CHOLERAIC DIARRHEA is the most dangerous form of intestinal flux to which children are liable. It occurs only during the summer months, runs a very rapid course, induces in a few hours a startling change in the appear ance of the patient, and often ends fatally. The affection has derived its name of choleraic diarrhoea from its resemblance in many of its symptoms to Asiatic cholera ; but it is not, like the latter disease, an epidemic malady, and appears to be essentially distinct in its nature, although in many re spects so apparently similar.
Causation.—Choleraic diarrhoea is especially a complaint of warm weather, and summer heat must be looked upon as a powerful predispos ing cause of the disease. Other agencies, however, must come in as excit ing causes, for the affection is not common in country Places, and indeed is rarely seen out of cities. Injudicious feeding, bad drainage, and the effluvium arising from decaying organic matter are probably auxiliary causes which have a notable influence in exciting this as well as the other forms of gastro-intestinal disorder. Infantile cholera, as its name implies, is a disease of early childhood, and is more common during the first six months than at a later period of infancy. It is said not often to be met with after the first dentition is completed ; but older children are subject, like adults, to attacks of cholerine or summer cholera, which have all the characteristics of choleraic diarrhoea in the infant. Boys are said to be more subject to it than girls ; and robust children are attacked by the com plaint as often as the ailing and the feeble.
Morbid Anatomy.—An examination of the intestinal canal in fatal cases of infantile cholera reveals little to account for the alarming character of the symptoms by which the progress of the disease had been accompanied. A patchy redness of the mucous surface may be visible, but often this is very slight and incomplete. Indeed, it may be absent altogether, and in stead of red, the mucous membrane may be paler and more bloodless than natural. The glands of Pet'er's patches, and the solitary glands of the large intestine, often stand out from the surface like little translucent projec tions, and sometimes the mucous membrane is softened. The softening appears to be a secondary lesion, and to occur as a consequence of the pro fuse serous transudation, which is one of the main features of the illness.
The same softened state of the mucous membrane is often seen in the stomach. If the course of the disease is very rapid, extensive destruction of the epithelial coating has been noticed in the gastro-intestinal canal. The organs generally are anmnic. The brain is especially bloodless, and is said to give evidence of fatty degeneration and oedema. The kidneys are congested, and, according to Kjellberg, may be sometimes the seat of acute parenchymatous nephritis.
Symptoms.—The outbreak of the disease may be sudden or gradual.
Sometimes it bursts out as a violent attack of vomiting and purging, which quickly assumes alarming proportions, and the child speedily passes into a state of collapse. In other cases it begins as an ordinary purging, but after a few days vomiting occurs, and the stools assume the peculiar watery appearance which is so characteristic of this fatal malady.
However it may have begun, the disease when established has very pe culiar features. There is obstinate vomiting and very persistent diarrhoea. The child first throws up the contents of his stomach, and all fluid or medicine swallowed instantly returns. Next, the ejected matters consist of mucus, thin watery fluid tinged yellow, or even pure bile. The stools, which are at first feculent, thin, and offensive, soon lose almost all trace of fecal matter, and consist of a copious flow of serous fluid, which soaks into the diaper, and when evaporated, leaves nothing but a faint yellowish stain upon the linen. The quantity of fluid discharged from the bowels is some times extraordinary. When thus serous, the stools are not especially offen sive ; they have not the horribly fmtid odour which is noticed in many cases of inflammatory diarrhcea—an odour which seems to cling to the diaper, and can be with difficulty washed away. The number of the stools varies. Sometimes twelve or fifteen are passed in the twenty-four hours. In other cases the bowels act less frequently ; but usually, if the stools are separated by a longer interval, a larger quantity of fluid is discharged on each occa sion, so that the abstraction of water from the body is very much the same.