Medical inquiries and observations. By Benjamin Rush, M.D. professor of chemistry in the University of Pennsylvania.
Rush, Benjamin, 1746-1813., Redman, John, 1722-1808, dedicatee., Rush, Benjamin, 1746-1813. Appendix: containing, the new method of inoculating for the small pox.
Page  112

AN INQUIRY INTO THE CAUSE AND CURE OF THE Cholera Infantum.

BY this name I mean to designate a disease, called, in Philadelphia, the

vomiting and purging of children.
From the regularity of its appearance in the summer months, it is likewise known by the name of "the disease of the season." It prevails in most of the large towns in the United States. It is distinguished in Charleston, in South-Carolina, by the name of "the April and May disorder," from making its first appearance in those two months. It seldom appears in Philadelphia till the middle of June, or the beginning of July, and generally continues till near the middle of September. Its frequency and danger are always in proportion to the heat of the weather. It affects children from the first or second week after their birth, till they are two years old. It sometimes begins with a diarrhoea, which continues for several days without any other symptom of indispositi|on; but it more frequently comes on with a violent vomiting and purging and a high fever. The matter discharged from the stomach and bowels is generally yellow or green, but the stools are sometimes slimy and bloody, without any tincture of bile. In some Page  113 instances they are nearly as limpid as water. Worms are frequently discharged in each kind of the stools that has been described. The children in this stage of the disorder, appear to suffer a good deal of pain. They draw up their feet, and are never easy in one pos|ture. The pulse is quick and weak. The head is un|usually warm, while the extremities retain their natu|ral heat, or incline to be cold. The fever is of the remitting kind, and discovers evident exacerbations, especially in the evenings. The disease affects the head so much, as in some instances to produce symptoms not only of delirium, but of mania, insomuch that the children throw their heads backwards and for|wards, and sometimes make attempts to scratch, and to bite, their parents or nurses. A swelling frequently occurs in the abdomen, and in the face and limbs. An intense thirst attends every stage of the disorder. The eyes appear languid and hollow, and the children ge|nerally sleep with them half closed. Such is the insen|sibility of the system in some instances in this disorder, that flies have been seen to alight upon the eyes when opened, without exciting a motion in the eyelids to remove them. Sometimes the vomiting continues without the purging, but more generally, the purging continues without the vomiting, through the whole course of the disorder. The stools are frequently large, and extremely foetid, but in some instances, they are without smell, and resemble the drinks or ali|ment which had been taken into the body. The dis|ease is sometimes fatal in a few days. I once saw it carry off a child in four and twenty hours. Its durati|on is varied by the season of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence, and disposes it to a favourable termination. It often continues with occa|sional Page  114 variations in its appearance, for six weeks or two months. Where the disease has been of long conti|nuance, the approach of death is gradual, and attend|ed by a number of distressing symptoms. An emacia|tion of the body, to such a degree as that the bones come through the skin, livid spots, a singultus, con|vulsions, a strongly marked hippocratic countenance, and a sore mouth, generally precede the fatal termina|tion of this disorder. Few children ever recover, after the last symptoms which have been mentioned make their appearance.

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 ap|pears only in one season of the year. Dentition I acknowledge sometimes aggravates the disorder; 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 tenth month. I think I have observed more children to die of this disorder 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 disorder 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 Page  115 not a single worm has been discovered in the bowels. It is true worms are in some instances discharged in this disorder, 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 pro|ducing this disorder. 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 mo|derate use of ripe fruits, rather tends to prevent, than to induce the disease.

FROM the discharge of bile which generally intro|duces the disease, from the remissions and exacerbations of the fever which accompanies it, and from its occur|ring nearly in the same season with the cholera and re|mitting fever in adults, I am disposed to consider it as a modification of the same diseases. Its appear|ance earlier in the season than the cholera and remit|ting fever in adults, must be ascribed to the constitu|tions of children being more predisposed from weak|ness to be acted upon, by the remote causes which pro|duce those disorders.

I SHALL now mention the remedies which are pro|per and useful in this disorder.

I. THE first indication of cure is to evacuate the bile from the stomach and bowels. This should be done by gentle doses of ipecacuana, or tartar emetic. The vomits should be repeated occasionally, if indi|cated, in every stage of the disorder. The bowels Page  116 should be opened by means of 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 primae viae 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 pepper-mint 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 disorder.

III. DEMULCENT and DILUTING DRINKS have an agreeable effect in this disease. Mint and mallows teas, or a tea made of blackberry roots infused in cold water, together with a decoction of the shayings 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 mut|ton broth, or of starch dissolved in water, with a few drops of liquid laudanum in them, give ease, and pro|duce other useful effects.

V. PLASTERS of venice treacle applied to the re|gion of the stomach, and flannels dipped in infusions of bitter and aromatic herbs in warm spirits, or Ma|deira wine, and applied to the region of the abdomen, often afford considerable relief.

Page  117 VI. AS soon as the more violent symptoms of the disease are composed, TONIC and CORDIAL MEDI|CINES should be given. The bark in decoction, or in substance, (where it can be retained in that form) mixed with a little nutmeg, often produce the most salutary effects*. Port wine or claret mixed with water, are likewise proper in this stage of the disorder. After the disease has continued for some time, we often see an appetite suddenly awakened for articles of diet of a stimulating nature. I have seen many children recover from being gratified in an inclination to eat salted fish, or the different kinds of salted meat. In some instances they discover an appetite for butter, and the richest gravies of roasted meats, and eat them with obvious relief to all their symptoms. I once saw a child of sixteen months old, perfectly restored, from the lowest stage of this disorder, by eating large quan|tities of rancid English cheese, and drinking two or three glasses of port wine every day. She would in no instance eat bread with the cheese, nor taste the wine, if it was mixed with water.

WE sometimes see relief given by the use of the warm bath, in cases of obstinate pain. The bath is more effectual, if warm wine is used, instead of water.

I HAVE had but few opportunities of trying the effects of cold water applied to the body in this dis|order; but from the benefit which attended its use in the cases in which it was prescribed, I am disposed to believe that it would do great service, could we over|come the prejudices which subsist in the minds of pa|rents against it.

Page  118 AFTER all that has been said in favor of the re|medies that have been mentioned, I am sorry to add, that I have very often seen them all administered with|out effect. My principal dependance, therefore, for many years, has been placed upon

VII. COUNTRY AIR. Out of many hundred children whom I have sent into the country in every stage of this disorder, I have lost only three, two of whom were sent, contrary to my advice, into that un|healthy part of the neighbourhood of Philadelphia call|ed the Neck, which lies between the city and the con|flux of the rivers Delaware and Schuylkill. I have seen one cure performed by this remedy, after convul|sions had taken place. To derive the utmost benefit from the country air, children should be carried out on horseback, or in a carriage, every day; and they should be exposed to the open air as much as possible in fair weather in the day time. Where the convenience of the constant benefit of country air cannot be obtained, I have seen evident advantages from taking children out of the city once or twice a day. It is extremely agreeable to see the little sufferers revive, as soon as they escape from the city air, and inspire the pure air of the country.

I SHALL conclude this inquiry, by recommending the following methods of preventing this disorder, all of which have been found by experience to be useful.

1. THE daily use of the cold bath.

2. A FAITHFUL and attentive accommodation of the dresses of children, to the state and changes of the air.

Page  119 3. A MODERATE quantity of salted meat taken oc|casionally in those months in which this disease usually prevails. It is perhaps in part from the daily use of salted meat in diet that the children of country people escape this disorder.

4. THE use of sound old wine in the summer months. From a tea-spoonful, to half a wine glass full, accord|ing to the age of the child may be given every day. It is remarkable, that the children of persons in easy circumstances, who sip occasionally with their parents, the remains of a glass of wine after dinner, are much less subject to this disorder, than the children of poor people who are without the benefit of that article of diet.

5. CLEANLINESS both with respect to the skin and cloathing of children. Perhaps the neglect of this di|rection may be another reason why the children of the poor are most subject to this disorder.

6. THE removal of children into the country before the approach of warm weather. This advice is pecu|liarly necessary during the whole period of dentition. I have never known but one instance of a child being affected by this disorder, who had been carried into the country in order to avoid it.