yellow fever; except when the powers of life seemed to fail, and
petechiae, vibices, haemorrhages, and other signs of malignancy had
occurred. In general, under such circumstances, the Peruvian bark,
either alone or combined with serpentaria, was administered in
preference to any other remedy of the same class. In cases, however,
unattended with reaction, tonics and diffusible stimuli internally, and
revulsives of all sorts externally, were had recourse to from the
commencement of the attack, and sometimes with the desired effect of
arousing the powers of the system. _Opium_ was never found beneficial,
on account of its tendency to aggravate or produce coma, as well as from
its effect in suppressing intestinal evacuations.
Whilst making use of the above remedies, the plentiful exhibition of
diluent drinks was not neglected,--care being taken, however, not to
load unduly the stomach, and to select such drinks as would suit the
taste of the patient. In almost every case, acids did not answer so well
as the bland mucilaginous infusions. The drinks were almost universally
allowed cold, except when there existed a tendency to perspiration;
under which circumstances they were administered slightly warm and a
little aromatic.
During the course of the yellow fever, some of the symptoms demanded
particular attention. Influenced by the idea of prostration and
dissolution, many practitioners, and myself for some time among the
rest, resorted to the bark and other tonics for the purpose of arresting
the black vomit, and of correcting that condition of the organs, which
gave rise to this effusion; but after many unsuccessful trials, I was
led to abandon this practice and to resort to other means. Of all the
remedies employed to attain this effect, calcined magnesia mixed in a
thick solution of gum arabic seemed to me to answer best; for whilst it
succeeded, in many cases, in arresting the vomiting, it tended to keep
the bowels open. Together with this, revulsive remedies were applied to
the skin, and sometimes succeeded very well,--a sufficient proof, I
think, that this haemorrhage is the effect of an increased action of the
mucous membrane of the digestive tube, and not of a passive condition of
the capillaries of the parts. For the purpose of controlling the great
irritability of the stomach, and arresting the vomiting occurring in the
early stage of the disease, besides the usual remedies used in such
cases, I found advantage in the use of small and frequently repeated
injections with a solution of salts, an infusion of senna, or the like
substances. Such a practice, however, did not seem to succeed so well in
the latter stage of the disease.
With the intention of promoting the secretion of urine, in cases in
which it was suppressed, all the diuretics, as well as every external
stimuli, were in vain employed;--this symptom, as I have already
mentioned, being, in all instances which fell under my immediate
observation, the forerunner of death.
ARTICLE V.--_Remarks on the Prophylactic Treatment of Cholera Infantum._
By JOSEPH PARRISH, M. D., one of the Surgeons to the Pennsylvania
Hospital.
The great mortality of cholera infantum renders it one of the most
interesting diseases, which come under the notice of the physician. Its
ravages among the infant population of our large cities, are too well
known, and too strongly felt, to require any comment. No disease
contributes so largely to swell our bills of mortality during its
prevalence; and were it not restricted to the summer season, it would
prove a greater scourge to the community than consumption itself.
This mortality is owing less to our ignorance of the nature of the
complaint, and the proper mode of treatment, than to the continued
operation of the causes by which it is produced. I have often compared
our endeavours to cure cholera infantum, while these causes remain, to
an attempt to relieve inflammation in a part, while a thorn is sticking
in the flesh. We may resort to bleeding and leeching; we may restrict
our patient to the lowest diet, and the most perfect rest; we may employ
all those remedies, which are ordinarily best calculated to reduce
inflammation: but so long as the thorn continues in the wound, our
efforts will be fruitless. Thus it is with cholera. We may obviate the
more violent symptoms; we may procure temporary relief; we may even
flatter ourselves that a cure has been effected: but the original causes
have not lost their power; an increased susceptibility to their
operation remains; relapse upon relapse is experienced; and at last the
little sufferer, worn out by the successive attacks, sinks beyond the
reach of medicine, and expires. Unhappily, the nature of the causes is
such, that, in very many instances, their removal is exceedingly
difficult, if not altogether impossible; and, under such circumstances,
the patient who has once been severely affected, seldom recovers in the
end. Hence it becomes of the greatest importance to prevent the
occurrence of the disease; and attention to the prophylactic treatment
is no less essential than the adoption of curative measures. It is with
the view of calling the attention of the profession to this subject,
that I have been induced to offer the following observations.
It is obvious, that, in the preventive treatment, two objects demand
attention; first, to remove, as far as possible, the causes of the
disease; and secondly, where their entire removal is not attainable, to
fortify the system against their influence. On each of these, I shall
offer a few observations.
I. Excessive and continued heat is, perhaps, the most fruitful source of
cholera. Thus we find, that the disease makes its first appearance in
the commencement of the hot weather, increases and becomes more fatal
with the rise of the thermometer, and declines with the return of cool
weather in autumn. During its continuance, it may be observed to vary
with every permanent change of temperature. A few very hot days in
succession, in the 6th month, are sufficient to call it into action; and
during the height of its prevalence, a spell of cold weather will
diminish, if not suppress it. In the summer of 1806, which was
remarkably cool and pleasant, there was very little of the disease; and
generally in moderate summers, it is much less prevalent than in those
of a contrary character.
I believe that it is by a direct operation on the system, and not by the
generation of miasmata, that heat proves so deleterious to the infant.
In the country, where miasmata are most abundant, there is comparatively
little cholera; for the heat of the sun is there moderated by the free
circulation of the air; and the debilitating operation of the high
temperature of the day is counteracted by the refreshing coolness of the
morning and evening. It is in the close air of cities, that the
complaint flourishes with greatest vigour; and the most confined
situations are the most favourable to its production. Let any one take
a walk, in a summer's morning, through the thickly built lanes and
alleys of Philadelphia. He will be struck with the appearance of the
children, reclining their heads, as if exhausted, upon the breast of
their mothers, with a pale and languid countenance, a cool and clammy
skin, a shrunk neck, and other signs of debility, arising from their
confinement, during the night, to close and hot apartments. It will
readily be believed, that such places are the very hot beds of cholera.
Heat, therefore, connected with confined air, being among the most
frequent causes of the complaint, it is necessary, as far as possible,
to counteract them. Should a strong predisposition to cholera be
suspected, the best plan will be to send the child into the country
during the summer. Both as a preventive and a remedy, country air is
decidedly the most effectual, to which we can resort. But in most
instances, it would be exceedingly inconvenient, sometimes impossible
for mothers to leave their homes and occupations in the city; and, under
such circumstances, it becomes necessary to substitute measures, which
may produce, as nearly as possible, the same effects. To keep the child
cool, and expose him to the fresh air, are the ends to be obtained. For
this purpose, he should be carried frequently into the open squares, or
beyond the suburbs of the city. I am in the habit of recommending to
parents, whose circumstances will not allow of a removal from the city
during the summer season, to make frequent excursions across the
Delaware, and into the neighbouring woods of New Jersey. The refreshing
effects of the air on the river are truly surprising. The brightened eye
and animated countenance of the infant, give speedy proof of their
favourable influence; and when labouring under the disease, even in its
lowest stage, the little patient will often exhibit immediate signs of
amendment.
In the prevention of cholera, much may also be expected from a proper
attention to the lodging of children. Many parents have a great dread of
the night air; and exclude it from their chambers, as sedulously as if
it were infected with poison. But, in guarding their children from
taking cold, they expose them to a much greater danger. Observe their
mode of treatment. The doors and windows are carefully closed; the child
is placed in a feather bed, with his parents on each side, and almost
smothered with the bed-clothes. Perhaps other children are lodged in the
same apartment; and thus the delicate system of the infant is exposed to
the debilitating influence of great heat and stagnant air, combined with
the effluvia, which, in such a situation, must be abundantly generated.
Simply to enter such a room in the morning, is almost sufficient to
sicken a healthy individual; how much more injurious must be its effects
upon the lodgers themselves. Examine in the morning a child, who has
passed the night thus confined. You will find him limber as a rag,
exhausted by perspiration, wholly destitute of animation, without
appetite, and on the very verge of cholera. I should recommend an
entirely different plan of management. Instead of a feather bed, the
child should be placed on a hard mattress, or on blankets folded and
laid upon the floor. The covering should be light, but comfortable. The
doors and windows should be open; so that fresh air, that _pabulum
vitae_, without which health cannot be sustained, may be freely admitted.
Thus treated, instead of the feeble and sickly appearance before
mentioned, he will present a lively countenance, with all that activity
of motion, and enjoyment of existence, which are natural to his age, and
afford the surest criterion of vigorous health. Experience has fully
convinced me of the great importance of attention to the lodging of
children, as a prophylactic measure; and this renders me desirous of
impressing upon the profession generally, the truth of my own
convictions on the subject.
With the same design of obviating the injurious effects of a high
temperature upon the infantile system, I advise frequent ablutions with
cool water, and its free employment as a beverage. Infants, unable to
make their wants known, often suffer exceedingly from the inability of
their attendants to understand them. During the heat of summer, the
increased evaporation from their surface is necessarily productive of
increased thirst, which, if unsatisfied, renders them uneasy and
restless. To quiet them, the breast or bottle is offered. Aliment is
thus given, where drink only was required; and the stomach, overloaded
and oppressed, is apt to become irritable, and is thus brought into a
condition most favourable to the occurrence of cholera. By attention to
the peculiar language of infants, expressed not by words, but by signs,
I have often been able to detect their wants; and, in many instances,
have afforded the most decided relief, by simply giving them a little
cool water for drink. From the dread which some individuals have for
cool air and cold water, it would seem that they were considered rather
as destructive poisons than as absolute necessaries. I have no fear of
either, when judiciously employed; and as prophylactics in cholera, I do
not think their place can be supplied.
But heat is not the only cause of this complaint. Dentition is well
known both to predispose the system to its attack, and, after it has
occurred, to increase its violence, and diminish the chances of
recovery. In the employment, therefore, of preventive measures, it is
highly necessary to attend to the state of the gums, and to remove or
counteract this source of irritation. If at all swelled or painful, they
should be lanced freely, and the operation should be repeated as often
as their inflammatory condition may demand. In severe cases, much good
may be expected from the application of blisters behind the ears. The
irritation thus receives an external direction, and the stomach and
bowels are in less danger of an attack. I was led to this practice, by
observing that the eruption, which, during dentition, is apt to make its
appearance behind the ears, often proves a most salutary effort of
nature; and that, while it continues, the infant generally enjoys an
exemption from those dangerous disorders, incident to this critical
period of life. To imitate nature as closely as possible, the discharge
from the blistered surface should be maintained for some time by
stimulating dressings. I have witnessed the most beneficial effects from
the practice, and can strongly recommend it to the attention of the
profession.
II. At the same time that we endeavour to remove or diminish the causes
of cholera, we should not neglect to put the system of the child in such
a condition, as may enable it most effectually to resist their
operation. As cholera is a disease of irritation, originating generally
in a debilitated state of the alimentary canal, I believe this end may
be most easily attained, by preserving the natural tone of the digestive
organs. For this purpose, all flatulent and indigestible food should be
carefully avoided. During the first year, the mother's milk is, in
general, the most appropriate nutriment. When the stomach of the infant
is very delicate, the diet of the mother should be strictly regulated;
and, in all cases, it would be adviseable for her to avoid articles of a
flatulent nature. While the child is still at the breast, if a
predisposition to cholera be suspected, I would recommend the occasional
use of nutritious animal juices. The sucking of small pieces of salt
meat, as ham or dried beef for example, will sometimes be found
productive of advantage. After weaning, animal food should always enter
into the diet of the child. Many parents, fearing to render their
children gross and unhealthy, restrict them altogether to vegetable
aliments; and thus, by weakening the powers of digestion, prepare the
way for that very result which they are most anxious to avoid.
With the same view of giving tone to the stomach, aromatics should be
used habitually during the summer, in those cases, in which there is
strong reason to apprehend the occurrence of cholera. While they produce
a cordial impression on the stomach, and invigorate generally the
digestive powers, they are liable to none of those objections which may
be urged against the employment of the narcotic stimulants. Indeed,
nature herself seems to have pointed them out as prophylactics against
the diseases of hot weather. Our most powerful and valuable spices are
the products of warm countries. Cinnamon, ginger, pepper, the clove, the
nutmeg, are to be found only in tropical climates. In this arrangement,
we see the hand of a beneficent Creator, who has provided, that, by the
same high temperature, which renders the equatorial regions so fruitful
of cholera, and other disorders of the bowels, the growth of those
plants should be promoted, which are best calculated to invigorate the
alimentary canal, and to fortify it against the inroads of disease.
Facts are not wanting to prove the efficacy of spices in preventing
intestinal complaints. We are informed by DEWAR, in his treatise on the
Diarrhoea and Dysentery, by which the British army in Egypt was
attacked, that among the Mamalukes of that country, it was a universal
practice, when they apprehended the approach of these disorders, to make
use of cinnamon or ginger, with the almost uniform effect of averting
them; and where the same practice was followed by the British soldiers,
equal advantages were experienced. In the French army, so highly was the
prophylactic power of the aromatics estimated, that every soldier was
provided with a box of spices, which he was directed to use freely with
his diet of fruit and melons.
When attending surgeon of the Alms-house hospital in this city, I had
occasion frequently to prescribe in a syphilitic ward, which being
situated directly under the roof, in a large garret, was liable, in the
summer season, to become very much heated. As the patients were
numerous, and the windows insufficient to admit of proper ventilation,
the air became much contaminated; and the consequence was, that bowel
complaints were very frequent and troublesome. I have often entered the
ward on a summer's morning, and found almost every patient affected more
or less with diarrhoea or cholera. It occurred to me, that the free
use of some of the aromatics might be found serviceable in preventing
the occurrence of these complaints. I accordingly directed, that every
individual in the ward should drink a portion of strong ginger tea
daily. I also ordered, that salt meat should be used twice in the week.
By the steady pursuit of this plan, a very considerable change for the
better was effected.
The employment of aromatics as prophylactics is not less beneficial in
children than in adults. I would not, however, advise, that they should
be given indiscriminately to all children, during the summer. It is only
to those cases, in which a predisposition to cholera infantum exists,
that I consider them peculiarly applicable; and here I believe they are
capable of producing much good.
Before dismissing the subject of the paper, I will simply remark, in
addition to what has been already said, that the occasional use of the
cold bath, by the vigour it imparts to the system generally, and through
it to the digestive organs, will often be found an excellent
preservative against the summer complaint of children.
In this short account of the preventive treatment of cholera infantum, I
have been less anxious to give a dissertation, embracing all that might
be said on the subject, than to communicate those particular measures,
which, according to my own experience, I have found most effectual. I
will conclude the paper by the relation of a case, in which a strong
predisposition to the disease was successfully counteracted. It will be
proper, however, to premise, that the treatment of this case is by no
means held out as an example to be generally followed with every
infant, which may possibly become the subject of cholera. It is
applicable in all its details only to those, in which, as in the present
instance, there is every reason to apprehend, that the only alternative
is between almost certain death, and the most careful prophylactic
treatment.
CASE.--A gentleman of this city, whose wife had arrived at a period of
life, when she could not expect to be the mother of many more children,
consulted me respecting an infant daughter, their only surviving child.
I was informed, that they had already lost eight children, all of whom,
with one exception, had died of cholera. It may readily be imagined,
that every feeling of parental anxiety was awakened for their babe; and
that no degree of attention on their part was considered too great,
which might contribute to its preservation. It was placed under my care,
not to be cured, but that I might, if possible, devise some plan of
management which would avert the disease they had so much reason to
apprehend. I felt the responsibility of the trust, and endeavoured to
find it to the best of my ability. Every opportunity which I could
desire was afforded me; for the infant, from its birth was submitted to
my direction; and both the disposition and ability existed, on the part
of the parents, to carry implicitly into effect every measure which I
might recommend.
As the mother was unable to furnish sufficient nourishment, the first
step was to provide a healthy wet-nurse, who might be willing to submit
to the necessary regulations in respect to diet.
I believed the children of these parents to possess a constitutional
weakness in the alimentary canal; and, on inquiry, I was told, that they
had been kept upon a vapid diet, under the impression that it would
contribute to their health. In the present case, therefore, the
principal object was to communicate strength to the stomach and bowels.
With this view, the child was accustomed, from an early period of
infancy, to a generous diet. When very young, portions of ginger tea
were given to it daily; and as soon as it was old enough to suck the
juice of meat, it was encouraged to do so. The nurse, during the warm
season, was kept upon a nutritious diet, consisting principally of
animal food, with the occasional use of ginger tea; and every
description of recent fruit and fresh vegetable food was forbidden.
Under this management, the first summer was passed without any symptom
of the disease; but I looked forward to the second with no little
anxiety, when the child would have to struggle with the irritation
arising from dentition.
The same plan was continued during the second summer, and still more
rigidly enforced. The child was now old enough to take animal food
freely in addition to the breast. It was allowed as much salt fish, ham,
beef-steak, essence of beef, &c. as it desired; ginger tea was given
daily; a little sound old port wine was occasionally directed; and both
the child and the nurse were restricted from every species of flatulent
and indigestible aliment. So anxious, indeed, were the parents, and so
careful to carry my directions into full effect, that they allowed no
forbidden article of food to enter the house, and denied themselves
their wonted comforts, lest possibly their child might be injured.
The gums were carefully attended to, and lanced whenever the operation
appeared to be requisite. All those measures, which I have before
mentioned as serviceable in obviating the effects of great heat, so far
as they were applicable to the case, were adopted. The second summer was
spent wholly in the country.
Very little medicine was required, and none was administered, except of
the mildest description. Frequently, when summoned to visit the babe, I
have found the mother trembling with fear, and anxious that something
might be done; and often, under such circumstances, have I begged it off
from a dose of physic, having determined to avoid a resort to every
thing of the kind, unless real necessity should demand it.
By a strict adherence to the plan above detailed, the period of
dentition was passed in safety; and it is with heartfelt pleasure I can
say, that no symptom of cholera afterwards made its appearance.
ARTICLE VI.--_Case of Neuralgia cured by Acupuncturation._ Communicated
by J. HUNTER EWING, M. D.
The attention of the medical public having been of late much excited on
the subject of acupuncturation, I am induced to communicate the
following case.