CHOLERA INFANTUM, 
fa- 
DIARRH(EA AND ENTERO-COLITIS, 
THEIR RELATIONS TO EACH OTHER, THEIR PATHOLOGY, 
AND THEIR TREATMENT. 
BY 
EDWARD H. PARKER, M.D., 
<m 
PHYSICIAN TO THE CHILDREN’S DEPARTMENT OF THE DEMILT DISPENSARY, FELLOW 
OF THE NEW YORK ACADEMY OF MEDICINE, ETC. 
READ BEFORE THE NEW YORK STATE MEDICAL SOCIETY, FEB. 4, 1857. 
[From the American Medical Monthly for May, 1857.] 
NEW YORK: 
EDWARD P. ALLEN, 9 SPRUCE STREET. 
18 5 1. CHOLERA INEANTUI, 
DIARRHOEA AID EITERO-COLITIS, 
THEIR RELATIONS TO EACH OTHER, THEIR PATHOLOGY, 
AND THEIR TREATMENT. 
Can any apology be necessary for calling the attention of the 
members of a Medical Society to the subject of Cholera Infantum ? 
If so, it must be found in the fact that the last census of the United 
States shows that 3960 deaths out of 323,023 (that is more than 
one per cent.) are caused by it ; and that out of 106 enumerated 
causes of death, this stands in rank, as to the number of its victims, 
the sixteenth. I know that a great deal has been written about it; 
that almost all our journals contain, every year, one or more articles, 
upon it; while the learned Society (the New York Academy of 
Medicine) which I have the honor here to represent in part, has 
lately crowned with a prize of one hundred dollars an essay upon it. 
Still, I beg your patient attention to the little I have to say; per- 
suaded, as I am, of its importance. If I do not follow the beaten 
track—if I venture to make some suggestions as to errors in the 
nosology, the pathology, and the treatment of this disease, as 
commonly received—it is not from any desire to be captious, but 
from firm conviction of the truth of my position, slowly attained, 
gradually arrived at, never sought by me, but into which I have been 
forced. 
I shall not so far presume upon the indulgence of the Society as 
to undertake here to recapitulate the history or to refer to the litera- 4 
ture of Cholera Infantum. Here, at least, it is unnecessary, familiar 
as all the members of this Society must be with them; but I at 
once state the following propositions, as those generally received by 
the profession, or at least as generally given by our systematic writers 
upon the subject :— 
1st. Cholera Infantum is a disease peculiar to this country, though 
not entirely unknown in Europe. 
2d. That Cholera Infantum is almost entirely confined to large 
cities, and is rarely seen in the country. 
3d. That the symptoms, course, and pathology of the disease, 
entitle it to a separate place in our nosological tables. 
4th. That the treatment is to be distinct from that of diarrhoea on 
the one hand, and dysentery on the other. 
5th. That “ perhaps the most alarming symptoms are those of 
hydrocephalus, occurring in the advanced stages.” 
What I have to say can be most conveniently arranged by dis- 
cussing these propositions in the order in which I have enumerated 
them. 
The first inquiry is as to the truth of the proposition, that Cholera 
Infantum is almost unknown in Europe, though frequent in this 
country. But before discussing this point let me first quote descrip- 
tions of the disease, so that we may have a certain fixed point of 
comparison as to what constitutes it. I use the language of others, 
rather than my own, for a specific purpose. One writer says :— 
“ When the attack comes on suddenly, it often commences with 
vomiting, and though in many instances the sickness does not recur 
frequently, yet sometimes the irritability of the stomach continues, 
for twenty-four or forty-eight hours, to be so extreme, that every drop 
of fluid taken is immediately rejected ; and that frequent efforts at 
vomiting are made even when the stomach is empty. Violent relax- 
ation of the bowels occurs almost simultaneously with the vomiting, 
and the child sometimes has as many as twenty or thirty evacuations, 
or even more, in the course of twenty-four hours. The motions are 
at first faecal; but they soon lose their natural character, and become 
intermixed with slime, often streaked with blood. At first they are 
abundant, and are often expelled with violence ; but before long they 
become scanty, though sometimes they still gush out without much 
effort on the part of the child. The character of the evacuations 
again changes : in the severest cases they not only lose their faecal 
appearance, but become like dirty-green water, with which neither 
blood nor intestinal mucus is intermingled. Usually, however, when 5 
the first violence of the purging has a little abated, although some 
serous stools may still be voided, yet the evacuations consist chiefly 
of intestinal mucus, intermixed with xi little faeces, and more or less 
streaked with blood. These scanty mucus stools are generally 
expelled with much straining and difficulty ; a few drops of blood 
sometimes follow them; and once or twice, at an early period of the 
attack, I have known an infant void as much as a table-spoonful of 
pure blood.” 
“ The skin becomes dry and very hot, though unequally so ; the 
pulse is quickened, often very much so ; the head is heavy ; the child 
fretful and irritable if disturbed, though otherwise it lies drowsily in 
its nurse’s lap, with its eyes half open, and scarcely closing the lids 
even when they are touched with the finger. Now and then, too, the 
disturbance of the nervous system at the commencement of one of 
these attacks of diarrhoea is so considerable, that a state of excite- 
ment alternates with one of stupor, that convulsions seem impending, 
and that there are distinct carpo-pedal contractions, or startings of 
the tendons of the wrist or fore-arm. The abdomen is usually full 
and tympanitic, but seldom very tender ; nor does the child seem to 
suffer much pain, though sometimes a degree of tormina appears to 
precede each action of the bowels.” 
Another writer says :—“ After a day of slight disturbance, with 
fever and vomitings, the diarrhoea appears and becomes very abun- 
dant ; the face suddenly becomes changed, and the eyes excavated 
in the space of one night, like what it is said takes place in softening 
of the mucous membrane of the stomach, and the child rapidly suc- 
cumbs. Recovery seldom takes place. In this case the symptoms 
gradually disappear or become prolonged. .... 
“ In most of the cases the commencement is less abrupt. The dis- 
ease becomes developed, like catarrhal and spasmodic diarrhoea, with- 
out attracting much attention. The child is indisposed and has slight 
relaxation of the bowels. The symptoms persist, and then the cause 
is discovered. They increase and become aggravated if their pro- 
gress cannot be arrested. The patient daily becomes weaker, and 
gently arrives at that degree of weakness and emaciation precursory 
of death. 
“ It is only in exceptional cases that this disease rapidly runs 
through its stages. It usually lasts fifteen days : the mean term 
necessary to the cure. It sometimes lasts two or three months. Few 
children die before the completion of the tenth day. The greater 
number succumb by the end of a month. . . . Amongst 6 
those who are cured the disease scarcely ever extends beyond the 
third week.” 
Now I respectfully submit it to the members of this Society, if 
these are not good descriptions, accurate as can be drawn, of the 
disease which we know as Cholera Infantum. And yet both are from 
European writers, drawing from their own experience, and not quoting 
the language of others. One is West,* of London, and the other 
Bouchut,f of Paris ; and I have made these extracts to show that the 
first proposition, though so generally received, is an error. True, 
neither writer uses the words Cholera Infantum, but calls it, the one 
(West) inflammatory diarrhcea, the other (Bouchut) entero-colitis, and 
to those cases which are most marked he gives the name of choleri- 
form enter o-colitis. Both of these writers speak of the rapid termina- 
tion of the disease, that is within two or three days from its com- 
mencement, as being rare in their countries ; but so it is here, if we 
count the commencement of the disease to be the occurrence of 
diarrhoea, as I believe it to be, and shall attempt to show hereafter. 
For the present I pass to the consideration of the second proposi- 
tion, namely, “ that this disease is chiefly prevalent in large cities, 
rarely occurring in the country.” 
I refer again to the mortality statistics of our last census upon this 
point. Here let me say that I am aware of the many sources of 
error to which we are exposed in basing any proposition upon these 
returns. Still the errors in the main counteract each other. In 
regard to this disease there is perhaps less occasion for fallacy, from 
the fact that the name is usually given by the medical attendant, 
“ Summer complaint ” being the more common term in popular use 
for diarrhoea. From these returns it appears that every State in the 
Union sends in its quota of cases of Cholera Infantum to swell the 
total to 3,960.| But one section of one State (the southern of 
* Treatise on Diseases of Children, pp. 388, 389. 
f Bird’s Translation, p. 469. 
t The number of deaths given for each State are as folhtcs: 
Alabama, 42 
Arkansas, 14 
California, 1 
District of Columbia, 25 
Connecticut, 85 
Delaware, 8 
Florida, 10 
Georgia, 75 
Illinois, 141 
Indiana, 156 
Iowa, 28 
Kentucky, 163 
Louisiana, 27 
Maine, 52 
Maryland, 166 
Massachusetts, 331 
Michigan, 13 
Mississippi, 114 
Missouri, 83 
New Hampshire,.... 47 
New Jersey, 105 
New York, 447 
North Carolina, 74 
Ohio, 232 
Pennsylvania, 260 
South Carolina, 64 
Tennessee, 17 
Texas, 12 
Vermont, 6 
Virginia, 150 
Wisconsin 14 
Minnesota, 2 
New Mexico, — 
Oregon, 
Utah, - 7 
Texas) is entirely exempt ; while of the territories Minnesota reports 
two cases of Cholera Infantum in a total of 27 deaths, and Oregon 
one of a total of 47. 
But again : there are a few States in which the districts were so 
divided as that one of them should be made up chiefly or entirely of 
a city ; and we are thus enabled to compare the proportion of this 
disease as reported in the city to that in the rest of the State. 
These States are New York, Pennsylvania, Massachusetts, and Lou- 
isiana. From these returns it appears that in this State the total of 
deaths from Cholera Infantum is 447, of which only 257 were in the 
city of New York. In Pennsylvania there were 260 deaths of which 
137 were in Philadelphia. In Massachusetts there were 331 deaths 
of which only 50 were in Suffolk county, which is almost entirely 
made up of Boston. In Louisiana 27 deaths from this cause give 
only 7 to New Orleans. Thus in four States, representing New Eng- 
land, the Southern and the Middle States, including the larger cities, 
we have for totals 451 deaths from Cholera Infantum in the large 
cities to 614 deaths from the same cause in the remainder of the 
States. That is about three-fifths of the deaths from this cause were 
out of the largest cities. So far then as the census goes we are jus- 
tified in saying that the disease numbers quite as many victims in the 
country as in the city, or, at any rate, that a disease known to coun- 
try practitioners as Cholera Infantum is as fatal in the country as the 
city. I appeal to gentlemen who practice in the country, especially 
in regions which are level, with a sandy soil and shut in by hills, 
whether or not the symptoms described by our writers as being those 
of Cholera Infantum are not constantly seen by them during the hot 
weather. I know that the best marked cases which have ever fallen 
under my observation are those seen by me in New Hampshire and 
Massachusetts, and no symptom described by city writers was absent 
from them. I contend then, that the second proposition, though gen- 
erally received, is incorrect. 
“ The third proposition is that the symptoms, course, and pathology 
of the disease, are peculiar ; and entitle it to a separate place in noso- 
logical tables.” 
The characteristic features of Cholera Infantum are thus defined 
by Dr. J. Forsyth Meigs, whose remarks on this disease are, on the 
whole, among the best that have been published in this country. 
“ These are its occurrence in very young children, and in the Summer 
months ; the evidences in the early stage of violent irritation and 
hyper-secretion of the gastro-intestinal mucous surface, and at a later 8 
period of inflammation, ulceration, softening and thickening of the same 
surface, particularly of the ilium and large intestine ; its chief symp- 
toms are vomiting and purging ; fever, generally of a remittent type, 
varying often with collapse ; rapid emaciation ; and towards the 
close, violent cerebral symptoms.” (Meigs, p. 28.) Authors describe 
affections of the bowels under three names, viz : simple diarrhoea, 
Cholera Infantum, and entero-colitis, and each one of these may be 
accompanied by these chief symptoms, to wit: vomiting and purging, 
remitting fever, collapse, emaciation, and “violent cerebral symptoms.” 
How then can it be known when diarrhoea ceases and Cholera Infan- 
tum begins ; or when does entero-colitis become Cholera Infantum. 
The fact is, that the continued and simple diarrhoea, when aggravated 
without any change in its nature, becomes violent, so that it is called 
Cholera Infantum. Entero-colitis commencing suddenly with vom- 
iting and purging, is Cholera Infantum in common professional par- 
lance, but no more a separate disease than is the first stage of pneu- 
monia a,separate disease from the last. It is rarely the case, if ever, 
that a simple diarrhoea runs on to be severe without the occurrence of 
vomiting, feverish exacerbations, collapse, and the other enumerated 
symptoms, and it is therefore necessary to say that if Cholera Infantum 
is a separate and distinct disease, it follows diarrhoea very frequently. 
On the other hand, entero-colitis is usually attended by vomiting as 
well as purging, and is thus said to be preceded by Cholera Infantum. 
So it is with the pathology of the disease. It is entirely impossible 
for any one to say, simply by an inspection of the post mortem appear- 
ances, whether or *ot the patient had died of Cholera Infantum or 
simple diarrhoea on the one hand, or on the other to distinguish 
between Cholera Infantum and entero-colitis. One school of writers 
have dwelt much on the altered condition of the liver, which is said 
to be enormously enlarged in some cases, and with all the intermedi- 
ate shades of departure from health. But this scapegoat for so many 
evils is not justly blamed. If Cholera Infantum is a peculiar and 
distinct disease, it is eminently an acute one, for it is improper to 
assign to it all that train of symptoms which drag after it for months. 
In this time the liver cannot enlarge, for it is not a sponge which can 
be filled with blood and be made to swell up and puff itself out to 
occupy half of the abdomen in three days or in three weeks—as seems 
to be intimated by several writers. This error must have arisen from 
neglecting to take into account the fact that in infancy the liver is 
proportionably much larger than in more mature life. As I have 
said of the symptoms, so it may be said of the pathology—it is impos- 9 
sible to draw a line on the one hand between Cholera Infantum and 
simple diarrhoea, and on the other between Cholera Infantum and 
entero-colitis. The disease has no distinct pathology, as will be evi- 
dent if we compare the given of the pathology of this 
disease by our writers with those given by European writers of the 
pathology of diarrhoea and entero-colitis. I claim then, that the 
third proposition usually received, is incorrect, and that there are no 
separate symptoms, course, and pathology of this disease, but that 
Cholera Infantum is in fact a name given to a particular condition 
arising in other diseases. 
Of course, if my position is correct, the fourth proposition, viz : 
that the treatment of the disease requires to be peculiar, goes with 
the third, for if there are no peculiar symptoms, course, and path- 
ology, there is no separate and peculiar treatment. The proposition 
was stated, however, to express the common belief upon the subject, 
and I suppose I am correct in saying that nine-tenths of the profes- 
sion would say so. As large a proportion would insist upon the 
necessity of using calomel or some other preparation of mercury, and 
that with more or less freedom. Some use it often and in large 
doses, some in full doses and but once, others use smaller doses, while 
still others approach the infinitesimals in appearance though not in 
reality. The doses vary from five grains to the sixteenth of a grain, 
but calomel is the desideratum with them, and calomel must be used. 
To cite my authorities for this, would be to cite almost every writer 
upon the subject ; few, if indeed any writers in our own country 
being content to advise entire abstinence from the use of this drug. 
Many of them insist as strongly upon the disuse of astringents, and 
on this point too, I am at issue with them. I have no particular 
fondness for astringents, neither have I any dislike of calomel, much 
less a prejudice against so excellent a remedy. But it certainly is a 
very potent one even in small doses, especially when given frequently, 
and I do not hesitate to say that it has often done in this disease 
great and grave injury. 
The 5th proposition, viz : that “ perhaps the most alarming symp- 
toms are those of hydrocephalus occurring in the advanced stages,” 
is in the very words used by Dr. George B. Wood,* in his excellent 
treatise on the Theory and Practice of Medicine, and is, I suppose, 
expressive of the common opinion. I confess that I should not have 
ventured to make such an assertion a year ago, for the simple rea- 
son that after the clear descriptions of the actual cause of the cere- 
* Practice of Medicine, vol. 1, p. 700. 10 
bral symptoms which Marshall Hall gave more than fifteen years 
ago, and which have been since repeated by Gooch, and more lately 
by West, it would seem improbable that the condition of anaemia or 
exhaustion should not be recognized as the cause. That it is not so, 
the prize essay to which I have before alluded, bears ample testi- 
mony, while the occasional favorable notices of that publication in 
which even eagle-eyed reviewers do not detect this error, give far- 
ther confirmation of it. Ilydrocephaloid is the actual condition, not 
hydrocephalic, and that antiphlogistics (as leeching, blistering, &c.) 
have not been successful in the essayist’s hands, is no wonder. The 
cool head ; the depressed fontanelle, the previous or continuing 
exhaustive disease ; the rapid improvement under the use of tonics and 
stimulants, all of these should have opened the eyes of practitioners 
to the actual cause of the symptoms. This is neither the place in 
which, nor the audience to which I ought to repeat what has been so 
well said by others ; but I may simply urge any who have not be- 
come fully convinced of the correctness of the distinction, to read 
again what West has said so well, and to study carefully the next 
cases of the disease which come under their charge. 
It would not be proper for me, having said so much that is nega- 
tive, to refrain from a positive statement of my own opinions con- 
cerning the topics on which I have touched. 
Diarrhoea in children (that is, too frequent and too fluid evacua- 
tions from the bowels) may be of all grades, from the slightest to 
the most grave. Especially apt to affect teething children, particu- 
larly those that are weaned, and to appear during the hot season, its 
symptoms (in general the same) may at any moment be aggravated and 
exaggerated by the continuance of the very causes that produced it. 
Nausea is a constant accompaniment of the diarrhoea, and the aggrava- 
tion of the diarrhoea, whether gradual or sudden, is attended by a simi- 
lar increase of the nausea, vomiting soon succeeding. If then a rapid 
or sudden increase of the diarrhoea occurs, which is always attended 
by an increase of the watery portions of the dejections, it is almost 
inevitable that vomiting should occur. Excessive thirst, intolerance 
of the blandest food, rapid prostration and emaciation are the 
accompaniments and results of this condition. Unfavorable hygienic 
conditions serve to increase the liability of children to the disease, 
while they at the same time retard, if they do not entirely prevent 
recovery from it. Pathological Anatomy shows to us throughout a 
continuation of the same condition, increasing in severity and gravity 
with the corresponding increase in the symptoms. 11 
When death occurs from the exhaustion produced by the profuse 
vomiting and diarrhoea, a condition to which is given in this country 
the name of Cholera Infantum, we find the intestines to contain more 
or less of a soft, usually light, yellow faecal matter, and the stomach a 
fluid resembling a thin gruel. The walls of the stomach are natural, 
unless the epithelial lining be a little too easily removed,—the epithe- 
lial lining of the small intestine, and sometimes of the large, being in 
a similar state. The walls of the intestines are almost translucent, 
bloodless, and apparently thin. Throughout their whole extent the 
solitary and agglomerated glands are very prominent, setting up almost 
like beads from the surface. The mesenteric glands are not changed. 
The liver is pale and anaemic, the gall bladder containing more or 
less of thin bile. General anaemia of the organs is the only other 
observable change from health. The brain itself is in the same con- 
dition, a passive congestion of some of the larger veins of its base 
being the utmost change notable in the blood-vessels. Where the 
prostration has continued a long time, we have a little serous fluid 
in the cavity of the large ventricles. Such is a general view of the 
pathological anatomy of these cases. The pathologist must there- 
fore be content with saying that the death is from exhaustion, and 
not from anatomical lesions of the organs. From the prominence of 
the solitary and agglomerated glands, it has been supposed that they 
are the seat of the disease, but a careful inspection will show that 
they are only filled with their peculiar secretion. Being without 
outlet, as Kolliker and others have distinctly shown, their excessive 
secretion only distends them, while the exsanguine condition of the 
neighboring tissues thins them, and thus gives to every independent 
prominence like the follicles, still greater exaggeration. Hyper- 
secretion is the only thing of which we have any evidence in the 
bowels, and hyper-secretion will account for the symptoms and the 
death. Back of this we must confess we cannot go, and irritation, 
inflammation, nervous force, or anything else may be invoked to 
explain it. Evidence of either we do not have. 
If instead of this sudden termination, the case runs along for 
weeks or months, we then have in addition to the other appearances 
abrasions, and even ulcerations in some rare cases, of the mucous 
surface. Punctate injection more or less abundant, and more or less 
general, though usually quite limited, is visible. The solitary and 
agglomerated glands have either disappeared or are in the same condi- 
tion of distension as that before pointed out. If it be the former, 
there results one of those depressions which are described as ulcer n- 12 
tions, but which are without the characters of an ulcer. Occasion* 
ally there may be seen patches of an apparently uniform redness, but 
closer examination shows that it still is of the punctate form. This 
is the condition to which, following the European writers, I give the 
name of entero-colitis. But this follows directly upon the continuance 
of aggravated diarrhoea. Other diseases may of course complicate 
it, but I speak now of pure and simple cases, of which many may be 
noted by every one engaged in the treatment of young children. 
The localities in which the disease most frequently occurs, as well 
as the class of patients who are especially liable to it, point out the 
influences against which we are to guard. Although the disease is 
marked, in many cases, by febrile exacerbations early arising, there 
is no reason to suppose it to be allied to periodical diseases of a 
malarious character. I have seen it as evident in regions wrhere no 
intermittent fevers are found, as in those regions which abound iu 
them. It is noteworthy that these exacerbations are not of a high 
grade of fever; and one who looks for a frequent and strong pulse, 
with flushed features, and the other usual marks of fever, will not 
find them. Instead of this, there is a very quick and frequent pulse 
and some increase of the heat. It is usually quite transient in such 
cases. In those of a more chronic character it is often more pro- 
tracted and rises higher; that is, this is more marked in entcro-colitis 
than it is in diarrhoea. The impure air of cities is justly, as well as 
generally, blamed for much of the disease ; but it is not the impure 
air which has the largest influence. The classes of patients wdio are 
particularly exposed to it in large cities, are those who are also under 
the most unfavorable hygienic conditions. Poor and squalid, the 
mother must turn every moment to a good account in making a 
living; or else, drunken and vicious, she spends in dissipation the 
time which should be given to her infant. In either case, her impov- 
erished and scanty milk compels her to feed her child, even if another 
pregnancy does not urge to the same course. Poor cow’s milk, 
crude gruels, and panadas, or bits of “ every thing that is going,” 
are the materials poured into the intestines, and these the child can 
not properly digest. The house in which they live is crowded, and 
close, and damp ; ventilation is a thing unknown or uncared for, and 
bathing is a luxury that is rarely indulged. Dentition, too, compli- 
cates matters ; for in no class are the disturbances produced by it 
greater, and in no class is there more frequent or strenuous objection 
to lancing the gums. In addition to this, insufficient light reaches the 
child, and in its etiolated state it is still more unable to contend 13 
with other unfavorable influences. But I have shown that it is 
not confined to large cities. The proportion of poor persons increases 
more rapidly in large cities than in direct ratio to the increase of 
population, and therefore the disease prevails in larger proportion 
ordinarily. This is not uniformly so, however, and the census to 
which I have so repeatedly referred, shows this in one instance quite 
singularly. In Massachusetts the whole number of deaths from 
Cholera Infantum is reported as 331, of which only 50 were in 
Suffolk county, which is almost synonymous with Boston, the single 
town of Chelsea being included within its limits. Now Essex and 
Middlesex counties, which make another district, and have about 
the same population, give 113 deaths from Cholera Infantum—more 
than twice as many. Boston, it is well known, is so built on hills 
that it is thoroughly drained ; and, at first sight, it might be thought 
that this was the cause of the slight mortality. But Essex and Mid- 
dlesex counties are not deficient in drainage, are not malarious, and 
are commonly considered as healthy districts as any. But these 
counties abound in localities in which the soil is light and porous, 
perhaps sandy, and where these lie upon the rivers, especially the 
Merrimac, they are shut in by hills at a little distance from the 
river. Here the heat during the middle of the day is intense, and 
often continues through the night. Under these conditions severe 
forms of diarrhoea develop themselves rapidly; that is, if it be pre- 
ferred, Cholera Infantum prevails, arid fatally. The same is true all 
up the Merrimac river wherever these conditions unite. Manchester, 
N. H., where, from the very sandy nature of the soil, and the rapid 
growth of the town, all these influences are in excess, is swept with 
this disease every Summer, to such an extent that a similar visitation 
in New York would be more terrible to children than the most 
malignant yellow fever. The same is true of Concord and Nashua, 
though not to quite the same extent, for the conditions are somewhat 
less aggravated. This fact, and the want of similar localities in 
Vermont, seem to me to account for the notable difference in the 
proportion 6f deaths from this cause, given in the census—Vermont 
having six and New Hampshire forty-seven—for in other respects 
the situation of the two States and the hygienic conditions of their 
people are very similar. The exemption of Boston I believe to be 
largely due to the refreshing sea breezes which prevail during the 
day and reduce the air to a delightful temperature. Serious as an 
East wind in that city is to delicate persons in the month of March, 
in the month of July it is exceedingly refreshing. 14 
But I hasten to close my remarks, already too protraoted, I fear, 
fey a discussion of the treatment which I believe to be best adapted 
to the disease. 
In the first place, I would lay it down as a rule, that diarrhoea is 
not to be allowed to run on in teething children. It is to be controlled, 
not to the extent of producing constipation, but to that extent that 
it ceases to be strictly a diarrhoea. Division of the gums in a proper 
manner and always when called for ; the use of chalk mixture, alter- 
nating occasionally with small doses of the aromatic syrup of 
rhubarb ; early resort to tonics, carminatives, and stimulants, 
together with the wearing of flannels next the skin, especially so as 
to cover the abdomen completely, are the remedies. Careful diet 
(which should be the mother’s milk if possible), regular exercise in 
the open air during the early part of the day, and protection from 
the excessive heat of noon, are the hygienic necessities. Daily warm 
baths and frictions, the baths to be once every week of salt water, 
are also important. And under these influences very many children 
are kept safe from the dangers of the more advanced disease. 
If the diarrhoea is more aggravated, though without severe vomit- 
ing, there may be given chalk mixture, with some carminative, 
astringent and tonic ; my own preference being for a combination of 
chalk mixture, tincture of catechu, compound tincture of cardamoms, 
and compound tincture of cinchona. To this mixture I sometimes 
add a little paregoric. At the same time the flannel which covers 
the abdomen may be sprinkled with brandy or tincture of camphor. 
When vomiting occurs with profuse discharges, that is, when the 
stage arrives to which the name Cholera Infantum is given ; if it 
comes suddenly, and there is a suspicion of undigested food in the 
bowels, a mild purgative may be given, and the best is syrup of 
rhubarb. This, however, should not be attempted more than once, 
unless the stomach has become quiet. Many, it is well known, pre- 
fer calomel in a cathartic dose, and it is easily taken and does not 
nauseate by its taste, but it is, to my thinking, too violent and irritat- 
ing a cathartic. The vomiting should be allayed by the use of bits 
of ice, (not teaspoonfuls of cold water, for that will not do it so 
rapidly,) which may be swallowed whole if desired ; by mustard 
poultices, small ones, to the pit of the stomach ; by quiet and not 
attempting to fill the stomach with food. The warm baths should be 
continued ; mild opiate injections or suppositories may be used, and 
an early resort be had to stimulants when symptoms of exhaustion 
appear. These may be given in almost any form, certainly in any 15 
that agrees with the stomach. At one time they will be best borne 
cold, at another hot ; sometimes diluted with water only, sometimes 
with milk, as punch or whey ; but all of these forms are to be select- 
ed from according to the occasion. At times these will not stay 
upon the stomach in any form, and then it is that bathing with diluted 
spirits should be carefully attended to. In this disease it is impor- 
tant to continue to try to save life as long as a spark of it remains, 
for, from the most unpromising condition recovery sometimes rewards 
the diligent and faithful attendant. 
When the disease becomes chronic it is necessary, to pursue a simi- 
lar, and yet in some respects, a different treatment. The chief 
difference is in the mode of procedure when there occurs a series of 
bloody discharges. That is when the colitis is more severe and 
prominent, and when the condition approaches that of dysentery. 
For several years, I have in this state of affairs, used with much sat- 
isfaction, a mixture of about ten grains of blue mass rubbed up in two 
drachms of syrup of rhubarb, to which is added one-half teaspoonful of 
paregoric and four ounces of chalk mixture. Of this, a teaspoonful 
every two or three hours, is the dose. The blue mass certainly does 
not act like the calomel, not producing, in purgative doses, so great 
prostration, and in small doses it does not lessen the proportion of fibrin 
in the blood, as is the case with calomel. lienee calomel is the bet- 
ter agent when the intention is to arrest the exudation of plastic 
deposits, as in the inflammation of serous membranes. It is probable 
that the portion of mercury in the blue mass which becomes converted 
into the black oxide, is the beneficial agent, and in this idea I have 
been confirmed, by noticing the effects of the black oxide of mercury 
prepared by means of ammonia. This, which some homceopathists 
use under the name of “ soluble mercury,” is a valuable remedy, and 
is worthy of more general attention, from its good effect and from 
the facility with which it is taken by children when rubbed up with 
sugar. It is of course understood that I do not recommend any 
dilution for the sake of potentization. 
In this state opiates, if none are contained in this mixture, are often 
of very great benefit when given with discretion, that is, in proper 
dose not too frequently repeated. Notwithstanding the prejudice 
against their use, I hardly know what we could do without them ; 
certainly they expedite recovery. Another prejudice exists against 
the use of chalk mixture, but I have yet to see or to learn of one who 
has seen the concretions ascribed to it after use in this disease. It 
should not be constantly continued for months, for the condition 16 
which calls for it does not require that. I do not dare to say how 
large a quantity of it I have prescribed during the last Summer only, 
but it has been very large, and I have yet to see its bad effects. 
Exposure to the fresh air is still more important, if that be possi- 
ble, than ever, and it should be regular and constant. I could speak 
of very striking instances of its benefits, but I fear I become weari- 
some. It does not absolutely require that the child should be taken 
into the country. Many of my patients are sent to the ferries to 
cross them so that the cool fresh sea-breeze may fan them, and it acts 
sometimes like magic to raise their drooping heads. Of bathing, too, 
in warm water, I could give illustrations, the most striking being 
where a gentleman, whose child was under another practitioner’s care, 
ventured to direct one leg to be washed hastily, contrary to the phy- 
sician’s advice, although the child had been sick several weeks. He 
distinctly affirms, that the leg so washed, got so much the start of the 
other, which was not similarly treated for a few days, that it took the 
latter a long time to catch up with it in strength and in flesh. 
In conclusion I present these propositions as expressing my views 
of this matter, in contrast to those which I first gave as expressive of 
the opinions more commonly entertained. 
1. The condition to which the name of Cholera Infantum is given, 
is not a separate and peculiar disease, but a collection of symptoms 
attendant on certain stages of other diseases. 
2. This condition is recognized by European authors in their treat- 
ises, though very properly it does not receive a separate title. 
3. That the principles of its treatment are the same as those of 
diarrhoea and entero-colitis. 
4. That Hydrocephalus is rarely if ever an attendant or sequent of 
it, but that the hydrocephaloid disease is very usual. CHOLERA INFANTUM, 
DIARRHCEA AND ENTER0-C01ITIS, 
THEIR RELATIONS TO EACH OTHER, THEIR PATHOLOGY, 
AND THEIR TREATMENT. 
BY 
EDWARD H. PARKER, M.D., 
PHYSICIAN TO THE CHILDREN’S DEPARTMENT OF THE DEMILT DISPENSARY, FELLOW 
OF THE NEW YORK ACADEMY OF MEDICINE, ETC. 
READ BEFORE THE NEW YORK STATE MEDICAL SOCIETY, FEB. 4, 1857. 
[From the American Medical Monthly for May, 1857.] 
NEW YORK: 
EDWARD P. ALLEN, 9 SPRUCE STREET. 
18 5?.