CHOLERA INFANTUM.
A contribution to the etiology, pathology, and therapeutics of cholera infantum,[[4]] by Dr. T. Clarke, Miller, opens fairly and clearly a theme which will be uppermost in the thoughts of physicians in the approaching hot weather.
The writer begins by pointing out how differently the name Cholera Infantum has been applied, including every phase of choleraic diseases. But, “Classification of these diseases to be practical, must of necessity be rather coarse in order to adopt itself to the grain of the great mass—the rank and file—who in the main observe well, though not so systematically as we could wish. The great office-workers do not contribute largely to our mortality statistics, but we will derive great comfort as we proceed, in finding that the figures of these common men are stupendously significant—that the bullet and bayonet are in the aggregate little less important than the epaulette and the gold lace.” He supposed that in the large majority of cases reported as cholera infantum that the choleraic feature was present at some time during the illness, though very likely not at or very near the time of death. For these reasons he considers that the statistics presented are not materially impaired.
“The onset of cholera infantum is characterized by copious watery evacuations from the bowels, often attended by nausea and free vomiting. Attending upon this or even sometimes preceding it, or rapidly succeeding upon it, is the extreme muscular prostration and great depression of the respiratory functions; there is generally more or less griping pain and restlessness, and a rapid appearance of all the symptoms of collapse, coldness of the surface and tongue, feeble rapid pulse, and partial or total loss of voice. Cholera infantum proper, lasts but a few hours—hardly a few days—when it ends in recovery, death, or inflammatory disease of some portion of the intestinal tract; in the latter case the choleraic disease is rapidly rekindled by conditions similar to those which brought about the first attack.
“The condition under which cholera infantum appears, and the only condition essential to its development, is continued high temperature day and night—a mean thermometer above 75°, with small daily range. This high and slightly varying temperature continued from six to ten days, will invariably, in our climate, bring cholera infantum (together with the bowel trouble symptomatically more or less distinct, but pathologically akin to cholera infantum), and the longer this condition of things continues the more numerous and the more intractable the cases become. This is as true in the country as in the city, though we are led to think, as we read the books, that this is a disease of the city especially. Deaths are registered, to be sure, and the books are made in the cities, but if the conditions above mentioned exist in the country, the disease appears there—of course, not a great many cases, for the susceptible bodies furnished by a single block in the city would outnumber those of two or three square miles in the country—yet I am glad to admit that the conditions for obvious reasons are not so likely to be present in the country; the contrast, in point of green grass, shade, cool water, and moving air, is no less marked than is the percentage of mortality, and it is no more marked.
“Few, if any, recoveries take place until the temperature falls; this fall is usually attended by rain; but this does not seem to be essential, the fall of temperature alone being sufficient to bring about a better state of things. When the temperature falls, cases improve and new cases cease to appear. Sewer emanations do not seem to have anything directly to do with the production of disease, except so far as they tend to impair the general health, and thus diminish the power of the system to resist any disease producing influence, and sewer poisons are no less abundant and deadly at other times than they are when cholera infantum cases are most numerous, and this is the time of year above others when the sewers are abundantly ‘flushed.’”
Filth he does not consider is any more abundant in the summer, and the disease declines with the increase of the very rains that favor increased decomposition. He does not attach much importance to unripe fruits as a causative element. “For whoever saw a youngster who would not exchange all his earthly possessions for a green apple, and whoever saw a child in good health injured by an unripe apple or by any quantity not altogether unreasonable?” And then the sufferers from cholera infantum are all under two years, and hence have not arrived at the green-fruit eating stage of their existence.
Nine tables are constructed, showing the weekly mortality from cholera infantum in Philadelphia, New York, Boston, Baltimore, Cincinnati and Chicago, and also as far as possible the record of thermometric range. An analysis of the table bears out the author’s views as regards the causative influence of continued high temperature.
He thinks there are some points of striking resemblance between this disease and sunstroke, so much as to suggest a pathological relationship. 1st. The same conditions seem to be sufficient for and essential to the development of each. 2. They come and go together. 3. The development is gradual and the recovery is slow in each, showing a profound impression made on the living-power of the patient. 4. The explosive character of the attack under the cumulative effects of continued high temperature with the sudden severe or fatal prostration consequent.
“Wash your children well with cold water twice a day, and oftener in the hot season,” is the direction of the New York Board of Health, and Dr. Miller thinks if this one prescription were carried out, cholera infantum cases could be well nigh eliminated from the mortality reports. He thinks it worth while to inculcate among our patrons that however important it may be to take special care in feeling, this will not be sufficient alone, to carry the infant safely through the high temperature of July and August; and we would try to have the people study to keep the little ones cool, and the means recommended is cool-bathing or cool-sponging. Medicines are not of much use if the surroundings are cool.