►t:*:- iMk 1- *2 \ SURGEON GENERAL'SNDFFICE LJjBRARY. - Section. No. 113, M>. W.D.S.Q.O. HSMX V 1*- * J/ Am 4 < [ October, 1841. ] THE SELECT MEDICAL LIBRARY (NEW SERIES) AND BULLETIN OF MEDICAL SCIENCE. EDITED BY JOHN BELL, M.D., LKCTUHEU OH MATERIA MEDICA ; FELLOW OF THE COLLEGE OF PHTSICIASS 01 PHILADELPHIA; MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETT ", CORRESPONDING SECRETARY OF THE MEDICAL COLLEGE OF PHILADELPHIA, ETC., ETC. UNDERWOOD'S TREATISE 0M" THE DISEASES OF CHILDREN. 4 PUBLISHED QUABTEBLY, AT $5 PER ANNUM, Payable in Advance. ; PHILADELPHIA : BARRINGTON AND HASWBLL. BOSTON"— OTIS, BROADERS & CO. Charleston, S. C.—Wm. H. Behrett: Richmond, Va.—Smith & Palmer : New York—Cabvi£l & Co. and J. & H. G. Langley : Baltimore, Mi.—N. Hickman : Lexington, Ky.—A. T. Skillman & Son j£ THE BULLETIN OF MEDICAL SCIENCE. Vol. I.] OCTOBER, 1841. [No. 4. HEALTH OF MEMBERS OF PARLIAMENT. The House of Commons was never, it would appear, in better (bodily) health than at the present time. Not a single Conservative member — excepting eleven pairs — was absent from the division on June 4th ; and if the eight absent Ministerialists laboured under any infirmity, the names denote that it was rather infirmity of purpose than sickness. It has been ascertained at musters of the troops in this country, that, on an average, 4\ per cent, are absent on account of alleged sickness ; so that, at this pro- portion, 29 of the 658 members would be constantly unwell. Thirty were absent from the division. Half of the sickness which keeps the troops from duty is slight (cutaneous, venereal, and other affections), and such as would not confine patients at home, much less members from a party division. At the dockyards, and in the warehouses of the East India Company, the number of labourers constantly sick amounted to 1* or 2jo per cent.; so that from 11 to 15 in 658 would be unfit for duty; and in friendly societies the proportion of members on the box (exclusive of pensioners) is not very different. Taking the age and all other circumstances into account, about 14 mem- bers of the House of Commons (or from 8 to 20) may be expected to be constantly labouring under severe sickness of one kind or other ; and it is probable, therefore, that several of the members and pairs on both sides, at the last division, were indisposed. The Times, in fact, talks of the " desperate shifts which a desperate Administration were obliged to have recourse to in order to obtain a few hours' longer lease of office." But the same or more desperate shifts must have been had recourse to by a desperate Opposition which mustered every one of its members, unless we suppose that the excitements of hope, and the prospect of the pro- mised land of office, silenced pain and disease in the faithful who have followed their leader for so many years through the privations of the wilderness of opposition, where there are neither manna nor living waters. After every allowance has been made for sick members brought down to a division, it is evident that the health of Members of Parliament is not now seriously impaired by their duties; and that the House of Com- mons is on the whole a healthy place. The following is a statistical summary of the muster of members on June 4th: — 4 38 Bulletin of Medical Science. Conservatives. Liberals. ToJ?a Present.......314 . . 314 . . 62H Pairs....... 11 . . 11 • • 22 Absent....... 0.. 8.. 8 325 333 658 Hence it appears that 628 of the members were present in this healthy season of the year: 600 were present in January, 1840, on the occasion of Sir J. Y. Buller's motion. — Lancet. operations for stammering. By Joseph Poett, Member of the Royal College of Surgeons, London. Sir : — Allow me to offer a few remarks on the results of the operations practised by Mr. Yearsley for the cure of stammering. The first author- ized announcement of his "discovery" appeared in the "Medical Gazette of the 12th of last March ; and Mr. Yearsley, in his letter to the editor of that journal, stated that in the previous December he operated on two children for deafness, and some time after, " as the cure of deafness advanced," he learned from their parents " that both children had been stammerers from their infancy, but that the cure of stammering had ensued immediately on the excision of the tonsils." He also stated, that since the cases above-mentioned he had operated on upwards of forty, "all of whom immediately felt themselves relieved of their impediment:" a sort of damper, however, on the benefit of the discovery was subse- quently added, viz., " that after their relief patients have yet to learn the proper use of the vocal apparatus." Mr. Yearsley having premised in his letter that he was actively engaged at that time in collecting materials for a more lengthened explanation of his views upon the subject, I waited for his promised publication, being determined to put in force his recommendation for the cure of the unhappy affection in question, provided his theory proved correct, and his practice decidedly successful; but of both I entertained great doubts, having for the last fourteen years pointed my attention to impediments of speech in general, treating these nervous affections, as the profession is well aware, medicinally, and partly philologically. Upon carefully perusing his pub- lication, I found he offered no other solidity, as to theory, except the two cases above alluded to, and another of a Mr. Butler, who was "one of the earliest cases he operated on ; and whose formidable case, and next to miraculous cure, appears in Mr. Yearsley's publication, page 8. In order, therefore, to personally satisfy myself as to these theoretic cases I visited Mr. Butler, who, so far from being cured, is as bad as before he ■was operated upon : his letter, which I inclose, acknowledges that while his throat was sore and inflamed he spoke with ease; " but no sooner had the part healed" than his old habit returned. I also called upon the two boys, named William Russell and John Toplis, whose parents, as aboved stated, informed Mr. Yearsley that they had been stammerers from their infancy, but were cured immediately on the excision of their tonsils, and to my very great surprise, the uncle and aunt of the former declared the boy never stammered ; and, to use the uncle's words, " never was a case of stammering :" and recently I re- Operations for Stammering. 39 ceived the inclosed letter from the boy's father, in which he states that he had a thickness of speech, and was occasionally hard of hearing, of which he is improved ; but he did not consider his son ever stammered. The other boy, John Toplis, I found labouring under a very marked im- perfection in his speech, was partially deaf, and he stated, in presence of his grandmother, that when he was agitated, or " flurried," he frequently stammered also. This investigation of mine being anything but satisfactory, and being convinced that Mr. Y. must have been misinformed, or did not quite com- prehend the parents' account of the childien " stammering from infancy," and being equally quite certain that Mr. Y. is incapable of asserting any contrary to fact, or to lead astray his medical brethren, I selected out all the cases vouched by him in his publication as cured; and I waited on some, wrote to others, and prevailed on some friends to visit the rest: the result of these inquiries, as to the cured cases, I beg leave to submit. In Mr. Yearsley's publication he gave an account of eighty-eight cases which he operated on; sixty-two of this number is stated as improved, or very much improved ; seventeen he acknowledges received no benefit from his operations; and the following nine persons were pronounced as cured, viz : — 1. William Butler, 31, Golden-square (late Tottenham-stieet), is the person whose letter I have inclosed. 1:1411:1° R„ys;;„, I «'• R»-»'s ■•«•, -'-«<. 4. Frederick West — I have heard that this person is wonderfully im- proved. 5. John Wigton — Ijinclose a letter from his mother, stating that he he was operated on twice, and " he is no better." 6. John Burroughs says he is greatly improved, but stammers as usual when nervoua. 7. George Nixon — the same account. 8. William Barr—cannot be found at the address given, 25, Long- lane, Smithfield. 9. William Dixon, 29, West-square, Lambeth; the inclosed letter is from the proprietor of this house, who states that his son-in-law is named William Dixon, ** but he never had the misfortune to stammer." The errors of the addresses of the last two persons are, no doubt, typo- graphical. The report of the above cases not proving to me quit satisfactory, 1 visited several cases which appeared in Mr. Yearsley's book as improved, or so much improved as to give him " sanguine" expectations of decided recoveries; but I really cannot discover, with all that I and others have inspected, the slightest chance of such taking place. They all owned that, at first, they felt relief, but when nervous or agitated, or, as some expressed their feelings, " flurried," they stammer as before: but it is an undeniable fact, that stammerers of the simplest species, or worst species of the affection, continue at times quite free from impediment; and they portray their infirmity only at moments when they feel nervous on the point of speech, they can at certain times, particularly whilst alone or unobserved, speak or read quite free from embarrassment, or tendency to stammer. Now this answer is at once an answer to Mr. Years- 40 Bulletin of Medical Science. ley's erroneous supposition, that the affection arises in consequence of diseased and enlarged uvulas or tonsils, or both. Surely at the time a stammerer is speaking correctly, and free from sympathetic nervousness on the point of speech, neither his uvula or tonsils become small or corru- gate, or does disease vanish from them during the time they are correctly speaking; but as to his supposition that these parts are diseased with stammerers, I positively can assert that I have, during the last fourteen years, rigidly examined-both tonsils and uvulas, and all other parts of the mouths of upwards of one thousand persons afflicted with impediments of speech, and never yet detected one case of disease. Some of this num- ber had large uvulas, and, perhaps, large tonsils ; but not more so in the same ratio than others, who have both very much enlarged, and yet do not stammer. It is an every-day occurrence for medical men to observe in their patients both uvulas and tonsils of greater size than others, and yet they have no impediments of speech, or a tendency to such affections ; but to revert to the fact, that it is only at certain times when stammerers feel nervous that they portray their malady, it is evident that the exci- sion of either uvulas or tonsils is quite inadequate to cure these nervous affections, which become more or less mental, and more complicated in effects, after a certain period of life. It is also a curious fact, that from every different mode a stammerer resorts to in the hope of being cured, he at first experiences sudden relief, which continues for an uncertain time, and he then relapses (without his affection be properly and rationally treated). But a bad toothache, rheu- matic affections of the jaws or face, slight tic-douloureux, ulcers on the tongue or inside of the lips, and other casualties, will cause a pro tempore cessation of stammering: therefore, in my humble judgment, the novelty of losing an uvula or tonsils, or both, together with the subsequent pain and inflammation, but above all, the forcible mental impression that the operation is to eradicate their miserable affection, produces that degree of relief observed by Mr. Yearsley, who, from want of experience in these peculiar nervous affections, is led to imagine that the alteration is a solid proof of the efficacy of his operations in curing this miserable affliction : not less so, because it is numbered in " the thousand natural shocks that flesh is heir to." — Ibid. EMPLOYMENT OF THE TINCTURE OF ACONITE IN CASES OF NEURAGLIA. By Joseph Curtis. Having been recommended by Dr. Pereira to use the tincture of aconite as an external application in cases of neuralgia and rheumatism, I send the following notes of cases illustrative of its effects for insertion in your valuable periodical. The cases to which this remedy is particularly applicable, appear to be chronic rheumatism and neuralgia, in which the usual symptoms of inflammation, fever, and other constitutional disorders are absent; in short, those cases in which there is no symptom of disease, except violent pain. I have, however, seen it occasionally useful in cases accompanied by febrile symptoms ; but perhaps the fever might not have been a ne- cessary accompaniment of the complaint, but brought on by continued suffering. As aconite applied externally never, as far as my experience Aconite in Cases of Neuralgia. 41 goes, does any harm, there can be no objection to trying it in any case of severe pain. The manner in which I use the remedy is to rub it on the part affected with a small piece of sponge, tied on the end of a stick, for if it wet the fingers it produces an unpleasant, numb sensation. The rubbing must be continued till the requisite quantity of the tincture is used. During the application of this remedy, the first sensation the patient experiences is that of cold, from the evaporation of the spirit with which the tincture is made ; this is succeeded by redness and swelling of skin, a glow, and sometimes a tingling, said, occasionally, to be as bad as that produced by stinging-nettles. This is in many cases followed by numb- ness. These symptoms pass off in a few hours, and frequently leave no remnant of the pain, which may have previously been exceedingly severe. Dr. Pereira recommends the internal use of the tincture of aconite in doses of five minims. I have used it in much smaller doses, but not suc- cessfully. I gave three minims to one patient, in whom it produced the most violent symptoms of intoxication, vertigo, delirium, &c. Case 1. Painful affection of the nerves about the hip. — Margaret May, aetat. 35, Jan. 16, 1840, about six weeks after parturition, was attacked with severe intermitting pains about the gluteal muscles and loins, and shooting round into the groin, and sometimes half way down the thigh. She is unable to sit up or move in bed; she has headache, but no other constitutional affection. Leeches, aperient medicine, &c, were used, from which she expe- rienced slight relief, but the pain soon returned. 18. The pain has been very severe to-day, but at present is easier, unless she move, which brings on a return ; bowels confined ; head much worse. Take two aperient pills, and rub in one drachm of the tincture of aconite. 19. Has passed a good night, and had no pain since the tincture was applied ; had cramp in the calf of the leg for a short time; has headache at present. She had no return of the pain about the hip after this; the headache was relieved by ordinary means. Case 2. — January 20, 1840,-----, a glazier complained of rheuma- tism in the elbow-joint, of three days' standing; the part was slightly swollen, and tender ; he experienced great pain upon extending or flexing the joint; no constitutional symptoms. Rub in one drachm of tincture of aconite. The pain was much relieved at the time ; could extend the arm, but not flex it, probably from the skin being swelled. He did not attend again. Case 3. — Jan. 23, 1840. Miss P., oetat. about 35, is subject to rheu- matism of the scalp, particularly in cold or windy weather ; has had severe pains to-day, the weather being very windy ; has no constitutional symp- toms. Rub in two drachms of tincture of aconite. 24. Has no pain since the application. I saw this lady occasionally for some weeks afterwards, during which she had no return of the pain. Although living near me, she has not since applied to me ; therefore I consider the cure perfect. 4* 42 Bulletin of Medical Science. Case 4. — Jan. 25, 1840, Mr. Y., setat. about 70, has severe pain along the lower jaw, on the right side, and shooting up to the forehead, in the course of the fifth pair of nerves ; likewise over the posterior part of the right parietal bone. Apply two drachms of the tincture. Felt the usual sensations of cold, heat, and numbness during the appli- cation ; and lost the pain in about a quarter of an hour. I saw him about six weeks afterwards, when he had had^no return of the pain. This gentleman was very much out of health at the time, his digestive organs being disordered, accompanied by fever, &c, which symptoms remained after the pain in the face was removed. Case 5. — Mary Keith, setat. about 40, has been long subject to rheu- matism, by which the use of her hands is impaired. At present com- plains of severe pain across the forehead, on the left side, in the situation of the course of the supra-orbital nerve. The pain comes on several times daily, and is much increased by going near a fire. During the accession of pain she loses the sight in the left eye. Has had pain under the right lower jaw, which is better; otherwise she is in tolerable health. Apply one drachm of the tincture. The application produced the usual symptoms, and with them the loss of sight in the left eye. After the numbness left her the sight of the eye returned, but she felt no more of the pain. This is a remarkable case, showing that there is some very important connection between the supra-orbital nerve and the organ of vision, -r- Ibid. " TRANCE--PSORIASIS." By J. M. Winn, 31.D. On the 17th of December, 1840,1 was requested to see, in consultation with Mr. Pearce, of St. Austell, a young lady of that town, aged 18, who had been ailing for eighteen months with anemia, disordered bowels, and irregular menstruation. I found her suffering from amenorrhcea of two months' duration, increased action of the heart, with bellows murmur, and a congested state of the left lung ; her face was pallid, and her legs slightly (Edematous. I was informed that she had been affected with chorea when 13 years of age, but that the complaint subsided on the first appearance of the catamenia. I was also informed that her spirits had always been remarkably good, and that she had never suffered from hys- teria. She had been under Dr. Hope's care when in London during the summer, and had taken steel, by his direction, with some benefit ; she had also lately resumed the use of iron by Mr. Pearce's advice. We mutually advised the application of a blister to the side, and some draughts, composed of digitalis and a saline aperient. The steel had been discon- tinued previous to my arrival. Dec. 10th. — I was informed that she wr.s considerably better on the 9th, but that to-day she was seized, immediately after vomiting some undigested food, with profound coma. She is now lying in a comatose state. When roused, she appears to be partly conscious, though speechless, and quickly relapses into an apparently sound sleep. The pupils are sluggish, and the heart beats strongly. With a view of rousing Trance —Psoriasis. 43 the nervous system, and of removing effusion, should any exist, we deemed it right to order turpentine injections, and blisters to the legs. 13th. — There has been little change in the symptoms. The bowels and kidneys have acted freely. The heart's action is less strong, and the bellows murmur is considerably diminished. The lungs appear to be entirely free from congestion. In consequence of the debility, am- monia and small quantities of wine were ordered. 15th. — She rallied after taking the stimulus, and opened her eyes and smiled, but speedily relapsed into a lethargic state. She takes small quantities of beef-tea and jelly at frequent intervals. Her deglutition remains unimpaired ; she will, however, frequently reject the food from her mouth. 18th.—Remains in a trance-like state. She frequently opens her eyes, and smiles vacantly, but never speaks. The same remedies were continued. 24 th. — In consequence of the symptoms remaining unaltered, large doses of musk, and ammoniated tincture of valerian, were ordered, in addition to the turpentine enemata. 26th. — Appeared to gain strength immediately after taking the musk, and smiled when her mother spoke. 30th.—Is evidently worse. The body is greatly emaciated; quite unconscious even when roused ; moans frequently, as if in pain, and has a distressing cough ; refuses at times to swallow. Jan. 2d. — Seized at 9 A.M. with a tremor of the whole body, resent bling paralysis agitans : the shaking lasted ten minutes. To take thirty drops of the Sesquichloride of Iron twice daily, and repeat the Tur- pentine injections. 8th. — To-day the catamenia, of a natural colour, reappeared, and she seems to be stronger. At one period of the day she laughed loudly ; she has also taken more nourishment. These circumstances have raised the hopes of all her friends. In consequence of a letter which I received from Dr. Hope, with whom I had recently corresponded respecting the case, we ordered, by his suggestion, that the turpentine injection should be doubled in strength, and that the steel should be continued. 19th. — Since the 8th she has been again declining. The breathing is hurried, the cough distressing, and the pulse at times scarcely per- ceptible. 21st. — The point of the nose has become purple from extravasated blood; there is a similar effusion under the cuticle of the nates. Breathing excessively fast; is evidently sinking. 22d. — Died at three P.M. Throughout the course of this singular case it was considered expe- dient to have an attendant constantly by the bed-side, to administer nour- ishment in small quantities ; and there can be no doubt but that life was prolonged by so doing. From the commencement of the attack to the day of her death, a period of six weeks, she never spoke; and although she occasionally smiled and opened her eyes, it is probable she never recovered, even for a moment, complete power of consciousness and voli- tion. It is remarkable, that although the complaint was so clearly a dis- 44 Bulletin of Medical Science. ease of innervation, yet the digestive organs performed their functions tolerably well during the period that the trance-like condition lasted. In Dr. Elliotson's Practice of Medicine, two cases of a similar kind are mentioned, both of which terminated fatally. These cases will teach the necessity of giving a guarded prognosis in severe forms of hysteria. Three weeks since, Mr. Paull, of this town, obligingly requested a patient of his to call upon me, who had been affected for five months with a peculiar complaint of the skin. The patient, a girl a?tat. 14, was a field labourer and appeared to be in good health. The catamenia had not yet appeared, and she complained of headache. The eruption was confined to the right fore-arm, the left cheek, and the skin aiound the orbits. The patches of eruption on the arm had a singularly symme- trical appearance, being composed of concentric rings. The lines forming the different rings were even, rather elevated, of a red colour, slighty fis- sured, and covered with thin scales. She stated that the patches com- menced with a small red spot, which soon became surrounded with a ring ; that another quickly ensued, and so on in regular rotation until the patches had acquired their present dimensions. The largest patch is about four inches in diameter, and perfectly circular. She says the eruption has never been attended with smarting, itching, or discharge. We prescribed a purgative plan of treatment, with calomel ointment; and at the end of a fortnight, when the girl called on me again, the eruption was nearly healed. I was almost sorry to find the remedies had taken effect so speedily, as it was my intention to have procured a drawing of the dis- ease at her next visit, that I might have had the pleasure of sending a sketch of the complaint to the Medical Gazette. Neither Mr. Paull nor myself had ever seen or read of a similar disease ; we, however, both consider it to be a novel form of psoriasis. — Lond. Med. Gaz. IODINE IN PHTHISIS PULMONALIS. By Alexander Leigh, A.B., M.B. The local application of iodine is of acknowledged use in healing external ulcers ; therefore, by analogy, it is concluded to be of similar use in pulmonary abscesses communicating with the atmosphere : experience also corroborates the above conclusion. Though physicians agree in the principle of action, yet they differ in the mode of application. Sir C. Scudamore recommends the inhaler; Dr. Corrigan impregnates the atmosphere of the patient's room with iodine. Both methods being inconvenient in practice, I direct the patient to apply a sufficient quantity of iodine ointment on the ribs, under both axillae, and to cover the head with the bed-clothes, to breathe the iodine volatilized by the heat of the axilla?; the ointment produces counter- irritation on the skin where it is applied, and is to be repeated according to circumstances. This method has appeared to me to arrest the progress of the disease ; and as I should wish to hear the result of more extensive trial, I beg you will place the above remarks (if you think them worth inserting) in the Medical Gazette. — Ibid. Combe's Principles of Physiology, etc. 45 A MODE OF INTRODUCING THE CATHETER IN DIFFICULT CASES.* Dr. Patterson has adopted a plan of introducing the catheter in cases of difficulty, which he thinks may be useful. We confess that we believe practice and dexterity are the things needful. But to Dr. Patterson's me- thod. It consists in attaching a bladder of water to the catheter, and, when there is an obstruction, directing a stream through the instrument upon it. He attaches a small bladder to the end of the catheter, after the manner of a mounted enema pipe, the bladder need not be large, one that holds about half a pint of water will be sufficiently so ; and the catheter must be furnished with a small cork, having a piece of twine fixed to it, just like the cork of an enema pipe. The largest sized catheter the urethra will admit of should be used, that the impetus of as large a jet of water as possible may act on the obstructed part of the canal, and also that the urethra being filled by the instrument, the fluid may be easily prevented from returning by the side of the catheter. The eye must be large, and very near the end of the tube ; or, what is better, the tube should have a large orifice within the circumference of its anterior extremity, with the edge rounded in so as that it shall not hurt, or catch the lining membrane of the passage. Also it must be a silver or permanently curved elastic catheter : for the injecting apparatus would prevent the withdrawal of the stilet necessary to maintain the curvature of a common elastic one. The instrument, having the attached bladder properly adjusted, is to be passed down to the obstruction : if it cannot now, on further trial, be made to enter the patient's bladder, it must be held by an assistant, while the small cork is being inserted into its outer end : about six ounces of luke- warm water are to be poured into the injecting apparatus ; the latter must then be closed, and tied as near as possible to the fluid, so as to exclude every portion of air. The operator is next to encircle the penis with the finger and thumb of his left hand, making gentle circular pressure to close the urethra round the catheter; he will then, having first withdrawn the cork, embrace the bladder of water with his right hand, so as to be able to apply strong and uniform pressure on as much of its surface as possible, in doing which, its contents being continuously and forcilby propelled into the urethra, and the handle of the instrument being at the same time depressed, the latter at once passes with facility into the patient's bladder. The left hand in holding the penis, should be quite passive, allowing the utmost freedom of motion to the catheter; the right hand should not touch any part of that instrument, but manoeuvre it through the medium of the attached bladder of water, in the act of compressing the latter, so that its extremity may be free to follow, as it were spontaneously, the course the current of water opens before it. — Med. Chir. Rev., horn. Med. Gaz., Jan. 29, 1841. The Principles of Physiology applied to the Preservation of Health, and to the Improvement of Physical and Mental Education. By Andrew Combe, M.D., Fellow of the Royal Col- lege of Physicians in Edinburgh, Physician Extraordinary to the Queen in Scotland, and Consulting Physician to the King and Queen of the Belgians. With thirteen wood-cuts. Tenth Edition : re- vised and enlarged. Edinburgh and London. 1841. Pp. 420. 12mo. We have been favoured, by its author, with a copy of this admirable * Dublin Journal, March, 1841. 46 Bulletin of Medical Science. work, which has done so much to enforce right notions of the laws of animal life, and to induce right practice under such notions. In his preface to the present edition, Dr. Combe tells the reader, that " various topics of partial or comparatively temporary interest have been omitted to make room for others of more general and permanent value, and upwards of fifty pages of entirely new matter, including a chapter on the Blood, and the Organs of Circulation, with several illustrative wood- cuts, have been added. The whole work has been carefully revised, and no inconsiderable portion of it re-written ; while, by increasing the num- ber of lines in each page, the necessary additions have been made without increasing the size of the volume, or in any way injuring its appearance, or adding to its price." The last Araercan edition of this work bearing on its title page New York, 1841, is a re-print from the seventh Edinburgh edition. Are not its publishers behind the requirements of the reading public in this case ? The Constitution of Man — Considered in Relation to Exter- nal Objects. By George Combe. Fifth Edition, revised, corrected, and enlarged. Edinburgh and London. 1841. Pp.111. Royal 8vo. We are not required, at this time, to speak of the distinctive merits of Combe's *' Constitution of Man," nor to enlarge on the extensive good which it has done, by teaching the practical application of hygiene, phy- siology, and phrenology to the government of our actions, both for our own and our neighbours happiness and improved well being. We merely avail of the occasion made by the kindness of the author in send- ing us a copy, to direct anew the attention of our medical brethren to this work as an able and philosophical exposition of those principles, which in their mixed character of teachers of medicine and ethics they are so continually called on to enforce both for the prevention and the mre of disease. In a leaf prefixed to this edition, and headed " Henderson's Bequest," there is a statistical return of the number of copies of the " Constitution of Man," which have been published since the year 1828, the date of it3 first appearance showing a sum total of no less than sixty four thousand copies. Of these fifty-two thousand were printed in double columns, royal octavo, at Is. 6d. per copy, in fashion called " The People's Edi- tion," and stereotyped. The copy now before us is of the tenth impres- sion, from new stereotyped plates. The first edition, in 1828, was of 1500 copies ; the second, in 1835, of 3000 ; the third (stereotyped) con- sisted of 1000 the first impression, 1000 the second, 1500 the third, and 3000 the fourth impression. The largest impression of the People's edition, already spoken of, was 10,000 copies in November, 1836, 20,000 copies at four impressions having been already struck off in the former part of this year. Of a school edition, at Is. 6d. in boards — an impression of 1000 copies was published in October, 1838. Nearly all of this immense issue, after the first edition, has been made in consequence of a bequest of the late W. R. Henderson, Esq., younger of Warreston and Eildin Hall, by which, after making certain devises, he disposed of the residue of his property " for the advancement and diffusion of the science of phrenology, and the practical application thereof, in particular." After some explanatory recommendations to his trustees, Mr. Henderson goes on to say — " And I think it proper here to Rigby's System of Midwifery. 47 declare, that I dispose of the residue of my property, in the above man- ner, not from my being carried away by a transient fit of enthusiasm, but from a deliberate, calm, and deep-rooted conviction, that nothing, what- ever, hitherto known, can operate so powerfully to the improvement and happiness of mankind, as the knowledge and practical adoption of the principles disclosed by Phrenology, and particularly of those which are developed in the Essay on the Constitution of Man, above-mentioned." Dissertations on Hemorrhages, Dropsy, Rheumatism, Gout, Scro- fula, &c.,&c.,&c. With a Formulary and a General Index. Phila- delphia: 1841. Lea & Blanchard. Pp.514. 8vo. This is the fifth volume, and that which concludes the first series of the Library of Practical Medicine. Its contributors are Dr. Burrows, Budd, Watson, Shapter, Rowland, Budd, Fierre, and Joy. Dr. Gerhard has added notes to the present volume, but not at all in such numbers as to oppress the text. The publishers may now pause for a while, and look back with allowable complacency on their very liberal venture towards the extension of medical science, as furnished in these five large and valuable volumes, sent forth by them within a comparatively short period of time. The volume now before us is a fit completion of the series, both by the interesting manner in which the diseases above specified have been treated, and by the " Formulary" of nearly a hundred pages at the end. The " Preliminary Remarks on the Art of Prescribing" are followed by a large number of extemporaneous formulae arranged under the head of the several classes of medicines — Stimulants, Narcotics, Antispas- modics, &c. A general index crowns the whole, and renders the pos- session of this volume, if not essentially necessary, at least very service- able to those who hold preceding volumes. A System of Midwifery. With numerous wood-cuts. By Edward Rigby, M.D., Physician to the General Lying-in Hospital, Lecturer on Midwifery at St. Bartholomew's Hospital, &c, &c. With Notes and Additional Illustrations. Philadelphia: Lea & Blanchard. 1841. Pp. 491. 8vo. Hardly have we announced the completion of the first series of the Library, or that on Practical Medicine, when we see the present; volume, which was published in London, as a part of the Library, in an American dress, — and that a very good one. The intrinsic merits of this System of Midwifery are such as to entitle it to be received as a useful guide and reference, by those who may have acquired from other sources a certain share of elementary knowledge of this branch of medi- cine. Dr. Rigby, with determinate and clear opinions of his own, is, we find, quite free in his reference to, and introduction of those of others ; but without tediousness or pedantry on his part. Among the authorities on whom he seems to rely, on several points of moment, we see, with plea- sure, the name of our late professor and teacher Dr. Dewees. The German writers, and particularly Naegele, are largely quoted. In the chapter on the signs of pregnancy we read the following : — " In reviewing what has now been stated respecting the diagnosis of preg- 48 Bulletin of Medical Science. nancy, it will be observed that we have enumerated four symptoms, whic must be looked upon as perfectly diagnostic of this condition, and on tn accuracy and certainty of which we may place the fullest reliance: two may be recognised at an early period by means of auscultation, viz., tne sounds produced by the movements of the foetus and by the pulsations ot its heart; the two others are not appreciable until a later period, and are afforded by manual examination, viz., the being able to feel the head ot the foetus per vaginam, and its movements through the abdominal pa- rietes. The next in point of value after these are the changes in the os and cervix uteri, those connected with the formation of the areola and in the breasts, and at a somewhat later period, the sound of the uterine circulation, changes which, although they cannot separately be entirely depended upon, are nevertheless symptoms of great importance in the diagnosis of pregnancy. Two other signs of pregnancy have been also mentioned, viz., the appearance of a peculiar deposit in the urine, as described by M. Nauche, or rather by Savonarala (Montgomery, op. cit. p. 157), and the purple or violet appearance of the mucous membrane lining the vagina and os externum, as described by Professor Kluge of the Charite at Berlin, and by M.M. Jacquemin, and Parent Duchatelet of Paris." On the Diagnosis of Twin Pregnancy, Dr. Rigby remarks, that " the stethoscope affords us the only certain diagnosis of twin pregnancy, and even here it is limited to the sounds of the foetal heart ; the increased ex- tent and power of the uterine souffle, as remarked by Hohl, arising, as he supposed, from the large mass of the double placentae, is not a proof which can be depended upon." Another useful application of the stethoscope is, in its enabling the ac- coucheur to ascertain whether the child is yet living in cases of protracted labour or prolapsus of the umbilical cord and other abnormal conditions of things, and in which he may be called on to take prompt measures for the expulsion or removal of the child, as by the use of the forceps, &c. In the chapter on Encysted Placenta, several cases are given of retained placenta, and of its subsequent absorption. We directed attention to this curious fact a few years ago, in the first volume of the Eclectic Journal of Medicine, p. 29, when speaking of the cases collected and recorded by G. E. Maslieurat-Lagemard — {Archives Gen. Mar. 1835.) The connexion of precipitate labour with mania is a question of im- portance in a medico-legal point of view, and one which, Dr. Rigby truly remarks, has already engaged attention in England, and, we may add, in this country. Cases of infanticide committed under temporary frenzy induced by this kind of labour " have been very carefully investigated in Germany of late, and in many of them the patient has been, we think, very properly acquitted, on the grounds of temporary insanity, having herself voluntarily confessed the act with the deepest remorse, at the same time declaring her utter incapacity to account for the wild and savage fury which seized her at the moment of delivery." Instructive notes have been added by the American editor, who, as he informs us in a short preface, " has restricted himself mainly to such ad- ditions and references as he conceived would render the work more useful to American practitioners." He has, we think, been quite successful in his design. TREATISE DISEASES OF CHILDREN; WITH DIRECTIONS FOR THE MANAGEMENT OF INFANTS BT THE LATE MICHAEL UNDERWOOD, M.D. j ***.....Mlll FROM THE NINTH ENGLISH EDITION, WITH NOTES, BY S. MERRIMAN, M.D., AND MARSHALL HALL, M.D., F.R.S.. ETC. WITH NOTES, BY JOHN BELL, M. D., LECTURER ON MATERIA MEDICA ; FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY J CORRESPONDING SECRETARY OF THE MEDICAL COLLEGE OF PHILADELPHIA, ETC., ETC. $fulaftelj)fua: ED. BARRINGTON & GEO. D. HASWELL. NEW YORK —J. & H. G. LANGLEY: CHARLESTON, S. C. — WM. H. BERRETT: RICHMOND, VA. — SMITH, DRINKER & MORRIS: CINCINNATI, OHIO —J. A. JAMES. 1841. [Entered, according to Act of Congress, in the year 1841, by Barrington &, Haswell, in the Clerk's office of the District Court for the Eastern District of Pennsylvania.] PREFACE BY THE AMERICAN EDITOR. In 1819, Doctor Underwood, then far advanced in years, revised the seventh edition of his Treatise on the Diseases of Children. In 1826, Doctor Merriman, so well and advantageously known as a skilful accoucheur and practitioner, prepared a new edition, which he enriched with notes on several points of interest: and in 1835, Doctor Marshall Hall, that popular writer and teacher, performed a similar duty for a succeeding (the ninth) edition. Here we have good evidence, both of the continued success of the work during the life time of its author, and of the estimation in which it is still held by distinguished medical men, as well as by the medical pub- lic at large. In preparing a new American edition of Underwood, its editor has retained, with very few exceptions, all the notes which en- hanced so much the value of the later English editions; and he has himself added numerous ones, in elucidation and enforcement of the pathology and treatment of several of the diseases described in the text. On Croup and its varieties, and on Cholera Infantum, the latter not noticed at all by Dr. Underwood or his English commenta- tors, and Scarlatina, he has enlarged somewhat beyond the limits of ordinary notes; but not, he believes, farther than the gravity and fre- quency of these diseases merited. The note on Vaccination supplies a void left by the author and his former editors. Throughout, he has endeavoured to bring up the Treatise on the Diseases of Chil- dren to the requirements of the day, as far, at least, as regards the main points of treatment. The added matter, although derived from other sources than the personal experience of the editor, on ' Purulent Ophthalmia,' and 'Gangrenous Sore Mouth of Children,' will, it is hoped, enlighten the practitioner who, for the first time, may be called upon to treat these formidable maladies. The intrinsic merit of Dr. Underwood's advice for the physical and medical management of children was less evident to the reader, on account of the verbosity and needless expletives, which rendered the perusal of his book irksome and unpleasant. This objection has been, in a great measure, removed by the first of its English edi- tors, Dr. Merriman, who, besides pruning many redundances, 8 PREFACE. has rendered " the language more exact and clear." The text of his edition has been preserved on the present occasion in almost uninterrupted series, until the section on the < Topical Diseases of Children' was reached. Of these the accounts of the ones more strictly peculiar to infancy have been retained : but no advantage could follow the insertion of notices of others which were quite too meagre for practical guidance ; and which, at the same time, be- longed to surgery, in the treatises on which, ex-professo, or in sepa- rate monographs, they are alone adequately described and treated. Of these latter may be instanced Cataract, Gutta Serena, Morbus Coxarius, Hernia, Hydrocele, Vari and Valgi. To have done jus- tice to them, with the requisite fulness, would have swelled the volume to an inconvenient bulk, and after all have added really nothing new to the treatment of the diseases of children. An explanation of some difference between the two last and preceding English editions, will be best given in the language of Dr. Merriman himself, as follows: — "The later editions of Dr. Underwood's Treatise consisted of three volumes, the third of which was appropriated to directions for the management of in- fants from birth and other subjects, which seemed naturally fitted to precede, rather than to follow, a Treatise on Infants' Diseases. These directions are, therefore, now made the introduction to the single volume ; in which the whole of Dr. Underwood's work, with the exception of his dissertation on the Properties of Human Milk, is comprised. This dissertation, written principally to con- trovert some opinions advanced by Dr. Joseph Clarke of Dublin, in 1786, it has not been judged necessary to reprint. Nor has the editor deemed it advisable to reprint some rather long controver- sial notes, which might perhaps have been spared when first in- serted, and for the publication of which now, no good reason can be assigned." The notes of Dr. Merriman are marked with the initials (S. M.) of his name. Those of Dr. Hall are in brackets [ ], and have the initials of his name (M. H.); they are mostly printed in the same type, with, and in the body of, the text. The additions by the American editor are indicated by a letter (a) prefixed until the alphabet was exhausted, and then double letters (aa) were em- ployed ; and they may be, also, farther known by their being in a different type from either that of the text, or of the notes of Dr. Merriman. A claim to additional value, as a work of reference, for the present volume, will be found in an Index, which was wanting in the English. CONTENTS. SECTION I. ON INFANTS APPARENTLY STILL-BORN. Notes by the English Editors SECTION II. ON THE MANAGEMENT OF INFANTS. On Dry-Nursing The General Management of Children On the First Clothing of Infants On Air On Short-coating Meat and Drink On the choice of Wet-Nurses On Weaning of Infants Sleep and Watching Motion and Rest On some slight natural Deformities Retention and Secretion Retention of Urine in New-born Infants On Retention and Execretion of the Bowels The Passions of the Mind ZJ SECTION III. ON THE EARLY DETECTION OF DISEASE. By Dr. Hall. On the Countenance ..... On the Gestures ..... On the Sleep ...... On the Respiration, and on the Beat of the Heart 10 CONTENTS. On the Cry On the Tongue and Breath . On the Skin and, General Surface pace 84 85 86 SECTION IV. ON THE DISEASES OF CHILDREN. Syncope, or Fainting Discoloration of New-Born Infants Retention of the Meconium . On the Intertrigo, or Chafings Tumid Breast of Infants Icteritia, or Infantile Jaundice Infantile Erysipelas Coryza Maligna, or Morbid Snuffles Inward Fits Disorders from Constipation and Wind Vigiliae, or Watchings Aphtha?, or the Thrush (Follicular Stomatitis) Aphtha Gangrenosa Eruptions on the Skin . The Strophulus, or Red-Gum, (Strophulus Intertinctus. Willan.) Crusta-Lactea, or Lactumen, {Porrigo Larvalis. Willan.) Tooth-Rashes ...... Essera, or Nettle-Rash, {Urticaria. Willan.) . Phlyctaense, {Pemphigus Infantilis. Willan.) Psora, or the Grocer's Itch, {Psoriasis Infantilis. Willan.) Sore Ears ....... Vomitus, or Vomiting ..... Cardialgia, or Inflammation of the Stomach Gastritis with Gelatiniform Softening of the Stomach Tormina, or Gripes ..... Diarrhoea ...'.. Lienteria, or Watery Gripes .... Cholera Infantum . . ' . Incontinence of Stools ..... On Diseases in the Abdomen Worms Vermifuges Convulsions Paralysis, or Palsy Skin-bound . Tetanus, or Locked-Jaw Epileptic Fits Chorea Sancti Viti Aphonia Spasmodica Intermittens, or Temporary Loss of Speech Incubus, or Nightmare ..... Singultus, or Hiccough . Sternutatio, or Sneezing CONTENTS. 11 PAGE Dentition ...... 189 Fever ....... 198 Remittent Fever ..... 205 Typhus, or Low Fever . . . 206 Mesenteiic Fever ..... 207 Remarks on the above Fevers .... 212 Hectic Fever, and Marasmus . 213 Febris Scarlatina, with or without Ulceration of the Throat . 216 Scarlet Fever, its Pathology and Treatment 219 Febris Miliaris, or Miliary Fever .... 220 Cynanche Parotidea, or Mumps 222 Hydrocephalus ...... 224 On the Diseases of the Head .... 233 On Hydrocephaloid Diseases .... 233 On the due Use of Bloodletting . . 240 Variola and Morbilli, with Note on Bloodletting in Infancy, anc I Cursory Remarks on Inoculation 243 Inoculation ...... 246 Vaccine Inoculation ..... 249 Vaccination— Varioloid .... 252 Varicella, or Chicken-Pox ..... 253 Ague ....... 257 General Observations on Coughs .... 260 Pertussis, or Hooping-Cough .... 261 Tussis Spasmodica ...... 268 Suffocatio Stridula ..... 270 Laryngitis Membranacea . ... 277 Laryngitis Stridulus ..... 284 Secondary Croup — Diptheritis .... 286 On the Effects of Swallowing Boiling Water, &c. 289 On Diseases of the Thorax ..... 292 Rachitis, or Rickets ..... . 292 Scrofula . . . . ... 296 Dysuria ...... 301 Anasarca and Ascites ..... 301 Ischuria Vesicalis e Muco .... 303 Incontinence of Urine ..... 304 SECTION V. ON THE TOPICAL DISEASES OF CHILDREN. Tinea, or Scald Head, {Porrigo Scutulata. Willan.) . . 307 Scurfiness of the Head, {Pityriasis Capitis. Willan.) . 309 Herpes, or Ringworm, {Herpes Circinatus. Bateman.) . 310 Herpes Exedens, or Serpigo, {Herpes Phlyctsenodes. Bateman.) 310 Herpes Miliaris, {Herpes Zoster. Bateman.) . . .311 Ophthalmia . . . . . . . 311 Ophthalmia Purulenta ...... 313 Purulent Ophthalmia . . . . . 314 12 CONTENTS. Psorophthalmia ...... Venereal Ophthalmia . ... Hordeolum Steatomatum, or the Stithe, or Stye Deafness ...... Abscess within the Ear ..... Earache ...... Cancrum Oris ...... Gangrenous Sore Mouth of Children Gangrenous Erosion of the Cheeks Gangrenous Affection of the Pudendum Paralysis of the Lower Extremities, with Curvature of the Spine Debility of the Lower Extremities On Cutting the Fraenum of the Tongue Suffocations from swallowing the Point of the Tongue, and Hemor rhage ...... Hemorrhage of the Nose ..... Hemorrhage from the Navel .... Soreness, or Ulceration of the Navel Unkindly Separation of the Funis Umbilicalis Tumefaction of the Prepuce .... Prolapsus, or Procidentia Ani .... Discharges from the Vagina .... Purulent Gonorrhoea ..... Encephalocele, or Hernia of the Brain Tumours of the Scalp ..... Lymphatic Tumours of the Head and Spine Spina Bifida, or Hydro-Rachitis Hepartomphalos, or Ventral Hernia On the Hare-Lip, and other external Blemishes, or Disorders, sup posed to be marks of the Mother Naevi, or Discoloured Spots .... Imperforate Vagina ..... Imperforate Anus ...... Imperforate Penis ..... Squinting ....... A TREATISE OK THE DISEASES OF CHILDREN. SECTION I. ON INFANTS APPARENTLY STILL-BORN. The present exordium is dedicated to the consideration of the state of apparently still-born children, and to point out the most likely means of their animation. And what I have here to offer is the result of an experience that has been attended with more success than might have been expected; at least from anything recorded by preceding writers. I have, indeed, both at the Lying-in-Hospital, and elsewhere, met with many instances of children born with very little, and others without even the smallest appearance of life; some of whom have remained entirely destitute of any sign of it, for more than a quarter of an hour, and yet have been happily restored. I pretend to little or no skill in this business, not generally practised, and can scarcely guess to what to attribute this success, unless it be an unwearied assiduity and perseverance in my attempts, whensoever there are no certain signs of death, till I conceive nothing is possibly to be expected from them. And this has so often succeeded, that I have been tempted to think its importance may not have been sufficiently attended to by every practitioner. I rest this presump- tion not only upon some fortunate events where I have had little or no previous ground for hope, but where other practitioners had, in some instances, abandoned it. A certain steady perseverance in our attempts to preserve life, as long as the least hope may re- main, is indeed not only a duty we owe to the public, but one successful attempt is an abundant recompense for many failures; especially as I imagine we shall rarely fail whenever there may be the least positive grounds for hope of a favourable issue. As to the means, they consist only of warmth, clysters, stimu- lants, and especially, blowing forcibly into the trachea. 14 UNDERWOOD ON CHILDREN. The ordinary stimulants are the smoke of lighted brown paper, or tobacco; juice of onions ; frictions with hot cloths, and with brandy ; cold brandy poured on the thorax, and on the funis umbi- licalis, where it is inserted into the belly ; striking the nates, and the soles of the feet ;* stimulating the nose and pharynx with a feather (drawing out the mucus that may present) ; with every other similar means calculated to excite a strong effort, especially that of crying; to which, and a consequent free respiration, our attempts ultimately tend. On this account, I believe, no benefit is to be expected from stroking the blood along the funis, or im- mersing the placenta in warm water; the foetal life being extinct, the recovery of the child will depend on the blood passing freely through the lungs, which it cannot do till the child is brought to breathe freely and forcibly; the continuance of which also is never secure till it begins to cry. To these ends, I have depended above all upon blowing into the trachea, through the mouth ; which I am satisfied may be more effectually done by the moutht of the assist- ant being placed immediately upon the child's, than by means of a blow-pipe ; although the air is certainly less pure ; at the same time preventing the return of the air before it has entered the lungs, by the fingers of one hand placed at the angles of the mouth, and those of the other on each side of the nose. But I have sometimes imagined that I might attribute much of my success not only to the continuance of this, but to the manner of doing it: by attempt- ing to imitate natural respiration, by forcing out the air I have thrown in, by a strong pressure against the pit of the stomach; thus alternately blowing in, and pressing out the air, for a long time together, omitting it only now and then, to make use of some of the above-mentioned means. I believe, however, that these means can do very little to insure the life of the child, until it begins not only to gasp, and that with shorter intervals, but also to breathe in a somewhat uniform manner. At this time, should the child not be disposed to cry, which is frequently the case, nothing seems so likely to succeed as a tobacco,X brandy and water, or other very stimulating clysters ; or putting a little Scotch snuff, or other pun- gent powder, up the nose : which latter, if they induce sneezing, will soon be followed by a strong cry, and the child be with cer- tainty restored. *A very general excitement of nervous energy is frequently produced, by gently rubbing, and irritating the soles of the feet with a nail or a tooth-brush. — S. M. f Perhaps the warmth imparted to the lungs of the infant by the breath of the operator, may be the means of rendering the vitiated air thus thrown in more efficacious than the more pure, but cooler atmospheric, air would prove. The objection frequently made, that it must be wrong to breathe into the lungs of a still-born infant from the mouth of the attendant, because the air is contaminated, is certainly shown by experience to be invalid. — S. M. £ Tobacco clysters so often produce syncope, that it seems extraordinary they should be recommended in such a case as this. All direct sedatives, of which tobacco is one, are likely to be prejudicial in this 6tate. — S. M. ON INFANTS APPARENTLY STILL-BORN. 15 Amongst other means, that of warmth is very essential, to which end, the infant should be entirely covered with very hot cloths, which should be renewed as fast as they become at all cool; or the body may be immersed in a tepid bath of salt and water, or milk, aud be well rubbed all over: the cord may likewise be suffered to bleed a little, especially if the face or body do not soon acquire the natural colour — but this ought seldom to be done, nor ought the funis to be divided as long as any pulsation is to be felt in it.* To these means may be added the cautious use of electricity, which appears as likely to be as successful in these, as in most other cases to which it has been applied, but I have never been in a situation to make trial of it in time, or I certainly should ; as I once knew a child happily recovered by it, after being laid out for dead for near two hours, in consequence of a fall from a two-pair of stairs window. The very great success of the means recommended by the Humane Society, in restoring life to drowned persons, after two or more hours have elapsed, may be advanced as a further induce- ment to steady perseverance in the plan proposed. For if an infant be not born positively dead, it is well known that the vital spark, though long dormant, may be roused into action : and the living principle, if respiration be promoted, will extend its influence through the animal frame, nor will fail to support itself, if no vital part has been injured in the birth. But should these several means fail, as a last resource, a very different kind of stimulant may be tried, and instead of laying the infant aside in a warm flannel, it should be exposed to sudden and severe cold; which I remember in one case succeeded, after the life of the child had been entirely despaired of. Mr. Herbolt, of Copenhagen, has conceived that many infants perish from the trachea being filled with water; and that infants in these circum- stances might in general be saved, by placing them in such a posi- tion that the water should run out.t I shall just add, that, amongst other symptoms supposed to prove that the child may have sustained irrecoverable injury in the birth, is that of a discoloured and often fetid, or bloody water * I have never found it beneficial to let the funis bleed, except in that particular case of incomplete animation, where from long continued, or very great sudden pressure, the face and head are tumid, dark coloured, and overloaded with blood ; where the pulsation in the funis is heavy and oppressed ; and the heart is labouring to maintain the circulation. Under these circumstances, to let the funis bleed to the extent of two or three table-spoonfuls, is good practice; otherwise it is not expedient to divide the funis, as long as the circulation between the child and the placenta continues strong. — S. M. f Before any attempt is made to expand the lungs of a child by breathing into them, whatever mucus or fluids may be in the mouth or fauces should be removed. This may be effected by passing the little finger, covered with the fold of a hand- kerchief or s*ft napkin, into the mouth, and wiping away what may be there col- lected. This should be repeated occasionally, as fresh mucus may accumulate, after the lungs have been made to expand and respire. — S. M. 16 UNDERWOOD ON CHILDREN. forcing out of the nose, after the lungs have been two or three times artificially inflated. Under these circumstances, however, I have succeeded, in two or three instances, so far as to animate children sufficiently both to breathe and to cry ; though they after- wards lay in a moaning state for four or five hours, and then expired. To succeed thus far, indeed, if I am rightly informed, may prove of importance, where the course of a family estate may be pending on a living child. I have, however, been fortunate enough to succeed more completely under the most unfavourable circumstances, and, in one instance, after a great quantity of dis- coloured mucus, and something like meconium, had been forced up both from the throat and nose, restored an unusually large child to life. It will be presumed, I dare say, that the above scrupulous atten- tion is not designed to be inculcated in every instance of apparently still-born infants; but where the death of the child may not only not be certainly ascertained, but there has previously been reason to expect it would be brought alive into the world, every possible exertion should be made and persevered in. The great importance, however, of the subject, it is hoped, will be a sufficient apology with most readers for the length of these directions; and as the attempt to restore infants to life has always been a most pleasing employment to myself, the desire of being an occasion of inducing others to a perseverance in the use of the like means, emboldens me to risk the censure of any who may deem it prolix or super- fluous. [The author's anticipations have been fully confirmed by later experience, and especially by that of my friend, Mr. Toogood, of Bridgewater, who has published some interesting cases in point, in the London Medical and Physical Journal, New Series, vol. iii., p. 99, for August, 1827. They are also in perfect accordance with the well-known physiology of the newly-born and very young animal, compared with the same species of adult age.* I. The first object is to excite respiration; and the means of doing so are these : — 1. The fifth pair of nerves should be excited by forcibly dashing very small quantities of cold water on the face, .or by stimulating the nostrils by ammonia, snuff, pepper, or the point of a needle. 2. The spinal nerves should be excited by forcibly dashing cold water on the thorax, and on the thighs, or by tickling, or stimulating the sides, the buttocks, the arms, the soles of the feet, &c. AVhat the par vagum is, as the medium of excitement of the respiration, in ordinary circumstances, the fifth pair, and the lateral spinal nerves, are in other circumstances : it is certain, at least, that • t^pVl16 sP,.e.ndjdJv°rk °fMr' ?dwards 5 and a paper by the p'resent Editor, in the Philosophical Transactions, for 1832, p. 321.— M. H.] ON INFANTS APPARENTLY STILL-BORN. 17 the means recommended frequently induce an act of inspiration, which proves the first of the series so essential to animal life. II. If these attemps to excite respiration fail, inspiration is to be imitated by artificially distending the lungs. 1. To effect this the practitioner's lips are to be applied to those of the infant, interposing a fold of linen, and he is to propel the air from his own chest, slowly and gradually into that of the infant, closing its nostrils, and gently pressing the trachea upon the oeso- phagus. The chest is then to be pressed to induce a full expiration, and allowed to expand so as, if possible, to effect a degree of inspi- ration. 2. But it is important in doing this, that the practitioner himself should previously make several deep and rapid inspirations, and finally a full inspiration. In this manner the air expelled from his lungs into those of the little patient, will contain more oxygen and less carbonic acid, and consequently be more capable of excit- ing the dying embers of life.* III. 1. In the midst of these efforts it should, in the next place, be the office of two other individuals to maintain or restore the temperature of the little infant, by gently but constantly pressing and rubbing its limbs between their warm hands, passing them upwards in the direction of the venous circulation. 2. When respiration is established, the face must still be freely exposed to the air, whilst the temperature of the limbs and body is carefully sustained. 3. As soon as possible, a little warm liquid, as barley water, at blood heat, should be given by means of the proper bottle fur- nished with leather or soft parchment. A tea-spoon must not be used for fear of choking. If the infant draws the liquid through its own lips, by its own efforts, there is no danger. IV. Lastly, if all these remedies should be tried in vain, I would strongly advise galvanic or electric shocks to be passed from the side of the neck to the pit of the stomach, or in the course of any of the respiratory nerves, and their appropriate muscles. No time should be lost in sending for a proper apparatus ; but should the lapse of an hour, or even more, take place, before it can be ob- tained, still it should be sent for and tried. — M. H.] * [I found this suggestion in an interesting communication by Dr. Faraday, in the London and Edinburgh Philosophical Magazine, vol. iii., p. 241, for Oct. 1833 It is ascertained that respiration may be suspended longer, as in diving, or in experiments, after such repeated forced inspirations, than in ordinary cir- cumstances, from the greater purity of the air in the lungs. — M. H.] 2* IS UNDERWOOD ON CHILDREN. SECTION II. ON THE MANAGEMENT OF INFANTS. ON DRY NURSING. Amongst the multifarious matter brought forward in the follow- ing pages, the aliment most adapted to infancy is one of the first importance. Previously, therefore, to treating of diet more ex- tensively, and the general arrangement of children, I shall enter into a discussion of the case of infants intended to be reared without the breast, or brought up, as it is termed, by hand, — a subject esteemed to be of the first importance by writers and practitioners in every age. An attempt to set forth all the improprieties of this mode of training up infants from the birth, would carry me altogether beyond the limits I have assigned to the work. It would be un- pardonable, however, in a work of this sort, not to insist how inadequate every substitute for the breast has been universally found ; and therefore how proper it is, that every child should be suckled, and always by its own mother, where her health can safely admit of it. Reason, instinct, experience, all conspire to support this opinion ; and whoever will determine to attend only to matters of fact, may soon be convinced of it.* Nature herself points it out: all the nobler part of the irrational creation is quali- fied for it, and by instinct obeys — the human race alone, possessed of nobler powers, and rational discernment, perverts those facul- ties to evade its dictates, and to invent excuses for refusing its claims. But puerile, indeed, are all arguments against it, in the greater number of instances ; and herein Dr. Armstrong! seems to have egregiously erred; for though, apparently, an advocate for suckling, he has laboured for arguments to apologize for the spoon and the boat, in too many instances.;}: It were easy, perhaps, to * The duty of suckling has the sanction of almost every writer, as well as of many persons of r;.nk; and is distinctly noticed in the remote times of Pliny. Van Swieten remarks, that one of the queens of France suckled her own son, and continued it even during a fever. One of her ladies, however, having, on some occasion, given the child her breast, the Queen was so much disgusted at it, that she forced her finger into her son's mouth to excite vomiting, unwilling that it should receive any nourishment but from herself. f Rules to be observed in the nursing of children, with a particular view to those who are brought up by hand, 1777. X I do not recollect to have seen anywhere such good directions for bringing up children by hand, as those published in a little volume, entitled, " Advice to Young Mothers on the Physical Education of Children. By a Grandmother." [1823.] They are much more appropriate and judicious than those of Dr. Arm- strong ; but neither the Grandmother, nor Dr. Armstrong, nor any other of the advocates for dry nursing, seem to be aware of the great fatality which attends ON THE MANAGEMENT OF INFANTS. 19 produce as sound arguments against eating more than once a day, because so many people become diseased from excess. On the other hand, a new and very rational argument in favour of breast- milk, is advanced by Mr. Moss, who observes, that the gastric juices of every animal may be supposed to be the best suited to act upon its respective milks. But not only is the breast-milk the only natural,* and most pro- per food for infants, (experience demonstrating no artificial one to be equally easy of digestion and nutritious,) but suckling conduces likewise to the easy recovery of the mother, though she should not be able wholly to support her child by the breast, nor to continue suckling so long as the infant may require it. But though, from much experience, I venture to give this opinion, I do by no means intend to assert that every mother is able to suckle her child, even for the month, or would do well to attempt it; but I am, never- theless, equally satisfied, that many are very well able who do not; and that several, who have only through fear been discouraged from doing it in two or three lyings-in, having afterwards been prevailed upon to make the attempt, have gone on with it several months, enjoyed better health when they suckled than at any other part of their lives, and their children have thriven perfectly well. Art and management will likewise afford some assistance, when the natural constitution alone may not be fully equal to the task. In this view, besides a suitable diet, air, exercise, and a regular manner of living, I will venture to recommend cold bathing, espe- cially in the sea, if the season of the year should permit; and this not only from my own experience, but that of the writer just quoted, who asserts that it is often found particularly useful in restoring the strength, and increasing the milk in nurses of a weak constitution ; adding, that it can never do any harm to a woman merely as a nurse, where no other reason, independent of that the attempt thus to rear children. It has been a part of my duty to endeavour to ascertain the amount of mortality among infants from this source ; and after much careful inquiry and investigation, I am convinced that the attempt to bring up children by hand, proves fatal, in London, to at least seven out of eight of these miserable sufferers ; and this happens, whether the child has never taken the breast at all, or, having been suckled for three or four weeks only, is then weaned. In the country, the mortality among dry nursed children, is not quite so great as in London, but it is abundantly greater than is generally imagined. The summer [in Great Britain] is the most favourable season fcr making the attempt; but if parents were fully aware of the hazard to which their children are exposed, in the endeavour thus to bring them up, they would rarely choose to place them under the care of the dry nurse. — S. M. * In some very northern parts of the world, as those of Greenland, and the neighbouring country of the Esquimaux, the breast appears to be, in the strictest propriety cf speech, the only food that nature has provided for infants ; insomuch that, whenever a suckling mother happens to die, her infant is buried with her ; experience (one would hope) having demonstrated the inerficacy of the hard and coarse diet which nature has there so sparingly dealt out, it is esteemed an act of compassion to put an end to an infant's sufferings by plunging it into the sea. 20 UNDERWOOD ON CHILDREN. situation, forbids it. The principal caution necessary, being not to bathe too frequently ; more than twice, or at most three times a week, beinsr often injurious to delicate habits. Thus, besides the advantages derived to infants, it appears that there are others resulting to the suckling mother, and some deserving a fur- ther notice. For by this means, where due care is taken, painful in- flammations and suppurations in the breast may often be prevented, as maybe fairly concluded, not only from the rarity of such complaints in theBritish Lying-in Hospital, where almost every woman suckles her infant, but from the like authority of Dr. Nelson, who reports, that " out of 4,400 women who suckled their children, only four had milk-sores, and that these had either no nipples or former sore breasts." It has likewise long been suspected,and of late years more generally imagined, that some of the worst fevers, and more rare ill effects of child-bearing may be prevented by suffering the milk to flow duly to the breasts, and be freely drawn from them, though only for the month. These advantages, one should hope, might tend to induce ladies of rank to set a general example, by performing this kindest and most pleasant office, at least during the month.* But it would be unjust not to add, that whenever they may pur- pose to assume it for a much longer time, they should determine to do it effectually, or they will but injure their children, as well as forfeit many of the advantages and comforts which, in a due exe- cution of it, they would have a right to expect. For a long time, however, writers have successively complained, that notwithstanding the many encouragements often brought to the ears, and urged upon parents, the tyrant, Fashion, has prevailed over the good sense and natural feelings of many, whose maternal * I cannot agree in opinion with Dr. Underwood, that it is right to recommend ladies to suckle, "though only for the month," if they do not intend, or have already determined, not to persevere in performing that office. On the contrary, I think, if they are to suckle their children " only during the month," that it is better, both for themselves and their infants, who, under these circumstances, are never half suckled, not to make the attempt for that short time. The first month of suckling is confessedly attended with more of uneasiness and suffering than is afterwards felt; indeed, after the first difficulties are over- come, this duty is accompanied with sensations of the greatest pleasure and de- light; and it seems cruel to rpquire of the mother to undergo all the trouble and pain of suckling, when she is to be debarred of all its pleasures. But we are told, " It has long been suspected, and of late years more generally imagined, that some of the worst fevers, and more rare ill effects of child-bearing, may be prevented by suffering the milk to flow duly to the breasts, and*be freefy drawn from them, though only for a month." If this be only suspected and imagined, much dependence cannot be placed upon the opinion. As regards the mammary abscess, I have much more frequently witnessed its occurrence when the mother has attempted to suckle for the month only, than when she has altogether declined putting her child to the breast. Certainly, if the mother is not to nurse her babe, particular care ought to be taken to guard against fevers, and other ill consequences, and with such care they are not much to be dreaded! The suckling of an infant is too serious a matter to be played with ; and if there be not a reasonable hope that the mother will be able to perform this duty com- pletely, she had better at once resign the charge.__S. M. ON THE MANAGEMENT OF CHILDREN. 21 affections can be, in no other instance, suspected. There are honour- able exceptions, however; and it is with great pleasure that I have been able to observe, in the later editions of this work, that ladies of rank are every year becoming converts to this maternal duty, and are proud of supplying their offspring with that due nourishment, wherewith nature has purposely endowed them. Another important and affecting consideration might be brought forward on this head, which I shall, indeed, only touch upon, as it calls rather for the pen of the moral philosopher than of the phy- sician ; I mean the sacrifice which poor women make in going out to suckle other people's children, the sad consequences* of which are often severely felt by their own, through neglect or misma- nagement, and especially for want of the breast. Indeed, no atten- tion of the nurse can duly compensate this loss, as only the most common substitutes for it can, in their forlorn circumstances, be allowed them. This has become a source of evil that, I fear, has not been sufficiently thought of, and has led to the sacrifice of many infants every year; a matter of serious importance, indeed, to the public, as well as to the families immediately concerned. It gives me real concern to find occasion for the least unpleasant reflection upon any part of the sex I so much honour, and upon any of my fair and sensible country-women in particular ; never- theless, I cannot help suspecting, that wherever any neglect of parental duties may exist, whether in regard to suckling, or super- intending the management of their children, that does not arise from want of health, or some equally warrantable excuse, it can be charged only on the depravity of the age, which insensibly corrupts the taste, and perverts the judgment of many who wish to do well; and depravity of manners, when once become general, has ever been considered as the leading symptom of a falling empire, and ought to be pointed out, as far as it extends, by every friend to the community, at whatever hazard of giving offence, in every conspi- cuous instance of it. Tacitus complains of the degeneracy of Rome in his days, though by no means its most degenerate era, lamenting that while in former times grave matrons attended to their children as their first family concern, they now, says he, intrust them to the care of some Grecian girl, or other inferior domestic. It is no small satisfaction to me, however, to observe, that in this country there has been no ground for much complaint on this head, and that the ♦It is indeed a lamentable reflection, that there should be such a sacrifice of health and life among the children of those women who hire themselves out as wet nurses. Dr. Clarke, in his " Commentaries on Children's Diseases," speak- ing of the prodigious mortality among these children, says, " In some families six, in others eight wet-nurses had lost their own children." If ladies who em- ploy wet-nurses were, in commiseration of the suffering of these unhappy infants, so far to interfere in their behalf, as to insist upon having them placed out under the care of sober, cleanly persons, and in open, airy situations; and especially if they would refuse to take a woman whose child is very young, unless a wet-nurse were procured to suckle it, they would be the means of preserving many lives, and of preventing much of lingering sufferance to these poor victims. — S. M. 22 UNDERWOOD ON CHILDREN. evil is annually diminishing; there are also examples of the first magnitude of a nobler conduct; and one at the head of all, which, wore it copied without exception in domestic life, would prove the glory of the present day. and a blessing to the rising generation. — May the time hasten when it shall be universally followed by her inferiors, whilst I attempt to point out, as far as my observa- tion has extended, the most prudent mode of executing this im- portant branch of female duty. It may not be amiss, at the opening of the ensuing observations, to remark, that the demand for the multifarious directions here offered, as well as all those given by others writers on the manage- ment of children, arises from the false reasoning of those to whose care the infant-state is frequently intrusted ; who, instead of being guided by the sober dictates of nature, have adopted the rules of art, falsely so called, or have followed the wild fancies of anile super- stition. On the other hand, the various tribes of the irrational species act in a thousand instances more prudently than we do ; and. being uniformly guided by instinct, are led implicitly and safely through all their operations. Many quadrupeds, fish, fowls, and even reptiles, seems to know what is proper for them as soon as they come into existence, and have strength sufficient to reach after it. In other in- stances, they are guided by the parent, who seems to adjoin some degree of knowledge acquired by experience, to the instinct with which it is endowed ; and gradually lead on its young to imitation, whether it be to eat, to swim, or to fly. Man, on the contrary, de- signed to be the pupil of observation, has scarce any innate discern- ment; and consequently, his infant race pass through a long period utterly helpless, alike divested of ideas to guide, and of strength to manage for themselves; but to the parent is imparted both, whose province it is to judge for them,and actually to put into their hands or mouths whatsoever they may stand in need of. When the parent, therefore, forsakes the paths of simplicity, and lays down arbitrary rules, the result of false science, instead of patient experience, or mis- takes the clamour of fashion for, or prefers it to, the voice of nature,con- fusion and disease must be the unavoidable consequence. Awaken- ed by these, man is loudly called upon to return to the simplicity of nature, and the result of dispassionate observation. To lead to this, will be a principal intention of this work, wherever danger and deviation are connected; assured that the experience of the most judicious and successful practitioners will applaud the design, and confirm the generality of the following observations on the general management of infants. [I must seize this early opportunity of strongly recommending a very little volume on the subject of the present Section, entitled » Letters to a Mother, on the Watchful Care of her Infant,"* which » Published by Seeley and Burnsidc, Fleet street. ON THE MANAGEMENT OF INFANTS. 23 I shall have occasion to quote repeatedly in the course of the first part of this work. — M. H. The author observes, — I have long considered that the duties of a mother to her children involve many circumstances not usually imagined to belong to them. And, chiefly, I regard the mother as the natural guardian of her infant's health. I do not mean that she is to supply the place or to undertake the office of the physician, which would be preposterous; but that she should be the watch over her child, and the alarmist if its health should become de- ranged. Do not therefore expect a system of quackery in these letters; a set of nostrums for infantile complaints. I have a far higher and nobler object in view. It is to enable you to judge when your infant is threatened with danger, and so to send for medical aid — before it is too late ! Physicians have, indeed, so often to regret that they are sum- moned in infantile diseases when the monitory signs, in cases of a sudden or insidious attack, have passed away unheeded, and when the disease has been allowed to run its course to a fatal stage, that I think it not only a legitimate undertaking, but an imperative duty, to speak to you first and principally of those monitory signs. And in order that you may become this guardian of your infant's health, it is absolutely necessary that you should be its nurse. In every point of view, then, I must consider this as your first and most imperative duty. The mother's milk, and the mother's warmth, are the proper sources of nutrition and of heat to her own infant. It should draw no other breast and lie upon no other arm. In order that the milk may be wholesome, the health of the nurse must also be unimpaired; her diet must be rigidly simple, the bowels carefully regulated, and every rule of health, even such as bodily exercise and mental quiet, must be undeviatingly observed. Who but a mother will submit to this system of discipline and self- denial ? Yet, if the diet be improper, — if the bowels be neglected, — if exercise be not duly taken, — if the mind be subjected to anxiety and care, the infant will assuredly be exposed to danger. In these circumstances, indeed, lie the hidden springs and sources of many an attack of convulsion, which the infant may not survive, or which it may survive with an impaired intellect or crippled limbs. This is a subject scarcely thought of by mothers; but it is one full of importance, and its neglect is fraught with the most melancholy consequences. It is notorious that the lower ranks, from which wet-nurses are alone taken, are indifferent as to the rules of diet, prone to indul- gence, and totally reckless of the state of their bowels. And as the wet-nurse has usually disposed of her infant, by " placing it out," as the phrase is, she is, if she have any tenderness for it, continu- ally a prey to anxiety on its account. It can therefore scarcely be, 21 INDERWOOD ON CHILDREN. but that her milk will he more or less morbidly affected, and thus become the hidden and unsuspected cause of indispositions, tne origin of which will be erroneously supposed to exist elsewhere. Further, wet-nurses are commonly very dishonest, and become quacks, and tamper with the infant's health by giving medicines. Many a tea-spoonful of spirits, and many a drop of laudanum, are swallowed by infants, unknown to their mothers. A present inconvenience, such as wind, or pain, is thus often removed, at the expense of much subsequent danger. Nursing her own infant, the mother becomes the watch over its growth and development; over its health, its happiness. Have you never seen an infant rickety because it was ill nursed ? Have you never known insidious and incurable diseases to steal on from a similar cause ? Have you not an eye also to see that one infant is happy, and another miserable, although but an infant? Be assured 'that it is often the mother's fault, if the infant's limbs be crooked, or its mind unhappy; or, I had almost said, if its health be impaired. To every mother, then, the care of her own infant and child is to be committed in its largest, broadest sense. She is first to submit herself to all those rules of diet, medicine, exercise, and quiet, which are essential to insure her own good health. She is then to supply her own infant with milk, and with warmth ; and for this latter purpose she should lay it by her own side in the night. She should become, in the third place, the superintendent of its health, detecting the first signs of indisposition, and seeking immediately for the remedy. Nor does the mother's office terminate even here. But she will go on to superintend the development of its bodily and its mental powers, its dispositions, and its affections. And now let me ask you what you think of a mother's duties ? Are they so trifling that they may be fulfilled by a hireling, desti- tute of feeling, of intelligence, and of education ; who will let your infant cry, or make it cry, without even imagining that it is ill in the first case, and made so in the second ? — that its temper is injured, its mind corrupted?"] THE GENERAL MANAGEMENT OP CHILDREN. Let us imagine an infant just born, who, at this moment, calls for our best attentions. At first, it may be observed that it ought not to be exposed to anything that may violently or too suddenly affect the senses; on which account Moschion and Albinus have well advised, that it should not be exposed either to great heat or cold; not to a strong light, nor odours of any kind, however grateful to adults; the unpleasant effects of which are sufficiently manifest- ed by the infant itself. It is hoped I may be allowed, in this place, to introduce a caution on the too early attention to mental improvement, which is, more frequently than seems to have been ON THE MANAGEMENT OF INFANTS. 25 imagined, essentially injurious both to the bodily health, and future progress of the mental powers; and I have myself known one or more decided proofs of its inducing a confirmed fatuity. The attention will next be called to the washing and dressing it, together with other little offices suited to the occasion; and this first washing is of greater importance than is usually imagined, being amongst the little things which are often overlooked by writers and others, and by some thought of no consequence ;* but it is not every little thing that may safely be neglected, or carelessly done. In regard to poor people especially, and infants born in hospitals, and other crowded apartments, the importance of proper washing is greatly increased; the foulness left upon the skin being a remote cause of some dangerous epidemic complaint.t Some infants also are covered much more than others with a thick viscid matter, which cleaves so firmly to the skin, that it is not easily washed off. There are, however, many reasons why this should be done ; and one very sufficient reason is, that the presence of this foulness is likely to obstruct perspiration, which can never be duly performed where the skin is left anywise foul. On this account nurses should be directed to be very attentive to this first concern of their infant charge ; and whatever wash:]: they make use of, it should always have soap in it, and the child be well rubbed and cleansed, especially under the arms, in the hams, and groins, where this mucus is apt to adhere : and to this end it would be better that no pomatum should be made use of, or other grease, which tends to stop up the pores, and prevent perspiration. In the same view it were well if it were a common practice to repeat the washing for two or three days, with light friction of the skin ; which it is not improbable might tend to prevent the red gum, and other similar affections of the skin, with such other complaints as may arise from the suppression of insensible perspiration. After a little time, and sometimes on the next day, most nurses wash a child all over with cold water, a practice highly extolled by Dr. Armstrong, as well as many other practitioners ; but though no one can be a greater advocate for everything that is bracing than I am, I cannot approve of this substitute, as it is called, for other bathing. The cold bath acts on quite a different principle, and is so very beneficial, that I could wish almost every child, especially those born in London, were bathed at three or four months old, (provided they be not costive, nor feverish,§ at the time, * Dr. Hamilton. f See Baumes on the Jaundice and Mesenteric Fever. j A mixture of soap and water, with the addition of a small quantity of brandy or any other kind of spirit, appears to remove this viscid, tenacious scurf more readily than any other wash. It should always be of a pleasant warmth as to temperature. — S. M. J That Dr. Underwood's strong recommendation of the cold bath should have greatly influenced many mothers and nurses to employ it, cannot be doubted. It is to be feared that, on many occasions, the rule he has laid down has been remembered, while the very important exceptions have been overlooked or for- 3 21 > UNDERWOOD ON CHILDREN. have no internal obstruct ions, nor the season of the year be im- proper) which I am certain would remove, or perhaps prevent, many of their complaints.' But to see a little infant of a few days gotten ; and the consequence has been, too often, the abuse of a beneficial prac- tice. So many instances have occurred, within my knowledge, of cold bathing, improperly and injudiciously adopted, having been productive of serious ill effects, that I should ill perform the duty of an editor, did I not caution my un- professional readers to be extremely circumspect, before they adopt the use of so powerful an agent as the cold bath, not only as regards infants, but children farther advanced in life. — S. M. * Mons. Le Febure de Villebrune, in his translation of this work into French, has added a chapter upon baths ,• in which he highly extols the warm-bath, and as strongly controverts the idea of the probable good effects of cold bathing, and even makes use of a long chain of arguments against it; deduced, indeed, from an ingenious theory, and supported by quotations from the ancients, who prac- tised, however, in a very different climate. The shortest, and perhaps the best reply to this specious reasoning, might be given in the well-known mode of Diogenes to Zeno, whose metaphysical arguments against the possibility of mo- tion Diogenes laconically refuted, by hastily getting up, and walking across the school. We have, in like manner, only to point to the numbers of children and young people, who, from very weakly infants, have been rendered strong and healthy, merely from a prudent use of ihe cold bath,- and may defy any man to produce the like instances of its opposite effects, when made use of with the cautions which every powerful remedy requires. The Spartan women, likewise, afford us sufficient evidence of the salutary effects of cold bathing, notwithstand- ing the comments made upon the women themselves, by Aristotle, as quoted by our author. So great, and oftentimes surprising, indeed, are the good effects of cold baths, that I do not wonder the priests, in times of ignorance, have been known to ac- count them holy, and dedicate them to some saint, to whose influence certain cures were attributed. The salutary operations of the cold bath are, however, easily accounted for, from its promoting insensible perspiration, and rendering that excretion less readily affected by the impression of external air. It may be known to agree with children, when they come out of it warm and lively, and their strength increases on the use of it. On the other hand, if they continue cold, are dispirited, and seem rather to lose strength, it will be as cer- tainly prejudicial. As a means, however, of acquiring that reaction and glow, which bathing is destined to effect, a loose flannel chemise may be thrown over the child the in- stant it is taken out of the bath. This will not only secure from the unpleasant shock arising from the cold air, but allow time for friction along the course of the spine, which should be continued all the while that an assistant is employed in wiping the lower extremities, and putting on their usual covering If this were duly attended to, I am persuaded that both many infants and aduft persons would be benefited by cold bathing, who, for want of that kindly glow, are unable to bear even bathing in the sea. But I must observe, that the above-mentioned unpleasant effects are frequentlv owing to an improper use of bathing, and for want of makincr a very obvious discrimination in the habit of body of different children. _ FoT the tender and delicate, not only should a good quantity of salt be put into the bath bu the water may also be at first a little warmed, and children be brought only by degrees to endure it quite cold, which they will not by this means be the Ls HkeYy to do; or, should the water never be perfectly so (hut merely below the heaf of he skin) the advantages of such bathing will, ^nevertheless, be^considerable hough the late Dr. Hunter and others, have thought differen\\y. For it s not' indeed, merely from the coldness of the water that the benefit a ises, bu rather ON THE MANAGEMENT OF INFANTS. 27 old, the offspring, perhaps, of a delicate mother, who has not even strength to suckle it, washed up to the loins and breast in cold water, exposed for several minutes, perhaps in the midst of winter, (when children are more liable to disease than those born in sum- mer,) itself in one continued scream, and the fond mother covering her ears under the bed-clothes, that she may not be distressed by its cries, has ever struck me as a piece of unnecessary severity ; and savours as little of kindness, as plunging an infant a second or third time into a tub of water, with its mouth open and gasping for breath, in the old-fashioned mode of cold bathing; both of which often induce cramps and pains in the bowels, and weakness of the lower extremities, but rarely an increase of the strength. It surely must be proper, in winter time at least, to use moderately warm water for the general washing; and all that is required with cold water, is to wash or sponge those parts with it, where any acrid discharge is likely to produce galling or excoriation. [I must protest altogether against that mode of cold bathing which consists in the immersion of the infant, over-head, in cold water. It is a barbarous practice, the suggestion of a vague phi- losophy, — if philosophy it can be called; unsupported by any analogy in animated nature. It exciies a degree of fright in the little subject of such cruelty, the effects of which might be equally terrible to the bystanders. Who can say that the fright and the shock to the nervous system might not issue in convulsion or suffo- cation ? It is also a trial to the powers of sustaining the animal temperature, to which an infant ought not to be exposed. The bath should, indeed, never be used so as to leave an im- pression of coldness, or actual loss of warmth, or lividity of any part of the surface. And when we consider how readily infants lose their temperature, and how slowly they regain it, we shall view the cold bath as one of those measures requiring great pre- caution in infancy. The best kind of bath is a shower bath, of great simplicity, newly brought into use. It consists of a tin vessel in the form of a large bottle, pierced at the bottom like a cullender, from the subject being immersed into a very different medium, in which the con- tact of the external air is taken off during the immersion, and is as suddenly restored on his being taken out. By this means the blood is alternately pushed forward into the extreme vessels, and suddenly repelled to the heart (in propor- tion to the coldness of the water and the powers of the system), and suffers an advantageous attrition against the sides of the vessels. The small passages are rendered pervious, and the contractile power of the heart is increased, as well as the muscular fibres proportionally strengthened. The salt added to the water pretty certainly prevents taking cold, whilst it adds to the stimulus on the skin, and has, therefore, a more salutary operation on the pores. The infant having been put quite under water, should be taken out as soon as it is possible. It should be received in a blanket, and wiped dry with a cloth in the most expeditious manner; and, as soon as it can be dressed, should par- take of such exercise as may be suited to its age. There will need no great attention to its being made perfectly dry, as a child will be less liable to take cold from a few drops of salt water being left upon it, than by being long uncovered in some part of its body, in an over-caution to wiping it dry. os} UNDERWOOD ON CHILDREN. and terminating, in the upper part, in a narrow tube: when put into water it becomes filled with this fluid, which is retained by placins the finger upon the tube ; on removing the finger, the water flows out gradually. The quantity and the temperature of the water musrbe proportionate to the age and powers of the child, the weather, and the season. It should be warm or tepid for infants at first; afterwards it may be used a little cooler. Its tonic effect may be augmented by the addition of bay salt, and by much active rubbing. The first few baths may be quite warm, and made a sort of amusement, until the infant is familiar with the little shower. It may gradually be made a remedy. Ami if it were universally used night and morning, in this metropolis, I think the benefit to the health of the rising generation would be extremely great. — INI. H.] See Bell on Baths and Mineral Waters. ON THE FIRST CLOTHING OF INFANTS. Upon the first sight of a new-horn infant, every one is struck with the idea of its weakness and helplessness ; and we often take very improper methods of strengthening it. It is designed to be weak and tender in this infant state, as is every object around us.* Take a survey of nature, from the first opening leaves of the vernal flower, or the more delicate foliage of the sensitive-plant, to the young lion or the elephant; they are all, in their several orders, proportionally weak, and cannot exist without some exterior support: but they stand in need of nothing but what nature has prepared for them. If seed be cast into a proper soil, it wants only the surrounding elements to insure vigour and maturity. So, if the tender infant be born of healthy parents, and at its full time, it is usually sufficiently strong; proper food and nursing (with ordi nary attentions to screen it from the extremes of heat and cold) are the elements whose fostering influence it requires : if it have these, it will need nothing more. It is true it is very weak ; but is it therefore to be tight rolled, under the idea of supporting it, and giving it strength ? It is a bundle of tender vessels, through which a fluid is to pass uninter- rupted, to be equally distributed through the body, and which are therefore surrounded by a soft medium, predisposed to yield to the impetus of their contents. Hence we cannot but conceive how injurious any great pressure must be to so delicate a frame, which before birth swam in a soft fluid. But besides this, the infant requires freedom and liberty on other accounts ; the state of infancy and childhood (as Dr. Gregory observes) is impatient of restraint in this respect, through " the restless activity incident to youth, which makes it delight to be in perpetual motion, and to see every- thing in motion around it." * Nous naissons foibles, nous avons besoin de forces; nous naissons depour- vus de tout, nous avons besoin d'assistance; nous naissons stupides, nous avons besoin de jugement? tout ce que nous n'avons pas a notre naissance, et dont nous avons besoin, etant grand, nous est donne par l'education. — Rousseau ON THE MANAGEMENT OF INFANTS. 29 Let us again advert to the irrational species, whose more saga- cious conduct so often disgraces our own. There is no occasion on which they do not seem to consult propriety ; and, having a right end in view, they as certainly accomplish it, and always in proper time. Doth a little bird desire to prepare a lodging for her young, it is sure to make choice of the fittest situation, whether to defend them from dangers, or obtain the most convenient supply of their wants ; if to this end it is necessary to construct the nest of rough and strong clay, it is still lined with down : the young lie warm and secure, but they lie at their ease. "In this view of nature (says a good writer*) we shall find the birds not only provide nests for their young, but cover them with their wings, to guard them from the chilly air, till time has in- creased their feathers. The beasts, with amazing tenderness, cherish their young till nature has lengthened the hair, the wool, or whatever covers them, or time has given them the power of action. Further, we shall find that insects, and all the vegetable creation, shoot out into life, and receive vigour, comfort, and sup- port, from that glorious body the sun : so indispensably necessary is warmth, and so essential to the raising and preserving of all." But, necessary as warmth and support most indubitably are, they must not be obtained at the expense of liberty and ease ; which, during the fragile state of infancy especially, are of peculiar im- portance. I am not ignorant, indeed, that for many years past, the very ancient tight mode of dressing infants has been discontinued, for which we were probably first indebted to Dr. Cadogan. It is certain, also, that for the last forty years the fashion recommended by him has been improving; but there is yet room to go forward : and were every tender parent in this country thoroughly sensible of its advantages, it would soon become fashionable to see children as much at their ease on a christening day, as they are at night when laid in their beds. And I may be permitted to add here, what every modern practitioner has adverted to, that were strings, almost in every instance substituted for pins, physicians would seldom be at a loss to account for the sudden cries and complaints of infants, which are too often produced by this, needless part of their dresst — a practice, it is to be hoped, which may in time be laid aside, since some of the first families in the kingdom have- already set the example. Nature knows no other use of clothing but to defend from the * Nelson; whose Treatise on Health I have perused-with more satisfaction than most of the modern productions that I have examined, because hehas taken nature for his guide. | A gentlewoman many years ago informed me, that one of her children, after long and incessant crying, fell into strong convulsions, which her physician was at a loss to account for ; nor was the cause discovered till after death ; when on> the cap being taken off, which had not been changed on account of its illness, a small pin was discovered, sticking up to the head, in the large fontanelJe.. a* 30 L'NDERWOOD ON CHILDREN. cold ; all that is necessary, therefore, for this purpose, is to wrap the child up in a soft, loose covering, and not too great a weight of it; to which ornaments enough might be added without doing mischief. And had this matter been always left to the most ordinary discretion of parents, this is probably all that would have been done ; but the business of dressing an infant has become a secret, which none but adepts must pretend to understand. The child itself, however, discovers to us the propriety of such clothing, by the happiness and delight it expresses every time its day-dress is removed, and its night-clothes put on, which are looser, and less thick than those worn through the day, and the lower limbs less confined. The art of dressing has laid the foundation of many a bad shape, and what is worse, of very bad health through the greater part of life. Instead, therefore, of a scrupulous and hurtful attention to such formalities, nurses would be much better employed in carefully examining new-born infants, in order to discover any malformation of parts, especially those concerned in the excretions necessary to life, which have sometimes been strangely overlooked. The infant being dressed, and having undergone such other little discipline as has been mentioned, is usually so far fatigued by it, as soon afterwards to fall into a sound sleep : we shall consider it as in this slate, and leave it awhile to be refreshed, whilst I endeavour to conduct my reader through the various other duties which the infant calls for, from day to day, till it happily arrives at an age free from the peculiar hazards of infancy. In the pursuit of such a plan, we meet with a variety of miscel- laneous articles; and though many of them are not of apparent magnitude in themselves, yet in their consequences they are highly worthy of notice : and that they may be thrown into some kind of order, it will answer our purpose to class them under the several heads of the non-naturals, as they have absurdly been called.* *The observation of the late Dr. James Mackenzie on this term, may not be unacceptable to some readers : — "The very sound of the epithet non-natural, when applied to aliment, air, sleep, &c, so essential to the subsistenceof mankind, isextremely shocking; nor is the long continuance of thi» ill-fancied appellation, which arose merely from the jargon of the peripatetic schools, less surprising. The origin of it appears in a passage where Galen divides things relating to the human^body into three classes : Things which are natural to it; things which are non-natural ; and things which are extra-natural. I shall subjoin his own words from the Latin version, " Qui sanitatem vult restituere decenter debet investigare septem rea -. res extra-naturam, qua? sunt tres, morbus, causa morbi, et accidentia morburn comi. tanlw From this fanciful distinction, the epithet non-naturals first arose and has been retained in common use to this day, though it cannot be understood without a commentary by which physicians seem to make an apoWv for the .mpropr.ety of it. Hoffman, for instance, and some others, when they^nplv the appellation non-natural to air and aliment, are obliged to subjoin the following explanafon: » A vetenbus h* res NON-NATuRALEs°appellantur, quoniam extra corporis essentiam constituta: sunt." i"«»iam »u