Cholera Infantum. 
TREATMENT OF THE COLD STAGE. 
A Paper read before the Shelby Co., O., Medical Society, 
on June 7th, 1877. 
By E. F. Wells, M. D., Minster, O. 
Reprint from the Cincinnati Lancet and Observer, 
August, 1877. 
CINCINNATI : Cholera Infantum. 
TREATMENT OF THE ('OLD STAGE. 
A Paper read before the Shelby Co., O., Medical Society, June 7th, 1877. 
E. F. Wells, M. D., Minster, O. 
Cholera infantum has been observed from the earliest ages, and 
appears during the hot season in every country on earth.* It 
is, therefore, a disease of great antiquity and of universal distri- 
bution. Although true that every part of the habitable globe is 
periodically visited by this Nemesis of early childhood, observa- 
tion shows that the great centres of population of all lands are 
especially afflicted. 
Not a little confusion has arisen in regard to the proper limitation 
of the term cholera infantum. Summer complaint, a name of popu- 
* Trousseau ; Clinical Lectures. Phila. Ed. 1873. Vol. II, p. 454, 2 
lar origin, and cholera infantum, have come to have a synonymous 
signification within and without the profession. This is much to be 
regretted, as it tends directly toward causing confusion and inac- 
curacy. The expression, "cholera infantum", should be applied to 
to such cases only as present a striking, well-known and never- 
varying array of symptoms, bearing a close resemblance to, or 
being identical with, the sporadic cholera morbus of adults; reserv- 
ing the more popular name, "summer complaint", for those other 
gastro-intestinal disorders of children occurring in summer, which 
pursue a more or less chronic course, and which are not easily made 
to assume their proper place in the nosological scale. The impro- 
priety of allowing a single name to describe diseased conditions so 
varying in character as veritable cholera infantum, dysentery, entro- 
colitis, etc., is so apparent, that the point does not require to be 
enlarged upon. In this paper I shall consider the former malady 
only. I will preface my observations on the treatment of this dis- 
ease by the statement of a series of propositions, the truth of which, 
singly considered, is acknowledged by leading writers : 
1st. Cholera infantum and cholera morbus are identical and the 
post mortem appearances are the same in both.* 
2d. Cholera infantum is of great fatality. 
3d. Cholera infantum is a self-limited disease, with a duration 
of not more than three days.f 
4th. If the patient can survive until reaction takes place, he 
will generally recover. 
5th. The indications for treatment are, to bring about reaction, 
restore the lost tissues and maintain the powers of life. 
Symptoms.-A well-nourished, active, rosy-cheeked child is taken 
'•■'Flint: Practice of Medicine, 3d ed. 1868, p. 465. See also Leube in Ziemssen's Cyclo- 
pedia. Vol. VII. 
f Edward Waldo Emerson, M. D., Boston Medical and Surgical Journal, July 27th, 1876. 
Flint, vol. cit. p. 465, states that when death occurs, it does so in one, two, or three days. 
Trousseau, vol. cit., p. 457, says that if the cold stage continues for more than 24 or 26 
hours death is almost inevitable. Dr. W. Walling, Am. Prac., Vol. IT. p. 279, found the 
average duration of 33 cases ending in recovery, to be 15 hours, and the greatest duration 
was three days. 3 
suddenly, generally at night, with profuse and active purging and 
vomiting, the discharges consisting at first of the contents of the 
alimentary canal and afterwards of clear or lightly colored liquid. 
The skin becomes cold, pallid, and looses its tonicity; beginning 
in the extremities, but rapidly extending to the trunk and head, 
which latter is at first extremely warm. The pulse is very rapid 
and can scarcely be felt at the wrist. Great and burning thirst is 
manifested in every case. The expression is pinched and the child 
has a look of age far beyond its years. The voice, as in sporadic 
and epidemic cholera morbus, is changed in tone and altered in 
pitch. After a while the vomiting becomes ameliorated, or alto- 
gether ceases; the stools also are less frequent and have assumed 
a greenish hue. The child is already greatly wasted; is pale, 
pulseless and cyanotic. With the fontanelles sunken, the abdomen 
relaxed, the urine suppressed, and the eyes half-closed and turned 
upward, the little sufferer lies drowsy, fretful, rolling its head from 
side to side; a picture of human misery, heartrending in the ex- 
treme, and one that must ever appeal to the humane physician to 
bend every energy to save and alleviate. Convulsions and coma 
often occur and are the direct cause of death in the great majority 
of fatal cases. If, however, the system rallies from the shock and 
reaction takes place, the patient usually recovers, and as there are 
no lesions involved which are of necessity fatal, convalescence is 
generally short and uneventful. 
Treatment.-We can assert, without fear of successful contradic- 
tion, that of all diseases known to science this one is treated, by a 
large majority of practitioners, with a presumptions empiricism 
that finds its parallel only in the practice of a past age. The treat- 
ment now to be recommended, I offer, not for occasionally occur- 
ring, exceptional cases, but to he followed in every case of true 
cholera infantum as routine treatment. 
The first indication is, undoubtedly, to attempt bringing about 
reaction, and to effect this object I know of no agent so sure and 4 
prompt as the mustard pack.* A cloth, sufficiently large to envelop 
the child from the feet to the chin, is saturated with highly sinapized 
warm water and wrapped suddenly around the child, the whole 
being covered by a thick and warm blanket. After the lapse of 
half an hour, more or less, the change in the appearance of the child, 
in case the treatment is to be successful, will be remarkable. Color 
and warmth will have returned to the surface; the tissues will have 
lost their pinched and old look, a natural perspiration will have 
appeared, the vomiting will have ceased and the alvine discharges 
will have become less frequent. The child is now to be taken from 
the pack and kept closely enveloped in a warm blanket. 
Meanwhile the second indication, supplying the waste of tissues, 
is to be promptly met. It has been shown, again and again, 
that only the watery and saline constituents of the blood are lost; 
therefore to meet this indication absolutely nothing, save water in 
which a few grains of common table salt have been dissolved, is 
required. Here is my formula: 
Water, one pint. 
Chloride of sodium, 10 grains. 
This is to be given, ice-cold, as freely as called for; true it is 
that many times it will be soon rejected by the stomach, yet in any 
case more or less is necessarially absorbed, besides it tends directly 
to prevent further transudation of liquid. In extreme cases, intra- 
venous injection of water at the temperature of the body (about 
100°) should be tried. 
Rapidly diffusible stimulants, such as ether and ammonia, are 
indicated outgeneral principles, and are to be given as required. 
I wish to raise my voice in emphatic protest against the too com- 
mon, pernicious practice of drugging little patients suffering with 
cholera infantum. The least familiarity with the principles of physi- 
*'Lindsey, Med. Gaz, 1832, Vol. TX, pp. 519-523, recommended mustard poultices in the 
treatment of the choleraic state, and since his day various modifications of this plan have 
been recommended by various authors. 
Trousseau, vol. cit. p. 457, lauds the mustard bath. 
E. W. Emerson, vol. cit. p. 98, advocates the pack, pure and simple. 5 
ology and pathology would certainly enable any one to know that 
almost all the medicines generally used in the treatment of this 
affection require to be digested before they can be assimilated, and 
that in the algid stage of cholera infantum such digestion is totally 
impossible. Food, also, for the same reason should be interdicted 
during the continuance of this stage. 
With the establishment of reaction, however, judicious dieting 
and proper medication may be made to accomplish marvelous re- 
sults; but this leads us into a stage of the disease that is beyond 
the limits and scope of the present paper, and with which we do 
not intend to cope on this occasion. 
In conclusion let me again call attention to the fact that I am not 
now treating of the summer diarrhoeas of children, but of another, 
entirely different affection, vastly more formidable, and one which 
Leube declares can not be distinguished from the cholera nostras 
of the adult.