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.