/ir Tj jr :^ Surgeon General's Offics \ '■5 w " #|:J*".3**> »'* ^ . * ' \:~77 J / / POPULAR DIRECTIONS FOR THE TREATMENT DISEASES OF WOMEN AND CHILDREN. BY JOHN BURNS, Lecturer on Midwifery, and Member of the Faculty of Physicians and Surgeons, Glasgow. ' NEW-YORK: ^6°^; PUBLISHED BY THOMAS A. RONALDS, NO. 188 PEARL-STREET. 1811. •Printed by D. & G. Bruce, No 20 Slote-lane. PREFACE. Im this work, it has been far from my intention to encourage unprofessional readers, to undertake the office of pre- scribing for diseases, which often baffle the skdl of the most experienced practitioner. But there are situations, in which a little medical know ledge,or a general acquaint- ance with the most frequent complaints, in- cident to women and children, may be of essential consequence to the comfort, or even the ISe of the patient, before regular assistance could be procured. Such know- ledge is also highlyuseful,ontheone hand, in preventing uunecessary apprehension, respecting symptoms by no means dange- rous, and on the other, in giving timeous alarm, where delay might be injurious, or fatal. For these purposes, I most sincerely hope that thefollowing pages will be found adapted. The reader is only to expect a general view of the subject. Imny "Prin- iv PREFACE. ciples of Midwifery," I have treated the matter professionally, for the use of medi- cal readers ; but here, my object has been, to give an outline of the different diseases, with some instructions for their treatment, plain enough, I hope, to be understood; yet not so minute, as to bewilder those readers, for whom they are intended. In the course of this work, I have in particular cases, mentioned the composi- tion of medicines, and the precise dose to be given. In others, I have merely spok- en of them in general terms, and there- fore, it will be necessary to premise the following few directions, respecting the quantity of medicine to be given. DOSES OF MEDICINE. Emetics.—For adults, a scruple of ipecacuanha, or an ounce of ipecacuanha wine. For children, from four to ten grains of ipecacuanha, or from a tea to a table-spoonful of ipecacuanha wine, according to the age. Antimonials are too severe for children, and ou^ht never to be given, except by special prescription. Laxativ.es.—For adults, a tahle-spoonful of castor oil, taken alone, or mixed with brandy, lemon juice, syrup, or the thin part of marmalade. An ounce and a half of Rochelle salts. But the pleasantest saline purge, is an ounce of patent salt, dis- solved in beef tea, or gruel. We also give, for the same pur- pose, from two scruples to a dram of compound powder of ja- lap; or six or eight grains of calomel, well rubbed with a little sugar. Or aloelic pills, or magnesia, cream of tartar. For children, rhubarb and magnesia, or senna-tea, the doses of which are commonly known. From a tea, to a desert spoonful of castor oil. From a quarter of a grain, to six grains of calo- mel, according to the age, from infamy to childhood. It is to be well rubbed wiili sugar, and given in a little syrup, jelly, or honey. When it is necessaiy to be give* without the knowledge of the child, it may be sprinkled on bread, and then covered with jtlU, or mixed with fruit, or a little light pudding, pana- da, kc. .Manna, is also employed for infants It is dissolv- ed in as much witter as makes it into a syrup, of which one or more tea-spoonfuls may be given, according to the age. . Opiates.—F-u- adults, a grain of opium, in the form of pill, or twin j five drops of laudanum, but sometimes, where there a-C se\. r pains, or urgent symptoms, it m..y be necessa- ry to give from iilty to a hundred drops. When it is given as a A 2 6 clyster, a tea-spoonful may be mixed with a tea-cup full of thin starch. It is to be retained as long as possible. Tincture of hyo- cypmusis also employed, but it must be given in double or tri- ple the quantity of laudanum. It cannot be depended on in its effects. Three grains of the extract, may be gfven in a pill, to procure rest. For children, from one to eight drops of laudanum, according to the age. But it is generally better to rub a little on the spine ; from half a tea spoonful, to rather more than a tea-spoonful, may be employed in this way. In clysters, we give from three to thirty drops, according to the age. Diaphoretics.—For adults, a table-spoonful every half hour of saline julap, made by adding to an ounce of lemcm juice, as much salt of tartar, as nearly destroys the acid taste, then we add five ounces of water, and as much sugar as makes it agreea- ble. This is rendered more effectual for producing perspira- tion, by the addition of a dram ofantimonial wine. Sometimes, for particular purposes, laudanum is added, as is mentioned in page 30. Ten grains of Dover's powder, taken in a little lemonade, and repeated in two hours, is a useful and powerful mean of exciting perspiration, particularly if the patient sip fre- quently warm lemonade, tamarind beveridge, or tea. Where stimulants are not improper, as in rheumatic, or muscular pains, without fever, volatile tincture of guaiac, or tincture of snake-root, may be employed, the first in the dose of a tea, the second of a table-spoonful at bed time. These excite only a gentle perspiration. For children, the best mean of procuring a perspiration is the tepid bath, succeeded by the use of a table-spoonful of sa- line julap, every hour, for two or three limes. Cordials.—For adults, the following mixture may b« employed. Take of aromatic spirit of hartshorn, two drams ; compound spirit of lavender, three drams; ciniv mon wa- ter, two oun< es; spring water, three ounces ; mix. The dose is a table spoonful, now and then. When a powerful cordial is wanted, to operate quickly, two tea-spo nfuls of compound tincture of cinnamon, may be given in a small glass of white wine. For children the best cordial is white- wine-whey. Antispasmodics.—In nervous complaints, a tea-spoonful of volatile tincture of valerian, taken in a glass of water, three times a day, is useful. When a speedy operation is required, as in obstinate hiccup, asthmatic affections, pain in the stomach, Sec. we give a tea-spoonful of sulphuric ether, in a glass of pep- permint water, with thirty or forty drops of laudanum. Prepa- rations of camphor, musk, &c. are also employed, but only by prescription. As carminatives, we may give to infants, a little sugar of an- ise, and to adults, two asafoetida- pills, or fifty drops of aromatic spirit of hartshorn in a little water. Those who are much trou- bled with flatulence and costiveness, with pain in the bowels, may take two of the asaftetida pills, with aloes, at bed-time. Clysters.—The common clyster is made by mixing a large spoonful of salt, and a spoonful of butter or oil, with an English pint of gruel. A stronger clyster is prepared, by dissolving two ounces of Glauber's salt, in an English pint of warm small beer, and adding an ounce of castor oil. For children, a clyster may be made of a cupful of gruel, and a tea-spoouful of salt, or a lable-spoonful of raw sugar. Opiate clysters have been already noticed. Astringents, and some other remedies for particular uses, are specially mentioned in the following page?, and do not require to be farther noticed here. Drinks.—Barley-water, toast-water, oatmeal-gruel, rice- gruel, ginger-wine and water, apple-tea, raspberry-vrnegar and water, lemonade, capillair and wat<-r, ginger-ale, jelly-water, imperial, milk and water, whey, butter-milk, inc. Sick diet.—Light boiled, rice, br»-ad or millet pudding; custard; stewed apples, prunes, or goose-berries; soft boiled egg; flummery; arrow-root, made with milk and water, and a little wine; sago; salup; tapoca-, plain boiled rice, with milk, or wine and sugar ; calves-feet jell) ; beef t<*a ; chiiken broth ; veal soup ; boiled ihicken ; sweet bread ; lightly broil-d steak ; spinnage; asparagus; broc»li; cauli-flower; turnip; sea-kale, &c. CONTENTS. Preface ..... Pag Doses of Medicine • Part I.—Of Pregnancy. Chap. I.— Of the Signs of Pregnancy Chap. II.— Of Abortion, and the means of preventing it Chap. III.— Of the diseases of Pregnancy Section 1. Of sickness and vomiting . Section '2. Of heartburn .... Section 3. Of fastidious appetite Section 4. Of pain in the stomach Section 5. Of jaundice * Section 6. Of costiveness .... Section 7. Of looseness . . . Section 8 Of aolic .... Section 9. Of piles .... Section 10. Ol heat, and pain in making water Section II. Of suppression of urine Stttion M Of feverishness . . . . Section 13. Of despondency Section 14. Of fainting fits .. . . . Section 15. Of palpitation Section IG Of cough . . . . Section IT. Of headach .... Sertioi 18. Of pain, and swelling of the breasts Sectio.i 19. Of muscular pain, &c. ■ Section 20. Of swelling of the feet Section -! Of unusu. Emuciation . . , , 249 Chap XX.— O/ Wonns ...... ^55 Chap. XXI.— Of slumps, or Brunka . . 259 Chap. X\II—Of Diseased Liver .... 260 Q-nA.£.X£UL—Ojtiiroj[)hu(tt ^ . . . 055 CONTENTS. XI Part TV.—Of Diseases of Grown-up Women. Chap. I—>Of the Monthly Evacuation Chap. II.— Of Painful Menstruation Chap III.— Of Obstructi n Chap. IV.— OJ Prof use Menstruation Chap V.— Of Fluor Albus Chap. VI.— Of Diseases f the Womb Section 1. Of polypus Section 2. Of tubercles Section 3. Of caneer . Section 4. Of moles and hydatids Section 5. Of enlarged ovarium Chap. VII.— Of Sterility Chap. VIII— Of Indigestion Chap. IX.—Q/"Hysteria . POPULAR DIRECTIONS, fyc. PART FIRST. OF PREGNANCY. CHAPTER I. Of the Signs of Pregnancy. IN laying down directions for the management of pregnant women, I shall begin by pointing out how they may safely arrive at their full time, or prevent a miscarriage, and then I shall proceed to shew by what means the disorders attending pregnancy may be relieved. It will be proper, however, previously to notice those signs or symptoms which indicate that a woman is with child. Some feel very soon after conceiving, such an al- teration in the state of the stomach, or in their sen- sations in general, as apprises them of their situa- tion. But usually the earliest intimation is afforded by the obstruction of the monthly discharge. This B 14 OP PREGNANCY. is an invariable effect of conception, for although a few women have, in the early part of pregnancy, a shew of menstruation, it yet is by no means regular in point of time, or of duration, or of quantity, neither is it in general attended with the usual symp- toms. Obstruction, however, it must be recollected, may take place from other causes; hence, though we conclude that she who is regular is not pregnant, we cannot infer, to a certainty, that she who is ob- structed has conceived. Very early after conception the stomach is affect- ed, the woman is troubled with heart-burn, acidity, want of appetite, or disgust at her usual food, and sometimes has a craving for things she formerly did not'desire. She is usually sick in the morning, and generally vomits after she gets up, though some have no sickness till the afternoon. Sudden qualms and feeling of faintness, with or without an inclination to reach, occur at different times through the day. The bowels also, generally, become bound. Some, instead of being sick, or in addition to the fits of sickness, are troubled with a constant desire to spit, with toothach, water-brash, cough, nettle-rush, or other affections. But the degree to which these extend varies, as well as the period at which they take place. After conception the breasts often become rather smaller, but by the third month they evidently en- large, the nipple is surrounded with a brown circle, and presently a milky fluid can be pressed out. OF PREGNANCY. 15 The belly usually becomes at first somewhat flat, but very soon it increases in size at the lower part> and augments as pregnancy advances. The navel becomes prominent. About the end of the fourth month, or a little sooner or later, in different cases, the motion of the child is perceived, and this is the most satisfactory of all the signs ; but those who are anxious to think themselves pregnant, when they really are not, are apt to mistake wind, passing along the bowels, for the motion of the child. The motion is at first gentle, it is felt pretty low, and resembles a gentle fluttering. The sensation is peculiar, and not un- frequently is at first accompanied with sickness, faintishness, or hysterical affections. It may be felt by night or by day, and may either be repeated pret- ty regularly, or may not be again observed for two or three days. It is called quickening, not because the child at this time begins to live, for it is alive from the first, but because it can now move, or its motion is not till this time perceptible. After this period the morning sickness and loathing of food usually go off, or at least greatly diminish. The complexion generally suffers in pregnancy, and the features are affected in the same way as in children who are troubled with worms. There are, however*, instances, on the contrary, where the looks are greatly improved, particularly after the fourth mouth. 16 OF PREGNANCY. In some cases the pulse continues at its ordinary rate, but more frequently it becomes quicker, and blood drawn during pregnancy is, in almost every instance, sizy. These different sigps usually enable a woman to judge early of her situation; but, when she is in any doubt, the period of quickening dispels it. An ex- perienced midwife can also judge from the changes produced in the womb itself, but such examination is neither proper nor necessary, except under pecu- liar and important circumstances. A woman in good health may accidently be ob- structed for one or two periods, but in this case the other signs of conception are usually absent, and at all events, prudence will dictate the necessity of patience till the fourth month. In bad health the courses are often stopped, but in such circumstances the appearances of pregnancy are absent, whilst tb« symptoms of the accompanying disease point out the nature of the case. There is a situation in which there may, for « time, be some ambiguity, and that is, where the woman has actually conceived, but the embryo has almost immediately perished, yet has not come away, but, together with some blood in the womb, is converted into a pretty firm but shapeless mass> called a mole or false conception. This may also proceed from a*lot of blood without pregnaiicy. It even in that case is generally attended with sick-* ness, enlargement of the breasts, and other signs of OF PREGNANCY. 17 conception, but the belly increases faster, is softer and more variable in this than in pregnancy, being sometimes as large in the second month of the sup- posed, as it is in the fifth of true pregnancy. The mole may be retained for a few weeks, but rarely beyond three months. If it be retained long it is usually converted into a substance, containing a great many little bladders, filled with water, which are called hydatids. The false conception is expel- led with symptoms similar to those which attend abortion. CHAPTER II. Of Abortion, and the means of preventing it. The child, along with a considerable quantity of water, is inclosed in a membranous bag, which is contained within the womb, and connected to its surface by innumerable vessels. These vessels are at one part very large, and enter into a thick soft sub- stance, called the placenta, or after birth. From this the child is nourished and supported by means of the navel string which is attached to it. If any part of the membranous bag, or of the placenta, be separated from the womb, the vessels must (*e torn and blood will flow from them. If the injury B 2 18 ,0F PREGNANCY." or separation be extensive, there is not only a very considerable discharge, but both the child and the womb suffer so much that a miscarriage takes place. Abortion is always accompanied with two cir- cumstances, separation of the membranou3 bag, and expulsive efforts, or contraction of the womb itself. The first is productive of discs arge, the second of pain like those of labour. Sometimes the separa- tion or detachment of part of the conception takes place before any pain is felt; on other occasions the pain or contraction of the womb takes place first, and produces a separation In the first of those cases, the abortion is usually occasioned by fatigue, a sudden exertion, a fright, &c. and the symptoms take place suddenly and without much previous warning. In the second, the child is freqaently dead for some little time before the pains come on, and there are particular feelings and changes which indicate that a miscarriage is likely to take place ; as for instance, the cessation of the morning sick- ness, the subsidence of the breasts, absence of mo- tion of the child, a feeling of weight or heaviness in the lower part of the belly, &c. ----L-^ When abortion is going to take place, the patient feels pain in the back and lower part of the belly, with uneasiness like colic, and a sensation of slack- ness. This state if it has not been preceded, is soon followed by a discharge of blood, and presently regular Rearing down pains are excited. The dis- charge is sometimes from the commencement red OF PREGNANCY, 19 and profuse, but in other cases it is at first rather watery, or sparing in quantity ; presently it flows more copiously, and considerable clots come away> and often pieces of skinny or fleshy looking substance may be discovered. In some cases there is much pain and little discharge, or the reverse may hap- pen, or both may be considerable and protracted. If the miscarriage take place at a very early period little can be detected except clotted blood, but if every thing be put into a bason of water we can some- times observe a more solid substance like a chesnut, which when examined contains a small bag of wa- ter with a child in it no larger than a bee. If the third month be entered into or completed, then we find that the whole conception comes away at once; like a bag covered with fringed vessels ; or if the bag burst before it comes away, a gush of water takes place ; by and bye the child is expelled, and in some time afterwards the placenta comes away. Abortion is sometimes preceded by shivering, and attended with great pain and a feeling of sickness or sinking about the stomach, or a tendency to faint; occasionally tile-patient is greatly troubled with wind in the stomach or bowels. But the attending symp- toms are not exactly the same in every case, and the duration of the process is variable and uncertain. In some instances the whole, is over in less than six hours, in others it is protracted for many days. It is possible for a woman who has conceived twins to part with one child and keep the other. 20 OF PREGNANCY. Women are more subject to abortion, during and before the third month, than after the time of quick- ening. Now when a woman is threatened with a miscar- riage, there are two objects to attend to ; the first is to prevent it if we can ; the second is, if that cannot be done, to manage it so that as little blood as possible be lost, and these are fortu- nately obtained both by the same means. This leads me to repeat, that abortion either comes on suddenly and without any long warning, or we have some time before, a diminution in the size of the breast?, whilst the morning sickness goes off, and the motion of the chilcj,, if it had taken place, stops- These symptoms shew that the child is dead, and therefore miscarriage, so far from being dread- ed, should be considered as a fortunate event. But if we have had nooe of those signs, but abortion is threatened in consequence of some accidental cause, such as along walk or afit of passion, then we certainly would wish to avoid it. If we have merely an ach- ing pain in the back, or a kind of colic in the bow- els, with a very trifling discharge, we may hope to stop it ; but if the pains be regular and bearing- down, and the discharge copious, and especially if, at the same time, any water have come away, or any portion of skinny looking substance, there is no ex- pectation of checking it. No woman ought to trust to her own manage- ment, or the skill of her nurse alone, during abor- OF PREGNANCY. 41 tion. But notwithstanding this it may be proper to give some useful rules for her conduct. The first direction is, that she immediately, on the first alarm, undress and go to bed with a firm deter- mination not to rise till the process be either com- pletely checked, or completely over. There should be little, or rather no fire at all in the room though it be winter, and if it be summer, the windows must be opened. The bed-clothes should be few, and the drink cold and taken in small quantity; the diet is to be low, and every thing stimulating is to be avoided*. Cloths wet with cold water, should be applied to the lower part of the belly and back. The reason of all this is, that heat, motion, and stimulants increase the circulation of the blood, and consequently the dis- charge. Hence is evident the impropriety of giv- ing port wine with a view to stop this; it in the early stages really increases it. A second direction is, not to be hasty in removing that feeling of sinking or faintishness which often comes on early ; .for this is a mean employed by na- ture for moderating the discharge. Cordials are only proper when given prudently by a practitioner. If the feeling of languor or sinking m the com- mencement of abortion be troublesome, a little pep- * Panado, arrow root, dry toast, rusk biscuit, or vegetables with little liquid, constitute a proper regimen, unless the pro- cess be protracted, and the strength much impaired ; in such a case the diet may be more liberal, and the light kinds of animal food, such as boiled chicken, are allowable, or calves feet jelly is proper. In every case ripe fruit is safe and useful. 22 OF PREGNANCY. perroint water, or a few drops of aromatic spirit of hartshorn will be useful. A third direction relates to blood-letting. . Many have recourse to this indiscriminately, and in every case. When the pains are regular, and the dis- charge copious, there is no chance of preventing abortion by this mean, and therefore it cannot be employed in this view, nay it even sometimes seems to hasten the expulsion of the child. But if the pains be trifling, and the discharge moderate, and the symptoms have been brought on suddenly by some such cause as a fall or exertion, then if the pulse be not feeble it will be very proper, and should be followed by the administration of twenty-five drops of laudanum ; or what is better, by a clyster made of a cupful of starch and a tea spoonful of lau- danum, which should be retained as long as possible. Opiates are useful in every case where we hope to prevent abortion, and must be repeated oftener or seldomer, according to the effects they produce aud the good they do. They are, however, seldom re- quired, and very generally improper in those cases where miscarriage must decidedly take place. Their tendency to occasion ccstiveness must be obviated by the use of some gentle laxative, such as calcined magnesia or a little castor oil. A fourth rule is, that if by any of these means the symptoms be checked, the woman is on no ac- count to rise for some days ; and should they con- tinue to be tedious, she is to be confined during the OF PREGNANCY, 23 whole time, as motion will infallibly make them worse. If there be a continued but trifling discharge, great advantage may be derived from injecting, three or four times a day, a solution of alum, by means of a small syringe. Indeed, in all protracted cases, this is of much benefit. The solution ought to be thrown up pretty high that it may reach the womb. Fifthly. If the whole conception come away at once, the pain and discharge usually go off, but if only the child come away, all the symptoms either continue and increase till the after-birth come away, or if they be for a time suspended they are sure to return. Sixthly. If the discharge at any period be very profuse, and do not stop on the application of cold to the lower part of the belly, it will be proper to press firmly a soft cloth or handkerchief into the passage to the womb, which will retain the blood, make it clot, and thus fill the mouths of the vessels and stop them. Should the discharge be copious, and the after-birth be retained long after the child is expelled, some means must be used for removing what remains. *njf Seventhly. After the process is over, if the wo- man do not keep her bed forborne time, and be very careful to avoid fatigue, a troublesome discharge is produced, which both add^to the present weakness, and also makes abortion mtintfaptto take place again. This is cured by elixer of *|triol, bark, and the cold bath, with gentle laxatives. 24 OF PREGNANCY. Eighthly* After all is over, means must be used for restoring the strength. The diet must be light but nourishing, and a moderate proportion of wine allowed, if it do not heat the patient, or produce pain in the breast, or cough. The bowels are to be Kept regular. Sleep, if necessary, is to be procured by opium or hyocyamus ; and as soon as possible the cold bath should be employed. If the woman be of a delicate habit, she is apt to become con- sumptive, if the strength be not soon restored, or she may remain obstructed for several months. A re- moval to the country and a milk diet are highly pro- per, and in such cases often cure the dry tickling Cough and night sweats, which accompany the de- bility thus excited. In a work of this kind it will be more useful to give direction&Jbr the prevention, than for the man- agement of abortiohy All women are liable to this misfortune, but some are peculiarly subject to it, and have it produced by very slight causes. A miscarriage may be produced by any cause which can separate the conception from the womb, or tear some of the vessels, going from tke one to the other. Hence it is often brought on by fatigue, dancing, sudden exertion, a fall, violent coughing, or vomit- ing excited by medicine, or passions of the mind, which hurry the circulation and agitate the system of the woman. It will also be caused by any thing which can directly irritate the uterus or any of the organs in its neighbouihood, and hence bowel com- OF PREGNANCY. 25 plaints, or strangury, produced by keeping on a blis- ter too long, may cause it. Circumstances imme- diately affecting the contents of the womb often cause abortion, such as the accidental rupture of the bag, which incloses the child, and the consequent escape of the waters; or some causes operating on the child, and destroying it. Medicines which are violent in their operation, or of a very stimulating quality, or diseases which are attended with great pain, or productive of much weakness, may cause abortion. There are, however, certain constitutions in which those causes operate more readily than in others, for some bear all manner of hardships, or intentionally use means to destroy the child, and yet do not mis- carry ; whilst others do so if the door be closed quickly. There may be certain states of the womb itself, and some other circumstances which cannot be here explained, which dispose to abortion. The child itself may be so feeble and delicate from the first, as to be incapable of living till near the full time, or the vessels which connect the child to the womb may be diseased, and cease to convey sufficient nour- ishment. But the most evident disposing causes of abortion are the following. First: Too much blood, marked by a very copious monthly discharge, which, continues beyond the general number of days, and is often met with in a full habit of body. When this exists to a considerable degree the pulse is full c 26 OF PREGNANCY. but sluggish, and sometimes the skin is flabby or puffed up, or loaded with fat. Second: A very irri- table constitution, the woman being easily fluttered, the pulse is readily quickened, and she is subject to palpitation, starting, and hysterical affections. Third: A considerable degree of weakness and delicacy of the whole body, so that the womb, like every other part, is unfitted for carrying on uniformly its func- tions. The different causes may be combined in different degrees. Now the first direction to be given is, to remove that condition which is found to dispose to abortion in particular instances. If the patient belong to the first class, and have too much blood, she should put herself on spare diet, and on vegetable rather than animal food, she should avoid malt liquor, take •some gentle laxative, the best of which is rochelle salt*, use moderate exercise, and for invigorating the functions, which are oppressed, she ought to take the cold bath daily. If the bath produce a head- ach with a sense of tightness or fullness in the head, it must be omitted, till by laxatives or sometimes by blood-letting the fullness be diminished. It will then agree with the patient. This treatment is pro- per before conception, but when she is pregnant then * Four ounces of the salt may be dissolved in a quart bottle of water, and a tea cupful, or more if necessary, taken every mor- ning two hours before rising, till the fullness be reduced. One, or at most two loose stools are sufficient daily. Much and long continued purging may ruin the constitution. OF PREGNANCY. 27 the exercise must be taken with circumspection ; she ought to continue the cold or shower bath, keep the bowels regular, avoid much fluid of any kind, especially malt liquors or wine, be bled occasionally, particularly if she feel aching pain in her back, and continue upon rather spare diet. >f— If she be very irritable and easily fluttered, it will be necessary to employ such means as diminish this state, particularly gentle laxatives, the cold bath, in the sea, if possible, strengthening medicines, such as preparations of iron, and if the irritability be great, the camphorated julap. If she be of a feeble delicate constitution, the cold bath is proper, provided it do not make her chilly afterwards ; if so, there must be as much warm water added, as makes it of summer or Buxton heat. Elixir of vitriol, bark, or a moderate pro- portion of wine, and nourishing diet, will be proper. Second. After a woman who is subject to mis- carriage conceives, it will be proper to continue our attention to the constitution, and use means for diminishing the tendency to abortion. The cold bath is of signal service in every instance, where it is not followed by chillness. I have derived so much benefit from it in my practice that I cannot speak too highly of it. Blood-letting is also of great service in every case, except when the consti- tution is feeble, which was the third state 1 men- tioned. Here the pulse is small and weak, the pa- tient delicate, and the general strength little. In 28 OF PREGNANCY. all other cases, when abortion is dreaded, blood- letting is of service, but the blood should be taken from a small opening and not much at once, lest the woman faint. It is better to repeat it occasion- ally. Sometimes we take only one cupfuL but repeat it every fortnight or three weeks, during the second and third orfourth months; at other times we take two cupfuls at once, or even more, and1 do not repeat the bleeding afterwards. The quantity taken and the repetition must depend on the consti- tution of the patient, on the particular symptoms in the individual, and on the effect produced by the evacuation. As there would appear to be a great- er tendency to miscarry about the return of the monthly periods than at other times, it is proper to bleed a day or two before the completion of the month.*f4f the patient be very plethoric, and has formerly miscarried early, we bleed about the 6th or 7th week; if not, we delay till towards the end of the third month. When the woman, on the other hand, is weak, blood letting is hurtful, and strengthening medicines, with rest, are most proper. Third. Every woman whenever she knows her- self to be pregnant ought, especially if she has formerly miscarried, most carefully to avoid those causes which are ascertained to be capable of pro- ducing abortion, such as carrying a heavy child, taking a long walk, dancing, stooping much, or reaching high, every kind of exertion or fatigue, strong purges, running quickly up stairs, sitting OF PREGNANCY. 29 long in a constrained posture, heated rooms, sud- den surprises, &c*^-Indeed, from the inattention of women to these causes, and their neglect of them till they have produced their effect, it might be ne- cessary to specify them as minutely as our law- givers do contraband goods, in a bill against smuggling. Fourth. Whenever any disease takes place, cap- able of producing abortion, immediate means should be used to remove it. )t-Hence cough, bow- el complaint, &c. ought never to be neglected. Fifth. Those who are peculiarly apt to be start- led, or who are nervous, ought carefully to avoid such situations as may be likely to expose them to agitation. Sixth. Those who are subject to abortion should sleep alone till after the third month. Seventh. If a woman who is liable to miscarry without any evident cause, ceases to be sick in the mornings, and the breasts fall away for some time before the symptoms come on, it is necessary to use such means as the state of the constitution points out, and which have been noticed above, in general the cold bath and the invigorating plan, and to redouble our care at a very early period. In some instances though wt fail once or twice, owing probably to some defect in the action of the womb, or peculiar condition of the child, we may ulti- mately succeed by perseverance. Eighth. If children are born from the sixth to the c 2 30 OF PREGNANCY. eighth month dead, and covered with bloatches, and without the skin, and especially if this happen re- peatedly, it will be proper to have advice how far the parents should take some internal medicine. Ninth. lu every instance, on the very first appear- ance of symptoms of abortion, or of any peculiar feeling in those who are subject to it, the woman ought to go to bed, and prompt measures must be employed to prevent the continuance of the symp- toms. ^^— Tenth. All women miscarry more frequently in the second or third month, than- at any other time, but some have a certain period at which they usu- ally go wrong, and do not vary a week from it. In all such cases our care must be increased at that time, and in some instances it is necessary to con- fine the woman to her room, or even very much to bed till that period be past. After the fourth month women miscarry more rarely. It may not be improper, before concluding this chapter, to take notice of the tendency which some have to bear dead children between the sixth and ninth xnotuh.'^'Qiildreii are born dead under two different circumstanced; either there is no unusual quantity of water in the womb, or there is much wa- ter, and the woman is perhaps as large in the se- venth as she ought to be in the ninth month. When there is no extraordinary bulk the child may be born dead, in consequence of any of the general causes producing abortion, operating at a« advanced in OF PREGNANCY. 31 stead of an early period; but it may also proceed from some disease of the child itself, occurring ei- ther accidentally, or in consequence of some com- plaint of the parent. When there is an enlarge- ment, the death of the child proceeds from a dis- ease of the whole ovum or conception, existing, in all probability, from the earliest date. The motion of the child is felt first of all to become weaker and more obscure, and then it ceases altogether for some time before labour conies on. This corffplaint re- quires much attention to discover the cause aud the remedy; it may, and certainly in many cases actu- ally cloes proceed from an infirmity in the constitu- tion of one or both parents, and I have little hesita- tion in saying, that if, in spite of attention to the general rules laid down above, the woman continues to bear dead children, we ought, whether the child have bloatches or not, whether it be fresh or putrid, to put the parents under a prudent course of mercu- ry, as being the most effectual remedy. I must al- so add. that it is consistent with my experience, that the state, whatever it may be, which gives ri^< to this calamity, seems sometimes spontaneously to de- cline. For a woman may, without any peculiarity in the treatment, bear in successive pregnancies her children a month later each tune, and they shall be successively first dead, then alive but so \\. ak as to live only a day or two, and then more robuit. it is -•' also a fact, that like some heiedtiarv disease, this stale shall operate upon one child and not on ano- 32 OF PREGNANCY. ther. Thus, of four children, the two first and the fourth may be'dead, whilst the third is alive and healthy. Some diseased states of the constitution, not much under our command, may also occasion the birth of dead children, which are likewise sometimes much deformed. Scrophula and lunacy seem occa- sionally to have this effect. When a child dies, the breasts become smaller, the belly Ceases to enlarge, and no motion is felt. It must, however, be recollected that in some in- stances very little motion is felt during the whole of pregnancy, although the child be healthy; and in other cases the motion ceases for some days, and the breasts fall off, but in a short time they again en- large, and presently the child is felt to move. CHAPTER III. Of the Diseases of Pregnancy. Pregnancy produces several changes in the system, many of which are attended with more or less inconvenience. Thi- is not to be wondered at, when we consider that the womb, which was for- merly very small, conies to augment so as to con- tain at last a laige child, and that from the first it becomes necessary to suppoit and nourish both the child and the increasing womb. OF PREGNANCY. 38 SECTION I. " The stomach, in most cases, very early becomes affected, the woman being troubled with heart- burn, sickness, acidity, disgust at food, vomiting, or pain in the stomach. Sickness and vomiting are most frequent immedi- ately after getting out of bed, hence the name of " morning sickness ;" but in some cases they do not come on till the afternoon, and continue till night. Some women are sick immediately after conception, but in general this does not take place for one or two weeks, and goes off about the time of quicken- ing. Some are never sick, others are sick the whole day, and for many months. The matter thrown up is either glary or bilious, or consists of the food and driuk. Sometimes it is vomited easily, in other instances not widiout very considerable reaching. Some are sick for many weeks, whenever they arc out of bed; others are well during the day, but awake through the night, sick, and very much dis- tressed with water-brash. When the complaint is moderate no remedies are required ; it is sufficient to keep the bowels open ; but when it becomes troublesome, and occurs through the day, and the woman vomits after eating, it is necessary to interfere, lest by continuance it become intractable. The most effectual means of relief are blood-letting and gentle laxatives, regularly adminis- 34 OF PREGNANCY. tered. If it be so frequent as to keep the person from eating, three or four leeches applied to the pit of the stomach are highly useful. Soda water either checks the retching, or makes the woman vomit ea- sily. Laudanum does no good, but often harm, at least if taken by the mouth. It may be rubbed on the pit of the stomach, qr sometimes may be given as an injection, when the vomiting is constant; for this purpose a tea spoonful should be mixed with a cupful of thin starch, and it is to be retained as long as possible. Lemonade, saffron tea, chamomile tea, bitters, elixir of vitriol, tincture of castor, &c. have also been tried, but cannot be depended on. In some cases the vomiting is so continued and severe, that it becomes necessary to support the strength with clysters of beef tea. It is remarkable, that al- though the retching be violent it rarely produces abortion. In the end of pregnancy, vomiting is sometimes caused by the pressure of the womb on the stomach. The woman must in this case eat lit- tle at a time, and often, keep prettv much in bed, preserve the bowels open, and she may take at bed- time three grains of extract of hyocyamus, but if this do no good at first, it is not to be repeated. SECTION II. Heartburn sometimes does not take place till af- ter the period of quickening, but in general it comes on very eaflv, nay some are tormented with it from OF PREGNANCY. 35 the moment of conception till some days after de- livery. It is often most distressing in the mornings, or about an hour after taking food, but in some cases. it is seldom absent; in others it gives little trouble through the day, but comes on with great severity during the night, and at last produces vomiting of a very hot and sour fluid. Magnesia is the usual re- medy, or when the bowels are rendered too open by that, prepared chalk is used. When it is very dis- tressing, and the patient is of a full habit, blood-let- ting is often of service. The bowels ought always to be preserved in a regular state. When it is not relieved by the common absorbents, a combination of calcined magnesia, with pure ammonia may be tried.* Bitter infusion, bark, elixir of vitriol, &c. have been employed, but with very little advantage. Dr. Denman, and some other practitioners of great reputation, have proposed emetics when the woman had much phlegm; but from the risk of these reme- dies producing abortion, they ought never to be giv- en without the greatest caution, nor can I conceive * R. Maguesiae Calcinates, Aquae Ammonke purae, aa. 3i. Aquae Rosarum. %vi. M. or, R. Magnesias Calcinatae, Spt. Amnion. Aroma, aa. £i. Tinet. opii Amnion. 9 i. Aq. Font. %iv. M. Of either of these a table spoonful may be taken when the heartburn is troublesome. 36 of pregnancy. that a single emetic should remove the tendency to heartburn. Gum arable or refined lickorice some- times are of use. SECTION III. Some women have the appetite greatly increased during pregnancy, others have it diminished, but still more frequently it becomes fastidious, the pa- tient being subject to loathing at particular things, and craving for others!^ It has been proposed to remedy this state, by tincture of castor or other re- medies ; but the best way is to indulge the inclina- tion, and let the person eat when she pleases, and what she pleases, nor has any bad consequences ever followed from this, unless the inclination be placed on something very indigestable. -Generally the desire lies to vegetables or light food. The mind like the body sometimes becomes more irritable or variable during pregnancy, and the desires are change- able, or placed on outre objects. These longings, as they have been called, whether they respect food or raiment, have been supposed to proceed from cer- tain conditions of the child, who would be marked or otherwise injured, if they were not granted. Whe- ther this doctrine was originally invented by some cunning dame, or whether it be, in defiance of jes- ters, a sober truth, 1 leave ta the ladies to determine, but one thing is certain, that since the days of Pere- orine Pickle longings have fallen into some disre- pute. OF PREGNANCY. 37 SECTION IV. Some are subject during pregnancy, especially in the first three months, to violent pain in the sto- mach or upper part of the belly. This is sometimes of the nature of cramp, the stomach feeling contracted like a ball, or the patient complaining of an agonizing twisting pain, often accompanied with retching and pain in the back, and contraction or hardness of the muscles of the belly, or cramp in the leg. It requires immediately a large dose of laudanum, with ether or peppermint water, follow- ed by a saline injection, and the application of a mustard poultice to the pit of the stomach. After the pain has abated a laxative should be given. If it be attended with sourness in the stomach, a little hartshorn may also be given. Should cramp take place in the end of pregnancy, and be accompanied with great sickness, ringing in the ears, or giddiness of the head, and appearance of fire flashing before the eyes, blood-letting should be immediately had recourse to. In some cases the pain is rather lower than the stomach, and darts through to the back. It £omes in very severe fits, and when these go off there is still left a dull pain, which sometimes seems to spread over the belly. The patient is nick, vomits, and during the pain the pulse is often slow ; she is costive, the stomach feels choaked up, there is D 38 OF PREGNANCY. much wind, and the tongue is white. In some cases jaundice accompanies this. The complaint proceeds generally from the passage of gall stones. If the pulse be full and the constitution sound, it will be proper to take away some blood, apply fomentations to the part, and give a full dose of laudanum ; or if this be thrown up, we give immediately a tea spoonful of laudanum, mixed with a cupful of thin starch as a clyster ; after the pain has abated gentle laxatives are proper. It is worthy of notice, that those pains though severe seldom cause abortion. SECTION V. Jaundice consists in a yellow colour of the skin and white part of the eyes. The water is very red, and dyes a piece of linen of a yellow colour. It also deposits a brick coloured sediment, the patient is costive, and the stools are generally clay coloured. The appetite is impaired or lost, there is great list- lessness, sickness, flatulence, and often an itching of the skin. It may take place in consequence of the passage of gall stones, and in this case is accompa- nied and preceded by very severe pains. It requires the treatment I have just pointed out, and wheuever the stone fairly passes, then the jaundice begins to go off. The reason why jaundice is not always an attendant on the passage of those stones is, that they are sometimes so irregular in their shape, that the bile can pass, although one of them be in the gall OF PREGNANCY. 39 duct. A secoud case in which jaundice takes place, is when the liver is diseased, and this is attended with pain in the right side, increased on pressure, and often in the top of the shoulder, fulness about the stomach, hiccup or cough, &c. This requires the instant assistance of a practitioner. Jaundice may also occur very soon after conception, without any violent symptoms, and then seems to be connected with that particular state of the stomach attendant on pregnancy, together with some tiitling obstruc- tion to the passage of the bile, which is also some- times secreted m an increased quantity. This is attended with little or no pain, and soon goes off, merely by employing gentle laxatives, such as cream of tartar. When a healthy woman, shortly after marriage, has this symptom, she ought to avoid all violent remedies for the cure of jaundice, such as strong vomits and quack medicines, as they may cause abortion. Jaundice sometimes takes place in the end of pregnancy, owing, to the pressure of the womb on the gall duct, but it requires no particular treatment, unless there be something more than mere yellowness of the skin. Brown patches, or other coloured spots sometimes appear during preg- nancy, particularly under the eyes or about the mouth. They go off after delivery, and till then admit of no cure. 40 OF PREGNANCY. SECTION VI. Costiveness is a common attendant on pregnancy, and if neglected may produce serious or troublesome consequences, such as piles, violent pains in the bowels, gripes attended with a great desire to go to stool, and the passage of a little thin slimy or bloody matter, miscarriage, &c. In many cases the quan- tity of magnesia taken for heartburn, or the use of a considerable quantity of boiled turnips or other vegetables in the diet, preserves the bowels open, but when this is not the case the common aloetic pill answers extremely weli*. One or more of those should be taken at night so as to procure a stool every day, unless in those constitutions where natu- rally a passage does not take place above twice a week, and where a daily stool produces sickness and weakness. If the bowels be neglected for se- veral days, then, instead of taking those pills or any other laxative, it is more prudent to give an injec- tion of, the thin part of bailey broth, without any salt, and it should be kept as long as possible, in order to soften the contents of the bowels. It may * When the common laxative pill is too weak, the following succeeds very well, and operates without griping. R. Aloes, 3i. Gambogiae, gr. xxiv. Ext. Cicntae, 3ii. Ol. Menth. Pip. gtt. x. M. div. in No. xxiv. One, orif necessary two, may be taken every night. OF PREGNANCY. 41 even be necessary, if the stools have been long retain- ed, and are very hard, to give a second of these in- jections at an interval of two hours, and then a dose of castor oil or rochelle salt, or a purging injection made with gruel,butter and salt. Were physictlken, without the previous use of an emollient clyster, great pain might be produced by its operation. When costiveness produces griping pains, and the patient passes some thin stools, she is apt to be deceived, and consider the disease as a looseness; but she will find that this state is attended with a pressing or an inclination to go often to stool, she passes slime or blood, and small pieces of hard ex- crement along with it. This is to be relieved by the use of emollient clysters and gentle laxatives, in the way directed above, and after these have brought away the hardened stools, an injection containing laudanum should be given to allay pain, but next day a gentle dose of castor oil,should be taken to pre- vent costiveness; or sometimes it is necessary to give an opium pill, and alternate this with a laxative for some days. If any degree of fever, and continued or severe pain attend this state, blood-letting will be proper. SECTION VII. A looseness may occur during pregnancy, instead of costiveness, and in this case the stools are either of the natural colour but thin, and the tongue is D 2 42 OF PREGNANCY. clean, and appetite good: or they are very ill smelled, dark or brown coloured, sometimes watery, sometimes pitchy or bilious; the patient feels a bad taste, the tongue is white, and the appetite diminish- ed.-f-Now, m the first case it may, especially in the early stage of pregnancy, and if the woman be of a full habit, and feel a tension about the belly, be dangerous to cheek it suddenly. In such circum- stances she should lose a little blood, and live on spare diet, which ofteu moderates it; or if it con- tinue after this, it can be kept in due bounds by au astringent mixture.* In the second case, five grains of rhubarb may be given, with the same quantity of cinnamon, and prepared chalk, four or five times a- day, till the stools become more natural. Then an injection with laudanum may be employed, to ease pain and bring the bowels into a less irritable state. Soda water sometimes relieves the sickness, and the diet should always be light. SECTION VIII. Colic sometimes takes place during pregnancy, and irregular pains in the bowels, as I shall after- wards notice, are very frequent in the end of gesta- tion. Abortion and extra-uterine pregnancy, a most * R Confect. Catechu. 3i. • Aq. Cinnani. Ji. Ap. Rosar. %iv 3M. A table spoonful to be taken four or five times a-day. OF PREGNANCY. 43 uncommon occurrence, are often attended with colic. But the most usual cause is costiveness, or eating some flatulent food. The best treatment consists in giving a saline injection immediately, and afterwards thirty drops of laudanum, in half a glass of pepper- mint water; or if this be vomited, a clyster with lau- danum should be given, after the operation of the common injection. SECTION IX. Piles are generally connected with a costive state. They cousist of painful livid tumors at the extremi- ty of the gut, sometimes very small, but often large, and surrounding it almost completely. These after some time may burst, and discharge more or less blood, and are then called bleeding piles. They also sometimes form in the inside of the gut, producing pain on walking or sitting long, but especially on going to stool. These are called inward piles, and may sometimes press forward to the passage to the womb. 'f The pain of piles is often very excruciating, and is attended with much heat, throbbing, bearing-down, and feeling as if the part would burst. If not relie- ved soon, they may in certain cases cause abortion, and if they exist during labour they always produce a painful delivery. The bleeding piles are less pain- ful, but if the discharge be great, very disagreeable weakness may be produced, and other bad conse- quences may ensue, 44 OF PREGNANCY. It is necessary in every instance,to keep the bowels open by means of cream of tartar and sulphur, or small doses of castor oil. The diet ought to be light, consisting chiefly of vegetables; and cordials, such as wine should be avoided. The patient should recline on a sofa, and if there be any fever, or con- siderable irritation, blood-letting is often proper. If the pain be very great, the application of a leech to the most uneasy spot is useful, and afterwards the part should be fomented with milk and water. Some liniments are also employed,but these are not always of benefit, nor is it easy to say before trial what will be useful. Cream mixed with vinegar, or with a little sugar of lead; or lard mixed with powdered galls, or with a smalktquantity of powdered opium, form good applications. In some cases dloths dip- ped in cold water, with a little sugar of lead are use- ful; in others, warm fomentations, with the addition of laudanum, answer better. Sometimes an injec- tion, containing laudanum, gives relief. If the piles burst, and much blood be discharged, it must be stopped by compression. SECTION X. In some cases during pregnancy, there is great pain or heat in making water, with a frequent de- sire to pass it. This is often conjoined with a most troublesome itching at the neck of the bladder, and neighbouring parts, especially during the night, and OF PREGNANCY. 45 is accompanied with a very considerable degree of fever, so that the nights are spent without sleep. This state requires blood-letting, and laxatives to keep the bowels open; and if there be much fever, the saline julap with a little laudanum is useful*. If the itching be great, the occasional application of a sponge wet with cold water, gives temporary relief. In the end of pregnancy there is sometimes an in- continence of urine, or the woman is obliged to void it frequently, but has no pain. This often proceeds from the pressure of the child's head on the bladder, and is considered as a favourable sign of a natural labour. It does not require any particular treat- ment. It may be mitigated by lying much on a sofa, and it is necessary to use the bidet frequently. SECTION XI. Another more serious affection is a great diffi- culty of passing the water, and ultimately au almost total suppression of it, at the same time that the stools are also obstructed. This is attended with much pain in the lower part of the belly, owing to the distension of the bladder, and a feeling of bear- * R. Sue. Limon. Ji. Carb. Potas. q. s. Syrp. Simpl. Jss. Tinct. Opii, gtt. xxxvi Aq. Font Jivss. M. \ table spoonful to be taken every hour 46 OF PREGNANCY. ing down, with a desire to go to stool. Presently the pain becomes more severe, and sometimes there is a stroug and painful pressing, like the latter end of labour, and if this continue long, a swelling can be discovered at the back part of the passage to the vvomb, and sometimes this sw elling descends pret- ty low. If t]he symptoms be still neglected, strong fever is excited,, the bladder becomes inflamed and bursts, and the woman dies. This complaint consists in a change of the position of the womb, which is turned nearly upside down, and is brought on some- times by a fall or sudden exertion, but much often- er by retaining the water too long. It chiefly takes place between the third and fourth month, and ne- ver in the advanced state of pregnancy. Hence is evident the great impropriety of women, about that period, retaining their water long from motives of false delicacy or otherwise. The greatest danger proceeds from the state of the bladder, and there- fore the first object is to have the urine drawn off, an operation which gives no pain, but which may be required to be performed morning and evening for some time. The rest of the treatment it is not ne- cessary here to explain. SECTION XII. Some suffer much from a species of fever attend- ing pregnancy. This may come on very early, but generally it does not appear till after the second or OP PREGNANCY. 47 even the third quarter. The pulse is frequent, the skin hot, the tongue dry, and the patient extremely restless, and sometimes troubled with an eruption like nettle-rush, or an uneasy itching of the skin, and occasionally with the pain in making water formerly noticed. The symptoms always become worse in the afternoon, and continue violent all night, producing much restlessness and distress. Towards morning they abate, and a little sleep is procured, but it is astonishing how little may be ob- tained for many weeks, and yet, except that the wo- man become thinner than usual, no great effect is produced by the want of sleep, and after delivery the recovery is as good as in other ~cases. The treatment consists in taking away a little blood oc- casionally, and preserving the bowels open; a small glassful of saline julap, taken twice or thrice in the evening, at the interval of an hour, is some- times useful. The patient must sleep with few clothes, and often is relieved by grasping a sponge wet with cold water. The diet should be light. Laudanum gives no relief, but sometimes does harm. Patience is an admirable and effectual remedy. SECTION XIII. It is not unusual to find women very despon- ding, during pregnancy, with respect to the is- sue of their confinement. This proceeds some- times from natural timidity, or from hearing of 48 OF, PREGNANCY. accidents befalling others, but in many instances it pr ceeds from a degree of melancholy, con- nected with the situation of pregnancy, which occasionally goes a great length, and produces much mental distress. The bowels are to be kept open, the patient should take gentle exercises, but above all, the mind must be kept employed, and cheered by some judicious friend, who with great truth may affirm, that her fears are without solid foundation. SECTION XIV. Fainting fits are not uncommon during preguan* cy, especially about the time of quickening. They may attack suddenly without any evident cause, but oftener they are produced by some little exertion, or by too much heat, or by mental agitation. There is a great difference in the duration of the fit. It may last only for a minute, or for above half an hour. There may be only one attack, or it may be repeated for many days. The patient is to be laid immediately on a bed, or the floor, if neither bed uor sofa be at hand. The window is to be opened, and cold water sprinkled on the face, volatile salt may be held to the nose, and hartshorn and water given internally. After recov- ery every exertion and debilitating cause must be avoided, and public places should be shunned. Hysteric, are often mistaken for fainting fits. They are generally at first attended with an uneasi- OF PREGNANCY. 49 ness about the stomach or heart, which very soon affects the throat, producing a feeling of fulness or choaking, succeeded by convulsive motions of the muscles. They often end in a state of quiet insen- sibility, only occasionally interrupted by sobs or slight struggles, so that to a superficial observer the pa- tient seems to be in a faint, but the pulse is not so weak as in the fainting fit. In some instances there is very great motion of the different muscles, and the patient at intervals shrieks aloud, or stares wildly about her, or alternately laughs and criesj and much wind is discharged from the stomach, or may be heard moving in the bowels. During the fit the patient should be laid in a re- clining posture, and have a tea spoonful of. volatile tincture of valerian, given in a little water ; or if the fit continue long, thirty drops of laudanum may be given, but this medicine should not be often employ- ed, if the fit be repeated daily, as it often increases the tendency to return afterwards. A repetition is to be prevented by keeping the bowels open, taking ' some blood, if the patient be plethoric, and putting her on spare diet; or if she be thin and delicate, em- ploying strengthening means, such as the cold bath, and more nourishing diet. Sometimes repeated doses of castor, asafetida, or camphor, are of use. Strong passions and mental agitation of every kind should be avoided. E 50 OF PREGNANCY. SECTION XV. Palpitation is a most distressing disease. It con- sists in a violent beating or pulsation in the left side of the chest, often extending to the throat, and ac- companied with a feeling of heat of the face, or pain or knocking in the head. It is also frequently accompanied with a great apprehension of danger, alternate fits of heat and cold shivering, and much wind in the stomach. It may take place at any period of pregnancy, but is often in the latter part of it brought on by a disordered stomach. During the attack the patient must remain at rest, and if it do not go off soon, thirty drops of laud- anum should be given in a little peppermint water, but if the fits are repeated, this medicine must not be employed- in every new attack, but rather pretty large doses of valerian, asafetida, or camphor. A repetition is to be prevented by keeping the bowels regular, avoiding every thing that disagrees with the stomach, and whatever can agitate the mind. If the patient be delicate, preparations of iron are useful; if of a full habit, blood-letting is more be- neficial. Fits of breathlessness coming on suddenly and going off again completely, require a tea spoonful of spirit of lavender, or tincture of valerian, in a lit- tle water. More permanent difficulty of breathing is of a different nature, and a practitioner should be immediately consulted. OF PREGNANCY. 51 SECTION XVI. Cough is sometimes an attendant on pregnancy, though it is attributed to an accidental exposure to cold. It is most frequent from the fourth to the sixth month, and may be accompanied with a sense of suffocation, giddiness and headach, or with spitting of blood. If neglected, it is apt to occasion abortion. It is most effectually relieved by means of blood-letting and gentle laxatives, afterwards, if necessary, lozenges containing opium may be em- ployed for a short time. Sucking gum arabic also allays tickling about the top of the wind-pipe. A warm plaster applied between the shoulders is some- times of use. The cough often forces off the urine involuntarily, but for this nothing can be done ex- cept wearing a compress of soft cloth when in com- pany. SECTION XVII. Headach is another distressing affection, which often is connected with a debilitated stomach and costiveness. The food sours soon after it is taken, there is much wind in the stomach, the tongue is white or yellowish, the eyes languid, the face pale, and the pain is frequently periodical, coming on about a certain time, and affecting often one part of the head. It may be accompanied with giddiness-. 52 OF PREGNANCY. It is relieved more effectually by gentle laxatives given daily for some time, than by any other plan, and the diet should be light. A more dangerous headach is attended with a feeling of fulness about the head, flashing of fire before the eyes, ringing in the ears, a troubled eye, and giddiness, increased on stooping or lying down. This kind of headach, which is never to be neglected, is sometimes atten- ded with pain and oppression about the stomach. It requires immediate blood-letting, laxatives and spare diet. By omitting these the patient may be seized with convulsions, the treatment of which it would be of no use to detail fully in a work of this kind. I may only caution against the use of cordials,or stimu- lants when they do take place. SECTION XVIII. Pain and swelling of the breast may take place very early, and with some are among the first signs of conception. The pain is not generally constant, but comes in fits, and darts out at the nipple. When this is the case, more relief is derived from rubbing the breasts gently with olive, or camphorated oil, than by other means, at the same time that they are kept warm and defended from pressure. The bow- els are to be preserved regular. If the pain come on later and the woman is of a full habit, and no re- lief is obtained by the oozing of a milky fluid from the nipple she ought to be bled. Sometimes the OF PREGNANCY. 53 pain is constant, and presently is accompanied with hardness and heat in some part of the breast. Should gentle friction not speedily relieve this, a warm bread and milk poultice is to be applied, and if matter form, it ought to be let out. Sometimes the breast suppurates twice during the same pregnancy. Pain- ful swelling with hardness, either in the breast, or near the passage to the womb, occuring during preg- nancy, always suppurates. Toothach sometimes is produced very early by pregnancy. The tooth ought not to be pulled, as this may cause abortion. Blood-letting is of more benefit. SECTION XIX. Pain about the back and top of the thighs is of- ten felt, especially in the early part of pregnancy, and frequently is brought on by walking rather more than is proper. The pain is sometimes pretty sharp, and is not constant, but may abate or go off even like labour pains. This requires a state of strict rest for some days, and the part to be rubbed with ano- dyne balsam, or if the pulse be full and the patient strong, some blood should be taken away. After- wards if the pains continue with less severity, but with obstinacy, the cold bath is useful. Another kind of pain affects the back alone, and is of an aching nature, with a feeling of weakness. This is E2 o4 OP PREGNANCY. often much relieved by the shower-bath, and the application of a strengthening plaster. From the distension of the muscles of the belly, pain is produced about the share-bone or end of the breast-bone, or on one side at tlie edge of the ribs. This is often a cause of much but groundless anxiety. It is not of any consequence, but it may continue till delivery. Rest, change of posture, rubbing with strong spirits, or with laudanum, give temporary re- lief. If the pulse be full and frequent, bloodletting is proper. Cramp in the legs is relieved by change of pos- ture, and rubbing with anodyne balsam. In consequence of the stretching of the muscles, some of the fibres may separate, so as to allow part of the intestines to be pushed out beneath the skin; or this may take place at the time of delivery, and a pretty large swelling arise on some part of the belly. If the opening be large, the bowel is easily pressed back, but starts out and renews the swelling when- ever the woman walks, or even attempts to rise. This is called a rupture, and it may also take place at the navel, &c. The bowel is to be reduced, and kept in by a well adapted but easy bandage, and costiveness is to be prevented. When the woman is in labour, and has forcing pains, it is often necessary to apply the hand to the part, to keep the bowel from being strongly forced out, and after delivery pressure must be immediately made, otherwise tauitiohueas may be produced. OF PREGNANCY. 55 r SECTION XX. It is usual during pregnancy, especially m the lat- ter end of it, for the feet to swell. This swelling is greatest at night, and goes off after having been for some time in bed. It requires no particular treat- ment, but is generally diminished by laxatives and moderate exercise. In some cases, however, the sw el- fing is great, or does not disappear on lying down. It even affects the arms, or trunk of the body, and sometimes the face. This is a very unpleasant dis- ease, and not free from danger. It is, however, generally removed by Mood-letting and laxatives, but in such circumstances the best advice ought al- ways to be procured. A different kind of swelling of the lego, proceeds from an enlargement of the veins. The feet are not necessarily swelled, but along the inside of the leg, towards the knees, is a chain of knots of a blue colour, disappearing by using friction after lying down. This is relieved by applying a roller, with a moderate degree of firmness, but not so tight as to give uneasiness, or affect the circulation. SECTION XXI. The belly may be unusually swelled either from dropsy, or fioni the uterus being gieatiy enlaiged. The first of these states is geneiaily accompanied 56 «P PREGNANCY. with a considerable swelling of the feet and leg», costiveness, scanty urine, white tongue, distinct fluc- tuation, and bad health, and is often connected with disease of the liver. The treatment cannot with utility be pointed out here, as the medicines employed for carrying off the water are too active, and require to be too much varied to be entrusted to the management of any one who is not skilful, The second state proceeds from an increased quan- tity of that water in which the child is contained before birth. About the third or fourth month, or later,- the belly is observed to be larger than usual, and increases rapidly in size, so that by the seventh. month it is often as large as it ought to be in the ninth; the motion of the child at the same time be- comes weaker, and it is felt rather to flutter than move briskly. Premature labour comes on, and the child is expelled either dead or very feeble, and a vast quantity of water comes away before it. The same person is liable to a repetition of the misfor- tune. On the commencement of this disease, the cold bath, laxatives, and occasional blood-letting should be employed. But if the swelling increase and the motion diminish, all that can be done is to moderate, by suitable remedies, coo.plaints of the bowels, &c. which may accompany this state, and when labour comes on, to have recourse to a skil- ful midwife, as flooding, or other bad accidents may take place. This condition of the conception some- times proceeds from a bad constitution of one or OF PREGNANCY. 67 both of the parents, and a repetition of the evil can only be prevented by the careful use of such reme- dies as the state of health may demand. In certain cases after every other mean fails, a prudent use of mercury is successful. SECTION XXII. Discharges of water may take place at different times during pregnancy, especially in the two last months. The quantity is variable and sometimes the discharge is accompanied or succeeded by ir- regular pains. Occasionally a small bladder comes away with the water. It is useless to enter here into the question whether this discharge consists of the water in which the child lies. It is sufficient to 6ay, that if the woman be not at the full time^ and labour have not commenced, she ought for a time to keep in bed, and if she feel irregular pains, to take thirty drops of laudanum, and afterwards some gentle laxative to prevent costiveness. By these means she may go to the full time. If the water come oozing away for many days, the use of an astringent injection, similar to that proposed in the chapter on abortion is proper. SECTION XXIII. Discharges of blood, during the three last months of pregnancy, are much more alarming than the 58 OF PREGNANCY. accident last described. Scarcely any subject re- quires more attention from the practitioner than the do ctrine of flooding. These discharges may take place under a variety of circumstances; they may succeed some unusual exertion, some sudden fright, or some imprudent and continued fatigue, or they may occur without any evident cause; perhaps the patient awakes as if from an uneasy dream, and feels herself wet with blood, or has an inclination to make water, and is astonished to find she is losing a great quantity of blood. The immediate effects of this discharge are usually those of fear, for the pa- tient is much alarmed, but no material bad conse- quences in general follow from the first attack. It stops presently, but how soon it may return is un- certain. In some cases it never re-appears; in many others it returns iA a short time, and returns oftener than once. The strength is thus impaired, especially if the treatment have been negligent, and in every case there is naturally an attempt made to excite labour. The pains, however are, in general both very slight and very ineffectual; but they serve this good purpose, that they render it* possible to deliver the patient both easily and safely. It would, however, be altogether useless to ex- plain here the various causes of this accident, or the different points of practice. It will be of infinitely more advantage to give the following short rules for conduct. The first is, that the woman go immedi- ately to bed without loss of time, and remain there OF PREGNANCY. £$ till the discharge be completely checked, and for several hours afterwards; and if it have been copi- ous, and is found to increase on moving, she must remain even for some days, and in those cases where it is easily brought back, it is necessary to confine her for some weeks. Second, Port wine and all warm drinks and cordials, do in general much mischief. Third, if the discharge be trifling, and abate soon after lying down, nothing more is at this time neces- sary ; but if it continue in small quantity, and be ac- companied with irregular pains, a dose of laudanum is often of benefit. Fourth, If the discharge be more copious, or contiuued, it is useful to apply cloths dipped in cold water to the entrance to the womb, or to press firmly with a soft cloth, but in such circumstances advice ought always to be pro- cured. Fifth, If the patient become faintish, she is not to be suddenly recovered with cordials, for these renew the discharge; nature stops it by the faiutish- ness, during which the blood circulates slowly. But if the faintishness continue long, and the skin is cold, a small quantity of wine, or hartshorn with lauda- num, may be given, and a warm flannel applied to the feet. Sixth, All external heat should be avoid- ed, unless the skin be cold; therefore few bed- clothes are allowable; the windows in summer should be opened, the drink must be cold, and the food of the lightest kind, such as stewed apples, soup, toasted bread, &c. Seventh, if the attacks be severe, or repeated, nothing can save the mother 60 OF PREGNANCY. and child but delivery, which must not be too long delayed, in expectation of pains coming on, or of their becoming brisk, if they have already taken place. It is extremely uncommon for the pains to become sharp or strong ; generally they at last die away, and the patient would, without assistance, perish undelivered. Even where no pain is excited by the discharge, we find that delivery is practicable, if the loss of blood have been great. I cannot do a greater service to any one in this situation than to impress upon her mind, that if a flooding be great, or repeated, or protracted, no reliance can be placed on the powers of nature alone; and in those cases, w here delivery is necessary for the safety of the mo- ther, the earlier that this can be accomplished, the greater is the probability of the complete rerestab- lishment of her health. The precise time to inter- fere, and peculiarities of treatment, required in par- ticular cases, must be left to the practitioner. 1 may only add, that in extreme cases, opium appears to be the most useful cordial for preserving the re- maining strength. I do not mean to say, that in every case delivery will be requisite, for by means of astringent injec-, tions, rest, and the occasional use of opiates, the patient, if the discharge be trifling, or be not repeal- ed, may go on to the full time, or be delivered natu- rally, but in all violent floodings there is little hope of this. OF PREGNANCY. Gl SECTION XXIV. Convulsions, as will afterwards be noticed, som&- times occur during labour, but they may also take place during pregnancy, especially after the sixth mouth. They are different from common epilepsy, for they attack those who never formerly had nor never again shall have a fit; and they are also more severe and dreadful in their appearance than epilep- sy. They are usually preceded by some symptoms which indicate their approach, such as a sense of fulness or heaviness in the head, severe or even ex- cruciating headach, dimness of sight, or appearance of substances floating before the eye, sometimes dark, sometimes of a fiery brightness. They may also be preceded by cramp in the stomach, attended with dreadful sickness. They are likewise to be apprehended, if the face and arms be swelled, in the same way as the feet are in an ordinary pregnancy. The fit comes on suddenly, the patient falls down convulsed, the face is most terribly distorted, and every feature rapidly altered ; she foams at the mouth, breathes with a loud snoring noise, and shakes with prodigious force. She is quite insensi- ble of all that is going on, and no exertion can rouse her, or make her understand. After the fit is over, she either remains in a deep apoplectic sleep, till agitated by another attack, or she becomes at once well and perfectly unconscious of what has happen- F 62 OF PREGNANCY. ed. The fit may last only a few seconds, or may, with scarcely any intermission, continue above half an hour. There may be only one, or there may be repeated attacks, and when this disease proves fatal, it is generally by inducing a state of apoplexy, or fatal stupor. At whatever period of pregnancy convulsions take place, we uniformly find, that if they are re- peated, and do not prove fatal, they bring on labour, or at least open the mouth of the womb. But there are many instances, where, by proper measures, the repetition of the fits have been prevented, and the patient has gone safely to the full time. The practice consists chiefly in evacuation. The patient must be instantly bled, and the bleeding must be repeated once and again, if it do not prove at first efficacious. A prodigious quautity of blood has been taken away with advantage, and has been the mean of saving life. The bowels are also to be opened immediately, by an injection of soft soap dis- solved iu warm water, and afterwards purgatives are to be given. The head is to be shaved and blister- ed. If by these means the disease be checked, then no more is to be done; but, by the use of camphor, the nervous irritation is to be allayed. But if the fits return, or if the first attack be obstinate and se- vere, and the mouth of the womb is affected by it, the security of the patient consists in artificial deli- very. The propriety of this important step depends altogether on the state of the womb. OF PREGNANCY. 63 It is a useful and general rule, in all convulsions, to insert a piece of soft wood, or some such sub- stance, between the teeth, to prevent the tongue from being bit. SECTION XXV. Many women are afflicted, long before their con- finement, with pains so nearly resembling those of labour, that they often are mistaken for them. They may affect the back, and come on with regular inter- missions, and are peculiarly apt to occur during the night. They may be distinguished by being rather more irregular and shifting than those of labour, or being more early attended with a pressing down. They are also usually accompanied with griping or wind in the bowels, or some difficulty in making- water. By degrees they abate aud go entirely off. They are removed by keeping the bowels in a regu- lar state, avoiding much exertion, losing a little blood, if feverish; and generally they are much mi- tigated by a dose of laudanum and change of posture. They are sometimes produced by worms, which are removed by giving an injection of strong decoction of chamomile flowers, with salt, and using laxatives. Occasionally they affect the side chiefly, and are accompanied with a great motion of the child. Rubbing the part with anodyne balsam sometimes does good. 64 OF PREGNANCY. Shivering not unfrequently occurs in the end of pregnancy, especially in the night time, and as labour sometimes begins with this, it creates an unfounded belief, that delivery is approaching. It is either un- attended with pain, or the pain is irregular, affect- ing chiefly the bowels or sides. It goes off by taking twenty-five drops of laudanum, in a glass of water gruel. PART SEC0N1}. OF LABOUR, AND THE CHILD-BED STATE. CHAPTER I. Of Labour. Pregnancx is completed in nine'calendar months, at the end of which time the child is so per- fect, and vigorous, that it is able to live when its connection wiih the mother is dissolved. It is usual, in calculating the time when labour is to be expected, to date conception a fortnight after hav;ng been last unwell, and this is generally suffi- c ently correct. Delivery then maybe looked for, for- ty-two weeks after the last regular appearance of the menses. This calculation, especially in those who can judge from former experience, is rectified by observing how far the period of quickening corres- ponds with the supposed time of conception, as the motion of the child is usually first perceived about the end of the fourth mouth. Some unknown F 2 66 ©F LABOUR, AND causes, or some error of calculation may, however, delay the delivery of the infant a few days beyond the expected time, but still more frequently we find, that the labour is earlier instead of later, than the period which a proper calculation ought to have fixed. Some women feel no pain nor uneasiness till labour actually commences. Others from shiverings, or spurious pains, fancy themselves to be on the eve of delivery many days, or even some weeks, before that event takes place. There are three different steps in the delivery of a child. First : The mouth of the womb must be gradually opened. Second : The child must be ex- pelled. And Third : The after-birth must be thrown off. The first of these effects is accom- plished by repeated contractions of.the womb, which produce sharp or grinding pains. The second is ful- filled by more forcible efforts, productive of bear- ing-down pains, which at last increase to great seve- rity. The third takes place some time after the child is born, and is attended with very slight pain. The first stage is preceded or accompanied by a subsidence in the size of the belly, and the child is often felt, even for some days, to be carried lower than formerly. The pains at first are short, and come seldom. They go entirely offduring regular intervals, but they often leave a considerable degree of gene- ral uneasiness, so that the woman feels restless and uncomfortable, or is hot and cold by turns, and in some cases has a sensation of sickness, or gi ipes, or THE CHILD-BED STATE. 67 a troublesome desire to make water. The pains are usually felt chiefly in the back, but in some cases they soon shift to the fore part of the belly, or are from the first felt there. They are at first very slight, and last only for a short time, perhaps not half a minute, and return at the interval of fully half an hour ; but they come on with more frequency as the labour continues, and are felt lower down in the back, and shoot round to the share bone, or top of the thighs, and after some time it is usual for them to stretch down the thighs, and cramps are also occa- sionally felt in the legs. They are also attended with an inclination to catch at, or take hold of, the chair, or of any thing which 13 near. The pains after a short time gradually increase both in sharpness and frequency, and then they often seem to decline for a time, after which they again become brisker. There is a .great diversity in the situation and degree of the pain ; for in some cases it is felt chiefly in the belly, in others in the back; sometimes it is attended with shivering and tremb- ling, in other cases with sickues3 and vomiting. These circumstances, though unpleasant to the pa- tient, are by no means unfavourable, but on the contrary, often attend a quick labour. Tliis stage is attended with a discharge of sli«)y fluid, which, when the orifice of the won.b is consi- derably opened, becomes of a red colour. These pains are often sharp, and seem to be doing no good, and the woman is apt to become restless and fretful, 68 OP LABOUR, AND and as they are sometimes attended with sickness, heartburn and vomiting, she becomes impatient or depressed in her spirits. These pains proceed from the attempt made by nature to dilate the mouth of the womb, and they must continue till this be accomplished. The com- plete dilatation is assisted and rendered both easier, and frequently more speedy, by the protrusion, through the mouth of the womb, of part of the membraneous bag which contains the child and the water. The degree to which it is pushed out of the womb, during a pain, varies much in different cases. Sometimes it forms a very slight projection, at other times it is very bulkv, being little less than the child's head. When the membranes be- gin to be pushed down, the water is said to " gather." The mouth of the womb being considerably open- ed, efforts are next made to press down the child, or to empty the womb. These produce a change in the pains, which are attended with a little inclina- tion to press down. This gradually increases, and at last the sensation of bearing-down become* very strong and irresistable ; and it is observed, that though the pains aie strong and forcing, they are productive of less complaint, than those which in the beginning of labour appeared to be less severe. There is a gieat vari ty in the duration of this part of the process. It i- sometimes gradual and slow, in other cases sudden and rapid. 1 he pains may be THE CHILD-BED STATE. Cji strong and forcing, and have very little interruption, or they may come on at very regular periods, with complete intervals of ease. During this period the membraneous bag, in which the child lies, usually bursts, and the water which it contained is discharged. This event is fol- lowed by an increase of the pain, which becomes more forcing, and the spirits of the woman rise in pro- portion. At length the head of the child comes to the birth, and by repeated efforts is at last expelled. This is followed by the gradual delivery of the body. After an interval of ease, one or two slight pains are felt, which serve to throw off and expel the after- birth. The duration of this process is various, but it is generally longer in a first child than afterwards. This is particularly the case with regard to the se- cond stage. Some women are uniformly expedi- tious, others always tedious. Some have the first stage slow, and the second quick; some have the wa- ter discharged early, others not till the child is born. Some have much sickness, or retching, or shaking, and others none at all. In short, there is a great va- riety in these respects with different women, or even with the same woman in different labours. In a na- tural labour, the whole process is concluded within twenty-four hours after its commencement, often in a much shorter period. It would be foreign to the intention of this work, to detail the management of labour; but it will be 70 OF LABOUR, AND useful to give some general rules of conduct, which though very simple, will yet, if attended to, be of great benefit. The first is to choose the largest, best, and quiet- est room to be confined in. The bed is to be placed so as neither to be too near the fire, nor exposed to a current of air. It is to be made up in a manner well understood by the sick-nurse, who places the mattress uppermost, as being more comfortable than a feather bed, when it is not daily made up. A folded blanket or dressed skin is put next this, in order to prevent it from being wet or soiled. Over this the undermost bed- sheet is thrown, and the bed made up as usual. Af- , terwards, a sheet in five or six folds is laid across the bed, and these being removed, when the child is de- livered and the woman laid up, she finds herself clean and dry without further trouble. Second. Every thing ought to be in readiness be- fore it can possibly be needed, particularly the baby- linen, and such articles of dress as the mother may require. Third. The nurse should be called early, and in- timation given to the midwife that she may be found, when the woman is satisfied that she is in labour, or requires her. Fourth. The bed ought to be properly made up when the labour begins, and it will be right for the patient to put.on a half shift or loose dress. Fifth. In every case, unless when the bowels are V THE CHILD-BED STATE. 71 too loose, it is of service to give a common saline clyster in the first stage of labour. This is at- tended with several advantages; it renders delivery a little easier and more comfortable, and some- times promotes it sooner. It is also of use after- wards. Sixth. During labour all heating drinks and stim- nlants, such as wine, caudle, cinnamon water, &c. are to be avoided, as they make the woman hot, restless, and uncomfortable, protract the labour, and lay the foundation tor subsequent disease, a The drink should be of the most cooliug kind, such as gruel, toast water, or cold water; and the food, if any be desired, ought, to be very light, and in small quantity. The bed curtains are to be kept open, and the room cool. If the light be disa- greeable, the window curtains can be let down. Seventh. In the first stage of labour, the patient may stand, walk, or sit, or remain in bed as she is inclined, but she ought by no means to stand so long, or walk so much, by way of forwarding the labour, as is productive of fatigue; and after the pains become very frequent and pressing, it will, in general, not be prudent to come out of bed. Eighth. Before the child is delivered, there is often a strong desire to rise to go to stool, but this is not to be indulged, without permission from the midwife, as the child might be born when the patient rises up. Ninth. An early examination is desirable, as it is 72 OF LABOUR, AND of consequence that the midwife ascertain the pro- gress of labour, and the presentation of the child soon after her arrival. If the presentation be bad, it is much more easily rectified before the water comes away than afterwards. Tenth. The mind must be preserved as tranquil and cheerful as possible, and for this purpose, if the patient be not disposed to sleep, during the interval of the pains, it is of great consequence to have a prudent nurse, or one friend in the room, to keep up easy conversation; but a collection of two or three people, especially if they be gossips, is very pernicious. Eleventh. Tossing in bed, and much crying or fretting, when the pain is off, must be avoided as much as possible, as these add to the^ fatigue. Twelfth. All attempts voluntarily to press down, during the pains, are generally unnecessary, and are highly improper at the end. It is, on the contrary, of consequence that the head should not be expel- led quickly, as the mother is apt to be torn. Thirteenth. After the head is born, the body should be allowed'to be delivered by a subsequent pain. There is often a considerable interval be- tween the birth of the head, and th& expulsion of Hie body, which ought to be no ground of anxiety, and the midwife should not be encouraged to hurry this part of the process. Fourteenth. If the patient have a rapid labour, and the midwife is at a distance, she ought to keep THE CHILD-BED STATE. 7& constantly in bed, and refrain as much as possible from bearing down. If the child should be born be- fore assistance is procured, the nurse should tie the cord firmly, near the navel, and apply another lig- ature about three inches from the first, and cut the cord between these; or if she be afraid to do this, the child must lie beside the mother till the mid- wife comes, taking care that the face be uncovered, to permit of breathing. Fifteenth. In the course of a short time after the child is born, the afterbirth is expelled with- out any assistance. The vessels which passed from the womb to the afterbirth would, when this was separated, pour out an increased quantity of blood, did the womb not contract so much as to diminish their size, and compress their orifices. This con- traction both expels the afterbirth, and prevents flooding. When, therefore, the afterbirth is expel- led, we have an evidence of the existence of that state of the womb which insures the safety of the mother. Until' this take place, both the patient and midwife should be attentive lest there be a great discharge, and if this occur, no time is to be lost in checking it. This is done by exciting the con- traction of the womb, by the application of a cloth, wet with cold water, to the lower part of the belly, and to the passage to the womb, and also by the in- troduction of the hand of the midwife to stimulate the womb. Some do this with the sole object of extracting the placenta or afterbirth, considering G 74 OF LABOUR, AND the retention of this as the cause of the flooding. But this opinion is wrong, and the mere extraction of the placenta can only do good, in so far as the introduction of the hand, and the means used to effect this, serve to excite the action of the womb itself. Forty or fifty drops of laudanum, in a little cold water, are useful as a cordial, in case of flood- ing. It follows from this view, that every exertion must be avoided before the placenta is expelled, and the patient must be kept cool and quiet. If flood- ing do occur, when no midwife is present, the nurse, or the most composed friend, should immediately apply cloths wet with cold water, open the win- dows to admit cold air, take off part of the bed-clothes, and give the dose of laudanum al- ready proposed. If the weakness increase, cor- dials, such as a little wine, will be proper to preserve the strength, till assistance can be procured. CHAPTER II. Of 'Tedious and Preternatural Labours. A natural labour is terminated within twenty- four hours, at farthest, after the mouth of the womb begins to open. Various causes, however, may conspire to prolong the process, and render la- bour tedious. It is altogether unnecessary, in a THE CHILD-BED STATE. 75 work of this kind, to enter minutely into a consid- eration of these causes, or of the different means employed for counteracting them. But some ad- vantage may be derived from a few general observ- ations. Tedious labour may occur under three different circumstances. First: The pains may be, from the commencement, few and weak, and the labour may, if left to itself, be long of becoming brisk. Second : The pains during the first stage, may be sharp and frequent, but not effective, in consequence of which the power of the womb is worn out be- fore the child has advanced far, or come into a sit- uation permitting it to be expelled. Third: The pains during the whole process, may be strong and brisk, but from some obstacle, the delivery may be either greatly protracted, or rendered altogether im- possible, without assistance. Different causes may produce these states, sucr as general weakness of the constitution ; particular weakness of the action of the womb itself; prema- ture discharge of the water; fear, impatience, and strong passions of the mind, which sometimes sus- pend the pains altogether for a time ; rigidity of the soft parts through which the child must pass, or particular states of the mouth of the womb, which can only be discovered by careful examination by the midwife; suppression of urine ; a dispropor- tion between the size of the child and the bones of the mother ; an unfavourable position of the head, &c. %6 OF LABOUR, AND These causes do not uniformly produce the same effect, nor is it possible for the patient herself to say by her feelings, in the early part of labour, whether or not it is to be tedious. The pains are sometimes slight and lingering» sometimes very severe, particularly in the back, and they may continue so for a long time, without doing any good; or towards the end, pressing-pains come on which have very little force, and rather ex- haust the strength, than forward the delivery. On this subject I shall satisfy myself with ma- king the following remarks. First. When the first stage of labour is severe and protracted, and the pains do little good, it can scarcely be disputed by any one who reflects on the matter, that in order to prevent the power of the womb from being exhausted, it is necessary either to make the pains more efficient, or to suspend them altogether for a time, till the strength be re- cruited, or the situation rendered more favourable. Second. When the pains are lingering and slight, or teazing, a saline clyster has very often the hap- piest effect in exciting more brisk and productive action. Third. A change of posture, or walking a little in the room, has also a good effect in making the pains brisker, provided that the patient is not tired or troubled by such motion. It is evident that whenever sitting or walking produce fatigue, or are felt to be disagreeable, they must do harm* THE CHILD-BED STATE. 77 Fourth. All efforts to bear down during the pains, in the first stage of labour, and every fatiguing at- tempt to iucrease the frequency, or force of the pains, must eventually retard labour, by exhausting the strength. Fifth. The strength, during a tedious labour, is to be supported by mild nourishment, such as beef tea, chicken broth, panado or gruel, &c and if the patient be much fatigued, a little wine may be given, provided it do not make her restless or hot. Sleep is to be encouraged, and the mind is to be soothed and supported, by looking forward to a happy ter- mination. Sixth. Some means are to be employed for pre- venting the pains from continuing severe but un- productive. These must vary according to circum- stances, but the end in view is of the utmost conse- quence, as we thus avoid much suffering, and some- times no small risk. In some instances, a little manual assistance is safe and highly useful; in oth- ers, remedies suited to the occasion must be re- sorted to. Seventh. Premature discharge of water is very apt to occasion painful and tedious labour, unless the mouth of the womb be relaxed, and the com- plete evacuation of the water be promoted. Eighth. The two most powerful means we can employ for remedying some of those conditions, which give rise to tedious and severe labour, are blood-letting and the use of laudanum, either as a G 2 78 OF LABOUR, AND draught or as a clyster. The states requiring or admitting of these it is impossible* to explain here, but it may be of service to do away a prejudice* which may exist against their employment when they are necessary Opiates are serviceable, some- times as cordials or general stimulants ; at other times, they are beneficial by suspending the useless but painful actipn of the womb, and thus allowing time for the strength to recruit, and these effects they produce more §afely and effectually than any other means could do. ' They are also of efficacy in checking that irregular spasmodic action of the ute- rus, which gives much pain, and rather retards than forwards the expulsion of the infant. With regard to blood-letting, there is only one objection of any weight, namely, that it will weaken the patient; but in reply to this I observe, that if it have the effect of reudering the delivery more spee- dy and safe than it would otherwise be, it will rather save the strength by preventing unnecessary fatigue. It is also well known, that a much greater quantity of blood is often lost after delivery, than would have been taken from the arm, and yet no bad effect whatever follows from it. \yiien convulsions occur during labour, or in the end of pregnancy, six times the quantity of blood that would be taken in any other situation, are often detracted with preeent re- lief and future advantage. Last of all, the expe- rience of different ages and various countries proves the safety of the practice. It is not a remedy new- THE CHILD-BED STATE. 79 ly introduced, the effects of which we are ignorant of, for it has even been the habit of some, to bleed women in natural labour, in order to render it still more easy and expeditious. Ninth. In tedious labour means are to be used for removing any disagreeable effect, which may follow either from the continuance of the pain, or the pressure of the child's head. We are, in parti- cular, to be attentive that the urine be voided reg- ularly, and that neither fever nor local inflammation be excited by the protracted labour. Blood-letting is a powerful mean of preventing either of these effects', and the use of the common saline julap is also serviceable. Tenth. Some unfavourable positions of the head, and some conditions of the mouth of the womb, may be rectified by the finger without giving any pain, and much suffering and risk may thus be avoided. Eleventh. If, notwithstanding all our care, the labour be protracted until the strength is impaired, and the pains are ceasing; or, if the obstacle be so great, as during the course of labour to make the head be fixed within the bones of the pelvis, and produce suppression of urine, or a tender state of the soft parts, with a sense of tightness within the pelvis, restlessness, giddiness or pain in the head severe pain or feeling of pinching, even in the ab- sence of the labour-pain, about the share-bone, or other symptoms, indicating to the practitioner, that 80 OF LABOUR, AND the powers of nature cannot any longer be safely trusted to, jt will be necessary to have recourse to the use of instruments. These are never to be re- sorted to except in cases of absolute necessity, but it cannot be too strongly enforced on the miud of a patient who requires them, that if she delay, after they have been advised by a practitioner of judg- ment and integrity, her own life and that of her child may be lost. Twelfth. Some positions of the child render de- livery impracticable, without the greatest hazard to the mother, and therefore it is necessary, when these are discovered, to have the child turned. This is in general easily accomplished, if the water have not been discharged, but if it have been long evacuated, it is not to be attempted till by the administration of sixty or eighty drops of laudanum, the pains are suspended. A neglect of this rule may be followed by very serious consequences. Falling down of the navel-string before the pre- senting part of the child, has no effect on the labour, but if the management be not very careful, the life of the infant may be lost. Thirteenth. Deadly sickness, with pain in the stomach, during labour; or head-ach, increased during the labour-pains, and accompanied with dimness of sight, or appearance of sparks of fire before the eyes; or severe tremors in the second stage of labour, after the mouth of the womb has been fully dilated; or great drowsiness durin^ the THE CHILD-BED STATE. 81 pains, with slow pulse, are very suspicious symp- toms, and indicate a tendency to convulsions. They are, if they do not very speedily subside, a sufficient warrant for having recourse to blood-letting, which prevents the evil, and also accelerates labour. If, however, convulsions do come on, then, besides instantly opening a vein, we must also deliver the patient. Fourteenth. If flooding occur during labour, to any considerable degree, there cannot be a questiou that the patient must be delivered, either by turn- ing the child, or by the forceps, according to the stage of labour and situation of the child. Fifteenth. Twins frequently produce a linger- ing labour, but there are no certain marks by which we can determine, that there are more children than one in the womb, either during pregnancy Or labour, till after the first child is born. The only remark necessary to be made here, is that more than ordi- nary care is required after delivery, to prevent flood- ing and child-bed diseases. CHAPTER III. Of the Child-Bed State. When the after-birth is expelled, it is too much the piactice with many to sit up immediately, and 82 OF LABOUR, AND have the clothes shifted. Most alarming floodings, and other bad consequences may result from this. The first thing to be done, is very slowly to remove the wet sheet from below the woman ; she next turns slowly on her back, and has a bandage applied so firmly round the belly as to give the feeling of a plea- sant support. The bandage often consists of a broad towel folded double, but it is better to have one made of stout cotton cloth, with tapes to tie, or buttons, with two rows of holes. It is prevented from slipping upward and wrinkling by a thigh piece, and in some cases it may be necessary also to have a shoulder strap*. Many with advantage apply under this a compress made, of a napkin or quilted pad. The bandage being applied, a flannel petticoat open in the middle, is next put on, and wrapped round the limbs, and a soft napkin is to be applied to ab- sorb the discharge. If the woman be fatigued, no more is to be done, but if she be not, an aired shift and bed-gown can be put on, and she is laid to rest, but if a half shift be used, during labour, there is, seldom very great occasion to change it, for some hours at least. , Although I am thus cautious re- specting speedy shifting on account of the effect often produced by slight exertion, especially after a * When the patient is able to rise, it is frequently both of ad- vantage, and productive of comfort, to have a firm bandage, with two broad pieces of whale bone in the back, to keep it even and smooth. It has shoulder straps above^ and below it is made like very short drawers. THE child-bed state. 8S lingering labour, or in delicate women, yet I wish to inculcate the necessity of changing the clothes as soon as prudence will permit, and afterwards shift- ing every day, and having the discharge washed a way, morning and evening, with a sponge and lukewarm water. Tiie number of bed-clothe-) must be regu- lated by the season, but they never should be so many as to promote sweating, which weakens the woman, and gives a tendency to catch cold. It is usual to give some cordial after delivery, such as brandy or cinnamon water. Unless the strength be exhausted, there is seldom occasion for this, and it often does harm. A little wine and water may be given, if fa- tigued, or a little panado with wine ; or if the la- bour have been lingering, and there is much languor, a little Madeira wine is very proper. A stool should be procured within thirty-six hours after delivery, by means of a suitable dose of mag- nesia, or a little castor oil. If the patient is not to nurse, the laxatives should be rather brisker. The urine should always be passed within twelve hours, at farthest, after delivery, and if there be any difficulty in voiding it, fomentations will be use- ful. After a severe labour it is necessary to be very attentive to the voiding of the urine, and the state of the soft parts. The diet ought to be light, and should consist for the first two days, of tea and cold toast for breakfast, beef or chicken soup for dinner, and panado for supper. Afterwards a bit of chicken may be 84 OF LABOUR, and taken for dinner, and as recovery goes on, the usual diet may be returned to. In these direc- tions, however, regard must be had to the pre- vious habits and present state of the patient. The drink at first should be toast water, and malt liquor is for some days to be avoided ; wine, or wine and water may be allowed, if no fever be present, and the weakness, or former habits of the patient require it. In a good recovery the patient may have the bed made on the third day, but during the time she should recline on a sofa. In a day or two longer, she may be allowed to be dressed and sit a little, but ought not to walk about, or leave her room for some time ; and even in summer should not go out for an airing in less than three weeks. Many before this time do rise, and even attend to domestic cares earlier, but they often suffer very much, either from a weak- ening discharge or a falling down of the womb. CHAPTER IV. Of Trembling and Fainting, It is not unusual for women, very soon after de- livery, to be siezed with a violent shaking or shiver- ing, sometimes in consequence of rash and sudden exposure to cold, after being heated with the exer- tion of labour, but often from no evident cause. No-, OF THE CHILD-BED STATE. 85 thing, in general, gives so speedy relief as a pretty large dose of laudanum, forty or fifty drops, for in- stance, in peppermint water, or in a little wine. At the same time the patient is kept in perfect rest, and when she is inclined to shake, she must be held gen- tly by an assistant, so as to prevent her from doing so in a great degree. If she feel cold, and the teeth chatter, the application of a warm cloth to the sto- mach and feet is useful. This is not a dangerous and seldom an obstinate affection. If it, however, should be prolonged, camphor is of service. Fainting is always an alarming symptom, and when it occurs, the first thing to be ascertained, is whether there be a great discharge or flooding; in which case the danger is extreme, and the treatment of this has been already pointed out. It may also attend inversion of the womb. But some women are, after a tedious and severe labour, and others even after very little suffering, liable to a short and tem- porary exhaustion, approaching to a fainting fit, or very often to that kind of insensibility, or lowness, which occurs in an hysteric attack; and like it, this is frequently preceded by an involuntary crying or sobbing immediately after the birth of the child.- This is not dangerous, indeed there is never great ground for alarm, whilst the pulse continues very good and there is no discharge, for in this case, tie patient may rather be said to be in a state of still- ness or quietness than fainting, in those cases where this state occurs, after delivery, a few drops H 86 OF THE CHILD-BED STATE. of oil of cinnamon on sugar are useful; or we give thirty drops of laudanum in a little wine, or brandy, or hartshorn and water, whilst a free circulation of air is to be preserved. Volatile tincture of valerian is recommended by Dr. Hamilton to be given, as soon as the child is born, to those who are subject to fainting fits, and certainly is a useful remedy. in those more alarming fainting fits, where the face is quite pale, the extremities cold, and the pulse nearly gone, if no medical assistance is at hand, the following directions may be useful. The heat is to be preserved by the application of warm cloths to the stomach, hands and feet; and if the patient can swallow, a spoonful of wine is to be given frequent- ly, until assistance can be procured. The slightest motion is to be avoided, and the patient is to be kept with the head low. If there be a discharge from the womb, a soft cloth is to be pressed firmly on the external opening, and pressure is to be made at the same time on the lower part of the belly with the hand, to prevent the womb from distending with blood, and to excite its action. Forty drops of laud- anum are also to be administered. When vomiting is produced by flooding, solid opium should be given instead of laudanum. OF THE CHILD-BED STATE. 8? CHAPTER V. Of After-Pains, and Pain in the Belly. After-pains are sometimes extremely trouble- some, during the first three days after delivery, and may even be more distressing than those of labour. They proceed from different causes, but the most frequent is the contraction of the womb to acquire its original size. This often occasions irregular grinding pains in the lower part of the belly, and sometimes in the back, like those of labour; they are usually accompanied with the discharge of clots of blood, and frequently are renewed for a day or two, whenever the child is applied to the breast. They are most effectually relieved by a full dose of laudanum, and warm fomentations. Another kind is accompanied with wind in tlie bowels; the pain is not merely felt in the bottom of the belly, but in different parts, and comes on often like gripes or cholic pains, sometimes accom- panied with a little fulness of the belly, and pain,on pressing hard. Tin's is relieved by an injection* to open the bowels, and afterwards a dose of laudanum in peppermint water, and fomentations. An injec- tion, containing laudanum, is also useful. Sometimes worms cause this pain. 38 OF THE CHILD-BED STATE. Severe pain between the ribs and haunch-bone may attack in paroxysms, continuing for more than half an hour, and then going off completely. It may be accompanied with quickness of pulse, and the urine is high coloured. It is relieved by opiates, fo- mentations, sinapisms and laxatives; and sometimes » pretty firm bandage gives temporary ease. Constant pain, accompanied with shivering, vomi- ting, swelling and tenderness of the belly, fever, and suppression of the cleansings, indicate inflammation, and require the earliest attention. Pain in the back and lower part of the belly, with a strong bearing-down, weakness, feeble pulse, and a discharge of blood, require examination, lest the womb be inverted. If much time be lost, the inver- sion may either prove quickly fatal, or remain during the whole life. It is neither necessary nor proper, in a work of this kind, to describe more minutely the inversion of the uterus, as the symptoms 1 have enu- merated ought to make every woman have recourse to immediate advice. When the womb is so com- pletely inverted that it comes out of the passage, the case is clear to the patient herself; but 1 must im- press it on the mind that this accident may also oc- cur, in a less degree, when there is no external pro- Irusfon. Pain in the belly, coming on suddenly, like cholic,* ■ without shivering or chilness, and attended with sick- ness, and sometimes frequency of the pulse, require* the immediate use of a salt clyster: the bellv is to bo OF THE CHILD-BED STATE. S§ fomented or rubbed with anodyne balsam, and the saline julap, with the addition of laudanum, is to be employed. If these means do not soon give relief* there is ground to fear, that whatever may have been the nature of the complaint at first, there is now great risk of inflammation taking place. Pain in the belly, with swelling, and inability to void the urine, if not relieved % fomentations, re* quires the immediate attention of a practitioner. Smarting and tenderness about the passages, re- quire fomentations; but if there be extensive lacera- tion, or an inability to retain the urine, a practitioner must be consulted; neglect may be attended with lamentable consequences. CHAPTER VI. Of Bearing-Down of the Womb. I am next lead to observe, that in consequence of weakness and relaxation, or of rising and walking too soon, the womb, being yet heavy and large, may fall low down, or may even come to protruaWexter- nally. This is called a bearing-down of theTpfcb, and when it proceeds so far as to appear outwHrrd- ly, the nature of the case is manifest. But this for- tunately seldoms happens at first, and the patient complains for a length of time of weakness and pain h 2 90 OF THE CHILD'BED STATE. in the back, a sense of dragging about the loins, weariness and aching about the thighs and bottom of the belly, and unpleasant sensations when she attempts to walk, particularly a bearing-down ; and by and bye, when the womb descends lower, she cannot make water easily, and in the whole progress of the complaint, the stomach and bowels are apt to be disordered, both in their functions and sensa- tions. These affections of the stomach and bowels are often very prominent symptoms, leading off the attention of the patient from the true cause, which can often only be discovered by the examination of a skilful practitioner, "-f-— This is a complaint which generally proceeds from relaxation, or from exertion before the womb has returned to its usual size, or from its remaining for a length of time larger than usual. This na- turally suggests a caution against rising too soon, or making any early exertion ; and it is peculiarly incumbent on those who are delicate in constitution, or enfeebled by previous disease, to be on their guard in this respect. Although, doubtless, rash management on the part of the midwife may occa- sion this complaint, yet it is much oftener the fault of thftrfjatient herself. It must also be impressed ?o«^p mind, that it may succeed a miscarriage, or rmry even occur in unmarried women, from exces- sive discharge, whites, or violent exertion, when out of order. Rest, in a recumbent posture, is of the greatest service in the early stage. The bowels are OF THE CHILD-BED STATE. 91 to be kept in a very regular state, by daily doses of Cheltenham salt, or sal polychrest. The diet should be such as tends to increase strength; and for the same purpose, in a month after delivery, the cold bath may be employed, if no particular symptom forbid it; and along with this very gentle exercise may be taken.^The application of a proper bandage round the whole belly, with a moderate degree of firmness, often gives great relief to the uneasy feel- ings. If the complaint have been neglected, or resist these means, and increase, the use of astringent in- jections, a course of strengthening medicine, and some mechanical contrivances, which it is useless to describe, as no patient can on her own judgment employ them, will be required. This is a complaint which is apt to be increased during the first three months of a subsequent pregnancy, but after the third month it disappears. There is another affection which may be con- founded with this, namely, a relaxation and protru- sion of the passage to the womb. This forms a soft swelling or promiuence at the orifice of the va- gina, which sometimes completely encircles the opening, but oftener is more on the one side than on the other, or is greatest behind. It givesuio par- ticular inconvenience, unless it exist in a gflffehV-. gree, and it usually disappears on going to becm It requires the use of astringent decoctions, or alum water, externally, and the frequent application of cold water, by means of a sponge. If the patient 92 OP THE CHILD-B^D STATE. be weak, strengthening remedies are useful, sueh as bark, steel, cold bath, Sec. CHAPTER VII. Of Alterations of the Lochial Discharge, An increased and sometimes a continued dis- charge, after delivery, is often the consequence of getting up too soon, or making some early exer- tion. It is usually attended with pain in the back, and always produces weakness. It is to be remo- ved by avoidiug exertion, taking some strengthen- ing medicine, such as bark and wine, and using, if it continue, the shower-bath. The aching pain in the back is often relieved by the application of a strengthening plaster. The lochial discharge is in some women very trifling, and may even stop very soon without any bad effect. But when it is suddenly checked by exposure to cold, or other causes, most painful consequences may follow, such as swelling of the belly, great pain, sickness and fever. These symp- tomji# dangerous at all times, but are still more to 6v dreaded as they often attend inflammation, and indeed the two cases can only be distinguished by minute attention. Uutil assistance be procured, a clyster should be administered, warm fomentations OF THE CHILD-BED STATE. $3 applied, and a perspiration encouraged by a saline julap, containing antimonial wine, together with te- pid drinks. Ill-smelled discharge proceeds from clots of blood lodging about the womb, and requires strict atten- tion to cleanliness; it may even be necessary to wash the discharge from the passage with milk and water, by means of a syringe. If, however, this discharge be attended with sickness or nausu.; quick pulse, hot skin, parched hands and feet, thirst and want of appetite, or repeated discharges of blood, and pain in the lower part of the belly and back, then there is reason to conclude, that part of the after-birth remains in the womb, and great attention is necessary to preserve the patient. This affection ofteu passes at first for a weed. The patient is worn out with nocturnal perspira- tion) fever, and want of nourishment, until at length a putrid mass is discharged from the womb, per- haps about the ninth or tenth day, or even after some weeks of suffering, and then the patient gene- rally recovers. The bowels are to be regulated either by laxa- tives or opiate injections, according to their state. The diet must be light, such as chicken broth, beef tea, calves-feet jelly, arrow root, &c. The elixir of vitriol is useful for promoting appetite and checking perspiration. Camphorated mixtmre is of service for allaying nervous affections. Great attention must be paid to cleanliness and ventilation. 94 OF THE CHILD-BED STATE. Exposure to cold, or a neglect of the proper ban- dage, often produces a swelling of the belly, which is not removed without great difficulty. It is pre- vented by having the bandage properly adjusted and kept with firmness, avoiding cold or exertion, and preserving the bowels in a regular state. CHAPTER VIII, Of Swelled Leg. After delivery one of thejegs is sometimes af. fected with a painful swelling, which is often,though not always correctly, attributed to some violence in the labour, or some imprudence afterwards. It makes its appearance about ten days after delivery, sometimes sooner or even later. It begins with fever and pain in the back, or lovver part of the belly, particularly about the groin, where there is consid- erable stiffness felt. The pain may gradually extend down the limb, but more frequently it is, after these symptoms, suddenly felt in the calf of the leg, or knee, aud presently the whole limb, which formerly perhaps was cold, becomes hot and swel- led. The acute pain then abates, but the limb continues tender, and can scarcely be moved. The pulse becomes much quicker, the face pale, the strength is greatly impaired, and frequently OF THE CHILD-BED STATE. 95 very copious perspiration adds to the weakness. At first this often passes for rheumatism. Even under the best management this may prove tedious, and therefore recourse should immediately be had to a practitioner. Leeches should early be applied to the groin, or cloths dipped in warm vine- gar, or solution cf sugar of lead. The bowels are to be opened. If the limb have become affected, then fomentations, and frictions with anodyne bal- sam, or camphorated oil, give relief; at the same time the bowels are to be kept regular with cream of tartar. When the acute symptoms are over, and the limb remains weak, friction with the flesh-brush is proper, and a roller should be applied with moderate firmness from the toes to the groin. The cold-bath is useful to re-establish the health. The diet ought, after the inflammatory symptoms have abated, to be nourishing, and sleep should be pro- cured by opiates. CHAPTER IX. Of Delirium. Delirium, when it is not dependent on inflam- mation of the brain, rarely comes on sooner than a week after delivery, and sometimes not for a much longer time. It makes its appearance very sudden- ly, the patient not unfrequently awaking terrifi- Q6 OF THE CHILD-BED STATE. ed from a dream/or all at once, she breaks out in to some absurd or furious conduct. There is oftei very little increase of heat of the skin, or other ap pearahce of fever; though in some instances then is considerable heat, and the pulse is very quick and this is especially the case when there has jwi been some strong exertion, or much speaking. But, as in all other cases of nervous constitutions,the state of the pulse is subject to considerable and suddet variation. The patient is usually extremely talka- tive, and sometimes speaks with wonderful volubili- ty. In some cases one idea seems to possess the mind; in others the.object of apprehension or con- sideration is rapidly varied. She can, however, for a short time be commanded, and at times, at least, appears perfectly sensible of what is going on be- %de her. It is not easy to say what causeproducesthb disease, for it does not appear to be connected with a tendency to mental deraugement in other circum- stances. The duration of this complaint varies from a few days to some weeks; but it rarely,under proper management, proves fatal. My experience leads me to consider blood-letting as useless and sometimes hurtful. The most effi- cacious practice consists in shaving the head, and applying a blister, opening the bowels, determining to the surface, with saline julap, and afterwards ' employing camphor freely to allay irritation. The patient must be carefully watched. OF THE CHILD-BED STATE. 97 Melancholy usually comes on Ltvr than delirium, and is more obstinate. Inflammation of the brain is also attended with deli- rium, but is very.diffeieut from the former complaint, which is chiefly dependent on nervous ii ritatiou. This usually appears on t c s cond or third day after deliv- ery, and from the time of delivery, or very soou after it, the pulse is frequent. The patient is, before the violent symptoms come on, ol served to be restless and watcl*- ful, and catinot sleep. The eye is very seusible to the light, and the patent hears acutely. She com- plains of headach, or to-ifusion in h r head, and the secretion of milk does not take place, or stops if it has. Furious delirium then occurs; the eyes are wild and sparkling She pays no regard to, or does not seem to recognise objects around, and she can rarely be commanded, even for a time, by any one. This is a more fatal disease than the former; for the patient is very apt to be carried off with symp- toms indicating oppressed brain, such as great stu- por, noisy breathi.ig, cold clammy sweats and con- vulsions. This tenniu iti >n occurs about the third or fourth day, though sometimes considerably later, It is not easy to say what excites this complaint. In some cases it has appeared to depend on a family disposition to mania; but in other instates it pro* ceeds from the child-bed stale alone, which often is accompanied with a strong tendency in particular or- gans to inflammation. The treatment consists chief- ly in the use of blood-letting, the applicaiiju of l 98 OF THE CHILD-BED STATE. leeches and blisters to the head, and purgatives. If the delirium continue after the inflammatory and febrile symptoms abate, camphor is the remedy principally to be depended on. Apoplexy may also occur in child-bed, partic- ularly in those who are of a full habit, and have complained of much headach during the latter end of labour, and after delivery. If, the headach and confusion, or giddiness, with appearance of fire flashing before the eyes, or sickness, are disregarded, it is not unusual for the patient to drop down, and remain insensible until death. I have always found this to proceed from the rupture of a blood-vessel in the brain ; and therefore the most effectual means of prevention consist in bleeding and purging. CHAPTER X. Of Looseness. Looseness in the child-bed state requires great attention. It is often produced by the costiveness which ocetirs during pregnancy, the hard stools ir- ritating the bowels. In this case the stools are ac- companied with pain, and sometimes bearing-down, they are slimy or bloody, and hard lumps are passed. This state requires gentle laxatives to clear out the bowels, such as solution of salts, or castor oil, then a starch injection, with laudanum, is to be given, OF THE CHILD-BED STATE. 99 and the bandage is to be kept firmly on the belly. The nourishment should be light. Looseness not preceded, by costiveness, and unaccompanied with much pain or pressing, and in which the stools are liquid, and contain no lumps, is generally caused by cold, or some irregularity of diet. It is often at- tended with a discharge of blood from the womb, and pain in the back. The belly should be frequent- ly rubbed with anodyne balsam, a gentle dose of rhubarb should be administered, and then an opiate injection, or a mixture, may be taken, containing confectio japonica. CHAPTER XI. Of Weeds and Fevers. Women who are disturbed much in their repose, who have suffered greatly during labour, who have very sore nipples, who are inattentive to their diet, distressed in their mind, or exposed to cold, are lia- ble to an attack of fever, called in this country a weed. The fit begins with chiJness, cold feet, and violent trembling, pain in the back, headach, and in some instances, inclination to vomit. Presently flushes of heat are felt, which at last become steady, and the patient feels extremely hot and restless. In some time afterwards, perspiration breaks out, con- tinues for a considerable time, and at last abates, 100 OF THE CHILD-BED STATE. leaving the woman free from fever, but very languid. During both the cold and hot stage the pulse is fre- quent, and there is thirst; but in the sweating stage both these symptoms decline. The whole fit is usu- ally finished within twenty-four hours, frequently in a much shorter period. There may be only one at- tack, but it is not uncommon for the tits to come on every day for more than a week, nearly about the same time, or an hour sooner or later each day; and in this case they are preceded by coldness in the back, accompanied with aching pain. In this state the stomach becomes filled with wind, the bowels are bound, and the patient is timid or hystericalt|-4t is not, in general, a dangerous disease, but if it con- tinue long, and the belly becomes swelled or tender, or the patient vomits frequently, or a degree of stu- por come on, there is the greatest danger. In many cases one of the breasts becomes painful during the fit, and afterwards suppurates, which adds to the distress. Palpitation of the heart, with sudden changes in the feeling respecting heat and cold, of- ten attend this disease. When the cold fit comes on, our object is to has- ten the hot one; which is done, not by putting many bed-clothes on the patient, for these are hurt- ful, but by giving frequently a small quantity of some warm drink, such as gruel or lemonade, and applying a bottle, filled with warm water, to the feet and pit of the stomach, or to the back, if it feel cold. When the hot fit is established, these appli- OF THE CHILD-BED STATE. 101 cations are to be removed, and the tepid drinks con- tinued till the sweat come out. Means are not to be employed for pushing this far, but by taking a very little drink, and lying quiet for some hours, it is to be encouraged to.continue in a moderate de- gree, till all the uneasy feelings and feverish symp- toms are removed. Then, warm dry linen is to be put on, and cold avoided with care. It requires much prudence to say when the perspiration ought to be checked, but it is a good general rule, to con- tinue it till the fever is removed. After the sweat- ing is over, a little panado with wine is proper. A repetition of the fever is to be prevented, by avoid- ing those causes which first brought it on, keeping the bowels open, and taking some strengthening medicine, such as bark, or a preparation of iron, and procuring rest by opiates. When there is a tendency to return, the fit is sometimes checked by taking twenty five drops of laudanum an hour be- fore the expected time of attack, and applying warm flannel to the back. If palpitation occur frequently, either along with this fever or without it, the best remedy is a large dose of laudanum, in a glass of peppermint water and during the intervals the volatile tincture of va- lerian, with laxatives, or the camphorated mixture will be proper. if the attacks of fever be repeated, or if it be- come continued, it will be necessary to give up nursing; and indeed in many cases the secretion of 12 102 OF THE CHILD-BED STATE. milk becomes so much diminished, as to lender it impossible for the child to be nourished by the pa- rent. In some instances pain, perhaps of short dura- tion, is felt during the weed, at the lower part of the belly, or in the back, which goes off in a few hours, or in a day or two; but when the patient rises up she feels a renewal of the pain, and so much unea- siness or pressing downwards, that there is ground to suspect that a beanng-down of the womb hat taken place. But the womb is felt in its proper place, and no relief is obtained by those mearu which alleviate that compluint. The inability to w alk, or stand long, may coutiuue until a slight dis- charge of blood takes place; and therefore, if this do not soon occur, it will be proper to wean the child, in order to encourage a natural alteration!!* the mean time, the boVvels are to be kept open and the strength supported by suitable means. It is, however, always proper, in a case of this kind, to have the best advice. Many are supposed to have a bearing-down of the womb, when, in fact, the symptoms originate entirely f om this complaint, and are not removed by the means which relieve the bearing-down. The womb, in this complaint, sometimes, but notalway*, remains a little enlarged until a cure is accomplish- ed. One aloetic pill should be taken every night, and two drams of sal polychrest, in a tumbler of water, in the morning. The patient must recline OF THE CHILD-BED STATE. 10S much on a sofa, and if there is much uneasiness at night about the back or belly, it may be useful to sit down for a few minutes, in a vessel filled with warm sea-water. But the most effectual relief re- sults from the patient becoming regular. ^--- .There is a species of fever which begins like a weed, but differs in being longer continued, and not consisting of repeated and daily attacks of shivering. The paiient, within eight or nine days after delivery, generally sooner, is seized with shivering and cold- ness ; the pulse becomes very quick, and the sto- mach is always affected, so that the patient is either sick, or loathes food. The skin, except about the feet, almost from the first feels hot to the touch of another person, though for some hours the patient complains of cold ; afterwards she feels hot, espe- cially in the feet and hands; the pulse is very fre- quent ; she is thirsty, has no appetite, has a white slimy tongue, is sick, and occasionally vomits phlegm or bile, or is plagued with wind. She does not sleep, but rather slumbers, and is troubled with dreams and visions, and talks during her slumber. Generally she complains of throbbing, often of con- fusion, but seldom of continued pain in the head. She has no fixed pain nor tension in the belly, but complains rather of flying stitches or griping. The bowels may be either bound or loose, but in both states the stools are foetid and dark coloured, and occasionally laxatives operate early and powerfully. The lochial discharge is not necessarily obstructed, 1,04 OF THE CHILD-BED STATE. nor does the secretion of milk suffer, in many in- stances, for several days. The eye and the counte- nance are nearly natural. The belly sometimes in the course of the disease becomes full and soft, as if the bowels were enlarged, and it may happen that this increased size continues for life. These symp- toms may be complicated with others proceeding from nervous irritation, such as palpitation, starting, &c. or with those indicating local disease. When pain is felt very frequently, though not very perma- nently, and is perceived on pressing the lower belly, or on turning, or on making water, there is reason to apprehend more or less inflammation of the womb, and probably matter may be, in the course of a fort- night, discharged with the stools, or from the womb. This fever may be caused by exposure to cold, by irregularities of diet, by costiveness in the end of pregnancy, or after delivery, and usually appears within eight or nine days after the birth of the child. The most useful practice, in this disease, is on the first attack to administer ten grains of ipecacu- anha, so as to produce gentle vomiting, and after- wards, when the stomach is settled, encourage a gentle moisture, by means of tepid drink, such as barley water, gruel, or tea. Then, in a few hours, we »ive a dose of rhubarb and magnesia, to remove the offensive matter from the bowels. This being accomplished, if there be griping, or a tendency to purging, an opiate clyster is next to be given, and repeated every night until the bowels are less irrita- OF THE CHILD-BED STATE. 103 ble, taking care, if they become costive, or the stools are foetid, to interpose occasionally gentle laxatives* The diet must be very light, such as beef tea, chick- en broth, calves feet jelly, arrow root, and ripe fruit, if there be no tendency to purging. Ginger wine with water, forms an excellent beverage, and in the course of a few days, one/>r two glasses of Madei- ra wine may be allowed, unless it produce heat and restlessness. In general it agrees well, is very grate- ful, and inspires a feeling of comfort and strength. When the tongue becomes cleaner, five or six grains of powder of colomba, given four times a-day, are of service. If there be much nervous irritation along with this disease, the camphorated mixture is useful. In those cases where pain is felt in the lower part of the belly, the most speedy attention must be paid to it. The treatment consists in procuring a copious perspiration, opening the bowels, foment- ing the belly, or if the symptoms be more acute, blood letting and sinapisms, ox some other external application, may be required. There are other fevers and diseases occuring in the child-bed state which are attended with great danger, which it would be improper in a work of this kind to describe, because such description might have a bad effect on the imagination in the irritable stale of lying-in, and also because no person ought in such cases to delay procuring the best advice. It will, however, I think be of great utility to add this geueral advice on the subject, that no fever is free 106 OF THE CHILD-BED STATE. from danger, and therefore no fever should be ne- glected ; that fevers attended with paiu in the belly, or obstruction of the lochial discharge, or vomiting, or much headach, or tendency to delirium, are pe- culiarly dangerous, and require prompt assistance, Shivering fits, succeeded by these symptoms, require immediate attention, i .^- CHAPTER XII. Of Worms. Women after child-birth are frequently very much troubled with worms, particularly the small white worms, called ascarides.f-These produce a very troublesome itching about the lower part of the intestine, for they are entirely confined to that por- tion of the bowel. ^They also occasion want of appetite, or depraved appetite, itching in the nose, pale face, irregular pains in the belly or sides, and sometimes a difficulty in mak ing water. If the stools are examined they may often be found mixed with slime, and worms can be discovered like small pieces of white thread. The most effectual mean of destroy- ing these animals is to use, twice or thrice a-week, at night, as long as the symptoms continue, a clyster, composed of two drams of aloes, rubbed up with four ounces of mucilage and eight of warm water. OF THE CHILD-BED STATE. 107 This is to be retained as long as possible, and in the morning three drains of Cheltenham salts are to be taken. Or the injection may be made of an Eng- lish pint of strong decoction of chamomile flowers, four ounces of oil, two ounces of epsom salts, and a dram of green vitriol. A different kind of worm, is found higher up, having to a superficial observer, much the appear- ance of the common earth worm, whilst another spe- cies, namely, the tape worm, is flat and jointed. Be- sides these there are others, some of which are very singular in their appearance, but which it is unne- cessary to notice minutely. These produce generally more pain in the belly, than ascarides, and seldom any itching about the extremity of the bowel. In some cases the fits of pain and sickness are severe, accompanied with hardness and fulness of the belly, and in other instances, in no long time after delive- ry, very severe cholic is excited by them. The symptoms, however, are, it must be understood, equivocal, unless worms are discovered in the stools, or vomited from the stomach. The treatment is two-fold, first to give a brisk course of purgatives, which not only forces the worms away, but by re- moving much of the slime of the bowels, destroys their favourite and necessary habitation. Calomel, epsom salts, gamboge, Harrowgate water, &c. are used for this purpose, and must be frequently re- peated. The second part of the treatment consists in giving such medicines as are supposed to kill the 108 OF THE CHILD-BED STATE. worms, such preparations of iron, aloes, Indian pink, oil of turpentine, &c. but as these ought not to be employed without advice, it is improper to en- ter upon their consideration. Worms often exist in the bowels, without producing any obvious symptom, until they either accumulate to a great degree, or some adventitious circumstance -conspires to make them give irritation, and fortunately in all such cases the worms themselves are partly dislodged, or destroyed, so that more or fewer come away, aud the nature of the case is shewn. CHAPTER XIII. Of the Milk-Fever. The secretion of the milk is often accompanied with a considerable degree of fever, called the milk- fever. This is partly owing to that disturbance which is always to a certain degree excited in the system whenever a new process is established, and partly owing to the swelling or irritation of the breasts themselves. In this view it may, though of short duration, be compared to the teething fever of infants. This fever commences about the second or third day after delivery, and consists of a cold, a hot, and a OF THE CH1LD-B»D STATE. 109 sweating stage, during each of which the symptoms are so much the same with those described under the name of weed, that it is needless to repeat them. It must not, however, be supposed that the fever takes place in every instance, more than that every child has a teething fever : and even in those cases where the fever is considerable there is very little dangerei-There can be no difficulty in distinguishing this disease, for the breasts are full, hard and painful, circumstances which at once point out the nature of the fever. By way of preventing this disease, it has been recommended that the child be applied to the breast as soon after delivery as the strength of the patient will permit, and this is extremely proper, if the trial be made in such a way as not to fatigue her. It is also useful to procure a stool early, as I have formerly directed, and it is even proper where the patient is stout, of a full habit, and does not propose to nurse, to give laxatives more freely, in order to diminish the quantity of milk, and prevent fever. When milk fever does take place, the treatment is very simple, consisting in giving warm drink, such as gruel, or lemonade, in small quantity, during the cold stage, and applying warm flannel to the feet and stomach. In the hot stage, the curtains are to be thrown open, the coverlet taken off, and tepid drink taken to excite perspiration. In the sweating stage the perspiration, which is generally sour suielled, is to be gently encouraged, till it be universal, and the patient feels reliev ed, then it is to be lessened, and K 110 OF THE CHILD-BED STATE. the management is the same as in weed. These means are to be employed to an extent, and with a degree of attention, proportioned entirely to the se- verity of the symptoms. In slight cases scarcely any thing requires to be done, except, perhaps, giving a little tepid drink, and opening the bowels. If the room be kept warm, and the patient oppressed with bed clothes, and obliged to drink often, espe- cially of stimulating liquors, much injury is done; the strength is impaired, and sometimes a miliary rush is brought out on the face and breast, or the fever may be rendered continued. In all such unpleasant cases, the management cannot with safety be in- trusted to the nurse or relations. CHAPTER XIV. Of Suckling. In the course of a few hours after delivery, if the strength of the patient have been recruited by rest, it will be proper to apply the child to the breast. This ought, if possible, to be done in a recumbent posture, and if the child do not fasten easily, she is not at that time to be fatigued by persisting in the attempt. If she cannot give suck lying in bed, she must sit up in the easiest way, being supported with pillows, and having the shoulders, back and breasts, OF THE CHILD-BED STATE. Ill completely defended from cold, both to avoid inflam- mation of the breast, and also to prevent a weed. Before applying the child, the nipple should be washed gently with a little spirits, and then with tepid milk and water, to remove the bitter substance which at that time often covers the nipplerT-The child may at first get very little, but presently the milk becomes more abundant, not as nurses suppose, because the young breath of die child brings milk, but from the excitement given by suction. If the nipple be flat or small, so that the child cannot get hold of it, it is often of use to have it sucked by a grown up person, provided it be done veiy gently; for much force gives paiu, and all painful sucking is hurtful; an elder child is also sometimes employed, or an elastic gum bag with a small glass bell at its mouth, is used, whilst the milk is pressed gently for- ward with the hand on the breast. But if the patient have resolved not to nurse, then it is necessary to take precautions for diminishing the quantity of milk. As little liquor as possible should be swallowed, and food should be taken spa- ringly, unless the patient have been reduced. The bowels, unless under the same circumstance, should be kept, for a day or two, rather loose. As suction is a great mean of promoting the secretion of milk, it ought to be avoided as much as possible, and is only to be resorted to, if the breasts are very painful, and the milk do not run out; in this case, as much may be taken away as merely relieves the tension: 112 OF THE CHILD-BED STATE. when the milk runs out, care must be taken to pre- serve the breasts dry. The pain and swelling are sometimes accompanied with a degree of fever, but by avoiding heat and drink, or by a gentle natural perspiration, or slight purging, or by the milk grad- ually oozing from the nipple, the uneasiness gene- rally soon goes off. Some means have been em- ployed to put back the milk, such as the application of camphorated spirits, cold vinegar, &c. but these are all more or less hurtful, and nothing is so safe or so proper, as simple but gentle rubbing with warm olive oil, and fomenting the breasts when they are painful, either with warm water, or w arm vinegar and water. CHAPTER XV. Of Inflammation of the Breast. When in consequence of exposure to cold, or of the pain and tension, occasioned by the retention of the milk, in those who do not, or cannot suckle, inflammation of the breast is excited, there is the greatest reason to apprehend that suppuration will take place. This disease is easily known by the pain, hardness and swelling which accompany it. In some cases, the whole breast appears to be affected, in others, only one side ; and in some the affection d OF THE CHILD-BED STATE. 118 is small and superficial. When the breast inflames, it is evident that the retention of the milk must, for a time at least, increase the pain. The first and earliest object then must be to have , the breast gently drawn, either by the child or by other means, provided these attempts do not give pain, for if they do so, and the milk do not come readily, more hurt than good will be done. The breast should be gently rubbed with the hand, and a small quantity of oil, and then a poultice applied of crumb of bread and tepid solution of sugar of lead. The patient should keep in bed, and have the breast properly supported. Spare diet and lax- atives are proper. If the pain and hardness do not very soon go off, but on the contrary, the pain be- come more severe and throbbing, suppuration must take place, and it is to be encouraged by warm bread-and-milk poultices. If the.abscess be small and superficial, the spot soon becomes red, and at last breaks, occasioning, comparatively speaking, little distress, and scarcely giving any interruption to nursing. But if it be more extensive, and the glandular part of the breast be affected, all the symptoms are more severe, the progress is more tedious and the strength is apt to be reduced by fe- ver, perspiration, and want of appetite. In these cases if the abscess do not poiut and break soon, no good can be gained by delay; an opening should be made, so as to evacuate the matter freely. This not only gives immediate relief, but prevents a far- K 2 114 OF THE CHILD-BED STATE. ther extension of the mischief, and the foundatioa of future disease. The poultice must be continu- ed for some time, in order to remove the hardness, and then the part must be dressed; but in a case of this kind, attended with so much present suffering, and having sometimes the future health at stake, no one ought to manage herself merely from written rules. I only add, that opiates are frequently use- ful to promote sleep, and tonics may be necessary to restore the strength.""^ If the parts do not heal within a reasonable time, there is. ground to, suspect, either that the matter is not properly, evacuated; or, especially if there be hardness, that the diseased t' part is influenced, either by some constitutional cause, such as scrofula, or debility, or by some ac- quired morbid action, which may require a gentle course of mercury, back, sea-bathing, or other meaus for the cure. Sometimes after the abscess heals, and the breast seems to be cured, it swells a little, especially toward night. This is from weak- ness, and is cured by using cream of tartar, and Strengthening the constitution. If care be not taken, the breast is apt to inflame a second time, which is occasionally a much more tedious process than the first attack, and may re- main long without going on decidedly to suppuration^ Poultices and fomentations, applied pretty hot, are useful. Indurations remaining after an abscess, require much attention, lest in a course of years they come O* THE CHILD-BED STATU." lljj to prove troublesome. They may often be remov- ed by the application of cloths, wet with a mixture of camphorated spirit of wine, and Goulard's extract. CHAPTER XVI. Of Excoriation of the Nipples, _ The nipples sometimes become tender and ex*- •coriated, and so very sensible, that the application of the child produces excessive paiu. This com- plaint is occasioned by suckling,, for if the child; be kept off for a day or two, very obstinate excoriations heal up. It has therefore been projected, to cure this by making the child suck through a cow's teat,fa«ten- ed to a metallic nipple, and this in. many cases gives at least considerable relief, and ought always to be tried. It b likewise of service to keep the nipple. dry and cool, for which purpose, rings of lead are frequency worn. The application of lotions re- peatedly in the course of the day, is also produc- tive of great benefit, such as ten or fifteen grains of white vitriol, or of alum, dissolved in four ounces * of rose water; or an infusion of galls; or laudan- um and water, in such proportion as not to smart much; or opium dissolved in white wine; or bran- dy and water; or port wine, &c. These must be 116 OF THE CHILD-BED STATE. frequently varied, for the same lotion soon loses its effects. Before the child be applied, the nipple should be gently, but carefully purified by bathing with water. The application of astringent washes to the nip. pie for sometime before delivery, is often useful to those who are subject to this complaint. Instead of superficial excoriations, there may be deep chops or ulcers on the nipple, bleeding when sucked or moved, and producing intolerable pain. They require to be dressed with strips of fine cad- dis, spread with spermaceti ointment. These are to be kept constantly applied, except merely when the child is sucking, which ought to be as seldom as possible. Applying with a pencil, a weak solu- tion of blue vitriol; or a mixture of cream and Goulard's extract; or an infusion of nightshade, is sometimes of benefit. It is needless to say, that all these should be washed off before the child be al- lowed to suck. If the ulcer be obstinate and ex- tending, the nursing must be given up, otherwise the nipple may be for ever lost. The pain and retention of milk, and sleepiest nights, produced by sore nipples, may excite ejither weed, or inflammation of the substance of the breast. V\ hen a hired nurse, has chops or small ulcers on the nipples, and the child has similar sores on the lips or tongue, an experienced practitioner must be consulted. OF THE CHILD-BED STATE. 117 CHAPTER XVII. Of the Choke of a Nurse. I am next to notice some of those circumstances which render it impossible, or inexpedient for the mother to suckle her child, and the qualifications re- quired in a hired nurse. Those who have scarcely any milk in consequence of profuse floodings, of previous illuess, of child-bed diseases, or of some-natural deficiency, or of the milk constantly running out at the nipple, it.stead of collecting in the breast, evidently cannot propose to nurse. In most of these situations the attempt would be highly injurious to the mother, and perhaps fatal to the child. Those who are of a delicate constitution, those who are easily fatigued and worn out, those who though not actually consumptive, yet have a tenden- cy to become so, ought not to endanger their health so far as to suckle the child. Those who, trying to become nurses, find that the duty is more'than they can perform, that they are tormented with headach, weakness of sight, inflamed eyes, loss of appetite, sleepless nights, cough, conti- nual pain in the back, &C will do well to relinquish 118 OF THE CHILD-BED STATE. at once a task, which they cannot without great im- prudence undertake. Others from the irregularity of fashionable hours, and the various and fatiguing engagements and amusements in which their time is consumed, have neither leisure nor ability to suckle their offspring. Now, as it is always right of two evils to choose the least, it is certainly better to hire a nurse than endan- ger the life or the future health of the infant, by giv- ing it milk, bad in quality, and deficient in quantity. This rule will apply still more forcibly, to those un- happy mothers who have become addicted to the miserable and depraved practice of private drinking ; a vice, which melancholy experience proves, not to be confined alone to one class or rank in society. In a few words, wherever the parent is injuredbj giving suck, or the child is stinted in nourishment, or hurt by the quality of the milk, it becomes a positive duty to procure a nurse. In the choice of a nurse, there are different quali- fications to be required. The first and most obvi-, ous is, that she have plenty of milk; next that her milk be good. These are however points, which are not always easy to be at once determined. Doubt- less, small and relaxed breasts indicate, that there cannot be an abundant supply; butou the other hand a contrary appearance is not always a proof of plen- ty; even the inspection of the nurse's child is not a criterion, for it may have been fed. But where fa- vourable circumstances are met witn; and the we- OF THE CHILD-BED STATE. 119 man is stout, active and healthy, there is very strong reason to expect, that she will make a good nurse. As to the quality of the milk, that cannot always be determined by inspection, for milk having the same appearance, may be laxative, binding, or flatulent. It is therefore proper to make a provisional agree- ment with the nurse, that if her milk prove deficient in quantity, or exceptionable in quality, she cannot be continued. Much depends on the nurse's looks and temper, for an open countenance, and cheerful, lively disposition, always bespeak a treatment more pleasant and useful for the child, than a dull, melan- choly, or sulky expression, and slow, careless or in- active habits. There is a prejudice against employing a woman who is nursing her first child, because it is uncertain how she may turn out. But as the history of those who have had many children cannot always be faith- fully obtained, there is, I believe, as much uncerti- tude in the one case as in the other. A stronger ob- jection is, the want of experience in the manage- ment of a child. A very young nurse may be supposed to be thoughtless, and sometimes may be more delicate than one between twenty and thirty years of a^e, whilst tme elder, on the other hand, has a greater chance of losing the milk. It is scarcely necessary to say, that the nurse should not have been long de- livered, for if she has already been nursing for many months there is less security of her milk continuing 120 C^F THE CHILD-BED STATE. a sufficient time. iKaalso always better to employ a nurse who has 0^nre|\ila|ly sucked ty a child, than one who having low, rVe^VhKd. has krpt in the secretion by milking tbe^Xeast$^e» by bring only occasionally sucked. In this case', the milk i> chan- ged in quality, and may not perhaps return in the former quantity and perfection. It is likewise pro- per that the nurse, as far as can be determined by inquiry and examination, be free from hereditary disease. Whether disease may be communicated by suckling is a disputed point, but no one in a matter of so much importance would wish to run any risk. It has even been proposed that mothers who labour under such diseases should employ another nurse, This is less clear, however, for every peculiarity of constitution that the mother is capable of giving, may be supposed to be already communicated to the child in the womb. But this is a point, in which individuals must judge for themselves. Lastly, it is of importance to determine the character and con- duct of the nurse, as much, and lasting misery, may be entailed upon a child, by an unprincipled and dissipated woman; and amongst other vices, a pro- pensity to tippling is one, which cannot be atoned for, by any property, or collection of properties. y BOOK III. OF THE MANAGEMENT AND DIS- EASES OF CHILDREN. CHAPTER I. Of the Management of Children. SECTION I. After the child is born, the first thing to be done, if it be lively, is to separate it from the mother, as I have formerly noticed. But if it do not cry or manifest signs of life, this is to be done with greater hesitation. Children do. not breathe in the womb, but have that function compensated for, by the circulation of the blood, through the after-birth, by means of the navel-string. Now, if after being born, the child do not breathe, gasp, or cry, then, after ascertaining that the face and mouth are not covered with the membranes, and that the navel- string is not encircled round the throat so as to pre- vent breathing, the next thing for consideration is, whether it is still deriving any assistance from the h 122 ©F THE MANAGEMENT after-birth, for if so, removing the child would be a fatal step. This we know, bv taking the navel string between the finger and thumb ; if a beating or pul- sation be felt, the circulation is going on, and as long as that continues, the cord ought not to be lied. There may be exceptions to this general rule, but of these exceptions, nurses and attendants cannot judge, and therefore to them, the rule is absolute. The child is to be kept warm below the clothes, except the face, and is to be rubbed with the hand, partic- ularly over the breast. If it begin to breathe soon, and give one or two convulsive struggles, there is seldom any risk ; it will speedily cry aloud, and may then be separated. But if it do not breathe, and the pulsation in the cord stop, then, after this, no good can accrue from letting the child remain in that situation ; the cord is to be tied and cut; or, if the pulsation stop immediately after the birth of the child, it is not to be continued connected to the mother. In either case, whether there never was pulsation discernible, or whether there was at first pulsation, but that have now ceased, the child is to be immediately removed, and measures used for re- storing animation, unless there be evidence from the putrid appearance of the child or cord, that it has been long dead. These means consist chiefly in preserving the heat, and endeavouring to produce respiration.^^The first is done by immersing the child up to the neck, in lukewarm water, or cover- ing it with warm flannel until that can be procured. AND DISEASES OF CHILDREN. 128 The second is effected by such means as tend to rouse the system in general, such as friction with spirits over the body, the application of some slimu- ulant to the nostrils, such as vapour of hartshorn, and giving an injection of warm water with a little salt, but chiefly by endeavouring directly to excite the function of respiration, by inflating the lungs with air through the nostril of the child, which every midwife is instructed how to do. These means sometimes are successful, but much more frequently fail. Children may be still-bom, in consequence of various causes, such as pressure on the navel string, during labour, so as to obstruct the circulation; long continued labour after the waters are drained off; or from remaining long with the head pressed in the bones of the mother ; besides other causes connect- ed with the state of the child itself, inducing actual death before delivery, or unfitting it for breathing after birth. In those cases, where the head is, from long pressure during labour, misshapen, and the pulsation remains in the cord, it has been proposed to cut this, and let it bleed a little to relieve the head ; but this, which forms the exception to the rule above mentioned never to cut the cord while the pulsation remains, is a practice which should only be adopted under the direction of a skilful judge, and generally it is better, rather to open one of the arteries in the cord, than to divide it com- pletely. 124 OF THE MANAGEMENT It thus appears, that there are chiefly two states of still-born children. In the first, the cord is beat- ing, the circulation is going on, and the after-birth is supplying the place of the lungs. In this case, cutting the cord is destroying at once the function, which is in the meantim e equivalent to breathing, and w hich is preserving the child; one of the arte- ries in the cord may be opened as we would a vein, in bleeding a grown up person, and the child may thus be bled, but upon no account is the whole cord to be cut. In the second state, the pulsation has stopped, the child does not breathe, and neither does he draw any benefit from the after-birth. He has nothing to supply the place of breathing, and therefore, this case is much worse than the former. The cord may without injury be divided and our on- ly resource is in the use of artificial breathing. SECTION II. But fortunately these means are seldom required, and the child in a few seconds after birth, cries and breathes freely. On being separated from the pa- rent, the first thing to be done, is cautiously to wash off the white crust which covers the skin, by means of a little soap and lukewarm water. The child being cleaned, a small bit of soft rag is next wrap- ped round the navel-string, and a band is wound round the belly. This ought pot to be very tight, otherwise, it will give uneasiness, and impede the AND DISEASES OF CHILDREN. I-" breathing. Its chief use is to keep the navel cov- ered, for it has in general very little effect in pre- venting rupture at the navel. After this, the child is, to be dressed, a process, which it is not necessary to describe here. I have only to observe, that the dress ought to be loose, and made to tie with tapes, as pins are dangerous. Almost every child cries on being dressed, and therefore, it is desirable to have the dress so contrived as to consist of* as few pieces as possible, that it may be speedily put on. Former- ly, children used to be bound up tightly in their clothes, so that they could scarcely move. This practice prevailed very early in this country. In one of Mr. Strutt's plates of antiquities, there is a view of a lady's bed-chamber, in which there is a child, as formally bandaged as if it were a broken leg, new- ly out of the hands of a surgeoa. How injurious this must be to the health, need not be told. One practice, somewhat similar, is still adopted by many nurses, namely, before the child is laid in bed, to wrap its* clothes pretty firmly round the legs, and then secure them with a pin. This confines the limbs, and makes the infant uneasy. Children should be washed morning and evening with tepid water for a fortnight, and then it may be made gradually perfectly cold. Their linen and clothes should be very frequently shifted. How often do we meet with little, infants, merely from sloth or ignorance, wearing the same dress for days, and rendered disgusting both to the sight and smell. Scarcely any other care or ad- L 2 126 OF THE MANAGEMENT vantage can prevent the child from suffering, when cleanliness is neglected. Attention should be paid to keep the child dry, and the clothes ought to be immediately removed when soiled oi wet; the child should also be wiped with a soft sponge, dipped in water. It is wonder- ful how early an infant may be taught to void the urine and stools at proper intervals into a pot. The temperature in which children are kept should be regulated. It ought never to be below that which is agreeable to an adult. By exposure to cold air, the infant is apt to have cough, or stuf- fing of the nus rils produced; on the other haudj warm apaitm»nts, and especially a neglect ol a tir- eulatiou of air, hurts the health, and makes nun lia- ble to fits. When laid to,*est, the quantity of bed-clotbei must be determined bv the season; and as his dress is warmer through the day than that used at night, he must when asleep be more lightly covered dur-: ing the day. A crib is the proper bed for a child. Cradles are hurtful, as the rocking is often earned to a dangerous degree, and, besides, they are so confined, and gen- erally so closely covered, that the child breathes an impure air. Infants sleep much at first, and ought not to be disturbed; in this respect, they may be left to their own propensity, and as they grow older, they sleep less. The only point to be attended to, when they AND DISEASES OF CHILDREN. 127 become so old as to have the sleep regulated, is to prevent their sleeping so much through the day, as would make them restless at night. A certain portion of exercise is necessary for eve- ry animal, in order to preserve health. For a week or two the mere washing and dressing of children, and the motion which they from time to time make w ith their arms and legs, is productive of sufficient exertion. By degrees, they may be tossed or dan- dled a little, and ought to be occasionally placed on the bed to allow liiem to kick, and move their arms freely. When they are able for it, they should be encouraged to creep on the carpet, and even when two or three month-, old, the*feeble and unavailing attempts they make to move, or to raise themselves are useful. At all periods preventing free mo- tion, or confinement long to one posture, is hurtful, both to the shape and the health. The age at which infants may be taken out, de- pends much on the season, in warm weather they may be carried out a little, when a fortnight or three weeks old, but in winter they must be older. It is of great consequence to have children much in the country. It is a mean of preventing debility of constitution, disorders of the bowels, and fevers proceeding from that source, if this be useful for every child, it must be still more so, for those who are delicate; they ought to spend, if possible, the first years of life in the country. It is too customary with the nurse to give to chil- 128 OF THE MANAGEMENT dren soon after birth, sugar and water, salt and water, or maguesia, to open the bowels. None oi these are generally necessary, and they may often be hurtful. If the child be applied early to the breast, the milk at that period being laxative, will open the bowels sufficiently, and carry off that green, or black looking matter, which is called meconium, and which exists in the bowels of every infant. If how- ever, the child do not get the breast, or be fretful, moan, or start, it may be useful to give a little mag- nesia, or manna ; more active medicines ought not to be given without advice. No doubt, great atten- tion is required to the state of the bowels, but this may be overdone, and a healthy child certainly very seldom requires interference. After the meconi- um is purged off, and the child sucks freely, the stools become yellow, or orange coloured, of a con- sistence neither firm on one hand, nor watery on ihe other, but somewhat like thin pudding, and rather of a curdled appearance. The smell is slight and different from that exhaled by the stools at a more advanced period of life. The number of stools in twenty-four hours varies with different children who are equally healthy; some have seldom more than one, others above four, for many weeks. When the stools change their appearance from that de- scribed,and have an offensive smell,then the bowels are certainly disordered, and must be attended to. A thriving child has natural stools, sucks freely, cries little, sleeps w ell, has a clear, firm, sound skin, AND DISEASES OF CHILDREN. 129 occasionally covered with red specks called gum, and gradually improves in strength, bulk, and liveli- ness. All infants when asleep, are apt to turn the eyes involuntarily, and start a httle ; but an infant who is not thriving, or who has some complaint, starts in general, a great deal, rolls the eyes much, cries often, or moans, and lies in a state half asleep, from which he awakens usually with a mournful whine. He does not suck well, the stools are ill sniel- led, and changed in appearance, generally increased in number, and the skin becomes loose, and often has a dirty appearance. SECTION 111. It is too much the practice, to give children food or drink, before putting them to the breast, on the principle of supporting them until the milk come. Doubtless, in cases, where the mother is a bad nurse, or long of having milk, this may be required; but where she has milk in the usual time, it is not necessary. Infants' do not suffer so much from want of nourishment immediately after birth, as they do when deprived of the breast for the same number of hours, after they have once sucked. The young of no other animal requires to be fed before sucking the mother ; and, if infants be ap- plied early to the breast, they will not require it either. If any thing, in spite of this, be given, it ought to be merely milk and water. Panado, gru- 130 OF THE MANAGEMENT el, &c. may disorder the stomach; and were parents to consider the matter, they would generally find, that the quantity of food given, though enough to do harm, and give the child gripes, is too trifling to have been of any use. No food is so proper for the child, as the mother's milk, and where she has plenty, and the milk agrees with the infant, it ought to constitute the sole sup- port for several weeks. Afterwards, it is proper to to givea little meat, first once, and then twice a day, in order to accustom the stomach to digest a differ- ent food, previous to weaning. Panado is general- ly employed, but this is apt to sour, and produce complaints of the bowels ; arrow root is much bet- ter, but the diet of children in this respect, i shall immediately consider. Infants generally suck gree- dily, and if allowed would gorge themselves, and injure the stomach. The mother, therefore, ought not to become the slave of the child, and especially, ought not to allow him to sleep all night at the breast. Children may early be taught to suck at regular in- tervals, and never should be indulged as ofteu through the night as through the day ; this breaks the moth- er's rest, is apt to hurt her health, and generally in- jures her as a nurse ; one suck late at night, and another early in the morning, will be quite sufficient. The time at which a child should be weaned, de- pends much on his health, and on circumstances con- nected with the nurse. A delicate child requires to be nursed longer than one who is stout; and where AND DISEASES OF CHILDREN. 131 there is reason to suspect a tendency to particular complaints, connected with weakness of constitu- tion, or where children suffer from teething, or for- mer children have suffered from weaning, it will be right to continue the nursing for near a twelve- month. But where the child is vigorous, he may be weaned at nine months, or even earlier, if any particular circumstance require it. When the milk disagrees with the child, producing either costive- ness or looseness, or when the health of the mother is suffering, then the child must either be weaned, or have another nurse provided, according to the state of his own strength. In all cases, the change ought to be made gradu- ally, the child receiving more food, such as arrow root, biscuit meat, calves-feet jelly, beef-tea, &c. and less milk for some time previous to weaning. It will also be of advantage to accustom him for a few weeks to have no suck early in the morning; noth- ing from bed-time, till an early breakfast. Many give drink through the night, which is merely a bad practice. By giving food three, or even four times daily, and lessening the quantity of milk gradually, as the other diet is increased, children very seldom suffer from weaning. The great cause of injury is, - the change of diet, which produces disorders of the stomach and bow els, and this, it is evident, cannot be so effectually prevented by any method, as making the change gradually. 132 OF THE MANAGEMENT The practice of giving a child toddy, or lauda- num, &c. to make him sleep, when he is weaned, is very hurtful, as these injure the stomach and bow- els. 'the food of a child, after being weaned, may consist of boiled nriik and bread, light bread pud- ding, arrow.root, biscuit meat, beef-tea, a little of i soft boiled egg, calves-feet jelly, or veal soup. When the bowels are not costive, rice is also proper; and when the powers of the stomach are stronger, oat- meal porridge forms a nourishing breakfast; this is sometimes with advantage mixed with barley meal, which makes it lighter and more laxative. A little animal food should be allowed after the double teeth come out. Wine ought not to be given to children, except by prescription. Ripe gooseberries and strawberries, &c. are useful, unless there be a bowel complaint. When the diet is proper, the child is not sick nor oppressed, and the stools are natural. , SECTION IV. It often happens^ that mothers cannot nurse, or have not an adequate supply of milk. An impor- tant question then arises, whether a nurse ought to be hired, or the child brought up on the spoon, as it is called. Whatever speculative writers have ad- vanced, there can be uo doubt, that the best and most proper food for the young of every animal which furuishes milk, is the milk of the parent. AND DISEASES OF CHILDREN. 13S Even the milk of another animal of a different class, cannot always be digested. Doubtless, we have examples of Romulus and Remus, being suckled by a she-wolf, and what is not less extraordinary, of a leveret being nursed by a cat; but these are no objections to the general rule. Chemistry teaches us, that there is in every different animal a diversity in the proportions of the constituent parts of milk. Milk, it is well known) consists of cream, curd, and whey; and the latter contains a considerable quan- tity of sugar. By standing, the milk throws up the cre!tm to the top, and by adding an acid or rennet, it separates into the curd, and the whey ; and, eva- poration of the w hey leaves a sweet substance, cal- led sugar of milk. The milk of cows contains the greatest proportion of cream, and next to it that of women, then of the goat, the cow, the ass, and the mare, in the order in which they are enumerated. The curdy part is greatest in that of the sheep, thefi of the goat, the cow, the ass, women, the mare. The whey is greatest in that milk which has least cream and curd, and consequently is more in that of women, than of sheep or cows. The quantity of sugar is most in the milk of mares, then of women, the ass, the goat, the sheep, and the cow. It has been denied by men of eminence, that women's milk could be coagulated, or contained curd; But it certainly does contain a portion of curd, though this is small, compared to that afforded by other milk and very tender and soft. The curdy looking mat-' M 134 OF THE MANAGEMENT ter vomited by infants consists in a great measure of viscid cream. It is a singular fact, that acids do not make the milk of women coagulate, though ad- ded to that of any other animal, they immediately form curds. Now, from what we know of the na- ture of women's milk, it is evident that cow's is very different. It can be easily coagulated, both by ren- net and acids, and the curd is thick and firm, it yields much butter, and becomes sour by standing. But women's milk has more whey, a very tender curd, much more sugar, and though churned, does not yield butter. When infants are fed with cows milk, they often vomit lumps of cheese, and the stools contain much curd, and are often, from the disorder produced, green and ill smelled. A mixture of cow's milk, water, and sugar, has been used as a substitute for breast milk; but we may with more advantage dilute the cow's milk, with a third part of new made whey, and add a sixth part of sweet cream, and a little sugar. This forms a compound more nearly resembling breast-milk, though no per- fect substitute has yet been discovered. Whey with the addition of cream, and a very little sugar with- out any milk, may also be employed. Whey con- tains much of the saccharine principle, and is more nourishing than many suppose. Adults have lived for many weeks on whey alone. Either of these compositions should be given lukewarm, and the child is to suck it from a pot which is contdvfed for tjhe purpose. The mixture is to be made just as it AND DISEASES OF CHILDREN. 13.5 is requiredX If it do not keep the bowels open, more or less manna may be added in place of some of the sugar; or if it purge, then, more cow's milk may be added in place of part of the whey. Asses milk, when it can be procured, is also employed as a substitute for breast-milk. In a few weeks, other articles of nourishment are employed, particularly arrow root, or biscuit meat, that is, rusk-biscuit, boiled into a pap with water, with the addition of a little salt. Some have employed ground malt, made into meat with water; or when the child is costive, ale-berry, sweetened with treacle. But the proper diet for some weeks, certainly is plenty of either cow's milk, with a third part of water or gruel, and some sugar, or the mixture already noticed ; after- wards, the various articles of diet mentioned above, may be employed according as they shall he found to agree. But although it is easy to give directions in a book for rearing children without a wet-nurse, yet in practice, they are seldom found to succeed ; for no composition has hitherto been discovered, which can be so easily digested as breast-milk. When the attempt is made, great attention is to be paid to the stools, and the progress the child is making. If he take the mixture freely, and be thri- ving, if the bowels are in a correct state, and the stools not ill smelled ; or if costiveness can be ea- sily prevented by a little manna, and looseness by ad- ding milk instead of whey, or using a little rice gruel; we may safely go on. But if the infant be 136 OF THE MANAGEMENT falling off, and especially, if he lie in a dull heavy state, cry much, and be alternately bound in the bel- ly and loose, purging offensive dark coloured stuff, there is great reason to fear, that he will be lost if a nurse be not procured. SECTION V. Much of the present comfort and future health of a child depends upon the nursery maid. Amongst the qualifications required in her, the following may be enumerated : First. Cleanliness in her own per- son, correct conduct, with a cheerful obliging tem- per, patience, steadiness without harshness, and a method in all her arrangements. Second. Atten- tion to preserve the nursery well aired, to regulate the temperature, so as to avoid either cold or exces- sive heat, and to have the clothes always dry and clean. Third. Prudence iu the diet of the child. Fourth. A perfect obedience to rules and ordeff, some of which may be deduced from the following remarks. A child in health, ought naturally to cry very lit- tle. Although the temper and abilities of children, are not altogether under the control of parents, jet they may be greatly improved. It is absurd to pretend, that a child is inferior to a puppy, and yet a puppy may be early rendered docile and gentle,or sulky and ill natured, according as he is educated. I wish to impress deeply on the minds of parents, AND DISEASES OF CHILDREN. 137 that they have it greatly in their power to regulate the disposition, as well as to influence the health of their offspring. "jIa child does not cry, unless uneasy from hunger, want of sleep, pain, or some incon- venience. Bodily uneasiness will, with any child, affect the mind, rendering it peevish and irritable, ^ and presently, causes, which may be called men- ^i tal, will do the same. For a child is not merely an animal machine, he has also a mind capable, very early 6f feeling various passions. Some chil- dren, we know, are cheerful, good humoured, live- ly, and little disposed to be petted or fretful, when denied w hat they wish. Others equally healthy, are perpetually crying, passionate and cross, if they do not instantly obtain what they desire. Peevishness and crying, cannot, when the child is sickly and un- easy, be prevented ; but even in such cases, a pru- dent nurse can greatly diminish this disposition. In health, however, it is much to be feared, when these propensities exist, that the fault lies originally and chiefly with the parents ; nor is it altogether foreign to the design of this book, to call their attention to this point, so intimately connected with the present comfort, and future happiness of children. 1 can- not, however, enter fully into theksubject, though I offer the following observations. First: It is of the utmost importance in early in- fancy, to prevent pain, and as far as possible to re- move every distress and sickness, on its first appear- ance. . M 2 138 OF THE MANAGEMENT Second : Children should be prevented from feeling any painful degree of hunger. Third : Proper means are to be had recourse to, for preserving the bowels in a correct state, and pre- venting griping, and cholic pains. Fourth : A due and necessary portion of sleep roust be encouraged ; and when awake, such a de- gree of exercise must be given, as is useful for pro- moting liveliness. Fifth : When children begin to notice, and to be attracted by sounds and objects, the nurse ought • to sing in a cheerful and lively strain. Sixth : We should present, and take away, in a cheerful and amusing way, objects which attract the eye, by which the child is early taught to receive, and readily part with, what he desires. Seventh: It is to be recollected, that a child has a mind, endowed with gradually unfolding powers and passions : that when he begins to notice and desire, he becomes an object of education or training, and that the great point is, to keep away such bodily sensations, as would spoil the temper, or the soil to be wrought on ; whilst the powers, weak and tri- fling as they are, must be occupied, and engaged, with such things as can arrest the at ention, and pre- vent that impatience and fretfulness, which neglect- ed children shew. If the means of doing this, should be no higher than the shaking of a rattle, or the spinning of a totum, they are not beneath the notice of those who look to the end. AND DISEASES OF CHILDREN. 139 Eighth : To teaze and contradict infants and chil- dren, is not the way to improve the disposition, or to teach patience !t but it is not impracticable to treat them in such a way as to prevent their crying, if they do not immediately obtain, or should be depriv- ed of, what they desire, whether that be the breast, or a shining toy. This4s to be accomplished, not by stubborn harshness, always hurtful to a child, and indicating a savage disposition in those who use it, but by prudence ; and perhaps, the principle of conduct may be resolved into the maxim of leading at first the attention to something else, by which the habit of uniformly expecting immediate gratifica- tion, is prevented from being acquired. Now all this is possible, without pain to the parent or child, but on the contrary, eventually, with unspeakable comfort to both. Does any child, at least any one not under the guidance of an absolute fool, ever make a practice of crying, because he is prevented from grasping the flame of the candle ? No, surely; and why ? because the mother or nurse never will yield to this, and very soon the child be- holds the candle, without a wish to do more than look at it; yet, the very same child shall cry him- self asleep, or almost into a fit, if prevented from scattering the sugar out of the sugar bason. Much of the misery, and many of the crimes of human life, have their foundation laid in the nursery ; and could some of those who have suffered most for their misconduct, know all the steps which led to.it, 140 OF THE MANAGEMENT they would regret, that the seeds of ungovernable passion, of selfishness, and other vices, had been planted, before they could discern their right hand from their left. Parents, then, ought not to forget, that the subject of this paper is an important duty, binding on themselves, and that they require their utmost diligence and circumspection in the choice of servants, who will not undo by their carelessness, folly, and mistaken fondness, all their truly valuable care. Ninth : The practice of servants scolding chil- dren in jest, and teaching them to scold in return, encouraging them to scratch, and revenge real or pretended injuries, and to take vengeance on chairs and stones, is productive of incalculable mischief, As it is evident, that children can be early educated to evil and mischief, I hope, it will not be denied, that with equal attention, they might have been trained to good. This untoward education begins before infants can understand what is said or meant, as if it were sincerely intended, that the most effec- tual measures should be taken to corrupt and de- stroy the mind The stupid rant, or rapid repeti- tion of one or two words which have no meaning at all, in a tone, calculated rather to confound than enliven the child, bad as it is, is better than this. It is not foreign to the purpose to observe, that at a little la'er period, great pains are taken to inspire the child with a terror at the doctor, and at niedi- AND DISEASES OF CHILDREN. 141 cine, the effects of which are best seen, when the child becomes sick. CHAPTER 11. Of Connate Diseases, fyc. In considering the diseases of children, 1 shall begin with those which exist at the time of birth. SECTION I. One of the most frequent of these, is the flesh mark, or redness on the skin, resembling a stain with a bramble. This may occur on any part, the face, the body, or the fingers. It has been attribut- ed to the effect of the mother's imagination, or to a fright, but without any sufficient cause. It is met with when no such circumstance has occurred; and on the other band, it is wanting in those cases, where, if this had the supposed effect, we whould chiefly expect it. The mark may be more or less exten- sive, and of different shades of colour. It is gen- erally level with the skiu, but sometimes is elevated above it, and in every case v\here it increases, it does, eventually, becomes elevated. It proceeds' from the collection of a great many blood-vessels, by which the structure of the part is altered. By 142 DISEASES OF CHILDREN. pressure, the redness disappears, for the blood is forced out, but it immediately returns. When it becomes elevated and enlarged, then there is an evi- dent pulsation in the part; it grows with more or less rapidity, at last bursts, anddischarges sometimes an alarming quantity of blood. Pressure applied early, when the mark is on such a part as to bear k, is frequently an effectual means of removing it, or at least of preventing all tenden- cy to enlarge. The application of some stimulant or astringent to the part, if it be small, the cuticle being previously removed by a mild blister, and al- so, occasionally employing pressure, may be useful, but this practice ought not to be undertaken without advice. In bad cases au operation may become necessary. SECTION II. Hare-lip is so well known, that I need not describe it. It may exist in various degrees; it may be confined to the lip, or may extend back along the roof of the mouth. An operation is in most cases necessary and useful, by which the appearance is improved ; then, by proper contrivances, a defect in the roof of the mouth may be supplied, and the child enabled to speak distinctly. This operation, however, ought never, when it can be avoided, to be performed till the child is a year old or more, for when resorted to early, it generally fails. ' In die Diseases of children. 143 mean time, if he cannot surk ;iie mother, he may perhaps be able to suck a nurse who has a very large nipple. N SECTION III. Sometimes the natural passages, particularly the bowels, may be shut up, the nostrils or eye-lids may be closed, or the fingers may adhere, or have fleshy attachments, like additional fingers. These cases admit of cure, only, by surgical operation. The one generally of the most importance, is the imperforation of the bowel, by which the stools are prevented from passing. A surgeon can often de- termine, whether the passage be merely covered, or the bowel be deficient, or whether the stools are re- tained by some indurated mucus. It is evident, that if relief be not obtaiued, death must soon take place, and perhaps some children have died from this cause, without any suspicion of the real nature of the case. An operation is in some instances exceedingly simple, in others it is more.hazardous, and very uncertain in the result; but even in the worst cases, an opening can be made into the bowel higher up, and then a chance of life is given. When a child does not make water, the use of a silver probe will ascertain whether there be any ob- struction, and if there be not, it promotes the dis- charge. 144 diseases of children. SECTION IV. When the tongue is fastened to the lower jaw, too neai Uvv poin-, the child canuot suck easily, nor can he afterwards speak distinctly, the motion of the tongue being impeded. This is a very rare case, for generally the fault is in the nipple or the nurse, rather than the child. If the tongue is not bound down, and if the child suck the finger when put into the mouth, there is no reason forsayinghe is tongue- tied. The operation, where it is really necessary,is very trifling, but if incautiously performed, the ar- tery below the tongue may be opened, and much blood lost. When the tongue is not sufficiently tied down, or too loose, it has been supposed that it might be turned back into the throat, so as to suffo- cate the child $ of this, I have never known any in- stance. SECTION V. Deformities may occur in almost any part of the body, but they are more frequent about the feet than elsewhere, inducing what is called club-foot. This may exist in different degrees, and w ith various complications, rendering the cure more or less diffi- cult, or impracticable. In every instance, immedi- ate attention ought to be paid; for, as the extremi- ties of the bones and joints of infants are soft aud DTSEASES OF CHILDREN. 145 pliable, gentle and continued efforts, by means of suitable bandages, and contrivances to bring the parts into the natural shape and situation, will then be much more effectual than if delayed. And indeed, after a certain lapse of time, no skill can cure a de- formity, which, soon after birth, might have been easily removed. Growths upon the back bone are very dangerous, and when the tumour is covered with a red or livid skin, thin like that of the lips, and part of the spine is deficient, there is no great chance of the child liv- ing above a few days, though sometimes he exists for months; or, in a few cases, for some years in a miserable and paralytic state. The tumour sooner or later bursts, and water is discharged, but the in- fant may die, even before this take place. It is to be covered with a soft cloth, to defend it from inju- ry, but scarcely any application can be of service. SECTION VI. Rupture, or a tumour about some part of the belly, occasioned by the protrusion of a portion of the bowel, is not an uncommon occurrence. The kind which is, in general, most immediately danger- ous, is that which takes place at the naval; where a great part of the bowel may be forced out, cover- ed only with a very thin and almost transparent skin. If this be so large that the intestines cannot be pres- sed back, the child generally dies, in consequence of N 146 diseases of children. the tumour inflaming, or going into mortification. But if the bowel can be pressed back, and, espe- cially, if the skin of the tumour be not very delicate, there is no risk. The application of a compress, and suitable bandage round the belly, keeps the in- testine in its place, and in the course of some time, the aperture closes so far as to prevent the protru- sion. This complaint is supposed to be owing to the child crying much, when the navel is unsupported, but this opinion is not always correct. The bowels may also protrude at other places, particularly at the lower part of the belly, and the case is distinguished by the tumour disappearing on pressure. A bandage cannot easily be applied with effect, to so young a patient, though it is still worth a careful trial. SECTION VII. A more formidable case, is that, where the heart is not properly formed, or does not perform its functions correctly. In slight cases, the symp- toms do not come on for a considerable time after birth, perhaps not for months, and then they gra- dually increase. But in those instances where the malformation is considerable, they appear from the first, and either carry off the child in a day or two, or a miserable existence is prolonged, according to their severity. The symptoms in the worst eases are coldness of the extremities, a livid appearance of DISEASES OF CHILDREN. 147 the lips, fingers and toes, and indeed, a blueness or purple colour, of the whole skin. The child lies in a dull moaning state, seems to breathe with difficulty, has even occasionally violent fits of suffocation, and generally in such cases dies soon. Where the disor- der is slighter, he seems at times to be tolerably well, but the skin has never a clear florid appearance; on the contrary it is of a bluish or tallowy look. There is a suffocatiug cough, sometimes resembling hoop* ing-cough, and a quantity of phlegm comes into the mouth. During the cough, and also at other times, when the child is quickly moved or cries, the the skin becomes purple, the face leadeu coloured, the nails dark blue, and the infant seems ready to expire. But after a little rest, or respite, the dan- gerous aspect gradually abates, and the infant is re- stored to a quiet state. This is a case, which is very little under the control of medicine. The bowels are to be preserved in an open state, and the child kept as quiet as possible. Three or four drops of the sweet spirit of nitre, and two of tincture of hyocyamus, may be given to an infant, four times a day, which appear to diminish the quantity of phlegm, and make the fits of suffocation less fre- quent. There may be some deviations^where na- ture can effect a cure, but in general the termina- tion is unfavourable. Dropsy of the pericardium, or a collection of water in the bag which incloses the heart, may ex- ist at birth and is productive of very fatal effects. 148 DISEASES OF CHILDREN. The child from the first, appears to breathe with difficulty, perhaps he is nearly still-born. He cries in a very low tone, is mnch oppressed, and subject to violent motion of the ribs, and deep stertorous breathing, or fits of suffocation. The skin is con- stantly of a leaden colour, the extremities generally cold, and no pulsation can be felt at the wrist, per- haps none even at the heart. He does not suck, can scarcely swallow, struggles often, and on look- ing at the face, it appears as if he were crying vio- lently, and yet he is making little or no noise. Some- times he has slight fits, and generally he dies within three days after birth. This is a complaint too of- ten incurable, for the child does not live long enough, to benefit by the operation of such medicines, as can carry off the water. SECTION VIII. Children inconsequence of a tedious labour, or other causes, have sometimes a considerable swelling on the head. The edges of this swelling are hard, and the middle soft, so that an inexperien- ced person would suppose, that the bones of the head were deficient at that part. A cloth dipped in equal parts of vinegar and brandy, may be applied morning and evening, but I believe the swelling will always go off, even without any remedy I mention it merely to prevent uneasiness. Marks or furrows on the head, are equally trifling. diseases of children. 149 The breasts of children, sometimes swell and in- flame, especially if attempts be made to press out forcibly, a milky fluid which they often contain. Gentle rubbing, with warm oil, is useful; and if from mismanagement they should suppurate, which indeed rarely happens, a bread and milk poultice is to be applied, and when the tumour bursts, the part is to be dressed with simple ointment. A swelling in the scrotum of male infants, from water, is sometimes mistaken for rupture. But it differs in being elastic, and it cannot be made to dis- appear by pressure. If it be placed between the eye and a lighted candle at night, it will be seen to be transparent. It is not attended with danger, and generally goes away by the repeated application of clothes dipped in a solution of two drams of sal am- moniac in eight ounces of water. From neglect, or from a bad constitution of the child, the navel, sometimes, after the cord drops off, becomes very tender, and excoriated, giving a good deal of trouble. Great attention is to be paid to cleanliness. It is to be bathed twice or thrice a day, with infusion of chamomile flowers, and afterwards with a solution often grains of white vit- riol in six ounces of rose water. A bit of singed rag is usually employed as the dressing, but when this sticks firmly,a little spermaceti ointment may be used. If the health be otherwise bad, care must be taken to support the strength with breast milk, the bowels are to be kept open, and the apartment is to be well n 2 150 diseases of children. aired. Wherever there is a redness spreading from the navel, or the excoriation is considerable, or an appearance of fungus, called proud flesh, advice ought to be taken. CHAPTER III. Of Squinting. Squinting can never, unless from disease, be- come an object of attention, till the child be, old enough to notice. It generally proceeds from the two eyes being of unequal power, so that they can- not both discern the same object; and therefore, the weak one is turned aside, in order to avoid confused vision. This cause is ascertained when the child is a year or two old, by holding an object to the two eyes in succession, and observing if it be seen dis- tinctly at unequal distances. Squinting may^alsobe produced, by particular conditions of the muscles or nerves of the eye; or, when both the eye and its appen- dages are sound, it may be caused by carelessness and a bad habit. When it comes on very early, and before the child can give any account of bis perceptions, the eye w hich squints, ought to be covered up, for a great part of the day; and when it is opened, there should be a black, or glaring patch, fastened on the inside of the eye, at the root of the nose, if the eye be turn- diseases of children. 151 ed outward, or made to project a little at the temple, if it be turned inwards. The sound eye ought also, occasionally, to be covered up, and the child obliged to use the imperfect one. Goggles have been em- ployed, to make the child look straight forward, but they have not this effect, as the sound eye alone is employed. It is however, sometimes of use to em- ploy goggles, with the opening of the one belonging to the sound eye closed up, making the squinting eye alone be used, and directed straight forward, by the position of the aperture. Squinting proceeding from affections of the mus- cles of the eye, is often caused by straining the vis- ion, and may generally be cured by coveriug up the weak eye for a considerable time, and being after- wards very watchful. If it arise from a shortness or contraction of one of the muscles, the eye is permanently turned to that side, and cannot be moved to the other. When it proceeds from an unequal power, of the eyes, it may sometimes be remedied by wearing spectacles, having a glass in the imperfect side, ca- pable of making its power correspond to that of the sound one, which is to be unfurnished with a glass. This can only be practised with those who are some- what advanced in age. Spectacles always look bet- ter than a squinting eye. When a child squints only occasionally, or even fre- quently, but has the power when he chooses of di- recting the eyes to the same object, it is always pos- 152 diseases of children. sible to cure him ; often merely drawing the hand over the eye when he squints, and keeping a cou- stant watch, will be sufficient. CHAPTER IV. Of Opthalmia. Children within a few days after their birth, in consequeuce of exposure to much light, or a strong fire, or fr-m other causes, some of them operating during delivery, have sometimes inflam- mation of the eye. The eyelids swell, and their inside, as well as the white of the eye, becomes red, and covered with a quantity of yellow purulent mat- ter, which comes out at the corner of the eye, and hardening, tends to glue the lids together. In some cases, the eye-lids are little swelled ; in others their inside is turned out, especially when the infant cries. If this be neglected, specks may form on the eye, or the disease may be communicated to the eye-ball, and suppuratiou take place within, destroy- ing vision for ever. In a case of this delicacy, ad- vice ought always to be early procured, for internal medicine may occasionally be required. Externalap- plications are best made by using a small syringe, with which the eye-water is gently squirted within the eye-lids. Four grains of white vitriol, dissolved in DISEASES OF CHILDREN. 15S as many ounces of rose water, will be a very pro- per application to begin with. When the inflamma- tion is high, a leech applied to the temple does good, and the child should be purged; if it do not abate in a few days, a drop of vinous tincture of opium, introduced into the eye, morning and eve ning, will be useful. At a more advanced period, inflammation may occur from accidental causes, and ought to be removed early. When it does not speedily yield to bathing the eye, with the solution of vitriol just mentioned, or of sugar of lead in the same proportions, the eye should be carefully in- spected, for there may often be an opacity beginning at the edge of its clear part, or cornea, or perhaps, over the pupil of the eye. 1 need not point out the practice here, as a surgeon must be consulted, and parents ought not to refuse to allow the vessels to be freely and repeatedly scarified, and some smarting remedies to be used, if this should be thought pro- per ; for by their timidity the child may become blind or disfigured. Long continued, or frequently returning, inflam- maotin of the eye, with soreness of the eye-lids, and the excretion of a thick humour, which makes them stick together in the morning, may be greatly relieved or cured, by applying widi a camel's hair pencil, a drop of vinous tincture of opium, into the eye, four or five times a day : anointing the eye- lids with the ung. hyd. nit. ; occasionally scarifying the .distended vessels ; keeping the bowels regular ; and using the sea bath, in the proper season. 354 DISEASES OF CHILDREN- CHAPTER V. Of Cutaneous Affections. SECTION I. Yellow gum is merely a species of jaundice, but is in general of very short duration. It affects most children in a greater or less degree, and usual- ly appears within a week, or much earlier after birth. It proceeds from the absorption of bile, and is known by a yellow colour of the skin, or even of the eyes, and is preceded, and attended by sleepiness, and carelessness about sucking. It re- quires merely a purgative, such as a little calcined magnesia, or solution of manna. A more serious disease of this kind, is distin- guished by the severity of the symptoms, for be- sides the yellow skin, there is a great degree of op- pression and moaning, interrupted by cries pro- ceeding ftom colic pain, sometimes by cougb, and not unfrequently by convulsions. The stools may either be dark coloured, or more pale, and this last is the worst kind of the disease. The proper prac- tice is to give three grains of ipecacuanha, to act as an emetic, and then half a grain of colomel, and a grain of magnesia, morning and evening, or three DISEASES OF CHILDREN. 155 times a day, in order to induce purging; taking care however, not to carry this too far. The strength is to be sedulously supported by the breast milk. SECTION II. The red gum, is an eruption which appears very early after birth, and in a greater or less degree for some months, changing however its appearance, as it recurs at different ages. The red gum of infan- cy, consists of a number of small, red, elevated spots. The top is clear, and the base is of a vivid red. This eruption is scattered over the trunk of the body, and sometimes on the cheek and fore- head ; on the feet the spots are still larger, more distinct, and sometimes a clear fluid is found at the top. When the redness round the base is consider- able, the rash has at first sight an appearance of measles, but there is no fever, nor sneezing, nor watery eye, nor cough; on the contrary the infant is in perfect health. There is no necessity for using any medicine. If however, the eruption should suddenly disappear, and the child be much oppres- sed, or have violent pain in the bowels, or a tenden- cy to spasm, the warm bath, and a gentle laxative will be proper. If their be much oppression, three grains of ipecacuanha are to be given as an emetic; and if the child continue pale and sick, a tea spoonful of white wine posset may be ordered, every hour. 156 DISEASES OF CHILDR SECTION III- The white gum, appears after the period, at which infants are subject to the former variety; it consists of a number of white, hard, elevated spots, the base of which is sometimes, but not always, j surrounded with a little redness. It resembles the itch, and is sometimes mistaken for it, but it is not infectious, nor is it itchy, unless the child be kept dirty, and the parts are irritated. It requires no particular treatment; merely cleanliness and atten- tion to the bowels. When speaking of this erup- j tion, I may mention, that there is also another, which still more resembles itch, though it generally is rather later of appearing than the white gum. It consists of soft, smooth, shining elevations of the skin, forming small papula?, or eminences, dif- fering little in colour from the neighbouring skin. They are itchy, and if the top be scratched off, a clear water oozes out, and if the scratching be fre- quently repeated, they become read and bloody, or covered with a darklittle scab. By washing with soup and water, and rubbiug the parts three times a day, with lemon juice, the complaint may be removed, but if it be neglected, it may become similar to the itch, and require the same remedies. The tooth-rash consists of very small red spots, or papulae, set so closely together as to form patches, from the size of a sixpence, to that of even a dollar, DISEASES OF CHILDREN. 157 especially on the extremities; whilst on the body the papulae are larger, more inflamed, and at a distance look like measles. This requires no medicine, un- less it be a gentle laxative occasionally. SECTION IV. Excoriations, or a red tender state of the skin, are apt to take place about the groins, be- tween the thighs, behind the ears, &c. These gen- erally depend on want of attention, though with very fat children, they may sometimes occur, not- withstanding great care. At first, it is generally sufficient to keep the parts very dry, and dust them frequently with tutty,or calamine, or levigated flowers of zinc. But if they have been neglected, and be- come fretted, they require to be washed frequently, with a solution of ten grains of white vitriol, in five ounces of rose water. If the skin be ulcerat- ed, and matter be discharged, the part must also be dressed with spermaceti ointment, spread thin on soft linen. Excoriations behind the ears may take place very early, but generally are worst about the time of teething. The part is to be kept clean and cool, and bathed twice or thrice a day, with the solution of white vitriol, or with a mixture, consisting of an ounce of water, and a tea spoonful of laudanum. If the discharge have been considerable, purgatives must at the same time be employed ; or if the child o 158 DISEASES OF CHILDREN. be fat, and disposed to convulsions, it may not be prudent to stop the discharge entirely, at least, until he have had the bowels repeatedly opened. In ob- stinate cases, diluted citrine ointment, spread thinly on a rag, is a useful dressing. In very bad, and neg- lected cases, where the sore becomes black, and the parts in the neighbourhood are livid, and threaten to mortify, they should first be frequently touched with camphorated spirit of wine, and then, if this do not prevent mortification, a fermenting poultice is the best thing to remove the sloughs. The strength is to be supported by breast milk, beef-tea, and white wine whey, but it is often a fatal complaint. SECTION V. Another cutaneous disease is the milk-bloatch, which appears on lusty children, especially about the time of teething. It is a scabby eruption, which generally appears first on the cheeks or forehead, and then spreads over the face. The pustules are red, and the top soon becomes covered with a scab, consisting of different layers. Sometimes the pus- tules are large, and separate, but often they are small, and run together, forming a considerable patch, They contain a matter, something like honey. Du- ring teething, the margins are often red, and at this time ihick, yellow, or brown crusts form ; and when these are rubbed off, the part below is watery and dark coloured, with little fragments of scab adhering DISEASES OF CHILDREN. 159 to it. Blanes are left for some time. On the body, we often observe small red spots, something like itch. The milk-bloatch is itchy, rather than pain- ful. It generally proceeds from too full diet, or a plethoric habit, and therefore requires, not ouly to have the diet lowered, if the child be weaned, or the nurse fed upon less animal food, if .on the breast, but also, to have occasionally a laxative. Local applications should be used with caution ; but if the eruption be very itchy and troublesome, and do not yield to change of diet and laxatives, it may be washed with lime water, three times a day, or with a scruple of sal ammoniac, dissolved in six ounces of rose water. In obstinate cases, ointment con- taining sulphur vivum, sometimes does good. SECTION VI. Children sometimes, very soon after birth, become covered with copper coloured bloatches, which, if neglected, end in ulceration and scabbing. The mouth and throat also become ulcerated, and the roof of the mouth may be covered, with a dus- ky wh.te aphthous crust, whilst the gums discharge a most offensive matter, and look as if they were going to mortify. The child is hoarse, and cries in a low voice. The fundament becomes sore and chopped, and sometimes the eyes are inflamed, and discharge much purulent matter. Great emaciation takes place, and the child is presently relieved by UiO DISEASES OF CHILDREN. death from its sufferings. This state proceeds from former irregularities on the part -of one of the parents ; or from infection received from the nurse, whose nipples on inspection, will be found to be ul- cerated. It must, however, be remembered, that as the nurse may infect the child, so the child may have infected the nurse, and the point in many cases to be determined, is which of them had the com- plaint first. In some instances, the child when born seems to have suffered from the disease, being much emaciated, and his countenance like that of an ape, or an old man. Not unfrequently, he perishes, within a few weeks or months after conception. A course of mercury, given to the child, can alone cure the complaint. SECTION VII. Erysipelas, or rose, is a very formidable dis- ease with infants. It appears generally at an early period, commonly within a few days after birth. It begins with a hardness and redness of some part of the skin, about the belly or the extremities, accom- panied with fever. The part is of a purple, or li- vid colour, somewhat tumid and firm. The child is restless, or oppressed, or lies in a listless state, with muc'a of the appearance of dying. The red- ness extends on the skin, blisters form, the part be- comes darker in colour, and ends in mortification; or the disease continues for a time stationary, and DISEASES OF CHILDREN. l6l then suppuration takes places. In favourable cases, the colour becomes lighter, the hardness abates,' and the other symptoms decline. The best practice at the outset, is to dust the part with flower., and open the bowels, with gentle doses of calomel The strength is to be supported with the breast milk, and white-wine whey. If the colour become dar- ker, the part is to be frequently bathed with cam- phorated spirit of wiae. Fortunately in private practice, this formidable state of the disease is rare. It is more frequent to meet with partial erysipela- tous patches, and tumours on the extremities, which generally yield to the use of calomel purges, and dusting the parts with flour. If suppuration take place, the abscess ought to be early opened. SECTION VIII. Sickly children are sometimes affected soon af- ter birth, with inflamed blisters over the trunk and extremities, accompanied with fever, and increasing debility. Cordials are proper, but in general, those alone, who had a tolerable share of strength before the attack, recover. Blisters appear on children at a more advanced period. These may be numerous and large, but are not attended with fever. They are often met with in warm weather, on those parts exposed most to the heat. They require merely, to have the water let out with a needle. o 2 I(J2 DISEASES OF CHILDREN. SECTION IX. Boils are not unfrequent, and when numerous, always indicate an impaired constitution. They may succeed some debilitating or eruptive disease, as fever, purging, small or chicken-pock, &c. or may appear without any previous ailment. They are of two kinds, the first becomes pretty large, and con- tains a considerable quantity of matter; but it forms slowly, the skin is dark coloured, and long of break- ing, and there is not much acute pain. There are generally, several in different stages of progression. Suppuration is to be encouraged by poultices, and the matter should be early let out. The bowels are to be kept open, and the strength and constitution improved by diet, good air, infusion of bark, &c. The second kind is harder and flatter, has an ex- tended stool, and the skin a livid appearance; the pain is not great, but the part is hot and itchy j sometimes the tumour discharges a brownish colour- ed matter, but not equal to its size. It then gradu- ally closes up, and the swelling and hardness disap- pear by degrees. Others open up more, and disco- ver a core within, which after a time is destroyed, or comes out. These are of a different nature from the former. Gentle laxatives are highly useful, and the best local application is a poultice. DISEASES OF CHILDREN. 163 SECTION X. The itch is a contagious eruption the skin. U is sometimes attended with fever, aud the eruption, which is hot and itchy, appears and dis- appears, alternately, very suddenly. A geatle emetic, followed by one or two doses of physic, is all that is required. SECTION XVIII. The chicken pox, is preceded by feverish symp- toms, such as chilness, quick pulse, hot skin, rest- lessness, diminished appetite, thirst, aud headach. In some cases, the fever is severe, and attended w ith distressing retching, great agitation during the sleep, and even delirium. In others, it is scarcely per- ceptible. On the third day, the eruption appears, first on the body, and then ou the face, and lastly on the extremities ; when the eruption appears, the fever declines. The pustules, which are very itchy, «arly contain a yelLw waitr, or hquor, aud by the 176 DISEASES of children. fifth day are covered with scabs, which leave no pits. There are different varieties of this disease, for in some the pustules are larger than in others, or go off sooner. This is scarcely ever dangerous, and is seldom even troublesome ; nor is it generally ne- cessary to confine the patient, or do more than give, one or two doses of gentle physic. The fever and uneasy feelings may be greatly mitigated, and the eruption rendered slighter, by washing the surface with cold water in the commencement of the dis- ease. The itqhing may be abated afterwaids, by sponging the skin Occasionally, with cyld vinegar and water. In some cases, especially if the bowels be neglected, and the child be allowed to feed gross- ly, the fever maybe strong, and the pustules become much inflamed. Some of them may even end in sloughs, which leave deep marks, worse than those of the small pox, and as in that disease, so also in this, very troublesome boils may harass the patient for a long time. This is chiefly the case in bad constitutions. I have mentioned the causes ; and the cure, or mean of prevention, evidently consists in the use of laxatives and light diet. SECTION XIX. It is fortunately now unnecessary, in a work of this kind, lo descnbe the smail-pox. The di-cove- ry of vibe cow-pock has clucked the ravages of that loathsome and dangerous disease. The cow-pock DISEASES OF C ULDREN. 177 consists of a single vesicle, wk:»ch appears on the spot where the vaccine matter is inserted. The co- lour is dull white, but it is red at the edges.. It contains a fluid as clear as crystal, about the eighth or ninth day. A redness or inflammation of the skin spreads to a little distance from it, or in medi- cal language, it becomes surrounded with a red areola, about the size of half a crown. This begins to fade on the eleventh or twelfth day, and the vesi- cle becomes brown, and presently is covered with a glossy, hard scab, which discovers, when it falls off, a permanent scar. Now we havehere, first to con- sider where the muoculation should be performed ; and secondly, if it be complete in its effect. Ir* boys, it is of little consequence where the ve- sicle is seated, and the arm- is as good as any part; but in girls it is better to innocniateon the outside of the thigh, a little above the knee. Upon the se- cond point, there has been a difference of opinion. Parents cannot tOo> generally know, that the arm may inflame, and yet the vesiele may not be of the genwine kind. If the progress be different from the usual course, then there is always a doubt, lest it may not give security against the small-pox. If, for example, there be no areola at all, or if on the other hand!, it appear early for instance on the fifth or sixth day, and especially, if the vesicle be not round or oval, but jagged or irregular, and contain on or before the eighth day, a turbid or white, in- tend of a clear fluid, it will be necessary to re-in- 173 DISEASES OF CHILDREN. noculate. It is possible also, that the vesicle may be of the genuine kind, but the constitution may not be fully affected by it. This cannot be determined by appearances or symptoms, but it may, by a very innocent and slight test. If on the morning of the sixth day, a second innoculation be performed on the other arm or leg, it will advance quickly, and become surrounded with a red areola, nearly as soon as the first vesicle will be. if this trial be neg- lected, we have still two other methods of deter- mining, if the constitutionue properly altered. The first is by innoculating with vaccine matter, any time after the child has recovered completely from the first innoculation ; the second is by using small- pox matter. In either case, the scratch only inflames a little, it soon heals, and no other effect is produced. Without one or other of these tests, no child can be pronounced secure, for I have seen small-pox suc- ceed cow-pox, where the vesicle had all the genuine characters, and had run its course regularly. In such cases, the small-pox has been mild, though the pustules have been .copious, and contained as much matter as usual. If it be asked, why every parent does not re-innoculate as a test, I can only answer, that it is fiom the same cause which makes many neglect insuring their property, namely, a be- lief that there is no great chance of its taking fire. It has been urged as an objection against the cow-pox, that it produced cutaneous diseases after- vardS; but this is groundless. Small-pox on the DISEASES OF CHILDREN. 179 •ther hand, may be succeeded by most troublesome boils, and may irreparably affect important organs, or the whole constitution. With regard to the treatment of cow-pox, I have nothing to observe, except, that the part should, when the areola forms, be dusted frequently with flour or chalk; and after the vesicle breaks, the same should be continued, in order to forma crust on the sore, which is much better than dressing it with ointment. SECTION XX. The disease named skin-bound, appears under differeut forms. It is only necessary to notice that which most frequently is met with in private prac- tice. The child in this species, which comes on slowly, becomes delicate, and has the skin fiom birth a little more rigid than usual, particularly about the mouth and neck. It gradually becomes hard, somewhat shining, and of a yellow colour, or waxy appearance, aud does not move over the parts below it, neither can it be pinched up between the finger and thumb. The joints become stiff, and the rigidity extends over the surface.' The child very early is dull, oppressed, aud moans much. The strength gradually sinks, and not unfrequeutly, he is carried off in a fit. The pulse in this disease is quick, the appetite impaired, the bowels, generally, but not al- ways bound, the extremities are cold, aud often dif- ISO DISEASES OF CHlLDHEN. ferent parts have a purple, or erysipelatous appear- ance, bat these are not hots they are sometimes even colder than the natural standard. In some instan- ces, the skin, in the beginning of the disease, is a little rough, or slightly herpetic. It may begin early after birth, or not for weeks, and the complaint fre- quently lasts upwards of a month. As this has oc- casionally attacked different children in the same family, there is reason to suppose, that it depends on a peculiarity of constitution, and in such cases, the tendency to this disease generally diminishes with every child of the same sex; for it is observable that it is in these instances confined, either to boys or girls. Calomel has done more good than other medicines, but too frequently, every thing fails. It may be prudent to try the effects of mercury on the parents, to prevent future accidents of the same kind. The other species of this disease are more rapid in their course, and generally attended with more appearance of erysipelas. They are not however less dangerous. SECTION XXI. Chilblains are too well known to require des- cription. They are produced by exposure of the extremities to cold and damp, and, particularly, by suddenly warming them after they have been thus cooled. The mode of preventing them, will there- DISEASES OF CHILDREN. 181 fore be evident. The extremities are to be defen- ded from cold, by warm gloves or stocking?, and preventing the child from sitting with them wet; a hasty approach to the fire is also to be avoided. When they are produced, the best remedy is the frequent application of camphorated spirit of wine, and the further operation of the causes which gave rise to them, must be checked. If they have ulce- rated, the best dressing is made, by mixing an ounce of basilicon, with a dram of finely powdered cam- phor. It is to be spread thin on linen. SECTION XXII. Scalds or burns have been variously treated, some using very cold water, others, strong spirits or vinegar. I do not mean to give instructions for the complete management of extensive burns, but it cannot be too generally known, that the most useful and effectual application, in almost every case, at first, is vinegar, applied by means of cloths fre- quently renewed; this often prevents blisters from rising. If vinegar cannot be immediately procur- ed, common spirits will form the best substitute till it be had. When blisters arise, they are to be opened with a small orifice, and the vinegar continued. If this gives much pain, from the vinegar acting on raw parts, they may be partially defended, by interpos- ing a thin rag, lightly oiled with olive oil, and the viuegar is to be applied above this. In slight cases, e 182 DISEASES OF CHILDREN. especially on the face or neck, after the vinegar has been continued for several hours, and the pain has abated, the part may be dressed with white lead ointment; or this may be frequently applied with a feather or pencil, and then a little white lead may be sprinkled over this; or if the scald be pretty large, finely powdered chalk may be used in place of it. This dressing is to be repeated three times a day, or oftener, if the part be very tender. It is to be gently cleaned morning and evening, with milk and water. Pain is to be abated with a suita- ble dose of laudanum. In more extensive burns, oil of turpentine alone, or mixed with basil icon, has been employed from the first as a dressing; and when the sores became fungous or discharged much, they have been covered with powdered chalk ; but no parent in a matter of so much importance will trust to his own judgment. CHAPTER VI. Of Aphthae, and Ulceration of the Mouth. The thrush or sore mouth, is a disease peculiar- ly frequent during the first month. The mouth is hot and the tongue, and inside of the lips, have white specks on their surfaces, like small bits of curd. These in slight cases are very few, but if ne- DISEASES OF CHILDREN. 1SS glected, they increase and spread along the inside of the cheek, and nearly cover the tongue, with a white cake, or crust, or they may even extend to the throat. In the course of three or four days, the aphtha? grow yellowish, shrivel, and fall off, leaving the skin red ; but differeut crops may appear in suc- cession, even on the same place. Along with this state of the mouth, we often find, that the child is dull, and has Jess inclination to suck, though iu some instances, he sucks with unusual greediness, or grasps the nipple firmly. He is subject to gripes and fits of crying, aud the stools have a changed appearance. This disease is apt to affect the nipple, producing excoriation; whilst on the other hand, a sore nipple ['• may produce aphthae. In general, it proceeds from [ a disordered state of the stomach and bowels, occa- sioned by giving too much meat, particularly pan- ado, or by attempts to bring up the child on the spoon, or by the milk disagreeing with him. It may also be produced by exposure to cold, especi- ally in damp seasons, which however, probably, op- erates primarily on the bowels. It is usual for nurses, to have immediate recourse to borax; but although this may clean the mouth, it does not re- move the cause, and if early employed, the spots will quickly re-appear. The best practice is to give a small dose -of rhubarb and magnesia first, which generally corrects the disordered stdte of the bowels; and for two days, or until the spots begin 184 DISEASES OF CHILDREN. to change their colour, a tea-spoonful of cold water, or water beat up with a little white of egg, should be put into the mouth frequently; afterwards a so- lution of borax will be very proper. Stronger stim- ulants are not in general so useful, and may even be hurtful. There is a worse species of sore mouth, which is preceded by, or attended with fever, and great op> pression; the bowels are much affected, the belly being tender, or the child much griped, and some- times he even has fits. When the aphthae appear, he seems a little relieved, but the relief is not in general permanent. The tongue becomes quite, covered with spots, and in some instances, so stiff, or so tender, that the child cannot suck. The stools are green, and sometimes so acrid, that the bottom is scalded. The child also is sick, and occasionally vomits, and lies in a dull drowsy state, starting or screaming at times, and if not soon relieved, sinks under the complaint. It would appear, that the aphthae may extend towards the stomach, or a little way into the wind-pipe, producing cough and diffi- cult breathing. Frequent vomiting aud purging, tenderness of the belly, drowsiness, moaning and spasm, are very unfavourable symptoms. If the child cannot suck, or the aphthae become brown, and are long of falling off; or if, after they come off, the parts are parched, and look foul, it is un- pleasant;-and he is never out of danger till he can suck freely. DISEASES OF CHILDREN. 185 In this species of aphthae, it is proper at the com- mencement, to give a gentle emetic of ipecacuanha, and afterwards small doses of magnesia, to rectify the state of the bowels, and lessen the irritation there. The great object however, is to keep up the strength of the child, by suitable nourishment. If he cannot suck, the breast-milk, or beef-tea, must be given frequently with a spoon, and a little white-wine- whey, must atso be given as a cordial, with a fre- quency, proportioned to the age and debility of the child. Injections of milk, or beef-tea, are also pro- per. Some employ bark, but it must, if it be used at all, be given in a clyster; and in this way, nearly a tea-spoonful may be thrown in at once, mixed with as little starch as is sufficient to make it pass easily through the pipe; four drops of laudanum may be fdloit, if it caunot be retained. It must be re- ed, at least three times in the twelve hours. A little jelly water, or port wiiie aud water, or a trust, be useful. First: In all cases of purging, accompanied with sickness, or oppression, or apparently connected with disorder of the stomach, it w ill be prudent in the beginning of the disease, to give a gentle emetic of ipecacuanha. Second: When purging is attended with quick pulse, and hot skin, the tepid bath morning and ev- ening will be useful. Third : When the stools are*#r3riged in their ap- pearance, being greeu and watery, and the disease has not continued long, a dose of rhubarb and mag- DISEASES OF CHILDREN. 195 nesia will be proper; or if the stools be foetid, frothy, or dark coloured, small doses of calomel, as directed above, will be useful. Fourth : After the operation of the laxative, it will generally be beneficial, and iu many cases of serious disease, essentially necessary, to give a clys- ter containing laudanum. This is to be repeated of- tener or seldomer, according to the violence of the disease. It is to be retained for some minutes, by pressing on the fundament with a cloth, and after this, it is likely to be kept for an hour or two. Fifth : The use of laudanum by the mouth, is ge- nerally hurtful, or at best, greatly inferior in its bene- fits to the clyster. It weakens the stomach and the whole system, and impairs the appetite. The exter- nal application of this medicine, is in almost every case, safe and useful. The belly may be rubbed with laudanum, or covered with a plaster, containing camphor and opium. Sixth : Astringents have in general, no good ef- fect, and may do harm. Medicines employed with this intention, when they do good, will be found to possess some additional property. A mixture of toasted rhubarb, with crabs eyes, water, and a little cinnamon water, and sometimes with a few drops of laudanum, has been employed, and in slight cases with advantage, but this it is evident, is not simply an astringent, ^wr*' Seventh : Where purging seems connected with teething, the gums ought to be cut, and any affec- 19# DISEASES OF CHILDREN. tion of other organs, must be promptly removed by suitable remedies. Eighth : If the child be not weaned, and the dis- ease be obstinate, it will be proper to try the efftct of changing the nurse, if altering her diet do no good. Or if looseness come on soon after wean- ing, some children might be saved by being again suckled, if they will take the breast. In other cases, and even when the child is receiving suck, it may be proper to give arrow-root, beef-tea, or biscuit-meat, boiled with milk. The strength is also to be sup- ported by white-vvine-whey. Clysters of beef-tea, or arrow-root, are of signal service. They ought in every instance of violent, or protracted bowel complaint, and indeed, in all diseases of children, when the appetite is gone, to be employed two or three times a day. The quantity may be a smalt teacupful, and if it cannot otherwise be retained, five or six drops of laudanum may be added. Some children by this practice have been evidently snatch- ed from the grave, their strength- being thus preserv- ed, until they were able to take nourishment by the mouth. DISEASES OF CHILDREN. 197 CHAPTER X. Cf Costiv:ness. Costiveness is natural to some children, ac- quired by others. In the former case, it often hap- pens, that the mother is of the same habit. Grown up children, in consequence of this -state of the bowels, are subject to fevers, St. Vitus's Dance, &c. and we cannot suppose, that when they are younger, they will suffer less. When infants are naturally costive, having only one stool in twenty- four hours, or in thirty-six hours, and at the same time make water freely, and are vigorous, lively, and hea'thy in their looks, there is no ground for uneasiness. But, if the child, after having been for some weeks open, like others, become cos- tive, and especially if he continue small, and do not thrive, or if from the first he have been costive, and is subject to fits of crying, is pale and delicate, there is no doubt of the propriety of interfering. Indeed, it should be remembered, that less risk will arise from using means, perhaps iu some cases without absolute necessity, than by uniformly resorting to them, only in the most urgent circumstances. It is better to interfere too soon than too late. Calomel is generally a safe and useful laxative, and may be given at first every day, for three or four Tt 2 198 DISEASES OP CHILDREN. days, in such a dose, as to make the bowels rather open ; half a gram, a grain, or even more, ac- cording to theeffects, may be employed. This prac- tice often prevents the continuation of costiveness, or if it do not, some other laxative is to be given daily, or once in the two days, so as to procure an easy stool. We may employ caster oil, calcined magne- sia, or manna, and occasionally in place of these, a suppository made of soap. When oppression, o* other bad effects have already resulted from neglect- ed costiveness, a smart purge must be employed, such as infusion of seuna, or some preparation of aloes. A continued tendency to costiveness, will require the use of laxative diet, such as barley meal por- ridge, with butter milk, ale-berry, sweetened with molasses, &c. or if the child be not weaned, it may be necessary to change the milk. CHAPTER XI. Of Convulsions. Convulsions take place at any age, and may occur either in the course of some other disease, under which the child has been labouring for some time, or suddenly, in a state of previous health. In the one case, they are highly dangerous, and of- DISEASES OP CHILDREN. JOgr ten indicate a fatal issue; in the other, they are fre- quently attended with little hazard. Convulsion* or draughts, as they are called, vary in degree, from a slight movement of the muscles of the face, to a rigid or convulsed state, of almost the whole body. In general, whatever be the degree of the movement, the countenance is altered, both in colour and ex- pression, and the patient is insensible, and cannot follow an object with the eyer» In some instances, the motion is so slight, that the child may rather be said to be in a state of fainting, or stupor, than of convulsion. In very young infants, there is some- times only a smile about the mouth, the eye, which- is half closed, turns slowly round, the breathing seems occasionally to flutter, and the child starts^ and throws out the arms on the least noise. These motions, called inward fits, frequently proceed from wind in the bowels. Convulsions vary in point of duration, as well as of violence. They sometimes go off in a few se- conds ; in other instances, they continue for several minutes. The child may have only one short attack, and become well immediately afterwards, or he maji remain in a languid sleepy state ; or he may have repeated attacks in a very shorf time, and continue insensible during the whole of the intervening pe- riod. Convulsious may be produced by wind, or ir- ritation in the bowels, dependant on worms, cos- tiveness, indigestible food, acrid stools, &c. ; or by teething -} or by breathing bad or confined air ; 200 DISEASES OF CHILDREN. or by the striking in of some eruption ; or during the coming out of others, such as small-pox; or by af. fections of the brain itself; QoTby other spasmodic diseases, such as hooping cough, &c. 1 shall not enter, however, into any minute consideration of the causes of convulsions, or professionally into the principles on which the different points of practice depend. It will be more useful to observe, First: That when the child has been ill for some time before convulsions come on, especially if the pulse have been quick, the skin warm, and the head affected, whilst these symptoms could not be traced to the effect of dentition, there is ground to believe, that the convulsions proceed from a diseas- ed state of the brain, most probably from water in the head. It is to be hoped, that every attentive parent will, from the previous symptoms, have been led to procure for her child professional advice, be- fore this period of the disease. Second : In the case of very young infants, if there have been no preceding disease, there is great reason to attribute the convulsion to the state of the bowels ; and we shall be confirmed in our opinion, by finding that the stools are not of a good appear- ance; that there is much wind in the bowels ; that the child has not been nursed or fed properly; that the nurse has been agitated by passion, or commit- ted some irregularity in diet; or lastly, in infants a few days old, that the meconium is not expelled. Thud : When young infants have convulsions DISEASES OF CHILDREN. SOI from the state of the bowels, we generally find, that the face is pale, and the motions slight; but if they proceed from the state of the brain, which is still more alarming,, the motions are stronger, and more deserving of the name of convulsion. Fourth : At this early period, children from an irritated state of the navel, when the cord drops off, aud also from affections of the nervous system, may, have locked jaw, and the spine stiffly bent back, by a convulsion. Fifth : After the child is two months old, irrita- tion of the bowels, proceeding from bad stools, worms, or indigestible food, does not produce those gentle motions, or that apparently languid state, ob- servable at an earlier period, but generally excites pretty strong and well marked convulsions; and therefore, after this time, the distinction: mentioned in the third observation will not hold good. Sixth : At the period when children are teething, convulsions may, be produced by irritation of the gums, more likely than by other causes; and. there- fore, we should in every case which occurs at that tone, examine carefully the state of the gums. When a child is seized witb convulsions, a great consternation immediately prevails, and without some determinate rules,.either nothing will be done, or very contradictory plans may be adopted. The first general rule in such cases, is to order the tepid batb, which is proper in every instance. When the motion is strong, it allays it; when 202 DISEASES OF CHILDREN. it is slight, it brings on a state of quiet repose.)^ The water should be agreeably warm to the hand, and the child should be kept in it, up to the neck for some minutes, if he do not get relief sooner. If he be very pale or languid, the addition of a table-spoon- ful of mustard or hartshorn to the bath is useful. Second: Whilst the child is in the bath, a common injection is to be prepared, and adminis- tered immediately after he comes out; and after- wards a dose of calomel proportioned to his age, is to be given. Third: if the child seem to be sick, or oppressed hi the breathing, or about the stomach, or have been known to have had something which has dis- ordered the stomach, vomiting should be excited, by tickling the throat with a feather, during the fit, or giving ipecacuanha, as soon as the child can swal- low. Fourth : After the child is taken out of the bath, it will be useful to rub him, particularly over the spine and the stomach, with oil of amber, or with spirits, having about a sixth purt of hartshorn added. If any rash have struck in, rubbing the surface with camphorated oil of turpentine, or applying a small warm plaster over the stomach, will be useful. Fifth: If the gums be swelled, or there be any appearance of teething, the part should be instantly scarified. Sixth : If these means do not speedily restore the child, or if there should be a repetition of the fit, or DISEASES OF CHILDREN. 203 the child do not completely recover, then we must take measures for preventing the recurrence, or res- toring health, if the face be flushed, or the head be large, or the child remain insensible or stupid, one or more leeches, according to the age, must be applied to the temples. The head ought also to be shaved, and covered with a blister. At the same time, it will be proper, to give such doses of calomel, as keep the bowels very open. This is more especially necessary, if the stools be foetid, or of an unnatural appearance?/4f the child remain languid or insensible, • it will be of benefit to rub the surface frequently with oil of amber, strong spirits, or camphorated oil of turpentine. When there appears to be much irrita- tion, rubbing the back-bone with laudanum is pro- per, but no opium should in general be given inter- nally. When there is a tendency to frequent returns, it will be proper, besides keeping the bowels correct by means of calomel, or rhubarb and magnesia, to give repeatedly a few drops of tincture of asafoetida, mixed with oil of anise. In all cases, the strength is to be supported by suitable nourishment, or even by clysters of beef-tea. Seventh: The directions I have given, are partic- ularly applicable to the convulsions of children above a week or two old. 1 may add, that although the same remarks may often apply to those who are younger, yet in general, the convulsions or inward fits of infants a day or two old, require chiefly gentle 204 DISEASES OV CWFLfUfEN. laxatives, such as magnesia and ihubarb, or calomel, and sedulous attention to nourishment, with gentle friction over the surface, especially of the belly, with 'camphorated spirit of wine. Eighth: When fits are apprehended in dentition, from starting, feverishuess, and other circumstances, ascertained by former experience, to have preceded convulsions, the gum should be cut, and a gentle emetic exhibited. Laxatives and the warm bath are also useful, and these means generally prevent the fit. CHAPTER XII. Of Chorea. Th e disease called chorea, or St. Vitus's dance, occurs most frequently, from the age of eight years to the period of pdberly. It approaches with lan- guor, and indifference with regard to the usual amusements, a variable, aud sometimes a keen ap- petite, continued costiveness, occasionally combined with a flabby, lank state of the belly, but much of- tener, with a hardness and swelling, particularly at the lower part. The stools are not of natural ap- pearance. Presently, convulsive affections of the face tike place, and are succeeded with twitches and starting of the extremities. The patient often can- DISEASES OF CHILDREN. 205 not walk easily, in consequence of one leg twisting in before the other. He is perpetually changing his position, aud fidgetiug when sitting. He can- not put out his tongue steadily, nor speak briskly, nor cut his meat correctly, far less can he write or paint. He is in constant motion, and even when asleep he is restless. In some instances, an arm or a leg becomes palsied, or shakes violently, and I have seen the head move with as much velocity as a rattle. The eye is dull, the countenance becomes vacant, and the patient may at last become idiotical. The pulse at first is regular, though often feeble, but at last fever may take place, and in every case, the patient becomes emaciated. This disease generally proceeds from, or is con- nected with, a costive state of the bowels ; a state which gives rise also to many other complaints, and some of them of a dangerous nature. It surely then will not be difficult, to impress upon the mind of parents, the necessity of paying great attention to the bowels. 1 do not mean to recommend the foolish practice, which at one time was in vogue, of giving physic indiscriminately, at stated periods ; but I believe, that much good may result from the occasional use of purges, as well as from daily at- tention to suitable evacuation. In the disease in question, nothing gives so essential relief, as regular and continued purging. When the patient is old enough to swallow aloetic pills, two, or sometimes more, of these may be taken, twice or three times a s 206 DISEASES OF CHILDREN. day; or where these cannot be used, infusion of senna, epsom salts,\r other purgatives, must be employed; and it will be found, that usually,though not always, the stools are foetid, or unnatural in their appearance. This, so far from weakening the patient, has a contrary effect; for although he may, perhaps, have five or six stools in a day, the pulse becomes stronger, the countenance brighter, the step firmer, and the gesticulations or twitches abate, and at last, after a period, varying from a fortnight to several weeks, or some months, the cure is com- pleted. The cold bath and tonics, may sometimes be useful; but the great remedy is the steady exhi- bition of purgatives, which have now been intro- duced into general practice, by Dr. Hamilton, senr. It is not necessary to give minute directions for conducting the course of purging, as this must al- ways be carried on, under professional inspection. But I may add, that parents ought most scrupulous- ly to administer the doses prescribed, and need not be apprehensive of repeated daily stools being inju- rious, unless there evidently be a great diqiinution of strength, and aggravation of all the bad symptoms. Such a case, I have never seen ; nor can it oc- cur, I think, in the hands of any judicious practi- tioner. DISEASES OF CHILDREN. 207 t 1 CHAPTER XIII. Of Croup. The croup is a disease, which does not usually affect infants under six months old ; but from that ' age, till the period of puberty, they are liable to it, more especially, however, about the time of being weaned. It is not an infectious disease, but is r brought on by damp and cold. It is of two kinds, fthe inflammatory, and spasmodic ; though there is, perhaps no case, in which spasm does not exist. These have also been called true and spurious croup. The inflammatory species, that which is most formidable, sometimes comes on pretty quicklv, but generally is preceded for a day, or longer, by a hoarse cough, as if the infant had a cold; and some- times the throat is sore, or red. Very soon, and usually in the evening, a difficulty of breathing comes on, or the breathing is performed with a con- siderable sound, and the cough becomes more fre- quent, shrill, or barking. A quantity of thick phlegm also comes into the mouth with it, but is not put out. Occasionally, these symptoms are ac- 208 DISEASES OF CHILDREN. companied with a tendency to vomit, and from the first, the pulse is frequent, and the skin hot. The face also becomes flushed, and tumid, and the eyes red, and watery. During the intervals between the fits of coughing, the child sleeps,* but not sound- ly ; he breathes with difficulty, is restless, tosses, and is frequently roused with the cough, which is succeeded by, or accompanied with, fits of suffoca- tion, and great agitation; the cliild, if old enough, starting up, and springing to the bed-post, or cling- ing to his miserable parent, in the vain hope of ob- taining relief.Vi he thirst is considerable, food can be swallowed pretty easily, and although the child is very fretful, he does not cry like one in pain. The face presently becomes much changed, the cheeks perhaps blue, and the lips livid, the extremi- ties cold, and the pulse very feeble, and intermit- ting. Death sometimes terminates the sufferings, within twenty-four hours ; in other cases, not for several days. If recovery take place, the symptoms gradually abate, and the child falls into a quiet sleep ; but is for many days in danger of a relapse, if exposed to cold. In this species, a thick lym- phatic crust is found to line the upper part of the wind-pipe, and this at last mechanically obstructs the breathing. The second species, or spasmodic croup, may take place, not only during iufancy, but is even far from being an uncommon complaint, of grown up girls and women. It in general makes its attack DISEASES OF CHILDREN. 209 suddenly, though sometimes it is preceded for one or two hours, by a hard cough. The breathing very speedily becomes difficult, and there is a crowing hoarse cough, but scarcely any phlegm comes into the mouth. The hands and feet, from the first are cold, and the pulse is generally quick. The fits of coughing and suffocation, are sometimes pretty se- vere, but there is no more restlessness in the inter- vals than can be accounted for, by the state of the windpipe. This species then is distinguished, chief- ly by the suddenness of its attack, and it, if proper- ly treated, seldom lasts above a few flours ; but, if neglected, it may end in true croup. The disease, which attacks grown up girls, is almost always of this species; and I have known it come on every night, for weeks together. When a child has a hoarse cough, the best prac- tice is to give an emetic, succeeded by a purgative dose of calomel, and to apply a piece of flannel round the throat. This geuerally prevents farther mis- chief. But if these precautions have been neglected, or the inflammatory or true croup taken place, then the most vigorous means must be employed, such as emeiics, blisters, bloodletting, and calomel. None of these can be trusted to exclusively, though in- stances may be produced, win re any of them has been successful. The best and safest practice, is at mice to begin with a brisk emetic, aud immedi- ately after this, to put the child in the warm bath for s 2 210 DISEASES OF CHILDREN. some minutes. When he is taken out, he is to be laid in bed, and calomel employed immediately, in large and repeated doses. If the child be from six to twelve months old, a grain and a half, or two grains, mixed with sugar, may be given every hour, and the dose is to be increased according to the age, giving four grains to a child of five years old, for instance. This is to be persisted in, till it produce co- pious purging, which is generally of a green co- loured matter; and when this takes place, the symptoms are usually mitigated, and then the dose is decreased, both in quantity and frequency. In some cases, it has been necessary in a short time, to give above one hundred grains. Dr. James Hamilton, who has paid great atten- tion to the diseases of children, recommends most strongly this practice, in preference to all other re- medies. Sorry I am to be obliged, in some mea • sure, to dissent from his opinion ; for 1 have, in more cases than one, pushed the calomel very far, and produced the desired purging without any bene- fit. 1 therefore must, in the first place, recommend other means to be used, as well as the calomel ; and give a caution against continuing the use of that medicine in large doses, after free purging has been excited, and the patient has not been relieved ; pushing it farther, would only sink the strength faster. Calomel is always most useful, when it produ- ces vomiting as well as purging. Of the pro- priety of using emetics, 1 have already spoken, and DISEASES OF CHILDREN. 211 I speak consistently with the knowledge of every one, when I say, that they sometimes give great and speedy relief in the outset of the disease, and in a few cases, at an advanced period, they seem to have snatched the patient, as it were from death, by ex- pelling that lymphatic crust, which lines the wind- pipe in croup. Blood-letting has been extolled by some, and de- cried by others. If the child be robust, blood may be taken at the commencement of the disease with advantage, but if the disease have made progress, and continued for some hours, I have mtf known it do any good ; it is even hurtful, by weakening the patient. If it do not give speedy relief, it ought not, even at the beginning of the disease, to be re- peated. It is always desirable to take the blood from a vein, rather than by leeches. The first me- thod, I have known of great service ; the second I have seldom seen do the least so >d: A small blister applied at the upper part of the throat may be benefi- cial, and 1 have never seen it do any injury. The strength ought to be supported by beef-tea, or the breast, if the child be not weaned, aud can suck; aud after the violence of the symptoms has aba'ed, mild nourishment must be given frequent- ly, a rf the child kept from cold, test a relapse take piacd. In the second, or spasmodic croup of infants, the same remedies, particularly enit i, ai.d ca omel, a.e to be employed ; and ihey give relief more easi- 512 DISEASES OF CHILDREN. ly, and speedily, than in the other species. But if the emetic do not decidedly mitigate the attack, and give considerable ease, blood-letting ought not to be delayed, in place of trusting merely to the calomel. It gives, I think, more certain and speedy relief, than in the other species. When grown up girls are attacked with this, it is often absolutely necessa- ry. With them, the attack is sometimes so sudden and severe, that the operation of an emetic, or of calomel, cannot always be waited for, and fortu- nately, the lancet gives instantaneous relief; for af- ter a certain quantity of blood has flowed, the breathing becomes free, and the complaint goes completely off. The sulphate of zinc operates speedily as an emetic, and sometimes removes the spasm, but in many cases it fails, or gives relief on- ly for a few minutes, and we are obliged to resort to the lancet. The chief objection to blood letting is, that as the disease in grown-up patients may re- turn frequently, this remedy must impair the health; but this consideration has little weight with a patient suffering all the horror of suffocation, and who knows of a mean of instant relief. The recur- rence is to be prevented principally by brisk laxa- tives, such as aloetic pills, castor oil senna, &c. Antispasmodics, such as asafuetida, have been employed, both with children and grown-up giiis, sometimes with a good etftct, but not unless con- joined with purges ; and 1 d > not think, they have any effect during the fit. Opium ought not to be DISEASES OF CHILDREN. 21S given to infants, and in very few instances, have I known it of use to elder patients. Exposure to cold, and damp, and all mental agitation, must be avoid- ed, and scarcely any supper should be allowed. During dentition, infants are subject to a spasm about the windpipe, which is very sudden in its at- tack, and is attended with a temporary feeling of suffocation, and a consequent crowing inspiration ; but there is no hoarse norcronpy cough, and in oth- er respects the child is quite well. It is apt to come on from crying, or from awakening suddenly, or from any cause which hurries, or at all affects the respiration. It may be combined with convulsions. The gums ought to be early cut, the b»wels kept open, and if the attacks are frequent, a combination of tincture of hyociamus, and of asafoetida, will be use- ful; and the throat should be rubbed at night, with a little laudanum, or camphorated spirit of wine, or anodyne balsam. The warm bath is serviceable. Many children are subject, especially if they get wet feet, to a croupy cough, without any feeling of suffocation. An emetic relieves this, or if the throat be also inflamed, a brisk laxative should be afterwards given ; and if any degree of wheezing continues after the emetic, a small blister should be applied to the upper part of the throat, 214 DISEASES OF CHILDREN. CHAPTER XIV. Of Catarrh. Infants, like grown up people, are subject to colds or catarrh, and the symptoms vary, according to circumstances.. In some instances, the affection ■ is confined altogether to the membrane of the nos- trils, producing an obstruction in breathing, or sniff* * tering sound. This is attended with a discharge, which sometimes excoriates the nostril and lip. It is also occasionally accompanied.with fever, and a disordered state of the bowels? t ihe only remedy that is in general required, is a gentle laxative, at the same time that the nostrils are anointed with olive oil by means of a pencil. In some bad cases, the fe- ver runs high, and the inside of the nose is excoriat- ed, and the bones may even become diseased. The treatment consists in supporting the strength, and making suitable local application, which can only be pointed out by a practitioner on the spot., Infants a few days after birth, have sometimes pectoral affections. They are restless, the skin hot, • they breathe with some degree of oppression, and very soon with a slight rattling, owing to phlegm in the windpipe. The cough is pretty frequent, but not hard, and often it is accompanied with a purple ; late of the face and neck. The child generally DISEASES OF CHILDREN. 215 sneezes. Vomiting not unfrequently attends the cough,^ora quantity of viscid phlegm, or in some . « cases, oV? mucous, very like purulent matter, / comes into the mouth. A gentle emetic, for in- [ stance, Tour grains of ipecacuanha, is useful at r first, and afterwards we give morning and evening, I. , for ♦some days, from half a grain, to a grain of cal- m omel, and a quarter of a grain of ipecacuanha. B Tins usually brings away dark green stools. The m warm bath is useful. In some cases it may be ne- v cessary to apply a small blister to the breast, or rub with camphorated spirits. The strength is to be supported. If this disease be not arrested in the | commencement, it is very apt to become obstinate, terminating in a state kuown to practitioners under f the name of chronic bronchitis. This consists in a universally diseased condition of the ramifications R" of the wind-pipe, which become lined with puri- form matter, and sometimes tubercles are formed iathe lungs themselves. The complaint is attend- * ed with great weakness and emaciation, and too of- ten terminates in consumption. If the early use of / the means already pointed out, do not relieve the symptoms, the child, if the weather permit, must be removed to the country. %. Children a little older, have catarrh, attended witli very frequent pulse, hot skin, slight red- ness of the cheeks, watery eye, sneezing, cough, and shortness of breathing. The bowels should be opened with a calomel purge. Ine warm- 216 DISEASES OF CHILDREN. • bath is to be used, morning and evening, whilst we determine to the surface, and at ihe same time allay the cough, by means of antimonials, combined with a considerable proportion of tincture of hy ociamus. The chest is to be rubbed with anodyne balsam, or if the symptoms be severe, a small blister may be necessary. If the face be early flushed, the pulse extremely quick, the skin very hot, the cough fre- quent, short, and in a manner restrained, and pro- ductive of much uneasiness, if the child cough more, and is more uneasy when laid down, or pla- ced on one side, than on the other, there is reason to apprehend inflammation of the lungs. This how ever, is, not so frequent as with adults. It re- quires the use of brisk purgatives, the early appli- cation of leeches to Ihe breast bone, the use of blisters, and the tepid bath, if the disease do not terminate soon, it ends either in abscess, or water in the chest. 1 have sometimes found after death, several ounces of water. When this is apprehend- ed, the digitalis is the best remedy, and the strength ■ in every instance, is to be carefully supported. The deseases of children differ in this respect from those > of adults, that there is scarcely any case where ab- stinence is proper, or not hurtful. Mild nourish- ment, such as milk, or beef-tea, is always necessary to infants. Cordials, such as white-wine-whey, are proper in almost every protracted disease. They are only injurious in inflammatory affections, during the acute stage of the disease, but they must not after- DISEASES OF CHILDREN. 21? wards be given in too great quantity. With chil- dren beyond the age of infancy, however, more fre- quent exceptions occur to this general rule, until we arrive at length at a period, when abstinence may be proper, and cordials ambiguous, oi hurtful, during many of the first days of disease. This ap- plies to several febrile diseases of childhood or boy- hood. CHAPTER XV. Of Hooping-Cough. The hooping-cough commences usually very much like common cold, but the cough is more obstinate and severe, and in some instances is-ittend- ed with considerable frequency of pulse, and even with oppression, languor, sickness, and loathing of food. Presently, the cough assumes the character- istic marks of the disease, the fits come on instan- taneously, or without much warning, the cough is prolonged for some time, and sounds something be- tween a cough and a hearty laugh. The breath is expended ; and to prevent suffocation, a violent ef- fort is made during the fit fo draw in air, which is accomplished with a loud sound or hoop. This of- ten ends the fit, but in other instances only gives it a momentary interruption, and the coughing is re- newed, till it is terminated by another long draught T 218 DISEASES OF CHILDREN. of air, or by vomiting. During the fit, the face be- comes purple, the extremities cold, the child is vi- olently agitated, supports himself by placing his hands on his knees, or grasps the nearest object, and to a bye-stander appears to be in danger of im- mediate suffocation, whilst sometimes blood gushes from the nose or ears. There is a considerable quantity of phlegm ex- pelled by cough or vomiting, at the termination of the fit, a great part of which may perhaps be formed, and forced up from the extremities of the wind-pipe, during the cough. The fits are gener- ally worst in the night time, and in particular hab- its are accompanied with a tendency to fainting, or may be productive of convulsions or insensibility. In the mildest cases, there is little or no fever, the fits, are gentle, and the hoop forms early; the health does not seem to suffer, and through the day the cough does not often take place spontaneously, but rather is brought on by some evideut came, such as eating much, running fast, or passion, whilst through the night it does not occur above three or four times. But in more severe cases, the disease is preced- ed by, or accompanied with quick pulse, hot skin, drowsiness, weakness, and want of appetite, with other symptoms which may be partly accidental. The cough is long of forming, it is severe and fre- quent iu its attack^ excLt d by the slightest circum- stance, and often cornes o.i w.tliout any perceptible DISEASES OF CHILDREN. 2]Q cause. It is also preceded, or followed by breath- lessness, and sometimes by pain in the breast. Con- vulsions occasionally are excited by the cough, and sometimes are both severe and frequently repeated. Stupor, and fainting, may also be produced. This is a disease, which is always caused by con- tagion, and the effects of this seem to be more severe, and more frequently fatal, in some seasons than in others. No age is exempted from its influence. It is extremely difficult to form an opinion in any individual case, of the probable duration or result of the disease. Even in mild cases, it usually con- tinues for two months, and in those which are more severe, it may last for a whole season. In both it may, after having been some time away, be renewed by cold, or by change of weather, or by violent passion. The danger is generally proportioned to the severity of the complaint ; but very mild cases sometimes prove suddenly and unexpectedly fatal. Children who were previously delicate and unheal- thy, or who had a tendency to complaints in the breast suffer more than others! The danger of chincough is two-fold ; for the child may be instan- taneously cut off by suffocation, or by a convulsion ; or he may sink gradually under the severity of the disease, and the derangement produced in the lungs. In order to allay the fever at the commencement of the disease, emetics, laxatives, the tepid bath, and occasionally the saiine julap are useful. If the 320 DISEASES OF CHILDREN. fever continue, notwithstanding these means, change of air is of great service. Many remedies have been proposed for the cough, but we have no specific, if it be not change of air. It is wonderful how speedily this operates in some instances, both in allaying fever or restlessness, and the cough. The more complete the change, the greater is the effect produced, but it often happens, that after the child has been for a week or more in one place, the symptoms which were at first relieved, increase again, and require a new change. In many instances, however, one removal, from the town, for instance, to the country, is sufficient, and effects a cure in a few weeks. Continued travelling has no advantage over a change of habitation. It is con- sidered as hurtful to make this removal before the hoop is formed, but of this there is no good evi- dence ; yet although not injurious, it does not ap- pear to be generally useful, unless in those cases, where there are considerable fever or violent symp- toms, resisting other means of abatement. Emetics are highly serviceable in all cases, and especially with young infants, to whom it is some- times necessary, to give them every day, for some time, by which we get quit of a great quantity of phlegm, which would otherwise be retained. . Re- peated vomiting, certainly diminishes the spasm, which takes place in the chest, and makes the cough easier ; it also abates feverishness. DISEASES OF CHILDREN. 221 Rubbing the spine and chest, with some stimulat- ing embrocation, is also useful in mitigating the cough. Oil of amber, with the addition of harts- horn, camphorated oil of turpentine, or anodyne balsam, are very proper for this purpose. Oil of thvnie forms the active ingredient, in a quack em- brocation frequently employed. Juice of garlic has been rubbed on the sobes of the feet, sometimes with good effect.^^ A variety of internal medicines have been em- ployed, the most useful of which, act either as emetics or as anodynes. Of the first class, is a quack medcine, called the antipertussis, which contains white vitriol, a powerful, and often a use- ful emetic ; of the second class are opium, hen- bane, and hemlock, which have sometimes the ef- fect of allaying irritation. The two latter, when given in proper doses, are always harmless; the opi- um on the contrary, in some instances increases fe- ver, and does harm, especially if its costive effects be not obviated. The diet should be light and nourishing, unless there be a tendency to inflammation. Full meals must be avoided, especially at night, but the child should eat frequently. Wine is hurtful in the com- mencement, but in the progress of the disease may be useful, and when there is much debility, is gene- rally proper. Bark has been given along with it, but not often with decided benefit, with respect to t2 222 DISEASES OF CHILDREN. the cough, though, if it be not nauseated, it tends to restore the strength. Fixed pain in the chest, with difficulty of breath- ing, and fever indicating inflammation, will require the application of one or more leeches to the chest of young children, or the use of the lancet in those who are older. Blisters are also highly proper in such cases. The tepid bath, and laxatives, are both useful, and these with spare diet, wtiere the inflammatory symptoms are not violent, will be sufficient without blood-letting; which in this, aud in all other tedious diseases, ought only to be had recourse to in urgent ca^es. Pain produced, merely by the violence of the cough, and going almost entirely off after the fit, is removed by those means which relieve the cough. If the fever continue, iu spite of change of air and laxatives, it will, if there be no symptoms of inflammation, be necessary to use wine or cordials prudently, to support the strength. If the child be of a full habit, and the cough very severe, it has been proposed to take away some blood, to prevent the rupture of a blood-vessel in the lungs. But unless there be also considerable uneasiness in the chest, or a bloody tinge of the ex- pectoration, laxatives will in general be sufficient. Convulsions may be produced by the rupture of a vessel in the brain, during a fit of coughing, and in this case, usually proves immediately fatal. Those which are notinstantly fatal, proceed however, commonly, from nervous irritation. They require DISEASES OF CHILDREN. 223 the warm-bath, laxatives, and the reined ies which I have pointed out, for the relief of convulsions. Change of air is proper and essential. Where the patient becomes emaciated and weak, or threatened with hectic, nothing is of so much benefit as coun- try air, and milk diet, at the same time that we pre- vent costiveness. If there be, in this state, pain in the chest, small blisters are useful ; or if there be watery swelling of the hands or feet, with livid coun- tenance and harassing cough, the fox-glove wii/ be necessary, aud in some instauces, brisk laxatives are required. If the face or lips remain swelled, a course of sal polychrest is useful. CHAPTER XVI. _ '> Of Teething. The teeth are begun to be formed long before the birth of the child, but with a very few excep- tions, none of them are so far advanced, as to come through the gum till he be some months old. The tooth is at first soft and pulpy, lodged in a cell of the jaw-bone, and covered with thick gum. There are only twenty teeth evolved in infancy, ten in each jaw, and these are not permanent. They generally begin to appear between the. sixth and the eighth 224 DISEASES OF CHILDREN. month, and the two middle incisors, or front teeth of the lower jaw, usually come through first, aud in about.a month, the corresponding teeth above ap- pear. Then the two lateral incisors below, and next those above, come out. About the twelfth or fourteenth month, the first, or anterior double teeth, appear on each side below, and then above. Be- tween the sixteenth and twentieth monlh, the space between the first teeth and grinders, is filled up with those which are called the eye-teeth, and from this time till the thirtieth month, the other back teeth appear; so that when the child is two years and a half old, he generally has all his milk teeth. These continue till he is six or seven years of age, and then are succeeded by others, which are stronger, and more permanent. Many children cut their teeth with great ease, but others suffer considerably. On inspecting the gums of a child, who is not yet teeth- ing, they are found to be sharp, and the skin, which covers them, seems even to form an edge or seam along the gum. But when a tooth is growing up, the gums and the skin which covers it, are put on the stretch, and the appearance of seam at that part is lost. In consequence,' partly of the distension of the gums, and partly of the activity of the parts, necessary for carrying on, and completing the pro- cess of dentition, we find, that the mouth becomes hotter than formerly. The child either grasps the nipple firmly and strongly, to relieve the gum, or if it be more tender, he is hurt, and suddenly rejects DISEASES OF CHILDREN. 225 the breast. The quantity of saliva is increased, the gum is itchy or painful, aud the pain seems to be augmented suddenly, or darts through the spot as in tooth-ach ; for the child is apt to scream without any other evident cause. From the irritation, we also sometimes find, that the gums or tongue be- come ulcerated. Besides these effects on the mouth itself, other parts suffer; the stomach is irritable, the bowels are frequently loose, or the skin is cover- ed with a rash, or the ears, and eyes become inflam- ed. Sometimes there is a short cough, spasmodic affections of the breathing, fever or convulsions. These symptoms are however not always produced, and vary, both in number and effects, in different children. Those who are of a full habit, and ro- bust, have more frequently symptoms of high vascu- lar and nervous irritation, hot skin, troubled eye, and discharge of humour from the eye-lids, erup- tions, short, disturbed sleep, screaming, and convul- sions JV They do not in general lose much flesh, unless a violent purging come on ; but they may, by fever or convulsions, be cut off speedily, Those on the other hand, who are small and spare, or deli- cate, suffer generally most in the bowels ; they are sick, or dislike food, are peevish, have a continued purging, become emaciated, and sometimes, after prolonged sufferings, siuk completely exhausted. The symptoms which are immediately produced by teething, may by continuance, produce other or se- condary effects, k Thus the fever, if strong and ob- 226 DISEASES OF CHILDREN. stinate, may excite water in the head, and the purg- ing may give rise to incurable changes in the cou- dition of the bowels. Lastly, teelhing may prove detrimental, when other diseases happen to occur at the same time, as for instance, hooping-cough, or scarlet fever. The simple effects of dentition, sel- dom continue troublesome above a fortnight at a time. All the troublesome and dangerous consequences of dentition, may be produced by other causes; and therefore, in forming our opinion, we must be influ- enced by the state of the gums and mouth, the ab- sence of symptoms chaiacterizing other diseases, aud the general appearance of the case. In the treatment of the effects of teething, we have chiefly three objects: First, to allay irritation: Secondly, to alleviate urgent symptoms: and Lastly, to support the strength. First: It is customary to give the child agum stick, to rub on the itchy gum; but if this be*4nade of any hard substance, it is apt to injure the gum, or the child may knock it into his eye. A crust of bread is often employed, but if a piece of it break off in the mouth, the child may be choaked. The fin- gers are instinctively used, nor is there any risk of the child, by being indulged in this respect, acqui- ring afterwards a bad habit. The most effectual mean of allaying irritation, is to cut the gum when it is distended or swelled. This is often indispensa- bly necessary, for the removal of Urgent symptoms; DISEASES OF CHILDREN. 227 it generally gives much relief, aud isalvvays safe and iniocent. It does not, even if the iuciskn should l.t-:!, lender the future progress in any degree more tedious. It is not painful, but gives, ou the contiaiy, immediate ease. Experience teaches us, that a costive >t ite of the bowels, adds greatly to the irritability of 'the system; and therefore, if there be no loc seness, it is always proper to give gentle laxatives, such as rhubarb and magnesia, during dentition. Cool air is highly useful, hut the child, is not to be impiudently exposed, to a great degree of cold. He should be frequently out, and ought to have the cold bath in the morning, and be washed with cold water at night. When there is considerable irritation, rubbing the spine, and surface of the belly, with a little laudanum is useful. " T..... Secondly: In the treatment of urgent symptoms, we must, besides cutting the gum, which is a general rule, have recourse to such remedies, as the particu- lar nature of the affections require. When the fever is high, that is, when the skin is very hot, and the pulse quick, it is proper to give laxatives, and use the warm bath, morning and evening, in place of the cold water. If the child be lusty, and drowsy, indicating a tendency to affection of the head, it will be necessary to give a pretty smart dose of phy- sic, and apply either one or two leeches to the fore- head, according to the age. If these means do not speedily relieve the child, the head should be shav- 228 DISEASES OF CHILDREN. ed, and a small blister put on. We never have cause to regret, having used prompt and decided means of preventing danger, but have much oftener to reproach ourselves with not having used early, those remedies which the result of the case shews to have been proper. Spasms and convulsions require the warm-bath, rubbing with laudanum, and a calomel purge, to- gether with all the attention, which I have recom- mended in considering convulsions. If these af- fections are apprehended from starting, or slight spasms, a gentle emetic is very useful; or if they occur frequently, or leave remains behind them, laxatives are proper, and a combination of tincture of asafoetida, and of hyociamus, may afterwards be given. Purging, if severe, or attended with weakness or emaciation, is to be restrained, by giving clysters with laudanum; and occasionally small doses of calomel or rhubarb, when the stools are unnatural, as has been formerly recommended. Sickness, loathing of food, and ill-smelled breath, are relieved by a gentle dose of ipecacuanha. A short cough, as well as tenderness of the eyes, will be removed by a burgundy pitch plaster, appli- ed to the back. Ulceration of the gum requires gentle laxatives; the strength is to be supported, and the parts bathed with port wine and water. Thirdly: The strength is to be carefully sup- ported under the irritation, and the other distresses, DISEASES OF CHILDREN. 229 by the breast-milk, if the child be not weaned, or beef-tea, arrow-root, milk and water, &C. if he be. In some cases, where the child is recently weaned, if will be of advantage to give him the breast again. If he do not take sufficient food by the mouth, nu- tritive clysters must be resorted to. In every ins- stance, nourishment is essential; but in some, par- ticularly when the weakness is increasing, eordials, such as wine-whey, must be added. It is scarcely necessary to observe, that as a mean of supporting the strength, we must restrain excessive, or continu- ed evacuations, such as purging. Whenever the child becomes greatly emaciated, it will g'enerally be found, that the looseness has been neglected, or has resisted the treatment. As connected with the subject of dentition, I may remark, that When any of the first set of teeth be- come loose, or decayed, aud at the same time irri- tate the gums, producing ulceration, they should be extracted. When any of the first are interfering with the second set, those, whose removal will most effectu- ally promote the regularity of the permanent teeth; ought to be taken out. When two of the second set are so distant from each other, as to make those next them grow out of the crub, or become uneven, they should, as soon as may be, be brought gradu- ally together by means of a wire. v 230 DISEASES OF CHILDREN. Buck-teeth ought to be early pulled, which is generally better than attempting to bring them into their place. CHAPTER XVII. ^^ Of Water in the Head. Hydrocephalus, or water in the head, is one of the most fatal diseases of children, and unfortu- nately, it is of very frequent occurrence. It may take place, either as a primary or secondary disease, and the primary may either be rapid or protracted. The rapid or acute species, is always marked in its commencement, by a high degree of action in the vessels of the brain, if not, by actual inflammation of some of the membranes of that organ. And in this case, the effusion of water is to be -considered as the consequence of that previous diseased state. The appellation, then, of water in the head, is given to the disease from its termination, and not from the coudition which prevails at its commencement. The protracted, or chronic s >ecies, on the other hand is not necessarily attended with high action at the out- set, but may be, and often is, an effusion in conse- quence of debility of the functions of the brain, DISEASES OF CHILDREN. 231 occasioned by various causes and circumstances, and it is to this species alone, that the name of dropsy of the brain can be properly given. The secondary hydrocephalus, is not less frequent than the primary. It is water in the head succeed- ing to some disease, which had not necessarily any direct tendency to produce effusion there. I have long remarked, and the fact is admitted by most practitioners, that every febrile disease of infants, tends to excite disease in the head. This is easily explained; for anatomists know, that there is a pro- digious quantity of blood, circulating in the brain, and the vessels there are large and numerous. Now, when the whole of the vascular system is acting in- ordinately, an organ so constituted, must be peculi- arly apt to suffer. This aptitude is the greater, the younger that the chijd is; for in infancy, the brain is more tender and more vascular than in childhood. In a young foetus, it is altogether fluid, and causes which may perhaps be very slight, but which we cannot determine, sometimes produce water in the head, and great enlargement of the skull before birth. Primary hydrocephalus, may be occasioned by falls or blows on the head, by the sudden removal of an external discharge, or cutaneous affection, and by every cause capable of exciting immediately the action of v essels in the brain. Contiuued cos- tiveness, or derangement of the bowels, may act, if not as an exciting, at least, as a predisposing cause. 233 DISEASES OF CHILDREN. Some families of children, have the brain so deli- cately constituted, as to be particularly liable to this disorder. ^4" — Secondary hydrocephalus frequently succeeds teetlung-fever, and sometimes those fevers which originate from a bad state of the bowels. It is not easy to give a general history of this dis- ease, for the symptoms vary somewhat in their order and degree, according to the age and constitution of the child, and other circumstances. When the patient is old enough, to give any ac- count of his sensations, we generally find, that hy- drocephalus begins with pain, more or less severe in the head, and perhaps confined to one side of it. This continues often for some days, and seems to go off entirely at times, and then returns, so that the child alternately complains, and is well, but the pulse is always somewhat quick. Then, after-a longer or shorter period, the symptoms become more severe, and the child seriously complains, or seems to have an attack of fever. This is attended with chilness, and is very early succeeded by vomit- ing, which continues for a day or two, and the mat- ter thrown up, is usually bilious. The bowels are commonly costive. The skin is hot, and the pulse exceedingly quick, and sometimes irregular. The eyes are very sensible to the light, so that the curtain must be closed. The sleep is disturbed, and inter- rupted suddenly as if by a dream, and both when asleep and awake, he early begins to moan, and DISEASES OF CHILDREN. 239 seems to be oppressed. The cheeks are alternately flushed and pale. He has no appetite, and not much thirst, at least, does not care to ask drink; often, when he rises to take it, he seems to have his headach and sickness increased by the motion, and becomes giddy when he sits up. He starts frequent- ly, grinds his teeth, picks his nose, and tosses his hands above, or over the head. Sometimes he is very early delirious, and is apt to scream suddenly, especially when slumbering. When these symptoms have continued for a short time, at farthest, for eight or ten days, the pupil of the eye becomes dilated, the patient generally squints, and does not complain so much as formerly of the light. In a few cases, the vomiting, which had gone off, is renewed. The pulse becomes slow, being sometimes below sixty in the minute, and in- termitting. He does not complain so much of the headach, for he is less sensible ; but he moans or screams most piteously. In some cases, he remains sensible, answers distinctly, and knows what is doing, till the stupor which precedes death comes on; in others, he is very incoherent and insensible. Pre- sently, the pulse becomes again quick, beating per- haps, a hundred and sixty in the minute. The urine is either retained, so that the bladder is distended, or it, as well as the stools, comes away involuntari- ly. One side becomes paralytic, and die other is perhaps convulsed ; indeed, convulsions may come on at any period, even at the commencement of the v 2 233*. DISEASES «F «BILD«E!N. disease; Before death, the eyes become glazed, the features much altered, the breathing noisy and op- ppessed, the pulse extremely weak, the feet cold, and the cbilU', by a state of complete stupor, is spared those pangs of separation, whieh wring the heart of the parent. It thus appears, that in the most distinct and re- gular form of the disease, there are three stages, hi the first, the symptoms are decidedly those of a fe- ver, accompanied with an affection of the head. h> the second, the pulse is slow, and symptoms of pres- sure on me brain appear. In the last, the pulse again becomes quick. I must observe, however, that sometimes, the pulse at no time becomes slow. This disease, generally runs on till the twenty-first day, if the patient be above two years old. But with young infants, it often proves rapidly fatal, car- rying them off in four or five days. Infants are un- able to give an account of thek sensations*, and there- fore, we cannot be certain- of the existence of this dis- ease, till symptoms of oppressed brain come on ; but we may suspect it, and ought always to act on the presumption of its approach, when they have a high fever, cannot bear the light, vomit, and are costive, start, aud; awake suddenly in a terror, are niuch oppressed, and put the hand frequently and quickly, to the temples, as if to rub off something. I have mentioned in this description, that costive- ness attends the disease ; but in some instances, the child pucges) at glossy, green, coloured stuff, and DISEASES Of CHILDREN. 335 generally, green, or dark stools, are brought away by physic. < There are chiefly two diseases with which this can be confounded, fever from teething, and fe- ver from a bad state of the bowels, which 1 shall presently describe. The first of these may be dis- tinguished by the symptoms indicating dentition ; but it is to be rememberedj that if there be in this fever much determination to the head, it may give rise to secondary hydrocephalus. The marks of the other fever, I shall hereafter point out. —x—<•«•>. Upon dissection, a quantity of water, generally clear as Crystal, is found in the ventricles of the brain. A variety of remedies, have been proposed for curing this formidable complaint, but much and melancholy experience convinces me, that none can be depended on, after effusion of water has taken place. It is only in the first stage, and very early; in that stage, before water is formed!, that our treat- ment can be successful. Unfortunately, at this time,, the symptoms are not such as to impress the mind of parents^ with a belief, that it is more than a com- mon fever, which it is hoped may soon abate. Practitioners sometimes from the same delusive ex- pectation, and from abackwardness to propose rem- edies, which by indicating great danger, would give rise to great anxiety, may fall into a similar error 5 and although their intentions are humane, the result. is a matter of the utmost regreU If this book then, 236 DISEASES OF CHILDREN. shall serve no other purpose, than calling the atten- tion of parents to the present subject, I shall uot have written in vain. I would beg of them to recol- lect, that in the disease, termed water in the head, there isin the commencement, actually no water ex- isting ; therefore, the case is then, not to be consid- ered, as so dangerous as it must afterwards be. The application of suitable remedies, and even an avowal of an apprehension of this disease from the practitioner is not to be looked ou as the death-war- rant of the patient. So far from this, these remedies bid fair to arrest the progress of the complaint, and in two days, may remove the symptoms of dan- ger. Whenever a child complains of symptoms of the first stage of hydrocephalus, no time ought to be lost in guarding the head from danger. Tins is done by brisk purging, and the prompt application of leeches to the temples. By these remedies employed in the first day, or even in some cases, so late as ihe third day, the headach may be relieved, and the fever much abated. The child is to be kept very quiet, and the food is to be cf the lightest kind. In the va- riable state which precedes ihe decided attack of fe- ver ; m that state, when the < hild is alternately well and ill, andlias attacks of pa n n die head, two or three tunes a day, these means, paiticuluriy the ap- plication of leeches, rarely fail in giving complete re- lief, and may check lor evu ihe tendency to this dis- ease. But if they have been uegltcted at tins period, DISEASES OF CHILDREN. 237 during which the practitioner unfortunately seldom sees the child, the parents themselves, thinking no- thing of the matter, then, on the decided attack, they are to be more vigorously used. The purges must be repeated two or three times, and the leeches applied oftener than once, if the pain recur, or do not go en- tirely off. The head is to be shaved, and bathed fre- quently with cold vinegar, and a blister must be ap- plied, if these means fail to procure relief, it is much to be feared, that the disease has made a pro- gress, which puts, it beyond control. Mercury, digitalis, iasxww^ auii^oilier remedies are usually em- ployed, but generally without success; norisitne- cessary for me,to pursue the subject beyond the first period, the period when it is chiefly useful for a pa- rent to know, or a practitioner to prescribe for, this disease. In the course of the malady, the comfort of the patient may be promoted, by great attention to cleanliness, and giving occasionally, a small quan- tity of beef-tea, arrow-root, or ripe fruit ; and for drink, gruel, lemonade, or in the advanced stage, wine and water. Relief is sometimes obtained to the pain, by placing the hand on the head. Some families are peculiarly liable to this disease. These children require to have great attention paid to the state of the bowels, and must avoid heavy and indigestible diet. Fatigue is hurtful, and exposing the head to much heat, especially the rays of the sun, is dangerous. In some instances, particularly when there are evident marks of a determination to the 238 DISEASES-OF CHILDREN. head, besides frequent laxatives, it is useful to have recourse to an'issue; and in every case, the earliest and slightest marks ofdisease must be attended to. The chronic hydrocephalus, attacks more slowly, and runs its course with less speed. In some cases, it seems to be slowly coming on from birlh. in other instances, it is years before the symptoms ap- pear. The child is dull, has a large head, and gen- erally w ide pupils of the eye. He is very subject to headach, and slight feverish fits, attended with giddiness, and often with pain or silliness m the neck. The bowels are costive, m«l tl»« water is scan- ty, and passed often with difficulty. The skin is hot- ter than usual, the pulse quick and irregular, though sometimes it very early, and for a long time, is found slow and intermittent. The head enlarges, if the progress be very slow, the body wastes, the powers of the mind decay, the pupils are dilated, the child squints, palsy comes on, and net unfrequently, con- vulsions take place. The urine is retained, so that the catheter is often required; the pulse, from being full and slow, becomes weak and fluttering, and the pa- tient dies iu an apoplectic state. These symptoms sometimes continue in a moderate degree for years, but generally, only for some months, or a few weeks. The degree of enlargement of the head, does not always depend on the duration of the complaint. On dissection, the ventricles of the brain are found greatly distended with water. In some cases 60 much, as to make the brain resemble merely • 1SEASES OF CHILDREN. '239 two bags of water. The bones of the skull, are s ometimes found very thin, and separated much from each other, and occasionally at the bottom of the cavity, the bones are very ragged and irregular. The practice consists in the use of calomel pur- ges, repeated blisters applied to the head, or the es- tablishment of au issue on the scalp. Digitalis combined with mercury, has more effect in this than in the acute hydrocephalus, for this is more strictly, a species of dropsy. If these means lessen the size of the head, a bandage must be applied round it, by way of support; and indeed, gentle pressure in this vyay, assists the operation of the medicine. If it be neglected, convulsions come on, when the bones be- comes slack. The secondary hydrocephalus, is both a frequent and a deceitful complaint, for as it occurs in the course of some other disease, the first set of sy mp- toins call the attention off to a different point. It is therefore highly prudent, in all diseases of chil- dren, to watch the head ; and whenever symptoms appear, indicating an affection of that organ, it is necessary to shave it, apply a blister, and in some instances, one or more leeches. Indeed, it is a good rule, in all protracted diseases, if there be the small- est ambiguity, to shave th e head, apply a small blis- ter, and give calomel purges. 240 DISEASES OF CHILDREN. CHAPTER XVIII. Of Fever. Fever, proceeding from different causes, is a frequent disease of children. 1 have already noti- ced that produced by the irritation of teething, and now proceed to describe another species, very com- moni and exceedingly obstinate, if not early attend- ed to. It is either produced speedily, after eating some improper and indigestible food, or the founda- tion is lard more slowly, by a previous state of cos- tiveness, or disordered condition of the bowels. In the first ease, it sometimes attacks very suddenly, after earing unripe fruit, or garden trash, or almonds; or pastry, and particularly, that kind of cake, called short-bread. In other instances, the symptoms de not come on for a day or two. The fever generally begins in the afternoon, the child is not disposed to eat, is peevish, the hands are warm, and the pulse is quick. He complains when toadied, although) not hurt, and can hardly tell why. In the evening he becomes sick, or vomits, is very hot, restless, and thirsty, but generally, the tongue is clean. Through the night, he is much disturbed. Next day the tongue is furred, or white, but he is rather better and livelier in the morning. In the afternoon, how- DISEASES OF CHILDREN. . 241 ever, the symptoms increase, and the disease goes on as the variety, which 1 shall next describe. In some instances, the disorder attacks more speedily. The child perhaps, when going out, complains a little of the head, becomes worse when walking, and returns, crying with pain in the forehead, is pale, hot, and the pulse quick, and if not soon relieved, has a very serious and obstinate fever established. The headach' in this fever, depends on the state of the stomach. It goes off at times entirely, but always returns before a fit of sickuess or vomiting. There can be no doubt as to the cause of this disorder, and there is little difficulty in checking it at once, by giving, on the first appearance of indis- position, a dose of ipecacuanha, and afterwards a smart purge. If the emetic be delayed for some hours, or till next day, it may. mitigate, but seldom entirely removes the disease. It is astonishingly difficult, often in these fevers, to move the bowels. Large doses of physic produce very little effect; often, after being retained for some time, they are vomited. In this case, they must be assisted with injections. The other variety, the consideration of which will include the farther treatment of the last disor- der, begins often more gradually, the child being for a day or two unwell, before he be altogether confined to bed. In the day time, he has several, attacks of feverishness, during which be '» dull, languid, and disposed to he down or sleep. In the x 242 DISEASES OF CHILDREN. intervals, he seems pretty well, but is easily put out of temper. The appetite is whimsical, and he cannot eat what he asks for. He has little thirst, and at this time, the tongue is pretty clean. The bowels are generally bound, but sometimes loose, and in this case, the stools are offensive. These symptoms may continue a day or two, or even for a week, before the child become so ill as to keep bis bed, or to have a formed complaint. Then an acu\e paroxysm of fever takes place, generally preceded by shivering, and attended by vomiting ; the pulse becomes very quick, and runs so high sometimes as a hundred and forty in the minute. The cheeks are flushed, and the patient drowsy, but he has no pain in the head, nor any where, unless, perhaps, in the belly ; for in some cases, he is sadly tormented with gripes, or even fixed pain in the bowels. The tongue now becomes foul, and the bowels appear to be very torpid, the appetite is totally lost, or what food is taken, is not digested. The stools are foetid, dark coloured, sometimes like pitch, or thin and olive coloured, or green and curdy-looking. The breath is offensive. There is a great desire to pick the nose and lips, so that sometimes, if the child be not watched, an ulcer may be produced. The fe- ver does not continue alike severe, during the whole day, but becomes less at times, though not at any stated hour.^-'Each exacerbation is attended with drowsiness. The face is occasionally flushed, and he eyes suffused; at other times it is pale, aud the DISEASES OF CHILDREN. 243 eye dull and white. Generally delirium occurs in the course of the disease, but by speaking to the child he can be recalled from this, and answers cor- rectly ; or although sometimes delirious, yet for an hour or two, he may be tolerably distinct, and insist obstinately on being carried out. The debility in many cases is excessive, the child picking the bed- clothes, whining in a fatuitous manner, and staring vacantly; yet even in this state, he may often be roused, and seems to understand, at least so far, as - to reject what he dislikes. 1 his disease runs on for a week or two, or even for several weeks, during which time, the appetite is very trifling, the thirst not urgent, the strength exhausted, the body wasted, and the feverish symptoms varying a little, but not greatly, in degree. If tbe fever continue obstinate and violent, the belly become swelled, and the de- bility and stupor increase, the danger is great. This fever bears a resemblance to hydrocephalus, especially in the commencement. But in hydroce- phalus, there is more frequent vomiting, and the pain in the head, is generally severe ; whereas, in this fever, there is either no pain, or it is evidently connected with the state of the stomach. By a ge- neral and careful comparison of the two diseases in their progress, a practitioner in most instances, may form a correct distinction. It is generally proper, to commence the treatment of this disease with an emetic of ipecacuanha, suc- ceeded by a brisk laxative. This practice, if adopt- 244 DISEASES OF CHILDREN. ed during the state of indisposition, which precedes the complete formation of the fever, will cut short the symptoms; and if laxatives be afterwards ad- ministered, till the bowels are brought into a correct state, a perfect recovery is the consequence, if however, the fever have fairly taken place, we can- not expect immediately to remove it, but must be satisfied with a slower process. The great remedy, still to be depended on, for mitigating the disease, and abridging its duration is purging, which is proper in every instance ; for if the patient be not costive, the stools are at least unnatural. In some instances, the usual doses of medicine will be suffi- cient ; but often the bowels are so torpid, that much larger doses will be required. This is a point of prac- tice, which requires discrimination ; for if the dose be not sufficient in quantity to purge, or if it be not repeated, so as to evacuate the morbid contents of the bowels, we come short of our object. On the other hand, if the purging be earned farther, we weaken our patient, injure still farther the intestines, and may bring on an irrecoverable loss of tone, so that the bow els are expanded with wind. Two cir- cumstances will direct us in this matter; the state of the stools, and the effect on the pulse, and on the strength. When the stools are foetid or unusual in colour or appearance, purgative medicines are not unnecessary. When these remedies do not exhaust the patient, and render the pulse more frequent aud smaller, they do good, and have not been pushed too DISEASES OF CHILDREN. 245 for. With regard to the dose, that ought to be no greater than is adequate to the effect. At first^ it is useful, and often absolutely necessary, to give one or two brisk and large doses, but afterwards, it is usually better to give, only such doses, as will keep the bow- els open, and support their action. Where there seems to be much irritation or pain of the bowels, an opiate clyster may be also given occasionally, and with much advantage. The belly is likewise, if there be much pain or griping, to be fomented, and rubbed with anodyne balsam. During the use of purgative medicines, worms are frequently expelled, which has given rise to a belief, that they occasioned all the symptoms, and hence this has been called a worm fever. That they may increase the disease, or, if in great quan- tity, may immediately produce it in some instances, 1 allow ; but in many cases, they never appear, and therefore the appellation is improper. Whether they exist or not, is not of so much consequence, as may at first appear, for it is by all admitted, that the cause of the fever consists in a morbid state of the bowels, and that this is to be removed by purgative medicines, which are equally good for expelling worms. But although purging, under the restrictions I have made, be a proper practice, yet it is not the w hole of our practice. In the early stage, we em- ploy such other means as allay fever. When the heat of the skin is considerable and steady, sponging x 2 246 DISEASES OF CHILDREN, the surface with cold vinegar and water, is of ser- vice. If this give much relief, and for a few minutes bring down the pulse, and abate the heat, the cold affusion of water, as recommended in the scarlet fever, may be safely practised ; but it is not to bo repeated oftener than once, if it do not give more than usual relief; nor is it to be employed with expectation of permanent advantage, unless im- mediately after the hot stage have been fully estab- lished. When the sponge does not give relief and com- fort, and the skin is hot and parched, the saline ju- lap, with a little aotimonial wine, is useful, not to bring out a copious perspiration, but a gentle mois- ture, or softness on the surface. prom first to last, light and nourishing food must be given, in such portions as the patient can take. Beef-tea, arrow-root, &c. are very proper. Toast- water, whey, milk and water, lemonade, ripe fruit, &,c are useful for quenching thirst. In the advanced stage, small doses of wine must be given, and always do good, unless they produce restlessness, heat, and flushed cheeks. Hyocyamus is sometimes useful to procure sleep. Opium is more beneficial, and safer, if given in a clyster than by the mouth. Depoction of bark, tincture of steel, and other tonics, are also proper, after the bpwels have been freely purged, provided they do not produce sick- DISEASES OF CHILDREN* 247 ness. It is to be recollected, that preparations of iron render the stools black. Delirium is sometimes, but not always mitigated, by shaving the head, bathing it with vinegar, and ap- plying a small blister to it. Great attention is to be paid to cleanliness and ventilation, and when convalescent, a removal to the country is of much benefit, in confirming the health, and removing hectic appearances, and copious noc- turnal perspiration, which often succeed this disease. Young infants are subject to a variety of this fe- ver, which begins with loss of appetite, restlessness, fretfulness, hot skin, quick pulse, and continual drowsiness, with bad smelled breath, and appearance of being hurt if touched or moved. There are ge- nerally distinct remissions, during which, the child is easier, and takes the breast, There is no appear- ance of teeth, which distinguishes this front teeth- ing-fever. It is more apt to be mistaken for hy droce- phalus; but in that disease, there is more impatience of light, heat in the head, screaming, or awakening suddenly and in terror, &c. and in the advanced stage, the symptoms of oppressed brain are evident. The treatment is to be conducted on the principles already laid down, particularly by procuring stools; for it will generally be found, that the bowels have been previously costive, or in a bad state. Children are also liable to (be common nervous, or typhus fever, if exposed to contagion. It is not unusual, when this disease gets into a family, where 248 DISEASES OF CHILDREN. ventilation and cleanliness are neglected, for it to at- tack in succession, every onet from the eldest to the youngest. It approaches, generally in a slow man- ner ; the child looks pale and wan for a day or two, the appetite is impaired, the sleep unrefreshmg, the skin of a dirty appearance, and the tongue white. Then a chilly fit comes on, or, without any great sense of coldness, the fever invades with a feeling of weariness and oppression, the pulse becomes fre- quent, vomiting or squeamishness come on, the head is painful, the skin hot, and the eye dejected, or sunk. These symptoms have generally a remission, once in the twenty-four hours. If the disease gain ground, the weakness increases, the pulse becomes more rapid, delirium takes place, and then the child sinks into a state of stupor, the eyes are half closed, the teeth covered with a black crust, and the stools are passed without knowledge. This state soon ends in dissolution. The disease may continue a fortnight, or three weeks, or even longer. This fever is to be attacked at the very first with an emetic, succeeded by a pretty smart purge. If the skin be very hot and dry, and the child do not at the same time feel any chilliness, the affusion of cold water will be very serviceable in the early stage, . But if this be neglected, or not practised, then we are to sponge the surface with cold water and vine- gar. If .the head be painful, one or two leeches, according to the age, are to be applied, in the be- ginning, to the forehead; and if the pain continue, DISEASES OF CHILDREN. 34§ and delirium approach, the head is to be shaved, and a small blister applied. If the skin be parch- ed and hot, and the sponge afford no permanent re- lief, saline julap, with a little autimonial wine, will be proper. The bowels are, during the whole pro- gress of the fever, to be kept open, and occasional purges are of much benefit, when the stools are of- fensive or unnatural. When there is much oppres- sion, and a dry foul tongue, a smart dose of calomel often gives much relief, by evacuating dark bilious stools. The diet should consist of stewed apples, beef-lea, panado, &c.; but in general, very little is taken. Gruel, toast-w ater, or lemonade, form pro- per driuks, and ripe fruits, are both grateful and useful. In the advanced stage, cordials, particular- ly wine, should be given prudently. When the fever abates, care must be taken to pre- vent any considerable exertion, or any error in diet, either of which might cause a relapse. .Nothing confirms the health, or removes the consequences of fever, so effectually, as going to the country. CHAPTER XIX. Of Emaciation. There are two species of general emaciation, or waiting, pn ce ding from the state of the bowels, and independent of any affection of the lungs. The 250 DISEASES OF CHILDREN. first arises from torpor or want of vigour in the intes* tines, without any glandular affection. It is gene- rally brought on by costiveness, and accelerated by improper or indigestible diet. It is characterized by a gradual loss of flesh, and of strength, an en- largement of the belly, loss of appetite, or a desire for extraordinary or improper substances, ill-smelled breath, slight thirst, pale, unhealthy countenauce, swelled upper lip, and obstinate costiveness ; or if the bowels are open, the stools are foetid, and dark coloured, and the patient has previously been cos- tive. In this condition, he remains for some time ; he is listless, and evidently falling off; but has no fever. His appearance excites uneasiness, but coming on gradually, it does not excite so much alarm as it ought. An inquiry at this period would shew, to any intelligent person, that the bowels are greatly disordered. There is. usually costiveness, and the stools are extremely offensive. How many children might be saved by attention to the diges- tive organs ! Under circumstances, such as 1 have described, a few doses of brisk purges, would re- store the appetite, strengthen the bowels, and pre- vent fever and other serious evils. But unfortu- nately the child is supposed merely to have worms, and either remedies are daily postponed, or tansy, and such like substances, are employed. If the disease be neglected, the pulse presently becomes qui k, the cheeks flushed, the skin hot and dry, the appetite is enhre.y lost, the child starts from his DISEASES OF CHILDREN. 251 sleep, grinds his teeth, picks his nose, his weakness increases so much, that he is confined to bed the emaciation proceeds, but the belly becomes hard and more swelled, the stools to the last are unnatu- ral, and after a few weeks of suffering, death closes ihe scene. The prevention of this deplorable state is to be effected entirely by careful attention to the bowels, an object I earnestly wish to impress on the mind of every reader. Even after the disease is complete- ly established, the great remedy consists in repeated purges, which must be regulated in their quantity and frequency, by the effects produced, and these must be judged of, by a skilful practitioner. The remedy is simple, but judgment is required in deter- mining the degree. Three circumstances require consideration. First: The accomplishment of our purpose, in procuring stools, natural in appearance and smell. Secondly : The effect of our doses on the strength. Thirdly : The change produced on the general face of the disease. Besides purges, such as aloes, rhubarb, senna, jalap, calomel, &c. varied according to circum- stances, we may also derive advantage from the use of some strengthening medicine, such as a light bit- ter infusion of colomba. The diet must be diges- tible and nourishing, such as sago, arrow-root, beef- tea, calves-feet jelly, chicken, &c. The other species of wasting, is connected with, and in great measure dependant on, a diseased state 252 DISEASES OF CHILDREN. of the glands, through which the vessels, that ab- sorb the nourishment from the intestines, must pass. Emaciation in this case, is produced, not merely from the effect of disease on the constitution, but also, by an actual obstruction to the transmission of nutriment. We cannot determine all the causes 'capable of exciting this state, but a very powerful one, is a torpid state of the bowels, such as that oc- casioning the more simple species of wasting, al- ready described. Another, seems to be the exis- tence of some severe or prolonged disease, which debilitates and injures the glandular system. Damp, cold, improper and scanty diet, also appear to act as causes. These different circumstances may, in amy constitu- tion, perhaps occasion this disease, but it is chiefly in a scrofulous habit that they operate. On this account, many have considered tabes mesenterica, as merely a variety of scrofula, but it will perhaps be more correct to say, that scrofula only gives a very strong predisposition to the disease ; for cases oc- cur, where we can discover no other maik of that constitution. This disease, does not generally appear before the time of weaning, nor after the age of puberty. In infants, we suspect it, when the stools are frequent and unnatural, the belly tumid, and the urine whit- ish, when the food passes through imperfectly di- gested, the child vomits occasionally, is fretful, fe- verish, has a short cough, and an uneasy respiration, DISEASES OF CHILDREN. 253 and gradually loses flesh and strength. Elder chik dren exhibit at first, very much the symptoms of ihe first species. The looks are unhealthy, the belly is enlarged, the appetite is fastidious, or much in- jured, the bowels irregular, and the urine white and thick. The skin is dry and hot, and the fat wastes away. Then, sharp shooting pains, of momentary duration, are felt in the belly. The stools are sometimes costive, oftener loose and frothy. The face is pale, the features sharp, the eyes sunk and glossy. The belly enlarges more, becomes hard, and when struck, sounds like a drum, and we can even sometimes feel the hard enlarged glands within. The fever becomes more distinct, the tongue is gene- rally clean, but in some instances, we find a crust on it, and in the termination of the disease it becomes .*ore, and the throat is tender. The feet swell, the forehead is covered with perspiration, and the whole body perspires through the night. In some cases, the vital spark dwindles away verv gra- dually ; in others, towards the end, the symptoms suddenly increase, and the patient dies sooner than is expected. On inspecting the body, the mesenteric glands are found enlarged, and contain- ing substance like cheese, or, occasionally, puru- lent matter. In the commencement of this truly dangerous disease, the daily use of small doses of calomel, conjoined with rhubarb, in quantity sufficient to keep ihe bowels in a regular state, is of advantage Y 254 DISEASES OF CHILDREN. but it is not useful to purge freely, as in the first spe- cies. Gentle and pretty long continued friction, three times a day, over the belly with anodyne bal- safn, and the use every night, of the warm salt wa- ter bath, will be proper. The occasional applica- tion of small blisters to the belly, the exhibition of a light bitter infusion, and supporting the strength with suitable nourishment, constitute the rest of the practice. When the disease ha3 passed its first stage, and the fever is considerable, we may mitigate it, and also reduce the size of the belly by purges. If these produce the desired effects, they are useful; but otherwise, we do not find it proper to continue them in expectation of removing the glandular affection. In that case, it is sufficient to give such doses as ob- viate costiveness, if it exist, or render the stools more natural, if there be looseness. If the dis- charge be considerable and debilitating, it is neces- sary to be very prudent in their exhibition, and sometimes to employ an anodyne clyster. Friction, and the warm salt water bath, ought still to be con- t inued. It can serve no good purpose, in this work, to be more minute, and to enumerate remedies, which though often employed, seldom do any good. DISEASES OF CHILDREN. 255 CHAPTER XX. Of Worms. \\ orms of different kinds, are found in the bow- els, but there are chiefly two, met with iu children, the lumbricus, or long worm, having a general re- semblance to the common earth worm, and the as- cans, or small white worm, like a bit of thread. These two kiuds inhabit different parts of the bow- els, for the ascarides are confined to the under part, or straight gut, whilst the lumbrici are found much higher. It is extremely difficult to account for the production of worms, as they are totally different from those found in the earth, or on vegetables. It •is evident, that they cannot be of external origin; but how they come to exist in the bowels of a child, is a very difficult question to answer. It has been popularly supposed, that particular kinds of food, or sweet-meats, or unripe fruit, breed worms; but this is only true, in so, far, as these disorder the stomach and bowels, and weaken their action, for worms rarely appear, when the action of the bow- els i» vigorous. It is also observable, that few in- fants have worms, till after they are weaned, which is to be accounted for, on the principle, that the bowels are in better order during suckling, than at- 256 DISEASES OF CHILDREN. terwards, when the diet is more varied, and indigest- ible. Worms may exist without producing any symp- tom until they either accumulate in considerable quantity, when.they cause more or less irritation in the bowels, or some slight indisposition takes place, and they by their irritation, increase it. All the in- jury they produce, is that of irritation, but the de- gree of this, and the effects of it, must vary, not merely according to the number of worms, and "their movements, but also according to the state of the bowels themselves. It is also to be remember- ed, that as a weakened state of the bowels is favoura- ble for the accumulation of worms, many of the symptoms may proceed from that state alone, inde- pendent of the new irritation. The lumbrici, may be suspected to exist, when the child complains of frequent griping, or pain iu > the belly, has repeated, and unexpected attacks of looseness, variable appetite, being sometimes seized suddenly with extreme hunger, has swelling of the belly, especially at night, disturbed sleep, frightful dreams, and grinding of the teeth. Besides these symptoms, we also observe, that the countenance is alternately pale and flushed, he picks the nose, has foetid breath, dry cough, and sometimes slow fever, or convulsive affections. These symptoms may exist in different degrees, and are ultimately attended with the expulsion of worms, either by vomiting or stool. It has been supposed, that a DISEASES OF CHILDREN. 257 very obstinate and protracted fever, called worm- fever, might also be produced, but this generally depends more upon costiveness, or a deranged state of the bowels, than simply upon worms. I have already noticed its symptoms and treatment, and al- so its resemblance to a most formidable disease,, the water in the head. A variety of worm medicines, have been employ- ed, such as tin powder, tansy, sulphur, hellebore, worm seed, cowage, indian pink root, &c. In gen- eral, however, we find, that with children, the most successful plan is to give frequent and repeated pur- gatives, to expel both the worms and morbid stools, and also to excite, and support, the due and vigo- rous action of the bowels. For tins purpose, the occasional use of a suitable dose of calomel, and the regular employment, on the intermediate days, of aloetic pills, if the child can swallow them, will be effectual. The extent to which this plan is to be carried, and the period for which it must be con- tinued, will depend on the effects produced. As long as the stools are foetid, and unnatural in ap- pearance, or as they contain worms; and as long as the medicines invigorate, instead of weakening, we may be sure, that it has not been carried too far. Under it, the appetite increases, and the health and looks improve. In many cases, where worms are suspected, this method effects a cure although none are expelled. In such instances, it is not unusual for much slimy, or ill-looking matter to be evacuated, Y 2 258 DISEASES OF CHILDREN. which parents suppose, is produced by the worms being dissolved. This is not correct, and it is most probable, that the symptoms proceed from some other irritation of the bowels, removable however, by the same means. It may be proper to remark, that often after other remedies fail, calomel or ja- lap, in such doses, as operate powerfully, and bring away slime or mucus from the bowels, will carry off the worms, by removing so much of their fa- vourite residence. Besides purgatives, it will also be proper, afterwards, to employ tonics, such as bitters, and preparations of iron, in order to strengthen the bowels, and invigorate all the di- gestive organs. Ascarides, besides producing griping, paleness, picking of the nose, disturbed sleep, &c. are disco- vered by the itching they produce at the lower part of the bowel. This is greatest at night, and sometimes exists to an intolerable degree, and from the irritation excited, even retention of urine may be caused. We are also confirmed in our bpinion, by frequently observing the worms in the stools, and sometimes, they even, spontaneously, creep from the bowel. This kind of worm, is removed like the last, by smart purgatives, and prevented from being increased, by strengthening remedies. Bat besides these means, we possess the power of applying to that part of the bowel, which they inhabit, substan- ces directly, in the form of clysters, capable of kil- ling them. For this purpose, the common salt in- DISEASES OF CHILDREN. 258 jection is useful, but one, containing aloes, or con- sisting of salt, oil, and a strong decoction of chamo- mile flowers, will be still more effectual. It may be given every second night, for some time; after- wards, once a week as long as any-symptom remains. CHAPTER XXI. Of Mumps, or Branks. The disease called Mumps, is a swelling of the parotid gland, which lies before the ear. It is an infectious disease, and begins with chilness, suc- ceeded by heat, frequent pulse, thirst, and headach. Very early, a small tumour can be discovered near the angle of the jaw, which presently increases, so that not only the back part of the cheek, but the side of the neck becomes swelled, and the jaw is stiff. There is however, no sore throat, and seldom any difficulty, either in swallowing or breathing. The swelling gradually abates, about the fourth or fifth day, and the patient soon gets well. This is a very slight disease in general, and nothing farther is required, than keeping the part moderately warm, by means of a piece of flannel, and abating the fever by spare or vegetable diet, and a dose of physic. 266 DISEASES OF CHILDREN. CHAPTER XXII. Of Diseased Liver. "The liver becomes diseased in children, more frequently than many suppose. It may inflame ra- pidly or slowly. In the first case, the symptoms are very acute. After being greatly heated, or suddenly exposed to cold, but especially, after eating something heavy and indigestible, such as nuts, pastry, sweet cake, &c. the child is seized with sickness, and violent pain like colic. This pain is felt chiefly in the up- per part of the belly, near the stomach, and is at- tended with chilness at first, and afterwards heat of the skin, and thirst. Sometimes, very early, the eye becomes yellow, and the urine very high coloured. Presently the colic pain abates, or goes off, aud the child complains only of a dull pain in the right side, or occasionally only of pain in the top of the shoul- der. He has a short dry cough, frequent attacks of sickness, white tongue, no appetite, though at times, he thinks he Can eat, and is distressed, particularly at night, with fits of breathlessness. The bowels are generally bound, and the stools are light in the DISEASES OF CHILDREN. 26l colour, but sometimes they are dark and offensive. The fever continues, he is very restless, and gets no sleep, or very disturbed sleep, and if be be not either soon relieved, or quickly carried off, he becomes greatly emaciated, at the same time, that the feet and belly swell from water. In this case, the weak- ness generally increases, and the patient is at last carried off, quite exhausted. There is another way, in w hich the disease may terminate, namely, by sup- puration. The abscess in the liver may burst, either into the lungs, and the matter is coughed up, or in- to the stomach or bowels, when it is discharged by vomiting or stool; or it may burst into the general cavity of the belly, and cause swelling very like dropsy. In this, which is a very rare case, many pounds of matter have been drawn off by tapping, or discharged by a natural opening taken place at the navel. The treatment of this disease consists in the early employment of blood-letting, if the pain be acute, and the fever considerable. In slighter degrees of the complaint, free and plentiful evacuation by pur- gatives may be substituted for the lancet; and after the bowels have been well emptied, occasional lax- atives are still to be employed. Blisters are also to be applied to the side, over the liver, and a course of mercury is immediately to be commenced. It is however unnecessary to give minute directions for the particular management of this disease, as no parent can with prudence undertake it. I may only 262 DISEASES OF CHILDREN. add, that when the existence of this complaiut is suspected, and the child is in the country, the most prudent plan will be, to give a smart dose of calo- mel, and apply fomentations, or use the warm-bath. This is a safe practice until regular assistance can be obtained. In the second species, or chronic inflammation, the symptoms come on more slowly, and frequently seem to he excited by some previous disease, which has unsettled the constitution. There is generally, sickness in the morning, accompanied with vomiting of phlegm aud bile, a short dry cough, wandering pain in the belly, variable and fastidious appetite, bound bowels, high coloured urine. Presently the symptoms increase, the tits of sickness are frequent, the appetite may be keen, but the patient, after eat- ing a mouthful feels filled to the throat. He is breathless, the pulse is quick, the cheeks flushed in the evening, the tongue white or yellowish, and not unfrequently, the eyes are yellow. He does not usually complain of much pain in the right side, but sometimes has an aching pain in the top of the shoulder, aud very frequently feels acute pain, like colic, across the upper part of the belly at night, which then becomes swelled. He sleeps little, the pulse is quick, the skin hot, the stools are at first clay-colouied, or white, and afterwards, perhaps dark, or almost black. The feet swell, and the bel- ly becomes distended, so that the fingers can no longer be pushed below the edge of the ribs. The DISEASES OF CHILDREN. 263 liver can be felt enlarged, and stretching to the left side, and the patient complains, when pressure is made on it. If relief be not procured, the patient is cut off. either by dropsy or hectic fever, and not unfrequently, before death, is much distressed with palpitation of the heart. The treatment of this species, consists chiefly in a course of mercurial friction, and keeping the bowels open. Blisters applied over the liver, have little effect; but in some instances, a seton or pea issue has done good. The diet must be light, and when- ever dropsical symptoms appear, diuretics, particu- larly squills, must be resorted to. CHAPTER XXIII. Of Scrophula. Scrophula depends on a peculiarity^" consti- tution, which'can be transmitted from one genera- tion to another. This peculiarity, is not alike strong in all the children of the same family, and it some- times passes completely over one generation, ami appears in the next. In many instauces, it is so powerful, as to produce spontaneously, the most distressing effects : in others, it seems to require the co-operation of external injury, or some acci- 264 DISEASES OF CHILDREN. dental disease, occasioning debility, and derange- ment of the constitution, to make it operate. We cannot discover this peculiarity of constitu- tion, with certainty, until it has produced some mor- bid effect. But nevertheless we find, that there are some particular habits, or some general appearan- ce^ which indicate the existence, to a greater or less degree, of this predisposition. The skin has either a peculiar softness and delicacy, and the com- plexion is very fine, with light hair, and blue eyes ; or the skin has a dull white appearance, the coun- tenance is altogether without colour, and the upper lip is tumid ; in these cases, the hair is oftener dark than light. Scrophula appears more frequently, in such habits than in others, but none are exempted. The effects of this predisposition may appear in any part of the body ; but the glands and the joints, are particularly apt to suffer. These effects may manifest themselves in infancy, or not till adult age ; but they most frequently are met with, between the third and the seventh year. The external glands, commonly affected, are those of the neck and throat. In some instances, one alone is swelled, in others, a great many are dis- eased, forming an extensive cluster. The tumour may be small, or it may increase to the size of a hen's egg, disfiguring the neck very much. The gland sw ells very slowly, it is not hard, but has a doughy feel, is moveable, and its shape can be distinctly ascertain- ed. It may remain in this indolent state for week* DISEASES OF CHILDREN. 265 or months ; then, it becomes softer, and may be felt by its elasticity, or fluctuation, to contain a flu- id. Next, the gland inflames, and adheres more firmly to the neighbouring parts; it has a hard mar- gin, and the top becomes red or purple. Present- ly, the purple Colour extends over the whole surface of the glandular tumour, which, after a considera- ble length of time, bursts, and discharges a curdy looking matter. The opening slowly enlarges, and thus an ulcer is formed, the surface of which is pale, and the margin tumid, purple, and Ather hard; the discharge is thin, and there is seldom much pain. By and bye, an elevated scab, or crust is formed, which is of a dirty while, or yellow colour. This falls off occasionally, and at length, the part heals below it, and is found to be marked with a smooth purple scar. If there be many tumours in the neck, they may either remain quite distinct, or the redness may spread from the one to the other, and the whole skin becomes purple, and is apt to be excoriated. Scrophulous tumours, sometimes subside,or the ul- cers dry up, in the winter, and recur in the spring or nr.nmer. It is not to be expected in this work, that I should enter fully into the method of treating this formida- ble disease. Many remedies have been proposed, for rectifying the constitution, and curing the ulcers which are produced. None of these are certain, and few of them do any material good. But, al- though we have no specific medicine, which can z 266 DISEASES OF CHILDREN. subdue this malady,yet, we may do some good, by enabling the constitution, to resist causes of injury. N There are chiefly two directions to be attended to, respecting those children, who are suspected to have a scrophulous constitution. The first is, to use means for invigorating the general system. The second is, to obviate, as much as possible, those causes which excite disease. ^-\— The first is to be accomplished, by nourishing and digestible diet, by sedulous attention to the state of the bowels, by comfortable clothing, regular exer- cise, particularly in the country, and by the use of sea-bathing. It has been supposed by some, that a large proportion of animal food, and the liberal use of wine, were of great advantage, in strengthening the habit. But experience does not shew, that those children, who have an unusual allowance of these articles, are stronger, or more healthy, than those, who are brought up with ordinary care. It is of more benefit, to avoid indigestible food, pa.stry, sweetmeats, &c. and to pay the utmost attention to the state of the bowels, on which the health, in a great measure depends, and disorders of which very frequently excite disease in the glandular system. Spending the early part of life in the country, is al- so a powerful mean of strengthening the constitu- tion. The second object is of great importance also, for every disease, which is long continued, or tends to weaken the system, renders the scrophulous dis- DISEASES OF CHILDREN. 267 position more powerful. Hence we find, that ma- ny children have swelling of the glands, and other symptoms of this malady, after fevers, or disorders proceeding from a neglected state of the bowels ; and diseases of the skin seem also to have a similar tendency, in proportion to the degree of inflamma- tion attending them, and the general injury they pro- duce. On this account, the sma.l-pox, very fre- quently, called the scrophulous disposition into ac- tion. Local injury, will also have the same effect, for many, evidently have this disease excited, both in the joints, and in the glands, by external violence, and similar causes. These being facts, it follows, that early attention ought to be paid, to every ail- ment, the constitution, being thus saved, from much derangement. When swellings have taken place, we have three objects in view. First, to endeavour to dis- pel the tumour : Second, if. this fail, and suppura- tion take place, to promote the early evacuation of the matter : and Thirdly, to heal the sore which is produced. We possess very little power over the tumour by external application. The use of sugar of lead, and discutients, has been attended with little bene- fit ; and perhaps the most effectual practice, though even it is not of great utility, is to rub the tumour gently for a quarter of an hour, three times a day. If the friction give uneasiness, a little olive oil, or camphorated oil may be employed. Mercury in 268 DISEASES OF CHILDREN. various forms, hemlock, muriate of lime, bark, steel, &c have been given internally, but seem to have no effect, except in so far, as some of them act as ton- ics, and improve the health. In this view, the reg- ular use of laxatives, either alone, or combined with some bitter, or tonic, such as myrrh, or steel, will be found useful. Hemlock poultices, &c. have been applied externally, with little benefit. i When it is evident, that matter is forming, suppu- ration ought to be promoted and hastened, by the application of a bread and milk poultice, and as soon as an abscess is formed, a puncture ought to be made. This is better, than allowing the part to burst of it- self, for the aperture is made in a more favourable situation, the consequent sore is less extensive, and the mark is smaller. After some time, the part is to be dressed with resinous ointment, spread very thin. If the ulcer do not heal soon,' it is most usefully managed with stimulant applications. Burned alum may be applied once in the two days, or the part may be bathed with tincture of myrrh, or kept dry with prepared chalk, either alone, or mixed with a small proportion of alum or camphor. If thq discharge be great, and the skin extensively- iurlam- ed, the application, first of cloths wet with cold wa- ter, or sugar of lead-water, and afterwards of chalk, to the parts, to keep them dry, is useful. If the sores be very irritable and paiufulx a hemlock poul- tice, sometimes gives frelief. DISEASES OF CHILDREN. 269 The healing of the sore may also be promoted by the regular use of laxatives, by myrrh, or other tou- ics, which improve the organs of digestion, and in- vigorate the system, Sometimes great and unnecessary alarm is pro- duced, by swelling of glands in the neck, or under the chin, which is not scrophulous. We can trace the complaint to cold, to teething, or absorption of acrid matter from the head or ears, &c. The swell- ing takes place suddenly, and is sometimes attended, even with a degree of feverishness, especially in in- fants. It either gradually subsides, or speedily comes forward to suppuration. The best practice, is to give, one or two doses of physic, and rub the gland with anodyne balsam, three times a day. If it inflame, it is to be poulticed, and whenever much matter is formed, a puncture is to be early made, and the part afterwards dressed with simple oint- ment. The mark presently disappears. If the gland remain stationary, especially in grown up children, 1 have found it of great service, to give every morning, a large glass of water, con- taining two drams of epsom salts. Besides the glandular affection, produced by scrophula, many other parts may suffer, such as the eyes, or eve-lids, the s,km, the spine, the joints, &c. To describe these various complaints, would not on- ly lend me into a very extensive field, but would also be unnecessary in a work of this nature. I z 2 $70 DISEASES 0£ CHILDREN. may only remark, that the earliest attention, ought te be paid, to pain or swelling of any of the joints, by which much and lasting mischief may often be avoided. PART FOURTH. OF DISEASES OFGROWN-VP WOMEN, CHAPTER I. Of the Monthly Evacuation. Having finished the remarks, I had to make, on the diseases of children, 1 am now led to notice, some complaints incident to grown-up women, but which could not be introduced into the former parts of this work, as some of them do not occur in the preg- nant, or child-bed condition. The age, at which the monthly evacuation com- mences, varies not only in different climates, but also iu different individuals, in the same place. In this country, it usually appears about the fourteenth year, aud continues for a period of thirty years. In some instances, this change takes place, with- out any previous indisposition, or uuea-y feelings. Bu' in general, it is preceded for some time, by va- rious affections of the stomach and bowels, list- 272 OP DISEASES lessness, diminished appetite, costiveness, bilious vomiting, and pain in the back, or lower part of the belly. The health seems to decline, and not unfrequently a train of nervous, or hysterical symp- toms occur. The evacuation then takes place in a sparing and imperfect degree, but in some time, it returns in greater perfection, and the general health improves. Many women have no farther inconve- nience ; but some, previous to, and along with ev- ery evacuation, have a renewal of the pain, sickness, bilious vomiting, and other distressing symptoms, and are apt to have spasmodic affections of the bowels, or difficulty of breathing. In every instance, the female system is peculiarly irritable at the monthly period, and more disposed to nervous affections. There is also a greater ac- tivity of the vessels at that time. On this account, we observe, that tumours grow faster, and those who are liable to inflammation of the eyes, or of any part of the skm, have that increased more, at this period, than at other times. Some pains are in- creased, others are relieved, by the evacuation ; and many women, before it takes place, have an eruption, like nettle-rush, on ihe skin. W;th regard to the management of the constitu- tion of young" women, about the time when this evaluation commences, i must observe, thit in al- most every instance, where ihe health suflvis, and the evacuation is long of fippciniig, oi even, when the usual age has not pa:»s*.;l, the symptoms arise, OF GROWN-UP WOMEN. 273 principally, from weakness of the whole system, or of particular organs When we have merely a declining, or delicate state of health, with a varia- ble condition of the stomach and bowels, the case is pretty clear. The most effectual means of giving relief are, keeping the surface of the body warm, by means of a flannel shift and drawers, the use of the warm-bath, every second night, particularly, the warm sea water bath, moderate but regular ex- ercise, digestible diet, and above all, preserving the bowels correct, by using daily, if required, one, two, or three, of compound rhubarb pills, or two tea-spoonfuls of epsom salts, and three grains of sulphate of iron, dissolved in a large tumbler of wa- ter, which is to he drank every morning before breakfast. It will also be useful to employ tonic medicines, such as tincture of steel, or carbonate of iron, alone, or combined with myrrh. If, besides a delicacy of constitution, there be symptoms, indicating an affection of particular or- gans, such as cough, palpitation, or pain in the side, it will be necessary to have early recourse to a prac- titioner. The symptoms are alarming,, from their resemblance to the incipient stage of consumption. Even great attention, and much experience, cart- not always ascertain the distinction ; nor must it be forgotten, that if due means are not used, manv re- coverable cases, will end in actual disease of the lungs The distinction is to be made, by a careful comparison of the symptoms of the two diseases, 274 OF DISEASES and by observing, that in the bad health, connect- ed entirely with the time of life, the cough has more of the appearance of being nervous, it comes on in distinct fits, at particular times, it is attended with no permanent difficulty of breathing, and there is no bad expectoration. Palpitation, and many hysterical symptoms,•accompany this, and we have, besides, a feeling of fulness and irritation in the uterine region, and uneasiness in the back. In a case, however, of so great importance, and so apt under neglect, to end in actual disease of the lungs, no time ought to be lost, in obtaining the best advice. In the state of bad health, 1 am at present describ- ing, the mean of cure, consists principally in the invigorating plan. ■ If unfortunately, it be supposed, in such a case, that the symptoms proceed from in- flammation of the lungs, or from some complaint, requiring the use of the lancet, the loss of blood is always productive of additional weakness, and in- creases the danger of the patient. Myrrh, com- bined with oxyde of zinc, is a medicine of conside- rable utility, as a tonic, and if given in a proper dose, it does not sicken Four grains of the former, and one of the latter, will be sufficient to begin with, and this, with the addition of a little cinnamon, may be taken three times a day. The bowels are to be kept open, by the compound rhubarb pill.^The diet must be lignt, and it is of great service, to re- move the patient to the country, and use exer- cise on horseback. Sleep is procured at night, OF GROWN-UP WOMEN. 275 if necessary, by hyocyamus, or laudanum. Pain in the side is relieved, by the application of a warm plaster. The occasional use of the tepid bath, is pleasant and beneficial, especially, if the skin be dry-and warm. As the health improves, the cold bath may become useful, but it is seldom so at first, as it produces languor aud chilness, or headach. When it does good, the patient feels a glow of heat after it, and a greater degree of liveliness. It has been proposed, to employ different medi- cines, in order to promote the appearance of the evacuation. But these' have seldom any good effect, and in some instances, do harm. The effectual re- medy, is to give the constitution vigour, and to in- crease the general health, without which, no medi- cine can have any effect, and which if accomplished, will of itself, produce the desired change. In some rare instances, the evacuation is prevent- edfrom appearing, by mechanical obstruction, which is, iu general, very easily removed, by a trifling ope- ration. • Fortunately, in mo<-t cases, the evacuation takes place in due time, and the constitution sustains no material, or permanent injury. It is however, in every instance, proper to pay particular attention to the system, during the continuance of the evacuation. For, either by imprudence in diet, or by exposure to cold, pain in the bowels, hysterical affections, or sudden obstruction of the discharge, may occur. It is the practice with some, to take every night 276 OF DISEASES warm drinks, containing, not unfrequently, the addi- tion of spirits. This is both unnecessary, and pre- judicial. It is unnecessary, because nature is cer- tainly capable of conducting all her operations in health, without aid ; and it is prejudicial, in as far as the stimulating ingredients may increase the dis- charge beyond due bounds. I do not however, from this remark, mean to say, that a single glass of warm toddy is improper, especially, if there be uneasiness in the bowels. But, 1 have uniformly observed, that those who attended least to this prac- tice, enjoyed the best health. The stomach and bowels, are at this period, very easily disordered, and therefore, every thing which is heavy or indigestible, ought to be avoided. Some are hurt by eating fruit, or vegetables, oth- ers by taking wine, or any fermented liquor. Jn this respect, experience must euable each individual to judge for herself. Exposure to cold, particular- ly getting the feet wet, is hurtful, as it tends sudden- ly to obstruct the discharge. The same effect is likewise produced by violent passions of the mind, which are also at this time, peculiarly apt to excite spasmodic affections, or hysterical fits. It is a general, aud very proper rule, not to ad- minister any very active medicines, at this lime, un- less some violent symptom absolutely require them.' Opiates for instance, are in many cases, necessary to allay spasmodic affections, or abate pain, and they are in such circumstances, uniformly safe. They OF GROWN-UP WOMEN. 277 give speedy relief, to hysterical feeling of suffoca- tion, or to spasm of the stomach or bowels. Blood- letting is also, in some instances, necessary, from particular circumstances, at this period, and in such cases, it is safe, and does not obstruct the evacua- tion. Dancing, exposure to much heat, or making any great or fatiguing exertion, are improper. These causes may increase, to an improper degree, the quantity of the evacuation, and in certain circumstan- ces, may give a disposition to a falling down of the womb. To conclude, the period or time of life when the monthly evacuation should disappear altogether, is considered as critical. It is really so in two cases. The first is, when the woman has suffered consider- ably at each period, from sickness, pain, and disor- der of the bowels. Such women, not unfrequently, when the constitution is freed from this monthly change, enjoy better health than formerly. The second is, when there is a tendency to disease, in some particular organ, especially in the womb* it- self, in some of the abdominal viscera, or in one of the breasts. In such cases, the time of life may prove the period, at which the disease begins to make progress. The time, at which this evacuation ceases, varies from (he forty-fourth to the fiftieth year. It is usu- al, for some time before it disappear, that it should become irregular. It not only is sometimes great- ' Aa 278 OF DISEASES ly less, and again, much more in quantity than usual, but it also is occasionally obstructed for some weeks, and then perhaps, conies oftener than it ought to do. The occasional obstruction, before the final cessation of the discharge, is frequently accompa- nied with sipkness, and swelling of the belly, from wind in die bowels. These circumstances, some- times incline married women, for some weeks, to consider themselves with child. To prescribe medicines, with a view of prolong- ing the evacuation beyond the period allotted by nature, is not more rational, and certainly would not be more successful, than the attempts of the al- chymist, to extend the term of human life, by an elixir. But although, in this view, few take medi- cine, yet many are disposed to use remedies, to prevent the supposed injurious effect, of, the cessa- tion of the evacuation. These are in general un- necessary, and it ought to be a rule, not to take me- dicine, uules3 some particular condition require it. The bowels are to be kept regular, but it is not ne- cessary to take smart purges, unless there be evident marks of fulness of blood ; inwhich case, exercise, and purgatives will be proper. Any disposition which particular organs, may have to disease, at this tin:.', must be checked, by appropriate remedies, which, depending on the nature of the affection, for which they are prescribed, cannot here be pointed out. / OF GROWN-UP WOMEN. 27.9 CHAPTER H. Of Painful Menstruation. In some instances, menstruation is attended with great pain in the back, thighs, and lower part of the belly. This state is sometimes accompanied, with suppression of urine, or violent colic pain, and spasms of the stomach. The discharge generally takes place slowly, and is sparing in quantity, and occasionally, portions of skinny looking substance come away, which may impose on the patient, ifshe be married, and make her suppose, that she has had a miscarriage. The pain, and other symptoms, appear to depend, on an imperfection of the menstrual action. They may also, though much more rarely, attend a pro- fuse discharge. Relief may be obtained from the pain, by the ear- ly application, of warm fomentations to the back and belly, or by sitting down,. for a quarter of an hour, in a tub of warm water. After this, the back, and lower part of the belly, ought to be well rub- bed with anodyne balsam, and if the pain continue, a clyster, composed of a cupful of thin starch, and a tea spoonful of laudanum, is to be administered. If these means have not ihe desired effect, it will be 280 OF DISEASES proper to give, five grains of Dover's powder, every hour, for four or five times, or till a gentle, but gen- eral perspiration be induced. This is also to be en- couraged, by drinking frequently, a little saffron-tea, or warm water, with the addition of a little ginger wine. If there be pain about the loins, and difficul- ty of making water, a tea-spoonful of sweet spirit of nitre, in a small cupful of warm juniper-tea, may be taken every two hours, till relief be obtained. Spasm, or pain in the upper part of the belly, may be removed by thirty drops of laudanum, and a tea- spoonful of aromatic spirit of hartshorn, in half a glass of peppermint water. In order to prevent this painful state, in those who are subject to it, we may, with advantage em- ploy the warm-bath, for three or four nights, prece- ding the menstrual period, and give on going to bed, ten grains of Dover's powder. The bowels are to be kept uniformly regular, by means of a preparation of aloes.* Exposure to cold, especial- ly near the time of the appearance of the discharge, is to be carefully avoided. . The constitution is to be improved, and strengthened by such means, as its particular condition requires, and in general, by the use of steel, and the shower or sea-bath, provi- • Take of aloes one dram ; of ipecacuanha twenty grains; of oil of peppermint, ten drops ; of extract of cicuta, a sufficient > quantity, to form a mass, which is to be divided into twenty pills. Of these, from one to three may be taken at night, as often as is Becessary. OF GROWN-UP WOMEN. £81 ded, these do not produce languor and headach, or pain in the back. CHAPTER III. Of Obstruction. From strong emotions and passions of the mind, or from sudden exposure to cold, during the men- strual period, the discharge may be speedily check- ed. This interruption is usually attended with , ♦ vSry considerable pain in the back, bowels, or stom- ach, and sometimes in the chest. In some in- stances, these symptoms are accompanied vyith much sickness, and inclination to vomit; in other cases, with hot skin, and frequency of pulse. In almost every instance, it is proper to have immedi« ate recourse to fomentations, or the warm-bath. It will also be generally useful, to put the patient to bed, and give half a glassful of saline julap, every half hour, with the addition of five drops of lauda- num, and twenty of* ipecacuanha-wiue. This dose may be repeated, until a gentle perspiration come out, and the pain abate, or until, at least, sixty drops of laudanum have been taken. When there is much fever, or violent pain in the chest or head, or discharge of blood from other organs, as for in- A a2 282 OF DISEASES stance, the stomach or lungs, it may be necessary to have recourse to the lancet. Many women have the evacuation postponed, for a week or two, beyond the usual time, or miss one or two periods without any very evident cause, and without inconvenience. But a continued ob- struction, is usually attended by bad health, or by some disagreeable, or troublesome symptoms. It is the general opinion of women, that all these ef- fects proceed eutirely from the obstruction, and that if it were removed, they would be well. This is d ubtlesB in some instances correct, but in many it is not; for the obstruction, may be merely ihe con- sequence of weakness of the constitution, and may have no effect in producing the other symptoms. -^ Obstruction, when it does not proceed from pre- vious bad health, aud debility of the system, is gen- erally of itself, productive of troublesome conse- quences. It may be caused by the application of cold, or by frights, or passion, during the flow of the evacuation, as 1 have already noticed; and the obstruction being thus once occasioned, may con- tinue for a length of time. It is likewise, sometimes caused by costiveness, or a disordered stale of the bowels. Obstruction so produced, is accompanied with symptoms of indigestion, frequently with sickness, especially in the morning, vanable appetite, heart- burn, inflation of the bowels, palpitation, distressing headach, swelling of the legs, bilious vomiting, OF GROWN-UP WOMEN. 283 and many hysterical symptoms. It is also, some- times, attended by vomiting, or spitting of blood, eruptions, ophthalmia, &c. Such is the general train of symptoms, but they will be somewh »t modified, by the constitution of the patient. Those, who are of a full habit, or ro- bust frame, are generally flushed in the face, have flying pains in the chest, peih ps (.pitting of blood, the pulse is usually somewhat trequeut, and there is even a degree of fever, giddiness, flushed face, cough, palpitation, difficulty of breathing, and a complication of nervous affections. The bowels are generally bound. / __ Those who are of an opposite habit, and espe- cially those, who have suffered severely from mis- carriage, difficult labour, or other debilitating causes, have different symptoms, constituting, what has been called chlorosis. The face is pale, the eye sunk, and the under eye-lid livid. The bowels are costive, the pulse small, and sometimes frequent, or irregular, and subject to sudden variations in frequency and strength. 1 he tongue is furred. The feet are sometimes swelled, and the belly tum- id. The appetite is diminished, or there is a ciaving for chalk or indigestible food. The sleep is gener- ally disturbed, though sometimes, the patient is un- usually drowsy. There is much wind in the stom- ach and bowels; palpitation, and a timid state of mmd. Often there is cough, aud nocturnal per- epilation, which gives lis* to an appiehension, that 284 OF DISEASES the patient is consumptive, and indeed, the diagnosis is often very difficult to make. But in this disease, the marks of pulmonic affection are less distinct, and the cough comes in fits; it is often worse in the morning, aud is not increased by lying on one side, rather than another; neither is there any pain, or strong excitement to cough, on making a long in- spiration. When obstruction occurs, in either of the states I have mentioned, prompt means must be employed for removing it; as the health may suffer materially. In the first case, fatal disease in the lungs, or stomach, or liver, may be induced. In the second, consumption, or dropsy, may be the consequence. In the first case, it will be of benefit, to pre- scribe a course of aperient medicines, particu- larly, mineral waters. But these are not to be carried to an undue degree, nor persisted in, when they occasion debility. Two tea-spoonfuls of epsom salts, in a tumbler of water, may be taken every morning, for a considerable time. The diet ought to be rather sparing; and, if there be marked symptoms of plethora, that is, fulness of blood, or much shooting pain in the chest, oppres- sion in breathing, or headach, the lancet must be employed. Should the skin, notwithstanding these means, remain hot and dry, the saline julap will be useful. Moderate exercise must be taken ; but the cold bath, in the early" stage, and always, until the fulness be diminished, is hurtful, and productive of OF GROWN-UF WOMEN. 285 headach, or pain in the breast. The febrile symp- toms, and plethora, being removed by laxatives, it will be of great benefit, to begin a course of strength- ening powders, each of which, may consist of five grains of myrrh, three of carbonated precipitate of iron, and six of supercarbonate of soda, with a little cinnamon, or ginger, in addition; one may be taken three times a day. Emmeuagogues, or forciug me- dicines, are not to be employed at first, but if these powders be not effectual, rather less than a tea- spoonful, of tincture of black hellebore, may be taken morning and evening, in a little water. _J5SeL^ In the other, or chlorotic species of obstruction, the treatment is much the same, as that recommend- ed in the first chapter, for the management of those who are long of having this evacuation. We are to employ, the warm salt-water bath, succeeded by friction over the body, with warm flannel, or the flesh brush. The bowels are to be kept regular, which is a point of great importance, and if the stools be offensive, it may even be necessary to give pretty powerful and repeated purgatives. Chaly- beate medicines are of great efficacy, and presently we may employ along with these, five grains of pow- dered savine, three times a day, in a desert spoonful of tincture of myrrh. The use of the Bath waters, is also of benefit. The diet is to be as nourishing as the patient can take, and such a quantity of wine, particularly Madeira, may be taken, as does not pro- duce.heat, or flushing. Previous to the expected 2c1i5 OF DISEASES time, when the evacuation should appear, it will be useful for one or two nights, to use the bath pretty hot; sometimes, an emetic taken ihe night before, has been of great benefit. Besides the remedies 1 have ordered, many others may in parlicular cases be required, such as mustard seed, madder, rue, sage, &c. When the strength increases, and ihe constitution becomes more vigorous, the cold bath, when it does not disagree, always does good, and confirms the health. In obstinate cases, a change of climate will be useful, and in every instance, a removal from the town to the country, is of advantage. Riding on horseback is highly proper. In those instances, where the evacuation has be- come suppressed, in consequence of previous bad health, it is evident, that no attempt to restore it, can be either effectual or useful, till the cause be removed. Means must be employed, for rectifying the state of the constitution, when this can be done. Some have obstruction caused, by very slight weak- ness, or very early in chronic diseases ; others con- tinue regular, till even the last stage of consumption. In those cases, where obstruction in married wo- men, continues for several months without injuring the health, it is necessary, before using remedies, to consider, whether there is not reason to suppose, that they are with child, and the signs by which this state may be known, have formerly been noticed. OF GROWN-UP WOMEN. 287 It is also possible, that the obstruction may proceed from a false conception. In some instances, how- ever, an obstruction may, in young and healthy wo- men continue for a great many months, without either of these causes, and without any inconve- nience. This is chiefly the case, in those who are very corpulent, or who have been in the pernicious practice of employing vinegar, and strong purges, to reduce their size. By the regular use of exercise, rising early in the morning, avoiding supper, keep- ing the bowels correct, and living, upon the whole, rather sparingly, the health will be preserved, and in course of time, the desired alteration will take place. This plan, at any rate, prudently couducted, never can doharm, whereas, extreme abstinence, and re* peated evacuations, by purgatives or other means, may be productive of the most lamentable conse- quences. Amongst other evils, we too often find, that the organs of digestion become impaired, and the patient flies to laudanum or ardent spirits for relief. Each dose calls for another, until at length, some fatal disease is induced; and in the last stage of weakness, when it is too late to profit by a change of conduct, the sufferer with unavailing sorrow, de- plores her error. Continual vomiting, repeated pain in the bowels, innumerable hysterical symptoms, diseased liver, or dropsy, are some of the evils en- gendered by indulgences in the use of narcotics, a craving for which, is too often excited by that sys* fern, which I have reprobated^ which even, although « 283 OF DISEASES it produce not this, may cause other ferrous evils, and which being considered in itself as inuocent and commendable, is apt to be pursued with avidity, by those who know not the danger to which it leads. CHAPTER IV. Of Increased, or Profuse Discharge, The menstrual evacuation may be excessive in quantity, and may also recur too frequently, as for instance, once in the fortnight, or three weeks. Some have naturally a much more copious dis- charge than others, and in these cases, although, at particular times, the quantity may be increased, the appearance is the same. But, in every instance, where the discharge is very profuse, or greatly in- creased beyond the natural quantity, its nature is to a certain degree changed, and clots of blood, or numerous shreds of lymphatic substance, often like part of a miscarriage, are met with. There is also, usually, considerable pain, both in the back, and lower part of the belly. Profuse discharge, may occur under two differ- ent states of constitution. In the one, the womau is robust, of a full habit, and often of a ruddy coun- tenance. In the other, she is pale, delicate, fre- quently of a slender make, and easily fatigued. OF GROWN-UP WOMEN 289 Married women chiefly, are subject to profuse discharges ; the unmarried, unless well up in years, though they may have occasionally, a considerable evacuation, seldom have an excessive discharge, ex- cept in those cases, where some debilitating disease, such as fever, occurs about the menstrual period, ^t— The effects of profuse discharge vary, according to its degree. Where it is frequently repeated, but not in- excessive quantity, the health suffers slow-* ly, the face beconies pale, the strength impaired, the appetite diminished, the digestion is injured, palpitation, and many nervous complaints are in- duced, the head aches, the back is weak and painful, the feet swell, and if the complaint continue long, the constitution may be irreparably damaged. If it take place suddenly, to an excessive degree, the strength is speedily exhausted, the patient feels cold and sick, the pulse is weak, and perhaps fluttering, the face pale, the lips pallid, the breathing oppres- sed, the extremities become cold, and if the dis- charge continue, vomiting and fainting, or perhaps* hysterical fits, are excited, or death itself, may be the consequence. A variety of causes may produce this troublesome disease. Some of these are general, such as a state of great weakness, or of too much blood ; others are local, such as debility of the uterus, occasioned by tedious labour, or frequent miscarriages. A sedentary life, indulgence in warm drinks, too much sleep in a heated room, or with many bed- nb 290 OF DISEASES clothes, irregularities of diet, fatigue, or strong passions of the mind at the menstrual period, &c. Will act as exciting causes, especially in those con- ditions which 1 have noticed, as predisposing to the disease. A diseased state of the womb itself, particularly at an advanced^ period of life, gives rise to obsti- nate, and repeated discharges of blood. This situ- ation is to be suspected, where there is constant pain in the back, a feeling of heaviness, or pain in the lower part of the belly, and frequent evacuations of clotted and fluid blood, in the* intervals, between which, there is a discharge of brown, yellow, ot green, ill smelled matter. In the treatment of this disease, we have two objects, first to moderate the discharge, and procure present security ; and second, to prevent a return. The first thing to be done, when the discharge is excessive, is to put the patient to bed, and keep her cool, for heat excites the circulation ; she is to have few bed clothes, the windows, if it be summer, are to be opened, and cloths dipped in cold water, are to be applied to the back, and lower part of the belly. The food is to be light and cool, such as panado, stewed apples, &c. The drink is to be cold and sparing, the thirst being rather quenched with ripe fruit, such as oranges, currants, goose-berries, or orapcs. Port-wine is generally given as a cor- dial and astringent, but unless, in cases of great de- bility, where the strength is much impaired, it does Jiarm by increasing the circulation. OF GROWN-UP WOMEN. 291 This is the general plan of treatment, but it must be varied in degree, according to circumstances. In those cases, where the patient is robust, plethoric and ruddy, it must be carried pretty far. The cloths wet with cold water, are to be applied fre- quently, or changed often, the bed-clothes must be exceedingly thin, aud nothing but a little dry biscuit, and cold lemonade allowed. It may even be ne- cessary, in order quickly to diminish the force of the circulation, to take away some blood from a vein. On the contrary, when the constitution has been feeble, and the patient delicate, or when the dis- charge has continued for a considerable time; and she feels cold and exhausted, or faintish, we must not push the cooling plan so far. We are not to carry it the length, of producing much or prolonged shivering. Nay, if the extremities be cold, it may eveu be necessary, in order to preserve the heat, to apply warm flannel to the feet. With regard to the farther treatment, and the use of internal medicines, I must observe, that we have in this disease two objects, during the continu- ance of the discharge ; the first is, to abate it, the second is to obviate its effects. In n.der to abate it, astringents, such as kino, alum, port-wine, &c have been employed. . Some of these do harm, and most of them very little good, If the strength be not much impaired, and the discharge have not con- tinued long, it will be sufficient to give fifteen drops of elixir of vitriol, in a glass of cold watei every hour, and in summer, the water may be cooled with 992 OF DISEASES ice. A few grains of alum, dissolved in cold water, may also be employed in place of the elixir. Port- wine, with plethoric patients, always increases the discharge, instead of diminishing it; but when the strength is impaired, and the vessels weak, it may then, not merely do good as a cordial, but may also check the discharge, which continues from debility. If the discharge be obstinate, it will be proper to press a cloth, very firmly into the passage to the womb, by which ihe blood is retained, and coagu- lates in the mouths of the vessels, stopping them up. Under these circumstances, opiates will be useful, as they, when given in a full dose, not only check the discharge, but also preserve the strength, and abate nervous irritation. If there be a tendency to faint, or the ^strength be much exhausted, we not not only give a pretty large dose, forty, fifty, or sixty drops of laudanum, or from two to four grains of opi- um, accordiug to the urgency of the case, but we al- so give at stated intervals, wine, cinnamon-water, aromatic spirit of hartshorn, or other cordials. We must also support the strength, by giving repeatedly, but in small quantity, beef-tea, calves-feet-jelly, &c. Vomiting is best restrained by opium, in the form of pills. Ipecacuanha, digitalis, and some other remedies have been recommended, and in certain cases may be necessary. But these, cannot with advantage, be committed to the management of the patient, or her nurse. It will therefore be sufficient to say, that in all extreme cases, the best piactice, tin- OF GROWN-UP WOMEN. 2Q3 til assistance be procured, is to press firmly w ith a cloth on the passage to the womb,iu order to restrain the discharge, and give an opiate, or small quanti- ties of wine, according to the circumstances of the case, which may be judged of, from the preceding remarks. All increased discharges do not require this care. In moderate degrees, it is sufficient, that the patient recline on a sofa, keep cool, and avoid the use of stimulating or heating substances. Our second object is, to prevent a return of the attack, in those who are subject to it. This is to be accomplished, only by considering the causes, which occasion or promote it. Where we find the patient of a full habit, it will be proper to reduce the quantity of blood, by the use of purgative medi- cines, such as a solution of Cheltenham salts, by reg- ular, but prudent exercise, by employing a consider- able proportion of vegetables in the diet, and by abridging the quantity of sleep. It will also be ne- cessary, to avoid all stimulants. When by these means, the plethora is removed, the shower bath will be useful to strengthen the vessels, which have been over-distended. In a great number of cases, however, we meet with a delicate constitution, aud spare habit, with pale countenance. This state re- quires, the use of sea-bathing, or the shower-bath, and the vessels of the womb are particularly strengthened, by pouring cold water daily, on the back and Idins. Strengthening medicines are use- b b 2 21H OF DISEASES ful, such as tincture of steel, or chalybeate waters, such as that of Tunbridge. The bowels are to be kept regular, by some gentle laxative, such as a small quantity of Cheltenham salt. The diet should be nourishing, and a proper proportion of wine is to be prescribed. Regular and invigorating exer- cise must be taken ; whilst on the other hand, fa- tigue, and especially exposure to relaxing heat, and the use of warm tea, must be avoided. In all cases of repeated discharge, especially, if it continue al- most constant, it is of signal benefit, to inject twice or three times a day, a saturated solution of alum, in order to constringe and strengthen the vessels of the womb. In obstinate cases, the occasional exhi- bition of a gentle emetic, has been of service. When there is reason to suppose, that the dis- charge is dependent on, or connected with, a diseas- ed state of the womb itself, such as schirrus, or po- Jypus, means must be employed for removing, or, where that cannot be done, abating the diseased con- dition, x__ CHAPTER V. Of Fluor Albus. Th e inner surface of the womb, and of the pas- sage to it, is at all times covered with a small quan- tity of mucus, which is furnished by glands and ves- OF GROWN-UP WOMEN. 295 sels, destined for that purpose. In many cases, how- ever, this mucus is greatly increased in quantity, and is also altered in quality, forming a discharge, com- monly called the whites. This may come from the passage to the womb alone, or from the cavity of the womb> or from both. In slight degrees, it is at- tended with very little inconvenience, but when the alteration is more extensive, the concomitant symptoms vary, from slight pain and weakness in the back, to universal, and considerable debility, with much derangement of the stomach and bowels, and also of the nervous system. The appearance of the discharge varies in dif- ferent cases. In the mildest form, it is slimy, and much the same with white of egg, having very little colour or smell. In the next degree, it is of a yel- lowish colour, but the colour is not very deep, and . the discharge is not offensive. In a greater degree of de- rangement, the colour is inclined to green, and the dis- charge is slightly offensive, and somewhat irritating. In the worst form, it has more resemblance to pu- rulent matter, is ill-smelled, and frequently mixed with blood. This form often is dependent on a se- rious disease of the womb itself. The simplest and slightest species is not attend- ed with pain in the back, or at least, it is very tri- fling. The health is not much affected, the strength scarcely diminished, though the back is rather weak- er than usual. The menstrual discharge is not inter- rupted, nor rendered irregular. In the next degree, the back is constantly weak, and after any exertion, 2g(J OF DISEASES aches considerably, the power of digestion is diminish- ed, and the bowels are generally costive,the menstrual discharge, however, continues pretty regular. There is sometimes a feeling of heat and itching, about the passage to the womb, particularly if the patient be plethoric. In a greater degree of this complaint, the back is constantly painful, and very weak, and there is a feeling of much weight or relaxation, about the lower part of the belly, and top of the thighs. The menstrual discharge is either obstruct- ed, or rendered irregular, or profuse. The stomach is much impaired in its vigour, the patient is costive, troubled with flatulence; want of appetite, or heart- burn, the face pale, and unhealthy; palpitation, and many hysterical affections take place, and the con- stitution see*ms altogether, to be very much debili- tated. This state is always productive of sterility. In the worst species, where the womb is diseased, the pain is usually greater in the lower part of the belly, the discharge is mixed with blood, and care- ful examination discovers the exact stale of the womb. The quantity of the discharge is variable. In some cases, it is very little ; in others, profuse. In some, it continues pretty uniform, in others, it increases and diminishes, or may altogether disappear for a day or two, or even for a longer period. When the mens- strual discharge continues, it is not unusual for the fluor albus, to be increased for a little before, and after the monthly period, or if the menstrual dis- charge be obstructed, the fluor may be in greater of grown-up women. 297 quantity about the regular period, and is in that case, attended with additional pain in the back. When the discharge takes place from the womb alone, and not from the passage, it is sometimes interrup- ted for a day previous to menstruation, and if the pa- tient conceive, it immediately stops. On the oilier hand, the discharge from the passage alone, is often increased during pregnancy, and in some instances, takes place only at that time. This disease may be produced by any cause, which either weakens or irritates the womb and its appen- dages. It may as rse from general debility of the constitution, or from torpor of the bowels, but it is especially caused by circumstances, impairing the power of the womb itself, as for instance a severe labour, a miscarriage, particularly, if the patient get too soon up, and mismanage herself, or profuse men- struation, or much fatigue, or exposure to cold at the menstrual period, or perhaps, at any time, in the same way, as discharge is produced by cold, from the mucus membraue of the nostrils, or wind- pipe. It is also produced by irritation, such as worms in the bowels, or by pregnancy, or affections " of the womb itself. In some cases it appears to de- pend on a full and irritable habit of body. A great variety of remedies have been employ- ed for the cure of this complaint, such as balsams, and resinous preparations, mercury, electricity, &c. &c. Of these, 1 am not able to give a favourable report, having seldom seen any benefit from their exhibition. 298 OF DISEASES In the treatment of this complaint, iegard must be had to the apparent cause, aud to the state of the constitution. If the habit be full, and the con- stitution disposed to fever, from slight causes, and if in these circumstances, there be a sense of heat about the passage to the womb, it will not be safe to stop the discharge by local applications. The proper treatment consists in the use of cooling lax- atives and spare diet. Neither is it proper to check this discharge, when it occurs as an early symptom of pregnancy, but if it increase to a troublesome degree, it may afterwards be moderated by mild as- tringent applications. In the great majority of cases, however, the complaint is dependant on Weakness of the uterus, and perhaps, of the consti- tution, and the most useful remedies are those which invigorate, such as the cold bath, infusion of bark, preparations of iron, and due attention to the state of the bowels, and to the regulation of the diet, which ought to be nourishing, but light. These means, strike at the cause of the complaint, but if they do not remove the effect very soon, we are not to trust to them alone. For when once a morbid secretion is excited, it is very apt to contin- ue, although the exciting cause cease to operate. . On this account, we ought very early, where there is no fulness of the general system, nor any affection of the womb itself, to have recourse to ihe use of an astringent injection, which is to be thrown into the passage, by means of a proper syringe, three or four times a day. The best remedy of this OF GROWN-UP WOMEN. 299 nature, is a solution of alum in water. Half an ounce of the former, may be added to a quart bottle of the latter. After many trials, 1 have satisfied myself, that although assistance may be derived, as I have mentioned, from internal medicines, and the cpid bath, yet the chief dependence is to be placed on astringent applications to the seat of the dis- charge ; and these, with the exceptions I have pointed out, are perfectly safe in all cases, and sel- dom fail in producing a cure. 1 need scarcely repeat, that when there are symptoms of disease in the womb, which the practitioner will of course sa- tisfy himself respecting, they are inadmissible or useless. When fluor albus proceeds from worms, purga- tives and bitter clysters, are the proper remedies. Aching pain in the back, is often mitigated, by the application of a large adhesive poster, spread upon soft leather. CHAPTER VI. Of Diseases of the Womb. SECTION I. I have formerly noticed bearing down of the womb, and therefore, need uo> lit re make any ob- servation on that subject. '1 here is however, a "\ 300 OF DISEASES complaint, Which is sometimes, at first mistaken for it, and which may occur at any period of life. I al- lude to the polypus in the womb, which is a firm tumour, attached to some part of the cavity of that organ. The mild polypus is connected to the womb generally by a narrow neck. It is, at first, at least, smooth, and grows slowly. As it grows, it of course makes the womb enlarge, and presently its mouth dilates, so that the polypus can be felt with the finger. Then it gradually descends into the passage, or in some instances, is forced down, with pains like those of labour. It cannot, however, come away, like a false conception, because it is still adhering firmly to the womb itself, but it remains in the passage, and if it be very large, fills it up so com- pletely, as sometimes to obstruct the discharge of the urine. The symptoms at first produced, are often pretty much the same with those, occasioned by the bearing down of the womb. There are aching pain and weakness in the back, uneasiness in the lower part of the belly, and a sensation of dragging about the groiiis. The belly is swelled, but the size is changeable. There is usually a discharge like fluor albus, which is sometimes foetid, and the health is more or less impaired. The appetite is diminished, the digestion bad, and many hysterical symptoms are occasioned. Presently,repeated dis- charges of blood take place, sometimes to an ex- cessive degree, and the health becomes gr«-atiy in- jured. Even although little or no blood be lost, of gbown-up women. 301 tlie constitution suffers. The patient is soon tired, can undergo very little fatigue, and complains much of a bearing down or heaviness. The pulse becomes quick, and at length hectic fever may be excited, which proves fatal. No evident cause can gene- rally be assigned for the appearance of a polypus. This disease, in many of its symptoms, bears a strong resemblance to a falling down of the womb, and mothers, resembles a more dreadful disease, an incipient cancer. It can only be certainly discov- ered, by accurate examination, which never ought to be neglected. No medicines have any power over this tumour, bat it may be safely and successfully removed, by the application of a ligature round its neck. This operation gives no pain, and is practicable, when- ever the mouth of the womb has dilated complete- ly. But if the symptoms be not urgent, it will he better to delay, until the polypus have wholly, or in part, descended into the passage, as the ligature can then be still more easily and successfully applied. SECTION II. There is a tumour of a different kind, met with in the uterus, which does not spring from the surface of its cavity, but is imbeded in its substance. It forms a knob or projection, which gradually in- creases, and in some instances, several of these form in succession, and the womb becomes considerably c c 302 ©F DISEASES enlarged. This tumour is called a tubercle, but it cannot be of any advantage, to be more particular, in describing its appearance or structure. It pro- duces, very nearly, the same symptoms with a poly- pus. It also frequently occasions a repeated dis- charge of blood, with shreds of skinny looking substance, which may pass for a conception. The distinction between this disease and a polypus, can only be made by a skilful examination, which de- termines the point. It is always proper to attempt the cure of this early; for, if neglected, it not only produces bad health, but may also eventually prove fatal, by the irritation it gives. It is not, however, in general, to be considered as a mortal disease; nay, in some cases, where it has been discovered after death, it appears to have given very little dis- tress during life. The growth may frequently be checked, and in several cases, its size may even be di- minished very greatly, by the regular use of laxatives. One of the best, perhaps, is the sal polychrest, from two to three drams of which, may, for a length of time, betaken early every moruing,in a large gh'=s of water. Should this not be sufficient, its operation may be assisted, by taking at night, an al- oetic pill. Much relief is also obtained to the un- easy feelings, and even some advantage over the tu- mour itself, by the use of the warm sea-water-bath every night. The diet must be light, and rather sparing. Wine and stimulants are to be avoided. The possibility of removing this complaint, or of .keeping it in subjection by proper remedies, and the of grown-up women. 303 great probability of curing completely a polypus, by a simple operation, or of relieving by a mechan- ical contrivance, a bearing down of the womb, must surely be powerful inducements for women, labouring uuder symptoms of these complaints, to submit early to a skilful examination, which can alone determine the precise nature of their disease. SECTION III. A more formidable, and dreadful disease, is scirrhus, or an induration, and generally an enlarge- ment, of some part of the womb, ending in cancer- ous ulceration. This begins w ith heat, and itching, about the passage to the womb, with darting pain in the lower part of the belly, and aching of the back. There is a dull pain felt at the top of the thigh, attended with a disagreeable bearing-down sensation. Along with these symptoms, or even sometimes before they appear, or at least, are much attended to, there is a discharge of whit- ish fluid, as in fluor albus, and sometimes discharges of blood, which pass for profuse menstruation. Presently, stinging pain is felt, shooting from the lower part of the belly, to the back, accompanied frequently with pain or difficulty in voiding urine. Then the pain becomes more fixed in the situation of the womb, and is of a glowing, or gnawing nature. The countenance very early becomes sallow and un- healthy, the patient is troubled with flatulence, in- digestion, vomiting, and pain in the bowels. Af- 304 OF DISEASES ter some time, the pulse becomes quick, the dis- charge increases from the womb, becomes foetid, and often mixed with blood; or repeated, and some- times very profuse, discharges of blood take place. In some cases, the ulceration extends to the bladder, or to the bowel, and either urine or the stools come away with the bloody matter. In other instances, the tumour becomes firmly fixed in the pelvis, and by its size obstructs the passage of either the urine or stools, or both. The appetite is quite lost, the weakness increases, the mind wanders, and at length, the patient is relieved by death, from her mortal sufferings. Such is the general progress of cancer, but there must, in different cases, be many modifications of the symptoms, according to the size and situation of the tumour, the state of the constitution, and other circumstances. Death may take place, before ul- ceration be produced, and when there have been very few attacks of bleeding, and even little fluor albus. The strength gradually sinks, though there is perhaps, very littlfe pain, and scarcely any fever, the pulse having during the course of the complaint, been regular and unaffected. Three or four days before death, it becomes quicker, fuller, and irregu- lar. Slight delirium occurs, or she refuses all food, lies for some time in a drowsy state, and suddenly the pulse becoming weak and fluttering, she dies somewhat unexpectedly. If, on the other hand, the disease be protraded, till much ulceration take place, there is greater suffering, very offensive discharge, OF GROWN-UP WOMEN. 309 blood in the womb, after a miscarriage, or profuse menstruation, or it may follow a delivery at the full time, or may be occasioned by the retention of a blighted conception. With very few exceptions, indeed, this is a disease, to which married women alone are incident. The eymptomsare very much the same at first, with those of pregnancy, so that this has been called a false conception. The menstrual discharge is obstruct- ed, the breasts enlarge, the patient is sick in the morning, the appetite is fastidious, and the belly in- creases in size ; it is however softer, and enlarges faster, than in pregnancy. Many of the symptoms may be occasioned by a polypus, but in that case, the breasts are flaccid, and the mouth of the womb is generally open, whereas, in the other complaint it is shut. Generally, the mole is expelled, before the usual time of quickening in pregnancy, but if it be retained longer, the size of the belly does not in- crease in the same manner as in pregnaucy, and no motion is felt. The mole is at length expelled, with the same symptoms as in a miscarriage, and it re- quires a similar management. A substance of a different nature, is occasionally met with, namely, a mass, consisting of small blad- ders, called hydatids. These bladders, which con- tain water, may be very numerous, and somewhat resemble a thick cluster of grapes. Some of them are not larger than the head of pins, others are lar- ger than a nut, or one or two may even acquire a great size. Generally speaking, they are produced \310 OF DISEASES by the same causes which occasion a mole, but they usually proceed from the retention of a blighted con- ception, which comes to be converted into hydatids. In this last case, the time when the embryo, or foetus perishes, is marked by the breasts becoming flaccid) and the morning sickness going off. The belly does not increase in size, or if it do, it is slowly. The patient does not become regular, as she would have done, had the womb been emptied, but she may be subject to irregular discharges of blood. At length, after an uncertain period, pains like those of labour come on, and the mass is expelled, often with a very considerable flooding. The manage- ment is the same as in an abortion. After the ex- pulsion, milk sometimes appears in the breasts. If hydatids are not occasioned by a conception, they are more frequently met with about the time, when the menstrual evacuation ceases, than earlier. This probably proceeds, from a retention of a clot of blood being most apt to take place then, the evacuation itself being more irregular; and more of the nature of a hemorrhage. SECTION V. There is attached to each side of the womb, though very loosely, a flat, glandular looking sub- stance, not larger than a garden bean. This is cal- led the ovarium, and it is liable to swell and become changed in its structure, containing a great many cells, tilled with a fluid like calves-feet jelly, or OF GROWN-UP WOMEN. 311 sometimes like water. This disease has very im- properly been called a dropsy of the ovarium. It very often seems to be excited by injury- sustained in child-birth, I ut it may also occur without any evi- dent cause, aud attacks the married, and the unmar- ried the young aud the old. It begins slowly, and the ovarium for a length of time is not larger than a hen's egg. Then it increases, and by its pressure on the bladder or bowels, it may interfere with the passage of the urine or stools, and it also is gene- rally productive of universal irritation of the bow- els, so that the patient is subject to indigestion, co- lic, pain, and hysterical affections. Presently, the tumour can be felt like a ball in one side, and not unfrequently, the thigh or leg of that side, is numb, or subject to cramp. The tumour at first is moveable, but afterwards, it acquires such a size, as to render the belly tense, and it cannot be moved as formerly, nor its shape distinguished. It there- fore, at this time, very much resembles dropsy, and indeed, after some time, it is usually complicated with dropsy. It gradually increases in bulk, and at last, the patient is much larger, than in the last month of piegnancy, and the diaphragm is pushed so much up, that she is very breathles s. In the course of this disease, there are occasional attacks of pain in the belly, and as the size increases, the neighbour- ing parts suffer from pressure and irritation. The feet swell, the urine is diminished in quantity, the bowels are generally costive, the skin ot the belly from* dirtensio..., becomes very tender, the bieath- 812 OF DISEASES ing difficult, the nights are spent without sleep, and at length, the constant uneasiness, and increasing weakness, end in death. The progress, however, which this disease makes, is very variable. In some cases it continues slowly advancing for more than twenty years, during which, though the patient is not well, she yet is not very ill. In other instances, it arrives at a distressing degree in a year or two. On the supposition, that th"s was a dropsy, it has been usual to employ diuretics, but from experience of their effects in my qwn practice, and in that of others, I can confidently s/iy, that they have no pow- er over the disease. They sometimes do decided mischief, by weakening the constitution, and there- fore, I would never recommend them, unless this be complicated with ascites, or some other species of dropsy. The fluid is contained in a great many cells, or bags, and is out of the reach of medicine. It is only removed, by making an opening into the largest sac, and evacuating the fluid.- This is some- times done by nature, the cyst bursting into the bow- els, and an immense quantity of foetid, dark colour- ed liquid, coming away by stool. This however, is" a rare occurrence, and therefore, it is necessary to draw *he fluid off by tapping, but this ought never to be done, till the tumour have acquired a great size, and produce breathlessness, and other urgent symp- toms. The reason of this delay is, that the sac soon fills again, and the renewal is productive of weakness. Every time the patient is tapped, the swelling returns with greater rapidity, so that the OF GROWN-UP WOMEN. 313 operation must be more quickly repeated. In one case, which has been published, the patieut required to be tapped, no fewer than eighty times, and once had one hundred and eight English pints drawn off. This disease can very rarely be cured. Our chief, and most rational object is, to keep it from increasing quickly. For this purpose, diuretics have been tried, but they have no effect. The best prac- tice seems to be, to make gentle pressure externally, with a bandage, so as to support the parts, at the same time, that we keep the bowels open, and use means for invigorating the constitution. Trouble- some symptoms, must be palliated, as they occur, by suitable remedies. This, it may be said, is inert practice, but I deem it better, to do little, where lit- tle can be done with advantage, than to d i mischief with more active medicines, which, if they are not beneficial, must be productive of evil. I have long been of Dr. Hunter's opinion, that the patient will live longest, under this disease, who does least to get rid of it. CHAPTER VII. Of Sterility. Sterility is a misfortune, which few women become altogether reconciled to. In various coun- Dd J14 OF DISEASES tries, and in different ages of the world, charms and spells, and powerful elixirs, have been resorted to ; rich ofleriugs have been presented at the shrine of a favourite saint; pilgrimages have been undertaken to holy wells, and in addition to all, the virtues of potent herbs and drugs, have been made trial of, for the removal of this infirmity. When we consult the writings of the old physicians on this subject, we find numerous receipts, containing medicines, sometimes of opposite qualities, sometimes of no quality at all. The practice of the moderns, is at least more simple, if not more efficacious. Sterili- ty proceeds from, either a temporary, or permanent, incapability of conceiving, or of retaining the em- bryo, till it acquire a form. The causes producing this incapacity, may consist in some malformation or deficiency of the womb, or its appendages, which cannot always, be discovered during life, or in mere- ly a weakness of the action of the womb. This last is by far the most frequent cause, and it is occa- sioned by local weakness of the womb, or by gene- ral affections of the whole system, and is marked usually by ah obstruction, deficiency, or redundancy of the menstrual evacuation, or by the complaint, termed female weakness. It is very r.ire indeed, for a woman to be barren, who is, in ail respects regular. We do not in the present age, pretend to the knowledge of any elixir or medicine, which has ihe rpec.iic power of curing sterility. We proceed on the principle of rectifying the constitution, where it OF GROWN-UP WOMEN. 31,5 is injured or weak, and of restoring the menstrual evacuation, to its due and,healthy state. The means foreffecting these purposes, must depend on the situation of the individual, and may be learned from some of the preceding chapters of this book. There are chiefly two states of the constitution, productive of those deviations in the action of the womb, which cause barrenness. The first is a state of fulness, and disposition to obesity. The person gradually becomes fat and inactive, the menstrual evacuation continues regular for some time, but at last diminishes, and'becomes obstructed, or it goes to the opposite extreme, and becomes frequent or profuse. The patient is either barren, or subject to false conceptions and abortion. This state is to be rectified, by spare or vegetable diet, total abstinence from malt liquor, regular, and constant exercise, especially early in the mornings, aud on horseback, the prudent use-of laxatives, and, after some time, the cold bath. These means will, if persisted in prudently, effect the desired change, but if pushed to an undue degree, and especially if repeated pur- gatives, and much vinegar, or great abstinence be resorted to, the health may be completely ruined. The second state, is that of relaxation, the habit is spare, instead of corpulent, the mind is lively, and perhaps even irritable, the menstrual evacuation either profuse, or it recurs too frequently, and, at times, clots and shreds are discharged. This re- quires a different treatment: the diet, if not un- 3l6 OF DISEASES usually nutritive, is at least not to be sparing, the exercise must not be carried the length of fatigue, the cold bath is useful, and strengthening medicines are required. Such remedies, as 1 have pointed out formerly for the removal of irregularities of the menstrual evacuations^ or of fluor albus, must be employed when necessary. By persisting carefully in a proper plan, sterility may at length be frequently removed. There are many instances of women bearing children, after having been several years barren. CHAPTER VIII. Of Indigestion. Indigestion is dependent oi> weakness) or di- minished vigour of the stomach, Tnis is productive of want of appetite, flatulence, acidity, heart-burn, hiccup, water-brash, fits of sickness and vomiting, headach, lassitude, unhealthy complexion, bad sleep, costiveness, turbid and high coloured urine, &c. Some modifications of this disease, are attended with vomiting of blood, or of bile, severe pain of the stomach, or are connected with uneasiness in the right side, bloody coloured urine, pain in the top of the shoulder, yellow complexion, repeated fits of vomiting, &e. of grown-up women. 317 Indigestion is caused by costiveness, by a seden- tary life, by irregularities in diet, by depressing pas- sions, &c. It is only the slighter degrees of this complaint, which can be managed with propriety, by a patient herself. The bowels are to be kept open by the regular use of some laxative. This may be equally neces- sary, although the bowels be loose instead of bound, if the stools be dark coloured or offensive. One or more compound ihubarb pills, are to be taken every night, or we may occasionally substitute for these a little magnesia and rhubarb, with the ad- dition of a small quantity of cinnamon, or canella alba. Aperient mineral waters, are likewise of ap- proved efficaCy. In England, Cheltenham, and in Scotland, Pitcaithly waters, are the most beneficial. No patient can expect to get well, without unremit- ting attention to the bowels. If the medicines I have mentioned are not effectual, the aloetic pill, may be safely substituted. ' Regular exercise is to be taken every day, to such an extent, as can be borne without fatigue ; and it will be of additional advantage to contrive it, so that the mind shall be employed, at the same time. The cold bath is of benefit in every case, where it does not produce pain iu the head or stomach, or is not succeeded by chilness and languor. The surface of the body, ought to be kept warm, by the use of flannel shifts and drawers, and woollen stockings. d d 2 318 OF DISEASES The diet must be light, and in general, it will be useful to employ a considerable proportion of well boiled vegetables. Coffee is generally preferable to tea. New baked bread is always hurtful; warm toast is equally so. Long fasting is injurious, and therefore, the patient ought to eat frequently, though not much at once. Nothing is more erroneous, than to suppose, that drams are necessary to digestion. The habitu- al use of cordials and drams after eating, is not only of no benefit towards digestion, but actually impairs it afterwards. All stimulants of this nature, occa- sion subsequent weakness, proportioned to the tem- porary excitement they produce. This is not the worst of the evil, for the exhilaration of spirit, and feeling of comfort, imparted for a time after taking cordials, comes to be a strong inducement for, the patient to take them at other times, in o;derto remove that languor and uneasiness, or those pains, which accompany indigestion. The consequence of which is, that gradually a habit of intemperance is induced, which ends in a bloated countenance, a diseased liver, a broken constitution, which terminates iu a dropsy; One or two glasses of Madeira wine, after din- ner, may be taken with safety and advantage, bat malt liquor should be avoided. A little ginger ale, may be taken during dinner, or water alone may be used, which often agrees, well w ith the stomach, if taken warm, and in small quantity. If it be neces- sary, on account of flatulence, to take any stimulant after eating, a little powdered ginger is the safest. OF GROWN-UP WOMEN. 3]£ Besides this regimen, it may also be necessary, to employ some strengthening medicine, to invigorate the stomach, such as twenty drops of tincture of steel, in a glass of water, three or four times a day. Or five grains of colomba,and the same quantity of, magnesia, with two grains of ginger, three times a day. Pain in the stomach, vomiting of blood, &c. though greatly relieved by purgative medicines, are too serious, to be entrusted to the management of the patient alone. Deficiency, or irregnlarity of the bilious secre- tion, with pain in the bowels, or swelling of the feet, a state not uncommon in indigestion, or about the time when the menstrual discharge ceases, will require mercurial preparations, in the form of pill. CHAPTER IX. Of Hysteria. In a well marked hysterical fit, a sense of pain or fulness is felt in the belly, near the navel, or to- wards the left side. This gradually spreads, and a sensation is felt, as if a ball passed upwards, and Stuck in the throat. The patient now usually falls down insensible, or convulsed, and seems to suffer much in breathing, sobbing violently, or uttering a kind of shriek. She is generally pale, and frequently, ap- 320 OF DISEASES parently insensible during a great part of the fit, or seems to be in a faint; but when she recovers, she is not only conscious of having been ill, but also of many circumstances which occurred during the fit. After remaining for a considerable time, in a state of muscular agitation, alternating with an appear- ance of fainting, the affection abates. V§ne ulters deep sighs, opens her eyes, and.looks around her, as if surprised, and at le.igth, recovers both compo- sure and sensibility, but remains for some time lan- guid, and complains of headach. This restoration is accompanied with eructation, and the discharge of a quantity of limpid urine. The duration of the fit, as well as the circumstances attending it, vary much. In some instances, it lasts only a few minutes; in others, for more than an hour. Sometimes there is great muscular agitation, or pretty strong convul- sions ; at other times, the fit resembles more a faint. In some instauces, violent paroxysms of crying and laughing, alternate with each other, whilst in many cases, these symptoms are entirely absent. These hysterical fits, depend on a peculiar irrita- bility of the system, which is always greatest at the menstrual period, and therefore, at that time, women are peculiarly liable to hysteria. A torpid, or bad state of the bowels, also powerfully disposes to this disease. Under such circumstances, any great or sudden passion of the mind, joy, fear, a surprise, exposure to much heat, great fatigue, &e. will im- mediately bring on a fit. OF GROWN-UP WOMEft. 32i The treatment duimg the fit, is briefly this. Let the patient be laid immediately either m bed, or on a sofa, aud if the room be warm, let the door, or part of a window, be opened. Volatile salts may be held to the nose, and the temples rubbed with lavender water. As soon as the patient can swal- low, a tea-sooonful of volatile tincture of valerian, in a little water, may be given, or the same quan- tity of compound spirit of lavender, alone, or with twenty drops of laudanum. If none of these me- dicines can be procured, forty drops of hartshorn, may be given in a little water, especially if the patient be languid, and apparently faintish. in stight cases, time alone, and soothing the patient, and keeping her at rest, will be sufficient. But where the agita- tion is extreme, forty drops of laudanum may be re- quired to calm her, and if she can swallow easily, a tea-spoonful of ether should be given in a glass of cold water. But this is not to be proposed, without previously trying, whether she can readily swal- low something milder, as it is so sharp and vol- atile, that it might otherwise, by getting into the upper part of the wind-pipe, produce disagreeable effects. After she recovers, it is of servke to ad- minister a purgative. A recurrence of fits, in those who are subject to them, is to be prevented, by rectifying the state of the constitution, which predisposes to them. Where the patient is of a full habit, florid, or robust, the diet ought to be somewhat sparing, and of the mildest kind; all high seasoned dishes, and much 322 OF DISEASES animal food, or wine, being injurious. Regular and considerable exercise, is also to be taken. Those, on ihe other hand, who are of a slender habit, debil- itated by previous disease, or naturally feeble and delicate in constitution, require a more generous di- et, though still the nutriment must be light, and eas- ily digested. Strengthening medicines, such as tincture of steel, &c. will be required, and the cold bath will be useful. In both cases, however, it is of the utmost importance, to attend to the state of the bowels, using such a number of aloetic pills dailv, as is necessary to expel all the dark coloured, offen- sive feculent matter, and afterwards to support the due and vigorous action of the bowels. Dr. Camper, and other practical physicians, long ago proposed very powerful purgatives as a mean of cure; and of late, the attention of the profession has been direct- ed to this point with great advantage, by Dr. J. Hamilton senior. Although at first sight it would appear, to be a matter of little moment, what laxa- tive be employed, yet, from careful observation, I am convinced, that the aloetic pills, recommended by Dr. H. claim in general, a decided preference to other medicines. In all those cases, where the menstrual evacua- tion is profuse, or obstructed, or otherwise irregu- lar, suitable means must- be employed for bringing it into a proper condition. When, from the sensation of the patient herself, or from other circumstances, the approach of a fit OF GROWN-UP W.OMEN. 323 is apprehended, it may often be checked, by im- mersing the feet in tepid water, and takino- a tea- spoonful of aromatic spirit of hartshorn, in a little cinnamon water. But besides the regular hysterical paroxysm, wo- men are subject to other affections of a nervous na- ture, such as palpitation of the heart, breathlessness, feeling of suffocation, stupor, severe and painful spasmsj fits of general irritability of the body and mind, &c. The particular treatment, of these va- rious symptoms, must vary according to their vio- lence, and the peculiar constitution of the patient. It is evident therefore? that this cannot be mintuely explained here. In some cases, blood-letting is re- quired, especially when there is some very urgent affection of the organs of respiration, or violent and obstinate pain. But in general, pain is relieved by opiates, and the application of a piece of flannel,' spread with mustard. Opiates indeed, are general- ly useful, and in many of the cases I have mention- ed, are the most powerful remedies. It may how- ever, be necessary, to conjoin them with camphor, valerian, asafoetida, or other antispasmodics. in order to prevent the repetition of these symp- toms, it is in general necessary to have recourse to the strengthening system, along with the use of va- lerian, and other antispasmodic medicines, but par- ticularly to the regular use of laxatives, which some- times fail in their good effect, from not being suf- ficiently strong. £24 OF DISEASES, &C. It sometimes happens, that hysterical or nervous affections, put on the appearance of much more dangerous diseases, or produce sympton s, at first, highly alarming. It is not always easy, even for a practitioner of the greatest experience, to form an accurate judgment, far less could this be done, by the reader, from any instruction I could deliver here. In every such case, it is most prudent to call timely aid. I may onjy observe, for the satisfaction of relations, that the patient expressing great ap- prehension, and fear of dying, is far from being an unfavourable sign, as it generally attends nervous affections. This impression is sometimes so violent, as even to constitute a species of delirium. It can- not be removed by reasoning, but it may be greatly increased by mistaken sympathy. It is of impor- tance, to subdue this, as much as possible, because, if indulged, it aggravates the disease, renders it more obstinate, and may ultimately be productive of a very distressing degree of melancholy. Cheer- ful company, and change of scene, are of great benefit when this impression continues long, or re- turns frequently. Indeed, in most nervous diseases, travelling, or frequent removal from one place to another, contributes greatly to the cure. FINIS. . ) £.* *-<* • V——* .. V 2_ 7- 6> ~b T^F*"" 2- ^ 2-^ *UJ£— Ip)| . __cJ_.