Koumiss has been strongly recommended as a food in this disease. Dr. Archibald M. Campbell, of New York, speaks highly of its value in arresting the vomiting, subduing the thirst, reducing the number of the stools, and improving their appearance. He recommends that it should be given at first in quantities of half or a whole teaspoonful every ten minutes or quarter of an hour, and that the quantity should be gradually increased. While it is being taken, iced filtered water can still be used to quench thirst. If the white wine whey be employed, no other stimulant is required ; but if koumiss be used, the child will require an occasional dose of pure brandy, of which five or ten drops may be given at one time.
On account of the early occurrence of collapse, the ease should be watched with the utmost attention, and any sign of exhaustion requires to be combated by energetic stimulation. The child must be placed for five or ten minutes in a warm mustard bath ; and afterwards brandy (ten to thirty drops) must be administered, and repeated at short intervals, until the warmth of the extremities is restored. It must be remembered that a high internal temperature is compatible with considerable coldness of the surface ; and that it is of extreme importance to encourage the heart's ac tion and improve the general circulation. Often the dose of brandy will have to be repeated every few minutes for a time. It is astonishing how large a quantity of spirit must be given in many cases to produce a suffi cient effect even upon a young baby.
If the child is seen early, before exhaustion has come on, and the tem perature is found to be high, it is well to reduce the pyrexia by placing the child in water of 75° or 80° Fahr. If, however, there is great feeble ness, the mustard-bath must be used as already described.
Medicines given by the mouth are very disappointing in this disease. French authors speak highly of the value of nitrate of silver. If this salt be employed, it may be given in quantities of gr. to gr. 8 several times in the day. A common prescription is a combination of bismuth with aromatic chalk powder. If used, the close of bismuth should be a large one (gr. v.—x. for a child of three months old), but the medicine is usually vomited ; and if retained, has never seemed to me to have the slightest effect in allaying the irritability of the stomach or arresting the purging. The use of the salicylate of lime has been proposed by Mr. Walter Kilner, and the value of the remedy has been very warmly praised by Dr. Hutch ings, of Brooklyn, New York, in the treatment of these cases. This physi cian administered the drug in doses of from three to five grains every two or three hours. If a small dose was given without effect, a larger one was substituted ; and the influence of the salt in controlling the purging, checking the vomiting, and reducing the temperature was very decided. The medicine was found, in most cases, to arrest the stools without modify ing their character ; although, in exceptional cases, a simple diarrhcea con tinued for a short time during convalescence. Another drug to which great value has been attached, is the bromide of pbtassium. It is said in some cases to produce a rapid improvement in the number and frequency of the stools.
Enemata are sometimes very serviceable. For a child twelve months old, three or four drops of laudanum in a tablespoonful of thin starch, with a quarter of a grain of sulphate of copper, may be thrown up the bowel. The injection can be repeated three times in the twenty-four hours, and will be sometimes followed by signs of evident amendment.
In my experience, by far the most valuable remedy is morphia admin istered hypodermically. The sulphate of morphia, as being less likely to be
converted into apo-morphia in the blood, is recommended by Dr. W. Hard man for this purpose. The quantity employed need not be large ; in fact, a small dose appears to be nearly as effective as a large one. For a child of a year old, one-thirtieth of a grain may be used, combined with five or six drops of ether ; and the injection may be repeated in an hour's time if the symptoms continue. This treatment is best suited to cases which are seen early, before symptoms of exhaustion have set in. In such cases the effect of the sedative so introduced is to arrest the vomiting and purging almost immediately, without producing any signs of narcotism. The child afterwards requires energetic stimulation to help him out of the state of weakness into which he has fallen. An infant should be fed with white wine whey. An older child can take the brandy-and-egg mixture in fre quent doses ; and it is very important to keep the extremities warm. In many of these cases, after the arrest of the more pressing symptoms, very vigilant and intelligent nursing is required to enable the child to resist successfully the depressing effect of the illness. Often there appears to be a tendency to failure of the heart's action. After making a step or two towards recovery, the patient may fall back again into a state of asthenia, and die, without any return of the gastrointestinal symptoms, or the oc currence of any inflammatory complication to explain the unfavourable change. This tendency must be combated by mustard-baths, stimulating frictions to the skin, and brandy given in frequent doses. A strong mus tard-poultice, placed for a few minutes over the heart, is often of service ; and the subcutaneous injection of ether may prove a valuable stimulant. In addition to the above measures, the belly must be covered with cotton wadding, and the air of the room should be kept pure, and frequently re newed.
In the attacks of choleraic diarrhoea or summer cholera which occur in older children, the use of morphia hypodermically is equally valuable. A sixteenth or twelfth of a grain may be used, and improvement follows very quickly.
A little girl, aged seven years, was seized at 1 A.M. with violent vomit ing and purging. The bowels acted very frequently, without any strain ing, and the stools consisted, after the first few evacuations, of thin serous fluid. The vomiting continued. The child looked pinched and blue, and was excessively feeble. When seen at 4 A.M., the surface was cold, and no pulse could be felt at the wrist. The stools had the appearance of faintly tinged water. The thirst was intense.
One-sixteenth of a grain of morphia was at once administered sub cutaneously, and the child was put to bed with a hot bottle to her feet. The diarrhoea then ceased, and although the vomiting recurred three times afterwards, it was each time excited by the swallowing of milk. At 9 A.M. the temperature was 100.4°, and a few hours afterwards—eleven hours after the injection—it was noted : "Condition greatly improved ; much stronger ; some blueness about mouth ; eyes sunken ; tongue slightly furred, not dry ; still excessively thirsty ; complains of no pain ; pulse fairly good, 138." After this note, the child only vomited once or twice, and the bowels only acted on two occasions, the stools each time being thin and offensive. The patient was soon convalescent.
The diarrhoea which sometimes succeeds to an attack of infantile cholera, must be treated as directed under the head of Inflammatory Diarrhoea.