THE PROPER TREATMENT OF CHILDREN, 
MEDICAL OR MEDICINAL. 
KK1NG THE 
ANNUAL DISCOURSE 
BEFORE THE 
MASSACHUSETTS MEDICAL SOCIETY, 
.JUNE 4, 1873. / 
\f 
CHARLES E. Ii&tfKlXGIIAM, M.D., M.M.S.S., 
Professor of Midwifery and Medical Jurisprudence 
in Harvard University. 
B O S T O N : 
A. WILLIAMS & CO 135 WASHINGTON STREET. 
David Clapp & Son, Printers. 
1 873. THE PROPER TREATMENT OF CHILDREN. 
BY CHARLES E. BUCKINGHAM, M.D. 
OF BOSTON. 
Read at the Annual Meeting of the Massachusetts Medical Society, 
June 4, 1873.* 
Mr. President and Fellows 
of the Massachusetts Medical Society:— 
The Massachusetts Medical Society has, it is said, 
been on trial for the past year or more, for the pur- 
pose of discovering if it had the legal right to man- 
age its own affairs. The Supreme Court of the 
State has been sitting upon the question; and, while 
waiting for its decision, the Committee of our body 
has wisely allowed all discussion of the subject 
quietly to rest. And now that the question has been 
decided, and all noisy declamation has been avoided, 
it may be as well for us to review the history of our 
Association, and look somewhat into its real object 
and its relations to the public, by whom and for 
whom it exists. 
* At an Adjourned Meeting of the Mass. Medical Society, held Oct. 3,1800, it was 
Resolved, “ That the Massachusetts Medical Society hereby declares that it does 
not consider itself as having endorsed or censured the opinions in former published 
Annual Discourses, nor will it hold itself responsible for any .Opinions or sentiments 
advanced in any future similar discourses.” 
Resolved, “ That the Committee on Publication its directed to print a statement to 
that effect at the commencement of each Annual Discourse which may hereafter be 
published.” THE PROPER TREATMENT OF CHILDREN. 
It exists by virtue of an act of the Common- 
wealth, not for the privilege of money making, not 
for the purpose of giving one set of men power over 
others, not to enable the so-called regular prac- 
titioner to take an advanced position at Court or on 
State occasions; but, in the words of its charter, 
“ As health is essentially necessary to the happiness 
of society, and as its preservation or recovery is 
closely connected with the knowledge of animal 
economy, and of the properties and effects of medi- 
cines ; and as the benefit of medical institutions 
formed on liberal principles, and encouraged by the 
patronage of the law is universally acknowledged ;— 
Be it therefore enacted,” &c. 
We can easily imagine how much more profes- 
sional jealousy existed among men equally well 
educated, before the year 1781, when this charter 
was granted; and how much this may have done to 
bring together, at that time, and to make known to 
each other the men of ability, of knowledge, yes, 
and of honesty in their practice, who had hitherto 
kept aloof from each other. 
In 1781, the profession and the public of New 
England were not so well off, so far as professional 
knowledge is concerned, as they are to-day in 
the farthest settlement of the most newly settled 
territory. 
There were, it is true, men who had been educat- 
ed abroad, and who, for family reasons, the desire 
for excitement, or on account of bad habits and 
worse name, had settled in the colony; and some of 
them were undoubtedly well educated for the time. THE PROPER TREATMENT OF CHILDREN. 
3 
But the great mass of medical practitioners had 
passed no examination, and received no degree. A 
few of them had pored over the small number of 
well-thumbed books in some equally unexamined 
doctor’s office; but ignorance of books, was the rule.* 
The most plausible talker, the sweetest smiler at 
the lady’s couch, the hypocritical knave who anxious- 
ly sought opportunity to pray himself into practice 
at the bedside of the dying ; these were the men 
who most rapidly, if not permanently, came into 
lucrative practice. The custom is not yet abolished ; 
but with the growth of knowledge, and the more 
free intercourse of men of education, the evil has 
become comparatively slight. 
At this day, attempts are made, by those who 
mean well, to make one standard of medical educa- 
tion, a requirement throughout this whole land, or 
to refuse fellowship to those who are not up to it. 
That standard cannot be forced, beyond the require- 
ments of the situation, by this Society, nor by the 
American Medical Association. 
The same amount of education is not needed in 
some little settlement in Omaha, that must be had 
in a large city. To get an equally well educated 
man for such a place, would require more money 
than the whole settlement could furnish, and the re- 
sult would be, that it would be without any medical 
attendant whatever. Nor in this Commonwealth 
is an equally well informed medical man required in 
every village, nor could such afford to live there. 
* Note A. 4 
THE PROPER TREATMENT OF CHILDREN. 
The Society was intended to protect the public, 
and to distinguish from pretenders, those who believe 
in no dogma, but who wish to practise honorably 
according to the light received. It asks no man 
whether he believes in bleeding or aconite as more 
certain to relieve fever; whether he knows that 
capsicum will cure sore throat or a cold bath be fol- 
lowed by sweating ; whether belladonna will prevent 
scarlatina or nux vomica will stop tetanus; whether 
he intends to use any particular drug in the treat- 
ment of any particular disease, nor whether he 
believes that every patient will do better without 
any medical treatment than with it. 
Notwithstanding the precedence which, under 
some circumstances, is awurded to knaves ; it is on 
the whole true, that by the existence of this Society, 
the better men are more patiently listened to. Hard- 
ly a man of us, who has been in court, but knoivs 
how testimony of honest men is twisted against 
themselves ; and how, after they have left the room 
disgusted with the jury, the bench and the bar, they 
have cursed law as a dishonest trade, and those who 
practise it as but little better than practical traders. 
But physicians must remember the difficulty in ap- 
preciating the mote in the eye, unless it gives pain 
to the bearer. Let them look around upon their 
own brothers, and they find the same trickiness in 
every profession ; theology, law, medicine. And the 
day comes when the best man in his calling is the 
man sought for. Enough has been had of the pro- 
fessed professional witness; but now the services of 
him, who is known to be looked up to by his profes- THE PROPER TREATMENT OF CHILDREN. 
sional brethren, are required, and the best man 
among regular practitioners is called for; not 
necessarily the man whom the public have supported 
the most, but the one whose opinions you and I 
respect. 
There are those who sorrow because the profession 
is looked upon with less of adoration than in former 
years; and so it is with the pulpit. We are not 
alchymists. We have no secret cures. There are 
those among us who doubt if we have any cures, and 
yet practise medicine with perfect success and honor. 
We should cheer all such on, if we believe in 
“ the benefit of medical institutions formed on liberal 
principles and encouraged by the patronage of the 
law.” In one thing we all agree; and that is, in 
ignoring theories unsupported by facts. We require 
to-day the evidence of any man’s claim to a success- 
ful treatment of any disease, if he speaks of such; 
and as members of this body, we are willing and 
anxious to hear from those who have had experience, 
whether we agree with them or not. We believe it 
to be a matter of duty, for those who have reached 
a certain position, to give the results of their observa- 
tion to those who are coming after; and this, not- 
withstanding the certainty that the observations of 
different men do not and cannot agree. It remains 
for some other party to point out the reasons for the 
discrepancy, and to draw the proper conclusions. It 
is simply an absurdity, to bind ourselves by any one 
set of observations ; for no two cases can be alike in 
all their present surroundings and all their precedent 
history, Those who are so easily satisfied that they 6 
THE PROPER TREATMENT OF CHILDREN. 
are right, from the fortunate result of single cases 
treated by them, it would be wasted time to talk to. 
We too often hear of the many hundreds of cases of 
some one disease, treated by a single man, when his 
whole constituency must necessarily have been 
afflicted with it, to enable him to count a tithe of the 
number. 
1 remember well in the early years of practice, 
and there are others present who cannot have for- 
gotten it, the having commented with severity, at a 
society meeting, upon the injudicious treatment of 
scarlet fever by those who reported the cases. We 
were, most of us, dispensary practitioners. Their 
patients died ; my patients got well. But what did 
their percentage or mine in the grand result amount 
to ? Absolutely to nothing. 
The surroundings of dispensary patients differ as 
much as those of patients in higher life. Every 
patient was not lying over a sewer. Every patient 
did not have a tuberculous ancestry. Every patient 
was not properly clothed, nor every one badly fed, 
nor every one injudiciously dosed by some dangerous 
neighbor. But the tables turned and percentages 
changed. Called to a child on Saturday afternoon, 
I found it one of five children in an Anglo-American 
family, just taken down with scarlet fever. The other 
four, so far as I could judge, were in perfect health. 
Before Monday night the five children were buried. 
“ But of what use is it,” asked a member of the 
profession, “ to tell stories like this to the public, or 
even to the profession % It will only cause distrust 
of our remedies, and want of confidence in our- THE PROPER TREATMENT OF CHILDREN. 
selves. The profession is sufficiently split up by 
differences of opinion in matters of treatment now.” 
And because of these differences of opinion con- 
cerning treatment I am glad. It shows thought, at 
least on the part of some. The public are not 
capable of judging. The same is true of many of 
the profession. The illogical exist within as well 
as without its doors. Discussion, however, and fair, 
candid statement of facts, will not deprive the pro- 
fession of its proper standing. Indeed, a properly 
recorded set of observations, properly discussed by 
those who are looking for true conclusions, never 
injured the reporter nor the profession. And if the 
profession is to be destroyed by absolute “ knowledge 
of the animal economy and of the properties and ef- 
fects of medicines”; why, gentlemen, the sooner it 
dies, the better; that we may earn an honest living 
by the sweat of the brow. It cannot be so, however. 
Prove, to-day, that medicinal treatment of any one 
disease, is useless or harmful, the medical treatment 
still remains for us ; and instead of wasting thought, 
poring over old books to enable us to decide upon 
medicinal combinations, we have the time before us 
for the study of the causes of the disease, and its 
prevention and even its cure. Medicine is not the 
only curative means; and were medicines (I do not 
say medical treatment) proved to-day to be absolutely 
useless or even noxious, there would still be enough 
for the physician to do. 
The relation of men to each other is such, that it 
has been found not only convenient, but necessary, 
to set certain men apart for certain work. All have 8 
THE PROPER TREATMENT OF CHILDREN. 
not time to hew timber, nor to lay brick. All have 
not the peculiar mental capacity to learn mathe- 
matics and navigation, nor the physical power to 
dig the ditch; and to some of us has been left the 
teaching of anatomy and surgery, of the mechanism 
of labor, of the physiology of digestion, of the easiest 
method of nursing, yes, even of the preparation of 
gruels, and the administration of enemata. 
Less than fifty years ago, almost every thinking 
man knew that the railroad system, if allowed to 
exist, would destroy the trade in horses, would throw 
hundreds of men out of employ who were engaged 
in stage building and driving, and would even oblige 
the poor farmer to sit with folded hands and starve, 
because there would be no use for his hay and his 
grain. But progress in railroad building has brought 
forward other problems to be solved. Where are 
we to get all the material that is going to be needed 
to supply the roads with cars ? The wood has been 
cut off, and it has become necessary to supply coal 
for fuel in its place, or cars will not run. As the 
coal is used, why not be alarmed lest that should be 
burned up and even Pennsylvania be left without 
means to afford us warmth and motion 1 My breth- 
ren, the progress of knowledge, consequent upon 
accident some may say, but surely consequent upon 
study and thought, consequent upon the intercourse 
between men of the same trade or profession, con- 
sequent upon discussion which sometimes seems 
severe, has always made the want and the supply 
come together, like the hour and the man.* 
* Note B. THE PROPER TREATMENT OF CHILDREN. 
9 
It is useless for us to cling to the old, one moment 
after it is proved valueless. It is useless, one mo- 
ment, to try and retain that which will not do the 
work so well as something else. He who waits is 
lost. 
You may respect the knowledge of him who stood 
at the head of his profession fifty years ago, or some 
of you may laugh at his ignorance. But if Syden- 
ham were here to-day, if Galen were a member of 
this Society, their position would still be in the front 
rank. They would not be 
“ The first by whom the new are tried; 
Nor yet the last to lay the old aside.” 
We say, as a Society, nothing against proper 
medicinal treatment; we only ask for properly record- 
ed histories and results to prove its propriety. But 
we vrant the whole history, the liberty to ask proper 
questions, and the power of full investigation. If 
we find our results not what we expect as logical 
conclusions from our premises, w7e are not such fools 
as to refuse further examination. If we find that 
we have neglected that which our fathers taught of 
what they thought they knew, we may, it is true, go 
back to venesection. Though I do not believe that 
wrhat we knew as antiphlogistic treatment, will ever 
be revived; yet I can imagine the case in which the 
lancet may be needed, or in which the actual cautery 
may seem to be the only resort. 
The relations of this Society to the public are 
such, “ because health is essentially necessary to the 
happiness of society,” that, as a profession, we are 
bound to investigate the minutest point and to 10 
THE PROPER TREATMENT OF CHILDREN. 
acknowledge the slighest error. There is no reason 
why quackery should exist among us; and by the 
freest examinations, and the most candid acknow- 
ledgment of errors, quackery is the most easily to be 
disposed of. 
In 1849, some of us who were attached to the 
Cholera Hospital in this city, were asked what 
objections we could make to allowing homoeopaths 
to have charge of the hospital with us. We made 
no objection. We simply proposed, that the patients 
should be put in alternate beds for their treatment and 
ours, as they came in; that we should have the right 
to examine each other’s medicines, and see that the 
treatment was what it purported to be. But our 
proposal was rejected, and the hospital remained in 
the hands of those first appointed. Investigation is 
a necessity with us ; and, as before intimated, if 
properly conducted, it can do no harm. 
There is no reason why we should not listen to 
new facts. Indeed, we cannot help listening to 
them. There was a time when the raising of certain 
fruits was a pleasure and a profit to the farmer. On 
riding through the State, to-day, one is somewhat 
struck with the fact that a large number of apple 
orchards have been suffered to go to decay; and, upon 
inquiry, he is informed that the tree is so fearfully 
diseased, that the farmer believes it will cost him 
more than he can receive in return, to take care of 
it. He turns his attention, therefore, to his pigs 
and cows, sheep and horses. If he believed that 
the cost of these animals would not be returned to 
him with interest, it would soon be seen that, like THE PROPER TREATMENT OF CHILDREN. 
11 
apple trees, they would be neglected and suffered to 
die, or even that active warfare upon them would be 
begun, only to end with their extermination. If the 
farmer knew that one-fourth part of his stock must 
die of disease before its first infancy was passed, 
would it not be difficult to persuade him to raise 
stock any more ? If by discussion with other men 
of his own profession, he could find out the causes 
of his loss, he would no longer hesitate, whether the 
result was to be in cider or in colts. And does this 
apply to medical menl Certainly, to all men. And 
no investigation, properly conducted, can do harm. 
You can no more force mankind to take physic, 
unless you can make them think there is reason for 
it, than you can oblige them to burn tallow candles 
or cultivate apples.* And if there be those who 
know that to prolong life you must “ purge freely,” 
so there are those who believe that the world is not 
so well off as it was when the distinction between 
classes was greater; who believe that master and 
serf was a good condition: but you also will find 
that some of them only believe these things, in case 
they were themselves to be masters; or, in the other 
case, if through some one else were to be the chan- 
nel for the Elixir Pro. 
To our Society, in this Commonwealth, belongs 
the investigation of the facts upon all matters of 
health, whether hygienic or therapeutic. 
The abusive name of Allopath has been put upon 
regular practitioners by those who pretend to 
* The writer does not forget that the fears of some people may be so acted 
upon to-day, that they will take whatever is recommended, when sick. He is 
looking forward to the results of medical investigation. 12 
THE PROPER TREATMENT OF CHILDREN. 
believe in what they call Homoeopathy, and some 
of our number have been willing, thoughtlessly, to 
receive it. But every man belongs to the army of 
quacks who allows, for one moment, a system. The 
moment you acknowledge, as a foundation for treat- 
ment, any dogma whatsoever, that moment you are 
among those who profess to cure diseases by Spirit- 
ualism, Homoeopathy, or Thomsonism. That mo- 
ment you are attempting “ to disorganize or destroy 
the Society.” That moment you have commenced a 
warfare against investigation and progress; and 
although your position may be a pecuniary success, 
and although it may not be possible to rid the Society 
of your presence, it would “ be disreputable for any 
Fellow to advise or consult” with you, or in any way 
to abet or assist you as a practitioner of medicine or 
surgery. 
Allow that medicinal treatment should be proved 
useless, which no man among us believes ; would 
there be nothing left for the physician to do 1 
The population of Massachusetts, at the time of 
taking the last census, 1870, was 1,457,351. There 
were bom of living children, in the years 1865 to 
1870, 209,989. There died in the same years, of 
children under three years of age, 47,671; and of 
these 31,326 were less than one year old. There 
were living in 1870, 95,346 children under three 
years of age. That is to say, that in those six 
years, there died of children under three years old, 
only two less than one-lialf of the number living in 
1870 ; and of these more than six-tenths died at the 
age of less than one year. Why tills mortality ? is a 13 
THE PROPER TREATMENT OF CHILDREN. 
subject for us to investigate. And this is but one 
question. And this leads to another, and a third, 
indefinitely. And so does every other question 
which may come up. It was merely selected as one 
subject for illustration. Let us pursue it for one 
moment. Why should there be so large a mortality 
among human beings in infancy, compared with the 
mortality among domestic animals ? There are 
several causes, some of which may be avoided, and 
some of which neither law nor argument can 
overcome. 
The farmer and stock raiser are cautious in select- 
ing the originals from which cows and pigs and sheep 
are to be raised. The bounds of fences and stable 
walls are a safeguard against the propagation of 
diseased animals, which the stock cannot overcome. 
The love which laughs at locksmiths among human 
stock, cannot easily evercome the bolts and bars of 
Eclipse’s residence and the bed-chamber of the fair 
Goldsmith Maid. 
And we never shall and never ought to reach that 
condition of society when parentage shall be estab- 
lished by law, and when certain families shall be 
forced to die out, because a grandmother had phthisis 
or her father was suspected of syphilis. The mar- 
riage of convenience is more likely to be followed 
by mental and physical suffering and moral decay 
than the marriage induced by love. If the children 
of the latter are not born in every respect faultless, 
so far as health is concerned, there certainly may be 
much done to improve their faulty condition. Were 
it possible to prescribe the particular husband and 14 
THE PROPER TREATMENT OF CHILDREN. 
the particular wife, the result, in form of child, 
would be more difficult to determine than now, when 
parties are left to make their own selection. The 
certificates concerning result would be like the cer- 
tificates attached to other quack prescriptions of the 
day; and you would find it difficult to say if directions 
had been implicitly obeyed. 
A word in behalf of children at this point. 
Some years ago, while in attendance upon a 
veterinary surgeon of some note, who has since died, 
I asked him how he found out wdiat was the matter 
with a horse, and how he detected his disease. His 
answer was : “ How do you find out what is the 
matter with a sick baby ? Babies and horses don’t 
lie.” 
And I imagine, if patients, generally, were unable 
by their own foregone conclusions as to their diseases, 
and by questions and answers framed upon these 
conclusions, to deceive their thinking medical 
attendants, involuntary though the deception often 
be, that their sickness would be often less, and the 
time of our attendance shortened. 
Of 9,873 children who died in Massachusetts in 
1870, under the age of five years, 1914 were 
reported as by cholera infantum, 477 by convulsion, 
298 by diarrhoea, 273 by dysentery, 110 by enteritis, 
495 were called infantile, 166 by canker, 2 by 
starvation, 302 by tabes mcsenterica, 308 by teeth- 
ing. Leaving.out the 610 deaths by cause reported 
unknown, and 366 by hydrocephalus, more than 
three-fourths of all reported as from those causes ; 
considering what we know of the causes of convul- THE PROPER TREATMENT OF CHILDREN. 
15 
sion, diarrhoea, dysentery, &c., it cannot be unfair to 
infer, that at least one-half of all these deaths were 
caused or consequent upon diseased digestive organs. 
That is to say, that of the 9,873 deaths of young 
children, more than one-half were from diseased 
digestive organs. It is the misfortune of the human 
species, that they are not endowed from birth with the 
power of distinguishing good from evil in their food. 
You can spoon death into their stomachs from the 
hour of cutting the umbilical cord. There the baby of 
the lower animal has the advantage. He is fed on 
natural food, only, from the beginning, because his 
father and mother don’t know enough to kill him. 
Man, the reasoning being, is defeated by the animals, 
wrho possess instinct only. They never for amuse- 
ment, nor curiosity, experiment upon the stomachs 
and lives of their children, with the desire of seeing 
how much indigestion they will bear with impunity. 
I am not alone in the belief that the excessive mor- 
tality, at an early period of infancy, is, very much 
of it, caused by attempts to substitute for natural 
nourishment that which will save time and trouble 
to the mother, and by attempts to force growth. 
Why do American born females make such poor 
wet nurses compared with the immigrant from 
Ireland or Germany ? After nearly thirty years of 
practice I cannot answer the question. That it is the 
fact, few practitioners in our large towns and cities 
doubt. Allow that some women, with us as with 
foreigners, object to be bound to their children’s 
calls, yet the mass of American females are totally 
unable to act the wet nurse with success. The 16 
THE PROPER TREATMENT OF CHILDREN, 
consequence of the early failure of the supply is the 
early attempt to fit the stomach for other food. Add 
to this the parental pride which interferes for the 
poor pleasure of seeing a toothless child swallow 
the food of an adult, and you have for the result — 
cholera infantum, dysentery, convulsions, tabes 
mesenterica, and if, by reason of extra strength, the 
child passes the first dentition, it is more likely to 
be cut off during the second, or to become later a 
dyspeptic, or even phthisical. 
Dr. Cumming, of Atlanta, Ga., wrote a little 
unpretending but useful tract, some years ago, upon 
the subject of artificial feeding, in which he recog- 
nizes the' fact, that it is an easy thing to raise a 
feeble child if you do not too much strengthen its 
food. Indeed he believes, in view of what he calls 
the degeneracy of the women of this age and 
country, that artificial food, made from the milk of 
another animal, may result “ in uninterrupted health, 
with vigor and energy of the bodily functions.” At 
first examination it seems absurd that nature should 
not be able to produce in the natural fountain, the 
supply of food and the kind of food most likely to 
carry life with its consumption. And it surely 
seems strange, that the parent with reasoning 
powers should be most likely to destroy her child 
with food. We have every reason to believe, if it 
were intended that the new-born should be fed on 
solid material, that they would have been furnished 
with the means to bite or tear. If grain were to 
be their proper diet, the means of grinding it would 
have been furnished. If starch, in any form, was THE PROPER TREATMENT OF CHILDREN. 
17 
to be the best means of furnishing flesh and fat and 
bone to them, their physiological functions would 
have been prepared for the work. Mothers stare 
when told that the artifickil food is too strong. It is 
true that there are cases, in which the preparations 
of Liebig and Ridge and others are borne by the 
child, and there are, doubtless, cases in which they 
seem to thrive better upon them than upon that 
which the mother has provided. But the cases are 
exceptional, and death, in the course of the second 
summer or fall, is more sure to be the result than in 
children for whom food of a more nearly natural 
character is provided. 
We are frequently having healthful looking, fat 
children pointed out to us, as the result of food which 
the doctor has forbidden; children who are said 
never to have had a sick day, although the parents 
were warned that there was cerebral disturbance in 
the coffee cup and death in the bean pot. And 
there are many of us, also, who, after a single score 
of years, can count mothers around us before whom 
we avoid conversation on this subject, least we bring 
up unpleasant memories of the past. 
Examples are frequently brought forward of 
children, who, from the earliest period of life, have 
fed on cow’s milk, almost pure, and have lived and 
done well. For every such case I believe that any 
gentleman, who keeps written records of his cases, 
can show accounts of twenty who have died. The 
stomach of the new*child was not made to digest, 
and cannot digest starch, nor muscle, nor the firm 
casein of the cow or goat. The calf and the kid are 18 
THE PROPER TREATMENT OF CHILDREN. 
older than the human child at the hour when they 
are born. 
And all milk is not the same milk. The earlier 
age at which it is drawn from the breast of goat, or 
cow, or woman, the less casein is to be found in it. 
In case of the woman, the percentage of casein in 
the solid constituents varied from sixteen at the 
beginning, to thirty-one at the close of four months' 
nursing; while the percentage of sugar ran down 
from forty-nine to thirty-six during the same time A 
Even with this enormous increase to nearly double 
the amount of cheese, the woman’s milk does not 
come up to that of the average cow, in the quantity 
of casein produced. And were it the fact that the 
two kinds of milk were exactly equal in the per- 
centage of their constituents, it is an easy experi- 
ment, with a bit of rennet and a wineglassful of 
each for a specimen, to see that though by the 
addition of water they may be made equal in their 
amount of coagulable matter, the character of the 
two masses is absolutely different. The milk of 
woman, with whatever it be curdled, forms its 
coagulum in smaller flakes, soft, and easily broken 
down; that of the cow is in solid masses, like the 
factory cheese, of which it is a specimen. 
Fresh milk, as received by us in cities, in the 
summer, often becomes sour in the course of twenty- 
four hours, even when kept upon ice; and I am 
informed that upon the farm this is sometimes the 
case. The addition of bicarbonate of potash to the 
* Note C. THE PROPER TREATMENT OF CHILDREN. 
19 
milk, as soon as it is received, not only prevents its 
becoming acid, but also prevents tlie formation of 
such firm curd in the stomach, as would otherwise 
be the case. If milk, to which this salt has been 
added, be rejected by early vomiting, as is generally 
the case with a very young child, whose stomach is 
over distended, the curd will be found to resemble 
the softer curd formed from human milk.* 
I am not chemist enough to detail the differences 
in organic masses bearing the same name, but any 
gentleman will find an interest in repeating the 
experiment himself. Addition of water to the milk of 
the cowr does not alone sufficiently humanize it. The 
addition of cane sugar as a substitute for milk sugar, 
which human milk contains more largely than cow’s 
milk, does not add much to the digestibility of the 
latter. That the child generally does better with 
pure crystallized cane sugar, than without any sugar 
added to its artificial food, there is no doubt: but it 
is not a perfect substitute for sugar of milk, often 
becoming vinegar in the stomach, and aggravating 
the sorrows of the infant dyspeptic. On the other 
hand, the sugar of milk is more likely to be properly 
digested, and, should lactic acid be the result, it is 
less likely to disagree, j* 
All cows are not alike. The boasted “ one cow’s 
milk ” does not help the matter. In examining the 
article of Prof. Simon upon the subject, one finds 
that in several analyses of cow’s milk, the solid con- 
* The amount of bicarbonate of potash should be about one-half grain to 
each fluid ounce of milk, 
t Note D. 20 
THE FROFER TREATMENT OF CHILDREN. 
stituents varied from one hundred and thirty-nine to 
one hundred and forty-three parts in a thousand. 
The largest amount of casein in the solid ingredients 
was fifty and three tenths per cent., and the smallest 
was forty-eight per cent. And what do liis reports 
show to be the difference between this and human 
milk ? In numerous specimens of human milk, the 
maximum of solid constituents was one hundred and 
thirty-eight and six-tenths parts in a thousand, the 
minimum was eighty-six parts only. Of these solid 
constituents the amount of casein was thirty-two and 
six-tenths per cent., the other twenty-two and seven- 
tenths only. 
The children in this family have more power to 
digest their food than the children in that family. 
The power of digestion varies like the power .of 
assimilation, or of hearing, or of thought. There 
is as much variation in mammary glands as in 
stomachs ; and the well developed breast and the 
fertile ovary may not exist in one and the same body. 
The woman who lias numerous children may be un- 
fit to nurse one; the woman who has had and can 
have but one child, I have known to nurse five in 
succession. It is hard to forbid a mother to nurse 
her own child, but nursing may be suicide to her— 
it may be homicide to the child. In several families 
in which the attempt has been made by mothers to 
nurse, the children have grown rapidly and appa- 
rently in perfect health up to a particular age, when 
death from convulsion during dentition has followed. 
Later children, fed by hired nurse or upon cow’s 
milk, have grown less rapidly, but have passed years THE PROPER TREATMENT OF CHILDREN 
21 
beyond the age of the brothers and sisters, and are 
still living beyond the age of puberty. The woman 
who has no milk is anxious to find one who has milk 
but no child. Another woman, under similar circum- 
stances, is jealous of the nurse, and anxious, as early 
as possible, to change the food. 
Single cases may be brought forward in abundance 
to prove anything; and 1 wish to call attention to 
the absurdity of binding ourselves by any one set of 
observations. 
Mrs. A. was unable to nurse her child, and a wet 
nurse was obtained for it, upon whose milk it throve 
well. Mrs. B. was unable to nurse her child. It 
was put upon cow’s milk, and that child did equally 
well. Both were well cared for in every way. 
Mrs. C. was unable to nurse her child, and it was fed 
upon pap and early upon meat and vegetables, and 
that apparently did as well as the other two. Mrs. 
I).’s died on the breast; Mrs. E.’s child, on the bottle ; 
Mrs. F.’s child, on the mixed diet; and all of these 
Avere equally neglected in every other way. This is 
a fair pattern of the evidence usually brought for- 
ward to prove some point in medical and medicinal 
treatment. 
Notwithstanding the interesting paper by Dr. 
Putnam last year, and Avhich, I trust, he will follow 
up by other experiments, I put aside altogether the 
question of Aregetable food for the new born child, 
believing that the nearer to the human mammary 
secretion the food can be made, the better. 
It is indeed sometimes difficult to advise Avhether 
the nourishment shall come from the woman or the 22 
THE EROFER TREATMENT OF CHILDREN. 
cow. On the whole, after considering all the points 
that occur to me, and including among them, that 
in my own field of observation the question is be- 
tween the milk of woman and milkman's milk, I 
have of late been inclined to feel that if the mother 
herself cannot nurse, the chances of life are better 
with the milk of the cow than with the milk and 
neglect and deceit of the ordinary wet nurse. Its 
being with us a mixture of milks is not of so much 
consequence as the quality of the mixture.* But 
the cow keeps good hours. She is not overworked 
bodily, nor are her mental trials sufficient, after the 
calf has been fairly removed, to trouble any of her 
secretions. She has a comfortable home, and her 
owner’s profit demands that she shall be well cared 
for. It is true, on the other hand, that farmers, like 
other people, have their peculiar notions about the 
treatment of stock ; and it is equally true that they 
will allow nothing to be done which they suspect to 
be injurious to the animal; while the human nurse 
will sometimes bolt the most indigestible of food, 
with the confidence that Mrs. Winslow’s Syrup, or 
some other morphia preparation, will stop the child’s 
belly-ache and give her a night’s rest. 
Still the nurse may be kept on too strict a diet. It 
occasionally makes one smile to find that the child 
has been fed with arrow-root or oatmeal to-day, 
because the nurse imprudently ate a piece of boiled 
beet or cabbage yesterday, and that the consequence 
was a restless night; or that cow’s milk was adopt- 
* Note E. THE PROPER TREATMENT OF CHILDREN. 
ed for the day, “ because vegetables were taken by 
the nurse, and they always injure the milk.” The 
fact is, that carnivorous animals need flesh to make 
their milk. You will find no sugar in the milk of the 
bitch, and it is of no use to feed her as if it were 
needed, Ilomulus and his brother to the contrary, 
notwithstanding.* The graminivorous nurse needs 
food fitted for her teeth, and upon any other, neither 
she nor the offspring will do so well. 
For the human nurse, a mixed diet is that pointed 
out by reason and experience; and it is no more fair 
to attribute the baby’s green discharge to the use of 
a digestible vegetable, leaving out of sight the mix- 
ture of ice cream, oysters, fruit cake and lobster 
salad, after the sweating of last night’s polka, than 
it would be to conceal the fact that your cow was 
stoned and beaten about the field yesterday, and fed 
on hot slops at night, if she and the calf are both 
sick to-day. 
Beef and potatoes will make good milk, but an 
alternation of these with mutton or fish,f with 
squash or other vegetables and fruits, will keep the 
patient in better health, and better milk will be the 
result. 
There is every reason for new experiment upon 
the feeding both of nurses and children. We 
take too much of -the statements of the past upon 
trust. Ale and porter, it is said by some, are good 
articles to give to the nurse. Others will tell you 
* Note F. 
t There is a common but erroneous idea prevalent among women, that fish 
is an article of food fatal in its effect upon recent nurses. THE PROPER TREATMENT OF CHILDREN. 
as surely, that they will eventually dry up the breast. 
And many farmers tell you that apples will dry up 
the milk of the cow. An article in the Hartford 
Courant, of this last season, gives an interesting 
series of experiments by Mr. Erastus Ellsworth, of 
East Windsor, Conn., upon this point A It surely 
contains statements which are worth investigating ; 
and it is by no means uncertain that a similar set of 
experiments may not show that the human nurse 
may sometimes benefit by the same treatment with 
fruit. The writer says : “ The popular notion that 
apples lessen the flow of milk, seemed to have no 
support except from the occasional breaking of 
bounds by cattle pent from the orchard. A glut of 
apples, from piles gathered for the cider-mill, may 
be as dangerous to an animal as a glut of grain or 
green clover, and no more so. Accordingly, a trial 
of the abundance of windfalls, principally Greenings 
and Baldwins, was commenced about August 1. In 
the manifold stomachs of a cow, these hard, sour 
apples, when bruised and ground, become sweet and 
soft quite as readily as in the vat of a cider-mill. A 
large cow, something along in years, feeding exclu- 
sively in her summer pasture and producing four 
wine quarts daily, was for the first experiment, 
beginning with four quarts of apples night and 
morning. The quantity was increased, until at the 
end of a week she was eating a bushel of the hard- 
est, sourest windfall apples each day. This cow was 
near her time of going dry, but such was the effect 
* A letter from Mr. Ellsworth to myself, a por tion of which is at the close of 
this paper, confirms the statement. See Note G. THE PROPER TREATMENT OF CHILDREN. 
25 
of the apples as to bring her produce of milk from 
four to rather more than six quarts per diem. 
“Another cow, in fresher milk, yielding eight 
quarts daily, was then put upon a ration of apples. 
At this time of measurement, Mr. Ellsworth’s cows 
had been running several days in rowen feed, which 
would naturally help to flush the milk-pail. Yet 
upon top of this succulent pasture the second cow 
was brought, when upon her full ration of apples — 
a half bushel, night and morning — to a regular 
daily yield of twelve to fourteen quarts of milk. * * * 
There arose a cry from the dairy, directly, for more 
milk-pans, and as the average increase upon the five 
cows was fully fifty per cent., and a notorious matter 
in the household, the warnings of ruin to Mr. 
Ellsworth’s dairy from kind-hearted neighbors 
soon ceased. The butter made from this milk was 
first-rate, as I had an opportunity of knowing. I 
inquired particularly whether at any time there had 
been the least symptom of ill effect upon the cow — 
upon the bowels or kidneys. ‘ Nothing of the sort, 
sir.’ * # * He told me kg was eighty-three years 
old—coming gloriously to the fore with these timely, 
painstaking and exact experiments, while young 
farmers, routine farmers, close farmers, men who 
wouldn’t waste a cent’s worth if they knew it, are 
actually gathering apples from their fall seeding 
grounds, and dumping them into holes in the street, 
rather than risk giving them to their cattle.” 
Undoubtedly every one has seen the milk of some 
nurse disturbed by the food which another could 
take with advantage. This surely is not remarkable, 26 
THE PROPER TREATMENT OF CHILDREN. 
when we remember that one of ns is distressed by 
eating beef fat, while he can swallow mutton fat 
without stint; that one can eat oysters, but has 
cholera morbus after clams; that cocoanut causes 
no distress to this patient, while strawberries produce 
erythema in that one; and even the smell of the 
lobster wheelbarrow is followed by asthma and 
urticaria in the very patient who can make a supper 
of olives and cheese with ice cream and coffee, pass 
a quiet night and wake in the morning with an 
appetite for breakfast. 
People are equally prejudiced upon the subject of 
one cow’s milk. But it is as necessary to know about 
the cow as about any other of your domestics. It 
is not needful that one cow should furnish the whole 
supply, and those gentlemen who praise the con- 
densed milk as a substitute for it, without any 
reservation, do not seem to understand that each can 
has in it the remnants of milk from fifty cows, and 
perhaps from fifty different cows in each new can. 
The fact that the milk is from a new milch cow 
proves nothing in its favor. There is as much 
difference in recent nurses as in old ones. The 
questions are : Is the milk good ? Does this milk 
contain all that is needed for this child] Does it 
contain anything injurious to this child which can be 
got rid of ? The special advantage to be obtained 
from milk from the new milch cow consists in its 
being less caseous than human milk, and in its 
bearing the same relation to the milk of later date, 
that the human colostrum does. 
I. A writer in the American Agriculturist, in THE PROPER TREATMENT OF CHILDREN. 
27 
October, 1870 (and his remarks will apply to human 
nurses also), says: “We may divide cows into two 
extreme classes with regard to the quality of the 
milk. One class gives milk; the other, milk and 
water: while if we have reference to the quantity 
of milk given, we find almost as great a difference 
in the one class as the other. The milk of those 
which give enormous quantities, say twenty-five to 
thirty quarts a day, is rarely very rich; ten to 
twelve per cent, of cream being almost as much as 
we have ever known the milk of such cows to yield. 
In some cases it is extremely poor, yielding four per 
cent, or even less. It is not only among the enor- 
mous milkers that we find the milk-and-water class 
of cows: there are thousands in the country, valued 
by their owners as excellent milkers, which really 
yield only milk and water, and very thin at that. 
The milk is mixed with that of others at the time of 
straining, and the good wife never dreams that some 
poor, thin, bony, hungry cow that gives only eight 
quarts of milk at her best, is producing a pound and 
a half to two pounds of butter a day, while the 
favorite of the herd, a whole or three-quarters Dur- 
ham, that gives twelve quarts at a milking, does not 
add four pounds of butter a week to the family 
stores: yet it is true in many cases.” 
Now, for the human child, it is not needful that 
the milk should be the richest in butter. That is 
the most variable of all the constituents in human 
milk, even in milk upon which children are doing 
the best.* Possibly that which would be the poorest 
* Note H. 28 
THE PROPER TREATMENT OF CHILDREN. 
for the dairy, might be the best for the child. 
Experiment alone can answer that question, and 
decide what good milk is. 
“However much,” says Simon, “the nutriment 
of the mother may vary, no great influence is thereby 
exerted on the relative quantities of casein and sugar. 
The changes consist in a greater or less degree of 
saturation, in the rich yellowish white or the blueish 
color, in the quantity of the milk and in the amount 
of solid constituents ; with the exception of the 
variation in quantity, all the other changes are 
dependent on an increase or diminution of the 
butter; the former occurs under the use of a copious 
and nutritious diet, the latter when the food is poor 
and scanty.” 
He says that he analyzed the milk of a very poor 
woman fifteen times, at regular intervals during half 
a year, beginning on the second day after delivery. 
She was suddenly deprived of the means of obtaining 
the ordinary necessaries of life. At this time her 
food was sufficiently abundant (Nov. 11), but con- 
taining only eight and six-tenths per cent, of solid 
material. On the 18th of November she was placed 
on full and nutritious meat diet. The milk conse- 
quently ran from the breast copiously, and left 
eleven and nine-tenths per cent, of solid constituents. 
She again became destitute, and while in this condi- 
tion, Dec. 1, the milk again became very thin, and 
left only nine and eight-tenths of solid constituents. 
On January 4, after she had been supplied for two 
days with a nutritious meat diet, the milk was very THE PROPER TREATMENT OF CHILDREN. 
29 
rich in solids, which amounted to twelve and six- 
tenths per cent.* 
II. Cow’s milk does not contain all that is neces- 
sary for the human child. The proportion of sugar, 
not cane, but milk sugar, is much less than it should 
be; and although the cane sugar may be to a certain 
extent a substitute, it is no more a proper substitute 
than lard would be for butter, provided indeed the 
substitution could be made. Many may endure it 
and be better than without any sugar; but it will 
not be perfect in its effect. If it becomes acid it is 
not lactic acid but vinegar that is formed ; and where 
the one may do service, the other will surely do 
harm.j' 
III. Does it contain anything injurious to the 
child? The statements before made, concerning the 
hard, caseous masses, is answer sufficient. If the 
child’s stomach has not been tampered with by 
drugs, or by attempts to force diet more nutritious 
than is required, it will digest cow’s milk, properly 
prepared. And the physician who means success 
must bear in mind that he is to take the whole 
responsibility of the case, even if it obliges him to 
be cook as well. Conscious that change for the 
better cannot always be immediate, he must be 
prepared to meet doubts and answer questions. The 
result, if he is fair and open in his course, will show 
that he is right. The discharges of the child must 
all be seen. He must be able to distinguish colors, 
and must know that large stains of uric acid are not 
blood. 
* Note I. 
t Note K. 30 
THE PROPER TREATMENT OF CHILDREN. 
The first experiment to try, is the removing a 
portion of the casein, by allowing the milk to settle, 
and watering the top. This gives us more butter 
and less casein at the top. This is to be watered 
and sweetened for use. With many, even new-born 
children, this diet will answer. With many other 
children, pain follows this food also, and the dis- 
charges are still undigested curd. Just so long as 
undigested food passes from the bowels of adult or 
child, that particular article should be diminished in 
quantity or rejected altogether, or possibly you may 
diminish the amount at one feeding and repeat the 
feeding oftener.* Milk which passes from the 
rectum in form of curd, is, of course, of no use. 
The curd is just so much food wasted or thrown 
away. You may think the milk too absurdly diluted, 
but it is still the fact, that what passes in form of curd 
is of no use. If your child continues to grow in 
weight, however slowly, and seems well in every 
way, what harm in feeding it on milk and water, 
one part in a hundred even, more especially if 
sickness, indigestion and pain follow the change of 
proportion to one in fifty. 
A great quantity of urine, perhaps, is passed by 
children fed on milk largely diluted, with great 
inconvenience to the mother. The inconvenience to 
the child, however, is less than pain would be. 
But you may reduce the proportion of milk in 
some cases to only a tenth of the mixture, and still 
* This proposition, recently re-published by Dr. Brown-Sequard, and by many 
supposed to be his original proposition, has been practised many years by 
physicians in this vicinity. THE PROPER TREATMENT OF CHILDREN. 
31 
undigested casein and pain are the immediate conse- 
quence; diarrhoea and waste, with mesenteric disease 
or fatal convulsion, the ultimate result. Drugs in 
such patients are useless. Calomel may blacken the 
discharges, rhubarb may turn them to an orange 
color; but these will not cure indigestion. Opium 
may relieve pain, but it will not increase the natural 
power of the child’s stomach. In getting rid of the 
casein, you may do all that is needed; but remember 
that in getting rid of that you have done more. You 
have thrown away also, in like proportion, the 
butter, the natural sugar and the salts.* You may 
not only have removed an enemy, but with him some 
of the friends. Before allowing matters to proceed 
to that extremity, it would be well to use rennet, or 
one of its preparations, and remove a large propor- 
tion of the casein with as small an amount of the 
other constituents as possible. 
Remembering, however, the feeble condition of 
your patient, continue to add water to the whey you 
have made, until the discharges contain no more 
undigested cheese. 
Gentlemen will be surprised to find how much 
caseous matter will continue to pass the bowels, 
after they are positive that all has been removed 
from the ingesta. I have known the whey reduced 
by adding seven and eight parts of water to one, 
before the digestion became relieved, and the child 
could take food without suffering. 
But how long is the child to go on in this manner? 
Just so long asvhe fails to digest his food prepared 
* Note L. 32 
THE PROPER TREATMENT OF CHILDREN. 
in any other way. Each case must be judged by 
itself. The strength of food should be slowly 
increased, and when pain or curd follows its increase, 
dilute again, and wait a little longer.* 
And this leads to another point. As the child 
grows older, it is true that it needs older food. But 
when should the change be made? Not while it is 
doing perfectly well. Not when the irritation of a 
new tooth is going on. It should be when the system 
is undisturbed. If the change be made while the 
growth is progressive, it is well to be cautious not 
to force the change too rapidly. Under such cir- 
cumstances we often find food pass undigested, 
diarrhoea and vomiting Supervene, and it is often 
impossible to return successfully to the original diet, 
Remembering the great disturbance of the system 
at every change of habit and of life, bear also in 
mind that an increase of food and a reduction in the 
length of dress should not come together. The 
impending irruption of a tooth is sufficient reason for 
delay. Teething is not a disease, but whether it be 
at six months or at six or eighteen years, the coming 
of a tooth has placed your charge’s system in such 
condition that he wavers between health and disease, 
and possibly a very slight change in diet may settle 
the question of life or death. So long as the fonta- 
nelle is not depressed, unless hydrocephalus exist, 
the child is not starving. So long as, from week to 
week, there is no loss of weight, the child is not 
starving. So long as it is not starving, with watch- 
* Note M. THE PROPER TREATMENT OF CHILDREN. 
33 
fulness you can be a little longer in carrying on the 
experiment. But suppose it be starving, and is, at 
the same moment, passing its food undigested, and 
wearing itself out with fretfulness and pain, what is 
to be gained by the addition of more food, which 
cannot be assimilated, and which is only going to 
increase the suffering] The want of sufficient and 
proper clothing, more especially in a cold climate, 
or in an excessively changeable climate, as that of 
Massachusetts is, even in the summer season, helps 
to explain the large number of deaths among chil- 
dren. This is true, whether the last cause of death 
be in the brain, the thorax, or digestive canal. The 
more likely seat of trouble is in the latter. The 
summer is looked upon by mothers as the more 
dangerous for children before completion of the first 
dentition; but, except in filthy localities, they will 
find that there are no more deaths among them from 
abdominal troubles in summer, than from thoracic 
diseases in the winter. There is, however, a mixed 
season of heat and cold, the period of hot days and 
chilly nights, in September and October, when, in 
the first few hours in the morning, more clothing is 
needed than at midday, when diarrhoea, dysentery 
and cholera infantum make their severest ravages. 
It is at this season of the year when the children 
between one and three years old, who have not 
completed their dentition, become the victims of too 
early weaning. There is a very common opinion 
that children run great risks if weaned in the 
months of May, June, or July. Other things being 
equal, the older a child in good health is, at the time 34 
THE PROPER TREATMENT OF CHILDREN. 
of weaning, the better is its chance for life. Under 
no circumstances should a change from the breast to 
stronger diet be made while a tooth is pressing upon 
the gum. 
Whether the pregnancy of the mother nurse 
requires that the child should be taken from the 
breast, is a question which generally is settled with- 
out calling upon the doctor. If the milk does not 
become suppressed, which is sometimes the case, it 
is more likely that the unborn child rather than the 
nursling will suffer. I have known four children in 
succession to be nursed by the mother without 
knowing when her pregnancy was to close, and 
have seen a contest between the child of five years 
with the child of two for a chance at the same nipple. 
If they have been removed from the breast prema- 
turely, you cannot teach them to nurse, nor if they 
have been taught to eat food fit only for adults, can 
you by any drugging make their stomachs recover 
the tone which the ignorance of the parents has 
allowed to be destroyed. The little white, sugary 
powder of calomel, left by the one who pretends to 
believe in homoeopathy, under the name of arsenicum; 
the more honest, but equally dangerous dark powder 
of hydrargyrum cum ereta; the nearly tasteless white 
powder of sugar with a little morphia, under the 
name of bryonia or nux; or the unmistakeable chalk 
mixture of the pharmacopoeia, are all drugs. But 
the best medicine is an extra yard or two of flannel 
applied externally ; an additional foot of clothing at 
the bottom of the dress, and a few inches more at the 
top, are better than rhubarb or opium. The case is THE PROPER TREATMENT OF CHILDREN. 
35 
rare in which anything bnt rest will check the 
vomiting in the choleraic class of cases, and the 
strong craving for simple cold water, if indulged to 
the fullest possible extent, will often relieve the 
suffering, which is sure to be increased by the sips 
and spoonfuls which only aggravate. 
Fashion, at this moment, has begun to indulge 
the new-born child in a sufficient amount of clothing, 
and, for a few years, it will not probably be neces- 
sary to preach in favor of the high-necked and 
long-sleeved dress. But when fashion changes, and 
the open neck and exposed breast are again in 
vogue, it will be the easiest matter in the world for 
the majority of young mothers to convince them- 
selves that children can be toughened to endure the 
cold, and that health and long life will probably be 
produced by exposure. 
Still the teachings of medical thermometry may 
avail somewhat, and it may be possible to convince 
the world that, although children produce heat 
rapidly, they also part with it rapidly; just as the 
stove which is wrell protected in the house will, with 
the same amount of fuel, keep warm longer than 
one which is exposed out of doors. 
Cleanliness is next to Godliness. But some very 
good and healthy people are very dirty; and making 
clean the outside of the dish does not argue, with 
any certainty, the good condition of what is within. 
But apparent cleanliness may be urged too far. So 
long as the new-born child is blue from want of 
properly inflated lungs, and the consequent want of 
proper action of the heart, it is certainly possible 36 
THE PROPER TREATMENT OF CHILDREN. 
that it may be supplied with too much external heat.* 
Heat and suffocation more surely go hand in hand 
than dyspnoea with a cold skin. The cold may 
produce a cry and an inflation of lung, that nothing 
else will. The respiration once established, the skin 
once reddened and the extremities once warmed, the 
return of lividity is much to be deprecated ; although 
if the child be strong and hearty, he may fight 
through all exposure and come off conqueror. 
Children may be washed too much. The feeble, 
chilly child is often a sacrifice upon the altar of 
Hygeia. Dirt is, to some extent, a conventional 
matter. What its character is to he considered, 
depends very much upon the position of an article. 
The odor of the rose would add nothing pleasant to 
the flavor of roasted beef, nor would tobacco smoke 
to the cologne bottle. Soap is no fit dressing for 
bread, nor the sweetest of oils for a cambric pocket 
handkerchief. But a child may be as clean with the 
application of oil as of soap. Indeed, the one who 
has tried to remove the vernix caseosa with soap 
and water alone, knows that it cannot be done at 
one washing. The previous use of oil upon the 
skin is almost a necessity. The use of oil alone, at 
a first dressing, is not a dirty practice. The child 
may be made cleaner by it than with soap and water 
alone, and if its circulation is at all imperfect after 
the first washing, it will be more comfortable to be 
washed with oil alone than with any combination. 
But it is after the first cleansing that an oil, not 
* See W. F. Edwards on the Influence of Physical Agents upon Life. THE PROPER TREATMENT OF CHILDREN. 
become rancid, is often a useful application, and 
therefore not a dirty one. The oil, externally, pro- 
motes heat within. There are many adults to whom 
I could point, who never knew what it was to sleep 
with warm feet, even with stockings upon them, 
until they were advised greasing the legs and feet at 
bedtime. No one would suppose, from any appear- 
ance of oiliness, that that had been used for the 
child in place of water. If it be needed, the skin 
takes up a very large proportion of it, and there is 
no more reason why the child’s clothing should be 
soiled by the remainder, than for its being soiled 
with water upon the skin after an ordinary wash. 
The towel, in either case, should do its portion of 
the work. Many a feeble child has taken up oil 
enough by the skin to keep it alive for weeks, as 
many a phthisical patient has been oiled with the 
result of less cough, more quiet sleep, and an actual 
gain of weight. If any article, used externally 
upon the child, makes it more likely to take cold, as 
it is called, or do it an injury, it is the wasteful use 
of brandy or rum, which dissolves the oil from the 
skin, and drying it, throws extra work upon the 
lungs and heart. 
One more combination of the enemies standing 
more especially in the way of infantile life, is the 
drug bottle and the popular treatise. The shrewd 
trickster, who calls himself homoeopath, has the 
advantage of us here. The little sugar pills, to be 
dissolved in so much water and given by the tea- 
spoonful, the mother will tell you are excellent for 
children. Before she used those, it was necessary 38 
THE RRORER TREATMENT OF CHILDREN. 
to send for the doctor in the night; but now, with a 
minute fraction of the pill, the child goes to sleep 
much better than when she gave it paregoric; and 
it wakes up well in the morning. But why not 
learn from quacks 1 A placebo is a medicine as 
much as hysteria is a disease. You can kill a man 
equally, whether you scare him to death with the 
warm water which he thinks is blood running over 
his skin, or blow him from a cannon’s mouth. The 
one makes less noise, perhaps, than the other. 
Those of us who realize that we are fighting under 
the banner upon which the motto is iinatura dace,” 
and wrho are growing more numerous each year, are 
perfectly willing to use the placebo, where placebo 
is the proper medicine. But we are not willing to 
enrol ourselves in that contemptible army of knaves, 
who, from fear of not getting patients enough, can 
say to the mother: “ I practise in either way ” ; and 
who whispers to himself, “ you pays your money 
and you has your choice.” If he need drugging, do 
the work, but do it honorably and openly. Let the 
patient alone who does not need treatment. 
There is a penny wise and pound foolish way, in 
many families, of consulting popular treatises on 
medicinal treatment; and the more the mother 
reads, the more doubtful she grows, the more 
miserable the infant becomes, the more frequently 
the treatment is changed, the more the necessity 
arises of sending for the doctor. Oh! the misery, 
when sick, of knowing anything of ourselves ; the 
misfortune of ever having heard of ulcerated Peyer’s 
patches, of having the knowledge that one has a THE PROPER TREATMENT OF CHILDREN. 
39 
lung, a stomach, a pancreas, a pineal gland; the 
suffering from the recollection of how little chloral 
hydrate killed one man, and the memory of Christi- 
son’s statement of the very small dose of opium that 
was fatal in a particular case! And is it strange 
that, since Buchan is out of date, and the more 
modern treatise is to be frequently found on the 
sitting-room table, bearing a surname which so 
many of us early learned to respect, and which is 
supposed by many of the public to be his work; is 
it strange, in the confused and pictorially illustrated 
medley of no less than three systems of medicinal 
treatment, that the poor and ignorant mother, who 
wishes to save expense, hurries her nursing child 
into its coffin? 
The day may be approaching when popular 
treatises upon medicine and physiology will be of 
occasional value; but I doubt whether they will 
ever be of any more service to the world than 
popular treatises upon watch-making or the building 
of locomotives. It may be that some ignorant 
neighbor’s prescription may be lived through, and 
some tough child may escape the normal conse- 
quences of a cold bath administered according to 
popular rules. 
The case is by no means unknown, in which a 
shot through the head did not destroy the intellect; 
and a bullet through the chest has been followed 
only by a bloody expectoration. The evidence in 
favor of popular treatises upon medicine, is equally 
strong with that upon the harmlessness of bullets. 
And the evidence amounts to this, they do not 
always kill. NOTES. 
Note A. — Page 3. 
The number of charter members of the Society was 
thirty-one. Twenty of these were graduates of Harvard 
University, but I can only find that ten of them ever 
received either the degree of Bachelor or Doctor of 
Medicine. The earliest graduate of the college was John 
Sprague, of the class of 1730 ; who, fifty-one years later, was 
sufficiently interested in the objects of the Society to petition 
for its charter. For many years after the organization was 
completed, the names of officers and members are recorded 
as M.D., M.B., A.M., Hon., Esq., or plain Dr. There are 
very few of the first two, till after the year 1800. 
It may be interesting, as a simple matter of history, to 
point to some of the early and honorable names: 
Edward Augustus Holyoke, our first president in 1781, 
was not M.D. till 1783. 
The first secretary, Dr. Nathaniel Walker Appleton, 
never was M.D. 
Samuel Danforth, an original member, and president in 
1795, became M.D. nine years after joining. 
Joshua Fisher, president; was not M.D. till 1804, several 
years later. 
William Kneeland, president in 1784, never had the 
degree. 
Isaac Rand, an original member, president in 1797’ at 
which time he was Master of Arts only, received the degree 
of M.D. two years later. 
Cotton Tufts, an original member, graduate of the 
college in 1749, was not M.D. till 1785, and became president 
in 1787. 42 
THE PROPER TREATMENT OF CHILDREN. 
John Warren, an original member, and instrumental in 
founding the medical department of the University, received 
his M.D. in 1786, and became president in 1804. 
John Brooks, who was a Colonel in the army of the 
revolution, Governor of the Commonwealth and President of 
this Society, received the honorary degree of M.D. as late as 
1810, and twenty-three years after being made a Master of 
Arts. 
William Eustis, who was a General in the army, and 
afterwards Secretary-of-War and Governor of the Common- 
wealth, never received the degree, although a member of this 
Society. 
It is not, at this day, a requisite that one shall be M.D., to 
enable him to obtain admission, but that he shall be 
sufficiently well fitted in certain branches to enable him to 
pass a satisfactory examination. 
Note B. — Page 8. 
“The curious fact has occurred that maize, or Indian corn, 
was raised so plentifully in some of the western States the 
last year, and commanded so low a price, that it was largely 
used as fuel; it having been found that a ton of corn is equal 
to a cord of wood for heating purposes, and did not cost so 
much by three dollars.—A?n. Hist. Record, April, 1873, 
p. 188. 
Note C.— Page 18. 
Having spoken of the use of cow’s milk as a substitute for 
that of the human female, and, indeed, as often preferable to 
that of the hired nurse, I do not forget the great adulteration 
to which it is often subjected in our larger cities. Neither 
do I forget that, in such places, much of it comes scores of 
miles, and is sometimes several days old before it reaches its 
destination. Indeed, no milk delivered from out of town, at 
a moderately early hour, can come from the cow on the day 
of delivery. While one person is in town, distributing milk, 
another is engaged out of town, collecting the milk for 
to-morrow’s supply. He gets a gallon here and there, or five 
or ten gallons at another place, until his rounds are made. 
This milk is put in large cans in a cool place until night, 
when a portion is poured off for cream, and the rest is 
brought up as nearly as possible to the standard by the addi- 
tion of salt, coloring matters, &c. The report of Dr. Arthur 
II. Nichols and Prof. F. Babcock, in the last Report of the NOTES 
43 
State Board of Health, contains some interesting information 
upon the subject of the adulterations. It is more than 
probable that no absolutely pure milk is brought to the city 
of Boston. From my own observations, I do not believe 
that the milk supplied by the so-called Milk Consumers’ 
Association is so good as that supplied by many milkmen. 
The reason for this is, perhaps, to be found in the union with 
the Association of those who were interested in making it 
unpopular. 
With all these facts prominently before me, living in this 
city, I should prefer cow’s milk for children to arrowroot, 
Liebig’s food, Ridge’s food, groats, or any vegetable food, 
and to the milk of most wet nurses. 
Note D. — Page 19. 
The following statement I received from Prof. E. S. Wood, 
M.D., of Harvard University :— 
“The first action of the stomach upon all kinds of sugar is 
the same, viz. : the conversion into glucose or grape sugar, 
which conversion is, however, due to the action of the saliva, 
or pancreatic fluid in the intestine. Sugar of milk as such is 
never found in the system except in the milk contained in the 
lacteal glands, the cells of which, therefore, have the property 
of reconverting glucose to milk sugar. 
Cane sugar never becomes converted into milk sugar by 
the action of the stomach, but into glucose. Milk sugar when 
pure is not susceptible of fermentation, but when in contact 
with casein, as in milk, it undergoes fermentation and lactic 
acid is formed, and small amounts of butyric acid, also, if 
the fermentation proceed far enough. This change may take 
place in the alimentary canal if digestion be impeded, so that 
the casein and milk sugar remain in contact sufficiently long 
for fermentation to take place. Cane sugar will also undergo 
this same variety of fermentation if its solution be added to 
casein or old cheese. In lactic fermentation, no alcohol is 
produced. 
Milk sugar has no effect upon the process of digestion, 
unless that process be an impaired one, in which case the acid 
produced, as well as the other products of the decomposition 
which would be formed, might irritate a little and create still 
more disturbance of digestion, in the same manner as undi- 
gested food always does.” 44 
THE PROPER TREATMENT OF CHILDREN. 
Note E. —Page 22. 
The County of Suffolk is to a larger extent supplied with 
milkman’s milk than any other county in the Commonwealth. 
As no milk is raised within its borders, it is probable that 
none, absolutely free from additions, is supplied to consumers. 
Under such circumstances we should naturally suppose that 
more of its children fall victims to cholera infantum. It is 
the fact, however, that Suffolk County stands in the fifth place 
on the list for the year 1870. The whole number of deaths of 
children of two years and under, for the year 1870, was 8,151 ; 
of which 1,914 were by cholera infantum, or 0.234 per cent. 
Suffolk County, as may be seen, stood a trifle below the 
average. 
The order of fatality, by counties, was as follows :— 
Middlesex, 
Deaths at 
two years old and less. 
1,606 
Per cent. 
by Cholera Infantum 
0.286 
Hampshire, 
. 181 . 
. 0.265 
Worcester, 
1,056 
0.254 
Essex, 
, 978 . 
. . 0.234 
Suffolk, 
2,310 
0.230 
Norfolk, 
. 366 . 
. 0.218 
Hampden, 
437 
0.215 
Franklin, 
114 . 
. 0.201 
Plymouth, 
218 
0.183 
Bristol, 
. 526 . 
. 0.161 
Barnstable, 
81 
0.160 
Berkshire, 
. 264 . 
. 0.151 
Dukes and Nantucket, 
14 
0.071 
Note F.— Page 23. 
The milk was drawn from one of the teats which was not 
used by the pup ; it was very thick (whereas from the teats 
which the pup was in the habit of sucking, it was very thin), 
had a disagreeable animal odor, and a rather saltish, mawk- 
ish, but not sweet taste. A period of ten days elapsed 
between the two analyses. 
1st. 
2nd. 
Water, ..... 
. 657.4 
682.0 
Solid constituents, . . . . 
342.6 
318.0 
Butter, ..... 
. 162.0 
133.0 
Casein, . ... . 
174.0 
146.0 
Extractive matter and traces of sugar, . 
29.0 
30.0 
Fixed salts, ..... 
15.0 
14.8 
Simon (Sydenham Soc. Edit., vol. ii. p. 66). NOTES 
It is worth while to compare the enormous amount of 
casein and butter in these two cases, and also the amount of 
sugar with that in the milk of the woman and cow. Taking 
Simon’s analyses of the milk of the three species, they stand, 
in a thousand parts, as follows: 
WOMAN. 
cow. 
BITCH. 
Butter 
54.0 
8.0 
40.0 
38.0 
162.0 
133.0 
Casein 
45.2 
19.6 
72.0 
68.0 
174.0 
146.0 
Sugar 
62.4 
39.2 
28.0 
29.0 
Traces o 
f Sugar. 
The milk of other animals was also examined by Simon 
[vide Sydenham Soc. Edit., p. 61 et seq.], and in a thousand 
parts we find that they contain : 
ASS. 
GOAT. 
EWE. 
Butter 
12.10 
12.9 
1.1 
45.6 
29.9 
58.0 
42.0 
Casein 
16.74 
19.5 
18.2 
91.2 
52.9 
153.0 
45.0 
Sugar 
62.31 
62.9 
60.8 
43.8 
20.7 
42.0 
50.0 
With the exception of the woman’s milk, and that from 
the cow, he quotes his record from other chemists. 
Note G. — Page 24. 
E. Windsor Hill, Conn., April 24, 1873. 
Charles E. Buckingham, M.D. 
Dear Sir:—The correspondent of the Courant called on 
me for information respecting an experiment which I was 
making in regard to feeding apples to cows, and I gave him 
verbally the information which he published. When his 
article appeared, I regarded it as correct, and giving a true 
statement of all the important facts. I fed at that time about 
two hundred (200) bushels to my cows and other cattle, with 
great satisfaction to myself; and could add, if necessary, to 
prove that there is great profit in the business, when contrast- 
ed with the miserable practice of converting apples into 
brandy. 
The business requires care and strict attention to the fol- 
lowing directions :—Commence giving the cow half a peck 46 
THE PROPER TREATMENT OF CHILDREN. 
at a time, twice a day, and add gradually to the quantity for 
eight or ten days, till the quantity reaches half a bushel at a 
time, say one bushel per day, given morning and evening. I 
would in no case exceed that quantity for the largest cows. 
To the smaller cows, I would not give so much, but say to 
| bushel. Reason for this rule—if cows have free access to 
all they will eat, they will make themselves sick and dry up 
their milk. This has happened so often in years past, that a 
great prejudice exists against feeding apples. 
I place my cows in the stable, where each is confined to her 
own allowance, and for fear of getting choked, chop the 
apples. This helps the cow to eat those which are hard. I 
have never had a creature get choked, but think the practice 
a good precaution. Some cows will show the effect more 
than others. After all the attention I gave the matter, I judged 
the effect was to increase the flow of milk from two to four 
quarts daily. 
Only one instance occurred in which I had occasion to 
discontinue the feed, and that was a yoke of working oxen ; 
my men thought the apples scoured them. 
If you think that I may furnish any additional information, 
please write for it. ****** * 
Yours in haste, 
Very respectfully, 
E. Ellsworth. 
Note H. — Page 27. 
Referring again to Simon’s observations [Sydenham Soc. 
Edit., p. 51 et seq.], we find no ingredient more variable than 
the butter. The first is the average of fourteen analyses, 
made at different periods with the milk of the same woman ; 
second, the milk of a woman aged thirty-six years ; third, of 
a nurse aged twenty years ; fourth, the maxima, and fifth, 
the minima of numerous analyses. The sixth, seventh and 
eighth (quoted from Clem) were made on the fourth, ninth 
and twelfth days, respectively, after delivery. From the 
ninth to the fourteenth, inclusive, quoted from L’Heretier ; 
the fifteenth and sixteenth, from Haidlen. 
1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 
25.3 
38.0 
28.8 
54.0 
8.0 
42.9 
35.3 
33.4 
9. 
10. 
11. 
12. 
13. 
14. 
15. 
16. 
42.5 
52.0 
35.5 
40.5 
54.8 
56.3 
13.0 
34.0 NOTES. 
47 
Note I. — Page 29. 
The following are the results of fourteen analyses made by 
Simon, and which are alluded to in the text; the dates there 
alluded to are in italics. 
Spec. Grav. 
Water. 
Solids. 
Casein. 
Sugar. 
Butter. 
Fixed Salts. 
Aug. 31. 
1031.6 
873.2 
126.8 
21.2 
62.4 
34.6 
0.84 
Sept. 7. 
1030.0 
883.8 
116.2 
19.6 
57.6 
31.4 
1.66 
8. 
1030.0 
899.0 
101.0 
25.7 
52.3 
18.0 
2.00 
14. 
1030.0 
883.6 
116.4 
22.0 
52.0 
26.4 
1.78 
Oct. 27. 
1034.0 
898.2 
101.8 
43.0 
45.0 
14.0 
2.74 
Nov. 3. 
1032.0 
886.0 
114.0 
45.2 
39.2 
27.4 
2.87 
No®. 11. 
1034.5 
914.0 
86.0 
35.3 
39.5 
8.0 
2.40 
Nov.18. 
1033.0 
880.6 
119.4 
37.0 
45.4 
34.0 
2.50 
25. 
1033.4 
890.4 
109.6 
38.5 
47.5 
19.0 
2.70 
Dec. 1. 
1032.0 
902.0 
98.0 
39.0 
49.0 
8.0 
2.08 
8. 
1033.0 
890.0 
110.0 
*41.0 
43.0 
22.0 
2.76 
16. 
1034.4 
891.0 
109.0 
42.0 
44.0 
20.0 
2.68 
31. 
1034.0 
861.4 
138.6 
31.0 
52.0 
54.0 
2.35 
Jan. 4. 
1032.0 
873.6 
126.4 
40.0 
46.0 
37.0 
2.70 
They show at a glance “that, with few exceptions, first, the 
quantity of casein is at its minimum at the commencement; 
it then rises considerably, and ultimately attains a nearly 
fixed proportion ; that, second, the quantity of sugar is at its 
maximum at the commencement, and subsequently dimin- 
ishes ; and that, third, the butter is a very variable constituent 
of the milk.” 
Note K. — Page 29. 
See Professor Wood’s letter in Note D. 
Note L. — Page 31. 
The proportion of fixed salts appears to be greater in the 
lower animals than in the woman ; the largest percentage in 
the healthy woman that I can find, being 4.5, in the cow 6.77, 
and in the bitch 15.0. 48 
THE PROPER TREATMENT OF CHILDREN. 
Note M. — Page 32. 
The following schedule, prepared by Dr. Cumming, is 
worthy the experiment of every one who has the charge of 
children’s food. For myself, I have never failed to find it 
satisfactory. 
“ Schedule showing the Dilution of Milk at various ages: 
2 to 10 days old, 
MILK. 
14 gills, 
WATER. 
34 gills, 
POOD. 
making 44 gills 
10 to 20 “ “ 
14 
ti 
4| “ 
it 
6 
20 to 30 “ “ 
24 
it 
6 “ 
it 
84 
ti 
1 to lj months, 
3 
it 
6| “ 
it 
9f 
a 
14 to 2 “ 
34 
ti 
7 « 
it 
104 
a 
2'to 24 “ 
4 
it 
74 “ 
a 
114 
a 
£ 
24 to 3 “ 
44 
it 
74 “ 
a 
12 
a 
P 
O 
3 to 3£ “ 
5 
H 
74 “ 
a 
124 
it 
34 to 4 “ 
54 
ti 
74 “ 
it 
13 
a 
2 
4 to 4£ “ 
6 
a 
74 “ 
a 
134 
it 
2 < 
44 to 5 “ 
64 
a 
74 “ 
a 
14 
o 
5 to 6 “ 
7 
a 
7 “ 
a 
14 
a 
cS 
S-i 
6 to 7 “ 
74 
it 
64 “ 
ti 
14 
a 
o 
7 to 8 “ 
8 
a 
6 
i( 
14 
tt 
Ph 
8 to 9 
84 
a 
6 “ 
it 
144 
a 
9 to 10 “ 
84 
a 
6 “ 
«< 
144 
it 
10 to 11 “ 
8| 
a 
6 “ 
it 
14* 
ti 
11 to 12 “ 
9 
a 
54 “ 
a 
144 
144 
if 
12 to 15 “ 
94 
ft 
54 “ 
it 
U 
15 to 18 “ 
94 
a 
5 “ 
it 
144 
if 
18 onward “ 
10 
a 
5 “ 
a 
15 
it 
“ It will be well to have a cup holding a gill when full. 
Eight ordinary table-spoonfuls equal one gill; six equal three 
quarters of a gill; four equal half a gill; and two equal a 
quarter of a gill.”