CHOLERA INFANTUM

CHOLERA INFANTUM

    In the days of old, when medical knights were bold in the use of drugs for the treatment of 'diseases peculiar to babies,' the mortality was great. Some preparations of calomel--particularly the gray powder--calomel and chalk--and some of the lighter preparations of opium and morphine, were in daily use.

    The enervating influence of hot weather and improper care, and the poisoning from food improperly prepared, will often bring on gastric disturbances in children. If the child nurses the mother, her milk may be ruined as a food because of improper foods, work, and unreasonable marital demands. The milk of a mother subjected to such influences will surely cause a child to have stomach and bowel derangements, and, when the summer heat is intense, kill many by what is called cholera infantum (cholera in infants). The symptoms of this disease are intense restlessness, high fever, frequent vomitings, at first curdled milk, then water in which there may be specks of white resembling rice. The bowel movements are called rice-colored discharges, and are considered characteristic of cholera. The rice specks are small curds of milk.

    The whole aspect of the child is one of intense suffering and great prostration. The vomiting and bowel movements are almost incessant. In a few cases the prostration comes on rapidly, and death ends the suffering in a few hours. Those who do not die within twenty-four hours will often settle into a state of bowel derangement named in text-books gastro-enteritis (inflammation of the stomach and small intestines) or muco enteritis (catarrhal inflammation of the small intestines).

    Cholera infantum is indigenous to the Mississippi Valley and other parts of the country where the climate is hot and moist. It is a disease seldom met with in high and dry altitudes.

    Symptoms.--Vomiting and purging, with great prostration. Rapid drain of water from the blood through the stomach and bowels by way of vomiting, and frequent watery evacuations from the bowels, deplete the body rapidly and bring on fatal exhaustions in a few hours. Plump babies weighing fifteen to twenty-five pounds will sometimes lose half their weight in from twelve to twenty-four hours.

    Treatment.--Obviously the rapid drain of water from the body will make a strong demand, by way of thirst, for water to supply the waste. Warm water may be given--never cold; for the heat of the body must be conserved by keeping artificial heat to the entire body to prevent fatal chilling. A hot tub-bath must be used as frequently as appears necessary to relieve the pain and restlessness. Hot baths, by stimulating the surface skin--circulation, draw the blood from the mucous membrane of the stomach and bowels, and prevent, as far as possible, the fluid drain that takes place from the congested mucous membrane.

    Thirst is often interpreted as hunger, and the accustomed food is given. No greater mistake could be made; for food given under such circumstances becomes a rank poison, and millions of children have been killed from overzealousness in trying to prevent starvation. Even water is rejected by the stomach and bowels, and, when the vomiting and purging is at its worst, a teaspoonful of hot water may be given occasionally. As much as the child will take will aggravate the vomiting. The lips and mouth may be wet with a small gauze swab. The swab may be put into boiling water after using it, or a fresh one may be made at each swabbing.

    When even water is rejected, the discerning should realize how impossible feeding would be. Thirst can be assuaged slightly by keeping a soft towel, wet in warm water, on the stomach and bowels, retained by a binder. Keep the towel warm by using an electric pad, or a hot-water bottle.

    The hot bath cannot be stressed overmuch; for its tendency is to draw the blood to the surface, relieving the engorgement of the mucous membrane. It soothes the nervous system and gives a little rest. In desperate cases, the bath should be prolonged for an hour, and repeated as often as necessary to get as much relief as possible. Hot water should be added, and the cool run out. Keep the water in the tub as near 104 degrees as possible. The child should be watched closely. So long as the symptoms indicate that the bath is soothing, continue it. When the heart indicates weakness or when there are signs of oppressed breathing, wrap the child in a soft blanket and give fresh air, but avoid cold extremities.

    If symptoms improve, and the vomiting and purging grows less frequent, do not meddle, but encourage any improvement by perfect quiet. Do not, however, neglect warmth. As soon as the stomach will tolerate water, increase the amount given by slow degrees, until the child can take all it wants. Gradually reduce the artificial heat. Keep heat to the feet and abdomen. When the bowels are fully relieved, leave off the heat, rub with oil, and keep a dry pad on the abdomen.

    Feeding should not start until the blood-vessels and tissues have had their loss of water supplied. The blood has been dehydrated. When the water has been replaced, give of the accustomed food up to one-tenth the usual supply. If the first day's test-feeding is received kindly, the second day two-tenths may be given. Increase each day by one-tenth, until regulation meals are given. Then stop the regular ten o'clock feed, and give fruit or vegetable juices at this meal time throughout young child-life.

    When children have been carried through cholera infantum carefully, as directed above, they will not develop a gastritis or gastro-enteritis, which is supposed to be a sequel of the disease. This, however, is a mistake. The so-called sequel of the disease is caused by feeding too soon, or by overfeeding, medicating, etc.

    Few realize that enervated mothers impart enervation to their children. The following is an incident among many similar ones that have come within my experience:

    Fifty years ago I was making a professional visit to the wife of a wealthy farmer. Mr. Howard, the owner of one of the show farms in Illinois. I complimented Mr. and Mrs. Howard on their beautiful home and farm, and remarked that they should be very happy. This brought from both the confession that they were not happy, because they had lost seven beautiful children in infancy, all having died from summer complaint--a blanket term for stomach and bowel diseases of infants.

    The husband, after visiting with me for a while, excused himself, saying that he must give some orders to his foreman; but, before going, he invited me, when through with my professional call, to come out to the barn and see some of his fine stock, which I did. Besides other prize animals, he showed me a young Kentucky mare with foal by one of the greatest racing sires of that day.

    I saw a chance to point a moral, and said: 'Mr. Howard, my horse needs a few weeks of rest out on your splendid pasture. Allow me to take this beautiful mare and use her while my horse takes a rest. I promise to take good care of her and feed her well. A little road work will give her some needed exercise.' Mr. Howard looked at me in amazement, and replied: 'My dear doctor, you don't know the consequences of what you ask! If her colt can stand on its feet at birth, it will be worth three hundred dollars. If you should drive the mare in your buggy for a while, the colt would probably die of scours.' I said: 'Mr. Howard, did it ever occur to you that you have lost seven children from the scours?' He dropped his head, knit his brow, and, after a short silence, came to me, took my hand in his, and said: 'You make a fiend of me. How stupid I have been! I see it all now. I have allowed Mrs. Howard to kill our children. She is ambitious and has worked too hard.'

    I was entertained in the Howard home twenty-five years later, and saw five splendid children. Mrs. Howard told me that they had never had occasion to call a doctor to prescribe for any of them.

    An enervated mother will impart enervation to her children. An enervated child has low resistance, and will give down easily from the depressing influences of hot weather, excitement, etc.