CHAPTER XIV.
Table of Contents SECTION I.
CHOLERA INFANTUM VERSUS STARVATION.
Table of Contents 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 indicate much 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.
SIGNS OF STARVATION.
Table of Contents 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 everything it 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 fotal 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,[11q] 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 not known 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.
SECTION II.
SYMPTOMS OF EMPTINESS OR STARVATION, WHICH MAY LEAD TO CHOLERA.
Table of Contents 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 another kind 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 to look 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.
SECTION III.
CHOLERA INFANTUM.-INFANTILE CHOLERA.
Table of Contents 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 sufferer will 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 babes with cholera; in the last stage,...
