ARMY MEDICAL. LIBRARY WASHINGTON Founded 1836 *a**b\ ^^^&^s£«^ CSy L!»/ AKHEX Section__.....__ Number...../.!?.^ / Z -7-...... Fobm 113c, W. D.. S. G. O. sfo 3—10543 (Revised June 13, 1936) F ) A TREATISE ON THE DISEASES OF CHILDREN, WITH GENERAL DIRECTIONS FOR THE M.iMAGEMEMT OF IJVFJ.VTS FROM THE BIRTH. BY MICHAEL UNDERWOOD, M. D. LICENTIATE IN MIDWIFERY OF THE ROYAL COLLEGE OF PHYSICIANS, IN LONDON, AND PHYSICIAN TO THE ERIT1SH LYING-IN HOSPITAL. TWO VOLUMES IN ONE. A JfEfV EDITION, HE VISED AND ENLARGED. Ornari Res ipsa negat, contentadoceri....MAKiL. J PHILADELPHIA: PRINTED FOR_TH£lMAS^DO«fr0^:--- -".;*"" NO. 41, SOUTH SE-CON-D-£.TjtEJjp$. / * '■ X » ;-o^-.;Y'o-;,:A>:i;"o-i-lC I8d2." 1T0IX3 PREFACE. THE quick sale of the first impres- sion of his Treatise on the Diseases of Children, has encouraged the author to take some pains in correcting and enlarg- ing this second edition. He has, at the same time, endeavoured to avoid all unne- cessary details, and useless distinctions, as well as extending it to subjects foreign from the immediate design. Should the reader apprehend any little exceptions in this respect, he will readily perceive the inducement; and, although the accuracy of system should really be violated, it is presumed, it has only given way to mo- tives of humanity and usefulness. Perfectly sensible, however, of nume- rous defects, the writer relies again upon the indulgence of the Public, though he hopes this edition will be found somewhat more complete, and more worthy of a continuance of that favourable reception vvherewith the former was so generally honoured. Particular acknowledgements, a 9- IV indeed, are due for the approbation of the faculty; and the like candor, it is hoped, will now excuse any alterations that have been intended to render this edition more easy and familiar to common readers. For the sake of public utility, the writer has carefully avoided all technical terms, or has so explained them, and so enlarged on the nature of diseases, and the doses of medi- cines, that parents, and others not versed in the practice of physic, may find all com- mon directions sufficiently explicit: when- ever they appear otherwise, readers of that description should conclude, that the case is too difficult for their management, and that probably the best guide might mislead them. The prolixity of other parts may be equally disagreeable to professional men. For the style in general, indeed, the author pretends to have but little to offer. Had he more leisure, possibly the faults might have been fewer; and perhaps, the neces- sity of clearly and intelligibly expressing what is to be said, may, in this instance, be pleaded with those who expect concise- ness and accuracy; which every writer should aim at. It may therefore be ob- served, that some consentaneous diseases have been longer dwelt upon, and their remedies oftener hinted, than might be ne- cessary for many readers. To such, v however, as are themselves obliged to sir perintend the health of their children, and to those who derive a happiness from con- tributing to that of their offspring, there will not be much apology necessary, either for entering so fully into the little mat- ters that compose the second part of the work, or for enlarging elsewhere on many circumstances that may appear trifling when separately considered. It was, in- deed, very much with a view to their use and profit, that the work was originally undertaken; and to their notice and pro- tection it is again submitted, in its improv- ed state, with all Deference and Respect. a 3 CONTENTS. Page THE diseases of Infants are too much neglected 3 Causes of this neglect - - 5 Arguments against such neglect 6 Their diseases easily understood - 7 Causes of Infants' Diseases . - 9 Symptoms, or marks, of their diseases 11 Meconium, what? - - 12 Retention of it, an occa- sion of disease - ib. Of no use afteV birth 13 Ought to be carried off early - - ib. Proper remedies to expel it 15 Instance of its retention for many days - 21 Icteritia, or Infantile Jaundice 22 Treatment - - 23 Sometimes occasioned by Jaundiced-milk - 24 Inward fits, what? 26 Treatment - - 27 Costiveness and Wind - - 31 Treatment - 32 Vll Page Watching, or want of sleep - 38 Often improperly treated 39 Imperfect Closure of the Foramen Ovale, and Canalis Anteriosus - 40 Symptoms - - - - 42 Erysipelas Infantilis - 44 Erysipelas Infantilis, Parts affected 45 Treatment 46 Aphthae, or Thrush - - 48 Appearance of it - 49 Causes - - 52 Remedies - -53 Red-Gum ... 58 Eruption, on the skin - - 60 Anomalous Rash - - 61 Crusta lactea, or milk-blotches - 62 Sore Ears - - - 69 Vomiting ' - - - 71 Not a common disease of Infants - - 71 Milk returned curdled 72 Treatment - - 73 Gripes ... 76 Purging ... 77 Cause - - ib. Kind of Stools - 84 Watery Gripes - 85 Treatment - 86 Purging, Dr. Armstrong's objections considered - - 80 Incontinence of Stools =■ 91 Vlll Page Worms - 92 Not usually dangerous ib. Kinds 93 Symptoms 94 Cause 95 Treatment 96 Convulsions 99 Of two kinds ib. Children oftener said to die of them than they really do 100 Causes 101 A remarkable Case ib. Treatment 102 Skin-bound 110 Not absolutely unnoticed 111 Symptoms 114 Cause 115 Treatment 116 Account of this disease on the Continent 118 Appearances after death 120 Tetanus - 122 Cause 123 Treatment 124 Epileptic-fits ib. Cause 125 Treatment ib. Chorea Sancti Viti, or St. Vitus's Dance, 127 Cause - * - ib. IX Page Ch,orea Sancti Viti, Appearances 127 Treatment - - ib„ Teething - - - 128 An important period in the Infant state - ib. Process of Dentition 1-30 Symptoms - - 131 Remedies - *- 132 Great advantage of lancing the gums - - 136 Fevers - - - 142 Infants not very subject to common fevers - ib. Causes of - - - ib. Treatment - - 14? Slow fevers with appearance of boils 150 Mesenteric-fever - - j 51 Symptoms - 1). Causes - 153 Treatment - 154 Hectic-Fever and Marasmus J < Sometimes curable 160 Treatment - 163 Scarlet-fever - - - 165 Symptoms - - 166 Treatment - 167 Cardialgia, or Inflammation of the Stomach - . . 169 Symptoms - - ib. Treatment - 170 General observations on the Small- pox and Measles - - 171 X , - . Pase Age and circumstances suitable for Inoculation - - 173 Chicken-pox ... 175 How distinguished from the Small-pox - 177 Ague ... 179 Symptoms - - ib. (Ague-cake) - 180 Treatment - - 181 Hooping-Cough- - - 184 Symptoms - • ib. Treatment - 187 Spasmodic cough - - 194 Croup - . . 195 Causes - - 196 Prophylaxis, or Means of Pre- vention - - ib. Symptoms - - - 197 Treatment - . 198 Morbid Appearances - 199 Rickets - . . 200' Cause - . 201 Symptoms - - ib. Treatment - - 202 Scrofula - . . 204 Cause - ib. Treatment - - 205 Hydrocephalus, or Watery-head " 208 External - ib. Hydrocephalus, Internal - 210 Cause and Symptoms 211 Treatment - 213 xi Incontinence of Urine Remedies The Seven-days-disease PART I. TINEA, or Scall'd-head - 222 In generalonly a topical complaint 223 Of different kinds - - 224 Treatment ... ib. Herpes miliaris, or Shingles, (Ring- worm) - - - 225 Appearances 226 Remedies - ib. Herpes exedens, or Serpigo - 227 Treatment - ib. Scabies, or Itch - - - 228 Ophthalmia, or Inflammation of the Eyes - - 229 Variously distinguished ib. The common inflamed Eye - ib. The watery Eye - - 231 The purulent Ophthalmy - ib. Treatment 232 Leucoma, or speck of the Eye 236 Cataract, or Gutta Serena - ib. Stithe, or Stye - - 239 Deafness ... - -240 Causes - - ib. Remedies - - ib. Canker of the Mouth - - 241 Remedies 243 * Page 214 ib. 215 Xll Page Gangrenous Erosion of the Cheeks 244 Appearances - ib. Treatment - 245 Psoas, or Lumber-abscess - 246 Symptoms - - ib. Treatment - - ib. Morbus Coxaris - - 247 White Swelling of the Joints - 248 Palsy of the lower extremities, with Curvature of the Spine - 249 Cause - - - 250 Symptoms - - - ib. Treatment, - - - 251 Debility of the lower Extremities 254 Cause ... 255 First Symptoms - ib. Treatment - - ib. Curvature of the bones from w eakness 257 Remedy - - ib. Paronychia, or Whitlow - 259 Furunculus, or Boil - 260 Chilblains - - - ib. Cause - - 261 Treatment - - ib. Burns and Scalds - - 264 Remedies - 265 Luxations and Fractures - 267 Luxation of the Lower Jaw - 270 Treatment - - ib. Cutting of the Tongue - ib. Suffocation from swallowing the point of the Tongue '- - 272 xiii •' Page Symptoms 272 Remedy - 273 Hemorrhage from the sublingual veins ib. Hiccough - - - 274 Sneezing - - - ib. Bleeding of the Nose - 275 Hemorrhage from the Navel 277 Herniae, or Ruptures - - 278 Rupture at the Navel - - 279 In the groin - - 280 Hydrocle, or Watery-rupture ib. Appearance - 281 Treatment - 282 Retention of the Testes - 283 Tumefaction of the Prepuce 284 Prolapsus Ani, or falling down of the Gut - 285 Treatment. - 286 Discharges from the Vagina 287 Of various kinds ib. Treatment - ib. Of the Venom of Insects, and of cer- tain Animals - - 290 Complaints mentioned by ancient writers - - - 294 Raaula - ... 295 Cause - - ib. Treatment - - 296 Crinones, or Grubbs - - ib. Morbum Pilare - - 298 Phthiriasis - - - ib.. £ XIV Page Macies - - - 299 On Congenite Disorders - 300 Encephalocele, or Hernia of the Brain ib. Occasion - 301 Treatment - ib. Tumors of the Scalp - 302 Treatment 303 Lj-mphatic Tumors of the Head and Spine - - -305 Treatment - ib. Spina-byfida, and Parenchymatous Tumors - - . 306 Treatment - ib. On other external Disorders, and cer- tain Blemishes, supposed to be Marks of the Mother - 307 Causes commonly assigned ib. Experience proves them to be groundless - 308 Blemishes that may be remedied ib. Hare lip 309 Properest time for the Opera- tion - - 315 On superfluous parts - - 317 Vagina Imperforate - . ib. Imperforate Anus - - 318 Operation - 319 Imperforate Penis - . 320 The Ears Imperforate - 321 Squinting - 322 Vari and Valgi - - . 323 XV PART II. GENERAL DIRECTIONS FOR THE MA- NAGEMENT OF INFANTS FROM THE* BIRTH. Dry-nursing, unnatural - 328 Arguments in favor of it usually futile - 330 The Duty of great attention to Infants 332 Hints taken from the irrational Spe- cies' .... 336 Means of Recovering Infants appa- rently still born (Note) . - 337 CJrreat Heat and Cold, and strong Light to be avoided - - 338 On washing of Infants - 340 On the Cold-bath (Note) - 343 On the Intertrigo, Chafings or Ex- coriations - - - '. 348 On forcing out the Milk from the breasts - - - 349 Errors in regard to the first-clothing of Infants- - . 352 Observations on the Non-naturals. On Air - . ■ „■ 354 Changes* of Clothes 356 On Meat and Drink j. - 357 Children require no food im- mediately after Birth ib. Milk, the most proper of all food 358 Infants will pine for a long time after the Breast, when prematurely tak- en from it _ 362 XVI Page Milk, or Bubby-pot, its excellent contrivance - - 366 Resemblance to the Nipple 367 Objections answered - 368 Proper times of feeding - .3 70 C hange of food as Children grow older - - - 372 Proper diet when 111 - - 377 On the acescent quality of the food of Infants, their disposition to Wind, and their remedies - 379 On the choice of Wet-nurses, and their Diet - - - 381 On weaning of Children - 834 On Sleep and Watching 385 Observations on the Cradle 387 Caution against the use of Opiates 3:88 On Motion and Rest - 389 Exercise how important to Health 390 Caution in regard to Females 391 Proper time of putting Children on their feet - - 394 On Rest - - - 397 On Retention and Excretion 398 .Retentionand incontinence of Urine 399 Infants' .bowels shoujd be always open - . . ib. On the Passions of the Mind 400 Laughter and Crying . ib. On the Tempers of Wet-nurses 402 A TREATISE, Bfc. THE following pages being conceived to contain a pretty full account of the difeafes incident to childhood, and fome of them fcarcely known to preceding writers, may poflibly throw fome additional light on this important fubje£t. They are, in this hope, refpe&fully offered to the notice of fuch practitioners in phyfic, as may not have made the complaints of children their parti- cular ftudy. The motives which have in- duced the writer to extend his plan to ano- ther clafs of readers, it is prefumed, may juftify fuch an attempt. He has, indeed, long lamented the very improper method in which the diforders of infants are treated by thofe who defign them the greateft kind- nefs, but whofe miftaken opinions too often counteract their benevolent intentions. The laudable affection of the fondefl: mother fre- quently becomes a fource of manifold injury to her tender offspring: And this is not only the cafe among the lower clafs of peo- A pie, 2 The Work calculated for pie, or in fituations where medical afliflance is procured with difficulty, but even in the metropolis itfelf, and in the higher ranks of the community, where many prejudices very hurtful to the eafe and health of chil- dren ftill prevail. It is intelligent Parents therefore, as well as the medical world, to whofe notice this work is addrefled ; and it is hoped, in the eflimation of both, no formal apology can be neceflary for taking up a fubject, that has long called for a thorough inveftigation. —For the manner in which it has been ex- ecuted, the author, indeed, again folicits the candor of the public. The mofl refpec- table authorities, however, have been con- fulted, a proper attention been paid to facts, and his befl endeavours exerted to obviate the effects of that peculiar veil * which is faid to obfcure infantile diforders. A prac- tical arrangement of them has been fludi- ed, and regard had to their refpective cau- fes and fymptoms, tending to elucidate their nature, ••* There is nothing to which this peculiar obfcu- riry may be referred, but the incapacity of infants to defcribe their own feelings.—There are, never- thelefs, other fources of information, lefs fallaci- ous fometimes than the more literal defcriptions of adults, which in nervous complaints particularly, would tend to perplex the ablcft phyfician if he flionld always be led by them ; and the like difcri- mination will ferve him equally well in the treat- ment of infants. Phyjicians and Parents. 3 nature, and render their treatment more ob- vious than has been generally imagined. To their immediate Difeafes, is added an attention to fome of the principal Accidents and little Injuries to which infancy and childhood are peculiarly liable; which though not neceffary, indeed, for fome readers, it is prefumed will have their ufe, and may, poflibly,prove no fmall fatisfaction to others. And here it may not be improper to obferve, that whatever merit former publications may pofiefs, it may, neverthclsfs, with great propriety be remarked, that they either make a part of fome large fyfteraatic work, the bulk of which muff be foreign from the intentions of a tract of this kind, or elfe they are far too concife, and have o- mitted many complaints of too much import- ance to be overlooked. It has been generally lamented by writers on thefe difeafes, that this branch of medi- cine has remained too much uncultivated. And, indeed, till of later years, little more has been attempted than getting rid of the wild prejudices and anile prefcriptions of the old writers, which had too often ferved on- ly to obfcure the true nature of children's difeafes. Another, and a very principal caufe of fo ftrange a neglect, has arifen from an idea fome people have entertained, that, as medical people can have but a very im- perfect knowledge of the complaints of in- A 2 fants, 4 Difeafes of Infants much Neghfted. fants, from the inability of children to give any account of them, it is fafer to intruft the management of them to old women and nurfes; who, at leaft, are not likely to do mifchief by violent remedies, though they may fometimes make ufe of improper and inadequate ones. How fatal fuch a miftake mufl be, is furely fufficiently obvious; fmce the de- finition of infants is eventually the deftruc- tion of adults, of population, wealth, and every thing that can prove ufeful to fociety, or add to the flrength and grandeur of a kingdom. It may, moreover, be obferved, that where mifmanageraent at this period does not actually deftroy the life, it often very effentially impairs the health ; the foundation of a future good or bad confti- tion being frequently laid in a flate of in- fancy. It is true, indeed, fome laudable attempts have been made of late years to refcue this important truft from being indifcriminately committed to fuch dangerous hands ; but it is ftill to be lamented, that even in this libe- ral age, fuch attempts have not been at- tended with all the fuccefs they have de- fended. It cannot therefore be improper, that fomething farther fhould be advanced on the fubject, in the hope of filencing the weak objections hitherto made againft pro- curing the bed advice as early as poflible. And The principal Caufesjf this neglecl. 5 And this is the more neceffary, becaufe thofe who have the greateft interefl in the fubject, the moft authority on the occafion, and the fincereft affection for their offspring, have frequently the greateft objections to medical afliftance, till it is, fometimes, too late to employ it with effect.—I may, indeed, be very inadequate to the talk of obviating fuch prejudices, but I iha'l ltate an argu- ment or two that has always appeared to me of great wvigat. A principal objection, taken from the con- fideration of the incapacity of infants to dc- fcribe their complaints, has been fligatly no- ticed already, and has been more fully dif- cuffed in a treatife written about twenty years fince, by Dr. Armftrong. * It is apt- ly icnarked by this writer, that the fame difficulty occurs in a variety of the moil dan- gerous complaints of adults at every period of life, which confeffediy require the great- eft afliftance j fuch are attacks of phrenzy, A 3 delirium, * This edition did not contain more than a dozen difeafes ; being confined to the hooping-cough, fcro- fula, teething, and the diforders of the firft-paf- fages. In the year 1783, Dr. Armftrong publilh- ed a fecond edition conliderably enlarged. It fo happened, that I had not feen it when the firil edi- tion of the prefeni work appeared, or 1 mould cer- taily have taken due notice of it, in regard to feve- ral diforders, mentioned in the Doctor's latter edi- tion ; to which therefore I fhall now attend, as oc- cafion iliall offer. 6 Arguments againjl this Negleft. delirium^ and fome kinds of convulfions : to which may be added, ail the diforders of idiots and lunatics. But thefe have been fuccefsfully treated in every age, not except- ing even lunacy itfelf, and the melancholy fubject happily reftored to fociety, his fa- mily, andhimfelf. It has likewife been obferved, if infants for the reafons abovementioned are to be ex- cluded the benefit of a phyfician's advice, it is difficult to fay at what age children may fafelybe intruded to his care ; fmce at the age of five or fix years, they would fre- quently miflead the enquirer, who fhould truft-to their own account of their com- plaints. Their ideas of things are too in- diftinct to afford us mfficient information, and they accordingly often call ficknefs at the ftomach, pain, and pain, ficknefs; they will frequently make no reply to general queftions, and when they are afked more particularly whether they have any pain in one or another part of the body, they al- moft certainly anfwer in the affirmative ; though it afterwards frequently turns out they were miftaken. To this idea I will venture to add, that although infants can give no account of their complaints in the manner we receive information from adults, their difeafes are all plainly and fufficiently marked by the countenance, the age, the manifeft fymp- toms, The Difeafes of Infants few. J toms, and the faithful account given by the parent, or an intelligent nurfe. This I am fo confident of, that I never feel more at my eafe, in prefcribing for any diforders than thofe of infants, and never fucceed with more uniformity, or more agreeable to the opinion I may have adopted of the feat and nature of the difeafe. Every diftemper may be faid, in fome fenfe, to have a language of its own, and it is the bufinefs of the phy- fician to be acquainted with it; nor do thofe of children fpeak lefs intelligibly.*—Limit- led as is human knowledge in every depart- ment, there are 'yet certain principles and great outlines, as well in phyfic as in other fciences, with which men of experience are acquainted, that will generally lead them fafely between the dangerous extremes of doing too little, or too much ; and will carry them fuccefsfully, where perfons who want thofe advantages cannot venture to follow them-—Let me afk then j is it Education, is it * In neither of thefe fentiments do I ftand alone ; Harris, of whofe work Sydenham is thought to have fpoken fo highly, has faid the fame things—" In- certse verd diagnofe«s (quae multum obtinuit) que- rela non tarn a fymptomatum defecla, quam a prae- poftcra ac inepta medendi ratione ortum fuum dux- iflc videtur." (page 8.) And at page 3.—" Ete- nim afferere non verebormorbos illius aetatis gener^ pauciffimos efle, et gradu tantummodo difFere ; imo curationem puerorummulto tutiorem ac faciliorem-, quam virorum ac nmlierum." De MorL Infant. 8 The Difeafeas of Infants few. it Obfervation and long Experience, that can qualify a perfon for the fuperintendance of infants, or the treatment of their complaints ? Surely all thefe fall eminently to the fhare of regular practitioners, to the utter exclu- fion of nurfes and empirics.* Having briefly ft ated this matter, as I hope, with impartiality, and given it the attention its importance demands, I fhall next obferve, that, as the complaints of infants are more obvious than it has been generally fuppofed, fo their number is comparatively fmall, their caufe uniform, f and the treatment of moft of them, fimple and certain. { For * Neque poteft fcire quomodo morbos curare conveniat, qui unde hi fint ignoret—Pertinet ad rem omnium proprietates noffe.—Celsus. f It may perhaps be objected to this idea, that their various difeales cannot all originate from one and the fame caufe ; nor is it my intention to affert it, though it is, indeed, true, in regard to a great num. ber of them. It is to be remarked likewife, that it is the complaints of early infancy that are here particu- larly fpoken of; though it is neverthelefs very evi- dent, that there is a greater unifon/iity alfo in the caufes of feveral diforders even of older children, than there is in thofe of adults, which have very often various, and diflimular remote caufes, at diffe- rent times, and in different habits : E. G. objhutted tatamenia, afcites, ire. f Facillime inquam in morbos dilabuntur infantes, et nifi aut ferius aut imperitius traclentur, facillime in fanitatera reftituMur.—Harris de Mortis acutis Infantum, Their Caufes few and Obvious. 9 For the proof of this, as well as in order to eftablifh a rational practice, I fhall firft con- fider the Caufes and Diagnoftics, or fpeci- fic nature of their complaints, before I at- tempt to enter upon their Cure. And here I fhall not attend to the various remote caufes, but mail confine myfelf to a practical confideration of the fubject, and briefly point out their obvious occafions and fymptoms. And on this account, I fhall not take notice of the various changes which nature herfelf induces during the growth of the infant, as it paffes from one ftage of life to another ; which is, doubtlefs, a remote caufe of fome of their complaints. A principal Cause, mentioned by anci- ent and modern writers, is the great moifture and laxity of infants; which is neceffary, however, in order to the extenfion of parts, and the rapid growth of young children. This laxity arifes from the vaft glandular fe- cretion, their glands in general being much larger in proportion, than thofe of adults, I might inftance in the thymus gland, and particularly in the pancreas and liver. But befides thefe, there are innumerable glands fituate within the mouth, in the gullet, fto- mach and bowels, which are continually pouring out their contents into the firft-paf- fages. This is, doubtlefs, a wife provifion of nature, and I cannot, therefore, think with Dr. Armftrong, that the gaftric, or ftomach io Their Caufes few and Obvious. ftomach juice, renders the chyle lefs fit for abforption; but, as we do not ftrictly fol- low her dictates in the management of chil- dren, as to their food, manner of clothing, fleeping, &c. this abundance of flimy mat- ter may often overload the ftomach and bow- els, the conftant feat of the firft complaints in the infant ftate. * The quality of the milk, or other food with which infants are nourifhed, may be reckoned a fecond caufe. A third arifes from the delicacy of their muf- cular fibres, and the great irritability of the nervous fyftem. In addition to thefe gene- ral caufes may be reckoned the want of ex- ercife, which at a more advanced age, hap- pily for us, we are obliged to make ufe of, and which art, in general, does not duly fupply in regard to children, f Hence arife acidities in the firft-paflages, a con- * Non quod aetas per fe fit caufa illius morbi, eft enim res naturalis et temporis determinatio, fed quia difponit ad morbos quofdam facilius fufcipiendos, fi caufge eorum acceflerint.—Primeros: de Murb. In- fant. j- Exercife is the grand mean of health___The ir- rational fpecies are capable of affording it to them- felves alraoft as foon as born ; and though infant children are not, they are paffive, and can be exer- cifed. Nature and inftincT: point out the expediency of it, and the fend mother who follows only her own inclination, naturally, and infenlibly adopts it, and is continually ftroking and playing with the little idol of her heart, whenever it is awake ; and as Their Caufes few and Obvious. 11 a conftant attendant upon all their early com- plaints.* The firft of which, is the reten> tion of the meconium, and the laft (which may be properly termed a difeafe at all pe- culiar to infants), is the cutting of the teeth, in which likewife the ftate of the bowels is very much concerned. Upon each of the above heads, it may be neceffary to make farther obfervations as oc- cafion may offer, in order to take notice of fome accidental caufes arifing from mifm*- nagement, or errors in the non-naturals, f as they have been called; efpecially in re- gard to the quantity of nourifhment admi- niftered to infants, and an inattention to the ftate of their bowels. The fymptoms of thefe firft difeafes of in- fants, (by which we alfo judge of their na- ture), are chiefly retention and excretion ; four belchings-; ficknefs; vomitings ; purg- ings ; the nature of the matter thrown off 5 watching; inquietude; contraction, and faarpnefs of the features; bluenefs about the month ; thirft; heat j the manner of breathing and of crying ; retr.-ction of the lower extremities ; and puftules, or erup- tions, as it grows older, fhe is led on to five it more cx- ercifc, as it can bear it, and according to the fatis- faclion the infant never fails to manifeft on the oc- cafion. * Sylvius de le Boe. Harris. j Such are food, air, exercife, and the like. 12 Retention of the Meconium. tions, external, or internal. The pulfe and urine are lefs certain marks than thejf are in older children, and adults. To thefe maybe added, the opennefs, or firmnefs of the fon- tanelles, or moles, and of the futures ; and the relaxation or contraction of the fkin in general, and of the fcrotum in particular. Having thus briefly adverted to the gene- ral* Caufes and Symptoms, I (hall now pro- ceed to the consideration of the Diforders themfelves ; and fhall begin with the RETENTION OF THE MECONIUM. HPHE Meconium is that black, vifcid, or tenacious matter, which, it is well Jcnown, every infant parts with by ftool, for the two or three firft days after it is born, or retains it to its manifeft injury. The ordinary fource of infantile com- plaints has already been faid to originate from fomething amifs in the firft paflages, accord- ing to the moft ancient opinions*, and I have long fufpected, that a foundation is fometimes laid for them, from not duly attending to an early expulfion of the me- conium ; which will fometimes firmly ad- here to the coats of the bowels, and remain for many days, unaffected even by power- ful medicines, as I fhall have occafion to re- mark as I go on.—I fhall only obferve in this 1 place, * Hrrroc. Celsus, ^Egineta. Meconium after Birth of no life. \ 3 place, that though it fhould not be all re- tained, yet a part will often remain much longer than has been ufually imagined, and will come away, perhaps unnoticed, at a late period, where no retention of it has been fufpected. Of this I can have no doubt, having been called to vifit infants after the month has been expired, who have been unwell through all that period, for want of having been properly purg'ed, and from whom meconium has ftillbeen com- ing away. A tea-fpoonful of caftor-cil, gi- ven once or more, has foon carried off" a great quantity ; upon which all their com- plaints have difappeared. The meconium appears to be no longer of ufe after the child is come into the world, unlefs it be to keep the bowels from collap- fing, till they be replenifhed with the aliment the child is foon afterwards to receive. Whereas, if it be not foon carried off", it will not only change the quality of the milk, or other food, as it defcends into the bowels, but itfelf alfo becomes highly acrid,(as it con- fids chiefly of gall) and cannot fail to produce incligeftion, flatulency, pain, purginp- or co'aivencfs, and other iimilar evils: And the meconium is farther difpofed to this acrid ftate, on another account, viz. from admixture of atmofpheric air. W hi I ft the infant remains inclofed in the womb, it is fecured from all contact of air, and there- B ' 10^ 14 Meconium to be purged off. fore the alimentary contents remain harmlefs and bland though increaimg for fo many months ; but it is well known, how foon every fecretion or extravafation will become ftcrid, upon the admiffion of air into any cavity where it may be lodged. And it is, doubtlefs, on thefe accounts, that provident nature has imparted an opening quality to the firft milk of all animals ; a certain indi- cation to the rational fpecies, to affift the expulfion of this matter, now no longer re- quired. For though a child fhould even be fuckled by its own mother, (in which cafe, there is, doubtlefs, lefs occafion for other aflift- ance) yet we know that nature doth not, in every inftance, always fully accomplifh her owndefigns: anditislromfomeftrikinginftan- ces of the truth of thefe obfervations, that I have faid fo much on this fubject, which I "have alfo been the more inclined to, bccaufe fo many writers have paffed it over almoft in filence. I am aware that all thofe who efteem me- dical people to be officious difturbers of na- ture, have objected to their affiftance in this inftance, and conclude, that fhe would do the bufinefs much better if left to herfelf.* And * The Editors of the Critical Review offered a remark of this kind, upon this part of the work, in its former edition ; and is the only critique I remem- ber to have feen. I have therefore no caufe of com- plaint Meconium to be purged off. 15 And there are even fome phyficians of this opinion, amongft whom I find Dr. Buchan, whofe abilities and reputation claim particu- lar attention, though he, perhaps, may not be fo much engaged amongft very young infants, as thofe whofe peculiar province it is to attend them from the birth. But there can be no general rule without mjjl"au.il ex- ceptions,* and as, doubtlefs, many children would do very well without any fuch affift- ance, fo am I certain, many would not: and I believe, none can be effentially injured by conftantly affifting in this work, provided the means firft made ufe of be lenient, as they ought always to be.—It is the province of art to fuperintend nature, and not only to guard againft her exceffes, but fo to watch B 3 over plaint againft any writers of that defcripriou, a;u! mould not have noticed the prefent cenfure, if I were not well fatisfied there is no room for f'.ich au objection. And indeed, it is now well known, ihfit the formidable difeafe, fo fatal to new-born children in the Weft Indies, called the locked jaw, or j iw- fallen,f is almoft always owing either to unvvh 1c- fotne, and confined air, or to a want of purging off the meconium. f See Tetanus, * Vix ul«la perpetua prascepta medicinalis ars re- cipit. Celsus. Praf. Lib. i. p. 17. 16 Antimonial Wine propofed by fome. over her. as to enfure the accomplifhment of her intentions, whenever we perfectly comprehend, and can effect them without the rifle of doing harm.* For this purpofe, amongft others, a new remedy has of late years been recommended as preferable to any purging medicines what- ever.-]- Mankind has ever delighted in ex- tremes'—no fooner has any thing, formerly judged to be hurtful, or even poifonous, been found in certain cafes, to be very ufe- ful, than it is fuppofed to be capable of do- Iii o- every thing, and fuperfedes all that the wild em of former ages has proved to be fa- lutary. Hence, fome advantages experi- enced from the ufe of wine of antimony, in a "Variety of children's complaints, as far as they arife from one common caufe, has in- duced fome people to extol it as an univerfal remedy. But wherefore give an emetic, calculated to empty the ftomach, in order to expel the meconium from the lower bow- els ?J It is univerfally allowed, and by this writer ^ * A Tree will produce fruit in its wild ftate ; but by human culture the tree is often prcferved, and its fruit improved, far beyond its natural ftate. | Dr. Armstrong on the Difeafes moft fatal i» infants. I 767. 4 On examining the firft-paflages of nill-born in- fants, (newly dead) it appears, that the large in- teftiues contain the true meconium ; the fmallcr bowels, only a thin bilious fluid mixed with a little gaftric The mildejl Remedies the bejl. if writer alfo, that emetics are not to be admi- nistered when the bowels are full, which, in this inftance, is precifely the cafe. It is true, the wine of antimony does not always vomit children, nor will a little matter often- times do this, (as I fhall have occafion to take notice very foon) ; it is fometimes, in- deed, found to act as a purgative: but if this be the intention, why not adhere to the old, and more certain method, and direct at once A ch things whofe proper operation may be depended upon ? Not the ftomach, but the bowels, are the natural and fafe out- let for moft complaints of children, and a want of due attention to this circumftance has been productive of fome evils, which many practitioners, I think, are not fufRci- ently aware of. It is very evident, that fome gentle pur- gative is indicated on this occafion, and that it fhould be of a kind that will create as lit- tle difturbance as poffible, and efpecially fhould not be of an offenfive, or indigeftible nature ; though fuch have been very com- monly advifed. In general, indeed, a very B 3 little gaftric juice. The ftomach contains ftill lefs, as no bile can enter it but by regurgitation from the duo- denum, and the gaftric juice is in fmall quantity, not enough to be brought up by an emetic without violent {training ; which I fhould imagine it can anfwer no good end to excite by a vomit, the firft hour a child comes into tire workl- 18 The mildejl Remedies the bejl. little matter will fuffice ; perhaps a little iy- rup of rofes, diluted with fome thin gruel, and given occafionally by tea-fpoonfuls, will moftly anfwer the end ; will alfo ferve to keep the child quiet, and fo prevent the x nurfe from giving it improper food. But if this fliouldfail to procure ftools, a watery infufion of rhubarb, (or a tea-fpoonful of the wine, diluted as above) will be found preferable to the indigeftible oily mixtures in common ufe.* In the country, where the above medicines may not be at hand, a little frefh whey and honey will be an excel- lent fubftitute.f The * See Harris. f As I have profeffed writing for the benefit of the intelligent parent, as well as to affift regular practitioners, I fhall take this early opportunity of dropping a hint in regard to the dofes of medicines, as a kind of general guide, where the exact dofe may not be pointed out. Indeed, it were impoffible, in many in fiances, fo to prefcribe, as to afford no lati- tude to the difcretion of thofe who are watching the infant, and are eye-witnefles to all its complaints ; and I might rather lead the lefs intelligent into er- rors, by attempting to lay down very particular and precife directions. The rules I fhall here offer will chiefly refer to vomits, purges, anodynes, (or co?npoftng medicines) and the teftaceous powders, or abforbents. Every one knows, that the dofes of medicines fhould be adapted to different ages ; but thefe are not in mere arithmetrical or geometrical proportions, v:A their due relation is only to be afcertained by " experi- Oily Purgatives always exceptionable. 19 The objection now made to oily medicines is very much increafed, from nurfes fcarcely ever giving the quantity that is directed, in the courfe of the firft twenty-four hours, as it is always defigned ; and adminiftering the reft long after the child has begun to fuck, or to feed. At this period, mixing with the nourifhment, it has a direct tendency to produce indigeftion, wind, and the very complaints, which the oils, adminiftered in proper time, were defigned to prevent. Not to add, that fome kind of oily medicine be- ing the ufiial purgative on this occafion, is an inducement to parents and nurfes to pro- cure experience, and in a reference to all the varieties of conftitution, and habits. From the refult of daily obfervation, one may fky, for example, to a child of/even years old, nearly the half of the dofe fuitable for adults; to one of three years, the feurth part ; of one year, the Jlxth part ; and the eighth or tenth part to an infant in the month. An adult perfon may take from fifteen to thirty grains of the teftacsous powders, and double that quantity of magnefia, at a dofe, to be repeated feve- ral times a day.—From fifteen to thirty grains of ipecacuanha, and from one to two, of emetic tartar, as a vomit. From one to two ounces of faits, or of manna, and from ten to thirty grains of jalap, and from four to ten of cohmel as a purge. From ten to thirty drops of laudanum, and from half an ounce to two ounces of fyrup of white poppies, as an anodyne. From this two-fold direction, parents may, per- haps, attain to a more accurate eftimation ofihedofe proper 20 Strong Purgatives •*. cure a repetition of it, and to adminifter it whenever an infant happens to be coftive during the month ; and from whence, the above evils may be frequently induced. But it has been obferved, the meconium is not always difpofed to come away, even by the affiftance of common purgative me- dicines. Having, therefore, begun with fuch as the above, if the child has no ftool for twelve or fourteen hours after birth, and efpecially if it fhould feem to be in pain, a clifter ought to be thrown up ; which may be repeated, if neceffary, a few hours af- terwards. And here I would obferve, that in the cafes where more powerful means are required, fcarcely any evacuation will be procured by thefe gentle means ; for, as I have feen, wherever I could procure one copious ftool by a clyfter, or gentle laxa- tive, the reft of the meconium has come away with little, or no farther affiftance. But as it fometimes happens, that neither clyfters nor purgatives have any fufficient ef- fect for feveral days, very powerful means muft then be made ufe of; there being rea- fon to fufpect a fufpenfion of nervous influ- ence. proper for their children, by means of the experi- ence they may have had of the particular quantity of any of the'above medicines ufually found fuffici- ent for themfelves, whereinfoever that happens to vary from the dofe here fuppofed to be proper for adults. Sometimes neceffary. 11 ence. I fhall clofe this fubject therefore, with a recent inftance of this kind, (of which, I have feen many) as a proof of what powerful remedies may fometimes be required, and how neceffary it is to pay fome attention to this firft complaint of in- fants. The child was born of very healthy pa- rents, (not at all of conftipated habits) after a quick and comprehenfively eafy labour, on the 2 2d. of February.—To avoid prolixity, I fhall not ftate the cafe in the form of jour- nal ; but fhall onlyobferve, that the child took a little rhubarb an hour or two after it was born ; but having had no ftool when I faw it the next day, I ordered a clyfter to be thrown up. In the evening, the child be- came drowfy and infenfible, and when rouz- ed, it moaned, but feemed unable to cry. It continued pretty much in this ftate, (and at times, feemingly, in great pain, and evi- dently convulfed) for fix days ; and was nourifhed chiefly by a tea-fpoon with a little breaft-milk, fddom reviving fufficiently Ml to fuck. It had no ftools, but fuch as made only a few fpots on the cloths about the fize of a {hilling, till the twenty-feventh, and thofe were very fmall, hard, and lumpy. On the twenty-eighth it had more of this kind, and it had not till the twenty-ninth any thing like a proper ftool, which was alfo mixed 22 Icleritia, or Infantile-faundice. mixed with hard lumps ; but on the third of March, they were thinner, and on the fifth came very freely.—In the courfe of fix and thirty hours, I prefcribed two ounces of the common infufion of fenna, two drams of ro- chelle falts, four grains of jalap, and a grain of calomel ; befides purging clyfters, and the ufe of the warm bath. The next day the child took four grains of ipecacuanha at two dofes, and forty drops of the new wine of antimony, at four times (in the courfe of an hour) without any effect; and at another period, fix drams of caftor-oil, befides feve- ral dofes of manna.* Three days after the child got rid of the meconium, the thrufh made its appearance ; which was flight, but continued above three weeks. IcTERiTiA,or Infantile Jaundice. THE jaundice of infants feems always to have been improperly conceived of. Thofe who have written only on children's difeafes, * From fuch in fiances as thefe, as well as the re- mark already offered on the Locked-jaw of the Weft- Indies, the expediency of having recourfe to fome fafe and effectual means of purging off the meconium feems to be evidenily pointed out ; more efpecially when we confkier the dangerous complaints, which are faid to arife in fome of the hofpitals in Paris from an undue retention of this vifcid matter. Icleritia, or Infantile-faundice. £i difeafes, have ufually paffed it over in filence, whilft others have confidcred it as rather a ferious complaint, and have prefcribed as for the jaundice of adults. On the other hand, parents and nurfes have ufually ac- counted the common yeilownefs that ap- pears about the third day after birth (term- ed by fome yellow-gum) as the true jaundice. Neither of thefe opinions feem to me to be juft ; for the la:ter of thefe appearances re- quires no attention at all, and though infants are not fubject to the troublefome jaundice of adults, (unlefs infected by the breaft- milk) they neverthelefs are liable to fome affections of that kind which claim fome at- tention. Thefe are eafily diftmguifhed from the common yeilownefs, mentioned above, by the tunica albuginea, or white of the eyes being always very yellow; but the nails are not tinged, as in the jaundice of adults, though it is probable they ufually would be, if the complaint were long neg- lected, and the child fuffered to be coftive. I have waited fome days to fee if the yeilow- nefs would go off" of itfelf, as the ufual tinge does ; but it has always increafed ra- ther than diminifhed. It arifes from vifcid matter obftructing the gall-ducts, which open into the duodenum, ancl therefore re- quires a little emetic. Wine of antimony is a very proper one on this occafion, as it may likewife procure two or three ftools; but 24 Icleritia, or Infaniile-Jaundke. but as children in this complaint are not ea~ fily made to vomit, fhould the wine fail, I would advife three or four grains of the the powder of ipecacuanha, which is more certain in its operation ; and the next day give four or five grains of rhubarb. Should the fymptoms continue, the emetic ought to be repeated after two or three days, and rhubarb be given about every other day, till the yeilownefs difappears ; which, un- der this treatment, never continues more than ten or twelve days, unlefs the ftools are of a very pale colour ; in which cafe a little more time, as well as the ufe of the warm-bath, will be required. Women long afflicted with jaundice, du- ring any part of their pregnancy, though actually brought to bed in that ftate, do not infect their children, unlefs they alfo hackle them ;* but, from fome ftriking inftances, I have found that fuckling in that ftate is capable of communicating the true jaundice to a great degree, and that it will not be cured, but by the recovery of the mother or nurfe, or by the infant being weaned, as well as properly treated. rr-il ine * I have myfelf never met with fuch an inftance ; but Mr. Baumes, who has been very attentive to the difeafe, once faw an infant fo infected from the womb t but in this cafe, the child died very foo;; in a very difeafed ftate, the internal part of the liver being in a ftate of fnpparation. Ifleritia, or Infantile-faundice. 25 The true jaundice, diftinguifhed by the fkin being every where difcoloured, as well as the whites of the eyes, feems to be much more common among new-born infants in France, than in this country ; as appears by a memoir written by Mr. Baumes, and to which a prize-medal of the Faculty of Me- dicine in Paris has been adjudged. In this work the various caufes and na- ture of the difeafe are diftinguifhed ; and a correfpondent treatment pointed out with great accuracy and judgment. Throughout the tract there feems alfo to be much inge- nious and plaufible theory; though 1 can- not agree with that able phyfician in fuppo- fing the jaundice to be occafioned by the re- tention of the meconium, otherwife than from this vifcid matter fometimes obftruct- ing the orifice of the biliary ducts ; for in the feveral inftances I have met with of the moft obftinate retention of that fecretion, there has not been the leaft difpofition to jaundice; nor can I conceive, that any part of the meconium is ufually abforbed in icteric cafes, as Mr. Baumes has imagined ; neither does fuch an incident appear to be neceffary in order to account for the fre- quency of the difeafe in that kingdom, or elfewhere. As to the treatment, under the different circumftances there defcribed, I meet with nothing that militates againft the more ge- neral account I have given of this difeafe, or C the 2^6 Inward-Fits. the treatment adapted to it, under the form wherein it appears in this country. Inward-Fits. ANY derangement of the firft-paffages is capable of giving rife to various complaints, among which, that of inward- fits, has lately been taken notice of by fome medical people, but I think fcarcely deferves the name of a difeafe. It demands atten- tion, however, becaufe fo much has been faid about it as to expofe the fond parent to continual apprehenfions, left this fubtile dif- eafe fhould be infenfibly at work, and mak- ing way for more fevere and outward con- vulfions. A conftant fymptom in this kind of fit, as it is called, is the infant's little mouth being drawn into a fmile ; which whoever has no- ticed muft have beheld it with pleafure. And if the complaint extends no farther than this fmiling, which is generally in its fleep, it arifes merely from a little wind, and is cer- tainly harmlefs, becaufe the wind in this cafe is not really confined ; and therefore an immediate recourfe to pukes or purges, is more likely to do harm, by ftraining the ftomach, or by relaxing the bowels, than to do any good. Every body is acquainted with the effects of different degrees of irritation of the nerves, from the fenfation produced by tickling with a feather, to that of a hard gripe In wa i d-1 its. ij gripe, or a violent ftrcke. The firft may be faid to be plcafing ; and fuch, 1 doubt not, is the ftimulus in queftion on the ner- vous coat of the ftomach of little infant?, and therefore produces fo agreeable a fmile, that I could never confider it as an indica- tion of pain. Indeed, I know of no com- plaint that ought to be termed inward fits ; andl mention this, becaufe nurfes are continu- ally talking to us about them, when children are perfectly well, and often give the fond parent needlefs diftrefs, as wTell as many an unpleafant medicine to the child.* Ihey are at the fame time treating the true con- vulfion, whilft flight, in ths fame way, be- ing led into the error by the ideas of inward fits ; a term they are ever ufmg but have no precife ideas of, nor do any two of them mean the fame thing by it. It were therefore better, perhaps, the term were altogether abolifhed ; as the child is either evidently convulfed, or has no kind of fit, at leaft none for which any remedy can be offered.f—If the child fhould C 2 fleep * It were certainly a good rule, to adminifler no medicine to infants for fuch fymptoms as do not in- dicate fome real complaint, unlefs where experience proves that fuch fymptoms neglected are apt to fore-- run fome well known difeafe. f Infants, as well as adults, do fometimes, in- deed, die fuddenly without any manifeft convulfion* But this more frequently happens after over-feed- 28 Inward-Fits. fleep too long, and this fmile fhould often return, the infant may be taken up, gently tapped on the back, and its ftomach and belly be well rubbed by the fire ; which is all that can be neceffary. This gentle ex- ercife will bring a little wind from its fto- mach, and the child will go to fleep again quietly. This complaint, however, is largely treat- ed of by fome writers, and Dr. Armftrong wifhes to give a few drops of the wine of antimony ; but it is very apparent, that when he confiders it as worthy of more at- tention than I have juft now advifed, it is either a true convulfion, in which the eyes are diftorted, and the mouth is difcompofed, inftead of putting on a fmile, or elfe he is prescribing for another difeafe under the name of inward-fits, which former writers have treated under the head of diforders arifing from collivenefs and wind. But if this lirtle turn of the features fhould arife from conftant over-feeding it were endlefs to adminifter emetics; the caufe of the com- plaint ing, and arifes from a fpafm of the ftomach ; or fomeiimes of the heart or lungs ; and infants may then be fid to die of inward-fts, there being no ex- ternal convulfion ; but this is, by no means, rhe kind of affection ufually understood by that term. mward-tits. 29- plaint is obvious, and upon the removal of it the remedy muft reft. Such has ever been my opinion of this much-talked-of complaint; and indeed I have not to this day, after a good deal of attention to infants, feen any thing myfelf to induce me^alter it; or I would in this edition, have cheerfully retracted the pre- ceding obfervations. As I wifh, however, to afford all the information I can on every complaint, I have to obferve, that it is con- ceived by fome gentlemen of great refpecta- bility and experience,.that though the term, inward-fits, has been often mifapplied, there is really fuch a complaint, and that it gene- rally proves fatal. Befides a little bluenefs of the lips, and flight turning up of the eyes, often noticed by nurfes, this complaint is defcribed to me as attended with a peculiar found of the voice (fomewhat like The croup) and a very quick breathing, at' intervals ; and is fuppofed to arife from a fpafm of the ftomach* lungs, or other vital organ; a complaint I have indeed too frequently feen,* but certainly very different from that ufually known by inward-fits. Thefe fymptoms are faid frequently to at- tack the child in its fleep ; and in their com- mencement will go off upon taking it up C 3 from *See Note, pages, 27, 28. 3o Inward-Fits. from its cradle. They are likewife obferv- ed to be induced by fucking or feeding, and to be increafed upon any little exertion of body, or tranfient furprife, and in this man- ner to recur for a length of time, before they become alarming. The remedies pro- pofed for the cure of this complaint are an emetic, on the firft attack, and afterwards volatiles and fetids ; but, as it has been ob- ferved, not often to good effect. In regard to coftivenefs and wind, which have bten faid to be the parent of what nur- fes commonly term inward-fits, as they do not always arife from one and the fame caufe, and are productive of other complaints than thofe above mentioned, I ftiail confi- der them by themfelves ; which, it is pre- fumed, will be purfuing a more rational plan, than adhering to a term obfcure in itfelf, and indicative of a difeafe not well defined, and which therefore may tend to miflead the generality of readersr Disorders C 3* ) Disorders arifing from CosTiveness and Wind. IT has been ufual with ancient writers, when concifenefs and accuracy were not fo much confidered as in the prefent day, to treat of coftivencfs and wind as diftinct heads cf complaint; and for the reafons aforementioned, as well as from this little tract bein^ calculated for .eneral ufefulnefs, and not merely for medical readers, it may not be altogether improper to comply with this cuftom. Wind is but a mere fymptom of fome preceding or attending complaint; nor are its troublefome effects either occafioned or increafed by air taken in with the food, as many people have imagined; atmofpheric air being effentially different from that pro- duced by indigeftion, whether owing to the . weaknefs of the ftomach, as it is called, or the improper quality or quantity of the food taken into it. It may, however, prove a fource of many complaints, and create watch- fulnefs, ftartings, hiccoughs, vomitings^ anct even convulfions, if not timely attended to, efpecially if the infant is coftive. Coftivenefs is either conftitutional, or ac- cidental, which ought always to be diftin- guifhed, the former being oftentimes harm- lefs > and, indeed, children of fueh a ha- bit 32 Diforders arijing from bit of body are frequently the moft thriv- ing. If the mother fhould be very confti- pated, her children generally are fo ; and fuch a difpofition, (whilft they continue in health) ought not, I believe, to be coun* teracted, though it will be prudent careful- ly to watch it. And this will be efpecially neceffary, in the cafe of children who are fubject to fits ; fine lufty infants being often feized with violent convulfions, without a- ny other apparent caufe than a natural cof- 'tive ftate of the bowels, and as uniformly. recovered from the fits, merely by procur ing ftook, and breaking off the wind. And this difpofition to fits has taken place long. before the ordinary period of teething, and has continued till children have been a twelve-month old; at which time the folids, and efpecially the nervous fyftem, has ap- peared to get ftronger. In fuch habits, a quarter of an ounce of manna, or the like quantity of the fyrup of rofes, may be put into any liquid, and as much of it given oy tea-fpoonsful, as fhall open the belly : or a tea-fpoonful of caftor-oil, * or from five to ten drops of the compound tincture of aloes, may * Oil of caftor may be rendered very acceptable to children, if rubbed down with gum arabic, and a little manna, and afterwards made into a draught ©r mixture with fome dill-water, and the addition" of a drop or two of the comppund fpirit of amrnoniay. where that may be proper., Co/livenefs and Wind. $% may be taken two or three times a-week. And here it may not be ufelefs to obferve, that rhubarb will not be a fit purgative, though it be joined with magnefia, which will not fufficiently counteract its reftringen- cy. Another reafon for objecting to this compound, is that of its being the almoft conftant prefcription of nurfes on every oc- cafion, whofe indifcriminate ufe of it is ge- nerally needlefs, and fometimes prejudicial; rhubarb alone, in ordinary cafes, anfwering all the purpofe intended, whilft the magne- fia makes an unneceffary addition to the bulk of the medicine, which fhould always be a- voided for children. A few grains of mag- nefia in a fpoonful of water, and fweetened with a little manna, forms a much neater medicine, and in coftive habits, which ufu- ally abound with acidity, anfwers very well in early infancy. But if the child be otherwife in health, it has been faid, it is, in general, inadvife- able to do much to counteract the natural habit of body. I have formerly, even dur- ing the month, directed manna, even to half an ounce at a time, to very little pur- pofe, unlefs it were almoft daily repeated, and have at other times given from three to five grains of jalap; till I learned there are fome conftitutions, even in infants,where the bowels cannot be kept open without a daily exhibition of fome purgative medi- cine, 34 Diforders arifing frcm cine, and that many fuch children are as well left to themfelves, and require only to be watched. If a ftool fhould be wanted, however, a fuppofitory made of a little flip of paper, twifted up, and well moiftened with oil, may be very eafily introduced, and will generally anfwer the purpofe: or fhould this fail, a bit of Cajlile foap may be intro- duced in like manner. Should fuch a coftive ftate of the bowels produce griping pains, which may be known by the drawing up of the legs, or q£ the fcrotum, and a certain manner of crying ; or fhould the coftivenefs be accidental, it muft fpeedily be remedied ; and if the oc- cafion of it be an improper food, which is very often the cafe, the food muft imme- diately be changed.. If the child be not ufually coftive, rhubarb # is often the beft purgative, as it ftrengthens the bowels af- terwards, infants being much more fubject to an over-purging than to almoft any other complaint, m * Some writers have in this cafe recommended oil, and particularly the French, who adminifter oil of almonds to infants much too frequently. Mr Le Feubre de Villebrune therefore, in the tranfla- tion with which he has honoured this work, gives the preference to oils; but I muft beg leave, in turn, to differ from him, being perfuaded, there are few cafes befide diforders of the cheft, in which any kind of oil, but thatofcaftor, will not be injurious to young infants, and particularly in affections of the firft-pafTages. Cojlivenefs and Wind. 35 complaint, efpecially if brought up by hand. It fometimes happens, however, that much more powerful medicines than rhubarb may be required, whether the child be natural- ly coftive, or not ; and in fuch cafes, much caution is neceffary on the part of parents and nurfes : For, where a proper dofe of fenna-tea has proved ineffectual, it is fur- prifing what large dofes even of rough pur- ges have been given in vain, or fometimes- to the injury of the child. On fuch occa- fions, I would rather advife a recourfe to clyfters, and efpecially thofe made of fuc- cotorine aloes. From five to twenty grains, according to the age of the infant, diflblved in boiled milk, will rarely, if ever fail of procuring two or three ftools, efpecially if preceded by the exhibition of a purge. But even draftic clyfters fhould be adminiftered with caution, and ought not to be very of- ten repeated, efpecially to very young chil- dren ; though lefs hazardous, in every viewr, than the frequent repetition of purges of a fimilar kind. It may be neceffary here to obferve, that purgatives for infants ought generally to be made potentially warm, by the addition of a little ginger, pounded cardamom-feed, car- raway-tea, or dill-water ; which is of more confequence than is ufually apprehended. I have known a careful attention to this cir- cumftance alone, happily fupprefs complaints in 36 Diforders ariftng from in the bowels, which had long continued obftinate, though, in other refpects, pro- perly treated. As there is ufually too much acidity in the firft-paffages in coftive and windy habits, a little magnefia may be given for a few days after the coftivenefs has been remov- ed ; and if the child be fuckled, the nurfe's diet muft be attended to. If any flatulency fhould ftill remain, (which will not often be the cafe if it has arifen merely from confti- pation^ a little dill-water is the moft harm- lefs carminative. But fhould it be an atten- dant upon a lax ftate of the bowels and in- digeftion, its remedy will confift in the re- moval of thofe complaints, which will be noticed in their place. I have hitherto fpoken chiefly of Coftive- nefs ; wind being, however, likewife fome- times a real complaint, though it fhould not happen to be fo confined as to become an occafion of fits. The only inftances of this kind, indeed, that I remember having feen, have been in new-born and very lufty infants, whofe mothers have alfo been pecu- liarly diftrefled by affections of that kind. This is, indeed, a fomewhat anile way of fpeaking, but it ftates the precife fact; and one inftance of an infant fuffering in this way was fo remarkable, that it may be worth no- ticing in this place. In this cafe, the meconium began to pafs off foon after birth, but not without repeat- 3 ed Cqflivenefs and Wind. 37 ed clyfters, purgatives, and the warm-bath, and was peculiarly vifcid, as well as in vaft quantity. Neverthelefs, the infant appear- ed, for feveral days, likely to be ftrangled, and was black in the face, merely through the abundance of wind in the firft-paffages ; though it was continually breaking off both by the mouth and the bowels, and by that peculiar, and very loud noife, when it came upwards, frequently obferved in the hyfte- rical fpafm of adults, and continuing for fe- veral hours together, fo that the infant was often thought to be dying. The whole face, except the nofe, became exceedingly fwelled, fo that the infant could fcarcely open its eyes, though without any difco- louration of the fkin ; being probably ow- ing to wind diffufed through the cellular membrane; the tumor fubfiding immedi- ately upon getting rid of the wind from the ftomach and bowels. Thefe fymptoms, however, yielded to carminative juleps, and purging medicines ; and the infant after the meconium was all come away, was freed from every com- plaint, without any farther femblance of fits, though frequently apprehended. D Watch- ( 3' ) Watching, or Want of Sleep. THIS is frequently a fymptom of the fore- going complaints, and is to be remov- ed by opening the belly, and afterwards adminiftering fome pleafant and carminative pearl-julep ; * which will then frequently act like an opiate f by reftoring reft. Some- times, indeed, this has fucceeded fo well, when given in large dofes, that I have been fufpected of having really given fome fleep- ing medicine ; which would in thefe cafes prove exceedingly hurtful, as the watchful- « nefs is generally a mere fymptom, and not a difeafe ; though when very obftinate, it is * This remedy has been fo called from having been formerly coinpofed of prepared pearls, and the name is here retained becaufe familiar to fome readers ; but the pearls having no virtue peculiar to them, are very fcldom made ufe of. The julep is now prepared from the (hell-powders, or teftacea. —As this term (or tefraceons powders) occurs very frequently in this work, it may not be amifs to ob- ferve, that t<.ftacea confi'l of prepared oyiter-lhells, crabs claws, crabs eyes, pearls, and red-coral ; which differ but little from each other. They are likewife denominated abforbents, in which latter clafs, arc alfo ranked prepared chalk, and magne- fia ; the former is more powerful and binding than any of the teftacea, and the latter is, on the other hand, moderately opening.—Either of them may may be given to infants, from three to ten grains at a dofe, three or four times a day. f Sec Harris De Morbis acutis Infant"?;:. Want of Sleep. 39 is fometimes the harbinger of epilepfy, and then requires purgative medicines. I can- not, therefore, avoid taking notice in this place, of the deftructive cuftom amongft nurfes, of giving opiates, in one form or other ; which, however ufeful on proper occafions, are fure to act as a poifon, and fometimes not a very flow one, when injudi- cioufly adminiftered, and never can be more fo, than in a coftive ftate of the bowels. Watchings may arife from worms, purg- ing, gripings from acrid breaft-milk, or other food, and from indigeftion, as well as from every thing capable of producing pain ; each of which will be ccnfidered in their proper place. The feat of this com- plaint is, indeed, ufually in the firft pafla- ges, and in very young infants is frequently owing to coftivenefs. I fhall only obferve farther, if watchfulnefs be confined only to the night, it is probable, the child fbeps too long in the day time, which may be re- medied by keeping it moving, and playing with it throughout the day ; of which far- ther notice will be taken, under the head of Management of Children. The preceding complaints would natural- ly lead me to confider the Thr<>fo, and other diforders connected with the ftate of the firft-paffages ; but it is neceffary firft to mention one or two of a very different kind, which cither exift at the birth, or D 2 appearing 40 Imperfecl Clofure of the appearing very foon afterwards, would o- therwife be much out of place. Imperfect Closure of the Foramen ovale, and Canalis Arteriosus ; with other preternatural Confor- mations of the Heart. THESE morbid deviations appearing in different parts, * have in all the fame tendency, viz. in a greater or lefs degree, to obftruct the paflage of the blood through the lungs, which in fome inftances has con- tinued nearly the fame as in the unborn-fe- tus. The peculiarity, is fometimes in the pulmonary artery, which is conftricted, or clofed, as it rifes from the right ventricle; at others, in the feptum cordis, which has an unnatural opening, affording a free com- munication between the two ventricles ; and fometimes in the imperfect clofure of the foramen ovale, or the canalis arteriofus. Thefe fources of difeafe are mentioned merely with the view of pointing out the fymptoms by which they may be known, and not of attempting a remedy ; which is out of our power. The recital, however, may ferve to prevent fruitlefs attempts, and perhaps * Sec Morgagni, Epif. 17. Art. 12. Lond. Med. Journal pag. 4. and Med. Obferv. & In%. vcl. vi. Foramen O-za'e, &c. 41 perhaps the aggravation of the fymptoms, andconfequent diftrefs of the patient, where upon due knowledge of the difeafe, art has, evidently, nothing to offer. The imper- fections are owing merely to an original malformation of parts, or in the two latter inftances, to a deficiency in the powers of the fyftem foon after birth ; the only time in which that diverfion to the circulation can take place, which nature has intended upon the change made in confequence of refpiration. The precife time when this change fhould take place, is not attempted to be fettled, the paffages being open in children of very different ages ; nor do both always clofe at the fame time. It is conjectured, however, that this procefs ought to begin from the birth, as it is found to do in the remains of the. yeffels of the navel-lfring; * fo that, although the fatal apertures in the heart fhould not be actually impervious at the end of fome months, it is imagined a con- fir! ction ufua'ly takes place, and that, at leal!., fome check is given to the blood's paiTing from one fide of the heart to the other, in the free manner it does in the fe- D 3 tus, * It is probable, however, that they are not ve- ry firmly doled for fome time, as I h.ve cafly ior- ced the veffcls open, by an injection, in children who died at the end of the month. 42 Imp erf eel Clofure ofthe tus. This, it is natural enough to conceive, and I apprehend, is owing to a greater quan- tity of blood ruffling into the lungs, in con- fequence of refpiration, (which leffens the difficulty of entering that organ); by which means, a greater quantity flows into the left auricle from the pulmonary veins, which filling the part, prohibits an entry from the right. Upon the like principle, the aorta being more diftended by a large quantity of blood from the left ventricle, prevents the pulmonary artery from emptying itfelf into it by the canalis arteriofus. Sometimes one of thefe apertures is found open, and the other clofed up, efpecially the canalis arteriofus, which is of the greater confequence ; the foramen ovale having in feveral inftances been found pervious in a- dults ; and it is imagined is always fo, in thofe divers, who can remain the better part of an hour under water. ^ Whether the preternatural aperture be in the veflels, auricles, or ventricles, or wherefoever any morbid ftricture may be, whenever it may prove of any confequence, the conftant fymptoms attending it are a dis- colouration of the face and neck, with a floe-blue, or leaden colour of the lips, fuch as is met with in fome fits of afthma. Thefe take place foon after birth, and the difco- louration is increafed, and attended with difficulty Foramen ovale, &c. • 43 difficulty of breathing, as often as the child is any wife agitated ; but are not relieved by procuring ftools, by the warm-bath, or any other mean made ufe of as a remedy for fits; nor can be, but by the child being kept as tranquil as poffible. If the aperture be in the canalis arteri- ofus, children ufually fink very foon under the complaint, of which I have feen one in- ftance only a few months fince ; but if the aperture be in the inferior parts of the heart, infants may furvive for months, or even for years. A recent inftance of which, with an accurate account of the difeafe, is re- corded in the third vol. of the Medical Tranfaclions of the College. In fuch inftan- ces, the fyftem having been accuftomed to the effects of this derangement, is better able to withftand them; the patient, however, can endure but little motion, the heart be- coming thereby furcharged with blood, and refpiration rendered more difficult; hence alfo the blood is detained in the extremities, and the face, neck, and hands become par- ticularly difcoloured. Some time, indeed, before the patient finks under the difeafe, the fymptoms are aggravated, and almoft the leaft motion endangers fuffbcation. Erysi- [ 44 ] Erysipelas Infantilis. "FN the former edition it was obferved, that this complaint did not appear to have been diftinctly noticed by any preceding writer.* This being now, confeffedly, the cafe (at leaft in refpect to the form in which it now appears) it feems neceffary to give a name to the difeafe, which, it is apprehended, may with propriety be termed Erifipelas In- fantilis. It is a very dangerous fpecies of the fpu- rious, or erifipelatous inflammation, which I have not met witii, but in lying-in hofpi- tals. The ordinary time of its attack being a few days after birth, it was remarked in » the * Hoffman, indeed, though he makes no mention of any fuch complaint in his Morbi Infantum, has the following intimation in his chapter de Febre Eryfipelacea, and it fhould therefore feem, was ac- quainted with that fpecies of the difeafe which ap- pears in the more fimple form of eryfipelas ; but which he had noticed only in the region of the bel- ly,—<< Umbiliulem rcgionum in infantibus frequen- tius infeftar, ac inde per abdomen fpargitur, cum gravibus pathematibus, funefto ut plurimum even- tu." De Febre Eryfipelacea, fee. i. cap. xiii. The French have likewife fpoken lately of a fomewhat limilar aff'eaion, combined with different endemic complaints infecting crouded hofpitals : the difeafe, however, does not appear to have been any where noticed in its fimple form. Eryfipelas Infantilis. 45 the former edition, that it was thought ne- ver to appear later than the month; but I have fince feen it in a child of two months old : and the late Dr. Bromfield informed me, that he had noticed it in a child much older. It feizes the moft robuft, as well as delicate children, and in an inftaneous man- ner ; the progrefs is rapid ; the fkin turns of a purplifh hue ; and foon becomes ex- ceedingly hard. The milder fpecies of it appears often on the fingers and hands, or the feet and an- kles, and fometimes upon, or near the joints, forming matter in a very fliort time. The more violent kind is almoft always feated about the pubis, and extends upwards on the belly, and down the thighs and legs ; though I have two or three times feen it begin in the neck. The fwelling is but mo- derate, but after becoming hard, the parts turn purple, livid, and very often mortify ; efpecially in boys, when it falls on the fcro- tum ; the penis fwells, and the prepuce puts on that kind of emphyfematous, or windy appearance, which it has in children when a ftone is flicking in the paffage ; or in the dropfy of the fcrotum. Upon examining feveral bodies after death, the contents of the belly have frequently been found glued together, and their fur- face covered with inflammatory exudation, exactly fimiiar to that found in women who have 46 Eryfipelas Infantilis. have died of puerperal fever. In males, the tunica vaginales have been fometimes filled with matter, which has evidently made its way from the cavity of the abdomen, and accounts for the appearances of the organs of generation juft now defcribed : in fe- males, the labia pudendi are affected in like manner, the pus having forced a paflage through the abdominal rings. Various means were made ufe of at the Britijh Lying-in Hofpital without fuccefs, . though the progrefs of the inflammation feemed to be checked for a while by fatur- nine fomentations and poultices, applied on the the very firft appearance of the inflam- mation ; but it foon fpread, and a mortifi- cation prefently came on ; or where matter had been formed, the tender infant funk un- der the difcharge. It is now fome years fince I prcpofed making trial of the bark, to which ' fometimes a little confectio aromatica has been added ; from which time feveral have recovered. My colleague Dr. Garthfliore, has for feveral years paft directed the appli- cation of linen comprefles wrung out of cam- phorated fpirit, in the place of the compound water of acitated litharge which has proved more fuccefsful in checking the inflammation in feveral inftances ; neverthelefs,the greater number of infants attacked with this disor- der, ftill fink under its violence, and many of them in a very few days. u i»v.C Eryjipelas Infantilis. 47 Since the former edition of this tract, the fame difeafe, as I apprehend, has appeared once in a new form, in the Britifh Lying-in Hofpital. In this inftance, the infant was not only born with hard, and fublivid in- flammatory patches, and ichorous veficati- ons, about t':e belly and thighs, but other fpots were already actually in a ftate of mor- tification. An efchar foon fpread to near three inches in length upon the fpine of the tibia, and other fmallsr ones appeared about the legs, and on feveral of the toes and fin- gers, the parents of the child appeared to enjoy good health, and the mother had plenty of good milk, which her infant was fortunately able to take in great quantity. The child was hereby duly nourifhed ; and taking likewife every day, from the time the mortification began to fpread, from four to fix ounces of a flrong decoction of the bark, it was fupported under an exceflive difcharge of matter, through this tedious difeafe. The part, affected were at the fame time frequently fomented, and were fome- times wrapped tip in warm cataplafms, and at others, dreffed with iheriaca, as the floughs became loofe ; and were covered with com- prefles wrung out of camphorated fpirit. The infant, however, loft two joints of one of its fingers, and the firft of another ; all the other fingers, and the toes, contrary to expectation, throwing off the mortified parts, were 48 Aphtha, or Thrufh. were recovered entirely, and the child was fent out of the hofpital perfectly well; and I had the fatisfaction of feeing it in good health, feveral months afterwards. Apth^e, or Thrush. TIT AV1NG confidered the above early com- ■*• ■*- plaints, I return to thofe which owe their immediate origin to fome affection of the firft paflages, as they are called. It is amongft the vulgar errors, that the thrufh is a very harmlefs complaint, or is even defirable to a child in the month ; for it is faid, if it does not then make its ap- pearance, it certainly will at a more advanc- ed age, and will then prove fatal, or will, at leaft, attend the patient in his laft illnefs. The fact is, it is a difeafe of debility, and therefore attacks very young, and very old fubjects, efpecially if otherwife weakened. From the above miftake, however, the dif- order is often neglected in the beginning, whereby the acidity in the firft paflages is fuffered to increafe, which always aggra- vates the complaint. It is, indeed, a much milder diforder in this ifland than on moft parts of the Continent (through a priori We might perhaps, fupofe it would be other- wife) particularly in France, where it reigns as a malignant epidemic, efpecially in the 2 Hotel Aphtha, or Thrufh. 49 Hotel Dieu, and Foundling Hofpitals, known by the names of Muguet and Millet, f The thrufh, however, is as much a difeafe, as any other that appears in the month, and is connected with moft of the foregoing com- plaints ; a proper attention to which may very frequently prevent it. This diforder is fo well known, as fcarce- ly to require any defcription, and generally appears firft in the angles of the lips, and then on the tongue and cheeks, in the form E of f It bas been already remarked, that feveral hofpi- tal difeafes in France are more complex than with us, poilibly from their infirmaries receiving a much greater number of patients than ours, and their apartments and beds being confcquently lefs clean, as well as the air more foul, and difpofed to multi- ply the contagion. This is remarkably the cafe in regard to the dif- eafes of infants, whofe temperament is a fingular union of debility and fpafm, which the French have aptly termed Laxitevtbrattic. The Muguet is a ftriking inftance of the above mentioncd'tendency, it being altogether an hofpital difeafe ; which though diftinguifhed by this name, appears to be a malignant thrufh, and is frequently ly attended with a fpecies of the infantile eryfipelas. * When fo accompanied, it is faid to be conftantly fatal, unlefs the hard and tumid parts terminate in benign abfeeftes, and fuppurate kindly; which is rarely the cafe, they being more commonly found to mortify. * See Memoirs de la Societe Royalc de Medicine annoi77g. 50 Aphtha, or Thrufh. of little white fpecks. Thefe increafing in number and fize, run together more or lefs, according to the degree of malignity, and compofe a thin, white cruft, which at length lines the whole infide of the mouth, from the lips even to the gullet, and is faid to ex- tend into the ftomach, and through the length of the bowels ; producing alfo a red- nefs about the anus. When the cruft falls off", it is frequently fucceeded by others, which are ufually of a darker colour than the former. But this is true only in the worfl kind of thrufh ; for there is a milder fort, that is fpread thinly over the lips and tongue, which returns a great many times, and always lafts for feveral weeks. I have feen this fo very often the cafe, that when I obferve a child to have the complaint very .;„; lightly, and that it does not increafe after two or three days, I venture to pro- nounce it will continue a long time, but will be of no confequence. Care, however, ought to be taken that the child be not ex- pofed to cold. The thrufh is faid to be generally attend- ed with fever, but this is not ufually the cafe where the thrufh. is an original difeafe but when confequent to fevere bowel com plaints, eryfipelas, and other infantile difor- ders, it is, indeed, often accompanied with fever, and when fo, proves either favoura- bly critical, or the infant ufually fmks very foon. Aphtha, or Thrufh. 51 foon. In ordinary cafes, however, I am confident in nine out of ten, there is not the leaft fever, though the mouth is of- ten fo much heated, as to excoriate the niples of the nurfe, and becomes fo tender, that the child is often obferved to fuck with reluctance and caution.—It is an old obfer- vation amongft nurfes, and there i.s fome foundation for it, that very long fleeping, in the courfe of the firft week or two, is often a forerunner of this complaint. It has long been a received opinion, that the thrufh muft appear at the anus, and nurfes will feldom allow it to be cured if it does not; but the truth is, that its appear- ance there is only a mark of the degree of the difeafe, and not in the leaft of its cure, and is not, therefore, generally to be wifh- ed for. The rednefs about this part is oc- cafioned by the fharpnefs of the fecretions in the bowels, and confequently of the ftools, which lightly inflame and fometimes excoriate the parts about the anus, and in a bad thrufh will do fo long before the com- plaint is going off; but in the lighter kind, no fuch effects are produced, or are, at leaft, very flight. And, indeed, this rednefs has been fo often mentioned to me as an indica- tion that infants muft certainly have already had a flight thrufh, or be likely to fuffer by it very foon, where children have efcaped it altogether; that I have ventured to imagine E 2 fuch 5* Aphtha, or Thrufh. fuch infants may be leaft of all liable to it, if otherwife in good health; at leaft, my experience feems hitherto to fupport that idea. And I have even conceived, that the acidity of the firft paffaees being in fome children more confined, may prove a remote caufe of fuch infants being troubled with the thrufh; whi!ft others by an open belly, and firmer vifcera, may efcape it, at the expence only of this forenefs of the exter- nal parts, which often continues for feveral days. The remote caufe of this difeafe, feems to be indigeftion, whether oecafioned by bad milk, or other unwholefome food, or by the weaknefs of the ftomach.—Perhaps thick victuals, particularly if taken hot, and made very fweet; alfo covering the face of the child when it fleeps, or its breathing the confined air of the mother's bed, may be amogft thefe caufes, and ought therefore to be avoided.—The proximate caufe, * is the * If fuch a term, after all that Gaubius and later profeiTors have advanced, may be ufed in any fenfe diftinguifhable from the difeafe itfelf, it is prefum- ed, that the circumftances enumerated may be dif- tinguifhed from thofe termed remote caufes. Should this not be allowed of, the term proximate caufe, feems to be perfectly ufelefs, and one to which we can never affix any precife ideas ; the caufe and the effetf being confounded.—But I do not mean to en- ter far into fuch a controverfy, and have touched upon Aphtha, or Thrufh. 53 the thicknefs, or acrimony of the juices fe- creted from the mouth, fauces, ftomach, &c. producing heat and forentfs in thefe parts.—A teafpoonful of cold water given every morning has been a good prophylactic, or preventive. Much has been faid in favor of emetics, efpecially wine of antimony, as being almoft a fpecific for this difeafe, but I cannot fay it has proved fo with me ; nor can I fee any fufficient caufe for departing from the more ancient practice, in the treatment of this very common complaint. There can be no objection, after having properly opened the bowels, to adminifter- ing an emetic, and where the thrufh is of a dark colour, and the whole infide of the cheeks are lined with it, I believe it will be ufeful, by emptying the ftomach of the crude juices oozing into it from the glands of this part. But, I think it would be almoft as endlefs, as it would generally be prejudicial, to perfevere in the ufe of emetics, for days, and even weeks together, and is both a fe- vere, and an unnatural method of^treating E 3 a upon it rather by way of apology for the ufe I have made of the term, in this and other parts, and to mark an obfcurity which I leave thofe to fettle whofe province it may be to take the lead in fuch matters. It were well, however, if fome able pathologift could affix fome idea that might be univerfally adopt- ed, fo that when we meet with the term in different authors, no reader might be at a lofs for the mean- ing. 54 Aphtha, or Thrufh. a tender infant, in which the bowels are al- ways the moft natural outlet for its com- plaints; on which, therefore, nature uniform- ly throws the offending matter on almoft every occafion, as appears plainly in teeth- ing, in which the firft paflages cannot be primarily affected. I believe, therefore, where there is no fever, nor any uncommon fymptom, tefta- ceous powders are the beft and fafeft reme- dy ; which may be joined with a little mag- nefia, if the body be coftive ; or if in the other extreme, and the child is very weak- ly, two or three grains of the compound powder of contrayerva in its ftead. Some fuch preparation fhould be adminiftered for three or four days fucceffively, and after- wards fomething more purgative, to carry down the fcales as they fall off from the parts. For this purpofe, rhubarb is generally the beft ; but when the thrufh is very violent, is of a dark colour, has come on very rapidly, and the child is lufty and ftrong, a grain or two of the powder of fcammony with calo- mel, * may be joined with it, agreeably to the * A very good method of adminiftering this pow- der, and other metalline preparations, is that men- tioned by Dr.Armftrong, by directing it in the form of a pill which may be broken into fmall pieces, and given mixed up with the child's food ; by which means, it will not precipitate, and be left at the bottom of the fpoon, as is fometimes the cafe when fuch remedies are adminiftered in powder. Aphtha, or Thrufh. 5$ the idea of Heister ; but this muft be given with caution. After the purgative, the teftaceous powders fhould be repeated for two or three days as before, till the dif- order begins to give way. Afterwards a tea-fpoonful of camomile-tea, or a few drops of the compound tincture of gentian, well diluted, may be given two or three times a day with advantage. The choice of the teftaceous powders, on which fome writers have faid fo much, is, I believe, of very little importance; the pureft and fofteft are preferable. The de- fign of thefe medicines, being to abforb and correct the predominant acidity,* their effect will be difcovered from the kind of ftools that fucceed, and the dofe may therefore be increafed or diminifhed, or they may be al- together difcontinued, as circumftances di- rect. In the mean time, if the child is fuck- led, the nurfe's diet fhould be attended to, and in general, her ufual quantity of porter or ale, (which is almoft always more than fufEcient) fhould be diminifhed. In * The French phyficians are of opinion, that the thrufh is owing to what they call a putrid alcaline humour, or fomething analogous thereto, rather than to an acid. But this cannot be the cafe in the ordinary thrufh, as is manifeft both from the ap- pearance, and the four fmell of the ftools, as well as from the more certain remedies for the complaint, which are alcalis and abforbents. 56" Aphtha, or Thrufh. In regard to applications to the part, it is neceffary to obferve, that as they have lit- tle to do in curing the complaint, it will be improper to have recourfe to them very ear- ly. I know, indeed, it is very common to begin with them, but they ferve only to in- creafe the forenefs of the parts, (efpecially in the manner they are generally ufed) and to give a deceitful appearance of amendment. If the infide of the cheeks and tongue are thickly covered with Houghs, it may fome- times be convenient to clean the mouth once a day ; but it will in general be ufelefs, till the complaint is paft the height, the floughs difpofed to fall off, and the parts under- neath inclined to heal. Proper applications will then have their ufe, both by k :eping the mouth clean, and conftricting and heal- ing the raw, and open mouths of the excre- tory veffels. For this purpofe, an hundred different lotions and gargles have been invented, which from the earlieft times have all been of an aftringent nature.—>-Honey of rofes and fpirit of vitriol, or of fea-falt, as re- commended by Etmuller and Dr. Shaw, form a very good one ; but nothing is pre- ferable to borax, which fome advife to be mixed up with fugar, in the proportion of one part of the former to feven cf the latter: a pinch of this put upon the child's tongue will be licked to all parts of the mouth. But I Aphtha, or Thrufh. 57 I prefer a mixture of borax and common honey, (about two fcruples or a dram of the former to an ounce of the latter) which hangs about the fauces better than in the form of powder. Either of thefe may be made ufe of as often in the day as fhall be neceffary to keep the parts clean, which they will effectually do, without putting the infant to pain, by being forcibly rubbed on. I muft own, I have frequently been diftreff- ed, at feeing nurfes rub the mouth of a lit- tle infant, with a rag-mop, as they term it, till they have made it bleed ; and this ope- ration they will often repeat half a dozen times in a day. It only remains to take notice of the black thrufh, as it is called, which is confeffedly a very uncommon complaint in the infant ftate. Dr. Armftrong fays he has never met with it. I have feen only two inftances of it, which were in ftrong and healthy chil- dren ; but the parts were not perfectly black, and if that be intended by the name, thefe cafes might not be precifely that complaint: they, however, both proved fatal. After the ftomach and bowels have been cleanfed, I believe, a decoction of the bark, with a little aromatic confection, is the moft likely medicine to be of fervice, and is fometimes neceffary in the worft kind of common thrufh, when the fucceeding Houghs are ve- ry 5 8 Red-Gum. ry opake, thick, and of a dark colour; which is, however, always a dangerous fymptom. The Red-Gum, or Benign-Eruption. TPHE red-gum is an efTlorefcence on the fkin, appearing ufually in fma'l fpots, often confined to the face and neck ; but at others, it extends to the hands and legs, and even the whole body, appear- ing in very large patches, and fome- times raifed above the furface. It will like- wife appear in the form of fmall puftules, filled with a limpid, or fometimes a purulent or yellow liquor; at leaft, I have never known what name to give this kind of erup- tion, but that of a rank red-gum, as it happens only in the month, or foon after- wards, and never gives any trouble. There is another fpecies as fmall as pins heads, or even their points ; firmer than the former ; often of a pearl colour, and opake, which has generally been accounted a kind of red- gum ; but it has of late been fuggefted, might for diftinction fake, be termed white- gum.* Every fpecies of this erunjtjon is produ- * It is to this comprint, that Vogelius feems to give the name of achorest ; but the old writers differ in this refpect—of that complaint, however, more will be faid in another place, when fpeaking of diforders defcribed under obfolete terms. Red-Gum. 55 produced by the fame caufe as the thrufh, but can fcarcely be termed a complaint, be- ing a kindly effort of nature to throw off fome acrimony ; confequently an evidence of the ftrength of the conftitution, as the thrufh is, ufually, of its weakn?fs. In the former, nature throws off the offending matter on the furface more completely than in the lat- ter, and therefore, when the eruption is flight, requires no afliitance. On this account it is, I apprehend, that writers have not ufually taken notice of it, though it fhould feem requifite, if only for the fatisfaction of parents, who are fome- times diftrefled on account of it, efpecially if it be of the more extenfive and rank-fpe- cies. It is neceffary only to give a little tef- taceous powder, or magnefia, according to the ftate of the bowels, and to keep the child moderately warm, otherwife the rafh ftriking in, the acrimony will fall on the firft-paffages, and be fucceeded by ficknefs, or purging, (till the eruption appears again on the fkin) or not unfrequently by the thrufh, or a flight return of it, if the child has lately recovered from it. Erup.. C «b ] Eruptions on the Skin. IT is, by no means, my intention to enter largely into this extenfive fubject, but imperfectly underftood, perhaps, even to this day. In another part of the work I fliall treat of the fcalPd-head, and two or three other troublefome affections of the fkin, but fhall at prefent confine myfelf to fuch eruptions as are peculiar to the ftate of infancy. Infants are liable to various anomalous kinds of rafh, both in the mqgth, and till the period of teething is over. The early ones may be regarded as a fort of red-gum, and children who are moft fubject to them, generally have their bowels in a better ftate ; the rafh carrying off, as has been faid, the acidity * with which they fo much abound. It may be remarked, however, that when infants at the breaft are inclined to frequent returns of fome eruption on the fkin, if the child be always indifpofed at fuch feafons, the rafh will often be found owing to fome ill quality in the breaft of milk, which ought therefore to be examined, and particularly in regard to its tafte. On fuch occafions I i have * See Harris, Pages 22, 23. Eruptions on the Skin. 6l have found, that milk which has been above a twelve-month old, has contracted a very unpleafant flavour, and that upon changing the wet nurfe, a very ill looking rafh has foon afterwards entirely difappeared, toge- ther with the other complaints. One fpecies of thefe early rafhes often takes place about the time of teething, and not unfrequently at the decline of fevers or fevere bowel complaints; infomuch that, upon a fudden appearance of it during a fe- rious illnefs, I have often ventured to prog- nofticate the recovery. This rafh very much refembles the itch, both in regard to the little watery heads and foul blotches ; and is confined to no particular part of the body, though it appears more frequently about the face and neck. Indeed, I have feen the whole body fo covered with it (and mixed with an eruption about the face, of a different appearance, and evidently red-gum) tljat in a confultation, it has been by fome taken to be the true itch. This eruption is certainly falutary, and even critical, requires nothing but to avoid taking cold, and is mentioned only becaufe it is not an uncom- mon appearance, and parents who are un- acquainted with it, are apt to be alarmed at it. But there is a very common rafh that calls for more attention, and to which medical writers have given the name of Crufla laclea F (Laclu- ■6 2 Eruptions on the Skin. (Laclumen, or milk blotches), which has a very unpleafant appearance, but is not- withftanding equally innocent with the for- mer, and even prevents other complaints. I think I never faw an infant much loaded with it, but it has always been healthy, and cut its teeth remarkably well. Indeed, it falls to the lot of the fineft children, and fuch as are well nourifhed; whence fome have imagined it owing only to the richnefs of the milk.* And it is remarkable in this eruption, that however"^ick and long-con- tinued the fcabs may be, the crufta lactea never excoriates, nor leaves any fear on the parts. It appears firft on the forehead, and fome- times on the fcalp, often extends half-way over the face, in the form of large loofe fcabs, and appears not very unlike the fmall pox after they are turned. Very little, I believe, is neceffary to be done ; but in bad cafes a perpetual blifter may fometimes be offervice. It ufually difappears of itfelf when the child has cut three or four teeth, though it may fometimes continue for feve- ral months, and in a very few inftances even for years : in fuch cafes, the Harrowgate, or any other fulphureous water will have a good effect; but the medicines commonly prefcri- bed do nothing. I have known teftaceous powders * SeeAftruc Eruptions on trie Skin. 63 powders and various alteratives adminiftered to no purpofe, as people of rank are very anxious to have it removed if it be poflible. I was lately confulted for a child who had taken a grain of calomel, at fhort intervals,, for feveral months without any benefit, and fortunately without any injury ; which is rarely the cafe when powerful medicines are adminiftered unneceffarily. This rafh-will now and then make^Hi^ its appearance very early, and has then been miftaken by thofe who are not much accuftomed to very young children, for the effects^the venereal difeafe. I not long ago faw fuch a cafe, and advifed only to keep the body open with a little magnefia ; the complaint got no worfe, and upon cutting fome teeth, difap- peared as ufual. I have known it, howe- ver, difappear fuddenly, previoufly to any teeth being cut, and after fome weeks be- come more violent than ever ; the infant re- maining all the while in perfect health. It were almoft endlefs to enumerate the various kinds of rafh to which infants are liable, but I mean chiefly to confine my re- marks to the more important, or rare ones, and fuch as may not have been,defcribed by preceding writers. Among fuch is the fol- lowing, whofe unufual appearance are apt to alarm parents and others, not aecuftomed to fee them. F z 'Exe 64 Eruptions on the Skin. The firft 1 fhall notice appears chiefly in teething children, very much refembles the meafles, and has been fometimes miftaken for it. It is preceded by ficknefs at the fto- mach, but it if attended with very little fe- ver, though the rafh continues very florid for three days, like the meafles, but does not dry off in the manner of that difeafe. It requires nothing more than the fhell-pow- ders, or fometimes the addition of a little nitre and compound powder of contrayerva, with a dofe or two of rhubarb, or other gentle laxative, on the going off of the rafh. An eruption ftill lefs frequently met with appears fometimes after children have cut all their firft teeth. I know not what name ought to be given to this kind of eruption, which breaks out in the form of round lumps as large as midling-fized peas, very hard, with a very red bale, and white at the top, as if they contained a little lymph. They come out fuddenly without previous ficknefs at the ftomach, are not fore, dif- pofed to itch, nor ever give any trouble, and are feldom feen but on parts that are ufually uncovered, and are fometimes there in great numbers, refembling the diftinct fmall-pox; but are harder, more inflamed, and lefs purulent. Alarming, as well as unufual, as is this appearance, I believe the eruption is always perfectly Eruptions on the Skin. 6g perfectly harmlefs, if not repelled by cold; or improper treatment; and will dry away in three or four days : nothing more beings neceffary than the little remedies, directed for the former, and to keep the child with- in doors, if the weather be cold. An eruption of an appearance equally un* common and analogous to the above, I have met with only in children of at leaft three or four years of age, and fuch as have alfo been affected with flight fymptoms of fcrofu- la; though I have not feen it frequently enough to afcertain its- being, in any de- gree, owing to that fpecific virus. It breaks out fuddenly, covering at once the greater part of the body, but occaftoning neither pain nor itching, nor are children fick at the ftomach nor otherwife ill with it, though- it lafts for two or three weeks. This eruption, therefore, like fome" others, is taken notice of chiefly for its fin- gular appearance, which, though fome- what like the nettle-rafh, is of a different figure, but may be pretty exactly conceived of by the little red lumps fometimes left by fmall-pox, after they are turned, and alfo rubbed, or picked off; efpecially after the chryftalline or warty fpecies, and where the piaftules have been pretty numerous. If the firft-paffages are at all difturbed, my attention is principally directed to thenv, otherwife to the ftate of the fkin; and in F 3 this 66 Eruptions on the Skin. this cafe, I have ufually directed fmall dofes of Dr James's rowder, to be taken for a few nights at going to bed, and the poly- chreft fait and rhubarb, occafionally, in the courfe of the day, with or without the ad- dition of a little of the acitated water of am- monia. In the courfe of a few days the eruption puts on a darker colour, is lefs prominent, and begins to fcale off in a branny fcurf, fomewhat like the meafles : but fhould no fuch change take place, the vinum antimonii fhould be taken two or three times a day ; to which, if no amendment fhould foon be perceived, a few drops of the tinctura can- tharidis may be added ; a remedy often ve- ry efficacious in diforders of the fkin ; but fhould be adminiftered with caution. Another rafh, or rather eruption, takes place both in bowel complaints and in teething, and always appears to be benefi- cial. It ccnfifts of vefications or blifters of different fizes, refembling little fcalds or burns, and continues for feveral days. They come out in different parts, but chiefly on the belly, ribs, and thighs ; and contain a {harp lymph, which it may be prudent to let out by a puncture with a needle, efpeci- ally from the larger ones. No medicine is neceffary but fuch as the particular ftate of the bowels may call, for,which ufualy abound Eruptions on the 6kin. 6 J with acidity whenever there is much erup- tion on the fkin. An eruption, vulgarly termed fcorbutic, infefting the face and neck, and difcharging a fharp ichor that excoriates wherever it runs, and difficult of cure by chemical alte- ratives, will often yield in a very fhort time to the expreffed juice of the fium aquaticum. From one, to four or five table fpoonfuls may be given, mixed with one or more lpoonful of new milk, three times a day, according to the child's a^e, and the ftate of its ftomach ; taking care* at the fame time, to keep the bowels open by fenna-tea or other common laxative. I fhall clofe this account with a defcription of an eruption that is Angular enough, re- fembling very much the herpes or broad- ring worm, or the adult-coloured fpots left on the face after an attack of St. Anthony's fire. I have feen it in various parts, but I think only on fuch as are more or lefs liable to be fretted: by fome part of the infant's drefs, efpecially on the nates and contigu- ous parts covered by the cloths , where the blotches, are always the broadeft and moft rank. Were it to appear no where elfe, it would feem to be occafioned by fome fharp« nefs of the urine and ftools, as the fkin has a very heated appearance, though the erup- tion, I belive, is not at all painful. It fre* quently breaks out before the period of teething, 68 Eruptions on the Skin. teething, but the bowels are generally fome- what difordered, and the ftools voided very green, or elfe become fo very foon afterwards. This I take to be one of thofe eruptions oc- cafioned by fome bad quality of the breaft- milk as I have never met with it but in young: infants whofe nurfe's milk has been old, and has alfo contracted a very difagreeable tafte. If that fhould not be the cafe, the rafh will probably require nothing but the light ab- forbent medicines before mentioned, and to guard againft conftipation. But if thefe means fhould not fucceed in a fhort time, the nurfe ought to be changed. In all the eruptive complaints of infants, taking cold ought to be carefully avoided, and great caution be ufed in regard to all external applications, as well as keeping the belly open. If the child is fick at the fto- mach, a little magnefia, teftaceous powders, or the compound powder of contrayerva joined with them, maybe given now and then; or fhould the rafh be haftily ft ruck in, and the child be ill, it fhould be immediately pnt into a warm-bath and afterwards take five or fix grains of the aromatic confection, with, or without a few drops of the wine of antimony, in fimple mint water. Should any fcabs become very dry and hard, which the crujla laclea will fometimes fee, efpecially when they extend to the crown; Sore Ears. 6g crown of the head, and feem to give pain, they may be touched with a little cream, or with oil of almonds mixed with a few drops of the water of kali; but not a large fur- face at a time. Or fhould they be very moift, and caufe pain by fticking to the cap, they may be dufted with a little common powder, or with flowers of fulrhur, and covered with a finged rag, but I iould be very cau- tious of doing much mo:e ; as the fuppref- fion of any confiderable eruption on the fkin may occafion the worft effects efpcially du- ring the time of teething. Sore Ears. QLIGHT blifters and ulcerations behind the ears of infants are fo very, common, that almoft every parent Is well acquainted with them; and in general require only to be waflied with cold water, or covered with a finged rag, to keep the cap from fticking to them, and thereby giving the child pain. They are, moreover, often very ufeful, ef- pecially during bowel complaints, or the eruption of the teeth. But there is in fome children of a grofs habit of body, and ef- pecially about the time of teething, a fpe- cies of ulcer that often requires attention, on account of its extending low down in the neck, occafioning great pain, and fpreading 7*o Sore Ears. into large and deep fores, infemuch that a mortification has fometimes come on, and even the proccffus majioidcus has become ca- rious. Here fomentations will be necefla- ry, efpecially thofe of bark, and its pow- der fhould be adminiftered internally. Such cafes, however, do not often occur ; but whenever the fores are large the cure fhould be begun by ablifter on the back, in order to draw off the heated ferum that flows to the parts. I have ufually given an opening powder of teftecea and rhubarb, with a little nutmeg, and fometimes nitre, to which is added either calomel, cinnabar of antimony, or hydrargyria cum fulphure ; the latter of which, I think I have found more fervice- able in>. fome eruptive complaints in young children, than feem to be generally imagin- ed. But above all, fome mercurial fhould be made ufe of to the fores, which, though they are often apparently inflamed, never offends them. A very clean and elegant preparation of this kind is the following, R. Calomelan. 5j. ad 5 if. Ung. Sambuci gj m. ftlinimentum,. A little of this liniment fpread on each fide of a piece of doubled linen cloth, and applied twice a day, will da more than all the fomentations, or healing ointments, that I have ever feen ufed ; and indeed has al- ways fucceeded with me,, though L have been toiwl Vomiting. y^ told the fores had fpread deeper from day to day under various other applications. From fuch treatment I have never found the leaft ill effects, but children have preferved their health as well as if the fores had kept open, which, when benign, are certainly defign- ed by nature as a prefervative from fome other complaints, efpecially thofe of the fto- mach and bowels, of which I now proceed to take notice. Vomiting. ^TOMITING is certainly not a common complaint of infants, I mean when con- fidered as a difeafe, unlefs it be attendant upon fome other, of which it is then rather a fymptom, or the confequence of fuch dif- eafe improperly treated. Neither are in- fants in health difpofed to vomit frequently, unlefs the ftomach is overloaded, the milk is then ufually ejected as foon as it is taken, and comes up unchanged. Nor is this to be confidered as a difeafe, or as calling for the difcipline recommended by fome writers. Wherefore fhould the refidue -of the ali- ment be forced off the ftomach by an eme- tic, when it has already parted with all the oppreffive abundance ? This kind of puking is not attended with any violence to the fto- mach : the milk, or other food feems to come 7'2 Vomiting. come up without anyfenfible action of the ftomach, or the child being fick. Nay, it is at once fo common to fome of the fineft children, that it is a faying with fome old nurfes, (though I am not very partial to many of their proverbs) that a puking child is a thriving child; and when fuch ejection comes only foon after fucking or feeding, and the aliment is caft up, fcarcely changed, matter of fact verifies the obfer- vation.* But if the food remains fome time on the ftomach, it will then be thrown up in a curdled ftate, which is an indication to attend to it, if it happens frequently. Not that the milk ought not to curdle on the ftomach, which it always muft do, in order to a due feparation of its component parts, and is the chief, if not the only di- geftion, it undergoes in the ftomach. The whey and the rich oil are there feparated from the curd and earthy particles, the for- mer being taken up by the lacteal, or milky-veffels in the bowels, f is converted into blood ; whilft the bulk of the latter is carried down and expelled with the other excrementious parts of the food, and gaf- 3 tric * See Prl»ieros : De Morbis Infant. f It is not intended in this place to fpeak with }>hyfiological accuracy, but merely to afford common readers fome ideaof the nature of the firft tiigeftion; in the fecond, indeed, it is probable, that fome por- tion Vomiting. j\ trie juices, for which nature has no ufe. This curdling of the milk, therefore, is the natural courfe of digeftion, though many writers have not been fufficiently attentive to it, and Harris has afferted it is owing to a predominant acid. But when the milk comes up in a curdled ftate, it proves that the fto- mach having digefted what it had received, hath not power to pufh it forward into the bowels, and therefore throws up a part of it. * If this be the cafe, the ftomach may perhaps require to be emptied of its whole contents, which may be eafily done by giv- ing a little warm water, or camomile tea. The caufe of the indigeftion was an acci- dental repletion; that removed, together with the confequent foulnefs, or bad juices of the ftomach, the effect alfo will generally ceafe, and unlefs the vomiting returns, from any farclxer injury the repletion may have occafioned, it requires nothing more. To G diftrefs tion of every conflituent part of our food may be farther yrepared to become nutritious ; the thinner ferving to renew the finer parts of our fyftem, and the grofier, fuch as the earthy particles, &c. more adapted to the renovation of the mufcles, tendons, bones, Sec. may be depofited in thefe parts. * 1 have known a child throw up a piece of curd fall as large at the thumb of a grown perfon, andas firm as a pece of dough ; and be perfectly well the next minute.—When infants, not over-fed, throw up the milk uncurdled, after it has been fometime in the ftomach, it is always a worfe fign. 74 Vomiting. diftrefs the child, on every fuch occafion, with a fickening emetic, or drench it with rhubarb and magnefia, is as needlefs as it would be to awake a patient out of a found fleep to give him an opiate. Only let the child fall a little after having emptied the ftomach of its load, and thenurfe be careful not to overfill it for the future, and it will rarely want any other affiftance. If the vomiting, on the other hand, has arifen from acrid diet, a little farther difci- pline may be requifite, becaufe fome half- digefted food has got into the bowels, per- haps for feveral days together. In this cafe, a gentle laxative, and change of food for one of a milder kind, is all that is generally neceffary ; or if there be a prevailing acidity in the ftomach, either the teftaceous pow- ders, or magnefia, (according to the ftate of the bowels) may be mixed with the food, or be otherwife adminiftered for two or three days, as the occafion may require. Or a drop or two of the water of kali, or a little cajiile, or almond foap, are excellent remedies, ■efpecially when the ftools are un- nfually green, or clayey; not only as they will tend to promote a fecretion of the gall, but correct acidity.* For which purpofe alfo, * It is well known, how fmall a quantity of foap put into a churn will prevent a due feparation of the component parts of the milk, fo as to allow very lit- tie, Vomiting. yt£ alfo, myrrhe, though an obfolete, feems to be an excellent remedy, when infants are a few months old. Should the vomiting be a fymptom attending fome other difeafe, its re- medy will turn on the proper treatment of its caufe. If fuch caufe be the hidden difap- pearance of fome eruption, on the fkin, the child may be put into a tepid bath; the limbs be well rubbed as foon as it is taken out of the water, and the infant be then put to bed : and if the vomiting continues, an emetic fhould be given, and afterwards a blifter ap- plied to the pit of the ftomach. Having mentionedemetics, I fliall take this occafion to obferve, that the choice of them will be always beft determined by the na-< ture of the complaints for which they are ad- miniftered. In thofe of the firft-paffages, ipecacuanha is generally the beft, but if a* fever fhould attend, or it be wifhed to pro- mote a gentle perfpiration, thofe of antimo- ny are preferable ; or laftly, in diforders of^ the breaft, the oxymel, conferve, or. tincture of fquills. But a more troublefome vomiting will fometimes arife in unhealthv children, from too great a fenfibility, or too great an irri- tability of the nerves of the ftomach. Such G 2^ medicines tie, or no butter to be made ; whereas, a little vine- gar effects the feparation almoft iuftamaneoufly, and faves a vaft deal of trouble. J 6 Gripes. medicines are then indicated as will brace, or ftrengthen that organ, and abate its fen- fibility. For the former, a cold infufion of the bark, or of camomile flowers, with orange peel, and fometimes a little rhubarb. For the latter, a faline mixture with a drop or two of laudanum. And the benefit of thefe may be increafed by aromatic and fpi- rituous fomentations to the pit of the fto- mach, or by the labdanum plahter, with a little theriaca added to it. Gripes. THE Gripes is a very common term amongft nurfes, and fome writers on children's difeafes have treated of it under a diftinct head ; but this ferves to perplex mat- ters, inftead of explaining them. If a child be not hungry, or hurt by fome parts of its drefs, there are always fymptoms attending, that will account for its crying, and other expreffions of pain, the caufe is, indeed, very commonly in its bowels, and may be increafed by coftivenefs, which has already been treated of, but more commonly mani- fefts itfelf by a purging, which comes next in order to be confidered. Purging. C 77' I Purging.- T TNDER the article of vomiting it was ob* ^ ferved,that frequent puking is oftentimes an attendant upon fome other complaint, and then demands a peculiar attention, and is to be treated agreeably to the nature of fuch complaints; and there is, perhaps, none which it more frequently accompanies than a Diarrhoea, or Purging. Vomiting and Purging very often arife from unwholefome milk or other food, from a moift cold air, or from the fudden difap- pearance of fome eruption on the fkin. The purging is not then haftily to be flopped, ■ nor even abforbent powders to be given, till the offenfive matter befirfl carried off; and if a vomiting attend, the cure fhould begin by adminiftering an emetic. But though the purging ought not to be checked with- out previous evacuations, nor to be flopped haftily, yet it is not to be treated with a daily exhibition of rhubarb, which though a common practice with many, ferves to keep up a purging after the caufe has been remov- ed,.by creating a continual irritation in the bowels. The diarrhoea, indeed, is a com- plaint often as difficult to treat as any in the infant ftate, and is therefore worthy of par- ticular attention. In a general way it may G3 be 7 8 Purging. be faid, that a fufficient dofe or two of rhu- barb fhould be adminiftered in the beginning," and afterwards abforbents. If the purging "1 fhould ftill continue, an emetic will be ne- / ceffary, as purges do not always lie long Jjj enough in the ftomach to carry off the offen- five matter it contains. After this, it is often neceffary, the child fhould be purged again, for it fhould be always remembered, that many complaints of infants, whether feated only in the firft-paffages, or attended with fever, will frequently feem to be giving way upon procuring ftools freely, but will ;, foon return if the fame means be not repeat- ed, till the whole irritating matter be carried down. Should fuch repetition fail of fuc- cefs, though the diet has been carefully at- tended to, the ufe of them at prefent fhould be laid afide, and recourfe fhould again be had to abforbents, and if there be no fever, to light cordials, and even to opiates, with- out the latter of which, many bowel com* plaints will not admit of a lafting cure, ow- ing to the great irritability of infants. Such medicines are not indeed very often requir- ed till children are fome months old : but when they are found neceffary, not only may "m fyrup of white poppies, but even laudanum \ be given with, the moft perfect fafety; * ..^ though * From the half of a drop, to two, or three drops, in the courfe of the day, will be a proper quantity fcr infants from a week old, to the age of fix months. rurging. Tg though from the time of Galen, (who cau- tions againft giving theriaca to children) till of later years, many phyficians have been fearful of directing them, (arguing from their abufe againft their ufe) and efpecially Harris, who in other refpects, has written fo well on their difeafes. I remember being called to fee an infant of only two days old, who, through a miftake, had taken fome hours before, four drops of laudanum. The parents were greatly alarmed at the child's lying in a ftupid, drowfy ftate, without be- ing able to take the breaft or open its eyes, I encouraged them, however, to believe the laudanum would do no kind of harm, if they would frequently get a little breaft-milk down withatea-fpoon. Accordingly, though the child lay fleeping above fix and thirty hours, it afterwards awoke perfectly well.—- This is mentioned, however, only by way of encouragement to fuch as may be fearful of adminiftering opiates even where they are neceffary. They are, nevertheless, very powerful medicines, and fhould be prefcrib- ed with due caution for patients of every age, and efpecially for infants. A like cau- tion may be neceffary in regard to cordials, which are, neverthelefs, in many cafes equals ly proper, notwithstanding a modern preju- dice againft them. There is a certain cold- nefs and langour in infants when they are ill, efpecially under fome bowel complaints; and 80 rurging. and whenever they may be in that ftate,. that clafs of medicines will have a very hap- py effect. " Purgfng in children, it is to be obferved, is not always a difeafe. The bowels are the great natural, and critical outlet in infants, as the pores of the fkin, and the kidneys are in adults. Not the mere difcharge, there- fore, but the caufe of it is, in the firft in- ftance, to be removed, and the ill effects are to be guarded againft by keeping the purg- ing within bounds. For this purpofe, the chalk julep, as it is an aftringent only by abforbing the acrid, or changing the acid, and irritating matter, is as fafe as it is ufefulr becomes an excellent anodyne, or com- pofing medicine, and after the bowels have been well cleafed, wiM ufually accomplifh the cure. ' Dr. Armftrong takes occafion to fpeak againft the ufe of abforbent powders, and prefers wine of antimony, becaufe modern; writers appear to depend fo much on the former, from their known property of cor- recting acidity, previous to the exhibition of- purges; and fays, that in cafes of extreme danger, a phyfician who is called in late,% would, according to this practice, often find no opportunity for purging at all. But fure- ly this is fcarcely an argument to prove the fuperiority of his method, fince no writer that I know of, ever defigned it as a rule without Purging. 81 without exception ; and Harris, who has faid as much as any man in commendation of the abforbent powders, does not deny the expediency of fometimes beginning with purgative medicines. But had it been otherwife, the argument goes no farther than to prove, that in cafes of great danger, the wine of antimony, being both an emetic and a purge, ought to precede the ufe of the teftaceous powders. Inftead of this, Dr Armjlrong Aides into a general conclufion from premifes evidently limited ; though he has advanced nothing againft an eftablifhed, and fuccefsful method of treatment. And I may add, that whilft he is fearful, that the abforbent powders, (which nobody pre- fcribes without fome purging medicines) fhould check the loofenefs, and thereby in- creafe the fever ; he ventures, after a repe- tition of the antimony, to adminifter what he calls a gentle paregoric, or opiate, to ap- peafe the pain, confuting of a dram of fyrup of white poppies, repeated every three or four hours, till that end be obtained. So that if the pain fhould continue for nine hours, a child will take half an ounce of the fyrup ; and this Dr. Armjlrong obferves is the only medicine he gives, except wine of antimony, which (notwithftanding the opi- ate) he fuppofes to be the efficient remedy. It is an improper exhibition of abforb- ents, I apprehend, rather than their dofe, that 82 Purging. that has made fome practitioners fo averfe to them ; for they certainly outfit, in many cafes, to be given in large quantities : but if adminiftered too early, and long continu- ed, the ftools may become like plaifter of Paris, and be wdth difficulty excreted. Such an inftance is mentioned by Boerhaave, who had, neverthelefs, a very favorable opinion of them, as will be noticed hereafter. There is, however, fome fallacy' in regard to the colour of the ftools, as this kind is fre- quently obferved in children who have ne- ver taken any of the teftacea, if the fecre- tion of the bile be obftructed ; as in jaun- diced adults. In his fecond edition, Dr. Armftrong mentions another method he has fallen upon for curing this diforder, which, however, appears to be recurring to the ancient method of treating bowel com- plaints, and feems, indeed, to overturn the idea he had entertained of the fuperiority of wine of antimony over every other medi- cine. This method, he tells us, is by cleanf- ing the bowels, by means of proper purga- tives, joined with anodynes, or opiates, in- termixed in fuch a manner as to correct the griping quality of the medicines, and leffen the ftimulus occafioned by the acrimony of the ftools.—A plan worthy of imitation, it is apprehended, and though not likely to be Purging. 83 be proper in all cafes, muft, as an occasi- onal practice, be fafe and beneficial. To return, it is of fome confequence to learn what part of the bowels is particular- ly affected, and the degree of pain children may endure; and fome indication may be had from undrefling the child, and careful- ly examining the belly, and gently prefling in different parts, as well as from the dif- ferent expreffions of pain the infant may manifeft, either by a forcible contraction of one or both legs, or of the arms, accord- ing as the irritating matter may be higher or lower, or on one, or both fides of the belly ; alfo from the coldnefs of the feet. Regard is alfo to be paid to the kind of ftools that come away, which in a diarr- hoea are feldom good, and are ufually diftin- guifhed into the four and curdled, flimy, green, clayey, watery, and bloody, fome of which are at times alfo fetid ; and in this cafe, fome powerful purgative, fuch as fen- na-tea, is oftentimes neceffary, if the child is not very young. True bloody ftools, however, are lefs common in infants than adults, and feldom occur but-4n the laft ftage of the difeafe ; but a few ftreaks of blood may fometimes be mixed with the fe- ces, which arifing only from the hemorrhoi- dal veins, is of no confequence. Should purgings return frequently, it will be very ufeful, (efpecially in the time of teething, 3 or $4 Rurg'tn&' or upon the ftrikin ,\ in of fome cutaneoui eruption), to procure a little difcharge be hind the ears, or to apply a burgundy-pitch plaifter to the back. For the former pur- pofe, fome fine'y pounded Spanijh flies may be rubbed on the part, till a flight excoria- tion, or rawnefs, is produced ; or perhaps a better, though not a common method, is to draw a piece of courfe doubkd worfted, or a bit of narrow tape, through a piece of common bliftering-plaifter, and lay it clofe behind the ears where they rife from the head, and repeating it occafionally, which will produce a difcharge exactly from the fpot where it is wont naturally to arife. When the ftools appear four or curdled, or the child is much difpofed to hiccough, the magnefia, and other abforbent powders are calculated to afford peculiar affiftance, and may be warmed by the addition of a little grated nutmeg. When the ftools are green, or white and clayey, a drop or two of water of kali may be occafionally put in- to the other medicines, or a little foap be diffolved in the clyfters, which are effenti- ally neceffary when much griping attends this complaint : the child's belly may like- wife be rubbed with a little warm brandy. The following preparation is highly extoll- ed by Boerhaave, * as an almoft univerfal medicine * Epift. ima—ad. J. B. Bassand : a phyllciaH at Vienna. Purging. 85 medicine in the difeafes of infants ; and is certainly a good remedy, efpecially in their bowel complaints: Take of Venice foap two drams ; prepar- ed pearls, one dram ; prepared crabs claws, one dram and an half; fyrup of marfhmal- lows, half an ounce; mint-water and fennel- water, of each three ounces ; mix them.—■ A defert fpoonful is directed to be taken once in eight hours. When purgings have continued a long time without any amendment, a peculiar tightnefs of the fkin will fometimes take place in the laft ftage of the difeafe, afford- ing always an unfavourable prognoftic ; and of which farther notice will be taken- under the article of Skin-bound. The true Watery-gripes, fo cal'ed, is ef- teemed the moft dangerous of all purgings, and is ufually thought fatal, though perhaps without reafon ; fince if properly treated, children recover from it as well as from ex- ceflive purgings of any other kind, unlefs it happen after fome other illnefs, or to ve- ry fmall and tender infants during the month. It is not the having a few very thin ftools^ however, that is an evidence of the true watery-gripes, for in almoft every purging of a few days continuance, the ftools are very thin as well as numerous. But in this cafe, they are thin very early in the difeafe; the child looks wretchedly, and every thing H it 86 Purging. it takes runs almoft immediately through it, with very little change, as in the lient/ry of adults. The cure fhould be begun by adminifter- ing one or more pukes, efpecially when the ftools are of a dark colour and fetid, as they frequently are in the earlier periods of the complaint. And to this end, a pretty ftrong one fhould be prepared, which fhould be given in divided dofes, at about a quarter of an hour's diftance, till a proper effect is produced; and fome hours afterwards a warm purge with rhubarb fhould be admi- niftered, if the difeafe be not very far ad- vanced. After the firft paflages have been cleared, the eighth part of a grain, or lefs, of ipecacuanha, or a drop or two of wine of antimony, given every three or four hours, with a few grains of the teftaceous powders, or the aromatic confection, appear to me amongft the beft remedies in the ear- lier periods of the complaint. Indeed, ve- ry fmall dofes of ipecacuanha, efpecially if duly guarded by fome gentle aromatic, is both fo ufeful and fafe a remedy, that it fhould not be haftily laid afide, and when perfevered in the ufe of for fome time, will effect wonders, not only in long purgings, but in other chronical complaints. In the more advanced ftages of the watery- gripes, and where the child is not very young, the following old medicine is a ve- ry Purging. 87 ry good one—Of LocatelWs balfam, one ounce, and conferve of red rofes, two ounces: from the quantity of an horfe-bean to that of nutmeg, maybe given three or four times a day, according to the age of the child.—The laudanum plaifter likewife, as directed for vomitings, or the following, may be applied to the parts above the navel: Take of Venice treacle, one ounce ; ex- preffed oil of mace, two drams; and oil of nutmegs, three drops ; mix them into a plaifter, to be fpread on a piece of foft lea- ther. Should thefe means fail, I have known the repetition of a vomit give an immediate check to the complaint, efp :cially where the ftools continue to be remarkably four. So long as this is the cafe, it would be both vain and hazardous to exhibit opiates, or powerful reftringents : the acidity muft be firft carried off by warm purges, and be corrected by abforbents ; the latter of which muft be given in large, and repeated dofes, and frequently their powers be augmented by the addition of water of kali, or tincture of myrrhe. And an excellent remedy fome- times, as an antiacid, is the fpir. falls am- mon. Juccinat. of Bate's difpenfatory. The acidity once removed, a ftarch clyfter may be thrown up, two or three times a day, with or without a few drops of laudanum, according to the number of the ftools, and H 2 weak- 8 8 Purging. weaknefs of the infant. A drop or two of laudanum may now likewife be given, once or more in the day, (according to the age of the child) cither joined with fome pur- gative, or in any of the afore-mentioned medicines, or in the chalk-julep, made warm with tincture of cinnamon, or of cardamoms; and in cafes of extremity, in the decoction of log-wood, which agrees very well with young children. If infants ill of watery-gripes, are brought up by hand, the ftricteft attention muft be paid to their food, which muft be changed from one kind to another, and efpecially trial be made of broths, (and to older chil- dren white meats) as long as the food fhall be difpofed to turn very acid on the fto- mach. In one cafe, I think I faved a child, by Bates's julepum vita, lowered with wa- ter, when nothing elfe would flay on the ftomach. This ferved both for food and medicine ; for the former of which, it was ftill farther diluted. When the watery- gripes, or indeed any violtn: purging, at- tacks young children at the breaft, no other food ought to be given, but the wet nurfe be changed, if the acidity and purging con- tinue many days, and medicine does not feem to take a proper effect; which it cannot, if any offenfive matter be continually thrown into the ftomach, it Purging. 89 It has already been hinted, that when there is no fever, purging medicines for children ought to be made potentially warm, and in no cafe is it more neceffary, than in long continued complaints of the bowels, which are fo apt to give rife to fpafmodic affections. I am not very fond of giving prefcriptions, but it may not here be alto- gether amifs for fome readers, fince the fol- lowing, confidered as a general medicine, has been found fo frequently ufeful, and will keep for a great length of time. Take of rhubarb from fifteen to twenty grains; two fcruples of magnefia alba; fweet fennel, and dill-waters, of each one ounce ; half an ounce, or fix drams of fyrup of rofes, and fifteen or twenty drops of the compound fpirit of ammonia. Of this, one, two, or three tea-fpoonsful maybe given two or three tunes a day, and being very plea- fant, infants are never averfe to it. Bowel complaints, it was faid, are fre- quently owing to improper food, which on this account, fhould at all times be peculiar- ly attended to ; and when a purging'has taken place, ought to be fuited to the na- ture of the ftools. In the fecond part of this work, fome farther notice will be taken of the article of children's food ; at prefent, I fhall only obferve, that cow's milk is often found to difagree with them, when their bowels are difpofed to be too open, at which H 3 times, go Purging. times, a little lean mutton broth, or beef- tea is abundantly preferable. On the fame account, rufks, * and bifcuit-powder are more fuitable than bread ; but at other times, I believe, either the common, or the French roll, which is already half digefted by a previous fermentation, is more eafily diffolved in the ftomach, if there be not a predominant acid in the firft-paffages. But where there is an habitual difpofition to a purging, i know of no diet fo proper for in- fants who do not fuck, or who cannot have enough of the breaft, as flour baked a long time in the oven, till it breaks into a foft, greyifh-coloured powder, j- and afterwards mixed with boiled cow's milk, the fcum be- ing firft taken off; the flour and milk fhould then be boiled a little time together, till the whole appears like a thin cuftard. This is a very light and fofi food, and fufficiently re- ftringent; and I have often known more good from it, than from all the abforbent medicines ever devifed, and have received more thanks for the prefcription, as it proves a permanent remedy. When children who are * Thefe are preferable to tops and bottoms, as they are called, which have a good deal of butter in them. f To this end, the flour fhould be put into a fmall jar, properly covered, and be taken out of the oven feveral times, and ftirred up from the bottom and fides of the jar, that it may not form into hard lumps, but the whole be equally baked. Purging. 91 are weaned, are attacked with repeated purgings, and even broth is found to run through them, I have obferved no food io generally ufeful as a bit of the white of chicken, not over-boiled, and afterwards lightly bruifed in a mortar with the chicken liquor, and a very little bread, into a kind of light jelly. But this fhould not be given oftener than twice, or at moft, three times a day. In all bowel complaints, it has been al- ready remarked, that infants are difpofed to eruptions on the fkin ; by which they are fo frequently benefited, that if any kind of rafh appears during long or fevere purgings, a recovery may almoft with certainly be prognofticated. That I may not multiply diftinct heads of complaint where little need fo be faid, I fhall briefly notice in this place, that many children who are accuftomed at all times to have a very open belly, do not feem to have the faculty of properly retaining their ftools, and need a fervant continually to attend them, even at two or three years of age; fo that fome have been fufpected of being culpable in the matter. I know of no par- ticular remedy, indeed, on this occafion, but, perhaps, the aqua calcis, and other abforbents may have been of fome ufe ; I have, however, obferved,. that the com- plaint 92 Worms. plaint wears off as fuch children grow up, though oftentimes not entirely for feveral years. Worms. THIS being a bowel complaint, I have noticed it in this place, efpecially as worms have fometims been voided by in- fants of only a few weeks old. It is even reported,* that Lille Van Deoverin has dif- covered them in the ftill-born fetus. Worms, however, are much oftener fufpected to be the caufe of children's complaints than po- fitively afcertained ; a mere foulnefs of the bowels often producing all the evils attribu- ted to worms: nor are all children equally affected by them where they are actually met with. Some infants conti; ue very healthy, though they are feldom free from them, whilft others are very ill who have apparently very few. Worms become hurtful chiefly from their numbers; firft, when they obitruct the bowels, or comprefs the adjacent parts by their bulk. Secondly, by fucking up the chyle defigned for the nourifhment of the child. Thirdly, by irritation. Fourthly, by actually deftroying the parts ; though this is certainly a very rare occurrence, and a * Philofoph.Tranfaa. Worms. 93 a far lefs frequent fource of injury than thofe beforementioned. Worms have, however, been faid to eat their way through the in- teftines ; and Lifter relates,* that fome re- fembling the Teretes, but of a whiter colour, have been feen coming from an abfcefs on the ankle. They are likewife faid to have occafioned hidden fuffocation, by rifing up into the throat and lodging there.f They are chiefly of four kinds, the large round worm ; the very fmall maw-worm, or afcarides, refembling bits of thread ; the fhort, flat white worm, or cucurbitina, and the jointed, called the tape-worm, or tinaa, which is often many yards long. This is the moft hurtful of all, and moft difficult of cure, becaufe it will remain long in the bowels even after it is dead, and is then feldom brought away but in pieces, and that by very powerful medicines. But as this kind of worm is certainly not common in children, tho' it may fometimes have been met with, and as it generally occafions a variety of fymptoms refembling other com- plaints, for which many different medicines may be required, the bare mention of it here may fuffice. \ The * Philofoph. Tranf. See alfo Heifter. \ Mr. Le Febure de Villebrune. % This is fo generally folitary, that it has even acquired the name j yet it is faid, there are fome- times 94 Worms. The Symptoms of worms are various, and many of them are very equivocal : I fhall name only the more conftant, and lels un- certain ones. Such are fetid breath, efpe- cially in the morning ; bad gums ; itching of the nofe, and of the anus, efpecially from the afcarides ; a very irregular appetite, al- ways in extremes, whether of hunger or of loathing ; a large, hard belly ; pains at the ftomach ; fometimes vomiting, oftener cof- tivenefs or purging, with flimy ftools; ir- regular colicks ; thirft; dulnefs ; peculiar unhealthy and bloated countenance, with a dark, hollow circle round the eyes ; ftart- ings in the fleep, and grinding of the teeth. To thefe fymptoms are often added, flow fever, with a fmall and irregular pulfe, pale, or whitifh urine, a fhort and dry cough, (which is an almoft conftant fymptom where the complaint is of long ftanding, and ha9 injured the health ;) fometimes even con- vulfions, epilepfies, and partial palfies of the lower extremities. Children, whofe digef- tion is weak, are moft liable to be troubled with thefe vermin, which are fometimes ve- ry eafily removed, and at other times very difficult of cure, and fubject to return. The times feveral of them, but, perhaps, attention enough may not have been given in the examination of them, it being well known, that this worm will live along time after it has been broken into fcvcra! parts. Worms. 95 The Caufe of this troublefome complaint is not perhaps certainly known ; but the great moifture of young perfons is thought to be an occafion of their being more infeft- ed with them than older people. Since the doctrine of equivocal generation has been juftly exploded, it has been generally ima- gined, that worms are engendered from the eggs of infects, which float in the air, or are fwallowed with fome part of our food, fuch as fummer fruits, vegetables, cheefe, and fome kinds of flefh meats. But perhaps this is not altogether fo certain as it may ap- pear at firft fight, unlefs we are to imagine that thefe fuppofed eggs produce very dif- ferent infects, from being taken into the ftomach and bowels, than they would other- wife do ; fince we do not meet with infects of this kind, efpecially the tape-worm, any where elfe.* It is, however, more than probable, that they were deftined by nature to be generated, and to live in the bodies of other animals, as obferved by Dr. Black.f The * Linnaeus and others have thoughfthe Teretes, or Lubrici, to be the fame with the common earth- worm ; but Tyfon has, by diffections, demonftrated the contrary. Phitofoph. Tranfattions. f Treatife on the Generation bf inteftinal Worms, and on the Means of deftroying them. See alfo, Dijfert. of J. Mathien Cefner, Mem. Gotting, an. 1751. 96 Worms. The like, however, are faid to be met with in running waters, as well as the bodies of different animals. But as the fact is not generally known, it were defirable to have it eftablifhed on the authority of feveral wri- ters : I happen to remember none, indeed, but that of Rofeen, whofe veracity, how- ever, I do not, in the leaft difpute. But whatever be the caufe, the general intention of Cure is obvious enough, which is to bring them away in the moft eafy, and expeditious manner, whether alive or dead; the difficulty chiefly confuting in diflodging them from their firm attachment to the fides of the bowels. To this end, a variety of medicines, pretty much of the fame kind, has been devifed, and has ferved the caufe ofempiricifmin every age. Moft of them confift either of the bitter purges, or mer- curials, to which are fometimes joined fteel, and tin. Worms exifling in the bowels can, in- deed, only be carried away by purging; and very active purges are indicated when the time of life and conftitution do not for- bid : on this principle, turn almoft all the empyrical medicines prefcribed for worms. But when the age and conftitution are ten- der, gentle purges given duly for fome time, by the conftancy of their operation produce, without harm, an effect equally, or per- haps more beneficial and lafting, that the active Worms. 97 active purges: hence have arifen the family receipts, as worm-feed, tanfey, and fuch like, (given in treacle or honey) rhubarb, fenna, &c. If the child therefore be of a delicate ha- bit, or the complaint not of long ftanding, a little fenna-tea taken every other morning, may be a proper medicine to begin with ; but fhould this, in any inftance, prove in- fufficient, a few grains of the powder of fcammony with calomel may be given the overnight, once or twice a week, according to the age and ftrength of the child. If purging much fhould, on any account, be found improper, the following is very fafe, and often effectual. r. Limatur: Stanni %\). Hydrargyr : 5iij. Mifce, finant amalgama. About eight or ten grains of this powder, with three or four grains of rhubarb, and as much unwafhed calx of antimony, may be taken every morning, in a little honey, for a week together ; after which, a clyfter of fuccotorine aloes, diffolved in warm milk, fhould be thrown up over night, and a pro- per dofe of rhubarb, or fenna-tea be taken the next morning: which courfe may be repeated, as the obftinacy of the complaint, or the ftrength of the child fhall direct.— Volatile alkalies alfo, in fome debilitated ha- bits, will prove ferviceable. I Amongft 98 Worms. Amongft other means, efpecially for fuch as may be \t a diftance from medical aflift- ance, is a mixture of pewter filings and trea- cle, of which children of four or five years old, may take feveral tea-fpoonfuls in a day, almoft at pleafure ; which they will alfo rea- dily do, for the fake of the treacle. At the fame time, from five to ten grains of jalap, with as much of the hydrargyrus cumful- phure fhould be given twice every week, to carry the worms down, as they die. To anfwer the laft purpofe, equal parts of bul- lock's gall, and powdered aloes, may be mixed up with butter, and the parts below the navel be anointed with it, two or three times a week ; or fuccotorine aloes and pow- der of dried rue, made inco a plaifter with Venice treacle, and applied round the navel, firft covering that part with a little cotton. —I mention thefe things with a view to the country poor, whom the benevolence of their neighbours may incline them to aflift, and who may, by thefe eafy means, do it at fo little expence to themfelves. Amongft fuch likewife, the decoction of quickfilver, in the proportion of about two ounces to a pint of water, may be made trial of, and and taken as a common drink, of which fome people have entertained a very high opini- on. When this fhall be drank, the like quantity of water may be added, as often as it may be wanted, If Worms. 99 If the complaint, however, has been of long ftanding, and the child not very young, mercurial purges are a more expeditious, and a fafe remedy ; though the hydrargyrus cumfulphure taken for a length of time, and occafionally purging with fenna, has fome- times fucceeded, even where there have been the fevereft convulfions. For which like- wife, or obftinate contractions of the limbs, the warm-bath is often effentially neceffary. Throughout the cure, and indeed after- wards, the diet fhould be ftrictly attended to, and all fat and greafy aliments abftained from. The child fhould live upon milk, broths, and meats of eafy digeftion, with toafted bread and honey, inftead of butter, which is exceedingly pernicious.—To pre- vent a return of the complaint in older children, or grown people, chalybeate-wa- ters and bitters may be made ufe of. Convulsions, QONVULSIONS are of two kinds ; the Jymptomatic, depending upon another difeafe, and the idiopathic^, faid to be an original complaint, and arifing from a mor- bid affection of the brain, though the dis- tinction be not, perhaps, perfectly philofo- phical, or accurate. It is for want of fome fuch difcrimination, however, that writers have had occafion to obferve, that children 12 are J oo Convulfions. are much oftener fuppofed to die of con- vulfions than they really do ; for though a convulfion frequently clofes the fcene, it has generally arifen from the great irritabi- ity of their nerves, and violence of the difeafe under which they have laboured. Such original Caufe may be a rafh impro- perly repelled ; but is much oftener feated in the gums, in the time of teething ; or in the firft-paffages, where fome undigefted mat- ter, or fometimes pent-up wind, irritates the coates of the inteltines, and produces irre- gular motions throughout the whole nervous fyftem. Such a load, whether from too great a quantity, or bad quality of the food, by occafioning a faulty fecretion, muft act like a poifon ; and that the convulfions are ow- ing to this caufe may often be known by the complaints that have preceded them, fuch as loathings, coftivenefs, purging, pale countenance, large belly, and difturbed fleep. If the child is two or three years old, any load at the ftomach may be more readily difcovered ; the tongue will be foul, the fkin hot, and the pulfe quick and weak. But fhould it be granted, that the convulfi- ons of children are generally fymptomatic, they may neverthelefs be faid to die of them more frequently than fome authors have al- lowed ; for where a difeafe is difpofed to produce violent convulfions, the convulfion, though a mere fymptom, may carry off the patient: Convulfions. i o I patient: but as it may fometimes be pre- vented or removed, by its peculiar reme- dies, (the difeafe which occaiioned it being at the fame time properly treated) infants may often be recovered, who would other- wife expire in a convulfion fit. Any little matter capable of irritating the nervous fyftem, will induce the fymptoma- tic convulfions in fome infants, whilft others will withftand a great deal. For fuch ha- bits as the former, the cold bath will be found the beft prefervative. Every young infant is, however, more or lefs, predifpof- ed to this complaint; and the difpofition continues throughout childhood, in a pro- portion to the age and delicacy of the ha- bit. The younger and more irritable, therefore, an infant may be, it will be fo much the more liable to the fymptomatic convulfion, efpecially from any confiderable difturbance in the firft paflages, as was men- tioned before, particularly the bad quality, or over thicknefs of the breaft-milk, or other food ; and from frights of the wet nurfe. Of this I remember a remarkable inftance in a patient of my own, in whofe houfe a vifiter dropped down fuddenly dead. The mother of the child, which was fix months old, was exceedingly alarmed, but her at- tention being for a moment called off by its crying, fhe incautioufly put it to her breaft. \t was not an hour afterwards that the in- I 3 fant 102 Convulfions. fant was feized with a fit, and lay either convulfed or drowfy, without fo much as taking the breaft, for the fpace of fix and thirty hours ; though it was at length hap- pily recovered. The cure of every convulfion will confift, principally, in removing the exciting caufes, which muft, therefore, be inquired into. If from improper food and indigeftion, a gentle emetic fhould be given. If the ir- ritation be in the bowels, whatever will car- ry down their acrid contents will cure the convulfions, if adminiftered in time ; and we ought generally to begin with a clyfter. If the ftools appear very foul after common purges, (in which cafe there will frequently be a difficulty of breathing) a few grains of the powder of fcammony with calomel may be given with great propriety. But if the difpofition to convulfions continues, after the bowels have been properly cleanfed, and no new irritation of them may be appre- hended, antifpafmodics fhould be adminif- tered, * fuch as tincture of foot, or of caftor, fpirit * I fpeak from my own experience of the efficacy of fuch remedies, and it may not beamifs to obferve that Harris, who is extremely cautious" of giving * heating medicines to infants, fpeak* favourably of fome of thefe—" Ufus horum (fays he) hauoVpror- fus improbandus eft,vel in tenellis : nempe quia aci- dum abforbendi facultate excellunt. Verum funinia eautione" Sec.--Great caution is certainly neceffary in regard LonvulJions. 103 fpirit of hartfhorn, or drop or two of lauda- num, or, what I have found remarkably fuccefsful, oil of rue ; which though an ob- folete medicine, I think I have never admi- niftered, when there was any chance of recovery, where it has not been ferviceable. Rubbing the back bone, palms of the hands, and foles of feet with oil of amber, or wa- ter of ammonia, has likewife had a good effect. A very common caufe, however, of recurring convulfions is worms, and' where no other probable one may appear, ought to be fufpected; the cure will then depend on the proper treatment of that complaint. Should the convulfions arife from the difappearance of a rafh, or of a difcharge- behind the ears, the warm-bath, blifters,* gentle purges, or a few drops of the com- pound fpirit of ammonia joined with the fait regard to every medicine prefcribed for infants, and: efpecially, it has been granted, for thofe of heat- ing quality : neverthelefs, it may be repeated, that in proportion as the diforders of infants fhall become more attended to, I doubt not, it will appear that, in this country at leaft, cordial and volatile medi- cines, are frequently both more expedient and ufe- ful, than many people have imagined. * Blifters may be dreffed with the common white eerate, rubbed down till it becomes fmooth, and fpread upon a double linen cloth, inftead of the hard drawing plaifters. commonly made ufe of, which, are very harfh to the render excoriated furface. 104 Uonvulftons. fait of amber, bid the faireft for adminifter- ing relief. But when the caufe is unknown, as the approach of fmall pox, meafles, or other eruptive complaint, bathing the feet in warm water, and throwing up a clyfter, are the fafeft means. If from teething, af- ter gentle evacuations, and other means di- rected under that head, blifters, oil of rue, laudanum, or the compound fpirit of vitri- olic aether, and efpecially lancing the gums, are the grand remedies. When repeated convulfions connected with fome diforder in the firft paflages, and recurring for feveral months have withftood all the above means of cure and been fuf- pected to arife from fome fault in the brain, they will fometimes difappear of themfelves as the infant gets older. At other times, the appearance of fome other complaint has put an end to the convulfions, and not un- frequently, changing the wet-nurfe ; and fometimes even weaning children, when fix or eight months old, has feemed to remove the complaint. I lately faw a remarkable in- ftance of the concurrence of two of thefe circumftances; the child being feized with the fmall-pox, and weaned, at, or near the fame time. The infant previous to this, for feveral months together as conftantly fell in- to violent convulfions as it chanced to chew a cruft of bread, eat a bit of plain pudding, or even take bread and milk, and though when Convnlfions. i o$ when debarred from thefe, and nourifhed only at the breaft of a healthy nurfe, the fits recurred every two or three weeks : but after going through the fin all-pox in a fa- vourable manner, and being taken wholly from the breaft, the fits foon difappeared, and the child was able to take all the light food ufually given to infants. If convulfions come on without any of the preceding fymptoms, they have^gene- rally been concluded to be a primary dif- eafe, and to proceed immediately from the brain. Some derivation is therefore to be made, by bleeding, if the child feems able to bear it, or by leeches behind the ears ; by blifters ; purging ; bathing the feet in warm water ; frictions of the legs, and rub- bing the foles of the feet with the water of ammonia. If children of two or three years old are fubject to flight and frequent fits, iffues or fetons fhould be made between the fhoulders, or in the neck, and be kept open for a length of time : chalybeate wa- ters may likewife be ufeful. But when the idiopathic convulfion attacks very young chil- dren, it generally terminates very foon, fometimes in ten minutes, and is, indeed, often fatal before any means can be made ufe of. Though, indeed I have often ima- gined, that we are frequently miftaken in regard to fuch hafty deaths, and that when convulfions prove fo fuddenly fatal, they are commonly 106 Convulfions. commonly Jymptomatic, and are occafioned much oftener than is fufpected by over-feed- ing.— I have known fome of the largeft and fineft children I have ever feen, die prefent- ly after the nurfe had boafted of their hav- ing eaten three boats-full of victuals. From this view of the difeafe, a few words more may not be wholly unneceffary, efpe- cially as they will hold out much comfort in regard to this alarming complaint; by which, I am however, affured, many in- fants have perifhed merely from its not be- ing properly diftinguifhed. For though, in- deed, every convulfion fit is to appearance exceedingly fhocking, yet under proper treatment they are much feldomer fatal than is commonly imagined, however often they may recur : neither is the frequency of their returns during infancy, nor the long conti- nuance of fuch a difpofition an indication of future evils, if the fits themfelves be of the kind here fuppofed. * But though experi- ence warrants my fpeaking with confidence on this head, and I fhould account myfelf exceedingly happy in preventing any unne- ceffary diftrefs that parents may endure, yet would * The above ebfervation is, I believe, ftriclly true in regard to fuch kind of firs ; and though in fome others, the intellects have appeared afterwards to be impaired, yet are the inftances fo very few, that there is ufually little room for parents to be alarmed in the apprehcnlion of fuch confequenccs. Convulfions. 107^ would I, by no means, put them off their guard ; fince the recovery depends fo en- tirely upon an expeditious ufe of the reme- dy, that even the time lot in calling in af- fiftance from abroad may be fatal to the in- fant. Fits of this kind are, indeed, pretty ge- nerally known to arife from irritating matter confined in the firft paflages, as has been already explained, but I believe it is not fo generally underftood, how often fuch mat- ters are lodged in the ftomach, (perhaps th© pylorus itfelf) ; or very low down in the reclum. Inftances of the latter are not wanting, wherein the hardened feces have lain fo low as to dilate thefphincter ani, (or lower opening of the bowels) fufficiently to expofe them to view, and yet the infant been dead before a clyfter could be procur- ed from a neighbouring apothecary's; where- as fuch fits ceafe immediately after a plenti- ful evacuation from the bowels, artificially induced : and I have feen an infant in the month, lying torpid for an hour together, in a kind of fit, and apparently in the very article of death, brought out of it entirely after a large and fpontaneous difcharge of thick feces. In like manner fudden death has taken place when the load has been in the ftomach; whilft other children have been faved by fpontaneoufly throwing it up. After 108 Convulfions. After what has has been faid it would be fcarcely neceffary to point out the remedies in a formal way, but for the fake of direct- ing the moft expeditious manner of apply- ing them. In the firft inftance, doubtlefs, the obvious means are a foap clyfter with two or more tea-fpoonsful of fait (fuch arti- cles being always at hand) and afterwards adminiftering one or other of the purges for- merly directed ; which it may often be ne- ceffary to repeat for fome days, perhaps with an interval between. But when an in- fant falls fuddenly into a convulfion very foon after fucking, or feeding, whether on any thing actually improper, or not, and the bowels have been for fome days in an orderly ftate, it may reafonably be prefum- ed, that the irritation is in the ftomach, ef- pecially if there be an unufual palenefs of the countenance, indicating ficknefs ; or on the contrary, any conliderable blacknefs, with fymptoms of futfocation ; which I think do not come on fo foon when the obftruclion is in the bowels. And it fhould here be re- marked, that it is not neceffary, that the load in the ftomach ihould be confiderable in quantity in order to induce fuch fudden and alarming convulfions ; it is fufficient that the ftomach be really oppreffed by it to a certain degree ; nor does it always appear to arife fo much from an oppreffive abun- dance, as from a fmall piece of undigefted i food, Convulfions^ 109 food, irritating, and perhaps fticking in the pylorus, or inferior aperture of the ftomach. •In the cafe here defcribed it would be improper to think of a formal emetic, at leaft without making trial of fome more ex- peditious means, fuch as irritating the Pharynx, or upper part of the gullet, with the finger, or a feather, or forcing in the fmoke of tobacco, if that be ac hand, which often inftantly produce vomit- ing, and put an end to the fit. To this end, the child fliould be fupported by a hand placed under its ftomach and belly, whilft the feather or other means are made ufe of; in which pofture the infant will be made to vomit more readily, and with lefs ftraining, than in any other pofition.—It is hoped that the importance of the fubject, as well as the very frequent fuccefs attend- ing the plans laft recommended, under the moft alarming appearances, may be thought an apology for the length of this chapter, as well as the fort of repetitions made ufe of. It is farther to be noted, that fymptoma- -tic convulfions are fometimes the effect of a falutary effort of nature, to produce a crifis in fome difeafe the child labours under; in which cafe, great caution fliould be ufed not to be over officious: bathing the feet in warm water, however, as mentioned before, K will 11 o Skin-bound. will be perfectly fafe, and perhaps ufeful.— Having fpoken of opiates, I fhall juft ob- ferve, that though they are often very fer- viceable, when judicioufly prefcribed, they become very hurtful if improperly admini- ftered. They will, however, always be fafe, where convulfions continue after the ■firft exciting caufe has been removed; or where they are fo violent as to become an obftacle to adminiftering proper remedies; or when the originial complaint is of a fpafmodic nature. When convulfions occur many times in a day, it is of importance to attend to the dif- tance of the paroxyfms, or returns ; from which a much better indication may be had of their immediate danger, than from the forcible contracti®n of the mufcles during the fit. For where the intervals are fhort, though the fit itfelf be not long, nor vio- lent, the difeafe is more dangerous, than where violent fits are attended with long intervals. Skin-bound. IN the preceding edition, this diforder was confidered only in a tranfient way, under the article of Purging; both from its being conceived to appear chiefly in the form ©f a morbid fymptom attending certain Skin-bound. 111 bowel complaints, and becaufe I had then neither feen, nor heard em.u.di of the dif- eafe to enable me to offer to the public any very diftinct account of it. I could indeed wifh that this diforder were yet better un- derftood, and that I were able to lay down a more fuccefsful method of treatment than has yet been made known : it is however in every view worthy of the moft diftinct eonfideration, as well from the obfervations made in this country, as from the late re- fearches by feveral phyiicians in Paris, as I fliall have occafion to notice very foon. Having met with no account of this dif- order either amongft the ancients, nor very modern writers when I mentioned it in a former edition, I prefumed I was announc- ing a difeafe, at that time fcarcely known, or at leaft was giving the firft public account: of it : and this I believe is no uncommon miftake of authors. Perhaps, it may be the wife intention of Providence, that in fuc- ceeding ages, many things relating to arts and fciences fhould be forgotten or over- looked, in order to emulate pofterity in the purfuit of knowledge; which men would, probably, be lefs inquifir.ve after, if things once known were very rarely loft fight of. However this may be, I continued to con- fult the oldeft writers, after having publifh- ed my former edition, and was once more led to conclude, that no account of this dif- J£ 2 order H2 Skin-bound. order had ever before been given to the public. At length, however, 1 met with a folitary cafe, which had occurred in the hof- pital at Stockholm, Anno 1718, accurately defcribed by Uzenbefius, and recorded in. Sairir.gii Embrologia (defatu Jrigido etri- gidoj,* but without adverting at all to its treatment. The cafe, as I fince find, is tranferibed into the Ephcmcrid.. Academ. Natura Curiofor. Cent. ix. The above is related in a manner import- ing it to be an uncommon occurrence, and the difeafe at that time little, if at all known: and though recorded in two diftinct works (the latter of which is rather confulted than regularly perufed) the cafe feems to have been univerfilly overlooked, and confe- quently the true nature of the difeafe has remained nearly in its original obfcurity. It was, indeed, not till a twelve-month af- ter my fhort account of it appeared, that this diforder began to engage the attention of the French phyficians, in confequence of Llonfeur Andry being called upon to take the charge of the Hojpice des Erfans trouvh ?.t Paris. The difeafe indeed had been for many years noticed both in that hofpital and * .The midwife is reported to have faid, that t"hi;, i ifarti though born alive, felt as intenfely coll and ripd when it came into the world as a piece of ice—How this might be, I Leave to the Academy of the Curious to determine.. •i4-. Stun-bound. 1*3 and the hotel Dieu, but having always prov- ed fatal, little attention had been for a long time paid to it, till Dr. Andry was elected phyfician to the firft mentioned charity ; iince which time, no pains feem to have been fpared in the investigation of it. That the prefent account of the difeafe may therefore be clearly ftated, I fliall firft confider it as it has appeared in this coun- try, and in the manner I had long ago in- tended, and had actually drawn up before I was favoured with fome farther defcription of it, by Dr. Andry, of Paris. It has, indeed, been much lefs common in this kingdom than on the continent, but is-equally an hofpital difeafe, and is feldom met with but accompanied with fome bowel complaint, and ftill more rarely appearing at the birth. It was firft fpoken of in pub- lic, I believe, by my friend Dr. Denman i (when, phyfician to the Middlefex hofpital, and a teacher in midwifery) ; as I remarked in the former edition ; and it is to him I was indebted for fome account of it before ; I ;had at all noticed the diforder myfelf. The Britijh Lying-in hofpital has been very little infefted.. with it,' and, poflibly,^ by being folely appropriated to the recep- tion of pregnant women, which the Mid- dlejex hofpital was not.:. I fhall therefore firft of all lay down the fymptoms exactly as they were noticed in that infirmary, by K 3 Dr,. IB4- Skin.bound. Dr. Denman, whofe unwearied attention to it, though not with all the defired effect, does him more honour, than could have been derived from the moft fuceefsful treat- ment of a difeafe lefs fatal than this has proved wherever itkas appeared. The following fymptoms may be confi- dered as pathognomonic, or characteristic of the difeafe. ift. The fkin is always of a yellowifh white colour, giving the idea of foft wax. 2d. The feel of the fkin and flefh is hard and refilling, but not edematofe. 3d. The cellular membrane is fixed in fuch a manner, that the fkin will not ilide over the fubjacent mufcles ; not even on the back of the hands, where it is ufually very loofe and pliable. 4th. This ftricture often extends over the whole body ; but the fkin is peculiarly rigid in the parts about the face, and on the extremities. 5th. The child is always cold. 6th. The infant makes a peculiar kind of moaning noife, which is often very feeble; and never cries like ether children. 7th. Whatever number of days fuch children may furvive, they always have the appearance of being dying. This difeafe appears at' no regular peri- ods ; but whenever it takes place it attacks feveral infants within a fhort time; and chiefly Skin-Bound. 11$ chiefly thofe, as I have juft noticed, who may be in the laft ftage of obftinate b.^wel complaints, in which the ftools are of a waxey or clayey confiftence. It has been alfo remarked,that itfometimes makes its ap- pearance as an original difeafe, and even at the birth ; in which cafe, the infant has ne1-- ver furvived many days. I have feen the rigidity extending beyond the cellular membrane, fo as to affect the mufcles, but only thofe of the lower jaw, which became perfectly rigid : but this fpafrti or tetanus is, by no means, a frequent fymp- tom, and does not feize the extremities, as it is found to do in France ; nor has the dif- eafe, in any inftance that I have heard of, been attended with the eryfipelatous affections conftantly noticed in that country. The Caufe of this dreadful complaint, when congenite, or evidently fupervenient to diforders of the firft-paffages, feems to me to be a fpafm depending very much upon a certain morbid ftate of thofe parts, and with which the fkin is well known to have a pe- culiar fympathy. But when, though an original difeafe, it does not take place till fome days after birth, which, I believe, is rarely, if ever the cafe except in large hofpitals, and other crouded apartments; wherever the irritating caufe, in fuch inftan- ces, may be feated, the difeafe feems to be an endemic of certain feafons, arifing from that r 16 Skin-Bound. that unwholefome air to which fuch places are peculiarly liable. The means of Cure in this country have been very different from thofe that have lately been found fuccefsful in France ; but inftances of recovery have been very few in either. As. Dr. Denman did me the kind- nefs of giving me the firft intimation of fuch a difeafe, I very naturally adopted his plan of treatment, wThich confifted in a ftrict at- tention to the ftate of the bowels ; and ren- dering the feveral medicines very warm by means of the compound fpirit of ammonia, which was adminiftered every four or fix tiours ; and was the only plan that he ever found attended with any fuccefs. Together with this, I after fome time directed the fre- quent ufe of a warm-bath, and chafing the ^hole body afterwards with foft flannel; ancj Ithinjc myfelf happy in having fallen up- pn one part of the plan that has fince ap- peared to fyave been attended with the firft inftances of fuccefs in France, as will be no- ticed below. As the difeafe raging fo much in France feems to differ in many refpects front ours, if is very doubtful how far the plan of cure lately adopted there may be applicable in this country, and my own experience has Eitherjto not gone beyond the means I laft mentioned: but I would venture to fuggeft, jtiajt in jnany cafes, jttjal might be /afely and properly Skin-Bound. 11J properly made, not only of carminative clyfters, but alfo of a grain of calomel pre- vious to the infant being put into the warm-bath : * and after a fufficient number of ftools fliall have been procured by thefe means, exhibiting other volatile and cordial remedies befide the fpirit of ammonia ; as well as anti-fpafmodks of different kinds. It was after I had made up my mind about this complaint, in the manner that has been juft noticed, that an advertifement appeared from the Royal Society of Medicine in Paris, propofmg this difeafe as the fubject for their next prize-medal. About this time alfo, Mr. Tenon publifhed his Memoires fur les Hopitaux de Paris, in which is a brief ac- count of this difeafe ; and very foon after this, Dr. Andry did me the honour of fend- ing me his Tract, intitled, Recherches fur L'endurciffement du Tiffu cellulaire des En- fans noveaux-nes. Though thefe works contain very accu- rate accounts of this difeafe, and to which Dr. Andry efpecially has paid an attention that muft do him great honour, they at firft ferved only to perplex my own views of it. This obfcurity arofe from the diforder be- ing combined, or as I then rather conceiv- ed, * To the warm water fliould be added* a good q.nnthy of fait, and Dine Caftile foap. 118 Skin-Bound. ed, intirely confounded with another com- plaint firft publickly noticed, I believe, in a former edition of this work, under the term anomalous inflammation ; and from which Dr. Andry had, on this occafion, made two or three quotations. I therefore took the liberty of writing to that eminent phyfician, and was foon favoured with a fa- tisfactory anfwer, by which I hope the pub- lic as well as myfelf may be obliged ; as it muft prevent any miftakes arifing from the accounts which the above mentioned works afford of this melancholy difeafe. After the defcription given of this difor- der asv it appears in London, little mere will be neceffary, I apprehend, than to felect the circumftances in which that in France is found to differ, as related by Dr. Andry in his.printedwork, as well as the letters with which he was pleafed to honour me. It has already been faid, that it is more frequently attended with tetanus, and never occurs without thofe appearances mention- ed under the article, termed in this edition, Infantile Eryftpelas, efpecia'ly the rednefs and hardnefs about the pubes, accompanied farther with tumour and rednefs of the foles of the feet. But thefe parts, it feems, tho' of a purple red, are intenfely cold, very rarely fuppurate, but fometimes mortify.* In * This is faid to hz the cafe in four or five chil- dren Skin-Bound. 119 In one very late inftance, however, the in- fant was not cold, but on the contrary, ex- ceedingly hot. The legs, thighs, and foles of the feet were red and hard ; but no men- tion being made erf" a general tightnefs of the fkin, it is probable this child was affected only with that infantile eryfipelas which ap- pears amongft us. Befides the above variations, the infants are faid to fwallow with extreme pain ; the extremities, efpecially the legs, are much enlarged, and attended with a ferous effu- fion in the cellular membrane, which we have not hitherto noticed : and the diforder is likewife faid to rage moft in the hotter months.—The infants are obferved to die about the third or fourth day, or at fartheft, on the feventh from the birth. It is pro- bable, there is another and very material variation, in refpect to the degree of ftric- ture and immobility of the fkin, which are not clearly expreffed to be either fo confi- derable or extenfive, as in the difeafe I have been defcribing ; but are more confined to thofe parts which become red and tumid. But drenout of twenty, all of whom certainly die in a few hours after the gangrene has..taken place ; and become fo putrid, that by the next day, the fkin fe- parates from every part of the body, fo as to adhere to the hands of thofe who have occafion to touch them. ■i 2o • Skin-Bound. But in the inftance recorded by Scuringius it was clearly otherwife, the infant being faid to feel, from head to foot, like a piece of flefli dried in the fmoke. The child furviv- ed a compleat day, during which time it took no \fort of nourifhment; but never cried, nor made any kind of noife. Upon examining a great number of dead bodies at the Enfans Trouves, the ferous extravafation is conftantly mer with ; is of a deep yellow colour and fluid, but coagu- lates with heat; the fat is peculiarly folid ; the glands and lymphatics, efpecially thofe of the mefentery, are found fluffed, and the liver uncommonly large, with a great quantity of deep coloured bile in. the gall- bladder ; and the lungs are faid to be load- ed with blood, as well as to contain an unu- fual quantity of air. The fuppofed Caufe of this difeafe amongft them, feems to me but ill accounted f.^r; being attributed to the. improper diet of the mother or her infant, or to cold it has taken at the birth : whereas, the coldnefs and ri- gidity of the fkin feem to be but mere fymp- toms, and not the difeafe ; efpecially as their children, like ours, are but rarely attacked from the birth. It fhould rather feem to be a true endemic, ariling from foul air, efpecially as it is found only to attack the poor, and particularly to infeft the two large liofpitals that are crouded above all others, 3 and Skin-Bound. 111 and receive the loweft and moft wretched part of them ; of whofe new-born children, it is fuppofed, one out of twenty is vifited with this difeafe. It has been hinted, that for a long while, little attention was paid to this complaint, on account of its conftant fatality, fix hun- dred infants finking under it every year, in a fingle hofpital; four hundred of which are born in the Hotel-Dieu. But fince Dr. Andry's election, various means have been attempted both by himfelf and his colleague, Mr. Auvety; and amongft other means, the warm-bath, which appears to have faved the firft child that was known to recover.* Trial has fince been made of blifters to the extremities, which fucceeded alfo in the very firft inftance, as well as fince in feveral others ; fo that, in the laft year, they are reported to have faved five infants out of an hundred, more than in the prece- ding one. L As * Monfieur Souville, furgeon to the Military Hofpital at Calais, has alfo given fome account of this difeafe, in the Journal de Medicine, under the name.of JEdematie Concrete, and obferves, that it is a very common diforder in the provinces, as well as in Paris. Under his direction, likewife, a warm, or rather vapor-bath, fucceeded in the only inftance wherein he had made trial of it. 122 Tetanus. As this difeafe, more efpecially in the form it puts on in Paris, is now, by the en- couragement of the Royal Society of Medi- cine, likely to be fully inveftigated, it may be hoped fome farther hght will be thrown on it: in the mean time, as it is evidently a complicated difeafe, the bark and cordials, with proper attention to the ftate of the bow- els, might poflibly be ufeful. Tetanus. THE Tetanus, or Locked-Jaw * of in- fants, is an equally fatal complaint, and as little known in this country, as the foregoing. In fome inftances, it has been confined to the jaw only, as in Jamaica; in others, it has been attended with contrac- tion and rigidity of other mufcles of the face, and a peculiar fixednefs of its features. Some- times, the rigidity has extended to the neck; and in one child I obferved it to be fpread fo completely over the whole body, that the limbs could not be bent fo as to place it conveniently in the veffel appropriated to a warm-bath. It has already been obferv- ed * This is the fpecies which Nofologifts have termed Triftnus maxilla inferioris R'rgiditasfpaftica. Species i"". TrifmusNafcentium Infantes intraduas primas a nativitate feptimanas corripiens. Vide Cullen. G. Ixix. Tetanus. 123 ed, that it is fometimes joined with the fore- going complaint, but rarely in this country; and even then, the jaw partakes only of that kind of rigidity common to other parts. In fuch inftances of Tetanus as I have met with, the attack has not been earlier than the fixth, nor later than the ninth day from the birth ; and as far as I could learn, the iufants had not been coftive (as menti- oned by Dr. Evans), nor apparently un- healthy : one, I remember, was a remark- ably ftrong and lufty child. It feems fome- what to differ, therefore, from the difeafe termed Jaw-fallen, in the Weft Indies ; and in one inftance appeared to have fome re- femblance to the catalepfy. The rigidity has ftolen on in a more gradual way in fome in- ftances than in others, but has always been very great as far as it extended," from the moment it has been difcovered ; fo that in inftances where the mouth has continued fufficiently open to admit my finger, I could not thereby deprefs the jaw. In fome, the eyes ,have been bloated, and the whole countenance much fwollen. The caufe of this complaint, which does not feem to arife from conftipation, or ne- glect of purging off the meconium, may, probably, be a certain ftate of the air, as hath alfo been fufpected in the Weft Indies; and the more fo, as the difeafe has appear- ed only once in the Britifh Lying-in Hofpital L 2 during 124 Epileptic-Fnts. during a great number of years and then attacked feveral infants in a fhort time. The remedies made ufe of at the hofpU tal were, the warm-bath ; fomentations to the rigid parts, frictions with oil and cam- phire, and Bates's anodyne balfam ; blif- ters behind the ears, and to the nape of the neck ; and opium, calomel, the bark, and aromatic confection have been given inter- nally. One infant, in whom the complaint was confined to the jaw, and who had lefs rigi- dity than any of the others; never looked ill, and had no convulfions in its limbs, died rather fooner than the reft. Only one fur- vived the third day : this child was not feized till the ninth from its birth, and lived to go out of the hofpital with its mother, at the end of the third week, and we hoped was then recovering; but it had never been able to take the breaft after the attack, and died three weeks after it left the hofpital, though, poflibly, not altogether from this complaint. Epileptic-Fits. '"THIS and the following complaint, as well as the two immediately preceding, which relate, fome to the more early, and others to the later periods of childhood, are noti- ced Epileptic-Fits. 125 ced together in this place, on account of their falling under the general clafs of con- vulfions, and it is prefumed lefs improperly, on the whole, than ranking them according to the different periods of time in which they might take place. Very few words, however, on the Epilep- fy, or falling-ficknefs, may fuffice, as it is either pretty eafily cured, or ufually conti- nues through life; and is too well known by this popular name to require a particular defcription : an account of the various pre- current fymptoms would be equally ufelefs in this work.—It may juft be noticed, th.it th" parient falls fudJenly to the ground, and fometimes without any perceptible warning, or at all fufficient to fecure him from injurv ; and is ufually much, convulfed,but frequent- ly retains his fvmfes during toefr. I believe it f mistimes takes its rife merely from foul bowels, aad ce.tainly mo e com- monly attacks children of a coftive habit of body: it fliould men be treated agreeably to tiie direction* 1 ready given in fuch cafirs, and efpecially with active and mercurial purges : after whic *, the bark, chalybeares, and fea battling may be fcrviccable. In other inftances, efpecially in more advan- ced life, and towards the time of puberty, the e.vilepfy feems to be owing rather to a rnoYt fcnfible nervous irritation. In fuch cafes, blifters to the back of the head may L3 be 126 Epileptic-Eits. be ufeful; and I have experienced much be- nefit from large dofes of the powder of va- lerian, and opium ; and in one inftance, by an infufion of favine, fennel feeds, and juni- per berries ; but I never could entirely con- quer the complaint by thefe means ; but the olium fuccini has, in feveral inftances, perfected a cure in young fubjects. In the worft cafes I ever met with, in which the fits were very long and violent, and to the number of twenty or thirty in a day, electricity has very foon rendered them weaker, reduced their number to three or four in a day, and gradually to one in a month ; but did not entirely remove them. In fuch obftinate cafes it is generally fup- pofed, that the brain is affected by fome local and permanent caufe, and a perfect cure is confequently defpaired of. When this difeafe has attacked children of five or fix years of age, and where no treatment has been ferviceable, the com- plaint has very frequently difappeared fud- denly about the time of puberty, and fome- times a year or two fooner. Where it does not, it will probably continue through life, and now and then prove fudden'y fatal. Upon examining the brain after d~ath, I have found a fnall point of bone ftanding out from the internal part of the os frontis, as fharp as a needle (of which Boerhaave has Chorea Santi Viti. 127 has recorded feveral inftances) and was, doubtlefs, the true caufe of the difeafe. Chorea Sancti Viti, or Saint Vi- tus's Dance. I SHALL be equally brief on this untow- ard diforder, which, though not often fatal, is like the former, 1 believe, rarely cured but in young fubjects. Worms and other foulnefs of the bowels in children, are likewife frequent caufes o£ this ftrange convulfion ; in which different parts, and efpecially the extremities are put into continual motion, giving the patient a very awkward appearance, particularly in his walk. If the firft-paffages are the feat of irritar tion, the complaint muft be treated in the manner noticed under the preceding article 5 and, indeed, in moft cafes, the cure fhould be begun by adminiftering aloetic, or racr- curial purges. But fhould the diforder apr pear to be owing rather to relaxation, as it fometimes is, the bark, chalybeates, and other tonics, efpecially the vitriolum album* and fea-bathing, are indicated, and are very frequently fuccefsful ; as I have feen in a late inftance, in a child of eleven years of age. Teething, r ™* 3 Teething. 'T'HE complaints arifing during dentition may next be confidered, many of the foregoing being blended with it, the firft- paffages and the nervous fyftem being al- ways more • or lefs affected. The flare of dentition is likewife not unfrequently an oc- cafion of many complaints afterwards to be mentioned, fuch as cough, fever, the rick- ets, and even ronfumption ; under each of which heads therefore, occafional references will be made to it. The time of teething is a moft important period of the infant ftate, and fubjects it to manifold complaints and dangers. Some writers, indeed, and particularly Dr. Cado- gan*, and Dr. Armftrong, feem to think otherwife ; and that teething is fcarcely to be ranked amongft the difeafes of infants. They have imagined that children, if other- wife healthy, would cut their teeth with no more danger than adults, who often cut their wife teeth, fo called, at an advanced age, without any difficulty, and always with- out hazard. They likewife obferve, that many children get their teeth eafily. But this argument muft fuppofe the heakhieft, and * See his Effay on Nurfmg, &c. Teething. 129 and beit nurtured children, to be, in all re* fpects, in the fame circumftances with adults, which is, by no means the cafe; as they are liable to fever, dangerous purgings^ and even convulfions, from caufes that would in no wife, affect the latter: nor can they ftand under fome of thofe com- plaints fo long as adults, nor endure the neceffary remedies. For the fame reafon, the meafles and fmall-pox carry off fuch numbers of infants, when attacked by them a little more feverely than common, whilft young and healthy people often ftruggle through the moft dangerous and complica- ted kinds, when properly treated from the beginning. Not to mention, that very few infants, who are unhappily affected with lues venerea, recover under any treatment^ whilft adults are cured in the moft advanced ftages of the complaint, notwithftanding fome parts may be actually mortified. I have, therefore, no doubt, that the time of teething ought to be ranked amongft the moft dangerous to infants, and that the greateft attention ought to be paid to it; though it is probable that Dr. Arburthnot greatly over-rates its fatality, when he fays that one child in ten may be fuppofed to fink under it. Some late writers, and particularly Mn Le Febure De Villebrune, have conceived this to be a mere difpute about words j but the 130 Teething. the difference, indeed, extends much -far- ther. For though I would, indeed, by no means affert dentition itfelf to be a difeafe, and have made ufe of any fuch like exprefli- on merely in a popular way, yet am I con- fident it induces difeafe in very many infants of every habit of body, and more efpecially, however ftrange it may feem, in the appa- rently healthy and robuft. Indeed, weak and even rickety children, more commonly cut their teeth eafily, tho' often very late ; or if they fhould be harrafled by a purging, and other complaints, they, neverthelefs, efcape with their lives oftener than lufty ftrong children, who are frequently carried off fuddenly at this period, unlefs the teeth happen to find a very eafy paffage through the gums. The fyftem, during dentition, being difpofed to inflammation, fuch chil- dren muft oftener fall into fever than the tender and delicate; like athletic adults, who are more difpofed to inflammatory com- plaints, than thofe who are of a colder, but ltfs healthy temperament: and it is by acute fever, or convulfions, that infants are carried off, who are well known to furvive a thou- fand lingering and vexatious complaints, if their vifcerahe found. This period ufually commences between the fifth and tenth months, and the procefs of the firft teething continues to the eigh- teenth at the leaft, and fometimes much lon- ger. Teething. 131 ger. The two front teeth in the lower jaw are ufually cut the firft, and it is commonly a few weeks longer, before the correfpond- ing ones in the upper jaw make their ap- pearance. After which, it is frequently a confiderable time before the next under- teeth come out; but fometimes, though not often, fix or eight are cut in a hafty fuccefli- on. Children fometimes cut their teeth ir- regularly, or crofs, as it is called, both by the teeth appearing firft in the upper jaw, and alfo at a diftance, inftead of being con- tiguous to each other : this is accounted, and with fome reafon, indication of difficult, or painful dentition. Teething is ufually preceded and accom- panied with various fymptoms : the child drivels, or flavers much ; the gums fwell, fpread, and become hot; there is often a circumfcribed redne/s in the "cheeks, and eruptions on the Ikin, efpecially on the face and fcalp; a Joofenefs, gripings,green ftools, watchings, ftartings in the fleep, and fpafms of particular parts ; a diminution, or increaf- ed fecretion of the urine, and difcharge of matter, with pain in making water, (imita- ting exactly a virulent gonorrhoea) which often mitigates the fever. A lefs common fymptom, appearing only in certain habits, is a fwelling of the tops of the feet and hands: it feems, however, of no impor- tance, and goes away upon the appearance of t$l Teething. of the teeth. 1 never met with it but in in- fants who cut them painfully ; and being feldom accompanied with a purging, it is likely may prevent that fever which is other- wife fo apt to attend. In all cafes, the child fhrieks often, and thrufts its fingers into its mouth: and thefe fymptoms are fometimes followed by a cough, difficult breathing, fits, Fever, fcrofula and marafmus, or univer- fal decay. Strong and healthy children cut their teeth both earlier and more eafily than the weak and tender. I have known a weak, and rickety child, without a tooth at twen- ty-two months old,* though it lived to grow up ; but at the age of five years became fcro- fulous. Therefore air, exercife, wholefome food, an open belly, and every thing that has a tendency to promote general health, will greatly contribute to the fafety of den- tition. vDifncult teething is to be treated nearly as other acute difeafes with local inflamma- tion. If the body Is* at all bound, fome opening medicine fhould be adminiftered, and it is to be obferved, that even a confi- derable degree of loofenefs is ufeful ; few children cutting teeth fo well as thofe whofe bellies are at this time much more than com- i monly * Primerofe fpeaks of it being as late as the third, or even fourth year. Teething. 133 monly open. Diluting drinks are alfo very neceffary, efpecially if the child does not fuck ; with a light food, in fmall quantities, and frequently taken. If much fever at- tends, the lofs of a little blood, in fome way, will be neceffary ; though children do not endure bleeding fo well as they do other evacuations. If the propriety of bleeding with the lancet be doubted, a leech or two, as Harris advifes, may be applied behind the ears, and is generally ferviceable. Cly- fters are alfo very ufeful, efpecially if there be retention of urine, which will likewife call for the ufe of the warm-bath. Gentle diaphoretics are alfo ferviceable, particularly of wine of antimony, or the antimonium tar- tarifatum, which befides opening the belly, often operate in this way : a blifter fhould likewife be applied between the fhoulders, efpecially if there is any difpofition to firs. And, indeed, if ftools do not afford fome confiderable relief, there fhould generally be fome difcharge from the fkin ; fince a purging, and eruptions on the fkin, when fpontaneous, are the grand means of eafy dentition. A little difcharge fliould there- fore, be kept up behind the ears, by rub- bing the parts with Spanijh flies, applying a thread as before directed, or putting on a fmall blifter ; which may be kept open. A burgundy-pitch plaifter laid on the back will fometimes fuffice, which fliould be re- M newed 134 Teething. newed every ten days, till the fymptoms difappear, or the teeth come into fight. Even before this period, light fcarifications of the gums are very ufeful, by taking off the tenfion ; or if the teeth are at all to be felt, lancing them, as it is called; the pro- per method of doing which will be noticed below. I fliall clofe what I have to offer on the general plan of treatment, by obferving, that the indications certainly are to aflift the eruption of the teeth, and to moderate the inflammatory and other fymptoms : which muft be treated according to their kind: all parts of the body readily confenting with the gums at the time of teething, but the nerves, the bowels, and the lungs, more particularly and importantly than the reft. It has been obferved, that a purging is be- neficial, and it is, indeed, furprifing how confiderable a diarrhoea children will ftand on this occafion, and how very bad the ftools will often be for many weeks toge- ther, and a child happily ftruggle through; though at another time, an equal degree of purging, with fuch bad ftools, and conftant fever, would prove infallibly fatal. The diarrhoea is therefore not only to be cauti- oufly treated according to the directions al- ready given under the article of purging, but is oftentimes rather to be encouraged than fuppreffed. Very pale ftools are at Teething. 135 this time not uncommon, and are fometimes in vaft quantity : I have known an infant have fifty in one night, at leaft by the ac- count of a careful and difcreet nurfery maid'; and from the quantity of feces that I faw the next morning, I had no reafon to dis- pute her calculation. For the fever of dentition, befides bleed- ing the abforbent powders are eminently ufeful, and are in various refpects calculated to afford relief. To thefe, fometimes a grain or two of Dr. James powder may be added at bed-time, which, if there fliould be any thing amifs in the ftomach or bow- els will either vomit or purge, but other- wife (it has been faid) will promote a kindly fweat, which is always beneficial. Nitre is very often ufeful, joined with the teftaceous powders, or a little of the compound powder of contrayerva—Sydenham directs three ©r four drops of the compound fpirit of ammo- nia in a fpoonful of water every four hours, for four or five times, and I have thought it very ferviceable after proper evacuations ; but this dofe may be confiderably increafed, according to the age of the child. Nor is a drop or two of laudanum to be feared, if the bowels have been previoufly opened, the pain be very great, and the breathing not difficult. A principal indication, it has been faid, is to aflift the eruption of the teeth. This M 2 is 136 Teething. is attempted, by cooling, fedative, and de- mulcent applications made to the gums ; by rubbing them with fome hard, polifhed body, fuch as the coral ; or by dividing them with the lancet: which laft is the on- ly mean to be depended upon. When it is found neceffary to lance the gums, (which is ever, at leaft, a fafe operation) it fliould always be done effectually, with a proper gum-lancet, and not with a needle, a thin fix-pence, or fuch like inftrument, which will not fufficiently divide the gum, or the ftrong membrane that covers the teeth. The lancet fhould always be carried quite down to them, and even be drawn acrofs the dou- ble teeth. It is certain, that this litle ope- ration gives fcarcely any pain, and the re- lief is at the fame time often fo confiderable that the child appears exceedingly pleafed with it, and will immediately fqueeze the jaws and grind them together forcibly, which proves the gums are not very fenfi- ble. The moft painful part of dentition, and that in which children are moft expofed to convulfions, is ufually from the teeth cut- ting through the periojleum (or nervous membrane mentioned above) that covers the jaw immediately under the gums. This, I apprehend, in difficult dentition, is often not cut through, but is forced up before the teeth, when they are- even in fight under Teething. 137 the thin gum ; hence it is, that cutting through the gum is fo very often ufeful, and takes off fever and convulfions, which fevere fymptoms could not arife merely from piercing the gum, which, it has been faid, is not a very fenfible part. At other times; the pain and fever feem to arife from almoft the very firft fhooting of the teeth within the jaw, and then they will very often not appear for fome weeks after the gums have been properly lanced ; and parents are therefore apt to conclude, the lancing has been unneceffarily done. I am, however, convinced from experience, that this little operation, though not in the general efteem it ought to be (and by the French phyficians even dreaded at this period)* is often inex- preffibly ufeful, and appears to have favr ed many lives, after the moft dangerous fymptoms had taken place, and every other mean of cure had been made ufe of. And I cannot here forbear exprefling myfurprize, at the fears fome people entertain of lancing the gums, and their delaying it fo long, if not altogether rejecting it, though no evil can poflibly arife from the operation. On the other hand, its advantages are fo great, that whenever convulfions take place about the ufual period of dentition, recourfe ought always M3 * See Lieutand. 138 Teething. always to be had to it, after an unfuccefsfal ufe of other means ; though by an exami- nation of the gums there may be no cer- tain evidence of the convulfions being ow- ing to fuch caufe ; the irritation from teething, it has been remarked, often tak- ing place in a very early ftage of the bu- finefs. At any rate, it has been faid, the operation can do no harm, even at any period, and fhould the fhooting of teeth be only an aggravation to the true caufe of the difeafe, lancing the gums muft be attended with advantage. But fhould teeth- ing be the proper and fole caufe, it is evi- dent how fruitlefs any other mean of re- lief muft frequently be : for fhould convul- fions, for inftance, take place from a thorn run into the finger, or toe, the proper indi- cation of cure, by an immediate extraction of the thorn, and the probable futility of other means, would be equally obvious. The operation may alfo be fafely repeat- ed, the fears doing no kind of harm. And indeed it will be frequently neceffary to lance the gums feveral times, on account of the extraordinary difficulty with which fome infants cut their teeth, efpecially the double ones, which are furnifhed with two or more knobs or points. Fever, purging, and even convulfions will fometimes arife from only one point of a large tooth offending the pe- riofieum that covers it, and being nearer the furface teething. 139 furface than the other points, the lancet fometimes does not completely divide the membrane that lies over the reft ; and this part not being injured by the tooth, the fymptoms fubfide on having divided that portion of membrane that was inflamed. But in a little time, another point of the fame tooth is found to irritate the periojleum, and calls for the like affiftance of the lancet, which again removes all the complaints. This, at leaft, I have conceived to be the procefs, when I have found lancing a large tooth immediately remove every terrible fymptom, though the fever and other com- plaints have returned, and the tooth not ap- peared till the operation has been three or four times repeated. I have feen the like good effect from it, when children have been cutting a number of teeth in fucceflion, and have bred them all with convulfions. Nothing having relieved or prevented thefe terrible fymptoms but lancing the gums, which has removed them every time it has been done, one or more teeth appearing a day or two after each operation.—In fuch cafes, it will often be proper to draw a lan- cet along a great part of one, or even both the jaws, at the fame operation. Some writers, however, and Dr. Millar particularly, have advifed, not to cut quite down to the teeth, but only to fcarify the gums, unlefs the teeth are very near." He fufpects '4° Teething. fufpects that the inftrument often injures them, and produces caries, which he thinks will be communicated to the fucceeding fet of teeth. But this is a needlefs fcruple, and I apprehend arifes for want of duly at- tending to the ftate of the teeth, which are perfect bone, and covered with a ftrong enamel, long before they get through the gums. The manner of the fecond teething of children likewife forbids fuch a fear; for though the firft fet, which are defigned by nature to be only of fhort duration) fhould actually be injured by the lancet, the fuc- ceeding ones are not at all likely to be af- fected by the carious ftate of the former. For the firft teeth of infants conftantly be- come carious at the roots, and are loofened and expelled by that means, when left to nature alone ; and though the upper parts of the new teeth are in contact with the ca- rious bottoms of the firft fet, they never ftrf- fer from this circumftance. I have dwelt the longer on this head, becaufe writers are not agreed on the fubject, and it is a mat- ter oftentimes of no fmall importance. I have, however, written from experience, and am perfeclly fatisfied of the propriety and fafety of what I have ventured to recom- mend.* ' It * See Mr. Hunter's copious and accurate account el ihe teeth, and their difeafes. Teething. 141 It has been hinted to be a common prac- tice to touch the gums with oils and mucil- ages, and to rub them with fome hard and polifhed body. To anfwer the firft inten- tion, perhaps a little honey, or fyrup of white poppys is as proper as any thing, or the honey may be lightly acidulated with fpirit of vitriol. Befides the coral, a cruft of bread, or a piece of liquorice root, may be often carried to the mouth, and may fometimes be preferable, as they will yield a little to the preffure of the gums. It fliould be a pretty general rule during the time of teething, to abate a little of the ufual quantity of food, and the encreafe the qnantity of drink ; unlefs the child is very weakly, or every thing is going on per- fectly well: or if the child be at the breaft, a fimilar regard ought to be paid to the diet of the nurfe. Children will fometimes have ulcerated gums in teething, and more frequently where they have not been lanced, which are eafi- ly cured by keeping ti: body open, and touching them with aftrhgent applications. As much white vitriol, r roch alum as will give a moderate roughne h to a lirle honey, is ufually fufficient for t lis pur,ofe. But fliould this fail in any cafe, it muft be treat- ed as directed under the head of Canker. Fever [ 142 ] Fever. r I * HOUGH fome writers have fuppofed ■*■ infants to be as liable to fevers as adults, and from the fame caufes, I have, by no means, found it fo, and I wifli parents to take comfort from the confideration ; hav- ing obferved for many years, as well in the hofpital, as in private practice, that infants do not readily take common fevers, though cxpofedfora longtime tothatcontagion which has appeared to affect adults around them. Their fevers are alfo of a fhort duration if properly treated, unlefs the few that arife from fome more permanent irritating caufe. Young children, however, are difpofed to fome febrile complaints peculiar to them- felves ; which, as I have enlarged this edi- tion confiderably, with the defign of taking in all their complaints, I fhall beftow fome pains in fpecifying, as well as pointing out the treatment moft adapted to each. The more frequent caufes of fever, are teething, foul bowels, worms, glandular difeafes, fome eruptive and very contagious complaint, or taking cold, and are often attended with fymptoms peculiar to children. If from the laft mentioned caufe, and the cold be fevere, it will always be attended with a cough, hoarfenefs, and fome difficulty of Fevers. 143 of breathing, and often with running at the nofe or eyes, which will diftinguiih the fe- ver from all others, except it be the mea- fles ; which will be attended likewife with violent fneezing, and a peculiar appearance of the eyes not often met with in a common cold. If a fever from cold be conflderable, the cough violent, and the difficulty of breath- ing very great, a blifter will always be fafe and expedient, and may be applied at the pit of the ftomach inftead of the back, as be- ing both lefs painful under any motion of the body, and more readily got at to be dreffed, or for the application of frefh cloths, where the difcharge happens to be confl- derable. But if the fever and difficulty of breathing fliould not be very much abated by the blifter, children though within the twelve-month, will bear and even be great- ly benefited by the lofs of a little blood, * at leaft by the application of two or three leeches. * In mittendo fanguine, non tam annos medicus numerare, quam vires segrotantis seftimare debet. Celfus. Lib. ii. cap. 10. p. 78. Galen indeed forbad bleeding till after fourteen years of age, but fince the time of Celfus, that ab- furd idea has been exploded. Rhazes permitted cupping after three or four months ; Avicenna at a year old—Some allowed of bleeding in the feet or legs, though not in the upper parrs; but this ufe- ful operation is now juftly unconfined ; and extend- ed, occafionally, to every period. * 144 Fevers. leeches, as I have frequently feen ; and I mention this again, becaufe it has been thought fo highly improper for infants. But I can venture to fay, they will be much lefs reduced by it, than by the continuance of the fever, which the lofs of a little blood will, in many cafes, fhortcn by two or three days; and which is fometimes abfolutely neceffary, and in peripneumonic cafes, may even be repeated with fafety and advantage*. Oily medicines, likewife, made into a neat emulfion, are often ufeful, efpecially if the child be not at the breaft ; but they fhould be preceded by an emetic of wine of anti- mony, as there is ufually much phlegm on ftomach ; children never coughing it up. In many cafes it is alfo neceffary to repeat the emetic, as often as the phlegm in the throat is collected in fuch a quantity as feems to impede refpiration. But if the cough be dry or convulfive, Bates's fpirit. fal. ammoniac, fuccinat. may be fafely and ufefully adminiftered, if there be not much fever. The body ?i the fame time fhould be kept p rfectly open, and this purpofe is ufually well anfwered by fmaller dofes of wine of antimony, or of Dr. James's pow- der; but if they fliould fail to procure ftools, as they fomtiimes will, where there 2 is * Multa in prascipiti periculo rede fiunt, alias amittenda. Id. Lib. iii. cap. 18. p. 150. Fevers. 145 is much fever, they rather do harm than good, unlefs a little manna, or rhubarb be joined with them. It is very neceffary here to obferve, that though preparations of antimony may per- haps be fafely adminiftered under the eye of very attentive parents, they are very pow- erful medicines, and not to be prefcribed by nurfes and ignorant people, or without great caution. And I hope this may be ad- mitted as an apology for the liberty I have taken in faying fo much againft fome prac- tices highly extolled by other writers, and efpeially the indifcriminate ufe of antimonial wine, * which has induced fome people to< make free with medicines of this clafs, who are in no wife competent judges, j- But where fuch medicines are found to agree, N and * It may be proper once for all to remark, that, it is prefumed truth calls for an undifguifed account of every writer's fentiments, from whomfoever he jnay differ ; who, the more refpeclable their names and opinions may be, and the oftener their autho- rity may be quoted, by fo much the more prejudici- al any erroneous fentiments or practice muft become. It is to method and meafures, not men, that writers have to object: when compelled fo to do, I wiih always to exprefs myfelf in a manner equally re- fpedrul and intelligible ; after which an impartial public will judge on which fide the fair eft reafon- ing, or fafer line of practice may lie. f A nurfe very lately propofed giving half a grain of tartar emetic to an infant of a few days old. 146 Fevers. and keep the belly open, children frequently ftand in need of no other ; though where the fever has been very confiderable, I have given nitre to advantage to infants of only a few months old. In the little fevers arif- ing from taking cold, to which fome chil- dren are very liable, I often join it with a little of Dr. James's powder, (proportion- ed to the age) and a few grains of the com- pound powder of contrayerva, lowered with teftacea ; which I find to be a medicine ex- ceedingly ufeful, when given in time. If the head is much affected, putting the feet into warm water, or applying a milt to them juft taken from the animal, are admirable remedies; and I think have fometimes fav- ed a life after all hope had been given up. Or a little frefh leaven, or dough, as ad- vifed by Mr. Le Febure de Villebrune, may be fpread thinly over the foles of the feet. If the fever be accompanied with much cough, and attended with difficulty of breathing, which comes on by fits, both may be greatly relieved by ten or fifteen drops of the fpirit of vitriolic aether, given three or four times a-day. But in the ab- fence of fever, the breaft-milk is often as good a balfamic as can be had ; or if the child be dry-nurfed, a little fyrup of balfam is both pleafant and ufeful. If the fever be not owing to taking cold, to worms, teething, or fome eruptive com- plaint, Fevers. rqrj plaint, it will generally be found to arife from fome foulnefs in the firft-paffages, in which cafe, opening the belly, and after- wards giving a puke and the teftaceous pow- ders, ufually remove it. But if otherwife, opening medicines muft be continued awhile longer, efpecially caftor-oil ; but if the flools are very fetid, the bafilic powder, or fmall dcfes of calomel are the fitteft purge ; though they require to be adminiftered with caution. I have known not only convulfi- ons, but paralytic affections, attended with great pain and continual fever, induced merely, as I apprehend, by a foul ftate of the bowels ; where, after the complaint has been unfuccefsfully treated as a fever of a- nother kind, all the fymptoms have been removed at once by an active purge. Even infants of only three or four months old will often have very confiderable fever, and fits, with fo coftive a ftate of the bowels as to require ftrong purgative medicines to be re- peated for feveral fucceflive days, with clyf- ters and the warm-bath, before the obftruc tion can be removed, or the fever will at all abate. And I doubt not, it may be mat- ter of furprife to thofe who may not fre- quently have met with fuch cafes, to find what a quantity of purging medicines have been taken by a tender infant before one proper ftool could be procured, and how certainly a relapfe will take place, if the N 2 opening 148 Fevers. opening plan be not perfevered in, in the manner recommended. In lefs urgent cafes, and efpecially in very young fubjects, much gentler means will ufually fucceed ; and af- ter the belly has been once or more well opened, many common fevers will nearly fubfide ; after which it will frequently be proper to return to fome of the abforbent powders, in one form or other, and that re- commended by Boerhaave * may be as pro- per as any ; though the union of different teftacea is of very little importance. Any of them will form an admirable medicine for very young children, as well under little fe- vers, as for almoft all their complaints not attended with much coftivenefs. This, the judicious Harris was fo fenfible of, that he thinks them alone fufficient to effect almoft every thixg during the infant ftate, and has done unfpeakable fervice by abolifliing that indifcriminate recourfe to cordials, and other heating and rough medicines, fuch as mer-. cury, aurum Julminans, theriaca, &c. to- gether with various anile and fuperftitious remedies, m hich the ; ncient writers fre- quently recommended on occafions peculi- arly improper. And though abforbents will not do every thing he has imagined, yet are there very few medicines of fuch general ufe. But fhould the fever withftand thefe * See the prefcript'on under the article of Purg- ing, page 85. Fevers. 149 thefe common remedies, or be found to in- creafe, it will be neceffary to give fome of thofe before recommended, or, what is fometimes very ufeful, little draughts with lemon juice and fait of hartfhorn, in which the latter is left a little predominant; or three or four drops of the compound fpirit of ammonia, in a little water, four or five times a-day. I have, indeed, lately expe- rienced very good effects from perfevering in the ufe of fmall dofes of wine of antimo- ny, given in a faline draught, in the little obfcure fevers of infants, where the caufe has not been fo obvious as it common- ly is. On the decline of fome fevers, efpecially thofe arifing from fowl bowels, it is not un- common to fee an eruption on the fkin, re- fembling that called the red-gumr, in the month, and fometimes even the thrufh will make its appearance, though the infant may have had that complaint already ; which are marks of the great difturbance the firft paflages have fuffertd, and of the confent they have with the fkin ; the former, it has been faid, is always a favourable indication ; but the obfervation does not hold good in regard to the thrufh. Fevers in children of three or four years old, are fometimes tedious of cure by any of the above means, and like thofe of aiults, require the bark ; which fhould be adm;- N 3 Altered 150 Fevers. niftered in a light decoction three or four times a day, in fuch dofes as the fymptoms may require. I have fometimes met with a fever, more remarkable for its being attended with in- flamed and painful tumors, than for any other fymptom peculiar to it. Thefe are feated chiefly on the legs, and particularly along the fpine of the tibia ; and rife in a day or two to the fize of a nutmeg. They are marked with all the appearances of ab- fceffes, feeling as if they contained matter, and on this account, they put on a formi- dable afpect to fuch as may not often have feen the difeafe; but what is remarkable, they never, I believe, come to fuppuration, but difappear again in a few days, though the fever fometimes continues. The like appearances have been met with in adults, and efpecially females, but perhaps more commonly in children from three to ten years of age ; and are not peculiar to fcro- fulous habits. As far as my experience has gone, (for I believe it is not a very common complaint) they are conjoined more fre- quently with that fever which attends a foul ftate of the bowels, than with any other; which therefore requires repeated purging, efpecially with calomel ; and on this ac- count, the pulvis e fcammon. cum cahme!. becomes a convenient preparation. Saline draughts with the Jpir. atheris vitriolicl may Mejenteric-Fever. 151 be given on the intermediate days, and in the end the bark is commonly ufeful. Mesenteric-Fever. ANOTHER caufe of fever has been hinted at, which is obftructed glands, efpecially the mejenteric ; and is often a fore-runner of the true hectic fever, or fatal marafmus. It, indeed, frequently arifes from fcrofu- la, which then difcovei-s itfelf by other marks ; and will require its peculiar treat- ment. But there is an early ftage of glan- dular obftruction in the mefentery, and of the fever here alluded to, that is often falfely attributed to worms; but will not yield to mere purgative medicines. It at- tacks children from the age of three or four years, the fever remitting, and fometimes intermitting irregularly ; is attended with lofs of appetite, fwelled belly, and pain in the bowels ; the latter more commonly tak- ing place, more or lefs, every day, or is generally more violent if the child be a day or two free from it. After opening the bowels, half a grain, or a grain of calo- mel may be given to advantage, two or three times a week, and on the intermediate days fmall dofes of the natron ppt. either alone, or neutralized with the juice of lemons, or in 152 Mejenteric-Fever. in fome inftances partially fo. If the belly be very coftive, as it often is, an infufion of the burnt fponge and fenna is more effec- tual than any thing; and when ftrained through filtering paper, make a neat pre- paration, and an excellent remedy for many little fevers, in older children, when the prima via, or firft paflages are concerned. When the glandular fever, juft now men- tioned, has abated, fome light bitter, as of camomile flowers, is ufeful to brace the fto- mach and bowels ; and to prevent a relapfe, it will often be found neceffary to adminifter fome chalybeate, of which the Unci, for. martialiumis ufually the moft proper for chil- dren. But as this fever, from its great fatality and frequency, has lately very much enga- ged the attention of writers, it may be pro- per to confider it a little more diftinctly in fome of its principal ftages; in each of which its nature and treatment fometimes materially differ. For before the mesente- ric glands become much enlarged, or the fe- ver continual; whilft the appetite continues, and the firft digeftion is but little impaired, and no purging has taken place ; the open- ing mixture of fponge and fenna, with a few dofes of calomel, and afterwards bitters and chalybeates, are the only remedies very likely to be called for. In this ftate, the diforder may ftill be confidered as in its firft ftage, Mefenteric-Fever. 153 ftage, and of which an unnfual coftivenefs, the hardnefs and recurring pains in the bel- ly, and an intermitting fever, are the prin- cipal fymptoms. The limits of this work, however, will not allow of a particular de- tail of the many others that attend this fever through its various ftages; and it is prefum- ed, they are fo well known to medical peo- ple as to render it unneceffary. But in ge- neral, it may be faid, that indigeftion, cof- tivenefs or purging; irregular appetite ; flufhed cheeks, or a total lofs of colour; impaired ftrength and fpirits; remitting fe- ver ; and a hard and tumid belly, with ema- ciated limbs, are amongft the more conftant fymptoms attending, at one period or other of the difeafe. Children are liable to it from their infan- cy to fix or eight years of age, it being often a confequence of the long continuance of almoft any of the preceding complaints, ef- pecially thofe of the firft paflages and denti- tion, as well as the meafles, and a few o- thers 5 of which that from teething will be feparately confidered. Among the poor, it is too frequently owing to a coarfe and unwholefome diet; indigeftion at the fto- mach, and a confequent vitiated chyle, with infarction, or obftructions in fome of the internal glands or lymphatics, being among the primary remote caufes of the difeafe. 154 Mejcnteric-Fever. As prophylactics, or preventives there- fore, good air, exercife, gentle frictions, an eafy drefs, frequent walkings of the bo- dy of young children with foap and warm water,* the cold-bath, in older children, and efpecially a light and nutritious diet, with fuch mild aromatics as may aflift digeftion, are fome of the principal and moft efficacious means. But when this fever is actually formed, it calls for the moft powerful remedies; and fuch have happily fucceeded in feveral in- ftances, wherein formerly little hope had been ufually entertained. As I am conftrained to pafs over many lefs important fymptoms occurring in the different ftages of this long difeafe, efpeci- ally fuch as arife from fome peculiarity of habit; fo will it be neceffary to confine thefe obfervations to the more general plan of treatment, without particularly noticing a variety of occafional remedies, which fuch fymptoms might at different periods re- quire. In a general way, the principal indica- tions are to remove the obftructions in the lymphatic fyftem, and effect a refolution of the indurated glands of the mefentery ; to carry * This idea is as ancient as the time of Hippo- crates, who Itrongly advifes it. De catubri Diata. \ IX. Mesenteric- Fever. 155 carry off this vifcid matter; and laftly, to ftrengthen the fyftem, and eftablifli a good digeftion, as well by means of proper diet as by medicine. To accomplifh thefe inten- tions, attenuants and deobftruents, purges and emetics, and tonic, or bracing reme- dies, muft be had recourfe to, in their turns. Amongft the firft, and as general deob- ftruents, are mercurial and antimonial re- medies, neutral falts, foap, fteel, and, ac- cording to fome, the cicuta. In regard to the efficacy of mercury and fteel in this difeafe, a vaft croud of teftimo- nies appears among writers,* in almoft eve- ry part of Europe. And a very rational idea has been fuggefted on this head, by Mr. Royer, that of adminiftering mercury clyf- ter-wife ; inafmuch as the refolution of local and partial obftructions, does not fo much require an exertion of the collected force of the fyftem, as deriving all the influence of proper remedies to the feat of the difeafe: an idea of late years pretty generally re- ceived, and in fome inftances, fuccefsfully adapted to the cure of fcrofula, as well as fome other chronical diforders. Calomel * White, Hartmann, Worlhof; Theden, Burch- arJ, Baurne, Baumes, Rofeen, Fouquet, &c i$& Mejenteric-Fever. Calomel is, perhaps, one of the fittcft remedies of this clafs, and may be combin- ed with fome purgative medicine, and given for feveral weeks, till there fhall be fome favourable change in the feel and fize of the belly. The Kghteft preparations offleel are ufu- ally preferable, fuch as its tinctures, or the fait, or merely fome chalybeate water; which will act both as aperitives and tonics; and amongft antimonials, the kermes mineral is found by experience to be more generally ufeful than any other preparation. The Evacuants mentioned as proper in this difeafe, were emetics and purges; to which may be added diaphoretics. The two former are more effentially neceffary ; but muft be adapted and carefully dofed, agreeably to the ftate of the bowels of the patient. As a purge, rhubarb and fait of tartar are generally the fafeft and moft ef- fectual, and may be perfevered in for the greateft length of time ; or the competition which, in regard to many cafes, has been defervedly extolled by Sir William Fordyce, rhubarb and polychreft fait; which, when- ever mercury may not be preferred, fhould be exhibited daily for feveral weeks, and will fometimes reftore the patient without recourfe to any other means, when the dif- order is not of long ftanding; being at 2 once Mejenteric-Fever. icy once both a purge and an efficacious deob- ftruent. As a Diaphoretic, farfaparilla, or a more compound decoction of the woods ; which may be taken together with any of the above mentioned remedies. The laft means recommended were tonic, or bracing medicines, which can very rare- ly be difpenfed with ; fince although the obftructions fhould actually be removed, the emaciated ftate to which the patient is ge- nerally reduced, peculiarly calls for bracing remedies, efpecially with a view to ftrength- ning the ftomach and alimentary canal, and promoting a good digeftion ; the only means of obtaining a bland and nutritious chyle, by which the body may be conferv- ed in good health. To this end, the bark, fteel, the cold-bath, light bitters and aro- matics, are the principal remedies ; to one or more of which, recourfe may be had, as the degree of remaining fever, and the ftate of the bowels may point out. To thefe may be joined daily frictions, efpecially of the belly and limbs ; or the common foap- plaifter, or one compofed of ointment of niarfh-mallows, gum ammoniac, and oil of chamomile, applied over the whole belly : or the body may be covered all over (as di- rected by Mr. Baumes) with fea-falt, reduced to a very fine powder. O It 158 Mejenteric-Fever. It has been already hinted, that the diet ought to be of the lighteft and moft nutriti- ous kind, and carefully adapted to the age and other circumftances of the child ; who, if at a due age, ought in many inftances, to partake of light white meats, as well as vegetables, and plain jellies ; but always avoiding fat and greafy aliments, paftry, and whatever may not be duly, as well as quickly digefted, or will not form a bland and nutritious chyle, however readily they may get out of the ftomach. Though in fome inftances, merely pur- ging with calomel or rhubarb, for a length of time has been faid to fucceed, and in others, fome one of the above remedies may be more adapted to the patient than the reft ; yet in general, each of them will be ufeful, at one period or other of the com- plaint, and fometimes the union of feveral: but above all, purging is always the moft effential to the cure of this dangerous dif- eafe. And though it is oftentimes attend- ed with coftivenefs and a voracious appetite, it is, at others, accompanied with a loathing of all food, and frequent ftools, which do not reduce the belly, but too often deter practitioners from the ufe of active, or re- peated purges ; without which, however, experience proves there can be no profpect of fuccefs, after the belly has once become enlarged.—I fhall clofe thefe obfervations Heclic Fever, Sec. 159 with offering the following form, which in a general way, may be as fuitable as any. It fliould be continued for a length of time, taking care that the bowels be kept proper- ly open by it, or by other remedies occa- fionally adminiftered. . R. Calomelan. gr. j. ad. ij. Pulv. Ipecac, grfs. ad. gr. j. Zingiber, gr. vj. Mifce, ft. Pilulce is, cum quantitat. fuffi- cient. vel. Conf. aromaticse, vel Conf. opi- atac, ut alvi flatus poftulct. Hectic Fever, and Marasmus. M OT a few, both of the preceding and following complaints, are fometimes found to induce a confirmed hectic fever, and marafmus, or a wafting of the whole body, called by fome writers Atrophia Lac- tantiwn ; though it often comes on too late properlv to admit of the name. I have no- thing new, indeed, to offer on this difeafe when it feems to be far advanced, unlefs it be by way of encouragement to hope fcr a better iffue in the hectic fever, under cer- tain circumftances than we are wont to ex- pect. This fever, as it is apt to arife from other O 2 complaints,' _ 160 Heclic Fever. complaints, is very often owing to their ha- ving been imprudently treated, or imper- fectly cured, efpecially by fuppreffing fome eruption or difcharge from the fkin, or in- cautioufly flopping a purging during the time of teething. In fuch cafes, and indeed whenever the hectic fever is of fome ftand- ing, the mesenteric glands become indurated, greatly increafed in fize, and often fuppu- rate, the belly getting large, though the limbs and other parts become emaciated ; which ftate has been treated in the former chapter, and has been fhewn to be curable, or otherwife, according to the degree of in- duration, and the length of the time it has exifted. But there is fometimes a threaten- ing appearance of hectic fever, where ne- verthelefs nature effects a falutary and won- derful change, and will reftore the emacia- ted infant as from the very jaws of death. .And this, indeed, is often the work only of nature, art doing no more than fuperin- tending it, and preventing her being coun- teracted by the ufe of improper medicines, or die:?. Nature alone wiil, indeed, oftentimes effect wonders for infants, and far beyond any thing to be expected in adults, if fhe be not officioufly counteracted. And the reafon is obvious, it being well obferved by a and Marafmus. 161 a great man, and a good phyfician,* lately deceafed, that " there is, in truth, a great- er luxuriancy of life and health in infancy, than in any other period in life. Infants, it is acknowledged, are more delicately fenfi- ble to injury, than thofe advanced in life ; but, to compenfate this, their fibres and veffels are more capable of diftenfion, their whole fyftem is more flexible, their fluids are lefs acrid, and lefs difpofed to putref- cence ; they bear all evacuations more eafi- ly, except that of blood, and, which is an important circumftance in their favour, they never fuffer from the terrors ofyn diffracted imagination. Their fpirits are lively and equal ; they quickly forget their paft fuf- ferings, and never anticipate the future. In confequence of thefe advantages, children recover from difeafes, under fuch unfavor- ble fymptoms as are never furvived by adults. If they wafte more quickly under ficknefs, their recovery from it is quick in proportion, and generally more compleat than in older people, as difeafes feldom leave thofe baneful effects on their conftitutions, fo frequent in adults. In fhort, a phyfici- an ought fcarce ever to difpair of a child's life, while it continues to breathe."—In O 3 farther t Dr. Gregory—Comparative view of the State and Faculties of Man with thofe oj the animal World. 1735. 102 Heclic Fever, fanher fupport of this fentiment it may be obferved, that their complaints are not often attended with acute fever, like thofe of adults, which is difpofed rather to break up the fyftem, than to rectify the machine. The above mentioned falutary turns in the true hectic fever, as far as I have obfer- ved, are chiefly in that fpecies of it arifing from worms or teething ; and in wdiich I have known recoveries after hope had long been given up, and all attempts been laid afide. There is, indeed, an atrophy, or uni- verfal decay in infants, for want of the breaft, or from the unfuitablenefs of it, or of what- ever elfe may be the child's ordinary food, (as 1 fhall inftance in another place :) but this is not ufually attended with fever, and is to be cured merely by making that change, which the nature of the different occafions points out. Harris recounts fome remarkable recoveries in what he calls the Atrophia verminoja, (or Worm-hectic) and attributes the cures to the free ufe of the hydrargyria cum fulphure, carefully prepa- red; but I have feen none fo marvellous as in the Atrophia Denientium, or Tooth-atrophy. In this, I have known children after being reduced by purging, and other complaints, lyingforthree months togetherin the cradle, fcarcely fit to be moved, with continual fever, fluflied cheeks, emaciated countenance and limbs, a large beily, inceffant cough, and almoft and Marafmus. 163 almoft without taking any nourifhment, re- cover, as it were in a few days, upon un- expectedly cutting half a dozen teeth. After what I have faid on this fever, it will not be expected I fhould offer much on the head of medicines ; I fliall therefore only obferve, that after makiug trial of the mixture recommended by Boerhaave,* when acidity may prevail in the bowels, or pre- ferring opening medicines, as directed un- der the heads of coftivenefs and purging, are the chief indications in this advanced ftage of the complaint. With this view, Sydenham's rhubarbrbeer, f and purging with mercury, if that has not already been done, fhould even now be attempted, fince children in this ftate will often bear ftronger dofes of purging medicines, and more fre- quently repeated, than under any other cir- cumftances.-----Some attention, however, fhould be paid to the diet, which ought fhould * Page 85. j Take of choice rhubarb fiiced, two drams ; let it be put into a glafs bottle, well flopped, with a quart of fmall-beer, or any other liquor the child may make ufe of. ( This medicated beer is to be his ordinary drink. When this quantity is drank, a fecond, and a third quart of beer may be poured on, as before ; afier which the rhubarb will commonly h::ve loft its virtue. Should the beer firft poured on be too much impregnated with rhubarb, and purge vco much, another pint may be added prefently af- ter the firft is drank up. 164 Heclic Fever, &c. chiefly to be of milk, rice, femolina, and fuch like, with light puddings ; but above all, plenty of frefh air, and as much exer- / cife as the weak ftate of the child will bear. In Dr. Armftrong's fecond edition, is a pretty long chapter on the hectic fever of teething children, wherein feveral medicines are prefcribed, which the doctor appre- hends may be very ferviceable early in the difeafe. He fpeaks of it as a very common complaint, beginning like other fevers, and gradually becoming remitting ; then a flow continual fever, and terminating in a fatal hectic. It is very probable, that a fever of this defcription, may be common among pau- pers, relieved at difpenfaries, and may de- ferve fuch a name, but, I believe, it will be rarely met with in higher ranks of life ; and if fo, perhaps, that ought to have been intimated in a popular work. It feems to me, (and Dr. Armftrong, indeed, fays as much) to arife from improper food and nur- fing, joined with a coftive ftate of the bowels, and is therefore, very much the offspring of neglect. When advice is fought for in pro- per time, it, accordingly, appears to be nothing more than the common fever I have defcribed, arifing from a foul ftate of the bowels, and is eafily cured by fuch medicines as are beft calculated to clear the firft paflages. Should this, however, be neglcaed, it may degene- Scarlet-Fever. 165 degenerate into a continual fever ; but it is not even then peculiar to the age Dr. Arm- ftrong has fpecified, nor, by any means, the common hectic fever of dentition. Febris Scarlatina—Scarlet-Fever, with or without Ulceration of the Throat. ■\XfHENEVER the Scarlet-fever becomes epidemic among adults, children rare- ly fail being attacked by it, in great num- bers, and frequently fink under it. This difeafe has, indeed, engaged the pen of the moft able phyficians, and has lately been accurately arranged by Dr. Perkins. It is therefore well underftood in this day, at leaft in the metropolis, and needs only on this occafion, to be adverted to as one incident to chidren, and its moft approved method of treatment to be briefly pointed out. The fdrlet-fever with ulcerated throat, has, perhaps, been diftinguifhed in too re- fined a manner, by fome writers, into the fcarlet-fever with malignant ulcerated throat, and the malignant fore throat with effloref- cence, or rednefs, on the fkin. But fuch diftinction, it is apprehended, is needlefs, fince the experienced practitioner will al- ways be guided by the degree of tendency i 1 the fyftem either to an inflammatory or 166" Scarlet-Fever. putrid diathelis ; and the lefs experienced will only be perplexed by multiplied;^/dif- tinctions. The mildeft fpecies of Jcarlatina anginoja fliould, however, be carefully diftinguifhed from the true inflammatory affection of the tonfils, which the angina maligna-w'iW fome- times refemble in its firft ftages: but the genuine marks of the two difeafes, and the caft of the epidemics reigning at the time, will direct the attentive practitioner ; who will in lefs certain cafes, take a middle courfe in his method of treatment, till the charac- teriftic fymptoms of either fhall become more evident. There is, however, a fcarlet-fever that is not atended with any affection of the throat, and was long ago defcribed by Sydenham,* though not much infilled upon by later wri- ters, which is attended with a harder pulfe, and other fymptoms of an inflammatory difpofition, but neverthelefs, in every in- ftance that I have met with, calls for the fame general treatment, only more cauti- oufly adapting the neceffary cordials and to- nics to the degree of fever, efpecially in the commencement of the complaint. The febris Jcarlatina of every fpecies be- gins with the common fymptoms of fever, often with languor and difpofition to faint- ing * See alfo Withering and Cullen. Scarlet-Fever. 167 ing, ficknefs, a quick pulfe, and pain in the head. The eyes are often inflamed, and where the throat is affected, there is fre- quently a ftiffhefs of the mufcles of the neck very early in the difeafe, which is foon fol- lowed by fome difficulty in fwallowing. The fever generally increafes in the evening, and is often attended with tranfient fits of deli- rium ; but fome remiflion takes place tow- ards morning, with fweating ; and on the fecond, or third day the efflorefcence ap- pears on the ikin, and generally firft on the face, neck, and breaft. The limits of this work allow me only to obferve, that the method of cure being di- directed to the two indications of the gene- ral diathefis, and the affection of the throat, the nature and extent of thefe muft ever be kept in view, and the fyftem be duly fup- ported. The throat fhould be often gar- gled, or rather fyringed, with mucilaginous infufions or decoctions, rendered more or lefs ftimulant; fuch as the compound decoc- tion of barley with honey of rofes, warmed with the compound fpirit of ammonia, tinc- ture of myrrhe, or a decoction of fnake- root; or other fuch like preparations. This fever, efpecially when epidemic, being almoft conftantly of a low type, the phyfician muft not truft to faline draughts, or other medicines of that clafs, without the addition of the aromatic confection, fnake- 168 with Sore Throat. fnake-root, or the bark, in one form or other ; and befide thefe, fliould direct a mo- derate quantity of wine to be given with the food, according to the age and other cir- cumftances of the patient. Should the affection of the throat there- fore to be evidently inflammatory, or fliould a cafe occur where the fever may feem to be of that kind, (which may be better afcertain- ed by the hardnefs of the pulfe than any other fymptom) it will rarely, if ever, bear bleed- ing, even in the beginning of the difeafe, as fymptoms of debility generally attend in fome period of the fcarlet-fever, and will al- low only of that middle courfe of treatment, hinted above. In a general way, a cordial plan is re- quired throughout the difeafe, and where the throat is much affected, either with floughs, or total blacknefs, the bark is in- difpenfably neceffary, howefover thick and florid the rafh, or however hot and dry the fkin may be ; the bark, as it were, ex- tinguifhing the fever above every other re- medy. Young chik'ren take it very well, ef- pecially the foft extract, diffolved in a ftrong decoction. Should it be difpofed to purge the child, a little of the fpirit of cinnamon, or a drop or two of the tincture of opium fliould be added to it ; or if the child, on the other hand, fliould be two or three days without a ftool, a laxative clyfter 2 fliould Inflammation of the Stomach. 169 fliould be injected.—If there is much exter- nal fwelling about the neck, blifters to the part are frequently very ufeful—Even af- ter the tfflorefcence has dried off kindly, a gangrene has fometimes feized the whole pa- latum molle. Cardialgia, or Inflammation of the Stomach. THIS is a difeafe very feldom met with, I believe in this country, but is com- mon in France, as it appears by a paper read lately before the Royal Society of Me- dicine, in Paris, by Mr. Saillant; and is faid to attack children of four or five years of age. The pathognomonic, orcharacteriftic fymp- toms of this difeafe are, violent pains in the region of the ftomach, fometimes recurring every quarter of an hour ; violent contor- tions of the child ; and the application of a hand to the feat of the difeafe. Mr. Sail- lant in the firft inftance, fufpected that thefe fymptoms might be owing to worms, and prefcribed accordingly ; but that child dy- ing in a few days, the body was afterwards opened, and the prefenee of genuine inflam- mation of the ftomach, and of a part of the inteftinal canal was clearly demonftrated. P The 170 Inflammation of the Stomach. The treatment of this dreadful difeafe is, however, reprefented as very fimple, con- fifting only in cooling and laxative remedies, which when adminiftered in good time, are faid to be ufually fuccefsful. For this pur- pofe, Mr. Saillant has generally adminif- tered the juice of the lettuce, by fpoonsful, every hour ; an idea he took up from Bag- livi, who directed the juice of the fow- thiftle in the hemitritus, under fymptoms analogous to thofe of the cardialgia. The juice of the lettuce was generally /^jWrfound to relieve the pains in a fhort time, and fome infants who had been judged to be in a hopelefs ftate, and even at the point of death, were perfectly recovered. * Mr. Andry has done me the kindnefs of acquainting me, that he has fometimes met with this complaint, in the hofpice des en- fans trouves, efpecially during the fummer, and at fuch times as infants have been obli- ged to continue there without the breaft, for the want of wet nurfes ; who are ufu- ally otherwife engaged in the harveft and vintage feafons, as well as during a hard froft. In the inftances Mr. Andry has feen, the infants were found to vomit up every thing that was given them, which it is pro- bable, muft generally be the cafe where the ftomach is actually inflamed. In fuch in- ftances, perhaps, fomentations to the fto- mach, and the ufe of a warm-bath ought to be made trial of. Small- [ >7" ] S M A L L-P O X, (I N o C U L A T i o n) and Measles. T T were very foreign to the prefent inten- *■ tion to treat diftinctly of thefe difeafes and their feveral varieties, being in no re- flect peculiar to childhood, and are noticed only to point out a few principal indicati- ons, and to introduce fome obfervations in regard to the propereft time for inocu- hition. Though the Small-pox is a complaint fo incident to the early part of life, that comparatively few children living to the age of eight or ten years, are found to efcape it, yet it is not fo readily communicated, in the ftate of infamy, as hath been general- ly imagined, unlefs by immediate infection.* ■P 2 The # # Some evidence of the propriety of this affer- tion may be gathered from the confideration of there always exifting a far greater number of infants within the month, than of children of any other age ; and for the like reafon, a greater number of thofe tinder a year old, than of fuch as arc two or three years of age. For, every infant that dies at the earlier periods, reduces the number to which thofe of the more advanced ages might otherwife have amounted ; whereas, all the children who ar- rive to two or three years of age, having been firft infant's in the month, and of one year old, the num- ber of the latter periods is not diminifhed by the death. i J 2 Small-pox, (Inoculation) The poor furnifh frequent inftances of the truth of this obfervation. I have at- tended where children born in an air, fatu- rated as it were, with the miafma of this difeafe, (as well as of the meafles) and even tying continually in a cradle in which ano- ther child has died a few days before, have neverthelefs efcaped the difeafe, and fome- times when they have flept together in the fame bed with one loaded with it. Hence it appears that highly tainted air, and even perfonal contact, are often infufficient to communicate the virus. Yet we know that r infants death of rhofeof a more advanced age. Now, eve- ry one knows how very few infants he has heard of who have received the fmall-pox» naturally, in the month, or even within the year ; though few- er of thtfe are inoculated than of children above a ycr.r old. And this exemption from the natural fmall-pox does not feem to arife from their not be- ing expoftd to the ordinary means of contagion, efpecially among the middling and lower ranks of people who form the bulk of mankind ; fince the medical men who ufually attend fuch lying in rooijw, arcvery much in the habit both of viliting the fmall-pox, and of inoculating, all the year round : and even in the higher ranks of life, if gentlemen in the general practice of phyfic happen to be confulted, the chance of their vifiting at the fame time infected patients, is not fo fmall as uaay be imagined ; not to fpeak of the probability there is, that fome one of the numerous vifitors, during the month, may by accident or otherwife, have been in fome infected houfe in the courfe of the day in which their vifits may be made. and Meafles. iy$ infants are very eafily infected, receiving the fmall-pox by inoculation as readily as adults; though neither are at all times e- qually fufceptible of it, Perhaps this latter circuraftance may not always be fufficiently attended to ; the mode of inoculation being often blamed, when its failure may be ow- ing to the indifpofed habit of the child. Poffibly, on this account, it may not be perfectly fafe to urge it, at fuch a time ; at leaft, inftances are not wanting, where twice introducing the virus having failed, an in- fant has had the difeafe very feverely, and even fatally, upon its being repeated a third j time. But in whatever way the fmall-pox or meafles may take place, they are to be treated as in adults, with but little other difference than what every practitioner is well acquainted with, that of greater cau- tion and tendernefs; as infants cannot bear the powerful antiphlogiftic regimen and eva- cuations, often proper for the other. * In the treatment of the Measles, not only ought children's bellies to be kept open throughout the difeafe, but unlefs they are very young, they will bear and even require one or more bleedings, at any period of it when the fymptoms indicate its propriety. P 3 And, * Ex toto, non fie pueri, ut viri, curari debeat. Celfus. Lib. in. cap. 7. p. 134. 174 small-pox, (Inoculation) And, indeed, the cure of the fecondary fe- ver, however long it may continue, will turn upon repeated bleedings, laxatives, and a total abftinence from wine, and all animal food. I have now only to drop a word or two on the fubject of Inoculation, becaufe pa- rents are very apt to fall into great miftakes reflecting the age, and circumftances moft proper for this operation. It is too common an opinion that a very young infant, fucking at the breaft, is the fitteft fubject for inoculation, and medical people have fome difficulty in perfuading parents to the contrary. Children are then faid to be clear from humors, their blood mild andbalfamic, their food innocent, and they are free from all violent paflions of the mind. But all thefe advantages may be counterbalanced by the delicacy of their frame, their difpofition to fpafm, and their inability to ftruggle with a fevere attack of the difeafe, if it fhould chance to fall to their fhare. And fuch, indeed, are the facts ; infants ufually have the fmall-pox very lightly, whether taken naturally, or from inoculation; though in both there are inftances of their expiring in a fit at the time of the eruption ; and they feldom get through the difeafe, if they are full, or it proves of the confluent, or malignant kind. And this ifumiflies a peculiar objection to inoculating and Meafles. 175 inoculating infants at the breaft, which arifes from their neceffarily lying fo much on the arm of the mother, or the wet-nurfe, efpe- cially in the night; the heat expofing them to a much more copious eruption, #than children who are weaned. This I have feen clearly exemplified in the inftance of a child whofe mother could fuckle only with the right breaft ; the confequence was, that the left fide of the child was perfectly load- ed with the eruption, (though the pock was of the diftinct kind) wnflft the other had on- ly a very moderate fprinkling. The child, however, funk under the fecondary fever at the end of five or fix weeks, though turned of two years old ; the only child I have known to die of inoculation at fo ad- vanced an age. I am aware that many children are inocu- lated very young, and even in the month, and generally with very good fuccefs; but the frequency of this practice, among emi- nent furgeons, its owing to the urgent foli- citation of parents, and their fear of conta- gion. I cannot therefore avoid faying, that however few may die under inoculation, un- der any circumftances, the fact is, that the far greater proportion that I happen to have had an account of, is amongft infants under fix months old. From this view of the matter, it is pret- ty evident, I think, that this operation ought, 176 Chicken-pox. ought, ufually, to be poftponed to a later period, which is pointed out by the child having cut all its firft teeth. To which may be added the obfervation juft made, that infants are not much difpofed to take the fmall-pox naturally, and that fifty chil- dren die under the age of two years, of 0- ther complaints, to one that dies of the na- tural fmall-pox. Should it, however, be in the fame houfe, or prevail in the neigh- bourhood, and the parents find it difficult to remove the child out of the way, it may run a lefs rifk in being immediately inocu- lated, as that operation is now fo well un- derftood, and fuccefsfully conducted, than by taking the chance of efcaping the infec- tion, or of recovering from the difeafe, if it fliould happen to take place. C h 1 c k e n-p o x. "pOR the reafon given in the former chap- ter, I fhall be very brief on this head. The complaint, neverthelefs, merits a few words, not only becaufe more incident, per- haps, to children than to adults, but alfo that parents are often at a lofs to diftinguifh it from the mild fmall-pox ; which it fome- times exceeds in violence, and is now and then even attended with danger. This is, indeed, not often the cafe, and the difeafe has LUicxen-pox. ijj has therefore been very feldom noticed by medical writers ; and even Dr. Heberden, who was among the firft that obliged the public with a diftinct account of it, fays he never faw any perfon with fo many as three hundred puftules over the whole body. Phy- ficians, indeed, as he obferves, are not of- ten called to vifit patients under a complaint ufually fo trifling, or a gentleman of his long and extenfive practice, would have met with inftances in which it muft have appeared of more confequence, as will pre- fently be noticed. It is from this difparity, I apprehend, that this diforder is fometimes denominated the fwine-pox, which is only a ranker fpecies of the difeafe, in which the fymptoms may run higher, as w?ell as the puftules become much larger. In this cafe, I have known the head and face as much fwollen as I have ever feen them in any diftinct fmall-pox, however full, and the puftules containing a yellow, and feemingly purulent matter, with highly in- flamed bafes, and exceedingly fore; and thefe have formed a complete mafk on the face, after the turn, as is often feen in the fmall-pox. One fuch patient whom I was called to vifit, was about fixteen years of age, of a plethoric habit, but very healthy; and what makes it very certain, that this complaint could not be the fmall-pox, is, that the young gentleman died of that dif- order 178 Chicken-pox. order a twelvemonth afterwards, and pofli- bly owing to its being neglected in the be- ginning, from an idea that the former illnefs had really been the fmall-pox. The latter miftake arofe from an improper anfwer hav- ing been then made to my enquiry after the day on which the eruption had firft appear- ed (as I was not called in to vifit him till the diforder was at the height) ; a miftake the young gentleman's mother had a perfect recollection of after I was gone, and of which I reminded her upon being called to vifit him in the fmall-pox, only the day be- fore his death. This cafe ftrongly verifies the remark of Dr. Heberden, that this complaint can, in fome inftances, be diftinguifhed from the fmall-pox only by its quicker progrefs to- wards maturation, and the fhorter duration of the puftules; a watery veficle always appearing on the fecond or third day from the eruption ; and the turn, at the fartheft, taking place on the fifth. The treatment of it differs nothing from that of the mild, diftinct fmall-pox ; but it more rarely calls for much attention, and only when a patient may have it very full. Ague. [ *79 ] Ague. '"THIS is a complaint fo well known, that it feems unneceffary here to enter mi- nutely into a defcription of it. It is fuffici- ent to fay, that it confifts of repeated cold and hot fits regularly fucceeding each other, with one or more well-days between them ; in which interval the fick paffes a high-co- loured urine, that depofits a red fediment. It, perhaps, partakes more of a nervous affection than other fevers may do, and is known to be endemic in fome flat marfhy fi- tuations, but is moft frequent in the fpring and fall of the year ; in the former of which it is generally eafily cured, and is even fome- times falutary. Autumnal agues, on the other hand, efpecially in the country, and amongft the very poor people who feed coarfely, will frequently continue a long time, and return again the next autumn ; whereby the conftitution becomes confider- ably impaired. In fuch inftances the legs are apt to fwell, and more efpecially the belly, which becomes hard, particularly on the left fide, and has been termed the ague-cake. This tumefaction, however, inftead of being a bad fign, as might be fuf- pected a priori, is a very favourable one, and indicates the recovery of the patient. This i8o Ague. This circumftance is noticed by Sydenham, and like other obfervations of that attentive practitioner, is a very juft one, and was doubt- lefs, the refult of his experience. The hardnefs is probably owing to an infarction of the fpleen, and ufually fubfides in the courfe of a few months, efpecially upon the ufe of moderate exercife, and a generous diet. It may be prudent, however, to ad- minifter fmall dofes of calomel, and after- Wards light bitters, adding likewife chaly- beates; if the habit of the patient feems to require them, and there are no fymptoms of morbid affection of the vijeera. It were needlefs to enter more largely in- to the fubject, and it is equally foreign from the prefent intention, to be more particular in regard to the cure of this oftentimes very troublefome complaint, as it would lead me farther than would be compatible with the defign of this work. Some notice of it, however, is taken becaufe, though no more peculiar to children than the laft mentioned crifeafes, yet it may be faid, that there are comparatively very few children who have not fuffered by it during the years ufually pafffed at fchool. The ague, indeed, attacks every age, (o that infants even under a year old are very liable to it, whenever it rages among adults. It is with a peculiar view to patients of the former clafs that the following directions are 2 given Ague. 1^1 given, the bark being ufually a fpecific for older children and grown people ; to whom, however, it is generally proper firft to ad- minifter a vomit, and one or more dofes of phyfic. In a ftate of injancy, the ague is often ow- ing to, or connected with a foul ftate of the bowels and obftruction of the gall-ducts,and is frequently accompanied with worms, or fuch a ftate of the alimentary canal as affords a proper nidus for them. The tertian, or more common ague, at this age generally yields to purges of the bafilic powder, or calomel and rhubarb, given on the days between the fits, and fmall dofes of Dr. James's powder on the return of the fever. Should this fail, a vo- mit fhould be adminiftered an hour or two before the next cold fit is expected, if the powder fliould not already have had that effect. In older children, the common fa- line draught, taken once in fix or eight hours, will frequently fucceed, as will warm bitters, and medicines that promote and keep up perfpiration. A linen waiftcoat with fine powder of bark quilted within it may be worn by infants next their fkin. Amongft popular remedies,* is a tea- Q_ fpoonful * It is hoped, thatai'efire of enabling .readers to affift their country poor, will be admitted as an aro- logy 18 2 Ague. fpoonful of white refin in fine powder, mixed with the like quantity of pounded loaf-fugar, taken a little before the cold-fit, and repeat- ed afterwards night and morning. Poor people, or fuch as live in the country at a diftance frwi medical help, may make trial of it with fafety, and with as good profpect of fuccefs as any other remedy I know of, having found it fuccefsful even where large dofes of the bark have failed. Such kind of remedies for this difeafe are numberlefs; I fhall, however, mention another, which, though as anile as any, feems to have been very often fuccefsful ; and is nothing more than the fpider's web, rolled loofely up to the fize of a child's marble, and wafhed down with a little warm wine and water, or camomile tea, before the cold fit is ex- pected : the child fliould then be put into a warm bed, and perforation be encoura- ged. Crude fait ammoniac, in the dofe of ten or twelve grains, for children of five or fix years of age, has fometimes cured this trou- blesome complaint; but may not be proper for delicate conftitutions. Myrrhe is abet- ter remedy for fuch, given from four to eight grains, before, or during the cold-fit, and as much cream of tartar, every two or three logy for this and other fiuiilar pafTagcs met with ift this work. Ague. 183 three kours, during the fever. Pepper, and likewife alum, are frequently given with fuccefs at this age, the former from five to ten grains ; the latter from three to five, joined with the like quantity of nut- meg, three or four times a day in the ab- fence of the fever. Another good remedy is flowers of brimfione, given in the quan- tity of a table fpoonful in a -Lfs of brandy, before or during the cold-fir ; this is a pro- per dofe for adults, but I have never admi- 1 iftered this medicine to children. I fhall clofe this lift of remedies wi.h the following from Dr. Kirkpatrick, which is a very good one for patients no otherwife averfe from the bark, than that the ftomach will not bear it in large dofes. Take of the frefh faffafras bark, of Vir- ginia fnake-root, of roch-allum, of nutmeg, of calcined antimony, and fait of wormwood, of each one dram : to thefe, well rubbed together into a fine powder, add the weight of the whole of the beft Peruvian bark, then add three or four drops of the chemical oil of mint ; and with fyrup of faffron make all into the confiftence of an electuary. This is to be divided into twenty-four dofes, one of which may be taken by children of eight or ten years of age, every four or fix hours, while the patient is awake.—To make this or any other preparation of the bark fit bet- ter on the ftomach, the patient fliould firft Q 2 eat 184 Hooping-Cough. eat a bit of bread, or other light food, that the bark may not be received into an empty ftomach. Hooping-Cough. THE Hooping-cough is a difeafe un- known, probably, to the old writers; the Greek and Arabian phyficians make no mention of it, and indeed it has not been well underftood in any part of Europe, till of very late years. Even Willis fuppofed its feat to be in the breaft, but Harvey makes it a difeafe of the ftomach, and Aftruc an inflammation of the larynx zndpharynx, pro- duced by an original affection of the former, from indigeftion. He feems to have been one of the firft that difcarded the ufe of oily and pectoral medicines, (which indeed fome practitioners have been weak enough to re- vive) ; though he advifed bleeding too in- difcriminately.* Mliis diforder furniflies another proof of tire obfervation made on the impropriety of fubmitti-g the complaints of children to im- pn per h;md-—the care of old women, and frequent change of a'r, being all that this diforder is thought to require : but perhaps the maxim was never worfe applied. There is, * See his Difeafes of Infants. Hooping-Cough. 185 is, indeed, a milder fort of hooping-cough, as there is of every difeafe, that calls for very little medical affiftance ; and it is al- ways in fuch cafes, that matrons and nurfes acquire their credit. But there is no com- plaint of children with which I am at all acquainted, in which medicine is at times more evidently ferviceable, than abad hoop- ing-cough. This difeafe is certainly highly infectious, and one of thofe that never appears a fecond time. It often begins as a common cough, and is attended with the ufual fymptoms of having taken cold, but in its progrefs foon becomes more fevere : the longer it may be before it plainly difcovers itfelf, by the hoop, the more favorable it is likely to be. The fits of coughing are attended with a peculiar noife, not ill-expreffed by the term hoop, and is fufficiently knov.n to every parent who has ever had a child feverely attacked by it, and to whofe feelings, it proves one of the moft diftreffing complaints their children are liable to. A flux of rheum frequently comes from the mouth,nofe, and eyes, and the food is thrown up, together with a vifcid phlegm, (often in great quantities) in the coughing fits ; between which the child generally ap- pears to be perfectly well, and eats its food very heartily. Thefe are the more cb"'unon fymptoms, but when the difeafe is violent, and has continued for feme t:mJ, they be- f Qjj .come 18 6 Hooping- Cough. come greatly aggravated, efpecially in the night, and the child will feem almoft ftran- gled in each fit, and the face and neck be- coming perfectly livid, till by a violent effort, attended by a hoop, it recovers its breath ; the blood will likewife fometimes rufh from the nofe and mouth. When taken in time, and properly treated, it is, however, rarely fatal, and fcarcely ever but to young in- fants. Dr. Armftrong has ftrongly recommend- ed wine of antimony as the proper and only remedy* for this, as well as for almoft every other complaint of infants, which, however oppofite, in this cafe, the remedy may be, in a general way, is faying no more than that emetics and gentle laxatives are ufeful, which all modern practitioners are agreed in ; and in which view, Dr. James had long before recommended his powder. But the fact is, that many other means are equally ufeful, and not unfrequently indifpenfably neceffa- ry, unlefs we fliould fuffer the patient to be ftrangled in a fit of coughing, or fall into a decline, from the injury which the lungs muft endure by a frequent repetition of fuch violence. This muft be exceedingly apparent from the above hiftory of the difeafe, the various fymptoms * In his fecond edition, many other means arc recommended. Hocping-Cough. 187 fymptoms of which, certainly demand a con- siderable diverfity in the treatment. The more important ones are, the ftate of in- flammation, fometimes inducing peripneu- mony ; the quantity and vifcidity of the phlegm ; and the fpafmodic affection, and danger of fuffocation ; together with the exhaufted ftate into which the patient may be reduced by the long continuance of the difeafe. If the breathing therefore be difficult, a blifter is indicated, which if the child is not very young, may be kept open for two or three weeks. If the face fhould be very livid and fwollen, during the fits of coughing, if any veffel give way, or the patient be plethoric, and more than two Or three years old, or fhould be hot between the paroxyfms, a little blood ought to be taken away, (which is fometimes inexprefii- bly ufeful) and a faline draught be admini- ftered, every fix or eight hours, till the fe- ver fhall difappear. Otherwife, if none of thefe fymptoms attend, bleeding does not feem, in general, to be indicated, but may rather have a tendency to protract the dif- eafe, by increafing the fpafmodic difpofition, and by weakening the patient. If there be an inclination to vomit, it ought to be encouraged, unlefs the phlegm be brought up with great eafe in almoft eve- ry fit of coughing, in which cafe, nature feems able to acc«mplifli the bufinefs her- felf 18 8 Hooping-Cough. felf, and it will then oftentimes be fufficient to keep the body open by the mildeft laxa- tive medicines. But it very rarely happens, unlefs in infants at the breaft, that fome kind of emetic is not neceffary in the firft ftage of the complaint. The difeafe, indeed," ve- ry frequently requires no other medicine , for fuch ufually keep the body open at the fame time, which it ought always to be, but not to fuch a degree as to weaken the pa- tient. For this purpofe, perhaps, wine of antimony may be as proper as any thing, when it anfwers the end, but it is lefs cer- tain than tartarifatc d antimony, and is not always, I think, of the fame ftrength. The latter is alfo rather taftelefs, and will there- fore have an advantage over every other medicine, when we are prefcribing for chil- dren. Two grains of this in two ounces of water, with the addition of a little fugar, is a medicine to which children will never make any objection. From one to two tea- fpoonfuls, given to a child of a year old, (varying the dofe according to the age) will ^ in general, act fufficiently ; and may be gi- ven upon an empty ftomach, every day, or every other morning, according to the ftrength of the child, and violence of the difeafe. If the cough fliould happen to be more violent at any particular time, the emetic fhould be given a little before the paroxyfrn is expected. Cr perhaps a ftill better Hooping- Cough. 189 better method, at leaft in fome cafes, and particularly in* very young children, is, to give the tartarifated antimony in fmaller do- fes, together with a few grains of magnefia, or prepared oyfter-fhell powder, (according to the ftate of the bowels) three or four times a day, fo as to keep the ftomach in an irritable ftate, as fhall fecure a gentle pu- king every time the fits of coughing come on. But in whatever way this medicine be directed, it will prove of no fervice if it does not vomir, and muft therefore be given in a dofe fuitable to the ftrength of the ftomach, which is exceedingly Various, not only at different ages, but in children of the fame age, and of the fame apparent habit of bo- dy. If the tartarifated antimony has any advantage of the wine, it has much more over every other emetic 1 have made ufe of, the ipecacuanha, and oxymel of fquills, be- ing exceedingly unpleafant, and the latter likewife uncertain. Such a plan is all that will be neceffary in the common hooping-cough ; but it has been faid, there are many cafes which will require other means, and demand all the fkill of the experienced phyfican. The cough, for inftance, will fomtimes increafe not only for days, but for weeks together, and the ftrangulation be exceedingly alarm- ing. In this cafe, the milk of gum ammo- niacum, but efpecially afa fcetida, frequently proves 190 ' Hooping- Cough. proves a fovereign remedy, and though ex- ceedingly naufeous, many children will take it tolerably well for the fhort time it appears to be abfolutely required ; and when they will not, it maybe adminiftered by way of clyfter, diffolved in two or three fpoonsful of penny-royal, or common water. Thefe medicines, however, will be improper in the very advanced ftage of the difeafe, when attended with hectic heat, hemorrhage, or other phthyfical fymptoms; a cautionequal'y neceffary in regard to the bark, which in the abfence of thefe fymptoms, and after the ftomach and bowels have been well cleanfed, is frequently very ufeful at the lat- ter ftage of the difeafe, when the patient has been exhaufted by its long continuance. Upon the fame plan with the afa fcetida, camphor and caftor are frequently benefici- al, and have the advantage of being lefs naufeous, but I think are proportionably lefs powerful. I take no notice of tincture of cantharides, though ftrongly recommended by fome writers, becaufe 1 have had no ex- perience of it myfelf, and indeed have never found any neceflity for trying it. It will fometimes be of no fmall fervice, to rub the hands, and the foles of the feet, with the compound fpirit of ammonia, fe- veral times in the day ; or the fpine of the back, and the pit of the ftomach, with oil of mace, (fo called) or oil of amber ; but as Hooping-Cough. 191 as the fmell of the latter is very unpleafant, it may be difpenfed with where the fpafms are not exceedingly urgent. But when they are fo, this oil is fometimes very ufe- ful, particularly when adminiftered inter- nally, and children of three or four years will often take a few drops of it very well, mixed in a fpoon with a little brown fugar ; from which I have feen as evident advan- tages, as from any medicine whatever. In a little child of my own, it immediately gave a turn to the complaint in the moft violent hooping cough 1 ever met with, and after almoft every other medicine had been tried to no purpofe ; fo that from the hour fhe took it, the complaint was no longer alarming, nor tedious of cure. But frequently, no antifpafmodic is equal to opi- um, in this, as well as in other difeafes. With this view, two or three drops of lau- danum, and, to younger children a fmall tea-fpoonful of fyrup of white poppies, or to grown people from five to ten grains of the pilula e ftyrace, taken at bed-time, will not only quiet the cough, and remove the ftrangulation during its operation, and pro- cure the patient fome reft, by which the ftrength will be recruited, but in many cafes, feems to have a kindly operation on the difeafe itfelf. It is in this way, I doubt not, that the cictka once feemed to gain fome reputation, but I believe, it is no other- 192 Hooping-Cough. otherwife a remedy for it than an anodyne. From a miftake, however, in this refpect, the ftrong manner in which this medicine has been recommended by Dr. Butter, has certainly done harm ; as I have known ma- ny people depend folely upon it in very bad cafes, to the exclufion of other remedies evidently indicated, which would, at leaft, have fhortened the difeafe. If obftrudtions in the lungs be fufpected, blifters fhould be applied, and recourfe had to gently deobftruent medicines; but at this period, the cure is chiefly to be accom- plifhed by a vegetable and milk diet, (efpe- cially affes milk) pure air, and gentle exer- cife. The cough after having difappeared for a week or more, is fometimes found to re- turn with great violence, efpecially upon taking cold ; but a gentle purge or two, a vomit, and abftaining from heavy food, ge- neral remove it in a very fhort time. If thefe cautions fhould be neglected, the cough will often prove extreme tedious. The only thing that remains to be fpoken of, is the proper diet, which for children even of five or fix years of age, ought to be little more than milk and broths. Thefe are eafily digefted, and will afford them much more good nourifhmerit than any kind of meats, and will fit much lighter on the fto- mach than puddings, or paftry, the latter 2 of Hooping-Cough. 193 of which is exceedingly injurious. The objection made by old nurfes againft milk, that it breeds phlegm, is utterly founded in a grofs miftake that cannot be too frequent- ly controverted. It has, indeed, been fome- times mentioned by a certain clafs of me- dical people, but the objection is fo unphi- lofophical and unlike objections of think- ing men, that it fcarcely deferves a reply. Should the milk, however, be found, to curdle remarkably foon on the ftomach, a little common fait, Caftile foap, or teftace- ous powder, may be added to it occafional- ly ; or where it can be afforded, affes milk may be fubftituted for cow's. Thefe light nourifliments foon pafs out of the ftomach, or if brought up by coughing fifty times in the day, (as I have known them to be) a child of four, or five years old, will immediately take more of them with avidity, and will be better fupplied in this way, I mean by taking a tea-cupful at a time, than by making fet meals, or taking a largequantity at once. If the child fliouldbethirfty, a little apple-water, toaft and water, and other thin drinks, will be pleafant and ufeful. Patients treated in this way, will get through the complaint, if not fevere, in a very fliort time ; and where it proves violent, a child will ftruggle through this long difeafe without any confiderable lofs of ftrength, pr will be very foon re- cruited by a decoction, or cold infufion of R- the J 94 Spajmodic-Cough. the bark, together with gentle exercife, and a little country air, the beft reftoratives af- ter every kind of difeafe. Such at leaft has been my own experience in this tirefome com- plaint, by which I know parents are vfually as much alarmed as by any incident to child- hood. But unlefs it has been long neglect- ed, or taken place in the month, I have ne- ver experienced it to be fatal, and then on- ly in one inftance, though I have known eight or nine children in a family labouring under it at a time ; and I wifh to mention this as an occafion of confolation to thofe who may have been led to think more for- midably of it. Spasmodic-Cough. VERY much a-kin to the former com- plaint, is a troublefome cough, proper- ly enough denominated fpafmodic, or convul- sive. In a certain ftate of the air it is fometimes epidemic, and young children,andeven infants in the month, are then attacked by it, as well as adults. The irritation feems to be about the larynx, (or fuperior parts of the throat) or only a very little lower down, andjs very diftreffing, at the time of coughing ; but the patient, though an infant, feems imme- diately afterwards to be quiet and comforta- ble. This cough is not ufually attended with fever, nor other ordinary fymptoms The Croup, 195 a common cold, nor is it to be relieved by the like means ; the cough remaining dry and hoarfe under the ufe of pectoral reme- dies. Children of four or five years old may be cured by the cicuta, and gentle laxative re- medies ; but the former being lefs adapted to infants in the month, fuch may take a few drops of the fyrup of white poppies, three or four times a day, and their bowels be carefully kept open ; which means feldom fail of removing the complaint in three or four days.—Should the fyrup conftipate the bowels, cr otherwife difagree, Bates's Sp. Sal. ammmon. fiiccinat. may be tried in its ftead ; which is a good medicine in other dry convulfive coughs, where there is no fever. The Croup. THE Croup, or acute afthrna, is a com- plaint fomewhat fimilar to the two for- mer, to which, perhaps, children only are liable, called t:erefore aflhma infantum JpaJ- modicran ; alfc fuffocatioflridula.* It rare- ly attacks thoie who have arrived to the age of ten or twelve years, and chiefly feizes in- fants newly weaned ; at which period it is R 2 the * EJ^uinancie membraneufe. 196 The Croup. the moft fevere. Dr. Millar is, perhaps, the firft perfon in this country who has writ- ten particularly on this complaint ; but it has been mentioned by fome German wri- ters, and well defcribed by them long be- fore it was noticed in Britain. Remote caufes of this difeafe may pofli- bly be the lax fibre of children, the abun- dance of moift humours natural to them, and the vaft fecretion from the bronchial, or air veffels ; and perhaps the change of food from milk, which is eafily affimulated, to one requiring more digeftion. The prophylaxis, or mean of prevention, is the fame as in moft other difeafes pecu- liar to children. If this complaint arife from the laxity of their folids, the quality of their food, and the natural weaknefs of their or- gans of digeftion, the general means of pre- vention, as well as of cure, will be readily indicated.—Their food fhould be fuch as may be eafily digefted, and may prove nou- rifhing. A due proportion of milk and broth, * taken feparately, whilft children are very young, or light meats when they become older ; good air and exercife, and a careful attention to the ftate of their bow- els. The * A diet of milk only, even in adults, when long pedaled in, though otherwife proper, will create flatulencies. Berry on Digeftion. The Croup. 197 The proximate caufe of this complaint is a morbid fecretion of a vifcid mucus in the trachea, adhering fo firmly to its fides as to impede refpiration. The quantity and vif- cidity increafing, gradually leffens the dia- meter of the wind-pipe, and if it effect this to a confiderable degree, the difeafe muft neceffarily prove fatal. The Symptoms of this complaint are fpaf- modic, being fuch as would be produced by any other matter conftantly irritating the trachea, and diminifhiig its diameter. They will therefore very much refemble thofe of the nervous afthma, but the complaint dif- fer? materially from the common fpafmodic afthma of adults, in the peculiar croaking noife made in refpiration, (from whence it has its name) and in the violence of the pa- roxyfms ; which, however, leave no appa- rent indifpcfition, idMe a certain dulnefs, and; a fenfe of u.-.r, in children capable of ex- prefling it. The fits frequently terminate- by fneezing, coughir?. or vomiting, and return without any regularity. It u attend- ed with a quick pv.lfe, laborious broiling, a rii-rp, a id fhrill voice, and h fiufhed countenance, which grows livid during the paroxyires, or fits. The diforder is probably inflammatory in the beginning; and i\z>\ <>;h Vms period feems to be very fliort, yet .Tiould the phy~. fician be confulted as foon as the diforder R 3. might 198 The Croup. might be afcertained, both emetics and bleeding might be ufeful; but after the croup, as well as difficult refpiration have thoroughly taken place, it would be im- proper to have recourfe to any debilitating means. It does not always feem to be an original difeafe; being fometimes a confequence of bad fevers, and of fome chronical diforders that have reduced the patient's ftrength. It frequently appears to arife from the fame caufes as the malignant fore throat, only having its feat lower down, and is therefore more dangerous. And it has, in feveral inftances, accompanied the malignant fore- throat, as may be known in the early flages of that complaint, by the croaking noife pe- culiar to the croup ; and, I beiieve, is in fuch inftances generally fatal. It is divided into two principal ftages; in the latter of which no method of treatment has appeared to be effectual, but medicine is never more efficacious than in the firft, if the diforder be not combined with fome other, and it be taken in time, though the crouping may be very confidcrable. This I faw remarkably exemplified in a little boy of my own, who was nearly cured in two days. The fovereign remedy feems to be afafcs- tida, which ought to be adminiftered both by the mouth and in clyfters, according to the The Croup. 199 the exigency of the complaint ; and in the firft inftance, before any marked inflamma- tion has taken place, may be given very freely. Antecedently to this, however, it may often be prudent to apply a leech or two to the threat, efpecially if there be any per- ceptible fulnefs of that part, and a blifter to the nape of the neck. At the clofe of the complaint, and to prevent a relapfe, the bark proves highly ferviceable, and will al- fo reftore the ftrength of the patient ; re- turning, however, to the afafcetida, if there fhould be any threatening fymptom of the afthmatic affection, which is not un- common. Should a patient fuffer two or more relapfes, to which a moift air will pe- culiarly expofe him, fome difcharge, by a blifter, or iffue, ought to be procured, and continued at leaft for fome months. The French writers depend much upon emetics, and afterwards lenient purges ; and to prevent a return, advife aperitives, flo- machics and tonics, particularly prepara- tions of fteel, and natural chalybeate wa- ters. I have examined the trachea after death in only one patient, in which I found the precife appearances defcribed by Dr. Mil- lar ; the wind-pipe being lined by a tough vifcid coat, fo as mechanically to clofe up the paffage.. Rickets,. [ 2°° ] Rickets. HPHIS is a late diforder in Europe : Al- taic obferves that England h faid to be the part in which it firft made its appearance, and that it was then defcribed by GliiTon and Mayow; but he thinks it probable, that it appeared at the fame ieafon over all Europe, through the coldntfs of the wea- ther. It was named rachites, from the Greek, implying that the Jpina dorfi is par- ticularly affected by it ;* though it rarely attacks the fpine till the diforder is Lr ad- vanced. It was firft noticed in the weftern parts of England, j- about the year 1628,5 an<* is faid * From this circumftance, it has been fuppofed to have been known in the time of Hippocrates; but his remark [Aphor. § 3. 26.) is certainly tco roncifc to -ftablilh the fentiment ; as it is fimply obferve J, that among other complaints, infants after the pe- riod or" dentition, are liable to -xetfiSfAiit,