Read before the Bureau of Pediatrics, I.H.A., JUNE 18, 1948.
Epidemic diarrhea of the newborn is a clinical syndrome generally limited to the first month of life. It is characterized by marked contagiousness, high morbidity and mortality rates. In a clinical pattern manifestations include frequent water stools, rapid weight loss, prostration, dehydration, and acidosis. At the autopsies there are no characteristic pathologic findings.
The etiology is obscure. We know of no definite causative agent as none has been identified. The latest investigations have led us to believe that a virus may be the etiologic factor. This syndrome seems to come in epidemics which have followed or have occurred during outbreaks of influenza among adults and older children. There may be a possible relationship, but this has not been proved. It is noteworthy that nurses who are in constant contact with infected infants have never contracted the infection.
This syndrome occurs as often among breast-fed as among bottle-fed infants, and is equally severe among the private patients as the ward patients. I have seen it at various seasons of the year. Up to the present time epidemics have only been reported from the north temperate zone. The newborn infant seems to have little, if any, immunity against the disease-the premature or undernourished infant is especially predisposed to it. I believe the severity of the illness varies from epidemic to epidemic and also from patient to patient in the same epidemic.
The symptoms of this syndrome seem to run quite a stereotyped course. The incubation period is very short, a matter of a couple of days. During the stage of invasion the infant refuses to nurse, usually does not gain or actually loses weight, and becomes restless or fretful. Occasional vomiting is a symptom and abdominal distension may develop. The temperature runs a course from 97F. to 100F. Many of the severe cases never develop a temperature over normal. The most remarkable symptoms are related to the character, frequency, and manner of expulsion of the stools. The stools are watery, yellow in color or green acid in reaction.
They contain no mucous or pus, and rarely a streak of blood. The stools are frequent and often expelled explosively. The noisy, rapid expulsion of a large, watery stool is so characteristic that it can be considered almost pathognomonic of this condition. The restlessness become more marked. It may be so marked and so persistent that traumatic ulcers may be produced on the knees and on the heels from the infants constant rubbing of them against the bed linen. The cry is short and feeble.
The loss of weight is progressive and continuous. Dehydration is marked. The infant becomes drowsy and coma may supervene. Acidosis with carbon dioxide determination as low as 15 volumes percent may occur during the stage of invasion and during the stage to toxicity. These infants who develop acidosis-hyperapnoea is frequently not presents; there is hemoconcentration with an elevation of proteins, nonprotein nitrogen and blood chlorides; albumin and casts are found in the urine. The clinical course varies markedly from few days to several weeks. The complications may include otitis media, bronchopneumonia, and septicemia.
The diagnosis of this diarrhea during the newborn period is usually established when one or more infants have diarrhea in the same ward and one of them becomes critically ill or dies. We all know that during the immediate neonatal period the character and number of the stools for a normal infant may vary considerably, and we are very frequently able to pick out the tangible causes.
Deviations in the bowels habit may occur from overfeeding and from improper artificial feeding, but I feel certain that a provisional diagnosis of epidemic diarrhea in the newborn may be made whenever two or more infants have otherwise an insignificant diarrhea with sudden weight loss. The prognosis in these cases must always be guarded. There has been a very high mortality rate. As far as I can investigate I feel that the fatality rate is 43 percent in the epidemics. The future progress of all the infants that have survived epidemic diarrhea as a rule is uneventful.
Prophylaxis is of the greatest importance and applies both to the prevention of the initial infection and the prevention of infection of other infants. This is primarily a hospital disease but care of the nursery and the nursing care are not within the scope of this paper.
Active treatment is much the same as that of any of the diarrheal disturbances that occur during infancy. The orthodox school has laid out a complete plan of treatment which consists of an initial starvation period with only glucose in saline solution by mouth. Parenteral fluids are given by the subcutaneous and intravenous routes for the state of acidosis. Ascorbic acid and thiamine chloride are used. Solution of the amino acids are especially valuable to avoid protein depletion. Their direct therapy, as I have observed it, belongs in the sulfonamide field. Blood and plasma transfusions are considered necessary adjuncts in the therapy to avoid the depletion of serum protein and to correct anemia. In the hospital blood carbon dioxide determinations are repeated whenever there is an exaggeration of any of the symptoms.
The acidosis should be corrected by the intravenous administration of calculated amounts of 5 percent solution of sodium bicarbonate or by the intravenous or subcutaneous administration of sixth molar solution of sodium lactate. Maintenance of the fluid balance is always essential. All of these cases must be kept under continuous observation by competent medical and nursing staffs. The feeding of these cases by the dominant school varies with the opinion and experience of the attending pediatrician.
Now we will consider the other type of treatment based upon homoeopathic therapy. The intelligent care of the baby by the homoeopathic pediatrician runs very close to the care offered by the orthodox school of medicine, that is, we should investigate the clinical findings such as blood carbon dioxide determinations, the acidotic symptoms should be corrected by the administration of calculated amounts of the sixth molar solution of sodium lactate. Complete blood work should be done and there should be no hesitation in the employment of blood and plasma transfusions to correct anemia. We must assist nature and support our patient so that we may secure a better reaction from our prescribed remedies.
Personally, I have not instituted the initial starvation period as these children become dehydrated very rapidly. I have not had occasion to worry about the vomiting symptoms as I have been able to control them promptly with the indicated remedy. As the stools are acid and show evidence of fermentation, my main diet had been acidulated protein milk. My rest diets have been pure water, carbonated water, whey, and fresh brewed tea.
In no case have I seen human breast-milk to be of any service.
We are confronted unfortunately in the care of these infants by their immaturity and their prematurity. The remedies that I have seen positive results from are: Argent. nit.; Arsenicum album; Camphor; Cuprum metallicum; Veratrum album; Calcarea phos.; Hydrocyanic acid; China off.; and Sulphur. For the collapsic symptoms: Arsenic; Camphor; Cuprum; Hydrocyanic acid; Veratrum.
I will give the clinical history of two cases with the hopes that I may prove the efficiency of the homoeopathic remedy in the treatment of this dreaded and fatal disease.
Case History No. 1- Baby Alice, delivered in the Womens Homoeopathic Hospital of Philadelphia, was discharged about the tenth day when the diagnosis of diarrhea was made. When I was called to see this baby on the day following its discharge from the Hospital, I saw an infant that presented the following picture (the prescribing for these infants must be done solely on objective symptoms and our observation must be properly interpreted). This baby was restless or seemed to have a constant uneasiness. Its face and lips were blue and cold. Deep sunken eyes with blue rings around them. Occasional efforts at vomiting.
The drawing up of the limbs and the stiffening of the limbs gave me the inference of cramps. Areas of cold sweat. Spasmodic twitching of the little hands and the fingers were jerky. The stools were frequent, small (that is not copious), watery, greenish in color, acid in reaction. Some excoriation about the anus. The mother fed the baby some sterile water. There was a gurgling sound as it entered the stomach. I analyzed my symptoms, found I had (1) Cramps (2) Coldness (3) Collapse (4) Convulsion (5) Cyanosis. My picture was Cuprum metallicum which was given in the 200th potency. I repeated it every 15 minutes until reaction took place, and it was withheld so long as there were no stools and no vomiting.
This infant was fed on small doses of whey, brandied water, and albumen water. In twenty-four hours I began the feeding of acidulated protein milk which was retained. The baby was critically ill, frightfully emaciated, and dehydration and acidotic symptoms were present. I gave this child one-sixth molar solution of sodium lactate, 50 c.c. by hypodermoclysis three times in 24 hours. The next day I used normal saline and glucose intravenously, being fortunate enough to get into a vein. On the third day the stools were down to four a day; the child was retaining food by mouth; the color had improved; cyanosis had left; the cry was stronger.
The Cuprum picture had disappeared, but the profound debility brought about by the loss of vital fluids through vomiting and diarrhea was manifest. Therefore, my prescription was China off. Which was given hourly. Along about the fifth day of treatment this child had three formed stools. I immediately stepped the diet up, increased the fluids, added a dextro maltose preparation to the formula, and the child began to have a daily increase in weight of one ounce. After the sixth day I discontinued all clysis.
The progress was slow but uneventful, and at the end of the second week I began feeding the infant orange juice and a whole milk formula with a dextro maltose as a carbohydrate. Here the baby presented still a picture of high grade malnutrition-the neck was markedly emaciated, sutures overlapped, the abdomen was sunken and flabby which gave me a picture, of Calcarea phos. which was the last remedy the child received. It is now 5 months old, weighs 142 pounds, had shown no evidence of any gastro- intestinal upset up to the writing of this paper, and is well and happy.
Case History No. 2-Baby G.M. was discharged from a Philadelphia Hospital on the fifth day post partum as epidemic diarrhea had developed in some infants at that Nursery. This was a full term infant, and was without a doubt the worst case I have seen cured. I have seen others who apparently were not as ill, but have died. This severe case gave a classic pattern. The infant had been il two days before I saw him, and the pediatrist who was called in would not treat the child at home. I was asked to treat the infant at its home. The parents were willing and could employ all the necessary nursing care and I too charge of the case reluctantly.
The history given to me was that the baby lost a pound within 8 hours; there had been a rapid and progressive loss of weight. The child was whimpering and wailing constantly. A general physical examination gave this picture: an emaciated infant with shallow, rapid, and at times difficult respirations which would occasionally stop for seconds. This child was cold and clammy to touch. Blue rings around the eyes. Lips cracked. Pulse was scarcely perceptible and very rapid. If a teaspoonful of water was taken, it was immediately regurgitated. The stools were scanty, watery, dark brown, and offensive. My prescription was Arsenicum album at once. Oxygen had been sent for. As this case had many willing relatives at hand, in a short time I gave this child a clysis of Hartmanns solution. In fact, we gave a clysis every 6 hours for 24 hours.
The child put through a very stormy night and its only nourishment was through venoclysis. In the morning I received a phone message from the nurse that the child had completely collapsed, had stopped breathing, and she was forcing pure oxygen. She had given 2 c.c. of coramine by hypodermic injection and this had brought some little reaction when I arrived at the house. The infant was probably dying so I immediately gave an intraperitoneal injection of 60 c.c. of plasma and 100 c.c. of normal saline solution. The picture of this child was collapse- pulse imperceptible, respiration slow, gasping, convulsive twitching of the face, inactive dilated pupils, staring eyes, a pure purple color of skin and mucous membranes; the face had a livid flushed color and cold body surface.
There was only one remedy to be given and that was Hydrocyanic acid which was given in drop doses in the 500th potency every 5 minutes. I believe this case was saved during this critical syndrome by this quick and powerful acting remedy, Hydrocyanic acid. This was the last sudden collapse the infant had. The vomiting had ceased, though weakness and vital depression were present. The child presented a picture of Arsenicum album and this remedy was given in frequent doses in the 30th potency.
At the end of a week only debility and weakness seemed to stare me in the face. I then prescribed China officinalis for the weakness due to the loss of much of the vital fluids of the body. At the end of 2 weeks this dying infant took a new lease on life, was having normal fecal stools, beginning to gain weight, and was taking a full milk formula. To this day I wonder why this infant survived. At the present time it is well and progressing normally in all respects.
After careful observation of these diarrheal cases in two Hospitals, and critically watching the modern orthodox treatment carried out to the letter, also noting the mortality rate of approximately 43 percent with this modern scientific treatment, I have much satisfaction in looking back at the five cases I treated with the homoeopathic remedy as the medicinal therapy, accompanied by intravenous clysis and scientific feeding. It also gave me great mental satisfaction to know that I discharge my patient living in their mothers arms and that none of my patients were sent home in a box.
DR. J. W. WAFFENSMITH: I should like to ask the doctor two question: First, whether he has had any experience in this condition with Aethusa; and, second, if he has had any experience with Chininum arsenicosum.
DR. WILLIAM B GRIGGS.: Aethusa cynapium in my experience of many years is a very narrow remedy, indicated only where there is milk intolerance, where the child is weak and vomits milk in large, tough curds that almost choke it. The temperature is almost always sub-normal, and there is a greenish, watery diarrhea.
I had no such picture in any of these cases.
There was only one remedy I was disappointed with, and probably it was my fault, and that was Carbo vegetabilis, in these collapses. It never did a thing for any case. One of the men had a case in extremis and came to me, and I looked at the baby and it was in collapse, eyes sunken, belly distended, cold, clammy skin, as cold as a frog, breath cold. I said, “Try Carbo vegetabilis 30.” It was given every five minutes, and the baby died. With that advice, he gave it to another patient, and that baby died.
We need the remedies indicated in cholera, by the type of collapse, such as Camphor, which I used successfully in one of my other cases, and Hydrocyanic acid, Arsenic, and so forth, but I never saw any results with Carbo vegetabilis in these case. I simply did my best. If I had taken on most of these cases, I would have had a mortality rate. At the present my mortality rate is zero and they are what they are because they were treated purely homoeopathically.
DR. ELIZABETH WRIGHT HUBBARD: Did I understand you to say you gave whole raw milk?.
DR. GRIGGS: No, diluted. I used Walker-Gordon milk diluted one-third, and when they tolerated that and had no diarrhea, and the temperature was subnormal, I added something to produce energy, a dextro-maltose preparation.
DR. ALLAN D. SUTHERLAND: I think the important feature of us to remember is not only the homoeopathic treatments the Dr. Griggs used, but also his supportive measures. I think too many times we have a tendency to depend entirely on the remedy. These case are in an extremely desperate state. It is of no value to be an accurate homoeopathic prescriber and still lose the patient because we have not replaced lost fluids or used other methods that will keep the patient alive along enough for the homoeopathic remedy to work.
DR. HARVEY FARRINGTON: It is worth coming all the way from Chicago, or even from the West Coast, to hear this paper. This disease seems to be a new one, although it may have occurred in the past and was not recognized. It has certainly puzzled the old school pediatrician. Doesnt it seem a crime that the only treatment he has thus far devised is the starvation of the infant, and just when it is most in need of nourishment? On looking back, it occurs to me that I may have cured two or three cases without knowing what the disease was. While still in general practice and delivering babies, I had several cases with symptoms that very much resembled the syndrome of epidemic diarrhea, and none of them died. In fact it is more than thirty years since I signed a death certificate for an infant or a child under sixteen years of age. One case recently came under my personal notice.
It was daughter of a patient of mine, born prematurely in a hospital in Louisville, Kentucky. It apparently recovered under the starvation treatment, but had a second attack and died. They told the mother that a second attack was always fatal. Out of seven cases, including this one, only two babies lived, and one of them was taken out of the hospital, when it was learned that the epidemic had started. No other system of medicine could do what Dr. Griggs did with his little sugar pills.
DR. WILLIAM B GRIGGS. (closing discussion): I want to tell Dr. Farrington I have seen all types of diarrhea, and the infant was very much debilitated when it got the attack, but easier to cure and more of the pattern of the original picture as described that is, not with watery, explosive stools. These children have looked wrinkled and old, and so forth. They were being fed barley water for twenty-four or thirty-six hours. I watched the intestinal flora and the chemistry of it. If I have an acid stool. That is really scientific infant feeding, the kind I learned at the Finkelstein Clinic in Berlin, and those men knew their chemistry and their work.
Thank you very much!.