A TREATISE ON THE PHYSICAL AND MEDICAL TREATMENT OF 
WILLIAM P. DEWEES, M. D. 
ADJUNCT PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF PENNSYLVANIA; MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, AND OF THE PHILADELPHIA MEDICAL SOCIETY; LECTURER ON MIDWIFERY, &C. 
THIRD EDITION, WITH CORRECTIONS, &c. 

PHILADELPHIA: CAREY, LEA & CAREY—CHESNUT STREET. 1829. 


EASTERN DISTRICT OF PENNSYLVANIA, to wit: 
BE IT REMEMBERED, that on the sixth day of November, 
(L. S.) in the fifty-first year of the independence of the United States of 
America, A. D. 1826, William P. Dewees, M. D. of the said 
district, hath deposited in this office the title of a book, the right whereof he claims as Author, in the words following, to wit: 
" A Treatise on the Physical and Medical Treatment of Children. By Wil* liam P. Dewees, M. D. Adjunct Professor of Midwifery in the University of Pennsylvania; Member of the American Philosophical Society, and of the Philadelphia Medical Society; Lecturer on Midwifery, &c. Second Edition, with Corrections, &c." 
In conformity to the act of the Congress of the United States, entituled, " An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned," and also to the act, entitled, "An act supplementary to an act, entitled, * An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies during the times therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." 
D. CALDWELL, Clerk of the Eastern District of Pennsylvania. 
BKEBRETT —NINTH STREET, THILADELrHIA. 


TO 
THOMAS C. JAMES, M. D. 
PROFESSOR OF MIDWIFERY 
IN THE UNIVERSITY OF PENNSYLVANIA, 
THIS WORK 
IS MOST RESPECTFULLY, AND AFFECTIONATELY INSCRIBED, 
HIS FRIEND, 
THE AUTHOR. 
Philadelphia, "> August, 1826, 5 




TABLE OF CONTENTS. 
BOOK I. 
PART I. 
Page, 
III. Of Exposure and " Hardening" - 133 
II. Of Fashion 131 
Sect. I. Of Temperature - 128 
II. Of the Air - 118 
III. Of the Necessities of the Child - 117 
II. Of Sleep 115 
Sect. I. Of Crying 113 
Chap. I. First Period 112 
PART II. 
XVIII. Of the Nursery 100 
X VII. Recapitulation of the Instructions given to the Female during Pregnancy, Labour, and Confinement, as well as Rules for the general Management of the Child during the Month 95 
XVI. Of the Duties of the Mother after the Month - 88 
XV. Of Observances towards the Mother during the Month 85 
X IV. Of Feeding the Child in the Month - - - 81 
V. Of Changing the Child - - 80 
IV. Of the General Dress of the Child 75 
III. Of the Belly-Band 72 
II. Of the Dress of the Child - - 65 
XIII. Of Dressing the Child ib. Sect. I. Of Washing - 62 
XII. Of Moral Injuries 61 
XI. Of Physical Injuries to the Child - - - 54 
X. Of the Mother Suckling her Child - - - 48 
IX. Of the Treatment of the Nipples ... 46 
VIII. Observations enforcing the foregoing Rules - 41 
VII. Of Conduct during the Month - - - - 39 
VI. Of the Conduct to be observed during Labour - 37 
V. Of the Food proper for Pregnant Women - 34 
IV. Of the Indulgence of Temper - 33 
III. Of the Influence of the Imagination - 26 
II. Of the Conduct of the Mother during Pregnancy 17 
IV. Of the Immediate State of Health 14 
III. Of Predisposition to Disease - 13 
II. Of Constitution - - - - 12 
Sect. I. Of Period of Life ... ib. 
Chap. 1. Of Marriage 9 


VI 
TABLE OP CONTENTS 
Chap. III. Of Food 142 
Sect. I. Causes which may render it improper for the Mother to suckle her Child 143 
IV. Of the Meconium, and its Management - 144 
V. Of the Proper Nourishment for the Child - 151 
VI. Of Partial or Artificial Nursing - - - 153 Sect. I. First Means, or where the Mother 
Suckles her Child - - - 154 
II. Second Means - - - - 162 
III. Third Means 172 
VII. Second Period. Of Weaning - - - 184 
Sect. I. On the Part of the Mother - - ib. 
II. On the Part of the Child - - 187 
A—Of the Teeth - ib. B— Of the Child's Health - - 189 
III. Of the Season of the Year - - 190 
VIII. Of Teething 193 
Sect. I. Of the Phenomena of Teething - 196 
II. Of Second Dentition ... 200 
IX. Of the Food Proper after First Dentition and Weaning 203 
X. Are there Substances in common use, absolutely hurtful to Children? 212 Sect. I. Of Fruit in general, and of Fresh 
Fruits - - - - - 214 
II. Of Dried Fruits - - - - 218 
XI. Of Exercise - 219 
Sect. I. Of carrying in the Arms - - 220 
II. Of Walking .... 224 
III. Of other Modes of Exercise - - 226 
A— Riding in a Carriage - - 227 
B— Riding on Horseback - - 228 
C— Of Games and Exercises of various kinds - 229 
V—Dumb-Bells - - - 231 
XII. Of Bathing, and Cleanliness - ib. XIII, Of Dress 241 
Sect. I. Of the form of the Garments - ib. 
II. Of the Quantity and Quality of Clothing 242 
PART III. 
Chap. I. Observances from Second Dentition to Puberty 246 


TABLE OF CONTENTS. 
VII 
BOOK II 
Sympathetic - - - - - 351 
Idiopathic - 350 
XXVI. Of Fomiting ------- 349 
XX V. Of Constipation - -347 
XXIV. Of Incontinence of Urine - 345 
XXIII. Of Diabetes - - 344 
XXII. Of Adhesion of the Labia Pudendi - 342 
XXI. Of Abscess within the'Ear - 340 
XX. Of Abscess of the Hip Joint - - - 337 
XIX. Of Inguinal Hernia 336 
XVIII. Of Umbilical Hernia ----- 334 
XVII. Of Hydrocele ib. 
Tliird Situation - - ib. 
Treatment in the First Situation - - ib. Second Situation - - 333 
XVI. Of Ulceration or Imperfect Healing of the Navel 332 
XV. Of Bleeding from the Navel String - - 330 
3. Of the Swallowing of the Tongue, and Haemorrhage ib. 
2. Of the original Conformation of the Fraenum, rendering the Tongue too short - - 328 
1. Of the adventitious Tying of the Tongue ' ib. 
XIV. Of Tongue-Tie 326 
Of Sore Ears - - - ib. 
5. Candidus - 324 
4. Volaticus - 323 
3. Albidus - 322 
2. i Intertinctus ib. 
1. Strophulus Confertus - 320 
A—-Crusta Lactea ... ib. B— Tooth Rashes - - - S19 
Sect. I. Of Eruptions - - - - 313 
XIII. Of the Diseases arising from Dentition - - 312 
. XII. Of Dentition 303 
XI. Of the Inflammation and Swelling of the Breasts of new-born Children 302 
X. Of Ulceration of the Mouth 300 
IX. Of Ophthalmia 295 
VIII. Of Colic 292 
VII. Of Aphthae - 284 
VI. Of the Retention of Urine 282 
V. Of Erysipelas 275 
IV. Of Jaundice 271 
III. Of the Meconium - - - - - 269 
II. Of Syncope, or Fainting 264 
page. Chap. I. Of the Want of Respiration - - - - 257 
OF THE DISEASES OF CHILDREN. 


VIII 
TABLE OV CONTENTS. 
Page. Chap. XXVII. Of Diarrhcea - - - - - 355 
Sect. I. Feculent .... ib. 
II. Bilious - - - - 362 
III. Mucous 368 
IV. Chylous 369 
V. Lienteric - - - - 371 
VI. Chronic Form of Diarrlwea - 376 
VII. Of the Treatment 387 
XXVIII. Of Cholera Infantum 395 
XXIX. Of Whooping Cough - - - - 408 
XXX. Of Cynanche Tonsillaris - - - 427 
XXXI. Of Cynanche Parotidsea, or Mumps - 431 
XXXII. Of Croup 434 
XXXIII. Of Worms 458^-- 
XXXIV. Of Scarlet Fever - - - v - - 476 
XXXV. Of Measles 484 
XXXVI. Of Nettle Rash - - - - - 493 
XXXVII. Of Burns -497 
XXXVIII. Of Prolapsus Ani 501 
XXXIX. Of the Whitlow 504 
XL. Of Discharges from the Vagina - - 506 
XLI. Of Scurfness of the Head ... 507 
A Translation of the Prescriptions - - 510 
A Glossary for explaining Technical Terms 513 
Index 517 


PREFACE. 
We thought it would be useful, before we treated of the diseases of children, to give a summary, of the physical treatment proper during the period of childhood. This subject is almost new in this country, though deserving of so much consideration. In treating this important part of education, we have consulted some of the best authorities, as well as endeavoured to make our own experience useful. We have tried to avoid speculation, by appealing to experience, and to reason; and have not permitted ourselves to be seduced into the diffuseness of Jean Jacques, nor to rest contented with the limited, though generally correct views of Faust. We have endeavoured to condense within as narrow a space as appeared consistent with perspicuity, most of the important points, which reason has dictated, or experience has sanctioned. 
The physical treatment of children, in its details, is almost infinitely varied; for custom, prejudice, and speculation, have imposed regulations, which in their extent are neither sanctioned by reason nor experience. The first declares its influence, by the perpetuation of restraints upon the body and limbs of the passive child, who suffers itself to be moulded to the form, which caprice, or hypothesis judges best for its future health, or proportions— hence, the unnatural practice of "swaddling. " 
We cannot but regard the now almost universal banishment of swathes, and stays, as one of the greatest improvements in modern physical education. This unnatural practice, will by and by, be looked upon as "a tale of the oldei) time," when fable usurped the place of truth; and we are not certain that we shall obtain belief, when we declare, that even in Great Britain, this custom was almost universal, half a century ago. Dr. Buchan informs us, (Advice to Mothers, p. 108,) that he was very instrumental in abolishing this cruel and absurd practice. His Inaugural Disser- 



X 
PREFACE. 
tation was upon this subject; and when he recommended a loose and easy dress for children newly born, he had not only to contend against the force of custom, and the stubbornness of prejudice, but also against the opinion of the "Medical Faculty of the University of Edinburgh," itself. 
It may not be amiss to state, for the information of those who have heard of " swaddling," but who know not its meaning, that this practice, consists in entirely depriving the child of the use of its limbs, by enveloping them in an endless length of bandage, and make them not unaptly resemble billets of wood. By this means, the skin is sometimes excoriated; the flesh compressed, almost to gangrene; the circulation nearly arrested, and the child left without the slightest power of motion. 
Its little waist is surrounded by stays of such stiffness, and such strictness of application, as to forbid flexion, either backward or forward, or indeed motion of any kind. Its head is compressed into the form the fancy of the midwife might suggest; and its shape maintained by properly adjusted pressure, by means of bandages. In fact, the talents of the midwife were estimated at this time, by her dexterity in the application of swathes, rather than by her professional acquirements. When the child is completely dressed in its bandages, it resembles but too nearly the form of an Egyptian mummy; and like its prototype, may, it is said, be thrown any where, since the swathing protects it from injury from this rudeness. In a word, it has no resemblance to any thing living; its frequent, but unavailing cries alone, determine it to be human. 
The second shows its power, in the almost entire conformity to usage, though a more rational mode is constantly presented for imitation; —hence, the continuance of customs, however pernicious and preposterous, by foreigners, among those who are more rational in their habits and manners. 
The third, from pre-conceived notions, prescribes rules, for that which it would be desirable to attain, rather than that which is practicable; hence the many Eutopian notions of Jean Jacques Rousseau. It would therefore seem, that this important part of education, consists rather in usage, than in regulations based upon reason and experience; for were these to be the foundation, 


PREFACE. 
XI 
much less difference would be found in the education of children than at present exists. 
The education we are now considering, consists in the development of the physical and moral powers of man; consequently, that scheme which does this in the most perfect manner, must be best—but much discrepancy prevails, in what this scheme shall consist. Wc make no pretensions to originality; nor shall wc boast of any superiority, in our present endeavour, over the systems which have gone before us: we only hope, that the result of long observation, and experience, will not be altogether unavailing. 
It will be seen by the arrangement of our subject, that it is our opinion, that the physical treatment of children should begin, as far as may be practicable, with the earliest formation of the embryo; it will therefore necessarily involve the conduct of the female, even before her marriage, as well as during the period of pregnancy. It will also be obvious, that the various contingencies which may affect her, as well in health, as in disease, must also exert an influence upon the foetus. To the mother then, we have addressed a few directions, that she may be enabled to contribute to the healthful stamina of the child, about to be born. 
We would not however say exactly with some, that every man is nothing more, nor less, than that which his mother has made him; nor that to her care alone is he indebted for a vigorous constitution; nor to her neglect, must he solely attribute a feeble frame; yet we dare advance, that very much depends on her to ensure the one, or that the other shall not be inflicted. 
To ensure the first of these objects, and to prevent the other, it would seem evident that the woman herself must possess health; and at all times to preserve this, is not only highly desirable, but it becomes an imperious duty, if she have a suspicion she is about to become a mother; for now she has committed to her trust the future welfare of a being, to whom she should be united by the most tender and endearing of ties. 
Let her then in early life convince herself, that an awful responsibility is attached to the title of "mother;" and that if she enter into holy marriage with heedless haste; and without weighing the nature and importance of the duties she voluntarily im- 


PREFACE. 
XII 
poses on herself, she will but too certainly discharge them without pleasure, if not with reprehensible neglect. 
As the influence of the maternal constitution upon the embryo must be admitted, we have thought it proper to suggest, how much a woman owes it to herself, as well as to society, that she enter not on marriage while she labours under such disqualifications as shall be sure to entail debility, or disease upon her offspring; we have therefore directed our first chapter to this object. 
In such horror did the ancients hold such marriages, that under the pretext of serving the public weal, the offspring were often condemned to death, without feeling or remorse. 
The cruel and severe laws of Lycurgus, forbad the parent to take charge of his child, or to educate him according to his own fashion; it was always submitted to the inspection of a jury of elders, whose decision was final. Should the child be found lively, robust, and well-shaped, it was maintained at the public expense, and had a certain portion of the public wealth assigned it; and from that moment, it became hereditary property; but if on the other hand, it were found feeble, deformed, or crippled, it was consigned without mercy or hesitation, by the same power, to death, by throwing it into the Apothetes. 
There is no fact better established, than, that the stamina* of offspring, almost exclusively depends upon the good health of the parents; and that upon the original healthy dispositions of the child will the success, of well directed physical education very much depend; for upon the judicious application of physical agents, healthy development takes place; and by their misapplication, the soundest stamina may be converted into neverending debility, or pitiable helplessness. 
How important then is good conduct, both before and after marriage, to the formation of healthy stamina. And, how especially essential and proper, are certain observances of the mother during pregnancy, that she may ensure desirable dispositions to her infant; at least so far as she is capable of imparting them during that period. And, on the other hand, how reprehensible is that heedless selfishness of a mother, who, for a momentary gratifica- 
* We employ this term in the singular, from usage, and not from the rules of grammar. 


PREFACE. 
XIII 
tion, neglects the opportunity of imparting health and vigour to her offspring! 
To constitute a mother, in the best sense of the term, much more is required than giving birth to progeny—it requires qualities both rare and estimable; it exacts a patient endurance of fatigue, and anxious solicitude, as well as a submission to privations, which nothing renders supportable, but that love of offspring which a kind Providence has so generally, and so deeply implanted in the female heart. Thus the toil and danger of childbirth ; the fatigue and anxiety of nursing, and the responsibility of education, exclusively for a time devolve upon the female; can the attempt then, to diminish the first, to relieve the second, and divide the third, be unacceptable? 
Is it not both unfortunate, and unjust, that the responsibility and care of early education should so exclusively devolve on the mother? For it is every way sufficiently severe upon her to superintend the concerns of her establishment, if it be an object that these shall be well and economically managed, without the burden and perplexity of educating her children. 
It is time then, that some changes were made, which would tend to the relief of the overburdened mother; and this can be most profitably done, by the father partaking in this arduous and interesting duty. This would not only contribute to the relief of the mother, but would command a conformity from the child, that would be highly useful, to its future welfare. 
Besides, the father from his education, and studies, is for the most part better qualified to direct and enforce, a proper system of physical education. But unfortunately at present, every thing connected with the nursery and education, " is voted a bore," by the modern fine gentleman; and the physical treatment of his children, is a duty he would feel almost disgraced to perform. Not so felt a Cato, an Augustus, a Henry the 4th, or a Montaigne: they felt it worthy of their most serious regard. 
The table of contents will nearly explain our plan; we have commenced with considerations on marriage; we have given directions for the conduct of the mother during pregnancy, labour, and the month of confinement; pointed out what is proper for the child during that period; attempted to convince the mother it is her duty to suckle her child; or in case she cannot, what is the 


XIV 
PREFACE. 
next best course; considered what is the best method of clothing, dressing, feeding, and exercising the child; explained the nature of our atmosphere; shown in what its purity and its deterioration depend ; in a word, we have attempted to determine the influence of physical agents upon the constitution of the being, from its embryo existence, to that state of development, called puberty. 


OF THE PHYSICAL TREATMENT OP 




OF THE PHYSICAL TREATMENT OF CHILDREN. 
BOOK I. PART I. 
CHAPTER I. 
OF MARRIAGE. 
i. Before we detail the duties of the married woman, either as regards herself, or the treatment of her children, we feel it proper to say a few words upon the subject of marriage, as it must have a strong bearing upon the health of offspring. We shall consider this subject under the following heads—1st, the most proper period to both sexes for its consummation; 2d, the respective constitutions of the individuals; 3d, their disposition to disease; 4th, their immediate state of health. 
Sect. I.— Period of Life. 
2. It is notorious, that the development of the body is successive, and requires a definite period for its completion; consequently, certain functions, cannot be performed in the best manner, until the body has acquired its full development—this rule applies as well to the female, as to the male. It is also familiar to observation, that when any viscus is prematurely or inordinately urged to action, that it is followed by the imperfection of the product dependent upon the part thus stimulated, as well as entails upon the organ so exercised, debility, if not premature decay. 
3. From this it will follow, that too early marriage is never to be advocated; since, it will materially influence the health, 
[2] 


10 
OF" MARRIAGE. 
and well* being, of offspring. This fact is no less in the inferior animals, than it is certain in its consequences in man. We would therefore not only say, that marriage should not take until the body is healthily and completely developed, but also, that there should have been on the part of the male, the most scrupulous continency, that the great, object of marriage, (the propagation of healthy children,) should not be defeated: this cannot be too strongly insisted upon, however '4 little it may be availing. The female is always supposed to be so. 
4. It would be difficult to fix rigorously the period by years, at which the body becomes fully expanded: since, original stamina, physical and moral education, climate, mode of life, &c. will have their influence; but we may with much certainty fix it in this climate, at between the twenty-third and twenty-fifth years, for the male; and from the nineteenth to the twenty-first years, for the female. We are informed by Tacitus, that the ancient Germans never married until the twenty-fourth or twenty-fifth year of their age, and were as continent before its consummation, as the females, to whom they were united; in consequence of which, they acquired a size and strength, that excited the astonishment, of even the Romans. 
5. It has frequently excited the surprise, as well as provoked the reproach of foreigners, that the females of this country lose their beauty so early; especially, when compared with the females of Europe, and particularly those of Great Britain. The cause of this hasty decay must be principally sought for in our very early, or rather premature marriages; but we confess that climate has also a decided, though a limited agency. And though we are far from discouraging early marriages, yet we are decidedly against premature ones. By early marriage we'would wish to be understood, such as may take place so soon as the body has received its final expansion; and that time, we have just fixed, as a general rule, at nineteen, or a little more, for the female; and twenty-three, and a little upwards, for the male. By'premature ones, we mean those which happen before the systgm has re r ceived its ultimate development, be this period when it may. 
6. It will readily be seen, that no precise or absolute rules based upon the lapse of years, can be laid down; since the 


11 
PERIOD OF LITE. 
bodies of both males; and females, may be precociously expanded, or may 4)e unusually retarded. In the first instance, the period we have assigned may be anticipated with safety; but in th'e second, it would be wise to extend it. Thus, oftentimes in India females become mothers at ten; while in Lapland they rarely give evidence of womanhood until eighteen; consequently, the women of India would be on the wane, did they wait for the limit at which it would be proper for a Lapland woman to marry; and the Lapland woman could not support the contingencies of marriage, did she attempt to regulate it by the usage of India. 
7. consequences resulting from precocious unions in this country, are familiar to every body—they are not limited to the diminished vigour,* and-shortened life, of the male ; nor to the faded beauty, the blastetl health, and the premature old age of the female; for they are extended to their unhappy off-" spring; on whom they have perhaps entailed a diminutive sta- debility of body, and imbecility of mind; or have handed down to them, strong predisposition t» consumption, riqkets,* scrofula, &c. It is therefore of the utmost consequence that parents do not consign their children to inevitable ill health, by consenting, or sometimes by urgingthem to too early marriages; and on the part of the children themselves, that they do not yield themselves up to almost inevitable destruction, (especially the female,) by anticipating the eligible moment for marriage consummation. 
8. We are however strong adVocates for early marriages, (agreeably to our definition of them;) we are persuaded of the importance of both their moral and political tendency; and we think they should be encouraged, wherever there is a rational expectation of both these great ends being answered. 9. The consequences of ill-assorted marriages were well known to the ancients, and were strictly forbidden by the Greek legislators; and though things have not proceeded to such length in this country, as to require the interference of the laws, it is nevertheless sufficiently common, to make a caution upon the point proper. Should no attention be paid to compatibility, the obvious and most desirable objects of marriage will be defeated, and one great source of health and longevity destroyed; 


12 
OP MARRIAGE. 
for it is a fact, no less important than well established, that a well regulated marriage, contributes largely to these two great ends. It is declared by Huffiand, that all those who have attained great age, were married even more than once, and generally at a, late period of life; and that there is no instance of a bachelor attaining a great age. We may give two remarkable instances of longevity, where marriage was often repeated: one in Thomas Parr, of England, who attained to one hundred and fifty-two years, and was married several times; and the other in De Longville, of France, who lived until he was one hundred and ten years old, and married ten wives; his last, he married in his ninety-ninth year, and she bore him a son when he was in his hundred and first. 
10. It seems agreeable to all observation, that better constitutions are perpetuated to offspring by men advanced in life, where the physical powers have been well preserved by moderate and proper use, than by young men who have been prodigal of them; for it is oftentimes better to be old in years, than in constitution. 
11. Though we have said that men advanced in life may have healthier offspring than the man who too early tests his prowess, or the one who has been too prodigal of his powers, we are not advocates for the union of old age to blooming youth. On the contrary, we are entirely convinced, that none so completely fulfil their duties to society, as those who unite themselves so soon as the proper development of body, and well established health, will justify their union. Yet we are equally persuaded of the truth of what we have just observed; namely, thataman advanced m years may have every requisite firmness of constitution, to justify a union; while a young man, who may have a natural feebleness of constitution, a strong predisposition to disease, or its actual existence, or a debility from overtaxed* powers, may be altogether ineligible to such a consummation. 
Sect. II.— Of Constitution. 
A \:, V 8 " 01 al ° ne sufficient f°r the best purposes of marriage, that the body has received its final development, either on the part of the male or the female; since all the functions of the 


13 
CONSTITUTION. 
body may be disturbed, by either feeble organization, disease, or accident. When, then, the male and female, or either, has suffered in constitution, it is not to be expected they can imparl to offspring that which they themselves do not possess. Itsh° ul( k therefore always be a consideration in a marriage that both parties be of sound health and constitution. 13. We are aware in many instances it may be said, that , hale,'healthy looking children belong to parents of feeble constitution: but we must be cautious how we admit this as militating against our position; since, such appearances are by no means conclusive of the goodness of health, or the soundness of constitution. We have many times seen children of robust appearance from parents of feeble health; but we do not recollect a single instance, where such children attained an age much beyond manhood—old age was out of the question. Indeed, it would seem, in many instances, that children of such parents most frequently give an early promise of future health; but it is illusory—for it is never, or but very rarely, realized. In the early part of the lives of the children of whom we are now speaking, a rapid, but morbid, development of the body takes place; every function is inordinately performed; and when the constitution is confirmed in appearance by such a display of health, it is but hastening to decay. Let us not then be deceived by such appearances; and when we are choosing for our children, let us select such as give a rational reliance upon the soundness of their 
constitution. 
Sect. III.— Predisposition to Disease. 
14. There are numerous diseases, or rather dispositions to them, which do not show themselves for many years after birth, or until they are called into action by some exciting cause, either suddenly or gradually applied; such diseases are gout, madness, scrofula, consumption, &c. Those who may inherit such predispositions, may for many years enjoy good health; and may not be led to suspect a cause to be lurking in their systems, which, when called into action, shall but too soon destroy such flattering expectations. It therefore becomes a point of duty in parents to investigate the tendency to hereditary complaints, before they con- 


14 
OS 1 MARRIAGE. 
nect their children with those, who can give but a temporary security against the most painful, afflicting, irremediable, or suddenly fatal diseases. 
15. We hold it selfish at least, if not dishonest, for either sex to marry under such predispositions, when from the knowledge of the diseases of their forefathers, there was every reason to anticipate a perpetuation of them. Who has not witnessed the 
most deplorable consequences of such unions?—and who, after witnessing them, would not deprecate their continuance, or further propagation ? This subject is one of much importance; for some of the best interests of society are involved in it; and every one is concerned in diminishing the evils spoken of, by preventing marriages, which can promise nothing but the extension of the most dreadful diseases. We have seen but too many instances of the perpetuation of the maladies above enumerated, not to feel desirous to arrest them, by recommending the two only means by which they can be either prevented or mitigated; namely, by judicious and well assorted marriages, and a well conducted physical education. 
16. By the first means, we may stop in a great measure the hereditary transmission of predisposition, by selecting such subjects as shall be free from constitutional taint; or at least we may diminish by this plan the risk of such occurrence, if we cannot ensure exemption from it. We may also do much good by preventing altogether the union of such as may have these tendencies; or diminish the-evils in a degree, when nothing better can be done, by not admitting to this union more than one of the party who may have hereditary taints. 
By the second, much may be effected; by invigorating the general system, so as to render it less susceptible to exciting causes; by attention, while conducting this education, to strengthen the particular parts, which may be predisposed to disease. But of this, more by and by. 
Sect. IV.— Of the Immediate State of Health. 
18. By the immediate or actual state of health, we would wish to be understood, that condition of the system in which either of the above named diseases is absolutely developed. It might 


15 
IMMEDIATE STATE OP HEALTH. 
at first sight appear strange that we should notice this state of the system; as every one would seem to be apprized of it, and consequently the person labouring under it would not be considered eligible, by any one, for the married state. But this is not exactly so; as we find that every kind of artifice is resorted to, to hide this condition from those most interested in the knowledge of it—hence, the frequency of marriages, under such circumstances. 
19. Besides, it but too frequently happens, that this foreknowledge is entirely disregarded by the persons most concerned— this may arise from several causes: 1st, to a want of proper feeling for the consequences of such diseases, when extended to offspring; 2d, to a hope of an escape from their consequences, as sometimes happens; 3d, to an ignorance of their nature, and of the risk of their propagation; 4th, to a disgraceful selfishness, where fortune, or beauty, is concerned. 
20. In Europe, they have such dread of the perpetuation of these diseases, (with perhaps the exception of gout,) that the inquiry is frequently made in the higher ranks of society, before the marriage contract is signed, whether either of these diseases is actually existing, or whether the parties are liable to them by hereditary descent; and we are informed, that marriages have been frequently broken off, and even at a late period, when it was discovered, on the side of either party, that consumption, or madness, had existed, or was actually existing, in any member of the family. 
21. It is not however predisposition to disease, or its actual existence, that exclusively disqualifies the parties for marriage— or that may entail feebleness of body or mind upon offspring; for there are others, equally certain, though less notorious to common observation ; such are the habits of general dissipation, and habitual intoxication. The first appears to have most effect upon the body; the latter upon the mind—therefore, a woman should not unite herself to a man who labours under either, if it be known; and the laws should protect her by granting a divorce, if it occur after. 
22. In this country, the vice of intoxication is more common than the other; but unfortunately for the poor female, it but too often occurs only after marriage; and against this the laws make 


16 
OP MARRIAGE. 
no provision—she is then doomed, in her own person, to all the horrors which await the vice; and her children are to be the inheritors of feeble constitutions; or, what is perhaps worse, the predisposition to derangement of mind. 
23. On the part of the female, certain physical disabilities may exist, which would render her ineligible for the married state: these should neither be concealed, nor passed over slightly; since, with a knowledge of them, it would be dishonest towards the man she may marry, as well as fatal to herself. We would therefore recommend to a woman who may be deformed, to abstain from marriage, as she may purchase the title of wife at too high a price; and we would advise such as may be disposed to cancerous affections, or such as may have one in an active state, to refrain from this state, as she can promise herself no advantage from this ceremony, as regards the melioration of her disease; for with it she will linger through continued ill health and pain; become a source of misery and expense to a husband, whose patience and resources may too easily be exhausted, and thus fall an earlier victim, than from disease alone. 
24. We would also recommend the female not to put off this ceremony to too late a period of life, when she can with propriety do otherwise; unless, she be content to endure more than ordinary suffering from child-bearing, and become regardless of the pleasure of seeing her children settled in life before she leaves the world, by even the common contingency of age. Women who have passed the thirty-fifth year of life, might perhaps do best to submit to farther procrastination, and permit the period of child-bearing to pass before they marry. 
25. Upon the same principle, in part, would we caution the very young girl not to enter into this state; as she, like the woman who may have waited too long, is liable to severe suffering from labour. In the woman too far advanced, the parts concerned in parturition seem to forget in a degree their offices; while in the too young female, they have not entirely or perfectly acquired the capacity. These facts are too well known, to be disputed; and nature seems to have contended for prerogative in both instances. Shall we then become voluntarily blind, by shutting our eyes against her obvious intentions? Do not these facts emphatically declare, there is a time best fitted 


17 
IMMEDIATE STATE OF HEALTH. 
for marriage ? This time we shall fix at nineteen for the earliest, and five and twenty for the latest best periods. 
26. We do not however mean to say the period fixed for the earliest may not without any very great risk be anticipated a little; or that the second, may not safely be exceeded—we mean merely to insist, that the periods just designated are best as general rules; for it is but general rules we can lay down upon this subject. 
CHAPTER II. 
OF THE CONDUCT OF THE MOTHER DURING PREGNANCY. 
27. When we consider, the delicacy, and uncertainty, of the attachment between the ovum and the uterus in the early months of pregnancy; and the facility with which this union may be destroyed, we cease to wonder, that abortion should so frequently take place; but at the same time we are taught to acknowledge, the care that is required for its prevention. 
28. Could we excite in the female, a proper dread of this accident and its consequences, by representing to her the facility of recurrence; the difficulty of interrupting its course when a habit is established; and the terrible train of evils in its suite, we should make her careful how she incurred the immediate risk to which so severe a penalty is attached; and this effect we should probably produce without the necessity of bringing into view the numerous chronic affections to which it oftentimes gives rise. 
29. Should she however disregard the physical evils which so uniformly attend habitual abortion, and set at nought mere bodily suffering, she surely could not resist the appeal which the neglect of proper care, constantly makes to her moral sense: she should most certainly question her right to destroy the fruit of that union she is bound to hold sacred, by any im- 



18 
OF THE CONDUCT OF THE MOTHER 
proper conduct of her own, at a time when it is completely in her power to prevent abortion by the observance of a few rules, which do not require severe privations, nor any very rigid conformities. 
30. To us, who are familiar with all the consequences which follow repeated abortion, it is truly a matter of surprise, mingled with regret, that females should so entirely shut their eyes against them, and brave the evils, numerous and serious as they are, rather than submit to a properly regulated plan for the interruption of their progress, or to avoid the causes which may produce them. We have but too often seen the fairest promises of health and long life blasted, by disregarding the friendly warnings, a first or second accident of this kind has given; and we feel it an imperious duty to proclaim the nature of those evils which are sure, sooner or later, to follow, in hope it may awaken the female to a sense of her danger, and excite her to a due regard for her future welfare. 
31. To the fine lady by profession, we are well aware this appeal would be in vain; or at least, it will not challenge her attention, until her health is either about to be destroyed, or very seriously injured; or when, there is but an uncertain chance of recovery. 
32. The consequences of repeated abortion are, first; a bad state of Leucorrhoea; second, immoderate flow of the catamenia, attended very often by the expulsion of coagula; their too frequent returns; or that distressing condition of this discharge, called dysmenorrhoea, or painful menstruation; thirdly, dyspepsia, with all its terrible penalties; fourthly, schirri and cancers; besides many other evils of minor importance. The catalogue here exhibited, is not the sportings of the imagination; it has but too real a foundation, as every practitioner of experience can safely testify. 
33. To prevent the consequences above stated, (32,) the pregnant woman must scrupulously avoid; 1st, such motion as shall unduly exercise her muscles, as too long walks; especially in such weather as will endanger her falling; or as shall overheat her, as dancing in very hot weather; hastily running up stairs; lifting heavy weights, &c; 2d, all such as shall take her mind by surprise if we may so term it, as unpleasant or dangerous sights; 3d, all such as shall inordinately hurry her circula- 


DURING PREGNANCY. 
19 
tion, as heated rooms, or stimulating liquors, &c. 4th, all such as shall embarrass the intestinal canal, or too severely tax the powers of the stomach; as flatulent vegetables, too great a quantity even of proper food, or any quantity taken at improper seasons, as late suppers, &c. 5th, all such as shall give too frequent motion to the bowels; as brisk or drastic purgatives; or such as shall too much retard their motion, as the unnecessary use of laudanum, or the unnatural use of chalk, or disobeying the proper calls of nature, &c. 6th, all such as shall make too severe and partial a pressure upon the chest, and abdomen; as tight lacing, &c. 7th, all such, as shall increase the irritability of the system; as the immoderate use of strong tea, coffee, opium or other narcotics; and the too long indulgence of repose in warm feather beds; 8th, all such as shall too exclusively occupy the mind; as severe study, nightwatching, &c. &c. 
34. But let not the mother believe she completely discharges her duty; or that she gives the best possible chance to her offspring, by merely escaping from a miscarriage. In this opinion she would certainly not be supported either by facts, or reasoning; for it is well known to those who are best acquainted with the subject, that the proper circulation and nutrition of the foetus, may, by the improper or heedless conduct of the mother, be impaired, though the foetus itself may not be destroyed. Of this we have abundant proof in the cases of those who narrowly escape from this accident, and who have had repeated threatenings; therefore, it behooves her as a rational, and an accountable being, as far as possible to avoid every risk of provoking abortion. She must not flatter herself, because she has not miscarried, that she has done no injury to the fruit of her womb. How many instances can almost every mother call to mind, of offspring born feeble and emaciated, and continue to be so; or with difficulty recover; when the cause may be traced to some impropriety of conduct on thje part of the parent, or to some accident during the period of utero-gestation, which might have been prevented. 
35. We are well persuaded, that much injury has been done by the prevalence of certain vulgar errors upon this subject; some of which it may be well to examine. It has been handed down from time immemorial, that pregnancy was constantly accompanied by a plethoric condition of the blood-vessels, and that 


20 
OF THE CONDUCT OF THE MOTHER 
consequently, there was a returning necessity for blood-letting. And practice has almost constantly been made to conform to this hypothesis by the ignorant and designing, and sometimes to the very serious injury of the patient. It is, however, our deliberate opinion, that this state of fullness does not always exist; and when it does, it by no means follows, that it should always be subdued by bleeding. 
36. We are warranted by long experience to declare, that unless this plethora produce some direct evidence of a mischievous tendency, as head-ache, pain in the chest, a sense of fullness in the head upon stooping, giddiness, &c. the patient should not have recourse to bleeding, without the express approbation of the physician. And perhaps it would be erring on the safe side to say, that even where the symptoms just enumerated are present, his advice had always better be asked. 
37. To women who are in the habit of miscarrying, this proscription of indiscriminate bleeding is particularly important; especially, as it is the remedy almost universally resorted to for its relief; than which, in very many instances, nothing can be more preposterous or improper. We know ourselves to be justified in saying, it has very often produced the evil it was intended to prevent. 
38. We are happy to avail ourselves of the opinion of the celebrated Dr. Struve upon this point; and shall quote his own words. "Many erroneously imagine that blood-letting is useful during pregnancy; hence mercenary bleeders and imprudent mid wives, contribute to support that ill-founded opinion. It is however certain that venesection is a remedy which ought not to be resorted to, without the greatest precaution, as ttfc loss of blood may precipitate a pregnant woman into many dangerous diseases, and even occasion miscarriage. Instances of this kind have occurred in my own practice; and I have known ladies who have unfortunately been subject to successive abortions, because by the advice of their friends, they regularly submitted to be bled upon such occasions. On their becoming pregnant again, I warned them of the mischief resulting from this practice, and they now enjoy the happiness of being mothers."* 
* Treatise on Physical Education, p. 16& 


21 
DURING PREGNANCY. 
39. We admit without hesitation, that there is a strong tendency to fever and fullness during gestation, when there is any cause in operation which may be capable of exciting the system to unusual action, or of filling the blood-vessels in an unusual degree; and it was under this impression, that we recommended the cautions suggested above. (33) For we are fully persuaded, that for the most part, a proper observance of the rules just referred to, will very frequently render blood-letting unnecessary ; nay, nature institutes nausea, and vomiting, to keep down this excessive fullness. 
40. It must not be inferred, however, from what has just been said, that we are hostile to blood-letting—this is very far from being the case; we consider ourselves among its warmest advocates, if a necessity for its employment really exist; it is against its abuse alone, we contend. We attach great value to this operation, where there is evidence of its necessity; and believe it oftentimes capable of affording relief, where no other remedy perhaps would avail; but of this necessity the experienced and judicious physician should be the only judge; it should not be left to the decision of every old woman. 
41. From what has just been said, it will appear, that it is not our opinion, that pregnancy necessarily renders the use of the lancet proper—it is a vulgar error to suppose so: and as this remedy is sometimes resorted to solely because impregnation has taken place, and this as stated above, (35, 36, 37,) with manifest injury, the sooner this error is corrected the better. We have an hundred times refused our assent to this operation, because there was no one reason for its being resorted to, save that the woman was pregnant. Under such circumstances, it is but little in its favour to say it can do no harm—but even to this trifling recommendation, it is not always entitled; for we can most safely declare, we have frequently known it do serious, and sometimes irreparable mischief. 
42. There is another error of no less moment than the one just combated, and which should also be corrected—namely, the free indulgence of a wayward, or a voracious appetite, because the woman is pregnant; and because ? according to common parlance, she has a child within her to support. We have often heard this reason given by females, who availed themselves of 


22 
OF THE CONDUCT OF THE MOTHER 
this condition to gratify their appetites for food, without the smallest regard to consequences. Indigestion, colic, choleramorbus, and even convulsions, have been too often the melancholy consequences of such indulgence. 
43. As this error originates in theory, it may be well to examine its pretensions; and if we can show, that there is no absolute necessity for taking more food than ordinary, we shall be perhaps, more able, to do away the practice. 
44. The demands which the foetus makes upon the mother for the means of its increase, is in proportion to the time of its continuance within the uterus. Now, if we average the weight of new-born children, eight pounds, would be excessive for each.* But, we will assume it to be such; this of course will give one hundred and twenty-eight ounces; the placenta, and membranes, may yield one pound more; and the liquor amnii, as much; the account will then stand thus, 
Foetus—8lbs. or 128 ounces. Placenta, and membranes 16 do. Liquor Amnii 16 do. Total 160 ounces, or 10 pounds, 
which will make a daily average demand to be less than threefourths of an ounce, since it requires about two hundred and eighty days for the perfection of the child; now this quantity is every way too small, to require an increase of ingesta, if the quantity taken each day was absolutely, and duly weighed; since, it is well known to every one, that we habitually take more food 
* The average we have taken is excessive, perhaps, even for this country, but decidedly so for Europe.—In France, or rather in Paris, at L'Hospice de la Maternity, the following table will show a much smaller average in 7077 cases, viz. 
34 weighed from 1 pound to 1£ pound. 69 2 do. to 2\ do. 164 3 do. to 3J do. 396 4 do. to 4£ do. 1317 5 do. to 5$ do. 2799 6 do. to 6$ do. 1750 7 do. to 7i do. 463 8 do. to 8£ do. 82 9 do. to 9| do. 3 10 do. to 10J do. 
Making an average of little more than six pounds. 


DURING PREGNANCY. 
23 
into our stomachs, than is strictly required for the nourishment of the body,* and of course the woman can spare daily without the slightest disadvantage, the quantity of food necessary to furnish three-quarters of an ounce of blood to be applied to the immediate purposes of the foetus; or in other words, the woman could furnish daily this quantity of blood for the purposes of the child, without feeling the demand to be oppressive; consequently she cannot require a freer indulgence in food. 
45. Besides, what does nature herself dictate upon this subject? Let us see if she really does not solicit a reduction of the quantity of food, rather than ask for an increase of it—What happens to almost every woman very soon after impregnation has taken place? Nausea and vomiting. Now, do these not most emphatically declare, that the system requires reduction, rather than an increase of fluids? or why should this subduing process be instituted? It certainly cannot be intended for any other purpose, since it is not only almost universal, but highly important when it occurs, as it would seem to add much to the security of the foetus; for it is a remark as familiar, as it is well grounded, that very sick women rarely miscarry—while on the contrary, women of very full habits, are disposed to abortion, if exempt from this severe, but as it would seem, important process. 
46. While on our present subject, it may be thought incumbent that we should say a few words upon that whimsical demand, or " longing" for certain substances, the reality of which desire has been doubted by many. No man' of experience however, we think will for a moment deny, that during pregnancy there exists occasionally the most wayward appetite, and that, even to the extent to which it is said sometimes to urge the unhappy patient. 
* To show how very much more is taken into the stomach than is required for the purposes of the system, we will extract a note from Friedlander's L'Education Physique de l'homme, p. 130. " I was informed," says Mr. Friedlander, " by the senator Moscati, that he gave a large dinner one day, and had, as a matter of curiosity, every article of the dinner weighed; and he found that one great eater had destroyed one hundred and ten ouncesj and that an ordinary feeder had eaten eighty-four ounces." These experiments were made at Milan; but he supposes not with the utmost exactitude; but they show with great certainty, that very much more is taken, than can possibly be required for the purposes of nourishment. 


24 
OF THE CONDUCT OF THE MOTHER 
47. As regards ourselves, we are entirely convinced of its existence; though we are not altogether prepared to determine the advantages of its gratification, or the evils which might arise from disappointment. We are certainly in possession of some remarkable facts upon this head; and in many instances where it could not be construed into an attempt to procure " the good things of this world" by sinister means. If women, who are governed by this hallucination of the stomach, were always to demand the most grateful or savoury food, there might be some room to suspect the employment of stratagem. But when this morbid, and fastidious appetite, sometimes demands for its gratification the most disgusting, and forbidding articles, we must yield to the belief, of the positive existence of "longings." We pretend not to account for this peculiar condition of stomach—we know it only as an attendant upon pregnancy; and will illustrate it by detailing some remarkable instances of it. * 
48. Mrs. , when not pregnant, had a great horror of eels; but when in this situation, demanded them with an importunity not to be resisted—she therefore would not only eat them with avidity, but in large, and repeated quantities, for the first few months; she would then become indifferent to them, but not averse, until after her delivery. 
49. Mrs. , riding over a common, scented some spoiled shad that had been thrown out; she was instantly so fascinated by their odour, that she obliged her husband to take some of them into his gig; and so soon as she arrived at home, began to eat of them, raw as they were, and continued to do so daily, until they were consumed, though they were extremely offensive to every body else in the house. 
50. Mrs. , in passing through her kitchen, saw a piece of 
* We beg, however, that our opinion upon this subject may not be construed into an attempt to foster or perpetuate, that waywardness of appetite, or capriciousness of selection, of the more stimulating and piquant dishes which are so frequently indulged in by women when pregnant; we totally disclaim any design to countenance such contemptible stratagems, with a view to exact compliance from an indulgent husband, through the medium of his fears, or his affections. The desires here alluded to, have their origin in mere fastidiousness and affectation —those we believe in, arise from the absolute cravings of a distempered stomach. 


25 
DURING PREGNANCY. 
bacon skin boiling in the soap kettle; she had it taken out immediately, and she ate it with great avidity. 
51. Each of the cases above stated, with the exception of the first, was related to us by the lady herself; in the first, we witnessed ourselves the eagerness with which the eels were eaten; and received the history of this lady's aversion to them when not pregnant, from her own mouth. Of the truth of the others, we have not the slightest doubt, as the ladies were of undoubted veracity. It is true, these are extreme cases; but they go to establish the existence of this peculiar appetite, and its indiscriminate, and we may add, of the two last, filthy selections. Instances of minor enormity are familiar to every body. 
52. In stating our belief in this peculiar, and indomitable craving of the stomach, we admit nothing in favour of the popular opinion, that a disappointment in procuring the desired article, would be attended with anymore serious consequence, than would follow a disappointment of any other kind, at a period when the woman was not pregnant —it might indeed, nay it very often does, occasion sickness at stomach, a temporary loss of appetite, and sometimes vomiting; but here the evil ceases, so far as we have observed. 
53. Nor do we believe in the influence of the "imagination" upon either the form, colour, or future destiny of the child, however powerfully this faculty may exert itself during gestation— we entirely reject all the reasoning, as well as the appeals to facts, supposed to be illustrative of this wonderful influence. We have, ever since our commencement in business been attentive to this subject; and we can most conscientiously declare, we have never in a single instance had reason to believe that the imagination had exerted the slightest control upon the foetus in utero; though this is contrary to our early belief upon this subject. 
54. As we feel this to be a subject of high interest to the female, we trust we shall be excused for occupying a few minutes upon its consideration; and the more especially, as we believe, that when the mind is so tenaciously occupied upon the object of its aversion, (as we always find it is,) when an apprehension has been once excited, it may do mischief to the foetus, by impairing its pabulum during gestation, through the medium of the 
[41 


26 
OF THE INFLUENCE OF IMAGINATION 
stomach or blood vessels, or both; and hence is connected with the " Physical treatment of children." 
CHAPTER III. 
OF THE INFLUENCE OF IMAGINATION UPON THE FffiTUS IN UTERO. 
55. There is no delusion of the mind during pregnancy, that renders the woman so truly wretched, as the belief, that the imagination can exert an injurious control over the child. Should she have an ungratified longing; should she have been disagreeably surprised, or greatly alarmed; or above all, terrified by some frightful or disgusting object, she at once becomes possessed with the apprehension, that tier unborn babe will receive an injury or blemish, similar to that which had excited her aversion or caused her alarm. She dwells upon this idea with pertinacity, until she becomes almost a victim to its influence. Her nightly "imaginings" are those of horror; and the day affords no relief, as her mind teems with prejudices, which are in favour of the influence she so earnestly deprecates —and nothing but the delivery of an unblemished child can sooth her agitated feelings, or remove her long-cherished fears. 
56. The origin of this belief, it is true, is coeval with our earliest records; but its antiquity should not entitle it to the least force, when this argument alone is employed; for were this to be a rule, there would be no end to error, however powerfully combated by reason, or opposed by facts. No one circumstance connected with the history of this prejudice, has so effectually contributed to its permanency, as the successful stratagem of Jacob, to secure to himself all the " ring-streaked" cattle from the flocks of Laban, as his reward for his faithful services to his selfish father-in-law, by placing before them, when they were about to drink, "rods of poplar, and of hazel, and of chesnut tree," 


UPON THE F03TUS IN UTERO. 
27 
on which was pilled white streaks. Indeed, this may with much propriety be considered as the origin of this distressing illusion; and it certainly is one on which the sticklers for this opinion chiefly rely, when strongly opposed by facts, and reasoning. 
57. We are willing to give every credit to the fact of Laban's cattle becoming "streaked" by Jacob's scheme, that it deserves; as we may unreservedly believe in it in that particular instance, without our standing committed for the belief, that this effect continues to be perpetuated to this moment. In the case under consideration, we are of the opinion with many enlightened divines, that there was God's indirect interposition in favour of Jacob, against the crafty Laban; since, as such means would not in general produce similar effects, it is more reasonable to suppose, that he was directed, (in the plan he adopted,) by some divine intimation, and rendered successful, if not by a direct miracle, yet by the Lord's giving a new, and uncommon bias to the tendency of natural causes. " Scott's Family Bible, Gen. Chap. XXX." And this supposition is rendered still more probable, by what follows in verses 10, 11, 12, and 13, of Chap. XXXI. 
58. If then we have rendered it more than probable that the hand of the Lord was in the effect produced by Jacob's motled rods, we think that much of the feeling upon this subject should be abated, and the mind be permitted to listen to the suggestions of reason, and yield to the force of facts. 
59. To remove these apprehensions altogether from the minds of pregnant women, is perhaps impossible; so fixed are their prejudices, and so cherished are their impressions upon this subject, that it is no longer a matter of reason—it is one almost exclusively of feeling. Yet we flatter ourselves the force of this error may be diminished, though not entirely subdued, by arguments, that are based upon the solid foundations of anatomy and physiology; facts which deserve to be well weighed before they are rejected. 
60. In the infancy of medical science, the opinion that the imagination exerted an influence on the child in the womb, was implicitly received; and Hippocrates himself, assisted in the propagation of the delusion. It became not only a popular, but a 


28 
OP THE INFLUENCE OF IMAGINATION 
fashionable belief; and kings and nobles, with the hope of realizing its efficacy, acted upon the principle; and even when certainly abused by their wives, they nevertheless credited its influence. It was made use of, (honestly we doubt not, at the time,) in some instances, for the protection of the supposed innocent, against the severity of the law, or the indignation of an injured husband. Thus Hippocrates saved by his testimony a noble woman who had been charged, because she had borne a coloured child, (she and her husband both being white,) by alleging that the darkness of its colour was the effect of a picture of an Ethiopian, which hung in her chamber, and which was often the object of her contemplation. * And Soranus declares that the tyrant Dionysius, who was deformed and ill favoured himself, employed the aid of beautiful pictures, with the hope, that his wife might have comely issue, t 
61. Galen was also of opinion, that a picture was sufficient to give a corresponding appearance to the foetus in" utero. And Caelius Rhodius informs us, that Fabius Quintillian saved a woman from suspicion after she had brought forth a little negro, by his assertion, that the circumstance arose, from her taking great pleasure in viewing the picture of one in her chamber, t And it was from the prevalence of this popular belief, that Heliodorus formed the first, and we may add, one of the most beautiful novels in the world. It is called the " Loves of Theagenes and Characlea;" the latter being born white from Ethiopian parents; but the Queen her mother had often viewed, during her pregnancy, the picture of Andromeda, who was painted with a white face; the sages attributed the white colour of the child to the force of the mother's imagination. 
62. Such notions upon this subject have existed from the earliest history of the world; and such, do they continue to the present moment, with this exception; if such cases as those related of Hippocrates and Quintillian were now to be presented for judicial decision, few juries would have sufficient hardihood to attribute the effect to the force of imagination; yet some not less marvellous and extraordinary stories gain full belief, at the present day, though not entitled to credit in any superior degree. 
* Turner, p. 169. 
f Ibid, p. 170. 


UPON THE FOETUS IN UTERO. 
29 
63. The different manners in which the imagination is supposed by its sticklers to affect the foetus, are 1st, by imposing upon its skin certain resemblances to things on which the fancy has been deeply concerned, or employed; such as fruit, wine, insects, or animals; 2d, by the production of additional parts, as two heads, four legs, additional fingers, toes, &c. &c. 3d, by the destruction of certain parts; as a leg, or arm, or both; the want of a head, or hand, or foot, or lip, &c. &c. 
64. These three effects, supposed to be produced by the power of the imagination, are the only instances, or nearly so, of its influence upon the foetus. We shall therefore say a few words upon each of these heads, respectively; but first we shall consider the nature of the connection which subsists between the mother and child, that our objections to the power of the imagination, may be the better understood. 
65. Anatomy has most satisfactorily proved, that the connection between the mother and child is altogether indirect, and exists only through the medium of the circulation. It has also shown, that there is no nervous communication between them; or in other words, that there has never been detected any nervous filament of the mother, entering any portion of the foetal system. From this wise and all important arrangement, it follows, that the foetus is not subject to the various and fluctuating condition of the sanguiferous, or to the never ending changes of the nervous system of the mother; since, no direct communication exists between her blood-vessels, or nerves, and those of the foetus, to impose upon it any alteration that may take place in her system, or to render the child liable through the medium of nervous connection, to the affections of the mother. 
66. If this arrangement be such, as is now represented, and of the truth of which, there cannot be a reasonable doubt, we may ask, how any condition of the arterial, or any affection of the brain and nervous system of the mother, can have an influence, or exert a control, over both these systems of the foetus, which has no direct connection with the one, nor even an indirect one with the other? Were this arrangement between mother and child more closely studied, better understood, or more justly appreciated, we should hear much less of the influence of the imagination of the mother upon the body of her infant; and one of 


30 
OP THE INFLUENCE OP IMAGINATION 
the most agonizing conditions of the human mind would be removed from the list of evils, attendant upon pregnancy. 
67. No one, so far as we know, has determined at what period of pregnancy the influence of the imagination ceases; or in other words, at which it cannot be successfully exerted—every period of utero-gestation, agreeably to the histories given to prove the powers of imagination, seems alike liable to its control. Now, this admission proves in many instances too much; for it not only gives to the fancy a generative power, but also an annihilating one. Thus in some cases, an arm, a leg, a thumb, or a toe, is added to the child; while, in others, there is a loss of one of these parts. Who has ever detected the severed member, or part, escaping from the womb of the mother, at the birth of the mutilated child? Must this not have been observed, did the histories of such cases give a faithful relation of the influence of the imagination? 
68. Besides, it gives to this power another very extraordinary capacity; namely, the stopping of the blood, after the part has been separated from the body, or limb; for the child does not die of haemorrhage while in utero, but is absolutely born alive! We once knew an instance where there was but the stump of an arm, which at the time of birth was perfectly healed, or rather, discovered no evidence that it had ever been a wound; yet the mother, in this case, declared herself to have been frightened, at the sixth month of her pregnancy, by an impudent beggar, who was well known in this city. But what became of the lopped off arm?—what arrested the bleeding? We certainly did not discover it; nor had we any evidence that there had been a bleeding; for the child was born healthy and vigorous; and no mixture of blood was discovered with the waters. Now, we must ask again, what became of the cast off arm? or what arrested the bleeding? 
69. Again, where resemblances have been supposed to be detected, between the child and some animal by which the mother had been frightened; and this sometimes even at a pretty advanced period of pregnancy, the power of the imagination must be very wonderful indeed, since, in order that the supposed effect should be produced; it must have new modelled the head, though the bones of the cranium must have been pretty solid. Thus, 


31 
UPON THE FOETUS IN UTERO. 
Bartholine* informs us, that in the year 1638, a woman was delivered of a child in every way well shaped, except the head, which resembled that of a cat; this deformity was owing to a severe fright which the mother had received, by a cat getting into her bed. In this famous case, if the point of resemblance to the animal by which the mother may have been frightened be admitted, it must also be acknowledged, that the head of the child must have been remodelled by some plastic power of the imagination! a circumstance not to be acknowledged by reason, nor to be proved by fact—therefore this case, like many others we could cite, proves too much. 
70. We will not deny that instances occur occasionally of the perpetuation of supernumerary parts, or even marks, in certain families; such as an additional thumb, or toe, or finger, or a mole; but these cases are not the result of any exercise of the imagination—they are the mere continuance of peculiarity, such as of warts or blotches, the instances of which are numerous—but here the fancy has no agency in their production. 
71. We have been attentive to this subject, as already remarked, for many years; and commenced our observations under the full persuasion of the efficiency of imaginative influence, and abandoned it only because it could not be sustained by facts; and at this moment, we are entirely convinced that the fancy exerts not the slightest control over the form of the foetus. 
72. We may mention here with much propriety, and we wish we could hope with much effect, the opinion of the late celebrated Dr. William Hunter upon this subject. Dr. Hunter used to declare in his lectures, that he experimented in a lying-in hospital upon two thousand cases of labour, to ascertain this point. His method was as follows:—So soon as a woman was delivered, he inquired of her whether she had been disappointed in any object of her longing, and what that object was, if her answer were yes. Whether she" had been surprised by any circumstance which had given her any unusual shock; and what that consisted of. Whether she had been alarmed by any object of an unsightly kind, and what that was. Then, after making a note of each of the declarations of the woman, either in the affirmative 
* Hist. Arat. Cent. 3. Hist. 44, as quoted by Turner. 


32 
OF THE INFLUENCE OF IMAGINATION, &C. 
or negative, he carefully examined the child; and he assured his class, that he never, in a single instance of the two thousand, met with a coincidence. He met with blemishes when no cause was acknowledged; and found none when it had been insisted on. 
73. It must however be confessed, that the Dr. owned he met with one case in his private practice, that puzzled him; and he told his pupils, he would merely relate the facts, and leave them to draw their own conclusions. A lady had been married several years without proving pregnant; but at last she had the satisfaction to announce to her husband that she was in this situation. The joy of the husband was excessive, nay unbounded; and he immediately set about to qualify himself for the all-important duty of educating his long-wished-for offspring. He read much, and had studied Martinus Scribelerus with great patience and supposed advantage, and had become a complete convert to the supposed influence of the imagination upon the foetus in utero. He accordingly acted upon this principle. He guarded his wife, so far as in him lay, against any contingency that might affect the child she carried. He therefore gratified all her longings most scrupulously; he never permitted her to exercise, but in a close carriage; and carefully removed from her view all unsightly objects. 
74. The term of gestation was at length completed; and the lady was safely delivered, by the skill of Dr. Hunter, of a living and healthy child ; it had however one imperfection—it was a confirmed Mulatto. On this discovery being made, the father was at first inexorable, and was only appeased by his dutiful and sympathizing wife, calling to his recollection, the huge, ugly negro, that stood near the carriage door the last time she took an airing, and at whom she was severely frightened. 
75. Our limits do not permit us to do more ample justice to this subject, by employing additional arguments, or more numerous facts, to disprove the agency of the* imagination upon the foetus in utero; we shall therefore dismiss it; and trust to what we have already said, to awaken the woman to reason, or at least to raise in her a rational doubt of the powers of the imagination over the fruit of her womb. We must now return to our general subject. 


OF THE INDULGENCE OF TEMPER, &C. 
33 
CHAPTER IV. 
OF THE INDULGENCE AND EXERCISE OF 
TEMPER, &c. 
76. Besides the prohibitions already suggested, there remains to be considered the injurious tendency an indulgence in unbridled passion has upon the immediate, as well as the future welfare of the foetus. The immediate evils, which may result from yielding to temper, are convulsions, nervous inquietudes, uterine haemorrhage, and perhaps, abortion. Should this last not occur, the foetus may yet receive such injury, as shall impair its natural stamina, and thus entail upon it a feebleness of constitution so long as it may live. It is a remark long since made, and we believe it to be in perfect conformity with fact, that passionate, and irritable women are more prone to abortion, than those of an opposite temperament. This fact alone points out the necessity and importance of resisting those tendencies to anger, which may threaten the life of the mother, or jeopardise the welfare of the child. 
77. Nothing contributes more certainly to the safety, and future good health of the child, than cheerfulness of mind; or, at least, equanimity on the part of the mother:—this fact was well known to the ancients; and they accordingly acted upon it, by giving great attention to the little wants of the pregnant woman; removing from her all disagreeable and disgusting objects, and constantly presenting her with subjects calculated to excite admiration, or to create agreeable impressions on the mind. 
78. The ancient Greeks were firmly persuaded, that the imagination of the female had a decided influence upon the beauty of the child; hence the practice, as we have already noticed, (35) of constantly providing for the chambers of their wives, the most beautiful specimens of art; such as the figures of Apollo, Bacchus, Castor and Pollux, Antinous, Narcissus, &c. that they might dwell upon their fine proportions, with that complacency of spirit, which a beautiful object is sure to produce. And we believe, if this scheme ever had success, it was by producing a 
[5] 


OF THE INDULGENCE OF TEMPER, &C. 
34 
tranquillity of mind, rather than by any formative influence of the imagination. On this principle also, we would explain the observation of Nicolai ;* who, while visiting some of the Catholic provinces of Germany, found a number of female faces, divinely beautiful, especially, when engaged in devotional exercises; this beauty had most probably been transmitted to them by mothers, who enjoyed the calm and placid sensations, which religious exercises are wont to produce. Here then, is a powerful motive to preserve equanimity, especially in the earlier months of pregnancy; as well as to curb a rising and rebellious spirit; and at the same time, by an indulgence in innocent pleasure, to chase away the gloom too common to pregnancy. 
CHAPTER V. 
OF THE FOOD PROPER FOR PREGNANT WOMEN. 
79. It is not necessary to give in detail the articles of food which may be proper, for the pregnant woman; especially, as in general they injure more by the quantity, than the quality; a circumstance we have already adverted to, and which need not be repeated. But we must not pass over in silence the highly injurious effects of an indulgence in stimulating drinks. 
80. It is a truth, which we must not disguise, that a habit of taking too large a quantity of strong drinks is sometimes contracted during pregnancy, from a desire to overcome the unpleasant sensation commonly present at this period, by using some cordial, or tincture, of high character for this purpose. Every body is aware, how often nausea and other distressing sensations assail the poor female, particularly in the early part of her pregnancy. To remove this, the good old gossip she may chance to consult, recommends the use of the compound spirit of lavender, the essence of peppermint, noyeau, &c. which, by affording perhaps a temporary relief, is again and again re- 
* Struve. 


35 
OF FOOD. 
sorted to—the quantity is of course a little increased at each time, that the effects may be maintained; and, by and by, the disgusting habit of tippling is too certainly established. 
81. No gratification is so dangerous as this: it should be resisted, from the moment it begins to be importunate; and a deaf ear should be turned to the dangerous maxim, that " if you want it, it will not hurt you." We have more than once seen health, domestic happiness, and even reputation destroyed, by this dangerous, and insidious counsel. 
82. It must not however be imagined, that the extreme cases, just stated, are essential, to constitute its hurtful tendency upon the foetus in utero. Intoxication is comparatively a rare vice among females; yet some are too much in the habit of indulging, during the period of pregnancy, in the use of ardent spirits; and it is wrongly imagined, that any quantity this side of inebriety is in no way hurtful; than which, nothing can be farther from the truth. For every thing, that can unduly stimulate the system at this time, is highly injurious, by putting both the nervous and vascular systems in an unnatural condition; consequently, the functions, so important to the welfare of the foetus, are interfered with, or imperfectly performed—• and hence, the children of women, who over-stimulate, or become intoxicated, are always less healthy, and less vigorous, than those of mothers who observe a contrary conduct. 
83. We are persuaded, from what we have seen, that the indulgence referred to, is most frequently the result of false impressions; impressions, we should be happy to remove, by declaring to the deluded female, that she cannot, from any circumstances connected with her situation, gratify a disposition to take strong liquors, without incurring the risk of destroying her own health, and that of her child. 
84. From what has been said, it would appear, that the woman has an important duty to perform, during the whole period of utero-gestation; and that her offspring may not suffer, in either body or mind, by her imprudence, she must most carefully avoid all the causes and circumstances enumerated above. Should she entirely neglect, or but imperfectly observe the rules so important for the welfare of her child, she becomes culpable in proportion 


36 
OP POOD. 
to the neglect. She may entail a frail constitution of body, a perpetual feebleness of mind, or even fatuity itself; or by exciting premature labour, she may immolate herself and her offspring. 
85. To a feeling heart, the thought of having destroyed a child by heedlessness, must be productive of the keenest anguish; and this feeling may be permanent in its effects. We well remember an elegant, but rather a careless young lady, who became a prey, for several years, to a settled melancholy, because she had but too much reason to attribute a premature labour to her own neglect. Even after she became the mother of several children, she reproached herself for the loss of the first; and time alone blunted the severity of her self-upbraidings. 
86. Were every female during her pregnancy, to regulate her conduct, as though she were accountable for the health and intelligence of her child, it would prevent much of the mischief so constantly witnessed; for, like fruit properly so called, the child in utero requires a certain amount of care, for its preservation and perfection. 
87.* There is one more point remains to be spoken of—one that is no less common than injurious, namely, the attention which pregnant women accord to the chilling and horrifying tales of gossipping beldames. This is of general occurrence, and is extremely injurious; their stories often sink deep into the mind of the unfortunate hearer, and tinge the remaining portion of her pregnancy, with the most gloomy and melancholy forebodings. We have too often witnessed the evil tendency of this state of mind, not to warn the pregnant woman against indulging in these idle reveries—we once knew abortion very speedily incident after a tale of horror; and frequently we have known months of sleepless nights succeed these evil communications. 
88. The following case of abortion, (alluded to above,) is every way illustrative of the influence of ill-directed conversation. Mrs. , in the fifth month of her first pregnancy, complained to an aged relation, of a pain in her right side; —the old woman inquired minutely into its seat and duration, shook her head most significantly, and then said, she was very sorry to hear her complain of that pain, as Mrs. , (a lady who had died a few days before,) complained, in just the same manner, and it was 


CONDUCT TO BE OBSERVED, &C. 
37 
owing to the after-birth growing fast to the side, from which the Doctor was obliged to tear it, piece by piece, and she died immediately after. The lady aborted before the next day. 
89. Having cursorily considered, in the preceding pages, the importance of care on the part of the female during gestation, that the best possible chance may be given to the child which she is carrying, we shall merely add a few words upon her conduct, and that of her attendants, nearly at, and during the progress of labour. 
CHAPTER VI. 
CONDUCT TO BE OBSERVED, NEARLY AT, AND DURING LABOUR. 
90. It would be a gross neglect of duty, should the woman disregard certain rules, which are of high importance to her own, as well as her infant's welfare, at the period of labour. We shall therefore lay them down for her consideration, even though she may not choose to adopt them, for her government. 
91. 1st, Let her seek the best possible aid, for this anxious moment, that the nature of circumstances will permit, both aS regards her physician, and her nurse. The propriety of this advice will at once suggest itself, without putting us to the necessity of giving our reasons. 
92. 2d, Let her not be impelled, by false theories, or by bad counsel, to use too much exercise, towards the last period of pregnancy. We are aware this is not popular advice; but it is correct. For she may be assured, whatever shall produce fatigue will do mischief, by provoking premature labour. No animal, (save man,) when left to itself, at this period disregards the natural instinct: it warns them against all unnecessary motion, or exertion, and they therefore always indulge in quiet. 
93. 3d, When symptoms warn her of the approach of this important moment, let her not indulge in gloomy forebodings, nor yield to unreasonable fears for the event. But, on the contrary, 


38 
CONDUCT TO BIS OBSERVED, 
let her console herself with the reflection, that death or even an untoward circumstance is of extremely rare occurrence, when the case is under the direction of a judicious practitioner. 
94. 4th, When labour has actually commenced, let her not yield to an overweening anxiety to hasten its progress, by taking, for this purpose, improper articles of diet or drink; nor, by repeated marchings in her chamber, hope to promote her general good, by exciting more numerous, or apparently more powerful contractions of the womb. Experience has never yet confirmed the propriety of this plan; and to us, it appears every way certain that it never can. This is not the place to give our reasons, for this belief; but let it be relied upon, that it is entirely confirmed by observation. 
95. 5th, As the very efforts of labour, however successfully or quickly exerted, must necessarily tend to hurry and disturb the circulation, and thus dispose to fever, let every thing, that can possibly increase the impetus of the blood, be carefully shunned, lest it take place—therefore the woman must abstain most scrupulously from stimulating victuals or drink, during the progress of labour, under the specious, but false pretext, of supporting her strength, that she may the more successfully go through her appointed travail. Let her take the experience of others, on this point, for granted—and this declares that an overcharged stomach is always unfavourable, at this time. 
96. 6th, Let not too much anxiety be indulged, for the event; nor too much apprehension be entertained, because the period of trial is of longer continuance, than she had anticipated.—She must recollect, that the duration of labour is not absolutely under the control of any one; and, that, all things being equal, a slow parturition, especially with a first child, is safer than a very rapid one; and that eventual safety does not, in any degree, depend upon the speed, with which this process is performed. 
97. 7th, As it is taken for granted, that the woman will employ no one, in whom she has not full or proper confidence, to attend her at this important moment, let her not indulge in any opinions that may clash with those of her attendant; let her yield herself entirely to his directions, for she cannot fail to know less than her physician; therefore she is not entitled to be her directress. 


39 
NEARLY ATj AND DURING LABOUR. 
98. 8th, Let her especially guard against any gust of passion, any childish waywardness, or unprovoked fretfulness, lest the nervous system be thrown out of balance, and hysterical convulsions ensue. 
99. 9th, After she is blessed by the cries of her infant, a new series of duties immediately commences; and she must now yield implicit obedience to the directions of her medical attendant; she must have no opinions of her own, as regards her physical and medical treatment; submission is her duty, that she may be able to discharge, in the best possible manner, the important task of watching over, and rearing her offspring. To secure this power, the observance of the following rules, during her month of confinement, will be found important. 
CHAPTER VII. 
CONDUCT DURING THE MONTH. 
100. As the future health and welfare of the child, after birth, mainly depend upon the healthfulness of the mother, and her capacity to supply it with sufficient, and proper nourishment, it will follow; that this important office demands the utmost care, that she be enabled to perform this delightful duty, with comfort to herself, and advantage to her child—therefore she must 
101. 10th, Avoid all such causes, as may tend to produce or augment fever; as too early sitting up; unnecessary exposure; indulging in too stimulating a diet, and drinks; too hot a room; too much closed curtains; the exclusion of fresh air; and seeing too much company. 
102. 11th, She must aid by her own good sense, the endeavours of her physician, to prevent the accession of fever, by not permitting the nurse, as is too often done, to run counter to his directions; she must therefore carefully examine her articles of diet, that no improper or forbidden substance enter its composition, as wine or liquor of any kind, animal food, or broths, un- 


40 
CONDUCT DURING THE MONTH. 
til after the complete secretion of milk has taken place, and all risk of " milk fever," as it is called, be at an end; that is, not until after the termination of the fifth day. 
103. 12th, With a view to give the best possible chance for the breasts to perform their functions properly, and to prevent, as much as may be, the occurrence of that bane to nursing, sore nipples, she should have the child applied to them, so soon as she is sufficiently recovered from her fatigue, to permit it; and this must be repeated every four or five hours, should nothing occur to render it improper. 
104. 13th, She must not delegate to any being the sacred and delightful task of suckling her child, unless there is the most decided and insurmountable impropriety, in continuing it at her own breast. 
105. 14th, She should most scrupulously attend to the dressing and undressing of her infant, if she cannot perform these offices herself; and also pay the strictest attention to its cleanliness; not suffering it to remain either wet or soiled, under the false pretext, of making it hardy. 
106. 15th, The mother should not permit her child to be fed, while she herself can supply it with sufficient nourishment; to insure this, of proper quality, and in proper quantity, she should eat nothing, which her experience has proved to be injurious; and she should take so much exercise, in the open dry air, (so soon as her health is sufficiently confirmed to permit it,) as will contribute to the restoration of healthy action in her whole system. 
107. The rules we have just laid down, for the woman's observance, during her labour and her getting up, as it is familiarly called, may require a few remarks, to make them entirely intelligible, or to insure conformity. 


OBSERVATIONS. 
41 
CHAPTER VIII. 
OBSERVATIONS ENFORCING THE FOREGOING RULES. 
108. To the first (91) we may observe, that, in the present improved state of midwifery, the risk of labour, when properly conducted, is very much diminished. This improvement has arisen from that change of manners, which placed the care of the female almost universally, in the hands of the male practitioner; and to the latter cultivating this branch, upon correct and well founded principles; principles derived from the laws of nature, and from correct observation. 
109. The officiousness of ignorant practitioners, as well male as female, of this branch of medical science, arising either from a desire to be useful, or their supposing they can be so during the progress of a natural labour, becomes a fruitful source of immediate as well as remote evil. How many females may truly date the origin of many long-continued diseases from the improper interference and misconduct of the midwife or physician, in their first confinement. 
110. It is proper we should say a few words in defence of our second direction, (92) as general opinion is against it; but we can safely say we have both reason and experience in its favour. Towards the latter period of gestation, there is, we believe, in almost all women, an inclination to repose; or it is rather, perhaps, an aversion from exercise; this arises, in most instances, from the inconveniences which are experienced from locomotion, owing to the increased weight of the womb and -its contents; and the constant exertion, necessary to preserve the centre of gravity. Hence we find women who may have born several children, experience oftentimes much difficulty in preserving their centre, owing to the advanced position of the uterus; especially after the seventh month. Hence the disposition to a recumbent posture, as they find themselves more comfortable in it ; and hence, 
[6] 


42 
OBSERVATIONS. 
the impropriety of interfering with this instinct. Besides, a long experience is in favour of our caution; we have an hundred times seen pains of labour prematurely excited, by over-exercise, near the end of gestation: we therefore uniformly protest, when consulted on this subject, against long walks, &c. by way, as is declared, of procuring a favourable delivery. * 
111. We are not however to be considered as unfriendly to all exercise at this time; on the contrary, we frequently recommend a moderate share of it—but we earnestly caution against fatigue; and consequently, forbid exercise to an extent, that will produce it. And, if the analogy, to which we have already appealed can furnish an argument in favour of our position, we may certainly be taught a useful lesson, upon this subject, from the practice of the brute creation. 
112. The consolation afforded in our third rule, (93) is founded upon extensive calculations, made from the reports of cases from different parts of Europe, and of this country; as well as upon those of many public institutions, in which the best possible chance offered itself for accuracy: and all of these tend to show how few women now die in child-bed, except occasionally, when some epidemic influence prevails to give child-bed fever. But let it be remembered, that this exception is almost exclusively confined to Europe, as we seldom or never witness such an atmospheric agency in this country. 
113. The cautions, suggested in our fourth, (94) are the result of long and repeated experience; for no truth connected with the practice of midwifery is better established than the one that declares, as a general rule, that the preparative stages of labour, properly so called, should never be interfered with, by any attempt to hasten, or retard their natural march. When this has been attempted, the effects have ever been mischievous: therefore, the whole -discipline to which a young creature is subjected by misguided gossips, or ignorant practitioners, especially with her first child, cannot be too severely reprehended. But we must not be understood to include in our censure, the proper and well timed administration of suitable remedies, to relieve premature or inefficient pain, which frequently attack the female; especially if her domestic duties require much or constant exertion. 


OBSERVATIONS. 
43 
114 But, at the same time let it be remembered, that, in administering to real exigencies, much caution and judgment are required; and the cases, where such necessity exists, should be confided to the care of an experienced practitioner. The indiscriminate use of laudanum, the lancet, and stimulating teas and drinks, cannot be too severely condemned, or too much feared. 
115. Our fifth rule (95) is one of great importance, yet popular feeling is decidedly in favour of its violation. It is wrongly imagined, that great muscular strength is essential to the due performance of labour, and that this can only be supported, by the free use of nourishing and stimulating articles of diet; hence the common practice of urging patients to eat and drink " to keep up their strength;" and hence, the too frequent production of fever. But let us place the result of experience in opposition to it; —this declares, that relaxation is the most favourable condition of the system, for safe and speedy delivery. 
116. The sixth admonition (96) is intended to prevent despondency in consequence of protracted labour, especially with a first child. It should be constantly borne in mind, that the progress of labour is almost always slower with a first, than with any subsequent child; the cause of this peculiarity we are not exactly prepared to state; the fact is notorious, however, and should be declared to be so to the impatient sufferer; especially, when it can also be confidently declared, that there is no more danger, all things being equal, and under proper management, than with any subsequent ordinary labours. This may tend to inspire a proper confidence in the powers of nature, and in the skill of the attendant; points of much consequence, at this period of suffering. Thus needless anxiety and injurious impatience may be prevented. Rules 7th, 8th, and 9th, sufficiently explain themselves. 
117. The tenth rule (101) is intended to prevent that artificial condition of the system, termed "milk fever;" we say, "artificial condition of the system;" for such, in our estimation, it almost always is. It is found constantly to exist, where the patient has indulged in the early use of either distilled or fermented liquors, animal food, broths, too great quantities of spices, or where any of the other causes enumerated in the proscription are in operation. We could wish, that the directions, contained in the rule, 


44 
OBSERVATIONS. 
(101) may not be carelessly passed over, as "milk fever" very often leads to the necessity of pretty active medical discipline, which must necessarily retard recovery, by producing weakness, or what is oftentimes very much worse, the formation of "milk abscess," —a disease of long and painful continuance, and sometimes the cause of the entire destruction of the future usefulness of the breast itself. The child must now be robbed of its natural support, languish for want of proper nourishment, or be committed to the care of perhaps a careless or profligate nurse, who may entail upon it never-ending disease or debility. 
118. The eleventh rule (102) is an appeal to the good sense of the patient, that the directions of her physician may not be disregarded, or she become the sufferer by her own supineness. A lying-in woman is looked upon, by the ignorant nurse, as in a state of great debility; with a view to overcome this creature of her imagination, she employs all her powers of cookery, for a system, already assailed perhaps by fever or very certainly disposed to it; —fever is kindled, and sometimes, before it can be quenched, the patient entirely succumbs, or escapes with a painful and protracted convalescence. Does it not then become the duty, as well as the interest, of the patient, to co-operate with her physician, in the proper application of his remedies, and observance of his directions? It should be constantly borne in mind, that no patient runs counter to the directions of her physician, but at the risk of her health, perhaps of her life; — therefore the common boast of ignorant and unprincipled nurses, that they have "cheated the doctor," betrays at once their dishonesty and total unfitness for the duties they are hired to perform. If every woman would decidedly and firmly oppose the impudent, and dangerous practices of her nurse, when they run counter to medical counsel, we have every reason to believe it would not only abridge her sufferings, but also diminish the risks of parturition. 
119. Let it not be hastily assumed, that there is more safety in following the directions of a nurse, than those of the physician, because she may have had some experience; for it must be quickly perceived, that the calculation is much in favour of the latter, since the nurse can attend but twelve patients per annum, while the physician may visit several hundreds, in the same period; 


OBSERVATIONS, 
45 
besides, his knowledge of the laws of the human system, gives him a very decided superiority. 
120. Our twelfth direction (103) contains most important advice, and should be scrupulously complied with, if the woman would wish to avoid inquisitorial tortures, or to be enabled to render justice to her child. A neglect of the caution suggested in the article we are now commenting on, will almost certainly be followed by sore or tender nipples. When this happens, a series of evils constantly ensue. 1st, The mother suffers extreme pain, whenever she attempts the duty of suckling; this necessarily produces an extreme reluctance to apply the child to the breast: the period of its application is postponed from hour to hour, until the painful distention of her breasts forces her to compliance. But in consequence of the accumulation of milk in the milk-vessels, they become over-distended, painful, or even inflamed; so that, when the child is applied to the nipple, its attempt to empty the breast is attended with such severe pain, that the infant is almost instantly torn from it, leaving the part denuded of its skin, and perhaps covered with blood. 
121. Secondly, In consequence of the extreme reluctance the mother feels to nursing her child under such circumstances: the breasts are imperfectly emptied, and the milk becomes, as it were, stagnant; or at least it undergoes such changes, as render it improper food for the child, and it also becomes impacted in the lactiferous vessels. Accumulations are formed, inflammation is excited, and milk abscess follows. 
122. Thirdly, From the condition, in which the breasts are placed, by the unexhausted milk, the child is not only made to receive it of bad quality, but also, in an insufficient quantity; it therefore throws it up, almost as soon as swallowed; it is attacked with disordered bowels and colic, and soon becomes most miserably emaciated, when, perhaps, nothing but a fresh breast of milk can save it from an untimely grave. The evils we have here enumerated, are of frequent occurrence; and so certain are they to follow this condition of the nipples, that we declare a fact in our opinion well established, when wc say, wc have rarely seen a well nourished child under such circumstances. 
123. It follows then, that, as a sound condition of the nipples is of the first consequence to the mother and child; and as it 


46 
OF THE TREATMENT OF THE NIPPLES. 
materially influences the future health of the latter, the consideration of the best mode of preserving them, properly belongs to our immediate subject. 
CHAPTER IX. 
OF THE TREATMENT OF THE NIPPLES. 
124. In treating this subject, we shall first briefly inquire into the causes of sore nipples; and secondly, point out the best mode, with which we are acquainted, for their prevention, or cure. 
125. The removal of the skin which covers the nipple, by the application of the child's mouth in the act of sucking, is almost always owing to the milk-vessels being over-distended, and to an incipient inflammation besieging them in their course, and at the extremities which terminate and open on the extreme end of this useful little organ, and sometimes to some of these little openings being nearly, or entirely obliterated, by compression, or previous injury; thus requiring considerable,'and repeated force, to extract the milk from them. The friction, which the nipples suffer, from the attempt to draw off the milk, soon renders these parts tender; and in a short time more, the skin is entirely removed. From that moment, the woman bids adieu to all comfort, in suckling; for the child's frequent demands for nourishment, prevent their healing. 
126. Now, it would seem from the premises just laid down, if we can prevent the over-distention, and inflammation of the milkvessels; and remove the obstructions from their external extremities, we should destroy the necessity of that degree of force, which we have just declared to be the efficient cause of sore nipples; and consequently protect the woman against them. To do this, we must most vigorously enforce the rules we have laid down for the conduct of the woman immediately after delivery, and persevere in them until the necessity shall cease. 


47 
OP THE TREATMENT OF THE NIPPLES. 
127. Besides this, the patient should begin to prepare these parts previously to labour, by the application of a young, but sufficiently strong puppy to the breasts; this should be immediately after the seventh month of pregnancy. By this plan the nipples become familiar to the drawing of the breasts; the skin of them becomes hardened and confirmed; the milk is more easily and regularly formed; and a destructive accumulation, and inflammation, is prevented. 
128. A variety , of washes have been recommended for the purpose of hardening the nipples; but so far as we can learn, or have observed, they have rarely succeeded; nor can they succeed often, from their very mode of action—for it is not so much an unusual tenderness of skin that gives rise to this complaint, as the degree of force which becomes necessary to extract the milk when these parts are over-distended, or inflamed. The true theory then of prevention is, so to manage the breasts, that neither over-distention, nor inflammation, shall take place. We have above suggested, the proper mode of doing this; namely, before delivery, by the regular application of the puppy; and after delivery, by the early application of the child to the breast, and a strict antiphlogistic regimen. 
129. Professor Osiander lays great stress upon the daily use of lukewarm water and fine soap; the nipples, he says, should be Washed with them every day, for some time before delivery; by which means the hardened scarf skin, after a short time, can readily "be removed by the finger, a blunt knife, or the edge of a card. When this is removed, he recommends hardening the tender nipple by certain stimulating applications; but of which we do not approve : —the best plan, we believe, after washing, is to expose the nipples to the air for a few minutes at a time, and several times every day. 
130. It perhaps may be useful to suggest, that these important parts are very frequently injured, by compressing them too tightly against the breast, with corsets. &c. This should be guarded against with much care, by every female, whether she be married, or single; and for this purpose they should be protected, especially in the pregnant woman, by an opening in the jacket, corsets or stays, so as to leave them at perfect liberty. 
131. Some women are so unfortunately organized, as to want 


48 
OF THE TREATMENT OF THE NIPPLES. 
the nipple altogether, or to have it very short, or sunken in— such may have the inconveniences, necessarily attached to this mal-formation remedied or improved, by the early use of the puppy, or the daily drawing them out with a large tobacco-pipe. 
132. Our thirteenth rule (104) contains one of the most important injunctions we can give, or that the woman can receive; it forbids her to delegate to another, the duty of suckling her child—a duty rendered sacred both by nature and by reason—an employment, that awoke the poetic powers of a Tansillo, and aroused the eloquence of a Rousseau. 
CHAPTER X. 
OF THE MOTHER SUCKLING HER CHILD. 
133. We shall consider this subject under several of its relations:—1st, that of duty; 2d, of pleasure; 3d, as it may affect the mother's health ; 4th, as regards the health of the child; 5th, the consequences to both, when neglected; 6th, the alternatives for this neglect; and their effects. 
Sect. I.— J%s a Duty. 
134. God has declared almost in every part of his living creation, that the female for a certain time, is the natural protector of her offspring; to the human female he has been particularly emphatic, by implanting in her affections, which are rarely subdued; and by giving her an organization most wonderfully fitted for the exercise of her best, and most enviable feelings. He has given her double powers to furnish nourishment for her helpless young, lest accident should circumvent his kindest purpose; and he has so arranged their powers as to yield the wonted supply, so soon as that supply, may be necessary. 
135. Every woman feels, but all unfortunately do not obey, these powerful appeals—to the latter, and to the latter only, is it thought necessary to address arguments for the discharge of one of the most sacred of duties; and to make her if possible alive, to her own interests, and her own happiness. 


49 
OP THE MOTHER SUCKLING HER CHILD. 
136. We are truly happy to find, and equally so in this opportunity to declare, that the number of women who may stifle this strong maternal yearning, is comparatively small, and form but exceptions to the noble rule—and that it may ever continue to be so, we most devoutly pray. That such exceptions have always existed, our earliest records would seem to declare; and that the example has never had but very limited influence, we are proud to admit—for, to" the honour of human nature, such mothers have ever been the subject of the satirist's lash, and the object of the moralist's declamation. 
137. By some, this neglect has been looked upon as absolutely criminal; and by Tansillo, no distinction is made between the woman who voluntarily procures abortion, and the one who abandons her child to the care of others, and it perish; for he asks— 
" Does horror shake us, when the pregnant dame, To spare her beauties, or to hide her shame, Destroys, with impious rage, and arts accurst, Her growing offspring, ere to life it burst— And can we bear, on every slight pretence, The kindred guilt that marks this dread offence? 
She who to her babe her breast denies, The sentient mind, the living man destroys." 
The Nurse, translated by Roscoe, p. 11. 
138. In such light is the mother's voluntary abandonment of her child viewed by a stern morality—we however do not regulate our opinion by so rigid a standard; for we hold it right in this, as in every instance of imputed turpitude, to fix the grade of enormity by the quo animo; and if this be made the test, as it certainly should be, it will be found much less flagrant than it would appear at first sight; for we know, that but few mothers could be found, who would voluntarily consign their offspring to inevitable death; and we believe, when this cruel, and unnatural repudiation takes place, it is generally owing to a temporary, but morbid suspension of the social, and moral perceptions, rather than to a destruction of them; and were proper means judiciously applied, they may be recalled, and the woman restored to a healthy, and natural state of feeling. 
139. It should be made known to her who may feel a temp- 
[7] 


50 
OP THE MOTHER SUCKLING HER CHILD. 
tation from mere selfish gratification, to put away her child, that it has also been a subject of question, " whether the child, which has been voluntarily abandoned by the mother to the care of others, should owe a tie, of either consanguinity, or of gratitude to her." This doubt must be resolved by the mother herself— we shall not undertake to decide it; lest our feelings should betray a stronger bias, than should justly attach to the subject, from the hasty consideration we have given it. 
140. It would not however be rightto throw all the blame upon the mother, when she does not suckle her child; the husband is sometimes so fashionably selfish; so unnaturally studious of his own ease, or comfort; and so ridiculously vain of his wife's appearance, as to force a tender, and affectionate mother from her duty; and this sometimes even to the sacrifice of her health, as well as that of his child. In this country, this character is much more rare than in Europe; and we sincerely hope, they may never increase, either, by the contaminating influence of example, or by the destruction of social virtue. 
141. In a political point of view, this subject may well merit consideration; for the pride of birth and of blood, may justly take the alarm, if the theory of Tansillo have a foundation; for he asks—- 
" Why, midst the fellow tenants of the earth, This high respect to ancestry and birth } Avails it aught from whom the embryo sprung, What noble blood sustain'd th' imprison'd young, If when the day-beam first salutes his eyes, His earliest wants a stranger breast supplies ? From different veins, a different nurture brings, Pollutes with streams impure the vital springs, Till every principle of nobler birth, Unblemish'd honour and ingenuous worth, Absorb'd and lost, Jie falsifies his kind, A grovelling being, with a grovelling mind/' The Nurse, p. 27. 
Sect. II.— Jls a Pleasure. 
142. If we can believe the fond mother upon this point, there is no earthly pleasure equal to that of suckling her child—and if any reliance can be placed upon external signs, she is every way worthy to be believed. This pleasure does not seem to 


OF THE MOTHER SUCKLING HER CHILD. 
51 
be the mere exercise of social feeling when the mother is witness to the delight of the little hungry urchin, as it seizes upon the breast —nor from the rapturous expression of its speaking eye, nor the writhing of its little body from excess of joy—but from a positive pleasure derived from the act itself; for most truly it may be said, when 
** The starting- beverage meets its thirsty lip, 'Tis joy to yield it, as 'tis joy to sip." The Nurse, p. 15. 
143. Yet there are mothers, who voluntarily forego this pleasure, by committing their helpless offspring to mercenary nurses; or who fail not to mar it, by degrading this delightful act to a task, by reducing the periods for its performance to a rule; and even this rule, regulated by selfishness, rather than by the demands of their beseeching infant—but in yielding thus to sinister feelings, may it not be justly considered a moot point, whether such a woman should be most pitied, or despised? for she may well be asked, if by this neglect 
« she can hope to prove More bliss from selfish joys, than from social love ? 
In part, even a father, upon such occasions, knows how to feel a mother's joy, or an infant's bliss; nor would he yield them, for any price. 
Sect. III.— *fls it may affect the Mother's Health. 
144. Nature here pleads her own cause, by creating, and even perpetuating disease in the mother, who may refuse this justice to her child—she becomes liable to milk abscess in its worst form; to translations to various parts of the body; to congestions in the milk glands, which may become schirri, or even cancers. We have known in several instances long-protracted head-aches to follow this unnatural abandonment of the child, which nothing but time seemed capable of relieving. One case in particular, may be worthy of relation, as it is every way in point— Mrs. , the mother of several children, was severely afflicted with head-ache, sore eyes, and a long train of nervous symptoms, which rendered her life miserable; and for which almost every remedy had been tried in vain. 


52 
OF THE MOTHER SUCKLING HER CHILD. 
145. We attended her for these complaints at the desire of a friend; but as she was pretty far advanced in her fifth pregnancy, we could neither hope nor promise, to do much for her relief at that time, —we however commenced a very particular inquiry into the origin and progress of her disease. From this we learned that these unpleasant symptoms attacked her soon after her first confinement; and they seemed to gain ground, after each of these events, until they became almost insupportable. 
146. Immediately after each confinement, and for a short period in the month, she would experience a slight relief; but by the time her month was up, it would return with renewed force, and would leave her but at rare intervals, even for an hour. We next inquired into her habits as regarded nursing her children; and understood that she had never suckled one of them; having lost her first a few days after its birth, she dried up her milk, and was soon after attacked with the complaints just mentioned. But so far from either herself or her friends attaching any blame to the sudden repulsion of the milk, that she was forbidden by her husband, her friends, and her physician, from ever attempting this office, as she had become so extremely debilitated in their apprehension, as to render even the attempt dangerous— accordingly a wet nurse was always procured before hand; and the mother's milk as before, was prevented from taking its course. 
147. From this account, as well as from a variety of other details not necessary to mention, we were at once instructed in the nature of her disease—for it was nothing more than a plethora arising from repelled milk; for the cure of which, we proposed she should nurse the child she was then pregnant with, and to follow such farther directions as the necessities of the moment might suggest —this was agreed upon. In due time, she was delivered of a small, but apparently healthy child—the child was early put to the breast in conformity with our practice; strict attention was paid to the mother as regarded regimen, &c. during the month. Milk was plentifully secreted in due time; the child throve; and the lady never had a return of head-ache; her eyes became strong, and perfectly sound, and the whole train of nervous symptoms vanished, to return no more. These are not the only advantages of this plan—we are of opinion that the risk of child-bed fever is much diminished, 


53 
OF THE MOTHER SUCKLING HER CHILD. 
by the mother suckling her child—for the consent or sympathy between the uterus and breasts is well known; and had not escaped the observation of the sagacious Hippocrates, two thousand years ago. 
148. This case is replete with instruction to the mother, who may voluntarily abandon her infant, by showing, that a severe and protracted disease may follow what she might look upon as a safe expedient; it is full of practical importance to the physician, who may be tempted to disregard the consequences of " repelled milk." But though confessedly important, it is neither new, nor rare—for unnatural mothers, " over-tender, and fashionable husbands," and inexperienced physicians, have ever existed. Tansillo, whom we have already so often quoted, was one of the " over-tender, and fashionable husbands;" and laments in a strain of beautiful pathos, his error on this subject in the following words; after having just before described the evils which this practice might give rise to, he says— 
" Nor think your poet feigns. Alas! too well By dear experience I the truth can tell; In dread suspense, a year's long circuit kept, And seven sad months I trembled and I wept, Whilst a lov'd consort press'd the couch of wo, And death oft aim'd, the oft averted blow. Nor her's the fault—misled by fashion's song, 'Twas I deprived the mother of her young; Mine was the blame, and I too shared the smart, Drain'd was my purse, and anguish wrung my heart." 
149. It may be asked is every woman capable of nursing her child? To this we must answer, No: and when we declare it to be the duty of every mother to do so, it is to be understood only as referring to every mother who is capable of this important office. We are aware there are causes which will render this attempt neither obligatory, nor not even proper; but such cases should be carefully distinguished; and should only be considered such, when they have the sanction of an experienced physician—neither the want of inclination to fulfil one of the most important duties of female life; nor the specious pretext of feeble, or ill health, should ever be admitted as sufficient reasons for such dereliction. 
150. To the intelligent practitioner, these pretexts are of easy 


54 
OF THE MOTHER SUCKLING HER CHILD. 
detection; and to render it within the capacity of any one, he need but recollect the consequences of the judgment of Solomon, upon (we had like to have said) a similar occasion. The proposition to separate the child from the feeling mother is heard, as if it were her death knell; but by the selfish and unfeeling one, is received with decided approbation, if not with joy. Of the causes which would render it improper for the woman to suckle her child, we shall have occasion to speak under the head of " food." 
Sect. IV.— *fls it may affect the Child. 
151. As we hold it to be an indispensable duty on the part of the mother to suckle her child, so nothing but the most satisfactory evidence of incapacity, or of bad milk, should be admitted, as a reason for its neglect—but as such satisfactory evidence must necessarily sometimes exist, it follows, that the child must become an alien to its mother's bosom. In such a case, it is the exception, and not the rule that is acted upon. 
152. The arrangement made for the nourishment of the child by the secretion of milk, declares, as we have already said, a mother's duties towards it; it also forces upon us the truth, that none other can be so entirely proper as that which she is destined to furnish. If this be true, as it unquestionably is, it follows as a consequence, that the child must incur a greater or less risk whenever it is deprived of it, either by choice or by necessity; it is therefore proper that we consider the nature of that risk. 
153. The injuries which a child may receive when condemned to the care of a hireling, may be of two kinds; namely, I. Physical, and II. Moral. 
CHAPTER XI. 
I. OF PHYSICAL INJURIES. 
These may be inflicted upon the child by a deficiency of milk; by its bad quality; by a just and proper care not being paid to 


OF PHYSICAL INJURIES. 
55 
its many necessities; by the selfishness of the nurse; and by the propagation of an actual, or an occult disease. 
Sect. I.— By a Deficiency of Milk. 
154. As there cannot be any absolute security against imposition from that class of females, who hire themselves for wet nurses, there must be a constant liability to be deceived. For, as a matter of course they will answer questions in such a manner as will give the best chance to be engaged; they will therefore declare they have the greatest abundance of milk, and will offer perhaps in proof of it, a fully distended breast—you receive them under such appearances; and your child for the first, and perhaps last time receives a sufficient supply. 
155. For upon subsequent applications of the child to the breast, it is obliged to put up with a meagre fare—the woman, aware, the deception she has practised will be discovered without the exercise of both cunning and address,.has immediate recourse to clandestine feeding; and that perhaps, of the most varied, and improper kind. Under such management, the child soon becomes pained and fretful, from a deficient, and improper diet; but the fears of the mother are for a while appeased, by the nurse declaring it to be the " colic" attendant upon a change of milk. Things proceed pretty much after this fashion for some time longer; and though the child cries less, and sleeps a great deal, it does not thrive! —but on the contrary, there is a great falling off, and perhaps a severe diarrhoea is added—the mother now takes the alarm; and her physician is consulted. From the history given he suspects the true cause of the child's diminished health—an inquiry is instituted, and it eventuates in the discovery, that the nurse has not sufficient milk, and that the child has been quieted, and apparently satisfied, by the regular exhibition of laudanum!! This is not " fancy's sketch"—it is drawn from the life. 
Sect. II.— From Milk of a Bad Quality. 
156. The healthy quality of milk may be destroyed, or impaired sometimes, without its quantity being very sensibly diminished; and though the child may receive abundance, it may not be sufficiently nourished. When this happens, we find the child rejecting the milk soon after it is received; or it passes with 


56 
OP PHYSICAL INJURIES. 
rapidity and pain through the bowels. If the diapers be examined the evacuations will be found copious and watery; offensive in smell; of a light green colour, and mixed with a portion of undigested milk curd. These discharges may not be very frequent; yet so large, as rapidly to weaken the child; a proof that but a small proportion of the milk received, had been converted into nourishment. 
157. The child becomes uneasy, fretful, and very frequently disturbed in its sleep; it suddenly cries as if in violent pain, and again falls into unrefreshing slumbers. It becomes pale; its flesh is flabby; and after a short continuance in this state, emaciates suddenly and becomes alarmingly ill from diseased bowels, or disordered head. 
158. There are many causes which may give rise to this bad state of the milk—improper diet; a deranged state of the stomach; the too free use of ardent or acescent drinks; bad organization of the breasts themselves; too great age of the milk; the regular returns of the catamenia, &c. &c. 
Sect. III.— *ft Want of due Care to the various Necessities of the Child. 
159. It truly requires all the affection of even a. fond mother, to administer duly to the numerous wants of a young child—we mean here only such wants, as are really essential to its health, and comfort, and not those of an artificial kind, which a fastidious, and capricious taste, may quickly create. The cares essential to the comfort of the child, consist, in the proper and regular application of it to the breast, that it need not suffer from hunger, or be injured by too long abstinence; in a proper, and due attention to cleanliness; and in the establishment of regular, and useful habits, as regards exercise, exposure, sleep, and evacuations. 
160. It will readily be admitted, that the proper discharge of these essential points requires more affection for the child, and a higher sense of duty, than can generally be found united in a wet nurse; and it also follows, if they are all, or even in part neglected, that the child must suffer. 


OF PHYSICAL INJURIES. 
57 
Sect. IV.— From the Selfishness of (he Nurse. 
161. Mothers who are fondly attached to their children, are fully aware of the many privations they are obliged to submit to, while nurses; and they but too often feel that it requires "all a mother's love," to perform the various duties of one, without complaining, or feeling "the task, severe." It must not then be a matter of surprise, that the hireling becomes restive, and negligent, under the discharge of her multiplied cares; and the child suffer in consequence. 
162. This selfishness however may exist in different degrees; and the child will suffer of course in proportion to the neglect it may experience. One of the most common causes of neglect, is, where duty to the child, interfere with the engagements of the nurse, and thus interrupts the consummation of anticipated pleasures. Should this happen several times in pretty quick succession, she becomes soured, and will contrive that it shall not happen soon again. 
163. Nurses generally make a point to have a certain period of the day at their command; and should they find this hour repeatedly interfered with by the wakefulness of the child, they will soon have recourse to such means as shall prevent its future occurrence. We have known a number of cases where laudanum was administered for this purpose, with so much cunning, as to elude detection for a long time, even after the suspicion had been excited. In one of these instances, the wily nurse boasted to the abused parent, of her good management, in establishing so much regularity in the child's sleeping. 
164. When a nurse is determined to employ laudanum for sinister purposes, she may do it for a long time before she may be detected notwithstanding the vigilance of an anxious mother. There are moments, when she must be alone with the child; and there are stratagems, by which her purpose is effected, of which the parent never dreamed. One of the most remarkable of this kind we have met with, we will relate. Mrs. requested us to visit her infant of nine months old, which, without any apparent indisposition, had slept unusually long, and unusually sound, for two or three days. When we arrived, the child was still asleep; we sat by the side of its cradle for sometime, in or- 
[8] 


58 
OF PHYSICAL INJURIES. 
der to observe any phenomena that might present themselves. The character of the sleep was marked by that peculiarity which a practised eye, and ear, immediately ascribes to opium; and we accordingly declared it to be our opinion, that the child had taken a quantity of this drug. 
165. Both mother and nurse protested in the most positive manner, that it had not taken a particle of that medicine in any lbrm whatever—we were equally positive it had; and directed our curative plan upon this belief. Upon our next visit, the child was much relieved—it had vomited freely, and had kept a considerable quantity of rich lemonade upon its stomach, which seemed to control the influence of the, (as we supposed,) laudanum. 
166. Before we left the house, we reiterated our suspicions to the mother—she, as before, was very certain, it had taken no laudanum; and urged in support of this belief, that the nurse never had been left alone with the child for a single instant; for when she was about to leave it herself, she was sure to place a young woman in the room, in whom she had the most entire confidence; and this young woman had assured her, in the most solemn manner, that she never saw her give the child any thing whatever, with the exception of the breast. We however did not give up our first opinion, and proposed to the mother when the nurse was asleep, to make an examination of her pockets; in one of which we were sure a bottle of laudanum, would be found. At our visit the next morning, we were told by the mother with tears in her eyes, that a vial of laudanum, as we had suspected, was found in a little pocket within the other pocket, and which was made for the express purpose of holding it. Though the laudanum was found as just stated, the manner of its exhibition was still a mystery, especially as we were convinced, from what Mrs. herself said, as well as the declarations of the young woman, that the nurse had never been left alone, even for a moment, with the child. It was however now certain in all our minds, that it had been given, by some stratagem or other; and with the hope of detecting the method, we inquired of the young woman, whether she had ever seen her make any applications to her nipples, for any purpose, or under any pretext whatever? she said she had; she had seen her apply 


OP PHYSICAL INJURIES. 
59 
the mouth of a phial containing the tincture of myrrh to her nipples, every day, for the purpose as she, the nurse had said, of hardening them. The mystery was now explained—it was laudanum, and not the tincture of myrrh which had been thus ingeniously applied; and by permitting it to dry from time to time, a sufficient quantity of opium was accumulated upon the nipple, to cause the deep sleep the child was found in. 
This nurse had been permitted to visit her own child, every afternoon, when the nurse child was not awake to require her attention; she accordingly procured a regular sleep at this time of day by the aid of laudanum, that she might get abroad with certainty. 
167. The selfishness of a nurse may show itself in other ways; namely, by eating and drinking such articles as she knows will disturb the stomach and bowels of the child, but has not sufficient feeling to give up the gratification of her own appetite for its benefit. The child becomes tormented by colic, or other affections, which are only relieved, by repeated doses of laudanum, until a habit is created, which it is almost impossible to break—the consequences of such conduct are well known to every body. 
168. Again, the life of the child may be forfeited, in case of its illness, by the too free indulgence of the nurse's appetite—in many instances it is of vital importance that the quality of the milk should be altered by a change of diet imposed upon the nurse—but will the selfish woman conform rigidly to the instructions of the physician for this purpose? Tansillo decides that she will not: 
" Sick, pale, and languid, when your infant's moans, Speak its soft sufferings in pathetic tones, When nature asks a purer lymph, subdued By needful physic, and tempei'ate food 5 Say, will the nurse her wonted banquet spare, And for your infant stoop to humbler fare ? Or with her pamper'd appetite at strife, One portion swallow to preserve its life ? Self her sole object—interest all her trade, And more perverse the more you want her aid." 7%f Nurse, p. 51. 
169. But perhaps nothing displays the selfishness-of the nurse 


60 
OF PHYSICAL INJURIES. 
in such strong relief, as the tyranny with which she attempts to govern the whole house—every body, and every thing, is laid under contribution, that her wayward pleasures may be gratified —if she frown, is sullen, angry, or capricious, every thing must be yielded, that her perturbed spirit may be appeased; and her demands increase in proportion, as they may have been complied with. 
Sect. V.— By the Propagation of an active, or occult Disease. 
170. We have had many opportunities of witnessing injuries, arising from this cause, when it was too late to prevent them; nor could they have been detected at the proper moment, whatever may have been the skill of the physician, or the vigilance of the parent. Diseases of the skin, as the itch, perhaps tetter, have been so frequently propagated, as to become familiar to the observation of every body; and in two instances, we had the immediate care of those, who had received from the nurse, the most loathsome and horrible of all diseases; it was communicated not only to the children who were at the breast, but also to four older ones. 
171. These cases are not so rare as we might hope; especially on the continent of Europe. They are more rare in Great Britain, and still more rare in this country. Rosenstein, in his treatise on the diseases of children, relates, that in a respectable family in Stockholm, the father, the mother, three children, the maid servant, and two clerks, were infected with the venereal disease, by a nurse who was admitted into the family without previous inquiry into her character. 
172. How far this last disease may be communicated by merely drawing the milk of a woman who may have it in a secondary form, we are not exactly prepared to say, from our own experience—there is much testimony in favour of such a transfer; but there is much reasoning against it: but there is one concession all will be willing to make—namely, that there is a risk in employing a nurse so circumstanced. 


61 
OF MORAL INJURIES. 
CHAPTER XII. 
OF MORAL INJURIES. 
173. The moral influence the nurse may have upon the child, every body is aware of; the parent may attribute to her, almost whatever the child may become in after life. On this account, the moral habits of the nurse, are almost paramount to her capacity to afford the proper nourishment—the hero, and the poltroon ; the liar, and the man of truth; the timid, and the daring; the superstitious, and the rational; the modest, and the presuming ; the amiable, and the froward; the humble, and the arrogant; the passive, and the active—all have received the first impulse of character in the nursery. 
174. Baldini, as quoted by Struve, relates the case of a little girl of seven years old, who had an irresistible desire to drink brandy, which she had contracted by drawing the breasts of a nurse, who was an habitual tippler. If this be so, more faith may be given to the story of Nero, and his nurse, than is commonly bestowed upon it. 
CHAPTER XIII. 
OF DRESSING, &c. THE CHILD. 
175. Our fourteenth direction (105) recommends that a mother should pay attention to the washing, dressing, and undressing of her child. This advice at first sight might appear to be imposing upon her a task of great labour; but it is not so—and if it were even much more so than it is really found to be, it should nevertheless be considered as one belonging to her. She need not do the mechanical part of this important operation; but she should never withdraw her eye from her child, while it is performing. The operation of dressing properly consists, in the washing, and putting on the clothes of the child—and first, 


62 
or DRESSING, &C. THE CHILD, 
Sect. I.— Of Washing. 
176. There must necessarily be a period at which the mother's absolute presence cannot be expected at the washing of her child; but there is none at which she cannot make her wishes known upon this point of discipline. But as young mothers are rarely well instructed upon this point, we shall offer a few rules, which she can either adopt in their full extent, or so modify, as may best suit her particular case, or as future experience may suggest. 
177. The object of washing, is, to remove from the surface of the body all impurities it may have contracted, either visible, or invisible, by the aid of water and of soap. 
178. A newly-born babe has always attached to its surface, an impurity which it brings with it from its mother's womb; this substance most resembles an imperfect soft fat; it is very tenacious, and oftentimes is of very difficult removal. A question has arisen, whether this should be removed? A certain German Professor, some years ago, insisted it should be let alone, as it would in the course of a few days become dry, and peel off spontaneously—this is strictly true; but does this fact prove the propriety of permitting it to remain on the surface of the body? Certainly it does not; and for the following reasons— 
179. 1st, When this substance has not been cleansed from the body, either from careless washing, or from the difficulty found in its removal, it has always produced a very disagreeable smell. 
180. 2d, When it has been suffered to remain from any cause, it has hardened itself so much, as to give pain from its mechanical irritation. 
181. 3d, When it has been suffered to dry, it has remained in some instances so long, as to leave the surface under it, so severely excoriated, as to require particular attention, for some days. 
182. For these reasons, we are persuaded it is highly proper, that this substance should be removed from the body of the child as completely as possible, at the first washing. It is also proper to point out the best mode of doing this. Every part of the child, should be smeared with fine hog's lard, before water is applied. This being done, the child should then be carefully washed, with lukewarm water, and fine soap. The nurse will be much aided in this operation, if she employ a piece of fine flannel, or sponge. 


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instead of linen, or cotton rag, as the former attach the offensive substance much more readily than the latter. 
183. Great care should be taken to remove this substance from every fold of the skin, and especially from the joints, groins, armpits, &c. that excoriations may not follow from the omission. 
184. We italicized the words, "lukewarm water and fine soap," that we might give our opinions upon each of these means —and first, of lukewarm water. We have ever held it proper to use the water a little warmed for new born children, as the application of cold water is in our opinion too severe. Let it be recollected, that the child has been suddenly removed from a temperature of at least 98° of Fahrenheit's thermometer, to one almost at all times lower, and very often very much lower; and that this transition, has a very powerful effect upon its nervous, its muscular, and its sanguiferous systems. The first is known by the suddenness, and the violence of its cries; the second, by the very powerful contractions and relaxations of its little limbs and body; and the third, by the rapidity of its circulation. 
185. It must also be kept in mind, that warmth is a sine qua non to a newly born child; for the heat it brings with it into the world, is nothing but the heat of communication; or in other words, that which it derives from its mother; and would be very quickly dissipated, if not carefully cherished, by external means. For to acquire heat of its own, if we may so term it, requires a free use of its lungs, and the complete establishment of its circulation, for some time. Then why should its little sum of warmth be wasted in conformity to an hypothesis? for it is nothing more, when cold water is used, with a view "to make the child strong." And we will now ask for the sake of information, can any one reason be given, why a child should acquire strength by the use of cold water? We shall have occasion to advert again to this subject. 
186. We have repeatedly seen it require the lapse of several hours, before reaction could establish itself;* during which time 
* I was informed within a few days by an experienced nurse, that upon one occasion where it was insisted on by the father that the child should be washed in cold water, that the little creature did not recover its warmth for twentyfour hours, though every expedient was employed for this purpose—the washing with cold water was not repeated of course. 


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the pale, and sunken cheeks, and the livid lips, declared the almost exhausted state of its excitability. We are persuaded we have known death itself to follow, the use of cold water, for the first washing of the child. It is true, in these instances the children were born feeble, and required but little of improper management, to destroy them; but at the same time, it should be recollected, had their little powers been well husbanded, they might have been restored to good, and perfect health. 
187. Rousseau condemns the application of warm water to even the new born child; or at least he says, "warming the water may be as well dispensed with; as among many different people the children are taken immediately after their birth, and bathed in the river or sea." This appears to us an act of necessity, rather than of choice; since few, we believe, do this but people in savage life, where from their erratic habits, few opportunities are offered for this kind of ceremony. Indeed a people of this kind, rarely have the conveniences for the purpose of heating water; therefore a necessity must not be mistaken for a wise speculation, on future good health. But if this were even strictly true, what does it prove? Is there any evidence that the children thus treated, are of better health than those managed in the opposite mode? There is no such evidence; for were it even proved that the health of a people who from birth used cold water, was better, than those washed with warm, we might justly doubt whether this increase of health, depended upon this circumstance alone. 
188. Indeed Rousseau himself seems to answer this question in the negative, since he attaches so much consequence, to country life, to uniform employment in the open air, to a free, and active exercise of the body in the various duties of the hunter, the shepherd, and the farmer. 
189. We have every reason to believe, that catarrhal affections have been produced by the use of cold water, especially to very young children, from which the poor little creatures have escaped with much difficulty. Now, as serious evils may arise from ablutions of cold water; and as we have never heard it even suggested, that immediate injury has followed the use of warm, the line of conduct to be pursued, would seem to be very easy to make choice of. 
190. Some, with a view to improve the quality of the water, 


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add brandy or other liquors to it; or if they do not mingle these with the water, they very carefully wash the infant's head with some one of them, for the purpose they say of strengthening it. This practice, though not so extensively injurious as the one just spoken of, is nevertheless decidedly improper. There cannot be any possible necessity for thus violently stimulating the poor babe—thus do they "banish simplicity from even dressing a new-born child." 
191. And, 2d, of "fine soap;" this direction should be carefully obeyed; a neglect of it is sometimes attended by great injury to the child. There is a brown, and highly stimulating soap in common use, called "rosin soap," because this substance enters very largely into its composition; this, if applied in strong solution to the tender skin of a new-born child, will very frequently abrade the cuticle to a very large extent; it should therefore never be employed. It is better to wash the child with plain warm water, than have recourse to this soap. 
192. During the whole process of washing, the child should be exposed as little as possible to a current of air; and if the weather be cold, it should be dressed near the fire. 
Sect. II.— Of the Dress of the Child. 
193. The dress of the child, should always be made subservient to comfort. If this rule be acted upon, it will be found to consist, 1st, in such arrangements of it, as shall sufficiently protect it against cold; and 2d, to insure it against all inconvenient, and injurious pressure and restraint, as well as producing too much heat; therefore, the cruel practice of swaddling, should be for ever laid aside. 
194. For this absurd practice, it would perhaps be difficult to assign a reason; it probably however arose from the inroads made by rickets upon the proper form of the human limbsmistaking the effect of disease, for a defect of nature; and thus applying a partial remedy, for the morbid condition of the whole constitution. In times of ignorance, when the care of women was entirely confided to females, this injurious practice may have originated in a false theory; and it was certainly perpetuated by 
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the designing midwife. For though every child was not born with a disposition to rickets, yet it is probable that these selfish women persuaded their patients, that the limbs of all children would become so, if not guarded against by proper management. This opinion seems in part confirmed, by this practice being in a degree abolished, so soon as midwifery became generally practised by men; for we never hear of an accoucheur performing this terrible ceremony for the poor child. 
195. Bufibn says, " with us (in France) an infant no sooner leaves the womb of its mother, and has hardly enjoyed the liberty of moving and stretching its limbs, than it is clapped again into confinement. It is swathed, its head is fixed, its legs are stretched out at full length, and its arms placed straight down by the side of its body. In this manner it is bound tight with clothes and bandages, so that it cannot stir a limb; indeed it is fortunate that the poor thing is not muffled up so as to be unable to breathe; or if so much precaution be taken as to lay it on its side, in order that the fluid excretions, voided at the mouth, may descend of themselves; for the helpless infant is not at liberty to turn its head to facilitate the discharge."* 
196. Can any thing be running so entirely counter to the dictates of nature? Let us consider the poor infant folded up in the smallest convenient form in its mother's womb, for the period of nine months; and then let us watch its movements so soon as it is free; and we shall at once be convinced, by the stretching of its little limbs in every direction, how much it enjoys its liberty. 
197. Analogous to the unnatural restraint imposed upon the limbs by bandages, we may reckon the common practice of even the present day, of pinning the ends of its garments close up to the feet of the child; thus preventing all movements of its limbs. This should be guarded against, by the mother forbidding the nurse to dress the child after this fashion. If the ends of the clothes must be turned up, let sufficient room be given, for the exercise of the child's limbs. In the same way, all motion is presented to the arms by their being confined by a napkin, when the 
* Hist. Nat. torn. iv. 190.12mo. 


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child is laid down; this is done under the specious pretext, of preventing the child from scratching itself with its nails, as it cannot command the direction of its hands. 
198. It would be much more useful to the poor infant to have the use of its limbs, even at the expense of an occasional scratch from its own nails; since, by their exercise, they would become strengthened, and in a short time the child would learn to direct them properly by a gradually increasing experience. We would therefore forbid every restraint to the motion of the limbs, body, and neck of the child; and thus permit them, to exercise their little muscles in any direction, or degree, they might choose. In cold weather, the arms may be covered to encourage warmth, but they should never be fixed down. 
199. It is to this freedom of the limbs, that the child is indebted, for its increase of strength, and its eventual power to walk; and to it, does it owe the preservation of the due vigour of the antagonizing muscles. For when but one set of muscles is employed, the antagonizing set become weakened; and if too long persevered in, sometimes even useless. We once saw a child, who had been made to nurse itself almost from its birth, lose the power of the extensor muscles of the legs, by its being obliged to sit for many hours together in one spot upon a hard floor. This child could never stretch its legs sufficiently straight, to learn to walk, and died a cripple at the age of seven years. 
200. Proper attention has rarely been paid, either to the materials, or the form of the articles of clothing, for a new-born child. They have generally been made of the same kind of stuff, whether the child be born in winter or in summer—this surely cannot be required. In general, however, the error has been on the safer side; for if the child have suffered, it has rather been from an unnecessary, than from a deficient quantity of clothing. But errors of every kind, should be removed when practicable; therefore, we would not have more clothing heaped upon the child, than shall be necessary to protect it against the existing cold. 
201. This adjustment however requires much care, and should, be effected by those of good judgment, though not precisely for the reasons assigned by Dr. Buchan, who says,* that "every 
* Advice to Mothers, p. 110. 


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child has some degree of fever after birth; and if it be loaded with too many clothes, the fever must be increased, often to such a degree, from the concurrence of other causes of heat, as to endanger the life of the child. Even though no fever should be excited, the greatest debility must be the consequence of keeping the child in a state of perpetual waste by excessive perspiration. Besides, in such a condition, the child is liable to catch cold uponWposure to the least breath of air; and its lungs, relaxed by heat, and never sufficiently expanded, are apt to remain weak and flaccid for life, so that every cold will have the most alarming tendency, and probably terminate in asthma or a consumption." 
202. The Dr. has really drawn a frightful picture, of the effects of too much clothing upon a young child; but it is one, we cannot recognise from experience, nor acknowledge from theory. We admit, that should the child be so abundantly clothed, as to keep it in a constant state of perspiration, there might be a risk of its catching cold upon exposure, or becoming much weakened. But we are of opinion, if mothers should take the alarm from this representation, they might do much worse, by running into the contrary extreme; and Dr. Buchan himself would confess, too thin clothing, might be attended with worse consequences than too thick. Besides, we do not agree with the Dr. in the premises he starts with, namely, that "every child has some degree of fever after the birth." 
203. We should be very careful how we admit this position, as it would lead to very wrong practice. That a new-born child like any other individual, might have fever as an accidental circumstance, we admit; but as a necessary consequence of its birth, We deny—first, because it would seem an extraordinary arrangement of nature, that every child should be ushered into existence in a state of disease; for fever is disease; and a disease of a formidable kind: 2d, we have never witnessed this, as a sequence of birth. Therefore, withholding a sufficiency of clothing, with a view to counteract, or to not augment an imaginary disease, would, to say the least, be idle. 
204. That new-born children may be improperly dressed, and improperly managed after they are dressed, we believe, nay know; but the state of perspiration which the Dr. so much 


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dreads, is owing, we believe, almost always, in cold weather, to their being placed under too many bed clothes. On this account, we would caution against both extremes; but not because the child has fever; nor from an apprehension of the evils which are supposed to follow a state of perspiration. As this is a matter of consequence, as every truth is that is connected with the welfare of infants, we shall say a few words upon the supposed consequences of this over-dressing. 
205. The Dr. says, the child is "liable to catch cold upon exposure to the least breath of air;" this is admitted, if the child be in a state of perspiration, and be improperly exposed; but this would be the case, did the perspiration proceed from an overquantity of bed clothes; and as it would be important to determine from which of these sources the evil proceeded, it would be well to give it a fair investigation; and to ascertain if possible, to which of the causes the error belongs. Therefore, should the child be moist though exposed to the air, it might justly be attributed to a solution of fever; but if it only perspired when closely covered, we would be certain it proceeded from an excess of clothing. We have however considered it sufficiently difficult in most cases to excite perspiration upon the skin of a new-born child, by almost any means; and for this plain reason—it is some time before the vessels upon the surface become sufficiently active, and filled, or the circulation sufficiently powerful to produce this effect. Examine the skin of a new-born child, and you will find it almost constantly cold, unless well protected by clothing made of materials which are bad conductors of heat—and hence the absolute necessity of maintaining this condition by suitable means. 
206. The Dr. also says, that "the child's lungs are relaxed by heat!" If this be so, how is it possible to prevent it?—If heat be improper to the lungs, all animals that have hot blood, must be precisely in the same situation! for the Dr. would not deny that warmth is essential to the existence of man; and if this be so, the lungs, like every other internal part, must have an equal temperature, and no more; now, how a temperature, which scarcely varies a degree at any season of the year, and which is natural to the human body, and inseparable from it in the 


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living state, shall produce relaxation of the lungs, we cannot possibly understand. . 
207. He farther states, "they (the lungs) are never sufficiently expanded, and are apt to remain flaccid for life." We would ask, why the lungs are never sufficiently expanded? Because the lungs are relaxed by heat, we suppose must be the answer from the premises! Now, it would seem from this, that our notions upon the expansion of the lungs must have been wrong; since heat is unfavourable to it, by producing relaxation of them. We have often heard of, and we believe we have seen, the sudden application of cold, interrupt the full expansion of these bodies; but we had to learn, that heat could do so, by producing relaxation in them. To our mind, this relaxation, if it exist, should favour expansion, since it implies less resistance. 
20S. In winter, or even in cool weather, flannel is absolutely necessary to form part of the child's clothing; especially, their little shirts, and petticoats; but this should be of such fineness, as not to oppress either by its weight or its thickness. It should always be of the white kind, where the circumstances of the parents will permit it—not that the first cost of the white need be greater than that of the coloured, but because it will for the sake of the eye, require to be more frequently changed, as it will more readily show any dirt that may attach to it; but for this very reason, it should be employed whenever it be practicable. Another reason may also be assigned; the white can always be procured of a finer quality, which sometimes is desirable. 209. There is a very common error upon the subject of flannel, which deserves to be corrected; namely, that it can remain longer dirty, without doing mischief by its filth, than any other substance; but in this there is no truth—flannel, from its very texture, is capable of absorbing a great deal of fluid, which it will retain so long, if permitted, as to allow a fermentative process to go on, and give rise to the extrication of some deleterious gases; therefore, flannel should not be worn even so long, on this very account, as linen substances. The principal advantage in the use of flannel is, its non-conducting property of sensible heat it is therefore well calculated to protect the body against the too rapid escape of this important fluid. 


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210. Agreeably to these views, flannel should be used whenever it will be proper to accumulate heat, or to prevent its too rapid dissipation from the body; it should therefore be employed precisely in the proportion which these ends may require. But it will be readily seen, that no precise quantity can be directed, since the degree of necessity will be constantly varying as temperature may alter, or as constitution, and period of life, may change. As a general rule, it may however be observed, that the younger the child is, the more of this article may be required ; but it should never be in such quantity, as to create a vapour bath. 
211. There is another operation of flannel, that is highly valuable, especially, in this variable climate; and its agency in this respect, may be considered as one of almost indispensable necessity—it is its protecting power against sudden reductions of temperature. By virtue of its non-conducting power, the system is saved from a prodigious expense of caloric, or heat, at a time when its sudden escape might be attended with effects of the most serious kind—the advantages of flannel in this respect are familiar to every one; for every body, adopts the practice, without exactly understanding the principle on which it is founded. Again, it powerfully guards the body against the cooling effects of evaporation, when it is in a state of perspiration; and by preventing its too sudden escape, it keeps a considerable portion of heat constantly applied to the surface of the skin, by means of this vapour; and thus hinders it from leaving the body too suddenly. 
212. Flannel may also be regarded as a very pleasant and extensive "flesh-brush;" by constantly giving to the skin, a gentle and an agreeable irritation. By this means the insensible perspiration is freely maintained; while all the evils arising from a check of the sensible, are very much guarded against. 
213. It must nevertheless baadmitted, that the utility of flannel has its limits; and beyond which its employment should not be urged. Flannel may be improper, 1st, where it excites too much perspiration, as in young children sometimes, during the extreme heats of our summers—when this is observed, it should be removed, and a similar garment of muslin, or even linen, should be substituted. The flannel should however be imme- 


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diately replaced, whenever an alteration in temperature may render this proper. Indeed, the only proper direction that can be given for the dressing of children during our summers, is, to vary the clothing with the variations of the thermometer. This it is true, may occasion some additional trouble to the parent; but the observance of it, it should be remembered, gives additional security to the health of the child; for we are entirely convinced, that very young children suffer extremely, and are sometimes even rendered ill, by their bodies being too much loaded with flannel. 
214. 2d, Flannel may also be improper, from idiosyncrasy— this should be carefully attended to; as the child has been known occasionally to suffer much from this peculiarity. It may readily be detected, by the child almost constantly expressing uneasiness, without any obvious cause; and by an efflorescence spreading itself over the body, which immediately disappears so soon as the flannel is removed. 
215. 3d, Flannel may also be improper, during a febrile condition of the system; it should therefore always be removed, when it may be desirable to lower the temperature of the skin. We are well aware, that this will appear extraordinary advice to many; and there may be even strong prejudices against the practice. But we fear no reproach upon this head; as it has been justified, a hundred times, in our own practice. The fear of " catching cold," as it is called, should not prevail against it, since you cannot engraft a slighter disease, upon a stronger.* 
Sect. III.—Of the Belly Band. 
216. This useful appendage of the child's dress, should be of flannel; but it should be made single; it should be worn, until the child is at least four months old; or even for a longer period, if the child be feeble, or has a tendency to umbilical hernia. 
* It may not be amiss to suggest, not only the utility, but the absolute luxury to the child, of frictions upon its abdomen, with the bare warm hand, for a minute or two every time it is dressed. This exercise is so grateful to the little urchin, that it never fails to express its delight, by its smiles, cooings, and the stretching of its limbs. We would therefore always recommend this practice, since, it not only delights the child, but also promotes the healthy action of its bowels. 


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This article, is of great importance, and should never be omitted; but much judgment is required in its application, that it do not produce the very evils it is intended to prevent. The object of a belly band is, to give a general support to the abdomen, and a particular one to the navel. The propriety of using it for the first object, will be obvious to every body at first sight; it protects the external covering of the belly from being suddenly, and partially distended, in the actions of crying, coughing, and sneezing ; and by this means, pain or more serious evils, are prevented. 
217. But the necessity and utility of the second, if equally evident, is certainly not so well understood. The umbilical cord, by means of which, the child is nourished during its residence within the uterus, is composed of several vessels which enter into, and depart from, the belly. The passage of these vessels, requires a hole entirely through the covering of the bowels; which for the most part closes, very quickly, and soundly, after the separation of the navel. But, several circumstances on the part of the child, may interrupt this natural process; which when they happen, give great liability to a portion of the bowels, or of the omentum, to be forced through this imperfectly closed opening, by any strong and sudden conquasitory motion, such as crying, coughing, sneezing, or straining. 
218. The circumstances on the part of the child, which may give rise to, or increase this liability to " rupture" at this part, are, 1st, an unusual size of this opening, as an original conformation ; 2d, the want in the part of a healthy disposition to close; 3d, an interruption being given to the natural process of closing, by the crying, &c. of the child, forcing the intestine, or omentum, frequently against it. 
219. It will follow, that this part being weak from its very organization, it will require a steady, and continued protection, that the accident of " rupture," may not take place. 
220. For this purpose, the belly band has been used from time immemorial—but its mode of action is not well understood by those-who apply it to new-born children. It is wrongly imagined, that the tighter this bandage is drawn over the part, the greater is the security against the evil it is intended to prevent— 
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than which no greater error can exist, as will be evident to any one who may give consideration, to the following circumstances of structure, of these parts. 
221. 1st, The cavity of the abdomen may be considered as completely filled, or occupied by its contents; 2d, that the abdominal cavity is formed without any absolute outlets, or communications with the external air; but has openings leading to other cavities, as those of the scrotum in males, but into which it is not intended, as a natural arrangement, that any portion of the abdominal viscera shall enter; and also, the one already described, as existing at the umbilical ring. 
222. Now, when the capacity of this cavity is diminished, or severely constricted, as it necessarily must be by the diaphragm being forced powerfully downward; and severally pressed on all sides by the abdominal, and lumbar muscles, as must necessarily happen, in the actions of crying, sneezing, coughing, or straining, that the contents of this cavity must be constrained, and powerfully pressed, against every part, and portion of its internal face; and if there be any one portion of this surface weaker than another, that part must necessarily yield, if the force be greater than that part can sustain. It will therefore follow as a matter of course, that the scrotal, and the umbilical openings just mentioned, being naturally the weaker points in this cavity,'they will, and must yield, when the impulses just named shall be greater, than the powers of resistance. 
223. From what has been said, it will readily be admitted, that any arrangement of dress which shall diminish the cavity of the abdomen, must have a tendency to do mischief, in the way we have just pointed out; therefore the belly band may become an agent of this kind, if not properly applied—hence, it becomes an important part of a mother's duty, to attend at each dressing of the child, that the band be not too tightly drawn. 224. Evils of a lesser kind, oftentimes follow the improper application of this article of dress; namely, pain arising from compression; and colics, from the want of room for the bowels to expand. The inconveniences enumerated above, as arising from too strict an application of the belly band, suggests, the importance of this article being as elastic, as will be compatible 


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with security—we therefore would direct that it should be made of a piece of flannel cut " bias," as the women term it, in order that it may acquire this property. 
225. The disease, for which we have been suggesting a prevention, so far as improper dressing may be concerned, is of vastly more frequent occurrence, than could possibly be imagined, by any one, who had not made it a subject of inquiry; and when it takes place, is of much more serious consequence, than might at first sight be supposed: therefore to prevent it, is of the first consequence. 
Sect. IV.— Of the general Dress of the Child. 
226. The other articles of a child's dress, may be regulated in such manner as will give sufficient security against too low a temperature in winter, or as shall not oppress in summer; therefore the petticoats for winter, fall, and spring, should be made of flannel, and of such length, as shall cover their limbs with certainty. Flannel may however be occasionally useful in summer; especially, on sudden changes of the weather, and should always be resorted to, upon such emergencies; for there can be no greater error committed in dressing a child, than to regulate its clothing exclusively by the almanac, or thermometer—the feelings alone should determine the quantity, and quality of them, during either midsummer, or winter. If these be made the rule, we shall find it very often important to vary the articles of clothing, two- or three times within four-and-twenty hours. 
227. The length of the child's clothes is by no means a matter of indifference. After it has arrived at its eighth or ninth month, they should be shortened, so as to leave the feet and ancles free. By this plan, the child will use its limbs earlier and to more advantage, since they will not be fettered by the restraint of long dresses. The muscles will acquire more firmness and tone, and be more obedient to the command of the will—they will also be exercised regularly, and the flexors and extensors will have their just proportions of power; so that when the child begins to walk, it will be able to balance itself much sooner, and more successfully. 
228. Some perhaps will object to this arrangement, especially 


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in winter, from an apprehension that the feet and legs may suffer from cold—but this objection is easily removed, "by covering these parts with their appropriate garments. 
229. We are aware that this last objection, is not in conformity with some writers upon this subject—we know that stockings are forbidden by them, for two reasons; 1st, because they will injure the child, by becoming wet; and 2d, because they will make it too tender. 
230. To the first, we would declare, that upon this principle the child should have no clothing whatever, since all is exposed to the same accident!—the diapers, the petticoats, &c. should be abolished, since they must often become wet in the course of the day; yet we hear nothing of injuries arising from this source. When these articles are wetted, care is taken that they are dried before they are again used, or their places supplied with fresh articles; and why should not the same attention be extended to the stockings? As regards the second objection, the reasons we have urged against all unnecessary exposure of the person of the child, will apply here; and therefore we shall not repeat them. 
231. Shoes are condemned, because they are said, 1st, to cramp the feet, and embarrass their motion; 2d, that the child does not learn to walk so early, as when they are exposed. These are very far from being solid objections to the use of shoes, since, the first, may be removed by their being made large, and of the most pliant materials; and as they afford protection from cold, and security against accident when the child is placed upon the floor, we are decided advocates for their employment, especially, upon carpeted floors, where pins, needles, or other sharp substances, are very often effectually concealed, by their being buried in the substance of the carpet. 
232. The second objection has perhaps less force than the first, since we have ever held the opinion, that no advantage is gained, by a precocious power to walk. Indeed we hold this to be very often injurious, especially to such children as may be disposed to rickets. We shall have occasion again to mention this subject. 
233. We have said, that the shoes may be so constructed as to do no injury to the child; this is strictly true, and should always be conformed to; but the plan proposed, (we believe ori- 


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ginally, by Faust, in his Catechism of Health,) merits the attention of every parent; namely, having shoes made upon two different lasts, one for each foot, as is now pretty generally done in this city. We object very much to the advice of Struve upon this subject—he recommends children to lay aside shoes for a short period at a time, that the feet may be better expanded. This is certainly bad advice; as most children would be subjected to serious colds by this plan* if not to dangerous disease. 
234. In winter, and in cool weather, we follow the proper plan almost instinctively, as regards clothing; for we accommodate the quantity by our feelings, without regarding the state of the mercury in the thermometer. Precisely the same should be done in summer—the relative heat, or cold, should be our guide. 
235. The principal articles of clothing are to be made of fine flannel; they are generally called the under clothes; fashion, caprice, or fortune, may regulate the rest, provided the garments for the feet and legs be excepted. We have ever held it of great importance to keep these parts warm in winter, and the feet even during summer. We therefore direct measures, to protect these parts of even very young children. We shall have occasion to revert to this subject, by and by. 
236. There is however a constant necessity to guard the child against the accidental, and partial application of cold, which is always occurring, from the very nature of things—the child should therefore be dried as quickly as possible after it may have become wet, by a speedy renewal of the diaper. A monstrous error prevails upon this subject; an error every way calculated to produce great disquiet, and inconvenience, if not positive disease. It is imagined, that enuring them to wet, contributes to the future health of the infant; or in other words, that it must remain wet and cold, that it may become hardened by this filthy process in constitution. The absurdity of this practice is at once exposed, by asking, is there a mother who would apply cold wet cloths to her child, with a view of hardening it, though she might be willing to let it wallow for a long time in its filth? 
237. It may however be said, these are not parallel cases; for the urine of the child can do no harm, as it is salt water. We admit it to be saline—what then? Will any woman apply cold 


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OP THE GENERAL DRESS OP THE CHILD. 
salt water to her child, for the purpose, and in the manner we have just mentioned? But it may be said, the water is warm when it first touches the child, and becomes cold afterwards! — So much the worse—but will any rational mother apply warm salt water to her child, and suffer it to grow cold, in the expectation of benefiting it? We are certain, every one of proper feeling, will say, No! 
238. The employment of too many pins in the dressings of the child, is also occasionally attended by much risk to the child, especially when small ones are used—the latter kind should be banished altogether from the nursery; as they cannot ever be necessary, and may, as has not unfrequently happened, be seriously injurious, by slipping into the folds of the skin, or joints of the child; or they may create a great deal of immediate pain, by their partial penetration into the skin. The clothes of the child, can readily be so arranged, as to do away with the necessity of these articles; or at least, the quantity may be very much diminished. When many are employed, they are constantly liable to be displaced, and of wounding the child. 
239. In general, nurses are in the habit of using from eight, to twelve pins, for the dressings of the child; a quantity every way too great for even usefulness, did no risk attach to their employment; especially, as the same ends can be completely answered by two, as is the regular practice in our own family. It is true, that to render so few efficient, strings, or tapes, must be used in their stead. The following is the mode employed—the belly band, and the petticoats have strings; and not a single pin is emplpyed in their adjustment. The little shirt, which is always made much larger than the infant's body, is folded on the back and bosom, and these folds kept in their places, by properlyadjusting the body of the petticoat—so far, not a pin is used. The diaper requires one; and it should be of a large size; and made to serve, the double purposes, of holding the folds of this article, as well as keeping the belly band in its proper place; the latter, having a small tag of double linen depending from its lower margin, by which it is secured to the diaper, by the same pin. Should an extraordinary display of best " bib and tucker" be required upon any especial occasion, a third pin may be ad mitted, to ensure the well sitting of the "frock" waist in front— 


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OF THE GENERAL DRESS OF THE CHILD. 
this last pin however is applied externally; so that the risk of its getting to the child's body is very small, even though it become displaced. 
240. Especial care should be taken, that needles be not used instead of pins; this substitution we have been witness to; and the risk in this case, is much greater, from their not having heads. The most serious consequences have sometimes followed their use; a case every way in point, we will relate. In the year 1798, we were requested to examine the child of Mr. J. H. B.—who, we were informed, had been for many months in ill health; it occasionally suffered the most excruciating agony, without any evident cause, and which could not be relieved but by large and repeated doses of laudanum.. The child was said to cry out violently upon certain motions of its body, and especially, upon moving its right leg; upon the upper part of which, there was a hard substance, which upon being pressed, gave pain. 
241. The child was about two years of age; and had been always a very healthy one until the last preceding seven or eight months. At about this time, it was discovered to be fretful, feverish, and indisposed to all exercise. It would occasionally scream violently; and would sometimes cease to cry, as suddenly, without any evident cause. At other times, the pain would continue, until it was controlled by the use of laudanum. It lost its appetite, emaciated rapidly, and had more or less fever constantly. 
242. This was the history we received from the mother of the child, upon our first visit. We found the child very much reduced, with considerable fever, and a profuse diarrhoea. We examined the part that was said to be painful, and found it to present a remarkable feel to the touch, as well as a singular appearance to the eye. It was placed immediately upon the tuber of the right ischium, or that part of this bone, on which we sit. It was considerably swoln; so much so, as to offer a strong contrast to the opposite one, which was very much emaciated. When this was pressed, the child would complain; it was firm, and resisting; and if the fingers were made to grasp it, it seemed to contain another very firm, and long tumour within it; giving 


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the sensation to the fingers, of a pretty long piece of bone, placed perpendicularly to the surface of the tuber of the ischium. 
243. We told the mother, there was unquestionably an extraneous substance beneath the skin; the nature of which, we could not pretend to determine; but our impression was, it was a needle; and that nature had set about a process for its liberation, in which she would certainly succeed in due time, should the child have sufficient strength to support the irritation necessary for this event: but this was a circumstance we very much doubted, as the child was not only very feeble, but very ill at that moment, from fever, lax, &c. We therefore proposed an operation, as a speedier and safer plan—it was instantly consented to. We made an incision with a scalpel, immediately upon the point of the inner tumour, from which issued about a tea-spoonful of a transparent, and pretty tenacious fluid, resembling the white of an egg; but not quite so thick. Upon placing a finger upon the incision, and gently pressing it against the tumour; we felt a hard pointed substance directly in its centre; this was seized with a pair of forceps, and we drew from it, a needle full two inches long. The wound was dressed with a little slip of sticking plaster, and healed in three days; the child from that moment had not an unpleasant symptom. The hectical diarrhoea ceased; as did the fever; and in a few weeks the child was restored to perfect health, without the aid of any medicine. 
244. How, or when this needle got possession of the child's system, could never be determined—it is presumable, it was introduced by its being employed as a pin. 
Sect. V.— Of Changing the Child. 
245. There is much error respecting the necessity, or propriety of frequently changing the dress of a child, after it becomes wet. Upon this subject, there should be but one opinion; and this should become a maxim, from which there should be no departure; namely, that the child should never be long wet, or dirty at a time. The healthiest children we have ever seen, were those on whom the greatest care of this kind was bestowed; especially, when they were very young; and it is to that period 


OF CHANGING THE CHILD. 
81 
we now have reference. If frequent changing be not had recourse to when the child is wet, there can be no security for the continuance of health; every time it may be permitted to remain wet, it incurs the risk of taking cold; besides provoking inflammation, or producing excoriations; whereas drying the child, as often as it becomes wet, will prevent these evils. 
246. But it should be well understood, when we speak of keeping the child clean, that we do not consider the repeated re-application of the same diaper, because it has been hung in the air, or before a fire and dried, as coming within our direction. There can be but two reasons for this filthy practice—laziness, and poverty. The first, should never be considered as a valid excuse for employing the same diaper several times, nor will it perhaps ever be urged as one, in direct terms; but it is unquestionably, the only one that does influence upon this subject, where the second does not obtain, to render this, even in appearance, excusable. If the second reason exist, and the child have not a sufficient change, it were much better that it be without a diaper from time to time, than have those returned to it stiffened with salts, and reeking with offensive odour. We have already adverted to the impropriety of keeping the child wet. 
CHAPTER XIV. 
OP FEEDING THE CHILD IN THE MONTH, &c. 
247. Our fifteenth instruction, (106) is one of much importance to the future health and happiness of the individuals for whom it was intended; for no one of the errors we have attempted to correct, is so frequently and so improperly infringed. We have assumed as principles, and as we think, upon broad and well established data—1st, that the mother is the proper and only source from whence a child, until a certain period, should derive its nourishment; 2d, that every woman, cseteris paribus, is able to furnish it; 3d, that no other nourishment, is so entirely proper, as the milk of a healthy mother. 
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248. If these premises be correct, the subject of feeding children within the month, is reduced nearly to a prohibition, wherever there is no exception to the above rules. Yet there may be, indeed there often is, a propriety in giving a young child something to sustain it, where there is not a sufficiently early provision made by the breasts of the mother for this purpose; and it should consist of an article as near in composition as possible, to the mother's milk. This object is readily attained by a mixture of cow's milk, water, and loaf sugar, in the following proportions:—milk two-thirds, water one-third, and a small quantity of loaf sugar. This may be given from time to time, until the mother is able to furnish a sufficiency; or when she has not enough, it may be made to supply the deficiency. 
249. This diet alone should be made use of; every thing else, is not only less proper, but oftentimes absolutely injurious. No addition should be made, under the expectation of making it more fit, or more nourishing; for every such addition renders it less useful, if not hurtful—we therefore proscribe every mixture, or combination, except the one just mentioned. We are aware we do not agree with the judicious Dr. Struve* upon this point— he directs, in cases of deficiency of milk on the part of the mother or nurse, that this want, should be supplied by a " pap prepared of bread perfectly baked, or what is still better, biscuits boiled in water, or fresh milk, to the consistence of thin gruel." We unhesitatingly declare, we have ever found this to be a bad practice; and the Dr. himself would seem to bear testimony against it, in another place;t for he says, "many mothers, and nurses in general, imagine that a child cannot be supported by the breast alone, and therefore ought to be allowed a more substantial nutriment. Impressed with this erroneous notion, they provide the usual pap almost as soon as the child is born; a species of food directly opposite to that, which is appointed by nature, and derived from a healthy mother; hence it cannot fail to prove injurious." 
250. "From this pernicious practice," continues the Dr. "arise inflations of the lower belly, gripes, and costiveness. Such children become afflicted with insupportable pains in the bowels, the iliac passion, and subsequently with rickets; they 
* Physical Education, &c. p. 224. 
f Ibid, p. 222. 


OF FEEDING THE CHILD IN THE MONTH, &C. 
83 
obviously lose strength, and muscular energy, notwithstanding all the care of plentiful feeding; their skin loosely covers their bones," &c. This is truly a hideous picture; but it is nevertheless true; yet, with this before him, he did not fail two pages after, to recommend this very substance. 
251. Every farinaceous substance in a state of fluid mixture, is liable to become acid, or to ferment when heated, even by a lower temperature than that of the human body, if sufficiently long continued; consequently, the child must experience all the evils which may follow such changes, when they take place in the stomach; therefore, all such substances must be highly improper. It may however be asked, will not the mixture just proposed be liable to the same objection? We say, No—at least, not to the same extent as the other; for if the milk be sweetened no more than to correspond in degree with the mother's milk; if it be sweetened with loaf sugar, and given as soon as mixed, there will be very little disposition in it to change, before the stomach will exert its influence upon it, and convert it into a new substance. * 
252. To make however the mixture of milk, water, and sugar, always acceptable to the child's stomach, several highly important rules should be observed, and never departed from, when it is practicable to observe them. 
253. 1st, The milk should be pure; that is, not skimmed, nor previously reduced by water; and should be used as quickly as possible, especially in warm weather, after it has been drawn from the cow. 
* Dr. Cadogansays, "there are many faults in the quality of the food of children—it is not simple enough. Their paps, panados, gruels, &c. are generally enriched with sugar, spice, and sometimes a drop of wine; neither of which, they ought ever to taste." We perfectly agree that neither spices, nor wine should enter into the composition of a child's food; but cannot consent, that sugar should be omitted, since nature herself has largely furnished it in the mother's milk. And we have ever found this article not only a useful, but a desirable addition to the food of a child. We siTlcerely believe that it does not happen once in a million of times, that sugar is not acceptable to children of all ages. It is proper it should be so, since it is highly nutritious. If sugar be improper, why does it so largely enter into the composition of the early food of all animals' It is in vain physicians declaim against this article, since it forms between seven and eight per cent, of the mother's milk. 


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84 
254. 2d, When practicable, it should always be taken from the same cow. The reasons for this injunction are, that cows feeding upon the same materials, give different quantities of milk; and the stomach becomes reconciled very often more readily to any one certain quality, than to a mixture. 
255. 3d, The milk should be given as soon as possible after its mixture with the water and sugar, lest it should be disposed to ferment, before it is exhibited. 
256. 4th, It should never be mixed, but when wanted; and no more should be provided than the child will take in a short time; for it is much better to prepare fresh, than to run the risk of its becoming sour before it is used. 
257. 5th, The milk should never be heated by the fire; it should always be done, by adding the water hot, that is intended for its reduction; or by a sand bath; this will give it a sufficient temperature, without incurring the liability to be overheated by being placed on the fire. 
258. 6th, In weather that is unfavourable for keeping milk, it should be placed in the coolest place that can be commanded; or kept in often-renewed cold water. 
259. 7th, Should the slightest tendency to acidity be observed in the milk, it should be rejected without hesitation; nor should an attempt be made at its supposed restoration, by using an additional quantity of sugar, as this will eventually but increase the evil. 
260. We cannot declaim too loudly against the filthy, and oftentimes injurious practice, of nurses, making every particle of the child's victuals pass through their own mouths. The only reason they can offer for this disgusting habit, is to prevent its being given too warm—this, we grant, is a necessary and useful precaution, but it can be easily arrived at, without the aid of their lips, by adding hot water to the milk as just directed, instead of placing it over the fire. 
261. Care should also be taken, that too much food is not forced upon the child at once; it is much better it be fed often, than it should receive too much at a time; for the child, when it is fed, cannot exercise the discretion, it is wont to do when it sucks; for when it has received enough by its own exertions, it will stop spontaneously. 


OF OBSERVANCES TOWARDS THE MOTHER, &C. 
85 
CHAPTER XV. 
OF OBSERVANCES TOWARDS THE MOTHER, 
DURING THE MONTH, &c. 
262. If the directions already given for the general conduct of the woman during labour, and immediately after her delivery, be strictly observed, it will rarely happen, that she will not have, what is called " a good getting up." This good getting up consists in the gradual restoration of health, by a return of strength, through the proper exercise of the functions of the stomach, and the judicious employment of the various muscles of the body. 
263. To ensure the healthy play of the stomach, and of the muscular system in general, the patient should be managed in such manner, as will, in great probability, prevent the occurrence of disease, rather than be treated as if the evil were absolutely present. For this purpose, frequent changes of linen, and of every other soiled article, is absolutely necessary, that there may be no offensive gases generated, so as to contaminate the air of the room, and render it unfit for the purposes of respiration. 
264. Fresh air, should therefore be freely admitted into the room; but the woman should be placed so as not to receive a partial current of it. Unfortunately for the interest of the patient, the nurse thinks for her on this subject; and to effectually guard against the possibility of such an accident, she incloses her in a space of six feet square by curtains, and condemns her to the horrors, and mischiefs of breathing twenty times, the air that has already been as often discharged from her lungs, and each time loaded with an increased quantity of irrespirable gases. 
265. One of the greatest improvements the lying-in room could receive, would be to banish curtains from the list of the " indispensables" for furnishing it—or at least, so to manage them, as to make them subservient to ornament alone. The pretexts for the employment of curtains are, first, " the bed looks so naked without them;" —this requires but a few fashionable examples, to make it appear " when unadorned, adorned the most;" 


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and it were " a consummation devoutly to be wished," that some few of influence, would lend their aid for this purpose, for the benefit of their fellow-creatures. Second, " the danger of catching cold;" —this is sheer cant; let every patient commence without these articles, as many from necessity are obliged to do, and they, like them, will have nothing to complain of, that should be directly, or with propriety charged to the want of curtains. If a room be so situated, as unavoidably to expose the woman to a draught of air, a temporary screen will fulfil every duty the curtains possibly can, without involving her in any risk. Third, " to protect the woman against too much light." This reason is even more futile, than the one last noticed; for the inlets by which light is admitted can readily be shut, without expense, or any very great exercise of genius. Fourth, and last, " Curtains in cold weather are necessary to keep the patient warm." An additional blanket will do this vastly better. 
266. Fresh air, we must repeat, is of the greatest possible service to the lying-in woman; it is in a word, indispensable to the regular return of health; and if properly indulged in, will prepare the patient without hazard for the enjoyment of it abroad, in suitable weather. It has been put to us as a question, "how soon can a woman after confinement, venture abroad with safety?" This question, like many others, would seem to require no condition, and might be directly replied to; but it, like many others of the same apparent simplicity, involves a number of considerations, which are essential to be known, before it can be properly, and satisfactorily answered. 
267. 1st, Because the period which may have elapsed after delivery, cannot of itself be a guide; for some women are better at the end of five days, than others may be, at as many weeks; therefore, the actual condition of the woman must be always considered, and this without reference to the days that may have elapsed from the birth of her child. 
268. 2d, Because the season of the year, and state of the weather, will very much influence a decision of this kind; for the weather may be such for weeks together, as to render it improper for a delicate woman, to leave the house; as in winter, fall, or spring; or even in summer, it might for a short time be equally so, from heat or rain. 


DURING THE MONTH, &C 
87 
269. Therefore, a conditional answer must always be given to this question; and we would say, as a general rule, if, at the middle, or end of the third week after confinement, the weather be fine, and sufficiently warm, to render much additional clothing unnecessary, and if the patient be without disease, though perhaps feeble, she may venture abroad in a close carriage, with much advantage to herself, and child. Robust women, when free from any febrile affection, or local inflammation, may venture even earlier. And it may be well to recollect, that the sooner the patient can safely take the fresh air the better, since, both she, and the child, will profit by its influence; for there is a vigour, and a healthy play given to every function of the body, by air, and exercise, that cannot be procured by any other means. The best nurses are therefore those of active habits; and those who can give employment to all the muscles of the body, in the open air. For it will be obvious to every one, that if the functions of the body be not healthily performed; especially those of the circulation, and the various secretions, the products of their actions cannot be entirely healthy; therefore, the milk by which the child is to be sustained, may not be sufficiently nutritive, or fail in other highly important qualities. 
270. To a nurse, as well as to her child, there can be nothing more prejudicial than an indulgence in too sedentary habits; the exercise therefore we have recommended, should be enjoyed whenever fit occasions may present themselves, that the milk may be more certainly, and abundantly secreted; and at the same time, its invigorating properties be increased; but in indulging in exercise, it is always to be understood, that any excess of it, will be prejudicial. We would therefore wish to be understood to mean, only that degree of it, which shall not too much hurry and disturb the circulation, or occasion overheating—consequently, running, too fast walking, or dancing, should be carefully avoided; especially, as much injury is done the child, by its receiving the milk, after such violence has been offered the circulatory system. 
271. But should accident, necessity, or inattention, place the system in the situation just mentioned, the child must be withheld from the breast for at least two hours after the occurrence; and then, the milk which was present in the breasts at that time, 


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88 
must not be offered it—it must be drawn off by some other means, and thrown away. The same may be said, after an indulgence in any violent passion, or emotion of the mind, as the most frightful, and deadly consequences have followed a neglect of this precaution. 
272. It is said by many to be a good practice, " to gradually accustom the woman to the air in the house, before she ventures abroad;" and too many adopt the plan, to the serious injury of the patient. This is done, in cold weather, by making her travel up stairs* and down, in a strong current of air. The consequences of such exposure may be easily imagined. 
CHAPTER XVI. 
OP THE DUTIES OF THE MOTHER AFTER THE 
MONTH, &c. 
273. There is no solicitude more natural, or more painful, than that which a young and inexperienced mother feels, when for the first time she is left to her own guidance in the management of herself and child, by the departure of her nurse. For up to this moment, she looked to her, for every direction, and for the fulfilment of every necessary, and important office, as well for herself, as for her child. But left to her own discretion, she feels with more than necessary force, perhaps, the responsibility of a mother; of a mother, on whose care and judgment the 
* There is a custom among nurses and gossips, no less absurd than ancient, which obliges the woman to go " up stairs," before she venture down—and this is insisted on, be the season, or weather, what it may. By this plan, the woman may be exposed to a cold and chilling atmosphere, immediately after leaving a warm room, and sometimes perhaps, even when she is in a state of perspiration. We have known a number of instances of severe " pull backs," as they are called, produced by a compliance with this superstitious, and dangerous practice. The good sense of every woman, who may become the object of this improper custom, should be exerted to destroy it, by not complying—and this, at the risk of even offending f * a nurse," 


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89 
future health and welfare of her child depend. She is willing to suffer privations, or even to make sacrifices for its benefit, but is ignorant when the one might be necessary, or where the other may be availing. Uncertain, from want of experience, of the propriety of any thing she may do for either its comfort, or its trembles lest she commit an error; nor is she confirmed in her own opinion, until she has the cold and negative proof, that what she has done, has not done harm. Or from too great an indulgence of her fears, she may neglect the most common, and obvious of her duties. 
274. The delightful task, to the experienced mother, of washing and dressing her infant, to her, is a source of inexpressible anxiety. She applies the water to its little body, with a sparing, and trembling hand; the child perhaps cries upon its application; the over-sensitive mother becomes alarmed, lest she has given it unnecessary pain, or has done something improper; she becomes agitated, and but partially washes, and but imperfectly dries its exposed body; or she abandons the operation to one of less feeling, and of perhaps, no more experience than herself, to the decided injury of her child 
275. We once witnessed a most interesting scene between a young mother, and her husband, upon an occasion similar to the one of which we are now speaking. We were chatting with a young lady in a lively manner, when her husband suddenly entered the room—she sprang upon her feet, and violently clasped him round the neck, and with a convulsive cry of exquisite pleasure, she sobbed out, " I dressed our Julia to-day, entirely with my own hands!" And never did we see a finer subject for a skilful painter, than the one presented by this interesting couple at this moment. We soon learned that the performance of this duty, had up to that moment, been one of great misery to the too timid mother. 
276. We would earnestly recommend to every mother with her first child, to try her skill daily at washing, and dressing her infant, a week or ten days, before her nurse leaves her, that she may become familiar with the routine, and gain a little experience in the method. 
277. The next anxiety which a young mother feels, is upon the subject, of what is most proper for her to eat and drink, "as 
[12] 


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OF THE DUTIES OF THE MOTHER 
a nurse." For this information she appeals to those whose longer experience she supposes would well qualify them to answer. By one, certain articles of diet are recommended as indispensable; by another, they are condemned as improper, if not as positively injurious. Other substances are extolled in their turn; but unfortunately, these are forbidden by other advisers, and that with an earnestness, that bids defiance to either argument, or resistance. Perplexed by such discrepancies, she knows not what plan to pursue; and when she has become almost a prey to anxiety, some sensible friend lays down a rule, which, as a general one, is the only one that should have been given at first; namely, to eat and drink such articles of diet as her former experience had proved, did not disagree; and to pursue this plan, unless, a farther experience should declare them to be improper, or injurious, to herself, or child. 
278. No advice perhaps can be more safe and judicious than this; for we have almost uniformly observed, that whatever food agreed with the mother, was sure to do so with the child; therefore, such substances as are said to disturb the latter, will almost always be found to have disagreed with the mother previously. Nor is this of difficult explanation. Any substance with which the stomach is not familiar, or to which it is not entirely reconciled, will be either rejected altogether, or will be but incompletely digested—if it be but imperfectly assimilated, it will enter the system as ill-elaborated chyle; and this necessarily will make a corresponding change in the quality of the milk. In this state it is received by the child; its stomach not being able to subdue it to a proper nourishment, flatulency is produced, or perhaps even vomiting, to the certain injury of the infant. 
279. Certain liquors, as ale, porter, beer, &c, certain substances, as cabbage, sweet potatoe, pickles, vinegar, &c, are all in their turn said to disagree with the child—that is, as we would insist, disagree with the mother; they should therefore be abandoned without hesitation for her own sake; for there the mischief begins; but there it will not stop, unless she have sufficient resolution to give them up; for her child will soon feel the effects of such irresolution, and how extensive these may become, it may be impossible to say. 


AFTER THE MONTH, . &C. 
91 
280. Serious mischief is oftentimes done by the mother attempting to remedy every temporary diminution of milk, by increasing the quantity of her food, or by imagining that some stimulating drink will answer this valuable end. Hence indigestion, fever, and sometimes a habit is generated of too freely indulging in ardent spirit. This practice has for its excuse, that the milk fails because the woman is weak, owing to her not taking a sufficiency of nourishment; hence too much feeding is indulged in, to remedy this supposed weakness—a task is now imposed upon the stomach it cannot perform, however healthy it may be, and indigestion must of course sooner or later be the consequence. Or owing to some trifling disturbance in the system, of a temporary kind, the secretion of milk may be for the moment suspended, or diminished; an attempt is made to recall it by an increase of food, by which, a slight inconvenience is converted into a permanent derangement of the system; or a fever of even a dangerous character, may be generated. Or owing to a false theory, or imperfect observation, it has been supposed, that certain liquors have a control over the secretion of milk; and hence, the too free use of certain combinations, in which ardent, or fermented spirits, too largely enter; thus porter, ale, milk punch, &c. become the ordinary beverage of nurses, to the almost certain destruction of their morals. 
281. We must not however be supposed to deny the influence of certain solid, as well as fluid substances, upon the secretion of milk; this would be turning our eyes from reason, as well as experience—for we well know, that unless the body be properly supported, there must soon be a diminution of milk. We only mean to insist, that it is the nutritious, and not the stimulating part of diet ; that is subservient to the plentiful, and healthful formation of this fluid. In proof of this, we need only observe that we have often been consulted upon the subject of the failure of milk, where an anxious mother herself, or a hireling nurse was concerned, and been informed by them, that they had tried every thing with a hope of improving it; such as rich victuals, porter, ale, beer, milk punch, &c. without success, or it was followed perhaps by a diminution of it. 
282. In such cases, we have often succeeded, in producing a 


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plentiful supply of milk, by adopting the opposite plan of treatment; for it must be borne in mind as an important truth, that this failure proceeds more frequently from an over, than from an under quantity, of food, or of drink. It is a fact well known, to all who have paid attention to the consequences of arterial excitement, that when it amounts to even moderate fever, the milk almost immediately diminishes in quantity; and also, when this action is diminished, (provided it had not continued too long,) by suitable remedies, that the secretion of milk again becomes more abundant. 
283. Upon this principle, we have frequently prescribed eva-, cuants, and abstinence, to promote the secretion of milk. With a view to illustrate this situation of the breasts, under an increased excitement of the system; and the advantage, nay the absolute necessity of reducing the force of the blood-vessels, for the purpose of restoring their secretory functions, we will relate one, of several cases in which this plan was pursued. 
284. Mrs. informed us, with great concern, that she would be under the necessity of procuring another wet nurse for her child, as the milk of the one she had, diminished so rapidly, as to make her certain her child could not be half nourished. It had begun to fail about three weeks before, without any evident cause; and though she had constantly tried the most generous diet, and cordial drinks, she could hear of, still it diminished daily, and was now so reduced, as to scarcely offer a plenty to the child once in twenty-four hour; or rather the whole quantity furnished in that period, would not amount to more than one good meal. 
285. We requested to see the nurse—she was accordingly presented. She was a young, healthy looking woman, of florid complexion, and clear skin, and without a single mark, that would lead to the suspicion of a deficiency of milk from any imperfection of constitution—her milk was six months old, as it is called; she had been engaged in this family about three, of that time. She was from the country, and for some time gave entire satisfaction, as to her conduct, temper, health, and quantity of milk. Upon being questioned, we found she was living upon a much more generous and stimulating diet, than she had been previ- 


AFTER THE MONTH, &C. 
93 
ously accustomed to—she not only ate more at each meal than she had formerly done, but ate a greater number of meals; and instead of drinking milk, water, or milk and water, as she was wont to do before at such times, she was indulged in porter, ale, beer, milk punch, &c, with a view of keeping up her milk. 
286. We found she had occasional head-ache; rested ill at night; had a disagreeable taste in her mouth in the morning; her tongue was furred, and her pulse full and frequent. It was evident her system was too much excited by her mode of life, and that nothing would restore her milk but a reduction of it. We accordingly ordered her to be bled; to take a brisk dose of salts; confine herself to a strict vegetable and milk diet, and to drink nothing but water. 
287. At first, we experienced much opposition to this plan; but it was eventually submitted to, and with such complete and rapid success, that in a week there was a sufficient secretion of milk. It may be proper to observe, that this woman after this period, confined herself to a plain, simple diet, and never after had occasion to complain of a deficiency of milk. 
288. This case among many others, shows us, that the scheme the wealthy, and plentiful families adopt with their wet nurses, is wrong from beginning to end. As little change should be made in the diet of the nurse, as is strictly consistent with sufficient nourishment; and none perhaps in her habits of employment—that is, she should not exchange, active, for passive habits. If she has been accustomed to work, give her by all means uniform employment. If she has been much exposed to the air and weather, let her and the child have the advantage of air and exercise, upon all proper occasions: the extremes of heat and cold should of course be avoided, as well as a wet atmosphere. 
289. This case also well illustrates the position we have endeavoured to sustain, namely, that a stimulating diet is not always the best method to procure an increase of milk. But at the same time, we are far from declaring, that a more generous diet may not be occasionally necessary —but such cases are by no means so common, as is generally imagined, and still more rarely, is a stimulating one proper. 
290. The remedies which we have ever found to contribute most to the improvement of the milk, are, regular exercise in 


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OF THE DUTIES OP THE MOTHER, &C. 
the open air, milk and water, milk alone, malt tea,* molosses posset,t or porter, or ale posset,:): when a mild stimulus may be required. These may be drank freely, at any period of the day or night; and the nurse who may employ them, will find herself much satisfied with their effects. 
291. Having in the foregoing pages considered what may be proper for the woman during the periods of gestation, labour, and during the period of confinement; also what may be deemed important to the child after its birth to the end of the month, it may be farther useful to bring the whole of our instructions upon these points into a condensed form; we shall therefore sum up the various directions we have given, divested of the arguments by which they were sustained, in the form of a "Recapitulation." By this means, the reader can in a moment become possessed of the instructions, without going through, a second time, the reasonings. This plan will contribute to aid the memory much, since the directions are numerous and perhaps in some instances novel; and may require repetition, to fix them sufficiently well upon the recollections of those, who may wish to abide by them, themselves, or merely to inform themselves of what can be said, upon this interesting, and highly important subject. 
* Malt tea is made by pouring a quart of boiling water upon a gill and a half of ground malt, which is permitted to stand, after two or three good stirrings with a spoon, until cold: it must then be strained off. The tea may be sweetened, or not; or it may have the addition of milk. 
f Molasses posset is made by throwing a wine-glassful of molasses into a quart of milk, after the latter has been heated nearly to the boiling point; it is then permitted to cool—the whey to be poured off, and drank. 
t Porter, or Me posset is made precisely as directed for the molasses posset, except, that half a pint of either of these liquors is substituted for the molasses, and it is permitted to stand until a separation takes place. 
Dr. Struve says, (Phys. Ed. p. 225,) "there are certain means by which the milk of a suckling woman may be increased, or diluted. In the first place, I would advise her to drink a glass of cold water every morning, but to adopt no remedies, however speciously recommended by common midwives." He then recommends the porter posset suggested above. 


95 
RECAPITULATION. 
CHAPTER XVII. 
RECAPITULATION OF THE INSTRUCTIONS, GIVEN TO THE FEMALE DURING PREGNANCY, LABOUR, AND CONFINEMENT; AS WELL AS RULES FOR THE GENERAL MANAGEMENT OF THE CHILD DURING THE MONTH.* 
292. To prevent abortion, &c. she should scrupulously observe the following rules. 
293. 1. She must avoid all unnecessary, and especially, violent exercise, or exertion; such as too fast walking, running, dancing, &c. 
294. 2. To avoid, as much as may be, placing herself in a situation which may subject her to unpleasant sights, or seeming dangers. 
295. 3. To shun over-heated rooms, and stimulating liquors of every kind. 
296. 4. To avoid all substances that have a tendency to produce a costive state of bowels; or those which may give rise to "indigestion," as late suppers, too great a quantity of food, &c. &c. 
297. 5. To take no substance, nor drug, that shall give too frequent, and too severe motion to the bowels; or such as shall too severely constipate them, as chalk, opium, &c. and especially not to disregard the calls of nature, when they would be successfully exerted. 
298. 6. To remove from her chest, waist, and abdomen every restraint; lest undue pressure should be made upon them. 
299. 7. To avoid all substances that may have a tendency to increase the irritability of the system; as strong tea, coffee, opium, &c. the too long indulgence in bed, &c. 
* We have not thought it necessary to make a summary of the chapter upon " Marriage." 


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300. 8. To shun all severe study, night watching, &c. 
301. 9. To avoid with much care unnecessary blood-letting, or submitting to this operation, merely because she be pregnant. 
302. 10. To have however recourse to this operation, when pain, head-ache, a sense of fulness, giddiness, the loss of, or imperfect sight, &c. may be present to declare the necessity of it— but it were always better when practicable, to have the advice of a physician. 
303. 11. The woman who may be in the habit of miscarrying, should never venture upon blood-letting without advice, as it sometimes produces the evil it is intended to prevent. 
304. 12. To avoid the indulgence of all inordinate appetites; as too much repletion of the stomach may give rise to many formidable diseases. 
305. 13. She must give up the false notion, that more food, &c. than ordinary, is required, because she is pregnant, as the opinion is not founded in either reason or experience. 
306. 14. She must assure herself, by a reliance upon the opinions of those whose business it is to ascertain the truth upon this point, that nature institutes the sensation of nausea, and the act of vomiting, with a view to prevent too great fulness, during this period. 
307. 15. She must not indulge in the fear, that should a certain longing have been ungratified, her child incurs the risk of being marked in consequence of the disappointment, as this apprehension is not warranted by reason, nor confirmed by experience. 
308. 16. She must dismiss from her mind, all apprehension of future consequences to her child, should she have been so unfortunate as to have suffered any great alarm; been surprised by any unexpected event, or appalled by some frightful object or occurrence—as there is no one good reason to believe in such influence upon the child. 
309. 17. To most sedulously guard against any sudden gusts of passion; as any indulgence in them, may be highly injurious, if not fatal to herself and child. 
310. 18. To solicit as much as possible, tranquillity, and equanimity; as their influence is highly valuable to herself and child. 


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311. 19. To believe, in general, that food injures more byits excess, than its quality; by taxing the powers of the stomach too highly. 
312. 20. To avoid with as much care, as she would impending ruin, an indulgence in cordials, liqueurs, &c. under the pretext, of calming sickness, relieving pain, or expelling wind; as a destructive habit is but too easily generated by their employment. 
313. 21. She must not persuade herself, it is only the excessive indulgence in such articles, that is mischievous; but she must clearly understand, that every thing which may unduly stimulate the system, is highly injurious to the pregnant woman. 
314. 22. Let her turn a deaf ear, to every tale of disaster, or of horror, which purports to have happened to the pregnant, or lying-in woman—for upon investigation, such tales will almost always be found without foundation, or very greatly exaggerated. 
315. 23. Let her procure the best aid, for the period of her necessities, that circumstances will permit. 
316. 24. Let her not be imposed upon by a false theory, or bad advice; nor use too much exercise towards the latter period of her time, lest she provoke premature labour. 
317. 25. Let her not, when the period of labour is approaching, indulge in gloomy forebodings, or in unreasonable fears for the event; nor by any means whatever, forget, how rarely death happens during, or after even a well-conducted labour. 
318. 26. Let her not attempt to increase the frequency, or force of her pains, by taking improper articles of food, or by frequent marchings across the floor. 
319. 27. Let every precaution be taken against an attack of fever; for this purpose, she must scrupulously avoid every stimulating substance, either as food, drink, or remedy. Let her bear in mind, that an overcharged stomach is always unfavourable to the healthy progress of labour, or its eventual safety. 
320. 28. To prevent despondency, because the labour may be rather longer than she anticipated; let her recollect, that the safety of this process does not depend upon the celerity with which it is performed. 
321. 29. That she may secure to herself the best possible chance for her safety, let her have no opinion of her own, that 
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RECAPITULATION. 
may clash with those of her medical attendant; let her therefore be passive, and obedient. 
322. 30. Let her not, as she values her life, indulge in any gust of passion; lest she provoke incurable convulsions. 
323. 31. Immediately after she is a mother, she must impose upon herself the most perfect tranquillity; that no untoward circumstance may be provoked. 
324. 32. She must carefully avoid all the exciting causes of fever, as far as in her power, by not indulging in improper articles of diet; sitting up too early, and too long; too hot a room; curtains too much closed; or seeing too much company. 
325. 33. She must aid the exertions of her physician, to prevent any after evil; by implicitly following his directions, and preventing, as much as may be in her power, the nurse running counter to them, especially until after the fifth day complete. 
326. 34. Let her not permit herself to be persuaded from having her child put to the breast; so soon as she herself may be able to bear the fatigue. 
327. 35. Let her not delegate to another, the sacred duty of nursing her own child; unless the reasons for so doing, are insurmountable. 
328. 36. She must most scrupulously attend to the dressing and undressing, or even performing this herself, when her health and strength will permit this delightful task. 
329. 37. She should never, under any pretext of convenience, permit her child to be fed, so long as she can supply it with sufficient nourishment herself; and to secure to herself this important point, she should pay a scrupulous regard to her diet, and her exercise in the open air. 
330. 38. The dressing of the child should early engage the attention of the mother; it should always be made subservient to comfort, instead of show. 
331. 39. This should consist in part of flannel; especially, during cold, or even cool weather. 
332. 40. The dressings of the child should be changed as often as they become soiled; when this luxury can be indulged in. 
333. 41. Though it may be found, that flannel is the most eligible substance as a general rule; there are cases, in which it may be improper; and these should be carefully distinguished. 


RECAPITULATION. 
99 
334. 42. The belly band is one of the most important parts of the child's dress; it should alwaysbe made of flannel, and should be always cut bias. 
335. 43. The greatest care should be taken to apply it properly; and too tight an application should be particularly avoided. 
336. 44. If this bandage be applied too tight; it may produce the evil it is intended to prevent. 
337. 45. The child should be carefully protected against all unnecessary wet; and when it is discovered to be in this situation, it should be changed as quickly as possible. 
338. 46. In dressing the child, as few pins should be employed as possible; three are all that are necessary, if the clothes be properly arranged. 
339. 47. As a general rule, the child should never be fed, at this period of its life; there maybe exceptions however that may render this necessary. 
340. 48. When an exception to this rule exists, the food of the child should consist, of milk, water, and sugar; and exhibited under the important restrictions we have made. 
341. 49. If the child be fed, it should have but small quantities at a time, and never crammed to surfeit. 
342. 50. The woman should exercise in the open air, as soon as this is rendered safe, by the state of her health, the period after confinement, and the state of the weather. 
343. 51. She should never subject herself to partial exposures, under the hope of "hardening herself." 
344. 52. The re-application of a diaper after it has been dried simply, should be prohibited; as several evils arise from the practice. 
345. 53. The mother may indulge in such diet, as her experience has proved to be innocent—for it will seldom or never disagree with the child, when it perfectly suits the mother. 
346. 54. When the mother experiences any inconvenience from the use of any substance or substances; she should not hesitate a moment to abandon them; for if they disagree with her, they will be sure to do so with the child. 
347. 55. Should there be a failure in the quantity of milk; the mother must not attempt to increase it, by highly seasoned food, and stimulating drinks. 


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RECAPITULATION. 
348. 56. She may sometimes, however use with great advantage, the nutritious substances recommended in the text. 
349. Having in the preceding pages considered the duties of the mother during pregnancy, and confinement; we shall now proceed to detail what may be proper for the offspring, from the period of its birth to that of puberty. We shall confine ourselves, in this part of our subject, strictly to the physical influence of certain agents upon the human body; and the most proper physical education, up to the period just prescribed. The medical treatment, will form a distinct subject of consideration, and the moral we do not propose to treat of. But before we commence this part of our subject, it will be well to describe the requisites of a nursery. 
CHAPTER XVIII. 
OF THE NURSERY. 
350. Every body almost in easy circumstances, has a part of the house appropriated to what is called the " Nursery." The one chosen for this important office, is generally, or at least too often, the most exceptionable part of the building. It is usually selected because it is "handy," or because it is the only one that can be spared; without the smallest attention being paid to its fitness for the purpose for which it is designed. 
351. The room for the purposes of a nursery, should have every advantage which space or location can give, when either or both can be commanded. We shall therefore say, in what a well appointed nursery should consist, leaving it of course to the ability of every individual to adopt or approach it, as nearly as circumstances may permit. 
352. The nursery should be spacious, with a high ceiling, and perfectly dry; it should not be exposed to the operation of any cause that may render it damp; as on a ground floor; too much shaded by trees; or placed beyond the occasional influence 


OF THE NURSERY. 
101 
of the sun. Its windows should be tight, and the walls dry; the floor should be of wood that will quickly dry after being wetted for the purposes of cleanliness; but the utmost care should be taken, not to hasten this process, by placing ignited charcoal in its centre. Serious mischief has frequently arisen, by this absurd and dangerous practice. 
353. It should be so situated, that the door or doors shall not open immediately on staircases; or should this be unavoidable, the heads of the stairs should be secured by latticed half-doors; and these so constructed, by having their slats placed perpendicularly, that the child cannot climb upon them, and thus defeat their object. 
354. The windows should have cross-bars placed before them, to remove apprehension of accident to the child. They should be five inches distant from each other, that the windows may be opened for the purposes of ventilation or air. They should have shutters;, that the room may be darkened, when the abstraction of light becomes necessary. The windows should not have curtains of a glaring colour, as the light will be increased thereby, and prove injurious to the eyes of young children.. 
355. If possible, the nursery should consist of two rooms; and if they opened into each other, it would yield very great advantages; the children could retire to one, while the other was ventilating, or getting cleaned, by washing or sweeping; this would contribute greatly to their comfort, as well as to their health. They would also be removed from the dangers of damp, the inconvenience of dust, the risks from a cold stream of air, while the room is drying or sweeping, besides having an enlarged space for the exercise of their limbs. In a space so extensive as this, they could improve their strength by engaging in many little sports which children are so ingenious to devise when they cannot, from the condition of the weather, take exercise in the open air. 
356. Besides, such an arrangement will permit the children to have a room fresh and sweet in the morning, after having rendered the other foul by sleeping in it. This is an advantage which has been but too little attended to, notwithstanding its obvious utility; especially, to the younger children, who cannot always escape into the purer air of other parts of the house. 


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OF THE NURSERY. 
357. Carpets in cold weather are decidedly useful, if they be properly managed; that is, well shook, and aired, every week. By this means, the dust is removed from them, and they have the advantage of becoming dry by exposure. We are sensible that several objections may be raised against carpeting a nursery; as the great quantity of dust they accumulate; their becoming often wet, without the chance of drying; their retaining grease so fixedly as not to be removed; their absorbing, and then giving out a variety of impurities, &c. But notwithstanding all these reasonable objections, we are persuaded, that one single advantage which they possess in a nursery, overbalances all that maybe said against them—namely, their protecting the heads and limbs of children from injury when they fall. 
358. The elastic material (wool) of which the carpet is formed, is well calculated to break the force of the blow which the head or limbs of the child receive, when it falls upon it; so much so is this the case, that we have not known a single instance of serious injury from falls upon them. We are sure to have our anxiety diminished, when called to a child who has received a blow upon the head from a fall, when we are informed, it fell upon a carpet. We are therefore of opinion, that when the child falls from a moderate height, it will rarely, if ever, suffer a serious injury from it—this certainly would not be the case, did the child fall upon the naked floor. 
359. We must however be understood to recommend carpets in cold weather only; for so soon as the weather becomes sufficiently warm to do without fire, the carpet should be removed, and its place supplied by an even, well stretched mat; or the floor may even be left bare; for at this period, it is to be presumed, children will be but little confined to the nursery, unless the state of the weather prohibits their enjoying the open air; this state of weather may consist in its being wet, too v/indy, or too hot. 
360. The furniture of a nursery should be as little in quantity as convenience will permit, that the children may have the space that would be unnecessarily occupied by many articles; especially chairs, and tables. It should therefore consist of the beds for the children and nurse, or we would rather say mattresses, as we are of opinion that feather beds should be driven from the nursery, for the following reasons—first, they are too warm for 


103 
OF THE NURSERY. 
the purposes of the best health, especially with feeble children; accumulating so much heat, as to unduly stimulate the whole cuticular system; thus giving rise to unnecessary, nay injurious perspiration; second, the effluvium from feathers is extremely oppressive, particularly in warm weather, and to children of feeble lungs; third, they discharge a prodigious quantity of dust, intermixed with minute portions of down, occasioning cough, and other inconveniences. 
361. If it be objected, that mattresses are too cold in our climate for winter, we would immediately obviate it, by recommending the spreading of a blanket over the mattress, which will effectually remove the inconvenience complained of. 
362. When practicable, children should sleep in separate beds; and these should be large; for it is injurious to have them cramped when they sleep, as well as indelicate to crowd opposite sexes together. Besides, the degree of heat generated by contact, will be certain to make them uncomfortable; they will throw off the bed clothes, and thus expose each other to colds. 
363. Children should never have more bed clothes spread over them, than is sufficient to maintain a proper degree of warmth; if more be put upon them, they become oppressed, or perspire; both of which should be avoided. 
364. Should we not however succeed in establishing our objections against feather beds in winter, we are persuaded every body will agree in the use of mattresses during hot weather. Should these not be at command, the sacking-bottom, or even the floor, should be substituted—for almost any thing is preferable to feathers. 
365. It is in the nursery in a great measure, that the habit of early or late rising is generated—this is a matter of much importance ; and the greatest regularity should be observed, that a proper one is formed. Children should therefore retire at a regular, and sufficiently early hour, to ensure their early getting up; for beyond a certain time, sleep is injurious. It would however be a little difficult to establish a positive rule upon this subject, as some children, like adults, will require more sleep than others. Children who exercise much, will need more sleep than those who exercise but little; consequently, they should not be confined to precisely the same number of hours. 


104 
OP THE NURSERY. 
366. All children are disposed to be early risers; this propensity should therefore be cultivated, by permitting them to retire sufficiently early to bed; and after they are in bed, they should not be allowed to keep each other awake by playing, and thus depriving themselves of sleep: for the same reason, no noisy employment should be permitted in the nursery, that the children need not be disturbed. Indeed it would be best, when children have attained their third year, or even before, that they should not be allowed even light in their rooms, that they need not unnecessarily be kept from sleep, as well as to prevent any apprehension from being left in the dark. 
367. When children first awake in the morning, however early this may be, provided it be after day-light, they should be allowed to get up, and be dressed; for if this be not done, and they are forced to lay longer than is pleasant to themselves, they will become fretful and dissatisfied, or again fall to sleep—in either case, a real evil is induced; in the first, the disposition of the child is injured; and in the second, a habit of lying too long is generated. 
368. It should be carefully guarded against, that no unnecessary habits are indulged in during the period set aside for sleep; such as drinking water several times in the night, or rising too often to discharge the contents of the bladder. If the first, be indulged in, an artificial thirst will be created; if the second, the bladder acquires a preternatural degree of irritability, which is almost sure to terminate in the disgusting and inconvenient habit of wetting the bed. 
369. After children have risen from their beds, they should be dressed as quickly as possible; they should be carefully washed, and combed, and then be permitted to inhale the fresh air, either in doors or without, with as much freedom, as the nature of things will permit. For the first purpose, the nursery should be well, but carefully ventilated; or what is still better, the children should be allowed to retire to another room when practicable, and especially during the time the nursery is cleaning ; hence, the propriety of two rooms being devoted to this purpose; and for the second, when the weather is proper, they may be allowed to go out of doors. 
370. So soon as the above necessary operations are performed, 


105 
OF THE NURSERY. 
children should have their breakfasts, so that the stomach need not suffer, either from too long fasting, or from the indulgence of too great an appetite, excited by long abstinence. 
371. A cradle for young children is a very important appendage to a nursery, notwithstanding the objections which have been made against it, by ingenious speculators upon the subject of the physical education of children. The advantages of the cradle are, 1st, it can be placed in any situation of the room, without disturbing the child, for the advantage of either warmth or coolness; for light or darkness, or for air; 2d, it supplies the most gentle and certain anodyne, if we may so term it; since it will amuse by its motion when the child is placed in it awake; lull by its sameness when disposed, for sleep; and perpetuate it, when desirable, by a familiarity with its action: for it must be recollected, that for nine months previous to birth, the child has been indulged in the gentlest motion, in the fluid in which it constantly swims; consequently, the motion of a cradle would seem to be but a continuation of an exercise, to which it had been long used. 
372. The objections to the use of the cradle are easily obviated. It is said, it may produce fatuity, by constantly shaking the brain; this could not possibly happen, unless the cradle were violently agitated; in which case, it would be the abuse of the cradle that should be objected to; since no such consequence could possibly follow its proper use: for did gentle agitation do mischief to the organization or functions of the brain, why are not all children born fatuitous, since that organ is subjected to it from its earliest formation? Another objection is urged, which is as easily obviated; it is said, the child runs much risk by its liability to overset—now, it must be by the employment of extreme violence, or carelessness, that this can be-rendered an objection to the cradle; for certain it is, the proper use of this machine can never be attended by such a consequence. 
373. In using the cradle however, we would suggest certain precautions, that it may not be converted into an improper machine. We would forbid all violent motions of it; since it would not only defeat the objects for which it is employed, but might be attended by the risk of oversetting. The motion of the cradle should be made an efficient means to procure rest; and should 
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OF THE NURSERY. 
therefore not be so constantly used as to lose its effects, by too frequently employing it; nor should its influence ever be taken advantage of, to procure more than the necessary degree of sleep, as it may tend to the disadvantage of the child; nor should we think the cradle necessary to children much beyond the second year, as at this time, their exercise will dispose them to sleep soundly without its agency. 
374. The means by which the nursery is warmed, is not a matter of indifference. Two important objects should always be kept in view in constructing it—namely; first, security from accident to the children; and secondly, affording sufficient warmth. 
375. These may be secured, by an open fire of wood, or of coal, protected by a high and substantial fender of wire, that the children may not approach it too nearly; or by a stove placed near the hearth, and defended by an iron railing. We however should never advise the stove, where an open fire can be made use of with equal advantage as regards heat; and we believe that the introduction of the Lehigh coal will secure to us this desirable end, with less expense and more security than any other method. 
376. The objections to a stove are numerous, and deserve a serious attention—1st, there is great danger that the children may get severely burnt, as we have often witnessed; 2d, they are almost always too much heated; 3d, the air is rendered too dry by a destruction of its moisture, and becomes impure by the burning of millions of the little particles which are constantly floating in it; and though one of these objections may be partially obviated by placing water upon the stove, yet it will not remove the second; 4th, the air is almost constantly injured by substances thrown upon the stove, as grease, meat,&c; 5th, there is always a temptation to do some kind of cooking upon or in a stove, to the annoyance of the comfort, or the injury of the health, of the little inhabitants of the nursery, besides the serious risk of scalding them by heating water upon it. We lately saw an instance of death from this cause, and have witnessed many times minor accidents from the same source. 
377. We have already forbidden the performance of a number of operations in the nursery—we need not repeat them here— we shall merely reiterate, that the nursery should be the purest 


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OF THE NURSERY. 
place in the house, as well as the one in which the children should most delight to be. It should therefore never be made a place of punishment, by banishing children to it, for any little delinquency, or inadvertence they may have been guilty of—but on the contrary, a temptation should constantly present itself in the nursery, by making it the seat of their amusement; children will then bear being placed there, without considering it a place of confinement, or one in which they are to experience privations. 
378. Among the proper provisions of a nursery, we should reckon a small backgammon table, with men, but without dice. Children, so soon as they are capable of comprehending the subject should be taught draughts, or checkers. This game is not only highly amusing, but is also very instructive, as it calls forth the resources of the mind in the most gentle, as well as in the most successful manner. It becomes a source of endless amusement, as it never tires and always instructs. 
379. Battledore, or shuttlecock, is also a proper game for the nursery; this gives great agility, as well as great vigour to every muscle in the body. It exercises with but little fatigue; it gives great practical accuracy to the eye, and to the hand; while the mind is agreeably amused. A large cup and ball, should be added to the above articles, as it affords great opportunities for acquiring skill, as well as excites an agreeable emulation to excel. 
380. A rocking-horse of a good size should also be an appendage to a nursery—this article however, should be considered as a luxury, or it will become abused by becoming too familiar; it should therefore only be introduced occasionally, and that as a reward for good conduct. This will teach children to find their seat upon a saddle, much easier than they would otherwise do, when they are placed upon the back of a living horse. 
381. Slates, and pencils, afford much employment, as well as amusement to children—it gives them the habit of making letters and figures very early, as well as calls forth their imitative powers in rude attempts to copy any of the objects of nature, or of art, which may present themselves. For the same reason, we would indulge children in the use of paper, and lead pencils. 
382. To children of proper age, dissected maps, and Chinese puzzles, or tangrams, are very acceptable, and highly useful: they exercise the memory, elicit ingenuity, excite a laudable emulation, and give the habit of patience and perseverance, in 


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their various attempts to correctly dispose of the one, or discover the various combinations of the other. 
383. A quantity of regularly shaped pieces of wood, of various sizes, should also be given to them; these they will arrange, and that sometimes with great ingenuity, into houses, temples, churches, &c. and thus become sincere admirers of each other's skill, in forming these mimic, but evanescent buildings, the destruction of which, they ardently wish for, the instant they are formed; and whose sudden demolition, by a stroke of the hand, affords the highest gratification, because they can construct another with almost as much celerity. 
384. A set of nine-pins and balls of proper size, afford great pleasure to children; and serve to divert, as well as to exercise them; for both of these are highly important, when the weather prevents their being taken into the open air. By affording them opportunities to exercise their skill, they forget they are confined; and thus is prevented, that peevish discontent, called ennui, by which they are sure to be assailed, when they have nothing to exercise their muscles, or to employ their minds. 
385. We might enumerate a number of other sources of amusement to children, but every parent almost will supply the deficiency, as tKe necessity for variety may present itself. We do not however approve of sharp-edged or pointed instruments for children—they can serve no possible use, and may be productive of serious mischief. We have known the loss of two eyes from pointed instruments; and a number of severe wounds from sharp ones. 
386. The nursery should be as free as possible from holes or crevices, that the children may not be exposed to partial draughts of air; and that the air of the room may be preserved in winter, of a pretty uniform temperature. Attention to this, will enable the children to play in every part of the room, without injury; and it will also prevent the desire to crowd round the hearth, which will serve to diminish the risk of their clothes taking fire, or doing themselves other injury. 
387. Too much care cannot be taken to guard against the accident of the clothes taking fire; there is but one security against this, when an open fire-place is the means employed for warming the room; namely, by dressing the children in worsted garments, or at least the outer ones—that is, the frocks and aprons. It is 


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but too common to disregard this important precaution; and the accidents are numerous, in consequence of the neglect. Many are in the habit of dressing their children in proper materials, as regards their body clothes; but seem altogether to forget, that if these be covered by a muslin or linen apron it may take fire, and do serious mischief; it is therefore not sufficient, that the under garments be made of woollen materials, if these be surmounted by an inflammable substance. 
388. Children that can just run about, as well as older ones, are almost constantly in the habit of having sharp-pointed sticks for playthings; and nothing is more common than to put an end of one of these sticks in their mouths, and run with it when it is in this situation, at the risk of doing great mischief to the mouth and throat, by its being violently driven into them by the force of a fall. My friend Dr. Physick related to me a case of lock-jaw, and death, from this cause; and we ourselves have witnessed many less severe accidents from the same source; and we were called hot long since to an accident of this kind, that created much anxiety, though it did well eventually. A child was running across the floor with a pointed stick of cedar in its mouth; it fell, and the point was forced through the palate, which it nearly separated. It produced much suffering, from an almost total inability to swallow from the inflammation that was excited. 
389. It is also wrong to permit children to run about the nursery barefooted, or in their stocking feet; especially, if the floor be covered by either carpet or mat; as it every now and then happens that they run into their feet, needles, pins, nails, glass, or other sharp substances, that may be concealed in the substance of the floor covering. 
390. The introduction of glass into the nursery should be avoided as much as possible; as a constant liability to accident is incurred, by its being broken, and strewed over the floor, and by the children treading upon, or handling the pieces. 
391. We cannot recommend too earnestly, the frequent ventilation of the nursery. The best possible method to purify the air, is by the admission of fresh air from without; this should be done at least daily, by opening the windows and doors for a short time. During the process of ventilation however, the children should be removed from the nursery, or protected by a screen, from the immediate current of air; but the former is the better 


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plan, as children are not always obedient to the wishes of their nurses, and may expose themselves very improperly. This ventilation should not be performed, if the weather be wet; as the damp air might prove more injurious, than the air intended to be removed. 
392. No sand should be strewed upon the floor of the nursery; as it is always inconvenient to walk upon, as well as furnishing a great quantity of very fine sharp dust, which is very injurious to the eyes, when the floor is swept, or it is otherwise disturbed. 
393. Some have recommended fumigations of vinegar, and other substances, for purifying the air; this is neither necessary nor availing, especially as we can always command a much better article, namely, the fresh external air. 
394. The air of a nursery should be maintained at a pretty uniform temperature—for this purpose, a thermometer should be a part of the furniture of every well appointed nursery. It should be placed remote from the fire, and not to face it; as it may, if so situated, give a false result, as it will be necessarily affected by the radiant heat of the fire. It should never exceed 66 or 67° of Fahrenheit. The thermometer should be placed out of the reach of the children, or it will be quickly destroyed. 
395. We are fully persuaded that the excessive heat of nurseries has occasioned a great mortality, especially among very young children. In the first place, it over-stimulates them; and in the second, it renders them so extremely susceptible of cold, that every draught of cool air endangers their lives. They are maintained in a constant state of perspiration, which is frequently checked, by an exposure to even an atmosphere of moderate temperature. 
396. Children should never be left alohe—-their helpless condition requires constant care, especially when very young. They should never be left to themselves while feeding, as they may choak for want of proper and timely assistance; nor should they be placed upon a chair or table, unless they are well watched. The children of the poor very often meet with serious accidents, from the necessity the mothers are frequently under, to leave them for a time to take care of themselves. A friend, lately related to me a fatal accident arising from this cause, which may perhaps serve as a warning to those who are in the habit of leaving children alone, when there is no absolute necessity to do so. 


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A poor woman, who had been spinning upon a large wheel, was obliged to leave the room for a short time. Before she went, she placed her child, (an infant who could not walk,) upon the floor, some distance from the wheel. She presently heard something fall, and her child to scream violently—she ran instantly into the room, and found the poor infant transfixed to the floor, by the spindle of the wheel passing entirely through its body. She supposed the child had pulled at the thread she had been spinning, which was sufficiently strong to overset the wheel. 
397. Animals should not be left with children when alone, for both dogs, and cats, may be provoked to do mischief, if too rudely assailed by them. Cats, by common consent, are driven from the sleeping places of children, under an apprehension that they will "suck the children's breath." If this phrase mean any thing, it is that the cat can produce suffocation, by arresting either the ingress, or egress of the air—a thing altogether impossible, unless the animal should have sagacity enough to stop both the mouth and nostrils at the same time; for should the mouth be closed, respiration can be carried on through the nostrils; should the nostrils be obstructed, it will go on through the mouth. 
398. When a night lamp is burned, it should always be placed in the chimney-place, or immediately before the door of a stove that the smoke may be carried off. If this be not done, the air of the room becomes loaded with lampblack, to the great injury of the lungs. 
399. It is not a matter of indifference, in which direction the light falls upon the child; young children eagerly seek it with their eyes; and if it do not fall directly upon the face, the eyes will be strained to the direction in which it is strongest. In consequence of this, the muscles will contract the habit of moving the eyes in an oblique direction, which may terminate in squinting. On this account, all objects capable of attracting the attention of the child from the vivacity of their colours, should never be presented to them sideways, or immediately over their heads. 
400. We have already forbidden washing or ironing, or any other operation being carried on in the nursery, which shall load the air with vapour; as it will necessarily expose the children to cdds, coughs, or other severe affections of the lungs. 


PART II. 
ON THE PHYSICAL TREATMENT OF NEW BORN 
AND OLDER CHILDREN, &c. 
401. For the sake of convenience, as well as of perspicuity, we shall divide the consideration of the physical treatment of children into the different and marked periods of their lives; that is, from the moment of birth, to the period of puberty. These divisions will comprise; 1st, the period from birth to that of weaning; 2d, from that period, to second dentition; 3d, from second dentition, to the period of puberty. 
CHAPTER I. 
FIRST PERIOD. 
402. Every child born alive, and at, or near the full time, cries so soon as the surrounding air gains free admission into its lungs. This grateful sound repays in an instant the suffering mother, for her pain, her anxiety, and her peril; or at least, it produces a temporary oblivion to them. But unaccustomed to the sound, and having all her life attached the idea of pain to the exercise of the functions of crying, she becomes alarmed, should this effort be continued any time, and most anxiously inquires "why the child cries so violently?" 
403. We will endeavour to explain, for her sake, this interesting question. The child while in the womb, is surrounded by water, and is enclosed within walls, if we may so term them, of limited extent. In the first, it securely floats, as it has no use for its lungs, while thus imprisoned; and against the second, it oftentimes tries the strength of its limbs, with much advan- 


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tage to itself, if not always with comfort to its mother. As the medium in which it floats is of the same temperature as that of its mother's body, it may be considered as constantly living in a warm bath. The uses of this bath are, 1st, to preserve the child as much as possible from external accidents; 2d, to give entire freedom to all its movements; 3d, to maintain it in a medium of uniform temperature; and 4th, to preserve the suppleness and sensibility of its skin. 
404. When the little stranger is ushered into the world, how changed are all its relations, and all its necessities! It now becomes almost an independent, though a most helpless being; for its immediate connection with its mother is at once cut off; instead of a bath of most grateful temperature, it is plunged into an atmosphere almost always a little lower than the one it has been in the habit of revelling in ; and sometimes into one, very much below it: and instead of the confined surface against which it was wont to exercise its sense of touch, it is now thrown, as regards it, into almost illimitable space. The first of the changes we have mentioned, makes a powerful, and doubtless sometimes, a painful impression upon its extensive surface of skin. Its little muscles are necessarily thrown into action; and as a consequence, the chest becomes expanded, and the air by which it is now surrounded, enters its collapsed lungs, and the action of "crying" is instituted. 
Sect. I.— Of Crying. 
405. " Crying" should be looked upon as an exercise of much importance, both to the immediate, and mediate advantage of the being. It is immediately useful, as it facilitates the passage of blood through the lungs, where, until this moment, it had been unaccustomed to travel, but which now is a sine qua* non to its existence; 2d, it serves more effectually to the expansion of the air cells of the lungs; thereby, presenting a larger surface for the action of the atmospheric air, from which the most important consequences are to flow; such as the due oxygenation of the blood, on which every healthy function of the system, to a greater or less extent, depends; the unloading of the system of certain materials, the retention of which, would be highly injurious; 
[15] 


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and thus contributing, either to the direct, or indirect production of animal heat. The mediate advantage of " crying," consists in its giving strength and tonicity to the organs employed in the act, by thoroughly expanding the air cells of the lungs, and thus early and constantly accustoming them to being stretched, at a period the most favourable to this extension; and at the same time freeing the lungs from mucus, that is constantly pouring into these cells; and preventing injurious accumulations. 
406. It may be farther observed on the subject of " crying," that this act is not always an expression of pain; it is intended very often as an appeal to the tenderness of the mother, when the child is impelled to make its necessities known—hunger and thirst, or sometimes, upon much more important occasions to itself, namely, uneasiness, from want of change of posture; for a constrained situation, renders it not only uncomfortable, but is really injurious to the child, if too long continued. The poor infant is too often condemned to one position, let this be ever so long, provided it express no objection to it by its cries; the consequences are, 1st, that the circulation is much impeded on the side on which it lies, from the compression the parts must suffer from the weight of the child itself; and 2d, its limbs are unequally exercised, especially when the mother, or nurse has a favourite side for the child to rest upon—this election should never be suffered, for reasons too obvious to need mention. We may however observe en passant, that the child should not be permitted to continue longer than an hour, or two at farthest, in any one position; the fear of waking it, should .never prevent an attention, so important to its health. Besides, we know from ample experience, that the child very soon becomes accustomed to the operation of turning, or changing its position, and will be almost sure to express the relief this attention affords, by instantly putting all its little limbs upon the full stretch, and again " addressing itself to sleep." 
407. We would particularly warn mothers and nurses against placing the child upon its back; as this position may be followed by very serious consequences, if it chance to throw up the contents of its stomach—we once knew suffocation from this cause. 
408. In very young children, there is a rapid accumulation of the excitability of the system, arising from their passive condi- 


OP CRYING. 
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tion, which requires the employment of the muscles, to keep it down to the healthy point; and "crying" is the "waste gate," to an excess of excitability. This act therefore, is more easily provoked in children, that the equilibrium of excitement, and excitability may be preserved. " Crying" is most useful in many instances for the same reason, even to the adult—who has not witnessed the relief afforded by a gush of tears, to an oppressed heart! and in our practice, we take advantage frequently of this circumstance, by permitting, nay sometimes soliciting "cries," at the trying, and important moment of a woman becoming a mother. 
409. To show farther the importance of this act, by creating a diversion of the excitability, and excitement, Dr. Rush used to relate to us in his lectures, the case of a gentleman in South Carolina, who was about to be cut for the stone. This gentleman thought it beneath the dignity of a man, to express pain upon any occasion: he therefore refused to submit to the usual precaution of securing the hands and feet by bandages, declaring to his surgeon, he had nothing to fear from his being untied, as he would not move a muscle of his body—and he truly kept his word; but he died instantly after the operation, from apoplexy. In this case, the excitability and excitement were too much accumulated in the brain; and it yielded to their influence, from the want of some outlet for the one, or diversion for the other. 
410. But in attaching so much consequence to "crying," we are not to be supposed to advise either the provoking of it, or perpetuating it, by artificial means; nor to consider this act, as always expressive of either pain, or uneasiness, or to require the interference of the mother or nurse; for on the contrary, we are fully aware how readily a habit of crying is generated, by a too prompt attention to the demands of the child; and also, that the most clamorous children, are those, you are the most solicitous to appease. Crying may however be indicative of disease; it will therefore be considered again, under this head. 
Sect. II.—Of Sleep. 
411. New-born children may be said to sleep constantly; their waking moments furnish but exceptions to the rule This is a wise 


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regulation of nature, since it permits a renewal of the excitability, as fast as it is expended. In this early stage of life, the gastric, the arterial, and the absorbent systems, are much employed for the purposes of digestion, of secretion, of deposition, or growth; and consequently, much excitability is required for the various contingencies now mentioned. And it would seem in general, more is generated, if we may so express ourselves, than is absolutely necessary, as it has to be carried off, as just noticed, by occasional crying, &c. This passive condition of new-born children is highly favourable to the healthy expansion of the body; for where it is interrupted by some derangement of the nervous system, which declares itself by too frequent crying, and watchfulness, the child ceases to thrive. 
412. It is some time before the nerves of hearing, appear to be affected by sound; hence, we see children almost insensible to loud noises, even weeks after their birth. This appears to be an especial care of Providence, that the important state of sleep, should not be too easily interrupted. This sense however, after a time, becomes exquisitely sensible; and if it were to be too much indulged by not permitting the child to become familiar to it, and that early as possible, much mischief would arise. 
413. We have often been consulted upon this occasion: over careful mothers think, that sleep should never be abridged, or interrupted; they therefore keep their nurseries so extremely silent during the sleep of the child, that it is constantly awakened in much alarm, whenever any sudden, or unexpected noise assails its ear: we have known children many times rendered so sensible to noise during sleep, as to be roused by even a light tread upon the floor; and when a louder noise has been made, to awake almost in convulsions, and always in extreme affright, and loud crying. To guard against these evils, and they are evils of much greater magnitude than might at first sight appear, since in many instances they have been perpetuated through life, we constantly recommend as a practice in all nurseries, to let the child fall asleep in the midst of noise, and never to consign the room to silence, as a precaution, during the whole of its nap. If you habituate children to fall asleep while surrounded by noise, and not interrupt that noise by design during the period of sleep, they will soon support without the least agitation, or other 


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inconvenience, any common degree of it, that may be made in their chamber. 
414. Much advantage is derived from this plan—1st, a morbid sensibility of the organs of hearing is not generated; consequently, the child will be exempt from all the evils, and inconveniences this condition would inflict; 2d, the functions of the body will be better performed, since they will not be interrupted by the repeated wakings of the child; 3d, the child will derive all the advantages which an undisturbed sleep will give; 4th, the duration of its sleep can be better calculated on; 5th, it will save its mother or nurse, much unnecessary anxiety, as well as trouble. 
415. If the habit of stillness during sleep has been established in the nursery, the quicker it be broken the better; this, if properly attended to, can be done in a short period; 1st, by obliging the child to fall asleep dufing a moderate noise, by not abstracting the noise from it—it will contend, for some little time, but not long; 2d, by continuing the noise during the period of sleep: by this plan, it will soon become familiar to it, and after a while may even sleep better than before. 
Sect. III.— Of the Necessities of the Child. 
416. The necessities of the child are no less remarkably changed, than its relations. It must now breathe a pure air, or it die; it must now receive and prepare food by the operation of its own stomach, for the purposes of its system, or it sink; it must now be protected against the variations of temperature, or it perish. In a word, a new kind of life commences from this moment; and that this may be preserved in the best possible manner, is the end and object of Physical Education. It will now be easily understood, why this species of education, should commence at the period we have assigned to it; since, it will be obvious, that the more perfect the health is of the individuals who marry; the better the foetal life has been conducted; the more successful will physical agents be, in properly developing, and perfecting the animal life, which is to follow. 
417. It will be seen that the body is now to be subjected to the influence of entirely new agents; and these may be consider- 


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ed under several distinct heads, as follow—1st, Air; 2d, Food ; 3d, Clothing; 4th, Exercise; 5th, Cleanliness. The agents we have just enumerated are of the first importance to the welfare of the being, on whom they are to act; their operations commence with the first moments of animal life; and they are perpetuated under one modification or another, to the last period of human existence. We shall therefore take up the consideration of each of these powers, in the order we have placed them—and first, of Air. 
CHAPTER II. 
OF THE AIR. 
418. By the air we mean, that immense mass of permanently elastic fluid, which surrounds the globe we inhabit. This substance is absolutely essential to the continuance of life in every species of animal; and its effects upon the human system are healthy or otherwise, in proportion to its purity. But this condition must be constantly varying, as it may lose one of its principles, or as it may receive an excess of another; or be loaded with noxious exhalations, from vegetable, animal, or mineral substances, especially in great cities. 
419. Modern chemistry has done much to illustrate the condition of our atmosphere, by pointing out the means by which it retains its vital purity, as well as by informing us in what this vital purity consists, and the manner it becomes deteriorated. Until the discovery of oxygen as a component part of our atmosphere, it was altogether conjecture, as to what it lost or gained, by combustion, respiration, or vegetation. The phenomena of combustion and of respiration, were well marked and described by the ancients; but their reasoning upon the causes of the changes which the air underwent by these processes, was altogether founded upon assumed principles; and the world was not much enlightened upon this subject, until oxygen was simultane- 


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ously discovered, by Scheele in Sweden, and Priestley in England, to be a constituent of the atmosphere; though Mayo, two hundred years before, had nearly arrived at the same discovery, and conclusions. 
420. For the discovery of the chief means by which the atmosphere maintains its purity, we are indebted to the experiments of the ingenious Dr. Ingenhouz. He found, that plants of every kind, while growing, and acted upon by the sun, yielded this salubrious air—the deadly nightshade, and the most innocent plant, alike gave out this gas. 
421. There is therefore every reason to believe, that the atmosphere in its extended sense, is as pure now as in the days of the patriarchs. If then, life be shorter now, than it was at that period, (a circumstance perhaps wanting proof,)* it is certainly not owing to a defect of purity in the general atmosphere. It must have its foundation in circumstances independent of any general atmospheric impurity. 
422. These circumstances, we are of opinion, are, the changes in the habits and manners of mankind at present, from those in the time we have just alluded to. Formerly, man was simple in his mode of life; and laborious in his habits; his occupations were confined very much to those of the hunter, the shepherd, or the tiller of the earth. 
423. From this it would seem to be ascertained, that air may be either pure, or be more or less deteriorated, as it may be subjected to such causes, as may be capable of altering its chemical, 
* Huffland says, "It is commonly believed, that during the early periods of the world, the lives of its inhabitants were more youthful and more perfect; that these primitive men had a gigantic size, incredible strength, and a most astonishing duration of life." " Some have not hesitated to seriously ascribe to our forefather Adam, the height of nine hundred yards, and the age of almost a thousand years. But the rational and accurate investigation of Modern Philosophy has converted the supposed size of giants, found in different parts of the world, into those of the elephant, and rhinoceros, (and we may now add the mammoth;) and acute theologists have shown, that the chronology of the early ages was not the same as that used at present. Some, particularly Hensler, have proved, with the highest probability, that the year, till the time of Abraham, consisted of only three months; that it was afterwards extended to eight; and that it was not till the time of Joseph, that it was made to consist of twelve. These assertions are, in a certain degree confirmed by some of the Eastern nations, who still reckon only three months, to the year." Art of Prolonging Life, p. 120. 


OF THE AIR. 
120 
or sensible properties. The chemical properties of the air, are principally affected by combustion, and by respiration; and the changes which it may undergo, are in proportion to the extent, or degree of the one, or the continuance of the other. 424 But to make this better understood by those who have never devoted any time to the subject, it may be necessary to state, that the « atmospheric air" is principally composed of two distinct substances or gases, in certain proportions to each other. One of these is called oxygen; the other nitrogen. It is the former which maintains combustion, and supports respiration; for these processes can be continued so long, as this exists in the combination; but the perfection of either, will depend upon the due proportion of oxygen. It must however be remembered, that an excess of oxygen does no material injury to either. 425. Now, as combustion, and respiration, are always going on in the habitable world, it follows, there must be a constant loss of oxygen; and if there were no sources or means, by which it could be supplied, the " atmospheric air" would be constantly suffering deterioration, even until it were exhausted of its vital principle. But a kind Providence has permitted a supply of oxygen in as great proportion as it is taken from the atmosphere; and thus by new processes, it maintains its qualities in a general sense at all times, in pretty nearly the same degree of purity. 426. The means by which the lost oxygen is supplied, are no less certain than extensive; thus all the living vegetable world emit it, so long as they are operated upon by sunshine; and the decomposition of water, furnishes another extensive source of supply. 427. From what has been said, it will readily appear, that combustion and respiration, which is in fact a kind of combustion, tend to diminish this vital property of the air; and in proportion to that loss, is it unfit to maintain either; it must be therefore evident, that, that air which has been once breathed, is less fit for another operation, in the exact proportion to the diminution of the oxygen it may have contained; and if this process be sufficiently long continued, it will be entirely exhausted, and in its place will be found a quantity of carbonic acid gas, equal to the removed quantity of oxygen, combined with the usual, or original bulk of nitrogen; neither of which is respirable. Hence 


OP THE AIR. 
121 
the air of great cities is necessarily less pure, than that of the surrounding country—1st, by having more causes constantly operating to destroy its chemical, and to alter its sensible qualities; and 2d, by having fewer means to restore the expended oxygen, and to abstract from, it its carbonic acid gas, &c. 
428. Independently of the greater consumption of vital air, and the inadequate means to supply it, in great cities, there are other causes constantly operating to render it still more impure, than respiration alone is capable of doing. Combustion, fermentation, and exhalations from putrid and other bodies, all tend to deteriorate the already too much impaired air, and will render cities less healthy than the surrounding country; and perhaps pretty constantly in the proportion we have mentioned. 
429. Therefore, it is no way surprising that the mortality among children should be excessive in cities, since, their stamina are incapable of supporting either the loss of so much oxygen, or the influence of the various miasmata by which they are constantly surrouhded—hence, agreeably to calculation, more than one-half of those who are born, die before the third year. It is true, we must not attribute this excessive mortality, exclusively to the causes just mentioned; there are others constantly operating to this effect, especially among the poor; such as bad nursing, and perhaps worse food. 
430. Rousseau, with a mixture of truth, and prejudice, inveighs bitterly against men shutting themselves up in cities—he says, "mankind were not formed to be heaped together in shoals, but to spread themselves over the face of the earth, to cultivate it. The more they assemble together, the more they corrupt each other. Man is, of all animals, the least adapted to live in herds. Flocks of men, like flocks of sheep, would all perish in a short time. Their breath is destructive to their fellow-creatures; nor is it less so in a literal, than in a figurative sense." In these few sentences we see at once his plan of education, and the impossibility of reducing it to practice; for all could not become cultivators of the soil, any more than they should all be shoemakers or tailors. And though we admit that cities are less healthy than the country, yet all men could not live in the country; and cities ever have, and always will be built, from the very nature of things. Nor is it difficult to foresee the consequences, [16] 


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OP THE AIR. 
should the genius of man tempt him to spread himself widelyover the face of the earth, and all become cultivators of the soil ; other evils would necessarily arise, which would be equally destructive of human life. 
431. Look at man in this condition, wherever he may be found, and what is it we see? Neither a more rapid increase of population; more brotherly love; greater longevity, nor greater improvement of the soil! And though we admit, there may be a greater exemption from disease in the country, it does not secure a greater share of either happiness, or population. Indeed, if we may credit what is found in books upon the relative conditions of man in a savage and in a civilized state, it would appear, that cultivation of the mind is even favourable to long life; and though there may be more general health in a savage state, there is less length of life. The instances of longevity among our aboriginals are fewer, than in refined life; so that what one gains by a greater freedom from disease, the other acquires by an increase of years. Rousseau's scheme of happiness for man, is therefore altogether Eutopian. 
432. In this country, the evils of cities are more limited than in those of Europe; they are, 1st, less populous; 2d, they are better ventilated, by the breadth and regularity of their streets; 3d, there are much fewer manufactories carried on in them; 4th, there is less poverty; or in other words, there are greater facilities of life. 
433. During the summer, our cities become unfriendly to our very young population; and much benefit is derived by carrying them into the country, when health has failed in the city. But this favourable change is not owing altogether to the purity of the country air; much depends upon taking children from the remote causes which produced the disease. That this is the case in many instances, we are entirely convinced by the fact, that children attacked with disease in the country, are very often benefited by their being brought to the city—this is familiar to every practitioner, as well as to very many others who are not physicians. 
434. We are also certain, that the country air is not made the best possible use of, by those who inhabit cities; for no sooner does the warm weather commence, than they leave the city; and 


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OF THE AIR. 
this when the children are in perfect health. In consequence of this, they become accustomed to the air of the country, as well as liable to any epidemic, or local influence that may exist there. The object of leaving the city is now defeated; since it cannot preserve health to those who fly to it for refuge; and it is found caeteris paribus, as difficult to cure a disease originating in the country as in the city—nay, as we have observed above, the patients are sometimes obliged to return to the city to get well. 
435. We are persuaded, those who profit most by the change of air, are those who repair to it as a remedy—children who have suffered, or are about to suffer from the heat of our cities, derive immediate, as well as permanent advantage from the change— but when taken to the country early in the season, they appear to us to be as liable, or nearly as liable to disease, as if they had remained in the city. Nor is this to be wondered at: they are surrounded by the remote causes, which produce disease in the country; (for no one will deny that the country is obnoxious to diseases as well as the city;) as well as liable to exposure to dews, both morning and evening, under the pretence, that a walk early in the morning, as well as in the evening, is wholesome; as if wet feet, and draggled skirts, would not destroy all the advantages of these early and late walks. They are surrounded by the temptation of fruit in all stages of immaturity, which we well know they do not resist; but on the contrary, they literally cram themselves to surfeit, more than once in the four-and-twenty hours. Need we wonder at their being attacked by disease? 
436. We have every reason to believe, that if proper attention were paid to children during the period of teething; if proper regard were paid to their food; if due pains were bestowed upon their clothing; and if a well-regulated system of exercise were established; there would be much less occasion for country excursions, for the exclusive benefit of health. , We shall attempt to explain these various and important topics in the course of our present work, in such a manner, as will make the putting of them in practice easy to every understanding. 
437. Rousseau, in his ardour to recommend a country life, becomes, like most speculators upon human conduct, inconsistent with himself. His first great object is, to oblige every mother to suckle her own child; yet he says, they must, " send 


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their children to regenerate themselves in the country." Is it practicable for every mother to retire to the country during the first two or three years of their children's lives?—to desert their home and family, as her children may present themselves? If they cannot do this, they must, agreeably to this scheme, commit the charge of their children to hirelings; the very thing he so loudly deprecates. Of the same nature is his advice to pregnant women, when he recommends them to lie-in in the country, instead of returning to the city for this purpose. How few could do this without creating greater evils, than it is even intended to cure! But to return. 
438. The proportions of these gases in forming the atmosphere, are as follows: in one hundred parts of atmospheric air, there are of Oxygen, 20 parts, 
Nitrogen, 80 do. 
100 
These proportions, we are aware, are not rigidly exact; but they are so nearly so, as to render a mention of their fractions unnecessary, when treating this subject in a general manner. 
439. It must however be recollected, when we speak of an impure air or atmosphere, we are not to be supposed to mean strictly, a mere diminution of oxygen; for the air may be filled with such impurities as to render it highly dangerous to be breathed, without its oxygen being diminished in the smallest degree. Thus, marsh miasmata; the contagious principle of smallpox, measles, &c. maybe floating in an atmosphere which may have its oxygen in full proportion. And it must be farther observed, that a full proportion of oxygen, does not by any means prevent the influence of these noxious qualities upon the human constitution. It is therefore necessary to distinguish between an impure air, and an irrespirable one; the one giving rise to disease; the other preventing respiration. 
It may be asked, if this be true, of what advantage is the oxygen of the atmosphere to the human constitution, since it has not a conservative power? The answer is as easy, as it is satisfactory. Experiment has clearly proved—1st, that this substance is absolutely necessary to respiration; and respiration is essential to life; 2d, that this gas performs also important offices 


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within the system; for should the blood not be duly supplied with this fluid, it would be rendered unfit for the purposes of the circulation; consequently, all the functions dependent upon this process, must be imperfectly performed, and life itself would soon cease. 
440. But it would be an error to suppose, that the more there is of oxygen, the better for animal life. This is by no means true; since this gas is so ethereal and stimulating, as to make us live too fast, if too freely indulged in. We can give abundant proof of this, in the air of the Glaciers, which is of the greatest purity, hut is rather prejudicial to health. In it we consume too fast, if we may be allowed to retain the figure, that respiration is a combustion: and the temperature is also too variable. 
441. Besides, Switzerland, the highest land in Europe, furnishes fewer instances of longevity than Scotland; and the causes of this are obvious—1st, the atmosphere at all great heights is too dry; for this reason, too much moisture is detracted the body; since its capacity to receive our fluids, and hold them in solution, is in proportion as it may be free from them; 2d, the variableness of temperature, which always obtains in high situations, is extremely prejudicial to the duration of life. 
442. On this account, islands and peninsulas, are more favourable to long life, than continents. For the temperature of the atmosphere is much more certainly preserved in the former than on the latter; and the sensible qualities of it, have a very decided influence upon animal life. The weight and temperature of the air, and especially the uniformity of these, have a great effect upon the human body. Wherever these are the most uniform, it will be found, (caeteris paribus,) most favourable to old age— hence, we are told that men live longer in the islands of the Archipelago, than in the neighbouring countries of Asia; in Cyprus, than in Syria; in Formosa, than in Japan and China; and in England and Denmark, than in Germany. 
443. From what we have said, it would appear, that the healthfulness of a place is not to be determined by the purity of the air; or rather by the quantity of oxygen which may enter into its composition; therefore something else is required, as we have already attempted to show; such as position, soil, cultivation, &c. And farther, that oxygen, as before suggested, cannot 


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interrupt the action of various poisons, especially such, as may be considered as the remote causes of fever. Yet this fluid is indispensable as a constituent of the air; and though its presence cannot protect against disease, yet its absence is certain death to the animal that is obliged to breathe an atmosphere from which this has been withdrawn, or is already consumed. 
444. Hence, great cities are so unfavourable to the extension, or even the continuance of human life. It is calculated that in London, Paris, Vienna, and Berlin, between the twentieth and twenty-third part of the population die annually; while in the surrounding countries, the mortality does not exceed a thirtyfifth or fortieth part. This difference in the mortality of the respective places just mentioned, is however in a great measure owing to the destruction of too large a portion of oxygen. If the population becomes still more dense, the mortality is still greater; and when many are crowded together, as in ships, and destruction is yet greater; and if the quantity of air be still more limited, the effects are awful; as was witnessed in the Black Hole of Calcutta, where a hundred and forty-six men were confined in a narrow space for twelve hours, out of which number, a hundred and twenty-three died. 
445. It is therefore evident, that no greater mischief can be offered the human lungs, than the want of a due supply of oxygen; consequently the cruel and absurd practice of nurses, of putting a neW-born child, or young children under the bed clothes, cannot be too severely reprehended. The consequences of this habit can readily be anticipated, from what has already been said; though it may carry conviction more readily, to explain the changes which constantly take place, when the child is so circumstanced. In placing a child under cover in the manner just mentioned, it must necessarily be placed in a space with a limited quantity of air. Of this quantity, it draws into its little lungs by every inspiration, a certain portion, and returns it again with a loss of a part of the oxygen; the place of the oxygen is supplied by an equal quantity of that noxious, or irrespirable gas, called "carbonic acid gas." Another, and another quantity is taken in, with precisely similar results, until by the repetition of this process, every particle of oxygen is abstracted, and its place as constantly supplied by fixed air or carbonic acid 


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gas; and this not being respirable, the child dies, unless it be in due time exposed to fresh air. 
446. A more serious objection may be made to the habit many women have, of keeping the child at the bosom all night, with its head closely covered with the bed clothes; the objections just made, will operate with equal force in this instance, as in the one this moment considered, with this addition—there is constantly emanating from the surface of every living body, a sensible, and an insensible perspiration, as well as an extrication of carbonic acid gas. If the body be covered closely, and the escape of this gas prevented, the air surrounding the body thus covered, is found unfit for the purposes of respiration. * Therefore, the child is oftentimes plunged into an atmosphere already rendered impure by the body of the mother or nurse, and consequently, in a short time, has less oxygen than is necessary for the purposes of respiration; and it perishes at its mother's very bosom. We have witnessed four instances of death from this cause.t 
447. It will be easily deduced, that every deterioration of the air, must be injurious to the child, precisely in the proportion to that deterioration; consequently, the utmost care is required, that no unnecessary process by which the air can be injured, should be carried on in the room or nursery, in which the child is kept. Hence, the decided impropriety of too crowded a room; of washing, drying, and ironing the things intended for the child or children's use; permitting the wet or soiled articles taken from the child to remain long in the room; burning of charcoal, or other combustible substances outside the chimney place; cooking of the various articles for meals; the too frequent wetting of the floor; smoking of tobacco; burning of oil, with too long a wick, &c. In a word, the nursery should be the purest place, in the house, if possible. We have had occasion already to advert to this subject, when treating on the nursery. (350, &c.) 
* If a candle be placed beneath the bed clothes alongside of a person that has been closely covered all night, it will be quickly extinguished, from the excess of carbonic acid gas. 
f We cannot better illustrate the injurious consequences arising from this practice, than by stating, that in Great Britain alone, there perished forty thousand children, by the practice of nurses permitting the children to sleep near them, from the year 1686 to 1800. Friedlander's Education Physique. 


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448. We cannot well condemn too severely, the filthy practice in too many nurseries, of drying the wet and soiled articles in the room with the child. If an article must be used a second time after having been once wetted, it should at least be removed from the nursery for the purpose of drying. But a much better practice would be, to consider a well wetted diaper as unfit for reapplication, until it had been washed. The same may be said of every other article belonging to the child, that has been wetted by its discharges; as its petticoats, sheets, bed, mattress, &c. 
449. The value of a pure atmosphere, does not cease at any period of the child's life; it is highly important at all times; though perhaps not so immediately essential, as during the first few days of its existence, as it is then less able to bear an impure air, than when it becomes older. 
If the directions we have just given be attended to, many sources of impurity will be removed, yet it will not amount to absolute security. Therefore, frequent ventilation is of much consequence; by this, the great mass of the air is removed, and its place supplied by that of a better quality. In doing this, however, some care is necessary, or the child may receive injury, by either partial streams of air passing over it, or by having one of too low a temperature applied to it. 
Sect. I.— Of Temperature. 
450. Children of tender age, should never be suddenly subjected to great changes of temperature,* whether the change be from a higher to a-lower one, or the reverse; therefore, children born in a cold climate, and in cold weather, cannot safely be placed suddenly in a very cold atmosphere, without great and immediate risk. It is true, we may guard their bodies against the influence of cold so effectually as to receive no injury; but we cannot protect, much more important parts, with the same certainty—for their lungs must receive the cold air within them; and hence the danger. 
451. But the danger just alluded to, does not arise so much from the immediate effects of cold air upon these organs, as from 
* Nor should their eyes be exposed to sudden and strong light. We have frequently seen severe inflammation of these parts, follow such incautious conduct. 


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the subsequent action of the warm air, in which they must necessarily sooner or later be placed. Violent reaction soon follows the state of torpor, which the cold air imposed upon the lungs; and inflammation, catarrh, or cough, will almost certainly be the result. 
452. A sudden attempt to " harden a child" as it is called, in cold weather, is but another determination to see how much a child can bear, without dying under the experiment. This scheme, a scheme founded neither on reason, nor experience, has had to our certain knowledge too many victims, for us not to caution parents against the preposterous and dangerous practice. 
453. We would ask, what has given rise to so decided a preference in favour of the system of exposure? This question would be difficult to answer, upon rational principles, or correct observation. It has proceeded without doubt, from some common fact relating to the effects of cold; as the general bracing power of a pretty low temperature upon the body; but without taking into view the various circumstances, which were essential to its favourable operation; for instance, with the mercury down to 10° of Fahrenheit, let two men, (every circumstance being equal but that of clothing,) engage in such an atmosphere, at any kind of active employment for a certain number of hours; the one to be sufficiently clad to prevent, when at rest, any very great inconvenience from the cold; and the other, less well protected; the this case would require additional exercise, to prevent suffermg. At the expiration of the assigned period, what would be the respective situation of these men? The one would be found to have performed his task without difficulty, or much fatigue; the other would be seen to have performed either less work, or be more exhausted; for in order to do the same quantity of work as his companion, he would have to labour much harder, to keep up the same degree of animal heat; or he will have per formed less, and have suffered more from the benumbing effects of cold. This is found to be the case also with animals, especially, horses. Where then is the advantage of this sudden attempt at bracing with cold? Besides, as regards the human con stitution, and especially that of children, it is agreeable to the observations of all medical men, that those children who are 
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properly and sufficiently clad, are freer from disease than those injudiciously exposed for the purpose of hardening them. 
454. It is undoubtedly true, that those who may have survived the ordeal of ill-conducted winter exposures, are generally best confirmed in their after health; but this only proves the strength of original constitution, since it stood the severe tests to which it had been exposed; but we are not informed of the fiftyfold failures of the experiment. Let us apply this reasoning to the effects of extreme heat upon the constitution, and see how ill the analogy, though correct, will support the practice of " hardening," or how few would be willing to have recourse to the trial. It is a matter notorious to every one, that the emigrants to the West India islands, or other hot climates, who survive the " seasoning," enjoy for the most part the best possible health; and perhaps these places will furnish as many instances of longevity, as almost any other parts of the world; but would any one give these instances as proofs of the healthfulness of an exposure to a tropical sun, or as a means to acquire long life? Would not any one to whom such a proposition was made, directly declare, that the great number of victims, to the few instances of success, are entirely concealed! 
455. It would seem to be a point acknowledged by all writers upon the treatment of children, that extensive and deadly effects are constantly witnessed, from the variability of climate, and from unnecessary, or from unavoidable exposure in cold weather. The great increase of acute, as well as of chronic affections during the winter, would seem to confirm this impression. In our mutable climate, the consequences of unavoidable exposure of the children of the poor to its inclemencies, are familiar to the observation of every one who may have felt an interest in the claims of humanity; and so far as we can collect from these observations, the opinion appears to be concurrent, that much suffering, great increase of disease, and an augmented mortality, are the constant results. Let us then hear no more of the arguments derived from this class of people, in support of the unstable hypothesis, that the health of the children of the poor is a proof of the advantage of exposure to harden the body against cold, or to confirm the system against disease. 


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456. We are aware, that instances of the entire success of this plan, may be quoted against us; thus, that Mrs. A,B,C, &c. accustomed their children to such exposure; and it will be triumphantly asked, " where can you find finer, or more healthy children ?" But we would ask in our turn, can they furnish us with an equally faithful list of those, who have died from the experiment? If they could, the argument would not be urged a second time. 
457. The occasional success of a hazardous experiment, is very often productive of the most serious evils; it is followed as an example, when it should have been regarded but as an exception; nor is the error corrected, but at the expense oftentimes of many lives. Thus for the supposed cure of an obstinate disease by an ignorant quack, the patient, grateful for his recovery, attributes to the skill of his attendant, and the virtue of his remedies, what justly belongs to the strength of his own constitution, or the favourable efforts of nature; and if they fail a hundred times in other instances, the disappointments are concealed; for each is ashamed to declare, he had reposed confidence in the remedies—therefore, the supposed success is alone heard of. 
Sect. II.— Of Fashion. 
458. Fashion has also exerted a most baleful influence over the best feelings of the mother, by rendering her willing to sacrifice the health and well-being of her offspring to its shrine, in spite of the remonstrances of reason, and of common sense. The preposterous, and unsightly exposure of the arms of children, cannot be too loudly reprehended, since it has neither convenience, nor beauty to recommend it: yet is it attended by the most serious, and manifest injury to the child. This practice may be perpetuated, by an ignorance of its dangerous tendency; and from the desire to give to the body an increase of power to resist cold. We have in several places condemned the system of hardening, rather from the manner in which it is attempted, than from its inutility, if properly conducted. In order however to render any plan effective, a knowledge of certain ana- and physiological facts, is essential; and we shall ac- 


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cordingly expose them in the best manner we can, as opportunity may present itself. But upon no occasion perhaps, shall we have it in our power so satisfactorily to show the injurious effects of cold upon the chest and lungs, as in the custom we are now attempting to destroy. The cautions suggested by the exposition we shall give, will be the more valuable, as they will strike the common sense of every body; and they will be the better appreciated, as the facts are the result of anatomical investigation, and not deductions from preconceived theory. 
459. Portal, in a memoir inserted in " La Medicine Eclaree," p. 335, shows with much clearness, the connection between the lungs and the superior extremities, by means of a great quantity of spongy cellular membrane, which proceeds from the upper parts of these organs; which, after passing under the clavicles, and accompanying the axillary vessels and nerves, penetrates the glands of the armpits. The spaces between the scapulae and the upper ribs, are occupied by this tissue; so also is the space between the great pectoral, and dorsal muscles, under which it passes, and extends itself to the muscles of the back, and those of the breast. The free and prompt communication between the lungs and upper extremities, is proved, M. Portal informs us, by injections. And nature may in part be imitated by the anatomist; for if he inject water into the cellular tissue of the lungs, it will be found to pass from air cell to air cell, until it arrive at the external part of the breast, and under the armpit; from whence it spreads itself to the arms and lateral parts of the chest, by means of the tissue just spoken of. M. Portal declares, he has reversed this experiment, by making water, or air, pass from the arms, or armpits, to the air cells of the lungs. From these facts the deductions are clear—namely, that whatever does injury to the upper parts of the arms, or armpits, will be felt by the lungs, &c; hence the injury which must necessarily arise from the exposure of these parts to cold, &c; and hence, in a practical point of view, the importance of remedial means to these parts, in cases of disease of the lungs; and hence, in children born of consumptive parents, the necessity and importance of having them sufficiently protected from cold by suitable covering. 


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Sect. III.— Of Exposure and u Hardening.' 1 '' 
460. In our variable climate, we oftentimes have every variety of the year, in any one given portion of it; thus in the middle of our winter, we have sometimes the mutability of April, or the mildness of May. If the latter be the case, or the temperature even lower, it would be folly to deny the enjoyment, and advantages of fresh air, (the body being properly guarded,) because our almanac declares the month to be January. The rule then for taking children into the open air, either in summer or in winter, must be founded in a great measure upon our sensations, and the thermometer; for in the former, it may indicate too high a temperature; and in the latter one too low, for the purposes of exercise or of exposure. 
461. But why should it be thought impossible to have fresh air in winter, unless the child be exposed to the inclemency of an out-door atmosphere? At that season of the year, is not the air, in a well-constructed house, of equal purity with that abroad? Cannot the temperature of a room be so regulated as to do away all risk in the enjoyment of the air? And is that air not sufficiently pure and elastic for all the purposes of health ? If these questions be answered in the affirmative, and we are sure every rational person will answer them so, we are in possession of a safe, and certain means to give the child fresh air, without the serious risk of exposure. 
462. Let us however admit to the sticklers for exposure, there might be an advantage in "giving the child fresh air in cold weather," agreeably to their opinions of fresh air, will it not be conceded on the other hand, that it will require much care? Will it not require that the child's body, or other parts, should not be exposed, and not only not exposed, but carefully, and sufficiently protected? Will it not also be admitted, that if attention be not paid to these circumstances, much risk, if not positive danger may be incurred? If these points be yielded, we will ask, if one mother in a hundred is so fortunate as to have a person to take the child "abroad," in which this essential confidence should be placed ? We are sure that many, perhaps very many, will say, Yes! because they believe so: yet any one of observa- 


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tion who travels our city, may contradict them; for they may constantly witness the limbs of the little sufferers exposed until purple with cold, while the nurse is attentive alone to her own pleasures or amusements, by holding a long gossipping colloquy with a dear friend, whom she has not seen for the "age of a week," or is examining in detail all the attractions of aprint-shop, or feasting her imagination with the delightful articles of a pastry-cook's window. After this, the child is brought home, benumbed with cold; the mother receives it with rapture, and because her darling has been breathing an air but little above Zero for several long hours, anticipates future health for her child; at the moment, perhaps, it has received its death-wound. 
463. It may perhaps be urged in opposition to these opinions, that the children of poor people are constantly "exposed," and have, in consequence, the best possible health. But upon this point, let the whole truth be told: we admit that " the children of poor people are exposed;" and also agree, that the number which remain of a family may even have "the best possible health;" but we would ask at what expense has this "best possible health" been procured? Look at our. bills of mortality, and see how large a proportion of the deaths, is made up of young children; and then examine the returns at the Health Office, and you will find how many of these "exposed" little sufferers die by the experiment, or rather from the necessity of "exposure." 
464. Many children, and especially those in large manufacturing towns; those of poor people, in crowded situations; and of those who have but a scanty supply of provisions, are born with strong predisposition to diseases. In severe weather, they are exposed to the debilitating effects of cold, besides the evils just mentioned, by which the latent dispositions are converted into active diseases; and the victims, made to swell the bills of mortality. 
465. Cold, when combined with poverty, exerts an almost irresistible influence upon the human constitution; they destroy, and spare not, the helpless infant exposed to their violence; they desolate without stint or measure; and have more victims, than any one disease, in the whole catalogue of human maladies. 
466. Adam Smith confirms this, when he says, "it is not 


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uncommon, I have frequently been informed, in the Highlands of Scotland, for a mother who has borne twenty children, not to have two alive. Several officers of great experience have told me, that so far from recruiting their regiment, they have never been able to supply it with drums and fifes, from all the soldiers' children that were born in it."* 
467. In thus attempting to point out the impropriety and danger of ill regulated, or indiscriminate " exposure" let us not be supposed to favour the opposite extreme—than which, nothing can be farther from our views. We as earnestly deprecate an overweening caution, as we condemn unnecessary exposure; the mean, is the golden rule; and the degree of temperature, regulated by the force of constitution. It would be no less preposterous than injurious, to subject every child to an equal degree of exposure. The strength of constitution varies in almost every individual—cold air, is unquestionably a cold bath, with certain modifications; now, no one would declare that the cold bath, and especially one of the same temperature, would be proper to every constitution, or at all times to the same constitution. 
468. We agree, that children may be brought up too tenderly; and we declare this mode to be as wrong, as the other—because, like it, it has its victims. Extremes, therefore, are never right. Upon a subject like the present, it would be impossible to lay down precise rules for every variety of case—we therefore can only give general directions upon this subject; the deviations which particular instances may require, must be left very much to the good sense, and discretion of the parent. We must remark however, 1st, that the lungs of young children cannot bear as low a temperature with safety, as children of more advanced age; nor those of even a more advanced age, so low a temperature as an adult; 2d, that the injury Which young children receive when exposed to a very low temperature, is through the medium of the lungs, and is not of a direct kind; for it generally requires the sudden application of warmth, to call into action the injurious effects of the previous cold—therefore this important caution suggests itself in the management of children, who have been unavoidably or unnecessarily exposed to a low temperature—viz. not to bring them too suddenly into an atmosphere 
* Wealth of Nations, Vol. I. p. 105. 


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of high temperature; 3d, as it is the lungs which especially suffer from a low temperature, no precaution of covering the body, can protect them with certainty against the consequences of §uch exposure; yet, if the body be well protected, it will very much diminish the chance of injury to the lungs, by tending to maintain, and equalize excitement; 4th, but if both lungs and body be exposed, the system has then to contend against the depression consequent upon the exposure of a large surface of skin, as well as that of the lungs; therefore, the risk of injury is increased, from this circumstance. 
469, We once urged the above, and similar objections against indiscriminate " exposure," to a lady who was a great stickler for it, when we were told with an air of triumph, that the plan she had adopted in sending out her children, would at once be an answer to all our objections to the practice. The plan, which shall be told in her own words, was as follows: " When the weather is cold, and that is the time you principally object to a child's being carried out, I take care not only to clothe the child very well, but also before the nurse sets out, to cover its little head completely with a good warm cloak, so that the cold air cannot get to its mouth; and it will sleep when it is thus covered up, as soundly as if it were in its cradle in the nursery. So you see that no possible injury can happen to the child, since it is not made to breathe the cold air, which you appear so much to dread." 
470. We admitted this completely prevented the child from breathing the cold air; but it unfortunately created an objection nearly, if not altogether as strong, as the one it was intended to remove—viz. that it obliged the child to breathe a heated and impure air, generated by its own lungs; consequently, the pretext for sending the child abroad, was entirely done away. We asked this lady, how she would like the plan of placing a child, on a very cold day, in the yard, after carefully wrapping it up in its " crib," that it might enjoy a nap in the open air? This she declared would be highly dangerous, and she could never think of running such a risk. We then asked her, in what this plan differed from her own? She became much puzzled for an answer, and could only defend her plan, by saying, that according to her method, the child had the advantage of exercise, which 


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the other had not. We then appealed to her candour, and asked if the child was more passive in the crib, than while sleeping in the nurse's arms? 
471. At another time, we were speaking with a lady who had lost three or four children with " croup," who informed us, she was convinced from absolute experiment, there was nothing like exposure to all kinds of weather, to protect and harden the system. By her first plan of managing her children, which was by keeping them very warmly clad, she lost several by the "croup;" but since she had adopted the opposite scheme, her children had been perfectly healthy, and never had betrayed the slightest disposition to the terrible disease which had robbed her of her other children. 
472. "Perhaps, madam," we observed, "you did not, in making your first experiments, attend to a number of details, which might be thought essential to the "plan—you perhaps did not take the proper precautions when you sent them into the cold air, or observed what was important when they returned from it." "Oh! yes, I took every possible care—when they were going out, I always made them wear a very warm great coat, well lined with baize, and a fur cape, or collar—I always made them wear a f comfortable,' made of soft woollen yarn, round their necks; and their feet, were always protected by socks or over-shoes, lined with fur or wool, as the weather might be wet or dry." 
473. " Do you believe, madam, they were kept at a proper degree of warmth, by these means?" "Oh! certainly: indeed, rather too warm; for they would often be in a state of perspiration, they told me, when in the open air, especially when they ran, slid, or skaited." "And what was done when they were thus heated?" "Oh! they got cool enough before they would get home." "And would they receive no injury in passing from this state of perspiration to that of chill?" "Not at all; for when this happened, I always made them take a little warm brandy, or wine and water; and made them ' toast' their feet well by the fire."* "Did they sleep in a cold or warm room?" In a warm 
* This absurd custom is a fruitful source of that distressing condition of the superior and inferior extremities, in winter, called "chilblains;" which article see, in the part which treats of the diseases of children. 
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room—a good fire was always made in the stove before they went to bed, which kept them quite warm all night." "Would they never complain of being cold towards morning, when the stove had become cold?" " Yes, certainly; but then there were always additional bed clothes at hand, with which they could cover themselves." " And did they always do so?" "Oh! I suppose so." 
474. " Well, madam, how did you carry your second plan into execution, which you say was attended with such happy results?" " I began by not letting them put on their great coats, but when the weather was so cold as to require this additional covering, and did not permit them to wear a ' comfortable' or fur, round their necks. I took away their over-shoes; and if their feet chanced to get wet, (for they were always provided with good sound shoes,) the shoes were immediately changed, if they were at home. If the weather was wet, or unusually cold, they were permitted to wear their great coats; but not without. If they came home very cold, they were not allowed to approach the fire too soon. I gave them no warm, heating drinks; and accustomed them to sleep in rooms without fire." 
475. Who does not recognise in this second plan for the enjoyment of "air and exercise," as judicious a plan of "physical education," so far as it goes, as can be well pointed out?—one we have been endeavouring to recommend, instead of the one it purported to be, " the happy results of indiscriminate exposure, in all kinds of weather, to harden the system;" and in the first, a preposterous routine of mischievous observances; observances entirely calculated to defeat the object for which they were so anxiously instituted. We were so successful as to convince this lady, in a very short time, that our " moderate plan" of exposing the body, was precisely the one she had pursued with so much success. 
476. We also inquired of this lady, what plan she pursued with her children, when too young to be subjected to the rules just mentioned? She informed us, it was the same system throughout, only the details varied, according as the circumstances of age, &c. made it necessary—that is, she sent her children into the open air at very early periods of their lives, provided in summer it was neither too wet, nor too warm; in win- 


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139 
ter, when the air was mild, dry, and clear; but always carefully wrapped up, that their little extremities might not suffer from cold. That she never suffered them to sleep in the open air, if it could be avoided; to prevent which as much as possible, she constantly charged the nurse to bring the children home, so soon as she found them disposed to sleep, unless it was when the children were very young, at which time it was impossible to guard against it. 
477. And when her children were sufficiently old to walk, she took care to provide them properly for it, whether it might be in warm, cold, or moderate weather. That she never sent them abroad for pleasure, at the risk of encountering a storm of any kind; nor permitted them to walk, at the hazard of getting wet, or very muddy feet. " Were the constitutions of your children pretty much the same?" we demanded of this lady. "No: one of my boys was extremely feeble, from his very birth." "Did you treat him after the same manner precisely as you did the others?" ** Yes, as far as regarded principles— that is, I permitted him to bear as much of cold, heat, or wet, as his constitution would support without pain, or injury; but the degrees were very different from those his brothers bore, had they been determined by the measurement of the thermometer, but precisely the same in effect, as far as could be ascertained by consequences—thus, if he were exposed to the same temperature as his brothers, he experienced no more inconveniences from it when it was very low, than they, because he had additional covering to protect him, &c." 
478. Let us not however be considered as advocates for a warm and enervating plan of education, because we condemn its opposite; for we believe nothing contributes with more certainty to impair stamina, than too great a delicacy of treatment, especially in the early part of childhood; and much as we deprecate ill-judged exposure, we are inclined to believe it is scarcely more injurious, than over-stimulating the tender systems of infants, by means of injudiciously applied heat. Heat beyond a certain degree, or when too long continued even in an inferior degree, acts like any other stimulus upon the vibritile system of very young children. It over-stimulates the nervous, goads to excessive action the circulatory, and relaxes the mus- 


140 
OF EXPOSURE AND HARDENING. 
cular system. In consequence of this, the different parts of the body do not develope themselves in their most healthy order, or in their natural proportions—the whole body is urged, to a precocious expansion. 
479. The cuticular system also suffers from this ill-managed application of heat: on the external surface, the sensible perspiration is greatly increased, and too long maintained; by which means, the sensibility of the skin becomes too much exalted, and cannot bear without immediate inconvenience, a lower temperature than that, to which it has been for a long time accustomed; hence, as soon as this part is exposed, there is an immediate check given to perspiration, by the capillaries terminating on the surface contracting themselves—disease is of course the consequence. 
480. It is not the external membranous system alone that suffers—the whole internal arrangement of it is more or less affected; for they either act inordinately, and produce affections of the bowels, or lungs; or they become torpid; and in this way, invite disease, by the destruction, or too great a diminution, of certain important secretions. 
481. Children over-tenderly brought up, either by heaping upon them too much clothing, or prohibiting a sufficient exercise in the open air, become liable to catarrhal affections, the instant "the winds of heaven, a little too rudely visit them;" and this misfortune is instantly quoted, against a proposal for a more invigorating plan of treatment. Thus, the effects of an improper system of education, are mistaken for a natural weakness of constitution; in consequence of which, the error is perpetuated, and the poor child becomes an early victim to a ferocious disease, or is made to drag out a protracted existence, in which there is neither comfort, nor enjoyment. 
4S2. Such a plan of education is sure to entail imbecility of mind, as well as debility of body upon its followers; for every part is put not only too extensively, but too early upon the stretch; in' consequence of which, no organ is duly prepared for its offices; and of course must perform its functions imperfectly. This hot-house plan of rearing children, has ever had more victims, than triumphs. It should therefore never be adopted, as it is contrary to the dictates of reason, as well as to the results of experience—and truly, 


141 
OF EXPOSURE AND HARDENING. 
like the hot-house plant, properly so called, is forced beyond its powers, and prematurely dies. 
483. One of the most remarkable instances of precocious maturity, is that related of Louis II. king of Hungary. He was born so much before his time as to have no skin.* At two years old, he was crowned; in his tenth he succeeded; in his fourteenth, he had a complete beard; he married in his fifteenth; he had gray hairs in his eighteenth, and in his twentieth, died. 
484. But, though we unhesitatingly condemn the plan of education just spoken of, yet are we at a loss to understand, why it should be considered so desirable to inure the body to extreme cold, in a climate like ours; since the attempt must in part be defeated, by every returning summer; and more especially, as the experiment is often of great price, from the manner in which it is too often conducted, by those who call themselves, the exact followers of nature. In climates where cold is in the extreme, nature attempts to guard against its evils, by established laws, and not by occasional or desultory experiment. In the very high latitudes, the inhabitants are enabled to support the low temperature to which they are exposed, by a physical conformation peculiar to such climates—thus they are almost invariably short of stature, fat, and enormous eaters of the most stimulating food. 
485. Their short stature enables the heart to drive the blood with more force and certainty to the extremities; and these are the parts most likely to suffer; for it is almost invariably found, even in our comparatively warm climate, that tall people suffer more from cold than short. And hence it is that the face collectively is enabled to support cold better than the hands, or feet, as it is nearer the source of circulation; and not because it is more accustomed to cold from exposure; for certain parts of it, (if we may so unite them,) as the ears, and the extremity of the nose, in which the circulation is more languid, suffer equally with the more remote parts of the body. The fat of people of high latitudes also tends to the same advantage; it is a bad conductor of heat, and thus serves to prevent its escape when gene- 
* This only means, we presume, that this covering to the body was excessively delicate, as we always witness when the foetus has not reached the seventh month. 


142 
OF EXPOSURE AND HARDENING. 
rated within the system; while their rapid digestion of the most stimulating substances, favours the extrication of caloric. 
486. Both reason and experience, then, seem to caution us against adopting with too much rigour, a system which is by far too general in its principles, for useful or healthful application; but they at the same time direct us to conform to one, which shall permit departures, whenever such departures shall be warranted by a change of circumstance, or rational expediency. And hence we may conclude, that there can be nothing more dangerous, than the random application of principles, that are in themselves doubtful. 
CHAPTER III. 
OF FOOD. 
487. The necessity of food commences after the first few hours of a child's existence; hence, the very early provision that is made by the mother's breasts. Of this we have already spoken at some length, and laid down some important general rules, which we do not think necessary to repeat here. When we were upon this subject, we considered the mother as the only proper guardian of the child; and we decided that it was her duty, and her's alone, to provide it nourishment from her own bosom; and the more effectually to ensure this under the best circumstances, we recommended the early application of the child to the breast, and gave our reasons at some length for this advice. In addition however to what we then said, we shall add other important arguments for such advice. 
488. In the last paragraph, we have in a very positive manner declared it to be the duty of the mother, and of the mother alone, to provide sustenance for the child, and that from her own bosom—this is our decided and unalterable opinion, as a general rule; a rule, that should not be heedlessly, or unnecessarily broken; one that should not be infringed, but from an imperious 


143 
OP FOOD. 
necessity. No plea of inconvenience or trouble; nor the subterfuge of imagined ill health, either immediate or remote, should be held valid. The incapacity, or incompatibility should be positive, ere the exception to the rule should be admitted; nevertheless, disqualifications may, and really do exist at times. 
Sect. I.— Causes which may render it improper for the Mother to nurse. 
489. The 1st is where there is no provision made for the nourishing of the child; or where this is not in sufficient quantity, owing either to a natural, or accidental derangement of the breasts, or the imperfect performance of their duty. 
490. 2d, Where the supply may be sufficiently abundant in the commencement, but where it habitually fails in a short period after, owing to some constitutional defect, which is perhaps neither evident nor remediable. 
491. 3d, Where upon former occasions, it was unquestionably found to disagree with the child.* 
492. 4th, Where there is a strong venereal or scrofulous taint in the constitution of the mother. 
493. 5th, Where suckling produces an active or painful disease in the mother, as cough, colic, &c. and also as 
494. 6th, Dr. Struve says, " those mothers who are so unfortunately situated that they cannot avoid provocation, grief, or sorrow; as well as others, who possess an irascible, and bilious temperament, or are subject to great nervous debility, accompanied by great susceptibility of every stimulus, will confer no benefits on their children by presenting them with a corrupted milk, which cannot fail to injure their health, and lay the foundation for consumptive, and fatal maladies, "t It must not however be imagined, that we intend to convey the idea by this quotation, that the milk itself contains the rudiments, or seeds of the 
* We must not however take this rule without exception—we have seen two instances, within the last two years, where the mothers upon former occasions were obliged at an early period to abandon suckling, owing to the bad qualities of their milk; but upon the occasions now spoken of, it was not only very abundant, but of most excellent quality. The children in both these instances, were of uncommon health and vigour. 
f Treatise on Physical Education, p. 215. 


144 
OF FOOD. 
diseases just mentioned, but merely, that constitutions labouring under such infirmities, cannot furnish healthy milk, or that of a sufficiently nutritive quality; and in consequence of the child being imperfectly nourished, its constitution yields to its predispositions, and active disease is produced. 
495. Parents labouring under certain chronic affections, may transmit to their offspring predispositions to such diseases; and the body so predisposed, if it be not properly nourished in its very early infancy, whereby it may become strong and well developed, the constitutional tendency may be called into action, and the child die early, or have a protracted disease as its consequence. These cases are daily presenting themselves to the physician, for his contemplation; and they have long, and anxiously engaged his most serious consideration; the result of which, so far as experience has yet determined, is, that nothing gives so effectual a check to this tendency, as bringing up the child upon a healthy breast of milk. 
496. Therefore, when either of these conditions of the parent obtain; either in the shape of infirmity of temper, or of actual disease, it is certainly proper to provide the child with some other means of support; the precise mode must be determined by circumstances; but the best for such cases as the fourth, (492) and the sixth, (494) is a healthy wet nurse, especially in the country. 
CHAPTER IV. 
OF THE MECONIUM, AND ITS MANAGEMENT. 
497. During pregnancy, there is an accumulation of a dark green substance in the bowels of the child, which is called " meconium," from its supposed resemblance to the syrup of poppies. This substance contains some bile; it is in various quantities; is of different tones of colour, and degrees of tenacity; and when permitted to remain undisturbed in the bowels of the child, is productive oftentimes of much mischief, especially in hot climates. This being the fact, it now seems io 


145 
OF THE MECONIUM. 
be admitted by all who are conversant with this subject, that it should be purged off, as early as circumstances will permit. It is only wonderful that there should have been two opinions upon this subject; since nature, if properly followed, performs this office by her own means, without the interposition of art—she effects this important end, by means of a substance called colostrum, found in the mother's breasts upon the first application of the child to them. 
498. But to derive advantage from this natural purgative, the child, as we have before remarked, must be applied early to the breast; if this be neglected until the secretion of milk, properly so called, takes place, it becomes too much diluted to serve this important end, and we are then under the necessity of having recourse to artificial purgatives, which never remove this substance so kindly as the colostrum.* Hence, in consequence of this neglect, the child is often tortured by colic or spasm, from the harsh remedy which may have been employed for this purpose. 
499. Purging off the meconium, is a matter of more moment than is generally supposed; or more properly, the manner of doing it. The propriety of this measure is so universally acknowledged in this country, that it has become a practice of routine in the management of new-born children; and in becoming so, it is made a matter of too much indifference by what agent this is produced—hence, the improper employment of stimulating, and drastic purgatives upon such occasions, to the decided inconvenience, if not to the manifest injury of the child. This disregard of the means by which the meconium is carried off, has arisen sometimes from an over-importance being attached to the consequences, should it be suffered to remain, or be found difficult to remove. 
500. Should this substance have been but imperfectly discharged from the bowels, all the evils which may chance to assail 
* It may be remarked, that those children who have been kept from the breast for several of the first days after birth, because, as the ignorant nurse declares, " there is nothing for them to draw," are uniformly more difficult to "cleanse," than those who have received into their stomachs the "colostrum" just spoken of. This substance, however, may be aided by the exhibition of a little molasses and water. 
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146 
OF THE MECONIUM. 
the child, are attributed to this neglect—nurses accordingly dreading such an accident, take care that no such blame shall attach to them; they therefore become indifferent to the means, provided the end be answered. In consequence, harsh and ill judged remedies are employed; and sometimes to the almost immediate destruction of the child. We are persuaded from our own observations, that many instances of severe and sometimes fatal bowel complaints, in very young children, have arisen from no other source; and it therefore, becomes an important part of our duty, to inveigh against this dangerous practice. 
501. The evil we are now speaking of, has principally arisen from two sources—1st, as has already been remarked, from due importance not being attached to the retention of the meconium; and 2d, from too unlimited a confidence being placed in the judgment of the nurse. As regards the first, we hold it highly proper, nay perhaps essential, that the meconium be carried off; because nature herself declares its propriety; but it by no means follows, that this must be effected, coute qui coute—the means should be properly adapted to the end; and of these we have a sufficient choice. For the purpose just suggested, a solution of molasses, or of manna, in a little warm water; a tea-spoonful of sweet oil; the same quantity of the simple syrup of rhubarb; or in more obstinate cases, a tea-spoonful of warm castor oil, is almost always sufficient. 
502. It is true, that we occasionally meet with instances of such tardiness of bowel, or so large a quantity of meconium, that a repetition of the above named remedies may be necessary; but they should never be persevered in after the object for which they were given has been answered; and this is ascertained with almost absolute certainty, by making ourselves acquainted with the appearance of the evacuations—if they are no longer tenacious, and of a dark green colour, the howels have been sufficiently purged. 
503. 2d, Much mischief has been done by reposing too much confidence in the judgment of the nurse. This always convenient, and oftentimes highly valuable appendage to the lying-in room, is too frequently self-willed, and will too often run counter to the advice of the physician. This arises from her attaching too much consequence to her own experience, or by having 


147 
OP THE MECONIUM. 
"the pride of office," in her opinion, too much humbled, by an appeal from her directions. To prevent her self-love being wounded by any interference in her management, she very often conceals from the physician in attendance, any casualty that may befall the child. This may be a complaint of a serious kind, when the physician is first made acquainted with it— but had it been attended to with sufficient promptitude, it might have been of little moment; here her want of knowledge of what was proper to be done, and the application of improper remedies, has permitted the disease to acquire a force, that bids defiance to future control. 
504. We trust we have a just, and due respect for this class of people; and we are sure we are incapable of bringing any false charges against them; but a long experience has settled in our minds, their exact value. The estimate we have made of their worth, makes us declare that some are invaluable for their patient endurance of fatigue; for their occasional successful exercise of judgment; and for an amiable display of social virtues; but others, are the very reverse of what we have just declared. 
505. During the attendance of the physician, the duty of the nurse as regards the medical treatment of both mother and child, is reduced to great simplicity—for she should but obey, and that implicitly, his directions. She should never violate his orders herself, nor knowingly suffer others to do so; but every thing which belongs to medical treatment, whether it be merely prophylactic; the absolute administration of medicine; or the observance of regimen, she should never interfere with; she should most scrupulously see them duly and rigorously enforced; for it is her bounden duty. During the period of convalescence, she should constantly make her directions and management conform to the general principles, inculcated by the medical attendant. When she does more than this, she does wrong, and ought to be made accountable for any mischief that may happen. But we have perhaps no right to expect any thing but the exercise of the blindest temerity, from those whose opportunities, do not afford intellectual culture. 
506. Unfortunately, the custom of society is in this particular, almost in direct opposition to what we esteem its best interests. 


148 
OF THE MECONIUM. 
The opinion of a nurse is oftentimes taken before that of an experienced practitioner! In this the world departs from all its other habits. If advice be wanted on a question of law, will it prefer the opinion of the constable, to that of the experienced advocate? If a text of scripture is wished to be expounded, will it apply to the church clerk, rather than to the learned divine? Or should even a coat or hat, or a pair of shoes, be wanted, will it prefer the efforts of the apprentice, to those of the master. 
507. If this practice had not a decided influence upon the immediate health, or the future welfare of the child, we should not think it worth a mention; but when we have witnessed so many serious errors committed at this period of the child's life, we think it an imperious duty to try to correct them. In making these charges against this class of highly necessary people, we disclaim all intention to criminate— we urge but an error of judgment. But from the number of victims, as we most conscientiously believe, this confidence in nurses has had, it is full time a stop were put to their ravages: for were we to declare honestly in round numbers, the instances of death of very young children, which we believe we have witnessed ourselves, in consequence of the evil we are speaking of, we should be afraid our truth might be questioned, and that we should be suspected of indulging in hyperbole. 
508. Nor will this statement excite much surprise, when the facts connected with it shall be investigated by rational and dispassionate inquiry. Let it be remembered by what a frail tenure, a new-born babe holds its ill established life; let it be recollected, how many causes may suddenly act, to weaken that life, which is now so frail; let it be taken into view, that if these causes be not successfully removed, they for the most part will produce death; then let it be admitted, how much judgment and experience are required, to detect the particular cause; how much care and knowledge are essential to the suiting of the strength of the remedy, to the force of the disease; and let it be acknowledged, that if these do not unite in the person of the nurse, who usurps now the place of the physician, that much danger must be incurred, and we shall cease to wonder, that their efforts, to say the least, are not crowned by success. 


OF THE MECONIUM. 
149 
509. It is our firm conviction, that the mortality among children is unnecessarily great; and that this excess originates in very many instances, in the mal-administration of the means of life, rather than to the operation of natural, or inevitable causes. Some are nursed to death, while many die because they are not nursed at all; some are fed to death, while others die from inanition; some are physicked to death, while others die from the want of a single dose of it—all of which go to prove, how much experience, and judgment are required to administer with success, to the many wants and infirmities of children. 
510. It must appear reasonable to every reflecting mind, that the great mortality among children must have for its cause a variety of circumstances, not absolutely essential; and that it is more than probable, that many of the contingencies to which the poorer class of children may be subject, are of a nature to be improved, if not altogether to be removed. It justly merits the consideration of every friend to humanity, to ascertain the causes which may produce this uncommon mortality, with all the precision of which the subject may be susceptible. 
511. To us short-sighted mortals, it would seem to be no part of God's providence, to create so many children that they may perish, at so early a period of their existence. And we are firmly persuaded, that the following are the principal means, by which this immense mortality of children may be diminished:—1st. Let none but a mother, when she is able, have the immediate charge of her child; for she alone should supply it with food; it is she alone who should administer its medicine. 2d. Let every mother make herself well acquainted with the best opinions upon the physical management of children; but never let her aspire to their medical treatment, except from dire necKfsity. 3d. Let nomother trust another to count out doses of laudanum, while she herself retains the faculty to do so, unless the person thus chosen has as deep, or nearly as deep an interest in the child, as the mother herself.* 4th. In case of indisposition, let the mother 
* We have italicized this direction, because of its importance; and because we wish it to be impressive; for we have every reason to believe,that the trustingthis important office to others, has been fatal in several interesting-cases, which have fallen under our immediate observation; in several, we have hadproof; while 


150 
OF THE MECONIUM. 
confide in no judgment for her child's disease, but that of her physician, if his advice can be commanded; and, above all, let not his prescription be interfered with, by the obtrusive advice of a nurse, or a still more ignorant old woman. 5th. Let a mother place no undue confidence in the prescriptions of a nurse, under the persuasion that her experience must be valuable, when the advice of an experienced physician can be obtained; for let it be recollected, that if experience is to be the guide, the latter sees a hundred patients, to one of the former. If these simple rules be well observed, we are persuaded, they will tend to abridge the mortality among children. 
512. Let us also call to our recollection a truth, which we believe none will dispute—that in general, children are born healthy, and with good stamina; and with the exception of purging off the meconium, they require no medicine. If this become necessary, it is no infringement of the rule—it is but the exception to it; therefore the vile and hurtful practice of drugging young children, cannot be too much reprehended. 
in others, strong- suspicions were entertained, that the deaths were owing to the too large exhibition of laudanum. This drug has now become so familiar, as to be ranked with the " domestic remedies;" its presence no longer excites dread, nor its exhibition, terror. But let it be remembered, that however the horror of the rattlesnake may be diminished by familiarity, its sting is no less deadly. 
We have every reason to believe, that thousands of young children are sacrificed yearly, by over-doses of this medicine. Its use is so common, and its virtues so often witnessed, that caution sleeps—for even children are trusted with its exhibition. A fatal instance of this kind has happened within our knowledge, within a few days. A fine little girl of nine years of age, complained to her mother of the tooth-ache—the mother told her to put some laudanum in it, and gave her a vial of the liquid for this purpose. The child took a quantity of it into her mouth, and held it there; but at the same time, swallowed enough to destroy her in a few hours afte*. And we once heard a mother who was about to leave home for some hours, desire her daughter, a girl of eleven years of age, to give the baby five drops of laudanum, should it be "cross" while she was gone! We remonstrated with her upon this extreme carelessness, but we were answered, " her daughter was used to it." 
It is still fresh within our recollection, when our prescriptions for laudanum would frequently meet with opposition; and if the counting of it were trusted to the " nurse," she would perhaps diminish the dose—but now! she gives it not only with a free, but oftentimes with a daring hand. A laudanum bottle is now a sine qua non to the furniture of a nurse's pocket. 


OF THE PROPER NOURISHMENT, &C. 
151 
CHAPTER V. 
OF THE PROPER NOURISHMENT FOR THE 
CHILD. 
513. Nourishment, and this derived if possible from the mother, is all that a new-born child requires; and it does not happen once in a hundred times, that the mother is not in every respect competent to this end; especially if she have previously discharged the duties of one, by paying a proper attention to her health. It rarely happens that the child does not find more than is absolutely necessary to its sustenance; therefore it were preposterous to furnish it with more. 
514. The reasons which are assigned, for giving the child other nourishment than the mother's milk, may be divided into the relative and the absolute. The relative are—1st, the fear of weakening the mother; and 2d, convenience. The absolute, is, the mother not furnishing a sufficient quantity, or that of a proper quality. It is therefore said, first, that the child should be fed to spare the mother. How spare the mother? If she furnish more than the child can consume, or only as much, how is the mother spared, by satisfying the child's appetite by other means? The milk is secreted in the breasts, by taking so much material from the general mass of blood; and all the consequences which can happen by that deduction, are already experienced in its formation. Therefore the woman is no «more weakened by the child's taking it from the breasts, than if it remained in them to be absorbed from them; or in other words, the woman will not be strengthened by permitting it to remain undisturbed in them. 
515. 2d. Convenience—it is said, the child should be fed early, that it may become accustomed to it, in case the mother should be sick, or should wish to go out, or to leave it upon any occasion. But we say, " sufficient for the day is the evil thereof"—and that the child should never be subjected to a certain evil, to guard against a contingent one; for should the mother 


152 
OP THE PROPER NOURISHMENT 
be ill, and suffer a diminution of milk, the child can then be taught to feed, as certainly, when feeding may be useful, as when it is not required. Therefore, there is nothing gained by this anticipation; but there may be something lost. And considered as a convenience, when the mother may wish to leave her child, it is both a cruel, and unnecessary one—cruel, because it will tempt a gossipping mother, to neglect her dependent child; and unnecessary, because a child that is governed by a well regulated system of nursing, can never suffer by any proper period of absence of the mother. 
516. It should however be observed, that the child should not be subjected to any laws of nursing, until it is six months old; for up to this period, it will be rarely necessary to establish a system, as it will seldom make unnecessary demands for nourishment, unless a bad one has been pursued from the commencement, by indulging, or rather attempting to quiet the child by the breast, or by the still more improper plan of giving it pap, because it cries. If this system be pursued, much inconvenience will result; for one of two things must happen. 1st. If the child does not cry from absolute pain, a bad habit will be generated; for the child will cry for the mere gratification of being nursed: this will not only create a great deal of trouble, but will be highly injurious to the stomach itself, by occasioning it to be overloaded, and thus producing vomiting, purging, or colic; or 2d. If the child cry from actual suffering, the food may not do any possible good, or it may much increase the evil, by its being given at an improper or unnecessary time. Therefore, before this kind of indulgence is established, let the mother believe the child may cry from other causes than hunger, especially, if the breast, or food, has not appeased it—let her examine whether a deranged, or ill adjusted pin, may not create the pain; or that its bowels may not be tormented by flatulency; in the one case it is evident that the feeding can do no good; and in the other, it may be mischievous. 
517. We all know how easily the stomach may be made to demand more food than is absolutely required—1st, by the frequent repetition of aliment, or 2d, by its variety; therefore, both of these causes must be avoided. The stomach like every other part, can, and unfortunately does, acquire habits, highly injurious 


153 
FOR THE CHILD. 
to itself —and that of demanding an unnecessary quantity of aliment, is not one of the least. It should therefore be constantly borne in mind, that it is not the quantity of food taken into the stomach, that is availing to the proper purposes of the system; but the quantity, which can be digested, and converted into nourishment, fit to be applied to such purposes. 
518. After the child has attained the sixth month, some system should be observed in all its little supplies, whether of nursing, or receiving of food, of rest, of cleaning, or of exercise; and as life really consists but in the performance of a routine of habits, it is a matter of much moment, that only such should be established, as will most effectually serve the general, and best purposes of the system—therefore, all unnecessary, as well as every improper one, should be avoided; consequently, the sooner we begin, and the more regularly we adopt those which are proper, the better. 
519. On this account, as little variety in the food of the child should he permitted, as possible; for when many substances are offered, the stomach will receive more than it can master; precisely like the adult at a plentiful table, each new article becoming a fresh provocative to appetite; and for this reason also, a little latitude should be given to the periods of sleeping or feeding; for though we distinctly perceive an advantage in some established order for these, yet this order should not be rigidly established, to the moment; for when it is strictly observed, the child will require both the one and the other from habit, rather than from necessity. Therefore, this extreme regularity must be avoided, as much inconvenience may otherwise result, to both mother and child. 
CHAPTER VI. 
OF PARTIAL, ARTIFICIAL NURSING. 
520. The absolute reason for feeding the child, namely, the mother not furnishing a sufficient, or a healthy supply, is the only one which should be considered as obligatory. Such cases however present a choice of means—1st, where the mother may 
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154 
OP NURSING BY THE MOTHER. 
continue to suckle her child, aided by artificial means; 2d, where she is obliged to have recourse to artificial means entirely; 3d, a wet nurse. 
Sect. I.— First Means; or where the Mother may continue to nurse her Child. 
521. We have always considered it best, when there is such a reduction of the mother's milk, as to but imperfectly nourish the child, to aid this scanty supply, with the preparation we have already noticed, (248) consisting of cow's milk, water, and sugar. This may be administered to the child, in one of two ways— 1st, by the spoon; and 2d, by the bottle. We should however never recommend the first, if the second can be enforced; and for the following reasons: 1st, it is always less cleanly, as the child's breast is almost always wetted in the attempt; 2d, the child is always fed lying down, and consequently, there is some risk of strangulation; 3d, the temperature of the fluid about to be administered, may be so high as to do injury to the child's mouth, and throat, by burning; 4th, there is a constant temptation to improve the victuals, by the addition of flour, &c; 5th, by the food being previously made to pass through the mouth of the nurse, before the child receives it; 6th, by this method, the child loses the advantage of the admixture of its saliva, with the food it is receiving. Therefore, we consider the second plan to be best, when it can be adopted. 
522. It may be asked, would we confine the child which is in part artificially nourished, to the diet just mentioned, until the period of weaning? We would say, No—we would permit the addition of barley water, of gum Arabic water, of rice water, or a small portion of arrow root, after the fifth month,* in cool weather, should there be a predilection in their favour; but up to this period, and in hot weather, we believe the simple diet above mentioned, to be the most proper; especially, as the stomach gets a habit, if we may so term it, of digesting articles with ease by becoming familiar with them; hence, the propriety, and importance, of confining the child to the mother's milk, whenever this is practicable. 
* We are always supposed, in our directions, to have reference to children in good health—the medical treatment of them is a distinct consideration. 


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523. Dr. Clarke very justly observes, that " nothing is more absurd than the notion, that in early life children require a variety of food; only one food is prepared by nature for them, and it is too presumptuous to assume that the Creator of the world, acted in error; and that the ignorance of man is capable to correct it, or make any improvement in his works."* 
524. The articles of food administered to the child by the artificial plan, should be as little varied as possible, for the reason just stated; and also, because each article has its period for digestion; it will therefore follow, that some may be of such difficult solution, as to be productive of much mischief. Much care is also required to preserve the artificial articles in a perfect state, as we have already noticed; and the directions given at that time, should be strictly adhered to, that the stomach may receive nothing in an altered or partially decomposed state. Besides, is it not folly to change that substance, which agrees perfectly well with the child? 
525. Indeed, nature has very emphatically declared, by the organization of the infant, that her laws respecting food cannot be transgressed without marked injury. The want of teeth, or the means to masticate, and the feebleness of the powers of digestion, in early infancy, strongly indicate the necessity, of an especial regard being paid to the food of the child, to preserve it even in common health, and to prevent the development of several painful, and fatal diseases. Therefore, it has always been found decidedly injurious, if not immediately fatal, to anticipate the powers of the stomach, by offering food to it, which was beyond its capacity to digest—hence, the frequent development of consumption, scrofula, and rickets, at an early period of life in the children of the poor, because food suitable to the ages of children, could not be procured; or in others from the disregard of a truth so obvious as, that a child of a few days, or even months old, cannot digest the food that may be proper for children, of a much more advanced period. 
526. From the earliest period of medical history, the importance of this rule has been insisted on: for Hippocrates himself 
* Commentaries, p. 58. 


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inculcated its necessity, and strongly insisted upon its importance, and devoted a considerable part of his works to the subject of diet; nor have his cautions, or instructions upon this point, ever been disputed. Therefore, a deviation from the rule, namely, to accommodate the nature of the food to the age, and powers of the child, should be infringed but from necessity alone. 
527. Nature has ever been attentive to this subject, throughout animal existence; she has governed the general system almost exclusively by the powers of the stomach; and we may trace the influence of this law from the simple hydatid, to the most perfect animal. She has so arranged the powers of the stomach, that a departure from the general law which governs it, cannot be made without evident injury, and perhaps death itself. Thus the cow cannot be made to live upon animal food, nor the tiger upon vegetable, &c. The same general rule holds good with regard to man, in the early, and after part of his existence. It will be agreed upon by all, that the infant could not be made to thrive upon the gross food necessary to adult age; and that adult age would be but ill sustained by the food of early infancy, however abundant it might be in quantity. And the same principle holds good in the whole class of mammalia. For in this class, milk is always the first article prepared for the sustenance of the young of every species; and they are confined to it universally, until fitted by a new arrangement of organization, to profit by other food. 
528. This law is more remarkable with main, perhaps, than with any other animal; for the state of probation, if we may so term it, is longer with him, than any other. The early parts of his life, are marked by most important and distinct periods; and each period has its appropriate state of mouth, and powers of stomach: thus, before the appearance of teeth, nothing can be proper but the milk of the mother; after the appearance of some teeth, the addition of some farinaceous substance may be permitted; and after their completion, or even a little earlier, animal substances may be added. 
529. It is often asked, at what age will it be proper to make a change in the diet of the child, by giving it a proportion of animal 


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food ? This question must be answered by referring to a principle, and not to a period of the child's life, marked by a lapse of any number of months. Nature has declared by the formation of the teeth, and by the organization of the stomach, that man is a promiscuous feeder; and that a due mixture of vegetable and animal matter, is essential to his best, and most perfect well being. The question now narrows itself, by asking, by what sign shall it be known, when a change of food can advantageously be introduced into the human stomach? This is fully answered, we trust, above. If the cutting of teeth shall mark the proper period for changes, (as we believe it does,) it will at once be seen, it cannot be fixed by dates, since, the cutting employs, from the third, to the eighteenth month, or even longer sometimes.* And it would seem to follow, from these premises that animal food cannot be given with propriety, even in small portions, to a child, before the system has protruded the grinding teeth; therefore, we would say, as a general rule, it would be improper, before that event had taken place. 
530. After a child has got its grinding teeth, its food may be a little more varied, as well as more substantial; yet it must consist principally of milk, in which grated cracker may bestirred; well baked stale bread; rice flour, or arrow root; and occasionally, a little animal food in substance may be given, provided it be previously well divided; or it may be used in the form of broth, or tea. After the eye and stomach teeth have come through, the child may be indulged daily, but only once a day, with solid animal food, which has been either boiled, or roasted; as any other mode of cooking it is exceptionable. 
531. An error is constantly committed, in the early exhibition of animal food—it is imagined, that all kinds are equally proper, and these either salted, or fresh. And further—if the child happen to be reduced by any cause, they suppose that the more frequently meat be given, the more the child will be benefited. But such people should be made to understand, that it is only that part which is digested that can be useful, and that this will depend exclusively upon the powers of the stomach; and more- 
* We have at this moment, (May, 1825,) a little patient, seventeen months old, who has not cut a tooth. 


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over, that these powers can be easily overstrained. And in corroboration of what we have just stated, it is agreeable to all observation, that the healthiest children, are those that eat the least animal food. 
532. Though the occasional and moderate employment of animal food, may be sometimes necessary from peculiar circumstances after some teeth may have made their appearance; yet the quantity, and quality, are not matters of indifference. It should never be given in such quantity, in a solid form, as to make it a meal, as the stomach most probably will be unable to manage so great a bulk; and certain it is, the exigencies of the system cannot require it. The most proper mode to exhibit it, is in a fluid form—such as beef, mutton, or chicken tea, without any mixture of vegetable juices. These teas should be given at such intervals, and in such quantities, as the deficiency of the mother's milk, or the situation of the child, may render necessary; or as a change of food may be judged important, from the number of teeth; or when the advancement of the age of the child, may seem to require this additional stimulus, without such a failure on the part of the mother. 
533. It is not a matter of indifference, what animal is made choice of for its flesh—some are decidedly better than others. Beef, mutton, fowl, are much to be preferred to veal, lamb, or pork. Oysters are very unexceptionable articles of diet, when made into a thin soup. In using however, any of these articles, especially in warm weather, care should be taken to have them fresh; as any progress towards decomposition, would be highly improper, if not really dangerous. Therefore, but small quantities should be prepared at a time, and used as quickly as may be, after. The lean parts of either of the first named meats, should be used in making the tea; or if it be difficult to separate the fat before boiling it, it is not so afterwards; for if the product be permitted to cool, the greasy portion can easily be separated. The red juice which flows upon the cutting of underdone beef, or mutton, can very advantageously be employed, by adding an equal measure of water, and suffering it to boil—there should always be a little salt added; and a blade of mace is a pleasant and proper addition, especially in hot weather. Veal, or lamb, 


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may be used, provided the beef, mutton, fowl, or oysters,* cannot be procured: they must however always be looked upon as inferior to the others. Pork is never admissible. 
534. Regular periods, or nearly so, should be observed in exhibiting the animal juice, that they need not interfere with the digestion of the milk the child receives from the mother; therefore it will always be best to give them at stated times, taking care to let it be received upon an empty, or nearly an empty stomach; especially, when this chsmge is commencing—the reason for this is, to ensure to the newly-introduced substance, the full powers of the stomach. 
535. On this account it is also right, that the mother observe, after a certain time, some regulation as regards the periods for suckling—we have elsewhere fixed the period at about the sixth month. (516) Before this time, but little injury can be sustained by a frequent indulgence at the breast; but after this, it becomes highly important, both as regards the mother, and the child. On the part of the mother, it prevents an over-stimulation, and consequent weakness of the glands of the breast; it permits a gradual accumulation of milk in the milk-vessels, and gives time to the nipples to recover their tone, and thus prevents their becoming sore. On the part of the child, it prevents overdistention of the stomach; it prevents fretfulness, or clamorous demands for the breast; and at night especially, it permits it to sleep, and thereby gives ample opportunity for the digestion of the food it had previously received. On this account, it is a good rule, that the mother should suckle her child, the last thing before she goes to bed. 
536. It is a common practice with many mothers, to permit the child to go to sleep at the breast. This should always be 
* Mr. Friedlander condemns oysters, as being* too heating. If this mean any thing, it must be, that they are too stimulating. Now, this is very far from being confirmed by our own observation, or, we believe, that of any other physician in this country. We have ever found them to be nutritious, and void of all stimulating qualities; so much so, that they are the first article we indulge our patients with, on their return to convalescence. He has ranked them, very unjustly, with muscles, lobsters, crabs, &c. which are known to disagree very often, especially in warm weather; whereas the oyster is very nutritious, and bland, and rarely offends, like the others, by any peculiar quality. 


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avoided when possible; for the fear in which this practice originates, is purely chimerical—namely, that the child may suffer during the night for want of nourishment. The frequent taking of the breast, is entirely a habit; and one, that is calculated to do mischief; as both the rest and digestion of the child are interrupted, to say nothing of the unnecessary fatigue to the mother. 
537. Occasionally, we have known the stomach reject these animal solutions. In such case, where the change of diet is desirable, we have found the substance itself, when divested entirely of its fat, answer very well; it should however always be chopped up very fine, and given in very small quantities at a time. By this plan of feeding, several advantages arise: first, the child has the meat well divided by the knife, which could not always be done by the teeth; 2d, if given in very small quantities, the child permits them to tarry in its mouth, until they become saturated with saliva—a circumstance of very great consequence to the process of digestion; 3d, it prevents the risk of temporary strangulation, as the bulk is not sufficiently great when thus divided, and given in small quantities, for this accident to take place; consequently, a disgust to the food is not excited. 
538. At this period, also, that is, after a number'of teeth are cut, the child may very profitably be indulged in the use of butter. Small pieces of good stale bread and butter, may be given, several times a day; the butter should however always be of the best quality; and unless this can be ensured, it is decidedly best it should not be given. Some young children will not take it when spread upon bread; it may then be given alone, in small quantities at a time. 
539. Strong prejudices are entertained by some, against the use of the last named article; so much so with a few, that it is entirely prohibited to young children, and sometimes even to older. The fear of butter originated in unfounded premises, and in absurd deductions. It is said, that in this climate, especially in warm weather, our diseases are almost all of a bilious character—butler is bilious; therefore, butter favours this dangerous tendency of the body. This absurd logic, appears to be the sum of evidence against the use of this delightful, and highly useful substance. * 


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540. For many years past, our habits, as well as our duties, have led us to make observations upon the use of butter, as an article of diet, and especially for young children; and frfrm all that we can collect upon this subject, we are decidedly of opinion, that it is not only innocent, but highly useful. It is grateful to almost all children; yet we do not recollect an instance, where an indulgence in it, was followed by the slightest injury. And as a medicine, in certain affections of the bowels, it constitutes in some instances an invaluable remedy, as we shall have occasion to notice in its proper place. 
541. Most people are in the habit of giving the potato to children of the age we are now noticing. The propriety of this, in our opinion, is very questionable; and we think its use should not only be very limited, but given with great caution. We have oftentimes witnessed very distressing results from the too free use of this vegetable; and especially, when it has been given, as it too frequently is, mixed with the gravy of meat. We have seen many instances of indigestion, cholera, colic, and sometimes even convulsions, succeed a too free indulgence in this article. If the potato be used, it should always be well mashed, with a little hot milk, a small piece of fresh butter, and a little salt. This is the most unexceptionable mode of using it; and even this should be given in small quantities at a time, and only to children beyond the ninth month.* 
542. To some stomachs, the potato is uniformly exceptionable; nor does a perseverance in its use, as has been often attempted, serve to reconcile it. This root does not contain as much nou- 
* It must however be confessed, that the introduction of this highly valuable root, has been attended with much good, even to young children, in countries where the means of life are scarce, and of course difficult to procure among the poorer classes of people. To these it has afforded a large supply of food, at a very moderate expense, besides its quality being absolutely better, than much of that which they were obliged to employ before its introduction—therefore, comparatively, it is much better than many other roots before in common use. Thus Professor Lentin, (Friedlander, 1'Education Physique de PHomme,) informs us, that the comparison of deaths in his parish, before, and since the introduction of the potato, is much in favour of this article. But all this, only declares in favour of this root, where it is put in comparison with certain other; it does not prove it to be the best, or even equal to many other articles; for instance, as good wheat flour, rice, arrow root, sago, or tapioca. 
[21] 


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rishment as is generally supposed; and what there is, is very difficult of extraction to even a slightly enfeebled stomach. Who has ritt seen it pass through the bowels, in the precise condition it entered the stomach? And who has not known this friendly warning disregarded, until serious injury has arisen from a perseverance in its use ? 
543. Many of the solid articles of diet, have been employed merely because they were solid; and this preference for solids has arisen from the vulgar belief, that they are necessarily more nutritious than fluids; than which, in many instances, nothing can be farther from the truth. Besides, it should be recollected, that before a solid can be converted into nourishment, it must be first reduced to a fluid state. > 
Sect. II.— Second Means; or where the Mother is obliged to use artificial Means entirely. 
544. When the woman is obliged to give up suckling her child altogether, and prefers the second (520) to the third mode of nourishing it, she is under the necessity of conveying food to it, as we have already observed, (521) in one of two ways—viz. by the spoon, or by the bottle; and we at that time gave our reasons for preferring the latter. We will now, however, say something farther on the subject of nourishing the child by the bottle. 
545. We consider the use of the sucking bottle, as a great improvement in the rearing of children. Unquestionably, it is one, that is attended with the most entire success in very many instances, though we at the same time admit it to be accompanied with considerable trouble, where it is administered in the best manner; and must always be regarded, but as a substitute for the breast. But where the choice lies between it, and a hireling nurse, we should without hesitation give it the preference, unless our choice could be very securely made in regard to the latter; or there are existing some particular circumstances, which render the bottle improper. 
546. There are cases however, in which we should very much prefer the breast; and this even at the hazard which must always attach, in making choice of a person to fulfil the important duty of a nurse. These cases are—1st, for a very young, and feeble 


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child, and where this weakness arises from its immaturity; from a natural delicacy of constitution; or from the previous illness of the mother; 2d, where the mother has a tainted constitution; and which taint, has been in other instances, or may again be perpetuated to the offspring; 3d, where the mother's milk has decidedly so far disagreed with the child, as to produce either bowel complaints, or great wasting; 4th, where the child is recovering from illness, particularly from complaints of the«tomach, and bowels; 5th, and especially, where the experiment of the bottle has been fairly tried, and it has not been found to answer. 
547. When the bottle is used, much care is required to preserve it sweet, and free from all impurities, or the remains of the former food, by which the present, may be rendered impure, or sour; for this purpose, the following cautions must be observed:* 
548. 1st. Never put a second supply of milk, or food, upon the remains of a former, unless a very short interval only has elapsed, and they are of the same making. 
549. 2d. So soon as the child has taken as much as it choose, or as may be judged proper for it, let the bottle be emptied, if any food remain, and immediately cleansed by hot water. 
550. 3d. When well cleansed by the hot water, let it be thrown into, and kept in a basin of cold water, in which there is a little soda dissolved. 
551. 4th. Before using it, let it be well rinsed with clean cold water. 
552. 5th. Let the extremity from which the child is to suck, be covered with a heifer's teat, in preference to any thing else; and with a view to its preservation, the following rules must be observed. 
553. 1st. Let this teat be one, that has been preserved in the best possible manner, by those who understand this art.t 
554. 2d. Let not the teat be of too large a size; nor one, that 
* It is not the bottle alone which requires this strict attention to cleanliness; it is every utensil that is employed, either in the preparing, or receiving the nourishment of the child—for they may become either sour or impure, by some of the victuals adhering to them; or they may be chemically acted upon; as vessels made of copper, or glazed earthenware. 
t They can be procured, of the best quality, at No. 33, Market street. 


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will permit too rapid a flow of the food, especially for a very young child. If it be found to pass too freely, let the piece of* sponge which is, or always should be, at its extremity, be either enlarged, or more strongly compressed. 
555. 3d. Immediately after the bottle has been used, remove the teat from its mouth; and let it, and the sponge, be well washed, and kept until again wanted, in a little whiskey and water. • When re-applied, let it be attached by a piece of clean thread, as the former piece will be sour. 
556. From what we have said, it will appear, that we prefer the flat oblong bottle, with a teat, to the bottle and tube—and we do this for the following reasons: 
557. 1st. The extremity of the tube is never so well received by the child, as the teat; nor is it so comfortable to its mouth. 
558. 2d. The tube frequently becomes obstructed by the curd of the milk; and it is oftentimes difficult to remove it; and if not removed, its objects will be defeated. 
559. 3d. It is much less convenient; requiring much more address in the management of it, than the bottle. 
560. 4th. It is much more difficult to keep clean, or Sweet; consequently, must be improper in proportion to that difficulty. 
561. The food for the child in this artificial nursing, is the same as we have already recommended, (248,) when only partially nursed by the bottle; namely, the cow's milk, water, and sugar. It should be frequently renewed, for the reasons we have already given; and it should never be made too tenacious by the addition of any other substance than those already recommended, as it will not pass through the pores of the teat, or through the tube with sufficient facility. 
562. Children who are brought up by artificial means in this country, have subsisted almost altogether upon cow's milk, reduced as directed before. The European writers speak highly of the milk of other animals; but of the qualities of these, we have had no opportunities to judge. Thus the milk of the goat, the mare, the ass, &c. have been much praised for their nutritious, and other qualities, by different writers. 
563. Dr. Clarke,* of London, declares " the milk of the ass, 
* Commentaries, p. 56. 


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to be the best substitute for that of the mother. Cow's milk is too rich, containing too much oil and cheesy matter." We will however give the results, which the analyses of the milk of several animals have afforded, agreeably to MM. Parmentier, Deyeux, and Vauquelin. 
564. One hundred pounds of milk gave of 
Cream Butter Cheese Sugar The Cow 4 T V m 8 44 9* Woman 8±4 3 7 T \ Goat 744 4,V 9| 4| Ass 2|f 344 4^ Sheep 11 T V 5±i 15| 4 T V Mare 14 14 ' 9 T V 
565. From this statement it would appear, that the milk of the ass and the mare, approach nearer to that of the human, than any other yet analyzed. The milk of the mare is remarkable for its containing so little cream, and so large a proportion of sugar. 
566. But the nearer we can approach the qualities of the breast milk, the better will be our compound; for nature has declared that to be, the best possible pabulum for the child; and there cannot well be a greater error, than to suppose every addition an improvement. We will not say that the substance just recommended is not susceptible of improvement; we mean only to declare, the simple mixture just mentioned to be the best we know for the child, up to a certain period—say, until it has cut several teeth. After this time, we may, should it be deemed necessary, improve its nutritive qualities, by the addition of gum Arabic water; barley, or rice water. We think we have seen decided advantages result from these additions, particularly from the gum Arabic water. Or, small quantities of some animal juice may be given in conjunction With the other preparation. 
567. But let it be recollected, much mischief sometimes arises from a fastidious desire of improvement. The necessity for alteration should always be ascertained, before the change is made; for it would be more than idle, to insist upon a change of diet, while the child is rapidly, or even perceptibly improving; especially, as the quantity of its food can readily be increased, in the 


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precise ratio to the necessity for such increase. Therefore, when it becomes desirable from any cause, as in certain stages of bowel complaints, &c. that the quantity of food should not be increased, we may with much advantage sometimes increase its nutritive qualities, by the addition of the above named substances. 
568. It would be very desirable, could it be always regulated with sufficient certainty, to permit the child to take no more into its stomach at a time, than this organ can assimilate in due time; for it has always been found better, that the stomach crave food, than to be oppressed by an excess of it. The quantity given at a time, must be regulated by the age of the child, and by the force of its digestive powers; and the periods for its exhibition, must in some measure be governed by the same laws. 
569. As a general rule, such an interval should be allowed between each feeding, as will ensure the digestion of the previous quantity; and this may be fixed at about every three, or four hours. The quantity to be given at each period may pretty successfully be determined, by the avidity with which the child receives it; for it will rarely demand more than it feels comfortable to receive—therefore, a little experience will enable any body to determine this point. When this matter is settled by repeated observation, it is proper that no more than has been generally found sufficient should be urged upon the child at that time, especially if it be taken rather reluctantly; but making at the same time due allowances for its advancing increase of size. There will also be constitutional differences, as to the quantity which may be required; but this to a woman of observation and care, will offer no embarrassment; but it should nevertheless be attended to, that an undue quantity need not be urged upon the child in one instance, nor an insufficient one, be given at another. 
570. There is one rule, which should constantly be attended to, especially as it is certain in its indication, and useful in its observance; namely, when the child ceases to extract milk from the bottle,* and it be restored to it, and it refuse to take it, let it not on any account, be urged to swallow more, than nature seems 
* This observation will hold good, and should be carefully observed, when the child is at the breast altogether. 


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to demand. We are aware that this will occasionally happen, from a previous bad regulation—namely, feeding the child just before it is offered the bottle. But be this as it may, the rule just laid down must be strictly observed. 
571. With children who are nourished by the breast, this business is left almost altogether with the feelings of the child; nor is this in general, attended with any serious consequences. Should it take more than is really required, or than is agreeable to the stomach, it is soon regurgitated, and the uneasiness removed. But it is not exactly so, in the artificial mode of rearing children; for the stomach does not so readily yield its contents, when it shall have become oppressed by quantity, as it does when it obtains its supplies from the breast; and on this very account, the artificial mode is less proper than the natural. It would seem, that the milk of the mother has some inherent quality, which provokes the action of the stomach to cast it off, so soon as it becomes offensive; but this is not so much the case with the artificial food, intended to supply its place. This however may arise from the one being drawn immediately from the breast, while the other has been exposed to the atmosphere, and suffered a change. The cow's milk contains more cheesy matter; and is on this account, of more difficult assimilation—hence, it is frequently thrown up in the form of hard curd. 
572. The stomach therefore will be more liable to these little inconveniences when confined to the bottle, than when it shall receive its natural supplies; but a little careful observation on the part of the nurse, will prevent any serious injury from this cause, as she will soon become familiar with the proper quantity to be administered; or in other words, how much the stomach will bear, without suffering from repletion. The quality of the food can be pretty much subjected to rule, by having regular proportions of the respective ingredients; and habit will soon enable a careful and observing woman, to determine the quantity. 
573. We have already upon several occasions, adverted to the care that is required in preparing, and preserving in a proper condition, the milk intended for the use of the child; we shall therefore only in addition observe, that upon no occasion, when the child is in health, will the milk require boiling. Boiling takes from the milk some of its best qualities, as may readily be 


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detected by the smell, when this fluid has been subjected to it. It should therefore never suffer this change, as it can never be necessary while the child is in health. 
574. In hot weather it is true, the tendency to decomposition is diminished by boiling the milk; but, as all the advantages which may result from this process, can be procured without its being absolutely boiled, it should never be had recourse to. It is every way sufficient for the purposes of preservation, that the milk be put, closely covered, over a hot fire, and brought quickly to the boiling point; so soon as this is perceived, it should be removed and cooled as speedily as possible. * By this plan, you prevent in a great degree, the formation of that strong pellicle, which is always observed upon the top of boiled milk, and by which the milk is deprived of a portion of one of its most valuable parts. 
575. The child should not receive its nourishment while lying —it should be raised, which will not only become a pleasanter position, but it also diminishes the risk of strangulation. After it has received a sufficient quantity of nourishment, which it should always do slowly, by stopping from time to time; it should be kept perfectly quiet, for at least half an hour after each repast; and if an attempt be made to use the common nurserypromoter of digestion, namely jolting, it should be immediately prohibited, in the most decided and positive terms. This preposterous, and highly injurious practice, has become so familiar, as to be overlooked as a cause of mischief; yet it merits a more severe reprehension, than might at first sight be imagined. 
576. As the future welfare of the child must necessarily in part depend upon the proper administration of its nourishment in the early part of its infancy, it must follow, if the due exhibition of it as regards quality and quantity be neglected, all the evils which can attach to deranged stomach and bowels, must follow; and if on the other hand, there be no complaint to be made as to these two points, but on the contrary they are regularly and judiciously ordered, but all their advantages destroyed 
* An excellent method to warm milk, is by a sand bath; which any body may command, by partly filling an iron pot with dry sand. If the milk be placed in a proper vessel in this bath, it may be heated by setting it over coals, or it may be placed upon a stove until it acquires a proper warmth. 


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by digestion being interrupted, it must follow that, the practice which shall do this, cannot be too severely condemned —there- the barbarous practice of jolting the child immediately after each meal, or perhaps after each portion of it, should be strictly forbidden. 
577. For a certain period after each meal, rest is as essential to digestion, as exercise is important at other times, to the general promotion of health—therefore, whatever interrupts or interferes with this repose, at once defeats the kindest intentions of nature, toward this passive, and interesting part of creation. Analogous to jolting, is the absurd, and oftentimes dangerous practice of tossing the child high, in such quick succession, that respiration is oftentimes suspended. Some seem to know no other mode of nursing a young child, than that of rudely tossing it about; and we have oftentimes been gratified by the disturbed stomach, indignantly pouring out its contents, to the dreadful annoyance of the holiday clothes of the boisterous, and thoughtless pro tempore nurse, who forced it to this retaliation. Nothing can speak in plainer language than the insulted stomach, upon such occasions; as it at once declares the evils which must ensue, whenever its functions are thus cruelly interfered with. 
578. We have often observed the bottle to become the plaything of the child. This has arisen most probably from the mother or nurse not having as much leisure as her duties to the child might require—the bottle is then given to appease its immediate clamours, and afterwards suffered to remain with it, that they may not be renewed. This is decidedly very injudicious, if any thing more than quieting the child be considered of any consequence. 
579. By this plan, the child receives a fresh supply of food every few minutes, without giving time for the previous quantity to be disposed of; the process of digestion is therefore never completed, or is constantly interrupted. In consequence of this, a great part of the food passes from the stomach into the bowels, nearly in the condition it was received, or but imperfectly assimilated; and it is there subjected to a sufficiently long delay, to ferment, or to become sour; colic, or diarrhoea, or both, are the result. Besides, the child is deprived by this plan, of a consi- 
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derable portion of its nourishment; for not only that which has undergone a change, as well as that which has not, escapes from the stomach, and passes through the bowels, without contributing to the nourishment of the body. Hence, children who are always eating, are never fat. 
580. There is also another evil arising from this mode of administering nourishment to the child—namely, the food becomes sour, or nearly so, before it is taken into the stomach, by its being kept constantly heated by the child's hands and body—the impropriety of this, will at once strike every body. 
581. Rousseau has advanced some strange sentiments upon the subject of milk. He says, " the milk of those' women who live chiefly on vegetables is more sweet and salutary, than that of carnivorous females." More salutary to whom, or to what? Does not this imply an imperfection, and a contradiction, in the works of nature? The milk produced by a mixed diet would certainly be most proper for such animals as naturally live upon mixed food; but would this be as sweet and as salutary to the young of the animal which feeds upon animal substances alone? We believe not —for there is every reason to suppose the milk to be suited exactly to the powers of their digestive organs. If he mean, that the milk of animals strictly carnivorous would be less sweet and salutary to those who are destined to be supported by milk from a mixed diet, we would most readily agree with him; but this would be begging the question. Now, as there is not in civilized life, one woman in ten thousand, who lives upon animal food alone, it must follow, that children deriving nourishment from the breast, must receive milk of a mixed character; and that appears to be as much as we have a right to expect. 
582. If there be any in the opinion of naturalists upon the nature of man as regards his food, it will be found, that he is intended to eat of both animal and vegetable substances; therefore, to confine him exclusively to either, would be as preposterous, as to urge animal substances upon the cow, or to force vegetables on the tiger. 
583. Rousseau further attempts to support his position, by declaring, that " every body knows, that pulse and vegetables increase the quantity of blood more than meat." Now, this is 


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not known to every body, or to any body; and consequently, his question, " why therefore not milk?" which immediately follows, intended as a deduction, answers itself. 
584. He admits, that vegetable aliment may possibly make the milk more apt to turn sour; but he says, he is " very far from regarding sour milk as an unwholesome nutriment. There are people in some countries who have no other, and yet are in good health." This is novel to us—and we regret he has not left us some indication of the country where the cows give nothing but sour milk. He most probably means, there are people who prefer milk in this condition, to sweet—this may be, but we do not believe there is a nation subsisting upon sour milk alone, and in good health, as this passage would seem to imply. 
585. This observation is not confirmed by any other writer; it is certainly contrary to our own experience, and we believe to that of every body else, who has not a theory to support. But Rousseau appears to be determined upon this point, since he enlists in his favour, the circumstance, that milk must be coagulated in the stomachy before it is converted into nourishment. But he was a poor physiologist, or he would have known, that the change produced upon the milk by the proper action of the stomach, is very different from that curdling which is the effect of spontaneous decomposition—the one is necessary to its due elaboration; the other, if not positively injurious, taxes the powers of the stomach pretty highly, to subdue it to proper chyme. * 
586. It will also readily occur, to any one who will give this important matter a due consideration, that the bottle with mothers, or nurses who are too much limited for time to bestow the necessary attentions on the child, will not succeed so well as it does in the hands of those who have more leisure; for their restricted time prevents that attention to the state of the bottle, that is so essential to its success. If due care be not paid to its being properly, and very often cleansed, it must fail of being as useful to the child as it should be. Cleanliness must therefore in this instance, as it is in many other, be considered as a sine qua" non to the success of the bottle plan, of raising children. 
587. We mentioned, in our account of the manner of prepar- 
* Besides, the coagulation spoken of by Rousseau, is not the coagulation of acidity; it is similar to that produced out of the body by " Rennet." 


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ing the cow's milk for the use of the child, (248) that a small portion of loaf sugar should be added; but did not at that time layany stress upon this ingredient. We shall therefore take this opportunity to observe, that this direction should always be strictly complied with—for the substitution of brown sugar, or molasses, may often be attended with much inconvenience, especially with very young children, by their becoming acid much sooner than good loaf sugar; and for a purpose like this, the difference of price cannot be considered an object. 
Sect. III.— Third Means, or employing a wet Nurse. 
588. We have already stated, that under some circumstances, a " wet nurse," with all the penalties that may attend the choice? is to be preferred to the greater, or worse risk, of the child perishing without one. But as this is a matter of necessity, and not of election, we must endeavour to diminish the evil as much as may be in our power, by selecting with as much care and judgment, as circumstances will permit, one with as few faults as possible. There is oftentimes so great a choice in those who may offer for this purpose, as to render it highly important to be acquainted with a few general rules, to aid it. 
589. It may justly be a question in morals, how far one part of society is to be benefited by the injury of another. The avowed object in employing a wet nurse, is to benefit the child for which she is employed. To do this, she must generally abandon her own child, either to a mercenary as selfish as herself, or allow it to be brought up by ill conducted, or worse adopted means. For the mother who abandons her own child to suckle that of another, must do it from the expectation of gain—this she cannot realize, but by procuring a place for her own, at a price lower than that which she herself is receiving; and unfortunately for the poor child, this kind of calculation is but too well understood by that class of people, to whom these remarks will apply; for they will most scrupulously regulate the quid pro quo, by the sine qua non. 
590. On this subject, Dr. Clarke makes the following pointed, but just remarks: " If the child lives, for which the wet nurse is invited by the prospect of gain to forsake her own, the child of the wet nurse often dies, or it becomes diseased, or crippled. Her other children are neglected, and her husband, for want of 


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her society, becomes drunken and profligate; she rarely returns home contented with her former situation, but compares her present privations, with the indulgencies which she has left; the whole comfort of the labouring man's fireside is broken up, and society has only exchanged the life of one child, for that of another, with all the disadvantages above enumerated." 
591. "On the whole," continues the Dr. "it would be better perhaps, that the children of the wealthy should be brought up artificially, where the mother does not suckle, because they would have every advantage of good nursing, cleanliness, air, and medical treatment; and would therefore have a better chance of living, than the child of the wet nurse, who will want all these advantages."* 
592. In our opinion, there is but one method to remove the objections so strongly and faithfully urged, against the system of wet nursing here described, and this is very far from being free from objections; which is by employing none, but those unfortunate females, who have been by "love betrayed," and such only of these, as may have lost their children. This plan would reduce the number of hireling nurses to a very few; but from this very circumstance, we see that several serious disadvantages would arise—1st, it would lead in many instances perhaps, to the neglect and ultimate death of their own children; 2d, it would increase very much the price for their services, which would operate as a bounty on their want of chastity. This view of the subject, should therefore become an additional reason to the mother, to suckle her own child, wherever practicable. 
593. It is true, Dr. Clarke proposes another plan, which in our opinion is as liable to objections: but we will give his scheme in his own words. "With every attention which can be paid to them, children brought up by hand will often die. Perhaps, the most desirable thing would be, that a strong wet nurse should as far as she is able, suckle her own and the foster child; and that the deficiency of both, should be supplied by artificial means, "t 
594. The objection to this plan, is at once obvious, by referring to a principle in human nature, and on which we have else- 
* Commentaries, p. 52. 
f Ibid, p. 54. 


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where passed a remark, (615) that the child of the nurse would be nourished, to the exclusion of the foster child. But to return. 
595. Did we undertake to declare in what a good nurse consists, "we should be considered," says Mr. Friedlander,* "as describing an ideal being. For she should be neither too young, nor too old; for before she is twenty, she has not arrived at her full development; and after thirty-five, she is upon the decline. She should be well constituted; she should be neither too fat, nor too lean; she should be fresh-coloured; have fine teeth, red lips, and sweet breath; her hair should not be too black, nor too deep a red, nor should she be subject to any violent passion. Her breasts should be of moderate size, with a nipple sufficiently projecting and irritable, and yielding milk upon the slightest force; her milk should be neither too thick, nor too transparent, and of an agreeable sweet taste. Added to these, she should have proper moral feelings, to second such useful qualities. Nor should these good qualities be debased by bad passions, or other defect of character. She should so regulate her diet, as to be entirely subservient to the advantage of the child." 
596. Or as this has been more elegantly expressed by St. Marthe, in his Paedotrophia, as translated by Dr. Tytler: 
" Choose one of middle age, nor old nor young, Nor plump, nor slim her make, but firm and strong; Upon her cheek, let-health refulgent glow, In vivid colours, f that good-humour show. Long be her arms, and broad her ample chest, Her neck be finely turned, and full her breast; Let the twin hills be white as mountain snow, Their swelling veins, with circling juices flow; Each in a well projecting nipple end, 
And milk in copious streams from these descend. Remember too, the whitest milk you meet, Of grateful flavour, pleasing taste, and sweet, Is always best; and if it strongly scent 
The air, some latent ill, the vessels vent." 
597. To this we would add, (what appears to have escaped the above judicious authors,) an exemption from her catamenia. We 
* L'Education Physique de l'Homme, p. 60. 
f This rule however, in this country at least, is liable to many exceptions; since the very best nurses we have ever seen, have been pale. 


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are however by no means sure, that he and many beside, would consider this a defect in the character of a nurse, as general opinion is in its favour* —on this account, it is worthy of investigation. It is a very common belief among females, that at each return of the catamenial discharge during lactation, there is a renewal of "the milk." We have very often had this circumstance whispered in our ear by some good old woman, who might be recommending a young friend for the office in question, with an emphasis, that bespoke at least the firmness of her belief, if not the soundness of her philosophy. Indeed, so common is this opinion among "nurses," that it has even been "similated," to enhance the value of the applicant, and to ensure her success. 
598. But unfortunately for such as may attempt to take advantage of such a circumstance, or impose by a mere declaration of it, it must by all who will duly weigh the subject, be considered as operating against the fitness of the individual who may be so situated. For nature neither acts idly nor capriciously; and though there may be occasional deviations from her usual scheme, they must be regarded, but as exceptions to the general rule. 
599. The laws of nature on the subject in question, are almost invariably as follows—1st. So soon as the catamenial discharge is arrested in consequence of pregnancy, the breasts almost immediately undergo a change; a change which is important, because preparative of the great office they are to perform subsequently. 2d. So soon almost as delivery has taken place, the breasts plentifully secrete nourishment for the child, and during a long period, faithfully discharge this important duty; but in the meantime, the catamenial evacuation is arrested, and continues to be so, in most instances, to any period almost, that the child may continue at the breast. 3d. At the time appointed as a general law of nature, for the re-appearance of the catamenia, (which is from the twelfth to the fourteenth month,) and this evacuation is again established, the milk is found invariably to diminish in quantity, and also to deteriorate in qua- 
* Struve observes upon this subject, (p. 233,) " a nurse's monthly discharges should either stop entirely, or take place only in a moderate degree, lest the milk might soon disappear." 


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lity; and the child to be but imperfectly nourished. The truth of these positions, we are sure will not be challenged. 
600. Now, if this be true, is it not worse than idle to declare, that the exception which nature makes to her general rule, should be better calculated for the good of the being, than the rule itself? If this discharge were so efficient in the production of milk for the benefit of the child, why would not nature have chosen this for the general law, and the suppression of it, for the exception? Or why is the milk not renewed and improved, upon the natural return of this evacuation? For these reasons, we have invariably objected to such nurses. 
601. The age of the milk, as it is called, should constantly be taken into calculation—this is always an important point; and its value is well known to those, who are to be subjected to inquiry, since they will always declare it to be of an early age, should this be necessary. We have no certain marks to direct us upon this point—we have therefore almost exclusively to rely upon the testimony of those whose interest it is to deceive, should the truth make against them. When truth can be elicited, either by testimony, or circumstance, we should always prefer the "young milk," when it can be had, even for an older child, provided, the disparity be not too great; and for this plain reason—it will, (all things being equal,) last longer, and in better condition. 
602. It is a received opinion, and generally a well founded one, that the substituted milk should be as nearly as possible of the age of the child who is to receive it. In many instances there cannot be any disadvantage in the observance of this rule, but there need be no absolute conformity to it, since there is no necessary and progressive correspondence in the age of the child and the quality of the milk, after the third or fourth month. Up to this period, as a general rule, the milk is not so nutritious as afterward; but this defect if it be so, is almost constantly compensated for, by its greater abundance; and this excess can be profitably employed by an older child, so that even this young milk for an older child, cannot be considered as a serious objection. But the converse of this rule will not hold good; nor should it ever be acted upon, but as a dernier resource, since, af ter the twelfth or thirteenth month, the milk almost always diminishes in quantity, as well as deteriorates in quality. 


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603. Yel it must be confessed, there is no fact perhaps better ascertained, than that the milk changes as the period increases from the time of delivery, but not always, advantageously—that is, it is less nutritious in the first few months, than it becomes afterwards, in obedience to the law we have elsewhere recognised, namely, that the nutritive quality of the milk is generally governed by the capacity of the stomach to digest it, and by the greater or less necessities of the system. This rule however has its limits agreeably to another law—that, as the teeth begin to show themselves, the milk may be aided by the administration of other substances, as the increasing demand of the system may require such aid; hence, as has just been observed, the deterioration of the milk after the twelfth or thirteenth month. 
604. A nurse should be able to suckle with both breasts; not altogether perhaps from the apprehension, that one may not be able to furnish a sufficient quantity, but because when the child is constantly nursed from one, it sometimes contracts a crookedness of form. And we may also urge collaterally, there will be most probably not only a more abundant supply, but also a greater security for its continuance from two; since an accident may befall this one, and thus deprive the child at once of its nourishment. 
605. We may also urge another observance upon women who suckle from both breasts, and which should not be neglected; and it may be considered as an additional argument in favour of two breasts—namely, that the child may be nourished alternately from them, to prevent the constant direction of its eyes towards one point, and thus produce the ugly habit of squinting. This direction should be acted upon from the beginning, that the child may not have a favourite breast established; which is very apt to be done, by a little carelessness on the part of the nurse, or from some cause in the breast itself. 
606. On the part of the nurse, this habit may be produced, by her being able to manage the child more adroitly on one side than the other; and on the part of the breast itself, it may be owing to the nipple being better on the one breast than on the other, or to the milk coming freer from one breast than the other, or its being too free from one of the breasts. The caprice of the 
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child however should not be indulged, if it can possibly be prevented, and for reasons that may be collected from what has just been said. 
607. It is far from uncommon, that the milk flows in too rapid a stream from the breast, for the feeble powers of deglutition of the child; thus threatening it with strangulation. When a nipple is thus situated, the mother should try to prevent it, by gently compressing it while the child is sucking. We have known nurses obviate this inconvenience, by making a ligature of white yarn, to press gently around the nipple. 
608. Much reliance is placed upon the appearance of the milk; more perhaps than it really deserves, since there is most probably a slight difference in appearance in each individual, as well as from the age of the milk itself, without necessarily affecting its properties—at least, we know this to be the case with the milk of cows. Farmers who are in the habit of attending much to cattle, will from the colour, and form of the cow, very nearly determine her capacity to produce milk, either as regards its quantity, or its power to yield cream. Yet in neither of these instances, would one milk be said to be more wholesome than the other. It is therefore possible, that complexion in the human female, may have a certain quality of milk attached to it—and hence perhaps, arises the objections to the very black, or very redhaired women, who may present themselves as nurses; in either of which, the milk may not be found equal in quality, to that yielded by women who have hair of the intermediate shades of colour. 
609. But perhaps in the red-haired women, there may be certain moral qualities, that may unfit them for the office of nurses; they are certainly of the sanguine temperament, and this temperament has attached to it great irritability of temper, as one of its characteristics—hence in a moral point of view, their unfitness as protectors of young children. Among the ancients, especially among the Romans, the moral qualities were considered of more consequence than the physical capacities of a nurse; and by them, consequences of such moment and extent were attributed to them, as at the present day at least, we should not expect to see realized. The habit of intoxication, to which Nero so immoderately yielded himself, was said to be owing to the influence 


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of a drunken nurse; and the bloodthirsty disposition of Caligula was attributed to the nipple being smeared with blood, to invite him to take it with more certainty, by his savage foster parent. 
610. We have never ourselves looked upon these stories, but as powerful and ingenious fables, to rouse the sympathies of the mother to the delightful duty of nursing her own child. But every body is aware of the influence of example—too much care therefore cannot be taken, that the nurse exhibit no improper Ones. Every precaution will be observed on her part to conceal her frailties, however watchful the mother may be to detect them; for this reason, the child should be as little as may be from under the mother's eye, that the evil may thereby be diminished as much as possible. Let the nurse be considered as the organ of supply, but not as the object of example; commit to her charge as few duties as possible, and let the mother assume to herself every other but that of suckling, and a few of the meaner, mechanical parts, which should, and must properly be considered, as belonging to the nurse. 
611. If this were more constantly done, it would tend much to diminish the inconvenience, and at the same time remove many of the objections, to the " wet nurse;" for by it many evils would be removed. By this plan, the affections of the child would be as much due to the real, as to the foster mother, and that most painful of all sensations, of seeing the affections of our child transferred to another, would in a great measure be avoided. By this plan, the manners of the plastic child, could be moulded by the will of its proper guardian, instead of being subjected to that of a hireling. And though last, perhaps not least, the affections of the parent would not be estranged from that child, which necessity had obliged her to rear by an alien breast. We are well acquainted with the father and mother of a child that was nursed abroad; and though they frequently saw it, and it was returned to them at eighteen months old, they both confess they have less affection for this little unfortunate, than for the rest of their children. It is a source of constant misery to them; and though the child is perfectly a stranger to the diminished affection of its parents, and has in every respect the same attention, and the same apparent love bestowed upon it, and consequently by these means suffers no real injury, still to the parents, it is the cause of endless 


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regret. We confess there may be a little too much refinement in this kind of sensibility; since with them, or rather with the mother, it amounts to self-reproach, though the necessity of sending it away may have been imperious; but a fear is constantly presenting itself to her over-sensitive mind, that she may fail in her duties towards it, though she is constantly watching herself to prevent the slightest neglect. 
612. With feelings like these, there can be little risk that the child will suffer from neglect; but if such apprehensions arise in the mind of a conscientious mother, what may not actually happen with those who have no such scruples to contend with? It at least makes an additional, as well as a strong objection against wet nursing; and especially against that still more exceptionable form of it, putting the child out of the house for the purpose. By this practice, all the evils which can possibly befall a helpless infant, repudiated from a mother's bosom, will exist in a higher degree, than when it may be nourished in the house; because it is now removed from the surveillance of a watchful parent, the only security it can have, that proper attention shall be bestowed upon it. 
613. Here, it will be doomed to all the penalties, which must await neglect of every kind, by the absence of the only feeling, that can bear up against the exercise of it—namely, a mother's love. Ask any mother, how much love it requires to fulfil justly, the duties of one! Then ask, can these duties, duties so varied, so multiplied, so essential to the happiness, nay almost the existence, of the helpless little one, be performed in the absence of such affection ? The answer is no less easy, than true—No! We will not go so far as to say, there is no exception to this rule—we believe there may have been, and may be again: but the chance is like the high prize of every lottery; and like all dealers in this species of gambling, each trusts he may be the holder of the fortunate ticket; and the evil is thus perpetuated. 
614. Nothing will so certainly ensure neglect to the child, as a want of affection for it—whether this want of love be on the part of the mother, or the nurse. It is unnatural on the part of the mother; and it must be sorely lamented that it happens, since from the want of it, she is deprived of one of the purest pleasures on this earth; and at the same time, loses the strongest 


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incentive to the discharge of her duties. On the part of the nurse, it is not to be so much wondered at, or so severely condemned; for she has either lost her own child, and cannot suddenly transfer her affections to another; or it is put from her by necessity, that she may foster the child of a stranger: —she dwells upon her privation; her mind teems with a thousand apprehensions; and in spite of her best wishes to the contrary, she must look upon her little charge, as an usurper of the rights of her own. During this period of conflict, the child is often the sufferer, from a want of that attention, which a proper affection would have ensured; and dies perhaps, before this necessary love is generated, because it had been too long withheld. 
615. Let us for a moment look more closely at the case we are now considering, that its enormities may the more easily be exposed. A woman consents that a child shall share her bosom with her own; the motive doubtless is, the reward it will bring—this at once declares, that poverty or avarice is the cause of that motive; it is therefore a mercenary transaction. She is remote from the watchful superintendence of a mother who has committed her child to her care—she is consequently under no restraint as to conduct: the child is therefore treated as circumstances, or caprice may direct. If a deficiency of milk occur, an event common to all nurses, and an allowance is to be awarded, to which is it natural she should give the \arger share? Her own child! Or perhaps she may yield the whole, making the other conform to the necessity, by giving it an improper substitute, for milk of her breast. Again: if the child be not deprived of its proper nourishment, it may be sadly abridged of the time necessary to its comfort, or essential to its health—filth and all kinds of uncleanliness, and even disease, dependent upon neglect, will be heaped upon the poor, passive child, thus committed to the care of an unprincipled nurse, because a mother's eye cannot watch, or a mother's vengeance overtake, the horrid breach of trust. 
616. Besides, other evils may arise, of a still more serious kind, by this mode of nursing. Dr. Struve, (p. 235,) quotes an anonymous German author of a work on " Matrimony," for an anecdote of a young Count, whose features bear so exact a resemblance to those of his foster mother, that a strong presump- 


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tion arises against the justice of his claims, to the paternal title and estate—dreadful substitution! 
617. When necessity obliges a parent to put away her child, let her seek a home for it in the country; and if possible, place it with one who may have had the misfortune to lose her own; and whose situation in life, would place her above a mere mercenary hireling. So placed, the child would have the best possible chance for health, care, and proper nourishment—consequently, the great ends of nursing, would be entirely answered. It can never be safe to trust a child for this purpose in a city, for reasons sufficiently obvious—it cannot receive the benefit of fresh air, especially in the summer; it cannot have that attention paid to cleanliness, that is so important to its health; nor receive a sufficient quantity of nourishment, if it divide the quantity with another; since the person who would undertake the charge, cannot live in a proper situation to afford the first, nor will she have leisure to attend to the second; and her feelings for her own child, will most probably tempt her to an unfair division, of the third. 
618. It must however be acknowledged, that a wet nurse has in many instances a hard duty to perform—she is narrowly watched in every movement, and in every act; she is sometimes forced to endure the caprice, the revilings, and censures of a wayward, and over fastidious parent—forced to swallow food she loathes; deprived of that to which she had been accustomed, and which she had always found to agree with her—but should the child be ill, it is owing to her neglect; if in pain, to the improper indulgence of her appetite. And when the time of her probation has nearly expired, pains are taken to alienate the affections of her charge from her, that the self-love of the mother need not be too severely wounded—she is perhaps for a time, even forbidden a house she has left with a sincere regret, because she bore a strong love for the child she fostered. And though we consider the child's exclusive love of the nurse, as one of the evils attending their employment, yet we should be sorry to see the faithful discharge of duties rewarded in this way. 
619. Did the evil stop here, it would not be so great; but this conduct, as Rousseau justly observes, "instead of making an 


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affectionate son of an unnatural nurse child, she only excites his ingratitude, and teaches him one day to despise her who gave him life, as he already despises her who nursed him with her milk." 
620. Hitherto we have said nothing upon the subject of drinks for the child, during the period we have been conducting our inquiries; having reserved its consideration until now, as a very few words will be sufficient upon this head, though much error prevails on it. It is a practice with many, and especially with people in the lower walks of life, to commence at a very early period of the child's life, to give it a variety of drinks, composed of ardent or fermented liquors; urging in defence, of the practice, that "children should become accustomed to eat and drink every thing." 
621. We have witnessed very often with sorrow, parents giving to their young children wine, or other stimulating liquors; nature never intended any thing stronger than water, to be the drink for children—this they enjoy greatly; and much advantage is occasionally experienced from its use; especially, after children have commenced the use of animal food. 
622. In the western part of our state, where ardent spirit has become almost the substitute for-water, whiskey is given daily in large quantities, from the youngest to the oldest child; and so quickly do they become accustomed to this pernicious liquor, that we have seen a child of six or seven years old, drink a wine-glassfull at a draught. The consequences of such a practice, can but too easily be foreseen. The directions for the use of drinks then, can be summed up in a very few words—namely, that nothing but pure water, should be given to healthy children. If they be diseased, they come under the direction of the physician; and his province, should never be usurped. 
623. We have often noticed with how much pleasure even very young children take from time to time, small quantities of cold water; and we believe there can be no good reason assigned for withholding its occasional use, though we confess we are at a loss to account for its great success in curing belly-ache, as many good old ladies tell us it does. We think we have seen it very frequently interrupt hiccough; and we have every reason to believe it to be both innocent and grateful to the little creatures, especially during the painful and fevering process of teething. 


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CHAPTER VII. 
SECOND PERIOD—OF WEANING. 
624. When the child arrives at a certain age, it is generally taken from the breast; and that separation is called "weaning." This to an affectionate mother, is a period as full of solicitude, as of pain; and it is consented to with a reluctance, that declares the pleasure the act of suckling had procured; as well as betrays anticipations of dangers, which may too certainly await the change. When weaning is determined upon, from the mere age of the child, it is no ways surprising, that maternal solicitude should be so powerfully awakened; since this rule if implicitly followed, must necessarily have its victims. The propriety therefore of this separation, must depend upon several circumstances, that it shall not prove destructive, or injurious to the individuals concerned. These circumstances may belong—1st, to the mother ; 2d, to the child; 3d, to the season of the year. 
Sect. I.— On the Part of the Mother. 
625. There are various circumstances on the part of the mother, which may render it ineligible, or even improper, she should continue to suckle her child—1st, she may be attacked with some constitutional affection, which may so reduce her, as to make it highly improper she should keep the child longer at the breast; she may be seized with some acute disease, which may require repeated,and extensive depletion; so much so indeed, as to prevent the system from furnishing the proper quantity of food necessary to nourish the child, yet sufficient to increase the debility of the mother, and retard her convalescence. It may also become necessary to keep the child from the breast, during the very acute stages of fever; as the fatigue of suckling, may do much injury, by increasing the activity of the blood-vessels. 626. In febrile affections of the mother, it may be proper however to observe, that the child is never to be withheld from 


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the breast, under the apprehension that it may receive injury; it is only to prevent in such cases, the mother suffering from fatigue. As regards the child, we feel every confidence in the truth of our observations, when we say, we have never witnessed the smallest injury from permitting it to take the breast under the most violent forms of fever. In the yellow fever itself, we have a number of times witnessed its most perfect exemption from injury, during the entire progress of this disease, and even indeed, to its fatal termination. Therefore as regards the child, we repeat, its safety we believe is never menaced from these causes. Yet under such circumstances, it may be highly important to the mother's safety, or necessary to her comfort, that the child be kept from her. And should the child be of a proper age, or in a proper condition for weaning, as we shall indicate presently, it may be proper to do it at this time. 
627. 2d. Or the mother may be attacked with some local affection that may render suckling extremely inconvenient, as well as improper; as milk abscess. In such case, the breasts may be so inflamed, and the milk-vessels so impacted, that much injury might be done, by the attempt to suckle. Under such circumstances, all things being equal, it would be best to separate the child. 
628. 3d. The supply of milk may be so diminished, even without an evident cause, as to render it altogether insufficient for the support of the child; consequently, both may be injured by a perseverance. If this happen, it will be best under proper circumstances, to wean the child. In a word, whenever any thing decidedly injurious to the mother's health, is increased by suckling, it should always be considered as a sufficient reason for separating the child; or whenever any thing occurs on the part of the mother, which so alters the quality of the milk, or so diminishes the quantity, as to render it insufficient for the support of the child, it should be regarded as a legitimate reason for taking the child from the breast; and if every thing necessary concur on the part of the child, to render weaning proper, it should be done immediately. 629. 4th. The woman may become pregnant while suckling; and this condition has ever been considered as a conclusive reason for weaning, be the age of the child what it may. We are 
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however of opinion, that this notion has been too hastily assumed ; or at least, has been too generally acted upon. There can be but two reasons why a pregnant woman should not suckle her child —1st, an alteration in the quality of the milk; and 2d, a great diminution of its quantity. But these reasons would be valid upon any other occasion; therefore the inquiry should be whether either, or both of these, necessarily take place from pregnancy? We know of no absolute reason why pregnancy, abstractedly considered, should render the milk of the woman who is giving suck, unfit for the purposes of the child; and for this reason, we should be unwilling to test this subject by argument simply, as the question should be determined by facts alone. Now, these so far as we have observed, do not declare positively either one way, or the other—for we have seen several instances where children were suckled with impunity, until others were born; and other cases, more numerous, where children were weaned at the usual time, though the mother was some distance advanced in her pregnancy, without the smallest injury having been done to the children so circumstanced; while others again, were obliged to be taken from the breast at a very early period, in consequence of the injurious effects of deteriorated milk. The rule, therefore, which we have for many years observed, is, if the milk disagree, let the child be separated; but if it do not, let it be continued at the breast until the proper time of separation; or at least until some injurious effect manifest itself. 630. There can be no possible injury arise from this plan; for the mother who may be thus circumstanced, will be upon an anxious watch, for the moment of injury; and therefore will, the instant it is perceived, make other provision for her child. The symptoms which may denote this state, are, on the part of the mother, the diminution of the quantity of the milk; and on the part of the child, its altered quality; the latter will declare itself, by being almost immediately rejected, and that in a state of hard curd; or in a thin semi-transparent condition, with a peculiarly disagreeable smell. 


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Sect. II.— On the Part of the Child. 
631. When the child has arrived at the eleventh or twelfth month of its age, it is generally thought to be sufficiently advanced, to be taken from the breast. But it will immediately strike any one of reflection, that the rule formed upon the age of the child, must be liable to many important exceptions. We shall therefore consider this subject, under two distinct heads; and these, subject to the variations, which the season of the year shall impose upon them. We shall therefore regard, 1st, the state of the teeth; and 2d, the state of the health of the child. 
a— Of the Teeth. 
632. It is evident, nature intended that the cutting of the teeth should have some meaning, as well as use; and in our minds, that meaning cannot well be mistaken, though she assumes much variety in the period at which this may happen. That the period of cutting the teeth is uncertain, is familiar to the observation of every body; yet, at whatever time this may take place, the circumstance marks the condition of the stomach, or of the digestive powers, in most cases, with much certainty. Thus, if a healthy child* cut teeth at four months, it is more than probable, that its digestive powers would be as great, as in a child that might not protrude them, until eight, or even a more advanced period; therefore, if it be proper from the circumstance of teeth appearing, to alter the nature of the food of the child, it must be so at the early, as certainly as at the later period. That nature intended these little instruments should be employed so soon as they made their appearance, is rendered more than probable, by their coming almost always through the lower jaw first. In this situation, they can be called into immediate requisition if necessary, which is not the case, when they appear first in the upper jaw. 
633. It would seem then, that a child is capable of preparing its more solid food, in proportion to the number of teeth it may have cut; and that, precisely at the period, at which they may make their appearance. Therefore, the number of the teeth more 
* We say, "if a healthy child cut teeth at four months," &c.; for we have seen several instances of precocious dentition, in extremely debilitated constitutions—such therefore must be regarded as exceptions to the rule. 


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certainly points out the powers of the stomach, than the period of the child's life at which they may show themselves. In confirmation of this last remark, we may observe, that we have almost constantly noticed, that children who are late in cutting their teeth, neither seemed to crave solid food more, nor digest it better, than those who were much younger, but supplied with an equal number of teeth. And again, we may remark, that the force of constitution is very well declared, by the periods at which the teeth may be made to protrude the gums. 
634. From these observations it will be evident, that the rule founded exclusively upon the age of the child, must be of very doubtful application, if not injurious in its observance; since it might sever a child from the breast, at a time when its stomach was ill qualified to provide for the contingencies of the system. We should therefore say, that the presence of teeth, is absolutely necessary to the success of weaning, let the age of the child be what it may; and consequently, that this should never be undertaken until several are cut. 
635. Dr. Struve recommends, that such children as may be suckled by a wet nurse, should be weaned as early as at six months, lest their future affections be transferred from the mother to the nurse. We cannot see the propriety of this advice; since, if the mother pursue the plan we have already laid down, (610) namely, to make the nurse the mere organ of nourishment, there is but little danger of any permanent transfer of the child's affections. Besides, it is unquestionably much too young, at least in this country, for such a privation; for the child at this period has not a sufficient number of teeth to masticate its food, or as would declare the stomach capable of digesting it; or this period may arrive at such time of the year, as we have already observed would be inconvenient, or improper. Again, he urges as an additional reason for this early separation, that "the trouble attendant on weaning them is generally much greater after six months, when their mental powers begin to expand, and the power of recollection daily increases, so that they cannot, without great struggles, forget the foster mother, and her breast." p. 229. This apprehension is altogether chimerical; at least, as far as regards any evil happening to the child. We have often witnessed such separations; yet we have never known any in- 


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jury happen to the child, though they have not been taken from the breast, until a much later period. But be this as it may, the benefit of the child's bodily health should be consulted, rather than this temporary affection of its mind. 
636. Indeed, Dr. Struve himself, furnishes a most conclusive argument against his own plan, by declaring, that " if the teeth should appear, while these arrangements are taking place with respect to a new system of diet, the child must, without hesitation, be replaced to the breast, till the first cutting of the teeth is effected by nature." p. 230. Is this not truly a work of supererogation? How seldom can it happen, that the child must not be restored to the breast, if the period of six months be the age for weaning, and the appearance of the teeth the contraindication to this process? Does this not decidedly declare, that nature did not intend this separation, until the child was in some degree prepared for it by the appearance of these little instruments? We cannot hesitate a moment to believe this to be the case. 
b—The State of the Child's Health. 
637. It will be evident at first sight, that the situation of the child's health, must have a decided bearing on the propriety of weaning, at the moment it may be proposed to be carried into effect; for the child may be much reduced by previous illness, or labouring under actual disease, so as to render this privation highly injudicious. If in the former condition, no nourishment at the moment, can be so proper perhaps as the mother's milk; or so certainly and freely conveyed, as by the mother's breast; and when nourishment is all important to the recovery of the child, as it very often is, it would be highly cruel, if not criminal, to withhold the breast from it—therefore weaning, as a matter of choice, must not be thought of, at this time. For in the latter condition, breast milk may be the only nourishment it may be proper to give; if so, it should be retained for this useful purpose. Besides, the experiment of taking away the breast while the child is actually ill, has always been attended by bad consequences, even where at such times it has spontaneously weaned itself—therefore it should never be attempted at that time, as a matter of choice. 


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Sect. III.— Of the Season of the Year. 
638. It is a fact so well known, that it scarcely requires mention, that the period of the year will much influence a decision, on the question of weaning. The season of the year may render this act, convenient, inconvenient, or improper. 1st. The convenient season of the year, will be all that period, when its temperature is moderate; as the months of March, April, May, June, October, or even early in November; when the nights are neither excessive in length, nor the atmosphere severe in temperature. 2d. It may be inconvenient from both these last named causes; as the months of December, January, and.February. 3d. It may be improper, in case of diseases arising from, or incident to a certain part of the year, being always aggravated in newly weaned children; as in the months of July, August, and September. Therefore, weaning should be in part regulated by these considerations. 
639. When weaning has been determined on, and rendered proper by the condition of the child, it will in a great measure be prepared for this process before hand, if it has been properly attended to, by having occasionally received other nutriment than the mother's milk. The task is then in part performed; and the whole of the trial may be rendered less severe, by the observance of the following rules: 
640. 1st. Accustom the child, from time to time, to take other food than its mother's milk, by feeding it on bread and butter, bread and milk, rice and milk, &c. or occasionally on beef, mutton, chicken, or oyster tea; or by giving small quantities of either of these substances, in a solid form, as has already been directed. 
641. 2d. Let the mother give the breast at longer intervals, and gradually prevent its being the principal support of the child. 
642. 3d. Let the child, after a little longer time, receive the breast as seldom as possible. 
643. 4th. Endeavour to excite an aversion to the breast, and thus induce the child to withdraw itself from it, rather than permit it to feel the want of the breast as a privation. 
644. 5th. This aversion may be excited in one of two ways— 


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either by touching the nipples with some bitter or disgusting substance, as aloes, garlic, assafostida, &c, or covering them with a forbidding one, as black wool, ink, court-plaster, &c. 
645. 6th. When you commence this severe process, be firm; and let no importunity of the little pleader, overcome your resolution, or your work will never be finished. 
646. The process of weaning is much facilitated, by accustoming the child for some time to the use of vessels from which it may drink any nourishing fluid, or even water, at first. When a cup, or glass is presented to them, their curiosity is immediately excited, and they at once express their eagerness to possess it, by stretching out their little arms, and seizing it with avidity; and no sooner are they in possession of it, than they carry it to their mouths. By taking advantage of this early propensity, children may be soon taught to receive food from almost any vessel that may be offered to them. This plan however requires one caution—should the child have teeth both above and below, it may be dangerous to trust them with vessels of either glass, or china—some metallic utensil will be much better. 
647. A great error is generally committed immediately after weaning, by giving the child not only too much food, but that of too gross and too solid a quality. Thfs injurious practice has arisen from the supposition, that the child not only requires it, but that it is certainly capable of digesting it. This plan of treating children at this time, is replete with mischief; and this mischief is commensurate with the tenderness of the child's age, and the solidity and grossness of the food exhibited. It injures the tone of the stomach, by overloading it; and its digestive powers are destroyed, by the severity of the duty imposed upon them: in consequence of this, the child falls away, and becomes weak in proportion as the plan is insisted on. If there be any latent tendencies to scrofula, rickets, or consumption, they are now called into actual disease; and the child falls a victim to the overweening desire of the mother, or its friends, to promote its welfare. 
648. Where milk will agree, there is no food so proper after the child is taken from the breast. It may be employed in any of its combinations, with good wheaten bread, rice, sago, &c, 


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only remembering, when either of these articles is found to agree, it should be continued perseveringly, until it may become offensive; in this case, some other combination may be required. Or, should the child be pretty well supplied with teeth, it may be occasionally aided by small quantities of either of the animal juices already mentioned; but subject to the restrictions, then suggested. Struve recommends on the authority of Hildebrandt, a soup made of the yolk of eggs and well fermented strong beer. As well as we can understand his limited direction, it is made in the following manner: two or three yolks of eggs are well beaten together, and gradually added to a quart of beer by briskly stirring it, to prevent curdling; it is then to be well boiled, and sweetened to the taste. Of this, the child may take small portions, several times in the day. 
649. It has now and then occurred, that neither cow's milk, nor any other, in its unaltered form, will sit upon the stomach of children, when attempts have been made to rear them by artificial means. When this happens, we have substituted with great advantage, gum Arabic in solution, in the proportion of an ounce to the pint of water; to this must be added a little sugar, and as much milk as will colour it, if the child be old enough to observe it. Or, we have recourse to rennet whey, a little sweetened, and disguised if necessary, as just stated. If neither of these have answered, we have substituted the weak animal juices, as before recommended. 
650. Dr. Clarke* recommends, under such circumstances, some farinaceous decoction, mixed with a little cream. Of this we can say nothing from our own experience—nor are we aware to what farinaceous substance he alludes, but suppose that either sago, tapioca, or arrow root might answer. 
651. In the midst of our care for the child, we should not forget that which may be necessary for the mother, or the nurse; for if proper management be not made use of at this time, she may suffer much from the swelling of her breasts. To prevent this, it may be well, especially with one who has an abundance of milk, that she begin to moderate it, so soon as she commences with the preparative steps of weaning, by eating and drinking less; and not having the child so frequently placed to the breast. 
* Commentaries, p. 57. 


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652. If these directions be duly attended to, the nurse will not experience much inconvenience from accumulated milk. But with a healthy woman, at whatever period almost she may remove the child, there will be a painful distention of the breasts; for the relief of which, let her observe the following precautions: 1st. After the child is separated, she should abstain as much as possible from all fluid nourishment; eating nothing but the driest food, as crackers, boiled rice, potatoes, boiled meats, or poultry. 2d. Let her avoid all salted articles, as they will increase thirst, and oblige her to drink. 3d. Let her drink nothing but pure water, and that in small quantities. 4th. Let her take a brisk dose of salts, if the pain be considerable; and avoid exercise as much as possible. 5th. If the breasts be very much distended, and very painful, rub them with a little warm sweet oil, or fresh hog's lard. 6th. Let the breasts remain without drawing, as long as it may be supportable; and when drawn, let it be only in such quantity, as shall remove the distention. 7th. Let the intervals of drawing be each time longer. 
CHAPTER VIII. 
OF TEETHING. 
653. In treating of this subject, we do not think it necessary to enter into minute anatomical descriptions of the first formation, progressive development, and successive changes, which the teeth undergo, before they are protruded through the gums; we shall therefore confine ourselves to a brief description of the arrangement and order, that nature pursues, in accomplishing this important, and oftentimes hazardous process. 
654. The teeth are formed in part, in the foetus; especially, the deciduous teeth. They are confined in distinct apartments, or sockets; the first being placed above the second or permanent set. The first set consists of four incisors in each jaw; two canini, or dog's teeth, and four grinders; making twenty altogether —that is, 
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8 Incisores, or cutters; 
4 Canini or dog teeth, or stomach, and eye teeth; and 
8 Molares, or grinders. 
655. It is the teeth passing through the gums, that creates the pain and mischief of teething, by stretching their investing membranes. The cutting of the first set generally commences about the sixth or seventh month, and ends between the second and third years. These teeth are always smaller than the permanent set, with the exception of the bicuspides, or small grinders. This is a wise provision of nature, since the jaw enlarges even to near adult age; consequently, as the jaws should be filled in both their circular portions, the teeth must be proportionally larger. 
656. The order of cutting, is generally as follows: first, the two middle incisors of the lower jaw; then, after an interval of three or four weeks, the upper corresponding incisors follow; but frequently, the whole four appear in the upper jaw, before the two lower ones protrude themselves. The two canine below, one on each side, now declare themselves; and these are followed by their like, on the upper jaw. Soon after, the two first grinders, one on each side succeed to the canine, in the lower jaw; those above, then follow. 
657. After a lapse of from four to six years, four more grinders are added to each jaw; these are permanent. At the age of twentyone, four more teeth are given, and are called dentes sapiential, or wisdom teeth. 
658. It must however be recollected, there are many remarkable, as well as curious deviations from the order just related; some of which it may be interesting to mention. 
659. 1. Sometimes children are born with teeth ready cut; but this precocity is no proof of vigour of constitution. * 
• We have witnessed but one instance of a child being 1 born with teeth. We had this opportunity in the year 1798. The teeth were two in number, and were the middle incisors of the lower jaw. They were very troublesome to the mother from their sharpness; and very painful to the child, from their not being firmly set in the jaw; they could be easily moved backward and forward, in consequence of which, the gum became irritated and inflamed. We cut them both out without the smallest difficulty, as they had no roots, nor did they appear ever to have had —they were loosely placed in the ridge of the gum. We do not 


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660. 2. Sometimes the lateral incisors cut themselves before the middle ones; at other times, the canine may be seen before the incisors.* 
661. 3. It is now and then observed, that the teeth are very tardy in showing themselves. We have several times seen the first tooth make its appearance after the fourteenth month; and Van Swieten mentions an instance, where this did not happen until the eighteenth month, though the child was perfectly healthy ;t and a child is now under our care, who has not yet cut a tooth, though rather beyond seventeen months old. 
662. 4. Rayer mentions a case, where the four canine teeth did not show themselves until the child was thirteen years old. This case was attended by severe head-ache, sore eyes, and convulsions, for eight days previously to their appearance. % 
663. 5. Fouchard relates an instance, where at six years old the child had none but the fore teeth. § 
664. 6. Brouzet gives an instance, where only one-half of the proper number of teeth were present at the twelfth year of the child's life; and whose gums had acquired the hardness of an old person's. || 
665. 7. Professor Baumes gives the history of a man who never had any teeth to appear. IT 
666. At the time of birth, the teeth are lodged, as mentioned above, in separate compartments; the deciduous and permanent ones having their respective stations within the cavity of the jaw bone, and placed over one another. Each tooth is at first but a pulpy substance, and acquires hardness as the foetus becomes older; the crown hardens first, the root then becomes ossified, 
believe these teeth were ever placed in the alveoli of the jaw—they seemed to be the product of the gum itself. 
There are several instances upon record of this kind. Lewis XIV. of France, and Richard III. of England, are said to have been born with teeth. They do not appear to be of the smallest use to the child; but are on the contrary, perhaps, mischievous. Children of this description are said to be less firm in constitution than those who cut their teeth at the regular period—they generally die before the third year. In the case we witnessed, the child died in its fourteenth month. 
* Diet. Scien. & Med. art. Dentition. 
t Ibid. * ibid. § Ibid. || Ibid. H Ibid. 


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and is hollow, that it may have transmitted into its substance, blood-vessels, and a filament of nerve. * 
667. The whole tooth is surrounded by a delicate, sensible, and vascular membrane, which may be considered as its periosteum. This membrane is put upon the stretch, so soon as the tooth acquires an increase of size; hence the pain and inflammation, which so frequently accompany dentition; and upon the cutting of this membrane, depends the relief, so often experienced by incising the gums. 
Sect. I.— Phenomena of Dentition. 
668. 1st. One of the first signs observed in a child about to cut a tooth, is a heat in its mouth, which is distinctly perceived by the delicate and sensible nipple of the mother. This heat produces thirst, and makes the child demand the breast more frequently than before. An itching most probably accompanies this condition of the gum, as the child, with a view to relieve it, seizes the nipple, and strips it frequently, by pressing its little jaws close upon it; it also rubs its mouth with its fingers, and presses upon every substance offered to its gums, however hard that substance may be. In proportion as the child acquires age before it cuts a tooth, is this disposition to press upon any thing placed between its jaws; hence, the mother is very often made to suffer by severe pressure upon the nipple. 
669. 2d. A slavering, or a slight salivation, almost constantly accompanies this condition of the gums, and seems intended for four distinct purposes —first, to diminish by this discharge the inflammation and irritation of the gums; second, to moderate the thirst consequent upon this local inflammation, as the child is observed to demand the breast less frequently, after this takes place; third, to supply an additional quantity of saliva, with a view to assist digestion, as the stomach and bowels are apt to become disordered by too much food, or, by its remaining too long undigested—hence, children who slaver much are more rarely affected with bowel complaints, than those who do not run 
* Mr. John Hunter, however, says, he never could trace the nerve distinctly, even to the beginning of the cavity. The nerves supplying the teeth are derived from the second and third branches of the fifth pair. 


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at the mouth ; fourth, it serves as an evacuant, thereby abating the general vigour of the arterial system, which too frequently is roused into inordinate action, by the process of teething. 
670. 3d. After these symptoms have continued a longer or a shorter time, the gum is observed to become redder, a little swelled, and immediately over the points at which the teeth would issue, we may frequently observe in the lower jaw, the parts to be semi-transparent; these points are small cells, and very often contain a little effused serum between the edges of the teeth and the external covering of the gum. At these points, we may also observe the little thread-like ridge to be effaced, which mounts the centres of the gums, before any swelling takes place, and the teeth soon after pierce the gum. 
671. 4th. The membrane lining the nostrils very often becomes sympathetically affected; hence the frequent rubbing of the nose, even to abrasion, sneezing, &c. 
672. 5th. Fever of a slight kind is very often provoked. This shows itself, by heated palms; highly coloured, and oftentimes offensive urine; flushing of the cheeks, frequently however but one at a time; great dryness of the lips, and heaviness of the eyes. 
673. 6th. If several teeth are about to appear together; if the absorption of the gums does not go on regularly; and if the system be naturally irritable, we find the salivation either excessive, or nearly arrested; the gums to become much swoln, very red, somewhat spongy, and extremely sensible; fever,even excessive at times;*the kidneys furnishing much urine; leucorrhoea in females; impatience, fretfulness, frightful dreams, startings in sleep; laughing, or whimpering while dozing; diarrhoea, more or less violent; swelling of the sub-maxillary glands; sore, or tender eyes,* and convulsions. 
674. Though these symptoms but too frequently accompany the act of teething, they are by no means constant. We sometimes see them much more moderate than above described; some one or two only of these symptoms appearing together, and they not alarming; and again, the whole of the teeth may make their appearance so regularly, and silently, as not even to attract notice. 
* The two last named affections are easily accounted for, as the teeth, maxillary glands, and eyes, in part, derive their nerves from the fifth pair. 


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675. The process by which the teeth appear above the gums, 
or as it is commonly called, " cut," is not generally well understood, especially by mothers. It is looked upon altogether as a mechanical process; whereas it is only so in part. We shall therefore describe the manner in which this takes place, as it is important that this process should be well understood. 
676. The teeth gradually enlarge within their respective sockets. This increase is in three different directions—first, upward, so as to press against the investing membrane and incumbent gum, and inducing their absorption—second, circularly, so as to press against the edges of the socket; this pressure, when it becomes very strong, presses the membrane which is fastened to the neck of the tooth, so as to kill it, and thus occasions its absorption— third, downward; but the depth to which the root sinks, is limited by the under part of the jaw. 
677. From these facts it will be perceived, that the act of cutting teeth is but in part mechanical; but that part is of great consequence, since it gives rise to the important animal function, called absorption. It is generally thought that the teeth force their way through the resisting gum; but this is not the case, in the strict meaning of the word forcing —for the pressure of the tooth below, stimulates the absorbents to take away the interposing membrane, and gum, that a passage may be made for it as it approaches the surface. 
678. The belief, that the teeth force themselves mechanically through the gums, gave rise to the practice of employing coral, and other hard substances, to aid this operation. This practice has been praised as rational, and condemned as injurious; those who have praised it, have done so upon a wrong principle; while those who have condemned it, have done so with no better information. 
679. Nature herself seems to institute this practice. This seems to be proved by the disposition all children have to press upon every thing hard or resisting that is presented to their mouths, from the moment dentition begins, to its final accomplishment. It is but complying with an instinct, from which they appear to derive both comfort and benefit, and is as constantly obeyed as the necessity is created; and this sometimes, to the manifest injury of even the mother's nipple. Is this desire to press the 


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gums upon every thing hard, a proof of the mechanical nature of cutting teeth, as insisted upon by the advocates of the coral, by presenting the part to be pierced, between two resisting substances? We think not; though we are advocates for the employment of certain substances for the purpose of pressure. 
680. We are of opinion, that the following advantages are derived, from indulging this instinct in children: 1st, it relieves the pain or anguish of the tender gums, by pressing upon them, as squeezing an inflamed finger, as in felons or whitloes, and in many other instances; 2d, by gently stimulating the gums, absorption is unquestionably promoted, and the teeth, in consequence, more quickly appear; 3d, it seems constantly to promote the salivation, by which the engorged vessels relieve themselves. 
681. The nature of the substance presented to the gums, as well as its shape, are not matters of entire indifference, as is but too generally supposed. For instance, the coral, which is always round and very hard, is improper, because the surface presented to the gums, in consequence of this roundness, is very small, and is thus calculated to do injury, by its partial pressure; and from its extreme hardness, to bruise the gum. We do not object to the coral, or other very hard substances, upon the principle generally urged by those who condemn their use, namely, "that they harden the gums, and thus prevent the tooth from coming through, or at least that it increases the difficulty of its passage," for we do not believe they "harden the gums," as it is called; but that they are calculated to bruise these parts, increase their inflammation, and thus retard the process of absorption.* 
682. The substance offered to the gums for the purpose of biting upon, may be of inferior hardness to the coral, ivory, &c., such as a piece of orris root, scraped liquorice root, but what is safer, a flat ivory ring. The rubbing of the gums with the finger, affords great relief to the little sufferers, when they are much irritated; and we constantly recommend this pleasant application. But we decidedly disapprove of any such substance 
* The process of dentition is sometimes one of difficulty among savage nations; as we are informed, that among the Dacotas, " the children suffer much; in such cases the gum is never cut, but the children are allowed smooth stones, and other hard substances, to rub against their gums." Long's Second Expedition, Vol. J. p. 312. 


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OF TEETHING. 
as honey, powdered sugar-candy, &c, to be employed for this purpose, as they only serve to irritate the gums, without furthering the object for which they are employed. The shape of the substance on which the child is to bite, should be nearly flat, and sufficiently broad, that it may present a large surface to the gums; it should also be of proper thickness. 
683. There exists a diversity of opinion on the propriety of aiding the protrusion of the teeth, by cutting through the swoln gums. We are however of opinion, there should be but one, and that should be in favour of the operation. We shall again consider this subject, when treating of the diseases which may accompany teething. See diseases of Teething, Book II. 
Sect. II.— Second Dentition. 
684. At about the seventh year, the deciduous, or milk-teeth, are replaced by others of a larger, and more permanent kind. The first teeth are almost always very perishable, and rarely last in a perfect state, until the jaws are supplied by the second crop. They are very apt to decay, especially with children of feeble constitution, or who have been much afflicted by sickness. The incisors are particularly liable to caries, especially those in the upper jaw—they frequently turn black, and break off close to the gum. The larger teeth are also disposed to caries, and often create much suffering by their decay. We have however never observed these inconveniences to influence the second cutting of teeth.* Indeed, sometimes it would seem to favour their growth, by offering less resistance to their passage. 
685. Parents very frequently neglect their children's mouths, at this period of life, to the serious disadvantage of their future comfort, especially when the front upper teeth are labouring under decay. Against this inattention we would wish to warn them, by recommending the removal of the stumps of teeth, whenever they ache, or the gum becomes inflamed. If the early stage of this inflammation be neglected, the coverings of the teeth are almost sure to inflame, and run on to suppuration. Gum-boils are formed, and the roots of the teeth find their way 
* This will be readily understood, when it is recollected, that each set is contained in separate apartments. 


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OP TEETHING. 
through the gum, by the sockets being absorbed in which they were confined—in consequence of this, the teeth, which are to follow, receive an injury, for the want of due protection from the plate of bone in front of them, which was too suddenly removed. It is therefore every way desirable and proper, that they should be removed in good time by a skilful dentist. The same observations will apply with equal propriety to any other of the teeth that may be painful, or that may have the gum surrounding them threatened by abscess. When the teeth are much decayed, and the time is approaching for the appearance of the permanent ones, the child's mouth should be examined, or rather submitted to the judgment of a skilful dentist. 
688. Before however the time for the second cutting arrives, the child undergoes very considerable changes in its person. This change happens generally after the second year; that is, very soon after it has completed its first dentition. The jaws are now observed to spread themselves, and to acquire an increase of strength, since at this time they can break down with the teeth pretty hard substances. 
6S7. The fontanelles are generally closed, or rather, the soft cartilage with which they were before covered, is now converted into bone of greater or less hardness. The limbs acquire an increase of power, and the child walks with more firmness and assurance. The abdomen loses its roundness, and becomes more flattened. 
688. The face becomes more expressive; the eyes acquire more intelligence, and the whole features of the child are now better pronounced: this is particularly the case with the nose, which now assumes its permanent form. The chin becomes rounder, and gives more freedom to the teeth within. The internal viscera augment with the other portions of the body; and the senses become more accurate in their several discriminations. The tongue gradually gives utterance to words; they quickly acquire the power of expressing their little wants. They thus obviously improve, until the seventh year, when the first teeth gradually drop out, to give place to another set—this operation is called shedding the teeth. 
689. We have already observed, that the first teeth arc but twenty in number; these are now replaced by twenty-four. At 
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OF TEETHING. 
about the twelfth or fourteenth year, four more are added; and the teeth of wisdom follow, at from the eighteenth to the thirtieth year. 
690. We have observed, that it is commonly supposed that the first set of teeth are pushed out mechanically, by the second rising under them; but this is not the case, for the following reasons— 1st, because the first and second set are not contained in the same cavities or sockets, nor are they immediately opposed to each other by situation; 2d, because the first set does not rise in proportion to the advance of the second, which would be the case were they lifted from their position by the second set; 3d, because there is a destruction of the sockets of the first teeth, while those of the second remain perfect, and increase in size; 4th, because some of the first set fall out, when there are no second ones under them; 5th, because the roots of the first set are almost always observed to be removed by absorption, so that the teeth are now only fixed by their necks to the gum, and can be easily moved in any direction; or have become loose. 
691. The reason for shedding the teeth, must be obvious to any one, who will give the subject due consideration. In the infant, the jaw is so small when compared even with that of a child of seven years, that much inconvenience would be experienced, did not larger, and a greater number of new teeth supply the place of the first; a fortiori, the inconvenience would be greater in the adult, did not these useful little instruments occupy a larger space. For were the grinders of the child to be the last to be provided, they would by the growth of the jaw in adult age, be thrown so much in advance as to be almost useless, by being removed from the centre of motion. 
692. From what has been said, it will be evident, that the first and second sets of teeth are pretty independent of each other; that is, the condition of the first set has little or no control over the second, and the reverse. 
693. The order in which the second set appears, is pretty nearly the same as that of the first—the incisors first show themselves, and are oftentimes much larger than those of the first set; but the first permanent grinders do not usually appear until about the twelfth year, the second about the eighteenth, and the teeth of wisdom from the twentieth to the thirtieth year, as 


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OP TEETHING. 
has been already noticed. So that the incisors, and the cuspidati, require about six or seven years from their first appearance, to arrive at perfection; the bicuspides, about seven or eight; and the molares, about twelve. 
694. The increase of size, and the augmented number of the second teeth, sometimes do not find sufficient room in the jaws, to arrange themselves in regular order. When this happens, some of the teeth are obliged to be extracted—but this is the business of the dentist. 
CHAPTER IX. 
OF THE FOOD PROPER FOR CHILDREN, AFTER THE FIRST DENTITION, AND WEANING. 
695. It must not be imagined, that every kind of food is proper, after the child has completed its first dentition; for though this important change has been successfully accomplished, still, the digestive organs require that only such substances shall be offered, as can be completely and readily subdued by the still feeble teeth. It would on this account be highly injurious to feed the child upon such food as would require great powers of mastication, as it would neither have strength nor patience, to reduce it to sufficiently small particles; it would therefore be at the risk of choking, swallow it whole, or having it conveyed into the stomach very imperfectly chewed. 
696. The stomach would thus receive food not adapted to its powers, and of course would suffer by its being improperly taxed. But it is not the quality of the food alone that is to be attended to when a change is contemplated—we should be particularly careful that, this change be not made too suddenly. The stomach during almost every period of life, seems to acquire from habit a power over substances of even an indigestible kind; and is capable of converting them into proper nourishment, when perhaps it might fail in subduing some other, which generally is of more easy solution. Therefore a part of the food at least, that 


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was given during suckling, may be continued with much propriety after weaning. • 
697. It must however be recollected, that an additional quantity will be required, since the child now loses a part of its former sustenance, by the abstraction of the mother's milk. This may be accomplished in one of two ways—first, by increasing the number of meals; or second, by augmenting the quantity at a meal. The last method is preferable, since it permits a longer interval for the digestion of the quantity, previously taken; for, as we have already observed, the process of assimilation should not be interrupted, when it can be avoided, by additional quantities of food being poured into the stomach. 
698. On this account, it is always important to establish regularity in meals; but for the child newly weaned, the periods which were formerly observed in suckling, may for a while be retained; taking care to prolong the intervals gradually, that they may after a time be reduced to an order. We would not wish however to lay down absolute rules for this purpose, since the intervals must in a great measure be contingent upon the powers of the stomach itself; and these must necessarily vary in different children—some digesting much more rapidly than others, owing to the original healthfulness of this organ, or to circumstances connected with air and exercise. Thus children running about in the pure air of the country, will digest their food more rapidly than those confined within the walls of the nursery, and who breathe the less pure air of the city. 
699. There is perhaps no period of the child's life, wherein so much care is required, to avoid overtaxing the powers of the stomach. It is at this time particularly, that the foundation of a weak stomach is laid, by giving too much food, even of a good quality; but more frequently by indulging children in such articles that their little stomachs cannot master. Many parents are of opinion, that children should be indulged in whatever they may fancy— believing most wrongly, that this organ never craves that which would be injurious to it. Hence the preposterous and injurious farrago with which children are sometimes crammed; and hence indigestion, with all its terrible consequences. 
700. The food of children cannot well, at this period, be too simple. A great mixture is bad, in every stage of life; but is 


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particularly injurious in infancy, and in childhood. The various jellies from vegetable substances, at this time, are very proper — such as the jellies of tapioca, rice, sago, or arrow-root; these may be taken with fresh milk, with the most decided propriety and advantage, since they are void of all stimulus, and are of easy assimilation. The quantity of these however, must be regulated by the good sense and discretion of the parent, rather than by the appetite of the child; for this may be naturally inordinate; or artificially so, by ill-judged indulgence. 
701. During the period of dentition, the system is almost always in a highly excitable state, and is but too readily roused into fever; therefore nothing can be more decidedly preposterous and destructive, than allowing children to live upon stimulating articles of food; yet nothing is more common. Parents cannot always resist the importunities of their children, though their better sense at the moment condemns the indulgence; a habit of importunity is created, and in a short period they permit themselves to be governed; and the children in consequence are rendered miserable, by a compliance with their artificial wants. 
702. It requires only a little firmness in the beginning, and that not of very long continuance, to make children conform to the dictates of their parents, and to render them entirely obedient to their wills; for it is only necessary to commence sufficiently early, to make the child know, it is not to think for itself. Neither its palate nor its caprice, is to be consulted—the parent must set before it for its meals, such articles of food as are judged best for it, and it is to be made to understand, that it must eat them, or nothing. If this plan be followed for a short time, all trouble will cease; since, as the child has never had a wish respecting its food gratified at the expense of propriety, it will soon cease to have any; or rather, it will never have any to arise. But if the parent be weak enough to consult the child's taste at table, it will soon demand a portion of every dish, nor be satisfied until it obtain it. We need not say, how subversive this conduct would be, of all order and propriety; or how seriously, nay, oftentimes, how irreparably the child may be injured by it. 
703. We must not however be understood to prohibit all indulgence to a child at table; on the contrary, we would wish to make them feel every now and then, that we were doing them 


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a favour, by occasionally departing from our general rule; taking care at the same time however, that we give nothing injurious to the stomach. By this plan, we shall make them feel their dependence; and also make them grateful for the occasional indulgences they experience. 
704. This mode of treating children, has many decided advantages over that of a compliance with the indiscriminate, and oftentimes injurious demands they make at table. Their moral, as well as physical powers are benefited by not yielding to their importunities; for if these be once complied with, there is an end to all future subordination—all control ceases, and health suffers almost in proportion to indulgence. How often does it become essential to confine children to a specific diet? But how can this be effected, if they have been permitted to select their articles of food? Let any parent who has allowed their children to eat indiscriminately of any or every article at table, answer, whether, it does not constitute one of their most difficult tasks, to withhold from them the prohibited articles, when they become sick? Our experience declares it to be a common acknowledgment, that it is next to an impossibility to do so, however imperious the necessity for such denial may be. Yet all this trouble might have been spared, if a proper system had been in due time adopted. 
705. It is not necessary to confine children always to the same form of food; this may be occasionally varied with advantage; especially, if it be perceived that their appetites flag a little from long continuance. Thus milk, which should constitute the chief article of diet of children until after complete teething, may be given in a variety of very acceptable forms; such as milk and bread boiled or unboiled; rice and milk, sago and milk, arrowroot and milk, &c. Plain rice pudding is a very acceptable dish to almost all children, and may be occasionally introduced as a " bonne bouche," with great advantage. 
706. We do not hesitate also, to indulge children, now and then, with small quantities of animal food, especially after they have their first teeth complete. But animal food should not constitute their principal support even at this time, since it may overtax the stomach, and too much excite the system; and before this time, it should be most sparingly indulged in, though not altogether withheld, for the reasons assigned above. 


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707. The drink of children should be pure water; or occasionally, milk and water. * There can be no possible propriety in giving them liquors of any sort whatever; for unless as a remedy in disease, the system never requires them; and when indulged in without a necessity, are sure to do mischief. But children should not be permitted to acquire a habit of drinking very often; for it will certainly be mischievous, by over-distending the stomach, too much diluting the gastric juices, and impairing the appetite. During their meals, a moderate quantity should be given to them, as it will then be useful, by forming a more complete pulp of the food taken in, and thus subserve the purposes of digestion. The water given to children should not be of too low a temperature, lest it give pain, and do injury to the powers of the stomach. We think we have seen serious injury result from the too free use of iced water. 
708. It will readily be perceived, that after a child has completed his first dentition, he may be permitted, by a gradual change, to eat food of a more nutritive kind—or in other words, more animal food. But in permitting this, a proper regard should be paid, first, to the kinds of animal food; second, to the mode of preparing it; third, to the period of the day at which it is taken; and fourth, to the quantity employed. 
709. 1. Of the kinds of animal food. It must not be assumed with too much facility, that even a moderate quantity of any kind of animal food is equally proper. It is no longer a matter of conjecture, but one of very often repeated experiment, that there is much difference in the degree of solubility, if we may so term it, of animal foods; and that, which from long observation has proved to be the most easy of digestion, should be the one generally preferred. On this account, beef, mutton, lamb, venison, fowls, turkeys, pheasants, partridges, &c. are to be preferred to veal, pork, pig, geese, and ducks; since it has been proved by almost universal experience, that the stomach assimilates the former more easily. We are aware, that this is not universally the case; but the exceptions only prove the rule. 
* We have found weak molasses and water not only a very acceptable drink, but a valuable one to such, as had tendencies to constipation; children therefore may be occasionally indulged with it as a pleasant beverage, as well as a very mild and certain laxative. 


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Therefore, when a child is at the age proper for indulgence in a portion of animal food, one of the first class enumerated should be employed. 
710. Veal and pork, are particularly unfriendly to the young and unconfirmed stomach; and should therefore never be selected for the diet of such children. We have known numerous instances of both these substances remaining undigested in the stomach for four-and-twenty hours, and even longer sometimes, and then thrown up, after having tortured the poor child with pain, fever, or colic, for several hours. The flesh of ducks and geese is nearly as bad as veal or pork, but not altogether so; especially, if care be taken to separate the skin from the flesh. 
711. Fresh fish boiled, of almost every kind, sits well upon the stomachs of children, when taken in moderate quantities, and at proper periods of the day; and even salt fish in very small proportions, is sometimes very acceptable. 
712. Eggs, when not boiled hard, are easily assimilated by most stomachs; they rarely disagree when fresh; and when given in moderate proportions, especially in the morning, are highly nutritious. Nay, they sometimes form a valuable article of food, when beaten up with sweetened water, or milk and water, during convalescence. 
713. Salted meats of every kind, are of much more difficult digestion than fresh, if we except pork. Ham, is less injurious than the fresh pork; but salted beef, salted venison, and dried mutton, are of more difficult solution than when fresh. 
714. 2. The mode of preparing it. It is a matter of great importance, that meats of every kind, should be properly prepared or cooked; for if this be not attended to, the most wholesome, may be converted into a temporary poison, by being rendered literally indigestible. For young children, plain boiled and roasted are the best; and these should be sufficiently done; or in other words, not too rear. Poultry, and fish, should always be thoroughly well roasted, or boiled; but the roasting should not be carried to the dissipation of all moisture—nor the boiling, to the falling to pieces of the article. 
715. Game, and poultry, may be treated after the same manner—either roasted or boiled, in a due degree. Some however are of opinion, that beef, mutton, lamb, or venison, cannot well 


209 
AFTER THE FIRST DENTITION. 
be too little done—hence, many have these articles brought raw to the table, sometimes, to undergo a second process; while others go to the opposite extreme. We think the proper degree, lies between these extremes. It is pretty generally agreed, that poultry, and certain game, as the pheasant and partridge, should be well done; if from among the poultry, we except ducks—the latter are generally preferred underdone. This unquestionably improves their flavour; but we are not certain, that it is any advantage to the stomach. 716. Fried, stewed, or highly seasoned meats, are always improper for children; veal-cutlets, stewed veal, fricasees, or ragouts, are always injurious, and should ever be avoided. The same may be said of every kind of meat-pies. Broiled meats are less injurious than fried; especially, beef, mutton, or venison. Poultry, treated after the same manner, is less healthful, and should not be as freely given as when roasted or boiled. 717. 3. The period of the day. It is very far from being a matter of indifference, at what period of the day, the child receives animal food—of so much consequence is this sometimes, that the same article may be either proper or injurious, as it may be given at one time or another. Therefore as a general rule, a rule indeed admitting of but few exceptions, animal food should be taken only in the morning, or at noon; and as another general rule, we should much prefer the latter, for the following reasons—1st. The child in the morning, from the previous night's rest, has its system rendered very excitable at that time; therefore it should be confined to bread and milk, weak tea or coffee,* and bread and butter, mush, boiled rice, or any other mild food. 2d. From the appetite at this time being rendered very keen, there is a risk that it will take too much, if animal food be added. At noon, the excitability of the system is a little worn down by exercise, &c; and at this time, the stimulus of a moderate quantity of animal matter, may not only safely, but profitably be indulged in. In the evening we would forbid it; as digestion will not 
* We mention weak tea or coffee from necessity, and not choice. In our large cities, it is not always easy to command the more suitable article, milk. But any injurious qualities appertaining to either tea or coffee, may easily be counteracted, or rather, they may be so diluted, by the liberal addtf.on of milk or water, as not to be injurious. 
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be completed before the child goes to bed, and it may have it* sleep much disturbed in consequence; or it may sleep too soundly, from the stomach being oppressed by an over quantity of food; or by the blood-vessels becoming too much filled. 
718. 4. The quantity employed. Children should never make animal substances a principal part of their food, until after the age of puberty. Before this period there should be a predominance of either vegetables, or milk. The vegetables however should be properly selected; and but one kind should be used at a time, as mixtures of them are always less manageable by the stomach, than when they are presented singly. The best vegetables are, rice, potato, spinach, asparagus, turnip, and squash—the less proper are, beans of every kind; cabbage, beets cooked with vinegar, peas, sorrel, and cucumbers. Animal substances must be used but in moderate quantities, especially with children who go to school; for if it be made the principal part of the diet of such children, they are sure to be over-stimulated; they become sluggish and drowsy, and thus incapacitated for study. Those children who have made milk the principal part of their diet, are always found to be the best students. The fatigue of study is much diminished by employing a mild, nutritious diet; since by this regimen, the faculties become more acute, and the memory strengthened. 
719. We may then consider it proper, to employ a moderate quantity of animal food after teething, and the quantity may be gradually increased until puberty arrive. Of the period subsequent to this, we have at present nothing to say. 
720. In regulating the diet of children, care should be taken, not to force any particular substance upon them, after it has been found by fair and repeated trials to disagree. There is both cruelty and bad judgment in doing so—it is cruel, because the poor child is forced to swallow that, which is disagreeable to it; and bad judgment, because it is perpetuating a disgust, which most probably would have subsided, had it been let alone—for the stomach will oftentimes forget injuries, if not reminded of them by repetition. 
721. Great care however must be taken at this period of life, that permanent dislikes are not formed against certain articles of food. Temporary disgusts are frequently experienced; and if not counteracted, may degenerate into inveterate aversion, to 


211 
AFTER THE FIRST DENTITION. 
the great discomforturc of the individual. The management of this case is oftentimes a point of great nicety; for it requires a good deal of close observation, and discernment, to distinguish between a wayward prejudice, and an actual disgust. The former, if indulged in too long, may be converted into the latter, and the latter may oftentimes, by judicious and well adapted means, be entirely removed. 
722. Waywardness, or prejudice, should not be yielded to— a little well-directed firmness, is almost sure to overcome it. It is always best managed by reasoning; by representing the inconveniences, and sometimes disagreeable consequences, which may arise from indulging in such feelings; and by persuading them, they would soon become reconciled to the article, if they were to make proper trials to become so. 
723. Real aversion arises from a particular feeling of the stomach itself, and which is not always under the control of reason, however strongly exerted. This condition may arise from a natural and inherent dislike to certain articles of food, the origin of which cannot be traced; nor its cause ascertained. One of the most frequent of this kind is that to mutton. Or it may arise from some accidental circumstance, as taking too much of any certain article; to this not being in a perfect state; or from its being imperfectly cooked—nausea and vomiting are excited, and the stomach becomes irreconcilable to its presence, ever after. 
724. The cure of either of these conditions of stomach, requires much perseverance, and determination—it should always however, be attempted. The best plan, we believe, (at least it was so in our own case,) is first to make the object endurable to the eye, by viewing it steadily and frequently, for some time, if this be persevered in, with a determination to conquer, it will be found that the object will gradually lose its annoying force. By and by, the eye becomes familiar to its presence, or can look upon it with indifference—this is a great point gained. The next step is to accustom the nose to bear its effluvia without horror, when it is near you, at table: when this can be supported, the cure is near at hand; for the stomach is much influenced by the eye and the nose. The taste is next to be reconciled—this is best done at a time when strongly urged by hunger. Small quantities may 


212 
Of THE FOOD PROPER FOR CHILDREN, &C. 
be given at a time; should the stomach not now revolt, it maybe swallowed with impunity. This must be occasionally repeated, until the aversion is overcome. 
CHAPTER X. 
ARE THERE SUBSTANCES IN COMMON USE, ABSOLUTELY HURTFUL TO CHILDREN? 
725. This question is very often asked, and is almost as variously answered. This arises frequently from the fondness or dislike people may have for certain substances, rather than from absolute experience; believing the substance of which they themselves are fond, to be always innocent, and that which may have accidentally disagreed, to be always injurious. To people who are able to judge for themselves, we shall offer no observations upon the various articles of diet constantly presented to them—they must be regulated by their own experience; for if this will not render them judicious in their choice, they must submit to the penalties attached to voluntary error. 
726. Not so however is our determination with respect to children, for whose health we profess to be sincerely anxious, and are desirous to promote by every means in our power. We shall therefore offer a few observations upon various substances in common use, and of which children are almost constantly made partakers. 
727. There cannot be a more absurd question, than " is such a thing wholesome?" since, to be answered safely, requires so many considerations, and so many exceptions, that no one should venture to answer it, either affirmatively or negatively, before duly weighing them. When the late Dr. Cullen used to be asked this question, he inquired of the speaker, "does it agree with you ?" If answered in the affirmative, he would declare it was wholesome. This is a most judicious answer, for a person who has experienced the effects of an article; but to the child, who has no such experience, such answer cannot apply. 


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OF SUBSTANCES HURTFUL TO CHILDREN. 
With a view therefore to aid the choice, we shall consider the subject a little in detail, and endeavour to fix some general principles, founded upon the influence of various substances upon the tender and unconfirmed stomachs of children We shall therefore lay down certain data, and reason from them as this may become necessary. 
728. 1. That nature never intended that the child, who had no teeth, should be nourished by precisely the same aliment, as the one who had, and the reverse. Therefore, the food that may be proper for the one, might be decidedly injurious to the other; consequently, animal food, pastry, fruit, confectionary, &c. would be positively injurious to the child without teeth. Yet neither of these substances, under proper circumstances, and in proper quantities, should be considered as positively hurtful, since they are only so quo ad hoc. 
729. 2. The food which may be proper after dentition is completed, may be highly injurious while that process is going on; hence, animal food, or any other stimulating article of diet, may be looked upon as positively injurious—though so, only for a limited period. 
730. 3. The food for adult age, if employed before puberty, would often be found highly injurious; though the general experience of the world, would deny their being positively hurtful in themselves. 
731. 4. The food which universal experience may declare to be "wholesome," can only be so, when taken in proper quantities, at proper periods, and under proper circumstances; therefore, any substance, in undue quantity, and at an improper season, may become hurtful; but must not be declared positively injurious, in a general sense. Consequently, when we speak of food, on which thousands have lived and done well, or from which others have suffered, being either wholesome or unwholesome, we must mean it is either the one or the other, according to age, and constitution; to the particular circumstances under which the body may be placed, as climate, sickness or health; or to the quantity, or particular quality of the articles referred to. 
732. It must not however be inferred from what has been said, that we consider every article of diet as equally proper —far from this; for though we do not admit that any of the usual articles 


214 
OP SUBSTANCES HURTFUL TO CHILDREN. 
of food are positively hurtful in themselves, yet we declare, it will always be proper to make a choice from them; and on that choice will very much depend the proper health of the individual who may employ them. Thus, we have already declared, that the meat of one animal is better than that of another; and so on with many other substances. Yet the best of either of these articles may be highly pernicious, when injudiciously administered; and the worst of them, may be useful under certain conditions of the body. 
733. Having made these preliminary remarks, we shall now proceed to our proposed inquiry—Are there substances in common use as food, which generally disagree with, or are improper for children, before the first dentition is complete? If there be, what are they? This question is perhaps fully answered already, in various parts of our book; but as indulgence in certain articles at the period designated, may be too often granted, and thus tend to either the immediate, or remote injury to the child, we shall consider them in detail; and first, 
Sect. I.— Of fruit in general. 
734. Fruit may be considered, generically, of two kinds -— namely, fresh, and dried. 
Of Fresh Fruit. 
735. The fresh may consist of apples, pears, peaches, cherries, raspberries, strawberries, melons, dewberries, blackberries, whortleberries, grapes, oranges, pine-apples, &c. 
736. Many opinions are entertained of the respective wholesome qualities of the articles above enumerated, when ripe; but we believe there is only one, namely, that they arc highly injurious, when they are not so. We shall therefore always be considered when speaking of fruit, to mean ripe, or mature fruit, unless it be expressly stated otherwise. 
737. We limit ourselves, when speaking of the effect of these articles, to the period before the first dentition, or the first two years of a child's life; and it may be asked, is fruit of any kind proper for children of that age? 
738= This question must mean one of two things—is fruit a 


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OP FRESH FRUIT. 
proper article of diet for children, at the period spoken of; or, will the occasional indulgence of a small quantity be improper? As to the first, we would decidedly condemn any article enumerated, since it almost always does mischief, when indulged in. When fruit is forbidden to children, it is asked, how can it be bad, since they are so fond of it; and since nature has furnished it so abundantly? As regards the first question, we would ask, are not children as fond of wine, ardent spirits, and many other improper things, as of fruit? Yet you would not give them either of these, because they might take a fancy to it. They would eat the fruit of the Jerusalem cherry, the berries of the laurel, or the seed of the stramonium, with perhaps equal avidity, though death would be the immediate consequence of the indulgence. And as regards the second, nature has spread her poisons, with as profuse a hand, as she has her most salutary fruits; consequently, the abundance of the substance cannot prove its usefulness as food. 
739. We therefore are of opinion, that whenever such a quantity of fruit is given to a child, as shall either by its quantity or quality, materially change the nature of the digested product, it is always bad; consequently, such a proportion should not be permitted to enter the stomach. Nor do we think it always safe, even in smaller quantities. If on the other hand so small a quantity be given, as not to influence the digested product, it may be given without injury, but we believe never with advantage. 
740. Fruit, by most people, is not only considered innocent, but positively useful; therefore, a free indulgence is generally permitted in its use, without attending to either the age, peculiarity, or condition of the person who may make use of it: yet we hesitate not to say, that unless due regard be paid to each of these circumstances, fruit cannot be useful, and very often not even innocent. It is familiar to the experience of every body, that one class of substances is of more easy digestion than another—thus animal food is of more easy conversion, than vegetable. This, as a general rule, is strictly true; and of animal food, as we have already remarked, some digests with much more ease than other. The same remark is applicable to the 


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OF FRESH FRUIT. 
vegetable class—and of this class, fruit may be considered, with young stomachs, of more difficult solution than almost any of the farinaceous substances in common use; consequently, must be less proper. 
741. The insolubility of most fruits, is well known to every body, either from their own experience, or from their observations upon the confirmed adult stomach of others; and with respect to children, the fact is notorious to all, who may have charge of them. Who does not constantly witness these substances passing rapidly through them unchanged, and especially at the age we are now speaking of? Can it then be for a moment insisted on, that that substance which the stomach cannot master, is useful, or even innocent? Let us not then be deceived, by mistaking the agreeable, for the useful. 
742. At the age we are now speaking of, the indulgence in fruit of any kind, should be very limited indeed ; and especially, where the stomach and bowels are not in the most perfect health. After this period, it may be given in moderate quantities, without much risk; but if there be even a small excess, the child is sure to suffer from a derangement of the stomach or bowels, or both; or if it escape from these evils, the stomach will be found less disposed for its ordinary meals, and the articles will be seen to pass unchanged. 
743. There is a vulgar error on this last point, which deserves correction; since it has no inconsiderable influence upon the conduct of many, in administering fruit to children. The passing of fruit unchanged through the bowels, has frequently been urged to us as a proof of its innocent nature; for it is said, that " if the child has taken a little too much, or if the stomach cannot assimilate it, it always comes away." Now, this coming away unaltered, a direct proof that the stomach cannot digest it; and of course, the child has been labouring under an indigestion; and though in some instances, it has not produced any violent symptoms, it must nevertheless be admitted, that the child runs a great risk. We must therefore lay it down as a positive rule, that whenever this is observed with any substance, no matter what, the stomach itself is out of order, or that the particular substance is not suited to its powers, or condition, and must not 


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OP FRESH PRUIT. 
again be urged upon it. It is owing to an inattention to these first revolts of the stomach, that dyspepsia is produced; and farther heedlessness, too certainly confirms it. 
744. There is another vulgar error with respect to certain fruits, which is even more mischievous than the one just mentioned ; namely, that they are not merely innocent, but positively wholesome. This opinion is entertained of the dewberry, and the blackberry; hence they have but too often been administered to children, who were labouring under acute or chronic diarrhoea, to the imminent danger of their lives. We have witnessed, this season, (August, 1825,) three instances *of dangerous cholera, brought on by means of these fruits; and one which had nearly proved fatal, from the use of the syrup of the blackberry. These instances are far from being rare; we have witnessed more or less of them, ever since we have been engaged in practice. 
745. We are fully aware how difficult it is, to root out a long established error; and that the dictum of an old woman, will very often outweigh the experience of the physician. We do not therefore calculate too largely upon the force or influence of our opinion, upon this important point. We feel it however a duty to state, that which has been sufficiently confirmed to us with respect to these fruits, when exhibited as a remedy—namely, that we have never known them to be useful; but we have very often known them to be injurious. 
746. We have another vulgar error to notice—namely, that " when you eat cherries, you must swallow the stones, to promote, digestion." This is one of the most absurd, as well as dangerous errors, that popular opinion continues to cherish; it is one replete with mischief, and has neither reason nor experience to countenance it. This mischievous practice took its origin most probably from the mechanical theory of digestion, or from some ill selected analogy. It was formerly taught, that the human stomach subdued the substances presented to it for digestion, by a mechanical action; and that consequently, the cherry-stones performed the same duty in it, as the gravel in the gizzards of fowls. This opinion has been long disproved, by the most satisfactory experiments; but the errors to which it led, unfortunately continue to prevail; and this with a class of people, from whom we would rationally expect better formed notions. 
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747. The same disposition to theorize, has found a utility for the purposes of digestion, in eating the skin of the apple and peach. They say, that nature intended the skin to promote this object; or why were they formed ? The same reasoning would render it proper to swallow the shell of the walnut, and the rind of the pineapple; but did not the opinion lead to practical injury, it would not have been worth the trouble to expose its absurdity. 
748. From what has been said, the following principles, we think, may be established:— 
749. 1. That before the child has attained its second year, fruit in any quantity cannot be considered useful; though very small quantities, properly administered, may do no injury. 
750. 2. That after the second year, small quantities of fruit may be given with less risk; especially, if the circumstances, which should always regulate its exhibition, be duly attended to. 
751. 3. That it should never constitute the chief article of diet; since in such a proportion, it would so alter the digested product, as might seriously injure the functions of the stomach. 
752. 4. That fruit, of almost every kind, is less digestible than any of the farinaceous substances in common use. 
753. 5. That when the stomach is incapable of assimilating it, much disturbance in the stomach and bowels is excited, terminating oftentimes in cholera; or, 
754. 6. If it does not produce this evil, it passes from the bowels in an unaltered state; and when this is the case, it is a .certain evidence that it is injurious. 
755. 7. That as a general rule, the older the child, the less the liability to injury from fruit, provided it be taken at proper times, and in moderate quantity. 
756. 8. That it is an error to suppose, that any fruit is positively useful, as a nourishment, or as a medicine, to young children. 
757. 9. That it is also an error, and one of a serious kind, to swallow the stones or skin of fruit, with a view to promote digestion. 
Sect. II. — Of Dried Fruits 
758. The dried fruits are raisins, cherries, apples, peaches, figs, prunes, &c. Of these it may be said with safety, that they 


OF DRIED FRUITS. 
219 
are still more exceptionable than the fresh, but not all in an equal degree. The most injurious are the four first named. Raisins are extremely indigestible, unless deprived of their skin; and should never be eaten, without attending to this precautionthere is no stomach, unless it may be that of the ostrich, of whose powers of digestion we hear so much, that can master the skin of a raisin—we know from observation, that a hog cannot overcome this insoluble substance; yet they are given by indulgent parents, in large quantities to children of every age, and of every power of stomach, to either their immediate or remote injury. We have known three instances of convulsions and death, from an over quantity of this fruit. 759. Of the dried cherries, apples, and peaches, it may be said, that they are altogether unfit to be received into the stomachs of children, and especially young children.* They are rendered fitter for the purposes of food, by having them well stewed; but even then, they should be taken in but moderate quantities—particularly the cherries and dried apples. The fig, and the prune, are less exceptionable than the articles just named • but they cannot be freely indulged in, with entire safety, by young children. The adult stomach, when sound, bears them with advantage when taken in moderation; especially where the bowels are tardy-but they never should be given for the same purpose to young children. 
CHAPTER XL 
OF EXERCISE. 
760. Under this head, we shall include, 1st, the exercise or motion useful or proper for very young children, up to the period ol their beginning to walk; 2d, walking; 3d, other modes of exercise-A, riding in a carriage; B, riding on horseback; C, games of various kinds; D, dumb-bells. 
foury p e a r W ,rr nStanCe ° f lon ff- con «nued and severe convulsions in a child of bv IS t ' eatmS a qUantity ° fdried a PP ,es > whIch he m Poured relieved of d ° UbtfUl * *** ****** bUt bei "* relieved of the ofFendn.g cause, by an active emetic, saved his life. • 


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OF EXERCISE. 
Sect. I.— Carrying in the Arms. 
761. Under this title, we may comprehend almost the whole of the motion, or exercise, which can be usefully employed, for very young children; and this may commence with advantage, a few days after birth. An error is almost constantly committed by nurses and mothers, in confining the child constantly to the bed, or cradle, covered with clothes, or buried in feathers, instead of carrying it about the room several times a day, carefully placed upon a pillow, that it may enjoy a renewed atmosphere, and have an opportunity of exercising its little limbs, which this important indulgence so strongly invites them to, even before they are a fortnight old. The custom of confining a child at this early period of its life, arose from the absurd aphorism, " that the more a child sleeps, the faster it grows." 
762. It should be constantly kept in view, that children, with respect to exercise, are precisely on a footing with adults, making the proper allowances for degree. The muscular system of the child, like that of the adult, can be strengthened only by exercising it; and the circulatory, nervous, and absorbent systems, can only be kept healthy, by the due and proper play of the muscular ; therefore, for the important purposes of health, it must acquire tone, by a well regulated plan for this purpose, or all the systems just mentioned will become deranged, or even diseased. 
763. If this be true, it will readily be admitted, that the sooner we commence with this important part of physical treatment, by a well adjusted plan, the sooner will the muscular system acquire the tone, so important to the many other functions of the body. 
764. To begin then with this useful practice sufficiently early, the child should be taken several times every day, after its wakings, from its nest of feathers, (even at ten days old,) and disposed of upon a plain, and sufficiently soft surface; freed from all restraint, and left to the enjoyment of its own sensations. In obedience to these, it will soon be found to exert its feeble limbs in every direction; and manifest by its repeated efforts, the pleasurableness of its feelings. It will discover, after a few trials, how much it enjoys this freedom from restraint, and the 


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advantage it is deriving from it, by an increased motion, and force of its limbs. In the position we recommend, namely, upon its back, it has a full opportunity of exercising all the larger muscles of the body; and it is surprising, when thus permitted to exercise, how rapidly the child acquires strength. 
765. Every body seems to be aware of the necessity of exercise to strengthen the muscles; but there are very few who institute a regular and proper series of experiments, for this purpose. Indeed, the exertions the poor infant is obliged to make in the hands of its nurse, are calculated to do more injury than good. The pride of the nurse, and too often that of the parent, become highly interested in the display the child is obliged to make, in keeping itself erect; and when from long and often repeated trials, the little creature is able to straighten its spine, it is praised for its forwardness, or quoted as a prodigy. But this kind of management is decidedly wrong; since, all this apparent vigour is oftentimes procured at the expense of some permanent derangement of the spine. 
766. It will be evident to every reflecting mind, that the incompletely ossified spinal column, is but ill calculated, at the period now supposed, to sustain the weight of the whole body, and the head beside; and when forced to do so by this injudicious management, it must yield in a greater or less degree; hence, crooked spines. We would therefore peremptorily forbid all such displays. We are well acquainted with a nurse, who from a perseverance, worthy a more noble and useful object, teaches the children she has charge of, to sit bolt upright, within the period of the month ; and it is truly ludicrous, as well as unnatural, to see the little creatures sitting as straight, as if they were stiffened by a back board. What may ultimately be the result of such a plan, remains to be proved—reasoning upon the subject, leads to nothing but gloomy anticipations. 
767. From what has been said, it will appear, that however important exercising the muscles may be, yet this must be done, without obliging the spine to support the weight of the body, as it must do, when the child is placed in an erect position. The employment of the muscles, must be the result of the voluntary act of the child; and it will most certainly and successfully exercise its volition, when placed in a position which frees it from 


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restraint; as on its back, with its head a very little elevated. When thus situated, with all its limbs at liberty, it will in a very short time become so familiar, and so pleased with its exertions, that it will every day more and more employ the muscles of these parts; and in a little time more, it will use those upon the posterior part of the body, to the manifest advantage of the yet feeble spine. 
768. Another error is almost constantly committed; namely, the management of the head of the child, during all the various attempts to make the child sit straight. During this discipline, the head of the poor little thing is permitted to hang on one side constantly, or it is suffered to roll about as if it were but loosely attached to the body. The injuries -arising from this inattention, are—1st, the child acquires a habit of holding its head upon one side, which is difficult to overcome; it also does mischief to the neck itself; for, 2d, if permitted to roll about, injury may be done to that part of the spinal marrow which passes through the vertebras of the neck, by the head making, from some cause or other, too large a sweep; or in other words, describing too large a portion of a circle. 
769. To prevent these evils, we would recommend; first, that the child should never be placed in an erect position for any length of time, before the spine is sufficiently confirmed to support the superincumbent weight, and the muscles have acquired strength to support the body in that position, without too much fatigue; and secondly, if the child must be placed in an erect position for any necessary purpose, the head should always be steadily sustained by the hand of the nurse being placed under it. The cautions now suggested are particularly important with respect to feeble, or very heavy children, or those disposed to rickets or scrofula. 
770. The child's body may be placed so as to make an angle of a few degrees with the horizon; but when this is done, it should always be by the hand of the nurse sustaining the back and head, by placing it against the shoulders and head. The child may be carried about in this position, and gently exercised, by a.movement up and down; this may be repeated several times a day, for a minute at a time. But we most earnestly deprecate a too rapid motion, even in the direction prescribed; but espe- 


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cially, a whirling motion. If the movement prescribed (770) be gently and properly managed, it not only tends to give strength and vigour to the child, but becomes a certain source of amusement to it, as is clearly perceived by its joyful expressions, and strong attachment after a while, to those who perform it. 
771. We have said, this motion should be gently performed; we would rather wish to be considered as insisting upon this as an essential condition; for if it be rudely done, mischief may follow, from the sudden shock the nervous system may receive. The child, when this movement is carried to excess, expresses its dislike, and apprehensions, by the sudden starts of its body; by its wild and affrighted looks; and by its convulsive sighs, and crying. We have strong reason to believe, in one instance, that death followed, from this movement being too suddenly and violently performed. When properly conducted, it has all the advantages of swinging. The same censure must be passed upon running violently with the child in the arms, hastily descending the stairs, jumping, &c. 
772. After the child has acquired sufficient strength to sit up without much support, it may advantageously be indulged in it, if properly managed;—that is, not too long at a time, nor too often repeated. The spine of the child will rarely acquire such firmness, as to render this proper, before the third month—after this time, it will, all things being equal, gain strength daily; and may now be occasionally carried on the arm of the nurse, provided she handle it properly—for on this much depends. We shall therefore lay down the following rules, for carrying children on the arm:— 
773. 1. It should never be so placed upon the arm, as either to oblige it to support itself, or fall backward. To prevent this, the hand of the arm on which the child does not rest, should be so placed over its body and chest, as to give a certain support to the whole body. 
774. 2. It should never be carried upon the arm, without additional support, until the muscles of the neck have acquired sufficient strength to carry the head straight, for reasons already suggested. 
775. 3. It should not always be confined to one arm; for if it be, it will, from maintaining one position too long, contract a 


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OP EXERCISE. 
habit of leaning to one side, or become crooked—therefore the arms should often be changed. 
776. 4. It should not be made to put an arm around the nurse's neck, while placed on the arm for carrying; as it will do injury to the side and back, by forcing out the shoulder-blade. 
777. 5. It should not be too firmly grasped by the nurse's arm, lest it bend or distort the bones of the pelvis, thighs, and legs; and on this account, the child should not be often trusted to those who are unskilled in carrying one; as they always embrace the child very firmly, from an apprehension they may let it fall—an experienced nurse can Carry a child without much pressure. This rule is of especial consequence to such children as may be disposed to rickets. 
Sect. II.— Of Walking. 
778. Before a child can learn this important art, if we may so term it, it has to acquire several powers—1st, that of using its limbs in all directions; 2d, crawling; 3d, standing, or balancing; 4th, the moving, without falling, of one leg before the other; which in its perfection, is walking. 
779. We have already directed the best method of ensuring the first, which if properly pursued, will quickly lead to the second, in which the child should be most freely indulged, without regard to the soiling of clothes, or the destruction of such perishable articles as it may be enabled to lay its hands upon. Most parents have an aversion to this necessary acquirement, and too frequently endeavour to interrupt it, to the decided injury of their offspring. We have constantly observed, that those children who learn to crawl, are always more robust, and better confirmed in their walk, (though they sometimes do not begin so early ,) than those who have been taught to walk without this useful intermediate step. The act of crawling exercises every muscle of the body; and this, without much fatigue— since it is a voluntary act of the child; besides, it is highly pleased by the employment of this power, for it always has an object for its exertions—consequently, is sure to be amused. This exercise, therefore, not only gives vigour to the body, but also agreeably stimulates the mind. 


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OF EXERCISE. 
780. Children permitted to crawl, will soon wish to do more; hence, they will endeavour to lift themselves upon their feet by the aid of a chair; and though they may fail in many attempts, they seem to feel it to be a point proper to gain, and will persevere until they accomplish it; by this they learn—1st, to raise themselves from the floor; and 2d, to stand, by holding the object on which they have seized. Presently, they can balance themselves without holding; and will proudly show you, they can stand alone. But fearful of yet trusting themselves to move their limbs without support, they do not venture to put one foot before the other; but seizing a chair, or any other body, they then dare to advance as far as the limits of their support will permit. This little adventure is repeated again and again, with increased exultation; when after numerous trials, they feel confident of their powers to balance themselves, and to the inexpressible joy of the parents, they run alone. When children learn to walk by this important gradation, it is always found that no injury is done to the proper form of the legs, which but too constantly happens by the other plan. 
781. It may therefore be useful to caution parents and nurses against the unnatural practice of forcing very young children to " find their feet;" since curved legs are almost sure to result from the practice. Children disposed to rickets should be particularly preserved from this mischievous exercise. For it was the intention of the Creator, that children should not walk before a given period; therefore, to prevent an abuse of this law, he annexed a penalty to its infringement. 
782. We grant that children may be taught to walk, without previously crawling; but at the same time, we must insist that there is no advantage in this plan—nay, there is often positive injury; the limbs are almost sure to be curved; and the walk of the child is marked by an uncertainty which does not obtain by the other plan. By crawling, the bones of the legs and arms strengthen with the muscles; and this, without curvatures of the legs, since they are not forced to support a weight beyond the power of resistance. 
783. Many plans have been devised, to teach children to walk—we without ceremony condemn the whole, since they all 
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OF EXERCISE. 
consist in obliging the child to make exertions injurious to the form of their limbs—of this kind are the go-carts, the leadingstrings, &c. The go-cart, and leading strings, are banished from the nursery, in almost every part of this country; and we sincerely hope that no false theory, or an attempt at a " royal road" to walking, may ever cause them again to be introduced. Those countries in which these artificial means have been most fully tried, most abound with ill formed legs—an indisputable evidence of their mischievous tendencies. 
784. Teaching children to walk by taking hold of one of their hands, is also a very exceptionable mode. In this case, the arm is severely extended; and should the child make a false step, it runs the risk of a dislocation, by the violent and sudden attempt to save it—or should it escape a dislocation, the arm suffers a violent extension of its muscles and ligaments, from which it is sometimes a long time before it recovers, as well as subjecting the poor child to a great deal of pain. Both hands being held at the same time, is less exceptionable, but not entirely free from objections. The best way is to let the child depend pretty much upon itself—taking care to break a fall, by gently seizing it round the waist. 
Sect. III.— Of other Modes of Exercise. 
785. After a child has learned to walk with tolerable steadiness, it is eager to employ its locomotive powers, by moving almost constantly from place to place, either to relieve ennui, or gratify curiosity, or both; hence, the desire of motion being so universal, that it may be considered an instinct. This kind of gratification they should be liberally indulged in, since, it keeps the mind amused, and profitably employs the muscular system— consequently, there can be no exercise so unexceptionable as that of walking, under proper circumstances. But it may so happen, that from the state of the weather, indisposition, or the distance to which it is desirable to remove them, other modes of transportation must be looked for; and the choice of the several that present themselves, must depend upon the age of the child, distance, &c. We shall therefore consider— 


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OF EXERCISE. 
A— Riding in a Carriage. 
786. Our remarks upon carrying children on the arm, leads to the conclusion, that it is not always the best mode of exercising them; therefore we are of opinion, that much advantage is oftentimes gained by the well regulated use of the "baby carriage." This however, to be as useful as it is capable of being, must be governed by the following considerations. These will relate—1st, to the vehicle itself; 2d, to the mode of using it; and 3d, to the child. 
787. 1. On the part of the carriage. It should be so constructed, as to render it difficult to be overset; therefore, the wheels must be low, and revolve easily, and equally; the axle should be broad, that the carriage may have even an over proportion of base. The body should be sufficiently long to permit the child to lie at full length, when necessary; and of such breadth, as shall prevent its being cramped, when placed in it. It should be of such depth, as will prevent the child from falling out; and its height should be so arranged, that the child may be protected from the sun, when this may be necessary. The wheels should be secured against running off, when the carriage is in motion. The body should be placed upon low springs, of sufficient elasticity, and strength. 
788. 2. The mode of using this carriage, is highly important, since an error in this point may defeat its best uses. To be useful, therefore, it should always be drawn steadily, and at a very moderate pace; it should never be violently jerked, nor rapidly put in motion. The place for its employment should always be smooth, and free from obstructions; as its passing over rough places, endangers the child, since it may overset, or do injury by the severity of its motions. 
789. 3. As regards the child. That this kind of exercise may prove beneficial, the child must be so disposed in the vehicle, as to be perfectly at ease. The most suitable position for this purpose, will depend very much upon the age of the child; we may therefore divide this into three periods—the first period is that, before the child can sit alone with certainty; the second, is where it is able to sit alone, but cannot walk; the third, is after the child can run alone. 


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OP EXERCISE. 
790. The position for the child in the carriage, at the first period, should be a horizontal one, with its head a very little elevated, for the reasons suggested. It should be secured against receiving injury from a sudden jolt, by laying it upon a pillow, or an elastic mattress; and so confined at its sides, as to prevent its rolling when in motion. The one for the second period, may be that of sitting; but the child must be so secured, as to prevent too much motion of its body, when the carriage is moving. For the third period, the same position will be proper; but there will be less necessity for the confinement just spoken of, as the child can now balance and support itself. Yet it may be proper to observe, that the greatest care should be taken, at every period, to guard against the child's falling out. 
791. Children, when placed in the carriage, should never be kept standing in the sun, if it be warm; nor should they be kept motionless, when the weather is very cold. Indeed, it would always be best, not to expose them to either extreme; since, the risk of injury is oftentimes greater than the benefit. When in the carriage, in cold weather, they should be amply covered, since from the passiveness of their situation, they will require additional clothing. Nor should the ride ever exceed a half hour at a time, especially if the child is observed to become sleepy— and this for two reasons; first, because it is always injurious to children, to sleep in the open air; and second, because, after a few trials, they will much prefer this mode of going to sleep; and thus destroy a well established habit, to the serious inconvenience of the parent or nurse. 
B— Riding on Horseback. 
792. Perhaps there is no mode of exercise, equally beneficial with this, if we except walking—it is one which employs all the energies of the rider, and that in the most agreeable way. There is scarcely a muscle unemployed, and at the same time the mind is highly amused. We must however be understood to speak of those, who feel a confidence in their horsemanship; for such only derive benefit from it. Therefore, a child, either male or female, should be early instructed in this important art. We say, they should begin at an early period to take lessons, when practicable; since by 


OP EXERCISE. 
229 
doing so, they become more confident, and better confirmed in their seat. When placed on horseback at an early age, they quickly acquire intrepidity; first because they have a nutural attachment to a horse, which they suppose will not do them harm; and secondly, because they cannot well anticipate all the risk they might run, either from the mismanagement of the reins, or the viciousness of the animal itself. On this account, children are fearless on horseback, almost as soon as they are placed there; and their enjoyment keeps pace with their trials; and for these reasons, the sooner they begin the better, for every purpose of health, or future usefulness. 
793. We would advise, under circumstances which can command this indulgence, that children commence, soon after their sixth year, to receive instructions under a careful and experienced master; and so soon as they have acquired "a good seat," they may accompany their father, a friend, or a careful servant, for farther improvement and exercise. A timid child should not be forced suddenly to mount a horse, for any purpose; he should be placed under the immediate care of a judicious person, who by address and management will remove his apprehensions,and cause him eventually to acquire a confidence in himself. On this account, a riding school deserves patronage. 
C— Of Games, and Exercises of various kinds. 
794. In large cities, there is a great variety of games and exercises presented for the amusement of children, some of which are very useful, and others are as injurious. It would occupy too much room to particularize the varieties, and reason upon them in detail. We shall therefore merely point out the tendencies of them all, and allow parents to choose such as will best conform to the general scheme of physical education. 
795. All the active games and exercises, (and these are the kind we are now considering, since they afford that important aid to health, exercise,) employ all the muscles of the body, with more or less severity; the remote tendencies of which, are to confirm the strength, and improve the skill of such as sufficiently employ them. But these advantages are not always gained without risk; either from the nature of the game or exercise itself, or 


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OP EXERCISE. 
from the severity with which it may be pursued; therefore, such as really may be attended with danger, had better be avoided at once; and only such followed as are not necessarily accompanied by risk. Of the former kind, may be considered skaiting; going in the water unprotected, before they can swim; descending from the tops of houses by a running rope, or windlass; diving or jumping into the water from a great height, &c. Of the latter we may reckon, playing at marbles, beating a hoop, flying of kites, playing at ball, or fives, shinny, &c. These last are not necessarily dangerous, but may be so accidentally—we would therefore wish to lay down the following general rules upon games and exercises:— 
796. 1. Not to permit a child to engage in such as are in themselves dangerous, as those above enumerated; and not to allow the plea, that A, B, and C, daily engage in them without accident to outweigh the force of positive examples to the contrary. 
797. 2. To allow a child to engage only in such, as are not necessarily injurious; and even such within the bounds of moderation, in order that evil may not follow the indulgence—that is, not to overheat the body, nor check perspiration too suddenly. 
79S. 3. To choose such of the latter, as will do the least injury to the child's morals; for by associating with vulgar characters, in the performance of certain games and exercises, much risk is incurred. On this account, a child is seldom safe, either morally or physically, who is permitted to choose its companions, the nature of its game, or amusement, from under the parent's inspection and control. 
799. Girls, from necessity, can have fewer games or amusements than boys; but there is a sufficient choice of these, for all the purposes of health, if properly pursued—such are shuttlecock, and battledore; skipping the rope, dancing, &c. Where circumstances will permit, a well arranged swing is one of the best, as well as one of the most delightful modes of exercise, to those who can enjoy it. Riding on horseback, we are sorry to observe, is too little practised among our young females. Unfortunately, this, like many other points essential to health, requires the powerful influence of "fashion," to bring it into use. There is perhaps no city in the world, where females enjoy this 


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most salutary exercise so little as in this; and perhaps there is none that offers stronger inducements to employ it. There are always masters to teach the art, where encouragement is given; but of the number who have offered their services to the public, not one we believe has succeeded. On what does this supineness rest? 
D— Dumb-Bells. 
800. The " dumb-bells" have been strongly recommended as an exercise for young people, especially when the weather will not permit it to be taken out of doors. These machines may be profitably employed, we have no doubt, where the weight of them, and the manner of using them, are properly regulated. The general idea is, that they should be made as heavy as the strength of the person can wield; than which, there can be no greater error—for all the advantage of weight can be gained, by using light ones, if the motions of the arms be quickened; and this need not be done, but as the person acquires strength. 
CHAPTER XII. 
OF BATHING, AND CLEANLINESS. 
801. It is a popular belief, and one founded upon correct observation, that the proper and healthy condition of the perspiratory organ, namely the skin, is highly important to health. Whenever this apparatus becomes deranged, either directly or indirectly, it is always found, that the body is less in the enjoyment of health and comfort, than when this is in the full exercise of its functions. It will therefore follow, that whatever tends to maintain the sensible and insensible perspiration in their proper proportions, will essentially serve the purposes of health. It has ever been acknowledged, that cleanliness is highly conducive to this desirable end; for where this is neglected, disease is sure to follow—therefore, the impure state of the skin, will sooner or later have its penalties. 
802. The ancients were well acquainted with this fact; and 


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so attentive were they to the removal of all casual impurities from the skin; so entirely convinced of the advantages resulting from it, that baths were erected and maintained, in many cf their cities, at public expense; of which the inhabitants of the respective cities had a right to take advantage, at any time they pleased. These valuable gifts of public munificence, cannot well be too much praised, or admired; and could they have been perpetuated to the present moment, in all such climates where heat makes them desirable, incalculable advantages would have arisen, to reward the liberal spirit by which they were maintained. 
803. Although there are no baths maintained at the public expense, in this country, we are nevertheless in possession of sufficient facilities for bathing, in almost every part of the United States, either by means of running water, or the late general introduction of baths, in almost every well built modern house in our cities. Therefore, when this important auxiliary to health is not attended to, it must be attributed to reprehensible neglect. 
804. Parents who are inattentive to the important duty of having their children well cleansed, by the frequent application of water to their skins, disregard one of the most valuable precepts which Hygeia can give, or that they can obey; and for the neglect of which, no adequate excuse can be urged, especially as the means are at the command of every body. In a climate like the one we are subjected to, where the extremes of heat and cold are alternately experienced in their respective seasons, too much care cannot be taken to preserve the skin in its most healthy condition; especially during the summer months, that disease may not result. Therefore, the useful discipline of washing, (every young member, at least, of the family,) should never be omitted. If this were done daily, during the warmer parts of our seasons, it would be but complying with a necessity, constantly created, by the action of heat upon the skin; it should not be omitted beyond every other day, unless some circumstance of health might render it improper. 
805. The object of all bathing, is to remove impurities arising from dust, perspiration, &c. from the surface, that the skin may not be obstructed in the performance of its proper offices. But 


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it requires to be cautiously conducted, that the subject may not be exposed to the risk of taking cold—it should also be so managed, that too much reaction shall not be excited. To ensure these important ends, the bath should be of tepid warmth, at least for several of the first years of the child's life; for by having the water very moderately warm, we remove with more facility and certainty the impurities from the skin; we prevent taking cold, and do not excite too much reaction. Of the best mode of conducting the bathing, we shall speak by and by. (827, &c.) 
806. We are aware, we are advancing opinions not in conformity with public prejudice; but we declare them without hesitation, as we are certain they are sanctioned by both reason and experience. The cold, is the favourite bath of people in general; but why it should be so, we are utterly at a loss to understand. This popular feeling originated in some unaccountable prejudice, or from an imposing, but limited experience. But as it has taken possession of the public mind, it may be well to urge with all due candour, our objections to its employment. 
807. 1. There are many latent predispositions to disease, or disease in an obscure form, to which the cold bath would be highly injurious, by calling into action the dormant affection, or by exalting the one already present. 2. There are many consti tutions, wherein the powers of reaction are so feeble, that the body is left in a state of exhaustion for a long time, because reaction is tardy in taking place; and wherever this happens, the system is sure to be weakened, instead of being invigorated. 3. There are many, who have strong dispositions to local determinations of blood; as to the head, lungs, liver, &c; in which cases, the cold bath is decidedly mischievous, by encouraging, or producing these determinations. 4. It has sometimes the most injurious effects upon the nervous system, producing a kind of syncope, or catalepsy. We know a lady who was nearly destroyed in this way, by a single plunge in the cold bath, although it was of moderate temperature —the warm, or tepid bath, she enjoys much. 5. The reaction after cold bathing is sometimes excessive, amounting in some instances to temporary fever; and when this subsides, the muscular system is found weakened/ 6. It never answers the purpose of cleanliness so well as the' tepid, or warm bath—therefore, one of the principal advantages 
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for which it was resorted to, is defeated. 7. It is always commenced with strong repugnance on the part of the subject of it, whether it be a very young child,or a child of more advanced age— the first, manifests its aversion, by crying during the continuance of the discipline; the second, by strong opposition, crying, &c. S. In very young children, it sometimes produces severe pain in the bowels, which can only be allayed by laudanum, as the following case, among others, will show:— 
808. We were requested to prescribe for a child of six weeks old, who, from the moment it was stripped for dressing, began to cry, and would not cease, until it took laudanum, for the purpose of quieting it; and this was uniformly the case, from the first dressing after its birth. We inquired into the mode of washing and dressing it; and were informed, that the nurse had begun by washing it with cold water, and the practice had been continued ever since; and that so soon as the water would touch it, it would begin to scream; that after it had been well washed from head to foot with the water, it was again washed with cold whiskey, and then dried and dressed; that it remained cold and shivering for a long time after the washing; and the cry was never out of its mouth, unless it were quieted by laudanum, or carminative. We recommended, that it should be washed with warm water instead of cold, and to lay aside the use of the whiskey. On the repetition of our visit, a few days after, we were informed, that the child had been nearly quiet during the dressings, and only cried while that was carrying on, and ceased altogether to do so, so soon as this duty was performed; and that it had not required laudanum, since the warm water had been substituted for the cold. 
809. In the case just related, it is evident, that the use of the cold water was injurious; it produced a painful condition of the bowels, which could only be relieved by anodyne medicines. The child therefore was not only made to suffer much pain by its use, but was acquiring a habit of taking laudanum, which could not fail to be ultimately injurious. 
810. It must however be understood, that we are not condemning the cold bath, without reserve; on the contrary, we regard it as a highly important remedy, where the condition of the system would indicate it; but wc are decidedly of opinion, 


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235 
that the constant use of it, should be reserved almost exclusively for this purpose. The occasional use of the cold bath, to people in health, may safely be indulged in; but where it is not employed as a remedy, it should be sparingly had recourse to. We shall not here treat of the cold bath, as a remedy—our present object is limited to the question, whether it, or tepid bath, as a constant, daily application, is most conducive to the objects of health, and cleanliness. 
811. We are however by no means sanguine, that we shall make many converts to the opinion we are advocating, as the prejudice in favour of the cold bath is inveterately fixed in the minds of most people. It is almost universally said to be "bracing," and the warm or tepid bath to be relaxing; than which, nothing can be more unfounded; the cold bath, in many instances, such as those already enumerated, as well as some other, ceases to be bracing; while the warm, in those very instances, would decidedly have this effect. 
812. But there is scarcely any thing more vague, than the relative terms of hot and cold, as applied to the sensations created on the living body, by media of various temperatures. It will be proper therefore to signify by some definite sign, what is to be understood by the cold and the warm baths. 
813. By the cold bath we are to understand, water so reduced in temperature, that when applied to the human body, it shall produce that sensation of coldness, called a shock. Now, there are various conditions of the body, which will necessarily prevent any fixed degree, from producing this effect, unless we run into an extreme; we can therefore only assume some general positions; but we must always be understood to mean, the effect of such application upon the body when in health. It will be readily seen, that we can fix with certainty the lower extreme of temperature, since water will not bear a greater reduction than 32° of Fahrenheit, without freezing. The other is not so easily fixed, since it may vary from 62° to 82°, as we are informed that the Buxton water is at that temperature, and a slight shock is experienced upon immersion; the medium would therefore be 72°. Water at this temperature will feel cold to the body; and at 62°, it will be found pretty severe, especially in summer, 


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if applied in the form of the shower-bath, though it is called temperate heat. 
814. The warm, or tepid bath, may consist then of a temperature, under some circumstances, above 82°, or from this to 98°, the usual heat of the human body—beyond this, it becomes a " hot bath," and should, like the cold bath, be employed but as a prescription of the physician; but we are not now considering this important auxiliary, but as a means to ensure cleanliness. Of this important part of physical education, too much cannot be said in commendation —it may truly be said to be a virtue. 
SI5. No mother should confide this duty to a servant—she should herself daily inspect the skins of her children, and see that no part of it has been neglected. It is not sufficient for the purposes of health, or cleanliness, that the hands and face are washed—there are many other parts of the child's body, which require a more rigid attention, and which, because out of sight, are too often neglected. Nothing perhaps in after life, so effectually administers to comfort, as the practice of habitual cleanliness; it is also one of the most efficient means of preserving health. But this habit, (or we had like to have said, this virtuous feeling,) is rarely generated, if it has been neglected in early life. 
816. An attention to cleanliness, costs neither time nor money beyond its worth; for the cleanly man, or woman, can make their toillette with as much despatch as the sloven, or the slattern; and they gain by it, that which the others can never experience—a feeling of inexpressible comfort. 
SI7. As a preventive of disease, it stands foremost; for the origin of some of the most loathsome diseases, may be traced to a neglect of this virtue; it should therefore be practised, and inculcated, from the earliest infancy, to that period of life, at which the child is able to judge for itself; when, if it have been brought up with proper habits, it will spontaneously decide in favour of bathing. Let any one inspect the nurseries of children who are slovenly, and of those carefully brought up, and the very first glance will convince him of the advantage of the latter, and the mischievous tendency of the other. 
SI8. Children may be so trained to cleanliness, that at a very early period of their lives, they will avoid soiling themselves. 


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A friend informed us that the little patient of eight months old, for which we were prescribing, had not worn a diaper since it was a month old; nor had it in a single instance soiled itself, either during the day or the night. When it felt a necessity, it would by signs make it known in such good time as to prevent accident. This we admit to be a rare instance of discipline, but it is not the less worthy of imitation. 
819. If this practice cannot always be attained, one of nearly as much consequence certainly can—namely, teaching the child, by frequently changing it, to feel uncomfortable when wet or soiled; and it will by its cries almost immediately make its condition known, and plead for relief. The above case, shows us how successfully this has been done; and we believe we may safely add, how easily it may be done, if properly commenced, and duly persevered in. For such is the effect of custom and good management, that children will very early declare their wants as regards their evacuations, if they be frequently placed upon their chairs, whenever they seem to manifest a desire to relieve themselves. 
820. The example of other children, when there are such, will much contribute to establish this habit; if the older be placed upon the chair, the younger will soon be willing to follow their example—and thus regularity will certainly be produced. This practice may be subjected to certain periods, by placing the child upon the chair at certain hours; for instance, soon after they rise in the morning, towards noon, and in the evening. But in doing this, the child must not be neglected at the intermediate periods, if it discover any marks indicative of its wants. 
821. Nothing perhaps will so decidedly prevent that disgusting and indomitable habit, of "wetting the bed;" since nothing so certainly tends to produce it, as permitting children to remain long wet; as evacuation will follow evacuation, until the habit is confirmed, by all sense of inconvenience being lost. 
822. It may be proper to say, en passant, that we do not confine the observance of cleanliness to the time of health alone; for if the child be ill, frequent changes become even more necessary, though the popular opinion is against it. 
%23. We have already declared ourselves to be in favour of tepid water for washing children, from birth, until they are at 


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least two years old. If at this period a change be thought desirable, the water may be used a little colder; but it must be recollected that if a change be made, it should be done gradually, as we have just stated; so that the constitution may not be subjected to too sudden a trial, by a great difference in temperature. Extremes of every kind, we must again repeat, are dangerous; therefore the gradation should be from tepid to cool, and from cool to cold, if this last should ever become necessary, even as a remedy. 
S24. We would however caution the over-timid mother, not to mistake hot, for warm, and thus defeat every advantage which the rules we are inculcating are intended to confer. This error would be as bad as the other; for injury would certainly follow. People frequently pursue opposite plans, to accomplish the same end—thus does theory sway the actions of every body! A delicate, frail constitution, will be treated by contrary means, agreeably to the particular notions entertained by the person who has charge of the patient, respecting the cause of disease, or the effects of remedies. Thus, for the removal of debility, which they suppose to be the sole cause of disease, the cold bath is prescribed by some, with a view, as they say, to brace the system; while others will employ the hot, that the feeble strength of the patient may be fostered. 
825. In this case, either of the plans might be wrong, since each is an extreme; consequently, neither can be ultimately proper, except in a very few instances, and never so, to commence with. In all instances, the temperature of the water should be regulated by the degree of vital energy; for though children of enfeebled constitutions are invigorated by a moderate bath, where there is no contraindication to its use; yet they would be as certainly injured, by the sudden application of the cold bath. So, on the other hand, a similar state of body may be cherished and improved by the tepid, yet might be severely injured by the hot bath. 
826. But, as neither the hot nor the cold bath, should be used without the advice of a physician; they should always be considered as remedies of great power, and only to be used as such, and for the diseases for which they are proper. The indiscriminate use of both, has done more injury, we fear, than can be 


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239 
compensated for by the good derived from their proper application. 
827. Dr. Struve lays down the following rules for bathing young children: "During the first three months of its life, an infant ought to be bathed in moderately warm water;* in the next nine months, the water should be only lukewarm; after the first year, its temperature may be still more reduced; and after the second, the bath should be cool. From the third year of its age, we may venture to bathe a child in cold water; but it should always be remembered, I do not mean as cold as ice."t 
828. There can be nothing more preposterous, or injurious, than the empirical use of the hot, or the cold bath, since they arc confessedly powerful agents; but warm, tepid, or cool water, for the purposes of cleanliness, may be daily used, under proper restrictions, not only with safety, but advantage. 
829. We say, under proper restrictions; by this we mean— 1st, that the child, when about to be washed, should be exposed no longer than is absolutely necessary for the operation; 2d, when the cleansing is done, it should immediately be well dried, and its clothes restored as quickly as possible; 3d, in cold weather, the water should be rather warmer than in hot weather; 4th, a little fine soap should always be used, by previously dis- 
* ** The term moderately warm, implies that degree of heat, when the hand, or, if this be not sufficiently sensible, the foot, may remain in it for some time, without experiencing the least disagreeable sensation. The lukewarm bath, is about the temperature of warm milk. The cool bath signifies a temperature equal to that of water which has been kept in a room for a considerable time, so that its dullness is taken off. And the cold bath ought to correspond with river water, in the height of summer." (p. 353.) 
It will readily be perceived, that Dr. Struve's definitions of temperatures, are extremely vague, since he does not measure them by the thermometer. Willich, his translator, has succeeded in being explicit, by saying, "Immediately after the birth of a child, the water in which it is bathed, ought never to exceed the 98th degree of Fahrenheit's thermometer. By progressively reducing the warmth one degree every month, it will stand at 86° when the child is a year old; which, I presume, will produce the sensation of what Dr. Struve calls lukewarm: —if this temperature be still farther reduced in the next twelve months, so that the mercury in the glass falls to 74°, when the child has completed the second year of its life, it may then with propriety be termed a cool bath." (p. 354.) 
| Treatise, p. 353. 


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solving a small portion in the water before it is employed, especially for the lower half of the body; 5th, the head, especially if the child be very young, should be first washed, dried, and its cap put on, before the other portions of the body are wetted; 6th, children should never be dressed in a current of air; 7th, they should never be roused from their sleep for this purpose, nor washed immediately after waking; but they may safely be permitted to sleep, after the fatigue of dressing. 
830. When the conveniences present themselves, children of both sexes should be permitted, under proper regulations of decency, to bathe in running streams, ponds of pure water, or rivers, during the warm weather of summer. But this should always be done under the superintendence of adults qualified to protect them against accident. They may thus be instructed in that most useful exercise, and art, swimming, of which no boy, (and why may we not add, girl?) should be ignorant after their ninth year. It is an important part of education, that youth be taught to swim; and we regret, that hitherto, no proper establishment of this kind has arisen among us. The one purporting to be for this purpose, has too many serious objections against it, to receive general patronage. In the first place, it is not conducted with sufficient decency; secondly, it is badly situated for the purpose; and thirdly, it is much too expensive. 
831. We have employed the words bathing, and washing, synonymously, in our present chapter. We think it necessary to explain this; as in no instance have we wished to be understood submersion, by the term bathing; and when we have spoken of washing, it always had reference to the whole body undergoing this discipline, in distinction to the partial cleansing of the hands and face. 


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CHAPTER XIII. 
OF DRESS. 
832. We have already spoken of dress, when applied to children of the first period—that is, from birth to weaning. We shall now say a few words upon this important point, from that time to the age of puberty. 
833. The object of all dress should be, first, to cover the body in such a manner that decency shall never be violated; and second, to protect the body against the vicissitudes of the seasons. 
834. The first object is easily obtained; and by the most simple means—to accomplish this, it would only be necessary to cover the body with a loose garment, of sufficient length and width. But this simple plan is rarely adopted; as caprice and fashion, pride and ostentation, are constantly interfering with it—hence the immense variety of dress to be observed in the different portions of the globe, as well as in contiguous places. Where this departure from the simplicity just spoken of, does not injure by imposing any restraint upon either the limbs or body, it is not a legitimate object for animadversion; since, causes which can never be within our control, will be constantly operating, to produce great variety in the form of dress. 
835. The mischievous and preposterous custom of swaddling, is nearly abolished, in almost every part bf the world; the child from its birth is now permitted more freedom for its limbs, which it exercises with much advantage to itself. But in fulfilling the second object, namely, a protection against the weather, many errors are committed—first, in the form of the garments; and secondly, in the quantity and quality of them. 
Sect. I.— The Form of the Garments. 
836. To a certain period, say until the fourth or fifth year; it is usual to habit both the male and female child, pretty much after the same manner; and luckily, when this plan was adopted, the dress of the male was made to conform to that of the female 
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—we say luckily, for so it truly was; since the dress of the latter in modern days, is much better calculated for both health and comfort, than that of the former. The loose style of dress now adopted for children, will certainly if persevered in, be of much consequence to the rising generation, since it imposes no restraint either upon the extremities or the abdomen. The stiff stays for female, and the tight waistbands of breeches for male children, which were formerly in use, have now yielded to the unconfined frock, and petticoats in the one, and the modern invention of suspenders in the other. By these changes, a much greater security is afforded for the preservation of health, since neither the chest nor abdomen in girls, nor the abdomen and lower extremities in boys, suffer from compression. 
837. We have already adverted to the evils which may arise from too great a pressure upon the abdomen, when speaking of the bellyband of infants; and it may now be proper to observe, that our observations upon this point are not confined to that period of life—they extend, properly speaking,' to every period; and will apply with much force to the stage of life we are now considering. Indeed we might say, with more forGe; since, joined to the pressure so earnestly deprecated, we must add, the almost incessant muscular exertion to which children yield themselves at this particular time, whereby the liability to rupture must be increased; and especially, as at this time, the parts give way with proportional facility. 
838. We therefore consider the loose dress now in use for females, and the almost universal employment of suspenders, for boys, to contribute much to their general health, beside very much diminishing the risk of theaccident just hinted at. On these accounts, we would earnestly recommend it to every mother, so to dress her children, as shall prevent every possible risk of too strong a pressure upon the parts designated. 
Sect. II. — The Quantity, and Quality of Clothing. 
839. The errors committed on both these points, are not less frequent, than obvious; they consist chiefly in extremes; theory in most instances directs both; and too often, in direct violation of both reason and experience. The extremes here alluded to, 


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consist, in a class, who suppose that the body can scarcely be covered too thinly, for the purposes of giving strength to the constitution ; hence, they banish nearly all the warmer articles of clothing, let the inclemency of the weather be what it may, with the view of inuring the body to any temperature to which it may be exposed. The other class consists of those who apprehend cold to be the most destructive agent that the human body has to contend against; hence, whenever their pupils are exposed to an out-door atmosphere of reduced temperature, care is taken to protect them against the mischievous tendencies which their apprehensions have conjured up, by every adventitious means, that wool and fur can supply. Both these plans must necessarily have their victims; and it is perhaps a moot point, which of the two is the most destructive. We have already dwelt upon this subject, on another occasion; and what we have said there, will strictly apply here. 
840. Our mutable climate, or rather our climate, which at one season has the heat of the tropics, and in the other the cold of the frozen north, requires corresponding changes in clothing, at those different periods. In summer our feelings oblige us to reject all superfluous covering; and in winter, they make us covet the warmest garments—there is but little risk, in general, in obeying the first impulse; but the second, may be carried to an extreme, especially in the early part of life. 
841. Exercise, which is so much desired by youth, and which is generally so advantageous, will render less warm clothing, even during our coldest periods, sufficient; hence, those who are habitually exposed to the weather, but at the same time sufficiently well protected, will require either fewer garments, or of less warm materials, than those who are almost constantly confined to the house, either from necessity or choice: nor will the former be so liable to injuries from the vicissitudes of the weather;- 
842. This fact is notorious to the observation of every body; yet so unnecessarily apprehensive are some, that they oblige their children to clothe themselves as warmly, when they are in the full exercise of their limbs at their various sports or avocations, as if they were about to perform a journey in a slow-motioned stage-coach or wagon. The consequences of this over-clothing under such circumstances, are, croup, pleurisy, or catarrhal fever, 


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from a suddenly checked perspiration, which had most unnecessarily been excited by a superfluous quantity of clothes. We have already remarked upon the other extreme. 
843. Too strictly guarding the neck and throat of boys, should be particularly avoided; for, from their proximity to the seat of circulation, they very quickly have their heat unduly increased by an over quantity of covering; to relieve which, the articles surrounding them are suddenly removed, perspiration becomes checked, and disease follows of course. Therefore these parts should be but moderately clothed, that the consequences just spoken of may not follow. 
844. Custom, among females, has almost deprived them of any protection to these parts, or even to their chests. This exposure to an inclement atmosphere, is decidedly wrong; and but too often lays the foundation of consumption, or other affections of the chest. (459) We are however not to be understood as advising any unnecessary covering for these parts; we would only wish to suggest, that when they are exposed to the weather, a greater protection should be afforded to these parts, than if they were within doors. 
845. The head should not be too warmly clad, of either a boy or girl, especially those who are in the habit of exercising much in the open air—nature intended that the hair should serve for its protection, particularly within doors. Therefore, children should not be permitted to wear their hats or bonnets in the house, as there the hair is an all-sufficient covering. In the extreme cold of winter, the ears of such as are exposed to the wind frequently suffer severely—to prevent this, a small piece of fur may be adjusted to the hat, so as to cover these parts; or a fur cap may be indulged in; but let it be forbidden to be worn in the house. 
846. But in no one particular are the sticklers for the hardening system more in error, than when they reject stockings in cold weather, and even in winter. We cannot refrain from expressing our surprise, that this absurd and cruel practice could ever obtain, since there are no portions of the body more liable to suffer than the feet and legs, and few that have a larger circle of sympathies connected with them. We therefore constantly recommend, that these parts should be kept covered by a sum- 


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cient protection by stockings and shoes. We say that a sufficient protection should be given to these parts; for we are aware, that like the coverings for other parts of the body, it may be overdone. In winter, the shoes can scarcely be too stout; not by their thickness to increase warmth, but to protect the feet against wet. The stocking may be of worsted; but these should not be too thick. If the stockings be too thick, they excite too much perspiration, and cold feet are the consequence. 
847. We have already remarked upon the propriety of keeping young children sufficiently warm in every respect; and of the necessity of accommodating their clothing to the vicissitudes of the weather; but we do not wish to be understood, that this system should be extended in all its details to children of greater age —that is, to children of the period we are now treating of; for after the fifth year, it is well to inure them to the changes of an external atmosphere, by often repeated, but not too long continued exposures. A person of but common observation, who has an interest in the child, will easily perceive when the cold becomes severe, by its complainings, as well as by its appearance—when this happens, the child should be immediately removed to a milder, but not suddenly to a heated, atmosphere. In these little, but important trials, the child should never remain passive for any length of time—if not of itself disposed, it should be induced by various little stratagems, which every good nurse is acquainted with, to put its little body in motion, that the circulation may be equally maintained; but if it cannot be prompted to activity, let it be taken into the house. 


PART III. 
CHAPTER I. 
OBSERVANCES, FROM SECOND DENTITION TO PUBERTY. 
848. It is impossible to treat this part of our subject, without constant reference to certain directions which have alreadybeen giyen, for the promotion of the general well being of the child. Up to the period therefore, now about to be considered, we are supposed to have directed the best physical treatment in our powerj that is, we have endeavoured to avail ourselves of the experience of others, as well as of our own, to give the best possible chance of a healthy, regular development of the system, by urging such observances and directions, as have been found best calculated for this important purpose. 
849. We shall not therefore repeat in detail, the directions for eating, drinking, sleeping, exercise, &c.; but merely state that as the body is still in a state of gradual development, as much care is necessary at this period, for the continuance of the system already commenced, as was in the earlier parts of life. Indeed, it may be said with much propriety, that as the individual is now left more to his own guidance from his increase of years, it behooves*him, by cautious conduct, that he defeat not the good already received from the government of watchful parents, to the irretrievable destruction of his health. Boys, at this period of life, are necessarily less under the eye of the parent than girls; consequently, more vigilance is required with regard to them. To render therefore any directions efficient, such a habit of obedience must have been created by previous moral discipline, as will render the will or commands of the parent availing; or all that has been done before, will be lost. 


247 
FROM SECOND DENTITION TO PUBERTY. 
850. Should children, from heedlessness or perverseness at this period of life, fail to continue the plan previously adopted for their benefit, they will be sure, either to call into action some latent predisposition, if any such exist, or lay the foundation for future ill health; since this period, like that of dentition, is marked by peculiar susceptibilities, and thus rendered more obnoxious to disease. We shall therefore say a few words upon the leading points of physical education, that we may not be misunderstood in respect to that we would wish to enforce; and, 
851. 1. Of Eating. If the physical treatment have been previously well begun, it will be found at this time, that the appetite, and digestion, will be in just proportion; -for the body has now acquired more vigour; and the play of the muscular system is more confirmed, and better balanced; consequently, the stomach will have an increase of power, and will perform its offices, with as much facility as success, provided it be not overtaxed by the quantity of food, or that this be not of an improper quality. But unfortunately for this period of life, children, as we have already observed, are less under the eye of the parent, and are but too apt to abuse this organ, either from a certain craving for improper articles, or a recklessness of consequences, however affectionately forewarned—hence, but too often, a foundation is now laid for future disease of the stomach. Sometimes indeed, parents themselves are not sufficiently upon their guard; they permit but too often the full indulgence of the appetite, from a persuasion, or rather from an unfounded hypothesis, that " children never eat more than is good for them." 
852. This unqualified assertion, is contradicted by daily experience; and therefore deserves the serious consideration of parents. They should learn to distinguish between the demands of a natural and healthy appetite, and the cravings of habit; or they will discover when too late, that the powers of the long suffering stomach are destroyed, never again to be restored. There is no point of treatment more easily complied with than this, provided the parent, or a judicious and faithful servant, take charge of the child during its meals, and become the judge of both quantity and quality. We shall therefore lay down the following rules for eating:— 


248 
OP EATING. 
853. (a) Children should never be suffered to eat alone, unless the proper quantity of food be meted out to them. 
854. (b) If a child demand more than is judged proper for it, resist at once its importunities with firmness, or you will but too certainly make a glutton. 
855. (c) As little variety as possible, should be set before children; since, every extraordinary article, becomes a new incentive to appetite. 
856. (d) Children should never be indulged with a second course; since, if they sit down with an appetite, they will generally satisfy it, by eating freely of the first article presented to them; consequently, all the rest is superfluous, and therefore injurious. If the appetite be small, the less they eat at that moment the better; as by taking but little, the appetite will be sure to return at the next meal. But should this instinct of nature for an observance of moderation, be neglected; or be attempted to be overcome by variety, repletion, with all its evils, will follow; therefore, instead of a renewed, and healthy appetite following, as it would necessarily have done, had the instinct been obeyed, it will be found diminished; and most probably, attended with head-ache, oppression, or even vomiting. 
857. (e) The food for children at this period, should be of the most simple, and digestible kind. The breakfast should be of milk with bread, mush, rice, &c; or of very weak tea, with much milk, bread and butter, and a soft boiled egg. The dinner may consist of plain boiled or roasted beef, mutton, chicken, &c. or the soup of either, divested of fat. The vegetable, (for there should never be more than one at a time,) may be the Irish potato, rice, hommony, Lima beans, or beets. This plain food will be every way sufficient for all useful purposes—more than this will be excess, and should therefore be prohibited. The supper should be similar to the breakfast. 
858. {/) Children should never be indulged with pastry of any kind—they may occasionally take a little of the cooked fruit of a pie, but even this should be in moderation. 
859. (g) Children should not be indulged with bread, bread and butter, &c. between meals, however hungry they may seem to be; for this will either destroy the regular appetite at dinner, 


OV HATING. 
249 
or they will eat too much. In the first case, the stomach will be interrupted in its regular routine of function; consequently, the appetite will become either irregular or whimsical; both of which must be avoided; in the second case, all the evils consequent upon an over-distended stomach must follow. 
860. (h) Children should never be permitted to exercise violently immediately after dinner; therefore, this meal should be presented to them soon after school hours; and they should be made to remain if not passive, at least, all severe exercise should be forbidden, until they again return to their school. 
861. (*) Children should be taught the importance of eating slowly, and chewing their food well—on this account, a habit of resting after eating should be early established, that they need not swallow their meals hastily to return to play—or in other words, this should never be permitted. 
862. (k) Children of the age we are speaking, may occasionally be indulged in small quantities of almost any of our fruits, provided they be perfectly ripe.* The most proper time for this, is when the stomach is in full possession of its powers, or an hour before dinner. The reason of this time being selected, is obvious; the stomach is now empty, or nearly so, and the gastric juice is in considerable quantity; for we have already observed, that fruit is not of the most easy assimilation. 
* Children of the age we are now considering, are more frequently, and seriously injured by eating unripe fruit, than is generally imagined. There is to a child's stomach, an irresistible charm in fruit of every description? and they will but too often procure it, coute qui coute. Having no guide but their own inclinations, they will eat of it even to surfeit, if able to procure it. Parental admonition would effect much on this important point, were it enforced by command, or even strengthened by example; but unfortunately, too many parents are either indifferent to what their children eat, or think it right they ** should be able to eat every thing." It is in vain then to rely upon parental authority to remedy this evil; we must look to the civil power, for its cure; and it is truly an object worthy of their most serious deliberation, to remove, by a law regularly and severely enforced, all the unripe trash, which so abundantly fills our market. Every kind of fruit offered for sale, should be rigidly inspected; and if it be found immature, it should not only be forfeited, but the vender severely fined—this would effect much more good than the seizure of a pound of butter, because it lacks half an ounce of the standard weight, 
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250 
OP EATING, DRINKING, SLEEPING, 
863. (/) Children should not be suffered to carry food in their pockets, to eat between meals, or during school hours; as the bad habit of requiring food at improper times is produced, and the digestion of the previous meal is interfered with, by a fresh quantity being thrust into the stomach, before it has properly digested that which had been before received. 
864. (m) Children should get their breakfast as soon after they have properly washed, and combed themselves, as may be—as their stomachs are now empty, and plentifully supplied with gastric liquor; if left too long without food, the cravings become either too importunate, or the appetite fails—either of which would be injurious. 
865. 2. Drinking. There is but one really proper drink for children; namely, water. In this they may be as freely indulged, as the necessities of the stomach may require; but they shall not be permitted upon every pretence to drink between meals, lest a disagreeable and mischievous habit be generated, and the stomach made to suffer. During meals, or soon after, they may drink water to advantage; but to encourage the habit of drinking between every mouthful they swallow, is bad. The stomach becomes unnecessarily distended by quantity; distressed by weight; and the digestive menstruum impaired in power, by over-dilution; consequently, the process of assimilation will be imperfectly performed. 
866. 3. Sleeping. This all necessary restorative, should be regulated with the utmost care. Its periods, should be as seldom as possible disturbed; and the child should be permitted to enjoy its full proportion, and this without interruption if possible. Some children require more sleep than others; it is therefore a useful study to ascertain, the proper quantity each individual should employ. To determine this, we must pay attention to the habits of every child; and that one, which expends by any means whatever, the most strength during the day, requires most sleep during the night to restore the lost quantity. We may therefore lay down the following rules for sleeping. 
867. («) Every child should go early to bed, that the due quantity of sleep may be certainly procured—by early we mean immediately after candle light in summer, and not later than 


251 
OF SLEEPING. 
eight or nine in winter, for a child not exceeding seven; and a little later for one more advanced.* 
868. (b) Sleep should be so regulated as not to interfere too much with the hours after daylight—therefore, the old saw of " early to bed, and early to rise," &c. is one of great moral meaning, and of great practical usefulness, t 
869. (c) Children should not however be put to bed immediately after a full meal—it would be proper, if any thing has prevented its taking supper at the regular and proper time, that the sleeping hour be a little retarded. 
870. (d) Children should never be unnecessarily, or suddenly awakened; lest their nervous system be thrown into disorder by the alarm. 
871. (e) Children should be early accustomed to sleep in the dark, both from a moral and a physical propriety—they should not fear the dark; nor should their sleep be interrupted, by the presence of light. 
872. {/) Children should not be permitted to indulge in bed long after daylight; as its warmth; the accumulation of urine and faeces, and the exercise of the imagination, but too often leads to the precocious development of the sexual instinct. 
873. Sleep is not alone useful by restoring lost energy; it is highly important to growth. It is a fact entirely established, that there is a considerable difference in the stature, especially of young people between the morning and evening. This arises from the approximation of the vertebras, by the superincumbent weight; consequently, opportunity should be given them to expand again, which they will do by their own elasticity, so soon as they have the opportunity, by the weight of the body being taken off by a recumbent posture. 
* It would be difficult to fix by hours the precise time a child should sleep, since it must in some measure depend upon constitution, as well as upon exercise, and mental exertion. In general we may say, that a child of seven years old might safely indulge in nine hours of sleep—and from that period, to manhood, eight hours may be safely allowed. 
f Children should not be played with after they are in bed; sleep like every other function of the body, has its periods—should this be incautiously interrupted, the child may remain wakeful during the whole night, and be thus unfitted to rise in proper time in the morning. 


252 
Of EXERCISE. 
874. 4. Exercise. In proportion as the child advances in age, will be his desire for employment; hence, the multiplication of his amusements. Every proper opportunity therefore should be given, for the due exercise of both body and mind; but neither should be too much fatigued. Care should be taken at this period, to provide such employment or amusement, as shall exercise the arms as well as the limbs; of this kind is battledore or shuttlecock, playing at ball, pitching of quoits, &c, for the period is now fast advancing for the completion of the human body; and its proper development very much depends, upon uniform exercise. Therefore, all such employments as but partially employ the muscular system, should be changed, for those which will call in requisition every part of the frame. 
875. After selecting proper games and exercises, for children, constant care should be taken, that none are indulged in to excess; for, the most innocent and amusing, if carried too far, may become a source of extensive mischief; therefore, amusements of every kind may be converted into evils. But let us not deny ourselves the advantages of such employments, because they may be abused. Let us only be judicious in choice, and set proper bounds to indulgence, and there is little to fear from the exercises of youth. 
876. Again, in choosing amusements, let them be well adapted to the individual for whose benefit they are intended—thus every boy cannot become a good fencer, a good dancer, a good runner, and a good leaper; yet he may excel in some one of them. His disposition, and skill for any particular species of amusement should be studied; and he should only be kept at such, as will give him a chance of not falling below mediocrity. If this be not attended to, he may become listless, and supine; and receive injury from that, which was intended for his benefit, by his self-love being mortified, by the superior skill and address of his companions. 
877. All hazardous experiments of skill, or strength, should be peremptorily forbidden—all attempts at posture making, are highly dangerous, and should not be reckoned among the proper exercises of youth. Every violent exertion must necessarily be attended by a proportional strain upon some one part or other, of the body; therefore, it should be instantly discountenanced; 


253 
OF EXERCISE. 
such as jumping from great heights, leaping over elevations, lifting great weights, &c; for in every exertion of this kind, the most serious risks are run, of producing a disability for life. It is by these hazardous experiments, that " ruptures" are so frequently produced. 
878. We should nevertheless be careful, that we do not produce timidity by a too indiscriminate reprehension of amusements that may be abused; children should be permitted to leap, or climb, or run, to a certain extent; but where, under ordinary circumstances, no danger can arise. At the same time they should be made acquainted with the mischief which may follow, any of these amusements, when carried to excess, or when improperly performed. They should be early made sensible, that lifting weights beyond their strength, throwing the body violently, and extensively backward, leaping over high places, jumping down very low ones, &c. may in a moment produce a " rupture," and disqualify them for any active employment for life. 
879. Very often at this period of life, strong dispositions are discovered for mechanical employments; when these are of a decided character, they should be encouraged; for though the individual may never follow the art his early predilection led him to select, yet, the dexterity acquired in his early years, may essentially serve him in some future business of life; thus, a surgeon has been often benefited, by his knowledge of the mode of handling tools, &c. Therefore, a boy, may often safely and profitably be indulged in the use of sharp tools, though it may occasion an anxious mother many heartaches, during his initiation into the mode of employing them. 
880. One general, and we might say essential rule, should ever govern youth in their plays and amusements; which is, never to engage in such as shall require much exertion, after a full meal, as the worst consequences may follow a neglect of this caution. 
881. It will be perceived, that the great object of all physical education is, the regular and healthy development of every part of the body, in its proper order and proportion. When this succeeds, the period of puberty advances in regular and unembarrassed order; and the intentions of nature are fulfilled without disturbance, or disease. The changes in both sexes, intended 


254 
OP EXERCISE. 
to mark this important period, take place in regular succession; and when accomplished, mark a new era in human life. And most happy should that individual be, who arrives at this period without accident, and proves the changes to be complete. 
882. Much care is required, at this all-important time, that neither accident nor design, shall interrupt the regular march of changes, which precede, and announce, the completion of the human fabric to be at hand. It is a period replete with moral and physical difficulties; and much prudence, and good sense are required on the part of parents and guardians, that they may be both successfully surmounted. It does not enter into our scheme, to treat this subject either anatomically, by tracing the alterations of structure in the parts mediately or immediately concerned ; nor medically, by pointing out the diseases and their cure, to which they may be liable. 


OF THE 
DISEASES OF CHILDREN. 




PREFACE. 
The diseases of childhood have never until lately, sufficiently engaged the attention of physicians, however strongly they have claimed it. It would be difficult to explain satisfactorily, the causes of this indifference; it may however, we believe, be chiefly ascribed to the following; 1st. To the practice of midwifery being confined almost exclusively to women, until within the last fifty or sixty years; thereby preventing the physician from seeing much of the diseases of children. 2d. In Great Britain especially, to a by-law of the Royal College of Physicians, "by which its fellows are compelled to exclude themselves from practising midwifery, " thereby operating like the first cause. 3d. To a belief, that the diseases of childhood are obscure, or even unintelligible. 4th. To parents supposing that nurses and old women are more conversant with these diseases than the most enlightened physician; whereby he is deprived of the opportunity of studying them with as much diligence and accuracy, as they deserve. 
But fortunately for the little sufferers, an almost entire change has been made within the years just stated, by the practice of midwifery becoming almost entirely confided to the physician; by the public mind inclining to the belief, that the diseases of infancy may be understood, by due attention and study; and also, that, there is rather more safety in the prescriptions of the physician, than in those of the nurse. 
In consequence of this alteration in public sentiment, the care of the diseases of childhood, has been committed to the physician; who now has the opportunity of watching them through all their changes, from the moment of birth, to that of puberty. Hence, we have within the last few years, some valuable treatises upon this subject; so many, it may appear to some, as to 
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II 
PREFACE. 
lead to the belief, that the subject is exhausted. Under this impression, the present undertaking may be thought to be unnecessary, or to require apology. 
In our defence, however, we shall merely observe, that the science of medicine must necessarily be a progressive one; and that its advancement must mainly depend upon the improvements its respective followers may make, in the exercise of its various departments; consequently, each one is bound to contribute his mite towards the general benefit. But as the improvement of any individual in the treatment of one or more of the complaints of childhood, would scarcely justify the writing of a volume to announce them; they are for the most part, diffused through the journals of the day; it follows, it must become the office of some one, to collect and embody them, that they may not be lost, and by such loss, society sustain an injury. 
This office we have undertaken; how successfully, must be determined by others. We hope we are not indulging an overweening vanity when we say, we feel ourselves to a certain extent, qualified for this duty; since forty years of our life have been spent in the contemplation of diseases; and those of childhood, have claimed a large share of our attention during that period. 
We may urge another inducement to this undertaking;namely, that hitherto, no one on this side the Atlantic has thought proper to give to the public at one view the American practice in the diseases of children. This supineness of our physicians, is no less surprising than reprehensible; especially as many are so well qualified for the task by their talents, and experience; and moreover, as such strong inducement is constantly held out, by the peculiar character of our diseases, and in many instances, by the novelty and boldness, of the mode of treatment. 
Hitherto, we have almost exclusively depended upon European publications for information upon almost every subject connected with medical science; and we acknowledge to have received much advantage from them; especially from their elementary works: but it must not be disguised, that the same advantage lias not been derived from their practical works. This has not arisen from a deficiency of either opportunity or of talent; for we confess both, in many instances, to have been great; but to 


PREFACE. 
III 
the want of proper adaptation of their remedies, to the state, force, and peculiarity of our diseases. For it cannot escape the observation of any intelligent practitioner who may have visited both countries, how essentially our diseases are modified by climate, soil, manners, and habits; and that these modifications require corresponding changes of treatment. 
Most of the diseases of this country, have a peculiarity of character; an intensity of force; and a rapidity of march, altogether unknown to European climates; and were reliance to be placed upon the feeble practice of that portion of the globe, however well suited to the state of its diseases, we should but too often have the mortification to see our patients hurried to an untimely tomb. 
The diseases of childhood in this country, like those of adult age, require to be met with promptitude, and with adequate force; a temporising treatment suits not their character, and if adopted, is almost sure to end in defeat.* 
Besides, the catalogue of the diseases of children by European writers, has in our opinion, been too much extended; at least for this country. Many of the diseases enumerated by Underwood, who is certainly one of their best writers upon this subject, are entirely unknown here; the study of them, therefore, becomes unnecessary, if not mischievous; since, from the enumeration of some general symptoms, one disease may be mistaken for another; or from an overweening desire of accuracy, and classification, may produce confusion; or make distinctions without differences—this is particularly the case, with the diseases of the skin. 
In our account of the diseases of childhood, we have endeavoured to separate the accidental, from the characteristic, or permanent symptoms; and have only detailed such, as are known to accompany the disease in this country. This determination has almost necessarily confined us, to the history and treatment of such diseases only as exist in this country; and especially to those in this part of our continent. Therefore the history of the diseases to which children in Philadelphia, and its neighbourhood are liable, will be, we are of opinion, a pretty faithful account of almost all in this country; since the heat of our summers will have nearly as de- 
* This declaration has reference rather to the necessity of early attention to the disease of our climate, than to any great difference In the nature of the therapeutical means. 


IV 
PREFACE' 
cided an influence upon their constitutions, as the sun of the Carolinas or Georgia; while the cold of our winters, will produce consequences analogous to those of more northern latitudes. 
At all events, very little mischief can arise from this mode of treating our subject; and none, which cannot be immediately repaired by any well instructed practitioner; for it will entirely consist in the proper adaptation of remedy, to the force of disease, taking it for granted, he understands its character; and in this country this is generally so uniform, as not to make him liable to much error. 
Indeed, we may safely add, that the general simplicity of the diseases of children, renders their management more easy, as well as more certain than those of adults; their complaints are almost always acute, and of the sthenic kind; hence, the necessity, and success of evacuations in almost all of them. 
We are fully aware, that the opinion just advanced, is not the popular belief; particularly in Europe; and especially since the promulgation of the doctrines of the ingenious, but ill fated Brown. He taught, and it is but too generally believed, that their diseases were almost always asthenic, and of course, bore evacuations ill. There is no one error perhaps in medical science greater or more mischievous, than this; —to this must be attributed mainly, the general want of success in the complaints of childhood; and the frequent difficulties the physician has to encounter in his treatment of them, from the interposition of such parents and friends, as may have imbibed the same prejudices. 
The experience of every day would prove, how well children support long-continued evacuations, did we not turn our eyes from the useful lesson—who has not witnessed the long continuance of diarrhoea, without producing even weakness, much less death ? And who has not seen a profuse salivation, of even months continuance, during the agony of teething, without even robbing the little sufferers' cheeks of their bloom? Would this obtain with the adult? No! He would perhaps die by the first; and certainly emaciate by the second. 
We are well aware of the importance of the views now under consideration; we shall therefore advance nothing in support of them, that docs not appear corroborated by our own experi- 


PREFACE. 
V 
ence. For to us there are no positions in medicine more clear, than that there are few of the diseases of childhood which will not yield to well-directed evacuations; and, that when not thus treated, they become not only obstinate, but often formidable. We are also equally persuaded, that could this view of the character of the diseases of children gain ascendency in the minds of parents, much less difficulty would be experienced in the treatment of them, and consequently fewer would be called to an untimely grave. 
It is well known to almost every parent that danger may await the sudden stoppage of a diarrhoea, or incipient dysentery, by the use of astringents; and many have had reason to remember with much sadness of heart, the improper drying up of the discharge from excoriated ears, especially, during dentition; yet in each of these instances, did we yield to the popular belief, that nearly all the diseases of childhood are of the asthenic kind, the early exhibition of laudanum, or some other astringent, would be proper in the first, and some drying application necessary in the second. 
Besides, it has been but too generally believed that the disorders of the internal organs of children, have no distinctive signs, by which we can determine, or fix either the particular part affected, or the precise nature of the affection. From this we must dissent; for we are of opinion, that we can by a careful, examination of symptoms determine the seat of the complaint; and by the particular state of the pulse, at least determine its general character; that is, whether it be a disease of too much, or too little action; and this is the main point of the investigation; for it at once enables us to adapt the remedies to the general state of the diathesis. For it must be recollected, that there is so little difference in the general treatment of the inflammations of the liver, lungs, stomach, bowels, windpipe, brain, &c. that little or no embarrassment can be created, should any uncertainty exist, as to the particular viscera that may be affected. 
And it must also be recollected, that every important viscus of the body, in a state of disease, has its corresponding marks and sympathies, by which a careful observer may certainly detect the organ to which it belongs. We grant, that much experience, 


VI 
PREFACE. 
and careful observation are required to determine this; as well as to become familiar with the diseases of children, and to prescribe for them with facility and certainty; but this is attainable by well disciplined bedside observation, and a correct habit of thinking. 
The belief that the diseases of children almost constantly present nothing but perplexing obscurity or embarrassing uncertainty, has much retarded the progress of inquiry, by engendering doubts of their susceptibility of successful investigation, lucid explanation, or useful arrangement; and of course, that every prescribed remedy has but an uncertain aim; and consequently a contingent, or doubtful effect. We are far from entertaining such opinions; and we are most anxious, so far as our feeble efforts may have power, to banish them from the minds, not only of the medical practitioner, but from all who may entertain them —for they are unworthy of the one, and painful to the other. 
The scepticism we are now speaking of, has almost become a popular belief, to the serious injury of the class of sufferers about whom we are so deeply interested—it has made many a parent resort to the prescriptions of an old woman, rather than to the advice of the regular practitioner, from a persuasion, her remedies are the safer, because apparently the more simple; thus losing precious time, or submitting to improper treatment. 
The loss of time, is often of the greatest possible consequence; since it permits a disease of a dangerous character, to take an insidious, and but too often, a fatal hold, before the danger is suspected, or the proper remedy applied—this loss of time may consist in a reliance upon an inefficient, or perhaps an improper remedy, or in the total neglect of any remedy whatever. We need but mention the overlooking of hoarseness in the early stage of croup, or the neglect of the proper remedy in dysentery. (See Chapter on Croup.) 
How many parents have had reason to repent of the neglect of a slight hoarseness, of perhaps even several days continuance, which terminated in a few hours after it had fully developed its character, in death; and how many, who, perhaps, in some measure aware of its tendency, had relied upon a feeble administration of antimonial wine, or a little of the expressed juice of the onion. 


PREFACE. 
VII 
when nothing but the prompt application of active remedies, could, even in its commencement, have subdued the disease. 
We have divested our language of as much technicality as would be consistent with a work strictly medical: and we have attempted to treat our subjects in as familiar a manner as we are capable of, without descending to a " Domestic Medicine." We have also given a translation of our prescriptions, and added a glossary of the medical terms, that those, who cannot procure medical advice, may derive some advantage from them. But let us be clearly understood to discountenance, if not absolutely to forbid, any interference with the province of the physician, where his services can be commanded; for we declare it, as our deliberate opinion, that much danger may arise from the neglect of it. 
" Ni Sutor ultra crepidam," 
is an adage of much pith, as well as of great practical value. 




OF 
THE DISEASES OF CHILDREN. 
BOOK II. 
GENERAL OBSERVATIONS. 
883. Children may be diseased, and even be near death, while in utero; but over such affections we have no control. It is therefore no way surprising that we should find them occasionally emaciated, feeble, or nearly, and sometimes quite exhausted, at the moment of birth. The diseases of children then may, with much propriety be said to commence, even before birth; though no remedy can be employed for their relief, until after that event has taken place. 
884. In treating therefore of the diseases of children, it is proper we commence our account with the affections which may declare themselves immediately after they are presented to the world; and these will consist in either the entire absence of respiration, or its imperfect establishment. 
CHAPTER I. 
OF THE ABSENCE OF RESPIRATION, &c. 
885. We are of opinion with Mr. White, Dr. Denman, Baudelocque, &c. that the premature tying of the cord is very often, if not always injurious to the child—therefore it is laid down as a rule, and it is one, we believe can never with entire safety be departed from; namely, that "the cord is not to be tied until the pulsations in the umbilical arteries have ceased." Mr. 
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258 
OP THE ABSENCE OF RESPIRATION, 
White we believe, first drew the attention of accoucheurs to this point; and he has almost universally established an acquiescence in the importance of the above rule; so general has it become at present, that if it were not recommended by any late writer, it would be looked upon as an important omission. His opinion on this subject, is founded upon the most correct physiological views; and he must be considered as having contributed much to the benefit of society, by the promulgation of a little essay " On the management of children at the time of birth." 
886. In favour of the practice there recommended there is so much concurrent testimony, that we have viewed with regret, the scepticism of Mr. Burns upon this point. He tells us,* that "when the child is vigorous, and cries lustily, there is no occasion of delaying, (the tying of the cord,) so long;" and adds, "nor have I ever known any bad effects result from this practice." And before in his text, he declares, "If it cry, or breathe vigorously, then it may be safely separated from its mother." These observations go certainly to call in question the propriety or necessity of the rule, so well established by the experience and reasoning of Mr. White, as well as of almost every other practitioner. 
887. It is true that Mr. Burns almost in the same breath, declares, " when the cord pulsates at the time of birth, we are never to be rash in dividing it. It is of importance to keep up the foetal circulation, till the new mode of acting can be established, and we ought not to divide the cord completely in such cases, till pulsation stop."t 
888. Now both of these directions cannot be right; on which shall the young practitioner rely? The propriety of Mr. White's rule, we think, should never have been questioned—for until it be proved an error, it is surely acting on the right side to adopt it; for it is not sufficient to prove it one, that Mr. Burns declares, he never knew any bad effect to result from the practice of applying the ligature while the arteries were yet pulsating. The evils arising from this practice are not always so immediate, as to make us challenge it for the cause; and the subsequent ones, may be too remote, however certain, to be considered as cause and effect. 
* Principles, Vol. II. p. 9, James's ed. 
f Ibid, Vol. II. p. 11. 


OP THE ABSENCE OP RESPIRATION. 
259 
889. The author of the little tract alluded to above, tells us, and tells us we think truly, that " the pulsation of the arteries of the cord proves the existence of the fcetal life.* The existence of the foetal life proves the imperfection of the animal life. While the animal life is imperfect, the foetal life ought not to be destroyed. The navel string therefore should never be divided or tied, while there is any pulsation in its arteries." 
890. Mr. Burns denies the validity of this reasoning, by saying, "it has been supposed, that as long as pulsation continued, the function of respiration was imperfect; but it is not so; the pulsation depends more on the continuance of the vitality or action of the placenta, than on the state of the lungs." This cannot be: the pulsation of the arteries of the cord, must necessarily depend upon those of the heart of the child. This is sufficiently proved, by observing the mode in which pulsation stops in the cord. The cessation commences next to the placenta itself, and gradually proceeds to the umbilicus of the child—this is invariable; now we would ask, what agency can the placenta have in perpetuating the pulsations in the cord, since they are always found first to cease next to this mass ? We grant the agency of the placenta in maintaining the foetal circulation—but this ceases to be a complete operation, before the pulsations in the cord cease; for these are maintained by the heart alone; and they would continue this action, did we prevent the return of blood to the child by opening the umbilical vein, or putting a ligature on it, until its system would be drained of almost every drop.t But we must not be understood as maintaining, that the pulsation of the cord depends upon the lungs—for we know, that when they become perfectly pervious to the blood by the new circulation being established, that they have a contrary effect—or rather, that the umbilical arteries must cease to beat from a necessity imposed, by this new condition of the lungs and circulation. We must therefore hold it important, that the cord be not tied until the pulsation of its arteries cease. 
* The author calls the life of a child in utero, the foetal life; and the life consequent upon respiration, animal life. 
f We suppose in these cases, that the placenta preserves its attachment with the uterus, and the circulation going on as before delivery. 


260 
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891. We have reason to believe we have seen several instances of death, and this of a painful and protracted kind, from the premature application of the ligature. And that this is probably one of the causes of the many deaths, in the hands of ignorant midwives, and practitioners, we have too much right to suppose. The constant practice of such pretenders is, to apply a ligature to the cord the instant the child is born; and this without regard to the state of the pulsation. 
892. The first great object after the delivery of the child, is the establishment of its respiration; for the most part this takes place the instant it is in the world, and very often it cries, and even forcibly, so soon as the head is protruded through the external parts. But should it fail to do this, every attention should be immediately paid, that respiration be established. The child may be born in one of the following conditions. 1. Feeble; but not exhausted by either delay in its delivery; by the compression of the cord; nor from a delicate stamina: these several conditions may be attended by a pulsating cord, or one in which pulsation has ceased. 
893. The cases in which the cord still pulsates, there is but little risk, as long as this action continues; and for the most part, all that is necessary is, to remove all impediments from the mouth which interrupt the passage of air to the lungs, and by dashing upon its little body some cold spirits or brandy; this almost instantly makes it send forth cries. But should there be no pulsation in the cord, the child's body flaccid, and especially if upon dividing the funis but a drop or two of black blood issue from the cut, the case is desperate, but not absolutely hopeless. 
894. We should in this case, 1st, carefully remove any mucus that may be in the mouth, fauces, or trachea, by wiping them carefully as far as we can reach with the little finger armed with a piece of fine dry rag; 2d, by inflating the lungs, by holding its nostrils, and applying our mouth to that of the child, and forcibly expanding its lungs, and then expelling the air from them by a gentle, but pretty firm pressure upon the thorax;* 
* Mr. Burns recommends, "the cartilages of the trachea to be pressed gently back to obstruct the oesophagus." (Vol. II. p. 11.) But this is never necessary if the head of the child be made to rest upon the right hand, and thrown a 


261 
OP THE ABSENCE OP RESPIRATION. 
3d, by placing the child's mouth downward, and holding the body and hips higher than the head, at the same time gently shaking the child, so as to disengage any mucus that may be lodged in the trachea, and permitting it to flow out of the mouth, by making this the depending part —then cautiously wiping the mouth as just directed, renew the inflations and the suspensions alternately, until the mucus flow from the mouth: by proceeding in this manner, we have often had the satisfaction of seeing the child restored. It is a circumstance worthy of remark, that sometimes, owing to the tenacity of the fluid within the windpipe, we cannot at first force air into the lungs; but by a little perseverance, we overcome this obstacle, and the mucus sometimes becomes so thinned, as to flow readily from the mouth, and at once relieve the child. This operation should never be neglected; nor should it be too soon given up; especially, if we can excite a few pulsations in the heart, or in the cord; these parts should be carefully examined, after each inflation; the pulsation of the heart, when very feeble, is best detected by placing the ear immediately over its region—that of the cord, by pressing it between the thumb and finger, close to the umbilicus. 4th. By the application of dry warmth, by means of heated cloths, frequently renewed; this precaution should be immediately had recourse to, and should be persevered in until the last moment. We much prefer dry warmth as an application to the child's body, to the warm bath, which is so much relied on in such cases—we think we have seen the latter decidedly injurious, though we do not pretend to explain the reason. Might not a properly constructed syringe be highly useful in removing the obstructing mucus? 
895. When the child shows signs of returning life, it is generally by a deep short sob, which may be repeated at longer, or shorter intervals; but when we think the interval too long, we should renew the inflations, &c. Should respiration be but imperfectly restored, we must carefully guard against fatiguing the child; therefore, it should not on any consideration be disturbed, by 
little backward; for in this position the skin on the fore part of the neck is put a little upon the stretch, and made to press against these cartilages, and carries them back sufficiently—the fingers of the left hand close the nostrils, while the mouth of the operator is applied to that of the child. 


262 
OF THE ABSENCE OF RESPIRATION. 
dressing it; on the contrary, it should be carefully placed in such a situation, as to permit the frequent renewal of warm applications to it, which are of primary consequence to the little sufferer. We have more than once had the mortification to see all our endeavours frustrated, and all our hopes destroyed, by an inattention to our directions upon this point, though given impressively. 
896. 2. The child may be born healthy and strong, the funis pulsating briskly, yet may not cry; because, a mechanical obstruction from mucus prevents the ingress of air into the lungs. This mucus may be in the mouth or posterior fauces, or it may be in the trachea—if the first, we may entirely remove it by a piece of fine rag upon the little finger, as just suggested; (894) if in the second, by suspending the child, as already directed, which will seldom fail to give relief, by the mucus being discharged by running from the mouth. We do not recollect an instance, where it was necessary to have recourse to inflation, while the pulsation of the cord continued: but when it stops before respiration is established, recourse must be had to it. When the child has made attempts to cry, we may often succeed in giving full force to it, by dashing spirits or brandy upon its body. 
897. 3. The child, from long delay in the passage, or having its neck tightly begirt with the cord, may be born still—in this case, its face will be livid, or even black, and swoln; the arteries may have ceased to beat, or may beat pretty vigorously. In such cases, nothing can save the child from immediate death, but instantly abstracting blood, by cutting the cord. Should the pulsation have ceased, we may sometimes still succeed in drawing some blood, by forcing it from the cord with the fingers; and then employing inflations, &c. If pulsation continue, we must abstract blood by also cutting the cord. The quantity to be drawn, must be regulated pretty much by the effect. When respiration is established, we need draw no more; but until we see some signs of this about to take place, we may abstract pretty freely, as this process most probably is interrupted by the congestive state of the brain, which can only be remo.ved by ample depletion. 
898. This practice of bleeding from the funis in our hands, has always answered a valuable purpose, in this congestive state of the brain; and to such cases it should always be confined. 


OF THE ABSENCE OF RESPIRATION. 
263 
Baudelocque recommends this plan; and we can bear witness, in many cases to its entire success; for we have repeatedly seen respiration established by this remedy, and by this alone. 
899. Mr. White informs us, however, that he has " repeatedly tried this method, and the almost uniform consequence has been the death of the child." We believe, that the cases which proved unfortunate in the hands of Mr. W. to have been ill selected, or of so desperate a kind, that no remedy could have saved them— for it does not follow, because the child has been born still, after " a very hard and tedious labour," that it is a case for depletion. And we have further reason to believe his unfortunate cases to have been ill selected, by his confession, that bleeding did not always fail. The livid and swoln condition of the face, must be present, to authorize the use of this remedy—if they be not, we would not feel ourselves justified in abstracting blood. Mr. Burns, with a view to get blood, recommends cutting one of the umbilical arteries with a lancet or scissors—but we believe, dividing the cord to be the better plan. 
900. It will be always proper, before the cord is divided, to pass a ligature loosely around it, that it may be tied the moment we have abstracted a sufficient quantity of blood. We should be provided with a diaper, or a white cloth of any kind, to receive the blood as it flows from the divided vessels, that we may have some means of determining the quantity abstracted. 
901. When respiration has been feebly, or imperfectly performed, we think we have seen good derived from a few drops at a time of warm wine whey. This may be repeated every half hour, until it shall be no longer necessary, either by the child breathing freely, or by its death. 
902. Mr. Burns thinks with Dr. Underwood, that if electricity could be employed, it might be useful. Of this we can say nothing from our experience; yet it would seem to bid fair to be beneficial, if it were used with the address, so powerful a stimulant would require. As a dernier resource, we would not hesitate to try it, were we in possession of the proper means for its application. And the case stated by Dr. Underwood, of the recovery of a child apparently dead for two hours, by electricity, should awaken attention to this subject. 
903. We have rather dwelt upon this subject, because we feel 


264 
OF THE ABSENCE OF RESPIRATION. 
it to be one of much interest—for every one is not in possession of the best method of treating still born, or nearly exhausted children, yet its importance will be obvious, upon a moment's reflection. How often does the life of the child depend upon the prompt application of the proper remedies! Yet how few, out of the profession, are qualified to give it, though the knowledge of what is proper upon such occasions is so easily attained? Every mother of a family should be acquainted with the proper method of treating children upon such emergencies, since she may be so situated as to direct them, either in her own case, or in that of a friend. 
904. We will illustrate this, byrelating a case which fell under our notice in the year 1798. Mrs. was suddenly surprised by labour, in the middle of the night. Her husband was despatched with all imaginable haste for us; while the lady was attended to by her sister. The labour advanced so rapidly, that the child was born before we arrived; and when we handled it, it was found to be perfectly dead. We nevertheless used all our endeavours to restore it; but they were in vain—its little spirit had fled. We found, upon inquiry, that its death was altogether accidental; and its life might have been saved, had its relation but suspended it by the heels, and well cleared its mouth of the mucus which obstructed the passage of air to the lungs. 
CHAPTER II. 
OF SYNCOPE, OR FAINTING. 
905. Under this head we may class the condition of some newborn children immediately after birth, as well as the syncope properly so called, which sometimes supervenes several days after this period. 
906. In the first case, the child seems exhausted altogether of muscular power; is pale, motionless, and flaccid; it gives no other evidence of life, than feeble pulsation of the heart and the umbi- 


265 
OP SYNCOPE, OR FAINTING. 
lical arteries; respiration is retarded, and perhaps would never be established, were the child left to itself. 
907. This condition may arise from the imperfect development of the child itself; though it may be considered as having tarried within the uterus its full time; or it may have been cast off prematurely. In both these cases, the chance of recovery is small; since, the want of development is a serious obstacle to recovery; yet it is not altogether hopeless. 
908. The first object to be attempted in such cases, is, the expansion of the lungs—this must be tried by dashing cold brandy upon the body; maintaining warmth, by means of heated cloths; and preserving the funis entire, so long as pulsation continues. 'If we succeed in producing respiration, the child should be so placed, that it may derive advantage from the repeated application of dry heat; it must be neither washed nor dressed; and its feeble powers must be sustained by the most unremitting application of warmth externally, and by the administration of a few drops of wine and water, or wine whey, from time to time, internally. If it cannot swallow, its lips and nostrils may be every now and then moistened with a little wine, or brandy and water. 
909. However unpromising appearances may be in the commencement of this case, we are justified in saying, that we have frequently been rewarded with success, by following the plan just laid down; it therefore always deserves a trial. Should this case be mistaken fOr one in which the brain is in a congestive state, and treated by blood-letting, it will surely prove fatal; and some of the instances in which the author of the little tract just named tried this remedy, and where the children died, were probably of this description. 
910. Children, who arrive at their full period, will of course, ceteris paribus, stand a better chance than those who are born prematurely; but the latter should never be abandoned, because the powers of life are feeble; especially, if they have attained their seventh month. We have witnessed two instances of complete recovery, where, from all the data we could collect, the children had but just exceeded the sixth month. These were neither washed nor dressed for many days; they were preserved in a uniform temperature by means of a stove, and a bed of cot 
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266 
OP SYNCOPE, OR PAINTING. 
ton. A few drops of warm whey, from time to time, was all the food they received for three weeks; but on which they throve surprisingly. 
911. One of these children was carefully weighed when it had attained its sixth week; its clothing, diaper, &c. and its little self, weighed one pound and three-quarters. The other was not weighed, from a superstitious feeling upon the subject; it lived but three months —its death was occasioned by a catarrhal fever, contracted from improper exposure. The former is living at this moment, and is now in her sixteenth year. She is still very small; but sprightly, and sensible. 
912. There can be no question but the two children just mentioned were preserved, by not subjecting them to the fatigue of washing and dressing. They were more than a month old, before they were exposed to these ordeals. 
913. Children who have undergone their full uterine development, and who would have possessed good stamina, had no accident unfriendly to their lives accompanied the labour, may from the nature of such accidents be liable to this state of exhaustion. Thus, whatever .shall diminish the proper quantity of blood circulating in their systems, will produce this state of weakness —as a separation of a portion of the placenta before birth; the placenta being too long and too powerfully compressed, by the tonic contraction of the uterus itself; by the cord being slightly compressed, when prolapsed, or when it interposes itself between the pelvis and the presenting part, &c; hence, the frequency of this state, when the causes just named are known to exist. 
914. These cases, if well managed, will very often terminate favourably. All fatigue must be avoided, and all purgative medicine be withheld. We have never ventured, under such circumstances, to purge off the meconium, until the child appeared to gain sufficient strength to bear the operation without risk, even though this required a number of days; for we believe that this substance may occasionally be serviceable in such cases, by keeping up the stimulus of distention. We may at least venture to declare, we have seen the child exhausted in a few hours, when several loose stools have followed each other, in quick succession. 


OP SYNCOPE, OR FAINTING. 
267 
915. A child so circumstanced, should not even be put to the breast, until its system has become more confirmed, by rest, and judiciously administered nourishment. The milk of the mother should be given it by the spoon, and this without removing the child from its place of rest; or should the mother have no milk, a little rennet whey may be substituted; or if something a little more cordial be thought expedient, weak white wine whey may be given. 
916. It now and then happens, that a child may be rather feeble when first born, but recover its powers by proper attention, and every thing giving promise of doing well—when of a sudden, it will become pale, flaccid, cold, with a long interval between each breathing, and at last respiration appears to stop; the fingers and hands become blue, or black; the lips livid, and the eyes fixed, and but half closed; the pulse extinct—in a word, looking " the image of death." After remaining in this condition for a short time, a slight convulsive motion will appear to play about the mouth; an imperfect inspiration will be taken, followed by an expiration, attended by a peculiar noise; the lips become less livid, as do the hands and nails; the eyes move languidly, and the pulse may now by close attention be perceived, like a vibrat ing thread, at the wrist; an attempt to cry is now made, but the sound is so feeble, that it can be heard only at a very short distance—and this finishes the paroxysm. 
917. After the " fit," as it is called, has terminated, the child will appear languid, and uneasy, for some time; it will generally swallow, if any fluid be presented to it, provided it be not too soon after the paroxysm. A discharge from the bowels almost always takes place during the " fit," of a small quantity of a very green fluid. These spells are repeated at longer or shorter intervals, unless the disease be arrested by the influence of remedies, or death closes the scene. 
918. A case "of this kind occurred to us lately, which we will proceed to relate; and the mode of treatment will at the same time be made known. 
919. Mrs. F. was delivered, on the 13th of March, 1825, of a small, but apparently a healthy child; she supposed she had not arrived, by two weeks, at her full period. The child cried distinctly, but not very forcibly. It was at the usual time wash- 


268 
OF SYNCOPE, OR FAINTING. 
ed and dressed, and took without difficulty a little warm molasses and water. The next day, it appeared to be doing very well; its bowels were opened freely, and it sucked when put to the breast. It continued to do as well as children in general, for several days, (until the tenth,) when it seemed more languid than usual, and did not take its nourishment so freely, nor draw so firmly at the breast; but as it had had several watery green stools during the night, its languor was attributed to this cause. The condition of the bowels was but little regarded; as the nurse supposed the discharges were not so frequent, as to require any medicine. In this situation things remained until the following day, when the child, after having repeatedly during the morning refused nourishment, " fainted," as the nurse called it, and I was immediately sent for. 
920. When I arrived, the child was in a state of faint, or syncope—so completely however did it resemble one dead, that I thought it was actually so, and expressed a fear to that effect. The nurse said, No—it was not dead; it had only fainted, as it had done several times before. I placed my ear over the region of the heart, but could hear no pulsation. 
921. I caused flannels to be wrung out of quite warm whiskey, and applied all over its little body; small sinapisms were placed upon the temples; a drop of brandy was insinuated into its mouth, and its nostrils were wetted with a little sharp vinegar. After these applications were made, which must certainly I think have occupied five minutes, the little creature began to discover signs of returning animation, contrary, I confess, to my calculation. The return, as it were, to life, was pretty much in the order stated above; the child however was found very much exhausted, and it was some time before it could swallow. 
922. The bowel complaint was now increased greatly, and the poor child nearly exhausted. It had no return of syncope while I staid, which was about an hour; it could however be scarcely said to be alive. I directed the whiskey stoups to be continued ; and a weak chalk mixture with a little laudanum, was ordered to be given every hour, or until the condition of the bowels should be improved. A little wine whey, with an equal quantity of cinnamon tea, were directed to be given as often as the child could swallow them. 


OF SYNCOPE, Oil FAINTING 
269 
923. 1 repeated my visit in the evening. The child had had during my absence one " fainting fit," but it did not last so long as the former; its bowels were still much disturbed, and the child looked more like a corse than a living being. I desired all the previous remedies to be punctually continued. My next visit was not until early the next morning. The child had had several slight " faintings;" its general appearance I thought more favourable; it swallowed with considerable freedom; its bowels were much improved; it could cry audibly, and looked about with some vivacity. During the whole of this period, its little eyes swam in a yellowish fluid, of considerable tenacity, and quantity—indeed, the quantity was so great, as to flow down its cheeks; and so tenacious, as to be traced through its whole course, by the coat which it left upon the skin. 
924. I desired a perseverance in the plan mentioned. From this time, it began to recover, and mended rapidly, without any return of the faintings. It is now alive, and doing well. 
925. Dr. Underwood recommends, upon similar occasions, a more stimulating plan, upon the authority of Mr. Hey, of Leeds; such as the volatile tincture of Valerian; and upon his own, the fumes of lighted tobacco forced into the child's mouth. I can say nothing as regards the efficacy of either of these plans, from any trials Of my own. It certainly comes recommended by high authority, and should therefore be deserving of confidence. I however confess, that I entertain some apprehensions of the tobacco fumes, from its known narcotic powers — but I will not oppose speculation to experience. During the severe part of the above child's illness, I did not permit it to be dressed—on the contrary, it was kept naked, for the better employment of the warm whiskey. 
CHAPTER III. 
OF THE MECONIUM. 
926. We have, in the first part of this work, (Book I. p. 144,) already spoken of the substance called meconium, and of the propriety, or necessity of purging it off We shall not repeat 


270 
OP THE MECONIUM. 
what we have already said upon this subject; but we may add what we did not urge at time. Since writing what is here referred to, a case has occurred, which most decidedly proves the necessity, if farther argument were wanting, of carefully and completely carrying off this offensive recrement. 
927. A child born healthy, had its bowels liberally purged, as it was supposed, by the ordinary remedies. It remained perfectly well for several days, and had taken the breast freely. At about the eighth day, the eyes and skin appeared rather yellow, though its urine was not altered in colour. Its bowels were a little affected, and had frequent, but very sparing watery stools; it hiccoughed often; its skin was dry and hot; it became very restless, and refused the breast, though evidently very thirsty, as it would receive with greediness, water, or any other thin fluid, from a spoon. It would often start, and at such times would move its limbs violently for half a minute together. Its tongue was very white, and loaded with a substance resembling a stratum of coagulated milk. It did not puke, though evidently distressed at stomach, as it would frequently gag, but could get nothing up. 
928. Believing its distress to arise from some irritating cause in the first passages, we ordered a tea-spoonful of warmed castor oil; and this to be repeated in two hours, if the first did not succeed. A second, and a third, were given, without moving the bowels. Magnesia, in five grain doses, followed by a tea-spoonful or two of lemonade, were then given. It took a scruple of this medicine, with no better effect. Its stomach now began to revolt at every thing that could be offered it; and the purgative medicines were in consequence suspended. The abdomen began to swell, and became very tense and shining. It could lie but on its back, with its little legs drawn close up to the belly, and was evidently in a state of great suffering. Its cries were piteous and incessant; and its whole skin became bedewed with a cold sweat. 
929. Injections of various kinds were thrown up the rectum; the child was placed in the warm bath; but no stools were procured, for the little tinged mucus which came away every now and then by severe straining, did not amount to a stool. We had upon several late occasions with children, found a solution 


OF THE MECONTTTM. 
271 
of the carbonate of soda, very useful in aiding the operation of medicine, in cases of constipation; we accordingly determined to administer a grain of this article in a tea-spoonful of lukewarm water, every fifteen minutes, until ten grains should be taken. 
930. At the expiration of two hours and a half, the bowels began to move; and in the course of three or four hours, there were ten evacuations, each of which evidently contained a quantity of the meconium, with the exception of the two first. The purging was now kept up by an additional tea-spoonful of castor oil, and was permitted to go on, until the meconium was no longer visible in the evacuations. Dr. Underwood gives a similar history; but one, in which a much larger quantity of medicine was exhibited. 
931. We have related this case, with several views: 1st, to prove the necessity of purging off the meconium; 2d, to show that this substance, when not completely carried off, will most probably create a good deal of distress, or even severe disease; 3d, that though the meconium may disappear from the early evacuations of the child, it is no proof that there is none remaining; 4th, that while it has possession of the bowels, it prevents by its tenacity the usual action of purgative medicines; 5th, that by the exhibition of the soda, some change was effected in the bowels, favourable to the operation of the remedies previously exhibited. 
CHAPTER IV. 
OF JAUNDICE. 
932. The skins of newly-born children are frequently of a yellow colour; but this does not constitute the disease in question. The yellowness here spoken of is not of a deep tone, though very generally diffused. This appearance may continue for several days, and then disappear without the aid of remedy, or without leaving any evil behind. It is difficult to say, to what this yellow tinge may be owing; certain it is, it cannot be attri- 


272 
OP JAUNDICE. 
buted to the presence of bile, since, neither the urine, nor the whites of the eyes, assume the yellow hue. 
933. We know that changes from a white to a yellow skin, take place upon certain occasions, and this sometimes with surprising rapidity, by some occult change in the cellular membrane, or rete mucosum, without our being able to declare the cause. This is remarkably the case in yellow fever; where the presence of bile cannot be detected in the circulating fluids. The same thing takes place with certain people, from strong affections of the mind, or peculiar derangement of stomach, without the aid of bile: it also occurs occasionally, with the new-born child. 
934. Therefore every yellowness of skin must not be mistaken for jaundice, as it would lead to great errors in practice. Our attention is frequently drawn to this appearance by nurses; and when it is observed, we make it a rule to investigate the condition of the child, lest a real jaundice be present. 
935. We direct our attention, 1st, to the whites of the eyes, and the secretion of tears; if neither of these be tinged yellow, we have reason to believe there is no jaundice; but if they are, we inquire, 2d, into appearances of the urine and fasces. If the first be yellow, we suppose it a still stronger ground of belief, that there is jaundice, and if the faeces, are paler than they should be, or of a clay colour, we are sure the child has a genuine jaundice. 
936. We have however known all the marks, or signs of this disease to exist, (with the exception of the pale or clay-coloured stools,) without the child appearing to suffer in the least. They have all disappeared spontaneously, or by the exhibition of a single dose of castor oil, without being followed by the slightest inconvenience. So long then as the stools are dark green, or yellow, we need not give ourselves any anxiety about it. 
937. But if on the contrary, the above marks are attended by deficiency of colour in the stools; if the bowels are costive or irritated to frequent efforts; if the abdomen swell, and become tense; if the child be uneasy, fretful, and inclined to vomit; if it really vomit, a white glairy mucus; if it refuse the breast, and frequently moan, as if in pain; if it hiccough, and emaciate rapidly; if its eyelids became glued together by a yellow tenacious serum, jaundice, in its most formidable form, is present. 
938. In cases of this kind, the liver itself has sometimes been 


OS* JAUNDICE. 
273 
found much diseased, as in the case related by Mr. Pearson; (Underwood, p. 14.) at other, the common duct has been obstructed as in the jaundice of adults. 
939. Dr. Underwood, (p. 13.) says, "I have found suckling in that state, (with jaundice,) is capable of communicating the true jaundice to a great degree, and that it will not be cured, but by the recovery of the suckling mother or nurse, or the nurse changed, or the infant being weaned, as well as properly treated." We think the Doctor must labour under an error in this statement. We have no difficulty in believing, that the serum of the child's blood may become tinged with bile, since the milk it sucks, is coloured by it—consequently, the chyle also will be coloured; hence, some of the common marks of jaundice will be present—that is, the whites of the eyes, the skin and the urine, will partake of the same general hue with the serum of the blood, but the essential mark of jaundice we are sure will be wanting; namely, the light or clay-coloured stools, or the absence of bile in them. It would be extremely difficult to conceive how the tinged milk of the mother, should either materially injure the liver, or obstruct the common duct: and without one or the other has happened, we believe a genuine jaundice cannot be produced. 
940. Nor is there any difficulty in accountingfor the yellowappearances of the child, or that it shall not get well, (that is, lose its yellow appearances,) until the mother or nurse is cured, and the child weaned, since it is constantly receiving the same coloured milk. 
941. When a genuine jaundice attacks a new-born child, it is but too often fatal, with whatever propriety or energy we may attempt to relieve it. It is generally recommended to commence the cure by an emetic; for this we have the authority of Armstrong, Underwood, Burns, &c.; to oppose our single experience against them, might appear ill judged, if not rash. Yet we dare not run counter to our own observations; especially, as we have given fair trials, (in our own estimation,) to the remedy; and the result is decidedly against the practice. 
942. Emetics have not only failed in our hands to remove the disease, but have rendered the stomach so irritable, as not to receive any other remedy, willingly. We have therefore abandoned them for some years, and find we can succeed better by another plan of cure. 
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274 
OF JAUNDICE. 
943. When we find symptoms of jaundice, that is, yellow skin, eyes, and urine ; we begin by giving small doses of castor oil; that is a small tea-spoonful every two hours, until it purges freely. If upon the inspection of the evacuations, we do not find bile in them, we follow up the purging the next day, by giving calomel in very small doses, until a cathartic effect is produced. This may, and does require sometimes, two or three days perseverance in the calomel, aided by small doses of soda, supersaturated by carbonic acid gas, before the bowels are moved; for it must be recollected they are most commonly very torpid. We have said we give calomel in very small doses; the following is our formula:— 
R. Calom. ppt. gr. iij. Sacch. alb. gr. vj. M. bene, div. in. xij. 
944. One of these to be given every two hours until they operate. They are best exhibited in a small drop of thin molasses, washed down by the solution of soda, in the proportion of two scruples to eight ounces of the carbonated water. 
945. A tea-spoonful of the solution of soda may be given frequently as a drink. Should the calomel at any time after exhibition, procure bilious evacuations, it should be desisted from or given less frequently. But should it not, it must be persevered in, unless the bowels become too much irritated; in this case, they must be appeased by laudanum, in quarter drop doses, every two or three hours until the effect is produced. During this period however, the solution of soda should be continued. We have thought that advantage has been derived, by bathing the abdomen with warm brandy, especially if this part be preternaturally hot or cold. In doing this however, a caution must be suggested, that the parts be not unduly pressed, or rudely handled, under the impression that this is essential to its efficacy. 
946. Should diarrhoea with bilious looking stools, supervene, the calomel must be stopped, and laudanum must be given as directed above. During the whole of this time, the child should receive its mother's milk as often as it well can, by sucking, if able; or by the spoon, the milk having been previously milked out. 


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947. We have thought also, that the occasional employment of the warm bath has been useful, especially, when there is a disposition to spasm, or frequent hiccough. 
948. But notwithstanding the employment of the above remedies, if the stools do not become bilious; if the tone of yellow in the skin be increased, or rather looking black; if the skin becomes mottled; the eyes blood shotten; the urine very scanty, and very high coloured, or if entirely suppressed; the hands and nails looking livid; if the child vomit, or is threatened with convulsions, the case must be considered as extremely desperate, though not absolutely fatal, as we once witnessed a case, where all these symptoms were combined, yet the child recovered. 
949. In the case just alluded to, we used, not knowing what else to do, but almost solely with a view to relieve the anxiety of the parents, a warm bath every two hours, for five minutes at a time, in which an ounce of the sweet spirit of nitre was mixed. After its first application, the child appeared revived; and each subsequent one was followed by improvement—bilious evacuations took place; there was a liberal secretion of urine, and the child mended from that moment with astonishing rapidity—we do not however wish to attach much consequence to this first trial—it was perhaps mere coincidence. It may however deserve farther trial: we have not ourselves had an opportunity to repeat it since. 
CHAPTER V. 
OF ERYSIPELAS. 
950. Children in the month are sometimes liable to inflammation of the # skin of the erysipelatous kind, which locates itself variously. It is not however a very common affection, especially among the higher classes of society. It is a disease of more frequent occurrence it would seem in Europe, and especially, in the lying-in hospitals, than in this country. 
951. When this complaint is a symptom of some prevailing 


276 
OF ERYSIPELAS. 
endemic of crowded hospitals, it is considered by both the French and English writers, as one of great danger. Dr. Underwood says he has not met with this disease often, except in lying-in hospitals. Its ordinary time of attack, is a few days after birth; and was thought by some, never to appear later than the month—but he says this is not the case; and this agrees with our own observations. 
952. We have seen this certainly later than the third month, and in one instance, and that, one of a most ferocious kind; the child was beyond the sixth month. It would seem that no part of the body is exempt from an attack of this inflammation; at least we have seen it commence upon various portions of it. In the instance just alluded to, it might be said to have had no " local habitation;" for we saw it occupy a leg, a thigh, an arm, the face, or the body, in the course of twenty-four hours. 
953. Its translations were rapid, beyond belief; and the part occupied at one moment, would in another, be left free from disease; while a new portion of the body, uncertain which, would be obliged to sustain its attack; which in its turn, in the course of two or three hours, might be left with equal capriciousness to fix upon some new part, without the one just left having received any material injury. The inflammation in this instance, did not vesicate until it had fixed permanently upon the head and face; which it did, after having pursued this erratic course forfive days. After the head and face became affected, the disease seemed to forget its fugitive course, but not its deadly character. The face and head became immensely swoln; the surface attacked became purple, and vesicated over its whole extent; delirium followed, and death soon closed the scene. 
954. The places most commonly selected for this inflammation agreeably to our experience, are the nates, the neck, the small of the back, and face. It usually begins by a spot of uncertain size, and ill defined extent. Fever is almost sure to attend;* and the child to betray great marks of suffering. The extent of the inflammation may be very limited for several hours, or even days, unless it vesicate early; when this happens, the 
* It would seem, there is much certainty that this disease is both idiopathic, and symptomatic—therefore, fever may follow the appearance of this inflammation; or this inflammation, may be supervenient to fever. 


277 
OF ERYSIPELAS. 
disease spreads with much greater rapidity, and the child suddenly becomes dangerous. The stages of this inflammation are sometimes passed, with great rapidity; a bloody ill looking pus, or ichor, is quickly formed, which very soon extends itself through the meshes of the cellular membrane, to an undefined distance. 
955. Whenever this inflammation extends to the cellular tissue, it is sure to destroy it, by forcing it to a rapid suppuration, and thus devastating the parts of this important membrane. Abscesses, or rather collections of matter, are therefore formed of unequal size, throughout its course; and when the subjacent parts are exposed by the removal of the skin, which before covered them, the muscles are as completely denuded of all their cellular covering, as if they had been most carefully dissected. 
956. Should the part attacked in this way be a depending one, the ill formed pus, or sanies, insinuates itself to an uncertain extent; for it has no bounds set to its ravages, by a protecting effusion of coagulable lymph, as in a genuine phlegmonic inflammation. Hence, we once saw it run from the lower point of the left scapula, to the base of the sacrum. 
957. Notwithstanding the apparent irregularity of this species of inflammation, it has four distinct stages; 1st, inflammation without vesications; 2d, with vesications; 3d, with vesications and suppuration; 4th, gangrene. There is something very peculiar, if not sui generis in this inflammation; and on this peculiarity does its danger very much depend; but our limits do not permit us to describe them but in very general terms. 1. Its erratic disposition—as it may in an instant almost leave the part it occupied, to seize upon another, however remote, or important that part may be. 2. Its disposition to vesicate. 3. The rapidity with which it runs on to its own peculiar suppuration, for it is without any provision, by the effusion of coagulating lymph, to limit its extent. 4. To its strong tendency to gangrene, seeming at once to kill the skin and cellular membrane, by the force of its previous inflammation. 
958. Much difficulty has ever been experienced in the management of this disease, especially in children, with whom its progress is almost always more rapid and subduing, than with adults; and not less diversity of opinion, than difficulty, has 


278 
OF ERYSIPELAS. 
existed, as to the proper plan to be pursued. In almost every part of Europe, this disease is considered one of great danger; and in this country, it has had but too many victims. Whether this disease is necessarily one of so much danger, is much to be doubted; unless difference of climate has more influence than the mode of treatment; for it has certainly, within the last few years, been less fatal than formerly; and this melioration, we believe, is justly attributable to the plan of cure. 
959. Dr. Underwood thinks the bark the best constitutional remedy; and saturnine, and camphorated applications, to be the best local remedies. Mr. Burns approves of cold watery applications, where the heat of the part is considerable; but thinks, with Dr. Gartshore, that the camphorated spirit of wine is the best application from first to last. He seems doubtful as to the efficacy of the bark; but recommends from five to ten grains of ammonia,* every three hours—but says, he has derived more benefit from calomel purges, than from any other medicine. 
960. We shall say a few words upon each of these plans, before we detail the one usually pursued by ourselves, and other practitioners in this city. 1. As the system evidently labours under high arterial action in the commencement of almost every case of erysipelas that requires medical treatment, the bark must not be thought of, either in the first or second stages of this disease; in either of the two last, it may often be proper, if the suppuration, or sloughing, be extensive. 2. As regards the topical applications recommended by these gentlemen, the cold saturnine, have always appeared to us, if not of hurtful tendency, at least of doubtful efficacy. In the early, or first stage of erysipelas, the camphorated spirit, we have thought occasionally useful, but never efficacious. 3. The propriety of using ammonia in such immense doses, to a child perhaps within a month old, is extremely doubtful, even if it were possible to give it, (which, by the by, in our opinion, is extremely problematical;) but its usefulness in any quantity may be justly doubted, especially as the disease, in its commencement at least, according to Mr. Burns himself, is attended with fever. Of the 
* We take for granted, that Mr. Burns means the carbonate of ammonia, by the simple word ammonia. 


279 
OP ERYSIPELAS. 
good effects of calomel purges, we entertain no doubt; but must say, purging with it, or any other cathartic medicine, seems to be much at variance with bark and volatile alkali. 
961. It is probable, that erysipelas may have a number of counter-agents; but there are very few, we believe, yet ascertained. In the time of Ambrose Pare, blisters were employed to interrupt the progress of this inflammation, both as regards the extent of surface over which it might be disposed to travel, as well as the terminations of two of its stages in either suppuration or gangrene. This remedy, however, was either forgotten or laid aside, for nearly two centuries, because the modus operandi of the application could not be explained. To Dr. Physick do we owe its revival, the importance of which can only be appreciated by those who have witnessed the almost wonder-working operation of this remedy. We have frequently succeeded with it, both in the adult and in the child; and can most safely recommend its application, when the inflammation attacks such parts as can readily be covered with a blister. * 
962. The plaster should be of such a size as will rest with certainty upon the sound skin—if this precaution be not taken, its application will avail but little. When the sound skin is well vesicated, the plaster is to be removed, and the part to be treated as if a blister had been used for any other purpose. 
963. It however very often happens, that a blister will be inexpedient, from the peculiar location of the disease; in such case, we use the strong mercurial ointment, (without turpentine,) by covering the inflamed, as well as the sound skin, with a coat of it; and when it is removed, or becomes dry, it is renewed by a fresh application. We use this ointment differently, however, in the several stages of this inflammation; we shall therefore describe our method; and, 
964. 1. Where the part is inflamed, but not yet vesicated. When we see the inflammation in this stage, we cause the whole of the reddened part, as well as a portion of the sound skin, to be covered with the ointment; which is to be renewed, when the part is deprived of any portion of it. 
965. 2. Where the part is vesicated, but the vesicles not opened. In this case, we cause the vesicles to be carefully open- 


280 
OF ERYSIPELAS. 
ed, and the ointment applied as just directed for the first condition. 
966. 3. Where the vesicles have opened spontaneously, and the part has become encrusted; but the inflammation is spread to either a considerable or to a more limited extent. In this case, we direct the ointment to be applied only to the surrounding inflamed margin, and on a portion of the sound skin. 
967. 4. Where portions have proceeded to suppurate, yet a part of the surrounding skin is inflamed. Under such circumstances, we open the collections of matter as early as possible; and apply the ointment to the margin, as above directed. (966.) 
968. Such is the efficacy of the mercurial application, that it almost immediately arrests the further progress of the disease; therefore, when practicable, it should be had recourse to early. 
969. We know but one objection to this powerful counteragen —the patient sometimes becomes salivated. This however selcfom or never happens with young children, who are most obnoxious to the disease for which it is prescribed. In adults, on this account, we sometimes prefer the blister.* 
970. We have already noticed, that the suppuration in the erysipelatous inflammation, is not of a genuine pus; it is always more or less bloody, and generally very offensive—this may also be said, when the part becomes gangrenous. The charcoal poultice, in such cases, is of great value; or the diluted pyroligneous acid may be most advantageously used; or a poultice made of a strong decoction of bark, or even of its substance. 
* It would seem, that the origin of the mercurial treatment is peculiar to this country; and the honour of the discovery is claimed by Drs. Little and Dean. Their claims are urged with such equality, that there would be a risk of doing injustice to one, by admitting the claims of the other. 
It appears, that this is not the only mercurial preparation that has been useful in this complaint. A solution of the corrosive sublimate, in the proportion of one grain to the ounce of water, Dr. Schott of this city informs us, has been found equally efficacious. And it may be justly questioned, whether this practice may not be of old date, but like many other substances, have fallen into disuse, from occasional failures; certain it is, we saw it used very extensively about the year 1785 or 6, in an erysipelatous condition of the leg from phlegmasia dolens. The precise effect of this application is not at this time recollected, as it was supposed at the time by me to be a part of the routine of practice in such cases. 


OP ERYSIPELAS 
281 
971. Hitherto we have dwelt upon the external treatment of erysipelas; we shall now speak of the internal remedies which we have found best suited to this disease. 
972. In the early stages of this affection, when accompanied by constitutional symptoms, as fever, headach, delirium, &c. the patient should be confined exclusively to the mother's milk, and that given but seldom. The bowels should be kept freely open,but notseverely purged, by small, but repeated doses of calomel. Should fever run high, with strongly marked cerebral affection, the child should lose blood from the arm; or from the temples, by leeches. 
973. Fresh, cool air, should be freely admitted to the body of the patient; and the room should always be well ventilated. Among many people there is a prejudice against this plan; they are fearful of adopting it, lest the inflammation "strike in." But of this, they should be assured, there is no danger; and the plan must be insisted on. 
974. When this inflammation runs on to suppuration, or terminates in gangrene, the system becomes enfeebled, either by the extent of the discharge, or the peculiar character of the disease; especially, when it has a tendency to become epidemic. Here, we are persuaded,the bark, insome form or other, becomes absolutely necessary; and as far as one case will justify the recommendation, in the form of a sulphate, is the most easy of exhibition, and is as efficacious as in substance or in decoction. The bowels at this time are very apt to become too loose—this must not be permitted to go on, or the little sufferer will speedily sink. 
975. To arrest the too free motion of the bowels, the chalk mixture, with minute doses of laudanum, should be given, in the form following:— 
R. Creta ppt. 3ij. Tinct. Thebaic. gut. x. 01. carui. gut. j. Sacch. alb. 3\j« Aq. font. |jiss. M. 
Of this a child of ten days old may take half a tea-spoonful every two hours, until better; one of a month, to that of two months, a tea-spoonful, as often, until the bowels are checked. Should it appear to be in pain, an additional quantity of laudanum must be given; say, from one to two drops. 
[37] 


282 
OF ERYSIPELAS. 
976. The child may now be indulged with the breast, to the extent of its appetite; and its little strength must be husbanded with every possible care. It may, with this view, from time to time, take two or three tea-spoonsful of wine whey, carefully made, and not of too great strength. ' 
977. The whey should be made as follows: take half a pint of new milk, and bring it to the boiling point, in an earthen or silver vessel—at that moment throw into it a common sized wineglassful of Madeira, Sherry, or good Teneriffe wine—stir it two or three times around, and then set it in a cool place to separate. When separated, pour off the whey from the curd, and sweeten it to the taste with loaf sugar. 
978. Of that form of erysipelas, which attacks the genital parts of new-born children, we have never seen but one instance; and this, not until nearly the whole of the parts were destroyed, and when art could do nothing for its relief. 
CHAPTER VI. 
OF THE RETENTION OF URINE. 
979. It very frequently happens with newly-born children, that they do not pass their urine for many hours after birth, or so sparingly, as to afford little or no relief; this creates a great deal of distress, and if not relieved by proper means, will sometimes occasion death. A very remarkable instance of this kind fell under the notice of our friend Dr. Parrish and ourselves, which we trust will require no apology for giving it in detail. Mrs. was delivered of a healthy baby, on the 15th of June, 1822. On the 20th, in the evening, the child showed uneasiness; and on the 21st, it cried violently, and continued to be much pained until the 25th. A variety of simple remedies were used for the relief of the urine, which had been either very sparingly passed, or entirely suppressed, most probably from the 20th 
—but without success. On the morning of the 25th, at ten o'clock, we found the abdomen very much distended, even to the scrobiculus cordis; the skin was shining, and the superficial veins were very much enlarged. The child had several very sparing 


283 
OF THE RETENTION OF URINE. 
stools, of a dark green colour: two tea-spoonsful of castor oil were given in the course of the morning. At half past one o'clock P. M. Dr. Parrish introduced a small flexible catheter, and drew offat onetime eighteen ounces andahalf of a straw-coloured urine.* At seven o'clock of the same day, the child appeared perfectly relieved; it slept soundly, and took nourishment freely. Two more tea-spoonsful of castor oil had been given since the visit at noon, but without moving the bowels; nor did any water pass. As the child was easy, it was permitted to rest without disturbance. 
980. From this time, the water was regularly drawn off by the catheter until the child's death, which happened on the 28th. It had gradually declined from the time of ourfirstvisit,anditsmouthhad become very sore. Permission was not obtained to examine it. 
981. We have recorded this case on account of its great practical importance, though unfortunate in its issue. We have seen several instances similar in their general appearance to the one just related, and like it ending in death: we have strong reason to believe they may have died of retention of urine, though we were assured that they had passed water—the same was insisted on, for a while, in the case just mentioned, and perhaps there may have been a small discharge, as always happens when the bladder becomes excessively distended. We know that this often takes place in the adult, from the same cause. We ever make it a rule to inquire into the state of the bladder, in all the little complaints of very young children; but we fear we have been too easily satisfied with the reports of the nurse upon this subject—we now make it our business, whenever we have any suspicion that the urine is not freely evacuated, to examine the abdomen of the child, espe- 
* "The introduction of the catheter is spoken of in the case of a child of ten days old. We have never had occasion to employ the instrument at so early an age, and fear that its employment is more easily described on paper than carried into execution in practice, particularly in the male."— Lond. Med. and Phys. Journ. August, p. 149. 
In a case similar to the one which gave rise to the above observation, it may be asked, what other resource does our art afford? I have not declared, nor even insinuated, that the catheter should be used upon slight occasions; but where the retention is confirmed; and where every usual expedient has been resorted to, and had failed; should we suffer our patient to die, because the introduction is considered difficult? I can truly say, in the above case, the gentleman who performed the operation, found no difficulty whatever. 
In relating the above case, I have confined myself to the detail of the main facts; I have not attempted to describe the mode of introducing the catheter. 


284 
OP THE RETENTION OF URINE. 
cially if it be reported as swelled—we carefully examine the region of the bladder, with a view to detect any distention of it, if it exist, that we may take our measures accordingly. We are sincerely of opinion, that, had the catheter been introduced twentyfour hours sooner, nay, perhaps twelve, the poor infant, whose case is related above, might in all probability, have been saved; but as there was a constant assurance that water passed, no suspicion was entertained of the state of the bladder, until all the mischief was done, that could well happen from its fulness.. 
982. We suggest, as a matter of probability, that the cases we have witnessed of death in very young children, where the abdomen has been much swoln, and the superficial veins passing over it much distended and very conspicuous, were similar affections of the bladder, though no such suspicion was entertained at the time. How far a distended belly, (indeed almost to transparency,) with greatly enlarged veins, may serve to distinguish this state of the urinary organs in very young children, must be left to future observation. We have felt it a duty to express this impression, with a hope that it may awaken attention in those whose province it is to witness numerous cases of sickness, especially in very young children. 
CHAPTER VII. 
OF APHTHAE. 
983. This complaint is generally called the baby's sore mouth; it consists of a greater or less number of white pustules on the inside of the mouth. It very generally begins on the inner part of the lower lip, or corners of the mouth, and resembles a small coagulum of milk; from this point it sometimes spreads itself very rapidly over the inside of the cheeks, tongue, and gums. When this efflorescence is extensive, the child slavers very much, and is frequently embarrassed in its sucking; it cries, and evidently betrays that it is much pained; it is very restless and very thirsty, as it evinces by its frequent stirrings, and its disposition to be continued at the breast. The eruption in its mildest form is very white, and looks as if a stratum of milk coagulum were spread over the mouth. It sometimes confines itself to the centre of the cheeks, at others to the lower lip, or one side 


285 
OF APHTHiE. 
of the tongue. In its severer forms, the appearance of the eruption is of a dark brownish colour, or extremely red; but both are evidently grades of the same affection, changed either by mismanagement, constitution, or force of the remote cause. 
984. This affection is supposed to be one of a symptomatic kind—and rarely, perhaps idiopathic. It is almost uniformly preceded by a deranged condition of the alimentary canal, and always, we believe, by some disturbance of the stomach itself. The brain also shows signs of participating in this complaint, as there is almost always an unusual inclination to sleep, though frequently disturbed by some internal irritation, perhaps of the bowels themselves. This disposition to sleep is so well known to nurses, that they will frequently tell you, " the child is sleeping for a sore mouth." The bowels are often teased by watery, acrid stools, of a greenish colour; their discharge is frequently attended with the eruption of much wind, and to judge from the noise, it would be supposed there was a very large discharge of faeces, when, upon examination it is found to be vox et praeterea nihil. 
985. The alvine discharges are frequently so acrid, as to excoriate the verge of the anus and nates very severely, especially when due attention is not paid to cleanliness, or to the frequent changing of the diapers. The stomach is also much deranged sometimes; vomiting the milk, as soon almost as it is received into the stomach, in the form of a dense curd, mixed with mucus, and a porraceous substance. If the milk be not voided by vomiting, the stomach constantly discharges, by eructations, a gas with a very sour smell. The child, when the disease is severe, soon becomes debilitated, and rapidly emaciates; it is almost constantly harassed by severe colics, and profuse diarrhoea; its stomach will scarcely retain the little it can swallow; and the oesophagus sometimes becomes so loaded with aphthae, that it can no longer transmit the small quantity which is reluctantly admitted into the mouth; and the child dies, either from the exhaustion consequent upon the profuseness of the discharges from its bowels, or from inanition. 
986. It is a popular belief, that this aphthous efflorescence passes from the mouth through the whole tract of the alimentary canal, to the very termination of the rectum; and the excoriation at this part is offered as evidence of the fact. Whether this be true or not we do not know, for we are not in possession of any facts from dissection which decide the point. We once examin- 


286 
OP APHTHiE. 
ed a body which certainly died from aphthae; the examination of which would by no means tend to confirm this common belief. A child, on the tenth day after birth, was observed to have a number of white spots upon several different portions of its mouth, which rapidly spread over its whole surface. It had the usual premonitory and accompanying symptoms, which increased daily in severity, in spite of every effort to oppose them. It was a feeble weakly child, of a consumptive feeble mother. Its sufferings were very great, though under some control from laudanum, so long as it could be taken by the mouth, or retained by injections —coat after coat of aphthae were thrown off, and each new crop appeared to be more abundant, and less amenable to remedies, until at last, at the end of two weeks of severe suffering, the poor infant could not swallow a drop of the thinnest fluid. Injections of bark and mutton tea, in conformity with popular opinion, were resorted to, but all in vain; the child in a few days more died from absolute starvation, or at least the catastrophe was certainly hurried by the impossibility of receiving nourishment. 
987. We examined the body after death—we found the whole tract of the oesophagus literally blocked up with an aphthous incrustation, to the sphincter of the cardia, and there it suddenly stopped. The inner coat of the stomach bore some marks of inflammation, as did several portions of the intestines; but not a trace of aphthae could be discovered below the place just mentioned. This case would, therefore, create a doubt, whether this affection besieges any other parts of the body than those just stated; namely, the mouth, posterior fauces, and the oesophagus to the sphincter of the cardia, since perhaps none could have been of greater severity; but it is with us a solitary case, and should not be received for too much. Dr. Heberden says, "the aphthae are supposed not only to infest the mouth and fauces, but to be continued down through the whole intestinal canal. In two who died of a lingering fever, and whose mouths were covered with aphthae which hung in rags all over it, there was not the least trace of them that could be found in dissection beyond the fauces."* The excoriations about the anus can certainly be accounted for, without the presence of aphthae to produce them; the stools are always in bad cases, extremely acrid, and the parts 
* Commentaries, p. 31, 


287 
op aphtha;. 
over which they constantly pass and spread, are, at such a tender age, very delicate, and very readily excited to inflammation. 
988. Dr. Good seems to admit without hesitation the trans mission of aphthae through the intestinal canal,for he says without reserve, f < the fauces become next affected, and it descends thence through the oesophagus into the stomach, and travels in a continuous line through the entire course of the intestines to the rectum, the faeces being often loaded with aphthous sloughs."* 
989. We are afraid there is too much taken for granted in this account; we know of no decided evidence of the fact, nor does Dr. Good name any authority for the statement. The case alluded to was certainly one of death from-aphthae; but in it, the aphthous efflorescence stopped at the cardia. Is it probable that any child could survive this affection, did it travel the whole course of the intestinal canal? we think not—yet aphthae is rarely a dangerous disease in infancy. Dr. Good's description of this affection would certainly lead to the conclusion, that it is the ordinary march of the disease to pass through the bowels, and manifest itself at the verge of the anus. 
990. Now, this cannot be so; since, it is in violent, and longprotracted cases alone, that the anus discovers any signs of irritation from this cause, which should not be the case, wereDr. Good's account correct. 
991. Dr. Good and others, suppose that aphthae communicates itself by a specific contagion; and give as evidence, the excoriations of the nurse's nipples. We do not hesitate to believe, there is a discharge from these little pustules which may be highly acrimonious to a denuded skin, but we think this is perfectly innoxious to a sound one. For we have never seen sore nipples produced by aphthae, where the skin of these organs was perfectly sound. That they aggravate the tenderness and inflammation when these parts are tender and abraded we admit, and so would any other acrid substance, without having recourse to the belief of a specific contagion. If this were the case, why do not the lips of children labouring under this affection, betray its influence? 
992. Thatthiscomplaint isoccasionallyepidemic, there isevery reason to believe; and this circumstance among some others to 
* Study of Medicine, Vol. II. p. 391. 


288 
0¥ APHTHJS. 
be mentioned, renders the opinion so commonly credited, (of its being a sympathetic affection,) very questionable. We have always considered aphthae as arising from some peculiar condition of the stomach; but from some late cases, and more mature reflection, we think it may be otherwise. Our reasons for doubt arc, 
993. 1. We have recently seen this affection in two cases, where the stomach and bowels were in the most perfect order before the eruption; but they became disturbed a little during the progress of the disease. 
994. 2. That this complaint has been very often removed by topical applications alone, where the efflorescence has been very considerable, and where there was no remedy of any kind addressed to the stomach and bowels. 
995. 3. That we do not uniformly see this complaint, where there has existed great disorder of both stomach and bowels, and these of a permanent kind. 
996. 4. That however the stomach and bowels may be disturb ed by acidity or other inconvenience; or however long these may continue, if the child has had this complaint, it is not renewed, though the individual is not exempt from a second attack, as in measles or small-pox; for in certain chronic affections they may be again visited by aphthae. 
997. 5. That this affection is sometimes epidemic, as stated above; for Dr. Good informs us, that f* not only all the children of the same family; however cautiously separated from one another, but many of those of the same neighbourhood, have been known at times to suffer from it simultaneously." (Vol. II. p. 391.) 
998. 6. That this disease is almost always ushered in by some cerebral affection; as great drowsiness, or watchfulness—the first is by far the most common. 
999. 7. That other portions of mucous membranes are liable to the same kind of eruption, without the condition of stomach or bowels being instrumental in its production; for we have seen it most plentiful, within the labia pudendi, as well as on the internal face of the prepuce. 
1000. These facts have made us lately question the sympa thetic origin of aphthae; yet we admit, they are not altogether conclusive in our own mind; but we thought it proper to sug- 


289 
OF APHTHjE. 
gest the possibility of its being a disease of the mucous membrane, and that of an idiopathic kind. 
1001. This symptomatic affection is not confined to early infancy; it shows itself in the more advanced periods of childhood; and from that, to any period of human life—it is sure to attend the last stages of almost every long-protracted chronic disease, especially those which may have wasting discharges; such as phthisis pulmonalis, dysentery, or diarrhoea; and when it does appear, it is almost sure to be a fatal harbinger. 
1002. This disease is rarely if ever accompanied with fever when it is an acute disease; and if it accompany any chronic affection which is attended with fever, it cannot be supposed to have either created, or heightened, the existing one. 
1003. Weakly children, and especially those born before their full period, are more obnoxious to this complaint than the robust, and those who have tarried to their full time in the uterus — the children of weakly women, and particularly those who make bad nurses from scarcity of milk, or from its not being of a sufficiently nutritious quality, are more disposed to this affection than the children of hale women, who have plenty of nourishment of good quality. The children fed much upon farinaceous substances, (535, 536,) are especially exposed to the attack of this disease, particularly when their food is sweetened with brown sugar or molasses. 
1004. The treatment of this disease should always be commenced by a regard to the stomach and bowels; there is, we believe, a superabundance of acid, which should be destroyed by the use of absorbents. Should there be no diarrhoea present, we are almost certain of finding whatever evacuations there may be, of a green colour; and when this is the case, small doses of magnesia should be given, until the bowels are purged; and this may be repeated pro re nata—should however the bowels be urged to frequent dejections of a sparing watery kind, and especially if attended with pain or straining, the following formula we have long adopted with entire success. 
R. Magnes. Alb. Ust. gr. xij. Tinct. Thebseic. gtt. iij. Sacch. Alb. q. s. Aq. Font. |j, M. 
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290 
OP APHTHifi. 
Of this a tea-spoonful is to be given every two hours until the bowels are more tranquil. Or if very frequent green stools are evacuated, we may substitute a drachm of prepared chalk for the magnesia; or if there be no fear of the diarrhoea weakening too much, a scruple of the prepared chalk may be added to the twelve grains of the magnesia; by this combination, we ensure the destruction of the acid, and prevent the lax from being too soon checked. We have found very often a great advantage from equal parts of lime water and milk, where green stools continued, but without diarrhoea—a tea-spoonful of this mixture may be given four or fives times a day. 
1005. When the disease has proved obstinate, and the bowels are much irritated by frequent small discharges, and especially if there be any streaks of blood, we have found the most decided advantage from a tea-spoonful of the oil of butter given three or four times a day. The oil of butter is prepared by putting a lump of perfectly sweet butter into a tea-cup, and pouring on it a quantity of boiling water, and agitating it well with a tea-spoon that it may be deprived of its salt—the oil is then skimmed off as it is wanted; should it not be sufficiently fluid, pour off the cold water each time, and add fresh warm water. 
1006. During the continuance of this complaint, the child, when practicable, should be confined to its mother's milk; and the mother should at this time avoid such diet as would become ascescenton the stomach—most of the common vegetables should be avoided, though she may indulge freely in boiled rice with her meats at dinner—she should abstain from all kinds of liquors, especially the fermented. She may drink freely of rice water, toast water, or milk and water. 
1007. We have constantly found in this complaint, that local applications, when properly managed, are of the utmost consequence; we therefore direct their immediate use.* The best 
* Dr. Underwood differs with us upon this head, though we have no hesitation to say, that general experience is much in our favour. He says, "in regard to applications to the part, it is necessary to observe, as they have little to do in curing of the complaint, it will be improper to have recourse to them very early." Vet a little further on he confesses that he has " met with an instance of a very copious thrush disappearing after cleaning the mouth with borax and honey, at noon ant] night, on the fourth day of the disease." 


291 
OP APHTHJE. 
we have ever tried, is, certainly equal parts of borax, (borat of soda,) and loaf sugar, rubbed together until very fine; a small quantity of this in its dry form is to be thrown into the mouth, and repeated every two or three hours. This mixture is quickly dissolved by the saliva of the child, and is soon carried over the whole of the mouth. We should be very positive in forbidding the mouth of the child to be rubbed with any thing whatever, under the pretence of cleansing it. The cruel and mischievous practice of scouring the mouth with a piece of flannel, cannot be too strongly reprobated. We have seen a poor little creature in agony, after it had undergone this rude discipline from the heavy hand of an unmerciful nurse; nay, we have seen it bleed, even freely, from the barbarous treatment it received under the specious pretence of doing it good. We are persuaded, from many years' experience, that the mouth requires no other washing or cleansing, than what may be procured from the application of the borax, and the frequent draughts of the mother's milk. 
1008. We do not however continue the borax, should the efflorescence become discoloured; we then generally employ the Armenian bole in fine powder with loaf sugar, and use it as we have directed for the borax; but should this fail to give pretty speedy relief, and particularly if the mouth be very red, livid, or ulcerated, we then have recourse to a weak decoction of the bark. We order half an ounce of powdered bark to be stewed in half a pint of water for twenty or five-and-twenty minutes over a slow fire, and then permit it to settle; about the third of a tea-spoonful of this is put into the child's mouth, every hour or two—as it is not agreeable to the child, it will not be much disposed to swallow it, by which means it will be diffused over the whole mouth—we have often seen this attended with most marked advantage. 
1009. During the continuance of this complaint, the most scrupulous attention should be paid to cleanliness—the child's nates should be washed with flaxseed tea after every evacuation; and the excoriated parts should be constantly defended by a coat of fine hog's lard; or the best quality of soft pomatum. The same diaper should not be used twice without washing. 


292 
OF COLIC. 
CHAPTER VIII. 
OF COLIC. 
1010. Owing to improper feeding, or the peculiar quality of the mother's milk, or perhaps in some instances to the particular constitution of the child, it becomes liable to severe attacks of pain in the bowels, which continue for several hours, with great suffering to the poor infant. These colics are of two kinds—1st, where they attack the child at any time of day, without evident cause; and 2d, where they observe a periodical movement. 
1011. In the first, the child may be seized at any time of the day, without our being able to trace the cause to any evident source. This kind generally attacks children of feeble constitutions, and though the mother may have plenty of milk, and the child may suck it very freely, yet it does not thrive; or it may attack children situated the very reverse of the one just described—here the child has not sufficient nourishment from the mother, or it is of bad quality: to supply the first defect, the stomach is overloaded with crude or improper diet, which not only fails to afford it a healthy nourishment, but quickly turns acid, to the decided injury of the child. Perhaps diarrhoea, with green stools, is produced; or it may not have too many evacuations, but they are evidently the remains of ill-digested food. When pain arises from the use of improper food, the child almost always becomes uneasy as soon as it swallows it; and if it arise from ill-elaborated milk, it complains so soon as it is done sucking. Its little abdomen becomes swoln and tense, and it writhes its body as if in the utmost agony. It sometimes becomes suddenly relieved, by eructating a considerable quantity of wind; or it passes downwards, carrying with it a very small portion of faeces. 
1012. It is obvious, that we must change the diet of the child, or alter the mother's milk, if we expect to relieve this complaint. We have already said enough on the subject of diet for young children, and need not repeat it here. When we are satisfied it is from the quality of the food that this complaint proceeds, it 


293 
OF COLIC. 
would always be advisable, if it were always practicable, to confine the child altogether to the milk of the mother; to destroy acidity by small doses of magnesia, especially if there be costiveness, as is sometimes the case. A small tea-spoonful of warm sweet oil, three or four times a day, is a remedy very often of great value. Should it depend upon the mother's milk, an attempt should be made to alter its quality, by an almost total change of diet. If all this does not succeed, we are obliged to have recourse to temporary remedies, rather than witness hourly the sufferings of the afflicted infant. This complaint most frequently commences in the month, but when it may cease it would be difficult to say. 
1013. We have sometimes been so fortunate as to succeed completely in curing this complaint, by the plan just suggested; but it requires the strictest attention to attain success, and this continued for some time most perseveringly. Care should be taken that the child do not remain wet for a long time after its evacuations, from an unfounded opinion, that it makes them hardy to use them to cold. By this management, the feet and legs become chilled, and the bowels are made to suffer in consequence, a double portion of torture. During, however, the trial of changing the food, we must temporise, and administer immediate relief to the sufferer: for this purpose, we have been in the habit of employing the following mixture, with the most decided advantage, it rarely failing to give instant relief, and sometimes effecting an entire cure:— 
R. r Magnes. Alb. Ust. 9j. Tinct. Foetid. gut. Ix. Theb. gut. xx. Aq. Font. |j. M. 
Of this, twenty drops are to be given when the child is in pain, and if not relieved in half an hour, ten drops more are to be administered. This dose is calculated for a child from two weeks to a month old. If it be older, a few more drops must be given; and as the child advances in age, or becomes accustomed to its use, the proportions of the ingredients must be a little increased. We must however caution against too rapid an increase of dose, as this is by no means necessary, and is wantonly subjecting the 


294 
OP COLIC. 
child to the use of a medicine, which should only be given when pain demands its exhibition. 
1014. The other form under which we are to consider this complaint, is, where it becomes distinctly periodical. It very often, however, commences with the erratic form, and after continuing in this uncertain state, settles down to a period, which is generally from four to six o'clock in the afternoon. Generally speaking, this form does not appear to be so injurious to the health of the child as the other—indeed it seems that the child even thrives with it, so that one might almost say, it is "cry and be fat." Certain it is, that some of the fattest and healthiest looking children are troubled with it. We have never found the diet of either the mother or child to have much effect upon this form of the complaint—and in this it differs materially from the first. It would seem to depend upon some constitutional peculiarity, over which we have but a temporary control; as it very frequently will stop of itself, so soon as the child reaches the age of three months—hence the old women say, the child has "the three months' belly-ache." 
1015. The child who is subject to this complaint, is usually habitually costive; but we have never we think, derived any advantage from the exhibition of purgative medicines; indeed, we think this in general to be a bad plan. When the constipation is more than usually protracted, we order a little opening medicine of a mild kind, such as sweet oil, or the castor oil, syrup of rhubarb, or manna in its food, as sweetening, when the child feeds; or we direct an injection of molasses and water, or the introduction of a suppository of soap. 
1016. For the immediate relief of the babe, we give it the mixture as just prescribed; only observing, it should be administered the instant the paroxysm is about to commence. Considering this as a true periodical disease, we have given a decoction of the bark for it, with the happiest effect, in several instances; but it has not always succeeded. This complaint should excite but very little apprehension, as we believe it is never dangerous, and is almost sure to wear itself out after a certain period. 
1017. We will relate a curious instance of the influence of an aching tooth upon the secretion of milk, and its indirect agency 


OF COLIC. 
295 
in producing the " belly-ache" of the first form. Mrs. was delivered of a fine, healthy looking boy, which appeared to do perfectly well for the first two weeks after birth. At this time it became uneasy, and frequently cried—the usual domestic remedies were from time to time employed for its relief, withou t the smallest benefit. The complaint seemed to increase every day; the pain became more severe, and longer continued; the stomach and bowels were affected, the one with sour vomitings, the other by frequently discharging green stools. The child could obtain no relief but from laudanum, and this we were obliged to give in large and constantly increasing doses; the emaciation was so great, as to render the child lighter at three months old, than when first born. In this situation did things continue, without much aggravation or amendment, until the child was five months old. By this time it was, (without a figure,) nothing but skin and bones. 
1018. At one of our visits we observed the mother apply her hand very suddenly to her face, and press it forcibly, as if in pain from a tooth—we inquired of her what she ailed; she informed us, she was very much tormented, both by day and by night, with toothach, and had been for some time before the child was born, and ever since. We immediately declared our opinion, that this was the cause of the affliction of her child— the constant pain she was enduring, and the great loss of sleep, so affected her stomach, and indirectly the breasts, that they could not yield a healthy nourishment We advised her to send immediately for a dentist, and have the tooth extracted—this was accordingly done; and from that day the child began to recover, and in a short time was perfectly restored to health. 
CHAPTER IX. 
OF OPHTHALMIA. 
1019. From about the fourth to the seventh or eighth day, or longer, after delivery, we sometimes find the eyes of the child beginning to inflame; they are first observed to glue up in the 


296 
OP OPHTHALMIA. 
morning, and quickly after the whole of the lids become swelled, and especially in the early part of the day, or until the eyelids have become unclosed, and given issue to some purulent matter. The eyes themselves are soon found to partake of the inflammation of the lids, and have a peculiarly fiery appearance; the child now keeps its eyes entirely closed, or closes them at the approach of even a weak light. After a plentiful secretion of pus has taken place, which generally happens after the third or fourth day, the lids during the night become pretty firmly attached to each other, in consequence of the discharge from them becoming inspissated, and thus gluing them firmly together; this permits a considerable accumulation of pus behind them, which distends the upper eyelids especially, very considerably, and swells them sometimes even with the socket. Upon moistening the eyes with warm water, the lids are enabled to separate, which permits a considerable quantity of pus to discharge itself—the eyes now seem to swim in pus, and the dark parts of them can no longer be seen. The whole of the internal linings of the eyes, which become exposed upon separating the lids, is of a bright scarlet red, manifesting an intense degree of inflammation, which, if not interrupted by very active remedies, runs on to disorganization, and total blindness. 
1020. The remote cause of this complaint, is some foreign matter they acquire in transitu-—this may be the matter of gonorrhoea, or leucorrhoea. 
1021. This disease may therefore with much propriety be called " the purulent ophthalmia." It would seem, that it could only arise, at the age at which it appears, from some foreign matter, as of leucorrhoea, or gonorrhoea. We are firmly persuaded, that one or other of these matters, is the cause of the affection under consideration; and for the following reasons:— 
1022. 1. Because it always makes its appearance within ten or twelve days after birth—a period in which such a cause might be supposed to act. 
1023. 2. Because in every instance in which we have met with this affection, we learnt upon inquiry, that the mother was subject to leucorrhoea; and in some few instances, in loose characters, to gonorrhoea. 
1024. 3. The suddenness, extent, and severity of the inflam- 


297 
OP OPHTHALMIA. 
mation, together with the profuseness of the suppuration, would seem to denote the application of some violent irritant to this tender and susceptible organ. 
1025. On this account, at the first washing, we direct the nurse, when we know or suspect this condition of the mother, to be very particular in applying plenty of water to the eyes. We have taught this doctrine of the remote causes of purulent ophthalmia, nearly thirty years; and have recommended the plan of freely washing the eyes, for the same period; and we have reason to believe, we have in some instances prevented it altogether, and in others have rendered it much lighter. In one case, where we knew gonorrhoea to be present in a violent degree, we prevented this affection almost altogether, by very carefully having the eyes washed with warm water for fifteen or twenty minutes, and pouring it upon the eyes in a full stream. The eyes suffered however a little; a slight inflammation supervened, but was relieved in two or three days by the mucilage of sassafras alone. We are of opinion however, that the inconvenience the eyes suffered, may be pretty justly attributed to the discipline they underwent in washing. 
1026. The mode of treatment is perhaps precisely the same in both instances—or, at least, we know nothing that more certainly controls the inflammation of gonorrhoea than that of leucorrhoea, unless in desperate cases of the former, we might apply some mercurial preparation—for instance, three or four grains of calomelsuspended in an ounce of gum Arabic solution, and applied three or four times a day, in addition to the remedies we shall presently mention. But this is altogether hypothetical, and we beg it may only be received as a suggestion. 
1027. Nothing can be more unsatisfactory, than Dr. Underwood's description of ophthalmia purulenta, nor any thing more vague than his plan of cure, if it even deserve that name. Instead of ordering his remedies to the different stages of the complaint; and pointing out the time, and the signs by which that time may be known, at which it would be proper to change them, he confounds under one general direction, opposite and incompatible remedies. 
1028. After vaguely describing the disease as just stated, he recommends in one breath, purging, leeching, and blistering, to 
[39] 


298 
OP OPHTHALMIA. 
the back, neck, and behind the ears; the last to be renewed every three or four days. ' 1 The edges of the eyelids should be greased throughout the day; at night, a lead-water poultice; but if the eye be affected by the weight of the poultice, it must be removed, for rags dipped in cold brandy and water, or some other more astringent lotion." He then adds, 
1029. " Throughout the complaint, astringent and stimulating applications are to be made use of, unless the complaint be very slight, or sensibly gives way very soon to mere greasing the lids, as it sometimes will." And then gravely declares; that " should emollient poultices, and merely cooling collyria be depended upon, the event were likely to be fatal." 
1030. I would ask any inexperienced practitioner, if he could possibly set to work to cure this formidable inflammation, by the direction just given? At one moment, the eyes are to have blood extracted from them; then he is immediately to employ astringent and stimulating remedies; " for if you depend," says the Dr. <e upon merely cooling collyria and emollient poultices, the event may be fatal." Yet with all this apprehension, he directs, just before, that the eyelids may be greased at night, which will very often cure the disease alone. We are of opinion, that no greater error can well be committed, than the too early use of astringent or stimulating collyria. We are fully persuaded, we have seen several eyes destroyed, by their ill-timed use. 
1031. Mr. Burns also recommends, in the beginning of this disease, "some astringent solution;" than which, we feel it our duty to say, there cannot well be a more hurtful application. We have been called in consultation several times, where the plan of Dr. Underwood and Mr. Burns had been employed; and from the state of the eyes when we first saw them, we are altogether convinced, that the stimulating or astringent collyrium had done irreparable mischief. We are therefore persuaded, they never can be successfully employed, but after considerable abatement of the inflammation. Even blisters used too early, we are sure are mischievous, though highly important in the progress of the cure. 
1032. This case must be actively pursued by remedies, if any good is to be derived from them; there is no time to temporise; the most vigilant attention must be paid to the eyes, or they 


299 
OF OPHTHALMIA. 
quickly perish. We should commence our plan by leeching— about three common-sized ones should be applied to each eye, (if both be affected;) the bleeding from the leeches should be encouraged for some time by the application of a soft bread and milk poultice, confined between the folds of a fine piece of linen rag. After the weeping from the leech wounds ceases, the eyes should be exposed to the air in a very dark room, and should be kept cool by a very weak solution of the acetate of lead in rose water, in the proportion of two grains of the former to an ounce of the latter. This is best employed by washing the surface of the eyes frequently, with a fine piece of linen rag, wet with the solution. The eyes should not be bandaged up, as the heat does much mischief. Should the eyes betray a disposition to glue up, notwithstanding the frequent moistening, care should be taken to prevent it, by washing them carefully with the mucilage of the pith of sassafras, every hour or two. We should keep the bowels freely opened, or rather purged; and for this purpose, we have found the following answer extremely well:— 
R. Calom. ppt. gr. iv. Magnes. Alb. Ust. gr. viij. M. div. in viij. 
One of these powders to be given morning and evening, mixed in a drop of any common syrup. Should this quantity not purge sufficiently, let another powder be given—should it operate too freely, give less. 
1033. If the inflammation be not abated by these means in the course of forty-eight hours, the leeching should be repeated, and the other treatment recommended strictly followed. So soon as the violence of the inflammation is overcome, we should apply a blister to each temple, which should be encouraged to discharge, by dressing with basilicon or weak savin ointment. Dr. James* says, that "blisters have occasionally been applied over the closed eyelids, with the best effect." We can say nothing of this from our own practice, but it can be safely relied upon, coming from such authority. 
1034. After the disease is so much weakened as to permit the child to open its eyes in a dark room, we may safely begin to 
* Burns's Midwifery, Vol. II. p. 32. Note. 


300 
OF OPHTHALMIA. 
use some weak, mild collyrium with advantage; the best that has presented itself to us, is a very weak solution of the acetate of zinc, as follows:— 
R. Acetas. Zinci. gr. ij. Aq. Rosar. ft. sol. 
The eyes to be washed with this four or five times a day. 1035. It is found to be very useful to wash the matter from the eyes by injecting warm water between the lids, three or four times a day, by means of a small syringe. The mother's milk is also thought to be very useful in preventing the lids from sticking together, by being frequently milked upon them. 
1036. The child is sometimes afflicted with pain in the bowels, which occasions it to cry very much; this should be prevented by giving it a little mild anodyne of almost any kind, half a drop to a drop of laudanum in a little sweetened water; or a little of Dalby's carminative from time to time, will be found a very good substitute for the laudanum, or the mixture prescribed above (1013) which will not produce constipation. 
CHAPTER X. 
OF ULCERATION OF THE MOUTH. 
1037. Children are frequently troubled with ulcerations of the mouth; it oftentimes confines its attack to the inferior portion of the fraenum of the tongue. It usually commences by a small inflamed point, and pretty rapidly extends itself along the inferior margins of the tongue, or rather the loose cellular portions of the skin to which the tongue is united—it seldom attacks the tongue itself, and for the most part confines its ravages to the gums, but especially to the cheeks, and the fraenum and its dependencies, where it most commonly commences. The edges of the sores are generally pretty high, and much inflamed, and the ulceration deep in proportion to its surface. 
1038. The child is first noticed to slaver very much, and to become fretful and uneasy, especially when it is about to take 


301 
OF ULCERATION OF THE MOUTH. 
the nipple, which it frequently seizes, and then lets it go with a whining cry as if in pain. Fever almost always is present at the beginning of the complaint, but pretty soon subsides after the ulceration has taken place, and the drivelling has become pretty considerable. The bowels are almost always confined, and the palms of the hands unusually warm. 
1039. The complaint is generally of pretty easy management if it be attended to at a proper time, or before the ulceration is extensive. Before we use any topical application for this complaint, and particularly if the febrile state be not passed, we should purge the child freely by magnesia, or small doses of calomel, and this plan should be continued until the system be free from fever. After the bowels are well emptied, or there is no longer fever, we may use topical applications with great profit. The following has so far never failed us:— 
R. Sulph. Cupri. gr. x. Piilv. C. Peruv. opt. 3ij« G. Arab. aa. 3> Mel. Commun. 3y- Aq. Font. m. et. f. sol. 
The ulcerations are to be touched with this mixture and solution twice a day, with the point of a camel's hair pencil. This has always speedily put a stop to the disease. 
1040. There is another ulceration of the mouth, and especially the gums, which takes place in children who are cutting their teeth, and particularly the back teeth, when a number are about to make their appearance together: this is a very different state of the mouth from the one just noticed. In this complaint the gums become swoln, very dark coloured, and spongy; they bleed from the slightest force; the child drivels constantly; the breath is extremely offensive; and there is always more or less difficulty in swallowing. The teeth that are cut at the time, soon decay; and those which were through before the ulceration commenced, become injured. We have rarely found any other treatment necessary, than cutting the gums, and having the mouth frequently washed with a pretty strong decoction of bark. 
1041. Dr. Underwood calls this affection of the mouth aphtha gangrenosa, and has given a very good general description of it; but why it should be classed with aphtha, we are at a loss to un- 


302 
OF ULCERATION OF THE MOUTH. 
derstand. For the aphthous appearance spoken of by Dr. Underwood we have never witnessed—that is, we have never seen real aphthae attend this complaint. We have frequently observed the little dark coloured sores he speaks of, but they do not bear the slightest analogy to aphthae. It is a disease of the gums, arising from cutting the last of the first set of teeth—it therefore never attacks after this process is completed; or at least not until the teeth of second dentition are about to appear. The gums first swell violently, and become of a very dark red; they are so extremely tender, as to make the child refuse its food, or sometimes even the mildest drinks. After the inflammation has continued several days, the parts of the gums immediately over the teeth about to be protruded, give way by ulceration to a greater or less extent. Other portions of the gums will now be subject to the same process, so that nearly the whole mouth will be in a state of ulceration. 
1042. This disease Dr. Underwood says is never dangerous; we have never seen a fatal termination of it ourselves; though we have seen it protracted to a great length, especially with children who have had bad teeth. 
CHAPTER XL 
INFLAMMATION AND SWELLING OF THE BREASTS* OF NEW-BORN CHILDREN. 
1043. It every now and then happens, that children newly born are found to have their breasts swoln, and evidently inflamed. This exists in various degrees, from a slight affection, to one that threatens suppuration. 
1044. There is a vulgar opinion, that these enlargements proceed from an accumulation of milk within these little bodies, and that it must be squeezed or milked out, that they may be cured. This absurd opinion, unfortunately has led to the preposterous, and mischievous practice just alluded to; in consequence of which, the parts have become so irritated, as to occasion much pain, and increase of inflammation. The little tumours have 


INFLAMMATION AND SWELLING, &C. 
303 
been violently pressed, with the view to force out impacted milk; but being disappointed in its not appearing, the pressure is renewed again, and again, and each effort with an increase of force; since, agreeably to them, if the cause be not removed, serious mischief will follow to the parts, and perhaps in females, for ever destroy their usefulness. In thus pursuing a bad theory, by a worse practice, the consequences which they so much dreaded, have absolutely taken place; suppuration has sometimes followed these rude manoeuvres, and has forever destroyed the organization of these most useful parts. 
1045. Or should the inflammation be controlled by the use of suitable remedies, and thus prevented from running on to suppuration, still so much mischief has been done these parts, by rough handling, as to destroy their organization; or so much injure it, that they never can serve the purposes for which they were intended. 
1046. It cannot therefore be too peremptorily forbidden, that these parts should be meddled with; for all that is necessary to their restoration, is a little time; or the application of a piece of linen moistened with a little sweet oil, unless the tumours are unusually large, and the inflammation very considerable. In this case, a bread and milk poultice renewed every three or four hours, will almost be sure to restore them to health, in a few days. 
1047. We have never seen any other treatment necessary, where the parts had not been ill managed by an ignorant and pver officious nurse; but we have in two instances after mismanagement been obliged to leech the parts, and continue poulticing for some time after. It would be difficult to say, how these swellings are formed; especially as they are almost always congenital, or rather connate. 
CHAPTER XII 
• OF DENTITION. 
1048. We have already spoken of this operation, as one of the important acts of the system; therefore shall not repeat here 


304 
OF DENTITION. 
the order of the appearance of the teeth, nor the process by which this important change in the condition of the mouth is effected. We shall now confine ourselves to the morbid phenomena of this process, and the best modes of relieving them when they occur. 
1049. One of the most remarkable circumstances attending teething is the variety of sympathetic affections it gives rise to; so that from the number, and oftentimes the severity of these, this act of the system is one of great suffering, as well as oftentimes one of great danger. 
1050. The calculations of the mortality of children at this period, have always appeared to us to be excessive; some making it, as Dr. Arbuthnot, one in every ten, others, one in every six. That many children die at this time, must be acknowledged; but it should be recollected, that at this period of life, children are subject to many other complaints, to which they often fall sacrifices, beside teething. Yet we are willing to admit, that the act of teething, abstractedly considered, has sometimes severe penalties attached to it; and but too frequently disturbs the system, and calls into action, many latent dispositions to disease, which otherwise might have slumbered, to a more remote period, or have been finally overcome—therefore in most instances, teething is but indirectly concerned in the formidable mortality of children at this age. 
1051. Teething is instrumental sometimes in producing death, by the condition in which the act itself places the system; by exciting fever, or by disturbing the natural functions of the alimentary canal; therefore, when the child is attacked by any acute disease, that disease is almost certain to be aggravated by the previous condition of the system. Hence the mortality of smallpox, measles, hooping cough, &c. at this period. Yet it cannot be truly said that many diseases are necessarily connected with the acquisition of teeth. 
10*52. The same may be said of certain chronic affections, as scrofula, glandular swellings, consumption, rickets, &c. If either have been developed before this period, they are now sure to be aggravated, and the child but too frequently succumbs; or if they have not been, they are but too often called into action. 
1053. The system at the period of teething, is more irritable, as well as more feeble than the after periods of life—hence, when 


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several teeth are pushing their way through the gums at once, it will suffer more than when this process proceeds slower; and if the body at this moment be attacked by fever, or convulsions; or if there be a disposition to either, they may be aggravated if present, or called into action if predisposed, by the condition of the gums. 
1054. But the teething should not be chargeable with these contingencies; since, it is itself altogether a functional process, as much so as the formation of the bones in other parts of the sys tem, or of any other parts belonging to the human body. 
1055. There are two states of the constitution, which may render this period, one of greater suffering, or even of danger, than where neither of these obtain—namely, where there is a decided and marked feebleness; and where there is evidence of a preternatural susceptibility to stimuli, though there may be the appearance of great vigour, and firmness of constitution. Now should these states not be relieved as they may be, by proper physical treatment, the act of teething may create much mischief by its operation upon both the nervous, and sanguiferous systems. 
1056. We have, in the first part of this work, directed the best mode of management for these two different temperaments—the first should enjoy a pure and temperate atmosphere, both at home and abroad; strict attention to cleanliness; proper diet or nourishment, and especially that of a mother, or nurse; well-regulated clothing; so that they shall not suffer too much by the winters" cold; nor be too much oppressed by the summers' heat; and by well-directed exercise. 
1057. The other must have its excess of irritability diminished by withdrawing every thing capable of fostering it; as too uniformly a warm temperature; by the abstraction of all unnecessary stimuli, from within, as that of animal food, spices, and liquors of every kind; by not sleeping too warm at night, or too long indulgence of bed in the morning; by a regular and efficient exercise; especially such as will agreeably occupy the mind, as well as employ all the muscles of the body, &c. (see Chap, on Exercise, p. 219.) 
1058. We are however not to be understood as underrating the dangers attendant upon teething; and though we are not disposed to consider teething in itself a disease, we are nevertheless 
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well aware that it invites such as may not be present, and aggravates those absolutely existing; consequently, must be considered as a period of great moment to the poor child. On this account it is every way important to point out both the extent of the influence of this act, as well as the numerous morbid sympathies to which it may give rise. 
1059. We have already described the order in which the teeth make their appearance, (Book I. Chap. VIII. p. 193,) and pointed out the principal local phenomena which accompany this function; we shall now advert to some of the most common morbid sympathies by which it is attended. These are 1st, eruptions on the skin; especially on the face and scalp; 2d, tormina of the bowels accompanied by a diarrhoea with various coloured stools, as green, very pale yellow, clay-coloured or a peculiar dark brown which leaves a very permanent stain of a black colour upon the diaper; 3d, spasms in various parts of the body, especially when passing from the waking to the sleeping state, or startings when asleep; 4th, an increased or diminished quantity of urine, of various complexions, attended with great pain in making it, and sometimes a discharge resembling pus from the urethra; 5th, partial palsy of the arms or legs; 6th, cough and difficulty of breathing; 7th, convulsions; 8th, fever, &c. We once saw a case where violent croupy symptoms would appear whenever a tooth was about to be cut; and these would cease when the gums were scarified, or the tooth would come through. 
1060. As a general remark it may be observed, that the children of the firmest constitutions, cut their teeth the earliest and the easiest—we must however admit exceptions to this rule. We have lately had under our care a child with a diseased spine, who cut a number of teeth before she was four months old. We have already noticed the departures from this rule, as well as the one which governs the order in which the teeth make their appearance. (See Book I. Chap. VIII. p. 193.) 
1061. We have never distinctly perceived the advantage of very early dentition; for if it be a sign of more vigour of constitution, it nevertheless has from this very cause its penalties— hence the frequency of fever, and other diseases of irritation. 
1062. Much of the difficulty that attends painful dentition, may be removed, as already suggested in various parts of our 


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OF- DENTITION. 
first book, by a proper attention being paid to air, exercise, food, bowels, &c.; for if these be duly regulated, the system will be less disposed to morbid action; though the local symptoms, such as swelling, redness, and inflammation of the gums, be considerable; and if proper care be bestowed upon the mouth, the force of the latter symptoms may be very much abated. 
1063. Indeed this important part of parental and medical duty should never be lost sight of; the mother should carefully inspect the situation of the child's mouth, from time to time; and should she discover a swoln gum, she should immediately have it attended to, and not wait for constitutional symptoms to appear, before she employs proper aid for her child. 
1064. Should she not be familiar with the appearances of the gums under distention and inflammation, she will at least be aware, that this condition is accompanied by slavering, heat of mouth, &c. which should give rise to the suspicion that the eruption of teeth is about to take place, if the age of the child will justify the supposition; or, if it have some teeth, that others are about to appear. 
1065. However truly the slavering of children may denote the cutting of teeth in general, the rule is not infallible. We have seen children drivel largely at three months old, and continue to do so for months, without a single tooth making its appearance. From this circumstance we are led to believe, this sympathetic affection may denote the formation and hardening of the tooth, as well as its being about to pierce the gum: for when the investing membrane of the tooth is put upon the stretch, by the increased size, and hardening of this body, it may possess an unusual degree of irritability, or sensibility, and thus give rise to several of the premonitory symptoms of this operation, before the gums are at all acted upon by its presence—hence, the slavering, the frequent thrusting of the fingers in the mouth, &c. 
1066. We have thought it proper to state this fact, because we have seen it produce much anxiety in parents; especially, if the subject be a first child; and it sometimes leads, at this moment, to the unnecessary expedient of having the gums of the child cut, before the lancet can well reach the crown of the tooth, however deep the incision may be made. We would therefore 


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OF DENTITION. 
wish to spare the poor infant this unprofitable pain, since it is both unnecessary and unavailing; for we have seen the whole of the symptoms for which the operation was performed, continue with as much pertinacity, after this had been done, as before the gums were incised: therefore, this operation should not be had recourse to, without the advice of the physician. 
1067. One of the most important indications to be fulfilled during teething, is to diminish the local irritation arising from the protruding tooth or teeth; and this should be attended to as early as may be, that as few constitutional symptoms may be provoked as possible. 
1068. For this purpose, the gums should be carefully inspected; and the portions of them in which teeth are due, or even supposed to be due, should be well examined, that any change in their colour or size may be detected, in order that the only appropriate remedy may be applied in proper time. We have laid down, (Book I. p. 193.) the order which nature usually pursues in the performance of this process; therefore, a person acquainted with this, will rarely fail to detect the point, from which the irritation proceeds. 
1069. It must however be observed, that as far as our observations extend, the two lower teeth, when they are the first, (as they should be,) that make their appearance, rarely require to be cut; whereas, the upper frequently do, whether they have come at their regular period, or have anticipated the lower ones. 
1070. If upon the examination of the mouth, the gums are found to be swoln and inflamed, the imprisoned tooth or teeth should be set at liberty by cutting through them until the tooth is felt. This operation becomes the more necessary, when the local irritation has not been relieved by the natural means, namely, by a salivation, or slavering, or by a diarrhoea; and especially so, when instead of a copious discharge of saliva, the mouth is found hot, dry, or clammy, and the bowels tardy. Under such circumstances, no time should be lost; the gums should be amply incised, and the child liberally purged, or we may expect some severe constitutional affection to follow; and if the child has been habituated to liberal feeding, and that of animal, or other stimulating food, it must be immediately withheld; and be confined 


OF DENTITION. 
309 
to the breast milk alone, if it be not weaned; and if weaned, it should be allowed nothing but milk, or milk and water sweetened. 
1071. We are persuaded, were proper attention paid to the child at this time, many of the evils arising from dentition would be avoided; but unfortunately, the friendly admonitions of nature are either neglected, or overlooked, by the greater number of parents. The efforts which nature makes at this time, are all calculated to prevent fever, or unnecessary local inflammation; accordingly a great quantity of saliva is poured from the mouth by the irritated salivary glands, that the vessels of the part may be unloaded; the appetite of the child is diminished, that less food may be taken; and the general system is reduced by a copious spontaneous diarrhoea. Thus nature declares, in plain, but emphatic language, what she requires to aid her; nor ought she |p speak in vain. 
1072. To co-operate, then, with this beneficial intention; let the child be put upon a mild and moderate diet, as just directed; and on no account be permitted, either to eat or drink any thing which has a tendency to stimulate the system. Let its bowels be carefully watched, that they may not become confined; or if they be so, let this condition be removed, by an appropriate diet, or by gentle laxatives. • 
1073. We have found a liberal use of molasses, when there was a tendency to constipation, of great service ; this may be employed in several ways, as may best suit the particular habits of the child. If it is confined to the breast altogether, it will nevertheless drink freely of this substance when mixed with water. If it feed in part, its milk or its milk and water may be sweetened with it; or if weaned, it may eat it on bread, or take it in any other practicable manner. 
1074. Should the molasses not be sufficiently aperient, half an ounce of flake manna may be given in any victuals which may require sweetening; and should this prove insufficient, a like quantity may be given in a few hours more. But should the symptoms of irritation not be relieved by this plan, a little calomel may become necessary. 
1075. But it must be evident, that little relief can be afforded by any general applications, so long as the membranous expan- 


310 
OF DENTITION. 
sion over the tooth remains entire—therefore, nothing but a free incision to the crown of the tooth can relieve the little sufferer. And it is often not less wonderful than delightful, to witness the complete relief it affords. We have often observed excessive fever, and a threatening irritation, subside almost instantaneously, after cutting the gums. 
1076. Notwithstanding the decided advantages resulting from cutting the gums, many are prejudiced against it; and will not, but with great reluctance, permit their children to undergo the operation, though they can cite no instance in which it has been attended with any mischievous consequence. The objections to cutting the gums, are, 1. That it is painful. Every body who has performed this operation with a proper instrument, and that in proper order, knows the contrary of this. In the first place, the gum is not at any time a part of exquisite sensibility; and secondly, the speed with which the instrument passes through, and the decided relief it almost invariably affords, at once prevents any complaint on the part of the patient. This however may be considered but negative proof; if so, we have sometimes the most positive evidence that the operation cannot be painful, in the children themselves asking for it to be performed. Our own children have repeatedly solicited this kind office at our hands. • 
1077. 2. It is said, it requires much judgment to perform this operation; for if it be done too soon, it will afford no relief, beside making the tooth cut with more difficulty, by its leaving a hard scar. As regards the degree of judgment necessary in this case, we should think it. very limited indeed, if upon inspecting the mouth, the person could not'discover whether the gums were, or were not, altered from their natural condition; if they were, it is at once evident that the tooth is producing irritation or inflammation, by its pressure against its coverings, and therefore they should be cut through. And though the tooth cut upon may be yet remote from the surface, still the operation may be of the greatest possible advantage, by dividing the membrane, now severely put upon the stretch, and from which the whole irritation proceeds. When this membrane has been once divided, it never unites again; and though the crown of the tooth may not show itself for a long time, yet the irritation ceases, and the 


OF DENTITION. 
311 
disturbance of the system is quieted, from the moment the gum is divided. 
107S. It is true, the gum will heal if the tooth be not very near —but this is of no consequence; as its healing offers no increase of difficulty to the passing tooth. Every body knows that the second teeth are always more easily cut than the first; yet these teeth have to pass through denser cicatrices than the first; as by the drawing or falling out of the first teeth, much larger wounds are made in the gums, consequently larger scars are left after their healing. 
1079. And if the gums are not changed, still the operation of cutting may be highly advantageous, and should always be tried in severe cases, as the irritation sometimes begins so soon as the tooth itself begins to swell. We have many times had occasion to prove the truth of this; therefore, the objection to cutting the gums, lest the scars may do mischief, is without foundation. 
1080. 3. Lancing the gums has been objected to, from a fear that cutting on them may do injury to the teeth by producing caries, and thus be injurious to the set below. But this cannot happen: 1. Because, if the lancet does touch the tooth, it can do it no injury, as its hard enamel, which it possesses before the tooth is about to be cut, will entirely protect it against such a consequence. 2. If it really did dispose the tooth, so touched, to become carious, it would do no injury to the teeth which are to succeed them, because they are not in contact with each other. 
1081. The gums of such children as have not been lanced, are more disposed to be ulcerated, than those gums which have been cut. 
1082. It may be well however to remark, that when this operation is to be performed, it should be done with a bold hand and a sharp instrument: for if the tooth producing the irritation be not cut down to, so as to be distinctly felt by the lancet, the operation will be of little avail. The mere bleeding of the gum answers little or no purpose; and failing in the intention for which it was proposed, only brings the operation into discredit, besides prolonging the sufferings of the little patient. 
1083. When the double teeth are about to be cut, they frequently show themselves, by one point piercing the gum —over the other portions of the tooth the gum remains, and is very tender: 


312 
OF DENTITION. 
so much so is this the case sometimes, that the child will refuse every kind of victuals which may require chewing. In such case the gum should be freely cut across, and thus liberate the crown of the tooth. 
1084. When a tooth which has been cut upon is remote from the surface, or the absorption of the gum goes on tardily, it will sometimes swell, and become very tender. When this is perceived, it should again be cut; and this repeatedly, as often as new necessities may arise. 
1085. The best mode of performing this operation, is by having the child held horizontally, with its head resting on the operator's knee—the hands of the child must be secured by the assistant, and the lower jaw depressed and held firmly; while the lancet, is introduced to that part of the mouth where the pained gum is; the edge of the instrument is then made to traverse the tooth, by an incision sufficiently deep to reach the tooth, which must be so distinctly felt by the operator, as to satisfy him that nothing is left interposing between his lancet and the tooth. If the operation be properly performed, it gives no pain to the child—on the contrary, we have known them to cease crying, the instant the instrument penetrated the gum. 
CHAPTER XIII. 
OF THE DISEASES ARISING FROM DENTITION. 
1086. Though we have perfectly agreed with Drs. Cullen, Struve, and others, that teething in itself is no disease, yet we are aware that many affections of childhood are dependent upon this operation, either for their existence, or augmentation. It would be unavailing, as well as injurious to the interests of society, did we attempt to shut our eyes against truths no less important than palpable. We therefore fearlessly entitle certain affections of the body at this period, "diseases of dentition." We shall place the various complaints promiscuously, since they observe no regular order, nor is the same child liable to the 


313 
OP ERUPTIONS. 
whole; though we have occasionally seen two, three, or even more united. As eruptions of various kinds are very frequent, we shall commence our histories with an account of them. 
Sect. I.— Of Eruptions. 
1087. It is notorious to common observation, that a child for the first two years of its life, is especially liable to affections of the skin. It is not our design to notice them all, or to enter into any nosological arrangement of them—we merely intend, in this place, to speak of such as appear evidently to be connected, in some way or other, with dentition. We shall therefore first notice, 
A— The Crusta Lactea, or the Milky Scall. 
1088. Dr. Good* supposes that this disease has acquired its name from the "milky, or rather the creamy appearance and consistency of the discharge." But as we have never witnessed this "creamy appearance'' to justify the name, we should rather suppose it has been given to it, from the circumstance of its generally appearing during lactation. At all events, it is a disease, we believe, exclusively belonging to infancy, t 
1089. This complaint begins sometimes sooner, and at other times later, as the disposition of the system to protrude the teeth, may exist; for we never remember to have seen it before dentition had commenced, nor after it was completed. 
1090. It usually begins upon the cheek, or near the centre of the forehead; it first shows itself by an assemblage of small whitish pustules upon a very red surface; these gradually change to yellow, and brown, which presently break, and form a scab of greater or less density, from which proceeds an ichorous discharge. New pustules soon appear, which after having undergone the change just spoken of, unite as it were with the former, and thus gradually travel to various parts of the body; but the face, scalp, and neck are particularly liable to it. We have seen it cover nearly every part of the cuticular system. When it is even very ge- 
• Study of Medicine, Vol. IV. p. 422. 
f We are well acquainted with a family of five children, who have all in succession had this complaint. It sometimes begins as early as the sixth month, and continues for twelve months, or even longer. We believe no attempt was made to relieve this formidable eruption in these cases. 
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neral over the face, it is a little remarkable, that it never attacks either the nose, or the eyelids. 
1091. There is a considerable variety in the intensity of this disease; it sometimes confines itself to very narrow limits; at others, it will be very extensive. We have seen it occupy the cheeks alone; at other times the forehead; but more frequently both. Sometimes the discharge is very acrid and profuse, leaving the surface of the skin both red and excoriated; at other times, the quantity discharged is small and mild, leaving the surface covered with a brownish dry scab. 
1092. When the scab drops off, and does not re-appear, the cuticle is found tender, red, a little elevated, and marked by fissures —this pellicle exfoliates perhaps several times. It is said, the skin never cracks into deep fissures, as after some other eruptions. 
1093. This complaint is generally considered more troublesome than dangerous; yet we have seen two instances of death, evidently from this disease. In these cases, the itching was unceasing, during the day and night; the children were worn down by want of rest, as well as exhausted from the excess of discharge. The eruption covered the whole body, and continued without amendment for many months, until the children were destroyed by the pertinacity of fever, and the profuseness of diarrhoea. 
1094. Some indeed believe it only dangerous when its progress, or duration, is interfered with; and therefore deprecate every attempt at cure. We are however very far from this opinion, because we believe it to be founded in error. They ask, "why should we meddle with a complaint which is evidently an effort of nature to get clear of a greater evil? Moreover, it is never a dangerous disease; nor does it ever leave unseemly marks; and if attempted to be dried up, will certainly prove injurious, to the child.'' 
1095. We shall take the liberty of making a few remarks upon each of these positions. What evidence is there of this being a critical eruption, any more than convulsions are critical spasms, or that fever is an effort of nature to get clear of some noxious agent? Yet who, without an effort to control convulsions, will see a child expire, because they are produced by teething?—or who will look on, and see it consumed by fever, without attempting to afford relief, because it arises from the irritation of protruding teeth ? 


315 
OF CRUSTA LACTEA. 
1096. As to its never being a dangerous disease, we have just stated that we have seen two instances of death from crustalactea: but suppose it were not dangerous—are we to suffer a poor child to bear with a loathsome and troublesome disease, without any attempt to remove it, because the disease will not perhaps terminate in death? Why should any of the non-fatal diseases of infancy be meddled with; since, they will not kill, however troublesome they may be, or however interminable may be their duration! 
1097. And, because it takes its departure from the body, after a troublesome visitation of many months, and leaves no unseemly scars, the poor infant, is to be left to support its inflictions, and bear with its ravages, the whole of that period, merely because it will not leave its mark behind! 
1098. It is asserted, when an attempt is made to cure this complaint, and we succeed in drying it up, that it has always proved decidedly injurious to the child. 
1099. As this is a broad assertion, and one that is confidently believed in by many, it will be well to examine into its truth, when a cure is attempted under proper circumstances. 
1100. We will first inquire into the nature of the eruption. The skin, like every other organ of the body, has predispositions to disease, peculiar to its structure. These predispositions may however lay dormant for many years or for ever, if the appropriate exciting cause be not applied, to call them into a state of actual disease. Before they are awakened into a palpable form, the system suffers neither inconvenience nor injury from the mere disposition to disease; but so soon as any circumstance shall convert this disposition into morbid action, the part thus acted upon will suffer in a degree proportionate to the extent and nature of this provoked disease. Therefore, in the case under consideration, the cutting of the teeth rouses the latent disposition into action; and the skin is now made to suffer under an active disease. 
1101. This being certain, we must now inquire, is the eruption in question a consequence of a critical effort of the system to relieve some other portion of the body of an existing disease?—or, is it a mere consequence of some specific irritation? If the first part of this question be answered in the affirmative, it must then be shown that it has ever fulfilled the intention for which it was instituted. Can this be shown ? We believe it cannot; for the local 


316 
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irritation in the mouth continues without abatement, however copious this eruption may be; it would therefore appear, it was not intended to remove, or even to diminish the consequences arising from the protrusion of the teeth through the gums, or it fails in the object; therefore it must be contingent, and not critical. 
1102. But it may be said, they are cause and effect, and in this relation they must be considered. Let this be admitted—their connection will then stand thus: there is a disposition in the skin, to crusta lactea, but this disposition requires some exciting cause, to bring it into action; and this exciting cause is the irritation of teething; hence, this disease only appears during infancy, and even rarely then. 
1103. But would it not seem extraordinary, that so loathsome and obstinate a disease as the one in question, should be instituted to relieve one of infinitely a milder grade? If this disease were a constant attendant upon teething, and teething were found to be less severe, and less hazardous, by its appearance, there might be some reason for inviting its presence, or fostering its continuance on the surface of the body; we therefore conclude, that however intimately some affections, at the period of teething, may be connected with this process, the one we are now considering, must not be ranked among the number. 
1104. The next question is, will the child suffer by the destruction of the crusta lactea? We unhesitatingly say, No; provided this be attempted in proper time, and in a proper manner—at least, this is the conclusion to which our own experience would lead us. If children have suffered from attempts to cure this loathsome eruption, the injury was altogether of an artificial kind; and made to arise from employing remedies for suddenly extinguishing the disease, after the system had become habituated to the waste from its surface. In attempts of this kind, we can readily believe, injury might be sustained; but this does not prove the critical nature of the disease in question; it only goes to show, that when a drain of this, or any other kind, is established, it must not be suddenly suppressed. 
1105. We see this well illustrated in ulcers of every kind, which are of long standing; but is there any one who would have hesitated to heal the fresh wounds, from which these sores originated? We think not—yet no one of real experience, would do 


OF CRUSTA LACTEA. 
317 
this after they had become confirmed drains, withoutfirst establishing some compensating change in another part of the body; or so gradually have encroached upon the daily waste, as not to be perceived by the system. This is precisely the case with crusta lactea. 
1106. For these reasons, we do not hesitate to attempt the relief of crusta lactea; especially when we see it early, (that is, when it is confined to the cheeks and forehead of the child,) and that by the most prompt remedies. We direct the diminution of nourishment of every kind, and never permit any in which animal food enters. If the child be still at the breast, we request it to be nursed less frequently; and sometimes, even confine the mother, or nurse, to a strictly milk and vegetable diet. If it be weaned, we forbid every stimulating article,and direct a reduction of its milk; confiningit to thin arrow-root, with very littlemilk,ortotherennetwhey. 
1107. At the same time, we order small doses of sulphur, or sulphur and magnesia, to be given so frequently, and in such quantities, as shall keep the bowels loose, but not severely purged. After persevering in this plan for a week, we almost always find an abatement of redness at the margins of the scabs, and diminution of the itching. 
1108. After having purged the bowels with sulphur, or sulphur and magnesia for a few days, as above directed, we then commence with small doses of calomel; as follows:— 
R. Calom. ppt. gr. x. Creta. ppt. 9j. M. div. in xx par. 
1109. One of these powders is directed to be given every morning and evening in a little molasses or syrup of any kind. Should they prove too purgative, from half a drop to a drop of laudanum is added to each dose. Should they not move the bowels sufficiently, an additional powder is ordered. 
1110. We pursue this plan for at least a fortnight, before we make any local application; and indeed we do not apply them then, unless there is an abatement of the inflammation, and itching as remarked above. But should both these have happened, we commence with the calomel ointment;* but confine its application to some one spot of diseased surface. When this becomes relieved, we select a second, and so on until all are relieved. But let it be 
• R. Calom. ppt. gij. Cerate Simp. ifj. Ess. Lemon, gut. xx. M. 


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OF CRUSTA LACTEA. 
remembered that the calomel powders are continued through the whole course of the disease, and even for some time after, if the disease has been extensive and obstinate. 
1111. When this plan is duly persevered in, it rarely fails to succeed; nor have we ever seen a single instance in which any untoward symptoms have arisen. We have sometimes substituted the citron ointment, reduced one-half, for the calomel ointment when the latter seemed to have lost its effect. When the discharge is considerably diminished, and nothing appears to remain but the dry scabs, we almost always employ the tarointmentinstead of either of those just mentioned—this maybe applied twice a day. 
1112. The citron, as well as the tar ointment, must be had recourse to as above directed, should that of the calomel not prove sufficient. Indeed we believe it would always be best to finish with the tar ointment; as it seems to have a peculiar facility in removing the scabs, and allaying the itching, which last, by the by, is one of the most troublesome attendants upon the disease. 
1113. Where the warm bath can be had recourse to with convenience, it should be used two or three times a week, as it greatly promotes the efficacy of the other remedies; and during the whole period of the attempt at cure, and especially in the beginning, when the discharge is both copious and acrid, the surrounding parts should be washed with a mild solution of fine soap, even three or four times a day. We have thought we have derived advantage where the discharge is free, from rubbing, or smearing the sound skin immediately surrounding the sores, after washing, with a little fresh hog's lard and bees'-wax melted together, to defend these parts against excoriation. 
1114. This complaint is sometimes treacherous; after giving promise of a speedy departure, it will suddenly return, with renewed force. Dr. Strack* has recommended the decoction of the viola tricoler, Lin. or heart's ease as a specific in this disease; but of this we can say nothing from our own experience. It might however in obstinate cases be tried in conjunction with the remedies recommended above. He directs a handful of the fresh plant, or half a drachm of the dried leaves to be boiled in half a pint of cow's milk, and this quantity given morning and evening. He affirms that for the first week, it greatly aggravates the complaint ; but at the same time the urine acquires the odour 
* Batcman's Synopsis, p. 153. 


319 
OP TOOTH RASHES. 
of the urine of cats; and at the end of a fortnight the crusts begin to fall off, and the skin underneath appears clean. But when the usual smell of urine remains, the disease will generally be of long continuance. Prof. Selle however has affirmed that this plant is either noxious or inert. * We have never perceived the smell spoken of by Dr. Strack. It may however be proper toobserve,that in all our endeavours to relieve this complaint as directed above, we have never witnessed any injury to arise from the attempt, t 
B— Tooth Rashes. 
1115. Nothing declares the intimate connection, or play of sympathies between the gums and skin during dentition, than the number of eruptions to which it becomes liable at that period. Authors, (Underwood, Bateman, &c.) have described, and we have seen, five or six different affections of the skin during the cutting of the teeth, all of which appear perfectly harmless, unless improperly treated. But as there are diseases of the system of a dangerous kind, which are accompanied with efflorescences, or pimples, much alarm is excited when any eruptions of analogous appearances show themselves upon the surface. On this account it may be well to give a short account of them. For this purpose we shall employ the descriptions of Dr. Willan, as they appear to us to be perfectly well marked. 
* Bateman's Synopsis, p. 153. 
¦J- We have had lately, (January, 1828,) a very severe and interesting case of the crusta lactea in a child of sixteen months old. It commenced when the child was eight months old in the common way, and spread gradually over the whole face, scalp, neck, body, and limbs. The child was feverish, restless, and almost constantly scratching, both day and night. A variety of remedies were tried before we saw it, without the slightest benefit. We commenced the cure by purges of sulphur and magnesia; confined the child to a diet of vegetable mucilages, as gum Arabic, tapioca, sago, rice jelly, &c. Ordered a warm flaxseed tea bath every other day. After a fortnight's use of the sulphur and magnesia, the calomel as directed above was given, together with a pretty strong infusion of the dulcamara. The sores were washed with the same infusion. After a perseverance in this plan for two months, an evident amendment was perceived in the nature and extent of the eruption. At this time we vaccinated the child; and this disease ran aregular, and satisfactory course. After the vaccine scab dropped off, the sores healed very rapidly, by the use of the tar ointment. In the course of another month, the child was perfectly well, and remains so to this time, (May, 1829.) 


320 
OP TOOTH RASH. 
1. Strophulus Confertus, or Tooth Rash, 
1116. "Is an eruption of numerous papillae, varying in their size, and appears on different parts of the body in infants, during dentition, and has thence been denominated the tooth rash. It is also termed sometimes the rank red gum." 
1117. " About the fourth or fifth month after birth, an eruption of this kind takes place, in most infants, on the cheeks, and sides of the nose, extending sometimes to the forehead and arms, sometimes, though less frequently, to the trunk of the body.** 
1118. This affection differs a little from the red gum, by being less vivid in their appearance, the pimples smaller, and more crowded together. We have repeatedly known this species appear much later than is fixed by Dr. Willan; and their production seems evidently connected with the process of dentition; for when this process is retarded, this appearance is retarded; therefore the time at which they show themselves, may be better fixed, by saying, that when dentition begins, they commence. Every child however is not subject to it. It is rarely attended by constitutional symptoms, consequently requires but little medical care. This complaint is usually of about a fortnight's continuance. 
1119. We however almost always think it best, should there be any disturbance in the bowels, to give a pretty full dose of magnesia; to keep the skin clean and soft by washing with warm water; and to remove any irritating substance from the surface that is covered with the eruption, such as flannel or muslin, and substitute linen. When this is attended to, we think the course of the disease is shortened; for the pimples soon after are observed to fade, and to cast off their little shells, and finally disappear. A decided advantage is obtained we think, by rubbing the part with a little dry flour after washing, when it becomes perfectly dry. 
2. Strophulus Intertinctus, or Red Gum. 
1120. This complaint is confined to early infancy, and especially to " the month," as it is called. Very few children escape this complaint; and most nurses are fond of seeing it—so much so indeed, and so inevitable and useful do they consider its pre- 


OP THE RED GUM. 
321 
sence, that should any indisposition befall the child, and this eruption not have possession of the skin, it is at once attributed to the absence of the gum. With a view then to invite its appearance the child is kept unusually warm, and some stimulating tea is given it, such as of sweet marjoram, saffron, catmint, &c. and after having been thus disciplined for a longer or a shorter period, the poor child is but too frequently loaded with a heavy crop of "Red Gum." 
1121. This eruption however seems connected in someway or other with a derangement of the stomach and bowels. This derangement may proceed; 1st, from the meconium not having been well purged off, or its being of an unusual acrid quality; 2d, it may proceed from an acid state of the stomach, owing to feeding the child with improper food; or to its being made to receive too great a quantity of it; to some ill quality in the mother's milk, or a constitutional feebleness of stomach. Hence, this complaint is commonly ushered in by nausea, vomiting, or diarrhoea; 3d, to the child being kept too warmly clad, or too warmly covered, especially its head, by which means it is obliged to breathe over and over again the same air; and is also thrown into a profuse perspiration. We have elsewhere noticed this injurious practice. (Book I. 126. par. 445.) 
1122. This disease for the most part, is rather provoked, than spontaneous; for children who are kept in a moderate temperature and who are dependent upon the breast for support, rarely have this disease, especially if the bowels have been well purged of the meconium, and the child naturally of a good constitution. 
1123. "The red gum, or gown, occurs chiefly within the first two months after birth, and is characterized by papulae of a vivid red colour, situated most commonly on the cheeks, fore-arms, and backs of the hands, but sometimes universally diffused. They are usually distinct from each other; but are mixed with red dots; or stigmata, and often with larger red patches, which have no elevation. Occasionally a few small vesicles appear on the hands and feet; but these soon desicate without breaking."* 
1124. This disease under ordinary circumstances, requires little or no medical treatment. It is nevertheless proper that 
* Batemau. 
[42] 


322 
OF THE RED GUM. 
due attention be paid to cleanliness, by daily washing with warm water; and also, if errors have been committed in either of the ways mentioned above, they should be immediately rectified. The bowels should be gently opened by small doses of calcined magnesia; and if pain attend, an half, or whole drop of laudanum may be given. The cold bath improperly used, or even a strong current of cold air, may do mischief at this time. And should this eruption be repelled from the skin, alarming symptoms may immediately ensue; such as great oppression and difficulty of breathing, drowsiness, or incessant crying; and spasmodic twitchings. The whole surface of the body is now pale; the pimples have all disappeared; the child becomes blue round the mouth; it refuses the breast; and stretches itself out stiff its whole length, and then becomes suddenly relaxed; cold skin, &c. 
1125. The best remedy under such circumstances is the warm bath, in which the child should be immediately placed, and kept until its skin acquire warmth; it should then be well dried and wrapped up in warm flannel—at the same time some pretty strong sweet marjoram tea should be given, or any other mild stimulant of the kind. Dr. Underwood recommends two or three drops, three or four times a day, of the compound spirit of ammonia, and a blister between the shoulders. We have never seen either of these necessary. 
3. Strophulus Jllbidus, or White Gum. 
1126. "This eruption consists of numerous, minute, hard, whitish specks, a little elevated, and surrounded by very slight redness. These specks, or papulae, when their tops are removed, do not discharge any fluid: they appear chiefly on the face, neck, and breast, and continue a long time." 
1127. This affection rarely requires any medical treatment, unless it has been driven from the surface by a current of cold air, or the application of cold water. It is rarely ever attended with any constitutional irritation, and therefore while it preserves its mild form deserves but little notice. But should mismanagement or any other cause have driven it suddenly from the surface, it may, like the red gum, (strophulus intertinctus, which see,) be productive of inconvenience, or even of danger, and must, when this happens, be treated like that affection when 


323 
OF THE WHITE GUM. 
it has been repelled. It is however proper in the species under consideration, that due attention should be paid to keep the skin free from all impurities, by washing with warm water. 1128. Dr. Willan describes a variety of this complaint which sometimes becomes very troublesome, though never dangerous. He declares it to be both painful and obstinate, yet requires no particular treatment, except that which is proper in all Jh/se affections, namely, cleanliness. We do not remember ever'to have seen this variety as described by both him and Bateman. 
4. Strophulus Volaticus. 
1129. "This variety is characterized by small, circular patches, or clusters, of papulfc; which appear successively on different parts of the body. The number of papulae in each cluster is from three to twelve; both the papulae and their interstices are of a high red colour. These patches continue red, with a little heat and itching, for about four days, when they turn brown, and begin to exfoliate. The eruption is, in many cases, limited to two or three patches, on the arms or cheeks. In some instances however, one patch declines, another appears at a small distance from it, and in this manner the complaint spreads gradually over the face, body, and limbs, not terminating in less than three or four weeks. During this time, the child has usually a quick pulse, and a white tongue, and is uneasy and fretful." 
1130. We have several times seen this complaint; but it has always as far as we can recollect, appeared later than is usually described, or not until the child be about to cut the jaw teeth, or little molares. We have found it occasionally very troublesome; and sometimes to require a treatment similar to crusta lactea, of which in this situation it has been considered by some as a variety. 
1131. As this complaint is usually attended by some derangement of the system, and particularly the bowels, attention should be paid to them. They must be treated agreeably to the state of the system; if fever attend, the diet should be diminished, if it be only milk—no animal food should be permitted in any form. The bowels should be purged with magnesia; and the calomel, and ointments, used as directed for crusta lactea. (1107) Should diarrhoea attend, it must be managed as directed for that complaint. 


324 
OV STROPHULUS C A.NDIDUS. 
5. Strophulus Candidus. 
1132. "In this form of strophulus, the papulae are larger than in the foregoing species. They have no inflammation around their base, and their surface is very smooth and shining, so that they appear to be of a lighter colour than the adjoining cuticle. Thfljf are diffused at a considerable distance from each other, over the loins, shoulders, and upper part of the arms: I have not observed them in any other situation. " 
1133. " This eruption affects infants above a year old, in the latter periods of dentition: it likewise occurs during the state of convalescence after fevers, and inflammation of the bowels and lungs. The papulae continue hard and elevated for about a week, then gradually subside and disappear." • 
1134. This affection requires no medical treatment—the whole attention must be paid to the state of the gums. 
Sore Ears. 
1135. Children during dentition very frequently have slight pustules form behind the ears, which soon become ulcerous: or look oftentimes like a superficial excoriation. This condition of the ears also takes place, before any suspicion of teeth being the cause can be entertained, especially in very lusty children. 
1136. There are few eruptions which attack an infant more decidedly cherished than that producing sore ears; hence, what was but in appearance a very slight excoriation in the beginning, and which might readily have been healed by proper and frequent washing with warm milk and water, or fine soap and water, is permitted to degenerate into a painful, tedious and oftentimes offensive ulcer: as its first appearance was welcomed, so is its continuance perpetuated, by various stimulating things, under the specious pretext of its being an important drain for the noxious humours of the body. 
1137. The sores being thus encouraged, eventually discharge a large quantity of both pus and serum: in a word, they are converted into "issues" which it is declared on all hands it will not do to dry up. This popular prejudice perpetuates an evil, which should never have been permitted to have existed—for a sore, is an evil, be it placed where it may, unless it be distinctly criti- 


325 
OP SORE EARS. 
cal, which we deny this to be. The reasoning we employed when speaking of the crusta lactea, will strictly apply here; and the motives which led us to the use of remedies in that complaint, would influence in this—therefore, we never hesitate a moment to set about this desirable end, nor have we ever witnessed, when properly managed, the slightest inconvenience to follow the practice. Dr. Good says, "the discharge is often peculiarly offensive;'* "it cannot be checked too soon; for if it continue for a few weeks, or perhaps even less, it may acquire a habit, the suppression of which may run the risk of superinducing some worse disease than itself, as dyspepsia, diarrhoea, or convulsions."* 
1138. We always commence with regulating the diet of the child, if this be necessary—that is, if it be in the habit of using animal food in any form, we forbid its farther employment and confine it to vegetables and milk. As rice, arrow-root, or sago, either of which can be taken with milk, or with a little sugar, without the milk. 
1139. The bowels must also be purged with small doses of calomel; that is, a grain or half a grain every morning and evening as the child may be older or younger, or it may affect the bowels. The sores themselves, must be kept perfectly clean by frequent washing with soap and water, or milk and water. During this time it would be well for the child to do without a cap, as it keeps the parts too warm, as well as sticks to the sores when in contact with them. Should the child be in the habit of scratching the parts, mufflers should be put upon its hands. A piece of fine rag spread with simple cerate; that is, a cerate composed of a little bees'-wax and sweet oil melted together; or what is better, fresh hog's lard instead of the sweet oil. When the child is placed for sleep, let it lie as much as possible upon its back, that the sore need not be kept too warm. 
1140. Should the sores be very much inflamed, and very irritable, a soft poultice of bread and milk should be applied, confined in fine linen rags, every four or five hours, until these symptoms are abated. The poulticing should not be continued longer, than to subdue the inflammation; for if it be, it invites a great many little pustular bodies, even on the margin of the sound skin, which 
* Study of Med. Am. Ed. Vol. 2d, p. 211. 


326 
OF SORE EARS. 
break, and increase the sore surface. Therefore, the instant this is observed, the poultice should be laid aside. 
1141. After preparing the body, as well as the parts in this manner, which may occupy a week, or even more, according to the extent of surface involved; the length of time the disease has continued, and the degree of inflammation present, we may commence with the calomel ointment. (1110) This must be smeared upon the external margins of the sores, as well as upon the sound skin itself, twice a day, taking care to wash the parts as before directed, before each application of the ointment, and gradually encroaching upon the sores every day, by a more extensive application of the ointment. This remedy will rarely fail to destroy the further disposition to ulceration, and pretty quickly alter the action of the parts, so as to make them discharge a healthy pus, instead of the ichor and sanies to which they have been so long accustomed. 
1142. When the parts have become healed, but covered with a scab, and especially if this be attended with itching, the tar ointment should be immediately substituted. 
CHAPTER XIV. 
OF TONGUE-TIE. 
1143. So far as we recollect, we have not met with any distinction being made between the accidental fetter which is occasionally imposed upon the fraenum of the tongue, and an original conformation of the fraenum, which renders the tongue too short; but this difference should be carefully noted, as very different consequences may result from mistaking one for the other. We shall therefore notice both these conditions of the fraenum of the tongue. 
1. Of the adventitious tying of the Tongue. 
1144. There is very frequently attached to the fraenum of the tongues of new-born children, a nearly transparent, whitish membrane, which pursues the natural fraenum through its whole 


327 
OP TONGUE-TIE. 
course; continues beyond the point where the fraenum stops, and terminates near the extremity of the tongue itself; so that the tongue is tied down as it were, to its proper bed. 
1145. In consequence of this disposition of the fraenum, the child cannot elevate the tongue, or protrude it, beyond the lips; and in its attempts to suck, it cannot apply it with sufficient force or certainty to the nipple, to make a complete exhaustion; therefore, it can suck but imperfectly; and this is accompanied by a clucking kind of noise. Whenever this is observed, the mouth should be examined, and it will almost always be found in the situation just described, but not necessarily; as there may be clucking without this membrane; but this membrane we believe, is never without the clucking. 
1146. This membrane is easily discovered by provoking the child to cry, or by elevating the point of the tongue by the extremity of the little finger. In making the attempt to raise the tongue, the child is almost sure to cry; and then this membrane is readily discovered, as it is now fully upon the stretch. 
1147. This defect is easily remedied. It should be done in the following manner. Let the child be laid across the lap of the nurse, with its face towards a proper light; the operator must stand behind the head, so that he does not interrupt the light. The chin of the child must be gently depressed by the forefinger of the nurse. When the chin is thus depressed, the little finger of the left hand of the operator, must be insinuated between the side of the tongue near its tip, and the inner corresponding portion of the jaw until it can lift up the point of the tongue; which being done, the membrane is immediately brought into view, and that upon the stretch; or should the child now begin to cry, as it almost always does, the operator can easily place his finger under the tongue, and keep this false fraenum tense, while by a single stroke directly across it by a sharp gum lancet, he divides it to the true fraenum; the operation is then finished. We have never known it necessary to repeat this operation. The incision through the membrane, never yields more than a small drop of blood; no haemorrhage can ensue, as this tissue is but very slightly vascular. 


328 
OP TONGUE-TIE. 
2. Original Conformation of the Frsenum, rendering the Tongue too short. 
1148. In this species of "tongue-tie," the difficulty to the child's sucking, accompanied by the clucking noise just mentioned, arises from the fraenum proper, being unusually fleshy, and carried too far towards the extremity of the tongue, so that there is but a small portion, or distance, from the insertion of the fraenum, and the outer extremity of this organ. 
1149. In this case, the inconveniences to the child, are precisely of the same kind as in the other, but not, so far as we have observed, to the same extent; indeed we have occasionally seen both combined. When the fraenum proper is thus conformed, we never venture to do any thing; 1st, because we have never found it absolutely necessary; as it never so far interferes with sucking, as to prevent it—the clucking noise, and the display of a little temper on the part of the child, in not receiving its nourishment as fast as it desires, are the only inconveniences attending it; 2d, because, it is extremely doubtful whether the operation has ever been useful; but it is certain, that it has often been troublesome, sometimes dangerous, and occasionally fatal. Bleedings to a fatal extent, swallowing the tongue, and convulsions, have followed the operation; we therefore, with our present views can never recommend it. 
Swallowing of the Tongue, and Haemorrhage. 
1150. We have often heard of, but we never have seen, a case of either swallowing the tongue, or of haemorrhage from cutting it. Dr. Underwood speaks doubtfully upon this subject: he says, " the occasion of this accident, it has been said, is cutting too deep in dividing the fraenum: I have here to notice its symptoms, and remedy. The former are those usually attending strangulation, and come on suddenly, and without any probable cause but that of the tongue being cut; but to which they are seldom attributed by those who are strangers to the complaint. The infant appears greatly agitated; the face turns black; and unless these symptoms soon disappear, the child goes off in a convulsion. But if they are presently removed, the infant is as 


OF SWALLOWING THE TONGUE. 
329 
suddenly well; though they generally return again, and have in several instances proved fatal." 
1151. " Mons. Petit, (Mem. de l'Acad. des Sciences,) has perhaps the credit of discovering the true cause of the complaint. The remedy consists in nothing more than in bringing the tongue into its proper place, and if the infant be suckled, putting it immediately to the breast, will give the tongue its natural direction. Should the child be brought up by hand, the tongue should be watched for some time, at least until the bleeding is stopped; the complaint taking place only in consequence of that being considerable, so as to become an inducement to the infant to continue sucking at the part." • 
1152. "When the sublingual veins are actually wounded, the danger, it has been said, is considerable; and it is to M. Petit, that we are again indebted for the best contrivance for suppressing this haemorrhage. The means consist only of a piece of ivory, in the form of a short fork; the prongs of which should be so placed as to press against the apertures in the veins, and the other end against the inside of the lower jaw, and should, therefore, be broad, and somewhat convex, that it may keep its place." 
1153. We are sorry we cannot give any thing more satisfactory upon this subject, than what we have just detailed. If it be true, as Dr. Underwood asserts, that swallowing the tongue arises only from too much blood flowing after cutting it, it must be of very rare occurrence. In this country, we have never heard of an accident from cutting the tongue; and we are sure that none can follow this operation, if the case be a proper one, or it be properly performed. 
1154. It strikes us,there must be something very reprehensible, when haemorrhage to any extent occurs, either in the mode of operating, or in selecting the case for it. It is generally recommended to employ scissors for this purpose; to these we have objected, for many years. We never employed them but once, and then found them so extremely inconvenient, that we determined to use them no more. We substituted the common gum lancet, as directed above; and we have every reason to be satisfied with it for this purpose. We have already pointed out the kind of cases we judge proper for this operation; in such no accident can occur, unless the most perfect mal-adroitness accompanies the operation. 
[43] 


330 
OP SWALLOWING THE TONGUE. 
1155. We have said, we have never seen a case of swallowing the tongue; that is, we were never present to observe the phenomena such an accident would present —but we were called to see a child who was in the habit of doing this; it was however relieved before we arrived. The nurse informed us, the child in question would swallow it several times a day, if not watched. She always relieved it by the handle of a tea-spoon pressed against the tongue, and drawing it forward. This child, we know, never had had any thing done to its tongue. 
1156. In case of haemorrhage, we believe filling the part beneath the tongue with dry lint, and holding it there some time, would answer better than Mons. Petit's contrivance, provided it be not an artery. We have seen within a few days a bleeding from the fraenum, occasioned by a cut with a piece of tin with which the child had been playing: the artery in this case was taken up, by Dr. J. R. Barton, with great skill, and as much success. 
CHAPTER XV. 
OF BLEEDING FROM THE NAVEL-STRING. 
1157. This accident cannot properly be called a disease; yet it is of importance to understand how to manage it when it occurs, that it may not prove injurious or fatal to the child. Whatever reasoning, ingenuity may employ to prove, that a ligature uponthe cord of a new-born child is unnecessary; experience shows, it is sometimes highly useful; consequently, since if properly applied it can never do harm, it should always be employed. 
1158. Those who are well acquainted with midwifery, know, that sometimes a bleeding from this part will take place, hours after it has been supposed it was carefully secured; therefore this part should occasionally be watched,lest a bleedingensue,and weaken the child very much. We have never known an instance of death from this cause, though we have seen children very much exhausted by it. 
1159. This haemorrhage arises from the vessels of the navelstring contracting so much as to be no longer compressed by the ligature: this only happens however, as far as our observations 


331 
OF BLEEDING FROM THE NAVEL-STRING- 
go, from two causes, namely, 1st, where the cord has been carelessly tied, or tied with improper substances; in neither of which, sufficient compression is made upon the vessels, though at the moment of cutting the cord they did not bleed; 2d, where the cord is unusually largt; in this case it is oftentimes very difficult to make sufficient pressure upon the vessels, however proper the materials of the ligature may be, or however well it may have been applied; for the cord shrinks in such cases so much, as almost to leave the ligature without pressure. 
1160. We once witnessed a bleeding from the cord, which had nearly proved fatal, where the vessels under the ligature were completely compressed; therefore there was no blame to be attached to the mode of tying, or to the substance of which the ligature was made. As this case was a little singular, we will relate it: 
1161. We were sent for in great haste, to see a child who was said to be bleeding to death. When we arrived, we found it extremely pale, and nearly exhausted by a bleeding from the cord. The child was three days old; it had been bleeding more than an hour. The gentleman who had delivered the child, could not be found at the moment he was sent for, but arrived immediately after we had got the cord exposed. 
1162. Upon examining its extremity, not a drop of blood was seen to issue from it, but a stream was observed to flow over the child's belly. The whole cord was now unwrapped, and the blood was found to issue from the side of the cord, about an inch below the tying. Upon examining this part carefully, it was found that the vein was varicose, and had ulcerated—from this ulceration the blood flowed. A new ligature was applied below this spot, the bleeding stopped instantly, and the child recovered. We will not pretend to account for the blood of the child forcing its way into the umbilical vein after the cord had been cut; we only relate the fact, which suggests the following practical cautions: never to apply a ligature above a varicose portion of the cord, if it be possible to apply one below; lest, a similar accident may occur. 
1163. When bleeding takes place from the extremity of the cord, 1st, let a second ligature be applied below the original one, taking great care that this second one shall not cut through the cord when drawn very tight; 2d, that the ligature be drawn 


332 
OF BLEEDING FROM THE NAVEL-STRING. 
sufficiently tight to compress the vessels. To prevent the first accident happening, do not let the ligature be of thread hard twisted together, especially the home spun thread; and to ensure the second, let it be a portion of a skein of fine linen thread; for neither tape, bobbing, nor cotton thread, can bt relied on for this purpose. 
CHAPTER XVI. 
OF ULCERATION, OR IMPERFECT HEALING OF THE NAVEL. 
1164. The umbilical cord separates from the umbilicus, from the fifth to the tenth day; and though this is a process altogether of the system of the child, yet we are occasionally obliged to interfere, that the separation may be entire, or the healing perfect. 
1165. The cord sometimes remains attached by a filament, for several days after the usual time of separation; when this is observed, it should be separated by dividing the connection by a pair of scissors. This is the simplest impediment to healing; this process may fail by the part shooting up a kind of fungus, which discharges a purulent matter, and is sometimes offensive. This condition of the navel always excites alarm, though there is no positive danger; the only disadvantage is, that the part will not spontaneously heal, nor the discharge stop. 
1166. This excrescence will be found in one of three conditions: 1st, the navel may exhibit an elevated ulceration of its whole surface; 2d, it may form a kind of button with narrow base, or pedicle; 3d, this button may have a broad base; each of which, will require a little difference in management. 
Treatment in the First Situation. 
1167. This condition of the navel, will be readily healed by sprinkling it with white lead, or finely powdered Aleppo galls, or calomel. All these substances act as escharotics; therefore, when either is applied, the surface immediately below becomes killed; therefore time must be given for the slough to come off 


333 
OF ULCERATION OF THE NAVEL. 
When it separates itself, a fresh portion must be applied, and so on until the part is entirely healed. 
Treatment in the Second Situation. 
1168. A dark red, round tumour may be discovered, within the cavity, formed by the retiring of the navel; this when pressed out, will have a foot stalk, and much resembles a cherry attached to its stem. All that is necessary here, is to pass a ligature round it, and sufficiently tightened. It will soon drop off, and occasion no pain. It sometimes may not immediately heal after the removal of the top, as the remaining portion may again shoot up a new product—if this happen, the remedies named for the first condition will quickly relieve it. 
Treatment in the Third Condition. 
1169. For this condition, a ligature cannot be applied, as its base is broad—we are therefore obliged to depend upon escharotics, as in the first case. It however will not always yield to the already suggested remedies; when this is the case, we have been a few times obliged to have recourse to a pretty strong solution of the nitrate of silver; this must be applied by means of a camel hair pencil, and repeated until the part heals. We have never known this application give pain; unless it were too liberally used, and made to act upon the sound skin. 
CHAPTER XVII. 
OF HYDROCELE. 
1170. This affection of the scrotum, resembles that of adults, it is most probable, in many cases the child is born with it; it is however, not generally noticed until four or five days, and some times even longer after birth. It always excites a good deal of alarm; and it is proper it should, as it always deserves attention, not so much for itself, since it is of easy management; but because a rupture at the part, resembles it. 


334 
OF HYDROCELE. 
1171. It may be distinguished from hernia, by its equal distention; by its transparency; by not being increased by the crying of the infant; its want of sensibility on handling of it, and by not retiring by pressure. So far as we have seen, the water is confined to one side of the scrotum; it may however be occasionally in both. We have several times seen the tumour as large as a small hen's egg. This complaint is not always connate; we have seen it occur several months after birth; and one case, several years. It is never productive of inconvenience to the child, yet it demands attention. 
1172. We have never seen it resist the application of cold water, though we have occasionally found it obstinate; as happened where it did not appear until after the child was three years old. In this case, the water was steadily applied morning and evening for several weeks, without any apparent amendment. The child was now confined to a milk and vegetable diet; and took daily, or every other day, as the effects were, ten grains of cream of tartar, and six of jalap. This purged him pretty freely for a fortnight; the water was however continued during the whole of this time, and in a fortnight more, the whole tumour disappeared, nor has the child had any return. 
1173. The best mode we believe to use the water, is to pour it from a height, pleno rivo upon the part. Two quarts at least of water should be thus let fall, morning and evening, through the spout of a tea-kettle. 
CHAPTER XVIII. 
OF UMBILICAL HERNIA. 
1174. We have adverted to the cause of hernia, in several places, but particularly in Book I. p. 72. under the head of Bellyband; as well as at p. 252, under the head of Exercise. When treating of the application of the belly-band, we gave it as our opinion, that the too tight application of this bandage was no unfrequent cause of this complaint, when from the conformation 


335 
OF UMBILICAL HERNIA. 
of the parts there was a disposition to it. We then suggested some cautions, to which we must beg leave to refer. 
1175. It may be proper to observe, that the nurse is always blamed when this accident happens, but not with sufficient reason; for we do not believe it to be in her power always, nay, we may say it is very rarely so, to prevent it; for in general it is owing to a natural defect of the part. Yet a prudent care is essential to the good health of the child. It must be remarked, that children who cry a great deal, and who have had very large umbilical cords, are more subject to it than others. 
1176. It would be well for the nurse to examine this part from time to time after the separation of the cord, especially while the child is crying. Should she discover any pouting out at this part, she should immediately inform the parents of the circumstance, and not reprehensibly conceal it, from a fear she maybe blamed for the accident. 
1177. Much important time is sometimes lost by this concealment; yet it is expecting rather too much moral courage in the nurse to discover it, as she is sure to call the blame upon herself, by her candour. On this account, it is every way important to be understood, how seldom, and how little agency the nurse has in its production. It is but justice to that class of people, to declare the truth upon this point. 
1178. So soon as this disease is discovered, it would be well to attempt to remedy it; —1st, because we are persuaded the best chance is, when it is taken as early as possible, that the passage for the gut may not be confirmed by the frequent appearance of this part in the opening; where if unrestrained, it will be sure to be, whenever the child cries, coughs, sneezes, or even goes to stool; 2d, because, at this early period there is a natural disposition in the hole to obliterate itself. 
117.9. Dr. Underwood and others recommend at first, compression by straps of adhesive plaster; this plan has never entirety succeeded with us, though repeatedly tried. But we have never failed to cure it, by the application of Dr. Hull's umbilical truss. This is simple in its construction, correct in Its principles, and gives but very little trouble in its action. 


336 
OF INGUINAL HERNIA. 
CHAPTER XIX. 
OF THE INGUINAL HERNIA. 
1180. This complaint is not so frequent, as the umbilical, but generally speaking, is of more difficult management, and of more serious consequence. This complaint consists of a descent of a portion of intestine or omentum into the scrotum; it may exist before birth, or may take place soon after. 
1181. Thiscomplaint maybe suspected, whenever the scrotum, especially on one side, is more than usually large; and it may be detected by the tumour being removed by pressure, and by the testicle not being discoverable. This disease may however take place at any period of life, but especially during its most active stages. 
1182. Dr. Underwood says, "the bubonocele may be safely left without a bandage, especially as the cold bath alone generally cures it, when happening to children before they go alone." We are always sorry when we are obliged to differ with this respectable author; and the complaint under consideration, is one of the instances, in which we are obliged to oppose the experience of Dr. Physick, as well as our own, to what he has advanced in the quotation just mentioned. 
1183. Dr. Physick advises without reserve, the application of a properly constructed truss to the part, whenever the disease may be discovered; and considers it unsafe to permit the child to do without one; especially, if the disease be properly managed by a well adjusted truss, a permanent cure may be effected; but if it be permitted to continue without such application, it may become strangulated., or the disposition of the hole to contract, through which the gut descends, may be lost, and the child ever continue to suffer under this complaint. 
1184. We would therefore advise, in conformity with an experience at once so extensive and valuable, as that of Dr. Physick, that recourse be immediately had to the only certain or proper remedy. In using a truss, however, for this purpose, much care is required; 1st, that the machine be properly constructed, for the end proposed; and 2d, that it be properly adjusted to the parts, that the end may be ensured; 3d, that the protruded parts be carefully replaced before it is applied. 


OF ABSCESS OF THE HIP JOINT* 
337 
CHAPTER XX. 
ABSCESS OF THE HIP JOINT, 
1185. The commencement of inflammation in the hip joint, is not perceived as early as would be useful to the patient; or if some alteration in the health and vigour of a limb be observed, it is not always sufficiently early attended to. This complaint is most frequent with children; the variety of little injuries which they must almost necessarily sustain in the exercise of their various juvenile sports, misleads very often, even anxious and watchful parents, when any slight complaint is made, of pain, uneasiness, stiffness, or even diminished ability to walk; since they are all in their turns attributed to a bruise, a fall, or a wrench, which they suppose will quickly pass away by rest. 
1186. Even after the disease has progressed some time; and an evident weakness is observed in the limb, by its being favoured at the expense of the other; when pain is felt from motion, and there is a disposition to fall from slighter causes than usual; and even, when the points of the toes look more inward, or outward than natural; the true nature of this disease is not suspected, as there is no fixed pain in the hip joint, not even upon pretty hard pressure—indeed the friends of the patient are constantly misled by his declaring he feels no pain, except in the knee. 
1187. If the two limbs be compared, even before the disease has proceeded far, the diseased one will be found rather longer than the other. After a while, the natural convexity of the hip is lost; and when the patient walks, it is found that the greater part of the weight of the body is sustained by the sound limb, and a limping commences. Though the patient locates his inconvenience in the knee, because he there alone very often feels the pain, yet this part will bear pressure, and motion, without experiencing the least inconvenience; but not so always, the hip joint; for if the sensations of the patient be carefully examined during the motions imposed upon the knee joint, such as bending it, and straightening of it, it will be found he experiences inconvenience in the joint of the hip. 
[44] 


338 
OF ABSCESS OF THE HIP JOINT. 
1188. This is the commencement of inflammation of the hip joint; and if it be not controlled in due time, it runs on to suppuration. An abscess forms, which opens, and gives issue to an unhealthy pus; the bones at the bottom of the abscess but too frequently become carious; hectic fever ensues; and after a suffering of a longer or shorter duration, the patient dies exhausted, by discharges and sufferings. 
1189. For remedies to be useful in this disease, they should be early applied, regularly persevered in, and the most perfect rest enjoined upon the patient; with such treatment, the disease may frequently be cured; but if the disease has been neglected in its early stage; the remedies, but partially administered; and the patient permitted to use exercise, the disease then becomes as painful as hopeless. 
1190. The cure must be attempted, by bleeding, leeching, cupping, purging, low diet and rest. We have seen three instances of entire restoration where this plan was completely tried; and we have witnessed more than twice that number, terminate in incurable lameness; fistulous openings with never-ceasing discharges of ill-digested pus, and death, from hectic, will follow. 
1191. From pain being seated in the knee, this complaint is always mistaken for rheumatism, or some other local affection of this part; and to it are all the remedial powers addressed—we need not say how unavailingly. 
1192. To Dr. Physick we are indebted for the proper mode of treating this affection; and to his happy genius are hundreds under obligation, who have suffered from it, for the preservation of their limbs, and for the enjoyment of life. It was he who first suggested constant purging, and entire rest; and to which, this formidable disease so often yields, when tried under proper circumstances. Valuable as this plan is, it must be confessed to be one of difficult execution; but we know, from experience, it is not impracticable; and from the same experience, we know it to be successful. Who then would hesitate to enforce a plan, that might save a lovely female from an incurable lameness, or a favourite son from a lingering death! 
1193. But let us be a little more particular, in developing the plan just spoken of. The child must abstain from all animal food or broths; he must be laid prostrate upon his bed or mat- 


339 
OP ABSCESS OF THE HIP JOINT, 
tress, and this without exercising the limb, but as little as possible; he must be bled freely from the arm if the pulse be active, or leeched upon the hip, if the bleeding be not indicated; these must be repeated in proportion to pain, or fever; if either come on. The bowels must be purged daily, or every other day, by the exhibition of cream of tartar and jalap, in doses suited to the age of the patient, and this persevered in until amendment is obvious, or the cure completed. Under this apparently weakening plan, it is astonishing sometimes to see how health and strength improve. Where it is impossible to confine the patient, much advantage is found from the curved splint, made to fit the hip and thigh. The ingenious Mr. William Rush, (ship-carver,) is very successful in adapting the splint to the shape of the parts concerned. To show how easily, and commonly, this case is mistaken for rheumatism, we will relate one case, of several of similar kind. In June 1823, we were requested to visit Miss 
, aged fourteen; she was from the country; she was there treated for a rheumatism in the knee, by stimulating, and other applications, for some time. At the request of a relation residing in the city, she was brought down for farther advice. We soon discovered the complaint to be a hip disease; and we wrote a letter of instructions for its treatment. After our taking leave, it was agreed she should remain in town to put the proposed plan in execution, and she accordingly commenced forthwith, and this with as much perseverance as success. She was bled and leeched twice; purged every day, or every other day at farthest, with jalap and cream of tartar; confined closely to her bed; and observed the most abstemious diet, for two months; at the end of which time, we had the pleasure to return her to her anxious parent perfectly restored; and up to this time remains well. But every case is not so quickly relieved. Dr. Physick and myself had a very desperate case lately, which required six or seven months to cure;* but which was in this time happily effected. The splint was modelled to the shape of the leg, three times, as it acquired length during the progress of the cure. 
* That is, the inflammation of the joint was subdued, and the threatening symptoms had ceased. But as the limb was very much contracted, it required the constant application of the splint for a number of months more, before it became straight. This young lady now walks without much difficulty, though the disease was for a long time a very serious one. 


340 
OF ABSCESS WITHIN THE EAR, 
CHAPTER XXI. 
ABSCESS WITHIN THE EAR. 
1194. Children after they are six months old, are sometimes found to cry violently, and toss their little heads from side to side, expressing thereby the greatest agony. Not being able to point out the seat of pain, it is variously located by the parent or by the practitioner. It will sometimes stop crying very suddenly, and fall into a sound sleep, from which it will be roused by renewed torture. This pain is not generally attended by any disturbance of the system; fever seldom attends. It is generally mistaken for colic, or belly-ache. 
1195. It may however readily be distinguished from this affection, by its not being accompanied by drawing up of the legs and thighs; by no flatus rumbling in the bowels; and by the hands and feet not being cold, or by the pain being relieved by remedies addressed to these parts. We have always reason to suspect this pain to arise from an abscess forming in the ear, when the child throws its head backward and forward, and indeed in all directions, during the paroxysm of pain; when it is found to lie on one side easier than the other; when laudanum procures but temporary relief; and when upon pressing the ear with the point of the finger placed against the lower portion of the external meatus, it complains; and above all, when the abscess can be discovered by looking into the ear; this however but seldom happens. 
1196. We have witnessed this affection so frequently, and have been so often alarmed by it, that we always apply remedies to the ears, when we have satisfied ourselves the pain is not in the bowels, by the absence of the symptoms noticed above, nor in the head itself, by the absence of all fever, or derangement of stomach. 
1197. When we suspect the ear to be in fault, and have been called to the child in the commencement of pain, we almost invariably order a few leeches to be applied under that ear, which the child will complain of, when pressed, as above directed. 


341 
OB" ABSCESS WITHIN THE EAR. 
We also direct a little laudanum on lint, pressed gently into the ear, and this repeated as occasion may require. Should these fail to afford relief, we advise a blister to be applied immediately under the ear, and purge the child pretty briskly. 
1198. This plan sometimes succeeds to admiration; and we believe it would oftener do so, were the remedies applied sufficiently early: but unfortunately, the time for useful exertion is almost always lost, by a trial of temporising applications; and we have but too often the mortification to witness only the discharge from the ear. When the ear discharges, the little patient is immediately relieved; it falls into a sound sleep, and forgets all its sufferings, until again it is obliged to go through the process a second, and even a third time, in the period of two or three months. 
1199. Sometimes the abscess heals without the smallest trouble, leaving the ear free from discharge in the course of a few days; but at other times, the mischief done the inner cavity of the ear is serious and permanent. The small bones of the ear become detached by suppuration, and are discharged with the pus which constantly flows from the external orifice of this organ. The discharge generally becomes very offensive; both from the matter being confined, as well as from the caries under which the bones are labouring. When caries takes place, the case is almost hopeless; and must in a great measure be abandoned to nature, only paying attention to cleanliness. 
1200. It is a matter of primary importance, to keep the parts clean by frequently washing out the canal, first with fine soap and warm water, followed by equal parts of lime-water and milk, and a small portion of the tincture of myrrh. Our formula for this purpose, is as follows: 
Of lime-water and milk, each two tea-spoonsful; Tincture of myrrh, twenty drops. Mix. 
1201. This mixture should be prepared only as it may be wanted, and thrown into the ear four or five times a day. At night, the child should be made to lie upon the affected side, that the matter may discharge freely. 
1202. This discharge from the ear is always attended by dullness of hearing; on this account it were desirable it. should be relieved as quickly as possible, lest its continuance do irreparable mischief to this organ, The mixture of lime-water and milk. 


342 
OP ABSCESS WITHIN THE EAR. 
when no serious injury has been done to the bones of the ear, will, if properly persisted in, very often succeed; and we are informed by a late writer on this affection, that a solution of the nitrate of silver, will be found a most valuable application. 
1203. We think we have seen advantage from the little patient wearing a plaster spread with Burgundy pitch, or shoemakers' wax, under the affected ear. And we once witnessed a case of years' standing, yield to an issue in the arm of the side affected. This was kept discharging for a year; it was then suffered to heal, which it did without any subsequent disadvantage. 
CHAPTER XXII. 
OF ADHESION OF THE LABIA PUDENDI OF CHILDREN. 
1204. The labia pudendi of young children arc very often found adherent. This may be congenite, but we believe it is very rarely so. We have seldom seen this condition of the parts, in children under six months old; and still more rarely, after the age of a year. From these facts, it would seem to be almost always adventitious; and owing principally to a want of cleanliness. Had the child been born with the labia in this condition, it is more than probable it would have been discovered early, as nurses, generally speaking, are at least curious, if not always careful, in their examinations. 
1205. When we consider the delicacy, and vascularity of the membrane lining the internal face of the labia; the ease with which inflammation may be provoked, in parts so organized; when we recollect how quickly the secretions of the parts become acrid, where proper attention is not bestowed upon them; and how easily a slight inflammation may be increased, by the frequent flow of urine; we shall cease to wonder at the frequency of this and perhaps only be surprised, that it does not more frequently occur. 
1206. We have reason to believe, in many instances, this com- 


343 
OF ADHESION OF THE LABIA PUDENDI. 
plaint had existed some time before it was discovered: this may especially be the case with fat or lusty children, and wheye the most scrupulous attention is not paid to the condition of these parts. Therefore, it must be looked upon, in general, as a most reprehensible piece of neglect; for it is the bounden duty of every mother, however averse she may be from its performance, to carefully inspect these parts from time to time, particularly, until the child is fifteen or eighteen months old, in order that the inconvenience under consideration shall not take place. 
1207. Parents should direct, and the performance should be insisted on from nurses, that these parts should be regularly cleansed every time the child is washed, by separating the labia and applying water to them liberally; they should then be tenderly dried with a soft linen cloth, and dusted with hair powder, or powdered starch, in which there is no blue. If this were regularly done in early infancy, the parts would become so hardened, as very much to diminish the risk of its taking place, when less attention is paid them. 
1208. We have dwelt upon this subject, because we know its importance; and because, it has not sufficiently attracted the attention of parents. Unfortunately for the female, sometimes it has not been discovered during infancy; and it is especially so, when it remains concealed until womanhood, when perhaps the first intimation she may receive of her situation, is at a time, when of all others she would wish to have been ignorant of it. The alternative, now, subjects her to an operation which should have been performed in early life; and by which all her finer feelings are excruciated with a severity, that can be better conceived than described. 
1209. This complaint sometimes becomes relieved spontaneously, but not always, happily; and this may occur more frequently than we are aware of; since the causes which may produce it, are too constantly operating, not to lead us to suppose this accident to occur, in cases where it may not be detected. We had two instances of this spontaneous change to happen under our own observation. 
1210. In one of these cases, there was so much inflammation and tenderness in the parts, that we did not think it advisable to operate, until the existing state of things was changed. We 


344 
OF ADHESION OF THE LABIA PUDENDI. 
directed soft bread and milk poultices, and a cathartic. On our next examination, a complete separation had taken place; by the adhering parts having suppurated, and exposing two raw surfaces, which required much attention to prevent a reunion by their healing. 
1211. The other case was something similar; suppuration had commenced, and the connecting medium was nearly destroyed, when it was first observed. It was poulticed, as in the other case; and when about to heal, care was taken to prevent a second coalescence of the parts. 
1212. This condition of the labia is easily detected, by their refusing to be separated. When the parts are distended as much as their condition will permit, a continuous line of adhesion will be observed through the whole track of the labia, as far as the meatus urinarius; of course, the os externum of the vagina is entirely concealed. The child passes its water without much difficulty; and when the complaint has been suffered to run on, or is not discovered until womanhood, the menstruous fluid has been evacuated through the same external aperture, by which the urine was discharged. 
1213. There is but one remedy, that we know of, for this complaint—and that is, to divide the parts. This is very easily performed, by passing a probe pointed bistoury into the orifice immediately before the meatus urinarius, and cutting downward to the inferior junction of the labia. A small dossil of lint, moistened with sweet oil, may be insinuated between the separated portions. The wounds heal without the smallest difficulty, in two or three days. 
CHAPTER XXIII. 
OF THE DIABETES OF CHILDREN 
1214. This complaint was first noticed by Morton, agreeably to Dr. Underwood; he considered it altogether a sympathetic affection, and we believe correctly—at least, the three cases 


OP THE DIABETES OP CHILDREN. 
345 
which we have witnessed, happened to children who were teething. There is nothing more surprising, that the kidneys should hold intercommunion with the gums, than that the neck of the bladder should; and of this we see frequent instances. 
1215. Morton speaks of this disease as a family complaint; having proved fatal to all the male children, with the exception of the last, which was under his care, and appeared to be relieved by the plan he adopted—namely, confining the child entirely to a milk diet, and to allay the excessive thirst, he allowed only milk, mixed with a chalybeate water. The diabetic symptoms in this case were wont to return, with every tooth that was about to pierce the gums. 
1216. This complaint consists in the immoderate discharge of urine, attended with great thirst, and emaciation. In Morton's case, the urine was as sweet as that of adults labouring under this complaint. In those we witnessed, we regret to say, we could not procure the urine to make a trial; and therefore cannot tell whether it was sweet or not. All the children we have seen with this complaint, were under fifteen months old; and though teething, yet from a careful examination of the mouth, we could not in either of these cases find teeth immediately protruding the gums. 
1217. The quantity of urine discharged was very great; and this at very many times; the children fell away rapidly, and weakened very fast. We ordered the bowels to be kept freely open; and a quantity of the spirit of turpentine, to be put upon the clothes of the children, so as to keep them in a terebinthinate atmosphere. This plan succeeded completely in every case. 
CHAPTER XXIV. 
OF INCONTINENCE OF URINE. 
1218. This is more frequently a disease of habit, than of any derangement of the sphincter of the bladder, or a symptom of stone, or calculi; yet it may occasionally proceed from either. 
1219. If this complaint arise from the presence of a stone in 
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346 
OF INCONTINENCE OF URINE. 
the bladder, it is evident, that nothing but the removal of it, can effect a cure; if from a lythic disposition in the urine, it may be sometimes improved by repeated doses of magnesia; soda, supersaturated with carbonic acid gas; lime-water and milk; a few drops three or four times a day, of the spirit of turpentine, or of balsam copaiva, &c. 
1220. But when it is purely habitual, as it most frequently is, nothing but the destruction of the habit can afford relief. This may be done, 1st, as directed very properly by Dr. Underwood, by taking the child up from its bed, after it has been there a while, and obliging it to remain on the pot, until it discharge its urine; having previously however, seen that it had emptied its bladder before it went to bed. Or 2d, by such remedies as appear to alter the condition of the neck of the bladder; rendering it less susceptible to the irritation of the urine; and by instituting new associations; by creating new sensations, or susceptibilities in it; as by the tincture of cantharides, in doses of ten or twelve drops, three or four times a day, in a little sweetened water; gradually increasing the dose two or three drops at a dose, until heat is perceived in making water; it must then be desisted from; and should strangury ensue, let it be quieted by drinking freely of flaxseed tea, gum Arabic water, or any other demulcent—if severe, by three or four grains of camphor, and a few drops of laudanum, or the warm bath. 
1221. Blisters applied to the sacrum, we have found highly beneficial; or even plasters of burgundy pitch, upon the same part. A most interesting case of this kind, fell lately under our care, which it may be useful to relate. A delicate boy of eleven years of age, was severely afflicted with this weakness, from an early period of his life. Every precaution which was likely to interrupt the habit, was had recourse to unavailingly. During the day, he was constantly running to discharge his bladder, so that he was obliged to neglect even his education; and at night, it seemed to pour from him, in almost a continuous stream. These discharges, were attended by severe suffering at the neck of the bladder; so much so, that it led us to suspect there might be a stone in the bladder, and we begged that our friend Dr. Physick might examine him—this was done, and no stone was found. The poor boy suffered considerably, in the passing of the 


347 
OP INCONTINENCE OP URINE. 
sound; the parts became a little inflamed, and his urine suppressed. By the use of neutral salts, laudanum, and the warm bath, he was pretty soon relieved of the suppression; and with it passed away almost entirely, his inability to retain his water. The black drop was ordered him at night, with the most manifest advantage— this he continued for a long time. We were unwilling to interrupt the use of this medicine, until convinced that the irritability of the bladder was destroyed—this took place in a few months after. 
CHAPTER XXV. 
OF CONSTIPATION. 
1222. Tardy bowels maybe either accidental, or constitutional; if the former, it is always well to inquire into the cause, that it may be removed as quickly as possible. The bowels of infants may become costive, from improper food, or food which in itself may be proper in some constitutions, yet may produce costiveness in others. Thus we find rice in all its preparations, will sometimes make the bowels of some children tardy; when this is found to be the case, it should not be employed under any pretext. Again, boiled milk will have this tendency occasionally, and so, many other substances, all of which should be laid aside, the instant it is known to produce this effect. 
1223. But there is a cause of accidental costiveness that is not generally known, which is much more injurious than that from any other—namely, from Jaudanum. Nurses are now so familiar with this drug, that it is as regularly carried about them, as their scissors or thimble, and is much more indispensable to their comfort, than either of these emblems of industry. If the child does not go to sleep; or it is even feared it will not, at the exact moment which will suit the arrangements of the nurse; or if it cry from any cause, so as to give any additional trouble, laudanum is given to make " assurance doubly sure." 
1224. The consequence is, that an accidental, is converted into an habitual, costiveness; or the child may fall a sacrifice to 


348 
OF CONSTIPATION. 
convulsions or other fatal diseases, before this disposition of the bowels may be changed. In all instances of accidental costiveness, the child should be watched; and if the bowels do not seem inclined to relieve themselves, they should be aided by artificial means; and that very promptly, if the slightest indisposition should manifest itself at this period. 
1225. The most prompt application for this purpose, is an injection; or even a suppository. The former may consist of a rich solution of molasses, in a gill or even less of warm water, to which may be added a pinch of common salt; the other may consist of a piece of the common brown or rosin soap, of an inch in length, and one-fourth of an inch thick, shaped round, and slightly tapering to a point. This must be dipped first in water, and then passed into the rectum, and pressed by the point of the finger, beyond the sphincter ani. Either of these means, will almost always procure the desired evacuation; and may be made always most safely, and very often most advantageously, to anticipate the operation of other medicine. 
1226. The most proper cathartic medicine for children, is castor oil, or magnesia. The quantity of either, must be proportioned to the age and habit of the child—from a tea-spoonful to a table-spoonful of oil will be a dose for children, from a month to two or three years old. Of magnesia, from one, to two large teaspoonsful will be doses for the same ages. The castor oil should always be given warm and alone; the magnesia should be most intimately mixed with a little sweetened milk. Manna may also be used as sweetening for the child's food—it may require, from a quarter to half an ounce for a dose. 
1227. When it is desirable, to alter the costive situation of the bowels as a habit, it is always better to do it by diet, than by medicine. Molasses freely used, is excellent for this purpose; but the best remedy we have yet met with is a mush, made by boiling a small quantity at a time, of the unbolted wheat flour in water, and straining it through a sieve, while hot. It will be perceived, this must be made thin. A portion of this must be used in the milk the child takes, or it may be fed with it a little sweetened, two or three times a day, or oftener, or more seldom, as the case may require. We have never seen this fail, when properly attended to. 


349 
OF CONSTIPATION. 
1228. But should this costiveness appear to have provoked fever, induced pain, or excited convulsions, more active medicines, as jalap, or calomel and jalap may be used; or the others, namely, castor oil, or magnesia may be repeated every hour or two, until the effect is produced. 
1229. Constitutional costiveness, not attended by any derangement of the system, rarely requires an interference. Dr. Underwood asserts, that the condition of the child's bowels, keep pace with those of the mother; this is certainly very far from being always the case. We have known the child very costive, while the mother was not so, and the reverse. This slow motion of the bowels may be from two days to ten, without the child receiving the least injury from this torpor. 
1230. We were once consulted for a child of six months old, on account of its excessive costiveness; it had an evacuation but once in eight or ten days, but was perfectly healthy; throve well, and in every respect might be said to be in excellent health. We advised that nothing should be done, as long as the child was free from complaint. What added to the peculiarity of this case, was, the relaxed condition of the mother's bowels; she was subject to a kind of diarrhoea, the whole time of her suckling. The child in question never required any medicine; when it began to cut its teeth pretty rapidly, its bowels became less confined, but was never free in them, until after weaning. 
CHAPTER XXVI. 
OF VOMITING. 
1231. Vomiting, with young children, is very far from always being a disease. This fact should be well remembered by young and inexperienced mothers, who are apt to become alarmed by incidents, which sometimes only prove the healthfulness of their children. Of this kind, very often, is the vomiting about to be considered, which if treated as a disease, by an incautious prac-titioner, may really be converted into one; whereas, if nature- 


350 
OF VOMITING. 
be permitted to have the management, she will secure the health of the child. 
1232. But it will be asked, are we never to interfere with vomiting?—and if we are, how shall we know when this interference may be proper, or when it would be best to let it alone? To answer these questions, it will be necessary to divide this act into the idiopathic, or spontaneous, and sympathetic, or provoked. 
1233. By the first we are to understand, that effort of the stomach, which it almost invariably makes to throw off whatever may be offensive to it, from its bulk, rather than from its quality, but in which the system at large has no participation. By the second we mean, 1st, that condition which arises from its connection with other parts of the body, which when in a state of disease, through the medium of that power called sympathy, becomes irritated to vomiting; 2d, or by the presence of some acrid, deleterious, or undigested substance within its own cavity, exciting it to this act; and 3d, when its powers are deranged, and consequently, its functions are not carried on in an healthful manner. 
Sect. I.— Of Idiopathic Vomiting. 
1234. Under this distinction, we must consider the throwing off of the contents of the stomach in young children, and especially those at the breast, when this organ has been compelled to receive too much; the distention becomes a.source of irritation, and the act of vomiting, (or rather, of regurgitation, for it is scarcely an effort,) is produced. Hence, we see children who have been liberally supplied at the breast, often throw up the greater part of that it had just before received. But this act must not be considered a diseased condition of the stomach, or one meriting medical attention. We therefore never interfere with such cases, so long as the child thrives, or the powers of this organ are not deranged. 
1235. When this kind of vomiting takes place, it is almost immediately after the child has sucked; the milk comes up pure and unchanged; it is discharged without any seeming effort, or even nausea; and the moment it is removed, is cheerful and apparently happy; nay, it very often happens in the midst of some 


351 
OP IDIOPATHIC VOMITING. 
little expression of its healthfulness and happiness, and this sometimes without altering the expression of cheerfulness. Now were this vomiting to be looked upon as injurious, and treated as a disease, the evil intended to be removed, would really be created, or en creased. 
1236. Though we do not consider this an unhealthy act, it is not, or rather it should not be made a necessary one of the stomach: for it almost always proceeds from repletion, or from this organ being disturbed by some rude handling of the child. To prevent its taking place from the first cause, the child should be taken from the breast the moment it begins to dally with it, or it ceases to draw as if it were really gratifying a necessary and proper appetite. If this be done, and the child suffered to remain for a while perfectly quiet after its removal from the breast, this inconvenience, (for such it is,) will certainly cease. But the too common practice of jolting and tossing the child, (see Book I. p. 168. par. 575.) immediately after nursing, will be sure to derange its stomach, and vomiting will ensue—therefore this barbarous custom should be instantly forbidden. 
1237. There is an error very commonly committed with children who throw up frequently; which is, to apply them to the breast immediately after they have discharged their little stomachs, under the pretence of " making up for what the poor little thing has lost,"' and thus this evil is perpetuated; whereas to manage this case properly, the stomach should be allowed to rest a while. 
Sect. II.— Of Sympathetic Vomiting. 
1238. 1. This act of the stomach, may take place, from affections remotely situated from it, as in certain fevers; affections of the kidneys, the head, the neck of the bladder, &c. through the medium of the nervous system. But in all such cases, the stomach cannot very often be quieted but by the removal of the original complaint. Dr. Underwood says, it may arise from " a suppression of the discharge behind the ears, and more especially if consequent upon the use of drying remedies;'' or from, " the sudden disappearance of some eruption on the skin.'' 
1239. We have never witnessed vomiting from either of the two last named causes; and we more than suspect, that too much 


352 
OF SYMPATHETIC VOMITING. 
has been taken for granted, unless it is where " drying applications," have improperly been made; in this case we can readily believe that some injury might follow such imprudent practice; but where the discharge from behind the ears, or the disappearance of an eruption from the skin have suddenly taken place, it would be right to inquire, what gave rise to the suppression of a discharge in the one case, or to the retrocession of an eruption in the other? for the cause capable of producing such effects, might also produce the vomiting in question. 
1240. The management then of vomitings of this kind, consists almost exclusively, in the treatment of the original disease which produced it. It is true, we occasionally succeed in mitigating this affection by remedies exclusively addressed to the stomach, but not often; unless it be when the original disease itself is yielding to treatment instituted for it. Then a little lime-water and milk, soda water, or injections with laudanum, will sometimes succeed. For young children, that is, under a year, a tea-spoonful of limewater and as much milk given once an hour, will generally be sufficient; half a wine-glassful of soda water from time to time may be given at once; or an injection of a table-spoonful of warm water, and eight or ten drops of laudanum may be administered. If the child be older, the doses must be proportionably increased. 
1241. 2. Where vomiting proceeds from some acrid or deleterious substance being received into the stomach, this action should be encouraged by warm water, chamomile, or common tea, or even cold water, until the offending cause appears to be removed, which may generally be determined, by no more of the offending substance appearing in what is rejected from the stomach. When this is the case, a brisk injection of a gill, (or more for an older child,) of warm water, and two large teaspoonsful of common salt, should be immediately given; should this not operate speedily, it must be repeated until an evacuation is procured. 
1242. If the injection operate freely, it will very frequently arrest the vomiting at once; but should it not, it must be followed by one in which laudanum enters; the quantity regulated by the age of the child. Upon this subject there is one general rule, which it is well should be known; namely, that a child 


353 
OF SYMPATHETIC VOMITING. 
will always bear by injection, three times the quantity of laudanum it will by the mouth. The remedies named above, (the lime water, &c.) may also be given in aid of the injection. 
1243. When the vomiting proceeds only from the child's having taken more into its stomach of its common or even some unusual food than it can well master, its effects will very generally cease after it has thrown up the undigested articles; and the dis - position to do this, should be encouraged as just directed, by the exhibition of warm water, &c. Should it not cease however, when the stomach is freed from the offending cause, a stimulating injection of salt and water will almost certainly do it. 
1244. 3. When vomiting proceeds from the deranged powers of the stomach, it is almost always owing, in young children, either to an excess, or deficiency of acid, or to the too great irritability of this organ; (and either of these may be occasioned, and most commonly is, by the stomach sympathizing with the gums as in teething;) or it may arise from some inscrutable cause, over which we can have no eertain control, though we often have it in our power to interrupt the effect; or it may proceed from some peculiar property in the mother's milk. 
1245. When it proceeds from an excess of acid, the child throws up its milk, in a few minutes after receiving it, completely curdled. The curd will be of different degrees of density, as the acid may be more or less abundant, or as the milk may have been a longer or shorter time in the stomach. This may be accompanied with either looseness, or costiveness. If it be after the child has commenced to cut teeth, the bowels are for the most part loose; but if before that period, it is very frequently attended by costiveness. 
1246. When an excess of acid prevails, it must be relieved by antacids, in small, but repeated doses. If the bowels of the child be loose, the best remedies we have found, are magnesia and soda—the former in mixture, as follows: a tea-spoonful of calcined magnesia, mixed in eight or ten of water or milk, with ihree or four drops of laudanum, and a little sugar. A tea-spoonful of this every hour or two, very quickly allays the irritation of the stomach, and quiets the disturbance of the bowels. 
1247. Should the bowels be confined, the laudanum must be omitted, and the mixture given, until the bowels are opened. Or should the bowels need no attention, the supersaturated soda 
[46] 


354 
OF SYMPATHETIC VOMITING. 
water, in small doses, will answer admirably well. If the child refuse to take the soda water, the lime water and milk, as just directed, may be given in repeated doses, until better. 
1248. In these cases, the mere destruction of the acid appears every way sufficient to relieve the stomach, which cannot fail to surprise, since at first sight this would seem to be but removing the effect of a cause, over which we do not know we have any influence: for one of two things must happen, in these cases; either, the acid is formally secreted by the stomach in too large a quantity; or the secretions of the stomach, by some peculiar disposition of this organ, become so immediately after their formation. It is therefore difficult to understand how, in the first supposition, the destruction of the loose acid shall prevent the further formation of it; and in the second, how it shall alter the action of the vessels, so as to change the tendency of the secretions to become acid, when free in the stomach. 
1249. It must be recollected, however, that every instance of the child throwing up coagulated milk, must not be considered as evidence of disease, or even of a superabundance of acid; for this change in the milk must take place before digestion is accomplished; therefore, in the most healthy and vigorous stomachs, if vomiting be provoked some time after the child has sucked, the milk may be thrown up in this condition. 
1250. If there be a deficiency of acid in the stomach, and a vomiting be produced, the milk will come up unchanged—nausea almost always attends this variety; and the child may be observed to become pale, and evidently to struggle against the efforts of its revolting stomach. The milk is ejected with great force, in a large column; and not unfrequently, a portion passes through the nostrils, to the very great discomforture of the child. 
1251. We have rarely seen this condition of stomach fail to be relieved by the occasional exhibition of small quantities of lemonade. The acid drink however should be stopped, so soon as the ejected milk shows signs of separation. An injection of a little salt and water, greatly promotes the recovery of the stomach. 
1252. If the stomach should possess too much irritability, the milk will be thrown up unchanged, almost as soon as swallowed, and will not be permitted to tarry sufficiently long to become coagulated, however abundant the acid may be. In this 


OP SYMPATHETIC VOMITING. 
355 
case, the efforts of the stomach are not so powerfully exerted, and the milk is discharged from the mouth with less force. The child, under such circumstances, should be nursed but seldom, and but for a short period. It should not be suffered to fill its stomach, or it will be sure to discharge itself immediately again. From a quarter to half a drop of laudanum should be given in a little sweetened water, about fifteen minutes before it is nursed, and this three or four times a day. A salt and water injection will be also proper. If it proceed from some peculiarity in the mother's milk, her diet must be changed; should this not answer, a wet nurse must be procured, or the child weaned. 
CHAPTER XXVII. 
OF DIARRHCEA. 
1253. By this we understand, a too frequent discharge of the feculent contents of the bowels, without tenesmus. The great variety of appearance in the matters discharged, has rendered it proper to divide this disease into several species; and first, of 
Sect. I.— The Feculent Diarrhoea. 
1254. Children under two years, or two years and a half old, are especially liable to this complaint. We shall cease to wonder at this, when we recollect the great length, sensibility, and irritability of the stomach and intestinal canal; the variety of parts with which they powerfully and almost constantly sympathize, (as the liver, the skin, the lower extremities, the brain, and the gums during teething;) and the immense surface they present to be acted upon by acrid or other offensive substances received into them. 
1255. Therefore, whatever is capable of increasing the peristaltic motion of the bowels, or even perhaps a portion of them, may occasion the disease in question; hence the frequency of this complaint, especially during infancy; since at that period, the bowels are decidedly more irritable, and many of the remote causes are constantly acting. 
1256. This increased action of the bowels, in this species of 


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OF DIARRHCEA 
diarrhoea, may be occasioned both directly and indirectly—directly, 
1257. h By improper or irritating substances being carried into, them; as food of a bad quality; or too much of that which may be good, when taken in improper proportions. Hence, children receiving into their stomachs, a vitiated milk; or other food, but of an irritating kind, as animal substances, either fresh or salt, before the stomach is capable of subduing them; or such as shall undergo a vinous fermentation; as too much sweetening in their victuals, and this permitted to stand until this change is about to take place, before it is given; thus, we have repeatedly known stale food occasion the complaint in question; or merely receiving proper food, but in excessive quantity. 
1258. In all the instances just supposed, the stomach not being able to digest its contents, the bowels become stimulated by the ill-subdued food urged into them, and make an effort to dislodge it as quickly as possible, by increasing their peristaltic motion; hence, their contents are rapidly and successively transmitted through them, and occasion what is called the feculent diarrhoea, Or it may be occasioned by the presence of bile in the duodenum: this bile may be either in too great quantity, or it may be highly depraved in its quality; and may in either condition so affect the peristaltic motion, as to produce diarrhoea. 
1259. This species of looseness, is almost always attended by some nausea, and a little pain; or such sensations as generally attend the exhibition of a cathartic of a stimulating kind, when it is about to commence its operation. This is the most simple fprm of diarrhoea; and it very often effects its own cure, by the profuseness, of its discharge:* but should it not, a dose of magnesia, if there be any evidence of acidity, or castor oil, or rhubarb, if there be none, will almost always be sufficient for this purpose. Should it not, it may be repeated, but followed by an appropriate dose of laudanum at bed-time, should fever not be considerable. 
* At other times, we may remark, the attack is ferocious; being' preceded by convulsions, and followed, as soon as sensibility is restored, by considerable pain in the bowels; fever, and this considerable; convulsive startings, &c. This particularly happens with children who have been over, or improperly fed, or who posses? an, unusual degree of irritability, or who teeth with much difficulty. 


357 
Of DIARRHCEA, 
1260. We may remark, before we go fart her, si nee the posi tion is of constant application, that it is not. a matter of indifference what substance we use as a cathartic in any one species of diarrhoea; for success will very often depend upon the proper choice. Thus, neither castor oil, nor rhubarb, would be so effectual as magnesia, in that diarrhoea in which the faeces had a predominating acid in them; nor would magnesia, be so successful as either castor oil, or rhubarb, where there was an absence of acidity, as it requires a combination, to a greater or lesser extent, with such a substance, to render it efficient. 
1261. It may be proper farther to remark, that during the operation of medicine, very little food should be given the child; and never any of a solid kind. 
1262. Should there be much nausea, or many efforts to puke, it will always be best to cleanse the stomach; as these symptoms are almost sure to arise, from the presence of a portion of whatever substance may have been offensive. For this purpose, we have ever found calomel, in proper doses, the best possible remedy; for it is almost as certain to cause puking, under such circumstances, as a medicine absolutely emetic, without the inconvenience of the latter remedy. The calomel, in such cases, had always better be given in divided doses—say, the full dose, divided into three parts, and a portion of it given every hour in a suitable vehicle,* until it effects the intended purpose. 
1263. The doses of calomel proper for the different ages and habits of children, are easily ascertained when given as just suggested, in divided doses; as this medicine almost always acts with more certainty and promptitude, when thus given, whether its operation is intended to be emetic or cathartic; and at the same time, no possible risk is incurred, as the child cannot take in this manner, an over dose. With the adult we know, that enormous doses are given by some; and this without any addi- 
* It is a matter of consequence, to attend to the vehicle in which calomel is given; its great weight prevents its being suspended by water, or any other equally thin fluid—it must therefore be mixed with a drop of syrup, almost of any kind; or, with a very small portion of loaf sugar, and may be thrown dry into the mouth. It is also of much use to attend to the quantity, as well as the quality of Uie vehicle, as much error is committed, by employing vastly too much of it. The quantity should be no more than will entangle the calomel 


358 
OF DIARRHCEA. 
tional sensible, though it is said with a greater certainty of ultimate effect; but this does not obtain in the child, where there is so much more irritability of system—and of course it must not be taken for a rule. Therefore, should a full dose be estimated to be six or eight grains, or even less, it must be divided into three or four portions; one of which, should be given every hour, until this quantity be taken, unless the previously exhibited parts have operated. And should this fail to have operated as an emetic, we may be pretty certain there is nothing offensive remaining in the stomach, and the calomel will sooner or later pass through the bowels. 
1264. We have made the above remarks, with a hope they may diminish the fears so very often entertained of the violence of this medicine; we can truly say, we have never witnessed a single instance of over-purging or puking, from this drug. We do not mean however to convey the idea, that it cannot happen; far from it; for we are sure it might take place, with it, as well as with any other medicine, injudiciously exhibited—we only mean, that too much apprehension is frequently cherished when it is exhibited. Therefore, a grain or two more of calomel to a child, beyond six or nine months of age is of no moment, provided this quantity is all the excess. Nor would we say there are not peculiarities of constitution, which would prohibit the use of this medicine. These cases however are so very rare as hardly to amount to an exception. But when they occur, they should be strictly attended to. 
1265. This complaint should never be neglected; especially, at such seasons of the year, as are most favourable for its production; namely, during the excessive heat of summer, or when the weather becomes cool in the fall; for when not attended to, it is apt to degenerate into a habit, and to be of extremely difficult removal. 
1266. 2. Indirectly. Diarrhoea may be induced, by the bowels sympathizing with some other part; as with the skin, upon the sudden check of perspiration; the application of cold to the surface of the body; or by the improper use of the cold bath. With the brain, from agitation of mind, particularly that of anger or fear; or with the mere sight of a purgative, which the patient is reluctant to swallow. The latter of these causes however, can- 


359 
OF DIARRHCEA. 
not be said to operate with children; and are only mentioned to prove, the exjent to which the bowels may sympathize. 
1267. When diarrhoea is produced by indirect agency, especially cold, it will frequently continue, even after the cause which produced it, is removed. This kind is rarely accompanied by pain, unless fever be excited; in which case, the bowels suffer sometimes very much; the skin is often very hot and dry; considerable thirst, white tongue, and great fretfulness. There is almost always mucus mixed with the faeces, in such cases. 
1268. This case is treated very much like the former, except where pain and fever attend; then castor oil is the best remedy. This should be given in appropriate doses,* every two hours, until it operate freely; or until the oil is observed to pass through with the faeces. If considerable pain continue after the operation of the oil, the warm bath may be used most advantageously. If perspiration be excited, the fever will quickly pass, though the tormina of the bowels may remain. Should this be so, an injection with a'proper quantity of laudanum may be given. This plan of purging, bathing, and giving laudanum, must be continued, as the symptoms may indicate, until the disease ceases. During the whole management of diarrhoea, the strictest regard should be paid to the diet and drinks of the patient. The former should consist of either of the diluted jellies of rice, tapioca, sago, or arrow-root; the latter should consist of thin flaxseed tea, barley water, rice water, gum Arabic water, or an infusion of the slippery elm bark. 
1269. Should the bowels be sympathizing with the gums, the disease will prove more obstinate, and perhaps be even continued in a chronic form, especially if the early part of the disease has been neglected, or improperly treated. 
1270. The mouth, under these circumstances, requires attention; for if the teeth give much irritation, the diarrhoea may con- 
* Castor oil should always be made thin by warming, before it is given; and it is always easiest to take, when it is not mixed with any other substance. A large tea-spoonful is a dose for a child from one to three months old; a desertspoonful, for one from three to nine months old; a table-spoonful, for one from nine months to eighteen months old. These are of course but very general directions, for only such can be given. The increasing, repeating, or diminishing the dose, must be regulated by circumstances; of which, almost any body who has charge of children, will be a competent judge. 


360 
OF DlARRHOSA. 
tinue so long as this last, however industriously we may address remedies to the bowels. In every case of this disease, where teeth can be suspected of having an agency in its production, the gums should be carefully examined; and in doing this, the recollection of the general order in which the teeth are cut, (See Book L p. 193. par. 656.) will greatly aid in the detection of the irritating teeth—but this order must not be scrupulously relied on, as the deviations as already noticed, are considerable. 
1271. Should the gums be swoln, the teeth should be cut down to, and that freely—but if there be no swelling, or inflammation in the gums, it would be as unavailing as cruel, to lacerate them. So far as our experience goes, we think we are justified in saying, there is no possible advantage derived from this operation, when there is no evidence of irritation in the gums from the protruding teeth; though we confess there are many experienced, and intelligent practitioners in the habit of performing it. We think we have never known the slightest advantage derived from dividing the gums, when there was neither inflammation, nor swelling in them, though the teeth were rapidly making their appearance; for the act of cutting teeth, as we have already said, (674) is not always attended by a sympathizing system. 
1272. We are aware, that many are opposed to the use of laudanum in the early stages of diarrhoea; but we think they are too indiscriminate in the rejection of this remedy. We are ourselves adverse to its administration, where the bowels have not been liberally purged; where there is fever; and where there is no pain; but where neither the want of due purging, nor fever, make a contraindication, we almost always give a few drops at night, and especially if the child be very restless, or in pain. We are persuaded we very much abridge this complaint by this plan; and almost certainly prevent its running into a chronic form, after we have removed, as far as ki our power, the exciting causes of the disease. 
1273. During the continuance of this disease, we strictly forbid animal food or juices, under any form.* If the child 
* We were not a little surprised to find the following observation from Dr. Cheyne, on the subject of proper diet for children; namely, that "an animal diet produces less irritation than one which is solely composed of vegetable matter," 


361 
DP DIARRHCEA. 
be at the breast, let it be confined to it, if the mother lias a sufficient supply; if she have not, let it be in part supported by reduced milk, and a little sugar. Its drinks may be very thin milk and water, barley, or rice water, or simply water, if it refuse those just ment ioned. No solid food whatever should be given during the existence of this complaint; and every kind of liquor, whether fermented or distilled, should be peremptorily forbidden. The child should be more warmly clad, than usual, unless the weather is very warm; and its feet should be covered with socks or shoes, both by day and by night. If the weather be not excessively hot, but especially if it be cool, the legs must be kept enveloped in woollen stockings, and its body in flannel; provided the disease be not in its active state, and accompanied by fever and a hot skin. 
1274. The greatest care should be taken, that through a mis - taken kindness, the child does not receive articles every way injurious to its disease—such as fruits, (see Book I. p. 214.) meats, preserves, raisins, &c; and that it be not suffered to swallow the hundred infallible cures promulgated by newspapers, or recommended by officious and visiting gossips. 
1275. The child should not be permitted to sit on a damp or cold place; as stone or marble steps, pavement, &c; nor placed 
p. 36. It is certainly contrary to our experience, and we had like to have said to that of every body else. We have ever found reduced milk, rennet whey, gum Arabic water, thin sago, tapioca, or arrow-root, vastly more proper in all the complaints of the bowels, where nourishment may be safely permitted, than any animal juice, however much diluted. But we are persuaded that during the acute form of the disease, where purging is necessary, where there is pain, and fever, the less of any thing the child takes into its stomach the better. For at this time the condition of the system is such, as not to require nourishment, for who wants " to feed a fever," or who ever knew pain arising from irritation, or perhaps inflammation of the bowels, relieved by cramming the child with food? The only proper thing at such times, is a little of the mother's milk, if the child be not weaned, or if weaned, milk and water, if milk be known to agree with it; or the occasional use of thin gum Arabic water. 
Besides, we would ask of what possible use nourishment can be of at this time, since from the deranged, and irritated state of the stomach and duodenum, healthy or perfect digestion cannot be performed; and if it cannot, that which has been received, and not properly subdued by the stomach and duoilenum, is an extraneous substance to these parts, and acls like one, by keeping' up irritation. 
[47] 


362 
OF DIARRHOEA. 
so as to receive a draught of air, especially if its skin be disposed to moisture. 
Sect. II.—2. Of the Bilious Diarrhoea. 
1276. In this species, the faeces are loose, copious, and of a bright yellow, or green; and the bowels are stimulated to inordinate action, by an overcharge of bile, either vitiated or not. This complaint is very frequent among our children during the heat of our summers, or as the fall approaches. The influence of a hot sun upon the actions of the liver, is well known to every bodyj it is familiar to common observation, that after a spell of very warm weather, even the healthy evacuations, of the adult, give evidence of its rapid formation, and sometimes of its abundant absorption. Thus the faeces are observed to be loaded with bilej and the urine to be deeply tinged with it; and when the complaint of which we are treating seizes upon children, it is called "the summer complaint." 
1277. If the adult system then can be so influenced by excessive heat, we need not be surprised that infants should suffer under the same power; and this very often, independently of the most of the remote causes enumerated under the first species. (1257.) 
1278. During our summers, the action of heat is both uniform and excessive; the liver feels its influence, and is forced to an inordinate secretion of bile, which being suddenly and rapidly poured into the bowels, stimulates them to excessive action, either by quantity or quality, or both, and thus the "bilious diarrhoea" is produced. 
1279. This action of the bowels, as in the species just considered, sometimes relieves them of their stimulating contents, and will thus effect their own cure—hence, this species like the other may be ephemeral; and is not more formidable than the feculent species, unless the formation of bile goes on almost indefinitely; or that fever is provoked. 
1280. No period of infancy is free from attacks of this kind; and especially, in summer, or early in the fall. We have seen extensive bilious evacuations from children often days old; and from this time, to every period of childhood they are obnoxious to them. 
1281. We believe teething very rarely occasions this complaint, 


363 
OP DIARRHOEA. 
though it may very much aggravate the general symptoms by increasing the natural irritability of the system, and thus give rise to fever. Should fever take place, the disease becomes more formidable: not because the discharges from the bowels may be increased, butbecause fever in itself under all modifications, is formidable. 
1282. The plan of treating this form of diarrhoea, will suggest itself; the bowels must be evacuated of their contents; and that by the remedy which so decidedly and successfully exerts a control over the actions of the liver; namely, calomel, in small, but repeated doses, until from the change in the appearance of the evacuations, it is judged the purging has been carried sufficiently far; that is, when a little of the mucus of the bowels, or small coagula of milk show themselves. 
1283. At night, in the absence of fever, the motion of the bowels should be tranquillized by a proper dose of laudanum*— preferably by injection if practicable; if not it must be given by the mouth. Should the complaint re-appear the next day, the calomel may be repeated, but at longer intervals, and only sufficient to procure a decided evacuation; this should again be followed by the anodyne, and so on, until the disease disappear. 
1284. The diet and drinks should he the same as before recommended; (1273) except, that rennet whey answers, both as nourishment and drink, an admirable purpose in this species of diarrhoea. 
1285. If fever attend, it will require more purging than if it be absent; but after the bowels have been properly evacuated by the calomel in the beginning, castor oil should be used; or if there be evidence of acidity, that is, greenish, or hard, small coagula of milk, magnesia, or magnesia and rhubarb are the pre- 
* The proper close of laudanum for infants and children, may be reckoned at the following rates. Half a drop for a child under ten days old; a drop, for one from that period, to the end of the month; a drop and an half, or two drops for one from that period, to three months; three drops from this time to nine months; four drops from nine months to eighteen; five or six drops from that time to three years—then for every succeeding year, a drop or two may be added. These doses are prescribed for children who are altogether unused to this drug; the power of bearing more, may be rapidly increased by habit. In giving directions for the use of laudanum, we should always understand the habit of the child in this particular, and regulate the prescription accordingly. When laudanum is to be used as an injection, we may safely increase the quantity three or four fold. 


364 
OF DIARRHOEA. 
ferable laxatives. The occasional use of the warm bath will also be proper. Much advantage is found in giving very minute doses of the tartrite of antimony every two hours in this condition of the system*—it maintains the action of the bowels, and very much abates the force of the arterial system. Should the small quantity given produce puking, give but half the quantity until the stomach will bear a fuller dose, unless bile be thrown up from the stomach—if so, encourage the discharge. 
1286. Mr. Burns says, " during the whole course of the disease, it is proper to support the strength with light nourishment, such as beef tea, arrow-root jelly, toasted flour boiled with milk, &c." " The strength should be supported by small quantities of white wine whey, given frequently." (Vol. II. p. 195.) 
1287. This advice must be taken with considerable caution, especially in using the beef tea, and the wine whey; as Mr. Burns himself admits, that fever attends this complaint, and that there is much intestinal irritation. In every disease almost, there is too much anxiety expressed, for the strength of the patient; it does not seem to be recollected, that the patient and the disease, are an unit; and when you attempt to strengthen the one, you run the risk of increasing the other; especially, if this be done with stimulating articles of diet. It should also be recollected, that debility is not disease—remove the disease, and you will rarely have trouble with the debility. Besides, where it is confessed there is much debility, it is never best removed by stimulants alone, unless every article of diet, however bland, or entirely vegetable, be considered as such. 
1288. Brown considers every thing, stimulants; and he divides them into two general classes; viz. the durable, as food of every kind; and the diffusible, as alcohol, in all its varied modifications, as brandy, wine, porter, &c. Therefore, agreeably to this scheme, every thing taken as diet, must be stimulating; let this be admitted; if it will be conceded at the same time, that they differ not only in force, but in their modes of action; that they differ in possessing, from the smallest, to the greatest power; and that the force or power of the stimulant, should be accurately 
* By small doses of the tartrite of antimony, we mean, from the tenth or twelfth to the twenty-fourth part of a grain. It should be carefully dissolved in itsproper or intended quantity of water, which should be accurately measured; the spoon by which the water was measured, should be the one to give it from. 


OF DIAKRHCEA. 
365 
proportioned to the state of the system. We will then say agreeably to this arrangement, that each article of food or of drink, must be dpfsidcred as a stimulant of a given power, and come under one of the classes just named; durable or diffusible. But on the other hand, it must be granted, that the true art of curing diseases consists in the regulation of stimuli, to the force of disease, or rather to the susceptibilities of the system to be acted upon. 
1289. If this be true, and we believe it will not be disputed, the use of beef tea, a highly stimulating article of the durable kind, and the wine whey, another, though not a very powerful one of the diffusible kind, are decidedly improper in affections of the bowels, where fever and local inflammation exist, as they do in almost every severe case of diarrhoSa. 
1290. It may be said Mr. Burns does not recommend them, where there is fever—he does not expressly; but he tells us, that " during the whole course of the disease, it is proper to support the strength with light nourishment, such as beef tea, &c." and "by small quantities of white wine whey, given frequently." (loc. cit.) Now what are we to understand by the whole course of the disease, but from its commencement to its termination? and fever, which he admits to accompany this disease, at least sometimes, can have existence but during some one part, or tlic whole of this period; therefore, the wine whey, and beef tea, must be given when fever is present; since it is "proper to support the strength, during the whole course of the disease." 
1291. If we can place any reliance upon the accuracy of our own observations, we can with much safety declare, that beef tea, or any other diluted animal extract, has uniformly been attended with bad consequences, in the commencement of almost all affections of the bowels; and this from a two fold action; 1st, it is too stimulating when applied to the surface of the irritated bowels; and 2d, in affording too much nourishment, for the febrile condition of the system. The wine whey, though a novel remedy to us in acute bowel complaints, is still more exceptionable, from its mode of action, than even the beef tea; therefore we should forbid it; as we make it a first and positive direction, that no animal substance of any kind, or in any form, shall be given in diarrhoea, even in its most simple form, when attended with bilious discharges; and we as positively prohibit, liquor of every sort. We have none of those overweening apprehensions for the strength of our 


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little patients, which would lead us to cram them with nourishment; consequently, we make very little provision for their support; believing the first object is, to free them from by the most prompt and efficacious means in our power, and until we do this, in acute cases, we permit strength to take care of itself. 
1292. But we must not be understood, to forbid all nutritious substances to the child; this we do not do; but we are very particular both as regards quantity and quality, when nourishment is permitted. The other articles enumerated by Mr. B. (arrowroot, boiled flour, &c.) we employ occasionally in small quantities, as well as rice water, barley water, gum Arabic water, thin sago, and tapioca; and rennet whey, during the period of purging, if the child be weaned; but if it be not, we confine it to the breast for nourishment,* and to barley, or rice water for drink. 
1293. It may be proper to observe, that in the species of diarrhoea we are now considering, we have not made, as some have, (Good, &c.) yellowness of the evacuations essential to it—we very often see them of various shades of green, from the bright grass green, to the bottle, or almost black green; this is sometimes accompanied by a frothy top, or the whole mass looking spongy, resembling very much the green production on the top of stagnant water; at other times, it is of pitchy darkness and tenacity. Where this last is observed, it has always been preceded by a pretty obstinate fever, which does not usually yield, until these black evacuations come away. 
1294. The bile is supposed, beside several other purposes, to neutralize the acid formed in the stomach; and when this is abundant, as well as the bile, it may give a tone of green to the evacuations. This use of the bile, must necessarily be important in infancy, where there is so strong a tendency to generate acid; or for the ingesta to become so, by tarrying long in the stomach and bowels. When then the bile is deficient in quantity, or the acid more than usually abundant, we have not only green stools, but oftentimes very frequent ones; owing doubtless to the presence of so much loose acid, coming in contact with the mucous coat of the intestines; hence the utility of absorbents in such cases, and the almost immediate cessation of diarrhoea after their 
* We even limit this sometimes; especially where there is much fever; or when there are many milk coagula discharged. In such cases, we permit the child to be nursed but seldom, and then in but small quantities. 


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exhibition, if they be purely absorbents;* as the prepared chalk, oyster-shells, &c. But as absorbents can only be given with advantage, where there is an excess of acid, they should be given with much caution, where this is not satisfactorily proved to exist; especially, where there is febrile irritation attending the diarrhoea, as almost always happens, when this complaint arises from teething. 
1295. Much injury has been sustained by mistaking green bile for acidity, and administering the cretaceous mixtures; authors abound with cases of cholera, convulsions, fever, &c. arising from this cause. It therefore becomes very important that the one should not be mistaken for the other. But we shall have occasion to revert to this subject, presently. 
1296. Where a bilious diarrhoea has continued for some time, either from the force of the remote cause, neglect, or ill treatment, and has been attended pretty uniformly by green and slimy stools,t we have often the satisfaction of seeing them speedily change to a bright yellow; this change in the appearance of the discharges, is almost a certain sign that the disease is about to yield. This has been effected, by ordering a proper regimen; regulating the heat of the body; covering the limbs with woollen stockings; applying flannel to the abdomen; prohibiting improper drinks; withholding "infallible remedies;"" lancing the gums; by the use of small doses of calomel, and the occasional exhibition of laudanum, either by the mouth, or by enemata. 
1297. In this stage of the complaint, we are sometimes aided very much, by giving lime-water and milk, in equal portions, % 
* We say, purely absorbents: by this we mean, where the union with an alkaline earth, will not form a purgative compound—thus when the carbonate of lime, as in chalk, meets with an acid, thetertium quid will not be purgative. But should we give magnesia, confessedly an absorbent, the union of the acid with it but improves its cathartic qualities; and of this we often take advantage, in certain conditions of the bowels. Hence, the risk which is sometimes incurred by the incautious use of the "cretaceous mixture," as suggested, (1295) by immediately putting a stop to the motion of the bowels. 
f By slime, we do not mean the mucous secretion of the bowels, which is white, or whitish, tinged with a little blood; but a tenacious bile itself, of a green colour, though not perhaps so intense as the general substance of the evacuation. 
\ The dose of lime-water and milk, may be a tea-spoonful of each, every hour or two, for children under six months; double this quantity, or even more, for older children. 


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several times a day; or sometimes by having their milk diluted with it instead of common water, where the child is either weaned, or is obliged to be supported in part by artificial means. 
Sect. III.— Mucous Diarrhoea. 
1298. The evacuations consisting of, or containing, a copious discharge of mucus. This species is commonly produced by a sudden check of perspiration, or the sudden application of cold to the surface of the body and the feet, especially in adults. We have seen it follow, in two instances, in children, the improper use of the cold bath. Children have been seized with this complaint, from the sudden transitions of the atmosphere, where they have not been properly protected. This species is perhaps the only one in which the teething of children has not been accused of an agency. 
1299. The discharges in this complaint are not so frequent, by any means, as in the species we have just been considering. There is sometimes a little forcing or tenesmus, and occasionally a little blood. The faeces are for the most part of a light green, and not very abundant, unless procured by medicine; then, oftentimes they are very copious, and offensive. A little mucus, always precedes the feculent matter, and is as sure almost to be followed by it. For the first few days, the mucus resembles that yielded by the nose in catarrh; after this, it becomes thicker, less transparent, and in a short time more purulent; and when purulent in its appearance, it is almost always found to be streaked with a little blood. This change is generally favourable, and bears a strong analogy to what takes place with catarrh, when about to get well. It therefore rarely requires any thing more than persisting in the demulcent food and drinks recommended above. Unless the stools now become numerous, thin and very yellow'or green; in this case, a little rhubarb tea, with very minute doses of laudanum, will be found to answer admirably well. 
1300. Fever rarely accompanies this complaint, in its milder forms; and it is of easy management, in general, with children; but in adults, we have known it very obstinate. The remote cause should not be repeated, if it proceed from cold bathing; and removed, or its operation prevented, if from cold, by additional clothing, &c. 
1301. The bowels should be gently purged by castor oil, and 


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its operation followed in the evening by a suitable dose of laudanum. This plan must be pursued daily, until the bowels are relieved; or they may be purged by rhubarb and magnesia during the day, and followed as before directed by an anodyne in the evening. The diet should consist of such articles as have been already directed; and the patient take freely of an infusion of slippery elm bark, or gum Arabic water. 
1302. Dr. Good condemns the use of purgatives, in this species of diarrhoea; but upon no good ground, that we can perceive— our experience is decidedly in favour of the plan just proposed, He would certainly purge in dysentery, to which it bears a pretty strong analogy, as far as regards effects and appearances; only in the mucous diarrhoea, there is in general no vascular excitement, and therefore most probably no inflammation, though certainly considerable irritation; whereas in dysentery,more or less always attends. Dr. Good, certainly would evacuate in catarrh, to which he says, it has "a striking resemblance." 
1303. He, and others, recommend in this affection, or in any " other looseness produced by a sudden chill upon the surface, small doses of ipecacuan. with or without opium." We have used this prescription at night, and we think with evident advantage; but it should not be given in the day, unless there is considerable pain; and then only after an evacuation of faeces has been procured. 
Sect. IV.— Chylous Diarrhoea. 
1304. This form consists of chylous or milky evacuations. It would appear that there is a deficiency of bile in this disease, as the dejections are not tinged with this substance—consequently, this complaint would seem to be necessarily accompanied by some derangement of the hepatic system, either positively or accidentally. The liver may not be in a condition to secrete this fluid abundantly, or its flow into the intestines, is by some means or other impeded. 
1305. We are inclined to believe in the first, rather than in the second condition of the liver; since we have never witnessed, that we recollect, this complaint being attended by jaundice. But why the lacteals should refuse to take up the chyle after it is formed, is very difficult to say. For there is a strong consent between the liver and the lacteals, as emaciation takes place very 
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rapidly, when that viscus is much deranged; or at all events, the lacteals may, like the intestines themselves, require the presence of a certain quantity of bile, to be healthfully stimulated. 
1306. Do the lacteals really refuse this fluid?—or is it only supposed they do not absorb any, because they do not take up the whole? Would this want of absorption really prove an incapacity to do so? May not the fluid ejected from the bowels be very far from a well concocted chyle?—and may it not, in consequence of this, lack the appropriate quality to stimulate them to the act of absorption ? 
1307. We have seen this complaint make its appearance suddenly in children, after weaning; and we have seen it make its approach gradually, after a pretty long continuance of bilious diarrhoea. In both these cases, we have supposed the digestive organs, particularly the duodenum, to be in fault, rather than the lacteals, or mesenteric glands. We have believed that the product of digestion has been ill elaborated, as well as too speedily passed through the bowels. The appearance of the dejections would seem to prove the first; and its quantity and fluidity, to countenance the second. 
1308. In consequence of ill elaboration, the chyme must possess new or unusual properties; possessing new properties, it would be likely to act upon the susceptible bowels, almost as a foreign substance; and they would, in consequence, be urged to an increased peristaltic motion; or become passive, by not being duly stimulated. And the absence of bile may be adduced in support of the belief of this absence of a certain quality in the chyme; since, the extremity of its duct is not properly stimulated to pour it out. 
1309. When a child is seized with this complaint, it very rapidly becomes weak, and emaciates with surprising suddenness; and if not relieved pretty soon, it becomes exhausted for want of nourishment. 
1310. In treating this complaint, whether it be pretty suddenly induced, or it follow a diarrhoea, we have always prescribed for the condition of the stomach; and we may safely say, we have generally succeeded. We should withhold almost all food from the stomach, that its weakened powers need not be longer overtaxed. We therefore confine the child to small quantities at a time of rennet whey, or gum Arabic water—nothing else is permitted. 


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We endeavour to restrain the passages, by an anodyne injection of full power, at night; and give, during the day, minute doses of calomel—say, a quarter-grain every four hours, with the twentieth of a grain of opium. We persevere in this treatment for a few days, unless the calomel urge the bowels too much—in this case, we diminish the quantity of calomel, and increase that of the opium. We have thought we have derived advantage from the application of a blister to the back of the neck, and keeping the whole body unusually warm. 
1311. We have seen the most decided relief from this planand giving the stomach very little to do, it becomes reconciled to its duties, and fulfils them after a little while perfectly. 
1312. Quere, would small quantities of bile, exhibited in some form or other, be useful in this complaint? 
Sect. V.— Lienteric Diarrhoea. 
1313. "The rapid passage of the nearly unchanged aliment through the bowels, constitutes this species of diarrhoea." With children, it sometimes follows the other species of diarrhoea, and perhaps oftcner dysentery. It is not accompanied by much acute pain, though the child appears uneasy after eating, but is immediately relieved by an evacuation, which is perceived to consist of the food a little while previously taken into the stomach. This complaint rarely comes on suddenly; and it may exist in differ ent degrees. When a tendency to this complaint is first perceived, it should be instantly attended to; for it is one of those affec tions, that rarely, if ever, cures itself. 
1314. It generally commences during the chronic state of diarrhoea, by showing perhaps, that some one article of diet only, has passed the bowels unchanged, as potatoc, apple, or other vc getable substance, or fruit, which has been incautiously given to the child. This is pretty soon followed by other articles, as meat, &c; and finally, every thing almost that enters the stomach, is speedily conveyed through the intestines, with little or no appearance of having been acted upon by the powers of the stomach. The appetite is sometimes voracious, in this disease; and the thirst is always considerable. 
1315. Dr. Good declares "the bile as in the case of chylous 


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diarrhoea is not duly secreted, or is obstructed in its passage; for were there a free flux of bile, the faeces, however crude and unconcocted, would display their common hue which they rarely exhibit." This is not altogether accordant with our experience; we have rarely if ever failed to see bile in a greater or less degree accompany the lienteric discharges, and sometimes we have seen the food embedded in a quantity of pure bile. That the functions of the liver may be impaired or vitiated in this complaint, we have no hesitation to believe; but that the secretion stops altogether, or that its passage is obstructed, as a common event, we cannot accede to, at least when it happens with children; and we confess ourselves not to be familiar with it in adults. 
1316. If no bile were secreted, none could appear in the stools; but Dr. Good seems to confess there is occasionally the presence of bile in them, though he says they " rarely exhibit" it. We on the contrary say we do not recollect an instance in which there was a total absence of this important fluid in the stools. It may readily pass unobserved, if it be not looked for; since the frequency of stools is sometimes so great, as to attach but little bile in their course. There cannot be an obstruction to its flow, as there are no signs of jaundice. 
1317. This complaint seems to be seated altogether in the stomach itself—and owes its existence to the too great irritability of this organ; for no sooner is food lodged in it, than it makes efforts by an increased peristaltic action to discharge it; and the intestines transmit it with equal speed to their extremity, there to be discharged. Dr. Good suggests that " the gastric juice may not be secreted in proper quantity or with proper qualities;" this may be; but it is not sufficient to account for the phenomena; for this happens precisely in dyspepsia, but dyspepsia is not attended with lientery. 
1318. We have been in the habit of treating this disease, very much after the manner of " chylous diarrhoea," to which it has a very strong resemblance in the rapidity with which the food is passed through the tract of the intestinal canal; and would seem to be but an excess of it—in the one, the stomach digests to a certain extent; but confessedly imperfectly, as the ill-concocted mass is hurried from the stomach into the intestines before it can be properly elaborated In the disease in question, it tarries 


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a still shorter time; and for the most part, passes with little or no change. Our plan of treating this complaint will be better understood by relating one of a number of cases which have fallen under our notice. 
1319. The daughter of L. A. aged ten months, had a pretty serious attacks of bilious diarrhoea, in consequence of her teeth passing with difficulty through the gums. She was however relieved of this, by small doses of calomel, the occasional use of laudanum, and by cutting her gums. Being an only child, and a great pet, especially with two or three aunts, who were doomed to "single blessedness," she was too early indulged in improper articles of food, though she was ordered to be confined to the milk of her mother. She was permitted to taste of every thing she craved, though several of these articles were observed to pass the bowels unchanged—among these were portions of Irish, and sweet,potatoes, and raisins. This gave no alarm to the loving aunts, or to the inexperienced mother; and she was permitted for a while longer to gratify her capricious desires, until the stomach lost control over every thing received in it; and of course its contents were transported through the bowels unchanged. We were now again sent for. 
1320. There was neither nausea, nor vomiting in this case; but the thirst was great; the urine small in quantity; high coloured, and of a very strong smell. The child began to fall away, and its strength to decline rapidly. We ordered that no kind of food whatever should be given, save that of the milk of the mother, and that only once in four hours, and then not in full quantity. Should the thirst require more fluid than the milk, to satisfy it, by giving from time to time a tea-spoonful of cold water. To put woollen stockings on its legs; flannel it was already wearing on its body. To have the abdomen rubbed three or four times a day, for ten minutes at a time, with the bare warm hand. To not awake the child when asleep, under any pretence whatever; to have her taken across the river in the steam-boat two or three times in the afternoon, when the weather was suitable. 
1321. In addition to this, she was to take four drops of chalybeate wine, and a quarter drop of laudanum every two hours, in a few drops of sweetened water, when awake. This plan was 


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pursued for two or three days before any change was perceived - but at the end of this time it was observed, that the food remained rather longer in the stomach after nursing, though the milk seemed to pass off unchanged, with some small tinges of brighter yellow than before. 
1322. Thinking advantage might be derived from stimulating the external surface of the abdomen more powerfully than by the frictions of the hand, we ordered the tartar emetic ointment in the proportion of a drachm of the tartrite, to an ounce of simple cerate; a portion of this to be applied once a day over the whole surface. The quantity of laudanum was increased to half a drop, every two hours; the nursing, drink, and exercise as before. 
1323. At the expiration of three more days, the discharges from the bowels were less frequent; the milk was perceived to be slightly curdled;* the bile more evident, the urine rather more abundant, and the skin of a more uniform and natural warmth. The ointment had produced no effect upon the* skin; it was ordered to be rubbed twice a day—no increase of nourishment, and the same drink. 
1324. At the end of three more days the stools had become less frequent; they bore evident marks of digestion, and were assuming a more decided tone of yellow. The skin was beginning to show signs of irritation; the ointment continued; the laudanum increased to three-fourths of a drop, the nursing, drink, and exercise, to be continued as before. 
1325. At the expiration of another period of three days, we found every thing much changed for the better—had had but two evacuations for the last twenty-four hours—digestion much more decided; stronger evidences of bile; the urine much freer, lighter coloured, and less rank in smell. The skin of the abdomen pretty much irritated. The laudanum was not increased; the nursing was permitted to be a little more in quantity, but not oftener; the water was sweetened now with a little loaf sugar, as the thirst was considerably abated. 
1326. Another interval of three days had passed. One stool only per diem, but it was large; some portions of white curd mix cd with the new yellow faeces—faeces pretty offensive; urine suf 
* In some cases, there appears to be an excess of acid; and the milk passes through, in the form of whey and coagulum. 


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ficiently abundant; the abdomen much irritated; the skin and pulse natural. It may be well to observe, that the pulse was little or none affected during the whole time, on which account we did not notice it hitherto in our reports. 
1327. As the mother's milk was sufficient in quantity, as well as good in quality, we ordered the child to be exclusively confined to it—but that it might be nursed rather more frequently; to permit the vesications on the abdomen to heal gradually; to continue the laudanum, but much less frequently, say, three or four times a day; and should the bowels now become rather confined, of which of course there was a risk, to have them opened by an injection of molasses and water. 
1328. The child was now ordered to the country, from which it returned in about three weeks, in perfect health. 
1329. We have found this disease, generally speaking, to be a manageable one, when sufficiently early attended to; but when suffered to run on to the last stage of debility, little or nothing can be done. Or when it occurs in the adult, it but too generally proves fatal, as it for the most part takes place, but in feeble and worn out constitutions, from hot climates, after chronic dysentery, or diarrhoea. 
1330. There are several varieties more of diarrhoea, but of which we have never seen cases, and consequently, can say nothing from our own experience; nor has the experience of others, discovered any certain method of cure. Besides, they appear to belong exclusively to the adult—at least, we have never witnessed them in children; such are diarrhoea serosa, tubularis, and gypsata. 
1331. In our account of the several diarrhoeas, which we have just passed, our histories, and the method of cure, have reference 
principally to their acute or sub-acute stages. We shall now occupy a few minutes, upon these diseases, when they have 
assumed a chronic form. But it may be proper to observe, it is not necessary to keep up the distinction of species; as they appear to merge into one common form of disease, after they become chronic. 
1332. Thus the feculent, the bilious, and the mucous, may become chronic, and require but little If any variation of treatment. This especially happens when these diseases are neglected, about 


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OF DIARRHOEA. 
the period of teething and weaning. Several writers have described this disease, as De Salle, Cruveilhicr, Hamilton, &c; but none so well as Dr. Cheyne. Mons. Andral has been very attentive to the chronic form of diarrhoea, and has made many post mortem examinations; they agree very much with those of Dr. Cheyne, as regards the state of the mucous membrane, and of the intestines themselves. 
Sect. VI.— Of the Chronic Form of the Diarrhoea of Infants, 
1333. We have already said, that several of the species of diarrhoea already treated of, may be made to run into a chronic, form, of very difficult management, as well as of great danger; 1st, by neglect; 2d, by the continuance of the remote and exciting causes; or 3d, by improper treatment; thus, those children, who have been too early weaned; improperly fed after weaning, or separated from the breast at an improper time, are more obnoxious to it than those, who have been more properly managed. 
1334. The form of the disease, which we are about to describe, occurs sufficiently often in this country, to make it formidable; but is of much more frequent occurrence in Europe. It would seem also, to be more common in one portion of country, than in another; thus in Scotland, agreeably to Dr. Cheyne, it is a disease of frequent occurrence; less so in England; and in France, according to De Salle, it was considered an epidemic. There the disease acquired the name of "Maladie de Cruveilhicr," because this physician, first described it there; though it is essentially the same, as that so well detailed by Dr. Cheyne, under the name of "Atrophia ablactatorum," or "weaning brash." 
1335. We have just hinted that the " Atrophia ablactatorum," or " weaning brash," was nothing more than the chronic form of the several species of diarrhoea,' to which infancy is liable. And though this complaint is confessedly more common, at the period of weaning, or immediately after the child is separated from the breast, it may occur at other periods, and from other causes. Every diarrhoea, after it has continued from fourteen to sixteen days, may be considered as chronic; therefore, the disease so ably treated of by Dr. Cheyne, must be considered only as a perseverance of the common diarrhoea of children, during sum 


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OP DIARRHOEA. 
mer and fall, and not a new, or distinct disease. This is confirmed we think, by the phenomena; the causes; the mode of treatment, and the post mortem examination. For even the feculent diarrhoea, or the cholera crapulosa of infants, may be continued to a chronic form; and when it has assumed this, it presents like phenomena. 
1336. Dr. Cheyne, (p. 16.) describes this disease as commencing with a "purging,and griping pain, in which the dejections are of a green colour." So do the diarrhoeas of infancy, very often, let the period of attack be when it may; for though in the mild forms of this disease; especially, in the very beginning, the stools are for the most part yellow, yet they are not so necessarily—for we have an hundred times, seen them green, from the very first discharge. 
1337. "When this purging is neglected,and after continuing for some time, there is added a retching, with or without vomiting; when accompanied by vomiting, the matter brought up is frequently coloured with bile," (p. 16, and 17.) Is this not precisely what happens in all loosenesses? Nothing is more common in a diarrhoea of some standing, than this affection of the stomach, or this appearance of the matter thrown up. 
1338. " These increased and painful actions of the alimentary canal, produce a loathing of every kind of food, and naturally are' attended with emaciation and softness of flesh, with restlessness, thirst, and fever," (p. 17.) Is this not the ordinary march of neglected, or ill treated diarrhoea? 
1339. "After some weeks, I have often observed a hectic blush on the cheek; but the most characteristic symptom of this disease, is a constant peevishness, the effect of unceasing griping pain, expressed by the whine of the child, but especially by the settled discontent of its features; and this expression of discontent, is strengthened towards the conclusion of the disease, when the countenance has shared in the emaciation of the body," (p. 17.) Who has not observed all that is said here, when diarrhoea had become protracted, and was hastening towards a close? 
1340. "In the progress of the disease, the evacuations from the belly, show very different actions of the intestines, and great changes in the biliary secretion; for they are sometimes of a natural colour, at other times slimy and ash-coloured, and some- 
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times lienteric," (p. 17.) Every author who has written on the subject of diarrhoea, describes this mutable complexion of the faeces in this complaint. 
1341. "The disease seldom proves fatal, before the sixth or seventh week; I have seen, though rarely, a child recovered, after the disease had continued three or four months; and again, I have seen the disease cut short by death, in the second, third, or fourth week, before it had reached its acme; the sudden ter* mination having been occasioned by an incessant vomiting and purging, or by convulsions, from the immense irritation of the bowels," (p. 18.) Cannot every practitioner of any experience declare, he has witnessed the same abrupt and unexpected termination of our summer and autumnal diarrhoeas? 
1342. "The disease is more frequent in children, who have been weaned before the eighth or ninth month, and in particular, in those who, in consequence of some accident happening to the nurse, have been weaned abruptly," (p. 18.) These observations comport with all experience in this complaint; especially, in this country. So well aware are mothers of this fact, that they never wean their children at this period, but from absolute necessity. 
1343. "This is a disease of the autumnal months. I have seldom seen it, comparatively speaking, commence before the solstice, nor after the end of the year; and I suspect that it is most general in sultry seasons." This agrees with the periods of our diarrhoeas of children entirely. This complaint is most rife with us, from the beginning of July, to the beginning of October. It is certainly too more frequent, in our damp, hot summers. We believe that moisture, contributes considerably to the production of this complaint, since the functions of the skin are less perfectly performed, than in dry summers. Our present summer, (1825,) is perhaps unparalleled in the recollection of any body, at least, for the intensity, and the long continuance of its heat, and the dryness of the atmosphere; and is so far, (August,) unparalleled for its healthfulness. The bowel complaints of children are few, and of easy management, when compared with other seasons. 
1344. " At the time when weaning brash comes on, the teeth are usually appearing; and from a common notion, that a flux is wholesome during teething, the disease is sometimes allowed to 


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make irremediable impression on the constitution, before the physician is called." In this there is the most perfect coincidence, with our "summer complaint," both as regards period and consequences. 
1345. The post mortem appearances, detailed by Dr. Cheyne, correspond with those made in this country, as well as those by Andral and Cruveilhier, in France. They are every way so interesting and important, that we trust, we shall be excused for quoting them, especially, as they are short. 
1346. " In every instance, I observed that the intestinal canal, from the stomach downward, abounded with singular contractions, and had in its course, one or more intus-susceptions; that the liver was exceedingly firm, larger than natural, and of a bright red colour, and that the enlarged gall-bladder, contained a dark green bile. In some dissections, the mesenteric glands were swelled and inflamed; in others, however, these were scarcely enlarged, and had no appearance of inflammation." 
1347. "These contractions and intus-susceptionsare entirely of a spasmodic kind; as in the latter, the contained part of the gut, was easily disengaged from that which formed its sack; and in no part of the entanglement, were there adhesions, or even the marks of inflammation; and the contracted portions of the intestines were again permanently dilated, by pushing the finger into them." (p. 22, and 23.)* 
1348. "These appearances lead me to imagine, that the weaning 
* IntuS'Susception is perhaps among the most frequent causes of death, when this disease has run on so long. It has been observed by almost all writers, that this form of diarrhoea terminates sometimes very suddenly, by violent vomiting, or convulsions. Now, is it not more than probable, in these cases, that the immediate cause of death may have been the invagination of the intestine? 
This condition of the bowels would seem to exist much oftener than is suspected; and to an extent that is almost incredible: thus Mr. Burns informs us that in one case no fewer than forty-seven intro-susceptions were found in the same body; and that invagination of the intestines is the most frequent cause of fatal diarrhcea; that not less than fifty cases had occurred to his brother, in the course of his dissections. (Vol. II. p. 190. James's Ed.) 
This condition of the bowels unquestionably occurs, where no suspicion is entertained of its existence; for we have no certain diagnostic of intus-susception. In general, it may however be remarked, where there is more than usual pain; bloody slimy stools; violent vomiting, sometimes of faeces, and convulsions, this situation of the bowels may be suspected. 


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brash, in its confirmed state, is imputable to an increased secretion of acrid bile, or rather to the morbid state of the liver, which occasions this." (p. 23.) 
1349. In the chronic form of this disease, we can readily imagine the hepatic system to be deranged; and the secretions of the liver, by being either imperfect in their kind, or acrid in their quality, may over-stimulate the already severely irritated intestines, either to profuse secretion, inflammation, inordinate action, or spasm. The first, or profuse secretion, may account for the quantity of the matter discharged; while the others may serve to explain the various appearances of the dejections, their great frequency, the state of contraction, and the intus-susceptions of the intestines. Thus, while the stomach and bowels preserve their powers, or are but very little impaired, we seethe faeces of a yellow colour, and pretty abundant; or they may be even green, without their being very seriously implicated; provided the tone of green is not very intense, is pretty uniform in consistence, and somewhat gelatinous. 
1350. When the bowels are more severely irritated, as almost always happens, after the disease has continued for ten or twelve days, and more or less inflammation present, there is strong evidence of the liver participating in the affection, by the increased quantity of bile: this now becomes flocculent as it were, of a deeper colour, and not unlike the green of rue, with copious watery discharges. When the bowels are still more urged by increased or more extensive lesion, the stools become of a brown colour, much resembling chocolate, and are extremely fetid. But should the liver itself be much affected, the faeces may become of a yellowish white, or pus-like. 
1351. In the commencement of this complaint, or during what we have termed its acute or sub-acute form, we believe that the stomach, and the smaller intestines, are alone deranged; and hence, when this disease is taken early, and properly treated, it is easily controlled. But if the exciting cause be continued, and the complaint injudiciously treated, the liver, from its strong and constant sympathy with the stomach and bowels, becomes involved; and when this happens, the disease becomes more severe in its symptoms, and more permanent in its duration-—it. then constitutes diarrhoea in its chronic form. 


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381 
1352. The bowels may now be urged to severer duties, by the presence of a greater quantity of bile; and the very irritation arising from this cause, serves both to augment and perpetuate the secretion, by the liver sympathizing with the over-stimulated bowels; so that they reciprocally injure each other. Or the same effects may follow, and doubtless do sometimes, when the quantity of bile is not augmented, but altered in its quality; or neither perhaps need be required in some instances, provided the mucous coat of the intestine be inflamed—a circumstance known to occur, by post mortem examinations. 
1353. It may be asked, how is it, if bile be not altered in its quality, that it should produce inconvenience to parts, over which, in the best health, it constantly flows? There is a law of the system, which satisfactorily explains this —which is, that secretions do not injure parts over which they flow, so long as these parts remain sound or healthy; but if they are injured in any way, then these secretions become causes of irritation, and even of inflammation. Thus it happens with the bowels: in a healthy condition, they receive from the bile a healthy stimulus; but if from any cause they become irritated, as in the chronic form of diarrhoea, their natural stimulus, the bile, may from their altered condition become a source of serious mischief. 
1354. When this complaint has run on for a long time, especially in children who have been weaned, and have suffered directly from the change of diet, the mesenteric glands are sometimes found inflamed, and enlarged; but this is by no means con stant. We have seen death from this complaint, where, upon examination, no injury was found to have been sustained by the mesenteric glands. At other times, we have seen them an entire mass of disease. 
1355. Dr. Cheyne asks, "May not this, (the enlargement of the mesenteric glands,) proceed from the acrid nature of the alimentary matter, to which their absorbing mouths are exposed?" (p. 27.) We believe this to be the fact; and that their swelling, or becoming inflamed, was an effort to arrest the farther progress of this acrid substance, as a bubo does the venereal poison. 
1356. Dr. Cheyne, after having stated his opinion, as just noticed, that a mor bid condition of the liver and its secretions may be the cause of "weaning brash," very modestly declares himself 


382 
OK DIARRHCEA. 
afraid of attempting an explanation of the phenomena. He however proceeds to it in the following manner: 
1357. "The breast milk is a mild food, adapted to the powers of the child; I shall not say, the weak powers of digestion in the child, but rather to the peculiar powers, and properties of the secretions. When the child is weaned abruptly, and put upon common food, this becomes too violent a stimulus to the intestines. Between the liver and intestines, there is the most intimate relation. This excited state of the intestines, causes a discharge of bile into them, which increases the stimulus, and assists in maintaining the purging. Had the original cause, been accidental and transitory, the bile, like the operation of a smart purge, would have thrown off the offensive matter, and cured the complaint; but crude unfit food, being still poured into the stomach, the disease must proceed. It is probable, therefore, that, in the first instance, a redundant secretion of the bile, which may also be an acrid and imperfect one, originating from an irritation of the stomach, is a salutary exertion of the system, to remove the cause of the irritation from the intestinal canal. But I think it likewise probable that the frequent repetition of this effort, brings the liver into such a state, that it cannot return to the performance of its ordinary and natural function, when the demand for its unusual action ceases; and it is in this manner that the disease may continue, after the original stimuli have been removed, by putting the child upon a proper diet." 
1358. "The dejections are sometimes ochrey, or even clay coloured, which does not seem to favour the idea of a redundant secretion of bile. However, they continue pale but a short time, and soon resume the thin consistence, with their dark colour. The explanation of this I presume to be, that, during this interval, the spastic contraction may have seized the duodenum, at that part where the common duct emulges the bile into the intestines. And farther, I presume the intestines have now become so irritable, that they are stimulated to inordinate action by the aliment, even at the time when, from the supposed stricture of the duct, the bile may be deficient; and hence the griping pain still continues." 
1359. "But it may and most probably is, in the ducts, that the explanation of this irregularity, in a great measure, is to be 


383 
OP DIARRHCEA. 
looked for. I have upon dissection, found the bile collected in such quantity in the gall-bladder, that this accumulation became the cause of the confinement of the bile; for then the natural curve which the cystic duct takes, becomes so acute, and the distended bladder presses so much upon it, that the bile is prevented from flowing, or flows in very small quantity. By this retention, the bile becomes more concentrated, and thence perhaps more acrid. And finally, by some action of the stomach and duodenum, by which the very enlarged gall-bladder is compressed, part of its contents is forced out, the distended ducts are relieved, and the intestinal canal is inundated with bile." p. 24. 
1360. Dr. Cheyne farther observes, " notwithstanding my most diligent inquiries, I have seldom been able to deduce any of the derangements of the infantine system from teething; and I have been inclined to think, that those physicians who have represented this function as teeming with danger, have not accustomed themselves to that careful investigation, without which these diseases cannot be understood. The weaning brash, I have the strongest reason to believe, has no connection with teething, farther than they sometimes meet in the same child. I have known this disease, in many instances, where the gums were neither swelled, nor indurated, nor inflamed, and where there was no salivation, nor any appearance of any pain in the mouth. I have seen it where children were cutting their teeth easily; and where many of them came without difficulty before weaning; still the disease has supervened. But perhaps the strongest argument that can be used, would arise from the observation which I have frequently made, that this disease occurs in children of three months; and I have often known it several months before teething came on." 
1361. We have already expressed our belief, (p. 303,) that teething in itself is no disease, but that in many instances, it either called into action some latent disposition to disease, or aggravated any that might be present during the continuation of that process. If teething were a disease, strictly speaking, it should be more uniform in its consequences; or present phenomena peculiar to itself; but this it does not always do, for we have many times known teeth to make their appearance, long before the ordinary period, and when they were not announced 


384 
OF DIARRHCEA, 
by any one of the usual phenomena. We have also known them make their way so silently, and this about the period at which they might be looked for, that the only knowledge of their approach was their presence. All this we say in confirmation of Dr. Cheyne's observation. 
1362. But on the other hand, we are equally certain, that they disturb the system under particular circumstances, and that very frequently and powerfully, by calling into action, certain dispositions, which cannot very well be subdued until the disturbance in the gums, or the local, or teething irritation if you please, has been either moderated, or subdued. Therefore, when this subject is looked at in a practical point of view, it must be considered almost a dispute about words; for whether the act of teething be a disease in itself, or whether it excites those which are latent,v or exalts those which may be present, we must regard the cir- \ cumstance of teething, as one well meriting the attention of the practitioner: and farther, if he disregard the practical hints, this operation affords him, we fear he will often protract the sufferings of his little patient, or sometimes, but too certainly witness its death. 
1363. In the disease in question, we are certain that the most decided and prompt benefit has arisen from incising the gums; and when the teeth are really aggravating the complaint, it is in vain we prescribe remedies unless we remove this source of irrition from the constitution, by aiding nature to push these bodies through the irritated or inflamed gums. We must therefore very often regard cutting the gums, as one of the remedies proper in the " weaning brash." 
1364. For the prevention of the " weaning brash," Dr. Cheyne advises, that as this disease appears " much oftener in the autumn than at any other time of the year, that delicate children should at that season be kept a month or two longer at the breast than might be thought necessary at any other, rather than be exposed to the aches and hazards which never fail to accompany this distemper." p. 33. 
1365. This advice is in strict conformity to the usage of this country; it is so well understood by every body here, that a physician is rarely consulted about its propriety. During the months of June, July, August, frequently September, weaning 


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is never performed as a matter of choice, let the age of the child be never so proper, unless it has completed the cutting of its first set of teeth. The dread of our females in this country is the " second summer." 
1366. No fact appears to be better ascertained, than, that the "second summer," is one of severe suffering, and oftentimes one of great hazard to our infant population. Every mother seems to be aware of the disposition of the bowels to become diseased at this period of the child's life; but she limits the apprehension almost exclusively, to the consequences of " teething." We have already declared our belief in the agency of this act, when untoward, in the production, or aggravation of the complaints of the bowels; but this is but one of the sources of evil, to the poor weaned child at this period—the change of diet immediately after this has taken place, as has already Been observed, is another. 
1367. In keeping the child then at the breast during the months of the second year, as above specified, is most decidedly, but tacitly acknowledging the influence of the long continued operation of a hot sun, upon the tender systems of children, rather than proving the direct agency of teething in producing their bowel complaints; since, they are during the first summer, at those periods of greatest heat, very liable to diarrhoea, though this disease may be, and but too often is, aggravated in the second year by the process of teething. 
1368. Our long summer heats, generate "disposition" to disease, in both the hepatic, and intestinal systems; and of course require at such periods, but slight exciting causes, to rouse them into action; and these causes unfortunately, are so numerous, and of such certain application, as to give the child in its "second summer," but a poor chance to escape with impunity. Our children are tempted at this period of their lives, and at this hot season of the year, by the offering of fruit in every stage of immaturity; or of an over quantity of that which may be perfect. They are liable to receive from the hands of but too many inconsiderate people, food of the most improper and indigestible kind; and at the same time, they are menaced with all the "penalties" of difficult dentition: can it then be a matter of surprise, 
[50] 


386 
01 DIARRHQSA. 
that at this period, they should be assailed by disease, or that they should succumb under its influence? 
1369. It is confirmed by multiplied observation, that at no other periods of the year, is there the same risk in weaning, as in the commencement, and at the termination of our summers; and this from the causes we have just mentioned: they arc therefore eschewed with the utmost care, when there is a choice upon the subject. Is this not a farther proof, that the effect of season is more to be dreaded, than the mere process of dentition? since, at other portions of the year, weaning may take place with impunity, if the organs of digestion are sufficiently confirmed by age, to bear a change of diet, though teeth may be pretty rapidly pushing through the gums? Again, it is a fact perfectly well known, that children are born in every day of the year, consequently they must cut their teeth at every period of the year: yet, but one part of this time, is considered dangerous for this operation; and the supposed direct consequences of this act, namely, diarrhoea, is familiarly called the " summer complaint of children!" It therefore only amounts to what we have already attempted to prove, that teething is but the exciting cause of diarrhoea. 
1370. To diminish the risk of this period of life, the remote and the exciting causes of diarrhoea, or " weaning brash" must be as far as possible avoided. 1st, Of the remote causes. The utmost attention should be paid to the clothing of the child, (see Book I. p. 75. par. 226,) that it may not suffer from either an excess or deficiency of it; 2d, it must be protected against the chilling effects of a damp and cold atmosphere, by removing it from it when practicable, as in certain locations; prohibiting its exposure to the dews of the evening, or to the fogs and dews of the morning; to forbid, or rather to prevent, the injudicious use of the cold bath, &c.; 3d, to guard against the direct effects of heat, by not exposing it to the hot sun, and to the too cool shade, after such exposure. 
1371. 2. Of the exciting causes. By being vigilant that the child may not receive injury from improper food; as crude fruit, indigestible meats, or vegetables; 2d, that the child be not nursed immediately after the mother or nurse has been overheated, or 


387 
OF DIARRHCEA, 
recovering from a fit of anger, or any convulsive action of the system; nor to persevere in the use of the milk of the breast, after evidence has been exhibited of its being of bad quality, either from its age, its imperfect elaboration, or the return of the catamenial discharge; 3d, to remove the irritation of teething, when this manifestly arises from the condition of the gums, by freely, and sometimes repeatedly, lancing them; 4th, by protracting the period of weaning, until some time after the forbidden months; 5th, by not weaning at too early a period of the child's life, though the season of the year be proper; 6th, by gradually accustoming the child to a change of proper diet, provided it has a sufficient number of teeth for this purpose. (See Book I. par. 695, et seq.) where we have sufficiently explained our views upon this point. 
1372. We firmly believe, that were these directions strictly complied with, it would rarely happen that children would be afflicted with diarrhoea, in either its acute or chronic form. We believe this, because we have more than once witnessed an entire exemption from diseases of this kind, even in large families, where strict attention has been paid to these points. 
Sect. VII.— Of the Treatment of Chronic Diarrhoea, or *' Weaning Brash. '' 
1373. Every body has experienced the difficulty of removing a diarrhoea, after it has taken a chronic form. This arises from several causes: 1st, because the hepatic system is now involved with the intestinal, (1278 and 1349,) in maintaining this complaint; 2d, because the stomach and bowels, independent of the condition of the liver, are seriously affected, by either inflammation, (1346,) ulceration, contractions, or inter-susceptions; 3d, because, very often the irritation is maintained by the presence of worms, which are sometimes difficult to dislodge; 4th, because the influence of habit is added to the original disposition to too frequent dejections. 
1374. When the first cause of difficulty prevails alone, the disease for the most part is of pretty easy management; the symptoms, here, may consist of too frequent discharges, of a green, slimy, or curdled appearance; with loss of appetite, nausea, 


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OF DIARRHCEA, 
and sometimes vomiting, and of increasing emaciation; the skin almost always dry, and very warm where covered; the urine scanty, and high coloured; the thirst great; and the disposition fretful, whimsical or sluggish. 
1375. Three indications here present themselves: 1st, to alter the nature of the actions of the stomach, bowels, and liver; 2d, to abate the frequency of the discharges; and 3d, to restore the lost strength of the parts immediately concerned, and the system in general. 
1376. The first indication must be fulfilled by freely emptying the bowels by castor oil, rhubarb, or calomel, and then by giving small doses of calomel; that is, from a quarter to half a grain, morning and evening, with three grains of prepared chalk, and from a tenth to a twentieth of a grain of opium, according to the age of the patient. The second must be attempted, either by rhubarb, or the cretaceous mixture: by rhubarb during the day, in the form of syrup, taken every three hours, in the dose of a tea-spoonful, or half a tea-spoonful, with half a drop or a drop of laudanum, according to the age of the child, to the degree of pain, or as the motion of the bowels may be more or less frequent; always proportioning the quantity of the laudanum, and the frequency of its exhibition, to the exigencies mentioned. At night, a sufficient quantity of laudanum by the mouth, or by injection, should be given, to keep the bowels quiet until the morning. 
1377. By the cretaceous mixture, when there is evidence of a prevailing acid in the evacuations. This may be known, 1st, by the green being light, and the evacuations watery; 2d, by the smell; 3d, by the appearance of portions of hard curd among the fasces; 4th, by the discharges becoming greener by standing; 5th, by the matter vomited, should vomiting attend, smelling sour, and the milk coming up in strong curd; 6th, by a dense white coat upon the tongue, which is a stratum of milk coagulum. 
1378. The best form of giving the mixture, is as follows: 
R. Creta ppt. 3iij. Tinct. Thebaic, gut. xx. vel. xxx. 01. Cinnam. gut. j. Sacch. Alb. 3ij. Aq. font. |ij. M. f. Julep 


389 
OV DIARRHCEA, 
A tea-spoonful of this must be given every two, three, or four hours, as it may influence the motions of the bowels. Where the motion of the bowels is kept up by acidity, the effect of this remedy is sometimes so prompt, that two or three doses, will entirely suspend the discharges—therefore, wherever this effect is observed, the medicine should be suspended, until the recurrence of a fresh necessity. 
1379. If it do not show this decided control over the motions of the bowels, it will nevertheless, if the greenness of the evacuations depend upon acid, very much abate their frequency, and change their green appearance to yellow; but should it depend upon bile, it will have little or no effect. It may be persevered in, as necessity may require. But we always feel it important in such cases, to tranquillize the bowels during the night, by a suitable dose of laudanum. 
1380. Should however, the motions of the bowels, be too long arrested, that is, beyond eight or ten hours, an injection of molasses and water, should be given; and if necessary it may be rendered more stimulating, by the addition of a little salt. In this way, the motions may be kept in subjection, or rendered obedient to the wishes of the physician. During the whole of the time, the most particular care must be paid to the diet, and drinks of the patient. 
1381. Nothing heating or stimulating, should be given, either as nourishment, or as drink; and every species of liquor, animal food, or broth, must be prohibited, if there be the slightest evidence of fever. The diet must consist only of such articles, as the stomach can best manage, as milk and water, gum Arabic and water, very thin arrow-root, sago, or tapioca; rennet whey, barley water, or rice water. Nothing solid of any kind, should be given. The occasional use of melted butter, is found oftentimes highly advantageous, in every state almost of chronic diarrhoea; but is especially so, where there is a predominance of acid, and where there are sparing stools, accompanied by hard curd, and a whitish mucus from the bowels tinged with blood. It is made by pouring boiling water, upon a lump of perfectly sweet butter in a tea-cup, and stirring it until it is melted; a tea-spoonful is skimmed from the top, and given several times a day. 
1382. It may be well to observe, that during the period in 


390 
OF DIARRHCEA. 
which too much acid prevails, but a very small quantity of milk should be used, unless it be reduced by lime-water—in this state of combination, it may be given; or if there be but very little fever, or none, chicken or beef tea may be used, instead of the vegetable jellies above mentioned; with the exception perhaps of the gum Arabic water. We are in the habit of continuing this mucilage throughout the complaint, where it does not disagree, or where the child does not refuse it. 
1383. The third indication may be fulfilled, by the proper use of diet.—permitting the use of weak broths, without vegetables being boiled in them, with the exception of rice; but even this must be strained from them before they are given. A soft boiled fresh egg, may after a while be given; a portion of ham may be sucked; or a little well boiled rice, with sugar, very fresh butter, and a little nutmeg, may be made to follow from time to time. 
1384. But if the child be weaned, nothing will so certainly contribute to its recovery, as its restoration to the breast, when practicable; or if the child be at the breast, and there is room to suspect the quality of the milk, a fresh nurse should be immediately procured. Should the teeth be in fault, the gums should be freely cut. Suitable exercise must be instituted; and when practicable, the child should be sent to the country for the benefit of a change of air. 
1385. Where the second condition (1373) obtains, the disease must be considered not only very far advanced, but highly dangerous; for it must not be concealed, that more or less danger must attend an inflammation of the mucous membrane of the intestines. Have we any certain marks, to distinguish this condition of the bowels? It may be suspected, where the pulse is very much accelerated; where the child is extremely restless; drawing up its feet and thighs towards the abdomen; crying loudly, or moaning frequently; if pain be increased by pressure upon the abdomen; if the skin be hot, and parched; if the evacuations be extremely frequent; a disposition to tenesmus; if the evacuations be sparing, slimy, or bloody, though frequent; if the thirst be excessive; and the tongue dry, red, and tender. All these symptoms, or the greater part of them, may attend an inflammation of the mucous tissue of the intestines. 
1386. The indications here, are, 1st, to abate the local inflam- 


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OF DIARRHOEA. 
matron-; 2d, to change the nature of the secretions of the liver and bowels, and to allay the irritation of the intestines; 3d, to diminish the frequency of the discharges; and 4tb, to restore lost strength. 
1387. The first indication must be attempted to be fulfilled, by local depletion, by leeches; by the occasional use of the warm bath; by blisters on the abdomen or thighs. The second, by the exhibition of the calomel in alternative doses; and by small, but repeated doses of castor oil. The third, by the occasional use of laudanum enemata, when they can be retained; or by its exhibition in small but repeated doses, by the mouth. And the fourth, by proper diet, as above proposed; by exercise; and by removal to the country. 
13SS. In this and in the subsequent stage, it may be proper to observe, that nothing but rennet whey, or weak gum Arabic water, should be given as nourishment, and even these in but very small quantities.* The thirst is best slaked by a tea-spoonful or two of cold water, given from time to time. 
1389. When this disease is still more advanced, and has been of long continuance, we have a right to suspect, what has been but too often proved by dissection to happen under such circumstances, contractions, ulcerations, and intus-susceptions. We have no diagnostic symptoms for these conditions of the bowels; and if we had, it might be justly doubted whether the knowledge of them would lead to any valuable practical end. We fear that in these cases, no other plan can be pursued, but a temporising one; for it is to be presumed, that every effort has been made during the previous stages of the disease, to arrest its progress. Therefore, we need but rarely flatter ourselves with the hope of a recovery, where the emaciation and weakness are extreme; 
* We are persuaded, that one of the most operative causes against recovery, in every bowel complaint, is the too frequent exhibition of food, both proper and improper; especially, during its active stage. The fear of weakness leads incessantly into error, on this subject; and neither reason, nor experience, is capable of destroying this absurd and dangerous practice. Every body would at once acknowledge it to be, not only preposterous, but even cruel, to place an additional weight upon the shoulders of a man who was staggering under the load already laid upon them—but they would think it right to do what is equally absurd and cruel to the stomach, by forcing upon it a fresh quantity of food, when it had not power to dispose of that which it had previously received. 


392 
OF DIARRHCEA. 
where nothing, or next to nothing, can be retained upon the stomach; where the abdomen becomes tympanitic; where there is almost a total stoppage of the secretion of urine; and where the stools are extremely offensive, dark brown, large in quantity, and mixed with either blood or a puriform matter, or both; and above all, when these are very frequently, and involuntarily discharged. 
1390. We have frequently known the bowels to continue to be purged, and that for a long time, by the presence of worms in the alimentary canal. We always suspect this cause, when the complaint has resisted the usual remedies; where the teeth cannot be in fault; where there is no appearance of bile, and especially, when the stools are of a dark brown colour, very thin and very offensive. The child also may have a tumid belly; a strong, or offensive breath; a furred tongue; a voracious or diminished appetite; itching of the nose, and sometimes regular febrile paroxysms. 
1391. We in such cases treat the disease as a worm case; either by pink root, worm-seed oil, or calomel. We always give a decided preference to the first remedy, where it is practicable to get the child to take it. And we may almost always succeed in doing this, with children who are of sufficient age to sit at table, and who are in the habit of drinking coffee, by using the pink root in the following manner. 
1392. Take the proper quantity of pink root,* and pour upon it about half a pint of pretty strong boiling coffee, and permit it to draw—pour off one-half into a cup, sweeten it, and put milk or cream in it, and give it to the child as if it were pure coffee, (for it is not to be informed it is not,) it will drink this almost always without the slightest hesitation. It will receive the other half at tea-time, managed as before; this must be repeated for three days, consecutively; on the fourth, should the bowels not be opened, (for it almost always stops the discharge in this period,) let the child have a dose of castor oil, or a few grains of calomel. 
* The dose of this article may be from a quarter of an ounce, to an halt ounce. The first quantity will do for children, from ten months, to a year; one-third of an ounce, from this time to two years; half an ounce from this pe riod to seven years old. 


OF DIARRHOEA. 
393 
1393. It must be observed, we have seen a stop put to a diarrhoea of very long standing, by a few doses of the pink-root, and this sometimes without any ocular proof that worms were the cause of it—we have therefore, for many years past, made it a rule, to exhibit this remedy, when the complaint has resisted the ordinary means. 
1394. If the pink-root cannot be given, the worm-seed oil may be substituted,* but it is by no means so certain. If neither can be given, or if there be too much fever for the worm-seed oil, (for it should never be given at that time,) the calomel may be used,and sometimes with the most prompt,and decided advantage. 
1395. The following case which has lately been under our care, will illustrate this practice very well. A child of C. E. C. was weaned at four months, in consequence of the illness of the mother. It was however very well nourished by the bottle; it throve well, and had several teeth before it was seven months old. It was attacked in the month of June with a bowel complaint of the ordinary kind, from which it was pretty speedily relieved by calomel, &c. In July it had a return of this complaint, with more violence than formerly; owing it was supposed, to several teeth that were making their appearance. 
1396. The gums were considerably swelled, and inflamed; and the child slavered very freely. Its lax was very profuse, but the stools were of a good colour. The teeth were liberated by lancing the gums; the diarrhoea abated by the use of calomel, syrup of rhubarb, and a testaceous mixture, and the child sent to the country to recruit. About a fortnight after it had been there, the bowel complaint returned with considerable severity; its evacuations were very frequent, bilious and offensive. The former remedies were again tried, but not with the former success. The child began to emaciate; to become sick at stomach, voiding green, acid and watery stools. By the use of absorbents, and very small doses of calomel, he was again relieved ; but this was but for a short time. 
1397. The bowel complaint became now very severe; the belly was much enlarged; the urine nearly suppressed; the child very languid and fretful; its food would frequently pass 
* There are printed directions accompanying each bottle of the oil, for its use. 
[51] 


394 
OF DIAKRHCEA. 
through it without change; it would almost every day have a kind of spasm in all the muscles of the body, which would last sometimes for many minutes together, and these would be repeated three or four times a day. A regular paroxysm of fever established itself at six o'clock, every evening, which would terminate next morning in a profuse perspiration; the child was incessantly picking its nose; was very fretful, and whimsical; appetite sometimes good, at other times would refuse every thing. When the febrile paroxysm was off, the pulse was pretty natural; its tongue was much loaded, and its mouth studded with many little painful pimples, and ulcerations; a great quantity of very tenacious, transparent saliva flowed constantly, even to annoyance. The child was now turned of ten months, and had ten teeth; the gums were carefully examined, but there was no swelling of them, to lead to the suspicion, that dentition was the cause of the symptoms. 
1398. Believing there were worms in the case; knowing the impossibility of giving the pink-root, and that the system was not in a situation to receive the worm-seed oil, we determined on the use of small but frequently repeated doses of calomel as in the following formula:— 
R. Calom. ppt. gr. iij. Creta. ppt. 9j. Gum. opii. gr. ss. M. div. in. xij. parts. 
1399. One of these was ordered to be given every two hours, until bed time, at which time six drops of laudanum were to be given. On our visit the next morning, we learnt the child had passed two worms, and was evidently much relieved.* The 
* The character of these worms, as far as we could judge of them in their mutilated state, was altogether different from any we have seen; and entirely different from each other. We regret that sufficient care had not been taken of them, to prevent injury. One was about double the length of the other; it was of a dark brown colour, broader at the tail extremity than at the head. It was seen by the aid of a strong glass, that the head was of a triangular form, and evidently had two oscula. The body was so much injured by compression, that we can say nothing certain about it. The other was about four inches in length; of equal thickness throughout; of a pale yellowish red; transverse lines very near each other through the extent of the body; the position of the mouth appeared to be transverse, and the head obtuse and round. 


395 
OV DIARRHCEA, 
bowels were very much less frequently moved. The powders were ordered to be continued. The medicine operated pretty freely the next day—brought away nothing very remarkable, except dark green slimy bile. The powders were continued, and was informed the day after, (being indisposed did not see the child,) that the child had passed the previous night, a knot of worms of the size of a nutmeg. This was all the information we received, but that the child was very well. 
1400. Habit sometimes perpetuates the discharges from the bowels; this cause may be suspected when the evacuations occur at nearly stated periods of the day; when they are not continued through the night, and when the digestion goes on well, and the stools look natural. Children from the long continuance of diarrhoea, and those of sufficient age to feel a sense of shame, and especially those who have been schooled into good habits in regard to their evacuations, are always sure to obey the first impulse, or warning the bowels give, that a discharge is about to take place, and by this means, no doubt have provoked an evacuation, which a little self-command might have checked. By this means almost all influence over the sphincter is lost, and the discharge is maintained from habit. 
1401. Laudanum we have found the best remedy for this kind of diarrhoea, especially when combined with prepared chalk; it should be given as frequently as the state of the bowels would seem to require—that is, given immediately after each evacuation, and telling such as can comprehend the instruction, not to obey the desire as long as they can possibly resist it. 
CHAPTER XXVIII. 
OF CHOLERA INFANTUM. 
1402. This is a disease almost peculiar to the climate of the United States. Children, in other countries, are liable, during dentition, or from other causes, to various affections of the alimentary canal, all of which differ from our endemic. 


396 
OP CHOLERA INFANTUM. 
1403. The exciting causes are, improprieties in diet and clothing; and it is likewise very often aggravated, by teething, worms, by premature weaning, and by a variety of adventitious circumstances. 
1404. Cholera infantum makes its approaches in different ways. In some instances, it comes on as a simple diarrhoea, though the stomach is also very apt to be affected; and in its more violent forms, there are vomitings and purgings, attended by no inconsiderable spasmodic uneasiness, constituting the cholera morbus of farther advanced life. In its ordinary forms, the fever, which soon supervenes, is of an irregular remittent character; the exacerbations being highest in the evening. The pulse is usually small, quick, and feeble, or irritated, and corded; but rarely full, strong, or voluminous. Determinations to the brain, or at least, this organ seems early to be affected sympathetically; as is manifested by a tendency to stupor or delirium, or sometimes even frenzy. The eyes, also denote this cerebral affection; they are either fierce, or languid, in expression; and when the patient sleeps, are half closed. Thirst is intense, and for a time really unquenchable—cold water is clamorously demanded; but if swallowed, is instantly rejected.* An unequal distribution of 
* We are however disposed to believe, this would not so generally happen, were this article more judiciously administered, than it usually is. From the vehemence with which drink is seized by the little sufferer, it is evident how severe the thirst must be; to relieve this, water is given it in full draughts, and is sometimes violently rejected, before the last portion has arrived at the stomach. 
The child instantly renews its supplications for drink; and this with a countenance so beseeching, and a manner so earnest, that no resolution scarcely, can resist the appeal, though there may be the most perfect conviction of its mischievous tendency. Again it is presented, again it is swallowed, and again it is thrown up—and so it would proceed, were the demands constantly supplied, to an indefinite period. 
Much resolution is required; for much firmness must be exercised, not to comply with these insatiable demands; or at least to the extent that would satisfy the craving and anxious child. But its vehemence may be amused, if not absolutely diminished, by exhibiting the water by tea-spoonsful, and this as warm as it can well swallow it; for such is its desire for something fluid, that it will swallow the hot water as readily as the cold; or if it like it less, it will sometimes be less importunate in its demands. 
We have several times seen the most prompt advantage result, from exhibiting to the little sufferer, very small pieces of ice, every few minutes. It seems more certainly to abate thirst, and at the same time tranquillize the stomach 


397 
OF CHOLERA INFANTUM. 
temperature commonly exists; the head, and region of the stomach and bowels, being hot, while the extremities are cold. 
1405. The appearances of the evacuations from the bowels, are various. The natural faeces are mostly retained, though occasionally, small lumps may be found involved in the other discharges. These are sometimes thin and watery, and at other times, more thick and tenacious; consisting chiefly of slime, or mucus, occasionally tinged with blood. The colour may be green, or yellow; or white, or brown; and may be inodorous, or exceedingly offensive. Commonly, however, the smell is that of sourness, or of putridity. The irritability of the alimentary canal is sometimes so great, that the ingesta rapidly pass off unaltered, as in lientery. 
1406. We have few diseases, in which emaciation so rapidly takes place, or where, in its latter stages, there is a greater alteration of general condition and aspect. The child, at first, becomes pallid, and the flesh flabby; and, so completely is the fat ultimately absorbed, that the integuments hang in folds; and in those parts on which the body rests, livid spots appear, followed by ulcerations. 
1407. The skin on the forehead is tight, as if bound to the bone; the eyes are sunk; the cheeks fall in; the nose is sharp; and the lips are shrivelled. Even under such circumstances, which would seem to denote immediate dissolution, life will be in some cases preserved for weeks, and a recovery finally take place. The belly becomes tumid, from flatulence; the feet still more frequently are cedematous; aphthae appear; the mind, as well as the senses, which hitherto may not have been impaired, are now obtuse, or so entirely lost, that the child lies unmoved by ordinary excitements, and will even allow flies to collect on the face, without being irritated or disturbed. This form of the disease, will sometimes continue for five or six weeks. But as death approaches, a gradual aggravation of symptoms takes place; and there is one, which, as far as we have observed, has always proved fatal: it is a crystalline eruption upon the chest, of an 
better than water; on this account, it always deserves a trial, with children of sufficient age not to be injured by its being received in its mouth, at the risk of getting into the windpipe. 


398 
OP CHOLERA INFANTUM. 
immensity of watery vesicles, of a very minute size. The best idea we can convey of the appearance of this eruption, is to imagine a vast collection of vesicles, apparently produced by flirting an equal number of very minute drops or particles of boiling water, and each particle producing its vesicle. We first pointed out this appearance to our friend Dr. Physick, in the year 1794, in the disease now under consideration; and subsequently, under like circumstances, to Dr. Rush; both of whom acknowledged the eruption new to them. 
1408. This symptom may readily escape observation, if not looked for; it requires that the surface on which it has spread itself, should be placed between the eye and the light, and viewed nearly horizontally. 
1409. There is another symptom, which attends the last stage of this complaint, which is much more common, but not less fatal; which is the thrusting of the fingers, nay almost the hand, into the back part of the mouth, as if desirous of removing something from the throat. The popular opinion is, that there is a worm irritating the back part of the fauces. And we may mention another, which we do not remember to have seen noticed; which is, the escape of a live worm or worms, in the chronic stage of this affection. If the worm comes away dead, there is nothing in the circumstance; but if alive, it is a deadly sign. We have remarked the same in dysentery. 
1410. In other cases, however, especially where it puts on the character of cholera morbus, or dysentery, its progress is more rapid, and runs in all respects the course of these affections. Death, in the former of these instances', sometimes take place in a few hours; and in the latter, from three to ten or fifteen days. 
1411. The symptoms of this disease arc so peculiar, and so well defined in the genuine forms, that it will always be recognised without difficulty; therefore, we need not dwell upon its diagnostics. And where it imitates other affections, as cholera morbus, or dysentery, or diarrhoea, it may be considered as essentially such, requiring no difference of treatment. Cases most nearly resembling it, are some of those brought on by the irritation of teething. Even here, however, the treatment is analo- 


OP CHOLERA INFANTUM. 
399 
gous, so that no nicety of discrimination is required; though there are circumstances in the season of the year; the wide spreading of cholera infantum; independently of symptoms, which will enable us to do it. 
1412. The prognosis is far more difficult; since death sometimes happens, most unexpectedly; and recoveries take place, in a state of things apparently desperate. In the most violent form of cholera morbus, it often proves suddenly fatal. But cholera infantum, in its ordinary forms, may be considered as doing well, where the pulse becomes slower, fuller, and more natural; where temperature is restored to the surface, and equally diffused; where the irritability of the stomach and bowels subsides; and above all, where the alvine discharges, previously denoting the want of bile, now consist of dark bilious, offensive, or inodorous matter; or exhibit a more healthy aspect. Till this happen, or in other words, without the liver is restored to its natural functions, it may be laid down as an invariable rule, that convalescence does not take place. 
1413. An opposite prognostication may be made, or at least, imminent danger is to be apprehended, where there is an absence of the favourable signs just enumerated; and particularly, where, with a cold damp surface, there is a small thready pulse; lank, haggard countenance; incessant puking of whatever is received; purging of a pink coloured fluid, or of greasy fetid water, or of a dark flocculose matter, attended with extreme nervous sensibility, or an entire extinction of it; the child lying stupid, with its eyes half closed, or with occasional convulsions. 
1414. In protracted cases, the eye-balls become perfectly bloodshotten; mimicking a genuine inflammation: but it is nothing but a case of pure error loci, and must always be regarded as a bad, but not necessarily a fatal symptom—we have seen some few instances of recovery, after it had taken place. One who is not experienced in this disease, may encourage hopes which can never be realized. At this period of the complaint, or rather just before its fatal termination, the eye sometimes has its brilliancy and vivacity renewed, after it had been a long time nearly extinct; the general symptoms seem to abate; the child receives food, even greedily; and manifests an intelligence that 


400 
OF CHOLERA INFANTUM. 
truly astonishes. But the practised eye sees nothing in these changes, but the immediate forerunners of death. 
1415. Dissections clearly inform us of the .seat and nature of cholera infantum. The brain presents no morbid appearances, in recent cases, except those of congestion; but, in the protracted shapes, effusions are often met with, constituting hydrocephalus. 
1416. The viscera of the thorax are rarely affected. It is on the contents of the abdomen that it mainly expends its force. The effects of previous inflammation may be traced, in some cases, throughout the whole of the alimentary canal, though it is in the mucous membrane that they are principally to be found. Dark livid spots, are dispersed over this coat of the stomach, and of the small intestines, particularly the duodenum, near to the pylorus. Coagulable lymph is also, in some instances, spread on their surface, or is found in detached pieces. In many parts, there is an alteration of structure, by the thickening of their coats; so much so, that the calibre of the tube is reduced considerably. 
1417. The large intestines are seldom involved in this mischief; and perhaps, never, excepting where the disease assumes the dysenteric form. Now and then appearances similar to those of the primae viae, may be seen upon the peritoneum, though not to any extent. The liver, under almost all circumstances, and especially in cases of long continuance, is greatly enlarged, so as sometimes to occupy two-fifths of the cavity of the abdomen. But, though thus increased, there is not any very evident derangement of structure. It is merely distended, or swollen, by congestion; and, on this account, is more firm and solid, than natural—a state of things, evidently induced by torpor in the portal circulation. The gall-bladder, in some instances, is found filled with dark green bile, and, at other times, with that which is pale, or nearly colourless.* The other viscera of the abdomen are usually healthy. It may, however, be proper to add, that the contents of the bowels, for the most part, consist of a thick, tenacious mucus, involving small lumps of faecal matter, occasionally coloured by bile. When this disease causes death, by assuming a chronic form, it very much resembles the chronic form of diarrhoea, or weaning brash. 
* We have in two or three instances seen the gall-bladder filled with a fluid nearly as white as serum, and of but little more consistency. 


401 
OP CHOLERA INFANTUM 
Treatment. 
1418. The disease, as already stated, usually commences with a very disordered state of the alimentary canal; and, it seems to be admitted, that our earliest endeavours are to be directed to theevacuation of the stomach and bowels. As regards, however, the precise course to be pursued, to effect this purpose, there is not the same unanimity. Generally, purgatives are employed in preference to emetics; and especially the castor oil. Cases of a mild nature, may undoubtedly be treated in this way, and particularly if laudanum be occasionally added, when there is little or no fever. But, in the more violent forms of the disease, attended by vomiting, it will be impossible to get such medicines to be retained. It is, therefore, necessary that we attempt to allay the irritability of the stomach. 
1419. For this purpose, there is nothing so certain, or so prompt, as an injection of a gill of warm water, in which are dissolved three tea-spoonsful of common salt; this is for a child of a year old and upward, proportionably less for younger. And however frequent the discharges may be per anum, it must not be regarded; the injection must be given. If it operate immediately, and bring with it a faecal or bilious discharge, the stomach becomes almost immediately quieted; and may then be repeated only pro re nata—that is, whenever the vomiting be again severe. Should it not bring any thing off, it must be repeated; and an attempt made to force it high into the bowels; or should the vomiting not cease, it must again be had recourse to. 
1420. This repetition of the injection will either procure the discharge required, or it will produce a most salutary irritation of the rectum, on which its chief efficacy depends. We would wish this fact to be remembered; for a common injection of molasses, oil, and water, will do little or no good, though it may procure a stool, as it lacks the stimulating ingredient, the salt, on which its virtue depends. So decided and effective is this simple plan, that we have a hundred times seen it relieve entirely, almost without the aid of any other remedy. 
1421. The great desideratum in cholera infantum, is to tranquillize the stomach; if the disease has been provoked by any irritating matter in the stomach itself, it should be our first endeavour to remove it, by encouraging the puking, by draughts of 
[52] 


402 
OF CHOLERA INFANTUM. 
warm, or even cold water, where the warm will not be drunk, until no foreign substance appears in the matter thrown up—but do not let us administer an emetic; for, so long as nature continues her efforts to dislodge the offensive substance, it cannot be required, as she will certainly succeed if she be aided by warm water; and it can never be otherwise than injurious, after it has cast off the irritating material. 
1422. When this complaint attacks very young children, nearly the same plan should be pursued—that is, an injection of the same materials must be given, of nearly the same strength, but of less bulk, and this repeated when necessary—or should the first not succeed in allaying the irritation of the stomach, it should be repeated in half an hour. A tea-spoonful of strong coffee, without sugar or milk, every fifteen minutes, should be given to very young children especially; but we believe all ages would profit by it in larger doses. We have, in a number of instances since we first tried it, seen it act like a charm. 
1423. In the commencement of this disease, we have never seen the temporizing remedies, as the alkalies, the absorbents, or external irritants, of the smallest service; we, therefore, never employ them. At this time, also, we "discard all strong smelling substances from the room; and especially from the stomach within, or the belly without; as mint, spices, brandy, gin, &c. as we are convinced they are extremely offensive to the stomach, through the medium of the olfactory nerves. 
1424. If the stomach has not been tranquillized by the injection, or the strong coffee, we immediately commence with minute doses of calomel. We first prescribed this remedy in doses of half a quarter, or an eighth of a grain in cholera, in the year 1795, and were, by some of our medical friends, severely ridiculed, for the supposed insufficiency of the dose. But this did not deter us from the practice; for we have pursued it from that period until the present moment, though we could then gain but few to be of our opinion: since, however, Mr. Ayre has written on the subject, it has got into general use. We nevercombine opium with the calomel, in the early stage of the disease; being convinced it is better to exhibit it alone. The following is the form and average dose we use: 
R. Calom. ppt. gr. iij. Sacch. alb. gr. vj. M. div. in par. xij. 


403 
OF CHOLERA INFANTUM. 
1425. One of these powders is thrown dry into the child's mouth, every hour, until the bowels are decidedly operated on by them; this may be known, by the stools being more copious, less frequent, and of a dark green colour, with a tenacious slime of the same or nearly the same tone of colour. When this change is observed, the powders are given much less frequently; say, once in two, three, or four hours, as the symptoms may have abated, or proved refractory. After the bowels have been well evacuated, and the child in pain or pretty much exhausted, we order an injection in the evening, with laudanum proportionate to the age of the child. 
1426. Should the symptoms persevere, we renew the treatment of the previous day, until similar effects are produced; and the laudanum injection at night; pretty much after this plan do we treat the first or acute form of this disease. If much fever attend, with great gastric distress, we have found the most decided advantage from bleeding, or the application of leeches over the region of the stomach; or if there be much cerebral determination, bleeding from the arm, or draw blood from the temples by leeches. 
1427. Should irritation of stomach continue, and the legs and feet become cold, much good is frequently derived by blistering the legs, or from having them rubbed with mustard and warm vinegar, or Cayenne pepper and warm brandy, until the action of the skin is excited. But from what has been said it will appear, that our chief reliance is upon the use of the calomel. We are aware that many respectable practitioners are in the habit of giving larger doses of this article than we are; be it so—we are not at present, however, disposed to change a plan that has for so many years borne us out successfully in this truly fatal disease. Let every practitioner proportion his doses agreeably to his own experience; the administration of this remedy is all w,e are solicitous about. If one practitioner has found this remedy to succeed best in larger doses, let him employ them; we are satisfied with its efficacy in more minute quantities. We all have the same object in view, namely, to quiet the irritation of stomach and bowels, and to make a decided impression on the hepatic circulation, to invigorate or calm its actions, and thus restore the lost equilibrium in the distribution of the blood, which is essential to the performance of its natural functions. 


404 
OF CHOLERA INFANTUM, 
1428. Having thoroughly evacuated the prima? viae, and reestablished healthy secretions, we are to desist from purges; we should be content with keeping the bowels in a soluble statexonly; unless, we have evidence of re-accumulations of bilious, and fouler contents, or of hepatic torpor and congestion, when the same course is to be renewed. But if irritation be excessive, and, as usual, productive of frequent and painful discharges, we may with much advantage, administer anodyne injections, three or four times in the course of the twenty-four hours, after having applied a few leeches to the region of the stomach. These remedies will, in most cases, certainly calm the intestinal canal; and, as soon as this happens, the acrid discharges, together with the other symptoms, very generally cease to be troublesome. Yet, it will be occasionally necessary, to administer a mild purgative to remove oppressive accumulations, when they manifestly exist; for this purpose castor oil is best. 
1429. In addition to what has already been advised, for the management of this disease, we should be attentive to the means calculated to make a direct impression on the skin. For this purpose the occasional use of the warm bath is highly important. Every case of cholera, as formerly stated, is more or less marked by great inequality of temperature—so much so, that one portion of the body, will be parching hot, while another is very cold. By immersing such a patient in warm water, we equalize temperature, and diffuse a glow over the entire surface, while other benefits are at the same time attained. The effects of the bath, however, are not lasting; and hence, it is required to be repeated daily, or even oftener. It may be rendered more effectual, where there is much cutaneous insensibility, by adding to it salt, mustard or brandy—and upon coming out, to employ frictions, &c. 
1430. We have already glanced at the use of blisters. They are serviceable at any stage of the disease, if unequal temperature prevail; and may be applied over the stomach, abdomen, or to the extremities, according to the state of the case, and the more striking indications, that is, if the extremities are as warm as the abdomen, we may apply a blister over the region of the stomach; but if the legs be cold, blisters had best be applied to the calves of the legs, first irritating the surface by rubbing them with a little spirit of turpentine. In addition to their ordinary 


OF CHOLERA INFANTUM. 
405 
effects, they very usually promote perspiration. It is a fact, not sufficiently known, that without vesication, in certain conditions of the skin, diaphoresis will not take place. 
1431. This plan, however, proving unsuccessful, it must be intermitted; and, the bowels continuing highly irritated, with bloody evacuations, we may try the oleaginous mixture, consisting of castor oil, gum Arabic, and laudanum—or what perhaps is still better, melted butter, or a union of sugar of lead, ipecacuanha, and opium. The lead here is occasionally very efficacious. 
1432. In the course of a few days, in some instances, and in others, a week or more, the disease passes into the nature of diarrhoea, which however is sometimes attended by a slight degree of tormina and tenesmus. It is also usual, at this time, to find the stomach greatly debilitated, with a loss of the power of digestion ; and so irritable, as hardly to retain any description of nourishment. At this time also, the stools are apt to become very watery and green; manifesting the predominance of acid. The remedies proper, under such circumstances, consist chiefly of the cretaceous and alkaline preparations, variously combined. 
1433. They may be prescribed as follows:— R. Cret. Prep, vel Test. Ostreor. 3iss. Gum. Arab. 7 Sacch. Alb. 5 ™ 5j - Tinct. Theb. gtt. x. Aq. Font. |iij. M. R. Sal. Tart, vel Carb. Sod. gr. xxx. Gum. Arab. } . Sacch. Alb. 5 55 3j - Tinct. Theb. gtt. x. Aq. Font. §iij. M. 
A drop of the oil of cinnamon may be advantageously added sometimes, to either form of the mixtures. Lime-water and milk may be also usefully employed. 
1434. At this period of the disease, preparations of rhubarb are sometimes resorted to with advantage. The spiced or simple syrup of rhubarb, may be given, combined with small doses 


406 
OP CHOLERA INFANTUM. 
of laudanum. In the use of these preparations, the dose is to be small, and repeated at stated intervals, so as to attain rather the tonic, or astringent, than the purgative effect, of this medicine. 
1435. As the disease advances, it loses most, or all of its acute or painful symptoms, and becomes a colliquative diarrhoea; and so profuse, as to produce from ten to twenty stools in the twenty-four hours. 
1436. The treatment of this case is similar to that of chronic diarrhoea; we shall only here point out some of the remedies, suited to the cases of children. (See Chapter on Diarrhoea.) 
1437. Combinations of chalk, with the tincture of kino, or with an infusion of galls, and laudanum, are worthy of confidence. The columbo in infusion, has much reputation. An infusion of logwood has also been employed. The decoction of the pomegranate bark, or flowers, is said to be of great service. The dose of each of these preparations, is nearly the same—about a desertspoonful to children above a year old, and less for younger. A strong infusion of the dew, or blackberry root is said by many to be useful; it has never done much in our hands. By some practitioners, the chalybeates are not a little prescribed—the best of which, agreeably to Dr. Chapman, is the supersaturated sulphate of iron, in the following formula:— 
R. Sal. Martis. gr. ij. Acid. Sulph. gtt. x. Sacch. Alb. 3j- Aq. Font. §j. M. The dose 3j. 
1438. Even here, however, calomel is serviceable, when there are marks of hepatic congestion, or want of bilious discharges, or the presence of vitiated humours. But the chalybeate must be laid aside, if it be proper to use the calomel; and the bitter infusion be given instead. 
1439. Exactly under similar circumstances, and especially if the mucous tissue of the bowels be much disordered, as is manifested by the loaded tongue, and slimy stools, the spirit of turpentine, has been found highly beneficial. With this we have several times succeeded, where all hope has been abandoned. The dose is from five to twenty drops three or four times a day, in sweetened cold water. Before we dismiss this part of our subject, it may be well to observe, the occasional use of laudanum, 


OF CHOLEIIA INFANTUM. 
407 
when there is pain, is absolutely necessary; a flannel roller around the abdomen, is sometimes productive of signal benefit. 
1440. This brings us to the consideration of regimen. In the commencement of the disease, the diet should consist exclusively of breast milk; which is of such importance, that a nurse ought to be procured, where the child has been weaned. It will of itself, sometimes cure the disease. Caution however is necessary even Here, as the child from excessive thirst, may demand the breast too frequently, and thus overload its stomach; the child therefore must not be permitted to suck too much or too often. If thirst be importunate, cold gum Arabic water may be given in small quantities frequently, instead of the often nursing.* But if the child will not take the breast, let it be fed on diluted sweetened milk, or barley or rice water and milk, or gum Arabic tea. These will serve also for drink. But balm, or marsh mallows tea, soda water, and burnt bread and water, may also be directed for this purpose. In the advanced stages, the farinaceous articles may be employed—as very thin arrow-root, tapioca, sago, rice, or boiled flour. Extreme debility of the stomach and bowels existing, and no fever present, a little ham, or salt fish may be allowed. Yet the only remedy which is sovereign, and nearly unfailing, is a change of air. As long as the child remains in the city, and exposed to the operation of the causes of the disease, we may palliate, or suspend its career, but can hardly ever make a radical cure—relapse upon relapse takes place, till strength is finally extinguished. 
1441. Great benefit is gained by a removal to the country, in every stage of the complaint. It is even said by the late Dr. Rush, that he never lost but three patients, where this advantage was commanded; and it must be admitted, that there is nothing so effectual. As soon almost, as the child gets into the countryair, we may discover a change. Where we cannot have a country residence, entirely, it will be useful to ride it out daily, or twice a day. Crossing the river we have very often found highly beneficial. 
1442. To prevent a disease, so difficult of management, and 
* For the purpose here signified, an ounce of gum Arabic will be sufficient for a pint of water. 


408 
OF CHOLERA INFANTUM 
so destructive of life, and happiness, we shall indicate those measures which common experience has found best. 
1443. 1. Never permit a child to be weaned within the year, when practicable to prevent it. No food is so salutary as the natural milk. As respects this complaint, weaning always predisposes to its attacks. 
1444. 2. Direct the wearing of flannel next to the skin, and worsted stockings. The great benefit of this system, is experienced by grown persons, prone to intestinal complaints, and we know its utility to be no less in children. 
1445. 3. Duly regulate the diet—let an excess of any fruit be avoided, and unripe or unwholesome kinds, absolutely abstained from. The proper food of a child, is, substantially, milk, with farinaceous matter, such as arrow-root, rice, biscuit, &c. After a few months, provided it has teeth, it will be useful to accustom it to a little animal food. It strengthens the powers of digestion, and the general tone of the alimentary canal. 
1446. 4. During dentition, let the gums be frequently examined, and if any appearance of swelling or inflammation exists in them, they must be lanced. Dentition, during hot weather, is but too apt to excite cholera; and if the complaint exist, it never fails to aggravate it. (See Chapter on Dentition.) 
1447. 5. Let the child, when practicable, be removed to the country; but not too early in the season. 
CHAPTER XXIX. 
OF PERTUSSIS, OR WHOOPING COUGH. 
1448. Whooping cough usually begins like a cold, with more or less fever, and catarrhal defluxions—these continue in some instances, throughout every stage of the complaint; while in others, they cease in a few days. The onset of the disease, is for the most part abrupt, without any distinct febrile movement, and is sometimes early attended by the peculiar inspiration, which gives it its common name. At other times, a considera- 


409 
OF WHOOPING COUGH. 
ble period elapses before ibis takes place; and in some cases, does not happen. Cullen tells us, he has had instances of a disease, " which, though evidently arising from the chincough contagion, never put on any other form than that of common catarrh." 
1449. The disease becoming confirmed, the paroxysm consists of a number of short expirations, closely following each other, so as to produce a sense of suffocation; to overcome which, a violent effort of coughing is made, which usually ends in vomiting, or a discharge of phlegm or mucus from the lungs. In many cases, when the paroxysm is over, there is complete relief in the interval; so much so, that the individual seems not at all affected, except perhaps temporarily a little weakened. 
1450. This complaint is not accompanied by a difficulty of breathing as a necessary attendant, unless in such as may have a chronic affection of the thoracic viscera. If it attend whooping cough in such as have no pectoral complaint ordinarily, it betrays for the most part some latent mischief in either the bronchial membrane or the substance of the lungs themselves—this may be either inflammation or engorgement. 
1451. Dr. Watt says that whooping cough is sometimes attended with great torpor of the bowels, requiring large and frequent doses of medicine before it can be overcome. We have never witnessed this condition; and when it does occur, it is perhaps only relative; the coats of the stomach and bowels being "varnished" as it were with mucus, and thus preventing the operation of medicine, by not permitting a contact between the medicine and the intestinal membrane. Also, that the urinary secretion is influenced, and micturation produced. 
1452. In the commencement, expectoration is sometimes very deficient; the cough is hard and dry; the paroxysms recur frequently, and are long continued. Congestion of the lungs now take place; which produce, by the interruption of the circulation, in these organs, a correspondent state of the head; and as a consequence, a turgescency and suffusion of face, amounting sometimes even to lividness, which is sometimes relieved by gushes of blood, from the mOuth, nose, eyes, or ears. In this manner, the disease runs an indefinite course, from one month to three, or even twelve months, though the average is, perhaps, the second period. This, however, very much depends on the season of the year; 
[53] 


410 
OP WHOOPING COUGH. 
it being alway s of longer duration, in winter. The popular notion is, and which is not far from the fact, that it is six weeks in reaching its height, continues for some time with but little abatement, then declines, and goes off in six weeks more. 
1453. Some writers, especially Webster, consider the whooping cough as consisting in some cerebral disorder; and adduce as evidence, the existence of head-ache, redness of the eyes and cheeks, and the relief that a bleeding at the nose affords, together with the appearance of the brain and its appendages after death. Dr. Gregory, like Webster, speaks "of a tensive pain of the forehead, and in severe cases this is obviously an urgent symptom, and one which demands attention in reference to practice." We have paid considerable attention ever since we read Mr. Webster's paper on whooping cough, to the symptoms which particularly mark this disease, but we have never satisfied ourselves of the existence of any primary cerebral disorder. We have occasionally had confessions from our patients, that they had more or less head-ache, especially after violent coughing; but there is surely nothing in this more than might be expected from such efforts of the chest as this disease demands. And of the " tensive" pain in the forehead just spoken of, we have never been able to satisfy ourselves that it existed even late in the disease. This may have arisen from our patients, at least nineteenoutof thetwenty whom wehave examined with this view, being too young to either describe it, or to make them sensible of our meaning; with the few that we interrogated that could comprehend what we suppose Mr. Webster intended by the expression, it was certainly wanting. Nor is the relief experienced by a bleeding from the nose any proof of the existence of the disordered condition of the brain and its appendages, since this kind of bleeding very certainly removes pain from the head, when the mucous membrane of the frontal sinuses are inflamed in catarrh. Besides, the existence of the appearances after death noticed by Mr. Webster, does not appear to be confirmed by Laennec. And Dr. Watts says that this disease is proved by dissection to be bronchitis. 
1454. With respect to the origin of pertussis, there is considerable doubt. It is supposed to depend on a specific contagion, which affects persons only once. To this, however, there may be exceptions. While it is pretty generally admitted, that the 


OF WHOOPING COUGH. 
411 
disease proceeds from contagion; there are writers, who maintain, that it occasionally, at least, prevails as an epidemic; and hence, must originate in a more common source. Much discussion has lately taken place on this point; but the facts are not sufficiently numerous, nor well authenticated, to warrant any very positive conclusion. 
1455. Yet, we confess, that we are inclined to believe that it depends on causes of a more general and pervading influence, than contagion. 
1456. That it does in some instances arise from other causes than contagion, seems quite certain. Willis, who was the first to describe it, accurately declares it to be an epidemic, occurring most commonly in spring, and autumn. By Hoffman, it is said to have spread in Berlin to a great extent, in the same way. In the tenth volume of the Medical Repository of New York, Dr. Willey gives an account of the disease having suddenly broken out in Block Island, and where it prevailed widely, without the inhabitants of the place having had any intercourse with an infected source. It is a rule, with few or no exceptions, that, where a disease can be traced to atmospherical influence, it does not prove contagious. Nature indeed can hardly employ two such opposite causes to produce the same effect.* 
* It is a well known fact, that many become affected, where every precaution is taken to avoid contagion; and that the disease is uniformly relieved, or even cured, by a removal beyond the limits of the supposed distempered atmosphere. Agreeably to Desruelles, the following writers have described epidemic whooping cough:— Traite de la Coqueluche, p. 100, &c. &c. Pasquier speaks of an epidemic of this kind, that broke out in March, 1411. More than one hundred thousand in Paris alone, were attacked with it. This account is confirmed by Mezeray. De Thou relates another epidemic that beseiged Paris, 1510; this was called whooping cough; the symptoms were not related by lum, though mentioned by Sennertus. Iiiverius mentions one that spread over almost the whole of Europe in 1557. Baillou gives the account of one in 1578. Geller describes one that took place in 1757, in the duchy of Mechlenburg. Aaskow, one that happened at Copenhagen, 1775. Arand, one that occurred at Mayence in 1769, &c. &c. It thus appears that this disease has occasionally appeared in an epidemic form from 1411 to 1815. The last, that is, of 1815, is said to have occurred at Milan. 


412 
OF WHOOPING COUGH. 
1457. Believing that the complaint is generated by specific contagion, we have perhaps too much neglected to look for other causes of its production. Yet on the whole, in the present state of our knowledge, it will be most prudent to proceed in practice, under the impression of its contagious nature. 
1458. It may be inferred from the history of the disease, that the diagnosis is neither difficult nor obscure. But this is not exactly so; for in its commencement, it so much resembles the common catarrh, that it is almost always mistaken for it; especially, in early spring, and late autumn: nor can it well be decided, which disease it may be, until the permanency and obstinacy of the affection declare it to be whooping cough. 
1459. The remote cause of whooping cough may be received at the moment catarrh is about to make its appearance; and thus may be confounded with it; or it may be called into action by the catarrhal affection, and thus perpetuate the symptoms of this disease. Or it may, and we believe it often does, at the periods just named, assume all the forms of catarrh, and from which in the commencement it would be impossible to decide, whether the affection under consideration be whooping cough, or catarrh: for whooping cough at its onset, in the spring and fall, is attended by as much febrile action as catarrh; and it is not until this inflammatory stage is about to pass away, that the cough assumes the paroxysmal form and declares the disease to be whooping cough. When the spring is pretty far advanced, and during the hot weather of summer, whooping cough is rarely confounded with catarrh; for at these periods, there will be less fever, and the disease will more quickly betray its peculiar character. But fortunately, no evil can arise from their being confounded; for at this period their treatment must be precisely the same. It also resembles the initiatory symptoms of measles; for in whooping cough there is sneezing, watery eyes, swelling of the eyelids, and an unusual fulness of the face. But the doubts to which of the diseases these symptoms belong is for the most part soon cleared up, by the eruption taking place in measles on the third or fourth day after the commencement of the catarrhal affection. It is, however, said that instances of measles have occurred without any eruption having taking place, but this we have never seen. 


OF WHOOPING COUGH. 
413 
1460. This disease is generally most severe with infants, as they cannot expectorate with the same freedom as older children, and are thus debarred this source of relief. Where it attacks with much fever and catarrh, it is also unfavourable; and with pneumonia, or peripneumonia notha, still more so. Consumptive subjects rarely or never recover. The favourable circumstances are —absence of fever, and oppression; free expectoration, and facility of vomiting. The disease terminates sometimes by the gradual wasting of strength, or runs into chronic affections, as consumption, asthma, hydrothorax, and hydrocephalus; or suddenly, by apoplexy, or suffocation, from spasm of the glottis. 
1461. It is obvious, that the irritation of the remote cause, wherever it may be primarily seated, induces an inflammation of the mucous membranes of different parts of the organs of respiration, occasioning an increased secretion of fluid; which accumulating, acts as an extraneous substance, and brings on the cough for its expulsion. When this natural effort succeeds, there is for a time a complete interruption of the coughing: but on its being re-produced, we have a repetition of "the paroxysm. By too long a continuance of this irritation, disorganization takes place in the lungs, &c.; and the system at large, participating in the morbid affection, a gradual exhaustion of strength, and death takes place: or the air-cells being choked up, or the glottis closed by spasm, or by collections of mucus, or lymph, the patient dies suddenly from suffocation: or possibly, in some instances, as is represented, the brain may become so affected as to constitute a new and more complicated case, terminating life by coma, convulsions, &c. At this period, an inflammatory state of the system undoubtedly exists; it however exhibits a very peculiar character, owing perhaps to the nature of the cause by which it is excited; for it unquestionably is far less obedient to the usual remedies than ordinary inflammation; and in many respects proves illustrative of the modification which this condition receives, from the agent producing it. 
1462. Dr. Watt regards this disease as essentially an inflammation of the mucous membrane of the bronchia; and that when it terminates fatally, it is generally by the production of severe bronchitis. Laennec, says that whooping cough holds a middle place between the mucous catarrh and pituitous catarrh, as far as 


414 
OP WHOOPING COUGH. 
regards the nature of the expectoration and the bronchial congestion ; but that it possesses some characters peculiar to itself. Such, rarely occurs twice in the same person; the cough taking place by fits; " each fit," he says, "is composed of a quick succession of sonorous coughs, with scarcely any perceptible inspiration between; except that from time to time the expirations of coughing are suddenly interrupted by a very deep, seemingly convulsive and noisy inspiration, accompanied by a lengthened hissing, which constitutes the pathognomonic sign of this variety of catarrh." " The stethoscope exploration of the chest in the intervals of the fits, supplies only the usual results of catarrh—namely, a feebler respiration than natural, or the complete absence of this in certain points, which however sound well—puerile respiration in other parts, and occasionally a slight sonorous or sibilous mucous rattle." 
1463. Desruelles makes it consist of an inflammation of the bronchia, complicated with cephalic irritation. But that the " inflammation des bronches est toujours primative, et 1'irritation du cerveau consecutive. v p. 77. We can readily imagine that the brain or its appendages may indirectly become implicated with whooping cough, since the very efforts of the thorax during the paroxysms, is well calculated to force an unusual quantity of blood into the brain—we therefore need not be surprised, that dissections have revealed water in its ventricles, though we cannot admit, that the inflammation which terminated by the effusion of water, w r as the cause of the affection of the lungs. Desruelles considers whooping cough as essentially inflammatory, under all its modifications and appearances. He says, "a quelques causes que puissent etre attributes les modifications que presente la coqueluche; quelles que soient l'activite ou la lenteur de sa marche, la violence ou la faiblesse de ses symptomes, la promtitude ou le retard de sa guerison, son etat de simplicit6 ou de complication, son issue heureuse ou funeste, cette affection offre toujours les caracteres d'une maladie inflammatoire dont les differens degres sont les principales causes des formes diverses qu'ellerevet." p. 217. 
1464. Notwithstanding a more correct light has been shed on the pathology of whooping cough, little new is proposed in the management of it. 


415 
OP WHOOPING COUGH. 
1465. As the whole phenomena at the commencement of this disease, declare it to be catarrhal; and, as in most instances, in the cold part of our seasons, it is attended with fever, and marks of local irritation and inflammation, there is the most decided necessity of treating this complaint by evacuants; as blood-letting, laxatives, and vomiting, and these to be repeated according to the exigency of the case. These should be persevered in until they produce direct evidence that the inflammatory stage of the disease is abated, or subdued; or, in a word, let the disease, in the first instance, be considered nothing more than a violent catarrh, and be treated accordingly. 
1466. We are persuaded, that this disease oftentimes becomes inveterate, and sometimes dangerous, from prescriptions being based upon a mistaken pathology. Thus both Burton* and Millart reject blood-letting altogether, though Millar sometimes ventured upon the application of leeches. LieutaudJ never employed it but in extreme cases; that is, when the fever was very violent, and the respiration difficult, &c. We would therefore wish the reader to keep in mind, the opinions of Laennec, Desruelles, Watt, and others, that in whooping, the bronchia, or other portions of the lungs are sure to be in a state of inflammation, especially in its commencement; and if proper depletion be neglected, a second stage is formed of the disease, and we then find a disposition, to either metastasis to the brain, or find that it participates severely with the original complaint—hence, convulsions, inflammation of the brain, or hydrocephalus are found to supervene. 
1467. Bleeding is demanded in many instances, independently of other circumstances, by the interrupted Circulation of the lungs; and affords almost always, the most decided relief. § And this must be repeated as the necessity for it may continue, or as this necessity may subsequently return in the progress of the case. Even in Europe, where the lancet, comparatively, is so sparingly employed, this practice is commended, and generally pursued; 
* Appendix to Treatise on the Non Naturales. f Observations on the Asthma and Whooping Cough. + Med. Prat. § By bleeding we wish to be understood, taking blood from the general system by means of the lancet. 


416 
OP WHOOPING COUGH. 
but in this country, its employment, for the most, part, is indispensable. 
1468. This was the practice of Willis, who was the first to give a regular account of this disease ;"* he chiefly relied for its cure, upon vomiting, purging, and blistering. This appears, too, to have been the general practice of the age, and particularly of Sydenham ; and we have, among many inferior names, those of Astruc, Huxham, Hoffman, Hillary, Home, Lettsom, &c. in favour of this course of treatment. 
1469. Evacuations of the alimentary canal must also be brought in aid of bleeding; and these may be made by emetics, or laxatives; of the latter, the best is castor oil, after the bowels have once been opened by calomel. The former are chiefly applicable to children; and where the attack is violent, and the oppression great, they may be repeated, provided the accumulation of phlegm is great and threatening. To keep up the impression on the stomach, small doses of the syrup of squills, or ipecacuanha, should be given in the intervals. Or what has answered all these intentions with the most decided efficacy, is Coxe's hive syrup, given in proper doses. 
1470. We always have recourse to this medicine, immediately after bleeding, if this has been necessary, and after having purged with calomel, hive syrup must be given in such doses as shall freely promote expectoration; or should there be oppression, or evidence of great accumulation of phlegm in the windpipe and lungs, in such quantity as shall freely puke. We, for the first purpose, order doses suitable to the age of the child, every hour or two, as it may show its effects. For a child of three or four months old, we would order eight drops'every hour or two, and a proportional larger quantity as the age advances; and, for the second view, we would give these quantities every fifteen minutes until an emetic operation is produced. Let it be, however, remembered, that children of the same age will bear very different quantities of this medicine, as well as of every other; therefore, the doses must be constantly regulated by the effects. After this medicine has operated as an emetic, it must be given, as be- 
* This was in 1664. 


417 
OF WHOOPING COUCH, 
fore directed, as an expectorant. * But should bleeding not have been necessary, the case will rarely require more than demul cent drinks, and a low diet. 
1471. The state of the expectoration is a matter of consequence, and should always be attended to; for from it much may be learnt. After the disease, in favourable cases, has arrived at its height, or is upon the decline, the expectoration becomes more profuse, and the sputa lose their mucous character, by assuming a more purulent appearance. But if this take place suddenly, or in the early part of the disease, it is for the most part an unfavourable sign. Nor is blood mixed with the expectorated matter, a good token, generally speaking. 
1472. The most abstemious diet should be observed during the whole of the catarrhal stage of this complaint, which is from three to six weeks, according to the season. Children at the breast should receive nothing but the mother's milk; those who arc weaned should be confined strictly to a milk and vegetable diet. All animal food or broths must, most scrupulously, be avoided. Rennet whey, is preferable to whole milk. The drinks should be barley water, flax-seed tea, gum Arabic water, bran tea, toast water, molasses and water, &c. 
1473. The milder laxatives, though recommended by many, do not answer as well as calomel for the first purging; for independently of its purgative effects, this medicine would seem to exercise some other power. Certain it is, that active evacuations by. calomel in the commencement of the disease, have, in a greater or less degree, the effect of breaking down the force of the catarrhal symptoms, and to abridge the career of the disease. We, therefore, almost always commence the treatment with a 
* The following 1 is the recipe for making the compound syrup of squills, or Coxe's hive syrup. Take of 
Seneca snake root bruised? each hglfa pound Squills dried and bruised j Water - - - eight pounds. 
Boil together over a slow fire till the water is half consumed; strain off the liquor, and then add of strained honey four pints. 
Boil the honey and the strained liquor to six pounds, or to the consistence of a syrup; and to every pound of the syrup, add sixteen grains of tartar emetic i that i?, one grain to every ounce. 
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418 
OF WHOOPING COUGH. 
mercurial purge; and repeat this for the first two or three days if the condition of the bowels require it. Whatever opinion may be adopted of its mode of action, we are certain of its utility; and as there can be no dispute as to the propriety of having the bowels well opened in the beginning of the disease, calomel seems to be the best suited to this purpose. 
1474. During the general treatment pointed out, we are not wholly to lose sight of some local remedies in this disease. Congestion and inflammation of the lungs are apt to take place; for the relief of which, blisters are found decidedly advantageous after proper evacuations; or, should it be necessary to draw more blood, let it be done by leeches or cups, from between the shoulders. We are decidedly of opinion, that blood cannot be taken by leeches or cups, with any thing like the same advantage from any other part, where there is a threatened congestion of the lungs; and it sometimes becomes important to follow this up, by a blister to the same part. * 
1475. When there is strong determination to the head, the same remedies are required, both general and local. Leeches to the temples we have found of singular advantage, where much pain in the head was experienced after each spell of coughing; indeed, we now never neglect this last symptom, as we are convinced it was the prelude to fatal issue in two or three cases we have seen, by extravasations within the brain—and who has not witnessed the advantage, or at least the immediate relief, from an accidental bleeding at the nose? 
1476. Though we admit of determination of blood to the head in this disease, and recommend, as just stated, local depletion for its relief, we are by no means of opinion, that cither this determination, or an inflammation of the brain, or its appendages, have the least agency in the production, or even the perpetuation of the cough with which either may be associated. Yet the supervention of inflammation, or even a congestive state of the brain, will very much increase the danger of the patient—therefore these conditions require the active means just recommended for their relief. Nature sometimes furnishes the means of relief herself, by instituting a bleeding from the nose—this, when sufficiently extensive, affords more relief than either cupping or leeching, and should therefore always be encouraged to an ex- 


419 
OP WHOOPING COITGH. 
tent every way compatible with the exigency of the symptoms, and the strength of the patient, if this be practicable. 
1477. But let it be remembered, that the bleeding from the nose, however instrumental and speedy it may be in abating the violence of the marks of determination to the head, or of congestion in the brain, only proves the immediate condition of these parts, and not an original agency, in the production of whooping cough. 
1478. In the use of the remedies recommended above, we would wish it to be understood, that we do not always prescribe bleeding, or loss of blood in any other way in every case of whooping cough, as it very often presents itself without the symptoms which would justify this, or perhaps any other remedy, except occasionally the use of the syrup as just directed to secure a free expectoration; or the administration of a few grains of calomel; or what is better after the few first days of the disease, the occasional use of castor oil, if the bowels are confined. 
147.9. If due regard has been paid to the treatment of the inflammatory or catarrhal stage of whooping cough; or if the remedies for subduing this state have been successful; a second period of this disease will arrive, in which other remedies may be useful. But it should be carefully ascertained before the character of the remedies are changed, that every vestige of inflammatory action shall have ceased; therefore, the pulse must be carefully examined, and it must be found sufficiently subdued, before we commence with the antispasmodic and tonic remedies. 
1480. Desruelles finds much fault with these directions; he says, " comment se fait-il que le Docteur Dewees, qui montre tant de confiance dans le regime, qui le prescrit avec tant de reserve et de sagesse, ait cru necessaire de donner l'emetique, d'entretenir les nausees par des petites doses d'ipecacuanha, de purger souvent avec calomelas, et de s'abandonner a l'action incertaine et souvent nuissible des narcotiques, des antispasmodiques, et meme des toniques? II preconise la saignee et la diete, et il administre des medicamens stimulans: n'est-ce pas detruire d'une main ce que l'on a fait de l'autre? Par quelle 6trange association d'idees peut-on faire concourir au meme resultat des moyens si opposes, si contradictoires?" p. 242. 
1481. In answer to the above questions it will be only neces- 


420 
OP WHOOPING COUGH. 
sary to say, that we differ a little in the progressive pathology of whooping cough, and on this circumstance does the difference of our treatment arise. Desruelles considers the bronchia at least, if not the brain or its appendages to be in a state of phlogosis during the whole continuance of the cough; while we are of opinion that the stage of inflammation passes away, and that if the cough continue after the pulse declares the absence of febrile action, that it arises from some impression upon the nervous system, or that it may then become the cough of habit. With this belief in view, we prescribe a rigid diet, order bleeding, either general or topical, or both, purging, &c. but after the necessity for this discipline has ceased, we think we have always found it useful to give either antispasmodics, or tonics. 
1482. We do not order, as will be perceived, these different plans at one and the same time; for we have just insisted, that "before the character of the remedies are changed, we should carefully ascertain that every vestige of inflammatory action has ceased." There is certainly no inconsistency in this practice— nay, it is very often essential to the cure of many affections, as fevers, and especially intermittents, that the system be reduced before tonics are given. We have just stated, that Desruelles, looks upon the whooping cough to be essentially an inflammatory disease, under all its modifications, and through the whole of its career, and that it consequently requires an antiphlogistic treatment from its commencement to its final departure; but as we have had any reason to be of this opinion ourselves, we have not adopted the opinion of this author upon this point. The difference of our views of the character of the disease during its progress, will readily account for the difference of our plans of treatment. We might retort bis queries with equal propriety to him, when he insists upon one uniform mode of practice through the whole course of the disease; for to us it appears as inconsistent as our plan does to him? 
1483. In justice'however to him, we have to acknowledge, that we have seen a number of cases of whooping cough subdued, and that speedily in some instances, by a perseverance in the antiphlogistic plan of treatment; but in justice to ourselves we must say that we have seen very many more, that required the change in the treatment, that we have laid down. 


421 
OP WHOOPING COUGH. 
1484. We believe it has been chiefly owing to want of attention to the state of the pulse, that this disease has not yielded more generally to the influence of remedies—for it has been prescribed for more empirically, than almost any other complaint in the long catalogue of human diseases. When the first stage has been neglected, or improperly treated, the disease will pursue its course in spite of all opposition; and the patient may be felicitated when it takes its departure, however protracted this may he, and leaves not behind, more serious evils than were experienced by its presence. 
1485. We have no confidence in the opinion, that this disease will have a determined course; and that we can only relieve the pressure or inconvenience of the immediate symptoms, though it is urged by Sydenham himself. Nor should we inculcate this belief, unless it were a well ascertained fact, as it would but too certainly foster supineness and indifference in the treatment of this formidable disease. Too much has already been taken for granted upon this subject; and because we are not yet in possession of proper counter agents to this complaint, it certainly does not prove it to be, indomitable. The intermittent fever, and lues venerea, were once thought to be equally, if not more unmanageable, than whooping cough; but the discovery of the bark, and the use of mercury, have rendered them comparatively harmless diseases; the proper or appropriate remedy for whooping cough may therefore be yet discovered. 
1486. If the opinion prevail, that whooping cough will have a definite duration, all exertion to abridge its career will be paralized, and the poor suffering infants and children, will be deprived of even the moderate aid it is now in our power to give. As regards ourselves, we are decidedly of opinion, that its duration may as certainly be shortened, as the march of fever; nor do we say this upon slight or inadequate grounds, if our observations have not deceived us. We have known this disease to be made to run its course in eight members of the same family, and at the same time, in less than six weeks; and in many other instances, the period has been abridged with equal success. But what has entirely confirmed us in the persuasion, that the period of this disease can be shortened, nay, even stopped short in some instances, was the success we once witnessed from the exhibition 


422 
OP WHOOPING COUGH. 
of the tincture of artificial musk, in a family of five children, who were all labouring under confirmed whooping cough. 
1487. When we prescribed this remedy, the disease had been of about two weeks standing; all the children were attacked within the period of a week; the catarrhal symptoms were very mild; it was summer, and they readily yielded to a moderate antiphlogistic plan. All inflammatory action was completely subdued, and all the children were put upon the use of the artificial musk at the same time. One, the youngest, (eleven months old,) ceased to cough altogether in less than a week, and neither of the others continued as long as a fortnight. 
1488. We however confess we have not seen so striking an instance of the influence of this article since; though we are every way convinced, it is a valuable remedy in this disease, and one that we have long been in the habit of using. 
1489. Another disadvantage arising from the belief that this disease cannot be shortened, is, the neglect of early measures to subdue, or moderate the inflammatory action of the system in its commencement; in consequence of this, cerebral, and pulmonic congestions form, of which the patient perhaps speedily dies, or such disorganization takes place, as to render him miserable for life. This doctrine is not understood by people in general— for when it is declared we cannot abridge the period of the disease, it is always understood to mean, we can do no good in whooping cough; of course the physician is but too rarely employed in this complaint. Yet we are certain, there are few diseases, in which more relief is experienced than well treated whooping cough in the commencement of the disease; of this opinion also was the experienced Dr. Underwood, who declares, "There is no complaint of children, with which I am acquainted, in which medicine is at times more evidently serviceable, than in bad whooping cough." Then why should poor children be abandoned in this formidable complaint, for an ill-sustained hypothesis? 
1490. Narcotics, and antispasmodics, are also directed at this period of the disease; among these, opium claims our first notice. After evacuations have been duly made, and there is a proper abatement of fever, or other marks of irritation, its use as a palliative of the more troublesome symptoms, is sanctioned by the 


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OF WHOOPING- COUGH. 
experience of almost every body. The pleasantest, and we believe the best form for its exhibition, is in the brown mixture, in suitable doses at night.* 
1491. During the prevalence of the pathology, which ascribed the disease to spasm, antispasmodics were the chief remedies. Of this class the whole were tried in succession, and particularly the castor, artificial musk, and assafoetida. Of the powers of the former, we are entirely ignorant, having never prescribed it. Cullen however, tells us, that it is of no value. 
1492. The second or artificial musk, has been long in use in spasmodic affections; and its powers have been, in some degree ascertained. It is only however, within a few years, that an application was made ofit, for the cure of pertussis; and we have already said, we have found it oftentimes a valuable remedy. 
1493. It is also highly estimated by Underwood; and especially, where the spasms are violent; it is given in the dose of live or six drops on sugar, or highly sweetened milk. 
1494. Of the antispasmodics, assafoetida has always borne a high character; but our own experience is by no means calcu lated to advance the reputation of its powers in the disease in question; we have found it occasionally useful, but never of decided efficacy. 
1495. We are next to consider the proper plan, after the cause of the disease, whatever it may be, has worn itself out, or is dismissed, and when the cough is kept up by the force of habit only; to interrupt the trains of morbid association, all the tonics have been directed, and especially such as arc supposed to have the 
* The following is the formula for the brown mixture; so called from its co lour.— 
R. Elix. Paregor. gj. Take Paregoric Elixir 1 ounce. Vin. Antimon. §ss. Antimonial Wine $ ounce. Sue. Glycrrh. jjiij. Liquorice Ball 3 drachms, Pulv. G. Arab. Gum Arabic 2 drachms. Aq. Fervent. §vj. M. ft. sol. Hot Water 6 ounces. Mix. 
Of this, a child from lour months to six, may lake a small tea-spoonful every two or three hours during the night, should the cough be troublesome. One from six months to a year, a large tea-spoonful, and repeat if necessary—one, from one to two years, a desert-spoonful, and repeat; one from two to four, a <able spoonful, and so on, as age increases. 


424 
OF WHOOPING COUGH. 
effect of subduing paroxysmal tendencies. The Peruvian bark was of course placed at the head of this class, and is much celebrated. Cullen bestows on it unqualified praise, and considers it by far the most certain means; and even says, when given in sufficient quantity, he has seldom seen it fail of speedily putting an end to the disease. It is reasonable to suppose, that the bark might be useful; though it must be confessed that we have not witnessed such striking results from it; and on account of the difficulty of getting children to take it with regularity, it is rarely prescribed in this city. 
1496. This objection however does not apply to the sulphate of quinine; and it deserves a fairer trial, than we suspect it has received. We have employed it in but one case; but this was one of the most forlorn kind—it produced almost, resuscitation. 
1497. Mr. Sutcliff combined the bark with cantharides, and administered it with great success, he says, in whooping cough. The following is his formula:— 
It. Tinct. Cort. Peruv. . Take of the Tincture of bark 6 ounces. Elix. Paregor. t^ ss ' Paregoric Elixir $ ounce. Tinct. Canthar. ML ' Tincture of Cantharides 1 drachm. Mix. 
Of this mixture small doses were given three or four times a day, gradually increasing until a slight strangury was excited; and then the dose was diminished, or taken at longer intervals. The strangury would generally take place about the third day; and the whooping cough seldom continued above six days from the first exhibition of the medicine. It however succeeded sometimes without exciting any strangury, though it generally produced its salutary effects sooner, when that circumstance came on, whether the bark was joined with the cantharides or not. 
1498. Dr. Lettsom informs us, that "during twenty years this ingenious practitioner has almost constantly continued to use this medicine with the most flattering success." Dr. Lettsom being desirous to know whether Mr. Sutcliff's more mature experience led him to place the same confidence in this remedy, wrote certain queries to him respecting chincough. 
1499. Mr. S. replied to these several queries, and concluded by remarking, " I never yet saw an unsuccessful event after using the composition of bark, cantharides, &€., having never 


425 
OP WHOOPING COUGH. 
lost a patient in the whooping cough." Dr. L. declares a similar success awaited his own trials of this medicine. Watt. p. 282. 
1500. But we have never employed any remedy, of equal efficacy with the garlic in substance, to relieve the cough of habit, after whooping cough. We have very often used it; and we have rarely seen it fail. The objections arising from its smell, are however, very strong in the minds of some; so much so, that they cannot be prevailed upon to use it. But children of six or seven years of age, or even older, can very often be prevailed upon to eat it, and become after a while very much attached to it. A child of six or seven, may begin by taking a third of a common-sized clove, morning, noon, and evening; gradually increasing the dose, as the system becomes accustomed to its action. One, of ten, may take half a clove three times a day; increasing it as it may be necessary; and so on for greater ages. 
1501. Desruelles again condemns us for the employment of the garlic, both externally and internally. Indeed he goes so far as to say, we give a blind confidence in this substance. This affects us not; and so long as we continue to experience benefit from it, we shall persevere in recommending it under the restrictions suggested above; namely, in the absence of all febrile excitement, and where the cough appears to be perpetuated by habit. The following case is highly deserving of attention. Miss M. W., aged twelve years, had the whooping cough in great severity, notwithstanding she was subjected to very active treatment in the early or inflammatory stage of the disease. It began in March, and the cough continued with great violence until July, at which time we were requested to prescribe for her—at our first visit, we had an opportunity of witnessing two fits of coughing; both of which spells exceeded in severity any thing we had ever seen. She was literally black in the face, and was threatened with immediate suffocation. These paroxysms were repeated frequently, especially during the day; they left her weak and exhausted; she lost flesh daily, and was so debilitated, as scarcely to be able to walk. She was ordered to eat a small clove of garlic three times a day; in forty-eight hours these paroxysms left her entirely; a slight cough remained for a few days, and then ceased altogether. We cannot but believe it was the garlic which afforded such speedy and happy relief; particularly, as it has frequently proved 
[55] 


426 
OP WHOOPING COUGH. 
as certainly, if not as extensively, serviceable in other cases of whooping cough. 
1502. Exactly on the same principle, the arsenical solution is employed; and we have the strong testimony of Simmons and Ferriar in support of it. Each of these writers goes so far as to declare, that it is the only medicine deserving of much confidence. On this point we can say nothing from our own experience; as we do not deem the few trials we have given this medicine, entitled to much weight; our impressions of its efficacy are not strong. 
1503. We have said nothing of the utility of topical remedies, in the acute stage of the disease; for they can rarely be useful: but in the one now under consideration, external applications may be advantageously resorted to; such as liniments of an irritating nature, as the volatile, or the camphorated; the spirit of turpentine, mixed with olive oil; or the juice of garlic, rubbed along the vertebral column. But above all, we think we have observed more advantage to result from the use of the tartar emetic ointment,* than from any other external application— this should be applied high up between the shoulders. 
1504. It is well understood, how much the action of the lungs is dependent on a nervous influence from the spinal marrow; and it is probably on this principle, the efficacy of such embrocations is to be explained. The muscles of the chest, diaphragm, and scapulae, receive portions of the cervical, and dorsal nerves; the accessory nerves of Willis, form a part of the par vagum, and assist in giving rise to the cardiac and pulmonic plexus; hence, the propriety of applications to the spine; and hence, the popular opinion of the utility of a Burgundy pitch plaster between the shoulders, is accounted for, from anatomical arrangement. 
1505. Of the efficacy of a change of residence, more particularly to the country, and even of a frequent exposure to fresh 
* The following formula, we are in the habit of using for children:— R. Tartar. Antimon. giss. 01. Lavend. vel Ess. Lem. gtt. xv. Cerate Simp. gj. M. 
With this the part indicated must be rubbed three times a day, until the part shows a number of small pimples upon it—dress with common cerate. 


427 
OF WHOOPING COUGH. 
air, every one is so fully persuaded, that the remedy is abused, by its general and indiscriminate adoption. It is by no means uncommon to see children exposed, in the coldest and most inclement seasons; and this sometimes, by the orders of the attending physician. Nothing can be more pernicious, and ill judged. 
1506. In the inflammatory catarrh, we guard against cold, by keeping the patient in a room duly warmed; the same should be observed, in the first stage of whooping cough. The lungs in this case are either inflamed, or peculiarly susceptible of inflammation—so that the slightest exposure brings on, renews, or violently exasperates the attack. Catarrh, or active pneumony, superinduced on pertussis, constitutes a most formidable case, and most frequently is the way in which the disease proves obstinate, or fatal. But, the inflammatory stage having passed, and the weather mild, much advantage may be derived from gentle exercise in the open air—this may be by walking, or riding in a carriage. But completely to eradicate the disease, the child should be removed into the country, provided the season of the year will justify this change. 
CHAPTER XXX. 
OF CYNANCHE TONSILLARIS. 
1507. This disease comes on with huskiness, and next with pain and inflammation of the throat, attended by some difficulty of deglutition, and sometimes with fever. In a short time, these are increased; and from the swelling of one, or both tonsils, there is a great inability to swallow. If the throat be examined at this time, we shall find the uvula, the pharynx, and the neighbouring parts, extremely red, and excessively tender. 
1508. It, however, in some instances, and especially where the individual has had many preceding attacks, shows itself as a mere local affection, without fever, or any general constitutional disturbance. 


428 
OP CYNANCHE TONSILLARIS. 
1509. In this form of the disease, we have phlegmonous inflammation, which lerminates, usually, either by resolution, or suppuration, and sometimes by induration of the glands. But in other cases, it puts on the appearance of erysipelas; and here, instead of red vivid inflammation, with much swelling, the aspect is dark, or purple; with superficial vesicles, or ulcers, of a white or gray colour, resembling ordinary aphthae. 
1510. Commonly, no species of this disease is dangerous, whatever may be the degree of the immediate suffering; and only becomes so, when the inflammation extends to more important structures, as the larynx. 
1511. The symptoms, however, sometimes run very high, and then great suffering is endured. For the tonsils become so enlarged and engorged, that they nearly fill up the posterior fauces. Deglutition is now extremely difficult, and sometimes altogether impossible, without a repetition of the greatest and most painful efforts. Under such circumstances it is not unusual for cough to be excited, and drive whatever is attempted to be swallowed, through the nostrils. The faucial extremities of the Eustachian tubes are very apt to be involved in this inflammation; when this is the case, each attempt to swallow is followed by an acute darting pain through the course of the tubes, which seems to terminate in the external ear. 
1512. One of the most troublesome symptoms against which the patient has to contend, is the free secretion of a very tenacious mucus; this quickly accumulates in sufficient quantity to force the patient to swallow it; on which attempt, the pain becomes so excessive as to produce a convulsive action of almost every muscle in the body. This secretion is particularly troublesome when the patient attempts to sleep—so much so indeed sometimes as almost to preclude the possibility. To obviate this as much as possible, the patient should make his mouth so depending, that it may flow out before it accumulates in such quantity as will oblige him to swallow. The whole of the muscles of the fauces and tongue partake so much of the inflammation that it is impossible sometimes to protrude it; and the effort is always attended with pain. The tongue is quickly encrusted with a thick, very white coat. 
1513. The fever which accompanies the cynanche tonsillaris 


429 
OF CYNANCHE TONSILLARIS. 
is sometimes very high; at others, very much less than we should suppose would attend an inflammation of such extent and apparent violence. With those who are liable to attacks of sore throat, the fever for the most part is moderate—indeed, in some instances it seems to decline in proportion to the frequency of the occurrence, as if the system had lost some portion of its sympathizing powers. We, however, know of but few diseases which leaves so much debility in the same time behind it. This may perhaps in part be accounted for, from the entire impossibility sometimes of taking down nourishment. 
1514. This disease is sometimes very obstinate; the inflammation not advancing to suppuration, nor receding by resolution. This is especially the case with those who may have cynanche supervene upon enlarged tonsils; or in those who have the lymphatic temperament strongly marked. 
1515. Cynanche tonsillaris, is almost exclusively produced by exposure to cold. There are many persons, peculiarly liable to it; and a predisposition seems to be especially given, by former attacks; and hence, caution is required, in the avoidance of the exciting cause. 
1516. The practice of washing the throat every morning with cold water, is said to be an excellent preventive; and we know that much advantage has been derived from gargling the throat every morning and evening with a solution of alum, for the same purpose. 
1517. The treatment of the disease, divides itself into that which is proper in its forming state; and into that, at the subsequent stages. 
1518. If we are called very early, and before diseased action is completely established, we may frequently check the attack, by a stimulating gargle—such as an infusion of Cayenne pepper;* and by rubefacients, as the spirit of turpentine, mustard and vinegar, applied to the external surface of the throat, until the skin becomes inflamed; or even by warmth, when the attack is very recent and mild, as a piece of flannel, or a worsted stocking, tied 
* Take a tea-spoonful of Cayenne pepper, pour on it a gill of boiling- water; stir for a couple of minutes, and then let it settle clear—let the throat be gargled with a portion of it every four hours. 


430 
OP CYNANCHE TONSILLARIS. 
around the neck. But should these fail, we must change the practice, and endeavour to reduce the inflammation by evacuations. An emetic is here exceedingly efficacious, generally resolving the swelling, and suppressing the fever, if such exist; this should be succeeded by a mercurial purge, to be worked off, and the bowels kept open, by the saline laxatives. 
1519. If necessary, we must next resort to blood-letting; and especially, leeching the throat: but the state of the pulse must always govern the use of these remedies. In many cases, it is not at all demanded; particularly, general bleeding, as it is rarely productive of as much utility as might be expected. Yet, where there is great vascular action, it must be employed and repeated according to the emergency. The topical bleeding, by cups, or leeches, is generally more effectual; and especially, where the affection is local, or the system is somewhat reduced. In violent cases, or even in cases threatening to be violent, blisters should be employed ; and this, as early after the leeching as possible. 
1520. Gargles, in this state of the disease, are always detrimental; as they aggravate the inflammation, by the violent and inverted action which they induce. As a palliative, a mixture of equal parts of nitre and loaf sugar finely powdered, occasionally put on the tongue, and as it melts, allowed to trickle over the inflamed surfaces, is oftentimes highly serviceable; as is also the stream of water, or vinegar and water, applied by Mudge's inhaler, or, as a substitute, a common tea-pot. 
1521. But should the disease obstinately run its course to suppuration, (which may be known by the surface becoming of a yellowish hue, and by the throbbings and disposition to rigour,) they may in urgent cases, be opened. With this view, emetics were formerly employed. But the practice is painful and unnecessary, as it may be readily done by puncture. Having discharged the matter, mild detergent gargles, as sage tea, honey, and vinegar, should be directed, to cleanse the parts, and dispose them to heal kindly. 
1522. As regards the erysipelatous species of the disease, the treatment is somewhat different. We rely more on topical bleeding, and the vesicatory applications; and where aphthae or sloughs appear, on stimulating gargles; and, in the event of extreme de- 


431 
OF CYNANCHE TONSILLARIS. 
bility supervening, the system is to be supported by bark, wine, the carbonate of ammonia, and whatever else enters into the treatment of putrid sore throat. 
1523. If due attention, however, be paid to the forming stage of this disease, it can very frequently be arrested in limine; for this purpose, stimulating external applications are for the most part efficient. The spirit of ammonia, of turpentine, or a mixture of the flower of mustard and vinegar, are the best. They should be applied immediately over the throat, and should be permitted to remain, until they produce decided irritation; they may be repeated when this effect disappears. 
1524. To such children as are subject to this affection, the above directions are highly important; and subsequent returns may often be prevented in those that can gargle, by a persevering use of alum water, or an infusion of nut galls, in the proportion of half an ounce of the powder to a pint of boiling water, and then simmered for a few minutes. This must be strained off, and used early in the morning, and on going to bed. We have found the following better in warm weather than the one just suggested. Pour half a pint of brandy or whiskey, and as much water, upon an ounce of powdered Aleppo galls, and shake them several times a day for a few days—let it then settle, and pour off the infusion for use. With a quantity of this the throat should be gargled the first thing in the morning, and the last at night. 
CHAPTER XXXI. 
CYNANCHE PAROTIDE, OR MUMPS. 
1525. This disease consists in an inflammation of the parotid glands, of the phlegmonous kind. It is often confined to one side, though more generally to both; sometimes the maxillary glands are also implicated, and hence, the swelling of the jaws. 
1526. For the most part, this is a disease of but little moment; especially if it occur in the warmer season of the year. But at other times, there is much constitutional disturbance. Rigours, 


432 
OP MUMPS. 
followed by much fever, sometimes happen, especially during the variable weather of early spring. The first sensation of inconvenience, is about the angle of the lower jaw: this part presently becomes painful upon moving the head; tumour is now perceived at this part, which goes on to increase until the fourth or fifth day; after which it gradually subsides, if not maintained by fever. It is not unusual for one side to be first affected, and after this has nearly run its course, the gland upon the opposite takes on inflammation, and also runs its course. "When this happens, the disease becomes more protracted and painful. 
1527. We have occasionally seen severe suffering from this complaint; this is in consequence of a high degree of inflammation, and an excessive enlargement of the gland. The jaws become closed, and deglutition is performed with much difficulty. The ears are now and then much pained, as in common ear-ache. The stomach is sometimes annoyed by nausea, or disturbed by vomiting; and in some few instances, we have witnessed excessive fever, and even delirium. 
1528. When this complaint is unattended by much fever, its progress is regular, and its termination favourable—in such case, it is scarcely an object of medical discipline; at most, it requires but lenient purging, a low diet, and some mild topical applications, as warm sweet oil, or hog's lard, and the pained parts kept, warm, by flannel. Care, however, should always be taken, even in the mildest forms of this disease, that the patient be not exposed to the risk of taking cold; as a remarkable peculiarity attends this complaint; which is its disposition to metastasis or translation; to the testes, in males, and to the breasts, in females; especially in adults. 
1529. In the severer forms however of this complaint, active measures are sometimes indispensable; bleeding, to a considerable extent we have occasionally found necessary; brisk purging, and the most strict observance of an antiphlogistic regimen. 
1530. Occasionally we have been obliged to have recourse to topical depletion by leeches, and this followed by warm cataplasms of bread and milk, to promote the farther discharge from the bites of these animals. The mercurial purges appear to answer best in this disease; especially, if their operations are promoted by either of the neutral salts. 


433 
OP MUMPS. 
1531. Should a translation take place, it may be accompanied by many distressing symptoms. In the male, we once saw the testes prodigiously enlarged; much suffering was endured, and great hazard was incurred by the change. Violent fever, and delirium accompanied this change of seat of the disease, and it required a perseverance in very active remedies to subdue them. 
1532. In the female, the breasts are the seats of the metastasis; they sometimes enlarge very much, and become extremely tender and painful; but we believe they never run on to suppuration. 
1533. In the treatment of this complaint under a change of seat, regard should always be paid to the part originally affected. With this view, we have always blistered the parts immediately over the parotids, and we think with decided advantage. If the change has taken place in the male, we also exhibit an emetic, and apply warm vinegar by means of flannel to the scrotum, and this to be repeated from time to time. A brisk purging should also be instantly instituted, after the operation of the emetic is entirely over, provided the blistering, and it, have not been successful in recalling the morbid action to the original seat of the disease. 
1534. In females, besides blistering, and purging, (for with them it is doubtful whether emetics are useful in this condition,) we apply warm vinegar by means of flannels, as directed above, to the inflamed breast. We have never seen any permanent evil follow these translations; though several such are recorded by authors. 
1535. This disease, like several others, affects the system but once; it is supposed to be contagious; but whether this is well founded we are not prepared to say—it is almost always epidemic, at least in this country; which may with much propriety call in question its contagious nature. 
[56] 


434 
OP CROUP. 
CHAPTER XXXn. 
OF CYNANCHE TRACHEALIS, OR CROUP. 
1536. It is not essential to our purpose to inquire wnether this disease was known to the ancients, or is one of comparatively modern origin. It is now sufficiently ascertained, that it is one of too frequent occurrence in this, as well as in many other countries; and also, that it is one of too frequent danger. 
1537. This complaint is almost altogether confined to the period of childhood; and is most frequent in infancy, or before the fifth or sixth year. It is affirmed, particularly by Cullen, that this disease rarely attacks infants till after they are weaned; and that there is no instance of its occurring in children above twelve years of age. As a general rule, this may be correct; but our experience has furnished us with a number of exceptions. We have seen it in its most formidable shape, in children at the breast; and we have witnessed death from it, in the adult.* 
1538. Children of a florid complexion, and enjoying high health, and especially those inclined to be fat before two years, are more obnoxious to it than those of an opposite temperament. It is a disease of more frequent occurrence in some situations than in others; and those which are near waters of great extent are more obnoxious to it than children in inland situations; in a word, where a cold, and moist air unite; and especially, when it 
* " The croup chiefly prevails in children from a short period after birth, until puberty; attaching itself to particular families." Cheyne, p. 15. To the truth of these observations, we have frequently borne witness. But we have seen this complaint after puberty, and in adult age, though Dr. Cheyne says, "I have heard of no example of this disease after the fifteenth year." He says further, " I have imagined this to depend on the change which happens in the constitution at puberty, and perhaps, in a more peculiar manner, in the change which the upper part of the windpipe undergoes." p. 23. This is ingenious; and probably, it is owing to this circumstance that it is a rare disease in adult age; but that it occurs even at late periods of life is certain. We have attended a lady within the last six years, who is now upwards of forty, several times, (certainly five,) with threatening attacks. 


435 
OP CROUP. 
suddenly alternates, with a dry, warm, air. Nothing perhaps can be more satisfactorily proved, than the agency of cold, moist air, in the production of this complaint; especially, in the spring, arid fall. So much so indeed is this the case in certain situations, that the mothers of such children as may be disposed to this disease, dread the prevalence of that wind, which shall bring with it, both. Thus, in this city, a north-east wind in early spring, or fall, is almost sure to produce, or reproduce, this complaint in those who are disposed to it. But with such, almost any sudden transition, which shall too suddenly arrest perspiration, will be attended by the same consequences. 
1539. Mechanical causes have produced a disease having all the characters of croup from other causes; thus Mr. Balfour informed Dr. Home, that he had " attended a child in a disease, which from the similarity of voice appeared to him to be croup. The child died. When opened, a piece of shell, which the child had sucked in with its breath was lying across the trachea, about an inch below the glottis, and the membrane was inflamed and dry." " Here," continues Dr. Home, " was an artificial croup raised, from which we may evidently perceive how the voice is altered in the natural disease."* 
1540. This disease attacks in one of two ways; 1st, by a hoarseness, which is perceived upon coughing, and which may continue without increase, for even several days, or until perhaps the sudden application of some exciting cause, as a change in the temperature of the air. For exposure to cold and damp, or to a check of perspiration, is sure to call forth some of its more formidable symptoms; as, more or less difficulty of breathing; an increase of cough without expectoration, and fever; this form is longer running its course, than the one about to be mentioned, but is less obedient to the powers of medicine. 
1541. Or, secondly, it may attack with the most alarming suddenness, where no such onset was suspected. When it is thus prompt in its appearance, it menaces life from the moment of its invasion; and if its terrible march be not very speedily arrested, it but too frequently triumphs, in death. 
1542. But whether the croup insidiously steals upon its vic- 
* Inquiry into the nature and cure of croup, p. 49. 


436 
OF CROUP. 
tim, or suddenly threatens it; the latter part of the evening, after a short, but rather disturbed sleep, and about two or three o'clock in the morning, are the most certain periods for it to declare itself—hence the frequency of our first attendance, during the night* 
1543. With the exception of hoarseness, we have never observed any premonitory symptoms to this disease; for we cannot with propriety consider a slight catarrhal affection, as properly belonging to this complaint, though they may occasionally precede the croupy symptoms. Cheyne's account is rather too poetical for ordinary occurrence; or at least, we cannot acknowledge we have ever witnessed, (and our own family has furnished us unfortunately with but too many examples,) that the patient "shuns his play fellows, and sits apart from them, dull, and, as it were, foreseeing his danger." p. 16. On the contrary, we have seen many instances, where this disease has attacked children, and that with great violence, after their having spent their evenings in high mirth, and merriment. 
1544. It must however be confessed, that we have known children indisposed, and dull, from catarrh, previously to the attack of croup; but in these instances, the latter was not anticipated from any of the then existing symptoms; consequently, this previous condition did not necessarily belong to, nor properly forerun, the latter. We believe it to be familiar to almost every practitioner, that croup may supervene upon catarrh; not, perhaps, as a consequence, ever; but as a coincidence: for catarrh is owing to a peculiar condition of the mucous membrane of the nose and windpipe; and for croup to form, or grow out of this affection, it will at least require an alteration of that condition; and not a mere increase of its force; for in the severest catarrhs 
* Dr. Cheyne says, " The disease generally comes on in the evening, after the little patient has been much exposed to the weather during the day, and often after a slight catarrh of some days standing." p. 15. The evening is the most frequent period for an attack of this complaint; but for this purpose, it is not necessary that " the little patient" shall have been " much exposed to the weather;" for we have often witnessed this disease, from the mere prevalence of a north-east wind, and where, in consequence of this wind, every precaution has been taken to guard against its influence, by confining the child, and keeping it warm. We have elsewhere declared, (1544) that catarrh is not a necessary forerunner of this complaint. 


437 
OP CROUP. 
we witness—catarrhs, which require not only prompt, but extremely active treatment, croupy symptoms do not make their appearance, as a necessary consequence. In this opinion, we are happy to find ourselves confirmed by an observation of the celebrated and accurate Laennec, whose work upon the diseases of the chest has been lately most ably translated by Dr. Forbes. He says, p. 120, "the false membrane which so frequently forms on blisters is, of itself, sufficient to prove that it is much less to the degree than the nature of the inflammation, that we are to attribute this concretion or coagulation of pus in certain cases. Indeed, the cause of it is much more probably to be attributed to some peculiar disposition of the fluids, than to any affection of the solids." 
1545. From this it would appear, that it is not sufficient for the production of croup, that the mucous membrane of the windpipe be merely inflamed; but that it requires a modification of inflammation, to induce it. 
1546. It may be farther observed, that during the prevalence of catarrhal affections, croup is more rife than at other periods; not that the one produces the other, (1544) but because, during such periods as the spring and fall, or the very moist and open weather of winter, there is a stronger disposition created to these diseases; and that they have, at one and the same time, the same exciting causes. 
1547. We have uniformly observed the insidious approach of this complaint, to be less under the control of remedies, if its first stage be neglected, than when the attack is sudden, however violent that attack may be. This is doubtless owing to its first symptom, hoarseness, being neglected. For this reason, we would wish to put parents upon their guard, whenever this symptom may take place; and to assure them, from long experience, that it is one of a most dangerous and threatening character. So attentive are we to this forewarning in our own family, (and we have taught others to be equally vigilant,) that it is attended to immediately, and opposed by most active remedies; and we have every reason to believe, that by the means recommended for this purpose, we have stopped this formidable complaint in limine, in very many instances. It is true, a hoarseness passes off sometimes without much mischief; but this is not 


438 
OF CROUP. 
the hoarseness of croup; for this, we believe, never takes its leave spontaneously. 
1548. The hoarseness, which disappears spontaneously, is very distinct from that of croup; the difference, however, cannot well be conveyed by words, sometimes unfortunately for those who may be assailed by it. * This however may be observed, that there is a certain clearness and distinctness in the croupy sound, that does not attend the other; the one, (the croupy) seems as if it issued from a metallic instrument; and the other, from one of a less vibrating material. The ear however, by long habit, may learn to distinguish between them; and when once instructed in this discrimination, never loses its tact. Again, we may observe, that the evanescent hoarseness is almost always accompanied by a little soreness of throat; while that of croup, we believe, never is. Again, the first is perceived in common speaking; whereas, that of croup is only discoverable, in the commencement, by coughing. Lastly, some little pain and soreness are observed about the posterior fauces after coughing, in the one; which never happens in that of the other. It may not however be amiss to observe, that a mere loss of voice, must not be mistaken for croupy hoarseness, as we have known it to be on several occasions, to the great terror of an anxious parent. 
1549. In this, and perhaps in every other country where croup is of frequent occurrence, every sudden difficulty of breathing, accompanied with cough, in children, is mistaken for it. Thus the acute pituitous catarrh is mistaken for it. Laennec says, "this disease is characterized by an extreme oppression attended by a copious pituitous expectoration. It sometimes begins as a common cold; but after a few hours, or even minutes, its severe character is soon declared by the violence of the cough, the intensity of the dyspnoea and oppression, the lividity of the face, marks of cerebral congestion, disordered circulation, and 
* Dr. Ferriar observes, (Med. Hist. Vol. III. p. 137,) "Children who are subject to croup, are sometimes seized with the deep, barking cough, which will increase to such a degree as to create much alarm, about the usual time of the dangerous exacerbation; yet it will decrease again, and at length go entirely off, without any other remedies than common demulcents. Cases of this kind, I suspect, have been described as genuine paroxysms of croup; and very trifling methods of cure have been recommended, in consequence of their apparent efficacy in the spurious croup, which always cures itself." 


439 
OF CROUP. 
coldness of the extremities. In children it is sometimes mistaken for croup."* 
1550. But it may be proper to advise, whenever hoarseness takes place, not to trust too much to the discriminating powers of the ear, for its nature; but instantly to proceed upon the supposition that it may be of a dangerous kind; especially, as the remedies employed for the one, will most certainly relieve the other. It is therefore erring on the right side, to treat it as if it might be of a mischievous character, though it might have passed away without such treatment. 
1551. It would seem necessary to the well understanding of the progress of croup, and its mode of treatment, that it be divided into three stages;t 1st, the forming stage; 2d, the completely formed stage; and 3d, the congestive stage. 
Of the First Stage. 
1552. We have already remarked, (1548) that one of the first and most certain signs of this complaint being about to take place, is a peculiar sonorous hoarseness, when the patient coughs, but which at this period does not affect the speaking voice; this peculiarity exists for a longer or shorter time, without much increase, even for several days, in some instances; while in others, the interval, or stage of formation, is very short, but very decidedly marked. This hoarseness may in some instances be accompanied or preceded by catarrhal symptoms, (1544) but not necessarily. % 
* Laennec on the Chest, Forbes' translation, p. 80. 
f Dr. Cheyne divides this disease into but two stages: 1st, "the incomplete, or inflammatory;" and 2d, "the complete, or purulent." In the first, "the membrane is not yet formed; in the second, it is fully formed." This division does not comprehend the whole history of the disease; for the forming- stage is one of the greatest importance in the treatment of the complaint, and therefore merits, we conceive, the distinction we have given it. Besides, we cannot regard Dr. Cheyne's second stage as representing this disease in its complete form; since the whole of the phenomena of that stage, are but consequences of the previous, or his " incomplete, or inflammatory." And he himself admits this, in several places of his lucid and excellent essay. 
+ " The inflammatory affection of the larynx is doubtless sufficient to account for the alteration which takes place in the sound of the voice and cough." Cheyne, p. 22. We believe there is in most instances an intermediate condition of the larynx, in the commencement of this disease; which is a degree of excitement in the part, accompanied by a little thickening of the 


440 
OP CROUP. 
In this stage, when not attended by catarrh, we find, for the most part, the circulatory system undisturbed, and the respiratory not confined, nor even hurried. The child, in general, is as cheerful as usual; and its appetite, and digestive powers, are undisturbed. In a number of instances, where the disease was making an insidious attack, we have seen children exert themselves even pretty violently, without creating any uncommon hurry in the breathing, or occasioning the slightest embarrassment in it; yet these very children, in the course of a few more hours, were reduced to the last extremity; and some of them did not escape with life. 
1553. We think we have observed, however, in this forming stage, especially in the insidious attacks, the hands to be more than usually cool; the face to be rather unnaturally pale; and the skin to resemble in a small degree, the cold stage of an intermittent, but not attended by a sense of cold: this state of collapse remains for several hours, in some instances, before the system is roused to reaction. But where the attack is sudden, we are by no means certain, that this condition always precedes the febrile state, which so frequently is awakened, and made to accompany this complaint. 
1554. During this period however, the mucous membrane of the nose is observed to be affected; since, the secretion in the nostrils is either arrested altogether, or very much diminished; and continues to be so during the whole course of the disease, unless it terminate favourably. The cough is short, dry, and sonorous; or if any thing be expectorated, it is thin and whitish, and in very small quantities. If the throat or fauces be inspected, nothing unusual, (at least as far as we have observed,) shows itself. The back part of the tongue, is perhaps rather more loaded than is natural, but it is far from being remarkable. * 
mucous membrane, but which does not absolutely amount to inflammation: for, could not hoarseness be produced by any thing short of inflammation, there could not be that species of croup, which Dr. Ferriar, and Dr. Cheyne himself, admit the existence of, namely, the "spurious crdup." (See note to par. 1548.) We are farther disposed to believe in this condition of the trachea, or larynx, in consequence of the very speedy removal, in many instances of this symptom, when sufficiently promptly attended to, by the remedies recommended for the first stage of this complaint. 
* "When in the urgency of the attack, the fauces and neck are examined with a view to investigate the cause of the symptoms, (hoarseness, &c.) even 


OP CROUP. 
441 
1555. After the continuance of the above symptoms for a longer or shorter time, a change takes place, by an aggravation of all of them; and at the same time, others are added; and these will constitute the 
Second Stage, or that in which the Disease is completely 
formed. 
1556. We now observe the hoarseness to be increased, and to affect the speaking voice;* that is, the tone of hoarseness is evidently deeper, more ringing, and betrays itself in every attempt to speak; the cough is more frequent, and the spells longer; a degree of exhaustion, attended by an increase of the difficulty of breathing, follows each effort; the face becomes flushed during the coughing; but generally subsides as the circulation becomes more equal, after the exertion, but leaves the perhaps only one, redder than natural.t The circulation is now much hurried in most cases; at other times, it is very little disturbed; when this latter is the case, the face is seldom flushed, and the hands and skin of the extremities are rather below the natural standard of heat. The child is drowsy, and falls into frequent, but disturbed slumbers, from which it is generally roused, by the most heart- 
when a sense of heat is complained of in the throat, the tonsils are not swelled, and but little inflamed." Cheyne, p. 18. 
*It may be remarked as a general rule, that where the voice becomes suddenly affected by hoarseness, which discovers itself in speaking 1 , and without being so in coughing, that it is not the hoarseness of croup. This kind of hoarseness, however, is more common to adults, than to children. 
f There cannot we believe, exist a doubt, of the condition of the mucous membrane of the trachea at this time—every thing would seem to declare it to be in a state of active inflammation. The formation of a deciduous membrane, which is sometimes thrown up, or after death proved by dissection to exist, and even the remains of turgid vessels in this part, all announce inflammation of an active kind to constitute the proximate cause of this disease. 
The following is Laennec's "Anatomical characters" of croup. "Croup is an inflammation of the mucous membrane of the air passages, with exudation of plastic pus, (coagulablc lymph,) which becoming concrete at the very moment of its formation, lines the (inner ?) surface of this membrane to a greater or less extent. When this false membrane is removed, the subjacent tunic is found of a deep vivid red colour, occasionally livid, and somewhat thickened." p. 119. 
[57] 


442 
OP CROUP. 
rending cough, and an increase of oppression. The child raises itself up, if sufficiently old to do so; or if not, elevates its head, with desire more freely to gain air. This state of things does not last long; for if the progress of the disease be not arrested here, it marches with rapid haste to the 
Third, or Congestive Stage. 
1557. At this period, the cough is attended with some expectoration of a thin, or frothy mucus, which affords no relief; it is more frequent in its recurrence, and more permanent in its duration; sometimes so much so, as to threaten strangulation—the child becomes much exhausted by these efforts, and throws itself back as if in despair, but from which it instantly springs, from the feeling or dread of instant suffocation. It cannot now lie down; and it either throws its head much in advance, as in asthma, or bends itself very much backward; or it finds no relief but in a supine position, and that apparently the most unfavourable to easy breathing. It is restless in the extreme; and alternately tries every position, without finding relief from any. 
1558. The face is no longer flushed; a dark lividity takes its place, which sometimes spreads itself, even to the neck; the lips partake of this change; and the gums become pale and white, while the tongue is not unfrequently blackish, as if the blood was retained in it by a ligature. The forehead becomes shining, and the skin looks as if it were tightly stretched over it—it is wet with cold perspiration, as is now indeed, almost every part of the body. The pulse is small, frequent, fluttering, and contracted. The heart beats with violence, nay sometimes audibly. The auxiliary muscles of respiration, are now called into requisition, and this process seems only maintained by their aid; a deep hollow is made immediately below the xiphoid cartilage, most probably by the severe contraction, or efforts of the diaphragm; and the action of the heart, is distinctly seen, even at a distance from its seat. 
1559. Though the cough is now more frequent, and the oppression much increased, the hoarseness is neither so great,, nor so sonorous. It is now almost a loss of voice, and the child, when it speaks, seems to employ for this purpose a loud whis- 


OF CROUP. 
443 
per. Even when it coughs, the voice is less harsh; or rather it has lost in a degree, that appalling, brazen, vibratory sound, with which the two first stages are attended. This change of tone has but too often misled the inexperienced ear,to a belief, that the disease was yielding; and thus has given rise to hopes, that were but too soon to be forever blasted. 
1560. Thirst oftentimes becomes so intolerable, as to render the demands for drink both frequent and clamorous, though every attempt to gratify it, is apparently at the risk of suffocation. The countenance is now anxious beyond expression; the eyes become most piercingly brilliant, and beseeching—they eloquently implore a relief, which neither affection nor science can afford; and the poor sufferer expires, with a look, full of supplication and anguish.* 
1561. This disease runs its course variously; sometimes it lingers for days, while at others, its career is finished in a few hours. This variety in termination, will depend upon the constitution; upon the period at which remedies were applied; upon the nature of the remedies, and their power or influence upon the system. 
1562. Dissection proves this disease kills in many instances by suffocation, from a mechanical cause; at other times, no such obstruction can be found—therefore, pathologists declare spasm to be the cause, where the mechanical one is not present. This by some has been extended, even to the formation of a distinct species of croup; namely, the spasmodic; a kind we have never witnessed. By others, this has been modified, and the pathology of croup made to consist in inflammation and spasm united. We do not believe in the presence of spasm, in either of the two first stages of this complaint; it may take place, and probably does, sometimes in the last. " Dr. Marcus, of Bamberg, in Bavaria, looks upon all fevers as inflammation of some one organ or other, and as entirely seated in the arterial system, regards croup as a local inflammation alone, utterly independent of spasm, which neither exists here, nor in fevers of any kind."t 
* We have sometimes seen, a short time before death, the little patient lie on its back, apparently resigning itself to a fate against which it could no longer struggle; and eventually expire, and that with a complacency, that would create the belief, that its sufferings had terminated before death had relieved them. 
t Good's Study of Medicine, Am. Ed, Vol, 2d, p. 235. 


444 
OP CROUP. 
1563. Some have disputed the formation of a membrane within the trachea; but it can only be by those, who are not in the habit of investigating diseases, by dissection—we have seen it, more than once, and of course we are convinced of its existence. Others, who will not venture to deny the presence of a foreign body within the trachea, deny it to be a membrane; —they declare it to be nothing but inspissated mucus, and not a membranous product. At this day, there can be nothing new in the declaration, that if lymph be poured out from vessels in a certain state of action, upon either exposed surfaces or within cavities, that it will form membrane; the pleura and the peritoneum furnish almost daily examples of this kind.* This membrane extends, from below the larynx to the bronchial ramifications; and we once saw it within them. 
1564. Laennec, p. 120, says, " the false membrane of croup corresponds exactly with the form of the canals which it covers. Its thickness is usually somewhat greater in the larynx and trachea than in the bronchia, and varies from less than half a line to a line. Its consistence is that of boiled white of egg, but this usually diminishes towards its extremities, so that it becomes sometimes, in this situation, scarcely more solid than the thick phlegm of catarrh. It is of a white colour, with sometimes a shade of yellow, and is almost entirely opaque." 
1565. From what has been said, it will be evident, that nothing but the use of very active remedies can arrest the progress of this disease; and for them to be availing, they must be employed sufficiently early, to prevent the inflamed lining of the trachea, from relieving itself by effusion. For when this happens, the case for the most part, is hopeless; though some few instances have occurred, where recovery took place after its formation— 
* When this substance is chemically examined, ** the secretion appears to consist chiefly, if not entirely, of the gluten, or coagulable lymph of the blood, diluted with its serosity, and copiously combined with that peculiar substance of the blood, which has received the name of fibrin."— Good's Study of Meditine, Am. ed. Vol. 2d. p. 234. 
"It is a little singular that children should be chiefly subject to its attack, at whose age fibrin is not peculiarly abundant, and whose blood contains comparatively but a small portion of azote, which in fibrin is so large a constituent."—Ib. 


OP CROUP. 
445 
but their rarity, only shows the little we have to hope at this stage, and the importance of early attention to this disease. 
1566. It is now so generally admitted, that this is a local disease, and one consisting in an active inflammation of a highly important part, that there is scarcely any dispute as to the general mode of treating it, though there may be some variety in the detail, and the agents intended to fulfil the same obvious indications. Therefore, with a view to the better illustrating the particular mode of treatment, we shall follow the stages we have made this disease to consist of, and shall begin with the mode of treating the 
First Stage. 
1567. If due attention were paid to the timely application of appropriate remedies, in the forming stage of croup we have every reason to believe, that this complaint could be stopped in limine, in nineteen cases out of twenty. It is to the ignorance of what a hoarseness may lead to, that this obvious, and almost certain symptom, when it first manifests itself, is neglected; and to this neglect, must be attributed, the too often fatal termination of croup. 
1568. Asufficientexperiencejustifiesthedeclaration just made; and the same experience will, we trust, screen us from the imputation of becoming alarmists, when we declare, that no hoarseness in children can be neglected, but at the risk of life. We can call to mind but too many instances of fatal issue, where this friendly warning was unheeded, because its tendency was not understood. Our anxiety to abridge the ravages of this terrible disease, has led us to dwell upon this point longer than would be necessary for the mere medical reader; but we hope he will excuse us for cautions, which though not necessary to him, may be very important to others, who may honour this work with a perusal. 
1569. It has been our misfortune to have witnessed but too much of this disease; and unhappily too much in our own immediate family. We were early instructed in all its phenomena; and but too sorely taught its deadly tendency. Our misfortunes, made us more than vigilant—made us tremblingly apprehensive 


446 
OP CROUP, 
to every thing connected with this disease, especially its formation. * But, perhaps, we have derived advantages from our losses; and most happy shall we be, if they can be made subservient to the general good. 
1570. For many years, nothing could exceed our horror, when called to attend a case of croup —for our too faithful ears could not forget the appalling sound of its breathing; alas! they were instructed, by instances of such endearment, that memory was almost a curse. 
1571. We were thus forced to a knowledge of the rise, progress, and issue of croup—would we could add, we were equally well instructed in its management —to this, however, we make no particular pretensions; though we think we have arrived at some certainty in arresting its march. Our particular horror of croupy horseness, led us necessarily after a time, to the very early application of remedies, for its removal—hence, for the last twenty years we have never suffered it in our own family, to exist a single hour, without an attempt to stop it. 
* The ear of one who has lost a child with this complaint, becomes so extremely sensitive, that it instantly gives the alarm, so soon as a hoarseness is perceived; and sometimes leads to an interference, that would perhaps not be justified upon any other occasion. To illustrate this, and to show how the feelings may be impelled under such circumstances, we will relate an anecdote which befell ourselves. Passing a house, towards evening, in one of our streets, our ears were assailed a hoarse cough, which proceeded from a shivering little boy of about three years old, who was at the door, but which was shut against him. 
He appeared very cold; it was a drizzly evening, and the month was November. At this time, our loss of an only child with croup, was recent; and we were labouring under all the wretchedness such a loss could inflict, and of course were peculiarly sensitive to anything which reminded us of a disease, which had created for us so much misery. We knocked at the door and begged to see the mother of the child; the person before us proved to be the one we wished to see. We represented to her the dangerous situation her little boy appeared to be in, and begged she would immediately send for her family physician, to visit the child, and advised, what we judged proper to be done, until he should arrive. The mother laughed at our fears; and said, it was nothing but a little cold the child had taken, and declared he would be well enough in a day or two, " without any doctor stuff." 
We took our leave; but feeling interested for the child, we went next day to inquire for him; and was told by a next door neighbour, that he had died early that morning of " hives;" —our feelings can be better imagined, than described. 


447 
OF CROUP. 
1572. As this disease most commonly attacks in the night, (1542) we have ever at hand, the remedies about to be mentioned, that a moment may not be lost in their application. It is, therefore, our constant habit, the instant we observe the croupy sound, to inflame the external throat by the application of the spirit of turpentine, hartshorn, or mustard and vinegar. This we repeat, if the first has not subdued the hoarseness, so soon as the rubefacient effect has subsided; for it may be proper to observe, we do not carry the stimulation to blistering. In aid of those external applications, we administer, in doses suitable to the age of the child, "the compound syrup of squills," or Coxe's hive syrup, as an expectorant, or if necessary, as an emetic. 
1573. If the hoarseness does not yield to the turpentine, or to expectorant doses of the syrup, we urge the latter, by quickly repeating the dose, to an emetic effect; but this is rarely necessary, if the complaint has been taken early, or if the throat has been well inflamed. For we can most truly declare, we have very often seen this disease subdued in an hour or two. But should the hoarseness not disappear, though much diminished, we continue the use of the syrup, until it does. Should the bowels be confined, we give a dose of castor oil,.in aid of the general intention. 
1574. With the same intention, we regulate the diet—or rather make it consist of barley water, or flax-seed tea; we confine the patient to an atmosphere of moderate temperature, and most sedulously guard him against exposure, or a draught of air. The throat must be protected by a piece of flannel, or some other warm covering, after the turpentine or mustard has been removed. 
1575. It is truly astonishing, with what certainty this plan arrests this disease, in by far the greater number of cases. An experience of very many instances, fully justifies our commendation of it. We therefore earnestly advise every mother, and especially those who may have children subject to this complaint, to have immediately at command the articles just mentioned, and to employ them, as just directed, the instant hoarseness may appear. If this be faithfully attended to, we shall rarely have an opportunity to prescribe for 


448 
OF CROUP. 
The Second Stage. 
1576. It may however happen, that the plan just suggested, may not be availing; that the proper time for their application has been lost; or, that we have not seen the patient, until the second stage had been completely formed; in either of these events, we are obliged to prescribe for the case as it presents itself. We shall find the system in the second stage, (1556) in one of two conditions; namely, 1st, where the disease is completely formed as regards the state of the trachea; but without the arterial system being much affected; or 2d, where the action of the arterial system is much exalted, in consequence of the inflammation of the trachea. These two conditions, in our opinion, require some difference in the mode of treatment; and first, of that condition, where the blood-vessels of the system at large, are not much affected. 
1577. In this case, the force of the disease is mainly spent upon the organs immediately concerned in respiration; hence, the cough is more frequent, nay, sometimes almost incessant; the hoarseness less deep, but more sonorous, and vibrating; no expectoration, or in a very trifling degree, and that of unconcocted serum, the discharge of which affords no relief. The face for the most part, rather pale, or partially flushed; the nostrils very dry; the hands and skin generally rather below the natural standard; the eyes somewhat bloodshotten; the pulse frequent, and small, and the respiration laborious, and every hour becoming more and more so. 
1578. In this situation, we have thought, the remedy so exclusively relied upon by many, namely, blood-letting, always to be injurious, or certainly never beneficial—we therefore cannot, agreeably to our present impressions, recommend it; since, under such circumstances, we never now employ it, either generally, or topically. We always commence the treatment, by the stimulating applications, (1572) to the throat; and quickly administer a brisk emetic of the tartrite of antimony; or should it be immediately desirable to procure evacuations from the bowels, we combine with it, liberal doses of calomel, according to the following formula, for a child of two years old, or rather more. 


449 
OP CROUP. 
R. Tartrite of antimony gr. ij. Calomel prepared gr. xij. 
These to be intimately mixed, and divided into eight parts —one of these to be given every twenty minutes, or half hour, mixed in a little thin syrup, until an emetic, and cathartic effect be produced. Should it prove pretty powerfully emetic, we make the intervals longer; that is, once in an hour, and more seldom in proportion to the effect, until the bowels are freely moved, Or even purged. 
1579. After the medicine has operated freely, we order the hive syrup in suitable doses, (1572) every half hour, or hour, or more seldom, as the effect may be more or less ample. Should the disease not have yielded to this discipline, we give calomel in pretty large quantities, every two hours, as long as the bowels will bear it without being too much purged; always recollecting, that the expectorant doses of the hive syrup are not to be discontinued, without there is much nausea. 
1580. If the above remedies make a favourable impression upon the disease, an abatement of all the unpleasant symptoms will take place, and give us some assurance of a favourable issue. In the condition of the system now under consideration, we must not neglect to observe, that we reckon among the favourable signs, a greater warmth of skin, with a slight disposition to perspiration, and an increase of force, and vigour in the circulating system; for when these take place, there is less risk of its running on to the congestive stage, or at least this period is delayed. Besides, this change is an evidence of the disease being now less concentrated, and that the system can now bear farther depletion, with advantage, should it be judged necessary. This is so decidedly the case sometimes, that we can with much profit to our patient, abstract blood, either from the system generally, or from near the parts, by cupping. In a word, the disease is now converted into the second condition; or where the arterial action is much exalted. 
1581. In this second state of the disease, the symptoms are rarely so appalling as in the first, though of the same general character. The disease is less masked, and we consequently, have a more open enemy to deal with. In this condition, we almost exclusively rely upon blood-letting to make a first, and 
[58] 


450 
OP CROUP. 
favourable impression; and there are few, who have not witnessed with what promptitude, and success, this is sometimes effected. The bleeding to be successful, must be carried to a sufficient extent; that is, until it makes a decided impression upon the pulse; or until it nutter under the finger, or a disposition to syncope discover itself. 
1582. Some have advised that the blood should be drawn from the jugular vein;, there may be an advantage in this, that our present experience does not recognise; certain it is, we should not hesitate to select this part, were we left entirely to ourselves, since its nearness to the diseased parts, would lead to the belief, that they might more certainly and speedily be relieved by it. But to make choice of this vein as a general rule to bleed from, we should have much prejudice to contend with; more perhaps than the selection is really worth—but at the same time, we would recommend, that this part should not be lost sight of, in certain ferocious cases, where life may depend upon the difference of influence, that the bleeding from one part rather than from another, may produce. 
1583. The repetition of the bleeding, must be governed by circumstances; for bleed we must in some cases, again and again, if the system reacts with force, and the pulse be found of difficult reduction. But here we would wish to caution the inexperienced practitioner, against making the difficulty of breathing the only indication for more blood-letting; this should constitute but one of the considerations; for of itself, it is not always sufficient, especially in a rapid case, or in one, in which the first stage of the disease was altogether neglected, and the commencement of the second, but feebly treated. 
1584. To make a second bleeding proper, there must be a continuation of the same symptoms, though perhaps with a lesser degree of force, which made us determine upon this operation in the first instance; that is, the pulse must be firm, the skin warm, the face flushed, and the oppression considerable. 
1585. If these conditions obtain, we should not hesitate a moment to draw more blood; and that, to an extent that shall produce an evident alteration in the force of the pulse: but two bleedings are not to follow each other, without the interval being employed in the exhibition of other remedies; and among the 


451 
op CROur. 
first of these, are, the emetics, and the expectorants, as has been already advised, (1572 and 1578) together with the use of calomel. In this state of the disease, as in the one just considered, the emetic should be followed by the hive syrup, so as to maintain a nauseating influence, as well as occasionally to provoke the stomach to puking. 
1586. The rubefacient remedies should now succeed the operation of the emetic; and such a quantity of calomel should be administered, either with the tartrite of antimony, or alone, as already suggested, (1578) as to procure a free discharge from the bowels. 
• 1587. The greater the disposition the disease has to run a rapid course, or in other words, the more sudden and violent the attack, the greater, as a general rule, will be the chance of success from the use of proper remedies, and especially, that of blood-letting; for it almost always happens, that the slower cases are attended by an indolent inflammation, or an engorgement, that will not so well bear the loss of blood; or will certainly profit less by it. 
1588. When the practitioner may be reluctant to draw more blood from the general system, and yet believes the inflammation cannot be subdued without farther depletion, he generally has recourse to local bleeding—hence, the frequency of leeching and cupping, in croup. 
1589. This practice is recommended by almost every practitioner; and by some, of very high authority; it may therefore not only excite surprise, but perhaps draw upon us reprehension, when we enter our protest against it; and especially, against leeching. 
1590. We are free to admit, it appears every way plausible, that drawing blood from near the inflamed part, should be attended with more success, than when it shall be taken from a part more remote; yet in the particular instance we are considering, our experience gives a uniform contradiction to the hope of benefit from the practice; though it does not impair the truth of the general position. But this failure of benefit from local bleeding, in the case under consideration, must not be considered, however, even as an exception to the general rule just mentioned, but as depending in a great measure, or perhaps altogether, on circumstances inseparable from the operation of leeching itself. The ope- 


452 
OF CROUP. 
ration of leeching is attended with several circumstances decidedly adverse to this disease: for, 1. It employs considerable time; during which, the patient is obliged to maintain an irksome position, and this may be extremely unfavourable to his breathing. 2. It often becomes important, that the quantity of blood to be drawn, should be very exactly determined: this cannot be done in leeching—especially, as the after bleeding is sometimes very considerable, in spite of every attempt to arrest it, to the manifest injury of the patient. 3. Their coldness; and the sudden exposure of the throat, after having been warmly covered, is oftentimes so mischievous, that the bad symptoms can be seen to increase during the operation; and are almost sure to follow, immediately after. We can most safely declare, we never have, in a single instance, seen it do good; but we have, in a number of cases, seen it do harm. 
1591. If topical bleeding must be had recourse to, let it be by cups—against these, the objections are not so strong. But, if they be employed, between the shoulders is the place to be selected; when drawn from here, we have seen it useful. Cups should never be applied over the throat, for reasons sufficiently obvious. 
1592. Dr. Cheyne says," when bleeding is used upon the commencement of the violent symptoms, the relief is often immediate; and I have scarcely believed that I saw the same child breathing softly, who ten minutes before lay gasping and convulsed." p. 17. We have never had the good fortune to see this sudden good effect from bleeding, in a case of genuine croup; we have a number of times witnessed very prompt relief from this remedy, in the spurious, or that kind which is accompanied with sore throat. (1548) For the vessels of the fauces seem to feel the influence of venesection, more certainly and speedily, than those of the mucous membrane of the trachea. 
1593. Neither in the stage of the disease now under consideration, nor in either of the other two, have we ever witnessed any advantage, from severe purging; though there is evident use, in having the bowels freely opened. Indeed, in the congestive stage, we think we have constantly found it injurious; for it rapidly diminishes the strength, without weakening the disease at the same time. For it would seem, there is less intercommunion 


453 
OP CROUP. 
between the bowels, and the respiratory viscera, than with almost any other part of the body. 
1594. Puking in this stage, (the second,) is manifestly useful; especially when considerable nausea accompanies the operation; it must therefore be repeated, as often as the breathing seems to be obstructed by accumulating phlegm. We believe the tartrite of antimony to be the best emetic, in this stage of the disease. The sulphate of copper has been highly extolled lately; with what propriety, we cannot say. 
1595. Blisters are highly recommended by some; as regards our own experience, we are by no means convinced of their utility, unless it may be in the forming stage of this complaint, and at the termination of the second; but even then, we are not in the habit of relying on them. We prefer the rubefacients, (1572) as their powers are more at command, and can be renewed whenever they have ceased to maintain a proper degree of irritation. It has appeared to us, there is a period of the disease, in which blisters may be useful; but are not exclusively to be relied on, as just stated; we have occasionally employed them at this time, and once or twice with marked advantage. It is, when the second stage is merging into the third. At this time, in some few instances, they seem to act with peculiar felicity. 
1596. " The warm bath is a very unequivocal remedy; but as it is a simple and popular one, it it generally used along with an emetic, before the physician is called; and together or separately, by their antiphlogistic powers, they in very many instances prevent the formation of the disease." (Cheyne, p. 25.) 
1597. There are few remedies in this disease so popular, or so much abused, as the warm bath—it is one, we feel more difficulty in prescribing, than any other of the materia medica; for it seems to us to be more uncertain, and varied in its effects, than any other. Nor is this to be wondered at; since, the temperature, is never exactly fixed, and each given temperature must be a new remedy; or at least a remedy with a different power. Again, the state of the nervous and arterial systems, must be constantly varying; therefore, the effects of this remedy, must necessarily be governed in a degree by these conditions. The state of the cutaneous system, must also vary as to susceptibility; therefore, temperature must have different operations upon it; 


454 
OF CROUP. 
these differences must of course lead to very different results; and this we have so uniformly found to be the case, that we never prescribe this remedy, but with all the uncertainty which must necessarily attend applications empirically made. 
1598. But we cannot agree with Dr. Cheyne, if in calling the warm bath a "simple remedy," he mean that it is one without any decided powers; we look upon it as one of extensive influence; and may therefore be most easily abused, if not judiciously directed; as it has unfortunately become a domestic remedy. Besides, let us call to mind the importance of the surface on which this remedy is to act; either as regards its own functions, or the parts which so powerfully sympathize with it; and we shall find there is no good ground to consider this remedy as a "simple" one; at least not agreeably to our definition of a simple remedy. 
1599. This, of all the remedies employed in croup, requires the most judgment in prescribing it; and certainly the most caution, properly to apply it. We have never seen it managed with so much address, as not to have made us tremble for the consequences; nor with so much success as to tempt us to brave them. We can most conscientiously declare, we have never in a single instance witnessed a decided advantage to arise from its application; but we can most truly say, we have had the most unequivocal evidence of injury. We therefore never prescribe it, in this disease. 
1600. Do not let us be understood to condemn this remedy, when employed by others, because we do not ourselves understand its management; we only mean to confess our ignorance of the proper state, or time, for its application. We are afraid that this renjedy has become too much a part of routine in this complaint; therefore, very likely to be abused. There is a popular feeling in its favour, which we are very certain it does not deserve; and in consequence, it becomes " a domestic remedy," and " is employed before the physician sees the patient/' and that we fear to the injury of the individual, who is subjected to it. 
1601. Laudanum in combination with antimony, is recommended by Dr. Cheyne, when the febrile symptoms run high— we admit this to be high authority for the practice; but unless we witness more success from this combination in the hands of others, 


455 
OP CROUP. 
than has been experienced by ourselves, we shall not again be tempted to employ it. Laudanum, as far as our experience goes, has ever been injurious in this stage. 
1602. If the disease does not yield pretty early after the formation of the second stage, to the remedies just pointed out, the vessels of the inflamed surface, relieve themselves by effusion, and thus form 
The Third Stage. 
1603. This stage consists in the formation of a deciduous membrane, (1557, &c.) which more or less, strictly fills the trachea, or else, in the pouring out of a quantity of purulent lymph, which does not coagulate; but almost as certainly obstructs the air passages. This effusion is not confined, however, in all instances to the trachea; the bronchial vessels relieve themselves, in the same manner; and this sometimes throughout the lungs; as far at least, as the naked eye can trace them. 
1604. It is of much importance to recollect this highly important pathological truth; since it will have a strong bearing on the question of an operation, whenever this may be agitated. 
1605. The third stage (1557) necessarily is one of great hopelessness; since we cannot with certainty, get rid of the existing obstruction; or if we could, we cannot alter, or at least but very rarely the disposition of the parts, to perpetuate the difficulty by new productions. 
1606. The indications in this stage, are, 1st, to remove the obstructing lymph from the windpipe; and 2d, to prevent the formation of more, by altering the condition of the inflamed surface of the trachea. 
1607. In some few instances, emetics have fulfilled, both the one, and the other indication; and the patient has been thus most unexpectedly snatched from the grave.* The membrane has been 
* "I shall here notice those (remedies) only which have been found decidedly beneficial. Of this kind are emetics repeated daily or even twice a day. They evidently accelerate the separation of the adventitious membrane, and favour its expulsion. However valuable this treatment may be, and I have myself obtained cures which I could attribute to it alone, it is no doubt too true that the greater number of cases still prove fatal." Laennec, p. 126. 


456 
OP CROUP. 
more frequently removed from the trachea, than its removal has been attended by success to the patient, after its discharge. This is a most melancholy truth, and one that should not be lost sight of; especially, as on the removal of the membrane, recovery is so confidently expected. Never shall we forget our feelings when this took place in a beloved g child of our own; nor ever cease to remember our disappointment, when we found it to be unavailing. 
1608. Michaelis, (Cheyne, case x. p. 65,) relates a case of death after the membrane was twice discharged by emetics; nor is this surprising, since, by the removal of the obstruction, we do not remove the disposition to subsequent effusion; and as long as this continues, there can be no security against new formations. 
1609. But this is not to make us abandon an enterprise in which so much may be gained, if we succeed in removing the obstructing membrane; especially as the same author furnishes us with an instance of success, after the membrane has been thrown up. 
1610. As in the third stage, the obstruction is purely mechanical, so far as we know; and as that consists of a membranous production, but feebly attached to the side of the trachea, (1562) as fresh lymph is most probably constantly pouring out, to weaken its adhesion, it would seem that, that remedy which would give the most sudden shock to the respiratory organs, would bid fairest of success, to remove it—hence the utility of pretty powerful emetics at this period. 
1611. In this all practitioners seem to agree; but there is some variety of opinion, on the proper substance for this purpose. In Europe, saline, or antimonial emetics are considered best; in this country the poly gala seneca in very strong decoction is preferred; and we believe with propriety. At least the only instance we have witnessed of the expulsion of the membrane, was produced by a very strong decoction of this root.* We would, therefore, 
* Take half an ounce of powdered seneca, pour on it half a pint of boiling water, and let it simmer until nearly half reduced; strain it carefully, and give a tea-spoonful every fifteen or twenty minutes, until it puke. This quantity will answer for a child from one to three years old—for one of greater age, two tea-spoonsful at a time may be given; but we believe the decoction should never be weaker than the above. 


457 
OP CROUP. 
rely on it with more confidence than any other of the emetic substances. 
1612. This medicine is, however, apt to run off by the bowels when exhibited thus strong; should this be the case, a quantity of laudanum sufficient to merely restrain its purgative effects, should be given from time to time. Two or three drops every two or three hours, will generally be found sufficient for this purpose. 
1613. We have but very little confidence in any other remedies in this stage of the disease; especially, any that can fulfil the second indication, unless emetics do. We have never seen calomel, blisters, or warm bath, do the least good at this period; indeed, the painful remedies should now, we think, be withheld, (if we except the more powerful rubefacients,) since they hold out so little promise of success. We thought we saw evident relief in a late case, from the spirit of turpentine. * Twenty drops were given every hour; it seemed to relieve much, but the patient died. 
1614. As a last resource, tracheotomy has been proposed with confidence; but it has been but too often performed without success. Nor is this to surprise us; since by the operation nothing more can be expected, than has resulted from the spontaneous discharge of the membrane; and we have already said, (1607) that this is but rarely followed by permanent relief. 
1615. In our opinion, the operation has been proposed with more intrepidity, than discretion; for until we can prevent new accumulations after the removal of the previous ones, we need promise ourselves but little success from this scheme. It has been said, that the failure from this operation has been principally owing to its being performed too late; and hence, it has been advised early in the disease. But who would promise himself, that he had saved life by this operation, should the patient even live, since if it be performed early, other remedies might have succeeded as well? And when performed late, who has 
* What might be the effects of this medicine in the congestive stage oi croup, if boldly pushed, we have yet to learn; we think, however, it deserves a trial, as its influence upon the mucous membranes seems to be undisputed. Wc shall certainly urge it, the first fair opportunity we have the misfortune to contend with. 
[59] 


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OF CROUT. 
witnessed its success? Therefore, in the early stage of the disease, the operation is certainly not called for, nor would it be proper to have recourse to it, since, the disease is very often relieved without it; and in the latter, we believe it has ever been unavailing. 
1616. We have seen it performed twice without success, where the operation simply considered, had every advantage which sound judgment, and consummate skill could give it—for Dr. Physick was the operator. And we believe we do not venture too much when we say, he has no confidence in it. Dr. Cheyne employs some most convincing arguments, against this operation; to which, we with much pleasure refer those who may wish to investigate this subject farther. 
1617. But notwithstanding the unmanageable character of this disease, when its first stages have been neglected, or feebly treated, we have the experience of some of the most respectable practitioners, as well as our own, to bear us out in the assertion, that when early attacked, by adequate means, there are few diseases so entirely under the control of medicine. 
CHAPTER XXXIII. 
OF WORMS. 
1618. There are few parts of the human, or even of the brute body, which may not be infested with worms, if any reliance can be placed upon the observations of philosophers and physicians. But our present purpose is only to give an account of such as infest the stomach, and bowels of children. 
1619. It would seem to be agreeable to all observation, that children are seldom without more or less of these animals; indeed so common are they in the human bowels, that Dr. Butter has attempted to sustain a most extraordinary thesis upon the subject. He declares them to be " nature's remedy for destroying the superabounding morbid humours; and to stimulate the first passages, by their crawling motions, and thereby assisting 


459 
OP WORMS. 
the peristaltic motion of the guts to carry off what remains of the offending load." 
1620. As a general rule, we believe it entitled to confidence, that children altogether confined to their mother's milk, never have worms. This is, to be sure, contradicted by M. de Lille, who affirms, that worms were expelled from his daughter, who was only eleven months old, and who was altogether confined to the breast. As regards our own testimony, we declare, never to have seen worms in children under ten months old; and only in two instances of that age; both of these children were weaned at four months. 
1621. From this it would seem, there is a protection against these animals in the mother's milk, so long as the child is exclusively confined to it; but the moment it leaves it, it becomes obnoxious to them. It is pretty evident then, that these animals are introduced into the stomach and bowels from without, by means of the various articles of food upon which the child lives. 
1622. Hence children who live much upon crude aliment, are more obnoxious to worms than those who are provided with a constant supply of wholesome, and nutritious articles of diet. And also, that those whose powers of digestion are strong, are seldom troubled with these vermin. In feeble, or dyspeptic stomachs, these animals are not only much more common, but also, much more mischievous; since, from the imperfect condition of the gastric powers, the secretions permit them to remain uninjured by its influence; therefore, the best security against these animals, is a healthy condition of the stomach; and a nutritious and invigorating diet. 
1623. Children who have access to crude unripe fruits, and who do not restrain their appetites from indulging in them, are particularly liable to suffer from worms; and this for two reasons: 1st, because, the ova of many are introduced by the food itself;* and, 2d, because the weakened powers of the stomach 
* We are aware that the idea of the ova of worms being introduced into the stomach, by fruit, and hatched there, is not believed by some, and even ridiculed by others, because, say they, there is no similarity between the worms expelled from the body, and the worms found in unripe or injured fruit—but this is taking but a limited view of the subject; since, it is certain, that very 


460 
OF WORMS. 
permit them to be hatched, from the want of force in the gastric liquor; for we have every reason to believe, that few animals can resist its influence, when in a state of perfect health. 
1624. And upon the same principle, it can be readily understood, how they can multiply and thrive, after they once have possession of the stomach and bowels; especially, as it is well known, they reside in the mucous secretion of these parts; and how to the parts themselves they may become irritants, and force them to a more abundant secretion; and hence, from a profuse supply of rich nourishment, they seem to thrive almost beyond their natures, and can scarcely be recognised as specimens of the class to which they belong. 
1625. Almost every writer on the practice of physic, mentions extraordinary examples of the kind; and both foreign and domestic journals furnish like instances. And it would seem to be a matter placed now beyond dispute, that many aquatic animals may gain possession of the stomach, either in the form of ova, or in a viviparous state. Thus, the horse hair worm, though an aquatic animal, is frequently found in the stomachs of the peasantry of Lapland, and introduced there agreeably to Linnaeus, by drinking of the half putrid water of their ponds. 
1626. After the same manner, the leech has been conveyed into the stomach when minute and young, along with the muddy and stagnant water they arc known to inhabit. Of this kind is the remarkable case related by Mr. Paisley, in Vol. II. Art, xxvi, of theEdin. Med. Essays. And also of an analogous kind, is that related by the late Dr. Bond of this city, in the Lond. Med. Observ. and Inq. Vol. I. p. 6S. In the first of these instances a gentleman voided two animals of the leech kind, each measuring a foot and a half in length, and an inch and a half in diameter. In the second a worm of twenty inches in length, was voided by a woman, after great suffering, and of which she died. On opening the body, it was found that the animal had worked its way 
considerable varieties have been observed to pass par anum, and many doubtless have escaped unnoticed. Besides the difference in nourishment, and even perhaps a change of habits may alter the form of these animals; the leech it would seem undergoes a great change when introduced into the bowels and permitted to revel there, as wc shall notice below, 


OP WORMS. 
461 
into the liver through the common duct, and committed great havoc on that organ; after which, it seemed to have travelled back, and had forced its way again with much difficulty through the same duct into the intestines, whence it was discharged dead, and in two portions. 
1627. It is in vain to urge that these animals cannot be introduced from without into the human system, as the aliment and mode of life must not only be different, but their habits must also be destroyed, in a place of such confinement—the facts speak for themselves. 
1628. It is true, the cases just mentioned arc exceptions to the general inhabitants of the stomach and intestines; yet perhaps there is nothing more marvellous in the one instance than in the other; since we cannot admit, with our present data, that there are varieties of worms, proper to the human stomach and bowels. If they are extraneous, as we believe them to be, it only follows, that the kind usually found, are much greater in number; more easily introduced; or of more hardy habits; resisting and overcoming the disadvantages of their new situation, and eventually thriving and revelling in the plenty of their adopted habitation. 
1629. The worms commonly found in the human body, are divided into the "round," and the "flat." These are arranged according to the diseases or symptoms to which they give rise: 1st, those which can be nourished in any portion of the alimentary canal; 2d, those which locate themselves at the lower extremity of the canal; 3d, those which have no "local habitation," and seem to have wandered there erroneously: hence, they are divided into three species, and called, 
1. Alvine worms, or Helminthia Alvi. 2. Anal worms, or Poclicis. 3. Erratic worms, or Erratica. 
Sjiecies 1. Of Alvine Worms. 
1630. "Worms existing and finding a proper nidus in the stomach or alvine canal, chiefly'' of children, and sickly adults; producing emaciation, a swelled hard belly, gnawing or pungent pain in the stomach, pale countenance, fetid breath, and irritation of the nostrils," (Good, Vol. I. p. 200.) 


462 
OP WORMS. 
1631. The worms which give rise to the above symptoms, and inhabit the region designated, are ranged under the following varieties:— 
A—Long round worm, or Ascaris Lumbricoides.* B—Long thread worm, or Tricocephalus.t C—Long tape worm, or Taenia Solium. J" D—Broad tape worm, or Taenia Vulgaris.§ E—Fluke, or Fasciola.|| 
* " The head of the long round worm is slightly incurved, with a transverse contraction beneath it; mouth triangular; body transparent, light yellow, with a faint line down the side; gregarious, and vivacious; from six to fifteen inches long; inhabits principally the ileum, but sometimes ascends into the stomach, and creeps out of the mouth and nostrils; occasionally travels to the rectum, and passes away at the anus." (Good, Vol. I. p. 200.) 
f "The body of the long thread worm is, above, slightly crenate; beneath, smooth; finely striate on the fore part; the head obtuse, and furnished with a slender retractile proboscis; tail, or thinner part, twice as long as the thicker, terminating in a fin£ hair-like point, about two inches long; in colour, resembles the preceding; gregarious, and found chiefly in the intestines of sickly children; generally in the coecum." (Ibid. p. 201.) 
t "In the long tape worm, the articulations are long and narrow, with marginal pores, by which it attaches itself to the intestines, one on each joint, generally alternate; ovaries arborescent; head with a terminal mouth, surrounded with two rows of radiate hooks, or holders; and a little below, on the flattened surface, four tuberculate orifices or suckers, two on each side; from thirty to forty feet long, and has been found sixty. Inhabits tho intestines of mankind, generally at the upper part, where it feeds on the chyle and juices already animalized. Is sometimes solitary, but commonly in considerable numbers; and adheres so firmly to the intestines, that it is removed with great difficulty. It is said to have the power of reproducing parts which have been broken off; but this assertion wants proof. The animal is oviparous, and discharges its numerous eggs from the apertures on the joints. The broken off joints have, when discharged, the appearance of gourd seeds: and it is hence denominated gourd worm by many medical writers; and is the lumbricus cucurbitinus of Dr. Heberden." (Ibid. p. 201.) 
§ "The articulations of the broad tape worm are short and broad, with a pore in the centre of each joint, and stellate ovaries round them; body broader in the middle, and tapering towards both ends; head resembling the last; inhabits the upper part of the intestines, and feeds on the chyle; from three to fifteen feet long; usually in families of three or four." (Ibid. p. 202.) 
|| "The body of the fluke is flattish, with an aperture or pore at the head, and generally another beneath; intestines flexuous; ovaries lateral; hermaphrodite, and oviparous." (Ibid. p. 202.) 


OF WORMS. 
463 
1632. As it is not necessary to our purpose, we have not given a long technical description of each of these varieties, nor shall we of the succeeding ones. We have mentioned them, because they are more or less frequently met with in practice. It may however be well to observe, that the first of these is found much more constantly than either of the other varieties—we would not however pretend to say, in what proportion. 
Species II. Anal Worms, or Helminthia Podicis. 
1633. "Worms, or the larves of insects, existing and finding a proper nidus within the verge of the anus, exciting a troublesome local irritation, sometimes accompanied by tumour, frequently preventing sleep, and producing pain or faintness in the stomach." (Good, Vol. I. p. 203.) 
1634. Under this species are included the following varieties: 
A—Thread worm, / »¦¦«.-'.¦*<.'» _"_ > or Ascaris Vermiculans. * Maw worm, V B—Beetle Grubs, or Scarabseus.t C—Bots, or CSstrus. % 
Species III. Erratic Worms, or Helminthia Erratica. 
1635. "Worms, or the larves of insects, introduced by accident, and without finding a proper habitation in the stomach or intestines; producing spasmodic colic, with severe gripings; and occasionally, vomiting, or dejection of blood." (Good, Vol. I. p. 205.) 
* "The head of the thread worm is subulate, nodose, and divided into three vesicles, in the middle of which it receives nourishment; skin at the sides of the body finely crenate or wrinkled; tail finely tapering-, and terminating in a point; gregarious; viviparous; about half an inch long; sometimes wanders into the intestines, and occasionally as high as the stomach." (Good, Vol. I. p. 203.) 
f "This variety has not been accurately described;" " the following seem to be the chief; gray larve, with yellowish legs, and ferruginous head;" "have six feet; are annulate, hairy, vesicular at the end of the abdomen, and furnished with a horny head." (Ibid. p. 204.) 
\ "The larves of the oestrus, breeze, or gadfly, are called bots, and are ol a round figure; pale green; tail obtusely truncate; head tapering; mouth horny, with two lips, and two recurved black claws on each side of the mouth." (Ibid, p. 204.) 


464 
OF WORMS. 
1636. Of these worms, according to Dr. Good, but little is known, though there is good authority for introducing them—and we have been the more readily induced to follow him in this particular, as wc met with two distinct species, as we arc disposed to believe, in the same child, within a few days, and altogether different from any wc have hitherto seen. 
Of the Cure. 
1637. Wc are but imperfectly instructed upon this point, and perhaps will remain so, until practitioners shall be better able to ascertain the effect of remedies on each individual sjiecics of these animals, and shall learn to distinguish them by the symptoms they give rise to. The whole of the symptoms which these vermin create, arc familiarly said to be produced by " worms;" and it is probable they do not yield the same variety in effect, as their diversity of species would lead us to suppose. Nor is this perhaps much to be wondered at, since the whole train of symptoms to which they give rise, is produced by an irritation imposed on some one portion of the alimentary canal or stomach; and it would require greater powers of discrimination than is generally possessed, to detect the cause, or the particular nature of the irritant. So general, and so uniform, for the most part, are the symptoms arising from almost any irritation of the bowels, that one cause may be readily mistaken for another; thus wc have frequently seen all the symptoms usually attendant upon worms, completely similatcd by the presence of acrid bile; and the reverse. Therefore, so far are wc from being able to detect the species of worms, that we cannot say with perfect confidence, that the symptoms are the result of even the genus; since, as wc have just observed, other irritants may produce similar phenomena. 
1638. Yet it is but reasonable to conjecture, that each species may have its antipathies, and even its poisons; and this would seem to be strengthened by what is observed with some other of the inferior animals, in the selection and rejection of certain articles, which may in their turn be food or poison, as it may be one species, or another, that employs them. Thus, the deer eats with impunity the deadly laurel; while the sheep is instantly destroyed by it; &c. 


OP WORMS. 
465 
1639. May not this diversity in what shall consist a wholesome nutriment, or in what may constitute a poison, help us to account for the extravagant encomiums bestowed by some upon an article, as anthelmintic; and the disparaging accounts of the same article, for the same purpose, by others? Is it not probable that the success of the article, when it proved useful, depended upon its being obnoxious to one species of worms; and its want of success, to its not proving so to others? Is this not rendered still more likely from the fact, that that, which shall detach and expel from the bowels lumbrici, shall not stir the taenia solium? 
1640. We believe this to be more than conjecture—and it would be well for practitioners, to record, with each successful treatment of worms, the particular species, nay, if possible, the variety of this animal; the precise nature of the agent employed, and the particular situation of the patient at the moment; to record any auxiliary remedies, if such there were; and to note down any and every circumstance, that in his opinion may have given efficacy to the plan which had been adopted. 
1641. We have observed, (1637) that the presence of any species or variety of worm, gave the same kind of disturbance to the system; and that at the present moment, we cannot detect by any peculiarity of symptoms, by what species the mischief is created. Dr. Heberden has laid down the marks by which worms may be suspected, (for it amounts to nothing more,) in the following order:— 
1642. "The evils which hence arise, and which cease upon their expulsion, are headachs, vertigo, torpor, disturbed dreams, sleep broken off by fright and screaming, convulsions, feverishness, thirst, pallid hue, bad taste in the mouth, offensive breath, cough, difficult breathing, itching of the nostrils, pain in the stomach, nausea, squeamishness, voracity, leanness, tenesmus, itching at the anus toward night, at length dejection of films and mucus. The broad tape worms produce the severest mischief on the body; the teretes and ascarides, (round and thread worms,) sometimes lurk, scarcely suspected, unless there is an itching of the anus, or they are traced in the faeces." 
1643. Yet what practitioner with all this long list of formidable symptoms combining in one person, would risk his reputation upon the event, that they were produced by worms? It must be 
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OP WORMS. 
familiar to every body exercising the profession of medicine, to meet with cases, in which so many of the enumerated signs have combined, as to leave no doubt of the existence of worms; yet the issue of the case, has not always verified the conjecture; at least not by any direct evidence; such as the expulsion of these animals. While on the other hand, he has seen them driven off in shoals, where a suspicion of their agency, has scarcely been awakened. 
1644. Dr. Heberden has failed to mention a symptom, which we believe was first noticed by Home, and which, when it exists, for it is not always present, is less equivocal than any other we have met with; namely, an oedematose swelling of the upper lip, and lower part of the nose. 
1645. Worms injure the body they inhabit, in one of three ways; 
1st. By irritation. 
2d. By destroying the nourishment intended for the support of the child. 
3d. By their bulk from accumulation. 
1. Irritation. 
1646. When the stomach and bowels become irritated by the presence of worms, there is scarcely a part of the body which does not sympathize with it, and manifest their sympathy, by some marked derangement of the part. Thus the lungs have assumed the appearance of consumption, by cough, haemorrhage, &c; the uterus has been urged to flooding; the brain to mania, coma, delirium; the nose to bleeding; the trachea to croup; &c. &c. if any reliance can be placed upon the observations of authors. 
1647. The production of cough is familiar; that of stimulated phthisis is more rare, yet met with. The uterus is but rarely we believe involved; not because it does not sympathize largely with many parts after puberty, but because the affections under consideration are more common to early life, and consequently, before this organ has received such development, as to render it a sympathizing part or source. The aberrations in the functions of the brain from this cause, every body almost has witnessed. A very remarkable instance of this kind fell under our notice lately, which it may be interesting to relate. 


467 
OF WORMS. 
1648. The daughter of T. P. R. aged eleven, was suddenlyattacked with fever and delirium. We were sent for immediately, but being unwell, a friend visited her for us. She was ordered to lose six ounces of blood, and to be freely purged by calomel, &c. The following morning the delirium was encreased; the fever equally high, though she had been liberally purged, and the blood had been drawn: the blood showed no marks of inflammation. She was ordered to lose six ounces more of blood; to take small, but repeated doses of calomel. In the evening, every symptom was aggravated, or rather, she was perfectly comatose, from which it was difficult to rouse her to take even drink; her tongue was very dark and dry as far as could be ascertained by looking into the mouth, for she could not be roused sufficiently to make her put it out; the pulse small, wirey, and frequent; the skin cold, but dry; no urine; the eyes half closed; her stools were of very dark brown colour, and extremely offensive, and were passed involuntary; and in the last, while we were there, a lumbricus was found. 
1649. The case appeared a forlorn one; but we did not abandon all hope; blisters, sinapisms, and wine whey; together with an infusion of pink root, (the spigelia Marylandica,) were ordered for the night. On our visit the next morning, seventeen lumbrici were shown us, that had passed a little while before. The patient in every respect better; the coma much less; the skin warm, but not febrile; the pulse more open, and less frequent; passed urine freely; had command of her evacuations. 
1650. The pink root tea ordered to be continued; no other medicine; wine whey to be withheld, and gum Arabic water substituted. On our visit in the evening, we found seven more worms had passed. The patient comparatively well—she rapidly recovered from this moment. 
1651. In this case, it is evident, the whole train of formidable symptoms were produced by some peculiar irritation in the bowels from the presence of worms; whether this irritation arose from the motion of these animals upon the denuded bowels by a destruction of their proper mucus; or whether, from a deficient supply of nourishment, they inflicted any mechanical injury upon the bowels, may be very difficult to say; but we think it every way probable, that their brisk motion against the internal surface 


468 
OF WORMS. 
of the intestines, producing great irritation or more or less inflammation of the mucous coat of the latter, may account for the extreme derangement of the system; especially, *if they had suddenly migrated from one part of the intestinal canal to another. 
1652. We have seen a number of instances where this change of abode has been made; and this most probably being suddenly performed, created prodigious disturbance in the system; and these cases are perhaps more frequent, than is suspected. We can best illustrate this position, by the relation of a case. M. M. aged between four and five years, was suddenly attacked by intense fever; face extremely red; skin burning hot, great thirst, with considerable nausea; great delirium; pulse bounding; together with a strong propensity to bite every thing presented to him, or even his bed-clothes. The child was one naturally of great vivacity; and for his age, used a great deal of exercise, and had never until that moment, shown any signs of indisposition, with the exception of fever from inoculated small-pox; (this was in 1790,) he had been almost until the moment of attack, as cheerful and playful as usual. Living in the same house with him, and being at home, we were requested to see him, and we found him in the situation just described. 
1653. From the suddenness of the attack, and the ferocity of the symptoms, and especially, as this was an indulged child, we judged that his indisposition could only arise from some improper article introduced into the stomach, either in the form of food, or drink—from this view of the disease, we prescribed ten grains of ipecacuanha, which was instantly administered; and it was equally prompt in its effects; the very first effort brought from the stomach, one, and the succeeding discharge, two more large lumbrici. These animals had hardly been rejected from the stomach, before the whole of the unpleasant symptoms vanished, to return no more, until twelve months after, when there was a repetition of all those just enumerated. The same plan was pursued; and the same result followed. Another year produced a repetition in every respect like the two former; and the same sudden cessation of symptoms followed the use of the emetic. Since the above period, we have seen several other cases, in every respect analogous to the one above described: these cases, evidence, that the mere crawling of these animals 


OF WORMS. 
469 
over the surface of the stomach, may produce symptoms of the most violent kind; and render it extremely probable, that the like, may arise, from a similar action on the tender surface of the intestines. 
2. By the Destruction of the proper Nourishment of the Child. 
1654. From the little we know of the habits of these animals; by their being almost constantly found to inhabit, or nestle in the mucous secretion of the bowels; by their never, so far as we recollect, being found attached to the coat of the intestines; from the certain emaciation which is sure to follow sooner or later, their presence, it is every way presumable, that they feed in part, if not altogether, upon the chyle intended for the support of the system. Therefore the injury to the child on this supposition, will in general be, in proportion to the number and size of these animals; hence the extreme attenuation of the body, from a large number of lumbrici, and from the taenia solium. Nor is this to be wondered at, when the former may be very numerous; or the latter, of almost incredible length. 
1655. They may contribute also to emaciation in an indirect manner; 1st, by stimulating the mucous membrane to excessive action, and oblige it to pour out an unusual quantity of fluid, either for their comfort as a nidus, or for their support as a nourishment ; 2d, by diminishing the appetite, and thus preventing the common quantity of food from being taken; or if there be appetite, it is generally of an inordinate kind, forcing the stomach to receive more than it can master, and consequently impair the powers of this organ, so that it will neither digest as much as ordinary, nor properly elaborate that, which it reduces to chyme. 
1656 It will be seen, that it will only be the " alvine, or erratic" worms, which can produce great emaciation; the anal, though creating great inconvenience, rarely produce emaciation; since, they do not appear to live upon any other than the stercal contents of the bowels, therefore cannot occasion any great waste of the natural fluids. 
3. By their Bulk from Accumulation. 
1657. Worms may do much injury by their bulk; as their numbers, as frequently happens with the ascaris lumbricoides, 


470 
OF WORMS. 
may become excessive. Of this we have seen numerous instances, and they must be familiar to every practitioner. One of the most remarkable instances of this kind which has fallen under our own notice, we shall relate. A poor woman living at the falls of Schuylkill, begged us when near her house, to look at one of her children, which she represented as being almost in the last stage of human misery. 
1658. The child, which we now visited, was about twenty months old: it had had during the whole of the summer, (our visit to it was in September,) a diarrhoea, for which every heard of, and almost every unheard of remedy, had been tried in vain, as regarded the relief of the child, though they abated the bowel complaint. The child had cut most of its teeth, and was still at the breast. It gradually wasted in its limbs and back, but its belly seemed to increase in a direct ratio to the emaciation of the other parts; it was literally nothing but skin and bones, with the exception of the belly, which was enormously distended and semi-transparent. It lay on its back, apparently without power to move from its position. It appeared in great and constant agony. 
1659. Believing this to be a case of worms, we ordered half an ounce of pink root in infusion; this to be given in small portions, as frequently as it would be received. On our visiting the child the next day, we were presented with a sight that was truly appalling; ninety-six worms were shown us in a vessel; the shortest of which measured six inches, and the longest ten. Forty-five of these came away in one mass; the remainder at several different efforts. The child required no other medicine; nourishment soon restored its health.* 
1660. Since worms may do injury in the several ways we have just pointed out, it becomes a matter of great consequence to expel them as certainly, and as quickly as possible—for this purpose, an immense number of substances have been tried; some of which, indeed we may say, by far the greatest proportion, have failed, though ranked under the head of anthelmintics by systematic writers. It would seem, from the long list of articles exhibited by authors, purporting to possess anthelmintic 
* We are told that one hundred and eighty lumbrici, from six to ten inches each in length, were found in the jejunum and ileum of a child that died of scarlatina.— Med. Chir. Rev. No. 15, Dec. 1823. 


471 
OP WORMS. 
properties, that many of them must have acquired this distinction, from the mere contingency of these animals being expelled after their exhibition, without their having any direct agency in their extrusion; for upon subsequent trials, they were not found to possess any such virtue. While on the other hand, some few appear to be justly entitled to the reputation they have acquired among practitioners, of almost every nation. Of this kind we may mention, the Carolina pink root, (SpigeliaMarylandica,) the Jerusalem oak, (Chenopodium anthelminticum,) the cabbage-tree bark, (Geoffraeainermis,) the cowage, (Dolichos pruriens,) the oil of turpentine, the male fern, (Polypodium filix mas,) calomel, and a few others. 
1661. The whole of the anthelmintics may be classed under three general heads; 1st, those which seem to possess some specific action upon the constitutions of worms, by a narcotic or other power; 2d, those which would appear to act upon their bodies, mechanically; 3d, those which seem to prevent, either the development of their ova in the oviparous kind; or act in an unfriendly manner upon the young of the viviparous so soon as they are expelled from the matrices of the parents; or by merely restoring to the bowels and stomach their lost tone. 
1662. Under the first division may be reckoned the pink root, the Jerusalem bark, the cabbage-tree bark, the male fern, the oil of turpentine, and perhaps calomel. Under the second, we may enumerate steel-filings, tin-filings, and the cowage. To the third belong, all the invigorating bitters, as tanzy, rue, wormwood, gentian, &c. the chalybeates, and the muriate of soda, or common salt. 
1663. We have already observed, (1637) that we are not in possession of the diagnostics of worms even as a genus, much less the species, if we except the expulsion of them; we are therefore obliged to prescribe for these vermin, pretty much at random, both as regards genus and species. In doing this, however, no serious mischief can arise, since if the remedy be not exactly suited to the species, it only ends in a failure, without doing any mischief, unless the anthelmintic plan has been injudiciously pursued, or too constantly persevered in. 
1664. When we have reason to suspect worms to be the cause of the symptoms for which we are desired to prescribe, it is 


472 
OP WORMS. 
recommended by Dr. Good, to commence the course, by brisk .purgative remedies, with a view to remove from the bowels a quantity ofthe mucus in which these animals are wont to burrow. We confess ourselves to have a high respect for the learning and talents of this gentleman, but at the same time, we must declare, it is a plan which has never succeeded in our hands; nay, it has for many years been our deliberate opinion, that it even proves mischievous, by making these animals, if we may so express ourselves, cling more closely to the bowels, by some power or other, and thus disappoint the expectations of the practitioner. We therefore never premise a purgative, when about to assail these animals, but at once commence with the remedy we may select for trial, and persevere in it for a given time; when this direction has been complied with for a proper period, we then give a cathartic: this may be either calomel, castor oil, or an infusion of senna. 
1665. The most decidedly efficacious remedy in our hands for the long round worm, (Ascaris lumbricoides,) (1631) is the pink root, in infusion; and we can most safely declare it has rarely failed where it has been faithfully administered. This remedy has to contend against much prejudice; it is declared, that the most violent, nay, deadly symptoms have followed its use—convulsions, paralysis, vertigo, loss of sight, permanent head-ache, &c. are said to follow its use. If such symptoms arise, (and there can be no doubt, but they have,) they can only proceed from over doses of this medicine;* and what medicine is not chargeable with similar evils, from similar mismanage- 
1666. We have prescribed this remedy many hundred times, and we declare, we have never but in a single instance witnessed any distressing symptoms to arise from it; in this exception, a slight squinting, with delirium, followed its exhibi- 
* In almost every instance of which we could with any certainty hear of mischief following the use of the pink root, it was owing to over doses of this remedy—we therefore are very particular in prescribing the quantity to be given; for children, from one year to two, we give but two drachms; for those from two to five, we order one-third of an ounce; from five to twelve, we give half an ounce; and for adults, we never exceed six drachms. We do not believe it safe to go beyond these doses; and we are certain from often repeated trials, that these quantities are sufficient, whenever this plant is the proper remedy. 


473 
OP WORMS. 
tion: but even in this case, the evils were very evanescent, for they disappeared in the course of four or five hours. The mother of this child informed us, this plant had uniformly produced the same symptoms in all her children. We are therefore of opinion, that there is no good ground for rejecting this medicine, upon the score of deleterious narcotic properties, whenever it shall be given in proper doses, and at proper periods. 
1667. An objection of another kind, however may with more success be urged against it; namely, its bulk. Some with a view to diminish this, have given it in powder instead of infusion. We have repeatedly tried this medicine in this form, but find it does not lessen the difficulty. For a number of years past, we have succeeded entirely, by exhibiting it in coffee, to such children as may be in the habit of using this article of diet—but with such as do not, the difficulty still remains. Might not an extract be made, and still retain the valuable properties of the plant? 
1668. Our plan for its use is as follows; pour upon the proper quantity of the pink root, from half a pint to three gills of boiling coffee, and permit it to stand, closely covered, until it be sufficiently cool to drink. One-half of this must be poured off, sweetened, and have milk or cream added to it; when thus prepared, the child is to drink it at its breakfast as if it were coffee alone; it may take with it bread and butter, &c. as in ordinary. The other half is to be given in the evening in the same manner, after warming it. This quantity is to be repeated for three days consecutively; and on the fourth, it must be followed by a pretty brisk cathartic of calomel and jalap, castor oil, or senna tea. We can say with much confidence, that this plan rarely fails to bring them away, should there be worms of the kind just mentioned. 
1669. Should however no worms appear; and the symptoms for which the pink root was prescribed continue, we are in the habit of giving the wormseed oil, (ol. Chenopod.) in appropriate doses, provided there be no fever—should fever attend, this remedy must not be thought of: in such case, small doses of calomel appear to answer best; therefore the pink root has a decided advantage over the chenopodium, since it may be exhibited with perfect safety even when fever is present. 
[61] 


474 
OP WORMS. 
1670. With young children who are not in the habit of using coffee, the wormseed oil is of more easy exhibition than the pink root, and on this account may merit a preference where the condition of the system will permit its use. The seed of the chenopodium is in familiar use in many places, and it is said, with decided advantage—of this we cannot speak from our own experience. The seeds are reduced to powder, and made into an electuary with any syrup. Of this a child of two or three years old may take a table-spoonful morning and evening, abstaining for several hours from food. These doses must be repeated for several days, if necessary. These seeds are also given on bread and butter. 
1671. Of the cabbage-tree bark, we can say nothing from experience; and of the cowage, we can say nothing favourable, as it failed in each of the few instances in which we tried it, though the pink root succeeded afterwards. Of the other mechanical remedies, we know nothing; the tin has been highly extolled, and may deserve a trial; but it would seem better calculated for the tape worm, for which it has been principally recommended. 
1672. For ascarides, (1634) the aloetic medicines are certainly the most useful. These worms produce more decided evidence of their presence, perhaps, than any other; since, the troublesome itching at the anus, rarely arises from any other cause: besides, they can often be detected in the folds of the rectum by distending this part by pressing the nates from each other, so as to open the sphincter ani; as well as in the evacuations; especially, after a costive stool. 
1673. The attempt to dislodge these troublesome intruders, is not always as successful as could be wished; particularly when they are old inhabitants of the rectum. The plan we have hitherto found most certain, consists in the exhibition of small, and often repeated doses of aloes. The preparation we are in the habit of employing for this purpose, is the elixir proprietatis, in doses suited to the age of the patient. * After this has been given 
* We give twenty drops of this medicine, morning, noon, and evening, in a little sweetened milk, to children from two to four years old; thirty, to those from five to seven; and to adults, a tea-spoonful. 


475 
OF WORMS. 
for some time, enemata of lime-water,* camphor,t or aloes, % should be had recourse to, which often destroys them altogether. When the itching is very troublesome, the lime-water injections relieve very decidedly; as does also, a little tar-ointment, forced within the sphincter ani. 
1674. We have no certain marks to distinguish taenia (1631) from other worms. From its immense size and peculiar habits, emaciation takes place more rapidly and extensively than in the other genera and species of worms. A gnawing sensation is often felt at the pit of the stomach, which nothing appeases but almost constant eating. The abdomen becomes tumid, and a sensation like something revolving in one portion of it, is sometimes experienced; more especially, in one of the sides. The head is often affected with pain or vertigo; and in females, a train of most distressing nervous symptoms are produced; in one, we saw repeated attacks of convulsions, resembling epilepsy, assail the patient, from which she was not altogether relieved by the expulsion of the worm, which measured nearly seven yards. The complexion becomes sallow and wan; the eyes sunken, with widely dilated pupils. This worm, however, rarely attacks children; therefore, its treatment does not properly belong to us— but for this we would make no apology, had we any thing new to offer upon the subject of its cure. The remedies on which the most reliance is at present placed, are the spirit of turpentine,§ 
* Lime-water may be used, of its ordinary strength, every evening; from half a gill to a gill, a little warmed, will be sufficient. 
f From five to ten grains of finely powdered camphor, suspended in a wineglassful of thin starch, may be given twice or thrice a week, at bed-time; or two or three tea-spoonsful of the camphorated spirit may be combined with the lime-water. 
$ A tea-spoonful or two of the elixir proprietatis, in a wine-glassful of warm milk, may be used two or three times a week, at bed-time. 
§ We have within a year prescribed for a tape-worm, in a very athletic man when in health, but who had become much reduced by this animal, with great success. He was ordered an ounce of castor oil, combined with as much of the spirit of turpentine, once a week, for three consecutive weeks. The medicine acted upon his bowels with great force each time it was taken; and each time, brought away very large portions of the worm—nay, to the amount of many yards. Since writing the above, this patient called upon us, under the apprehension, that all the worm was not discharged. He was again directed to use the same remedy, to which he readily assented. 


476 
OP WORMS. 
the male fern, powdered tin, and the cowage. The worm expelled by the lady who became epileptic, was driven off by drinking every morning for seven days, a pint of a saturated solution of common salt. 
1675. Some children are very much more disposed to generate these vermin, than others; so much so is this the case in many instances, that they may be said to be almost always present. As the disposition to cherish these animals, seems to consist in a weakened condition of the stomach and bowels, we always make it a rule, with such constitutions, to give tonic medicines, after these animals have been expelled, either in part, or altogether. The best with which we are acquainted, consists of equal parts of the carbonate of iron, and common salt; from ten to thirty grains, according to the age of the child, of this compound, must be given for twelve consecutive mornings. It is best exhibited in molasses; and should be taken early in the morning, fasting. A diet of animal food, chiefly, should be observed. Milk is also a very proper article of diet, at this time. 
CHAPTER XXXIV. 
OF SCARLATINA, OR SCARLET FEVER... 
1676. This is so denominated, on account of the peculiarly florid appearance of the skin, by which it is accompanied. In some one of the several forms, which we shall presently see it puts on, this complaint has, from an early period, occupied no inconsiderable share of attention. It is frequent in its occurrence, extensive in its prevalence, and, at times, exceedingly fatal in its terminations. The complaint prevails more in winter and spring, than in summer or autumn; attacking children, in preference to those who are more advanced in years.* By the nosological writers, it is divided into three forms; which are to be regarded, 
* Sir Gilbert Blane says, that he never saw a person turned of forty, affected by it. 


OF SCARLET FEVER. 
477 
however, as nothing more than the same disease, marked by different degrees of violence:—the scarlatina simplex—scarlatina anginosa —and scarlatina maligna. To many, the latter is more familiar under the name of the malignant, or putrid sore throat. 
1677. By scarlatina simplex, is to be understood, the simple constitutional disease, without any morbid affection of the throat. By scarlatina anginosa, a higher degree of the same complaint— the throat being at the same time inflamed and swollen. By scarlatina maligna, the same disease, in still greater violence— the throat being affected, or otherwise, and the symptoms malignant. 
1678. It is unnecessary to enter into an elaborate discussion, to establish the identity of the diseases. 
1679. Like most other fevers, scarlatina commences with chilliness, fulness of the head, and lassitude; to which succeed, prostration of strength, which at times is very great; and nausea, or vomiting. The surface soon becomes florid, and hot; and on examining the throat, it will sometimes be found inflamed; and the same red appearance extends to the tongue. * There is often at this time, more or less catarrhal affection; the head suffers severe pain, particularly about the frontal sinuses; and with which is sometimes associated, a disturbance of the intellectual faculties. The degree of these symptoms, indicates with sufficient exactness, the strength and character of the forming disease. Being very slight, the complaint will be simplex; if less so, the anginosa; and where they are severe and threatening, the maligna. 
1680. In the worst variety of scarlatina maligna, the commencing symptoms are alarmingly violent. The attack is, for the most part sudden; the patient becomes pale, sick, and faint; the head is giddy, heavy, and confused, rather than severely pained; the oppression about the prsecordia, is extreme; the heart palpitates, and the stomach suffers great uneasiness, though there is no vomiting—this organ being probably prostrated below the power of reaction. The face is pale, or livid; the eyes 
* This last presents a very peculiar aspect. Through the fur with which it is covered, the elongated papillae project their points, and are of intensely deep scarlet hue. 


478 
OP SCARLET FEVER. 
exhibit a glairy appearance, and are marked by a fatuitous or inebriated expression. " A remarkable tumefaction of the fingers sometimes takes place, which, with the erysipelatous tinge they soon acquire, is often of itself sufficient to characterize the disease.'' Gregory. 
1681. On the second or third day from the commencement of the disease, the febrile symptoms are considerable; the skin becomes morbidly sensible to the touch, and begins to be covered with an efflorescence, or florid eruption. * About the same time, a degree of redness and swelling appears in the fauces. The skin becomes excessively hot; more so perhaps than in any other form of febrile disease. The pulse is also very frequent, rarely being under one hundred and twenty strokes in a minute. 
16S2. The reaction of the system being now completely developed, the pulse exhibits the character which belongs to the existing form of the disease—preternaturally frequent, quick, and active, though still moderate, if the disease be simple —more frequent, irritated, and tense, if it be anginose —of greater frequency still, but not so full, resisting, and firm, if it be malignant. The temperature of the body, the thirst, the scurf on the tongue, are also graduated in the same way; each symptom increasing in intensity, according to the augmented violence of the case. 
1683. The eruption assumes, at times, the form of red points, though generally, that of red patches, which spread and unite, so as to cover the whole surface. It appears first on the face and neck; and in the course of a short time, spreads gradually to the lower extremities. The redness is often considerable about the loins, and the bendings of the joints, and on the hands, and ends of the fingers, which feel stiff and swollen. The eruption is not very regular, either as to the time of its appearance, its steadiness, or its duration. It usually continues about four days, and goes off with desquamation of the cuticle. As the disease proceeds, the neck and lower jaw grow stiff, the tonsils swell, and become marked with specks, which degenerate into ulcers, covered with superficial, ash-coloured sloughs. These sloughs, in favourable cases, separate and come off, about the eighth or tenth 
• The tone of colour is said to be that of a boiled lobster. 


OP SCARLET FEVER. 
479 
day, when the ulcers underneath are fresh, and florid, and heal kindly. The fever, at the same time, gradually abates, and a great amendment becomes apparent. 
1684. But, in the more malignant cases, the course of the disease is very different. The sloughs on the tonsils grow fouler; and the discharge from them, and the nostrils becomes exceedingly acrid. The mouth assumes a dark colour, and is often encrusted with a black or brown fur. The breath is extremely offensive, a tenaceous mucus secretion infests the fauces. The eyes and nostrils furnish an acrid serum. Haemorrhagies sometimes take place from these parts, as also from the bowels; diarrhoea of a severe kind is often found present; so also delirium or coma. If the throat be examined, it will be found studded with more or less sloughs, with dark or livid bases. The parotids are swelled and tender to the touch. Painful induration of the glands of the neck, which sometimes terminate in large suppurating abscesses; tenesmus, and diarrhoea; which sometimes speedily sink the patient, if not early removed. 
1685. This is reputed to be a contagious disease. On this point, however, the evidence, to say the least, is equivocal. The facts connected with the spreading of scarlatina, seem to be perfectly explicable, on the ground of its being epidemic, and not contagious.* In this country the belief that it .is a contagious disease, is by no means so general as it is in Europe, and especially as it is in Great Britain. I have never seen so far, any decided proof, that it has communicated itself in any one instance. On the contrary, I am strongly disposed to doubt its contagious quality. I attended a child with scarlatina anginosa, in a family of eight children; the child that was ill was constantly surrounded by the well children, yet not one of these sickened afterwards with this disease. The same thing precisely occurred in my own family; besides many less remarkable instances. Gregory says 
* The weight of European authority is perhaps against us; and in actual practice, it will be safest to act under such a conviction. We are indeed told, that the power of infecting endures for a very considerable time—certainly for a week or two after the cessation of the efflorescence, and probably as long as the desquamation of the cuticle lasts. Persons who have been exposed to the contagion, have the disease, it is said, to break out on the fifth or sixth day. 


480 
OF SCARLET FEVER. 
"the slowness of its diffusion is one of the most remarkable circumstances in its history." Vol. I. p. 237. 
1686. As regards the prognosis, it is unfavourable in proportion to the malignant character of the disease. Thus great prostration of strength; delirium; or coma; extreme restlessness; a distillation of very acrid sanies from the nose; a purple or livid appearance of the fauces, without tumefaction, interspersed with white specks, or dark sloughs, attended by diarrhoea of acrid matter; and above all, a change of the efflorescence to a mahogany colour, are mortal, or extremely alarming symptoms. The termination of this disease is sometimes exceedingly abrupt, and unexpected. We have known death to take place, in several instances, and this most suddenly, where every hope was entertained of recovery,* but a short time before. The favourable signs in scarlet fever are, the patient surviving the ninth day, without any decided mortal symptoms; the intensity of the colour of the skin abating gradually; desquamation of the cuticle, and the departure of the swelling from every portion of the body to which it had extended; the separation of the sloughs, with a healthy appearance of the parts from which they separated; pulse becoming slower and less irritated; heat abating; urine depositing a lateritious sediment, refreshing sleep, and return of appetite. 
1687. In its simple form, scarlet fever calls for very little medical aid. An emetic of ipecacuanha or antimony; purging with calomel, and afterwards with some one of the neutral salts; venesection, in case of fullness and pain in the head; the mild diaphoretics, aided by diluting drinks; and a regulated diet,t are all we need prescribe. But in the anginose state of the disease, more is required—the treatment, here, must be circumspect and vigorous; and much reliance is to be placed on the thorough evacuation of the alimentary canal. Unless, as is sometimes the case, 
* When the disease is very malignant, death sometimes takes place on the third or fourth day; while in its milder forms, it will linger on to the second, or even third week. Generally, however, the patient is safe after the ninth day, under either form of the disease. 
f By a regulated diet, we mean, a strict antiphlogistic one; that is, an entire forbearance from animal food; from every kind of liquor, whether fermented or distilled; and from spices of every species. 


481 
OF SCARLET FEVER. 
the violence of the symptoms calls for the immediate use of the lancet, let the treatment commence by puking with ipecacuanha. Emetics are of the highest importance; and may sometimes be repeated during the course of the disease, should the symptoms be persevering. 
1688. The emetic should be followed by laxatives. Calomel would seem to be the most suitable, on account of its tendency to prevent, and remove congestions of the abdominal viscera, which are much to be dreaded, and vigilantly guarded against, in this disease. This is a disease in which congestions of the great viscera, are very apt to occur; and requires mercurial purging to unload the vessels, and restore the balance, which is thus destroyed in the circulation. In the more advanced stages of the disease, however, provided the bowels have been already fully evacuated, some of the milder purgatives may be employed. The best mode of exhibiting calomel is in divided doses—say six or eight grains divided into six parts; one part to be given every hour, until the whole is taken; unless the previous quantity may have answered. Should this quantity however fail to move the bowels, it must be followed by two or three tea-spoonsful of calcined magnesia, mixed in a little sweetened milk, and drinking after it, some lemonade. 
1689. In case the pulse be full, tense, or hard, immediate recourse is to be had to venesection. The quantity of blood drawn, and the repetitions of the operation, are to be directed of course, by the judgment and experience of the practitioner. The relief felt by the patient, the appearance of the blood, and the effect on the pulse, must determine, whether it shall be repeated—the bleeding must be followed by purging. In the early or inflammatory condition of scarlatina, however, when there is considerable arterial action, and vast augmentation of heat on the surface, cold ablution, or sponging, gives great relief to the symptoms, and is a most comfortable process. We prefer, however, sponging to ablutions. Some however are afraid of these cold applications, because the throat is sore; but this forms no exception; for it is not accompanied by cough or other pneumonic symptoms like measles; and the sponging, or even affusion has checked the sore throat most evidently. We would however 
[62] 


482 
OP SCARLET PEVER. 
make an exception to the employment of cold water, &c. when they produce chilliness; in this case tepid water may be substituted. 
1690. We are told the warm bath is exceedingly efficacious, when the eruption imperfectly takes place, owing to general langour; and especially when attended by coldness of the surface— or, having appeared, suddenly recedes, inducing great gastric distress, and other very unpleasant symptoms—to cleanse the foul ulcers of the throat, emetics are found most effectual—the emetic may be followed by the use of detergent gargles; the best of which are composed of Peruvian bark, with a portion of the tincture of myrrh—or, barley water, acidulated with the sulphuric or muriatic acid, with the addition of honey. An infusion of Cayenne pepper, alone, or mixed with barley water, or the decoction of bark, is much, and we have reason to believe not too much, praised as a gargle,* as far as we can rely on our own observations. 
1691. In the malignant shape of this disease, the general practice is nearly the same as in the preceding or anginose state. We rely mainly, on evacuations of the primae viae—first, by emetics, and next with the mercurial purges. 
1692. Whatever may have been the primary form of the disease, in the advanced stages, when appearances of great depression supervene, we have recourse to nearly similar measures. The object is to support the enfeebled system, and which is best accomplished by the carbonate of ammonia, camphor, turpentine, bark, and wine—aided by the ordinary external irritant applications. 
1693. Long after the cessation of the active symptoms, there are certain consequences show themselves, to which our attention should be immediately called. Deafness is one of these; this proceeds from inflammation having invaded the Eustachian tube, and leaving it in a state of obstruction. It is an unpleasant affection, though we have never known any permanent mischief 
* We are in the habit of using the Cayenne pepper gargle in the incipient stages of anginose affections, with the most decided advantage; and in the disease under consideration, it seems to us to be the only remedy that affords relief, if ulceration has not taken place. 


483 
OF SCARLET FEVER. 
to result from it; it requires no treatment.* (Edematous swellings of the lower extremities, are a common, as well as a more serious inconvenience. The best treatment is to purge moderately, and afterwards exhibit the digitalis. It is here, that it sometimes proves pre-eminently beneficial. But in the removal of the effusion, it may be aided by frictions and bandages, if the swelling be large, and by exercise duly regulated, and persevering in a milk and vegetable diet. We have known the inflamed parotids run on to extensive suppuration, and require much time for healing. When this takes place during the continuance of considerable fever, and the parts exposed by sloughing look as if they had been carefully a~nd beautifully dissected, death has constantly followed, as far as our observations have extended. 
1694. Dropsical affections frequently succeed to scarlet fever; this takes place after the mild, as well as after the severer form of this disease. We are inclined to believe, that this affection arises from the accompanying inflammation, not having been properly subdued by early depleting remedies. In consequence of this, the inflammation acquires a chronic, or a sub-acute form, which is only relieved by purging, even by blood-letting, and diuretics of the saline kind; as nitre, or nitre and squills. For children under seven years, and above three, we would give eight grains of nitre and one-fourth of a grain of squills three or four times a day. For those above seven to fifteen, twelve grains of nitre, and half a grain of squills may be given; from fifteen to adult age, from fifteen to twenty grains of nitre, and a grain of squills may be administered. 
* Dr. Gregory however states, that "not unfrequently permanent deafness is left by it." Vol. I. p. 240. Of this however we have never seen an example. 


484 
OP MEASLES. 
CHAPTER XXXV. 
OF MEASLES, OR RUBEOLA. 
1695. This disease occurs for the most part in winter and in the spring; at least its appearance is much more frequent at these periods than at other portions of the year. It may, however, prove epidemic in the summer. This disease is evidently influenced by the state of the weather; it is more moderate in mild, than in severe weather. 
1696. It is the opinion of some, that measles is regular in its recurrence as an epidemic; the interval is said to be seven years. Whether this is rigidly the case, we are not prepared from present data to decide; it is however rendered probable, that there is either a regular return at this period, or at least an approximation to it. 
1697. It is said to be contagious; but this may be pretty fairly disputed, notwithstanding the imposing experiments of Dr. Home, who declared he propagated the disease by inoculation. An Italian physician, (Speranza,) declares he has succeeded in an attempt at inoculation by puncturing a full measle with a lancet, and inserting the blood that was yielded by the puncture—he declares he was successful in six cases. On the other hand, Dr. Chapman, (MS. lectures,) says upon this point, that " experiments of this nature were instituted in the practice of our Dispensary in 1801; in which the blood, the tears, the mucus of the nostrils, and bronchia; the eruptive matter in the cuticle, properly moistened, were all tried, and without success in any one instance." 
1698. Neither is it settled, whether the constitution can be made to suffer the rubeolus action a second time; evidence is so entirely contradictory on this point, that it would not be safe to draw a positive conclusion either in favour or against it. One thing we however may safely declare, that if it be taken a second time, it is contrary to the ordinary character of this disease;* 
* There is a variety of this disease, however, which affords no protection against the genuine measles; this is called the French measles or the rubeola sine catarrho. Dr. Gregory says this "is a very rare variety, and only inte- 


485 
OF MEASLES. 
or in other words, it is but an exception to the general rule, as regards several of the diseases which propagate themselves by specific contagion, as small-pox, cow-pox, whooping cough, chicken-pox, &c. For it is now well ascertained, that exceptions do occur—we have ourselves known each of the diseases just enumerated, repeated, and seemingly so unequivocally, as to leave no doubts in our mind upon the subject. 
1699. The measles are ushered in, like other febrile affections, by chilliness, languor, oppression, heat, and thirst, especially the first day; these terminate in a perfectly well-formed fever, and sometimes sickness, and even vomiting. The fever is pretty high from its first assault, but not regularly so; occasionally it would seem to augment for two or three days, and becomes very considerable at the time the eruption makes its appearance upon the skin; which usually is not before the fourth day. 
1700. Cough, a little hoarseness, slight sore throat, pain in the chest, and difficulty of breathing, are the usual attendants upon this disease. The eyes are particularly affected; they are almost always slightly inflamed, and the lids a little swelled; and these to be attended by a plentiful secretion of scalding tears. Sydenham looks upon these symptoms as the most certain of the approach of the measles. The discharge from the nostrils is also abundant, as well as acrid sometimes. Sneezing is almost a never failing attendant upon this complaint. 
1701. The eruption almost always occupies the face and neck before it is observed elsewhere; it however for the most part, spreads itself successively over the whole body. But should this not strictly occur, and the eruption show itself in " large red spots, not rising above the surface," it may nevertheless be a genuine measles.* This eruption is mostly very florid, and it retains this colour for the first three or four days, after which time it becomes brownish, and then gradually vanishes; and is followed by a desquamation of the cuticle. "These red spots are composed," agreeably to the same author, "of small red pimples, seated near each other, and rising a little higher than the 
resting in a pathological point of view." We have had several opportunities to see this form of measles. Dr. Hosack witnessed it in 1813 in New York. It has never required any active treatment as far as we have observed. 
» Sydenham, Vol. I. p. 257. 


486 
OP MEASLES. 
surface of the skin, so that they may be felt upon pressing them lightly with the finger, though they can scarcely be seen.* 
1702. The eruption does not much abate the severity of the fever; at least the heat of the skin remains equally great, and especially that of the head and neck, both of which have a look of greater fulness than natural. Sometimes, however, an abatement of fever may be observed after the completion of the eruption; but for the most part, does not entirely cease until the cuticle is cast off. The vomiting, which usually accompanies, or ushers in the disease, always ceases at this period; but the fever and cough seem rather to augment, and is very frequently accompanied with drowsiness. 
1703. We have said cough was an attendant upon this complaint; indeed it may be said to be of never failing occurrence. It is in the commencement dry, frequent, and sometimes painful; but as the fever declines, it becomes more open, and oftentimes the expectoration is even great. 
1704. Pneumonic symptoms very frequently attend measles; and sometimes this disease when epidemic, is characterized by this tendency. We remember it to have been epidemic early in the spring of 1785 or 1786—at which time almost every case was marked by pneumonic symptoms of greater, or less violence. This disease was of difficult management; it ran its course with unusual rapidity; and not unfrequently terminated in death; and in all instances almost, the cough was severe, obstinate, and of very long duration. Indeed, in many cases, it yielded but to the genial heat of advancing spring, or even that of summer. 
1705. The only disease with which measles can well be confounded is scarlatina; yet it is pretty easily distinguished from it, by attending to the characters of each. The sneezing, the watery eyes, the severe cough, the pneumonic tendency, all serve to distinguish the measles from scarlatina. Besides, in measles there is less swelling in the skin; the redness is not so uniform, nor is the tone of colour precisely the same. For in scarlatina the tone of colour on the skin is much more vivid than in measles, and seems to lay beneath the cuticle—it is truly a scarlet colour. In measles, the eruption has a mixture of the Mo» 
• Sydenham, Vol. I. p. 257. 


OP MEASLES. 
487 
dena with the scarlet—that is, it has a shade of purple. Besides, in measles there is a little roughness to be perceived if the hand be slowly passed over the skin that is occupied by the eruption, which is not the case generally, indeed very rarely, with scarlatina. 
1706. In measles, the eyes are much more sensible to light, and are very much more tearful, than in scarlatina; nor are the fauces so much affected in the former, as in the latter disease. Indeed we have seen many cases of genuine measles without the throat being at all affected, which rarely happens with scarlatina. In measles, there is less certainty of a desquamation of the skin; indeed in the former, it is more a branny scurf, than a true desquamation. 
1707. As regards the prognosis, it may be observed, that this disease is dangerous in proportion as the head, the lungs, and the stomach may be affected. And in habits disposed to consumption, it is always bad; at least, it is always to be feared. 
1708. Much fever without a corresponding quantity of eruption ; or the latter making its appearance reluctantly, or of a pale or livid colour, is always a bad sign, and is usually attributed to a want of vigour in the constitution; but this is not so without exception; or perhaps it is very rarely the case. We shall again advert to this condition, presently. 
1709. The abrupt disappearance of the eruption, or its becoming pale, is unfavourable; especially, on the first day or two of the eruption; or if it be attended by a severe vomiting; a great tenderness of the epigastrium, or a diarrhoea. Should none of these untoward symptoms take place, the case will most probably terminate propitiously. But we must be upon our guard, not to mistake the ordinary progress of the disease, for a retrocession of the eruption. For, as the disease usually runs its course in eight or nine days, the eruption is observed to disappear pretty generally at this time, which by the ignorant is supposed to have taken place much too soon, and with a view to maintain it upon the skin, stimulating drinks and medicine are freely exhibited; the patient is covered warm from head to foot and every avenue for air carefully shut up. In consequence of such treatment the patient is thrown suddenly into imminent danger—fever is rekindled; cough and other pneumonic symptoms increase; and the eruption assumes a livid or black 


488 
OP MEASLES. 
hue, and if not relieved soon by proper treatment, the patient quickly dies. 
1710. Measles seems to be more decidedly attended by that condition of the system called inflammatory, than almost any other of the eruptive diseases; or in other words, its epidemic character is more frequently inflammatory than otherwise. There are exceptions of course, imposed by constitution, and season of the year; but above all, by the epidemic peculiarity of the atmosphere; hence, it is sometimes highly inflammatory; requiring the most active evacuations, and extensive depletion by bloodletting, &c. to keep it in control. While again it may have a highly malignant character, for the relief of which, we must have recourse to the opposite means. Sydenham, however, did not order bleeding in the beginning, nor even at the height of the disease, though so fond of this remedy, under almost every circumstance, at other periods of the disease. This in our opinion shows how discriminating this great man was—for he would not prescribe for the name of a disease: the epidemic of 1670 does not appear to have been highly inflammatory, as a strict antiphlogistic regimen, with demulcents, he informs us, " seldom failed to cure the disease." 
1711. Therefore, regard must be had to the character the measles assumes, and must be treated accordingly—if fever be high, cough and oppression severe, blood should be drawn immediately, though these symptoms occur at rather an uncommon period of the disease, namely, in its forming stage. For such changes may be imposed upon the character of measles, by some constitution of the air, or other cause, as to render this very frequently necessary. 
1712. From this view of the constitutional differences of measles, it will at once appear, that its treatment must vary according to its specific character; or its form may be so mild as to require no medical treatment. We have not been under the necessity of bleeding but once this season, for this disease, though we have prescribed for more than one hundred, up to this time, (April, 1829,) so mild has the character of measles been. 
1713. In attacks of severity, especially, where much cough, oppression, or pain in the chest attend; the first remedy we can profitably use is blood-letting; the quantity must be regulated by the age of the child, the force of disease, and the immediate 


OP MEASLES. 
489 
effect of the remedy. It must however be remarked, that in measles, though we are obliged to repeat this operation, it rarely requires large quantities to be drawn at a time: and the repetition must be governed by the state of the pulse, and continuance of the violent symptoms. 
1714. Much objection is made to bleeding in the measles by some; this fear is without foundation in most cases of this complaint; for as a general rule, we may declare, there are few diseases, which more decidedly require this remedy; for there are few in which the lungs are so seriously implicated. Under the best management, it is but too apt to leave a troublesome, and obstinate cough behind; but this is sure to be augmented, if blood-letting has been neglected where the case required it; and we may most safely add, that this but too frequently happens; since, this operation is but too often proscribed. 
1715. It is true, if we are to believe authors, that now and then, the character of this epidemic is such, as to forbid, in almost every case, blood-letting; but this is but the exception to the rule. And we are disposed to believe, that these exceptions in many instances have been imaginary; or rather, that the true mode of treatment has been ill understood. Sydenham appears to us to be authority for this belief; for we are of opinion that few would have bled under the circumstances, which he declares he found the maid servant of " Lady Anne Barrington, who had the measles, joined with fever, difficulty of breathing, purple spots over the whole body, and many other dangerous symptoms, all of which," says he, " I ascribed to the hot regimen and medicines which had been too freely used. I directed bleeding in the arm, and prescribed a cooling pectoral ptisan to be taken often, by means of which, and a more cooling regimen, the purple spots, and all the other symptoms went off by degrees," p. 264, Vol. I. There are few diseases which put on a menacing appearance, that are worse treated than measles; especially, when the eruption is about to make its appearance. Should this fail to be as rapid in its progress, or as extensive in its diffusion, as meets the views of some old woman, or ignorant nurse, the disease is almost sure to be converted by stimulating applications, into one of danger, however simple it might have proved, had its course and tendency been undisturbed. With a view to promote an eruption, heating teas of various kinds, and even liquors 
[63] 


490 
OF MEASLES. 
are given, to the certain injury, if not to the absolute destruction of the patient—this conduct cannot be too strongly reprobated, or too peremptorily forbidden. 
1716. The same error is committed almost always, where the eruption seems tardy, or reluctant in its appearance; for it is wrongly imagined, that this can only proceed from a want of force in the system, and that the efforts of nature must be seconded by heating teas of various kinds, wine whey, milk-punch, &c. when nothing could have relieved the oppressed system but blood-letting, and other evacuating remedies; and hence we are disposed to believe, this disease so frequently proves fatal. For if the pathology of the measles, now so generally assumed, be true, the cause of the eruption not appearing upon the skin, may be owing to the intensity of the gastric irritation or inflammation, as we have already attempted to explain, and which may require the loss of blood, either from the system at large, or from over the region of the stomach, by leeching, or cupping. 
1717. In aid of the bleeding, we should employ calomel, so as to freely discharge the bowels, without urging them to brisk purging. And also to prescribe a strict antiphlogistic regimen; together with demulcent drinks, as flaxseed tea, barley water, bran tea, gum Arabic tea, &c. It may also become necessary, where the pneumonic symptoms continue after bleeding, to draw blood from near the seat of the local affection by cupping, and this to be followed by a blister. 
1718. When the system is sufficiently reduced to bear opium in some form or other, it should be administered, so as to appease the cough, which but too often is very distressing.* 
* We have found the following mixture answer admirably well:— 
R> Sperm. Ceti. gij. Take Of Spermaceti 2 drachms. Vitel Ovi. j. Yelk of an egg one. Pulv. G. Arab. gij. Powdered gum Arab. 2 drachms. Elix. Paregor. sjvi. Paregoric elixir 6 drachms. Vin. Antim. 3jss. Antimonial Wine 4 drachms. Sacch. Alb. ijiij. White Sugar 3 drachms. Aq. Font. § vj. Water 6 ounces. M. M. 
Of this a table-spoonful is to be given every two or three hours until the cough is relieved. This dose is calculated for an adult—for children the quantity must be proportional. 


491 
OP MEASLES. 
1719. One of the best forms of giving opium, is that of the " black drop," or the acetated tincture of opium. This should be administered at night, in combination with antimonial wine, in suitable doses—for instance, a child from two to four years of age may take three or four drops of the black drop, with ten of antimonial wine at bed time; and should this not relieve the cough, and appease the inquietude, in two hours, it may be repeated—for children more advanced, we must increase the dose a little. But a few trials of rather an under dose, will soon lead to the knowledge of the required quantity. 
1720. For children under two years old, we have found the syrup of poppies to answer admirably. This may not only be given at night, but also in the day, and may most advantageously be repeated, as the necessity arises; from a small tea, to a papspoonful will be sufficient for a child from six months to two years old. 
1721. Should the character of this disease be typhoid,* the lancet must be sparingly used, and perhaps not at all, except in the beginning; but when there is much oppression, or pain in the chest, with much cough; cupping will be found both necessary, and advantageous—this must for the most part be followed by blistering. 
1722. Emetics are also useful in this species of measles, and should be employed where there is a great accumulation of phlegm, and the expectoration but inconsiderable. Mercurial purges are also to be given, even to plentiful purging. It is useful also sometimes to employ the warm bath, especially where the character of the eruption is not sufficiently healthy; looking either too pale, or livid, provided the pulse is not so active as to require bleeding. 
1723. Should the appearance of exhaustion supervene, we must have recourse to the diffusible stimuli, as wine whey, and the volatile alkali: and these may be aided by blisters to the extremities, or by sinapisms to the soles of the feet. 
1724. It is of much consequence, throughout the whole course of this disease, that the temperature of the air of the patient's 
* We are of opinion that too much care cannot be taken, not to confound what is termed "a typhoid condition," with an existing inflammatory condition of the system; witness the case related by Sydenham, p. 489. 


492 
OP MEASLES. 
chamber, should be regulated, and not made to exceed sixty-four or five; sixty perhaps would be the best standard. This temperature would be warmer than would be useful for small-pox—but measles requires this; but it is never proper to keep the patient hot, by either a heated atmosphere, or bed-clothes. The constant disposition to cough will readily explain, why measles requires a higher temperature than small-pox. Dr. Gregory observes, that " it is well ascertained that these, (the symptoms of thoracic inflammation,) are often aggravated by a free exposure of the body to cold, either during or previous to the eruption; and some have remarked, that this aggravation of the catarrhal symptoms is occasionally attended by a recession of the eruption. Moderate warmth therefore is on all accounts advisable in measles." 
1725. Measles but too frequently leave disagreeable consequences behind them; especially cough. This secondary, or supervening cough, is too often neglected, owing to the belief that more or less must necessarily follow this disease. This affection takes place after the patient has gone through the eruptive stage; and dissection reveals, that it is owing to an inflammation having attacked the mucous membrane of the bronchiae. This complaint comes on sometimes so insidiously, that it makes a fatal progress before danger is apprehended. We should therefore never trust to nature and time, a patient, in whom a considerable difficulty of breathing exists, accompanied by a wheezing. Nor must we be deceived, because the cough is not severe, for in some of the worst cases, the cough is not always violent. The cough for the most part is dry and fatiguing, and comes on by paroxysms. The pulse is hard for the most part, and always frequent; thirst great; tongue loaded; bowels constipated, and a hot skin. This is a state of great danger; the bronchia are soon filled with mucus, and the patient dies from the failure of the due oxygenation of the blood. This complaint must be treated as an acute bronchitis. A deranged state of the bowels may also follow, particularly i$ the disease has been ill managed, by over stimulating, by exposure, or improper diet, too soon after the fever has passed away. On this account, a patient recovering from this disease, should never be exposed to cold or damp; and should be confined for some time to a milk and vegetable diet, and made to wear in cold or cool weather, flannel next the skin, Sydenham informs 


493 
OF MEASLES. 
us, that the diarrhoea following measles, has always been best relieved by blood -letting. 
CHAPTER XXXVI. 
OF URTICARIA, OR NETTLE RASH. 
1726. This very troublesome, and oftentimes obstinate complaint, is wont to attack children who are teething, or who indulge much in ascescent food, or fruits, in the summer season especially. Dr. Good defines the idiopathic species to be— "Rash in florid, itching, nettle-sting weals; appearing about the second day; irregularly fading and reviving, or wandering from part to part: fever, a mild remittent." Vol. II. page 384. 
1727. This definition may be correct in what Dr. Good calls the idiopathic form of urticaria; but there are some remarkable deviations from it. We have seen many instances of this complaint come on very suddenly, when certain substances have been taken into the stomach, and which was only relieved by such substances being again discharged from it. We knew a gentleman in whom this complaint has been several times produced by eating of very young boiled chicken; when roasted or broiled they would not affect him; by boiled young cabbage in the spring of the year, and by a draught of cold lemonade when his body was overheated. After either of these substances was received into the stomach a few minutes, he would become violently sick; would vomit, and in a moment be covered with weals, which would remain until he would effectually cleanse his stomach from the offending matter. 
1728. Dr. Hewson mentions several cases of eruptions which arose from taking of balsam copaiva; some resembled the weals of urticaria, others, erythema, or roseola. Strawberries sometimes gives rise to urticaria; we know a lady who never fails to have it after eating of this fruit. 
1729. This is a very troublesome complaint in consequence 


494 
OF NETTLE RASH. 
of the excessive itching which always attends it. It is almost always accompanied by sickness of stomach, headach, giddiness, and great susceptibility to become chilly, upon the slightest exposure of any portion of the body. The fever which attends may be of greater or less violence, but almost always observing an evening exacerbation, at which time, all the symptoms are increased, and especially the itching. The weals which appear upon the skin are sometimes very extensively spread over the body; and at other, confined to certain portions of it, especially upon the inner surface of the fore arms, and inside of the thighs. 
1730. From the surface of the weals there issues an acrid serum, or lymph, which serves to perpetuate, or renew the troublesome itching; and such is the disposition of the skin, while labouring under this affection, that you may at pleasure, if the fever be considerable, produce a continued eruption, by drawing the nail forcibly over the skin, at almost any portion of it. 
1731. This eruption sometimes disappears as suddenly as it had showed itself; and when this is the case, serious consequences have sometimes resulted, though this disease is but very rarely fatal. We but once have witnessed danger from the retrocession of the eruption. In this case, the patient had had previously several attacks of an intermittent, from which she had been relieved each time by the sulphate of quinine. Her health appeared to be rapidly mending for some time, and she had nearly acquired her wonted strength; when very early one morning she was attacked with urticaria, to which she had been occasionally liable. 
1732. Soon after it had made its appearance, she became extremely sick, and vomited very freely; she complained of a severe pain in the head, which was quickly followed by delirium. At this time we saw her; besides the symptoms just named, we found her extremely restless, throwing herself into a variety of positions, as if unable to keep quiet for a moment. The face was cadaverous, and evinced much uneasiness; her intellect was not sufficiently collected to give us any rational answer to our questions. The extremities were cold, the pulse nearly extinct, and the breathing very laborious—in a word, her situation was truly alarming. 
1733. Hot applications were made to the feet and legs; a very 


495 
OP NETTLE RASH. 
large warm sinapism was applied to the region of the stomach; and ten grains of the carbonate of ammonia were ordered every hour, together with a spoonful of hot brandy toddy every few minutes. 
1734. The parts of the body from which the eruption had disappeared, exhibited a motled livid hue; other portions of the skin were " goose-fleshed" to a great degree. The bowels were spontaneously opened, at the time the puking took place, and she passed a large quantity of urine. 
1735. We saw our patient after an interval of two hours, and found her in rather a more favourable situation, but very far from being relieved. The legs and feet were a little warmer, but the mustard had scarcely acted upon the skin. The volatile alkali and brandy toddy sat well on her stomach; the delirium somewhat abated, and the whole skin looked more natural. The remedies were ordered to be continued. 
1736. At the end of two more hours, we again visited our patient; and now found her much amended—that is, the warmth of the body greater, and more natural; the delirium, and jactitation, less; the pulse more open; the countenance more natural, and less distressed, but no return of the eruption. Remedies were ordered to be continued. 
1737. In the evening, upon our return, we found a pretty plentiful crop of the eruptive weals, attended by much itching. The warmth of the skin rather above the natural standard; the delirium gone; the inquietude over. The volatile alkali and brandy were suspended; a liberal dose of magnesia ordered ; and a little chicken water, from time to time, was allowed. 
1738. On our visit on the following morning, we found our patient feeble, but relieved from the eruption, and free from fever. She was soon restored to health. * 
1739. It would be difficult to say, what may be the cause of idiopathic urticaria; be this what it may, the force of the disease is chiefly spent upon the cutaneous system; but with which, the stomach is sure to sympathize: or the stomach may be the seat 
* Though professedly treating of the diseases of children, we thought the case just related might not be uninteresting, notwithstanding it occurred in an adult. 


496 
OP NETTLE RASH. 
of the affection, and the skin sympathize with it. It sometimes becomes chronic; and we have known several young people liable several times in the year to returns of it, without any evident exciting cause. 
1740. This disease however is much more frequently a sympathetic affection, and arising sometimes from difficult dentition, and at other from some offensive substance taken into the stomach—this is especially the case with children, until the age of puberty. Acids of every kind seem capable of producing it— hence the frequency of its appearance after crude fruit, cucumbers, young cabbage, lemonade when the body is heated, &c. 
1741. The plan of treating this complaint is in conformity to the condition of the stomach; for whether this disease be idiopathic or symptomatic, the stomach is sure to possess great acidity—to destroy this, is essential both to its alleviation and cure. Magnesia should therefore be freely prescribed; lime-water and milk should also be given, particularly when the eruption has continued several days. A milk diet should be adhered to; and if no fever be present, chicken water and beef tea may be indulged in. 
1742. It is common in this disease, to give saline purges; but this is decidedly injurious—there is no purgative so certain or proper as magnesia, or magnesia and rhubarb. It is also common to permit the patient to take lemonade; but this is still worse—plain water, or toast water not too cold, are the best drinks. Solid food should be avoided, as should damp places, or streams of cold air. 
1743. To relieve the excessive itching, the patient should be liberally dusted with well toasted rye or wheat flour, and resist as much as possible the desire of scratching; instead of which, let the part be well rubbed with a handful of flour, and much relief will be experienced. 
1744. In the chronic form of this complaint, we have found a persevering use of small doses of Fowler's mineral solution, to have succeeded in every case in which we have hitherto tried it. 
1745. A very interesting case of chronic urticaria is related by Cazenave. "In the Hospital of St. Louis, in a patient of Mr. Biett's wards, we have seen it accompanying a quotidian intermitting fever, and after having lasted for four years, finally in- 


497 
OP NETTLE RASH. 
duce swellings and great distention, ecchymoses, ruptures, and ulcerations. In many paroxysms it was accompanied with a general tumefaction, sometimes to such a degree that the patient was nearly suffocated, his respiration was hurried, the movement of the thorax very slight, the neck swelled, the face puffed up and of a violet colour, the pulsations of the heart intermitting and at times scarcely perceptible, and death, which appeared imminent, only prevented by large bleedings. This patient, who had passed through several hospitals, and in which every means of cure had failed, was at last restored to health by the use of Fowler's solution."* 
1746. We believe we were the first to recommend Fowler's solution, for the cure of chronic urticaria. Children of from seven to fourteen years old, may take four drops every morning, noon, and evening, in sugar and water; or should this sicken, give but three. 
CHAPTER XXXVII. 
OF BURNS. 
1747. Accidents from fire, or hot water, are so frequent and so sudden in their occurrence, and so dangerous oftentimes in their consequences, that it becomes important that almost every body should have a knowledge of the modes of treating them. 
1748. The extent of such accidents must necessarily be various; consequently, all cases of burns need not be treated precisely in the same manner. A burn may consist simply of inflammation; or it may be accompanied by vesications; or the mischief may be still greater, and the part may be killed. 
1749. The great anxiety when this accident happens, is to know what should first be applied. Authors differ widely in their opinions upon this point; and opposite remedies in their 
» Pract. Syn. of Cut. Dis. Trans, p. 65. 
[64] 


498 
OF BURNS. 
turn are proposed, or had recourse to. We shall not enter into the disputes upon these points; but shall simply relate what we ourselves have found to answer best; and only name some of the other remedies, of which we have no experience. 
1750. When a part is merely inflamed, we have found the steady application of cold whiskey, brandy, alcohol, and even water, not only relieve the immediate pain, but sometimes to quickly remove the inflammation, especially if it be not extensive. If the inflamed portion of skin be considerable, the same plan may be pursued; but the relief will not be so sudden, though it may eventually be as certain. Wrapping the part in cotton, is highly recommended, but we cannot speak of it from experience. 
1751. If vesications attend, we almost always apply the spirit of turpentine a little warmed, to the part, and protect it from the air as quickly as possible, if the wound be considerable, and also, that the turpentine should not be applied to the sound skin. Should much pain attend, we give a suitable dose of laudanum. We almost always allow the first dressings to remain for twelve hours; and when we re-open the sore, we take care it shall not be exposed to a current of air, or a cold atmosphere. Our second dressing consists of the basilicon ointment, according to the recommendation of Dr. Physick. 
1752. We are in the constant habit of opening the vesications by the point of a needle, before we apply the ointment. This kind of dressing is continued so long as the peculiar inflammation of a burn continues; or as the common people express it, until the fire is out. Should the discharge now become too abundant, (a very common occurrence, especially if the surface be large,) we use the cerate of Turner, or the simple cerate, in which a quantity of prepared chalk is incorporated. 
1753. Should the burn be deep, and of course the part killed, the basilicon is the best application until the parts begin to show signs of separation. But should the parts immediately round the injured part be much inflamed, we are in the constant habit of using the bread and milk poultice, until it subside. When the inflammation is reduced to a healthy degree, wc return to the basilicon, or to the cerate, until the part slough out. After this has taken place, wc either use Turner's cerate, or the basilicon, 


OP BURNS. 
499 
or simple cerate, as the wound may seem to require. We use the first where the discharge is too abundant; the second, where it is deficient; and the third, where the suppurating process is going on kindly. 
1754. In extensive burns, the patient almost always complains of a sensation of cold. When this is the case, a free dose of laudanum should be given, and he should be placed in an atmosphere of a moderate temperature. The wound should be opened only when necessary. Should much reaction take place, all stimulating substances, as liquor, animal food, or broths, should be withheld; and in some few instances, even bleeding and purging are necessary. 
1755. The consequences to be apprehended, or in other words, the prognosis of burns; are sometimes extremely difficult to pronounce—for they do not always endanger in proportion to their extent, yet they do so as a general rule. * We once saw death in a very few hours, follow a scald over the region of the stomach. The wound was not more than four inches square; the whole of the cuticle was removed in taking off the clothes. The child made no complaint; on the contrary, it soon fell into a sleep, from which it did not properly awake, before it died. A remarkable circumstance attended this wound; it appeared to heal over its whole extent, an hour or two before death, t 
1756. Nor is the pain in proportion to the injured surface; on the contrary, small burns sometimes give more pain than large ones, owing doubtless, to the more or less destruction of the vital principle in the parts affected. My friend Dr. Physick and myself, witnessed a remarkable case of this kind, in a young lad, 
* " The unqualified statement that constitutional irritation is in proportion to the extent of surface destroyed, or the depth to which the destroying agent has penetrated, would be incorrect; such a statement would apply generally, if not universally, after the lapse of three or four days from the injury; or in other words, to the after-stages of the process; but it is unquestionable, that the situation of the injury is, as regards the first days, of greater importance— burns upon the neck, chest, and abdomen, exclusively, proving oftener fatal by direct irritation."— Trovers on Constitutional Irritation, p. 76. 
f "Where the cutis is charred and killed, the constitutional sympathy is less than where the cuticle, ravelled up into folds like wetted paper, leaves the cutis bare; and for similar reason, vesications, however large or numerous, excite less irritation than the state last mentioned." — Ibid. p. 76. 


500 
OF BURNS. 
who had fallen into a soap-boiler's chaldron up to his chin. He was quickly taken out, but complained of no pain whatever. He died in a few hours after the accident. 
1757. When burns become extremely painful soon after they are inflicted, we believe nothing affords such certain relief as cold. This may be applied by means of a bladder nearly filled with water and applied to the part—it sometimes is useful to add ice to it; or ice may be applied over the dressings, agreeably to the recommendation of Sir James Earle. 
1758. Burns have almost always this peculiarity in healing; namely, they shoot up fungus most rapidly; nor is this easy to subdue, even by active caustics, which we are almost always obliged to use. There is little or no sensibility in this fungus, when it is abundant; we have applied caustic often to such surfaces, without the patient expressing the least uneasiness. When it is more moderate in quantity, it is generally more sensible. 
1759. It may be proper to mention, that we have seen great error committed in the application of caustic, by its being spread over the whole fungus surface. This we believe, is never necessary; for the healing proceeds pretty constantly from the margins of the wound; consequently,, it is only necessary to suppress its excess immediately at the edges. Dry lint, where compression can be easily made, is very useful in removing this superabundant product. But the lunar caustic is the least irritating, and most certain of all the escharotics we have employed, if we except the burnt alum. In a case where a large exposed surface was filled with a feeble jelly-like fungus, we sifted over its whole extent the burnt alum almost daily, with the most marked and prompt advantage. This application did not appear to give the slightest pain, though we had anticipated a very different result. 
1760. When burns are healing, great pains should be taken, that no two parts that are naturally separate, should come in contact, lest they adhere permanently. On this account, when the hands or feet are the seats of the accident, the fingers and toes should be kept separate, by well-regulated dressings. Splints and bandages may also be necessary to prevent coalescence, or contractions. 


501 
OP PROLAPSUS ANT. 
CHAPTER XXXVIII. 
OF PROLAPSUS ANI. 
1761. This is a very troublesome complaint, where the habit of descending is of long standing. It always excites a great deal of solicitude for the event, though the disorder cannot be considered as dangerous. 
1762. As the inner coat of the rectum is looser, and longer than the external, it is frequently made to descend, by whatever will excite a straining, or tenesmus—hence, the frequency of this accident after bowel complaints, especially dysentery. The worms called ascarides; (1634) a stone in the bladder; over purging; long-continued costiveness, &c. will sometimes produce this complaint. 
1763. It will descend to various lengths; from half an inch to several inches; and will very often in the recent state of the disease, return of itself, for a time. But this is but of short duration; for repeated descents for a few days will generally confirm the complaint, and its falling will soon become habitual. When it is down, the child suffers considerable pain, especially if it be not soon returned; as the sphincter ani acts as a kind of ligature upon the prolapsed gut. If thus constricted, it soon swells, and inflames; and sometimes the stricture is so confirmed, as to prevent a free return of the venal blood of the part; in consequence of which, it soon becomes livid, or even black, and assumes an appearance really menacing. 
1764. To prevent this, care should be taken the gut be returned as quickly after its descent as may be possible; especially where it is from time to time threatened with this kind of strangulation. To insure the return of the gut, after it has prolapsed, as soon as practicable, the mother should be instructed in the method of reducing it, that no time may be unnecessarily lost after its escape. The method of doing this is extremely simple, and equally easy in recent cases; but in the chronic affection, it is sometimes very difficult to accomplish. 


502 
OP PROLAPSUS ANI. 
1765. For the purpose of reducing the prolapsed bowel, the child must be laid across the lap, with its head a little lower than its hips. The part must then be lubricated by sweet oil, or fine hog's lard; a piece of fine linen may be laid over the part; then commence the attempt at restoring it, by making a gentle, but continued pressure in such direction as shall tend to return the gut within the sphincter ani. When you have diminished the distended part, by forcing a portion of blood from it by the pressure made by the fingers, the gut must be urged upward, arid a little backward, until it retire within the verge of the anus. 
1766. Sometimes this operation succeeds best, by placing the point of the fore-finger against a portion of the prolapsed gut, and carrying that portion immediately forward,until it pass thesphincter, or the constricting part. After this has passed, another and another portion is carried in the same manner, until all is restored. This method has never failed with us, when the prolapsed part has not been considerable; but it may not succeed when a large portion is down. In this case a steady pressure, as above directed, (1765) is the only one we know to be useful; for it requires some patience for the pressure so to reduce the swoln part, that it may repass the sphincter ani. 
1767. Indeed, it sometimes becomes so enlarged by hanging down, that it would be in vain to attempt the replacement, until the bulk of the tumour was reduced by proper applications, and management. For this purpose the child should be kept in a horizontal position upon its back, with its knees drawn up, and the hips raised higher than the head. The part itself should remain exposed to the air,* but occasionally moistening it with lead-water of a proper strength; for on this much depends.t 
1768. Dr. Underwood declares, (Vol. II. p. 54,) that, "should such a case occur in children, as it frequently does in adults, in which the bowel may not be easily returned, on account of super- 
* If the weather be cold, the child should be protected by a sufficient quantity of covering, though the part itself should be left free. 
f The following formula for the lead-water is the one we are in the habit of employing:— 
Sacch. Saturn. Qi. 
Aq. Font. ,?viij. f. Sol.— 


OP PROLAPSUS ANI. 
503 
vening tumour and inflammation, the stricture will never fail to yield to an injection of cold water with a few drops of aq. lithargyri acetati, * with five or ten drops of the tinct. opii. An hour or two after such an injection has been thrown up, the prolapsed intestine, though perfectly black as well as swollen, will be found to retire of itself." 
1769. In cases however of prolapsus ani, the great object is to prevent a recurrence of its dropping—for this purpose, the plan of Dr. Physick is highly important, as we have more than once tested by experience. He directs, 1st, that the patient should live altogether upon rye mush sweetened with molasses, or brown sugar. By this diet the faeces become very soft, and of course can be readily expelled, without any effort of the child for this purpose; consequently, the risk of the gut coming out is diminished. 2d, That the child should be made to pass its evacuations while standing; by this means the habit of straining is interrupted, and the bowel permitted to retain its situation. 
1770. The child should sit upon a hard bottomed chair without arms; and it should be of such a height, as not to allow the feet to touch the floor. 
1771. It will be proper however, to observe, that as this affection may have a number of causes, any attempt for its relief will be totally useless, until the complaint producing it, be removed— therefore, in all such cases, as do not depend merely upon habit, attention should be first directed to its remote cause. 
* The following form may be used for this prescription, for a child from three to five years old:— 
R. Sacch. Saturn. gr. v. Tinct. Thebaic. gut. x. vel xv. Aq. Font. frig. §j. M. f. enem. 


504 
OP THE WHITLOW. 
CHAPTER XXXIX. 
OF THE WHITLOW. 
1772. The extremities of the fingers are liable to a very painful inflammation, termed whitlow; which almost always terminates in suppuration. It is commonly divided into four species, which perhaps merely differ in degree. 
1773. The first species is the mildest; and locates itself at the side or root of the nail. In this species, the inflammation seems to penetrate no deeper than the true skin; and when it terminates in suppuration, the matter is confined immediately below the cuticle. Should the matter find its way beneath the nail, the patient has to endure a great deal of pain, from its confinement in so unyielding a part. 
1774. In the second species, the inflammation penetrates below the true skin, near the extremity of the finger. It creates much pain, especially in very young people; it eventually suppurates; but it requires a good deal of time before the matter discharges itself. 
1775. In the third species, the inflammation is seated within the theca which covers the flexor tendons. When suppuration takes place in this species, the matter finds great difficulty in passing to the surface of the skin, in consequence of which it is found to pass along the sheaths of tendons, even to the wrist sometimes. 
1776. In the fourth species, the periosteum is the seat of the inflammation; and even the bone itself sometimes becomes inflamed. But in this case, the inflammation and suppuration are more limited than in the last species. 
1777. In both the third and fourth species, the pain is extreme; and the inflammation sometimes runs so high, as to swell both the hand and arm. Much fever is sometimes excited; and we have known even delirium to attend. 
1778. This disease is frequently produced by punctures, or other injuries of the like kind—we have known it several 


505 
OF THE WHITLOW. 
times produced by the sharp fin of a fish; and especially, the cat-fish. 
1779. The different species will require something different in the treatment. It rarely fails to suppurate; and we still more rarely have it in our power to prevent it. Several plans however have been proposed for this purpose; some of which are said to have been attended with success—such as holding the finger in very warm water, vinegar, or ley; poultices of the white of an egg and honey; of ley, of brown soap, &c. 
1780. As this complaint almost always runs on to suppuration, the sooner this is promoted the better; especially, in the two first species. For this purpose, we believe there is nothing better than the good, old-fashioned bread and milk poultice. This must be repeated every few hours, until the matter forms. When this happens, it should be discharged, by opening the abscess as soon as it becomes evident. The wound may be dressed with simple cerate. 
1781. In the third and fourth species, much more trouble and pain are experienced. Blisters are said to have relieved this deepseated inflammation; we believe this has happened, but it has been rarely. Much patience must be exercised, and suffering endured, before the matter in these cases will find its way to the surface; and sometimes much mischief is done the parts below and around it, before this happens. The bone and tendons are killed, and the usefulness of the hand is sometimes destroyed, by permitting this complaint to run its course. 
1782. On this account, it is considered best, to cut down to the part, in the direction of the finger, before suppuration has taken place, or as quickly after as possible; and not to wait for the tedious and painful operation of spontaneous opening. By this plan, immediate relief is always experienced; for if suppuration has not taken place, a wound which will quickly heal is substituted for an untoward inflammation, which would eventually terminate in it. If matter has formed, it will now be discharged, and the parts will readily heal, by very common attention—the wound may be poulticed for two or three days after the incision has been made, and then dressed with simple cerate. If the bone, or tendon, has sustained injury, the progress of the cure will be very slow. Bone may exfoliate; or tendon slough. 
[G5] 


506 
OP THE WHITLOW. 
The portions of bone should be removed by forceps, when loose; and the protruding tendon cut off, as it may appear. If proud flesh shoot up through the external opening, it must be removed by caustic, or the opening enlarged. 
CHAPTER XL. 
OF DISCHARGES FROM THE VAGINA. 
1783. We occasionally find, that very young children have a discharge from within the labia, of a thin acrid kind, or of a purulent appearance. When this occurs in very young subjects, it almost always proceeds from a neglect of cleanly attention to these parts; either by withholding a frequent use of lukewarm water, or permitting the child to remain too long wet. In either case, the difficulty is easily removed, by frequent washing, and the occasional use of weak lead-water. (See note to par. 1767. t) 
1784. Children however more advanced in age, have also discharges of a purulent character, that seem to arise from a morbid action of the mucous membrane of the vagina or labia. This frequently shows itself about the fifth year, and may continue, if neglected, to almost any period. Parents therefore cannot be too much upon the alert, when this discharge is discovered on their children; nor too early in the application of suitable remedies for its removal. It is in a great measure owing to this neglect, that fluor albus, or whites, become so common, and of such difficult management, in adult age. 
1785. If not interrupted in the beginning of its career, it is apt to continue until the period of puberty, over the phenomena of which, it but too often exerts an unfriendly influence.* 
1786. The cure of this complaint must be attempted, by a strict attention to cleanliness; having the parts washed three or four times a day with warm water; and each of these washings 
* Treatise on the Diseases of Females, Chapter on Deranged Menstruation, by the author. 


OF DISCHARGES FROM THE VAGINA. 
507 
to be followed by another, of warm lead-water. Should the parts be inflamed, or excoriated, they covered from time to time with very fresh lard. If the bowels be costive, small doses of magnesia should be given daily, so as to keep them a little free. Should they not be costive, or inclined to lax, the prepared chalk mixed with magnesia, or alone, according to either of these states, may be used. The diet should be strictly of milk; rice, or Indian mush, may be taken with the milk, or bread simply, if preferred. 
1787. Should these fail to interrupt the discharge, we must have recourse to some other remedies. The most certain that we have found, is the tincture of cantharides in proper doses. * But should a prejudice be entertained against it, or if it fail, small doses of the balsam copaiva may be given ;t and a plaster of Burgundy pitch should be applied to the back, very low down. But care should be taken that it is not allowed to remain long, after it excites considerable itching; as it may produce too much irritation. 
CHAPTER XLI. 
OF SCURFINESS OF THE HEAD. 
1788. Children within the month, contract a dark coloured scurf; especially, from the top of the forehead to the back part of the head. It usually commences near the anterior fontanelle, or opening of the head, and gradually spreads itself, until it covers 
* It is proper to begin with small doses of this medicine, say, five drops, every morning, noon, and evening, in a little sugar and water. After this quantity has been taken a few days, the dose may be increased a drop or two; and it may be thus augmented to ten or twelve drops, or even more if necessary. But if any irritation of bladder show itself, it must be laid aside until it cease. Should it be required after this by a continuation of the discharge, it may be commenced again, and proceeded with as just mentioned. 
f From eight to ten drops of this balsam may be given three or four times a day, dropped on some brown sugar, and washed down by a little warm milk. 


508 
OP SCURPINESS OP THE HEAD. 
the whole crown. It acquires a considerable thickness, and will sometimes be thrown off in large flakes, or be frequently removed by rubbing, in consequence of its itching. 
1789. At times, this itching is so severe, as very much to interrupt the comfort of the child. This scurf is occasionally very offensive; its smell resembling that of a sour curd. If the part be closely viewed, it will frequently be found covered with a vast number of small pustules, which after a while, pour out a thin acrid lymph; and this becoming dry, forms a crust. Upon the removal of this crust by any kind of violence, the skin underneath is often found inflamed. The removed crust, however, will quickly be replaced, by the exposed surface pouring out a quantity of fresh lymph, which quickly hardens into a new one. 
1790. The formation of this crust, is for the most part owing to neglect; and this neglect arises from prejudice; it being supposed by many, that it would be wrong to remove it; and thus it is permitted to accumulate, in unsightly and injurious quantities. 
1791. As this complaint, (if it may be so termed in its commencement,) originates from a neglect of cleanliness, it should be removed, after it has occurred, by suitable means; or be prevented, by proper precautions. If it be neglected, this now inoffensive scurf may degenerate into a real disease, and require time for its removal. The proper plan of management, will consist, 1st, in its prevention; and 2d, in its cure after it has taken place. 
1792. 1st. To prevent this, all that is necessary is to have the head of the child regularly washed every morning with water, or with a little fine soap and water; to have it well wiped and dried with a fine cloth; and then brushed with a brush, of sufficient stiffness to penetrate to the skin; and not to have the caps of the child of a too thick material. 
1793. 2d. After the incrustation is formed, it should be rubbed with sweet oil, or fine lard, at night, and washed off with a strong solution of borax and water—that is, in the proportion of an ounce of the borax to three half pints of boiling water. 
1794. The borax water should be a little warmed, before the head is washed with it; and this repeated daily, until the scurf is removed. After the scurf is removed, the part should be washed daily for a few days with the solution of borax, which will effectually prevent its re-formation. 


509 
OF SCURFINESS OF THE HEAD. 
1795. Should however the skin beneath the scurf be inflamed, or yield a purulent discharge, the parts should be rubbed once a day with the tar ointment, having first prepared the parts by washing, &c. as just directed. 
1796. We have seen this scurf attempted to be removed, by simply washing and combing the head. We do not approve of this plan; as the fine comb, which is always employed, frequently produces so much irritation, as to increase the disease. A brush is the most proper instrument for this purpose, as just suggested. 
THE END. 


A TRANSLATION 
OF 
THE PRESCRIPTIONS. 
Page 274, par. 943. Take, Of prepared calomel, 3 grains. Loaf sugar, 6 grains. Mix intimately, and divide into 12 parts. Page 281, par. 975. Take, Prepared chalk, 2 drachms. Laudanum, 20 drops. Oil of caraway, 1 drop. White sugar, 2 drachms. Water, 1 ounce. Mix. 
Page 289, par. 1004. Take, Calcined magnesia, 12 grains. Laudanum, 3 drops. Loaf sugar, enough to make sweet Water, 1 ounce. Mix. 
Page 293, par. 1013. Take, Calcined magnesia, 20 grains. Tincture of assafoetida, 60 drops. Laudanum, 20 drops. Water, 1 ounce. Mix. 
Page 299, par. 1032. Take, Prepared calomel, 4 grains. Calcined magnesia, 8 grains. Mix, and divide into 8 parts 


511 
TRANSLATION OF THE PRESCRIPTIONS. 
Page 300, par. 1034. Take, Acetate of zinc, 2 grains. Rose water, 2 ounces. Dissolve, 
Page 301, par. 1039. Take, Blue vitriol, 10 grains. Powdered (best) Peruvian bark, 60 grains, or 1 dr. Gum Arabic, ditto. Honey, 2 drachms. Water, 3 ounces. Dissolve and mix. 
Page 317, par. 1108. Take, Prepared calomel, 10 grains. chalk, 20 grains. Mix, and divide in 20 parts. 
Page 317, note to par. 1110. Take, Prepared calomel, 2 drachms. Essence of lemon, 20 drops. Common cerate, 1 ounce. Mix. 
Page 388, par. 1378. Take, Prepared chalk, 3 drachms. Laudanum, 20 to 30 drops. Oil of cinnamon, 1 drop. White sugar, 2 drachms. Water, 2 ounces. Mix. 
Page 394, par. 1398. Take, Prepared calomel, 3 grains. chalk, 20 grains. Opium, half a grain. Mix, and divide in 12 parts. 
Page 405, par. 1433. Take, Prepared chalk or oyster-shells, 1 drachm and a half. Powdered gum Arabic and ? , , j u loafsugal, £ each 1 drachm. Laudanum, 10 drops. Water, 3 ounces. Mix. 


512 
TRANSLATION OP THE PRESCRIPTIONS. 
Same page and par. Take, Salt of Tartar or Soda, 30 grains. Gum Arabic and loaf sugar, each 1 drachm. Tingture of opium or laudanum, 10 drops. Water, 3 ounces. Mix. 
Page 406, par. 1437. Take, Copperas, 2 grains. Oil of Vitriol, 10 drops. Sugar, 1 drachm. Water, 1 ounce. Mix. 
Page 426, note to par. 1503. Take, Tartar emetic, li drachm. Oil of lavender, or essence of lemon, 15 drops. Simple cerate, 1 ounce. Mix 
Page 502, note to par. 1767. Take, Sugar of lead, 1 scruple. Water, (soft,) 8 ounces. Make a solution. 
Page 503, note to par. 1768. Take, Sugar of lead, 5 grains. Laudanum, from 10 to 15 drops. Cold water, 1 ounce. Mix for an injection. 


GLOSSARY, 
EXPLAINING THE TECHNICAL TERMS USED. 
•Abscess, a collection of pus or matter. •Abdomen, the belly or paunch. Abdominal viscera, the contents of the abdomen. •Abortion, miscarriage. •Anthelmintics, medicines against worms. •Antiphlogistic, such medicines as reduce an inflammatory habit. •Aphthae, baby's sore mouth. •Artery, a strong, elastic, circular tube, which carries the blood from the heart. •Axillary, belonging to the arm-pit. 
Cardia, the upper, or left orifice of the stomach. Catamenia, the monthly discharge of women. Chyle, a white fluid produced by digestion. Chyme, the first product of digestion, and from which the chyle is separated. Clavicle, the collar bone. Coagulum, a clot of blood, or of milk. Colostrum, the first milk after delivery. Colyrium, a wash for the eyes. Combustion, burning. Congenital, made or formed at birth. Connate, born with. 
Diaphragm, a muscle which separates the belly from the chest. Dorsal, belonging to the back. Duodenum, the first bowel below the stbmach. Dyspepsia, depraved digestion. 
Enema, or Enemata, injection, or injections. Excitability, the capacity to be acted upon by stimuli. Excitement, the action produced by the application of stimuli. Exfoliate, the act of casting off dead bone or scales. 
[66] 


514 
GLOSSARY, 
Farinaceous, mealy. Foetal, belonging to a foetus. Foetus, a young animal before birth. 
Gangrene, a mortification, or nearly the loss of life of a part 
Idiopathic, an original affection of a part. Iliac Passion, dry belly-ache. 
Leucorrhoea, the whites. Liquor Amnii, the water surrounding the foetus. Lumbar, belonging to the loins. 
Meconium, the faeces of a foetus. Miasm, sing. Miasmata, plur. any fume or effluvia capable of producing disease. 
Nausea, sickness at stomach. Nitrogen, one of the constituents of the atmospheric air. 
(Esophagus, the gullet. Ophthalmia, an inflammation of the eyes. Ovum, an egg. Oxygen, the basis of vital air. Oxygenation, acquiring oxygen. 
Pabulum, food. Papula, a very small and accuminated elevation of the cuticle, with an inflamed base, very seldom containing a fluid, or suppurating, and commonly terminating in scurf. Pectoral, belonging to the breast. Physical, that which relates to natural agents —that which is opposed to moral. Physiology, the doctrine which teaches the use and actions of living parts. Placenta, the after birth. ; ' r ', 
Plethora, fulness of blood. Pus, the matter found in abscesses, and other parts after inflammation. 
Pustule, an elevation of the cuticle, with an inflamed base, containing pus. 
Pickets, a disease of the bones. Rupture, a protrusion of any of the contents of the belly through the parietes of that cavity. 
Sanguiferous system, the blood-vessels, both arteries and veins. 


GLOSSARY. 
515 
Scab, a hard substance, covering superficial ulcerations, and formed by a concretion of the fluid discharged from them. Scirrhus, a tumour affecting glands. Scrotum, the bag under the penis containing the testicles. Scurf, small exfoliations of the cuticle, which occur after slight inflammation of the skin, a new cuticle being formed underneath during the exfoliation. Secretion, the separation of various fluids, and other matters by glands from the blood. Stigma, a minute red speck in the skin, without any elevation of the skin. 
Symptomatic, arising from, or indicative of some other affection. 
Tenesmus, an ineffectual urging to go to stool. Tormina, a griping pain. Tubercle, a small, hard, superficial tumour, circumscribed and permanent, or suppurating partially. 
Umbilicus, the navel. 
Umbilical cord, the cord connecting the child with the mother. Umbilical hernia, a protrusion of a bowel at the navel. Uterus, the womb. Utero-gestation, the term of pregnancy. 
Vesicate, to blister. Vesication, blistering. Vesicle, a small orbicular elevation of the cuticle, containing lymph, which is sometimes clear and colourless, but often opaque, and whitish or pearl-coloured. 
Weal, a rounded or longitudinal elevation of the cuticle, with a white summit, but not permanent, not containing a fluid, nor tending to suppuration. 




INDEX. 
The first numbers refer to the paragraph, and the latter to the page at which the subject commences. 
Par. Page. A. 1 Abortion, cause of the facility with which it may be procured, 27 17 physical evils resulting from 28 17 moral obligations to the prevention of - - - 29 17 dreadful consequences from repeated ... 30 18 rules to be observed for prevention of - 33 19 produced by a gossip's story ----- 88 36 general rules for the prevention of ... 292 95 Appetite, not to be indulged during pregnancy - 42 21 Air, of the - - 118 general observations on 418 118 importance of pure air to children ... 445 126 Arguments against the opinion that the imagination has power to mark the child in utero 68 30 Appeal to the good sense of parturient women - - - 118 44 Absurd modes of dressing young children - 194 65 Accidental and partial application of cold to be avoided - 236 77 Aphths, or sore mouth of children 284 symptoms - 983 284 whether the aphthx pervade the whole alimentary canal 986 285 whether contagious or epidemic - 991 287 time of life subject to it 1001 289 treatment ........ 1004 289 B. Beauty in females, cause of early loss of - 7 11 Bleeding not to be used without advice of a physician - 36 20 Dr. Struve's opinion on 38 29 of great importance under judicious direction - 49 21 Buchan's errors in relation to children's dress ... 201 67 Belly-band, necessity and utility of 217 73 reasons why it should not be too tight - - 221 74 Bathing and cleanliness, general observations on - - 231 cold bath, definition of and objections to - - 812 235 warm and tepid bath 814 236 neither warm nor cold bath to be used without the advice of a physician ------- 826 238 Dr. Struve's rules for bathing young children - - 827 239 Breasts, inflammation and swelling of, in new-born children 302 erroneous opinion respecting 1044 302 treatment of 1046 303 Burns .......... 497 treatment where the skin is merely inflamed - - 1750 498 where vesications attend .... 1751 498 when healing 1759 500 caution lest adhesion takes place .... 1760 500 * 


518 
INDEX 
Par. Page. C. I Consequences of ill assorted marriages .... 9 11 Constitutions, the best, how perpetuated .... 10 12 Constitution, of the 12 soundness of to be considered in marriage contract 12 13 fallacious appearances relative to soundness of - 13 13 Conduct to be observed before and during delivery - - 91 37 during the month 39 Childbirth rarely dangerous in this country ... 112 42 Children always to be suckled by their mothers - - 132 48 lives may be endangered by selfish nurses - - 167 59 Child, rules for washing the 62 general dress, observations on 226 75 to be changed whenever circumstances render it necessary 245 81 Children, new-born and older, physical treatment of - 112 Crying of infants 405 113 Cause of child crying at birth 402 112 to a degree salutary 405 114 causes of - - - - - . . . 406 114 Cleanliness and bathing of children 231 Colic of infants 292 divided into two species - - - - - 1010 292 treatment of each 1012 293 Constipation 347 oftentimes produced by laudanum - - - 1223 348 treatment of 1225 348 Cholera infantum 395 exciting causes 1403 396 symptoms 1404 396 prognosis 1412 399 seat and nature of 1415 400 treatment 1418 401 in very young children .... 1422 402 regimen during 1440 407 removal to country 1441 407 prevention, modes for the ----- 1443 407 Cynanche tonsillaris, or sore throat 427 symptoms of - - - - a 1507 427 treatment of 1517 429 prevention of 1524 431 parotidsea, or mumps 431 symptoms of 1526 432 treatment of - - 1528 432 trachealis, or croup 434 age subject to its attacks - - - - 1537 434 mode of attack and time .... 1540 435 most dangerous when neglected in forming stage 1547 437 Laennec's opinion of its character ... 1549 438 its anatomical character, by Laennec, note f 441 divided into three stages .... 1551 439 first stage, or incipient - - - 439 second, or when the disease is formed 441 third, or congestive stage - - - 442 formation of false membrane - - 1563 444 treatment of first stage 445 of second stage .... 448 of third stage .... 455 his account of the false membrane - - 1564 444 the successful remedies, note * - - - 1607 455 


519 
INDEX 
Par. Page. D. Disease, predisposition to ...... 13 dispositions, diseased, do not appear till long after birth 14 13 hereditary, dishonesty of concealing ... 15 14 Diseases produced by repelled milk - ' - - - - 144 51 how removed - 147 52 Drinks, stimulating, very injurious 80 34 never used with impunity ... 84 35 Diet of mother during the month, general rules for - - 311 97 Diapers alwavs to be changed when wet, &c. - - - 236 77 Dress of the child 193 65 how to be regulated to avoid the use of pins - - 239 78 within the month, general rules for - - 330 98 from weaning until puberty 241 form of garments 241 quantity and quality of clothing ----- 242 Duties, social, best accomplished when the body is healthy and full grown 11 12 of the mother after the month ----- 88 mother should learn to""wash and dress infant - - 273 88 food proper for mother and rules as to diet - - 277 89 danger of attemptingto remedy partial diminution of milk 280 91 failure of milk more frequently from an over than under quantity of food 281 91 remedies contributing to improvement of the milk - 290 93 Diseases of Children. Book 2 257 Dentition 303 gives rise to a variety of sympathetic affections - 1049 304 states of the system when attended with danger - 1055 305 morbid sympathies connected with ... 1059 306 symptoms attendant on - - - - - - 1063 307 lancing the gums, directions for - - - - 1068 308 co-operative treatment 1070 308 advantages arising from cutting the gum, &c. - 1075 308 diseases arising from 312 eruptions 313 crusta lactea, or milky scall - 313 tooth rashes - -- -- 319 strophulus confertus. Tooth rash - 320 intertinctus. Med gum - 320 albidus. White gum - 322 volaticus - - - 323 Candidas - - - 324 sore ears 324 Diabetes of children - 344 Diarrhoea of children 355 feculent 355 bilious 362 mucous 368 chylous 369 lienteric 371 other varieties 1330 375 chronic form 376 treatment of chronic diarrhoea, or weaning brash - 387 E. Evils of precocious marriages - 11 Europe, dread of hereditary diseases in .... 20 15 Error relative to extra food for pregnant women, &c. - 43 22 Exercise to the extent of causing fatigue to be avoided - 111 42 


520 
INDEX 
Par. Page. Exceptions to the rule relative to suckling, very few - - 136 49 Exposure and hardening of children 133 general observations 460 133 danger of exposing infants to cold and damp - 464 134 anecdotes respecting 469 136 danger of too great delicacy of treatment - - 478 139 Exercise for young children 219 carrying in the arms 761 220 walking 778 224 general observations on other modes ... 785 226 riding in a carriage 786 227 riding on horseback 792 228 games of various kinds 229 dumb-bells 231 Erysipelas 275 time of attack and part of body affected - - 954 276 stages of the disease 957 277 treatment 959 278 Ear, abscess within the 340 F. Females may be ineligible for marriage from various causes 23 16 Fullness of the head in pregnancy, how to be avoided - 39 21 Foetus, membranes, and weight of 44 22 Food, dictates of nature relative to quantity of - - - 45 23 proper for pregnant women - 34 Food 142 causes which may render it improper for the mother to nurse 489 143 proper for children after first dentition and weaning • 203 care to be taken that permanent dislikes to certain food are not formed 720 210 are there substances in common use absolutely hurtful to children? - - - - - - - 212 fruit in general - - 724 214 fresh fruk 735 214 dried fruit 758 218 Feeding the child in the month 247 81 substitute for mother's milk ----- 248 82 injurious effects of pap during the month - - 249 82 mode of preparing substitute for mother's milk - 252 83 general rules as regards 339 99 Feelings, distressing, caused to a mother by recollection of her neglect 85 36 Flannel absolutely necessary in winter or in cool weather - 208 70 error relative to dirty 209 70 protection afforded by, in variable weather - 211 71 may be improper for various reasons ... 213 71 belly-band should be of 216 73 Fashion 131 danger of exposure of arms of children - - - 458 131 Fire, great care to be taken to prevent accidents from to children 387 108 G. Galen's opinion of the power of imagination, &c. - 61 28 Gossipping stories injurious to pregnant women - 87 36 productive of abortion ... - 88 36 Glass not to be introduced into nursery if possible - - 390 109 H. Hereditary complaints, tendency to, to be investigated - 14 13 


521 
INDEX 
Par. Page. Health, immediate state of, defined 18 14 why disregarded by parties concerned 19 15 Habits, bad, objections to marriage 21 15 Hunter, Dr. experiments and conclusions on the power of imagination 72 31 singular case related and accounted for by 74 32 Highly injurious effects of stimulating drinks ... 80 34 Hydrocele 333 diagnosis 1171 334 treatment 1172 334 Hernia, umbilical 334 nurse not to be blamed for this complaint - - 1175 335 to be attended to as early as possible - - - 1178 335 treatment ........ 1179 335 Hernia, inguinal 336 symptoms 1181 336 Dr. Underwood's opinion erroneous - - - 1182 336 Dr. Physick's plan of treatment ... - 1183 336 Hip joint, abscess of 337 not perceived or attended to early ... 1185 337 mode of detection and symptoms - - - - 1187 337 mode of treatment 1189 338 curved splint ....... 1193 339 I. Instances of longevity ...... , 912 Intoxication after marriage, unfortunate frequency of - 22 15 Injury to child in utero from causes insufficient to produce abortion - 34 19 Imagination has no influence on the unborn child - 53 25 origin of the belief in the powers of - 56 26 prejudices on the subject of, difficult to remove 59 26 general opinion among the ancients as to its power 60 27 Important duties of a pregnant woman ... - 84 35 Indiscriminate use of laudanum and the lancet reprehended 114 43 Intention, the test of criminality, in cases of neglect - - 138 49 Is every woman capable of nursing? 149 53 Injuries, physical, caused by deficiency of milk - 155 55 from bad milk 156 55 from want of care, &c. .... 159 56 from selfishness of nurses .... 161 57 from propagation of an occult or active disease 170 60 Jaundice 271 symptoms, &c. 932 272 whether communicable from milk of mother or nurse 939 273 treatment 942 273 L. Longing 46, 51 23,25 singular instances of ...... 48 25 disappointment of, not to be dreaded ... 52 25 Labour, risk of diminished by presence of good medical aid 108 42 commencement of, never to be interfered with - 113 42 arguments against despondency during a first - - 116 43 general rules to be observed at period of - - 317 97 Laudanum artfully used by selfish nurses - - - - 164 57 detection of a nurse in the clandestine use of - 166 57 never to be administered but by mother or some trusty person ,511 149 Labia: pudendi, adhesion of, in children .... 342 [67] 


522 
INDEX 
Par. Page. Labia pudendi, adhesion of, importance of early attention to 1208 343 treatment 1213 344 M. Marriages, too early, not approved of 3 9 judicious, combined with proper physical education, best preventive of hereditary diseases - 15 4 why not to be long deferred by females - - 24 16 why not to be entered into by very young girls - 25 16 Modes in which the imagination is supposed to act on the foetus 62 29 Marks, certain, may be hereditary 70 31 Milk fever, an artificial condition produced by errors in diet 117 43 Moral injuries caused by nurses ------ 173 61 Materials of children's dresses to be suited to the season - 200 67 Milk posset, how to be made ------ 94 Molasses posset --------- 94 Mother, general rules for conduct after birth of child - « 323 98 Milk of mother, general rules respecting ... - 347 99 Meconium, of the, and management - - - - - 144 to derive advantage from it, child must be applied to the breast early 498 145 purging off the meconium of moment, but drastic purges not to be used ----- 499 145 proper remedies to be used 501 146 observations on 269 7 case of disease from retention of - - - - 927 270 c. r 1 N. Notions, ridiculous, relative to the power of the mother's imagination 62 28 Nature of the connexion existing between mother and child 64 29 Nipples, causes of sore 125 46 means of preventing soreness of - - - - 126 47 injured by compression 130 47 how to bring out when imperfect ... 131 47 Nurses, their selfish tricks exposed 59 too much confidence reposed in their judgment - 503 146 duties as regards physicians - - - - - 505 147 Nursing, important rules relative to 511 149 partial or artificial - 153 only reasons for 520 153 present a choice of means 520 153 1. Means where mother may continue to nurse - 154 substitute for milk and mode of giving ... 521 154 age proper for change of diet and rides respecting 529 156 child not to be permitted to sleep at the breast - 536 159 use of butter, &c 539 161 2. Where artificial means must be used exclusively 162 feeding from the bottle to be preferred to the spoon, and rules - - - - 544 162 analysis of milk of different animals - . - 563 164 general rules as to feeding child - - - - 566 165 mode of preserving milk in a proper condition - 573 167 Rousseau's opinion as regards milk ... 581 170 3. Means or employment of a wet-nurse - - - 172 general observations 588 172 requisites in a nurse, &c. 595 174 mother should assume all duties but that of suckling 610 179 if child is sent away to be placed in the country - 617 182 


523 
INDEX 
Par. Page. Nursing, drinks for a child 620 183 Nursery, of the 100 rules for choice of nursery, and plan - - - 352 100 should be carpeted 357 102 mattrasses to be preferred to feather freds - - 360 102 early and late rising, observations on - - 365 103 cradles, advantages of, and observations on - - 371 105 mode of warming 374 106 amusements for children in - - - - - 378 107 accidents children are liable to 387 108 ventilation to be strictly attended to, and rules respecting - - 391 109 children never to be left alone, or animals to be left with them 396 110 rules as to lights 398 110 Nourishment proper for child 151 milk of mother to be preferred ... 513 151 child not to be subjected to laws of nursing till six months of age 516 152 rules to be followed after sixth month - - 516 152 Needles not to be employed in place of pins ... 240 79 case of serious injury from - - - - - 241 79 Necessities of new-born children 416 117 Navel-string, bleeding from 330 should be occasionally watched - - - 1158 330 causes 1159 330 curious case of bleeding from navel-string - 1160 331 practical cautions ------ 1163 331 ulceration or imperfect healing of 332 exhibits three different conditions - - - < 1166 332 treatment of each 332 O. Officiousness of ignorant practitioners and midwives, injuries caused by-------- - 109 41 Observances towards the mother during the month - - 85 great cleanliness to be observed - - - 263 85 importance of free ventilation - 264 85 how soon a woman may venture abroad with safety after confinement 266 86 importance of proper exercise - - - - 270 86 towards child from second dentition to puberty 246 eating 851 247 drinking 865 250 sleeping 866 250 exercise 874 252 Ophthalmia - 295 symptoms and causes 1019 295 prevention and treatment - - - - - 1025 297 Dr. Underwood's description unsatisfactory, &c. 1027 297 astringent lotions not to be used early - - 1030 298 treatment - - - 1032 298 P. Period of life at which the body is matured ... 10 not to be precisely fixed by lapse of time - 10 Pregnancy does not necessarily require the use of the lancet 41 20 appetite for food not to be excessively indulged during 42 21 


524 
INDEX 
Par. Page. Period at which the imagination is supposed to act upon the foetus undetermined 67 30 Popular error relative to " keeping up the strength" - 115 43 Pins, too many used in dressing infants ... - 238 78 Pertussis, or whooping cough 408 symptoms 1448 408 duration of complaint 1452 409 pathology of - - - - - - - - 1453 410 origin - - - - 14 54 413 various writers on, note 415 considered as essentially inflammatory, by Drs. Watt, Desruelles, Laennec, &c. 1462 413 opinion of Desruelles 1463 414 most severe in infants ------ 1460 413 treatment - - - 1462 415 bleeding in, opposed by Burton and Millar - - 1466 415 absolutely necessary in many instances - 1467 415 the plans of treatment of Willis, Sydenham, &c. - 1468 416 not of opinion it is caused by cerebral inflammation 1476 418 observations as to the determined course of the disease 1452 409 danger of opinion that the disease cannot be shortened 1485 421 defence of author's mode of treatment against the at-? 1481 ?419 tack of Desruelles 5 1501 5 425 use of bark in - 1495 424 Sutcliffe's plan in 1497 424 change of residence 1505 426 Prolapsus ani 501 causes 1762 501 symptoms - - - - - - - 1763 501 to prevent constriction 1764 501 mode of reduction - - - - - - 1765 502 Dr. Underwood's opinion - 1768 502 prevention, Dr. Physick's plan - - - 1769 503 R. Reasons why pregnant women should avoid too much exercise 110 41 Remedies which contribute most to the improvement of the milk - - - - 290 93 Rules to prevent abortion 292 95 for conduct during labour 320" 97 after the birth of child ... - 323 98 as regards nursing 326 98 dressing child - - - - 330 98 to be observed by nurse after weaning child - - 652 193 Room proper for purposes of a nursery .... 351 100 Rocking horse as an appendage to a nursery - 379 107 Respiration, want of, &c. in new-born children - - - 257 premature tying the cord often injurious to the child 885 257 Mr. Burns's opinion 886 258 first object after delivery of child is establishment of respiration 891 260 rules to be observed if there is no pulsation of chord 894 260 where chord pulsates strongly, but child does not cry - 896 262 where child is born still from delay in the passages 897 262 bleeding child from the funis . - - - 898 262 rules for doing this - - - 900 263 


525 
INDEX 
Par. Page. Respiration, interesting case 904 264 Retention of urine in children - - - - - - 282 new-born children often do not pass their urine for some time after birth - - - t - - - 979 282 interesting ease of retention - -' - - - 979 282 state of the bladder should always be examined - 981 283 report of nurses not to be relied on 981 283 Rubeola, or Measles 484 most frequent in winter and spring ... 1695 484 said to be epidemic every seven years - 1696 484 said to be contagious - - - - - - 1697 484 whether the constitution is subject to a second attack 1698 485 symptoms 1699 485 prognosis 1707 487 more generally inflammatory than other eruptive diseases - - 1710 488 treatment 1712 488 sequelae of measles 1725 492 S. Safety and comfort in pregnancy promoted by cheerfulness 77 33 Sore nipples to be avoided by applying the child early - 103 40 evils resulting from - 120 45 Suckling considered as a duty 134 48 neglect of, accounted criminal .... 137 49 as a pleasure 142 50 as it may affect the mother's health - 144 51 as it may affect the child 151 54 if there is failure in quantity of milk, not to attempt to increase it by stimulants 347 99 milk of mother fittest nourishment for child - - 513 151 child not to be permitted to sleep at the breast - 536 159 if wet nurse is employed, mother to attend to all duties 179 but that of suckling 610 179 Stockings recommended, and objections against - - 230 76 Shoes recommended 231 76 objections to, considered 232 77 Sleep of new-born children 411 115 not to be permitted to sleep always in a quiet room - 413 116 Syncope or fainting of new-born children - - - - 264 immediately after birth 906 264 causes of - 907 265 treatment 908 265 children at full period more likely to survive the attack 910 265 cases of recovery of six months children - - - 910 265 causes which may induce it in nine month children - 913 266 mode of treatment - - - - - - 914 266 " fits" of new-born children - - - - - 916 267 case of "fits" - 919 267 Dr. Underwood's plan 920 269 Scarlatina, or scarlet fever - - 476 has been divided into three forms ... 1676 476 definitions of these 1677 477 are identical but different stages of the disease - 1677 477 symptoms 1678 477 state of pulse in different stages - - - 1682 478 eruption 1683 478 whether it is contagious 1685 479 prognosis 168G 480 


526 
INDEX 
Par. Page. Scarlatina, treatment of simple form 1687 480 of other forms 1691 482 sequela: of the disease 1693 482 Scurfiness of the head - 507 symptoms 1789 508 owing oftentimes to neglect .... 1790 508 treatment 1792 508 comb should not be used 1796 509 T. Time of life best suited for marriage 25 16 Temper, evils to pregnant women from indulgence of - 76 33 Treatment of the nipples - 46 Temperature, of 128 proper in a nursery - ~ - - - - 394 110 children at an early age not to be exposed to great changes 450 128 danger of attempting to "harden" children - 452 129 Teething 193 general observations on the appearance of the teeth 654 193 § 1. Phenomena of dentition 196 signs of teeth about to pierce the gums - - 668 196 symptoms are not constant - - - - - 674 197 the process of cutting teeth not mechanical - - 675 198 observations on use of the coral, &c. ... 678 198 nature and shape of coral of importance - - 681 199 § 2. Second dentition - 200 phenomena of this process 684 200 parents too often neglect their children's mouths at this period 685 200 changes that take place in the person at this period 686 201 first set of teeth not displaced mechanically by the second 690 202 reasons why the teeth are shed - - - - 691 202 order in which second set appear .... 693 202 See Dentition Tongue-tie - - 326 arises from two causes - - - - - 1143 326 1. Adventitious tying of the tongue ... 326 mode of remedying 1147 327 2. Original conformation of the fraenum rendering the tongue too short 328 danger attendant on dividing fraenum - - - 1149 328 Tongue, of swallowing and haemorrhage .... 328 Dr. Underwood's account of it .... 1150 328 Petit's mode of remedying - - - - 1151 329 haemorrhage to any extent, ought never to take place in dividing the fraenum - - - - - 1154 329 plan proposed in case of haemorrhage - - - 1156 330 V. Ventilation of nursery, importance of 391 109 Ulceration of the mouth - - - ' - - - - 300 symptoms 1037 300 of easy cure if taken early .... 1039 301 treatment - - - - - - - 1039 301 arising from cutting teeth ... - 1040 301 Dr. Underwood's opinion .... 1041 301 Urine, incontinence of 345 most frequently a disease of habit - - - 1218 345 


527 
INDEX 
Par. Page. Urine, incontinence of, mode of cure in such cases - - 1220 346 interesting case 1221 346 Vomiting 349 not always a disease 1231 349 division into three species - - - - - 1232 350 § 1. Idiopathic vomiting 350 definition of - 1234 350 causes of, and treatment 1236 351 § 2. Sympathetic vomiting ------ 351 causes - 1238 351 treatment, when arising from a suppression of discharge, &c. - - h- 1240 352 treatment, when from some acrid or deleterious substances in the stomach - - - - - 1241 352 treatment, when arising from the deranged powers of the stomach - - 1244 353 from excess of acid 1246 353 from deficiency of acid 1250 354 Urticaria or Nettle-rash 493 Dr. Good's definition of - - - 1726 493 symptoms 1729 493 danger from retrocession ... 1731 494 causes - - - - - - 1727 493 treatment 1741 496 of the chronic form - - 1744 496 Vagina, discharges from - 506 in very young children 1783 506 in children of more advanced age - - - 1784 506 if not checked is detrimental - - - 1785 506 - treatment 1786 506 W. Weaning 184 general observations ------ 624 184 § 1. On the part of the mother ----- 184 causes which may render it improper for the mother to suckle 625 184 constitutional affection of mother - - - - 625 184 child never injured by suckling whilst mother is labouring under fever - 626 185 local disease of mother 627 185 from diminished supply of milk ... - 628 185 from pregnancy taking place 629 185 § 2. On the part of the child 187 A. Of the teeth 187 number of teeth better guide than its age - 633 187 Dr. Struve's opinion 625 188 B. State of the child's health - 189 should not be weaned when sick - - ¦ 637 189 §3. Of the season of the year - - - - - 190 best season to wean in - ... . - . 638 • 190 child should be previously prepared - - ¦ 639 190 rules for weaning - 640 190 mode of facilitating the process .... 646 191 error in giving child food 647 191 most proper diet 648 191 Dr. Clarke's opinion j 650 192 mother or nurse not to be neglected - - - 651 192 rules to be followed by them .... 652 19" 


528 
INDEX 
Par. Page. Worms 458 Dr. Butter's extraordinary opinion .... 1619 458 children under ten months not subject to them - 1620 459 they are introduced with the food - - - - 1621 459 instances of other animals living in the bowels - 1626 460 division into classes 1629 461 § 1. Alvine worms - 461 Dr. Good's account of 1630 461 different species of alvine worms - - - 1631 462 § 2. Anal worms 463 Dr. Good's definition of .... 1633 463 different varieties of - - - - - 1634 463 § 3. Erratic worms ...... 463 cure of worms 464 symptoms as given by Heberden ... 1642 465 Worms injure in three ways - 1645 465 1. By irritation - 465 cases 1648 467 2. By destruction of the proper nourishment of the child 469 the anal worms do not create emaciation ... 1656 469 3. By their bulk from accumulation .... 469 case ...... . 1657 469 division of worm medicines ¦ - - . - - 1661 471 observations on commencing cure with purgatives - 1664 471 best remedy for long round worm .... 1665 472 ascarides - * - - - - 1672 474 taenia ( 1674 475 after treatment to be pursued - - ' 1676 476 Whitlow 504 divided into four species 1772 504 symptoms of first species ..... 1773 504 second - 1774 504 third - 1775 504 fourth - 1776 504 causes 1778 504 cure of first and second species .... 1779 505 third and fourth - 1781 506 


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VII. SKETCHES of CHINA, with Illustrations from Original Drawings. By W. W. Wood, in 1 vol. 12mo. " The residence of the author in China, during the years 1826-7-8 and 9, hasenabled him to collect much very curious information relative to this singular people, which he has embodied in his work; and will serve to gratify the curiosity of many whose time or dispositions do not allow them to seek, in the voluminous writings of the Jesuits and early travellers, the information contained in the present work. The recent discussion relative to the renewal of the East India Company's Charter, has excited much interest; and among ourselves, the desire to be further acquainted with the subjects of ' the Celestial Empire' has been considerably augmented." VIII. FALKLAND, a Novel, by the Author of Pelham, &c. 1 vol. 12mo. IX. MEMOIR on the TREATMENT of VENEREAL DISEASES WITHOUT MERCURY, employed at the Military Hospital of the Val-de-Grace. Translated from the French of H. M. J. Desruelles, M. D. &c. To which is added, Observations by G. J. Guthrie, Esq. and various documents, showing the results of this Mode of Treatment, in Great Britain, France, Germany, and America, 1 vol. 8vo. X. PRINCIPLES of MILITARY SURGERY, comprising Observations on the Arrangements, Police, and Practice of Hospitals, and on the History, Treatment, and Anomalies of Variola and Syphilis; illustrated with cases and dissections. By John Hennen, M. D. F. R. S. E. Inspector of Military Hospitals—first American from the third London edition, with Life of the Author, by his son, Dr. John Hennen. M The value of Dr. Hennen's work is too well appreciated to need any praise of ours. We were only required then, to bring the third edition before the notice of our readers; and having done this, we shall merely add, that the volume merits a place in every library, aud that no military surgeon ought to be without it."— Medical Gaxette. " It is a work of supererogation for us to eulogize Dr. Hennen's Military Surgery; there can be no second opinion on its merits. It is indispensable to the military and naval surgeon."— London Medical and Surgical Journal. XI. PATHOLOGICAL and PRACTICAL RESEARCHES on DISEASES of the STOMACH, the INTESTINAL CANAL, theLIVER, and other VISCERA of the ABDOMEN. By John Abehciiombte, M. D. 
« We have now closed a very long review of a very valuable work, and although we have endeavoured to condense into our pages a great mass of important matter, we feel that our author has not yet received justice."— Med. Chin Review. XII. A COLLECTION of COLLOQUIAL PHRASES on every Topic necessary to maintain Conversation, arranged under different heads, with numerous remarks on the peculiar pronunciation and use of various words—the whole so disposed as considerably to facilitate the acquisition of a correct pronunciation of the French. By A. Bolmab. One vol. 18mo. 
XIII. A SELECTION of ONE HUNDRED PERRIN'S FABLES, accompanied by a Key, containing the text, a literal and free translation, arranged in such a manner as to point out the difference between the French and the English idiom, also a figured pronunciation of the French, according to the best French works extant on the subject; the 


Published by Carey Lea. 
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whole preceded by a short treatise on the sounds of the French language, compared with those of the English. XIV. The First Eight Books of the ADVENTURES of TELEMACHUS, accompanied by a Key to facilitate the translation of the work. 
XV. A TREATISE on PATHOLOGICAL ANATOMY, by William E. Horner, M. D. Adjunct Professor of Anatomy in the University of Pennsylvania. " We can conscientiously commend it to the members of the profession, as a satisfactory, interesting, and instructive view of the subjects discussed, and as well adapted to aid them in forming a correct appreciation of' the diseased conditions they are called on to relieve."— American Journal of the Medical Sciences, No. 9. XVI. A New Edition of a TREATISE of SPECIAL and GENERAL ANATOMY, by the same author, 2 vols. 8vo. XVII. COXE'S AMERICAN DISPENSATORY, containing the Natural, Chemical, Pharmaceutical and Medical History of the different substances employed in medicine, together with the operations of Pharmacy illustrated and explained, according to the principles of modern Chemistry. To which are added Toxicological and other tables, the prescriptions for Patent Medicines, and various Miscellaneous Preparations. Eighth Edition, Improved and greatly Enlarged. By John Redman Coxe, M. D. Professor of Materia Medica and Pharmacy in the University of Pennsylvania. In 1 vol. 8vo. XVIII. An ESSAY on REMITTENT and INTERMITTENT DISEASES, inoluding generically MarshFeverand Neuralgia—comprising under the former, various anomalies, obscurities, and consequences, and under a new systematic view of the latter, treating of tic douloureux, sciatica, headache, ophthalmia, tooth-ache, palsy, and many other modes and consequences of this generic disease; by John Macculloch, M. D., F. R. S. &.c. &c. Physician in Ordinary to his Royal Highness Prince Leopold, of Saxe Cobourg. " Dr. Macculloch is a great philosopher and logician. His views are calculated to do much good. We have therefore taken great pains to concentrate and dit fuse them widely through the profession. Nothing but a strong conviction that the work before us contains a multitude of valuable geins, could have induced us to bestow so much labour on the review. In rendering Dr. Macculloch's work more accessible to the profession, we are conscious that we are doing the state some service."— Med. Chir. Review. " We most strongly recommend Dr. Macculloch's treatise to the attention of our medical brethren, as presenting a most valuable mass of information, on a most important subject."— Am. Med. and Rhus. Journal. XIX. WISTAR'S ANATOMY, fifth edition, 2 vols. 8vo. 
XX. The ANATOMY, PHYSIOLOGY, and DISEASES of the TEETH. By Thomas Bell, F. R. S., F. L. S. &c. In 1 vol. 8vo. with plates. " Mr. Bell has evidently endeavoured to construct a work of reference for the practitioner, and a text-book for the student, containing a ' plain and practical digest of the information at present possessed on the subject, and results of the author's own investigations and experience.' " * * * " We must now take leave of Mr. Bell, whose work we have no doubt will become a class book on the important subject of dental surgery."— Medico-Chirurgical Review. XXI. MORALS of PLEASURE, illustrated by Stories designed for Young Persons, in 1 vol. 12mo. 


4 
Valuable Works 
" The style of the stories is no less remarkable for its ease and gracefulness, than for the delicacy of its humour, and its beautiful and at times affecting simplicity. A lady must have written it—for it is from the bosom of woman alone, that such tenderness of feeling and such delicacy of sentiment—such sweet lessons of morality—such deep and pure streams of virtue and piety, gush forth to cleanse the juvenile mind from the grosser impurities of our nature, and prepare the young for lives of usefulness here, and happiness hereafter. "We advise parents of young families to procure this little book—assuring them that it will have a tendency to render their offspring as sweet as innocent, as innocent as gay, as gay as happy. It is dedicatad by the author ' to her young Bedford friends, Anna and Maria Jay' —but who this fair author is, we cannot even guess. We would advise some sensible educated bachelor to find out.''— N. T. Com. Adv. XXII. The PRACTICE of PHYSIC, by W. P. Dewees, M. D. Adjunct Professor of Midwifery in the University of Pennsylvania, 2 vols. 8vo. The profession need not be informed how much a work like that now published was wanted. It has been the particular object of the author to endeavour to accommodate the mode of managing - the diseases of which he treats to the many pathological discoveries recently made, both in this country and in Europe) and having also availed himself of his long experience, he trusts that his work will remove many of the embarrassments experienced by practitioners. XXIII. DEWEES on the DISEASES of CHILDREN. Third edition. In 8vo. 
The objects of this work are. 1st, to teach those who have the charge of children, cither as parent or guardian, the most approved methods of securing and improving their physical powers. 'I bis is attempted by pointing out the duties which the parent or the guardian owes for this purpose, to this interesting, but helpless class of beings, and the manner by w hich their duties shall be fulfilled. And 2d, to render available a long experience to these objects of our affections, when they become diseased. In attempting this, the author has avoided as much as was possible, "technicality;" and has given, if he does not flatter himself too much, to each disease of which he treats, its appropriate and designating characters, with a fidelity that will prevent any two being confounded, together w ith the best mode of treating them, that either his own experience or that of others has suggested. XXIV. DEWEES on the DISEASES of FEMALES. Second edition with additions. In Svo. 
XXV. DEWEES'S SYSTEM of MIDWIFERY. Fourth edition, with additions. 
XXVI. CHAPMAN'S THERAPEUTICS and MATERIA MEDIC A. Fifth edition, with additions.. XXVII. The ATLANTIC SOUVENIR, for 18S0, in elegant fancy leather binding, and with numerous embellishments by the best Artists. The publishers have spared neither pains nor expense in endeavouring to render this, their fifth annual volume, still more worthy the high degree of favour which its predecessors have enjoyed. All the impressions being from steel render them equally perfect, and the binding being a fancy leather, the whole will be rendered more permanent. In the list of Authors will be found many of the most distinguished writers in this country. A few copies remain unsold of the ATLANTIC SOUVENIR, a Christinas and New Year's Present for 1827, 1828, and 1829, with numerous embellishments by the best Artists. XXVIII. A CHRONICLE of the CONQUEST of GRENADA, by Washington Irving, Esq. in 2 vols. " On the whole, this work w ill sustain the high fame of Washington Irving. It fills a blank in the historical library which ought not to have remained so long a blank. The language throughout is at once chaste and animated; and the narrative may be said, like Spencer's Fairy Queen, to present one long gallery of splendid pictures. Indeed, we know no pages from which the artist is more likely to derive inspiration, nor perhaps are there many incidents in literary history more surprising than that this antique and chivalrous story should have been for the first time told worthily by the pen of an American and a republican,"—London Literary Gazette. 


Published by Carey Lea. 
5 
Recently published new Editions of the following works by the same Author. THE SKETCH BOOK, 2 vols. 12mo. 
KNICKERBOCKER'S HISTORY of NEW YORK, 2 vols. 12mo. 
BRACEBRIDGE HALL, 2 vols. 12mo. TALES of a TRAVELLER, 2 vols. 12mo. XXIX. NEUMAN'S SPANISH and ENGLISH 
DICTIONARY, new Edition. XXX. The WISH-TON-WISH, by the Author of the Spy, Pioneers, Red Rover, &c. in 2 vols. 12mo. " We can conceive few periods better calculated to offer a promising field to the novelist than that which these pages illustrate; —the mingling of wildest adventure with the most plodding industry—the severe spirit of the religion of the first American settlers —the feelings of household and home at variance with all earlier associations of country—the magnificence of the scenery by which they were surrounded—their neighbourhood to that most picturesque and extraordinary of people we call savages;—these, surely, are materials for the novelist, and in Mr. Cooper's hands they have lost none of their interest. We shall not attempt to detail the narrative, but only say it is well worthy of the high reputation of its author. All the more serious scenes are worked up to the liighest pitch of excitement; if any where we have to complain of aught like failure, it is in the lighter paits, and some of the minor details, which are occasionally spun out too much."— London Literary Gazette. New Editions of the following Works by the same Author. 
The RED ROVER, in 2 vols. 12mo. The SPY, 2 vols. 12mo. 
The PIONEERS, 2 vols. 12mo. The PILOT, a Tale of the Sea, 2 vols. 12mo. LIONEL LINCOLN, or the LEAGUER of BOSTON, 2 vols. The LAST of the MOHICANS, 2 vols. 12mo. 
The PRAIRIE, 2 vols. 12mo. XXXI. A TOUR in AMERICA, by Bash. Hall, Captain, R. N. in 2 vols. 12mo. XXXII. AMERICAN ORNITHOLOGY, or NATURAL HISTORY of BIRDS inhabiting the UNITED STATES, by Charles Lucian Bonaparte; designed as a continuation of Wilson's Ornithology, vols. I., II. and III. %* Gentlemen who possess Wilson, and are desirous of rendering the work complete, are informed that the edition of this work is very small, and that but a very limited number of copies remain unsold. XXXIII. The AMERICAN QUARTERLY REVIEW, No. XV. Contents.— The Gulistan of Sadi.—-Napoleon and Bourienne. —Anthon's Horace.—Falkland and Paul Clifford.—Tanner's Indian Narrative.—Dramatic Literature.— British Debate concerning Mexico.—Sunday Mails.—Life of Sir Thomas Munro. —Fanatical Guides. — Terms, five dollars per annum. XXXIV. The AMERICAN JOURNAL of the MEDICAL SCIENCES, No. XII. for August, 1830. Among the Collaborators of this work are Professors Bigelow, Channing, Chapman, Coxe, Davidge, De Butts, Dewees, Dickson, Dud- 


Valuable Works 
6 
ley, Francis, Gibson, Godman, Hare, Henderson, Horner, Hosack, Jackson, Macneven, Mott, Mussey, Physick, Potter, Sewall, Warren, and Worthington; Drs. Daniel!, Emerson, Fearn, Griffith, Hays, Hayward, Ives, Jackson, King, Moultrie, Spence, Ware, and Wright.— Terms, five dollars per annum. XXXV. EVANS'S MILLWRIGHT and MILLER'S GUIDE. New edit, with additions, by Dr. T. P. Jones. XXXVI. HUTIN'S MANUAL of PHYSIOLOGY, In 12mo. 
XXXVII. HISTORICAL, GEOGRAPHICAL, and STATISTICAL AMERICAN ATLAS, folio. XXXVIII. MANUAL of MATERIA MEDICA and PHARMACY. By H.M. Edwards, M.D. andP.VAVAssEun, M. D. comprising a Concise Description of the Articles used in Medicine; their Physical and Chemical Properties; the Botanical Characters of the Medicinal Plants; the Formulae for the Principal Officinal Preparations of the American, Parisian, Dublin, Edinburgh, &c. Pharmacopoeias; with Observations on the Proper Mode of Combining and Administering Remedies. Translated from <he French, with numerous Additions and Corrections, and adapted to the Practice of Medicine and to the Art of Pharmacy in the United States. By Joseph Togno, M. D. Member of the Philadelphia Medical Society, and E. Durand, Member of the Philadelphia College of Pharmacy. " It contains all the pharmaceutical information that the physician can desire, and in addition, a larger mass of information, in relation to the properties, &c. of the different articles and preparations employed in medicine, than any of the dispensatories, and we think will entirely supersede all these publications in the library of the physician.' 1 '' — Am. Journ. of the Medical Sciences. XXXIX. An EPITOME of the PHYSIOLOGY, GENERAL ANATOMY, and PATHOLOGY of BICHAT, by Thomas Henderson, M. D. Professor of the Theory and Practice of Medicine in Columbia College, Washington City. 1 vol. 8vo. " The epitome of Dr. Henderson ought and must find a place in the library of every pnysician desirous of useful knowledge for himself, or of being instrumental in imparting it to others, whose studies he is expected to superintend."— North American Medical and Surgical Journal, No. 15. XL. ADDRESSES DELIVERED on VARIOUS PUBLIC OCCASIONS, by John D. Godman, M. D. late Professor of Natural History to the Franklin Institute, Professor of Anatomy, &.c. in Rutgers College, &c. &c. With an Appendix, containing a Brief Explanation of the Injurious Effects of Tight Lacing upon the Organs and Functions of Respiration, Circulation, Digestion, &c. 1 vol. 8vo. XLI. ELLIS' MEDICAL FORMULARY. The Medical Formulary, being a collection of prescriptions derived from the writings and practice of many of the most eminent physicians in America and Europe. To which is added an Appendix, containing the usual dietetic preparations and antidotes for poisons. The whole accompanied with a few brief pharmaceutic and medical observations. By Benjamin Ems, M. D. Professor of Materia Medica and Pharmacy in the Philadelphia College of Pharmacy. 2d edition, with additions. 


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u A small and very useful volume has been recently published in this city, entitled ' The Medical Formulary.*- We believe thaf this volume will meet with a cordial welcome from the medical public. We would especially recommend it to our brethren in distant parts of the country, whose insulated situations may prevent them from having access to the many authorities which have been consulted in "arranging materials for this work."— Phil. Med. and Phys. Jour. XLII. ELEMENTS of PHYSICS, or NATURAL PHILOSOPHY, GENERAL and MEDICAL, explained independently of TECHNICAL MATHEMATICS, and containing New Disquisitions and Practical Suggestions. By Neil Abnott, M. D. First American from the third London edition, with additions, by Isaac Hays, M. D. *,* Of this work four editions have been printed in England in a very short tirrte. All the Reviews speak of it in the hightest terms. XLIII. LA FAYETTE in AMERICA, in 1824 and 1825; or'a Journal of a Voyage to the United States, by A. Levasseuh, Secretary to the General during his journey, 2 vols. 12mo. Translated by John D. Godman, M. D. XLIV. Major LONG'S EXPEDITION to the ROCKY MOUNTAINS, 2 vols. 8vo. with 4to Atlas. ' XLV. Major LONG'S EXPEDITION to the SOURCES of the MISSISSIPPI, 2 vols. 8vo. with Plates. XLVI. NOTIONS of the AMERICANS, by a Tra* veiling Bachelor, 2 vols. 12mo. By the Author of the Spy, Pioneers Sec XLVII. The HISTORY of LOUISIANA, particularly of the Cession of that Colony to the United States of North America; with an introductory Essay on the Constitution and Government of the United States, by M. de Mabbois, Peer of France, translated from the French by an American citizen, in 1 vol. 8vo. " From the extracts with which wc have indulged our readers, they will be able to form an idea of the character and spirit of M. de Marbois's performance. The outline w hich we have drawn, however, does very scanty justice to the merits of the whole work, which, we repeat, is in our judgment the_ best that has recently appeared, either at home or abroad, on some of the most important topics of American history and politics. If we do not.agree with all the author's opinions, we cannot but accord to him unqualified praise for his fairness, liberality, good judgment, and enlightened views. The volume will be a treasure among the historical annals of the country. We are glad to know that a translation of it by a competent hand is in progress in Paris, and will speedily be published in the United States."— North American Review. 
IN THE PRESS, 
I. The YOUNG LADIES' BOOK, a Manual of Instructive Exercises, Recreations and Pursuits. With numerous plates. This is a work recently published by Messrs. Vizetelly, Branston & Co. London, with upwards of seven hundred embellishments, engraved in a superior style on wood. The volume is a duodecimo of more than five hundred pages, and sells in England for one guinea. It is intended to make the American edition a perfect fac-simile, or as nearly so as practicable in this country, and to afford it at % 4, neatly bound in silk, and elegantly gilt. This work cannot be classed as Annual, but may be said to be a Perennial, a suitable memorial for all times and seasons. It differs essentially from the whole class of Literary Gifts usually presented to Young Ladies, being a complete manual for all those elegant pursuits which grace the person and adorn the mind. The London pub- Ushers state that the various subjects of which the volume is composed, have been confined to proficients in their several departments, and the engravings have been executed in the best style of the English artists. 


8 
Valuable Works, fyc. 
II. CHEMISTRY APPLIED to the ARTS, on the basis of Gray's Operative Chemist. In 8vo. with numerous plates. III. The PRINCIPLES and PRACTICE of MEDICINE, by Samuel Jackson, M. D. 
IV. EXAMINATION of MEDICAL DOCTRINES and SYSTEMS of NOSOLOGY, preceded by PROPOSITIONS containing the SUBSTANCE of PHYSIOLOGICAL MEDICINE, by F. J. V. Broussais, Officer of the Royal order of the Legion of Honour; Chief Physician and First Professor in the Military Hospital for Instruction at Paris, &c. &c. &c. Third edition. Translated from the French, by Isaac Hays, M. D. and R. E. Griffith, M. D. V. BECLARD'S GENERAL ANATOMY, in 1 vol. 8vo. 
VI. FARRADAY'S CHEMICAL MANIPULATION, first American, from the second London edition. VII. THOMPSON on INFLAMMATION, second American, from the second London edition. VIII. WILLIAMS on DISEASE of the LUNGS. 
IX. ARNOTT'S ELEMENTS of PHYSICS, or NATURAL PHILOSOPHY, GENERAL and MEDICAL, explained independently of TECHNICAL MATHEMATICS— Second volume. 
X. A TREATISE ON FEVER. By Southwood Smith, M. D. Physician to the London Fever Hospital. " For simplicity of arrangement, j>erspicuity of view, power of argument and practical deduction, this Treatise on Fever stands without competition, at the head of all that has been written on this abstruse disease."— Westminster Review, Jan. " There is no man in actual practice in this metropolis, who should not possess himself of Dr. Smith's work."— London Medical and Surgical Journal, Feb. " While the study of this work must be a matter of duty to the members of the medical profession, the general reader will find it perfectly intelligible, and of great practical utility."— Monthly Repository, March. " With a mind so framed to accurate observation, and logical deduction, Dr. Smith's delineations are peculiarly valuable." — Medico-Chir. Rev. March. XI. The MUSSULMAN, by R. R. Madden, Esq. author of Travels in Turkey, Egypt, Nubia, and Palestine, in 2 vols. 
" The portraiture of Turkish Kfe and character, which this work exhibits, has perhaps, never been equalled. The account of Mohamed Ali, the destruction of, the Mamelukes, the picture of Bedouin warfare, the description of the Dervish, and of the Arabian Astrologer, are indeed among the most splendid delineations ever introduced into the pages of fiction." — Sun. XII. The ARMENIANS, a Tale of Constantinople, by J. Macfarland, in 2 vols. 
" The author will appreciate our respect for his talents, when we say that he has done more than any other man to complete the picture of the East, dashed off by the bold pencil of the author of Anastasius."— Edin. Lit. Journ. XIII. JOURNAL of the HEART, edited by the Authoress of Flirtation. 
" This is a most charming and feminine volume, one delightful for a woman to read, and for a woman to have written; elegant language, kind and gentle thoughts, a sweet and serious tone of religious feeling run through every page, and any extract must do very scanty justice to the merit of the whole. ****** We most cordially recommend this Journal of the Heart, though we are unable to do it justice by any selection of its beauties, which are too intimately interwoven to admit of separation."— Literary Gazette. 


Philadelphia, May, 1830. Just Published, by Carey Sf Lea, And sold in Philadelphia by E. L. Carey $ A. Hart; in New-York by G.fyC.& H. Carvilt; in Boston by Carter & Hendee —in Charleston by W. H. Berrett— in New-Orleans by W. M'Kean; by the principal booksellers throughout the Union, 
AND IN LONDON, BY JOHN MILLER, ST. JAMES'S STREET. VOLUMES HI. CONTAINING ABOUT 1500 ARTICLES, ( To be continued at intervals of three months,) OF THE ENCYCLOPEDIA AMERICANA: A POPULAR DICTIONARY OF ARTS, SCIENCES, LITERATURE, HISTORY, AND POLITICS, BROUGHT DOWN TO THE PRESENT TIME AND INCLUDING A COPIOUS COLLECTION OP ORIGINAL ARTICLES IN 
AMERICAN BIOGRAPHY: On the basis of the Seventh Edition of the German CONVERSATIONS-LEXICON. 
Edited by Dr. FRANCIS LTEBER, Assisted by EDWARD WIGGLESWORTH, Esa. 
To be completed in twelve large volumes, octavo, price to subscribers, bound in cloth, two dollars and a half each. EACH VOLUME WILL CONTAIN BETWEEN 600 AND 700 TAGES. 
The Conversation Lexicon, of which the seventh edition in twelve volumes has lately been published in Germany, origin ated about fifteen years since. It was intended to supply a want occasioned by the character of the age, in whicli the sciences, arts, trades, and the various forms of knowledge and of active life, had become so much extended and diversified, that no individual engaged in business could become well acquainted with all subjects of general interest; while the wide diffusion of information rendered such knowledge essential to the character of an accomplished man. This want, no existing works were adequate to supply. Books treating of particular branches, such as gazetteers, &c. were too confined in character; while voluminous Encyclopaedias were too learned, scientific, 


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ENCYCLOPAEDIA AMERICANA. 
and cumbrous, being usually elaborate treatises, requiring much study or previous acquaintance with the subject discussed. The conductors of the Conversation Lexicon endeavored to select from every branch of knowledge what was necessary to a wellinformed mind, and to give popular views of the more abstruse branches of learning and science; that their readers might not be incommoded, and deprived of pleasure or improvement, by ignorance of facts or expressions used in books or conversation. Such a work must obviously be of great utility to every class of readers. It has been found so much so in Germany, that it is met with everywhere, among the learned, the lawyers, the military, artists, merchants, mechanics, and men of all stations. The reader may judge how well it is adapted to its object, from the circumstance, that though it now consists of twelve volumes, seven editions, comprising about one hundred thousand copies, have been printed in less than fifteen years. It has been translated into the Swedish, Danish and Dutch languages, and a French translation is now preparing in Paris. A great advantage of this work is its liberal and impartial character; and there can be no doubt that a book like the Encyclopaedia Americana will be found peculiarly useful in this country, where the wide diffusion of the blessings of education, and the constant intercourse of all classes, create a great demand for general information. In the preparation of the work thus far, the Editors have been aided by many gentlemen of distinguished ability; and for the continuation, no efforts shall be spared to secure the aid of all who can, in any way, contribute to render it worthy of patronage. The American Biography, which is very extensive, will be furnished by Mr. Walsh, who has long paid particular attention to that branch of our literature, and from materials in the collection of which he has been engaged for some years. For obvious reasons, the notices of distinguished Americans will be confined to deceased individuals: the European biography contains notices of all distinguished living characters, as well as those of pa st times. The articles on Zoology have been written expressly for the present edition by Dr. John D. Godman; those on Chemistry and Mineralogy, by a gentleman deeply versed in those departments of science. In relation to the Fine Arts, the work will be exceedingly rich. Great attention was given to this in the German work, and the Editors have been anxious to render it, by the necessary additions, as perfect as possible. To gentlemen of the Bar, the work will be peculiarly valuable, as in cases where legal subjects are treated, an account is 


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ENCYCLOPAEDIA AMERICANA. 
given of the provisions of American, English, French, Prussian, Austrian, and Civil Law. The Publishers believe it will be admitted, that this work is one of the cheapest ever published in this country. They have been desirous to render it worthy of a place in the best libraries, while at the same time they have fixed the price so low as to put it within the reach of all who read. 
Those who can, by any honest modes of economy, reserve the sum of two dollars and fifty cents quarterly, from their family expenses, may pay for this work as fast as it is published; and we confidently believe that they will find at the end that they never purchased so much general, practical, useful information at so cheap a rate.— Journal of Education. If the encouragement to the publishers should correspond with the testimony in favor of their enterprise, and the beautiful and faithful style of its execution, the hazard of the undertaking, bold as it was, will be well compensated; and our libraries will be enriched by the most generally useful encyclopedic dictionary that has been offered to the readers of the English language. Full enough for the general scholar, and plain enough for every capacity, it is far more convenient, in every view and form, than its more expensive and ponderous predecessors— American Farmer. The high reputation of the contributors to this work, will not fail to insure it a favorable reception, and its own merits will do the rest.— Silliman's Journ. The work will be a valuable possession to every family or individual that can afford to purchase it; and we take pleasure, therefore, in extending the knowledge of its merits.— National Intelligencer. The Encyclopa;dia Americana is a prodigious improvement upon all that has gone before it; a thing for our country, as well as the country that gave it birth, to be proud of; an inexhaustible treasury of useful, pleasant and familiar learning on every possible subject, so arranged as to be speedily and safely referred to on emergency, as well as cm. deliberate inquiry; and better still, adapted to the understanding, and put within the reach of the multitude. * * * The Encyclopedia Americana is a work without which no library worthy of the name can hereafter be made up.— Yankee. The copious information which, if a just idea of the whole may be formed from the first volume, this work affords on American subjects, fully justifies its title of an American Dictionary; while at the same time the extent, variety, and felicitous disposition of its topics, make it the most convenient and satisfactory Encyclopedia that we have ever seen.— National Journal. If the succeeding volumes shall equal in merit the one before us, we may confidently anticipate for the work a reputation and usefulness which ought to secure for it the most flattering encouragement and patronage.— Federal Gazette. 
The variety of topics is of course vast, and they are treated in a manner which i3 at once so full of information and so interesting, that the work, in stead of being merely referred to, might be regularly perused* with as much pleasure as profit.— Baltimore American. We view it as a publication worthy of the age and of the country, and cannot but believe the discrimination of our countrymen will sustain the publish, ers, and well reward them for this contribution to American Literature.— Baltimore Patriot. We cannot doubt that the succeeding volumes will equal the first, and we hence warmly recommend the work to the patronage of the public, as being by far the best work of the kind ever offered for sale in this country.— V. S. Cfaz. It reflects the greatest credit on those who have been concerned in its production, and promises, in a variety of respects, to be the best as well as the most compendious dictionary of the arts, sciences, history, politics, biography, &c. which has yet been compiled. The style of the portion we have read is terse and perspicuous; and it is really curious how so much scientific and other information could have been so satisfactorily communicated in such brief limits.—JV. Y. Evening Post. A compendious library, and invaluable book of reference.—JV*. Y. American 


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ENCYCLOPEDIA AMERICANA. 
This cannot but prove a valuable addition to the literature of the age.— Mer Advertiser. The appearance of the first volume of this valuable work in this country, is an event not less creditable to its enterprising publishers, than it is likely to prove lastingly beneficial to the public. When completed, according to the model presented by the first volume, it will deserve to be regarded as the spirit of all the best' Encyclopcedias, since it comprises whatever is really desirable and necessary in them, and in addition, a large proportion of articles entirely original, or expressly written for its pages. This is the condition of all the articles of American Biography, by Mr. Walsh; those on Zoology, by Dr. Godman ," and those on Mineralogy and Chemistry, by a gentleman of Boston, distinguished for his successful devotion to those studies. The work abounds with interesting and useful matter, presented in a condensed and perspicuous style; nor is it one of its least commendations that it is to be comprised in twelve octavo volumes, which may be placed on an office table, or occupy a shelf in the parlor, ever ready for immediate reference, instead of requiring almost a room to itself, like its ponderous predecessors, the Britannica, Ediriburgensis, &c. The vast circulation this work has had in Europe, where it has already been reprinted in four or five languages, not to speak of the numerous German editions, of which seven have been published, speaks loudly in favor of its intrinsic merit, without which such a celebrity could never have been attained. To every man engaged in public business, who needs a correct and ample book of reference on various topics of science and letters, the Encyclopedia Americana will be almost invaluable. To individuals obliged to go to situations where books are neither numerous nor easily procured, the rich contents of these twelve volumes will prove a mine which will amply repay its purchaser, and be with difficulty exhausted, and we recommend it to their patronage in the full conviction of its worth. Indeed it is difficult to say to what class of readers such a book would not prove useful, nay, almost indispensable, since it combines a great amount of valuable matter in small compass, and at moderate expense, and is in every respect well suited to augment the reader's stock of ideas, and powers of conversation, without severely taxing time or fatiguing attention. These, at least, are our conclusions after a close and candid examination of the first volume.— Am. Daily Advertiser. We have seen and carefully examined the first volume of the Encyclopsdra Americana, just published by Carey, Lea and Carey, and think our readers may be congratulated upon the opportunity of making such a valuable accession to their libraries. — Aurora. The department of American Biography, a subject of which be disgraceful to be ignorant, to the degree that many are, is, in this work, a prominent feature, and has received the attention of one of the most indefatigable writers in this department of literature, which the present age can furnish.—Boston Courier. According to the plan of Dr. Lieber, a desideratum will be supplied; the substance of contemporary knowledge will be brought within a small compass ;— and the character and uses of a manual will be imparted to a kind of publication heretofore reserved, on strong shelves, for occasional reference. By those who understand the German language, the Conversation Lexicon is consulted ten times for one application to any English Encyclopaedia.— National Oaz. The volume now published is not only highly honorable to the taste, ability and industry of its editors and publishers, but furnishes a proud sample of the accuracy and elegance, with which the most elaborate and important literary enterprises may now be accomplished in our country. Of the manner in which the editors have thus far completed their task, it is impossible, in the course of a brief newspaper article, to speak with adequate justice.— Boston Bulletin. We have looked at the contents, generally, of the second volume of thhs work, and think it merits the encomiums which have been bestowed on it in the northern papers. It continues to be particularly rich in the departments of Biography and Natural History. When we look at the large mass of miscellaneous knowledge spread before the reader, in a form which has never been equalled for its condensation, and conveyed in a style that cannot be surpassed for propriety and perspicuity, we cannot but think that the American Encyclopedia deserves a place in every collection, in which works of reference form a portion."— Southern Patriot.