Cholera Infantum

water, doses, hours, symptoms, temperature, repeated, grain, grains and atropine

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[Opium is used by a majority of writers, and, when administered ration ally, is an agent of the greatest value. It should not be used until decomposing matter has been removed from the ali mentary canal. When the passages are small, infrequent, and of bad odor, it is decidedly contra-indicated, and it should not be pushed to narcotism in any case. It should never be combined with the ordi»ary diarrhceal mixtures, which are usually given at short intervals, but should be administered alone, and at intervals varying with the symptoms. HOLT and CRANDALL, Assoc. Eds., An nual, '92.] Infants bear atropine wonderfully well. Almost adult doses of atropine given to children only a few months old; for instance, 1/„ grain of morphine and grain of atropine, repeated two to four times in twenty-four hours. This controls the phenomena of cholera in iantum, which would terminate life per haps in a few hours without such treat ment. William Bailey (Amer. Pract. and News, July 1, '93).

There is no drug comparable to small doses of atropine for controlling the de pression and purging of cholera infantum. Cecil (Amer. Pract. and News, June 15, '98).

Morphine, it should be remembered, is contra-indicated in condition of drowsi ness or stupor. Strychnine hypodermic ally will also prove of some service as a cardiac and respiratory stimulant. The effect of these remedies must be watched and the injections repeated as may be necessary to secure the desired action. It is better to avoid giving powerful drugs by the mouth, as doubt must exist as to the rapidity and. extent of their ab sorption.

in threatening cases of heart-failure strong coffee, hot or iced, recommended, according to circumstances; or the in jection into the bols-el through a long flexible tube of hot water with some alcohol, and 1 or more drops of tincture of opium. Jacobi (Pediatrics, July, '96).

The main indications are flushing of the colon, and use of tepid baths, and will cause the temperature to fall and the symptoms to abate. Two or three douches may be required daily. Small doses of opium—not to check the diar rlicea, but to allay nervous symptoms— may be given in the early stages. fbe following prescriptions are of value:— R Bismuth. subgallat., 29 to 30 grains.

Pulv. opii, 1/, grain.

Pepsini, 6 to 12 grains.

AI. Div. in pulv. No. 12.

Sig.: One every four hours, alternat ing with the following:— 13 Hydrarg. chloridi mitis, V2 grain. Cerii oxalat., 2 grains.

Saech. alb., q. s.

AI. Div. in pulv. No. 12.

Sig.: One every four hours.

No antiseptics. No food first twenty four hours; only ice or iced water in small quantities and perhaps stimulants. Stengel (No. Car. Aled. Jour., Apr. 20, '99).

For the pyresia cool baths are de manded, and should be administered in all cases when the temperature rises over 103° F. The bath, at the outset, should have a temperature of 97° F. and should be gradually cooled by the addition of ice or iced water till a temperature of 85° is reached. The infant should remain

in the bath from five to fifteen minutes, according to the effect produced; while in the bath brisk friction should be em ployed over the limbs and body gener ally. If baths are impracticable, the cold wet pack may be employed. An ice-bag or cold cloths should be kept applied to the head.

To counteract the effects of the drain of fluid from the tissues no method can compare with the injection into the cel lular tissue of a sterilized saline solution (45 grains of sodium chloride to the pint of water). About V, pint or more of this solution may be injected at once into the subcutaneous tissue of the thigh, abdo men, or buttock; the injection may be repeated twice a day. Marked improve ment in all the symptoms generally fol lows its employment. A suitable sy ringe can be easily made by attaching an hypodermic needle to the nozzle of a Davidson syringe by means of a few inches of rubber tubing.

Saline solutions or artificial serum suc cessfully used. The physiological salt so lution, which seems to be absorbed rnost readily, and Hayem's serum preferred. The most practical method of introduc ing the fluid is subcutaneously into the lumbar or gluteal regions, antiseptic pre cautions being observed. The fluid forms a swelling beneath the skin, the disap pearance of which can be accelerated by light massage. Alarois (Revue Alen. des Alal. de l'Enfance, Dec., '93).

In children of 6 weeks to 3 months old suffering from infantile cholera, subcu taneous injections of normal saline solu tion in doses of about 14 drachms, morning and evening, resorted to. After the first or second injection the fre quency of the stools diminished, they began to regain their normal consistence and appearance, and in a few days the patients recovered. Loin (Sem. MEd., vol. clxxvi; Brit. Med. Jour., Nov. 20, '97).

Hydrencephaloid symptoms call for a free use of stimulants; but opium, in this condition, is better avoided.

During the course of the disease care must be given to insure all possible warmth for the extremities. Sinapisms over the stomach may be of occasional benefit.

There is a growing tendency on the part of clinicians to consider even pure sterilized milk as a source of danger, owing to the properties which it mani fests as a culture-medium. French ob servers are especially averse to its use, particularly in the acute stage. St. Philippe states that its suppression from the dietary often proves curative.

Meat- and vegetable- broths given in small doses very frequently repeated are kept down when milk will at once be ejected. White of egg beaten up in cool water and sweetened with sugar of milk to precede the administration of brotbs recommended. Sterile water should be given ad libitam. Fitch (Med. Times, Sept., 1900).

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