flflnvt itlOM« mm mx ■:.'■'■■■■ : ■'.-*■-'? "?■:$'» ^gTv^ ™ Ji %rt,^;....... •■■■■ .-•.- - K. •,, ■..'^-. .,.-?■■--■ ^.^ *•• ^^^»'->..-. ....■..•........ <-'"-«F%. NetD Dork : FOWLERS AND WELLS, PUBLISHERS, CLINTON HALL, 131 NASSAU STREET. BOSTON: 142 WASHINGTON STREET. [Swootypsd Edition, j 1004. tl'ric« On* Dollar.] A h r, ( •* '» Entered, according to act of Congress, in the year 1852, by Joel Shew, in the Clerk's Office of the District Court of the United States for the Southern District of New York. INTRODUCTION. One of the saddest of all pictures to be seen in human life, is that of the great amount of mortality in infancy and childhood. Let us, for a moment, look at the facts. According to the " Annual Report of the Registrar General of Births, Deaths, and Marriages, in England," presented to Parlia- ment for the years ending June 30th, 1838, and June 30th, 1839, it appeared that more than one third of the total number of deaths occurred under two years of age, the exact proportion being 342.54 per 1,000 of the deaths registered. In Belgium, where the returns are made out with great accu- racy, and where the population is in possession of a high degree of domestic comfort and general intelligence, the mortality of infancy is found to be also very great. According to M. Quetelet, 22,472 in every 100,000 die within twelve months after birth; and 2946.4 in 100,000, or more than two in every seven die within the first two years. According to the Belgian tables, it also appears that one in every ten infants born alive, is cut off within the first month; and that among male children born in towns, only 5,738 in every 10,000, or little more than half, are alive at the end of five years. In the city of Manchester, England, matters are still worse than VI INTRODUCTION. in Belgium; for out of every 1,000 deaths of males, 496 were of children, under three years of age, as appeared by the registrar's second Report. In England, during the year ending June 30th, 1839, the mor- tality within the first year of life was 218.5 per 1,000 of deaths. In Prussia, during the period from 1820 to 1828, the mortality within the first year was in the proportion of 26,944 in 100,000 of deaths. In France, in 1802, the mortality within the same age was 21,457 to the 100,000 of deaths. In Amsterdam, during the period from 1818 to 1829, the num- ber of deaths within the first year, was 23,735 to 100,000 of the mortality. In Sweden, in 1821-25, the mortality in the first year was 22,453 per 100,000 of deaths. According to the Registrar's Second Report in England, it ap- pears (from Dr. Combe's estimate) that in the city of Manchester and its suburb, Salford, that out of 9,276 deaths, 2,384, or about one fourth, occurred under one year of age; 3,680, or more than one third, under two years; and 5,145, or considerably more than one half, under five years of age. In the city of New York a similar state of things exists ; and in the American cities generally, the results, if we had the means of knowing at hand, would be found to be about the same as those of the metropolis. I have made the estimates from the City Inspec- tor's Report for four years, and which are as follows : The number of deaths, including the still-born, in the city of New York in the year 1847, was 15,788. Of these there were, one year and under, 4,116, or more than one fourth of the whole mor- tality; 1,835 between one and two years of age, and 1,422 from two to five, making in all 7,373; so that very nearly one half INTRODUCTION. vii the whole mortality occurred among those under five years of age. In 1848, the number of deaths, including the still-born, was 15,919. The number of deaths of children under one year of age, was 3,547, or nearly one fourth; from one to two years, 1,806; and from two to five, 1,494, making of children under five years of age, 6,847, or nearly one half the total mortality. The number of deaths, including still-born, during the year 1849, was 23,773 ; the number of deaths of children under five years of age for the same year, was nine thousand and fifty-seven; and, notwithstanding this was the year in which epidemic cholera prevailed—a disease which attacks adults more than children—the mortality of the latter under five years of age, was as usual nearly half the aggregate number of deaths. The number of deaths under one year of age was 4,652, or about one fifth of the total mortality. The number of deaths, including the still-born, in 1850, was 16,978; the number of deaths of children under five years of age for the same year, was 8,052, being very nearly one half of the whole mortality. Of these, 4,279, about one fourth of the whole number of deaths, were under one year of age. It appears, then, from all well-attested authority, that in the civilized world as a whole, about one third of the race perish with- in the first three years of existence, and one half during the first five years. Now, we know, not only from analogy, but from the facts of experience, that this mortality of infancy does not consti- tute a necessary part of the arrangements of the Creator, but is owing almost entirely to circumstances which lay within the sphere of man's control. It is mainly, though not wholly, I admit, through our ignorance and mismanagement in regard to fulfilling the laws of Divine Providence, that such a result is found to obtain. It is the object of the following work to instruct those who are viii INTRODUCTION. interested in this subject in regard to the management and diseases of children. A very considerable amount of labor has been ex- pended upon it; and if it shall be found in some degree useful to those for whom it is intended, the author will have the satisfaction of knowing that he has not labored in vain. It has been objected, on the part of some, that the people are not benefited by the publication of popular works on the subject of health. This objection comes oftenest from those who are sup- posed to be most interested in the premises; namely, from physi- cians themselves. But, let us look at the matter a little. How often, in the present state of knowledge, does it happen that a child sickens, and, before the parents are aware of it, the patient has passed to a dangerous state. The physician is called, it is true, but too late to save life. How much better, then, would it have been for both parents and physician if they had pos- sessed the knowledge which would have caused them to seek medi- cal aid at a proper time. Again: if a physician is obliged to practice among the ignorant he is never safe; at one time his efforts to save life may be unduly appreciated, that is, he may receive far more credit than is due him, while at another time he may do all that it is in the power of human art and benevolence to do, and yet be blamed for his want of success. And not only may he be blamed, but even subjected to the disgrace, trouble, and expense of a prosecution at law for mal-practice. Now all this is very hard to suffer, provided a man has done the best that could be in a given case, and such things do every now and then happen in the practice of that noble calling, the healing art. The plain truth then is, that the more we disseminate knowledge on the subject of health the Jbetter for all concerned. We need not INTRODUCTION. ix be afraid that any one will learn too much. The more the publio know concerning the laws of life, the more will the labors of the truly enlightened and benevolent physician be appreciated, while the ignorant pretender will be compelled to seek his own place. I repeat, we have nothing to fear from knowledge, but from igno~ rartce every thing. I close this introduction, therefore, by remarking that the work herewith presented, has been written more expressly for the peo- ple. There are hundreds and thousands of parents throughout the length and breadth of this great country who have confidence in the water treatment, while they have none at all in drug medi- cation. These people can have no access to a physician such as they would choose to employ. I have often thought of these " wa- ter converts " while preparing the pages of this volume, and if ) may judge of what has sometimes happened in consequence of my other attempts at authorship, I may hope that this work will also be the means of doing good. • CONTENTS. CHAPTER I. Paternity and its Circumstances—Custom of Catholics in worship- ing the Mother of God—Responsibility of Parents in regard to the Health and general Well-being of Children—Important Con- siderations for Woman—The Laws of Lycurgus—The Health of Offspring depends in great part on the Health of Parents—The future Health of Children depends much on their state of Health at Birth—Testimony of Sir James Clark in reference to Scrofula —It is comparatively easy to rear a Child healthfully if he has inherited a good Constitution—This Subject is one of great Im- portance, not only to Parents, but to every Member in Society. 19 CHAPTER II. Of Marriage, and its Connection with the Birth and Well-being of Offspring—At what Time should it be consummated—Late and early Marriages—Arguments on both sides of the Question—No precise and fixed Rules can be given on the Subject—The Time should vary in different Parts of the World, and according to In- dividual Circumstances—Growth of the Body should not be con- founded with the Development of the Uterine Functions-Some ge- neral Advice on the Subject—Some assert that Marriages are generally too early formed in this. Country—Want of Proof—Do Women retain their Health and Beauty longer in Great Britain than in the United States—Fullness of Flesh and ruddiness of Complexion not necessarily Proofs of Health—American Women probably as Healthy as the European—Remarks of Dr. Dewees 0 zii CONTENTS. in regard to precocious Marriages in this Country—Answer to his Arguments—The earlier Children of a Marriage apt to be more Healthy than the later—Custom of Society as fixing the proper Time for Marriage—Dr. Granville's Table—Early Mar- riages on the whole to be recommended.................. 23 CHAPTER III. Who should Marry, and Who not—A Discussion on the Subject— Scrofula considered—An unhealthy Child may experience much more Happiness than Misery in this Life—A Case in Point—No Persons are perfectly Healthy—Health and Disease, to a certain Extent, relative Terms—Disease may be eradicated by good In- fluences, on the same Principle that it may be brought on by bad Influences—Practical Inferences from the Subject..... 29 CHAPTER IV. The Health of the Offspring depends greatly on the Health of the Mother during Pregnancy—Abortion, a very serious Evil—A public lack of Knowledge on the Subject—The Effects of Mis- carriage—Prevention—Persons who are most liable to this Evil— Cold bathing, a Remedy for Abortion—Vaginal Injections use- ful—Effects of Feather Beds and overheated Rooms—The Vege- table Diet—Hemorrhage from the Womb—Abortion, a more se- rious Matter than is generally supposed—The older the Habit the worse it becomes—Very feeble Persons should avoid Preg- nancy—Dr. Cheyne's Opinions concerning this Evil........ 32 CHAPTER V. Of Blood-letting in Pregnancy—Erroneous Opinions on the Sub- ject—Reasons why Blood-letting has been practiced in this state of the System—Nausea and Vomiting an Evidence of benevolent Design in the Creator—Blood-letting not a harmless Practice— Animal Food—Of Longing in Pregnancy—Singular Facts in re- gard to this Symptom—The most disgusting Articles sometimes craved—Longing docs not occur in Persons of good Health, or of good Habits—It should not be gratified—Different Opinions on the Subject......................................... 89 CONTENTS. xiii CHAPTER VI. The Mother's Imagination, as affecting the Child previous to Birth —Errors of Popular Belief—Marks upon the Child—Ancient Delusions on the Subject—Evils arising from Superstition—An- atomy, as bearing on the Subject of Marks, etc.—Hereditary Predisposition—Singular Cases of Deformity—Amusing Testi- mony of Dr. William Hunter—Opinion of Dr. Dewees—Gossip- ing Women should not be heeded—Practical Inferences on this Subject—Terror and Fright of the Mother, as affecting the un- born Child—Remarkable Cases in illustration—Practical Les- sons to be drawn from the Subject....................... 46 CHAPTER VII. The Child after Birth—Separating the Umbilical Cord—This should not be done too hastily—Custom of the Ancients—Remarks of Dr. Denman—Bleeding at the Navel—Division of the Cord—The Ligature—Umbilical Hernia—The Child should have pure Air immediately after its Birth—Healing of the Navel—A Method of treating Umbilical Hernia............................ 58 CHAPTER VIII. Of Asphyxia, Syncope, and Still-birth—Congestion—Still-birth, and its Causes—The Evils of Separating the Umbilical Cord too Boon—Treatment of Asphyxia—Cautions in regard to Insuffla- tion—Asphyxia from Debility—Treatment................ 68 CHAPTER IX. Of Washing the new-born Infant—Safety of the Water Treatment Illustrated—All Infants need Bathing soon after Birth—Prac- tice of the Araucanian Indians—Of the Pitcairn Islanders—The New Zealanders—Custom of the Ancients—Of the Russians—Of the Romans—Safety of the Cold-Bath—A medium Temperature the Best—Dr. Combe's Advice—Medicated Water should not be used—Opinion of Velpeau—Drying the Child—How Often should the Child be Bathed?.............................1--- 77 o Xiv CONTENTS. CHAPTER X. Of Clothing—The Binder or Bandage—Its Evils—Testimony of Dr. Dewees—Of Dr. Combe—Of Buffon—Of Dr. Baynard—Of Boer- haave—Probable Origin of Swathing—A Case illustrative of the Abuse of the Practice—Reason why Swathing is bad...... 90 CHAPTER XL Of the Action of the Child's Bowels soon after Birth—The Meco- nium—An Erroneous Practice concerning it—Nature in general competent to do her own Work—Of Artificial Aid—Medicines injurious—Water the best Remedy for Torpid Bowels...... 106 CHAPTER XII. Food of the young Infant—Errors in regard to it—Rules for Nurs- ing—Feeding by Hand—Milk and its Properties—Sugar not Healthful for the young Child—Substitutes for Milk—Nursing Bottles and their use................................... 110 CHAPTER XIII. Of Wet Nurses—Wrong Advice of Physicians—Mothers should, if possible, nurse their own Children—Cases in which she cannot do it—Of partial Nursing—Rules for selecting a Wet Nurse in Cases where it is necessary—It is better, in general, to feed a Child by Hand than to employ a hireling Nurse........... 126 CHAPTER XIV. Frequency with which the young Child should be fed—Great Im- portance of this Subject—Popular Errors refuted—Physiological Character of the Child at Birth—Mere crying is no Evidence of real alimentary Want in the System—The several Stages of Di- gestion explained—Probable length of Time that should elapse between the Infant's Meals.................-.....:..... 137 CHAPTER XV. Of Weaning the Child—This is generally done at too early a Pe- riod—The Menses—Evils of too early Weaning—It should be made a gradual Process—Crying, not an Evidence of true Hun- CONTENTS. XV ger—Giving Food should be regulated according to Physiological Rules—Evils of Overfeeding—The proper Kinds of Food for a young Child—Milk and the Farinacea—Animal Food—How often should the Child be fed ?—Evils of Sweets and too concentrated Food generally........................"................ 145 CHAPTER XVI. Of Exercise—Condition of the Infant at Birth—Too much Exercise • deprecated—When should the Infant be taken into the open Air —Heat, in general, more to be feared than Cold—Position in which the Child should be carried—Rocking, and the use of the Cradle—Swinging—Its Evils—Of Clothing in connection with Exercise—Dress should be Comfortable—The great Importance of Cleanliness—Of Sleep—The Effects of Light........... 154 CHAPTER XVII. Of Dentition—Growth of the Teeth—Periods at which the differ- ent Teeth usually appear—The different orders of Teeth—The Teeth do not naturally decay—Dentition not naturally a danger- ous Process—Management of its different Periods—Of Treat- ment, Local and Constitutional—The great Value of Water as a Remedy in Teething—Bowel Complaint, Skin Disease, Croup, Cough, and other Ailments connected with Dentition—The great Value of pure Air—Dentition one of the most dangerous Peri- ods of the Child's Life.................................. 169 CHAPTER XVIII. The Diseases of Infancy and Childhood—Hare-lip—Imperforate Anus—Imperforate Urethra—Imperforate Meatus Auditorius— Adhesions of the Eyelids—Hernia, or Protrusion of the Umbili- cus—Rupture of the Abdomen—Spina Bifida............. 190 CHAPTER XIX. The Diseases of Infancy and Childhood continued—Tongue-tie— Club-foot—Congenital Dislocation of the Hip—Swelling of the Scalp—Marks and Blemishes—Inflammation of the Eyes—Dis- charges from the Nostrils—Running at the Ears—Ulceration of the Navel—Hemorrhage from the Navel............... 197 XVI CONTENTS. CHAPTER XX. The Diseases of Infancy and Childhood, continued—Absence of the Skin—Jaundice—Discharges from the Vagina—Prolapsus Ani, or falling of the Bowel—Hemorrhoids or Piles—Diabetes—Reten- tion of Urine—Incontinence of Urine—Painful Urinating. -- 210 CHAPTER XXI. Diseases of Children, continued—Erysipelas—Thrush—Vomiting— Hiccough—Diarrhea—Its different Forms................ 229 CHAPTER XXII. Diseases of Children, continued—Cholera Infantum—Its Treatment —Dysentery—Method of Cure........................... 239 CHAPTER XXIII. Diseases of Children, continued—Constipation, and its Cure—Colic —Means of Relief—Worms in the Bowels—Treatment.....270 CHAPTER XXIV. Diseases of Children, continued—Laryngitis Stridulous, or Croup —Its Treatment—Pneumonia, Pleurisy, and Bronchitis—Their Treatment—Parotitis, or Mumps—Its Treatment—Quinsy—Ton- silitis, or Sore Throat—Method of Cure.................. 284 CHAPTER XXV. Diseases of Children, continued—Hooping-cough—Its Nature and Treatment............................................ 3U CHAPTER XXVI. Diseases of Children, continued—Measles, and its Cur.e...... 326 CHAPTER XXVII. Diseases of Children, continued—Scarlatina, or Scarlet Fever, and its Treatment......................................... 846 CONTENTS. xvii CHAPTER XXVIII. Diseases of Children, continued—Variola, or Small-Pox—Its Treat- ment, with Cases of Cure...............................369 CHAPTER XXIX. Diseases of Children, continued—Vaccinia, or Cow-Pox: its Na- ture and Effects—Varicella, or Chicken-Pox: its Nature and Treatment............................................405 CHAPTER XXX. Diseases of Children, concluded—Convulsions—Earache—Scalds and Burns............................................427 r TREATISE ON CHILDREN, CHAPTER I. Paternity and its Circumstances—Custom of Catholics in worship- ing the Mother of God—Responsibility of Parents in regard to the Health and general Well-being of Children—Important Con- siderations for Woman—The Laws of Lycurgus—The Health of Offspring depends in great part on the Health of Parents—The future Health of Children depends much on their state of Health at Birth—Testimony of Sir James Clark in reference to Scrofula —It is comparatively easy to rear a Child healthfully if he has inherited a good Constitution—This Subject is one of great Im- portance, not only to Parents, but to every Member in Society. What is it that enables woman to undergo so great an amount of fatigue, to exert so great a degree of pa- tience, to willingly undergo the pains and perils of childbirth, to pass patiently through the long period of nursing required in bringing forth and rearing a child 1 It is that love of offspring, that deep fountain of affection which a kind Providence has written so in- delibly in her heart. Beautiful and sublime is it to witness the power and extent of maternal love ! The Catholics, we are told, superstitiously worship 20 TREATISE ON CHILDREN. the Mother of God. But if we consider the greatness of the responsibility, the nature of the condition, and relation of a mother to the race, is there not some sem- blance of reason for that which the Catholics thus do 1 If, in the wide world, there is a situation in which we would suppose that human beings must naturally feel their responsibility, it is that of one who expects to bring forth a child. How exceedingly great is this responsibility! to give to a child a good or a bad, a healthy or an unhealthy constitution, a peaceable or a vicious disposition, and then to rear that child both physically and morally—what greater responsibility can rest on a mortal than this 1 Accordingly as a child is reared healthfully or un- healthfully, in both a physical and moral sense, d6es the happiness of the parent, in great part, depend. On the one hand there arises the highest possible earthly enjoyment, and on the other, the greatest pos- sible mortification and disappointment. Let woman, then, from the first, be convinced that to become a mother, is one of the most momentous of all earthly considerations; and that if she enter into the " holy state of matrimony," without carefully con- sidering the nature and importance of the duties she thus voluntarily takes upon herself, she will not only bring trouble and vexation upon herself, but will en- tail misery and misfortune upon the offspring she may bring forth. There was some reason in the so-called cruel and severe laws of Lycurgus, which forbade the parent to take charge of his child, or to educate him in any way HEALTH OF OFFSPRING. 21 according to his own mode. By these laws it was re- quired that every child should be subjected to the in- spection of a jury of elders, whose decision was final. If the child was found lively, robust, and well-formed in every part, it was educated and maintained at the public expense, and had a certain portion of the public wealth assigned it; and from the time of its inspection it was considered public property. But if the child was found to be a feeble or deformed one, it was, with- out mercy, consigned to death by throwing it into the Apothetes. This ancient custom, severe and unjust as it was, recognized the importance of the healthful- ness of offspring as a great public good. According to all observation and analogy, the health of offspring depend in a great degree upon the health of parents; and it should be remembered, that the child is almost certain to inherit a constitution less healthy than the average health of the parents ; in other words, the tendency of disease, as regards hered- itary descent, is always to grow worse. Not only are children liable to the diseases which parents themselves have at the time of begetting them, but by an unhealthy condition of the functions of the system in the parents, diseases may be brought on in the offspring which they have never had. " The chil- dren of those who have suffered long from dyspeptic com- plaints, gout, cutaneous affections, or any form of chronic disease, originating in derangement of the di- gestive function, which has produced an influence on the constitution," observes Sir James Clark, " are very frequently the subjects of scrofula, or of disorders 22 TREATISE ON CHILDREN. which dispose to, and ultimately induce tuberculous (scrofulous) habit." It is, then, a well-established principle in nature, that upon the original healthy organization of the child, the success of well-directed physical education must in a great part depend. It is comparatively an easy matter to rear a child healthfully if he has inherited a good constitution; but if the health of one or both of the parents is in a bad condition previous to the birth of the child, the offspring must necessarily suffer thereby. View this subject of rearing children therefore in whatever light we may, it appeals most emphatically and loudly to parents, and to every individual in soci- ety. The health or well-being of children does not any where, in modern times, receive that attention which an enlightened philanthropy and true self-interest de- mands. It is to be hoped that through the efforts of many well-wishers of the race, light will be dis- seminated ere long upon this subject in a greater de- gree than the world has ever yet known. There are, at this day, multitudes who are willing to take upon themselves the task of following such instruction in re- gard to the birth and management of children, as shall tend to produce in them the best organizations, and the best capacity for happiness and good. CHAPTER II. Of Marriage, and its Connection with the Birth and Well-being of Offspring—At what Time should it be consummated—Late and early Marriages—Arguments on both sides of the Question—No precise and fixed Rules can be given on the Subject—The Time Bhould vary in different Parts of the World, and according to In- dividual Circumstances—Growth of the Body should not be con- founded with the Development of the Uterine Function—Some ge- neral Advice on the Subject—Some assert that Marriages are generally too early formed in this Country—Want of Proof—Do Women retain their Health and Beauty longer in Great Britain than in the United States—Fullness of Flesh and ruddiness of Complexion not necessarily Proofs of Health—American Women probably as Healthy as the European—Remarks of Dr. Dewees in regard to precocious Marriages in this Gountry—Answer to his Arguments—The earlier Children of a Marriage apt to be more Healthy than the later—Custom of Society as fixing the proper Time for Marriage—Dr. Granville's Table—Early Mar- riages on the whole to be recommended. The subject of marriage being one that is most inti- mately connected with the health and general well-be- ing of offspring, some remarks concerning it will not be out of place in a work like the one which I am now about to present to the public. First, as to the time of life at which the matrimonial connection should be entered into. On this subject there are a variety of opinions. We are told on the one hand, that the development of the body is successive, and requires a definite period for its completion, and that consequently certain func- 24 TREATISE ON CHILDREN. tions cannot be performed in the best manner until full development has taken place, and that when any organ of the body is prematurely or inordinately urged to action, it is followed by the imperfection of the product dependent upon the part thus stimulated, as well as that it entails upon the organ so exercised, debility, if not premature decay. It is contended, on the other hand, that marriage, being a natural institution of the Creator, and being moreover desired on the part of both sexes at an early age, should consequently be consummated at an early period of life. This question, like all others, has its two aspects, and being one of great importance, is worthy of being considered somewhat in detail. It cannot, I think, be maintained, that any precise or absolute rules, based upon the lapse of years, can be laid down in reference to the time at which marriage should be consummated. In one part of the world the bodily developments are found to take place at a much earlier period than in other parts. Thus we are told that in India, females not unfrequently become mothers at ten; while in Lapland they rarely attain womanhood before eighteen. And even in the same country and latitude, some girls arrive at the marriageable state much earlier than others. Hence it is that the time of marriage should be regulated, so far as mere physical ability is concerned, in accordance with the circum- stances of each particular case. A woman who com- mences to menstruate at ten or twelve years of age may certainly marry at an earlier period than one with EARLY MARRIAGES. 25 whom this function appears at the age of eighteen or twenty. Nor should we confound the growth of the body gen- erally with the development and maturity of the uterine function. Instances not unfrequently occur in which the bony and muscular systems become early developed, while the menstrual function is tardy in becoming es- tablished. On the other hand, the menstrual function is sometimes preternaturally developed while the body generally is yet immature. In the first mentioned case it would be altogether improper to make the bodily de- velopment the guide as to the time suitable for mar- riage, while in the second, it would be equally unwise to determine this period by the appearance of the men- strual function. In both cases the whole system should be, at least, fairly matured before marriage should be entered into. It is maintained on the part of some, that marriages are generally too early formed in this country; and foreigners have said that, as a consequence of these early matches, the females of this country lose their beauty, which, in other words, means their health, earlier than they do in Europe, and more especially in Great Britain. In answer to this, it is to be remarked that we have no proof that marriages do take place earlier in this country than the old; and if it be admitted that the women in the latter retain their beauty, health, and vigor, longer than is the case with our own females, there are a number of other reasons besides marriage by which to account for this difference. Who does not 3 26 TREATISE ON CHILDREN. know that in the old country, women of all classes are more in the habit of going out into the open air than our own females are. The climate, also, is much milder in Europe, generally, than it is in this country, being never oppressive in respect to heat, or inclement as regards cold. I have no doubt that in our American cities, at least, the great heat of summer does make a considerable difference in regard to personal beauty, as well as of health. But it is not certain, I think, that American women are more unhealthy than the English ladies. Fullness of flesh, and redness of com- plexion, are by no means necessarily synonymous with health. I am not, by any means, convinced that our American ladies, take them all in all—in the North I mean—are not as tough and enduring as the English ladies are. And one thing appears to be very evi- dent—that the Europeans are more subject to scrofula and consumption than we in this country are. All things considered then, the so called "decay" of American women cannot be brought as an argument against early marriages. " The evil consequences resulting from precocious unions in this country," observes Dr. Dewees, " are familiar to every body; they are not limited to the di- minished vigor and shortened life of the male; nor to the faded beauty, the blasted health, and the prema- ture old age of the female; but are extended to their innocent offspring, on whom they have perhaps detailed a diminutive statue, debility of body, and imbecility of mind; or have handed down to them strong predispo- sition to consumption—rickets, scrofula, etc. It is, EARLY MARRIAGES. 27 therefore, of the utmost importance that parents do not consign their children to inevitable ill health, by con- senting, or sometimes urging them, to too early mar- riages ; and on the part of children themselves, that they do not yield themselves up to almost inevitable destruc- tion (especially the female), by anticipating the eligible moment for marriage consummation." In answer to all this, it is to be remarked, that we have no evidence whatever that this country is pro- verbial for its subjects of " diminished vigor," " short life," " faded beauty," or " blasted health of females." Nor, according to the tables, is there in this country a greater " predisposition to consumption, rickets, scrofu- la, etc.," than there is in other civilized communities ; and as far as England is concerned, we, of the two, are the better off in this respect. I myself am inclined to the belief that the first chil- dren of marriages, generally, are apt to be stronger and more healthy than those of after years. It is oftener, I think, that the latest children of a family are the most unhealthy and liable to disease. There are so many circumstances in individual cases, that go to make a difference in regard to the time at which marriage should be allowed, it would be impos- sible arbitrarily to fix the period at which this event should take place. Some have stated it at one age and some at another; but, as before remarked, the pecu- liarities and circumstances of each individual case should determine the time, and not any arbitrary or fixed rule. If we were to take the custom of the world as some 28 TREATISE ON CHILDREN. guide in this matter, the greater proportion of mar- riages should take place at about the twentieth year. This would appear from the table of Dr. Granville, the only one that has been published on this subject. This author made an examination of eight hundred and seventy-six cases in lying-in hospitals, etc., in which the ages of marriage were as follows: Years of age. Years of age. Years of age. 3 at 13 85 at 22 7 it 31 11 14 59 23 5 82 16 15 53 24 7 33 43 16 36 25 6 34 45 17 24 26 2 35 67 18 28 27 0 36 115 19 22 28 2 37 118 20 17 29 0 38 86 21 9 30 1 39 On the whole, then, it will be observed that I am in favor of what would be termed early marriages. These, it must be admitted, are sometimes precocious, and too early formed; but as a general rule I regard it better, if the parties are in suitable circumstances, have good health, and are inclined to this step, as most persons under such auspices are, to marry at a time that would generally be regarded as early. In so doing, the health and happiness and well-being of both parents and chil- dren will, I am very confident, be mutually enhanced. CHAPTER III. Who should Marry, and Who not—A Discussion on the Subject— Scrofula considered—An unhealthy Child may experience much more Happiness than Misery in this Life—A Case in Point—No Persons are perfectly Healthy—Health and Disease, to a certain Extent, relative Terms—Disease may be eradicated by good In- fluences, on the same Principle that it may be brought on by bad Influences—Practical Inferences from the Subject. It has become a dogma with some, at the present day, that none but those who are perfectly healthy should ever marry. Now if this doctrine were to be carried out strictly to the letter, who is there but that would be " found wanting1?" But let us look at this matter a little more narrowly. I once heard a discussion between two brothers, on this subject. The one was a physician, and the other a business man, and of a scrofulous family. They also married sisters, who were likewise considered as being scrofulous. The physician maintained that it was ab- solutely wrong for persons of such constitution as all of these four mentioned were, to become the fathers and mothers of offspring. " It is wicked," said he, " so long as we have the seeds of disease within us, to entail such disease, or a liability to it, upon children. We should first become perfectly healthy, or otherwise not procreate at all." In behalf of the other brother, I commenced arguing his case thus : In the first place I asked, who is per- 30 TREATISE ON CHILDREN. fectly healthy ? Can any such person be found ? For one, I never yet found such a case. All persons are either more or less diseased, or have a predisposition to it. I conclude that a perfectly healthy person cannot, now-a-days, in civilized society, be found. In the second place, I referred to the brother's child. He was a fine son, of about eleven years of age. He had had, at different times, symptoms of scrofula, and had also been severely attacked with certain forms of acute disease. By great care, however, in diet, bath- ing, and other hygienic habits, he had been kept more free from the outbreaks of disease than most children are, and was, moreover, evidently improving, year by year, in constitutional vigor. He had, likewise, for some years, been a great help to his parents, and a comfort to them in various ways, especially to his mother when she was left at home alone, as was often the case in the necessary absence of her husband, who was often called from home on business. He was, in short, a most lovely and excellent boy. Now, I said to the other brother—the physician— here is this scrofulous boy, as you call him, the only son of a scrofulous father and mother; suppose that he were to die to-day, would not the parents yet have great reason to be thankful that they had brought him forth 1 Has not his life been a great blessing, relatively, both to themselves and to him 1 True, he has suffered from disease, and is yet liable to it; but has not his life, on the whole, been one of very much greater bless- ing than misery, both to himself, and all concerned 1 Besides, too, I remarked, that under good influences, WHO SHOULD MARRY. 31 the tendency of nature is ever upward, as under bad influences, it is ever downward. A sickly child, if carefully reared in every respect, has a tendency to grow more healthy in just the same proportion that it has a tendency to grow more unhealthy under bad man- agement. Hence, there is such a thing as making a child more healthy by good care, than the parent is; and of making the adult more healthy than he was when a child. From the foregoing considerations, I am led to re- mark, that the notion which is prevailing to a consider- able extent at the present day, namely, that a person must be perfectly healthy to entitle him to the privilege of becoming a parent, is a fallacious one. I admit, however, that it is always desirable that those who are to marry, should be as healthful as possible, and that it is a sad thing, to say the least, for any one to be the means of bringing forth a child, that is to lead a life of suffering and disease. Too great pains cannot any where be taken in regard to avoiding the ravages of disease. I have, in another place, insisted upon this point. CHAPTER IV. The Health of the Offspring depends greatly on the Health of the Mother during Pregnancy—Abortion, a very serious Evil—A public lack of Knowledge on the Subject—The Effects of Mis- carriage—Prevention—Persons who are most liable to this Evil— Cold bathing, a Remedy for Abortion—Vaginal Injections use- ful—Effects of Feather Beds and overheated Rooms—The Vege- table Diet—Hemorrhage from the Womb—Abortion, a more se- rious Matter than is generally supposed—The older the Habit the worse it becomes—Very feeble Persons should avoid Preg- nancy—Dr. Cheyne's Opinions concerning this Evil. That the health of the offspring depends much upon the habits and health of the mother during the period of pregnancy, is a truth which no one can doubt or deny. Some of the leading considerations of this kind will now be entered into. I shall speak first of abor- tion. This is one of the most serious, as well as most com- mon, of the injurious consequences arising from errone- ous notions and management during pregnancy. But women, generally, are not in the habit of looking upon it in this light; they either regard it as a temporary evil, of a few hours, or, at most, days of debility and suffering, so far as their own health is concerned. It is doubtful if the destruction of the fetus even, is re- garded, in a moral point of view, as a wise and benev- olent conscience would dictate that it should be. In OF ABORTION. 33 addition to the fact, that every such occurrence should be regarded as a source of grief and disappointment to the mother, there are still others, relating to her own personal welfare, which it is hoped, when properly pre- sented, will not fail to excite a suitable degree of at- tention to this important subject. And what are the effects of miscarriage, as it is gen- erally witnessed among females ? It is not positively dangerous to a woman's life at the time to experience miscarriage, as many suppose. Such a thing as imme- diate death in consequence of this occurrence, is almost an unheard of thing; it can but seldom happen. But there are other circumstances which are certain and sure in their effects. The first and most prominent evil to be feared from abortion is, a much greater liability to its recurrence. Those who have miscarried once, are always much more liable to do so a second time, and so on in proportion to the number of miscarriages experienced. Prevention.—I have remarked in another place in this work, that nausea and vomiting, as also the dis- like of animal food in pregnancy, appear to be among the benevolent institutions of the Creator in preventing the pregnant woman becoming too plethoric and full. This same principle is strikingly illustrated in regard also to abortion. It is a remark both familiar and well- founded, that those who suffer much from nausea and vomiting, or in other words, that very sick women, sel- dom experience miscarriage, while, on the other hand, women of full habits—the more healthy ones—accord- ing to common parlance—are disposed to miscarriage, TREATISE ON CHILDREN. if exempt from those troublesome though important symptoms. Fat women, and those who experience excessive menstruation, those who are hysterical, very nervous, irritable, or excessively sensitive; those who are rick- ety, much scrofulous, or have any other formidable constitutional deterioration; those who have dropsy, or are effected with cancer; and those who must com- press their bodies with stays, corsets, tight clothing, or other appliances of art, are most subject to miscar- riage, and consequently should avoid pregnancy—for their own good, as well as that of their offspring. And not less important is it to observe, that sexual com- merce should be carefully guarded against during the period of pregnancy.* There are vile books in circulation, sold, too, some- times, by highly respectable booksellers, in which the writers affirm that abortion can be produced without * Dr. Edward Baynard, an able and very sarcastic English writer, one hundred and fifty years ago, in speaking of the evil ef- fects of swathing and dressing infants too tightly, indulged in the following reflections : " 'Tis a great shame that greater care is not taken in so weighty an affair, as is the birth and breeding of that noble creature, man ; and, considering this stupid and supine negligence, I have often wondered that there are so many men as there are in the world; for what by abortions, too oft caused by the unseasonable, too frequent, and boisterous, drunken addresses of the husband to the wife, when young with child, and her high feed- ing, spiced meats, soups, and sauces, which with strait lacings, dancings, and the like, one full half of the men begotten are de- stroyed in the shell, squabed in the nest, murdered in embryo, and never see light; and half of the other half are overlaid, poisoned by ill food, and killed at nurse," etc. COLD BATHING. 35 any harm to the constitution. There is one physician in this city, whose book we saw a few days- since in a bookstore in the city of Boston, in which he proposes to effect abortion with perfect safety, but for the pack- age of medicine a fee of ten dollars must be sent, of course, in advance. It may be of service to some who may peruse these pages, for me to inform them that there is always great danger in causing the expulsion of the fetus. The most powerful medicines for this purpose are often known to fail. Gastritis, enteritis, peritonitis, and death itself has been caused by medica- tion, without causing the intended abortion. As a means of preventing the sad evil in question, cold bathing, for its tonic and constringing effect, has for centuries been recommended as a most valuable means of preventing abortion. In pregnancy, the same general principles should be observed in fortifying and invigorating the general health as at other times. No violence should be done to the system. A general bath in the morning, cool or cold, according to the individ- ual's strength ; a hip or sitz bath of five or ten minutes' duration, two or three times during the day, and an ab- lution with water, not too cold, on going to rest, will ordinarily be sufficient for the daily routine of treatment in those cases where there is tendency to abortion ; such a course is in fact good at all times. The wet girdle, elsewhere explained, will often be of advantage ; but to make it a tonic or strengthening application, as it should always be under these circumstances, great care must be taken that it does not become too warm. This is very apt to be the case in hot weather. It must then 36 TREATISE ON CHILDREN. be changed often and rewet. If it becomes too hot, it weakens the system instead of strengthening it, thus tending to cause the very difficulty it is intended to pre- vent. " Injecting cold water into the vagina, twice or thrice a day," says Dr. Burns, in his work on mid- wifery, " has often a good effect, at the same time that we continue the shower-bath." And this writer also observes, " that when there is much aching pain in the back, it is of service to apply cloths to it, dipped in cold water, or gently to dash cold water on it, or em- ploy a partial shower-bath, by means of a small water- ing can." Water, let it be remembered, is the great- est of all tonics to the living system. Sleeping upon feather beds and in overheated rooms has much to do in causing abortions. People ought never to sleep on a feather bed, unless, possibly, very old and feeble persons, who have long been accustomed to them. In such cases it might not always be safe to make a change in cold weather suddenly. But for a pregnant woman to sleep on a feather bed is one of the worst of practices. And here also I must mention, that feather pillows, as well as feather beds, do a great amount of harm. Even those who have emancipated themselves from the evils of feather beds, usually retain the feather pillow. It is a wise old maxim, " to keep the head cool." The head has blood enough, more than any other part of the system, to keep it warm. No person, not even the youngest infant, should ever Bleep on a bed or pillow made of feathers. The animal effluvia coming from them is bad, and the too great REMEDIES FOR ABORTION. 37 amount of heat retained about the surface debilitates the system in every respect. The vegetable diet was observed by the celebrated Dr. Cheyne, of England, to have a great influence in preventing abortions. Milk, however, was generally used, which is in some sense animal food. A total milk and seed diet, as Dr. Cheyne terms it, was a most ex- cellent means of preventing infertility and abortion. Hemorrhage from the womb, during the months of pregnancy, is not necessarily attended with abortion. Great care, however, should be exercised if hemorrhage occur during this period, as there is then always great danger of losing the child. Abortion, as a general fact, is a more serious matter than birth at the full period. Hippocrates asserted that a miscarriage is generally more dangerous than a labor at full term. The reason of this is, the first is an unnatural occurrence ; the second natural. In many instances, however, the abortion itself is of far less con- sequence than the condition of the general health which allows of such an occurrence. For the most part it is only the feeble and debilitated that experience abortions. Women who miscarry once, are much more apt to do so again. The body, like the mind, appears to have a great tendency to get into bad habits ; and the older the habit the worse it becomes, and the more difficult of control. It were better for very feeble persons not to place themselves in the way of becoming pregnant; certainly not until the general health has been attended to. And it is a fortunate thing for society that many feeble and 4 38 TREATISE ON CHILDREN. diseased persons are wholly incapable of begetting off- spring ; otherwise the race would soon run out. More than one hundred years ago, the celebrated Dr. Cheyne remarked, concerning abortion and its causes, as follows : " It is a vulgar error to confine ten- der-breeding women to their chambers, couches, or beds, during all the time of their pregnancy. This is one of the readiest ways to make them miscarry. It is like the common advice of some unskillful persons to such as have anasarcous or dropsical legs, namely, to keep them up in chairs on a level with their seats, which is the ready way to throw up the humors into their bowels and fix them there. The only solid and certain way to prevent miscarriage, is to pursue all those means and methods that are the likeliest to procure or pro- mote good health, of which air and gentle exercise are one of the principal. All violence or excesses of every kind are to be carefully avoided by the parturient; but fresh air, gentle exercise, walking, being carried in a sedan or chaise on even ground, is as necessary as food or rest; and therefore is never to be omitted, when the season will permit, by tender breeders." CHAPTER V. Of Blood-letting in Pregnancy—Erroneous Opinions on the Sub- ject—Reasons why Blood-letting has been practiced in this state of the System—Nausea and Vomiting an Evidence of benevolent Design in the Creator—Blood-letting not a harmless Practice— Animal Food—Of Longing in Pregnancy—Singular Facts in re- gard to this Symptom—The most disgusting Articles sometimes craved—Longing does not occur in Persons of good Health, or of good Habits—It should not be gratified—Different Opinions on the Subject. Not many years since, it was very generally supposed that a woman could not pass through the period of pregnancy safely without being bled; and although a change has been wrought in the public mind in regard to this practice, there are yet many who labor under erroneous impressions in regard to this subject. There are those who regard it as indispensable to resort to this measure, notwithstanding there may be no partic- ular symptom that, under other circumstances, would be considered necessary to warrant a resort to the measure. It must be admitted, however, that pregnancy is at- tended with a degree of fullness, and a tendency to plethora, which does not obtain in other states of the system. There is, indeed, always, during pregnancy, a greater liability to febrile and inflammatory diseases than is ordinarily experienced. But all this does not 40 TREATISE ON CHILDREN. prove that blood-letting should be practiced in all, or in any considerable number of cases. Besides, also, it is doubted by many honest and able practitioners of the medical art, as to whether bleeding is ever, under any circumstances, necessary. There are others, too, who believe in the comparative necessity of blood-let- ting under certain conditions of the system, but who, at the same time, hold that there are better, safer, and more efficacious means of bringing about the required object. At all events, physicians very seldom, at the present day, resort to blood-letting during pregnancy, either in this country or the old; and in those rare cases in which this measure is resorted to, it is in an- swer only to indications of an imperative and decided nature. If we could but take into our minds the whole scope of nature, and if we were able to trace, like the Infi- nite Mind, causes and effects, we should doubtless, much oftener than we now are, be struck with the evi- dent goodness of the Creator, even in the physical suf- ferings which He has made it our lot to endure. It is well known that women, during pregnancy, are apt to be troubled with nausea and vomiting. Now it is pos- sible, under bad management, for these symptoms to become actually alarming in their extent. But what it is well for us to inquire, is the design of these oc- currences, so common during the period of gestation 1 Plainly, to restrain the woman from the gratification of a voracious and wayward appetite, the indulgence of which could but be of material detriment to both mother and child. OF LONGING. 41 Nor is the practice of blood-letting a comparatively harmless one, as many suppose it to be. " Why," it is said, " if it is not absolutely necessary, it can yet do me no harm." This is a poor recommendation of a remedy. If a remedy is not capable of doing harm under some circumstances, it would hardly be possible for it to do good at any time. The testimony of the strongest advocates for the practice is, that blood-let- ting has frequently been known to do serious, and sometimes irreparable mischief, when practiced dur- ing the period of which we are speaking. So, too, in regard to the use of animal food. Ac- cording to the common notion, the woman, because she is pregnant, and has two to support, must eat a larger than ordinary portion of aliment, particularly that of the animal kind. But what are the teachings of na- ture on the subject ? Notwithstanding the fact that the woman believes it indispensable to eat flesh meat, under the impression that this is the most nutritious kind of aliment, it is almost certain to disagree with her, and in many cases becomes actually revolting to the taste. * Longing during Pregnancy.—Pregnant femalesi sometimes experience the most strange and wayward fancies in regard to particular articles of food, longing, as it is termed, for some particular article, and which, it is believed, must be gratified in order to prevent a likeness of the article longed for being imprinted upon the unborn child. Some, indeed, have doubted the existence of any such sensation as the one to which I refer. But I should 42 TREATISE ON CHILDREN. think as strangely of any man who would strenuously deny his existence, as that females experience what are popularly termed longings during the pregnant state. There are some remarkable facts on record concern- ing the symptoms which I am considering, and which would go to prove that it is not always the good things of this world that are longed for. If women were always in the habit of craving good and savory dishes under these circumstances, we should have some reason to suspect them of dishonesty in regard to the reality of longing; but when the fickle and morbid appetite is found often to crave the most unrelishable articles, we must admit the truth of the doctrine of which we are speaking. A lady has been known, who, when not pregnant, hav- ing a great horror of eating eels, and yet when in this situation she has demanded them with an importunity not to be resisted. She 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. A woman pregnant, riding over a common, has scent- ed spoiled shad that had been thrown out, and became instantly so fascinated by their odor, that she obliged her husband to take some of them into his gig; and as 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. A woman pregnant, while passing through her kitch- en, has taken a disgusting piece of bacon boiling in a OF longing. 43 soap-kettle, out of the vessel, eating it afterward, with the greatest relish. These are, it is true, extreme cases; but there are many which are far from being of a character so trifling as to warrant the conclusion that no such thing as long- ing for strange and disgusting articles during pregnancy exists. Indeed, the truth of the doctrine is so well understood among all classes as not to need any fur- ther proof. Should these longings in pregnancy be gratified, and if so, to what extent? This is a question of great prac- tical importance, and one which we shall consider some- what in detail. It is notorious, in the first place, that longing sel- dom, if ever, occurs in a woman of good health and a well-constituted mind. If we observe correctly, we shall find that it occurs seldom, if ever, in any other than delicate and nervously irritable women. It occurs, in the second place, particularly among those who are indolent in their habits, having little or nothing to do, and without any wholesome object of thought or occupation with which to " kill time." It occurs, in the third place, to those who have been in the habit of being pampered and indulged on every occasion. A woman who is forever in the habit of saying to her indulgent husband that she wants this, that, and the other thing, and if the good husband sees fit to gratify his interesting spouse in every thing which a morbid fancy can imagine, he will have busi- ness enough to kill his time, and a feeble, sickly wife in the bargain. 44 TREATISE ON CHILDREN. If this longing occurs only to the feeble and delicate, to the nervous, the indolent, and those who have been habitually pampered, what, I ask, are we to do in the premises 1 Shall we gratify every whim of a nervous, unhealthy person, or shall we rather advise her to live on plain and wholesome food, at the same time direct- ing her to occupy herself, body and mind, as a reason- able being should 1 It does not certainly require much common sense to enable one to settle this question as it should be. But there are those among women who honestly be- lieve that if their cravings are not satisfied in preg- nancy, the child is very liable to become marked with an appearance like that of the article longed for. The fallacj 0I* ^s belief will at once be apparent, when it is considered how many cases of longing there are—cases, too, which are never gratified, while, at the same time, but very few children are ever found mark- ed. The imagination can have no more effect here than in the cases of malformation, the absence or ad- dition of a part, or in determining the color of a child. Hence a woman need not fear, as I have known them to do, that if their morbid appetite is not gratified in every particular, they are in danger of bringing forth a marked child. Some physicians are of the opinion, it is true, that it is best to gratify longings to a certain extent. But suppose they are not; the worst that can come is sickness at the stomach, nausea, and possibly vomit- ing—symptoms which, all of them, vanish soon enough, OF LONGING. 45 if the diet is made what it should be, in common with good habits generally. If, then, the mother wishes to get along well herself through pregnancy, and, above all, if she wishes to bring forth a beautiful and vigorous child, let her in no respect gratify the symptom of which I have been treating, but, on the contrary, pursue the prudent and eafe course. CHAPTER VI. The Mother's Imagination, as affecting the Child previous to Birth —Errors of Popular Belief—Marks upon the Child—Ancient Delusions on the Subject—Evils arising from Superstition—An- atomy, as bearing on the Subject of Marks, etc.—Hereditary Predisposition—Singular Cases of Deformity—Amusing Testi- mony of Dr. William Hunter—Opinion of Dr. Dewees—Gossip- ing Women should not be heeded—Practical Inferences on this Subject—Terror and Fright of the Mother, as affecting the un- born Child—Remarkable Cases in illustration—Practical Les- sons to be drawn from the Subject. % That the imagination of the mother has a very great influence upon the health and future characteris- tics of the unborn child, is proved by all well-ascer- tained facts and experience. And the importance of the principle is not generally considered as it should be, or regarded in a proper light in practice. There is, however, one particular in which popular belief has gone beyond the reality, and has ascribed effects to the mental habitudes of the mother which do not at all belong to it. Thus it is believed that the marks which sometimes appear on children, and continue through life, are to be attributed entirely to the workings of the mother's imagination during the period of pregnancy and that even the color of the offspring may be determ- ined by this circumstance alone. The origin of this belief is, indeed, coeval with the history of the race. But antiquity alone is not a suf- OF THE IMAGINATION. 47 ficient argument for any doctrine. No matter how old or how venerable a theory, if we know it to be dis- proved by the actual facts. If we were to take the antiquity of a doctrine or belief as the rule, and not have regard to reason and experience, there would be no end to error, and no improvement. In the earliest periods of medicine this delusion pre- vailed; and Hippocrates, honest and learned as he was, yet believed it, and aided in its propagation. Through his influence kings and nobles acted upon the principle, which, in some cases, at least, was made the cloak of wickedness and deception. Thus Hippocrates saved a noblewoman—and honestly, without doubt, though ignorantly—fronf the severity of the law, when she had given birth to a colored child, herself and hus- band both being white. He alleged that the darkness of its color was the effect of a picture of an Ethiopian that hung upon the wall in her chamber, and which was often the object of her contemplation. Galen was also of the opinion that a picture was sufficient, if contem- plated with interest, to give a corresponding appearance to the fetus in utero; and Soranus declares that the ty- rant Dionysius, who was deformed and ill-favored him- self, employed the aid of beautiful pictures, with the hope that his wife might have comely issue. Caelius Rho- dius also mentions that Fabius Quintillian saved a woman from suspicion, after she had brought forth a negro child, by asserting that the circumstance arose from the fact of her taking great pleasure in viewing the picture of a black man in her apartment. From the prevalence of this belief it was, likewise, that 48 TREATISE ON CHILDREN. Heliodorus formed the first, and, as is said, one of the most beautiful novels in the world, called the "Loves of Theagenes and Charachlea," the latter having been born white from black parents, but the queen, her mother, had often viewed, during her preg- nancy, the picture of Andromeda, who was painted with a white face; and the sages attributed the white color of the child to the force of the mother's imagi- nation. This superstition—for it does not deserve a better name—has probably always been believed in the world, and for a long time will continue to be by many, but not to that extent which it anciently was. We cannot believe, if cases like these, occurring in the time of Hippocrates and Quintillian, were to occur in our own day, and were now to be presented for judicial deci- sion, that any judge or jury could be found so ignorant as to decide that the color of a child can be changed by force of the mother's imagination alone; but things scarcely less ridiculous and absurd are believed by al- most every member of society who has any belief what- ever on the subject. Thus it is now a matter of com- mon belief, that the imagination of the mother may impose upon the skin certain resemblances to things upon which the fancy has been much employed, such as fruit, articles of food and drink, animals, insects, etc., or by the destruction of certain parts of the body, such as the head, arms or legs, lips, etc., or by the production of an additional part, as the fingers, toes, head, etc. In order to settle this question satisfactorily, and OF. LONGING. 49 beyond the possibility of mistake or doubt, it is well for us to look at the facts of nature as they exist everywhere about us, or, in other words, to the anatomy and physi- ology of the human body as it really is. In regard to the anatomical connection between the mother and fetus, it is to be observed that it is alto- gether indirect, and is carried on only through the me- dium of the circulation. There is no nervous connec- tion between mother and child; that is, no nervous filament, however small, has ever been detected pass- ing from the one to the other. " From this wise and all-important arrangement," observes Dr. Dewees, "it follows that the fetus 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 fetus, to impose upon it any alteration that may take place in her system, or to render the child liable, through the medium of ner- vous connection, to her affections." If the indirect connection that exists between the mother and child were better understood, and more justly appreciated, we should, doubtless, hear much less of the influence of the imagination of the mother upon the body of her infant, and thus one of the greatest of the attendant evils of pregnancy would be removed. It is not to be denied that cases do occur in which there seems to be a Hereditary predisposition to the perpetuation of supernumerary parts, marks, etc., in certain families ; such as an additional thumb, finger, too. or double teeth, in place of single ; but such cases 5 50 TREATISE ON CHILDREN. are not the result of any mental emotion, but are merely the effect of hereditary predisposition, the truth of which is admitted on all hands, and is a very differ- ent thing from that which we are now considering. It has not been attempted, on the part of any, to de- termine at what precise period during pregnancy the imagination begins or ceases to have an influence upon the body of the child, but, according to the accounts given, every period is liable to the accidents or anoma- lies in question. The imagination, it is supposed, has the power, not only of causing the creation of a new part, but also of destroying one or more of the mem- bers of the body. Now, suppose a leg, an arm, or a toe, to be cast off, must it not be expelled from the womb ? And who has ever detected such an occur- rence? Besides, too, is it to be supposed that nature would arrest the flow of blood after the part has been separated from the body of the fetus ? Dr. Dewees mentions the case of a child that was born with but the stump of an arm, which, at the time of birth, was perfectly healed, or, rather, pre- sented no evidence of having ever had a wound upon it at all. The mother declared that she had been frightened at the sixth month of pregnancy by a beg- gar. But what became of the lopped-off arm? and what arrested the bleeding? The child was born healthy and vigorous, and neither scar, wound, or blood could be discovered. In this case, as in all oth- ers of this kind, the " freak of nature" commenced at the first of gestation, the imagination of the mother having nothing to do with it. DR. HUNTER'S CASK. 51 The most learned and experienced medical men are all agreed on this subject. Dr. William Hunter, it is said, used to declare in his lectures, that he experi- mented in a lying-in-hospital upon two thousand cases , of labor, to ascertain this point. His method was as follows : As 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 an- swer were Yes, whether she had been surprised by any circumstance, that had given her an unusual shock, and of what that consisted ? Whether she had been alarmed by any object of an unsightly kind, and what was that object ? Then, after making a note of each of the declarations of the woman, either in the affirm- ative or negative, he carefully examined the child; and he assured his class that he never, in a single in- stance of the two thousand, met with a coincidence. He met with blemishes when no cause was acknow- ledged, and found none when it had been insisted on. Dr. Hunter, however, confessed that 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 that 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 off- spring. He read much, and had studied Martimus Scribelerus with great patience and supposed advant- 52 TREATISE ON CHILDREN. age, and had become a complete convert to the sup- posed influence of the imagination upon the fetus in utero. He accordingly acted upon this principle. He guarded his wife, as far as in him lay, against any con- tingency 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 car- riage, and carefully removed from her view all un- sightly objects. The term of gestation was at length completed, and the lady was safely delivered, by the skill of Dr. Hun- ter, 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 inexor- able, and was only appeased by his dutiful and sym- pathizing 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! Dr. Dewees, whose experience in matters connected with the birth of children was probably as great as that of any other individual, tells us that he commenced practice with the popular belief concerning the effect of the mother's imagination upon the physical condi- tion of the child. But he had watched these things attentively for many years, and for the want of facts to substantiate the truth of the common belief, he was obliged to abandon it. He came to the conclusion that the imagination of the mother has no influence whatever upon the form or complexion of the fetus. Fortunately, these absurd notions have lone since MARKS AND BLEMISHES. 53 been rejected by all sensible, observant, and intelli- gent physicians; and the fact that multitudes of those who are, or are to become mothers, do yet believe them, is the only reason for attempting a refutation of them. If we can but convince mothers of the fallacy of the belief we have been combatting, we shall save them a great amount of anxiety and alarm. With many, who are not by any means to be classed among the " weak, ignorant, and superstitious" of females, every sudden or unexpected occurrence that happens to strike them with alarm, or produces any strong mental emotion or excitement, is apt to impress them with alarming apprehensions as to the effects it may have on the development and conformation of the child in the womb. These ridiculous illusions, moreover, are often much increased by the strange stories re- specting marks and malformations, occasioned, as is asserted, by the imagination of the mother; and these narratives always find their way among the credulous in society, for ignorant nurses, and gossipping idlers among the old women, are everywhere to be found, and all of them are well stocked with extraordinary exam- ples of the pretended influence of which we are speak- ing. If a child is born with any spot or blemish upon its body, or with any malformation whatever, forthwith the mother is questioned as to the whole circumstances of the matter. If, at any time during pregnancy, any thing has attracted her attention, or strongly impressed the mind, which bears any resemblance, or similitude, to the mark, spot, blemish, or malformation of the child, it is at once put down as the certain cause of 54 TREATISE ON CHILDREN. the defect. In this way, then, absurd apprehensions are often made to take so deep a hold upon the mind of pregnant females, that no expostulation, or ridicule of the physician, or other friend, can entirely subdue them; and in some instances these apprehensions be- come so fixed as to cause a great degree of anxiety and distress of mind, and not unfrequently cause a great amount of physical suffering, and ill health. While, therefore, it is admitted that the physical health, the cheerfulness, the temper and general frame of mind of the pregnant female exerts an indirect in- fluence upon the health, character, and general well- being of the child, we yet know that the mother's ima- gination can have no direct influence in producing marks, spots, blemishes, or deformity of any kind. And the sooner, and the more widely this truth is pro- mulgated, the better, for both individuals and society at large. As intimately connected with the foregoing remarks, the subject of mental emotions requires some attention in this place. Strong impressions upon the mind can- not be too carefully guarded against by any one who is in the pregnant state. Some of the most remarkable cases illustrative of the effects of fright of the mother upon the child, are given by Baron Percy, an eminent French military sur- geon and professor, as having occurred at the siege of Landau in 1793. As quoted by Dr. Combe, it is stated that, in addition to a violent cannonading, which kept the women for some time in a constant state of alarm, KFFECTS OF FRIGHT. 55 the arsenal blew up with a terrific explosion, which few could listen to with unshaken nerves. Out of nine- ty-two children born in that district within a few months afterward, sixteen died at the instant of birth ; thirty-three languished for from eight to ten months and then died; eight became idiotic and died before the age of five years; and two came into the world with numerous fractures of the bones of the limbs, caused by the cannonading and explosion! "Here, then," as Dr. Combe observes, "is a total of fifty-nine children out of ninety-two, or within a trifle of two out of every three, actually killed through the medium of the mother's alarm, and its natural conse- quences upon her own organization." Cases are re- corded, in which the mother, being abruptly informed pf the death of her husband, has suffered an immediate miscarriage in consequence. In some cases the child has survived, but has afterward, throughout life, been subject to great nervousness and liability to fear. James I., King of England, is said always to have had a constitutional aversion to a drawn sword and to any kind of danger, which was attributed to the constant anxiety and apprehension which his mother suffered during the period of gestation. The practical lessons to be drawn from such facts are numerous and easy to comprehend. We see from them, how important it is that a woman who is preg- nant should, by all that is in her power, shun scenes of fear and danger. Husbands, and all who are in any way connected with her, should spare no pains that, during this important and trying period of her life, her 5G treatise* on children. mind should be kept in a calm, composed, and tranquil state. All strong emotions, of whatever kind, should be most sedulously guarded against. I at one time saw an instructive instance of carefulness on the part of the husband toward his wife. It was while I was in the old country the last time, in 1848. I was journey- ing from Graefenberg in Silesia, Austria, toward Paris. Unexpectedly I had the good fortune to be accompanied by an experienced courier, whose business, for years, had been, to travel from home with rich families to the different parts of Europe. A courier is a sort of gen- tleman servant. This one, Charles Lambelet of Paris, was a very worthy and intelligent man of the kind. He had expected to remain from home a much longer time, and was in the habit of living away from his fam- ily for a year or more at a time. As he was not at all expected by his wife, and as he had not had time to get a letter to her after concluding to return home, he said he must not come upon his wife too suddenly, as it would endanger her health, she being of a highly nerv- ous temperament. On arriving at Paris, the question was, how to manage the matter. An intelligent young servant woman had accompanied us, and the plan he fixed upon was, to send her to his house first. He did so, which was in the evening. She was instructed particularly by him how to proceed, which was, first to inquire for Madam Lambelet, then to tell her that she had just come from Silesia, and had seen her hus- band, which she would be very glad to hear. Then she was also to say that he was well and to return home soon ; and then, finally, that he was already in the strong emotions. 57 city. The intelligence coming to her thus gradually, caused her no harm; but her husband informed me that if he should come home suddenly, her emotion would be so great that it would make her down sick, and perhaps endanger life. I do not know that the woman was pregnant, but whether she was or was not, the lesson is an instructive one, and for which many would be the gainers for following. I know it made a strong impression upon my own mind at the time, al- though I had for years been well aware of the import- ance of avoiding the evils of which I have been speaking. CHAPTER VII. The Child after Birth—Separating the Umbilical Cord—This should not be done too hastily—Custom of the Ancients—Remarks of Dr. Denman—Bleeding at the Navel—Division of the Cord—The Ligature—Umbilical Hernia—The Child should have pure Air immediately after its Birth—Healing of the Navel—A Method of treating Umbilical Hernia. I pass now to certain considerations connected with the management and health of the child after it has been born. And in doing this, I shall explain various mat- ters which have generally been supposed to belong ex- clusively to the physician. Cases, however, often oc- cur in which it is necessary for non-professional per- sons to act on their own responsibility; and it is in such instances that a work of this kind is designed es- pecially to become useful. Of separating the Umbilical Cord.—Soon after the birth of the child, the separating of the umbilical cord requires our attention. How shall this be done ? Shall we use a sharp or a dull instrument in making the di- vision ? Shall we apply a ligature ? where, and in what manner to the cord ? It is reported of the aborigines of Brazil, that they merely bite or chew off the cord, as many of the animal tribes are found to do. This was imitating nature closely enough certainly; and more so, perhaps, than the umbilical cord. 59 the usages of civilized society would warrant us in doing at the present time. The New Zealanders, I am informed by a medical friend who spent some time among that people, cut, or rather tear off the umbilical cord with the edge of a shell, something like that of the clam or oyster of our own country. It matters little, however, what instrument or ma- terial is used to effect the object in question. The cord being immediately after birth a dead substance, pos- sessing no sensibility whatever, we may bite it off, or we may use a shell, a sharp knife, or a pair of good scissors or shears, whichever method we choose, re- membering always that it is of little consequence how we do it, and that it is as natural, precisely, for a man to exercise his ingenuity in making and using a con- venient instrument as it is for a brute to use his teeth. In the time of Hippocrates, it was not customary to divide the umbilical cord previously to the expulsion of the placenta. If this was slow in coming away, the child was placed upon a pile of wool, or on a leather bottle with a small hole in it, so that by the gradual subsidence of the skin or pile of wool, the weight of the child might draw almost by insensible degrees upon the placenta. In this way it was extracted without vio- lence. In modern times, it has been universally the custom to separate the child very soon after delivery, and be- fore the after-birth has come away. " As soon as the child cries lustily, proceed at once to separate the cord," is the common doctrine among medical practitioners. 60 TREATISE ON CHILDREN. But it is better, evidently, to wait, before this is done, until all pulsation has ceased in the cord. If we take the cord between the thumb and finger, we readily as- certain when its pulsation has ceased. It has a large vein in it for the transmission of blood from the mother to the child, and two small arteries, which return the impure or worn-out blood after it has gone the rounds of the fetal circulation. Blood is the only nourishment the child has while it is in the mother's womb. Hence it would be manifestly improper to rob the child of any portion of the fluid coming from the mother to it. The ancients not only waited for the expulsion of the after-birth before tying the cord, but if the child was at all feeble or dead at birth, the placenta when expelled was laid upon its belly as a comforting and restoring application. This practice, singular as it may appear to us in modern times, is not altogether without its philosophy ; the mild, genial warmth of the after-birth, was supposed to act favorably on the feeble powers of life, if such existed, or if it was dead, it was supposed the infant might thus be recovered. Speaking of later methods, Dr. Denman observes: " It has been the practice to divide the funis (cord) im- mediately after the birth of the child; and the weaker this was, the more expedition it was thought necessary to use; for the child being supposed to be in a state similar to that of an apoplectic patient, a certain por- tion of blood might, by this means, be discharged from the divided funis, and the imminent danger instantly removed. There is another method which I have seen practiced, the very reverse of the preceding; for in THE UMBILICAL CORD. 61 this, the loss of any quantity of blood being considered as injurious, the navel-string was not divided, but the blood contained in its vessels was repeatedly stroked from the placenta toward the body of the child. In all these different methods, and many others founded on caprice, or on directly contrary principles, children have been treated in different times and countries, and yet they have generally done well; the operations of nature being very stubborn, and, happily, admitting of consider- able deviation and interruption, without the prevention of her ends." " There is yet in all things," continues this author, " a perfectly right as well as a wrong method; and, though the advantage or disadvantage of either may be overlooked, the propriety and advantage of the right method must be evidently proved by individual cases, and of course by the general result of practice. In this, as well as in many other points, we have been too fond of interfering with art, and have consigned too little to nature, as if the human race had been destined to wretchedness and disaster, from the moment of birth, beyond the allotment of other creatures." It is the testimony of this author, however, that some children, after they had began to breathe, had respira- tion checked, and died after the cord was divided in consequence, this having been done too soon. Beyond a doubt, many children have been destroyed in this way, and in this as in many other things in the healing art, medical men have been too much in the habit of interfering with nature, and thwarting her in her oper- ations. G 6:2 TREATISE UN CHILDREN. It is the order of nature, and moreover a truly won- derful phenomenon, which exhibits most strikingly the evidence of Almighty design in the economy of man, that in proportion as respiration becomes established in the new-born child, the pulsation in the umbilical cord begins to cease, first at the placenta, and so gradually onward to the child; physiologists are puzzled to ex- plain the circumstance, but the fact is plain. Hence it follows, that if the cord were left to itself without any ligature, it would not expose the child to hemorrhage or other accidents, even though it should be cut clean and not contused or torn; some little blood might flow from the cut end, but every thing being left to nature, this could amount to but little, and such as would do no harm. But for the sake of cleanliness, it is proper that a ligature should be applied. But it will be objected, that in some cases—though very rare—children have been known to bleed to death at the umbilicus. This has, indeed, happened in some few cases in spite of ligatures, and every thing else in the way of styptics that could be applied. But these extreme cases are not to serve as guides in forming rules of practice. Nature has exceptions to all her rules. Besides, we may account for many of these occurrences, by the fact that the natural operations are often per- yerted by improper treatment. Thus, if children are swathed tightly, as ha3 been too often the case in civil- ized society, compressing the chest and the abdomen, and causing them to cry from distress, the embarrassed state of the viscera suffices to disorder the general circu- lation, and enable the blood again to pass out of the navel. THE UMBILICAL CORD. 63 Hence, as a matter of practical safety, although ifr is not necessary, as a rule, to apply a ligature to the umbilical cord, even when we cut it very near the ab- domen of the child, we had better do it, as no harm can come from the procedure; it is possible for it to do good, even to save the life of. the child ; properly ap- plied, it is not possible for it to do harm. Whether the cord is tied or not, it soon separates from the abdomen at the point where it joins the skin, and consequently a few lines from the surface of the abdomen. This separation is effected by the ulcerative process. If soft wet linen cloths are laid upon it, and renewed from time to time, the ulcer heals sooner than from any other application that can be made. It is, besides, a more cleanly method of practice than that which is usually adopted. As to the point at which we divide the cord—whether at a half an inch or an inch and a half from the abdo- men—every one must be his own judge. It is an old woman's notion, both in this country and in the old, which was derived from the physiology of the ancients, and which requires that the cord should be cut very near the umbilicus if the child is a girl, and very far from it if it is a boy, such a mode of cutting being sup- posed to exert a great influence upon the development of the generative organs. Notwithstanding the objections of some of the old women, I have separated the cord very near—say with- in half an inch of the abdomen. This is a much neater and more cleanly mode than it is to leave two or three inches of a dead substance to putrefy upon the child ; 64 TREATISE ON CHILDREN. ■besides, the more cleanly the part is kept, the more quick does the healing process take place. " As to the ligature itself," says Velpeau, " De la Motte advises us to apply it at the distance of one inch, Deventer, Levret, and the moderns, at the dis- tance of two fingers' breadth, others at three, four, five, six, and even twelve inches from the abdomen. Some persons have recommended the application of two, and in such a way that the one nearest the abdomen should not be so tight as the other. Sometimes it has been recommended to draw it very tightly, at others very loosely. " One person is content with a single turn, and a single knot; and another thinks there should be two turns and a double knot; a third, like Planck and M. Desormeaux, makes first one turn and one knot, and then bends the cord into a noose to tie another knot upon it." " A majority of the Philadelphia accoucheurs," says Professor Meigs of that city, " in tying the navel cord, pass two strong ligatures each twice around it, secur- ing them with two knots; the one an inch and a half, and the other two inches and a half from the abdomen, and divide it between the two with a pair of sharp scis- sors. This is a cleanly practice in all cases, and pru- dent, if not essential, in twins;" cleanly, that is, be- cause, as the professor means, the second ligature that is, the one that is nearest the mother, prevents the blood coming from the placenta and soiling the bed; the same principle I usually adopt, only the first ligature is placed a half an inch, instead of an inch and a half from the abdomen. Sometimes, however. THE LIGATURE. (Jo as in the night, it is, perhaps, better to leave the cord an inch or two long, and the next day tie it nearer the body. The ligature, since we use it at all, should be drawn very tightly; the cord being a dead animal sub- stance after birth, very soon shrinks ; hence if the liga- ture is not very tightly drawn, it may slip off in a day or two. In tying the ligature we should be careful not to pull at the child, for in so doing we might cause a rupture, or a tendency to such an occurrence. In making the division—which is done usually with a pair of good shears or scissors—we must be careful to avoid cutting off a finger, toe, or the private mem- ber. The infant, in its struggles, is very apt to get some of these parts in the way just as one is making the cut. As to the kind of ligature: some think they must always have a narrow tape; and hence we often find, in attending a case, that the mother has already pre- pared herself with this* material. But a common round thread is to be preferred; we can draw this more tightly than we can a flat ligature. A strong linen thread, doubled and twisted if we think it necessary, I consider the best. " Some would not dare to use any thing except tape," says Velpeau, " whereas wiser per- sons make use of whatever they can find at hand." One circumstance should be particularly noticed in regard to tying the cord. It is said that it is possible for umbilical hernia to take place before the child's birth. In such case a portion of its intestine must have protruded into the cord. Hence, in such case, if we were to tie a ligature about the cord near the Qi5 TREATISE ON CHILDREN. body, and where the intestine is—a fact that we can know by the cord being bulged out, or enlarged next to the body—and should cut it off so as to sever the in- testine, we should inevitably kill the child. Few prac- titioners have ever seen such a case ; but inasmuch as it is said that such hernia may possibly exist, we should always watch for it. It would be easy to de- tect, but if one should have any doubt as to whether there is hernia or not, he may apply the ligature an inch or two from the child's body, and thus make sure of doing no harm. It is important to remember, that at the time of; and before making the separation, the child should be so placed as to allow the most free respiration; it has just begun to breathe for the first time in life; it is just as important that it has good air as it is for any of us. Many a tender infant has been injured at the very beginning by being smothered among the bed- clothes as soon as born. Peopli everywhere, think it will take cold as soon as it is exposed to the air; but think, you who understand the anatomy and physiology of the human system, how exceedingly delicate the fine internal net-work of its little lungs is! And think you that the external skin is less able to bear the new impression of the atmosphere than the lungs are ? As to difficulties at the child's navel, I have never had them. It is certainly a very simple thing to leave it altogether to itself, with the exception, the second day and onward, of laying upon it a soft, clean, wet compress, of four or five thicknesses, so that it remains constantly moist. This water-dressing, often renewed THE WATER-DRESSING. 67 and kept thoroughly clean, will, as I have before re- marked, heal the navel more quickly than can be done in any other known way. From what I have been able to learn, I infer that with water-dressing this healing is effected in from one fourth to one third less time than by the usual methods. The dead portion of the cord separates itself from the living part usually in four, five, or six days. Com- plete cicatrization is commonly effected by the end of the second week. The healing powers vary somewhat in different cases. In one case, where both the father and the mother were of the scrofulous tendency, it was a number of weeks before the healing process was fully completed. The child, however, in the end did well. If umbilical hernia presents itself, the tumor, we are told, may be readily replaced. This occurrence is more apt to happen, it is believed, in the female than the male. CHAPTER VIII. Of Asphyxia, Syncope, and Still-birth—Congestion—Still-birth, and its Causes—The Evils of Separating the Umbilical Cord too soon—Treatment of Asphyxia—Cautions in regard to Insuffla- tion—Asphyxia from Debility—Treatment. In most instances the child begins to breathe and cry, and the various functions of animal life commence their circle of action, as soon as it comes into the world. In such cases we have nothing to do in regard to the res- piration, nature alone being wholly competent to do her own work. But cases do now and then happen, in which the signs of animation are either very imperfeet, or do not at all manifest themselves. This state of imperfect or suspended animation de- pends either upon feebleness or exhaustion of the vital powers, on syncope, or on an apoplectic condition of the brain. In this latter case the child's countenance exhibits a very dark or deep red and swollen appearance; the eyes are more than usually prominent, the surface of the body, as in other cases, warm, and the skin red- dish, and somewhat tense. The causes of this appearance are, that the child may have been too long delayed in its passage from the mother, its head may have been too much com- THE STILL-BORN. 69 pressed, or the umbilical cord may have been tightly begirt about its neck. " It is difficult to conceive," says an able writer, "how a long-continued and powerful action of the uterus could fail to produce dangerous or fatal san- guineous congestion in the brain. The water by which the fetus is surrounded being wholly incompress- ible, the entire force of pressure exerted by the womb must necessarily act directly upon the child, and cause so great a compression of the more yielding parts of the body, as nearly to arrest the circulation in them, the inevitable consequence of which must be, an ex- cessive accumulation in the brain, heart, and lungs, parts that are protected against external pressure by the bony walls which inclose them." The child may also be born still, from its not having passed to its full period, or from various causes it may not have vital stamina enough to enable it to live. In some cases the child is born without any manifestations of life whatever appearing. The face is swollen and livid, the body flaccid, and the navel-string does not pulsate. In such cases we "should not at once wholly despair of life, although there is not usually much to hope for; yet, inasmuch as cases of this kind are now and then recovered, they ought not to be immediately aban- doned without making suitable efforts for the resuscita- tion of the vital powers. A frequent cause of the absence of respiration in the new-born infant, is the separating the umbilical cord too soon after birth. Such is the opinion of Den- man, Burns, Baudeloque, Dewees, Eberle, etc., etc., 70 TREATISE ON CHILDREN. and there can be no doubt that many a child has been destroyed by this inconsiderate practice. By all well- qualified and skillful practitioners it is laid down as a rule, " that the cord is not to be tied until the pulsa- tions in its arteries have ceased y" and this any per- son of ordinary understanding, and without medical knowledge, can easily ascertain, by simply taking the cord between the thumb and forefinger. In consequence of the neglect of this rule, Doctor Dewees tells us that he had reason to believe that he had seen several instances of death, and this of a pain- ful and protracted kind. " And that this is probably one of the causes of the many deaths, in the hands of ignorant mid wives and practitioners," this another ob- serves, " we have too muoh reason to suppose." The practice with many is, to apply a ligature to the cord the instant the child is born, without any regard what- ever to its pulsation, or the state of the child's respi- ration. At the expense of some repetition, I have insisted upon this plain principle of practice, hoping that it may be regarded as it should be by all into whose hands this volume may fall, or who may have occasion to act in an emergency without the aid of a physician, as is often the case, particularly in the country parts. In the cases of asphyxia, to which I have referred, various methods of treatment have been adopted, some of which are, no doubt, valuable, while others are med- dlesome, and worse than useless. If the child is livid and dark-colored, it has been recommended to abstract blood. This is best done at THE STILL-BORN. 71 the umbilical cord; that is, by separating it. If the blood will not flow, it is recommended to strip some blood from it. It is, however, admitted that, in gene- ral, very little, if any, can be obtained in this way. It has also been recommended to apply a cupping- glass to the umbilicus, so that by exhausting the air from the part the blood may be brought into motion, and thus made to flow, and this even after the heart has ceased to act. I know of no author, however, who has succeeded in this method. The object of abstracting blood in any of these va- rious ways is to set the vital fluid in motion, and to relieve the congested parts. But it appears to me that there is a far better method than this, and that is simply by friction with the wet hand. The child has in no case too much blood ; it is only in the wrong place. The wet hand does not at all injure the skin ; the cold water—for cold only should be used here— acts as a stimulus to the vital power, and the motion of the hand and the pressure will set a hundred-fold more blood in circulation than the mere separating of the umbilical cord coald do. Hence it is that I would depend much upon friction, and very little, if any, upon the abstraction of blood. This latter practice is destined to become as obsolete in time, as that of bleed- ing in a severe injury or shock of the system—a meth- od which has deservedly gone out of date among all scientific practitioners of the medical art. In conjunction with the measure which I have just recommended, there is another of importance, which should be faithfully made; and that is, an effort to 72 TREATISE ON CHILDREN. excite the respiratory function by artificial inflation of the lungs, and compression of the chest with the hands, so as to imitate in a measure the natural acts of inspi- ration and expiration. In doing this the operator must apply his mouth to that of the infant—the latter hav- ing been first freed of the mucus that attaches to it— at the same time closing its nostrils, and endeavor by a moderate but uniform force of expelling the air from the mouth, to fill the lungs of the child. As the air is thrown into the lungs, the chest of the child must be allowed to expand as much as it will; and then, as this act is discontinued, the chest should be compress- ed a little, carefully, so as to imitate the natural motion of these parts. Authors disagree as to the amount of force allowable in forcing air into the lungs of a new-born child. Some have recommended a " forcible insufflation," while others contend that such a practice is fraught with danger to the child. It appears from a series of experiments that have been made in France on animals, and from observations relative to the human subject, that no very great force of insufflation is necessary to rupture the delicate air-cells, and cause a fatal emphy- sema of the pulmonary structure. In sheep, and in the dead human subject, the air-cells were ruptured by a force of insufflation not greater than that which may be made by a person of ordinary respiratory vigor, without any very violent effort. Of the tendency of forcible insufflation to rupture the air-cells of the lungs, Dr. Eberle gives us a strik- ing example that occurred in his own practice. " A THE STILL-BORN. 73 few years ago," he observes, " I attended a lady in a tedious and rather difficult labor. The child was still- born, but I nevertheless made some efforts to effect a resuscitation. I inflated the lungs in the usual way. The child, however, did not recover. A singular tu- mor (or swelling), situated just above the middle of the left clavicle, induced me to ask permission to examine it with the scalpel. The tumor extended a short dis- tance into the thorax, in following which I opened the chest. On raising the sternum, I found the superior portion of the left lung in a complete state of emphy- sema, and a good deal of air diffused under the anterior and lateral surface of the pulmonary pleura. With the exception of the inferior portions, both lungs were crepitous, and appeared to have been well inflated. That the emphysema was the result of rupture of the air-cells, caused by the forcible inflation, and not of putrefactive decomposition, I could not doubt; for up to within about two hours of the termination of the labor, the child's motions were distinctly felt both by the mother and myself." In perusing a narrative like the foregoing, one hard- ly knows whether he most admires the benevolent in- tention of the physician in attempting the unpleasant task of endeavoring to resuscitate a still-born child, or the candor of the author in stating so freely the error into which he fell; and it was no doubt a serious ques- tion in his own mind, whether he had not been the means of destroying the child by his too forcible efforts, when with gentler means, sufficiently persevered in, it could have been made to live. At all events, he lays 7 74 TREATISE ON CHILDREN. down the caution that, to obviate the unfortunate acci- dent of rupturing the air-cells of the lungs, the air should be thrown into the respiratory passage through a silk handkerchief folded double, or a fine napkin laid over the mouth of the infant. In all cases of retarded, impeded, or suspended res- piration immediately after birth, care should be promptly paid to the removal of the viscid mucus, which is usually to be found lodged in the mouth and throat of new-born infants. In some instances the quantity of mucus is so great, and its quality so tough, that it is believed the child could not possibly breathe if the ob- struction was not removed from the parts. In all cases, therefore, if there appears to be any difficulty whatever, in regard to respiration, it is best to remove this mucus by means of the finger, surrounded by a handkerchief or piece of soft linen. If there is reason to believe that the mucus is also lodged in the throat and beyond the reach of the finger, it has been recommended that the child should be turned with its face downward, and the body raised higher than the head. In this po- sition, the child's back, between the shoulders, is to be patted with the hand, and its body gently shaken, so as to disengage any matters that may be lodged in the trachea, and permitting it to flow out of the mouth by making this the depending part. At the same time, if the back is rubbed with the hand wet in cold water, the stimulating effect will aid in the expulsion of the offending cause from the throat. Infants are sometimes born in a state of asphyxia, when, instead of lividity, and swelling of the counte- TREATMENT. 75 nance, there is the opposite extreme, the face and sur- face of the body, generally, being pale, exhibiting a want of vitality. In such cases, it is of the utmost importance that the cord be not divided too hastily; on no ^account, indeed, should this be done until the pulsation has ceased. The viscid mucus should at once be removed from the mouth and fauces by the methods before mentioned; and it has been recom- mended to apply brandy, spirits of camphor, hartshorn, etc., to the mouth and nostrils, with the view of exciting the respiratory function. It is doubtful, however, if such articles do any permanent good whatever, and they are certainly liable to harm. At any rate, it is better, I am confident, to sprinkle cold water upon the surface, and to make friction with the cold wet hand. This will set the blood in motion, and aid the vital powers incom- parably more than the stimulants mentioned. It is also advisable in these cases, if respiration is particularly tardy, to inflate the lungs carefully, accord- ing to the method before recommended. But the ap- plying hot brandy, flannels wrung out of hot spirits, etc., which have often been used on such occasions, are worse than useless, and ought never to be resorted to. Infants, in this condition, should not be given up too hastily. Numbers of cases have happened in which a half hour or more has elapsed before respiration has been established. Even a much longer period than thirty minutes has transpired in some cases before the breathing has been established. The time will come, probably, when electricity will become so well understood, as to enable us to make it 76 TREATISE ON CHILDREN. a valuable agent in cases of still-birth and suspended animation. In the present state of knowledge, how- ever, it is better, I think, to depend on the stimulus of cold water, frictions, and the other means to which I have already referred. But great care is necessary in the management of all such cases, and I have no doubt that many more infants have been killed by the too meddlesome and injudicious management, than have been saved by the use of artificial means. CHAPTER IX. Of Washing the new-born Infant—Safety of the Water-Treatment Illustrated—All Infants need Bathing soon after Birth—Prac- tice of the Araucanian Indians—Of the Pitcairn Islanders—The New Zealanders—Custom of the Ancients—Of the Russians—Of the Romans—Safety of the Cold-Bath—A medium Temperature the Best—Dr. Combe's Advice—Medicated Water should not be used—Opinion of Velpeau—Drying the Child—How Often should the Child be Bathed ? We will now suppose the newly-born child to be well and strong, crying lustily, and moving its limbs in all manner of ways, with the umbilical cord separated as has been described ; what next is our duty to the in- teresting little stranger which has just been brought forth ? Usually the child is wrapped in a flannel blank- et, or other cloth, and delivered over to the nurse, or assistant, who takes upon herself the important duty of washing it. And here I am led to make a remark in reference to the safety of water-treatment. How often have we, who have had in the beginning to fight its hard battles, been told that water will agree only with some persons ; that while it may help some, there are yet many who cannot bear the force of the treat- ment. All such objectors evince an amount of igno- rance of which they should be ashamed. Water-treat- ment not agree with a person, when every infant, how- ever feeble, and in whatever climate it may be born. 78^. TREATISE ON CHILDREN. is, the first thing of its life, subjected to it! What nonsense ! But there is a right way as well as a wrong way of doing things ; and the fact that water may be so easily made to injure a person, is an evidence of its power, and proves to us how valuable it may be made when employed by skillful hands. That the new-born infant should, in all cases, be subjected to some method of cleansing, is very evident. Without undertaking to decide whether our first pa- rents were at the trouble of this procedure in managing their children, and without recurring to the question which has been raised by some physiologists as to whether the unctuous matter found upon the fetus at birth, is a mere result of the sebaceous secretion, rather than a deposit of some principle contained in the liquor amnii, we may safely conclude that none but beneficial effects can follow its removal. The child should, I think, be thoroughly washed soon after its birth. True, some infants appear to be almost perfectly clean, and to need but little cleansing; but with the majority, it is otherwise. Nor have I been able to ascertain that the previous habits of the mother exert any influence in regard to the cleanliness of the child. I think it will be found that the most uncleanly mother may bring forth the most cleanly child, that is, cleanly so far as external appearance is concerned. The amount of unctuous matter found upon the child at its birth, then, appears to have no relation whatever to the purity and health of its system generally. I remarked, it is evident that the new-born child should be cleansed. We see that the sheep, goat, WASHING THE INFANT. 79 V cow, and many other animals, lick their young with the greatest solicitude and care, almost as soon as they are brought forth. Man, then, being endowed with a high degree of mental powers, as naturally exerts his ingenuity as the brute its instinct. No one, therefore, need be at the trouble of reasoning from analogy that human beings are to subject their young to the process of licking, as animals do; but the analogy holds good so far as cleansing is concerned. The brute acts in accordance with its instinct; man acts in accordance with his reason; and he who reverences nature most, ever holding his mind open to the Fountain of all Truth, and loving it better than his own opinions and conceits, will, in the end, be led into the right way. But different nations have adopted very different methods in regard to the management of infants. I believe all authorities agree, that the aborigines of this country, everywhere, wash the new-born infant in cold water almost immediately after its birth. According to Stephenson, author of " Twenty Years' Residence in South America," " among the Araucanian Indians of that country, a mother, immediately on her delivery, takes her child, and going down to the nearest stream of water, washes herself and it, and returns to the usual labors of her station." The children of Otaheite, according to " A Descrip- tion of Pitcairn's Island and its Inhabitants," are gener- ally bathed in cold water three times a day. A cripple is hardly seen among the Otaheitians; a sickly child is nev- er known; "any thing resembling it," says Capt. Cook, "would reflect the highest disgrace on the mother." I 80 TREATISE ON CHILDREN. A very worthy medical friend, who spent a number of months at New Zealand, in 1839, informed me that a woman of that island, as soon as she experiences the first symptoms of labor, retires some little distance from her work—for she generally employs herself ac- tively a considerable portion of the day in out-door labor—to a pure stream of water among the bushes, where, unaided and alone, she gives birth to her child. Not unfrequently within an hour the mother returns to her companions, having previously subjected both her- self and child to a free ablution in the pure element J Writers tell us that the ancient people of Germany, Britain, Scythia, and Greenland, were in the habit of plunging the new-born child into cold water or ice wa- ter, or even to roll it in the snow, immediately after its birth. This is said, indeed, to be still the custom in some of the more remote parts of Russia; and we know that in that country the people are remarkably hardy, vigorous, and long-lived. The ancient Romans were also in the habit of fre- quently immersing their youngest children in cold water. It was the recommendation of Lycurgus, that not only the strong and healthy children, but the deli- cate and deformed, should be subjected to this process, and to use a style of garment the same in all seasons and all vicissitudes of weather. It has become a fashion with certain medical writers to assert that " the vigor and the robust constitution of those people depended upon their diet, and the ex- ercises to which they were accustomed," and that "if they had among them no weak and delicate children, THE COLD BATH. 81 that may be accounted for, not by saying that the cold bath gives strength and health to weakly children, but that those that were weakly at first soon died, and that none remained but such as were endowed with more vigorous constitutions." But all this is a mere bag- ging of the question, and is assuming that to be true which is in no wise supported by facts. In all the minuteness of the history of both ancient and modern nations, we have no proof that infant mortality has any where been increased by cold bathing. Medical records are sad enough in their details of infant mor- tality, as it exists in the more enlightened nations at the present day; but cold bathing cannot be in any sense or degree a cause of it, since it is not at all practiced. I repeat, then, that so far as history and medical records go to settle the question, they prove that cold bathing is, at least, a safe practice in the management of infants and children. We have reason also to infer that the contrary practice is to be reckoned as one among the causes of the great and alarming amount of infant mortality which we see at the present day. But there is no need of ultraism on this subject. The great tendency of the world is always to go to ex- tremes ; and if people are, on the one hand, set upon using cold water, they must have it at a very low tem- perature ; on the other hand, those who dread its use commit the opposite error, and must have it very warm. The more judicious plan is to avoid both ex- tremes, and adopt a medium course. And yet I would not have people frightened at every 82 TREATISE ON CHILDREN. little use of cold water. We are everywhere more liable to get harm by heat than by cold. But I repeat, I would go to no extremes. I have known delicate young infants in the city of New York to be bathed daily, from the first onward, with water as cold as could be obtained. These in- fants have done well, so far as I know, every one of them. I have not been able to learn that any have been injured. But I have not myself recommended such a course; and while I am convinced of its general safety, I do not believe it to be necessary. Having the water at about 60° to 70° Fahr. in winter, and 70° or 80° Fahr. in summer, is probably as serviceable as a colder temperature would be in most cases, and certainly much more agreeable to the feelings of the infant than water that is very cold. But to return to the subject of the first cleansing of the infant immediately after its birth. Dr. Andrew Combe, in his excellent work, entitled, " The Physio- logical and Moral Management of Infancy," gives us the following advice regarding the treatment of the new-born child: " If the infant is active and breathes freely, it may forthwith be washed, to free it from the tenacious coating of unctuous mucus, which served for its protection during its sojourn in the womb, but which now becomes a source of irritation, and a direct impediment to the healthy ac- tion of the skin, and must therefore be removed. This is generally done simply by washing with warm water and a sponge; but as the bones of the infant are so soft as to be incapable of sustaining its own weight in any WASHING THE INFANT. 83 thing approaching to an erect or sitting position, and it cannot be held up by the hand without inconvenient pressure, it will answer still better to make use, as is done in Germany, of an oval-shaped, shallow, wooden bath, with a raised portion at one end for the head, and containing a quantity of water, just sufficient to cover or float the child. By this plan every part of the body is effectually protected from cold, while the position of the infant is that which is best suited to its natural feebleness of structure, and which admits most easily of the head and face being thoroughly washed, without any risk of the impure water running into its eyes. After the infant has been immersed for three or four minutes, it ought to be rubbed gently all over with a soft sponge, great care being taken not to chafe or injure the skin by too much friction. Treated in this way, the mucus separates easily, and the use of soap, or any oily substance in addition, is rarely required. Part of the mucus is apt to adhere to the folds of the skin and joints, to the ears, eyelids, and other irregular surfaces, unless it be cleared away by very careful washing. But as the eyes are extremely delicate, and easily injured at birth, great caution should be exer- cised not to touch them with the sponge which has been used to cleanse the rest of the skin, or to allow any of the water, now loaded with impurities, to drop upon the eye or eyelids. Neglect of this precaution, especially among the poor—who are less scrupulous in regard to cleanliness—is one of the causes, perhaps the chief cause, of a severe form of ophthalmia, or in- flammation of the eyes, which is apt to come on within 84 TREATISE ON CHILDREN. two or three days after birth, and which often ends in loss of sight. To avoid every possible risk from this cause, it will be best to use perfectly clean water, and a separate piece of sponge for washing the eyelids." The plan more commonly followed in New York is, for the nurse, or person who washes the infant, to sit on a chair—a low one, if such is at hand—and having water enough near her, she holds the child upon her lap, and with a sponge, or piece of soft flannel, or other cloth, washes it. Possessing a fair degree of skill and dexterity, I think the nurse may accomplish the cleans- ing of the child well in this way. Possibly immersion may be the better plan, and may be performed more quickly. I think it would be a good way first to put the child in water, with the view of loosening somewhat the matter upon it, and the finishing of the operation to be done while it is held in the lap. If it is to be dipped in the water at all, any common wooden tub— making sure always that it is entirely clean—will be sufficient. After all, more depends upon the skill and ingenuity of the person who performs the task, than upon the method employed. A careful, ingenious nurse will do it well in almost any way, while a care- less and slovenly one will not succeed by any method. ' As to the temperature of water proper to be used, there exists, as I have before remarked, a diversity of opinion. I am very confident that it is generally em- ployed at too high a degree. Suppose it to be in the winter, the temperature of the atmosphere in the room is perhaps 50°, 60°, 65°, or perhaps 70° Fahr., though it ought not to be so high as this. Suppose that it is BATHING OF INFANTS. 85 at 60° or 65° Fahr., do what we will, the delicate lungs of the infant are to be subjected to its influence. And we know, moreover, that a much colder atmosphere does not harm its respiratory organs. How, then, can water of a similar temperature injure it externally? It must be admitted that water somewhat warm acts more favorably for cleansing than that which is cold; but this affords no argument for putting it at a high degree. If a washerwoman uses water well up toward the boiling point, as being best for the process of washing clothes, it is no proof that we should use it for the infant; we know, indeed, that it would injure it, if the water is used at a temperature much above blood heat, which is in all climates and at all seasons of the year 98° Fahr. Dr. Combe inculcates that the temperature of the blood should be our guide as to the temperature of the water. " If it is either much warmer or colder than blood heat," he observes, " mischief is sure to follow. Water at a low temperature causes a far more rapid loss of heat than the child can bear; while at a greater heat than 96° or 98°, if continued for more than an in- stant, it relaxes and debilitates. Momentary immersion in water two or three degrees warmer is sometimes very useful in rousing the vital energies of a feeble or lan- guid infant, but if it is long continued, it will inevi- tably induce exhaustion." After all, it is to be remarked that the temperature of the surface of the body is usually much lower than that of the blood. It would seem to follow, therefore, that the atmosphere would prove a safer guide. Ex- 8 86 TREATISE ON CHILDREN. perience and well-ascertained facts will guide us better than all reasoning on this subject. I have myself regarded that a temperature of from 60° to 70° Fahr. in winter, and from 70° to 80° Fahr. in the summer, is probably, in the generality of cases, the best. But, as I have elsewhere observed, infants have done well being bathed from the first in very cold water; and I have known them also to do apparently well by being washed in water at a much higher tem- perature than I should myself recommend. In another part of this work I shall speak of the treatment of dysentery—a disease which is attended with great de- bility, and in which very cold water has proved to be an invaluable remedy, incomparably better than any other known. In the complexity of the medical art, it has not un- frequently been recommended that we employ medi- cated water in bathing the new-born infant. As the medical art has been, people everywhere in civilized society have had more confidence in complex than in simple means. Tea and coffee, always harmful, are reckoned better than pure water, the best of all drinks. So also it has been believed by many, that medicated, - alcoholic, and other so called " strengthening" baths, are preferable to the pure element. But the great Velpeau, in referring to these applications, tells us, " if they are strong, they deprive the skin of its supple- ness, interfere with the expansive movements of the fluids, and may give rise to the most serious accidents ; if weak, they at least do no good, and I should not make use of them, except where the fetus might be BATHING OF INFANTS. 87 excited in a general manner, so as to communicate a greater degree of activity to its languid functions." Many, also, are in the habit of bathing the head of the new-born infant with brandy, or some other spirit- uous liquor, in order, as is imagined, to invigorate its system and fortify it against the injurious effects of cold and other causes of disease. " This practice," observes Dr. Eberle, " can serve no useful purpose; and as it may do mischief by overexciting the system, as well as by causing pain and inflammation of the eyes, it ought to be abandoned." After the ablution, in whatever method performed, much care should be exercised in drying it. In hand- ling it, regard should be always had to its natural deli- cacy and feebleness of frame. Even the bones of a new-born child are very soft, and may be easily broken or put out of shape. It has been recommended to have a large flat pillow or cushion ready prepared and covered over with two or three large, soft, warm napkins, on which to lay and dry the child immediately on its being taken out of the water. The cushion ought to be soft enough to yield somewhat, but not too much, to the pressure of the child; and it may be laid either across the nurse's knees or on a small table. By this means, the infant may be dried easily and in a very short time, and gentle rubbing continued with the hand over the whole surface, till a genial glow is excited. This rub- bing should not be too hard, lest the skin be chafed in the performance of it. While bathing the child, but more particularly while drying it, care should be taken to avoid currents of air. 88 TREATISE ON CHILDREN. But people are much more apt to injure children by having them where it is too warm, rather than too cold. Notwithstanding, it should be remembered that air of any given temperature lower than the heat of the body, abstracts, when in motion, as in a current, much more heat than when it is still. Hence I remark, the child should not be kept near a window, door, or other opening, where it may be too much exposed. It should be remarked also, that people often suppose that a child has taken cold, when, in reality, such is not the fact. Infants often sneeze and cough soon after birth, without having taken a cold. It seems natural for them all to learn to exercise these functions; and this learning, if I may so call it, is to be acquired by the actual performance of it, just as a person in learn- ing to sing can only do it by the exercise of the art. Perhaps, also, there may be foreign matters lodged in the throat and nasal passages, to remove which, there is need of these expulsive efforts of nature to rid them of the offending substance. How often should the Infant be bathed ? On this subject authors have not spoken. One thing, however, we may be sure of; the child should be washed often enough to insure its cleanliness. Those parts of the body which are soiled by the natural discharges should be cleansed as often as they become soiled. Not only the health of the child, but its comfort, requires this precaution. It will, moreover, well repay the parent to have this duty attended to faithfully, for the child will be much less troublesome and difficult of management, than it otherwise would be. BATHING OF INFANTS. 89 As to washing the whole body, two times in the twen- ty-four hours will ordinarily be sufficient. I am now speaking of the state of health. In disease, we would bathe the child many times; as often as the nature of the case should demand. But in health, the morning and evening general bath are quite sufficient. The ablution of the infant should be performed be- fore nursing, rather than after it. Nor should it be allowed nourishment immediately after the bath. In all considerable changes that are to be made in the physiological habits of infant, as well as adult life, the system should be allowed some little time before passing from the one to the other. CHAPTER X. Of Clotting—The Binder or Bandage—Its Evils—Testimony of Dr. Dewees—Of Dr. Combe—Of Buffon—Of Dr. Baynard—Of Boer- haave—Probable Origin of Swathing—A Case illustrative of the Abuse of the Practice—Reason why Swathing is bad. Supposing that the infant has been thoroughly washed and made dry, what are we to do in regard to its cloth- ing ? Some are of the opinion that in a strictly natural state of society, no clothing whatever would be used. This might answer in some portions of the globe, but certainly not in all. Nor do I believe that the Almighty intended that man should any where live in a state of nudity; and He has endowed us with reasoning fac- ulties by which we may be guided safely as to the na- ture and amount of clothing that under any particular circumstances is to be worn. In cold climates we need a covering to the body, to enable it to maintain its proper warmth. In the torrid regions we need a thin, light garment, to serve as a protection from the sun's rays. In both cases, clothing is both natural to the health of the body, and produc- tive of its general well-being and comfort. The Binder or Bandage.—This usually consists of a thin, elastic, fine flannel bandage, of five or six inches in breadth, and long enough to go once or twice round the body. This is applied partly for warmth, butprin- BANDAGING THE INFANT. 91 cipally with a view to protect the navel, and prevent the bowels from being forced outward at that part during crying or other sudden effort. In winter it has been customary to use flannel; but if the skin is un- usually sensitive, or the weather hot, a light cotton or linen roller has been substituted. But is this bandage at all necessary ? Certainly we have no analogy for its use in the animal creation. What would we think of a farmer who should always insist upon swathing his calves and lambs ? and yet the calf and the lamb need it as much as the child, so far as support is concerned. It has been supposed that this bandage is necessary to prevent umbilical hernia; but, as Dr. Burns well remarks, " Hernia does not take place because the child is not bandaged, but because the umbilicus is unusually wide ; < and in those countries where no com- press is used, hernia is not a frequent complaint." " A tight bandage," continues this author, " produces pain, difficulty of breathing, and other deleterious ef- fects. The only purpose to be served by a bandage is to retain the rag, which is, for the sake of cleanliness, applied round the cord." But I have elsewhere shown the superiority of the water-dressing for this purpose, so that, by the admission of so high an authority as Dr. Burns, we need no bandage at all in the case. The practice of swathing and binding closely and tightly the body of the new-born infant with band and roller, has long prevailed in this country, as well as in Europe, and for how long a time, we know not. Whether such were the swaddling clothes in which the 92 TREATISE ON CHILDREN. Saviour was bound, we cannot, perhaps, determine positively. We have, however, every reason to believe that such they were not, since the clothing used at the East was of a loose and flowing kind. This exceedingly injurious practice originated, no * doubt, in two ways: First, the parent, proud, igno- rant, and superstitious, believed that the form of the infant's abdomen would be improved. Secondly, phy- sicians believed that swathing would tend to prevent rupture; but this idea was as mistaken as could be, for the application made is one of the most certain means ofc ausing the difficulty mentioned. The bowels are crowded downward and out; rupture is thus more apt to be caused; besides, from the heat retained about the surface, and the uncomfortableness and irritation caused by the bandage, the evil is much more likely to occur. Besides all this, " Let a person put the hand on the abdomen, or region of which the navel is the center, and feel the rising swell of this part during every inspiration, or drawing of the breath, and it must be very obvious, that to compress this region by a bandage passed round and round the body, cannot but interfere with the freedom of respiration, by pre- venting the complete enlargement of the chest and the descent of the lungs. The viscera, or organs, con- tained in the great cavity itself, being thus pent in by the bandage in front and all round, and pressed upon above by the midriff, in its descent at each inspiration, will greatly suffer, and be forced into new situations, or kept in forced contact, irritating and inflaming each other." BANDAGING THE INFANT. 93 One time in a thousand, there may be a rupture at the navel that requires a very light, cool bandage, but never one that is so tight as to crowd the bowels down- ward, or impede, in any manner, the motions of res- piration, or become, in any degree, a source of discom- fort to the infant. From the first of my practice, those mothers whom it has been my lot to attend in childbirth, have obeyed my injunctions as to omitting the bandage. The best of results have always followed this mode, and there cannot be infants and children any where found of health and form superior to those treated in this way. Who would think of swathing an animal, to give it a better form than God directs ? Dr. Andrew Combe quotes a writer, who, in describ- ing the Caribs one hundred and seventy years ago, says, in a tone of regret, " They do not swaddle their infants, but leave them to tumble about at liberty in their little hammocks, or on beds of leaves spread on the earth in a corner of their huts; and, neverthe- less, their limbs do not become crooked, and their whole body is perfectly well made.'n And again, " Although the little creatures are apt to roll about on the ground, in a state of nudity, they, neverthe- less, grow marvelously well; and most of them be- come so robust as to be able to walk without support at six months old." " The naivete of this expression of surprise at the little Caribs growing marvelously well with the as- sistance of Nature alone, and without the use of stays and bandages imported from Europe," says Dr. 94 TREATISE ON CHILDREN. Combe, " is extremely amusing, and shows to what extent prejudice and custom, once established, will continue to prevail, even when we have before our eyes the strongest evidence of their being hurtful. Our ex- cellent author seems never to have allowed the thought to enter his head, that the Europeans produced the deformity by means of swaddling and bandages, and that the Caribs escaped it simply by avoiding its causes, and giving liberty to both limbs and trunk of the body." Mr. Stevenson says of the Araucanian Indians of South America; " The children are never swaddled, nor their bodies confined in tight clothing. They are allowed to crawl about nearly naked until they can walk." To the loose clothing which the children wear from their infancy, may, doubtless, be attributed the absence of deformity among those Indians. The in- habitants of Otaheite wear at most but very little clothing, and this loose and flowing in its form. We are told that among the Otaheitians a rickety child is never known. Any thing resembling it would reflect the highest disgrace on the mother. It is to be observed, also, that mothers among these people are very affectionate, tender, and remarkably fond of their children. " They nurse them with the utmost care, and are particularly attentive to keep the infant's limbs supple and straight. A cripple of any kind is hardly ever seen among them in early life." Dr. Dewees uses the following language, concerning the practice of swathing infants : " We cannot but regard as one of the greatest im- SWATHING DESCRIBED. 95 provements in modern physical education, the now al- most universal abandonment of swaths and stays. This unnatural practice will, doubtless, hereafter be looked upon as ' a tale of the olden time,' when fable usurped the place of truth ; for we are not certain, even at this moment, it will not obtain belief, that in Great Britain half a century ago, this custom was almost universal. Dr. Buchan informs us, that he was very instrumental in abolishing this cruel and absurd practice. His In- augural Dissertation 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 opinions 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 are ignorant of 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, so as to make them unaptly resemble billets of wood. By this means the skin was 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 was 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 was compressed in such a form as the fancy of the midwife might suggest; and its shape maintained, by properly adjusted pressure, by means of 96 TREATISE ON CHILDREN. bandages. In fact, the talents of the midwife were es- timated at this time by her dexterity in the application of swaths, rather than by her professional acquirements. When the child was completely dressed in its bandages, it but too nearly resembled the form of an Egyptian mummy; and, like its prototype, might, it is said, have been safely thrown any where, as the swathing would protect it from being injured by such rudeness. In a word, it had no resemblance to any thing living: its fre- quent but unavailing cries alone determined it to be human." Dr. Combe has also given us good testimony on this subject. " Whatever tends either to compress the body, or to restrain the arms and legs," he observes, " ought to be unrelentingly forbidden; and particularly every ap- proach to the former practice of swaddling in rollers like a mummy—a practice still prevalent in many parts of the continent, and the only advantage of which is, that the mother, when called out of the room or house for a time, can hang up her infant on a nail, like an inanimate bundle, with the positive certainty of finding it in the same position on her return, neither burned to death by the fire, nor with its face scratched, or its eyes put out by the cat or the pig, as sometimes happens when it is carelessly left sprawling on the floor, or even in its cradle." Buffon says, " With us (in France) an infant no soon- er leaves the womb of its mother, and has hardly en- joyed the liberty of moving and stretching its limbs, than it is clapped again into confinement. It is swathed, EVILS OF SWATHING^ 97 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 cloths 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 ex- cretions, voided at the mouth, may descend of them- selves ; for the helpless infant is not at liberty to turn its head to facilitate the discharge." Dr. Baynard, an able though quaint and sarcastic writer on water treatment, one hundred and fifty years ago, gives us, in his popular work, some idea of what the customs regarding swathing were in his times. Speaking of the birth of children, he remarks : " But now to tell you how many children have been destroyed by swathing and rolling is a black scene. Hence, most diseases of the chest and lungs, asthmas, short breathings, consumptions, and all the coughing tribe. I have opened, and seen opened, a great many men and women in my life, and I profess in near the half of what I saw, either one lobe or the other stuck, adhered, and grew to the ribs, that is, the pleu- ra ; and I principally attribute this misfortune to swathing and rolling, and my reasons are these : First, it has been observed, as far as I could learn by inquiry, that the Indians and several other nations, as the High- landers in Scotland, and the native Irish, are proper and straight, because never rolled. My next reason is, because infants, when so very tender and young, are iu<-i^ h~4-+„.. +u~^ a gqUaD duck or chicken, a mere cal- 9 98 TREATISE ON CHILDREN. \ lous or gluten, and may be writhed or wrung by the least mis-bandage into any inform figure or shape. Hence, crooked backs, buckle hams, baker knees, etc. Now, when this poor infant is tight rolled, and wrapped in flannel, nay flannel upon flannel, and laid to bed in harness, 'tis impossible that the chest can expand to its full stretch in inspiration, so consequently can't grow to its due extent; but the lungs are at liberty (for they can't be rolled), and so grow in bulk too fast for the chest in breadth; but the breast not extending equally with the growth of the lungs, the lungs grow too big for the hollow of the thorax, and by touching and adhering to the pleura there stick and grow. " Hence, 'tis that for the most part such children are pot-bellied, and have large heads, because the head and belly can't be so conveniently rolled as the ribs, etc. And such children, if they live, besides the in- firmity in breathing, are usually ventricious, and not so agile and nimble as other children, and are apt to slide into white swellings, leucophlegmatices, etc. " Observe a child when 'tis loose and unrolled, be- fore the nurse puts it to bed; how it plays with its little hands and legs, and is so pleased ; and how sour and forward when 'tis buckled up for a whole-night's pain and torment. " 'Tis a great shame that greater care is not taken in so weighty an affair, as in the birth and breeding of that noble creature man ; and considering this stupid and supine negligence, I have often wondered that there are so many men in the world. For, what by abor- tions, too oft caused by the unseasonable, too frequent, EVILS OF SWATHING. 99 and boisterous drunken addresses of the husband to the wife, when young with child, and her high feeding, spiced meats, soups, and sauces; what with strait lacings, dancings, and the like, one full half of the men begotten are destroyed in the shell, squabbed in the nest, murdered in embryo, and never see light; and half the other half overlain, starved, poisoned by ill food, and killed at nurse, etc." This plain, truth-telling old author in another place tells us that he had been sent for often, and sometimes knocked out of bed, to see children just dying in fits, as they called it; and he had sometimes seen the child black in the face, hands, and arms. " I straight caused it," he says, " to be stripped naked, and the child was well in an instant; and I always found (or very rarely otherwise) it was either tight swathing, chin stays, or other hard bandage, that was the only cause of the fright and fear ; and if the physicians, surgeons, and apothecaries should club their observations on this head, I doubt not that, besides what really die for it, two thirds of the people of this nation have been a hun- dred times half hanged before they were a year old." " How many poor infants," continues Dr. Baynard, " have I seen brought shackled to the font, half choked, to receive the first seal of its salvation, with a face as black as my hat, as if it blushed for original sin, and all through the superfine light dressings of Madam the midwife, or her principal maid of honor, Mrs. the nurse; nay, some have been so hard swathed, they have been forced to slacken the bandage even in the church." 100 TREATISE ON CHILDREN. In a volume of lectures by the great and good Boer- haave, published in London, 1757, he remarks : " I saw an apoplexy in a new-born infant, and suspected that the head was compressed by the midwife, or too tightly bound by the nurse. I ordered all the dress- ings to be taken off, whereupon the child surprisingly returned to itself, almost in less time than one can tell twenty." Fortunately we do not often nowadays see swathing practiced to any thing like the extent to which it for- merly was. Whether the change, in regard to the art of midwifery being put more into the hands of men in modern times, is the occasion of the improvement, I will not myself attempt to determine. Dr. Dewees is of the opinion that the absurd practice arose probably from the inroads made by rickets upon the proper form of the human limbs, mistaking the effect of disease for a defect of nature; and thus applying a partial remedy for the whole constitution. " In times of ig- norance," this author remarks, " 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 the midwife, for though every child was not born with a disposition to rickets, yet it is probable that these women persuaded their patients that the limbs of all children might become so, if not guarded against by proper management. This opinion seems in part confirmed, by the practice being in a degree abolished as soon as midwifery became generally practiced by men; for we never hear of an EVILS OF SWATHING. 101 accoiicheur performing this terrible ceremony for the child." Be this, however, as it may, a great change for the better has been wrought in modern times. Now and then, it is true, we learn of something like the old cus- tom being put into practice. One case I saw myself, some years since, in a little village (Camptown, New Jersey) not far from this city. At the time I noted down the particulars of the case. Another practi- tioner, a worthy and gentlemanly man, had delivered the patient, Mrs. Bonnell, in the morning. I myself saw her first at evening. The child had been crying much during the day, instead of sleeping, as it ought. New-born children sleep much of the time, if they are rightly managed in all respects. I told the good nurse we would try soon to ascertain what the matter was. She said she had fed it sweetened water and a variety of things, but all to no purpose; it would cry. "Well," I said, " let us look at the bandage." Such another old-fashioned rolling a child up, or, rather, binding it up, not hand and foot, but the whole body, i.e., the trunk, I never saw. The roller was of firm flannel, three or four thicknesses wound round, and from the armpits to the hips. It was with the greatest difficulty that the child could breathe; the folds and wrinkles of the flannel had made deep indentations in the flesh, and altogether the child was in a most pitiable condition. On removing the swathing the greatest relief was at once apparent. I had the surface washed until the wrinkles caused by the swathing had all disappeared. The little sufferer then fell at once into a most sound 102 TREATISE ON CHILDREN. and quiet sleep, and thus rested during the frhole night. The good nurse was frightened a good deal to see the bandage thus unceremoniously taken off; but I told her it was no use ; she had tried her way all day ; I should have mine now, and she should be convinced it was the best; that she, although old, was all wrong in these things, and that I was all right. So it proved in the end. The child got on finely, and the nurse was faithful to her task. From before the first of my practice in midwifery, I could not understand why a child should be swathed, any more than a goat or a lamb, or why the same gen- eral principles of physiological science should not in every respect apply the same to the young of the hu- man animal as the brute. Nor could I understand why the delicate stomach of every infant indiscrimi- nately should, at almost first breath, after looking forth upon the world, be dosed with molasses and wa- ter, castor-oil, or herb tea, not to mention the farrago of more powerful articles, that are on such occasions sometimes resorted to. I could understand how proud, ignorant, and super- stitious mothers and old women could get into those habits as well as those of tea and coffee-drinking, snuff- taking, etc., and how granny practitioners, of which- ever sex, with as little brains in their heads as heels, could come to aid in the perpetuation of such practices. The latter I could well enough understand, but not so the former. I therefore resolved to find out the right and wrong of these things for myself. Whether or not I have succeeded, I leave others to decide. SWATHING BAD. 103 From the foregoing facts and observations it will ap- pear evident, I think, that swathing and bandaging the new-born infant should be wholly dispensed with. At least this should be the rule. The notion that the bowels require a support, to prevent their protrusion, is evidently an erroneous one. In looking at the new- born infant, we readily perceive that respiration is carried on chiefly by the rising and falling of the ab- domen, and not nearly so much by the expansion of the chest as it is in after-life. Any thing, therefore, which tends to impede the free rising and falling of the belly, must not only injure the organs contained within it, but must also impede the natural dilatation of the chest, thereby hindering, to a great degree, respiration and circulation. Nor is this all of the mischief; by compressing the abdomen its contents are forced too much downward as well as upward, so that there is a great likelihood of producing the very evil we should seek to avoid. " I have repeatedly known rupture in the groin produced in this way," says Doctor Eberle. Thus, then, if we wish to prevent hernia—always an unfortunate occurrence—if we wish to allow a full and free expansion of the chest—the best possible condition of the circulating and digestive organs—if we wish, moreover, to allow the child the most quiet, comfort- able, and peaceable state of which it is susceptible, we must not put about it any bandages, swathings, stays, or other appliances which will in any way hinder the natural functions and movements of any part of the body; and I beg mothers everywhere to be assured that if they will but follow out this advice faithfully, 104 TREATISE ON CHILDREN. they will be more than rewarded in the trouble saved. Always the more free the infant's body is left from all compression, the more good sleep it enjoys, and the less perplexity will it be to those who have the care of it. From what has already been said, therefore, much will be inferred in reference to the principles which should guide us in adapting and arranging the infant's clothing generally. It will appear evident enough, I trust, that we should in particular avoid compressing the body in any of its parts. With the young, as with all, elothing should always admit of the freest possible motion of every limb and part. After the new-born child has been washed and dried, it is customary with some merely to wrap it up in soft flannel, shawls, or other material, and allow it to sleep; this is, in fact, the better method, for after the exercise and worriment of washing, the sooner it is allowed to repose the bet- ter ; and if it is properly treated in every respect, it will be found very soon to pass into a quiet slumber. CHAPTER XI. Of the Action of the Child's Bowels soon after Birth—The Meco- nium—An Erroneous Practice concerning it—Nature in general competent to do her own Work—Of Artificial Aid—Medicines injurious—Water* the best Remedy for Torpid Bowels. After the birth of the child, there is found to be an accumulation of a dark greenish excrementitious sub- stance in the bowels, occupying principally or wholly the colon and rectum, and which, from its supposed resemblance to the syrup of poppies, is called meconi- um. It varies in quantity, contains more or less of bile, is of different shades of color and degrees of ten- acity, and, if permitted to remain undisturbed in the bowels, is supposed to be productive often of much mischief, especially in torrid climates. It may, under such circumstances, give rise to intestinal irritation, exhausting and painful diarrhea, colic, inflammation of the intestines, jaundice, convulsions, erysipelas, etc.; at all events, such is the opinion of medical men j but I myself am humbly of the opinion that this long train of evils has been owing more to the effects of inordi- nate drugging, in such cases, than to the presence of the meconium in the lower bowel. It is natural, however, that this substance should be discharged soon after birth ; and we have reason to believe that if in anv case it should be allowed to re- 106 TREATISE ON CHILDREN. main long in the system, that sundry evils would ne- cessarily follow. But we should always be very cau- tious in all our efforts to aid nature by artificial measures, or we shall do her more harm than good; and thus make matters worse than they otherwise would have been. In regard to the meconium there has been every- where great error in practice, I am well convinced; and physicians themselves—the " keepers of the public health"—have been as much in fault as the people at large, and I am inclined to think more so; for in the beginning it was through the advice of the medical at- tendant that the people learned the bad habit of drug- ging the new-born infant. Indeed, who but a doctor could have thought of such a thing ? A common ob- server, looking abroad upon creation for his instruction, would have supposed nature herself, in these cases, to be able to do her own work. But it is the doctor's business to meddle ; and meddlesomeness has done vastly more harm in the management of children than the opposite extreme. Even Dr. Dewees, who was a most honest, skillful, and in many respects, a correct practitioner, while he deprecates excessive meddlesomeness, on the part of the medical attendant, and speaks particularly of "adapting the means to the end," recommends for general use " 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." Now mark, that the meconium is in the lower part THE MECONIUM. 107 of the bowels, the colon and rectum. How much bet- ter, quicker, and more effectual in its operation then, must a clyster be, in exciting the expulsion of this ex- crementitious substance, than those irritating substances mentioned, which, taken into the stomach, must pass some twenty or thirty feet down the alimentery canal, doing mischief all the way to the delicate tissues, be- fore they can effect the object required ? Besides all this, they often fail of the object, become absorbed or digested in the system, and cause constipa- tion, the very evil they were intended to remedy! But the best of all is, that, in ninety-nine cases out of every hundred, if every thing is well managed, nature is competent to her own task. I speak from ex- perience on this point, and know positively of what I affirm. Experience is the best of all teachers, and it is from this source that I have learned. I had from the first imbibed the notion that there was a great deal of er- ror abroad on this subject. I set out, therefore, to learn for myself. From the first of my practice, which was nearly ten years ago, I have never allowed any cathar- tic or aperient substance to be given the child to re- move the meconium. Occasionally, perhaps, some ig- norant old woman has got the start of me ; that is, has disobeyed my injunctions. But in almost every case of childbirth which I have attended, nature has been allowed to do her own work. Nor has she failed us, as a general thing. I cannot but think that medical men have been in error in stating that the first milk of the mother—the 108 TREATISE ON CHILDREN. colostrum, as it is called—is the natural purge for the infant's bowels. According to my own observation, the bowels act freely, in most cases, long before the child receives any thing from the maternal breast, and not unfrequently very soon after it is washed, sometimes indeed before that process has been fully completed. I suppose, moreover, that the molasses and water, magnesia etc., which are given the new-born child so commonly, do, in reality, prevent the bowels from acting so soon as would be the case, if these articles were not given. If we set up an irritation in the upper portion of the alimentary canal, it would certainly divert the forces in that direction, and thus hinder the speedy action of the lower part of the intestines, where the excrementitious matter that is to be discharged is lodged. View it in whatever light we may, it is far better not to resort to the use of any of the articles mentioned. But cases do occur in which it is necessary to aid nature. From unhealthiness of the mother, from im- proper habits, or other causes, the child's bowels may, even from the first, be constipated or tardy in their ac- tion. Here it is, then, that art must come in to assist nature in the work which she is not able of herself to perform. If, then, the child's bowels do not act within twenty- four or forty-eight hours, and especially if it seem, in any way, to suffer, we should at once resort to the injection of tepid soft water. I say soft, if it is pos- sible to get it, but if not, use hard water rather than drugs. But spare no pains to get the soft. Have a THE MECONIUM. 109 small syringe that is in good order, put a little oil upon it, or, what is generally sufficient, merely wet it, having first also wetted the part to which it is to be applied. Use no undue force, but introduce water enough to effect the object, that is, to make the bowels act at once. Properly administered, the application can do no possible harm. It is indeed nature's own remedy, the most salutary that can be used. Sometimes an extra bath or two, the water being tolerably cold, will very soon cause the bowels to act in these cases. Washing and rubbing the abdomen with the hand wet in cold water, will also aid the operation. In all such cases, the wet girdle should be kept con- stantly applied. It will aid in strengthening the bow- els, which are in all such cases more or less weak. Dr. Eberle has recommended immersing the legs and lower part of the body in warm water, and putting, at the same time, a cloth wet with cold water upon the head; and he informs us that he has seen much benefit arise from this course. I should myself, however, ra- ther depend upon the remedies I have already recom- mended. If the bowels should continue tardy in their action, the wet girdle should be kept constantly applied until complete relief ensues. The treatment proper in this case will be found under the head of Constipation. 10 CHAPTER XII. Food of the young Infant—Errors in regard to it—Rules for Nurs- ing—Feeding by Hand—Milk and its Properties—Sugar not Healthful for the young Child—Substitutes for Milk—Nursing Bottles and their use. In no one particular, probably, is there so great and universal error in the management of children as in nursing and feeding them. " There is, probably, no single source of disease during the first few years of life, the influence of which is so destructive," observes Dr. Eberle, " as improper management in relation to the diet. The foundation of irremediable chronic dis- eases, and of constitutional infirmity, throughout the subsequent period of life, is often laid within the first month, or even first few days after birth, by errors of this kind; and a great amount of the suffering and mortality which occurs during infancy must be ascribed to the same prevailing source of injury and disorder." Everywhere we find the crudest and most unrea- sonable notions prevailing concerning the early man- agement of the child as regards food. No sooner has the infant been subjected to the processes of washing and dressing, neither of which have been properly per- formed, than the nurse is ready with her molasses and water, gruel, or pulverized crackers and water, or some like preparation, to fill its stomach to the utmost ca- THE INFANT'S FOOD. Ill pacity ; and this stuffing—for it deserves no more dig- nified title—is kept up with a diligence such as would make it seem that the very life of the child was sup posed to depend upon it. Now, by such a process, who does not understand that the foundation of severe, and perhaps irremediable injury, is laid within the first twenty-four hours of life ? Nature herself points out most plainly the impropri- ety of such a practice. She withholds the nourishment she is afterward to provide, for many hours after birth. If it were necessary for the child to have nourishment very soon after birth, nature would certainly have pro- vided it, in the majority of cases at least. It may be true, and doubtless is in some instances, that the se- cretion of milk is delayed longer than it would be pru- dent to keep the child without nutriment; but such is not the fact in a majority of cases; it is only an ex- ception to the rule when such is the fact. It cannot for a moment be presumed that after birth the digestive organs at once assume a degree of vigor which demands an immediate supply of food. If such were true, then there would be a natural supply for such a demand. The general rule is, that from one to three days elapses after delivery before the flow of milk com- mences. If the secretion should be tardy, it is, per- haps, better to give something as a substitute; but Tissot was in error when he recommended that a long interval—even more than twenty-four hours—should elapse before the child is permitted to suck, and that ip the mean time its appetite should be satisfied with 112 TREATISE ON CHILDREN. gruel, panada, etc. If this plan is followed, the con- sequences cannot but be prejudicial to the health of both mother and child. In order to establish the se- cretion of milk, it is necessary that the child should suck at the breast even before any milk can be ob- tained, for by such a course the lactiferous function is excited to action sooner than it would otherwise be; and without thus putting the child early to the 'breast this part is liable to become tense, painful, and in- flamed, and the natural flow of milk is delayed or en- tirely suppressed; while at the same time the health of the infant suffers from its being fed on other, and often pernicious food. Rules for Nursing soon after the Child's Birth.— After passing through the fatigue of labor, the mother should always be made as comfortable as her situation will admit of; and then some hours of repose should be allowed before any duty is undertaken by her. Generally within six or eight, or at most, ten or twelve hours, the child will be found to manifest a strong de- sire for the breast, especially if its stomach has not been previously nauseated with food or medicine, nei- ther of which should, under any circumstances, be given it for the first twelve hours at least. In ten or twelve hours, then, let the child, according to its nat- ural desire, be put to the breast; and even if it does not at first succeed in getting any nourishment, it will yet have an exercise which will of itself afford it grati- fication, and will besides, as before remarked, aid in exciting the secretion of milk. At first the lacteal secretion is small in quantity, * FEEDING THE CHILD. 113 and resembles whitish serum or whey more than milk. Gradually it becomes more rich and nutritious, and more copious in quantity, in which circumstances we see the beautiful arrangement of nature in adapting her means to her ends, for as the child grows older it needs more and richer nutriment. Feeding a Child by Hand, and the Substances to be Used.—But in some cases, either from the impaired health of the mother, from some natural defect, or other cause, it becomes necessary to feed a child by hand, as it is called. In such cases the selection of the article is a matter of great importance, great not only to the child, but in reference to the comfort of those who are to have the care of it. It is customary in this country to feed a child that is thus brought up by hand, milk and water sweetened, sometimes with rolled cracker, fine bread, boiled flour, wheat or rice in it. Children are sometimes so tena- cious of life, that it seems they would live whatever imprudences they may be subjected to. Hence, it is that some children apparently do well fed on the arti- cles referred to, and perhaps on articles still less friend- ly to infant life. But such is not the rule of cases; infants, in general, are very easily made sick and de- stroyed by imprudence in diet, and particularly those that are brought up by hand. We will suppose it absolutely necessary to feed a child by hand. If it is for a day or two only, as in those cases where the appearance of the milk is tardy, or for a longer period, what can we introduce as the best substitute for the natural food ? 114 TREATISE ON CHILDREN. Iii the old country, goat's milk is much used, and by many, is recommended as the best substitute that can be obtained for the mother's milk. In this coun- try we can seldom obtain it, and I, having never seen it used, cannot speak from experience of its effects. I will here introduce a table from an excellent and learned author, Pereira (see his work on Food and Diet), showing the composition of several kinds of milk, and which is calculated to throw some light on the im- portant subject before us. Milk of the Constituents. Cow. Ass. Woman. Goat. Ewe. Casein .... 4-48 1-82 1-52 4-02 4-50 Butter . . . . 3-13 0-11 3-55 3-32 4-20 Sugar of'milk . . 4-77 6-08 6-50 5-28 5-00 Various salts . . . 0-60 0-34 0-45 0-58 0-68 Water .... 87-02 91-65 87-98 86-80 85-62 Total . . . . 100-00 100-00 100-00 100-00 100.00 Solid substances 12-98 8-00 13-00 13-20 14-38 It is important also to observe, that milk varies con- siderably in its constituent parts according to the food of the animal. This will appear from the subjoined table, showing the composition of cow's milk, the ani- mal being fed in the one case on carrots—principally we suppose—and in the other upon beets. COMPOSITIC N OF COW'S MILK. Kind of Food. Carrots. Beets. Casein. 4-20 3-75 Butter . 3-08 2-75 Sugar of milk 5-30 5-95 Salts . 0-75 0-68 Water 86-67 . 86-87 Total . 100-00 . 100-00 Solid Substance . 13-33 13-13 COW'S MILK. 115 There are other circumstances, also, which go to vary the character of milk. One animal gives a richer article than another, although, perhaps, less in quanti- ty. Milk varies also, in proportion to the length of time that has elapsed since lactation commenced. One thing more should be said in regard to the use of cow's milk. It is of the first importance that the milk be obtained from a healthy animal. A young one is supposed to be preferable. She should have an abundance of good and healthful food and water, and should not be shut up where she cannot have free access to light and open air. It would be better, particularly during the long days of summer, that she be milked three times, instead of twice a day, as is the usual custom. The milk, in such case, would be less fe- verish and less liable to cause colic of the child than if milked but twice a day. It is better always to have it from one cow and the same one; but if it cannot be done, the best milk that can be had of a mixed kind should be used. To return now to our tables : I do not see why goat's milk should be preferred to that of the cow, for it is more rich—that is, it contains more butter and more sugar of milk than the latter, according to the first table given. Cow's milk appears on the whole to be nearer in chemical composition to that of human milk, than any of the other kinds referred to. I cannot see any sense of propriety in recommending mare's or ass's milk for a child, as some physicians have done. WTho would think of eating the flesh of these animals ? If no one, then why should the milk 116 TREATISE ON CHILDREN. be advised ? This matter, however, is hardly worthy of notice, since few could be found who would be so foolish as to follow the advice. Cow's milk, then, is probably the best substitute we can have in place of human milk; and fortunately it is by far the most easily obtained. It is, indeed, in most cases, the only substitute that can be obtained in the form of milk. It is generally understood among mothers and nurses, that human milk contains a larger proportion of sugar of milk than that of the cow. I suppose it is from this fact that it is almost the universal custom to sweeten cow's milk before it is given to the child. But it should be remembered that sugar of milk and common sugar are articles quite different in their nature, and besides, that either article introduced artificially must have an effect totally different from that which is found in the natural state. It is important, also, to under- stand that sugar, artificially separated as we find it in commerce, is one of the most difficult articles of diges- tion that can be introduced into the stomach, whether of the infant or the adult. Years ago I was in the habit of directing mothers to put a very small piece of white sugar—say as large as one or two marrowfat peas, but not more—into a tum- bler of milk which had been reduced one third to one fourth with pure soft water, and with this to feed the child. Later, however, I have been in the habit of ad- vising no sugar, and find that good cow's milk, reduced from one third to one fourth with water, is abundantly rich for an infant. And it is my opinion, that it is al- COW'S MILK. 117 together better not to use sugar at all under these cir- cumstances, and for the reasons which I have given. It should be borne in mind in this connection, that the milk of different cows varies a good deal in richness, so that while the milk of one animal might need reducing one third to one fourth, that of another would need no addition whatever. The season of the year, as also other circumstances, may make a good deal of differ- ence in regard to the richness of the milk. Thus, for example, when the animal eats grass in the summer which is much more watery in its nature, the milk would not be so rich as at other seasons of the year, when the food is of a more dry and nutritious character. Those who live in the cities cannot, as a general thing, obtain milk that is free from admixture with water— so much are human beings in the habit of cheating their fellows. If they do not actually put into their milk- can a certain amount of water, they yet rinse out their milk-pails with a pretty liberal portion of it, and pour the whole into the can. Hence it will seldom be found necessary to reduce the milk in a city, and perhaps taking it as the milk-man brings it, will be the best general rule. If, under any circumstances, it should be necessary to employ an artificial substitute for cow's milk, some farinaceous article, in the form of a sort of pap, would doubtless be the best that could be fixed upon. As to what farinaceous article is best, it is not easy to de- termine. We may use arrow-root, although, I think, something else would be better in most cases, inasmuch as this article can seldom be obtained in a fresh state in 118 TREATISE ON CHILDREN. our latitude. Some have used a panada of superfine bread; but I should think more favorably of rice flour boiled in water. White Indian meal I should regard as a still better substitute for milk than either of the other articles mentioned. Let it be boiled well in pure soft water, in the form of gruel; then strain it through a linen cloth, and feed the child with that which passes through the fabric, rejecting the remain- der, as being too coarse for the delicate stomach of the infant. Most children, I think, if they could live in pure country air, and be well managed in every respect, could be reared on Indian meal and water alone, although cow's milk is doubtless a preferable article. I have remarked, that at the commencement of lac- tation the mother's milk is more watery; in other words, less rich at first than some days after. If, therefore, we are to feed a child—as I think we should do, if the mother's milk does not make its appearance within twenty-four hours from birth—we should put more water into the cow's or goat's milk, whichever may be used, than we would some days later. In this we imitate nature, which, although we cannot do it perfectly, we have a right to attempt. But some practitioners are in the habit of not allow- ing the child any nutriment whatever until its own natural aliment makes its appearance. I have never yet known a child to be injured by thus having to com- mence its life with a prolonged fast; but I apprehend that such advice is seldom followed, even when it is strongly insisted on by the doctor. Old women are NURSING BOTTLES. 119 not always the most obedient creatures in the world, and as for Mrs. Nurse, it would surely be very inhu- man in her to let her little subject famish for the want of a little sugar and water or milk. Even if the doc- tor did request her not to feed the baby, it would yet be better to do it, and prevaricate, rather than let him suffer. I have with my own hands taken some milk and wa- ter and fed a child, twenty-four hours old, when the mother's milk did not come, and, as I believe, with none other than good effects. I have been in circum- stances where I could watch the matter closely, and I improved the opportunity. I have taken a small spoon, and, with milk and water, about half and half, I have fed the child, and found that it took the food with a decided relish. I have not been able to trace any evil effects from thus feeding the child; and having often advised others to the same course, I am led to believe that it is better to feed the child after it is twenty-four hours old, and the mother's milk has not come. But I would be careful not to overload its delicate stomach, or feed it too often, as many do; and if I should feed it with sweetened water, I should expect, the next time of seeing it, to hear of its having the colic, and of its crying a great deal, and perhaps of its keeping the household awake all the night. JYursing Bottles and other Artificial Means.—If a child is to be raised by hand, it is a matter of import- ance to know how we are to give it its requisite nour- ishment. Various plans have been adopted to this end. There are nursing bottles, artificial teats, and a 120 TREATISE ON CHILDREN. -*, variety of means by which the milk is to be given to the child. One of the best plans I know ofy is to have a number of small, say half-pint bottles, with conve- nient necks of same length, and to have in its mouth a sort of plug, or teat, of sponge. When the bottle is tipped up somewhat and put to the child's mouth, it readily sucks the milk through the sponge, which, if it is put into it pretty firmly, will not allow of the milk coming out too fast. This, by the way, is important; we should never allow a child to take its nourishment too rapidly. It is better to take it away pretty often, even if it should cry, than to let it suck too fast. If it is allowed to get its milk as fast as it can swallow, it will very soon have indigestion, if not a worse com- plaint, and will be very apt to make plenty of trouble with its crying. If there can be no better way con- trived, the child may be fed always from a small spoon, a few drops at a time; and by patience this course may be made a good one. But I think the use of the sponge is one of the best possible modes. Too f much pains cannot be taken in regard to the cleanliness, not only of the food, but all of the arti- cles, the bottles, sponges, spoons, etc., which are brought into requisition in feeding the child. The sponges, if these are used, should often be boiled out and cleansed in the most thorough manner. The bot- tles, too, should be kept most scrupulously clean; for without this the milk will often become rancid, in which case it will with the utmost certainty disagree with the child; so that the least troublesome as well as most honest and humane course is to do every thing as it NURSING BOTTLES. 121 should be done, that is, to keep every thing strictly clean. In regard to the use of the bottle, the following rules, in order to insure strict cleanliness, should be observed: 1. Never put a second supply of milk with that which has been used, unless the interval be a short one, and the article positively good and fresh in both cases. 2. As soon as the child has taken the necessary amount of nourishment, let the bottle be well and thoroughly cleansed by means of hot water, with the addition of a little pearlash, saleratus, or soda, in or- der to remove the oily portion of the milk. 3. When well cleansed in this manner, let it remain in cold water, in which also it would be well to have a little of one of the alkalies referred to, and let it re- main there until about the time it is again needed for use. 4. Before using it, let it again be cleansed with hot water, and afterward with cold. 5. If the sponge teat is used, let the same rules be followed in regard to cleansing it that we observe in reference to the bottle. 6. The sponge should always be removed from the bottle as soon as it is taken away from the child. I do not know, but I suppose the manufacturers of India-rubber have before this time invented something in their line which will prove an excellent article for artificial nursing. If they have not, they soon will, for there is no end to man's ingenuity in these things. Some of the sucking bottles in use are furnished 11 122 TREATISE ON CHILDREN. with a glass or other tube, and which some have pre- ferred to any other contrivance. Dr. Dewees was in the habit of recommending the bottle supplied with a preserved heifer's teat, as the most convenient and useful apparatus. The teat should be one that has been preserved in the best pos- sible manner by those who understand the art. It should not be of too large size, nor one that will per- mit a too rapid flow of the food, especially for a very young child; and if it is found to pass too freely, the piece of sponge which is, or always should be, within it, at its extremity, should be either enlarged or more strongly compressed into the cavity. Immediately after the bottle has been used, the teat should be re- moved from its mouth, and both it and the sponge should be well washed, and the former kept in whiskey or spirits and water till it is again to be used. Dr. Dewees preferred the flat, oblong bottle with a teat to the bottle and tube, for the following reasons : 1. The extremity of the tube is never so well received by the child, as the teat; nor is it so comfortable to its mouth. 2. The tube frequently becomes obstructed by the curd of the milk; and it is oftentimes difficult to re- move it; and if not removed, its objects will be defeated. 3. It is much less convenient; requiring much more address in the management of it, than the bottle. 4. It is much more difficult to keep clean or sweet; consequently, must be improper in proportion to that difficulty. wF ARTIFICIAL NURSING. 123 5. Besides, the flat-bottle and teat need no reheating of the food during the night, as it can be taken into the bed and kept sufficiently warm by the heat of the body; whereas the tube and bottle require that the food must be warmed by the fire, which is found to be extremely troublesome, or the child must receive its nourishment cold. Dr. Eberle remarks concerning the use of the heifer's teat, "that an article of this kind properly prepared is not always to be procured; nor does it appear to be preferable to a few folds of fine, soft linen, drawn over the mouthpiece of a nursing bottle, with a small orifice in them corresponding with the opening of the tube. The teat is often too bulky for the child's mouth, and it is very apt to become hard and unyielding, unless removed and immersed in water after each nursing, in which case it is, on the other hand, liable to become too flaccid and relaxed. Two or three folds of soft linen are readily applied, and may be taken off and washed or substituted by a fresh, clean piece, without any inconvenience." In the place of a better contrivance, a common goose-quill might be inserted into a cork fitted to a common bottle; and with the folds of linen over the quill, the child would be able to nurse very well. A number of corks and quills might be kept on hand, so that they could, at each time of feeding, be made clean. I am inclined to believe that a teat made of India- rubber will be found preferable to any other, unless it be the simple sponge. It cannot, however, make any 124 TREATISE ON CHILDREN. great difference what is used, provided the strict rules of cleanliness are properly observed, and the child is not fed in too rapid a manner. The cow's teat can- not be obtained, generally, in the country, for it is only in the cities that such articles are prepared and kept. The India-rubber article would be more durable, and the sponge can be obtained in any country store or drugshop. The ingenious mother or nurse can get along with almost any thing, and if necessary, with a silver spoon only. Tact and genius are worth more than all the contrivances of art, and it is the charac- teristic of a good workman, that he works well with such tools as he may be able to find. Nursing with but one Breast.—It sometimes happens that one of the breasts is incapable of performing its natural function; it may be destroyed by abscess, or breaking, as it is called; or from some previous cause, one of the breasts may be found useless, while, at the same time, the other one takes upon itself the double duty of furnishing a sufficiency of milk for the child. In such a case it is necessary for the mother to exer- cise great caution, or the child may be injured from always lying on one side. It is apt to contract squint- ing or cross eyes, in consequence of having its eyes al- ways directed in one way while nursing. I am confident I have known cases, also, in which the nose has been considerably turned to one side in this way. How unfortunate it is for a child to get its nose bent over in this way, all for the want of a little care on the part of the mother. There is likewise some danger of the shoulders acquiring an oblique or crooked form, if the NURSING WITH BUT ONE BREAST. infant is carelessly held while it is obliged to nurse principally or wholly at one breast. Some mothers, and more particularly hired nurses, are apt to suckle principally with one breast only,' when, at the same time, both breasts furnish a full supply. This should, on no account, be allowed, and for the important reasons just given. In nursing the child, as well as in holding and carrying it, the position should be frequently changed. Its bones are very soft and pliable, it should be remembered, and without pro- per care in all these little matters it may be irremedi- ably injured, and that for life. CHAPTER XIII. Of Wet Nurses—Wrong Advice of Physicians—Mothers should, if possible, nurse their own Children—Cases in which she cannot do it—Of partial Nursing—Rules for selecting a Wet Nurse in Cases where it is necessary—It is better, in general, to feed a Child by Hand than to employ a hireling Nurse. It has become, of late years, quite common in our cit- ies among the fashionable circles, for the doctor to ad- vise the mother not to nurse her child. " Why, mad- am, you are too weak," the fashionable pill-monger sagely observes. " It will injure your constitution; and you cannot raise your child ; you must have a wet nurse." All this is very easy for the man of black cloth and little brains to say. And there is one or two important reasons for this advice. The fashiona- ble mother thinks it is very ungenteel to nurse a baby ; it does not belong to a lady to do that. Besides, she wants to go to the theater, to parties, and other fash- ionable scrapes, and to fiirt and coquette a little withal; and to be perplexed with the care of nursing a baby, she will not consent to that. Now the learned doctor, who knows well where his bread and butter comes from, wishes of course to give just such advice as he knows his interesting patient will follow. He knows, too, that if she weans her child at once, she is more apt to become pregnant soon again, so that he WET NURSES. 127 will be more likely to get another job at midwifery, which pays well. What are we to think of the mother, who thus vol- untarily permits her child to nurse at another breast ? How are we to regard the morals of such a mother— one who willingly allows another person to gain the af- fections of her child, for it always becomes more at- tached to the one who nurses it than to its own pa- rent? Besides, too, the character of the one who suckles the child is, to a great degree, stamped upon it, and that indelibly, too. Is a mother, then, willing that the child shall take on the character of another, and of one whose disposition and mental peculiarities she probably knows nothing ? For one, I cannot envy the man who has a wife that can willingly resign her child to another to nurse. The consequences of this'practice are evil in various respects. First, there is the great injustice, in most cases, of robbing another child of its rightful food, for the wet nurse is generally a hireling, who is compelled, in consequence of poverty, to put out her own child " to board," as it is called, and for which, in this city, she must pay generally about two dollars per week- For nursing the child of another she gets three, and possibly in some cases, four dollars a week. For this paltry sum, then, the life of one child is endangered and often destroyed, and the other often injured. It is unreasonable to suppose that a hireling nurse can feel that love and affection for a child that a mother Bhould. And what are we to think of a hireling who takes care of the child that is put out to board ? Are 128 TREATISE ON CHILDREN. we to suppose that she will, or can, feel that interest in the tender infant which any one who has the care of it should feel ? There is yet another evil arising from this practice, which, however, is not of so great consequence as those I have already referred to. The health of the unnat- ural mother, who will not nurse her child, suffers from her not fulfilling the order of nature in giving suck. Her system must inevitably get harm from not allow- ing it to go through the period of lactation naturally. Her life of dissipation, too, is poorly calculated to con- tribute to health, compared with staying at home and fulfilling the order of nature, as God designed she should do. But she gets her reward even here. There is no period of woman's life in which she has so great enjoyment, such perfect physical health, as when she is nursing the offspring of her own blood. Her shattered nerves and broken health are poor pay for the so-called enjoyments of a dissipated life. But it will be said, there are cases in which it is impossible for a mother to fulfill the office of nursing her own child. She may be physically unable, that is, she may not have any milk to give it, her health may be so feeble, and her constitution so much depraved, that it would not be admissible to do so; the mother, too, may lose her life, and thus the child be left to another. In regard to those who are physically unable to nurse, there have been mothers who have brought up their children by hand rather than let them draw their nourishment from any other breast. Suoh mothers FEEDING THE CHILD BY HAND. 129 are satisfied with nothing short of feeding their own child, and so great is the determination of their will, that nothing, it would seem, but death itself is strong enough to prevent them from fulfilling their duty to their offspring. There are cases, too, in which it would doubtless be better for the child to be brought up by hand, than to be kept on the sickly milk of a diseased system. In such cases, the choice then lays between a wet nurse and feeding by hand. And for my own part, it would have to be a very healthy woman, of good disposition and character, and of most affectionate deportment, and who has lost her own child, who should be allowed to nurse a child of my own. Unless she possessed most rare qualifications in every respect, I would a hundred times rather trust its life to feeding by hand. But what shall be done in those cases, when the mother dies at or soon after the infant's birth ? This is a sad thing to think of. Physicians are sometimes thought to be hard-hearted ; but if seeing human life in its saddest aspects has any effect to soften the feel- ings, they ought naturally to be most keenly alive to every sympathizing emotion; and they, doubtless, gen- erally are. In such a case as I am supposing, it ap- pears to me to be the duty of the husband to get his child nursed if he can by some near relation; and if not, to obtain such a friend to bring it up by hand. He should spare no pains or expense in endeavoring to get a mother, or sister, or some near and dear friend, to perform the great and important task of rearing his child. If he should ever think it costs him too much 130 TREATISE ON CHILDREN. money or trouble to have his offspring taken care of properly, let him think of what his own parents did, and especially the mother that bore him. How many nights of pain and anguish did she suffer for him, and in bringing him forth, what agony did she endure? Can it then be too much for him to spend his time with- out pain or agony for his own child ? For humani- ty's sake, I should hope not. Partial Nursing.—It sometimes happens that the mother has only a partial supply of milk ; that is, not enough for the child's entire support. In such cases, it is the opinion of some that it is better either to wean the child entirely, or to obtain a wet nurse. It is natural for the mother to have a full and abun- dant supply of milk for her offspring; such is always the order of nature, or in other words the rule. But nature, like every thing else, has exceptions to the or- dinary course of things. But a scanty supply of milk is not of itself a sufficient reason why the child should be weaned. If a mother is very sickly; if she is, for example, in the last stages of consumption, it would be wrong for her to sow the seeds of her disease through her milk; besides, too, there may be cases in which nursing would prove posi- tively detrimental to the mother's health. In such cases, of course, prudence would dictate that some other means than the breast of its own mother, should be employed in rearing it. But in most cases, it is better for both parent and child that the infant be nursed by its own mother. As I have remarked elsewhere, the period of lactation is PARTIAL NURSING. 131 naturally one in which a woman experiences her high- est degree of bodily enjoyment and health. If every thing is well managed, her head feels remarkably clear, her spirits buoyant, and all animal sensations are of a pleasant and healthful kind. Hence it is that physicians should be far more careful in advising women to wean their children, than is often the case. In many in- stances of debility, nursing is the thing of all others which the mother most needs. I regard it better, then, in almost every conceivable case, that the mother nurse her own child, even though she may be able to do it only in a partial manner. It is, besides, an old saying, " that a half a loaf is better than none." The child that gets a portion only of the food that nature designed for it, and has at the same time a proper quantity of cow's milk, and at proper in- tervals, is much more likely to do well than the child that must be altogether raised by hand. There is one objection which has often been raised against this plan of half feeding, which is, that the child will refuse to take any thing other than the moth- er's milk, even though there be not half enough for its support. But this objection is altogether a fallacious one; a child will never famish for the want of food if it can have enough of good cow's milk. True, it may show temper for a while at first, and refuse to be fed by hand, when it would be well for it to have food; but it will never harm itself by a protracted fast of this kind. As to its crying, it is a small matter; and the parent should resolutely refuse to comply with its wish- es in any other respect in those cases, than to give it 132 TREATISE ON CHILDREN. the cow's milk at a proper time when it may be willing to take it. In cases of partial nursing, the same general rules should be followed in regard to the frequency of giving nourishment as in other cases. If there should be any difference made, it should be on the side of caution in regard to frequency. With only a part of mother's milk and the rest artificial food, the infant is somewhat more liable to indigestic colic, and other internal troubles, so that in this case, greater, rather than less caution, is required. Choice of a Wet Nurse.—Notwithstanding the fact that in hiring a wet nurse, there is often liability for the child to contract diseases ; that hired nurses can- not be expected to take that interest in a child which is not her own, that should be exercised toward it, and notwithstanding the many other objections to the prac- tice of putting the child away to another, there are yet numbers—and among them people of good intentions— who will persist in doing what seems so contrary to nature, as for a mother to allow another to nurse her child. To such persons, then, a few thoughts on the proper selection of a nurse may not be inappropriate, although I wish it from the beginning to be most dis- tinctly understood, that I regard being obliged to pro, cure a wet-nurse, as always a sad evil, and one that cannot but be viewed as such by every humane and sen- sible mother. In selecting a wet nurse, then, the following rules should be observed; CHOICE OF WET NURSE. 133 1. She should be a person well known for faithful- ness and honesty in her dealings with mankind. 2. She should have no child of her own to take care of, since it would be quite too much to expect of human nature, that a nurse would attend as faithfully to the child of another as her own. The foster-child is al- ways more or less neglected when the nurse has an in- fant of her own to attend to. If there should be a deficiency of milk for both children, the promptings of maternal feeling would be certain to lead her to favor her own child; and if the latter should become sick, the foster-babe would be certain of not receiving proper attention. 3. The child should be kept, if possible, at its own parents' house, in order that its wants may be better looked after than would be if it were taken away. 4. The nurse selected should be as healthy as possi- ble. If there is any scrofula in her family, or any other known taint, it would be far better to undertake the rearing of the child by hand. If the woman has led a debauched life, although she may have reformed, she cannot yet be regarded as a safe person to nourish a child. Females of this description are apt to have their systems contaminated with morbid taint, which would be certain of rendering the milk more or less unwholesome, and would, moreover, be very liable to transmit the same taint to the child. The existence of scabby and scaly eruptions on the skin should al- ways be considered as a serious objection to a nurse. 5. A most important rule is, that the nurse was de- livered at about the same time of the birth of the child 12 134 TREATISE ON CHILDREN. that is to be nursed. The milk of a mother is at first less nutritious than afterward, when the child needs a more substantial diet. Hence if a wet nurse has been delivered a number of months, her milk would be cer- tain of disagreeing with a new-born child, on account of its too great richness. As a general rule, therefore, the age of the milk should aot vary much from that of the child. If there should be any difference, it would be better for the child to be older than the milk, for it is safe for a child some months old, five or six, for exam- ple, to be nursed by a woman with a fresh breast of milk, while, on the other hand, it is not safe for a new- born child to be nursed by one who has been delivered a number of months previously. 6. The occurrence of the menstrual function should form an objection to a wet nurse. In general the menses do not appear during the normal period of lac- tation. If a child, three or four months old, is put to the breast of one who has commenced menstruating, it is said that it rarely fails of experiencing derangement of the stomach and bowels. It will therefore be a safe rule never to employ a nurse with whom menstruation has commenced. 7. A nurse who has but one good breast should not be selected, from the facts that a child held constantly on one side is apt to contract squinting, to have the nose bent to one side, from its pressing always on one breast, and that other deformity is apt to follow such a practice. 8. A very important rule is, that the nurse be of good dietetic habits. If she will persist in eating CHOICE OF WET NURSE. 135 gross food, as most nurses do, and in drinking tea and coffee, no sane parent ought to be guilty of employing such a one. It would be better a hundred-fold to feed the child on good cow's milk, than to have it suckled by a dirty, pork-eating, tea-and-coffee-drinking, and snuffing nurse. And let it be forever remembered, that wet nurses, whatever may be their professions, are almost universally addicted to some bad habit or other, which must of necessity injure a child. 9. The most important rule of all, if possible, is that which relates to the temper and moral habits of the nurse. A woman who is passionate, irritable, peevish, and sour-tempered, should on no account be allowed to nurse a child. It is bad enough for such a mother to nurse her own; if so, what are we to think of letting her nurse the child of another, and in which she could be but little interested ? Not" only is the child at all times liable to be mistreated by a nurse of this character during her fits of ill-nature and passion, but the most serious and alarming effects may be pro- duced on its delicate and susceptible organization by the milk of such a nurse. Nothing in regard to health is better established than that violent anger and habit- ual sourness of temper are peculiarly apt to give a per- nicious quality to the milk. Children have been thrown into violent convulsions by suckling soon after the nurse was agitated by violent anger, and alarming vomiting and purging are apt to follow such an occurrence. So, too, all strong mental emotions are unfavorable to the healthful quality of the milk. In conclusion, I wish to repeat, that I consider it, as 136 TREATISE ON CHILDREN. a general thing, and to which rule but few exceptions can occur, better to attempt the bringing up a child by hand, than to employ a wet nurse to fulfill this of- fice. There are, in almost every case, so many diffi- culties in the way, that I should consider it safer, and in every respect better, to feed a child than to have it nourished from a hireling breast. CHAPTER XIV. Frequency with which the young Child should be fed—Great Im- portance of this Subject—Popular Errors refuted—Physiological Character of the Child at Birth—Mere crying is no Evidence of real alimentary Want in the System—The several Stages of Di- gestion explained—Probable length of Time that should elapse between the Infant's Meals. How often should the young Child be fed ?—We now come to a very important question, and one upon which there is, even among men of much experience, a great diversity of opinion. Considering the impor- tance of this subject, I have determined to give it a separate head, in order that it may be the more fully considered, and its importance the more fully im- pressed on the reader's mind, and that it may be con- sidered somewhat at length, and in proportion to the importance which should be attributed to it. In no respect is a caution more necessary than in regard to nursing a child too frequently. If, as the common practice is, the stomach is too often replen- ished with food, the natural function of the organ will necessarily become perverted and enfeebled, and gripes, colic, flatulence, and crying will be the effect: nay, more, death itself is often the result. More children, a hundred fold, have been destroyed by overfeeding than by want of food. The vulgar notion seems to be, that the child at 138 TREATISE ON CHILDREN. birth has just been undergoing a long and protracted fast. But if this even were true, how unreasonable would it be to commence at once to cram it with a va- riety of rich things, such as sugar and water, molasses and water, or sweetened milk and water. By such a course we would be certain of making it sick. But the child, at birth, is not to be regarded as being in the condition of a person that has been kept on a fast; it should rather be considered as having just finished a hearty meal, especially if the umbilical cord has not been separated too soon. If the child must be fed so very soon after it comes into the world, how does it happen that it has grown at all without food ? To the last moment of its existence in the womb, it has been furnished with a copious supply of rich and nutritious blood, prepared according to the strict and precise rules of the great laboratory of nature, for its support. Hence some hours, at least, must necessarily elapse be- fore any real alimentary want can be experienced by it. At the time of birth the stomach and bowels are unfit for their natural .office of digestion until after they have been cleansed of the dark mucous matter, called the meconium. This natural purging of the alimentary canal does not usually take place until some hours after the child has come into the world; and consequently had it been in immediate need of nutriment after its birth, the Creator would not have allowed this state of things to be present in the ali- mentary tract. Most certainly He does his work well. Nothing can be more perfectly certain than that if He had designed that the infant should be fed as soon as OF CRYING. 139 it comes to the light He would not only have adapted the digestive organs to the purposes of immediate nu- trition, but would also have furnished a supply of nat- ural food. But as He has seen fit to do neither, and has moreover rendered the first secretion from the mother's breast laxative rather than nutritious, it would be the height of folly and imprudence to mark out any course other than that which He has ordained. We find also many and serious errors prevailing in regard to nourishing the child after the time when it is necessary to do so. Do we not everywhere see that as soon as the child cries, or shows the least symptoms of uneasiness or pain, the breast is offered it, as if this were a universal panacea for all the ills it can be brought to endure ? Or is it 'to be supposed that hunger is the only sensa- tion the infant can experience ? So we should judge, if the almost universal custom of mothers is to be re- garded as a test. Suppose a man has eaten a dinner of pork and beans, and so heartily that he gets a good fit of colic to remind him of what he has done ? And suppose that to cure his colic he sets at work as soon as possi- ble to eat a second dinner of the same article ? We should think this a very strange mode of practice, and would consider him very foolish, to say the least, who would do it. Now it is just as wrong, just as absurd for a mother to put the child to the breast as soon as it begins to cry. What is crying? It is the child's language, and its only language. The new-born child is a very sen- 140 TREATISE ON CHILDREN. sitive being; it shrinks instinctively from all strong impressions, whether of hunger, heat, cold, pressure, or pain. It has no other way of expressing itself ex- cept by crying, and it is perfectly natural for it to do so. If it is allowed to become too warm or too hot it cries; if it is swathed and bundled up too tightly it cries; if it is pricked by a pin, if it is allowed to re- main too long wet, or too long in one position, or if it is allowed to become too hungry, or if it is overfed—it is all the same—it cries; it has, in fact, no other method of making its pain or discontent known. Be- sides, too, it cries without any particular want or un- easiness, this being the natural exercise for its lungs and chest. Now, to give it the breast under all these circumstances, is most foolish and absurd. Silence may, indeed, be sometimes gained by treating the child in this way. With the stomach overloaded in this manner there occurs a sort of apoplectic stupor which, however, is far enough removed from sound and re- freshing sleep. I remarked, that it is natural for an infant to cry, and that, to a certain extent, this exercise is an inten- tional provision of nature. Crying, when it is not caused by actual suffering, serves to exercise and de- velop the chest and lungs, to promote the circulation of blood, and to excite the bowels to a natural action. It is indeed, to a great extent, the substitute for that bodily activity which, in later years, becomes indis- pensable to the maintenance of health. Mothers can, in most instances, easily determine whether a child cries in consequence of some trifling OF CRYING. 141 matter, or from actual pain. If it is sick, the best and surest means should at once be taken to prevent the cause of its uneasiness; but if the crying is simply an omen of distress, instead of regarding it as proceed- ing from hunger alone, the mother should seek to at- tract its attention by carrying it about the room, giv- ing attention to its clothing, if wet, and a variety of little things that may serve to divert it from the one incessant thing of nursing. If it is allowed to think that on every little occasion of uneasiness, it can have the breast by crying for it, the mother will be sure to have enough to do at all hours of both the day and the night to gratify its wants. Soon, too, she will find that it has indigestion and colic, if not some more for- midable and dangerous complaint. Every mother who has reared a family of children, knows full well that a crying child is quite as apt to make a strong and healthy adult as one that is a good child, as the saying is. In this fact also we have a proof that crying is not necessarily an unfavorable symptom. It is in fact the more feeble and puny chil- dren that do not trouble the mother or the nurse with much of the symptom of which we are speaking. It will be understood, then, that we are to have some other rule by which to regulate the periods of nursing than the mere symptoms of uneasiness mani- fested by the child; and in order to establish the prin- ciples on which mothers should act in regard to nurs- ing, we must look at both analogy and experience for our guide. There is always going on in the living body, from 142 TREATISE ON CHILDREN. the first hour of its existence to the last, constant change. Every respiration of the lungs, and every pulsation of the heart, may be considered as so many marks or evidences of waste in the body. The great principle of proportioning the supply of food to the quantity of material expended in the growth of the body, or in the waste or effete matter which is thrown off in various ways from it, or in both of these agen- cies combined, is equally applicable in infancy and in later life. But inasmuch as all the vital processes go on more rapidly in infancy than in later years, food should be given more frequently to an infant than to an older person. We know that when families perish from hunger, the younger members are the first to die, and that the older ones, in whose bodies the change of matter is less rapid, survive the longest. During the first few weeks of existence the infant, if well man- aged, does little but to nurse, digest, grow, and sleep. Hence, also, it is evident that it should be nourished oftener than at a later period of life. As to the ques- tion regarding the precise period that should elapse between the times of nursing, it is not so easy to de- termine. One thing, however, is certain; there should be some regularity concerning it; the child should not be nursed at hap-hazard, and without any sort of rule or regularity, as is generally the case. We know that digestion consists of several stages. Thus, at first, the milk in the child's stomach becomes curdled, that is, the acid of the gastric juice separates the cheesy from the more watery part of the milk; then this wa- ter is absorbed, after which the process of chymifica- HOW OFTEN TO NURSE THE CHILD. 143 tion goes on. Now suppose that one portion of milk has been taken into the stomach, the casein has sep- arated from the whey or watery portion, and the pro- cess of chymification has just commenced; what but derangement of the whole process can occur if a fresh portion of milk is introduced. And yet this is the case almost always when children nurse, that is, the breast is given them so often that one portion cannot possibly be digested before another is introduced. With such management it is no wonder that infants and young children are almost universally sickly, and that about one half of the race die within the first three years. I remarked, that it is not easy to ascertain the pre- cise amount of time that should elapse between the hours of nursing; and it is for this reason, that it would be better to err on the side of fasting than repletion. There is always more to be feared from the child's nursing too often, than from the opposite extreme. If we knew just how long it requires the infant stomach to digest a portion of milk, and then if we should al- low of sufficient time for the organ to rest and recruit its energies, we could say with precision just how much time should elapse before a second meal should be al- lowed. We know that the inferior animals always re- pel rather than encourage the first advances of their young toward getting nutriment; they do not let them suck on every occasion when they manifest a desire for food. Hence we may safely conclude that mothers should not be too forward in allowing the infant to take the breast. Among the young of the lower ani- 144 TREATISE ON CHILDREN. mals, we seldom see disease or pain of any kind; while among infants, disease and suffering is almost the uni- versal rule. Dr. Combe is of the opinion that a child should not be nursed oftener than once in three hours during the day, and still less frequently during the night. From what I have seen in some cases, I am confident that this is often enough, or rather that the three hour rule is a safe one. Some mothers have done admirably well by nursing the child only once in four hours dur- ing the day, and not at all after her going to rest at night. I have never known a child injured by its be- ing nourished only at periods of three or four hours ; but, on the other hand, we know that many are made sick by being nursed at shorter intervals and irregu- larly. CHAPTER XV. Of Weaning the Child—This is generally done at too early a Pe- riod—The Menses—Evils of too early Weaning—It should be made a gradual Process—Crying, not an Evidence of true Hun- ger—Giving Food should be regulated according to Physiological Rules—Evils of Overfeeding—The proper Kinds of Food for a young Child—Milk and the Farinacea—Animal Food—How often should the Child be fed ?—Evils of Sweets and too concentrated Food generally. The period of weaning the child is one of the most precarious of its whole life; and I have long been of the opinion, that more children are destroyed by injudi- cious management in regard to this process than in any other connected with the rearing of the young. The principal error on this subject is that of weaning the child too soon. My candid opinion is, that in this country, generally, children are nursed only about one half as long as they should be. If the menses appear during the period of nursing, it is generally considered better to wean the child soon, even if it be at an earlier period than would otherwise be fixed upon. At all events this should not be done too suddenly; and I have known children to do well nursing for months after the menses had appeared. It was the opinion of Sir James Clark, who gave great attention to the subject of consumption, that the children of consumptive parents should be suckled for 13 146 TREATISE ON CHILDREN. eighteen months or two years, as the surest means of rendering them healthy and robust. And Dr. Combe regards that the soundness of this principle is unques- tionably borne out by experience, provided that an abundant supply of good milk is to be obtained for that length of time from a healthy and well-constituted nurse. The Indian women of our country continue to nurse their children for two years or more before weaning; and, as Dr. Rush well remarks, " it is easy to conceive how much vigor their bodies must acquire from this simple but wholesome nourishment." Nor do they at all allow of cohabitation during this period; a practice which might well be imitated by the more enlightened portions of the human race. " I shall not undertake to determine," says Dr. Rush, " how far the wholesome quality of the mother's milk is increased by her (the Indian woman's) refusing the embraces of her husband during the time of giving suck." The time of weaning should, of course, vary some- what according to the state of the child's constitution. One child may become more matured, and consequently a more fit subject for weaning, at twelve months than another at eighteen; hence it follows, that, so far as the child itself is concerned, the circumstances of each par- ticular case should form the criterion as to the time at which this change should be made. A grand rule of weaning is, to make it a gradual process. It is generally done in a manner by far too abrupt. Such a procedure is injurious to both mother and child. Dr. Combe tells us, that in the old country ♦ NURSING WITH BUT ONE BREAST. 147 it was formerly the custom to make the transition sud- denly Now, however, it is accomplished in so gradual a manner that many sustain no inconvenience from it. I have known many children made dangerously sick in this city by too early and too suddenly taking them away from the breast; and in some instances death has been the result. In those cases, therefore, in which it is proper for the mother to continue nursing her child as long as na- ture demands, it should, gradually, after the teeth have come out, be accustomed to some light nourishment other than the mother's milk. This should be taken at the same times of its nursing, and there should be all possible attention observed in regard to regularity. The same general rules are to be observed in reference to spoon or other feeding as to nursing; and it should ever be remembered that if it is important to the stron- ger system of an adult, that strict periodicity should be regarded in reference to the times of taking nutriment, how much more necessary must this be in the case of the delicate infant. The practice of giving a young child pieces of meat, candy, sugar, or even the simple article of bread, at all times and hours of the day, as many do, is a most injurious practice, and as a matter of self-interest, as well as of duty and benevolence to- ward the child, should never be tolerated. It is too often the case, after weaning, as at other times, that the mother considers every cry of the child a sign of hunger which she must at once proceed to satisfy. It not unfrequently happens that a morbid craving for an undue amount of food occurs very soon 148 TREATISE ON CHILDREN. after weaning has been accomplished. This has more- over been brought partially into existence, perhaps, by the irregular nursing that has been practiced. It is, no doubt, painful to a mother's feelings to witness the apparent suffering of her child, and which she can, for the time at least, easily remove. But it should be a much greater source of pain for her to know, that by thus converting a temporary evil into a much greater one, she actually endangers the life of her offspring. How much better is it, in every respect, to let the child cry a little, and exhibit, if it will, a fit of passion, in consequence of not yielding to its every craving, rather than make it sick by an opposite course, and be obliged in the end to have a hundred-fold more trouble, leaving out of question the suffering it must endure. When this craving to which I have alluded shows itself soon after weaning, and especially if it is accompa- nied with a more than ordinary fullness of the abdomen, it should at once excite the utmost solicitude on the part of those whose interests are most at stake in the child. This symptom is far oftener than otherwise a result of excessive alimentation; the child has been allowed too much food, or that which is of too rich a character; and if the practice be persisted in, it must almost in- evitably lead to glandular enlargement or consumption of the bowels by tuberculous disease. This circum- stance is said to be of more common occurrence in Ger- many, where it is much more common to bring up chil- dren by hand than it is in this country or Great Britain. At whatever age the child may be weaned, it should not be when it is sick; a time should, if possible, be WEANING. 149 selected when it is in its fullest possible vigor. The season of the year should likewise be regarded. If it is in the hot season, and particularly if it be in a large city, it will almost certainly be made sick, whatever pains may be taken to prevent such an occurrence. The cooler parts of the spring and autumn appear to be, on the whole, the healthiest portions of the year, and would therefore be the most suitable times for tak- ing the child from the breast. The winter is also a very suitable season, and more especially so if the child is taken daily and often into the open air and light, as it should be. A great deal depends also upon its being kept from overheated, badly ventilated, and poorly lighted rooms. A most important matter connected with weaning is the selection of the proper kind of food. Authors have not generally been very full or explicit in regard to this subject, and the practice of society generally is very different from what it should be. I have elsewhere spoken of cow's milk, and the other substitutes for the mother's milk, at an earlier period of the child's existence. The same remarks apply to a considerable extent in this connection, as well as in the other referred to. We can, however, take more lati- tude in proportion as the child is older, in selecting the proper nutriment for it. Cow's milk, when it agrees with the stomach—and it will in most cases, if it is not given too rich, too rap- idly, and too often—is one of the best forms of aliment for a child that is being weaned. It is well also to 150 TREATISE ON CHILDREN. mix with it a moderate portion of some indigenous farinaceous substance, such as a little finely mashed mealy potato, bread, rice, Indian meal, etc. I have seen children do well on all these articles ; but I think fine white Indian meal, well boiled in water before it is added to the milk, one of the best articles. But it must be well boiled, remember, or it will disagree. Dr. Warren, the celebrated physician and surgeon of Boston, extols highly the brown or unbolted wheat bread for young children. This should be of the best possible material, and should be well soaked in the milk, or milk and water, before it is used. This kind of bread keeps the child's bowels in an active state, which is a most excellent means of warding off disease. The less superfine bread the child is allowed the bet- ter, I regard. If potato is used, it should be most carefully mashed before using it. But favorable as the milk diet appears to be for young children generally, I have known some cases in which a pap made by boiling brown wheaten bread in pure water, answered a much better purpose. For example, a child some two years old, which has had ague and fever, if kept upon milk, or bread and milk, was certain to be made worse, and especially consti- pated ; but on giving him the pap three or four times a day, and nothing else whatever for food, his bowels would very soon become regulated, and after a little the fever would break. For a time it seemed that any diet which contained any kind of animal food whatever, would be absolutely certain of bringing on the fever. ANIMAL FOOD. 151 I believe that medical writers generally are agreed that animal food—in the form of flesh, I mean—is pre- judicial to young children. We know but too well how much more liable children are to disease than adults; and there can be no doubt but that the mis- use of animal food—using it too early and in too great quantity—increases materially the tendency to inflam- matory disease. This is manifestly the case in adults, and if so, how much greater must be the risk in chil- dren. Vegetarianism is, I am convinced, the true rule throughout; and if animal food must be used in child- hood at all, it should be with the greatest caution, and always the later it is commenced the better. How often should the child be fed after it is weaned ? This, too, is a very important query. Four times, at most, I am convinced, is the best rule for all children that are from eight to nine months old and upward. I must here, at the expense of some repetition, again give a caution in regard to the use of sweets. In this country, where sugar, as indeed eatables generally are so cheap, children are by many fed almost constantly with candies, sugar, sweetmeats, cakes, and the like. Now this is all wrong, and if parents could but know it, is the cause of a vast deal of trouble, suffering, dis- ease, and death. When will they learn wisdom in these things ? So far as my humble authority may go, let it be most distinctly understood, that from birth ONWARD, THE LESS WE EAT OF SUGAR AND SWEETS GENERALLY,THE BETTER FOR HEALTH. The evils of concentrated food being so great, and 152 TREATISE ON CHILDREN. the practice of giving such food being so very common at the present day, I shall here devote some remarks to the subject. It is a well-ascertained law of the animal economy, that food, to be healthy, must contain a considerable portion of matter that is wholly indigestible and innu- tritious. Thus, Magendie, the physiologist, found that dogs, fed upon sugar, gum arabic, butter, olive oil, and some other articles of rich or concentrated nature, each given to the animals separately with pure water, they very soon lost their appetites, began to droop, became emaciated, were attacked with ulcers, and died, inva- riably, within the space of four or five weeks. Fed upon superfine flour-bread and water, they lived uni- formly about seven weeks, varying only a day or two. When fed upon coarse or military bread, such as con- tained either the whole or a considerable portion of the bran, the dogs thrived perfectly well, and were found in no respect to suffer. The same truth has often been illustrated upon ship-board at sea. In many cases, where the hay and straw were swept over- board, it has been found that the animals, in a few days, famished, unless some innutritious substance, as the shavings of wood, was mixed with the grain given them. The animals have been observed to gnaw at the spars and timbers, or whatever wood they could lay hold of; and thus the idea was suggested, that the grain alone was of too rich a nature for their suste- nance. The same principle holds good in reference to the health of the human body, and as a general fact, food, EVILS OF CONCENTRATED FOOD. 153 in civilized life, is of too concentrated a quality. This is particularly true in those parts of the world where an abundance can be had ; in other words, in the more civilized and enlightened parts of the world. A host of diseases, both acute and chronic, are either caused or greatly aggravated by concentration in food. Indi- gestion, with its immense train of evils, constipation, loss of flesh, corpulency, nervous and general debility, torpor, and sluggishness of the general system, are the principal roots of all disease in the human family, and these are among the difficulties caused by too great richness in food. Children are often injured in this way. Mothers, in their kindness, think nothing too good for their little ones. In many parts of our coun- try, the infant at the breast is taught to suck at its piece of pork, or other fat meat. Sugar, sugar candy, sweetened milk, superfine bread, and rich pastries, are all given for the same reason, by mothers and nurses in their mistaken kindness. Children reared in this way can never be healthy for any considerable length of time, are generally very puny and weak, and often die within two or three years of birth. Scrofulous and other ulcers are frequently thus caused, and so also those derangements of the stomach and bowels, which so often, in spite of the best remedial means, sweep these little sufferers from their earthly existence, and this at the very time when their growing mind be- gins to gladden the parent's heart. There is great and prevailing error upon this subject, and happy are those parents who take it upon themselves to gain wis- dom in regard to this most important matter of food. CHAPTER XVI. Of Exercise—Condition of the Infant at Birth—Too much Exercise deprecated—When should the Infant be taken into the open Air —Heat, in general, more to be feared than Cold—Position in which the Child should be carried—Rocking, and the use of the Cradle—Swinging—Its Evils—Of Clothing in connection with Exercise—Dress should be Comfortable—The great Importance of Cleanliness—Of Sleep—The Effects of Light. Although the infant is at first very delicate and fee- ble compared with what it is destined to be eventually, it yet needs a certain amount of bodily motion, or, as we call it, exercise, and for which it manifests a de- cided wish. The infant at first needs principally growth and de- velopment of organization. There is neither the de- sire for voluntary motion, nor the power of will to de- termine it. Hence, for a number of the first weeks of its existence its exercise must be of a very gentle and passive kind. It is wrong for parents and nurses to endeavor to excite the child to premature exertion in sitting up, or endeavoring to bear its own weight, as is too often done. If, for example, the child is carried too much in a sitting posture while it is very young, its spine will be almost certain of giving way under the effort, giving rise to curvature and debility of the part. The lungs, heart, and other viscera, will also suffer from pressure OF exercise. 155 and displacement, and as a consequence their functions will become deteriorated. We see, therefore, how in- jurious it must be for parents to endeavor to stimulate the young child to over-exertion, with the view of mak- ing it appear smart, as the saying is. It is much bet- ter for them as well as for the child, to be content with carrying or holding it upon the arm, in a slightly re- clining position, a practice which is both agreeable to the child and convenient for the mother, or one who holds it. At most seasons of the year it will be best, for two or three of the first weeks of the child's existence, to keep it altogether within doors; and I need hardly ob- serve, that the nursery should be the best aired, the best lighted, pleasantest, and most healthy part of the whole house. Is it not certainly of more importance to give a young and delicate child the best possible chance for its life, which at best is sufficiently preca- rious, than to keep the best part of the dwelling for the purposes of showing off in society ? I am heartily tired of seeing people devote the best and most healthy portions of their residences to that which is of the least possible importance. After two or three weeks the child should, if the weather is not very inclement, be gradually carried into the open air and light. But mark, these changes should be made gradually, and not all at once. It may be well to commence the change at first by simply carrying the infant to an adjoining room, where the air is cooler than in the nursery, that is, if the season is very cold. If the weather is hot, the sooner it is car- 156 TREATISE ON CHILDREN. ried out the better, provided it is not subjected to too great a degree of heat and light. In this hot climate we should be very careful never to expose a child's head to the direct rays of the sun in the summer, as by such a course inflammation of the brain, which is always a most dangerous disease, is easily brought on. But taking the child into the open air and shade would prove both pleasant to its feelings, and salutary to its health. In order to make these changes both safe and salu- tary, it is important that two things should be kept in mind and observed; the first is, that the room where the child remains should be kept at a moderate temper- ature in the cool and cold seasons, so that when it is taken out the change will not be so great as to endan- ger its health. The second is, that the nursery should be a light, airy room, so that when the child is taken into the open air its eyes will not be endangered by too great a contrast between the light of outdoors and the room in which it is kept. It is very important that these circumstances be observed, otherwise the child may be made to suffer from that which should prove of essential benefit to its constitution and health. While on the one hand experience proves that wc have, in the United States, much more, on the whole, to fear from the effects of heat than from cold, there is yet much danger to be apprehended from the latter, especially when the child has been kept in a room at too high a temperature, as is generally the case. Dr. Combe has noticed an inquiry instituted by Dr. Milne Edwards to discover the cause of the greater mortal- OF EXERCISE. 157 ity of infants in France during winter than during summer, and in the northern than in the southern de- partment of that country, and stated that it was satis- factorily proved to be owing chiefly to premature ex- posure to cold, in carrying the child to the office of the Maire, within a few days after its birth, for the pur- pose of being registered in legal form. Dr. Combe quotes also, in proof of his position, the observations of Dr. Nicholai, who gives a view of the comparative mortality, at different ages, out of 10,000 in France, Russia, Austria, and Sweden, and shows that, while in the colder climate of Sweden, the number of children dying under three years of age is considerably larger than in France, being as 4,243 to 3,976, yet the pro- portion of persons surviving at the age of eighty years is no less than 546, and only 231 in France. All experience proves, that we ought always to be extremely cautious how we expose the delicate infant to a low temperature, and yet I repeat that there is always more to fear from the opposite extreme. The true policy is to guard carefully against all great and sudden transitions ; and the more so, the less liable the child will be to suffer from the attacks of disease. The position in which the young infant is carried during its exercise, is a matter of importance. Some have recommended that it should never be carried in the sitting posture, as in this way its comparatively large and heavy head will be observed to hang over on one side in such a way as to impede breathing, and perhaps swallowing. A sudden jerk of the head to one side while being carried on the arm, has been 14 158 TREATISE ON CHILDREN. known to kill a child immediately. I am led to ob- serve however, in this place, that the infants of moth- ers who have practiced cold bathing during pregnancy, are decidedly stronger than those where such is not the case; and in no respect is this improvement in vigor more manifest than in the child's ability to hold up its head more firmly than is ordinarily the case. Bathing the child also in cold water, or that at least which is suited to its case, increases its bodily vigor materially, besides rendering it more proof against the vicissitudes of temperature and moisture. The practice of carrying the infant in an oblong basket, while very young, has been strongly recom- mended as a means of preventing the too great exer- tion on its part, in being held in such a way that it must make some degree of effort to support its own weight. The gentle swinging motion which it neces- sarily gets when carried in this way, has also been supposed to be of advantage, but this I think is al- together an erroneous conclusion, since experience teaches that the less swinging and rocking the child is subjected to the better. Hence, so far as this effect is concerned, the plan of carrying the child on the arm I should call the preferable one. In this method also care should be exercised not to injure its limbs by any undue motion, and the child should be frequently changed from one arm to the other, and not carried always upon one, as the custom is with mothers and nurses generally. By this means, if the child is car- ried out as much and as often as it should be, it will be liable to become deformed ; but if it is frequently OF EXERCISE. 159 shifted from one side to the other, it will prevent all such risk, be of much greater advantage to the child in every respect, and more easy for the one who car- ries it. In infancy all the bones, ligaments, and muscles of the body are comparatively weak, the sockets are shal- low, and the joints feebly bound together so that dis- locations may easily be caused if great care is not ob- served in lifting the young infant. No one should ever be allowed to lay hold of a young child by its arms, as is sometimes done; but if it is to be raised, the hands should be placed at the sides of the chest, immediately below the arms, and thus it may be raised without in- curring any risk of dislocating its joints. One of the best modes of taking the child into the open air for exercise is to lay it in a carriage con- structed for the purpose. If it is old enough it should be allowed to sit up while riding, but if not it should lie upon well-arranged pillows, and the road should not be too rough. Children are very fond of such exer- cise, but they should have it little and often, rather than too much at a time, and at long intervals. It is surprising to see how delighted infants and young children are to go into the open air; and it should give every parent the most sincere gratification to know that, under proper regulations, the good thus to be obtained is as great as the satisfaction afforded. The Cradle.—Rocking children in a cradle is an exercise that should never be allowed. No doubt a cradle is an excellent thing to help get a child the sooner to sleep. The child, however, will be found to 160 TREATISE ON CHILDREN. sleep soon and easily enough without rocking, even in a chair, if all the habits and circumstances connected with it are. properly attended to. The reason why a child sleeps more readily when rocked is, that the motion of its head causes a degree of congestion in the brain; and the effect of this must, in the end, be, to induce more or less debility of the part, so that the organ will be rendered more liable to inflammation and dropsy, or water upon the brain, as it is called, than it otherwise would be. Hence it would be better if both cradles and rocking chairs were banished from the nursery; and I am convinced if parents would follow this advice they would, in the end, find their trouble in rearing their children less than it would be if an opposite course were taken; and whatever motion is allowed the child, whether in the lap, the arms, or other place, none but that of the gentlest kind should be practiced. Swinging.—From what has already been said, it will naturally be inferred that I am no advocate for this kind of exercise. No matter if children delight in, and are excited by it, it is yet harmful, and should not be allowed as a general thing. A few swings, now and then, would be a matter of small moment; but to keep it up day after day, by the hour at a time, as is often done, cannot but be harmful to the brain, and consequently to the whole nervous system. I myself knew one young lady well who was rendered an idiot for life, as every one believed, by her being swung a great deal in a basket, when a very young child. OF CLOTHING. 161 Clothing.—The limits of this work will not admit of any lengthy remarks upon the subject of clothing. A few practical hints, however, should be made in this connection. I have spoken elsewhere particularly of the ill effects of tight clothing, swathing, bandaging, etc., which cau- tions I would have the reader always to bear in mind when this subject is considered. As in other things, the tendency among people at large is to go to extremes in regard to the amount of clothing worn. Sometimes too much is put upon the child; at other times too little. Some parts of the body likewise are dressed too warmly, while other and equally important parts are, perhaps, left altogether uncovered. Now, things should not be managed in this foolish way, even if fashion—that most successful of all tyrants—does decree it. A child should be dressed according to the principles of sound physiology; and to follow any other course knowingly, is one of the most wicked things which a parent could possibly be guilty of in the management of his child. The general rule by which we should be governed in selecting a child's clothing, should be that which re- lates to comfort. That which is the most comforta- ble is the most healthful, and that which is the most healthful is the most comfortable. Many suppose that it is absolutely necessary for young children to wear flannel next to the skin. But while I admit, or rather affirm, that the child should always be comfortably clad, I do not think it the best course to put the woolen material next to the surface. 162 treatise on children. Have as much of it about the body as may be neces- sary in the cold season to insure a proper degree of warmth, but none of it upon the skin, I regard the better rule. And of all substances, linen appears to be the most healthful to be worn upon the cutaneous surface; it is the most cleanly, and, at the same time, the most productive of bodily comfort. The next best available article, probably, is cotton. The child's clothing cannot be kept too cleanly, or too well aired. Parents are in general a great deal too careless in these little things. An infant's cloth- ing should all of it be changed always at night, and if this were done once or twice during the day it would be the better for it. It is not necessary to wash the garments at each time; but they should be well aired before a fire, or in the sun or open air. These appa- rently trifling matters exert, in the aggregate, a great influence on the child's health, and are well deserving the strictest care and attention on the part of parents. Sleep.—For a number of the first months of exist- ence the child spends, naturally, a great portion of its time, by day as well as night, in sleep. The more healthy, apparently, the more sleep it enjoys. But in order that this should be sound and refreshing, a num- ber of particulars should be observed. It should not be allowed to sleep on feather-beds or pillows, since those made of cotton, or still better, »wool or hair, are more conducive to health. These can be made suffi- ciently soft, and are assuredly warm enough for the wants of the system. RULES of sleep. 163 It is very important that the child's clothing should be as loose and airy as allowable while it is sleeping. and if parents would be at the trouble of changing it as soon as it wakes, although the trouble would be con- siderable, they would yet be more than repaid for that which might at first appear an irksome duty. It is the custom with most parents to allow the child, even when it is two or three years old, to sleep with its shoes, stockings, and other clothing upon it, the same it has had on while playing or going about. Now, re- membering that the skin is a breathing organ, it will appear evident how much less refreshing the sleep must be than it would if air was allowed to come freely about the surface. If a grown person—a lady, for ex- ample—who is under the necessity of taking a nap^n the forenoon, sleeps with the ordinary amount of cloth- ing about the body, the sleep will be much less refresh- ing than it would be if the clothing were removed. This any one can easily prove to be true by experiment; and if the weather is hot, the difference will be found to be very plain ; and it is even more necessary to ob- serve these precautions in the cases of children than adults. Noise and light, even if these should not cause the* child to wake too soon, should be avoided while it is sleeping. The impression of these agents upon the delicate nerves of the young infant, would cause some degree of unnatural irritability, which may, in the end, render it more wakeful than it otherwise would be. Light, as affecting the Health of Children.— 164 treatise on children. Light is one of the so-called life-agents, and a most important one. True, a person could live longer with- out it than he could without air, food, or water; butjn the end light is quite as important as any of them. The effects of light upon the growth and well-being of the living system, are not, by many, appreciated. Children, who are more apt than adults to follow the dictates of nature and common sense, are invariably fond of going into the light. Nowadays the parlors of our ladies are often more like dungeons than pleasant rooms, and many persons practice reading, sewing, and the like, in rooms so inadequately lighted that a very troublesome and sometimes permanent weakness of the eyes is brought on. The general system, too, grows pale and unnatural in color, something as would a plant under the same circumstances. A few physiological facts on this point it may not be amiss to give. Ac- cording to experiments that have been made, it has been shown that if tadpoles be nourished with proper food, and be exposed to the constantly renewed contact of water, so that their respiration may be fully carried on while they remain in their fish-like condition, but be deprived entirely of light, their growth continues, but their metamorphosis into the condition of air-breathing animals is arrested, and they remain in the condition of a large tadpole. So the rapidity with which water- flies, insects, etc., of pools undergo their transformations, is found to be much influenced by the amount of light to which they are exposed. If equal numbers of the eggs of the silk-worm, be preserved in a dark room, and ex- posed to common daylight, a much larger portion of EFFECTS OF LIGHT. 165 the larvae are hatched from the latter than the former. " An infant, if deprived of heaven's free light," says Dr. Moore, " will only grow into a shapeless idiot, in- stead of a beauteous and reasonable human being." And, according to this same author, "in the deep, damp gorges and ravines of the Swiss Valais, where the direct sunshine scarcely reaches, the hideous prevalence of cretinism startles the traveler. It is a strange, mel- ancholy idiocy. Many cretins are incapable of any ar- ticulate speech; some are deaf, some blind, some labor under all these privations, and all are misshapen in almost every part of the body." Says Sir James Clark, "If we take a child of three or four years of age, in perfect health, having been born without any hereditary predisposition to disease, well nursed, and hitherto pro- perly nourished, let it be fed upon coarse, innutritious food, and confined in close, ill-ventilated apartments, where neither the heat nor the light of the sun has free admission, and ice shall soon see the healthy, blooming child changed into a pale, sickly, leuco- phlegmatic subject." It is also well-known that cows kept badly and in dark stables, as in our large cities, soon become diseased with scrofula, and would soon die of consumption, if not sold to the butcher in the commencement of the disease. Rabbits may also be rendered tuberculous in a few weeks by feeding them poorly and confining them in a dark place. Various other examples might be given illustrative of the influ- ence of light on the natural growth and development of living bodies. Deformity and Disease.—It has been observed that 166 TREATISE ON CHILDREN. a remarkable freedom from deformity is to be found among those nations that wear but little clothing, thus leaving the system more to the influence of light .as well as air; while, on the other hand, among those that are much confined within doors, or brought up in cellars, mines, narrow and dark streets, there is an un- usual tendency to deformity. Of course these effects are more or less modified by a variety of causes; as, for instance, the want of a due circulation of pure air in dark and confined places, producing debility of the body, which always tends to deformity and disease of the worst forms; but it is demonstrably and inevitably true, that the want of light is also a prominent cause in the production of these effects. It has been sta- ted by Sir A. Wylie (who was long at the head of the medical staff in the Russian army) that the cases of disease on the dark side of an extensive barrack at St. Petersburg, have been uniformly, for many years, in the proportion of three to one, to those on the side exposed to strong light. And in one of the hospitals, with a long range of frontage looking nearly due north and south, it has been observed that a residence in the south wards is much more con- ducive to the welfare of the patients, than in those on the north side of the building. From observations of the above kind, then, what practical inferences are we to make ? Very plainly, the room in which the in- fant is reared should not be kept darkened, as mothers and nurses are so much in the habit of doing; at a pro- per age, and at suitable times, it should be taken into the open air and light which it so much loves, and the EFFECTS OF LIGHT. 167 little girl, that so gladly spends hours in her gambols, should be gratified, and not restrained as a " romp." Let nature be more closely followed in these things, and great good will be the certain, inevitable result. I need, perhaps, here introduce a caution on too strong lights. In the deep ignorance that prevails on hygienic subjects, persons are continually committing extremes. The room of the infant is kept for days, and perhaps weeks, dark. Then, all at once, the light is admitted freely, or the infant is taken out of doors, making a great and unprepared-for change in regard to light. Beyond a doubt, the eyes are often greatly injured in this way. There is likewise a very pernicious custom in the use of candle and lamp lights. These are made bright and glaring, and left unshaded, so that the infant gazes directly at them. For children, and, indeed, per- sons of all ages, glaring lights should be shielded in such a way that they do not affect strongly the organs of sight. The practice which some have of waking the child suddenly, exposing to its gaze the candle or lamp, cannot be deprecated in too strong terms. From the foregoing facts and observations, we may gather many important practical truths in regard to the management of a young child. We see how im- proper it is to keep a child housed up continually, as the custom with many is, particularly during the colder months of the year, at which time there is less solar light, and consequently still more need than at other seasons for sending it out freely and often into the open air. One of the healthiest children I have ever known was born in the city of New York, in the month 168 TREATISE ON CHILDREN. of September, and for many months during the whole winter following and longer, it was carried out for a number of hours each day. It was fortunate for the child that a good and faithful nurse could be employed, whose whole business it was to aid the mother in tak- ing care of it. She often spent almost the whole day with it out in the open air, returning at proper inter- vals to have it nursed and made clean. I have wished? many a time, that every mother could be possessed of the knowledge and pecuniary ability which the mother of this child enjoyed. If such could be the case, we would very soon see a great reduction in the bills of infant mortality in our unhealthy metropolis. CHAPTER XVII. Of Dentition—Growth of the Teeth—Periods at which the differ- * ent Teeth usually appear—The different orders of Teeth—The Teeth do not naturally decay—Dentition not naturally a danger- ous Process—Management of its different Periods—Of Treat- ment, Local and Constitutional—The great Value of Water as a Remedy in Teething—Bowel Complaint, Skin Disease, Croup, Cough, and other Ailments connected with Dentition—The great Value of pure Air—Dentition one of the most dangerous Peri- ods of the Child's Life. The period of dentition, or appearance of the first or temporary teeth, is one of the most precarious of the child's life. We cannot for a moment suppose that teething is naturally a time of danger, or that the All- wise Creator designed that infant life should be sub- ject to such a variety of ills as we find in civilized life to occur at this period. On the contrary, we know, from both fact and analogy, that it is no more natural or necessary that a child should be made sick by the process of teething, than for the young of other ani- mals to be thus affected; and, assuredly, we never see them suffering any inconvenience whatever from this source. This subject being one of great importance, I shall enter into it somewhat in detail. The formation of the teeth is begun, evidently, early in fetal life. We do not, indeed, know precisely at 15 170 TREATISE ON CHILDREN. what period these organs begin to develop themselves ; but that this development commences long before the fetus leaves the uterus, is well known to be true. The growth of the teeth is carried on slowly at first, and is not completed till several months after birth. The parts concerned in this process are the jaw, the gum, the nerves, and the soft rudiments of the tooth itself. The jaw, at first, has only a channel running along its surface, but this is afterward divided, by a natural process, into separate cells. These become, in time, the alveolar processes. In eaeh of these cells is lodged a membranous sack, containing a soft pulp. The bag consists of two laminae or coverings, both of which contain nerves and blood-vessels, the outer one being the more vascular. These sacks adhere very closely to the gums, so much so, that if they be pulled away from the jaw, the sacks adhere firmly to them. The pulp is also vascular; that is, contains blood- vessels, and it assumes very nearly the size and shape which the body of the tooth is to have after ossifica- tion or hardening has taken place. The tooth consists of two parts—the bony matter and the crystallized en- amel covering the bone. The bone is formed of the pulp, which gradually hardens, and in the eighth or ninth month of fetal life all the pulps are found to be more or less ossified ; at birth, the shell of the tooth is found considerably advanced. Soon after this pro- cess commences, the inner surface of the sack deposits a soft earthy substance, which crystallizes and forms enamel. When ossification is advanced so far as to form the shell of the body of the tooth, the lower part TEETHING. \>J\ becomes contracted, so as to form the neck; and, as the shell thickens, the pulp, though diminished in quantity, protrudes at the neck, forming a kind of mould for the fang. If the tooth is to have two roots, a septum is stretched. across the cavity of, the neck, and the pulp protrudes in two divisions. As ossifica- tion advances on the root, the body rises in the socket, and the sack rises with it; but, in proportion as the enamel is crystallized, the sack becomes less vascular and thinner, and is at last absorbed; and when the tooth has acquired its proper height, the whole mem- brane is destroyed. Thus it appears the sack is not stretched, and bursts by distention, but is absorbed, and being fixed to the neck of the tooth, and not to the jaw, it rises with the tooth. During a number of months, of the earlier period of the child's life, it is destined, according to the intention of nature, fo draw all its nourishment from the mater- nal breast. Consequently, no food is to be taken that needs mastication or breaking down by the grinding power of the teeth. Suction alone is all that is required during the earlier months; and for this, the mouth, in- cluding the tongue, lips, and cheeks, are amply suffi- cient. In perfect accordance with this beautiful ar- rangement of nature, the parts afterward to be em- ployed in the process of mastication are in a compara- tively imperfect state; the jaws are shallow, short, and not provided with teeth ; the soft parts, also, concerned in the process are, for some months, comparatively weak. It is a law of nature, that all her processes are car- ried on gradually, often in a manner almost impercepti- 172 * TREATISE ON CHILDREN. ble. In this way she prevents those ailments which would necessarily arise from a sudden and severe com- motion in the system. Suppose the teeth were all to come out at once in a single day; the life of the child would, with certainty, be destroyed by such a change. But Nature does her work in a more careful manner; the process of dentition is a slow and gradual one. In the course of a few months, as the infant advances to- ward a state of development in which more solid nutri- ment is needed, the bones of the face gradually increase in their dimensions; " the jaws increase in length, depth, and firmness of structure; the gums become more elevated and resisting on their upper edge; the cavity of the mouth enlarges; the muscles which move the jaws increase in size and vigor ; and, in exact pro- portion to these changes, the infant manifests increased power of mastication, and an increased tendency to carry to its mouth any object it can lay hold of; thus evidently contributing to develop still farther the bones and the muscles concerned in mastication. About the sixth or eighth month—the period varying considerably in different cases—the teeth begin to cut the gum. Generally, the two middle incisors of the lower jaw appear first; in about a month later those of the upper jaw cut through; then the two lateral in- cisors of the lower jaw, and next those of the upper one appear; about the twelfth or fourteenth month, the an- terior grinders of the lower, and soon after of the upper, jaw make their way through the gum. Between the sixteenth and twentieth month the cuspidati or dog teeth appear; and, from that period to the thirtieth TEETHING. 173 month, the posterior grinders come forth. Thus the child, when arrived at the age of two and a half years, usually has all the first set of teeth through. There is, however, according to differences in constitution or idiosyncrasy, considerable variation from the periods mentioned. COMPLETE SKT OF INFANT TEETH. (This plate exhibits the jaws of a child at the age of about four years.) The temporary or milk teeth continue generally till about the sixth or seventh year. The permanent teeth— twenty-eight in number, not including the four wisdom teeth—are supposed to be in progress of development all this time. Gradually the permanent teeth come forward to displace the temporary ones. This change, like that of-the coming forth of the milk teeth, is not a 174 TREATISE ON CHILDREN. sudden process, but gradual, and such as a healthy child may, without inconvenience, pass through. In all of these curious and interesting processes we see displayed most clearly the wisdom of an Almighty hand. In the foregoing description I have used, for the most part, technical terms to designate the different kinds of teeth. In Latin, incisor signifies any thing which cuts; hence this name for the cutting teeth. Cuspis signifies the point of a spear; and molar a mill. The milk teeth, twenty in number, consist of eight incisors, front or cutting teeth, four being in each jaw; four cuspid or canine (dog teeth), two being in each jaw; and eight molar or grinding'teeth. The permanent teeth, including the wisdom teeth, so called, consist of eight incisors ; four cuspid, canine, dog or eye teeth ; and twenty molar or grinding teeth. The latter term is sometimes restricted to the three back grinders on each side of each jaw; in which case, the remaining two, forward and next to the cuspid teeth, are called bicuspid or double spear-headed, from their being sup- posed to bear some resemblance to the cuspid or spear- like teeth. The subjoined cuts will serve to give the reader a still clearer idea of the location and appearance of the different kinds of teeth. It will be found, in reference to the growth, develop- ment, and health of the living body, that Nature always adapts her means to her ends; in other words, that the organization will be found, at every period of life, to be adapted, with the utmost precision and accuracy, to the wants of the individual. Thus, when the child i« OF TEETHING. 175 young and feeble, demanding only the bland nourish- ment furnished from the mother's breast, no teeth are provided; these, under such circumstances, would be rather a hindrance than otherwise. But, as the child grows and becomes more strong, requiring, as a conse- quence, a more substantial nutriment, the teeth come forth. And still later, when the constitution becomes still more developed and strong, the first or more deli- cate teeth are thrown off, in order to give place for the stronger and more permanent ones, and which are in- tended to go with the individual through life. We see, COMPLETE SET OF PERMANENT TEETH. 176 TREATISE ON CHILDREN. too, also, in precise accordance with this law of adapt- ation, that when, from weakness of constitution, or other causes, the development of the constitution goes on with unusual slowness, and solid food is not so soon needed by the system, the growth and development of the teeth are in the same proportion delayed ; afford- ing us an instructive lesson, that weaning should not be directed according to any arbitrary rules as regards days and months, but should be regulated according to the progress of organization, and the child's state of health. Teething may be reckoned as having two distinct periods, although these naturally run into each other. During the first period, the capsule of the tooth en- larges, as is known by the swelling of the surrounding parts. It is in this stage of the process of teething that there may be a considerable degree of constitu- tional disturbance, without the teeth at all making their appearance. During the second period, the tooth increases in length, rises upward, presses against the gum, and in time cuts through its surface. Al- though these two stages are supposed to be present in every case, yet it not unfrequently happens that there appears to be only one period, the tooth appearing very soon after the constitutional disturbance is discovered. In other cases, too, the cutting of the tooth is so easily effected, that there are no symptoms of general dis- turbance whatever noticeable. I have before remarked, that teething being a nat- ural process, there ought to be no difficulty during the growth and development of these masticatory organs, OF TEETHING. 177 and, if the laws of nature were properly observed, we would have in the catalogue of human disorders no such diseases as those of teething. But as the habits of society are, in the present state of human improve- ment, the period of teething is, probably, all things considered, the most dangerous one of our whole lives. " The first stage of teething," according to an ac- curate observer, " is induced by symptoms of general irritation in the mouth, and of some constitutional dis- turbance. The child becomes restless, and the saliva begins to flow in quantities from the mouth, and, on the least uneasiness, the infant cries, but, in a little while again smiles with its wonted placidity. Tears and smiles thus succeed each other at intervals. The eyes and cheeks become red, the appetite capricious, and thirst frequently considerable. Sleep is disturbed or interrupted by dreams, and a general expression of uneasiness pervades the frame. The gums, which were at first unaltered, begin to swell, and become in- flamed and painful. The child now carries every thing to its mouth, and is evidently relieved by rub- bing its gums. The bowels, at this time, are gener- ally unusually open; but a certain degree of bowel complaint is beneficial during teething, and therefore its occurrence need not cause any uneasiness. After going on for a longer or shorter time, these symptoms gradually abate, and are followed by an interval of comfort and repose. " The second stage of teething soon follows. In- stead of regularly carrying any thing to the mouth, the child now often shows a fear of allowing any thing to 178 TREATISE ON CHILDREN. touch it, and often cries when he happens to bite un- warily. The gums and mouth become burning hot; a pale or bright red elevated spot appears on the gums, which becomes very painful when pressed upon. The child changes color frequently, is restless, wishes to be laid down, and is no sooner down than he is anxious to be again in the nurse's arms ; nothing pleases him. At one moment he will demand the breast, and at the next abruptly turn away from it. He snatches at every thing and retains nothing. The child appears, in short, to be driven about by successive and sudden impulses, without being able to find rest in any posi- tion ; and with these appearances slight fever and bowel complaints are often combined. WThen once the teeth are fairly cut, however, all these symptoms vanish." Such is the period of teething as often seen in the present state of society; but in cases of well constituted children, especially if they are reared care- fully according to the natural laws, none of those dis- turbances whatever are noticed; and that such is the benevolent intention of the Creator, both facts and analogy conclusively prove; and it is the great im- portance of the subject of infant management during this critical period of teething, that causes, in the writer's mind, an anxiety that it should be understood. Certainly there can be no scientific knowledge of greater importance to every parent, than that which enables them to rear up healthfully the offspring com- mitted to their care. The different orders of teeth make their appearance with greater or less difficulty, according to their size OF TEETHING. 179 and the depth from which they come. Thus a child may experience no trouble whatever with the first teeth; but later, when the cuspidati and molars are about to make their appearance, troublesome and per- haps serious consequences may ensue. Sometimes too, it happens that the principal difficulty is experienced when the first teeth appear. In such cases either there is an improvement of the constitution through some means disconnected with the process of teething, or the system, by becoming accustomed to the change which has commenced in its development, is better ena- bled to bear the excitement after the first teeth begin to come forth. The symptoms of teething seldom continue severe more than eight or ten days at a time. If a child be particularly irritable, or if the tooth come forth with more than usual rapidity, or if several teeth make their appearance at the same time, the unpleasant effects are apt to be more than ordinarily severe. The system may become feverish, with a determination of blood to the head, costiveness or a bowel complaint, more or less severe, may supervene, and which in some cases may be attended with convulsions. Not unfrequently the head becomes so much affected, that affusion takes place upon the membranes of the brain, which must in almost every case end in death. Eruptions of the skin may come on as symptoms of teething, but these appearances are regarded as favor- able rather than otherwise. The child is evidently bet- ter off with an eruption under such circumstances than with the other disturbances referred to. 180 TREATISE ON CHILDREN. In all cases of troublesome dentition we are to treat the patient according to general principles, just as we would do with the same symptoms arising from other causes. In order, however, to convey clearer ideas on the subject, I remark, that in the management of cases of difficult dentition, three main indications of treat- ment are to be observed :—first, to allay local irrita- tions ; second, to alleviate constitutional symptoms, and, third, to support the strength. 1. In regard to the gums ; many suppose it absolute- ly necessary to cut them freely with a knife or lancet, while others are opposed to the practice. Some sup- pose that this measure is so important a one that life is often actually saved by it, while on the other hand, it is supposed that life may be destroyed by the irrita- tion set up by the operation of dividing the gum. Now as to my own opinion on this matter, I do not believe it ever necessary, provided we use the right way, to cut the gum; I will not say it never does any good to perform this simple operation; but I do not consider it at all necessary. I regard, besides, the good effect of it to be in all cases, doubtful. But I freely admit that 1 do not fear the operation as many have done. On a small scale it is a cruel measure; but as to its real in- jury, I think that it is seldom worth considering. But what are we to do in the way of relieving local irritation of the gums ? I answer, first, that general means, such as the tepid or cold-bath, suited to the na- ture of the case, the wet-sheet pack, the shallow-bath, with prolonged friction, and wet compresses, are among the best possible means. We can generally, if not al- OF TEETHING. 181 ways, operate more effectually upon any local part, through general treatment than through local, and yet both have their place, and are to be resorted to. Thus we may bathe a child as often as the fever demands; give him wet sheets, apply friction, put wet compresses about the body, and at the same time make suitable ap- plications to the mouth and throat. Every one knows the good effect of giving the child, when teething, some substance or other to press his gums upon, such as coral, ivory, a piece of India rubber, and the like. Many have recommended a crust of bread; but there are two objections to this article; first, the child gets necessarily more or less of it into the stomach, which is very apt to disagree with it, and thus in the end make matters worse ; and, second, a part of the crust may break off and choke the child. A ring of ivory, India rubber, etc., are in every respect better than the bread crust. If the gum is so sore that pres- sure could be only harmful, it is at the same time so tender that the child will not put any thing into his mouth. The objection then, that these hard substances may do harm is groundless, from the fact I have just mentioned. Rubbing the inflamed gums with the finger wet in cold water, is an excellent means of removing local ir- ritation of the part, and of helping the tooth through. In the later months of teething, the child may be taught to sit by the side of a basin or bowl of water, and dip his own hand into it, and rub the gums. I have known a child to amuse itself by the hour in this way, very 16 182 TREATISE ON CHILDREN. much to its comfort and to the advantage of the teeth and gums. Washing the face, neck, and chest often with cold water, is a serviceable means in reducing the local irritation of which I am speaking. The water may be cold—I care not how much so—and the parts should be rubbed well, if practicable, till they become red. By proper perseverance in this simple way, a great amount of relief may be afforded, and in a very short space of time. 2. In regard to the constitutional symptoms attend- ing difficult dentition, such as pyrexia or general fever- ishness, general irritation and fretfulness, loathing of food, vomiting, costiveness, bowel complaint, etc., we have in water-treatment ample means. We do not have to resort to those barbarous methods, such as " keeping the bowels open by small purges ;" "giving opiates at night," which it is admitted, however, " are not to be given without much circumspection;" " giv- ing calomel or blue pill at proper intervals " when the tfc- stools are bad; " applying leeches to the forehead and a blister to the occiput" if the child is drowsy and the head hot; I repeat, we have in water-treatment incom- parably better, safer, and more effectual means. If the child'is hot, it is but a matter of common s§nse to cool it. And how 1 By washing it in cold water if it is strong, or in tepid water—which is always cool- ing in effect—as often as the case may demand; every hour, or every half hour, if need be, till the fever is wholly quelled. So, too, who cannot understand the good effects of cool fresh air in feverishness. But, asks OF TEETHING. 183 a mother, will not my child having such treatment take cold 1 The answer is, Whenever the body is fever- ish, NO MATTER FROM WHAT CAUSE, THE PATIENT cannot take cold ! After the fever is reduced, of course there is no farther need of continuing the means. " Enough is as good as a feast." And again the mother asks, " suppose my child is stupid, and cannot be roused, what am I to do 1 I an- swer, this is always a dangerous condition, and should not be at all trifled with. I know some stupid mothers are very glad to see their child lie still, no matter what the cause. Some, too, who are by nature active and well-disposed, sit and look on while the child is in stu- por, and do not know what to do. In all such cases, if the mother does not well understand what she is about, and has not the fullest confidence in herself, she should send for a physician, or some one who understands the water-treatment thoroughly, to aid her. As to getting a physician who knows nothing of the water-cure, she had better keep him out of her house—she can do better alone. ' Still, as it is so much more respectable for a patient to die under the hands of a physician, she had better, perhaps, send for one; afterward she can do as she pleases, and if she has for once had the doctor, her neighbors will not be so apt to say that she has killed her child, supposing that she should be so unfortunate as to lose it, in spite of the best possible treatment. Suppose the child is restless and cannot sleep. What then? In general, this condition arises from feverishness, though it might from slight pain in the Btomach or bowels. If the pain should amount to a col- 184 treatise on children. ic, the child would be more than restless—it would cry. For the general fever and restlessness, then, what is there in the wide world so good as a tepid or cool bath, an injection, if necessary, and a wet girdle? Those who have had experience can testify to the good effects of these things. If the child has nausea, loathing of food, or vomit- ing, symptoms that frequently arise from teething, all the means I have spoken of will be useful. The sitting- bath, too, would be excellent, using it as often as it may be needed. Giving water freely to drink—that which is pure and soft, remember, that is, if you can possibly get such—will help much in the stomach sick- ness. There is nothing in the world like pure water to "settle the stomach," in teething, as in every thing else. But we cannot always get a young child to drink; and then the satisfaction is, that the other means are amply sufficient. Sometimes the child will be very much constipated : the bowels will only seldom act, and then not in suffi- cient quantity, the foeces being feverish and hard. This is always an unsafe condition of the system, and the parent should never rest contented till it is re- moved. In teething, as in any other case, we treat it by regulating the diet on proper physiological principles, by injections, sitting-baths, the wet girdle worn con- stantly, general ablutions, and, if necessary, the packing wet sheet used two or three times a day till the difficulty is mastered. Who does not know that the more we give drugs for constipation, the more we may? or OF TEETHING. 185 rather, at this day, who is there that should not know the fact? And in bowel complaint, how salutary are sitting- baths, the wet girdle, general ablutions, injections, and, in short, the whole course of treatment adapted to such a case! How many children die every week, especially during the hot season, in New York, in great part for the want of these simple, everyday means ? We treat, then, the bowel complaint that occurs dur- ing teething, on the same general principles that we would any other attack of the same kind—always ac- cording to the nature of the case; no two, perhaps, precisely alike in all respects, for we never find any two cases exactly similar, but still on the same great principles which govern us in the management of this class of diseases. Should the child become afflicted with cutaneous eruptions, as is often the case during teething, the greatest caution should be observed in regard to exter- nal applications of a drug or medicinal kind; these should, in fact, be wholly avoided. This is particu- larly important in regard to discharging sores behind the ears, and eruptions about the head. " The appli- cation of drying, or repelling substances," says Dr. Eberle, " may lead to the most violent and dangerous consequences." "Indeed, these affections," continues this author, " like the copious secretion of saliva, may have a favorable effect by deriving the irritation and preternatural flow of blood from the brain and other internal organs. If the external affection be sup- pressed, the sympathetic irritation will not be sub- 186 TREATISE on children. dued, but only transferred to some other part of the system. If it falls on the brain, as it often does, con- vulsions, or dropsy of the brain, may be the result; if on the lungs, severe pneumonic or cynancheal affections may be the result; and if the stomach and bowels re- ceive the introverted irritation, rapid and unmanagea- ble diarrhea or cholera infantum will probably ensue." This, as Dr. Eberle affirms, is no imaginary view of the evil consequences that may result from an improper meddling with the eruptive affections of a scabby or humid character, about the head, during dentition. In these, as in all other affections that occur during teething, we are to treat the case on general principles. We need not worry ourselves about healing the parts. It is no harm to keep wet compresses upon them ; and to keep the parts most scrupulously clean is, of course, salutary and good. When the system gets into a proper condition, soon enough the eruptions heal. During teething infants are liable to a peculiar croupy affection, of a spasmodic character, and de- pendent evidently on cerebral irritation. It is attended with much difficulty of respiration, and the hoarse, pe- culiar cough of ordinary croup. The attack is said always to be sudden, and generally of short duration, seldom continuing for more than fifteen or twenty min- utes, and often a much shorter time even than that. The attacks may come on almost every night for weeks. After teething is accomplished the affection ceases of itself ordinarily. But this, as all other af- fections that occur during dentition, is modified to a great extent by the general management of the case. OF TEETHING. 187 Slow and difficult teething is sometimes attended with a peculiar cough, of the spasmodic or nervous . kind, and which causes the parent a good deal of trou- ble and alarm. It comes on in sudden and violent paroxysms, at irregular intervals, and more or less re- mote. The breathing, during the fit, is suffocative and oppressive ; and it generally continues until the contents of the stomach are thrown off. The child is apt to be more restless at night, the breathing peculiar and irregular, being at times extremely hurried and short, and then again slow, and perhaps interrupted by sighing and moaning. In some of these cases the urinary secretion becomes small, and is voided, evi- dently, with a good deal of pain. After the teeth are all cut, it generally subsides of itself. Much, how- ever, may be done to arrest or modify its course. In many of these cases the principal difficulty is lo- cated in the stomach. In these instances the stomach is swollen more or less, the bowels disordered, and the discharges glairy and bilious. The fit of coughing, in these cases, is more apt to come on soon after nourish- ment is taken into the stomach, and it continues gene- rally till the organ clears itself of its contents. In these cases of disordered stomach much may, of course, be done in the way of palliating the difficulty. For this object we proceed just as we would in any other similar case. I have already in this work repeatedly urged the ne- cessity of giving great attention to the subjects of pure air, exercise, diet, and bathing, in the management of young children. Much as has been said, however, on 188 TREATISE ON CHILDREN. these points, a few remarks more appear to be necessary in this connection, and more especially concerning the effects of country air. "Nothing," says an accurate observer, "tends so di- rectly as the constant enjoyment of a pure air, to coun- teract and subdue that nervous irritability which is the characteristic of infancy, and the source of so many of its diseases. If a child spend some hours daily in the open air, occupies a large and thoroughly ventilated apartment within doors, and is not overfed, it rarely suffers much from teething. Whereas, when it is taken out to exercise only at distant and irregular intervals, and is cooped up in a warm or ill-ventilated nursery, it is placed in the situation of all others the most likely to render dentition a process of difficulty and danger, because such are precisely the circumstances most calculated to increase its already predominant irri- tability." The First Annual Report of the Registrar General for Great Britain, as quoted by Dr. Combe, strikingly exemplifies the good effects of the pure atmosphere of the country as compared with that of large towns and cities. In this Report there is given an abstract of the causes of death in the thirty-two Metropolitan Un- ions, containing a population of 1,594,890, and a cor- responding abstract of the causes of death as occurring in the Unions of the counties of Cornwall, Devonshire, Dorsetshire, Somersetshire, and Wiltshire, containing a rather larger population of 1,599,024. According to these abstracts it appears that, out of an equal pop- ulation, the number of deaths from teething is six OF TEETHING. 189 times greater in the impure and crowded atmosphere of the Metropolitan Unions, than in the comparatively « pure air of the country, the actual numbers being 477 in the former and only 78 in the latter. It appears also from this Report, that in another country popula- tion of 1,656,455, only 75 deaths occur from teething, while in a smaller town population, no less than 524 deaths were caused by it in the same space of time, being about seven times greater than in the purer air of the country. Such facts need no further comment. In regard to exercise, light, clothing, and diet, all that has been insisted on in the foregoing pages of this work, should be most carefully considered in reference to get- ting the child safely through the period of dentition. It should always be remembered that this period is one the most precarious of its whole life, and that conse- quently there is no condition in the whole range of human responsibility in which it is more necessary to observe all good physiological rules than in reference to the time of which we have been speaking. Nor is there any con- dition in which a parent will be better rewarded for all the pains and trouble he may take for his child. CHAPTER XVIII. The Diseases of Infancy and Childhood—Hare-lip—Imperforate Anus—Imperforate Urethra—Imperforate Meatus Auditorius— Adhesions of the Eyelids—Hernia, or Protrusion of the Umbili- cus—Rupture of the Abdomen—Spina Bifida. Having considered the physiological management of children in the preceding chapters of this work, I am now to speak of the diseases peculiar to infancy and childhood. Always after the birth of a child, it is necessary to ascertain whether it has any congenital imperfection, or whether it has met with any accident during the delivery. If any such imperfection exists, or if any accident has happened, it becomes a question of serious importance, both to the parent and the medical attend- ant, as to whether the imperfection or accident come within the control of medical or surgical treatment, and if so, at what time such treatment should be re- sorted to. Hare-Lip.—One of the most common among the congenital imperfections to which the human system is liable, is hare-lip. And in the treatment of this often formidable difficulty, we have an exemplification of the great value of that noble art, surgery, when practiced rightly, and in its proper place. This affection may exist in very different degrees; but most cases are, to a DISEASES OF CHILDHOOD. 191 great degree, remedied if a suitable operation be per- formed. As to the time : it has sometimes been done very soon after birth. But it is thought best by oth- ers to be safer, and in every respect better, to wait till the child is ten or twelve months old. It is, probably, better to wait at least some months, because in doing so we lose nothing as regards the prospect of success, and gain in regard to the vigor of the child, or, in other words, to its ability to endure the operation. There is one inconvenience, however, in waiting; the child must, in most cases, be brought up on the spoon until the difficulty is remedied. Sometimes, however, when the defect is but trifling, the child can suck very well, particularly if the nipple is large, and the milk flows freely. It is not necessary, in a work of this kind, that I should describe the operation necessary to be per- formed for the remedy of this deformity. That is the surgeon's business, whereas I am now writing only for the non-professional reader ; and no one of this class, certainly, would undertake an operation of the kind in question. Imperforate Anus.—This defect, also, may exist in different degrees. There may be an appearance of an opening—the anus—but an obliteration higher up. This may be ascertained by introducing a silver probe, a gum-elastic catheter, or simply by introducing the little finger, or a roll of oiled paper, up the part. If we find resistance, we may know that imperforation exists: of course a suitable degree of care should be exercised in all such operations; as a little undue 192 TREATISE ON CHILDREN. rudeness upon these delicate parts of the young infant might be attended with serious consequences, of a last- ing, if not life-long nature. The examination should be in good season, that is, we should not wait many hours, provided the bowels do not act as ordinarily, soon after birth. Sometimes, in this deformity, there is only a thin membrane found stretching across the anus. In this case the difficulty is easily removed. In other cases the rectum itself seems to be quite obliterated. In other cases it may terminate in the bladder of the male, or in the vagina of the female. In the last in- stance, the result might not necessarily prove fatal; but in the former it could hardly fail of being so. In the operation for remedying this difficulty, an opening is made where the anus should be, sometimes to the extent of an inch or more deep; after this, pro- vided the bowel is reached and a free opening is made, a gum-elastic plug, or catheter, or some other suitable substance, must be kept introduced in order to prevent the part again closing up ; and it may be necessary to continue this for a whole year or more, all of which the surgeon will be, in each individual case, the proper person to determine. If it is found impossible to make the desired open- ing into the rectum, what is called an artificial anus is sometimes made at the left side into the colon. This is, of course, a very delicate operation, and should be undertaken only by those who are well acquainted with the nature of the difficulty, and location of the parts to be operated upon. DISEASES OF CHILDHOOD. 193 Fortunately, this congenital deformity is very rarely met with; and for the consolation and encouragement of parents, it is to be remarked that death does not necessarily attend it if an operation is not performed. There is on medical record—in the Revue Med., for 1833, as quoted by Dr. Burns—an account of a man, then alive, and aged seventy, who had both the anus and urethra imperforate; and although he was always, for this long period, under the necessity of voiding both the feces and urine by vomiting, his life was no doubt like that of most men, a blessing rather than a curse. It is a question whether, in some cases, where an ope- ration has been performed, destroying the life of the patient, nature would not in some way or other have helped herself, and life have been saved. Still it should always be remembered, that in many cases art can be made to supercede nature; that surgery, cruel as it appears to the uninitiated, is yet often a most necessary and useful means. Imperforate Urethra.—This is not a common deformity; and generally where it appears to exist, the urinary canal opens somewhere between the scro- tum and penis. It would not, in this case, be advisa- ble to operate upon the young child; but after he has grown up to years of understanding, an operation may be entered upon with the view of extending the canal to its proper termination. Imperforate Meatus Auditorius.—This is of rare occurrence, and can seldom, if ever, be remedied, except where the deformity consists simply in a mem- brane being stretched across the canal of the ear. 17 194 TREATISE ON CHILDREN. Adhesion of the Eyelid.—When this occurs, it is often complicated with a disease of the eyeball itself. If this is not the case, an operation will, per- haps, be advisable, and much more likely to be at- tended with success. |V Hernia, or Protrusion of the Umbilicus.— This deformity may exist at birth, or it may take place months after. Between the second and fourth months we are, probably, more likely to find it than at any other period. Sometimes the protrusion is only a trifling affair % but at other times a large portion of intestine is found forced into the sheath of the umbilical cord. In this case it is found that, do what we will, the child gene- rally dies within forty-eight hours. Still, on the prin- ciple that always, while there is life there is hope, we should do what may be done with the hope of saving the child. We should do, indeed, as faithfully and diligently as if we supposed we were certain of success. And the physician may always rest assured that al- though he may fail of effecting the desirable object, and be obliged to see his best efforts ineffectual, he will yet enjoy the gratitude of the parents for what he has done. It is necessary he should always re- member that it is the part of a true physician to at- tend the dying as well as those who are to live. Nor need he be afraid in so doing that he will lose favor among his patrons; but, on the contrary, the more faithful he proves himself in cases of dreadful emer- gency, the more will his benevolent, though trying la- bors be appreciated and felt. DISEASES OF CHILDHOOD. 195 In these cases, however, where the protrusion is but slight, and where the bowel has not passed out far into the cord, a cure may, with certainty, be effected. There are various modes of doing it; one of which is simple pressure, kept lip steadily upon the part. One of the best modes is to place a suitable pad of linen cloth upon the protrusion, securing it with long strips of adhesive plaster, applied to it in different directions. This is a simple procedure, and may sometimes be ac- complished by the mother herself. In general, how- ever, it will be found better to call in a competent medical attendant. Physicians, having more than parents to do with matters of this kind, are to be sup- posed to know most about them. The following mode of treatment, according to Dr. Coley, will be found invariably successful: " A coni- cal pad, composed of successive layers of adhesive plaster, spread on thick, white leather, should be ap- plied, with its apex on the tumor, and confined by means of a strip of adhesive plaster, long enough nearly to surround the body, and two and a half or three inches in depth. The pad and long plaster should be re- moved, and renewed once a week, or oftener, when they become loose. By this proceeding the cure will be completed in a few months." Rupture of the Abdomen.—This is found to occur far oftener than rupture of the umbilicus. In general it should be treated by the surgeon. In many cases, however, little or nothing can be done except attention to the general health, and in all cases of rup- ture it should be remembered that the constitutional 196 TREATISE ON CHILDREN. treatment—that which goes to invigorate the system— has much to do in curing as well as preventing the difficulty. It should be remembered, too, that parents often, by their carelessness in dressing the child too tightly, and often by allowing it to cry to an undue extent, are the means themselves of bringing on this formidable difficulty. Spina Bifida.—This is an affection of the vertebral canal, and, perhaps, also of the spinal marrow itself. It is not often to be met with. In this disease, one or more of the bones of the spinal column is defective, the back or posterior part being wanting. A tumor pro- trudes at the part, which is supposed to contain a fluid. The skin covering the tumor sometimes appears like that of the surrounding parts, but is oftener found thinner, of shiny appearance, and purple or reddish color. At birth it may be as large as a common chestnut; later, if the child survives, it becomes a good deal increased in size. The fluid contained in it may be of different colors. The tumor may appear upon any part of the spine from the neck downward; but it happens oftener in the lumbar region. This disease is said generally to be connected with hydrocephalus, always with dropsy of the spinal sheath. The lower extremities may or may not be paralytic, and the urine and feces may or may not be discharged involuntarily. This disease is almost always a fatal one. A child may live-on for weeks, months, or even years, and in some very rare instances cures have been effected. CHAPTER XIX. The Diseases of Infancy and Childhood continued—Tongue-tie— Club-foot—Congenital Dislocation of the Hip—Swelling of the Scalp—Marks and Blemishes—Inflammation of the Eyes—Dis- charges from the Nostrils—Running at the Ears—Ulceration of the Navel—Hemorrhage from the Navel. Tongue-tie.—When the frenum linguae—in common language, the string which holds the tongue down to the lower part of the mouth—is too short, or is attached far forward, the child is what is called tongue-tied. As long as the difficulty is not remedied, he can neither suck well nor speak as distinctly as he should. The affection, if such it may be called, is a rare one, and not unfrequently when it is supposed to exist there is no real need of an operation, nature in time appearing to do her own work. The best test as to whether an op- eration is necessary, is to introduce the finger into the child's mouth. If he sucks it readily, we may know that the operation is not at all needed, although very likely the mother believes that it is so. The remedy for this defect consists in dividing the frenum linguae with a pair of sharp scissors—blunt- pointed ones are the best—to a sufficient extent to let the tongue loose. Care must be taken in operating, lest a vein or artery be wounded, in which case a trouble- some and possibly fatal hemorrhage might ensue. 198 TREATISE ON CHILDREN. Club-Foot.—This is not an uncommon deformity, and it is sad to see how many are walking about with distorted feet, who might have been cured, or greatly benefited, by almost any good mechanic. The foot, in this deformity, may be turned either inward or outward, and sometimes even backward or upward. Pressure is the great thing for remedying club-foot. It should be made gradually and constantly by means of bandages, splints, etc., and in some cases it will be necessary for the surgeon to divide some of the tendons. of the part. The earlier the treatment is commenced the better the prospect of success. Congenital Dislocation of the Hip.—This dis- ease is very seldom met with ; it is more common in cities where scrofula is oftener to be found. It is seldom, if ever, a curable disease, owing to a defect of the socket of the joint. Swelling of the Scalp.—After birth, especially if the labor has been a severe and protracted one, there is sometimes observed a circumscribed swelling upon the top of the head. The sack seems to contain a fluid, having hard and well-defined edges, so that one unacquainted with the difficulty would naturally sup- pose that the bone was deficient. This swelling soon cures itself without any treat- ment. It would be well, however, to wash and gently rub the part a number of times daily, and to keep wet compresses upon it. Marks and Blemishes.—These are comparatively frequent, and may occur on any part of the body. DISEASES OF CHILDHOOD. 199 There are two kinds of marks : First, simple discol- ored patches of the skin, generally of purplish red color, and not elevated. They do not appear in any way to injure the constitution, and are certainly, in no respect, attended with danger. They can in general be cured by destroying the skin with caustic, or by re- moving it with the knife ; but the scar which would of necessity remain, would be quite as bad as the original defect. Hence they are seldom meddled with. The second kind of blemishes of this nature, called naevi, are those which are elevated, spongy, and highly vascular. If they increase, as they are apt to do, they are liable to burst, and be followed by excessive and, perhaps, fatal hemorrhage. They may be seated on almost any part, as the eyelid, lip, face, etc. When upon the spine, they resemble spina bifida, but are more solid, and the bone is not deficient. It is advised by many surgeons that these naevi be removed as soon as they begin to show the least signs of increase. If they are situated upon the gums, or any part within the mouth, it is particularly advisable to remove them, because of the great vascularity of these parts. When upon the palate or tonsils, they are considered to be particularly dangerous. The surgeon can in general readily remove them, and with very little pain or trouble, and wholly without danger. The best method is to introduce under the naevus a fine needle, and then to tie a ligature about the part. In this way it is hung, as we may say, and the death of it must necessarily take place. It then sloughs off, and a small scar only remains. 200 TREATISE ON CHILDREN. Local applications, by means of cold or pressure, which are sometimes recommended, cannot at all be relied on; a blister, or a succession of blisters, may in some of the slightest cases effect the object. Inflammation of the Eyes.—The new-born in- fant is not unfrequently attacked, very soon after its birth, with an inflammation, more or less severe, of the eyes. It may begin within the first two or three days, the eyes seeming at first to be glued together, after which a thick pus is discharged. The inside of the eyelid is found to be very red at first, but, before long, they swell so much that they can only be opened with difficulty. If the child cries, the lids turn outward, not unfrequently, and their inner surface is covered with pus. If the inflammation is allowed to go on, and in some cases it must probably, do what we will to arrest it, the cornea in a few days becomes affected, a thin film gathering over it, so that after a while—a few weeks only in some cases—the eye is lost. Causes.—A depraved state of the child's constitu- tion seems to be the most common cause of inflamma- tion of the eyes. In the asylums, if children are kept well in every respect, having good food, air, water, and especially if a proper regard to ventilation and cleanli- ness are observed, we seldom, if ever, find this dis- ease. But as things are often managed in public institutions of this kind, we often see ophthalmia pre- vailing among the children ; and once the disease gets started among them, there seems to be a great diffi- culty in controlling it. In the new-born infant there is one cause to which diseases of childhood. 201 this disease is attributed by medical men which* should be particularly noticed. It is believed, and there can, I think, be no doubt of the truth of the statement, that leucorrheal matter getting into the eye at the time of the birth causes the eyes to inflame. Now if a married woman is troubled with leucorrhea—and how often is this the case ?—she should do every thing in her pow- er to have it cured before she allows herself to bring forth a child. Who would wish to become a mother while she has upon her a most offensive disease, which may communicate itself to her offspring, and perhaps render it blind. But suppose that, either ignorantly or otherwise, she has become pregnant, and is about to bring forth a child ; a great deal may be done by way of sitting-baths, tepid clysters to the vagina, wet sheets, and other hydropathic means. Even during labor, and as near up to the time of delivery as may be, she should take sitting-baths, so as to expose the child as little as possible to the acridity of the discharge. Treatment.—One of the best possible things in all inflammations of the eye—and particularly those of a purulent kind—is frequently to wash out thoroughly with tepid water the affected part. In no disease is the most scrupulous regard to cleanliness better reward- ed than in this. A piece of soft linen, a soft sponge, or perhaps better, a small eye syringe may be used. At all events, make thorough work in cleansing the part. This, with appropriate constitutional treatment, will in most cases be found successful. But the treat- ment must be persevered in diligently according to the necessity of the case. The more we can do in purifying 202 TREATISE on children. and invigorating the constitution of the child, the better we shall succeed. It is highly recommended by some—and there can be no doubt of the good effect of the application in many cases—that we put once or twice a day into the eye, by means of a soft brush, a few drops of a solution of ni- trate of silver in pure soft water, of the strength of four or five grains to the ounce. Other of the astringent metallic solutions have also been recommended, such as sulphate of zinc, copper, muriate of mercury, etc. But the nitrate of silver is probably the best application of the kind. I would, however, rather trust to pure soft water than any of these. Blisters, also, are highly recommended. They are placed upon the back of the head, back of the ears, upon the temples, and even over the eyelids. There can be no reasonable doubt of the good effect of these applications, so far as the eye is concerned—in many cases at least; but it should be observed, that blisters often bring harm upon the constitution. I would not myself, in any case, use them; not but that they may in some cases do more good than harm, but there are better means ; means, too, which are more effectual for good, and can be attended with no possible harm. It will readily be inferred, that in inflammation of the eyes, as in all other inflammations, the diet of the child should be light. If it is a nursing child, the mother should not allow it to take the breast every time it cries or manifests a desire to do so. It is better to allow it to worry and cry a good deal than to expose it to overfeeding. The mother should also keep her is DISEASES OF CHILDHOOD. 203 breasts well drawn at all times, in order to prevent the milk becoming feverish. She should also remember that it is of the utmost importance that her diet is of a mild and unstimulating kind, since the food she takes affects the child quite as much as herself. She should likewise, if it be possible, avoid undue watching, care, and fatigue; for all these may affect materially her health, and consequently, the quality of her milk, on which the health of her child so much depends. Discharges from the Nostrils.—Infants and young children are sometimes affected with very offen- sive discharges from the nostrils, so much so that it is disagreeable to come near them. The mucus dries and comes away in thin pieces. Treatment.—In this affection a great variety of re- medies have been recommended ; both local and general remedies have been administered, the first with a view to correct local difficulty; the latter to operate upon the local difficulty through the general health. It is acknowledged, however, that medicinal applications often fail of doing any good. As to local treatment, pure soft water administered sufficiently often to ensure constant cleanliness, is be- yond doubt the best application that can be made. For the general treatment, suitable bathing, diet, exercise, that is, being carried out frequently, particularly when the weather is fine, into the open air, in short, just that course of treatment which is best calculated to invigo- rate the general health, is the only truly rational course to be pursued. The day of drugging children with the hope of benefiting their condition, is now—thanks to 204 TREATISE ON CHILDREN. the water treatment—fast passing away. Nor need we fear a return of these delusions, so long as steam- boats, railroads, and the magnetic telegraph continue to be used. Running at the Ears.—This often attends ear- ache. A great many children in the cities are troubled with it, and deafness is not unfrequently the result. In such cases too great care cannot be taken in re- gard to cleanliness of the affected part. The ears should be syringed out with tepid water, pure and soft, but never with cold; the latter, although it might in some instances be borne, would in others do harm, and is never so good as the lukewarm. Too warm wa- ter would be as bad, and probably worse than the cold. A temperature of from 80° to 90° F. will be found the best. I repeat, the water should be pure and soft. I have seen the most marked effects in these affections of the ear, from sending the child out of the city—I speak of New York—in the summer season, to some healthy part. I have seen a child that had been troub- led with earache and running at the ear almost every month of its existence, very soon recover on being sent, pretty early in the spring, to Oyster Bay, Long Island, a most beautiful and healthful locality, and where the water is as pure and soft as that of any known place. The child would probably have died if it had been kept in the city, although it was bathed every day from its birth, and much more than ordinary pains taken in re- gard to its diet and general management throughout. The Croton is very good, but there was always one import- ant thing lacking—good air. Even in the cold season, DISEASES OF CHILDHOOD. 205 and in the most healthy parts of this great city, the at- mosphere cannot possibly be so pure as it is in a healthy location in the country. So much for the good effects of good air and good general management in cases of running at the ears. Swelling of the Breasts.—Children sometimes have a swelling of the breasts soon after birth. In con- nection with the swelling there is sometimes a secretion of milky fluid. Mothers are apt to think they must be very particular in squeezing this out, and it is said that much injury has sometimes been done by the force thus used. There is no harm in using a moderate degree of pressure in this way; but more than that is neither necessary nor useful; and it should be remembered, that squeezing out the milk tends rather to keep up the discharge than to dry it up. Hence, the less that is done in this way the better, except in urgent cases, where palliation may warrant a moderate use of the means. It is an erroneous notion that these enlarge- ments proceed from a quantity of milk within the breasts of the infant at birth, which must be squeezed or milked out that mischief may not follow. This wrong opinion has in some cases led to the mischievous practice just alluded to, in consequence of which the parts have be- come so irritated as to occasion much pain and increase of inflammation. The part has been too violently pressed with the view to force out the milk-cake as it is called ; but no milk appearing, the effort is renewed again and again, and each effort with an increase of force. The consequence, in some cases, has been an inflammation 18 206 treatise on children. and suppuration of the parts, which has forever destroyed their usefulness. Treatment.—Wet compresses used according to the degree of heat in the part are better than any of the poul- tice applications usually resorted to in such cases. Friction, likewise, with the wet hand is preferable to that with oil or any other substance. But remember, no undue pressure, no rude maneuvers should ever be allowed upon these delicate parts. Ulceration of the Navel.—Always the separa- tion of the umbilical cord, causes more or less of ulcera- tion ; this is, indeed, the only way by which nature can effect the necessary separation of the dead from the liv- ing part. But in general, and especially if the child is of good constitution and healthy, this process is very trifling and causes no trouble whatever. But in other cases the result is very different; a troublesome and of- fensive ulceration continues, which may prove very diffi- cult to heal. Treatment.—Here, as in all cases of ulceration and festering, the strictest cleanliness should at all times be observed. We use, also, wet compresses, changed frequently to promote healing. There is no application in nature, let it be remembered, that will at all compare with water for promoting the healing of a sore part. The best attention should also be paid to the constitu- tional treatment. Sometimes in hot weather, particu- larly if it be in a city, it will require weeks, or perhaps months, to cure ulceration of the navel. A great deal will depend on good management throughout; and from beginning to end we are to proceed in its cure, upon diseases of childhood. 207 the same principles as in any other case of ulcera- tion. Hemorrhage from the Navel.—In my work on midwifery I have spoken somewhat at length on the subject of hemorrhage from the navel. It will be ne- cessary, however, here to speak particularly of this ac- cident. In general there would be no bleeding—none, at least, of consequence—if the umbilical cord were not tied as it is customary to do. But in some cases bleeding takes place even after the cord has ulcerated and come away. This can happen only in a depraved constitution, or when the child's dress is improperly applied. Thus, if it is bandaged, or in any wise dressed too tightly, the circulation as a consequence becomes deranged, the blood is forced in improper directions, and bleeding may be the result. But in a really healthy child properly managed, hemorrhage could no more take place than in an animal; and with animals we never see any such occurrence. But in practice we have to take things as we find them, and not as they should be. After a hemorrhage has commenced we cannot go back to the remote cause ; we must deal with it as it is. Treatment.—In most cases this kind of hemorrhage will cease by simply removing all pressure from the child's body, by astringents locally applied, and par- ticularly by the cold bath. Some cases, however, prove exceedingly obstinate, and lives have been thus lost. " The actual cautery," says Dr. Burns, " has been proposed, or nitrate of silver, or cutting at the navel, 208 treatise on children. and applying a ligature at the end of the vein, which is supposed to bleed oftener than the arteries." " I have known from experience," continues this author, " that no compress can at all times be depended on, except the point of the finger, and that cannot well be steadily applied for hours or days in succession; yet in obsti- nate cases, I know no safer nor better plan, the assist- ant being relieved at proper intervals for some time, both night and day." Dr. Burns gave this opinion from finding other means, apparently more powerful, fail. Strong astringents, or escharotics, caustics ap- plied so as to form an eschar, a ligature carried, by means of a needle, round the umbilical aperture, and tied tightly, the twisted suture, made by crossing two needles, and working the whole navel over tightly with thread, have, according to Dr. Burns, all failed, and appeared,. by propagating inflammation to the peritoneum, to hasten death. I have never myself witnessed a case in which there has been any serious difficulty in arresting this kind of hemorrhage. I know there may be cases where me- chanical means, such as compression, ligature, etc., may be needed; cases, in which nothing else would an- swer. But I am also equally certain, that there are multitudes of cases where severe and harsh measures have been deemed necessary, when the simple applica- tion of cold wet cloths frequently made over the abdo- men, and the repetition, if necessary, of the cold bath would have been amply sufficient, nay, indeed, have saved life, and this when every other means has failed. The best part of this whole matter, however, is, that diseases of childhood. 209 if parents will but persevere in carrying out the rules of health from beginning to end in the rearing of in- fants and children, they will have no need of the appli- cation of such knowledge as I have now been communi- cating. I repeat, if parents themselves observe the laws of nature, and manage their children in a manner ac- cordingly, they need not fear anj thing from the oc- currence of a hemorrhage such as I have been speak- ing of. CHAPTER XX. The Diseases of Infancy and Childhood continued—Absence of the Skin—Jaundice—Discharges from the Vagina—Prolapsus Ani, or falling of the Bowel—Hemorrhoids or Piles—Diabetes—Re- tention of Urine—Incontinence of Urine—Painful Urinating. Absence of the Skin.—For nearly two months the fetus in the womb is supposed to have no epidermis. About the end of the second month, however, the skin begins distinctly to show itself. For some months longer—till about the middle of the period of pregnan- cy—it is simply a thin, colorless, transparent mem- brane, after which, it assumes a more reddish or rosy appearance till about the eighth month ; it then assumes a paler hue, except in the folds. About the middle of pregnancy the sebaceous follicles begin to appear, first upon the head, and afterward upon other parts of the surface. The skin may be absent or deficient at birth in one or more parts of the body; but in connection with this state of things, there is almost always a deficiency or absence of the parts beneath. The skin covering the abdomen, chest, or head is deficient when the osseous or muscular parts of these cavities are absent. When a considerable portion of the skin is deficient in the fetus, the borders of the defective parts are red, a little hardened, and adherent to the subjacent parts ; there diseases of childhood. 211 is, in short, all the appearance of a true disorganiza- tion. Causes.—It is perhaps impossible to determine in all, or in many cases, how this destruction of the epidermis is effected. If the uterus contain within its cavity some morbid growth or production of sufficient size to alter considerably its size and form, the compressing part may so operate upon some part or parts of the fetus, as to cause absorption of the skin. It was also the opinion of Hippocrates, that a blow upon the abdomen of the mother, during pregnancy, is liable to cause a corresponding degree of injury to the fetus at the part on which the force of the blow is received. Different authors have also noticed facts which have been sup- posed to favor the hypothesis. The destruction of the skin may also be produced in the embryo by a tumor or morbid growth upon itself. We sometimes see rickets existing in the new-born child without the skin being disorganized; but the progress of the swelling or tumor more frequently pro- duces a thinning of the skin which covers it, followed by ulceration and rupture. The same which is thus observed after birth may also take place in the uterus ; and, according to Dr. Billard, it is, without doubt, in this same manner that the thinning or ulceration of the skin which covers the tumor of spina bifida in some children at the period of birth takes place. Treatment.—In this, as in all other chronic ail- ments, our most important object is improving the general health. If we wish to promote the growth of any particular part, we are to aid nature as much as 212 treatise on children. possible, by augmenting her forces to the greatest pos- sible extent; and there is much more depending upon such a course in effecting this object then is generally supposed. As for local applications, soft, wet linen cloths, kept very clean, changed often, and covered with dry ones, if the part is not too hot, are the best known healing means. Water, properly used, is the greatest of all agents for promoting animal as well as vege- table growth. This, although comparatively a new fact in the world—one at least which has, until of late, been understood only by a very few — is destined to work the greatest changes in the healing art. In the treatment of deficient skin, it is not unfre- quently necessary to contrive some means or other for protecting the organs which are deprived of their nat- ural coverings. For this purpose bandages are in va- rious ways applied. In closing my remarks on this subject, I will men- tion that my friend Dr. Gleason, now of the Forest Water-Cure Establishment, near Ithica, N. Y., but late the Glen Haven, on Skeneateles Lake, informed me that at the latter place he effected the cure of a boy, who was born almost wholly without any skin. All other means had proved ineffectual until water was resorted to. Under the judicious care of our friend, the happiest results were brought about. Jaundice.—After the child has become two or three, or at most a few days old, it is not an uncom- mon thing for it to be attacked with jaundice, or a yel- DISEASES OF CHILDHOOD. 213 lowness of the skin. This appears, in many cases, not to be a true jaundice, but only a discoloration of the skin, which is in no perceptible way connected with biliary derangement. In real jaundice the liver is always more or less affected; it does not perform its office properly—that is, it does not separate the bile from the blood as it does in a state of good health, but allows the yellowness of the blood to pass onward through the circulation, and hence the discoloration of the skin, eyes, urine, etc., and the absence of the proper degree of yellowness in the feces. If, therefore, the child's skin turns yellow soon after birth, we are to turn our attention to the white of the eyes, to the color of the tears, and to the urine. If all these are tinged with yellow, or are more than ordi- narily so, and if the feces are at the same time less yellow than is natural, of a clayish color, as we say, we are to call it a case of genuine jaundice. But if these appearances do not exist, there is, to say the least, doubt in the matter. In the majority of cases this discoloration of the skin will be found to come on within three or four days after birth. In most cases, likewise, it is not attended with any perceptible deterioration of the general health; it requires no special attention, and gradually disappears of itself in a short time. But there are cases now and then to be found, that assume a very different aspect. Thus, for example, if, in connection with the symptoms above mentioned, the bowels become constipated, if the abdomen swell and become hard, if there be vomiting of a white, glairy 214 TREATISE ON CHILDREN. mucus, if there be hiccough, and the child become restless, uneasy, and emaciated, it is necessary that something prompt and decided be done. Sometimes the fault is all in the mother's health. A mother having the jaundice is almost certain of com- municating it to the child she nurses. In such cases it is necessary to cure the mother herself, or all our efforts with the child would be unavailing. Dr. Dewees regards, " that when a genuine attack of jaundice comes upon a new-born child, it is but too often fatal, with whatever propriety or energy we may attempt to relieve it." And this author further re- marks, " that it is generally recommended to com- mence the cure by an emetic, for which there is the authority of Armstrong, Underwood, Burns, etc." But in his own practice he had not only found emetics to fail in removing the disease, but rendered the stom- ach so irritable as not to receive any other remedy wil- lingly. The application of leeches and blisters have also been extolled in this affection. The latter rem- edy, as well as emetics, are absolutely dangerous in the treatment of infants, and as for abstracting blood, it is, to say the least, not the best method that can be adopted. The same thing also is to be said of calo- mel, which, in the old practice, is universally resorted to in such cases. But Dr. Eberle admits, " that in some cases the calomel fails to excite the action of the liver, and causes injurious irritation of the mucous membrane of the bowels, giving rise to frequent small turbid watery discharges, attended with severe griping and increased abdominal tenderness." JAUNDICE. 215 But if we were to admit that all the drugs, orthodox and otherwise, which have been recommended in this affection were harmless—which, by-the-by, is very far from being the case—there are other, and by far more efficacious means, and these are, the simple processes of the water-cure. But water, simple as it appears, is complex in its action, and requires as much skill in its administration as calomel, opium, and blisters. But there is not a hundredth part the danger in the use of the former that there is in the latter. What then are we to do in a case of jaundice of the young infant ? The patient, we must remember, is a very delicate one, and must not be treated in a man- ner too harsh. In the first place, we should give it a wet-sheet pack two or three times daily, and a wash-off with water that is not too cold. Neither should it be too warm, as that would weaken the child and so make it worse. From 60° to 80° Fahr., according to the season of the year and strength of the child, will be appropriate. These applications will operate most favorably in re- gard to changing the color of the skin, and in promot- ing the strength. In the second place, we should keep the wet girdle constantly applied. It should be re-wet every three or four hours at the very least, and oftener if the stom- ach or bowels should become much disordered, or if there should be much heat in these parts. If the child should be troubled with hiccough and vomiting, we should get it to swallow some pure, soft water if we can, and at the same time giver the slightly 216 TREATISE ON CHILDREN. tepid shallow-bath, renew the wet girdle, and, if ne- cessary, repeat oftener the wet-sheet pack. Tepid clysters are at the same time useful. If the bowels are costive, the tepid clysters should be given as often and as freely as the case demands. All the other appliances named aid also in promoting a healthful action of the bowels. As to the nursing or feeding, the same general rules apply here as in other cases of severe disease. The above treatment is, I repeat, incomparably more powerful for good than that by calomel, opium, etc.; and if faithfully applied, can seldom, if ever, fail in effecting a speedy cure of the disease in ques- tion. Discharges from the Vagina.—It sometimes happens that very young children suffer from a dis- charge at the genitals, of a thin, watery, but acrid fluid, or it may be of matter having a purulent appear- ance. This affection uproceeds in almost all cases from a manifest cause. " When it occurs in very young sub- jects," says Dr. Dewees, " it almost always proceeds from a neglect of cleanly attention to those parts, either by withholding a frequent use of lukewarm water, or permitting the child to remain too long wet." Children of more advanced age are likewise subject to discharges from these parts. In these cases it is more apt to be of a purulent character, and arises evi- dently from a morbid action of the mucous membrane of the vagina or more external parts. The complaint is apt to commence about the fourth or fifth year, and, FALLING OF THE BOWEL. 217 if neglected, may continue to puberty, or even to adult age, causing in the end fiuor albus, or whites, and derangement of the menstrual function. Treatment.—In the first-mentioned variety of this affection, simply washing well the parts with tepid water, and, if necessary, with the addition of a little mild soap, will soon effect the object. If, however, it should prove at all troublesome, we should resort to active constitutional treatment to correct the morbid tendency of the system. In the local treatment we should syringe out the vagina, if necessary, several times a day with tepid water, or mild soap-suds, finishing, however, in such case with pure water alone. In the second form of the disease, that which occurs after the period of infancy, we have also to pay the strictest regard to cleanliness. These cases will be found more persistent and difficult of cure than those of younger subjects. They will also need more thor- ough constitutional treatment, by means of wet sheets, general baths, etc. The diet should also be regulated in the strictest manner ; in short, every thing possible should be done to purify and invigorate the general system. Prolapsus Ani, or Falling of the Bowtel.— This is not an unfrequent disorder of childhood, and 3Tet, so far as I have observed the disease, it has not been generally a very troublesome one. The children affected have outgrown it, although in some cases it has lasted for a considerable time. The complaint excites a good deal of solicitude on the part of pa- 19 218 treatise on children. rents; but it cannot, on the whole, be considered as a dangerous one. The inner coat of the rectum, in these cases, is looser and longer than the external, and hence it is made to descend by whatever causes a straining or bearing down sensation. In dysentery, there is a great deal of tenesmus (bearing down), and falling of the bowel is very apt to follow it. Ascarides in the bowels, over-purging with medi- cines, long-continued costiveness, and affections of the bladder will sometimes cause this difficulty. The bowel in these cases descends to various lengths, sometimes to the extent of several inches; at other times not more than half an inch. When it is down the child usually suffers more orJess pain, in some cases a- good deal, but in others little or none at all. In some cases the bowel returns of itself to its proper position in a few minutes after the descent. Always the sooner it is put into its right place, the better. If it is allowed to remain down, the constriction of the part by the sphincter ani will cause it to swell and inflame; and sometimes this constriction will become so confirmed as to prevent a free return of the venous blood of the part; in consequence of which it soon presents a swol- len, livid, or almost black appearance, and one that is frightful to look at. Now, to return the fallen bowel in these cases, re- quires some skill and judgment. The method of doing it in recent cases is simple and easy. For the purpose of reducing the prolapsed bowel, the child should be laid across the lap with its head a little FALLING OF THE BOWEL. 219 lower than its hips. The part must then be lubricated with sweet oil, or a little hog's lard; a piece of fine linen may be laid over the part; after which the mother or other person operating, is to commence the attempt of restoring it, by making gentle pressure in such di- rection as shall tend to return the bowel within the sphincter ani. By this means a portion of the blood will be forced up from the distended part, after which the bowel is to be urged upward, and a little backward, when it will soon be found to return within the verge of the anus. In some cases it will be necessary to continue the pressure much longer than in others. Care, gentle- ness, and perseverance are essential in all such cases. There is another method which succeeds well in many cases of prolapsus ani. By placing the point of the forefinger against a portion of the prolapsed bowel, and carrying that portion immediately upward until it passes the constricting part, a portion of the protrud- ing part is replaced, after which another, and another, and another portion is returned in the same way, until the whole is replaced. This method will not fail in any case where the protrusion is not very large. But in some cases it will be necessary to make steady pressure in the manner before stated; and in some instances a good degree of patience must be exercised in order to enable us to effect our object. But, in some cases, the bowel will become so en- larged by hanging down a long time, that it will not be possible to effect a reduction of the tumor without first reducing the inflammation and size of the protrud- ing part. 220 TREATISE on children. Dr. Underwood declares that, " should a case occur in children, as it does frequently in adults, in which the bowel may not be easily returned on account of supervening tumor and inflammation, the stricture will never fail to yield to an injection of cold water, with a few drops of the lith. argyri acetati (acetate of sil- ver and lead), with five or ten drops of the tincture of opium. An hour or two after such injection has been thrown up, the prolapsed intestine, though per- fectly black and swollen, will be found to retire of it- self." I am convinced, however, that cold water— and I am not sure but that tepid would be still better in many instances—will be found fully as effectual without any foreign admixture whatever. A tepid sitting-bath, long continued, would in such a case prove highly beneficial; it would not only be a means of relieving pain and soreness, but would bring down the inflammation and size of the protrusion, and thus facilitate its return to its normal position. One of the best possible means for preventing the pain—and this is very excruciating at times—is to en- velop the patient in the wet-sheet. It may be used in the half or folded form, or the entire envelopment may be had recourse to. Its action, in such cases, is that of a great and soothing poultice, the good effects of which can be appreciated best by those who have ex- perienced its salutary effects. But, probably, the most efficacious of all known means for relieving pain in these cases is fasting. Let the patient be kept a whole twenty-four hours, and longer if necessary, from all food, and all drink except falling of the bowel. 221 pure soft water. This course will bring the most sal- utary relief. It may also be adopted in connection with other means. The great thing, however, in cases of prolapsed bowel, is to effect a permanent cure of the difficulty. In order to accomplish this desirable object, it is ne- cessary to institute such a course of diet and general regimen as shall best promote the vigor and constitu- tional stamina of the body. Bathing, diet, air, and ex- ercise—these are all to be brought into requisition. The celebrated Dr. Physic, of Philadelphia, was in the habit of curing these cases by a very simple pro- cess. He directed first, that the patient should live altogether upon rye mush, sweetened with molasses or browrn sugar. By this course the natural discharges become very soft, and such as can be easily expelled without much effort of the child for this purpose ; con- sequently the risk of the bowel falling is diminished. Secondly, that the patient, if old enough, should be made to pass his evacuations while in the standing pos- ture, as by this means the habit of straining is inter- rupted, and the bowel permitted to remain in its nat- ural situation. This method of Dr. Physic's is a good one, and such as would succeed in almost all cases—in all, doubtless, except those in which there is some other local malady in the system, of an incurable nature. But, even in such a case, this course would cause a great deal of re- lief, and, as a palliative measure, cannot be too highly recommended. It should be observed, in this connection, that the 222 TREATISE ON CHILDREN. less of molasses or sugar the patient takes with the mush the better; and the unbolted form of the article "would be better than that from which the bran has been removed. Wheat, as well as rye, would answer every purpose. The use of a moderate portion of milk with the rye or wheat mush would be allowable, and, indeed, prefer- able, I think, to molasses or sugar. The danger of milk, however, would be that of the patient taking too much. In some cases it would doubtless be better to avoid it altogether, as also the sweet. I am of the opinion that a moderate use of good fruit, in its season, would not hinder a cure in such cases, but, on the contrary, be of service. Dr. Dewees recommends that a child, in such cases, should be made to sit upon a hard-bottomed chair, without arms, and of such height as not to allow the feet to touch the floor. I do not exactly see into the philosophy of such a measure, even if the child could be made to submit to it, which would be impossible without the application of physical restraints. I should remark, that the abdominal wet girdle should be worn constantly, night and day, in all these cases, until a cure is effected. It is an invaluable means for promoting the vigor of the stomach and bow- els, and is thus an excellent auxiliary in the treatment. Hemorrhoids, or Piles.—This affection, which is very nearly allied to the one we have just been consid- ering, is to be treated on the same general principles. The diet, the injections, of which tepid are the best, the wet girdle, wet sheets, ablutions, and exercise—all diadetes. 223 of these are to be brought into requisition, according to the severity and persistency of the case; and if every thing is well managed, children are, in general, very easily cured of these affections. Diabetes.—Children, as well as adults, are some- times the subjects of this strange and nondescript dis- ease. In the case of children, diabetes • seems to be inti- mately connected with the process of teething. In some cases it has been observed to come on whenever any of the teeth are about to cut the gum, while at other times the child has not been troubled at all with the malady. Dr. Dewees tells us that all the children he had seen with diabetes were under fifteen months of age; but in his own cases (three in number) he could not, after careful examination of the gums, find any teeth immediately protruding through them. The quantity of urine discharged in this disease is often very great, and the thirst appears to be in a pro- portion corresponding to this secretion. If the symp- toms keep on for a time, great debility is certain to supervene, and the flesh becomes very thin. Treatment.—Diabetes is evidently a disease of de- bility. All attempts to fathom the chemical nature of the malady have been without avail; nor do post- mortem examinations throw any light on the subject. The most contradictory modes of treatment have been recommended both as to medicines and diet; and the faculty have not yet fixed upon the method of treat- ment that is regarded by the mass as orthodox. But one thing is very plain; the disease should be 224 TREATISE ON CHILDREN. treated as one of debility, and whatever tends to pro mote the patient's strength will aid best in the cure. Diet has much to do with this disease. Dr. Morton is said to have cured diabetes in a child, by keeping it wholly on milk. Giving but one kind of food would, doubtless, do good in the way of preventing the child's taking too much ; this seems to be the great thing in this complaint—to keep the patient from eating too much. The less food is taken the less will be the thirst, and the less the quantity of urine voided. Bathing three or four times daily, the constant use of the wet girdle, taking the child daily and often—the more the better—into the open air, with strict attention to the diet, are the means to be used in this affection. It may, perhaps, be better to keep the child wholly on milk, especially if it is not above two years of age. Retention of Urine.—This affection may arise from the fact of there being no opening for the ure- thra ; but far oftener, it consists simply in a spasm of the neck of the bladder or of the urethra. Those who have the care of the young infant should look well to the matter of its voiding a natural quan- tity of urine. Children have died in consequence of inflammation caused by protracted retention, when the real cause was not at all suspected. In the worst cases of retention there is always some of the renal se- cretion voided, and for this reason both parents and physician have failed to detect the real cause of the mis- chief. If, therefore, the child should be found to void only a small quantity of urine, and should become RETENTION OF URINE. 225 very restless, and suffer great pain, we should always bo on the look-out in reference to the action of the bladder. Treatment.—In some cases—though very rarely— it will be necessary to have a surgical operation per- formed, as, for example, where an artificial opening must be made in the urethra to allow the fluid to escape. Such cases are, fortunately, most rare. In those cases where there is simple retention from spasm of the parts, sprinkling the child's abdomen and legs with cold water, or the cold bath, cold compress upon the abdomen, etc., are in general sufficient to re- move the difficulty. Possibly, in some cases, however, it may, in spite of all remedial measures, be found ne- cessary to introduce a catheter. Some have been of the opinion that this cannot be done safely in a young infant; but we know the fallacy of this belief, for the operation has often been done without any sort of diffi- culty or inconvenience, and with none but the best of results. Hence in all cases of retention, if the exter- nal means which I have recommended do not very soon remove the difficulty, no time should be lost in calling a physician or surgeon whose skill cannot be questioned. If the child can be made to swallow a considerable portion of moderately warm soft water it will aid the flow of urine materially, and in case it may be necessary to use the catheter, the use of soft water will enable us the sooner to dispense with it. If the retention is in consequence of a stone in the bladder, the only radical cure is to have it removed by 226 TREATISE ON CHILDREN. an operation. These dreadful cases are fortunately very rare. Incontinence of Urine.—Voiding urine too fre- quently, and particularly at night, is a very common affection of childhood, but is generally outgrown as the patient becomes older. Some have regarded that this is a disease more of habit than of any real derangement of the sphincter of the bladder ; but this certainly is not always the case. I know that I was myself greatly troubled with this complaint, when I would have given worlds if I could have felt certain that I could get along without " wet- ing the bed," which I often did. I shall never forget the great trouble and mortification which I have hun- dreds and hundreds of times experienced on account of this infirmity, and which I did not fully outgrow until after I had passed the period of childhood. There is no doubt, however, that children often wet the bed at night more from carelessness and wrong habit than any thing else. And to avoid this occur- rence, they should be made to pass urine not only when they go to rest, but afterward, when the parents them- selves are about to retire to sleep. The diet has a great deal to do in causing this diffi- culty. If children are allowed to eat irregularly and late at night, they are much more apt to be troubled with this symptom than they otherwise would be. If they are allowed to eat apples or other watery food freely in the after part of the day, they are particularly liable to experience urinary troubles in their sleep. Over-stimulating food, as well as excess in quantity, PAINFUL URINATING. 227 have great influence in aggravating this affection when it already exists, and no doubt in many are its princi- pal cause. Treatment.—Every thing which tends to the better- ment of the constitution aids in keeping off this diffi- culty. The processes of water-cure are admirably adapted to remove the complaint. Among other means the wet compress about the abdomen, and the wet dia- per at night are highly useful. Painful Urinating.—Pain in passing urine is not an unfrequent complaint of childhood. The child, per- haps, appears as well as any other child ordinarily, but as soon as it attempts to make water, it manifests the greatest uneasiness, and sometimes shrinks uninterrupt- edly until the evacuation is completed, after which, it soon regains its usually playful state. If a young infant is observed to have occasional fits of shrinking, as if it were suffering great pain, we should always be on our guard to see if it does not arise from the evil in question. Painful urinating is more apt to occur during teeth- ing than at any other period. In such cases it may continue for months before it can be fully conquered. Treatment.—In all of these cases there appears to be an unnatural state of the urine, as may be seen by examining it. This proves to us that the difficulty is a constitutional one; such, at least, is the fact in most cases. We should, therefore, adopt that course of treat- ment which is best adapted to fortify and invigorate the general health. If we can know soon enough when the child is about 228 TREATISE ON CHILDREN. to pass water, we can afford great relief by causing it to sit in a small tub of cold water. This course makes a great difference in the amount of pain, and tends di- rectly to the removal of the difficulty, both by its local and its general effects. CHAPTER XXI. Diseases of Children continued—Erysipelas—Thrush, or Sore Mouth—Vomiting—Hiccough—Diarrhea—Its different Forms. Erysipelas.—Very young infants are sometimes affected with erysipelatous inflammation of greater or less intensity. It is not a common affection in this country, but appears to be more so in the old, espe- cially in the lying-in hospitals of the great cities. When it occurs in an epidemic form, as it sometimes does in crowded hospitals, it is to be looked upon as a very dangerous affection. It occurs oftenest within the first month, but may happen at a later period. It comes upon any part of the body, but the places most liable appear to be the nares, the small of the back, the neck, and the face. A singular feature of this disease is the rapidity with which it sometimes changes from one part to an- other. Dr. Dewees has related a case in which its translations were rapid, almost beyond belief; the part occupied at one moment, would at another be left free from disease, while a new portion of the body, uncer- tain which, would be obliged to sustain its attack; and 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 ma- 20 230 TREATISE on children. terial 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 its erratic course five days. After the head and face be- came affected, the disease seemed to forget its fugitive course, but not its deadly character. The face and head became immensely swollen; the surface attacked became purple, and vesicated over its whole extent; delirium followed, and death soon closed the scene. Treatment.—Great difficulty has ever been expe- rienced in the management of this terrible disease. It is quite dangerous enough in adults, but far more so in children. Fortunately, it happens but seldom. I have myself treated but one case, and that with the best of success. I attended the birth of a child in the city of Brooklyn, in the hottest part of the summer of 1849, and at the very time when cholera was raging with its most fearful violence, and in the immediate neighborhood where the child was born. The second night it was taken with great feverishness, and ap- peared to suffer a good deal of pain, as it cried almost continually, and did not sleep. In the morning I found that the disease had spread over a large portion of its body, and its face and neck in particular were much swollen. Its flesh seemed to be as hot as it is possible for living flesh to be. My object in treating it was, as soon as possible, to abstract the abnormal heat, taking care, at the same time, to do no violence to the sys- tem. The child was wrapped again and again in soft, linen napkins, wet in pure water moderately cold. The weather being so very hot, no dry covering was ERYSIPELAS. 231 placed over the wet application, and these were changed every few minutes, as soon as they began to grow warm. The relief was most surprising, and in the course of two or three hours—I cannot tell pre- cisely how long now—all the undue heat, all the swell- ing, and all the pain were removed. The cure was, indeed, almost as sudden as the attack had been. All things considered, I have great reason to believe, that if the child had been treated by any other mode it would have died. This then I hold to be the great principle of treat- ing erysipelas: prevent the heat ; and I regard cold water—not too cold, as in the case of the delicate infant—but cold enough to effect the object, as by far the best of all the thousand and one remedies that have been tried for it. Thrush, or sore Mouth.—Infants are not unfre- quently troubled with what is called apthae, or thrush, which is " a peculiar eruption of minute pustules, giv- ing rise to a whitish incrustation of the tongue and lining membrane of the mouth and fauces." As a gen- eral fact, there may be observed more or less general indisposition, and disorder of the stomach and bowels, before this affection of the mouth makes its appear- ance. The disease is more generally of a mild character, and is soon cured of itself. In some cases, however, eruption becomes so extensive as to cause a considera- ble degree of constitutional derangement and general suffering in the system. Feeble and sickly children, in almost all cases, have 232 TREATISE ON CHILDREN. * more or less of sore mouth, while the strong and healthy seldom, if ever, suffer from it. Those that are kept in crowded and badly ventilated apartments, and have not suitable care in regard to cleanliness, diet, etc., are much more subject to thrush than such as are well kept in every respect. Treatment.—People generally have a notion, that some drug substance, or some foul and disgusting wash or other application, must be made in this affection. It is true, that the strictest regard to cleanliness should be observed, in regard to the mouth as well as the other parts of the body; but otherwise all that we have to regard is the management in reference to the general health. Remove as far as possible all the causes of the disease, and at the same time pursue that course of treatment which is best calculated to restore the general health; this is all that is necessary in such cases. Ulceration of the Mouth.—This is an affection altogether different from the eruption of which I have spoken, but, although sometimes alarming in appear- ance, is by no means necessarily a dangerous affection. It is most apt to occur during dentition, and more especially at that part of the period when the back, or larger teeth, are making their appearance. Treatment.—This is substantially the same as in thrush, and should be that which is best calculated to fortify the general health. There is more apt to be febrile action in this than the former disease. If fever occurs the case should be managed accordingly, as the symptoms demand. VOMITING. 233 Vomiting.—This, with young children as well as with adults, is far from being always a state of dis- ease ; and the injudicious use of remedial means, in these cases, has doubtless often been the source of much harm to the infant's constitution. It often happens that, as the habits of society are, the stomach is made to receive too large a portion of food. Hence, we are to look upon vomiting as a be- nevolent provision of nature in warding off the evils that would naturally arise from excessive alimenta- tion—evils, too, which would otherwise be of incalcu- lable harm to the constitution. The kind of vomiting now under consideration, al- most always occurs very soon after the child has been nursed. The milk comes up sometimes apparently pure and unchanged, and almost without effort. At other times it is curdled, which circumstance often alarms the parent, who does not know that curdling is a necessary part of the process of digestion, and with- out which no good blood could possibly be formed. If we see a young infant throw up its food, whether in the natural form of milk, or that which is curdled, it should excite no alarm; we should rather be glad to see that the child's stomach has strength enough to rid itself of an offending substance. But, although we are not to consider this kind of vomiting as an unhealthy symptom, we should endeavor not to make it a necessary one. As before remarked, it almost always proceeds from repletion, and it is al- ways better to avoid giving the child too much nutri- ment at a time. 234 TREATISE ON CHILDREN. It is possible that, in some cases, a too rude hand- ling of the child soon after it has nursed, may be the means of causing it to vomit, and when, if proper care should be taken, no such result would be observed. In consequence of this liability, it has been recom- mended that the child be allowed to remain as nearly quiet as may be, for a short period after it has taken the breast. Afterward, vomiting would not be so likely to take place. In regard to the vomiting that occurs in connection with teething, diarrhea, biliousness, cholera infantum, etc., it is to be observed that it is to be treated on gen- eral principles, the same that we are to observe in such cases generally. Every thing that tends to the removal of fever, to cleansing the stomach and bowels, and to support the strength, is favorable to arresting this symptom. Hiccough.—According to Sir Charles Bell, " vom- iting and hiccough are actions of the respiratory mus- cles, excited by irritation of the stomach." Debility is to be considered the remote cause of the affection, and some disturbing agent, such as unhealthy or undi- gested food, acidity, bile, etc., in the stomach, the ex- citing cause. " Excess of food, and especially in a weak stomach," says Dr. Good, " is often a sufficient stimulus; and hence the frequency of this complaint among infants." Drunkards are very apt to be trou- bled with it when the stomach is overloaded with spir- ituous liquor; and children, that are dosed with toddy and the like articles, are more apt than others to have it. HICCOUGH. 235 Hiccough, if the proper means of relief are not re- sorted to, is liable to become a chronic affection, which is sometimes far from being easy to subdue. Cases have occurred in which every kind of medical treat- ment that could be devised, has proved wholly power- less and inefficient in regard to arresting the complaint. As a chronic affection, hiccough sometimes recurs at irregular intervals. Thus it has been known to at- tack the individual at periods from four to twenty-four years. As a permanent attack, hiccough has been known to continue for many days, and even months, without ceasing. A case is related by Dr. Parr, in which it continued for a whole month, with scarcely any inter- mission, even at night. " The sleep was at last so profound that the convulsions scarcely awoke the pa- tient." In some cases—though not many—it has been sup- posed that death has been caused by this affection. In these instances it is, however, doubtful whether there was not some other disease of which hiccough was only one of the symptoms, and not the real cause of dissolution. Treatment.—I have remarked that general debility and irritation of the stomach, are the more prominent causes of this affection. Hence, it will be apparent, that whatever tends to remove the causes of the disor- der will also be useful as an immediate remedy. Hiccough is in general easily cured, and will, in fact, almost always cease spontaneously. Generally, in the case of children, the offending cause is lodged in the 236 TREATISE ON CHILDREN. stomach, and vomiting soon removes the difficulty. If this does not take place, however, the hiccough gen- erally yields to a very simple remedy, and the one which is most convenient to give—a draught of cold water. This, by its anti-spasmodic effect, cures the difficulty at once; nor are camphor, spirits, or the like articles, at all to be compared with it. We may imagine, however, that the child is so young that it will not drink the water. I have said already, that hiccough usually cures itself in a short time; but if in any case it should prove troublesome, a bath, sim- ply making bare the abdomen, and washing it well with the hand wet in cold water, the wet girdle, an in- jection or two of cold water, carrying the child into the open air—all of these means are useful in such a case. It is a very poor practice to nurse or feed the child every time it is troubled with hiccough, as mothers and nurses are apt to do. This is only adding fuel to the fire, or in other words, making the matter worse. A sudden fright, or other strong mental emotion, will often arrest hiccough; but the practice some parents have of frightening the child to stop it, ought never to be allowed. Better to allow the hiccough to go on and cure itself, than to resort to such a course. In these lamentable cases, where this symptom seems to be a forerunner of death, that is, in the last stages of fatal disease, the simple means which I have advised, will generally be found effectual in arresting the symp- toms. Swallowing pieces of ice have also, in such cases, been resorted to with good effect. Diarrhea.—By this is meant a too frequent dis- DIARRHEA. 237 charge of the feculent contents of the bowels with little or no pain. Diarrhea is divided into a number of varieties. Feculent Diarrhea is attended with some nausea and perhaps pain, or such sensations as usually attend the action of a cathartic of a stimulating kind. It is the most simple form of the complaint, and usually cures itself by the discharge. It may, however, be attended with convulsions, fever, nervous twitchings, etc. Bilious Diarrhea is that in which the feces are loose, copious, and of a bright yellow or green color. The bowels are supposed to be excited to an inordinate action by the presence of an undue quantity of bile, either vitiated or otherwise. It is apt to pass soon into a more serious form of bowel complaint, and should in the very beginning be treated with the utmost cau- tion. Mucous Diarrhea is that in which the discharges contain a considerable quantity of mucus. The dejec- tions are not so frequent as in the bilious form, and are more apt to be attended with bearing down pain. If this, however, should amount to much, and especially if blood should be discharged, we should call it dysen- tery, and treat it accordingly. Chylous Diarrhea is that in which the evacuations are of a milky color, showing that there is a deficiency of bile in the feces. Lienteric Diarrhea is that in which the food passes nearly unchanged. It is not accompanied with much pain ordinarily. The appetite is apt to be voracious in this disease, and the thirst considerable. 238 TREATISE ON CHILDREN. Chronic Diarrhea is that of any of the foregoing forms, it having passed into a confirmed^ state. Unless arrested within a few weeks at most, it is apt to prove fatal. The treatment of the different forms of diarrhea will be inferred from that hereafter to be laid down for cholera infantum and dysentery in this work. All of these forms of bowel complaint are very apt to run into either cholera infantum or dysentery in this country, and the formidable class of ailments that belong under the head of bowel complaints, is more to be feared than any other belonging to children. I shall, there- fore, speak of cholera infantum and dysentery—the most dangerous of these diseases—somewhat in detail. CHAPTER XXII. Diseases of Children continued—Cholera Infantum—Its Treatment —Dysentery—Method of Cure. Cholera Infantum.—The cholera of infants differs, in some respects, from that of adults. It is more apt to be attended with symptoms of febrile action, comes on usually in a more gradual manner, and is much more liable to take on a protracted or chronic form in the former than in the latter. " In many instances the disease commences with diarrhea, which, after having continued for a few days, becomes associated with more or less violent vomiting. In the majority of cases, however, the vomiting and purging come on at the same time, without any other premonitory symptoms, than, perhaps, diminished or unusually craving appetite, flatulency, and acidity of the prima vice lasque, and an uneasy and fretful tem- per. From the commencement of the disease, whether its accession be sudden or gradual, the pulse is usually frequent, quick, small, and somewhat tense. The tongue is generally, at first, covered with a thin, white fur; but in the progress of the disease, particularly where it tends to a chronic form, its surface often ac- quires a dry, red, smooth, or polished appearance. At first, the discharges from the bowels usually consist of 240 TREATISE on children. a turbid, frothy fluid, mixed with small portions of green bile, or of a nearly colorless water containing small flocculi of mucus. After the disease is fully de- veloped, the evacuations very rarely exhibit any traces of bilious matter, the biliary secretion being evidently entirely suspended. In some instances the disease commences and proceeds with such violence as to ex- haust the vital powers, and terminate in death in the course of a single day. More commonly, however, the vomiting and purging are not so rapid as to prostrate the system immediately, and the disease continues for five or six days before convalescence begins, or fatal exhaustion ensues. In many instances the vomiting, in the course of four or five hours, becomes less and less frequent, and finally ceases altogether, or recurs only two or three times daily, while the diarrhea goes on until at last it assumes a strictly chronic character. In the early stages of the disease, the little patient is evidently harrassed with painful and distressing sensa- tions in the stomach and bowels; and when the dis- charges are violent and very frequent, the muscles of the abdomen, and even those of the extremities are apt to become affected with spasmodic contractions. If the disease does not terminate fatally during the first few days, rapid emaciation ensues, the hands and feet become cold and pale, while the head and body are al- ways preternaturally warm, the skin is usually dry and harsh, and acquires a peculiar wilted appearance, particularly on the inner part of the thighs, and over the abdomen. The countenance becomes pale and con- tracted, the eyes inanimate and sunk, the nose sharp, CHOLERA INFANTUM. 241 and the lips thin, dry, and shriveled. The thirst is always very great, more especially after the disease has continued for some days, and no drink is palatable but cold water, which is generally thrown up soon after it is swallowed. Food of every kind is generally loathed and refused. If the disease be not subsided or moderated by proper remedial means, the little pa- tient, by degrees, becomes somnolent, he sleeps with the eyes half open, rolls his head about when awake, and at last sinks into a state of insensibility and coma, and dies in a paroxysm of convulsions, or under symp- toms resembling those of the last stage of acute hydroce- phalus. When the disease is of protracted duration, or assumes a chronic form, the above discharges generally acquire a dark, very offensive, and acrid character. The digestive powers become so enfeebled that almost " every thing taken into the stomach passes through the bowels in a perfectly undigested state. Aphthae finally appear on the tongue and inside of the cheeks ; the face acquires a bloated or oedematous appearance, the abdomen becomes tumid and tympanitic ; the parts about the anus are excoriated by the acrid discharges, and toward the fatal conclusion spots of effused blood under the cuticle sometimes appear on various parts of the body, more especially on those upon which the pa- tient lies. The little patient at last lies in a coma- tose and insensible state, with eyelids half open, and the globe of the eye turned up so as completely to hide the cornea." Duration.—Cholera infantum varies much as to length of time in different cases. In extreme cases it 21 242 TREATISE ON CHILDREN. may run on to a fatal termination in five or six hours, and not unfrequently death takes place within one or two days. On the other hand, it may continue for many weeks, until the body is reduced to a state of extreme emaciation and debility, in some of which cases the pa- tient dies, but in others, contrary to the expectation of all concerned, most unexpectedly recovers. Causes.—Children that are getting their teeth are much more apt to suffer from bowel complaints than those that have already passed through the process of dentition. Hence, if a child is about to cut his teeth as the hot season commences, or during its continuance, a much greater degree of care is requisite in order to guard him from it, than would be requisite under ordi- nary circumstances. Effects of Heat.—High atmospheric temperature is manifestly a great cause of this disease. It is aptly termed summer complaint. It commences with the hot weather, and as Dr. Parrish observes, " increases and becomes more fatal with the rise of the thermo- meter, and declines with the cool weather in autumn. During its continuance, it may be observed to vary with every prominent change of temperature. A few very hot days in succession in the month of June are suffi- cient to call it into action; and during the length of its prevalence, a spell of cold weather will diminish if not suppress it." " Let any one," continues this au- thor, " take a walk in a summer morning, through the thickly built lanes and alleys of Philadelphia, he will be struck with the appearance of the children, reclining their heads, as if exhausted, upon the breasts of their CHOLERA INFANTUM. 243 mothers, with a pale and languid countenance, a cool and clammy skin, a shrunk neck, and other signs of de- bility arising from their confinement during the night, to close and hot apartments. Impure Air.—This is a disease, it should be remem bered, that prevails most in large cities. Hence, when we are treating a case in such a locality, we should ad- vise that the child be taken, if possible, to the pure air of the country. I am very confident I have saved lives in this way. Sometimes a few hours' ride upon some of the rivers or bays about this city (New York) is suf- ficient of itself to arrest a bowel complaint that has threatened life. " This change " (removing the child to the country), says Dr. Eberle, " is often sufficient to subdue the disease in a short time, without the aid of any other remedial means." * y JfOWLERS AND WELLS, up NO. 131 NASSAU STREET, NEW YORE. American Phrenological Journal and Miscel- lany. Devoted to Phrenology, Physiology, and Self-Improvement. A year, $100 Amativeness; or, Evils and Remedies of Ex- cessive and Perverted Sexuality, with Advce to the Married and Single,- 12J Accidents and Emergencies. By Alfred Smee. Illustrated. Every family should have it,.....12$ Botany for all Classes; containing a Floral Dictionary, with numerous Illustrations. By John B. Newman, M.D., - 50 Bulwer and Forbes on the Water Treatment. Edited, with Additional Matter, by R. S. 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Twentieth edition, - 50 Mesmerism in India. A superior work, by the celebrated Dr. Esdaile. Highly recommended by professional men, • 50 Matrimony ; or, Phrenology and Physiology applied to the Selection of congenial Companions for Life, 25 Moral and Intellectual Science. By Combe, Stratton, Cox, Gregory, and others. Illustrated with Portraits, - - 2 00 Natural Laws of Man, physiologically con- sidered. By Dr. Spurzheim. A work of great merit, 25 Psychology, or the Science of the Soul. With Engravings of the Nervous System. By Joseph Haddock, M D., - • 25 Physiology of Digestion. The Principles of Dietetics. Illustrated with Engravings. By Andrew Combe, M.D., - 25 Phrenology Proved, Illustrated, and Applied. Embracing a concise Elementary View of Phrenology, with a Chart - I 00 Phrenological Guide. Designed for the Use of Students of their own Characters. 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By Andrew Jackson Davis, 50 Religion, Natural and Revealed ; or, the Natural Theology and Moral Bearings of Phrenology, .... 50 Self-Culture and Perfection of Cha/acter; including the Management of Youth. Improved stereotyped edition, • 50 FOWLERS AND WELLS'S PUBLICATIONS. Science of Swimming: Giving the History of Swimming, with special Instruction to Learners. Illustrated, - - 12} Sober and Temperate life : With Notes and Illustrations by Comaro, whojived, 154 years. Read this Book, - - 25 Synopsis of Phrenology and Physiology: II- luetrating the Temperaments. Designed for Phrenologists and others. - .12$ Temperance and Tight-Lacing: Founded on the Laws of Life as developed by Phrenology and Physiology, - - 12$ Tobacco: Its Effect on the Body and Mind. The beSt work on the subject. Every body should read it, - - • 25 The Use of Tobacco; Its Physical, Intellect- ual, and Moral Effects on the Human System,......12J Teeth; Their Structure, Disease, and Man- agement, with the Causes of Early Decay. Full of Engravings, - - 12J Thoughts on Domestic Life. Its Concord and Discord, with Suggestions to both Sexes. By Nelson Sizer, - - 12$ Tea and Coffee ; Their Physical, Intellectual, and Moral Effects on the Human System,.......12A The Parent's Guide, and Childbirth made Easy; with Advice to Mothers. By Mrs. Pendleton, .... 50 The Illustrated Self-Instructor in Phrenology and Physiology ; with One Hundred Engravings and a Chart, - - 25 Vegetable Diet, as Sanctioned by Medical Man, and Experience in all ages; also a System of Vegetable Cookery, - 50 Water-Cure library; Embracing all of Im- portance on the Subject. In seven large 12mo volumes, - - - 5 00 Water and Vegetable Diet in Scrofula, Can- cer, Asthma, and many other Diseases. By Dr. Lamb, 50 Water-Cure Manual; A Popular Work on Hydropathy. With familiar Directions. Every family should have it, - 50 Water-Cure Almanac, Containing much im- portant matter for all classes. Published yearly, .... 6] Woman: Her Education and Influence. With a General Introduction, by Mrs. Kirkland. With thirteen Portraits, - 40 Water-Cure Journal ;and Herald of Reforms. Devoted to Hydropathy and Medical.Reform. Circulation 25,000. A year, 100 Water-Cure for Women in Pregnancy and Childbirth. Illustrated with numorons cases. A g*od work, - - - 25 Water-Cure in Every Known Disease. By J. II. Ilausse. Translated by C. H. Meeker, from the G.;rm in, - . 50 All Works on Phrenology, Physiology, Mag- netism, Physiognomy, Phonography, the Water-Cure, or Hydropathy may be obtained of Fowlers and Wells, 131 Nassau Street, New York.' r \ \ ^vV'- Jl> iff ltd tit ! ill) )')}(> «i.im7i«i:i l,»iMi-fli-||. 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