CHOLERA INFANTUM. A disease of infants characterized by intestinal disturb ance more or less obstinate and dangerous. Opinion is unsettled in regard to the nature of the complaint, and it passes under different names in different countries. In this country, besides C. I. a common name for it is summer complaint, because it is essen tially a disease of hot weather. Most British authorities describe it under the general head of diarrhea, others call it weaning brash, watery gripes, and choleric fever of children. In France it has various names, principally alluding to its location, as colo enteritis, follicular enteritis, and gastrointestinal catarrh, the latter name being also the one in most frequent use in Germany. But the disease as it is known in this country, and doubtless elsewhere, depends upon a variety of pathological conditions, which, however, may change from one to another during the progress of the case. The causes of the complaint are not completely settled, although all the authorities agree that hot and badly ventilated apartments and malaria generally are highly conducive to it. The older American physicians were, with Dr. Benjamin Rush, accustomed to call it infan tile bilious remittent fever, and many of the cases which occur in those rural districts where remittent malarial influences prevail have much of the character of remittent fever, but in cities, particularly where the sewerage is bad, and the streets are suffered to be choked with decaying garbage, the diarrhea has more the character of that of typhoid fever, and many of the symptoms are of a general typhoid, that is, of a weak nervous character. Too high a heat maintained in the nursery, will, if continued, probably so alter the functions of secretion as to bring on the disease; especially if the diet is defective, as from poor milk, or the injudicious giving of solid articles of food. It sometimes conies on very suddenly, but is often insidious in its advances, deluding, the mother and family with the idea that it is merely a temporary diarrhea that "will soon pass away, or can easily be relieved. The attack, however, may commence with violent symptoms, and there will be much excitement of the circulation, with vomit ing and purging. There is in all cases great weakness of the digestive and assimi lative powers. Milk which has been given but a short time before is voided by the rectum in curds, mixed with greenish slime of various depths of color, and contain ing fibrinous shreds and gelatinous masses, indicating mucous inflammation, and having a peculiar and diagnostic odor. The evacuations are preceded by colic pains, often intense, the movement usually giving temporary relief. The abdomen may be quite full at first, but gradually, often rapidly, grows gaunt, with more or less rapid emacia tion of the whole body. The child becomes peculiarly fretful and impatient, the expression of its features and its general appearance being highly diagnostic to the experienced observer. In advanced stages there is a withered, clammy appearance of the hands, arms and legs, peculiar to the disease. Without change of air or diet, or under bad treatment, the disease usually runs a rapid and fatal course, but sometimes, under fair but not decided treatment, the sufferer lies for several weeks, when, accord ing to statistics, death is more likely than recovery. There is a considerable differ ence, according to the testimony of practitioners, in the mortality which occurs in the practice of different individuals. In some charitable institutions the deaths of cases of C. I. run as high as 70 per cent, even under as good hygienic regulations as may be had in a city, and many private physicians, from the result of their practice, place the percentage of deaths above 50 per cent. There are others, and they form a large portion of the profession, who maintain that under, their .inclliod of, treatment the
- mortality is much less, ranging on an average from 10 to 25 per cent, and even below this. All concur as to the importance of pure air and proper diet. Often the simple removal to a mountainous district will, alone, result in recovery; or even a change from hot to cold weather, without removal, will often produce decided relief. As the digest ive functions arc very much weakened, the food should be the most digestible which can be obtained, also nutritious. If the case be one in which the child is suckled by the mother, but there is reason to suppose that her milk disagrees with it, weaning may be advisable; but, as a rule, the mother's milk is the best food for a child under 14 months of age. When the child is fed from a bottle, beef tea, made either from fresh beef, or from beef extract, may be given with advantage. Farinaceous articles, such as farina, tapioca, corn starch, and arrow root, are, contrary to the ill-advised conclusions of many, not proper food for infants. The only article of the kind that ever ought to be given in a case of cholera infanturn, is rice water, which, from its slight astringent prop erties, may sometimes be given in moderate quantities together with good milk and beef tea. The radical difference between physicians, in the medical treatment aside from hygienic measures, and aside from any reference to the different "schools" of medicine, consists in the degree of reliance to be placed upon opiates and astringents, or in other words, upon palliative treatment, as distinguished from that which seeks to produce a decided change in the functions of the various secreting organs, a great majority of which are manifestly much deranged in the disease under notice. The bile is scanty and not of normal character, and the inflamed and highly irritated mucous membrane of many parts of the intestinal tract interferes greatly with the functions of the mucous glands of these parts. There has long been a discussion among physi cians as to the therapeutical value of mercurial preparations, particularly as to calomel, and its power of influencing the secretion of the liver, and diminishing inflammation. It. seems proper therefore to say that in the experience of the most successful physicians it is found that the administration of small and oft repeated doses of calomel in cases of C. I. is attended, as a rule, with decidedly beneficial results; so that in the course of two or three days, frequently in a few hours, a change takes place for the better in the char acter of the fecal evacuations and in the appearance of the patient. The administration of the calomel alone, given in a little pulverized sugar, slightly moistened and placed on the child's tongue, in quantities from one twelfth to one quarter of a grain, and repeated every two, three, or four hours, will often produce decided relief; but it is generally advis able, or necessary, also to give a slight opiate, such as paragoric elixir, and perhaps a few drops of the tincture or aromatic syrup of rhubarb. The calomel must be persisted in for several days after the evacuations have become natural, although not given so often. It is a rule with but few exceptions among physicians of experience, that an infant cannot be salivated. On the contrary, the child grows strong and hearty under the use of calomel in those cases when the secretions are much deranged and the system reduced. In doses sufficiently small it undoubtedly possesses the power of improving assimilation. Warm baths, or rather warm sponging, and general attention to cleanli ness, and the preservation of an equable temperature, should not be neglected. Patients who cannot be removed to the country, may be taken out in an easy carriage and wheeled on the shady side of the street, or in a park or grove.