This disease has been ascribed to several causes; of each of which I shall take notice in order.
I. It has been attributed to dentition. To refute this opinion, it will be necessary to observe, that it appears only in one season of the year. Dentition, I acknowledge, sometimes aggravates it; hence we find it is most severe in that period of life, when the greatest number of teeth make their appearance, which is generally about the 10th month. I think I have observed more children to die of this disease at that age, than at any other.
II. Worms have likewise been suspected of being the cause of this disease. To this opinion, I object the uncertainty of worms ever producing an idiopathic fever, and the improbability of their combining in such a manner as to produce an annual epidemic disease of any kind. But further, we often see the disease in all its force, before that age, in which worms usually produce diseases; we likewise often see it resist the most powerful anthelmintic medicines; and, lastly, it appears from dissection, where the disease has proved fatal, that not a single worm has been discovered in the bowels. It is true, worms are in some instances discharged in this disease, but they are frequently discharged in greater numbers in the hydrocephalus internus, and in the small-pox, and yet who will assert either of those diseases to be produced by worms.
III. The summer fruits have been accused of producing this disease. To this opinion I object, that the disease is but little known in country places, where children eat much more fruit than in cities. As far as I have observed, I am disposed to believe, that the moderate use of ripe fruits, rather tends to prevent, than to induce the disease.
From the discharge of bile which generally introduces the disease, from the remissions and exacerbations of the fever which accompanies it, and from its occurring nearly in the same season with the cholera and remitting fever in adults, I am disposed to consider it as a modification of the same diseases. Its appearance earlier in the season than the cholera and remitting fever in adults, must be ascribed to the constitutions of children being more predisposed from weakness to be acted upon, by the remote causes which produce those diseases.
I shall now mention the remedies which are proper and useful in this disease.
I. The first indication of cure is to evacuate the bile from the stomach and bowels. This should be done by gentle doses of ipecacuanha, or tartar emetic. The vomits should be repeated occasionally, if indicated, in every stage of the disease. The bowels should be opened by means of calomel, manna, castor oil, or magnesia. I have generally found rhubarb improper for this purpose, while the stomach was in a very irritable state. In those cases, where there is reason to believe that the offending contents of the primæ viæ have been discharged by nature (which is often the case), the emetics and purges should by no means be given; but, instead of them, recourse must be had to
II. Opiates. A few drops of liquid laudanum, combined in a testaceous julep, with peppermint or cinnamon-water, seldom fail of composing the stomach and bowels. In some instances, this medicine alone subdues the disease in two or three days; but where it does not prove so successful, it produces a remission of pain, and of other distressing symptoms, in every stage of the disease.
III. Demulcent and diluting drinks have an agreeable effect in this disease. Mint and mallow teas, or a tea made of blackberry roots infused in cold water, together with a decoction of the shavings of hartshorn and gum arabic with cinnamon, should all be given in their turns for this purpose.
IV. Glysters made of flaxseed tea, or of mutton broth, or of starch dissolved in water, with a few drops of liquid laudanum in them, give ease, and produce other useful effects.