other indications are, great
debility, pale face, and voracious appetite.
Colocynth. Bilious diarrhoea, accompanied by violent spasmodic, colicky pains.
Phospho.rus. In cases that have become chronic; painless
discharges, and gradual loss of strength.
Phosphoric acid. Watery and slimy diarrhoea, with discharge of undigested substances, or involuntary stool.
Podophyllum, Petroleum, Muriatic acid, Sulphur, Graphites,
Cina, Leptandra, and all the remedies mentioned under previous headings may be indicated in summer complaint,whether its most prominent features may be diarrhoea, dysentery or
gastromalacia, I therefore shall give under each of these conditions a few of the most characteristic remedies.
Where dysentery is the most prominent feature, the remedies not already referred to are: Baptisia, Capsicum, Hamamelis, Polygonum punctatum, Secale cor., and Veratrum viride.
When there is evidence of tendency to softening of the
stomach-such remedies as Argent nitricum, Causticum, Bismuth sub nitrate, Hydrastin, Nztric acid, and Sulphuric acid,
may prove beneficial.
Dr. T. G. Comstock, in an article on Summer complaint in
the "U. S. Medical and Surgical Journal," vol. v., page 210,
says:




38


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



CHOLERA INFANTUM.


39


phyllum, Secale, or Veratrum, will be often indicated; the last
named may be given in profuse diarrhoea with vomiting, involuntary stools, and great tendency to a collapse; if the child
has fever, either Aconite, Belladonna, Bryonia, Rhus tox., or
Gelseminum, may be selected, and in some cases, alternated
with one of the other remedies.
Dr. Richard Hughes recommends Nux Vom. and Lycopodium, where there is evidently a muco-interitis. He also suggests the use of Phosphorus, Arsenic, or Phosphoric acid, for
the diarrhoeas which accompany the 'wasting diseases' of children. Another remedy not to be neglected, is Colocynth, for
greenish stools, accompanied with severe colic pains. Chamomilla we have not spoken of, but it is the remedy in slight
cases, Where there is much rumbling in the bowels. In children from two to five years old, where the diarrhoea becomes
chronic and has resisted all other remedies, an infusion of Cistus Canadensis (Frost-wort) will be found worthy of trial.This 'Frost-wort' is useful in chronic dysenteric-diarrhoeas of
adults, as well as children. We have certainly cured a great
many cases with it, after other remedies had been tried in
vain. Another remedy seldom used, but often found servicable when the child is irritable and restless, showing symptoms
of exhausting and a general decline, is Staphysagria.
DIET. One great cause of summer diarrhoea in young children, is that the mother, believing that she has not enough
milk to nourish the baby properly, feeds it artificially, and
thus deranges the stomach. A young child, until the first incisor teeth come through, does not need anything but its
mother's milk. Mothers will not believe this-they nearly all
insist that they have 'not enough milk,' and begin to stuff the
cnild with something else; they insist that 'the child is starving.' Now this is a very popular error, but so deeply rooted,
that we seldom succeed in getting it out of the mother's head.
The All-wise Being who gave the child to the mother, has, in
the greater majority of cases, provided her with a secretion of
milk sufficient to sustain it.
Another very popular error, which has become quite fashionable is, for the mother to insist that she must constantly
drink lager beer, in order that it, the beer, shall 'make milk.'According to Dr. Condie's statements, lager beer actually lessens the quantity of the milk. After the mother milk, cow
milk is the best diet for children under six months; it should
be properly diluted, and not given too strong.  Condensed
milk will be found appropriate, if cow's milk of good quality
cannot be procured. In one instance that we call to mind, in




40


CHOLERA INFANTUM.


a child whose mother died during confinement; the child was
'brought up by hand,' upon condensed milk, and took no other sustenance for seven months or more. This child did well,
and the condensed milk proved to be a great convenience.When children are weaned, the best diet for them is beef tea,
arrow root, Liebig's food, gelatine, or carrot pap.
This carrot preparation is admirably adapted to scrofulous
children. We have used it for many years, and can speak
highly of it. It is good for adult dyspeptics, as well as for
children. The following formula for its preparation we extract from "Bednar's Kinder-Krankheiten," page 39:"An ounce of finely grated carrot should be put into halfa-pint of cold, soft water, and should stand twelve hours, being frequently stirred; it should then be strained through a
sieve, and all the juice pressed out. This juice is then to be
thickened with grated bread or arrow root, and to be set upon
a slow fire. After boiling up once or twice, it should be sweetened, and is then ready for use.
The juice of the carrot combined with water-crackers or
crusts of bread, contains all the material that is necessary for
the nourishment of weaned children-albumen, starch, gelatin, sugar, fat, and salt, and finally, even the phosphate of
lime, and phosphate of magnesia. In the preparation of this
food the greatest cleanliness must be observed. The juice
must be prepared fresh every day, and must, moreover, be
carefully watched, lest fermentation ensue. The large and
full-grown carrots are preferable to the young and small, this
article of diet is also recommended for older children suffering from scrofula, worms, and rickets, and is also suitable for
patients convalescing from acute diseases."
In older children, when the diarrhoea has become chronic,
the existence of worms may be a cause; if so, Santonine or
cocoa-nut rind, should be given as vermifuges; but if no worms
are present, then it is recommended to give the child some cider once daily, and some one of the remedies for diarrhoea
above indicated may be selected.
It should be borne in mind that softening of the stomach,
and water upon the brain, are complications of the summer
complaint. Both affections are almost incurable, but occasionally a child recovers from the latter. The great thing in
summer complaint is proper ventilation; keep the child in a
temperature of about 60 Farenheit, and when the weather is
intensely hot, see that it is lightly covered, and do not annoy
the little thing by keeping upon it flannel garments, for they




CHOIRIAJ INFANTUM.


4l


only assist in keeping up the irritation and enervation pf the
child. The child should be daily carried out. in the fresh air
early in the morning, and after the sun has gone down.
COFFEE IN SUMMER COMPLAINT.
Before closing this article, we desire to call the attention of
our medical brethren to the use of coffee as an aliment and
stimulant in this disease. We noticed an article some years
since, written by Prof. Dr. F. W. Hunt, of New York from
which we extract the following:"Coffee as an article of diet, as well as a medicine, is highly useful in the summer complaint of children. Extreme emaciation, distended abdomen, pulse small and frequent, great
restlessness, imperfect sleep, with eyes half open, and convulsive motion of the eyes when awake. A teaspoonful of the
ordinary infusion of coffee has arrested the vomiting, causing
tranquil sleep, changed the character of the evacuations
from the bowels, and improved the digestion and general
strength."
Those physicians who always interdict coffee, will be surprised at the above, but our experience confirms what Dr.
Hunt has so well and plainly described. Before we had our
attention called to Dr. Hunt's recommendation, we had often
noticed non-injurions effects of coffee in similar cases, where
mothers insisted on giving it; but after reading the above, we
took occasion frequently to prescribe it, and, in a great many
instances, with the best results. In some instances, children
who were almost in an extreme case of marasmus, have been
sustained by coffee alone, for several weeks, and have finally
recovered.
It has been our practice to give it with cream and sugar;
but in some cases, we have given black coffee without cream,
but sweetened a little. Dr. Ludlam has also recommended it
in similar cases. In marasmus, there is a tendency to decomposition of tissue, and coffee is well known to prevent such a
decomposition, and thereby it is most useful in circumstances
of unusual fatigue or deficient alimentation.
6




42               CttOVRKA INAitfiM.
Another remedy wfich acts similar tb "coff'de i"'S Coa t
leaves are officihal.:This Coca is aýPerývian laht",'ad ea i
now be obtained of pharmaceutiss t in e6~k''  Seviral
years ago, we obtained some from Peru, and; found it to act
like a charm, in cases where digestion was weak and difficult.
It is very different from and not at all related to cocoa; it'as
the peculiarity of producing a pleasant excitement. To children with marasmus, we have given it in a weak inýusi"l i t' s
a remedy of great practical utility in cases of confirmed dyspepsia, and is especially useful for hypochondriacs. Severia
years ago I experimented with it upol myself. It is a most
powerful and agreeable stimulant to the brain and nervous
system; is especially useful to counteract fatigue of niind and'
body, and enable the prover to live upon at least one-half fhis
daily allowance of food. I hope our brethren willexperiment with this medicine. Its technical name is Eryt~boxylon
Coca."
DIET OF INFANTS AND YOUNG CHILDREN.
Dr. J. C. Morgan in a little pamphlet on " Diet of Inffits
and Young Children," says--
"Firstly: However agreeable and nutritious any diet pay
be to-day, rotation of the bill of fare is sure to he required at
sometime, or disgust, indigestion, etc., will follow.
Secondly: The food must be composite-nitrogwenos as: w4l
as carbonaceous, to supply at once flesh, fat, and animaal
heat. But these are to be variously proportioned in diyersr
cases.
Thirdly: It must not appear in the stool undiges~ed~r, be
vomited in a like state. Quality or quantity, either one, m: y
be at at fault and must be rectified.
In this connection, let me say---we should always denrnd.
a daily exhibition of the diapers. Children ofteniof indir
gestion, discovered only when they areý moribujýd  ehp.
and that too when they have had but the mother's milk,- a~br
dant, agreeable even, but curdling in the intestina tr~aiait;showing a good hue., but closely resembitig colpied,.Lr.,
led eggs; the mother daily testifying that the stools are per



CHOLERA INFANTUM.


43


fect. A temporary abstinence from  natural food, and a substitution of pure cream, or other nourishment, with the right
medicine, (not forgetting the mother) may often restore the
babe to the breast in a few days. If even digestion be good,
quantity may overdo its action, or again, deficient supply may
require to be supplemented artificially. Amongst the artificial dietetics, we find some whose normal temperature is
somewhat high, as milk and cream. As a rule, food at the
heat of the stomach itself is best suited to this organ, and
great harm may be done by neglecting to attend to this point.
In other cases, easily distinguished, nature craves and must
have cooler food.
Milk is the foremost on the list, even in its oriinary state;
but for all that, babes have often starved to death on it, because of not digesting it. Amongst the special articles, one
of the first to be named, is pure cream; warmed, diluted and
sweetened, or frozen, or natural, it is a grateful and nutritious
substanqe-in very many instances; sometimes a little laxative, and thus differing from the farinaceous. If frozen, it is
of course to be used in very small portions, and to meet a definite craving of the patient, not a mere notion, but a real instinct, as in other cases of peculiar appetite. But cream from
the cow, as well as milk, is liable to dangerous contamination
by the weeds of the pasture; hence must be selected with
reference thereto. How many colics and diarrhoeas come by
that channel, who can tell?
Cream which is illy separated from the milk, has often the
same fault of indigestibility and consequent coagulation in the
primie viae with itself. Even pure rich cream may prove unacceptable, causing vomiting; when, by adding warm water
in new-born children, four parts of water to one of cream,
with a little white sugar (or sugar-of-milk) it may do quite
well; but the whole stock must not be diluted at once, since
the process of putrefaction is thereby favored: In summer it
sliould be preserved on ice in vessels of fastidious cleanness.
If gastric irritability be marked, very small quantities of this
or-ariy other nutriment are to be given at any one time, but




44


CHOLERA INFANTUM.


frequently, as the organ will bear it without vomiting or disr
gust; say a teaspoonful every half-hour. In some cases the
rectum may supersede the stomach as the receptacle of food,
of which yolk of an egg with cream  is probably the best
form, two tablespoonfuls being injected every two to four
hours, for a little child. Nutrition may be maintained through
many days in this manner.
But other components of cow's milk may sometimes be
separately utilized. The curd separated by rennet, sweetened,
or even, for older persons, the well known "schmier-kaas," or
cottage cheese, with cream and salt, and possible pepper, may
prove acceptable and digestible in case of general loathing.Whey, the curd removed, being the residuum after treatment
by rennet, contains the sugar and salts of milk, and is by no
means valueless as a semi-nutritious and bland, broth-like fluid, when only such things can be borne. Into all these preparations we may presume that there enters a certain quantam of modified Pepsin, which may be expected to exert a
happy calalytic influence upon the stomach, and its other contents, whatever they be. As for themselves, being already
digested by the same agent, they are more manageable by
the enfeebled organs, than the original milk.
The universal voice of the profession is for milk of one cow,
Very well, if the milk be young, and the milkman honest(?).
By young milk is meant that the calving of the animal is recent. Sometimes, the milk of one locality proves hurtful,
that of another beneficial. Young cows are also preferable.
Asses' milk is probably the most nearly normal of all substitutes for that of the mother; but the comparative rarity of
this creature in America, renders it more a matter of curiosity to use than otherwise.
In any case, whether of choosing a wet-nurse, or a cow, or
any other animal, as the source of an infants food, the age
of the secretion should be less than that of the baby. That
is to say, for instance, that a cow with a calf one month o1d,
may dovery well to feed a child six or nine months. Aw older udder, on the other hand, may but add to the causes ofina



(C1ALF*ak1. IN)FANzTVM.        '46


'45


nition. Wherever the casein transcends in proportion to lte
powers of digestion, as,often occurs with an old secretion,
even of the mother, mischief is inaugurated forthwith. The
cure lies in its refections by the wary physician and nurse,
with perhaps a little medication.
In this country, the most common substitute for the mother's milk, next to that of the cow, is goat's milk. A  young
secretion bears a fair resemblance to good human milk, and
more frequently agrees with even a sick infant than even the
best selected cow's milk. supposing it to be used entire; as, if
the digestive organs be good, it may indeed sometimes be,
especially in children who have acquired some general and
gastric tone, of which the forwardness of dentition is a pretty
good criterion. Whatever the form of milk used, let it never
be forgotten that the diaper is the final test of results, and the
coagula of casein, a sufficient condemnation of the article in
use, as a present diet for the particular patient, which no
amount of dilution can set aside,
Condensed milk is now so common in commerce as to have
become an important substitute for the recent article. Sufficiently diluted, it is certainly better than the latter,injured as
it often is, by the vicissitudes of the hot season. Its character must, however, depend upon exactly the same considerations with ordinary milk. Careful selections and preparation
may render it invaluable. But of this, at present, we have to
run the risk. In extreme cases, a swab or teat of linen may
be dipped repeatedly into cream, or any chosen fluid, and the
child permitted to suck it. Even the well known "sugar-teat"
(white sugar tied up in a piece of linen) with all the fear of
"swallowing wind," swallowing the rag, etc., etc., which varying its use, is an occasionally valuable method of conveying
nourishment;,and may contain other things besides sugar,
suited to the purpose., Butter is too much of a bugbear to
those who feed young children,; it is ialorifacient, palatable
when good, and usually digestible.
Many.other articles of.the iWfant' diet list require for
prvpar tion the aid ofi a milk n!bsome form or other:; its excellence is therefore a matter of prime importance, in a very




40


CHOLERA INFANiTUM.


large number of cases. Buttermilk should not be forgotteni;
if sound, it may be of use in low conditions of the digestive
system; it has been beneficially added to rice flour gruel.Next to these, we naturally consider the substances known as
farinaceous.
And first of these, the starches, viz: arrowroot, tapioca, sago, tous les mois, salep, corn starch. These hydro-carbons
alone are calorifacient, and so far useful in that direction;but are utterly without value in nutrition of the undue combustion and waste of these in the process of calorification.They also allay the sense of emptiness and hunger, when other food cannot be taken. The same may be said of sugar in
every form, including honey, molasses, rock candy, gum drops,
etc. A dash of tea or coffee, in diluted and sweetened milk,
(formerly called "cambric tea,") may have a more positive influence against waste in such cases; supposing them medicinally unobjectionable.
Mucilages, as of gum Arabic, or Irish and Iceland mosses,
belong to the same category with starch and sugar; barring
the iodine of the Irish, and the bitterish cetrarin of the Iceland moss. They are prepared by steeping either in cold, or
better in hot water; sugar or rock candy being added if desired.
[ Slippery elm bark, macerated in water, and the water given to the child to drink, is often preferable to either Iceland
or Irish moss.-W. c. R.]
Gelatine or jelly, with or without wine, is comparable with
the starches and mucilages. As a constituent of soup, prepared from the young shinbone of beef, (not wholly devoid of
meat fibre) it may prove valuable. Pearl barley, or rice,mnay
often be added with advantage. So also vegetables; which;
for a young child should be strained out. Vegetable soup
itself may be mentioned here; it is composed of all the ordinary market vegetables, in their season so far as convenient,
made into a decoction and strained. Out of season, canned,
or dessicated vegetables may answer. In the preparatloft of
these, and in all other sick cookery, so far as can be, ntoname



CHOLERA INPANTUM.


tallic surfaces only should be allowed in contact with the materials used. A simple method is to put them intob an ordinary
bowl, setting this into a sauce-pan of water, and covering the
bowl with a saucer, (the "water-bath.") The water in the
saucepan is made to boil; and thereby the food is duly.
cooked. If higher heat is required, a pan of sand, (the "sandbath") may take the place of the saucepan of water.
Miss Beecher favors the universal use of salt in cooking.---
The Germans prepare soups of many things not so used by
Americans; and it may be well to learn them.  Milksbup,
breadsoup, etc., may be said to be soup, or porridge-like preparations of those substances rather thin, and often none the
worse for that. The inside of roasted potatoes, perfectly done
and mealy, prepared to suit the taste, say with butter, milk or
cream, and salt will often prove good food, if no contraindication exist.
As a general rule, all fruit and vegetables have a laxative
tendency; but exceptions may occur, and a mealy roasted
potato is as little objectionable as anything of the kind.--
Fricasseed or steamed potatoes, prepared with drawn butter,
may sometimes do better, so far as delicacy of palate is concerned.
Various CEREALS hold a high place as artificial diet. Maize,
or Indian corn meal, apparently the crudest of all, at times
prove palateble. The white meal being finely bolted, and extremely well cooked with water, salted to taste, and dressed
with cream and sugar, is usually wholesome as well as nutritious. Whole, cracked, or ground wheat, barley, rye, oats,
rice, beans. lentiles, peas, in soup-like, gruel, or porridge form
strained, or made into bread, and as rice,the well-boiled grain
all are available, prepared with cream, butter, sugar, etc.according to circumstances. Strained bean soup has proved
"just the thing" for a child convalescing from dysentery.Pearl barley is the crude article wholly deprived of bran, by
mutual friction of the grains during the continued agitation in
a revolving mill, without other change. Farina, a well-known
dietetic, is flour prepared from wheat, which has been thus




CHOLERA I INFANTUM.


"pearled."  Both of these consequently require long cooking.
in order to render their starchy constituents soluble. Moreover, the pearling process is wasteful of the gluten and phos-,
phates, so needful for the nutrition of muscle, bone, etc., andi
which are largely removed along with the bran.
A better preparation, probably, may be improvised by an
old fashioned recipe. Any kind of flour may be tied up in a
cotton bag, dry, placed in a vessel of boiling water, and subjected to a long subsequent boiling. [ The flour must be boiled at least four hours.--. C. R.] The product is then subduced to anew to a powder, and may be kept at hand for use,
in like manner requiring less cooking than farina, etc. It is
known as " boiled flour." It has some repute as a remedy in
diarrhoea, given in the form of "pap."
Hominy-(Indian corn, deprived of its siliceous exterior by
steeping in lye)-if soaked in cold water over night, and subjected to long boiling, lastly dressed with butter and salt, is a
digestible as well as delicate dish. But for children, the smallest hominy, Grits, should be used; so also, in the case of convalescents generally. The thorough cooking of these is the
condition of their digestibility.
" Mush," renowned in verse, as "hasty pudding," or fine
white Indian meal prepared by very long cooking, salted, and
dressed with milk, butter, molasses, or sugar, is a well-known,
and very important dietetic, often too much overlooked.
The same sort of preparation of oatmeal-"oatmeal mush"
-is often preferred; and rye flour is equally in favor with
others. Oatmeal is to some, when used at supper, a positive
laxative.
GRUELS of the same materials are familiar. Less known,
are gruels made of rye flour or pulverized cracker, or soda bis-.
cuit. "Cracker dust," ready-made for other purposes may be
employed conveniently for this, and produces a very good dietetic. Unbolted Graham flour, may be used in like manner,
thus securing a large amount of nutritious matter, in the way
of gluten and phosphates, which are lost in preparing fine
flour.




CHOLERA iNFANTUM.


49


Bran mush well cooked, is often an acceptable dessert for
the well, and may be dressed as suggested above; being like
other forms of bran flour, laxative to the bowels. Thick or
thin, or like gruel, it may become a special diet for children.
Bran bread, or Graham bread, is valuable for similar rea-:sons, and is, like the other forms, in favor with dyspeptics who
are constipated, on account of the mechanically laxative effect it exerts. So also, bran crackers. The same may occasionally be used for children, prepared in any of the forms
in which we shall have something to say directly. Bran bread
adding consist of the crumbs of bran bread, over which has
been poured boiling cream, sweetened to suit.
Rye bread is suitable for rotation with other forms, or even
a main diet.
Plain panada, is a primitive but often (when rightly made)
very palatable diet, It should he prepared thus: remove the
crust of a slice of baker's bread a day old, break it small into
a hot bowl, sprinkled with sugar to suit the taste; pour over
this a liberal portion of cream or rich milk, and finally enough
scalding hot water to cover the bread; chop it rapidly with a
silver butter knife, until reduced to a fine loose pulp, (never
mash it with the side of the knife or spoon) and allow it
to stand until cool enough to swallow, when it should be
eaten.
Crackers. sweet or plain, or other kinds of biscuit, dry or
soaked in water, or "cambric tea," buttered or not, are often
invaluable. Ordinary bread and butter, bread and gravy, andthe like, when moist, often afford a good nutriment for even
very young children, as most mothers are aware.
Unfermented bread, and biscuit, i. e., that made of dough
without yeast, but charged mechanically with pure atmospheric air-may be preferred when common bread sours on
the stomach.
Bread toasted, deprived of the crust, may be treated in a
similar manner, and may prove serviceable if flatulence from
decomposition of food, etc., be a symptom; and also for the
mere purpose of rotation. But occasionally it causes such
symptoms when not already present, probably in character of
Carbo vegetablis. The ordinary milk toast, cream toast, or
7




50


CHOLERA INFANJTUM.


water toast, with butter, may often be utilized in the case of
children.
Zweiback-bread of the kind called "rusk," or "tea buns,"
twice baked-that is, baked in slices, susceptible of minute
division with ease, and may be used somewhat like cracker
dust in a gruel form, or in panada, or soups.
Sponge cake, plainly made, is something which most children relish. A similar cake is " lady-fingers." Both of these
may given dry, or moistened, to almost any child, sick or
well.
The youngest children, those who have no teeth, may be
fed with comparatively strong food, if the mouth of a healthy
person be employed to masticate it beforehand. The starchy
part of the bread, crackers, etc., is thus acted on by the saliva
and all substances perfectly comminuted before administration.
Hence, a most important diet for a half-fed infant, sick or
well, may often be found in chewed cracker, chewed meat,
etc., etc.
A child may, if not voracious, be satisfied by sucking a
cracker, or a tough crust of bread, held to its mouth. The
same may be said of meat cut into a strip, parallel with the
grain, in order not to separate in chunks. But so brittle a
substance as soda biscuit should not be so used, lest, as I
have witnessed, a small flake getting over the glottis, fatal
suffocation occur.
Meats of various kinds are all important in many cases of
artificial feeding of infants, whether in fluid or more substantial form. They should be neither too young nor too old;
both are indigestible and do mischief, each in its own way.--
Mature, but still young meat, is valuable in various forms.Beef, mutton, and chicken, may serve as types of all, and
may be resorted to in rotation. Salt meats may sometimes
vary the list.
Common soup has already been alluded to. Decoctions of
the above are familiar as beef-tea, mutton broth, or chicken
tea.  Farinaceous or other addenda, are sometimes employed.
Beef extract, (often misnamed beef-tea) may be prepared
fresh, or its partial equivalent obtained from a roast joint
when cut. It is best made in a good sized clean bottle putting
finely divided beef within it, corking tightly, and boiling the
bottle in water for some time. The liquid is then poured off;




CHOLERA INFANTUM.


51


a trifle of salt should be added. Salt put in at the beginning
of any such process, may become so concentrated as to render the extract or the decoction unfit for use; and even without this, the natural salines may occasionally do the same.
The concentrated beef extract so commonly sold, is, when
not objectionable to the taste, of great use. In wafer capsules
it may be made applicable in still other cases, perhaps. This
is sold as " Liebig's Extract of Beef," sometimes under other
names.
Cold infusion of beef, salted slightly, may prove agreeable
as a diet drink, when such temperature only is acceptable.The process of percolation, a la cafe Francaise, may be applied by non-metallic apparatus to finely divided meat, the
product being kept surrounded by ice; or being finely divided
and pounded in a crash cloth, it may afterwards be subjected
to a strong press, a little water added to the residue and
pressed again, just as in the preparation of the fruit syrups.
Meat, raw or cooked, may be scraped, so as to afford nourishment for an infant; or it may be finely hashed,as if for sausage. The latter may be reinforced by potatoes, etc., when
not contradicated by diarrhoea. The great danger is, that the
comminution may be imperfect.   This must be guarded
against.
Damacene preserve, consists of raw beef chopped and pounded along with white sugar, until finely comminuted. This has
proved a life-saver in many instances. The one doubt of its
value, lies in the possible presence of parasitic germs, (as of
tzenia) in any form of raw meat.
Frying, as a method of cooking is generally objectionable;
but meats broiled or roasted are good; the latter, especially.
A close utensil, such as a " Dutch oven," which retains every
particle of vapor, is economical of the volatile principles, and
hence secures the choicest product; which may then be employed in any of the ways herein alluded to.  The same instrument bakes the best Indian corn bread.
An excellent temptation to appetite is found, often in a
wafer of beef, the thickness of card-board,cut across the grain,
carefully broiled, buttered, and slightly salted; and for a little
child, very finely divided.
Stews and Fricassees are adapted to those who can chew,
when convalescent, and to whom the peculiar flavor of a roast
may be disagreeable; or, in the way of rotation, very fine
hashes, may suit some who cannot masticate.
Dessicated meats, i. e., with the moisture completely evaporated, may be sometimes utilized-being easily grated, and con



52


CHOLERA INFANTUM.


taining in this state. a large proportion of absolute nutritious
matter. This may be given like the beef-extract, in hot water
or dry, in a suitable vehicle, as the wafer, or jelly, or stewed
fruit, which may be punctured to insert it; small masses at
a time.
Any form of meat diet is of doubtful propriety, to say the
least, in typhoid fever, when the urine is without sediment.And in ulceration- of the bowels, any solid food may cause
perforation, and fatal peritonitis; whilst ice-cream has killed
a convalescent, by intestinal haemorrhage.
Shell fish, i. e., Oysters, (rarely clams,) are often a boon.The juice or the soup of a plain stew, with cracker, or otherwise, may be the initial form; afterwards, the tender portion
of the oyster itself. In stewing, the juices should first be
cooked with milk and salt, and the oysters added when it
boils; letting them remain on the fire only until heated
through. Thus they remain tender.
Oyster hash, very fine, made only of the tender portions of
such stewed oysters may be given when that form is most
manageable. Even a fresh oyster may sometimes be chewed
very fine by the mother of a sick or badly nourished child,
and prove in this state a grateful and digestible diet.
But one of the most precious hints I have ever received in
the matter of diet, was derived from a half-nourished babe, in
the presence of a plate of raw oysters. It made such violent
demonstrations of craving for them, that the mother, holding
a fine one by the tough muscular portion, allowed the child
to suck the remainder, which it thus demolished in a short
time; and by acting on this hint, the difficulty in the case
was bridged at once. I have since repeatedly prescribed the
same with excellent effect, even in adults, who, whilst unable
to eat, could suck a raw oyster.
In cough cases, intestinal disturbances, etc., white of an
egg, with water, kept cool by setting on a bowl of ice, and
given in sips, is often a palatable demulcent and nourishing
drink. Or if a high temperature be wished for, it may be
first mixed with very warm (not boiling) water, and set in a
hot water bath, on the stove or nursery lamp.
Egg soup is the same as the last, with the addition of the
partially beaten yolk; and in this case a little salt will be desirable. The ordinary softly boiled egg, especially with bread
crumbs, and a little butter and salt, is a frequently available
diet for young children.
Plain custard, i. e., egg, milk, and sugar, without spices,may
sometimes prove an agreeable form.












E R RA TA.
On page.3 t- seven tenth line from top for "une dram", read hl-dram.
On page 3! eighth line from h ottom, 'for " three, 9k. three-fourtbs" read ov'Fea- id three
On same page sixth line from bottom, for "W8', read eig-hi