■
 
UNITED STATES OF AMERICA
M£d
WASHINGTON, D. C,
GPO  16—67244-1
* 
 
 
                      A


               TREATISE


                    ON THE



 DISEASES OF CHILDREN.


              WITH DIRECTIONS


                     FOR


    THE MANAGEMENT OF INFANTS

               FROM THE BIRTH.


        BY MICHAEL UNDERWOOD, M. D.
Licentiate in Midwifery of the Royal College of Physicians in London,
   Physician to her Royal Highness the Princess of Wales, and late
       Senior Physician to the British Lying-in Hospital.


    WITH NOTES BY A PHYSICIAN OF PHILADELPHIA.
Ornari Res ipsa negat, contenta doceri.
                    Mawih,
  THREE VOLUMES IN ONE.


        VOL. I.

FROM THE SIXTH LONDON EDITION.
              PHILADELPHIA:

PUBLISHED BY JAMES WEBSTER, 10, S. EIGHTH STREET.

         William Brown, Printer, Prune Street.

                   1818.
 
Eastern JJiiii-iclof Peumuliaiiia, toicit:
    BE IT  REMEMBERED, That on the eighteenth day of May, in the forty-
second year of the Independence of the United States of America, A. D. 1818,
James Webster, of the said district, hath deposited in this office the title of a
book, the right whereof he claims as proprietor, in  the words following, to wit:

** A Treatise on the Diseases of Children.  With Directions for the Management
  of Infants from the Birth.  By  Michael Underwood, M. D.  Licentiate in Mid-
  wifery of the Royal College of Physicians in London, Physician to her Royal
  Highness the Princess of Wales, and lately Senior Physician to the British Ly-
  ing-in Hospital.  With Notes, by a Physician of Philadelphia.  Ornari res ipsa
  negat, contenta doceri.—Manill.  Three volumes in one.  Vol. I.  From the
  sixth London Edition."

  In conformity to the act of the  Congress of the United States, entitled, " An act
for the encouragement of learning, by securing the copies of maps, charts, and
books,  to the authors and proprietors  of such copies, during the times therein
mentioned."—And also to the act, entitled, "An act  supplementary to an act,
entitled, ' An act for the encouragement of learning,  by securing the copies of
maps, charts, and books, to the authors and proprietors of such copies, dining
the times therein mentioned,' and extending the benefits thereof to the arts of
designing, engraving, and etching historical and o»her prints."
                                                   D. CALDWELL,
                                              Clerk of the District of Pennsylvania. 
TO  THE  QUEEN.
Madam,
     Highly honoured in the permission of laying  this work six
times at your Majesty's feet, it has been my ambition  to render each
impression, in some  degree, worthy of so high a patronage.  The
advantages resulting from time and experience have been especially
cultivated to render  this edition  as  complete as  my other employ-
ments, and  my  abilities would allow.  Should it ultimately afford
that benefit to my fellow creatures at which I have been industriously
aiming, the public will be greatly indebted to your Majesty's kind
auspices.  On this account, as well as the Queen's known goodness,
there is no person to whom the work could with so much propriety be
addressed.
     I have the honour to be, with the most grateful obedience, your
Majesty's devoted, and obliged servant,
                                     Michael Underwood.
Knightsbridge,
 Oct. 10,1811 
 
PREFACE.
    The  repeated and indulgent reception of former at-
tempts to investigate the diseases of children, has induced
the author successively to extend his original plan.   And
he hopes he may have so  far succeeded, as to present the
readers of this sixth  impression with an ample and dis-
tinct account of them.
  Besides something new in the form of the work, it con-
tains several diseases never noticed before, as well as fur-
ther improvements in the arrangement and description of
others; together with complete directions for the manage-
ment of the nursery, to which is prefixed a dissertation on
the nature and properties of human milk, the result of re-
peated experiments 5 forming,  it is presumed, a suitable
Introduction to that part of the work.
  If any thing at all important  has been overlooked, it
has arisen as well from the very recent occurrence of some
new disease, as from a possible want of peculiar oppor-
tunities of information, which the writings or practice of
others may, in some instances,  possess.   He has availed
himself, however, of every advantage he could command;
and is indebted to one or more friends for some valuable
communications.   He has, at the same time, endeavoured
to avoid all unnecessary details and useless distinctions of
diseases, as well as touching upon subjects foreign from 
VI
PREFACE.
 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 somewhat be violated, it is presumed, it lias only
 given way to motives of humanity and usefulness.
   To tliis sixth edition, undertaken since my merciful re-
 covery from a severe indisposition, that, in an instant, al-
 most precluded me for several years  from any attention
 to business, due corrections, and several additions have
 been made;  and  it is presumed that the work will be
 found, upon the whole, inferior to none of the kind that
 has appeared in this country, or in any other part of Eu-
 rope.  It has been asserted,  indeed, by a learned and
 popular writer on the  diseases of children, that the very
 formidable catalogue of the complaints  of childhood ex-
 hibited by  some authors, seems to represent that period
to be a state of disease. Whether it be really such or not,
it is not only universally acknowledged, that a far greater
 number of our  race dies under two years of age than  at
any other period, (as Dr. Armstrong himself has observ-
 ed,)  and afterwards, in a gradual proportion, to the age
of eight or ten years 5* but I can, with the greatest truth,
assert, that I have made mention of no disease that I have
not very frequently met with, excepting the  few which I
have expressly remarked as very rarely occurring: it is
very natural, however, for a writer who wishes to notice
 only a very small number of the diseases  incident  to the
 state of childhood, to have it thought he has given a suf-
ficient account of all that are worthy of notice.   Perhaps,
 one merit at least, this multifarious catalogue of infantile
 complaints may be  allowed to boast of,  is the frequent
 exhibition of calomel, both in large and frequent doses, a

  * It has been remarked, that the first month, and particularly the first day of
 the birth, is marked by the greatest number of deaths; so that out of 2,785 child-
 ren who have died very young, 1,292 have expired the first day, and the rest in
 the first month. 
PREFACE.
VII
medicine peculiarly useful in a great variety of children's
diseases:  that very valuable drug having never been ad-
vised by any other writer thereon to my knowledge, till it
appeared in the first edition of my treatise thereon.   It is
now, however, not only come into general use amongst the
ablest practitioners, but is  more or less recommended by
every late writer; and by none that I have examined while
this edition has passed under review,  nor so properly in
what may be accounted very large doses (often less likely
to salivate than frequent smaller ones) as in an anonymous
writer, a few years ago, in  a small tract  on the practice of
midwifery, to which is subjoined the most sensible brief
treatise on the  diseases of infents I have met with ;  and
were the terms of art and the prescriptions brought to the
level of female readers,  would present  them with  a far
more valuable and concise treatise for domestic use^ than
that by Dr. Armstrong, which has passed through various
editions, and undoubtedly  had the great merit of having
led the van,  and paving the way for the great improve-
ments made in the treatment of the  diseases of children;
whilst the anonymous writer (probably from the  want of
longer experience,) condemns  the use of antimony  (so
judiciously first prescribed  by Dr. Armstrong) far too in-
discriminately.
   Though the writer  has taken the liberty of commend-
ing and censuring the works of others, he is perfectly sen-
sible of numerous defects in his own, and relies again
upon the indulgence of the  public ; though he hopes that,
as this edition will be found more  complete, it  may  be
proportionality worthy of a continuance of that favourable
reception wherewith the former ones have been so gene-
rally honoured.  Particular acknowledgments,  indeed,
are due for the approbation of the faculty;  and the  like
candour, it is hoped, will accept the  alterations attempted 
Vlll                   PREFACE.
in the two preceding editions, to render the work appro-
priate to medical readers.
  For the style in general, indeed, the author pretends to
have but little to offer;  though it is hoped, that many of
the greater imperfections which  appeared in former edi-
tions, are here done away.
  Prompted by a laudable ambition of being useful in his
generation, and leaving behind him something beneficial
to posterity in the only way he could attempt it, he is per-
suaded the benefit will not terminate here; but that others
will be excited to perfect this long neglected, but most im-
portant branch of the profession.  It  has, indeed,  been
universally lamented, that in no age has the study of the
disorders of children kept pace with the advancement of
science:  nor  have the improvements in the practice of
physic in the present century, produced as full and accu-
rate accounts  of  them, as of the diseases of adults.    "*• i-
deed, till of late  years little more has been attem;-u i    n
getting rid  of the wild prejudices, and anile prescript,  is
of the old writers, which had served only  to  obscure  i'.ie
true nature of children's diseases.  In this  atteinpr, how-
ever, and particularly in meliorating the practice, seme of
the best of the more modern writers have run into a con-
trary extreme, in not a few instances.
  A very principal cause of the  above-mentioned neglect
has arisen from an ancient idea, for a long time loo gene-
rally entertained, that, as medical people can have but a
very imperfect knowledge of the  complaints of infants,
from the inability of children to give any account of them,
it is safer to trust the management of them to old women
and nurses; who, at least, are not likely to do  mischief
by violent remedies, though they may sometimes make  use
of improper and inadequate ones.
  Futile as such objections most certainly are, they have,
nevertheless, had considerable influence, and for a Ions: 
PREFACE.
IX
lime retarded a methodical investigation of infantile dis-
orders.   This  defect  has been noticed by  successive
writers, and particularly in a treatise written  above forty
years since by Dr. Armstrong.  It is aptly remarked by
this writer, that the same difficulty occurs in a variety of
the most dangerous complaints of adults, at every period
of life, which confessedly require the greatest assistance;
such are attacks of phrenzy, delirium, and some kinds of
convulsions:  to which may be added, all the disorders of
idiots and lunatics.   But these have  been successfully
treated in every age, not excepting even lunacy itself, and
the melancholy  subject  happily restored to society,  his
family, and himself.
   It has likewise been observed,  that if  infants, for  the
reasons above mentioned, are  to be excluded the benefit
of a physician's advice, it is difficult to say at what age
children may safely be entrusted to his care;  since at the
age of five or  six years, they would frequently mislead
the inquirer, who should trust  tothejr own account of their
complaints.  Their ideas of things are too indistinct to
afford us sufficient information, and they accordingly often
call sickness at the  stomach,  pain, and pain,  sickness;
they will frequently make no reply to general questions,
and when they are asked more particularly whether they
have any pain in one or another part  of the body, they
almost constantly answer in the affirmative; though it af-
terwards frequently turns out  they have expressed them-
selves carelessly.
   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 diseases are all
plainly and sufficiently  marked by the countenance, the
age, the manifest symptoms, and the faithful account given
by the parent, or an intelligent nurse.  This I am so con-
fident of, that I never feel more at my ease, in prescribing
                         b* 
x
PREFACE.
for any disorders, than  those of infants, and never sue-
ceed  with more uniformity,  or more  agreeably  to  the
opinion I may have adopted of the seat and nature of the
disease.   Every distemper may be said, in some sense, to
have  a language of its own, and  it is  the business of a
physician to be acquainted with it; nor do those of child-
ren speak less intelligibly than those of adults.*   Limit-
ed as is human knowledge in every department, there are
yet certain principles and great outlines, as well in physic
as in other  sciences,  with which men of  experience are
acquainted, that will generally lead them safely between
the dangerous extremes of doing too little, or too much;
and will carry them successfully, where persons who want
those advantages cannot venture to follow them.f  How
far, however, this  and other assertions  of the author are
made out in the subsequent tract, the writer  must submit
to the judgment and candour of the public.

  * In neither  of these sentiments do I stand alone ; Harris, of whose work
Sydenham is thought to have spoken so hightyyhas said the same things.—" In-
certx vero diagnoses (qua multum obtinuit) querela non tarn a symptomatum
defectu, quam  a prxpostera ac inepta medendi ratione ortum  suum duxisse
videtur."  (page 8.)  And at page 3.—" Etenim asserere non verebor morbos
illius xtatis genere" paucissimos esse, et gradu tantummodo differe; imo cura-
tionem puerorum multo tutiorem ac faciliorem, quam virorum ac mulierum."—
De Morb. Infant.
  f Neque potest scire quomodo morbos curare conveniat, qui unde hi sint ig-
noret—Pertinet ad rem omnium proprietatis nosse.  Celsus. 
CONTENTS OP THE FIRST VOLUME.
DISEASES OF CHILDREN.
Dedication   .......
Preface     .......
Exordium       .......
The Disoases of Infants are too much neglected
Their d.seases easily understood       ....
Causes of Infants' diseases  .       .      .      .      J     ->
Symptoms, or marks of their diseases  ....
Syncope, or Fainting       ......
Discoloration of New-born Infants     ....
Meconium, what ?
          Retention of it, an occasion of disease
          Of no use after birth     ....
          Ought to be carried off early
          Proper remedies to expel it
          Instance of its retention for many days
Icteritia, or infantile Jaundice      ....
        Treatment     ......
        Sometimes occasioned by jaundiced milk
        In some families hereditary   ....
        Morbid appearances after death
Erysipelas,  infantile     ...      ...
           Appearances   .....
           Remedies   ......
Coryza  maligna    ......
        Symptoms       ......
        Cause       ......
        Treatment      ......
Inward fits, what ?   .
           Appearances       .....
           Treatment     .....
Constipation and Wind  ......
                    Treatment   ....
Vigiliae, or Watching    ......
Aphthae     .......
       Appearances of it
       Causes     ......
       Remedies        ......
Aphtha gangrenosa ......
Cutaneous Eruptions    ......
Strophulus, or Red-Gum   .....
Crusta Lactea   .......
Tooth Rashes      ......
Essera^or  Nettle Rash       .....
        Treatment ......
Phylyctense    .......
Psora, or Grocer's-itch     ....
      Treatment        ...... 
xu
CONTENTS.
 Sore Ears    ......
 Vomitus, or Vomiting   ....
         Not a common Disease of Infants  .      .
         Milk  returned curdled
         Treatment  .....
 Cardialgia,or-inflammation of the Stomach
           Symptoms      ....
           Treatment   ....
 Tormina, or gripes  .....
 Diarrhoea       .....
         Cause      .....
         Not always  a disease
         Kind of stools     ....
 Lienteria, or W atery-gripes
         Treatment  .....
 Incontinence of Stools   ....
 Worms      ......
       Not usually dangerous
       Kinds        .....
       Symptoms       ....
       Cause        ....
       Treatment       ....
"Mad. Noufrer's Remedy for the tape-worm  .
 Convulsions     .....
           Of two kinds    .....
           Children oftener said to die of them than they really
           Causes    .....
           The nine-days disease
           A remarkable Case
           Treatment   ....
 Paralysis, or Palsy    .....
         Symptoms     ....
         Treatment        ....
 Skin-bound     .              ,
           Symptoms      ....
           Cause       ....
           Treatment
           Account of this disease on the Continent
           Appearances after Death
           Cause       ....
           Remedies
 Tetanus, or Locked-Jaw .
         Time of attack    .      ,
         Description
         Cause
         Treatment     ....
 Epileptic fits  .....
           Cause
           Treatment
           Appearances after Death
 Chorea Sancti Viti
                Cause
                Treatment
Aphonia Spasmodica Intermittens, or temporary Loss of  Speech
                               Remedies
Incubus, or Night-Mare  .
Singultus    ....
Sternutatio
Dentition, or Teething
         An important period in the infant state
         Process of,
do
ID.
93
ib.
95
ib.
ib.
96
ib.
97 
CONTENTS.
XU1
Dentition, Symptoms    ....
         Swelling of the tops of the feet and hands
         Remedies     ....
         Great advantage of lancing the gums
Fevers   ......
      Infants not very subject to common,
      Causes of .      .       •             ■
      Treatment     ....
Slow Fever with appearance of boils
Remittent Fever       ....
Typhus, or Low-fever
Mesenteric-fever      .      .      .       ■
              Symptoms
               Prophylactics .
               Causes
               Treatment
Hectic fever and Marasmus
                         Causes of .
                         Sometimes curable
                         Treatment
Febris Scarlatina, and angina maligna
                                  Symptoms
                                  Treatment
 Febris miliaris  .
              Symptoms ....
              Treatment
 Cynanche Parotidea, or Mumps  .
                             Symptoms
                             Treatment
 Hydrocephalus  .....
              External
              Internal  ....
              Cause and Symptoms
              Prophylactics
              Treatment
 General observations on Variola and Morbilli, or the Small-pox and Measles 137
                     Inoculation   .            .
                     Age and circumstances suitable for it
                     Cautions in regard to pregnant women
                     Varicella, or Chicken-pox .
                              How distinguished from the Small
For Variola: Vaccinae see Appendix at the end of the Volume
Ague  .....
     Symptoms
     (Ague-cake)
     Treatment
General Observations on Coughs
Pertussis,  or Hooping Cough
                         Symptoms
                         Treatment
Tussis Spasmodica
                Description
                Remedies
SufFocatio  Stridula, or Croup
                         Of two kinds
                         Causes
                         Prophylaxis, or means of Prevention
                         Symptoms
                         Nature  .
                         Treatment
                         Morbid Appearance
PAGE.
   98
.   99
   ib.
.  100
  105
   ib.
  106
   ib.
  110
  111
  112
  113
  114
  115
  113
  115
  117
  118
   ib.
  119
  121
   ib.
  122
  124
   ib.
  125
   ib.
   ib.
   126
   127
   128
   ib,
   129
   131
   132
pox
140
 ib.
142
143
 ib.

144
 ib.
145
 ib.
148
149
150
151
156
 ib.
 ib.
158
 ib.
 ib.
 ib.
159
 ib.
 ib.
 165 
XIV CONTENTS.		
		PAGE.
Rachitis, or Rickets		. &165
Cause	. . • •	166
Symptoms	. . •	ib.
Treatment	. . .	167
Scrofula ....	. • • •	. 169
Cause .	.	ib.
Treatment .	....	. 170
Dysuria	.	172 . ib.
Treatment .		
Anasarca and Ascites .	■	173
Treatment	....	174
Ischuria vesicalis e Muco		175
Symptoms		ib.
Treatment	• . . •	176
Ischuria renalis, or Suppression of Urine .		. 177
	Symptoms	ib.
	Causes	. ib.
	Remedies	ib.
Gravel ....		. 178
Remedies	.	ib.
Incontinence of Urine	. . •	. ib.
Remedies	.	179
Polydipsia, or Excessive Thirst		. 180
Remedies		181
Diabetes infantilis .	.	. 182
The Seven-days disease, and Pecheguera of South America .		ib.
Vaccine Inoculation	.	. 184
CONTENTS OF THE SECOND  VOLUME.
Preface              .......
Introddctios—On the means of recovering infants apparently still-born
Tinea, or Scalded head
      Is highly contagious
      In general only a topical Complaint
      of different kinds
      Treatment
Scurfyness of the Head
Scabies, or Itch
Herpes, or Ringworm
         Appearances
         Remedies
Herpes exedens, or Serpigo
          Treatment       .                    ..
Herpes miliaris      ••......
Verrucae............
Clavi Pedum...........
Steatomatous Tumours.....•
Ophthalmia    ....        .......
          Variously distinguished.......
The common, inflamed Eye........
Epiphora............
Ophthalmia purulenta   ....        .....'
Sore Eye after Small-pox and Measles, and Scrofulous Ophthalmy (Note)
 i
iii
 1
ib.
 2
ib.
 3
ib.
 4
ib.
ib.
 5
ib.
ib.
ib.
 6
 7
 8
ib.
ib.
ib.
ib.
10
12 
CONTENTS.
XV
                                                                PAGE.
Psoropthalmia...........12
Epyptian Ophthalmy..........13
Venereal Ophthalmy..........ib.
Hints on the Lues Venerea       ........ib.
                Treatment       ........14
Ophthalmy of Dentition.........ib.
Leucoma           ..........»'.   ib.
Cataract, and Gutta Serena       ........15
Intimation of remedies..........16
Hordeolum steatomatum, or Stithe.......17
Deafness      ............18
Deafness—Causes..........     ib.
           Remedies    ...........   19
Abscess within the Ear.....'' .     .    .    .     ib.
Ear-ach.........  .                20
Tooth-ach............ib.
Cancrum Oris............ib.
        Remedies..........21
Gangrenous Erosion of the Cheeks        •  ,    •       •      •      .22
           Appearances       .      .      .            .           ib.
           Treatment       ......       ib.
Induration of the Breasts       ......     23
Abscess in the Hypochondrium    .      .      .      .      .      .24
              Treatment      ......     ib.
 Psoas, or Lumbar Abscess    ......       ib.
        Symptoms     .......     25
        Treatment       .......   26
Morbus Coxaris  ........     27
        Symptoms     .      .       .      .      .             .       ib.
Abscess under the Fascia of the Thigh        .      .      .      .28
White Swelling of the Joints      .      .      .       .      .         ib.
Paralysis of the lower Extremities, with Curvature of the Spine           29
          Cause       .......       ib.
         Symptoms           .       .      .                        ib.
          Treatment      .......   30
Debility of the Lower Extremities      .....     32
        Cause        .......       ib.
        First Symptoms        .      .                               ib.
        Treatment        .......   ib.
Discoloration, accompanied with Debility of the Limbs         .      .     33
             Treatment                   .      .       .      .       ib.
Curvature of the Bones from Weakness        ....     34
          Remedy               .            .             .         ib.
Paronychia', or Whitlow        ......     35
Furunculus, or Boil    .......       36
Perniones, or Chilblains                      .                        ib.
         Cause     .                         .      .       .         ib.
         Treatment    .      .             .      .             .37
Ambustiones   .       .      .      .      \.      ,             .       38
           Remedies   .......     39
Luxations and Fractures    .     .            .      .             .41
(Luxation of the Lower Jaw)    .             .      .'.'.'   ib.
          Treatment        ......       42
Cutting of the Tongue    .           .       .                   .43
Suffocation from swallowing the point of the Tongue           .      .44
           Symptoms    .....             .     ib.
           Remedy         ......        ib.
Hemorrhage from the Sublingual Veins        .             -    '  .     ib!
            Remedy      .      .                   .       ,      .   ib.
Hemorrhage of the Nose                    •      .       >      .      ib. 
XVI
CONTENTS.
Hemorrhage from the Navel
Soreness, or Ulceration of the Navel
Unkindly Separation of the Funis Umbilicalis
Herniae        .....
Exomphalos    .      •
Bubonocele       ....
Strangulated Herniae
Hydrocele
           Appearance
           Treatment
Pneumatocele
Retention of the Testes
Tumefaction of the  Prepuce
Prolapsus Ani
         Cause
         Treatment
Discharges from the Vagina
           of various Kinds
Purulent Gonorrhoea
        Treatment
Of the Venom of Insects, and of certain Animals
On the Bite of morbidly  enraged Animals
Complaints mentioned by ancient Writers
Ranula     .
      Cause
      Treatment
Seriasis      .
Crinones, or Grubs
Morbum Pilare
Plithiriasis
Hydroa
Macies     .
PAG»-
   45
   46
   48
   49
   ib.
   ib.
   50
   ib.
   ib.
   51
   ib.
   52
   ib.
   53
   ib.
   54
   ib.
   ib.
   55
   ib.
   56
   57
   60
   61
   ib.
   ib.
   ib.
   62
   63
   ib.
   ib,
   ib.
                         On Congenite Disorders.

Encephalocele, or Hernia of the Brain
               Appearances
               Treatment
Tumours of the Scalp      ....
                 Treatment
Lymphatic Tumours of the Head and Spine
             Treatment    ....
Imperfect Closure of the Foramen Ovale and Canalis arteriosus
             Symptoms    ....
Spina Byfida, or Hydro-rachitis
       Writers  on this Disorder       .         .         .
       Description       ....
       Cause        .        •       •
       Progress of the  Disease
       Remedies       ...        .         .
Parenchymatous Tumours
                   Situation
                   Treatment
Hepartomphalos       ...
               Description
               Treatment     .     .
               Appearances after Death
On other external Disorders, and certain Blemishes, supposed to be Marks
     of the Mother      ....
Maculae—Causes commonly assigned
64
ib.
ib.
65
ib.
68
ib.
ib.
ib.
70
ib.
ib.
71
ib.
75
79
ib.
ib.
80
ib.
81
82

83
ib. 
CONTENTS.
xvii
Maculae—Experience proves them to be groundless
Hare-Lip    .....
         Properest lime for the Operation
Macuix that may be remedied
On Discolored Spots
Tumours and Superfluous Parts
Unusual  Figure of the Parts
Blemishes after  Birth
Vagina Imperforate     ...
Imperforate Anus      ....
(Rectum opening into the Vagina)
                Operation
Imperforate Penis      ...
The Ears imperforate       ...
Squinting     .      .            ."
Vari and  Valgi,  &c.
Peculiarities of the Hair and Eyes
The Albino (Note)
PAGE.
   84
   85
   87
   ib.
   88
   89
   ib.
   ib.
   90
   91
   ib.
   ib.
   92
   93
   ib.
   96
  ib.
   ib.
CONTENTS  OF  THE  THIRD  VOLUME.
 Preface     ......
 Introduction, on the Nature and Properties of Human Milk
            Directions for the Management of Infants from the Birth
 On Dry Nursing, contrary to Nature
                Arguments in favour of it usually futile
 The duty of great attention to Infants
 Hints taken from the irrational  Species
 Great Heat and Cold, and strong Light to be avoided
 On washing of Infants          .
 On the Cold Bath  (Note)
 On the Intertrigo, Chafings, or  Excoriations
 On forcing out the milk from the breasts
 Errors in regard to the first clothing of Infants
 Observations on the Non-naturals
 On Air      .     .
      The Snuffles       .      .        .        .
      Change of Clothes, or short coaling
 On Meat and Drink       ...
        Children require no food immediately after Birth/
Milk the most proper of all food     ...
Infants will pine lor a long time  after the Breast, when prematurely
  from it      ...•      .
The Milk, or Bubby-pot, its excellent contrivance
      Resemblance to the Nipple
      Objections answered      ...
      Change of food as Children grow older
Proper times of feeding         .         .        ,
Proper diet when ill         •         .        .           *
On  the acescent quality of the food of Infants, their disposition  to
  and their Remedies       .....
On the choice of Wet Nurses, and their Diet
                                C *
taken
Wind,
  v
  1

 25
 ib.
 28
 29
 30
 ib.
 31
 33
 34
 35
 36
 38
 40
 ib.
 41
 ib.
 43

 44
 43
 ib.
49
 51
 52
ib.

5">
 55 
XVill
CONTENTS.
                                                                     56
On weaning of Children      .                                          58
On Sleep and Watching         ...                     59
      Obseivaiions on the Cradle     .        ■         •                 61
On Motion and Best       .       .       .        •                      ib
Exercise how important to Health     .                                  jb'
Proper time of putting Children on their feet       •         ■        •      '
Inquiry into the fatality amongst the Children of the poor, and some attempt  ^
  towards a remedy proposed      .                                    g5
Caution in regard to Females         "        "        "         '       66
On Rest      .        .         •        •            _  _  *    .   „i
On some slighter natural Deformities, with the  means of  Prevention ana  ^
  Cure            •        •        •        •                         70
On Retention and Excretion                       •         •            ib
      Retention in new-born  Infants     .               •                71
      Incontinence of Urine     .        •                 •
     Infants' bowels should be always  open     •        •                ig-
On the Passions  of the Mind    .        .         •         •         •   1~
      Laughter and Crying     ,                      •                '
       On the Tempers of Wet Nurses                      •            7o
                   DIRECTION TO THE BINDER.


The Table of different Milks to be placed immediately after the Introduction. 
A
TREATISE
                         ON THE

DISEASES   OF  CHILDREN
  THE following account of the diseases of children, which, in its
later editions, has made its appearance in a somewhat new form, and
less exceptionable to professional men,  it is  hoped may place this
branch of medicine upon a respectable footing, and exhibit a practice
as founded and rational as in any other.  That no such  serious at-
tempt had been previously made,  is sufficiently acknowledged; al-
though detached parts, and some of the more important diseases of
childhood, have been ably considered at different periods.
  For the manner in which the work  is now executed,  the author
can only say, that in addition to a long experience, he has carefully
consulted the most respectable authorities, as well ancient as modern;
while by a close attention to facts, he has endeavoured to  obviate the
effects of that peculiar veil* which is said to obscure infantile disor-
ders.   A practical arrangement of them has been studied, compre-
hending likewise the natural  consecution of parts, and the order of
time in which the complaints  severally appear; that some conformity
may be every where observed.   Regard has also been had to their
respective causes and symptoms, tending to elucidate their nature,
and  render their treatment more  obvious than has been  generally
imagined.

  * There is nothing to which this peculiar obscurity may be referred, but the
incapacity of infants to describe their own feelings.  There are, nevertheless,
other sources  of information, less fallacious sometimes than the  more  literal
description of adults, which in nervous complaints particularly would tend to
perplex the ablest physician, if he should always be led by them; and the
like necessary discrimination will serve him equally well in the treatment of
infants.
A 
2
DISEASES OF CHILDREN-
  To their immediate diseases is added an attention to some of the
principal accidents and little injuries to which  the earlier periods of
childhood are peculiarly liable; and though such articles may, indeed,
be very unimportant to some readers, it is presumed they will have
their use, and may, possibly,  prove no small satisfaction to others.
And here it may not be improper to observe, that whatever merit the
publications of others may possess, it may, nevertheless, with great
propriety be remarked, that they either form  a part of some large
systematic work, or else, they are  far too concise, and have  omitted
complaints of too much importance to be overlooked, as well as been
necessarily silent on many, with which the authors themselves were
unacquainted.
  The judicious treatment of infantile  disorders demands,  indeed,
equal attention and experience; close and repeated observation being
the great mean of  supplying the  want  of  that  kind of  assist-
ance  which the personal  information  of adult  patients frequently
affords.   The  disorders of childhood, however,  are  nowise myste-
rious, nor would ever have been  thought so,  if they  had always
been  submitted to proper  hands,  and been  as carefully  investi-
gated as  the   diseases of adults.    Nor  is  it  otherwise  with  the
diseases of the earliest infancy, of which (as a further balance to the
want  of oral information) it  may be  safely asserted, that  as  they
are more obvious than they are generally supposed,  so is their num-
ber comparatively small, their cause uniform, and the treatment of
most  of them  simple and certain.*   This is especially true of the
disorders of this period, though it may, perhaps, be objected, that
their various diseases cannot  all originate from  one  and  the same
cause; nor is it my intention to assert it, though it may be  safely ad-
vanced in regard to a great number of them.  It is  to be remarked
likewise, that  it is precisely the complaints of early infancy that are
here spoken of; though it is, nevertheless, very evident that there is
a greater uniformity also in the causes  of the several  disorders even
of older children  than there is in  those of  adults, which have very
often  various and dissimilar remote causes,  at different times, and in
different habits: e. g.  obstructed catamenia, ascites, Sfc.
   For the proof of these assertions, as well  as in order to establish a
rational practice, I shall first consider distinctly the causes and diag-
nostics  of their  complaints, before I  attempt  to enter upon their
cure.
   And here I  shall not attend to  their  various remote  causes, but
shall  confine myself to a practical consideration of  the subject, and
point out their obvious occasions and symptoms.  And on this account,
I shall not take  notice of all the changes which Nature herself induces


  * Facillime inquam m morbos dilabuntur infantes, et nisi aut serius aut im-
peritu^ tractentur, facillime in sanitatem restituuntur.  Harris, demortis acutin
infantum. 
DISEASES OF  CHILDREN.
3
during  the growth of infants, as they pass from one stage of life to
another;* which are, doubtless, remote causes of some of their com-
plaints.   A more  minute attention, indeed, would lead only to diffuse
and uncertain theories, which have been established in one age only
to be rejected in the next.   In  this country,!  at  least,  such vague
theories are now deservedly laid aside, though an era, perhaps, bet-
ter calculated for their investigation, than  those wherein such sub-
jects were agitated with  a zeal proportionate  to  the writers' com-
parative ignorance  of anatomy, and those principles of the ani-
mal economy, which can only be established by a close observance
of facts.
   A principal cause, mentioned  both by ancient and modern writers,
is the great moisture ^rfd laxity  of infants;  which is necessary, how-
ever, in order to the  extension  of parts,  and  the rapid  growth  of
young children.  This laxity arises from the vast glandular  secre-
tion, their glands in general being  much larger in proportion than
those of adults.   I might instance in the thymus gland, and particu-
larly in the pancreas and liver.   But besides these, there are  innu-
merable glands situate within the. mouth,  oesophagus, stomach, and
bowels, which  are continually pouring out their  contents into  the
first-passages.   This is, doubtless, a wise provision of nature,  and I
cannot, therefore, think, with Dr. Armstrong,  that the gastric juice
renders the chyle less fit for absorption, for  without a  due proportion
of it, no good chyle can be  made; but as  even the best  things may
sometimes exceed, and as we do not strictly follow  the  dictates of
nature  in the management  of children, as  to their food, manner of
clothing, sleeping, &c.  this  abundance of slimy matter  may often
overload the stomach and bowels, the constant seat of the first com-
plaints  in  the infant state.:}:  A  second cause  arises from  the great
irritability of the nervous system, and the  delicacy of the  muscular
fibres, whereby the serous juices do not readily enough return,  but
remain longer  than is consistent with a free circulation through  the
extreme parts.  The quality of  the milk,  or other food with which
infants  are nourished, may be  accounted  a third.   In  addition to
these general causes, may be reckoned the  want of exercise,§ which


  * See Preface.
  •j- It is to be lamented, that this is not  yet more universally the case else-
where even amongst men of letters, as appears from an anonymous Latin work,
on the diseases of children, published at Amsterdam in 1760, replete with ob-
solete theories, and remote causes of diseases, but possessed  of less practical
matter than one should have thought any work of so late a date must contain.
  t Non quod setas per se sit causa ullius morbi, est enim res naturalis et tem-
poris determinatio, sed quia deponit ad morbos quosdam facilius  suscipiendos,
si causae eorum accesserint.—Primeros:  deMorb. Infant.
  § Exercise is the grand mean of health.—The irrational species are capable
of affording it to themselves almost as soon as born ; and though infant children
are not,  they are  passive, and can be exercised.  Nature and  instinct point out 
4                    DISEASES OF  CHILDREN-
at a more advanced age, happily for us, we are  obliged  to make
use of, and which art, in general,  does not duly supply in  regard to
infants.*
   Hence arise acidities in the first-passages,  a constant  attendant
upon  all  their  early complaints.f   Among the first  of which has
been reckoned the retention  of the meconium,  and the last (which
may be termed a disease at all peculiar to infants) is the cutting of
the* teeth, in which likewise  the state of the bowels  is very much
concerned.
   Upon each of the above heads, it may be necessary to make fur-
ther observations  as occasion may offer, in order  to  take  notice of
certain accidental causes arising from mismanagement, or errors in
the non-naturals, as they have been called; especially in  regard to
the quantity of nourishment administered to infants, and an inatten-
tion to the state of their bowels.
   The symptoms of these first diseases of infants,  (by which  we
also judge of their nature,) are chiefly retention and excretion; sour
belchings; sickness;  vomitings; purgings;  the  nature of the matter
thrown off; watching; inquietude; contraction,  and sharpness of the
features;  blueness about the  mouth; turning up of the  eyes; thirst;
heat; the manner of breathing and of crying; retraction of  the lower
extremities; and pustules, or  eruptions,  external  or internal.   The
pulse and urine are less certain marks, in the greater number of their
complaints, than they  are  in older children, and adults.   To these
may be  added, the openness, or firmness of the fontanelles, and of
the sutures; the  size and figure of the head, and the  strength of the
bones; and the relaxation or contraction of the skin in general,  and
of the scrotum in particular.
   Having thus briefly adverted to the general causes  and symptoms,
I proceed to the consideration of the disorders themselves,  beginning
with one hitherto unnoticed by writers;  which though very rare, I
the expediency of it, and the fond mother, who follows only her own inclination,
naturally, and insensibly adopts it.  On this head see the article of Motion and
Rest.

  * Together with these sources might be noticed another, not mentioned by
writers, though not, indeed, an efficient cause of infantile complaints, but an
occasion arising from that constitution the Creator appears to have established
as a law of nature running through the animal race,  1 mean, the rank which
the several species hold in that scale.  For, whatever their apparent compar-
ative strength may be, the more noble and useful  amongst them, whether
domesticated or wild, (though, indeed, we cannot say precisely what the latter
would be in a perfect state of nature,) seem to be liable to far the greater num.
ber of evils.  It is possible, indeed, some philosophers may be disposed to draw
very unbecoming inferences from such a position ; but there are others who con-
ceive it to be very justifiable, and analogous to various established facts in the
dispensations of Providence towards lapsed creatures.
f Sylvius de le Boe. Harris. 
SYNCOPE.
5
believe, seems to be  the  first that can take place after birth, and is
a kind of
                      Syncope,  or Fainting.

   Many  new-born  infants, it is wrell known,  lie, for some time, in
a very feeble and uncertain state, with no  other sign  of animation
than a weak pulsation of the heart, and the  arteries of the umbilical
cord.  But I have  only in one instance seen any thing at all  re-
sembling  the true syncope, after  the  living powers have  once pre-
vailed.   In this case, the  child was born  at the instant  its mother
was moving from her chair into her bed, and in  consequence,  un-
.fortunately, fell with violence on the  floor.   It, however, very soon
cried, and did not appear  to  be materially injured; but a day or
two afterwards fell into a strange, languid state, very different from
anything I had been  accustomed to see.   Stools being procured, it
revived,  and  frequently  took  plenty of nourishment;  but  at in-
tervals, sunk into its former languor, breathed very faintly, and died
about the sixth day.
   But with the following case,  which comes precisely under the
idea of syncope^ I have been favoured by the ingenious Mr. Hey,
senior Surgeon to the  Infirmary at Leeds.
   He reports, that an infant, born at  the full time, lay moaning and
languid for four or five hours, and was then  seized with a fainting fit,
in which it continued for half an hour.   In this state  Mr.  Hey found
it.   It had ceased to breathe, except now and then giving a gasp, or
sob;  and  was as pale as a corpse.  There was, however, a sensible
pulsation  of the heart, though feeble and slow;  but whether the cir-
culation had been kept up all the time previous to his visit, could not
be ascertained.
   As soon as Mr. Hey had time to consider the case, he directed the
infant's nostrils and temples to be  stimulated with the volatile alcali;
and when it became capable of  swallowing,  a few  drops  of the
tinctura valerian,  volat. were administered in  a tea-spQonful of wa-
fer, and repeated at proper intervals:  it likewise took a tea-spoonful
of theol.  ricini.
   The child had three other similar attacks  in the course of the day,
though it had slept composedly between whiles, and sucked  at the
breast.   It had seven  more fainting fits in the night, two of which
were severe ones;  but Mr. Hey was not called again till the next
morning.    He then observes, that reflecting on the  case, and com-
paring it  with that of  a man whom he had seen thrown into convul-
sions by a large bleeding, after having hanged himself, which were
 cured by the above tincture, given  in  wine; Mr. Hey pursued the
 like plan with  the child,  and administered the  drops in a tea-spoon-
 ful of a  generous white-wine, every two  hours.   The  infant  was 
 6            DISCOLORATION OF NEW-BORN INFANTS.

 very sensibly refreshed by the -first dose, and  had no return of the
 disorder, except in the slightest degree; and became a very healthy
 child*
   The tinct. valer. vol at. administered in this manner, is also an ex-
 cellent remedy in other instances of debility and  languor, when the
 primae via? have been previously cleansed.
   A kind of syncope, not dissimilar to this, but taking place a few
 days  after birth, has  been  removed by a very different  stimulant,
 which would  not have  been had recourse to, if various other means
had not failed.  Infants  in  this  syncope,  appear  to be dying for
several days, and have even  been concluded actually dead; but re-
 viving again,  relapse as before.  In this state, the fume of lighted
 tobacco has been forced into the mouth with the  happiest effect,
though at the expence of a considerable struggle, succeeded by a strong
convulsion.   Upon the spasm subsiding, however,, the infant soon
falls  asleep, and  awakes  apparently well,  and continues so for
several hours; but the syncope  returning,  the fume  should be re-
peated.
   If the struggle should return, it will prove slighter than the former,
and neither that nor the  convulsion,  will probably be renewed after
a second recovery.
                Discoloration of New-Born Infants.

   An affection of new-born infants, not  much more common than
the former, is a discoloration of the face and extremities, and some-
times of the whole body, and like the former, seemingly independent
of the circumstances attendant upon the birth.  A mere discolora-
tion of the face after laborious deliveries, is known to be very com-
mon, and gradually disappears, without  affording any occasion  of
alarm.  But in the present instance,  the parts are very black, and
afterwards turn  of a leaden-blue  colour; sometimes appearing  at
the  instant of the birth, and at others have not been particularly
noticed for an hour or two afterwards, or sometimes a day or two.
In one instance, I remarked the discoloration of the  face to be par-
tial, appearing in spots;  the greater number being of the size of small
peas, but some  larger.   In some  instances, the discoloration abates
a little, and in others not; sometimes  it goes entirely off  and re-
turns again,  and  in that case is of more serious consequence, and
commonly dangerous.   From an examination of the parts after death
I have learned, that this recurring  blackness depends  upon some in-


  * What more striking proof could we have, if proof were  wanting, of the ana-
Iqgy which exists between the diseases of adults and those of infants?
                                                          E.D. 
RETENTION OF THE MECONIUM.
1
ternal malformation or derangement,*  (similar, though not precisely
the same with one to be noticed under the head of  congenite disor-
ders,) and  for which nothing that I know of can be attempted but
the general remedies for  fits; by which it is usually followed when
none of the little subsequent means prove effectual.
   From the result of this recurring blackness, it seems always to be
owing to some  fixed cause, excited into action  by certain circum-
stances particularly any sudden-agitation of body or mind.   In such
cases, the  disappearance of  the  discoloration is followed by a re-
turn of the tinge of as deep a colour as at first.  But in the innoxious
kind, which is the more immediate subject of this chapter, though
the blackness in some instances, after abating a little, again returns;
it never acquires the deep colour it had at first, and when it has once
completely disappeared, it never returns.
   This discoloration,  therefore, probably depends  merely on  some
spasm affecting the external veins, and interrupting the free return of
the btood into the larger vessels.  Where this is the sole cause, the
discoloration,  howsoever great, is probably harmless, and  would  in
every case soon abate, and in time  entirely disappear;  but  is  re-
moved sooner  by proper remedies.   The only necessary means seem
to be, to procure stools, (which should be immediately solicited by
clysters); to excite vomiting  if the infant appears to be  sick at the
stomach;  and to rub, or gently chafe the body and limbs before the
fire.  But  nothing tends  to remove the blackness  so  suddenly or
sensibly, as applying a leech or two  upon, or near the livid parts;
and should therefore always be had recourse to, if the  blackness
does not very  evidently abate in  an hour or two  after birth, by the
help of one or more of the means that  have been  recommended.
   A disorder as common as the  two foregoing ones are  rare, and
probably the next in order of time, is
                 27ie Retention of the Meconium.

  The Meconium is that black, viscid, or tenacious matter, which,
it is well known, every infant parts with  by stool, for the first two
or three days after it is born, or retains it to its manifest injury.
  The ordinary source of infantile complaints has already been said
to originate from something amiss in the first-passages, according to
the  most ancient and modern writers.f   And I am satisfied, that a


  •  In one instance, the subject of which died about the tenth day after birth,
the malformation was in the stomach; the pylorus being preternaturally s'rait,
with difficulty permitting the food (which was only breast-milk) to pass into the
bowels.
t Hippoc. Celsus, .Egineta, Harris, Armstrong. 
8
RETENTION OF THE MECONIUM.
foundation is sometimes laid for them, from not duly attending to
an  expulsion of the meconium,  which will  sometimes firmly adhere
to the coats of the  bowels, and remain for  many days, unaffected
even  by powerful medicines, as 1 shall have  occasion to remark as
I go on;  sometimes occasioning dangerous complaints from the birth,
and at others, giving  rise to more remote evils.   I shall only ob-
serve  in this place, that though it should not be at all retained, yet a
part will often remain much longer than has been usually imagined,
and will  come away,  perhaps unnoticed, at a late  period,  where no
retention  of  it has been suspected.   Of this I can  have no doubt,
having been called to visit infants after the  month has been expired,
who have been unwell through all that period, and from whom me-
conium has still  been coming away.  A tea-spoonful  of ol.  ricini,
given  once or more, has soon carried off a great quantity; upon which
all  their complaints have disappeared.
  The meconium is,  probably,  no longer  of use after  the child is
come  into  the world, unless it  be to keep  the bowels from col-
lapsing,  till they can be replenished with  the  aliment the child is
soon afterwards  to receive.   Whereas, if it be not soon carried off,
it will not only  change the quality of the milk,  or other food,  as it
descends  into the  bowels, but itself also becomes  highly acrid, (the
greater part of it being bile);  and cannot fail  to produce indigestion,
flatulency, pain, purging or costiveness, and other similar evils: and
the meconium is further disposed to this acrid state, on another ac-
count, viz. from  the  admixture of atmospheric  air; as well as that
which is engendered by the food and imperfect digestion.   Whilst
the infant remains inclosed  in the womb, it is secured from all  con-
tact of air, and therefore the  alimentary contents  remain harmless
and bland, though increasing for many months; but it is well known
how soon every secretion or extravasation  will become acrid, upon
the admission of air into any cavity where  it may  be  lodged.   And
it is doubtless, on these accounts, that provident nature has imparted
an opening quality to the colostrum of all animals;  a certain indica-
tion to the rational species, to assist the expulsion of this matter, now
no longer required.  For though  a child should  even be suckled by
its own mother,  (in which case, there is, doubtless, less occasion for
other  assistance,) yet we know,  that nature  doth  not, in  every in-
stance, always fully accomplish  her own designs: and it is from some
striking instances of the truth of these observations, that I have  said
so much  on this  subject, which  I have also been the more inclined
to,  because so many writers have passed it over almost in silence;
whilst others have opposed our over officiousness.
   I ani not surprised, indeed, that all those who esteem medical people
to be officious disturbers of nature, should object to their assistance in
this instance, and conclude, that she would do the business much better
if left to herself.   But there are  even some physicians of this opinion,
amongst  whom I find Dr. Buchan, whose  abilities and reputation 
RETENTION OF THE .MECONIUM.
9
< laiivi particular attention; though he, perhaps, may not be so much
engaged amongst very young infants, as those whose peculiar province
it is to attend them from the birth.   But there can be no  general
rule without exceptions,* and as doubtless, many children would do
very well without any such assistance, so have I  found others would
not,f though suckled by  the parent herself; of which I shall presently
give a very striking instance.   On the other hand, I believe, no in-
fant can be essentially injured by constantly assisting in this wrork,
provided  the means first made use of be lenient, as they ought al-
ways to be.  It is the province of art to superintend  nature,  and not
only to guard against  her excesses, but so to  watch over her, as to
ensure the accomplishment of her intentions, whenever we perfectly
comprehend, and can effect them without the risk of doing harm.J And
this intention is as rational, as the practice is successful, there being
an evident acidity in the meconium, as I have ascertained by repeated
experiments.§   The red-gum and thrush are also much more rank
where the symptoms of acidity are most prevalent, and on the other
hand,  less commonly take  place  (as I have for many years observed)
where the meconium has been early purged off.
   For this purpose, amongst others, a new remedy has of late years
been recommended, as  preferable to any purging medicines what-
ever. j|  Mankind has ever  delighted in extremes—no  sooner has
any thing, formerly judged to be hurtful, or  even poisonous, been
found in certain  cases  to  be very useful, than it is supposed to be
capable of doing every thing, and supersedes all that  the wisdom of
former ages has proved  to be  salutary.   Hence, some advantages
experienced from the use of vinum antimonii, in a variety of children's
complaints, as far as they arise  from one  common  cause, has in-
duced some people to extol it as an universal  remedy.   But where-
fore give  an emetic, calculated  to empty the stomach, in order  to
expel the meconium from the lower bowels?**   It is universally al-
  * Vix ulla perpetua pr<ccepta medicinalis ars recipit.  Celsus, Fraxf. Lib. i.
p.  17
  \ Indeed, it is now wpII known, that the formidable disease, so fatal to new-
born children in the  I Vest Indies, called the locked-javv, or jaw-fallen, (See
Tetanus,) is almost always owing either to unwholesome, and confined air, or to
a want of purging off the meconium.
  i A tree will produce fruit in its wild state; but by human culture the tree
is often preserved, and its fruit improved, far beyond the course of nature.
  § This change from its  original nature (which is bilious) may be occasioned
by an admixture with whatever food the infant  may have taken, or even with
air.

  || Dr. Armstrong, on diseases most fatal to infants, 1767.
  **  On examining the first-passages of still-born infants, (newly-dead} it ap-
pears, that the large intestines contain the true meconium; the smaller  bowels,
only a thin bilious fluid, mixed with a little gastric juice.  The stomach eon- 
10
RETENTION OF THE MECONIUM.
lowed, and by this writer also, that emetics are not to  be adminis-
tered when the bowels are full, which, in  this instance, is precisely
the case.  It is true, vinum antimonit does not always vomit children,
nor will alittle matter oftentimes do this; it is sometimes, indeed, 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 such  things
whose proper operation  may be depended upon?   Not the stomach,
but  the bowels, are the natural  and  safe outlet for most  infantile
complainis, and a want of due attention to this circumstance has been
productive of  some evils, which  many practitioners, I think,  are  not
sufficiently aware of.
   It is very evident, that some gentle  purgative is indicated  on thia
occasion, and that it should be of such  a kind as will create as little
disturbance as possible, and especially should not be of  an offensive,
or indigestible  nature; though such have been very commonly  ad-
vised.   In general, indeed, a very little matter will suffice; perhaps
a liitie syrup of roses, diluted with some thin gruel, and given oc-
casionally by tea-spoonsful,  will answer the end;  will also serve to
keep the child  quiet, and so prevent the nurse from giving it impro-
per food.   But if this should  fail  to procure stools, a watery infusion
of rhubarb, a tea-spoonful of the wine,  diluted as above, or a drachm
of easier oil, will be found preferable 10 the common oils and syrup in
general use.*
   The objection now made to oily medicines is very much increas-
ed, from nurses scarcely ever giving the  quantity that is sent, in  the
course of the first twenh-lour hours,  as  it is always designed; and
administering the rest long after  the child has begun to suck, or to
feed.  At this period, mixing with the nourishment, it has a direct
tendency  to produce indigestion, wind,  and  the  very complaints,
which the oils administered in proper time, were  designed to pre-
vent.  Not to add, that, from common oil and  syrup being the usual
purgative  on this  occasion, nurses are  led  to procure a repetition of
it, and to administer it whenever an infant happens to be costive dur-
ing the month; and from whence, the above evils maybe frequently
induced.
   But it has been observed, the meconium is not always disposed to
come away, even by the assistance of  common purgative medicines.
Having, therefore, begun with such as the above, if the child should
have no stool for twelve  or fourteen hours after birth, and especially
if it seem to be in pain, a clyster ought to be thrown up; which may
be repeated, if necessary, a few hours afterwards.  And here I would

tains still less, as no bile can enter it but by  regurgitation from the duodenum,
and the gastric ju.ee is in small quantity, not enoutfh  to be brought  up bv an
emetic without violent straining; which 1 should imagine it can answer no {rood
end to excite by a vomit the first hour a child comes into the world
* See Harris. 
RETENTION OF THE  MECONIUM.
11
 remark, that in the cases where more powerful remedies are requir-
 ed, scarcely any  evacuation will be procured by these gentler means;
 for, wherever I could procure one copious  stool by a clyster, or gen-
 tle laxative, the  rest of the meconium has afterwards come  away
 with  little, or no further assistance.   But as it sometimes happens,
 that  neither  clysters  nor ordinary  purgatives have  any sufficient
 effect for several  days,  very powerful means must then be made use
 of; there being reason to suspect a morbid suspension of nervous  in-
 fluence.  I shall close this subject, therefore, with a remarkable in-
 stance  of  this kind, (of which I have seen many,)  as a proof of
 what powerful  remedies may sometimes be  required, and how"
 necessary  it is to pay some attention  to this early  complaint  of
 infants.
   The child was born of very healthy parents, (not at all of consti-
 pated habits) after a quick, and comparatively easy labour; and
 appeared to be  itself in good health.   To  avoid prolixity, I shall
 only  briefly observe, that the  child took a  little rhubarb  an hour  or
 two after it  was born,  but  having had no stool when I saw  it  the
 next  day,  I ordered a clyster to be thrown  up.  In  the evening,
 the  child  became drowsy  and  insensible,  and  when  roused,  it
 moaned, but seemed unable  to cry.   It continued pretty much  in
 this state, (except that  at times  it appeared  to  be in great  pain,
 and  was  evidently convulsed)  for  six days;  and was  nourished
 chiefly by breast-milk, given by tea-spoonsful; seldom reviving suffi-
 ciently  to suck.
   It had no stools, but such as made  only a few spots on the cloths
 about the  size of a shilling,  till the  sixth  day, and then they were
 very small, hard, and lumpy.  The  next  day it had more "of this
 kind, and had not till the eighth  day, any thing like a proper  stool,
 which was also  mixed with hard lumps; but on  the eleventh day,
 they were  thinner, and on the thirteenth came  very freely.  In the
 course of six-and-thirty hours, I prescribed two ounces of the  com-
 mon  infusion of senna, two  drachms of rochelle salts, four grains  of
jalap, and  a grain of calomel; besides purging clysters, and the use
 of the wann  bath.  The next  day,  the child  took four grains  pf
 ipecacuanha  at two doses, and forty drops of vinum antimonii,  at
 four times (in the course of an hour) without any effect; and at ano-
ther  period, six  drachms of castor-oil, besides  several  doses   of
 manna.*  Three  days after the child  had  gotten rid of the meco-
 nium, the thrush  made its appearance; which was slight, but  con-
tinued above three weeks.
  • See a similar instance in the chapter on the Croup.  The obvious cause of
the inactivity both of emetics and purgatives, which we sometimes meet with in
infants, is probably the great quantity of mucus with which the first-passages
are lined, together with a deficiency of nervous  influence, a frequent concomi-
tant of such a state. 
n
ICTERITIA
    From such instances, as well  as the remark already offered on
flu tetanus of the West-Indies, the expediency of having recourse to
some safe and effectual  means of purging off the meconium  seems to
be evidently pjimed out; more especially when we consider the dan-
gerous compl tints which are said to  arise in some of the hospitals in
Paris, from an undue retention of this viscid matter, as will be fur-
ther noticed in another place.*
                  Icteritia, or Infantile Jaundice.

  The jaundice  of infants seems always to have  been improperly
conceived of.   Those who have written only on children's diseases,
have usually passed it over in silence, whilst others have considered
it  always as rather a serious complaint, and have  prescribed as for
the jaundice of adults.   On the other hand, nurses have usually ac-
counted the yellowness that appears about the third  day after birth, if
unusually deep,  (termed by some the yellow-gum)  as the true jaun-
dice.   Certainly neither of these opinions  is just; for the latter of
these  appearances requires no attention at all, and though infants are
not very often troubled with the true jaundice like adults, they never-
theless are liable to slighter affections of that kind which claim some
attention.   These are easily distinguished from the common yellow-
ness,  by the tunica albuginea being always very yellow; but the nails
are not tinged, as in the jaundice of adults,f  though it is probable
they usually would be, if the complaint were long neglected, and the
child  suffeied to be costive.   I have waited some days to  see if the
yellowness would  go off of itself, as the usual tinge does;  but it has
always increased rather than diminished.   It arises from viscid mat-
ter obstructing the gall-ducts, and therefore requires a little emetic.
The fartarised wine of antimony is a very proper one on  this occa-
sion,  as it may likewise  procure two or three stools; but as children
in this complaint  are not easily made to vomit,  should the wine fail,
three or four grains of the powder of ipecacuanha mav be given, as
more certain in its operation; and the next day four or five grains of
rhubarb.   Should the symptoms continue,  the emetic ought to be
repeated after two or three days, and rhubarb be given  about every
other day, till the yellowness disappears; which, under this treatment,
never continues more than ten or twelve days, unless the infant be
very  costive, or the stools are of a  very pale  colour; which is  but

  * It will be found, on referring to the chapter on Tetanus,  that our author
does not agree with Dr. Evans, who supposes that disease to be produced by
constipation ; but rather inclines to the opinion of Dr. Clark, who attributes it to
the smoke with which the negro houses are clouded, from the want of chinv
nies.—E. D.
i See the note in page 13. 
ICTERITIA.
In
a
rarely  the case.  "Where an  emetic has  been objected to, and the
whole  attention confined to keeping the belly open, the yellowness
has continued when I have taken my leave at the end of the month,
attended with  languor, and other symptoms of debility.   When the
belly is unusually costive, and the stools very pale, infants are gene-
rally found to  have a true  jaundice, and require  some saponaceous
medicines, such as the aqua kali, together with daily frictions of the
stomach and belly, and the use of the warm-bath.
   Women long  afflicted with jaundice, during  any part of  their
pregnancy, and even actually brpught to bed jn that state, do not
infect their children,* unless  they also suckle them;  but from some
striking instances, I have found, that suckling in that state is capable
of communicating the true jaundice to a great degree, and that it will
not be cured, but by the recovery of the suckling mother or nurse, or
the  nurse changed, or the infant being weaned, as well as properly
treated.
   The true  jaundice, distinguished by the skin being every where
discoloured,  as well as  the whites of  the eyes,  seems to be  much
more  common among new-born  infants  in  France  than  in   this  ^
country, as appears from a memoir written by Mr. Baumes,  and to
winch a prize-medal of the Faculty of Medicine in Paris has  been
adjudged.
   In that work the various  causes and  nature of the disease are  dis-
tinguished;  and a correspondent treatment pointed out  with  great
accuracy and  judgment.  Throughout the tract there seems  also to
be much ingenious and  plausible theory; though I cannot agree with
that able physician, in  supposing the  jaundice to be occasioned by
the retention of the  meconium, otherwise than from this viscid  mat-
ter sometimes obstructing the orifice of the biliary ducts.   For in the
several instances 1  have met with of the most obstinate retention of
that secretion, there has not been the-least disposition to jaundice;
nor  can I conceive, that any part of the meconium is  usually ab-
sorbed in icteric cases, as Mr.  Baumes has imagined: neither  does,
such an incident appear to  be necessary in order to account for the
frequency of the  disease in that kingdom, or elsewhere.

  • I have myself never met with  such an instance ; but Mr. Baumes, who has
been very attentive to  the disease, is satisfied, that he once saw an infant  so in-
fected from the  womb: but in this case, the  child died  very soon in a very
diseased state, the  internal  part of the liver being in a state of suppuration.
Other instances are given, but they  are not unexceptionable.  Vide Jl. JV. Cu-
rious. Dec. 1. A. vj.  Obs. 241. Dec. iij. Jl. ij. Obs. 40.  Fr. Delaboe. Silvins,  Prar.
Med. Lib.]. Cap. 46,No. xi.  p. 302.  Theod. Kerkr'rng, Spicil. Obs. 57, p. 118.  I
have, indeed, lately seen an infant  (the mother of which, however, was not
icterjc) whose finger nails were, at the birth, of as deep a yellow as any icteric
adults, and very sensibly from a tinge underneath them ; but those of the toes
were not at all discoloured,  nor had the infant any other symptoms of jaundice.
It, indeed, brought up, by puking, a considerable quantity of yellow matter, ap-
parently bile, very soon after it was born;  but the tinge of the nails disappeared
the next day, and the infant  throve verv well. 
14                        ICTERITIA.
   As to the treatment, under the different circumstances there  de-
 scribed, I meet with nothing that militates against the more general
 account I have given of this disease, or the treatment adapted to it,
 under the form w herein it appears in this country.
   There are not wanting evidences of this disease, both in the more
 slight and severe forms of"it, being in some families  hereditary; of
 the former, Morgagni has furnished a remarkable example in his own
 family; and of the latter, Mr. Pearson has favoured me with a very
 curious one, which the reader cannot fail  to be pleased with, as no
 such instance, I believe, is to be found upon record.   I shall  submit
 the account in his own  words, arid without any comment;  as fur-
 ther experience is  necessary to  enable us to draw any practical in-
 ferences.
   Mr. Pearson's account runs thus:
   Mrs. J. had been the mother of eleven children; on  nine of which
 the jaundice appeared a few days after they were born, and they all
 died within the period of a month after their birth.  The tenth child
 Jived six years, was then afflicted with the jaundice, and died.   In
 Mar, 1798, Mrs. J. was delivered of her eleventh  child; on the third
 da\ after its birth,  the skin became yellow, and the child was at the
 same time remarkably torpid and sleepy, and seemed to be slightly
 convulsed.  On die following  days,  the  colour  of the  skin often
 varied,  being sometimes  of a  deeper yellow,  and at other times
 nearly regaining its natural colour; the child continued, however, in
 the same languid and almost insensible state, but received nourish-
 ment, and sucked the breast of  its mother, till within a few hours of
 its death, which took place on the ninth day.   I  opened the body of
 this child the day after it died, and shall now proceed to describe the
 appearances exhibited on dissection.
   The skin had nearly lost its yellow colour;  and the child did not
 appear at all reduced by the disease.
   The  liver was almost twice its natural size; the whole concave
 surface of the right lobe had a livid appearance, but this dark colour
 did not penetrate above a line or two; and the internal  substance was
 sound and healthy.   The convex part of the liver, was  of  the  na-
 tural  colour and firmness, except on  the  margin of both the lobes;
 there the thin edge exhibited a highly injected  appearance; the  red-
 ness was, however, less vivid and remarkable  on the  left lobe than
on the right.   There was also a slight adhesion of the lower  part of
the right lobe to  the peritonaeum.  The gall-bladder was nearly fill-
 ed with bilp of a deep yellow colour; and its ducts were perme-able.
The stomach was in a natural state, and the intestines  were without
 any marks of disease.  In the thorax, the lungs  were of a healthy
appearance.  The heart seemed to be larger than common, and  the
blood vessels  on  its surface were remarkably turgid.   The right  au-
ricle was distended with blood; and the pericardium contained about
 a table spoonful of water.   Every person who is conversant with the 
ERYSIPELAS INFANTILE.
15
diseases of children, knows, that although new-born infants are some-
times affected with the true jaundice, requiring its appropriate reme-
dy, this appearance is at others  but of little importance, and some-
times even  disappears spontaneously.   Morgagni has  furnished a
remarkable  example of this in his own family.   De quindecim filiis
meis, cum mox a partu flavi omnes, et nonnulli etiam haud ita leviter,
essent facti,  cunctis per se, nullo prorsus artis auxilio, paulatim icterus
solutus  est.   Lib. iij. Epist. 48.  Jlrt. 60.
                       Erysipelas Infantile.


    In a former edition, it was observed, that this complaint, (noticed
 under the term  anomalous inflammation,)  did not appear to have
 been distinctly noticed by any preceding writer.   But I have since
 found that Hoffman, though he makes no mention of any such com-
 plaint in his Morbi Infantum, has  the following intimation  in  his
 chapter De Febre Erysipelacea* and  it should therefore seem, was
 acquainted with that species of the disease  which appears  in  the
 more precise form of erysipelas;  but which he had noticed only in
 the region of the belly.—" Umbilicalem regionem in infantibus fre-
 quentius,  infestat, ac hide  per abdomen  spargitur,  cum gravibus
 pathematibus, funesto ut plurimum eventu."  The French have like-
 wise spoken lately of a  somewhat similar  affection,  combined with
 different endemic complaints infecting crowded hospitals: and  it is
 certainly sometimes found to follow  disorders of the  first-passages.
 The disease, however, not appearing to have been any where noticed
 in its simple and genuine form, it has seemed necessary to give a na-ne
 to the disease; which, therefore, in my latter editions has been term-
• cd Erysipelas Infantile.
    It is a very dangerous species of the spurious  or erysipelatous in-
 flammation, which I have not often met with, but in lying-in-hospi-
 tals.   The ordinary time of its attack being a few days after birth, it
 was at the first thought never to appear later than the month;  but
 this has been since found not to be the case.  It seizes the n:ost
 robust, as well as delicate children, and in  an instantaneous manner;
 the progress is rapid; the skin turns of a purplish hue;  and soon  be-
 comes exceedingly hard.
    The milder species of it often appears on the fingers and hands, or
 the feet and ankles, and sometimes upon, or near the joints; forming
 matter in  a very short time.  The  more violent kind is  generally
 seated about the pubis, and extends upwards on the bellv, and down
* Sec. i. Cap. 13. 
16
ERYSIPELAS INFANTILE-
the thighs and legs; though sometimes it begins in  the neck, and  is
equally fatal.  The fact, indeed, seems to be, that it is generally far
more dangerous when it seizes,  or spreads  to any parts of the body,
than when confined to the limbs.  The swelling is but moderate, but
after becoming hard, the parts turn purple, livid, and very often
sphacelate, especially in boys when it falls on the scrotum; the penis
swells, and the prepuce then puts on that kind of emphysematous ap-
pearance, which it has when a stone is sticking in the passage; or in
the anasarca of the scrotum.
   Upon  examining several bodies after death, the contents of the
belly have frequently been found glued together, and their surface
covered  with inflammatory exudation, exactly similar to that found
in women who have died of puerperal fever.   In males, the tunicac
vaginales have been sometimes filled with matter, which has evident-
ly made its way from the cavity of the abdomen, and accounts for the
appearances of the organs of generation just now described:  in fe-
males, the labia pudendi are affected in like manner, the pus having
forced  a passage through the abdominal  rings.
   Upon  the complaint being first noticed in the British Lying-in-
Hospital, various means were made  use of without success; though
the progress of the inflammation seemed to be checked  for a while
by saturnine fomentations and  poultices,  applied  on the  very  first
appearance of the inflammation; but it soon spread, and a gangrene
presently came on; or where matter has been  formed, the tender in-
fant has  sunk  under the discharge.   It is now several years since I
proposed making  trial of the bark, to which sometimes a little con-
fectio aromatica has been  added: from which period several have
recovered.  Some time  after this,  linen  compresses wrung out  of
camphorated spirit, were applied in the place of the aqua lithargyri
acetace, which has proved more successful in checking  the inflam-
mation in several instances; nevertheless, the greater number of in-
fants attacked with this disorder, sink under its violence, and many'
of them in a very few days.
   In a few instances, the disease has been attended with  some va-
rieties.   Infants have not only come into the world with several
hard, and sub-livid inflammatory patches,  and ichorous vesications
about the belly and thighs, but with other spots already actually in a
state of mortification.  A large  eschar has  soon  spread  upon the
spine of the tibia, with smaller ones about other parts of  the legs,
and on several of the toes and fingers.  In such cases  particularly,
the bark  and cordials must be exhibited liberally, and the  inflamed
and mortified parts be well fomented, and  dressed with warm appli-
cations.
   From the good  effects attending these  means,  particularly on  a
very copious use of the bark, there is further room to hope, that we
may be  yet more successful in  the treatment  of this formidable 
C0RYZA MALIGNA.
17
disease; which has not, however, appeared so frequently at the hos-
pital for the last seven or eight years, as in former times.*
   In two instances, where the bodies of infants dying of this disease
were examined by Dr. T. Walshman, the stomach, lungs, and othep
internal parts, were found very much diseased; the former being in so
tender a state as to  give way upon the slightest pressure: whether
any thing  of this kind  usually takes place  in consequence of this
disease, further  examinations must evince.  Such a  state of the
stomach is,  however, by no means, peculiar to this disorder; being
met with in the examination of scrofulous and hectical children; and
very lately occurred also in the body of an infant which I examined,
that had lived to  be  only six days old: in this instance, likewise, the
intestines, kidneys, and other parts, were greatly diseased.


           '   Coryza  Maligna,  or Morbid snuffles.

   I have given this appellation to an uncommon  discharge from the
nostrils, taking place in the month,  usually  in  the first  or second
week after birth; and in one or two instances  the infant has seemed
to be born with it.   This disease  has passed under the  name of the
■snuffles, on account of the kind of noise  such infants  make in re-
spiration: but it is not only a  far more severe, but a very different
complaint from the one commonly intended by that name.    The dis-
charge is much more abundant than that arising from  taking cold,
and is truly  purulent from the beginning, and afterwards sanious:
though, in a few  instances,  children, affected with  every other
symptom of  this  disorder, have no discharge from the nose.   But
under every form of the disease, infants always appear  weakly, and
as if unwell, though  without  any precise complaint, and  are con-
stantly incommoded  from the  stoppage  of  the head, especially  in
their sleep;  during which they breathe with difficulty.   It generally
continues for several weeks, and upon its going  off",  children who
have had the  disorder only slightly, have become  otherwise unwell,

  * The erysipelas of adults is very successfully  treated ?by the application of
blisters to the part affected, while the state of the system is kept constantly in
view.  This practice is of ancient date, but had fallen  into disuse for some rea-
son which it is difficult to discover; of late, however, it has been revived by Dr.
Fhysick, to whom our profession is indebted for many of its most valuable con-
tributions.  If so well adapted to the complaint in persons somewhat advanced
in life, may we not conclude, from analogy, that the  same plan might be so mo-
dified as to meet the indications in the tender infant.  In the treatment of this
disease, much diversity of opinion has prevailed among medical men:  for while
some have pursued the antiphlogistic plan in  toto,  others have been led into a
practice directly the reverse. By Garthshore, we  are advised to apply the cam-
phorated spirit of wine externally, while by others,  ammonia, in large doses, is
prescribed.  Burns has derived most adyantage from small doses of calomel, so
employed as to keep up a continued action upon the  bowels.  How far either of
these methods  may be superior to the others, I am unable to determine, from the
narrow limits of my own experience.—E. D.
                                C 
IS
t-ORYZA MALIGNA.
and such as have been brought up by hand, have been dangerously
ill in their bowels.
   The plan of treatment which I adopted in the first instances I met
with was, to keep the body cool and open; or if the infant happened
to be over-purged, or was languid, to administer absorbents and cor-
dials.  I recommended the nurse's diet  to be  attended  to, when a
child is  suckled, and to  keep a little  blister open on  its head, or
on the nape of the neck; but this has  since appeared,  in some in-
stances, to be hazardous, although no evil ever ensued where I had
directed it.
   I had attained  no further knowledge of this complaint, when Dr.
Denman obliged the public with a more ample and formidable detail
of it; which had fallen more frequently in his way, than  it had done
in any other practitioner's.
   His account of it is so accurate, that  I shall again in  this edition
likewise borrow the description of its principal symptomS from him,
adding to it such as later experience has furnished.   He remarked,.
that this  disease seemed to be new in its manner, though not in its
kind, at the time of its first making its  appearance, which was fre-
quently in the summer of the year 1790; in the  June of which year it
wras that I also first saw it.
   After mentioning the little varieties noticed in  the discharge, and
the most formidable symptom of the disease, the difficulty of breath-
ing through the nose; he observes, that  the latter was not  constant,
and that, when free from it, children appeared to be in  no danger;
that the difficulty of breathing was at other times so great as to re-
quire an attendant to watch a child sleeping and waking, in order to
©pen its mouth as often as it might be requisite.
   Dr. Denman further notices a singular purple  streak at the verge
of the eye-lids; which he afterwards considered in a manner pathog-
nomonic of the disease;  and, indeed, I have rarely met with the dis-
ease  without it.   He describes also a general fulness about the throat
and neck externally, taking place soon  after the commencement of
the complaint;  which he seems to date from the appearance of the
purulent discharge from  the nose:  though it has been remarked, that
this symptom, although one of the most formidable,  may be entirely
wanting.
   That, when these symptoms had continued for  some days, accord-
ing to the strength of the patient and degree of the  disease, children
became pale and languid; and that upon  looking into the throat, the
tonsils were found tumefied, and of a dark red  colour, with ash-co-
loured specks upon them, and in some there were extensive ulcera-
tions.  The parts on which blisters had been applied in the begin-
ning of the  disease, and which had been  apparently  healed   often
spacelated towards the conclusion.
   The infants (he reports) gradually declined in  their strength, and
had a particular catch in respiration, as if the velum pendulum palati 
CORiZA MALIGNA.
19
were elongated.   They were unable to suck, though not universally;
swallowed with difficulty whatever was given  in a spoon; and died
in convulsions, or with all the marks of great debility, though not on
any particular day of the disease.
   Dr.  Denman observes, that in the course of eight months he had
attended eight children in this disorder, six of whom died; that the
body of one of them was afterwards opened by the late Mr. Hunter
and  Mr. Home, but that nothing was discovered,  except that the
membrane lining  the nose was of a dark red colour,  and its blood
vessels more turgid than ordinary.
   The true nature of the disease, and  consequently its appropriate
treatment, were for a considerable time but imperfectly understood;
and hence arose its frequent fatality.   It would be superfluous, there-
fore, to take up the reader's  time with an account of the means for-
merly  made use of;  neither  can it be  necessary to add much to the
more perfect, though hasty account I added, to the last impression,
by way of appendix.  It need only to be  observed, that  Dr.  Den-
man, by a fortunate occurrence, having  discovered  the true nature
of this  disease, has,  in consequence, happily adapted a remedy that
has proved an almost certain cure for it, if attended to in  time.
   The true source then appears to  be a defluxion and inflammation
over all that extent of Schneider's membrane lining the antrum High-
moiianum, posterior nostrils, and contiguous parts.   Hence, the co-
pious secretion of purulent matter irritates the trachea, and produces
that spasm, and croaking noise, with recurring sense of suffocation,
so uniformly observed in this disease.   By  descending into  the
stomach and bowels,  it disorders these parts; and if not very soon
properly treated, induces such general disease as presently  debili-
tates, and at an  uncertain, but generally an early period, carries off
the little  patient, in the manner that has  been  already  described.
The stools it may be noticed,  are sometimes thick  and pasty,  and
when otherwise after repeated purges, they are of a peculiar green
colour, or sometimes blue,  different from what I have noticed on al-
most any other occasion.
   From this account of the disorder, an attention to the state of the
bowels, as  I intimated in the  first instance I had seen of it, is  the
manifest indication; but with this further  light thrown upon it by
Dr.  Denman, that keeping  them very open,  so as to prevent the
lodgment of the matter falling into them, is the grand mean of cure:
there being much less to be affected by absorbents and anti-acids to
correct the constant sourness, and ill-condition of the stools, than by
carrying them off speedily and frequently.
   To this end, one or more tea-spoonfuls of castor oil should be given
every day, so as to procure three or four motions daily.   If a child
should be weakened by this means, some cordial medicine should be
occasionally interposed; or should this prove insufficient to support
the infant, the purgative must be somewhat abated: but it is remark- 
30.
CORYZA MALIGNA.
able, that even weak infants endure purging better under this com-
plaint than any other, unless it be the tooth-fevers.   If a convulsion
fit should supervene, as it sometimes does, clysters, and the usual re-
medies for spasm should be administered, and especially the cordial;
which, breaking off wind from the stomach, and giving tone to the
bowels, becomes a very useful one in this case.   In several instances,
a recourse to opium, or syrup of  white  poppies, has been attended
with good effect; and may, in that case, be administered every night
when the purgative  has operated properly.   Or a good medicine, in
many cases, is Dalby's  carminative, which may be given every six
or eight hours; and particularly when repeated doses of the laxative
medicine are given through the day.   From eight to twenty drops, or
more may, in that case, be given between each  dose of the purgative;
and has in some instances been  considered as a principal mean of
cure.
  Under such treatment, the morbid snuffles has been found to yield
in the course of two or three weeks; some purging medicine being
continued as long as the discharge, or difficulty  of breathing shall re-
main.   It, however, sometimes runs on as much longer, and is at-
tended with a spasm in respiration, as if the infant were dying: this
symptom, as well as the snuffling, often recurring some time after an
infant had seemed  to be cured: and in  one case I was  only a few
weeks ago attending, not only  the snuffling, but the  discharge oc-
curred more than once, after the disorder had seemed wholly to give
way.   In such instances, besides purging, it has been thought useful
to foment the bridge of the nose, and afterwards apply some aromatic
liniment.
  When the disorder is found not only to  hang on for many weeks, (as
it sometimes will even where it has not  been peculiarly violent,) but
together with the continued use of purges, to keep the infant pallid
and feeble, notwithstanding the exhibition of cordial medicines; a re-
course to the decoction of oak-bark has at once  removed the snuffling,
and given vigour to the child in the course even of a few days.—A
remedy that does not seem to be sufficiently known for this and many
other complaints.    Indeed, where a tonic  medicine is found neces-
sary, but where, either  from a frebile diathesis, or a disposition to
glandular obstructions, the cortex peruvianus  may be thought inex-
pedient,  the oak-bark will generally be  found  a safe and efficacious
medicine and  mesenteric.
   It is necessary only to  add,  that though  this disorder had never
until very lately been met with after the month, I  have seen it at a
more advanced age; in one, or more instances, however, it has  been
thought, I know not how justly, that some slight symptoms of it had.
in that case, appeared in the month. 
r'H
                           Inward Fits.

  It has been already said, that any  derangement of the first pas^-
sages is capable of giving rise to various complaints, among which,
that of inward fits has lately be^en taken notice of by some medical
people, but I think scarcely deserves the name of a disease.*   It de-
mands attention, however, because so much has been said about it
as to create apprehensions, lest  this subtle disease should be insen-
sibly at work, and making way for more severe, and outward con-
vulsions.
   This complaint may take place at any period of early infancy, and
is said to be  more dangerous  the  younger the infant  may be.   A
constant symptom in this kind of fit, as it is called, is the infant's lit-
tle mouth  being drawn  into a smile;  which  whoever has noticed,
must  have  beheld it with pleasure.   And  if the  complaint  ex-
tends no further than  this smiling, which is generally in its sleep, it
arises merely from a little wind, and is certainly harmless, because
in  this case the wind is not really confined; and therefore an immedi-
ate recourse  to  emetics  or purges is more  likely to  do harm, by
straining the stomach, 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 sensation produced by  tickling
with a feather, to that of a hard gripe, or a violent stroke.   The first
may be said to be pleasing; and such, I doubt not, is the stimulus in
question on the  nervous  coat  of the stomach of little  infants,  and
therefore produces so  agreeable a smile, that  I could  never consider
it any more  as an  indication of mischief than of  pain.   Indeed, I
know of no  complaint that ought to be termed  inward fits; and I
mention this, because nurses  are continually talking to us  about
them, when children  are perfectly well, and often give the fond pa-
rent needless  distress,  as well as many an unpleasant medicine to the
child.  They are at the same time treating the true convulsion, whilst
slight, in the  same way, being led  into  the error by the idea of in-
ward fits;  a term they are ever using, but have no precise ideas of,

  * We cannot agree with our author in the opinion  which he has expressed on
the subject of inward fits; he thinks that they exist only in the apprehension of
fearful nurses, or if they have reality, considers them as harmless.  Judging from
my own experience, 1 should say,  that they not only have existence, but are
commonly the precursors of thrush, a disease always unpleasant in its effects,
and sometimes fatal in its consequences.  My experience, however, is limited,
and may not be deemed  (by the generality of readers) sufficient grounds upon
which to establish the opinion I have broached.  Armstrong, in his Treatise on
the Diseases of Children, states the same fact; and certainly the correctness of
his observation, and the  credibility of his testimony,  is not to be doubted upon
mere assertion.  To say that he was mistaken in those cases of which he makes
mention, is, in other words, saying that he who saw the disease could not judge
so correctly of its nature as he who did not see it.  Such reasoning will have lit-
Me weight with those who are calculated to decide.—E. D. 
22
INWARD FITS.
nor do any two of them, nor indeed medical writers intend the same
thing, as may be seen by so good an author as Stoll, in his late pub-
lication.   It were therefore better, perhaps, the term were altogether
abolished; as the child is either evidently convulsed, or has no kind
of fit, at least none for which  any remedy can be offered.—-Infants,
as well as adults, do sometimes,  indeed, die suddenly without any
manifest convulsion.   But this more frequently happens after over-
feeding, and arises from a spasm of the stomach,  (of  which I shall
treat  at large, in the chapter on  true convulsions;) or sometimes of
the heart or lungs;  and infants may then be said to die of inward fits,
there being no external  convulsion.  Infants are likewise  carried
off suddenly from water in the head; of which I have lately seen two
instances in the same family, (where the  disease was ascertained by
opening the cranium;) both  the children appearing  perfectly well
only a few minutes before they died: but neither of these occasions
is, by  any means, the kind of affection  usually  understood  by the
term, inward fits.  If the infant should sleep too long, and the smiling
above  mentioned should often return, the infant may be taken up,
gently tapped on the back,  and its stomach and belly be well rubbed
by the fire;  which is  all that can  be necessary.  This gentle exer-
cise  will bring  a little wind from its stomach, and the child will go
to sleep again  quietly.
   This complaint,  however, is  largely treated of by some writers,
and Dr. Armstrong wishes  to  give a few drops  of the wine of anti-
mony; but it is very apparent, that when he considers it as worthy
of more attention than I have just now advised, it is either a true con-
vulsion, in which the  eyes are distorted,  and the mouth is discom-
posed, instead  of putting on a smile; or else he is prescribing for
another disease under the name of inward fits, which former writers
have treated under the head of disorders arising from costiveness  and
wind.   But if this little turn of  the features should arise from  con-
stant over-feeding, it were  endless to administer emetics; the cause
of the complaint is obvious, and upon the removal  of it  the remedy
must rest.
   Such has ever been my opinion of this much talked of complaint;
and, indeed, I have not to this day, after  a great deal of attention to
infants, seen any thing sufficient to induce me to alter it; or I should
have suppressed the preceding observations.  As I wish, however, to
afford  all the information I can on every complaint, I have to observe,
that a gentleman, of great respectability and experience, has conceiv-
ed that though the term inward fits has been often misapplied, there
is really such  a complaint, and  that it generally proves fatal.   Be-
sides a little blueness  of the lips, and slight turning up of the eyes,
often noticed by nurses, this complaint is described  as attended with
a peculiar sound of the voice,  (somewhat like the croup) and a very
quick breathing at intervals;  and  is supposed to arise from a spasm
of the stomach, lungs, or other vital organ.—A spasm I have indeed 
INWARD FITS.
23
ioo frequently seen, but certainly very different from that usually ac-
counted inward fits.
   These  symptoms are  said frequently to attack the child  in  its
sleep; and in their commencement will go off upon taking it up from
its cradle.   They are likewise observed to be  induced by sucking or
feeding, and to  be increased upon  any  little  exertion of body, or
transient surprise, and  in this manner to recur for a length of time,
before they become alarming.  The remedies  proposed for the cure
of this complaint are, an emetic on the first  attack,  and  afterwards
volatilcs and fetids; but, as it has been observed, very seldom to good
effect.
   These symptoms, indeed, I have frequently  met with; and howso-
ever alarming their appearance, if they be not accompanied with
any other, they have,  fortunately, turned out  more favourably than
this complaint is reported to do.  Hitherto,  at  least, I have suc-
ceeded in removing this  extraordinary spasm, in every instance, by
treating it as I had before hinted, as a  chronical croup, by adminis-
tering  different antispasmodics;  asa faetida, ol. succini, tinct, fulig.
musk, or cicuta,  being prescribed as particular  circumstances have
indicated: and so far from its generally proving fatal, I have  not
been able to  learn by  the most diligent inquiries, that any children
so affected,  excepting * two  out  of the numbers  I have attended,



   * One of these infants had very severe and repeated convulsion fits for several
days, together with the croup, and was suspected to have  water in the head. It
appeared, however, to be at length perfectly recovered, so that Dr. Reynolds (who
attended with me) and I had taken our leave for about a fortnight. The fits then
returned, but were so slight that the apothecary only  was sent to; but in one, the
most slight of any, the infant almost in an instant expired, very much in the
manner described by the  gentleman above alluded to.  But as infants not un-
frequently die suddenly of hydrocephalus, (see the chapter on Hydrocephalus,)
and  as that, or some other morbid affection of the  brain had  been suspected,
and the infant was not opened; the conclusion on  either side is  incomplete.
   Should it be objected, that although this child  had several convulsion fits, at
the same time that it was  affected with the crouping noise, and that these re-
turned after the croup had given way ;  yet itcertainly died precisely in the sud-
den  manner that infants are said to do of what  has been termed inward fits-;
and, therefore, neither this child, nor others who recovered under the treatment
described, had a disorder that ought to be termed spasmodic croup, but were
all ill of inward-fits, although only one of them died suddenly as  such infants
usually do : should the whole or any part of this  reasoning be granted, (which
in my opinion it ought not) yet is the term inward-fits, equally improper,  and
nowise descriptive of so singular a disease as is  intended by it; and can only
lead to an indeterminate use of a term calculated rather to obscure a dangerous
disease than to lead to a any good practical use.  The other infant was only
five  months old, and appeared to be recovering under the  use  of asafctida,
when it died very suddenly ; and the body being opened, it was  with much sur-
prise that the  marks of true apoplexy were met with, there being a coagulum
of blood on the pia matter of nearly four inches wide.  This is the only instance
I have heard of, where an examination has been made after death;  but it is nrt
supposed, that the brain is, the seat of disease in other instances of sudden death
in the disorder that has been termed inward fits : such, at least, is the svrtiment 
24
DISORDERS ARISING EROM
 have been carried off suddenly, or by any thing resembling this com-
 plaint.
   Since the two former editions, I  have, indeed, very frequently
 seen what I have termed the chronical croup, in children of various
 ages,  and indiscriminately in those nourished  by the spoon, or the
 breast.   I have known it attended with severe and repeated epileptic
 fits, and then the bowels have  usually been costive,  or the stools
 very clayey; but in every instance, the crouping noise has  yielded,
 and (with the  exception above mentioned) children have continued
 well, treated in the manner I have described; and I therefore cannot
 but think the complaint under consideration is of that kind.
   In regard to  costiveness and  wind, which have been said to be the
' parent of what nurses commonly term inward fits, as they do not al-
 ways arise from one and the same  cause, and are productive of other
 complaints  than those above mentioned,  I shall  consider them by
 themselves;  which, it is presumed, will be pursuing a more rational
 plan, than  adhering to a term obscure in itself,  and indicative of a
 disease  not well defined, and which therefore  may tend to mislead
 the inexperienced reader.


          Disorders arising from  Constipation and Wind.

   It has been  usual with  ancient writers, when  conciseness  and
 accuracy were not so much considered as in the present day, to treat
 of costiveness and wind as specific complaints;  and for the reasons
 aforementioned, it may not be altogether  improper to comply with
 this custom.
   Constipation   is either constitutional,  or accidental, which ought
 always to be distinguished,  the former being oftentimes harmless;
 and, indeed, children of such a habit of body are frequently the most
 thriving.  If the mother  should  be very constipated,  her children
generally are  so; and such a disposition,  (whilst they continue in
 health) ought not to be forcibly counteracted, though it will be pru-
 dent carefully to watch it.   And this will be especially necessary, in
 the case of children  who are subject to fits; fine lusty infants being
 often  seized with violent convulsions, without any other apparent
 cause than a naturally costive state of the bowels, and  as uniformly
 recovered from  the fits, merely by procuring stools, and breaking off
 the wind.   It is likewise sometimes an incitement to recurrent fever,
 as I have   very lately noticed in one of the  finest and otherwise
 healthy  children I have  seen; who relapsed for two or three years
 into repeated fevers seemingly from no other cause than a naturally


 of the respectable authority, from which the description of it has been given
 above; but rather, as before observed, that it is a spasm of the lungs, stomach,
 or other vital organ below the brain. 
CONSTIPATION AND WIND.
25
very constipated state of the bowels, which it was scarcely possible,
either by diet or  medicine, duly to counteract.   The above  men-
tioned disposition to  fits  has taken  place long before the ordinary
period  of teething,  and  has  continued  till children have been  a
twelvemonth old; at which time the solids, and especially the ner-
vous system, have appeared to get stronger.  In such habits, a quar-
ter of an ounce of manna, or the like quantity of the syrup of ros^,
may be put into any liquid, and as much of it given by tea-spoonfuls,
as shall open the belly. Or should these prove insufficient,  a drachm
of  ol. ricini,  may be taken two or three  times a  week: or a few
grains of the pulv. fol. sennae, or its extract, with, or without, a dust
of grated nutmeg, or cloves:  or a few drops of the tinct. aloes comp.
or tinct. jalap, to infants of some months old.   But  it were needless
to observe to most readers, that rhubarb will not be a fit purgative,
though it be joined with magnesia, which will not sufficiently coun-
teract its restringency, howsoever proper in other instances;  though
the observation may be proper, that nurses may be cautioned on this
head, with whom it is so frequent a prescription, during  the month;
and whose indiscriminate use of it is sometimes prejudicial.  Rhubarb,
or  magnesia alone, as the child is naturally costive, or  otherwise,
generally, though not always, answering all the  purpose  intended,
especially for  very young  infants; whilst the union often  makes an
unnecessary addition to the bulk of the medicine, which should al-
ways  be avoided.   A  few  grains  of  magnesia in  a spoonful  of
dill, or common water, and sweetened with a little manna, or syrup
of roses, forms a much neater medicine, (which may be  quickened
and warmed by the addition of a few drops of tincture of senna) and
in costive habits,  which usually abound with acidity, answers  very
well  in early infancy.*
    But if the child be otherwise in  health,  it has been said, it is, in
general, inadvisable to do much to counteract the natural habit of body.f
I have formerly, even during the month, directed  manna, to the dose of
half an ounce at a time, to very little purpose, unless it was almost daily
repeated, and have at other times given from three to five grains of ja-

  • A remedy much better calculated to obviate the inconveniences above men-
tioned, than either of those noticed, is a combination of lac. sulphuris,  and
calcined magnesia in equal proportions.  About the half of a tea-spoonful of this
mixture, administered every day or two in a little molasses, will keep the bowels
open and comfortable without producing purging.
                                                            E. D.
  f I have attended in many families of numerous children, all of whom have
grown up strong and healthy, but been uncommonly costive, and from their in-
fancy have beemfor several days without a motion ; nor would any gentle means
procure it statedly.  And on the day when this note was made. I was consulted
for  an infant of only three weeks old, who had had no stool for five days, and
yet was  perfectly healthy and easy.  This is  not mentioned, indeed, to lead
practitioners to abate of their attention to a costive habit of body in  infants; but
in proof only of its behjgin some instances innoxious, and therefore no c.nse of
ularm as long as children are otherwise perfectly wt!\
                                P 
26
DISORDERS ARISING FROIM
 lap; till I learned, that there are some constitutions, even in infants,
 vdjere the bowels cannot be kept open without a daily exhibition of
 mm purgative medicine,  and that  many such children are as well
 left to thc-mselvcs, or at least, require only to be watched.  If a stool
 should be wanted however, a suppository (or dry-clyster) made of a
 little slip of paper, or linen cloth, twisted up, and  well moistened
 4W) oil, may be very easily introduced, and will generally answer
 the  purpose:  or  should this fail, a bit  of castile  soap, mallow-root,
 red beet, or a parsley stalk, may be introduced in like manner.  These
 means will be assisted,  and a costive habit relieved, by rubbing  the
 stomach and bowels frequently every day with a warm hand, or piece
 of flannel.
   Should such a costive and  windy state  of  the  bowels  produce
 griping pains, which may generally  be  known by the drawing up of
 the legs, or of the scrotum, and a certain manner of crying, it will
 be  proper to  apply external warmth to  the stomach and bowels, by
 means of heated bran, or chamomile flowers, put into a soft flannel-
 bag; fthich will  both tend to abate the pain, and assist the operation
 of  the  laxative.   Or should the costiveness be accidental, it must
 speedily be remedied; and if the occasion of it be food of an impro-
 per kind, or too thick,  which  is very  often the case, the food must
 immediately be changed.   If the child  be not usually costive, rhu-
 barb is, indeed, often the best purgative, as it strengthens the bowels
 afterwards, infants being much more subject to an over-purging than to
 almost any other  complaint,  especially if brought up by hand.  It
 sometimes happens, however, that much more powerful medicines
 than rhubarb may be required, whether the child be naturally costive,
 or not;  and in such cases, much caution is necessary: for, where a
 proper dose of senna tea has proved  ineffectual, it is surprising what
 large doses even of rough purges have been given in vain, or some-
 times to the injuryDf the child.  On such occasions, I would rather
 advise a recourse'to clysters, and especially those made of  succoto-
 rine aloes.  From five to twenty grains, according to the age of  the
 infant, dissolved  in  boiled milk, will rarely, if ever, fail of procuring
 a stool, and will often procure two or  three, especially if preceded
 by the exhibition of a purge.   But  even drastic  £lyst£rs should be
 administered with  caution, and ought  not to be very often repeated,
 especially to very young children; though less  hazardous, in  every
 view, than the frequent repetition of purges of a si%ilar kind, and
 when used alternately  with gentle  purges,  become  e»edient and
 beneficial.                                         '■*•
  Some writers, particularly the French, have much wk frequently
 advised oil of almonds for infants of such a habit.   Mr. Le Febure
 le Villebrune  therefore,  in a note to the translation with which  he
has honoured my  first edition of the diseases of children, testifies  his
preference to oils; but I must beg leave  in tur^o differ from him,
being persuaded,  there, are few case3 beside didders of the chest. 
CONSTIPATION AND WIND-
V(
in which any kind of unctuous oil, but that of castor, will not be in-
jurious  to  young infants, and particularly i a  affections of the  first
passages.   It  is  dubious,  however, whether  oil of almonds, ot^f
olives, always proves a laxative,  or whether, by diminishing the na-
tural force and action of the intestines, it may not frequently prove
the reverse.                                                    4
   As there is  usually too much acidity in  the first passages in cosjipe
and windy habits, a little magnesia, or a few drops of aqua kali,im.ay
be given for a  few days after the costiveness has been removed; and
if the child be suckled, the nurse's diet must be attended to.   I£ any
flatulency should still remain, (which will not often be  the case, if it
has arisen  merely from  constipation) a  little dill-water,  or a few
drops of spir.  ammon. comp. properly diluted, are very safe and gen-
tle carminatives; or  should one  more powerful  be expedient, the
fluid parts of the warm opening  mixture directed in the chapter on
purging may be given, without shaking up the vial.  But if the fla-
tulency be an  attendant upon a lax state of the bowels  and indiges-
tion,  its remedy will  consist in  the removal  of those complaints,
which will be noticed in their place.  Should  it, however, continue,
it may sometimes prove a real complaint, though it should not happen
to be so confined as actually to become  an occasion of  fits.   It is
usually, indeed, but a mere symptom of some preceding or attending
complaint;  nor are its troublesome effects either occasioned or in-
creased by air taken in with the food, as many people have imagined;
atmospheric air being essentially different from that produced by in-
digestion, whether owing to the weakness of  the stomach, as  it  is
called, or the  improper quality or quantity of the food taken into it.
It may, however, in conjunction with other causes, prove a source
of many complaints, and  create  watchfulness, startings, hiccoughs,
vomitings, and even  convulsions, if not timely attended to, espe-
cially if the infant be costive.  A principal remedy in that case will
consist  in  keeping the boweis open, with frequent frictions of the
stomach and abdomen; a mean of no small importance in every com-
plaint connected with affections of the first passages.
   The only instances that  I remember to have met with  of wind
proving of much consequence, when not preceded by other com-
plaints, have been in very lusty  new-born infants, whose mothers
have also been peculiarly distressed  by affections of that kind.  This
is, indeed,  a somewhat anile way of speaking, but it states the  pre-
cise fact; a»d one instanse of an  infant suffering in this way was so
remarkable^that it may be worth  noticing in this place.
   In this case  the  meconium began  to pass off soon after birth, but
not without repeated clysters,  purgatives, and the warm-bath, and
was peculiarly viscid, as well as in vast quantity.  The infant, the
meanwhile, appeared for several days likely to be strangled, and was
black in the  face^merely through  the abundance of  wind in the
first passages;  th^M\ it was breaking off both by the mouth and the 
28
VIGILIJJ, OR WATCHINGS.
  brwls, and with that peculiar, a  • very loud noise,  when it came
  ut wards, observed oftentimes in die hysterical spasm of adults, and
 ^ntinuing, with only short intervals,  for several hours together; so
  that the infant was several times thought to be dying.   The whole
  face, except the nose, became exceedingly swelled, so that the infant
4 could scarcely open  its eyes, though without any discoloration of
* tfet skin;  being probably owing to wind diffused through  the cellular
  membrane, (as hath  been known  to happen in the case of a small
  wound of the lungs from a fractured rib;)  the  tumour  subsiding
  immediately upon getting rid of the  wind from  the stomach and
  bowels.
    These  symptoms,  however, yielded to  carminative juleps,  and
  purging medicines, (which is all that mere windy complaints usually
  require;)  and the infant, after the meconium was all come away, was
  freed  from every complaint,  without any further semblance of fits,
  which before  had been frequently apprehended.
                     Vigilice, or Watchings.


   Watching, or want of sleep, is frequently a symptom of the fore-
going complaints, and in  that case, maybe removed by opening the
belly, and afterwards administering a carminative absorbent julep;
which will then  frequently act  like an opiate,* by restoring rest.
Sometimes, indeed, this succeeds so well, when given in large doses,
that we are suspected of having really given some narcotic medicine;
which, doubtless, would in these cases prove exceedingly hurtful, as
the watchfulness is generally a mere symptom, and  not a disease;
though when very obstinate, it is sometimes the harbinger of epilep-
sy, and then requires purgative medicines.
   Watchings may arise from worms, purging, or gripings, whether
from  acrid breast-milk, or other food, and from indigestion, ns well
as from every thing capable of producing pain;  each  of which pro-
bable causes should be very attentively inquired into before we pre-
scribe, and will  therefore  be distinctly considered in their proper
place.  The usual source may, indeed, be  said to be some default in
the first passages, and in very young infants is frequently owing to
costiveness.   I shall only observe further, if watchfulness be confined
only, to the night, it is probable the child sleeps too long in the day-
time, which.may be remedied by keeping it moving, and playing with
it throughout the day; of which little matters  more  precise notice
will be t-!<en in the part devoted to the Management of Infants.


                ' See Harris De Morbis acitiisIr.ft^mn 
20
                      JIpldhcR, or the Thrush.

  Having  considered these lighter  early complaints, I proceed to
others which equally  owe their origin to some affection of  the  ali-
mentary canal, and are oftentimes of a more serious nature.
  One of the most important of these disorders, is the thrush; a com-
plaint that, probably, depends not a little  upon the different natural
habits of infants,  as well as upon their management, particularly in
regard to food, air, and the state of the bowels*  This seems to be
the case, inasmuch as the thrush is sometimes found to  seize every
infant in certain  families,  in whatever way  the  children  may be
managed; as well  as  to  occur occasionally in  others,  upon a want
of proper attention to the state of the alimentary  canal,  where  a
great number  of other children,  properly watched, have uniformly
escaped it.   Instances of the latter kind may  have  been noticed,
where the  mothei happening to  be ill, the whole attention of the
 family has  been thereby engaged; or, where one infant has been put
 out  to nurse, whilst all the rest of the children have been  carefully
 brought up at home.
   It is amongst the vulgar errors, however, that the thrush  is a very
 harmless complaint, or is even desirable to  a child in the month; for
 it is said, if it does not then make its appearance, it certainly will at
 a more advanced age, and will then prove fatal, or at least, attend the
patient in his last illness.   Tile fact is,  it is a disease of debility, and
 therefore attacks  very young, and  very old subjects, especially  if
 otherwise weakened.   From the  above mistake,  however, the dis-
 order is often neglected in the beginning, whereby the acidity in the
 first passages is suffered to  increase, which always aggravates the
 complaint.   It is, indeed, a much milder disorder in this island than
 on most parts of the continent, (though, a priori, we might, perhaps,
 suppose it  would  be otherwise,) particularly in  France,  where  it
 reigns as a malignant epidemic, especially in the  Hotel Dieu,  and


  * It requires but a slight acquaintance with the diseases of children to satisfy
 ourselves, that most  of their complaints originate in the stomach.   So close i's
 the  connection of this organ with the rest of the system, and so strong the sym-
 pathy between it and the  other viscera, that each may occasionally be mistaken as
 the  primary  seat of the disease, when the viscus only is really in fault.  That
 thrush is merely a disease of the stomach, requires but little argument to prove;
 the symptoms speak for  themselves.  Sickness of the stomach, vomiting, or an
 affection of the bowels, constantly precede it.  To meet  these7 indications, an
 emetic should first be administered; from this we derive much advantage; the
 stomach is cleansed of all indigestible substances, a new set of actions are intro-
 duced, and the way is prepared  for the exhibition of some mild laxative.   Any
 of this class  of medicines will answer  our purpose;  but  perhaps the one best
 suited to the case, is a  combination of rhubarb  and magnesia; this not only
 operates as an apeuffc but will likewise prove an antacid.~-K. D. 
30
aphtha:.
Foundling Hospitals, known by the  names of Muguet and Millet.*
The thrush, however, is as much a disease, as any other complaint that
appears in the month, and is connected with most of the foregoing; a
proper attention to which, it has been suggested, may  very frequently
prevent it.
   This disorder is so well known, as scarcely to require any descrip-
tion, and generally appears first in the angles of the lips, and then on
the tongue and cheeks, in the form of little  white  specks, which
some writers have  termed ulcers.   These increasing in number and
size,  run together more or less, according to the degree of malignity;
composing a thin white crust,  which at length lines the whole inside
of the mouth, from the lips even to the oesophagus, and is said to ex-
tend into  the stomach, and through the whole length of the intes-
tines; producing also a redness  about the  anus.   When the  crust
falls off, it is frequently succeeded by others of  a darker colour: but
this is true only in the worst  kind of thrush; for there is a milder
sort, that is spread thinly over the lips and tongue, which returns a
great many times, and  always lasts for several weeks.   I have  seen
this so very often  the case, that when I observe a  child to have the
complaint  very slightly, and that it does not  increase after two or
three days, I venture to pronounce it likely to  continue a long time,
but that it will be of no consequence.  I have likewise seen a return
of thrush in a child three months old, and the infant no wise ill, nor
costive.   Care, however, ought  always to  be  taken that  children
with any degree of this complaint, be not exposed to cold.   It is an
old observation, and there is some foundation for it,  that unusually
long sleeping in the course of  the first week or two, is often a fore-
runner of this complaint.
   The thrush, in its commencement, is said to be generally  attended
with fever; but those who have been of this opinion, do not seem to
have  made what is a very necessary distinction, since I have, by no
means, found  this to  be the case  where the thrush  is  an original


  * It has been already remarked,  that several hospital diseases in France are
more complex than with us, and possibly from their infirmaries receiving a much
greater number of patients than ours, and their apartments and beds being
consequently less clean,  as well  as the  air foul, and disposed  to  multiply
contagion.
  This is remarkably the  case in regard  to the diseases of infants, whose tem-
perament is a singular union of debility and spasm, which the French have  aptly
termed Laxitc vibratile.
  The Muguet is a striking instance of the above mentioned  tendency, it being
altogether an hospital disease; which, though distinguished by this name, ap-
pears to be a malignant thrush, and is frequently attended with a species of the
infantile erysipelas.*   When so accompanied, it is said to be constantly fatal, un-
less tlie hard  and tumid  parts  terminate in  benign abscesses, and suppurate
kindly;  which is rarely  the  case, they being  more  commonly  found  to
mortify.

        '  See Jlemoires de la Socicti Iioyale de MedeciilKtimo 1779. 
APHTHA.
31
disease.  When consequent to severe bowel complaints, erysipelas,
and other infantile disorders,  it is indeed, often accompanied with
fever, and  when so, proves either favourably critical, or the infant
usually sinks very soon.  In ordinary cases, however, I am confident
in nine out of ten, there is  not the least fever, though the mouth is
often so much heated as to excoriate the nipples of the nurse, and be-
come so  tender, that the child is often observed to  suck with reluc-
tance and  caution.   In very bad kinds of thrush, it has been hinted,
a fever may attend; but even here it does not appear at the commence-
ment of  the complaint, but rather  towards the close; the fever also
being of the low kind.  And this is owing to the general ill health
induced  by the  morbid state  of the  gastric juices and alimentary
canal, in the same manner as the common hectic fever is induced by
the long  continuance of other bowel complaints.
   Zuingerus,* indeed, gives an instance of fever accompanying this
complaint; but it was in a child of four years of age, and the thrush
not the  original disease; which serves only to confirm what I have
said.  Symptoms  of  slight inflammatory fever had  preceded the
thrush, which appeared a little the next day, and  both that  and the
fever were increased  the day after.   On the third, both were con-
siderably abated, and  on the fourth day the child was perfectly well.
   It has long been a received opinion, that the thrush must appear at
the anus, and many people will not allow it to be cured if it does
not, and for the like reason, they  always  suppose it to be going off
when this redness  takes place.   But the truth is, that its appearance
there is  only  a mark  of the degree of the disease, or of the acidity
that occasions it, and not in the least of its cure; and  is  not, there-
fore, generally to be wished for.  The redness about this part is oc-
casioned by the sharpness of the secretions in the bowels, and conse-
quently  of the stools, which slightly inflame and sometimes excoriate
the parts about the anus, and in a bad thrush will do so long before
the complaint  is going off;  but in the lighter kind, no  such effects
are produced, or are,  at least, very slight.   And,  indeed,  this red-
ness has been so often mentioned to me as  an indication that infants
must,  unobserved, have already had a slight thrush, or, according
to others, be likely to suffer by it very soon, where children  have,
nevertheless, escaped it  altogether; that I have ventured to  imagine
such  infants may be least of all  liable to it, if otherwise  in good
health, at  least, my experience seems to support that idea.   And I
have even conceived, that  the acidity of the first passages bein^ in
some children more confined, may prove a remote  cause of such in-
fants being troubled with the thrush;  whilst others, by an open belly,
and stronger viscera, may escape it, at the expense only of this sore-
ness of the external parts, which  often continues  for several davs.
And this has led some people, on the other hand, to call this simple

      * Tbcod. ZuiiflR-i, Archiatri Basil.  Pedojatreja Practica, 1T2°. 
32
aphtha:.
redness the thrush, and we therefore often hear it said, that children
have had  it only in this part.
   A principal remote  cause of this disease seems to be indigestion,
whether occasioned by bad milk, or other  unwholesome food, or by
the weakness of the stomach.   Perhaps  thick victuals, particularly
if taken hot, and made very sweet; also covering the  face of the child
when it sleeps, or its breathing the  confined air of the mother's bed,
may be amongst these  causes, and ought therefore to be avoided.—
The proximate cause,* is the thickness, or acrimony of the juices
secreted from the  glands of the mouth, fauces,  stomach,  &c. pro-
ducing  heat and  soreness in these  parts.  A tea-spoonful of cold
wrater given every morning, has been thought a good prophylactic:
but keeping the bowels duly open, is certainly a  much better.
   The  means of  cure  must be sufficiently obvious, if due attention
be paid to the nature and occasion of the complaint.   As a general
observation, it may  be  said, that when the thrush attacks  robust in-
fants of a costive  habit of body, it is easily cured,  and, indeed, re-
quires nothing more than keeping the bowels  well open; for which
purpose, the daily exhibition of castor oil is usually  the fittest mean.
But on the other hand, the complaint is attended with some hazard
in delicate infants,  whose bowels have  been previously weak, and
especially where the child is nourished only by  the spoon.  Much
has been  said in favour of emetics, especially wine  of antimony, as
being almost a specific for this disease, but I cannot say it has proved
so with me,—unless in the slight cases just mentioned;  nor can I
see any sufficient cause  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 bow-
els, to administering an emetic, and where the thrush is of a dark
colour, and the whole inside of the cheeks is lined with it, I am per-
suaded it  maybe useful, by emptying the stomach of the crude juices
oozing into it from the glands of this part.   But I think it would be
almost as endless as it  would generally be prejudicial, to  persevere
in the use of emetics, for days, and even weeks together, and is both
a severe and  anf  unnatural  method of treating a tender  infant,  in

  * If such a term, after all that Gaubius and later professors have advanced,
may be used in any sense distinguishable from the disease itself, it is presumed,
that the circumstances enumerated may be distinguished from those termed re-
mote causes.  Should this not be allowed of, the term, proximate cause, seem* to
be perfectly useless, and one to which we can never affix any  precise ideas ; the
came and the effect being confounded.  But I do not mean to enter far into such
a controversy, and have touched upon it rather by way of apology for the use I
have made of the term, in this and other parts, and to mark an obscurity which I
leave those to settle whose province it may be to take the lead in such matters.
It were well, however, if some able pathologist could affix some idea that miirht
be universally adopted, so that when we meet with the term in different authors,
no reader might be at a loss for the meaning.
  f Whether emetics are or are not unnatural remedies, depends upon the mean-
ing we attach to the word.  If the idea intended to be c^veyed, is that they are 
APIITHJS.
ft
which the bowels are always the most  natural  outlet for its com-
plaints;  on which, therefore,  nature uniformly throws the offending
matter on almost every  occasion, as appears plainly in  teething, in
which the first passages cannot be primarily  affected.   Should the
vinum antimonii,  indeed,  be deemed  useful  otherwise  than as an
emetic  or purgative,  and by any alternative virtues capable of re-
moving certain morbid  actions of the glands seated in the first pas-
sages, a  recourse to it would certainly be  rational; but I have myself
had no such evidence.
   I believe, therefore, that where there is no fever, nor any uncom-
mon symptom, testaceous powders are the best  and safest remedy;
which may be joined  with a little  magnesia, if the  body be costive,
administered twice or more in the  day; or if in the other extreme,
and the  child  is very weakly, three or four grains of the compound
powder of contrayerva in its  stead.  Some such  preparation should
be administered for three or four days successively, and afterwards,
something more or less  purgative, to carry down the scales as they
fall off from the parts.  For this purpose, rhubarb  is generally the
best; but  when the thrush is very violent, is  of a  dark colour, has
come on very  rapidly, and  the child is lusty and strong, a grain or,
two of the pulv. c scammon. cum calomel may  be joined with it,
agreeably to the idea  of Heister, and the  testaceous  powders be re-
peated for two or three days as before, till the disorder begins to give
way.  On the other  hand, when an  infant with  this bad thrush is*
weak and delicate, a  decoction of the Peruvian,  or  oak bark,  with
aromatic confection, is found the best remedy.
   The choice of the testaceous powders, on which some writers have
said so much, is, I believe, of very little importance: the purest and
softest are preferable.   The design of these medicines, being to ab-
sorb  and correct  the  predominant acidity,* their effect will be dis-
covered from the kind of stools that succeed, and the dose may there-
fore be increased or diminished, or they  may be altogether discon-
tinued, as  circumstances direct.  In the  mean time, if the child be
suckled, the  nurse's diet should be  attended to, and, in general, her


improper under all circumstances, and in all cases, the observation is incorrect
and erroneous.  But if, on the contrary, it is understood that they are " unna-
tural" only when u*ed in  a healthy state, then we most fully concur in the sen-
timent. It is true that they were introduced into practice long before medicine
wasascence;  yet experience has confirmed the enlightened physician In the
precept, which  instinct taught the savage.—Ed.
  * The French physicians are of opinion, that the thrush is owing to what they
call a putrid alkaline humour, or something analogous  thereto, rather than to an
acid.  But this cannot be  the case in the ordinary thrush, as is manifest both
from the appearance and the sour smell  of the stools, m. well as from the mors
certain remedies for the complaint, which are alkalis and absorbents. The ma-
lignant thrush, (already hinted at,) which appears in some of their crowded
hospitals, is certainly a very different complaint, and seems, indeed, to be of a
putrid nature.       }
                                V; 
34
APHTH.E.
usual quantity of porter  or ale, (which is almost  always more than
sufficient) should be diminished.
  In regard to applications to the  part, it  is necessary to  observe,
that as they have little to do in curing the complaint, it will be im-
proper to have recoiuse  to them very early.  1 know, indeed, it is
verv common to begin with them,  but  they serve  only to increase
the"soreness  of the parts, (especially  in the manner they are gene-
rally used) and to give a deceitful  appearance of amendment.  The
proper intention of these remedies, at this period, is merely to pre-
serve the infant's mouth clean and comfortable,  and to prevent  as
much as may be, any pain or injury to the  wet-nurse.  If, therefore,
the inside of the cheeks  and tongue are thickly covered with sloughs,
it may be convenient to cleau the  mouth two  or  three times a day;
but otherwise, it will in general be improper till the  complaint is
past the height, the sloughs disposed to fall off, and  the parts under-
neath inclined to heal; which never takes place till the secretions in
the first passages are become bland and mild.  Proper applications
will then have their use, not only by keeping the mouth clean, but
by  constricting and healing the raw and tender apertures of the ex-
cretory vessels.
   I have, indeed, met with an instance of a very  copious thrush dis-
appearing after cleaning the mouth with borax and honey, at noon
and night on the fourth day of the disease.  Until this  time  it  had
been increasing, and I expected would become worse; and, therefore,
directed the mouth to be cleansed  so early, only to  render the  infant
comfortable, and to prevent, as much as might be, any inconvenience
to  the  wet-nurse.  There was but very little appearance of thrush,
however, the next morning, and not the least after that day.  It is,
therefore,  likely,  that  the  parts were  rendered  perfectly  clean
by the help  of the borax  somewhat sooner  than they otherwise
would; though I can by  no means conclude that  it had  any other
share in the cure.
   The like observations I have had occasion to make in regard to an
exceeding slight appearance of thrush, which had continued  in the
same  state for three days;  but   upon being cleared  off by once
using the borax and honey, never re-appeared.   In both cases, the
 usual internal remedies were  administered both before and after the
recourse to topicals.
    Of the latter of these  also, a variety have been in use, in the form
of lotions and gargles, which from the earliest times have all been of
 an astringent nature; and it scarce needs be added, should be of an
innoxious kind; as some portion of them will be swallowed:  and I
 mention this because Stoll reports, that the  English  advise a solution
of sacch. saturni, which, for my own part, I  never heard of before.
Honey of roses and spirit of vitriol, or of sea-salt,  as recommended
by Ettmuller and Dr. Shaw,  form a very  good one; but nothing is
preferable to borax, which some advise to  be mixed  up with  sugar, 
APHTHA
GANGRENOSA.
35
in the proportion of one part of the former to seven of the latter: a
pinch of this put upon the child's tongue will be licked to all parts
of the mouth.   But I  prefer a mixture of borax and common honey,
(two scruples, a drachm, or even more of the former, to  an ounce of
the  latter,) which hangs  about the fauces better than in the form of
powder.   Either of these may, at this period, be made use of as
often as shall  be necessary to keep the parts clean, which they  will
effectually do, without putting the infant to pain,  by  being forcibly
rubbed on.
  It only remains to take notice of the black thrush,  as it is called,
which is confessedly, a very uncommon complaint in the infant state.
The late  Dr.  Armstrong said he had never met with it among the
great number of children brought to his  dispensary.    I have  seen
only two  instances of it, which were in strong and healthy children;
but the parts  were not perfectly  black, and if that be intended by
the name, these cases might not  be  precisely  that complaint: they,
however, both proved fatal. After the stomach and bowels have been
cleansed, I believe the decoct, cortic, and confec.  aromat. as before
mentioned, with the addition of tincture of snake-root, is the most
likely medicine to be of service.  The bark especially should be ad-
ministered very freely, and the bowels be kept open;  which is more
safely done by rhubarb, than any other purge.
                      Jlphtha  Gangrenosa.

  The aphtha infantum hath been generally regarded as an  idiopa-
thic disease; but I believe, that every other species of the aphtha has
been considered either as purely symptomatic of fever, dysentery, &c.
or as a critical termination of some acute disorder.  The aphthous
affection, which I am now going to describe, does not, however, seem
to be the consequence of any preceding general disease; and I am in-
clined to think, that it is the cause, rather than the effect of  those
febrile symptoms which accompany what I shall call by the name of
aphtha gangrenosa.
  This disease most commonly attacks children that are above two
years of age, and I believe, rarely after nine, unless by infection. Its
first  appearance is marked by a very spongy state of the gums, and
a remarkable tenderness of the inside of the cheeks and mouth.   Soon
after this, little aphthous sores, having a dark coloured surface, appear
upon the gums, the  inside of the lips,  and  upon the tongue:  some-
times, similar ulcers are seen upon the uvula and tonsils; but this is
not always the case.   As the disease proceeds, the cheeks become
slightly  tumefied, and are very tender when touched; and there is
often an unusual redness upon that portion of the skin which covers
the lower jaw.   Besides the aphthae which appear upon the tongue, 
36
STROPHULUS, OR RED GUM
that part is usually much furred, and the teeth about the edges of the
gums are likewise covered with a blackish fur; the breath is  very
offensive, and at this period the disease is highly infectious, even to
adults.   In the progress of this complaint, the sub-maxillary glands
become enlarged,  and  slightly painful;  and there is generally a  pre-
ternatural flux of saliva, which is sometimes discharged in considera-
ble quantities from  the very beginning of the attack.   Sometimes
the angles of the mouth are  found to be ulcerated, but this is, by no
means, a common  appearance.
   The gangrenous thrush  is always accompanied with considerable
languor, and sense of  debility;  an increase  of heat;  a small quick
pulse; the appetite is impaired; but the  children do not sleep ill, and
they are often cheerful and active, at different parts of the day.
   The disease does not observe any exact periods; some children re-
covering in a fortnight, while others have been more or less affected
from a month to six weeks.
   Formidable as the appearance of this disease maybe, it is not found
to be dangerous, and the remedies are obvious.   The infus. cort. cas-
carillae, warmed with tinctur. cort. Peruv. conip. should be exhibited
three or four times a day,  in doses suited to the age; and the parts
frequently washed with the  decoct, cort. Peruv. rendered as sharp
with the acid. vitr. dilut. as children can bear it.


                      Eruptions on the  Skin.

   It is, by no means,  my  intention to enter  langely into this exten-
sive subject,  but imperfectly understood, perhaps, even to  this  day,
at least in regard to classification and arrangement: though certainly
progressive, through the pains taken by Dr. Willan, and in respect to
children, sufficiently plain to every practical use.   In  another  part
of the work I shall treat of the scalled-head, and two or three other
troublesome affections of the skin taking place at  different ages; but
shall at present chiefly confine myself to eruptions peculiar to infancy;
adverting first of all to such  as are connected  with the state of the
first passages.  The earliest of these is,


                    Strophulus, or Red Gum.

  This eruption has been distinguished by  different terms: I speak
here of the strophulus intertinctus, which is an  efflorescence  appear-
ing usually in small  spots, often confined to the face and neck;  but
at others, it extends to  the hands and legs, and even the whole body;
appearing in very  large patches, and sometimes raised above  the sur-
face.   Eruptions will  likewise appear in the form of small postules,
Which are filled with  a limpid, or sometimes a purulent, or yellow 
STROPHULUS, OR RED GU.M.
3T
liquor, and frequently turn dry and horn),  and scale off; at least, I
have never  known what uame to  give this kind of eruption, but that
of a ranker strophulus, as it happens only in the month, or soon after-
wards, and never gives a-ty trouble: this seems by some writers to  be
that termed strophulus confertus.   There is another species  s  s.:■. .11
as pins heads, or even their points; firmer than the former; often of
a  pearl colour, and  opake, which  has generally been  accoutre! a
kind  of red gum; but it has  of  late been suggested,  might for dis-
tinction  sake, be termed the  strophulus albidus, or the white gum;*
as the former might  be called strophulus subalbus.   Another species
appears  in  small  circular patches, and is denominated strophulus
volaticus; and a fifth, in which the patches  are larger than in any of
the foregoing, and are more diffused, appearing chiefly on the loins,
shoulders, and the upper part of the arms.  Every species of  this
eruption, like the thrush, is  the effect of a predominant acid, but  can
scarcely be termed a complaint,  being  a kindly exertion of nature to
throw off some acrimony; consequently an evidence of the strength
of the constitution, as the thrush  is, usually, of its weakness.  In the
former,  nature throws off the offending matter on  the surface more
completely, as well  as on less irritable parts than in the latter,  and
therefore, when the eruption is slight, requires no assistance.
   On this account it is, I apprehend, that writers  have not usually
takcn notice of it, though it should seem requisite, both on account
of the various appearances of it, and especially of one  species more
rank  and extensive  than the  rest.   In general,  it is necessary only
to give a little testaceous powder, or magnesia, according to the state
of the  bowels, and  to keep  the child  moderately  warm;  otherwise
the rash striking in, the acrimony will  fall on the first passages,  and
be succeeded by sickness, or purging, (till the eruption appears again
on the skin) or not unfrequently by the thrush, or  a slight return of
it, if the child has lately recovered from it.   In the case of sickness
at the stomach, or any disposition to fits, upon this eruption  being
repelled, some light cordial, such as a  few  drops of the spirit. Am-
monias  comp. should be given  two or three times a day, and  the
child's feet, or. perhaps the  whole body, be put into  warm  water,
and a  blister be applied between the shoulders, if any untoward
symptoms should continue.   The state of  the skin, and the bowels
have  a peculiar consent, and  on this  account, infants whose first
passages  have been  frequently disordered, are always benefited by
eruptions on  the  skin; and in such,  peculiar care is necessary to
guard against their  being repelled, as well  as  to invite  their re-
turn.


  * It  is to this complaint, that Vocelt us seems  to give the name of achores.-
but the old writers  differ in this  respect—of that complaint, however, more
will he said in another place,  when speaking  of disorders described under ob-
solete  terms. 
38
CRASTA  LACTEA.
   Dr. Hamilton speaks of copper coloured blotches of the size of a
sixpence or shilling piece, on the nates or  soles of t!.e  feet, oceur-
ing in the first or second week after birth,  indicating a diseased state
of the  infant's  habit, and requiring  the  most  serious  attention.
He adds,  that if neglected,  ulcerations of the  palate, throat, and
nostrils, follow; the  nurse's nipples, armpits and throat become in-
fected; and if  the infant survive for air, length of  time, (which is
not cofimon)  the arms  and legs are covered  with  an ugly  scab,
which keeps  up a  constant degree of irritation.   He informs us,
thai the only cure for this  affection  is  mercury, which ought to be
exhibited both to the nurse, in  such doses as /shall  affect her milk,
and also to the infant, in doses adapted  to its strength, and  to the
virulence of the disease.
   I  have  myself never  noticed this  eruption,  but the statement
coining from such authority, I thought ought not to pass unnoticed  in
this new, and probably my last edition.
   Infants are peculiarly liable to various  anomalous kinds of rash,
both in the  month,  and  till the period of  teething  is over.    The
early  ones may be regarded as a sort of red-gum, and children  who
are most subject to  them,  general h  have  their bowels in a  better
state;  the rash seemingly carrying off, as has been said,  the  acidity*
w;""> which they so much abound.
   It may be remarked, however, that when infants at the breast are
inclined to  frequent returns of some eruption, if the child be always
indisposed  at such seasons, the  rash will often be  found owing  to
some  ill quality in the breast-milk, which ought therefore  to be ex-
amined, and particularly in regard to its taste.   On such occasions I
have  found, that  milk which  has been above a twelvemonth old has
contacted  a very unpleasant flavour; and that upon  changing the
wet-nurse,  a very ill-looking rash has  immediately abated, and has
soon afterwards entirely disappeared, together with  the other com-
plaints.!


                  Crasta Lactea, or Lactumcu,

   Tins, it is well known, calls for  a little more  attention,  and has
often  times a very unpleasant  appearance, but is,  notwithstanding,

  * See Harris, pages 22, 23.

  f The only circumstance in this disease, worthy of our attention, is the resem-
blance which it sometimes  bears to measles : 'but from this it may be distin-
guished by the absence of fever, sneezing, cough, and watery eyes  &c  No
medicine will be required unless upon a sudden  disappearance of the eruption,
the bowels become  affected, or the  respiration difficult: in  the former case a
mild laxative, and m the latter an emetic may be administered with evident ffood
effect.—Ld.                                                    » 
CRASTA LACTEA.
39
equally innocent with the former,  and even  prevents other com-
plaints.   I think I never saw  an infant much loaded with it, but it
has always been healthy, and  cut  its teeth remarkably well.   In-
deed, it falls to the lot of the  finest children,  and such as  are well
nourished; whence some have imagined  it owing only to  the rich-
ness of the milk.*  And it is remarkable in this eruption, that how-
soever thick and long continued the scabs may be, the crusta lactea
never excoriates, nor leaves any scar on the parts.  It may possibly
be different in some  other climates, though  I cannot guess for what
reason it should be so on the continent:  it is insisted  upon, however,
by Dr. Caroli Stack, as well  as, that children long affected with it
become unhealthy. He recommends the viola tricolor. Linn, of which
a handful of the fresh, or half a drachm of the dried leaves, is directed
to be boiled in a half pint  of cow's milk,  and  strained off.   This
quantity of the decoction is to  be taken night and  morning.
   The crustea lacta appears first on the forehead, and sometimes on
 the scalp, often extends half way over the face hi the form of large
 loose scabs, which as the disorder  increases, appear not very unlike
 the small-pox after they are turned.   It begins with  white vesicles,
 larger than the itch, which, soon become of a dark colour,  to which
succeed  the scabs, with  efflux of ichor, and great itching of the  af-
fected parts, sometimes  covering the head, and, it is very improperly
said by some, the whole body.   It is also said to  degenerate into the
scalled head;f  but I  have never seen any thing like the true tinea in
young infants.  It is sometimes confounded with the crusta sepiginosa,
which is a much more obstinate complaint.
   Very littlej  1 believe, is necessary to be done; but in bad  cases a
blister is sometimes  of service;  and, further, usually answers the
grand purpose  of  abating the  itching,  which in  some instances is
exceedingly great: for this end, however,  the repetition of a blister,
if needful, is preferable to keeping one constantly open.  Washing
the  parts also  with the anile remedy of butter and beer is likewise
very useful, especially when  the  discharge is  hot and acrid.   To
the like  end the ung. picis, (made with thepetrolium, instead of the
pix liquida) spread thinly on a piece of linen,  and applied after the
infant is  jot into its night's sleep, is equally safe ; but should be care-
fully wasned off the next morning.   If the urine  becomes turbid, or
fetid, it is thought the rash will be of short duration.   At any rate, it
usually disappears of itself when the child has cut three or four teeth,
though it may  sometimes continue  for several months, and in a very
few instances even for years:  in such cases, the  Harrowgate, or any
other sulphureous water will have a good effect; but the shop medi-
cines commonly prescribed  do nothing.   I have known testaceous


   * See Astruc.
   f Tractahis de Morbis Puerorum. Jlmstolodami,  1760.  Anonymous. 
40
TOOTH RASHES.
powders, calomel, and  other alteratives administered to no purpose,
as people of rank are very anxious to have it removed,  if it be pos-
sible.  This rash will now and then make its appearance very early,
and has then been mistaken by those who are not much accustomed
to attend very young children, for the effects  of the  venereal disease.
Though it has been said, that it usually dies off upon cutting some
teeth;  I have known it  to disappear suddenly, previously to any teeth
being cut, and after some weeks become more violent than ever;  in-
fants remaining all the  while in perfect health.
   It were almost endless to enumerate the various kinds of rash to
which infants are liable, but I mean chiefly to confine my remarks to
the more important, or rare ones,  and such as may not have been
described by preceding writers.  Among  such are the  following,
whose unusual  appearance is apt to perplex such as are  not accus-
tomed to see them.
                         Tooth Rashes.

   The first I shall notice is  somewhat anomalous, being like the
former, not confined to dentition.   It  appears, indeed, under differ-
ent complaints; particularly at the decline of fevers and severe bowel
complaints; insomuch, that, upon a sudden appearance of it during a
serious illness, I have often ventured  to  prognosticate the recovery.
This rash very much resembles 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 seen the whole body so covered with it (mixed
with an eruption about the face, of a  different appearance, and evi-
dently red gum) that in a consultation, it has been by some taken to
be the true itch.   This eruption is certainly salutary, and even criti-
cal,  requires nothing but to   avoid taking  cold, and  is mentioned
only because it is not uncommon, and has alarmed  such as are not
acquainted with it.
   I have two or three times during dentition, noticed a rash that has
so exactly resembled  flea-bites, having even a depressed point in the
middle of the  elevated spot, that I could not be persuaded by the
nurse^s account that it  had not been occasioned by the sting of some
such insect, until  I had made repeated observations, and found it re-
curring uniformly a little before a tooth has been cut.
   Another, a very common rash, appears chiefly in teething children,
which very much resembles the measles, and has been sometimes
mistaken for it.   It is  preceded by  sickness  at the stomach, but is
attended with very little fever; though the rash continues very florid
for three  days, like the  measles, but does not dry off in the  manner
of that disuse.   It requires nothing more than the testaceous  pow-
ders, or sometimes the  addition of a little nitre and compound pow- 
TOOTH RASHES.
41
der of contrayerva;  with a dose or  two of rhubarb, or other gentle
laxative, on the going off of the rash.
  At this period, especially whilst the double or eye-teeth are cutting,
I have noticed a rash which at its first appearance is very similar to
the above, and has likewise been mistaken for the measles.  It, how-
ever, soon spreads into larger spots  and patches of a bright red, and
afterwards of a darker hue,  resembling the ill looking petaechiae
which appears in bad fevers; but is nevertheless of a benign nature.
It is, indeed, attended with some  fever, arising, possibly, from  the
irritation occasioned by teething, and  has been followed by small and
hard  round tumours, on the legs,  which softening in two or three
days, always appear as if they would suppurate, though I believe
they never do;  as will be further noticed in a similar appearance of
boils, under the head of fever.
   The  treatment, like that of other rashes at this period, is very sim-
ple, requiring little more than an attention to the state of the bowels,
or, perhaps, a few grains of the compound  powder of contrayerva,
 unless the fever be considerable, which must then  be treated accord-
 ing to the  directions given under the different heads of  fever  and
 dentition.  Should the lumps succeeding this rash, not begin to die
 away in three or four days, a decoction of the bark will be found use-
 ful, when the fever of dentition may not forbid recourse to it.
   I have  seen  a third kind  of rash,  in appearance resembling  the
measles, and like it covering the whole body, but with larger inter-
mediate patches like the eruption in the scarlet fever; which is men-
tioned  more  for its uncommonness,  which  might prove  alarming,
than for its being at all  dangerous, or important.  It was, however,
in every instance, preceded by sickness, by purging, pain, and a lit-
tle fever; the whole subsiding upon the appearance of the  rash, which
therefore seemed to be critical, or at least, like some other eruptions,
consecutive to convalescence.
   Some infants  never cut  a tooth without its being preceded by a
rash;  and sometimes by  a very singular one, the eruption appearing
in every part of the body;  in some parts consisting of hard elevated
pimples as large as peas; and in others, of red patches on the fingers,
the arms, and about the shoulders and back, as  broad as a  shilling:
but in no case have these eruptions required any particular attention;
but on the  other hand,  have seemed  to  prevent the more ordinary
complaints of teething.
   An eruption still less frequently met with than most of the above,
appears after children have cut their first 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 middle-sized peas, very hard,
with a  very red base, and white at the top, as if they contained  a
little lymph.
   They come out suddenly without previous sickness at the stomach,
are not  sore, disposed to itch, nor ever give any trouble, and are sel-
                               r 
42
ESSERA, OR NETTLE RASH.
dom seen but on parts that are usually uncovered, and are sometimes
there in great  numbers, resembling the  distinct  small pox; but  are
harder, more inflamed, and less purulent.
   Alarming, as well as unusual as this appearance may be, I believe
the eruption is always perfectly innoxious, if not repelled by cold, or
improper treatment; and wdl dry away in three or four da) s: nothing
more being necessary than the little remedies directed for the former,
and to keep the child within doors, if the weather be cold.
   An eruption of an appearance equally uncommon, and  analogous
to the  above, I have met with only in children of at least three or
four years of age,  and such as have also  been  affected with slight
symptoms of scrofula;  though I have not seen it frequently enough
to ascertain its being, in any degree, owing to that specific virus.   It
breaks out suddenly, covering a*f once the greater part of the body,
but occasioning neither pain nor itching; nor are children sick at the
stomach, nor otherwise ill with it, though it  lasts for  two or three
weeks.
   This eruption, therefore, like some others, is taken notice of chiefly
for its singular appearance;  which, though somewhat like the neitle
rash, is of a different figure; and may be pretty exactly conceived of
by the little  red lumps left sometimes by the small-pox, after they are
turned, and also rubbed, or picked  off, especially after the crystalline
or warty species, and where the pustules have been pretty numerous.
   If the  first passages are at all disturbed, my attention is principally
directed  to them, otherwise to the state of the skin; and in this case^
I have usually directed  small doses of the pulv.  antimonial. to  be
taken for a  few nights  at going to'bed, and the polychrest salt and
rhubarb, occasionally in the course of the day, with, or without  the
addition  of the aqua ammonias acetatae.
   In the course of a few days the eruption puts on a darker colour, is
less prominent, and begins to scale off in a branny scurf, somewhat
like the  measles: but should no such change take place, the  vinum
antimonii, or the hydrang yr. cum creta should be taken two or three
times a-day; to which, if no amendment should soon be perceived, a
few drops of the tinctura cantharidis may be added;  a remed) often
very efficacious in disorders of the  skin,'but should be  administered
with caution.
                     Esseru, or Nettle Rash.

  An eruption, with every appearance of the nettle rash, sometimes
occurs in children, and more generally under two years of age, and
is exceedingly troublesome to the infant, as well as matter of surprise
to those about it, from the suddenness of its  appearance.  Children
going to bed perfectly well, awake very uneasy, and frequently con-
tinue screaming for some time before the cause is discovered; when 
PHLYCT.fcN.aE.
43
  upon examining the body, and the lower limbs, they are found  co-
  vered with large wales, resembling  those arising  from the sting ol
  nettles.    -                                                 ,
    The Essera, or  Uticaria, is attended, perhaps, with  the slightest
  of all fevers, though its  accession is sometimes preceded by  rigor,
  sickness at the stomach, and pains in" the head;  especially when the
  sudden  consequence  of  exposure to a very cold wind in  athletic
  youths; but is never dangerous,  and only  where  it may  happen to
  continue  a very long time, can demand particular notice.  The net-
  tle rash of infants is of still less importance:  and the species now un-
   der consideration requires less  than any other, and, indeed, often
   disappears in a few hours.  When it continues  longer, a few grains
   ef the pulv. contrayervae comp.  or other of the  milder absorbent
   powders, with or without a few drops of the spirit, ammoniae comp.
   may be given two or three times a day, and the  bowels kept open.
      This is, probably, a milder species of the nettle rash.  When the
   body is more  covered with it, and it continues long, a little more
   care is required to prevent its being repelled; and  if it should, the
   tepid bath,  and light cordials,  as before mentioned,  should be had
   recourse  to, in order to  procure its return to the surface; which is
   always of the greatest   consequence  if the  child should continue
   unwell.
      In athletic youths,  it  has been noticed, the nettle  rash is some-
   times attended with the  usual symptoms df fever; during which, the
   patient should be confined to the bed.   It will also in some instances
   become  chronical, and  is then not  always easy of cure.   The fol-
   lowing has in such cases been found useful.

      rj,. Hydrarg. sulphuris rubri 3~s. Rudic. Serpentar. Virg. pulv.
   9j.  Syrupi simpl. Q. S. ut  fiat bolus, bis die  sumendusj  superbi-
   beiulo haust. Infusi flor  sainbuci.

      Amongst rashes attended with some little fever, there are various
   anomali, and one resembling both the above, and the febris scarlatina,
   but  without the  marked symptoms  of the  latter, or drying off in
   branny scales in the usual manner of that eruption.   The form and
»  colour of the  rash and  degree  of fever, however, are more of that
   kind than of the nettle rash.
                          Phlyctamce.

  Another rash, or rather eruption, takes place both in bowel com-
plaints and  in teething, and I have seen it in new-born infants, re-
sembling the pemphylus of adults, but  seems rather to be what the
old writers have  termed phlyctaenae, or phlyctides,  and  always  ap-
pears to be beneficial.   It consists of vesications or blisters,  of dif- 
44
PSOkA, UK
ferent sizes, resembling little scalds or burns, and continues tor scve-
ral days.   They come out in different parts, but chiefly on the belly,
ribs, and thighs; and contain a sharp lymph, which it may be pru-
dent to let out by a puncture with a needle, especially from the larger
ones.  No medicine is necessary but such as the particular state of
the bowels may call for, which usually abound with acidity whenever
there is much eruption on the skin.
   An eruption, vulgarly termed scorbutic, infesting the face and neck,
sometimes  also the nates and thighs, and even  about the finger-nails,
and discharging a sharp ichor  that excoriates wherever it runs, will
often yield in a short time to the expressed juice of the sium aquati-
cum.  From one, to four or five table spoonsful may be given, mixed
with one or more spoonfuls of new milk, three times a-day, according
to the child's age,  and the state of its stomach; taking care, at the
same time, to keep the bowels open by senna-tea,  or  other common
laxative.   Should this fail, or not be to be procured at some seasons,
the calx, hydrag. alb. or the hydrargyr cum creta, may be administer-
ed two or three times a-day.  In some instances, however, and espe-
cially in children of a costive habit, purging has done more than any
thing; in teething children, indeed,  the eruption will recur many
times until all the first teeth are cut.   To allay the intolerable itch-
ing,  the application of the unguent picis prepared  as recommended
for the crusta lactea, and spread upon linen, is frequently efficacious]
and has no tendency to repel.
                             Psora.

  1 have several times met with an eruption resembling the Psora
of the Greeks, or what is called amongst us, the Grocer's itch;
whether depending at all upon the weather, it is difficult to say; but
it is remarkable, that I have seen it chiefly during a cold season, and
have  then usually met with several children  affected  with it about
the same time.  It  often begins about the arms and thighs, but al-
ways  extends soon afterwards to other parts, and frequently spreads
quite  from the head to the feet.
  It appears in some parts in  very small eruptions like the points of
pins,  with watery heads, and  in other parts, as large as peas, and
sometimes in foul blotches, which  after  breaking,  form sores  and
broad ugly scabs.  These die away, and the like appear, successive-
ly, in other parts, sometimes for two or three  months; leaving the
skin of a dirty adust hue.  In other parts, the eruption is in the form
of small hardened pimples, which do not break, nor are at all sore to
the touch.
  This eruption appears alike in children who have cut all their first
teeth, and in infants at the breast;  though I have happened to see  it 
THE GROCER'S ITCH.
45
I think, more frequently in teething children, and it then seems to be
connected with  dentition.   And this  has appeared pretty evident,
because, previous to my being  acquainted with the remedies best
adapted to the complaint, children who had taken a variety of medi
cines, and continued to break out in fresh places, suddenly got rid of
the eruption altogether upon my lancing the  gums, and three or four
teeth in consequence coming through.
   When this eruption has appeared in infants at the breast, I have
several times known the suckling mother  or nurse, in a few weeks
afterwards break out in like manner with the child; but whether by
accident, or from  contagion from one to the other, I was for a long
time unable  to ascertain; but having  of late found it spreading to
others who have slept with the nurse or child, I have now no doubt
of its being contagious in that way; though not by a more distant, and
slight intercourse  like the true itch.   A very useful discrimination
in such a disease.
   I was for a while much puzzled with this ill-looking eruption, the
long continuance of which could not fail to be very distressing to the
parents, and has even caused  a suspicion to rest on the wet-nurse;
the eruption being sometimes suspected to be the itch, and  at others
venereal; which it certainly is not.
   It has been always benefited for a while by washing the parts with
two drachms of the aqua kali puri in a pint of water; which I would
always recommend, though it will not alone  effect a cure.  Various
internal remedies also, which remove other eruptions, have generally
failed in this, such as  the  hydrargyrus cum  creta,  and  hydrargyrus
cum sulphur, given in  large doses; as also the sium aquaticum.  The
external application, however, of an ointment consisting of the un-
guentum sulphuris, and unguentum hydrargyri nitrati, with a greater
or less proportion of the latter, has hitherto never failed me, together
with the internal exhibition of one  or  other of the forementioned re-
medies.*   In some of the  more  obstinate  cutaneous affections,  and
particularly in this, I have  noticed a spontaneous purging  taking
place upon the decline of the rash, and have  always  accounted it
a good  sign;  having  never  observed  the  child to be weakened by
the purging, though it  has sometimes continued excessive for two or
three weeks.
   I shall close the account of eruptions with the description of one
that is singular enough, resembling very much  the herpes, or broad
ring-worm, or the adust-coloured spots  left on the face after an attack

  * A much neater preparation than either here noticed, and one which seldom
fails in effecting a cure, consists of a lotion composed of sulphuric acid and
water, in the proportion of one drachm of the former to six ounces of the latter.
The great advantage  which this prescription possesses over most other reme-
dies tor iich, is the cleanliness which may be observed while using it, and the
total  freedom from all disagreeable or offensive odours.  In private practice
this is a circumstance deserving much attention.—Kn. 
46
PSORA, OR THE GROCER'S ITCH-
of St. Anthony's fire.   I have  seen  k in  various parts, but I think
only on such as are more or less liable to  be fretted by some part of
the iufant's dress, especially on the nates and contiguous parts cover-
ed by  the clothes; where  the blotches are always the broadest and
most rank.   Were it to appear no where  else, it would seem to be
occasioned by some sharpness of the  urine and stools, as the skin has
sometimes a very heated appearance, though the eruption, I believe,
is not at all painful.   It frequently breaks out before the period of
teething, but the bowels are generally somewhat disordered, and the
stools voided very green, or  else become  so  very soon  afterwards.
This  I take to be one  of  those eruptions  occasioned  by some bad
quality of the breast-milk; as I think I have never met  with it but
in young infants whose  nurses' milk has been  old, and has also con-
tracted a very disagreeable taste.  If that should not be the case, the
rash  will probably require nothing but the light absorbent medicines
before mentioned, and  to  guard against constipation.  But if these
means should not succeed in a short time, the nurse ought  to be
changed, lest some worse consequence should  ensue,  as  will be no-
ticed under the head of convulsions.
   In  all the eruptive complaints of  infants, taking cold ought to be
carefully avoided^ and great caution be used in regard to  all  external
applications,  as well as keeping the belly open.  If the child is sick
at the stomach, a little magnesia, or testaceous powder, with,  or with-
out the addition of the pulv. contrayervae  comp. may be given now
and then; or should the rash be hastily struck in, and the child be ill,
the remedies before mentioned should be had recourse to; particular-
ly bathings in warm  salt and water, which, indeed, will expedite the
cure in many eruptive complaints of the more permanent kind.  The
reader is reminded of this, from the great  importance of attending to
such  retrocession, as I have  known  it, in a previously healthy child
of only six months old, followed not  only  by vomitings and  purging,
but by a rapid decline; and  upon  examining  the body  after death,
the lungs have been found as replete with tubercles as I have ever seen
them at a more advanced age.  Instances of so  great marks of disease
have, however, occurred to me only in families inclined to scrofulous,
«r hectical affections.
   Should any scabs become very dry  and hard, which the  crusta
lactea, for example, will sometimes be, especially when  they extend
to the  crown of the head, and seem to give  pain; they may be touched
with a little cream, or with oil of almonds mixed with ariew drops
of the aqua kali: but not a large surface at a time.   Or  should they
be vesy moist, and cause pain by sticking  to  the cap, they may be
dusted with a little common powder, or with the flos sulphuris, and
covered  with a singed rag; but I should  be  very cautious  of doing
much more with desiccative applications, for the reasons  above men-
tioned, especially during the time of  teething. 
47
                           Sore Ears.

   Slight blisters and ulcerations behind the ears of infants are very
 common, and, in general, require only to be washed with cold water,
 or covered with a singed rag, to keep the cap from sticking to them,
 and thereby giving the child pain.   They are, moreover, very often
 beneficial, especially during bowel complaints, or the irruption of the
 teeth; and will  sometimes get  well  and break out again  into very
 foul sores several  times, without any cause of alarm.   But in chil-
 dren of a gross habit of body, and especially about the time of teeth-
 ing, there  is a species of ulcer that  often requires attention,  on ac-
 count of its extending low down in the neck, occasioning great  pain,
 and spreading into large and  deep sores; insomuch that a gangrene
 has sometimes come on, and even the processus mastoideus become
 carious.  Here fomentations will be necessary, especially those of
 bark; and its powder should be administered internally.  Such cases,
 however, do not very frequently occur; but whenever the sores are
 large and painful, fomentations of white poppy heads boiled in milk,
 will be beneficial.  If such ulcers are very foul, the cure should  be
 brgun by a blister on the back,  in order to draw off the heated serum
 that flows to the parts.   Where the bark has not  been  indicated, I
 have usually given an opening powder of testacea and rhubarb, with
 a little nutmeg,  or sometimes nitre, to which is added, either calomel,
 cinnabar of  antimony, or hydrargyrus cum sulphur; the  latter of
 which, I think I have found more serviceable in some eruptive com-
 plaints in young  children, than seems  to be imagined; but then it must
 be  administered in much  larger doses than  it usually is.   But above
 all, if this species of ulcer be not soon disposed to heal after  such
 treatment, some mercurial application  should  be made  use  of,
 which, though the sores  are often  apparently inflamed,  never of-
 fends them.  A very clean  and elegant preparation of  this kind is
 the following.


                     &  Calomelan.  3j ad 3ij.
                Ung. Sambuci gj  m. ft. linimentum.

  A little of this liniment spread on  each side of a piece of doubled
 linen cloth, and applied twice a-day, will do more than all the fomen-
 tations, or healing ointments,  that  I  have  ever seen used; and in-
 deed has always succeeded with me, though I have often been told
 that the sores had spread deeper from  day to day under various other
 applications.   From such treatment I have never found  the least ill
 effects, but children have preserved (heir health as well  as  if the
«oro, had kept open;  which, when benign, are certainly designed by 
48
VOMITING.
nature as a preservative from other  complaints, especially those of
the stomach and bowels, which are the  next in order to be no-
ticed.
                       Vomitus, or Vomiting.

   I come now to the several disorders of the alimentary canal, which
have been said to be  so  materially connected with  eruptive  com-
plaints;  and first, of those of the  stomach.
   Vomiting is certainly not a common complaint of infants, I mean
when considered as a disease, unless it be attendant upon some other,
of which, indeed, it is then rather a symptom,  or  the  consequence
of  such  disease improperly treated.   Neither are infants in health
disposed to  vomit frequently, unless the stomach is overloaded; the
milk is then usually ejected  as soon as it is taken, and comes up un-
changed.  Nor is this to  be  considered as a disease, or as calling for
the discipline recommended by some writers.  Wherefore should the
residue of the aliment be forced off the  stomach by an emetic,
when nature has already parted with all the oppressive abundance?*
This spontaneous puking  is  not attended  with  any violence  to the
stomach: the milk, or other food seems to come up  without any sen-
sible action of the part, or the child being sick.   Nay, it is at once
so common to some of the finest children, that it is a saying with some
experienced nurses,  that a puking  child  is a thriving child; and
when such  ejection  comes only soon after sucking or  feeding, and
the  aliment is cast up scarcely changed, matter of fact verifies the
observation-!   I have even known clotted blood thrown up, without
any apparent  effort, in an infant  not two days old, and without the
least ill effect.   But if the food  remains some  time  on the stomach,
it will then  be thrown up in a  curdled state,  which is  an indication
to attend to it, if it happens frequently.  Not that the  milk ought not
to curdle on the stomach, which it always must, in order to a due
separation of  its compotent  parts, and is the chief, if not the only
digestion, it undergoes in  the stomach.  The  whey and the rich oil
are  there separated  from  the curdy and earthy particles, the former


  * This opinion certainly requires some limitation ; for if our author be under-
stood to speak literally, and  the precept  be practised upon, much mischief
would undoubtedly be the result.  For example, in Cholera Infantum, one of the
most prominent symptoms is vomiting:  now if nature  has thrown off all offend-
ing matter, why exhibit an emetic? Why harrass the  tender infant by remedies
so unpleasant and debilitating?  But it is idle to reason against established facts.
Experience teaches us that nature, when unassisted by art, can seldom accomplish
her purposes, and that we are most successful when her suggestions are kept in
view, but not implicitly followed.—Es.
f See Primeros ; De Morbis Infant. 
VOMITING.
49
being taken up by the  lacteals* is converted  into blood; whilst the
bulk of the  latter is  carried down and  expelled with  the other ex-
crementitious parts of  the food, and gastric juices,  for which nature
has no longer any use.   This curdling of the milk, therefore is the
natural course of digestion, though many writers have not been suffi-
ciently attentive  to it,  and Harris has asserted, that it is owing to a
predominant acid; implying, that an  undue acid is the only cause of
the separation;  which  it certainly is not.   It  may, indeed, occasion
it to take place too suddenly, or  form too hard a curd, and give rise
to various  ill consequences;  although such separation ought to be
made, as the natural and proper effect  of  mixing duly with the  gas-
tric juice.   When infants, therefore not over fed, throw up the milk
uncurdled, after it has  been some time in the stomach, it is always a
worse  sign.  But when the milk  comes  up  in a  curdled state, it
proves that the  stomach having digested what it has  received, hath
not power to push it forward  into  the bowels, and therefore throws
up a part of it.f   If this be the case, and the infant  be not imme-
diately relieved by it, the stomach may perhaps require to be emptied
of its  whole contents,  which may then  be  easily done  by giving
a little warm  water,  or camomile  tea.   The  cause of the indi-
gestion was an  accidental  repletion;  that removed,  together with
the consequent foulness, or  bad juices of the stomach, the effect also
will generally cease;  and unless the vomiting  returns,  from  any
further injury the repletion  may have occasioned, it requires nothing
more.   To distress the child, on  every such occasion, with a sicken-
ing emetic, or drench it with rhubarb and magnesia, is as needless as
it would be to awake  a patient out of a sound sleep to give him an
opiate.  Only let the  child fast a little  after having emptied  the
stomach of its load, and the nurse  be careful not to overfil it for the
future, and it will rarely want any other assistance.
   If the vomiting, on  the other hand, has arisen from acrid diet, a
little further discipline may be requisite, because some half digested
food has got into the bowels, perhaps for  several days together.  In
this case, a gentle laxative, and  change of food for one of a milder
kind, is all  that is  generally necessary; or if there be a prevailing
acidity in the stomach,  either  the  testaceous powders, or magnesia,
  * It is not intended in this place to speak with physiological accuracy, but in
a mtic reference to the first digestion :  in the second, indeed, it is probable, that
some portion of every constituent part of our food may be further prepared to
become nutritious; the thinner serving to renew the finer parts of our system,
and t lie grosser, such as the earthy particles, &c. more adapted to the renovation
of the muscles, tendons, bones, &c- may be deposited in these parts.

 | I have known children to throw tip  a piece of curd full as large as the thumb
of a grown person, and as firm as a piece of dough ; and be perfectly well the
next minute ; though it might, doubtless, have done much injury, if it had rr.
mained on the stomach.
rv 
50
VOMITING.
(according to the state of the bowels) may be mixed with the food,
or be otherwise  administered for two or three days, as the  occasion
may require.  Or a drop or two of the aqua kali, or a little Castile,
or almond soap, are excellent remedies, especially when the  stools
are unusually green, or  clayey;  not only as they will tend  to cor-
rect acidity,*  but promote the secretion of bile, as well as a gener-
ous warmth in  the first  passages, and assist  the  digestion.  For
which purposes  also, myrrh, though an obsolete,  is an excellent re-
medy, when infants are a few months old.  Should the vomiting be
a symptom attending some other disease, its remedy will turn on the
proper treatment of its cause.   Should it follow upon  a suppression
of discharge behind the ears, and more especially if consequent upon
the use of drying applications,  a return of the discharge should be
solicited.   Or if the cause be  the sudden disappearance  of some
eruption on the  skin,  its  appropriate  remedies must  be employed;
and the infant be put to bed: and if the vomiting continues, an eme-
tic  should be given, and afterwards a blister, or warm plaister, appli-
ed  to  the pit of the  stomach; or some light  cordial be adminis-
tered.
  Having mentioned emetics, I shall take this occasion to observe,
that the choice of them will be always best determined by the nature
of the complaints for which they are administered.  In those of the
first passages, ipecacuanha is generally the best; but if a fever should
attend, or it  be wished to promote a  gentle perspiration, those of
antimony  are  preferable;  or lastly, in  disorders  of the breast", the
oxymel, conserve, or tincture of squills.
   But a  more  troublesome vomiting  will sometimes arise  in un-
healthy children,  from too great a sensibility, or too great an irri-
tability of the nerves of the stomach.   Such medicines are then in-
dicated as will brace,  or strengthen that organ, and abate  its sensi-
bility.  For the former,  a cold infusion of  the bark, or of camomile
flowers, with orange peel and ginger, and sometimes a little rhubarb:
for the latter, a saline mixture with a drop or two  of laudanum.
And the benefit  of these may be increased by aromatic and spirituous
fomentations to the pit of the stomach, or by  the  labdanem plaister,
with a little theriaca added to it.  Also the following:

    r>. Gum  Mastic,  elect.
      Stor. calamin.
      Pulv. Nuc. Fr. Myristicze
      Fol- Myrti.
      Flor. Balaust. aa 3j.

  * It is well known, how small a quantity of soap put into a churn will prevent
a due separation of the component parts of the milk, so  as to allow very little, or
no butter to be made; whereas, a little vinegar effects the separation almost in-
staneously, and  saves a vast deal of trouble. 
                          CARDIALGIA.                        51

     Cerae atque Tercb, al Q. S. ut -ft. Emplastrcm, aluac indu-
cciulum.
   $>  Ung. simpl. 5iij.
     Olci Macis (diet.)
     —— Rorismarini aa. 9 fi
     Bals. Peruv.  9'ij.
  M. F. Unguent, quo tot quotidie Regio Stomachi atque Umbilici
calidie  inungatur, supraponendo ulterius morsum lanulae.

  Lastly, a vomiting may arise from  a strangulated hernia.   When
therefore, scarcely any thing is found to stay on the stomach, or  all
the  above remedies  fail to remove a frequent disposition to vomit,
practitioners will be aware of it, and make a due examination of the
several parts where ruptures appear.
            tHardialgia, or Inflammation of the Stomach.

   This is a disease very seldom met with, I believe, in this country,-
bat is common in France, as appears by a paper read before the Royal
Society of Medicine in Paris, by Mr. Saillant; and is said to attack
children of four or five years of age.
   The pathognomonic symptoms of this disease are, great pain in the
region of the stomach, sometimes recurring every quarter of an hour;
violent contortions of the child; and the application of a  hand to the
seat of the disease.  Mr. Saillant in the first instance suspected these
symptoms to be owing to worms, and prescribed accordingly; but that
child dying in a few days, the body was afterwards opened,  and the
presence of genuine inflammation of the stomach, and of a part of the
intestinal  canal was clearly demonstrated.
   The treatment  of this dreadful disease is, however, represented as
very simple, consisting only in cooling  and laxative remedies, which
when administered  in good time, are said to be usually successful.
For this purpose,  Mr.  Saillant has generally administered the juice of
lettuce, by spoonfuls every hour; an idea he took up from Baglivi, who
directed the juice of  the sow-thistle in the hemitritus, under symp-
toms analogous to those of the cardialgia.  The juice of  lettuce was
generally  found to relieve the pains in a short time, and some infants
who had been judged to be in a hopeless state, and even  at the point
of death, were perfectly recovered.
   Mr. Andrij has done me the  kindness of acquainting me, that he
has sometimes  met with this complaint in the Hospice  des Infans
Trouves, especially during the  summer, and at such other times as
infants have been obliged  to continue there without the breast, for
the want of wet nurses,  (who are  usually otherwise engaged in the
harvest and vintage  seasons;) as well as during a hard frost.  In the
instances  Mr.  Andrij has seen,  the infants were found to vomit  up 
52
TORMINA, OR GRIPES.
every thing that was given them, which, it is probable, must general-
ly be the case where the stomach is actually inflamed.   In such in-
stances, perhaps, fomentations, or a blister to the stomach,  and the
use of a warm bath, together with castor oil, or other demulcent laxa-
tive,  ought also to be made trial of.



                         Tormina, or Gripes.*


    The gripes is  a very common term amongst nurses, and some
writers on children's diseases have treated of it under a distinct head;
but this serves to perplex matters, instead of  explaining  them.   If
a  child be not hungry, nor hurt by some parts of  its dress, there
will  always  be symptoms  attending to account  for its crying,  and
other expressions of pain.   The cause  is,  indeed, very  commonly in
the bowels, and may be increased  by  costiveness and wind, which
have already been treated of, but more  commonly manifests itself by

  • Considering the violent nature  of the disease, and the fatality which usually
attends an attack of it, we cannot but express our surprise at the vague and un-
satisfactory description which has been given  of it in the chapter now under con-
sideration.   There  would  certainly have been  less  impropriety  in passing it
over unnoticed, than in treating of it as has been done. But to our subject  Gas-
tritis is most commonly produced by the ordinary causes of inflammation:  such
for instance as cold, violent blows upon the epigastric region, acrid or poisonous
substances,  &c. taken  into the stomach.  The symptoms of this  disease are nu-
merous ; but only such shall be  noticed as are most frequent in their occurrence.
A sensation of great heat in the stomach, distention of the abdomen, soreness, to
the touch, nausea, and severe vomiting, are considered as pathognomonic.  To
these we may add, unquenchable thirst, immoderate anxiety, unceasing restless-
ness, and muscular prostration. The febrile symptoms  (so far as they are in-
dicated by  the pulse) are by no means violent $  it is commonly lower and more
feeble than in  health,  and this too in proportion to the extent of the inflamma-
tion.  Experience, however, has taught us that the pulse is no guide; and that
the apparent debility can only be removed by  the most powerful depleting reme-
dies.   We  have to contend with inflammation  active and violent, seated  in aa
organ confessedly the  most delicate and important in the human body.  These
circumstances  seem at once  to point out the proper mode of treatment.  The
lancet is unquestionably the only remedy in which confidence should be placed.
For it no substitute can be  found.  So great is the irritation of the stomach, that
medicines cannot be retained ; and even if they should, our object could not be
effected by their means.   Small and frequent  bleeding, as recommended  by
European writers, will never arrest a disease which requires the copious use of
the lancet, guided by a hand  at once resolute and judicious.  In fact, no  point
can be fixed beyond which  it would be dangerous to deplete : general rules only
can be laid down; and as such  it may be observed,  that until the most urgent
symptoms are relieved, the plan is to be steadily pursued.  The abstraction of
blood locally, is not to be omitted.   Much advantage may be  derived from the
application of cups or leeches to the abdomen. High on the list of remedies we
place epispastics, which act not by depleting, as has  been supposed, but by ex-
citing irritation externally, and thus counteracting internal inflammation. Fomen-
tations, and the warm bath, sometimes alleviate the sufferings of the patient for a
time, but they are merely palliatives.  The condition of the alimentary canal, will
at this time claim our attention; the  bowels should, ifpossible.be kept in a soluble
state.  To meet this indication,  suppositaries  and emollient injections must be
resorted to. Mild cathartics  should be employed as early as possible.__Ed.. 
DIARRHffiA.
53
a purging, which comes next in order to be considered.   I shall only
previously ooscrve, that children when very much griped, sometimes
refuse taking the breast, though offered them repeatedly, when placed
in the usual manner, on  the nurse's arm, but will take  it neverthe-
less, very readily,  if they are held upright before her.  The reason of
this, perhaps,  is,  that  the offensive and  irritating matters in  the
stomach then descend from the cardia, which is exceedingly sensible
from its numerous nerves;  and this may further  manifest the impro-
priety  of infants being so  uniformly fed in  an horizontal  posture,
which I have noticed elsewhere.
                           Diarrhaa.

   Under the  article of vomiting, it was observed, that frequent
puking  is oftentimes an attendant upon some  other  complaint, and
then demands a peculiar attention, and is to be treated agreeably to
the nature of such complaints; and  there is perhaps, none which it
more frequently accompanies than a diarrhoea.
   Both vomiting and purging very often arise from unwholesome
milk or other food, and from  a  moist cold air; as well as from the
sudden disappearance of some eruption on the skin.   The  purging is
not then hastily to  be stopped,  nor  even absorbent powders to be
given, till the offensive matter be first carried off; and if a vomiting
attend,  the cure  should begin  by  administering an emetic.  But
though the purging ought not to be checked without previous evacua-
tions, nor to be stopped hastily, yet it is not to be treated with a daily
exhibition of rhubarb, especially in very young infants, howsoever
small the dose; which, though a common practice with many, serves
to prolong a purging after the  cause has been removed, by keeping up
a continued stimulus: as I have  frequently seen.  The diarrhoea, in-
deed, is a complaint  often as difficult to treat as any in the infant
state, and  therefore demands  the most precise directions.   In a ge-
neral way, it may  be said that  a sufficient  dose or  two of rhubarb
should be administered in the beginning, and afterwards absorbents.
If the purging should still continue, an emetic will be necessary, as
purges do not always lie long enough in the stomach to carry off the
offensive matter it contains.  After this, it is often necessary thai
the child be purged again; for it should be always remembered, that
many complaints of infants, whether seated only in the first passages.,
or attended with fever, will frequently seem to be giving  way upon
procuring  stools  freely,  but will soon return if the same  means be
not  repeated,  till  the  whole irritating matter be  carried  down.
Should such repetition fail of success, though the diet has been care-
fully attended to, the use of them at present should be laid  aside, and
recourse be again had to absorbents, and if there be no fever, to light
cordials, anderen to opiates; without the latter of which, many bowel 
51
DIARRHOEA.
complaints will not admit of a lasting cure, owing to the great irrita-
bility of infants.   Such  medicines are not,  indeed, very often re-
quired till  children are some months old:  but when they are found
necessary, not only may syrup of white poppies, but even laudanum,
be given with the most perfect safety;  though from the time of Ga-
len, (who cautions  against giving  theriaca to children) till of  later
years, many physicians have been fearful of directing them, (arguing
from their abuse against  their use) and  especially Harris, who, in
other respects, has  written so well on their  diseases.   I  remember
being called to see an infant of only two days old, who,  through a
mistake, had taken some hours before, four drops of laudanum.  The
parents were greatly alarmed at the child's lying in a comatose state,
without being able to take the breast  or open its  eyes.   I advised,
therefore,  only to get a little breast-milk down with a tea-spoon, and
encouraged them to believe that the laudanum would do no kind of
harm; the infant having no disorder for which that medicine was im-
proper. Accordingly, though the child lay sleeping above six and thirty
hours, it afterwards awoke perfectly well.  This is mentioned, how-
ever, only by way of encouragement, to such as may be fearful of ad-
ministering opiates even where they are necessary.  They are, never-
theless, very  powerful medicines, and should be prescribed with due
caution for patients of every age, especially for infants, and particu-
larly when a purging is connected  with teething, or is attended  with
fever;  in which cases I am almost daily seeing the  fatal effects of ar-
resting a purging.   A like caution  may be necessary in regard to
cordials;  which are^ nevertheless, in many cases equally proper, not-
withstanding a modern prejudice against them.  There is a certain
coldness  and languor in  infants  when they are ill, especially under
some bowel  complaints;  and whenever they may be  in  that state,
that class  of medicines will have a very happy effect.
   It is to be remembered, however, that a purging is  not always a
disease; but on the other hand, a remedy, and a very common aiid
important one.  The bowels are the great natural  and critical outlet
in infants, as  the pores of the skin and the kidneys are in  adults; al-
though in both, from their vast extent of surface, they spread a very
broad mark for the shafts of disease.   Not the mere discharge, there-
fore, but the cause  of it is, in the first instance, to be removed; whilst
the ill effects are to be guarded against by keeping the purging within
bounds.   For this purpose, the chalk julep, as it is  an astringent only
by absorbing the acrid, or changing the acid and irritating matter, is
as safe as it  is useful; becomes an excellent anodyne,  and after the
bowels have  been well cleansed,  and the  irritating cause removed,
will usually accomplish the cure.
   Dr. Armstrong takes occasion to  speak against the use of absorbent
powders, and  prefers  wine of antimony, from a suspicion he has en-
tertained of the great  dependance that modern writers appear to have
placed in them, previous to the exhibition of purges, on account of 
DIARRIICF.A.
55
ihcir known property of correcting acidity; and says, that in cases of
extreme danger, a physician who is called in late, would, according
to this practice,  often  find no opportunity of purging at all.   But
surely this is scarcely an argument to prove  the superiority of his
method, since no writer that  I  know of, ever designed  it as a rule
without exception; and Harris, who has said as much as any man in
rommendation of the absorbent  powders,  does  not deny the  expe-
diency of sometimes beginning with purgative medicines.   But had
it been otherwise, the argument goes no further than  to  prove, that
in cases of great danger, the wine of antimony, being both an emetic
and a purge, ought to precede the use of the testaceous powders.
Instead of this, Dr. Armstrong slides into a general conclusion from
premises evidently limited; though he has advanced nothing against
an  established and successful method of treatment.  And I may add,
that whilst he is fearful, that the absorbent powders (which nobody
prescribes without some purging  medicines,) should check the  loose-
ness, and thereby increase the fever;  he ventures, after a repetition
of the antimony, to administer what he calls a gentle paregoric, or
opiate, to appease the pain, consisting of a drachm of syrup of white
poppies, repeated every three or four hours, till that end be obtained.
So that if the pain should continue  for nine hours, a child will take
half an ounce of the syrup; and this, Dr. Armstrong observes,  is the
only medicine he gives, except  wine of antimony, which (notwith-
standing the opiate) he supposes to be the efficient remedy—but how
much more powerful a restringent, in its ultimate effect, the syrup is,
than the absorbent powders, it is unnecessary to say.
   It is an  improper exhibition of absorbents, I apprehend,  rather
than their dose, that has made some practitioners so averse  to  them:
fur they certainly ought, in many cases, to be given in large quanti-
ties: but if administered too early, and long continued, the stools may
become  like plaister of Paris, and be with difficulty excreted.  Such
an instance is mentioned  by Boerhaave,  who had, nevertheless, a
very favourable  opinion of them, as will be noticed hereafter.   There
is,  however, some fallacy in regard to the colour of the stools;  as this
kind is observed on different  occasions, in children who have never
taken any of the testacea, if  the  secretion of the bile be obstructed;
(as in jaundiced adults,) and will be noticed in its place.
   In his second edition, Dr.  Armstrong mentions another method he
has fallen upon  for curing this disorder, which, however, appears to
be recurring to the ancient method of treating bowel complaints; and
seems, indeed, to overturn the idea he  had  entertained of the supe-
riority of wine of antimony over every other medicine.  This  me-
thod, he tells us, is by cleansing the bowels, by means of proper pur-
gatives,  joined  with anodynes, intermixed  in such a manner as to
correct the  griping quality of the medicines, and lessen the stimulus
occasioned  by the acrimony of the stools.   A plan wrorthy of imita- 
56
DIARRHOEA.
tion, it is apprehended,  and though not likely to be proper in  uU
cases, must, as an occasional practice, be safe and beneficial.
   Regard is to be paid to the kind of stools that come away, which
are seldom  healthy and natural, and are usually distinguished into
the sour and curdled, slimy, mucous, green, pale, clayey, watery, oyer
tenacious, and bloody;*  some  of which  are  at times also fetid^
Under some of these, and particularly the latter two, some powerful
purgutive, such as senna-tea, is  generally necessary, if the  child is
not very young.   True bloody stools are less common in infants than
adults, and  seldom  occur but in the last stage of the disease; but a
few streaks of blood may sometimes be mixed with the feces, which
arising only from the hemorrhoidal veins  is a matter of no  conse-
quence.  Watery stools  will be  considered apart, under the head of
the true watery-gripes: I  shall here anticipate only to say, that very
threatening  appearances  of that affection,  when green and  curdled
matters are  purging off, are  sometimes happily removed, in a day or
two, by a gentle emetic and such a warm purge  as  that noticed be-
low.   When the stools  appear very slimy, and more especially the
sour, or curdled, or when the child is much disposed  to hiccough, the
magnesia, and other absorbent powders are calculated to afford pecu-
liar assistance, and may be warmed by any suitable aromatic.  When
the stools  are very  green, or white and clayey, a drop or two of the
aqua kali may be occasionally put into the other medicines, or a lit-
tle almond  soap be dissolved in the clysters; which are essentially
necessary when much griping attends this complaint; some light cor-
dial is  also  frequently useful, and the  child's belly  may be  rubbed
with a little warm brandy; or be fomented with  a decoction of ca-
momile flowers, or white poppy heads.   But if the tormina be great,
clysters of the whey  of cows or asses milk, as advised by Hoffman
will often be found very  useful, and should the infant be much ema-
ciated,  a portion of the  sugar of milkf should be added to  them—
where  anodynes are judged proper, the tinct.  hyosciami is often pre-
ferable to laudanum.
   It may  be observed in this place, as a  pretty general indication,
that purgatives for infants ought to be made potentially warm, by  the
addition of a little ginger, pounded cardamon-seed, carraway-tea, or
dill-water; which is of more consequence than is usually apprehend-
ed.  I have, indeed, known a careful attention to this circumstance
alone,  happily suppress complaints in  the  bowels, which had long
  * On feces discoloured by blood, or otherwise blackish, particular notice will
be taken, under the head of fever, and where mention is made of sore nipples.

  f The sugar of milk may be procured by only evaporating the whey by
slow boiling; but may be made more pure by first clarifying it by the wh>e
of eggs»_ 
DIARRHCEA.
m
continued obstinate, though, in other respects, properly treated.   On
this account, I venture to recommend the following as an excellent
general remedy,  especially  as infants are pleased with it, and it will
keep for a great length of time.

     Rj  Pulv. Rhei gr. xv.
         Mat>;nes. albse 3 fS
         Aq Faeniculi
           Anaethi ill 5 vj.
         Syrupi Rosas 5 13.
   Spir.  Ammoniac comp. gtt.  xv. ad xxx. ft. mistura, cujus suman*
Wr < 'ochl.  ij vcl iij minima, bis, terve in die, vol ut opus sit.   Or,
     &.  Pulv  Rhci
         Nucis myiist.
         Mapjncs. alboe Ha. gr. iij vel iv.  Sit pro pulvtre, degiutiendo
o cochleare minima syrupi Rotse.

   Should  purgings return frequently, it  will be  very useful (espe-
cially in the time of teething, or upon the striking in  of some erup-
tion on the skin,) to procure a little discharge behind the ears, or to
apply a burgundy-pitch plaister to the back.   For the  former pur-
pose, some finely pounded Spanish flics may be rubbed on the part,
till a slight excoriation, or rawness, is produced; or perhaps a better
method, which 1 have  long recommended, is  to draw a piece  of
coarse doubled worsted,  or a bit of narrow  tape, through a piece of
the emplast. cantharidis, and lay it close behind the ears where they
rise from the head, and  repeating it occasionally;  which  will pro-
duce a  discharge exactly from  the spot where it is wont naturally to
arise.   The following preparation is highly extolled by Boerhaave,*
as an  almost universal medicine in the diseases of infants;  and is
certainly a good  remedy, especially in their bowel complaints, and
particularly when attended  with green  stools, after the exhibition ef
proper opening medicines.

    r^.Sapon. iii1r.Hisp.5ij.
       Margarit pn*. 5'*
       Syr.'Alth. §  6"
       del. tuner, ppt.  51  $
    \r\. Menth. sativjc
       l'seniculi ul 5iij
  ft. mistura,  cujus sumatur cochl. infantum octav.l ^Uctq. r.ora.

  Notice is taken in another place,! of pale stools being no uncom-
mon occurrence when children are breeding their teeth.   They are


  * Epist. 1. ma.—ad J. 15. Bassand: a physician at Vienna
  r See the Chapter on Teething.
                               IT 
58                        DIARRIICEA.

also met with in fevers as well as in simple disorders of the bowels;
and therefore might be introduced under either of the former heads;
instead of this place: but as the stools are very numerous and watery,
and the purging itself is the  first occurrence,  it has seemed, upon
the whole, proper to give it a formal discussion  under the present
article.
  The complaint, however, has been found most obstinate in children
who are turned of a year old, and  cutting their double teeth.   The
stools are not only clayey, thin, and very white, but curdled like those
of very young infants at the breast.   In the beginning, it is seldom
attended with any degree of pain,  or other complaint, except  it be
the loss of appetite;  and this has led  parents, and sometimes other
people to think, that the discharge ought to be  checked by absor-
bents, or opiates.  But nothing can be  so improper;  the skin soon
becoming hot, the tongue white,  and the disorder rarely yielding to
any treatment under two or three weeks.  This is almost always the
case, if teething be any wise concerned in the  complaint, unless the
teeth happen to be nearly cut through: though a purging with   pale
stools, it has been said, is met with in fevers of another kind, where
the cause is confined wholly to the first passages.
   Whatever the age of children may be, they are always somewise
indisposed while the alvine discharges are of this colour; and whe-
ther there be either fever or purging, or not, children lose their flesh;
as it is, indeed, likely they should from  this clay-like matter stick-
ing to the coats of the intestines, and preventing  the due absorption
of the  nutricious parts of their food.   This is  especially true, when
the stools are thick as well as pale; or  if they be of a leaden-blue
colour and very adhesive,  or pasty, and in amazing quantity,  as is
sometimes the  case.
   Under these last circumstances particularly, small doses of calo-
mel, administered as an alterative, is an admirable remedy.    The
safety  of the use of this medicine for any length of time, has, how-
ever, been lately disputed  by  Dr. Curzons of Birmingham;* but the
opinion seems  to be supported rather by theory than established by
facts, the doctor asserting only that, " many children  have fallen a
sacrifice to the improper exhibition  of this medicine;"  and of  what
medicine this may not be said, no one will surely dispute.   On the
other hand, I am persuaded,  that the benefits  I have  seen derived
from a proper, though long continued use of this drug are, at least,
equally numerous.
   Whether teething be materially concerned or not, purging, by one
mean or other, is the proper and principal remedy, unless the  gums
are in a state to be lanced, or the stools should continue a long time
very pale, or clayey, after  the fever and purging disappear.  In the
latter case, some saponaceous medicine will prove  serviceable, such
* Medical and PhysicalJournal, Vol. iv. No. ?1 
UIARRHtKA-
59
as the aqua kali praeparati, or a few drops of spiritus ammoniac com-
positus, taken two or three times a-day; the boWeis being still care-
fully kept open.
  Where dentition is the probable source of irritation,  and of these
pale stools;  but lancing  the gums has not accelerated the irruption
of  the  teeth; or  the period is too early to expect benefit from it;
children  are oftentimes  not  only free from fever, but  are, on the
other hand,  cold and languid, and should therefore be purged less  fre-
quently.  Some cordial  medicine should also be administered on the
intermediate days,  as  well as on the  evenings  after the physic has
operated.
   In the early part of  the disease,  the active purges  are  the most
proper, such as caster  oil, senna, and frequently calomel; or, if the
fever be considerable,  an infusion  of burnt sponge and senna; a
preparation  equally adapted  both  to  the fever,  and this kind of
purging.
   Another bad kind of  stools appears sometimes during teething,
that has been alarming  to many, as nothing like it, that 1 know of,
appears spontaneously  in infants at any other  period;  though  it is
not uncommon  in  adults, and  especially,  I think, in females.  This
is a discharge of a very thick  mucus, which appears in great quan-
tities, and sometimes accompanied with a little blood.
  Neither of these discharges, however, do any harm, if the bowels
be kept a little more than usually open, by some soft  purgative,  and
some light cordial interposed, or the test, ostreor.  ppt.  if found ne-
cessary, in order to strengthen the bowels.
  The cause of this appearance seems to be of  the same kind with
that in adults, and from  mere irritation falling on the glands of the
bowels, and keeping up an increased  secretion of their natural  mu-
cus: and it  is well known that the time of teething, is that  in which
the bowels are peculiarly liable to irritation.
  To the various observations that have been made I shall briefly
add;  that there is a disordered state of bowels,  which frequently oc-
curs, and is disposed to continue a long time, during which, infants,
though not often precisely ill,  do  not  thrive, nor  look well.  The
stools are said to be always bad; being sometimes of a green colour,
at others, of a pasty consistence;  sometimes very numerous, and at
others, infants are  for several days very costive.
  In  this, as well as other bowel affections before described, when
laxative, alcaline and  absorbent medicines have been found to  pro-
cure no permanent good  effect, calomel often proves a sovereign re-
medy; and may be given in the dose of half a grain,  or more, to in-
fants in the  month, for  two, three, or four  successive nights.  In ge-
neral  nothing purgative  should be administered the following morn-
ings, but the mercury be left to its proper action.   It is certain,  that
this mineral has a marked operation  on the liver, obviating a morbid
action, and as a stimulant, when  inert; and is an equally well known 
60
DARIUKEA.
 deobstruent  for all  the glandular system, and will be found a  vtiv
 safe  and efficacious medicine; infants being known to bear mercury
 much better even than many adults.
   When purgings have continued a long time without any  amend-
 ment, a peculiar tightness of the skin will sometimes take  place in
 the last stage of the  disease,  affording  always an unfavourable prog-
 nostic; and of which further notice will be taken under the article of
 Skinbound.
   I conic, lastly, to  treat of the Licnlcry, or true  IVatery  Gripes, so
 called, uhich is esteemed the most dangerous of all purgings, and is
 usually thought fatal, though perhaps  without reason;  since if pro-
 perly treated, children recover  from it as  well  as from  excessive
 purgings  of any other kind, unless it happen after some other illness,
 or to  very small and tender infants during  the  month,  especially
 when attempted to be brought up by hand.   It is not the having a
 few very thin stools, however, that is an evidence  of the true wa-
 tery gripes, for in almost every purging of a few  days continuance,
 the stools are very thin as  well as numerous.   But in this  case, they
 are thin very early in the  disease; the child looks wretchedly, and
 every thing it takes runs  almost  immediately through it,  with  very
 little change, as in the lientery of adults.   It should likewise be re-
 marked, that these symptoms continue, and are increased as  the dis-
 ease advances ;  it having  been already noticed, that there  is a sem-
 blance of watery gripes, that will otherwise deceive, as it  requires a
 different  treatment;  and to which it may be proper in this  place to
 advert a little more particularly.   For here the stools are  more per-
 fectly fluid than  in  the true watery gripes, and are tinged  only with
 the bile, and are very numerous; the  thin stools arising  from a vio-
 lent; but  ineffectual effort of nature to get rid of offensive matter: for
 upon exhibiting a warm purgative, calomel, or castor oil, several very
 thick, and always clayey stools  are brought away.  A mixture with
 chalk and aromatics should then be administered; to which  laudanum
 should be  added, if the stools are still too  numerous, and the child
 appears much debilitated.  The purging medicines must be afterwards
 repeated  as long as the stools  shall be clayey; and the restringent
 cordial interposed, as occasion may require.
   In the true watery gripes there is not the like indication for purg-
 ing; but  the cure should  be begun  by administering one or more
 emetics, especially when the stools arc of a dark colour and fetid; as
 they frequently are in the  earlier periods  of the complaint.  And
 to this end a pretty strong one should be prepared, which  should be
 given in divided doses, at about a quarter of an hour's distance,  till
 a  proper  effect is  produced; and some hours afterwards a warm
purge with rhubarb should be administered, if the disease be not very
far advanced.   After the first passages have been cleared, the eighth
part of a grain, or less, of ipecacuanha, or a  drop or two of  wine of
 antimony, given every three or four hours, with a  few grains of the 
»ARi.H<i. \.                         bl
 K-sLueuus powders, or the aromatic confection, appear to me amongst
 i he best remedies in the earlier periods of the complaint.   Indeed,
 ipecacuanha in very small doses, especially if duly guarded by some
 gentle aromatic,  is  both so useful and safe a remedy, that it should
 not be hastily laid aside; and when persevered in the use of for some
 time,  will  effect wonders, not only in long purgings but  in other
 chronical complaints.  The  like may be said of the vinum anii-
 monii,  which in the less aggravated  watery gripes, or where a purg-
 ing is for a  long  time attended with very bad  stools, forbidding the
 use  of restringents;  as well as  in  some little feverish complaints,
 I  have  found equally useful,  and even sometimes more manageable
 as an alterative than ipecacuanha, because less disposed to nauseate
 infants  where an emetic may not be  directly intended.   There being
 also cases in which the physician wishes a  medicine  may operate as
 a  corrector of the secretions  in the first passages,  or to expel their
 contents,  either upwards or downwards, as may be ultimately most
 useful,  antimonials seem in this view likewise to claim a preference
 to all other medicines.
   In the more advanced stages of the watery gripes, and where the
 child is not very young, the following old medicine  is a very good
 one.   Of Locatelli's balsam, one ounce, and conserve of  red roses,
 two ounces:  from  the quantity  of an horse-bean to that of a nutmeg,
 may be given three four times a day, according to  the age of the
 child.   Others have advised red bole, and gum tragacanth.   The
 labdanum and other plaisters likewise, as  directed for vomitings, or
 the following, may be applied to the parts above the navel, especially
 in case of the great pain:

     R. Theiiac.  Venet. §j.
        Olei cspresis Macis diet. 5 j
        Olci N. Moscli. gtt. iij.
     Mi see, ft. Empi.alul. indue.  Or,
     1\. Axung. Auserin. 5'j.
       Oiei expressi  Mac;is (diet.) 5j-
        Mentliae sativse9j.
        Bacc. Junip.
        Chamaenuci. Ox 9 ft
     Misce it. Liiiimcnlum.
   Itiungatur eo bis vol tor quotidic Stomachi ct Umbilici Regiu.

   Warm flannel, with or without heated  bran, may be afterwards
laid over the whole belly, and renewed frequently.
   Should these means fail, I have known the repetition of  a vomit
give  an immediate  check to the complaint, especially where the
stools continue to  be remarkably sour.  As. long as this is the case,
it  would be both vain and hazardous to exhibit opiates, or powerful
restringents: the acidity must be first  carried offby warm purges, and 
ii2
DIAKRIJCEA.
be  corrected by absorbents; the latter of which must  be given in
large and repeated doses, and frequently their powers be augmented
by the  addition of aqua kali, or tinctura myrrhae.  And an excellent
remedy  sometimes, as an antacid, is  the spiritus salis ammoniaci
succinati of Bates's  dispensatory.   The acidity once  removed, a
starch  clyster may be thrown up, two or three times a-day, with  or
without a few drops of laudanum,  according to the number of the
stools,  and weakness of the infant.  A drop or two of laudanum like-
wise, may now be given, once or more in the day, (according to the
age of the child) either joined with some purgative, or in any of the
afore-mentioned medicines, or in the chalk-julep, made warm with
tincture of cinnamon,  or  of cardamoms; and in cases of extremity, in
the decoction of logwood,  which agrees very well with young chil-
dren: or a medicine now out of use, and no  longer kept at apotheca-
ries'-hall, (but easily made at the proper season,) I mean the rob of
sloes; a few grains of which, with a little grated nutmeg, and a small
quantity of rhubarb, p. r.  n, I have lately found immediately suc-
cessful after opium, decoct, campechens. and every ordinary restrin-
gent have failed of any  lasting benefit.   In the advanced stage of
watery gripes, or in the case of great debility, the liberal exhibition
of aromatics and opiates  is  essentially necessary.
  Bowel complaints,  it was said, are frequently owing to improper
food, which, on this account, should at all times be peculiarly attend-
ed to; and when a purging has taken place,  ought to be suited to the
nature  of the stools.   In  the latter part of this work ample notice
will be taken of the article of childieu's food;  at present I shall only
observe, that cow's milk is often found to disagree with them when
their bowels are disposed to be too open, at which times, a little  lean
mutton broth, or beef-tea  is abundantly preferable.   On  the same
account, rusks, and biscuit-powder are more suitable than bread;*
but at other times, I believe, either the Uxbridge or the French  roll,
which  are already half digested by a previous fermentation, are more
easily dissolved in the stomach, if there be not a predominant  acid in
the first passages.   But where  there  is an  habitual disposition  to a
purging, I know of no diet so proper for infants who do not suck, or
who cannot have enough of the breast, as  flour slowly baked for a
long time, till it breaks into a soft greyish-coloured  powder,f  and
afterwards mixed with boiled cow's milk, the scum being first taken
off; the  flour and milk should  then be boiled a little time  together,
till  the whole appears like a thin custard.  This is a very light and

  • Rusks are preferable to tops and bottoms, as they are called, which have a
good deal of butter in them ; and are the least disposed to offend an infant's
stomach of any thing of the bread kind.
  •j-To this end, the flour should be put into a small jar, properly covered, and
taken out of the oven several times, and stirred up from the bottom and sides of
the jar, that it may not run into hard lumps, but the  whole be equally baked. 
INCONTINENCE OP STOOLS.
63
soft food, and sufficiently restringent; and  I have often known more
good from it, than from all the absorbent medicines ever devised, and
have received more thanks for the prescription, as it proves a perma-
nent remedy.   So also  the powder of  arrow-root,  boiled in water,
and then mixed with milk, is an admirable remedy when it can be
procured genuine.   When the watery gripes, or, indeed, any violent
purging, attacks very young children at  the breast,  no other food
ought to be administered, but the wet-nurse be changed, if the acidi-
ty and purging continue many days, and medicines do not  seem to
take a proper effect;  which they cannot if any  offensive  matter be
continually taken into the stomach.
   If infants, ill of watery gripes, are brought up by hand, the strict-
est attention must be paid to their food, which must be changed from
one kind to another, and  especially trial be made of broths, as long
as the food shall be disposed to  turn very acid  on the stomach.   In
one  case,  I think I saved a child by Bates's julepum vitae,  lowered
with  water, when nothing else  would stay  on  the stomach.  This
served both for food and medicine; for the former of which it was
still further diluted.
   When  children, who are weaned, are attacked  with repeated
purgings, and even broth is found to run through them, I have  ob-
served no food  so generally useful as a bit of the white of chicken,
not over-boiled, and afterwards lightly bruised in a mortar with  the
chicken liquor, and a very little bread, into a  kind  of  light jelly.
But this should not be given oftner than  twice, or,  at most, three
times a-day.
   In all bowel complaints, it has been  already remarked,  that in-
fants are disposed to eruptions on the skin; by which they are so fre-
quently  benefited,  that if any kind of rash  appears  during long or
severe purgings, a recovery may almost with certainty be prognosti-
cated.  The like good effects have been noticed from  a purging tak-
ins: place in some obstinate cutaneous eruptions.


                      Incontinence of Stools.

   The long continuance of the last-mentioned complaint, as well as
others which may debilitate the  habit, may prove an occasion of that
now  under consideration.   Children  who are  accustomed  at  all
times to have  a very open belly, being especially liable to  lose the
faculty of properly retaining their stools,  and need a servant conti-
nually to attend them, even at two or three years of age; insomuch
that some  have been suspected of being culpable in the matter.
   No very appropriate remedy, I believe, is likely to be necessary,
having never ordered any thing more than dashing the parts, daily, with
cold water, or  at the most administering aquae alcis, or other absorb- 
G4
WORMS.
 ent;  the  complaint always  wearing  off as such  children grow up,
 though oftentimes not entirely for several years.


                              11onus.

   Worms may,  probably, exist in almost any part of the body, as
 well  as in the stomach and  bowels.  They have, accordingly, been
 found in the pericardium, bladder, the nose, and sinuses of the head,
 and  even in the lungs, liver, and  other solid parts.*  But as wc
 neither know  how they are produced, nor  how  to dislodge them
 from these recesses,  which  they also more rarely occupy in young
 children, it is quite sufficient to notice  the fact; our inquiries being
 properly confined to worms  in the first passages.
   It   is  on  this  account,  that the complaint is noticed  in this
 place,  especially as  worms are said to  have been voided by in-
 fants of only a few weeks old.  It  is even reported,! that Lille Van
 Deoverin has discovered them in the still-born fetus.  This, indeed,
 is much  doubted  by others, it being a very old observation,  that
 worms are never voided by infants who are  nourished only at  the
 breast; and if so, it is not likely they can be generated before birth.
 Mr. De Lille, however, disputes this, asserting, that worms were ex-
 pelled from his own daughter, when only eleven weeks  old, and liv-
 ing entirely at the  breast.
   However this may be,  it is  evident that worms  are much  oftener
 suspected to be the cause of  children's complaints, than  positively
 ascertained; and of this,  practitioners who  deal in secret medicines
 have  in every age made their advantage; it being certain that a mere,
 foulness of the bowels will  produce most of the  evils  attributed  to
 worms.   Neither are all children  equally affected by them where
 they  are actually met with;  some  infant children  (as well as quad-
 rupeds) continuing very  healthy, though they are seldom  free from
 them, and others parting with  great numbers unexpectedly,  without
 any previous  indisposition;  whilst some children are  very  ill who
 have  apparently very few.   The pains and  other complaints  in such
 case arise from some other source, of which I lately saw an instance
 in a girl of twelve years of age, long subject to excruciating pains of
 the stomach, for which she took various  worm medicines, and actual-
 ly parted  with several large  lumbrici, but without the least relief to

  * JJaglivtj reports, that worms are found in the heart; Rvysch in the lungs,
 the sph't-n, kidneys, in the gonorrheal discharge, and even in the marrow of the
hones  ; Schenkins, in the urinary bladder; Itiunchi in the  uterus and in ulcers ;
Hippocrates in the vagina ; and they are said to be frequently under the skin in
the Negroes in our West India islands.
  •j- Pldlosoph. Tram-actions.—The same author reports,  that a peasant,  after
taking an emetic, brought up  forty Dutch ells  of tape-worm, md yet left some
part remaining, having through lus agony, bitten the  worm off. 
WORMS.
63
her pain; which afterwards immediately yielded to antipasmodic re-
medies.
   I, nevertheless, cannot agree with Dr.  Butter,  that worms in the
human intestines are altogether innoxious,  much less as he seems to
think, useful, and intended as  " nature's remedy for destroying the
Miperabounding  morbid humours;  and for stimulating the first pas-
sages by their crawling motions, and thereby assisting the peristaltic
motion of the guts to carry off what remains of the offending load."*(*)
On the other  hand,  children who are most troubled with  worms, arje
generally of a costive habit.
   Worms become hurtful chiefly from their  numbers;  first, when
they obstruct  the bowels, or compress the adjacent parts  by their
bulk.  Secondly, by sucking up the chyle designed for the  nourish-
ment of the child.   Thirdly, by irritation.   Fourthly,  by actually
destroying the parts; though this is certainly a very rare occurrence,
and a far less frequent source of injury than those before mentioned.
Worms have, however, been said to eat their way through the intes-
tines; and Lister relates,f that some resembling the teretes,  but  of a
whiter colour, have been  seen coming from an abscess on the ankle
They are  likewise said to have  occasioned suffocation, by rising up
in the throat and lodging there.|(f)
   They have  been usually accounted to be of four kinds;  ov to speak
more correctly,  according to  Dr. R. Hooper and  Baillie, the native
human intestinal worms are divisible into  two orders, round  and flat;
the former comprehending,  1. the ascaris lumbricoides,  or  teres,

  * Remittent Fever.
  (*) To one at all conversant with the diseases of infancy, it must appear sur-
prizing that a difference of opinion should ever have  existed among physicians
:is to die innoxious or injurious nature of worms.  In children they are the fruit-
ful source of disease, and few are their complaints whose symptoms are not so
exactly imitated as to deceive the experienced and discriminating practitioner.
They exist much oftener than is suspected j  and many patients have been unsuc-
cessfully treated for epilepsy, mania, croup, and dysentery, until accident has led
to the suspicion of worms ; and then some mild anthelmintic has put an end to
the symptoms.  Facts in support of this opinion are so commonly detailed by
practical authors, that it is unnecessary fcr me to  quote examples : suffice it to
say, that two cases of the kind have occurred  within the sphere of my observa-
tion.—Ed.
  ■j- Philosoph.  Trans.  See also  Ileister.  Their appearance on a sore may,
however, be otherwise accounted for than by supposing them to have made theji'
way from beneath the ulcer.
  t Mr. Le Febure de  Villebrune.
  (|)  One of my medical friends was some time since called to a patient labour-
ing under all the symptoms of croup.  An emetic wae immediately administer-
rd, but its operation afforded no relief. The patient was now immersed in a warm
hath, and the lancet was freely employed : these remedies produced no decided
effect.  Much surprised  at the obstinacy and unyielding nature of the disease
which had hitherto proved very manageable in his hands, he paused  to reflect.
At this moment a large worm was thrown up, and the synnton.s instantly *ii<?.
appeared-—r. n. 
GO-
WORMS.
 (the lopg round worm, resembling the earth worm;)  2.  ascuris ver-
 micularis, (the  maw, or  thread  worm;) 3. trichuris vulgaris,) the
 lopg thread worm.)
   The second order embraces,  1. tenia osculis marginalibus, (the
 tape, or long  joint worm, solium.   It  is the separate joints of this
 species which constitutes the tcenia  cucurbitina, or gourd worm,
 from its  resemblance to the seeds of  the  gourd, or water melon.
 2. tcenia osculis superficialibus,  (the broad tape-worm.)  This spe-
 cies seldom separate into joints.  It is very seldom met with in this
 country,  but is endemic in Switzerland and Russia, and very com-
 mon in Germany  and other parts of Europe.   Linnaeus enumerates
 another species, which he savs has two oscula, one on each side, and
 which he terms tcenia vulgaris, but  which is thought by some to be
 merely a variety of the other.
   The tcenia, it is well known, is often many yards long, is the most
 hurtful of all, and most difficult of cure, because it will remain long
 in the bowels even after it is dead, and is then seldom brought away
 but in pieces, and  that by very powerful  medicines: though I think I
 have seen dead portions of this worm  come away  where no kind of
 purgative has been administered.  But as  this kind of worm is cer-
 tainly not common in children, though it may sometimes have  been
 met with; and as  it  generally occasions a variety of symptoms re-
 sembling other complaints, for which many different medicines may
 be required, little  more than the  mention of it may suffice.*
   The  symptoms of worms are various,  and many of them  very
 equivocal: I shall name only the more constant, and less uncertain
 ones.   Such are fetid breath, especially in the morning; bad gums;
 itching of the nose, and of the anus,  especially from the  ascarides;  a
 very irregular appetite, always in extremes, whether of  hunger  or of
 loathing;  a large,  hard belly; pains at the stomach; sometimes vomit-
 ing,  oftener costiveness, or irregular purging, with slimy stools;f ir-
 regular cholies; thirst; dullness; peculiarly unhealthy  and bloated
 countenance, with a dark, hollow circle round the  eyes; startings in
 the sleep, and grinding of the teeth.   To these symptoms ace often
 added slow fever, with a small and irregular pulse, pale, or whitish
 urine, a short and  dry cough, (which is  an almost constant symptom
 where the complaint is of long standing, and has injured the health;)
 sometimes even convulsions, tetanus,  epilepsies, and partial palsies

  * It is so uncommon to find more than one of this kind, that it has acquired
the name of the solitary worm ; yet it is said there are a few instances in which
several of them have  been met with ; but perhaps attention enough may not have
been  given in the examination of them, it being well known that this worm will
live a  long time after it has been broken into several parts.  See Letter of Df-
Nitret to Da Haen, Act. Med. xij. 219.  The head, and probably that alone, has
the property of forming the jojnts; so that if that be left after the rest of the worm
has been  voided, fresh ones will be produced.
  f The peristaltic motion of the  intestines being increased, the secretion of the
 mucus must consequently be in larger quantity. 
WORMS.
67
uf the lower extremities.   In the case of convulsions, if there be a
small pulse,  attended with a hiccough, it is an almost  certain sign
that the convulsions are occasioned by  worms.   The like may be
said of pain at the stomach, if it be very violent, sudden,  attended
with great anxiety, and a hardness and soreness of the  parts above
the navel.   But more especially, according to Home, an edematose,
swelling of the upper lip, and of the nostrils, is a certain  token of
worms.
   The cause of this troublesome complaint is not, perhaps,  certain-
ly known; but the great moisture of young persons is thought to be
an occasion of their being more infested with them than older peo-
ple: and children whose digestion is weak, are more  liable to them
than others.   Hence, debility seems as much a cause, as it is an ef-
fect of worms.  Since the doctrine of equivocal generation has been
justly  exploded,  it has, however, been  generally  imagined,  that
worms are engendered  from the eggs  of insects,  which float in the
air, or are swallowed with some part  of our food, such as summer
fruits, vegetables, cheese, and some kinds of flesh meats.  But, per-
haps,  this is not  altogether so  certain as it may seem at  first sight,
unless we  are to imagine that these supposed eggs produce very dif-
ferent insects, from being taken into  the stomach  and bowels, than
they would if deposited elsewhere; since it is generally  thought that
insects of this kind, especially the tape-worm, are not met with  any
where else;* neither will it account for their existence in the unborn
fetus, if that be really a fact.   It is, however, more than probable,
that they were destined by nature to be generated, and to live  in the
bodies of other animals, as observed by Dr. Blackf and  Rosseen.
   But whatever be the cause, the general  intention of  cure is ob-
vious enough, which is to bring them away in the most easy, and ex-
peditious manner, whether alive or dead;  the difficulty chiefly con-
sisting in dislodging them from their firm attachment  to the sides of
the  bowels.
   In this view, systematic writers state the indications to be, first, to
destroy the nidus;  and secondly, to kill and expel the worms.    The
first may be  effected by alcalis, as aq. kali ppt. sapo  venet. bitter

  * Although this seems to be the fact, there are not a few learned men of a dif-
ferent opinion.  Many travellers, and others, better acquainted with natural his-
tory than 1 am, have reported, that the very same kind of worms may be met
with amongst vegetables, in the earth, and both in standing and running waters.
That the tape-worm, particularly,  has been seen in the waters  about Constanti-
nople, where the complaint is very common ; and that natives of northern cli-
mates, who  have resided for any length of time in Turkey, are very frequently
afflicted with the toenia, as it is supposed, in consequence of drinking of the foul
standing waters of that hot climate.  Linnxus also, and others, have thought the
teretes or lumbrici,  to be the same with the common earth worm: but Tyson
has, by dissections, demonstrated  the contrary.   Philosophical Transactions.
  f Treatise on the  Generation of Intestinal Worms, and on the Means of De-
stroying them.  See  also Dissert, of J. Matbieq Gesrier, Men. Gotting. an. 1751. 
Qb
VVORiMS.
aromatics, and mercury;  or by resolvents, as.the gums, asafcetida,
galbanum, and  such like.  Secondly, worms  are killed by oils, in
clysters, especially with  the addition  of the infusion of the semina
santonica; by honey, and by indigestible substances, as the testaceous
powders, steel,  and tin; and by poisons,  as preparations of mercury,
which at the same  time  expel them.   To these ends, indeed, a va-
riety of medicines, pretty much of the saAc kind, has been devised,
and has served the cause of empiricism in every age.  Most of which
consist either of the bitter purges, or mercurials.
  Worms existing in the bowels can,  indeed, only be carried away
by purging; and very active purges are  indicated when the time of
life and the constitution do not forbid.  But when these are tender,
gentle purges given duly for some time, by the constancy of their opera-
tion produce, without harm, an effect equally, or perhaps more bene-
ficial  and lasting, than the  active  purges.  These  are  often joined,
or administered alternately with bitters;  and hence  have  arisen the
family receipts, as worm seed, tansy, and such like, given in treacle
or honey; or joined, as it has been said, with rhubarb, senna, or other
gentle laxative.   With many,  and especially French  writers, the
male  fern alone, is reckoned a specific.   Olive oil, likewise, has been
said to be a good remedy,  as being  destructive to  worms; but  castor
oil is  preferable,  which,  by its  purgative quality, also  carries them
off by stool.  Dr. Parr, in liis Medical Dictionary, recommends the
helleborus fetidus, as a specific.
  Agreeably to the above view of gradually ridding the  habit of
these  vermin, children of a delicate frame and such as have not been
long infested with them may begin  by taking a small dose of infus.
sennae every other morning;  but should this prove insufficient, a few
grains of pulv. e scammon. cum  calomel, may be  given them over
night, once or twice a  week,  according to the age and strength of the
child; and some tonic medicine be interposed.   If purging  much
should, on any account, be found improper, the following is very safe
and often effectual.

             R. Limalur. Stanni *:.j. Hydratgyr. 3'ij.
                      Misce, fiaut amalgama.

  Eight or  ten grains of this powder,  with three or four grains of
rhubarb, and as  much unwashed calx  of antimony, may be taken
every morning in a little honey, for  a week together;  after which,  a
clyster of succotorine  aloes, dissolved   in  warm  milk, should be
thrown up over night, and a proper  dose  of rhubarb,  or  senna  tea be
taken the next  morning:  which  course may be repeated, as the ob-
stinacy of the complaint, or the  strength of the child shall direct.
Volatile alkalis, ajso, in some debilitated habits, will prove servicea-
ble, as well as  valerian,  especially  if it  be occasionally joined with
jalap.  But one of the  most powerful means, long in use with coum- 
WOiiM:
bl>
try praetioners, and  of late  stongly recommit udcd by Mr.  Cham-
berlaine, is the  dolichos pruiiens, variously prepared;  but the most
simple form, that of giving it mixed up with treacle, is, perhaps, the
best of all.   It should be taken night and morning for three or  four
days,  and then be purged off with senna tea, or jalap; and this course
be repeated as occasion may require.
  Amongst other means, especially for  such as may be at a distance
from  medical assistance, is  a mixture of pewter filings and treacle,
of which  children of four or five years old, may take several  tea-
spoonfuls in a day, almost at pleasure; which they will also readily
do, for the sake of the treacle.   At the same time, from  five to ten
grains of jalap, with as much of the hydrargyrus cum sulphure should
be given twice every week, to purge off the dead wrorms.   Dr. Rush
of Philadelphia, strongly recommends the  rust of iron, from five grains
to half  a drachm, for infants from one  year old  to  five,  exhibit-
ing a purge every fourth or fifth day, to  carry  the worms down, as
they die.   To answer the  last purpose,  the following plaister is some-
times sufficient:

    rj. Aloes succotorin.
       Pulv. flor. Chamaem. 5.i  3j-
       Tereb. venet. Q. S. ut ft. Emplaslrnm  (cum  marginc  en:--
plast. adlioesivi) apud regionem umbilici admovendum :  sed antes
upplicaiionem, imponatur loco umbilici morsum gossipii.

Or equal parts of bullock's gall, and powdered  aloes, may be mixed
up with  any unctious substance, and  the parts below the navel  be
anointed with it, two or three times a week:  or succotorine aloes and
powder of dried rue, made into a plaister with  Venice treacle,  and
applied round the navel, first covering that part with a little cotton.
I mention these things with  a view  to the  country poor, whom the
benevolence  of practitioners may incline  them to assist, and  who
may by these easy means, do it at so little expence to themselves.
  If  the complaint, however, has  been  of  long standing,  and the
child  not very young, mercurial purges are a more expeditious, and
a safe remedy;  though the  hydrargyrus  cum sulphure taken for a
length of time, and occasionally purging with senna, has sometimes
succeeded, even where there have been  the severest convulsions.
For which likewise, or obstinate contractions  of the limbs, the warm
bath is often essentially  necessary.
  Throughout the cure, and indeed afterwards, the diet should  be
strictly attended to, and  all fat and  greasy aliments abstained from.
The child should live upon milk, broths, and meats of easy diges-
tion, with toasted bread and honey, instead of  butter, which is ex-
ceedingly pernicious.   To prevent a return of the complaint in older
children, or grown people, chalybeate waters and bitters may be made
use of. 
70
WORMS.
   As it is not my intention to enter formally into the  distinct treat-
ment often necessary for the tcenia (which, indeed, I have sometimes
seen brought away by very gentle means;)  I shall do  no more than
refer to Shmucker's new medicine, as well as the celebrated remedy
of Madame  Nouffer, said  to be made use  of with great success in
France  and Geneva;  as I have also  known it  to  be,  two or three
times, in this country.   It  can,  in no wise, however,  be proper for
young children, though it may, possibly, be  safely had recourse  to
for robust  youths, growing up to manhood.  It is intended to ope-
rate very powerfully on  the bowels for  many hours, the patient be-
ing supported the while by  repeated  large  draughts  of broth,  or
green tea.
   The preparation  of the  preceding day, and some  other ;reAise
directions, are  equally needless  in this place,  and perhaps the pre-
vious exhibition of two or three drachms of the Radix Filicis mas-
culini, is of as little importance.   For a full account of the proce;,
the reader is refered to Madame  Nouffer's Treatise, published  b/
Dr. Simmons anno  1787.
   The purge is as follows:


    $>. Mercur. dulc. optimt sublimat.
      Resin. Scammonii elect, a gr. x.
      Gambogiae  gr. vj. vel vij.
      Conserv Cynosb. Q. S. ut  ft. bolus.


   The  Cevedella  or Indian  Caustic  Barley  is recommended by
Shmucker, in the fifth volume of the  Journal de Petersburg,*  as aD



  * Mr. Loefler, the author  of the Journal assures us, that it may be taken
thus with perfect safety; and annexes cases of its success in expelling worms of
different kinds. A very powerful remedy, much used  in the West Indies, par-
ticularly for the lumbrici, is the Spigelia Anthelmia, a species of Indian Pink;
but it has not as yet, I believe, been made use of in this country.*

  • The notice taken of the Spigelia Marylandica, in the author's note is by no
means such  as it deserves : it will not, therefore, be deemed superfluous for me
to make some additional observations on it.  It is an article possessed of much
power,  and  requires caution in administering it; the  narcotic principle some-
times produces the most alarming train of nervous symptoms, as vertigo,  false
vision, distortion of the countenance, convulsions, &c:  but all these may be ob-
viated by combining with  some mild cathartic, as calomel, in the dose of three
or four grains.  There are two preparations of it used; the powder and infu.
sion ; of the former form x to xv grains, is  an average dose for  a child  of two
or three years old. The infusion is prepared by pouring a pint of boiling water
upon one ounce of the  bruised  root, and allowing it to simmer  until one-third
has evaporated; of this about  a wine  glass  should be given  three times a-
day. Another article much used in the practice of the southern states (and
perhaps the  most  powerful  anthelmintic which we possess,) is  the Melia Aze-
darach, Pride  of India, Pride of China, Poison Berry Tree, &c. &c.  The inner
bark of  the root is the part in which its medicinal virtues  reside.   It is com- 
WORMS.
71
almost infallible remedy for the tcenia.   He directs a drachm of the
seeds, in fine powder, to be given every morning fasting, mixed with
honey;  and to exhibit on the fifth morning a drastic purgative.
   Mathews, late apothecary at Berlin, received an annual premium
from  the king  of  Prussia, (1801)  for his arcanum  for the tape-
worm, viz.

    §».  Limat.  Stanni angl. pur. |i. pulv.  rad. filicis  maris dr.  yj.
       pulv. semin. Cynae ^ss.  pulv. rad.  jalappae  resinosse, salis
       polychresti aa 3'- misce, ft. cum  mellis commun. sufficiente
       quantitale electuarium.
    5,. Pulv. rati,  jalappae resinos.  salis  polychr. 5S.   3'iij.  scam-
       monii aleppensis ^j Gummi guttae gr. x. misae  ft. cum melle
       comrjnuni,  electuarium.

   He directs a spare diet  of only broths and vegetables before the
exhibition of the medicine, of which a teaspoonful  is to be  taken
every two hours,  for two or three days, till  the worm is felt moving
in the bowels:  the patient is then to take of the purgative electuary
likewise a teaspoonful, every  two hours, till  the worm passes off.
If it should  not, castor oil is to be taken with it, or to be administer-
ed in clysters.   These remedies should  be  proportioned to the age
and constitution, and under the eye of  a  physician.   The goodness
of the fern is said to be  an important matter, viz. the root of the
polypodium felix  mas, which  when  reduced to powder, is of a red-
dish colour.   (Saltsburg Medical Chirurgical Gazette, in German,
No. 39.)*
  Dr. James Sims has lately succeeded with the 61. tereb. of which
the patient for another complaint had taken two drachms as a dose:
but, possibly, that disorder might concur with the medicine in expel-
ling the  worm.f
monly employed in decoction; not much accuracy is necessary in the propor-
tion : the rules laid down for the preparation and administration of the spigelia
apply also to this article —Ed.

  * Medical and Physical Journal, No. 26, for April 1801.

  \ There is, I believe, little doubt of the efficacy of the oleum terelinthinae, in
cases of taenia.  To say that it does not always  succeed,  is merely asserting a
truism of which no one doubts, and which might be urged, with equal propriety,
against every  article of the Materia Medica.  I have seen it used in three or four
cases, and each time with the happiest result.  In this country, the article is so
well known, and so  generally employed, that it is unnecessary for me to make
any farther observations upon it;  and I will only add, that the dose to an adult
may be increased much beyond the quantity here mentioned, with perfect safety
to our patient.—En. 
Convulsions-
   CosvuLsioAb, it has been said, may be induced bv the last men-
tioned, and  several of the preceding complaints.  They are of two
kinds; the symptomatic, and the idiopathic; though the distinction
may not, perhaps, be perfectly philosophical, or accurate.   It is for
want of some such discrimination, however, that writers have had oc-
casion to observe, that children are much  oftener supposed to die of
convulsions than they really do; for though a convulsion  frequently
closes the scene,  it has generally arisen from the great irritability of
their nerves, and violence  of the disease  under which  they  have
laboured.   On the other hand, should it be granted,  that the con-
vulsions of children are generally symptomatic,  infants may, never-
theless, be said to die of them  more frequently than certain authors
have allowed; for where a disease is disposed to produce some vio-
lent convulsion,  that, though a mere symptom, may carry off the
patient: and as it may sometimes be  prevented or removed, by  its
proper remedies,  (the disease which occasioned it being at the same
time properly treated,) infants  may often be recovered, who would
otherwise expire in a convulsion-fit.
   Such original cause may  be  a rash improperly repelled;  but the
source of fits is much oftener seated in the gums, in the time of
teething; or in the first passages, where some undigested  matter, or
merely pent-up wind, irritates the coats of the intestines, and  pro-
duces irregular motions throughout the whole nervous system.  Zim-
merman* relates,  an instance of this kind, of a child who,  during the
first months of its life, had  frequent  attacks of violent convulsions,
which disappeared entirely upon  the prohibition of meal-pap.   In-
deed, too  much caution can scarcely be  given  on this head, thick
victuals being a very  frequent occasion of convulsions in young chil-
dren.  Many infants  can bear no kind  of thickening in their food;
any sort of bread, rusk, Sic.  disordering their bowels, by occasioning
their contents to turn pastey, and cleave to the coats of the intestines,
whereby,  it has been noticed, a due absorption of the nutricious part
of the aliment is  prevented,  so that children, in the daily habit of
taking sufficient food, are, nevertheless  emaciated.   Weak and ten-
der as they are, they, in this state, require  repeated purges, especially
of castor-oil, with some light cordial on  the intermediate days, and
a total abstinence from farinaceous food.  For such children,  veal-
tea mixed with milk, is amongst the most innocent and  nutricious.
Any offensive load, whether  from  too great a quantity, or bad quality
of the food,  by occasioning a faulty secretion, must act like a poison;
and that the convulsions are  owing to this  cause may often be known
* Acta Societatis Zyrick, vol. 2. 
CONVULSIONS.
73
by the complaints that have preceded them,  such as loathings, cos-
tiveness, purging, pale countenance, large belly, and disturbed sleep.
If the child is two or three years old, any load at tbe stomach may
be more readily discovered; the tongue will be foul, the skin hot, and
>he pulse quick and weak.
   Any  little matter capable of irritating the nervous system, will in-
duce the symptomatic convulsions in some infants, whilst others will
withstand a great deal.  For such habits as  the  former,  the  cold-
bath will be found the best preventive.  Every young infant is, how-
ever, more or less, pre-disposed to this complaint;  and the disposition
continues throughout childhood, in a proportion to the tender age, and
delicacy of the habit.   The younger and  more irritable, therefore, an
infant may be, it will be so much the more liable to the symptomatic
convulsion, especially from any considerable  disturbance in the first
passages, as was mentioned before; particularly the  bad quality, or
over thickness of the breast-milk, or other food; and from frights of
the wet-nurse.   Of this I  remember a remarkable instance in  a pa-
tient  of my own, in whose house a visitor dropped down, suddenly,
dead.   The mother of the child, which was six months old, was ex-
ceedingly alarmed; but her attention being for a  moment called off
by its crying, she incautiously put it  to her  breast.   It was not an
hour afterwards that the infant was seized with a fit, and  lay either
convulsed or comatose, without so much as taking  the breast, for the
space of six and thirty hours;  though it was at length happily  reco-
vered.
   Among the various causes of convulsions, (though equally an  occa-
sion of many other complaints) may be  mentioned  that of foul air,
and want of cleanliness in the dress,  and other accommodations of
infants; against which the lower class of people cannot be  cautioned
too often, or too earnestly.   Such a source of convulsions has been
peculiarly exemplified in a  disorder whose attack being within the
first nine  days  after  birth, has  been denominated the  nine-days
disease.  Readers desirous  of a full account  of it, are referred to a
paper of Dr. Clarke of Dublin, published in the Transactions of the
Royal Irish Academy for the year 1789.
   It is noticed on the present occasion, however, merely to record a
fatal convulsion, induced by mismanagement: it being mentioned by
Dr. Clarke himself, as altogether an endemic in the Dublin lying-in
hospital, where it raged for many years, and carried off some  thou-
sand children.   But it appearing after a while to the Doctor, that the
disorder might probably be entirely owing to bad air,  and want of
cleanliness, he was at great pains to remedy these  local defects; and
thereby prevented those very frequent  attacks of a  disease, which
under the former circumstances, none  of the physicians  had  been
able to cure, in a single instance.   Of the like kind, possibly, was a
somewhat curious case  I lately met with; and which I shall there-
fore state particularly.
j; 
74
CONVULSIONS.
  The infant was seized with fits when scarcely a fortnight old, and
had many severe ones for three days; when becoming more frequent,
I was desired to see it.   The child was suckled by its mother; but
she being very feeble, and having a little fever at the time, her milk
was diminished; which occasioned the  child to be fed with bread vic-
tuals, especially in the  night.  This  I directed to  be changed for
cow's milk and gruel; and in  a, day or two a wet-nurse was taken to
assist the mother in suckling; who, in consequence of getting rest, was
soon able to nourish her infant entirely.
   The child's stools being thick and  pastey, castor-oil,  and after-
wards calomel were given repeatedly; and the fits became less fre-
quent.   In a few days, however, they again became numerous, and
afterwards increased to twenty and thirty in twenty-four hours; and
some of  them very violent.   When the infant  was five weeks old,
the fits became almost constant; so that except  an hour or two at a
time that the child was sleeping, it was seldom five minutes out of a
fit, some of which were long; and from which the infant recovered in
a kind of struggle, as if it were suffocating; but the greater number of
the fits were short and slight.
   Almost every medicine that I have  ever thought useful in fits was
carefully administered for full  five weeks that  I attended statedly
once or more every day; particularly, oil of amber, musk,  and lauda-
num were given very freely;  and seemed at first to be useful, except
that the  latter no otherwise abated the fits than by procuring sleep,
from which, however, the child often awoke in a convulsion. Leeches
at this time were applied to the temples, and a blister in the direction
of the longitudinal sinus.
   Every means appearing to be in vain, all medicine was given up
during the last week of my attendance, except when necessary to ob-
viate costiveness; but the fits continued exactly the same,  and the in-
fant, in a very emaciated state, was expected to expire from one hour
to another.
   The curious part  of this case is, that when  the child  was  eight
Weeks old, it was taken two or three miles into the country, at a time
that its fits were almost constant.  It left town in the evening, and
had many fits the ensuing night; but the next day had only two, and
from  this time they ceased entirely,  without  recurring to the use of
any medicine.
   This sudden change, and speedy entire recovery, can  only be at-
tributed, I imagine, to a change of air; which is the more probable,
from the infant being removed from a bad one,  the child's parents
keeping  a liquor-house, the lower parts of which, at least,  had always
a very strong, and disagreeable smell of ardent spirits.  The mother,
however, had borne  other children in  the same house, none of whom
had any kind of fit.  May it not seem probable, that though  such an
unwholesome air might not be  sufficient to induce convulsions in a 
CONVULSIONS.
16
healthy child; yet the habit being once formed, such an atmosphere
might keep it up in a debilitated infant?
   Another peculiarity may be noticed in this place, that in some in-
stances of the severest  convulsions,  one side of the body has been
much more affected than the other;  and from which some  affection
of the head is justly suspected, whether primarily or otherwise; there-
fore, bleeding with leeches, and afterwards the  application of a blis-
ter  to the head  on  the  side most affected,  has  appeared to  be
useful.
   The cure of every kind of convulsion will consist principally  in
removing  the exciting causes, which must, therefore,  be  inquired
into.  If from improper food" and indigestion, a gentle emetic should
be given.   If the  irritation be in the bowels, whatever will carry
down their acrid  contents will cure the convulsions, if administered
in time; and we  ought generally to begin with a  clyster.  If the
stools appear very foul  after common purges, (in which case there
will frequently be some difficulty of breathing,) a few  grains of the
pulv.  e scammon.  cum calomel, may be given with great propriety.
But if the  disposition to convulsions  continues, after the bowels have
been  properly cleansed, and no new irritation  of them may be ap-
prehended, antispasmodics should be administered;* such as tinctura
fuliginis, castor, spir.  cornu cervi, ol. succini rectif. a drop or two of
tinct.  opii, or hyosciami, or of olei rutae; which, though an obsolete
medicine, is a very excellent one; as likewise, in  some instances, is
the aq. kali, as advised by Dr. Hargens of Kiel:  but to begin with
such remedies as is  sometimes done, is  as hazardous as empyrical.
The  continuance of the convulsion  here treated  of, frequently de-
pends on the  debilitated state, or tender age of the infant.   The  oil
seems to act by invigorating and  restoring a due tone to the  alimen-
tary canal, the grand spring of good health.  A remedy  less common
than  those above mentioned, but in some instances given  with the
best effect, is zincum vitriolatum purific.   This  administered  in a
proper dose, usually acts as an emetic, and if it should,  must be con-
tinued afterwards in  smaller doses.   Dr.  Cooke  very  strongly re-
commends a mixture with  spermaceti and ol. anisi, and perhaps such
a  medicine, from its sheathing and warm carminative qualities, may
be as proper as  many other; though  the style  of the author is not

   * I speak from my own experience of the efficacy of such reme* 2s ^jand it
may not be amiss to observe, that Harris,  who is extremely  caution ; *1 giving
heating medicines to infants, speaks favourably of some of these.  " Usus horum
(says he) haud prosus improbandus est, vel in tenellis:  nempe quia acidum ab-
sorbendi facultate excellunt.  Verum summa cautione,"  &c.----Great caution is
certainly necessary in  regard to  every medicine prescribed for infants, and
especially, it has been granted, for those of a heating quality: nevertheless, it
may be repeated, that in proportion as the disorders of infants shall become more
attended to,  I doubt not, it will appear that, in this country at least, cordial and
volatile medicines are frequently both  more expedient  and useful, than many
people have imagined. 
76
CONVULSIONS.
likely to  recommend his  prescriptions very  strongly in the present
day*  Rubbing the spine, the ribs, palms of the hands, and soles of
the feet with oleum succini, or the aqua ammoniae, has likewise had
a good effect;  as well as frictions over the whole body; which, from
the consent  of parts, seems  to  afford more benefit than might be
imagined.   A very common cause of recurring convulsions has been
■said to be worms; and where no other  propable one  may  appear,
ought to be suspected: the cure will then depend on the proper treat-
ment of that complaint, the  symptoms of which have  been already
sufficiently pointed out.
   Should the  convulsions arise from the disappearance of a rash, or
of a discharge behind the  ears,  the warm bath,  blisters,!  gentle
purges, or a few drops of the spiritus ammoniae comp. joined with
sal succini,  have  been already  mentioned as the proper remedies.
But  when the cause is  unknown, as the  approach of small-pox,
measles, or other  eruptive complaint, bathing the feet  in warm  wa-
ter, and throwing up a clyster, are the safest means.   If from teeth-
ing,  after gentle  evacuations and other  means directed under that
head, blisters, oleum rutae, laudanum, or the spiritus ajtheris vitriolici
 comp. and  especially  lancing  the gums, are the  grand remedies.
 And in a view to the latter,  it may not be improper in this place, to
 anticipate some of the directions for doing this little, and most salu-
tary operation,^ more effectually  than it usually is;  especially in the
 case of convulsions.   It is pretty well known, indeed,  that  it is not
 sufficient to cut down boldly to the tooth,  and liberate it in every
 part; nor merely to free all such teeth  as  are manifestly  making
 their way; but that others also must not be overlooked, wdiich, though
 less  evidently, have oftentimes  a share  in  the  mischief.   But that
 which I  would here also insist  upon is, to repeat the  operation fre-
 quently, till either the teeth make their way, or the convulsions dis-
 appear.   And as no harm can arise from  the repetition, I wish to en-
 force the idea very  strongly in  every instance, where teething is re-
 garded as the  cause of convulsions: a perfect cure of  very obstinate

   * After having looked into almost every work that has fallen in my way, on
 the subject of infantile diseases,  I did not  expect to meet with any thing of so
 late a date as 1769, that could reflect any such disgrace on the practice of physic,
 as the very anile performance of this writer.
   ■f Blisters may be dressed with the common white cerate, rubbed down till it
 becomes smooth, and spread upon a double linen cloth, instead of the hard plas-
 ters commonly made use of, which are very harsh to the tender excoriated sur-
 face.  Blisters will sometimes inflame, or be for many weeks indisposed to heal
 up, in children as well as in adults ;  in either of these cases,  covering the part
 with a collard or other soft cabbage leaf, (with the  hard fibres  on the back part
 cut off, and gently bruised with a kitchen rolling pin,) will often remove the in-
 flammation sooner than any other application.   Dusting the surface afterwards
 with very finely levigated powder of lapis calaminarts will frequently dispose the
 ill-conditioned ulcer to heal.
i See the chapter on Teething. 
CONVULSIONS
77
fits being sometimes effected by lancing the gums for even five or six
days successively.   The obvious reason of this direction is, that the
divided parts  often tumify, or heal up again, and give rise to suf-
ficient irritation, in certain habits, to keep up convulsions, which, on
the other hand, yield upon securing the nervous parts from fresh irri-
tation occasioned  by the continued protrusion of the teeth.  In this
view it will sometimes be proper to lance the gum across, as  for the
double teeth, as suggested by  Mr. Ware in the case of ophthalmy
occasioned by difficult dentition.
   When repeated convulsions, connected with some disorder in the
first  passages, and recurring for  several months,  withstand  all the
above means of cure, and are suspected to  arise from some fault in
the brain, they will sometimes disappear of themselves as the infant
gets older.  At other times, the appearance of some other complaint
has  put an  end to the convulsions: and not  unfrequently, changing
the  wet nurse;  and sometimes even weaning children  when six or
 eight months old,  has evidently removed the complaint.  I remem-
 ber a remarkable instance of the concurrence of these circumstances;
 the  child being seized with the small pox, and weaned at or near the
 same time.   The infant,  previously to this, for several months toge-
 ther, as constantly fell into violent convulsions as it chanced to chew
 a crust of bread, eat a bit of plain pudding, or even take bread and
 milk;  and though when debarred from these, and  nourished only  at
 the breast of a healthy nurse, the  fits  recurred every two  or three
 weeks: but after going through the small pox in a favourable man-
 ner, and being taken wholly from the breast, the fits soon disappear-
 ed, and the child  was able to take  all  the light food usually given to
 infants.
    If convulsions come on without any of the preceding symptoms, they
 have generally been concluded to be  a primary disease, and  to pro-
 ceed immediately from the brain.   Some derivation from the head is
 therefore to be attempted, by bleeding with  the lancet, if the child
 seems able to bear  it;  or by leeches behind the ears, on the temples,
 or inside of the arms; by blisters; purging;  bathing the feet in warm
 water; frictions of the legs,  and rubbing the soles of the feet with
 aqua ammoniae.  If children of two or three years old are subject to
 slight and frequent fits, issues or setons should be made between the
 shoulders, or in the neck, and be kept open for a length of time: and
 in  weakly children chalybeate waters may be useful.
    The idiopathic convulsion, if not removed in a few days,  is that
 from  which  future bad  consequences may sometimes be  expected,
 being followed by a temporary loss  either of the sight, or hearing,
 and sometimes of  the intellects.   If the former, it is attended with
 an  unmeaning countenance, and  a constant stare and motion of the
 eyes.  If water  in the head be not particularly suspected, and the
 common nervous medicines, with  purges and blisters,  have had  no
 good effect,  bleeding with leeches, and repeated emetic? should  be 
78
CONVULSIONS.
had recourse to; and if the bowels continue in  a good state, the aqua
kali, ppt. as a diuretic, may be made trial of.
  Such are the usual remedies to which recourse has been had for the
idiopathic convulsion; but of late years I have  been led to make trial
of musk; and from no small success, think I am warranted in strong-
ly recommending it to the notice of physicians.   And I am the  rather
led to this, because I conceive it to have been long out of repute as a
remedy for children, and probably one that has never had a proper
trial in their nervous affections; as in that case, we should expect it
would have been noticed more particularly by the older writers.*
  In some of the worst cases, however, of long continued convulsions
and fits, apparently  truly epileptic, not to be attributed  to the  usual
causes of infantile irritation; as well as  where all the customary re-
medies have been previously and unsuccessfully tried, a free exhibi-
tion  of  musk has  restored children  to  health.   And this  not only
where the  long continuance of the fits  has led good physicians to pro-
nounce them idiopathic; but where the convulsions have  also induced
total blindness, or otherwise deranged the faculties for several months.
At least, I may assert, that an immediate abatement of the fits has
followed the exhibition of this medicine, and in the end, the removal
of all its ill consequences.
   But when the idiopathic convulsion attacks very young  children,
it generally terminates very soon, sometimes, indeed, instantly; and
in many is fatal before any means can be made use of; especially in
the case of hydrocephalus.   I have,  however, often imagined, that
we are frequently mistaken in regard  to such  hasty deaths,  and that
when convulsions prove so suddenly fatal, they are more commonly
symptomatic, and are occasioned  much  oftener than is suspected by
over-feeding.  I have known some of the largest and finest  infants I
have ever  seen, die suddenly in  the  month,  immediately after the
nurse  had  boasted  of their having  eaten three  boats-full of vic-
tuals.
   In this view of the disease, a few words more may not be wholly
unnecessary, especially as they will hold out much comfort in regard
to this alarming complaint; by which I  am, however, assured, many
infants have perished merely from its  not being properly distinguish-
ed.   For though, indeed, all convulsion-fits are in their appearance
exceedingly alarming, yet under proper treatment they are much less
frequently fatal than is commonly imagined, however often they may

  * It is not mv intention, however, to assert that musk has, at no time, been fre-
quently administered in these cases; though it is probable not very lately.  I am
not ignorant  that many valuable medicines have been long neglected, in favour
of others of the same class, and  been taken up again at a future age.   Practi-
tioners, nevertheless, ought to state what has been their own experience of any
medicine, in preference to others, after a fair trial of several, in particular com-
plaints  Dr. W. Heberden, however, though he acknowledges this drug to be
frequently useful, conceives I have extolled it too much ; but if I have spoken
from personal experience, it is hoped I may be justified in stating it. 
CONVULSIONS.                        79
recur,* neither is the frequency of their returns during infancy, nor
the long continuance of such a disposition, an indication of future
evils, if the fits themselves be of the kind here supposed.!   But
though  experience  warrants my speaking with confidence on  this
head, with a view to prevent any unnecessary distress, yet would  I,
by no means, put the practitioner off his guard; since the recovery,  in
many cases, depends so entirely upon an  expeditious use of the re-
medy, that even the  time lost in sending abroad for a remedy may be
fatal to the infant.
   Fits of this kind are, indeed, pretty generally known to arise from
irritating matter confined in the first  passages,  as  has been already
explained; but I believe it  is not so generally understood, how often
such matters are lodged in  the stomach, (perhaps the pylorus itself;)
or very low down in the rectum.  Instances of the latter are not want-
ing, wherein the hardened  feces  have lain so low as to  dilate the
sphincter ani sufficiently to expose them to view, and yet the infant
been dead before a clyster could be procured from a neighbouring
 apothecary's;  whereas  such fits cease immediately after a plentiful
 evacuation from the bowels, artificially induced: so also I have seen
 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 spontaneous discharge of thick feces.   In
 like manner, sudden death has taken place when  the load has been
 in the stomach; whilst other children  have been  saved by sponta-
 neously throwing it up.  Whether in  the former case, the noxious
 irritation be in the  rectum, which may, possibly, be doubted; or from
 the  obstruction there,  acrid  matter  be confined higher up,  is  not
 of any  particular  importance; the confined feces below,  and their
 timely removal being alike, the certain occasion, and remedy of the
 evil.
    After what has been said, it would be scarcely  necessary to point
 out  the  remedies in a formal way, but for the sake of directing  the
 most expeditious manner  of  applying them.  In the first instance,
 doubtless,  the obvious  means are a soap clyster with two or more
 tea spoonfuls of salt, (such articles being always at hand)  and after-
 wards administering one  or  other of  the  purges  formerly directed;
 which  it may often be  necessary to  repeat for  some  days, per-
 haps with  an interval between.  But when  an  infant falls sud-
 denly into a  convulsion very soon after  sucking,  or feeding, espe-
 cially if on  any  thing  actually  improper, and  the bowels have

    • The account in the yearly bills of mortality is especially erroneous in regard
 to this complaint, and has perhaps added to the alarm which the appearance of
 a convulsion universally occasions.
    ■J-The above observation is, I believe, strictly true in regard to such kind of
  fits ; and though in some others, as hinted before, the intellects have appeared
  afterwards to be impaired, yet are the instances so very few, that there is, upon
 the whole, little room for alarm in the apprehension of such consequences. 
80
CONVUL&IONs.
 been for some days in an orderly  state, it  may reasonably be pre-
 sumed, that the irritation is in the stomach, especially if there be an
 unusual paleness of the countenance, indicating sickness;  or on the
 contrary, any considerable blackness, with  symptoms of suffocation;
 which I think do not come on so soon when the obstruction is  in the
 bowels.  And it should here he remarked, that it is not necessary,
 that the load ip the stomach  should be considerable in quantity in
 order to induce such sudden and alarming convulsions; it is  sufficient
 that the stomach be really oppressed by it to a certain degree; nor
 does it always appear to arise so much from an oppressive abundance,
 as from a small piece of undigested food, irritating, and perhaps con
 fined, as has been said, in  the pylorus.
   In the case here described it would be improper to think of a for-
 mal emetic, at least without making trial of some more expeditious
 means, such  as irritating the  pharynx with  the finger, or a feather,
 or forcing in the smoke of  tobacco,* if that be at hand; (the latter of
 which should,  however, be cautiously done;)  either  of which often
 instantly produces vomiting, and puts an end to the fit.  To this end,
 the child should be supported by a hand, placed under  its stomach
 and belly, whilst the  feather or other means  are made use of;  in
 which position the infant will be  made  to vomit more readily, and
 with less straining, than in any other.   It is hoped, that the import-
 ance of the subject, as well as the very frequent success attending the
 plans last recommended, under  the most alarming appearances, may
 be thought an apology for  the length of this chapter, as well as the
 sort of repetitions made use of.
   It is  further to be noted, that symptomatic convulsions are some-
 times the effect of a salutary effort of nature, to produce a crisis in
 some disease the child labours  under, in which case, great caution
 should be used not to be  over  officious:f bathing the feet in warm
 water,  however, as mentioned before,  will be perfectly  safe, and

   * If there is any truth in analogical reasoning, the employment of the remedy
 here advised would be attended with  much hazard.  In the most violent diseases
 of adults, the remedy is employed with a cautious, not to say, a fearful hand.
 How much more deleterious it would prove to  the irritable system of the tender
 infant, it is not difficult to surmise.—En.
  f Some qualification seems requisite to render this sentence perspicuous; for
myjown part, I am not able to conceive of a case, in which our endeavours to put
an end to the convulsions could be considered as  ill-timed officiousness.  In
 the treatment of convulsions, the chief object is to remove the exciting cause,
and to this end all of our remedies should be directed.   If they appear to origi-
nate from the improper quantity or quality of the food, an emetic is our best re-
medy ; if from  the acrid contents of  the alimentary canal, a few grains of rhu-
barb and magnesia may be prescribed.  If wind is the exciting cause, carmina-
tives may be used with advantage: if they occur during dentition, free incisions
should be made down to the teeth   The lancet should never be spared when
there appears any particular determination to the head.  In conclusion we may
observe, that in most cases it will be adviseable to adminisier an active purgative,
and this should be succeeded by an anodyne injection.—Ed. 
PARALYSIS.
81
 perhaps useful.  Having spoken of opiates, I shall just observe, that
 though they are often very serviceable, when judiciously prescribed,
 they become very hurtful if improperly administered.  They will,
 however, always be safe, where convulsions continue after the first
 exciting cause has been removed;  or where  they are s^o violent as to
 become an obstacle to administering proper remedies; or when  the
 original complaint is of a spasmodic nature;  and, perhaps, particular-
 ly where the hands are  constantly clinched, and the thumbs  drawn
  down, in which  case, (after properly clearing the primae viae,) in-
  fants will often be  benefited by large and.  repeated  doses.  When   x
  arising from debility and languor,-the  tinct. valer. volat. adminis-
  tered  in  some  generous white-wine,  has  been found  a success-
  ful  remedy.  Amongst  the  later  remedies,  fixed  alkalis, particu-
  larly the sal  tartari, and aqua kali ppt. have  been recommended
  by Dr. Stut, and sometimes the volatile alkali,  and it should seem
  with success.
    When convulsions occur many times in a day, it is of importance
*  to attend to the distance of the paroxysms;  from which a much  bet-
  ter indication may be had of their immediate danger, than from the
  forcible contraction of the  muscles  during the fit.   For, where the
  intervals are short, though  the  fit  itself be not long,  nor  violent,
  the  disease  is  more  dangerous than  where  severe  paroxysms
  are attended with long intervals.   The curious case related, at  p.
  73,ms, indeed, an exception to this  general rule; and there  may be
  others.
                      Paralysis, or Palsy.

  The Palsy, as being an affection of the nervous system; and after-
wards other spasmodic complaints, may be considered in this place.
Paralysis, indeed, is a more common disorder in infants, and young
children than writers  seem to have  imagined; being confined to  no
age  (having been seen as early as the third day after birth,) and  at-
tacking children  in very  different degrees, in  the  manner it does
adult persons.  It,  accordingly,  sometimes  seizes  the  upper,  and
sometimes the lower  extremities; in some instances, it takes away
the entire use of the limbs it has attacked, and in others, only weak-
ens  them.  Sometimes the speech  is very  much  affected, and at
others not  at all;  the intellect is also  greatly impaired  in  some
instances, and in others  is only torpid; for though children may
be  dull  and heavy, like other paralytics,  yet when roused, their
imagination  is found  to  be fully awake to the  common objects
around them.                                 .          .     .
   The palsy more commonly appears in the form of hemiphlegia;
but if it be neither fatal, nor soon cured, it is often found to steal  mi-
L 
82
PARALYSIS.
 perceptibly upon the other side of the body.   In one instance, I was
 witness to the paralytic affection quitting one  side to seize the other,
 only two days before the child died.
   In  any case, the treatment of palsy is  much  the same in young
 subjects as in adults; and being usually attended with costiveness,
 calls for brisk purges in the first instance, and a repetition of open-
 ing  medicines throughout  the course of the complaint.   And, indeed,
 if cathartics and blisters do not soon afford relief, the disorder  usually
 becomes chronical,  and the child sinks gradually in the course of a
 few months, or drags on a  miserable life for ten or twelve years, with
 more or less  debility of the arms or legs; but very rarely arrives at
 manhood.  Indeed, the causes of palsy, particularly in young people,
 who are still  growing, are so numerous, and are often  so entirely out
 of the reach of art, as well from  their nature, as  their seat; being fre-
 quently in the nerves themselves,  or the brain, that such  an event
 cannot be wondered at.
   But where  no  morbid  change of parts has taken place, perhaps
 infants and young children  are perfectly  cured  than  those more
 advanced in  years,  by the  mere  exhibition  of two or three brisk
 purges, whereof calomel  often  forms a necessary part,  as the palsy
 frequently originates from foul matters in the  first  passage?.*   After
 purging,  blisters should be applied, and if  no  fever attends, nervous
 medicines be  administered,  such as valerian,  castor, ammonia prae-
 parata, and the spiritus aetheris vitriolici compositus.   In some in-
 stances, the bark and steel  have proved useful;  or frictions with
 flannel and aromatics, or ether,  and the use of the wathers at Bath;
 and  as frequently as any other  mean, electricity, especially, if instead
 of giving shocks, the electric aura only be  applied, or sparks  drawn
 from the body seated in the insulating chair.  If the head should be
 much  affected,  a small blister, or leeches applied to the temples may
 be-proper, in  certain habits.
  When the palsy becomes chronical, more general remedies will be
 called for, according to the particular symptoms that may occur; but
 more commonly, remedies  of the warmer class.
  The palsy is  sometimes occasioned or succeeded by water in the
head;  and in  the  former  case, the sutures  of the skull being gene-
rally still open, and allowing  of distension, the symptoms of com-
pressed brain  will not appear so  soon as they otherwise would.
  In the suspicion of hydrocephalus,  mercury,  and  diuretic medi-
cines may be  made use of: though it is to be feared,  with but little
prospect of success, when the original disease has proceeded thus
far.
  * The plan of treatment here detailed, is very similar to that adopted by the
best practitioners in the United States.  It is only requisite for me to make one
farther observation, which is, that in addition to cathartics and blisters, we use
the lancet without  hesitation, wherever circumstances seem to demand it.—Ed 
SKINBOUND.
83
   I  have  noticed  a few instances of a partial paralysis of one,
or all the  extremities;  but this has always given way very soon.
Besides teediing  infants, whom  it has  been  said  to attack,  I
have  seen  it  in  others  who are older,  and  the finest children,
and  is  then generally attended  with  a foul  state of  the bowels.
In any case,  the  only  remedies I have  found necessary, have
been calomel or some other purgative; sometimes an emetic; aro-
matics  and bitters; and  volatile  embrocation  to the limbs.   Elec-
tricity,  I am told, has been advised in one instance; and if the com-
plaint should not otherwise yield, may as properly be had recourse to
in this, as  the former instances.   If these  means should fail, the
whole course of the spine should  be carefully examined, and  if any
curvature be discovered,  recourse must be had to one or  other of the
means recommended for the paralysis of the lower extremities:  and
it may be  remarked here,  that  the seat of the disease,  having
been high up in the  neck, close to the head, has sometimes been over-
looked.


                            Skinbound.

   Tins being a spasmoding affection, and  sometimes  attended with
the tetanus, may be here noticed, as introductory to that convulsion.
It is a disorder but little known either to the ancient or modern wri-
ters, (and has been less understood;) being only twice publicly no-
ticed, that I know of, until  a few years ago.   The one at the be-
ginning of  the last  century, in a still born infant, in the hospital at
Stockholm, and the other about forty years ago, in a Neapolitan  girl
of seventeen years of age, in the  royal hospital at Naples; the suc-
cessful  treatment of whom,  I think, may throw some light on this
disease, hitherto so  little known.   The  former is accurately describ-
ed by Uzenbesius,  and recorded in Scuringii, Embrologia (de foetu
frigido  et  rigido,*) but without  adverting at  all  to  its treatment.
The  case, as I since find, is transcribed into the Ephemerid. Academ.
Naturae Curiosor. Cent. ix.
   The  above is related in a manner importing it to be  an uncommon
occurrence, and the disease at that time  little, if at all known:  and
though  recorded in  two distinct works, (the latter of which is  rather
consulted than regularly perused) the case  seems to have been gene-
rally overlooked, and consequently the true nature  of the disease re-
mained nearly in its  original obscurity. It was,, indeed, not till a twelve-
month  after my short account of it appeared, that this disorder began to
engage the  attention of the French physicians, in consequence of Mon-
sieur Andrij being called upon to take the charge of the Hospice des

  * The midwife is reported  to have said, that this infant, though born alive,
felt as intensely cold and rigid when it came into the world as a piece of ice.
How this might bef I leave to the Academy of the Curious to determine. 
84
SKINBOUND.
 Enfans trouves at Paris.  The disease, indeed, had  been often seen
 both in that hospital and the Hotel Dieu, but having always proved
 fatal, little  attention had been for a long time  paid to  it, till Dr.
 Andrij was elected physician to  the  first mentioned charity;  since
 which time, no pains seem  to have been spared in  the investigation
 of it:  and the subject having since been taken up by the Royal So-
 ciety of Medicine, it is hoped additional light will be thrown upon
 it, if the distracted state of affairs in that kingdom can admit of the
 calm consideration of such subjects.
   That the present account of the disease may be  clearly stated,  I
 shall first consider it as it has appeared  in this country, in the man-
 ner I had long ago intended, and had actually drawn up before  I was
 favoured with some further description of it, by Dr. Andrij.
   It has, indeed, been  much less common in this kingdom than on
, the  continent, but is equally an  hospital disease, and seldom met
 with but accompanied  with  some bowel complaint, and  still  more
 rarely appearing at the birth.  It was  first spoken of in public, I be-
 lieve, by my friend Dr. Denman, when a teacher in midwifery, and
 physician to the Middlesex  hospital;  whose unwearied attention to
 it there, though not with all the desired effect, does him more honour
 than could have  been derived  from  the  most successful treatment
 of a disease less fatal than this has  proved, wherever  it has ap-
 peared.
   The British Lying-in-Hospital has  been very little infested with
 it, and, possibly, by being solely appropriated to the reception of preg-
 nant women, which the Middlesex is not;  the air of which may on
 that account be less pure and salutary.

   " The following symptoms (Dr. Denman observes) have been con-
 sidered as pathognomonic, or characteristic of the disease.

   1st. The skin is always of a yellowish white colour, giving the idea
 of soft wax.
   2d. The feel of the  skin  and  flesh  is hard and resisting, but not
 edematose.*
   3d. The cellular membrane is fixed  in such a manner that the
 skin will not slide over the subjacent muscles; not even on the back
 of the hands, where it is usually very loose and pliable.
   4th. This stricture often extends  over the  whole body; but the
 skin is peculiarly rigid  in the parts about the face, and on the extre-
 mities.
   5th. The child is always cold.
   6th. The infant makes a peculiar kind of moaning noise, which is
 often very feeble;  and never  cries like  other children.

  * To me the appearance and feel of the skin have  exactly resembled that of
a person who  has died during a very hard frost. 
SKINBOUND.
85
  7th. Whatever number of days such children may survive, they
always have the appearance of being dying."

  This disorder commences at no regular  period, unless where it
appears as an original disease, and in that case more commonly with-
in the first ten days after birth: a  few children,  it has been  said,
have been born with it,  and such have never survived many days.
Whenever it takes place- it attacks several  infants within a  short
time;  and chiefly those who may be in the last stage of obstinate
bowel complaints, in which the stools are of a waxey or clayey con-
sistence.
   I have seen the rigidity extending beyond the  cellular membrane,
so as  to affect the muscles,  but only those of the lower jaw, which
became perfectly rigid: but this spasm or tetanus does  not seem  to
be a frequent symptom, nor do convulsions extend to the extremities,
as they are found  to do in France;  nor have I discovered any extra-
vasation in the cellular  membrane after  death, reported to be con-
stantly met with  in that country.   Moreover, in  no instance, that I
have  heard of,  has  the disease  been attended with erysipelatous af-
fections uniformly noticed there.
   The cause of this dreadful  complaint,  when  either  congenite  or
evidently supervenient to disorders of the  first passages, seems to me
to be  a spasm depending very much upon a certain morbid  state of
those parts, and with which the skin is well known to have a pecu-
liar sympathy.   But when, though  an  original disease, it does  not
take place till some days after birth, which, I believe, is rarely the
case  except in large hospitals, and other crowded apartments;  the
irritating cause,  in such instances,.is probably seated in the seba-
ceous glands, and the disease seems to be an endemic of certain sea-
sons, arising from that unwholesome air to which such places are pe-
culiarly liable.
   The means of cure in this country, (where,  it has been said, the
disorder is more simple,) have been different from those that have
lately been found successful in France;  but instances df recovery
have  been very few in either.  When the disorder was first noticed,
its treatment was confined to a strict attention  to the  state  of the
bowels, and rendering the  several medicines very warm by means of
of the compound  spirit of ammonia, which  was  administered every
 four  or six hours; and was the only plan  attended with  any suc-
cess.  Together with this, I after some time directed the frequent
 use of a  warm bath, and  chafing the whole body afterwards with
 warm flannel;  means which have since appeared to have been at-
tended with the first instances  of success in France, as will be no-
ticed  below.
   As the  disease raging so much in France differs in many respects
 from ours, it is very doubtful how far the plan of cure adoped there
 maybe  applicable in this country, and my own experience  has 
8G
SKINBOUND.
hitherto not gone beyond the means I have mentioned:  but  I  would
venture to suggest, that in many cases, trial might be safely and pro-
perly made not only of carminative clysters, but also of a grain  of
calomel previous to the infant being put into a vapour bath; and af-
ter a sufficient number of stools shall have been  procured by these
means, exhibiting other  volatile  and cordial remedies beside  the
spirit of ammonia; as well as antispasmodics of different kinds.
   After the  description given of this disorder as it appears in Lon-
don, little more will be necessary, I apprehend, than to select the cir-
cumstances in which it has been noticed,  that in  France is found to
differ.
   It has already been  said, that it is more frequently attended with
tetanus, and never occurs without those appearances mentioned  un-
der the article Erysipelas infantile, especially the redness and hard-
ness about the pubes,  accompanied further with tumour and redness
of the soles of the feet.   But these parts, it  seems, though of a pur-
ple  red,  are  intensely cold;  very rarely suppurate; but  sometimes
mortify.*  In one very late instance, however, the  infant was hot
cold,f but on the contrary, exceedingly hot.   The  legs, thighs, and
soles of the feet were red and  hard; but no mention being made of
a general  tightness  of the  skin, it is probable  that this child  was
affected only  with the infantile erysipelas which appears amongst us.
   Besides the above variations, the infants are said to swallow with
extreme pain;  the extremities, especially the legs, are much enlarg-
ed, and attended  with a serous effusion  of the cellular membrane,
which we have not hitherto noticed:  and the disorder is said to rage
most in the hotter months.   One instance, however, of difficulty of
swallowing,  fell  under my notice;  the  child at least, refused  the
breast, and  swallowed unwillingly wdiatever was offered  it:  but
this  infant scarcely survived the attack fifteen hours.   In France, it
is further observed, that the infants die about the third or fourth day,
or at furthest, on the seventh from the birth.   It is probable, there is
another and very material variation, in respect to the degree of stric-
ture and intmobility of the  skin, which is not clearly expressed to be
either so  considerable  or extensive, as in  the  disease I have been de-
scribing;  but is more  confined to those parts which become red and
tumid.    But  in the instance recorded by Scruringius, it was  clearly
otherwise, the infant being said to feel from head to foot, like  a piece
of flesh dried in  the smoke.   This child survived a complete day,


   *  This is said to be the case in four or five children out of twenty, all of whom
are found to die in a few hours after the gangrene has taken place ; and become
so putrid,  that by the next day, the skin separates from every part of the body
so as to adhere to the hands of those who have occasion to touch tbem.
   |  One instance of this  kind also occurred at the British  Lyingin.IIospital;
and  in this case there  was likewise tumour, hardness, and redness about the
pubes, and different parts of the extremities. 
SKINBOUND.
87
during which time it took no sort of nourishment, and never cried,
nor made any kind of noise.
  Upon examining a great number of dead bodies at the Enfans Trou-
ves,the serous extravasation is constantly met with; is of a deep yellow
colour and fluid, but coagulates with heat; the fat is peculiarly solid;
the glands and lymphatics,  especially those of the mesentery, are
found stuffed, and the liver uncommonly large, with  a great quantity
of deep-coloured bile in the gall bladder;  and the  lungs  are said to
be loaded  with blood, as well as to contain an unusual quantity of
 air.
   The supposed  cause of this disease amongst them seems to me but
 ill  accounted  for; the complaint being attributed to the improper
 diet of the mother or her infant; or to cold it has taken at the birth:
 whereas the  coldness and rigidity of the skin seem to be but  mere
 symptoms, and  not the disease;, especially as the im children, like
 ours, are but rarely attacked from the birth.   The disease appears
 to  be a true endemic, arising from foul air, especially as  it is found
 only to attack the poor,  and particularly to infest the  two large hos-
 pitals that are crowded above all others, and receive the  lowest and
 most wretched part of them; of whose new born children, it is sup-
 posed, one out of twenty is visited with this disease.
   It has been hinted, that for a long while, little attention was paid to
 this complaint, on account of its constant fatality, six hundred infants
 sinking  under it every year, in a single hospital; about four hundred
 of which  are born in the Hotel Dieu.
   But since Dr. Andrij's election to the Hospice des Enfans trouves,
 various means have been attempted both by himself and his colleague,
 Mr. Auvety; and amongst other means, the warm, bath, which ap-
 pears to have saved the first child that was known to recover.  Trial
 has since bean made of blisters  to the extremities, which succeeded
 also in the very first instance, as well as since  in several others;  so
 that, in the last year, they are reported to have saved five infants out
 of every hundred, more than in the preceding one.
    Monsieur Souville, surgeon to the Military Hospital at Calais, has
 also given some account of this disease in the  Journal de Medicine,
 under the name of iEdematie Concrete, and observes, that it is  a very
 common disorder in the  provinces, as well as  in Paris.   Under his
 direction, likewise, a warm, or rather vapour bath, succeeded  in the
 only instance wherein he had made trial of it.
    And this part of the treatment  agrees with the account  of the
 Neapolitan  girl  to which I  have alluded, as well  as with the result
 of our further experience at the British Lying-in-Hospital; where the
 warm bath, in one instance, however, was thought to hasten the death
 of the infant.
    The former was  read before the Royal Society,  May 16, 1754,
  The disease was in this young woman exceedingly severe, the skin be-
  in<;so veVy  rigid over the whole body,  from  head to foot, that she 
88
TETAM'S.
could scarcely move her eyelids, or open her mouth; nor could she
move any of her limbs without pain, as well as difficulty, though the
rigidity was evidently in the skin and  adipose membrane, and not in
the muscles.
   It may be sufficient to say, that the  patient recovered, but not
under a twelvemonth.   The means had recourse to were the warm,
and vapour bath, mercury, sarsaparilla, and friction of the skin.
   The warm bath, gave her so great pain (as it was supposed, from
the weight of the  fluid) that after a few trials, she fell into convul-
sions through her dread of it, as they were about to put her into it.
But the warm vapour very soon afforded relief by relaxing the skin,
yet very little, or  no perspiration was produced; nor had she ever
had the least from the commencement of the  disease;  but it was after
the vapour  bath considerably  promoted  by the internal exhibition
of twelve  grains  of quicksilver  every  day, with  a decoction of
sarsaparilla,  assisted by constant  warm air, and frictions of the
limbs.
   How far any part, or the whole of this treatment may be successful
in infants, to whom the complaint seems to  be confined in this coun-
try, experience only can prove; but it is presumed that the means are
worthy of trial.
                     Tetanus, or Locked Jaw.

  The tetanus* of infants is an equally fatal complaint, and in this
country nearly as little known  as the foregoing.   It is either idio-
pathic or symptomatic; which  distinction is of more importance in
hot climates, where the latter is always  found to be incurable.  In
some instances it has been confined to the jaw only, as in Jamaica;
in others, it has been  attended with contraction and rigidity of other
muscles of the face, and a peculiar fixedness of its features.  Some-
times the rigidity has extended to the neck;  and in one instance so
completely over the  whole  body, that the limbs of the infant  could
not be bent so as to place it advantageously in a  vessel, somewhat
too  small,  appropriated to a warm bath.   It has  already been ob-
served, that it is sometimes joined with the foregoing complaint, but
rarely in this country; and even then, the jaw partakes only of that
kind of rigidity  common to other parts.
  In such instances of tetanus as I have met with, the attack has not
been earlier than the sixth,  nor later than the  ninth day from the


  *  This is the species which nosologists have termed trismus maxillae inferi-
oris Rigiditas spastica.  Species Ima. Trismus Nascentium infantes intra duas
primas a nativitate septimanas corripiens.  Vide Cullen. G. Ixlx. 
TETANUS.
89
birth* (excepting one instance, early oil  the tenth,) and as far as I
could learn, the infants had not been  costive, (which Dr. Evans re-
ports to be usually the case  in Jamaica,)  nor apparently unhealthy:
some, I remember, were remarkably strong and lusty children.  It
seems  somewhat to  differ, therefore, from the disease termed jaw-
fallen, in the West  Indies; and  in  one instance appeared to have
some resemblance to the catalepsy.   The rigidity has  stolen on in a
more gradual way in some instances  than in others, but has always
been vecy great as far as it extended, from the moment it has been
discovered;  so that in instances where the mouth has continued suf-
ficiently open to admit my finger, I could not thereby depress the jaw.
In some,  the eyes have  been bloated,  and  the whole countenance-
much swollen.
  The  cause  of  this complaint has been  differently conceived of.
Dr. Evans,  who  has been very  conversant  with it, attributes it to
costiveness, and   thinks  he has greatly prevented  its frequency
amongst the  negro  infants, by purging them  from the birth.  Dr.
Bartram, of Philadelphia,! attributes this fatal disease to a want of
swathing, or proper bandage to new born infants, and to the applica-
tion  of scorched  linen to the navel;  but  his reasoning, to say the
least of it, appears to be  very inconclusive.   It has  also been at-
tributed- to the cord being divided by  instruments not sufficiently
sharp.   But the  cause has at length been clearly ascertained, and
happily its prevention, by Dr. James  Clark,| who, perceiving that
those houses were free from this disease in which there were no
(ires, very soon demonstrated it to be owing to the smoke from burn-
ing wood; the negro houses having no chimneys to carry it off.
  It does  not,  in this country, seem to arise from constipation, or ne-
glect of purging off the meconium, and much less for want of swath-
ing, but is owing (as I have  always stated, and has since  been de-
monstrated,  as above remarked) to  a certain state of the air; and
the more so, as the disease appeared only  once  in the British Lying-
in Hospital, during a great number of years, and then attacked seve-
ral infants in a short time.   It  has appeared again, however, in six
instances, since the above account of it was given in former editions.
In older children,  as in adults, it may arise  from various sources of
irritation,  and  particularly from worms; especially, it is said, from a
certain species of the tcenia.
  The remedies attempted at the hospital were, the warm bath; fo-
mentations to  the rigid parts;  frictions with  oil and camphire, and
Bates's anodyne balsam;  blisters  behind the ears, and" to the nape of

  • In the West  Indies, also, never later than the ninth day.—(Dr. James Clark.)
In France, however, it is said to attack much older children, though rarely after
i wo years of age. Memoire de la Sociele Royale de Medecine,  Ann. 1787, S.
  j- See the Transactions of the College of Physicians at Philadelphia.
  : See his Treatise on  the Yellow Fever, fee. 1?97.
                                M 
90
EPILEPTIC FITS.
the neck;  and asafoetida, opium,  calomel,  the bark, and aromatic
confection,  have been  given  internally.   It remains,  however,  to
make trial  of more  cordial and tonic remedies, as recommended by
physicians  in  North America, where the disease is  more common
than it is here; such are the oleum succini, musk, wine, and the cold
bath; though concerning the latter, writers differ: Dr. Clark assert-
ing that it has in no instance succeeded.*
  One infant, in whom the complaint was confined to the jaw, and
who had less rigidity than any of the others, never looked ill, and had
no convulsions in its limbs, died rather sooner than the rest,  except-
ing the one attacked so  late as the  tenth day, which was a remark-
ably large  and healthy infant:  this child, after being five minutes  in
a tepid bath of salt  and water, fell  into a more profuse sweat than I
had ever noticed in any young infant, and died in a few hours after-
wards, and only twenty-four from the attack.  I have known  only
one child survive the third day, and that was not seized till the ninth
from its birth, and  at the end  of the third  week  seemed to be reco-
vering;  but it had never been able to take the breast after the attack,
and died when six weeks old, though, possibly, not altogether from
this complaint.
                         Epileptic Fits.

  This and some of the following complaints, as well as the two or
three immediately preceding, which relate, some to the more early,
and the others to later periods of childhood, are noticed successively
in this place, on account of their falling under the general class of
convulsions;  and it is presumed less improperly, on the whole, than
ranking them according to their importance, or the different periods
of time in which they might take place.   The state of dentition, as
so materially connected with nervous  affections, will then be con-
sidered, which will  lead to pyrexiae in the different  forms they as-
sume in children.
  In regard to epilepsy, very few words, however, may suffice, as it
is either pretty easily cured, or usually continues  through life; and is
too well known to require a particular description.  An account of
the various precurrent symptoms would be equally  useless.  It may
just be noticed, that the  patient  falls suddenly to the ground,  and
sometimes without any perceptible warning, or at all sufficient to se-

  *  If the disease is idiopathic, we would advise the trial of an enema of tartar
emetic; the quantity used  must of course depend upon  the age of the patient.
For this fact, I am indebted to Dr. Chapman, to whom I believe the  credit is due
of introducing it into practice.  It has proved so efficacious in his hands, that it
is deemed unnecessary to apologize for recommending it to the attention of every
medical man.—Ed. 
EPILEPTIC FITS.
91
  cure him from injury;  and is usually much  convulsed, especially on
  coming out of the fit, but frequently retains his senses the  whole
  time.
     The means of cure must be adapted to the different causes  of the
  complaint.  It sometimes takes its rise merely from foul bowels; and
  certainly more commonly attacks children of a costive habit of body:
  it should then be treated agreeably to the  directions already given in
  such cases, and  especially with active and mercurial purges:  after
  which, the cortex peruv. vitriolum  album, chalybeates, and other
  tonic remedies, may be serviceable; and  especially sea bathing.   In
  other instances, especially in more advanced life, and  towards the
  time of puberty, the epilepsy seems to  be owing rather  to a more
  sensibly nervous irritation.   In such cases, blisters to the back  of the
  neck may  be useful; and I have experienced much benefit from large
  doses of the powder of  valerian,  and  from  opium; and in  one in-
  stance,  from an infusion of savine, fennel  seeds, and juniper berries;
  but I could never entirely conquer the complaint by these means,
  when become chronical: but the  oleum  succini has, in  several in-
  stances, perfected a cure in young subjects; and where that has fail-
  ed, I have succeeded with musk.
    In the worst cases I ever met with, in which the fits  were very long
  and violent, and sometimes to the number of twenty  or thirty  in a
  day,  and the disorder of many years standing, electricity has  very
  soon rendered them  weaker,  reduced their number to three or four
  in a day, and gradually  to one in six weeks; but has not entirely re-
  moved them.  In  such  obstinate  cases, it-is generally supposed that
 the brain is affected by  some local or permanent cause, and a perfect
 cure is consequently despaired of: though  I have known the fits abate
 greatly after having  continued for twenty years, and  the subject of
 them afterwards become the mother of several children.   But  par-
 turition, as well as whatever else may tend to debilitate the system
 I have always found increase the  number of the fits for a certain
 time.
   When this disease has attacked children of five or six years of age
 and where no treatment has  been serviceable,  the complaint has
 very frequently disappeared suddenly about the time of puberty  and
 sometimes a year or two sooner.   Where  it does not,  it will proba-
 bly continue through life, and now and then prove suddenly fatal  as
 I have seen in a late instance.
   Dr. John Wilson of Spalding has  lately strongly recommended
 the internal use of the argentum nitratum, in doses of gr. ij ft  three
 times a day.*  And in the Medical and Chirurgical Journal,'edited

  • So much difference of opinion exists among practitioners, as to the efficacv
of this article, that it is not a little difficult accurately to determine its merits
for while some extol ,t much above its value, others declare it to be totally inert
and useless.   Perhaps truth  will be  found between the two opinions- and Uie
success in some cases, and the failure in others, may depend upon  circumstan- 
95
ST.  VITts's DANCE.
by Professor Hufeland, is an account of a cure effected in a case of
three years standing, by  the cuprum ammoniacum given in the dose
of half a grain a-day, and increased to five grains daily.
   When the patient can foretel  the approach of an attack,  it  has
lately been recommended to exhibit an emetic of blue vitriol as soon
as the patient's feelings announce the  approaching paroxysm.   The
curative powers of the two former of these remedies, however, have
been lately disputed by Dr. J. Magennis of Plymouth.*
   Upon examining  the  brain  after death, I have sometimes found
water in the ventricles, and at others,  a small point of bone as sharp
as a needle  standing out from the internal  part  of the os frontis,
or from  the cella tursica,  (of which Boerhaave  and others  have
recorded several instances,) and was, doubtless, the true cause of the
disease.
            Chorea Sancti Viti, or St.  Vitus''s Dance.

  I shall be very brief also on  this untoward disorder,  which is
equally well known, and though not often fatal, is, like the former, 1
believe, rarely cured but in young subjects.
  Worms, and other foulness of the bowels in  children, are likewise
frequent causes of this strange convulsion; in which different parts,
and especially  the extremities are  put  into  continual   motion,
giving the patient a very awkward appearance, particularly in his
walk.
   If the first passages are  the seat of irritation,  the complaint  must
be  treated in the manner noticed under the preceding article; and,
indeed, in most cases, the cure should be begun by administering
aloetic, or mercurial purges.   But should the  disorder appear  to be
owing rather to relaxation, as it sometimes is,  the cortex peruvianus,
chalybeates, and  other  tonics,  especially the  vitriolum album, and
sea-bathing are  indicated, and are  very frequently successful.  1
have also known it immediately yield to electricity; but in  this  case,
it has been attended with other symptoms of palsy, which have  come
on suddenly.   Electricity, however, has lately been very useful in a
very extraordinary  instance;  but the complaint returning,  yielded
afterwards to a perpetual blister on  the os sacrum, directed by Dr.
 Delarive of the Public Dispensary.   The pilulae cupri were admin-
 istered at the same time, in the dose of gr. ft; but no benefit wasper-


 c£8 with which we are wholly unacquainted.   Among  children, I  have never
 known it used : but to adults, 1 have seen it administered  in  every proportion,
 from one to seventeen grains in twenty.four hours ; in this case, no evident ef-
 fect was produced, and no benefit was derived.—Ed.
            • See Medical and Physical Journal, vol.  iv. No. 21 
              APHONIA SPASMODICA INTERMITTENS.             93

reived till the blister was applied. Dry-cupping has also been thought
useful.
  Dr. Hamilton, in his treatise on the  disorders of infants, observes,
I hat his father, as well as Dr. Parr, of Exeter, adopted the idea of
irritation of the stomach and bowels, long continued, producing this
disorder in its chronic form; and that Dr. Parr has succeeded in fifty-
nine out of sixty cases in the  cure of it, by giving repeated and pow-
erful  purgatives.*
   dphonia Spasmodica Intermittens, or temporary loss of Speech.

  This complaint, when it  occurs  in children,  though it  is not a
common one, takes place  between the  fourth  and seventh year  of
their age;  is only a transient loss of speech, and is a harmless affec-
tion: for though it may recur for a length of time, I believe it never
degenerates into a permanent disease.  It is  rather a difficulty  in
articulating, than a perfect loss of speech; lasts  only for a  few mi-
nutes,  or at most a quarter of an hour, and recurs frequently in the
course of  a day.   It is thought to  be somewhat of the nature of the
chorea sancti viti, and to be occasioned by worms, or other irritation
in the  bowels; and sometimes by teething.
  If neither the irruption of teeth, nor the exhibition of mercurial
purges, and other remedies for worms, should produce a speedy good
effect,  any advantage from other medicines is more doubtful; but the
long use of the cold-bath, or perhaps time only, whereby a child may
acquire more strength, may  be expected to remove the complaint.
It may be proper, however, to make a trial of local applications of a
stimulating kind during the paroxysm, or fit; of which remedies the
most innocent is a lump of sugar  wetted  with lavender drops, and
amongst the stronger, a decoction of the pellitory of Spain, afc a lotion
to the  mouth.   Should these little remedies do  nothing, and the com-
plaint  anywise  increase,  it should seem that electricity may be had
recourse to with safety and propriety; but the  disorder is too  rare-
ly met with to have  furnished the  opportunity of speaking  from
experience.


  * The practice of Dr. Hamilton in  this  disease is, I believe, very generally
adopted, and is deserving of much confidence.  But to place implicit reliance
upon the statement here made of Dr. Parr's success,  requires more credulity
than  I am master of.  It certainly proves too much, and we should ever keen
IfbT"  e   maxim of the lawyer'which says>"Quod probat nimi8' Probat 
95
                     Incubus,  or J\T,ghl-Mare.

   It will be sufficient barely to notice this affection, it being gene-
 rally well known, I  believe, and  requiring very little to  be done
 for  it;  children either out-growing the complaint altogether, or any
 occasional return of it, when older, being esteemed rather as con-
 stituting  an unpleasant moment, than a disease requiring medical
 treatment.
   The incubus,  probably,  arises from a spasmodic constriction  of
 the  diaphragm and muscles of the chest, taking  place during sleep,
 and occasions  a  sense and  dread of suffocation,  and of some huge
 weight lying across the breast.   When children,  who  happen  to
 sleep with a bed-fellow, awake under the  paroxysm, they are wont to
 say  that their companion has lain with all his weight for a long time
 across them.
   The cause of this complaint seems to be flatulency in the stomach,
 and  indigestion, and chiefly attacks children or young people of a de-
 licate habit, and  such as eat too freely of fruits, and especially such
 as are unripe; or who are in the habit of eating much supper, a short
 time before going to rest.
   The  paroxysms  are of different  duration,  some children lying a
 much longer time in this unpleasant state than others; but in all, some
 degree of palpitation of the heart, lightness of the head, tremor, anxi-
 ety, or lassitude remains for  some time afterwards.
   The curative indications are to rouse and fortify.   During the fit,
 volatiles and fetids may be applied to the nostrils;  and as soon as may
 be, some  antispasmodic should be administered  internally.  After-
wards  clysters, bitter purges, or emetics, should be exhibited, as the
state of the first passages may indicate, and the cordial volatile medi-
cines be continued.   To these should  be added  proper stomachics,
assisted by a nutricious diet of easy digestion, and  cold-bathing,  if
not otherwise improper.
                     Singultus, or Hiccough.

   This has been ranked among children's diseases, but it is, by no
means, a complaint of  consequence, as it  sometimes  is in adults,
though it is, indeed, a true convulsion; and may, therefore, be noticed
in this place.   It occurs very frequently, indeed, in infancy, but sel-
dom requires much attention; as it  more commonly comes on only
after over-feeding, or in consequence of the  over thickness, or sweet-
ness of the food, and is one of their  most harmless  consequences; it
offers another argument, however,  for their  prohibition.   But whea 
STERNUTATIO,  OR SNEEZING.
95
 it depends on  an acid state of the juices of the stomach, or oc-
 curs in long bowel complaints, the testaceous powders should be
 administered  very freely.  Should  it,  however,  continue  for  a
 length of time, the emplast. ladani may be applied to the pit  of the
 stomach.
   The hiccough is an  affection very incident also  to more advanced
 childhood; but  is equally harmless as in infants.   It is well known,
 that it may be  generally removed for the present, by any little cir-
 cumstance that may serve powerfully to divert the child's attention at
 the moment, in a way of surprise, or otherwise.   And it may not be
 amiss to attempt it whenever the hiccough may return, in order to ob-
 viate  the influence of habit, by which this affection may be  increas-
 ed.  Caution only  should  be had not to make use  of such violent
 means as might occasion any considerable alarm; which  in children
of an  irritable habit, who are the more  common subjects of the hic-
cough, might induce some greater evil than the one  intended  to  bfc
removed.   A less known and pretty certain remedy is a  small quan-
tity of any powerful acid; lemon-juice  generally answers very well;
but a  tea-spoonful of vinegar seldom or never fails in the accidental
hiccough of youth, or of very old people.
                    Stemutatio, or Sneezing.


   This has likewise been mentioned by some writers as a complaint
 of young children, for which Rhazes prescribes refrigerants and ano-
 dynes; but it is certainly not a  common one, and, indeed, I have
 never met with it in the form of a disease.  Should it so occur, how-
 ever, some one of the antispasmodics,  such as musk, castor, or cam-
 phor, may probably be exhibited to advantage.
   It may be occasioned by looking too long against any strong light
 as the fire, and especially the sun,  or other very luminous body.  It
 is, indeed,  a well known  symptom of the measles, and of many com-
 mon colds, but in neither, I believe,  requires any particular  atten-
 tion.  It is mentioned  here, only because I  would not pass over a
 complaint that has  at any time been ranked  among  the disorders of
 children.   But knowing nothing further of it myself, and having no
 idea ot its being a complaint of much consequence  in this country, I
 have not chosen, under such Circumstances, to be a  mere copyer from
others.  If violent, however,  it  may  be further  worthy of  atten-
tion; when in conjunction with  other causes, it may lead to the rup-
ture of some small  vessels of the nose; which will  be noticed  in its
place. 
90
                     Dentition, or Teething.

  vPhe complaints arising during dentition may next be considered,
many of the foregoing, it has been noticed, being blended with it, the
first passages and the nervous system being always more or less af-
fected.   The process of dentition is likewise not unfrequently an
occasion  of many complaints afterwards to be mentioned, such as
cough, fever, the rickets, and even pulmonary consumption, and maras-
mus; under each of which heads, therefore, occasional  references will
be made  to what will be advanced under this.
  The time of teething is a most important period of the infant state,
and subjects it to manifold complaints and dangers.   Some writers,
however, and  particularly Dr. Cadogan* and Dr. Armstrong, seem
to think otherwise; and that teething is scarcely to be ranked amongst
the diseases of infants.  They have imagined that children, if other-
wise healthy, would cut their teeth with no more danger than  adults,
who often cut  the dentes sapientiae, so called, without any difficulty,
and  always without  hazard:  they  likewise observe, that many chil-
dren  get their teeth easily.   But this argument must suppose the
healthiest and best nurtured  children  to  be, in all respects, in the
same circumstances with adults, which is by no  means the case; as
they are  liable to  fever,  dangerous purgings, and even  convulsions,
from  causes that  would in  nowise affect  the latter:  nor can they
Maud under some  of those complaints so  long as adults, nor  endure
the  necessary remedies.   For the same   reason, the measles and
small-pox carry off such numbers of infants, when attacked by them
a little more severely than common, whilst young and healthy adult
subjects often  struggle through the more dangerous and complicated
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, whilst adults  are cured  in the most ad-
vanced stages of the complaint, notwithstanding some parts may be
actually  mortified.   I  have,  therefore, no doubt, that  the time  of
teething  ought to be ranked  amongst the most hazardous to infants,
and  that the greatest  attention ought to  be paid to  it;  though, it is
probable, on the other hand, that  Dr.  Arbuthnot over-rates  its fa-
talitv, when he says that one child in ten  may be supposed to sink
under it; at least, I believe  this is not  the case where  the symp
toms are timely  attended to.
   Some  late  writers,  and particularly Mr.  Le  Febure  De Ville-
brune, have conceived this to be a mere  dispute about words;  but
the difference, indeed, extends much further.   For though I would,
by no means, assert dentition itself to  be a disease, and have made

  * See his  E^say on Nursing-,  &c. and Aimslrong on the Diseases of In*
faiita. 
DENTITION.
87
we of any such like expression  merely in a popular way,  yet am I
confident it induces disease in  very many infants of every habit of
body, and more especially, howrever strange it may seem, in the ap-
parently healthy and robust.  Indeed, weak and even rickety chil-
dren commonly cut their teeth easily, though often very late; or if they
should be harrassed by a purging, and other complaints, they, never-
less, escape with their lives, while very lusty strong children are fre-
quently carried off suddenly at this period, unless the teeth happen to
find a very easy passage through the gums.   The system, during den-
tition, being disposed to  inflammation, such  children much oftener
fall into fever than the tender and delicate; like athletic  adults, who
are more disposed  to inflammatory complaints, than those who are of
a colder, but less  healthy temperament: and it is by acute fever, or
convulsions, that infants are carried off, who are well known to sur-
vive a thousand lingering and vexatious complaints,  if their viscera
are sound: it may, however, be observed, that convulsions more rare-
ly take place where a fever attends.
   There are also other circumstances that affect the process of den-
tition, among which the three noticed by Hippocrates, I  believe, are
well founded:  " That infants cut their teeth more  readily  in winter
than in summer; that such as are  rather inclined to be lean, cut
•them more easily than those that are very fat; and  children who are
loose in their belly the most safely of all."   Rhazes* and Primerose
are of a different  opinion in regard to the fittest season; but of the
truth of the last of these observations there can be no doubt.
   This period usually commences between the fifth and tenth months,
and the process of the first  teething commonly continues to the six-
teenth  at the least, and sometimes much longer.   It almost invaria-
bly begins with tiie incisores of the lower jaw.   Usually  two of these
are  cut, and then the corresponding ones in the upper jaw.  After
two teeth in each jaw have appeared, it is in some instances a consider-
able time before the contiguous ones come out; but sometimes, though
not often, six or eight are cut in a hasty succession.  The incisores
are succeeded by the four molares, then the canini, and the last of all
of an infant's first-teeth, their antagonists, or  the eye-teeth; making
in all sixteen.   This,  it is well known, is the  ordinary number of
children's first-teeth, as  they are called; but some infants cut four
double-teeth in each jaw, instead of only two, making the whole
number twenty; though this is  by no means  so frequent an occur-
rence  as some  late  writers  have asserted.  I have,  however, very
lately noticed a more rare irregularity, that of a child cutting twenty-
four teeth; and what is remarkable, another infant, its near relation,
appears to be at this time cutting a twenty-first tooth, and if really so,
will likewise have twenty-four.


  • Apud Sennert de Dentit. in Prognost. Sect. 5. Sennertus, however, endea-
vours to reconcile th£ two opinions, Sect. 5. of the above work.
                                N 
98
DENTITION.
  The above wonted order in cutting the four incisors appears to be
owing to those of the lower jaw being less  deep in the alveolar pro-
cess, as well as thinner and  sharper at their points, and, then tore,
likely to force their way before those in the upper jaw: accordingly,
at least one of the  incisores  in  the  former is usually the first cut.
The one opposed  thereto, in the upper jaw,  sometimes appearing
next, rather than the contiguous one in the  lower, seems to be occa-
sioned by the friction of the prominent tooth, against that part of the
upper jaw  at which  its  antagonist is to appear.  This attrition re-
peated every time  the jaw closes, derives a greater portion of fluids to
that part, increasing its natural action,  and thereby forwarding the
growth of the tooth; while by the forcible  and  frequent pressure of
the gums and periosteum against it, as  soon as  it has made its way
through the bone,  its irruption  is further assisted.   If the succession
be otherwise,  and  a  second tooth  in the  lower jaw be cut before one
appears in the upper, as, for the reason first given is more commonly
the case, it is not  unfrequently before many days; and the two corre-
sponding teeth, in  that case, either follow  in two or three weeks, in
consequence of attrition, o'r else do not appear for some months: but
whatever the period may be, they generally come forward before any
more teeth are cut in the under jaw.   It is usually some weeks, it
has been remarked,  before the other two front-teeth in  the lower jaw
are cut; and in a week or two afterwards, if there be no constitutional
impediment, the corresponding ones in the upper jaw are commonly
pushed forward, and for the reasons given for the early appearance of
the antagonists to  the two first cut teeth.
   In children who are strong and healthy, this process goes on pretty
much as above described, and the teeth are cut both easily and soon;
but in unhealthy and weakly infants the   process, is  both slow and
uncertain.  Accordingly  children sometimes cut their teeth irregu-
larly, or cross, as  it is called, both by the teeth appearing first in the
upper jaw, and also at a distance, instead of being contiguous to each
other: this is accounted, and with some reason, an indication of diffi-
cult, or painful dentition.   It may also be remarked, that the  ease
or  difficulty of dentition may  be guessed  at, by the  circumstances
 under  which the  two first  teeth  shall happen  to be  cut;  the
 succeeding ones  frequently making  their way in  a correspondent
 manner.  To all  these general positions there are, however, various
 exceptions.
    Teething is usually preceded and accompanied with various symp-
 toms: the child drivels"; the gums swell, spread  and become hot;
 there is often a circumscribed redness in  the  cheeks, and eruptions
 on the skin,  especially on the face and scalp; a looseness, gripings;
 green, or pale stools, or of a leaden-blue colour, sometimes mucous,
 often thick and pastey; watchings, startings in the sleep, and spasms
 of particular parts;  a diminution, or increased secretion of the urine,
 sometimes of a milky colour, at others, staining the cloths in patches, 
BENT1TI0N.
$9
as if it deposited  a brown powder;  a discharge of matter, with pain
in making water,  (imitating  exactly a virulent gonorrhoea,)  which
often mitigates the fever: in almost all cases,, the child shrieks often,
and thrusts its fingers into its mouth.   The difficulty in micturition,
however, is sometimes very troublesome, and the pain apparently very
great, attended with long and  vehement shrieks, for some time before
the urine has passed.
   If the infant be only fouror five months old, the demulcent reme-
dies recommended in the chapter on iscuria e muco, can scarcely be
taken in sufficient quantity, especially  if the infant be suckled; but
if nourished by the spoon, they may be  made trial of for a little time,
as they sometimes succeed.   But  should  they fail in  any case re-
course should be had  to  the means  prescribed in the chapter on
dy surra.
   A symptom less common than any of the foregoing, and appearing
only in certain habits, is a swelling of the tops of the feet and hands:
it is seldom, however, of much importance, and goes away upon the
appearance of the teeth.   I  have never met with  it but in infants
who cut them painfully; and  being seldom accompanied with a purg-
ing, it is likely may (in its stead) prevent that fever which is other-
wise so apt to attend.   In  some instances, however,  this symptom
has been accompanied with considerable fever, but in such, children
have either been costive, or the stools been fetid and clayey, and the
swelling of the extremities very considerable.   In such cases, purg-
ing with calomel  will  be proper; and it  may  sometimes be  neces-
sary to give a few drops of tinct. scillae.   Nevertheless, if  there be
no internal disease, this affection proceeds no further; but whenever
it may, it must be treated as  the anasarca, which will be noticed in
its place.   I  have likewise, in a few instances, met with a transient
palsy of the arms or legs, which in one  infant recurred as often  as
teeth were making their way.   The above  mentioned symptoms are
often followed by a cough, difficult  breathing,  fits,  fever, scrofula,
and  marasmus;  and sometimes  by hydrocephalus.   A symptom of
less Consequence,  though  alarming to parents, is  the tumifying of
one or more of the glands of the  neck; but is rarely  followed by sup-
puration;  a bread and  mill  poultice, or an embrocation of volatile
liniment is all that is usuall  required.
   Strong and healthy children, it has been observed, cut their teeth
earlier than the  weak am! tender:  I  have, indeed, known a weak,
and rickety child, without a tooth at twenty-two months old* though
it lived to grow up; but at the age of five years became scrofulous.
The robust, however, are more subject to fever, and for the reasons
already assigned.  The fact, indeed, is,  that the extremes of high
health, and of debility, are both dangerous; the one being exposed
*  Prime-rose speaks of it being' as late as the third, or even fourth vear. 
IOC
DENTITION.
 to acute fever, or convulsions, the other to a slow hectic and ma*-
 rasmus.   Therefore, air, exercise, food of easy digestion, in small
 quantities, and taken frequently; an open belly, and every thing that
 has a tendency to promote general health, and to guard against fever,
 will greatly contribute to the safety of dentition, and to children pass-
 ing quickly through this hazardous period.
   Difficult teething is to be treated  nearly as other acute  diseases
 with local inflammation.   If the body be at all bound, some  opening
 medicine should be administered, and it has been observed, that even
 a considerable degree of looseness  is useful.   Diluting  drinks are
 likewise very necessary, especially if the child does suck.  If much
 fever attends, the loss of a  little blood  will be necessary; though
 children do not endure bleeding so well as they do other evacuations.
 If the propriety of bleeding with the lancet be doubted, a  leech or
 two, as Harris advises, may be applied behind tire ears, and is ge-
 nerally serviceable.   Clysters are also very useful, especially if there
 be retention of urine, which will likewise call for the.  use of warm
 bath.  Gentle diaphoretics are also serviceable, particularly vinuca
 antimonii, or the antimonium tartarisatum,  which, besides  opening
 the belly, often operate in  this way:  a blister should likewise be ap-
 plied between the shoulders, especially if there be any disposition to
 fits.   And, indeed, if stools do not  afford some considerable relief,
 there should generally  be  some discharge from the skin;  since a
 purging, and eruptions on the skin, when spontaneous, are the  grand
 means  of easy  dentition.   A  little  discharge  should,  therefore, be
 kept up behind the  ears, by rubbing the parts with  Spanish flies,
 applying a thread as before directed, or putting on a  small blister;
 which may be kept open.   A  Burgundy pitch  plaster  laid on the
 back will sometimes suffice, which should be renewed every ten or
 twelve  days,  till  the symptoms disappear, or  the teeth  come into
 sight.   Even  before this period, slight scarifications of the gums are
 very useful, by taking off the tension; or if  the teeth are at  all to be
 felt, lancing them.
   I shall close what I have to offer on the general plan of treatment,
 by observing, that the indications certainly  are to assist the irruption
 of the teeth, and to moderate the inflammatory and other symptoms;
 which must be treated according to their kind:  all parts of the body
 readily consenting with the gums at the  time of teething,  but the
 nerves, the bowels, and  lungs, more particularly and importantly
 than the rest.   It has been observed, that a purging  is  beneficial,
 and it  is, indeed,  surprizing how considerable  a diarrhoea children
 will stand on this occasion, and how very bad the stools will  often be
 for many  weeks together,  and a child  happily struggle through;
though at  another time, an equal degree of purging, with such bad
 stools, and constant fever, would prove infallibly fatal.    The  diarr-
 hoea is therefore, not only to be cautiously treated according to the
 directions already given under the article of purging, but is generally 
DENTITION.
101
rather to  be encouraged than suppressed.   Very pale stools have
been said  to be not uncommon  at this time, and are sometimes in
vast quantity:  I have known an  infant have fifty  in one night, at
least by the account of a careful and discreet nursery maid; and from
the quantity of feces that I saw the next morning, I had no reason to
dispute it.
   For the fever of dentition,  besides bleeding, the absorbent pow-
ders are eminently useful, and are, in various respects,  calculated to
afford relief. To these, sometimes a grain or two of Dr. James's pow-
der may be added at bed time.   Nitre is  very often useful,  joined
with the testaceous powders, or  the pulvis e contrayerva comp. as
there may happen to be more or less fever.   Sydenham  directs the
compound spirit of ammonia in a spoonful  of water every four hours,
for four or  five times, and I have thought it  very serviceable after
proper evacuations.  Nor is a drop or two of laudanum to be feared,
if the bowels have  been previously opened, the pain be  very great,
and the breathing not difficult.
   A free  discharge from the bowels,  however, must  above  all be
preserved, when children cut their teeth with fever; and the testa-
ceous powder therefore not be administered too frequently.  The state
of their gums  must  also  be carefully attended to, or their fevers
will be  mistaken, and attributed  to cold, or  other causes, when the
source of irritation is wholly in the gums.
   The lungs, it has been said, is one of those parts on which the irri-
tation from teething is apt to fall,  and when  fixed there,  the  symp-
toms bear an alarming aspect.   A precise acquaintance  with their
true cause is therefore of the greatest importance;  or for the want of
it an unsuccessful plan of cure will be adopted.  I  speak this from
much experience, having known good physicians  overlook the true
cause of the inflammatory symptoms; especially when children have
cut the  usual number of first teeth.  This, it is well known, is six-
teen, but it has been remarked, some children  cut four of the molares
in each jaw, instead of only two,  making the whole number twenty.
One instance of this number was very curious, the child having only
three dentes incisores in the upper jaw; but, at two years of age, cut
a third grinder tooth on the side of the under  jaw,  thus making up
twenty teeth.
   After this period of the usual  first teething, I  have met with the
most  alarming  peripneumonic  symptoms; soreness of  the  chest,
cough, and great  difficulty of breathing, with loss of appetite, con-
tinual fever, and the appearance  of  general  decay.   In  this state,
purging the bowels, and  properly lancing all the suspected teeth, has
given  immediate relief;  and by keeping  up the purging for three or
four days, every threatening symptom has so thoroughly subsided,
that in a fortnight's time, a child expected  from day to  day  to die of
inflammation, or fall into marasmus, has been restored  to  its former
health and spirits. 
102
DENTITION.
  A principal indication, it has been  said, is  to assist the  erup-
tion of the teeth.   This may be assisted by cooling, sedative, and
demulcent applications  made  to  the gums; by  rubbing them with
some  hard polished body, such  as  the coral; or by dividing them
with the lancet:  which  last is the only mean to be depended upon.
Rubbing the  gums  however, I apprehend,  not  only  somewhat ap-
peases pain, as adults sometimes experience in the tooth-ach, but it
also forwards the growth of the teeth, by drawing more  nourish-
ment to them; as  well  as assists their  irruption,  by pressing the
gum and periosteum  firmly against their points.  Suitable applica-
tion on this occasion may be, either mel.  com. or syr. papaver. albi;
or the honey maybe lightly acidulated with the acid, vitriolic, dilut.
Besides the coral, a crust of bread, or a piece of liquorice root may be
often carried  to the mouth, and may sometimes be preferable, as they
will yield a little to the  pressure of the gums.
  These means, nevertheless, and especially the coral,  have been
objected to by some modern refiners; but the objections are certainly
groundless, as in giving this direction we are only following  nature.
For the young of all animals who suck, as soon as the teeth begin to
shoot  are always strongly inclined to gnaw such things as afford a
little resistance.   This may be every day observed in domestic ani-
mals; to prevent which in puppies, recourse is  had to a ridiculous
operation of worming, as it is called, which rendering the  mouth a
little  sore, may  prevent them for a time from gnawing every thing
that comes in their way: and if their gums become easy, or teeth are
cut the  meanwhile, they have no longer any desire  for it, but what
arises from the playfulness of youth.
  When it is found necessary to lance the gums, (which is ever, at
ltast, a safe operation,) it should always be done effectually, with a
proper gum lancet;  that both the gum and  the strong membrane that
covers the teeth  may be  sufficiently divided.  The lancet should al-
ways  be carried quite  down to  them, and even drawn across the
double teeth.  It is certain, that  this  little operation  gives scarcely
any pain, and the relief is at the same  time often so  considerable,
that the child immediately manifests it, by smiling, and by squeezing
the jaws, and grinding them together forcibly; which proves that the
gums are not very sensible.
  The most painful part of dentition, and that in which children are
most exposed to convulsions, is usually  from the teeth cutting through
the periosteum.  This, I apprehend, in difficult dentition, is often not
cut through, but is forced up before the teeth, when they are even in
sight under the thin gum; hence  it is,  that cutting through the gum
is so very often  useful,  and takes off fever and  convulsions, which
severe symptoms could not arise merely from teeth piercing the gum,
which it has  been said is not a very sensible part.  At  other times,
the pain and  fever seem to arise  from almost the very first shooting
of the teeth within the jaw, and then they will very often not appear 
DENTITION.
103
for  some weeks after the gums have  been lanced;  and parents are
therefore apt to  conclude  the lancing  has been unnecessary, if not
improper.  I am, however, convinced from experience, that this  little
operation,  though not in the general esteem it  ought to be, (and by
the French physicians perfectly dreaded even in this day,*) is  often
inexpressibly useful, and appears to have saved many lives, after the
most dangerous symptoms had taken place, and every other mean of
cure had been made  use of.   The mere bleeding from the gums is
capable  of affording some relief,  as it  is frequently found  to do in
adult persons  distressed with the toothach.   And I cannot here for-
bear expressing my surprise at the fears some people entertain of
lancing the gums, and their delaying it so long, if not  altogether re-
jecting it, as I experienced only a few months ago;  though no evil
can possibly arise from the operation.   On  the  other hand, its  ad-
vantages are so great, that whenever convulsions take place about the
usual period of dentition, recourse ought always to  be had to it, after
an unsuccessful use of other means, though by an examination  of the
guins  there may be no certain  evidence of the convulsions  being
owing  to such  cause;  the irritation  from teething, it has been re-
marked, sometimes taking place in a very early stage of the process.
At any rate, (it is repeated) the operation can do no%harm, even  at
any period; and should the shooting of teeth  be only an aggravation
to the  true cause of the disease, lancing the  gums must be  attended
with advantage.  But should teething be the proper and sole cause,
it is evident how fruitless  any other mean of  relief must frequently
be: for should convulsions, for instance, take place from a thorn run
into the finger, or toe, the proper indication of cure, by an immediate
extraction of the thorn,  and the futility of other means,  must be equal-
ly obvious.
    The operation may also be safely  repeated, the scarsf  doing no
 kind of harm.   This,  however contrary to  popular prejudice, may
 be very evident, not only from  the fact of infants cutting their first
 teeth  very easily some weeks after being lanced, but also  from the
 circumstances under which the second teeth are often cut.  At this
 period, children, from their more  advanced  age, and  decreased irri-
 tability, are less subject to  fever,  and evidently  appear to suffer far
 less pain than in the first teething, though the second teeth often have
 to make their way through much  more considerable scars than have
 been  made by a lancet, from the gums having been  lanced prema-
 turely.   This fact is likewise established from the many instances  in
 which dentists have thought it expedient to draw  out the first teeth
 long before the second are prepared  to take their place.|   The ob-

    * See Lieutaud.
    t See pages 76,77.
    * This practice is, by no means, adduced in a way of approbation, but merely
 lor the sake of the inference drawn from the ikct; the writer being persuaded 
104
DENTITION"
jection to lancing the gums, from any apprehension arising from the
scars, is, therefore, altogether ill-founded; and, indeed, it will be fre-
quently necessary to lance the gums several times, especially on ac-
count of the extraordinary difficulty with which some infants cut their
double teeth, which are furnished with two or more knobs, or points.
Purging, fever, and even convulsions, will sometimes arise from only
one point of a large tooth offending the periosteum that covers it; and
being nearer the surface than the other points, the lancet may some-
times not completely divide the membrane that lies  over the rest, (or
it is afterwards healed;)  and this part not being injured by the tooth,
the symptoms subside  on having divided that portion of membrane
that was inflamed.  But in a little time, another point of the same
tooth is found to irritate the periosteum, and calls for the like assist-
ance of the lancet, which again removes  all the complaints.   This,
at least, I have conceived to be the process, when I  have found lanc-
ing  a large tooth immediately remove every terrible symptom, though
the  fever and other complaints have returned,  and the  whole of the
tooth not appeared till  the  operation has been three or four times re-
peated.   I have seen the like good effect from it, when children have
been cutting a number of teeth in succession, and have bred them all
with convulsions.   Nothing having relieved or prevented these ter-
rible symptoms 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 such cases,  it has been said, it will often be proper to  draw the
lancet along a great part of one, or even both  the jaws, instead of
over only one or two teeth, as is commonly done;  as  well as some-
times to lance the  incisores by a crucial incision, as is commonly done
for the molares.   Some writers, however, and Dr. Millar particu-
larly, have advised not to cut quite down to the teeth, but only to
scarify the gums, unless the teeth are  very near.   He suspects that
the  instrument often injures them, and produces caries, which he
thinks will  be communicated to the  succeeding set of teeth.   But
this is a mistaken theory,!  owing to inattention to the true state of the
teeth, which are perfect  bone,  and covered with  a  strong enamel,
long before they get through the  gums.  The manner of the second
teething of children likewise forbids such a fear;  for though the first
set, (which are designed by nature to be only of short duration) should
actually be injured by the lancet, the  succeeding ones are not at all

that the succeeding teeth are thereby frequently ill-placed, by one tooth appear-
ing long before others, and growing so large as  not to allow  proper space for
the rest.
  *  Precisely similar remarks have been made by Mr. Hunter.  See his Practi-
cal Treatise on the Diseases of the Teeth, page 121.
  j-  Such instances manifest the great impropriety of establishing practice from
theory, instead of deducing theories from facts. 
FEVER.
105
likely to be affected by the carious state of the former.  For the first
teeth of infants  constantly become carious at  the  roots, and  are
loosened and expelled  by that means, when left to nature alone; and
though, in many instances, the upper parts  of the new teeth are  for
some time  in contact  with the carious  bottoms of the first set, they
never suffer  from this circumstance.   I have dwelt the  longer on
this head, because writers are not agreed on the subject, and it is a
matter often  times of no small importance.  I have, however, written
from experience, and am perfectly satisfied of the propriety and safe-
ty of what I  have ventured to recommend.
   Children  will sometimes  have ulcerated gums in teething, and
more frequently where they have not been lanced; which are  easily
cured by keeping the body open, and touching them  with  astringent
applications.   As much white vitriol, or rock alum  as will give a
moderate roughness to a little  honey, is usually  sufficient for this
purpose.  But should  this fail in any case,  it must be treated as  di-
rected under the head  of canker.
   The diet of infants at this period remains to be noticed: and it should
be a pretty general rule during the time of teething, to abate a little
of the usual quantity of the food, and to increase the quantity of drink,
unless the child is very weakly, or every thing is going on perfectly
well: or if the child be at the breast,  a similar regard ought to  be
paid to the diet of the nurse.
                             Fever.

  Having considered the  more  early  disorders of children, and
especially such as are sometimes  connected  with pyrexiae;  it will
now be proper to  treat more  distinctly  on the species of fever  in-
duced  by them, or otherwise incident to childhood.   In a view  to
the  latter, however, it may be observed, that though  some  writers
have supposed  infants to be as  liable to fevers as adults, and from
the  same causes,  I  have by no  means  found  it so;  having ob-
served  for many years, as well in the hospital, as in private practice,
that infants do not readily take common  fevers, though exposed for a
long time to  that contagion  which  has appeared  to affect adults
around them.*   Their fevers  are also of a short duration if properly
treated, unless  the few that arise  from some more permanent irri-
tating  cause.
  Young children, however,  are  disposed to  certain  febrile com-
plaints, and to  some peculiar  to themselves;  which,  as this work is

  *  Every physician attending lying-in hospitals, must not only have known
many infants suckled, wiihout injury, through  the  whole stage of bad fevers
from which mothers  have recovered, but also, i;i other instances, sucking greedi-
ly within an hour or two of th-ir mothers' death.
                                 n 
106
FEVER.
now considerably enlarged, with the design of  embracing all their
complaints, I shall  bestow some pains in specifying, as well as point-
ing out the treatment most adapted to each.
   The most frequent  causes  of fever,  are teething,  foul bowels,
worms, glandular diseases, some  eruptive and very contagious com-
plaint, or taking cold; (some  of which  have  already been noticed)
and are often attended with symptoms peculiar to children.
   To begin with the last  mentioned cause, as one often suspected:
if the cold be severe, it will be easily distinguishable, as the febrile
heat will always be attended with a  cough, and hoarseness, and
some  difficulty of breathing, and often with running at the  nose or
eyes, which is noticed in no  other fever, at its commencement, ex-
cept it be the measles; which will be attended likewise  with violent
sneezing, and  a peculiar  appearance of the eyes not often met with
in a common cold.
   The treatment of this fever in children is  usually as manifest as
its cause.   Should the heat be considerable, the  cough  violent, and
the difficulty of breathing  very great, a blister  will always be safe
and expedient, and may be applied at the  pit of the stomach  instead
of the back; as being both less painful under any motion of the body,
and more readily got at to be  dressed, or for the application of fresh
cloths, where the discharge happens to be considerable.   But if the
fever and difficulty  of breathing should not be very much abated  by
the blister, children though within the twelvemonth, will  bear and
even be  greatly benefited by the loss of a little blood;* and if not by
the lancet, at least by the application of two or  three leeches, as I
have frequently seen, especially if the head be affected;  and  I  men-
tion this again, because it has  been thought so  highly  improper for
infants.  But I can venture  to say, they  will be much less reduced
by it, than by the continuance of the fever, which the loss of a little
blood will,  in many cases, shorten by two or  three days: it is alse
sometimes absolutely necessary, as in peripneumonic cases, in which
it may even be repeated  with  safety and  advantage.!   Indeed, in
some instances the  only means of saving  an infant's life, is  taking
away at once  a sufficient quantity of blood,  at the commencement
of the peripneumonic symptoms.   And this becomes the  more ex-
pedient,  from the consideration that not only inflammation, but true
tubercles of the lungs  are formed at a very early age; having myself

  *  In mittendo fanguine, non tarn  annos medicus numerare,  quam vires
xgrotantis aestimare debit.  Ctdsus. Lib. ii. cap. 10. p  78.
  Galen indeed forbade bleeding till after fourteen years of age, but since the
time of Celsus, that absurd idea has been exploded. Uhazes permitted cupping
after three or four months j Avicena at a year old.  Some allowed  of bleeding
in tht  feft or le^s. though not in the upper parts ; but this useful operation is
now justly unconfined, and extended, occasionly, to every period.
  * Multa in  prsecipiti periculo recte fiunt, alias amittenda. Id. Lib. iii. cap. 18.
p. 150. 
FgVEB.
107
 seen them, after death, as will be further noticed on the mesenteric
 fever.   Oily medicines, likewise, made  into  a  neat  emulsion,  are
 often useful, especially if the child  be not suckled; but they should
 be preceded by  an  emetic of wine of antimony, as there is usually
 much  phlegm on the  stomach;  children never coughing it up.   In
 many cases it is also necessary to repeat the emetic, as often as  the
 phlegm in the throat is collected in  such a quantity as seems  to im-
 pede respiration.  But if the cough be  dry or  convulsive, Bates's
 spirit sal. ammoniaci succinat. may  be safely  and usefully  adminis-
 tered,  if there be not much fever.  The body at the same time should
 be kept perfectly open, and this purpose is usually well answered
 by smaller doses of wine of antimony, or of Dr. James's powder; but
 if they should fail  to  procure stools, as they sometimes will, where
there is much fever they rather  do harm  than good, unless a little
 manna, or rhubarb be  joined with them.   Should the head be much
affected (the symptoms of which are noticed in their place;) putting
the feet into warm water, or applying a milt to them just taken from
the animal, are  admirable remedies; and I think  have sometimes
saved a life after all hope had been given up. Or  a little fresh leaven,
or dough,  as advised by Mr. Le Febure de Villebrune, may be spread
thinly over the soles 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 the compound
spirit of vitriolic ether, given three or four times a day.
   Though the severe treatment above  mentioned  is indispensable
when the  cough, difficulty of breathing, and  degree of fever are con-
siderable; it is proper here to remark, that I have known children
of two or  three years old seized with a sudden difficulty of breathing
 in coughs  arising from common colds, where the fever has  not b- n
proportionate to the other symptoms.   In such  cases the difficulty of
breathing may arise from bile on the steniach,  and  it  may therefore
be prudent, previously to bleeding and a blister, to give a small dose
of James's powder, which will pretty certainly  act as a vomit, if our
suspicion  has  been just;  and will remove that  threatening1 symp-
tom very soon.
   It is scarcely necessary to remind the  reader, that preparations
pf antimony are very powerful medicines, and not to be  prescribed
indiscriminately  as they sometimes  are by those who are, in no wise,
competent judges;* and against which practitioners  will do well  in
offering a caution in the nursery.   But where such medicines are
found to agree, and keep the belly open, children  frequently stand
in need of no other; though  where the fever has been  very consider-
able, I have given nitre to advantage to infants of only a few months
old.   In the little fevers arising from taking  cold, to which some

  • A nurse very lately proposed giving  half a grain of tartarised antimony to
an infant of a few days  old. 
108                         FEVER.

children are very liable, I often join it with Dr. James's powder, and
a few grains of the compound powder of contrayerva, lowered with
testacea; which I find  to be a  medicine exceedingly useful, when
given in time.
   If the fever be not owing to taking cold, to worms, teething, or
some eruptive  complaint, it  will generally  be found to arise from
some foulness in the first passages;  in which case opening the belly,
and afterwards giving an  emetic, and the testaceous powders, usu-
ally remove it.   On this account great attention ought to be  paid to
the state of the bowels, and not only in regard to the number of stools,
but their kind.  This should be a maxim with all  those who have
the superintendance of children, especially infants, under whatever
complaints they may labour;  as a principal indication must be taken
from the state  of their bowels.   In the present instance, if a laxa-
tive and emetic have  not removed the  fever, opening  medicines
must be continued a while  longer, especially castor oil; but if the
stools are very fetid,  the  pulvis e scammonio  cum calomel, or small
doses of calomel alone,   are the  fittest purge.  I have known not
only  convulsions, dilated pupils, and drowsiness, but also paralytic
affections, attended with  great  pain  and continual  fever, induced
merely by a  foul state of the  bowels; where, after the complaint had
been unsuccessfully treated as a fever of another kind, all the symp-
toms have been removed  at once by an active purge. At other times,
infants of only three or^four  months old will  often  have very consi-
derable fever, and fits, with so costive a state of the bowels as to re-
 quire strong purgative medicines to be repeated for several succes-
 sive  days, with clysters  and the warm bath, before the obstruction
 can be removed, or the fever will  at all  abate.   And I doubt not, it
 may be matter of surprise to those who may not frequently have met
 with such cases, to  find how great a quantity of purging medicines
 have been taken by a tender infant before one proper stool could be
 procured,* and how certainly a  relapse will take place, if the open-
 ing pb?n be  not persevered in, in the manner recommended.  In
 less  urgent cases, and especially in very young subjects, much gentler
 means will usually  succeed, and after the  belly  has been once  or-
 more well opened,  many common fevers will nearly subside;  after
 which, it will frequently be proper to return  to the testaceous pow-
 ders, in one form or other.   These  will compose an admirable me-
 dicine for very young children,  as well under little  fevers,  as for al-
 most all their complaints not attended with costiveness.   This, the
 judicious Harris was so sensible of, that he  thinks them alone suf-
 ficient to effect  almost  every thing during the infant state, and has
 done unspeakable service by abolishing that  indiscriminate recourse
 to cordial, and other heating and rough medicines, such as mercury;
 aurum fulminans,  theriaca, &c.  together with various  anile  and
* See pages 11, 12. 
FEVER.
109
superstitious remedies, which the ancient writers frequently recom-
mended on occasions peculiarly improper.   And though absorbents
will not do every thing he has imagined, yet are there very few me-
dicines  of such general use.  But  should the fever withstand these
common remedies, or be  found to  increase, it will be necessary to
give some of those before  recommended, or what  is often very use-
ful, little draughts of succus limon. and kali ppt. in which the latter
is left a little predominant; or a few drops of the spirit,  ammoniae
comp. four or five times a-day, as recommended for the fever of den-
tition.
   In  many little fevers of infants, where the cause has not been so
obvious as it commonly is, I have experienced very good effects from
persevering in the use of small  doses of the vinum antimonii, given in
a saline draught; this medicine sometimes acting as  an  emetic or
purge, and at others, as a stimulant and diaphoretic, possesses pecu-
liar advantages.    But the  manner in which this medicine is directed
to be prepared in the new pharmacopoeia, under the title  of vinum
antimonii tartarisati, renders it exceedingly preferable to the com-
mon  antimoiiial wine; and  may be frequently given in the place of
the pulvis antimonialis, in the  dose of five or six drops, to a young
infant; or in the dose of three drops,  instead of five of the old  anti-
monial wine.
   There is a fever to which children long after the time of teething
are liable, that is of no marked  type; which, though it turns out to be
owing to foulness of the primae viae, arises more from the acrid  se-
cretions from  the liver, or  other glands,  than  from  a collection of
feces, or a costive habit; and is more remarkable for the great pain in
the bowels than for any other symptom.
   It  commences like other little fevers in children, and is of uncer-
tain duration. The pulse is oftentimes exceedingly quick, the breath-
ing bad; the tongue  dry and brown; with a cough more or less violent,
throughout the complaint.  On this  account, it is in the beginning
often suspected to be owing to taking cold; but the cause, I believe, is
always in the first passages.
   Though procuring stools freely for several days is  found to abate
the fever, yet the child is at no time entirely free from it, though it
frequently remits; which may assist us to distinguish this fever from
others.
   The stools, which at first are very fetid, in a little time become very
numerous, mixed with a great  quantity of slimy matter, and are at-
tended, or followed, by very great pain.  This has sometimes dis-
couraged p-actitioners from further  purging;  but where no  other
source of fever  is discovered, and cooling and antimoiiial medicines
are found to afford  no essential relief, the exhibition  of repeated
purges  has proved  the surest  remedy.
   To this end,  two or three  grains of calomel, taken every night,
 and  infus. sennas the next morning, has seemed to have the best ef- 
110
FEVER,
feet, in the earliest stage of the disorder; but after the severe pain
and slimy stools have taken place,  castor-oil may be substituted, and
given only every second or third  day; composing  the  bowels, and
taking off the spasmodic pains, by repeated doses of laudanum, on
the intermediate days, and especially on the nights after the opera-
lion of purgatives.
   This plan should be continued until the  fever entirely subsides,
(which will sometimes run out to two,  or even three weeks) and the
appetite for food  returns.   Previously to which some  light bitter,
given in a saline draught or  lac amygd. or  with the pulv. e traga-
canth. comp. in the  intervals of purging,  will  tend to  comfort the
bowels, and hasten the natural inclination for food, from which there
is often a long aversion.
   There is a fever which may be just hinted at in this place, which
will be more particularly noticed  in the  chapter on hydrocephalus,
for which  also  repeated purging  is the remedy.   The symptoms
strongly resemble those of water in the head, but the stools are of a
very uncommon appearance, resembling meconium: which, however,
resist common purges, but are brought away in great quantities, and
for a considerable  time, by calomel; the fever and stupor abating  in
proportion as this kind of stool is brought away.
   I have sometimes met with a fever, more  remarkable  for its being
attended with inflamed and sometimes painful tumours, than for any
other symptom peculiar to it.   These are seated chiefly on the  legs,
and particularly along the spine of the tibiae;  and rise in a day or two
to the size  of a nutmeg.  They are marked  with all the appearance
of abscesses, feeling as if they contained matter, and on this account,
they put on  a formidable aspect to such as may not  often have seen
the disease; but what is  remarkable, they never, I believe, come  to
suppuration, unless irritated by the clothes or other means, but disap-
pear again in a few days, though the fever sometimes continues.  The
like  appearances have been met with in adults, especially females,
though perhaps more commonly in children  from three to ten years
of age;  but are not peculiar to scrofulous habits, though the tumours
have very much of a scrofulous appearance  and feel.  As far as my
experience has gone, (for I  believe it  is not a very common com-
plaint) they are conjoined more frequently with that fever which at-
tends a foul state of  the bowels, than with any other; which, there-
foie requires repeated purging, especially with calomel: and on this
account, the pulvis e scammon. cum calomel, becomes a convenient
r  r.iration.   Saline draughts with the spir. aetheris vitriolici comp.
m v  be given on the intermediate days, and in the end the bark  is
coi :inonl\ useful.
   These appearances have sometimes been preceded by scarlet spots,
jr patches, resembling the petaechiae observed in malignant fevers,  as
was noticed under the article of rashes.
   On the. decline of some fevers, especially those arising  from foul 
REMITTENT  FEVER.
ill
bowels, it is  not uncommon to see  an eruption  on the skin, resem-
bling that called the red-gum, in the month, and sometimes even the
thrush will make  its appearance, though the infant may have had
that complaint before; which are marks of the great disturbance the
first passages  have suffered, and of  the  consent they have  with
the  skin: the  former, it has been said, is  always a favourable in-
dication, but the observation is far from holding good in regard to
the thrush.
   At the decline also of certain anomalous fevers that have lasted
ten or twelve days,  (and sometimes after the febris scarlatina,) great
pain of the  neck  has taken place,  attended with  a little tumour
of the part, and great rigidity of the muscles, drawing the head forci-
bly to one side.  A general debility, and want of appetite has conti-
nued, though the bark has been administered, and seemed no wise to
disagree.   In this  state,  fomentations  and poultices  applied to the
neck, together with some volatile embrocation, has soon removed the
contraction and pain; after which children  have recovered  as  on a
sudden their  appetite and spirits.   During very cold weather, how-
ever, I have  known a slighter  degree  of pain  and stiffness of the
neck, with a  little  fever,  return a week or two afterwards; possibly
from taking  cold,  and  as I  have thought, from improper food.
The antimonial powder  with  saline  draughts,  and a repetition  of
the topical  applications, have in such case  had an immediate good
effect.
  Fevers in  children of  three or four years old, particularly in  cer-
tain  seasons,  are found tedious of cure by any of the above means,
and like  those of adults require the bark,  (especially under the re-
currence of the thrush)  which should be administered in  a  light
decoction, three or four times a-day, in such doses as the symptoms
may require.
                        Remittent Fever.

   Notwithstanding what has been observed respecting the remit-
tent fever as described by Drs. Armstrong and Butter, there is cer-
tainly  a fever of that type that deserves a cursory consideration in
respect to a peculiar  symptom, which, I believe, always attends  it;
though the fever itself certainly arises  merely from an  affection  of
the primae viae.
   Indeed, it is well known to practitioners much conversant with the
disorders of children,  that various  febrile affections, differing in de-
gree, and  the time of their  continuance, originate from  the state
of the  first  passages; but as the treatment is  similar in  them all,
varying chiefly in regard to the strength, or  other  circumstance',
of the  purging  medicines exhibited, it  would be  equally unneces- 
112
TVPHUS, OR LOW FEVER.
sary and perplexing to multiply names, where no essential distinc-
tion subsists.
  The present chapter, therefore, is added only to denote a fever of
this kind, (which, under this name, I have said  has been  much in-
sisted upon by some writers;) which constantly remits and increases
again, (as I have already noticed little fevers in children are wont to
do,) sometimes for three or four weeks, or sometimes much longer,
and is attended with  the remarkable symptom of picking at various
parts of the body until they are made to bleed, and even become sore,
particularly the fingers, nose, the lips, or the tongue.   But this fever
being equally remarkable for being always, I believe, void of danger,
it is necessary only to remark, that it seldom attacks children under
four years of  age, nor  upwards of ten; and that, although it has been
distinguished into the  acute, slow, and low infantile-remittent, it re-
quires much less variety of treatment than such distinctions seem to
import.   The proper, and always successful plan, being confined  to
the repeated  exhibition of some gentle purgative medicine, or light
cordials, when accompanied with much  languor; as  is not  unfre-
quently  the case.
                      Typhus, or Low Fever.

  A fever of much importance, however, is  mentioned by Dr.
Hamilton, which 1 had never met with in young children till since
the  last edition of this work; and is a true low fever, or typhus.   It
is very accurately described by him, and particularly as commencing
generally rather with marks of languor and fatigue, than with any
distinct rigor.   The stomach is frequently sick, which is soon suc-
ceeded by heat, pain in the head, and great thirst  and restlessness.
On  the second day, there is an evident remission, which is at the first
very regular, and continues, though in a less degree, till the termina-
tion of the fever, which will run on to three weeks, and sometimes
five; and yet, as far  as my experience has gone, the little  patient re-
cover, if duly supported: and, I think, I once saved the life of a child
of seven years old,  by  sitting at the bed-side, with my hand on  the
pulse, and as often as that sunk,  (as it often did so much as not even
to be felt,)  supplying the child with burnt brandy, and other cordia s:
though at times it was doubted whether it was able  to swallow. The
attempts were at such times, of course, made with great caution, by
administering  only a tea spoonful at a time, which was  sometimes
retained a while in the  mouth, and at others swallowed  with avidity;
the  pulse always rising  in consequence.
  It will be obvious, that if called  in pretty early in the  disease, a
powerful emetic should be administerd, and perhaps ipecacuanha is
one of the most certain and best; and some purgative medicine admi- 
MESENTERIC fever.
113
nistered soon afterwards.  Washing the body and the head, if the
pain be extreme, with cold vinegar  and water; whilst diluting sub-
acid liquors should be taken freely as long  as the thirst is intense;
and whenever an evident remission takes place,  recourse should be
had to cordials, and sometimes the bark.   On the other hand, if the
pain in the head should increase, or the nose be disposed  to bleed,
the early application of leeches is indicated, previous to the recourse
to cordials, or application of  external  cold.   The bowels should, in
every case, be kept open, and when the stools are green, or very fetid,
active purges should be administered: the air of the apartment should
be cool, and a window frequently be opened in that, or an adjoining
room, according to the season of the year, and other circumstances.
When the vital  powers sensibly fail, besides  the free  exhibition of
cordials, blisters, or sinapisms should be applied to the feet, and be
left on long enough to become rubifacients; and be repeated again as
the degree of debility may require.


                        Mesenteric Fever.

    Another cause of fever has been hinted  at, which  is obstructed
glands, especially  the mesenteric; and is often a fore-runner of the
true hectic fever, or fatal marasmus.
   It, indeed, frequently  arises from  scrofula, which then discovers
itself by other marks; and will require its peculiar treatment.   But
there is an early stage of glandular obstruction in the mesentery, and
of the fever here alluded to, that is often falsely attributed to  worms;
but will  not  yield to mere purgative medicines, as that disorder
usually does.   It attacks children from the age of three  or four years,
the fever remitting, and  sometimes  intermitting, irregularly; is  at-
tended with loss of appetite,  swelled belly, and pain in the bowels;
the latter sometimes taking place more or less, every day, or is gene-
rally more violent if the  child be a day or two free from it.
   After opening the bowels,  half a grain, or a  grain of calomel may
be given to advantage, two or three times a-week, and on  the inter-
mediate days small doses of the natron ppt. either alone, or neutral-
ized with the juice of lemons, or  in some instances partially so.   If
the belly be very costive, as it often is, an infusion of spong. ust. and
sena is more effectual than any thing; and is an excellent  remedy
for many little fevers in older children, when the primae viae are par-
ticularly concerned.  When the  glandular fever, just now mention-
ed, has abated,  some light bitter, as of  camomile flowers, is useful
to brace  the stomach and bowels; and  to prevent a relapse, it will
often be found necessary to administer some chalybeate, of which the
tinctura florum martialium  is one of the  fittest for children;  if  it
should offend the stomach, a few  drops of the tincture of cardamoms,
or other stomachic, should be joined with it.
                                v 
114
MESENTERIC FfiVER.
   But as the mesenteric fever, from its great fatality and frequency,
has lately very much engaged the attention of writers, it may be pro-
per to consider it a little more distinctly in some of its principal stages;
in each of which its nature and treatment sometimes materially differ.
For before the mesenteric glands become much enlarged, or the fever
continual; whilst the  appetite  continues,  and the  first digestion is
but little impaired, and no purging has  taken place; the opening
mix! ure  of sponge and senna, with a few doses of calomel, and after-
wards bitters  and chalybeates,  are the only remedies very likely to
be called for;  and  almost always succeed, if duly persevered in.   In
this state, the  disorder may still be considered  as  in  its  first stage,
and of which an unusual  costiveness, the hardness and recurring
pains in  the belly, and a remitting fever, are the principal symptoms.
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
stages; and it is presumed they are so well known as to render it
unnecessary.   But in general it may be said, that indigestion, cos-
tiveness  or purging, irregular appetite, flushed checks, or a total loss
of colour, impaired strength and spirits, remitting fever, and  a hard
and tumid belly, with emaciated limbs, are amongst the more  con-
stant symptoms attending, at one period or other of the disease.
   This being a glandular complaint, not only are  the glands  of the
mesentery affected, but I have found those of other parts, and especial-
ly of the lungs, in a very morbid state  before any of those symptoms
of inflammation have been  noticed, which are  constantly met  with
in similar cases, in older subjects.*
   This fever will sometimes take place in infants at the breast,  and
children are liable to it till they become eight or ten years old,  (and
in scrofulous habits much longer) it being  often  a consequence of the
protraction of almost any of the preceding complaints, especially those
of the  first passages and  dentition,  as well as of the measles, and a
few others;  of which that from  teething will be separately consider-
ed.  Among the poor, it is too frequently owing to a coarse and un-
wholesome diet, and the want of proper exercise and rubbing; indi-
gestion at the stomach, and a consequent vitiated chyle, with infrac-
tion, or  obstructions in  some of the internal glands  or lymphatics,
being among the primary remote causes of the disease.

  * In examining the viscera of more than one infant of only a few months old, I
have found tubercles, and  even purulent matter in the  lungs, which have not
been preceded by any manifest  symptoms of such mischief, and even where
there has  been no cough nor difficulty of breathing, until a few days before
death, and then only so slight as  to be scarcely noticed.  In one instance, I found
in some parts of the lungs tubercles as large as nutmegs, and in others, clusters
of smaller ones, (and particularly about the superior and back part of the  medi-
astinum;) some of which were hard, and others full of matter.  Such appearances
seem, therefore, to be common in all  glandular diseases, to rickets, and similar
disorders  arising from cachochymy;  Glysson having remarked, that he seldom
examined  the bodies of infants, dying of rickets, without meeting with such ap-
pearances in the lungs. 
jpHSENTERIC FEVER.
115
  As prophylactics, therefore, good air, exercise, gentle frictions, an
easy dress, frequent washings of the body of young children with soap
and  warm water,* the cold bath in older children; and especially a
light and nutritious diet, with such mild aromatics as may assist diges-
tion, are some of the principal and most efficacious means-  In regard
to frictions, it may be properly remarked here, that they are as proper
as a mean of cure as a prophylactic; and  should be  regularly  had
recourse to, at least night and morning.
   But when  this disease is completely- formed, it calls for the most
powerful remedies; and such have happily succeeded  in several in-
stances, wherein formerly little hope had been entertained.
   As I have  passed over many less important symptoms, occurring in
the different stages of this long disease, especially such as arise from
some peculiarity of habit; I shall for  the  like reason, confine these
observations to the more general  plan of treatment, without particu-
larly noticing a variety of occasional remedies, which such symptoms
may at different periods require.
   In a general way,  the principal indications are to remove the ob-
structions in the lymphatic system, and effect a resolution of the in-
durated glands of the mesentery;  to carry off this viscid matter;  and
lastly,  to strengthen the  system,  and  establish a good digestion, as
well by means of proper diet as by medicine.  To accomplish these
intentions, attenuants and deobstruents, purges, emetics, and tonics
must be had recourse to, in an obvious order.
  Amongst the first,  and as general deobstruents, are mercurial and
antimonial remedies, neutral salts, soap, steel, and the cicuta; to
which, with propriety I think, may be added, electricity.
   In regard  to the efficacy of mercury  and steel in this disease, a
vast crowd of testimonies appears among writers,!  in almost every
part of Europe.   And a very rational idea has been suggested on this
head, by Mr. Royer, that of administering mercury clyster-wise; in-
asmuch as the resolution of local and partial obstructions,  does not
so much require an exertion of the collected force of the system, as
deriving all the influence of proper remedies to  the seat of the dis-
ease: an idea of late years pretty  generally received, and in some in-
stances successfully adapted to the cure of scrofula, as well as some
other chronical disorders.
   Calomel is, perhaps, one of the fittest remedies of this class, and
when administered by the mouth, may be combined with, or follow-
ed by  some  purgative medicine, and given  for several  weeks, till
there shall be some  favourable  change in the feel and size of the
belly;  though it will, indeed, be sometimes proper both to  exhibit this

  * This idea is as ancient as the time of Hippocrates, who strongly advises it.
—De Salubri Diacta. § IX.                                      ,
  t White, Hartmann, Worholf, Theden, Burchard, Baume, Baumes, Roseen,
Fouquet, &c- 
116
MESENTERIC FEVER*
powerful deobstruent  in large doses, and to continue it for a much
longer time;  and afterwards in very small doses, which I frequently
direct in the following form:

   &. Colomelan: gr. 1.
      Suchari albi 51. caute misceantur et divid. in Chartulasduode-
cim. e quibus sumat unam maie meridie et hoi a somni quotidie.

   The lightest preparations of steel are  usually preferable, such as
its tinctures,  or  the salt, or merely some  chalybeate water; which
will act  both  as aperitives and  tonics.  Amongst antimonials, the
kermes mineral  is found by experience to be more generally  useful
than any other preparation.
   The evacuants mentioned  as proper in this  disease, were emetics
and purges; to which may  be added diaphoretics.   The two former
are more essentially necessary;  but must be adapted and carefully
dosed, agreeably to the state of the bowels  of the  patient.   As a
purge, rhubarb and tartarised kali are generally  the  safest and most
effectual, and may be persevered in for the  greatest length of time;
or the composition which, in regard to many cases, has been de-
servedly extolled by Sir William Fordyce, rhubarb  and polychrest
salt;  which, whenever mercury may not be preferred, should be ex-
hibited daily for several weeks,  and will sometimes restore the pa-
tient without recourse to any other means, when the  disorder is not
of long standing; being at  once both a purge and an efficacious de-
obstruent.
   As a diaphoretic, sarsaparilla, or a more compound decoction of
the woods; which may be taken together with any of the above men-
tioned remedies.
   The last means recommended were tonics, which can very rarely
be dispensed with;  since although the obstructions should actually be
removed, the emaciated state to which the patient is generally re-
duced, peculiarly calls for  bracing remedies, especially with a view
to strengthen the stomach and alimentary canal, and promoting a
good  digestion;  the only means of obtaining a bland and nutritious
chyle, by which the  body may be  conserved in good health.  To
this end, the bark,  steel, the  cold  bath,  (which, however, and
especially the latter, should not be ventured upon till the obstructions
are removed) light bitters and aromatics are the principal remedies;
to one or more of which, recourse may be had, as the  degree of re-
maining fever, and the state of the bowels, or the debility of the pa-
tient may point out.  To these may be joined daily frictions, especial-
ly of the belly,  limbs, and spine;  or the common  soap plaster, or
one composed of ointment of marsh-mallows, gum ammoniac, and oil
of camomile, may  be applied over the whole belly: or the body be
covered  all over with sea salt, reduced to a very fine  powder.
   It has been already hinted, that the diet ought to be of the lightest 
HECTIC FEVER AND MARASMUS.
in
and most nutritious kind, and carefully adapted to the age and other
circumstances of the  child; who, if at a due age, ought in many in-
stances to partake of light white meats, as well as vegetables, and
plain jellies; but always avoiding fat  and  greasy aliments, pastry,
and whatever may not be duly, as well as  quickly digested, or will
not form a bland and  nutritious chyle, however readily they may get
out of the stomach.
   Though  it  has been  said, that merely purging with  calomel or
rhubarb, for a length of time, will in some instances succeed, and in
others, some of the above  remedies may  be  more adapted  to  the
patient than the rest; yet more commonly, as before  noiiced, each
of them will be useful, at one period or other of the  complaint, and
sometimes the union of several; but above  all, purging  is always
the most essential to the cure of this dangerous disease. And though
it is oftentimes attended with costiveness and a voracious appetite, it
is, at others, accompanied with a loathing of all food,  and frequent
stools, which do not reduce the belly, but too often deter practition-
ers from the use of active, or repeated purges; without which, how-
ever,  experience proves there can be no prospect of success, after the
belly  has once become  enlarged.   And  I wish  here to add, as
the result  of experience since the  last  edition, that I have  been
equally surprised at the great quantity of purgative medicines,  espe-
cially calomel: and at the  success  attending  the  protracted use of
them  in cases wherein I had myself  at first despaired of being of any
use.   I shall close these observations  with offering the  following
form,  which in a general  way I have found very suitable.   It should
be continued for a length of time, taking care that the bowels be kept
properly open.

         r>. Calomelan. gr. j. ad ij.
            Pulv. Ipecac,  gr. ss. ad gr. j.
                  Zingiber, gr vj.
  Misce, ft. Pilula: iv, cum quantitat. sufficient, vel. Conf. aroma-
ticae vel. Conf. opiatae, ut alvi status postulet.  E quibus  sumatur
j singulis  aut alternis noctibus,  vel omni  nocti  maneque.   Post
aliquod tempus addentur pulv. rad. columbae grana octo vel decern.

Together with this pill, the cicuta will sometimes  be  very ser-
viceable.
   Since I  quitted general practice in London, the solutio arsenica
has been used with considerable success in this disease: but should
certainly be administered to children only in the smallest doses.

                  Hectic Fever and Marasmus.

  Not a few a both of the preceding and following complaints are
sometimes found to induce a confirmed hectic fever, and marasmus, 
118
HECTIC FEVER AND MARASMUS.
called by some writers atrophia lactentium; though it  often  corue.s
on too late properly to admit of the name.   I have nothing new, in-
deed, to offer on this disease when it is far advanced, unless it be bv
way of encouragement to hope for a better  issue in the  hectic fever,
under certain circumstances, than we are wont to expect.
   This fever, as it is apt to arise from other complaints, is very often
owing to their having been imprudently treated, or imperfectly cured,
especially by suppressing  some eruption or  discharge from the skin,
or incautiously stopping a purging, during the time of teething.   In
such cases, and, indeed, Avhenever the hectic fever is of some standing,
the mesenteric glands  become indurated, greatly increased in size,
and  often suppurate, the belly getting large, though the  limbs  and
other parts become  emaciated;  which state has been considered in
the former chapter, and has been shewn to be curable, or otherwise,
according  to the  degree  of induration,  and the length of time it has
existed.   But there is sometimes a threatening appearance of hectic
fever, where, nevertheless, nature effects  a salutary and wonderful
change, and  will  restore  the emaciated infant as from the very jaws
of death.   And this,  indeed, is  often  the work only of nature, art
doing no more than superintending, and preventing her being coun-
teracted by the use of improper medicines, or diet.
   Nature alone will, indeed, oftentimes effect wonders for infants,
and  far beyond  any thing to  be expected in adults, if she be  not
officiously counteracted.   And the reason is obvious; it being well
observed by  a late equally good writer and  physician,* that " there
is, in truth, a greater luxuriancy of life and  health  in infancy, than
in any other period in life.  Infants,  it is  acknowledged, are more
delicately sensible to injury, than  those advanced  in  life; but, to
compensate  this,  their fibres  and  vessels are more  capable of dis-
tention, their whole system is more flexible, their fluids are less acrid,
and less disposed to  putrescence; they bear all evacuations more
easily, except that of  biood;f and, which is an important circum-
  * Dr. Gregory—Comparative view of the State and Faculties of Man with
those of the animal World.  1785.
  ■j- The  general assent which  this opinion has received both in Europe and
America,  is by no means sufficient to convince  me of its truth ; especially as
my own experience tends to prove the contrary. 1 cannot but think it a preju-
dice which has arisen out of an opinion much too prevalent among medical men;
viz. that children, owing to the extreme  delicacy and frailty of their constitu-
tions, could not bear the operation of active remedies. Than  this, no theory can
be more erroneous ; yet physicians have  acted upon it,  and their practice has
been characterised  by a want of energy much to be lamented.  Fearful  and
timid in the use of his own weapons, he  has watched with anxiety the unequal
contest between the patient and  the disease ; himself observing  a  strict neu-
trality.  Fortunately for us, the darkness in which this practice originated has
pas.sed away, and the lancet is now used among children with freedom ; the
state of the system is our only guide. It was occasionly resorted to by Syden-
ham, yet it is to Ru3h that we are indebted for the revival  of the practise.  IJe 
HECTIC FEVER AND MARASMUS.
119
stance in their favour, they never suffer from the terrors of a distract-
ed imagination.   Their spirits are lively and  equal; they quickly
forget their past sufferings, and never anticipate the future.  In con-
sequence of these advantages,  children  recover from diseases, un-
der such unfavourable symptoms as are  never  survived by adults.
If they waste more quickly under sickness, their recovery from it
is quick in proportion, and  generally more  complete than in  olde^
people;  as diseases seldom  leave  those baneful effects on their con-
stitutions, so frequent in adults.   In short, a physician ought scarce
ever to despair of a child's  life, while it continues to breathe."  In
further support of this sentiment it may be observed, that their com-
plaints are not often attended with acute fever  like those of adults,
which  however salutary in some instances, 4s, from mismanagement,
or otherwise,more commonly disposed to  breakup the system, than
to rectify the machine.
  The  above-mentioned salutary  turns  in  the true hectic fever, as
far as  I have  observed, are  chiefly in that  species of  it arising from
worms, or teething; and in which I have known recoveries  after
hope had long been given  up, and all attempts been laid aside. There
is, indeed, an  atrophy in  infants for want of the  breast, or from the
unsuitableness of it, (which is the true atrophia lactentium)  or of
whatever else  may be the child's  ordinary  food, as I shall instance
in another place; but this  is not  usually attended with fever, and is
to be cured merely by making  that change, which the nature of the
different occasions points out.   Harris  recounts some  remarkable
recoveries in what he calls the atrophia verminosa, and attributes the
cures to  the  free use  of the hydrargyrus  cum  sulphure, carefully
prepared: but I have seen  none so  marvellous as  in the atrophia den-
tentium.  In  this, I have known children  after being reduced by
purging, and other complaints, lying for three months  together in the
cradle, scarcely fit to be moved, with continual fever, flushed cheeks,
emaciated countenance and  limbs, a large belly, incessant cough, and
almost without taking any nourishment, recover,  as it were in a few
days, upon rapidly cutting half a dozen teeth.
  After what  I have said on the true hectic fever, it will not be ex-
pected I should offer much on the  head vf medicines; I shall there-
fore only observe, that the chief object in this advanced  stage of the
disease is an attention to the state of the bowels.   This will be  found
to vary frequently; sometimes calling for restringent, and at others,
opening remedies.  In a view  of the former, Sydenham's rhubarb-
is of opinion that they require VS. oftener than adults, in  consequence of
the  " peculiar excitability of their blood vessels."  Without entering into  any
discussion on the subject, I will only observe, that it is beneficial inmost of their
acute diseases, and indispensable in some.—Ed. 
120
HECTIC FEVER AND MARASMUS.
beer* is a very good medicine.  Also purging with mercury, if that
has not already been  done, should even now be  attempted, since
children in this state  will often bear stronger doses of purging me-
dicines, and more frequently repeated,  than under  any other cir-
cumstances:  to these may be  added, the artificial  Seltzer, or soda
water.  Attention, likewise, should be paid to the diet, which ought
chiefly to  be of milk, rice, semolina, and such like,  with light pud-
dings: but  above all,  children should enjoy plenty  of fresh air,
and  take  as much  exercise  as their degree  of debility  may ad-
mit of.
   In Dr. Armstrong's second  edition, is  a pretty  long chapter on the
hectic fever of teething children, wherein several medicines are pre-
scribed, which the doctor apprehends may be very serviceable early
in the disease.  He speaks  of it  as  a very common complaint, be-
ginning like other fevers, and  gradually becoming remitting; then a
slow continual fever, and terminating in a fatal  hectic.  Dr. Butter
likewise expresses himself much in the  like manner, in an accurate
account he has given of a fever that frequently made its appearance,
as it should seem, in Derbyshire, which he terms the infantile remit-
tent fever; of which further notice will be taken  in its place.
   It is very probable, that  a  fever of the description given by  Dr.
Armstrong may be common among paupers, relieved at dispensaries,
and may  deserve such a name, but, I  believe, it will be rarely met
with in higher ranks of life;  and  if so, perhaps, that ought  to have
been intimated in a popular work.  It seems to me,  (and  both  Dr.
Butter, and Dr. Armstrong, indeed, say as much) to arise  from im-
proper food and nursing, joined with crudities and a costive state of
the  bowels, and  has nothing uncommon  in  it.  When  advice  is
sought for in proper time, it accordingly, appears to be nothing more
than the  fever I  have described  arising from  a foul state of  the
bowels, aggravated by neglect; and  is  easily cured by  such medi-
cines as are best  calculated to clear the first passages.   Should this,
however, not  be attended to, it may degenerate  into a continual
fever; but it is not even then peculiar to the age Dr. Armstrong  has
specified, nor, by any means, the common  hectic fever of dentition.
At this period, indeed, children call  for more exercise,  air, and  ge-
neral attention than  common people can  procure  for  them; it is,
therefore, not to be wondered at, if neglected and costive, they should
at this time fall  into slow fevers, whether aggravated or not, by the
shooting of their teeth.

   • Take of choice rhubarb sliced, two drachms;  let it be put into a glass bot-
tle, well stopped, with a quart of small beer, or any other liquor the child  may
make use of.   This medicated beer is to be his ordinary  drink. When this quan-
tity is drank, a second, and a third quart of beer may be poured on, as before;
after which the rhubarb will commonly have lost its virtue.  Should the beer
first poured on be too much impregnated with rhubarb, and purge  too  much,
another pint may be added presently after the first is drank up. 
FEBRIS SCARLATINA.
121
    Febris Scarlatina, with  or without Ulceration of the Throat.


   Whenever the scarlet fever becomes epidemic  among adults,
children rarely fail being attacked by it, in great numbers, and fre-
quently sink under it.  It is, indeed, rather a child's  disease, and
very contagious amongst them, but is not often communicated  from
them to adults.   It  has engaged the pen of the most  able physi-
cians, and is therefore well understood in this day, and needs only on
this occasion, to be adverted to  as one very incident to children, and
its most  approved method of treatment  briefly pointed out.
   The scarlet fever,  with ulcerated throat,  has perhaps been dis-
tinguished in too refined a manner, by some writers, into the scarlet
fever with malignant ulcerated throat, and the malignant sore throat
with efflorescence, or redness on the skin.   But such distinction,  it
is apprehended, is needless, since the experienced  practitioner will
always be guided by the degree  of tendency in the system either to
an inflammatory or putrid diathesis; and the less experienced will only
be perplexed by multiplied distinctions.
   One observation,  indeed, may be offered on this head, which is,
the propriety of distinguishing the mild scarlet fever  (in which the
throat is much inflamed, and slightly affected with superficial and
white foulness rather than slough,) from the more malignant kind in
which the tonsils are less swelled and florid, and  exhibit the precise
complaint  by some practitioners termed  the  angina maligna  with
efflorescence on the skin.  An error in this respect, has certainly led
less experienced practitioners to administer both  bark and wine too
early and liberally in the mild scarlet fever, which has thereby de-
generated into  a low remittent,  bordering on hectic; and unless the
treatment has been changed in a little time, has endangered the life
of the patient.
   The mildest species of scarlatina anginosa should also be carefully
distinguished from the true inflammatory affection of the  tonsils,
which it will sometimes resemble in its first stages: but the genuine
marks of the two diseases, and the cast of the epidemics reigning at
that time, will direct the attentive practitioner; who will, in  less cer-
tain cases, take a  middle course in his method of treatment, till the
characteristic symptoms of either shall become more evident.
   There  is, however, a scarlet  fever that is  not attended with any
affection of the throat, and  was long ago described by Sydenham *
though not much insisted upon by latter writers, which  is attended
with a harder pulse, and other symptoms of an inflammatory dispo-

                   * See also Withering and Cullea. 
122
FEBRIS SCARLATINA
sition, but nevertheless, in every instance that 1 ha\e met with, calls
for the same  general treatment, only more cautiously adapting  the
necessary cordials and  tonics to the degree of fever, espcially in  the
commencement of the complaint.
  The febris scarlatina of every species begins with the  common
symptoms of fever, often  with languor and  disposition to fainting,
sickness, a quick pulse, and pain  in the head.  The  eyes are  in-
flamed, and where the throat is affected, there is frequently  a stiff-
ness of the muscles of the  neck very early in the disease, which is
soon followed by some difficulty in  swallowing.   The  affection of
the neck should be  carefully inquired  into,  especially  in younger
children; the soreness of the throat being sometimes not complained
of in the most severe attacks of the  disease, until  but little prospect
remains of any mode of treatment  being attended with success; a  cir-
cumstance I was early in practice much  astonished  at,  by  finding
children swallowing with  apparent  ease, and denying having  any
soreness of the throat,  when I have found the tonsils both tumid  and
covered with specks.   The fever generally increases in the evening,
and is often accompanied with transient fits of delirium; but some
remission takes place  towards morning, with sweating;  and on the
second, or  third day the efflorescence appears on the skin, and gene-
rally first on the face, neck, and breast.
   At this time the parts tumify, especially the hands and feet;  and
the patient complains much of pain in the head; is comatose or very
restless, and is at times delirious; the tongue is in the beginning very
white  and  thy, afterwards becomes foul, and then of a florid  red.
About the  fifth day,  there  is  usually a remission  of fever, and the
eruption then beginning to scale off, disappears about the seventh.
If the disease has  been violent, the patient is  about seven days more
in a low state; and it is oftentimes a fortnight longer before he reco-
vers his strength and spirits, and in some cases, is distressed with foul
abscesses on the outside of the neck.  In other instances, after the
efflorescence has dried off kindly,  an appearance resembling the true
gangrene  has sometimes seized the whole palatum molle,  and the
fever has been rekindled; but  the parts recover their natural  appear-
ance after a few days, without any eschar being thrown off.
   The  limits of this work allow  me only to observe that the method
of cure being directed to the  two  indications  of the  general diathe-
sis, and the affection  of the throat,  the  nature and  extent of these
must  ever be kept in view, and  the system be  duly supported.
 Should  the  body be   costive  at the time of the attack, an  opening
 medicine should be  given previous  to the administering of bark or
cordials.  The throat should  be often  gargled, or  rather syringed,
with mucilaginous infusions or decoctions,  rendered more or less
 stimulant; such as the decoct,  hord. with mel rosae, warmed  with
 spir. ammon. comp.   tine,  myrrhs, decoct,  rad.  serpent, or other
 such like preparations: though the quality of the  gargle is, perhaps; 
FEBRIS SCARLATINA.
123
of far less importance, than its being frequently made use of, which
is absolutely necessary, especially in young children, in order to keep
the  mouth tolerably clean; otherwise the difficulty of deglutition will
be greatly increased, as well as the morbid mucus be conveyed into the
stomach.   On this account, also, the patient ought to wash his mouth
previously to  taking  his medicines  or drink.   In many cases where
the  parts are in constant pain, syringing the throat frequently  with
warm water, is found to administer immediate relief.
  This fever, especially when epidemic, being almost constantly of
a low type, the physician  must not  trust to saline draughts, or  other
medicines  of that class, without the addition of the conf. aromatica,
radix serpent, or the  bark, in one form or other.  A moderate quan-
tity of wine likewise, according to the age and other circumstances
of the patient, should be given with  the food, which  should consist of
whey, caudle, and such like thin and nutricious aliments; with  plen-
ty of barley water, or gruel, with a  view to promote a moderate per-
spiration.
  Should the affection of the throat, therefore, be evidently inflam-
matory, or should a case  occur where  the fever may seem to be of
that kind, (which may be better ascertained by the hardness of the
pulse than  any other symptom) it  will very rarely bear bleeding,
even in the beginning of the disease;  as  symptoms of debility gene-
rally attend in some period of the scarlet fever, and will allow only of
that middle course of treatment, hinted above.
  In a general way, a cordial plan is required throughout the disease,
and where the throat is much affected, either with  sloughs, or total
blackness,  the bark  is indispensably necessary howsover thick and
florid the rash, or however hot and dry the skin  may be; the bark, in
moderate doses, as it  were, extinguishing the fever in the milder spe-
cies, above every other remedy, (when evidently called  for,) and in
the  more malignant it supports the  system, till  the regular stages of
the  fever are accomplished, and a perfect crisis is formed.*   Young
children take it very  well, especially the soft extract, dissolved in a
strong decoction.  Should it be disposed to purge the child, a  little
of the spirit, cinnamomi, or a drop or two of the tinctura opii should
be added to it; or if the child,  on the  other hand, should be two or
three days  without  a stool, a  laxative clyster should be injected.
Where  delirium attends,  a few drops of laudanum  are often  very


  '  Children cannot commonly be induced to take a sufficient quantity of bark
internally to  produce the desired effect; it therefore becomes necessary to h;ive
recourse to other expedients, tor the accomplishment of our purposes.  Under
these circumstances we  may resort to the bath of bark, and quilted jacket, as
it is termed: this consists of a waistcoat, having bark quilted between the lining
and  external part of it, and worn next the person.  To these, we may add the
bark enema, from which  much advantage may be derived.  Whether these are
in themselves sufficient to efiect a cure, is very questionable, but  Kcrlftinly they
will  prove important auxiliaries.—En 
124
PEBRIS MILIARIS.
serviceable. If there is much external swelling about the neck, blis-
ters to the part are frequently very useful.
   A very unpleasant turn of the complaint, is a secondary fever.
which has  already been hinted  as being sometimes the consequence
of administering bark  and wine too early, or too liberally in the
milder  scarlatina.   In  such  case,  upon  the  disappearance of
the rash, the limbs,  especially  the hands  continue swollen,  and
a general soreness  takes place;  the patient loses all  appetite  and
strength, and a tendency to hectic fever supervenes.   The bark in
this case is no longer useful; but  soft demulcent medicines, and light
cordials should be administered,  with asses milk, and a light nour-
ishing diet, (if the pulse be not full;) costiveness should likewise be
obviated, and country air had  recourse to, if the patient should not
soon appear convalescent.   If the  fever be considerable,  purging,
with calomel, of which I can scarcely speak too highly, is acknow-
ledged by  most physicians to have  an  immediate good effect;  and
should be repeated  as long  as the fever continues: a small  bleeding
also, where the pulse is full, or  hard, is sometimes necessary; a criti-
cal bleeding from the nose, though in a very small quantity, having
sometimes instantly abated the  fever, when the state of the child has
appeared very hazardous, and the prostration of strength  been con-
siderable.
   In some foreign  parts, particularly Sweden, convalescents  from
this fever are  many of them seized with a partial, and some, a more
general anasarca, which often proves fatal.   Whether this be the na-
tural course of the disease, or the  consequence of improper treatment,
may be  doubted, as  their best physicians  seem  to  consider it too
much of a kind with the measles; and, therefore may direct too cool-
ing a regimen and medicines.
                Febris Miliaris, or Miliary Fever.


  I Shall be brief on this complaint, which does  not seem to be so
strictly a disorder of young children as of adults, unless from conta-
gion ; though I have seen one or more instances of it, where no other
person in the family has been so affected, and without its spreading to
any other.
  The miliaria, or  red eruption, is preceded by the usual symptoms
of fever, together with much itching of the  skin, and a very profuse
perspiration; which, however, procures  no  remission of the fever,
until the eruption takes place, which is  at the latest on the third or
fourth day.   It very much resembles the measles, but is a little  ele-
vated above the  skin, giving it a very rough feel.  It is sometimes
intermixed,  from the  beginning, with very small crystallines; which. 
tfYNANCHE PAROTIDEA, OR MUMPS.
125
on the other hand, often do not appear for a day or two afterwards,
and come out in successive crops,  especially, if the  child be  kept
over-hot.   Some of the red eruptions  are often larger than  others,
and resembles those in the scarlet fever, with which the miliary rash
is also sometimes thought to be mixed, in seasons when eruptive com-
plaints are very ripe.
   Previous to the eruption, as well  as some time afterwards, the pa-
tient is usually very thirsty, is hot and cold, by fits, and the breathing
is short and difficult.   The  urine  is high-coloured, there is a slight
delirium, and sometimes a sore throat, especially where the eruption
is  broad  and very florid.
   Children generally revive as the  rash comes out freely; but unless
the complaint be very slight, the fever is rekindled, and they acquire
no appetite for food until the eruption begins to turn dry.
   This fever being of the low kind, is attended with great languor,
and calls for support; on which account both the medicines and diet
should be of the cordial kind.   White-wine whey, and wine in the
panada and sagoe,  in proportion to the degree of debility, are gene-
rally  necessary even for children of only a year or two old.   The
saline draught with confect. aromatica, and mistura camphorata is a
good general medicine; and if the  symptoms are more aggravated,
the bark, volatile alkali,  and  the  spir. aether, vitriol, compositus:
blisters  also are often very useful.   A stool  should be procured
ence in two days by means of a clyster, or a  little  rhubarb;  and*
plenty of-drink be allowed, which may be lightly acidulated,  and at
times taken cool.   The chamber should be kept airy, but the child
screened from the wind, and be confined  to the bed, until the rash
disappears.
   If on  the rash drying away, which in  the milder  species,  is in
three or  four days, no fresh eruption  should take place, the appetite
and spirits soon return; and only a little rhubarb, or other gentle laxa-
tive, is required, with the usual cautions in regard to diet, so neces-
sary for  every convalescent, and especially children, who have no
discretion of their own.  But if fresh crops appear, and the fever re-
turns, the former plan must be continued: but if without fever, a few
doses of physic, and quitting the warm bed will, probably, put'an end
to the complaint.
                 Cynanche Parotidea, or Mumps.

  This is a tumour of the neck and throat, giving that peculiar cast
of countenance  from which the complaint has acquired the English
name.   It is usually only a slight disorder in children, but as it ad-
vances, the skin becomes  inflamed, putting  on a light damask-rose
'•olour; but the  parts very rarely suppurate, which  is the more re- 
126
CVNANCHE PAROTIDEA,  OR MUMPS.
 markable, as the disorder seems to be seated in the cellular or adipose
 mnnbrane.  This, however, does sometimes happen, but the abscess
 always heals kindly.
   It is a complaint rather of young people than of infants; but fre-
 quently attacks children of five or six years of age.   It is certainly
 contagious, and is often an  epidemic  disease.  It begins  with  the
 common symptoms of,fever,  which are usually slight, but the  tongue
 is frequently covered with thick fur, or is very white.  The patient
 complains early of a stiffness and pain of the neck,  and genepallythe
 next day of a soreness of the  throat; but this seems oftentimes to be
 merely symptomatic, the tonsils being rarely inflamed.  At this time,
 a fullness of the neck may be discovered, which gradually extends to
 the throat, and the parts become tender to the touch, and in some in-
 stances, the pain is exceedingly great, and recurs suddenly with al-
 most regular intervals.   The tumour generally continues to increase
 for two or three days, and then as gradually subsides.
   In general, very little medical treatment is required, it being suf-
 ficient to confine the patient  to the house: at most, to give night and
 morning,  a few grains of the pulv. contrayervae com. with, or with-
 out, a small proportion of nitre, and to procure a stool once in twenty-
 four hours.   But should an unusual degree of fever attend, as is more
 common in such as are advancing towards puberty, bleeding will be
 found necessary in the beginning, and the patient should be kept in
 bed  for the first or second day, and take  a saline draught with nitre,
 once in six or eight hours.  On the other hand, should it be attended
 with any uncommon languor, the conf. aromatica may be given in-
 stead of the remedies before  mentioned.   When the swelling is tho-
 roughly subsided,  two or three gentle laxatives may be  administered
 at convenient intervals.
   In a few instances, after  suppuration has taken place, and the
 sores are healed up, a hardness of the parotid  and  maxillary glands
 remains, which is usually soon dispersed by rubbing in a little mercu-
 rial ointment, or sometimes by only anointing with  the common lini-
 menturn ammonia?.  Should it, however, prove tedious, a few doses
 of calomel, and  common laxatives should be exhibited,  at proper in-
 tervals.
   In adult males, or such as  are growing up to manhood, the tumour
 of the neck has sometimes been found to  subside very suddenly with-
 out any abatement of the fever, and  then the testicles have been as
 suddenly inflamed; which is attended with more pain and fever than
the swelling of the neck, and is cured more slowly;  upon this metas-
 tasis, bleeding is always proper, though these parts  have never been
found to suppurate.*

  *A swelling of the testicles attended with  pyrexia, but unaccompanied with
any affection of the glands of the  face or throat, was epidemic not long since at
 Wallingford, in Uerkshire, as reported Dy Mr Golding. 
HYDROCEPHALUS.
127
  A translation from this part again, is  sometimes very suddenly ef-
fected, and the irritation then generally falls upon the brain;  and the
worst consequences are justly to be apprehended.   Every thing ne-
cessary and proper for  the true phrenitis is then speedily to be had
recourse to, and the  tumefaction invited to  the parts it has  left;
and until  that can  be effected the patient" will be  in great  danger.
Such a metastasis is much more common in  North America than it
is amongst us.'
                           Hydrocephalus.



  This complaint is distinguished into the external, and internal; in
the former, the water lies upon the surface of the  brain, over the pia
mater, but in the latter it is  seated much deeper, within the ventri-
cles.   The external makes it  appearance at, or  it is said, in some
instances, soon  after birth; though it is certain,  that  children with
hydrocephalus externus are more commonly still-born.   I have,  ne-
vertheless, known three arrive  to full  ten years  of age,f who were
then unable to walk, or even to sit upright in a chair.   From a late
instance,  however, I have learned, that when no symptoms of hydro-
cephalus  appear at  the birth,  although the enlargement should be
manifest very soon afterwards,  and  increase  rapidly, the water is
soine'iitnes, at least,  contained  within the ventricles of the  brain4
and from  the circumstance of no children living long with an internal
hydrocephalus, but such whose heads enlarge within a few  months


  * Under these circumstances the antiphlogistic plan  of treatment  is to be
adopted in toto ; purgatives of the most active kind are to be administered ; the
lancet is to be used freely, yet it is to be directed by judgment, and tempered by
sound discretion.  A blister, covering the  whole head, will  be attended with
much  advantage; yet it will be very proper to  shave the head, several hours
previous to its application.   By observing this precaution, two  objects are at-
tained: first, we have an opportunity of making cold applications to the head.
which may render the blister unnecessary ; and, secondly, we avoid stranguary,
which always proves an unpleasant symptom : why the shaving of the head a fen-
hours before the application of the blister should be attended with this effect, is
not very intelligible, but of the fact there can be no doubt—Ed.

  f See Medical Communications, vol. 1, in which there is mention of two  peo-
pie then living, one ot whom  had attained  the age of 29,  and the  other 45
years : the former did not appear  to have any enlargement of the head for three
weeks alter birth.

  * In the Medical Journal, vol. 2. p. 1,  an instance is related by Mr. E. Ford oi
a child seized with symptoms of water in the head, at the  age of nine years,  who
 ived eleven months afterwards;  during the last eight of which he was unable
to stand upon his feet.  After death, the features were found to be separated to
a considerable  degree, the ventricles containing eleven ounces of water, bu'
were was no water exterior to the brain. 
128
HYDROCEPHALUS.
afterbirth, I should suspect the disorder has, in such instances, taken
place in the womb.  The fetus, at this time, enjoying only a kind of
vegetative life, may tome to maturity under such a disease; various
instances  being met with, in which full  grown fetuses  have had
neither head, nor heart, nor lungs.  Accustomed  to the above-men-
tioned disease, we may presume such infants more likely to live for
a certain time with water in  the ventricles, than those in  whom the
disease is supposed to take place, suddenly, after birth.
   In the instance  alluded to, the child's head began to be  sensibly
enlarged when the infant was about four months  old,  and the child
lived to the fifth year,  unable to walk, or  even  to support its head.
Upon a careful examination  of the  parts after death,  the water, to
the quantity of three  pints, as I  am informed by  the  surgeon, was
evidently  contained within the ventricles, which were so stretched as
to compress the brain in  such a manner, that it appeared only like a
smooth thick membrane  within the dura mater;  and of all the solid
contents of the skull, scarce any thing but  the cerebellum remained.
Tulpius, Hildanus, Vesalius,  and Morogagni,have noticed  the like in
children from two to five years  of age; and it must, therefore, be still
more likely to happen where the hydrocephalus internus has taken
place in the fetus in utero, when the brain is much more tender.   Dr.
Whytt of Dublin likewise, mentions no less than three instances of
the same kind, in  which the  brain was so compressed by the  great
quantity of water within the ventricles, as to put on the appearance
of only a  small gland.                            _    ,
   The external  hydrocephalus, at  whatever  period  it  may  com-
mence, has always been esteemed a fatal, as well as  most distress-
ing complaint; but I have been informed, that where the disorder has
not been very manifest at the birth, blisters on the head have sensibly
diminished the bulk.   These should be applied, successively, to dif-
 ferent parts, especially along the top of the head, in the course of
 the longitudinal sinus, so as to keep up a constant discharge; which
from the  good effects in  two or three cases, when had recourse to in
 good time, may possibly, in  some instances, effect a perfect cure: at
least the advantages already observed are  sufficient to justify the at-
 tempt in a disorder hitherto esteemed incurable.   In a late publica-
 tion however, by Dr. Hill, we have the account of an effectual cure,
 under the employment of oxygen gas", after the head had acquired an
 enormous size.*
    Of the internal watery head it may be proper to treat  more large-
 ly   This  melancholy  disorder  seems not to have been  distinctly
 known to the ancients,  though there can be little doubt, it must often
 have been met with;  but the want of those frequent examinations ol
 dead bodies which the moderns  have made, deprived them of those

   • Practical Observations on the use of Oxygen, or vital air, in the cure df
 diseases, &c 
                        HYDROCEPHALUS.                    ,'-a
                         \
opportunities of distinguishing this disease from affections of the head
arising from other causes.  Hieronymus Mercurialis,* who wrote in
the beginning of the sixteenth century, was, perhaps, the  first who
mentions the disease as  having its seat in  the ventricles.   Wepfer
also just savs, that water  has been found in the cavities of the bratn.t
Boerhaave," Petit, and others, have likewise spoken of it; but no au-
thor, I believe,  described it at all accurately before Dr. Whytt, who
wrote expressly on the internal watery head, anno 1768.   But it has
not been generally noticed, that the water lies  sometimes between
the pia mater and  the brain, as it is found to do in maniacs; and I
have met with it both there and in the ventricles,  in the same sub-
ject, and always in infants under two  years old.
   The hydrocephalus, indeed, is said usually to take place between
two and ten years of age;  but I have known so many instances of
water in  the  head being found after  death, in  children under two
years of age, that this account of it, probably, is not very accurate.
I have noticed  this early appearance twice in the same family;  the
infants also dying suddenly without any previous mark of the disease;
but as no  dangerous  symptoms of any other  kind attended, it can
scarcely be doubted,  that the  water found in the ventricles was,  in
these instances, the true calise of the sudden death; as I am satisfied
it  hath sometimes  been in others, by producing a fit.   This com-
plaint, however, at whatever early period  it may commence, is also
found  sometimes to take place later than  the  tenth year.  It is a
like dangerous complaint with the  hydrocephalus externus, and  the
method of treatment not  yet well established; and as it can scarcely
be ascertained whether any have recovered from  it, (the certainty of
its existence rarely being known but by examination  after death,) it
is  not likely that a very  determined and successful  treatment  will
shortly be settled.
   It may arise from falls  and blows on the head, from scirrhous  tu-
mors  and excrescences within the skull; a watery state of the blood,
or a lingering illness.  It may likewise, probably, be owing to pres-
sure  on the  brain, and fulness of  the vascular  system from other
causes, as conceived  by Dr. Quin.  I  have, at least, met with one
case, in which  there were all the  usual symptoms of water in the
ventricles;  and the late  Dr. Warren, whom I met on the occasion,
was fully of that opinion.  But upon  examining the  head  thirty-six
hours after death, a great  number of sharp points of bone were found,
and  especially  of the spinal  process of the os  frontis, which was
most uncommonly long and sharp. . The vessels were all found very
turgid with blood, and  there were light, flakey appearances on  the
pia mater, similar to those found on the peritonaeum pleura, and other
membranous parts  in a state of inflammation.  In t!v  > case, only half

  * Opuscula aurea, Lib. de Morbis Puerorum.
  r Histor. Apoplccticorem
                               n 
130
HYDROCEPHALUS.
an ounce of water was found in the ventricles.   A similar remark is
made by Mr. Edward Ford,* who observes, that more remote causes
may be an inflammation of the vessels of the pia mater, which may-
owe its origin  to the  measles, small pox, scrofula,  and other com-
plaints; which may affect the  brain in the same manner they do the
mesenteric and other  glands.   As the disease  may originate from
such different causes, there can be no doubt that it may sometimes
be a chronic disease,  and its appearances very insidious.   It appears,
likewise,  to be a family complaint in some instances;  for  I have
known six children, born of the same parents, die successively of it
at the age of two years, five of whom were  afterwards opened.!—
Children  with  a large head do not seem to be  more subject to this
disease than other children.
   The attack  is sometimes very sudden; but  the complaint more
commonly begins with the appearances of slow fever, especially in
older children, with debility of the arms, and pains in the limbs, and
frequently in the upper part of the neck.   It has also been remarked,
that in the commencement, the child has appeared to be more acute
and lively than ever before, but the spirits decline as the disease ad-
vances.   After a while, the child is suddenly seized with pain in the
head,  and generally in the fore part,  and retches once or more: it
becomes heavy and dull; can bear no posture but that of lying hori-
zon, ally; the pulse becomes irregular, but usually very slow:  in the
progress of the disease the  faculties and senses are impaired, and the
eyes are offended by the light; the patient sees objects double,  and
becomes  delirious.   As the disease advances, the pulse grows  fre-
quent, the cheeks become  flushed, the pupils of the eyes are dilated,
the stools and  urine  come away  involuntarily, and the patient lies
sleeping, or is convulsed, and at times in great pain.
   In  the youngest subjects, I have  known it  begin  with a cough,
quick pulse, and difficulty of breathing, attended with circumscribed
flushed cheeks, as in teething, recurring on every little exertion, with
continual fever and costiveness; and sometimes a discharge from the
nose and eyes.  Other symptoms indicative  of the  disease  in very
young subjects are, a hand often put to  the head, or lifted upwards,
 and  waving about;  vomitings; costiveness;  expression  of anxiety,
 and  dislike to be moved;  at  other times, an unmeaning look,  and
 marks of insensibility; the fingers often clenched, and hands tumid;
 drowsiness; picking   of the nose, and grinding of  the teeth during
 sleep, as in the case of worms: the eyes are  in  some cases impatient

   *  London Medical Journal,  vol. ii, part 1.
   f This is undoubtedly correct; for, though my own observation in this disease
 is very limited, yet I am  acquainted in one family, three of whose members have
 already died of this disease, and a fourth has suffered much from an affection
 of the head, which, however, was  fortunately arrested  in its commencement, by
 the judicious, but decided practice that was adopted by the physician in attend-
 ance..— Ed. 
HYDROCEPHALUS.
131
of light; in others, vision is so imperfect that the child does not regard
any objects, however close to them;  and before this period, one  or
both the eyes are in many instances turned towards the nose.  The
pupils are often not dilated till near the close of the disease, and such
young patients sometimes hear and comprehend, and take food to the
last, and die suddenly upon the decline of the febrile symptoms, when
they have been thought to be recovering.   These  and other symp-
toms, however, laid down as indications of water in the brain, arc,
in some degree, common to other diseases of children, especially the
dilatation of the pupil and sleepiness,  in fevers arising from foul bow-
els, as will be noticed below; which, I am persuaded, are sometimes
mistaken  for the fever of hydrocephalus.  In such cases, some chil-
dren have been erroneously thought to have recovered from this dis-
ease, especially  if  calomel  has  been  administered, though with
another view; while others have perished from improper treatment,
and  mistaking their complaiut.  Perhaps, the most decided symp-
toms early in the disease (at which time it is of the most importance
to ascertain it) are, an inclination to  lie  on the back, and unwilling-
ness to be moved, and an increase of pain in the head upon  being
raised from a supine to  an erect posture; but especially  an  almost
constant drowsiness, and a tendency to fall asleep, after being roused
by being  lifted up, or otherwise disturbed.  Sometimes,  however,
neither these, nor other decided symptoms are  found  to take place
until the second stage of the disease.
   Though it is sometimes a very short disease, and at others of many
months standing, it seems always to be divided into three stages;*
which are best distinguished by the state  of the pulse.   In the first,
the pulse is always quick as in other complaints attended with fever:
but  the true nature of  the disease is often overlooked till the next
stage,  in which the  pulse is slow, irregular, and often intermitting;
and in the third it  becomes again very quick, and usually regular.
The urine frequently deposits a sediment of a light consistence, and
white  colour;  and the  breath  has  an offensive and sickly smell,
especially in the last stage.
   From  what has been advanced, it is  difficult to say if medicines
are so often successful as hath sometimes been imagined; for when a
patient recovers, it has been said, it may be suspected he has not had
the true disease.  I offer this suspicion as well from my  own expe-
rience, as from the doubts entertained by other writers;  having some-
times been persuaded,  (and  supported  in that opinion in consulta-
tions,) that infants have  been  ill of water in the head,  who have
afterwards  recovered from the use of medicines adapted to fever
from a foul state of the bowels.   Two such children, besides the di-
lated pupil and other usual symptoms of hydrocephalus, lost the use
of their speech, (and one  of them, of the  sight) for several day; but

   ' See a Treatise on this disease by Dr. Charles William Quin.  Anno 1790, 
132
HYDROCEPHALUS.
recovered after a daily discharge of very uneoniinon stools, resembling
the meconium of infants.   And it is very remarkable, that only calo-
mel brought these away; the  experiment being repeatedly  made by
omitting it, and giving only the ipfusion of senna: but upon  the calo-
mel being exhibited again, the same stools were always observed, as
black and adhesive as meconium,* and in very great quantity, until
the children perfectly recovered.
   Whatever may have been supposed to be the immediate cause of
hydrocephalus, practitioners seem chiefly to have depended on  re-
peated bleedings; purges with jalap, or calomel; blisters to the neck,
or head,  diuretic medicines,  and  the external use  of mercurial
ointment.  A large bleeding early in the disease I have thought very
beneficial, especially in children of a robust habit.   The use of ster-
nutatories, as  the  compound powder of asarum, or  white hellebore,
have likewise been recommended by some experienced practitioners;
and  possibly,  with some little  prospect of advantage, some  children
having recovered in consequence of a discharge of a  thin fluid by
the nostrils, as Dr. Harvey acquainted me  he had  seen in two  in-
stances.   With  a  view  to promoting  absorption, electricity  has
likewise been  recommended: to all which I would  add the applica-
tion of a  narrow caustic upon  the head, along the  whole  course of
the longitudinal sinus, instead  of trusting to a small blister on  the
crown.
   Dr. Garnett has some very  good  remarks  on this disease, which
he conceives to arise from an inflammation of the brain, and says the
water is not always met with; and that it may not therefore be the
source of the disease, but rather an effect; that it  should be treated
as inflammation by cooling remedies, when assistance is called for in
the first  stage, which is not always the  case.   He  remarks that he
has recovered three children by bleeding (or by leeches in young sub-
jects) blisters, nitre, calomel  and mercurial  ointment, and keeping
the bowels open;  and by the  digitalis.  To this I can add my own
experience of  early bleeding, and the antiphlogistic plan, having prov-
ed successful where I had  no doubt of the existence of the precise
disease.   In regard to  blisters, there seems to  be great, propriety in
the suggestion of  Dr.  Clarke, that they should be applied to the legs.
in a view to derivation from the head.
   Mr. Recards  of Brentford,! speaks  highly of calomel,  some
drastic purgative; also of squills (as a diuretic) and the patient  be-
ing supported  by  bark;  for a child of eight years old  he  directs as
follows:

  • Stools of this colour take place  in the month, long after the meconium seems
to have been duly carried off. when  infants are very dangerously ill; though it is
at other times a  very harmless symptom, as will be remarked  hereafter, where
notice is taken of suckling, and sore nipples.
| Medical and Physical Journal. 
HYDROCEPHALUS.
133
   $,. Pulv. Cortic. Cinchon.  fi»v:  |i.
        Tinct. Gentian, tomp  3s».
        Aq : distil.  §;ii ss, nuscc.
        Suniat. Cocui. ij. quartis horis.

Every other  morning, the  calomel  and jalap, or gamboge, or aloes,
or even pulv. Elateni gr.ij. if the costiveness be very obstinate.

   Though  I have made  mention of mercury, I cannot say I have
seen any decidedly good effects from its use, either as a purge or  an
alterative (after the  disease has  been  clearly ascertained;) adminis-
tered  either externally  or internally, though I have  had recourse to it
very early as well  as  late  in the disease, and  in  consultation with
different practitioners."   Should the use  of it, however, be deter-
mined upon; in whichever way  it may  be advised,  it should be  as-
sisted  by diuretics.   Calomel  is probably the  fittest preparation  for
internal*  use; though the  quicksilver, together with diuretics,  has
  • That an observer so accurate, and a  practitioner so experienced, as our
author, should entertain such an opinion  as is here expressed, excites our sur-
prise, while it diminishes our confidence in the remedy.  It is with  much  hesi-
tation that I venture to oppose Dr Underwood's authority  upon a point of prac-
tice, yet such opposition  seems peculiarly  necessary in the present instance;
for the overthrow ol the mercurial plan of treatment (unless its place could be
supplied  by some article  equally powerful) would be pregnant with much
mischief to our profession.  Admitting that  this article proves a weak  and fee-
ble weapon when opposed to the disease in question, and this I am by no means
prepared to admit, yet it has in some cases proved successful; and who would
not prefer entering the lists with weapons confessedly fragile, than to encounter
his enemy, unarmed  and defenceless ?  It is, we confess, difficult to account
for the uniform ill success which has attended our author in the use of mercury,
whether employed as " cathartic or alterative, internally or externally, early or
late in the disease."  Without detracting from our author's credibility,  we may
observe, that it would be unjust and illiberal  to reject at once, the testimony of
Dobson, Hunter, Armstrong, Buchan,  and  a host of names equally respectable,
that might be enumerated   We are not without strong evidence in our own
country, in testimony of the efficacy of the  mercurial practice  in  this  disease.
In this city it has certainly succeeded in two or three cases after the  death of the
patient had been predicted with much confidence.  One of the cases to which I
allude is the  daughter of Dr. Chapman, professor of the practice of physic in
the University ol Pennsylvania.  The child was attacked with the various symp-
toms of hydrocephalus, which continued to increase, until  all doubt as to the na-
ture of the disease had ceased.  Most of the remedies commonly recommended
were tried, but no advantage was derived  from  their use.  Death appeared
inevitable.  So circumstanced it became a duty to adopt any plan which afford-
ed a ray of hope ; the disease was desperate, and remedies of the most power-
iul kind were requisite to meet the crisis.  Mercury in its various  forms were
employed with  a liberal hand : Calomel was administered internally,  and the
unguent was externally employed ; flannel drawers, thickly smeared with it,
were worn by the patient, while her feet were placed in socks lined with the
same.   The bed linen was not changed, and the unguent used  was of double
strength  At the end of fourteen days, a gentle ptyalism  came on, and the pa-
tient soon recovered. During the period above specified, upwards of nine l»mnds
 :if the unguent had been used.—-Ed. 
134                    HYDROCEPHALUS.
been thought to be administered with success in the following form,
to infants of two or three years of age.

     B,  Confect.  Aromat. 3j.
        Hydrargyr. puiif. j)j.
Simul terantur donee plobuli visum fugerint.
     Rj   Massae supraprsesctipiae  9 ft
        Pulver. Scillae ;;r. ft
        Aquae  Menth. sathae  § ft.
        Spir. .fother. niliosi. ^u>.  x.
               Misce,
Fiat haustus, bis terve in die sumenduS.

   The external application of mercury has, however, been more ge-
nerally preferred, as acting more powerfully on  the  system,  and
creating less disorder in the bowels.  Some physicians have directed
it to be used both externally and internally; and it may be so made
use of very freely, as a salivation  is not very easily raised in young
children, especially in this disease.
   Though I have said that I cannot boast of success in the recourse
I have had to mercury, it is proper, however, to observe,  that it has
been strongly recommended by Drs. Carmichael, Smith, Dobson, John
Hunter, Ha;, garth, Moseley,and Armstrong; but I am informed by other
physicians of eminence, that they have not been so successful in the
use of it; and some good arguments have lately been advance.!;-?.;-Inst
an indiscriminate recourse to it, by Dr. John Warren,  who  advises
trial to be made of emetics.
   The digitalis purpurea has lately succeeded in one instance, and
that a most unpromising one; the  patient, a youth of about fourteen
years of  age, having been some time greatly convulsed, and  able  to
swallow  only with great difficulty.  This  medicine was  given in a
strong tincture, half an ounce of the dried  leaf being infused in two
ounces of brandy, of which from five to twenty drops were taken once
in five hours.   It acted, as usual, \ery powerfully  as a diuretic, but
without  producing  any unfavourable symptoms,  and though it was
long  ago given unsuccessfully in  some instances, by the late Dr.
Fothergill, may be worthy of further trial; but should generally  be
joined with aromatics, or with asafostida.
   As I am always  happy in the  opportunity of  reflecting any  light
upon obscure diseases, I shall  close these  means of cure  with some
observations from  Drs. Percival* and Temple, as  well  as from Dr.
Rush, at*l since confirmed by  Dr. Paterson; but not having had ex-
perience of their  efficacy, I offer them only as  the  sentiments of the
several writers.
''  See Medical Facts, vol. 1. 
HYDROCEPHALUS.
135
  The lattter is decidedly of opinion, that the commencement of this
dis, ase is always  truly inflammatory, being what he calls a phrem-
cula, or diminutive species of phrenitis, and that it should be treated
boldly as an acute disease: the aqueous effusion,  he is persuaded,
being the mere  effect of  inflammation; the tender structure  of the
brain, during infancy very probably rendering that viscus more liable
to such a consequence than it is at a  more advanced age.

   Dr. Rush  speaks of great success in treating the complaint agree-
ably to this idea,  and  advises,

   1st. Bleeding, which in some cases he directs to be repeated seve-
ral times in the first stage of the disease.
   The second  remedy in  this stage is,  purging, plentifully and
repeatedly; to  which he  was first encouraged from the benefit de-
rived from that remedy in palsies, and other cases of congestion in
the brain.
   3d. Blisters  to the  head, neck and temples, for  the relief of the
pain  in the head; which are, therefore proper in any stage of the
disorder.
   4th. With the like view, linen cloths,  dipped in cold vinegar, or
ice water, and  applied to the forehead.
   5th. Mercury, particularly calomel, as a purge, in any stage;  but
mercury in larger quantities, as a stimulant, as soon as may be after
the inflammatory action of the system is sufficiently subdued by pre-
vious evacuations, or otherwise.   Bark, wine, and opium,  he says,
promise success only in the last stage of the disorder, assisted by mer-
cury, where  the state of the system may call for them.

    If we may place much  confidence in  these observations of Dr.
 Rush, whose theory appears  to be supported by plausible reasoning
and the history of several successful cases, some  further light seems
to be thrown upon this dangerous disease;  and the  indications for the
antiphlogistic plan, to which I have long  been partial, particularly
bleeding, and that often topical, and the proper use of mercury, point-
 ed out with somewhat more precision than thitherto.
   The chief doubt remaining, is, that his patients  may have recover-
 ed from some  very different complaint,  particularly fever from foul
bowels;  in which it has been said, both the head  and eyes are often
 greatly affected.   And this  may  be the  more apprehended,  from
 many of those who die of hydrocephalus being very tender/and pre-
 viously sickly  children, who can neither endure much evacuation of
 blood, nor much purging; and in  whom, indeed, there are no symp-
 toms of  congestion either of solid feces, bile,  or other alvine stimu-
 lant. 
136
HYDROCEPHALUS.
   The intentions of cure as laid down by Dr. Percival arc "very si-
 milar to the foregoing, being calculated, he says,

       To mitigate the pain and spasm ;
       To promote absorption ; and
       To increase the serous excretions.


   When the pain and spasms are considerable, he advises opiates in
 large and repeated doses, unless there be  coma, and in  that case, he
 substitutes musk combined with sal cornu cervi.   He directs  repeat-
 ed blisters to  the head, and recommends joining the digitalis with
 opium and calomel; though he is  inclined to think, that the good
 effects produced by this composition are rather attributable to the com-
 bination of the opium and calomel, than to the digitalis. If the mer-
 cury be disposed to run off  by the intestines, he guards  it further by
 opium.
   Dr. Temple*  having observed, that the  doronicum  germanicum,
 administered in some paralytic affections, was disposed  to excite the
 cuticular vessels  in the head,  in a very extraordinany manner, pro-
 ducing a copious sweating of the part, was led to advise it in hydro-
 cephalus internus; and in a recent instance with marked success, in
 consequence of an abundant perspiration from the head.   Opium and
 calomel were, indeed, joined with it, but as it is not known, he says,
 that such effects have been produced from the combination of mercury
 and opium, he concludes, that  the  doronicum  had a  considerable
 share in them.f
   Since the last edition I am able to speak more decidedly  in favour
 of Dr. Rush,  with the very important addition, however, of opium
 with the calomel, and the use of the  digitalis,  first  recommended, I
 believe,  by Dr.  Percival;  by which, success may be   expected be-
 yond what has been experienced from any other mode  of treatment,
 in cases decidedly hydrocephalic
   As a  prophylactic, or preventive, where several children in a
 family may have suffered by it, some  writers have advised  a  caustic
 to be applied to the nape of the neck.  And other  physicians have
 thought, that the progress of  the  disease  has been stopped, after
 threatening symptoms had taken place, by covering the  whole crown
of the head with a blister, and keeping the  sore open for  a year or
  * See his Practise of Thy sic.

  fit hence appears, that Dr. Temple had not eeen Dr. Percival's remarks on
this disease. How very differently do men oftentimes argue from the same
fact! 
OBSERVATIONS ON VARIOLA AND MORBILLI.           137
more; of the good effects of which, I  have  seen one  instance,  in a
family where the complaint had been three times fatal.*



    General Observations on Variola and Morbilli, with Cursory
                       Remarks on Inoculation.


   It will scarcely be expected, that I  should treat  distinctly of  the
small-pox,  or the measles in their several  varieties, being in  no re-
spect peculiar to childhood, nor of a nature to demand a  full inves-
tigation in a work of this kind;  and are noticed only  to point out a
few principal indications, and to introduce  some practcial  observa-
tions in regard to inoculation.!
   Though  the  small-pox is a complaint so incident to the early part
of life, that comparatively few children, living to the age of eight or
ten years, are found to escape it, yet it is not so  readily communi-
cated, in the state of early infancy, as  hath been generally imagined,
unless by immediate infection.:}:   This is equally true in  regard to


   * It may  be worth  noticing in this place the manner of  making a perpetual
blister, or what is called a perpetual issue, at Edinburgh :  which is, by apply-
ing a  plaster, consisting of equal  parts of emplastrum cantharid. and cereum.
This, it is said, does not erase the cuticle, or  erode the parts under it, but leaves
them entire, and suffers the hair to grow up.  As these in ten or twelve days
push off the plaster, it is necessary to leave it off;  and as soon as the skin can
bear the razor, to take off the hair, and apply a fresh plaster.  This gives less
pain, is  free from the inconvenience usually attending the blistering  plaster,
where the cantharides is absorbed, and gets into the blood,  whereby a strangury
is brought on.
   t I copy the following observations from Dr. Pearson, (Medical Review and
Magazine for August 1799,) that inoculation for the small-pox was strangely
neglected till  introduced into England  from Constantinople; although it bad
been practised time  immemorial in  the Barozzo mountains on the frontiers of
Gallicia, in the same rude manner as it  is  at this day.  This intelligence, Dr.
Pea; son observes, was communicated to him by a Portuguese nobleman, whose
opportunities for information and accuracy  authorised the Doctor to mention
the fact: but an attested account from some of the inhabitants of those mountains
is intended for him.  See a book written by Jacobus a Castra de Sacramento, in
which Dr. Pearson says he is informed this fact is asserted.

   $ Some evidence of the propriety of this assertion may be gathered from the
consideration of there always existing a far greater number of  infants within the
month,  than of children of any other age;  and for  the like reason, a greater
number of those under a year old, than of such as are two or three years of age.
Forjit is evident, that every infant, dying at the earlier periods, must reduce the
number to which those of the more advanced ages might otherwise have amount-
ed ;  whereas, all the children who arrive to two or three years of age, having
been first infants  in the  month, and  of one  year old, the number of the latter
periods  is not diminished by the death of  those of a more advanced age.  Now,
every one knows how very "few infants he has heard  of who have  received the
imatl-pox, naturally, in the month, or even within the year; though fewer of these
are inoculated than of children above a year  old.   And this exemption from the
natural small-pox  does not seem to arise from their not being exposed to the ordi-
nary means of contagion, especially among the middling and lower  ranks ofpeo-
S 
138        OBSERVATIONS ON VARIOLA AND MORBILLI

many other diseases, as I have noticed elsewhere, and the principle
may very probably be, as  conceived by Mr. Kite, that the  younger
and weaker the subject is, the less of life it possesses, and the less
susceptibility it has for these  complaints.
   The  poor furnish frequent instances of the truth of this observa-
tion.   I have attended where children born  in an air, saturated, as it
were, with the miasma of this disease, and even lying  continually
in a cradle in which another  child has died a few days before, have,
nevertheless, escaped  the disease, and sometimes, when they have
slept together in the same bed with one  loaded with  it.   Hence it
appears, that highly tainted air, and  even  personal contact, are often
insufficient to communicate the virus.   Yet  we  know that infants
are very easily infected,  receiving the small-pox by  inoculation as
readily as adults; though neither are at all times  equally susceptible
of it.* Perhaps this latter circumstance may not always be sufficiently
attended to;  the mode of inoculation being often blamed, when its
failure may be owing to the indisposed habit of the child.   Possibly,
on this account it may not be  perfectly safe to urge it, at such a time;
at least, instances are not wanting, where  twice introducing the
virus having failed, an infant  has  had the disease very severely, and
even fatally, upon its being repeated  a third  time.   In no other view,
I imagine, can the repetition be accounted hazardous; and this holds
out encouragement to such as from any uncertainty in regard to inr
fection, may wish to  be  inoculated  once or more; Dr. Richard de
Hautefiercyt  having inoculated a young person every fortnight for a
whole year.  The first of these operations communicated the dis-
ease, and the subsequent ones in no wise injured his health.
   The like observation will  apply to the  measles; I mean, the indis-
position to contagion  during  infancy.   I have known, in more than
one instance, a twin escape the disease, while the other child suffer*
pie, who form the bulk of mankind ; since the medical men who usually attend
such lying-in rooms, are very much in  the habit both of visiting patients in the
small-pox, and of inoculating, all the year rouud: and even in the higher ranks
of life, if gentlemen in the general practice ot physic happen to be consulted,
the chance of their visiting at the same time infected patients is not so small as
may be imagined ; not to speak of the  probability there is, that some one of the
numerous visitors, during the month, may, by accident or otherwise, have been
in some infected house in the course of the day in which their visits may be
made.

  * Dr. Young inoculated several children at the Royal Infirmary at Edinburgh
at about a week old ; yet in none of them could he perceive the infection to take
place.  And a respectable physician lately informed  me, that he knew a young
woman to be inoculated eight times in  the course of thirty days, who also at
the same time attended several children who had the small-pox from inoculation,
mid yet was not infected herself. She, nevertheless, caught that distemper about
seven weeks afterwards, and died of a confluent sort.
f Nic. Itosen-von Rosenstein. 
            OBSERVATIONS ON VARIOLA AND MORBILLI.         139

cd by it severely, and both were nursed in the same  apartment, and
suckled by the mother.
   But in whatever way either of these diseases 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
caution and tenderness; as infants cannot bear the powerful  anti-
phlogistic regimen and evacuations, often proper for the other*
   In regard to the disease itself, it may just be observed,  that  in the
mild distinct small-pox the eruption  does not appear till the fourth
day inclusive  from the  attack; but in the severe,  confluent kind, on
the third, and even sometimes early on the second day. In the former
also, the fever and other complaints usually vanish upon the eruption
appearing on  the skin, whereas in the confluent,  however it may
abate for a short time, the fever is rekindled,  and  increases with the
progress of the disease.   There are likewise some peculiarities in
regard to young children, both in the mode  of attack, and in the
symptoms attending the latter stage  of the  disease, which may be
slightly noticed  in this place.   The vomiting, shivering, and pain in
the back and  head, being rarely succeeded  by a sweat in infants,
and is far less common in all young children than adults, under any
of their complaints, and is less  commonly salutary or critical.   In
the progress of  the disease there  is likewise as frequent a difference,
children having usually a purging in  the bud confluent sort, in the
 place of that salivation which usually appears  in adults, and de-
 mands a judicious  management.  It may, therefore, be further re-
 marked, as too  common  an error possibly, that of procuring stools
 about the turn  of the pock, when   infants  have this disease  pretty
 full, whether of the distinct, or the  confluent kind; children  some-
 times sinking suddenly after one or more copious stools, who would
 be in less danger from remaining costive at this period of the disease.
 These circumstances, as well as their tender age, will call for some
 little diversity in the treatment; with all which, however, the  reader
 is supposed to be acquainted, who will be careful to make proper dis-
 criminations in this complex disease.
    In regard to the measles it needs only to be remarked, that child-
 ren  ought to be kept in bed, and not  only  ought the  belly to be
 preserved open  throughout  the disease,  and cooling medicines, and
 diluting drinks be  administered, and  amongst  others  linseed tea,
 where the cough is peculiarly troublesome;  but  unless  the children
 be very young, they will bear and even require one  or more bleed-
 ings, at any period of  it, when the symptoms indicate its propriety.!
  *  Ex toto, non sic pueri, ut viri, curari debent  Celsus. Lib. iii. cap. 7. p. 134.
  +  In all cases of local inflammation, or tendency to it, topical bleedings should
have the preference, especially if it be not necessary to take away a large quan-
tity of blood, (which it can rarely be in young children ;) or if the operation be 
140
1iN0CULAIIu>,.
 And,  indeed, the cure  of the secondary fever, and cough, however
 long they may continue, will turn upon repeated bleedings, laxatives,
 and a total abstinence from wine, and all animal food.  It may be
just remarked, that instances occur  even in the benign measles, of
 the eruption continuing much longer than four days before it begins to
 dry off.
   Dr. Hamilton has disputed the  propriety of  this evacuation, and
 argues as strongly for the exhibition of purges, and of wine and bark
 at this period of the disease.   For my own part, I have never lost a
 patient in this disease, and probably from not being consulted in the
 worst cases, nor nearly so frequently attending in this or the small-pox,
for obvious reasons; and, therefore, shall by no means oppose my ex-
perience to that of Dr. Hamilton, or Dr. Parr, (who has adopted the
 like sentiment,*) but rather esteem it my duty to apprise the readers
of this work of the different sentiments of practitioners of their re-
spectability.
   The same writer has mentioned a feverish disorder, resembling at
first the measles in every respect, as  occasionally met with.  "Within
twenty-four  hours  from the eruption having come  out the feverish
symptoms are highly aggravated, attended with delirium, starlings,
and  even convulsions; and on several parts of the  skin, particularly
on  the face,  the eruption recedes,  leaving large portions of the  sur-
face of a pale yellow, with a small white blister or vesication in the
middle. The eruption disappears in a day or two, and, under proper
treatment, the fever soon abates.
  The alarming appearance of great determination to the head, in
the first  case or two of this kind to which I was called, led me to
apply leeches to the temple, at  the same time that  I prescribed the
warm-bath, a brisk laxative, and a blister to the back.   Since  that
time  I have omitted  the  leeches, and although the utmost danger
seemed to threaten in all the cases I have witnessed, the recovery
was  rapid in  every instance.
                            Inoculation.

   I shall drop a few words more on this subject; because parents
are very apt to fall  into great mistakes respecting the age  and cir-


often repeated.  In the present instance, therefore, if the  child be very young,
or very weak, it  may be sufficient to draw off a little blood by leeches, from
some part about the chest. But should it be designed only to lessen the quantity of
the blood, they may be more conveniently applied to the leg, or arm, as the child
will be less exposed to taking cold during the  application-  and if the leeches
should not draw well, those parts can afterwards be commodiously immersed in
warm water to promote the bleeding ; or a bandage may be easily applied to re-
strain it, if it should prove too profuse.
* Medical Dictionary. 
inoculation.
141
cumstances most proper for this operation, and sometimes draw me-
dical people into an imprudent compliance.
   It has already been remarked, that young infants are not very lia-
ble to contagion; which is surely an argument against early infection,
if it  be attended with anv peculiar hazard,  as it most certainly is.
Whereas, it is too common  an opinion,  that a  very young infant,
sucking at the breast, is the  fittest subject for inoculation.   Children
are then said to be clear from humours, their blood mild and  bal-
samic, their food innocent, and their minds free from  all violent pas-
sions.   But all these advantages may be counterbalanced by the de-
licacy of their frame, their disposition to spasm, and their inability to
struggle  with a severe attack of the disease, if it should chance  to
fall to their  share.  And such, indeed, are the facts: infants usually
have the small-pox very lightly, whether taken naturally or from ino-
culation:  though in both there are a few instances of their expiring in
a fit at the  time of the  eruption, (the  risk  being  greater  also the
younger the infant may be;)  and they seldom get through the disease,
if they are  full, or it proves of the confluent,  or malignant  kind.
And this furnishes a peculiar objection to inoculating infants at the
breast, which arises from their frequently lying so  much on the arm
of the suckling mother, or nurse, especially in the night; the heat ex-
posing them to a much more copious eruption, than children who are
weaned.  This I have seen clearly exemplified in  the instance of a
child whose mother could suckle only with the right breast; the con-
sequence was, that the left side of the child was perfectly loaded with
the eruption, (though the pock was of  the distinct kind,) whilst the
other had only a moderate  sprinkling.   The child, however, sunk
under the secondary  fever  at the end of five or six weeks, though
turned of two years old; the only child I have known to die of inocu-
 lation at so advanced an age.  A similar instance is related by Mr.
 Moss; who not being able to prevail on a young woman whom he had
 inoculated, to keep her feet (which Were very cold) out of the warm
 ashes  of a  hearth-fire, at  the time of the  eruption, they were in
 consequence so loaded with it, as  to  appear one continued blister;
 though the disease was very distinct, and went on favourably in other
 parts.
   I am aware that many children  are inoculated very young, and
 even in the month, and generally with very good success; but the
 frequency of this practice, among eminent surgeons, is owing to the
 Hrgent solicitation of parents, and their fear of contagion.   I cannot,
 therefore, avoid saying, that however few may die under inoculation,
 under any circumstances, the fact is, that the far greater proportion
 that I happen to have had an account of, is amongst infants under six
 months old.  A remarkable proof of this disproportion appeared a
 few years ago  under a  general inoculation at Luton, during the pro-
 gress  of a malignant small-pox; which  had carried  off one half of
 those who were attacked by it in the natural way.  In the midst of this 
142
INOCULATIUiV
 fatality, twelve hundred and fifteen paupers were inoculated, through
 the humanity of the then Bishop of St. David's,* many of whom re-
 fused  all preparatory medicines, and were  besides addicted to the
 use of strong liquors: nevertheless,  out  of  the twelve hundred and
fifteen, only five died—all of whom were infants under four month old.
 Seven hundred  adult people of better condition, in the same neigh-
 bourhood were inoculated a short time afterwards, and with the like
 good success with the former.
   From this view  of the matter,  it  is pretty  evident, I think, that
 this  operation ought, in genera], to  be postponed to  a later period,
 which is pointed  out by the child having cut all its first teeth: to which
 may be  added another  observation from the well known fact, that
 more than fifty children die under the age of two years, of other com-
 plaints, to one that dies  of the natural small-pox.   Should it, how-
 ever, be in the same house, or prevail in the neighbourhood, and the
 parents find it difficult to remove the child out  of the way, it may run
 a less risk in being immediately inoculated, as that operation is now
 so well understood and successfully conducted, than by taking the
 chance of escaping the  infection, or  of recovering from the disease,
 if it should happen to  take place.   I  shall just  observe, however,
 on this head, that  the  late  Professor Monro  seems to recommend
 the use of a bath of water  and juniper-berries, and fumigating the
 chamber with the  juniper-tree, during the course of severe small-
 pox; which is said  to have succeeded in  eight or nine instances as a
 preventive.
   The inoculation  of pregnant women  being in certain instances
 dangerous to the  infant, it is presumed, that it cannot be totally fo-
 reign from the subject to annex a caution on that head: it having
 until of late been generally imagined  that the child is not infected by
 the parent passing  through the small-pox, whether from inoculation
 or otherwise.  It is, indeed, comparatively rare,  that the  unborn
 fetus takes the disease, howsoever  severely the mother may suffer by
 it; yet from  a very accurate account of this matter lately published
 by Dr. Pearson,  and some cases by  Messrs. C. Kite  of Gravesend,
 and W. Turnbull, the fact is established  as the result of much expe-
 rience and reflection, where the parent  has been infected after the
 sixth month  of gestation.   Previous to  that  period,  however,  the
 fetus (whatever be  the cause) har,  very seldom been known  to take
 the disease; and  later than that, it is presumed, few mothers would
 be inclined to submit to  the operation, unless from some urgent neces-
 sity.   The parent,  it is  added, is not in much additional danger from
 being  inoculated in a state of pregnancy, unless the disease should
 prove considerably  more severe than it is ever expected, from inocu-
 lation; but when communicated to the fetus, the  infant always dies.
 One instance of infection at an early period of gestation, has lately

  ■- See a Tract on Malignant Fevers, by the hte Sir William Fordyce, 1790. 
VARICELLA, OR CHICKEN-POX.
143
been adduced by Mr. Ruinball of Abingdon, that does not precisely
accord; the fetus taking the infection when its mother had only com-
pleted the fourth month of gestation.  She was then seized with the
natural  small-pox of a bad confluent  kind, and recovering with
difficulty, was delivered, at the end of the seventh month, of an
infant who bore strong marks of the disease, and survived only half
:.n hour.
  In regard to inoculation of the measles, it may just be noticed, that
Dr. Francis  Home of Edinburgh  has practised  it, in ten or twelve
instances, with success, and that Dr. Rosenstein seems to intimate
ihe example having been followed  in Sweden.*
                   Varicella, or Chicken-pox.

  Though this disease is, Indeed, usually a very light one, it merits
a few words, not only because more incident, perhaps, to children
than to adults, but, also, that it is sometimes mistaken for the mild
small-pox; which it sometimes exceeds in violence, and is now and
then even  attended with  danger.   This is, indeed, so uncommon,
that the disease has  been  very seldom noticed by medical writers;
and even Dr. Heberden, who was among the first that obliged the
public with a distinct  account of it, says he never saw any person
with so many as three  hundred pustules over the whole body.   Phy-
sicians, indeed, as he  observes, are  not often called to.visit patients
under  a  complaint  usually so  trifling; or  a gentleman  of  his
long and extensive practice would have  met with instances in
which it  must have appeared of more consequence,  as  will pre-
sently be noticed.
  It is from this disparity, I apprehend, that this disorder is some-
times denominated the swine-pox; which is only a ranker species of
the disease, in which the  symptoms may run higher, as well  as  the
pustules  become much larger and more purulent.   In this  case, I
have known the head  and  face as much swollen as  I have ever seen
them in any distinct small-pox, however full, and the  pustules con-
taining a yellow matter, with highly inflamed bases, and exceedingly
sore; and these have formed a complete mask on the  face, after the
turn, as is often seen  in the small-pox.  One such patient whom I
was called to visit, a  few  miles from town, was about sixteen years
of age, of a plethoric habit, but very healthy; and what makes it very
certain, that this complaint could  not be the small-pox is, that the
young  gentleman died of  that disorder a twelvemonth afterwards;
and possibly owing to its being neglected in the beginning, from an
idea that the former illness had really been the small-pox.   The  lat-

              * Treatise on the Diseases of Children, 1771. 
144
AGUE.
 ter mistake arose from an improper answer having been then made
 to my enquiry after the day on which the eruption had first appeared,
 (as I was called  to make him only one visit, when  the pock was on
 the turn;) a mistake the young gentleman's mother had a perfect re-
 collection of after I was"gone,  and of which  I reminded her upon
 being called to visit her son in the small-pox, only the day before his
 death.
   This case strongly verifies the remark of Dr. Heberden, that this
 complaint can, in some instances, be distinguished from the small-pox
 only by its quicker progress towards maturation, and the shorter du-
ration of the  pustules; a  watery vesicle always appearing  on the
 second or third day from the  eruption, and  the turn, at the furthest,
 taking place on the fifth.   In young children, a teazing cough some-
times comes on  about the time that the eruption is complete,  and
 continues until two or three doses of physic have been  taken; which
 on account of the cough seems to be necessary.
  The  symptoms preceding the eruption are  sometimes  so slight,
that even where the  eruption  has proved  pretty considerable, the
disorder has not been expected so soon;  though, from its being in the
family,  the closest attention has been paid to it.
  The treatment of it differs nothing from that of the mild, distinct
 small-pox; but it more  rarely  calls for much attention, and only
when a patient may have  it very full;  or, as sometimes happens,  a
second crop appears, after  the first has dried off.


                              Jlgue.

  This  is a complaint so  well known,  that it  seems  unnecessary
here to enter minutely into  a description of it.  It is sufficient to say,
that it consists of repeated cold and hot  fits  regularly succeeding
each  other,  with one or  more well  days between  them; in which
interval the  sick  passes a high-coloured urine,  that deposits a red se-
 diment.
  It, perhaps, partakes more of a nervous affection than other fevers
may do, and is known to be endemic in some flat marshy situations,
but is more  frequent in the spring and fall of the year;  in the former
of which it  is generally easily cured,  and is even  sometimes salu-
tary.* Autumnal agues, on the other hand, especially in the coun-


  *  In the low and marshy grounds of our southern states, the ague is so regu-
lar a visitor, and the treatment so successful,  that  little doubt  can exist as to
the best mode of practice-  The opinion here expressed by our author is, un-
doubtedly, a relic of the humoral pathology, which taught, that the ague should
be allowed to go on, that morbific matter might be  eliminated   This is the ad-
vice of Boerhaave, who says,  " cum morbus jam aliquo tempore duravit, &c."
Vanswieten inculcates the same doctrine, and both  follow Sydenham's opinion.
Directly the reverse is now the established practice, and nil "agree, that to cure 
AGUE-
145
ir-y, and amongst very poor people who feed coarsely, will frequently
continue a long time, and return again the next  autumn;  whereby
the constitution becomes considerably impaired.   In such instances
the legs are apt to  swell, and more especially the belly, which  be-
comes hard, particularly on the  left side; the tumour being termed
the ague-cake.   This tumefaction,  however, instead of being  a  baa
sign,  as might be suspected  a priori,  is a very favourable one,  and
indicates the recovery of the patient*   This circumstance is noticed
by Sydenham, and,  like other observations of that attentive practi-
tioner is a very just one, and was doubtless the result of his  expe-
rience.  The hardness is probably owing to  an  infarction  of the
spleen  and usuallv subsides in the course of a few months, especially
upon the use of moderate exercise, and a generous diet.   It may be
prudent, however, to assist the resolution of the tumour, by adminis-
tering small doses of calomel, and  afterwards light  bitters,  adding
likewise  chalybeate*,  if the habit of the patient seems  to require
them, and there are no symptoms  of a  morbid affection of the  vis-
cera.  Even the bark has been recommended with this view by Drs.
Brocklesby and Strack, though formerly esteemed so improper under
infarctions of the viscera.                                .
   It were needless to enter largely  into the subject, and it is equally
foreign from the present intention,  to be more particular in regard to
the cure  of  this oftentimes very  troublesome  complaint.   Some
notice of it, however, is taken, because though  no more peculiar  to
children than the last-mentioned diseases, yet  it may be said,  that
there  are comparatively very few children  who have not suffered by
it during the vears usually passed at school.
   The ague/indeed, attacks every  age, so 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 class that the following
 directions are given, the bark being usually a specific for older child-
 ren and grown people: to whom, however,  it is generally  proper
 first to administer a vomit, and one or more doses of physic, as  well
 as sometimes to assist the bark by the addition of aromatics, or steel.
 It. would be improper, however, to administer these remedies  very
 early in the disease, but to suffer the patient to have  two or three re-
 gular fits  before the bark and other tonics  be administered, if the

 the disease as  soon as possible, is a duty  imperiously demanded of the physi-
 cian.  It is never salutary, and always  proves more obstinate,  the longer it is
 neglected.—Ed.
   • It is by no means easy to conceive how the enlargement of the spleen car, con-
 tribute to the patient's recovery, x etthe observation is here made withoul qualifica-
 tion or reserve. The opinion, though not  novel, is by no means generally received,
 Hums thinks it generally proves fatal,  and we are inclined  to agree with hm..
  The treatment is the same as in the enla; gement ot other viscera; exercis,- in
 ,he open air, and a flannel roller ihmly applied round the body, will be attended
 «•.''!' much fidvantage —Wd.
                               T 
146
AGUE.
child be of a plethoric  habit, and the febrile  paroxysms  seyere.*
The small-pox, whether taken naturally, or by inoculation, as well as
other acute complaints, has sometimes  removed obstinate autumnal
and chronical agues.
   In a state  of infancy, the ague is often owing to, or connected with,
a foul state of the bowels and  obstruction of the biliary ducts,  and
is frequently accompanied with worms, or such a state of the alimen-
tary canal as affords a proper nidus for them.
   The  tertian or more common ague, at this age generally yields to
purges of the pulv.   scammon. c.  calomelane, or calomel and rhu-
barb, given on the days between the fits, and small doses of the pul-
vis antimon. on the return of the fever.   Should this fail,  a vomit
should be administered an hour or two before the next cold fit  is ex-
pected, if the powder should not already have had that effect. A linen
waistcoat with fine powder of bark quilted  within it, may be worn
by infants next  their skin: or, as a more expeditious remedy, the
bark  may be made into  a poultice, and  applied warm to the  region
of the stomach, and renewed through the day as often as it  may get
cool.f  With the like view,  a piece  of bread hot from the oven,
and sprinkled with spir.  camphor,  is a very convenient mode  of fo-
mentation, in this and other complaints, where a speedy perspiration
is wished for.
   In  older children,  the common saline  draught, taken once in six
or eight hours, will  frequently succeed; as will warm bitters,  and
medicines that promote  and keep  up perspiration.   Crude  salt am-
moniac also in the dose of ten or twelve grains, for children of five
or six years  of age,  has sometimes  cured this  troublesome com-
plaint;  but may not be proper for  delicate constitutions.   Myrrh is
a better remedy for such,  given from four to eight grains, before 01
during the cold fit; and as  much cream of tartar, every two  or three
hours, during the fever.   Pepper,  and likewise alum, are common
quack remedies, and may be frequently given with success at this
age;  the former from  five to ten grains, the latter from three to five,
joined with the like quantity of nutmeg, three or four times a-day in
the absence of the fever.  Another good  remedy is  the  flowers of
brimstone, given in the quantity of a table spoonful in  a glass of


•   " The treatment  of ague should certainly be commenced by administering
an emetic  or cathartic,  or both; if the former be given a short time previous
to the expected attack, it will frequently  put an end to the disease by entercept-
ing that chain of morbid associations, upon which this and probably all other
periodical diseases depend.  Why it should be improper to prescribe the bark,
early in the disease, we are  at a loss to determine ; the practice will certainly
not be followed in this country upon mere assertion, especially when  our ex-
perience teaches us, that it is founded  upon a theory not supported by facts

  \ SeeRosensteln on the diseases of children; also Med.Observ and Inq. vol,
ii p. 255. 
AGUE.
147
brandy, before or during the cold fit; this is a proper dose for adults,
but I have never administered this medicine to children.  These re-
medies are supposed to be beneficial by producing a different actios
of the parts.
   A remedy of late years brought into more common use is laudanum;
but I have not yet had a  fit opportunity of making  trial of it  in
younger subjects.  Thirty, or more, drops, should be administered
an hour before the cold fit  maybe expected:  this, it  is said,  often
proves an effectual remedy, even without the assistance of the bark,
or when that medicine has failed, after three exhibitions, at the most,
and not unfrequently on the first.
   Amongst popular remedies* is, a tea spoonful  of white  resin  in
fine powder, mixed with the like  quantity of pounded loaf sugar,
taken a little before the cold fit,  and repeated afterwards night and
morning; this I have found successful even where large doses of the
bark have failed.  Bracelets of mustard seed and garlic have like-
wise been applied  to the wrists and ankles, and, upon the testimony
of Dr. G. Fordyce, with good effect.   Such kind of remedies for
this disease are numberless;  I shall, however,  mention  another,
which,  though as  anile as  any, seems to have  been very often suc-
cessful, (as I have  been informed by the late Dr. Huck Saunders,  as
well as others;)  and is nothing more  than the spider's web, rolled
loosely up to the size of a child's marble, and washed down with a
little warm wine and water, or chamomile tea, before  the cold fit is
expected:  the child should  then be put into a warm bed, and  per-
spiration be encouraged.  This may be done, amongst  other means,
by fomentations to the pit  of the stomach.   A piece  of bread, hot
from the oven, and sprinkled with camphorated spirit, is  not a con-
temptible one, in this and other complaints, where a speedy perspira-
tion is wished for.
   I shall  close the list of remedies with the  following from Dr.
Kirkpatrick, which is a very  good one for patients no otherwise
averse from the bark, than that the stomach  will not bear it in large
doses.
   Take of fresh  sassafras bark, Virginia snakeroot, roch alum, nut-
meg, calcined antimony, and salt of wormwood, of each one drachm:
to these, well rubbed together into a fine powder,  add  the weight of
the whole of the best Peruvian bark;  then add three  or  four drops
of the chemical oil of mint, and with syrup of saffron  make all into
the consistence of an electuary.  This is to be  divided into twenty-
four doses, one of which may be taken  by children of eight or ten
years of age, every four or six hours, while the patient is awake.  To
make this or any other preparation  of the bark sit easy on the sto-


  * The occasional obstinacy  of this complaint is offered as  the apology for
such kind of prescription. 
148
GENERAL OBSERVATIONS ON COUGHS.
mach, I have been long in the habit of advising the patient  first to
eat a bit of bread, or other light food, with which it may mix, in-
stead of being received into an empty stomach, whereby it frequently
nauseates.*
                  General Observations on Coughs.

    Previously to treating of the hooping, and what I have termed the
 spasmodic cough, it may not be unwelcome to students in medicine,
 that I should premise some  slight observations on coughs in general; a
 complaint in children that«we are often consulted for.  It is, indeed,
 always of importance to be able to make  proper distinctions ip this
 affection,  as it accompanies divers complaints^ especially in infancy;
 and is  sometimes a very  harmless attendant, while  at  others k is
 of the  greatest  magnitude, and calls  for  its  appropriate treatment
 from the beginning.   My remarks here, however, will need only to
 be very brief.
   From what has been said in different parts of this work, it will be
 very evident, that a  cough  is not always to be considered as the ori-
 ginal complaint, like the hooping cough, any more than a direct con-
 sequence  of a  cold, or of specific pulmonary affection,  as in  the
 measles.  Where it may  happen to be so, enough, it is presumed,
 has been said under the head of fevers; and the hooping and spasmo-
 dic coughs will  be presently treated  of distinctly.   The intention
 here is principally to remind the reader,  that a cough often attends
 teething, and some bowel complaints, or a foul state of the stomach, as
 well as a  common cold, and inflammatory and other fevers, (which,
 however, are often suspected whenever children are attacked with a
 cough;) and is a recurring symptom in many delicate habits.   Very
 slight occasions are oftentimes  sufficient to excite it in such children,
 whether from a frosty or damp air, or from any little illness that has
 reduced the strength, and particularly if the child be of a scrofuloue
 habit.    Every confirmed glandular affection will, indeed, be attended

  * It may not perhaps be deemed superfluous to notice,  in  this place, an arti-
 wmmihi  o?"g   VP''eSent ."?  much e™Pl°yed, is generally known, and
 r^  lPof  ;ni LttS°^efu,.H^Pri0d Stand hi*h on our ,ist of remedies for  the
 rini Lar   T Tl  l allude to Carbon« wnich has lonS been used in  medi-
 cine, and is placed, by writers upon the  Materia Medica,  among the laxatives.
 £5S?iX^,PrVCd ,l ^k6P°SSeSS,ed °f "Arable 'tome pfwers, and dur-
 pJruXiLt  ,*^s»85dby.n\any of the army surgeons  in preference to  the
 Urn cases of L,?^c'S Pe"-0d ""TT"8 exPeri™"t» have been made with
 had been mr^r?   a"V '" *" 0t the? £a»swered  the expectations that
 had failed  inlf,!-' ^ ?°me ,l P™v«* effectual after the baric and arsenic
 2?ti!?T    u3 ?ra,se'Its advocates have been enthusiastic, but it is certainly
J^»tode™iSfrD2,:hCOlMfnCe"  JhS be?tc-bon,sofaras  ^"KS
rutd^th^sam'e S5S£L£.d°—^ "" *S the <""*' and * to 
                        HOOPING  COUGH.                     149

with a cough, which in that case is of the worst kind, as it is attend-
ed with fever, loss of strength, and manifest disease; in the la* stages
of which the cough becomes permanent.
   In every case, therefore, the cause and attendant symptoms, rather
than the mere cough, should  be carefully attended to, and especially
if the child be costive, or the bowels foul, and their discharges of an
unusually offensive smell.  Purging medicines,  it  has been before
said, are in this case the proper remedies, which should frequently be
joined with saponaceous ingredients, such as  the  aqua kali, natron
ppt. or spong. ust. nothing being more common than an obstinate and
teazing cough, especially during the night, when  the bowels  have
been long in  a costive state,  and the alvine discharges are very fetid,
or of a stiff and clayey consistence.
   Though I have said, my intention has been rather to discriminate
the causes, than to direct the precise remedies for coughs; yet it may
not be amiss to give a few suitable  prescriptions for coughs attendant
upon common colds,  especially after  the period  of early infancy.
And to this I am inclined, on account of the more  ordinary remedies
 met with in books being usually of the oleaginous kind, and ill suited
 to the state of the stomach in young people, and, indeed, not always
well adapted to adults.

       &. Mucil. gum.  arab. 3'ijj
          Mellis acetati £i ft
          Aq distilatse 3X
          Syr. papav. albi 31J ft mistura.
       Addatur P. R. N. spir. aether, nitrosi gtt. xij

        5». Pulv.  etragacanth. comp. |j
          Syrupi Limonise  § ft
                  Papayeris albi
                  vel mororum 5ift
          Spir. astheris nitrosi  31J
       Misce, ft. Linctus.

       R. Mellis accetati §j
          Syrup, papav. albi
          -------mori aa 3vj
          Tinct. Tolutan. gtt. xx misce
        Fiat Linctus.
                  Pertussis, or Hooping Cough*

  This complaint, called also tussis ferina, is a  disease  unknown,
prob ibly, to the old writers; and is supposed to have been conveyed
into Europe from Africa, or the JSast Indies: the Greek and Arabian 
150
HOOPING COl'GH.
 physioians make no  mention of it, and, indeed, it has not been well
 understood in any part of Europe, till of late years.  Hence, proba-
 bly, its great fatality in  Stockholm, where, from the year 1749 to
 to 1764, inclusive, 43,393 children are reported to have sunk under
 it.   Even Willis  supposed its seat to be in the breast, but Harvey
 makes it a disease of the stomach, and  Astruc  an inflammation of
 the larinx and pharinx, produced by an original  affection of the for-
 mer, from  indigestion.   He  seems to have been one of the first that
 discarded  the use of oily and pectoral  medicines, (which, indeed,
 some practitioners have  since been weak enough to revive;)  though
 he advised bleeding  too indiscriminately.*
   This disorder furnishes another proof of the  observation made on
 the impropriety of submitting the complaints of children to improper
 hands—the care of old women, and frequent change of  air, being all
 that this disorder  is, by  some people, thought to require:! but, per-
 haps, the  maxim  was never worse  applied.  There is,  indeed, a
 milder sort of hooping cough,  as there is  of every disease,  which
«alls for very littu medical assistance; and it is always in such cases,
 that matrons  and old nurses acqi'ire their  credit.  But there is no
 complaint  of children,  with which I  am at  all  acquainted, in
 which medicine is at times more evidently serviceable, than a bad
 hooping cough.
   This disease is  certainly highly infectious, and one  of those that
 never appears a second time.  It may attack at  any age, adults be-
ing liable to  its influence as well as younger people; but it more
commonly takes place between the age of four months and  twelve
years.   It  often  begins  as a common  cough, and is  attended with
the usual symptoms  of having taken cold,  but in its  progress soon
becomes more severe; though the longer it may be before it plainly
 discovers itself, by the hoop, the more favourable it is likely to  be.
A flux of rheum frequently comes from the mouth, nose, and eyes,
 and the food  is thrown up, together  with a viscid phlegm, (often in
great quantities,) in  the coughing fits; between which the child gene-
rally appears to be perfectly well, and eats its  food very heartily.
These are  the more  cOmmon symptoms; but when the disease is vio-
lent, and has continued for some time, they become greatly aggravat-
ed, especially in the  night, and the child will seem almost strangled
in each fit, the face and neck becoming perfectly livid, till by a vio-
lent effort,  attended  with a hoop, it  recovers its breath; the  blood

  * See his Diseases of  Infants.
  f If this be true to any degree, so that children, with very little assistance from
medicine, have  seemed  to get rid of an obstinate hooping cough, by removing
from one air to  another  ; it is not improbable, that this may have arisen as much
from getting out of infected beds and apartments, which might keep up the con-
tagion, through the medium  of respiration, as from any specific influence of die
 air, resulting merely from a change. 
hooping cough.
151
will likewise sometimes rush from the nose and mouth; and I have
in two or three instances seen the eye-lids as black as if injured by a
violent blow, and remain so as long as the cough has  continued se-
vere.   When taken in time, however, and  properly treated, the
hooping cough is  rarely fatal, and scarcely  ever  but to young in-
fants, and never as long as the patient is free from fever, or other
disease.
   It has been thought by some practitioners, that little more than
emetics, and gentle laxatives are  required, in which view it was,
that the late Dr. James recommended his  powder;  though a late
writer* has  very imprudently wished  to discard the former  alto-
gether; whilst others have conceived, that this disorder will run a
certain course, according to  the degree of its violence, and the age
and constitution of the patient; and that no medicine tends much to
its shortening, and that frequent change of air is the most appropriate
remedy, as  I was told very  lately in a consultation with a very re-
spectable  physician.  But the fact is, that  many  other means are
equally useful, and  not unfrequently indispensably  necessary, unless
we should suffer the patient to be strangled  in a fit of coughing, or
fall into a decline, from the injury which the lungs must endure by a
frequent repetition of such violence.
   This must be exceedingly apparent from the above history of the
disease, the various  symptoms of which certainly  demand a consi-
derable diversity in the treatment.  The more important ones are,
the state  of  inflammation, sometimes  inducing peripneumony; the
quantity and viscidity of the phlegm;  and the spasmodic  affection,
and danger of suffocation; together with the exhausted  state  into
which the patient  may be reduced by the long continuance of the
disease.   If the breathing, therefore,  be difficult, a blister is indi-
cated, which, if the child is not very young,  may  be kept open for
two or three weeks; or, what is sometimes preferable, the repetition
of a small one, once in six or eight days; or a plaster of equal parts of
the emplast. cantharid.  and emplast. cerse.   If the face  should be
very livid, and swollen, during the fits of coughing; if any vessel give
way; or the patient be plethoric, and more than two or three years
old, or should be hot between the paroxysms, a little blood ought to
be taken away, and a saline draught be  administered every six or
eight hours, and the bowels kept  open, till the fever shall  disappear.
Otherwise, if none of these symptoms attend, bleeding does not seem,
in general,  to be indicated, nor much purging,  but may rather  have
a tendency  to protract the  disease, by increasing the  spasmodic dis-
position,  and by weakening the patient.  On the other  hand, sto-
machic cordials, such as the oil of cloves and bitter tonics, are  often
exceedingly useful.
   if there be an inclination to vomit, it ought to be encouraged, un-
* Mr. J. G. Jones 
152
H00P1NU COUGH.
less the phlegm be brought up with great ease in almost every fit of
coughing, in which case, nature seems able to accomplish the busi-
ness herself, and it will then oftentimes  be sufficient to  keep  the
body  open by the mildest laxative medicines.  But it very rarely
happens, unless in infants at the breast, that some  kind of emetic is
not necessary in the first stage of the complaint.   The disease,  in-
deed, frequently requires no other medicine; for such usually keep
the body open at the same time, which it ought always to be.   For
these  purposes, perhaps, wine of antimony  may be as proper as any
thing  when  it acts  as an emetic; but I have thought it less certain
than  tartarised  antimony,  from its  not being always of an equal
strength.  I have, however, been lately in  the habit of using it very
frequently,  and when the proper dose has been ascertained,  thought
it  operates more  mildly than the tartarised antimony, which some-
times proves far too violent for very young infants^  Whensoever
preferred, however, dissolved in water with the addition of a little
sugar, it forms  a medicine to which children will never make any
objection; and maybe given upon  an empty stomach, everyday,  or
every other  morning, according to  the strength of the child,  and de-
gree of disease.   If the cough should happen to be more  violent at
any particular time, the emetic should be  given a little before the
paroxysm is expected.  Or, perhaps, a still better method,  at least
in some cases, and  particularly  in very young children, is,  to give
the tartarised antimony in smaller doses, together with a few grains
of magnesia, or prepared oyster-shell powder, (according to the state
of the bowels,) three or four times a-day, so as to keep the stomach
in such an irritable state, as shall secure a gentle puking every time
the fits of coughing come on.  But in whatever way this medicine be
directed, it  will prove of no service  if it does not excite vomiting,
and must, therefore, be given in a dose suitable to the strength of the
stomach, which  is  exceedingly  various, not only at  different  ages,
but in children of the same  age, and of the same apparent  habit of
body.   If one preparation of antimony may have any advantage over
another, they have  all much more over every other emetic I have
made use of; the ipecacuanha,  and oxymel  of squills, being  exceed-
ingly unpleasant,  and the latter, as far as my experience goes, usually
more  uncertain than any other emetic.
   Such a plan  is all that will be necessary in the common  hooping
cough; but it has been said, there are many cases which will require
other means, and  demand all the skill of the experienced physician.
The cough,  for instance, will sometimes increase not only for days,
but for weeks together, and  the  strangulation be exceedingly alarm-
ing.   In this case, the lac ammoniaci, but especially  asafoetida, fire*
qucntly proves a  sovereign remedy, and  though exceedingly nau-
seous, many children will take it tolerably well for the short time it
appears to be absolutely required; and when they will not, it may be
admipistered by way of clyster, dissolved   in a small quantity of 
HOOPING COUGH.
153
penny-royal, or common water.   These medicines, however, will be
very improper in the advanced stage of the disease, when attended with
hectic heat, hemorrhage or other phthisical symptoms; a caution equally
necessary in regard to the bark, which in the absence of these symp-
toms, and after the stomach and bowels have been well cleansed, is
frequently very useful at the latter stage of the disease, when the pa-
tient has been exhausted by its long  continuance.   Upon the same
plan with the asafcetida, camphor and castor are frequently beneficial,
and  have the advantage  of being less nauseous, but I think propor-
tionably  less powerful.   I take no notice  of tincture of cantharides,
though strongly recommended by some writers,  because I have had
no experience of it myself, and indeed have never found any neces-
sity for trying it.  For the like reason I say nothing of arsenic, lately
strongly recommended by Mr. Simmons of Manchester.*
  It will sometimes be of no small service to rub the hands and the
soles of the  feet with the spirit, ammoniae comp. several times in tire
day; or the spine of the  back, and the pit  of the  stomach,  with oil of
nutmeg, or oil of amber; but as the smell of the latter is  very unplea-
sant, it may be  dispensed with where the spasms are not exceeding-
ly urgent.  But when they are so, this oil is sometimes very useful,
particularly  when administered internally; and  children of three or
four years old will take a few drops of it very well, mixed  in a spoon
with a little  Lisbon sugar; from which I have seen as evident advan-
tages, as  from  any medicine whatever.   But frequently, no  anti-
spasmodic is equal to opium, in this as well  as  in other diseases.
With this view, a few drops of  laudanum, or if a pill be preferred,
two or three grains of the pil. e* styrace,  and  to younger children a
small tea-spoonful of syrup of white poppies, taken at bed-time, will
not only quiet the cough, and remove the strangulation during its ope-
ration, and  procure the patient some rest, by which the  strength will
be  recruited, but in many cases seems to have a kindly operation on
the disease itself.  It is in this way,  I doubt not, that the cicuta has
gained so much reputation, but I believe,  it is no otherwise a remedy
for it than as an  anodyne.   From a  mistake, however,  in  this re-
spect,  the strong  manner in which this  medicine has  been recom-
mended  by Dr. Butler  has certainly done harm; as I have known
people depend solely upon it in  very  bad cases, to the exclusion of
other  remedies evidently indicated,  which  would, at least,  have
shortened the disease,  joined with emetics and other means, as the
symptoms may indicate,  it is, nevertheless, a valuable medicine; and
where the form of a pill be, on any account, objected to, may be dis-
solved in a little water, or syrup.   Instead of the ol. succini, the fol-
lowing will often have a good effect  in children of four or five years
of age; acting both as a tonic cordial,  and ultimately a sedative.


              • See Duncan's Annals of Medicine  for 1797 
154
HOOPING COUGH-
     R. Olei Caryophil. aromat  gtt. xxiv
        Sacchari purissimi 3 ft
        Muc gum  arab. 311J
     Simul optime ter ntur. addendo gradatim
        Aq. cinnam  ^ift vel 5ij
        Aq  distil  £iv
 Ft mistura, cujus siimatur cachl. j largum tusse appropinquante,vel
 statim posttussem.

   If obstructions in the  lungs be suspected, blisters should be  ap-
 plied,  and recourse had to gentle deobstruent medicines; but at this
 period, the cure is chiefly to be accomplished by  perseverance in
 cooling laxative medicines, by a vegetable and milk diet, (especially
 asses'  milk,) pure air, and gentle exercise.
   The cough, after having disappeared for a week or more, is some-
 times found to return with great violence, especially upon taking cold;
 but a gentle purge or two, a vomit, and abstaining from heavy food,
 generally remove  it in a very short time.   Should this fail,  a grain
 of asafoetida, taken two,  three, or four times a-day,  according to  the
 age of the child, never fails to check it immediately.  If these cau-
 tions should  be neglected,'the cough will oftentimes prdve extreme-
 ly tedious.   And  in this  case  I  have known the lichen, or  ash-co-
 loured ground liver-wort, prove an excellent remedy.   One ounce
 may be boiled  in  two pints  of water, to one; or a like decoction of
 the oak-lungs; a table spoonful may be given two or three times  a-
 day to infants of a year old.  These have had an immediate good ef-
 fect where infants have appeared to be going fast into an hectic state,
 after the cicuta, ol. succini, and cortex peruv. have failed, or the dis-
 order has  hung on unpleasantly.
   A mode of cure of a very different kind has lately been announced
 by Dr. Struve of Gorlitz, and may be noticed in this place, as worthy,
 at least, of a trial in obstinate cases, and in  a conjunction with other
 means; though with a caution to young practitioners, in regard to in-
 fants and delicate children.
   After prescribing  an emetic, the following mixture  is directed to
 be rubbed in every two hours, in small quantities, about the region
 of the stomach.

     R. Antimon. tartarisati 3j
       Aquae purae ^ij
    ft. solutio;  cui adde
       Tinct. cantharid. fort. £j.

  In various instances, the doctor observes, that a gentle  perspira-
tion came on during the night, after the use  of this application; that
the violence of the cough  immediately abated, and in  a short  time
the symptoms totally disappeared. 
HOOPING COUGH.                     155
  In the like view of an auxiliary, I shall notice the experiments on
inhaling the nitrous vapour, made by  Mr. Paterson, surgeon to For-
ton hospital.  This he has not only proved to be perfectly harmless
in very young children, in the mode recommended for fevers by Dr.
Car. Smith; but was of very probable benefit in four of his own child-
ren, in all of whom the disease proved, at least, to be  very slight.
   The only thing that remains to be  spoken of is, the proper diet,
which is, indeed, of considerable importance; and for children, even
of five or six years  of age,  ought to  be little more  than milk  and
broths.  These are easily digested, and  will afford them much more
good nourishment than any kind of meats, and will sit much lighter
on the stomach than puddings, or pastry,  the latter of which is ex-
ceedingly injurious.   The objection made by old nurses against milk,
that it breeds phlegm, is utterly founded  in a gross mistake, that can-
not be  too frequently controverted.  It has, indeed, been sometimes
mentioned by a certain class of medical  people, but the objection is
bo truly unphilosophical, and unlike the objections  of  thinking men,
that it scarcely deserves a  reply.   Should  the milk, however, be
found to curdle remarkably  soon  on the  stomach, a  little common
salt, Castile soap, or testaceous powder, may be added to it occasion-
ally ; or asses' milk may be substituted for  cow's. These light nourish-
ments soon pass out of the  stomach, 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 supplied in this way, I mean by taking a tea-cup-
ful at a time than by making set meals, or taking a  large quantity at
once.   If the child should be thirsty, a little apple-water, toast  and
water, tamarind-tea, and other thin drinks, will be pleasant and use-
ful.   Patients treated in this way, will get through  the complain*, if
not severe,  in a very short time; and where it proves violent, a child
will struggle through this long disease,  without  any considerable  loss
of strength,  or will  be very soon recruited by a decoction, or cold in-
fusion of the bark, together with gentle exercise, and country air, the
best restoratives after every kind of disease *


  * Hooping cough is one of those diseases  which commonly prove  very obsti-
nate, and sometimes resist all our remedies,  though selected with skill, and
applied with energy,  it continues its march, heedless ot our attack, and unsub-
dued by our perseverance. To  meet the most prominent  indications, and to
obviate the most dangerous symptoms, is frequently all that we can accomplish.
As might have been anticipated, numerous remedies have  been  proposed, and
each, by its author, has been declared a specific.  The following was long since
proposed by Dr. Pearson :

            &• Carbon. sodae,grs. iii
              Vin. ipecac, gtt v
              Tinct  opii gtt. i
              Aq. font. §i. ft. mist. 
lob
                       Tussis Spasmodica,

   Much akin to the former complaint, is a troublesome cough, pro-
 perly enough denominated spasmodic,  or  convulsive.   In a certain
 state of the air  it is sometimes epidemic,  and young children, and
 even infants in the month, are then attacked by it, as well as adults.
 The  irritation seems to be about  the larinx, or a very little lower
 down, and  is exceedingly distressing at the time of coughing; but
 the patient, though an  infant,  seems immediately afterwards to be
 quiet and  comfortable.   This cough  is not usually attended with
 fever, nor other ordinary symptoms  of a common  cold, nor is it to be
 relieved by the like means; the cough remaining dry and hoarse under
 the use  of pectoral remedies.
   Children of two or  three years old may be cured by the cicuta,
 and gentle laxative remedies; but the  former  being less adapted to
 infants  in the month,  such may  take  a few  drops of the  syrup of
 white poppies, three or four times a-day, and their bowels  be care-
 fully  kept open;  which means seldom fail of removing the complaint
 in a few days; should the syrup over-much constipate the bowels, or
 otherwise disagree, Bates's sp. sal.  ammon. succinat. may  be tried
 in its stead; which is a good medicine in other dry convulsive coughs,
 where there is no fever.
   I have met with this complaint very frequently in children  from
 two to four years of age, in some of whom it had been of several
 weeks standing, and after various  remedies for coughs had been
 made trial of.   In every instance, the  complaint  has been immedi-
 ately  relieved by  the cicuta, and in a week or ten days, been usu-
 ally removed.   The like good effect has attended an infusion of the
 oak lungs, after  many of the ordinary remedies for coughs have


  This dose  is to be given every three hours, to a child of one year old, pro re
 naia.  Another very popular remedy is as follows:

            J$>, Carbon.potass. 9i
              Cochineal, grs. iii)
              Aq. font. |iv. ft. mist.

  A teaspoonful of the mixture may be given every three hours, or p r  n These
 »ecipes unquestionably prove beneficial, yet they will be found much more effi-
 cacious it their component pans be doubled.  The tincture of cantharides  used
 in such doses as to  produce strangury, has been recommended by Lettsom Of
 its efficacy I can say nothing from my own personal observation ; it comes to
 us, however, from  authority so respectable, that it is certainly worthy of trial
 when other remedies have failed.  In this cruntrv we administer emetics early
in the  disease and repeat them whenever  circumstances seem to demand their
exhibition.   Mercurial cathartics are used to preserve the bowels in a comforta-
vimTk^S^SZ* is never spared when the state of lhe s>stem ™» 
TUSSIS SPASMODICA.
151
failed;  and may very well be administered together with the cicuta,
if that  should not be soon attended with good effect.
  There are, however, some more formidable cases, in which  the
symptoms are greatly aggravated, and children continue longer in  a
convalescent state.  I have also been called to visit some under all
the semblance of approaching death, with profuse sweats, rapid and
feeble pulse, and laborious respiration, supposed by able physicians
to be sinking fast under peripneumonia notha, or the  true pleuritis,
though with more obscure fever.
  Although reduced to this state, under the best conducted antiphlo-
gistic plan, yet has a recourse to the cicuta  succeeded equally well,
giving  immediate relief to all the symptoms.  But a degree of dyspnoea
all along merely spasmodic, having, in some cases, still continued,  it
has been found expedient, after a week or ten days, to have recourse
to the bark.  At the same time, the violence of the cough attended
with very copious secretion of phlegm, which young  children  sel-
dom spit, up, has required two or three gentle emetics, which have
then not failed having  a happy effect;  though administered  pre-
viously to the cicuta, I have known them greatly aggravate the symp-
toms,  probably, by  increasing   the  debility, and disposition  to
spasm.
  As many practitioners  not very conversant  with this complaint
under  its more aggravated appearances, have, been led to consider  it
as inflammatory, so others, from the continuance and violence of the
cough, have expected it to terminate in  the hooping cough, but have
been equally mistaken; this  being a distinct  species of spasm, and
never attended with the true hoop.
   Mr. Moss speaks of  a spasmodic cough, different, he thinks, from
any previously described* and probably an endemic of Liverpool;
resembling, however,  the humoral asthma of adults (he says) more
than any other.
   It is said to commence a few days after birth, and to continue fop
several weeks, or sometimes for months; and in either case so com-
monly proves fatal, especially amongst  the, lower  class of people,
that Mr. Moss is at a loss to  suggest any appropriate remedy.
   If it be truly an endemic, I can, probably, judge but very imper-
fectly of it; but from many circuWances ip  the  spasmodic cough
described in this chapter, it does not seem unlikely,  that the cough
at Liverpool may be of the same kind.   What the'former might be-
come if  very long neglected, or improperly treated; or in what time
it  might prove fatal,  I  am not prepared to say; having always soon
succeeded  m its cure  by the means I have  recommended; which
may, possibly, be worthy of  a trial at Liverpool, as they will not set
aside the little general remedies in use.   To these may be added, the
*  An. 1781. 
158
SUFFOCATIO STRIDULA.
use of musk, camphire, Peruvian bark, and  quassia, which appear,
since my former edition, to  have been given with  success in the
spasmodic I have described; but whether preferable, in general, to
(he plan here recommended, time alone can determine.
                        Suffocatio Stridula.

   The croup, or acute asthma, is a complaint somewhat similar to
 the  two former; to which, perhaps, children only are liable, called,
 therefore,  asthma  infantum  spasmodicum, also, suffocatio stridula,
 cynanche  trachealis,  and esquinancie  membraneuse.   It  is  more
 probable that it is not contagious, as, besides other negative evidence,
 it appears that in  Chesham  poor-house,  where  there were nearly
 thirty children, only one had  the croup, though it was much in the
 town at that time, in the year 1793, and 1794.
   Though this complaint has for several years infested this country,
 it has been greatly misunderstood, both by writers and practitioners;
 there being certainly two species of it, perfectly distinct,  and requir-
 ing very different treatment;  the one being acute, or inflammatory,
 the other chronical, or spasmodic*  These seem to have been con-
 founded  by some authors, and one of them, perhaps, not known to
 others.  Neither of them are often found  to attack those who  have
 arrived to  the  age  of ten or twelve years, and, according to Dr.
 Millar, the spasmodic  chiefly seizes infants newly  weaned, and is
 then the most severe.  The acute croup, however, has appeared in
 children from within  the year, to the fourteenth year.  He is, per-
 haps, the first person in this country who has written particularly on
 this species;  but  Dr. Home has treated more distinctly on this com-
 plex disease, which had, however, been mentioned by some German
 writers, and well described by them long before  it was  noticed in
 Britain.
   Remote causes of this disorder may, possibly, be the lax fibres of
 children, the abundance of moist humours  natural to  them, and the
 vast secretion from the bronchial vessels; and perhaps the change of
 food from milk, which is easily assimulated, to  one requiring more
 digestion.
   The prophylaxis  is the same as in  most other diseases peculiar to
 children.   If this complaint  arise from  the laxity  of their solids,
 Vhich is certainly not always  the case,)  the quality of their food,

                                                             •
  • It is not my intention  to deny the existence  of the distinction which our
 juitnor lias here made between the spasmodic and inflammatory croup, yet I am
 by no means prepared 10  admit that they require very different treatment.
bach ol them harasses the patient, by irritating the trachea, and diminishing its
diameter; now the lancet will relax spasm as certainly as it will check inflam-
mation.—Ed. 
SUFFOCATIO STRIDULA.
159
 and the natural weakness of their organs of digestion, the general
 means of prevention, as well as  of cure, will be readily indicated.
 Their food  should be such  as  may be easily digested,  and may
 prove nourishing.   A due proportion of milk and broth,  (taken
 either separately or mixed,) whilst children  are very young, or light
 meats when they become older; good  air and exercise, and a careful
 attention to the state of their bowels.
   The  proximate cause of the chronical croup is the presence of
 spasm, howsoever excited;  the cause of the inflammatory is, a morbid
 secretion of a viscid mucus in the trachea, adhering so firmly to its
 sides as to impede respiration,  The  quantity and viscidity increas-
 ing, gradually  lessens the diameter  of  the  part, and  if  it effect
 this to  a considerable degree, the disease  must  necessarily  prtoe
 fatal.
   The symptoms of either kind are spasmodic, being such as would
 be produced by any thing constantly irritating the trachea, or di-
 minishing its  diameter.   They will therefore  very much  resemble
 those of the nervous  asthma, but the complaint  differs materially
 from the common spasmodic asthma of adults,  in the peculiar croak-
 ing noise made in respiration, (from whence it has its name,) and in
 the violence of the  paroxysms;  which, however,  when the disor-
 der is light, and in its commencement, leave no apparent indisposi-
 tion, save a certain dulness, and a sense of fear, in children capable
 of expressing it.   The fits,  especially,  in  the spasmodic croup, fre-
 quently terminate by sneezing, coughing, or vomiting, and return
 without  any regularity.   It  is attended with a  sharp  and  shrill
 voice, and a flushed  countenance, which grows livid during the pa-
 roxysms.
   Dr. Millar, who has written largely on this disease, (I apprehend,
 as it appears in Scotland,) divides it into two principal stages; in the
 latter of which no method of treatment has appeared to him to be effec-
 tual,  but medicine is never more  efficacious, he thinks, than in the
 first, if the disorder be not combined with some other,  and it be
 taken in time; though the crouping maybe very considerable.  This
 I sevy remarkably exemplified in the first instance I met with, which
 was in a little boy of my own, who  was nearly cured in two  days.
 The sovereign remedy he directs is asafoetida, which should be ad-
 ministered both by the mouth and  in clysters, in doses according to
 the exigency of the  complaint; and where no marked inflammation
 h,ts taken place, may be given very  freely; and  afterwards the  bark,
 when the spasms remit.
   This account of the disease can, however, apply only to the  spas-
modic, and is not the  disorder usually known  in  this  city by  the
  * A diet of milk only, even in adults, when long persisted in, though otherwise
proper, will Create flatulencies. Barry on Digestion 
160
SUFFOCATIO STRIDULA.
term croup, but a mere spasmodic complaint, totally unaccompanied
with inflammation;  at least is so,  whenever asafoetida is thus useful
in the first instance.   And this seems to be further evident, from the
recovery of such patients,  and the consequent want of proof of the
existence of that tough* membrane found  in those whose bodies have
been examined after death; in whom the  disease is always of short
continuance after the  croup,  or croaking  noise  in  respiration,  has
taken place.  Whereas, the other kind of croup has sometimes been
known to continue for two months, and then has yielded to opium.
Instances have likewise been met  with of children crouping  for two
or three days, and being then seized with hooping cough, which  ha9
instantly removed the croup: these circumstances seem to prove  that
species of croup to be truly spasmodic.   I  have seen it repeatedly in
this form  attend the cutting of teeth;  being  then  the mere conse-
quence of irritation, as we see cough, and various other  symptomatic
affections induced at this period. How far Dr. Millar may have mis-
taken what he calls the two stages of the  croup, for two very differ-
ent species of this complaint, has been hinted already.  From  my
own experience, however,  which has been considerable, as well as
his authority, it seems very proper that a trial should be given to the
asafoetida, when  there is  no degree of fever, and  the child seems
little, or nowise indisposed, in the intervals of  the crouping.   Eme-
tics likewise will sometimes be found necessary,! as will the cicuta


  • This membrane has  given rise to so much controversy among medical
men, that it seems necessary to notice it.  Its structure is a point by no means
settled,  for on the one side we find the respectable names of  Home, Monro,
and Davidson, declaring it to be inspissated mucus,, while Rush, Crawford, ana
Alexander, contend that it is coagulating lymph, An opinion, somewhat novel,
has of late years been  advanced by Dr. Caldwell, of this city, who believes it
to be a membrane " sui genris."  Some of the  disputants  declare, that  their
opponents are all  wrong, and deny  " in toto,"  the existence of such  a  mem-
brane;  but this is assertion, not argument.  No greater proof of the difficulty
of deciding this question could be offered, than the difference of opinion which
exists among the  gentlemen above named, each declaring  his testimony to be
founded upon actual observation.  Previous to entering the lists,  I will  only ask
if any particular advantage will result from an  adjustment of the differences
which now exist on this subject ? lam aware of noiie, for our object would still
be to throw off' the membrane, and for  this purpose an emetic  would be  em-
ployed.—Ed.

  | In one instance, medicines  of this class were given in such uncommonly
Urge doses, (as it was observed in a former edition,) that it may not be amiss to
noiice them here.
  From beginning with one grain of pulv. antimon. which was several times re-
peated, the child (under three years of age) took afterwards a drachm, and two
drachms ot vin. antimonii; then pulv. 'ipecacuanha: half a scr. ers  xv   and
one scr. to which was added gr. j antimon. tartarisati; and at length er x  and
atterwards one scr of vitr. album. The trial of  emetics was then given up for
several day.,  at the expiration of which he took oxym. scilla  three drachms
with one drachm vmi.antim. which succeeded  better than any tninT UWh i
puked turn only very moderately ; but continued to  do so for the three orK 
SUFFOCATIO STRIDULA.                  161
and bark; one or other of which  must be persevered in, as long as
any symptoms of the disease, and particularly the  croaking noise,
shall remain.  And from the success  attending this practice, and  a
proper discrimination  of the disease, (one species being often mis-
taken for the other,)  there may be more room for hope in this cruel
disorder, than some practitioners have been induced to think.
  But the other species of croup is a most dangerous disorder, being
truly inflammatory in the first instance, and is, I believe, always at-
tended with a quick  pulse, cough,  and laborious  breathing very
soon after the croaking noise has taken place, and sometimes before
it, with a sensible fulness about the  fore part of the throat;  although
at the time  of the attack other children have  appeared in perfect
health.
  It does not,  however, always seem to be an original disease;  be-
ing sometimes a consequence of bad fevers, especially the febris scar-
latina, as well as of some chronical disorders that have reduced the
patient's strength, and is then much more dangerous.   But the worst
kind frequently appears to arise from  the same causes as the malig-
nant sore throat, only having its seat lower down, and  is therefore
more severe.  And  it has, in several instances, accompanied it, as
may be known in the early stages of that complaint, by the croak-
ing noise peculiar to the croup;  and, I believe, is in such  instances
generally fatal.   It has likewise accompanied the last stage of  the
putrid thrush, and has then  carried off' the little sufferer in a few
hours.   The croup has likewise been found to hang on  for several
weeks, like  the  spasmodic croup, without any alarming symptom,
and has even disappeared,  and suddenly recurring, has ended fatally
in a very few days, before the child has seemed to be in danger, and
after eating  an hearty meal.  An instance of this kind,  with the  ap-
pearances on dissection proving the nature of the complaint, is given
by Dr. Edlin, of Uxbridge,  in  the  Medical Review and Magazine
for June 1800.
  On the means of cure for  this species very few directions will be
necessary; the disease (except in  rare instances) being always short,
and  the treatment very evident.   Bleeding is always necessary, if
the physician be called at the commencement of  the disease, or "stri-
dulous noise; and if the  patient be visited too late  to  endure  this
evacuation,  I believe  no  hope  can remain  of bis  being benefited
without it, unless the infant  be very young, which, however, in ano-
ther view, cannot but add to the danger.   If the patient be three or
four  years old, and plethoric, a pretty copious bleeding  by the lancet
may be the preferable mode; but if much younger, or of a delicate habit,
four, six, or  even more leeches should be immediately applied to  the

limes that he took it.  l.vr the remaiks  on the inertness of eme'ics and purees,
seep. 12. Note          -                                    l   *
X- 
162
sUFFOCATIO  STRIDULA.
throat, especially if there be any perceptible fulness of that part, and a
blister applied to the nape of the neck.  The  patient  may likewise
breathe the vapours of warm water with vinegar in it, or an embro-
cation be  constantly applied, by compresses of linen,  to  the fore
parts of the throat.   After the leeches  and  blisters, a vomit should
be administered, and the sickness kept up  for several hours,  or even
days, by small doses of the antimonial powder; which will generally
succeed if had  recourse to within six  or  eight  hours of the com-
mencement of the disease.   If  the bleeding, whether topical or ge-
neral, should  afford no relief, or if after an evident amendment, any
exacerbation come on, leeches  should be applied to the throat, and
the vomiting kept up.   At the close of the complaint, and to prevent
a relapse, the bark proves highly serviceable, and will also restore
the strength of  the patient.*
   In the  fifth volume of the Memoirs of the Medical Society are
some good practical observations on this disease, by Mr.  Field.   He
prefers general  to topical bleeding, when called early in  the disease;
advises the body to be kept soluble, but dissuades from great evacua-
tions by stool; objects to blisters to the throat;  but recommends  the
following embrocation.


    5». Aquae ammoniae acetat  : £ij.
       Spir. aether: vitr : comp : |j.


or for very young children, equal parts of these and of water.
   He thinks he has  reason to  conclude  the disorder to be conta-



  * There are few of  the infantile diseases, which the American physician ap-
proaches  with more confidence of success than the one now under considera-
tion.  Without entering into any discussion  upon the nature of the disease, or
the modus operandi of the remedies used, I  shall  simply detail  the treatment
which in this country is found most  successful.  An emetic is to be administer-
ed as soon as possible after the attack of the disease, and this will sometimes
prove of itself sufficient to check  the progress of the complaint.  If,  however,
this remedy should produce no effect, the  warm bath is also to  be employed;
should this also fail VS. is always to  be had recourse to.  The case must indeed
be obstinate, that resists all of these remedies combined; but such cases will
sometimes occur,  and, then the emetic is to be  repeated, and the lancet urged
" ad deliquium  animi."  The great  torpor which exists throughout the prims
vise must  always  be kept in view by the practitioner in attempting the cure of
this disease.  Doses which would under other circumstances destroy life, here
prove totally inefficacious; it should always be recollected,  that the medicine
must be repeated until  the effect is produced, without attention to quantity.
In a short space of time, Dr Chapman administered xv. grains of tartar emetic
to a child within the year.  The local applications are not to be overlooked:
cups or leeches are to be advised, and a blister or sinapism applied to the throat
In very urgent cases I have seen flannel wrung out of boiling water and applied
to the neck with much advantage; the cuticle separated as soon as it was with-
drawn and all  the  good effects expected from a blister were  accomplished.

ffi A^sfflr?/rcturn,ns health *th*resiomion °f Ule "^ 
SUFFOCATIO STRIDULA.                   163
gious;*  but as he has not mentioned the ground of his suspicion, the
opposite presumption, from the accounts from Chesham, is the more
probable one.
  The  French writers likewise depend much upon emetics, and af-
terwards lenient purges;  and to prevent a  return, advise aperitives,
stomachics and tonics, particularly preparations of steel, and natural
chalybeate waters.
  In the kingdom of Ireland, particularly  about  Mullingar,  in  the
county of Westmeath, where there are many lakes,  the  croup  is  a
very common complaint, and equally inflammatory and  dangerous
as amongst us.   It is likewise apt to return, (though seldom  so  vio-
lently as in the first instance,) if the patient ventures abroad too soon,
and is exposed to the bad air of  that quarter.  The method of treat-
ment there is somewhat different from ours, blood being immediately
drawn from the foot, instead of the throat or arm,  and  often  in a
large quantity, the child being placed, at the time, in  a warm bath; a
blister is then applied between the shoulders, and  the bowels  are
kept open,  chiefly by clysters.    Emetics  are not had recourse to,
nor indeed any means but the above; the violence of the  complaint
abating very soon, or the child  thought to  be past recovery.   The
complaint is, possibly, not perfectly understood in this quarter, and in
the northern parts of  that kingdom, neither  this species nor the chro-
nical croup is at all known, according to my information.
  In North America, a very different mode of treatment has been
adopted; calomel being recommended as  a most successful remedy,
after bleeding and the application of blisters, (when peripneumonic
symptoms attend,) and the ordinary remedies of emetics and purges.
And Dr. Rush  of Philadelphia  is  so  sanguine in regard to it as to
assert, that  the bark is scarcely a more  certain  remedy  for  inter-
mittents, than calomel, when thus administered, is in this species of
cynanche.f
  In  a former  edition  I  merely announced the sentiments  of Dr.
Rush, having then had no  opportunity of making trial of calomel,
his  observations having but just come to  hand.  Since  that time,
however, I have made trial of calomel,  with  success, though I do
not feel myself warranted to speak of it in  the strong terms that Dr.
Rush and some others have adopted.  Together with calomel, I have
found it necessary to have recourse also to emetics and repeated bleed-


  * The late learned professor Barton, of the University of Pennsylvania, and Mr
Rosenstein ot Stockholm, stand foremost on the list of those who believe in the
contagious nature of croup.  Their  arguments in support of the opinion are
Tsedtotfi m —£penence as wel1 as l°e weight of authority is certainly op-
  t  J« » note to Dr Chapman's edition of Burns, it is observed, that the ere-
dit^ot introducing the mercurial practice in cynanche is due, not to Dr. Rush
but to Dr Kuhn, who used it nearly half a century since.-ED.              ' 
164
SUFFOCATIO sTWOULA.
ing with leeches, even in young infants; the former being administered
frequently, so as to keep an infant throwing up as often as i  croup-
ed throughout the day.  Mr. Anderson senior, of Ldipburgli, testi-
fies the merit of this medicine, after other means had failed, and the
patients' lives been despaired of: other  accounts, however,  by Dr.
Ramsev, of Chesham, are far less favourable; the exhibition of calo-
mel, together with emetics and other remedies, failing of success in
ten cases  out of nineteen; and the  disease evidently less severe in
the nine which terminated favourably.   But  Dr. Hamilton speaks
equally favourable of calomel, given "in  frequent  and large doses,
until the breathing be relieved, and  then to be immediately abated :
this, together with the warm bath, with which he  always begins,
having succeeded in almost every instance.  Upon the whole, every
reader, from  these statements, and his own experience, will judge
for himself; whilst the author, from his own, has no doubt that calo-
mel will  be highly useful, whilst  bleeding,  the  warm bath,  re-
peated emetics, and a blister to the  throat are very essentially ne-
cessary.
   In Dr.  Ferriar's Medical Histories and Reflections, vol.  iii, there
are likewise some very good  observations  on this  disease; which
he  also has very properly divided into the acute and  spurious.   In
the former he remarks certain precurrent symptoms whereby this
dangerous disease may be  foreseen; but  I am satisfied, this is not
always the case:  though much deference is due to his great atten-
tion to this sad disorder, and the very considerable  experience he
has had.   The treatment  recommended  is very  agreeable to that I
have laid down; but with  the addition of one  remark, very worthy
of attention,  viz. that the venaesection should be very copious, and
nearly ad deliquium.
   Some years ago, Dr. John Archer, of  Harford county, Maryland,
in America,  has strongly recommended the seneka root, (Polygala
Serega, Linn.)  as  an almost infallible  remedy in this  disease.   I
shall therefore  present the reader with the  doctor's  account in his
own words, in a letter he wrote to Dr. Barton, of Pennsylvania Col-
lege.

   " I have  in a great many instances found a decoction of the se-
neka the most powerful medicine in the cure of this disease, and I
am happy to  tell you that  I believe it  may be depended on.  I make
a strong decoction of  the  root in the  following manner, viz. half an
ounce of the seneka,  in coarse powder, is boiled in eight ounces of
water, down to four.   Of this I give  a tea spoonful every half hour,
or hour, as the  urgency of the symptoms may require;  and at inter-
vals a  few drops, to keep up the stimulus, until it either acts as an
emetic or cathartic.   I then repeat it, in smaller quantities, so  as to
preserve  the stimulus of the seneka constantly in the mouth and
throat. 
RACHITIS
165
    '■ It the disease be more advanced, and the breathing more diffi-
 cult, with a peculiar harsh or shrill sound,  like air forcibly drawn
 through a small aperture,  attended with the retraction of the upper
 part of the abdomen under the cartilages  of the  ribs; I then give
 calomel  freely and frequently, and  rub  mercurial  ointment on the
 throat and contiguous parts, so as to affect the glands of the throat
 and mouth, as quickly as possible.  This I do that the mercury may
 co-operate with the action or  stimulus of the seneka, and thereby
 hasten the separation of the  membranous  substance formed  in the
 trachea.
    " In this method I have  succeeded in the cure  of the croup, even
 beyond my most sanguine  expectations."

   Having never made trial of the seneka in  this disease (though I
 have lately found it very  useful  in the latter stage of pleurisy) be-
 cause I have  found other  emetics successful,  I have only to remark
 upon it, that I am informed it has been so  lately in this country, in
 one or more very bad cases, and seems to be  very similar to the re-
 peated doses of emetic tartar that have been repeated in this chap-
 ter; while the exhibition of calomel, and mercurial ointment accord
 with the application of blisters.   Which of these means may be the
 more successful; or how far the  application of leeches, at the com-
 mencement of the disease,  may be safely dispensed with, actual ex-
 periment only can determine.
   Instances of success likewise with the tinct. digitalis (as directed
 by Dr.  Maclean) have been twice announced by Mr.  Custance,  of
 Kidderminster.   The last was  in a  child  of  two years of age,  to
 whom gtt. vi. were  administered  every six  hours.   A great recom-
 mendation of this medicine is, that the three cases in which it suc-
 ceeded,  are the  only ones in  which Mr. Custance has had an op-
 portunity of making trial of it."*
   I have examined the trachea  after  death in  only three patients, in
 two of which I found the precise appearances  described by Dr. Mil-
 lar and others; the wind-pipe  being  lined with a tough viscid coat,
 so as mechanically to close  up the passage.  The third instance was
 in an infant who died suddenly of the  hydrocephalus, a few days after
 appearing to be recovered from the croup.


                      Rachitis, or Rickets.

   This is a late disorder in Europe:  Astruc observes that England
is said to be the part in which it first  made  its  appearance, and that
it was then described by Glisson and Mayow; but he thinks it pro-
Medical and Physical Journal, vol. iv. 
1GG
RACHITIS'.
bable, that it appeared at the same season over all Europe, through
the coldness of the  weather.  It was  named Rachitis,  from  the
Greek, implying that the spina dorsi is particularly affected by it;*
though It rarely attacks the spine till the disorder is far advanced.
   It was first noticed in the western parts of England,! about  the
year  1628^ and is  said to have taken  place upon  the  increase of
manufactures, when people left the villages and husbandry, to settle
in large manufacturing towns; where they wanted that exercise and
pure air,  which they had enjoyed in their former situation and em-
ployments.
   Tin's is a pertinent observation to have been made at that time,
and accords with late  experience and facts;  manufacturing towns
abounding with this disease  above  all others, especially among  the
poor.   It  may, therefore, frequently  arise  from  unhealthy pa-
rents,  especially  from mothers  who  pass  too  sedentary  a  life
in  a  bad air,  and  fied upon a weak and w-atery diet:  from child-
ren's  food  being weak, watery,  or too viscid to  be  properly  di-
gested; but  above  all, perhaps,  from  bad  nursing, and children
being  left wet, dirty, or exposed to  a cold moist air,§ without suffi-
cient covering; from want of proper exercise,  and  from close and
crowded  apartments.  On this account, children of poor people are
particularly liable to this disorder: parents, and gov?mors of work-
houses, ought, therefore, carefully to  guard against :!•  last-mentioned
causes.   Or,  lastly,  from the  habit  of body beiiig  reduced  by the
long continuance of almost any of the complaints hitherto considered.
From these sources  arise what may be termed its proximate causes;
such  are, a load of undigested juices  in the stomach, intestines,
and all  the first passages; an universal viscidity  in  the extreme
vessels,  especially  of the joints;  a  corrosive  acrimony  from a too
languid circulation,  and a general  obstruction in the fibres of the
muscles.
   The usual  symptoms of rickets are, soft flesh; bloated,  or a very
florid  countenance;  weakness; dislike to motion; with enlargement

  * From this circumstance, it has been  supposed to have been  known in the
time of Hippocrates j  but his remark (Aphor. § 3. 26.) is certainly too concise to
establish the point; as it is simply observed, that among other complaints, infants,
after the period of dentition, are liable to KxpSfiioc, irovtdvXii rov kxtx to inn
situ aries.  In Mons. Le Febure de Vilkbrune's Greek edition  of the Aphor-
isms, there are, however, some observations tending to evince, that this disease
is of an older date, by some centuries, than it has been generally imagined; and
this, it  should seem from the nature of the disease, is not unlikely.
  | See Glisson.
  £ Primerose.
  § From the experiments lately made by Drs.Beddoes, Withering, and others,
npon atmospheric air, and its relation to diseases, it cannot  be at  all surprising,
that this disorder, particularly,  should often be owing to foul air, in which, what
has been lately termed the azote, is loo  predominant.  And it is worthy of re-
nark, that this complaint is scarcely known in very hot climates. 
RACHITIS.
167
of the belly, head, and joints.   The wrists and  ankles enlarge first,
afterwards the back and  breast-bones; and, indeed, all the bones
swell and become soft, especially the more spongy ones.   The pulse
is quick and feeble, and  the  appetite and digestion  usually bad.
Teething  is commonly late, though not frequently difficult, but the
teeth often rot early and fall out.   Great acuteness of mind has been
observed in this, and some other chronical  complaints.   It  seldom
attacks children before they are six months old, or above  two years;
the reasons for which are obvious.
   As it appears to arise from a general weakness  and relaxation,*5
the indications of cure are, to brace and strengthen the solids, and to
promote  digestion, and the formation  of  good  chyle.  These ends
will be promoted by wholesome and dry food, suited to the age; good
bread, or biscuit; and roasted meats, rather than boiled; with a little
red port wine.   Should the child be too young to eat flesh meats, its
diet ought to be chiefly of broths, milk, rice,  millet,  pearl-barley,
salep, and semolina, with spices, if it be not inclined to be feverish.
This, however,  is sometimes the case  in older children, though, per-
haps, too rarely suspected, and requires  in that stage of the disease
a very opposite  treatment; even small bleedings being then found
serviceable.  The child must, above  all, have good nursing, and es-
pecially exercise and air, without being kept very hot or very cold:
unless a strict attention be paid to these, medicine can  be of but lit-
tle service.  If the child be too young to exercise itself by  walking
and such like, the nurse, besides affording  it every exercise it can
bear, may induce the infant to exert itself to no small advantage, by
the following easy means.  She  has  only to  dash a  few drops of
water suddenly  in its face several times a-day,  in the manner often
done to recover people from a  swoon, though less violently.  This
will oblige the  infant to  put  almost  every muscle into action,  by
 which the blood will be forced through the minute vessels, and many
of the advantages of exercise produced, and in a more powerful man-
ner.   To the same end, linen  cloths  wetted with cold water, with
the addition of a little spirit of any kind,  may be applied to the arms
and legs, or to the spine every time the child is dressed or undressed,
 especially if the bones of these parts are become enlarged or distort-
 ed by the disease.   The parts  should  afterwards be rubbed very dry
 with a piece of warm flannel.
   If the child be of a gross habit,  the eighth part, or a quarter of a
 grain, of ipecacuanha, taken once or twice a-dav;  gentle pukes, and
 very brisk purges, especially of the pulv.  c  scammonio cum calomel.
   Monsieur Bonhomme of Paris has formed a different and strange theory ol
the nature of this disease , and recommemls very strongly the internal exhibition
of phosphate ol lime and phosphate of soda, together with an external washing
with an alkal.ne liquid made by dissolving half an ounce of common pot-ash, or
sal tartan, m a pound ot verv pure spring water 
168
RACIIIIIS.
 prove of use.   The tinct. aloes comp. is also a good medicine, a few
 drops once  or more in a-day, (as may suit the state of the bowels,)
 taken on a bit of sugar, or otherwise. * In such habits, all foundation
 of a cure must  be laid in reducing the belly to its proper size,  and in
 strengthening the stomach.   If rather delicate, the cold-bath is often
 of more service  than anything else: but this should not be entered
 upon in winter, nor without previous purging.   Frictions afterwards
 with flannel  and aromatic  powders, or the fumes  of frankincense,
 mastic or amber, especially on the back and belly,  will further tend
 to strengthen the habit.
   Besides  such means, the cold infusion of bark and other bitters,
 especially columba; or small  doses flor. martial, tincturae myrrhae, or
 the vinum ferri, have often the best effect.   Dr. Temple prefers the1
 following form above any other.


     $,. Rubig. ferri gr. iv
        Pulv. rhei  gr. iij
        Sacch.  albi gr. x.
 Misce, ft. pulvis, mane et vesperi sumendus quotidie.


   The rhubarb should be increased or diminished/as may be neces-
 sary, two stools  a-day, it is said, being fully sufficient.   The follow-
 ing is likewise from him.


     5,  Zinci calcinat. gr. ij
        Test, ostreor ppt.
        Sicch. alb.  al £j
        Pulv. aromat. gr. xij
 Misce et divid. in chart, vi.  quarum capiat  unam nocte et mane
quotidie.


   The rubigo ferri  and the zinc are to be gradually increased.
   It has been before remarked, that under every plan, a good diet,
air, and exercise, especially riding  on horseback, are of the utmost
consequence; which, if duly  persevered in, and the state of the sto-
mach and bowels properly attended  to, will  often effect  wonders.
A cure, therefore, should not  be  despaired  of, under any  circum-
stances, provided the internal and vital parts are not diseased.   Be-
sides, this  is one of those chronical  complaints which seem  to be
gotten the better of by time, and like  the following  one,  wears itself
out,  as it  were; and to which  the  above-mentioned  means  will
greatly  contribute—Saepe  Pertinacia  Juvantis, Malum  Corporis
vincit.   (Celsus.) 
169
                            Scrofula.

  This is primarily a glandular disease, though in its progress it at-
tacks the adipose membrane, the eyes, the muscles, tendons, and even
the bones themselves, especially the joints.*  Such at least has been
the general opinion, though from later investigations there is reason to
imagine  that  it  originates  in  the  cellular membrane.   It seldom
makes its appearance before two years of age, nor later than ten os
twelve, (unless it be in regard to affections of the eyes,) though there
are more exceptions in respect to the latter period; and it then often
proves fatal by falling on the  larger joints,  the lungs, or other noble
part.  It is frequently observed to  follow  other disorders, particu-
larly the small-pox, whether taken naturally or from inoculation; also
the hooping-cough, measles, teething, rickets, and many other disor-
ders already mentioned.  Hence the nature of this disease is better
understood, as it so often falls upon weak and tender habits,  either
originally of a lax fibre, or worn out by previous diseases;  or is gra-
dually brought on by a heavy, indigestible, and  bad diet,  or a low,
wet, and unhealthy situation.  It  is, however,  sometimes found to
be  hereditary, but will very frequently lie  dormant for two or three
generations, (resisted sometimes by intermarriage in a  healthy fami-
ly,) and  afterwards appear with redoubled violence; as well as affect
the greater part  of a family very much, whilst the rest shall be en-
tirely free from it.   It is often attended, or  rather preceded, by a
peculiar look  about the eyes, which are generally large, and a  thick-
ness of the upper lip; and sometimes proves a source of ill-health
through life, but is not usually fatal in the first instance.   Long be-
fore the external glands become affected,  especially in young sub-
jects, the belly is sometimes observed  to be hard and enlarged; and
after death, the mesenteric glands, the lungs,  and even the pancreas
have been found  diseased.
   Though this is always a peculiarly unpleasant complaint, and fre-
quently does not admit of so  much relief by medicines, nor so uni-
formly to the same, as many other disorders, yet it oftentimes  disap-
pears at the time of puberty, (and  sometimes sooner,) especially in
females; but whether this be  owing to the  increased strength of the
solids, or to other changes in  the habit, naturally happening at that
period, is not  an inquiry proper for this place.   On the other hand,
after disappearing for several  years, during which perfect health has
been enjoyed, the humour has, unexpectedly, fallen upon some intcr-

  * From tliis propensity to spread, the disorder is said  to have taken its name.
" Struma:, vel scrofulx, sic djcunttir quia  frequenter in scrosis, Id est, suibus, in
f.ollo 6unt; vel  a multiplied partu, quoniam sicut sues multos eriunt partus, sic
inscrofulis ex una postundum fiuntplures."  (Traclalus de Morbis, Puerorum.
Amstolodami, 1760 )  The struma is, nevertheless, a complaint as different from
scrofula as it is  from the broococcle, and is chiefly endemiqal.
Y 
170
SCROFULA.
nal Glandular part, frequently  the  mesentery, occasioning various
pains and complaints, often attributed to other causes, and has under-
mined  the  constitution; producing  ultimately pulmonary consump-
tion, or a fatal marasmus.
   Although  I  thought it  very necessary to  mention this disease
amongst others to which the state of childhood is liable, I am sensible
how difficult it would be to point out any thing  like a general and
adequate  remedy.   At  its first appearance,  however,  bitter  or
mercurial purges are sometimes of use,  as are also antimoiiial vomits;
and frequently burnt sponge, and saponaceous medicines, warmed with
spices, and continued for a length of time;  though it should be ob-
served, that this  disorder, like  the  preceding,  sometimes  falls on
habits  of a somewhat  plethoric temperament, and may for a  while
demand the interposition  of  certain antiphlogistic remedies.  But
when the disease is confirmed, lime-water and decoctions of the
woods, together  with crude  antimony, kermes  mineral,  sulphur
aurat:  antimonii, bark, and steel, writh wine, and a  generous diet,
are, I believe, most to be depended upon as  internal remedies; from
some of which, I have seen no inconsiderable cures affected.   As ex-
ternals, the following have been found useful: ox-gall, with camphor,
Unguent, hydrargyri, empl. cicutae, liniment, ammonias, and fomen*
tations with cicuta.   But in this, as in other chronical complaints,
good air and exercise are  of the greatest importance.   Indeed, the
advantage of exercise in this disease is so great, that I wish to lay a
very great  stress on it.   But then it must be daily had recourse to,
and, by degrees, be so considerable as to render the  patient every
night sensibly fatigued.  Thus, I have known riding behind a car-
riage, almost without the aid  of any medicine,  entirely remove the
complaint.
   When there  are  external tumours, I am satisfied that the opinion
I have already given to the public, in a larger tract on this complaint,*
is both rational and safe; and that whenever they are at all disposed
to come forward, and not seated on improper parts, they ought to be
brought to as speedy a suppuration  as  is possible.  To this end, an
epithem of honey, flour, and yolk of egg should be applied twice  a-
day, and the parts be electrified.  The scrofulous virus, when thrown
on the surface, so far resembles the cancerous, according to the de-
scription of  the  late ingenious Mr. Hunter, that it  is inclined  to
spread to a considerable extent; but as tumours of the former class
will bear rougher  treatment than the  latter,  I  am  confident that
much benefit may arise from the use of external stimulants, by stop-
ping the progress of the disorder in the neighbouring parts, as well
as by invigorating them, and thereby disposing  the ulcers  to heal.
Of this kind are, fumigations of hydrargyrus sulphuratus ruber, and
hydrarg. cum sulphure.  Also, light frictions with mercury, so as to
* See the author's Surgical Tracts. 
SCROFULA.
171
make it pass freely through the lymphatics of the distempered parts,
without affecting the system, have, in a course of time, been benefi-
cial, and deserve to be brought into more general practice than they
have hitherto been.
  Under such a plan, it will be very necessary that the body be kept
open; and to this end, one drachm, or  more, of the  sal cathartic.
may be dissolved in  a pint of water, and taken every day as com-
mon drink.   This quantity of salt will give very little taste to the
water,   and,  in some instances, has alone had a good effect in this
dreadful complaint, especially in stronger children and such as are
otherwise healthy.   On the other hand, children of a delicate  and
spare habit are more likely to be benefited by the tonic remedies before
mentioned, and such  as warm and invigorate the system;  of which
class one lately recommeded in France  has  been found exceedingly
useful, and of which  I  shall here subjoin the form in  which I  have
generally made use of it.

     R. Ammoniae ppt. 3ij.
        Rad. Gentian, incis. 9j.
     Affunde Spir. Vini Galhci £ xij.
     Fiat Tinctura.
     Sumat aeger cochl. infantum ad cochleare largum ex aquae purae
q. s. ter, quaterve in die.


   I have had further reason to be confirmed  in the  above opinion
respecting stimuli, from  observations  communicated to me by Mr.
Partington, who, since the hints I threw out  in  the afore-mentioned
work,  has made use  of electricity with very  good effects, in these, as
well as other cold tuhiours and ulcers I had mentioned;  which have
all healed very kindly, or  been  dispersed in a reasonable time, in
consequence of this stimulus to  the parts. * When scrofulous ulcers
have been healed, and Only some small tumours remain, I have ex-
perienced very good effects from the external use of as strong  a so-
lution of camphor in oil of almonds as can be made, which has dis-
persed them very soon;  and it has  been found  a very  successful re-
medy, in the cure of the incipient bronchocele, though enlarged to
the size of a turkey's egg;  and  requires only to be very well rubbed
into the parts, three times a-day.   The patient should at  the same
time take a drachm or two of the tartarised natron every morning.
   The following is strongly recommended by Dr. Temple.


     R  Terrae ponderos. salit. gr. x.
        Aq.  nienthae sativae £ ft
Misce ft. iiaustus, ter quotidie" sumendus ; et sensim augeatur quan-
titas terrae ponderosae ad guttas xx. 
17a
DYSURIA.
  Tobacco  has also been lately very strongly recommended in a
treatise on this disease, by Dr. C. W. ilupeland of Jena, author of a
treatise on  the Art  of prolonging Life.  Readers may consult the
former work with  considerable profit, as it contains a fuller investi-
gation of the disease, and better selection and adoption of remedies,
than has ever fallen  under the author's reading.
  An obvious discrimination should be made in  regard to  tumours
about the neck, so frequently  the  early  seat  of this disease; since
many of them are of a harmless nature, or even salutary, the conse-
quence of a slight feverish disposition, or  of some little cold from a
sudden stroke  of air on  the  neck.  These,  it is well known, rise
suddenly, become painful, and increasing daily in size, either very
soon  put on the usual appearance of suppuration, or begin to  sub-
side;  and whether they break  or not, are  no  indication of any thing
materially wrong in the habit.   On the  contrary, scrofulous tumours
always rise slowly, unless in very young  infants, and  immediately af-
ter the small-pox; often  continue a  long time at a stand, and some-
times are not only months, but even  some years before they suppu-
rate;  and then with very little pain, or true inflammation.  Fof
such, particularly when very large as well as indolent, embracing a
large part of the neck, the white lily root, with  an equal  quantity
of bread, made into a poultice with milk, has been followed, at least,
with a surprisingly good effect, the tumour subsiding entirely in the
course of a few weeks.
  I  shall  only add  further  on  the head of  scrofula, what is very
well known, that sea bathing alone sometimes effects a perfect cure;
and, perhaps, in tepid water oftener  than in its natural state. Should
the   hild therefore have several scrofulous tumours, or the  habit be
conceived to be much affected, trial should  be made of the sea, in
whatever manner it may be determined the tumours shall be treated,
if not dispersed by sea bathing, as they frequently  are.
                           Dysuria.

  Difficulty in micturition was mentioned in the chapter on denti-
tion, and has been found more  commonly troublesome during that
process than any other period  during infancy.  The pain  is some-
times exceedingly great, if we may judge from the  long and violent
shrieks of the child, who at times seems likely to be thrown into fits;
but upon voiding  the urine becomes instantly quiet,  and  returns to
its wonted cheerfulness, and ordinary habits.
  Demulcent  remedies, as noted in the chapter on teething, may be
tried;  but if the infant be very young, or nourished  bv the  breast^
can rarely be  taken  in sufficient  quantity for  any length of time 
ANASARCA AND ASCITES.
178
If they fail, therefore, of good effect, I have added antimonial wine,
which has always very soon been of use.
  Some such form as the following has been prescribed:

    5>  Kali ppt. gr. v.
        Sue. Limon. 5j-
        Aq  Rossc, Rtt. xx.
          — distil. 3hs.
          — fcenicuu 3--S.
        Sp. juniper, gtt. xxv.
        Pulv. e" tragacanth. comp. gr.  v.
        Vini antim.  gtt.  iij. ad vj.
        Syr. Alth. 3*s
Misce, ft. haustus, ter, quatcrve in die exhibendus.  Or a decoction-
of the semen daucii has often afforded speedy relief.

  Together with either of these, I have kept the bowels open with
castor oil and manna; thrown up a clyster twice a-day;  and put the
infant up to the waist in a tepid bath twice or more every day, when
the pain has been most urgent.
  In  some forms of this multifarious disease also, the solutio arsenica
has lately been administered with success, and with safety, if confin-
ed to  very small doses, once or twice a-day.
                     Anasarca and Ascites.

  I shall not enlarge much on these disorders, however important,
since they are not very common in young children:  I have  met with
instances of both, however, at different ages.
  In the chapter on teething it was remarked, that although a consi-
derable depot of water may be made on the tops of the hands and feet
during dentition, a general anasarca, or ascites, does not take place,
if there be no internal disease.   And, indeed, whatever bad  health
may, for a while, be induced by difficult teething, a morbid affec-
tion of any of the viscera is  very rarely a consequence, unless a
purging be  improperly suppressed.
  But infants previously in bad health, and especially such as have
been prematurely weaned  or fed upon too thick victuals, not unfre-
quently have indurations of the mesenteric glands:  and  the  com-
plaint may be  followed with dropsy, if dentition should at this time
prove unusually difficult;  and is then more likely to be fatal.
  One case of anasarca accompanied with ascites, was of this kind
the  infant having previously had a tumid and hard belly, loss of ap-
petite and fever; and though these symptoms had  been entirely re-
moved, and the child apparently for several weeks in  good health, a
renewed process of dentition  was  accompanied with an universal 
r<4
ANASARCA  AND ASCITES.
anasrca, and a large collection of water in the belly; with an almost
entire suspension of the urinary secretion.
   Purging with calomel and jalap,* produced  no  good effect,  nor
moderate doses of the scilla, spir. aether:  nitrosi, and other diuretics;
but  an  increased dose of these, and an ointment as in the following
formulae, soon produced a change, and both the anasarca and ascites
in a  little time gave way.

     rj,. Infus. amari 3'j-
         Ag. distil. 5j.
         Vini ferri 3*s
         Tinct. sciliae gtt. viij ad  xij.
         Tinct. cinnamomi gtt. xv.
         Syrupi e cort. aurant. 3ss.
Misce,  ft. Haustulus quartis horis sumundusv
     R. Ung. hydrarg. fort. 5ss.
         Spit, tereb.
         G. camphor, aa 3j<
         Olei olivar. 3X"J'
   Misce, ft.  linimemum ;  quo totiem umbilici et dorsi regionemin-
ungatur bis quotidie.

   The following pill also  recovered  an infant of fifteen  months old,
after being in a very debilitated state; though the operation both as an
emetic and a purge was very considerable, requiring  strong cordials
and  wine for the infant's  support.  One  pill  was given  every six or
eight hours,  for two or three days: nor would  so powerful a  me-
dicine have  been  ventured upon if every gentler  mean  had  not
failed.

     R.  Gummi Ammon.
         Sciliae recent.
         Sapon.  Venet.
         Pulv. sem  cardam. aa 3ss
         Elaterii ^j
         Antim. tartaris. gr. x.
   Misce ft. massa pilularis cum syrupo alth.  et divid. in pil. xxx.

   A remedy  brought lately into use,  as successful in adults, though
I have had no opportunity of  making trial of it in young children,
seems worthy of notice, as it is not so nauseating as  as the above,
nor as many  other diuretics.   Indeed, it does not  always act  upon
the kidneys,  though it frequently carries  of  the  complaint;  some-


   The super tartrate of potash (the common cream of tartar) should always
be combined with  jalap when used as a hydragogue  cathartic  in dropsy.  A
decoction of the juniper berry may likewise be used with much advantage.—Ed. 
ISCHURIA VESICALIS E MUCO.
175
times by promoting a general diaphoresis, and at others, by somewise
promoting absorption, and strengthening the primae viae. The remedy
consists only of the expressed juice of the leek, which I have given
to an adult, in the following form:

     R. Succi porri expr. 3J ad 3'iij.
        Mucilag. gum. arab. 3'ij
        Tinct. cardam. comp. 3ss atl 3j
   Misce, ft. haustus, bis, ad quater in die sumendus.

   External stimulants are sometimes proper, especially in the serous
dropsy consequent upon a debilitated, rather than morbid state ; of
this kind is the application of a broad flannel band round the abdo-
men and loins,  dipped in spirit of hartshorn  diluted with  water,
about two parts of the latter to one  of  the former, which may be
increased as the  parts are  found able to bear it;  which has had an
immediate good effect.   In its stead the following may be had re-
course to.

     R. Linimenti saponis fiss
        Tinct. cantharidii Jss. misce.

   If but little benefit should be procured by medicine, in a reasona-
ble time, it may be  proper  to make a few few punctures on the tops
of the feet, and especially  on the praeputium penis, if that part be
very anasarcous;  there being very little hazard in young children of
the punctured parts inflaming, or becoming otherwise troublesome.*
   After the water is got off and diuretics  laid aside, the steel joined
with cordials should probably be continued, till the child's strength
be restored.
   It may be needless to suggest, that as dry a diet as  may be should
be employed, and the bowels be kept open throughout the disease.
                   Ischuria Vesicalis e Muco.

  By this term is here intended ?n affection of the prostate glands,
or the coats of the bladder; though the same symptoms  may also
arise from the ureters or kidneys, whether owing to a stone or other
stimulus.
  Like the last-mentioned  complaint, it sometimes appears during
dentition, and other inflammatory affections, and  will then call  for

  *  In this opinion we cannot concur, for although  my own experience is li-
mited, yet it is sufficient to convince me that punctures cannot be made under
these circumstances, without incurring the danger of inflammation, suppura-
tion, and even mortification.—Ed 
176
ISCHURIA  VES1CALIS E  MUCO.
cooling remedies: it generally disappears when the teeth have made
their way through the gums, and the fever subsides.   Even in more
advanced childhood, there is nothing like  fever or  other  precise
marks of disease excited by this complaint;  though it may be said,
this disorder more commonly attacks children of a tender and deli-
cate habit.
   It is attended with the like frequent inclination to void the urine
as in the former complaint, and with more or less pain in its excre-
tion, or more commonly before it begins to come away.  But in this
disorder, the urine is  always very foul,  is loaded  with a very ropy
mucus, and sometimes comes away discoloured with blood, and at
others small coagula fall  to  the  bottom.   This disorder, indeed,
puts on every appearance of the like disease common in adults, espe-
cially old men, but is usually much slighter,  and, therefore,  more
easily and  speedily cured; for children being more irritable, the uri-
nary passages are over stimulated by causes that would not affect
adult persons.
   The appearance is, nevertheless,  alarming,  as it may, possibly,
arise from  a morbid affection of the prostate gland, or the bladder,
and must then be a serious complaint; or it may be owing, it has been
observed, to a stone in any of the urinary passages, in which case a
cure cannot be effected as long as the stone  remains.   Fortunately,
however, this is not a frequent cause in early childhood; and is not the
case here intended.
   The disorder  sometimes yields  in  two  or  three weeks  to mere
diluent, and demulcent medicines, such as the lac  amygdal.  with
syrup,  alth. barley water and gum afabic,  spermaceti, and  such
like; and it is probable, in such instances, might in a  short time dis-
appear of itself.                                        .
   In other instances more powerful means are required, which, either
by creating a different stimulus, change the action of the  parts af-
fected, or,  by their restringency, prevent that secretion which has
been the cause of the irritation.
   The aqua calcis, aq.  kali,  balsamum copaibas, or decoct,  cor-
ticis,  seem to  be the properest remedies  in  the absence of fever.
From three to ten drops of the aq. kali, or  balsam, copaibae, ac-
cording to the age of  the child, will be a proper dose, and may be
taken three or four times  a-day, as the urgency  of the complaint
may require.
   After appearances  of being perfectly well, the urine, in  some in-
stances, has become as turbid  and mucous as  at first, and the former
 irritation returned.   In one  such case, the complaint seemed to yield
to an infusion  of the golden-rod, of which two or three table spoon-
 fuls were taken three  times a-day.  To this the mother of the  clnld
 had been advised by one of her friends, upon the complaint return-
 ing some time after I had declined my visits. 
177
              Ischuria Renalis, or Suppression of Urine.

   This dangerous disorder is easily distinguished from the ischuria
 vesicalis, or ordinary suppression of urine, in which the secretion is
 duly made in the  kidneys, and the urine conducted to  the bladder;
 but being detained there, the accumulation is readily discovered both
 by the pain and tumour in the regio pubis.   In the  ischuria  renalis,
 on the other hand, the urine is not secreted at all: but the superabun-
 dance of watery fluid is retained in the blood.
   This disorder, I believe,  is more common  in adults, especially el-
 derly people, than in childhood, and is  a true palsy of the kidneys.
 In such instances, if the secretion be not restored in afiout twenty-
 four hours, the suppression has usually proved fatal very soon; though
 it is not commonly preceded by any considerable derangement of the
 general health.
   In these  respects it corresponds nearly with the ischuria of in-
 fants; for the first, and a very accurate  account of which dangerous
 disorder, we are obliged to Dr. Willan,  who happened  to meet with
 several instances  of it within a short 6pace of time.   In  each  of
 these the disease was introduced by similar symptoms, a slight fever-
 ish heat being observed for about  a week, accompanied with diarr-
 hoea, and sometimes bilious vomiting.  Towards the end of this time
 the urine  was made in small quantity,  and in about twenty-four
 hours the  discharge  of it entirely ceased,  and the  patients died
 unexpectedly, without complaining of pain or any particular unea-
 siness.
   Inflammation of the mesentery is judged to  be the source of the
 first symptoms; and  the suspicion   has been  supported, in  one in^
 stance,  by an examination of the parts after death.  A gangrene
 also, which  had  taken place, Dr. Willan conceived to  be the cause
 of the fatal suppression of urine; but in a subsequent  instance, it was
 found otherwise,  the patient being  perfectly recovered from the sup-
 pression, and apparently restored  to health  by the  application  of
 leeches to the belly,  and a blister near to the os sacrum;  but the child
 died about a month afterwards, with symptoms of hydrocephalus dis-
 tinctly marked.
   The  above-mentioned remedies,  with gentle  purges, clysters,
 and cooling  diuretics,  and the repeated use  of the  warm bath,
 are, probably, every thing that our  art  has to offer for the  cure
 of  this  novel disease in  infants; and were  its symptoms more
 distinctly marked, or formidable in their first appearances, so as to
 lead to  a recourse to  it on the  earliest approaches of the disor-
 der, the remedies misrht be oftener successful  than they have, hitherto
been.
                               4 
178                INCONTINENCE OP URlNE.
                          The Gravel,

  Although we see children of almost  every age  afflicted with
stone in the bladder, and such frequently voiding gravel mixed with
their urine; the  gravel  is by  no means a common complaint in
others.   I have, however, been several times consulted for children,
under three years of age, who have been so affected; which has seem-
ed in some instances to be hereditary.
  The disorder is usually slight at this early age,  and merely acci-
dental, sometimes disappearing of itself in a few days, or after  tak-
ing only a little oil and manna, or other soft  laxative, and some of
the demulcent  medicines recommended for the ischuria e muco.  In
other instances,  I have directed  a decoction  of marsh-mallow and
parsley, or wild  carrot-roots, or the  infusion of  sweet-fennel and
wild parsley  seeds, sweetened with  syrup of marsh-mallows, or
honey.   A  bit of castile soap also  may be dissolved in milk, and
taken as a breakfast or supper; or a few drops  of bals.  copaibas be
administered two or three times a-day, and the body kept open by the
kali tartarisatum, or the  sal polychrestum.
   Should the complaint continue long, and the quantity of gravel in-
crease, as much  Seltzer water should  be  drank daily as  the age of
the  child may  admit.  If it be attended with  much pain, the warm-
bath would, probably, be useful; but I  have never  known it so  great
 as to require any kind of opiate.
   This complaint, however, is sometimes more serious, lasts several
 months, and the water is almost daily  loaded with gravel  of different
 kinds;  being sometimes soft, and of a  pale  colour,  and at  others, red
 and very gritty, or sand-like.
   One case of this kind in an infant of two years old, after  appear-
 ing to be benefited by several of the above, and by other medicines,
 returned again with greater violence  than ever,  and was attended
 with great pain  in micturition.   Sedatives, gentle diuretics,  calo-
 mel, and the bark were in turn had recourse to; the latter of which,
 together with a free use of mephytic water, appeared to carry off the
 complaint, and the child went into the country.
                     Incontinence of Urine.

  This is not a very common complaint, I believe, in children, un-
less combined with the stone in the bladder, and then is not so con-
stant, nor to the degree that is intended here.   It is  an  involuntary
flow of the urine, sometimes by day as well as during the night; aris-
ing, I apprehend, from a relaxation or otfier affection of the sphinc- 
INCONTINENCE OF URINE.                 179
ter of the bladder,  as in very old people, but  is not attended with
manifest fever, nor symptoms of decay.  An affection of this kind,
in which the urine runs away in the sleep only, is more common;
and I have  known it continue to the age  of fifteen or sixteen years
when not properly treated, and afterwards yield to sea-bathing.   If,
however, it be an original  affection, and confined only to the night,
(when every part is more disposed to relaxation,) and the  child  be
young, it usually disappears as the child grows up, and thereby ac-
quires strength; but it may be often  assisted in the mean time, mere-
ly by exercise, living on dry food, dashing the contiguous parts with
cold water,  and such little means as may tend to impart tone to the
sphincter muscle and neck of the bladder, and  scrupulously abstain-
ing from drink near the time of going to bed: perhaps,  camphor and
laudanum, often useful in the like infirmity in  old people, may not
improperly be made  trial of.
  The total  incontinence generally comes on gradually, and is some-
times attended with excessive gonorrhoea, even in very young child-
ren, and is more difficult of cure: so  likewise, if the complaint should
succeed to other disorders,  as the stone, inflammation  of the  neck of
the bladder, or forcible use of the catheter;  and especially, if it follow
any somniferous disease, or a palsy of any other part of the body; in
which case the appropriate remedies must be employed.
  In a general  way,  tincture of catechu, or of  gum kino; the cortex
peruv. balsam, copaibas, and vitriol, album, may be made trial  of;
but nothing is  usually so effectual as repeated blisters applied over
the os sacrum; with proper doses of the tinctura cantharidis, or  the
powder, carefully administered in some soft emulsion.  The former
may be  administered in  doses of ten or fifteen drops to children from
five to ten years of age, and increased to two scruples and a drachm,
two or three times a-day; or the powder from half a grain  to a grain
and an  half, given as often; which  has generally removed the com-
plaint, if there  has been no morbid affection of the spine, as is some-
times the case.   If these means should  fail, recourse  should be had
to sea-bathing, and  other tonic remedies.  But I have, since  the late
edition of this work, been led to a different mode of treatment, from
remarks made  on this weakness in  very young children,  who from
their  unwillingness possibly to be disturbed in the night, almost con-
stantly wet  their beds.  In such instances, success has attended tak-
ing them up frequently in the night,  and placing them on the pot;  not
suffering them to rise from it till the bladder be emptied.   By this
means,  children, whether from the habit of getting rid of the urine,
or their dislike of being so often taken up, have been uniformly  in-
duced to call, and even to awake their  attendants as often as neces-
sary; and the complaint  has, in consequence, entirely disappeared:
when it may continue long, it may be prudent to anoint the neighbour-
ing part with soft liniment. 
180
                 Polydipsia, or Excessive Thirst.

   The affection here adverted to, is not a symptomatic but  idiopa-
 thic disease, though it seems to depend,  indeed, upon an  idiosyn-
 crasy; and is equally incident to children as to adults.   It is, how-
 ever, so rare a  complaint in either, that but little can be said of its
 true nature, there being but few instances of it,  I believe, upon re-
 cord.   Of these, one began at, or soon after birth, and another when
 the child was about four years and a half old; a  short time before it
 was seized with the natural small-pox.  The former is now an adult
 woman, and mother of eleven children, in whom the disorder still
 continues in a very extraordinary degree.  The latter is yet a child,
 and from  the last accounts, is  very lively, and though apparently
 healthy, drinks  every  twenty-four hours ten  quarts  of  water, and
 makes  daily  twelve of urine,  as clear as the water  he  drinks.
 Through the day he requires a draught every half hour, and  once
 every hour in the night.
   Dr. Simmons, I believe, gave to the public the first accounts of
 polydipsia, as idiopathic, and has been at great pains in ascertaining
 the facts   Boerhaave, indeed, seems to speak of such a complaint;
 and Zuingerus of immoderate thirst as a  very common affection of
 young children,  coming  on without fever or  any other complaint,
 unless it be a lassitude of the extremities:  says,  the  appetite conti-
 nues very good,  but the desire for drink so great, that  on withholding
 it, they express vehement displeasure, and are  threatened with con-
 vulsions, and other nervous disorders.   He does  not, however, al-
 lude to  the quantity that  such children  require,  and adds,  that
 in a  little time their  bellies become  tumid; that  they are  sub-
ject to glandular affections, and  fall into atrophy.   On these  ac-
 counts, this species of polydipsia  seems to have  no  relation to the
 cases adduced.
   The above-mentioned instances of it occurred  in France; and one
has been met with  in Stanground, near Peterborough, in  an adult
 man near fifty years old, in whom the affection first took place  after
 an  intermittent  fever, when he was  in his twenty-seventh year.  A
 similar case also presented about three years  ago at the Middlesex
 hospital.   This  was in a child, but the thirst was not in this instance
so great  as in the afore-mentioned ones.
   Though  I can, indeed, have but little to offer with any confidence,
for the treatment of a disorder which is both rare and depending upon
a peculiar temperament of the body; yet this curious disease appears
worthy of  some  notice  in a  work that is thought to comprehend a
more complete account of the disorders of children than has hitherto
appeared.   A slight record of it will also possess  the  further advan-
tage of apprising practitioners of there being such a complaint; which 
EXCESSIVE THIRST.                 '   181
it is presumed cannot fail of being  acceptable, if any into whose
hands the work  may fall should meet with children who have any
evident tendency to it.
  How far internal, tonical medicines, with the cold bath and  elec-
tricity,  or attempting to promote insensible perspiration, might tend
to a removal of  it, upon  its first  approaches,  though I can by no
means venture to say, they may, possibly, be worthy of trial.   Per-
haps the plan lately  adopted with  success by Dr. Rollo of Wool-
wich, in the  diabetes* might likewise be ventured upon.  This re-
fers equally to regimen and medicine.   Hepatised ammonia makes a
chief part  of the  latter, administered at first  in  very  small  doses.
The diet should consist of milk, with lime water, for  breakfast and
supper, and animal food for dinner,  and that long kept, and very fat,
without the least  vegetable,  bread, or other farinaceous substance.
Confinement to  the house, and rest,  are also  strictly enjoined.   But
if none of the above means, nor any other remedies that may be
suggested, should pretty soon afford any  degree  of relief, it is pre-
sumed, that no violence should be offered to so peculiar a tempera-
ment, lest some worse or real evil should appear in its place.
   In the Medical and Physical Journal,! however, notice is taken of
instances of this disorder occurring in adult  persons;  the one in  a
French clergyman, at Berlin, and the other  by Dr. Dyce, of Aber-
deen.   The  former seems to have been perfectly cured by very sim-
ple means by Dr. Domeier, who,  in order  to check the excessive
perspiration  that in this instance accompanied the disease, made his
patient dress much cooler than he had been accustomed to do;  to use
the cold  bath,  and put his feet from time to time, into cold  water.
He likewise  directed acidulous drinks, made  with the sulphureous '
acid, to quench the inordinate thirst.
    In  consequence of the above account by Dr.  Dyce, another in-
stance of this disease, in an adult person, has appeared in the same
Journal;}  which was also cured by somewhat similar means,  in the
course of a month.   An ounce of cort. peruv.  and  half a drachm of
sulp. zinc, was divided into sixteen doses; one of which was taken
every six  hours in a glass full of  wine—porter was the patient's
drink, with  the tamarind decoction to allay his thirst; and after a
while, an  opiate  was taken  at night;  and fifteen drops  of the acid.
vitriol, dilut. three or four times a day; whilst the bowels were kept
open with castor oil.§

   * Notes of a diabeticcase, 1797.
   f For Oct. 1800, No. xx.
   $ Vol. iv. No. 21, y Tuaam Peaal.
   § A few years only have  elapsed since I had an opportunity of witnessing a
 case of this kind, in the person of a gentleman, who put himself under the care
 of one of my medical friends.  The disease made its appearance immediately at-
 ter his recovering from a severe attack of small-pox.  All the remedies here no- 
182
THE SEVEN DAYS DISEASE AND PECHEGUERA.
                        Diabetes Infantilis.

   This complaint is related by Moreton in his Phthisiologia, and is
worthy of notice in this place; but it is not an idiopathic disease like
the former.   He mentions  it as not being a common disorder, and
terms it a consumption from diabetes; attended with great thirst, as
in the fore-mentioned disease.  He speaks  of it as the effect of irrita-
tion from teething, and as a family disorder, having been fatal to all
the male children in one family, except the last infant, to whose as-
sistance he was called at the commencement of the thirst, and  in-
creased secretion of urine; which  was sweet, as  in the  diabetes  of
adults.
   This child, therefore, appears to have been saved by the treatment
he adopted, but was not entirely free from complaint, as he had right-
ly foretold, until all  the first teeth  made their way.   In the progress
of the complaint, the Doctor remarks,  that  the diabetes was attended
with considerable diarrhoea, under which the infant  wasted fast, but
without cough.  The treatment, in the mean time, consisted in con-
fining the child strictly to a milk diet from  the first;  and  to allay the
excessive thirst, he allowed only milk mixed with the Islington chaly-
beate water.   This plan very soon became useful; but the symptoms
recurring with aggravation  whenever  a tooth was  making its way,
the Doctor was induced to  advise  a  few grains of rliubarb every
morning, and a little diascardium  at bed-time.   These means were
persevered in for two or three years,  that  is, until  the first teething
was completed; after which, the child enjoyed perfect health.


The Seven Days Disease, and Pecheguera of Spanish South America.

    I shall close this part of the  work with a brief account of two
very extraordinary disorders, which  should have been noticed among
the earlier  complaints of infants,  if they  had  been  diseases of this
country, or even much known in other parts of Europe.   As the
seven days disorder  has, however, actually made some  appearance
in this quarter of the globe, and may,  therefore, at some future pe-
riod, become  more common, it may be proper it should be mentioned.
The following account is translated from the French of Mr. Le  Fe-
bure de Villebrune, who refers to the Spanish work of D. Ulloa,
(Disc XI. § § 19 and 20) andBarrere's Voyage to Guinea.
   § 19. The disease of seven days of new bom infants is common  in

liced were tried, but they proved ineffectual: others were suggested,  but they
proved equally feeble and impotent.  The case was then efiven up, and the pa-
tient was informed that time was the only  source from whence he could expect
relief.  Since that  period he has enjoyed the most perfect state of health, and
thinks his thirst gradually diminishing.—Ed. 
           THE SEVEN DAYS DISEASE AND PECHEGUERA.       183

both quarters of America, and equally dangerous in the high as in the
low parts.  A great number of infants die of it, without any symptom
antecedent to its accession, leading to a suspicion of it.   They are,
on the contrary, apparently healthy and robust, when the disorder
makes its attack in the form of epilepsy; and few of those who are
visited with it are found to recover.   Though  it has been said, this
complaint is not altogether unknown in Europe, it is neither so com-
mon, nor so  dangerous.  It is conceived  that  the best preventive
would be to guard infants from being  exposed to the wind, till the
first seven days are over.
   This imperfect account allows of very little comment; but it seems
probable, that  this disorder may not be very unlike the tetanus  of
the West Indies: and from the mode of prevention proposed, the dis-
ease  may be owing to  some local custom or circumstance, as Dr.
Clarke has noticed in regard to the  latter.
   § 20.  But infants at Guaneavelica are still liable to another very
extraordinary  complaint.   Having  escaped  the seven days disease,
they thrive well until the third or fourth month; they are then seized
with cough and pulmonic affections, which they there call pecheguera.
The complaint goes on  increasing without any sensible  relief from
 the medicines made  use of; and a swelling  taking place they pre-
sently die.   The disorder attacks only the white people, or children
of the Spaniards; the Indians and the mongrels are not subject to it.
The way to escape it is, to remove infants from the spot, before they
 are two months old, and to carry them to more favourable climates,
 into one of the Zuebrades,  (or low grounds between the mountains,)
 that are at a little distance.   It is imagined,  that the cold and intern-
 perature of the climate is the occasion of infants being so soon seized
 with this complaint.   This may be  the case in some degree: but the
 vitiated  habit of body of their parents, and the sulphurous vapours
 continually arising from the furnaces for the extraction of mercury,
 may likewise contribute to it.   In fact, these vapours  are so abun-
 dant, that when reunited by means of the cold, they form such a thick
 cloud in the atmosphere, during the season there called summer, as
 to cover all the colony,   Notic.  American. Disc. II. p. 205, L. 
APPENDIX.
                    On the Vaccine Inoculation.


   Having for some weeks waited for the report of the Vaccine In-
 stitution, which was at that time daily expected to appear,  this ac-
 count stands a little out of place; the printer having proceeded far
 beyond the proper one  before the report could be seen.
   The extent to which Vaccine Inoculation has been practised since
 the last edition of this work was published, and the attention which
 has been  paid to its progress and effects,  has established a body of
 evidence  upon the subject, which is  highly satisfactory.   Not only
 have medical gentlemen of the most respectable talents made it the
 subject of their attention, but public institutions have been founded
 and supported by the legislature, which have at once served to ascer-
 tain its merits, on the  largest scale, and to give it universal spread.
 The result appears to be,  that vaccination, though not  an  absolutely
 infallible  preservation  from the contagion of small-pox, is  one in so
 great a majority of instances,  as to render it highly probable, that if
 it were universally adopted, the small-pox would in a few years be-
 come entirely extinct.   In the island of Ceylon, near 130,000 per-
 sons have been vaccinated, and  the happy consequence appears al-
 ready  to  have followed;  the  small-pox not having appeared there
 since February, 1808,  except in a few individuals who had not been
 vaccinated, and who caught it from a boat that landed at Jaffapat-
 num from the Malabar  coast.   But its spread as an epidemic in that
 settlement is no longer apprehended.
   By the report of the Vaccine Institution  in  Broad  street, lately
 published, it appears that only nine cases of failure have occurred in
the practice of that charity in 5,000 that have been inoculated; and
that all the authenticated  cases  of failure which have taken place
amount only to forty-three, which, among the many thousands who
have been vaccinated in this country, is a proportion probably less
than 'hat  in which small-pox has taken place  twice.   The latter
occurrence has recently appeared three times in patients who have 
vaccine inoculation.
185
been under the care of one respectable practitioner  at the west end
of the town.*
  It is probable, that in  many cases where vaccination has failed,
some error  has been  committed as to the previous state of the sub-
ject, or the progress of the pustule afterwards.   It seems important,
therefore, in order to perfect security, that the following observations
should be strictly attended to.
  The child to be inoculated should be at the time free from fever and
every eruptive disease.   If any irritation from teething arises, the
gum should be lanced.  The matter  employed  should be taken from
a decidedly characterised cow-pock, which  is  proceeding regularly
through its respective stages;  and it will be more  certain of produc-
ing the disease, if it is taken before  the eleventh day.   " If the in-
fectious matter produce the required effect, in three, four, or five days,
there will be seen a red spot  like a  small gnat bite; in six or seven
days, a  small vesicle will appear; in nine days,  a  circular vesicle
(improperly called a pustule)  will be found,  as  large as a pea, or
from  about two-tenths to four-tenths of an inch diameter, usually
surrounded by a red  areola.   By the eleventh day, the vesicle  be-
gins to scab, or grow dry,  and turn black  in  the  middle,  and  the
areola becomes more extensive.   By the fifteenth day,  but often
later, the pock becomes a mere scab, circular, prominent, well de-
fined, of a blackish  or mahogany colour, adhering firmly; but the
areola disappears.  Unless it be separated by violence, the scab does
not fall off, in general, sooner than  the  twentieth day.   It then be-
comes a cicatrix permanent through life."f
   Little medicine is required during the progress of the  disease.
The bowels should  be kept regular; and if feverish symptoms arise,
 a saline draught may be given occasionally.  The principal incon-
venience which  the patient  experiences appears to arise from the
 soreness of  the  inoculated part; this  will  be alleviated when  it
 amounts to any considerable  degree, by laying  on  it a piece of linen
                                                            i
  • Of the like kind is the following:—Mr. Pallas, in his Voyages <&ns les Gou-
 vernemens  Meridionaux de  l'Empire de Russie, en 1793 et 1794, relates the
 following circumstance, which occurred while he was at Sarepta.
   Retenu malgre moi d'une part par la chaleur excessive  qu il taisoit en mois de
 Juillet, et augmenioit encore  a un point insupportable par l'embrasement du step
 des deux c»»tes du Volga, dans  circonference bien  etendue, je le fus encore
 par la maladie de la petite verole qu' y eut ma fille, bien assurement pour la
 seconde fois, a une epoque ou ce fleau epidemique, qui s'eto.t declai ee avec vio-
 lence depuis le commencement de l'hiver a Sarepta, commencoit a dimmuer.
   f The description here given of the vaccine disease in all its various forms
 and shapes  is correct:  nothing need be added, except that the scab  communi-
 cates the disease with as much certainty and purity as  the matter taken from the
 arm  This fact, I believe, was first made known  to  the medical world by i\Ir.
 Brvce Surgeon to the Vaccine Institution  of Edinburgh ; he published Ins paper
 on the subject in the year 1802-  In the Eclectic Repertory, vol. i. page 362 is
 a valuable paper by Dr. S. P  Griffitts of this city, who details the proper method
 of preserving and using the scab.—Ed.
                                  * a 
186
VACCINE INOCULATION.
dipped in water, which should be frequently renewed till the paia
abates.
  When the vesicle begins to scab, a dose of any mild purgative may
be given, and repeated in two or three days.
  If the scab  falls off before the part is completely healed, a  little
spermaceti cerate may be applied, to defend it from the friction of the
clothes.
  Where any doubt exists whether the vaccine inoculation has been
effectual, it should be repeated; for it appears, from the report before
alluded to, that re-inoculation with vaccine matter is as good a test
of the patient having regularly gone through the cow-pock, as inocu-
lation with small-pox  matter: the constitution being rendered in-
sensible to both diseases, after it has gone regularly through either
of them.
  It does  not  appear, that vaccine inoculation induces  any other
disease, as was feared in the beginning of the  practice.
  All eruptive diseases in children predisposed to  scrofula, are oc-
casionally followed by that disease, but none of them in any degree
equal to the small-pox; the cases in which scrofula has followed the
cow-pock will bear no comparison  in number with the melancholy
objects  in whom small-pox has  produced it with its most dreadful
symptoms.  As it is also evident in the experience of every practi-
tioner, that scrofulous affections less frequently appear after the inocu-
lated, than the  natural small-pox, (and it is presumed, as being a
less severe disease, it producess less excitement of the system,) so is
it not to be wondered at, that they still more seldom occur after vac-
cination.*
  It is  to be hoped,  therefore, that the great mildness of this pre-
servative from so dreadful a disease as small-pox has long proved to
be, will ere long cause it to be universally adopted; and preponderate
over the  erroneous representations of those who,  for want of better
information, or from unworthy motives, still  continue to  oppose it,
and to leave the helpless and  innocent offspring of the poor exposed
to one  of the  most destructive and injurious  maladies to  which the
human  body is liable.  But whilst we recollect, that inoculation for
the small-pox had  to  wade through a torrent of the like obloquies,
and finally triumphed over them; we  have further reason to hope,
that the hour of cool reflection is at hand, when the sober good sehse
for which our nation has long been remarked, will be no longer sul-
lied by a fastidious rejection of a  far greater blessing, because in its
origin a novel invention.

  * Without entering into any discussion upon this subject, I will only observe,
t'a! unquestionably children have crusta lactea, &c. after vaccination, but does it
thence follow that the latter are a consequence of the former ? It is worthy of
notice, that the opposers of vaccination have never proved the existence of anr
new cutaneous disease, produced by the introduction ef the cow-pox.—Er
END OP VOL. I 
A TREATISE
          ON THE







DISEASES  OF  CHILDREN. 
 
&
TREATISE
ON THE
DISEASES  OF  CHILDREN.
WITH DIRECTIONS
FOR
THE MANAGEMENT OF INFANTS

           FROM THE BIRTH.
       BY MICHAEL UNDERWOOD, M. D.
Licentiate in Midwifery of the Royal College of Physicians in London-
   Physician to her Royal Highness the Princess of Wales, and late
       Senior Physician to the British Lying-in Hospital.
Ornari Res ipsa negat, contenta doceri.
                    Manill.
                  VOL. II.

          FROM THE SIXTH LONDON EDITION,


              PHILADELPHIA:

PUBLISHED BY JAMES WEBSTER, 10, S. EIGHTH STREET.
         William Brown, Printer, Prune street.
                   1818. 
 
PREFACE.
   The preceding volume having embraced all the more important dis-
eases falling under the immediate province of the physician, there re-
main only (unless the cow-pox be deemed an exception) a few anoma-
lous matters in his department; which, having some relation to other
complaints now to be noticed, may be suitably arranged in this part of
the work. These will be classed relatively to other matters; having
here a principal regard to the disorders  falling under the province
of the surgeon, with others that may be said to be of a mixed kind;
but should be  all familiar to every accoucheur.

   But, beside  those affections  consequent to birth, which may be
precisely termed Diseases,  many infants present themselves  to the
world under circumstances that call for immediate assistance,  being,
as it were, in  a kind of intermediate state between life and positive
death, and even  with the appearance of being  actually dead; but
may, nevertheless, be re-animated by timely and judicious aid, so as
to be perfectly rescued from any peculiar dangers.

   On this account, some practical directions, on this head, it is pre-
sumed, may form a suitable introduction to  this volume;  as the sub-
ject could not, with  strict propriety, be  arranged under the head of
Children's Diseases. 
 
INTRODUCTION.
                           ON

APPARENTLY STILL-BORN INFANTS.
   Having in the prefaee touched upon all such topics  as might
be  deemed necessary to  an introduction to the subsequent parts of
this word, the reader is reminded, that the  present exordium is de-
dicated to the consideration  of the  state  of apparently still-born
children, and to  point out the most likely means of their animation.
And what I have here to offer is the result of an  experience that has
been attended with more success than might have been expected.
   I have, indeed, both at the Lying-in Hospital,  and elsewhere, met
with many instances of children born with very little,  and  others
without even the  smallest appearance of life; some of whom have
remained entirely destitute of any sign of it, for more than a quarter
of an hour; and yet have been happily restored.   I pretend to little
or no skill in this business not generally practised, and can scarcely
guess to what to attribute this success, unless it may be an unwearied
assiduity and perseverance in my attempts, whensoever there are no
certain signs of death, till I conceive  nothing is possibly to be ex-
pected from them. And this has so often succeeded, that I have been
tempted to think its importance may, possibly, not have been suffi-
ciently attended to by every practitioner.   I rest this presumption,
not only upon  some fortunate events where I  have had little or no
  vol.  ii.                     B 
IV
INTRODUCTION.
previous ground for hope, but where other practitioners had, in some
instances,  abandoned  it.  A certain  steady perseverance in our at-
tempts to preserve  life,  as long  as  the least hope may remain, is.
indeed, not only a duty we  owe to the public, but one successful at-
tempt is an abundant recompence for many failures; especially,  as I
imagine we shall rarely fail whenever there may be the least positive
ground for hope of a favourable issue.
  As to the  means,  they  consist only of warmth, clysters, stimu-
lants, and especially blowing forcibly into the trachea.
  The ordinary stimulants  are, the smoke of lighted brown paper, oi
tobacco; juice of onions; frictions with hot cloths, and with brandy;
cold brandy poured on the  thorax, and on the funis umbilic, where
it is inserted into the belly; striking  the nates, and the soles of the
feet; stimulating the noise and pharinx with  a feather, (drawing out
the  mucus that may present;)  with every other similar  mean calcu-
lated to excite a strong  effort, especially that of crying; to which,
and consequent free respiration,  our  attempts ultimately tend.   On
this  account, I believe,  no great benefit  is  to  be  expected  from
stroaking the blood  along  the funis, or immersing the  placenta in
warm water; the fetal  life being extinct, the recovery of the child
will depend on the  blood passing freely through the lungs, which  it
cannot'do till the  child is brought to breathe freely and forcibly: the
continuance of which also  is never secure, till it begins to cry.  To
these ends, I have depended above all upon blowing into the trachea,
through the mouth; which I am satisfied,  may be more effectually
done by the mouth of the  assistant being  placed immediately upon
the child's, than by means of a blow-pipe;  (although  the air is, in-
deed, certainly less pure;)  at the  same time, preventing the return of
the air before it has entered the  lungs, by the  fingers  of one  hand
placed  at the angles of the mouth, and those of the other on each
side of the nose.   But I have sometimes imagined, that I  might at-
tribute much of my success not only to the continuance of this, but
to the manner of doing it,  by attempting to imitate natural respira-
tion, by forcing out the air I  have thrown  in, by a  strong pressure
against the pit of the stomach; thus alternately blowing in, and press-
ing out the air, for a long time together, omitting it only now and
then, to make use of some of the above-mentioned means: whieh latter,
however, (though some practitioners dispute  it,) can do very little to
insure the life of the child, until it begins  not only to gasp, and that 
INTRODUCTION.
with shorter intervals, but also to breathe in a somewhat uniform
manner.  At  this time,  should the child not be  disposed to cry,
which is frequently the case, nothing seems so likely to succeed as a
tobacco, brandy and water, or other very stimulating clyster; or put-
ting a  little Scotch snuff", or other pungent powder, up the nose;
which latter, if they induce  sneezing, will soon be followed by a
strong cry, and the child be with certainty restored.
   Amongst other means that of warmth was recommended; to which
end, the infant should be entirely covered with very hot cloths, which
should  be  renewed  as fast as  they become at all cool: or the body
may be immersed in a tepid  bath of salt and water, or milk, and be
well rubbed all over: the cord may likewise be suffered to bleed a
little, especially if the face or body do not soon acquire the natural
colour—but this ought seldom to be done, or the funic be divided  as
 long as any pulsation is  to be felt in it.
    To these means may be added the cautious use of electricity, which
 appears as likely to be successful in these, as in most other cases to
 which  it has  been applied:  but I have never been  in a situation  to
 make  trial of it in time, or I  certainly should; as I once knew a
 child happily recovered by  it, after being laid out  for dead for near
 two hours, in consequence of a fall from a two pair of stairs window.
    To  what has already been said on a steady perseverance in the
 use of the means recommended, the very great success of the Hu-
 mane  Society, in restoring life to drowned persons,  after two or more
 hours  have elapsed,  may be  advanced as a further inducement for
 continuing to make every probable effort.   For if an infant  be not
 born positively dead, it is well known that the vital life, though long
 dormant,  may be  roused into  action; and the living principle, if
 respiration be promoted, will  extend its influence through the animal
 frame, nor will fail to support itself, if no vital part has been injured
  in the birth.
    But should these several means fail; as a last resource, a very dif-
  ferent kind of stimulant-may be tried, and instead of laying the infant
  aside in a warm flannel, it should be exposed to sudden and severe cold;
  which I remember once to have succeeded after the life of the child
  had been entirely despaired of.—Mr. Herbolt, of Copenhagen, has
  conceived that many infants perish from the trachea being filled with
  water; and that infants in these circumstances might in general be
  saved! by giving them such a position, that the water should run out. 
VI
INTRODUCTION.
   I shall just add, that amongst  other  symptoms of some  supposed
irrecoverable injury a child may  have sustained in the birth, is that
of a discoloured and often fetid,  or bloody water forcing out of the
nose, after the lungs have been two or three times artificially inflated.
Under these circumstances, however,  I many years ago succeeded in
two or three instances so far as to animate children sufficiently  both
to breathe and to cry; but they afterwards lay in a moaning state for
four or five hours, and then expired.   To succeed thus far, indeed,
if I am rightly informed, may prove of importance, where the course
of a family estate may be pending on a living  child.   I have, how-
ever, lately been fortunate enough to succeed  completely, under the
most unfavourable circumstances, and after a great quantity of dis-
coloured mucus, and something like meconium, had been forced up
both from the throat and nose;  and  the child, an unusually large one,
is still living.
  It will be presumed, I dare say, that the  above scrupulous atten-
tion is not designed to be inculcated in every instance of apparently
still-born infants,  but principally  where the  death of the child may
not only not  be certainly ascertained, but there has previously been
reason to  expect  it would  be brought alive  into the world.   The
great importance, however, of the subject, it is hoped, will  be a suf-
ficient apology  with most  readers for  the length of these directions;
and as the attempt to restore infants to life has  always been  a most
pleasing employment to myself,  the desire of being  an occasion of
inducing others to a perseverance in the  use of the like means, em-
boldens me to risk the censure of any who may deem  it  prolix or
superfluous. 
A
TREATISE
DISEASES OF CHILDREN.
  IN the former volume, considerable  attention  has been paid to
cutaneous disorders;  either from their being found to require direct
medical treatment, or from their standing  in  connexion  with other
complaints strictly appertaining to the physician's department.
  There are, nevertheless, many affections of the  skin of a different
kind, which being  either usually unconnected with  any  disorder of
the system;  or else forming sores on the surface  requiring their ap-
propriate topical remedies, accord more strictly with the province of
the surgeon, and will therefore be considered in this place.
   Of the cutaneous affections coinciding with one or other  of the
latter descriptions, I shall, for order sake, treat first of such as appear
on the head.


                     Tinea,  or Scald  Head.

   The tinea, or porrigo, is a very troublesome complaint, and is said
to be often a scrofulous symptom; but it is certainly more commonly
communicated by contact, and when lighting  on a scrofulous habit
may be more difficult of cure.   It is, indeed, highly contagious, espe-
cially amongst children at schools, or other places where they mix
freely together, exchange hats, or other covering of the head, with
such like  intercourse; by which means, it has sometimes been com-
municated through a whole school.   I  hope, however, to point out a
successful method of  cure, the unpleasantness of which has, impro!-
perly, I think, prevented its being more generally adopted.
   From some considerable experience, I  may venture to say, that
being usually a mere complaint of the  skin, it maybe most success-
fully treated by topical applications.  This disease is seated in the 
2
TINEA.
little glands at the roots of the hair: is sometimes dry,  but at others
moist,  and then produces little  ulcers; which being thoroughly
cleansed, and  made  to digest, may be safely healed up; as I have
found in many other affections of the  skin, in which the system has,
often over scrupulously, been conceived to be concerned.
   It is not uncommon, I know, to administer a variety of internal
remedies,  and perhaps they may sometimes be  required, though I
think I have seldom given any thing more than lime water, or a de-
coction of the  woods, and a few purges at the decline of the erup-
tion; which is always prudent, and sometimes with the addition of
calomel.
   If the  complaint  be taken early, before it has spread far over the
head, and whilst the scabby patches are  small and  distinct, it  may
frequently  be cured by an ointment made of equal parts of sulphur,
flower of mustard, and powder of staves-acre, mixed up with  lard or
other unctuous substance; or by the sulphur ointment, with a small
addition of the calx hydrargyri alba.  And this last  preparation  may
very safely be  made  use of, if the patient be kept within doors, and
the body properly open, as it will be necessary to rub  in  only a
small portion once or twice a-day,  on  the parts immediately affected.
But if the disease should  spread, or has already extended itself  over
a great part of the head,  the hair must be shaved off, and  the head
washed twice a-day with a strong  decoction of tobacco;  repeating
this process till the scabs disappear, and the hair grows up from the
parts  they had  occupied.   Or,  instead of the decoction of tobacco,
the head may  be well washed with the lotio saponacea, with the ad-
dition of a  small quantity of the aqua kali puri, and  the scabs anoint-
ed  with the unguent, hydrargyri nitrati  in the place of the sulphur
ointment and  calx of mercury, the former being a very powerful, as
well as  a safe application, and may be used in any quantity  that
may be necessary.
   But the complaint is sometimes of long standing before medical
assistance  is solicited, and  is not  only extended over all the head,
but the scabs are thick, and rise  high  above the surface, returning as
often as  they may fall off.   I have, however, never failed to cure the
common  tinea by a method  perhaps well  known, but too  seldom
complied with in time, on account  of  its  supposed severity.   It con-
sists only in well washing the head, first close shaved,  with  a piece
of  flannel and a strong lather of  soap suds, and then rubbing  in very
forcibly an unguentum picis, made of the petroleum,  instead of the
pix liquida; and if this fail,  adding  a good quantity  of the ptilvis
ellebor. alb. or  other  safe  depilatory, for near  an hour at  a time,
always using it very warm; and covering  the head with a bladder to
preserve the ointment on the part, as well as to keep it from sticking
to the cap, or  other covering made use of.  When this has been done
three or four times,  not only the "cabs, but the hair will also  loosen, 
SCURFINESS OF THE HEAD.                  ii
which must be  pulled  out,* however unpleasant the operation may
be, as it will,  indeed, prove a kindness in the end;  and must be re-
peated till all the hairs be taken out: after which new hair will rise
free from scabs, which is a sufficient indication that the disorder is
effectually removed.  Some writers with the like  view advise the
application  of repeated  blisters, after  the head  has been  close
shaved.
   The  following  plaster is strongly recommended by Mr. Thomas
Morison, surgeon in Dublin, as successful in ••he worst  cases.
   The head is to  be well washed and a bread  and milk poultice ap-
plied, if the scabs are very dry; and the plaster afterwards applied,
spread on strips of linen, which are to be renewed  every day. Take
of common  ale, one pound; of the  finest flour, three ounces; mix
them intimately;  and having set them over a very brisk fire, add two
ounces of yellow  resin, stirring them constantly until they shall be
perfectly incorporated,  and take on a smooth gelatinous appearance.
   There is, however, a spurious  kind of scald head, that is some-.
times more difficult of  cure; but it  requires nothing but patience in
the use of one or more of the above remedies, or at most, an alterative
plan of the flowers of sulphur, or of some mild mercurial prepara-
tion, with the common decoction of the woods, or the Lisbon diet
 drink:  and in some cases to open an issue, or fix a seton in the nape
of the neck.   Or, should the difficulty consist in getting out the hair
 entirely, or destroying  the diseased  glands at  its roots, the  calx viva
 may be  had  recourse  to, in one form or other; and is  exceedingly
 preferable  to an  adhesive pitch plaster.   In a few  instances, the
 unguent, hydrargyri mitius has a wonderful efficacy.  This  remedy
 should, however,  be cautiously applied; and instead of being  forcibly
 rubbed  in, like  other topical applications,  should be only spread
 lightly,  and very  thin on the scalp: the body should at the  same time
 be  carefully  kept open.
                     Scurfiness of the Head.


  Some infants early contract a scurfiness on the head, which in-
creases as they grow up; becoming likewise very thick, and itching
exceedingly.   It is more commonly dry, but is sometimes moist, and
even discharges  a great quantity of a  very  thin fluid.  In either
case, it can rarely be termed a disease, and  is  scarcely worthy of
notice, but in a view to prevent mischief, from the application of im-
proper remedies;  or its degenerating into a real complaint,  through

  •  This has long been practised by Dr. Physick, who was induced to adopt the
remedy, by observing the beneficial  effects which  resulted from its use in a
similar disease seated in the eyelids.—En- 
4                   HERPES, OR RINGWORM.
 neglect.   Amongst the poor, indeed, it often arises from that source,
 and can be removed only by proper combing of the bead, and other-
 wise keeping it clean.  But should it arise spontaneously, as it some-
 times does about the time of teething, very little need to be done,
 nor ought to be,  further  than  keeping the head  clean, and often
 combing, or brushing it  cautiously  as above directed:  at most, the
 scabs may be touched, every now and then, with a little cream till
 they begin to  loosen, or with a drop or two of arquebusade water,
 if they are too moist; at the same time, carefully avoiding taking cold
 on the part.
  I have, however, sometimes seen a scurfiness of the head, taking
 place even during the month, attended with an excessive discharge
 of a thin  fluid; which it would  be alike improper either to repel, or
 encourage.  A good general application in this case,  though truly
 anile, is that of warmed butter  and beer,  with which the head may
be washed twice a-day;  and certainly not  only does no harm,  and
keeps the head clean, but has appeared in some instances, to do more
to remove the complaint than any thing I have seen used.
                        Scabies, or Itch.

   This disorder so commonly known and  easy of treatment, is men-
tioned chiefly in order that nothing may be overlooked relative to the
disorders of childhood.   It is a very contagious disease, but usually
easy of cure, and seldom requires any thing more than a free use  of
the unguentum sulphuris.   There is* indeed, a spurious kind, (as  of
the tinea,) which is far less or often nowise contagious,but is more dif-
cult of cure, or at least more tedious, than the genuine.  Should the
brimstone ointment, therefore, fail,  sulphur should be  administered
inwardly, and sometimes mercurials; which may likewise be added
to the ointment, and in a few weeks, at most, will  not fail of remov-
ing the complaint. It is common to administer at the same time some
alterative diet-drink.
                     Herpes, or Ringworm.

  The herpes, like the foregoing complaints, is a disease of the skin,
infesting some children almost annually, and appearing  in dry scurfy
blotches, on different parts of the body, and usually of a circular form.
It becomes troublesome chiefly from the violent itching that attends
it, and would probably get well of itself:  it even sometimes has the
appearance of being critical,  or  is, perhaps, rather an  indication of
some favourable change in valetudinarians, especially in adults, who
are sometimes found getting the better of chronical complaints at the 
HERPES MILIARIS.
5
time the ring-worm makes its appearance.   It is, however, often a
blemish, as it frequently attacks the hands and face,  and especially
the forehead; and in the former case, is sometimes sore.
   The herpes yields very readily to stimulating and astringent reme-
dies.   Spirit of wine; saturnine lotions, with the addition of vinegar,
or white vitriol; and ointments containing lead, answer very well; or
an ointment of calcined zinc and lard: but the unguent, hydrarg. ni-
trati is preferahle to most others. The use of a flesh-brush is a good
prophylactic, in habits accustomed to the complaint.  It can be only
in unhealthy children, that  there can be any fear in regard to topical
applications, or need of internal  remedies.
   Should the  shingles spread and become sore, it should be treated
as directed below.
                   Herpes Exedens, or Serpigo.

  This is a malignant species of the above complaint, but is gene-
rally local.  It is mentioned in this place, as having relation to the
former; being itself rather a sore than an eruption, and not very com-
mon in children.
  Suppurative applications may be made use of in the early stage of
the  complaint,  such as ointments of minium, soap, and Venice tur-
pentine, or a suppurative poultice, in order to liberate the diseased
glands on the surface, and absorb  the acrid discharge.  A very good
poultice of this kind may be made of figs,  onions, and white  lily
roots, boiled in water to a soft pulp, with or without the addition of
a little bread and milk.   After this, the parts should be washed with
saponaceous  lotions, and  lastly,  with strong solutions of vitriol.
Should these fail, the ung. hydrarg. nitrati will be proper; and  as the
last remedy, caustic applications;  of which, butter of antimony is the
best,  with which the little ulcers may be touched lightly from time
to time.   The  patient may take at the same time of a'decoction of
burdock-roots, or sarsaparilla.
                        Herpes Miliaris.

   The herpes miliaris, zona herpetica,  or shingles, was well known
to the ancients; but has not been accurately distinguished by modern
writers, as I know of, except by Mr. Pearson; being confounded usu-
ally with the common herpes, or ring-worm.
   It appears in  the form of small vesications, which are filled with
an almost transparent fluid,  which if large and distinct, have but lit-
tle redness in the interstitial spaces; but when confluent, there is a
much more  considerable discoloration.
vol. II. 
6
VERRUCJE—CLAVI PEDUM
  This complaint  is, however,  attended  with an affection  of the
system, which the foregoing are not, being not without fever; and is
often preceded by rigor, nausea, and sometimes vomiting; but is very
rarely attended with danger.   The febrile symptoms do not usually
disappear on the eruption of the pustules, which gradually subside as
the fluid  acquires a denser consistence; after which the pustules dry
off in the form of dark-coloured crusts; and the disorder terminates in
a period  of from  eight to twelve days, and not unfrequently without
medical  aid.
   In the confluent  species, which is  attended with more fever, the
patient should be&ept in a warm atmosphere, take gentle diaphore-
tics andcordials, and sometimes diuretics; and on the drying off ofthe
pustules, a gentle purgative  should be administered.
   It is amongst the vulgar errors, I believe, that when it appears on
the  breast or loins, if it should extend round the whole  body,  it
would prove fatal.   It is this form of the disease that is termed zona
herpetica.
                    Venue®—Clavi Pedum.

  Those  warts which appear upon the fingers, hands, and necks of
children, may be considered as a small inconvenience, or a trifling
deformity, rather than as a disease.   They are seldom painful, ex-
cept they have been improperly irritated; and have no tendency to
proceed to any unfavourable event.
   Surgical writers have generally agreed in considering them as the
effect of a certain morbid state of that part of the skin in which they
are situated; but what that peculiar  condition of the skin is,  by
which they are produced, has not been exactly ascertained: the va-
rious accounts of it are all very problematical; and of these, perhaps,
Mr. Freke's is as ingenious as any.
   The hard, and almost insensible wart, with a broad base, and hav-
ing a cutical covering, is the most common species.  This little ex-
crescence seldom rises high above the  level ofthe  skin, on the back
ofthe hand; and is often remarkably flat and low when it  germinates
on the inner part ofthe hands or fingers; and being a spurious pro-
duction, seldom possesses a vital energy sufficient to prolong its dura-
tion beyond a  few years.   Hence we commonly observe   that those
warts which appeared in infancy  disappear imperceptibly after the
 a»e of puberty, without the aid of external applications.  Ibis is
sometimes  the case  likewise,  when warts have  first appeared
in adult  age, more especially where they have been  small and

 M The various methods that have been recommended of destroying
 warts, may be reduced to the  two following classes.   Such as inter- 
C.LAVI PEDUM.
<5
cept the circulation ofthe blood through the substance ofthe wart;
or secondly, those which produce  a destructive inflammation  in
them.
   1st. Ligatures made of horse-hair, or silk-threads.  Whenever
these can be conveniently applied, they are the least dangerous, and
the most effectual.   For it is a certain fact, that warts removed  by
ligature return less frequently, than when destroyed  by any other
means.
   2dly. Caustic applications, or the actual cautery; or spirit  of  sal
ammoniac  with quick-lime;  vitriolated copper; nitrated silver; but-
ter of antimony; burning sulphur.
   When the surface of the wart is destroyed by any of these applica-
tions, the hard crust must be scraped off the next day,  and the medi-
cament be  re-applied; and this process must  be repeated daily until
the excrescence be destroyed down to its root.
   When a wart is situated on  a joint, or one  of the lips, or on the
eye-lid, it  will not be prudent to use caustic applications.
   I have not mentioned the excision of the wart, because the excres-
cence is so very liable to sprout again when it has been cut through,
that this method is  advisable only when it is proposed  to employ
caustic applications to the wounded part.
                          Clmi Pedum.


   Young people are less subject to this excrescence than adults; but
being, nevertheless, not exempt from it, a cursory notice of it, at least,
may not be improper.*
   Corns appear always about the feet; usually the upper part ofthe
toes, and on the joints; on the under part of the foot where the pres-
sure is the greatest; or under the nails; and are painful, especially if
pressed much by tight shoes, or other covering of the feet..  They
differ also  in other respects from the wart; the corn having the ap-
pearance of an inverted wart, the surface ofthe former being not un-
like the inferior part ofthe latter.
   The corn seems to be little  more than hardened skin,  and to be
owing  merely to  compression: it is, therefore, rather  a  morbid
change of  that part than an  organized  excrescence, and on that ac-
count, does not endure the  rough treatment of the wart:  it may, how-
ever, be safely pared down from time to time, but not to that degree
as  to be made to bleed, or rendered  sore, especially in people ad-
vanced in years.  The common wafer made use of for sealing le -
ters, moistened and applied to  the corn, is both a harmless covering

   * The reader may see a fuller account ofthe nature of corns, and their treat-
ment, by Mr. Carlisle.  Medical Facts and Observations, vol. vii. 
8
OPHTHALMIA
and defence, and has sometimes appeared to loosen this excrescence,
and occasion it to be thrown off.
           Steatomatous Tumours, or the Suet-like Wart.

   Besides the above-mentioned excrescences, there is one of a very
different kind;  which though, when appearing about the neck and
face, it  passes with many people for the common wart, is really a
suppuration of the little sebaceous glands.   It appears chiefly about
the face, neck, and head, where this kind often grows in great num-
bers; and is the kind of steatoma here principally treated of.   They
more commonly infest young children, and particularly infants when
cutting their teeth; and will fall off, and appear again frequently, dur-
ing that  period.  They discharge a suety, or cheese-like matter, as
other inflammatory tumours of this class; after which they heal up,
and  return again, like the stythe, or stye on the eye-lids.
   Being of this harmless nature, it is unnecessary to say much on
their treatment.  As a preventive,  the adjacent parts may be well
rubbed two or three times a day; but when the tumours are grown to
a certain size, they should be inclosed in a ligature before they break,
or should be touched with the argentum nitratum immediately after-
wards.   The application of vitriolic ether has likewise been  re-
commended, as producing the greatest degree of cold during its eva-
poration.
   I  shall just add, that in very large steatoma, it has been recom-
mended* to pass a seton through the middle of the tumour; whereby
inflammation and  mortification being produced,  large pieces of
the  substance of the  mass  is  separated,  until the whole is  re-
moved.
                           Ophthalmia.

   Having discussed the foregoing trifling matters, we come to more
serious complaints; and first, those of the eye.
   This important organ, however, has also some slighter affections,
which require but little attention.  Accordingly we find,  that  the
eyes of a new-born infant are very apt to water, as it is  called, and
be slightly inflamed, especially if born in the winter season.  If it
be owing to taking cold, it is probable it has been either immedi-
ately after the child was born, before  it has been given away to  the
nurse, or very  soon afterwards;  and  on this  account, a  flannel cap

               * See Gotha Journal of Inventions, No. zil. 
ophthalmia.                         9
becomes a very necessary part of its covering previously to its being
formally dressed.   This  kind of inflammation, however, is  seldom
of  much consequence; and generally disappearing of itself,  upon
merely keeping the head  warm, or by washing the eyes with a little
rose water.  Should it,  however,  continue many days,  or perhaps
seem to increase,  three or four drops of the aq.  lithargyri  ace: jti
and a grain or two of white vitriol may be added  to two ounces of
the  rose water; and the  infant take a little manna, or rhubarb and
magnesia, if the  bowels should  not be sufficiently  open.  A still
more trifling affection is the sugillatio, which will oftentimes  remain
during the month, return, and disappear again,  without the slightest
injury to the infant.
   But there is an inflammation to  which  infants are liable,  that
sometimes continues a long while,  and therefore calls  for further at-
tention.  This affection is accompanied with the true appearance of
ophthalmia, attended with a discharge as in the ophthalmia of adults:
it will sometimes  get a little better by common means,  but  seldom
remains so for many days together, and generally increases  at the
end of the month.   It often  seems connected with the state of the
bowels, and the coming on  of a purging will then frequently cure it.
   Only the more  common remedies, however, are called for, unless
it prove tedious, as  it  has  been said it sometimes does;* in which
case the parts behind the ears should be made  sore, and be  kept so
for  some time.   Previous to  this,  it is often necessary to apply a
blister to the back, and a leech to  one or  both  temples;  to keep the
body open, and  make  use of the cooling collyrium  before recom-
mended.   If the child be  inclined to  a  frequent return  of it for
years, as I have known even in very healthy children, it will some-
times degenerate into what is termed the watery eye; an excellent
remedy for which is a grain of white vitriol,  mixed  with  such  a
small portion of any unctuous substance as will form it into a lini-
ment,! which  should be put  into the inner angle  of  the  eye every
night at going to bed.   In some of these  cases, however, the ointment
of nitrated quicksilver has  proved  a more speedy remedy, and is a
less painful application.
   There is, however, a case of watery eye attending older children,
in which the discharge is very hot  and acrid, and the eye at the  same


  * For a more full  account of the treatment of ophthalmias, see the  author's
Surgical Tracts, 3d edition,
  ■j- Upon the subject of ophthalmia generally, we may observe that collyria
•are too indiscriminately used even  by medical men ; an inflamed eye and some ■
specific and  infallible lotion usually go hand in hand.  Under these circum-
stances, instead of allaying irritation and assuaging pain, they are calculated t6
excite the  one, and  increase the other.  When they are necessary, the mildest
are lo be preferred,  and of these the pith of sassafras boiled in water is one of
the best.—En. 
10
ophthalmia  purulenta.
lime inflamed.   These  affections disappear, and recur  again  sud-
denly, without  children having  sensibly taken cold,  or any other
manifest cause; and will continue so doing for a great length of time.
It  is not a common complaint, and as far as I have noticed it, has
attended only such children as have other marks of humour, so call-
ed, or some disorder of the skin.
   The complaint has proved very obstinate, both in regard to the in-
flammation  and watery discharge, though all the common means of
cure have  been  successively  attempted, until the head has  been
shaved, and an oiled silk cap applied over the whole scalp.   This
never fails to procure a great discharge  from the head, in conse-
quence of which, I  have  known the  disorder removed in two o:
three days.
                     Ophthalmia Purulent a.

  But there is a far more formidable inflammation, which has of late
years been called the purulent ophthalmy, distinguished from every
other by the vast  quantity  of thick  matter  discharged, and  great
swelling of the lids.
  This is so dangerous an inflammation as to  require the best advice
on its very first  appearance.  It now and then appears at the birth,
but more commonly seizes  an infant a few days afterwards, w ithout
any  previous complaint; and when  neglected, has sometimes  not
only destroyed the  sight, but dissolved the eye itself,  in less than a
week's time.   I have likewise seen it exceedingly violent in children
of four or five years old, but rarely at that age, without some blow,
or other accident.
  In this disease every thing that may remove inflammation, and un*
load the vessels of the part, should be immediately had recourse to.
The body should, therefore, always be kept open, and leeches be ap-
plied to the temples,  especially in children  of four or five years of
age. In bad cases at this period, scarifications also of the tunica con-
junctiva,  (which  generally falls out upon their being opened;) blis-
ters  to the back, nape of the neck,  and behind the ears, are often
essentially necessary.   It should ever be remembered, that in  ad-
vanced childhood, the taking away of blood at the beginning is often
not to be  dispensed with, nor to be sparingly done.   The  applica-
tion of one leech to  the temple or neck will have no good  effect,
though often repeated: two, three, or more, according to the strength
of the child, should be put on at a time:  and a blister to the back soon
afterwards; which will  often do more to conquer the  inflammation,
than most other means put together, if had recourse to  in time.
  Even  in new-born infants, it is expedient  in some cases, both to
take away blood,  and to keep up a constant discharge from behind 
ophthalmia purulenta.
11
ihc cars, which may be done by applying, every three or  four days,
a  narrow slip of blistering plaster to these parts, and afterwards
dressing them with the ceratum spermaceti, or other mild ointment.
The edges of the eyelids  should be kept constantly greased through-
out the  day, especially in new-born infants, that the thick matter may
find an easy escape.   At night  the ceratum lithargyri acetati may be
spread on soft linen, and applied to the  eye, and over it a very soft
cold poultice made with the aqua lithargyri acetata, laid on as lightly
as possible; that by its constant moisture,  the  eyelids may always
be kept supple.   But if the discharge  should seem  to be confined,
or the eye aflected, by the weight of the poultice, this application
should be changed for soft linen rags, which should  be  frequently
wetted with cold brandy and water, or some yet more astringent lotion.
   Throughout the  complaint,   astringent  and stimulating  applica-
tions are to be made use of, unless the complaint be very slight,
or sensibly  gives way  very soon to mere  greasing  the  lids,  as it
sometimes will;  being  not  only  far  preferable to other means,
but so necessary, that should emollient  poultices, and merely  cool-
ing collyria be depended upon, the event were likely to be  fatal.
What may be the very best  remedy, in  the worst cases, it may not
be very easy to determine, having,  for many  years  succeeded,
and in a reasonable time, by different means* but ever since I have
seen Mr. Ware's first publication on diseases ofthe eyes, I have had
much frequent and successful recourse to  the aqua camphorata, as re-
commended  by him, that I am inclined to give it a general prefer-
ence to other remedies.  One drachm ofthe aqua camphorata of Bate's
dispensatory, to two ounces of  water, will be  sufficient  strength to
begin with.   A few drops should be instilled into the eyes, several
tilths in the day, as well as the  lids  be frequently washed with it.
It will   sometimes be necessary to inject  it  into the eyes with a
syringe, the lids  being so much swelled as^not  to admit of its en-
trance by other means.*
   The  topical remedies alluded to, in  the place of  the  aqua cam-
phorata, are, tinct. opii, and the unguentum hydrargyri nitrad, which
should  be applied every night at going to rest;  the  former  being
dropped into the  eye after the lids have been touched with the oint-
ment.f   It  is sometimes proper  to lower and  soften the ointment

   * The glands of meibomius are  usually considered as the seat of this dis-
ease, but Dr. Physick (as we learn from the Elements of Surgti-y) lias been led
from his own observation to believe that the seat of  the  inflammation is at the
roots of  the eyelashes.  In proof of»the correctness of this opinion, we will only
observe, that the disease is ve»y speedily terminated by pulling r±t the eye-
lashes —En.
     t $>. Unguenti hydrarg. nitrati ^%s.
          —:---— cerse jj.
          Gummi camphor, gr. ii-j
           Misce S: A: 
12
PSOROPHTHALMIA.
with a little fresh butter, or ol. amygdal. and lo add a little camphor;
or oftentimes one somewhat weaker, (with the addition of camphirc
as directed in the note.)   In a late  instance, the complaint has been
speedily removed by the electric aura.
   It has been said, that where this  inflammation has not been pro-
perly treated from the beginning, the eye is sometimes exceedingly
injured by it, so that even the coats  of the eye will burst.  At other
times the  cornea  becomes much thickened, and the pupil  more or
less opaque,* by means of one or more specks which the inflamma-
tion has occasioned.  It should be remarked however, that we some-
times meet with an agreeable surprise at the decline of this formida-
ble complaint, and find the eye much less injured than had been sus-
pected  at the time we  were first able to get  a sight of it.  And at
others,  even  where the cornea has burst, the aqueous humour has
been restored, and being confined by the cicatrice, the patient has re-
covered his sight.  On the other hand, the cornea has sometimes been
so greatly injured, or the iris contracted, that though the eye has not
been sunk, the sight could  not be restored by any means.   In other
instances, a long and cautious use of escarotics, and paring off the
thickened parts of the cornea, have afforded  a  certain  degree of
vision.
                         Psorophthahuia.


   This  complaint is so much of the nature of the  former, but with
more sensible  affection of the lids, and less  of the eye itself, that I
need only to recommend for it the use of the like applications.   In
particular, slight scarifications of the lids, in some instances, and the
application  of the  ung. hydrarg.  nitrati, and immediately after-
wards instilling a few drops of laudanum into the eye, will usual-
ly very soon have a good effect;  but  the cure is often a work  of
time.


   The above tincture and ointment are usually a very speedy remedy for the
sore  eye induced by the sm dl-pox, and measles ; as well as for the ophthalmy
in  scrofulous habits ; a complaint under almost every other mode of treatment
very tedious of cure.

  * Should the cornea become opaque directly opposite to the pupil, and vision
be thus obstructed, the case is by no means irremediable.  An operation for the
restoration of sight under  such circumstances, has been  recommended and
practised with success.  But for a correct history of the operation, and the
method of performing it,  we must refer our readers to  the  " Elements  of
Surgery," vol. I  page 3u4. where will be found in  detail much interesting in
formation on the subject.—Ed. 
VENEREAL  OPHTIIALMV.
13
                      Egyptian Ophthalmy.

  A disorder of the eye and the lids, not unlike the two preceding,
has of late years been very prevalent in this  country, and has been
communicated through our soldiers who returned from Egypt, and is
very contagious; and of which I have seen several instances both in
children and adults: it is always, I believe, attended with excruciat-
ing pain,  and frequently with, at least, a  temporary  loss of sight.
From my own experience, I shall only say, that the above-mentioned
applications are the best I am  acquainted  with, together with very
lightly covering the eye with the crumb of a new French roll, with
a suitable hollow cut in  it, and soaked in the aqua litharg. acetat.
dilut. which should be renewed as often as it shall become anywise
hard or dry.  I am aware, that every degree of pressure is strictly
interdicted by some practitioners whom I highly honour for their suc-
cessful treatment of disorders ofthe eyes;  whilst the immediate  use
and benefit I have known to follow this application makes it my duty
to announce it,


                       Venereal Ophthalmy.

   In permanent inflammations in young infants, I have been inclined
to the opinion of the late Dr. Hunter and others, who after having,
tried a  variety of means, and assisted in consultation with different*
physicians, have been induced to think, that many of the very stub-
born ophthalmias originate  from a venereal  taint,  and  can only be
successfully treated by  its specific remedy,  in  one form or other.
This sentiment, however, requires a nice  discrimination; and every
practitioner will be very careful how he takes up such an opinion in
particular instances;* however, it is right to observe, that if none of
the means above recommended should produce  a favourable change
in eight or ten weeks, I believe nothing but  that specific species of
alteratives will have any lasting effect.
   Though it is not my precise design to treat on this disease, it may
not be amiss to observe, that whenever a venereal taint actually exists,
it is more safely treated  by unction than in  any other way; and in-
fants would probably be cured much oftener than  they are,  if re-
course were had  to it in better time than it commonly is.   If inter-
nal  remedies, however, are for any reason  preferred, I have found

   • The French physicians seem too much inclined to regard the purulent oph-
thalmy in this view, being a very common symptom, amongst others truly vene-
real, in many infants in the Hotel-Dieu, l'Hospice  de S;«ltp£iriere, Vaugiard, and
des Enfans trouves ;  but when this species of ophthalmy appears  alone, the
case should not be  hastily concluded to be venereal, howtv*r violent the oph
thalmy may be.
   VOL. II                        T> 
14
LEUCOMA, OR SPECK OP THE EYE.
 none so efficacious, convenient,  and safe as the late Mr.  Ware's
 white drop.  In a writer before quoted, I find a strong recommenda-
 tion of the soft pulp of sarsaparilla reduced to a fine powder, and
 administered in the infant's pap.   But having had no experience of
 it myself, I can only say, that where  it may be found to agree with
 the stomach, it may have its advantages for new-born  infants, or per-
 haps, prove an auxiliary to mercury in those of  a more advanced
 age.
   In an appendix given by Mr. Ware to his last account of ophthal-
 my, he mentions a species  he has lately met with in young children,
 originating from a foul state of the primae viae.   In this kind no topi-
 cal means will effect  a cure without administering at the same time
 active purges.  He advises calomel particularly, of which  a few
 grains should be taken at bed-time, and a dose of jalap the next morn-
 ing.   This course should be repeated three or four times in  quick
 succession.  Tonic remedies, such as the bark and steel, are said to
 be sometimes useful afterwards.
   A like  inflammation he attributes to difficult dentition; which ne-
 cessarily calls for a thorough, and sometimes repeated lancing  of the
 gums.


                  Leucoma, or Speck of the Eye.

   This is often a consequence of long continued ophthalmias, and is
 mentioned by  Dr. Armstrong amongst the diseases of children, in his
 second edition.   He directs a  variety of things for the cure  of  it,
 which he says are often efficacious if the specks have been recently
 formed; but when of long  standing,  he has never seen any method
 successful.  I shall only observe, that  in a very great number  of
 cases, a drop  or two ofthe aq. cupri ammon. instilled into the eye,
 two or three times a-day, has removed such specks, in the course of a
 few months, and sometimes much sooner, without any other means.
 Should this fail, however,  recourse may be had to a solution of hy-
 drargyr:  muriatus,*  at  first only one grain  being dissolved in four
 ounces of water, afterwards gradually increasing it to two grains, as
 the eye shall  be found able to  bear it, and the ointment of nitrated
 quicksilver be applied  in  the  manner before recommended; and
 like the other  remedies be continued  as the disposition to inflamma-
 tion may admit.

  * To this speck the nitrate of silver may be applied with much advantage.  It
is to be scraped to a point, secured in a quill, then brought into contact with the
 ulcer, and suddenly removed. The sloughs separate in a day or two, the opera-
 tion is then to be repeated until our object is obtained.—Ed. 
15
                   Cataract, and Gutta Serena.

  Although these disorders are not very common in young child-
ren, they  do, nevertheless, sometimes occur;  and infants have even
been born with a  cataract in one or both eyes, or totally deprived of
sight by the gutta serena.   I shall, therefore, speak of these two dis-
eases together, and the rather because some of the remedies are here
accommodated to both.
  In the former of these, it is well known, that the pupil appears
white or pearl-coloured, instead  of black; and in the latter has but
little of an unnatural appearance, except that it is larger, and neither
dilates nor contracts when exposed  to different degrees of light,  or
does so in a very small degree.
  It would, indeed, ill become a man of the least character and ex-
perience to affect to have much to offer  in a way of remedy for these
dreadful   complaints; the  oldest and best practitioners never hav-
ing pretended to be very often, or by  any means uniformly successful
in the treatment of them.   From what I have known, however, they
are not to be despaired of, and I should think it unpardonable not to
hold out  every occasion of good, or of comfort in my power, how-
ever little it may be, in cases wherein  art has so  generally failed—
 Valeat quantum valere potest.
  Where a disposition* to cataract and gutta serena have been sus-
pected, I  have  known very considerable benefit obtained, and even
the sight fully restored by an  alterative plan of calomel and cicuta;
or by the long continued  use of an aromatic vapour wich spirit, am-
mon. compos.f conveyed to the  eyes by means of a  tube  properly
adapted, and brushing the eyes and the  adjacent parts, several times
a-day, with soft and smooth brushes, which are properly constructed
by Messrs Ayliffe and Gee, in Wardour street.
   Somewhat agreeable to this idea is the plan since recommended by
Mr. Ware in his late treatise on  certain disorders of the eye; and like
many other important discoveries, was the effect of accident.   Upon
this he happily improved, having succeeded in several instances  of
incipient cataract, when the consequence of external injuries,  by ex-
citing a transient inflammation.  The application he  has  employed
to this end has been ether, either alone, or  diluted with a third or
fourth part of a weak solution of hydrarg. muriatus, and sometimes

  * What the marks or signs of such a " disposition" are, is a question to which
the medical world have long sought an answer; but they have searched in vain.
It is, therefore, much to be lamented, that our author has not detailed them,
especially as in such cases he has known considerable benefit obtained, and the
sight even fully restored by an alterative plan of calomel and cicuta.—Ed.
  f Half an ounce ofthe spirit with two ounces of water should be kept boiling
over a lamp, and be made use of two or three times a-day. 
16
CATARACT, AND GLITA SERENA-
mixed with oleum succini; which has in some cases been soon at-
tended with a sensibly good effect, though  in others not till it baa
been  repeated for several weeks.*  The  success  attending these
cases, Mr. Ware adds, encourages him to hope for the like where the
opaque crystalline is either soft, or fluid; in which state it  usually is
when the disorder is discovered in infants, either at the time of theu
birth, or shortly afterwards.
   In  the gutta serena, electricity has succeeded in several cases; and
in one instance, a lady whilst under such a course suddenly recover-
ed the perfect use of her eyes, through a blow she accidentally re-
ceived on the face, which  produced a copious hemorrhage from the
nose.   In imitation of this, the  like discharge has been artificially
procured by wounding the internal vessels of  the nostrils;  but with-
out apparent good effect.   Mr.  Ware in the above-mentioned treatise
confirms the favourable opinion of electricity, and  adduces four in-
stances of gutta serena cured  by it,  and as  many by a medicated
snuffcomposed often grains of hydrarg. vitriolat. with about a drachm
of the pulvis asari comp. or in  place of that, the glycirrhiza, or sac-
charum  commune.   The external use of the capsicum has likewise
lately been attended with success.  To this end one grain of Cay-
enne  pepper is to be infused in cold water, of which a few drops are
to be  instilled into the eyes, three times a-day.
   A curious remedy has been  lately had recourse to with  some suc-
cess,  by professor Arnemann, of Gottingen; and any new remedy for
such a disorder  is an acquisition.  This  consists only in exciting
vertigo by placing the patient in a whirling chair,  with his head at
various  distances from  the centre.  Not that the vertigo, it is ob-
served, is a  co-operating cause,  (though it  is a  favourable sign,)
but the strengthening and restoring tone to  the eye, by exercising it
with vertiginous, or rotatory commotions ofthe head.  Another re-
medy advised by this author is, the exhibition  of camphor,  with and
Without belladona; the former in  doses from two to six grains, gene-
rally, twice a-day, and the latter in doses of one or  two grains, every
day.   These medicines, however, it is remarked, can be productive
of good only in cases of real debility, arising from want of excita-
tion, or in asthenic;  while, on the contrary, in plethoric weakness,
they must necessarily be  detrimental to  the patient, and aggravate,
rather than diminish, the symptoms of the disease.
  * Mr. Ware's practice has, in this country, been imitated by many of our most
eminent surgeons, under circumstances (as far as it was in their power to deter-
mined similar to those in which it was prescribed by that gentleman.  The re-
medy, in their hands, has not been attended with such success as to warrant very
sanguine expectations of its future utility.  By this observation, we would not be
understood as  attempting to impeach the veracity of Mr. Ware, to whom our
profession is so much indebted, but only as guarding practitioners against excit-
ing hopes which may not be realized.—Ed* 
HORDEOLUM STEATOMATUM.
17
  It should be observed, however, that where the belladona can be
dispensed with, it certainly ought, as it is a medicine not to be trifled
with.  The exhibition of calomel, together with the camphor,  with-
out the  belladona, has also  been used with much success lately in
London, especially while under a course of electricity.
  To these brief observations I have only to add, that a gentleman
of near sixty years of age, for whom I had been consulted about three
years before, some time after having been let blood  in  the above-
mentioned way, and making trial of electricity without any apparent
advantage, recovered from a gutta serena of near two years stand-
ing, under the use only of a  common colljrium: which as I cannot
conceive  to have  had  any share in  the  cure, conspires with a few
similar instances to hold out  ground of encouragement to other suf-
ferers, sufficient to prevent despair, under this melancholy disease.
   I have little  more to say in relation to the cure of the cataract by
a  surgical operation,  either by extraction or depression, than  that
neither of them is advisable  for infants unfortunately  born with the
disease, till they shall have attained to five or six years of age.*  How
far readers may at any time  be disposed to make trial of the means
for the dissipation of the cataract hinted by Mr. Ware, will, pro-
bably, depend upon some further information with which that atten-
tive practitioner may favour  the public.   In the mean time surgical
readers  will do well  to consult the above-mentioned treaiise  for
some very excellent practical observations on the mode of extracting
the opaque crystalline; as well as the observations of Dr. Reima-
rus,f adopted by Dr. Grasmayer, at Hamburg, on the use of the ex-
tract of the bell\dona dissolved  in water, previous to the operation.
A few drops instilled into the eye, soon rendering  it  paralytic for  a
short time, with  great dilatation  of the pupil; whereby the eye is
said to be rendered very manageable under  the hand of the ope-
rator.
          Hordeolum Steatomatum, or the Stithe, or Stye.

  The species of stithe here intended is sufficiently distinguished by
the nosological term.  It is a small inflamed tumour on the edge of
the eyelids, more commonly on the side towards the nose; but there
are sometimes two or more at a time.  It rises suddenly, as if from
a cold, or blast, and in the end suppurates, forming matter of a thick,
or cheesy consistence;  often, indeed, not for several weeks, or even
months, but sometimes much sooner.  It is occasioned  by an  ob-


  * On the subject of congenital cataract, and the best mode of treating such
cases, the reader is referred to the Elements of Surgery, vol. i. p. 338.—Ed.
f Magazine Encyclopedique, 1797. 
18                        DEAFNESS.
struction in the glands of the eyelids; and the matter being inclosed
in a hard cyst, the inflammation often returns in  the same spot, till
the cyst being destroyed by repeated suppurations, the cavity is after-
wards filled up, and the complaint disappears.
   All  that is necessary to  prevent  the  returns  of the temporary
blemish, which greatly weaken the  eye, is to imitate this process of
nature.   To this end, the little abscess should be touched, as soon as
it breaks, with the  argentum  nitratum, cut  to a point, (carefully
avoiding doing injury to the eye,)  which, by destroying the cyst, at
once removes the complaint.
   When these stithes are small, or hang by a very narrow base, they
may be safely cut off, or tied very tight with a bit of silk; arid when
separated, touched with the caustic as before mentioned.
                            Deafness.

   Children are frequently rendered deaf in different degrees, in
one or both ears, by very slight colds, and at the expiration of a few
days the hearing returns, without recourse to any means.   It is, how-
ever,  sometimes otherwise, and it becomes necessary to give a little
purging physic; to keep the ears warm; and  to  confine the child to
the house:  and where this does not succeed,  the complaint is not a
little  difficult to cure, unless when owing merely to indurated wax.
In this case, it will be proper to syringe the ears with warm water,
to which should be added a tea-spoonful of lavender, or honey water;
and a few  drops of warmed oil of almonds may be instilled into the
ears at  going to bed.   If these little means  fail, warmer remedies
should be made use of, such as the following, which, after properly
syringing,  will always  be  successful,  if indurated wax be the only
occasion of the complaint.

     £, Olci amyg-d. *£.
        Ol. succini rectilic gtt. xx.
        Spir. camphorat. Jss.
        Tinct. castor, 5j.
     Misce, ct instill, guttas  iv vel vj calefact. aur. affect, nocte et
   mane.

   Deafness, however, is  sometimes owing to the want of a due se-
cretion of  wax, and is then  much more difficult of cure.   To  pro-
mote this secretion a  few drops of the  soap liniment, oil of almonds
and ether, and such like warm acoustics should be tried, and con-
tinued for  some time,  if they should not occasion much pain;  and in
all cases, blisters may be  applied behind the  ears.  The juice of
onions, or  a clove of garlic,  raw, or roasted, put into  the ears  has
 sometimes restored the secretion, and removed the  deafness; and in 
ABSCESS  WITHIN THE EAR.
19
many cases it has been effected by  electricity.   I have, however,
lately fallen upon a method that has been universally  successful by
very simple means, consisting only in  adapting an entire covering to
the ear, made  of any adhesive plaster spread upon thin leather, so as
completely to  exclude the external air.  The plaster  should  be  re-
newed as often as it gets anywise loose, repeating it  till the secretion
of wax is in sufficient quantity;  which seldom  requires more than
five or six weeks.   But I am sorry to add, that although aurists have
found it so difficult to restore this secretion, and have therefore con-
ceived deafness to be often owing to the want of it,  I have frequently
found it nowise relieved by a return of the secretion.   Possibly, this
may be owing to the cause of deafness lying in the auditory nerve,
which is frequently the  case; and here also,  electricity is particu-
larly adapted,  either through  the meatus  auditorious externus, or
the Eustachian tube. Medicated snuffs also, that invoke gentle sneez-
ing,  and discharges from  the head, have sometimes been found sur-
prisingly efficacious; as hath likewise sea bathing.   Should these
different methods fail, very little is to  be expected from art.   Nature,
however, sometimes  effects  the cure; and  children, after  having
been deaf  for several years, suddenly recover their  hearing, espe-
cially females: one fortunate instance of which happened lately.
                     Abscess within the Ear.


   It is not uncommon to meet with fetid discharges  from the inter-
nal ear, either with, or without inflammation, and external soreness;
but this is usually in children of one or more years old, rather than
very young infants.   If a little cooling physic, and wiping  out  the
matter frequently,  should not remove the complaint,  detersive  in-
jections should be used, and some one of the warm acoustics direct-
ed for deafness, be afterwards dropped into the ear. The child should
also be made to lie, as much as may be, on the affected side, that the
discharge may have a free vent.
   Should the quantity  and fetor of the  matter increase, a blister
should be kept open on the nape of the neck, a few purges of calo-
mel be taken, and on the  intermediate dap, the hydrargyrus cum
sulphure.  But above all, in the worst cases, fumigations with the
hydrargyrus sulphuratus ruber, and hydrargyrus cum  sulphure mixed
together, should be made use of morning  and evening; from which
[ have seen the best effects when the discharge  and fetor have been
very great, and the ulcer of long standing. 
20
CANCRUM ORIS.
                           Ear-Ach.

  It is needless to say much on this article.   The pain is usually
spasmodic, or if not, it is owing to taking cold in some part about
the head, especially the teeth.  In this case, a diaphoretic at goinj
to bed, and a dose of cooling  physic the next morning, with a clove
of garlic put into the ear, or a poultice of onions applied over it, will
remove the pain; which is liable to recur,however, if accompanied
with  tooth-ach.  If these fail, a blister may be applied behind the
ear.
   If it arise from spasm, the  pain  is often exceedingly severe, and is
apt to return frequently; being readily excited by every little cold,
especially in some habits, tormenting  young people at times for se-
veral years.  The juice of rue is here a good remedy, or if this fail,
a little laudanum  added  to the acoustic directed for deafness, and
dropped warm  into the ear.
                           Tooth-ach,

  I just glance at this painful complaint as at the former, which
also  frequently accompanies  it  at  every age; while  some  young
children  suffer by it  greatly, during or after shedding their first

  If it be proper to  have them  drawn, that is the well-known, and
most certain  remedy; but when that operation may be  on any ac-
count  objected  to,  palliatives will  sometimes succeed; such as a
blister behind the ear; a  clove  of garlic, or a few drops of lauda-
num, made warm, and instilled into it; or a pepper-corn bruised, put
inio  a little linen bag, and wetted in  hot brandy; pounded ginger
and  white of egg, laid to  the cheek;  a few drops of  ol. caryophil.
aromat. applied on lint to the hollow tooth, or the smoke of tobacco
forced into the ear, and especially the paste, or plug, contrived by the
late  Mr. Cockran, which  the great good effects I have been witness
to,  will,  I  hope, be a sufficient apology for mentioning; especially
as it is calculated to become a permanent remedy.
                           Cancrum Oris.

  This is chiefly a complaint of children,  is often talked of by
nurses, and is usually as trifling as any.  It has, indeed, been said
by some  writers to prevail very much in England and Ireland, and 
CANCRUM ORIS.
21
 to be often a serious complaint.  Such a disorder,  if  it really be
 canker, may be treated as under the  next  article;  but the common
 canker is rarely troublesome to cure.
   It sometimes makes its appearance in the month, at others, about
 the  time of teething; and frequently at the age of six or seven years,
 when children are shedding  their first  teeth, and  the  second are
 making their way through the gums;  which  are covered with little
 foul sores, extending sometimes to the inside ofthe lips  and cheeks.
 It seldom requires  more  attention  than was mentioned under the
 article  of dentition; any mild  astringent  application, and  keeping
 the body open, usually effecting a cure;  or  if  it does not, and  the
 complaint makes its appearance  at the time of teething, it will ge-
 nerally go away as soon as the teeth are come through.
   The  worst species of this complaint that I have happened to see,
 has  been during the second period of dentition,  when  a child has
 been shedding a number of teeth together, leaving the rotten stumps
 behind, which have been neglected to be drawn out.  The whole
 gums will then sometimes be spongy, or dissolve into foul, spread-
 ing ulcers, and small apertures will be formed, communicating from
 one  part to another, accompanied with an  oozing  of a fetid,  and
 sometimes purulent discharge.
   If the stumps of  the decayed teeth  can, in this case, be easily got
 at, they ought  to be extracted; after which, some such application
 as the following will soon brace the loose gums, and  heal up the ul-
 cers, howsoever foul, or numerous they may h?


     R. Bol.  armen.
         Gum. myrrhse
         Cort. peruv. pulu.
        Cremor. tartari aa 31.
        Mel. Rosae q. s. misce, ft. pasta,

     R.  Aq. calcis 3vij.
        Tinct.  myn has
        Mel. rosae 5a |fi. ft. mistura.


   The  gums should be touched several times in the  day,  espe-
 cially after meals, and at going to bed, with the above paste, and the
 mouth washed occasionally with the mixture.
   If no considerable change for the better  should take  place, in a
we< k or ten days, a drachm of alum may be  substituted in the place
of one of the astringent powders;  and instead ofthe above mixture,
one acidulated with  as much  of  the muriatic acid as the parts will
endure,  occasionally  made stronger, till some amendment be  per-
VOL. TT
F 
2£          GANGRENOUS EROSION  OF THE CHEEKS.
ceived;  the belly being, in the mean time, kept properly open.   If
internal remedies be  thought necessary, Peruvian bark, sarsaparilla.
and mineral acids will be the  properest; and the child maybe kept
on a diet of milk and vegetables.
               Gangrenous  Erosion of the Cheeks.


  This complaint has some resemblance to the canker, though it is
much more dangerous, and is not a mere local disease.  I have seen
no clear account  of it in any late writer but Mr. Dease of Dublin,
who seems to have met with the disorder pretty frequently, and de-
scribes  it very  accurately in his tract on the Diseases of Lying-in
Women, &c. to which  I am very  much indebted  on this occasion.
Mr. Hurlock, indeed, in his Treatise on Dentition,  printed in  1747,
mentions a complaint that seems to be of this kind, though he docf
not appear to be well acquainted with it.
  It usually attacks children from two to six or eight years of age,
especially the unhealthy, and such as have been subject to worms.
The whole body often feels cold on the approach of the disease; af-
ter which a  black spot appears  on one  of the cheeks  or lips  and
spreads fast; but  without any marks of inflammation.   Oftentimes
the whole side  of the face is eaten away, together with the lip, so
that the bare jaw-bone and inside of the mouth appear.   In the
end, the entire  lower jaw falls down  on the breast,  and the  whole
side of  the face is dissolved into a putrid mass; a colliquative  diarr-
hoea taking  place from the offensive matter that is  continually swal-
lowed, especially by very young children.
   In the cure,  internal as well as external  remedies are required;
but only such as correct putrescency, and support the  strength, seem
to be of any use.   A few drops of the acidum muriatic, therefore,
taken inwardly, in the infus. rosae, or in the child's  drink; the saline
draught in effervescence; and  in the end, the bark, in doses suited
to the age, with good broths, jellies and wine, are  the proper reme-
dies.   The  parts should be washed, and likewise injected with  mu-
riatic acid in chamomile, or sage tea,  and afterwards dressed with
the acid mixed with honey  of roses, and over all a carrot poultice.
The child should  in the mean time be gently purged  with magnesia
or rhubarb,  to carry down the putrid matters it may have swallowed.
By this treatment, Mr. Dease informs us, he has recovered every pa-
tient except one, since he had recourse to this plan, which  the world
is much indebted to him for making public; though fortunately this
romplaint does not appear to be, by any means, a common one. 
28
                    Induration of the Breasts.

  It would be improper to pass over the slightest affection that has
on any occasion exceedingly alarmed parents, and  sometimes  per-
plexed the younger part of the profession.  Of this kind are affec-
tions of the breasts in females, previously to, or about  the time  of
their beginning to  enlarge.  At this period, they sometimes  become
very painful; and  upon examination, a  hardness and swelling are
discovered,  and in some  instances, sharp points may be felt, which
are very painful  when pressed.*  The  hardness  is  deep  seated,
around  and behind the nipple,  and is sometimes  loose, at others
somewhat fixed, and attended with severe lancinating  pains, which
have given rise to  disagreeable suspicions in regard to the probable
nature of the complaint; and would, indeed, at a more advanced
age claim serious attention.   When  happening in families addicted
to scrofula, that disorder is naturally suspected, and sometimes a  mor-
bid scirrhus  has been feared.  In some instances, only one of the
breasts is  affected, and after some months, the other, or sometimes
both nearly at the same time.
  A variety of alterative medicines, aided by topical applications,
have been administered in different instances, and continued for se-
veral months.   These have sometimes taken away the pain,  reduced
the tumour, and diminished the hardness; but have, in  no instance,
entirely removed the complaint.   Yet no evil consequence, in any
instance under my eye, has ever ensued in patients at the  above-
mentioned age; nor  have I heard of any from other  practitioners,
though it  has sometimes been seriously apprehended.
  The result of the whole  has shewn,  that the remote cause of the
complaint  has originated in an  irritability of habit, in connection
with that  distention of  the  parts, which at a certain age  nature al-
ways promotes.
  The design of this  chapter being to  hold forth  encouragement,
from the probable harmless nature of the complaint, it were need-
less to point out the means, that  on different  occasions have  been
sometimes unnecessarily employed.   I shall remark only, that keep-
ing the body open and cool, with  every other attention to the general
health, must jn every  instance be proper; and should the pain be very
great, a poultice of bread and milk, or of aq. lithargyri acet. comp.
may be applied.
  * It will be proper under these circumstances to pursue the antiphlogistic
plan of treatment in its various forms, to apply leeches over the part, and re-
peat them whenever the lancinating pains return.---Ep. 
«4                PSOAS, OR LUMBAR  ABSCESS.
                 Abscess in the Hypochondrium.

   Children though less liable to this  disorder than adult person,
are sometimes attacked by it at an early age.  It commonly arises
from falls, or blows received on the part, or from lying on the grass,
and other similar occasions of a cold in the bowels.   It is always at-
tended, and sometimes preceded by alvine complaints,  and not un-
frequently by the true cholera.  In  either case, there  is always  a
pretty early appearance of tumour near, or upon the regio pubis, ac-
companied with great tenderness  and pain, especially upon  pres-
sure.
   The intentions of cure are directed to the pain, fever, and state of
the bowels.   To these ends, the antiphlogistic plan is to be pursued,
in order, if possible, to prevent suppuration.  Therefore, soft open-
ing medicines are required, such as castor oil, infusion of senna  with
oil of almond and manna, and  such like; with frequent clysters, and
afterwards opiates and saline draughts, as the degree of pain and fever
may demand.  The part affected  should be  fomented  externally
with the decoct,  papav. albi;  leeches  should be  applied once  or
more, and afterwards a blister, if no relief be obtained, and the ex-
ternal tumour be  not in the mean time increased.   But if the parts
become more swollen, a large bread and milk poultice should be ap-
plied, and changed two or three times every twenty-four hours; and the
matter let out as soon as may be. The suppuration being between the
muscles and the peritoneum, there will  not be much discoloration of
the skin, as in the case when matter  is formed in the cellular, or
adipose membrane, above the  muscles.  Such  a .change, therefore,
must not be waited  for; but an opening made as soon as any fluctua-
tion can be  perceived, lest the matter should make its way info the
abdomen, or produce sloughs and a foul ulcer.  After the matter  is
let out, no other application is usually required than the same kind
of soft poultice.   The bowels must likewise be kept open bv the gen-
tle laxatives before  mentioned, and the diet be very light, and t)f easy
digestion; which should be continued for some time.
                   Psoas, or Lumbar Abscess.

  Frequently as this disorder takes place in adults, it is as often
met with in younger subjects, and even such as are only four or five
years  of age; and must, therefore,  be ranked among the diseases of
childhood.
  It is  a trUe  chronic  inflammation, and, like the last-mentioned
complaint,  is often occasioned by bruises, strains, or lying on damp 
                  PSOAS,  OR LUMBAR  ABSCESS.                25

ground; and is not uncommonly connected with a scrofulous taint of
the habit.  The inflammatory symptoms being rarely severe, suppu-
ration takes place slowly,  and many months elapst before the matter
can be  felt externally;  which sometimes points high  up about the
loins, hip, or groin;  and at others, above the middle and on the in-
side of the thigh: in the most benign, the abscess frequently  bursts in
the groin.  It is, in  any  case, a very dreadful disease, and is noticed
here, for the sake of pointing out to young practitioners  the first
symptoms of  this insidious complaint, and marking the outlines of a
practice which has proved the oftenest successful.
   A slight lameness and shortening of  one of the legs is usually the
first symptom.  In a little time, the thigh is observed to be bent for-
ward and upwards, which gives  an appearance of depression to the
glutaei muscles.  But its most characteristic mark, in its early  stage,
is a sensation of weakness in the loins, with a tenderness about the
origin ofthe psoas muscle, manifest upon a careful examination ofthe
parts.
   The  first indication is to procure a resolution, if possible, upon the
approach of these first symptoms, and before those of a hectical na-
ture supervene; but, unfortunately, they arc too often overlooked, or.
mistaken in the beginning.
   With a view te a resolution of the inflammation,  recourse should
be had  to  bleeding by leeches, and cupping; by blisters, issues, and
setons;  by emetics;  purging with calomel; by the warm bath; a su-
pine posture, and low diet; and sometimes,*a caustic, or quicklime
mixed with honey, applied near the lumbar vertebras;  but above all,
as lately recommended,  by electricity: a stimulus, which in all affec-
tions of the joints, previous to  the formation of pus, is perhaps the
 most successful.
   Should these means fail, or  advice be sought for too late  to ex-
pect any  thing from them, of no less  consequence is the treatment,
 after the matter is  formed; which should be evacuated, by an artifi-
 cial opening, as early as possible, and by a very small aperture.*  If
 the abscess be large, one or more setons may be  employed, in order
 to prevent the matter being too  suddenly evacuated,  as well as to
 keep up a beneficial stimulus, to  induce the cavity to  fill  up.  By
 these means, (which contain considerable improvement upon the an-
 cient practice,) several  very unpromising cases have been recovered;
 but it would  be unjust not to notice, that a more important improve-
 ment has been made by Mr. Abernethy, which is peculiarly adapted

   ' The danger of op'ening the abscess depends upon the constitutional irrita-
 tion, which usually follows such an operation: and if caries of the vertebrae
 exists, evacuating the  pus will advance the cure but little, as suppuration will
 necessarily continue so long as the existing cause remains.  Hence it would ap-
 pear, that the rule laid down by our author does not hold good under all cir-
 cumstances ; especially, when we consider, that no danger exists ofthe abscess
 opening into the cavity of the abdomen.—Ed 
2G
PSOAS, OR LUMBAR  ABbCESS.
to very large collections of matter, and seems likely to render this
disease, for ages usually fatal, far less untractable.
   The  principal circumstance in this plan is, the making a small
opening in such a manner and oblique direction as to be capable of
being closed again after having given vent to the present collection of
pus; and repeating the little operation at such intervals, and as often
as shall be necessary.  But for further information the  reader is  re-
ferred to the tract itself; it being both beside my purpose to enlarge,
and  would be unjust to add any thing that might induce him to over-
look the accurate account with which Mr. Abernethy  has favoured
the public.
   Nevertheless, as it is certainly the duty of every writer to offer what
lie accounts the best information, it becomes me to observe, that Mr.
Abernethy's reasons for emptying the cyst both at first,  and on every
subsequent opening,  are,  at  least,  controvertible.   It  has been
thought by others to be an improvement to let out only a part of the
matter  in very large collections of it.  And I have myself known
some, and heard upon good authority, of other cases,  in which the
latter method seems to have the preference; none  of the evils from
the distention of the cyst, which Mr.  Abernethy suspected, having
taken place.
   Mr. Abernethy, however, as it appears from a more  recent publi-
cation,  retains his opinion, as the result of experience, and is now
not  anxious about the obliquity of the aperture.  He,  nevertheless,
closes it carefully, and assists its healing, and makes a fresh punc-
ture as  often as the abscess shall fill to a certain degree.
   This sentiment is submitted to the public upon Mr. Abernethy's
authority,  having had no reason myself for altering my opinion; the
only case I have seen since my former edition, in which the whole of
the matter was evacuated, did not succeed.
   Mr.  Abernethy is further of opinion, that opium administered at
regular intervals, and in doses suited to the occasion,  has been very
useful in  mitigating the pain and irritability of the abscess, and in
consequence, the corresponding hectic  fever.
   When the  abscess has been some time opened* the  diet should be
changed for one more cordial and nourishing; and the bark, steel, or
vitriol  be  administered, and the patient enjoy a  pure  air,  and take
such gentle exercise as his situation will admit  of without an  in-
crease  of pain.
   I have only to add, under the  sanction of a solitary case yet pend-
ing, that nature will endeavour to relieve herself,  even in this dread-
fuf disease, by absorbing the pus, very many months after a large


   • Why this direction should be confined to any period, after the opening ofthe
 absc ss, it is difficult to determine.   We would rather say, that the diet should
be changed for one more nutritious, and the bark, steel, &c. &c  should all be
 used, whenever the patient's health r>npcars declining.—Ep 
MORBUS COXARIS.
at
quantity has been  formed.  In this instance, wherein a lady  was
long confined to the house, and chiefly to her bed, through extreme
weakness, and the  weight of the limb, the size of the tumour is  very
considerably diminished; the appetite greatly returned; and the  use
of the limb so restored, that she is able to walk abroad, and partake
of the ordinary comforts  of convalescents,  who are yet in a weak
state.   This was the statement of the case in a former edition; to
which I have the pleasure of adding, that it is now some years since
she was first able to take this exercise;  though she has not recovered
her  strength.
                        Morbus  Coxaris.


  A verv similar and equally dangerous disease with the above is-.
the morbus coxaris, or abscess of the hip-joint; a complaint differing
only in the precise seat of the disease.  The swelling and pain are
here, indeed, more circumscribed, and the abscess always gives way
near the region of the joint.   The preceding symptoms, however,
much resemble those  above mentioned.  But the equivocal nature of
the first appearances, and the difficulty of ascertaining the probable
degree of subsequent .injury, are such as will not allow of a discus-
sion in detail in a work of this sort.
  I shall observe, however, that a degree of lameness is frequently
the first thing noticed; and a short time afterwards, both the thigh and
the calf of the leg become sensibly lessened.  The patient also doth
not stand equally on  both legs,  and the  affected one  projects out-
wards from the body; and in the  end the thigh becomes shortened.
It is generally attended with  a severe pain in the knee,* and very
early an uneasiness in moving the  head  of the thigh bone in its
socket.  It  occurs  from infancy to manhood, and  often derives its
origin from  trifling accidents.   It is frequently  at its  first  appear-
ance  mistaken  for other disorders;  accordingly, the  paleness, lan-
guor, and listlessness that follow the  first symptoms are  often attri-
buted to worms, and the tumour  itself considered simply as scrofu-
lous; whence an erroneous practice  is frequently adopted.  It is,
moreover, mistaken for rheumatism and sciatica in adults; and  in
children, for indolence and trivial accidents.
   On the head of treatment I shall only observe that, in a view to


  * This circumstance should be constantly kept in view, as the neglect of it is
frequently the cause of much regret to the surgeon, and irreparable mischief to
the patient.  The former directshis whole attention to the knee; believing it to
be the part in pain, he presumes it to be tiie part diseased.  Embrocations, lini-
ments, blisters, &c. have been applied,  and, of course, with no other effect than
that of harassing and distressing the patient—-Er. 
28
WHITE SWELLING OF THE JOINTb.
procuring a resolution, which  is the first intention, the  means can
dflTer but little from  those  prescribed for  the foregoing  complaint;
and we have the authority of the late Mr. Pott,* for expecting con-
siderable benefit from issues or setons, applied in the manner direct-
ed for the palsy of the lower extremities.   Should an abscess, never-
theless, be formed, its after treatment must vary considerably, accord-
ing to the degree of injury of the joint, and adjacent parts.t   Nothing,
however, will contribute more  to the cure than long and strict rest of
the limb.J
               Abscess under the Fascia of the Thigh.

   The nature of this deposit is so much of a kind with the two pre-
 ceding ones, as  well as so much less  dangerous,  that it would be
 needless in  this  work to do much more than mention it in  its place.
   Mr. Abernethy  is of opinion that the whole of the matter  should
 in this case  also be evacuated,  and by a larger opening than for  the
 lumbar abscess;  and  does  not, therefore, advise a reunion ofthe lips
 of the orifice.  I have, however, seen the method which I have no-
 ticed  as successful in the  former, equally so in this  abscess; and,
 from the result in one very bad  case, am disposed to think there may
 be considerable advantages in closing the aperture, and making fresh
 punctures as the  matter shall collect.


                    White  Swelling of the Joints.

   I  shall be equally brief also on this article, the disease being well
 known to  every  surgeon; and my intention in naming it being only
 to mention, from experience, a few  remedies  that have  been found
 successful  in young subjects, if had recourse to in good time, and be-

  ' See a short Account of his Life, by Mr. Earle.
  f As the surgeon is rarely called in during the first stage of this disease, it is
 seldom in his power to employ those active and diversified antiphlogistic reme-
 dies which are necessarv to effect  resolution of the inflammation.  It is, there-
 fore,  his duty to adopt those which experience has proved to  be most efficacious
 under similar  circumstances.  From Dr. Phvsick, whose observations are both
 extensive and accurate, we learn that those cases have always been most happy
 in their termination, which have been  treated by active  and long continued purg-
ing.  A combination of sup. tart, potass  and jalap administered every day or two,
is, he thinks, the best cathartic; as under its use the health and strength of the
patient, instead of declining, is  found to improve daily.  Little advantage, how-
ever, will result from the preceding directions, unless the patient be confined to
a vegetable  diet, and the limb be kept perfectly at rest by  means of a carved
splint.—Ed.
  * For a full account of these abscesses, readers are referred to a Treatise by
 Mr. E. Ford. 
PARALYSIS OF THE LOWER EXTREMITIES, &C
29
tore matter has been formed.   Such are the repeated applications of
eight or  more leeches,* and  afterwards small blisters to the joint;
gentle frictions ofthe part; two or three vomits a week;  with entire
rest ofthe limb;  and in the  end, sea bathing, especially if the pa-
tient be of a scrofulous habit   It has been said, that  a  poultice of
boiled turnips, with a lump of hogs' lard, applied twice a day, has, in
several incipient  cases, entirely removed the complaint.   And in a
few instances that I have  known, electricity has  had an immediate
and wonderful  good effect, even where the joint has been consider-
ably enlarged, the pain very great, and the child incapable of straight-
ening the limb.
   Paralysis of the Lower Extremities with Curvature of the Spine

   This complaint  has been of late years so thoroughly announced,
that it should seem unnecessary for most  readers  to enter into  a
minute detail of it, after the accurate description given by the late
Mr. Pott, whose early account and judicious treatment of this dread-
ful disease, has added lustre to the reputation acquired  by his for-
mer publications.   Some late observations have, indeed,  seemed to
detract both from his merit and expected  success; I can, neverthe-
less, from my own experience, vouch for the great utility of the plan
in this morbid deformity.
   It will be proper, however, carefully to distinguish it from the sim-
ple curvature of the spine, in which a greater number of vertebrae is
concerned, and the legs are not peculiarly affected; as well as from a
complaint presently to be noticed, under the name of debility of the
lower extremities, in which there is no manifest change of figure in the
spine.
   The palsy ofthe lower extremities is certainly confined to no age,
and being  at first very frequently mistaken in young  children for the
trifling effect of some fall or strain, is entitled to peculiar notice in
this work.   I have  never met with it,  indeed, where it has not  been
preceded by  some  fall  or violent exertion, though, as Mr. Pott has
observed, such supposed accidents are seldom much noticed previous
to the debility  taking place:  it is, however, probable, there may be
some predisposing cause, without which no common strain would in-
duce so much mischief in a part continually exposed  to accidents.
   The curvature is generally in the neck or back, though sometimes

  * It is scarcely necessary for me to observe how entirely useless would be the
application of leeches as here directed.  Inflammation of  the knee joint requires
for its cure the most active depleting remedies; and in this country we would be
more apt to direct the application of eighty, than of eight leeches.  Of European
diseases we can say nothing from experience, yet they must be very dissimilar
from our own, if such treatment as  is here recommended ever prove success-
ful.—Ed.
   VOL. IT.                       ? 
30
PARALYSIS OF THE LOWER EXTREMITIES.
in the upper part ofthe loins, and varies in extent and degree, ac-
cording to the number ofthe vertebrae that may be affected.   The
first symptom noticed by children of an  age capable of expressing
their feelings, is an increased sensibility, and  irregular twitchings in
the muscles of the thighs.   This is succeeded by a dislike to motion,
especially to moving briskly; the patient on such occasions finding
himself likely to  fall, his legs getting entangled through their weak-
ness, and a disposition to cross each other, in his attempts to step for-
ward.  Soon after this, he perceives himself unable to stand upright
long together, and that the legs and thighs  have lost much of their
natural sensibility.   Matters  seldom continue long in this  state, and
the weakness increasing, patients lose more  and more the use of both
the lower extremities, till some are unable to move them at all, even
in bed ;  and these advances of the disease are said to be more  rapid
in adults than in infants.   In the latter, I have particularly remark-
ed that rigidity of the ankles noticed by Mr. Pott, by which the toes
are pointed downwards, so that the heels cannot be brought to touch
the ground.
   As my intention is  only briefly to point out the disease, and the
properest means  of relief, it is  not of importance to  enter into  a fur-^
ther detail of the progress  of this disorder, and of other complaints
which are induced by it whenever the  original disease has been long
neglected.
   The obvious  remedy is that first happily  suggested by Mr. Pott,
•and is nothing more  than a large issue, or seton  placed on each side
the curve, at such a  distance as may prevent their bursting into one.
Where the curvature comprehends three or more vertebras, the seton
may be preferable to an issue; but if the  latter be on any account
elected, I should advise its being made by the knife rather than a
caustic; not only as being less  painful, but  also for the  very effect
Mr. Pott has disapproved of, I mean, the  consequent inflammation
before there has been time for suppuration to take place.  It may,
indeed, be doubted,  whether the  benefit derived from the issue may
not arise rather from the inflammation and  stimulus produced on the
surface, than from  the discharge; to which, nevertheless, Mr. Pott
solely attributes  the  cure.*   In  a recent case, however,  and a very

   * It has been a common idea,  that  the discharge furnished by  an ulc«rated
surface is the source of all the benefit that may be derived from abscesses, un-
less blistered surfaces  be an exception; in regard  to which, physicians have
usually considered the  stimulus produced by the canthandes as the chief mean
of benefit, especially in  cases of great local pain and inflammation.  It is, indeed,
matter of some surprize, that thinking men have not more generally adopted the
like idea in regard to other inflamed surfaces, whether induced by natural or ar-
tificial means.  It should surely  seem, that that state of the system, or of the
parts by which suppuration is induced, is more likely to be the occasion ol bene-
fit than the discharge of a large portion of the richest animal juices, which is but
Lhe consequence of the other.  Thus, in most critical abscesses,  the fever is
found to abate as soon as the external inflammation takes place, and the patient,
 ;nstead of being afterwards benefited by a copious discharge,-is not unfrequently 
WITH CURVATURE OF THE SPINE.
31
unpromising one, in an infant ten months old, a very sensible relief
was afforded as soon as the inflammation took place,  and before any
suppuration appeared;  and though the  child had been some months
a cripple,  with loss  of health  and appetite,  unable to  support its
head, and the sternum very much distorted; the relief was so great
in one week after the incisions were made, as left  no room to doubt
of a perfect recovery;  which accordingly took place a short time  af-
terwards, without any deformity remaining.  Had Mr. Pott advanced
any other  reasons for the preference given to the caustic, or merely
asserted such preference, I should readily have submitted to the great
experience-he has had in this dreadful complaint; but though I may
very possibly  be mistaken in my reasoning, it appeared a duty just to
state it, as well as to notice this instance in point, in a disease of so
 much importance.
    The  issues should be kept open till the patient  perfectly recovers
 the use of his legs, or even a while longer; at least one issue, which
 ought not to be dried up till the patient can walk firmly alone,  and
 shall have recovered all the height which he may have lost in conse-
 quence of that stooping which the disorder had induced*
    In addition to the use of these means, Mr. Pott has suggested those
 of cold bathing, frictions, the bark, and such like; but I have myself
 had no experience of them, nor does it seem very probable, that such
 auxiliaries are likely to avail much when the issues shall fail.  After
 the recovery, however, if the patient is of a scrofulous  habit, sea
 bathing- is peculiarly indicated.
    The moxa has been  successfully made use of in one instance, by
 Mr. Gimes* after the caustic, as directed by Mr. Pott, is said to have
 failed.  But as the burning was several times repeated, and the re-
 covery appears to have been unusually slow, it is not very certain,
 but a repetition of the caustic might have proved equally beneficial.
     Since the last  edition of this work, however, the assistance of the
  stay made by Jones, or Bowley, has been recommended upon the au-
  thority of Sir James Earle; a  mean whichr together with his testi-
  mony and experience, appears  so congenial with the nature of the
  disease,  as  may well  entitle  it  to trial whenever the issues  may
  fail, or the cure seem to be at a stand.


  hurried by it into a fatal marasmus, when the abscess has been large, or impro-
  perly seated.  There may be other instances, indeed, in which the suppuration,
  and even the great quantity ofthe discharge, may be beneficial to the system;
  but it is probable, that this is not in general the case, and much less in the pre-
  sent instance, which is attended with symptoms of general debility.
     * Jour, de Med. Fev. 1788. 
32
                Debility of the Lower Extremities.


   The disorder intendeJ her. is  not noticed by any medical writer
within th- compass of my reading, or is not so described as to ascer-
t  n the disease here intended.   It is not a common  disorder any
where, I believe, ,-nd seems to occur seldomer in  London  than in
other parts  of this kingdom.  Nor am I  enough acquainted with it
to be fully satisfied, either in regard to the true cause or seat of the
disease, either from my own observation or that of others, with whom
I  have corresponded, except in the instance of teething, or of foul
bowels; and have not myself had an opportunity of examining the
body of any child who has died  of this complaint.   I  shall, there-
fore, only describe its symptoms,  and mention the several means at-
tempted for its cure, in order to induce other practitioners to pay at-
tention to it.
   If it  arises from teething, or foul bowels, the usual remedies should
be employed; and have always effected a  cure.  But the complaint
as often seems to arise  from debility, and usually  attacks children
previously reduced by fever; seldom those under one, or more than
four or five years old.  It is then  a chronical complaint, and not at-
tended  with any affection  of the  urinary bladder, nor with pain?
fever, nor any manifest disease; so that the first thing observed is a
debility of the lower extremities, which gradually become more in-
firm, and after a  few weeks are unable to  support the body.  If there
be no signs  of worms, (as is here supposed,) nor other foulness ofthe
bowels, mercurial purges seem to have been of no use; neither has
the bark, nor hot, nor cold-bathing.   Blisters, or caustics on the os
sacrum, and the great trochanter,  and volatile and stimulating appli-
cations, with friction with mustard and oatmeal, dry, to the spine,
legs and thighs, have been chiefly depended upon; though there is no
appearance of an enlargement of any of the vertebrae, nor of suppura-
tion in  the external parts,  anda therefore,  no resemblance to the in-
flammation of the intervertebral cartilages, the psoas abscess, nor the
morbus coxaris of De Haen.
   When only one of the  lower extremities has been  affected, the
above means, in  two instances out of five or six, entirely removed the
complaint: but when both have been paralytic,  nothing has  seemed
to do any good but irons to the legs, for the support ofthe limbs, and
enabling the patient to walk.   At the end  of four or five years, some
have by this means  got better,  in proportion as they have acquired
general strength:  but even some of these have been  disposed to fall
af-erwards into pulmonary consumption, where the debility has not
been entirely removed.   On this  account  it may be  suspected, that
the complaint is  sometimes owing to scrofula: and I have been very
lately informed by a gentleman of character in the country,  that he 
DISCOLORATION, &.C
83
has seen one instance of a paralysis, or debility of this kind, in which.
upon opening the body after death, the internal surface of the lower
vertebrae lumborum was found carious, though there was no abscess
of the psoas muscle, nor external tumour on the back, nor loins.
   I have seen a similar debility seize grown people, especially wo-
men,  after a very long illness, and has continued a year, or more;;
during which time they were utterly incapable of walking without
the help of crutches.  These cases, however, have always been at-
tended with great pain in the commencement ofthe complaint, though
without tumour ofthe limbs; and have seemed to be benefited by the
external use ofthe waters at Bath.
       Discoloration, accompanied with Debility of the Limbs.

  Attendant upon debility of the lower extremities, there is some-
times a discoloration equally distinct from those  already mentioned,
and  another yet to be  noticed.  It takes place at a more advanced
age, and seemingly in consequence of previous bad health.  I know
of no writer who has noticed such  a  complaint, and have not met
with it often enough to be distinctly acquainted with its nature; nor
have I, as yet, fairly seen the result.
  Children so affected have gone  off  their feet, as it is called, or
dragged them only very feebly, after having been able to walk stout-
ly for some time.  They have become in  every  respect weak  and
languid; their head has grown large, and their limbs become ema-
ciated, but do not feel cold to the touch, though of a deep leaden-
blue colour from the fingers and toes to the elbows and knees; with
the face almost equally discolored, and like that of adults in a fit of
asthma.   A fall, or such like accident, has sometimes been suspected
as the cause of these symptoms, but unsupported by any appearance
on the vertebrae, or other parts.
  The bark and cordials have been  made trial of without any advan-
tage; and cold-bathing has  seemed to be prejudicial.  The applica-
tion of  leeches to the livid  parts, friction, spirituous and volatile em-
brocations,  and  blisters; repeated electricity;  tepid  sea-bathing;
steel, exercise,  and a generous diet, are the means I  have hitherto
directed, after purging with calomel; but as yet, I have said, I am
not able to state their certain effects; the most ofthe subjects I have
been consulted for residing out of town.
  In several instances, a discoloration of this kind, appearing only
at times, and recurring again, during  many months; attended with
cough and occasional difficulty of breathing; has disappeared totally
as children have acquired general strength  and good health, without
any manifest advantage from the means that have been  used. 
34
             CuYvalwe of ilie  Bones from  Weakness.

  Crookedness of the bones, particularly those  of the lower ex-
tremities, has been mentioned as a common consequence of rickets,
and may claim a transitory notice.
  The principal inquiry in the treatment of deformities of this kind
respects the use  of irons for the support of the limbs, whenever the
distortion happens to be considerable.   The propriety of this assist-
ance has, indeed, been doubted by some practitioners, as well as their
unpleasant appearance objected to by parents; who have, therefore,
been inclined rather to trust only to cold-bathing.   Friend, however,
as I am to the latter,  I may venture to say from experience, that it
is likely to be prejudicial  at the time it is often had recourse to; for
by strengthening the system, it rather serves to confirm the crooked-
ness which the bones  have already contracted.   It is an advn i•  ge,
on the other hand, that -the bones remain soft and «iclding as iong as
the curvature is considerable, if so be the pressure of the  superior
parts be at the same time duly counteracted.   To support the limbs,
therefore, with  irons, as  long as the softness of the bones  disposes
them to yield under the weight ofthe body, is certainly a rational in-
tention, and has been very beneficial in numberless instances; and in
one very bad case I am occasionally seeing at this  time.  This end
obtained,  the bones being still lengthening as the child grows up,
they naturally incline to become straight; and at this time the cold-
bath and other tonics  are properly indicated, and will co-operate to
the cure ofthe complaint.  The only care required is, that the irons
be made as light as possible, and be properly adapted, and that they
be lengthened as often as may be necessary.  It is, possibly, for want
of due  attention to this last particular, that irons have in  some in-
stances been really found to do harm; the reason for which must be
obvious to every one.
   When a curvature takes place in the spine (without any disease of
the vertebra? or cartilages) the like method should be taken.   Proper
instruments to  support the head and upper parts  of the body have
been contrived by different artists, but those made by Jones, or Bow-
ley, appear to be the best.   There  is, indeed, a slight disposition to
this curvature in some children of a scrofulous  habit, that  does not
require so inconvenient an instrument; and for which the stays made
by Laurie and  Holmes in Bartholomew Close, may,  therefore, be
preferable.
   But  if the injury extend to the hip  and contiguous bones, it will
 not be  manifest at the time; and when discovered,  can be benefited
 Only by the cold-bath, and other general remedies.  If this distortion
 sho^s'd  be considerable, it may, indeed, become a source of manifold
 evils in females, as will be noticed in  another place. 
PARONYCHIA.
35
   Should the bones ofthe arm be curved, either by accident or dis-
ease, in  this soft state, rollers and  pasteboard splints, properly ap-
plied, will be sufficient to support, and restore them to their natural
form.
                           Paronychia.

   This  complaint, it  is well  known, occurs in very different de-
grees, but is introduced here  principally in  a view to the most be-
nign; many young people being very subject to a mild species of this
complaint, which being perfectly superficial, is not improperly term-
ed the cutaneous whitlow, and  will attack the ends  of the  fingers,
several times in a year, without any previous injury of the part.*
The subject is noticed, therefore, chiefly with the design of recom-
mending  a  prophylactic which I have frequently seen  successful.
This consists only in bathing the fingers, several times a-day, in the
following mixture, the moment that a sense of any  preternatural heat.
or pain, shall be felt.

       Rj. Misturaecamplioratae §iv
          Ag. litharg. ,>cetati 3'J
          Tinct. opii 5ft
       Misceantur.

   In the malignant, or deep seated whitlow, doubtless, the best me-
thod is to make an early opening down to the bone, which will occa-
sion the patient much less pain, than allowing the matter gradually
to make its own way to the surface: which is likewise always at-
tended with much mischief to the parts; and sometimes even gan-
grene.
   I shall only add, that in the commencement ofthe tumour and pain,
nothing can be more improper than the recourse so commonly had to
a bread and milk poultice; instead of which, where poultices are re-
  * This,  though apparently a trifling disease, requires more  attention than
patients are willing to allow,  or the surgeon to devote to it.  From this cir-
cumstance it is suffered to progress, under the care ofthe ignorant nurse, who,
in the shape of " healing plasters and drawing salves," possesses many infallible
remedies for the complaint.  At the period for calling for surgical aid, it com-
monly happens that great destruction ofthe adjacent parts has taken place. It
then becomes necessary for us, not only to prescribe for the cure of the disease
itself, but also to remedy the mischief which has resulted from improper treat-
ment.  Paronychia is of four kinds; each of these requires  to be managed
differently, according to the peculiar circumstances of the case.  Rut to no-
tice each of these, and their proper mode of treatment, would lead me into de-
tails much too extensive for a note,  I therefore refer the reader, for full and
;wcuratc tnfonna1:"n, to the Elements of Surgery.—T>. 
w
l'ERNIONES.
quired, those made with the water of acetated litharge are abundant-
ly preferable, and should be applied only very moderately warm.
                          Furunculus.

   The common boil only is intended here; and is noticed from its
frequency in young people towards the  time of puberty, who are
sometimes vexed with a succession of them.  This is the true phleg-
mdnic inflammation, and is therefore most acutely painful,  and the
skin of  a  deep red  colour before the  suppuration  is  complete.
Though oftentimes hurtful in older subjects, they are, however, just-
ly accounted salutary in others,  and do harm only when repelled, or
hastily dried up.   If a poultice of bread and  milk, therefore, be ap-
plied  from the first, (if the boil be in a convenient part, otherwise a
gum-plaster,) and  the abscess dressed with any warm digestive as
soon as the skin gives way, the  slough, which the boil always forms,
will soon be thrown off.   It is sometimes for the want of this, that
another boil forms  in the neighbouring parts, or the child is teazed
with sore eyes, or some humour, as it is termed, on the skin.
   Two or three  doses  of purging physic may be taken,  at  proper
intervals, after the  boil is healed.
                           Pemiones.

   This is a complaint so well known, that it can need no descrip-'
tion.   It is generally owing to the circulation  of the  blood in the
minute vessels of the extremities being checked, by a  child having
been long exposed to cold or wet, and afterwards running to the fire
instead of recovering the natural  heat by general exercise, and  fric-
tion of the parts affected.   If the injury be exceedingly great,  as it
sometimes is when a person has Iain for several hours in the snow, the
circulation cannot  always be restored, and  some parts actually mor-
tify.  To prevent this, if possible, instead of  bringing the person
near a fire, he should be immediately  stripped,  and well rubbed all
over,especially the parts  most affected, with snow, and afterwards
with salt and water, and be then put into bed.  If neither snow, nor
ice be to be  had, cold water should be  made  use of,  or flannel
sprinkled with spirit, or volatiles.  If  the parts be turned  black,
which  they often are when they are what is called  frost-bitten,  the
patient, especially if a young child, should be confined to the  bed,
as long as the weather is  severe,  and the  parts shall  continue dis-
coloured.   But my intention is to treat chiefly of slighter attacks;
on the first appearance  of which, known by the heat, itching,  red- 
perniones.
37
Bess, and swelling ofthe heels, toes, ol fingers; the parts may be well
rubbed with a  soft brush,  or soaked in smiths' forge-water,  and
afterwards rubbed with mustard and brandy, soft soap,  or salt  and
onions;  or they may be  embrocated  with the  liniment, saponis, or
spirit, camphoratus,  to two ounces  of which  may be added a  tea-
spoonful of the aqua litharg. acetati.  But  I have, for some  years,
experienced the good effects of far simpler means than any of  these,
and which I have hitherto never found equalled by any ofthe warmer
remedies  alone.   It may, indeed,  be made use of together with
them;  and is nothing more than the cerat. sperm, ceti spread on a
large piece of thick lint, or the emplast. saponis on cloth, to be ap-
plied as soon as the extremities begin to itch,  or become painful: or
if this should not very soon be of use, both  embrocating, and cover-
ing the parts with compresses of flannel wrung out of the aqua  am-
moniae acetatae, which should be continually preserved moist.
   Some children  are disposed to have chilblains every winter; as a
preservative against which, if it be the hands  that are liable to be
affected,  warm leather  gloves should be worn,  (avoiding  woollen,
which  in these cases is  unfriendly to the  skin;)  and above all,
wearing for a  few hours  in the  day or night, and especially when
abroad in the cold, oiled silk gloves, which is one of the best preven-
tives both of  chilblains  and of chopped hands,   that  has been
hitherto known.   But if the feet are usually the affected  parts, the
heels only may be covered by a piece of washing leather, and over
this  a  piece of oiled silk, secured round the  insteps,  and worn
day  and night  during the cold  months; and should be  taken off
only for the purpose of washing them, and rubbing the parts with the
brush or liniments, as mentioned above.
   When  the swellings are broken, it is  common to  dress the sores
only with a little cerate, and to wait for the return of warm wea-
ther, when they  usually  heal of themselves; but by this  means,
they often remain bad through all the winter, and when  large, are
sometimes not well till the summer is very far advanced; and  I have
even seen them remain very bad both in children and grown people,
at the end of September.
   After  having  attended great numbers in  this complaint, I  am
satisfied  that  this  kind of  sore  requires  applications  somewhat
more invigorating,  being  a species of mortification; and though it
will not always endure very warm  digestives like   many  other ul-
cers, yet  when the chilblains are  pretty large, a portion of some di-
gestive joined with the  cerate, is very "friendly to them.  And I  have
known some sores, though very  small,  which had  remained  in  a
very obstinate  and tedious state long  after the  breaking up of a hard
frost, whilst they had been dressed only with cerate, or other  mild
or drying applications as they arc called, begin to heal immediately
 upon adding a small portion "of some warm digestive, and applying
 a flannel   roller,  without  any other attention in the plan.  But  if
vol. h 
33
AMBUSTIONES,
they are spread to any considerable size, nothing contributes so much
to their healing, as touching the  sores  every day with bracing  and
invigorating lotions, particularly diluted solutions of  steel, or tinc-
ture of myrrh;  which in  a very few  days will produce  kindly
granulations in these, and other cold sores, though of long  stand-
ing.
   When the parts are much swollen, and the sores been long foul,
it will  be often necessary in severe weather, to make use of poul-
tices, of which those  made of rye meal and the compound water of
acetated litharge are more active, and therefore preferable to bread
and milk:  the latter, however, if a little brandy be added to it, an-
swers very well  in  many ca.ses.   If these are applied over the above
dressing of cerate and digestive, and changed twice a-day, the sores
will heal in much less time  than by any of the common applications
I  have  seen used; especially if the parts  surrounding the sore be
well  rubbed with camphorated spirit.  If children be  not very
young,  purging them with a little calomel twice a-week, will often
expedite the healing of the  sores: in the worst cases, a decoction of
the bark, a* well as cordials, and a generous diet are required.
   I have now for many  years had  strong proofs  of the good effects
of electricity in chilblains, both as a remedy and  a prophylactic,
especially in elderly people,  many of whom are afflicted with them
every winter.
                           Ambustiones*

   Burns and scalds are mentioned by some old writers; and though
a  misfortune by no means confined to young people, they too often
fall to the lot of infants, through the carelessness of their attendants:
and for want of being properly treated at the instant, children often
suffer exceedingly, when a  fit application would have rendered the
injury trifling.
   When such an accident happens, the nearest astringent at  hand
should be made use of, such  as brandy, or other spirit, oil of tur-
pentine, wine, or even  cold water, till something more proper can
be procured; into which the injured part should be plunged, or be
covered with pieces of cloth dipped in such liquors, which will pre-
vent the blistering  of the  part: or, in the momentary want of any
of these, holding  the injured  part before  a moderate fire.   As
soon as it is possible to  procure officinal remedies, the following will
be very proper.

     R,. Aq. calicsLBj.
        -----litharg. acetati £ 6
        Spir. vini Gall.fij.
        Misceantur. 
AMBUSTIONES,
39
   Where ice can  be conveniently applied, and  renewed day and
night, for three or four hours at a  time,  it will be  found the best
early remedy in every bad case;  or in the want of this, keeping the
parts constantly wetted with cold water.
   If the injury has been too long received to admit olf much relief
by these means, and deep sloughs  are actually formed,  a  very pro-
per dressing may be made of equal parts of cerat. e lapide calamin.
and unguent, sambuc. viride; diminishing the proportion of the latter
as the sloughs shall be  thrown off, and the sores  become disposed
to heal.   But should the injured surface be large, or the pain occa-
sioned by removing the dressings, be very great, it will be sufficient
to cover the parts with pieces of linen dipped in cold-drawn linseed
oil, which should be moistened every day, and suffered to adhere till
the sores are in a state to admit of being dressed in a common way.
A short time ago the repeated application of cold water has been
strongly recommended, and afterwards strips of litharge plaster.*
   A strong  solution of  soap in  water  has long been  in  use with
artificers employed in any business exposing workmen to very bad scalds;
and is a very excellent remedy.  About three quarters of an ounce of
soft soap is a proper quantity for a pint of water. But the soap taking
some time in dissolving, and requiring a certain proportion  of boiling
water, the lotion cannot be made cool enough for immediate use by
the addition of the proper quantity  of cold water; a  remedy, there-
fore,  more convenient, and perhaps  more efficacious, may be made
of ol. oliv. aq. fluv.  frigid, and aqua kali puri.   Six ounces of oil to
ten of water, with two drachms of the ley will make a pint.  This
quantity may be sufficient for a burn on the hand or foot,  which is
to be immersed, and kept about half an hour in the liquor, which will
remove the injury if had recourse to immediately; but must be repeated,
as the pain  may require, if the scald or burn be of some standing.
Could a person scalded all over, be instantly put up to  the chin in a
eold bath of this kind, and the head,  at the same time, be frequently
immerged, or well washed with the liquor, I believe very little injury
would ensue.f   Another good domestic remedy is that mentioned by
Mr. Parkinson; a strong brine, made by placing sliced  potatoes and
common salt in alternate layers in a pan,  allowing them to remain
until the whole of the salt is liquified, which must then be drained off,
  • Baynton on Ulcers, by a letter from Mr. Simmons, of Manchester.

  + With all due deference to  our author's accurate observation and practical
information, we must declare that this assertion proves him deficient in know-
ledge upon one point highly important in forming our prognosis of burns.  I
allude to the well known fact that burns are always dangerous in proportion to
their extent  The remedy, we believe, is yet to be discovered, which, though
applied immediately to tbe whole surface of the body, can effect a cure—Ed. 
40
AMBUSTIONES-
and preserved in bottles, ready for immediate use.   Whatever soreu
may be formed, should be treated afterwards according to the forego-
ing directions.*


  * For some new ideas on the nature of burns and their treatment, the reader
is directed to an Essay, written by Mr. Kentish, 1797.
  The above note appeared in this place in a former edition published a short
time before I left London, on account of ill health; since which, Mr Kentish in
his  second Essay, has usurped the critic's chair ; and passing judgment on every
preceding writer, has been pleased to make himself particularly merry, as he
imagine*, at  my expense. And indeed, if such a mode of debating medical subjects
can have given him any pleasure I do not envy him such a gratification, much less
shall 1 attempt to imitate it.  Concerned for the credit of the profession, and its
advantages to society, my heart as  well aspen will say, let that p\a.n be establish-
ed by which those ends shall be best promoted.
  Mi. Kentish,however,has been pleased to class me in respectable company ;
Sii  W Farquhar, Bart, and Sir J. Earle, coming in  for their full share of his cen-
sure ;  but with what satisfaction to the public, it is their province to judge.  In
regard io myself, however, M>\ Kentish may not, possibly, have proved the vciy
gross contradictions  he conceives me to be guilty of, nor  the entire want of
principles and  system that he seems to think. For, I apprehend, that  >heex-
tremes both of hot and cold applications, when  far beyond the natural tempera-
ture of parts,  produce in many instances  a  similar  effect, though b • different
modes, in the first instance ; and will tend ultimately to the same end.f
  Fact and  experience seem to confirm this assertion, with  whatever theory it
may accord, or be at variance.   Mr. Kentish, indeed,  thinks very differently,
and concludes that 1 never could  have ventured such opposite prescriptions, if
I had read his work; but whether this be a compliment to my understanding,
or to  the force  of his reasoning, the reader may be as good  a  judge as I  am,
nor do I wish to bias  his opinion.   It is certain, however, that I  had read enough
of the work t6 recommend it  to the attention of the public, and, as I intended
at least, with respect  But what Mr. Kentish may consider still more perverse
in me, though neither thr most firm, nor obstinate man living ; now that I have
read his second essay, I have ventured the chapter again, unaltered, both to the
public's  and Mr Kentish's critiques ;  and among other reasons, because  it ac-
cords with my plan and experience.
  Spirit, cold water, &c. may be  at hand when a  proper fire may not, and vice
vers! . and I am persuaded, that greater  benefit will oftentimes be derived from
an immediate recourse to either, than to wait even for a fitter one: I have in no
pan of my work stood forth as the champion for a system, though a friend  to
established theory ;  but  satisfied  that the remedies 1 have ventured to recom-
mend havt, in repeated instances, obviated much  pain,  local inflammation, and
fever, with their train of  ill consequences, my obvious intention has been to say
to the reader,—mutatis mutandis, utrum horum mavis accipe.
  But if Mr. Kentish hath, indeed, fully ascertained to the satisfaction of com-
petent judges, that his  method  of practice is in all cases preferable to  every
other, I join him,  I have said, in  wishing that  it may become universally adopt-
ed ; save that, at present, I  should wish, that if unfortunate enough to burn  or
scald  any of my extremities, the  part should be  immediately held to the fire;
or if  nearer to a pond, be plunged into water, if  strong spirits, or oleum terete
were not at hand; the latter of which, I am informed, every good surgeon would
not in many cases pi efer.
  Having declined the practice of surgery, it is not very likely 1 may myself be
competent to determine  on the exclusive excellency of Mr. Kentish's practice ;


  f This we  believe is  strictly  true, for it is by no means uncommon to find
patients much injured by fire declaring, that their chief suffering consists  in the
excessive degree of  oold they experience. 
41
                      Luxations and Fractures.


   Infants are not only liable to these misfortunes by a fall from the
lap, but the  bones, or joints, may sometimes be unavoidably injur-
ed in the birth.   There is in this case  seldom  any luxation, I be-
lieve, but of the shoulder; which  is not  difficult to be reduced, and
requires little afterwards, but that the limb be kept perfectly quiet.
   It is very common  for nurses, especially during the month, to sup-
port the lower jaw of an infant whenever it happens to yawn, in the
apprehension that the jaw  might otherwise  be dislocated.   This
practice is, at least, an  evidence of the nurse's attention, and can do
no harm, though I have, indeed, never known the accident happen.
Should it, however, take place, either  at this age, or in older children,
through some violence, it will occasion a very awkward appearance,
and prove very distressing to the child, who will be disabled from talc-
ing any nourishment till the luxation be reduced.  Nothing more, how-
ever, is required to this end, than to  place the thumb of  each hand
in the back of  the mouth, and the fingers on the outside, under the
jaw so as to depress,  and at the same  time bring it a little forward,
to disengage  the  head of the condyle, and then  force the jaw sud-
denly back.


and may therefore still be permitted to tread the via trita, and recommend with-
out offence what my former experience has suggested.
   Fevers of a certain type are, indubitably,  cured upon the Hippocratic plan, as
well as by the cortex cinchon. and wine; and though  oftentimes more slowly, it.
is possible, that some one of those, wherein the latter plan has failed, might have
terminated more favourably under the former.  The best practitioners, however,
have sometimes had their doubts, in certain stages of fever, what may be the
very best mode of treatment;  and such have always been the most disposed to
judge modestly of other practitioners whose  reasonings have  not exactly ac-
corded with their own.  Let such men settle the discordia fratrum.
   As a more curious novel device in a view  to lessening the pain and inflamma-
tion consequent to burns, the metallic traders of Dr. Perkins, to which such
marvellous effects have  been attributed, can be mentioned only in the way of
caution not to depend on them.*


   •  Without entering into the dispute between our author and Mr. Kentish,
which will be found upon the preceding page, I have only to observe, that our
experience in this country by no means confirms the opinion here expressed with
regard to the superior efficacy of cold applications in burns and scalds.  The
Kentish Unguent, (composed of basilicon, softened with oleum terebinthinae)
spread upon lint or soft linen, and carefully applied to the injured part only,
certainly does  allay inflammation and alleviate pain,  more than  any remedy
which has been used under my observation. Of late the basilicon itself without
any addition has been used with success by Dr. Physick in these cases.  Much
ingenuity would be requisite to explain upon theoretical principles the modus
operandi of the  oleum terebinthinse  in curing the inflammation arising from
burns.   To apply so powerful a stimulant, to parts alreadj irritated, appears so 
42
FRACTURES.
   Fractures, indeed, are not quite  so easily managed as luxations,
and probably happen more frequently.   The bones are yet but little
more than gristle, and if strained beyond a certain degree, are easily
bent, or even broken.   The former is  very readily  restored, but I
shall be more particular on  the latter, as the subject is of some im-
portance.
   Fractures in the birth  are usually of  the collar-bone,  the  arm, or
the  thigh; the treatment  of the two former of which will  include
all that is necessary to be observed of such as may happen in other
parts.
   The. first,  however, requires very little attention, as it will be  ne-
cessary only to draw the shoulders back, confining them in that pos-
ture, by two or three pins in the clothes, and to apply a piece of the
empl. litharg. cum resina, or emplast. saponis, spread on leather, upon
the rising end of the bone, and a larger  piece over the first.
   A fracture of the arm  demands  a little more attention, but will
always end  perfectly well.   The  difficulty consists in keeping  the
fractured ends of the  bones opposed to each other, without rolling
up the arm  so tight as to  occasion pain,  or much swelling of the
hand; which in  a new-born  infant, a very small pressure  will effect*
I have found no method so well adapted as the following,  which, al-
lowing of a little tumour about the fractured part, without the neces-
sity  of loosening  the roller, preserves the ends of the bones  in due
contact, without drawing the roller so tight as to prevent the  free re-
turn of blood from the inferior parts of the limb.
   To this end, three little splints, about half an inch in width, and
an inch and  a half long, may be made of fine linen  cloth, five or six
times folded together, to the thickness  of common pasteboard; and
being soaked in  a mixture of flour and white of egg, should be placed
in the usual  manner, along the fractured  ends  of the bone.   Being
applied wet, they  will accommodate  themselves exactly to the figure
ofthe limb, and  when become dry, will  be sufficiently strong to sup-
port the bones.*  They should  be applied immediately on the skin,
without the intervention of a roller; by which means, when the parts
swell, which they should  always do a little,  there  will be space
enough between them  to  allow of it,  notwithstanding the pressure
from the roller;  which  should be applied over them.  This ought to
be of very fine flannel, and should  not be drawn near so tight as  for
adults, nor will there  be  occasion for  it,  as the chief dependence

contrary to reason, that nothing  less than the test of experience could have
forced it into general ase.   It is not my intention to attempt an explanation of
the circumstances  here noticed, but  only to observe, that asserting it,  to be an
action "sui generis," and therefore requiring peculiar treatment, is merely stating
the fact, but certainly throws little light upon the subject.—Ed.
  * Pasteboard certainly affords a support for the arm more cleanly and dura-
ble than the preceding; it will adapt itself precisely to the shape of the limb,
»nd should, therefore, always be preferred.—Ed. 
CUTTING THE  TONGUE.
43
ought to be on fastening the arm  down close to  the side, by strong
pins fixed into  the little gown, in the manner the surgeon may best
contrive at the  time.   The gOwn, therefore, ought not to be changed,
nor the arm moved, but in his presence: and if the hand be not in-
flamed, nor very much swelled, and the child continue easy, the part
will not need to be opened under eight or ten days.   Till this time,
the same gown should be worn, and be preserved clean by such co-
verings as  may be easily removed.   The speedy  union of the  bones
will depend upon a strict attention to keeping  the  limb as still as
possible; and if it be so preserved, the accident will afford very little
trouble after the first ten or twelve days; and  at the month's end, the
child will  move that arm nearly as well as the other.
                     On  Cutting tlie Tongue.

  The directions on this head, as well as the notice taken of many
of the following  little disorders, proceed rather from a desire that
nothing on the subject of children's complaints should be omitted,
than from their real importance.   Some of them, indeed, have been
entirely overlooked by preceding writers; and though they will sel-
dom require much attention, it  may sometimes be of advantage to
know what has been serviceable in similar cases.   The instance
under consideration, however, is too trifling a matter to dwell upon.
And, indeed, the little operation, performed in order to  lengthen the
tongue, is very frequently called for where there is  no absolute oc-
casion for it,  the confinement being seldom  so considerable as to
make it really necessary to divide the fraenum.   The child will suf-
fer so very little, however, in the  operation, that when it is care-
fully done, it will be attended with  no inconvenience; and if it can
afford the mother any satisfaction, it will be very proper to  comply
with her request.*  It seems, therefore,  only  necessary to add, that
some little care and steadiness are required,  or the sublingual veins
mav  be wounded, and  in consequence  an infant may lose  its life.
To* avoid this danger, the bridle may be divided by  a small curved
bistoury, instead of scissars.   The  handle and blade, when open,
need not exceed two inches in length; and the point should be a lit-
tle curved, and the back made  broad,  whereby the  point  may be
easily forced through the  fraenum  in  the most troublesome case,
whilst the back of the instrument will  sufficiently  press down the
veins, so as to be entirely out of the way of  being injured.   These


   • To determine whether this operation is necessary, we have only to introduce
the finger into the child's mouth ; if it sucks this readily, a division ol the frx-
 num is not called for, and the wishes of the mother aie by no means sufficient to
 justify the surgeon in performing the operation.—En. 
44
HEMORRHAGE  OF THE  NOSL.
cautions have been judged by some people to be very trifling; but be-
sides that infants have actually bled to death, the following equally
fatal accident has arisen from cutting too deep, which I shall, there-
fore, notice in this place, as well as describe an instrument contrived
for suppressing the bleeding.
    Suffocation from swallowing the  Point of the Tongnc,  and
                          Hemorrhage.

  The occasion of this accident, it has been said, is cutting too deep
in dividing the fraenum:  I  have hereto notice its symptoms  and re-
medy.  The former are  those  usually attending strangulation, and
come on suddenly,  and without any probable cause but that of the
tongue having been  cut; but to  which they are seldom attributed by
those who are strangers to the complaint.   The infant appears great-
ly agitated; the face turns  black;  and unless these symptoms soon
disappear, the child goes off in a convulsion.  But if they are pre-
sently removed, the  infant is as  suddenly well; though they generally
return again, and have in  several instances proved fatal.
  Mr. Petit* has, perhaps, the credit  of discovering the true cause of
the complaint.  The remedy consists in nothing  more than bringing
the tongue into its proper place,  and, if the infant  be suckled, putting
it immediately to the breast, which will  give the  tongue a  natural
direction.  Should  the child  be brought up by hand,  the tongue
should be watched for some time, at least till the bleeding shall be
stopped; the complaint taking place only in consequence of that being
considerable, so as to become an inducement  to the infant to conti-
nue sucking at the part.
  When the sublingual veins are actually wounded, the danger, it
has been said, is considerable; and  it is  to  Mr. Petit that we  are
again indebted for the best contrivance for suppressing this hemorr-
hage.  The means consist only of a  piece of ivory, in the form of a
short fork; the prongs of which should be so placed as to press against
the  apertures in the veins, and the other end against the inside ofthe
lower jaw, and should, therefore,  be broad and somewhat  convex,
that it may keep its place.
                    Hemorrhage of the Nose.

  This complaint was hinted at in the chapter on  Sneezing, and
some account of it is met with among the old writers; I shall, thcre-


                * Memoires de I'Academie de Sciences. 
hemorrhage  from  the navel.
45
fore, bestow a few words upon it, though it is not often of much con-
sequence, I believe, before the age of puberty.
   If a child  be feverish, or  otherwise  unwell, the  hemorrhage  is
often a  mere  symptom arising from the complaint under which  it
labours, and will disappear upon that being properly treated.   But a
bleeding at the nose sometimes takes place in the healthiest children,
the vessels of this part being weaker than those which are covered
by the true skin, and often afford a salutary outlet,* in case of ple-
thora, and, therefore, usually contract when the intention of nature
is answered; after which, a dose or two of cooling physic should be
given.   But  it may be sometimes necessary to draw  a little cold
water up the nose, to which some vinegar may be added;  to  com-
press the nostril from which  the hemorrhage arises; and confine the
patient as much as may be to an  upright posture.   Should these lit-
tle remedies fail, the head, hands, and feet, may be bathed with cold
vinegar and  water, and the nostrils be stopped up  with  dossils  of
lint, which upon urgent occasions must be dipped in warmed oil of
turpentine, or other styptic liquor, and  must extend to  the  posterior
aperture.   The last means will almost always succeed; but if other-
wise, some blood should be taken from the arm, if the pulse does not
forbid; the*feet be bathed in warm water,  and the body kept open by
manna, and cream of tartar; and the patient should live for  a long
time  pretty much  upon  whey,  vegetables, and  milk; at  least,  he
should not dine wholly upon animal food.  In the intermediate days
of purging,  the  testaceous  powders and tincture  of  catechu may
be taken; and in some instances of debility the bark, or  the Ncvilholt
water, will be proper.
                   Hemorrhage from the Navel.

  The navel of new-born infants is liable to several disorders, some
of which are of considerable importance; but I speak in this chapter
only of the slighter ones.   Of these, one is an oozing of blood from
the part,  after an unkindly separation of the cord, and is owing to the
shooting  up  of a soft fungus, which prevents the skin from covering
the divided vessels in the manner it otherwise does.  This rawness,
however, is not always attended with hemorrhage, as will be noticed
in the next chapter; but when it is so, and has not been attended to,
it may continue for several months, and in some instances, in such
quantity  as  to  prove alarming  to  the  friends of the child,  lest it
should in the end be injurious to its health.   The little vessel from

  • In these cases, it is always most safe to take the business entirely out of tie
hands of nature. It is true, she does much in the cure of disease, yet we can.
commonly supply her place, and ought always to direct her movements.—Ba
   VOL.  II                     » 
46          SORENESS, OR ULCERATION OF THE NAVEL-

whence the blood issues, lies always so deep that it cannot be secur-
ed by ligature, nor be conveniently cauterized; the latter of which,
indeed, would be very disagreeable.  I have, however, conveyed the
lunar caustic to the part, which has stopped the bleeding for a time;
but it has always returned.  Nothing further, however, is necessary,
than to adapt a  proper compress, and secure it by sticking-plaster
and bandage; which should be continued for two or three weeks; or
it may be restrained merely by a small dossil of lint, and cross strips
of sticking plaster applied in the  manner hereafter directed for the
rupture at this part.
  There is, indeed, another kind of hemorrhage of more importance,
but this seems to  be sympathetic, and is attendant upon infants who
are in an ill state  of health daring the month, and is, perhaps, a bad
sign.   It takes place where the cord has been apparently well heal-
ed; but the skin  afterwards gives way, and the bleeding  is much
more considerable than in the  former.   It requires, however, no-
thing more than the application of common styptics, with proper com-
press and bandage.  The bleeding not appearing, in the least, to be
critical, ought to  be suppressed as soon  as  may be,  and whatever
complaint the infant may  labour  under, be  treated according to its
kind.
               Soreness, Gr Ulceration of the Navel.

  The care of this part has been so uniformly submitted to nurses,
that unless some very unusual complaint has appeared, medical men
have seldom been consulted.  On this  account,  its disorders have
rarely been mentioned by writers, nor probably have all the affections
to which it is liable been generally known.
  The separation of the cord is the  work of nature, whose opera-
tions are usually performed in the best manner and time.  It may
here be remarked, however, that in regard to the time there is a con-
siderable variety; a complete separation in some instances taking
place in five days, and even earlier,  and in others not till  the  fif-
teenth, or sixteenth.  When so late, the funis is usually found hang-
ing for some time only by a very slender filament,  which if perfectly
dead, as it usually is, ought to be divided; nature having herein fail-
ed of her intentions.  From the neglect  of this, a  source of irritation
and discharge is kept up, which I have  suspected being the cause of
some ofthe  little disorders now to be noticed.   In  a late instance that
I met with  of a long discharge  from the navel, I afterwards learned
that the funis had been in the above  state for several days, and had
not dropped off till the fifteenth.
  The separation of this part,  however, is not  often followed by
much soreness or pain, though there  is frequently a true ulcer of the 
SORENESS, OR ULCERATION OF THE NAVEL.
47
part.   The common  applications of a bit of singed linen cloth, a
toasted raisin, and dusting the part with hair-powder, or the powder
of ceruse,  are usually sufficient for the common soreness consequent
upon  the separation of the cord.   In some instances, however, the
discharge is very great, and  the part continues  o appear raw, and
indisposed to heal, or dry up.   In  such cases,  I have often found
three or four small pieces of a soft cabbage leaf one of the best appli-
cations.   They should  be laid one over another, that they may be
preserved  moist and cool, and should be continued as long  as the
discharge shall be  considerable.
   A more  troublesome case is that of the part becoming sore, often
some  weeks after it has appeared to be healed;  and as far as I have
seen,  (unless in some very bad  cases presently  to be  noticed,) has
taken place only where the skin ofthe belly has extended an unusual
way on the cord; occasioning likewise, as will be noticed in a sub-
sequent chapter, a disposition to exomphalos.  This soreness is like-
wise attended  with much thin discharge, which  disappears and re-
turns irregularly, together with a raw appearance ofthe part; which
is not many days in the same state.  The bowels  are in this case
usually affected, and should,  therefore, be carefully attended to, and
proper remedies administered according to the nature and number of
the stools;  the  part being  at the same time covered  with cabbage
leaves, or with a poultice of bread and  milk, or of aq. litharg. ace-
tati comp. or the decoct, corticis, according as it may be more or less
healed; or  the raw part touched now and then with the argentum ni-
tratum, blue vitriol, or pulvis lapid calaminaris,  as its appearance
and the quantity of discharge may suggest.
   By one or other of these means, I have always found it get  Well,
but sometimes  not in less than five or six weeks, when it has usually
dried up suddenly; previous to which the infant has seldom thriven
properly.   In several recent instances, however, I have enclosed the
raw part in a ligature; and this method has usually removed the com-
plaint in a couple of days; and seems, therefore, always to be pre-
ferable where it can be  effected.
   But there is  a  much  more alarming  ulceration, which, like the
former, takes place some time after the  part has been properly heal-
ed, and is, probably, always  the consequence of some other illness,
or a general debility of the infant.   In such  cases, the sore has been
found to spread over  a  great part of the belly, and even to mortify.
Here very little can be  done, I believe; all the instances, excepting
two, that I have known any thing  of, having proved fatal, not so
much, indeed,  from the local affection, or tender  age of the subject,
as from the original cause of the gangrene.
   Whatever is found  proper in a similar state of parts on other occa-
sions, should be made trial of, such as fomentations, poultices, and a
liberal exhibition of the bark and cordials; under the use of which, 
48           SEPARATION OP THE FUNIS UMBILIOALIS.

however,  the infant rarely survives long enough to afford a due trial
of their effects.
   Mr. Pearson, nevertheless, has informed me of two cases of this
kind of ulceration, which took place in children turned of six months
old; one of whom recovered, under his care, by the means above re-
commended, which were had recourse to as soon as the sore began
to spread.  The other case had been attended by another gentleman,
and was not seen by Mr. Pearson till a short time before the infant
died.
   A case of this kind, but more mild, fell  under my observation very
lately; in which, upon the separation ofthe funis, a foul ulcer with
great tumour and hardness took place, which was not healed till the
end of the fifth week.   Fomentations and poultices, however, with
the exhibition  of cordials, effected the cure,  without recourse to the
bark; though the infant was not free from danger, till near  the end
of the month.
           Unkindly Separation of Hie Funis Umbilicalis.

  The uncommonness of the  appearance here intended may be of-
fered as a reason for noticing it, as it can require but little if any
medical assistance.   I have only once seen such a case; and being
at a loss what turn it might take, it  is  imagined, that other prac-
titioners may not be displeased with this account  of the probable
result.
   This case is hinted at under the article Hepartomphalos, the sub-
ject of which was born  in  the Lying-in hospital; where the funis
was tied in the ordinary manner, about three inches from the abdo-
men.  But instead of separating close to it as usual, only the  part
enclosed by the ligature  decayed, the  portion below it preserving its
former appearance,  except that it was a little shrunk or shortened:
some unusual vessel, or vasa vasorum, it is probable, keeping up the
life of this caducous part.  In this state it remained for some days
before the nurse made mention of it to any one; and as it afterwards
appeared probable  it would gradually shrink away, no  particular
directions  were  given; but  it was  purposed in a  few  days,  to
tie  the  funis close to the  belly, if that should not be  rendered
needless by the cord becoming dry,  and dropping off in the usual
manner.
   When the child was  near three weeks old, the funis  appeared a
little raw and moist, and the ligature was then determined upon; but
the  mother being called  to a place as wet-nurse to a great distance,
left the hospital  suddenly,  the remaining funis being still  a living
part, but  only half  an inch  in length, and the child very healthy. 
hernia.
49
and having heard  nothing  of it since,  it  is presumed has  con-
tinued so.
                            Hernial.

  Ruptures may take place in different parts, but they usually ap-
pear at the navel, or the groin.  The exomphalos is sometimes com-
plicated with the  ventral hernia near the part, and is  occasioned by
the separation of the recti muscles, the linea alba being there defi-
cient; but it seldom extends far  above  or  below the navel.   The
simple exomphalos is a very common complaint, which, if imme-
diately attended to, is easily cured, perhaps merely by the use of the
cold-bath:  but if neglected, may prove troublesome as the  child
grows up; especially to  females;    It will be sooner cured, however,
if treated like the hemorrhage of the navel, by adapting a pyramidi-
cal compress, made of round pieces of good sticking-plaster, spread
upon thin leather, with pieces of card  placed  between them; or
what is more easily prepared, and  is adapted to poor people, a piece
of  bees-wax  as  broad  as a shilling, and half an inch thick: the
upper part of it may be round, and the other flat, which should be
placed on the navel.   But if the child be a twelvemonth old, these
remedies  will then require a pretty tight bandage round the  waist;
and such a compression, I  have frequently observed nurses afraid of,
who often loosen the bandage so much as to render  it of very little
use.  On this account,  I have for  several years recommended Bow-
ley's elastic bandage, which if this rupture be complicated  with the
ventral, becomes the more necessary; and sittjng quite hollow on the
sides, and making no kind of compression  but on the part  affected,
and the opposite point of the back, perfectly  answers the end, and
generally in  three or four months.   But for the simple exomphalos
in young children, I have for some years succeeded equally well by
the ingenious contrivance of Mr. Kelson  of Seven-Oakes.   This
consists only in bringing  the parts together by means  of  three or
four strips of adhesive plaster, applied  star-wise,  across the navel,
which  are to be renewed as occasion may require.  It has been
said, that I have often  observed   startings  of the  navel  happen to
such infants, in whom the skin  of  the belly has extended further
than is common  upon the funis; on which account, nurses should be
directed to  be particularly  careful in such instances, and  keep the
part more than ordinarily confined.
   The bubonocele  is  of more  consequence, yet may be safely left
without a bandage, especially as the cold-bath alone generally cures
it when happening to children before they  go alone;  the nurse care-
fully attending  to returning the prolapsed parts as often as  may be.
In early infancy, there  is  likewise some difficulty in retaining the 
so
HYDROCELE.
 truss on the part, and  it is continually liable to be  wetted.   If a
 rupture,  however, should  be very large,  and the  infant unusually
 fretful and crying, recourse may be had to a steel-truss, to which it
 will be necessary to pay some attention, lest it slip out of its place,
 or the rupture fall down,  and be bruised by the pad.   After two
 years of age, indeed,  when children begin to take more exercise,
 the use of a truss seems to be absolutely necessary, of which those
 made of steel by Mr.  Bowley are incomparably the  best.  Should
 the cure of either kind of rupture proceed slowly, cold bathing will
 assist it, as well as be proper, for some months, after leaving off the
 bandage or truss.
   Lastly, it may be prudent to drop a word or two on the strangulated
 hernia; which is  more apt to take place in the  groin  than in any
 other part,  though happily, it is not very common  in children.    I
 have, however, very lately seen  a fatal instance of it in an infant on-
 ly six weeks old.   It can be necessary to do little more,  than to re-
 peat here the  observation  made in  the  chapter on vomiting;  that
 when any part of the intestine is strangulated, the stomach will fre-
 quently eject every thing that is put into  it,  and should, therefore,
furnish  a suspicion of such an  accident, and lead to  an immediate
examination of the parts.   Should the slightest  appearances of tu-
mour or heat be discovered, the experienced surgeon will pay a pro-
per attention to it, and can  need no  directions from this  work.  I
shall only observe, therefore, that the free application of cold water,
or of ice, after the ordinary remedies have failed, has in several in-
stances succeeded: upon the like principle, vitriolic ether has been
recommended.
                            Hydrocele.

   This distention of the scrotum is of a nature similar to the hy-
drocele of adults, and when it falls to the share of infants, I believe,
usually appears at the birth.   It has been sometimes mistaken for  a
common rupture, and a linen bandage been applied in the  ordinary
manner.   It is, however, easily distinguished from that complaint,
by the tumour  being transparent;  without  pain; and from  not rea-
dily retiring upon pressure, nor being increased by the crying of the
infant.
   It has been thought always to be a congenite complaint,  and that
the tumour does not retire upon pressure;  but I have  seen a few in-
stances where it has been otherwise.*  In one I had occasion to ex-
amine the parts very attentively at the birth, on account of a little

  * Mr. Le Febure de Villebrune met with it in  a child of  twenty-two months
Old. 
PNEUMATOCELE.
51
mal-conformation of another kind, and neither then nor the next
morning saw any appearance of hydrocele; nor was it discovered by
the nurse or mother  till  six weeks afterwards, though the parts, lor
the reason above mentioned, were frequently examined.   About this
time I was sent for in haste, on account ofthe appearance ot a large
hydrocele, which, however, by the mother's report, was before l goi
there  considerably  diminished.   The  scrotum, nevertheless, con-
tained (as I imagine) near a table  spoonful of water, and was Irom
this time  distended in different degrees, as  the water  happened to
retire, more or less, through the  tunica vaginalis  and rings ot the
muscles, which I apprehended must have been preternaturally open;
though no portion of the  mesentery, nor intestines ever descended.
The complaint, however, disappeared in a few weeks, by only dash-
ing the parts with cold water, three or four times a-day.  This infant
was a twin; and it is remarkable, that the other child had likewise a
hydrocele, which was not discovered for three weeks after the former,
but was much smaller, and got well by only the like gentle treat*
ment.                                                   ,.   ,
   The hydrocele is a  harmless complaint,  and would probably al-
ways disappear of  itself in the  course  of a few months;  but may
much sooner be dispersed by some astringent lotion.  The aq.  am-
mon.  acetate  has  succeeded with me perfectly well, and I have
sometimes made use of compresses wetted  in vinegar and  water,
 with the addition of a little spirit, as the skin has been able to  beav
 it.  Perhaps the addition of crude sal ammoniacus, as advised by-
 Mr. Keate, in the treatment of adults, might assist the absorption ot
 the water;  but I have myself never had occasion to make trial of it.
 The smoke of burning gum benjamin received upon  flannel,  and
 applied to the part, is likewise a  good remedy.  But  the  speediest
 method is to puncture the bottom of the tumour with the point ot a
 lancet; which, as it may always be done  with  perfect safety, and
 with very little, and only a momentary pain to the child,  is often
 preferred by the mother, as it instantly removes a blemish which can-
 not but be unpleasant to her, whenever any other person may chance
 to be witness to it.  In whatever way the water be gotten rid ot, I
 never knew it  return, nor the  child suffer  any consequent inconve-
 nience; though the complaint is so common that I have seen it m
 many score instances, and cured in different ways.


                           Pneumatocele.

    Having never  seen the complaint, and conceiving that the pre-
  ceding  disorder has  often been mistaken for it, I should not have
  noUcedit,but in  the view that nothing  relating to infantile com-
  pla tots might be  overlooked.   Should the scrotum, however, be 
52               TUMEFACTION OP THE PREPUCE.
really distended with wind, a piece of cotton, fumigated with gum
mastic, may be applied twice a-day, and  the  part embrocated with
the compound  water of acetated  litharge and camphorated  spirit,
and be supported with a proper bandage.
                     Retention of the  Testes.

  One  or both of the testicles, in some  instances, remain  in the
abdomen of infants at their birth, and then a tumour appears  in one
or both  groins, forming another affection resembling the hernia, and
is noticed on that  account.   As the application  of a steel truss, or,
indeed,  any other bandage, might here be attended with bad, if not
fatal consequences, it is of importance to avoid the mistake.
  This  complaint being generally  owing to a preternatural stricture
of the rings of the abdominal muscles, or to a want of  due action in
the cremaster or gubernaculum; I  have nothing to recommend, un-
less it be in a negative way, to forbid any rude handling of the  part,
in order to force the  testicles into the scrotum.   If any thing of this
kind should be judged necessary,  from a disposition of the parts to
give way, the descent tshould  be only very cautiously  assisted, and
that not  frequently.   In the course of  a few weeks, or  months,
however, the obstacle, of whatever kind, usually gives way; though
sometimes, indeed, the part  remains  confined through life,  and its
unnatural position is certainly attended with some inconveniencies,
and a greater chance of injury to the  testes;  of which I have seen
more than one instance in adults.  In some an hernia  congenita has
likewise  taken place, and been attended with such troublesome ef-
fects, as to render it necessary to have recourse  to a truss, (carefully
 adjusted,) notwithstanding the situation of the  testicle.   Should in-
flammation  take place,  in consequence of any accident, during in-
fancy,  every proper means of counteracting it should be immediately
had recourse to, such as gentle laxative medicines, and sedative em-
brocations and cooling poultices,  made of the  compound  water of
 acetated litharge.
                   Tumefaction of the Prepucfi.

  This little complaint, like the hydrocele, arises from extravasated
water, and is a partial anasarca, and  if it be not attended with in-
flammation, nor owing to a stone sticking in the passage, as it some-
times is, it never  proves of any consequence.   It is sometimes pre-
ceded by a copious discharge from the part, of a thick but soft con-
sistence, resembling  a strong lather  of soap, or the froth ot milk, 
PROLAPSUS.
53
which disappears as soon as the  tumefaction subsides;  by which the
natural secretion from the glands has been confined.
   The part may be  washed frequently with the aq.  litharg.  acetati
comp.  or be wrapped up in a poultice  of that kind, and the body be
kept  open, which usually removes the  complaint  in two or three
days;  but if it should not, the part  may be  lightly scarified, and af-
terwards  fomented.   Should  it  arise  from inflammation, as in the
erysipelas infantile the inflammatory cause must be properly treated.
If from a stone in the passage, the stone must be extracted, if within
reach, or if otherwise, it should  be  forced back into the bladder.
                  Prolapsus, or Procidentia Ani.


   This is a descent of the internal coat of the lower bowel, (this
coat, it is well known, being much longer than the others and full of
folds;)  and is either owing to its laxity, or to irritation.  It is no un-
common complaint, nor  usually difficult of cure, being generally a
symptom of  some  other;  such as  worms, or other  foulness  of  the
bowels, or has been  induced by rough purges, diarrhoea, long costive-
ness, a stone in the  bladder,  or  other irritating cause; and is usually
preceded by tenesmus:  to each of. which the proper remedy must be
applied, or the cure of the prolapsus will be attempted in vain.
   But if the complaint should remain, after the irritating cause has
been removed, it will then depend merely upon a relaxation  of  the
part, arising from the Jong habit of descending every time the child
has gone to  stool,  and is,  in  general,  easily  cured merely by an
astringent lotion*  To  this end,  a compress  of  lint, or soft tow,



   * Even under these circumstances it is very difficult to cure the disease, and
from my own observation, lean  assert, that an  "astringent lotion merely,
Will  not be  sufficient to effect  this purpose.  Neither will bandages, stippo.
sitories, or  any other  mechanical contrivances, prove  an adequate remedy tor
this distressing complaint.  If we consider the loathsome nature ot this disease,
the anxiety usually experienced by mothers for its cure, or the suffering of the
little patient, it will readily appear how important it is for us to be well acquaint-
ed with the best method of treatment.  By Dr. Physick, we believe, a  remedy
has  been introduced which is calculated to do more towards effecting a  per-
manent cure than any which has hitherto been proposed. He confines his patient
entirely to a diet of rye mush and molasses or sugar ; of this the child eats very
heartily for several days, but soon becomes satiated, and the quantity of course
is diminished.  During the use of this diet, we learn from its author, the abdo-
men becomes less tumid, the bowels are in a state somewhat oose, and the feces
a.-e all of a soft consistence.   These circumstances all comb.ne to  render ex-
ertion on the part of the child less necessary in the txpu.Mon ot the txces, and
consequently, there is more  probability of  the bowel reta.nmg its situation.
Dunn* a stool the patient should not sit, but stand upright; thin direction  may
appear trilling, but it  is important,  for by this means we break-the habit which
the patient may have acquired of placing his elbows on his knees and straining
most violently.—F.i».

   VOL. IT.                       * 
54
DISCHARGES PROM THE VAGINA.
 wrung out of the dregs of the red wine, to which may be added a
 few drops of the aq. litharg. acetati should  be often applied and se-
 cured by a linen bandage, so as to make a firm compression  on the
 part;  or a compress may be sprinkled with fine powder of myrrh,
 frankincense, and dragon's blood, or impregnated with the smoke of
 turpentine cast on burning  coals.  Or, suppositories may be made
 of  powder of  balaustines, red rose leaves and oak bark, in honey,
 and introduced into the bowel, after going to stool.   It may be found
 expedient  to have the part supported at  such times, by a  servant
 placing a finger on each side of the gut, as well as the child to  sit
 on  a high seat,  so that the feet may not touch the ground, or older
 children to stand; but  these cautions will not be necessary unless the
 complaint has been of  long standing, or the descent be considerable.
   When this is the case, astringent fomentations and injections will
 also be expedient.  These may be made of a decoction of the cortex
 querci, which must sometimes be rendered more powerful by the ad-
 dition -of alum, the quantity of which should be increased  as the
part may be  able to bear it.
   Should such  a case occur in children, as it frequently does in
 adults, in which the bowel may not  be easily returned, on account of
 supervening tumour and inflammation, the stricture will never fail to
 yield to an injection of cold water with  a few  drops of the aq,
 lithargyri acetati, with five or ten of the tinct.  opii.  An hour or two
 after such an injection has been thrown up, the prolapsed intestine,
 though perfectly black  as well as  swollen, will be found to retire of
 itself;  the  sedative quality of the injection removing the spasm and
 stricture, which afforded the only  impediment to the re-ascent ot the
 bowel.   With the like view, Mr. Bell, in his System of Dissections,
 recommends the use of " a strong cone of paper softened (by being
 moistened at the point) and  oiled.   This is to  be introduced into the
 gut with gentle but continued pressure; and when the gut is  com-
 pletely reduced within  the anus, the cone is easily withdrawn, with
 little risk of its bringing down the intestine again."
   Children affected with this complaint should usually sit on a hard,
 flat-bottomed stool, or  a chair without arms, and of such a height
 that their feet may not touch the ground. For children of eight or ten
 years old, who take much  exercise, recourse may be  had to Mr.
 Gooch's suspensory as  improved by Mr. Savigny, instead of the linen
 bandage above  recommended.
                  Discharges from the Vagina.

  These are either sanguineous, mucous,  or purulent.   As I speak
professedly only of appearances  before the age of puberty,  I  have
merely to remark on the first, that infants have sometimes such a dis^ 
PliRULENT  GONORRHOEA-
£5
oliarge from the vagina a few days after birth, and, that the like hap-
pens to girls  of eight or ten years old; but neither appears to be of
any consequence.   Should it, however, on any account, be thought
necessary to prescribe something, a little testaceous powder, or mag-
nesia, according to the state of the bowels, will be sufficient, as the
discharge always disappears in a few days.
   Children of five or six years old, are subject to a  mucous gonorr-
hoea, resembling the genuine fluor albus of adults, which  will, in
some instances, be in an excessive quantity, so as to run through all
their clothes; and is sometimes, though rarely, tinged with  blood.
If it were  suffered to continue, it  would probably injure the health,
but I believe may always be cured, by one or other of the means re-
commended  for the  next, which may be called purulent gonorr-
hoea.
                      Purulent Gonorrhoea.     •

  This is also no uncommon complaint, even  in children of two
years old, and is then, in general, easily removed by a little cooling
phvsic, and keeping the parts perfectly clean.  I have sometimes
made use of a lotion of the aq. litharg." acet. comp. which I believe
is preferable to most others, if had recourse to in the commencement
ofthe complaint; and if there be any excoriations, they should be
covered with  the  unguent, c  -ssae acetatae,  spread upon linen, or
lint.  Instances will now  anu then occur  in this  species  also, in
which the quantity of discharge  will be exceedingly  great, so as to
run down the child's limbs, several times in  the day;  and will
last  for  two or  three weeks:  but it has always disappeared in that
time, and not uncommonly,  where  it has  been the  most  copious,
ceases almost suddenly.
  When the purulent discharge makes its  appearance much later,
as it not unfrequently does, and is  much discoloured and  fetid,  it
gives rise to a suspicion which young practitioners cannot be too
guarded  against.  There are, indeed,  instances of little girls, not
more than  six years old', being injured; and it is, therefore, of con-
sequence to make a judicious discrimination; but there are, on the
other hand, instances of a very suspicious appearance, as late as the
age of thirteen or fourteen, where no injury could be  received with-
out the consent of the party, who is generally perfectly innocent, and
where, therefore, the  least suspicion  would  be very distressing to
her, and might make a whole family miserable*


  * Induced by motives of humanity, I hope I may be permitted to add a word
or two more on this subject; since the prudence and information of Petition,
eVs m*™°t only prevent a yast deal of unnecessary distress to many  worthy 
56
ON  the  venom of  insects, &c.
   Discharges with the worst appearances are frequently carried off
in eight or ten days, merely by the treatment above recommended;
but I have seen some  cases in the youngest subjects, of a bad habit
of body, where mercury, as a deobstruent, has proved useful, chough
I could not  have the least suspicion of  a venereal taint.   In  such
cases, I have found Ward's white drop a more tonvenicnt medicine
than any other preparation of mercury: it may be given in the dose of
half a drop,  and by degrees, be increased to two  and  even three
drops, once  or twice a-day, for two or three weeks.   But where
this  has failed, I have only to add,  that  I have been  a]nays able to
succeed by giving the decoctum corticis, cum lalsam, capaibae,  ovi
vitel. solutum; which  is also an admirable medicine in the fluor albus
of adults.
           On the Venom of Insects, and of certain Animals.

   Though the following accidents, like  some  others before men-
tioned, are not confined to any age, they are, at least, more formida-
ble when they fail  to the lot of little children.   On this  account it
may not be improper  to  recommend  suitable antidotes against the
bite,  or sting of certain venomous creatures to which they may he
more particularly exposed;  and first, of such insects as  the wasp,
gnat, and other flies.   Indeed, for the most venomous, such help can
rarely be had before  considerable  inflammation has taken place;
after  which it will  take  its course,  and will continue, if occasioned
by the large gnat, three  days, and by some other insects,  for  six;
though the tormenting itching may be allayed much sooner by the
means of proper applications.   If the bite should be  on the eye-lid,
the inside ofthe lip, or ear, very troublesome symptoms may follow,
and the infant will  be  vexed by it exceedingly.
   In  the absence of better  remedies, the first application may be of
the strongest spirit at hand, three parts, two of vinegar, and one of
sweet-oil; taking care it do not get into the eyes.  But as  soon as
may be, the following should be applied very frequently; which will


families, but may even save the character, or life of another party suspected of
criminality.  For, besides many instances wherein inattention or ignorance
mighfcgive rise to injurious suspicions, there are cases which call both for great
attention and experience, in order to form a just and decided opinion.  I have,
indeed, known the discharge to be so ill-coloured and fetid,  and attended not
only with great pain and inflammation, and excoriation in different parts, but
such tumours and other appearances resembling violence offered, about the
furca,  and in other instances, with an abscess in the labia ; that had the patient
herself advanced any charge, I fear, I should not have hesitated to have joined
in with it; and yet from the event, as well as the whole history of several
cases,  it has been very evident, that no kind of injury had been received; nor
any thing like intercourse taken place. 
         ON THE BITE OP MORBIDLY ENRAGED ANIMALS.       OT

check the progress ofthe venom, and allay the pain and itching im-
mediately.

       r>. Spir. camphorati, ffi
          Aceti distil.
          Tinct. opii aii 3j
       Misceantur.

  To which, if  the injury be not too near the mouth, may be added
twenty drops of the water of acetated litharge.
  The bite of the common bug which infests crowded places,  not
only occasions a tormenting itching in children of a very delicate
skin, and in certain  grown people newly come from open villages,
but will also sometimes raise  blisters as large as pigeons' eggs, and
will inflame the parts for  several days.  A very good application is
vinegar with a small quantity of olive-oil, and a few drops of lauda-
num: oil alone  would rather increase the size of the blisters.  But
the best application for  the sting of any of the above-mentioned in-
sects, where the  inflammation extends far, is ice, which immediately
takes off the heat and itching; and should be repeated for an hour,
or more  at a time,  every three or four hours, as long as  may be
necessary.
  The sting of some insects has sometimes been found to penetrate
one, or more of the absorbent vessels, and has then produced an
appearance that would have been very alarming  if such  insects
could convey a truly morbid poison.   I have seen large branches of
lymphatics, very tumid and inflamed, running from the knuckles to
the axilla,  producing an almost intolerable  itching and burning, until
the  last-mentioned remedy has been applied;  which has presently
abated these troublesome symptoms,  and  carried off the  hardness
and inflammation by the next day.  For the  highly venomous bite
of the viper, the  immediate application of olive-oil is the well
known and certain remedy; as well as the internal exhibition of the
volatile alkali.
             On the bite of Morbidly enraged Animals.

  Under the painful impressions of an awful accident that happen-
ed in my own family, at the time I was first engaged in this part of
the  work; (though, I  thank God, the alarm terminated happily;) I
cannot avoid dropping a few words on the envenomed bite of mor-
bidly enraged animals*  It is not my intention, however, to advert
* The disease among dogs, has been known, it is said, about 2050 years. 
58        ON THE BITE OF MORBIDLY ENRAGED ANIMAL?

to the peculiar nature of this most malignant poison, nor to enumerate
the many deceitful remedies that have been at different times pro-
posed with  an air of infallibility, imposing on  the  ignorant;  but
whose inefficacy  is too well ascertained.*  Nor is it my design to
propose any new remedy, but  rather to lament,  that the best pre-
ventives should be so ill attended to, particularly amongst the infe-
rior class of people, to whom this dreadful accident happens oftener
thairto the rich.   And on this account, as well as the subject being
rarely treated of, it is hoped, the intention will apologize for obtrud-
ing a friendly caution in this place.   For, after  a good deal of ex-
perience, and much inquiry and reading on this subject, I am confi-
dent, that nothing ought, in any instance, to be  depended upon, but
taking out the injured parts, by the knife or  caustic, or the assistance
of both; which, however, if duly and timely effected, cannot fail to
prevent every evil  apprehended.f   But whenever  the situation of
the wound may not admit of going deep  enough to  insure success,
or too much time may already  have elapsed, the stronger mercurial
ointment ought to be rubbed in very freely, so as to raise a salivation;
which has not  only been thought to  have proved an effectual prophy-
lactic, but to have also succeeded even where evident symptoms of
infection had taken place:| though such testimony, I am sorry to add,
is much weakened by many later experiments.
   For the sake of such readers as may not have opportunity  for read-
ing many different publications, it may not be superfluous to subjoin
the judicious directions ofthe faculty in Paris, submitted to  the com-
mittee of public instruction, which will bring the whole of  the indi-
cations into view.
   Let the wound and the  surrounding parts  be well washed with
lukewarm water, to take off the slaver as much as possible.
   Let the wounded flesh  be then instantly  cut out with a sharp in-
strument, or cauterized with  hot iron, or  with spirit of  nitre,  or
vitriol,  (commonly known by the  name  of aqua fortis, and oil of
vitriol§)  or by the argentum nitratum.

   * In regard to dipping, or rather, half-drowning in the sea, I shall just remark,
that I should have more hope of its efficacy upon the first  approaches of the
hydrophobia, than as a preventive very soon after the bite.
   f Since former editions of this work, this opinion is further confirmed by the
eases of Mr. Jesse Foot, published in Dr. Simmon's Medical Facts and Obser-
vations; in which we see the different success attending excision of the parts,
and various other highly extolled remedies, even in subjects bitten by the same
animal.  A remarkable case is also given in the 4th vol. of the Memoirs of the
Medical Society of London, by Dr. James Sims.  A very melancholy case has
also lately been published by Dr. Moseley.
   % See Histoire et Memoires de la Societe royale de Medecine, Annee 1783.2de
 pat tie.  Tissot, Dr. Layard, &c.
   % Dr- Hamilton's experience confirms the efficacy of excision in numerous in-
 stances, when done as late as the fifth and sixth day after the bite ; and in
some instances after re-inflammation ofthe bitten  parts, and commencement « 
          ON THE BITE OF  MORBIDLY ENRAGED ANIMALS.       59

  Suppuration will be accelerated,  and pain alleviated, by filling
and covering the wound with a poultice of bread and milk, applied
lukewarm, and renewed every four hours.
  Let the surrounding parts be  then rubbed  with strong mercurial
©intment.  If the danger be imminent, and the bites deep, or nume-
rous, salivation should be  excited as  soon as possible.   It is also ne-
cessary in this extremity, to cut away, burn, or cauterize the flesh
around the wound, or even although it should appear to be healed up.
It is certain, that the wound opens, when the hydrophobia makes its
appearance.
   In a work calculated for  an extensive  usefulness as the writer's
resources may supply, it can scarcely be judged improper to add to all
that I have said,  the  pertinent observations found in  Dr. Hamil-
ton's  last  edition on  this melancholy disorder, as guards, or pre-
ventives of injury.
  The following symptoms, he tells us, may be noticed in dogs about
to become rabid.
   1st. A disinclination to food.
   2d. A marked melancholy.
   3d. The eyes appearing mixed and dull.
  These symptoms, he says, mark the first stage; yet with scarcely
any thing pathognomonic.  But, it is added, that the animal now oc-
casionally forgets his master, and is irregularly peevish; and it be-
comes at this time highly proper  to  regard our safety,  and  not to
trust him if he snarls, nor to caress him.
   The second stage  is more  distinctly marked;  the  dog does not
feed with avidity, though  he does not refuse either his victuals, or
drink; the latter in no stage offending him as it does man under this
disease.   But he  shuns other dogs, and  is equally shunned by them.
A convexity may  likewise be  discovered in his  back,  formed by
drawing his hinder towards  his fore legs;  and an extreme dryness of
his nose.
   In the last stage he loses all recollection, quits his master's house,
runs forward any where,  and rushes, without barking,  at every ani-
mal coming in his way; but  turns not aside to bite any;  and within
the space'of two  days after dies  convulsed.  If he be tied  up, he
bites at his chain in this stage, and  is furious if approached.
   I have only to add, (what it is, indeed, a great satisfaction to be
able to say,) that, dreadful as this accident is where the poison has
taken effect, it is evident, that  only a very small proportion of those
who are bitten  by animals actually enraged, becomes really infect-
the symptoms.  He also prefers an excision of the parts, as more certain than
the caustic, unless the kali purum is made use of, which, forming an immediate
eschar to some depth, the eschar may be removed by a spatula, and the rvost*.
be repeated immediately, as often is may be judged necessary. 
60       DISORDERS RECORDED UNDER OBSOLETE TERMS.

ed.*   Fortunately, the clothes sometimes prove a defence, by wip-
ing off the foam from the animal's teeth; at others, it does not hap-
pen to be forced into the wound, or is not yet possessed of a poisonous
quality: or lastly, it  is not absorbed, or the system may not be  in a
state to be infected.   These assertions are supported by numberless
facts, though much less frequent, perhaps, in London  than in some
other parts, especially in  the vicinity of large forests  on the conti-
nent, where such  animals are very commonly met with, and often
wound great numbers of people.
   It is, doubtless, the uncertainty of the  bad consequences of such
injuries, that has  supported the credit of many fallacious remedies
on this melancholy occasion.  Encouraging,  therefore, as the above
circumstances certainly are, it would, indeed, be madness to confide
in them, where the proper remedy may be made use of in  time; and
though I should wish to conceal rather than spread  these acknow-
ledged facts, could I think they would have such an effect;! it is, on
the other hand,  no small  satisfaction, that such encouragement may
be justly held out to those who  may  be under any alarm for them-
selves or their friends.
    Disorders recorded under obsolete Terms by Ancient Writers.


   I should here close the account of diseases, did I not meet with
several others recorded by the ancients,  which  may, therefore, be
briefly noticed; as some readers may meet with the terms elsewhere,
which they may be at a loss to  comprehend.   They appear in the
works of Rhazes, Paulus,  ./Etius, Fabricius  ab  Aquapendente,
Celsus, Primerose, and a few less ancient writers.   Of some of the
diseases  there  mentioned, I, indeed,  know nothing but.from  the
author's own account of them, or that they are needless distinctions
of diseases  (already sufficiently noticed) which the  ancients were
very fond of making, especially in complaints of the skin;  but can
answer no practical  end:  of the others a more particular  account
will be given.  Among the diseases recorded  by these writers are,
Lentes, Hispiditas, Achores,  Favus, Psorophthalmia,  Impetigo, Ra-
nulae or Batrachos, Seriasis, Paristhmia, Parulis, Inflatio, Crinones,
Malum Pilare, Phthiriasis,  Hydroa, Macies.


  * Dr. Hamilton says, not one in sixteen.
  f Indeed, a late, and well  known, melancholy instance of rabies canina, in  a
medical gentleman,  and  the uncertainty of the  more ordinary means, might
sufficiently caution every one from neglecting any suspicious case, or trusting to
inadequate remedies. 
FAVUS, &C
61
  The first six are affections of the skin,  or of the eyelids. Achores
and Favus are a sort of Crusta lactea, so called by some, when of a
dark colour, or ulcerated and extending to the head, and Impetigo
when it attacks the chin; but by others the term Achores  is applied
only to adults.   The Scald head also, denominated Tinea when the
scabs have resembled moth-holes  in  cloth, and Favus  when like a
honey-comb, has been by some termed Achores, when the discharge
has been unusually acrimonious.   Psorophthalmia  is confined to the
eyelids, and is named by TEtius, and others after him.
  Ranula is  said to be  an inflammatory tumour of the  parts under
the tongue, and,  according to the ancients, particularly ofthe veins:
it sometimes ulcerates,  but often presents a species of soft and lax
oedema.   Celsus says the tumour is sometimes inclosed  in  a cyst,
which must be taken out; the operation for which is fully described
by Aquapendente.   Although such seemingly different accounts are
given of this complaint,  the Ranula appears to be no more than an
infraction of the sublingual glands;  and, I believe, is not very com-
mon either in infants, or adults; and indeed is  mostly an endemic
complaint.   I have seen it, however, in this country, in  both;  and
lately in an  infant  of about  a year old, in whom it rose very sud-
denly, and increased so  much on one side of the tongue, that in about
two months, its edge was turned  up to the middle of the  roof of the
mouth.   At this time the  tumour was very hard; but  soon after-
wards becoming soft, it was judged likely to break at one point.
But soon getting softer  and loose, the tumour abated, and the edge
of the tongue resumed its natural position.  The whole tongue, how-
ever, appeared now to  be elevated; and from the child being so
young, and the difficulty of examining the  parts very accurately, Mr.
Sharpe, who was attending  with me, was, as well as  I, for a few
days, in  some doubt, whether the natural, horizontal position were
owing to the absorption of a part of the fluid, or to its having spread
to the opposite side.  About this time we had proposed the external
use of mercury; but this change led us to postpone it for the present,
and in a little time the whole tumour disappeared; the infant having
been all the while in good health, and able to suck (its weaning hav-
ing been postponed) as well as to feed by the spoon.
   I have seen it in an adult bigger than the largest walnut, and  wag
then very troublesome, both in speaking and deglutition.  When of
such a  size, it is usually soft, and contains a fluid, and sometimes
calcareous concretions, owing to an obstruction of the salivary ducts.
In this case, it needs only to  be opened, and to be cleared of all the
concretions;  but if it be hard, the whole  tumour must be  extirpated.
Tulpius relates  a case  in which the matter adhered so firmly, that
the surgeon, after having laid open the cyst, was obliged  to have re-
course to the actual cautery to destroy the inspissated juice. Senasis,
from e-<g««, quia caput quasi excavatum cernitur; the bones about the

   VOL  M                       K 
62
PARULIS, &C
fontanelle, or  sometimes  the membrane only, being  depressed, or
drawn in.  Paulus (Lib. i.) describes it as an inflammation about
the cerebrum,  in which  the brain it is  said  oftentimes to mortify
within three days; but if it should not, the child, it is said, will re-
cover.*  I have never met with any thing like this disorder accom-
panied with a depression of the skull, though  I have  seen the pre-
cise depression unaccompanied with any disease, and something very
like the disease without the depression.   The latter was noticed in an
infant of five  weeks  old, who died of convulsion fits, the  brain ap-
pearing as if  in  a state of mortification, and  smelling exceedingly
fetid.  Paristhmia is an inflammation of the tonsils, or  throat, but is
certainly not common in this country; it is hinted by Hippocrates in
his book de Dentitione. Parulis is a complaint described by Paulus
as a painful tumour about the gums;  Rhazes calls it a blister in the
mouth.  Inflatio is a distention of the skin from wind or water after a
child has been reduced by long illness.  Crinones, or Grubs, is lit-
tle known as a disease, I believe, in Europe.   It is a secretion from
the sebaceous glands, and  appears on the arms, legs,  and back,  of
sucking children, and is absurdly enough thought by some to be pro-
duced by insects:f older children are often found to have  some ap-
pearances of it, but it seldom  affords  them further trouble than a lit-
tle itching, and  they amuse themselves  by forcing out  of the skin
what they call worms.   In the instance of infants so affected, rub-
bing the parts with a coarse cloth, by the fireside, is all that will usu-
ally be necessary  in northern climates.
   Though this kind of affection is generally  of  little consequence,
whether in infants or young children, I have nevertheless, sometimes
known it prove a very troublesome complaint in older subjects, espe-
cially in females about the time of puberty.   In such instances, the
whole neck, back, and breast, will be covered with little black spots,
which gradually  inflame till the parts become totally  covered with
heated pimples.   These at first itch intolerably, so as frequently  to
keep  the  patient from sleep  through  the greater part  of the night;
and in consequence of being continually rubbed, turn to  little  in-
flamed and angry  boils.  When some of these have discharged the
sebaceous matter and are healed up,  others will arise, in succession;
and at the end of  several months, the superior parts of the body are
covered with them.
   After making trial of common purges and alteratives, to no lasting
advantage, I have  cured the complaint by washing the parts morning
and evening, for a few days, with the lotio saponacea, and afterwards


  * Perhaps Hippocrates may allude to this disease,  Aph. SO. sect. 7. « Quibus
cerebrum fideratum est, intra tres dies interiunt, si vero hos superuverint, sani
fiunt."
t Astruc. Libutard. Peachy. 
MORBUM  PILARE, &C.
63
rubbing in a little unguentum hydrargyri nitrati; and when the sore-
ness has gone off, making use of a proper flesh-brush, for two or three
months.  The patient may at  the same time take fifteen or twenty
drops of the aqua kali ppt, two  or three times a-day, in a cup of sassa-
fras tea, or milk and water.
  A complaint sometimes confounded with the  former, is that call-
ed Morbum pilare, and is supposed  to  be spoken of by Hildanus as
sadly tormenting  one of his own children.  It is also  mentioned by
Parey;  but I have never met with it myself.  It is said to  be owing
to hairs not duly expelled, which stick in the  skin, especially in the
back of young infants, whom it torments  by an  incessant itching,
and sometimes raises small tumours.  The cure is said to  consist in
fomenting the parts, and then pulling out the hairs with a pair of nip-
pers.
  Phthiriasis, or Morbus  pediculosus, is  a complaint I should not
have mentioned, were it not sometimes found very troublesome,  and
the heads even of children who  are kept  the most cleanly,  much
pestered with these ugly vermin.  It is  not, therefore, intended to
treat of it as a disease in other parts,  (which are sometimes equally
occupied by them,) and will be quite sufficient to say, that the cure^is
in general, very simple, and requires only that the  hair be  sprinkled
for a few days  with the powder of staves-acre;  a remedy that is
kept a secret by some foreign  perfumers,  who sell it at a great price.
Should this, however, be  ineffectual,  a very small quantity of the
calx hydrargyri alba may be joined  with it.  Some people have
strongly recommended an ointment made  of parsley seeds boiled in
fresh butter,  which is to be well rubbed into the hair for three or four
days.   Hydroa, or Sudamina, is a trifling eruption  from the sudorific
glands.                                      .     .        ,
   Macies, or according to some, atrophia lactentium, is applied to a
decay, said to arise either  from worms, (and  is then called atrophia
verminosa,*) or  to the  unsuitableness of the  breast-milk, which,
 though it may be good in its kind, will not prove alike nourishing to
 all children.  The milk is then properly directed to be changed,
 upon which  it is remarked, the child will often recover, as 1 shall
 have occasion to  notice  more  at large, in  the third volume, on the
 management of children.  This disorder is, however a true atrophy,
 or marasmus, from whatever  cause;  and into  which an infant may
 fall in consequence of almost  any ofthe complaints treated of m the
 foregoing pages, when they may happen  to prove  of very long con-

 ^Thave now  gone  through  all  that  can  possibly be  ranked
 amongst the disorders of infants, and have taken sufficient notice, as
 I apprehend, of every complaint worth mentioning that I have met
 with either  in my reading or practice;  and may flatter myself this
'  See Harris. 
64         ENCEPHALOCELE, OR HERNIA OF THE BRAIN.

tract will be found to possess the advantage of completeness above
every work of the kind.   That nothing may  be overlooked,  it re-
mains to take  notice  of some  congenite  disorders, and  external
blemishes; and first of those on the  head.
               Eticephalocele, or Hernia of the Brain.

   Many infants  come  into the world  with various parts imper-
 fectly formed, especially about the head;  and never more commonly
 than in the upper  part of the skull.  If the deficiency be very great,
 and accompanied  with a like want of brain,  which it usually is,
 such fetuses fall under the class of Monsters; and being  never born
 alive, are not subjects of this work.
   The  hernia ofthe brain, on the other hand, is met with in infants
 otherwise completely formed, and is generally curable.   The public
 is indebted to Mons. Ferrand for an accurate description of this com-
 plaint, given in the fifth volume  of the  Memoires  de l'Academie
 Royale de Chirurgie.
   The Encephalocele is a soft circumcribed tumour, usually of a
 round form,  and correspondent in size with the  extent of the defi-
 ciency of cranium; to which the complaint is owing.  It is without
 fluctuation, or discoloration of the skin, but is attended with a per-
 ceptible pulsation  of  the brain, which synchronizes with the pulse.
 The tumour  retires and disappears upon  pressure, and is always
 situate  either on  one of the fontanelles, or in the course of one of
 the sutures, and is never larger than  a pullet's egg.  Where the de-
 fect in ossification is very considerable,  a much larger portion oi
 brain is consequently protruded; which, strictly speaking, it were less
 proper  to call a  disease, than  a fatal mal-formation, as it is perti-
 nently remarked by Mons. Ferrand; and no more  resembles the true
 encephalocele, than an eventration resembles  the common intestinal
 hernia.   It will be very necessary, however,  carefully to distinguish
 this incurable evil  from other soft tumours  of the scalp, presently to
 be noted, which it very much resembles;  the  latter having frequent-
 ly the like precise feel of a bony margin around them,  as  is com-
 mon, indeed, in cases of extravasation  upon any solid surface.  The
 tumour is also colourless, and often as large as  in the fatal mal-for-
 mation, but has a considerable fluctuation; and is further distinguish-
 able by the  tumour not  retiring  upon pressure, nor being attended
 with any pulsation.
  The encephalocele is,  indeed, easily distinguished from them all,
 by the brief description above given of  it; and fatal as  it  would be
were it left to itself, requires only to be properly understood, in order to
adapt a rational and effectual remedy, which consists only in a care-
ful and due compression of the part.   This may be effected by the 
TUMOURS OF THE SCALP.
65
application of a piece of sheet-lead, somewhat larger than  the tu-
mour, and pierced with holes, that it may be  sewed to the child's
cap.  The compression should at first be very moderate,  and never
so great as to  give the infant pain, nor disturb any of the natural
functions; though it should be gradually increased as the tumourshall
retire.   This is all that is required from art, the cure being the busi-
ness of  nature, which  if the child continue healthy, will proceed in
the work of ossification, and in due  time fill up the vacancy in the
skull.   The protrusion of the brain was before an obstacle  to this
process; whilst  the injury that tender organ  must sustain  by the
pressure from the sides of the bone, exposed it to all the evils which
compression never fails to produce, and which it were needless to
enumerate in this place.
                      Tumours of the Scalp.

  There are other tumours on the head of new-born infants, which
it were improper entirely to pass  over.   The one I shall first men-
tion  is of the least importance of  any, being occasioned merely by
long compression in the birth.   It  is of  different sizes,  and the skin
is always discoloured; but in any case can seldom  require much  at-
tention,  as it frequently disappears in  a few hours.   If large, it is
common to bathe, or foment such tumours with wine, or with brandy,
or vinegar diluted with  water;  and in  general  they gradually sub-
side, though sometimes not perfectly for several days.  Some of them,
however, are of more consequence, and concerning the treatment of
which practitioners have differed;  the absolute impropriety of open-
ing any tumours arising from compression having been conceived of
by many.  On the other hand, I believe,  it may in some  cases be
really necessary, in order to prevent a troublesome fungous  sore,
and  even a caries of the skull.   The  discrimination,  however, is
sufficiently obvious, such assistance being required  only where  the
above remedies and compression have had no effect, and the tumour
is found sensibly to increase day after day, which in some instances
has been the case to the end of the month.   Such growth  is always
owing to the extremities of the arteries ruptured by long compres-
sion, being still open, and pouring  out an ichorous fluid into the cel-
lular membrane, and  thereby keeping up and increasing the original
tumour.
  Upon opening the integuments, a bloody fluid is let out, and the  tu-
mour nearly subsides, which  afterwards requires nothing but mode-
rately astringent applications and pressure, which should be continu-
ed for a little time after the aperture is closed.
  Another kind  of tumour of a more unfavourable appearance, was
hinted at under the article of Encephalocele, and of which it may 
66
TUMOURS OF THE  SCAI.t\
be proper in this place to take a little further notice.  These tumours
contain a kind of serum, and are often very large, but without that
discoloration of the scalp and bruised appearance, which there con-
stantly is in those  last described, nor do they, indeed, seem  to arise
from compression; I have at least seen them extending over a third
part of the head, and raised an  inch or  more from the skull, after
the shortest and  least painful labours.  To  the  description before
given of them it may be added, that this kind of tumour, I  believe,
will always subside very kindly, though sometimes not completely,
until the end ofthe month.   In some instances,  it begins to lessen
in six or eight days after birth,  but in others, not till near the end
of the third week, and  then subsides very rapidly;  and as it falls,
more and more of  the skull  may be felt, from day to day, in  propor-
tion as  the  absorption of the fluid  takes place.   To  assist  nature,
therefore, in this operation,  embrocations  of  acetum distil, sal. am-
mon. crud. and spirit camphoratus,  should be made use of, with a
gentle compression of the part;  as well as keeping the bowels pro-
perly open.
  A tumour of a different nature from each of these is described  by
Michaelis,  of Harburg; but as I have  never seen it,  and,  indeed,
imagine it is not known in this  country, I shall merely state it as re-
lated by Lorder.*
  This tumour is to be distinguished from swellings on the head, with
which children are sometimes born, or that appear after a slow and
difficult birth, occasioned by long pressure or the rupture of  some
blood-vessels; and  it differs  by  the following  marks, from  any other
swelling of the head, hernia  cerebri, or hydrocephalus interims.
  1st.  By  being often observed after very easy labours.
  2d.  By  not always  appearing on prominent  parts of the head;
though this may sometimes be the case, on account of their generally
being remarked at the temples.
  3d.  By commonly appearing one day  after birth.
  4th. By being more elevated and circumscribed than any other
swelling on the head, and by shewing a  perceptible fluctuation.
  5th.  By the skin, with winch it is covered, keeping its natural co-
lour and state, and by its being easily moveable on the tumour, with-
out changing the situation of it, a circumstance that seems to prove
its being deep; the skin, therefore, appears to move on the tumour
when the child is crying.
  6th.  By not disappearing, or diminishing on the application of
pressure, and where, also, no stupor is  occasioned; a symptom that
always takes place in a hernia cerebri, or hydrocephalus internus.
  7th.  It differs from a tumour  caused by the rupture of blood-ves-
sels, or from a lymphatic swelling, by the singular change which the
bone, on which it is situated, is  observed to undergo.  The external
* Lod. Journal of Surgery, vol. 2. 
TUMOURS OF THE SCALP.
67
table of the bone is entirely wanting; the diploe uncovered, and the
edge of the impression that is thus occasioned may be plainly felt.
By this peculiar circumstance, the tumour is particularly distinguish-
able from any other
   On opening it, a black and coagulated blood is found in it, lying
immediately on the diploe.  It  is very probable,  that the  tumour
originates  from  a disease ofthe  bone;  and that it  is not occasioned  -
by the former, on account of their both being found in the same state
from the first moment.
   To remove this tumour by discutients, is an attempt that  has, in
most cases, proved ineffectual.   The disease ofthe bone is increased
by the pressure  of the blood exciting the absorbent vessels to a great-
er action  in the  bone, whereby, at last,  a hole is occasioned, and  the
brain injured by its being pressed.  The only thing that can be done
is to open the tumour;  and to let out the blood, in order to prevent
the further absorption of the bone.  This  operation is not without
danger, on account of the loss of blood that runs  from the bone as
from a sponge;  but by making the incisions small, it may in a great
measure be avoided.   It is,  however, very seldom that it succeeds
in healing the bone, and the children generally fall a sacrifice to this
singular affection.  It is, fortunately, rarely observed; but according
to Dr.  Michaelis, it seemed to  occur  more frequently at Harburg
 than any where else.  He relates a case of this disease, which may
be briefly stated, as follows:—a tumour of the size of an egg appear-
 ed on the right  temple of a new born infant, the following day after
 a  labour  which  had been uncommonly easy.  As it shewed the
 above-mentioned  characters, there could be no doubt of its being this
 species of tumour.  He first tried to dissolve it, and a cold solution
 of sal ammoniac and saltpetre in vinegar, and cataplasms of the herb
 Arnica, were accordingly applied: but having continued them nearly
 a fortnight without the least effect,  the tumour was opened, and a
 black thick blood discharged from the wound.  The bleeding, which
 was not very considerable, ceased on the application of alcohol,  in
 which scraped  linen was dipt.   The wound began to suppurate the
 next day,  and in twelve days it was healed up;  the child felt no pain
 whatever, and was quite well:  an impression, however, remained
 from the want  of the external table of the bone.   A few weeks after
 the child was seized with a general erysipelas, of which it died. Dr.
 Michaelis being curious to inform himself of the state of the bone
 where the tumour had  been situated,  cut  through the integuments,
 when he found the bone  appearing with a rough surface, deprived of
 its external table as far as the tumour had extended, and only seem-
 ing to be regenerated in some places. 
68      PRETERNATURAL CONFORMATIONS OF THE HEART.
            Lymphatic Tumours on the Head and Spine.

   There is another kind of tumour appearing sometimes on the head,
and at others, on some part ofthe spine, which is not owing to acci-
dents in the birth, but is of a morbid nature.  These tumours con-
tain a lymph, and are attended with evident fluctuation,  as may be
discerned by the touch; and unless they are exceedingly small, ought
in no case, I believe, to be punctured, or even removed by ligature,
though adhering only by a small pedicle.   Those on the spine of the
neck, or back, or on the loins, if they do not arise from the dura ma-
ter inclosing the medulla spinalis, seem to originate at least from the
 eriosteum ofthe spine; and the issue having a morbid source,  will
 e kept up after the tumours are opened, or even totally  extirpated,
and preventing the sore from  healing, the infant sinks under the dis-
charge,  or dies  in convulsions.
   But there are other tumours of a similar appearance, which being,
nevertheless, of a different kind, may be sometimes  safely  extirpated,
and will be noticed below, after the spina byfida, to which  likewise
they bear a considerable resemblance.
 Imperfect Closure of the Foramen Ovale, and Canalis Arteriosus; with
          other Prceternalural Conformations of the Heart.

   The subjects of these affections have been termed pueres ca>ru-
 leati; but the  affection itself might more properly lead to a name,
 and be termed cutis  caeruleata; though neither would describe at all
 the nature ofthe disorder.
   Dr. Sandefort, Mr. Abernethy,  and more  lately Dr.  Nevin,  of
 Glasgow, have given instances of it, which accord with those before
 offered to the public, by other writers.
   These morbid deviations appearing in different parts,* have in all
 the same  tendency, viz. in a greater  or less degree, to obstruct the
 passage of the blood  through the lungs, which in some instances has
 continued nearly the same as in the unborn fetus.   The peculiarity
 is  sometimes in the pulmonary artery, which is constricted, or closed,
 as it rises from the right ventricle;  at  others,  in the septum cordis,
 which has an unnatural opening, affording a free communication be-
 tween the two ventricles; sometimes in the aorta arising equally from
 the anterior  and posterior ventricles; and sometimes in the imperfect
 closure ofthe foramen ovale, or the  canalis arteriosus.
   These  sources of  disease are mentioned merely with a view of
pointing out  the symptoms by which they may be known,  and not of

  * See, Mortgagni, Episi 17. Art. 12.  Lond. Med. Journal, page  4, and Med.
 Observ. and Inq. vol. vi. 
IMPERFECT CLOSURE OF THE FORAMEN OVALE, &C.
69
suggesting a remedy;  which is out of our power.  The recital, how-
ever, may serve to prevent fruitless attempts, and perhaps the aggra-
vation ofthe symptoms, and consequent distress of the patient, where,
upon due knowledge of the disease, art has, evidently, nothing to
offer. The imperfections are owing entirely to an original mal-forma-
tion of  parts, or to a deficiency in the powers of the  system  soon
after birth;  the only time in which that diversion to the  circulation
can take place, which nature has intended upon the change made in
consequence of respiration.
   The precise time when this new mode of circulation should take
place, is not  attempted to be settled, the passage between the auricles,  ■
and that between the two great arteries, being open in children of
very different ages; nor do both always close at the same time.   It is
conjectured, however, that this process ought to tyegin from the birth,
as it is found to do in the remajns ofthe vessels of the  funis umbili-
calis;*  so that, although the  fetal  apertures in the heart  should not be
actually impervious at  the end of some months, it  is imagined that
some constriction has usually taken place, and that, at least,  some
check is given to the blood's passing from one side ofthe heart to the
 other, in the free manner  it does in the fetus.  This, it is natural
 enough to conceive,  and I apprehend, is owing to a  greater quantity
 of blood rushing into the lungs, in consequence of respiration, (which
 lessens the difficulty of entering that organ;) by which means, a great-
 er  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 distended by a  large quantity of
 blood from the left ventricle, does not allow the pulmonary artery to
 empty itself into it by  the canalis arteriosus.
    Sometimes one  of these  apertures is found open,  and  the other
 closed up, especially the canalis arteriosus, which is  of the greater
 consequence; the foramen ovale having in several instances been found
 pervious in adults;  and it is imagined is always so in those divers
 who can remain the better part of an hour under water.
    Whether the preternatural aperture be in the vessels, auricles, or
  ventricles; or wheresoever any morbid stricture may be, whenever it
  may  prove of any consequence,  the constant symptoms attending it
  are, a discoloration ofthe face and neck, with a sloe blue, or leaden
  colour ofthe lips, such  as  is met with in  some  fits of asthma; and
  sometimes  an unnatural coldness of the body.   The discoloration
  almost always takes place very soon afterbirth, and is increased, and
  attended with difficulty of breathing, as often as the child  is anywise-
  agitated; and whereby he is disposed to throw himself in a horizon-
  tal posture.  These symptoms are not at all relieved by procuring

    • It is nrobable, however, that they are not very firmly  closed Tor some time,
   as I liaveSylSced the vessels open, by an taction, >n children who !U*«
   died at the end of the month.
     VOL. II.                      L 
70
SPINA BIFIDA, OR
stools, by the warm bath, or any other mean made use of as a reme-
dy for fits; nor can be, but by the child being kept as tranquil as
possible.
  If the aperture be in the canalis arteriosus, children usually sink
very soon under the complaint, (although this is not always the case,)
of which I have seen one instance a short time ago;  and for want, it
is imagined, of a due portion  of oxygen gas, owing to the full pro-
portion  of blood  not passing through the lungs.   But if the aperture
be in the inferior parts of the  heart, infants more commonly survive
for months, or even for years;  although  some physiologists have con-
ceived there may be the like disproportion of oxygenated blood.   A
recent instance of such prolonged life, with an accurate  account  of
the disease, is recorded in the third volume ofthe Medical Transac-
tions of the College.  In such  instances, the system  having been ac-
customed to the effects  of this derangement, is better able to with-
stand them; the patient, however, can endure but little motion, the
heart becoming thereby surcharged with blood, and respiration ren-
dered more difficult; hence also the blood is detained in the extremi-
ties, and the face, neck, and hands become particularly discoloured.
Some time,  indeed, before the patient  sinks under the disease, the
symptoms are aggravated, and  almost the least motion endangers suf-
focation.
                Spina Byfida, or Hydro-rachitis.

   This morbid affection is more commonly known here by the for-
mer of these terms, though the latter is thought by many to be the
more proper name; the first being taken only from an effect, the other
being descriptive of what is jeemed the original disease.   It  is also
known by other names,  as writers have been severally impressed by
the cause, effects, or the appearance of the  disease.   Ruysch, there-
fore, calls it a dropsy, and Bertrandi* a hernia of the medulla spina-
lis; the medullary  structure being in some instances destroyed, and a
spongy substance filling up the cavity of the membrane, and protrud-
ing through the byfid spine.
   It is remarkable, that this complaint, or mal-formation, though now
every where to be  met with, was not described, as 1  believe, before
Tulpius wrote,t whose observations and cases were first published in
the year  1641, and afterwards, with some additions, as late as 1716,
which is the edition I have seen, and contains an accurate account
of the spina byfida.
   Since  the above period, the disorder has been regularly noticed
by various writers; but not being a very common  one, and very lit-

  • Opere di Ambrogio Bertrandi.  Tomo ii. Torino 1786.
  f Tulpii Observations Medicins. 
ITYDR0-RACHITI3.
71
tie having ever been attempted or proposed for its relief, I judged it
sufficient in the earlier editions of this work, barely to  notice and
describe the complaint, in order to guard against its being mistaken,
and an infant's life shortened by rashly opening the tumour.   But as
various solitary cases and observations are diffused through different
medical works,  and none of  the late writers  having methodically
collected and  arranged them, nor any since Morgagni paid much at-
tention to  the subject, I have  now been induced to take  it up more
at large.   Having also, myself, seen the disease about  eight or ten
times, (under which one child languished seven weeks,  and  another
several months,) as well as conversed with many practitioners who
have as often  met with it; I have thought that, in a work devoted to
the diseases of children, it  might be agreeable, if not instructive, to
the  reader, to see  all that  is  of importance on the subject  brought
into one view.
   With this  intention, I shall briefly advert to the writers  we  are
 obliged to for any account of this congenite derangement; and after
 considering its nature, cause,  and the periods at which it proves lata!,
 shall  state whatever has been proposed, or attempted  in a way ol
 palliation, or cure.                      ,  ,   ,.  ,       ,  ,
   It is remarkable, that in a disease for which so little can  be done,
 both the earliest and latest writers  have agreed so well in their opi-
 nion, and  description of it; though some, indeed, do little more than
 mention it, notwithstanding they all appear to have seen the disease.
 It hath been  observed, that it does not seem to have been noticed by
 any of the ancient writers; and Tulpius himself appears to speak of
 it as of one he had not long  been anywise acquainted with; we ac-
 cordingly find him saying  but little on  its precise nature, or cause.
 Soon after him, wrote CStalpart Vander Wiel, and Muys* the one
 hX year 1682, the other in 1695, and about the same time Bone-
  us t but these throw very little light on the subject    Ruysch treats
  more largely upon it, and, it has been noticed,  calls it a dropsy of the
  sp „amarrLrasthe hydrocephalus is of the headI, o.-bra.n  and
  with some propriety,  as will presently appear.  Bidloo,t physician
   oKingTO iam the'third, and" Salzmannus,§ his cotemporary have
    *•   a 1* Aie****   Knttvll eives a good anatomical account of it.
  noticed the disease.   Kutty|| |pwes a go           ^       ful,  in
  Titsinsh  wrote upon it in 17.3.3."!   z.ecnar. ridiuct            j
  1745" andlAcidlft ia H48.  Van Swieten and Morgagni  wrote, it


    • Praxis Medico-Chiurgica  rationalis.
    f Sepulch.          .


    fl De Spina Byfida. 
n
SPINA BYFIDA, OR
is well known, nearly at the same time; the former of whom copie*
Tulpius and Ruysch, but the latter quotes various other writers, and
takes as much pains to investigate this disease as almost  any other
that he has recorded.  Our countryman, Mr. Warner,* was well ac-
quainted with it, and relates an instance of a man, living to twenty
years of age, though the disorder had induced a palsy of the lower
extremities; but not so  bad as to disable him from walking.  Dr.
Monro, in his treatise  on  the  dropsy, in  1756, merely names the
disease; but Mr. White describes it well, in his surgical cases, writ-
ten in the same year. JBlanchard also mentions it; likewise Monsieur
Le Catf in 1765, Gooch in  his  Surgery in  1771, Ambrose Ber-
trandi:!: in 1786, and Louth§ as late as 1788; and a little before this,
a remarkable case was noticed by the Royal Society of Medicine at
Paris; the subject of which is said to have endured the complaint for
twenty years, and at length was perfectly recovered from  it; and on
which I shall presently have occasion to offer some  remarks.
   By the accounts given by these writers, it appears that this disease
fixes either upon the superior parts of the  spine, and is then seated
upon the last vertebra of the neck, and the  first of the back; or else
is lower down on the last of the loins, or more commonly, on the  os
sacrum,  and is usually  upon the  centre,  and posterior  part  of
these false vertebrae: but Wepfer|| saw one on the right  side of the
loins.
   The skin is sometimes entire, and sometimes ruptured externally,
at the birth; and in the latter case, I believe, the infant is always
still-born, at least it has been so in all the instances that I have met
with; though such  fetuses are often full-grown.  In this case, the
edges are prominent, and the centre is, of course, depressed, the ulcer
very much  resembling  the form of the  human  mouth  when the
angles of the lips are drawn together, and the middle part is pushed
forward.
   When the skin is entire, the disease appears in  the form of a tu-
mour, varying in size from that of a pea, or even smaller, to that of
a half-crown piece; being also more or less elevated.   The highest
point is usually very thin, and sometimes transparent, from  having
no true skin; other parts of the tumour are red or livid, having much
the appearance of some cancerous tumours upon the point of ulcera-
tion.  The surface is generally very soft to the touch, especially in
the  centre, from a fluid retires upon pressure, and round the margin
of the swelling the bony edges ofthe spine  maybe distinctly felt; a
circumstance that ought always  to be  attended to, as leading to a


  * Surgical Cases, ir50.
  f Dissertation sur la Sensibilite de la dure mere, &c.
  * Opere di Ambrogio Bertrandi tomo ii. Torino.
  § Nosologia Chirurgica.
  || Wepferi Observationes. 
HYDRO-RACHITIS.
73
certain  diagnostic.  In other cases no  fluctuation is perceptible,
but a-carneous substance, hard  and thick; and such infants cannot
endure  being laid on the back,  but presently  become convulsed.
Muysch mentions  an  instance of the disease being situated between
the scapulae, in which the skin was not at all discoloured; the deficien-
cy of bone was therefore, probably, very small, as likewise seems to
have  been  the case  from  the event, as will be mentioned in its
place.
   The internal appearances are  various: suffice it to say, that as the
disease, takes place during the process of ossification, the internal de-
rangement seems to depend very much upon the period at which the
complaint may commence.   In general,  there  is a confusion of
nerves, blood-vessels, membranes, and ligaments, together either
with  a hard flesh-like substance, or a certain portion  Of discoloured
lymph.    This is,  probably, small at first; but the necessary support
of bone being wanting, the lymphatics of the membrane investing the
spinal marrow, it  has been supposed, continually deposit  their con-
tents; enlarging the tumour,  and increasing the disease.   I saw one
instance in a  fetus of about five  months growth, where the bone (the
os sacrum, as yet, indeed, in a cartilaginous state) was complete on
the outside, but deficient within; the spinal marrow was also wanting,
and there was a considerable quantity of water.
   Many children  born with this complaint do not seem to have suf-
fered by  it while in utero, being healthy, often  large,  and very
strong; but some are  otherwise mutilated; it being not uncommon to
find one or both the ankles distorted, or to have the lower extremities
weak, and sometimes totally  paralytic: and there is  in others a great
deficiency of bone on  the upper part of the cranium.   The  higher up
the seat ofthe spina byfida may be, the greater is usually  the injury,
and the sooner the infant perishes, unless the aperture of the bone be
very  small, as, it has  been observed, is sometimes the case.
   From what has been said, as  well as from a similar disease being
occasioned by internal injuries  of the spine, as mentioned by Le
Cat,* it will appear, that the disease, as hinted above, may be owing
to some interruption  to the process of ossification, and a consequent
distension of the  membrane investing the spinal marrow from the
pressure  of the  fluid, which  in return becomes a further impediment
to that process.  It is not improbable, however, that this undue secre-
tion of lymph may be oftener the original source of the disease; the
water, as an unnatural compression, either preventing the  formation,
or afterwards destroying a portion, of the  bony arch  intended by
nature as a protection to the tender marrow; a part  essential to the
animal functions.   Hence, Lauth has very properly defined the dis-
ease to be, Aqua in Specu Vertebrarum collecta in Infante, Vertebras

   * Traite de Mouvement musculaire j de  la Sensibilite, de l'lrritabilite1, 8cc.
 1765. 
71
SPINA BYFIDA,  OR
 ultimas Columnar Pondere suo findens, et Tumorem prope  Os Sa-
 crum constituens: though it does not, m it has been  said, appear al-
 ways in this part.
   It is sometimes a mere local disease, confined within  the circum-
 ference of the tumour, and at others, the water rises a little higher in
 the vertebral column; and hence Ruysch has considered this disease
 as a proper dropsy of the part, as the hydrocephalus is  of the head.
 In some instances again, the column is open from the occiput to the
 os sacrum, and the water is even found to  descend from the fourth
 ventricle ofthe brain; the two diseases being then conjoined.   These
 disorders  have also sometimes  been found to  succeed each  other;
 several such  instances being  related  by  Wepfer and  Morgagni.
 The latter of these writers relates one of a child of four years of
 age, where a dropsy of the spine  succeeded to an hydrocephalus,
 which had taken place in consequenee  of a contusion  of the head.
 The former being opened, the  tumour  of the head in  a little time
 greatly subsided, and upon pressing that part with a hand,  a palish
 ichor rushed out from the aperture in the os coccygis; a circumstance
 recorded also in other instances: the above infant, he reports, reco-
 vered.   In another, upon the consolidating of the spina  byfida after
 an aperture had been made, water, in a few days, began to form in
 the head,  which afterwards enlarged to a very considerable size.  On
 the other  hand, it has been noticed,  that  there is sometimes no
 water, but the bony column is filled up with a carneous substance,
 or spongy marrow, and the complaint is then termed a hernia of the
 spinal  marrow; agreeably  to a similar congenite disease ofthe head,
 which has been aptly called a hernia of the brain.  In this case,
 some mal-formation of the spinal marrow may be considered as the
 original disease, unless it  be supposed, that the proper cause exists
 in some interruption given to the  process  of  ossification; whereby
 the medulla being deranged for want of its natural support, is in con-
 sequence distempered.
  The disease, it has been said, becomes fatal in consequence of the
 tumour being  opened, or the integuments  otherwise giving way,
 which  is usually from a little slough, or  gangrene, forming upon the
 thinner parts, which soon spreads wider and deeper, and so opens a
 way for the escape of the lymph.   In  a few days  afterwards, and
 Usually on the third, the infant dies, unless the  parts should soon
 close again; which has but very rarely happened.   A remote cause
 of the child's death  then seems to be the escape  of the lymph, which
 is frequently soon followed by a strong convulsion, in which the lit-
tle sufferer expires.   But where the integuments have remained en-
tire for any length of time, their rupture  has been followed by hectic
fever and  marasmus,  in consequence of a profuse drain from  the
part.   But it is more common for the little patient to die either in a
few days,  or a week or two after  birth, and then,  probably, from
some morbid change taking place in the medulla spinalis, from the 
HYDRO-RACHITIS.
admission of air; which is supposed to be always injurious to internal
parts, and more particularly to membranous ones, and, therefore, must
be peculiarly offensive to the spinal marrow and  its sensible cover-
ing.  These  parts have, indeed, suffered from the birth, from the na-
ture of the disorder, and it is not, therefore, to be wondered at, that
such infants are more or less convulsed, and appear several times to
be dying, before that event actually takes place, and that  they are
often otherwise ill; though some children appear pretty well till the
integuments give wray.   I  remember one child who would not take
the breast for twenty-seven days, and  was several  times thought to
be dying; but afterwards taking to it properly, was greatly recruited;
appearing, except for this disease, in a  promising way, and lived four
weeks afterwards.   The late Mr.  Hunter told me, that he  had seen
a child living with the disease at the age of eighteen months; and one
born at the British Lying-in hospital about six years since, was alive
a short time  ago.
   The means of cure  that  have  hitherto been  proposed for this
dreadful disease, are, opening  the tumour,  in order to evacuate the
water; or pressure with a view to retain it, and consolidate the parts;
neither of which, that  I can with  any certainty  learn, have ever
succeeded, unless it  be in  the instance mentioned by Morgagni, (in
which the disease was not congenite;) and the one I have alluded
 to, reported by the French Royal Society of Medicine.   In this, the
 tumour was opened when the sufferer  was twelve years of  age; soon
 after which  the tumour is said to have grown up again; but being-
 ruptured eight years afterwards, by the patient accidentally lying
 upon  it, after it had increased to the size of a  child's head, the hu-
 mour was  absorbed, and  a firm cicatrix being formed, the patient
 survived.
    From this case, and that occuring some years ago at the  hospital;
 as well  as the one reported to me by  Mr.  Hunter, and one 1  am at
 this time attending in an infant, now about  eighteen months old in a
 family of high rank, where the best advice has been sought, I have
 entertained some doubts whether tumours  precisely of the  like ap-
 pearance, are as precisely of the like kind, or whether there be m
 them all a deficiency of bone; it having been the opinion of several
 of the first physicians and surgeons in repeated consultations,  that
 the case in  this infant is  not  precisely the spina byfida.   If ai mis-
 take, in this  respect may have been made by the reporter in the Royal
 Society of Medicine in Paris,  no  inference can be  drawn  of any
 probable  success attending the evacuation  of the fluid, or  a  firm
 pressure made on the tumour.   The means, however, do  not  always
 seem to have been employed with proper discrimination;  since the
 verv  possibility of their succeeding will  depend upon the  size, and
  other circumstances of the tumour;  for the aperture can never be
  adviseable where the tumour is large, and the consequent internal de ■ 
76
SPINI BYFIDA, OR
rangement of parts is considerable; nor pressure, where the water is
found communicating with the ventricles of the brain.
  The size of the tumour, it has been noted, is various,  and agree-
ably thereto must be the possible chance of recovery, as  well as the
probable duration  of the disease, where it proves ultimately fatal.
This,  indeed, is more frequently within three days after  birth, or if
the infant survives much beyond that  time, it will be owing to the
resistance of the integuments; young children it has been said, sel-
dom surviving the third day after the water begins to be freely evacu-
ated.  This, together with the matter  of fact, where the  tumour has
been opened,  furnish a  sufficient caution  against artificially letting
out the water.  Muys* records a case of this kind, in which a child
had lived to be three years of age, but the tumour being then  opened,
a great discharge of water  was kept up,  which  induced a hectic
fever, and the child sunk  at the end of three weeks.  At the same
time, a case related by  Wepfer equally forbids the  indiscriminate
use  of pressure.   In this, an  aperture, made  by a surgeon,  from
whence three  ounces of water had issued,  being  healed up in con-
sequence of firm  pressure, an immense hydrocephalus formed by the
end of the fourth week after birth.    And Van  Swieten,  who copies
the  case, justly observes, that if nature cannot  get relief, in such
cases, by letting out the water at so distant  a part from the head, no
benefit can be derived from any means that may necessarily occasion
an  accumulation  in the brain itself.
   In such instances as the above, it  is  probable, that the source of
the disease  has been in the head, the water having  made  its way
from the fourth ventricle  ofthe brain; nature ever attempting to re-
lieve Ihe oppressed, and  especially  more noble parts.  But in  other
cases  it should seem, that the disease has  commenced in the loins,
and the secretion being great, and the resistance below considerable,
(possibly from the  ossification being far  advanced) the water has
ascended to the head.f But by dissection after  death, it appears, that
the water has more commonly been confined to  the spine alone, and
then has not been in great quantity.
   It must be in the latter case  only,  as well as where  the  tumour
and deficiency of bone are inconsiderable,  that any benefit  can  be
expected from puncture  and bandage, as Mr. Abernethy has lately
ventured to propose.  But from several objections  which have been
noticed above,. arising  from circumstances which  Mr. Abernethy
does not seem to be aware of, nor can  be  always previously ascer-
tained, I should not think that parents would  readily consent  to the
experiment, or that surgeons can have  much to offer as an induce-
ment to it;  especially as the want of success must necessarily hasten

               *  Praxis Medico chirurgica rationalis, 1695.
               f  See Opere di Ambrogio Bertrandi, torn. ii. 
HYDRO-RACHITIS.
77
the death of the infant.  These considerations, I imagine, have made
burgeons in this country  cautious  of  making  any attempts,  and
have  induced me to state, as I have done, the result as  given by
foreigners.
   Since this statement in former editions,  Mr. Abernethy has ven-
tured to make the experiment, and though he is led to think, that the
attempt is, at least, proved to be harmless,  I can, by no means, alter
my opinion, and have, therefore,  suffered my former observations to
remain.   Mr. Abernethy acquaints us,  that  u the tumour  was
punctured  every fourth day, for six weeks, during which time the
chiid  continued unaffected.  No contraction,  however, of the in-
teguments took  place; and at this time  one of the punctures did not
 h;-al,but permitted the fluid to ooze  out.  The  discharge  gradually
 changed from a limpid to a puriform appearance, and in a few days
 the  child  died.  This case (he  adds) is interesting,  though unsuc-
 cessful, as it shews, that the attempt at a cure may, at least, be made
 without hazard."  I should, however,  rather conclude, that the last
 aperture not healing  up, and the child dying a few days after, serves
 to confirm the prognostic I  had  ventured  to make, not only ofthe
 probable  inutility ofthe  puncture,  but ofthe hazard.  The collec-
 tion of the water, if  it  be in any instances the first occasion of the
 disease, is not  the whole ofthe evil;  there being distemper .in the
 membrane, and generally of the bone, which the admission of air to
 cannot be harmless;* while the puncture cannot prevent a re-accumu-
 lation of the fluid.
    From the general report of authors, therefore, as well as the result
 of my own experience, it should seem,  that little relief can, in gene-
 al  be expected anywise from art.   Some discrimination of  cases,
 however, should be made, and  perhaps thia will refer principally  to
  absence of  any symptoms indicative of water m the head, and to the
  size of the tumour, on whatever part of the spine it maybe; but the
  lower down  on the os sacrum,  the more favourable.   As to the first
  of these, the usual symptoms of compression of the brain do not, in-
  deed, present  themselves, and  it  is probable, owing to the  relief
  which that part receives from the  descent ofthe water to the parts
  below  The presence of water in the head may, nevertheless, some-
  times be  discovered, it being reported by Morgagni  that upon press-
  ing the tumour, the'rising up3 of water has been felt by a hand placed
  on the fontanelle; and that from a  firm pressure there, the water has
  aeain forcibly  descended into the tumour on the spine
   S In the absence, however, of every symptom leading  to the sus-
  picion of water in the head, and when the tumour on the spine, espe-

              •    ,,„„,MI(1P I,-,, Utelv been controverted,  and some decisive


   1798.
    VOL.  II                      M 
78
SPINA BYFIDA, &C
cially if low down on the sacrum,  is very  small, (for it has been
met ivith ofthe size of a vetch seed;*) a firm compress, and sprink-
ling the part with astringent powders, or the use of similar fomenta-
tions, may be had recourse to, as recommended by Acrell,|  and also
by Ruysch,  who says he has seen ten cases.   Acrell was led to this
opinion from some children having lived for several years with this
complaint: but the tumour in such instances, I apprehend,  has been
very small,  and  the  children have  died whenever it  has  acquired
the size it has  more commonly at the birth.   In such  cases only, I
imagine, can the attempt with any propriety be  made;  as otherwise,
the tumour will, probably, be  only ruptured the sooner by the ban-
dage, and in consequence, the life of  the infant be shortened.
  There is not, however,  the like objection to the use  of an astrin-
gent, or  cold embrocation,  or more  especially to drying powders,
such as bolus armen.  pulv. catechu, aluminis, and such like;  which
may be sprinkled on the part as occasion may require, to prevent the
oozing of the lymph,  by forming a kind of  crust over the pellucid
surface.   Such applications may  also have a tendency to retard the
rupture of the integuments, and thereby prolong the life of the child;
which  is generally all that art can  effect;  and  I have myself, in-
deed, no further experience of their efficacy in the true  spina byfida;
although I have known such means, as well as excision of the parts,
effect a cure in  cases very similar in form and appearance to this fa-
tal complaint,:]:  but without any deficiency of bone.
  In  regard to bandage, I have been informed, that Dr. Hunter in
his  lectures at one time,  used to caution against the attempt,  from
his  own experience of its hastening, as he thought, the rupture ofthe
integuments; but whether the trial had been made in the fittest cast
as here described, I could get no information.
  Should the size or figure of the head, however, be from such man-
agement affected, or the  infant manifest any increase  of pain; or it
convulsions, coma, or other bad  symptom should  supervene, the
bandage ought to be taken off, and the mildest  application be sub-
stituted,  in place  of the astringents. In this view, a bread and milk,
or saturine poultice,  may be had recourse to, which is the modern
practice whenever the tumour is large from the birth, and is, probably,
in such cases the fittest application that  can be made use of, as it
will sit easy on the part,  and by forming a soft  cushion, as it were,
for the tender skin to  rest  upon, will in  so  far  dispose it to be  pre-
served entire as long as possible; the life of the child, it having
been noticed, in almost every case, depending entirely upon  that cir-
cumstance.

  *  See Ruysch.
  | Memoirs of the Royal Academy of Sciences'at Stockholm. Anno  1748.
  $  See Parenchymatous Tumours in the next Chapter 
79
                   Parenchymatous Tumours.


  The resemblancewhich some of these bear to the last-mentioned
disorder, renders them worthy of particular notice, being not always
easily distinguished from it.   They appear on different parts of the
spine, but more commonly near the neck,  or to  the os sacrum; are
accounted marks, and are often of a morbid nature, and it is imagin-
ed, would not unfrequently prove  fatal, if  left to themselves.  As I
design, however, treating only of such as will admit of some remedy,
I shall mention only two.
  The first is a tumour on some ofthe vertebrae, usually of the neck,
or the first of the back; it is of a sublived hue, unequal,  internally
spongy, and very vascular.   I saw one of this kind some years ago,
in consultation with the late Sir  Caesar Hawkins, who advised to
preserve the skin unbroken as long as it should be possible, which he
feared was all  that could be done for it; and to this end, recommend-
ed the free use of the compound water of acetated litharge.  It was
then about the size of  a  crown-piece, and not raised very much
above the level  of the surrounding parts.  The tumour, however, in-
creased, and the skin not long afterwards  gave way, and the child
became ill; in consequence of which the late Dr. Hunter was desired
to give his opinion, who advised the extirpation of the tumour, as the
only chance for preserving the child's life: but the father disapproved
ofthe operation.  The part soon began to bleed a good deal at times;
in order to suppress which, as well as to lessen the tumour, which
was now considerably more  prominent,  I sprinkled it  with the fol-
lowing powder:

        &  Bol. Armen. Pulv. Catechu a Jij
          Alumin. rup. 3j
       Misce.

   Over this, compresses wetted as above were applied  frequently
 through the day.  These would sometimes adhere for several days,
 owing to the blood and powder forming a sort of paste,  till a fresh
 oozing from the vessels loosened  them; at which time the bleeding
 returned,  and  the applications were repeated: by the continuance of
 which, however, for seven or eight weeks, and compression with a
 piece of thin lead, the vessels gradually shrunk, and the discharge
 being dried up, the part was happily skinned over, and the child re-
 covered its health.
   I have  seen  another tumour of this kind, which was treated in  a
 different manner.   It was  seated on the last vertebrae of the back,
 and was apprehended to be the true spina byfida: but as  no margin 
80                  HEPARTOMPHALOS,  AND
of bone could be distinctly felt, nor  the  tumour, by pressure, be
made to recede, I hoped it might be otherwise, r,n ! ventured to ad-
vise taking it off.   This was accordingly done when the child was
about eight days old, and though a good deal of blood was lost in the
operation, from a deep seated  artery, the sore at the  end of the
month was perfectly healed, and the child soon afterwards became
as healthy as any other in the family.
             Hepartomphalos, and Hernia Ventralis.

  The congenite ventral  hernia, in which,  from a  deficiency of
muscular integuments and skin, some of the abdominal viscera, and
not unfrequently the liver, is protruded, is  very often met with in
abortions in the  earlier  months; though less  commonly  in the full
grown fetus.   I  have never seen it in  living children,  unless in that
instance of it termed hepartomphalos; which is the  more imme-
diate  subject of this  chapter, and will be clearly exemplified in  the
fmncxed C8.sc •
   In  the true hepartomphalos, however, there is, possibly, no actual
deficiency  of the  muscular  or  ligamentous integuments, and still
more probably, not of  the  skin; but, as the  term strictly implies,
some part ofthe liver forms a congenite hernia ofthe navel.   The
liver, while very small, is, as I conceive, somewise drawn down by
the vessels of the umbilicus which enter it, (possibly by some action
ofthe fetus;) or, as it has  lately  been  said by  Lassus on the umbili-
cal hernia, the  fiver is preternaturally large  and heavy, through its
receiving an undue proportion of blood from the vena umbilicahs, and
is thereby protruded at the muscular ring in the linea  alba, and falls
into  the funis  umbilicalis;  which it dilates and  distempers.   This
disease is a  very rare one, I believe, in living children,  and  I  had
met with no written account of it, until  Dr. Combe  put into my
hands a Thesis  de hepartomphaloce congenita, by Francisc. Henn-
 cus Rockholtz,  printed anno 1768.
   The easy there  related  corresponds  so exactly with the one I met
 with, and both the infants surviving the disease; but some months
 afterwards dying of other complaints, and their  bodies  being  care-
 fully examined; the fact is established, and demonstrates the powers
 of the animal  machine,  in  removing  obstacles to  its well-doing,
 that  might be thought insurmountable.
   The subject  of the present case  being born in the  neighbourhood
 ofthe British Lying-in hospital, was brought there for the  advice of
 the physicians on a day when I was in attendance.   The child was
 then eight days old, and the nurse informed me that the tumour still
 remained of the exact size it had acquired when the infant came into 
HERNIA VENTRALIS.
81
the world; but that previous to the binding it down tight, the skin had
seemed to be thinner, but was even  at that time discoloured, though
it had a kind of transparency, as if it contained a fluid; and that the
next day it turned black.
   The dry funis was now appending from the centre of the tumour.
which was as large as a good sized china orange; was black, and the
skin, as I thought, in a sphacelated state.
   Whether this tumour contained the liver, or any ofthe intestines.
I could not at all determine; or whether it might be a mere paren-
chymatous enlargement of the funis umbilicalis, of which I had late-
ly seen an uncommon instance, of about one third of this  size; but in
that, the enlargement commenced about three or four inches from the
belly.
   I had little doubt, however, from the size  and colour of the tu-
mour, that  in  the  present instance, the infant would die in  a few
days, or at least, soon  after the integuments should give way; as it
appeared highly probable, there would  then be an opening into the
cavity of the abdomen.   I directed nothing, therefore,  but a bread
and milk poultice, and this  merely in the view to its  being a soft
 cushion  for the tumour to rest upon; which did not, however, appear
to be very sensible, though the infant eried much upon being moved,
 as if it were thereby put to pain.
   Four days afterwards the child was brought again to the hospital.
 There was then but little change in the appearance of the tumour,
 nor much discharge from it; and the child having taken kindly to  the
 breast had a healthy appearance;  so that, save from the suspicion
 arising from the nature of the tumour, it seemed  very likely to live.
 Half an ounce of the decoction of bark was  directed to be  given
 three times a-day.
    I did not see the infant again for three weeks; and  it was then
 near five weeks old.   I now learned, that the child  had thriven so
 well the parents were  satisfied it was likely to live; and that  the
 funis  had fallen off on the fifteenth day, without being followed by
  any unpleasant symptom.   That the tumour had burst about a week
  after  the funis  came  off, from which time the swelling had sensi-
  bly subsided  as the discharge kept up;  and  that  at  the  end of
  the month, the discoloured  integuments all  sloughed off, and left a
  superficial sore of the  size of a small tea-cup„ to use the mother's ex-

    The  poultice was directed  to  be continued until I should see the
  infant again; which was about a week afterwards.   There was then
  an oblong, benign  ulcer,  about  the size of a sixpence, and disposed
  to heal  up.   I now  desired  the  poultice  might be  left off,  and
  only  to  apply a bit of cerat. e lapide calamin.  and moderate com-
  press  By  these  means  the sore was healed,  when the infant
  was  eight weeks  old; soon after  which I saw the child in perfect
  health. 
82
HEPARTOMPHALOS, &C.
   The integuments at this time had not the usual appearance ofthe
navel, but were, on the contrary, thin and a little elevated, but with-
out any thing like an umbilical hernia.   The scar was not larger
than a sixpence, and was not precisely  in the middle of the abdo-
men, but a little on the left side of the point from which the funis
naturally rises.
   From the  disagreeable  appearance of this case when the infant
was first presented  at the hospital, such a  termination  was very
pleasant to us, as it leads to encouragement concerning other obscure
diseases; and manifests what unexpected things nature is capable of
effecting, even at this early period, when not interrupted by any im-
proper treatment.
   The unfortunate infant, it has been said, fell a sacrifice, about six
months  after birth, to another disease; in consequence of which its
body was afterwards carefully examined by Dr. Marshall.  Dr.
Combe  happening to hear of it, was present,  and informed me, that
there could be no doubt of the liver having occasioned the tumour
we had  seen;   there being yet a sensible  depression  remaining,
evidently marking the stricture  made  upon it by the  linea alba
and recti muscles; which  had included about one-third of its left
lobe.
   Since the last  impression,  I  have  met  with  another instance
of the hepartomphalos, in a  full grown, but still-born  fetus; the
complaint being also ascertained by an examination of the parts.
   Whence it should come to pass, that  infants  should  not only be
born alive with, but survive  the  hepartomphalos, rather than the
common ventral congenite hernia; or than  they would do  a  large
congenite exomphalos ofthe intestine; may be worthy of inquiry in
this place.   And the reason, probably,  may be, that in the  hernia
ventralis congenita, whether from the  protrusion of the liver, or any
other of the  abdominal viscera, there must be  a deficiency  of the
muscular and other coverings ofthe abdomen, and, therefore, nothing
to support, or defend the protruded organs so essential  to life, but
the thin peritoneal  expansion.  But that, in the former, there  is,
perhaps, no actual loss of substance, but a mere dilation of the parts;
the liver being at the same time defended by the strong expansion of
the funis umbilicalis, which does not give way after birth, until na-
ture has  had  sufficient time to withdraw that viscus into the cavity
ofthe abdomen.   This, it is imagined, is effected not only by the re-
moval of the first cause of its descent,  but also by that  respiration
which takes place immediately on the birth, and is further assisted by
the  ligament by which the  liver is attached  to  the  diaphragm;
and by  means  of which it is  mechanically drawn up, during every
expiration. 
83
On the Hare-Lip, and other External Blemishes, or Disorders, sup-
                 posed to be Marks of the Mother.

   Though it be beyond the  present purpose, to  treat in detail on
surgical operations, I shall beg leave to notice a circumstance or two
relative to that for the hare-lip,  as I  already have in a few others,
which frequent opportunities of comparing the different success at-
tending them have furnished.  I  shall  afterwards  advert to some
other equally common blemishes, in a view to assisting the younger
part of my readers to combat the unhappy prejudices of mothers in
relation to  marking their children.   This,  unfortunately for them-
selves, they are always disposed  to attribute to a violent impression
from the sight of some disagreeable object, or  to a disappointment in
something they may have longed for, during their  pregnancy.—And
I have chosen  this place for such observations as  I have to offer on
this head, because the hare  lip, and some other blemishes remaining
to be noticed,  bear that resemblance to  objects around us, which is
wanting in those before mentioned.
   The repeated experience of every  attentive  observer, has uniform-
ly militated against the tormenting suspicion  alluded to; but still  it
prevails, though only to the injury of those who ought, for their own
sake, to be persuaded to the contrary.  Every man long in business
has  known many instances of mothers tormenting  themselves for six
or seven months, in the painful apprehension of discovering some sad
blemish in the child, (and on this account have trembled to look on
it when it has  come into the world;) which has afterwards proved to
be as perfect as they could have wished, and as the more dispassion-
ate  amongst their friends have all along ventured to foretel.  On the
other hand, where children have been born with some real blemish,
it has not been suspected by the  mother* unless now  and then in a

  *  Among several instances of such blemishes in children born in the British
Lying-in Hospital, we have had some remarkable ones ofthe entire ignorance of
any  supposed cause.  In one, the infant was more marked than almost any one I
have ever seen;  but 1 shall only notice, that the eye-lids,  part ofthe nose and
temple, and the greater part of one of the cheeks, were as  black as ink, and ex-
actly resembled a dry gangrene of the parts.  In a recent instance, the extre-
mities were uncommonly ill-formed, not unlike those of aquatics; but the mothers
of these infants had gone on to their full time, without having  received any ingot
they could recollect, or suspecting any thing amiss in their children.
   These children, however, were really so disfigured, that a lively imagination,
 with a mind strongly impressed, might not only have conceived m them a great
resemblance to many objects, but it is more than probable, that the parents must
 have actually noticed not a few such, during the period of gestation.  Where any
 such deformity, therefore, may actually have taken place,  practitioners may
 areue the point  with their patients, and endeavour to persuade them, that such
 sights have not been the true cause of it, and that such objects, therefore, can-
 not contribute to the production ofthe like appearances another time—In this
 view, 1 cannot help observing, that a few years ago, a lady of rank acquainted me,
 th»t she had passed almost the whole term of gestation in the apprehension of 
84
macula;.
most timid person, (who has always bred in fear on account of one
disagreeable object or other she has seen;) or else,  the blemish has
turned out to be something perfectly irrelative to it.   And here  it
ought to be noticed, that where a child has really been marked, and
the mother has insisted on her having seen, and been frightened by
an object which the blemish has resembled, it has (to the best of my
knowledge, at least) appeared always  to be  an  after-thought, by
which the supposed occasion of it has been  discovered; and has not
been taken  notice of before-hand:  whilst other women, it has been
said, have born  children  considerably  disfigured,  who have recol-
lected no alarm nor disappointment whatever.  It is,  however, the
furthest from my thoughts to upbraid the sufferer on this painful occa-
sion.  I wish only to obviate the influence of a sentiment that I take to
be without foundation—a sentiment that has originated in ignorance,
and to which nothing but length of time and prescription could have
given a sanction.
  That there are blemishes which bear a resemblance to various ob-
jects around us, daily experience has proved; though the precise oc-
casion of them is not, perhaps, understood.  The like deviations from
the ordinary course is observed, not only in various other animals,* and
that not unfrequently, but also in the vegetable kingdom; in which the
supposed influence can  have no place.   Thus, fruits are often joined
together and discoloured, having excrescences, and odd shapes, offer-
ing strange  representations  resembling animals, as well as anomalous
irregularities,  similar to those found on the bodies of infants: all,
doubtless, proceeding from  the established laws of motion, though not
well understood by us.
   In regard to  various discolorations in  the skin of infants, fancied
to resemble fruits, and  like them becoming  of a deeper red in sum-
mer; it may, however, be in point to observe, that the epidermis is,
in such kind of marks, frequently altogether wanting, and if not, is
always thinner than on  other parts.   The small blood vessels being
also more numerous, or nearer the  surface, the discoloration of the
skin becomes a natural consequence;  nor can it be any wonder, that
this discoloration should be greater in summer than in winter, the
cutaneous vessels  being then more turgid  with blood.  The  like
change takes place in every mark on the  face, when the person either
cries, or is made  angry, or when  by any other means the blood is

her Infant being born with a hare lip, on account of her having been daily met by a
labourer working in her own grounds, who had such a blemish. In this instance.the
imagination seemed to have done its utmost; as the lady conceived she met with
this man oftener than any other, and that she could not avoid him, walk which-
soever way she might; and  in consequence had his image continually before her,
either in reality or in recollection ; and being kept under a continual alarm by it,
in the end declined walking at  all in her garden.—After the opinion 1 have ad-
vanced, it may be needless to add, that the child was born free from the appre-
hended, or any other blemish.
* See Mr. John Hunter on the Free Martin. 
MACUL.E.
85
made suddenly to ascend to, or rest longer than usual in the superior
parts.   All such appearances are, therefore, very easily accounted
for, without  supposing them the consequence of  the parent having
longed for such fruits as ripen, or grow red, in the summer months.
We observe,  also, similar changes in adults from long continued se-
vere exercise, or hard drinking;  many people, before of a fair com-
plexion, suddenly acquiring a red face, or have the nose  both disco-
loured and mis-shaped.
   The  laws  of motion will also equally account for the mutilation,
and want of parts, the growth of which is  somewise interrupted;  it
being well known, that the several members and parts  of the body
are not all formed or unfolded  at once, but are  pushed  forward  in
their turn after some established law of nature, and organical matter.
If, therefore, a due proportion of nourishment be withheld from any
part, its proportionate growth is  suppressed, or its  formation entirely
prevented.  The like process takes place in flowers:—thus, if a rose-
bud, for instance, be blighted, some of its leaves are found curled up,
and the flower turns out ill-shaped; or perhaps it is so much injured,
and the bud so far withered, that only a few leaves  appear, the rest
being never completely formed,  or  unfolded.  Hence, the hare lip;
the two sides of the face, which are said to be formed separately, be-
ing hereby prevented  from growing together:"'  the  upper lip is, at
least, one of the last parts that come  into coalition.  For the like
reason it is, that infants come into the world  with large ventral her-
niae, the muscular parietes, and especially the skin being one of the
last processes in the embryo.f   But whatsoever may be the weight of
these observations, there is certainly  nothing that we know of in  a
fright or longing, that can produce such a change in  organized mat-
ter, nor can operate in  the manner that has  been supposed, much less
at such different periods; but there is, on the other hand,  every thing
against  such an hypothesis; which has accordingly always given way
in enlightened ages.
   It is  well  observed  by Dr. Blondel, that were a due catalogue
drawn up of  all the irregularities  discovered at  the birth,  that are
supposed to proceed from  the mother's imagination, they would ap-
pear to be the same over and over again, with  no great difference, and
very capable of being reduced into certain classes.   Does not this in-
timate, that they proceed from the laws  of motion, and the structure
of the organs?  There  are besides,  many considerable  deformities,
which are never referred to the  imagination, viz. the irregular con-
formation of the viscera, &c.  Is the whole empire of the microcosm


  • For further remarks on this subject, the reader  is referred to  a paper writ-
ten by Mr. Lucas, of Leeds, in the Memoirs of the Medical Syciety of London,
vol. iv.
  f Harvey, Exer. 56 and 69.
  VOL.  II.                      N 
86
THE HARE-LIP.
so divided between nature and the imagination, that one rules with-
in, and the other governs the outward parts?
   The fetus is also a distinct individuum; it has the circulation ofthe
blood independent on the mother; its own genus nervosum;  a sepa-
rate secretion of juices, and all the functions of animal economy  in
itself.   On this account, we see a feeble mother bearing a very strong
and lusty child, et vice versa; the mother being  to her infant, what
the earth is to a plant: the latter being strong may not be injured by
being moved into a very different soil: or being tender, may, or may
not, be benefited by it.
   Children have  likewise diseases of their own while in utero, such
as cataract and gutta serena, varices, aneurisms, hydrocephalus; they
are born blind, deaf, &c.
   The  instance so often adduced from the sacred historian in oppo-
sition to such arguments*  is, by no means in point; for without ad-
verting to the very peculiar  physical circumstances in that transac-
tion, which are wanting in ordinary instances, it is sufficient to ob-
serve, that  there was therein  an  evident  supernatural  interposition
Should any one in this sceptical age  doubt of this, he has only to
make a similar experiment, the result of which will, probably, have
more weight than ten thousand arguments.! As matter of fact, there-
fore, as before observed, does not at all  countenance, but  directly
contradict  the hypothesis, there is good  ground for married women
being argued  out of such fears, and delivered from that painful con-
flict for weeks and months together, which so many of them endure.
It will give me great pleasure if any thing I  have advanced on the
subject, should answer so desirable an end; whilst reason, philosophy,
experience, and every thing on which we ought to depend, conspire
to support  such an attempt.
   Amongst the various marks resembling some ofthe objects around
us, that called the Hare-lip is the  most common; a blemish, there-
fore, too well  known to require a formal description.   It is sufficient
to observe, that it is of two kinds; the simple, wherein the upper lip
only is divided, either wholly or in part, with  some loss of substance;
and the complex, in which the  fissure of the lip is double: in some
instances, the portion between the fissures is likewise too small to fill
up the  cavity, and in some it adheres to the very tip of the. nose; and
in a few instances, both lips are affected: the upper jaw, also, with
the palate ofthe mouth,  and even the uvula are sometimes divided.


   • Genesis, chap. 30. ver. 37-42.
   f Though I  have ventured to say this, it is probable, there was also a coin-
cidence of circumstances, although not in  the  manner vulgarly conceived of.
For many critical and satisfactory remarks,  however, on the  above passage of
holy writ, the more curious reader may consult a learned tract, on the Strength
of the Imagination in Pregnant Women, written by Dr. Blondel, a Member of
the College of fbysicians, Anno  1727. 
THE HARE-LIP.
87
It would be beside my purpose,  it has been noticed, to  treat of the
manner in which this deformity and defection is  to be remedied,
especially as that must vary considerably in different cases; I shall
confine myself to speaking only of the time in which it ought to be
attempted.
  Various considerations contribute to make the  distressed parent
solicitous to have this blemish removed soon after the infant is born,
or at furthest  before the month  shall be expired.  On this account,
1 am convinced, the operation has sometimes been prematurely per-
formed,  contrary to the  better judgment of the operator, and the
child thereby fallen a sacrifice;  whilst others have received much less
benefit than they would have done, had the operation been postponed
for a reasonable time.  Where the blemish is  very  trifling, indeed,
and the operation simple, it may, in many cases, be done with safety
in the course ofthe month, or a little after; and if the child be able to
suck, which is not always the case, there  are even some advantages
in  performing it sooner.   For as the  child will not be  able to suck
for two days  at least after the operation, it  will with  difficulty be
kepi tolerably quiet by the spoon after it has been once  put to the
breast;  but as  infants need but very little nourishment for the first
days afterbirth, and generally sleep a good deal; if the operation be
done twenty-four hours after the child is born, it will be  in  a con-
dition to suck by the  time it requires much nourishment, and the
mother's breast  is prepared to furnish it.   But in the complex hare-
lip the case is exceedingly different, and  the  longer the operation is
postponed, the better it is likely to succeed;  and should, at least, be
deferred till the child shall be four or five months old.   By this time
also, the infant will have got over the period in which it is peculiarly
liable to several painful and  dangerous complaints; will be thorough-
ly weaned  from its  hankering  after the breast, and have learned
to feed contentedly with the spoon, by which children with  this kind
 of hare-lip are obliged to  be supported,  they being generally unable
 to suck.  At this period  likewise, the parts  will have acquired such
 a size as will admit of handling them to  greater advantage as well
 as a degree of firmness necessary to retain the needles;  for  the want
 of which, though the operation may appear to have been  favourably
 performed, the  needles will  sometimes break out, and the deformity
 be but little removed, or perhaps sometimes increased.
    1 have once seen another blemish of the mouth  in a  child bora at
 the hospital, which required a similar operation.  In this infant, the
 mouth was much wider on one side than on the other, and  appeared
 as if it had been divided far into the cheek, which occasioned a very
 awkward appearance; but  as  it was  capable of being remedied in
 the slme manner as  the hare-lip, I shall only observe, that  when I
 withdrew the pins on the third day, the parts adhered very firmly, and
 the child left the hospital at the usual time. 
88
                       Discolored  Spots.

  Amongst other blemishes that may  require  surgical assistance,
are those which women  are wont more especially to call marks; be-
ing spots, more or less elevated above the surrounding skin,  and of
various forms and colours. These may fall on any parts of the body,
but are  very little regarded, except when found on some uncovered
part, especially the face, where, perhaps, this kind is most commonly
met with.
  These, however, vary so much in shape, size, and  in some other
more important circumstances, that it were nugatory  to attempt to
poini out  the precise operation  adapted to many of them.   Suffice
it to say, that in  some, excision of the discolored and elevated parts,
or destroying them by caustic, is the  only remedy.;  in others, com-
pression alone is sufficient; and in a few, compression, together with
slight puncture and caustic, will be called  for.   In some parts of the
face,  as the cheeks, lips, the nose  and near the eyes, the knife' or
lanet must be had recourse to with  caution;  though whenever made
use of, it will be  necessary to carry them full as deep, and far, as
the distempered vessels  may happen to extend, or the operation will
not be completely successful.  It is, indeed, sometimes necessary to
repeat it; and it would, in many instances, be better  to do so, than
to risk, in the first operation, destroying any sound parts unnecessari-
ly,  by which the scar might be extended.  Where great caution has
been found necessary, it will sometimes  happen, that though  the
blemish may seem to  have been fully removed, the redness  and tu-
mour will after some months return; but even here, as a touch with
the argentum nitratum, after lightly scarifying the parts, or at most,
the carrying the lancet a little deeper than at first, will  perfect the
cure, it were pity it should be neglected, distressing  as  the idea of
a second  operation must be  to the  parents of the infant.   In some
instances, however, the recurring elevation as  well as discoloration
of the part, when slight, have gradually subsided without a second
operation;  which  it may therefore  be  proper  to  defer  for  a  few
months:  an instance of which I saw lately, where a  second opera-
tion had been advised by the late Mr. Hunter.   From the very great
advantages  derived  from these  means, in some  very unpromising
cases that I have been witness to, I have been led to  offer these  re-
marks;  and not  doubting that other practitioners have seen the like,
i wish to  impress the idea of consulting some  skilful surgeon upon
ever, great blemish; persuaded that many parens will, in the event,
have occasion to be thankful for such consultation. 
BLEMISHES AFTER BIRTH.
89
                Tumours, and Superfluous Paris.

  A different kind of blemish  consists in little tumours  and su-
perfluous parts without any discoloration of the surface. The former
lie more or less deep under the skin,  and consist  of extravasated
lymph, hardened fat, or indurated glands.   Some of these likewise
may be effaced  merely by compression, while others  can be removed
only by caustic or excision.   Pendulous  parts sometimes adhere
only by a small base, like  a thread, and may then be removed by
only passing a tight ligature round them.  But should any even ad-
here more firmly, and be only a small joint, such as a finger or a toe,
it were better  to have it taken off on the first days, as  the vessels
will then bleed but little, and the gristles by which  such joints are
usually connected, are  not yet become bony.   But should the part
be more  completely formed, it may be necessary to  delay the opera-
tion awhile longer,\hat by discovering which of the duplicates mav
may take the lead, the more promising one may be preserved; which
rs not always to be known with certainty at the birth.



                  Unusual  Figure  of  the Parts.

    I  notice these  trifling  blemishes  with  a peculiar satisfaction,
 from experience that nature alone is able to remedy them in certain
 instances wherein  I had previously conceived that some considera-
 ble recourse  to art  would  be  necessary.  These blemishes more
 commonly occur  in some parts  about the head, particularly of the
 ears and nose.  The latter of these is  certainly,  of the  more im-
 portance, and  is sometimes turned greatly on one side; with one he
 nostrils open very largely, and the  other compressed.   Suffice it to
 Lf hat after trying what might be done by plaster, bandage, and
  Sr contrivances, nature alone, by the force of the circuiting juices,
  has broughi the parts, in the course of  a few weeks, into the.r proper
  form.
                     Blemishes after Birth.

  Bffore I quit this part ofthe subject, it will be proper to notice
  Before i qui     y                          but  these are nol

vmcomm in.'  They conti of small red, or black spots, about the
£7e, w«T believe are disposed to increase in size, and  should, there- 
i'O                   IMPERFORATE VAGINA.
fore, be early removed by the point of a lancet, as may then be easily
done.
  Besides the afore-mentioned derangements met with at the birth,
there are others of far greater importance, some of which demand
an operation  as the  only chance for preserving the life of the in-
fant.   Such  are  imperforations of the vagina, the anus, and  the
urethra.
                       Impe rforate Vagina.


   The vagina is sometimes imperforate on the external, at others,
only in the more internal parts; and is in different degrees.   The
latter more commonly relates only to the hymen, which requiring an
operation to be performed about  the age of puberty,  I shall do no
more than barely mention here, especially as it requires only a  sim-
ple,  or crucial incision, and to preserve  the  orifice open.  Where
the imperforation is in the substance of the vagina itself, I have never
found an operation to be of any use, though I have known it attempted,
in the adult, with great address and resolution.
   I have never met with the external parts  totally imperforate, there
being always a small opening at the meatus urinarius; but I have found
the aperture to the vagina so very small as to  require a little opera-
tion,  which is  mighty easily done with the point of a lancet, there
being always a raphe, or line, directing the extent nature has seemed
originally to intend; which being cut through, requires only that the
parts be kept asunder for a few days by a bit of fine lint.
   This has been the  usual mode of remedying this defection; but I
have for some years altogether rejected the assistance  of the lancet,
the parts being very easily separated by the fingers even  in children
of several years old.  It is not  improbable,  the like method might
succeed, though the operation  should  be neglected till the time of
puberty, the parts seeming rather to adhere in consequence of some
very slight inflammation, than to have been originally ill-formed.  A
mere oozing  of blood is  perceived in consequence of this mode of
separating the labia, which, in  the present  instance at  least, seems
preferable to incision, and may  possibly afford  less pain to the infant,
as well as be less unpleasant in idea to its parents.
   It is, in this instance, peculiarly important,  that practititioners in
midwifery, and others attending at the birth, should examine infants
very attentively in regard to this complaint, which  may be other-
wise overlooked; the defection proving no obstacle to the natural ex-
cretions.  I have met with several instances of it in children  from
three to six years old, in whom the complaint was but  newly dis-
covered, and it has been in others neglected to the time of puberty, 
IMPERFORATE  ANUS.
91
and even of marriage, and must then prove of serious consequence,
and may even be attended with hazard*
  The rectum, likewise, is sometimes found opening into the va-
gina;  a case that affords but  little prospect of relief.   It should,
however,  be attempted; but the kind of operation  must depend so
much upon circumstances, that it cannot be here pointed out with any
precision.
                       Imperforate  Anus.


  The anus is sometimes closed only by a thin membrane,  so that
the  day after birth the meconium  may  be distinctly felt, and in a
manner seen  shining through it.   Zuingerusf reports  such a case,
which was relieved by only a slight puncture with a lancet, and pass-
ing the point of a finger into the bowel  for two or three days after-
wards—a  bougie,  one  should  think,  would be  every wise  as
proper.
  But more commonly the  imperforate anus is a melancholy case,
as it seldom allows of an effectual  remedy, the gut often terminating
in a cul  de sac so high up  as not to be reached; it  is not, however,
always to be despaired  of,  though no  fluctuation of the intestinal
contents should  be  felt for two  or three days after  the infant is
born.
   Though this sad defection is  not very uncommon,  I remember
o^y two cases of the kind in live-born children at the British Lying-
 in hospital.  One of these it fell to my lot to attend, and I happen-
 ed to succeed, contrary, indeed, to all expectation, and after the child
 had puked up a great quantity of meconium; and not only the belly,
 but also the face was become  exceedingly tumid, and the eyes had
 not been opened for  some time.
    The manner of doing this operation must, in different cases, de-
 pend so much on the  discretion  of the operator, that I shall do no
 more than describe that which I made  use of in the instance allud-
 ed to; and this may, possibly, be  acceptable, as the operation is not
 often performed with success.  It may be previously observed, that
 it ought to be postponed as long as it safely can, that the depending
 part ofthe bowel may be distended, and pushed as low down as pos-
. sible; the  reason for which is sufficiently obvious: and  to this delay I
 am much  inclined to attribute the success with which it was follow-
 ed in the  operation  I performed.


    ♦ See Henrici  a Mornishen Observaliones  Mcdico-Chirurgics.   Dresdx,
  1691.
    f Theodor  Zuingerus.  Basile*, 1722. 
92
IMPERFORATE PENIS.
   This was not determined upon by my colleagues till the third day
A longitudinal incision was then made, of about half an inch, above
and below the part where the anus ought to have been, which was
marked by  a little excrescence; a small bistoury  was afterwards
thrust up in the usual direction of the bowel, for more than an inch.
No meconium following this puncture, I examined carefully with my
finger, and feeling something like the fluctuation meconium would
make, I introduced a trocar,  and withdrawing my finger, 1  carried
up the instrument in such a direction as to avoid injuring the blad-
der, or forcing it against the  os  coccygis, for near an inch  further;
making allowance, however,  for the  yielding of the parts, which
might be somewhat forced up by the trocar.  The instrument having
now passed forwards, without that resistance it had hitherto met with,
gave me the sensation of having entered a cavity; when withdrawing
the trocar, we had the  satisfaction of finding the meconium running
out at the canula.  The child was now put into a warm-bath, up to the
waist, and in a few minutes having voided a considerable quantity of
meconium, it opened its eyes,  looked cheerfully about it,  and fell
into a pleasant sleep before it was taken out of the bath.
   A piece  of bougie  was occasionally introduced,  and sometimes
left in the part, for a few hours, for the first  fortnight; after which
the child recovered fast, and at the usual time was  taken  from the
hospital in pretty good  health, though it had been much reduced by
a bad thrush, which unfortunately made its appearance soon after the
operation; but it always voided its stools perfectly well.
                       Imperforate Penis.

   The imperforate penis  is not quite so common a case; but is not
unfrequently suspected, when the aperture of the passage is merely
stopped up by a little mucus; and should, therefore, be examined in
good  time.  In this case, washing the part with warm milk and
water, or at most, a little assistance with a small probe, or any such
blunt pointed  instrument, will be sufficient to  open the passage.
But it is evident, if the urethra be wanting no operation can be un-
dertaken: it is, however, more commonly found open  a certain way,
and often as far as the basis of the glans, and sometimes near to  its
extremity;  in  which  last  instance, it is necessary only to make a
small aperture with a lancet, or  a fine trocar, and to keep the part
open by the occasional introduction of a slender bougie.   The more
common complaint of this  part, however, is that ofthe urinary pass-
age terminating by a] small aperture at a little distance  below the
glans, and sometimes  on one side of it.  In these cases, the  precise
circumstances  must determine the propriety of any operation;  which
if not judiciously managed, may render the case worse than it was. 
SQUINTING.
93
I recollect, two, indeed, in which I was able to do considerable ser-
vice, one of which was in the presence of the late Sir Czesar Haw-
kins, and  the other of the late Dr. Hunter; in the latter, the urine
was discharged from  one side of the  penis, and pretty low down,
which was very happily remedied.
  There are other mal-formations of this part, by which it is drawn
downwards,  or to one side; the  peculiar circumstances of which
must point out the nature ofthe operation most likely to afford relief.
This will generally consist in a simple incision of the skin, where it
may happen  to be too tight or short, and  keeping the divided edges
at a distance from  each other, till the little sore  shall be healed; or
sometimes by dividing the upper part of the prepuce, as in the perj-
phimosis; which I  have found successful in a late instance.
                      The Ears Imperforate.

  I have likewise known the ears to be imperforate, a case that
admits of no remedy; but the external  appearance may sometimes
be improved,  when the helix is  turned forwards over the tragus,
covering that part which ought to lead  to the internal ear: but in
these cases, I have always found the concha, and meatus auditorius,
totally obliterated.
                           Squinting.


  Another, and a very common blemish, is that called squinting,
which is sometimes contracted by very young infants, and  may then
frequently be remedied, especially if confined to one eye; but if a
child be  born with this deformity, or it be consequent to  fits, it is
not so likely to be removed.  The means I have to recommend are,
indeed, very simple.  A very important one, however,  is, to apply
a piece of sticking-plaster, spread on some bright coloured silk, hi
such a position, either on  the temple or nose, conformably to the
side on  which  the eye is distorted,  as may attract it the contrary
way   In order to keep up this  allurement, the colour of the  silk
ought to be  varied from time to  time, as well as its situation  plac-
ing it a little higher, or lower, both for the sake of change, that the
skin may not be fretted, as well as to answer any other end, that a
due observation on its effects may point out.   Besides this  the child
ought always to  be placed  with  that  side towards the light from
which the eve is distorted; and for the like reason, its parents, nurse
play-things, and every other object that can attract its notice, should

  VOL.  II. 
91
VARI AND VALGI.
as constantly as possible be on the same  side, that the child may
have every inducement its age and circumstances will allow, to draw
the eye the right way, and by early habit, counteract a muscular ac-
tion that is not yet become permanent.
   Another method more proper for older children, is covering the eyes
with ogles, which are glasses fixed in a little case,  such as many peo-
ple wear when they ride on horse-back.  They must be so placed,
that the child can see no object but by turning the eyes to  the sides
from which they are distorted.  Or,  an opake covering of  a similar
form may be worn, with only a very small aperture in the centre, by
which the child will be  obliged  to  look straight  forward.   It  is
scarcely necessary to add, that these contrivances must be worn con-
stantly, till the bad habit shall be overcome.
   Where the cast is confined to one eye, it has been recommended
to cover the other; whereby the infant will in a little time acquire the
habit of  directing the affected one more properly.  After  this, the
sound eye should be gradually uncovered; so  as  to admit the light
by degrees.   The child, it is said, will, by this means, very soon be
enabled to direct both eyes properly to the same object.
   To this end, likewise, such children may be made to look at their
own eyes in a mirror for a few minutes, several times in a day; but
with the precaution  that each eye be directed to that which corre-
sponds with  it in the glass;  contriving, somewise, to  render this
remedy a kind of amusement.  I shall  only add  on this head, that
children  who are inclined to squint ought not to be exposed to a very
strong light, nor learn to read  very young.
   Infants are  liable,  indeed, to innumerable blemishes; but as I
mean to treat only of such as  call for medical attention, and admit
of some remedy, I shall  mention  only two or three more, which are
very common, and with them close what I have to say on their com-
plaints.
                        Van and Valgi.

  These are distortions of the feet, and differ only with respect to
the side to which the foot is turned; in  the former, the soles  of the
feet being turned inwards, and in  the latter outwards: the curative
intention  is therefore alike  in both.  The complaint  is sometimes
very trifling, and seems to have been owing only to some cramped
position of the feet in utero;  and in that case, disappears before the
end of the  month.  In other instances, there is evidently a contrac-
tion, if not accurtation of the tendons, which calls for  considerable
attention.  The remedy, however,  is obvious enough', and frequently
consists only in the proper  application of a  roller and pasteboard
splints, so as gradually to bring the foot to its  natural position; and 
               DISTORTIONS OF THE FEET AND HANDS.          95

in proportion as it inclines thereto, increasing the force  and tightning
the roller, every two or three days.
  There is also another very common distortion of the feet, in which
they are turned upwards  towards the instep: but the mode of treat-
ment is alike in them all, and the  cure will usually be effected in a
reasonable time.   The like easy means, therefore, will generally be
sufficient  to remedy a contraction  of the joints of the fingers, and
various awkward positions of the toes, with which some infants come
into the world.
  All these  complaints may nevertheless, be sometimes more consi-
derable, and in  such case, especially if neglected for many months,
or even years, as they sometimes are, require the assistance of some
steel instrument, or irons, (as they  are  called) which are properly
contrived for these and other distortions,  as of the knees, &c.  by
Messrs. Bowley, Sheldrake,  and other  truss  makers,  who  seldom
fail of bringing the parts into  a more natural form, even in the
worst cases, whenever the  complaint may be  thought worthy of the
time and  attention that may be required.   But a  less troublesome
contrivance, and therefore better adapted to some country places, is
a shoe made of tin, and lined with leather, as invented by  Mr.
White, of Manchester.   This must be well adapted to the foot, and
a part  of  the leg, and be properly secured  by strings.
  Other imperfections might be noticed,  either remediable by ob-
vious means, to  be adapted, according to peculiar circumstances, by
the persons attending,  or such as  happily remedy themselves in a
little time.  Among the  former, I shall, however, mention one that
occurred lately, which  being new to other gentlemen who were con-
sulted  as well as myself,  its favourable termination  afforded peculiar
satisfaction.
  The subject of this, besides  a slight  degree of varus in one foot,
had a  contraction of the leg and thigh on that side; so that the heel
and foot  were  drawn back  towards the nates, and the knee drawn
up  to the  abdomen.  In  this position the  infant  seemed to be easy,
but  to suffer great pain  when the  limbs were forced into the same
extended position  with the others:  for   it  never  stretched them out
itself for  upwards of  three weeks.   Two or  three  consultations
were held during the month, and it was thought by one gentleman,
that the gluteei  muscles were a little swollen; but this  fulness was
not very  evident.  Oily embrocations, a blister, leeches, and the se-
micupium were had recourse to, of  which the two latter were pro-
bably  the most  useful; but it was  not until they had been several
times employed, that the infant was observed to straighten the limb
and at first,  only now and then; but a few days afterwards it moved
it as freely as the other. 
96
THE  ALBINO.
  As a matter of  curiosity and novelty to the young reader, I shall
close this part of my subject with  briefly  noticing certain peculiari-
ties respecting the eyes and hair; (some of which have likewise been
laid  to  the  charge  of the  imagination.)   The latter  sometimes
changes  more than once to opposite colours:  hair, for instance, of an
unusually light colour, has at the age of three or four years, changed
in a short time to a very dark brown; and the child, in consequence,
not been recognised by those who had not  seen it for several months.
I have seen as great an alteration take place in the opposite respect,
which is certainly less common, and in one family in all the children;
the hair from a very  dark colour becoming exceedingly light, and in
one, very white, while under two years of age.   And the mother of
these children was herself  born with very dark hair,  which,  when
she was about five years old, became very  white, (as her own mother
informed me,) and is now again changed to full  as dark a colour as at
her birth.  Accounts of a similar change  in the colour  of the eyes
are, I  believe, not well founded; at least, I have never noticed it my-
self, nor heard of any such change upon good authority;  though the
eyes of infants  have  been  thought to become  darker, than they
were conceived to be at the birth.   But there are instances of infants
born with the eyes of different colours, as well as the hair on the head;
and in both,  the colour is  permanent.   Sometimes, only one lock of
the  hair  has varied from  the rest;  but I have seen two instances of
the one half being red, (as it is termed)  and the  other half,  in one
instance, black, and in the other, white.   In  the latter, the white
part was exceedingly bright, soft, and of a silky texture, unlike that
of hair, but  feeling like undressed, or raw silk, and nowise differing
from that of the Albino,* of which likewise, I  have known two in-
stances in this country, and children of the  same parents, who  had
the one, brown, and the other, black hair.

  *  As a matter of like curiosity may be added a brief account of the Albino.
  This name is given by the Italians lo children whose heads are covered with a
peculiar white hair of a very soft  texture, not uncommonly met with about the
Italian  side of  the Alps, and likewise in Switzerland.
  The hair is whiter than that of any old people, or of  any quadruped, as well
as much softer ; it, indeed, resembles silk more than hair, and retains this tex-
ture through life.   What is further remarkable  is,  that all children born  with
this kind of hair have eyes of as singular a colour, and that is, a pale red, or
pink, which extends as well to the pupil, as over the iris.  It may be remarked,
by way of analogy, that some quadrupeds amongst us, of a breed originally
foreign, whose hair is perfectly white, have always eyes either of a fine blue, or
of a pink colour; but in the Albino they are always redish, which, like the hair,
is subject to no change.
END OF THE SECOND VOLUME. 
A TREATISE
ON THE
DISEASES OF CHILDREN. 
 
TREATISE
ON THE
DISEASES  OF  CHILDREN.
WITH DIRECTIONS
FOR
THE MANAGEMENT OF INFANTS

           FROM THE BIRTH.
       BY MICHAEL UNDERWOOD, M.D.
Licentiate in Midwifery of the Royal College of Physicians in London,
   Physician to her Royal Highness the Princess of Wales, and late
       Senior Physician to the British Lying-in Hospital.
Ornari Res ipsa negat, contenta doceri.
                    Mahijli,,
                 VOL. III.

          FROM THE SIXTH LONDON EDITION.


              PHILADELPHIA:

PUBLISHED BY JAMES WEBSTER, 10, S. EIGHTH STREET
         William Brown, Printer, Prune street
                   1818. 
 
PREFACE.
     Whatever splendour the actual treatment of diseases may re-
flect on the science of medicine, it by no means comprehends the
whole of its province: for prevention being in every case preferable
to remedies,  the  medical art would be more imperfect than other
sciences, were it devoted only to the latter.   In the management of
infants more especially, such a variety of other articles occurs sub-
ject to medical direction, that this work would be peculiarly incom-
plete, if confined merely to the cure of disorders.   In a view, there-
fore, to  such miscellaneous matters,  and certain recurring affections
too trifling to be ranked as diseases, this volume is annexed; and it
is hoped, may contain every thing  on which the most inexperienced
can wish for information, without being tedious, by enlarging  upon
trifles.   In all matters of importance, a becoming firmness has been
adopted, but I have  not  equally insisted upon others, wherein the
manners of a refined age cannot comply, nor have urged any peculiar
modes which the generality may not adopt.   Should any  opinion be
more obstinately maintained, it is, probably, in relation  to  the ali-
ment most adapted to new-born infants; an article frequently alluded
to in the following pages.
   In a view to this, an introduction is given on the Nature and Pro-
perties of Human Milk, as more especially connected with the  sub-
ject  of this volume:  which, it is hoped, will  exhibit apian as ratio-
nal in design, as the author is led to believe it has been successful in
its application.
   Experience having so fully confirmed every argument ofthe ablest
theorists on the peculiar attentions due to the state of infancy and
childhood,  and the  fatal effects of mismanagement in  regard to the
non-naturals, so called; the author has reason to hope, that the  sub*
   vol.  in.                    B 
VI
PREFACE.
sequent revised pages on the head of management, as well as the two
volumes on their diseases, will still meet with the sanction of a candid
public.   He has, indeed, paid no inconsiderable attention on each of
them, by perusing the several treatises on the diseases of children,
that have appeared since his retirement  from London;  esteeming it
his duty to present his own readers with everything he might judge
worthy of notice in those publications,  in this, most probably, his
last revise.  And  the  author presumes he cannot better introduce
this last volume than by making certain extracts from Dr. Hamilton,
and Dr. Buchan; the treatise of the former containing the most ju-
dicious abridgment of the diseases of children, for domestic use, that
has fallen in his way;  whose accurate representation ofthe state of
infants  in utero, and at the  time of their birth, from which useful
practical inferences may be drawn, he shall here beg leave to tran-
scribe.
   " The infant,  when in the womb,  surrounded by a fluid which
defends it from external accidents, and supplies it with an  equable
degree of heat,  nourished by a  somewhat which  its  own organs do
not prepare, and furnished with the vivifying principle of air, by a
beautiful and wonderful machinery, may be said to vegetate only.
   " But when separated from the mqther by  the process of delivery,
it undergoes a great and important revolution.   The  supply of heat,
and protection from injury, must depend on  the attention of others;
nourishment must be prepared by the  digestion of food received into
his own stomach; and the benefits of air can  be obtained by the ope-
ration of breathing,only.
   " Did not experience prove, that nature has most bountifully pro-
vided for these changes, an examination  ofthe structure ofthe infant
would lead to the supposition,  that it  is  ill calculated to sustain so
wonderful a revolution.
   " Thus its  bones are soft, spongy,  and imperfect.   Those which
are afterwards single,  are generally divided into several portions, and
almost all of them  have their  extremities or edges  in the state of
gristle^
    " The different parts cannot, therefore,  be  well  supported, nor
steadily moved, while the organs lodged within the  cavities cannot
be properly defended.
   " The fleshy fibres  are soft and tender, and the cellular substance
which connects them, is of a lax texture, and in large proportion, so 
PREFACE.
Vll
that the several limbs have not that accuracy of shape which takes
place at a subsequent period of life.
   " All the vessels are extremely numerous, and their actions are
very frequently repeated, which accounts for the pulse of infants be-
ing twice as quick as that of grown persons, and for all the secretions
and excretions being performed rapidly and abundantly.
   " The nerves too are not only in large proportion, but extremely
susceptible of excitement, so that many circumstances, as degrees  of
heat and cold, which do not affect  grown persons, occasion pain and
serious derangements in the systems of infants.
   " The skin is ofthe most  delicate  texture; it is influenced by the
most trifling external impressions, and it shews an immediate and an
extensive sympathy with all the other parts.   Hence the slightest at-
tractions of heat and cold produce an almost instantaneous effect upon,
 and often disturb rapidly, the functions ofthe skin or bowels.
   " All the fluids are  mild and watery, and furnished in great quan-
 tity.   The chyle is more nutricious, and the blood is less acrid than
 in grown persons.   The slimy and gelatinous fluids are  bland;  and
 the bile and urine have very little acrimony.
    " The head is large in proportion to the body.  As  its bones are
 aot indented into  each other, but  connected by membranous layers,
 the brain,  which is very  soft,  may  be readily compressed  and  in-
 jured.
    " The face has not the expression which it  afterwards assumes.
 The eyes at first have  no power of distinguishing objects.   They, and
 their appendages,  being remarkably delicate, suffer from the slightest
 accidents;  the nose, from the state of its bones, is also much more
 exposed to injuries, and the sensibility of its nerves renders it highly
 irritable;  but the bad effects which would often be the consequence
 of this structure, are probably counteracted by the mucus with which
 its inside is constantly lubricated.   The ears for some time, like the
 eyes, do  not appear to possess much power.   The  mouth is not
 usually supplied with teeth for some months after birth; for, although
 formed, they remain  under the gums till that time.   The  lower jaw
 is divided by a portion of gristle into two piepes.
    « The trunk of the body is not  so firm as to support properly the
 superincumbent parts, nor to defend the organs contained in it: for a
 great part  of the spine is gristly, and die breast is entirely so   The
 ribs  indeed, are more perfect than many ofthe other bones; but they 
VlH
PREFACE.
can be  easily made to yield from the state of the  breast; and the
fleshy parts,  &c. which surround the belly, being soft and delicate,
cannot  afford resistance to any  circumstance that  may injure the
bowels.
   " The lungs, hitherto small, collapsed,  and supplied with little
blood,  immediately after birth begin to perform the  operation of
breathing, and to receive the whole blood of the body;  which func-
tions continue during life.  These organs are at first weak and irri-
table.   The  heart acts with considerable force and quickness.
   " The liver is of a  remarkably large size  in  proportion to other
parts, and is  not so well defended as afterwards.  The gall-bladder
is nearly in the same proportion.   The stomach differs only in size,
and in delicacy of structure: and the same may be said of the in-
testinal canal.   But in the  great  guts,  a  substance different from
what is observed in grown  persons is lodged:  it is  a black, viscid,
tenacious matter, called in  medical language the  meconium.  The
kidneys are lobulated;  and the renal glands are larger in proportion.
The urinary  bladder, and the other organs in the bason, are differ-
ently placed, as that cavity is very imperfect, from the gristly state of
the bones of  which it is composed.
   "The extremities are weak, and the condition ofthe articulations,
and quantity  of gristle  on the superior and inferior extremities, ren-
der them incapable of performing their proper functions  for  a consi-
derable time.
   " The changes by which the  size and strength of every part of the
body are increased, and the  perfection of the several organs is com-
pleted,  proceed gradually, and are not  fully accomplished till the
period of puberty."

   Childhood (the Doctor adds in another place) extends from the
time at which all the milk teeth are  protruded  above the gums, to
the age of puberty.  During  all that time, the growth of every
part of the body is progressively advancing; the several limbs are
acquiring increased activity and strength; the various secretions and
excretions are gradually altering in their appearance  and nature; and
the organs of the senses and the faculties  of the mind  are improv-
ing in power and in energy.
   While those important changes are going on,  the bones acquire
additional strength and size, the ligaments  and muscles become firm, 
PREFACE.
IX
the cellular membranes and skin more  dense, the action of the heart
and arteries  less frequent, the respiration more slow, the nervous
system less susceptible of impression, and the sympathy between the
skin and the  internal parts less considerable.
   I shall close  this  Preface with  the philanthropic observations of
Dr. Buchan, on the late Dispensary for the relief of the Infant Poor,
with which he has  closed his revised edition of Dr.  Armstrong on
the Diseases  of Children; and I most cordially wish that this further
circulation of the  Doctor's  statement might tend to promote his
laudable  design, by anywise  conducing to the re-establishment of
the Dispensary.  His statement  and benevolent proffer are as fol-
lows:

   " A perusal of this plain but interesting account of the Dispen-
sary for the relief of the Infant Poor, will probably impress the minds
of many readers, as it has done that of the editor, with surprise and
regret, that an institution of such evident public utility should have
been discontinued, for the want of the very moderate pecuniary aid
requisite for its support.   Among  no people,  either in ancient or
 modern times, was there ever so much money set apart for the relief
ofthe poor and the distressed, as in England; and at no former pe-
 riod were charitable institutions more numerous  in this country, than
 at present.   Whatever may be the political effects of these  charities,
 it is  impossible to cavil  at the motives  of those who support them.
 Distress is always an object of compassion.  But whether that pe-
 cuniary assistance to which the natural  decay of  friendless old age
 has the  most indisputed claim, should be equally extended to those
 premature infirmities which originate in intemperance; or that the
 money which would be well bestowed in the relief of suffering vir-
 tue, is with  the same propriety expended in  affording an  asylum to
 the voluntary profligate, may, perhaps,  be questioned.  The  utility
 of administering medical relief to the children  of persons in the in-
 ferior ranks of society admits of no such doubt.   When the children
 ofthe poor  are afflicted with sickness,  to which  those who live in
 the close unventilated habitations of great towns  are peculiarly lia-
 ble, natural affection, which knows no  distinction of ranks, renders
 the' mother anxious  to obtain medical  assistance.  The expense of
 such as lies within their reach quickly exhausts their slender means;
 while the small quantity of medicine that can be consumed  by an 
X                          PREFACE.

infant, is not sufficient to induce the practitioner, who has no other
means of being remunerated for his time and  trouble, to pay the re-
quisite attention  to his patient.  The complaints  of  children  are
not in general of such a nature as to be exasperated by being brought
into the air under the care of their parents.   They may in general
be alleviated by a small quantity of appropriate medicine,  and their
recurrence may frequently be prevented by suggesting  some  rules
concerning diet and general treatment,  to which I have observed
that young mothers especially,  are commonly attentive, and  will-
ing to put in practice.    These  circumstances  render  children
peculiarly fit  objects  of  Dispensary relief.   And it will  hardly
be  denied  that this, or any  other plan  which enables parents to
rear their children  at home,  is preferable to the best system  of
education in a public  institution, by which they are necessarily se-
parated from each other.   That the labouring class of people in
the metropolis are sensible  of the  benefits of such an institution,
and ready to  avail themselves  of the best  medical  advice they can
obtain for  their offspring, is  abundantly proved  by  the numbers
who  applied  to  Dr.  Armstrong's Dispensary when it became ge-
nerally known.  For  several years past, I have dedicated a part of
the morning to the purpose  of giving gratuitous advice to the  child-
ren 6f poor persons.   Even in this narrow  sphere  of observation,
I have seen  enough  to convince me that such assistance is  thank-
fully  received, and  often productive of beneficial  consequences.
Should any  well disposed persons be influenced by these remarks,
to re-establish a Dispensary for the exclusive  purpose of relieving
the children of the poor, my humble services shall not be wanting to
further their benevolent intentions."

   It is not unlikely that  it is owing to this and  other institutions
of affording proper advice and medicines to the poor,  as well as to
the great attention that has been paid to the improved management
of infants, and to the  treatment of their  diseases  amongst the su-
perior orders of society, by writers and practitioners of late  years,
that so sensible a decline in the  fatality of infants  has been observ-
ed; comparatively great as  it still  is with that of advanced child-
hood, and may perhaps still remain.  I shall close this Preface with
a proof of this happy abatement strongly marked  in Dr. William
Heberden's comparative view of mortality occasioned by two dis- 
                          PREFACE.                         XI

eases the most destructive to the infant race, at the beginning, middle,
and the close ofthe 18th century.

                           TABLE.

             Beginning,          Middle,          End.
   Rickets   .  .  380    .     .11     .        1
   Scrofula  .  .   70    .     .18          .8

   May future ages mark the like progressive diminution  in  every
 other  infantile complaint, arising from mismanagement. 
f 
INTRODUCTION.
ON THE
PROPERTIES OF HUMAN MILK
  If facts are the basis of sound reasoning  and the source of im.-
provements in science, they will be assiduously cultivated by every
investigator of the laws of nature; persuaded that,  howsoever mis-
applied for a season,  they must eventually confirm  his maxims,  or
correct his mistakes.   In this persuasion, the author's attention has
been repeatedly awakened by various publications, but especially  by
some  later observations upon   Human  Milk, by  Dr. Clarke  of
Dublin*
  Such a subject, while  it arrests the speculation of the  natural
philosopher, will further claim the physician's attention in  regard to
the influence  which  the diet of infants must ever have  on  their
health, especially that nourishment which Nature herself hath,  in
every climate, provided for them, at their birth: for it  is only from
a due acquaintance with this, that art is likely to supply  the fittest
substitute  when the natural cannot be procured.   Nor can the  in-
quiry be deemed superfluous in  a treatise embracing both the means
of prevention and cure of their diseases, nor form an improper intro-
duction  to this volume.   And it being Dr.  Clarke's express design
to dispute not only some of the  supposed constituent parts and pro-
perties of breast-milk, and especially  that of any true curdy princi-


  * Observations on the properties commonly attributed to human milk; on  the
changes it  undergoes in  digestion,  and the  diseases supposed to originate
from^his source of infancy.  Transactions of the  Royal Irish Academy, anno
1786
vol. in
c 
S
ON  THE  PROPERTIES OF
pie; but also various  ill effects conceived to be produced  by it in
sucking infants, and the means of relief; I seem to be com'-i'ed to
take some notice of that work.  Indeed, the spirit of inquiry mani-
fested in the essay is truly laudable, and the experiments set on foot
are worthy the notice of every practitioner in medicine; not to add,
that the establishment of the fact* whatever it may be, is likely to
become of general use; though practitioners, it is presumed, will not
readily agree with Dr. Clarke in regard to the extent to which he
carries his sentiment, any more than in all the  inferences he would
draw from it.
   Indeed, when  his observations  fell  in my way, I was, from the
first,  not a little surprised at the confidence with which he opposed
a sentiment almost universally adopted; and I determined assiduous-
ly to investigate the matter for myself.   For this, I knew I  had op-
portunities equal to those of Dr. Clarke, and I  pleased myself with
the idea of being, at any rate, a certain gainer; as I should, at least,
get at a fact which must in the result be favourable  to my general
pursuits.   I  must acknowledge, that I was inclined  to  suspect the
doctor had  been mistaken in toto, until repeated experiments, by
various means, and under a variety of circumstances convinced  me,
that there is certainly much less curd in human milk  than had been
commonly supposed,  and that  whatever the precise quantity  might
be, it is not very easily detected by runnets and acids; since  in  far
the  greater number of experiments  made upon fresh milk, not the
least could be perceived, though in a few, I seemed to be satisfied at
the time, that there was a small portion of true curd.f
   Surprised, as I indeed was, at the first result of these experiments,
threatening the subversion of an opinion entertained  for ages,  which
howsoever  unfounded, had been but little suspected;  no sooner  did
the essence of the fact appear to  be established,  by demonstrating
the paucity of the curd, than my wonder not only ceased, but  I con-
ceived there was every reason  to  imagine that  human milk should


  • Dr. Rutty, indeed, made the like experiments in the  year 1762, and Pro-.
fessor Young since, though with a less decided opinion, from similar results: and
it is presumed, that the experiments made in consequence ofthe present inqui-
ry, have set this matter in its true and proper light.
   How to account for the difference ot  opinion from the same experiments, <<:•
for their seemingly different results, consistently with the honour of those who
profess to have made and reported them, with equal attention and integrity, may
be less difficult, perhaps, than might be imagined.   In  regard to the principal
point in debate, however, 1 conceive, that some gentlemen have taken certain
congelations  for true curd, without putting them to  the proper test; whilst
others, from the like neglect, have  overlooked small portions of it, which have
been blended with other matters ; but  especially have  too much neglected one
obvious, though less common mode of discovering it; or in the few experiments
they have made in that way, have not allowed sufficient time for the curd to form,
as will hereafter appear.
  •J- Mr. Navier long ago, and Dr. Ferris in his Harveyan Dissertation, at Ediu
anno 1783, have adopted this sentiment. 
HUMAN  MILS.
$
be very much of the nature Dr. Clarke  had supposed; though he
should over-rate the result of his experiments, or his inferences be
unfounded, as I have since proved to  be the case.   It may be sus-
pected, indeed, that a partiality for a  mode  of practice, that myself
and  many others had long taken up, might naturally render me
anxious to support it  at any rate, and to accommodate every fact to
my prejudices.  However this may be, I  found that the attempt, in
the present instance, required very little  pains or  application, and
terminated in the perfect satisfaction  of my own mind; since the
like stubborn things (which are met with  every day in the treatment
of infants) cannot be accounted  for but in the way I have all along
done; and must evidently demonstrate the  existence of an  acid in
the first passages of infants, of what nature soever the food may be
on which they are  supported.   How this attempt was executed is
now of very little importance to lay before the reader, since the
mode and  number  of  experiments I have since made on  human
milk, prove to a demonstration  the constant presence of curdy or
true cheesy principles,  and must, therefore, totally subvert the prin-
 cipal arguments and  inferences of Dr. Clarke, were they much more
 specious than they are.  I shall, therefore, enter no further into such
 arguments wherewith a long experience has furnished me, respect-
ing the tendency to acidity in the first passages  of infants, (which
 became so  necessary upon the  supposition of there being no curdy
 principles in  human  milk,) than the  acknowledged small proportion
 of true curd may seem to demand; though, (as above hinted,) these
 might be sufficient to prove the point, were there even no curd at all
 to be discovered in human milk.  The smallness of  its proportion *
 however, with the resistance it  offers to acids,  as justly stated by
 Dr.  Clarke, is still in mv opinion  as agreeable  to reason, as the
 experiments  upon which  the  sentiment is founded  appear  to be

 C°Mankind,  during  infancy,  is certainly  amongst the most feeble of
 all animals that are  nourished in the like mode by  the parent, and is
 liable to more complaints, especially to disorders of the alimentary
 canal.   It is reasonable, therefore, to  conceive,  that his aliment
 'should be ofthe most easy digestion, light, thin, and verynutncious;
 at once affording as little labour to the stomach as possible ;ana easi-
 ly convertible into chyle, or blood.   We  accordingly  fin I  human
 U, though vciy^lin, ™«  2™^*^

  ETatu^d fTtisSe^e'rof  digestion  than other mi Iks
  owing to the smaller quantity of curd it  contains; which, wh.l  it s
  Z  nutricious than the other parts,  is also much more difficultly di-
  less nuinciou:. muui it      r   »         .         persuaded is 
4
ON  THE  PROPERTIES OF
but let us be careful  that we do not draw as unjust inferences from
truth, as have been supposed to  arise from error.*
   For does it follow, that if a theory be somewise erroneous, our
practice must necessarily be wrong? I think not; (or Hippocrates and
Galen must lose sight of their clinical renown) being persuaded that
experience, and the closest attention to facts, will confirm the general
mode of practice enforced in the several editions  of this work, and
in some part before recommended by Harris and his followers.  Let
us, however, consider the arguments and inferences alleged by Dr.
Clarke against the hypothesis of a prevailing acidity in infants, and
noxious coagulation of the milk,f which writers on their  complaints
have uniformly established; and, contrary to Dr. Clarke, conceive to
be a principal source of their complaints.
   Not that they attribute almost all the diseases and totality amongst
infants to that source alone, as Dr. Clarke has imagined; who does
not  allow  due weight to other co-operative  circumstances they
mention,  considering them  merely as predisposing causes; parti-
cularly the  extreme  delicacy of their  frame.  For it is certainly
through this extreme delicacy,  that infants  sink  under complaints,
which to adults are often little more than inconveniences, and prove
in some respects an advantage, by exempting such habits from the
more dangerous disorders of athletics.}
   The atony of infants, therefore, whilst it is a predisponent cause,
proves likewise an occasion  ofthe severity of their complaints, and
ofthe great fatality attending them; and this fatality arises from dis-
orders of the stomach and alimentary canal: for how very  few infants
die in the first months, in whom these parts are not, both  at first and
last, the evident seat of disease;  and with what difficulty are  many
others preserved from similar complaints, especially children brought
up by hand?
   Having premised these things, and illustrated  the nature of the
debate, let us proceed to the particulars stated by Dr.  Clarke;  who
having pursued this important subject at some length, and given his
arguments every due advantage, I beg leave to bespeak the reader's
pardon, if in following him through it, I should seem  diffuse, if not

   * I am sorry to find Dr. Clarke expressing a suspicion that his opinion may not
be readily embraced by other physicians.  There are, doubtless, many who are
glad to collect facts from any quarter, and to entertain truth in every form, and
such will always be open lo every well supported inference from them.
   f By the term coagulation,  or curdy matter, made use of in  this and other
places, it is not meant to assert, that the milk always separates into  proper curd;
it having been granted, that although it certainly does contain  true curd, it is
not so readily separated by acids (out of the body) as the curd of quadrupeds
is; but as human milk abounds with an oily or buttery part, it is disposed  to
jelly or coagulate into a pretty firm mass offensive to an infant's stomach.  And
this kind of coagulation aUo takes place out of the stomach, from an admixture
of an acid with human milk, equally as with cows.
            t Aeidum  eructantes non sunt pleutitici.  Hippoc 
HUMAN  MILK.
G
tautological, in purposely stating diversified views of facts, in order
more clearly to exhibit their decided result.
   The first* observation of Dr. Clarke that I shall notice, regards the
fact in question, and upon which he grounds his objections both to
the concurrent sentiments and practice of writers on the diseases of
infants.
   " Women's milk, (says Dr. Clarke) in  a  healthy state, contains
no coagulable, mucilagmous, or cheesy principles, or that it contains
so very little as  not to admit of sensible proof."
   Coagulating principles, unless that term be used in a very precise
and limited  sense,  every  nurse must have frequently  observed, at
least in their effects; since large flakes frequently appear in the mat-
ters thrown up  from the stomach of  unhealthy infants.  Whether
these  congelations  be owing to  some  small  portions  of curd, or
cheesy principle the milk  certainly contains,  (Which may possibly
be too small to account for their frequency and quantity;) or to an
oil, fat, or butter, is not of  importance to the fact. For human milk
certainly contains  a much  larger proportion of cream, or fat, than
cow's milk does, as is evident both from the natural, as well as an
artificial separation of it by different kinds of acids; and from whence
result certain coagulations*  And perhaps this,  as  I shall have
occasion to  remark,  might serve to account for  the symptoms of
 acidity,  and the rancid and acid matter so prevalent in  infants,
 and for the various effects of absorbent, alcaline, and  lightly cordial
 remedies, without a reference to any true curdy principles in human
 milk; which it is presumed, however, Dr. Clarke in this place pre-
 cisely intends.                                  .              .
    I proceed, therefore, to  observe, that the assertion of  Dr. Clarke
 as to this great point in question, is, in  no view, strictly just; since
 it is insisted, that there certainly is a portion  of true  curd in hu-
 man milk; which, as Dr. Young has remarked,  separates spontane-
 ously.  Dr.  Clarke, in his remark upon this observation, I know
 not why, concludes, that it is stated by Dr. Young merely as " mat-
 ter of opinion, and not the result of any experiment."   Nothing
 further, however, is necessary than to make it, and to wait a suffi-
 cient time for the result;  no particular degree of heat being neces-
 sary, in any of the various experiments I have made though so stated
 by Dr. Young.   But whence it is, that runnets, acids, and spirits do
 not always separate any very sensible quantity-of .this curdI in the
 course  of  eight and forty hours, as they constantly do from cow-s
 milk, and  wherefore a much longer time seems to  be necessary for
 lis spontaneous separation, I  am not chemist  enough to offer any


    . It is notorious that ^^^^
  Sla^^S SSh'SS.-^ matters offensively acid. 
6
OJ*  THE PROPERTIES  OF
opinion, and therefore confine myself to  the  fact: observing, how-
ever, that this peculiarity is doubtless, to answer some wise purpose;
and very probably, may be a principal reason of womens milk agree-
ing so much better with infants, than the milk  of every other animal,
and  it is  hoped,  may in  time furnish some  very useful practical
observations.
   Dr.  Clarke's next Observation relates to the time, in which human
milk becomes sour:  upon which he remarks thus:
   " If we find human milk out of the body so very slow  in running
into an acescent state, does it not afford strong  presumptive evidence,
that the milk of nurses cannot be so very prone to  run into acidity in
the  stomach of infants as authors endeavour to persuade us?"
   To this it may be  replied, that though  human  milk,  out of the
body, does not, indeed, run into an acescent  state so soon as cow^s
milk does, (and for the full establishment of  this  fact also, we are
much  indebted to Dr. Clarke;) yet, I think, that experience, (which
must be allowed to be full as good evidence as any experiments can
be)  as fully demonstrates, that like  many other milks, and most ve-
getables, it is much more disposed to occasion acidity in the stomach,
than food prepared from  pure animal juices.  Moreover, it is not
usually so slow in acquiring an  evident acidity, even  out  of the
body, as might be conceived from some experiments Dr.  Clarke has
industriously made, and I doubt not as fairly reported; for at the end
of four days, and even sooner, I have sometimes met with it full as
sour to the taste as cow's milk, kept the same length of time, though
this is not usually the case;*  and when become putrid (by that  test)
which I have known it to be in ten days, it  has been equally so with
cow's milk.f  And surely it  is not imagined, that human,  or any
other milk, remains on the stomach long enough to become acid from
that spontaneous separation of parts which takes  place in the dairy;
and therefore the question is not so much, in  what time it will be-
come so,  as to what degree, or by what means, this change may be
effected:  and in these respects, it is found to differ little from the
milk of quadrupeds.   For though runnet does not always separate
true curd in any sensible quantity from breast milk, out ofthe body;
  * Dr. Clarke also takes notice of a variety in this respect.
  | It is worthy of remark, that so far from human milk  being usually indis-
posed to be much changed by long keeping, as Dr. Clark* has observed ; it has
not only always become putrid before I have thrown it away, but that about three
quarters of a pint -which I kept (in  a basin) at the hospital, only a fortnight,
for the purpose of collecting the curd by a spontaneous separation, had rendered
the room, for more than a week, sensibly offensive to every one who entered it;
but was so very fetid when I strained it off, that the matron who assisted me, be-
ing less accustomed to putrid effluvia than I have been, was disgusted by it ex-
•eedingly. 
HUMAN MILK.
7
yet, not only will it render human milk as acid a3 it doth cow's milk,
but true curd also being found in the pukings of infants when most
vexed with acidity, (as will be stated in its place) seems to demon-
strate the means of its separation, as well as the fact and degree.
   Dr. Clarke, indeed,  speaks of human milk kept in a  phial  for
more than two years, at the end of  which time it has become only
moderately acid; whereas I have often found  it  very sour, according
to his own  criteria with chemically  stained paper, in  four  or five
days, so that one would be led to suspect, that like putrid  waters,
the milk must have depurated  itself by some kind of fomentation.
And  though it was  rather ludicrously that this idea first occurred to
my mind, I have been since disposed to think, that both human and
other milks, when preserved  from the air, are capable  of such
changes; having observed both womens and  cows milk, at  the end
of many weeks, become entirely without taste or odour.*  The lat-

   • In further vindication of the above sentiments, the author may, at least,
offer the following statement; for the accuracy of which the reader's implicit
 j-redit is requested. It respects several portions of human and cow's milk, with
observations on their changes taken precisely as dated below.

   On one portion, preserved in a phial, and well corked, it is noted

             Human milk, procured, Nov. 22, 1790.
             Nov. 25 Now, rather tart to the tast«-
                  26  very sour.
                  27 not fetid  to the taste.
                  28 smells very fetid.
                  29 fetid taste.
           1791, Jan. 1 very fetid, now.

   I examined this milk just before this volume went  to the press, (in March
  1795, not having noticed it before for near a twevlemonth;) and found it turned
  ofa'dirty brown  colour, and smelling exceedingly fetid.        ...
   Another portion of human milk,  procured within a lew day of the above-
  mentioned, and preserved in a phial, no better corked, did not at this time smell
  at all fetid  nor disagreeably acid, although it had so smelt and tasted, a long
  time before, was not changed in its colour like the former, but seemed merely to
  have undereone the natural separation into curd and whey.
    IcarSy examined these two portions of milk, Nov 11th, 1797, and found
  them in nowise changed since the former  examination in March 1795.)
   (Whiteth Uwork was in the press, Afay 1799,1 examined these portions again,
  and  couW Te^nsible of no change, though they had then been in the phials

  Ti^oTSTmilk *»« a ™"th after the fi-t-mentioned,  I found at
  lhUtKe%£«*^95) changed exactly in like manner  in its colour, and dc

  C%^of^                  "ini ™St ^edly more offen-
   . v? m* P°*ll0n  ,V,i"„ thP human milk 1 (May 1799,  t was in the same state.)
  ^ZmX£^&*™^«^ was,at r ,same lir ?r}
    Hunun mine «»»" *  .    ',  seua,.ate<i  mto curd and whey, and without
  preserving  >U colour,  ^^f,^^^,^ more acid taste than cow's milk,
  the least acid or put  d sme"' »n" "d ^  d d    nor wa9 lhere any noise nor

  SSWJta homan'and cow's milk, which hud changed then- colour. 
8
ON  THE  PROPERTIES OF
ter kept on my mantle-piece, over a large fire, has not been fetid a(
the end  of five days, and was by no means more offensively acid to
the taste, than I have known human milk become in four days. And
it is further worthy of remark, that out of several parcels of human
milk, preserved under precisely similar circumstances, some became
very sour and even putrid to the taste, several days before the  others
seemed to be at all  changed.   And as this variety occurred  under
repeated  experiments, it may assist in accounting  both  for the fre-
quency of bowel complaints  in  some sucking infants  which  other
children are free from,  and for the frequent good or bad effects of a
change of milk, whether occasional or more permanent: and has not
every physician of experience seen infants frequently thrown into tor-
mina immediately after coming from the breast of an unhealthy  mo-
ther, or one who has but little milk?
   In regard to the means by which this acescency may be produced,
we know very well,  how very small a portion of the prepared calf's
stomach  is requisite for making sufficient runnet to separate the curd
from  a large quantity of milk,  and communicate acescency  to  the
whey; and is it at all improbable, that the infantile gastric juices,
assisted by the  natural  action of the stomach,  by  surrounding and
mixing with  the milk in every point, may operate much more power-
fully upon it, and dispose it to become so sour and curdy,* as  to of-
fend that organ, if it  should not soon pass into the intestines?! which
it is presumed it ought  always  to  do    Moreover,  acidity seems to
be one of the states  iato which all animai and vegetable substances
naturally, or very frequently run,J in the course of digestion, or  fer-
mentation, equally constantly with that putridity or fetor  which pre-
cedes their dissolution, or separation into first principles;  and,  there-
fore, in a certain degree, probably ought to take place in the stomach
or small  intestines, as the fetor does in the lower bowels.   The lat-
ter is never so great in infants as it is in older subjects, though  adults

  (On Nov. 11th, 1797, this portion also continued in the state above described.)
(And in May 1799, it was nowise changed.)
  * It  is elsewhere observed, that the separation of the curd from the whey is
the natural process of digestion.
  f In proof of the powerful operation of the gastric juices, while in'the sto-
mach,! may here advert to the well-known fact of that viscous being frequently
found corroded a few hours after death, (as I have myself seen it;) and I ima-
gine, it is generally, though not universally believed in this day, that the corro-
sion has taken place subsequent thereto, and that the gastric juices have only
acted upon that part, as they would upon any other animal substance divested of
the vital principle.
  * Perhaps this may not be the proper and natural course of digestion, as Dr.
George Fordyce has taken great pains  to demonstrate; yet are the first pas-
sages in most people so disposed at times, that through indigestion, acid matters
are very commonly formed.  And it is worthy of remark, that  the late Mr.
John Hunter always found the gastric juices lightly acid in everv healthy animal
that he examined. 
HUMAN  MILK.
9
should for a time live only on a vegetable or milk diet.   A princi-
pal reason probably is,  that the bile is weaker in infants; but being
at the same time a less powerful corrector  of acidity,  it is likely
they may be, on that account, more disposed to the latter; and, per-
haps, ought to be.  Nor can I see, wherefore that very probable
evidence of an abundant acidity in the first passages of infants aris-
ing from the very sour smell,  and curdy appearance of both the
vomitings and stools of many infants, and the uniform relief afforded
them by  a proper use of absorbent and alkaline remedies, should not
have much more weight in the argument, than can be brought against
it from experiments made on  human milk, out of the body, and its
acknowledged indisposedncss to turn sour so soon as cows' milk: for
we know, with what extreme caution we ought to apply both chemical
and physiological experiments to the explanation ofthe  phenomena
of diseases.   Not to insist again in  this place upon the idea already
suggested, that breast milk is not supposed to remain long enough
on the stomach to separate  into curd  spontaneously, in  the manner
of cows'  milk kept in a dairy; it is sufficient to advert  to facts; both
the smell and curdy appearance mentioned above, and the relief af-
forded by medicine, being  exactly alike in  all indisposed sucking
infants, as in  children  who are brought up  by hand, although the
latter are,  indeed, more frequently afflicted with such bowel com-
plaints.  The great difficulty also of adapting food to infants brought
up by hand;  and the frequent recurrence of all the ordinary  symp-
toms of indigestion, with the  relief frequently afforded them by the
substitution of broths for cows' milk; may serve to strengthen the idea
of a disposition in the first passages to generate wind and acidity in
the digestion of their food, and to  coagulate every kind of aliment
capable of coagulation by the gastric juices, especially if not in their
most natural and sane state.
   But as so much of Dr. Clarke's argument turns upon  there being
very little or no curd in human milk, it may be asked, is it, indeed,
a well ascertained fact, that the flaky matters brought  off the sto-
mach of infants nourished  by cows' milk,  is usually proper  curd,
any more than that ejected  by children nourished  at the  breast? for
it is possible it may be the  fat or buttery part, or only a very small
portion of proper curd,  in the one case as well as the  other:  and if
so, the whole  force of the  doctor's arguments, and his consequent
objections to the popular plan of treatment, may, possibly, fa 1 to the
sround; for the symptoms, complaints, and remedies in  both cases,
ft has been said, are the same, and are well accounted for by a sup-
posed prevalent acidity in the  first passages, and a proneness of their
intents  to be, in some sort, curdled by it.*  Of the generation of an

  • That  the acid ofthe stomach  is capable of forming proper curd I have no
d0,.li hiving noticed it frequently, and sometimes ,n large portions.  And, in-
deed, I have^Jneot these still by 'me, preserved in spirits, of above an inch m

   VOL. III. 
10
ON  THE  PROPERTIES OF
 acid in the stomach, however, 1 have incontestible proofs in several in-
 stances, in the pukings of infants nourished only by breast milk, which
 changed blue paper red, upon being applied at the moment the} were
 brought off the stomach.
    For the like  certain detection of true curd, I  endeavoured for
 some time together to make experiments at the hospital, upon the
 pukings of infants nourished only at the breast; but either the nurses
 there did not attend sufficiently to it, or the  quantity they could pre-
 serve was always too small, or too much blended with other matters,
 to ascertain, with precision, whether they contained any true curd or
 not.   But since that time an opportunity presented in private prac-
 tice, in an infant who  I was well assured was nourished only by the
 breast.   Having sucked very plentifully, the child became sick, and
 throwing up  a mouthful of strong cord, I look up a lump of it, about
 the size of a nutmeg, which adhered together firmly, and was pretty
 free from other matters; leaving behind in the basin a larger quantity
 divided into  small  portions, and too much entangled with  a viscid
 phlegm  to answer  my purpose.  The  portion I took  out, together
 with some slimy matter adhering to it, weighed twenty grains, and
 when separated  from every thing that could be squeezed from it, or
 evaporated by heat, exhibited one  grain  of hard, caseous  matter,
 which exposed  to  the  flame  of a  candle,  burned,  and smelt like
 coarse cheese; but  being before divested of all its oil or butter, waa
 incapable of being melted.  And according to similar experiments
 made upon human  curd, dried in different  degrees,  I imagine that
 the above-mentioned portion, previous to its being reduced to the
 consistence of hard cheese,  might contain six or eight grains of soft
 curd.
   I think this may be considered as a decisive proof, that the gastric
juice  can separate curd from breast milk in the stomach of infants,
 and I believe is no  uncommon thing;* nor was it long before I met

 length, and half an ineh in thickness,-which was many years ago puked up by an
 infant I was attending; but whether the child was brought up by hand, or not,
 I do not now at  all recollect.  While the present edition was in the press, another
 little patient threw up a like piece.
  * By this mean it is, as I have elsewhere remarked, that in the ordinary course
 of digestion-, the thicker parts  are  always separated from  the  whey; but  as
 breast milk abounds with oil or butter, the viscid matters thrown up often ap-
 pear more like rlotted cream  than true curd: nevertheless, either from the
 milk remaining  for an undue time in the stomach ;  or from  an excess of acidi-
 ty ; or, perhaps, other circumstances concerned in digestion not always known
to us, the separation ofthe component parts becomes sometimes more complete,
 and true curd appears. How far this may be owing to infants being in an  ill
 state of health,  to fever in particular;  or simply to weak digestive powers, and
a depraved state of the gastric juice; time and attention to  their complaints
may possibly discover; but, at present, I am inclined to think, that the gastric
juices, (which  are at  all times lightly acid,)  always possess  this property,  as
they certainly do of separating the curdy  of cows' milk, if it should happen  to
stay a sufficient time on the stomach.  This we also know to be the case with
many adults. 
HUMAN  MILK.
11
with another instance equally  satisfactory.  This infant,  at  eight
months  old, was attacked with severe peripneumonic symptoms,
which were at that time epidemic among children; and several times
threw up curdy matters soon after  taking the breast, which was its
only nourishment.   The nurse twice preserved the cloth upon which
they had been received, from which I scraped them, and after proper-
ly pressing and  drying them, I  found, that about the one-third part
turned  out  to be pure caseous matter, burning  in a candle, and
insoluble like the former;  and in this hard and dry form, weighed a
grain and a half.*                                       .       ,
   Now if, by the above, and  other arguments and facts, it shouW
appear, that human milk, from whatever cause,  does actually be-
come both sour and curdy, in different ways,  and that infants are
 frequently injured by  it;  the less  disposed thereto it may naturally
 be, the more we may, indeed,  be led to admire the wisdom  ot Pro-
 vidence,  that women's milk should, in that respect, differ from the
 milk of many other animals; yet mere presumptive evidence against
 frequently turning  sour, in the stomach of infants, cannot invalidate
 the fact of this  being  sometimes the case, and may, possibly, much
 oftener than has been discovered, or suspected.       '
    Dr.  Clarke himself, indeed, seems to be aware that .here may be
 reasons for such a supposition,  and therefore says:
    « In the adult state, we know that there are few  morbid causes
  less noxious to the human body than acidity, and few more subject
  to the control of medicine."                                .    .
    This position, though, in a  certain sense, a very fair one, i  not
  wholly so, when taken with  all  the  inferences  which  Dr  Cla ke
  wou kldeduce from it: for if the acidity be very great, and the cause






  tion Naturally  produces ac d ty, and is mcreased by t,« wc ^ m
  ma„y pregnant women, and m various^affecUons  ^^'Ibo
  ticularlywhen it  is diseased in ^X^aftenvards examined,
  died of a scirrhus m the s«°>acw «>  ^ ^        >
  wai, tormented forthe la.  «*mon            ^ ^ fc     ing) by
  acidity; which though often relieved,   p     y^ ^.^

  ^T^Tho^nSy^ved;  so that he spat  up ac.d
never
exposure
true curd> _
there is no oil or butter. 
u
ON THE PROrERTIES
matters all  the day long, and died, after  a very tedious  illness,
perfectly emaciated, though he took a sufficient quantity of food of
different kinds.
   L>r. Clarke goes on to make further concessions.
   " But granting (says he) such acidity to prevail in infants, we arc
in possession of many harmless medicines (called absorbents) capa-
ble of neutralizing acids, and thus forming innocent compounds."
   We have, indeed, many useful  remedies in such cases, but none
that will certainly remove the complaint, either in  infants or adults,
until the state ofthe stomach be changed; which in infants is often
effected by time.  For comparatively light as the evils of a disposi-
tion to acidity most certainly are, when it is light or transient, it be-
comes even in adults a  source of manifold infirmities, when depend-
ing upon  some permanent cause, as  has  been above stated,  which
cannot fail occasioning an almost  daily return of every troublesome
symptom.   A viscid phlegm also, instead of a harmless compound,
often results from the alkaline  remedies and natural acid, (commix-
ed, as they may be, with  other heterogene6us matter,) which, though
insipid, is very indigestible; and at other times,  a more offensive
acrid matter is formed  in the stomach of many adults, and  is with
difficulty got rid of where the digestion is weak; and is continually
adding to  the  complaint.   Every practitioner must have  met with
many such cases;  and from one  more immediately under my eye,
whereby I was for a long time  witness to the effect of an atonic state
of the stomach, I can speak very confidently to the point.  This pa-
tient was of a spare, and delicate  habit, very sober, and remarkably
free from almost every complaint, but those immediately arising from
a weak stomach, as it is called.  This sensible organ, however, was
easily  put out of order, especially by butter, vegetables, milk, and
similar things disposed to generate wind or acescency in their diges-
tion, and was at such times loaded with acidity; which though often
corrected  by alkalis and  absorbents, the stomach would, at other
times, eject  matters in so very acrid a state as would instantly render
the fauces of a  deep scarlet hue, produce soreness of the  throat, fall-
ing of the palatum molle, excessive hoarseness, and some difficulty
in swallowing, which  would  remain for many hours.  After long
vomiting,  a bitter matter would come up, sometimes of a light, at
others of  a deep green colour; but rarely yellow,  though evidently
bilious.  Sometimes, upon taking alkalis and absorbents  previous-
ly to vomiting,  the  acid would  be  neutralized, at others, no quantity
would render the juices bland; but instead of an acid, a heavy, acrid,
and most  viscid phlegm  would be ejected,  inflaming or flaying the
fauces, in the  manner just mentioned, and  in this state no kind of
medicine had  any  good effect; though previous to the  acid  matter
(the source  of the  complaint) being  changed into this acrid state,
alkalis and  absorbents very frequently prevented vomiting; which,
however, nothing could do after the contents of the stomach lost their 
OF HUMAN MILK.
13
acidity, and became acrid: so far were they from being usually con-
verted into a harmless  compound.  It was  only after being many
years tormented in this way, and having daily  recourse to alkaline
and absorbent  remedies, columba  and bark joined with  steel,  and
other powerful tonics, with exercise and a scrupulous attention to his
diet, that he was sensible of any abiding amendment;* though from
the great benefit he at length received, by a strict adherence to such
a  plan,  it  may  be presumed he  had no morbid affection of the
stomach, though that had been often suspected.
   Excess of acidity, and an acrid, ropy phlegm, are, indeed, the well
known  attendants on an imperfect digestion, and will recur in many
adults,  feed on whatever they may;f  though the evil must, doubtless,
be increased by certain kinds of aliments; and of that class are those
administered to infants.   If adults, therefore, of a similar habit  to
that just now  stated,  though  in  the end often restored  to perfect
health, may continue for a long time greatly tormented, whilst the
most powerful correctors of acidity, and known tonics are had re-
course to; and  if improper  food be occasionally received into the
stomach, their complaints will at such times be  greatly aggravated;
wherefore should it be supposed, that delicate infants must always  be
restored, if  the breast-milk, as well  as other  nutriments on which
they  may feed, be  confessedly,  to a certain  degree, disposed to add
to the complaint.  And can  it be urged from any experiments made
on human milk, or will Dr.  Clarke or others affirm, that  it is so ut-
terly unlike every other milk, and even  so much more anti-acid than
animal food, that it has nothing in it likely  to become sour (save  in
a few weakly children) by an admixture ofthe gastric juice ?
   I now proceed to Dr. Clarke's remarks respecting the green colour
 sometimes observed in infant stools.   Dr.  Clarke doubts of the ex-
 istence ofthe supposed predominant acid, of which that  colour has
 been imagined to  afford some  evidence, because, he says, common
 acids do not give that tinge to the bile out ofthe body, and that only
 mineral acids give it a green colour.
   But as some kinds of acids can produce this effect, it cannot surely
 be proved, that  the natural  acid of the stomach and bowels cannot
 effect the like;  especially when  it is considered, that in adult persons
 affected with dyspepsia, bitter matters of a green colour are frequent-

   * This, perhaps, might be further promoted, by his  becoming now full forty
 5 cars of age.
   + I ronceive that this habitual acid affords a too great and improper stimulus
   -f l concede, ui.u. l" '     Mr;t:n„ both a superabundant and morbid secre-
 to the glands of the stomjach  exatmg botl a  p          exceedingly viscid,
 tion.  By th.s means, *«  f J»tri« J^c|^ ££' membrane from the stimulus of
 (in the manner of the*c»to°nh^ tenadous from mixing with the acid,  and
 a cold,) o';afte:wn^d(f^°sToemach  Thts seems probableffrom the vast quan-
 ill digested contents  of^theJ*0™*-  * J.  , , has' been observed, people long
 S^wM* 3S *S2^^« the stomach for hours together,
 andfrequentlyfo/severalsuccessive days. 
11
ON  THE PROPERTIES
ly ejected after very acid vomitings, as it has just now been remark-
ed.  And though as Dr. Clarke observes in a quotation from Syden-
ham, " porraceous  matters are ejected by children who have been
over-purged or vomited, and by  healthy  adult  persons when sea-
sick;"  yet the  like appearances under such circumstances can scarce-
ly destroy the conclusion; since  all such violent agitations of the
chylopoetic viscera, by disordering and perverting their due and na-
tural action, upon which the  same state of their secretions indubit-
ably depends, may sufficiently  account for the  sudden forming  of
acid, acrid,  or any  other  unnatural and unhealthy gastric juice,  as
well as for the vomiting up of bile, which in  its passage will certain-
ly be mixed with it, and be somewise changed from its natural colour.
And, indeed, Sydenham's  reasoning upon this subject, a little further
on, is of a similar kind, though  expressing himself in the language  of
that day, he  attributes this  foreign, or morbid secretion, to  a con-
fusion  of the animal  spirits; which, indeed, for any thing I know,
may be a remote cause of  it.  It should likewise be considered as  of
some importance in the argument, that it is during the  time that in-
fants appear to be affected  by a predominant acid in the first passages,
that the dejections and vomitings are of this  green colour.  Upon the
whole, therefore, the prevalently sour smell of some  infant stools,
which  Dr. Clarke thinks so very nugatory an argument, seems to af-
ford much better evidence of the presence of an acid, than his argu-
ments  can be against the change of colour by such a mean.   More-
over, I may affirm, that the green stools of sucking infants, and even
some stools that are of a bright yellow colour, do  certainly contain an
acid; having detected it under repeated experiments made with blue
paper,  the instant the stools have come away;* however it might
turn out in the experiments made by Dr. Clarke.   And  I may, there-
fore, possibly be allowed in my turn, to express some surprise at the
confident manner in which Dr. Clarke has  taken upon him  to dis-
pute the fact.                      t
   But  Dr. Clarke observes  further, that " Those writers  who have
laid the greatest stress on such appearances in infancy, do not pre-
tend to apply the information to be derived from thence to  the treat-
ment of the diseases of adults."
   I, probably, do not fully comprehend the import of this observa-
tion; for the information mutatis mutandis is most certainly applica-
ble, and the complaints of each arising from acidity are capable  of
cure or relief, in the same way, viz. by alkalis, tonics, and aromatics,
with a well  adjusted diet.  I have  intimated, that the  doctrine  is
partially applicable, because the bile of adults  being  more exalted
and acrid, or otherwise stronger,  (if I may so speak,) may not upon
meeting with  the like acid, change their stools just to the same co-

  * These experiments were made before witnesses at the British Lying-in Hos-
pital. 
OP HUMAN MILK.
15
lour of those of infants; nevertheless, the stools of adult persons, tor-
mented  with acidity, especially under peculiar aggravations, are of a
much paler colour, than those of people of much stronger digestive
powers, and as I have always  thought, through a deficiency,  or  ill
concocted  state of the bile.   And here it may not be  improper to
consider the very material circumstance of the very different diet to
which adults are addicted, as well as the medicines they may take;
which, it is well known, often affect the colour and smell both of the
stools and urine, in the course of a few hours, as the stools of infants
(though ever so green before) are changed in their colour upon taking
rhubarb, saffron, and similar  medicines;*  while the  diet of  infants
being perfectly  simple,  the contents of the bowels are  likely to ac-
quire no other colour than that of the  bile itself, (as  is  actually the
case in a healthy child,) or such as through their accidental property
may be chemically induced by the admixture.  Not to add, that the
urine in healthy adults is usually of a much  deeper colour than that
of infants,  and is also not unfrequently occasioned by a certain diet,
as  well as by medicines; and varies  with  them.  And perhaps it
may be from a similar natural  tendency to a very dark colour, that
we find the first stools of new  born infants are not truly green, though
often of a greenish black;  nevertheless, there is sufficient acidity in
their gastric juices to occasion the stools voided previous  to infants
taking any kind of food, to tinge blue paper red,  (as I have found by
careful  experiments,) though such stools contain a very large propor-
tion of  bile.
   These observations, it is imagined, may apply to Dr. Clarke's re-
marks in  regard to the colour of the stools of adult  persons, vexed
with acidity,  which  he says are not of  a green colour  like those of
infants.  And in respect to  ejections from the stomach when so
tinged,  it seems to have  been a- constant  remark, that bile lodged
there has been diluted by an acid; to  both of which, physicians  are
in the habit of administering their appropriate remedies.
   Doctor Clarke goes on to say,
   " Upon the whole, I hope it will appear probable  to  the generali-
ty of readers,  that predominant acidity in the first passages, is by no
means so general, as  to be considered  as the only, or even principal
source of infantile disorders; that such a morbid cause may now and
then occur in infancy, as in adult age, from a weakness ofthe stomach,
costiveness, or improper food, can admit of no doubt."
   This inference is surely far from being made out from all that  has
been advanced—but let us consider of what the arguments consist.
« Human  milk out ofthe body, does not turn acid so soon as cows
milk does;" (but cows' milk requires twenty-four hours or more; a.

  • Sninace and other things impart their colour to the stools of young child-
ren.inaway they do not to heahhy adults; and perhaps, from their d.gesm*
powers being weaker. 
16                  ON  THE PROPERTIES OP
much longer time than the milk remains on the stomach;)  " nor the
common acids curdling the milk of quadrupeds produce scarce  any
sensible curd from human  milk;  (though the quantity  is certainly
greater than Dr. Clarke has supposed;) that only mineral acids will
?in«*e the bile of a green colour; and that in the adult state few mor-
bid°causes are less noxious than acidity, or more under the control of
medicine;" (though it has been proved but partially so.)   To con-
clude from hence, that acidity in  the first passages ought not to be
considered as so general a cause of infantile complaints, or to be of
such dangerous consequences as it may usually have been imagined,
does .not appear to me to  be perfectly founded; nor to  be evidence
sufficient to subvert the arguments and evidence  adduced in support
of that sentiment, in connexion with the acknowledged atony of in-
fants.  It is true, indeed, that ex niliilo nihil fit—if there be no curdy
principles in human milk, no species of acid in the stomach can bring
curd out of it; yet may the combination of an acid and milk offend
the stomach otherwise.   It has been observed, that all common vege-
tables, butter, and even bread, are often very imperfectly digested by
adult persons with a  stomach overcharged with  acidity; yet is no
part of such aliment necessarily  converted into  any thing  like true
curd; though  the stomach in all such persons is as certainly offended
by the curdling of cows' milk.
   Nevertheless, I have hinted  long ago* that  simple  acidity may
not, in the first instance, or in a general way, be necessarily so inju-
rious  as some writers  have contended, and that  infants  suffer  more
severely from an acrid matter, (less capable of correction by absorb-
ents than by aromatics,) which, though it originates from a predomi-
nant  acid, generally becomes so very offensive in conjunction with
some other cause, be  that a peculiar atony, or  otherwise; robust
children being always far  less disordered,  though not wholly free
from  some ofthe vexatious symptoms of  acidity.   Upon the whole,
however, I am persuaded, that acidity is accidentally, and, in fact, a
frequent source of mischief, and that because it is so constant a con-
sequence, and further  aggravation, of indigestion, in such  adults as
have  what is called  a weak stomach.  For it is, perhaps, only in
adults of a lax fibre, approaching to the atony of infants, and not in
athletics, that we meet with that morbid source  which Dr. Clarke
observes sometimes occurs  in adult persons.   And if the stomach, or
digestion of infants be naturally weak, why should we not expect to
find them peculiarly liable to acidity and  its consequences? the  state
of stomach being certainly the grand source of general good, or bad
health, at every age.   And, indeed, were I to say no more than that
infants, in proportion to the greater weakness of their digestion, must
be more disposed to acidity than  adults, with many of whom  a milk
diet always disagrees, (and is the infant's constant nourishment,) it
* In the very first edition ofthe subsequent tract. 
IIUMAN  MILK.
17
were saying a great deal towards subverting the whole that has been
advanced by Dr. Clarke against its prevalency, in connexion with
the general atony of all young infants, being a principal source of
their complaints.*
   Dr.  Clarke concludes by  observing, that " the  young of all the
ruminant animals, fed on milk of a much more acescent nature, suf-
fer no  inconvenience from this source."  To such laconic arguments,
I think it might be fairly replied,  that many ruminant animals can
eat, and digest, bones; and  hop about, likewise, when  their  own
bones  are broken or dislocated, without manifest injury, or much ex-
pression of pain. And in this view I might adduce the remark, made
elsewhere,f on the rank which animals severally hold in the scale of
beings:  it being very evident, that besides the  ground of comparative
health and disease arising from the bulk and  strength of various ani-
mals,  there is that of their several ranks  in that  scale, commencing
with man, the  head, and extending from the invaluable sheep,  the
cow, or the horse, to the lowest of our domestic animals, and to rep-
tiles;  the more noble and useful (from whatever cause) being,  I  be-
lieve,  uniformly subject to the most  and severest disorders,   lhus
 the fragile worm daily survives some kinds  of  injuries  which  the
 sturdy ox could not; while the delicate infant would sink under that
 Which  the lamb  could  with safety endure.   But what should  we
 learn, on  the  present  occasion,  by pursuing  such comparisons?
 « Man  (said one) is  not a fly"-no, nor yet a tyger.   Such  argu-

   • Since the former edition of this work, and subsequent to two or three let-
     since meionnci w"   ri__t- i,as offered a few observations on some in-
 rr^n^^                                 of the Royal ,rish
 tortile MmPXh-i PinUns «°e present debate is, an observation on green
 Academy.  All that concerns tne P"»         d a '   curious observation it
 stools  voided by  an infant he was •'gj™*'^^/* yenow colour after the
 is; the nurse having »torngd han/*^g^££! ^this rep0rt the doctor
 ^yi«i«t««»«^JJ3J^      Joarto depend

 up^ome^                     »e **R* ab0VC ^^ ^
 reS^e^rSnts,not inper^ct^^^^^^^
  low colour, will turn green upon beingjtept^twelve or^niy      b    ,' must
  have been observed by every ^^^^^fuSS^ltow, whatever
  confess  that I never before have heard °{ f^en^0b^7n\L l.abit of paying
  the infant's complaint may have been.  J^ave  nowjeen "        ,  •  £ £
  attention to children's stools tor many^years  ^/^^"n preserved, for two
  a daily attendance, a great numbe'*<^™\™kl change common,  I am
  or three days, for my inspectionso^ that, were suc^       s  articu,ar doths
  persuaded, I could not have faded to />*'£ ^pW£*a corner of the room,"
  shown to Dr. Clarke might meet with.• on^th^JSiwce thefe      fae -n
  to account for such a change;  or ^"^^Xefore, for the present,  shall


   anftfs^
   Jeft the fair inference from innumerable facts.
                         | Vol. I—page 3, Note.

     vol. in- 
18
ON THE PROPERTIES OF
ments, at the best, are very equivocal, and one might be set against
another without end.  We do not, for instance, suspect that quadru-
peds in a state of pregnancy, are tormented with acidity or heart-
burn any more than their young are  from the curdy principles of the
milk by which they are nourished;  but we are  certain that  many
breeding women are afflicted with such complaints for a great length
of time, feed on  whatever they may.  It is confessed  also, that the
milk of quadrupeds abounds with cheesy principles, and that human
milk contains a far less proportion; (or according to our author, none
capable of sensible proof:) here then  is a glaring disparity in the very
point at issue; and from which the  inference drawn by Dr.  Clarke
(were even his experiments conclusive) does not seem  more natural,
than the observation already advanced on the  wisdom of Providence
in abating of that quality in human milk, because a greater propensity
to acidity, or excess of a cheesy principle, must, from the atony of in-
fants, render such a quality peculiarly noxious to them.
   It has been observed, however, that I can, myself, no longer entertain
any doubt of the existence of this principle in breast milk, though it
may vary in its quantity and consistence; nor hesitate to insist, that the
result of my experiments on human  milk, and infantile green stools,
(which, it has been said, do stain blue paper red,) completely over-
turns all that Dr. Clarke has advanced, to the entire satisfaction of
my own mind: but as our contradictory assertions, (as  to facts) can-
not satisfy  those who have not made the like experiments, I  have
submitted the matter in a way  of fair argument, and appeal to the
discernment of the reader.
   Since these observations on Dr. Clarke's essay were drawn  up,  I
have, however, been  able  to adduce a  testimony which  I conceive
wrill not generally be disputed,  and  with which many of my readers
may, possibly, have been well acquainted before I was.  Had I met
with it sooner, it would,  probably,  have saved  me a  great deal of
trouble; but the Histoire et Memoires de la Societe Royale de Mede-
cine, annee 1790, might not, perhaps, have fallen in my way to this
day, if my good friend Dr. Andrij, of Paris, had not made me a pre-
sent of it;  though  long  after I had completed my experiments on
human milk.  It were needless, in  this place, to quote, in detail, the
experiments there recorded; it  must be sufficient to  give tables of
thtir result,* and to say, that they accord exactly with my own, re-
ferring to the volume itself for an ample account of the modes  of in-
vestigation, further properties, and component parts of various  milks
there specified,  demonstrated by numberless experiments, and upon
multiplied authorities.
   To sum up the  whole, then, upon Dr. Clarke's own principles,
and forbearing for the present to insist either upon my own experi-
* See the Table at the end of this Introduction. 
HUMAN  MILK.
19
uients, or others,  it maybe fairly urged, that, in disorders ofthe first
passages, the matters ejected both by vomiting and stools are frequently
flaky, and coagulated, and sometimes curdy; that they have a sensi-
bly sour smell; and that the stools are often of a green colour, very
numerous,  and attended with  griping pains.   That these symptoms
and complaints are removed by such remedies as are allowed to cor-
rect acidity in other instances, or are mitigated in  a greater or less
degree, as  long as such medicines remain in, and are acting on the
stomach and bowels,  and mixing with their contents.  That, more-
over, every kind of aliment which, during its digestion, is alike pecu-
liarly disposed to produce acidity, both in the adult and infant states,
always increases the above symptoms; breast milk, however, (from a
healthy nurse,) the peculiar food of infants, being less commonly found
hurtful to  them, because  more thin and lighter on the stomach than
most other food, and having less of that true curd found in most other
milks.   But whenever human milk happens to disagree, the symp-
toms are exactly the  same as infants brought up by  hand; though, in
other instances,  a recourse to it  (or  even asses'  milk) frequently
proves  a remedy, for children whose  bowels have been disordered
 from being previously nourished  by the spoon.  And  though this
 fact mav indeed, fairly prove it to be far less  disposed to  urn curdy
 Snd S\han couv milk, and farinaceous substances; yet the circum-
 stance  of  sucking children being often  afflicted m precisely the same
 manner and relieved by the same medicines with children brought up
 bv hand   equally demonstrates the cause  of their  complaints to be
 exactly similar;  and that human milk, when mixed with the gastric
 iuTce is dbposed to turn acid, and its component parts to separate im-
 iroperly,  or\ perhaps, too hastily, as in  adults whose digestion is bad.
 And tha  on these accounts, the milk becomes curdy, occasioning in-
 totion  and wind, which ointly irritate the nervous coat of the sto-
 ned *wd., 'and pj.ce complaints that endanger the mfanft
 life  unless remedied by the  known correctors of  acidity.  JNoi are
 theseSby any means, rare occurrences, or confined to tender
   ndeSe infants, as Dr. Clarke would ifnuate:  and ^ head
  I mav venture  to appeal to his own, and every  practitioner s ex
  nerience  as veil as  o the mortality in the Dublin Lying-in hospital *
  peuence  as wen a       j:,nos;tion to these complaints often  con-
  It may be added that a dlsP^\°"  breast or live on any other milk
  tinues as long as m^nts remainjtthe bre^ve     y
  diet, but are diminished as soJ» » ^J^rtheir more advanced
  and'that this change does ^^^JZitm the like advao-

  ^t^^X^^ * ** **• "~ °<
the note at the close of this Introduction. 
%(*
ON THE PROPERTIES  OP, &C
and  complaints  of the first passages during infancy; and such are
the effects  of certain  medicines known to correct or abate acidity;
and to what shall  they be attributed, or what can be more naturally
inferred from these premises, than that there  certainly is an acescent
tendency in the gastric juices of infants, (useful, no doubt, upon the
whole,) and a quality in every kind of milk  disposing it to be curd-
led or coagulated, and become  acrid by the admixture?  To these
observations might be added that of  infants  being so very rarely at-
tacked with fever,  however severe or  continued their pains, or other
complaints may  be;  and though  many good  reasons might,  doubt-
less,  be  given for this exemption, yet none can exclude the well-
known aphorism of the father of physic, before quoted, nor be more
appropriate to the occasion than that maxim, " acidum eructantes
non sunt pleuriticu"
   I  have  no desire to enter into  a formal  dispute  with any man,
much  less  to  contend  for  mere opinions  irrelative to practical
truth;* but should any persons be determined, to dispute  both  the in-
ferences and facts  I have advanced, let then*T at least, tell  us  what it
is that so uniformly  acts as an  acid might be expected to do, curd-
ling or thickening, the contents of the stomaeh, offending the bowels,
producing green and sour-smelling stools, with other symptoms of in-
digestion recurring so  uniformly in delicate  infants: effects  which
nothing could ever be  contrived totally to prevent, nor can any thing
so uniformly relieve as ant-acids or absorbents.   May it not justly
be presumed to be something not easily distinguished from what we
term an. acid in atonic adults? How much less injurious, however, this
disposition may be, than that tendency to putoescency prevailing in the
latterr indueed by a very different diet, and a  more exalted bile neces-
sary to digest it, may be fairly presumed; and upon, which, it has been
noticed,  I have  already given my own sentiments at large, even in
former editions of this work.   It mayT howevery, be jjust remarked in.
this place, that it might possibly, be fairly urged, that infants must,
therefore, either be exempt from their share of the infirmities of hu-
man  nature,  (unless infected by their parents with scrofula,  lues,
&c.)  or be  peculiarly liable to  disorders arising from acidity in the
first passages; which are confessedly amongst the slightest evils, and
at the same time a probable occasion of their escaping those of a more
dangerous tendency>
   I conclude, therefore, with observing,, that indebted as  the public
is, and particularly gratified as. I am, by the pains and researches of
Dr. Clarke, I cannot but insist, that his inductions are  neither

   * Still less have I been induced to dwell so long  on this subject from any of-
fence taken at Dr.Clarke, who has conducted himself very respectfully towards
me in our  epistolary debate; but the more respectable his character  is in the
eye of the public, the more it became me to intrude on my readers' patience, in
order to establish  the sentiments  I have so long entertained, and he has at-
tempted publicly to subvert. 
COMPARATIVE STATEMENT OF LYING-IN HOSPITALS.
21
properly made  out by experiments, nor supported by the arguments
he has advanced:  nor is it, perhaps, perfectly certain, what essential
difference there  may be  between every possible combination with
human milk out of the body, and its natural mixture with the gastric
juice in  the stomach of an infant.  What changes the temperature
and action of that viscus, whether mechanical, or chemical, may be
capable  of producing, cannot for certain be either proved or dis-
proved  from mere speculation; so that  whatever opinion  we may
form, must remain very problematical,  any  further than matter ot
fact may discover their operation, in the different stages of digestion,
both in  atonic  and athletic subjects.  But, in fine, whether under all,
or any particular circumstances,  any of the  gastric juices be pre-
cisely what chemists  would term an acid; or  whether the  offensive
matters, under an imperfect digestion,  be usually of the  nature of
 curd, butter, or  phlegm; or whatever theory Dr. Clarke, or others,
 may from his researches  be justified in advancing,  at some  future
 period,   cannot weaken the force  of any fair  inference  from facts.
 The author of this work,  indeed, ardently wishes, that a practical
 improvement  may be made of every  discovery: but  whatever the
 improvements may be, it does  not seem  likely from the above im-
 partial  statements, that the treatment of infantile  disorders recom-
 mended by him,  and in many particulars very generally adopted for
 the last half century, will undergo any essential alteration.

   •  Dr  Clarke concludes with expressing  a hope, that a  system  of practice
  more rational than the  present may be struck out.   What has been the precise
  mode of practice,  or its success in Ireland, I can guess only trom Dr. Clarke s
  statement in regard to the Dublin Lying-in Hospital; where, passing by those
  years in  which an epidemic  is said to have raged amongst the childien, the
  number of deaths  has ever been far beyond the average in the British  Lying-in
  Hospital, in London, where the old plan of treatment is pursued.
    In support of this assertion, I submit the following statement of the two hos-
  nitals, and it is  presumed, not an unfair one, being copied from the printed ac
  counts of that in Dublin, and from  certain outlines drawn up, on another occa-
  sion" by Dr. Clarke himself; and  contrasted by other corresponding extracts
  from the British Lying-in Hospital, subsequent to those quoted by the Doctor.}
    And firs  from  his own statement it appears, that in the old Lying-in Hospital
  in Dublin!  (reckoning from its first institution, when, probably, the furniture
  was neT and there existed no peculiar remote causes of disease,) out of 3,746
  mfants  241  died  within the month;  that is,  between  six and seven  in every
  K„n?WH  hotXt in the British Lying-in Hospital, (though confessedly a very
  M and?ill contrived^edifice  recko'ninl likewise  from its first  institution the
  Doctor^^reports  that only 146'died out of 3,611,  which is only four to the hun-

  ^After this period the epidemic commenced,* and the fatality greatly increas-

           .  •       4-.,<> a^nrnpv  it is not to be  expected we should either of
  JJZ^Z^Tjr:^Se end upon the report of interior  officers > but
  0,1 my own part, no wilful or suspected misstatement ,s offered.
     * See Transactions of the Royal Irish Academy, Anno 1789.
     § See nine days disease, vol I. 
f>0
COMPARATIVE  STATEMENT OP
 ed; the Doctor then remarks, that after proper means were taken to remove the
 remote causes of that fatal disease, only 419 infants dicd.out of 8,033 births; that
 is, from five to six in every hundred.
   It appears from the printed accounts of the hospital, that this period is taken
 from  the year 1783 to 1788, inclusive.  But  the  like accounts of the British
 Lying-in Hospital during the very same years,  report that, out of 3,374 children
 born there, only 95 died, which is under three in each hundred.
   But to render these calculations more immediately applicable to Dr. Clarke's
 observations on the treatment of infants, I shall to those six years  add the Dub-
 lin printed account  of the three succeeding ones, thereby increasing the above
 period to nine.  During these years the number of deaths was,  indeed,  amaz-
 ingly decreased, so that the endemic, especially during the three last, seems to
 have entirely given way ; and it being also during this period, that Dr. Clarke
 had taken up his new theory both of the nature of human milk, and (he early
 diseases of infants, a comparison of the number ot deaths in  the two hospitals,
 and any inference from it, will be brought to a fair issue.  It appears, then, that
 from the year 1783 to 1791, 12,688 children were born in the Dublin Lying-in
 Hospital, out of which 593 died, which is as four and two-fifths in an hundred.
 But, in the  British Lying-in Hospital, during the same yeai s,  5233 children be-
 ing born,  only 112 died; which is  but little more than two in each hundred.  In
 the  last of the above years  (as well as during many former ones) only two
 children died in the British Lying-in Hospital, out of 627 born there ;  and in the
 year  before that, no  more than five out of 630, (which number also was not ex-
 ceeded in several preceding years,*) and during the last  year  only one  infant

   *  So that the number of infants  dying in the  British Lying-in Hospital  under
 three weeks old, is usually far less than that of still-born children, as Dr. Clarke
 seems to notice with some surprise, in regard to one of the London hospitals he
 has occasion to mention ;  but as it, indeed, ought to  be every where, at that
 early period.  It small things may be compared with  great, it  may be added
 here, that speaking  from memory, I have reason to  think, that in my private
 practice, during the last five years, 1 have not lost more than three infants under
 a month old ;  which is much below the average  of stilt-born children, that has
 fallen to my lot, and  of which 1  have an exact register.
   In allusion to this remark, as well as to add my mite to assist the inquiries of
 other calculators, I annex the following statements taken from the registers of
 the hospital.

                            Infants Still-born.
                  During the first ten years,    one in 32.
                         the second ten years,  one in 37.
                         the third     .    .   one in 26.
                         the fourth    .       one  in 19.

  It hence appears,  that the average of still-born children has been, as one to
 twenty-eight.

                          The Average of Deaths,

                  During forty years, has been, one in 34.
                          the last eight years,f one in 84.

                           The Average of T-wins,

                    During forty-eight years, one in 86.
                          Boys to Girls, as 17 to 16.

   f It appears from  the hospital register, that during the last five and twenty
 years, the average of deaths has   been  considerably lessened, and also that a
 smaller proportion of infants has died  in the last eight  than at any period since
the first institution of the Charity; and it may, perhaps, be fairly conjectured,
through improvements made  in the management of infants, which was  not for-
merly so fully consigned to physicians. 
LYING-IN HOSPITALS.
23
died ; and seems to prove almost to demonstration, that the entire management
of infants  in that hospital, as well as the practice of the present day, must be
rational and judicious ; and is far from calling for a total subversion ot the prin-
ciples by which they have been always regulated.                   .       .
  1 add, that in the British Lying-in Hospital, from the year 1757, (being that in
which the hospital in Dublin was instituted,) to  the  year 1791,  the average ot
children's deaths has been under three in the hundred;  but that in the hospital
in Dublin, during the seven most successful years it ever experienced, (e'tn^r
previous, or subsequent to the endemic,) the average is above four; though the
mothers,  usually, remain there only a fortnight,  but those in the British Lying-
 in Hospital, three weeks, and sometimes a month.                 _
   I have been at the pains of stating this average, in the two hospitals, at dif-
 ferent periods, that the reader might be competent to judge, cxteris paribus, ot
 the probable better practice ; and may see for himself, that, if the management
 of new born  infants, or the treatment of their  disorders, has been of late any-
 wise influenced in Dublin, by Dr. Clarke's new theory, it has not, hitherto, to say
 the least  of it, any great claim to the practitioner's attention, on the score ot its
 success. 
 
Quantity of Milk.
                    A  COMPARATIVE  ANALYSIS

OF THE  MILK  OF WOMEN, THE  COW, GOAT, ASS, SHEEP, AND THE MARC

                By M. Boyssou, of Aurillac, in Upper Auvergny.
    One
Mark-pound
  Weight.
 (8 ounces.)

   Ditto.
Ditto.
Ditto.
 Names of the
several Animals.
Ditto.
Ditto.
Woman's
  milk.
Cow's milk.
Goat's milk.
Ass's milk.
Sheep's milk
Mare's milk
Their Nourish-
  ment, &c.
Ages of the Milks,
Inhabitant of
   a City.


 Fresh Pas-
   turage.
7 months.
6 weeks.
Quantity of
  Butter.
Ditto.       3 months.
Ditto.
Ditto.
Ditto.
2 months.
3 months.
2 months.
4 drachms,
48 grains.
3 drachms,
45 grains.
4 drachms,
24 grains.
10 grains.
5 drachms,
40 grains.


 6 grains.
 Quantity of
Cheesy Matter.
1 drachm,
48 grains.
5 drachms,
51 grains.
 Quantity ot
Saccharine S.ilt.
6 drachms,
48 grains,
in 4 crystal-
lizations.

4 drachms,
40 grains,
in 5 crystal-
lizations.
Quantity of
 Extract.
7 drachms,   3 drachms,
48 grains.  |  in 4 crystal-
             lizations.
2 drachms,
16 grains.
7 drachms,
30 grains.
2 drachms,
48 grains.
6 drachms,
16 grains,
in 6 crystal-
lizations.

3 drachms,
in 4 crystal-
lizations.

4 drachms,
48 grains,
in 5 crystal-
lizations.
1 drachm.
A drachm.
i drachm.
1 drachm.
i drachm.
2 drachms,
36 grains.
Produce or Extract
  in Bal Maris.
1 ounce,
8 grains.
9 drachms,
42 grains.
2 ounces,
16 grains.
7 drachms,
12 grains.
2 ounces,
16 grains.
7 drachms,
12 grains.
		A COMPARATIVE ANALYSIS,			
By A BR AH.	Van STRir-RiAA:* Luissio, Physician to the Dauphin ; and Nicot. Bondt, Physician at Amsterdam.				
Scale 100.	j Cream. i Butter.			Cheese.	Sugar.
Cow's milk		4~tV	O 11	8-ii-	3-tV
Woman's		8-H-	3	2-tt-	7-iV
Goat's		7__j.* ' T6 "	4-tV	9-f-	*-i-
Ass's		9___15 16"	---	3-tV	4—f -
Sheep's .		1 1___ 9 1 l iff'	5—if	15-|.	4-lV
Mare's . .		13	---	1~f-	9-tV
 
 
TREATISE
ON THE
DISEASES  OF CHILDREN.
DIRECTIONS FOR THE  MANAGEMENT  OF INFANTS FROM THE
                        BIRTH.
  Amongst the multifarious matter brought forward in the follow-
ing pages, the aliment most adapted to infancy has been said to be
one of the first  importance.   Previously, therefore, to treating of
diet more extensively, and the general  management of children,  I
shall enter into a candid discussion of that particular, by consider-
ing the case of infants intended to be reared without the breast, or
brought up, as it is termed, by hand—an article esteemed to be of
the first importance by writers and practitioners in every age.
                      On Dry-Nursing.

  An attempt to set forth all the improprieties of this mode of train-
ing up infants from the birth, would carry me altogether beyond the
limits I have assigned the work.  And I am glad to find by some re-
cent examples among persons of rank, that there is less occasion for
it than there appeared to be some years ago: and, indeed, the mis-
take has generally originated with parents, rather than with medical
voi. in.
t-- 
26
MANAGEMENT OF INFANTS, AND
men.  It would be unpardonable, however, in a work of this  sort,
not to insist how inadequate every substitute for the breast has been
universally found;  and, therefore, how  proper it is, that every child
should have it, and even be suckled by its own mother, where her
health can safely admit of it.  Reason, instinct, experience, all  con-
spire to support this opinion;  and whoever will determine to attend
only to matters of fact, may soon  be convinced of it.*  Nature her-
self points it out: ail the nobler part ofthe irrational creation is quali-
fied for it, and by instinct it obeys—the human race alone, possessed
of nobler powers, and  rational discernment, perverts those  faculties
to evade its dictates, and to invent excuses for refusing  its claims.
But puerile, indeed, are all the common arguments against it, in the
greater number of instances; and herein Dr. Armstrong seems to have
egregiously erred;  for though, apparently,  an  advocate  for suckling,
he  has laboured for arguments to apologize  for the  spoon and the
boat, in too many instances.   It were easy, perhaps, to produce as
sound arguments against eating  more than once a-day, because so
many people become diseased from excess.   On  the other hand, a
new and very rational argument in favour of breast milk, is advanced
by  Mr. Moss, who observes, that the gastric juices of every animal
may be supposed to be the best  suited  to act  upon its respective
milks.
   But not only is the breast milk the only natural,! and most proper
food  for infants, (experience demonstrating no artificial one to  be
equally easy of digestion, and nutricious,) but suckling conduces like-
wise  to the easy recovery of the  mother;  though she should not be
able wholly to support  her child  by the breast, nor to continue suck-
ling so long as the  infant may require it. But though from much ex-
perience I venture to give this opinion, I do, by no means, intend to
assert that  every mother is able to  suckle her child,  even for the
month, or would do well to attempt it; but I am, nevertheless,'equal
  * The duty of suckling has the sanction of almost every writer, as well as of many
persons of rank : and is distinctly noticed in the remote times of Pliny.  And Van
Swieten remarks, that one of the Queens of France suckled her own son, and
continued it even during a fever.  One of her ladies, however, having, on some
occasion, given the child her breast, the Queen was so much disgusted at it, that
she forced her finger into her son's mouth to excite vomiting ; unwilling that it
should receive any nourishment but from herself.

  f In some very northern parts of the world, as those of Greenland, and the
neighbouring country ofthe Esquimaux, the breast appears to be, in the strictest
propriety  of speech, the only food that nature has provided for infants ;  inso-
much that, whenever a suckling mother happens to die, her infant is buried with
her;  experience, one would  hope, having  demonstrated the inefficacy ofthe
hard  and coarse diet which nature has there so sparingly dealt out, it is esteem-
ed an act of compassion  to put an end to an infant's sufi'erings by plunging it
Into the sea. 
YOUNG CHILDREN.
n
ly satisfied, that many are very well able who do not; and that several
who have only through fear been  discouraged from doing  it, in two
or three lyings-in, having afterwards been prevailed  upon to make
the attempt, have gone on with it for several months; enjoyed better
health when they suckled than at any other part of their lives, and
their children have thriven  perfectly well.   Art and management
will likewise afford some assistance, where the natural constitution,
alone,  may  not be fully equal to the task.   In this view, besides a
suitable-diet, air, exercise, and a regular manner of living;  I will
venture to recommend cold-bathing, especially in the sea, if the sea-
son ofthe year should permit; and this not only from my own expe-
rience but that ofthe writer just quoted, who asserts, that it is often
found particularly useful in restoring the strength, and increasing the
milk in nurses of a weak constitution; adding, that it can never  do
any harm to a woman merely as a nurse, where no other reason, in-
dependent of that  situation,  forbids it.   The principal  caution  ne-
cessary being, not to  bathe  too  frequently;  more than  twice, or,
at  most,  three  times  a-week being  often  injurious  to delicate
habits.
  Thus, besides  the advantages derived to infants,  it appears there
are others  resulting to  the suckling mother, and some  deserving a
further notice.   For by this means,  where due care is taken, painful
inflammations and suppurations in the breast may often be prevented,
as may be fairly concluded,"  not only from the rarity of such  com-
plaints in  the British Lying-in Hospital, where  almost every woman
suckles her infant, but from the like authority  of  Dr. Nelson, who
reports, that " out  of 4,400 women who suckled their children, only
four had milk-sores, and that these  had either no nipples or former
sore breasts."  It  has,  likewise, long been suspected,  and of late
years more  generally imagined, that some of the worst fevers, and
more rare ill effects of child-bearing may, generally, be prevented,
by suffering the milk to flow duly to the breasts, and be freely drawn
from them,  though only  for the month.  These  advantages, one
should hope, might tend to induce ladies of rank lo set a general ex-
ample, by performing this kindest and most pleasant office, at least,
during the month.*  But it would  be unjust not to add, that when-
ever they may purpose to assume it for a much  longer  time,  they
should determine  to do  it effectually, or they will but injure their
children,  as well as forfeit many of the advantages  and comforts,

  * The present day is peculiarly favourable to ladies determined upon this
laudable attempt, through the admirable discovery of Mrs. .'elf's nipple case,
sold at  No. 12, Bell's Buildings,  Salisbury Square, Fleet street, or at Mr. Sa-
viffny's, Surgeons'  Instrument-maker, in St. James's street.  Though a most
simple, it is an efficacious  contrivance, especially with the late improvement
of the'plate being  made of glass  instead of silver, equally calculated 10 assist
the infants to draw  out the milk without trouble to itself, or pain to the parent,
howsoever unfavourably formed, or tender the part may be. 
36
MANAGEMENT OP INFANTS, AND
which in  a due execution  of it,  they  would  have  a right  to
expect.
   For a long time,  however, writers have  successively complain-
ed, that, notwithstanding the many encouragements often brought to
the ears, and urged upon parents, that tyrant fashion has prevailed
over  the good sense  and natural  feelings  of many, whose maternal
affection can be, in no other instance, suspected.  There are honour-
able exceptions, however; and it is with great pleasure, that I have
been able to observe, in the later editions of this work, that ladies of
rank are every year becoming converts to this maternal duty, and  are
proud of supplying their offspring with that new nourishment, where-
with nature hath  purposely endowed them.
   Another  important  and affecting consideration might be brought
forward on this head, which I shall, indeed, only touch upon, as it
calls  rather for the pen ofthe  moral philosopher than of a physician,
I mean, the sacrifice which poor women make in going out to sucklj
other people's children; the  sad consequences of which are often
severely felt by their own, through neglect or mismanagement, and
especially for want of the breast.   Indeed, no attention of the  nurse
can duly compensate this loss;  and only  the most common substi-
tutes for it can, in their forlorn circumstances, be allowed  them.
This hath  become a source of  evil, that  I  fear has not been suffi-
ciently thought of, and  has led to the sacrifice of many infants every
year; a matter of serious importance, indeed, to the public, as well
as to the families immediately concerned.
   It  gives me  real concern, to find  occasion for the least unpleasant
reflections upon any part of the  sex  I so much honour, and upon  any
of my fair  and sensible countrywomen in particular.  Nevertheless,
I cannot help suspecting, that wherever any neglect of parental  du-
ties may exist, whether  in regard to suckling, or superintending the
management of  their children,*  that does  not  arise from want of
health, or  some equally warrantable excuse, it can be charged only
on the  depravity of the age, which insensibly corrupts the taste  and
perverts the judgment of many who  wish to do well.  And depravity
of manners, when once become general,   has ever been considered
 as the leading symptom  of a falling  empire, and ought to be pointed
 out far as it extends, by every friend to the community,  at whatever


   * This has long been the case amongst the lower class of people in France :
 and that nation, therefore, has been very much indebted to the goodness ofthe
 late monarch, who, to the last, was making solicitous inquiries through Europe
 to discover the best substitute for  the breast.f Should the method recom-
 mended, in the subsequent pages, be, amongst others, adopted, its claim will
 soon be determined; and I venture to hope, will yet be to the advantage ofthe
 rising generation in that kingdom, and elsewhere.
   -J- See Questions proposed to the Royal Society of Medicine in Paris, October
 1739, by the late king's authority. 
YOUNG CHILDREN.
29
hazard of giving offence, in every conspicuous instance of it.  Taci-
tus complains of the degeneracy of Rome in his days, (though by no
means its most degenerate  era,) lamenting that, while in  former
times grave  matrons attended to their children, as their first  family
concern, they now, says he, intrust them to the care of some Grecian
girl, or other inferior domestic.  It is no  small  satisfaction  to me,
however, to observe, that in this country there has been no  ground
for much  complaint on this head, and that  the evil  is  annually
diminishing; there  are also examples of  the first magnitude  of a
nobler conduct, and one, at the head of all, which were it  copied,
without exception, in domestic life, would prove the glory of the pre-
sent day, and a  blessing to the rising generation.   May the  time
hasten  when it  shall be   universally followed by her  inferiors,
whilst  I  attempt to point  out as  far as  my observation has ex-
tended, the most prudent means of executing  this important branch
of female duty.
   It may not be amiss, at the opening of the ensuing observations to
remark, that the demand for the multifarious directions here  offered,
as well as  all those given  by other writers on the management  of
children, arises from the false reasoning of those to whose care the
infant state is frequently intrusted; who, instead  of being guided by
the  sober dictates of nature, have adopted the rules of art, falsely so
 called, or have followed the wild fancies of anile  superstition.
   On the other hand, the various tribes of the irrational species act
 in a thousand  instances more prudently than we do, and being uni-
 formly guided by instinct, are led implicitly and safely through  all
 their operations.   Many quadrupeds, fish, fowls,  and  even reptiles
 seem to know what is proper for them as soon as they  come into
 existence, and have strength sufficient to  reach after  it.   In  other
 instances, they are guided  by the parent, who seems to adjoin  some
 degree of  knowledge acquired by experience,  to  the instinct with
 which it is endowed;  and  gradually leads on its young to imitation,
 whether it be to eat, to swim, or to fly.   Man, on the contrary, de-
 signed to be the pupil of observation, has  scarce any innate  discern-
 ment; and, consequently,  his infant race pass through a long period
 utterly helpless, alike divested of ideas to guide,  and  of strength to
 manage  for themselves.   But to the parent is imparted both;  whose
 province it is to judge for them, and actually to  put into their hands
 or  mouths, whatsoever they may stand in need of.  When the pa-
 rent, therefore, forsakes the paths of simplicity,  and lays down arbi-
 trary rules, the result of false science, instead of patient experience;
  or  mistakes the clamour of fashion for, or prefers it to the voice of
  nature; confusion and disease  must be the unavoidable consequence.
  Awakened by these, man is loudly called upon to return  to the sim-
  plicity of nature, and the  result of  dispassionate observation.   To
  lead to this,  will be a  principal  intention of  this work  wher- 
30
MANAGEMENT OF INFANTS, AND
ever  danger  and  deviation  are connected;  assured  that  the  ex-
perience of  the  most judicious and successful  practitioners will
applaud  the design, and confirm the  generality of the following ob-
servations on
                The General Management of Infants.

   To this end, let us imagine an infant just born,  who, doubtless,
 at this moment, calls for our best attentions.  And first, it  may be
 observed, that it ought not to be  exposed to  any thing that may vio-
 lently or too suddenly affect the senses: on which account, Moschion
 and Albinus have well advised,  that it should not be exposed either
 to great heat or cold, nor to a strong light, nor odours of any kind,
 however grateful to adults; the unpleasant effects of which are suffi-
 ciently manifested  by the infant itself.*   It  is  hoped, I may be
 allowed  in this place to introduce a caution on the too early atten-
 tion to mental improvement; which is more frequently than seems
 to have  been  imagined essentially  injurious  both to the bodily
 health, and  future progress of the mental powers; and I have  my-
 self known one or more decided  proofs of its inducing a confirmed
 fatality.
   The attention will next be called to washing and dressing it, to-
 gether with other little offices suited to the occasion.   And this  first
 washing is of more importance than is usually imagined, being amongst
 the  little things which are  often  overlooked by writers and  others,
 (and by  some, thought of no consequence;!) but it  is not every little
 thing *hat may safely be neglected, or carelessly done.   In regard to
 poor people, especially,  and infants born in  hospitals,  and other
 crowded apartments, the importance of proper washing is greatly in-
 creased; the foulness left upon the skin being a remote cause of some
 dangerous  epidemic  complaints-!  Some infants  also are  covered
 much more than others with a thick, viscid matter, which cleaves so
 firmly to the skin, that it is not easily washed  off;  which there is,
 however, another reason for doing, as it would obstruct perspiration;
 which can never be duly performed, where the skin is left anywise

  * Perhaps the extraordinary convulsion case mentioned, vol. i. page 72,  may
illustrate the propriety of Moschion's observation. 1 having lately learned, that
 the infant there alluded to, after its  health was fully restored, and thriving
well, was seized with a kind of spasm on the chest, and was dead in two or
three seconds of time in the bar-room of the liquor-house, where its parents re-
sided, and to which the infant was brought back ; but I  was not informed ofthe
event in time to solicit the examination ofthe body.
  ■j- Dr. Hamilton.
  t See Mons-  Baumes, on the Jaundice and Mesenteric Fever 
YOUNG  CHILDREN.
51
foul.   On this account, nurses should be  directed to be very atten-
tive to this first concern of their infant charge,  and whatever wash
they may make use of, it should always have soap in it, and the child
be well rubbed, especially under the arms, in  the hams, and groins,
where this mucus is apt to adhere: and to this end,  it would be bet-
ter that no pomatum should be made use  of, or other grease, which
tends to stop up the pores, and  prevent perspiration; or that nurses
be, at leastr very careful the grease be  afterwards  well  wiped off.
In the same  view, it were well if it were a common practice to repeat
the washing for two or three days, with light  friction of the skin;
which it is not improbable might tend to prevent the red gum,  and
other similar affections of the skin, with such  other complaints as
may arise from the suppression of insensible perspiration.
   After a little time,  and sometimes on  the  next day,  most nurses
wash a child all over with cold water; a practice highly extolled by
Dr. Armstrong, as well as  many other   practitioners.   But though
no one can be a greater advocate  for every thing that is bracing than
1 am, I cannot approve of this substitute for cold  bathing, as it  is
called; at least, as  a too indiscriminate practice.   The cold bath acts
on a quite different principle, and is so very  beneficial, that I could
wish  almost every child,  especially  those born in London,  were
bathed at three or four months old, (provided  they be not costive,
 nor feverish at the  time, have no  internal obstructions, nor the season
 ofthe year be improper;) which  1 am certain would remove, or per-
 haps prevent, many of their  complaints.*  But to see  a little infant

   * Mons. Le F£bure de Villebrune, in his translation of this work into French,
 has added a chapter upon baths; in which he highly extols the warm bath, and
 as strongly controverts the idea of the probable good effects of cold bathing,
 and even makes use  of a long chain of arguments against it, deduced, indeed,
 from an ingenious theory, and supported by quotations from the ancients; who
 practiced, however, in a very different climate.  The shortest, and perhaps the
 best reply to this specious reasoning, might be  given in the well known modft
 of Diogenes to Zeno, whose metaphysical arguments against the possibility of
 motion, Diogenes laconically refuted, by hastily getting up, and walking across
 the school.  "We have, in like manner, only to point to the numbers of children
 and young people, who from very weakly infants, have been rendered strong
 and healthy,  merely  from a prudent  use of the cold bath  ; and may defy any
 man to produce the like instances of its opposite effects, when made use of with
 the cautions which  every powerful remedy requires.  The Spartan women,
 likewise, afford us sufficient evidence of the  salutary effects of cold bathing,
 notwithstanding the comments made upon the women themselves, by Aristotle,
 as quoted by our author.
   So great, and oftentimes surprising, indeed, are the good effects ot cold baths,
 that I do not wonder  the priests, in times of ignorance, have been  known to ac-
 count them holy, and dedicate them to some saint;  to whose influence certain
 cures were attributed.
   The salutary operations ofthe cold bath  are, however, easily accounted for,
 from its promoting insensible  perspiration, and rendering that excretion less
 readily affected by the impression of external air.
   It may be known to agree with children, when  they come out of it warm,
 lively, and their strength increases on the use of it.  On the other hand, if they 
3^5                MANAGEMENT OF INFANTS,  AND
of a few days old, the offspring, perhaps, of a delicate mother, who
has not even strength to suckle it, washed up to the loins and breast
in cold water, exposed for several minutes, perhaps in the  midst of
winter,  (when children  are more liable  to disease than those born
in summer;) itself in one continued scream, and the fond mother co-
vering her ears under the bed-clothes, that she may not be distressed
by  its cries; has ever struck me as a piece of unnecessary severity,
and  savours as little of kindness, as plunging an  infant a second or
third time, into a tub of water, with its mouth  open, and gasping for
breath,  in the  old fashioned mode of cold bathing:  both  of which
often induce cramps  and  pains in the bowels, and weakness of the
lower extremities, but rarely an increase of the strength.   It surely
cannot be amiss,  in winter time at least, to take the cold off the wa-


continue  cold, are dispirited, and seem rather to lose strength, it will be as cer-
tainly prejudicial.
  As a mean, however, of acquiring that re-action and glow, which bathing is
designed to effect, a loose flannel chemise may be thrown over the child the in-
stant it is taken out ofthe bath.   This will not only secure from the unpleasant
shock arising from the cold air, but allow time for friction, along the course  of
the spine, which should be continued all the while that an assistant is employed
in wiping the lower extremities, and putting on their usual covering.  If this
were duly attended to, I am persuaded, that both many infants and adult per-
sons would be benefited by cold bathing, who, for want of that kindly glow, are
unable to bear even bathing in the sea.
  But I must observe, that the above-mentioned unpleasant effects are frequent-
ly owing  to an improper use of bathing, and for want of making a very obvious
discrimination in the habit of body of different children.   For the tender and
delicate, not only should a good quantity of salt be put into  the bath, but the
water may also at first be a little warmed, and children be brought only  by de-
grees to endure it quite  cold, which they will not by this means be the less like-
ly to do: or should the water never be perfectly so, (but merely below the heat
ofthe skin) the advantages of such bathing will, nevertheless, be considerable ;*
though the late Dr. Hunter and others have thought differently.  For it is not,
indeed, merely from the coldness of the water that the benefit  arises, but is
rather from the subject being suddenly immersed into a very different medium,
(if so be,  that medium be not  actually warm;) in which  the contact of the ex-
ternal air is taken off during the immersion, and is as suddenly restored on his
being taken out.  By this means, the blood is alternately pushed forward into
the extreme vessels, and suddenly repelled to the heart,  (in proportion to the
coldness of the water and the powers ofthe system,) and suffers an advantage-
ous attrition against the sides of the vessels.  The small passages are rendered
pervious, and  the contractile power ofthe heart is increased, as well as the mus-
cular fibres proportionably strengthened.  The  salt added to the water pretty
certainly  prevents taking cold, whilst it adds to the stimulus  on  the skin, and
has, therefore, a more salutary operation on the pores.
  The infant having been put quite under water, should  be taken out as soon
as it  is possible.  It should be received into a blanket, and wiped dry  with a
cloth in the most expeditious manner; and as soon as it can be dressed, should
partake of such exercise as may be best suited to its age.  There will need no
great attention to its being made  perfectly dry, as a child will be less liable to
take cold from a few drops of salt water being left upon it, than by being long
uncovered in some parts of its body,  in an over caution to wiping it dry.

  * Hippocrates, speaking of bathing, cautions against  the two extremes  of
heat and  cold.—De Liquid. Usa. 
YOUNG CHILDREN.
33
ter for the few first days, which it has been observed, will be useful
in other respects;  and whenever cold water is made use of,  it will
be quite sufficient to wash the child as far as a regard to cleanliness
may require,  which will always be the parts exposed to the worst
kinds of galling  and excoriation; on which I shall here drop a few
hints.
                 On the Intertrigo or Chafings.

  To obviate these  troublesome affections, washing with cold water
is certainly useful;  but can  never  call for an infant being plunged
with its feet or nates into a  panful of cold water, and be afterwards
dashed all over with it, to its daily  discomfort and terror.   Cleanli-
ness and bracing  the skin are the  proper intentions;  and with this
view, therefore, beside the  nates and groins, the arm pits, folds  of
the neck, and parts behind the ears, being  also disposed to  slight
chafings, may be occasionally washed with  cold water; and if the
discharge be not  checked by it, they should be dusted with a little
hair powder, the powder  of lapis calaminaris, or of ceruse, or a little
white  vitriol may be added  to the water;  which if the excoriations
are not very considerable, will generally heal them very soon: should
these fail, they may be dressed with the red drying ointment of Bate s
dispensatory, which is an excellent remedy in a thousand instances,
and has very undeservedly fallen into disuse.   But these drying re-
medies should rarely be applied to  the ears.  In a very acid state ot
the stomach, during the month, particularly where there is a purging
with very green stools, the parts covered by the cloths are moreover
infested with  a still more troublesome excoriation  called intertrigo,
 and whilst that state continues, will not be healed by any drying ap-
 plications.  I have found nothing so  pleasant and useful m this case,
 as  covering the parts with the thin skin found upon the veal kidney,
 which softens, and cools them, till  the cause  of the complaint may be
 removed by the use of proper absorbents.  There is a mixed affection
 of this kind, however, in which these parts  are  not actually excon
 ated.faut are very hard and swollen,  as well  as pamfu  and inflamed,
 and the affection seems to be  kept up by the acrid nature of the ex-
 cretions, though not originally caused by it   In  this  cas, instead of
 daubhwhe parts with wetted fuller's  earth,  gruel, or greasy niix-
 aauDing me pans  w»tii     ,,'«„,„„.„,,,*.,.  with as much boiling
 lures; an  embrocation of elder flower water  vvitn a.s n          »
 milk as will render it immoderately  warm ^en^efoMj*
 (inrimis   Bv the use  of these means, the worst cases l nave met



 by Dr. Armstrong.  i>u     &                 article* of so much

 j^nsrsM^ -*  ,— *-them'if'
    vol. nr. 
34               MANAGEMENT OF INFANTS,  AND

had not already far exceeded the bounds I had intended, as well  as
presumed it unnecessary for the generality  of readers.  A vulgar
error,  however, may be noticed, which is still too common, that ol
wearing a pilch (as it is called;)  an old fashion still too much in use,
and contributes not a little to make children weak; it being original-
ly designed to be worn only for the few first  weeks after birth, but
is often continued  for as many months.   It  can answer no possible
end but that of saving a little trouble, since, instead of keeping child-
ren dry and clean,  it has the directly contrary effect; for if it has re-
ceived any wet through the usual cloth laid under it, it ought itself
to be  changed as often as the  other, or must certainly be danip and
uncleanly:  whilst,  by heating the loins, and lower limbs, it has a
manifest tendency  to  relax, and dispose  infants to become rickety.
It may  be  proper,  however, to drop a word more, with a view to
 counteract  a vulgar notion, familiar only to  common people, that a
frequent change of linen has a tendency to weaken new born child-
 ren;  an absurd idea, that has not the smallest foundation in reason
 or fact.  It is, on the other hand, next  to impossible,  that a child
 should thrive or be healthy, if the strictest  attention be not paid to
 cleanliness, which is one of the principal articles in which the child-
 ren of poor people are at a great disadvantage, and which becomes a
 constant source of rickets and distortions among them.   But, indeed,
 little  infants, if healthy, may oftentimes be so managed as to be much
 more cleanly, than even people of great  delicacy have  been wont to
 imagine; so as even to supersede altogether  the use of cloths, cither
 by night or day.*
                   Tumid Breasts  of Infants.

  Another imprudent, and certainly useless operation practised by
nurses, is that of forcing out the milk from the little breasts of new-
born infants.  Some children a day or two after they are bom, have
the breasts exceedingly tumid, hard, and painful,  containing some-
thing like milk; and nurses imagine it  to be a great kindness to milk
it out, as it is called.   But I have often been grieved, to see a nurse
rudely rubbing, and even squeezing the breasts already in a state of
inflammation, and continuing  it even  for some minutes, though the
child's cries might convince her she is putting it to pain.   In  the case
of inflammation, a bit of bread of milk poultice is the propcrest ap-

  * I hare, indeed, known only four or five instances of it, (though there may
be many that I have not been made acquainted with;)  the first of which was in
the family of a lady of rank, whom I was some years ago attending.  I was there
myself a witness to the good effect of holding a little pan under an infant of
only four months old, as it lay across the nurse's lap ; which I was assured had
been her practice from the month, and that the lady had obliged her nursery
maids to do the like with her two former children. 
YOUNG CHILDREN.
33
plication; but if the  part  be not inflamed, it can want nothing at
all: or should it  be conceived, that something ought to be done, a
little oil with a few drops of brandy may be gently rubbed in, or small
pieces of the litharge  plaster may be applied,  and lie on  the parts
till they fall off of themselves.   I have, indeed, had sufficient evi-
dence of such considerable tumefaction and hardness, as to satisfy
me, that when no violence is offered to the  parts, the application of a
bread and milk poultice will always prevent either suppuration, or
other unpleasant consequence.   I have met with instances  in which
the tumour has been much larger  and harder than I could have sus-
pected on such an occasion, and yet after continuing for more than a
week w ithout any sensible diminution or amendment, has soon after-
wards subsided entirely.                                    „
   Having considered the necessary preparations, I proceed to otter a
few remarks on the prevailing errors in Dress.
                On the First  Clothing of Infants.

  Upon the first sight of a new-born infant, every one  is struek
With the idea  of it? weakness and helplessness;  and we often take
rery improper methods  of strengthening it.  It is designed to be
weak and lender in this infant state, as is every other object around
is *  Take a survey  of nature, from the first opening leaves of the
  mal flower, or the  more delicate foliage ofthe sensitive plant,  to
IhrvounJuon, or the  elephant; they are  all in their several orders,
oroffiXweak, and cannot exist without  some  exterior sup-
f^r  But they stand in need of nothing but what nature has p re-
    ed £*£ If seed be cast into  a prop, soil  it waiits, on yhe
surrounding elements to ensure vigour and maturity   So ii the ten
der infant be born of healthy  parents, and a^^/»" .^V^".
ally sufficiently strong;^^^


 need nothing more.                   therefore to be  tight rolled,
    It is true,  it is very weak   but is it urer^         s    bim_
 under the idea of supporting it, and giving U  ^^  uninterrupt.
 die of  tender vessels, through which a fluid  is ^ P as           £_

 ed, to be equally^^J^f ^5ed£ yield to the in, 
36
MANAGEMENT OF  INFANTS, AND
jurious any great pressure must be to  so delicate a frame, which be-
fore birth swam in a soft fluid.   But besides this, the infant requires
freedom and liberty on other accounts.   The state of  infancy  and
childhood  (as Dr. Gregory observes) is impatient of restrainst  in
this respect,  through " the restless activity incident to youth, which
makes it delight to be in perpetual motion, and to see every thing in
motion around it."
   Let us again  advert to the irrational species,  whose more saga-
cious conduct so often disgraces our own.  There is no occasion on
which they do not seem to consult propriety; and having a right end
in view, they as certainly accomplish it,  and always in proper time.
Doth a little  bird design to  prepare a lodging for her young?  it is sure
to make choice of the fittest situation, whether to  defend them from
dangers, or obtain the most convenient  supply of  their wants; if to
this end it be necessary  to  construct the nest of rough and strong
clay, it is still lined with down: the young lie warm and secure, but
they lie  at their ease.
   " In this view of Nature, (says a  good  writer* about fifty years
ago)  we shall find the  birds not only provide nests for their young,
but cover them with their wings, to guard  them  from  the chilly air
till  time has  increased  their feathers.   The beasts, with amazing
tenderness, cherish their young, till nature has lengthened the hair,
the wool,or whatever covers them; or time has given them the power
of action.   Further, we shall find, that insects, and all the vegetable
creation shoot out  into life, and receive vigour, comfort,  and  sup-  •
port from that glorious body, the Sun:  so indispensably necessary is
warmth; and so essential to the raising and preserving of all."  But
necessary as  warmth  and support most  indubitably are, they must
not be obtained  at the expence of liberty and ease; which,  during
the fragile state  of  infancy especially, are of peculiar importance.
   I am not ignorant, indeed, that for  many years  past, the very an-
cient tight mode of  dressing infants has been  discontinued; and for
which we were probably first indebted to Dr. Cadogan.   It is certain
also, that for the last forty years, the fashion recommended by him
has been improving; but there is yet room to go forward; and were every
tender parent in this country thoroughly sensible of its advantages, it
would soon  become  fashionable to see  children as much at their
ease on a christening day, as they are when laid at night in their beds.
And I may be permitted to add here, what every modern practitioner
has adverted to, that were strings, almost in every instance,  sub-
stituted for pins, physicians would seldom be at a  loss to account for
the sudden cries, and complaints  of infants, which are too often  pro-


  • Nelson ; whose Treatise on Health I have perused with more satisfaction
than most of the  modern productions that 1 have examined, because he has
taken Nature for his guide. 
YOUNG CHILDREN.
3<J
duced by this needless part of their dress*—A practice, it is to be
hoped, which may in time be laid aside, since some of the first fami-
lies in the kingdom have already set the example.
   Nature  knows no other use  of clothing but to defend from  the
cold; all that is necessary therefore for this purpose is,  to wrap the
child up in a soft loose covering, and not too great a weight of it: to
which ornaments enough might be  added without doing miscniel.
And had this matter been alwavs left to the most ordinary discretion
of parents, this  is,  probablv,  all that would have been done; but
the business of dressing  an'infant has become a secret, which none
but adepts must pretend  to  understand.   The child itself, however,
 discovers to us the  propriety of such clothing, by the happiness and
 delight it expresses every time its light day-dress is removed, and its
 night-clothes put on, which should always be looser, and less  thick
 than those worn through  the day, and the lower limbs be less confined
 than they sometimes are.  Whereas, the art of dressing has  laid the
 foundation  of many a  bad  shape;  and what is worse  of very bad
 health,  through the greater part of life.  Instead, therefore  of a
 scrupulous and hurtful attention to such formalities, nurses would be
 much better employed in carefully examining new-born infante, in
 order to discover any  malformation o  parts, especially thosecoi-
 cerned in the excretions necessary to life, which, it has been said, is

 STh"^
 little discipline as  has been mentioned,»J»™Hj  » ^igued by
 it as soon afterwards to fall into a sound sleep.  We  shal  considci
  i\s in this state, and  leave it a while to be refreshed, whdst I en-
  deavour to conduct my reader through the various other duties  which
  thelnfant caUs for from day to day, till it happily arrives at an age
  free from the peculiar hazards of infancy.
    In Z pursuit of such a plan, we meet with a variety of miscel-
  laneois aLles, and though "many of them are not o  app^t mag-
  nitude in themselves, are in their consequences lg;^«
  I-      w^u +Lo* *Iipv mav be thrown  into some kind  ot order, may








                 *• „ ne the late Dr James Mackenzie on this term  may not be
   f + The observation ot the late ur.jam-=
   unacceptable to some readers           turaU when applied to aliment, air,
     « The very sound ^.^f.^Xistence of mankind, is extremely shocking;
   sleep,  &c. so essential to^the subs ntenc         Uati    which ar0Se merey
   ™J9*^                       ^surprising.  The  origin of ,t 
38
3IANAGLMEM  OP INFANTS, AND
Sleep and Watching; Motion  and  Rest; Retention  and Secretion.,
and the Passions of  the Mind: a due attention to which, may pre-
vent many of the evils incident to this tender  age.   To begin with
(he first of these:
                              On Air.

   The great importance of this has been set forth when speaking
ofthe diseases of infants: I shall here in a more particular way ob-
serve, that the age, constitution, and circumstances of the child, and
the season ofthe year,  ought always to be taken into consideration;
that being highly proper on one  occasion, which would be very de-
trimental at another.   In general, it has been said, that warmth  is
friendly to very young infants; but they should, nevertheless, be in-
ured gradually to endure the cold air, which is absolutely essential to
their health.   I cannot, therefore, agree  with Dr.  Armstrong, who
thinks that the reason  of the rich losing  fewer children than  the
poor, is from their being kept warmer.   On the other  hand, it was
aptly said by one, that u a warm nursery fills a cold church-yard."
In fact, it is  not a mere cold, but a damp and confined air, that is  so
injurious  to children, and to which the poor are peculiarly exposed,
especially during sleep.   Much caution, indeed,  is necessary on this
head in this unsettled climate, and evinces the necessity of parents
superintending those to whose care they intrust infant children; since
nursery-maids are  often indiscreet in keeping them too long in the
air at a time; which is a frequent occasion of their taking cold, and
deters many parents from  sending  them  abroad so often  as they
should.   Another, and  a wrorse, as well as common fault  of nurses
and servants is,  that of standing still with children  in  their arms  in
a current of air,  or even sitting down with other servants, and suffer-
ing children who can run about to play at a little distance by them-
selves, sit down  on the grass, and such like irregularities; the conse-

nppears in  a passage, where Galen divides things relating to the human body into
three classes :  Things which are natural lo it; things which are non-natural; and
lliings which are extra natural.  I sliall subjoin his own words from the vulgar
Latin version, class vii. lib. de ocul. paitic. tertia, cap.2. ' Qui samitatem vult
restitueredecenter debet investigare  septem res naturales, qu?e sunt elementa,
complexiones, humores, membra, virtutes, spiritus, et operationes.  Et res non-
naiurales, quae sunt sex, aer, cibus portus, inanilio et rcpletio, motus et quies,
somnus et  vigilia, et accidentia animi.  Et res extra-naturam, qua: sunt tres, mor-
bus, causa morbi, et accidentia  morbum  comitantia.'  From this fanciful dis-
tinction the epithet non-naturals first arose, and lias been retained in common
use to this day, though it cannot he understood without acommentary, by which
physicians  seem to make an apology for the impropriety of it.  Hoffman, for  in-
stance, and some others, when they apply the appellation  non-natural to air and
aliment, are obliged to subjoin the following explanation : '  A vetcribus hae res
non-naturales appellantur, quoniam extra  corporis  essentiam constitute sunt.'
Hissertatio 3, Decadis 2." 
YOUNG CHILDREN.
39
qucnces of which are often  a long confinement to a warm room,
and either a prohibition against going out so much as they ought,
or a fresh cold, owing to some of the like irregularities.
   But if children be properly clothed and attended to, they will not
only endure a great deal of very cold, but of other inclement wea-
ther;  though it has been observed, that caution and prudence are re-
quired in training  up  infants to withstand, and  profit  from being
abroad when the air is very cold or moist.  Notwithstanding, it cer-
tainly may be accomplished; and it is a known fact, both amongst
the higher as well as inferior ranks of people, that those  children are
the healthiest and suffer the least from colds, who arc accustomed to
be abroad in almost all kinds of weather.   But to render children
thus  strong and healthy, it is not sufficient that they be abroad daily
 in a  coach; they should be carried on the arm, and be  put on their
 feet,  at a proper age, and partake of such exercise, for a reasonable
 time, as  shall keep them moderately warm, and bring them home in
 aglow,  instead of wishing to rush towards a fire the moment they re-
 turn; such sudden  transitions being always improper, and only render
 children more liable to taking cold.
    Kruger has  some  such  pertinent remarks  on  this head  as it
 will  scarce be thought a  digression to  transcribe.  " The  im-
 portant step (says he,)  a man takes  into this  world imparts to
 him  all the privileges thereof, of which  this  is one, the ability
 to bear the effects  of the  air.  Why  then debar  him  from  this
 privilege,  as he  is  all his life to be  encompassed with this  air,
  at one time cold, at another  warm, now  moist, again dry?  For
  the  cold of the air so anxiously avoided, brings along with  it  tuc
  means that secure against its own inclemency; the great strength ot
  fibres imparted by it to the child, procuring, by means of a brisker
  circulation, a greater degree of heat, and consequently the reverse ot
  its  violent impression.  This, indeed, may seem unintelligible to
  Ihose who imagine the human body to be  only an hydraulic ma-
  chine,  consisting of innumerable tubes,  in which the wheel is moved,
  without a proper power, consequently without a sufficient reason;
  not to  those who can distinguish  between the effects of nature and
   art  who are apprised ofthe power that moves the animal body, and
   that the sensations are such a power, which arise without our know-
   ledge and our will.   To such only  it  will be  intelligible, in * hat
   manner an increased resistance,  produced  by the cold inthe solids
  «nd fluids, is capable of bracing the heart,  he source of life-   Horn
   a slight knowledge of mechanics wc come to understand tha* the re-
   sistance diminishes that power, which in  animal bodies  it increases;
   come to see, that the most ingenious constructions produce no man-
   ner of motion; that all mechanical  laws are, indeed, perfectly.,us ,
   but mow accurately to be determined, in order to a proper applica-
   tion of hem to the human body,  in which the wdL, pagination, and
    ensation^e the springs of motion, without which all potion v,c,,. 
iO
MANAGEMENT OF INFANTS, AND
cease, and only leave a machine resembling a water-work, to be car-
ried about by wind.   We  need only appeal to experience,  which
will teach us, that in  order to a healthful state, we  need not be
brought up like those  who  are indulged with a bed of down, and a
warm room,  but those, of whom no other extraordinary care being
taken, are greatly left to their own disposal."
  I cannot better close these remarks on the benefit of a pure air,
than by quoting the remarks of  the Rev.  John Howlett, who ob-
serves, that in consequence  of the humane suggestions of Mr. Jonas
Hanway,  about fifty years ago,  an act of Parliament  was passed,
obliging the parish officers of London and Westminster, to send their
infant poor to be nursed  in the country,  at  proper distances from
town.  Before this time not above one in twenty-four of the poor
children received into the work-houses lived to be a year old; so that
out of two thousand eight hundred, the average annual number ad-
mitted, two thousand six hundred and ninety died; whereas, since this
measure  was adopted, only four hundred  and fifty out of the whole
number die; and the  greater part of these deaths happen  during the
three weeks that the children are kept in the work-houses.
  It is, indeed, generally owing to sudden transitions only that some
infants so readily take cold.  This sometimes  happens  as soon as
they are born, and repeatedly during the month; the slightest symp-
tom of which is a stoppage, or stuffing of the  nose, which may be
here briefly considered.
                        On the Sniffles.

  The stoppage, so termed, is, indeed, only a trifling complaint, and
seldom requires  more than a little pomade  divine, or other unctu-
ous aromatics to  be put to the nostrils when the child is laid in the
cradle; or if this fail, a little white vitriol may be dissolved in rose-
water, and the ossa nasi often wetted with it.  A matter  of m>ich
more importance, however, under this head, is to remind the reader
of a much more  serious complaint, which this resembles only in the
kind of noise which the stuffing of the nostrils occasions;  and has
been  termed Coryza maligna, or  the Morbid snuffles, and been al-
ready largely considered
                       On Short-coating.

  It will  be advisable,  in order to  inure  infants to  the  air, that
this change  in  their dress be  made  as early as  the season of the
year will permit; but their dress should be still loose and easy, and
many children may continue without stockings even for two or three 
YOUNG CHILDREN.
41
years, and boys  till they are breeched.   As to the latter change, I
think,  it would with  more propriety  be made in the beginning
of winter, than in summer, as the dress upon  the whole is wanner,
especially about the chest, which from having been open for three or
four years, it seems rather strange to cover, all  at once, at the begin-
ning of hot weather.*
   But though  I  have, said many children would be as well with-
out stockings,  for a  considerable time, I must  remark, that  cir-
cumstances  are always to be taken into consideration.   Mutatis
mutandis should not only be the  motto of physicians, but of common
life, and we should  be guided by it  in  regard  to, all general
rules.   For want of this  caution in  the present instance, tender
children suffer exceedingly in  severe  winters, and  are  distressed
with chilblains merely for want of proper covering to their tender
limbs.   I have seen  a  child of  four years old, the daughter of  peo-
ple of fashion, whose legs were  covered with these sores quite up
to the knee,  and yet  her mother could  not be prevailed upon,  in
time, to suffer  stockings to be  put  on, because strong and healthy
children are thought to be better without them.  And there is, in-
deed, of late years an  additional reason for such cautions, from  a
fashionable mistake  of this day of habiting  young children indis-
criminately too thinly;  the feet, legs, and arms, being more unco-
vered than the hands, which, when children  are abroad, are orna-
mented with gloves:  a  mode  of dress howsoever appropriate to the
athletic, must be hazardous to those of a delicate habit.
   We  now proceed  to the second article  under  the  head of the
 Non-naturals.


                         Meat and Drink.

    This is, indeed, worthy of ample discussion; having as yet been
 considered only in relation to the expediency of breast milk, where

 ^„T™r^                     that  although, an  infant
 be  suckled  by its own mother, it certainly can  stand in no.real
 need of any food, till the time nature will bring milk  into her
 breast   supposing the  child be laid to it in proper time; which,
 doubUessChTto  be as soon  as the mother may  by sleep  or
 o'htwTse be sufficiently refreshed to undergo the little fa.gue that
 at attempt to suckle may occasion.  This method how ve- unusual
 wlA some,  is the most agreeable to nature,  and to observations on




    vol, in.                     a 
42
MANAGEMENT OF INFANTS,  AND
the irrational species; who, in many th;ngs, are the very best guides
we can follow.*  And herein I am constrained to differ from a late
writer,! whom I have more than once quoted with approbation; for
by means of putting the child early to the breast, especially the first
time of suckling, the nipple will be formed, and the milk be gradual-
ly brought  on.  Hence,  much pain, and its consequences,  will be
prevented,  as well as the  frequency of sore nipples,} which in a first
lying-in, have  been wont to  occasion  no inconsiderable trouble.
But should this, or even an abscess take place, they are both  far less
distressing  under proper management than has been usually imagin-
ed^  and what is of great importance, the latter is attended with  a
negative good;  no woman, I believe, having been seized with puer-
peral fever, who had a milk abscess.   However, should the  mother
be unable to suckle, and  a wet-nurse be engaged, there can be no
harm in putting the  child to the breast,  after it has taken  a  dose or
two ofthe opening medicine; or should it be brought up by hand, and
not easily kept quiet, a spoonful or two of water-gruel, sweetened
with a little Lisbon sugar  or honey,  may be given for this purpose,
which will  usually  set it asleep;  after which it will be  ready for
whatever culinary food shall be thought proper for it.
   And on this article a vast  crowd of absurdities  open upon us at
once; and many of them  with (he  sanction of custom and authority.
I shall first advert to the thickness  of the food: and  it has,  indeed,
been matter of wonder, how the custom of stuffing  new born infants
with bread could become so universal, or the idea first enter the mind

  * This subject is largely and elegantly treated by Dr. Gregory, in his Com-
parative View, before quoted.
  ■j- Mr. Moss.
  $ It may be proper to notice in this place, the colour sometimes given to an
infant's stools, from a little blood it has repeatedly swallowed, when  the nipples
of the suckling mother have continued to be very sore; a circumstance, indeed,
that does not often occur, but has been alarming for want of the true cause be-
ing understood.  The stools,  in this case, will be of a strange blackish colour,
such as have been noticed under the head of fever, and very  similar to the first
stools of new-born infants.
  § See the author's Surgical Tracts before-mentioned, in  which the milk ab-
scess, and sore nipples,  are fully considered, and a successful and easy method
of treatment pointed out.
  From motives of benevolence, I beg leave to mention here a new contrivance,
which has succeeded so far beyond every former device, for defending ihe nipples,
and enabling women to nourish their own children, that I cannot but wish to ex'.end
its advantages, by this public  recommendation ofthe Nipple Shield.  It may be
had ofthe ingenious contriver,  Mrs. Keif, No. 12, Bell's Buildings, Salisbury
Square, Fleet street; or for families at a  distance from London, by application to
Mr. Savigny. Surgeons'  Instrument maker, in St. James's street.
  In Struve's Education and Treatment of Children, published in Hanover, some
apparently similar contrivance is mentioned,  called  the Wendelstoedtian, by
which it is said, suckling may be accomplished, although the nipples should be
very deficient in their formation;  but the writer has given no description of this
useful invention. 
YOUNG CHILDREN.
43
or a parent, that such heavy food could be fit for its nourishment.  It
would be well, that all who are entrusted with the management of
children should have more just ideas ofthe manner in which we are
nourished; and especially, that it is not from the great quantity, nor
from the nutritious quality of the food, abstractedly considered; since
the inhabitants of different parts of the globe are equally healthy and
long lived,  who feed on the most opposite  diets.   Every  one, one
should think, may be  led to conceive,  that our nourishment arises
from the use the  stomach makes of the  food it  receives, which  is to
pass through such a change in digestion as renders it  balsamic, and
lit to  renew the mass of blood which  is daily wasted and consumed.
An improper kind, or too great a quantity  taken at a time,  or too
hastily, before the stomach  has  duly disposed  of its former contents,
prevents this work of digestion,  and by  making bad juices, weakens
 instead of strengthens the  habit;  and  in the end produces worms,
 convulsions, rickets, scrofula, slow fevers, purging, and a  fatal ma-
 rasmus.                                  .      ,    .„  »
    Nature, it should be considered, has provided only milk, tor every
 animal adapted to draw it from the breast; and that of women is cer-
 tainly amongst the thinest of them,  but at the same time, far more
 nutritive than bread, and, probably,  than  any other milk,  as it con-
 tains a greater proportion of saccharine matter;* which is  thought to
 be hat quaUty „ aPll our food which  renders it nutritious   It is true
 bread, as it requires more  digestion, will lie   onger on the stomach
 both of infants and adults; and hence, probablv, because it satisfies
 he nresent cravings, it has been conceived to afford a greater propor-
£nP Jwuri hment  though mixed up only with water  as i too ire,
uuenUy is, it is far less nutritive than has been imagined   Children
S to be frequently hungry, and as often supplied with l.ght food
of which milk is really the most nourishing that we are acquainted
with    TW  could never be doubted, but from its passing so quickly
Zfof the stomach  on which account, indeed, though  not the nro-
^todfraduits, employed ^^^^^JS



 solid  ^'^^"t Tiding to this consideration, that Dr.
 must have been fowant of ^»dl  »     f bread and othcr thick
 Armstrong has  said  so  ™™*              ^ of for his 0W(l
 victuals:  which, by the  bye,  he began           recominend it,) at
ofthe Introduction. 
4.4               MANAGEMENT  OP INFANTS, AND
as a poison; which if  not puked up, or very soon voided by  stool,
may occasion sickness, gripes, what are called inward fits, and all
the train of bowel complaints, which may terminate in one or other
ofthe evils just mentioned.   And this I see almost daily exemplified;
new born infants,  after being so fed, and seemingly thriving for  a
short time, suddenly falling into a purging, or being carried off by
fits.
   Milk itself (like  all the other animal juices)  is produced from food
taken in by the mother; and is  the richest part of it.  It is in her
stomach that the aliment is digested, which by a combination of pow-
ers in the chylopoetic viscera, is so far animalized as to be converted
into a kind of white blood; from  whence it has been observed, every
animal  body is daily recruited.   Hence it is very apparent, that pre-
vious to an infant having acquired strength enough to convert solid
food into this wholesome chyle; the parent, by this wise substitution
in nature, has, in a great measure, previously accomplished this work
for the  infant she is to nourish.   During infancy, therefore, both na-
ture and reason most clearly point out the expediency of a milk diet;*
but how long it ought to be persevered in, or infants wholly confined
to it, is not easily ascertained, and will be further considered in its
place, with a latitude that the question demands.   There is a period
in life,  indeed, to which this nutriment is more particularly adapted,
both experience and theory demonstrating it to be more suitable to
young people than adults,  as Arbuthnot  has  remarked; and it has
been observed, that it does not appear that the gastric juice of the
cow will produce the same change upon milk, as that ofthe calf does,
which is, therefore, constantly made use of in  dairies, for separating
the curd from the whey.
   It can scarcely  be  improper  before I entirely quit the article of
suckling, to relate  a recent instance, and a remarkable  one out of
many,  as a proof of the degree to which infants  may  pine for the
breast,  even to the great hazard of perishing for the want of it, where
the real cause ofthe disease is not suspected.   This little history will
 likewise further serve to illustrate  the preference of human milk,
 which  has been so strongly insisted upon.
   The little infant alluded to was very healthy  when it was three
 months old, and  was then weaned  on account of the illness  of the
 wet-nurse; but soon afterwards  ceased to thrive, and had continual
 bowel  complaints.  At the age of nine months I was desired to visit
 it, and was informed that it slept very little, was almost incessantly
 crying, and had for many days brought up nearly all its food;  was

   * Whether the parent be able to suckle her own child, or that office be per-
 formed  by a hired nurse, is not here particularly considered.  The design is only
 to prove that milk is  in general the most proper food for an infant. Whether
 that, indeed, be prepared by its own mother, a nurse, or by such animals as the
 eovv, or the ass, is equally to the purpose: where the  former cannot be had* the
 best^and most natural substitute should be provided. 
k'OUNG CHILDREN.
45
become very rickety, and had all the appearance of an infant almost
starved.   Trial  had been made of every kind of food, except the
breast, and the child been many weeks under the care of an experi-
enced apothecary; was constantly in a state of purging, and seemed
to have been just kept alive by art.
   On the first sight of the child, and upon the face of this account,
it was very evident, that this infant was not nourished by the food it
received, and that the complaint lay wholly in the first passages.  But
reduced as it was, I had little expectation from medicines; and there-
fore gave as my opinion that either the child still pined for the breast,
in which case, I  doubted not, it would  take it, though it  had now
been weaned six months; or, that it ought to be carried immediately
 into the  country, and be supported for  some time only upon  ass's
 milk, or perhaps be fed, now  and then, with a little good broth.
   My advice being taken, a good breast was procured, which the in-
 fant seized the moment it was put to it, and after sucking sufficient-
 ly, soon fell asleep for several hours; waked without screaming, and
 took the breast again.  It  is sufficient to add, that the child ceased
 to puke or be purged, and recovered from that hour; and after suck-
 ing eight or  nine months longer, became in  the  end  a fine healthy
 child.                                             .  .  .
    Although this instance has something extraordinary in it in respect
 to the  length of time  the child had been taken from the breast; and
 though infants are generally completely weaned in six or seven days
 at the  furthest; yet are similar occurrences met with, differing only
  in degree,  it being no uncommon thing for children, when ill, to take
  the breast  again, after seeming to be thoroughly weaned for three  ov
  four weeks.  And this circumstance is  the more worthy of notice, as
  it sometimes is a very fortunate one; and should lead to making the
  trial whenever infants newly weaned may be seized  with any com-
  plaint, under which  a return to the breast  may be useful,   buch,
  particularly, is the hooping-cough; under which I have known a child
  of more than  a year old, and apparently thoroughly weaned for a
  month, take to the breast of a stranger very cheerfully, in the pre-
  sence of its former nurse, with  the precaution only of leading it to
  make the  first attempts during night.  Such children,  for the few first
   days, turn away from the  new wet-nurse to their former one  as soon
   as they have satisfied  themselves at the breast,  and  go back to the
   nurse again very readily whenever they find an inclination to suck.
     To rfturn-  I am  free then to lay it down as an axiom, that milk
   oueht to be the chief part ofthe diet of infants for  a certain time,
   wheth r it be the breast-milk or any other;*  and  that ,t will prove
   Tufficienty nourishing for nineteen  out of twenty  I might  perhaps
   saSty-nine out  of a  hundred:  exceptions, I believe, there m
   £, but mU fewer children would perish if no  exception were to be

    • See Dr. Parsons, who has some .-unions observations on ^head. 
 46              MANAGEMENT OF INFANTS, AND

 made, than  by absurdly rushing  into the contrary  extreme.  But
 supposing a very strong child, at  the end of the month, really  not
 satisfied with milk only, and always craving the moment it has been
 thus fed, it,  doubtless,  may have  a  little boiled bread added lo it,
 two or three  limes in the day;  but I should be very cautious of ex-
 tending it further.*   In the case, however, of an infant at the breast,
 if it be always craving as soon as it is taken  from it, the occasion of
 its craving will generally be found to be in the nurses milk; previ-
 ously,  therefore, to  allowing a more solid food,  the quality of  the
 milk, as well as the state ofthe  nurse's health, should be enquired
 into, and  the milk be  changed, if its goodness be  suspected; and
 should its quantity be found deficient, its quality is always propor-
 tionally inferior.   Perhaps, where  bread  and  milk is  allowed,
 whether at a very  early or later period,  it would be an advantage to
 boil a piece of roll, together with the upper crust, in  a good deal  of
 Water, till it  is very soft, by which means the bread will  part with
 some of its acescent quality; the water should  then be strained off,
 and the bread be mixed up with the milk, which  ought to be boiled
 if the child is very young, or inclined to a purging-!
   It would, I perceive, lead me  beyond  all bounds to enter further
 into this matter; I  shall,  therefore, only add, that infants certainly
 ought not to  be fed lying on their backs, but sitting upright, howso-
 ever contrary to long established usage;  as they will in this position
 swallow their food more easily,  as well as more readily perceive when
 they have had enough.   So also children nourished  at  the breast,
 ought to be withdrawn from it  for a short  time, especially  just after
 waking from  a long sleep; whereby, besides other advantages, much
 undue labour to the stomach may be prevented, as well as enabling
 it to retain what it has received; a part of which is otherwise very
 frequently thrown  up.
   If milk  be the  proper food  for infants  brought up by hand, the
 next inquiry will naturally  be, what milk is the  best? and  what is
 the fittest instrument for feeding with?  And it is  from long experi-
 ence, as well as from reason and  analogy, that I venture again to re-
 commend the ingenious contrivance of the late Dr. Hugh Smith, which
 I shall presently describe.   The  milk he  likewise advises, is cow's
 milk in preference to  all others, as  being the most nourishing, and

  * " In Italy,  Holland, Turkey, and through the whole Levant, children  are
 rarely allowed any other food than the breast milk, during the first year:" (Buf-
 ibn) and the Savages  in Canada suckle for four or five, and often  six or -rven
 years.—In some extreme northern climates  (as hath been already remarked,) we
 know they can have no other food, for a long time; and yet, there, the death of
 an infant is as rare an event as that of a suckling mother.
  -{• For infants subject to acidity and indigestion, it will  be found very advan-
 tageous to boil the milk two or three times, waiting after each till the milk shall
 cool sufficiently to allow the curd, or cheesy parts to rise  to the surface, which
 should be carefully taken off'; whereby a much  smaller proporlion of the less
easily digestible part of the milk remain to ofFcnd  such irritable stomachs.  - 
YOUNG CHILDREN.
4'.
therefore,  in general, the most proper; and  I  wish to refer the  in-
quisitive reader to such other reasons as the Doctor has given,* to
which  I  can  add nothing but my own experience of their validity.
To the milk should  be added a little thin  gruel, or barley-water,
which forms a very smooth and pleasant nourishment; the latter  be-
ing more  proper if  the  bowels  are too  open.  A few weeks after
birth,  (and I  think  in general the  sooner the better,) instead of the
barley-water or gruel, there should be mixed with the milk a small
quantity of light jelly made from hartshorn shavings, boiled  in water
to the  consistence that veal broth  requires when it has stood to be
cold.f   The design of the jelly is obvious and rational, at once  cal-
culated to render the food more nutritive,  as  well as to correct, in
some  measure, the  ascescency of  the  milk;  this quality  being
thought to abound in the milk of different  animals, in proportion to
the quantity of vegetables  on  which they feed.}  And the milk of
 quadrupeds,  we know,  is  produced from  vegetable juices only,
 whilst breast-milk is  formed by a mixture  of animal and vegetable
 food.   A little Lisbon sugar may be added to this compound of jelly
 and milk, if the child be not inclined to a purging, or in  that case
 a little loaf sugar; but the less of either the better.   It will be  pro-
 per to have the milk and jelly warmed  separately, and no more at a
 lime than maybe wanted; when it should be put into the pot, which
 must be very carefully cleansed and scalded, at least once every day
 and the spout be thoroughly rinsed, lest  any sour curds should  stick
 about it;  and to this end, it may be convenient to be  provided  with
 two.fc   At first the milk ought to be boiled, to render it less opening,
 but when the child  is several months old,  or may chance to be cos-
 tive, the  milk need  only be warmed.  If it be fresh from  the  cow,
 and very rich, a portion of water may be added to it, whilst the in-

  <•  * See his Treatise on the Management of Children, in a series  of letters ad-
 dressed to married women.
    + There is sometimes a difficulty in making this jelly, on account or the harts-
 horn bdng badTthose who shave i often mixing with it die **«n?^ UJrterj,
 which may, however, he distinguished by their bnitleness.   It the "havings a e
  good, tw^ounces of them  boiled very slowly in a  quart ot water to a pint,
  will make the jelly of a proper consistence.
    * See Dr. Young, De Natura et Usu Lactis, in diversis Animalibus.
    « Theobiection to this mode of feeding, made by a writer at Dover, that the
    § I he objection u> us     therefore the food become sour, appears to me to
  pot may often be left foul, and thereloe u.e                   ^ ^^ q(


  d'redVaVS^
  superintended, but must.be ^™^X the shops where the infant feeding
    Having been often sent to ton <  rect on       is'al     kept  at Philips's in

  mi St. Paul's Church-yard. 
48
MANAGEMENT OF INFANTS, AND
fant is very young.   Indeed, it ought to be as new as possible, since
milk, as an animal juice,  probably contains some fine subtile par-
ticles, which evaporate upon its being long out of the body.
  Though I  have said cow's milk is usually preferable to any other,
it will be  conceived, that  I  mean for infants who  are strong  and
healthy.  Ass's milk, on  the other hand, being more suitable  for
many tender infants during the first three or four weeks, or perhaps
for  i* longer time, as well as for children who are much purged; as it
is thinner and having far less curd  than any other milk, it sits much
lighter on the stomach, both  of tender infants and adults; although
in a few instances, it is found to be too opening.  And, perhaps, it
may be inferred, from the very different proportion of cream, and of
cheesy principles, that the  milks of different animals contain, that
Providence has  rather considered the benefit of man  than  of  the
young of various quadrupeds; though, doubtless, the milk is likewise
properly adapted to them.
  In  regard to the mode of feeding  infants, I can say, from expe-
rience, that for the delicate and tender at least, the boat, the  spoon,
and the horn, are in nowise comparable to the pot, which is so con-
trived,  not only as to please the  child by its resemblance to the nip-
ple, and the milk coming slowly into its mouth; but also to afford the
infant some little degree of labour,  in order to acquire the quantity
it needs, (which the horn does not;) by which means the food is al-
so duly mixed with saliva.   The like little fatigue  takes  place in
children nourished at the breast^and by this means it is, that infants,
especially when very young, are not  so apt to  oversuck,  as they  are
to be  overfed by  the boat or  the spoon; the food  of which being
sweet and  pleasant,  and requiring  only the  trouble, or rather  the
pleasure of swallowing it,  the child is tempted to take too much at
a time; whilst the nurse often forces down a second or third boatful,
in order to put a stop to the cries, which indigestion from the  former
may have occasioned.
  The  writer just  now  alluded to, as  well as Mr. Le Febure de
Villebrune, detracts from the advantages of this way  of feeding, by
observing,  that infants may be fed  as slowly and cautiously  by  the
spoon:  but the fact is, that this is, indeed,  one of  the things in which
servants cannot be depended upon, whilst there are such temptations
to the contrary, (at  least  I  have not met with many who could;*)
nor will children, indeed, oftentimes endure slow feeding, if they  can
anywise prevent it, but  will be screaming all the while, instead of
being kept quiet by their food:  though the  hope of quieting them,

  *  Amongst the exceptions I  have met  with, I was lately greatly pleased with
a nurse, who said, " I always let my children ask for their food:" which she
pertinently explained by saying, I do not feed infants because they cry ; but if,
after fasting a reasonable time, they begin to moan, I endeavour to amuse them
till they anxiously hunt about them, and repeatedly form their lips in a certain
way, that assures roe it is a want of food only that makes them compla,m. 
YOUNG CHILDREN.
49
it has been observed, is frequently the nurse's sole motive  for giving
it  But when an infant can get it only slowly from the pot, and yet
is itself all the while employed in the business, it will be agreeably
diverted  while it is acquiring its nourishment, in the same manner
that it is amused at the breast.
  The pot is formed in the shape of  an Argyle, or gravy-pot, with a
long spout, rising from  the  bottom, and pierced only with a  few
small holes at the end, which is to  be covered with a piece of vel-
lum, washing-leather, or parchment.
  This covering should  be left loose  a little way over  the spout,
which will render it soft and pleasing to the infant's mouth; and it
has been said, is nearly as acceptable to many children as the breast,
as I have often been a witness.
  This manner of feeding is not only pleasant to the child but very
convenient to the nurse,  and the food equally at hand in the night as
the day; being easily kept warm by a lamp, or even in the bed. The
only objection I have ever known made to it  by those who have made
trial of it, is that which I  esteem one of its highest recommenda-
tions; which  is, that  children thus  fed are  frequently hungry,  that
is,  they are what nature designed them to be; this food sitting light
on  the stomach,  and being easily  digested,  like the breast-m.lk,
children often need a supply of it.
   I shall iust mention another popular objection  to the plan here re-
commended.   This is taken from some line children we meet with
who have been brought  up by hand from  the birth,  and fed with
thick bread victuals all  the day long,  whilst we every now and  then
see some of those who have been debarred that sort of diet  weak  and
tender till they become ayear or two old. Not to stop long to observe, that
 this objection militates equally against children living on  he  breast,
 though that is the food nature has designed for them, it will be suffi-
 cient to say, that it is only strong children who may be bred up al-
 most  anywise, that can  at all digest thick victuals; that there are
 o hers who cannot endure the least thickening in their food, nor any
 kind of bread; and that weakly infants, who are scarcely preserv-
 ed by the most'eareful attention  to their food wouldsooni be hurried
 out of the world if  that attention were withheld.  And th s remind
 me of an observation of a very judicious friend iin the nor th of En

 land, which greatly ™^™e* ^^0^et^^ which  ™
 with any observation  from him before, me  prop   y
 not  exceedingly obvious »^»™X^ Ise^ed"tha/we
 number of fine children  heinfl^m   S^lf.starved children in the
 f f r/LonIn3 as hemmS with m the  country, and  that he bad
 streets of London, as lit.  u       .    ■  }[  purines to town.  It
 often before "rietelteotecntoo£*     J    mistake, and I
 appeared to me that:my ^"^ m^ aVsuch a remark coming from
 STSfi rrZtTXllsh^t by insisting on the  fact,
him;  when  he  remov
   VOL.  Ul 
50              MANAGEMENT OF  INFANTS, AND
with the following obvious solution  of it:—I apprehend,  says he,
there are scarcely any but fine and strong children in London, who
live to be two or three years old, the weaker ones for want of good
air, and exercise,  sinking  under  their  infirmities; whilst  the  ten-
derest  children in the country, by being turned out to crawl in  the
wholesome open air,  or  by sitting  at the door almost  all  the day,
escape the fatality of your gross air  and hot nurseries,  and survive
the tning periods of infancy, though  some of them remain  weak
and rickety till they become old  enough to endure severe  exercise;
which can alone strengthen them  effectually.
   I have no doubt of their being certain exceptions  to the mode of
feeding I have recommended, that are  worthy  of more attention;  al-
though very few have  actually come to my knowledge,  and though 1
am persuaded, that, as a general plan, it is both a natural  and salu-
tary one.  Instances may be met with, however, of some very athle-
tic children who may acquire a more nourishing,  and perhaps some-
 what  more solid diet;  and the state  of  bowels in others, will call for
a greater variety of food, and of a kind not calculated to be adminis-
tered in the mode here recommended,  as hath been already noticed
 under the head of purging.  On  these accounts,  I would  offer ano-
 ther observation or two in regard to the thicker kind of victuals; and
 first,  that in families accustomed to bring up their children by the
 spoon, I think I have found a  greater number of infants well nour-
 ished by the French,  or the Uxbridge-roll boiled in water to a jelly,
 and afterwards diluted  with milk, than on any other  kind of pap.
 From such families I have likewise learned, that some  change in
 the food is, however, frequently necessary,  and will  be indicated by
 the degree of relish which the infant may discover towards different
 kinds of food, as well as by their effects  on the bowels, though the
 child be not supposed  to be  at such  times really unwell.  Such
 changes principally  respect the different kinds of bread, or other
 farinaceous substance usually mixed  with milk; and sometimes the
 substitution of broth, for a few days,  in the place of the latter.
    When children brought up by hand  become four or five months
 old, especially if strong and healthy, they may, doubtless, be allow-
  ed a thicker kind of victuals, because their digestive powers being by
  this time become stronger, they  are able to extract good nourishment
  from it;  though this change is not equally necessary for children
  brought up at the breast, at least,  such do not require it so early;
  breast-milk, it has been said, being more nourishing than any other.
  The first addition of this kind, however, whenever it becomes neces-
  sary, I am persuaded, ought to be beef-tea or good  broth,* which

    * " I cannot help remarking here, that the gravy of beef or  mutton, not over
   roasted, and without tat, properly diluted  with water, is the wholesomest and
   most natural,  as  well as nourishing broth that  can be made." Dr. Hugh
   Smith. 
YOUNG CHILDREN.
51
with a little bread beat up in it in the form of thin panada, will be
at once an agreeable and wholesome change, and prepare them for
further advances in this way.  But as this cannot well be given
oftener than two or  three times a-day, (unless where  other food is
found to turn acrid on the stomach,) a little bread and milk may also
be allowed them every morning and evening, as their strength and
circumstances may  require.   A crust of bread likewise, as soon as
the child has a couple of teeth, will amuse and nourish it, whilst it
will assist  the cutting of the rest, as well as carry down a certain
quantity of the saliva; a secretion too precious to be lost,  when the
digestive powers are to be further employed.   As the child grows
older, to broth may be added light puddings, made of bread, semo-
lina, tapioca * or rice; salep boiled in milk, and such like.   But to
feed a child with veal, chicken or other animal food, before nature
hath given it teeth  enough to chew it, howsoever small it may be
 minced in the  kitchen, is altogether  as  unnatural,! and  can prove
 nourishing only to such children as, from the  great strength of their
 natural constitution, need least of all the assistance of art.  It is by
 degrees only, that children ought to be brought to such food; which,
 at a certain period, indeed,  is as necessary as a light diet at an ear-
 lier age.   For it is certain, that the error of  some parents runs the
 contrary way, and  their children are  kept too long upon a fluid, or
 too slender diet; whence their bellies and joints  become  enlarged
  and the bones ofthe lower extremities too weak to support them, at
  an age when they  want more exercise  than  their^ nurses  can give
  ?hem   For when  they go alone, not only is a little light  meat and
  cerUin vegetables  to be allowed them  once  a-day,  or  alternately
  with broths, puddings, or blamange, white-pot, custards,  and such
  nke kiShen preparations of milk;* but even a little red wine is bene-
  ficial to many constitutions.   This will not only  promote  digestion
  and obviate in a  great measure  a disposition to worms  but  by
  sSengthenTng the  habit, will also render children less;  liableto be-
  come rickety, at the very period they are very much disposed to t.
  SuTh a plan is the rather insisted upon, because some  parents, the


    . The best tapioca, * ^^^^
  is called by the generalterm, fanne.  1... w^very          caSsada:§  in this
  India Islands, where ,t ''^f'H^u.e, and may be preserved for a very
  form, therefore, it is ^^^.KEf be boiled'slovvly in  three  pmU ot
  a^-^^r.i'^^Ufb a sieve: alittle milk being added,





   —X'==S2<-—-——•"""
   not on Aliments.
                    § The Satropha Manibot of Unax\a. 
52
MANAGEMENT OF INFANTS, AND
  most desirous of doing right, fall into a like mistake even in regard
  to older children,  whom they keep too  low, allowing  animal food
  only every other day to those of four or five years of age; which, un-
  less in very particular habits, is surely an error, at least  in this damp
  climate; and disposes our children to scrofula.   But so many little
  infants, on  the other hand, fall  a sacrifice to the use of indigestible
  food under the  age of six months; being  carried off by vomiting,
  purging, or fits;  that  whoever would  preserve them over the  most
  dangerous period of infancy, cannot too cautiously attend lo their diet
  at this time.*
     It is a common  direction in works of this kind, to point out the
  properest times  for feeding  an infant  brought up  by hand, and  to
  direct how often it may safely be fed.  I shall just observe, therefore,
  that  no adequate rules can be laid down on the  occasion; and, on that
  account, none ought to be attempted,  since none can be sufficiently
  comprehensive;  and I am happy in not being at all at a loss in  this
  instance, wherein writers have differed so widely.   For infants, not
  usually taking too much at a time, in the  manner of feeding that has
  been recommended, on account of the little fatigue which, it was ob-
  served, they undergo in acquiring their nourishment, may generally
  be permitted to partake of it as often as they might of the breast.f
  This is, however, by no means the case, when children are allowed
  to eat thick victuals, and are fed by the spoon, by which, it has been
  said, they are always in danger of taking too much; an evil that can-
  not be too often pointed out.
     Before I close this head of the management  of  children, perhaps
  the most important of all, I shall point out the most suitable  diet un-
  der the different complaints to which they are most liable.   But after
  the hints that have been thrown out through the former part of this
  work, the directions need not to be very ample and precise; I shall,

    * From a note in Dr. Smith's letters, it appears, that the average of births an-
  nually, within the bills of mortality, for ten successive years, was  16,283 ; out of
- which were  buried under five years of age 10,145, and from amongst  these
  7,987 were under two years.  So that almost two-thirds ofthe children born in
  London and  its,environs, become lost to. society, and more than three-fourths of
  these die under two years of age.   This proves how hazardous a period that of
  infancy is, in this country;  and I am sorry there is so  much reason to be per-
  suaded, that the want of air, exercise, and a proper diet, has added unnecessa-
  rily to its dangers ;  there being no such mortality in barbarous nations, whose
  inhabitants live in a state of nature; nor in any part ofthe known world, amongst
  other young animals. Although these, and other calculations I have seen, should
  be tound ever so accurate, it is a pleasant reflection, (to whatsoever the circum-
  stance may be owing,) that since the time they were taken, the proportion of
  deaths at the early period above alluded to, has been very considerably decreas-
  ing ;  and the writer has noticed, that for some  years the average  of deaths,
  according to  these  bills, has not been more than six in sixteen; which is but lit-
  tle more than one-third.

    t Optimum  vero medicarnentutn est opportune- cibus datus.  Celsus.  De 
VQUNG CHILDREN.                    ^u
therefore, only observe, that  as  light a diet as is possible is usually
called fur when a child is unwell, let the  disorder be almost what-
ever it may.   If a fever should accompany it, the child  will require
still less food than in any other complaint, but plenty of drinks;
which may also be so calculated as  to furnish nearly as much nour-
ishment as the infant will require, and may in summer time be given
cold.   Such are, barley water,  water in which a crust  of bread has
been boiled, and thin tapioca; or if a purging attends, rice, or arrow-
root water;  and a drink made of hartshorn shavings, with  a little
baked flour in it.  In this complaint, wherein  more nourishment is
required  to support the child than under most others, (if not attended
with fever,) baked flour mixed up  with boiled milk, (as mentioned
 under the article of purging,) is admirably calculated both as a pro-
 per diet  and medicine.   For the like complaint, arrow-root, or the
 food directed bv  Dr. Smith, is very well  adapted, and will afford a
 little variety.   He orders a table-spoonful of ground rice to be boil-
 ed with a little cinnamon,  in half a pint of water, till the water is
 nearly consumed; a pint of milk  is then to be added  to it, and the
 whole to simmer for five minutes: it  is  afterwards to  be  strained
 through  a lawn sieve, and  made palatable with a little sugar.  In
 this way, or joined  with  arrow-root, milk may generally be made to
 agree perfectly well, even when the bowels  are purged; and  when
 it does  so, proves  exceedingly nourishing.   Should  it chance to
  disagree, owing  to the great acidity of the first passages, good beef-
  broth ought to be made trial of, which may be  thickened with baked
  flour, instead of  bread, or  mixed  with  an equal quantity of thick
  gruel,  and makes  a very pleasant, as  well  as anti-acescent diet.
  Likewise, the patent sago, properly boiled, adding to every half-
  pint a large tea-spoonful of red port wine, for the use of infants ot a
  week old? cautiously increasing the quantity of wine  as they grow
  older.  A large family of  children whose bowels had been  conti-
  nually disordered by various  other food, has been brought  up by
  this, which was persevered in till they had four, or more teeth,and
  were able  to  partake of pudding and other common food.   Young
  children in this  country so seldom tasting wine  it may ^strange
  to advise it for infants in the  month; but it wil be  "collated by
  some readers, that the practice is very  different m w^countne ,
  where  it is often  exhibited  as well for food as medicine,  andIs
  Te of the best  cordials for iqtanta, as I  have experienced in various
instances.
  Perhaps much more has been said on the subject of acidity  by
  ™J™  than reallv ought to  have been, or it may at least be
some ™te"> ™^ ™X°nUtfon has not been paid to the peculiar cir-
suspected,that a proper^n"0"      h d   ^   to it. Acidity, when
cumstances of infants, who  e  11 mucn   p          ^ ^ ^
injurious, is probably, ^enlin^ ™"^ to be natural to them,
I^^Ct^^  organs of diction, and the 
51
MANAGEMENT OF INFANTS, AND
nature of their food; though there is no doubt, that their complaints
are afterwards aggravated by an abounding acid, or rather, probably,
from this natural acid becoming morbidly acrid, through over-feed-
ing, and other errors in their diet, or from its being accidentally con-
fined  in the first passages.   Nature, however,  seems to have de-
signed the food of infants to be acescent; and till the body be disor-
dered, and digestion hurt from  one cause or other,* this quality of
their food is  not likely to be very injurious to them; and, probably,
is far less so, in  a general way, than food  of a very  alkaline nature
would  be  with a like weak digestion.  It is true,  indeed,  that as
many similar  complaints in adults who feed on  different diets, will,
caeteris paribus, have their varieties, and each have some  relation to
the different  qualities of their food; so it is not to be wondered at,
that the complaints  of infants should  be attended with  wind  and
other marks of acidity, which in adults are usually the least hurtful
of all;  and are,  indeed, for the most part, pretty easily corrected in
children, while that is the only complaint.   When  they are much
troubled with wind therefore, it cannot be wrong to mix some carmi-
native  seeds,  or the waters distilled  from them, now and then, with
their food; such as sweet fennel,  or cardamom seeds, bruised very
fine; but the  aq. anaethi is that I have generally recommended, and
being a liquid, is always ready to be added to the food, without loss
of time. .  But though such an occasional addition to their food is
often exceedingly useful, I cannot  help speaking against its being
made  a constant practice; by which children not  only suffer when,
by accident, or absence from home, it has been neglected, but it de-
stroys  the very end for which it was used, by the stomach becoming
accustomed to it.
   Children, however, become less subject to wind and hurtful acidities
as they grow older, and the stomach gets stronger, as it is called.  But
should these complaints, notwithstanding, continue obstinate, a little
fine powder of chamomile flowers, or a few drops of tinctura columbo,
mixed  in water, and warmed with  a  little ginger,  will  prove ex-
ceedingly bracing to the stomach and bowels, and render them less
disposed to acidity. Exercise also, according to the age and strength, is
a grand preventive and remedy;  and especially making infants break
wind  after sucking or  feeding.  And  this may  generally  be ef-
fected, as every one knows,  by raising the infant  up, and gently
tapping it on the back, or rubbing its  stomach,  before it be laid in
the cradle to sleep.
  I have only to add, that when through  an abundant acid,  milk is
frequently thrown up curdled, a little prepared  oyster-shell  powder
may be added to it, or a very small  quantity of almond-soap, or of

  * Such cause, it  has been observed, may be an  over quantity, or too sweet  a
food, or heavy and indigestible diet;  which, indeed, prove more frequent occa?
sions of a di stempered acidity, than any thing else. 
YOUNG CHILDREN.
55
common salt, which will not at all injure the flavour, and will pre-
vent this change happening too soon in the stomach.
   It will be proper to include under this head, some observations re-
lating to wet nurses,  and to weaning.
                  On the Choice of Wet Nurses.

  The first and essential point in a wet nurse is, doubtless, that her
milk be  good; to which end  it is necessary she be healthy and
young; not of weak nerves, nor disposed to menstruate whilst she
gives suck: and that her bowels be rather costive than otherwise.
Her nipples should be small, but not short, and the breast promi-
nent, and rather oblong than large; such distention being rather from
fat, than  from milk.  The chief marks of good milk are, its being
thin, of a bluish  colour, rather sweet, and in great quantity; and  if
under four months old, it is, doubtless, an advantage: and certainly
ought not to exceed six.   And this is of more consequence, than  it
seems of late years to be thought; for after this time it generally be-
comes too thick for  a new-born infant, unless very robust;  and is not
 easily digested.  On this account, though an infant may not be really
 ill  I have frequently observed it not to thrive, though  it take great
 plenty of such milk.  When the milk is of this age, there is also a
 greater  chance of its failing before the infant be of a proper age  to
 be weaned.   A wet nurse ought,  furthermore, to have good teeth,
 at least,  her gums should be  sound,  and of a florid  colour.  She
 must be perfectly sober, and rather averse from strong liquors, which
 young  and  healthy people seldom need in order to their  having
 nlentv of milk.  She should be cleanly in her person,  good-tem-
 pered, careful,  fond  of children, and watchful in the night, or at
 least, not liable to suffer in  her health from  being robbed of her

    The diet proper  for wet nurses is likewise worthy of notice.  And
 here,  an invariable attention should be paid to natural constitution
  and habit.   Due allowance being made for these  it may be said,
  that milk, broth, and plain white soups; plain puddings,  flesh meats
  of easy  digestion, and  a due  mixture of vegetables;  with plenty of
  diluting drinks, and such proportion of more ge-nerou^iquorB (spirits
  excented ^ as the variety of circumstances shall direct, will be a pro-
  ZtetlJr suSSg women.  Respecting vegetables particulary,
  "he strictest regard should be had to constitution and habit.  Wher-
  evei vTgetables,or even acids, uniformly agree with the suckling 
5d
MANAGEMENT OF  INFANTS, AND
should be  added an  attention  to  exercise, and frequent walks in
the open air: to these,  hired  wet nurses  have been previously ac-
customed,  and are, therefore, sure to suffer by confinement to warm
rooms, equally to the  injury of  their own health, and of the infants
they suckle.
   I  shall  close these general  directions with the following from
Struve, in  a view rather  to suckling parents of a delicate  constitu-
tion,  than  hired wet nurses.   " Let two parts  of milk rise over a
gentle fire, and add one part  of well  fermented  beer, previously
boiled.   This beverage is to be taken cold, and has been  attended
with  the greatest  advantage  by women who were already so ex-
hausted,  that they thought it impossible to continue suckling their
children; they became replenished in a  short time, and  recovered
their strength  with a continued  increase bf milk."  Tract on  the
Education  and Treatment of Children, &c.—Hanover.
                     On Weaning of Infants.

   A principal article under this head, is the age at which it should
take place;  and  this will depend greatly upon attending circum-
stances.   A child ought to be in good health, especially in regard to
its  bowels;  and, doubtless, ought  first to have cut, at  least, four of
its teeth;  unless that process should commence very unusually late.
This seldom takes place  till  it is near a twelvemonth old; and it
may be observed, that healthy women who suckle their own children,
and take  proper exercise, do riot usually become pregnant again  in
less time.   We shall not be very wide,  therefore, of the  order of
nature, if we  say that children in general ought not to be weaned
much earlier than this;  making proper allowances, however, for
all just exceptions to general rules,* and especially as  far as teeth-
ing may be concerned.   Small and weakly infants, if  rather feeble
than ill,  are oftentimes  benefited  by being weaned; they should,
therefore,  about this age,  be taken from the breast, instead of being,
on account of weakness, nourished much longer in that way: a trial
of such a change  should,  at least, in most instances be made.
  Any preparation for weaning is generally needless, and especially
that  of feeding children  before-hand, though  made a common ex-
cuse for stuffing them whilst at the breast with indigestible food.   I
have seen many mothers  needlessly torturing themselves with the
fear of their children being  weaned  with difficulty,  because they
could not  get  them to feed when  eight or  ten months old, and still
at the breast; but I have  always found  such children wean, and
feed just as well as others, when once taken wholly from it. I, there-

  * Astruc advises children to be suckled till they are two years old, but with-
out giving any sufficient reasons. 
YOUNG CHILDREN.
57
fore, never have any fear in that respect, and therefore wish to coun-
teract, if possible, a sentiment encouraged by several writers, which
has, I believe, no real foundation in fact, but has  too often been
productive both  of much inconvenience and mischief.  But I do not
by this intend to say, that a child of eight or ten months old would
be injured, or oftentimes not benefited, by a little  food, once a-day,
of a more solid  nature than  the breast-milk, as, indeed, I have inti-
mated before; but  when children happen to be weaned much ear-
lier, <ind are fed almost from the birth merely with that view, (which
is often  the case,) they maybe essentially injured by it.
  Objections  to immediate weaning, which has of late years been
brought forward, have arisen,  I am persuaded,  from fallacious rea-
sonings, and not fron facts and experience; having mjself lived, as
it were,  in the  nursery for many years, and never found any ill ef-
fects from the sudden transition from breait-milk to artificial food,
when properly chosen;*  and as long as I shall continue the pupil of
nature, I shall hearken to no argument in favour of adding a less
adapted nutriment to that which nature has provided, in order to ob-
viate possible injurious  consequences, the existence of which  I- do
not think have been confirmed by facts.
  It has been remarked, that infants who are indisposed to feed at
all while at the breast are nevertheless weaned, and feed just as well
as others, when  once taken wholly from  it.  There is, however, in
a few children a little difficulty for the first two or three days under
any circumstances;  but it is remarkable,  that the instance  attended
with  the  greatest aversion  to common food, that I  ever witnessed,
was in an infant who had been allowed a little chicken broth once a-
day for  two months before  the  weaning  was  entered upon.   Ihis
child was very healthy, slept well, and scarcely cried at all upon be-
ing taken from the breast, and yet would not receive even the food it
had been accustomed to; so that for six and thirty hours it  con-
tinued averse from  every thing that was offered to  it, though  it  ap-
peared  in  very  good humour.   After the  second day, however, it
took a  moderate breakfast, and in a little time  it fed as readily as
other weaned children.                                     -^j*
   Under such circumstances, if the weaning has been committed to
the wet-nurse,or she be still in  the  house, it  will be proper,.that
strict inquiry be made and the nurse be watched;  there  being in-
stances  of  such  hankering after the breast being kept up, bv  u oc-
casionally  indulging the child in that way.  It may be f   her ob-
served  that if the infant be in the least degree costive, a little mag-
nes a andrhubarb should be administered, which besides opening the
bowels  will tend to  create  an appetite.   Such infants also, where

  . Were weaned  infant, to bo im^tdy crammed with^^f^e
indeed, bear some analogy to adult persons * >tl» dj W>,   u« jj
forced to live upon Cheshire cheese.
VOL. I"- 
55-
MANAGEMENT OF INFANTS, ANP
there are more young children in the family, should sit at table with
them when taking their meals;  as they  will thereby, through mere
imitation, be disposed to take food.
   When the weaning is once  entered  upon, a  great  part of their
food ought  still to be of milk, with puddings, broths,  and but litth
meat, supposing the  infant to be of a fit  age  to  admit  of any; and
every kind   of food,  and  even drink should be prohibited  in  the
night,  even from the first, supposing them to be weaned at a proper
age.  The   mere giving them drink,  even only for a  few  nights.
creates  the pain and trouble  of two weanings  instead of one, and
if it be continued  much longer, it not only breaks the  rest, but the
child will  acquire a habit  of being fond  of drinking; the  conse-
quence of which very often is a  large  belly,  weak bowels, general
debility, lax joints, and all the symptoms  of rickets.   The only need
is, that the  last feeding be just before the nurse  goes to bed, which
may generally be done without waking it: and whilst the child seems
to eujoy this sleepy meal,  it becomes a most pleasant employment to
the mother, or nurse, from observing how greedily the  child takes its
food, and how satisfied it will lie for  many hours on the strength  of
this meal; the mention of which naturally leads  to the consideration
of the next article proposed, viz.
                      Sleep and Watching.

  After what has been  already advanced on this article, under the
head of their complaints, only a few observations will  be necessary
hi this place; and first,  that healthy children sleep a great deal for
the  first three or four days after they are born, probably from having
been previously accustomed to it.   They ought not, however, to be
suffered to continue  this habit in the  day  time,  to  the degree some
children  are  permitted, but  should be  gradually broken of it; and
indeed, if not indulged, they will not be so much disposed to sleep
as  is  generally imagined, and will therefore take more rest in the
night;  which is mutually beneficial to the child  and the  mother, if
she  be in the same room, who especially if she suckles, will be less
disturbed,  at a time when  she particularly requires this  refresh-
ment.
  Therefore, when infants are sleepless in the night, they should be
kept more awake, and have as much exercise  as  possible in the day
lime, which though they be ever so young  may be pretty considera-
ble, (as  will be directed  more at large in its place,)  by playing with
them, or dandling on the kneer and  otherwise  amusing them;  and
when older, by every kind of exercise they can bear.  The child, if
healthy, will  soon contract a habit of being very much awake while
it is light, through  that lively and restless spirit peculiar to infancy; and
by this means, another evil will be very much  avoided, that of often 
YOUNG CHILDREN.
59
laying a child down to sleep in the daytime, for hours together, load-
ed with a thick dress, and covered besides with heavy clothes in a soft
cradle or bed.
   But though  I am confident these  cautions will have  their use, I
am equally satisfied that many  children have much less sleep than
they require; but then this deficiency is chiefly in the night, and is
often  the consequence of some complaints which the child  labours
under.  Upon  these, however, sufficient has already been said in the
former volumes, to which therefore the reader is referred.
   Before I quit this article, it may be remarked, that the custom of
constantly placing infants on  the back, whether in the cradle or bed,
is very improper; for by this means, the superfluous humour secreted
in the mouth, which, in the time  of teething especially, is very consi-
derable, cannot be  freely discharged, and must fall  down into the
stomach, where its abundance occasions various disorders.*  Infants
should therefore be frequently laid on one side, particularly the right,
as favourable  to the stomach getting easily rid of its  contents; to
which  side also children, when strong enough, will  instinctively
turn, if not prevented by the weight and confinement of their own
clothes, or those of the cradle  or bed.   The chief  apology for  all
which is, a fear of the infant's falling, or turning on its face;  but this
is rather an apology for the neglect  of  that necessary  attention to in-
fants, which, whenever it can be commanded, should never be spared

   It  only remains, under this article, to say something of the cradle,
which most writers have spoken against.   I believe there is no doubt
but the custom of laying children down awake, and rocking them m
a cradle in the day time, or at seven or eight o'clock  in the evening,
when they are to go into their night's sleep, as it is called, may be an
occasion of making them more wakeful in the night   or at least mT
cause them to expect that kind of motion whenever they awake.  But
yet I cannot help thinking,  there  is something so truly  natural, as
well as pleasant, in the wavy motion  of  a  cradle, (when m ,do use
 of at proper times,) and so like what all children  are used tc  before
 they are born;  being then suspended  and accustomed to nd,   is it
 were, or be gently swung in a  soft fluid, upon every motion of the
 mother, and even during her sleep, from the effecs of respirati n
 that  always  wishing to  follow nature as  I io, lean.not,  n the
 whole  but give an opinion rather in favour  of the cradle.   It is at
 kasf amonf the little things in which we may harmlessly err, and in
 whenCry mother may  therefore  be safely guided by her  own
 wnicn evciy i         f' i:nM   And if the child  in consequence

 ta Deing wm                     .„    t b      difficult  to find a
* See vol I. page 3. 
GO
.MANAGEMENT  OF INFANTS, AND
mechanically, to pat and gently move a child, whether feying oa the
lap or the arm, whenever it appears to awake prematurely. The ob-
jections to the cradle made by some late writers, militate only against
the abuse of  it, from  any violent  rocking; as though infants  must
necessarily be jumbled  in a cradle like travellers  in a mail-coach.
For I cannot  easily persuade myself,  that we are in every thing be-
come so much wiser than our fore-fathers; with whom for  some ages,
and in distant countries, amongst rich and poor, the cradle has been
judged to be  a necessary part of family furniture.
   Since the last edition  of this work passed under my own revise,
new and  stern objections have been offered to the arguments I had
advanced, and  from very respectable authority; but I conceive, not
the result of actual  experience of any  ill  consequences attached to
the practice I had ventured to  espouse.  It is objected, however,
that infants afterbirth pass into a very different state to that they had
been accustomed to in utero.   True,  but I have not advised children
to be  rocked  all the time  they sleep, like the unborn infant; but
have  merely  said, that as some new-born infants certainly do not
sleep so  much, nor so  long at a time  as they ought;  and are often
with difficulty got into  that state, through illness  and other causes;
I conceive, they cannot  be injured by gentle rocking when they are
first laid  down in the cradle, nor  from  being gently, and to them-
selves pleasantly moved, when they may be disposed to awake pre-
maturely—more than this  I never  intended; whilst  my argument
from  the infant having been accustomed to this waving  motion in
utero, was calculated only to combat the frivolous objection, as I
conceived it to be, against this very ancient practice, and not as be-
ing in itself a reason for its  continuance.  But the writer observes,
that ' no prudent person would recommend any unnecessary expe-
dient, which  may, through inattention, be improperly used.' As this
argument stands,  it must carry conviction with it; but if by unneces-
sary,  be  meant useless expedient, I beg leave to deny the supposition;
and in  return to inquire, what actual  evils have  resulted from the
practice? For if these be neither frequent nor great,  I  would ask
again, what good thing  is there that has not been  abused? or what
is there of more importance to children than sleep? every innoxious
inducement to which, it should seem,  ought to be encouraged;  and if
so, the cradle, or some similar mean of grateful motion, does not ap-
pear to be wholly unnecessary.  In  regard  to watchfulness,  how-
ever, as  was  observed  in another place, it is usually a mere  symp-
tom, and should be treated according to its cause;  but in  a general
way it may be said, that nothing can so safely and effectually con-
tribute to procure natural rest as that exercise to be further consider-
ed under the next head. 
kOUNG CHILDREN
Gl
                        Motion and Rest.

  It is chiefly the former of these that will claim our attention, as
infants ought scarcely ever to be in a quiescent posture, except when
asleep; and happy for them, that active principle with which nature
hath endowed them, is so vigorous and overflowing, that they reluct-
antly submit to it.   Exercise,  like air, is, indeed, of such universal
importance, that  children cannot possibly be truly healthy without
it;  care only should be taken that it be properly suited to their age.
   The first kind  of  exercise, it has been said, consists in dandling,
as it is called,  patting the back after feeding, and gently raising the
child up  and  down in the  arms;  taking care at  first not  to toss it
very high, infants being very early susceptible of fear, and even ca-
pable of being thrown into fits by it.  Another exercise adapted to
this tender age, and  of the utmost advantage, is  rubbing them  with
the hand.  This should be done all over, at least twice a-day, when
they are  dressed and undressed, and  especially,  as noticed before,
 along the whole course of the spine, and ought to be continued tor
 some time, being peculiarly agreeable to the child, as it constantly
 testifies by stretching out  its little limbs, and pushing them against
 the hand, with a smile expressive of  the satisfaction it receives  from
 it.  Such gentle exercise may be partially repeated  every time the
 child's cloths are changed, by rubbing the  lower limbs  and every
 other  part within reach.   Likewise dashing the face with  cold wa-
 ter, in the manner recommended for the rickets,* but more lightly,
 will produce the effects of exercise well adapted to this age.
    When  children  are  older, their exercise should be proportionally
 increased, and as has been observed, they ought never to be  carried in
 a quiescent posture, but the  arm that supports them should be con-
 tinually in such  motion  as the nurse may  be  able to continue.   For
 children, it  has been noticed, delight to be in constant motion; and
 this exuberant activity is given them for  the wisest  Ptoses and
  ought by no  means to be counteracted.   And I  notice the mode of
  carrying them, because  I have seen children slung carelessly over the
  arm in such a manner, as  neither affords them ^y exercise nor al-
  lows them to give any motion to themselves, which  lively children
   v 1atoy. entavoi to do.  And, indeed,  the manner of crying
  an nfant is of more importance than is generally imagined, for, from
   t hfchid wiU contract ahabit, good or bad, that it will  not readily
  rive up, and may  be as much disposed to  become rickety by impro-
  per m^agement in the arms, as if  it were lying wet  in  the cradle;
  die ill effects of which have been pointed  out already.
     It  may b a proper inquiry in  this place at what  age children
   should  be put  on their feet; a point on which people  have d,f-
Vol. I, page 167. 
62
MANAGEMENT OF INFANTS, AND
 fered considerably;  but I apprehend nothing, more is required than tc*
 follow nature, whose progress is always gradual, as our imitations of
 her should be, and we shall then seldom run very wide of her inten-
 tions.   If  we take notice  of a healthy child, it  has been said, we
 shall observe it to be always in motion, and as soon as it gets strength,
 it will be supporting itself by the help of its hands and feet, and be
 crawling  about  wherever it  is  permitted.   From this exercise, it
 will soon acquire an increase of strength;  and whenever it is upheld
 by the  arms,  and disentangled from  the weight of its clothes at the
 time of dressing and undressing, it will naturally walk up the waist
 of its mother, or nurse;* and by the manner of moving its limbs, and
 its bearing more or less on  the arms, will show what  advances it has
 made.   Whenever  it  is strong enough,  it will have attained suffi-
 cient knowledge  to walk by itself,  and will never attempt it till it
 is fully equal to the task.   It will then be perfectly safe to permit  it
 to follow its inclination, at least as far  as the straitness of its limbs is
 concerned, and  I think I may defy any one to produce a single in-
 stance of a child getting crooked  legs, from  being suffered to walk as
 soon as  it has been disposed to make  the attempt.   But in nowise
 ought  nature to be forced;  a maxim applicable to every other occa-
 sion, " aware, (as  a  writer  before quoted,f  finely  observes,) that
 whatever forms may, by artifice, be intruded upon her, and she com-
 pelled to assume, to enlarge or contract her bias and inclination, she
 can never be made  eventually, to deviate without  manifest injury to
 herself, from the station and bounds unalterably impressed upon her
 by the unerring Power, which  first created and  gave  her laws."—
 But the mischief is, we lead on children prematurely to the trial, by
 backstrings and  goecarts, and other contrivances,  calculated only to
 spare  idle  nursery  maids,  or what is  really pitiable,  to allow poor
 people time to attend to other concerns, who are obliged to work for
 their bread.   But where this  is  not the case,  such contrivances are
 unpardonable, and are  the consequence of ignorance, or idleness,

  * I cannot avoid taking notice here of an imprudence on this occasion, which
 it is well if it have not been prejudicial oftener than has been suspected; I
 mean, that of suffering a child to crawl so high up the neck, as to render the
 mother, or nurse, incapable of raising ihe arms high enough to support it: for
 not only may a child be suffered to slip out of the hands, but the mother may be
 injured.  I have felt much on this occasion, from seeing tender and delicate.
 ladies with their arms on a stretch, suffering  a  heavy child, perhaps  with its
 shoes on, tocrawl over the breasts, distended with milk, and squeezing them so
 forcibly against the edge of the stays, that  parents have sometimes cried out
 from the pain, and yet not been  able at the moment, to bring the infant down  in-
 to the lap. But the degree of  evil attached to this, depends not a little on the
 fashion which the dress may assume at the time.  This note was calculated for
 an abridged edition of this work, for domestic use ;  but as every medical gentle-
man may not have noticed this injurious custom, by not being often present when
ladies are suckling their children, it is thought the caution might not be whollv
improper here.                                       °
  f Mr. Moss. 
YOUNG CHILDREN.
as
which are productive of great evils, and then  by way of excuse it
is asked, at what age a child may be  put on its feet; a question, I
apprehend, that ought to be replied  to only  in the manner I have
done;* leave children to themselves, and they will afford a satisfac-
tory answer in good time.
  It is said, however, by a sensible writer,t that children's legs do
not become  crooked by putting them too early  on their feet, and he
asks if any  other animal  has crooked  legs, though they stand on
them almost as soon as  they  are born.   But this  is running to the
contrary extreme; the cases, I apprehend, being  widely different; qua-
drupeds and fowls are designed by nature to be early on their legs, and
it is  necessary they should be so.   They are accordingly calculated
for it, their bones being strongly ossified  from their birth;  but this is,
by  no means, the case with the  human  species,  and therefore no
argument can be founded upon it  without considerable latitude, and
making such  allowances for the different circumstances of children
as have been  pointed out.   But if it be meant only to suffer child-
ren to feel their  way, if I may so speak, for themselves, they will
never deceive  us, nor do I think their limbs ever become  crooked,
but by urging them to it by contrivances of our own, for which poverty
is the only apology that can possibly be offered.
   A note of  Dr. Buchan on  the subject of giving exercise to child-
ren,  which some people from their straitened  circumstances cannot
spare time to  afford them, charmed me exceedingly. The good sense
 and philanthropy manifested  in  it, as well as  a desire  of extending
 its useful contents, will,  I hope, be apology sufficient for transcribing
 it, especially  as it  is at present  so apposite  to  my purpose.   And
 though  I cannot flatter  myself that government, however benevo-
 lently disposed, will, or  perhaps can, at this time, adopt such a plan,
 either from his recommendation or mine, it is, nevertheless, in the
 power of people of large fortune, both in town and country, to give
  it very considerable effect, especially if the premium were made dou-
  ble for such children as should be produced  in  good health.   Ihe
  Doctor's words are:
    « If it were made the interest of  the poor to keep their children
  alive, we should lose very few of them.   A small premium given
  everv year to each  poor family, for every child they have ahve at the
  Year's end, would save more  infants' Jives than if the whole revenue
  of the crown were  expended on hopitals  for  that  purpose.   Ihis
  would make the poor esteem fertility a blessing, whereas many ot

    *  I have seen a child walking alone before it has been nine months old, and
      ina\eseenavii       b          in its hands, whilst other children,
  iS^^^S^^S^^^ '—been unable to do half as
  m^cli at two years of age" I have even* seen  a child wrikmg t^y alone, tor a
  few steps, the day before it was eight months old.
    f Dr. Hugh Smith, Letters to married women. 
64
MANAGEMENT  OF INFANTS, AND
them think it the greatest curse that can befal them;" and I may add,
I have known them express great thankfulness, when any of their
children have died.
   The advice contained in this chapter is further worthy of serious
attention from late discoveries  of a  much  greater fatality amongst
the children of the poor of this metropolis than I ever suspected.
   To ascertain the fact, an inquiry has been for some time set on
foot, at the British Lying-in Hospital, at the suggestion  of  my col-
league, Dr. Combe.   Inquiries  have likewise been  making  ever
since in different ways,  and I have no reason  to suspect that the
statement  made out from  the  report  of the women offering them-
selves at the hospital, is at all beyond the fatality  in other poor fami-
lies in London, but, indeed, rather under it,  in regard to still poorer
people.
   The following is a brief statement of the result ofthe investiga-
tion at the Hospital, during the first  year:
Several women	who had borne	
3 children, had lost as many as		2
4	. .	. 3
5 .		4
6		. 5
7 .	.	6
8		. 7
9 .		8
10		9
11		8 and 10
12		10 and 11
14 .		11
And several of the mothers of different numbers had lost them all.

  During another long period, only one woman having borne as ma-
ny as five children, had reared them all; and one having had twelve,
had eight living.  But some having had four, had lost three; and five,
had lost four; and six, five; and seven, six; and eight, six and seven;
and  ten,  seven  and nine; and  women having  borne eleven and
twelve, had lost eight, nine, and ten;  and fourteen eight:  with  many
who had borne four,  five, and six, one twelve, and another twenty-
one, had buried them all.  In addition to this, may be remarked the
sad and rickety state of many of the surviving children.
  The above, indeed, contains the most formidable view of this mat-
ter, but the most favourable is,  by no means, such as to counter-
balance it; there being, during a year and a half, no more than three
women, I think, who having borne  only three children;  and one
women, (lately come from  the country) having four children;  who
had lost none of them.   Only one having had as  many as six, had
them all living;  and another, who had preserved eight children out 
YOUNG CHILDREN.
65
of ten.  Amongst the surviving ones, however, it was frequently ob-
served, was the last born; therefore, one  less likely to be reared
than an older child.                                      .    . ,
   From these different degrees  of fatality further  contrasted  with
the small number of deaths in the hospital, within the  month,  we
may suspect the different care and  attention bestowed upon young
children, as well as the want of certain accommodations; and may
fairly argue on their effects, there being no  such fatality  amongst  the
opulent:  a singular corroboration of this remark, I had the oppor-
tunity of noticing only a few days ago; where a lady who had borne
fifteen children, and no more, had them all sitting  around her table
at dinner;  and  in two other families, there  were twenty-one children
 at table; and a lady I  visited a few  months ago, told me, that  the
 number of her  children and grand-children amounted to forty-seyen.
   It would be  unpardonable not to add a  few words in this  place
 with a peculiar reference to females; upon whom  beside every in-
 firmity common to the other sex, is imposed the painful task ol cnuu-
 bearing.   It is the benefit of the lower class of people, indeed  that
 I have here principally in view;  though the  caution is not utterly
 unnecessarv elsewhere.-The many distressing, and someUmcs total
 labours I have been witness to,  have  led me to regard with a kind of
 horror a rickety, distorted female infant;  whose parents'or nurses
 ne Lt, or ignorance, is heaping up for its additional suffermgs  and
 dangers, to those which are great enough under every advantage that
 art, and good health can contribute.
    From the age of two years therefore, or rather earlier, this care s
 especially called for; and besides every caution alreadypP™ted  °£>
 lays a strict prohibition on girls being  suffered to sit,  for hours to-
 gether, on a low seat;  whereby the  pelvis is pressed  between the
 lower extremities and the spine, and  is made to grow ou of its nau-
 ral form.  The consequences of this change of figure, if  it be anywise
 considerable, cannot fail to be productive  of increased pain and  dan-
  gers in  parturition, frequently dually  fatal both to the parent and

  hC I amSe, that many poor people are not in circumstances to give
  their children'all the Exercise'they require: ^™J>*™^
  suffer them to afford as much as possible  to themselves,by allow ng
  them to crawl about on the floor, near an open window or doorn-
  stead of compelling them to lie on their backs or to■ s,t»£8^»-
   ned in a  chair;  the ill consequences of which  are so exceedingly

   ^IUs'honed  no apology may be thought necessary for these  obvi-
   ouremaTs  since no pains should be thought too great if they may
   J^?eXhe« pointed out, nor can too much be said to »-
VOL. IH.
* See the Introduction to this volume.
               L 
6G
MANAGEMENT OF  INFANTS, AND
culcate good nursing, (and especially exercise) which is alone ade-
quate thereto.*
   A very few words may  suffice on the head of rest, the irregulari-
ties therein  being far less numerous  and important than in the for-
mer.   In a  general way, it will be sufficient to notice them in regard
to the improper inducement of young children to continue in action
after they feel themselves wearied, and in  keeping them out of bed
beyond a proper hour.  Children  in health never wish to  sit  still
when they do not actually feel it to be  necessary,  much less to go
to bed over early.   But it is to be remembered, that  young people
require more sleep, and  to be longer in a recumbent posture than
adults;  for though they usually rise very early, they get to rest more
than proportionally  soon, being disposed  to fall  asleep almost the
moment they are still; and this is  natural to them, and is a  demon-
stration ofthe advantage of exercise.


               On some slight Natural Deformities.

   Prolix as these articles may already have appeared, it may, never-
theless, add a completeness acceptable to the  younger part of the
profession, to comprehend under them other particulars of  no small
importance, that relate equally to both.  These will respect the dif-
ferent  modes of motion and rest, in order to point out several impro-
prieties that have  a natural tendency to induce, or increase various
corresponding deformities.
   Such will relate  to the manner of children's standing,  walking,
sitting, and lying; and  will particularly respect the position ofthe
head and feet, and the  form of the back, shoulders, and hips.  It
may not, therefore, be improper  in  this place, nor, it is hoped, be
thought going out of the true line of my profession, to advert a little
to each of these.   Indeed, to propose regulations of any kind merely
with a view to a graceful manner  of standing or walking, would be
highly  incompatible with the  intention of the work; but since this
part of it is appropriated to the general management of children, it is
hoped the reader  may not deem it altogether impertinent  that he is
invited to pay attention to certain things, which, for want of correc-
tion whilst  children are young, and frequently under the eye of me-
dical people, may, by the neglect of their ordinary, and less intelli-
gent attendants, grow up to real evils.  For it is  very certain, that
from an improper manner of resting upon any of the extremities,
whether in sitting or otherwise, different parts may take an ill form;

   * A proper attention to this, and many of the preceding articles, has been con-
ceived to be of so much importance, that the benevolent governors ofthe British
Lying-in Hospital, some years ago gave orders, that suitable directions on these
heads  should be drawn up, and given to every mother, on  her leaving that
charity. 
YOUNG CHILDREN.
bl
and  what is  worse than an  awkward  appearance, (to which their
parents are apt  to confine their attention,) children  often grow up
weak; whereby the poor become unfit for those labours and exercises
for which they are designed, and the necessities of their situation fre-
quently demand.
   And I here beg leave to remark, that the very  means frequently
made use of by people of rank to prevent some of these deformities,
may, on the contrary, occasion them.   Such  are the  use of steel col-
lars, various sorts of stiff stays, and other tight bandages.   For I am
confident, nor am I singular in the opinion, that when recourse is had
to these things, before any parts  have taken a wrong turn, they  are
very likely to  occasion it.   Not that such contrivances are afterwards
improper; for when the bones have, by any means, been thrown out
of their natural direction, art can  frequently rectify it, and  point out
where to apply, or to take off pressure; and has been fully consider-
ed in the account of diseases.   But before this,  and  while the bones
are  growing,  compression, however properly  applied, is in effect
oftentimes ill-directed, owing to the continual and irregular action of
children, especially when they feel any parts unpleasantly confined.
   I  come now to the circumstance immediately hinted at, and first
those which regard the head or neck.
   Many infants come into the world  either  with  the neck drawn a
little to one side; or an awkward turn of the head  appears  to take
place afterwards.   In the latter instance, it may be the effect of habit,
and  amongst other causes may be owing to children  being placed in
the cradle, or carried improperly, so that the light, and other objects
that forcibly attract their notice, are too frequently on the same side.
The remedy in either case, as far as it  may become such,  is obvious,
differing nothing from the intentions already noticed in the chapter on
squinting;  every thing should be  so contrived as  may tend to draw
the head to the other side, and especially such things  as may  have a
9udden and forcible operation on  the muscles,  by producing strong
voluntary motions.   It may not, perhaps, occur to  every one, how
much may be effected by  such means: several  striking instances of
it, however,  have been met  with;* and  we daily  observe  similar
effects of a certain position in flowers and shrubs, which, without aiiy
help from the hand, turn about, obedient to the air and sun operating
upon their internal structure.

   *  An ambassador from Morocco, being  at Paris, went  to see the Charity
Hospital, where passing the  ward for the wounded, six of  them who bad not
stirred for several months before, rose up and came to the ambassador, to the
great surprise ofthe whole Hospital ;f curiosity or surprise effecting that.Vhich
the most powerful medicines could not, in so short a time.   The like circum-
stance is reported to have taken place very lately from a firf happening m the
house where an elderly lady had long lain bed-ridden? who,  perceiving tne hre,
•uddenly rose up from her bed, without any assistance, and ran into the street.
   t  Histoire de I'Ajnbassideur de Moroc, Envoye au Roi de  France, en 1682. 
68
MANAGEMENT OF INFANTS, AND
   The next observations  respect the back and  shoulders.   Some
young children, naturally well-formed, acquire after a while what is
termed round shoulders; the vertebra? ofthe neck and back project-
ing too much, and forming an unsightly curve.
   The morbid affection of this part  has been mentioned already; I
have only to notice  here  a change arising merely  from some bad
habit or custom, through an improper manner of sitting or standing.
In regard to the former, it may be observed, that the soft  concave
bottomed chairs,  in which young  children usually sit, are on many
accounts  improper for their years, who should  always make use of a
flat and hard seat, and generally without arms,  as directed  for the
prolapsus ani;  which complaint it would have a tendency to prevent.
But in  the hollow bottomed  chairs children find themselves  obliged
to recline in one way or other, or to be making certain exertions  for
keeping themselves upright,  and  preserving an equilibrium of the
body; and it is obvious, that either a bending posture, or the efforts
necessary to avoid it, if often repeated, may become hurtful to weak-
ly children.
   An improper manner of standing,  though less  frequently a source
of this  kind  of mischief, on account  of the position being more fre-
quently varied than in sitting, is, nevertheless, capable of giving an
awkward turn to the back and shoulders, as well  as to the feet.   We
are creatures of habit, both in respect to  our  bodies and minds, so
that to whatever we may have for a little while accustomed our-
selves, we have an increasing propensity; and when the habit is once
formed it is with difficulty broken.   Children should, therefore, be
early accustomed to stand very upright, instead of being suffered to
lean upon whatever may happen to  be near  them, as they are fre-
quently disposed to do.
   Should one  of the shoulder blades project more than the other,
the child should lie as much as may be on the contrary  side; as the
shoulder upon which one lies always  projects beyond the plane of the
back.  When the shoulders  themselves  happen  to  be  too high, a
child so disposed should never be  suffered to  sit in an elbow-chair;
nor should any child sit before a table, that is either much too high
or too low for the seat  in which he may be placed, especially if it
be for  the purpose of reading, writing, or any  other employment that
may engage him for any length of time.   But if one of the shoulders
is higher than the other, the child  should frequently be directed to
stand only upon the foot  of that side, at  least to bear his weight
chiefly upon it; by which means, the shoulder that is too high must
necessarily fall lower, and the other be raised: or a small weight may
be put upon the shoulder  that is too low, which will  incline  the
child to raise  it  up.  Or he  may be caused frequently to carry a
light chair, or such like, as a.play-thing in the hand of that side,
which will have  the same effect.  The like  means  should  be used 
VOUNG CHILDREN.
69
when one hip is higher than the other, which is both a very common
and peculiarly unfortunate complaint, especially to females.
   Another easy  and efficacious mean of rectifying the shoulders, is
to make the child support himself with  a very short cane on the side
where the shoulder is too high, which will oblige him to lower it;
end at other times,  to put one that is too long for him into the other
hand, which will raise the shoulder on  that side.   He may likewise
often sit in a chair with  two arms, one of them being made a little
higher than the other.
   These and  other similar means may be very easily complied with;
 and  several of them so managed as to be made  a sort  of play or
 amusement to the child; and if properly persevered in, will correct
 many deformities that have originated merely from bad habits, as well
 as conspire with other contrivances to remedy such as may depend
 upon a slight mal-formation.
   The feet of children, it has been said, are likewise liable to re-
 ceive an improper turn;  and this  may arise from  habit, as well as
 from  original  mal-formation, which has  already  been noticed.
  Children, when conversing with those with whom they are familiar,
  seldom stand firmly on their feet,  but are apt to lean upon one side
  of them,  so as  to  bear almost upon the  ankle  instead  of the soles
  of  the feet.  By degrees, this habit  is not only increased,  but the
  tendons themselves are disposed to contract, or those on the opposite
  side become weakened.   In the like  manner by  standing upon the
  toes, the tendon ofthe heel, in time, becomes shorter  as was formerly
  very manifest in women who wore very high heeled shoes To obviate
  the former, little more is required, than to correct Uie child's manner
   of standing, by teaching him to bear  firmly on the  bottom of his feet:
   or  if a fit be turned very much to  either side, the so  e of the shoe
   may  be  thickened upon the side  on  which the  child bears   It by
   treading upon the toes, the  heel is  become contracted, the heel-
   p?ece shouH be taken 'off from that  shoe instead  of its beng.raised
   as hath sometimes been very improperly done.  Beside this.such
   children should  be frequently caused to walk  "P^ep as en s  by
   which they will be obliged to raise up the fore part ofthe foot,  w here-
   by the Spn 0f the leg  will be stretched, and the heel  must fall

   10Most of the remedies proposed for these little  disorders, will have





    CTl\1rnotCaSy"diar exceeded the bounds I  had intended, I 
 70               MANAGEMENT OF INFANTS, AND


 tract a few of the pertinent and elegant remarks  of Desessartz* on
 this head, whilst I more briefly observe, that exercise tends to push
 forward the blood through the  small vessels, and to unfold them in
 the manner nature has designed them to be extended, in order to pro-
 mote the growth of the infant, whilst it preserves  the  blood in a pro-
 per state of fluidity, and promotes both the secretions and excretions;
 which are the next things it was proposed to consider.


                      Retention and Excretion.


   Every medical reader  will  be sensible,  how greatly health  de-
 pends upon a due  proportion between  the  daily supplies, and  the
 various  discharges of the  body: the latter will vary  according to the
 diet, age, and particular mode of life of each individual.   The excre-
 tions of infants, however, insensible perspiration excepted, are chiefly
 from the bowels and bladder; but the latter is not very  liable to dis-
 orders; as it sometimes takes place, however, it ought not to be  en-
 tirely passed over.


              Retention of Urine in New-born Infants.


   After what  has  been  already  advanced  under the  head of
 diseases, it will be sufficient to say, that the retention of urine during

  * " La liaison et la dependance que l'auteur supreme de la nature a etablics
 cntre toutes les parties de ce compose' merveilleux, sont  si intimes, que le
 Prince de la Me"decine nous a represente le  corps anim€ et jouissant de ses
 fonctions, comme un cercle dans lequel on ne peut reconnoitre ni commence-
 ment, ni fin.  En effet, les instrumens destines a la chylification tirent touto
 leur force des organes de la sanguification, ceux-ci des nerfs et du fluide qu'ils
 contiennent: et ce fluide (si nous en  croyons le  syste'me le  plus universelle-
 ment adopte, et auquel il manque peu de chose pour etre demontre :) ce fluide
 tire son origine du sang, et le sang des alimens que nous prenons tous les jours.
 De la Constance et de la regularite de fonctions aussi diffifirentes  et aussi multi-
 pliers dependent notre sante et notre vie.  Il ne suflit pasde prendre des nour-
 ritures, il faut qu'elles soient bien digerees, changers en sang, et ce sang doit
 etre assez travaUle pour fournir non seulement la lymphe nourriciere de tout le
 corps, mais encore un fluide tres-subtil qu'on appelle fluide animal.  Chaque
 liqueur doit etre separe"e dans ses glandes, et cedes que la nature rejette comme
 inutiles et dangereuses, doivent etre poussees au dehors.
  " Or, rien n'est plus propre a faciliter et a perfectionner  toutes ces opera-
 tions, que l'exercise.  Si nous jettons les yeux sur notre  corps, nous y apper-
 cevrons une multitude de vaisseaux qui sont entrelasses lesuns dans les autres,
 serpentans entre les fibres musculaires, a la pression successive desquelles Us
 doivent une grande partie de leur movement et de leur action sur les fluides.
 A mesure que les muscles entrent en jeu, Us produisent des secousses reiterees
sur les vaisseaux sanguins, qui se communiquent dans tout  le syste'me arteriel
et veineux. Ces secousses non seulement procurent aux fibres  la force, et la
 souplesse, qui  caracterisent leur bonne constitution, mais elles  broyent, at-
tenuent et subtilisent les liquides contenus dans les vaisseaux, achevent la trans-
mutation du chyle en sang, en lymphe, et en fluide animal; la circulation est
plus fibre, les secretions se font  mieux, et plus uniformement, et la digestion
en devient plus parfeite."— Twite de ^Education corportlle des Enfans en bw Age. 
YOUNG CHILDREN.
71
early infancy is chiefly from the birth, and is usually removed by ap-
plying a bladder of hot water to the belly, and gently rubbing with a
little warm brandy, with oil  of juniper,  and oil of almonds, or an
onion; and throwing up a clyster: or should these fail, the infant may
be put up to the breast in a pan of warm water, and take a spoonful
of marsh-mallow, or parsley, or wild-carrot  tea, sweetened with
honey, with  the addition of two or three drops of the spirit, aether
nitrosi.  This, if there be no mal-formation of parts, will generally
produce the desired  effect in the course of a few hours; though cases
have occurred in which infants have voided no urine for the  space oi
four days, and  have suffered very little inconvenience: I have even
known one instance of the suppression continuing for five;  and it  is
remarkable, that two former infants in this family voided  no urine
for  three days.  Should the suppression, however, continue during
two complete days, the following cataplasm may be applied warm to
the  region of the pubis.                                   .   .
   Take of parsley and mallow-roots, leaves of cresses,  and jumper
 berries, of each a handful, and of the roots of garlic one ounce; boil
 them slowly in water, or in wine, to  the  proper consistence for a
 poultice.   On the other hand, the sudden application of cold to the
 regio pubis has sometimes  produced an  immediate  good effect.
 Where all these  means have failed, and the  infant been in much
 pain, I have directed a clyster with a few drops of laudanum, which
 has presently removed both the pain and suppression.
     As in adults a suppression  of a very distressing  kind sometimes
  occurs merely from a spasmodic stricture of the urethra; and not only
  resists for a length of time the ordinary means of cure, but is found
  to  recur again after a temporary removal; it may not be amiss just to
  notice it here, as the complaint may, possibly, be met with in robust
  youths, although I have never yet seen it.   The remedy for it is also
  Very simple, and I believe newly discovered, and first announced by
  Mr  CUne* consisting only in the tinctura fern muriati, which he
  advises in the dose of gtt. x. to adult persons, every ten minutes  dl
  some relaxation shall take place; which generally does m  the course

  °f SomeUof the old writers have spoken  also of incontinence of urine,
  arisen"  from weakness of  the sphincter of the bladder; but I have
  never meJwin it iu  early infancy.   They  prescribe  agrimony and
  mvrrh  ^ direct astringent fomentations of red wine to the belly
  myrrn, aim ui        fJ^ulls fit being no uncommon complaint in
  £5*EE ?££££ °, clmphor io*. pill, and fifteen or twenty
  troftandt^in a dose „? camphor julep, twee  a-day,  has

   S<e^rl'LC2s't therefore  chiefly confined «..the
   J,„wdl which would call  for a scrupulous attentat .n th,s place, tf

                     « Medical Records and Researches. 
12              MANAGEMENT OF INFANTS, AND

so many particulars  relative to them  had not  been discussed  in  a
former part of this work.   It were needless, therefore, to say more,
than that (generally  speaking,) infants are rarely healthy  long toge-
ther, who have not two or three stools every day;  or  should there be
more, for the first three months, if the child be  brought up at the
breast, and the  nurse have a sufficiency of milk, it will generally
thrive the better.  The stools likewise ought to  be loose, of a yellow
colour, free from lumps, or curdy matter,  neither of a very acid, nor
fetid smell, and  should come away without griping.  When children
are about a year old, or perhaps earlier, pains  should be taken to
procure one stool  at least  every day, as well  periodically, as con-
stantly;  and  for this the morning  is most adapted, and after their
breakfast, by which the stomach and bowels will be stimulated.  To
this end they should be set on the chair, and not suffered to play till
they have  had  an opening, for which they should  strain, till at
length it becomes customary, as may be easily effected; and by which
we shall gain a  point, with respect to the health of children.   On
the other hand, if an infant is brought up by hand, the danger ge-
nerally lies in the other extreme, such children being disposed to be
purged, and to have griping and sour stools, from the acescent,  and
often indigestible nature  of their food, especially if fed by the spoon,
and therefore require an early attention when their bowels are  dis-
posed to be open,  or, on the other hand, the feces are too stiff and
clayey;  and their food be changed, in  the manner directed under the
article of purging.
                   TJie Passions  of the Mind.

  This is the last article mentioned as included in the non-naturals,
and on which I shall be very brief, it being the happiness of infants
to be  very little  affected by them.   This  article can, therefore, re-
late to them merely in regard to their mode of expressing such pas-
sions, and principally respects laughter and crying.  The former, if
long kept up, or very violent, may not   only  induce the  hiccough,
but it is said, may even throw an infant into fits.   The latter is, in-
deed,  much oftener suspected of being  mischievous, and  chiefly  by
occasioning fits,  or a  rupture; the  excess of both these affections
should, therefore,  be  guarded against.   Moderate, and not  too fre-
quent crying, however, ought not to be alarming;  and, indeed, a va-
riety of considerations induce me  to  think, that this expression of
the passions in infants is not only much more harmless in itself than
is generally imagined, but is also, in some respects, salutary.  The
first cries it makes we know to be so, and that children recover  from
the paroxysms of some complaints (as  was mentioned in regard  to
the croup)  by an effort of this kind.   It  is  evident likewise,  how
very much health depends on a free circulation of the blood  through 
YOUNG CHILDREN.
73
the lungs, and on their  free expansion  from the dilatation of the
bronchial vessels.   But as new-born infants are incapable of giving
themselves  any exercise,  and, indeed, of receiving that kind which
tends to promote such an  effect, I have conceived crying to be an ef-
fort which nature may have wisely substituted in its stead.*   What-
ever  is  truly  natural I always conceive to be right,  though every
thing is capable of being abused, and the most beneficial dictates of
nature may be exceeded.   I am satisfied, however, that the pacifying
of children by improper means, and especially cramming them with
food when  they are not hungry, (against which so much has been
said,) occasions far greater evils in thousands of instances, than ever
were produced by the irritation from crying.
   The cries of infants, however, it must be confessed,  are, very com-
 monly, plaintive;  and as  they seem to  argue distress,  cannot but
 create it  in every person of sensibility around them, and merit a
 strict inquiry into the particular occasion of them.  The nurse, there-
 fore, who can with calmness  hear an infant cry, without attempting
 to pacify it, by everv proper means, is a monster 'in human shape,
 unfit to  be trusted with the care of rational beings, much less  with
 a tender, helpless creature, whose only language, by which it can ex-
 press its wants or  sufferings, is its tears.
    I cannot take my leave of  the reader without offering one apology
 more for having dwelt so long on this, and  some  other heads less
 important'than the rest;  my motive has been the  desire of instruct-
 ing  though in some instances at the risk of tiring, or otherwise dis-
 pleasing; but practitioners, who  feel  as parents, will endeavour, by
 every means,  to lessen a mother's fears as far as they may appear to
 be needless, wherever no other remedy can be offered.
    I shall conclude by observing,  that, though the  passions of the
 mind refer so little to infants, they relate  very materially to the wet
 nurse,  who besides endeavouring to keep her spirits  as  calm as pos-
 sible, ought to be exceedingly careful not to put a child to her breast,
 when under the  influence of undue passion, of whatever kind it
  maybe-  the bad effects  of which have already been  instanced under
  the head of diseases.   And I shall think myself well recompensed
  for the trouble I have had,  if the  counsel I have been  able to offer
  mav prove the means of lessening the dangers of the ipfant state, and
  the consequent sad fatality that attends it; as well as of abating the
   anxiety of the fond mother, who,  after  having brought  her tender
   charge  into the world with sorrow, is pierced with  double pangs at
   its leaving it.  An event which, as  experience warrants me to say,
   mav bv art and good management, be often prevented the  author ar-
   dently hopes, that both parents and practitioners may have fewer oc-
   casions to lament.
    * Fletusmoderatuspuerisnonobest-pectus  dilatat et calefacit.  Primeros.
   See abo AriTt Polit. Lib. vii. C. 17, where the idea is supported more at large.
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