k: V 'i SURGEON GENERAL'S OFFICE LIBRARY. Section ~ No. 113, W.D.S.G.O. so.UAl.kV 8—613 L* m , -^v % wmmmr-mi V@^ 3^ W--'. fo"L-( 4 Broad-Street. 1825. L?3JP Msirict of South-Carolina. *6COO# BE IT REMEMBERED, That on the seventeenth day et Q 0 November, Anno Domini, one thousand eight hundred and Q SEAL. 0 twenty-four, and bi the forty-ninth year of the Inoepen- Q Q d<=ncr of "he United States of America, George Logan, de- ♦CCOO-fr posited in this Office the title of a hook, the right whereof he claims as proprietor and author, in the words following, to wit: " Practical Observations on Diseases of Children, comprehending a descr'p- tion of Complaints and Disorders, incident to the early stages ot life, and method of treatment. By George Logan, M. D. Honorary Member of the Medical Society of South-Carolina, and Physician to the Orphan-House. " Particular matters of fact, are the undoubted foundations on whiob our civil and natural knowledge is built: the benefit the understanding makes of them, is to draw from them conclusions, which may be as standing rules of knowledge, and con-equeutly, of practice."—Locke. ■ Tn conformity with the act of Congress of the United States, entitled " An act for th" Encouragement of Learning, by securing tbe copies of maps, charts, and books, to the authors anil proprietors of such copies, during the times therein mentioned," and also an act entitled '' An act supple- mentary to an act, entitled, ' An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and pro- prietors of such copies, during the times therein mentioned', and extending the benefits thereof to the arts of designing, engrav ng and etching histori- cal and other prints." JAMES JERVEY, Clerk of the District of South-CarohnH. to.* CONTENTS. PART I.—CHAP. I. hifantile Diseases. I'AUE. Section I. Still-born Children, Asphyxia, - « - 13 If. Clothing and Treatment, - - - - 1? III. Nourishment, - - - - - * *■' IV. Yellow Gum, Icterus Infantum, - - - 27 V. Red Gum, Strophulus Intertinctus, - - 28 VI. Thrush, Aphthas Infantum, 30 VII. Excoriations, he. ----- 32 fill. Spasmodic Twitchings, &c. 33 IX. Locked-Jaw of Infants, Trismus Nasceutum, 3-4 X. Erysipelas, Infantum, - 3tf CHAP. II. Congenite Diseases and Affections. Section I. Imperforated Anus, ----- 39 II. Hare-Lip, Labia Leporina, 40 III. Cloven Spine, Spina Bifida, Hydro Rachitis, 43 IV. Blemishes, Spots, and Marks, ... 45 V. Uumbilical Hernia, Exompholos, 46 VI. Swellings of the Scalp, he. ... 47 VJI. Tongue-Tied,......48 4 CONTENTS. PAGE. VIII. Distorted Feet,......49 IX. Defectio i in the Heart, ... - 50 X. Encysted Hydrocele, - - - - lb- XI. Milk in the Breasts, .--•-- 5* CHAP. III. Constitutional Diseases. $!ectioji 1. Rickets, Rachitis,.....52 II. Scrofula, Struma, or King's Evil, 54 III. Diseases of the Eyes, - - - - 50 IV. Inflammation of the Ear, Otitis, 65 V. Foetid discharges from the Nose, Ozena, - 67 CHAP. IV. Dentition,.........69 Section 1. Diseases induced by Dentition, (or usually occuring at this period,) 72 II. Cholera Infantum, Bowel Complaints, he. - 76 III. Convulsions, ------ 81 IV. Tooth-Rash, Rank Red Gum, Strophulus Confertus, • - - ... 93 V. Milk Eruption, or Blotch, Crusta Lactea, - 84 VI. Dropsy of the Brain, Hydrocephalus, - - 85 CHAP. V. Catarrh, or Cold,........ c# CHAP. VI. Section I. Croup, Hives, Cynanche Trachealis, - 92 CONTENTS. 5 PAGE. II. Inflammation of the Throat, Cynanche Tonsillaris, ------ 96 III. Malignant Sore-Throat, Cynanche Maligna, 98 IV. Mumps, Cynanche Parotydea, - - - 102 CHAP. VII. Pneumonic Inflammation, Pleurisy, - 104 PART II.—CHAP. I. Febrile Diseases, Pyrexias,...... 107 Section 1. Intermittent Fever, Ague and Fever, - 108 II. Remittent Fever,.....113 111. Typhus Fever,.....115 IV. Worm Fever,......118 V. Yellow Fever,......121 VI. Inflammatory Fever, .... 127 VII. Hectic Marasmus, &c .... 128 VIII. Mesenteric Fever,.....129 IX Rheumatism -.....131 X. Dysentery, ---... 134 CHAP. II. Eruptive Diseases. Section I. Small-Pox, Variola, - 136 Prophylactics, -*.-.. 141 Inoculation, --.... 142 Vaccination, --.... 144 IL Chicken-Pox, Varicella, 147 JIL Swine-Pox, Bleb, &c. 149 * 6 CONTENTS. IV. Measles, Rubeola, V. Scarlet-Fever, - VI Nettie-Rash, Urticaria, VII. Miliary Eruption, VIII. Anomalous Eruptio is, CHAP. III. Cutaneous Disorders, (local affections unattended with Fever.) Section 1. Itch, Psora Scabies, Sic. * * - 163 II. Ringworm, Tetter, &.c. - - - - 166 III. Shingles, Herpes Zoster, - - - - 167 IV. Dandriffe, Pityriasis Capitis, - - - 168 V Scald-Head, Tinea Capitis, ... ib. VI. Stye, or Stythe, Hordeolum, - 170 VII. Whitlow, Paronychia, - - - . 172 VIII. Biles, or Boils, Furunculi, - 173 CHAP. IV. Abcess of the Hip-Joint, Morbus Coxaris, ^ . 175 CHAP. V. Spasmodic Diseases. Section I. Epilepsy, - - II. Spasms, Tetanus, III. St. Vitus' Danee, Chorea, - IV Hooping, or Chin Cough, Pertussis, PAGE. 150 154 158 160 161 17-7 180 185 187 CONTENTS. 7 FAOE. CHAP. VI. Worms,......--- 193 CHAP. VII. Diarrhoea, Lax, or Looseness, - - - - 199 CHAP. VIII. Dropsy,.........203 CHAP. IX. Wounds,.........205 Section 1. Incised Wounds, ----- ib. II. Punctured Wounds,.....206 III, Lacerated and Contused Wounds, - - ib. IV. Poisoned Wounds,.....207 CHAP. X. Luxations and Fractures, ------ 209 CHAP. XI. Burns and Scalds, ........ 211 CHAP. XII. Observations on Management, ----- 214 ERRATA. Pages 14, line 32, for "um?>eiecal" read umbilical 21, 7, for " a cold bathing," read cold bathing 11, for " mocouium," read mecouium. 48, 22, for " haermorhage," read haemorrhage. 59, 2, for " selerolica," read sclerotica. for " salphale," read sulphate. 105, 27, for " two or three grains," read the half'Vr third. 117, 11, for "produced," read preceded. 121, 25, for " precursion," read precursor. 124, 9, for " paroxyism," read paroxysm. 125, 4, for " has not," read has. 134, . 1, for "an," read as. 162, 10, for " quurs" read qu'un. 18, for " haemoptius," read hcemoptisis. 155, • 19, for " anginosa, read anginose 162, 23, after "character," add, the treatment must be conducted. 168, 24, for "thin acrid and viscid," add, and some- times viscid. 195, 1, for " slow indigestion," read slow digestion. 213, 6, for " secum," read serum The indulgent reader is requested to correct those that are not above noticed. INTRODUCTION M. he advancement of medical science, is a subject of univer- sal interest. It is contemplated, with joy, by the professor, who, commiserating where he cannot cure, experiences the painful sense of responsibility; by the valetudinarian, whose tedious hours of suffering, are sustained by that hope, which ig inherent in life, and is cherished, while the feeble spark holds out; and by those in health, who from the daily examples of Others, are taught to expect, in their turn, afflictions and cala- mities ; but, especially, by the fond mother, who alternately presses, with agonized feelings, the tender object of her solici- tude, to her breast, and looks up, in confidence, to the benefi- cent Providence, who directs the means, and controls the issue of events. A desired perfection would, certainly, be obtained, if writers were strictly influenced by the results of observations, or de- ductions from conclusive experiments. Unhappily, however, most authors deem it obligatory on them, to bestow something under the imposing form of novelty, or fashion, either wholly hypothetical, or founded on false and erroneous inferences. It is, indeed, the property of genius, to soar above secondary- causes ; but, these flights of fancy, too often indulged, tend to idle speculations, and useless disputes of no practical advan- tage The beaten track of experience, the sure way, is ob;m] doned, and the theorist plunges into an inextricable labyrinth of error and controversy* 10 INTRODUCTION. It should never be forgotten, that medicine is not a speculative science, but, rather a practical art, in which, perfection is to be acquired by long and continued labour and experience. Centuries have elapsed, since the most important discoveries in Physiology were made; and, at later periods, many inte- resting experiments, illustrative of the extent and power of the chylopoetic viscera, without material benefit to the practice of medicine, While we are led, irresistibly to contemplate the astonishing efficacy of vaccination, in arresting the ravages of that most loathsome disease, small-pox, and unite in the tribute of grati- tude, due to one of the great benefactors of mankind—the illustrious Jenner! we must, nevertheless, acknowledge, that the outlets of human life, and trophies of mortality, are almost as numerous as in the days of many of his great predeces- sors, who still have done much to advance the profession, and whose names are held in the highest estimation among sages and philanthropists. We might apply our remarks to the remote age of Hippo- crates, and we shall, by no means, find our expectations realiz- ed, in the extent of improvements of the present day. The dis- criminating judgment of this acute pathologist, by which he de- termined the critical days of disease, is truly inimitable; and when we reflect on the subsequent discoveries, and the enriched state of the materia tnedica, we shall, with amazement and con- cern, find, that scarcely more has been effected, than a repeti- tion, and establishment of many of the doctrines inculcated by physicians of antiquity. There are, however, charges applied in those days, from which we certainly must exempt practitioners of modern times the chief of which, consists in leaving too much in the hands of nature, when the employment of art was indicated; or, in the use of two feeble remedies, although we may possibly incur the imputation, of sometimes erring in an opposite extreme, and by too energetic a practice, transcend the object of our zeal and solicitude. This, however, can never discourage a system of proceeding, justified by circumstances in the opinion of physi-. cans. INTRODUCTION. 11 The treatment of complaints and diseases of clrldren, was long supposed to require but little aid from the physician, be- ing confided to nurses, who were deemed sufficiently informed, and fully competent. The office of constant watching, enabled them to ascertain many little disorders of i ifancy, and to afford relief in the generality if cases Indeed, the obscurity in which diseases of early life are involved, and the difficulty experien- ced in obtaining sufficient information, to guide the practitioner with satisfaction, to a certain extent countenanced, if it did not excuse the practice. It was not until an augmented population in the large cities of Europe, with ail annual loss to these communities, of a dispro- portionate number of infant subjects, that the tenderest emo- tions of sympathy, awakened the attention of a wise and hu- mane police to the subject, and the faculty, in particular, to a sense of duty too long overlooked. The valuable productions of Drs. Underwood, Armstrong, Willan, Hamilton, and others, are comparatively of recent date, and succeeded this long remissness and silence, on an oc- casion so deeply interesting to the cause of humanity, where parental anguish claimed assistance, and loudly called for pro- fessional exertion. To dwell on the merits of these * orks, would be superfluous It will be sufficient, briefly to say, that they contain the lan- guage of truth, founded on the experience and observation of philosophers, and men of science. A sense of duty, and not the ambition of being an author, has prompted me to publish the result of many years experience, in the oosecution of my profession, both in private and public pi act ice, and in reading on the treatment of infantile com- plaints. In the arrangement, those diseases are first introdu- ced, which are observed in early childhood, and, in course such as are evolved at later stages. To the professional reader, I must apologize for using fami- liar term*, my wish being to adapt this essay, as well to the use of the pra'-r;'inn«r, us to the comprehension of country resi- dents; especially those who, inhabiting our widely extended districts, between the salubrious sea-coast, and "the benign 12 INTRODUCTION. Hills of Santee," while they await with painful anxiety the dis- tant ride of their physician may render emergencies, obtain some temporary aid. The principles I have endeavoured to support, are snch, I trust, as will be concurred in It remains but for me to add, n the appropriate and often-quoted sentiments of Horace, -----------" Si quid-noresli rectius istis, t'andidus imperii; si non, his utert mecum—Ep. 6, lib. 1. THE AUTHOR. 9 MOW H0A1L OB^VMKOHTA Diseases of CVxWdren. PARTI. CHAPTER 1. {infantile Diseases. SECTION I. STILL-BORN CHILDREN. (Asphyxia.) b1 all the changes in the economy of life, which a child undergoes upon entering into the world, the most important is that of the action of the lungs, as breathing and living are synonymous terms. But various circum- stances concur to pro luce a suspension of this essential process, or an appearance of the death of the infant, This state of Asphyxia is characterised by a livid or purple colour of the skin, feeble or imperfect rrspira- tion, or a total defect of the pulmonary circulation. 2 14 Practical Observations The most frequent causes are, pressure of the head during preternatural or tedious labour, and long conti- nuance of the child in a narrow pelvis, or compressure of the cord. In either instance, fatal consequences must ensue if seasonable relief is not obtained. The case may be considered in two points of view : First, when the action of respiration has been prevent- ed or delayed, by, perhaps, a weak or torpid condition of the vital powers. Secondly, when pulsation in the cord has ceased, and faetal life seems extinguished, but especially when evidences of putrefaction exist. In the first instance, a prognosis more or less fa- vourable, may be drawn from a knowledge of facts con- nected with the case occurring at, or previous to the birth, which must also influence the treatment. If the child breathes faintly or imperfectly, and the face and surface of the body pale and lean, it is advi- sable to delay the division of the cord—to use, friction, by rubbing over the breast with the hand—to stimulate the child's nostrils with a feather—and percussion, (by slapping the breach, &c.) But the most effectual reme- dy consists, in blowing into the mouth through the bar- rel of a quill, or in applying the assistant's mouth to the patient's, closing the nostrils, and by blowing, to endea- voui, in this manner, to inflate the lungs ; and to assist this intention, the thorax, or chest, is to be alternately pressed, and rubbed until evidences of distension, pul- monary action, or respiration, appear—after which the cord may be divided. If, however, the appearance has been otherwise than above stated, or the infant is plump or fleshy, some advantage will be derived from opening one of the umbelical arteries with the point of a lancet On Diseases of Children. 15 or scissors, and allowing two or three teaspoonsful of blood to flow. In the other instance, when no pulsation is observ- able in the cord, a longer connection with the placenta will be unavailing, the cord should therefore be divided, the child put into a warm bath, and afterwards wrapped in dry flannel before afire, (if in cold weather) and the means above directed for promoting respiration, adopt- ed. It is wrong to abandon the case as hopeless, or consider the child as past recovery, while warmth of the body is perceptible, and no manifest disorganization has taken place. Infanticide.—To detect an atrocity of this character, where there is suspicion of its being perpetrated, is of great importance; and to determine, in particular in- stances, whether a child has been born alive, or ceased to breath, after delivery ^ will require the exercise of the greatest judgment. In courts of judicature, the practitioner is expected to pronounce his opinion with firmness and decision, when the utmost circumspection is necessary. He will act conscientiously in allowing circumstances and facts to possess their full influence over his mind, and always incline to mercy, when these are involved in doubt an(j obscurity. A child, when newly born, after the full term of ute- rogestation, will weigh from six to seven pounds, and will ordinarily measure from twenty to twenty-two inches in length. If he has not breathed longer than thirty hours, and there is no indication of external dis- ease, or violence—and if a. portion of the lungs, when removed or placed in water, seems to be distended with 10 Practical Observations air, or floats, the child has unquestionably been born alive. When it is further ascertained, that during de- livery the case was unskilfully managed—that the cord was not tied, or negligently treated—that no clothes Were in readiness, or other usual preparations for re- ceiving the infant, and an indifference, or manifest dere- liction of that anxiety (generally observed on these oc- casions) in the mother or friends, as well as a disposi- tion to conceal the birth, strong suspicions are excited, that the child was destroyed after being born. Such an opinion may, accordingly, be expressed. When, however, the child has been born two or three days, and marks of putrescency are discovered, or ap- pearances of unhealthiness, disease or disorder, and pre- parations were made for the reception ; above all, when there has been a marked degree of anxiety and distress, natural on afflicting occurrences, we might, with equal Confidence assert, that the child was still-born. There are certain other indications, or phenomena, noticed in particular instances, which will assist in our correct diagnosis. Death, from strangling or suffocation.—In this case the eyes are prominent, with marks of inflammation ; the tongue projects from the mouth, which has a frothy saliva about it; thence is swelled, and livid, &c. Death from Hemorrhage.—Whether from the cord or otherwise, may be known by a blue or pale appear- ance of the body, as well as of the viscera ; the cavities of the heart, and large veins will be found almost desti- tute of blood, &c. Other concurring testimony, will confirm or support an opinion, which may be formed in these cases—cases On Diseases of Children. 17 abhorrent to human nature, but may, nevertheless, im- plicate the reputation of an innocent person. The most prominent diagnostics are here suggested, such as are deemed sufficiently applicable to questions of medical jurisprudence. SECTION II. TREATMENT and CLOTHING op INFANTS That nature is not competent to the performance of all her works, it would be repugnant to reason or good sense, to doubt, and impious to deny, inasmuch as it would he presumptuously arraigning the wisdom of un- erring Providence. Among uncivilized nations the inference is conclu- sive, that nature accomplishes every thing ; but refine- ment, luxury, and the adoption of certain fashions, not strictly conformable, have effected such changes, as re- quire the interposition of art in bringing into the worldt as well as in raising the human offspring. The navel string should be tied, about three fingers breadth from the umbilicus; and it is advisable to make another ligature, a little beyond this; then, with a sharp pair of scissors, divide the cord between them. The child is next to be removed and washed in tepid water and soap, if necessary ; and when wiped per- fectly dry, received in a flannel or cotton mantle, as the weather, or season, indicates. The portion of navel String attached to the child, must be wrapped in a piece *2 18 Practical Observations of soft rag, and covered with a compress of the same, which is to be secured with the moderate pressure of a cotton or flannel roller, passed round the body with such a degree of tightness only, as will prevent its slip- ping, without giving uneasiness. The infant's dress must be suited to the season ; pins are always to be used cautiously; tape may be gene- rally substituted. Children's clothes should be put on so as not to confine their limbs, or produce unnecessary pressure on their bodies. Their heads ought not to be kept too warm; and caps, in this climate, may, with advantage, be dispensed with. A due regard to cleanliness is important, and will most effectually tend to prevent many troublesome tom- plaints of infancy. This advice is peculiarly applicable to the use of napkins, which should always be removed as soon as they are soiled with faeces, or become wet with urine. They ou^ht never to be put on until perfectly aired and dried; when this is neglected, troublesome chafing and excoriations usually succeed. A child is soon taught a habit of cleanliness, by care- ful perseverence and diligence in the nurse. He will express, by certain motions, his feelings and desires, earlier than is generally imagined ; and will, therefore, be soon accustomed to the use of a basin or pot. After the second or third month, the cold bath will be found very beneficial; at first, moderately warm and gradually, colder; it should be used, with but few exceptions, daily. Infantile constitutions will be preserved, or rendered robust, by this management; and it is generally pro- per. There are some delicate, weak and lean chil- On Diseases of Children. 19 dren, with whom it will not agree; and as this may easily be perceived, it will be unsafe and hurtful, to pur. sue a plan with the vain hope of improving the constitu- tion. Not only experience, but analogy from vegetable life, justify and support a discrimination. The clothing of a child, in this country, and treat- ment, are certainly objects worthy of our greatest at- tention inasmuch as diseases, at a more advanced age, may be materially influenced, accelerated, or their foun- dations laid, by incautious management in early life. The constitution may receive an assault, from which it recovers slowly, and leaves a predisposition to future suffering. We have here, especially in prospective, Catarrh and Pneumonia, which too often eventuate, in our At- lantic cities, in Pulmonary Consumption. The prevail- ing humidity and versatility of climate, would furnish a solution of our inquiries, if they were not of too general application ; and in the concatenation of causes, we are irresistibly induced to look back to an early period of the subject's existence for an elucidation. It is not, surely, an unprofitable inquiry, whether such an evil may not proceed from a neglect or defi- ciency of clothing, or the stamen is thus impaired, and sustains a shock affecting future growth and vigour. While too much clothing will therefoie prove hurtful and debilitating, a defect of it will be not less preju- dicial. Dr. Beddoes has asserted it as his belief, that the greatest mortality in England is among those children, where attempts were made to bring them up very hardy, and it has consequently been ascertained, that at least 20 Practical Observations one-third of the poor born in Great Britain, die during infancy. It is obvious, that the vital warmth should be care- fully preserved, when the infant is lean and delicate. By far the greatest proportion, however, are born fat and healthy, and require, in mild climates, little or no adventitious covering. Divine beneficence is here con- spicuously displayed from the dawn of life. Plump- ness, while it conduces to the infant's beauty, retains, by a non-conducting property, that heat of body so es- sential to good health ; but, when deficient, our aid is necessary. The trees of the forest are protected by a covering of bark—the birds of the air have their plumage—animals an ample coat of hair or fur ; but man, superior in crea- tion, is endowed with the faculty of reason, to assist and guide him in adapting his dress, and that of his offspring, to every climate and season, whether his lot be cast in the rigours of a polar region, or under the fervors of a tropical sky. The infant constitution ought certainly to be consult- ed ; in peculiar cases, the early use of flannel is ser- viceable, especially during winter, the cool spring, or autumnal months; but the constant use of this article of dress must enervate, and proves prejudicial; it is therefore proper to remove or suspend it, when the warm season sets in. The happiest effects in this climate, are produced by the early use of thecold bath.; when the temperature of the atmosphere is above 80 degrees of Fahrenheit's thermometer, it may be employed with advantage, even with very young children; it wafts off the superabun- On Diseases of Children. 21 dant and accumulated heat of the body—braces the constitution, improves the appetite, complexion, &c.; while, in other instances, langour, debility, and paleness of countenance, mark the effects of prostrating heat and predispose to many diseases. There are, as already observed, exceptions; but these are few indted, to the use of a cold bathing, espe- cially in summer ; while a glow and increasing spright- liness succeed, it cannot fail to be salutary, and ought to be continued. The suitable accommodation of dress, with regular and careful attention to washing and cleanliness, are in- dispensable to the preservation of health, and in raising children. SECTION III. ON NOURISHMENT. It has become almost an established custom, to ad- minister something to purge off the moconium immedi- ately after the birth ; the expediency of tnis practice is not only questionable, but revolting to nature. If the child is put to the breast early, the secretion of milk is promoted, and its first operation on the stomach and bowels is sufficiently apparent. As soon as the mother has sufficiently rested, or ta- ken a little sleep, the child should be laid by her, and attempts made to induce it to suck. There is some- thing in the smell of the milk, which favours the inten- tion ; after a few trials the child will take the nipple / 22 Practical Observations Which, by this early proceeding, acquires a better or more convenient form than when delayed, and prevents congestions in the mammillary vessels, and other con- sequent disorders, which are painful and distressing. Nothing but the delicate health of the mother ought te prevent its adoption. Should the meconium not be freely voided in the course of ten or twelve hours, and the child seem un- easy, a teaspoonful or two of cold expressed castor oil, may be given to him, taking care not to increase the dose, unless^ after several hours, it should seem neces- sary. Although children, when somewhat older, bear purgatives better than could, apriori, be expected, it will be dangerous, at this very tender age, to excite the peristaltic action of the bowels too strongly. The functions of the liver soon commence; and, in some instances, the secretion of bile is so redundant, that an absorption takes place, which discovers itself in an icteric tinge called gum, attended with drowsiness. This morbid appearance of the complexion will else- where be noticed. A repetition of castor oil, or some gentle laxative, as about one drachm of Epsom salts in fennel-seed tea, will be proper. The custom of admin- istering carminatives, or cordials to young subjects, on slight occasions, is unjustifiable and reprehensible, and ought not to be allowed ; for the wisest of purposes, the circulation of the blood in an infant is rapid. When newly born, the pulse beats about 130 strokes in a mi- nute, and therefore cannot be accelerated without mani- fest danger. In bringing up a child, the most proper nutriment is the mother's milk. To raise by proxy, can neither be On Diseases of Children. 23 countenanced by reason or antilogy. Is is the pecu- liar province of the mother. What office can be more conformable to nature, in unison with affectionate feel. ings, or more delightful, than to nurse and suckle her in- fant ? " No voice so sweet attunes his cares to rest; " So soft, no pillow as his mother's breast " Or, in the eloquent language of an ancient philoso- pher—*' Quod est enim hoc, contra naturam imperfec- tum atque dimidiatum matris genus, peperisse, ac sta- tim absese abjecise"—"vinculum illud coagulum que animi atque amoris, quoparentes cum filiis natura con- sociat, interscindunt." Should any constitutional or other causes, interrupt or prevent this, a kind, careful and healthy nurse must be procured; an over-fastidiousness, however, in the choice, is culpable. It is true, among the ancients, Dio- dorus relates, that the intemperance of Nero, and the sanguinary character of Caligula, were imbibed from their nurses ; but this was the age of heathenish super- stition. The antiquated idea of evil propensities and habits, being received in this manner, is rediculous, and has now but few advocates. Human milk is best adapted to the power of strength of the infant organs of digestion ; it contains the sacha- rine principle in greater abundance than any animal ex- cept the Mare; the whey is less liable to fermentation, or to be coagulated. When the child cannot be supported by the breast, the food intended for it, should be made to resemble 24 Practical Observations human milk as much as possible, in all its properties. He should be fed by means of a sucking bottle, or from the spout of a tea pot, (or some vessel of that kind,) a piece of soft cloth being previously tied over it and per- forated. The child will soon acquire the habit of suck- ing his nourishment, from these. The gradual manner in which it is thus conveyed into the stomach, the pres- sure of the mouth upon the bottle, &c. in imitation of the nipple, affords time for a necessary flow of saliva; consequently, digestion is more complete, and the child is not so frequently distressed with griping and pain, as when the spoon is employed. The food ought never to be made in large quantities at a time, especially in summer, as it will ferment, be- come sour, and acquire unwholesome properties, and produce colicky pains, flatulencies and othei disorders. Equal quantities of thin, well-boiled rice, corn gruel, or barley water, and fresh cow's milk, sweetened spar- ingly with loaf sugar, will answer for the first three or four months; after which, a little light broth may now and then be added; bread or biscuit, carefully softened down with milk and water and sweetened, or hora- mony, &c. The child should be fed at regular hours; and this rule may be observed when it is also wholly brought up at the breast. The health of the mother, as well as the child's, will be better preserved by this system. Notwithstanding the success which often attends the mode of nourishing children, above described, it must be discontinued when they do not seem to thrive under it. This is ascertained to be the case when they be- On Diseases of Children. 25 come fretful, with disordered bowels, the stools being loose, frequent and foetid, and the food undigested. Should suitable medicine fail in correcting or remov- ing these complaints, there ought to be no delay in put- ling an afflicted child to the breast again, or obtaining a sufficient nurse—a neglect of this will be fatal to it. After the fifth or sixth menth, as the strength of con- stitution increases, some latitude may be allowed in nu- triment, should the mother's health require this aid. There can, however, be nothing more wholesome than. homony, or soaked biscuit. Many fine, healthy chil- dren, have been exclusively raised in this manner It is always proper to examine the diet, to see that it is well boiled or prepared, and not sour. When an in- fant is to be fed, the nourishment should not be given thick, or in large quantities at a time. Weakly children will require nursing longer than the fat and healthy. A child may be suckled from tin te thirteen months, if the mother's constitution permits j but no precise time for weaning can be laid down, as this must be influenced by a variety of circumstances. It will certainly be improper, when the child has any complaint connected with dentition, and ought not ge- nerally to be attempted in this country, during the months of April aild May ; previous to this season, or later, would be advisable, as cholera and bowel com- plaints are then most prevalent. A mistaken idea has prevailed, that prejudicial ef- fects result from keeping a child long at the breast; the reverse of this is certainly the fart. Many inconve- niences and complaints succeed premature weaning. 3 26 Practical Observations The practice of exciting disgusting associations, by putting aloes, &c. on the nipple, to prevent a child's sucking, is dangerous and reprehensible; a little care and resolution, for a few days, will overcome difficul- ties, and seldom fail in establishing a new habit. It is customary, when a child is well grown, to give it a bone of chicken or animal food ; but until it has teeth to masticate with, this must be cautiously done. It may be choked by swallowing large pieces, or the stomach may become oppressed, or disordered. The great importance of cleanliness, which has been adverted to, cannot be too strongly recommended, and faithfully observed. Children should be regularly combed and washed, and their heads kept clean, to in- sure good health, and exemption from a number of com- plaints and disorders. The constitution will not be materially benefitted, by the adoption of any system of living differing from that which is established, and appears to suit. Attempts to render children hardy, are often productive of distress- ing consequences of a permanent nature, and other (or new) habits, when they are confirmed, cannot be de- parted from in adult life, without bad effects. A child, when six or seven months old, may be en- couraged in attempts to creep ; with* this design all un- necessary restraints are to be removed; its clothes should be shortened, and the nurse attentive, to prevent its falling. As soon as its limbs acquire sufficient strength, it should be taught to walk, and not confined to the house, especially when tbe weather is fine and dry. Fresh air, out of doors, tends to render it ro- bust and healthy. On Diseases of Children. 27 SECTION IV. YELLOW GUM, (Icterus Infantum.) This disease has been noticed as occurring soon af- ter the birth, when the first copious secretion of bile takes place, which is absorbed to a certain extent, and thrown upon the surface. It may be aggravated by meconium impacted in the bowels, and other obstruc- tions ; but the causes are .generally of a transient na- ture, and the complaint exists as a mild form of jaun- dice. No anxiety is ordinarily produced by it, and it soon wears off. A laxative dose, of one or two tea- spoonsful of castor oil, or a little Epsom salts, or an in- jection of warm water, with salt and molasses, or soap and water, will answer the purpose. Dr. Underwood's excellent advice, of administering a gentle emetic, con- sisting of a k\v grains of ipecacuanha, or antimoniai wine, ought not to be neglected when the disease conti- nues. This treatment will effectually remove the yel- lowness. It has often been remarked, that when thii unplea- sant appearance subsides, the infant's constitution and complexion speedily improve, and seem better than previously. This is considered, however, by some writers, as an " innocent delusion." 28 Practical Observations SECTION V. RED GUM, (Strophilus Intertinctus.) The red gum bears a resemblance to measles, but may be distinguished by an absence of catarrhal symp- toms and fever, and the system is not materially dis- turbed. It consists of numerous red pimples on the chest and body ; those which break out on other parts are extremely small, resembling specks with inflamed bases, which are most conspicuous, when the infant is very young. These minute papulae are clivated above the cuticle, and contain a clear fluid of no determinate duration; in which respect, the disorder again differs from measles. The eruption sometimes appears in clusters or patch- es* about the arms, and is now and then found to ter- minate in a slight exfoliation ot the skin, but does not dry off as in the disease abovementioned. This infantile disease is subject to some variety, and usually discovers itself a few days after the birth; in most instances before the second month, and seems to be induced by acid acrimony and disturbance in the viscera, subservient to digestion. The food or milk, probably does not agree with the child; and, therefore, should be changed. * It is called by the French practitioners, " fluorescence be* nigne." On Diseases of Children. 29 In those cases, however attended with pain or unea- siness of the stomach and bowels, and when the erup- tion changes colour, or is repelled, the following treat- ment is proper:—Mix six or eight grains of ipecacu- anha in two ounces of warm water; of which, two tea- spoonsful are to be given every fifteen minutes, until the child vomits two or three times. After the operation, one or two drops of laudanum may be administered, mixed with a small quantity of fennel-seed tea, sweeten- ed, and the warm bath. On the succeeding day, the following" laxative mix- ture may be necessary :—Take of Epsom salts one drachm, carbonate of magnesia twenty grains, mixed with two ounces of warm water; give two or three tea spoonsful every hour, or oftener, until physical stools are produced. The cure may be accomplished by ad- ministering now and then small doses of magnesia, with or without a grain or two of rhubarb, as the state of the bowels indicates; or a spoonful of lime water, with fresh milk, two or three time a day if the stools are thin, sour (or green.) When the child is debilitated, two or three drops of spirits of hartshorn, or compound spirits of ammonia, may be added. A due regard to cleanliness must be Observed, and cold, damp air, guarded against. When irritation and itching become troublesome, the parts are to be dusted with fine starch or flour. *S $0 Practical Observation* SECTION VI. THRUSH, (Apthce Infantum.) The thrush, as an original disease, usually occurs within the month, and is seldom attended with fever. It appears in white specks on the tongue, lips, fauces, and insides of the cheeks, extending sometimes down to the oesophagus, resembling particles of curds. These ac- quire, after a time, a yellowish appearance, and then dry off. They are, in some cases, renewed two or three times. These succeeding crops of thrush, are justly remarked by Dr. Armstrong, to be thicker than the first, " and not so white." The child's mouth, at first, becomes hot, and the in- telligent nurse, Dr. Bateman observes, is thus early ap- prised of the approach of the disorder, as the nipple is often excoriated by the eruption. It may, in this man- ner, be a means of communicating the complaint to another child, if suckled at that time, and, therefore, convey an idea of contagion. In a few cases the aphthae spread, to the trachea, oc- casioning uneasy respiration and cough, or croupish symptoms. The child's tongue, in some instances, has been ob- served so severely affected by these sores, as to prevent sucking. When vomiting and copious stools succeed, the case becomes alarming. In most cases, the thrush of infants is more distress- ing and troublesome, than serious or dangerous, and the On Diseases of Children. 31 disordered bowels attending, the effect of indigestion and acidity. A gentle emetic of ipecacuanha will, in the first in- stance, be advisable ; after which a purging mixture of two or three drachms of Glauber's salt, with one scru- ple of magnesia, in two ounces of fennel-seed tea, may be given in doses of two or three teaspoonsful every hour, until the stools loose their green colour or foetid smell, and become physical. This mixture ought not to be administered until the day after the emetic. A mixture of magnesia, given in doses, at distant intervals, (every two or three hours) will sometimes answer ; but when the stools continue thin, and are frequent, the pre- pared chalk, or crab's eyes, should be substituted for magnesia. The addition of one or two grains of rhu- barb, will occasionally be necessary in affecting a change in the passages, and subsequently restoring tone to the bowels. When the child draws up its legs, and seems in pain, add one or two drops of laudanum to the chalk mixture j administer two or three teaspoonsful every hour, and employ the warm bath. The specks or eruptions in the mouth, may be touch- ed or covered with borax, reduced to a fine powder, and mixed with an equal part of loaf sugar ; or a little of it n ay be put into the child's mouth, when it will lick it about with its tongue; and, in this manner, the aphthae will be covered with some of it. This has been found the most useful application. Washing with a mop- stick is unnecessary and painful. In severe forms of this complaint, the bowels are ex- coriated by acid stools. In these cases, after evacuat. 32 Practical Observations ing as directed, the Peruvian bark, in decoction with magnesia or crab's eyes, will be serviceable. The mouth, &c. should also be washed with the decoction ; to which, a few drops of tincture of myrrh may be add- ed. Lime-water and milk will also be beneficial. When the rectum is affected, a lotion, or injection of the bark, should be employed. The child's strength must be supported with thin ar- row-root, barley, rice, or corn gruel, with milk, and by changing the nurse, should such a measure seem nece* sary. SECTION VII. EXCORIATIONS OF THE NAVEL, &c Excoriations of the navel, behind the ears, &c. are common among children ; the latter is rather more fre- quent during dentition. These affections commonly proceed from the neglect ef cleanliness, and are more troublesome than danger- ous. They will be removed by washing the parts well with warm water and soap, and afterwards dusting with calamine in fine powder; or, by the use of some dis- cutient lotion as lime-water, a solution of sugar of lead in water, or white vitriol. Should there be ulcerations, these may be dressed with litharge ointment, spread oa soft linen rag. When they assume an ugly appearance, which, in a few cases, has been noticed, a lotion of camphorated On Diseases of Children. 33 spirits will be proper; and the bowels should be kept sufficiently open, with a saline purging mixture as in the foregoing instance, (see Sect. 6,) or two or three grains of calomel may be administered in a little syrup. SECTION VIII. SPASMODIC TWITCHING, &c. There are sometimes twitchings, or spasmodic con- tractions observed about the mouth of the infant while it sleeps ; at other times, it moans, starts, and seems in pain; but, now and then the features will assume a smile. These various appearances, or expressions of uneasi- ness, have received the appellation of inward fits, and proceed from wind in the stomach and bowels ; conse- quently, disturbance in digestion. The child's food will be found, in these cases, not to agree with it, or it has been improperly exhibited. The magnesia mixture with fennel or aniseed tea, will remove this uneasiness. The stomach and body ought to be gently rubbed with a warm hand. Should the treatment not prove sufficient, an emetic of ipecacu- anha will be proper; after which, the bowels, if neces- sary, are to be opened with castor oil. 34 Practical Observations SECTION XIX. LOCKED-JAW OF INFANTS. (Trismus Nascentium.) There are but few infantile diseases in Carolina more fatal than trismus. It is of the same character with tetanus of adults, common in tropical and warm climates, but not unknown in other countries, especially on the Mediterranean coasts, as well as in higher lati- tudes. It attacks children about the close of the first week, and seldom after the ninth day, and is commonly be- lieved to proceed from unskilful management of the umbelical cord. Dr. Clark thinks it originates from smoky apart- ments and impure atmosphere. Although in many the disease occurs, when the navel has not healed Up properly, and looks inflamed and ul- cerated, I have attended where no such circumstances influenced the case. A want of cleanliness, a neglect in changing wet napkins, laying the child to sleep in a damp place, or taking cold, and constipated bowels, are among the or- dinary exciting causes. This is confirmed by the fact, that children, born of persons in low conditions of life, and of people of co- lour, are its most frequent victims. The prevailing irritibility of the infant system, pre- atisposes to spasm, from inconsiderable causes. To ob- On Diseases of Children. 36 viate these, will be therefore of importance, and the ne- glect inexcusable, inasmuch as the means are within the reach of most persons, however limited their circum- stances. The pulse is not much disturbed in this disease. The little subject moans, and seems uneasy; twitchings of the muscles of the face, jaws, and temples are observed j a tension of those of the neck and back succeed ; these soon become stronger; at length, the child drops the nipple and is unable to suck; the bowels are consti- pated and convulsions supervene. If effectual relief be not speedily obtained, it expires, an event not unfre- quent within fifty hours of the attack. The child's bowels, in the first instance, must be free- ly opened, by administering one or two teaspoonsful of castor oil, and repeating the dose every three hours, un- til the desired effect is produced. Enemas* of luke- warm water, with soap, may be employed as auxiliaries in assisting the medicine, and by their warmth, relaxing the tension of the abdomen. If the navel has not heal- ed, and looks inflamed, milk and bread poultices, mixed with two or three drops of oil of turpentine, should be applied with a slight degree of warmth, to the part, and afterwards mild dressings of oil and wax. The neck under the jaws, and along the course of the spine, ought frequently to be rubbed with a piece of flannel, moisten- ed with oil of amber, turpentine, or laudanum. Trismus may sometimes be relieved, after the bowels are moderately opened by a gentle emetic mixture, as before directed, of ipecacuanha, or eight or ten drops of * Glysters. 36 Practical Observations antimonial wine, repeated at short intervals. The vo- miting induces a favorable relaxation, and prepares the system better for anodynes or anti-spamodics, which will become necessary. Dr. Duncan, of Jamaica, advises blisters near the jaws, (under the maxilloe) or on the lateral parts of the neck, which I have found serviceable. Should the spasms seem to resist these remedies, the following mixture may be given when practicable:— Take of laudanumjfa>p drops, compound spirit of ammo- nia ten drops, infusion of fennel or anise seeds two ounces ; mix them ; one teaspoonful to be administered every thirty or forty minuets, persevering also in the external remedies, and injections, now and then, of warm soap and water. section x. ERYSIPELAS, {Infantum.) This disease also receives the appellation of " St. Anthony's fire." There are some varities discribed by writers. The Erysipelas of infancy occurs a few days after the birth, and rarely beyond the second or third month. It sometimes attacks suddenly, and consists of a diffus- ed swelling and redness about the hands and feet, and not unfrequently on the neck and face. The parts af- fected are slightly elevated ; on pressure with the fin- ger the redness disappears, «leaving a white spot," (On Diseases of Children. SI hut resumes the former appearance again. It is accom- panied w;th much heat and occasional fever, succeeded, by vehicles, vvhich break and terminate in suppuration and ugly scabs. The characteristic marks correspond with the varie- ties observed in adults ; occasionally the colour is that of the rose or bright red, the skin clear and shining, at- tended in these subjects with a " pungent pain." The disease seems to be seated under the cuticle; and in mild cases, the vesicles, after six or eight days, dry up. In the worst species, the brain becomes affected with delirium, &c. and the parts diseased are gangre- nous. The causes producing Erysipelas are, too great ex- posure to heat of the fire, &c.—to damp air, improper food, and consequent disorder of the chylopoevic vis- cera ; morbid state of the bile; the action of poisons, wounds, contusions, &c. A gentle laxative mixture will, at first, be proper, Consisting of Epsom salts, with magnesia, or two grains of calomel, which should be repeated in four or five hours, if stools are not produced. On the succeeding day, an emetic of ipecacuanha, if the stomach is disor- dered, and the parts inflamed dusted with fine chalk, flour, or calamine powder. In the more severe kinds, camphorated spirits may be applied, and ammonia in- ternally in doses of three or four grains, every three or four hours. Where there is a tendency to sphacelus, the decoction of Peruvian bark must be administered, and the strength supported with wine whey. If there is a determination to the brain, blisters to the back, (between the shoulders) and on the arms, are ne- 4 38 Practical Observations cessary. The swelling, &c sometimes attacks the body, thighs and legs, and rapidly spreads, acquiring a livid or purple appearance; the genitals also bme affected. This form of the disease frequently even- tuates unfavourably. On Diseases of Children. 39 CHAPTER II. ttongenU? Mmsaum an* Affections*. SECTION I. IMPERFORATED ANUS. his deplorable congenite defect, is observed in va- rious degrees. Although there may be an external appearance of perfection in the Anus, should meconium or fceces be retained longer than ten or twelve hours, an oiled bou- gie, or piece of thin, soft whalebone, covered with rag, may be cautiously introduced up the rectum. If, on being withdrawn, these appear soiled, the obstruction is but temporary, and will be removed by administering a little castor oil, or some mild laxative. But, should any resistance be met with, in introduc- ing the above means of inspecting; or, if they do not appear soiled, we are then assured that the gut is clos- ed, at the place of resistance which has been reached. When the defect is external, an incision must be made with a lancet, at the part where the Anus is ordi- narily met with, and carried about an inch in depth, if necessary; but, if this does not meet with, or open into 40 Practical Observations the rectum, which must be ascertained by inserting « bougie, or blunt probe, the incision should be carried deeper, in the direction of the rectum, and be kept from uniting again, by the continued use of bougie plasters, rolled into a proper thickness. In those instances where an incision cannot be made to reach the part obliterated, there remains no alterna- tive, but that of making an artificial anus, by dissecting down from the left iliac region to the colon, opening it, and securing the sides to the aperture or wound of the integuments, by ligatures, until a union takes place. The Urethra in males, and the Vagina- and Hymen in females, are sometimes impervious at birth, and are fo be managed in a corresponding manner. In the foregoing cases, bougies, carefully employed, will afford relief; but, when malconformation is very jreat, puncture of the bladder becomes indispensable. Consult Benjamin Bell's System of Surgery, vol. 6. SECTION II. HARE LIP, (Labia Leporina.) Malformation of the mouth is not an uncommon occurrence. There are instances of vacancies extend- ing through the palate bones to the uvula ; and cases are on record, in which these bones are wanting. When a child is born with a fissure, or longitudinal division of the upper lip, the most common form, the blemish is thought to resemble the animal, from whicb On Diseases of Children. 41 it derives the appellation. This aperture is sometimes double, with an intervening portion of lip. The condition of the mouth described, is not only disagreeable, but it deprives the subject, in a great mea- sure, of the power of receiving nourishment; and it is expedient to adopt some method of counteracting the inconvenience. If the defect is not seasonably remov- ed, it will also prove a material impediment to speech. However distressing, and even serious this deformity may appear, it can happily, in most instances, be re- moved, when the defect is confined to the lips only, by an operation, which generally succeeds very well. This may be performed about the third month, or some time previous to dentition. The liability to con- vulsions is not then as great, as at an earlier or later pe- riod ; there is less resistance made, and the cicatrix will be smaller. The operation consists in reducing the fissure to the exact state of a recently incised wound, by cutting oft all the pulpy or callous marginal parts, and removing any piece of flesh or lip which interposes; and lasdy, in retaining the divided edges of the wound in such a man- ner, as will enable a union, by the first intention,to take place. For this last purpose, the cautious application of adhesive strips, supported by a suitable bandage, has been adopted and recommended by an eminent surgeon. But, this method will only answer while the subject is in infancy. When the child is older, the plan by the twisted suture is most effectual, andought to be adopted. The operation being determined on, the patient is to be conveniently situated and supported. A flat piece of whalebone, stout pasteboard, or blade of a spatula 42 Practical Observations must be placed between the side of the lip to be firs* divided and the gum; tbe lip is then to be stretched down upon it, and the edge accurately and neatly cut off with a sharp knife, so that the pulpy or cuticular margin, from below up to the apex, is sufficiently re- moved with one sweep of the instrument. Any inter- posing piece of lip is next to be cut off. The fienum connecting this portion of lip, to the gum beneath, will require to be dipt. The callous margin, on the oppo- site side of the fissure, is now to be divided, 01 cut, with the same neatness and precision as the first. These ex- cisions, when completed, produce a recent wound, re- sembling an inverted V. In order that the two edges, when approximated, may exactly correspond, and form in coalescing as neat a cicatrix as possible,the divided edges are to be brought into close and exact contact, and retained in this man- ner by inserting through them two silver pins, with steel points ; one of these must be pushed about the sixth of an inch from the margin of the wound on one side, and going to the depth of about two-thirds of the substance of the lip ; then passing through the margin, the pin is forced through at an equal distance opposite to where it was entered. The second pin is to be introduced at such a distance from the first, as will be found most completely to accomplish the indication, so that the union may be formed with the utmost degree of exact- ness. The first pin is to be inserted through the edges ef the wound, near the under part or termination of the lip ; the second at an equal distance from the first, and the apex, or superior point of the wound. On Diseases of Children. 43 When the pins have been introduced as directed, and the parts are supported in contact, thread, of sufficient strength, well waxed, must be wound around the ends of the pins passing alternately, transversely and obliquely, so as to describe the figure of 8; the edges of the wound are thus retained with firmness. Any effusion of blood, during the use of the knife, will cease when the pins are secured. When this operation is com- pleted, the points of therms, which are constructed to ■unscrew, should be removed, a compress of soft linen laid over the wound, and a double-headed roller band- age applied. Five or six drops of laudanum, may be given at bed time, in a little water. In the course of five or six days, the pins may, with ease, be removed, and the wound treated with light dressings. Consult Benjamin Bell's System of Sur- gery, vol. 4th, Sharp, Dessault, &c. SECTION III. CLOVEN SPINE. (Spina Bifida, Hydro Rachitis.) The records of Medicine, or Surgery, do not furnish a more deplorable disease than this. It consists in a defective state of the vertebral column. In most cases the defect is in the lumbar ; sometimes, however, in the dorsal and the cervical vertebrae. 44- Practical flbservations In this morbid and inco-npl- t. .; .te of the spine, the imperfect ossification is supplied by a tu nor over the part com lining a fluid. It is now and then found con- nected with hydrocephalus internus ; and the disease has been thought to originate here, and the fluid to de- scend through the spinal canal, to the part where it has lodged, eroding the contiguous bones, and constituting the spina bifida. It will readily be conceived, that it rarely admits of a cure, although the palliative plan has been so success- fully conducted, that there are instances recorded, of subjects being supported under it for many years; in one case the patient survived the age of puberty. The fluid contained in the tumor is serous, but of- tener gelatinous, sometimes streaked with blood. On pressing over the part, the continuity of spine is per- ceived to be interrupted, while the spinous processes of the next vertebrae are distinctly felt. As the death of the child has been generally accele- rated by opening the tumour, it is seldom attempted. The practice, however, of gradually evacuating the contents, was introduced about fifteen years since. This was effected by puncturing with a needle; and the subsequent careful application of a truss and bandage, with a view to afford support and ultimate coalescing of the sides of the sack or tumour. This has been advised as a radical cure; and as a palliative, a compress or truss, (without puncture.) Consult Benjamin Bell's System of Surgery; Abernethy's; Astley Cooper in the vied. Ch. Transactions, L. vol 2d. The external applications in common use, are, oint- ments prepared of cerussa acetataj letharge, or the On Diseases of Children. 45 ether preparations of lead ; or lotions, with camphorat- ed spirits; of zinc, as solutions of white vitriol; also,,, vinegar, &c. SECTION IV, BLEMISHES, SPOTS, OR MARKS. (Nevi Materni.) Children are not unfrequently born without marks, spots, tumours, or excrescences; in and by far the greatest number of cases which are met with, but little attention and assistance are required. Should they, however, acquire any extent or magnitude, efficient remedies, when practicable, ought to be employed. Moles, or tumours, which rise above the skin and be- come troublesome, may be safely and entirely removed with a knife, without inconvenience Marks of fruit, or of certain animals, are thought to be produced by a strong excitement on the mind of the mother during gestation. These unfortunate impres- sions, occasioning indelible marks, can, however, only be made during an early stage of foetal life. Deficiencies in fingers, toes, hands, feet, &c. or where these are superfluous, deformed, &c. monsters, and lusus naturae, have been subjects of amusing, but un- profitable speculations; useless, because they are irre- mediable evils of embriotic origin, perhaps of the first or second months. Unexpected and casual shocks, corf- 46 Practical Observations veyed through the mind of a parent, can, if at all, only operate at this period; and they are, for the most part„ unavoidable. section v. UMBELICAL HERNIA, (Exompholos.) A protrusion of the bowels at the navel, when it is large, at or soon after birth, constitutes this disease. It most frequently occurs about the third or fourth month. A radical cure can sometimes be effected, by efficient but cautious compression. For this purpose, a soft cushion, suited to the part, must be supported and re- tained by a wide bandage of cotton or linen, previously reducing the protruded part by gentle pressure. The opening at the umbilicus may contract and be obliterated, by skilful treatment, during infancy, but not in the adult stage. Should the foregoing method fail, the intestine must be reduced as directed, and the flaccid sack tied with a ligature. If done with exactness, this process is eligi- ble and expeditious; the adhesion of the side of the sack is complete, and a subsequent rupture thus ob- viated. A large portion of the intestines occasionally pro- trudes, with a diseased state or deficiency of the abdo- minal integuments or parietes. Under these aili.» ting circumstances, a reduction of the rupture is difficult. On Diseases of Children. 41 and will avail but little, as the child cannot long sur- vive. Hernial affections, generally, are to be managed oa similar principles ; thai is to say, by careful reduction, and the subsequent use of a compres; or truss. Con- sult Benjamin Bell; OSuvres Chirugique de Desault; Tom 2, «&c. section vr. SWELLINGS OF THE SCALP. Prjeternatitral shape and swellings of the head, sometimes succeed tedious labour. An apparent lap- ping of the bones is not uncommon, or a seeming defi- ciency with a tumid state of the scalp. In the first instance, gentle pressure, made by pass- ing the hand around the scalp, two or three times a day, will remove these, and tend to mould the head into a natural shape. Swellings of the scalp, should be treated with spiri- tuous or camphorated embrocations, applied by means of cloths dipped in them. By persisting in this plan, any effused fluid will be absorbed. Hydrocephalus. (See chap. 4, sect. 6th.) 48 Practical Observations SECTION VII. TONGUE-TIED, &c. This congenite affection is very frequently mej witli^ but, in many instances so slight, as to require no assist- ance from the surgeon. Mr. Moss, surgeon to the Lyinff-in-Charity., Liverpool, asserts, that " one out of three or four childien are tongue-tied, more or less." It is certain, that mot'ices and nurses apprehend its exist- ence as an impediment, oftener than circumstances jus- tify- It will be discovered by the frenum or membrane, attaching the tongue to the lower part of the mouth, Stretching ton far forward to its apex ; therefore, confin- ing it in its use. The child is observed to drop the nipple, and clucks in a singular manner. This limited motion of the tongue will also prevent its speaking distinctly as it grows up, if not remedied. The operation, when necessary, consists in liberating the tongue, by dividing this membrane, as far as it can be done, with a pair of blunt-pointed scissors. The raninal artery lies near the attachment of the frenum, and is, therefore, in danger of being wounded ; dread- ful instances of which are recorded; generally speak- ing, the operation is simple. Should any haermorrhage onsue, it is to be suppressed by compression with dry lint, or the application of caustic. The operation ought never to be performed while the child sucks a well shaped nipple; or the finger, pre- viously dipped in milk, sweetened with a little sugar. On Diseases of Children. 49 and put into its mouth. These will afford satisfactoiy evidences of the non-existence of the case. section vm. DISTORTED FEET, &c. Subjects born with their feet turned inward, are tailed vari; when in the outward direction, valgi. Distortions of the first kind, are most commonly met with. The early and careful application of splints, ingeni- ously adapted, so as to counteract the distortion, may be employed with advantage. These should be so placed as to prevent the parts in which they are in contact, from suffering by unequal pressure, and ought therefore to be carefully examined. To support the splints, suit- able bandages are necessary, renewing them from time to time. Beneficial effects can alone be expected, by a long perseverance in these means. Children are also sometimes born with deformed hands; the treatment must be conducted on the fore- going principles. 3 50 Practical Observations SECTION IX. DEFECTION IN THE HEART. The structure of the foetal heart may continue—there may be an imperfect closure of the foramen ovale, after the child is born. This is manifested by a dark, un- healthy complexion, livid appearance of the lips, uneasy respiration, asthmatic cough. The last is always a dangerous symptom. Medical aid will avail but little in these cases, as the subjects cannot be expected to recover, although they are sometimes known to survive the second year, or longer. The diet of the child must be carefully directed, and the state of the bowels attended to ; costiveness should be obviated ; change of climate may be tried. The child ought not to be allowed to fret. section x. HYDROCELE Of the Tunica Communis, and of the Tunica Vagi- nalis Testis. Infants are frequently afflicted with the former, which is an encysted tumour, consisting of water, con- tained in the common membrane of the testis, and ©r- On Diseases of Children. 51 dinarily occupies the middle space between the testicle and groin. In the other case, the water is contained between the testicle and vaginal coat. Children are sometimes born with it. In the first instance, the disease sometimes spontan- ously disappears, or may be removed by warm fomen- tations, or the application of some astringent lotion, as, the solution of muriate of ammoniac,* sugar of lead and white vitriol, brandy and water, &c.; when these fail, the watery contents should be evacuated by puncture with a lancet. A similar process may be pursued when the effusion is lodged beneath the vaginal coat. When puncture, with a lancet or trocar,t has been adopted, the return of the watery collection may be effectually prevented by injecting port wine, or brandy and water, into the sack, or between the coats where the fluid was contained. SECTION XI. MILK IN THE BREASTS, Sec. It is not uncommon to observe, a few days after the birth, the breast of the infant somewhat swollen, with a milky secretion. It is unnecessary and improper to squeeze this out. The swelling will, in a little time. disperse. No external, or other remedies, are required. * Salt of ammoniac. t Vide Pott on Hydrocele, Sif James Earle, &t. 42 Practical Observations CHAPTER III. Constitutional Dfacase*. SECTION I. RICKETS, (Rachitis.) J. his disease was formerly believed to depend upon a defective, or morbid condition of the spinal marrow, as the name imports. It is known by a pale and sickly countenance of the child, and an unusual size of the head; the chest, body and limbs are deformed, the breast-bone projects, while there is a distortion of the spine, the extremities of the long bones are enlarged, especially the knees, el- bows and wrists; the thighs and legs are crooked, and bent outward ; the sacrum and bones of the pelvis, also undergo a morbid change, and seem to approach, so as to diminish and compress the contained viscera, and the belly becomes tumid. In short, every appearance indi- cates debility and disease. One of the first symptoms discovered, is a swelling of the head, which acquires a much larger size than na* turaf. t)n Diseases of Children. 53 This dreadful disease generally shews itself after the sixth or eighth month, although the child has been known to be affected from the birth. It is often con- nected with scrofula. The received opinion is, that a want of firmness in the bones of the subject, is occa- sioned by a deficiency of phosphate of lime. It may be excited in predisposed constitutions, by bad food or im- proper tnilk. Rachitis has been known to terminate in hydrocepha- lus internus or convulsions ; or the child wastes away in a gradual manner. Sometimes, rickety subjects spon- taneously improve in health, and recover an unexpected degree of strength and firmness of limbs. While this favourable change of body progresses very slowly, we observe the faculties of the mind prematurely evolved. In the treatment of rickets, the remedies employed must be adapted to the state of the case. Due regard should be had to the remote and exciting causes, which are to be obviated or counteracted as far as may be consistent. Bandages are serviceable, and are to be applied in such a manner, as to afford a support without imped- ing the circulation in the limbs. The cold bath is also beneficial. Exercise, in the open air, especially where it is more salubrious than that which the patient is ac- customed to breathe. Wall respect to medicine, the occasional use of laxa- tives will be proper. For this purpose, the phosphate of soda, (or tastless salts,) Epsom or Glauber's salts may be given in sufficient doses. Chalybiates have certainly done good. I have given, the muriated tincture of iron, to a child four years old, night and 54 Practical Observations morning, in doses of eight drops, for several weeks^ witfa decided advantage. This, however, will not answer when the stools are green, disordered, or foetid. Pur- gatives are then indispensable ; after which, one table- spoonful of lime-water, with an equal quantity of fresh milk, two or three times a day, will be serviceable. The aqua potassre may be substituted for lime water.* Emetics are sometimes beneficial; and Peruvian bark, and other tonics, have been recommended. Children, with this disease, are generally, but not invariably, the offspring of parents who have been af- flicted. I have met with cases where no such predis- position could be traced. It is certain, bowever, that several children, in the same family, have become rickety. SECTION n. SCROFULA, STRUMA, or KING'S EVIL. The scrofulous constitution is generally strongly marked, and said to be hereditary, and derived from the father, although eminent writers maintain, that females are most subject to it. The first symptoms do not ^usually appear before the second or third year of the : child's life, but rarely after puberty. A predisposition to scrofula, may be distinguished at the birth, by a softness andflaccidity of habit, light hair * See a Treatise on Rickets by Dr. Witherhead, London. 1820. On Diseases of Children. 55 and blue eyes, with a dulness of the sclerotica. There is also a remarkable tumidity of the upper lip, " with a chop in the middle, stretching into the nares." It is sometimes connected with a rickety constitution, or fol- lows that disease. It is also said to succeed small-pox in some instances; although, most common in temper- ate climates, scrofula may be met with in every region. Scrofulous tumours first appear on the neck, below the ears, or under the chin. When handled they move under the skin, and do not seem to augment in size for one or two years. The lymphatic glands are most affected ; in the course of time, however, the salivary partake of the disease; also, the large joints, the spongy ends of these bones, as well as the articulations of the fingers and toes. The testicle is not unfrequently found to suffer, and the breasts of females are sometimes affected. The tumours described, in time, enlarge and loose their elasticity ; a fluctuation is discernable, and all the symptoms are, in course, aggravated. Strumous swellings are now and then observed in early life, with the attendant symptoms, and wear off with age. The disease is not infectious, and, there* fore, cannot be communicated by a nurse. Perhaps there is no bodily affliction, recorded in the annals of medicine, for which a greater variety of reme- dies have been invented than this. Many have acquir- ed great celebrity ; but this has been transient or ephe- meral. Supernatural means were formerly resorted to. In England, during the reign of Edward the Con- fessor, such was the superstition of the times, that the royal touch was deemed infallible; the number of these £6 Practical Observations afflicted objects who sought this favour from Charles the Second, seems almost incredible. This moii.u.-h is stated to have administered the sovereign specifi( t«> up- wards of ninety thousand persons ! Its illusory char- acter was, at length, exposed by the increasing splen- dour of the light of truth, of reason, and of science. When these strumous tumours are large, and dispos- ed to suppurate, the process may be forwarded by emollient poultices. That composed of the yolk of egg, honey and flour, is most effectual. If the contents are discharged, the matter is seldom purulent, but re- sembles white flocc li, not unlike the whites of eggs, or a thin whey-like, or curdy fluid; after which, a sinus forms, attended with ragged, inverted edges, and pain- ful ; the .bony parts which lie beneath, or, in their course, become carious. This is, especially, the case in the struma maligna. When fluctuation is perceptible in these tumours, as described above, an opening should be made in the most depending point, with a lancet. When left to themselves, they are usually tedious in bursting ; and there is always such a destruction of substance, that the succeeding ulcer is rendered larger and more painful, than when the lancet is used. The dressings should consist of simple ointment, or wax and oil, in which a small quantity of burnt alum ie occasionally mixed, to favour the process of suppura- ration, the ulcer being previously washed with warm water, and sometimes a solution of sulphate* of copper; the' dresshjirs aie to be covered with compresses of soft linen folded, and supported by bandages moderately • Blu» Vitriol. On Diseases of Children. 57 tight, or secured with adhesive strips laid over them. In some cases of long standing,the ulcers may be dress- ed previous to bandaging, with the Quain's* delight, sprinkled over the part. Scrofulous ulcers frequently heal up while tumours form in other places. The cold bath has been used with great success in this as in other cachectic habits, during the warm sea- son. The disease often alternates with phthisis pul- monalis ; therefore, the indiscriminate use of the re- medy, where a predisposition to catarrh is very strong, will certainly be hurtful; also, in delicate constitutions it is to be carefully employed, in every instance before observed, when treating of the cold bath, (see chapter 1, section 2,) a glow over the surface of the body and increased animation, are to be considered evidences of its beneficial effects. Bathing in salt-water should be preferred, when the condition of the patient will admit of it. The tepid, or warm bath, will be serviceable where the cold is inadmissible. These should be con- tinued a length of time, and at regular periods. In the first stages, laxative doses of Epsom, or Glauber's salts, are necessary. The gum guaiacum, in doses of two or three grains., with one or two grains of calomel, may be given with much advantage, once or twice a week. The tonic virtues of the preparations of iron are here also deservedly commended. The muriated tincture of this metal, as advised in Rachitis, should be exhibited daily, mixed in a cold infusion of carduus or quassia, Most of the tonics of the mineral or vegetable kingdoms >' StiJlin^ia Sylvatica of Linnaeus, (powdered) 58 Practical Observations are valuable. Arsenic, zinc, barytes, lime, hemlock, and Peruvian bark, the latter in the form of decoction, with a few drops of elixir of vitriol, three or four times a day, has been very useful in many instances. Cos- tiveness should be guarded against, by the occasional exhibition of enemas,* or some convenient laxative medicine. Mr. William Farr, surgeon, of London, in a late trea- tise on scrofula, speaks of the great efficacy of " fric- tions" with strong mercurial ointment, and the internal use of the alkalis, especially Brandish's liquor potassae. In the worst description of this disease, the struma maligna, its destructive progress has been arrested by the following alterative plan : Take of murias hydrargyri (corrosive sublimate) one-eighth of a giain, muriatic acid ten drops, French brandy half an ounce, water seven ounces ; mix. The subject, six years old, took one tablespoonful every other morning for three weeks successively. The pa- tient evidently improved in health; the action of the liver seemed re-excited; its functions previously were suspended, or torpid. The cold bath was subsequently employed with advantage. A salivation has not been found beneficial in scro- fula. * Glystcm On Diseases of Children. 59 SECTION III. DISEASES OF THE EYES. Ophthalmia, or inflammation of the eyes, or in which red globules are projected on the surface of the s^to- lica, will frequently occur in childhood. The minute vessels on the eyes become distended, and excite exqui- site sensibility; light is painful, and sometimes in- supportable; the secretion of tears is copious and dis- tressing. Evacuant remedies, consisting of Glauber or Epsom salts, and now and then two or three grains of calomel, and ihe use of collyria, composed of one grain of the sulphate of zinc, and two of acetite of lead, with four ounces uf cold water, will accomplish a cure. A collyrium, to be efficacious, should be employed six or eight times a day, or oftener. In tedious cases, blisters applied to the temples, nape of the neck, &c. will be serviceable. Should the disease resist these, and the vessels on the eyes be distended, turgid, or va- ricose, they are to be cut or divided; the operation commonly termed scarifying, must be effected with the shoulder of a lancet. Excisions of th,e conjunctiva^ when the turgescence is great, prove more beneficial. A small pair of curved scissors are to be used for the purpose; and the parts which have been dipt, should be bathed or well washed in warm water, as well to favour a flow .f blood from the divided vessels, as to remove coagulation. 6& Practical Observations When the inflammation is violent, and the little pa- tient suffers much pain, leeches may be applied to the temples. Blood-letting also from the arm will be ad- visable. Cathartics and blisters are to be repeated, until relief is obtained. Cool air, light dress, and diet easy of digestion, as vegetables, bread, milk, &c. and shading the eyes from stiong light, especially from candles or fires, must be strictly enjoined. After the second or third day, if the tongue appears coated, or furred, an emetic will be highly serviceable. The Prussian surgeons give the Peruvian bark in ob- stinate cases, "without any unfavourable effect on the inflammation." In protracted cases, or chronic oph- thalmia, tonics are certainly useful. Collyria, consist- ing of one grain of green vitriol, (salphate of iron) to three ounces of cistern, 01 rain water; or ten drops of laudanum to six ounces of water, used six or eight times a day, have produced happy effects. The purulent ophthalmy is a very commonform of the disease in early childhood, and is often constitutional. In this complaint, there is a constant discharge of thick matter from the inner surface of the eyelids ; these are sometimes much swollen and turned out, exhibiting an ugly and distressing appearance. The inflammation is frequently so great, as to threaten the organization of the eye. in these cases, the disorder is communicated to the cornea, and in some instances to the iris. A weak collyrium, composed of white vitriol, should, by means of a syringe, be now and then thrown up be- tween the li'J and globe of the eye. Laxatives are also to be occasionally administered. Dr. Underwood's On Diseases of Children. 61 Surgical Tracts, and Mr. Ware's Treatise, contain much valuable practical information on the subject, and may be consulted with advantage. I have used, with excellent effect, an ointment com- posed of lard, (axungia porcini) half an ounce, camphor one grain, calomel twenty grains, well mixed. A little of this is 10 be inserted under the eyelid; or the disor- dered parts to be anointed with some of it, two or three times a day, the eye being previously washed with tepid water. The aqua camphorata,* advised by Mr. Ware, is also very useful. Calomel, in small doses, as an alterative will be beneficial; one or two grains may be given for three nights, successively; and after sus- pending it for five or six days, the medicine may be re- sumed. Should this not act upon the bowels, or touch the salivary glands, which will be no disadvantage; the doses are to be altogether discontinued, and laxatives of castor oil or Glauber's salts, resorted to. Recourse must also be had to blisters, on the temples, nape of the neck, &c. and the nurse changed, or the child's food altered. In tedious cases, the change of air, or climate, may be beneficial. Poultices have been employed, but their effects, even in the chronic form of ophthal- mia, are equivocal; they seem to exasperate the pain and re-excite inflammation; they certainly counteract one indication here, which is, to restore tone to the de- * Prepared in the following manner;—Take of blue vitriol and armenian bole, each four grains; camphor one grain ; mix, and pour upon them four ounces of boiling water; when cool, filter off the clear lotion. Inject a mixture of 40 drops of this preparation, with one ounce of cold water, between the lid and ball of the eye, frequently. 62 Practical Observations bilitated vessels, through which red blood has been propelled. I have frequently met with a disordered state of the margin of the eyelids, which were tumid and ulcerated, apparently a morbid condition of the glands of mobo- meus. The visual organ did not partake of disease here. The treatment which succeeded best was, anoint. ing the parts with mercurial ointment every night, and the occasional exhibition of laxatives, as two or three grains of calomel twice a week, alternated with a suffi- cient dose of Epsom salts. The complaint sometimes proved tedious, and obstinately resisted every remedy. An epidemic ophthalmia prevailed in the Orphan- House of this city, during the months of June and July last One hundred and thirty-two children were afflict- ed with it. The attack of the disease was extremely sudden. A child, while in school, or at play, felt a darting and acute pain in his eyes, sometimes first in one, but within twenty-four hours, both were affected. On examination, the external parts and palpebrae, exhi- bited a red, or often a livid appearance, resembling the effects of a smart blow. In a few hours, the sclerotica became inflamed, accompanied with a severe and dis- tressing pain and turgescence of the vessels of this coat. The light was, at this time, almost insupportable, and there was a copious watery effusion, which increased in attempting to open the eyes. This continued for three or four days, when suppuration, in many cases, suc- ceeded ; the matter discharged from the ball and under parts ol the palpebrse was thin, of a green and yellow Colour. On Diseases of Children. 63 About the seventh day the patient began to recover. The convalescence was sometimes rapid. In the course often days, no appearance of the disease existed. The violence of the inflammatory symptoms requir- ed prompt depleting remedies, which afforded relief. In many instances, it was necessary to take blood from the arm. The bowels were freely and repeatedly eva- cuated ; saline laxatives, as well as antimonial powder, calomel and jalap, were imployed with this intention, and to determine to the skin. The turgid vessels of the sclerotica were divided ; and, in several cases, more effectual excisions were made. Blisters were also re- sorted to. Emetics were, on some occasions, bene- ficial. Collyria of white vitriol and sugar of lead, were ser- viceable, after the second day. For the first and se- cond days, no topical application gave relief, but seem- ed to aggravate the pain. In the suppurating stage, the subjects were strictly enjoined, not to allow the matter secreted to remain on the eye ; and when the lids were much swollen and sore, the margins were anointed with lard, in which a little calomel was mixed. This treatment proved happily efficacious; neither specks on the cornea, nor organic visual affection of any kind, succeeded. Boys were more subject to it than girls, and the san- guineous and plethoric than those who were thin and delicate. No satisfactory causes could be assigned for the pre- valence of this epidemic, unless we were to consider as such the previous and frequent, as well as sudden vicis- $itudes of temperature, from cool and wet to extremely 64 Practical Observations hot and dry weather. Epidemics, however, often oc- cur in large institutions, without any assignable, remote, or exciting causes. A spongoid affection of the eyes, with a diseased state of these organs, now and then occur. The eyes in these cases, eventually suppurate and burst. Excre- scences sprout out, and the bones forming the inner can- thus, becomes carious. This is to be considered as a cancerous complaint, and proves fatal if extirpation, is not seasonably adopted It is believed to originate from wounds, or blows on the eyeball; or succeeds violent ophthalmias, which have been neglected, or unskilfully treated with poultices, or improper topical remedies. Violent head-aches, and great sense of heat in the eyes, precede the disease. It is asserted, that the larg- est proportion of these subjects, received into the hos- pitals of Paris, are under twelve years of age. The remedies advised in the first instance, are, blood-letting, local and general. In this case, the tem- poral artery may be opened. Laxatives are also indis- pensable ; and blisters to the temples, nape of the neck, and head. When these fail, the operation ought not to be delayed. Night blindness, or nyctalopia. This term is used by writers with much ambiguity; or, in a contrary sense, especially with certain eminent moderns. Pro- fessor Scarpa, and Baron Boyer,* apply to it the name of hemeralopia, and treat it as a sympathetic disorder, * Traite Des Maladies Chirorgicales, ^c. Tome 5ieme. p. 479. V On Diseases of Children. 65 of periodical recurrence, influenced by the state of the stomach. I have met with it, in several instances, in subjects under the ninth year. There was a constant irregularity or contraction of the pupils; and as the evening advanced they became entirely blind, and groped their way when called. These children were of delicate constitutions. It may be considered as a species of amourosis ;* or may depend upon a constitutional debility of the retina, not unfrequent in warm climates. In the cases above adverted to, emetics, tonics, especially Peruvian bark, with compound spirits of ammonia, and the cold bath, were, at different times, serviceable. In one case, an intermission, or period of suspension of several months, occurred. SECTION IV* EAR-ACHE, (Otitis.) Inflammation of one, or both ears, with excruciat- ing pain, occurs, sometimes, in early childhood ; but, very frequently between the second and fifth years, leaving a remarkable predispdsition to recurrence. When tbe child is too young to express its feelings, vre conclude, from sudden fits of crying, the inclination of its head, and frequently moving it, and restlessness, * Vide Haller's Physiology, vol. 2, p. 89. *6 66 Practical Observations especially when the ear is touched, that this is the cause of its suffering. The paroxyism lasts several hours, when a remission of pain takes place, and the patient falls asleep. This is followed by a thin discharge of matter, which is dis- covered on its cap, or the pillow. I have known it to continue three or four days, with slight remissions of pain only in the morning; after which, the discharge was very copious. The tympa- num and internal structure, but, in particular, the termi- nation of meatus auditorius internus, have, in a few instances, been ulcerated, and the sense of hearing per- manently impaired, although the effect, generally, is only temporary. In this complaint evacuants are required; the bowels should be opened with Epsom salts or castor oil, and the ear carefully and frequently syringed, or washed with a lotion, consisting of ten grains of sugar of lead, sixty drops of tincture of myrrh, with eight ounces of water. After which, should the pain continue, a little .audanuQi, mixed with olive oil, may be dropped into the ear; or a few drops of vitriolic ether, upon cotton or wool, put into the ear for a short time, and repeated, until relief is obtained. Blisters, as near the parts as possible, will be beneficial. Mr. Curtis, of London, in a valuable work on Otitis, advises poultices when the inflammation does not sub- side ; and when suppuration takes place, to puncture the ear. In slight cases, keeping the ear warm, by means of a handkerchief, or bandage, and the topical application of On Diseases of Children. 67 laudanum and oil, or ether, as above directed, will sel- dom fail to afford complete relief. The ear-ache, is most commonly produred by taking cold. This should be obviated by careful attention, and cleanliness. SECTION V. FOETID DISCHARGE FROM THE NOSE. (Ozcena, Sfc.) The constitutional disease on which this depends, which we consider to be scrofulous, must be taken into view. It is, however, often met with at a late pe- riod of life, as a symptom of cachexia syphyloidea. The discharge from the nose is purulent and foetid, and seems to proceed from an ulcer. The matter is discharged in the greatest quantity in the morning, and a sneezing attends. The matter, at first, rather resembles mucus than pus, but gradually assumes this appearance, and is now and then streaked with blood. The aloe nasi and cheeks occasionally partake of the ulcerations. During the progress of the disease, the bones of the nose, as well as those common to the face and skull, become carious. The internal remedies advised in scrofula, have been found beneficial here. A decoction of sarsaparilla, with elm bark, has proved efficacious. 68 Practical Observations Laxative doses of antimonial powder and jalap, or cream of tartar, &c. are to be exhibited once or twice a week. The following external applications have been found very useful. Take of the mineral solution of arsenic three drachms, gumarabic two drachms, warm water four ounces ; when the gum has been dissolved, add one drachm of tincture of myrrh. Some of this to be intro- duced into the nostrils, and applied to the parts affected by means of a feather or camel's-hair pencil, five or six times a day. A weak solution of blue vitriol, (sulphate of copper) will also prove beneficial, as well as mercurial washes. The most valuable lotion of this mineral, is prepared as follows :—Take of lime-water eight ounces, cor. sub.* one scruple; shake the phial well, and use it as above directed, four or five times a day. * Murias Hydrargyrf. Qn Diseases of Children. 69 CHAPTER IV,. Dentition. Jj/entition constitutes an interesting and important epoch in childhood. The teeth are formed in the jaws some time before the birth. In the faelal state, each jaw has a groove, extending over its surface, which, in time, is divided transversely into cells, becoming the future sockets, or alveolar processes. In each of these are small pulpy bodies, contained in their appropriate capsules or sacks. In due season, these bodies ossify, or rather acquire the substance of teeth, as well as their several forms; and, at their appointed time, pierce through the surrounding vascular substance, denominat- ed gum. They are connected with the jaw by a spe"' cies of articulation termed gomphosis. A tooth consists of three parts; the body, or all that part which is above the gum ; the next is its neck, which separates it from the fang or root, being that por- tion which is under the gum, and implanted in the sock- et. The body of the tooth is thickly covered with a dense white and polished vitrious substance called ena- mel, down to the neck, when it ceases. The neck and roots are closely invested by a thin membrane, the pe- riostum and resemble bone in structure, but some- what more compact. There is a cavity in each tooth, for the reception of blood-vessels and a nerve. 70 Practical Observations Instances have occurred, of children being born with teeth ; and they have not unfrequently been known to appear at the third or fourth month; but the usual time for cutting them, is not until the child has attained its seventh month. The symptoms are, fulness, swelling and inflamma- tion of the gums of the lower, and afterwards, of the up- per jaw. The child is fretful, and often thrusts its fin- gers into its mouth. There is an increased secretion and flow of saliva. It sometimes happens, however, that this is suspended, the bowels aie disordered, and the heat of the body augmented, with restlessness and other febrile symptoms, subsultus tendinum, and con- vulsions. All these symptoms are more or less violent and distressing, in proportion to the degree of irritation and pain consequent on a departure from regularity, in the usual time and order of teething. The following is the order in which the teeth gene- rally appear:—The two centre incisores (front teeth) of the lower jaw first cut the gum. In about one month after, the corresponding in the upper jaw make their appearance; these are after a few weeks, followed by the other two incisors. Between this and the ninth or twelfth months, the contiguous front teeth protrude, the lower preceding the upper, as with the first. At the close of the sixteenth month, as there are no bicuspides among the deciduous, or milk teeth, the first molares, or grinders, push through the gum, leaving a space between them and the incisores, for the cuspidate or canine teeth, which do not ordinarily appear before the twen- tieth month, being deeper in the jaw. The large mo- fores do not discover themselves until the second year. On Diseases of Cfiildren. 71 Thus, we find that the first set, or milk teeth, are ten in number, in each jaw, viz. four incisores, two cuspidati, and four molares, or grinders; while the adult, or permanent set, consist of sixteen, viz. four in- cisores, two cuspidati or canine, four bicuspides and six molares. The two last, in each jaw, are called wisdom teeth, (denies saspientioz) being seldom evolv- ed before the twentieth year. The deciduous, or milk teeth, are adapted in number and structure to the capacity or dimensions of the \a- famWe jaws; their bodies are small, and their roots comparatively superficial; but, about the sixth year the jaws enlarge, and the first set of teeth begin gradu- ally to yield to those which are to be permanent; sub- ject, however, to some irregularities, occasioned by nu* merous . auses. From the seventh to the eleventh year, the adult teeth are supplanting those of infancy. That a process of the animal economy, so perfectly natural and inevitable in its occurrence, should be asso- ciated with disease, will cease to excite surprise when we reflect, that innovation, and a dereliction from pri- mitive manners and customs, have entailed upon the offspring of man, evils which, perhaps, are scarcely known to the aborigines of our country, or among other uncivilized nations. An effeminacy of manners may have destroyed an in- herent or instinctive defence against disorders. Ii most, however, be admitted, that under every cir- cumstr-nce and condition of life, the eruption of teeth is, with the greatest proportion of subjects, accomplished 72 Practical Observations easily, and without any complaints or diseases which awaken anxiety, or excite distress. Analogy certainly supports the impression, that dis- orders from cutting teeth are not among the natural evils. SECTION i. DISEASES INDUCED BY DENTITION. Symptomatic complaints, excited by local irritation, are comprehended under this head. These are not un- frequently alarming and dangerous. Deviations from the natural order in the eruption of infantile teeth, occasionally occur to a great extent. The canine and first molares sometimes advance ra- pidly, so that, at this stage, (between the sixteenth and twentieth months) eight teeth are presumed to be press- ing on the gums ; all the symptoms of difficult teething are, therefore, aggravated. Diarrhoea, fever, some- times a cough and cholera, attend ; if speedy relief is .lot afforded, convulsions may also supervene. The means of moderating this excessive irritation, and of alleviating symptomatic disorder, require the ut- most care of the practitioner. To fulfil the first indication, it is advisable to ex- -amine the condition of the gums; and if they seem, in any degree, full and swollen, over the parts where the teeth are to protrude, to divide the same with a lancet down to the teeth. On Diseases of Children. 73 It is proved, by experience, that even when these have not approached the surface, the scarifications, as they are termed, afford relief. Various substances are employed for the child to press its gums upon, which afford only temporary relief. Gum sticks of coral or wax, or a piece of biscuit, or crust of bread, answer the intention; but some caution must be observed, or the child will injure, or perhaps, choak itself, with detached portions of the latter. Those substances which, in a slight degree only, resist the pressure, as wax, &c. are otherwise preferable to coral, which is too hard, and increases the pain and swelling of the mouth. When, however, the gums in- flame and swell, children are naturally inclined to thrust their fingers into their mouths, which may be allowed, unless there is a habit acquired, of pressing upon one finger only. I have seen ugly ulcerations produced in this manner. To effect the second intention, or to modeiate febrile symptoms in teething, laxative medicines are useful. For this purpose, a sufficient portion of Epsom salts, dissolved in fennel-seed infusion, may be given at re- peated doses, until physical stools are produced. Should the passages be foetid, mixed with green or acid, and vitiated bile, a little magnesia may be added to the mixture ; or, it will be proper to exhibit an emetic of ipecacuanha, which will more effectually remove grip- ing pains; afterwards, an absorbent and aperient, of magnesia one drachm, rhubarb five grains, infusion of fennel-seed two ounces, mixed, and given in dos^s of two or three teaspoonsful every two hours, will change 7 74 Practical Observations the appearance of the stools, and restore the healthy and natural operation of the viscera. When the heat of the body is distressing, the tepid, or even cold baths, will be serviceable. But, should the child's bowels be loose, or much disordered, it will be more benefitted, by being placed up to the navel in warm water, or the application of cloths, wrung in warm water, as a fomentation to the umbilical region and epigastrium, or pit of the stoma< h. Sponging these parts with spirits, to which a little laudanum is added, sometimes has a good effect. Children, of gross habits, may require a repetition of laxatives. Their bowels are to be kept freely open, es- pecially when much fever attends; and when there is a determination to the head, a few ounces of blood should be taken from the arm ; or leeches, applied to the head, and a blister between the shoulders. If the looseness, (or diarrhoza) on the contrary, ex- ists and proves distressing, or alarming, the absorbent mixture, already mentioned, must be resorted to, and injections of rice or barley water, with four or five drops of laudanum, thrown up every fourth or sixth hour, until the disorder abates. The warm fomentation described, will also be useful. In other cases, where the irritability of stomach con- tinues troublesome, eight or ten drops of compound tincture of opium (paregoric) mixed with one scruple of prepared chalk, and two ounces of water, should be ex- hibited in doses of two or three teaspoonsful, every half hour, until relief is obtained. It is sometimes neces- sary to apply a blister to the epigastrium. To effec- On Diseases of Children. 75 tuate the design, if the gums have not been lanced, this must no longer be delayed. In the application of blister plasters, to young per- sons, it is seldom necessary to keep them on longer than three or four hours. On their removal, although they appear to act now and then only as rubefacients, a com- plete vesicle, in a little time, succeeds. When convulsions supervene, synapisms, or mus- tard plasters, are to be applied to the wrists and ankles, or soles of the feet, which should be removed in thirty or forty minutes, and re-applied, if necessary; about eight or ten drops of spirits of hartshorn, or the com- pound spirits of ammonia, may be added to the chalk mixture? as above, and two or three teaspoonsful given every twenty minutes, until the alarming symptoms subside. The pediluvium, or what is more effectual, a warm bath, will be often of beneficial result; as well as injections of warm water, in which a small quantity of soap has been dissolved. If the bowels, however, have been confined, two or three teaspoonsful of castor oil should be given; and where the stomach is oppressed, an emetic of ipecacu- anha will generally prove salutary, especially when the tongue is coated, or furred. 76 Practical Observations SECTION II. STOMACH AND BOWEL DISORDERS. (Cholera Infantum.) Children are most subject to cholic affections, ac- companied with griping and diarrhoea, between the eighth and sixteenth, or twentieth months, and some- times after the second year. No constitutions are ex- empt ; although delicate children, and those who have been recently weaned, or cut their teeth late or irregu- larly, are most liable. The pain and irritation of teeth- ing, season of the year, neglect of cleanliness, and local circumstances, concur in producing an increased and vitiated state of bilious secretion, acidity, acrimony, and other disturbances in the first passages. Cholera sometimes prevails as an epidemic during the spring and early part of summer. It formerly re- ceived, in this city, the appellation of " April and May disorder." The mortality among infant subjects, from this cause, anterior to the last thirty years, was awful and distressing; and it continues to occur, but by no means so generally, or severe, as at those periods. An increased salubrity of climate, which accurate re- cords, faithfully preserved for many years, incontestibly prove, has greatly diminished this sourse of anxiety. The late Dr. Ramsay, in his valuable medical History of South-Carolina, remarks, prior to the year 1800, " that the spring months were formerly the terror of On Diseases of Children. 77 parents; and that, diseases of that season, had become less frequent and less mortal." There are more children lost to the community by cholera, at this critical age, than at any other stage of life. A moist and warm climate, or situation, must al- ways be deemed unfavourable to health ; but, we shall not find, on. a careful examination of the bills of mor- tality, that the more northern atlantic cities are exempt, or are less subject to this annual affliction. It may, in fact, be considered the common outlet of infant life in all our large towns. It cannot fail to excite the most pleasing and grateful emotions, when to observe, that this evil does not in- crease, but very sensibly diminishes. Previous to the year 1820, the bills of mortality, during the spring months, as published by order of the board of health, exhibited the deaths of a larger portion of children, by one-fifth, than have been subsequently known. The child is sometimes very suddenly attacked with sickness and vomiting, which, at first, consists of little more than the contents of the stomach; but, a frothy matter, with phlegm and green bile, is soon after brought up. If nourishment is given, he rejects it al- most immediately. Other indications of great gastric excitement, langour, lassitude and debility, succeed, with a cool clamminess of the surface of the body and extremities. The child lies in a listless state, or sleeps with its eyelids partially closed. Every exertion brings on vomiting. Now and then the puking subsides; but diarrhoea, or oftener, rather a rush through the bowels, takes place j the stools are watery, much heated, and have a very Practical Observations jur smell; or, they are mixed with green, vi- utttlu w..v*, the palms of the hands become dry and warm, and there is a peculiarly heated and sour smell of the breath ; the pulse is somewhat quick, but seldom full, and there is usually an evening exacerbation. These symptoms, in some instances, decline after a day or two, then recur and assume, for several weeks, a chronic or milder form. Sometimes the approach and progress of the complaint are gradual, but not less fatal in the issue. In the treatment of cholera, it should be first observ- ed, how far the eruption of teeth may be concerned in producing it. Should this be ascertained by the swollen state of the gutns, they are to be lanced or scarified, in the manner described in chap. 4, sect. 1. A mitigation of all the alarming symptoms often attend this practice. The warm bath is highly useful; and injections of thin warm gruel, or barley water, are serviceable. When the bowels have not been affected^, a teaspoonful of Glauber's salts should, be added to these. If mode- rate evacuations of the bowels are produced, the vomit- ing will generally be restrained, or suspended; but when this last symptom is violent, a mixture, composed of half a drachm of magnesia, with two ounces of infusion of cinnamon, and eight or ten drops of compound tinc- ture of opium (paregoric) may be given in doses of two ©r three teaspoonsful every hour; or sometimes alter- nate this, with a spoonful of lime-water, and an equal quantity of fresh milk, until the stomach .is composed; after which, administer the mixture of magnesia, rhu- barb and fennel-seed tea, as before advised, until the bowels are moderately opened, or a laxative prepara- On Diseases of Children. H9 lion, composed of one or two drachms of Epsom salts, about twenty grains of magnesia, and two ounces of water, or fennel-seed tea, until stools are produced. It is not uncommon for a thrush, or aphthous affec- tion of the tongue and mouth, to take place in chronic cases, or the anus becomes excoriated. The symptoms attending this disease, are often so alarming, as to require the instant use of the warm bath—synapisms (or plasters of mustard) to the wrists and leet—warm fomentations to the body, and blisters to the epigastrium, in order as well to support the pow- ers of life, as to determine to the surface. The chalk mixture, with an infusion of cinnamon, and two or three drops of laudanum, is also required to check the violent irritability of the stomach. I have sometimes preferred a grain or two of the compound powder of ipecacuanha, (Dover's powder) mixed in ateaspoonful of toast water, or something of the kind. This plan of treatment is particularly required, when an alarming diarrhoea or rush through the bowels occur. After which, the mix- ture of magnesia and rhubarb, should be exhibited. Glysters of rice or barley water, with five or six drops of laudanum, are useful auxiliaries in these cases. When the stools are attended with pain, and a dis- charge of mucus, or become dysenteric, with irregular chills and fever, one or two grains of ipecacuanha may be advantageously combined with the prescription above advised, or a gentle emetic of the same. When the disease has been, in some degree, restrain- ed, small doses of powdered Columbo root, from five to eight grains, mixed in a spoonful of cies of cynanche is not contagious, although it often arises from local causes; and many, alike pre- disposed, may become affected. It is commonly pro« duced by taking cold, from exposure to damp situations, during spring and autumn, and after sudden atmosphe- rical vicissitudes in winter. The young, robust, and those of sanguinious temperament, are its most usual subjects, although it occurs at all ages, and no constitu- tions are emirdy exempt. A habit of recurrence of this complaint, on taking cold, seems to establish itself over the constitution. On Diseases of Children. 91 The inflammation and tumour, generally occur in one tonsil first; afterwards, the other side becomes affected. When much fever attends, bleeding will be advisable, -and an emetic mixture, as directed in the former dis- ease. When the child has rested a few hours, saline laxative doses, to which a few drops of antimonial wine should be added, will be required to keep the bowels open, and to encourage perspiration ; to which, there is usually a disposition, and which is of a salutary ten- dency. The following emollient and detergent gargle, will also be highly beneficial:—Take of honey one ounce3 sulphate of zinc (white vitriol) four grains, warm water eight ounces. The throat to be gargled, or washed six or seven times a day, with some of it. When the tu- mour has burst, eight or ten drops of muriatic acid should be substituted for the white vitriol, or sage tea^ with honey and alum used. If the complaint is pro- tracted, or increased, blisters to the nape of the necka and throat, will be proper. When the swelling of the tonsil is large, it may be advantageously opened by lancing it, and the throat frequently gargled, as above directed, or, with a decoc- tion of Peruvian bark, with a few drops of tincture of myrrh. Should the disease prove tedious, and ulcerations take place, with a croupish hoarseness of voice, the pa- tient is to be considered in danger, and the case must be treated as directed, for cynanche maligna, 9 98 Practical Observations SECTION III. MALIGNANT SORE-THROAT. (Cynanche Maligna.) Infants and children are the most frequent subjects of this disease. It generally attacks the weakly and delicate; but will sometimes spare neither those who are older, nor the more hardy. The symptoms are, a sense of cold, or chilliness, succeeded by nausea, anxiety, restlessness and fever* A stiffness or uneasiness is felt in the neck and throat, with hoarseness of voice. The internal fauces are of a deep red colour, with some tumefaction. Deglutition is always painful. Ash-coloured spots soon after appear, covering the inflamed parts with sloughs, followed by ulcerations Catarrhal symptoms usually accompany it, and the watery discharge from the nostrils, &c. (coryza) is often acrid, and even excoriating. The de- jections, in young children, are also of an acrid pro- perty. The pulse is frequent and irregular, but seldom full. Slight remissions occur in the morning, attended with great prostration of strength and spirits As the disease progresses, commonly on the second day, something like an erysipelatous eruption, appears on the neck and arm, which, in the course of thirty hours, extends to the extremities, being most thick on the Hands and fingers. About the third or fourth day, a On Diseases of Children. 99 disquamation takes place, without material relief, or remission of febrile symptoms. When the fever continues, after the second day, the ulceration spreads, with frequent bleeding from it, and other gangrenous indications, of a dark or livid colour, with foetor. It terminates on the third or fifth days. In the progress of the disorder, the fauces, larynx, seso- phagus, and sometimes the whole alimentary canal, as well as the respiratory organs, suffer, and a fatal issue may be induced by suffocation or spasm, effusion or mortification. An increasing hoarseness, or wheezing, as in croup, is considered a dangerous symptom. The common sore-throat frequently subsides, or goes off by resolution, or the inflammation terminates in suppuration; after which, the parts heal up kindly; but the origin, as well as the progress of cynanche ma- ligna, are of a different character. There is always here, a quick pulse and continued febrile action, and a tendency, in the parts diseased, to ulceration and gan- grene. Croupish respiration is a frequent concomi- tant. This distressing form of cynanche, is commonly be- lieved to be contagious in England; although sporadic cases occur on this side of the atlantic, during the au- tumnal months, and at other seasons of the year; or, rather a milder kind, than that above described. The symptoms are protracted in these instances, notwith- standing which, it is frequently of fatal issue. When the disease is mild, the ulceration is not ex- tensive, and more superficial. A pale, cineritious slough succeeds. When the case is more alarming, this becomes more livid, or dark with fcetor, and a 100 Practical Observations frequent tendency to bleed, with coma and delirium. The delicacy, softness, and laxity of the throat and fauces of young children, dispose them to suffer most; consequently, the younger the subject is, the greater the danger. To allay the irritation of the system—to promptly arrest and counteract the transient inflammatory ac- tion—to obviate the dangerous prostration, or debility^ which rapidly follows gangrenous tendency, by quickly diminishing arterial excitement—inducing a new and salutary action, and, at the same time, supporting the vis vitoz, are indications to be answered. Blood-letting can only be employed in the earliest stage. The following treatment has been found effica- cious :—Take of the decoction of Seneka snake-root (polygala) six ounces, tartarised antimony two grains, spirits of nitrous ether sixty drops, loaf sugar half an eunce; mix them, and give from one to two table- spoonsful every half an hour, until vomiting is freely produced. After two or three hours, proceed with this preparation, but diminish the quantity of tartarised an- timony to one fourth of a grain, in the six ounce mix- ture, and give one tablespoonful every hour and a half, or two hours. A gargle, composed of half a pint of sage tea, one ounce of honey, and fifteen drops of mu- riatic acid, should be used. The throat and fauces be- ing very frequently gargled, or washed with some of it, in a tepid state. If the bowels are not freely opened, give from two to four grains of submuriate of mercury, (calomel) every two hours, and assist the operation, On Diseases of Children. 101 with glysters of warm soap and water, or the internal exhibition of a little castor oil, or Epsom salts.* Should the disease resist these active depleting re- medies, evacuants, after the first or second days, are to be cautiously used ; although costiveness must always be obviated by the means above advised. Blisters to the arms, neck, throat, &c. will be proper ; also, a de- coction of serpentaria aristolochia, (Virginia snake- root.) In the course of the disease, I have frequently wit- nessed the good effects of a gargle, consisting of a de- coction of Seneka, with honey. It seems to produce a salutary exudation from the diseased and tumid surface, on which it acts, and excites a stimulant effect, which is of a beneficial tendency. A camporated gargle is also of similar utility, prepared as follows :—Take of cam- phor eight grains, vitriolic ether thirty drops, honey one ounce; rub these well together, and pour on half a pint of hot water; when cool, strain off and use as above di- rected. The analogy in the modus operandi, of Se- neka and camphor, has frequently induced me to sub- stitute the one for the other. A gargarism, composed of capsicum, or common pepper vinegar, honey and wa- ter, has also proved very serviceable. When the gangrenous process has advanced the de- coction of Peruvian bark, with tincture of myrrh slightly acidulated, with a few drops of muriatic acid, will be. necessary. The external application cf camphorated spirits to the throat and neck, as well as tincture of myrrh and » Vide Hamilton on Purgatives. *9 102 Practical Observations vinegar, ought not to be omitted ; and the patient's* apartment may be occasionally sprinkled with some o^ these. The symptoms indicating a favourable change, occur on the third or fifth days. The redness and swelling of the skin, neck, &c. in these cases, subside—the pulse becomes more regular, or less rapid—the sloughs of the fauces, &c. are cast off—the ulcers fill up—respiration is easier, and the child sleeps quietly, and there is a re- turn of appetite. The change, however, is sometimes very gradual. SECTION IV. MUMPS, (Cynanche Parotidea.) Children are most subject to this disease after the seventh month. It is of a contagious character, and usually prevails as an epidemic ; for the most pan pain- ful, and more distressing than dangerous. It commences with a slight fever, accompanied soori after with a glandular tumour on the neck, below the angle of the lower jaw, which is moveable. This swelling increases, and spreads over the anterior part of the neck. As the tumour enlarges, for three or four days, the fever goes off; after which, all the symptoms, as pain, heat, tumefaction, &c. decline ; so, that by the tenth day, or earlier, the complaint disappears. As the swelling, in this disorder, subsides, it is not Uncommon for the testes in males, and breasts in ft- bn Diseases of Children. 103 males, to become swollen ; which, after a few days, spontaneously decline. Although this disease is commonly so mild as to ex- cite little anxiety, instances have occurred, where fe- ver, pain, tension and swelling of the neck, occasion great alarm. When the tumefaction, especially, re- cedes suddenly, the brain may be disturbed, and deli- rium, &c. take place. In the treatment of mumps, it will be proper to keep the patient on an easy, light diet, to evacuate the bowels, by means of some saline laxative, afterwards, an emetic mixture will be proper. With this intention, mix ten grains of ipecacuanha, and one of tartarised an- timony, with four ounces of warm water, and give one tablespoonful every twenty minutes, until the child vo- mits three or four times. The parts swollen should be kept warm, by tying a soft linen, or silken handker- chief, over the head and neck. If the tension and pain become severe, so as to excite a sense of suffocation, or to obstruct respiration, in any degree, a few ounces of blood may be taken from the arm, or leeches applied to the swollen parts. The bow- els must be kept open by Epsom salts, &c. and the emetic mixture repeated. When the tumour has sud- denly receded, blisters to the throat and neck, emetics, the warm bath, &c. are necessary, to obviate evil con-- sequences. 104 Practical Observations CHAPTER VII. pneumonic Xnflammatton, tyltuvteg. (Pneumonia, Pleuritis Infantum.) Inflammation of the bronchia? (and pleura) is, by no means, uncommon among young children, in winter, but, especially, during the early part of the spring sea- son, when inflammatory diseases are most prevalent. Pneumonic inflammation, may be considered an aggra- vated cold, determined to the chest, analogous to the pleurisy of adults. It is ushered in with a dry and burning heat of the skin, flushed face, oppressed breath- ing, with sometimes a copious secretion of mucus, or tough phlegm, which the child will swallow, if not re- moved with the finger, as it is unable to expectorate. The pulse is quick and tense ; a cough attends, which is most troublesome, when the secretion of mucus is in small quantities, and the pleuira most affected. The paroxyisms are increased when the child is laid down. After the disease has continued a little time, it seems easier when lying on one side, than the other. If these alarming symptoms are not soon relieved, dyspnoea, or laborious respiration, restlessness, anxiety, &c. precede a fatal effusion of lymph upon the pleura and lungs—a catastrophe, which may take place on the third, but, more frequently, on the fifth or seventh days. On Diseases of Children. 105 When the symptoms, which usher in the disease, are violent, blood-letting should be promptly employed. Cathartics and emetics are also necessary. To effectu- ate the former intention, one or two tablespoonsful of the infusion of Seneka snake-root, to which a sufficient quantity of Epsom salts has been added, and five or six drops of antimonial wine, ought to be exhibited every hour. This will also favour expectoration. An emetic mixture of ipecacuanha and tartarised antimony, may be necessary on the succeeding day, if the fever and dyspnoea increase ; and a repetition of blood-letting in the evening. If, after this treatment, the case does not improve, powders, composed of two grains of calo- mel, and an equal quantity of antimonial powder, should be given in a little syrup, every third or fourth hour. At intermediate hours, a spoonful of the Seneka infusion may be exhibited; to which, fifteen or twenty' drops of syrup of squills may be added. Injections are also serviceable, if the bowels are not sufficiently open. The warm bath will sometimes be of the most beneficial result; and, in obstinate cases, blisters to the breast, between the shoulders, to the arms, legs, &c. are re- quired. In certain cases, when the febrile and inflammatory symptoms have subsided, if the bowels have been suffi- ciently opened, about eight or twelve drops of pare- goric, (compound tincture of opium) or two or three grains of compound powder of ipecacuanha, may be given at night. Should the disease end in suppuration, or abscess within the chest, or on the lungs, which may burst, pu- rulent matter will be coughed up, if suffocation does npt 106 Practical Observations immediately follow, and hectic fever characterised, by flushes and quick, small pulse, with night sweats, irre- gular chills, short cough, &c. &c. These are pheno-. mena, common in pulmonary consumption. Blisters, successively applied to the chest, are here proper. From the fourth to half a grain of powdered fox glove, and one grain of calomel, should be given in syrup, every sixth or eighth hour ; and Seneka snake- root tea, with syrup of squills, as before directed. The child's strength must be supported with proper nourishment, whey, &c. In this view of the case, fatal consequences are to be, apprehended. On Diseases of Children. 107 PART IX. CHAPTER I. fftbtilt Mutants. (Pyrexia?.) JLoiopATHic fever, in infancy, is generally admitted to be of rare occurrence. The constitution, at this e rly stage of life, seems to be protected, in a great degree, from the operation of those exciting causes, which pro- duce febrile action, in adults, as well as in children, who pass the period of dentition. Among the ostensible and assignable reasons, are to be noticed, a previous excitement maintained in the sys- tem, by the constant influence of natural stimuli, as the growth of certain important visecra, as the liver, &c.; also, the bones, and eruption of teeth. These, and the peculiarly bland and mild nutriment, during lactition, destroy, in some degree, the properties of miasmata. The vis-incita, or irritability, at this period, constantly predominates over sensibility. The sanguiferous sys- tem is sympathetically affected, by the excitement indu- ced by ihe causes adverted to; consequently, as has elsewnere been remarked, the infant pulse is always ra- pid. Vide chap. 1, sect. 3. Among the causes which shield the infant constitu- tion from the destructive agency of atmospheric not- 10fc Practical Observations Sons, which, at other periods, produce specific febrile disease. During lactition, we should add the regularity of living, and the mild state of the secretions tnemselves. Fever, therefoje, for the first and second ye;rs of life, is, for the most part, sympathetic, attending sonic primary disorder, or accasioned by morbid irritation from some local cause, as in dentition, &c. The case is different, when the child attains its-third year. The predisposition to disease and fever, from miasm and contagion, exist—a fact which experience but too strongly attests. Dr. Cullen happily observes, that those diseases are more strictly " called fivers, which have the general symptoms of pyrexiae, without any topical affection, that is essential and primary."* Fever is distinguished by increased heat of the body, succeeding a chill, or shivering; an increased frequen- cy fulness or irregularity of the pulse, and disturbance and disorder of several functions,'with diminution of strength. This is the general character; but there ate certain other phenomena, peculiar to the several species of fever which occur, SECTION I. INTERMITTENT FEVER, (Ague and Fever.) This is the most common form of fever, produced by vegetable decomposition, or miasm. The symptom ■* Collen's firjt lines. On Diseases of Children. 109 are, langour, debility and lassitude, small and irregular pulse, with frequent stretching, paleness of countenance, coldness of the extremities, gradually extending to the back, body, &c. This sense of cold increases, with shivering and rigours; during which, the features are contracted, and the lips quiver. After this has continued some time, a warmth and flushing takes place, followed by preternatural heat of the whole body, and redness, especially of the face and eyes; pain in the back and joints; head-ache, thirst, &c. attend, with a dry skin, restlessness, full and fre- quent pulse. After some duration of these symptoms, a sweat breaks out, first about the head and face, and gradually extends all over the body, &c ; which, after a certain period, subsides, when a natural sense of feeling and temperature return. These several states of the system, are called the cold, hot and sweating stages. It is further to be remarked, that in the cold stage, the respiration is also often oppressed, or uneasy, and sometimes accompanied with a cough ; the appetite for food ceases, or is impaired, with nausea and vomiting of bile, and the urine, when passed, is colourless. These, generally, terminate theirs* stage. In the hot stage, a dry, or clammy state of the mouth attends, with thirst; consequently, a suspension of the flow of saliva. The urine is also in dimished quantity, and the bowels are costive. In the sweating stage, which terminates the paroxysm, the urine usually de- posits a sediment. 10 110 Practical Observations 'The paroxysm of an intermittent, is commonly fin- ished in twenty-four hours. The usual intermission, interval (or space, from its termination of a paroxysm, to the commencement of another,) is forty-eight hours, and is named tertian. The next, of seventy-two hours, is a quartan. That of twenty-fours, is a quotidian. The quartans and ter- tians, sometimes become quotidians; and these " pass into remittents," being that form of febrile disease, in which there is no perfect apyrexia, between the pa- foxysms. Quartans commonly attack in the evening ; tertians at noon, and quotidians in the morning. The intermittent, or the most frequent form of coun- try fever, occurs during summer and autumn ; and, as before mentioned, is produced by miasma, or noxious exhalation from marsh, and low grounds. It is some- times difficult to remove, and tedious, and seems to re- Cur long after the cause is supposed to have been re- moved, by a kind of habit acquired over the constitu- tion. The indications of cure, are to lessen febrile symp- toms, and to obviate the predisposing and exciting causes. An emetic, with tartarised antimony, is first proper. After which, purgatives are necessary to carry off the excessive secretion of bile, which takes place in this disease, as well as to favour the salutary termina- tion to the skin by sweating. To unite these inten- tions, the following mixture may be exhibited with good effect: Take of the decoction of Virginia snake-root eight ounces, tartarised antimony two grains, Epsom salts On Diseases of Cliildren. Ill one ounce; mix, and give from one to two tablespoons- ful, according to the age of the subject, every hour, until evacuations, by vomiting and stools, are freely pro- duced, encouraging the operation with some warm herb tea, and, subsequently, thin gruel, &c. After this, should the fever continue, powders, composed of two grains of calomel, and an equal quantity of antimonial powder, are to be given every three hours, in syrup, until the paroxysm subsides. The thirst may be oc- casionally relieved by toast-water, or lemonade, and the apartment sufficiently aired. During the intermission, if the stomach and bowels have been sufficiently evacuated, light nourishment should be allowed, and ripe or baked fruits. Some mild tonic may be exhibited, at intermediate hours, as chamomile, or weak horehound, or Columbo tea. When the stomach will bear it, the infusion of tho- rough wort,* given in doses of two tablespoonsful, every two hours, excites an excellent diaphoietic and tonic effect. Should the paroxysm, recur evacuants are again to be resorted to, and the treatment, as in the first in- stance, observed ; but, during the succeeding intermis- sions, the Peruvian bark ought to be administered, in substance or decoction, with the Virginia snake-root, or a few drops of compound spirits of ammonia, in each dose, to be repeated every hour, while the fever is off; or, if the stomach is weak, and has discovered no symp- toms of acidity, a few drops of spirits of vitriol may be substituted for the ammonia. * Eupatorium perforatum. 112 Practical Observations. Tonics, but, especially the Peruvian bark, ought never to be employed, until evacuants have been pre- mised. Their premature exhibition, tend to produce obstruction in the liver, spleen, &c. called ague cakes, appropriately termed suffocated excitement.* The Peruvian bark is more especially useful in the autumnal intermittents. An obstinate intermittent, may sometimes be sus- pended, or removed, by exhibiting an emetic of one grain of tartarised antimony, and eight or ten of ipeca- cuanha, as soon as stretching and other premonitions of the attack, are observed. A blister to the region of the stomach, has produced the same good effect. When the paroxysms have often returned, and resist the system proposed, the mineral solution of arsenic may be tried, in doses of three or four drops, in a small glass of cold water, or chamomile tea, three times a day; or powders, composed of from one scruple, to half a drachm of Peruvian bark, with ten grains of powdered snake-root, five or six times a day. Sulphur, in doses of twenty grains, may also be tried, exhibited three times a day, in a spoonful of milk. Of late years, the sulphate of quinine, has been successfully used, when the foregoing were inadmissable, or the stomach reject them. The chalybeate preparations, as rust of iron, and the tinctures of this metal, have been useful. * Rush's Inquiries. On Diseases of Children. 118 SECTION II. REMITTENT FEVER. [Fever, in which there is no perfect apyrexia, or inter- mission, between the paroxysms.) This form of fever frequently occurs, and is excited by the operation of stronger miasm, exhalations from low grounds and vegetable decomposition ; or, is sym- pathetic, and ushers in some other disorder. It may be induced by various causes, as some indigestible sub- stance taken into the stomach, &c. This fever comes on suddenly, in most cases, in the course of the evening, or night, with a chill, paleness of countenance, and restlessness. The child complains of head-ache, pain in its belly, or, in the iliac region, sick stomach, and sometimes vomiting attends; the skin then becomes hot and dry; the pulse quick and full; thirst, &c. The bowels are, generally, costive. An emetic mixture, and after eight or ten hours, a brisk cathartic dose of six or eight grains of jalap, and two or three of calomel, will be required. The latter must be repeated every second hour, until the desired effect is produced ; which seldom fail in mitigating the febrile symptoms. This treatment should be followed up, when the dis- ease continues, with saline laxatives and sudorifics, as the alvine discharges are not lequired to be as copious as on the first attack. The following mixture may be sufficient:—Take of Glauber, or Lpsom salts, one *10 114 Practical Observations ounce, dissolve in six ounces of warm water, and when cool, add forty drops of antimonial wine, and sixty of spirits of nitrous ether, loaf sugar one ounce. Doses of two tablespoonsful, are to be given every two hours; which must be reduced, when the subject is young, to one half. This fever often exists several days, with an exacer- bation, (or accession of symptoms, at night.) During each exacerbation, emetics, or cathartics, are necessary; and while the fever continues high, the antimonial pow- der, and calomel, in doses, as directed, under the last section, until a critical perspiration, or abatement of febrile symptoms, take place. A constipation of the bowels sometimes takes place, with such an irritable state of the stomach, that nothing can be administered with effect. Glysters, with warm water and soap, or castor oil, will here be useful auxili- aries, and lemonade, &c. will allay the retching ; but, no remedy answers this intention so completely, as blood-letting, when the pulse is tense, or full; and in other cases, a blister to the region of the stomach, will be necessary. It sometimes happens, that a worm in the stomach will produce this distressing excitement. Five or six grains of calomel, with a spoonful of castor oil, will, in this instance, prove efficacious, assisted with warm in- jections, as already advised. During the remissions, especially when the bowels have been sufficiently opened, the neutral mixture will be serviceable. Take of purified pot-ash (salt of tar- tar) one drachm, lime juice one ounce; mix, and after the effervescence, add half an ounce of loaf sugar, and On Diseases of Children. 115 eight ounces of cold water; two tablespoonsful to be given every hour. This will also tend to remove the irritation of the stomach, and promote perspiration. But, when the abatement of fever is but slight, the eyes are much inflamed, and head-ache severe, blood-let- ting again, in the evening, will be proper; and the powders of antimony, with calomel, &c. If the heat of the body is very great, the epigastrium, and region of the umbilicus, should be sponged with spirits, or a blis- ter may be applied. It sometimes happens, that while the child retches, some indigestible substance is vomited up ; or a worm, or their exists acidity in that organ. In the latter case, magnesia may be advantageously combined with the saline mixtures. The fever may run on to the third, fifth, or seventh day, or terminate in a low typhus fever, in which the sensorium, or nervous system, becomes highly diseased, and delirium, &c. occur. Blisters to the extremities, as well as to the back and stomach ; the camphorated mixture, and liberal use of wine whey, are required, and must not be omitted. SECTION Hf. TYPHUS FEVER. This is distinguished by langour, great prostration of Strength and spirits, lassitude, loss of appetite, pale countenance, and dulness of the eyes j the pulse is 116 Practical Observations quick, but not full ; the skin is dry and hot, although not always so; the surface of the tongue is sometimes free from furr; but, in the course of the dise.it. ac- quires a dark brown colour, and is dry and hard, and sometimes assumes a bright-red appearance. The throat and fauces also partake of this dryness, so that the voice is croupish. Head-ache is not a constant concomitant; but, the child, when raised up, will com- plain of giddiness. Picking the nose, and grinding the teeth, are sometimes observed; but, these are symp- toms commonly observed in protracted fever, with chil- dren. The exacerbations are sometimes marked by a pain in the loins, tiack, or knees, generally at noon, and in the evening, when a slight flush of the face and eyes> may be observed. As the disease progresses, the stools become foetid ; the patient lies in a state of drowsiness and stupor; when roused and spoken to, it says it feels no pain. In other instances, it is frequently observed to wink, and feels the bed-clothes, or picks at them. The urine is turbed and sparing. In the advanced stage, dflirium attends. The most successful treatment has been, that in which emetics were early employed ; and afterwards, laxatives of Epsom salts, with magnesia; or, from three to six grains of calomel, with five or six of rhu- barb, or jalap, may be given every two or three hours, until the stools* lose their fcetor. At the intermediate hours, the decoction of serpentaria, should be adminis- tered in doses of one or two tablespoonsful, every hour * Vide Hamilton on Purgative Medicines. On Diseases of Children. 117 »>r two, adding to each dose, five or six drops of spirits of ammonia. Lemonade, toast-water, or weak chicken broth, may be allowed ; and ripe fruit, excepting such as are too heavy, or pulpy. Should much heat be perceived about the body and stomach, bathing the parts with cold spirits, will be be- neficial. Cathartics are never to be pushed so far, as to pro- duce excessive evacuations. Copious stools, after the first stage of the disease, or the first day or two, will prove hurtful. Mild laxatives will answer. A drachm or two of magnesia, with ten or fifteen grains of pow- dered rhubarb, may be combined with eight ounces of the decoction of serpentaria, and given for the purpose, in doses of two tablespoonsful, every hour or two; or, three or four grains of calomel, in a little syrup. Should a favourable crisis be produced, all the fore- going symptoms will gradually subside; respiration will become easy and natural; a perspiration breaks out, and becomes general ; sensibility is restored ; and a desire for nourishment expressed. This favourable change, is sometimes produced by a temporary deafness, or an abscess. When the disease continues to resist the foregoing treatment, blisters are useful, and should be applied to the back, (between the shoulders) breast, the ankles, thighs, as well to the arms and wrists ; and, if neces- sary, sinapisms to the soles of the feet. In very low states of the system, bruised garlick will tend, more speedily, to produce re-action Blisters, in these cases, ought never to be allowed to remain on longer than may ^>e sufficient to induce vesication ; and where a ten- 118 Practical Observations dency to gangrene is ohserved, in the parts blistered, they should be dressed with powder of Peruvian bark, or charcoal. The internal exhibition of Peruvian bark, wine, camphorated mixture, with ether, &c. are neces- sary, essecially when twitehings, &c. are observed. Wine whey, arrow-root, chicken broth, &c. are to be frequently given in this debilitated state. If the belly seems puffed, glysters of soap and water, or castor oil, with salt and water, should be occasion- ally thrown up, in a moderately warm state, or fomen- tations to the region of the umbilicus. This fever may continue to the tenth, fourteenth, or twentieth day ; if beyond this, the patient commonly sinks under it, unless some mitigation has been pre- viously observed. The typhus sometimes originates in contagion; but, in this country, it is frequently entirelyunconnected with, and independent of this cause; and, in by far the great- est number of instances, succeeds catarrhal, remittent, and other forms of continued fever. SECTION IV. WORM FEVER. This insidious form of fever, may be confounded with that attending hydrocephalus, as described in jiart 1, ch?.p. 4, sect. 6 ; from which, it can. however, be dis- tinguished, by the absence of that distressing affection of the head, which induces screaming, restlessness, On diseases of Children. 119 throwing up the hands in expression of pain. Vomit- ing, when it occurs, is less frequent, the tongue less fur- re.!, and although the pupils of the child's eyes are fre- quently, duri.i i the disease, dilated, strabismus, or squinting, is rarely observed. The morning remissions, are distinctly noticed in a worm fever, and the exacerbations marked with a chill, or c.ldness of the extremities. A tumid state of the upper lijt is, in most instances, observed. In the first instance, the child droops for three or four days- seems reluctant to play, or amuse itself—be- comes irritable—picks its nose—grinds its teeth while it sleeps—its appetite is irregular—febrile heat attends, but thirst is not remarkable. After several days, an aguish chill occurs, succeeded by a smart paroxysm of fever—the pulse is quick, but neither full nor tense— nausea sometimes attends. If the child is asked where it feels pain, it points to the umbilicus, and often to the left iliac region. It now and then complains of its head. Its bowels are sometimes costive, and tongue, at this stage, partially furred. Should retching take place, the child will sometimes bring up worms ; but, in many instances, these do not appear until convalescence takes place; or, when the issue is unfavourable, on dis- section, these animals are found in the alimentary canal. It not unfrequently happens, after some duration, the exacerbations become milder, and the child sits up, al- though there is an aversion to food. This apparent change is transient, the bowels are more constipated, and active cathartics and injections are required. On the fiist appearance of the disease, it is proper to evacuate the bowels freely. For this purpose, take one 120 Practical Observations ounce of Epsom salts, magnesia half a drachm, oil of mint, or of worm-wood, two drops ; rub these together, and gradually add six ounces of water. Give the child one or two tablespoonsful every hour, until it operates freely. On the next day, an emetic of tartarised anti- mony and ipecacuanha, may be necessary. Should febrile symptoms continue, give two grains of calomel, with five of finely powdered spigelia (pink-root) and one of antimonial powder, every fourth or sixth hour, mixed in a spoonful of syrup and water ; and at inter- mediate hours, the neutral saline mixture, as directed in the preceding section, until an easy perspiration, and abatement of fever, &c. are observed. When the ex- acerbations return, without material alteration, after pursuing this plan foi forty-eight hours, discontinue the same, and give a decoction of spigelia and serpentaria, in doses of two tablespoonsful, with six or eight drops of antimonial wine, every two hours. Keep the bowels open by means of glysters of soap and water, or oil and salt and water, or an infusion of spigelia, with a spoon- ful of olive oil, &c. If necessary, a few grains of rhubarb, with a grain or two of calomel, administered in a little syrup, will more effectually answer this purpose. The warm bath will also be of service, as well a» the emollient applica- tion of bitter herbs and spirits, to the stomach and ab- domen 1)' the disease resists these remedies, blisters are to be resin ted to; and a decoction of Peruvian bark, spigeiia, and serpenuna, given in doses of a spoonful or two, every hour, or five or six times a day, during the remis- On Diseases of Children. 121 suons. The child's strength must be supported with wine whey, arrow-root, seasoned with wine, broths, &c. In advanced stages of this disease, active or strong purgatives are prejudicial. Costiveness may be pre- vented, by castor oil, or some of the means already di- rected. If no crisis occurs before the twentieth day, the pa- tient gradually wastes away, as in hectic cases. section v. YELLOW FEVER, (Typhus Ictorodes.) This is a tropical disease ; but, it also exists during the hot seasons of many temperate climates in Eu- rope, as well as in America, particularly in Gibraltar, and the southern coasts of Spain. It has, at different periods, been the scourge of most of the atlantic cities of the United States; and continues to be so frequently the theme of medical historians, that it would be here superfluous to enlarge on the subject. It will be sufficient, for our purpose, to treat of this hydra of disease, in the manner it has occurred in Charleston, as an endemic, during the summer and au- tumn of many years, within the recollection of its inha- bitants. Its recurrence is, by no means, regular; the reputed precursions have often proved deceptive; a lapse of several years, have been marked between the dates of its prevalence. After an absence of more than four 11 122 Practical Observations years, we have had, recently, to deplore its desolating and unrelenting sway. Its remote and exciting causes, are involved in much obscurity ; generally speaking, it has been observed to occur after unusually oppressive and sultry weather, es- pecially when the summer has set in early, and mois- ture predominates. Strict observation may also detect some evidences of a morbid state of the atmosphere; and, although it will lequire a temperature above eighty degrees of Fahrenheit's scale, to produce it, the disease will continue, with unabated malignancy, until the sea- son of frost. Sporadic cases have been noticed, dur- ing healthy summers, and ate to be traced to some ex- traordinary circumstances. Natives, and those who have resided in Charleston, for four or five successive summers—infants, and Afri- cans, are, for the most part, exempt from its attack, or the latter, in a very mild form ; while strangers, from higher latitudes, and young persons particularly, such as have been absent for several summers, are the almost exclusivcsubjects. Much diversity of opinion has been expressed, and continues to be entertained, of the pathology of yellow fever, a subject greatly to be lamented. " The History of Medicine," says a learned physician and philoso- pher, " must be that of a progressive science, and not of opinions, which, in time, will sink into oblivion." We have no well authenticated instance of the dis- ease having been communicated by contagion ; conse- quently, the duties of the nurse, and the tender offices of friendship, are without apprehension, assiduously and faithfully rendered. On Diseases of Children. 123 The symptoms are, a slight chill, lassitude, head- ache, pain of the back, loins, knees, and calves of the legs; soreness or uneasiness about the epigastrium, es- pecially on pressing this part. The eyes are inflamed, painful, and a singularly*suffused appearance is observ- able ; anxiety and involuntary sighing attend. The pulse is full, or tense, and frequent, and sometimes on the close of the second day, is vacillating. The tongue is white, or silghtly brown, and furred. Nausea and vomiting often occur to a distressing degree; while the bowels are costive, and sometimes the secretion of the kidnies seems suspended. These symptoms continue, in an aggravated form, on the second day. Although a slight, but transient re- mission, in some instances, takes place, the evening ex- acerbation is violent. On the third day, a dullness of the eyes, with a dusky* yellow tinge of the sclerotica, is commonly observed. The patient becomes more rest- less, ejects nutriment or drink, soon after swallowing, with a frothy phlegm, sometimes mixed with bile. The pulse is more contracted, and the countenance expres- sive of anxiety, with prostration of strength. About this period, a black matter, resembling coffee-grounds, is vomited up,t and the evacuations bear a resem- blance to this, or exhibit a tar-like appearance. Respi- ration, at length, becomes oppressed and laborious. Delirium supervenes, and the patient expires. * Vide Dr. Jackson on Febrile Diseases. t This is, by no means, however, invariably observed; strongly marked oases often occur, and terminate fatally* with- out black vomit. 124 Practical Observations If a crisis is not strongly marked, before the third day, the issue of the disease will be unfavourable, al- though it may be protracted to the fifth or seventh days. A yelloic colour of the neck and chest, as well as the face, is observed after death ; 3nd when the patient re- covers, a sallow complexion continues for some time. Treatment. This disease is an unique in character, and consists of two stages. Correctly speaking, there is but one paroxyism, the remission being slight and scarcely perceptible; the functions of the abdominal viscera are generally disturbed; and the brain even- ,- tually ; but, from the commencement, there is a strongly maiked determination to the stomach. On the third day, the low typhus state is observed. Occasionally, when the season is advanced, and cool, this change does Bot take place, until after the fifth or seventh days. The indication of cure, consists in reducing the inor- dinate action of the heart and arteries; in allaying the ardent heat which exists; in restraining gastric irrita- bility, and determination to that viscus ; and lastly, in supporting the powers of life, and exciting a healthy action. To effectuate these, various methods have been recommended, and are still pursued. The plan by mercury, has many and highly respect- able advocates. This consists in previously evacuating the bowels, and sometimes in the use of the lancet; subsequently exhibiting calomel in such a state of com- bination, and such frequent and repeated doses, as will most speedily and effectually excite its peculiar influ- ence over the constitution, and thereby vanquish the disease. On Diseases of Children. 125 This, indeed, appears to have become a popular me- thod, and, on some occasions, has been considered the most successful. It must be acknowledged, however, that, in many instances where the practitioner has not been early consulted, it entirely fails ; and it is but too manifest, that in contending with the disease in young subjects, mercury does not triumph. It is one of the properties of this medicine, to in- crease the irritability of the system; consequently, the action of the heart and arteries, already under an alarm- ing state of excitement, must have their impetus dan- gerously augmented. In pursuing this plan, the addi- tional stimulus thus employed, with that operating and morbidly imparted, may overwhelm the constitution, and labouring in the conflict, the little patient is hur- ried into the grave. It cannot be denied, that, in other cases, in any cir- cumstance, and under every diversified form, or prepa- ration, several days elapse before the mercurial influ- ence can possibly be excited; the excitement induced by the disease, transcending the power and stimulus of the remedy; but, there are not wanting, cases where a salivation has been produced, notwithstanding which, the issue was fatal. Facts, confirmatory of the opi- nion, above advanced. Shall we then prosecute a plan, occasionally tardy, and too often precarious, when the work of disease, dis- organization, and death, is rapidly progressing? and shall we entirely overlook the distressing, dreadful, and permanent consequences of this medicine ? It would, undoubtedly, comport better with the duty of the physician, and fulfil, with a greater prospect of *il 126 Practical Observations success, the indication of cure, to accommodate the treatment to the actual condition of the patient, by re- ducing immoderate action of the sanguiferous system, if necessary, by depleting, cathartics, emetics, diaphore- tics, &c. When the subject is of robust and plethoric habit, especially, should his pulse be full or tense, much pain of his head, his eyes inflamed, &c. blood-letting is re- quired, and may, perhaps, be repeated with advantage, within thirty or forty hours, of the attack of the fever. This remedy tends to restrain vomiting, diminishes the velocity of the circulation, and prevents a concentration t of disease in the stomach. Cathartics of jalap, with calomel, or saline mixtures of Rochelle salts, or Epsom salts, with magnesia, are proper. After which, if the tongue is much furred, an emetic of ipecacuanha, with tartarised antimony, will be required. Sponging the epigastric and umbelical regions, with spirits, or affu- sions of cold water, have a happy effect. On the second day, a neutral mixture of salt of tar- tar, (purified pot-ash) with lime-juice and water, as di- rected in the preceding sections, will be useful. Lime- water may also be given ; two or three spoonsful now and then, occasionally mixed with an equal part of fresh milk. These have been often known to restiain the disposition to retch, which is not only an alarming symptom, in the beginning of all acute diseases, but embarrasses or baffles the efforts of the physican. The period of the disease, however, or state of the pulse, ought to guide and influence in the treatment. The early application of blisters to the region of the stomach, is often efficacious; and the decoction of s_er- On Diseases of Children. 127 pentaria and Seneka snake-root, if the bowels and sto- mach have been sufficiently evacuated, will conduce to a salutary perspiration, and support the neivous sys- tem. In the typhus state, blisters to the arms, legs, and between the shoulders, are often required ; and in low states, sinapisms and garlic, applied to the feet and wrists, will produce re-action. The strength must be supported by arrow-root, chicken broth, whey, wine, porter, or good cider, &c. section VI. INFLAMMATORY FEVER, (Synocha.) This is distinguished by redness of the skin, or surface of the body and eyes, with heat, thirst, uneasy sense of fulness, head-ache, white tongue, restlessness, &c. It seldom occurs at any time of life, unconnected with to- pical affection, as in the several forms of cynanche ; or it ushers in some eruptive disease, as small-pox, &c. The symptoms, pain, &c. will, therefore, assist in the diagnosis, or determine the character of the fever. Evacuants, as cathartics, emetics,-blood-letting, cool air and drink, the abstraction of stimulating diet, and light, &c. are indicated. Blood, when drawn in this state of fever, exhibits what is termed the inflammatory, huffy coat. It is a glutinous part of the blood, which, tl on cooling, is found separated, and lying on the sur- face of the crassamentum." 128 Practical Observations Experience fully confirms the accurate opinion of Dr. Chalmers, that youths are more liable, in the spring months, to inflammatory fevers, which are often catarrhal and pleuretic. These, if not promptly treat- ed with depleting remedies, as cathartics, blood-letting, blisters, &c. degenerate into pulmonary consumption. Very young children also suffer by this form of disease. (Vide, part 1, chap. 6.) SECTION VII. HECTIC FEVER AND MARASMUS. This also occurs, symptomatic of local disorder, as, in abscess of the lungs, liver, &c. in scrofula and other morbid affections, and is characterised by chills, suc- ceeded by a quick, full pulse, flushing of the face, or a circumscribed redness of the cheek, &c. The remis- sions are marked by copious relaxing, colloquative sweats, especially at night, and emaciation. The bow- els are, generally, costive, but sometimes loose and dis- ordered. The appetite usually weak, but sometimes preternaturally increased. Treatment. The original disease must be attended to. Laxatives are, occasionally, necessary. The fox glove in tincture, infusion, or in powder, also, the inter- nal use of acetite of lead, are serviceable. The pa- tient's diet should be light, consisting of milk and vege- tables, and sometimes ripe fruit; but, in cases of ex- treme debility, wine whey, wine, &c. will be proper. On Diseases of Children. 129 Febrile disease, of this character, sometimes suc- ceeds the unskilful use of astringents in bowel com- plaints of children at the breast. It is the marasmus, or atrophia lactentium. A wasting away, or emacia- tion, takes place. The hectic seems to be kept up by an organic affection of some of the chylopoetic viscera, or by worms. The child's nutriment will sometimes be found defective, or improper; or, the milk does not agree with him. The food, or nurse, should, therefore, be changed. A little magnesia, or prepared chalk mix- ture, will be necessary ; and tonics, as decoction of Pe- ruvian bark. About this time, a few grains of rust of iron in syrup, or, occasionally, a little calomel, will be useful as anthelmintics. SECTION VIII. MESENTERIC FEVER, (Tabes Mesenterica.) Children, between the third and ninth years, are the most frequent subjects of this disease. It often suc- ceeds some previous visceral complaint, but may origi- nate independently. Its distinctive characters are, a slow fever, of irregular form. There is, commonly, however, an evening exacerbation. Debility, emacia- tion, costiveness, but now and then diarrhoea, attend. The complexion is sickly, wan, or sallow ; the belly tense and tumid, with aching or uneasiness, chiefly of the right side, just above the umbilicus ; sometimes of 130 Practical Observations the back, which is increased by stretching, or endea- vouring to extend the body; now and then an acute pain is felt. The child, at length, becomes restless, looses all in- clination to play, tbe appetite is impaired, sometimes there is a loathing of food. The fever, at night, in- creases, the tongue is covered with a brown fur. or, now and then looks as if spread with gruel; the pulse contracted and quick; the skin cold and clammy; co- pious sweating about the head, and, in some instances, the feet swell. The child, after lingering, beyond all expectation, for weeks, and even months, expires with- out convulsions, or scarcely a struggle, the powers of life being completely expended. The disease is erroneously ascribed to worms, and is often confounded with the former; from which, it can be distinguished by a due regard to the symptoms. In two fatal instances, I have known the depraved appetite of dirt-eating, connected with it. Dissections discover an induration and enlargement of the mesenteric glands ; sometimes a partial suppura- tion, schirrosity of the left lobe of the liver, and other morbid appearances of the glands. An obstinate cos- tiveness attends throughout the illness of the patient; and also a cough, which, however, at times, would en- tirely subside. In treating this disease, the greatest prospect of suc- cess will arise, from active remedies early employed. Like many others, it is slow and insidious, but fatal, if its progress is not speedily arrested. Gentle emetics, adapted to the age and constitution, are, in the first stages, proper, and have a happy influence on the sub- On Diseases of Children. 131 sequent treatment. Cathartics are also essential; the bowels maybe freely opened with rhubarb, or jalap, in doses of six or eight grains, and three of calomel; or, the occasional use of castor oil, or Epsom salts. Fric- tion, over the abdomen and stomach, with the hand, ought to be frequently employed, or mercurial ointment may be rubbed on these parts ;* or blisters, successively applied between the epigastrium and umbilicus, renew- ing them as often as they dry up. To obviate tenesmus, the patient should drink freely of barley water, or flax-seed tea. When the weather is cool, flannel must be worn next to the skin; and after evacuants, a regular attention to the state of the bowels. A small cup of Columbo, or wild horehound infusion, with five or six drops of tincture of fox glove, should be given three or four times a day. Gentle and frequent exercise in the open air; and, as a last resort, a change of climate. SECTION IX. RHEUMATISM. Acute rheumatism, or a rheumatic state of fever, is not an unfrequent occurrence in this country, in chil- dren : after the seventh year, during a wet autumn, or a cold, damp spring, it is generally brought on by lying, "> Dr. Fletcher, in the first volume of the \merican Medical Recorder, speaks, with confidence, of the efficacy of laxatives and warm bathing. 132 Practical Observations or setting in some cool, moist place, after being over- heated. The parts most affected, are the hips, knees, ankles, or wrists; sometimes the extensor muscles of the neck suffer. The symptoms are, chill, succeeded by heat, restless- ness, fever, thirst, the tongue is white and coated, the pulse full, frequent, and tense, indicating inflammatory action. Stiffness and pain are, soon after, experienced in some part abovementioned, which, in a few hours, become acute, and almost insupportable—the pain is aggravated by moving the limb, or part. The febrile spmptoms usually remit towards morn- ing, but the pain continues. After the third day, the paroxysms are milder, and the affected part becomes red and swollen. About the seventh, or ninth days, when suitable remedies have been used, the disease entirely subsides ; or, swelling and lameness of the part remain, constituting the chro- nic form of rheumatism. As this disease is highly inflammatory in the first in- stance, the antiphlogistic treatment will, alone, miti gate its severity, arrest its progress, and prevent the chronic stage. When acute pain and fever attend, and the subject is plethoric, or robust, blood-letting will be adviseable. After which, an evacuant mixture, composed of a solu- tion of Epsom salts and tartarised antimony, should be administered, at repeated doses, until the emetic, and subsequent cathartic effects, are freely produced. On the succeeding days, two grains of calomel, with the like quantity of antimonial powder, should be adminis- tered every fourth hour, until the fever remits, or per- On Diseases of Children. 133 spiration is excited. In aid of this intention, a spoon- ful or two of Seneka tea, with sugar, may be given at intermediate hours; and, occasionally, a little Epsom salts. If the bowels are disposed to be confined, the patient should be allowed gruel, toast-water, or sage tea, &c. The parts pained, ought to be kept at rest on a pillow, in bed, or in a sling, if the upper extremity is affected, and bathed, now and then, with vinegar or camphorated spirits. In more protracted cases, the oil (or spirits) of turpentine, is an useful embrocation. If no material mitigation of pain, &c. take place in three or four days, blisters to the parts are serviceable. The powders, directed above, are to be omitted after the second day; and an infusion of Seneka, with Ep- som salts, administered every fourth hour, with five or six drops of antimonial wine, and the like quantity of spirits of nitrous ether, to promote evacuations, and a free diaphoresis. When the case is protracted, beyond the fifth or sixth days, and the fever subsides, leaving the parts pa med, one or two grains of the compound powder of ipeca- cuanha, (Dover's powder) may be given, occasionally at bed time, in a little tea. The patient's strength is to be supported with arrow-Koot, chicken broth, and sometimes diluted whey. In obstinate cases, five grains of powdered guaiacum, should be given in syrup, every other day, and the af- fected parts covered with leaves .-vf datura, stramo- nium, (Jamestown weed) previously mms-en^d %vith vi- negar. Electricity has been resorted to, with great ad- vantage, in some cases. 12 134 Practical Observations SECTION X. DYSENTERY. This is to be considered as intestinal form of fever, and commonly occurs during cold, wet weather in the spring, or autumn. It is often produced by taking cold, or by suppressed perspiration ; also, from indiges- tible or improper diet. Children, under seven years, are seldom afflicted with it; and, as long since has been observed by Dr. Sydenham, they have it in a slighter manner than grown persons, and it is managed with a greater prospect of success. Symptoms—chill, succeeded by febrile heat, head- ache, thirst, the tongue white, sometimes furred, a fre- quent desire to stool, accompanied with severe pain in the bowels. The passages consist of little more than mucus, streaked with blood, which afford no relief to the patient. The complaint is usually more trouble- some at night. Loss of appetite and nausea, also at- tend. The disease is believed to be seated in the large bowels. The treatment consists in allaying the febrile symp- toms, mitigating the irritation of the bowels, removing the tenesmus, and restoring the natural functions of the bowels. An emetic of ipecacuanha is, at first, proper, and af- terwards, a cathartic mixture, consisting of one ounce of Glauber's salts, six ounces of warm water, and one ounce of brown sugar. Two tablespoonsful to be given every hour, until physical stools are produced. When On Diseases of Children. 136 these indicate acidity in the bowels, by a green appear- ance, cVc. the following mixture will be required:— Take of rhubarb twelve grains, ipecacuanha six grains, magnesia half a drachm, mint-water half an ounce, wa- ter eight ounces. After the cathartic mixture, begin with this, and give from one to two tablespoonsful every hour, until the mucus and green stools disappear. If, however, the pain of the bowels and dysenteric passa- ges continue, the cathartic mixture ought to be repeat- ed. At bed time, after evacuants, on the second day, six or eight drops of laudanum may be given, or one or two grains of compound powder of ipecacuanha. The warm bath is also beneficial. As there is an abrasion of the mucus of the bowels, mucilaginous drinks, as thin gruel, arrow-root, benne* or flaxseed tea, are pro- per, and will, in some measure, supply this loss. Ani- mal food ought not to be allowed ; nor should any heat- ing spirits, or vinous drink, be permitted. In the first attack, when the inflammatory symptoms are strongly manifested, bleeding may be necessary; and afterwards, in violent, or obstinate cases, blisters to the epigastrium are serviceable, especially if the stomach is irritable ; also, to the wrists, arms, &c. In protracted, or chronic cases, calomel, with opium, will be bene- ficial; and a decoction of Peruvian bark, with a"few drops of laudanum, occasionally, to support the pa- tient's strength, and allay the irritability of the bowels. The symptoms indicating danger, are coldness of the extremities, a sudden abatement of pain, vomiting, de- lirium, hiccup, which generally denote a gangrene of the bowels. • Sesamum orientate, (an infusion of the leaves in cold waters 136 Practical Observations CHAPTER II. SECTION I. SMALL-POX, (Variola.) his is a contagious, inflammatory, febrile disease, which, on the close of the third day, and, in some cases, earlier, is attended with an eruption, and ceases on the fifth. The eruptions become pustules, suppurating in the course of eight days; and afterwards, forming scales, or scabs, which leave depressions on the skin, called pits. There are two species of small-pox generally observ- ed, namely, the distinct and the confluent. First—the distinct small-pox (variola discreta.) Symptoms—chill, or shivering, particularly a coldness of the feet, succeeded by febrile heat, pain in the back and loins, severe head-ache, drowsiness, nausea and vo- miting. On pressing the pit of the stomach, the child complains of pain. As the disease advances, the fever increases, the face flushed, e}'es suffused, a starting, grinding the teeth, and stupor, are all remarked. Just previous to the eruption, which, in this species, takes place on the beginning of the fourth day, children, who have passed the period of teething, sometimes have one On Diseases of Children. 137 or more fits ; these, however, are not unfavourable, and precede the mild kind. The symptoms commonly abate when the eruption conies out. It is first of a pale red, appearing on the face and neck, gradually extend- ing to the other parts, and lastly, to the extremities. In very favourable cases, the eruption is entirely out, on the beginning of the fifth day. These gradually inflame and enlarge, and the spaces between them are swollen; the whole then acquire a florid red appearance, especially in the face, where the eruption is greatest. The eyelids are, also, so much affected, as, sometimes, to close. The hands and fin- gers also swell. As the pustules are filling up, some degree of soreness of throat, and hoarseness, will be no- ticed. On the fifth and sixth days, they contain a lim- pid fluid, with white elevations. On the eighth, suppu- ration gradually takes place, and yellowish matter is formed on the surface, assuming a rough-white appear- ance, the pustules having increased to the size of small peas. On the eleventh day, the matter has exuded, is discharged, or begins to be absorbed, and diy or scale off, and are succeeded (although not in mild cases) by pock-marks, or pits. By the fourteenth or fifteenth, the disease has run its course. On the seventeenth, the marks are a little elevated above the skin, and still look red. On the twentieth, they become smooth and flat. From the first appearance of the disease, however, and during the process of suppuration, some variety is observed. In young children, the eruption is ushered in with a convulsive fit; while, in those who are older, and in adults, a tendency to sweating is observed. It is gene- *12 138 Practical Observation* rally remarked, in very mild cases, that the eruption ap- pears early on the fourth day, less copious, and ceases sooner, than in those which are unfavourable. The face is sometimes swollen, but more so in the severer kinds. The milder the kind, the sooner suppuration takes place, and the disease terminates more speedily. In the second kind, or confluent small-pox, (variola confluens) also called the black or malignant species, the symptoms, above described, occur, but in a more violent, or aggravated degree, as fever, pain, uneasi- ness, or anxiety, nausea, &c.; the pulse is more fre- quent, but not full, corresponding with the typhus. Stupor, coma, and delirium, often attend; and, in in- fancy, convulsive fits, on the first days of the disease, which are sometimes fatal, previous to the eruption. There are some other peculiarities which distinguish it. The eruption appears earlier on the third day. The fever and concomitant symptoms, do not decline at this period, as they do in the eruption of the distinct kind, but only abate in a slight degree. On the sixth day, the fever increases and continues on; under which the patient sinks, commonly on the eleventh day. An efforescence, or rash, sometimes ushers in the eruption ; the pustules are more numerous, and not so much elevated above the skin, or irregular. When suppuration takes place, they run into each other; the matter is not yellowish, but of a dark or brown colour, never acquiring the same maturity, or consistence, as in the distinct. It is observed, with great correctness, that the slower ftie eruption is, in coming out, in either kind, the more favourable the prognosis. On Diseases of Children. 13$ Generally, about the fourth day, a spontaneous flow- ing of saliva takes place, in well-grown children and adults, resembling that produced by mercury, but with- out its foetor, and this continues until the tenth day ; but it does not occur in very young subjects, a diarrhoea be- ing the most frequent attendant. In the confluent small pox, from the sixth to the eighth day, in consequence of the swelling and suppu- ration, the face and body present a most loathsome ap- pearance. The greatest violence of the disease, is de- termined by the quantity of eruption in the face, and vice versa. The eleventh day is the most dangerous, as it then frequently proves fatal; but, in the distinct kind, the eighth is the most critical. The method of treatment, must be entirely regulat- ed by circumstances. It is evident, from the foregoing sketch of the disease, that a material difference exists in the order or violence of symptoms, accompanying the two species described, in the first attack, as well as dur- ing their progress, in the state of the pulse, &c. the most correct mode of proceeding, will be, to prescribe for the condition of the patient, and adapt the remedies to the urgency of symptoms. In the first instance, pain, febrile heat, and restless- less, are to be moderated by evacuants, cool drink, and air, &c. For this purpose, Epsom salts ought to he given in efficient doses; or, if the child is subject to worms, a few grains of calomel may be given previous- ly. Cool and fresh air, and toast-water, or cold watery should be allowed. The child, if not weaned, must not be permitted to remain in the nurse's arms, or at the breast, longer than may be necessary. It should be 140 Practical Observations laid on a mattress, and not near the fire, if in winter, and in some cool place in summer, for the pustules are most thick, on those parts which are kept covered, or are most warm, and the danger is proportionate to the quantity of eruption on the face and neck. The diet must be light, and no animal food allowed. Emetics of ipecacuanha, and tartarised antimony, are proper, after the foregoing; to be exhibited, as directed in the cure of fevers. These are, especially, indicated when the stomach is oppressed, and during the progress of the symptomatic fever; and the neutral mixture, (see chap. 1, sect. 2, of part 2.) lemonade and cool drinks, are also serviceable. Costiveness is to be obviated, by gentle laxatives and glysters. While the eruption is advancing, it is improper to administer active medi- cines, or, on the eighth or ninth days. At the close of the disease, when the scabs fall, or dry off, some lax. ative medicine, however, may, with propriety and ad- vantage, be given. In the more violent form, the confluent species, tbe antiphlogistic treatment, as cold air and drink, with laxatives, are also necessary. In the earliest stages, an emetic may be serviceable ; but, the evacuant plan must not be pursued too closely. The state of the pulse, and prostration of the system, commonly render such a course injudicious. The neutral mixture, gentle laxatives, or glysters, lemonade, &c. will serve to mo- derate the symptoms. A few grains of calomel, on the first or second day, may be useful in some cases. All kinds of ripe fruit, oranges, &c. are here grateful to the patient, and may be allowed. The concomitant sore- ness of throat, should be relieved with gargles of sag« On Diseases of Children. 141 tea; and afterwards, a decoction of bark, honey, and elixir of vitriol. When diarrhoea takes place, one or two grains of the compound powder of ipecacuanha, or five or six drops of laudanum, with mucilaginous drink, or nourishment, as arrow-root, with cinnamon, &c. are to be given. As the pustules fill, and during the sup- purating process, the decoction of Peruvian bark, with a few drops of elixii of vitriol, chicken broth, arrow- root, and even whey, or wine, may be required to sup- port the strength of the patient. If alarming convulsions, or delirium occur, blisters to the nape of the neck and head, sinapisms to the wrists, &c. are necessary. These applications, as well as the warm bath, are peculiarly useful, when the eruption suddenly recedes. The camphorated mixture, and de- coction of Peruvian bark, with four or five drops of com- pound spirits of ammonia, every hour or two, also} wine whey are required to support the constitution, and re-produce the eruption. In cases, where the eruption and inflammation affect the eyes, the colyria, &c. advised for ophthalmia, are serviceable. PROPHYLACTIC REMEDIES. There are two methods of protecting the system from the violence of small-pox, or of entirely destroy- ing the susceptibility to this dreadful disease. First, by inoculating with small-pox matter; second, by vaccinating. 142 Practical Observations First—by Inoculating. Rather more than a century has elapsed, since the in- troduction of the system of inoculating with variolous matter, with a view to introduce into the constitution, a milder form of the disease, than that which is excited in the natural way, by the operation of contagion. The advantages were so incalculably great, that, previous to the discovery of cow-pox, inoculation was almost uni- versally adopted. When a choice of subjects can be safely made, it would certainly be proper, to avoid inoculating newly- born infants, as well as children, who are teething, or such as are afflicted with any cutaneous disease; but, there should be no unnecessary delay, as the child may, in the mean while, take the small-pox in the natural way. Children, three years old, and upwards, especially of a gross habit, may be prepared for the disease, for a week or ten days, by giving, every second or third night, two or three grains of calomel; and on the suc- ceeding morning, a laxative dose of Epsom salts, or a few grains of rhubarb, when the calomel does not purge. The manner of inoculating is perfectly simple. A very slight scratch, or puncture, must be made in the skin, with the point of a lancet, previously moistened with matter, from a ripe pustule of small-pox. The upper and external parts of the arm, or fore arm, about five inches below the shoulder, or cubit, as m iv be determined on, are the usual places for insert- ing the matter. The puncture, or incision, must not be On Diseases of Children. 143 made deep, but so, as scarcely to produce one or two drops of blood. On the third day, the scratch, or puncture, begins to look red, which is an evidence of success. On the fourth and fifth days, the redness and inflammation ex- lend, around the inoculated part, which first becomes hard, when touched, and is succeeded by a pock. On the sixth, these appearances increase; and, on the se- venth, or eighth, pain is felt in the axilla (arm pit) of the side inoculated. The child now, generally, feels sick, with chill, succeeded by fever, and other symp- toms, described in the distinct small-pox, but milder. On the eighth day, and always before the tenth, a pus- tule, characteristic of the variolous disease, is formed, being an elevated pock, rather flattened in the centre, with a circumscribed redness, or inflammation. The patient should be kept moderately cool, through the suppurating stage, and the state of its bowels at- tended to His diet must be light; and alter the scab has fallen off, a gentle laxative dose is proper. The sore of the arm heals, without any particular attention. It is only required of the nurse, to prevent its being rubbed, or scratched off, or an ugly sore may succeed. Sometimes, one or more pustules appear, during the progress of the disease, near the inoculated part, with- out aggravating the symptoms. It has been remarked, that many troublesome, con- stitutional disorders, are removed by the small-pox, or rendered milder by it. • 144 Practical Observations The second prophylactic remedy is vaccination, (va- riola vaccina.) The practice of inoculating with the lymph, or mat- ter of the cow-pox. Although an investigation of the astonishing proper- ties of cow-pox, took place at an anterior date, it was not until the year 1798, that the practice of vaccina- tion became general. It is certainly proper, to convey this rnild disease into the constitution, as early in lite as possible, especially when there is danger from the pre- valence of small-pox, as an effectual, and, by far, the most desirable preventive remedy. Vaccination riiay be performed at any time; but, with most propriety, at some period after the tenth day from the birth. The manner of performing, and suit- able parts, are the same as those recommended for inoculation. The matter, or lymph used, should be taken from a regularly progressing vesicle or pock ; that on the close of the seventh, or beginning of the eighth day, will be found most active; but, the genuine disease may be produced from one rather older, as well as frojn a care- fully preserved scab. The point of the lancet used, should be perfectly clean, before it is charged with the lymph ; and when introduced under the skin, a valvu- lar puncture must be made, not deeper than was direct- ed for inoculating. The lancet ought not to be instan- taneously removed, but a moment allowed for absorp- tion of the fluid. On the third day, after vaccination, we find ^is part slightly inflamed. On the close of the On Diseases of Children. 146 sixth, a vesicle, with an elevated margin, depressed in the centre ; the vesicle exhibits a pearly-white colour. It is observed, that whatever extent has been given to the scratch, or puncture, it assumes, invariably, at this time, a circular, or slight oval form. On the eighth, or ninth days, the depressed centre is most remarkable; the contents of the vesicle, that of a colourless lymph, destitute of any opacity, or resemblance to pus. On the tenth day, or rather earlier, an areola, of a bright- red colour, takes place, gradually surrounding the vesi- cle, with an efforescence, sometimes to the extent of two inches, or more. Swelling, in the axilla, is, at this period, observed, which is sometimes very painful, and attended with slight fever. On the eighth day, the aieola recedes, and the centre of the vesicle becomes dry and brown; a mahogany-coloured scab succeeds, which falls off about the nineteenth day, leaving a cica- trix, or scar, with minute indentations, or pits, within its circumference. During the progress of the vaccine disease, it is scarcely necessary to administer medicine. As i!ie ob- ject of introducing it, is to destroy the susceptibilii. to small-pox, the constitutional influence of the former, ought not to be impaired, or checked. It should, con- sequently, be allowed to exert its full force ov*jr the system. To render this more efficacious, vaccination may be performed in two or three parts. When a deviation from the regular character of cow- pox is observed, especially in its leading features, the circumscribed, elevated margin, and depressed centre, the limpid, colourle.»«i contents of the vesicle, as describ- ed in the seventh, eighth or ninth days, the areola, &c 13 146 Practical Observations the child must be re-vaccinated. Even should the con- tagion of small-pox have entered the system, the cow- pox will mitigate its violence. There are certain peculiarities of constitution occa- sionally existing, which destroy the predisposition to re- ceive the cow-pox, for a length of time. Among these, have been remarked, an irritation from the gums during the process of dentition, and the existence of certain cu- taneous disorders. But, no considerations should occasion unnecessary delay, or prevent a repetition of attempts, to intro- duce this inestimable remedy. Instances have occur- red, of the system resisting it for a length of time; but, by persevering, complete success has ultimately re- sulted. Several kinds of spurious cow-pox, have been men- tioned by medical writers, and are met with in the course of practice ; but, the genuine disease, as above described, alone possesses the preventive property. The true cow-pox, notwithstanding the ingenuity of certain skeptics, still triumphs as a prophylactic. In Denmark, and some other kingdoms of Europe, small- pox has become extinct, by the general use of vaccina- tion. In Russia, anterior to the year 1812, more than one hundred thousand subjects, had undergone its bene- ficial influence. On Diseases of Children. 147 SECTION II. CHICKEN-POX, (Varicella.) This eruptive, vesicular disease attacks a person but once during life. It is contagious, but generally of a mild character, seldom involving much anxiety. Vari- cella, however, has been mistaken for small-pox, on the first appearance of the eruption ; and an aggravated form has prevailed, in some of the northern cities, un- der the appellation of the varioloid disease. It is, in its ordinary character, easily distinguished, by the fol- lowing peculiarities. The child, here, as in small-pox, appears languid, loses its appetite, or is affected with nausea and vomit- ing ; its pulse is, at first, quick and tense, or full; the tongue white, or furred, pain of the back and legs, with head-ache, attend ; it has, also, a hoarseness of voice, flushed face, and sometimes pain of the epigastrium. In a few instances, the patient starts in its sleep, screams out, or may have a fit; but, all these must certainly be considered as uncommon symptoms. After three days, the eruption breaks out, accompanied with some degree of uneasiness and smarting, first on the breast and back, afterwards the face and head, and then on the extremi- ties. The febrile symptoms may continue after the eruptive stage, but these are never severe ; nor do they induce so much sickness as in the variola. The vesi- cles of chicken-pox are somewhat broader, and more flat, and very soon fill with a thin fluid, or lymph; 148 Practical Observations whereas, in the other case, the pock is hard and promi- nent, and contains pus. The varicella? scab or dry off, without piting, or leaving scars. They seldom appear thick in the face, and are further distinguished by a characteristic itching. The constitution is not protected from the contagion of small-pox, by this disease. It must be confessed, however, that, in a few instan- ces, it has borne so strong a similitude to the variola, as to render much attention necessary, to discriminate on the first attack. The reader will consult, with ad- vantage, Dr. Willan's excellent work on cutaneous dis- eases, in which, some varieties of varicella, are, with great accuracy, described. Notwithstanding the diagnostics above defined, and the general mild character of chicken-pox, when the variola prevails as an epidemic, the former may put on the livery, or acquire some of the violent symptoms of the latter. At these periods, therefore, in a practical , point of view, the distinction may not be important, for the existing condition of the system, will always be the surest guide to the physician. Cool air, light diet, laxatives, in which a. portion of magnesia, or soda, is combined, and, occasionally, a gentle emetic, when the stomach is oppressed, or the tongue furred, are required with the treatment. Bathing the body with warm, or tepid water, will also be serviceable, On Diseases of Children. 149 SECTION III. SWINE-POX, (Bleb-Pox.) This disease, has been considered in England, as a variety of the varicella; and, as such, has been de- scribed by Dr. Willan. In this country, however, it appears under very different circumstances; the con- stitutional disorder is but slightly perceptible. The child seems unwell, or has a feverish skin, and some degree of nausea. On the second day, pustules come out on the body, neck, shoulders, and extremities, seldom in great numbers, and but very few in the face and head. They soon enlarge, become oval, contain a serous fluid, their bases are broad, and much inflamed, but are distinct, and never disposed to become con- fluent. A troublesome burning, or itching, attends on the third day, and in the subsequent stage. After the pustules break and discharge, scabs are formed, and several successive crops of the eruption break out, which are troublesome and painful, especially about the feet and legs. Children, from the second to the se- venth years, are most subject to it, although the dis- ease may be communicated, by contact, to younger children. In the treatment of this, as well as many similar eruptive complaints, I have found an emetic mixture of tartarised antimonj', conjoined with some saline lax- ative, serviceable; or, it may be followed by a solution of Epsom or Glauber's salts, combined with magnesia. The latter must be repeated every third or fourth (' *13 150 Practical Observations so as to produce three or four evacuations. The diet should be light. When the pustules discharge, the parts may be washed with a weak solution of acetite of lead; or, should the ulcers prove troublesome, cover them with a little calamine ointment. In obstinate cases, I have given two or three grains of calomel at bed-time; and, in the morning, a saline laxative dose; afterwards, the decoction of cinchona, or infusion of camomile; and, occasionally, a little magnesia, which moderately opens the bowels. SECTION IV. MEASLES, (Rubeola.) This eruptive, or exanthematous disease, attacks a subject but once during life, and is produced by conta- gion. The symptoms usually appear ten or twelve days after exposure. Children, who have passed the ages of dentition, are most predisposed. The premoni- tions are, loss of appetite, and dejection of mind; whicb last is more remarkable, than in any other complaint. The symptoms of the attack are, a sense of chill, or shivering, followed by febrile heat, pain in the back, quick and full pulse, anxiety, nausea, and sometimes vomiting, head-ache, chiefly through the forehead, sneezing, inflamed or suffused eyes, which exhibit the strongest diagnostic of measles. To these are added, soreness of the throat, (coryza) or watery discharge from the nose, &c.; hoarseness, drowsiness, white On Diseases of Children. 151 tongue, pain, fulness, or sense of stricture in the chest, an<|, thirst. These phenomena increase, gradually, un- til atiout the fourth day, when the eruption, consisting of small red spots, somewhat elevated above the skin, first appear on the forehead, then the neck and chest; and on the day after, on the extremities By the close of the fifth day, these are, generally, all out; in some parts, they come out in patches; and, in other places, distin -t, the intervening skin being natural. The face, eyelids, &c. are observed to swell, and have, on the sixth day, a very vivid appearence. When the erup- tive stage is complete, the fever moderates; but, the af- fection of the eyes, hoarseness, cough, nausea, &c. con- tinue, as well as, dyspnoea, until the sixth day. In common, on the seventh day, the redness and inflam- mation put on a paler appearance, but, in violent cases, the fever increases, and the eiuption acquires a darker colour. After this, it looks mealy, or disquamation and bleeding at the nose, sometimes occur. The symptoms now subside, and the appetite returns, al- though a looseness of the bowels, or diarrhoea, often succeeds the sickness of stomach. Among the poor, or- where children have not been carefully attended to, or live in confined situations, an eruption about the body follows the measles; a soreness of the mouth, and weak state of health, with irregular chills and fever, swellings about the neck, disordered bowels, &c. These have been all observed, and, in young children, prove fatal. This is a distressing disease, but is not often fatal, ex- cepting in scrofulous constitutions, when it has been im> 152 Practical Observations properly treated; or, when the eruption has receded, and the lungs become diseased. The violence of the symptoms seem to depend much upon the condition of the alimentary canal, or stomach. Indeed, this is to be remarked in almost all exanthema- tic affections; so much so, as to render it extremely problematical in the opinion of some European physi- cians, whether rubeola may be considered as an idiopa- thic disease. In the Die. des Sciences Med. Tome 32, p. 218, we observe, " La Rougiole n'est qu'urs, appen- dice de lirritation interne." The measles prevailed in the Orphan-House of Charleston, at the beginning of the winter of 1813. As the season advanced, the epidemic was more violent; the catarrhal symptoms were very distressing ; and al- though the eruption was of a large and distinct kind, the affection of the chest was, in many instances, alarming. Hcemoptius was not an uncommon attendant. About eighty-seven children were afflicted in the space of five weeks. Convalescence proved tedious ; but, the dis- ease did not terminate fatally in any case. Treatment.—The condition of the patient, and exist- ing circumstances, must produce some difference in the mode of practice, in the fiist instance. In plethoric subjects, when the catarrhal and inflammatory symp- toms are strongly manifested, blood-letting will be ser- viceable, especially when the disease occurs during the winter and the spring. After which, an emetic mix- ture of tartarised antimony, to which about forty drops of spirits of nitrous ether may be added, will be proper. The temperature of the apartment, must be neither too cold, nor warm j a moderate degree of light only On Diseases of Children. 153 should be admitted, and the thirst allayed with flaxseed tea, or barley water, slightly acidulated with lime-juice, and sweetened, if necessary. The bowels are to be kept moderately open with laxatives ;# for which pur- pose, Glauber's, or Epsom salts, with magnesia, are most suitable. The child's nourishment should be light, as gruel, chicken water, &c. Ripe fruits may be allowed. When the respiration continues oppressed, the dysp- naea distressing, and a tendency to local or pulmonary disorder observed, blood-letting may be repeated, if the pulse is full; and blisters to the breast (or sternum) are necessary, one or two grains of calomel, and as much of the powdered fox glove, ought to be given night and morning. If the cough continues troublesome, or the bowels disordered, give one or two grains of the com- pound powder of ipecacuanha, at bed-time, occasion- ally. When the eruption is slow in coming out, or sud- denly recedes, the case is alarming. Blisters to the legs, chest and arms, are proper ; and the camphorated mixture, as directed in pait 2, chap. 1, sect. 2. The warm bath is here also advisable. Should the eyes also continue inflamed, or sore, a colyiium of white vitriol, four grains, and eight ounces of water, will be beneficial. If the disease breaks out in the summer, or during autumn, the lancet must be cautiously used. Blood- letting, indeed, is scarcely admissible. Emetics, lax- atives, pectorals, and acidulating drink, will, generally, prove sufficient to mitigate the symptomatic fever, and accelerate recovery. * Repeated and active purgatives are improper. 154 Practical Observations Laxatives may al>o be advantageously employed, when the disquamation takes place. Afterwards, ca- momile tea, or Colunibo infusion, will restore the strength and appetite.* When the constitution has suffered by protracted debility, care should be observed, in clothing the child sufficiently ; flannel may be necessary ; and, lastly, a change of air, from a damp, or moist, to a high and dry situation. SECTION v. SCARLET-FEVER. ''Scarlatina, Simplex, Anginosa, and Maligna.) A disease, extremely analogous to this, the cynan- che maligna, has been treated of in part 1, chap. 6, sect. 3. Perhaps the pathognomic symptom, in the present instance, is the scarlet eruption, which almost invariably attends it. Although an ulcerated throat is usually observed, many exceptions occur. Scarlatina anginosa, is of a contagious character; the symptoms are evolved, for the most part, in the eve- ning, or at night. About five or six days after expo- sure^ the infection, the child droops, feels chilly, or cold, becomes sick at the stomach, complains of pain * Various, but unsatisfactory attempts, have been made, to produce a milder form of this disease, by inoculating with the fluid from the vesule- On Diseases of Children. 155 in his belly, stomach, loins, and extremities ; with rest- lessness. •■• mlse is quick and full, respiration uneasy and oppn .-ed, the eyelids are inflamed and swollen. On the second day, a stiffness of the neck, and sore- ness of the throat, attend with hoarseness, the heat and fever increase, the tongue is, at first, red, but after- wards, furred. About this time, or sooner, the eruption appears, in small points, very thick on the head and neck, spreading to the other parts of the body, and the extremities, so that by the third day, it becomes gene- ral, and assumes a deep red, or scarlet colour, which is most remarkable at night; the patient is, at this time, drowsy ; sometimes coma and delirium come on. On the beginning of the sixth day, the febrile symptoms, &c. subside, the eruption puts on a mealy appearance, and disquamation, with itching, takes place. By the seventh, the disease has run its cdurse. In the milder species, the benigna, or simplex, the anginosa symptoms, (sore-throat, &c.) attend, in a very moderate degree, or not at all. The pulse is seldom as full as in the other form; and the eruption, although very thick, does not assume the dark scarlet hue, being scattered, universally, about the fingers, &c yet seldom confluent. There are noticed, interstices ot healthy, natural skin between them ; the face, notwithstanding, is swollen. In the maligna, all the foregoing symptoms are ag- gravated ; the pulse is small, irregular, or rapid ; lan- gour and debility, oppressed respiration ; the efflore- scence is of a deeper red, or purple, which is commu- nicated to the tongue, internal parts of the mouth, the throat, &c.; the ulceration on the tonsils, and conti- 156 Practical Observations guous parts, are dark and sloughing; firtid breath, coma, delirium, &c. In the course of the disease, in some cases, the trachia partakes violently of the general disorder, and the child expires of suffocation, or from n gangrenous state of the parts affected. Treatment.—On- the first attack of scarlatina, the following mixture may be given :—Take of Glauber's, or Epsom salts one ounce, tartarised antimony one grain, warm water six ounces, add half an ounce of brown sugar ; from one to two tablespoonsful to be giv- en every thirty or forty minutes, until the medicine operates as a cathartic and emetic. If the latter effect is not produced, it may be accelerated, by adding ten or fifteen drops of antimonial wine to each dose. Pro- fes>s<>- Rush, and other eminent practitioners, have ex- tolled the effects of vomiting early in the disease. Gar- gle tlin throat frequently with an infusion of Seneka snake-root, or sage tea, with honey, acidulated with muriatic acid, as directed in cynanche trachialis. (See sect. 2, -hap. 6.) On the succeeding day, three or four grains of calomel may be administered every sixth or eighth hour, while the febrile symptoms continue high. This medicine, as judiciously remarked by the author above quoted, passing over the inflamed parts in deglu- tition, exerts also an excellent local effect. Should the bowels not be sufficiently open, small doses of cither of the above salts, may be required. Ripe fruits may be freely given, and the child's strength supported with arrow-root, chicken broth, and other suitable nourish- ment. In the malignant form, an active emetic of one grain of tartarised antimony, and five of ipecacuanha, will, in On Diseases of Children. 167 the first instance, be serviceable ; but, the evacuant system must be cautiously employed. A sudden pros- tration of strength is to be dreaded. A few grains of calomel, will be sufficient to keep the bowels open. The camphorated mixture, decoction of cinchona, aci- dulated with vitriolic, or muriatic acid, are early re- quired, and may be given in doses, frequently repeated. Wine whey will be necessary, and arrow-root, seasoned with wine, &c. In the early stage, a blister to the nape of the neck, has been beneficial. Generally speaking, the prognosis may be drawn from the intensity of the scarlet colours of the eruption. Sponging the body with spirits, has been, in some instances, successfully employed; and the external use of vinegar, in a tepid state.* The throat and fauces are to be washed, or gargled with a strong decoction of Se- neka, or brandy and water, or decoction of cinchona, to which tincture of myrrh is added. The symptoms denoting danger, are, coma, dulness, or heaviness of the eyes, oppressed respiration, durr- hcea, petechia?, and haemorrhage from the throat, iu>se, &c. The case sometimes terminates fatally and unex- pectedly on the third or fourth day, or may be protract- ed to the seventh; and as far as the nineteenth day, with a like unfavourable issue. The glands of the neck, in some instances, are enlarged and tumid, and require lotions of vinegar, or camphorated spirits, deaf- ness is now and then observed. When it occurs, the ear should be syringed with warm water; to which, a few drops of laudanum may be added. When this form of scarlatina prevails, as it is generally contagious,* the • I have generally used this term in contradict inction to infec- tion ; by contagion, is to be understood, an active, morbid prin- 14 158 Practical Observations unaffected children ought to be removed, and the apart- ment well ventilated, and frequently sprinkled with vinegar. SECTION VI. NETTLE RASH, (Urticaria.) There are several species of this eruptive disease, enumerated by medical writers, especially by Dr. Wil- Ian.* That which I have to treat of, occurs in child- hood, between the second and eighth, or tenth years, is the mo.st common form, and not essentially differing from the same complaint in adults. Ihe most fre- quently exciting causes are, violent exercise, eating too freely of some indigestible fruits, oi certain kinds of fish, especially shejl-fish, crabs, &c. The child is, sometimes, suddenly attacked ; it complains of sick- ness of the stomach, with pain, stricture in the chest, or ciple, emanating from certain diseased bodies, and susceptible of being communicated to those who are predisposed, on a near approach, or contact, as in the case under consideration, or in small-pox, &c. Infection conveys the idea of n poisonous pro- perty, imparted to the atmosphere (within some limited place, or point) by marsh, or vegetable decomposhion, or the occa- sional commixture of these with aniruat effluvia, under peculiar circumstances, in hot seasons. These, miasmata excite u. such as are predisposed, and come within their sphere of union, in the jirst instance, country fevers, (or remittents and intermit* tents) and in the latter, yellow fever. * Cutaneous diseases, vol. 1, p. 301, et port. On Diseases of Children. 159 dyspnoea, head-ache, lassitude, and drowsiness; re- jecting nourishment; febrile symptoms now occur, the pulse quick and full, and the tongue covered with a white fur. On the succeeding evening, a slight chill, or rigour, precedes the eruption, (or wheals.) The effo- rescence consists of patches of a red colour, with a trou- blesome and distressing tingling, or itching. The nettle rash consists of those oval, or longitudinal elevations above the skin, which are large and flat; the top is white, and surrounded by an efforescence, or has an inflamed base, as above described. They appear upon the shoulders, loins, thighs, and knees, also, the neck and head, &c. accompanied with a burning sensa- tion. Whatever part itches, and is rubbed, is succeed- ed by the eruption, which recedes and appears again several times, in the course of seven or eight days, when it commonly declines, or entirely disappears. The eruption is most troublesome at night, and when the skin, or surface, is uncovered. The sickness at the sto- mach subsides, when the rash comes out. In some constitutions, this complaint prevails periodically, gene- rally during the spring season. Although this complaiut does not ordinarily exceed eight days in duration, and is not dangerous, it has, sometimes, been attended with fatal consequences, when it has suddenly disappeared. It has, also, in many instances, occurred in a chronic form, without fever, receding and coining out again, for several weeks and months together. It is manifest, that this disease is influenced by some disturbance, such as acidity and acrimony in the sto- mach and bowels. The method of treatment must, therefore, be directed accordingly. An emetic mixture 160 Practical Observations may, at first, be given, consisting of fifteen, or twenty- grains of ipecacuanha, and one of tartarised antimony, mixed in four ounces of water, and given in doses of one or two table spoonsful every twenty or thirty minutes, until vomiting is produced. On the succeeding day, a laxative mixture of Glauber's, or F.psom salts, with magnesia, will be proper, if the bowels arc not suffi- ciently open. The parts of the body,j&c. most affect- ed, should be covered, especially when the weather is damp, or chilly. Th child's diet must be sparing, light, and easy of digestion. During the course of the complaint, a gentle laxative may be repeated, if the bowels are confined. Afterwards, for several days, some mild sub-tonic, as camomile tea, &c. will be ad- visable. The nettle rash is now and then observed during teething, and may proceed from irritation of the gums, &c. Lancing the swollen gum, will be necessary, and some absorbent and laxative, or a gentle emetic of ipe- cacuanha. The urticaria is not considered contagious. section vtr. MILIARY ERUPTION. Children are now and then, during warm weather, affected with an eruption of the size of millet-seed, breaking out, generally, about the upper parts of the chest, neck, back, shoulders, and thighs, attended with On Diseases of Children. 161 heat and a pricking sensation, but differing from prick- ly-heat. The child is sometimes restless, feverish, and has a furred tongue, for two or three days before the eruption appears, which consists of numerous red mi- nute specks, with watery heads. The complaint may continue two or three weeks, receding at times, and re- appearing in patches, without any serious constitutional disorder. Young children are not as subject to this disorder, as those who are older, and take more active exercise, which is the usual exciting cause. This affection may also be produced by exposure in some damp place, after being heated. Saline laxatives, mixed with magnesia, are here pro- per ; or, an emetic may be necessary, when the sto- mach is disordered, or the disorder continues. The child should neither be kept too warm, nor cool. SECTION vm. ANOMALOUS ERUPTIONS. A variety of cutaneous diseases, have been describ- ed by Drs. Willan, Clark, Underwood, and other medi- cal authors, under the heads of exanthemata, erythema, rashes, &c. Some of these have occurred under my notice, and are, accordingly, treated of under the res- pective heads of complaints, incident to infancy, denti- tion, &c. Those, in early life, for the most part, when not symptomatic, or connected with some febrile disease, *14 16-jj Practical Observations are produced by acidity, acrimony, or both, disturbing or impairing the functions of the stomach and bowels. These may generally be removed, by an emetic of ipe- cacuanha, or some laxative, combined with magnesia; or, (if the bowels be too much opened) prepared chalk, or the internal use of lime-water, with milk, as already advised. The prickly-heat, (or lichen tropicus) of Dr. Wil- lan, is very common among children, as well as adults, towards the close of the summer, especially among those who are strangers to the climate. A sensation of burn- ing and pricking, with itching, attends it, which is al- most insupportable. The eruption comes out in patch- es, over the shoulders, breast, &c. consisting of ex- tremely minute pimples, or vesicles; and when rubbed, a scruf succeeds it, rarely accompanied with pain. It disappears and breaks out again, several times during the warm season, and is considered salutary in its ten- • dency. A little laxative medicine, now and then, or cream of tartar, with sugar and water, may be given, when this proves troublesome. External applications are not necessary. Although in some tropical countries, lime-juice is a common re- medy, the subject should subsist on diet light, and easy of digestion.* Every article, which may tend to heat the system, both in food and clothing, ought to be dis- pensed with. In eruptive complaints, of no definite character, on similar principles to the foregoing, cleanliness, and fre- quent bathing, or washing, cannot be too strictly en- Joined. * Vide, Dr. Hillary's diseases of Barbadoes. On Diseases of Children. 163 CHAPTER III. Gutaneotw Btsorfcccs mrtr Hocal ^ftectionsi, Unattended with Fever. section i. ITCH, (Psora, Scabies, %c.) his odious disorder, frequently arises from a neglect of cleanliness; it is also thought, to proceed from too con- tinued a use of salt food, or farinaceous diet. Animal- culce, discovered in the vesicles, or pustules, are rather effects than causes, and microscopic observations, may detect them in many of the morbid secretions, although they have been mentioned among the causes of itch, herpetic eruptions, &c. The itch first appears in small pimples, on the inter- nal parts of the wrists, near the hand, and between the finders, the upper and lateral parts of the thighs, &c. These become vesicles, or rather, small pustules, attend- ed with an intolerable desire to scratch, which, when indulged, the watery heads are rubbed off, and inflam- mation and ulceration follow. When the disorder has not been properly treated, or neglected, the pustules be- T 164. Practical Observations come larger, contain acrid matter, and are ultimately diffused over the body. When it has continued long, the general health will become impaired, and the erup- tion acquires so great an ascendancy over the cutaneous system, that it cannot be extinguished, or eradicated, without great difficulty, and skilful management; in- deed, in some constitutions, it has baffled the best exer- tions of the practitioner. The most effectual remedy for the itch, is sulphur; if seasonably applied, and duly persevered in, it will rare- ly fail in accomplishing a perfect cure. The external application of this mineral, is of most importance; it may be used in the form of ointment, mixed with equal quantities of lard, fumigation, or in baths.* The last method has been strongly recom- mended by Sir Arthur Clark, M. D. in an essay on dis- eases of the skin, published in London, in 1821. The bath is, unquestionably, safe and eligible for very young subjects, and may supply the place of the more disgusting ointment. A few grains of the mineral, in a sublimed state, may also be given, mixed in milk, daily, for several days, without bad consequen- ces. For a child, of two years and upwards, the simple ointment, with sulphur, (as above directed) should be carefully rubbed over the affected parts, every night, previously washing with water and soap. A teaspoon- ful of sulphur, may also be administered, every second * This may be prepared, by pouring two quarts of boiling wa- ter upon two tablespum sful of sulphur, or bruised brimstone. When cool, the parts affected are to be washed with some of it, night and morning. On Diseases of Children. 165 or third morning, in milk. The linen and clothing are to be frequently washed. The diet should be light, and salt, or stimulating food, avoided. When this disorder has not been attended to, or be- comes inveterate, resisting the ordinary remedies, the black, or Ethiop's mineral, (sulphur of mercury) may be exhibited, with good effects, in doses of five, and up to ten grains, every night, mixed in syrup, repeated for three successive nights ; then suspending the medicine, and after as many days, resuming it. The patient may, now and then, be purged with Epsom salts. In these cases, an ointment, composed of equal quantities of lard, and ointment of the nitrate of mercury, (or citrine oint- ment.) may be used every second or third night, alter- nating its use with sulphur and lard. The decoction of tobacco leaves, has been recom- mended as an efficacious detergent lotion for itch, or, an ointment made with this plant; but, these cannot safely be employed with young subjects. When the disease is removed, the child's clothes must be changed, the bedding, A.c. carefully pwified, and washed, and cleanliness observed. This disease is so infectious in its character, as to be easilv communicated ; and, without due care, will be re-introduced into the system. 166 Practical Observations SECTION II. RINGWORM, OR TETTER. (Serpigo, a species of Herpes.) This is a very common cutaneous disorder, and consists of an accumulated mass of minute vesicles, crowded together in clusters, with inflamed bases, ac- companied with some degree of smarting, (or itching) which is increased by rubbing the parts; these will af- terwards spread to the extent of one or two inches, or more, in circumference, and seem to contain an acrid matter, or humour. They, generally, occupy a cir- cumscribed space, and appear upon the upper parts of the chest, neck, and face, especially the cheeks, upper lip, &c. These affections are often difficult of cure, and liable to return periodically. The sulphur ointment, when early employed, will remove them ; but, the most effec- tual application is, an ointment prepared with equal quantities of citrine ointment and lard, rubbed upon the part at night, and washed the succeeding morning, with warm wafer and soap. When the disorder proves te- dious and obstinate, argentum nitratum may be rubbed over it. The tincture of cantharides is, sometimes, successfully used ; also, hydrargerus murialus, (corro- sive sublimate) in lime-water, as directed in page G8; but. when the subject is young, in all cases, it ought to be dibiitd with an qual part of water. It is believed to be infectious. No constitutional disorder attends it. On Diseases of Children. 167 SECTION III. SHINGLES, (Herpes Zoster, Zona Herpetica.) This affection breaks out, most frequently, upon the breast, neck, and, now and then, is seen upon the loins. The disorder consists of numerous small vesicular erup- tions, at first white, afterwards of a bright red. These come out in clusters, extending in a circular manner, like a zone, or belt, about two inches in diameter, and sometimes entirely surrounding the body. I have fre- quently met with this singular complaint amongvchil- dren, who have passed the second year. There is an itching attending it, but not as distressing as in other eruptions. When the part is rubbed, the watery heads of these vesicles are rubbed off, and a scurfiness suc- ceeds. The child's appetite is impaired, and he has some degree of nausea ; but the general health is very slightly disturbed. In the two last cases, which occurred under my care, an emetic of ipecacuanha, with a small quantity of tar- tamed antimony, brought away acid bile, and removed these symptoms. The eruption was treated with exsic- cants, being dusted with flour. Saline laxatives, com- bined with magnesia, will, occasionally, be serviceable. Should the parts ulcerate, or become inflamed and pain- ful, a discutient ointment, of half a drachm of white vitriol, with an equal quantity of camphor, mixed with one ounce of lard, will prove useful. The eruption disappeared, in almost every instance I have met with, in the course often days. 168 Practical Observations SECTION IV. DANDRIF, (Pityriases Cupitis.) This is an eruption of a scurfy, or scaly appearance, breaking out on the temples and forehead of children, where it is observed to be white and mealy. It forms again after being rubbed off. On the vertex and back parts of the scalp, it resembles small scales, or tiling. The cure is to be accomplished, by cutting off or thinning the hair, and washing the head with warm wa- ter and soap, which is most effectually done with a brush. A lotion, composed of two drachms of carbonate of potash, (pearl-ash) dissolved in eight ounces of water, is found serviceable. It sometimes proves troublesome, and requires attention to cleanliness, and daily perse- verance in these remedies. section v. SCALD-HEAD, (Tinea Capitis.) This often proves a tedious, troublesome, and dis- tressing disorder. It consists of many small ulcera- tions, on different parts of the head, diffused among, and in connection with the roots of the hair, and dis- chargin_ thin acrid and viscid humour. This re-action is first effused from small vesicles, which gradually 6cab On Diseases of Children. 169 and fall off; successive crops of these form, becoming large until the whole scalp, in some instances, seems matted with the hair. The sebaceous glands are commonly believed to be the seat of the disorder, especially in scrofulous consti- tutions. It very frequently, however, occurs indepen- dantly of this cause. Children, but twelve months old, are sometimes afflicted with it, but of a milder form than that which occurs at more advanced stages. The causes producing scald-head, are believed to be similar to those which induce certain other cutaneous affections; among these, are a want of cleanliness, and poor and unwholesome diet; although it must be ac- knowledged, that tinea is sometimes met with in fami- lies, in affluent circumstances, who are careful in ma- naging their children. In the mild species, the ulceration is superficial; bu t when it has existed long, or been neglected, the unor- der is more deeply seated, the pericranium, and even the bones of the head are affected. The remedies employed, in the cure of this di>ease, are, for the most part, of a topical nature. In cases which have long resisted these, internal mea--s *;». also proper. A few grains of calomel, may be given as an alterative, combined with one grain of cicuta, nnce or twice a week ; also, an infusion of sarsaparilla and glH- aiacum, sassafras, &c. The external applications claim our attention as most important in the cure. To render the m cts more certain, the child's hair should be cut, or shaved oft', (as their roots present a material obstacle ;.■ he head well washed twice a day, with soap and water. 15 170 Practical Observations To fulfil the intention completely, a brush must be em- ployed; after which, a plaster, composed of pitch, or tar. with sulphur, spread on oil-cloth, skin, or bladder, should be laid over the scalp, covering all the ulcerated part. This should be occasionally, or. in a day or two, removed, and the head washed, as already directed. A lotion of elder decoction, or white vitriol and water, in the proportion of one drachm to eight ounces of water, or lime-water; an ointment of mutton-suet, with one- third of ointment of nitrate of mercury, will, in obsti- nate cases, prove effectual. In some instances, the unyielding character of this disease, seems t.> depend upon the rapid growth ot hair. On these occasions, the pitch-plaster, with sulphur, will be serviceable. Linen rags, soaked in a lotion of lime- water, which has been digested on sulphur, and laid over the sore parts, will prove beneficial, by keeping down for a long time, or destroying the roots of the hair. The scald-head is believed to be contagious, and is communicated by contact. SECTION VI. STYE, OR STITHE, (Hordeolum.) This is a painful, inflammatory tumor, which sud- denly appears, and projects from the edge of the *y jd, near the internal, or greater aiigle of the «'V . ,t--. m- bling, in size, a grain of barley, and of a bright-red co- On Diseases of Children. 171 lour. The pain is, sometimes, very severe, and the in- flammation spreads a little distance from its base. It seldom terminates in dispersation, or resolution, but slowly progresses to suppuration, and that not com- pletely ; for, in some instances, under any treatment, which may be adopted, it does not reach that stage for three or four weeks. In consequence of this slow pro- gress, the stye is supposed to consist of obstruction, or disease, in one of the glands of the eyelids, (glands of meibomeus.) Discutient applications may, at first, be tried; for this purpose, an ointment, composed of ten grains of white vitriol, one grain of camphor, and two drachms of lard, should be rubbed over the tumor, two or three times a day. When this fails, after several days trial, and the swelling continues red and painful, a small poultice of yolk of egg, honey, and flour, or milk and biead, must be laid over the part, and renewed two or three times a day ; and, when suppuration is complete, the matter let out, by a sufficient incision, with a lan- cet. If the tumor be not freely emptied in this man- ner, the matter must be squeezed out, and one or two warm poultices subsequently applied, which will re- move the inflammation and swelling. It generallv, however, becomes necessary, to destroy the little sack, or membrane, containing the matter, by cautiously applying to it, a solution of the sulphate of copper, or the lunar caustic, which is more effectual. This may be done, by dipping a camel Vhair pencil in a solution of the latter, and applying it to the sack when emptied. This process is necessary to accom- plish a radical cure. When omitted, a troublesome re- 172 Practical Observations currpnce of the tumor, with pain and swelling, ordina- rily take place. SECTION VII. WHITLOW, (Paronichia.) The paronychia is a well known, painful tumor, or abcess, situated at the end of the finger, near the nail. There are instances of their occurring, also, on the toes. A most distresing pulsation and throbbing is felt in the part, for several days before suppuration takes place. It is generally necessary, to give a free discharge to the matter, by opening with a lancet These affections often arise without any assignable cause ; they are sometimes produced, by suddenly ap- plying the hands near the fire, after being chilled, by pricking the fingers, by contusions, &c. Four species of paronychia aie mentioned by wri- ters; some of which are mild and superficial; but, others, more deeply seated, and attended with excruci- ating pain, inflammation, fever, and swelling of the whole hand. In these forms of the disorder, when sup- puration takes place, the matter is lodged under the tendons, or upon the periosteum ; which, if not dis- charged as soon as remission of fever, &c indicate this process to have been accomplished, the bone becomes eioded, or carious, and a part of the finger, or band, may be lost. On Diseases of Children. 175 This disorder usually begins on the inner side of the finder; and, as already observed, advance^ slowly. Commonly, in two or three days, a speck, or spot of white, or yellow, indicates that matter is collecting. Fluctuation, on pressure, can seldom, in this case, be distinctly perceived. In treating the witlow, it is first proper to examine, whether any splinter, or other extraneous substance, is lodged in the part, which must be removed. The child's hand should be suspended in a sling, and the finger repeatedly immersed in hot, or warm lye. If the hand is much swollen and inflamed, linen rags, soaked in camphorated spirits, ought to be frequently applied over the parts affected. When the swelling points to the spot, poultices, as directed, are to be applied, and the matter early and freely discharged. section vur. BILES, OR BOILS, (Furunculi.) Biles about the face, neck, head, and sometimes the chest, are very common among children, during the summer and autumnal months. They are, generally, of a chronic character, and unattended with any consti- tutional disorder. Those who take much violent exer- cise, are most subject to them. They are often produ- ced by bathing in cold water, soon after being heated. Fat, or gross and plethoric subjects, suffer most with them, although the lean and poor are not exempt. *15 174 Practical Observations Those biles I have here reference to, are considered salutary in their character; the subjects being, usually, free from any other complaints, during the eruption. They have been denominated the extroversive form of fever. These have a conic shape, with inflamed bases; suppuration takes place in a few days, without assist- ance, with a copious discharge of well-digested matter; which, however, ought to be accelerated by means of a puncture. Biles commonly heal up without subsequent inconve- nience, or disorder ; although, in a few cases, indelible cicatrices, or marks, remain. It may be proper to give a little medicine ; for which purpose, six or eight grains of calomel, and the succeed- ing day, a dose of Epsotn salts, will answer. On Diseases of Children. 1 75 CHAPTER IV. Mbsttnti near ttje ?£ij)=3Jofnt (Morbus Coxaris.) _!! his disease is not uncommon among children, under the twelfth, or fourteenth year, and occurs independ- nntly of any strumous habit. I have met with it in three cases, where it could be traced to some casual cir- cumstance, as lying in a damp place, contusions, &c. The symptoms are, acute pain near the hip-joint, be hind the great trochanter ; in the groin, and now and then along the course of the last lumber vertibrae. When nei- ther the swelling, nor other morbid appearances are dis- cernable, this is accompanied with lameness, slight at first but gradually increasing. The child frequently com- plains of great uneasiness, or pain, about the knee of the affected side, which may misguide the inexperienced. Some degree of fever also attends; the exacerbations are observed at noon, preceded by a coldness of the ex- tremities. At length, a deep-seated fluctuation is per- ceived ; after which, the febrile symptoms, and pain subside, but the lameness increases, and there is not un- frequently, an elongation of the limb, and a succeeding contraction, or shortness of the same, in consequence of the disorganization of the joint, and action of the mus- cles. At, or before this period, if the matter is not dis- 176 Practical Observations charged, the bones forming the articula'ion, become diseased, or carious, the capsule destroyed, and the limb perishes, or permanent lameness and deformity are induced; or, in some instances, the patient sinks under a hectic and emaciation. On the first attack of the disease, the child must be kept in a resting posture; and, if the case is connected with scrofula, the treatment, as diiected in that disease^ to >* o n^rve.l, especially a low diet, and the daily use of purgatives. For this purpose, jalap, with cream of tartar, and Glauber's, or Epsom salts, should be given in sufficient quantities, to operate two or three times a day, or oftener, while the inflammation and fever continue. With the same intention, (to diminish these symptoms, and effect resolution) blisters about the joint, issues, cupping, and leeches, are proper. But, when there is reason to believe, that suppuration will take place, omit all these, and apply poultices of biead and milk, &c. As soon as fluctuation takes place, the matter should be discharged, by puncture with a lancet. Light diet is, subsequently, necessary, and laxatives, now and then; but, camomile tea, Columbo infusion, or some mild tonic, may be daily exhibited with ad- vantage. Should, however, any causes concur, to pro- duce a less-favourable issue, or the child, after the fever subsides, and the abscess has ; at length, the patient lies in a state of apparent insensibility, comatose, or drowsy; from which, after a 178 Practical Observations few hours, it recovers, but, without a consciousness of what has happened to him ; excqiting, daring the ex- istence of the fit, there is but little fev.?r, or irregularity of pulse. I have known epilepsy to occur periodically. In general, the fits proceed from some functional, or organic disorder of the sensorium, produced directly, or indirectly,* which, however, may not be congenite. Fatuity, or an idiotic expression of countenance, is sometimes observed in these subjects, although not per- haps until after repeated attacks. The predisposition is not greater in girls than in the other sex; and no remarkable delicacy of frame is no- ticed, although a mobility of constitution is observable, 01 rather, a predominance of sensibility. The frequent exciting causes are, strong and sudden eimnicfls of the mind, fright, or horror, operating un- duly, and impairing the energies of the brain, a painful association of ideas, or periodical turgescence, or con- gestion. In two, out of seven cases of epilepsy, which have fallen under my care, in the course of the last five years the children were afflicted with taenia ;t and a violent fit usually preceded the discharge of a portion of the worm. Of the others, two were under eight years of age, and were deformed from their birth. The moral faculty was, evidently, diseased, which discover- ed itself in a propensity to mischief, or evil practices, from which, they were, with difficulty, restrained. When epileptic fits proceed from irritation, or sym- pathy with the bowels, as in worms, especially taenia j * Or, in rapdical language, idiopathic, or symptomatic. t Or tape worms. On Diseases of Children. 179 or the gums, as in te-thing; or the skin, as in small- pox ; !, experienced its usefulness. Dm ing the course of hooping-cough, it is now and then necessary, at bed-time, to exhibit a few drops of laudanum, camphorated tincture of opium, or one or two grains of compound powder of ipecacuanha, parti- cularly when a laxative dose, or emetic, has been ad- ministered in the course of the day; but, too frequent use of anodynes, will be prejudicial. The salt of tartar and cochineal, or rather, the mine- ral alkali, as advised by Dr. Pearson, of London, may be serviceable, when acidity exists in the stomach, which is frequently the case in the chronic stage ; but, small doses of magnesia, combined with a lew grains of powder of Columbo, in doses, repeated two or three, times during the da}', will prove more efficacious, by gently opening the bowels, and strengthening the diges- tive organs Subservient to this view, or as sub-tonics, the infusion of camomile, with flaxseed, Columbo, or wild horehound, should be employed; but, if no catarrhal symptoms exist, effusions of cold water, in summer will conect the rehxing power of the weather, and seem to diminish the frequency and duration of the cough Their invigorating; effects have been remark able in many cases. Equal advantage may result from the use of the warm bath in winter. * Vide, London Medical Repository, for Jan. 1821. 192 Practical Observations Although the too frequent employment of emetics, and active purgatives, are improper, they are required, whenever inflammatory symptoms re-appear. When cedematous affections occur, or the lungs be- come diseased, which may be recognized by pain, puru- lent expectoration, and hectic fever, from one to two grains of fox glove, and the like quantity of calomel, may be given, daily, and blisters applied to the chest. With young children, violent fits of coughing are sometimes succeeded by convulsions, which carry off the little sufferer, or it may suffocate during a paroxysm. The warm bath must here be immediately resorted to, and a few ounces of blood taken away; and those means adopted, for restoring suspended animation, which are directed for the recovery of still-born chil- dren, as, inflating the lungs, rubbing, &c. (see chap. 1, sect. I, part. 1.) Change of air, riding, or such moderate exercise, as will tend to amuse the mind, and increase the action of the perspiratory vessels, will almost invariably be found usetul. On Diseases of Children, 193 CHAPTER VI. s&iovmg* J. ntestinal worms are so common, that there are few children exempt from them. There is something humi- liating in the reflection, that these animals are known to exist in the living body, from the earliest period to an advanced stage of life ; they have been voided in the feces of an infant of ten weeks, and by adults of sixty years. Generally speaking, they rarely infest the bow- els of children at the breast, or those who are healthy and robust; and the secretions of grown persons, parti- cularly the bile of those who are in health, is destruc- tive to them. Delicate children, those who subsist most on vegeta- ble diet, and are most frequently indisposed, are such as suffer most by them. The number they sometimes pass, is al nost incredi- ble. I have seen six and twenty lumbrici, (round worms) voided by stool, from a subject of four years, within thirty hours. Dr. Rush has observed, what daily experience and dissection confirm, that they seldom induce sickness, but when in great numbers; or when fever, from other causes, renders the intestinal heat too great for them, the irritation then excited, engenders disease more com- plicate and dangerous. 17 194 Practical Observations " Worms serve as scavengers,* by removing the su- perabundant mucus in the bowels of children.'- But, it will readily be conceived, that they may also induce emaciation and debility, by destroying the chyle intend- ed for the support of the body, and may, mechanically, obstruct the functions of the bowels. There are four kinds found in the human subject: the ascarides, resembling small white threads ; the tri- chures, about two or three inches long, with capillary ends; lumbrici, or common round worms, resembling earth-worms, but longer and white, having only two longitudinal lines, or marks; and the taenia, or tape worm, which is of great length, and usually voided in detached portions. The two first kinds infest the ilium and rectum, and often creep away spontaneously, or may be washed out by glysters. The two latter kind occupy every part of the bowels ; they sometimes get into the stomach, and are vomited up. This is, in- deed, a common occurrence with respect to the lum- brici ; and instances have occurred, of their creeping into the throat, and producing suffocation. Worms are, certainly, more frequently believed to be the cause of many chronic complaints of young persons, than any circumstances justify ; and remedies, of a pre- judicial nature, are, accordingly, administered. The manner in which they are produced, in the liv- ing system, must remain a matter of speculation. As young and delicate persons suffer most, it seems extremely probable, that they are generated in the mu- cus of these subjects. The weak state of the bile, con- * Rush's observations. On Diseases of Children. 195 sequent slow indigestion, and constipation, favour their increase. The symptoms usu illy discovered in children, affect- ed by worms, are, an indifference to food, or loss of ap- petite; but, sometimes this is irregular, and now and then, even inordinate; frequent picking of the nose, grinding the teeth, especially at night, screaming, its breath is fcetid and disagreeable. There is often a swelling of the upper lip, the complexion pale and sick- ly, the belly tumid, with pain and costiveness, although sometimes a diarrhoea attends, the stools are fcetid, at times dysenteric, or slimy, with other evidences of in- testinal irritation; a dark circle is, occasionally, ob- served about the eyes, a short, diy cough, fever, and head-ache; convulsions are also among the concomi- tants. The treatment must be regulated by the state of the constitution, and attendant symptoms, especially where fever attends, (vide, part 2, chap. 1, sect. 3.) Gene- rally speaking, it is improper to exhibit emetics in the first instance. Purging doses, consisting of three or lour grains of calomel, and six of jalap, with one or two drops of oil of wormwood, mixed in syrup, may be ad- ministered now and then ; especially if costiveness at- tends, during the intermediate days, a glass of decoc- tion of Peruvian bark, with spigelia, or infusion of Co- lumbo, two or three times a day. Should much debi- lity attend, or acidity of the primoevioe, the addition of a few drops of compound spirits of ammonia, or a few giains of magnesia, to each dose, will be advisable. The bark of the root of pride of India, may be substi- tuted for spigelia; but, neither of these anthelmintics 196 Practical Observations are to be administered in too strong doses. Affec- tions of the eyes, and even convulsions, may be pro- duced by them, when thus incautiously used. When, however, these unpleasant effects are observed, a table- spoonful of olive oil, or a dose of castor oil, or about ten grains of ipecacuanha, should be administered. As a vermifuge purgative, a tablespoonful of castor oil, with from ten to thirty, or sixty drops of oil of turpentine, often proves efficacious, in expelling both the lumbrici aud taenia. The spigelia, in doses of six grains of the powdered root, with one or two of calomel, will be serviceable in obstinate cases. The dose may be repeated, for three nights successively ; and, on the following day, if the medicine does not open the bowels, the cathartic dose, above directed, with oil of turpentine, will be proper; also, powder of rust of iron, in doses of six or eight grains, with two of calomel, every other night, in syrup. When much emaciation and debility attend, the de- coction of cinchona, or Columbo, as advised, will be necessary, and generous diet, with sometimes a little wine, or brandy and water. The carbure, or rust of ion, is here also serviceable, in doses of ten grains, or more, in syrup. Should the child be disordered in the bowels, or diarrhoea take place, an emetic of ipecacu- anha, rhubarb, and magnesia, and, occasionally, a few drops of laudanum, will be serviceable. The spigelia? calomel, castor oil, oil of turpentine, gamboge, and aloes, are all efficacious in taznia. The expulsion of this species of worm, is frequently preceded by epileptic fits. On Diseases of Children. 197 Several cases have occurred under my notice, where large portions of taenia have been spontaneously voided, when no symptoms were manifested ; and one recent instance, in which the patient was believed to have been perfectly restored to health, and no medicine had been administered for a length of time. This is the case of a boy, in his twelfth year, who was placed un- der my care, being afflicted with epilepsy and taenia. In the course of twelve months, he had passed several pieces of the worm. A fit was always the precursor to the expulsion; his complexion was unhealthy ; and among other symptoms, there was a preternatural dila- tion of the pupils, with tendency to strabismus. In August, 1822, after a course of anthelmintic ca- thartics, as above described, he voided fifteen feet of taenia, the largest piece measuring nine feet. From this period his health improved, as well as his intellec- tual powers, a degree of fatuity having been previously induced by the violence of his fits. These did not re- cur, and, to all appearance, he had quite recovered. On the sixth of May, 1824, without any premonition, excepting a slight fit, he expelled another piece of the worm, measuring fifteen feet, differing in colour and size from the former portions. This was of greater width at one extremity, and terminated in short and narrow joints. The colour was milk white. It re- tained life for several hours after being voided. Since this, he has enjoyed an entire exemption from fits, and his constitution seems re-established. Theie are cases on record, of electric shocks passed through the body, having destroyed the tape worin. •17 198 Practical Observations The thread and hair-like worms, (ascarides and tri- chures) are dislodged by glysters of soap and water, decoction of pride of India, spigelia, &c. two grai.s of aloes, and the like quantity of calomel, made into a pill with soap, taken once or twice a week, will prove very effectual. The portion? of the ingredients, are to be re- gulated by the age and constitution of the patient On Diseases of Children. 199 CHAPTER VII. Diarrfjoea. (Lax, or Looseness, and Disorder of the Bowels.) Vf hile treating of stomach and bowel complaints, in part 1, chap. 4, sect. 2, this disorder, in early child- hood, was adverted to as occurring during dentition. The complaint, as now considered, arises from other remote and exciting causes. These are various, such as taking cold, by premature change of clothing, un- wholesome food, worms, acidity* and acrimony in the stomach and bowels, &c. repelled eruptions, &c.; the two latter may be ranked among the most common oc- casional causes. The digestive organs of children are frequently op- pressed, during summer especially, with fruit and im- proper diet. If the stomach does not seasonably reject these, fermentation, and consequent acidity and diarr- hoea, take place; the quantity, as well as the quality, of the substance, will also prove hurtful, and produce inordinate peristaltic motion, and morbid dejections. In this complaint, there is pain or soreness about the umbilicus, sometimes fever ; the stools are frequent, of a dirty, or dark colour, very liquid, the patient is lan- guid, and loses his appetite. When acid predominates, the passages acquire a dark-green appearance, and, 200 Practical Observations especially when the secretion of bile has been increased by fever. The disease is, sometimes, suddenly brought on, by indiscreetly drinking large quantities of cold water. Many children are allowed to indulge in this pernicious habit, of distending their stomach. The pump-water of this city is, in summer, twenty degrees cooler, than the temperature in which we breathe. Copious draughts, therefore, impair diges- tion, induce debility in the chylopoetic viscera, and dis- order which discovers itself in cholera and diarrhoea. In those cases of diarrhoea, accompanied with pain, or soreness of the epigastrium, and about the umbilicus, an emetic is proper. Ipecacuanha, combined with tar- tarised antimony, should be given in a mixture, until vomiting takes place. Acid, or green bilious matter, with some indigestible substance, will generally be brought up. In the evening, eight or ten drops of lau- danum may be necessary ; this ought to be mixed with a little prepared chalk and water, or cinnamon tea. On the succeeding morning, a mixture of Glauber's salts, with magnesia, will be advisable; to be adminis- tered in small doses, until physical stools are produced; after which, the child's strength is to be supported with arrow-root, veal, or chicken broth, &c. The cure may be accomplished, after these, by a few grains of ipecacu- anha and rhubarb, with prepared chalk, in a mixture, and one or two tablespoonsful of it given six or eight times a day. Occasionally, a few drops of laudanum, or one or two grains of compound powder of ipecacu- anha, will be required in the evening. Should much debility, or loss of appetite attend, an infusion of Co- On Diseases of Children. 201 lumbo, with a few drops of tincture of rhubarb, or lime- water and milk, ought to be administered daily. The warm bath is also beneficial; and, in tedious cases, a decoction of bark, with cinnamon, sometimes adding a few drops of laudanum, and a change of air. In severe and protracted instances of diarrhoea, blis- ters to the epigastrium, or near the umbilicus, have a good effect. A few grains of calomel, will serve to change the nature of the stools, and carry off vitiated bile. After which, a gentle emetic of ipecacuanha, or a mixture of small doses of this medicine, with a few drops of laudanum, will produce a happy effect. When diarrhoea proceeds from repelled eruptions, (or the striking in of some cutaneous disease,) the system above advised, is also proper. Blisters are here of sin- gular efficacy, applied to the back, (between-the shoul- ders) to the wrists, as well as to the epigastrium, in suc- cession ; if the strength is too much reduced to bear emetics and evacuants, these, with the warm bath, and a mixture of small doses of ipecacuanha, with prepared chalk and laudanum, piove highly beneficial. Arrow- root, seaso led with cinnamon, and a little wine, or brandy, will, in such cases, be useful; and the flesh brush, or frictions over the body and extremities, ought not to be neglected. Sometimes the bowels are loose and disordered, with- out pain. A mixture of a few grains of magnesia, with peppermint, and three or four drops of laudanum, un- der these circumstances, will remove the complaint. However imperious the call for astringents may seem in diarrhoea, they are to be cautiously used in \oung subjects. There is always danger of obstructions, es- 202 Practical Observations pecialiy in the mesenteric glands, when intestinal disor- der is attended with pain, tumefaction of the body, and febrile symptoms. Children bear evacuants better than has formerly been admitted ; and the early use of astringents, except in urgent cases, is highly improper. In this view of the subject, the indication of cure will be, to allay and remove the centripetal disorder; which may safely be performed, by adopting the abovementioned plan. Where obstructions are suspected, a laxative dose, with three or four grains of calomel, once or twice a week, will prove serviceable, and the system advised ia mesenteric fever, (see chap. 1, sect. 8, pait. 11.) On Diseases of Children. 205 CHAPTER VIII. Dropsy J. his consists of an accumulation of serous, or gelati- nous fluid, in the cellular texture, or in some particular cavity, and is general, as in anasarca, or encysted, as in hydrocele, &c. already treated of. It is, in reality, but the effect of some previous disease, and seems to be immediately induced by debility, or torpor of the lym- phatic system; or, as some writers allege, an increased exhalation and diminished absorption. Dropsies attend, or succeed obstructions, or schirosi- ties of the viscera, of Ihe thorax, or of the abdomen, protracted remittent, and intermittent fevers. Anasarcous swellings, in young persons, now and then follow the typhus form of fever, when blisters, if they have been employed, are observed to sphacelate. The symptoms are, a pale complexion, thirst, swel- ling, partial, or general, uneasy respiration, debility, quick pulse; but, when there is an effusion in the chest, it is irregular, or intermittent. Dry skin and drowsi- ness, are usual concomitants; the urine is, at first, pale, but afterwards, high-coloured, scanty, and deposits on standing, a red sediment. As an inflammatory diathesis still exists in young subjects, especially when the disease has been suddenly induced, they frequently recover; but, with those who 204 Practical Observations are older, the prognosis is less favourable. When the effusion is in the body, (in ascites) a fluctuation, or un- dulatory motion, is readily perceived, by placing the hand on one side of the patient's body, and gently strik- ing it on the opposite side with the other hand, and in the extremities, by the parts retaining the pressure of the finger. In the treatment, the original disease must be consi- dered. If the effusion has not long existed, and the ap- petite and constitution not materially impaired, car- thartics of jalap, and cream of tartar, emetics, and at intermediate times, tonics, diaphoretics,' and diuretics, are proper. For this purpose, a small glass of the infu- sion of thoroughwort, with eight or ten drops of tinc- ture of fox glove,' or squills, may be given two or three times a day. When worms are concerned, the spigelia, or pinkroot, should be added. Exercise, or when im- practicable, frictions over the body, ought not to be ne- glected. When the disease is in the chest, a salivation has proved highly efficacious. On Diseases of Children. 205 CHAPTER IX. JIlS it is, in a peculiar manner, the province of surgery, to treat of these subjects, I shall content myself w'nh of- fering only a few remarks, on injuries proceeding from these causes. SECTION 1. INCISED WrOUNDS. Wounds, inflicted by sharp cutting instruments, re- quire immediate attention; when blood-vessels and arte- ries, in particular, are divided, which bleed profusely, the patient may die of hemorrhage. If, therefore, a limb be the wounded part, a tournequet should be ap- plied, until the bleeding Vessel is held by a forceps, a better instrument than the tenaculum, and secured by a ligature. The wound must then be washed, and the edges neatly approximated, and secured by the inter- rupted suture, and adhesive strips, and covered witk light dressings ; the whole to be supported by bandages. Whenever practicable, an union of wounded parts sbould be effected by the first intention! with this 18 206 Practical Observations view, fingers and toes, when almost separated, may be retained by bandages and strips, anil made to re-unite. Hemorrhage, from wounds of the head, may, gene- rally, be restrained by compression, and suitable ban- dages. SECTION II. PUNCTURED WOUNDS, These should always be carefully exartiined and washed ; and any extraneous body, as a splinter, thorn, nail, portion of glass, &c. extracted, or removed. After which, oil of turpentine may be dropped into the wound, and the part poulticed for several days It is generally considered most safe, to persevere in this application until suppuration takes place. Under this treatment, unnecessary exercise may be avoided. section m. LACERATED AND CONTUSED WOUNDS. Lacerated wounds are to be allowed to bleed mo- derately, and to be washed and dec. used of any extra- neous substances, which may keep up irritation in the injured part. When there is much laceration, poultices should be applied, and repeated until suppuration takes On Diseases of Children. 207 place. Subsequent pain and inflammation may, how- ever, require blood-letting from the arm ; and the anti- phlogistic treatment, comprehending laxative medicine, low diet, cool air, &c. Contused wounds require dis- cutient embrocations, as vinegar, solutions of the sugar, or acetite of lead, camphorated spirits, &c. In the Pa- ris hospitals, lotions of salt and water, are used with equal effect. Inflammatory symptoms, when they take place, must be subdued by blood-letting, laxatives, and the antiphlogistic treatment, as advised in the foregoing case. SECTION IV. POISONED WOUNDS, Inflicted by the bite of a rabid animal, a rattlesnakefN . and venemous insects. A wound, produced by the bite of a dog, suspected to be mad, or any other rabid animal, ought to be im- mediately washed by copious and long-continued effu- sions. Warm lye-water, if at hand, will be most effec- tual ; but, when not convenient, the cold is to be used ; the object being, to remove, as speedily as possible, the saliva of the animal, and the poison. When the bite has not been inflicted contiguous to a joint, or some im- portant blood-vessel, or vital part, exsection of the wound is the most certain preventive of hydrophobia* » Vide. Rees' Cyclopedia, and Laltas' System of Surgery. 208 Practical Observations •r amputation, if the finger, or toe, has suffered ; and there should exist, no doubt of the rabid state of the animal, nor ought this to be delayed. But, should the nature of the case preclude a resort to this operation, the wound, after being well washed, as directed, may be burnt with lunar caustic, or washed with a solution of ammonia, and, subsequently, dressed with poultices of bread and milk, or the bruised leaves of the Scutellaria, •r scull-cap,* which has acquired some reputation in these cases. The foregoing system should be pursued, although a day or two may, unfortunately, have elapsed, after re- ceiving the injury; hopes may still be cherished, that excision, or amputation, will save the constitution, or preserve the subject from one of the most dreadful disorders to which humanity is liable. The bite of a rattlesnake, viper, &c. may be treated on similar principles to the preceding. Dangerous ■consequences of wounds, of this description, are, for the most part, to be prevented, by freely and copiously- washing the wounds, and afterwards, pouring upon them spirits of ammonia, or hartshorn, and subsequent dressings with olive oil and meal, or bread and milk poultices. A similar plan may be adopted, for relieving the dis- tressing and painful effects of the bite, or sting of veno- mous insects. Soft linen rags, soaked in oil and lime- water, and spirits of ammonia, are to be laid over the part affected, after being washed. * The internal use of the scull cap, is also recommended in hydrophobia, in doses of one teaspoonful, mixed in milk, morn- ing ami evening-, for three or four weeks. The plant here re- ferred to, is the Scutellaria galericulata. On Diseases of Children. 209 CHAPTER X. titrations an* tftattuvtn. he softness, or imperfect ossification of the bones of infants, prevent that liability to luxations and fracture from casualties, which we observe in children of larger growth Injuries, however, of the spine, the hip, and the large joints, are sometimes discovered long after a fall, or other accident. Close examination, and early counter- acting remedies, ought, in every instance, to be attend- ed to. Fractures of the arm, the leg, clavicles, ribs, &c. are readily discovered by the crepitus, or crackling produced by handling them, and the usual deformity, or rising up of one end of the broken limb, or bone. When a fracture of one, or more bones of the leg, or forearm, occurs, the limb must be reduced to the natural state or position, by the process of extension, counter- extension, and coaptation, and so secured by bandages and splints. When the bones of the arm, or thigh, are broken, the extension must be carefully maintained, by an apparatus accurately and judiciously applied. Ths splints* and bandages, employed with this in- tention, should be adjusted in such a manner, as to counteract the constant tendency of the muscles, which » Vide,Dessaulfs Surgery, Potts, and other eminent writer* •18 210 Practical Observations cover and act upon these parts, to displace the fractured extremities, and defeat the object of the surgeon. A common luxation, is that of the head of the hume- rus, by a blow, or falf, upon the point of the shoulder. The head of the bone, by this violence, is driven from its connection, (the glenoid cavity) most commonly into the axilla,* where it is easily felt. The luxation is reduced by an assistant, extending the arm, by uniform- ly, but firmly pulling it, when in a direction nearly at a right angle with the body, while the surgeon, passing a towel, or a long and wide bandage, under the arm-pit, brings the ends across, or over the shoulder, and pulls obliquely upwards, producing, in this manner, a coun- ter-extension. When this is performed, with due pre- cision and force, the dislocated head is soon heard to re. enter the cavity from which it had been forced. Luxations, as well as fractures of the collar bone, are to be reduced by raising the forearm and hand, and resting them in a sling, previously applying a cushion in fhe arm-pit,t with a bandage suitable for retaining it, as well as for making a due degree of pressure upon the ends of the fractured bone, immediately over which, a compress of soft linen cloth had first been placed. * Arm-pit. 1 The reader will consult Dessault's Surgery, also Potts, Bell; Proper, &c. On Diseases of Children. 211 CHAPTER XI. tfurns an* Scaltrs* J. hese are the most distressing casualties to which children are liable. Human nature is not susceptible of greater torment, nor of enduring more intense pain, than they inflict; nor are the sympathetic feelings more strongly excited for a little sufferer, than in these cases. A bnrn, although it often affects a part severely, oc- casioning, sometimes, a destruction of substance to some depth, does not, generally, prove so alarming and dangerous as a scald. The hot, or boiling liquids, which produce the latter, usually operate more exten- sively, and danger, for the most part, is proportionate to the extent of injury; exceptions, perhaps, where some particular part of great sensibility has been injur- ed, in contiguity with a vital organ. The symptoms attending a burn of any extent, are violent inflammation and pain, fever, coma, drowsiness, oppressed breathing, and mortification of the injured part. To diminish pain and inflammation, are the first ob- jects of the practitioner. A variety of topical applica- tions, have been recommended with this intention. The evil, and, sometimes, fatal consequences, which result from the delay of judicious and suitable reme- dies, in these cases, render it advisable and prudent, 212 Practical Observations to provide such as are most reputed. There are, hap- pily, however, such a variety, suited to this painful and alarming emergency, that a due degree of presence of mind, seems alone necessary to their seasonable and efficacious employment. They may be mentioned in the following order:—cold water, vinegar, spirituous li- quors of any description, a mixture of equal parts of lime-water, and linseed oil, and raw cotton. When the hands, or feet, have suffered, they should be immediately plunged into a basin, or tuh of cold water, and kept there for some time ; as the water be- comes warmer, it should be changed. It will be pro- per, to preserve the hand in an extended state, as the flexor tendons may be permanently contracted. When the body, chest, &c. are affected, soft linen rags, soaked in spirits, may be applied ; and these are to be continued and renewed, if necessary, until all painful feelings subside; after which, the parts should be covered with dressings of lime-water and linseed oil. When the injury has been very violent, and much inflammation has been excited, blood-letting and lax- atives are required, and ought not to be omitted when the symptoms are accompanied with fever. In some cases, it may be proper to administer an anodyne, after the remedies, above advised, have been employed. I was first led to the choice of cold water, as a topi- cal remedy, from witnessing its decided efficacy, on a boy, who burnt his hand in a shocking manner with gunpowder. With the palm opened, it was immersed in a basin of cold water; which, in ten minutes, began to prove most happily efficacious; the pain, which was) excruciating, and inflammation, subsided; and after On Diseases of Children. 2\S continuing this remedy for two hours, complete relief was obtained. Appearances, in the first instance, were very alarming. Equal success invariably continued to attend the adoption of this plan. Scalds, when neglected, produce vesication ; the ef- fused secum should be let out, by means of small punc- tures, without removing the cuticle; and spirits, or lime-water, and linseed oil applied, as above advised. Ulcers, succeeding burns, heal slowly; which fact furnishes an additional inducement, for using remedies as above described. They directly abstract heat and inflamamtion, consequently mitigate pain, and exert a salutary astringent property. When, however, from inattention, or other causes, ulcers take place, the growth of fungus is luxurient, and, with difficulty, kept down. The application of burnt alum, or lunar caustic, and the pressure of bandages will most speedily remove it, and favour cicatrization. When mortification, or gangrenous appearances, are observed, the external use of tincture of myrrh, and Peruvian bark, as well as its internal exhibition with wine, and, occasionally, laudanum, become necessary. 214 Practical Observations ) CHAPTER XII. <&u J&auafltmtut. I$jLan is the creature of imitation and habit, "angel yet in this, that to the use of actions, fair and good, she kindly gives a livery, or a frock, which aptly is put on." This is conspicuously exemplified in childhood. There are but few persons acquainted with well-regu- lated families, who do not bear testimony to the com- fort, peace, and happiness enjoyed by the social circle, where a system of management has been adopted, with children, tending to control the early influence of im- proper dispositions and affections, or to discipline the temper. There is a period of life, when this can be effected with comparative facility, without unnatural exertion, or violation of the feelings of the tender pa- rent. Like noxious weeds, evil qualities spring up, unper- ceived; and if not seasonably removed, acquire a growth, which must cost great pains and labour to sub- due, or eradicate. To use the sentiments of the learned Bishop of Dur- ham, childhood is the state of discipline and improve- ment, and that both in our temporal and religious capa- city, " the subordinations* to which children are accus- * Butler's Analogy, page 87. On Diseases of Children. 215 tonied, will teach self-government in common beha- viour, and prepare them for subjection and obedience to the civil authority;" consequently, for the most rational degree of peace and happiness. The advantages of the system adverted to, are incal- culably great, whether considered in the morning of life, or in maturer age. As in the foregoing sketch of diseases, there have been shown, " leading phenomena of fever, consisting in a series of movements, which produce crisis and types;"* which serve to regulate the course of the wary and discerning practitioner. So, there are pre- monitory symptoms, and the intelligent parent, or nurse, may profit by them. They should never be dis- regarded, as the prevention can, wilh less difficulty, be accomplished, than a cure, when the complaint is esta- blished. To answer this indication, (in the prophylactic sys- tem) due regard to cleanliness, suitable diet, and dress, are of vital importance, and indeed, require attention at all seasons. Their neglect must be considered among the most prolific sources of disease. I am, by no means, an advocate for prescribing on slight occasions; parental anxiety, too often leads to the practice of crowding, or oppressing the child with medicine. When, however, it becomes necessary to administer something of this kind, promptitude and pre- cision in management, ought to be observed, and are, especially, enjoined, in cases where the physician has been consulted. It is both just and generous, that hijs * Medical Louie, by Sir Gilbert Blane, page 50. 216 Practical Observations directions should be conformed to; the delay of one hour, or even a few minutes, will often frustrate his in- tention, and, perhaps, prove fatal. It is truly afflicting to see, on some occasions, the conduct of the child, and want of firmness in the pa- rent. Persuasion and coaxing are unavailing ; with as little effect, are disgusting and impotent threats resorted to. So far from being productive of good, they prove reciprocally hurtful, by aggravating the disorder, and in some measure, defeating the object of the prescrip- tion. Far different is the case, when a child has been taught to conform to the commands, or wishes of a parent. It will take what is directed, and feeling relief, and the pleasure obedience imparts, will, subsequently, as ex- igencies require, from these causes, and an acquired sense of duty, conform to the authority which directs him. I am here, unavoidably, induced to notice an error of a serious nature, too often fallen into by relatives and friends, as well as parents; which is, to yield to des- pondency, or relax in the means advised for the little patient, while there is a possibility of their being effec- tual. Having, in numerous instances, witnesssd recoveries of children, who were brought extremely low by sick- ness, 1 feel encouraged in saying, that hope may be che- rished, while the pulse is discernable ; and when pro- fessional opinion sanctions a perseverence in remedies, they should not be abandoned. But, even when the awful issue appears inevitable, the avenues to dissolu- tion may be soothed. An obligation to other endearing On Diseases of Children. 217 ties, demand a due composure and moderation in the. expression of sorrow. Religion claims it with a sub- mision to Divine Will. Of all the afflictive dispensations of Providence, we must surely admit, that there is none more keen and severe than that, we here contemplate, it forms a cloud between divine goodness and the finite views and con- ceptions of man ; and the anguish of soul almost over- whelms. The loss of a child is like tearing away a vital part of the body. Life is so dear, that " all that a man hath, would he give for it." But, the pious mother is consoled with the assurance, that the angel of death, lingers to conduct the infant sufferer to the gates of paradise, to bear him from a world of sickness, sorrow, and trouble, to the mansions of purity, peace and joy. Revelation declares this to be the lot of those children, who pass from life to eter- nity. Often, too often, perhaps, are we called to con- template the dreadful condition of maturer age, when the awful stroke of mortality is, at once, a dismission from life, and the summons to judgment! 1 Much may be adduced in support of the happy in- fluence of an early control over the dispositions of children. Where the family is large, it is but with the first child, that the task is at all difficult. The exam- ple, once established, almost accomplishes eveiy thing with those who are younger. In the Orphan-House of this city, where there have been, for ten years past, about one hundred and eighty children, annually nursed and provided for, instances rarely occur, where difficulty is experienced, in admin- 218 Practical Observations, #*e. istering medicine, or in the performance of an operation however painful. It will astonish the stranger to hear, that a child of but five or six years, will sit to have a tooth extracted, its eve scarified, or be bled, with as much, or more com- posure, than many adults ! The explanation is suffi- ciently satisfactory ; the afflicted child is instructed to believe, that its pain will be removed ; it is not intimi- dated by the anxious but impolitic expression of fear, too common with parents. It complies with the desire of its nurse, obtains relief, and this is witnessed by its little associates, who, as occasions offer, emulate this conduct. FINIS. x^VC ' '£&' > - • ©■;• /< ,/^ .- -» v*. . \ -X - I ■ V >"-^ : x b \' , * S' s/ ' / v, \0m- ■' • /