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A N - % 
 
 INAUGURAL DISSE^rATltJN 
 
 ON THE ' ' V\ 5% /,; ?■>"> V 
 
 DIARRHOEA INFANTUM. 
 
 SUBMITTED to the PUBLIC EXAMINATION 
 
 OF THE 
 
 FACULTY OF PHYSIC, 
 
 UNDER THE AUTHORITY OF THE 
 
 TRUSTEES OF COLUMBIA COLLEGE, 
 
 IN THE 
 
 STATE OF NEW-YORK: 
 WILLIAM SAMUEL JOHNSON, L. L. D. Prefident 
 
 FOR THE DEGREE OF 
 
 DOCTOR of P HTS IC; 
 
 ON THE FIFTH DAY OF MAY, 1 79j- 
 
 By P % E TER ANDF.RSO N, A. B. 
 
 And Citizen ot the State ot New-York. 
 
 Non f c, non purnuram, non n altum divitias, 
 
 n"n in naturn ( i hnbutum ; 
 
 fed .-..; -r.uju utilitati info vienfem, dignitas fequitur. 
 
 Nichols. 
 
 NEW- . 
 TIEBOU1 
 
 —1795.— 
 
Imprimatur 
 
 w. P. SMITH. 
 
 d(£Z, 
 (71S- 
 
WILLIAM SAMUEL jbtul^N; l 'tii & 
 PRESIDENT of COLUMBIA COLLEGE 5 
 
 Whofe Eloquence, Wifdom and Talents , 
 
 as an 
 
 Orator and Statesman ; 
 
 Whofe elegant Erudition, as a Scholar ; 
 
 And whofe Virtue and Philanthrophy, as a 
 
 Member of Society, 
 Will ever render his name juftly refpefted,. 
 
 
1 
 
 ALSO, TO 
 
 NICHOLAS ROMAYNE, M. D. 
 
 <yjlu t/iol& aim j'adhhU O idor ; 
 
 A perfon eminently diflinguifhed for his 
 deep, and extenfive acquaintace with the whole 
 circle of Medical Science, for his humanity and 
 ufefulnefs, in the practice of his profeffion ; 
 
 And for his poiitenefs, as a Gentleman : 
 
 THIS 
 
 DISSERTATION 
 
 Is Infcribcd, 
 
 With the mod fincere fentiments of gratitude 
 and refpecl, 
 
 By their obliged Friend, 
 
 And fellow-citizen, 
 
 The AUTHOR. 
 
ERRATA., 
 
 ige a, Line &, for two, read too. 
 
 do* 7, for prevaling, prevailing. 
 
 do. 7 of the Note, for ferret, fecrete. 
 
 2d, line, from thebotlorn, for ' diieafe, 5 'dileafes.' 
 
 15, 20, for emotion, emotions. 
 
 j 6, 22, for two too.. 
 
 %%, i, after the word "this,." imert "general, 
 
DISSERTATION 
 
 ON THE 
 
 DIARRHOEA INFANTUM. 
 
 N. 
 
 O difeafes, to which man is fubjecr. in the different 
 progreihVe ftages of his life, more neceffarily claim our 
 compaHIon, and the extenfion of medical aid, than thofe 
 which are incident to the periods of infancy and child- 
 hood. The greyt fenfibility and irritability of infants, the 
 accfcent nature of their food, their incapacity for exercifc, 
 and, above all, the mifmanagement of thofe, who have the 
 immediate care of them, render them peculiarly the fubje&s 
 of pain and difcafe. So great, indeed, is the mortality 
 among children, in large cities, that, by pretty accurate 
 ellimates, it has been found, that above one half of them 
 die, within the fir (I four and five years.* 
 
 Until the age of five, " human life, like a fire beginning 
 to bnrn, is very feeble," and eafily cxtinguifhed. — various 
 are the caufes and feats of thefe difeafes. But fome of the 
 niofl frequent, and fuch as are attended with the mod dif- 
 tr effing fymtoms, are thofe, which affect the alimentary 
 canal. Of fuch genera] importance to the human (economy, 
 he due action of thefe parts been deemedj that Hip* 
 Id fome others of the ancient Phyficians.confidered 
 
 amorh I date of them, as the principal and 
 
 ' .— Sinii'u Letteri — 
 
6falh?xf fotirce cf iitfarfule -difeafes. Certain we are, that 
 this clafs oi uifeafes, bbth from the frequency of their occur- 
 rence, ^hd/thegrea-t mortality attending them, demands the 
 niceit attention. I fhali, however, confine myfelf to the 
 confideration of one particular genus of them, the Diarrhoea, 
 or purging of Children. This difeafe, particularly in its 
 mod malignant forms has been viewed as a fpecies of Cholera 
 morlns, and hence denominated the " Cholera Infantum." 
 But, that this is not, in general, a different difeafe from the 
 Diarrhoea, bur. merely a variety or modification of the fame 
 fpecies, will I. conceive, fully appear from the following 
 confiderations. 
 
 i. Becaufe it attacks children of the fame age, and habit 
 of body, as the Diarrhoea. 
 
 2. That, in a great proportion of cafes/ even in the fum- 
 imr months, a fimple Diarrhoea alone appears, unaccompa- 
 nied with any vomiting. 
 
 3. That, even in thofe inflances, where a vomiting does 
 truly take place, it is often merely of the aliment taken in, 
 of a four, greenifh, or other matter different from bile.* 
 
 4. Bile feldom appears in the firfl afts of vomiting, and 
 feems afterwards to be poured too copioufly into the flomach 
 and duodenum, from the previous agitation of the abdomi- 
 nal vifcera, and the debility and relaxation induced. The 
 more rrequent appearance of vomiting in the Diarrhoea of 
 Infants, than in that of Adults, arifes from the greater 
 irritability of the former, than of the latter. 
 
 5. It is deftitute of fome of the other fymptoms of a 
 genuine Cholera. 
 
 6. It is probable, both from the nature of children's food, 
 
 and the general difpofition of their fyftems to a fuperabun- 
 
 dance 
 
 * Gerardi Van Swietan Comment, in Boerh Tom. 4.— -Halleri opera 
 majora Tom, 6. P. 548, 
 
( 9- ) 
 
 dance of acid, as well as from the evident marks of acidity 
 in the primce vis, that a true Cholera docs feldom occur. 
 
 7. This probability is further fupported by thewtll known 
 mild and inert nature of the bile in infants.* — " In infants 
 the bile is frequently not fufficiently active, and generally 
 fecreted in two fmall a quantity, which in them induces dif- 
 eafes of prevaling acidity. "f 
 
 8. And, laftly, we may conclude both complaints to be 
 generally of the fame nature, as well from their origin, 
 which is moftly in the form of a Diarrhoea ; as alfo the me- 
 thod of cure and prevention, which reft principally upon 
 the view of obviating and correcting acidity. The treat- 
 ment being likewife different from what is proper in the 
 Cholera of adults ; and in infants, nearly the fame, whether 
 accompanied with vomiting or not, and in cafes of vomiting, 
 whether with bile, or any other matter. 
 
 From all thefe confiderations, it will he pretty evident, 
 that a vomiting, ando ther violent fymptoms, and even a vomit- 
 ing of gall are not always fufficient to conftitute a different 
 genus of difeafe, but only perhaps a diftindl fpecies or variety, 
 included under the Genus Diarrhoea. £ HIS- 
 
 * Halleri Phyfiolagia. 
 + Dr. Saunders on the liver. 
 
 * The fize of the liver in the foetus, and foon after birth, is no 
 proof of a contrary doctrine ; as it is particularly large in the former 
 flatc, without any known adequate ul'c for the bile. And as other 
 Glandular parts :irr- alio larger at the fe two periods, than at any oehcr 
 period, without our being able to afecrtain their ufes. '■ We do not 
 know the whole function of the liver : we know that its principal ufe 
 fe< ret the bUe, but then in the fceius it ojbupies the 
 .1 the cavity ol the abdomen, and a confiderable portion 
 ol th<- blood, returning from the placenta, circulates through its Pub- 
 ftance. I occupiei lets fpace in proporrion in the cavity ol the abdo- 
 men, as the body grows up, and it is more than probable, thai il 
 11 function nol yel underflood " Whai greatly favoui 
 
 fize ol the blood-vi II ited to the 
 
 :i are double 
 mm ' '" "" v other 
 
 gee Ci he Abforbenl Syfl :id 
 
( 1° ) 
 
 HISTORY of the DISEASE. 
 
 Definition.' Dejeftio frequens ; morbus non contagiofus ; pyrexi 
 
 nulla primaria. 
 
 Culhni. Kofofogia Method 
 
 THIS difeafe may arife at any period of the infant 
 ftate £ and few children entirely efcape it. It alfo affumes 
 various appearances. But, it is my intention to defcribe it 
 only, as it occurs as an idiopathic difeafe ; and, more parti- 
 cularly, that form of it, which prevails during the warmer 
 feafons of the year. 
 
 Although this complaint may attack children of any age; 
 we find that it moll frequently occurs from the fecond or 
 third week after birth, until the third and fourth year. 
 It becomes moil prevalent, and is attended with fymptoms 
 of the greaietl danger and malignity, during the warmer 
 months of fummer, and the beginning of autumn ; when it 
 is known by the common name of " The Difeafe of the 
 Seafon." It always fpreads, and affumes a more dangerous 
 form, in proportion as the heat of the feafon increafes. 
 Alfo, as the weather is fubjefl to fudden and confiderable 
 viciffitudes of heat and cold. Sudden and long continued 
 falls of rain, after a very warm and dry ftate of the at- 
 mofphere, greatly favour the operation of the exciting 
 caufes. For thefe reafons, we find, that during the courfe 
 of the fummer of 1793, it prevailed, in this city, to aa 
 alarming and dangerous degree ; whereas, from the mildnefs 
 and almoft uniform temperature of the atmofphere, during 
 the laft fummer, it was comparatively of rare occurence., 
 It generally begins in the month of June or July, and con- 
 tisaues till ths latter part of September. Although, frona 
 
( " ) 
 
 the premature heats of fummer, it may appear much earlier j 
 or, from the unufual continuance of the fame, be coniider- 
 ably protracted. 
 
 The firft appearance of this difeafe is marked commonly 
 by a moderate degree of lootenefs ; though fometimes, a 
 conitipation precedes the Diarrhoea. This loofenefs is diflin- 
 guifhed, according to the appearance of the matter difcharged, 
 The mod common appearance of it is green, and curdled, 
 emitting a four, and peculiarly rank odour ; but, the ftools 
 are alfo clayey, watery, bloody and fetid. In fome cafes, 
 particularly in the advanced ftages of the complaint, they 
 confift (as in the Lientery of Adults) merely of the aliment 
 taken in, without having undergone any material change in 
 its paffage. Acid and bitter eradiations generally attend. 
 Vomiting, alfo, frequently occurs throughout the courfc of 
 the complaint, particulaly during the exceffive heats of kSum- 
 mer. The matter thrown up is green, or yellow. Some- 
 times the vomiting continues without the purging ; though 
 more frequently the contrary. The abdomen is often affed •■ 
 ed with a confiderable hardnefs and fwelling. Thefe fymp- 
 toms are accompanied with fevere pain and griping ; which 
 we may know from the child's ftarting, and frequent fits of 
 crying, when attempting to fleep, and the forcible contrac- 
 tion of its arms and legs towards the abdomen. A great 
 degree of thirft moftly attends. The pulfe is weak, quick, 
 and frequent. The fkin hot and dry, efpecially about the 
 head ; but, as the difeafe advances, the extremities become 
 cold ; fometimes remarkably fo, while the belly is as re- 
 markably hot. In long-continued Diarrhoeas, a procidentia 
 a;ii fometimes takes place, which proves a very obftinate 
 and troublcfome fymptora. The duration of the difeafe is 
 
 B 2 
 
t 12 ) 
 
 various. In fome inftances, it terminates in a few days; 
 but, in others, it continues with little or no remiffion, for 
 a month or more. I have known it to continue, in fome 
 children, for three, four, and five months, with very few 
 occafional alterations. Eruptions on the flan, will fometimes 
 appear during its progrefs. And, in complaints of long 
 {landing, a peculiar tightnefs of the fkin (called Jhin-bound) 
 is faid by medical writers, to take place.* In the word 
 ftage of it, there is a conftant inclination for ftool, though 
 the {tools are little in quantity, watery and green. — - 
 At kit the eyes become hollow and languid, with fome- 
 thing of a pearly whitenefs in them, the body is fo greatly 
 emaciated, that the bones almofl protrude through the fkin, 
 a fore mouth, livid fpots, hiccup, convulfions, and a ftrongly 
 marked hippocratic countenance generally precede the fatal 
 termination. f 
 
 y a &bj 
 
 DIAGNOSIS. 
 
 THE difeafes, with which a Diarrhoea in children, may 
 be confounded, are a genuine Cholera morbus, a Dyfentery 
 and worms in the alimentary canal. 
 
 1. To diflinguifn it from Cholera, we may be affifled, 
 in fome degree,- by attending to the feafon, in which it hap- 
 pens ; by the matter vomited, as we'll as that difcharged by 
 ftool, being entirely of a bilious nature, in the latter ; from 
 this complaint being of fhort duration, and attended with 
 violent fymptoms from its commencement. 
 
 2. From the Dyfensery, by its not being contagious ; by 
 its not being attended with that pungent pain, griping, and 
 
 * Dr. Underwood. 
 
 + Dr. Rufh's Med. Inquiries, vol. i, 
 
( '3 ) 
 
 tenefmus, which are fo dittreffiug in Dyfintery. We may 
 alfo form our judgment, from the fever not being of that 
 highly typhous, malignant nature, that it is in the latter 
 complaint, and, upon the whole, from the Dyjlntery being 
 a very rare difeafe among children. 
 
 The 3d. difeafe, with which it may be confounded, is 
 the affection, ariiing from ivorms in the alimentary canal. 
 But from this, it will be fufficiently diuinguifhed, from there 
 not having been any woims difcharged in the firft attack of 
 the difeafe ; from an attention to the epidemic conilitution 
 or nature of difeafe moft prevalent ; and from its not having 
 been preceded by a voracious appetite, difturbed Seep, Sue, 
 The appearance of the ftools will be different ; and the 
 effential charac~T.eiift.ic fymptoms of worms will be wanting. 
 
 CAUSES. 
 
 THESE, as ufual, (hall be divided into the Remote and 
 Proximate ; and the firft fubdivided into the Predifponent 
 and exciting caufes. We (hall conllder them, as they fuc- 
 ceed each other, in the order of time, and approximate the 
 perfect ftate of difeafe. 
 
 PRE DISPONENT CAUSES. 
 
 " Predi8POS1TIOK, being that Mate of the body, which 
 n . a pcrfon fufeeptible of the operation of the Exciting 
 or Occaf,';nal c.ufeb ;" the following may be viewed as the 
 principal prtdifpotunt caufts yf the complaint, under con- 
 
 1. An 
 
( '4 ) 
 
 1. An hereditary difpofition, arifing from weak and de- 
 praved parents, producing a weak, fickly organization. 
 
 2. A peculiar irritable ftate of the fyftem, or of the fto- 
 mach and bowels, arifing either from natural conformation, 
 independant of hereditary taint, or a difeafed ftate of the 
 body ; as happens frequently from dentition, &c. 
 
 3. A particular ftate of the atmofphere, either a very 
 warm, and moift, or cold and variable ftate of it. 
 
 4. A diet affording little nutritious matter, or, atleaft, 
 affording matter, which requires to undergo certain changes 
 from fermentation, in the ftomach, before it can be con- 
 certed into chyle. Hence a vegetable diet, either in whole 
 or chiefly fo, and of a bad quality, often lays the foundation 
 for this diforder. 
 
 5. Breathing an impure and confined air.* 
 
 6. The want of that due exercife, the defire of which i» 
 mftinftively implanted in the breaft of every child. 
 
 7. An inattention to cleanlinefs. 
 
 8. and laftly. The neglect of purging off the meconium^ 
 foon after birth, frequently lays the foundation for this com- 
 plaint, by irritating and ovtfrftretching the inteftines.f 
 
 EXCITING CAUSES. 
 
 ONE of the moft frequent exciting caufes of difeafes 
 of the alimentary canal in children, is generally ailowed to be 
 a fnperabnndant acidity.:}: This appears to be fuch a com- 
 mon 
 
 * Dr. Bryan Robinfon has fhewn, that infants contain moreblood, in 
 proportion, than adults. And it is well known, that their circulation 
 is much quicker, and of courfe their refpiration. Hence there is a 
 greater quantity of impure air emitted from theij lungs. See Me- 
 moirs of the Arts and Science, Vol, 2d. 
 
 t Dr. Underwood's " Treatife on the difeafe of children." 
 t Harris " de morbis Infantum." Cullen's " firfl Lines." 
 
( '5 ) 
 
 mon caufe, that Harris, who isefteemed a very good writer 
 on the difeafes of children, has attributed every morbid af- 
 fection, to which the infant Hate is liable, to this fource. 
 And, in fact, from the food of infants being of a very 
 acefcent nature, and readily undergoing fermentation in the 
 ftomach, as well as from various phenomena, that take place, 
 we can have little doubt of acidity being a very common caufe 
 of this difeafe-* 
 
 But, perhaps, acidity is more frequently a coufgquence of 
 debility and difeafe ; than the caufe of them. 
 
 The 2d. caufe is irregularity in diet. The tender bowels 
 
 of children may either be oppreffed by too great a quantity 
 
 of food, or irritated by that, which is difficult of digeftion, 
 
 and liable to become acrimonious from its delay in the fn'fl. 
 
 pafTages. 
 
 A 3d. caufe may be fuppofed to be paffions of the mind, 
 
 either in the nurfe, or child. That the firft may operate by 
 
 altering the quality and quantity of milk fecreted, is very 
 
 probable from the very intimate connection, and mutual 
 
 influence, which fubfift between various emotion of the 
 
 mind and glandular fecretions. And, that paffions of the 
 
 mind 
 
 * I would not have it underftood, from what is here faid, that I fup- 
 
 pofe the milk of the mother to be the general caufe of this morbid 
 
 acidity. Milk, both from its general properties, and its being almoil 
 
 the univerfal food, provided by nature, for the nourifhment of the 
 
 orn animal, is evidently the heft adapted for the weak digeftive 
 
 organs of Infants. But, when the flomach of an Infant is debilitated, 
 
 11 the jnilk. ol the nurle becomes vitiated by grief or other emo- 
 
 ->: the mind, difeafe, or improper food, it may undergo fimilar 
 
 chang' bles, from fermentation. Thefe law very readily pafs 
 
 ;h the acid fermentation, when expofed to a moderate hcai, out 
 
 body. Hence probably, in certain ftatca ol the fyftem, fi 
 
 changes take place, during the proccl ch and 
 
 • ■ n ,i\ his opinion, thai "I al I 
 
 the children, in tl hat arc dry ''1 who 
 
 die under four mc lirdi 01 even ihri fourths fall victims 
 
 h .ind boweii occafioned by improp ■ 
 
 Pj igl r and Di M'Bride oo Fermentation. — Mois 
 
 • :. >'. . I 
 
( 16 ) 
 
 mind in infants, will produce Diarrhoea, maybe concluded 
 from the powerful effe£l they have on the brain and Nervous 
 Syltem, which in infancy are peculiarly large and fenfible. 
 In confirmation of it, we may alfo adduce the inftances of 
 adults, who are liable to the fame complaint, from a fimilar 
 caufe.* 
 
 4. The fudden repulfion of certaineruptions on the fkin. 
 This fometimcs happens with the Exanthemata, the red 
 Gum, &c. 
 
 5. The fudden ftoppage of perfpiration, from a moid and 
 cold ft'ate of the atmofphere. An obftruftion of perfpiration 
 may alfo arife from want of cleanlinefs, which may further 
 operate by favouring the generation, if not actually generating 
 an acrimony of the fluids. Cold particularly produces this 
 difeafe, when applied to the feet,f and probably, from fome 
 part of the clothing of Infants, applied over the abdomen, 
 being fuffered to remain on damp and cold. 
 
 6. A very warm, and dry ftate of the atmofphere, parti- 
 cularly if long continued. 
 
 The 7'ch. and la ft caufe of this complaint, is the ufe of 
 the draftic purgatives, or the long and two frequent ufe 
 of rhubarb, magnefia alba, &c. which by irritating the 
 interlines may produce aDianhoea.J 
 
 PROXIMATE CAUSES. 
 
 % . 
 
 In eftabliihing the proximate caufe of Diarrhoea, there 
 has been a great diveffity of fentiment among phyficians. 
 
 Some 
 
 * Gaubii Pathologia-— Cul'en's Firfl: Lines. 
 + Throwing cold water on the lower extremities, has lately been 
 found a very effectual remedy in removing. obftinate coftivenefs. Med. 
 *~ '" - 1 t Hamilton. 
 
( '7 
 
 Some fuppofe it to confift in a fpafmodic affection, arifing 
 from an atony and debility of the parts.* Others affirm, 
 that it arifes from a laxity of the mufcular fibres. Dr. Brown 
 claffes it among the afthenic difeafes, and alledges, that it 
 arifes from direct debility. f But, the mod probable opi- 
 nion feerns to be that, which imputes it to an increafed 
 periftaltic motion, of the inteftinal canal, arifing from the 
 action of ftimulants.^: 
 
 What is the peculiar nature of the ftimulants, that more 
 immediately excite the action of this canal, is difficult to 
 determine. Although, from many circumftances of their 
 operation, as well as from direct poilons often operating in 
 the fame way ; I am inclined to believe, that it is owing to 
 fome noxious quality in the fubftances, which in a certain 
 quantity might prove deftructive to the fyftem.$ 
 
 That acidity operates as a ilimulus to the inteftinal canal, 
 may be inferred from the vegetable acids (of which nature 
 is the acid in the ttomach) readily exciting appetite, and 
 increafing fome of the fecretions ; as alfo the general bene- 
 ficial effects of the fermented vegetable acid, as an externa: 
 application, in obviating and corretling putrefcency. Hence 
 its frequent life in contagious fevers of great debility. 
 
 But, it is not improbable, that a redundant acidity is 
 very much favoured in its operation, by exciting the mu- 
 cous follicles of the inteflines to a larger exudation of their 
 contents, and rendering more acrid the mucus thus poured 
 out. It may, alfo, have an effect of eroding the mouths 
 of thefe veffelis, as well as the inner coats of the inteftines,j{ < 
 and thus increafing their irritability. When 
 
 ... ; i ta Medicine. 
 
 Med, 
 mony i> known fo ■ ! '" 
 
■ C is ) 
 
 When a Diarrhoea arifes from a fuppreifion of the per- 
 fpirable matter, or the fudden repulfion of eruptions from 
 the' fkin, k is to be imputed to the fympathy, that fubfifts 
 between the furface of the body and the alimentary canal. 
 
 It remains flill a queftion to be decided, how far, and in 
 what manner, heat is to be confidered as the caufe of this 
 difeafe. As this is a fubject, which has not, to my know- 
 ledge, been fully examined by any medical writer, it would 
 be great prefumption in me to pretend to efrahlifh an opinion 
 entirely free from objections. It however appears probable, 
 that excefiive heat operates firft by indirectly debilitating 
 and relaxing the furface of the body, and then, by confent 
 of parts, relaxing the inteftinal tube. We well know, that 
 the {kin and alimentary canal mutually participate in health 
 and difeafe. Hence we may eafily conceive, that, as the long 
 application of violent heat may overftretch and relax the 
 veiTels on the furface, and caufe an excefiive difcharge of per- 
 fpirable matter ; the internal parts, either at the fame time, 
 or during the interval of its application to the external parts, 
 may fuffer a preternatural exudation there of the various 
 fecretoiy difcharges. Thefe fluids may accumulate, and 
 from ftagnation and the continuance of heat, become pre- 
 ternaturally acrid, fo as to irritate and excoriate the very 
 delicate coats of the interlines.* Acidity is always increafed 
 in the prima vis, during warm weather. And, as the appli- 
 cation of ftimulants, is generally more powerful, in proportion 
 as the body is weakened, it appears evident, that the -ufe of 
 all indigeftible food, &c. will much more readily induce 
 difeafe. But, as this difeafe prevails efpecially at the com- 
 ing 
 
 * What greatly favours this opinion, is, that children who poffefs a 
 much larger proportion of fluids, -efpecially of the mucous kind, than 
 grown people, and adults of a fimilar make, are particularly liable t* 
 this complaist, 
 
( 19 ) 
 
 ing on of cold and rainy weather, after great heats, we may' 
 fuppofe, that, from the fudden fuppreffion .of perlpirartion, 
 and the relaxation of the fyllem, there will be a greater 
 afflux of fluids to thefe parts, which irritate in proportion to 
 the debility. 
 
 PROGNOSIS. 
 
 THE extreme irritability of the infant fyfteni, render- 
 ing judgments drawn from the pulfe precarious, their being 
 eafily reduced by ficknefs, and their incapacity to exprefs 
 their diftrefs, as well as the difficulty of adapting our re- 
 medies to every particular emergency of early impotence, 
 render a prognofis often extremely difficult. While on the 
 other hand, children are not under the influence of many 
 tircumflances, which retard the recovery of adults. They 
 are not influenced by various impreflions on the mind, their 
 difeafes are far lefs complicated, their habits lefs vitiated, 
 their wants but few and fimple, feldom of a hurtful kind, 
 and they appear to be more immediately under the guidance 
 of nature. Hence it is the opinion of an elegant and judi- 
 cious writer, that H we ought never to defpa'ir of a child's 
 life, while it continues to breathe".* 
 
 When the difcharge is moderate, and not of an acrid 
 natuie, if it does not injure the child's health, and particu- 
 larly, if fleep is little diilwbcd, and the functions of the 
 ftomach are not impaired, we may view the diieafe as in 
 fome meafure, of a barmlefi nature. 
 
 may generally predict & favourable termination, if the 
 difeafc proceed from cold, or fomc little impropriety in 
 if, after the exhibition of the proper remedies, the vomiting 
 
 C 2 (when 
 
 * Gregory'* Comp. View. 
 
( 2Q ) 
 (when it attends) is fuppreffed, the purging either flops en- 
 tirely, or in part, and the matter voided, affumes a more 
 natural appearance, and efpeciajly if at the fame time, an 
 eruption appears on the fkin. 
 
 If the child be dry-nurfed, and his fleih become flabby, 
 his colour pale, and the flools of a black colour, and fetid, 
 the prognolis will be more doubtful. 
 
 But, when the difeafe is epidemic, when it has continued 
 for a long time, attended with a frequent vomitino- of acid 
 or bilious matter, and an inability to retain any thing on the 
 ftomach, it will be very unfavourable. And, if a frequent 
 hiccup, livid fpots, that peculiar tightnefs of the fkin 
 (called fkin-bound) a fore mouth, convuifions, and a general 
 emaciation of the body fupervene, it will terminate fatally. 
 
 METHOD of CURE. 
 
 Before we enter on the method of cure, it will be proper 
 to remark, that it is not every kind or degree of Diarrhoea, 
 that is to be viewed as a difeafe. A iraall degree of loofe- 
 nefs is common, and may often prove of fervice to children. 
 The bowels appear to be the great natural and critical outlet 
 in them, as the kidneys and furface of the body are in adults.* 
 It is chiefly, when the difeafe arifes from (oxns powerful caufe, 
 or fome caufe often repeated, when the difcharge i» excejjive in 
 degree? or of an unnatural appearance, and particularly when 
 threatened with fymptoms^f debility, that remedies become 
 immediately necsfiary. I fay immediately neeeffary, becaufe 
 the leaft delay, under fuch circumftances may often put it out 
 of our power to afford any effectual relief. 
 
 We 
 * Dr. Underwood. 
 
Tot ^ 
 
 We fhall omit taking notice of any fymptSmatic Diarrhoea 
 (arifing from dentition, worms, £sV.) as thefe require a 
 method of treatment, fuited to the primary complaint. 
 
 This difeafe may be often entirely prevented by a timely 
 attention to obviating the remote caufes, both predifponent 
 and occaiional. We may, for this purpofe, employ every 
 means for giving jlrength to the fyftem, by the daily 
 ufe of the cold bath, by the moderate life of animal food, of 
 a light kind, and the occafional ufe of a little Port Wine. 
 The utmoft attention to cleanliaefs, the accommodation of 
 the drefs to the (bate and changes of the weather, and the re- 
 moval of children to the country, at the approach of the 
 fummer fcfon, will be of eflential benefit.* 
 
 Before we form our method of cure, it will be proper to 
 attend to the remote caufes, and to endeavour to remove, or 
 moderate them. If the remote caufe be cold and moiftare, 
 it will be neceftary to obviate the effects of thefe, by keeping 
 the patient warm and dry ; or, if it proceed from improper 
 food, to change it for that which is more wholefome. 
 
 In the idiopathic Diarrhoea, the indications of cure, ai 
 founded on the view of obviating and removing the remote 
 and proximate caufes, and as fully confirmed by experience, 
 may be reduced to the following heads : 
 
 i. To evacuate the acrid fordes from the ftornrxh and 
 intefl: 
 
 2. To dimiiiifli the irregular action of the parts, and 
 
 3. 'j the ftrength and vigor of the whole fyftem. 
 The fir ft. intention is anfwereel by the exhibition • 
 
 and Emetics. ll< :;v, (hat 
 
 e few cafes, where the difeafe is far advanced, and 
 
 of great debility, and 01 may 
 
 • Rush, on the " C 
 
( 22 ) 
 
 centraindicate their ufe, we may pafs over this indication, 
 and have immediate recourfe to the remedies hereafter to be 
 mentioned. Though in general, it is of the utmolt import- 
 ance to attend carefully to emptying the ftomach and 
 bowels, and a circumftance that ought by no means, except 
 in the inflances before mentioned, to be neglected. 
 
 Perhaps one of the greateft. errors in Medicine, and one 
 v/hich is neverthelefs too often apparent, is a hafty and 
 blind attachment to particular remedies, to the entire ex- 
 clufion of others of equal, or perhaps fuperior virtues. It 
 would, no doubt, be of great fervice in the practice of 
 Phyfic, to keep in mind, and apply to moft of difeafes, the 
 practical remark of the learned Boerhaave ; " Nullum fe cog- 
 novi/fe remedium, quinfolo tempeJli<vo ufu talejieret" Phyficians 
 would not then obftinately adhere to one uniform mode of 
 treatment, without any regard to the variety and fucceflion 
 of Jymptoms.* 
 
 This has been a fault, particularly in treating the difeafes 
 of children. Some, from an idea, that acidity is the fole 
 and primary caufe of their difeafes, have advifed the conflant 
 ufe of abforbent and alkaline medicines. While others, pro- 
 bably from feeing the bad effedts of the injudicious ufe of 
 thefe remedies, and the advantages, in many cafes, of 
 emetics, have been as ftrenuous in their oppofition to the for- 
 mer, and defence of the latter. Whereas, if we were more 
 guided by reafon, and the appearance of fymptoms, we mould 
 feldom run into thefe exceffes, and there would be lefs vari- 
 ation of opinion and practice among phyficians. 
 
 * " Mutatis mutandis," conduft fhould be regulated by circum- 
 ftances, is a maxim fully as proper in Medicine, as in Morals and 
 Politics. Both Harris and Armfhong, almoft indifcriminately. re- 
 commend the ufe of their refpeclive favourite remedies, and declare, 
 " that they are as effectual in curing the Gripes," (as it is frequently 
 called) " as the bark in intermittents." 
 
( *3 ) 
 
 In determining, whether purgatives or emetics are mo ft 
 proper to be adminiftered, in this complaint, it will be highly 
 neceffary to attend to the particular fymptoms. When the 
 bowels alone are affe&ed, fo as to produce limply too fre- 
 quent a difcharge of their contents, without the affection 
 being immediately communicated to the ftomach, and unac- 
 companied with fymptoms of fever, purgatives will be 
 fufficiently fafe. 
 
 If a want of the ufnal appetite, a loathing of food, or 
 when aliments are taken in, an uneafinefsin the time of their 
 digeftion, fuch as flatulence, acid eructations, &c. occur, 
 emetics will be neceffary. Arid it will be particularly necef- 
 fary to have recourfe to emetics, if along with ficknefs, naufea, 
 and vomiting, the febrile fymptoms run pretty high. Alfo, if 
 the complaint has been of confiderable duration, and re- 
 turned feveral times, after having remitted, or entirely gone 
 off. Emetics have fome confiderable advantages over purga- 
 tives in Diarrhoea, which render them particularly ufefnl. 
 They more effectually empty the ftomach, and perhaps the 
 fmaller inteftines, and determine freely to the furface. It is 
 probable alfo, that vomiting may give fome inverfion of the 
 periftaltic motion which is determimined too much down- 
 wards in Diarrhoea.* 
 
 The remedies proper to be employed as cathartics, are 
 rhubarb, magncfia, or thefe combined, and in fome cafes, 
 talomel well prepared. This Jail is faid to be particularly 
 ufefnl, given to children above four or five months old, in 
 dofes of half a grain, when the bowels arc foul, and the ftooli 
 •try offcnfive.f Manna and cajlor oil, which have been 
 
 * Y:n Swieten in Boerhaav. — Tom. 2, p. 389.— Cullca's Fir ft Lin's. 
 + Dr. Armllr" . 
 
( -4 ) 
 
 employed, on this occafion, appear to me equally improper ; a» 
 the latter is very apt to become rancid, during warm weather ; 
 and the former, from its being entirely of a facchar'ine nature, 
 will readily increafe the fermentation, and confequent acidity 
 in the already debilitated itomach. 
 
 The emetics ufuaUy adminiitered in this difeafe, are Ipecacu- 
 anha and the anlimonial medicines. The antimonial wine, 
 fince the high character given of it by Dr. Armstrong, has 
 been viewed as almoll a fpecific in the difeafes of children 
 in general, and of Diarrhoea in particular. But, as it is 
 difficult to afcertain the exact dofe of this medicine, from 
 its difference of ftrength, which is greater or lefs, according 
 to the greater or lefs degree of acidity of the wine in its pre- 
 paration and from fome other confiderations; the Tartar Eme- 
 tic, as being lefs liable to variation, appears to me a preferable 
 medicine. This lad can be given in any neceffary quantity, 
 with a very great degree of exactnefs. 
 
 But, as fome perfons have ilrong prejudices againft the 
 ufe of this excellent remedy among children, in order to 
 remove thefe prejudices or fcruples, and to prevent the effects 
 of an imprudent administration of this, and other emetics, 
 the following circumftances are worthy of attention. Eme- 
 tics ought never if pofnble, to be given to infants, on art 
 empty Jlomach ; nor while the bowels are coftive. Hence the 
 mod proper time for their exhibition, is generally the evening. 
 We ought to be careful not to give with the antimonial 
 emetics, any acid or acid drink, as lemonade, or even fugar, 
 which is too often combined with thefe medicines. It will 
 alfo contribute to render the operation more mild, if inftead 
 of the common mode of diffolving the emetic fubftance, in a 
 fmall quantify of water, we add a large bulk of fluid. This 
 will render the medicine more tall clefs and agreeable (which 
 
 with 
 
( *5 ) 
 
 with children is an objeft deferving confiderable attention) 
 and prevent the emetic from convulfing and cramping the ilo- 
 raactt. We (hall alio be more certain of a perfect Solution 
 emetic tartar. 
 In cafes, aiding from acid or putrid fordes in the (lomacli, 
 fever, the Ipecacuanha is Sufficiently efficacious. 
 the complaint is occalioned by an obstruction of pcr- 
 fpiration, and is attended with a hot and dry ilate of the 
 a . i, when from the marks of acidity and debility in 
 h, the emetic tartar may b'e viewed as not tuffiqi- 
 I would recommend the life of the ^qmes'spoivaer* 
 But : thi medicine Sometimes runs off too quickly by the 
 bowels, it will he of Service to add a grain or two of ipecacu- 
 anha to evei y dofe of the James's powder. Some of the good 
 effecls of antimonials are juflly attributed to their relaxing 
 n, and producing a determination from the internal 
 Tor thefe purpofes, the above powder mull be highly 
 tageous, as it appears from observation, to poffefs the 
 quality in a Superior degree to all the other anti- 
 preparations** 
 . be difficult, from the weaknefs and irritability of the 
 •h, to retain the emetic for a Sufficient time, it ought 
 to be given in very Small dofes, and often repeated. Or, wc 
 lave recourse to purgatives, combined with opiates ; 
 or medicines administered per anum. 
 
 The 2d. indication is to be fulfilled by the ufe of abfor- 
 opintes, the watm bath, particularly fomentations of 
 the abdomen and warm emollient lavements. 
 
 re hive been great prejudices entertained by fome 
 
 phytic! 10 ufe of what are called antacids, or ab- 
 
 L) /-> • 
 
 »D ' Phytic, i7«)2— i- 
 
( 26 ) 
 
 /orients,* and opiates.-f And, that the indifcrhnlnate ufe of 
 thefe remedies has done great harm, we cannot but lament. 
 But, furely, after the ftomach and bowels have been two 
 or three times freely emptied of their acrid contents (as be- 
 fore directed) there can be no impropriety in removing all 
 remaining acid tendency, by the ufe of abforbents, ufually 
 given for that purpofe, and in allaying irrhafwn, by the fame 
 remedies and opiates. With refpe6t, however, to thefe reme- 
 dies, it will be proper to remark, that to derive benefit 
 from them, the fir ft ought to be adminiftered in large 
 dofes, though not often repeated ; and the latter is feldom 
 to be given, while the {tools are green, or have a very unna- 
 tural appearance. Magnejia is, in general, preferable to all 
 other abforbent medicines. But, when given rneielyasan 
 abiorbent of acidity, it ought to be in its pure and calcined 
 ftate. When given in its impure ftate, it is apt to occafion 
 pain and flatulencies, from the difengagement of the carbonu 
 acid. Given in the manner here directed, it is perfectly 
 mild (free from cauMicity) and as it contains more of the 
 real earth of magnefla, it rauft be more effectual.;}; 
 
 To remove pain and irritation in the ftomach and inteftin£3, 
 it will be of great fervice to apply flannels, wrung out of 
 brandy and warm water, over the abdomen. And, where 
 nothing can be retained on the ftomach, to apply an opiate 
 platter, or a plafter made of fome of the eflential oils, and 
 warm gums. 
 
 Our 3d. indication is to be anfwered by tonic and ftimulant 
 medicines, and a nourifliing diet. 
 
 The principal tonic, or ftrengthening medicine in this, as 
 in other difeafes, attended with debility, is the Peruvian bark. 
 But, as children are very averfe to fwallow medicines, which 
 
 * Dr. Armftrong. 
 
 f Van Swieten Tom. 4 P. 662, &c. Hairis. 
 
 % Black on Magnefta, Ptidtley on Arr. 
 
k 27 ) 
 
 *re naufeous to the tafte, and that require to be taken in large 
 quantities ; for thefe, and fome other reafons, it appears to 
 me, that the bark ought feldonito be given to them infuMaace.* 
 Various bitter, and flightly altringent fubftances, may alfo 
 be advantageoufly given in the advanced flate of the com- 
 plaint, and after the free ufe of the before mentioned remedies. 
 Bitters, befides their power of ttrengthening the ftomach, 
 have the property of correcting acidity and flatulence, which 
 they do out of the body.f 
 
 The flimulants employed are chiefly dramatics and the 
 'warm feeds, which are generally employed as carminatives. 
 Thefe are neceiTary in long continued Diarrhoeas, where 
 there is no fever, and where there is a conhdtYixblz Jfiafmodic 
 ajfetTion of the bowels. It is fometimes of fervice to add thefe 
 ftimulants, or what is fuperior, a little of the volatile alkali 
 well diluted, to the abforbent medicines. To thefe, or a 
 combination of them with opium, it will often be neceflary 
 to have immediate recourfe ; efpecially when the patient is 
 much weakened, and there is reafon to think, that the of- 
 fending matter has been already evacuated by the efforts of 
 nature. 
 
 D 2 But, 
 
 " The method of' giving (he bark in fubftance, it in many cafes im- 
 proper, on tliis account; that the Iigneouc ,md indigestible part of it 
 mu!t neceffarily irritate and injure the very delicate coats of the flo- 
 rid inieftines. Hence its readinels to Lie rejected ; and, probably 
 alfo, ill frequently prodm nit; Diarrhoea, and pain and tincture in the 
 ■ litis arife from the woody part of the baik. we 
 infer froin '.he inlufion of it in cold water and magncfia, being frc- 
 u'ned on the ftomach, alter the bark in fubftancc • s it is 
 called) had been conftantly thrown up. The addition oi the lagnefia* 
 eated of, is obvioufly advantageous Dr. Ro- 
 • 1 M M l.- ftun on Few< 
 
 Mat. M 
 
( 28 ) 
 
 f But, an object of equal, or perhaps fuperior importance 
 to any that has been mentioned, is the regulation of the 
 did. When children at the breaft, are attacked with this 
 dileafe, the nurfe ought to avoid every thing that may injure 
 her milk ; if fhe has lived on a vegetable diet, flie mud change 
 it for one of a more animal nature. It will be neceiTary to 
 alternate the ufe of a little animal broth with the mother's 
 milk to the child, or to change the nurfe. And, when 
 children are brought up by the hand, or fomewhat advanced 
 in age, we muft employ chiefly the nutritious juices of anl- 
 malSj freed -from all oily, indigeftible matter, fuch as ve Si arid 
 chicken-broth , beef-tea, and calves-feet jelly. Animal food, given 
 in tin's manner, will, belides being eafy of digeuion, and 
 affording a rich chyle, contribute greatly to correct the 
 acid tendency in the prima vice. If the child be unable to 
 take milk from the nurfe, it will be neceiTary to fubdi- 
 tiite fomething, which approaches human milk as nearly as 
 pofiible.* 
 
 Some of the farinaceous fubftances, fuch asfalep, fago, 
 and tapioca, are aifo employed with advantage. 
 
 But, if all thefe medicines fhould fail, and children ate 
 attacked with this complaint, during the warm feafons of 
 the year, it will fometimes be found, that the belt remedy in 
 this, as in the moil of chronic difeafes, will be pure, country 
 air, and feme gentle exercife of geflation. 
 
 It would be ingratitude in me, were I fo conclude this 
 effay, without expreiTing, in the warmeil terms, my fenti- 
 rnentG of refpeot and efteero, to thofe medical gentlemen, 
 from whom I have received repeated marks of friend/hip and 
 
 * As A'ffes' or Goat'A-rr.ilJc, when thefe can be procured ; or, by 
 adding to one part 6'f fre'ft; Cow's milk two parts of pure, well boiled 
 water, while vvarvu. — VanSwieten in BoeiLauv. — Mofs on Nurfing. 
 
C 29 ) 
 
 kindnefs. To Doctors Wm. Moose, 11. KhTam, andWm. 
 P. Smith' of this city ; as well as to Dr. Vavick of New- 
 Jerfey, I am particularly indebted. Permit me to affure 
 thpfe gentlemen, that as long as ufeful and difiuterefted 
 fervices merit regard, and while gratitude deferves to be 
 viewed as a viitue, a grateful remembrauce of their names 
 mall not be effaced from my mind. 
 
 FINIS.