CHOLERA INFANTUM, Definition.—A particularly grave form of infantile diarrhcea, with symptoms closely resembling those of true cholera; frequent persistent vomiting, copious serous dejections, high fever, and a rap idly-developing condition of profound collapse.
It is a comparatively-rare disorder, forming not more than from 1/2 to 2 per cent. of all the diarrlioal cases met with during the summer months. Unfortu nately for the accuracy of our statistics, the term has been applied indiscrim inately to all cases of severe infantile diarrhoea. In the opinion of the best writers the name should be limited to such cases as are characterized by intense eholeriform symptoms.
[intelligent work upon this subject is still greatly impeded by confnsion in no menclature. Many excellent articles are diminished in value or rendered actually worthless by the indiscriminate use of the terms "cholera infantum," "enteritis," and other indefinite expressions, render ing it impossible to determine the form of disease to which the author refers. The term "cholera infantum" is the one most frequently used incorrectly. It is limited by nearly every author of promi nence to cases characterized by large, serous stools, accompanied by profuse vomiting, high temperature, prostration, and marked nervous symptoms. If writers for the journals would observe the same rule it would save very much confusion, and render their work of decidedly more value. HoLT and CRAN DALL, Assoc. Eds., Annual, '92.1 Symptoms.—After a variable, but gen erally brief, period, characterized by rest lessness, abdominal discomfort, and a rising temperature, the infant begins to vomit, and simultaneously or shortly af terward purging commences. The VOM iting recurs frequently. At first, the con tents of the stomach are ejected; then a bile-stained MUCUS; and, lastly, noth ing but a serous fluid. The evacuations from the bowels soon assume the same serous character. They lose their frecal appearance and acid reaction, and con sist almost entirely of a colorless fluid, copious in amount, alkaline in reaction, and generally with a peculiar musty odor. Examined microscopically, little has been found in this fluid beyond a large amount of epithelial debris, some round cells, and numerous bacteria. Such dis
charges soak into the diapers, leaving al most no stain and scarcely any fmcal mat ter to indicate that the fluid has come from the intestines. Although these evacuations are very frequent, recurring every half-hour or hour, pain is not gen erally a marked feature.
The temperature taken in the rectum is always elevated, generally between 103° F. and 105° F.; nevertheless the body feels cool to the hand. Thirst is extreme; but liquids and foods of all kinds are rejected by the stomach shortly after they are taken. With such a drain upon the fluids of the body the infant rapidly loses weight and strength, and in a few hours its appearance is greatly altered. The face is of an ashy pallor, the eyes sunken, the features pinched, and the expression anxious. The open fontanelle is much depressed; the pulse is quick and weak and may be intermit tent; the urine is scanty and in severe cases appears to be altogether suppressed.
During the earlier hours of the dis ease restlessness is a marked symptom; but, as the strength fails, this is gradu ally replaced by a condition of apathy, which, later on, may develop into the hydrencephaloid state: the spurious hy drocephalus of older writers. Should the disease take this course, the infant will be found lying in a semicomatose condi tion, with head drawn backward, pupils sluggish and sometimes unequal, abdo men retracted, and respiration possibly irregular and of the Cheyne-Stokes type. There may also be twitching of the arms and legs. Toward the end the infant be comes more comatose, or an attack of convulsions may supervene and usher in the close.
In some cases a condition of hyper pyrexia may precede the fatal termina tion. In others, the high temperature of the earlier hours may pass away and a more moderate pyrexia, or even, accord ing- to some writers, a normal Or sub normal temperature tak-e its place. Nev ertheless, if the graver symptoms of col lapse persist, this fall must be regarded as an unfavorable omen. In such cases we sometimes find that both vomiting and purging cease a few hours before the end occurs.