CHAPTER XIV.
If cholera of infants can be reckoned as a distinct disease, then can starvation. Whether starvation causes two-thirds of all the infantile mortalities, during the latter part of summer and the first part of autumn, or not, the symptoms indicatemuch the same treatment as in cholera. This statement can only be proved by close unbiased observations; books can never do it.
We will first notice some of the symptoms of starvation which may be present in real consumptive babes, also the signs of starvation that may develop in cholera; after which I shall endeavor to describe the symptoms of cholera as viewed in the light of a disease.
Starvation of a child is seldom detected by friends who may be constantly caring for it, but the eye of a practitioner cannot fail to do so at once, assisted by the required information. Notwithstanding, a physician may permit doubts to enter the mind, or through over cautiousness conceal the real opinion.
A child may be apparently well and hearty at birth, may thrive even at the breast for a few months; then all at once seem to fail. It may be fed on whatever is ordered if not at the breast from the first; yet barely live on for months, whining, drooping, and struggling, as it were, to live. Such patients lay awake, listen, and watch the motion of passing objects; when spoken to, will try to indicate something, look pitiful, act intelligent concerning wearing apparel or toys. In fact such a child is termed cross. It will cry after everythingit sees, and that it don’t see; will slap things, such as cake or crackers, out of your hand. Nothing offered is welcomed as a relish. The bowels are generally loose, the urine copious; yet in many cases the water is voided in large quantities, while the bowels are dry. The eyes retain their brightness, as if to invite attention to the fact, “I would thrive if I had what I need.” The patient may drink half a gallon a day without the least sign of satisfaction.
Starvation may begin with the fœtal development either from lack of nourishment from the system of the parent, or by reason of repeated attempts at abortion; either of which is sufficient to blunt the vitality of the germ. Such children are likely to “hang on,” perhaps till the period of youth, and with good care may arrive to manhood or womanhood. The most doubtful cases are those that have a dry cough, eat a great deal, yet are never content, bloat at certain times, and grow more stupid; the body becoming a mere skeleton, and with difficulty kept warm. The new being is dependent upon the state of the parent’s blood from the moment of conception till weaned from the breast. If the food upon which a child is fed is the cause of the trouble, it should be changed as soon as possible. If from other causes there are medicines which can in a measure supply the needed basis. But generally the real cause is notknown or even suspected until too late to repair the injury, and the patient dies after having exhibited all signs of consumption. Children born of consumptive parents may come out quite bright in some branches of thought, yet be quite delicate, seldom passing the flower of youth in life.
I feel incompetent to decide whether a consumptive mother had better nurse her child, and thus fasten the germ of disease upon it, with a view to prolonging her own life; or whether it is best for her to yield to her fate, and substitute some different food for the chance of her child’s life.
If, as heretofore mentioned, the solid or nutritive principle of the milk has been withheld from the babe by adulteration in any way, the blood becomes watery, the fat cells cannot develop, the tissues that hold the fluid with which to moisten the parts dries away, and the flesh becomes soft or skinny. The milk may be nutritive, too, and yet for some reason fail to mix with the juices in the stomach so as to insure healthy blood.
These facts, however, are seldom found out by a casual medical attendant until the powers of digestion are too weak to derive much benefit from anotherkind of diet. Besides, the expense of the articles mostly ordered by physicians renders a trial almost out of the question. There are, however, many articles of nourishment obtainable, which, if perseveringly administered, will do much to assist in building up the little frame.
The most marked of the signs that may end in cholera are vomiting, dulness of the eyes, rolling the head, as if to rock, spitefully crying when taken up to be changed, and begging for everything, as they say; also crying, if old enough, for the very things no one thinks it should have. If a child could have some of what it smells and craves, at such times, no doubt but that recovery would commence. But a general languidness of the whole system, and a loathing of the sight of a bottle or its accustomed food, shows signs of certain destruction. In the last stage the child screams faintly, starts at the sound of almost anything; sometimes the breathing is scarcely perceptible. The discharges from the bowels are seldom white and frothy, as in the last stage of acute cholera; owing, perhaps, to the fact that the diet has been continued in the former, whereas in the latter all food is generally suspended during treatment, except it be fluids of the mildest nature; unlike in the last stage of consumption, when the little sufferer seems to watch every movement of its nearest friend, sometimes rising half way up tolook about, then falling back exhausted, it now lies quiet.
It may be remarked just here that infants affected with inanition or starvation, consumption and cholera, most invariably retain to the last hour their instinct to suck, whether it be of the bottle or of the breast. It is a well-known fact that infants who were nearly destroyed by starvation from being fed on poor milk by hand, have been successfully raised by being put on breast-milk.
We will now consider that much-dreaded disease termed “cholera infantum.” I have seen babes attacked with it from two weeks old and upwards. A child may be nursing at the breast or feeding from a bottle, when all of a sudden it leaves off, and looks languidly about in a comparatively stupid and pitiful manner; the eyes lose their lustre, are rolled about as if not noticing any particular object. Fluids are thrown up as soon as swallowed; passages from the bowels are frequent, though many times but a speck in the centre of a wet napkin, most of the report being wind. The matter discharged at first is likely to show in some measure the cause of the irritation.
After the acidity has been corrected by medicines,unlike a simple looseness, the purging and vomiting of infantile cholera still continue, showing conclusively the inactivity of the internal organs of digestion. In some cases the remedies that are scientifically administered pass out into the napkin unchanged; in others, they seem to lodge somewhere and dry up. The chances are always considered favorable to recovery if the remedies have a desirable action.
A child may drool or throw up its food at any time, yet be quite healthy. If a babe is sucking, and the mother indulges in a mixed or meat and vegetable diet too early, the first passages after it is taken sick will show signs of heat, fermentation and inflammation; they will either be of a deep yellow, or more or less green, and slimy. In such instances it is always advisable to take the infant from the breast for a while and feed it on arrow-root boiled in water, till the acidity is corrected; then in milk, no sugar being added, alternating with gum-arabic water. The mother, or wet-nurse, having been put under strict diet for a week, might with propriety resume nursing. Robust, perfectly developed children are apt to exhibit considerable vitality through the different phases of the disease; but as far as my experience has been, they succumb to the worst more quickly than the more delicate-appearing.
As the disease progresses the little suffererwill thrust its fingers in its mouth, as if to intimate hunger or dryness, and gag, as though something was sticking in the throat. The hands and arms are the most active. The lower extremities are seldom moved from one position; and when moved by any one, they are quickly reversed. Every movement of the body, in bathing or changing, is followed by a discharge from the bowels. These discharges vary in consistence even before any medicine has been given. After the bowels have been purged, as is recommended by most physicians to begin with, the discharges from the bowels may run off frequently, and in small quantities, depositing in the napkin a whitish, frothy fluid, which settles down to a chalky substance, giving out the smell of lime. If such emissions continue, they will effect a rapid destruction; or they may have the same appearance from the beginning if the internal organs have been previously rendered weak from starvation, or rather where the food has been but little better than water sweetened; and, too, these frothy emissions greatly chafe the parts if they are allowed to remain soiled.
The tongue is dry and stiff, as a general thing, throughout the disease. The body, with the exception of the belly, is dry and cool. The mouth is apt to be hot from the beginning, a sign remarked by mothers who have suckled babeswith cholera; in the last stage, the disposition to sleep, but start at the least noise; the mouth lying half open, the intelligent attempts to suck; the decrease of the discharges from the bowels; the cessation of retching; the sinking in of the features; the nervous grasping, as if to catch some passing object; jerking of the body, and moaning, may be looked upon as unfavorable signs.
It is a great mistake to conclude that infants will have cholera if weaned early, or if they are to be artificially nursed. The fear comes from persons having been so educated within the last half century.
All kinds of preparations are advertised and eagerly sought for baby diet; as if the internal organs of babes were entirely different from what they were before, and must needs be supplied with something more supernatural than those of the adult. The symptoms of cholera are by no means uniform. For instance, they may be cut short, or aggravated by overdosing, before the facts in the case are made known. Thus, if paregoric, laudanum, or any alcoholic carminatives are habitually put in the drink, the most marked signs will be the smell of the breath, the presence of constipation, stupor and sinking in of the features more or less, with very little vomiting. Such cases, no doubt, are seldom admitted, the victims being dead, or nearly so, when medical aid is called.
SECTION IV.GENERAL TREATMENT OF CHOLERA INFANTUM, MEDICAL AND DOMESTIC.
Unfortunately for many children, it is usually in the last stage of the disease that a physician is consulted. Probably any number of palliatives have been given with good intentions and high hopes of success. For one, the old cleaning-out remedy, so much thought of by old ladies, and doctors not a few,—castor-oil. Whatever may be deemed as proper treatment, it should be remembered that nothing short of the most untiring vigilance on the part of the attendant, guided by Divine aid, can bring success in raising a child on whom cholera has fastened its blighting fangs. Yet what encouragement it is to know that by those means it can be saved.
My course for the last fifteen years has been to first ascertain, if possible, the cause of cholera, and have it removed; also particularly to inquire how long it has been since the child has been noticed to fail in the effort to suck; then as to the color and frequency of the discharges. I have never known, through my observations of over twenty-three years, any better corrector of acidity, sourness in the human bowels, than calcined magnesia.After giving from two to three grains every hour, or according to the degree of acidity, until it is all apparently changed, then, as cautiously as needful, I proceed to quiet the motion of the bowels, as in case of purging within the month, by the use of mixture No. 1, which if put up by a regular chemist, and given according to directions, can be no more objectionable because inserted in this little book than thousands of other recipes scattered over the community by tons in expensive books.
No. 1, R. Mixtura Creatæ, preperata, zj.—Chalk Mixture, Aquæ Cinnam. zss.—Cinnamon Water. Add Opii Tinct. Gutta vj.—Laudanum.
Shake well before using. Dose—A small teaspoonful after each stool. Increase the dose according to age of patient. Of course it is not expected that the inexperienced would attempt to administer anything other than domestic remedies, unless put up according to the rules of art.
For a decided case of cholera, it is best to begin with half a teaspoonful of the mixture; which, by the by, should be sucked down by the patient very slowly, in order to have it remain on the stomach. No time should be wasted listening to the old story of working off a bowel complaint; few are the adults that ever have survived the experiment, much less the weakly infant. Deaths from cholera cannot possibly be so numerous in consequence ofthe discharges having been checked too soon, for the usual precaution is not to arrest them; so they are let to go on increasing, till all hopes of contracting the vessels are vain. It would be well in all cases before administering Mixture No. 1, to fill a flannel bag with hops, wring it out of warm, salt water and lay it over the chest and belly, re-wetting every two hours; this done will alone sometimes prove successful.
When the mouth remains dry and hot, a little cool water, sucked slowly from a spoon, does seem to revive the little sufferer, and I have no reason to doubt its efficacy in abating the suffering, if not the disease. Stimulant astringents are what is needed after the passages are checked. The least mite of Nature’s stimulant—common salt—laid on the back part of the tongue, will excite a flow of saliva, and greatly assist in removing a sort of hair-worm which has been noticed to infest the throat in some patients. When there is a continuance of vitality, and the passages continue to be green, or tinged with blood, and external cooling applications, as of flaxseed poultices, have been well tried, an effort should be made to stimulate the liver; this is very likely to be the case where the age and constitution of the child is sufficient to permit the disease to run on for quite a while. Hydrargium chloridum-calomel, is sometimes the most reliable drug that can be used to correctthat. This drug is unsafe in the hands of the inexperienced, but quick and safe when under the guidance of medical skill. The dose for a child six months old should never exceed one-sixteenth of a grain, or one grain in sixteen hours, followed by a sip of warm milk.
The nourishment during this time should consist of the breast-milk, if possible; if not, arrow-root boiled in milk and gum-water, fed from a spoon twice a day, or oftener. But either should always be given about a half hour after any medicine, unless otherwise directed. Cold water should never be allowed to a patient while medicine is being administered, the nature of which is unknown. Light, air, sponging the body with warm salt water, a change of clothing or bedding, each tends to stimulate the pores, quench thirst, and give tone to the whole system. Thin flour-gruel acts as a pasty lining to the entrails. After the irritation has ceased, great care is required to prevent a relapse; therefore in all cases when the breast-milk cannot be obtained, the various vegetable astringents should be relied on to build up the muscles, the different grains, as corn-meal, starch and oatmeal, given often but in small quantities, will build up the fat cells. If, after the liver has been acted upon, the green stools do not cease, and there seem to be a general weakness of the digestive organs, the juice of theblackberry, raspberry, or whortleberry, will, in most cases, effect a cure; also, the rinds of ripe peaches boiled in milk till well done, strained, and given when cool—a teaspoonful five or six times during the day, and about as often at night—is excellent. The effect of either of these remedies should be closely watched, as by their astringent nature they might induce constipation.
With a view to the comfort of the sick one, and the convenience of the nurse, it is better to prepare a bed of some light material, on which the patient can lie with its body flexed. Too often the little creature is forced to lie in a narrow place, or more frequently on the lap, in one position, till it would seem as if it would be paralyzed. There should be two sets of bedding in order to expedite recovery. The material should consist of goods that could be easily washed, and kept clean. It is essential, too, that flannel be worn by the sick one; but it is a sad mistake to imagine that flannel clothes do not need changing as often as cotton ones.
When I have suggested a bed for sick infants, some grandmas have thought me cruel. But in such critical cases as the one in question, a few moments’ trotting and rolling on the lap might undo all that it had taken weeks to do. Should the stomach become settled, but the lower bowels remain rather weak and liable to looseness, andthere is no fever present, I think much of the burnt brandy in small doses. I prepare it in the following manner: Take a wineglassful of the best brandy, one tablespoonful of refined sugar, dissolve it well, then pour it in a shallow dish and set fire to it with a lighted paper, not a match; when the blue flame is off it is fit for use, and should be put in a clean vial and labelled. Of this, I give to a child six weeks old and upward, six drops in a little water, say about three times within twelve hours. To one six months and upward, I give ten to fifteen drops twice a day. This warms up the stomach and stimulates the digestive fluid glands to action. After the brandy has had the desired effect, a speedy recovery may be hoped for. The bathing, nourishing diet, quietness, and, above all, patience, need to be continued with greater zeal when recovery is apparent. The recovery from cholera is probable only when the surroundings are favorable; it is doubtful where the locality is densely inhabited, the disease prevalent, and where there is a lack of means to provide ample care and nourishment. Patients recovering from a disease like cholera, which so undermines the nervous system, require a deal of determination to prevent the undoing of what has been done by catering to their whims.