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A
PRACTICAL  TREATISE
ON
THE DISEASES OF CHILDREN.
                   1/

        BY JOHN BUCHANAN, M. D.,
                ******        '    '

PROFESSOR OF SURGERY AND INSTITUTES OF MEDICINE, AND CLINICAL LECTURER ON
   DISEASES OF WOMEN AND CHILDREN IN THE ECLECTIC MEDICAL COLLEGE
           OF PENNSYLVANIA, PHILADELPHIA.
ADAPTED TO THE USE OF FAMILIES AND PHYSICIANS.



           to"LiL.;:,AltT. %
           PHILADELPHIA:
JOHN BUCHANAN, M. D., 227 NORTH TWELFTH STREET.

              1866. 
/-\r\v,£x





   I  TO^
         THAT  NOBLE FRIEND


     OF MEDICAL  REFORM,

                    f
GEORGE  H.  REOCH,  Esq.,


        BROOKLYN,  NEW YORK,
BY  HIS FRIEND,
THE  AUTHOR
    Printed by W«. B. Sklheimee,
Oor. Pifth and Chestnut Sts., Philadelphia. 
INDEX.
                                 Page.
Acidities,........................   26
Accidents to Infants,..............   12
Alteratives,......................   11
Asphyxia,.......................   19
Aphthae,.........................   30
Asthma,.........................   55
Arterial Sedatives,................   11

Baths,...........................   11
Bronchitis,.......................   54
Boils,............................  104
Bruises,..........................  104
Bullea,.........................   82
Burns,..........................  103

Catarrh,........................   43
Circulation,......................   10
Chilblains,.......................  104
Cholera Infantum,................   97
Chorea,.........................   90
Cleft Palate,.....................   13
Countenance,....................    7
Curvature of Spine,...............   14
Club-foot,........................   14
Cry,.............  ...............    9
Cutaneous Eruptions,............   23
Colic.............................   is6
Croup,........................   38
Convulsions,.....................   37
Corvza,........................   43
Consumption,...................   6Q
Congestion of Brain,.............   85

Diagnosis of Infantile Diseases,.....    7
Discharges by Vomiting, &c,......   10
Diaphoretics,.....................   11
Disease..........................   15
Diarrhoea,..................... 28, 92
Disease of the Heart,.............   6<i
Disease of the Ear,...............   64
Disease of the Skin,..............   80
Disease of the Nervous System,...   85
Dysentery,...................  • • •   94

Erysipelas,......................   22
Emetics,.........................   ^
Excoriations,...................   21
Eruptive Fevers,.................   69
Earache,.......................   65
Erythema,.......................   8U
Eczema,.........................   82
Epilepsy,........................   »»
Epistaxis,........................  104

Frost Bite,.....................   103
                                 Page.
Gestures and Attitudes,...........   8

Hare-lip,.......................  13
Plydrorachitis,....................  13
Healthy Children,................  14
Hic-coughs,......................  22
Hooping-cough,..................  51
Hemorrhagia,....................  81
Herpes,........................  81
Hydrocephalus,...................  86
Hydrocele,...................... 103

Introductory Remarks,............   5
Infantile Therapeutics,............  10
Infantile Erysipelas,..............  22
Infantile Leucorrhoea,............. 103
Inflammation Umbilicus,..........  13
Intermittent Fever,...............  29
Influenza,........................  45
Impetigo,........................  82
Ichthyosis,......................  84
Intestinal Worms,................ 100
Incontinence of Urine,............ 102

Jaundice,.......................101

Lepra,.........................  84
Laryngitis,.....................  46
Lichen,........................  83
Leucorrhoea,..................... 103
Lock-jaw,.......................  28

Management of Infants,. .........  12
Malformations,...................  13
Mumps,.........................  42
Measles,........................  74
Marasmus,.......................  98
Maculea,........................  85

Nephritis,........................ 101

Otalgia,.........................  65
Otitis,...........................  65
Otorrhcea,.......................  66
Ozaena,...........................  45
Ophthalmia,.....................  32

Peculiarities of the Infant,.........   5
Peculiarities of Disease,...........   6
Furgatives,......................  11
Fro lapsus Ani,...................  32
Purulent Ophthalmia,.............  32
Parotitis,........................  42
Pharyngitis,.......  .............  46
Putrid Sore Throat,..............  48 
IV
INDEX
                                 Page.
Pleurisy,.........................  57
Pneumonia,......................  59
Purpura,  .......................  81
Pemphigus,......................  82
Pustula,.........................  82
Parasite,  .......................  82
Papula,.........................  83
Prurigo,........................  84
Psoriasis,........................  84
Pityriasis........................  84
Paralysis,........................  92
Peritonitis,......................  99
Phymosis,.........-.............. 102

Quinsy,..........................  41

Rickets,.........................  13
Retention of Meconium,...........  20
Ringworm,.......................  83
Respiration,.....................  10

Sleep,...........................   9
Skin,............................   9
Sedatives,.......................  11
Stimulants,......................  12
Swelling of Breasts,...............  13
Stammering,.....................  14
Scrofula,.......................  67
Small Pox,......................  70
Scarlatina,.......................  76
Scurvy,.........................  81
      .                           Page
Scabies,.........................  |^
Squama,.........................

The Sleep,.......................    j|
The Cry........................    %
The Mouth,......................    ;:
The Skin,.......................    *
The Respiration,..................  }JJ
The Circulation,..................  ™
The Yellow Gum,................  21
Tabes Mesenterica,...............  98
Tubercula,....................• • •  85
Tongue-tie,......................  13
Treatment of Disease,.............  17
Tetanus,.........................  28
Teething,........................  34
Tonsillitis,.......................  46
Tinea Jonsurans,...............  83
Tinea Favosa,......  .............  83
Tinea Decalvans,.................  83
Tinea Sycosis,...................  83

Ulcerations,.....................   21
Urticaria,........................  81

Vomiting,........................  27
Vesicula,........................  81

Weaning Brash,..................  36
Wry Neck,  .....................   14 
                 A PRACTICAL TREATISE
                                ON THB

DISEASES   OF  CHILDREN.
   One of the greatest wants of the age is health—a sound mind in a sound
body.   Without it our national  future, the future of  families, of races,
becomes  more a matter of chance than  a  certainty.  Physical degeneracy
has blotted out many names from the face  of  the earth that ought to have
been perpetuated to bliss and to take part in the civilization and progress
of the  world.  Many a parent  has  brought into  the world feeble children
because the laws of life  and growth were not understood.   Many more have
consigned their loved ones to an early grave, or had them afflicted with dis-
ease, feebleness and deformity, through  a want of a knowledge of the natu-
ral laws of the body.  It is a true maxim  that a large and healthy popula-
tion is  the life and strength of a nation, as well as the source of i's success
in science, art, agriculture and commerce  ; and  it  is  therefore  a point of
momentous importance, the securing to our children a perfect state of health.
It is true that pure air, cleanliness, suitable clothing, plain natural food,
will do much in preventing disease and prolonging life.  It is also true that
marriages of parents of like temperaments should  never be con- ummated ;
neither should  there be  any incompatibility in  ages, disposition or blood
affinity.  In order to do her duty to herself, to her country, a pregnant
mother should  sustain  her  health in its highest state of perfection.  This
she will accomplish  by  attention  to diet, clo.-hing, cleanliness, exercise and
moral discipline.
   The  diet should be simple, light, nutritious, adapted to the requirements
of the  individual and the condition of the  digestive organs.  The clothing
should  be warm and comfortable, avoiding tight lacing, corsets and the like.
Cleanliness is very conducive to health, but remarkably so during gestation.
Tepid  bathing or sponging is highly commendable.  Exercise in the open
air is the best and simplest means of promoting an easy delivery and regu-
lar bowels.   Violent exercise  should be avoided.   Well ventilated rooms.
so that pure air may at  all times be  breathed.  Mental  and bodily equili-
brium are essential on the part of the mother to  a perfect mental consti-
tution, moral feelings and affections.   Her  mind should be calm, cheerful;
all emotions, desires, should be regulated by intellectual  occupation, a high
sense of her social duties, and a trust in Him whose name is honored in his
marvellous works.   The mental condition of the mother stamps the charac-
ter of  the future man, the future mental  condition of an immortal being ;
so that every precaution should be adopted to maintain the parent's body in
a perfect state.
   Peculiarities of  the Infant.—Infancy may be said to extend 'from birth
to about the second year, or completion  of  dentition, and childhood to the
age of  puberty..  The general  appearance  of a new-born  iufant  is as  fol- 
6           .          DISEASE8 OF CHILDREN.
lows:  it  measures usually about  twenty  inches, and weighs  about six
pounds.   The skin is very vascular, sousitive  and delicate, o(  a deep red
color.   All the prominent, parts of  the body1 are well protected  by fat and
cellular tissue;  the tendons and ligaments are imperfect; the muscles are
soft and gelatinous.   The bones are small, chiefly cartilaginous, deficient in
earthy matter.   The lower extremities are less developed than  the upper;
the pelvis is small, an i  looks contracted ;  the thorax small, flattened at its
sides, prominent in front; the head and abdomen are disproportionate large
compared  with the rest of  the body,  and  the size they attain in after life.
   The digestive organs  are perfectly adapted  for  producing  rapid  changes
in the food introduced into them ; indeed, they afford room for a continual
supply of  the materials  for nourishment and growth.  The mouth is beauti-
fully adapted for extracting the food prepared by the mother, and  convey-
ing it to the pharynx.   The stomach is small and long, which shows that it
is uot suited for receiving much food at a  time, or for retaining  it  long.
The intestines are  smaller and shorter than  in  the adult; their peristaltic
actions are very rapid, so  that all excrementitious matters are quickly got
rid of, the infant having an evacuation every five or six hours.   The mucous
membrane of  the  whole  of  the alimentary  canal  is  thick, soft, villous,
vascular, very sensitive, easily  irritated by improper food.   The  salivary
glands, the pancreas,  the lacteal vessels, the mesenteric  glands  are largely
developed; the kidneys are large, the supra-renal capsules of considerable
size;  the  spleen is small; the  liver very large, occupying one-third of the
abdominal cavity,  but becomes  smaller by the changes that take place  in its
circulation.  The respiratory organs undergo a great change;  the lungs on
being permeated by air become  increased in size, light, vesicular in struc-
ture, and  of a deep rose-red.   The  respirations are nearly double those of
an adult.   The action of the heart is quick, varying from one hundred and
twenty to one  hundred  and forty beats  in  a minute.   In  looking at the
nervous system, we find the brain  large, soft, imperfect in  structure, and
weighing  about ten  ounces.   The  convolutions are imperfectly marked:
intelligence is in  direct proportion  to their extent,  while the  cineritious
portion scarcely differs in color  from the  medullary portion.  The meninges
are more vascular  than  in the adult.  The structure of the spinal cord and
nerves is more perfect than that of  the brain ;  these parts being  devoted to
functions of sensation and voluntary motion.   The organs of the external
senses are all present at birth, and the nerves distributed to them are large.
  Peculiarities of  Disease in Children.—During  childhood  there is a pre-
disposition to disease  on account of the weakness of organization, the ease
with which impressions  are made, &c.;  and disease at  this  period is very
insidious,  apt to run into  organic change with tremendous rapidity.   The
activity of the vital forces, the  rapidity of circulation, the abundant way
in which blood is supplied t© the various tissues, accounts for many of the
inflammatory disorders,  while the plasticity of the  blood, with effusions and
the great susceptibility of the  nervous  system, causes  any affection  to be
keenly felt by the  whole system.  Hence the slightest illness or indisposi-
tion in a child should never be  regarded  with indifference.  It is also true
that this  same activity of the  vascular  and  nervous systems imparts an
energetic  reparative  power  upon  the child, and  essentially aids recovery
from some severe affections which would  prove fatal in advanced  life.
   The skin, the mucous membranes of the respiratory and digestive organs
are the principal surfaces upon  which morbid impressions are imprinted in 
DIAGN0SI8 OF INFANTILE  DISEASE.
children.   But although disease most frequently has its starting point there,
it -seldom remains confined to those  parts, but is  either reflected or propa-
gated to distant parts.  The skin being so very vascular, delicate, excitable,
is rendered liable to irritating and dangerous disease, from the most simple
rash to the most violent inflammation.   Many of  the skin diseases are due
to a morbid state of the stomach, neglect of cleanliness, poisons, as we
have in the eruptive fevers.
  The  mucous  membrane of the  larynx,  trachea and bronchial tubes is
hable  to inflammation of various   grades, mostly of  an acute character*
The gastro-intestinal mucous membrane is another frequent feat of disease
in early life ;  and  owing to  the frequency of disease in these parts, and
other causes, we have the circulation  through the brain extremely readily
deranged.   Hence the frequency of congestion, inflammation, hydrocepha-
lus and convulsions.  The  early  development of  the lymphatic system
causes it readily to become the seat of the disease.  Diseases of the urinary
organs are not frequent nor severe.
  The  diseases  of  children  present  many  interesting and  remarkable
features, the peculiarities decreasing  as age  advances.   All affections of
children, even  the process of teething, are attended with fever of a remit-
tent  type, having exacerbations towards  evening  or  during the  night.
Cutaneous diseases are very common during childhood.  Next  the mucous
membranes are very apt to suffer
  In all cases  the direct  cause of disease are nearly the same in all periods
of life, though they act upon a child with greater severity than  an adult.
Errors in  diet, impure air, inattention to cleanliness, intense heat, cold,
damp, improper clothing, exposure to  contagion, morbid poisons, excite-
ments of the nervous system, dentition, presence of worms,  accidents, &c.
Again, many disorders that occur  in early life may exist at  birth; thus
children are often born  with syphilis,  tuberculosis, scrofula,  feeble vital
power.  The chief Causes of death are teething, disease of the mesenteric
glands, convulsions, disease of the brain, disease of the  bowels, as cholera
infantum.
  Diagnosis of Infantile Disease.—It requires considerable tact to investi-
gate the disorders of childhood ; a correct diagnosis  is essential to success-
ful  treatment.   This  can only be  obtained  by signs,  which nothing  but
habit, experience and patience  will  enable  us  to  interpret.   The  chief
sources from which an intelligent  practitioner derives his  information,  are
the countenance, the  gestures, attitude, the sleep, the  cry, the mouth and
breath, the respiration and circulation.  Before  noticing these separately,
I would give  the following  rules  to  young practitioners, to  be on their
guard as to epidemics, which always vary in their intensity;  to diseases of
the  nervous system,  which  are exceedingly  dangerous;  to  give a very
guarded opinion if there is  any hereditary predisposition.  Symptoms  are
often masked  or complicated by the improper administration of purgatives
by the mother  or nurse.   Always  beware of giving  up  a  child,  for young
children are extremely tenacious  of life,  and often rally from  the most
severe disorders : and they should  never be regarded  as hopeless  till  the
vital spark has actually fled.
   The countenance is  the most interesting and intelligible page in the book
of nature.   In its calm and  smile we  read health, ease, happiness of mind
and body.   In pain and suffering we discover disease.
  In general uneasiness,  excitement and fever, the whole expression of  the
• 
8
DISEASES OF CHILDREN.
    countenance is  altered ; a  flushed and heated condition, with  occasional
    wrinkling of the features, being remarkable.
      In affections of the brain and nervous system, the expression of the upper
    portion of the face—as the forehead, brows and eyes—is especially changed ;
    the forehead contracted and heavy ; the brows are knit, and the eyes wild
    and vacant, or fixed and staring.
      Morbid conditions of the organs of respiration or circulation affect th«
    features of the middle of the face ; the  nostrils in pneumonia are dilated,
    tips of  cheek red ;  sharp dark  circle round the mouth.
      In disease of the abdominal  viscera a peculiar expression is given to the
    cheeks, mouth and lips ; the cheeks sallow, sunken ; the mouth retracted or
    drawn,  and the lips colorless.  In affections of the brain the face is generally
    flushed, turgid and  hot; the eves are vacant or staring, the upper  eyelid
    cannot  be raised, the eye is half open: there may be squinting,  contracted
    in the early stage,  dilated as the disease advances.  The upper lip is draws
    firmly over the gums, and is of a livid hue, and convulsions of the features.
    The deformity of hydrocephalus can never be mistaken.
      In diseases of the organs of respiration, dusky red appearance  of the
    countenance, wide dilatation of the nostrils  during each inspiration, and a
    strong contraction with each expiration ; knitting  of the eyebrows ; lividity
    of the lips, which are open to facilitate respiration.   If the breathing  is
%   much oppressed, and if the disease assumes a chronic form, the  features
    will become  emaciated, and present  an appearance  of decrepitude.  The
    expression of countenance  produced  by disorders of  the  abdomen is very
    characteristic;  the peculiar, peevish  look, sharp features,  sunken eyes.
    pallor, and dark color of the  lips  and skin surrounding  the mouth.   In
    gastro-intestinal inflammation the face becomes sallow, emaciated ;  the lips
    are stretched firmly on the gumsrand are pale, dry, crackel: the chin pro-
    jecting ; the  nose appearing swollen.
      In chronie irritation of the  bowels from worms, the nose  and upper lip
    are tumid ;   the conjunctiva has a pearl-like look.  In  exhaustion from
    diarrhoea the face is alternately flushed and pale, hot and cold;. in  extreme
    cases pallid, cold, glistening; the eyelids half  closed.   In jaundice the
    countenance yellow.  In measles the  lachrymatioD, the redness of  the eye,
    swelling of the eyelids can never be mistaken.
      Gestures and Attitude.—The beginning  of  disease in  a  child is made
    apparent by  inattention to surrounding objects,  by  their listlessness and
    dislike to movement.  They then  become  restless, languid.   Inflammatory
  *  pain may make a child very still.  In abdominal inflammation the child lies
    quiet, the knees bent and drawn up, twisting about,  uttering loud  cries on
    the sudden accession of pain.  Acute  spasmodic  pain induces  immediate
    contraction of the whole muscles, and the infant starts  in terror.  In con-
    vulsions the head is drawn  backwards, an  arm becomes  rigid, or a  leg  is
    drawn upwards, and the child cries violently from  pain or fear; the breath-
    ing is spasmodically affected, the thumbs and  fingers are drawn into the
    palms of the hands, the toes are firmly flexed downwards.   In inflammation
    of the brain or its  membranes, the hand is frequently raised  to the  head •
    attempts are  made to tear off the cap, and performs other movements with
    the hands, while the head is rolled from side to side as it lies on the pillow.
    In disorders of the  tongue or fauces, and during dentition, the child presses
    its fingers into the mouth, or seizes the nipple roughly and greedily, or rubs
    the gums with anything it can  get hold of.  In croup and other diseases 
THE SLEEP, THE CRT, ETC.
9
producing difficulty of breathing it pulls at the larynx, tries to compress it
laterally, and by its cries, till placed in a sitting posture, indicates the seat
of suffering.   During dentition, or from irritation of the digestive canal, we'
have convulsive movements.
   The Sleep.—The sleep of a healthy child  is tranquil, deep, prolonged ;
its countenance is calm and  happy;  the breathing is slow and  easy; its
limbs relaxed ; on awaking it is lively, and seeks the breast.  In disease
the rest is disturbed, broken ; the respiration is loud, labored ; the brow is
contracted, or the mouth drawn ;  there is grinding of the  teeth or gums;
sudden startings; the  child  is fretful, peevish.  Any irritation in  the
bowels or in  the  brain, or any pain, lessens the ability to  rest.   A strong
indication of a tendency to convulsive  disease is evidenced by a rigid exten-
sion of the limbs, with a turning inwards of the great toes and thumbs dur-
ing sleep.
   The Cry.—The first indication which an infant gives of life is to cry ; and
the more and lustily it does so, the better, since it proves that the  most
important vital  organs are well formed,  and  the  child  is  not deficient in
health and vigor.  But after a few hours of existeuce, the well cared for
infant cries  but little;  the act of crying being reserved to express  pain*
distress, hunger.  Great pain is generally productive of crying.   In aflec--
tions of  the lungs the cry is more of a groan.  In  croup it is hoarse, muf^
fled  and crowing.  In acute cerebral disease there is a single, sharp, power-
ful cry at distinct intervals.   In diseases of  the  intestinal tract  the  cry is
prolonged, low or moaning.   The little patient does not  shed  tears  until
about the  third  month, because the functions of  the  lachrymal gland are
not brought into action till that  time.   If a child shed  tears in the  act of
crying, a favorable prognosis  may be given :  but if the eyes are dry, sunk
in the orbits, great danger to life exists.
   The Mouth and Brea'h.—In health,  the  mouth is moist and  pale, the
tongue smooth, and  partially covered  with  a layer of whitish mucus, the
gums red, the breath free from  smell,  or  having only the  odor of the
mother's milk.   This is altered by slight causes;  the mouth may become
hot, red  and dry; the tongue loaded with a white, curdy matter, and the
breath hot, sour  or acid.   This is the case in fevers, acute affections of the
abdomen, in  diseases of  the alimentary canal, in painful dentition.  In the
eruptive fevers, the tongue often swells, becomes covered with a dark brown
fur.   In scarlatina, the tongue is  loaded with a thick white  fur, through
which papilla project, but as  the fur clears  away it becomes clean, red, of
a strawberry appearance.   Aphthae of the mouth, throat, tongue, are com-
mon in infants—due  to improper food, impure air, irritation  of  dentition.
The breath may be rendered fetid by attacks of fever, indigestion, gangrene
of the gums  and cheek, or ulcerations about  the throat.
   The Skin and its Temperature.—In  a  healthy child, the skin should be
firm, elastic, smooth, of a rosy-flesh color, neither  hot nor pale, moist and
cool   A hot, dry skin is present  in all febrile diseases ; a cold, moist one
in constitutional  feebleness or prostration.  Increased redness is indicative
of inflammation or eruptive fevers; a pale, doughy skin warns^ us against
scrofula or tuberculosis; intense blueness, to cyanosis, or some interference
with  the oxygenation of the  blood; yellow skin  to some  affection of the
liver ; a dirty, sallow hue may be produced by diarrhcaa.   Rigors do not
occur  in young  children,  even suffering  from malarial  fever; the  usual 
10
DISEASES  OF CHILDREN.
symptoms being paleness of the face, decoloration of the lips, a bluish tint
beneath the nails.
*   Thi.: Respiration—An infant breathes instinctively, without  method or
regularity.  All diseases of the air-passages are attended with noisy respi-
ration and cough, which is hoarse and  spasmodic in inflammation of the
glottis; ringing in laryngitis;  crowing in croup.  In  bronchitis, pleurisy
and incipient pneumonia, the breathing is merely hurried, the cough hack-
ing and dry, and unaccompanied* with expectoration.   As the inflammation
increases the rapidity of the breathing becomes great, so that in pneumonia
it is panting, at the same time rapid dilatation and contraction of the nostrils.
In pleurisy the respiration is restrained;  in peritonitis  the inspirations are
short, jerking, difficult.
   The Circulation.—The heart's action is more variable in infancy than at
any other period, and  impressions of every kind  quicken the  pulsations.
From a careful analysis the pulse ranges from 130 to 140.
   Discharges  by Vomiting and  Stool.—Any disturbance  of the process of
digestion will induce sickness.   Repeated vomiting may be due to improper
food,  to disease of the  stomach-or brain.   Some of the eruptive fevers are
ushered in by  vomiting; so is cholera infantum.   The  paroxysms of hoop-
ing-cough are frequently  terminated by a fit of vomiting.  Expectoration
from the  bronchial-tubes are often ejected with the contents of the stomach.
   In  infancy evacuations from  the bowels are more frequent than  in after
life.   Diarrhoea is readily  induced by excess or by  improper articles of
food,  by irritation of dentition.
   The first stools after birth—the  meconium—are of a  dark green or black
color, very viscid.  Subsequently they become of a brown  or yellow hue,
of a curdy consistence, and free from odor.  Frothy, acid evacuations, of a
pale green color, indicate some disorder of digestion.   Discharges  of slimy
mucus are common  during dentition, or when worms are  present in the
intestines.   Thin, fetid, dark-brown stools indicate chronic diarrhoea ; and a
dark  green  color  of the discharges  indicate disease  of  the  stomach and
intestines.   Constipation is not common, and when it does  prevail it  is
usually due to some derangement of the  liver, preventing the free  secre-
tion of bile.
INFANTILE THERAPEUTICS.
  The great aim and object of the physician is to relieve pain and suffering,
and  aid  nature  in  the cure of  disease.   Too  much  attention, therefore,
cannot be paid to the means at his control, the remedies  he employs.   It is
a noteworthy fact that many of the diseases of early life may be effectually
arrested  by very simple treatment;  that drugs are frequently unnecessary,
and what are used should be those whose  composition, effects and modes of
action are thoroughly and positively known.  In administering any remedy
it should be in as small bulk as possible, and in a liquid form; and it should
be made as palatable as possible.  A judicious and well educated  prac-
titioner will pay regard to the mode of accession, the supposed cause, dura-
tion of the symptoms, the  general aspect, nutrition, vital constitution  and
peculiar temperament of the little gufferer; to the  condition of  hygiene by
which it is surrounded; the nature and  type of the diseases  prevalent  at
the time.   He will watch the  progress of the disorder;  he will  be careful
not to attribute  too much to the action of medicines, for  they may not have
been administered, or they may be inert or useless.  As to the dose  in all 
BATHS, PURGATIVES, ETC.
11
cases it should be suffioient for the object to be attained ;  positive medica-
tion  should be the rule;  no tampering with infinitesimal or dynamic of the
igno:ant or ridiculous.   The infant should be well and properly nourished
at short intervals ;  no lowering or depleting remedies should be used : give
nourishment, drinks, cold drinks ; augment  the  secretion of  the  kidnevs
promote exhalation by the skin and lungs, and above all  see to cleanliness,
fresh air.  Never expect  to  cure  in a close, over-crowded, ill-ventilated
apartment:  it is an impossibility.
   Baths.—All forms of baths may be employed with the  greatest advan-
tage in the diseases of infauts and  children.  Bathing  subdues irritation,
allays pain, lessens fever, or equalizes, promotes  perspiration, and induces
sleep.   The  best temperature  is about 95° Fahr.. and the child should
remain in the bath from five to  fifteen minutes,  according  to  its  age, and
should  be quickly and carefully dried and  put  to  bed.   The  diseases  in
which  the warm bath  is  indicated, are convulsions, cutaneous  disease,
eruptive fevers, dropsy, scarlet fever, and all inflammatory and febrile com-
plaints.   The vapor bath is more derivative to  the surface, more diaphor-
etic, more lowering, valuable  employed  in  scaly  eruptions, in rheumatism.
The heat of the vapor should be about 100° Fahr.   Medicated  baths con-
sist of water  impregnated with medicinal agents.  The warm  artificial salt-
water  bath is good for  promoting tone and vigor  to the system,—made
simply by dissolving  common table  salt in warm water.  Alkaline baths
stimulate the  skin, promote the functions of absorption and secretion.  Sul-
phurous baths, made  by adding sulphuret  of potassium to water—power-
fully stimulant and alterative—valuable in scabies,  psoriasis and lepra, and
in nervous disease.  Iodine baths are usually prepared by adding ten grain*
of iodine, thirty grains of iodide potassium  to a gallon of water.  Nitro-
muriatic acid  baths, ferruginous baths, bitter baths,  tan baths, are all excel-
lent.  The cold  bath  is a powerful  stimulant, tonic, of great efficacy.   Sea
bathing, shower  bathing,  cold  sponging, cold  effusion,  are  applicable  to
various forms of disease.
   Arterial. Sedatives are of great  value in the  treatment of all disease*
wh:re the nervous or vascular system is unduly  excited: as aconite, vera-
trum, asclepin, &c.
   Purgatives.—To cause  alvine evacuations, increasing the  action of the
intestines, promoting  secretions from  the mucous lining, we have some excel-
lent cathartics, as euonymin, juglandin, leptandrin,  rbein, &c.
   Emetics.—Infants  vomit very freely—more easily than adults, because
their stomachs are elongated,  closely  resemble tbe intestines in form.   This
wise provision enables the  infant to readily get rid of the contents of the
stomach.  The best are ipecacuanha, lobelia, sanguinaria.
   Diaphoretics and Expectorants, as  ipec, lobelia, asclepin, senega, squills,
are valuable.
   Sedatives and jYarcotics.—This  class of  remedies are  peculiarly  indi-
cated  in  all  diseases of children, for the purpose of allaying pain, morbid
sensibility, regulating  the  organs of  circulation;  for this  purpose hyoscy-
amin, cypripedin, opium, aconite, asclepin, digitalis; and in obstinate con-
vulsions, ether and chloroform   The  rule in all cases is, let the little sufferer
have sleep by some means.
   Alteratives.—This class of  remedies for promoting secretion and exhala-
tion are  often indicated.   All glandular enlargements, indurations, thick-
enings, growths of various kinds, are removed by  this class of remedies. 
12
DISEASES  OF CHILDREN.
Among our best we  may mention irisin, menispermin, phytolacea, rumin,
Btillinyin.                                                        .
  Stimulants and Tonics.—Tonics  are agents which  gradually and insen-
sibly increase the tone and power of the system.   Stimulants rapidly excite
action, without increasing  the  real strength.  Tonics  give  power to  the
nervous system to generate or secrete  nervous influence, by which the whole
fabric is  strengthened.  Stimulants give rise to excitement, act  indirectly
as tonics;  they are divided into two classes, specific  and diffusable.   Our
best tonics are bark, hydrastin, populin, goldthread; our best stimulants
are xanthoxylin, ammonia, brandy, capsicum, &c.
  Management of Infants at Birth.—The most striking picture  of perfect.
helplessness that can  be imagined, is that of an infant at birth ;. for if assist-
ance is not speedily afforded it  will perish.   The first thing to be attended
is the umbilical cord, which should be tied about an inch from  the abdo-
men ; then the mucus should be removed from the mouth and ears ; and it
should be carefully examined to see that'it  is a perfect child.   After the
function  of respiration is  established, the  infant should be well  protected
from cold, and then washed and comfortably clothed.  Then, the first food
of the infant should  be  the motber's  milk—that which nature has  pro-
vided—a perfect combination for the due elaboration  of every  tissue in the
body.  There can  be  no  doubt  but  that  this  is  the  proper aliment  for
infants, and the sooner the child is  put to the breast the better.  The early
nursing of the child is of great  importance, as it gives a proper form to the
nipple, facilitates the  flow of milk ; the irritation also of  the breasts tends,
by reflex action, to contract the uterus, and thus diminish the risk  of second-
ary hemorrhage.
  The child sbould.be weaned between the ninth and  twelfth month, when
the teeth, development and  muscularity of the  stomach indicates that a
more solid  diet is required.   The change should not be made abruptly: and
hence the propriety of giving a little supplementary food, as Leibig's food,
arrow-root, beef tea.   By adopting this course, the child will  be prepared
for  the change, while the motber's milk gradually diminishes  as the demand
for  it lessens.
  Cleanliness is of  the utmost  importance  to every healthy child.  Hence,
every  care must  be  taken,  by frequent   and  thorough  ablutions, gentle
frictions, and clean, soft clothing to maintain the healthy action of the cuta-
neous surface.  The best plan is to bathe the infant morning and ni^ht:  the
whole  body should  be immersed into a tub or basin of warm water—say at
90° to 96° Fahr.; it should be well rubbed with  a soft sponge and glycerine
soap.  After bathing for five minutes or so, it should be taken out, quickly
and thoroughly dried, and have well aired clothing put on.   Tepid bathing
for infants is preferred.
   About the fourth month, a child should  have sufficient exercise in  the
open air, be occasionally placed in a sitting position, and allowed to  roll
and kick at its pleasure.   All these movements  not  only afford amuse-
ment, but  act beneficially by calling the different muscles of the  body  into
action, and so increase their strength.  A child should be exercised during
the day  so that it may enjoy undisturbed repose at night.  Sports, amuse-
ments, &c, are most appropriate during the day.
   Accidents to jYew-born  Infants.—Inflammation  of the umbilicus.   The
 separation of  the umbilical cord is usually completed  about  the  third or
 fourth day after birth.  When the separation is favorable, a slight oozing 
SWELLING  OF THE BREASTS, ETC.
13
 of serum may take place, and" the part will bo healed.  But it may happen
 that instead of cicatrization following, the umbilicus becomes inflamed and
 ulcerated ;   suppuration  takes  place, and  very serious  hemorrhage  may
 occur.   When there is  merely a slight inflammation or ulceration, *reat
 Cleanliness  and the washing with a  lotion of permanganate of potash^and
 Keeping the same  applied, or a lotion of hydrastis;  but  if there is  great
 hemorrhage, a saturated  solution of  the percbloride of iron, with moderate
 pressure, usually succeeds.
   Swelling of the Breasts.—A painful swelling of the breasts sometimes
 taKes place a few days after birth, which  generally disappears spontaneously,
 without giving r.se to much  trouble.  The  best application is  a spiritous
 lotion,  or the muriate of ammonia  ^i., aqua  dest., giii.—M.,  kept  con-
 stantly applied.                                                 F
   Malformation.—From certain unknown causes the fetus is now and again
 met with deformed, defective or mutilated.  The various rare  malforma-
 tions it is unnecessary for us to mention in this  brief treatise.
   Tongue-tie.— The tongue  may bo unnaturally adherent to the sides  or
 to the under surface of the mouth, so that nursing may be prevented.   The
 adhesions must be  cautiously divided with a bistoury, and  the bleeding con-
 trolled  by the  percbloride of iron.  Genuine tongue-tie is where the bridle
 of the tongue is so short as to reach nearly to its tip, and interfere with  its
 motions.  This can only be  remedied by dividing the edge of the frenum
 with a pair of blunt scissors.
   Hare-lip.—The  simplest degree of this deformity is simple hare-lip, in
 which  the  lip  is fissured only on one  side ;  it  may be complicated,  with
 partial or complete fissure of the palate.  The greatest malformation of this
 kind  is  double hare-lip,  with  fissured  palate.   The arrest of development
 occurs only in the  upper  lip: the fissure never occurs  in the mesial line, but
 always  under one or  both nostrils, and the deformity may vary from a notch
 to a complete fissure, extending close into the  nostril.  The only point of
 interest  is  the  treatment.   The  operation for  the relief  of this difficulty
 should  be performed immediately after birth.   The  edges  should be well
 pared, and hare-lip pins inserted, two-thirds the  thickness of the lip, from
 its anterior  face.   A sufficient number of pins  should be used, and the.
 figure eight, with repeated turns of lead wire over each, should be resorted
 to in preference to  silk.
   Cleft Palate.—Hare-lip  is  frequently accompanied with fissure in the
 roof of the mouth  ; yet the  latter  often exists alone.   The best mode  of
 operating consists  in  paring the edges, in applying the  lead shield  and
 button-hole suture.   Nearly all oases that  I  have  treated with this  have
 been successful.
   Hydrorachitis, fissure of  the spinal  column  and  dropsy  of  the  spinal
 medulla, are usually connected together.  The  less the tumor is interfered
 with the better.  Various other congenital malformations  might be spoken
 of, but as  they are  rare, it is needless to speak of them, as each case
requires to be treated upon general principles.   In addition  to a large list
of congenital malformations, we  have also  a long  list of non-congenital
deformities which are peculiar to children.
  Rickets.—This is one of the most common.  It is characterized by debi-
lity, emaciation, impaired assimilation, softening of  the osseous framework,
so that the natural  shape becomes altered, either from the superincumbent
weight of the body  or from muscular contraction.  It is essentially a disease 
14                      DISEASES OF  CHILDREN.
of infancy, and common among the poor, who have  insufficient and impro-
per food, who breathe impure air.  The children of parents who are them-
selves weakened by sexual excesses or impaired  by syphilis, or tainted wi
struma.
   In treatment, the greatest good wi'l be obtained from thorough hygiene,
generous diet, suitable  clothing, baths daily, medicated with salt or iron,
internally iron, cinchona, bydrastin, phosphorus,  phosphate of lime, hypo-
phosphate, cod-liver oil.  The greatest benefit will be derived from perfect
rest and passive exercise in the open air.  The  bowels should be  regulated
with rhein, leptandrin ;  and sedatives  should be given to give  the patient
comfortable rest.   The  employment of articles statable to build up the bony
system.
   Curvature of the Spine is  met with under several varieties:  as lateral
curvature, posterior and  anterior curvature.  In the treatment, the most
important points to keep in mind are these:  to maintain the health at  the
highest point by the best of diet, tonics, iron, cod-liver oil, the phosphates,
and to strengthen the muscles and ligaments which act  on the vertebra by
frictions, shampooing, gymnastic exercises of various kinds.  Forbid the use
of articles of dress which prevent the free play of the muscles, and remove
from the spinal column  any superincumbent weight, by keeping the patient,
when not exercising, on a hair mattress in the horizontal  position.  This is
of vital importance.
   Torticollis.—Wry-neck is characterized by an inclination and rotation of
the head to one side.   Anything  that disturbs the  equilibrium  may be a
cause.  The  treatment must be modified to the  cause, if due  to a defect in
the nervous  apparatus.   Counter-irritation to the spine, subcutaneous injec-
tions of strychnine;  internally, such remedies as  iron, nux, rhus radicans,
phosphorus ;  and, if all fail, division of the sterno-mastoid muscle is  often
successful.
   Club-foot.—The various varieties may often be successfully treated with-
out division  of the  tendons, by frictions, baths, splints  and removing  the
cause.  But if all means fail, sub-cutaneous tenotomy should be resorted to.
   Impediments of Speech.—Stammering, in  nearly  all cases, is a nervous
affection—a functional  disorder ;  for, in the worst cases, the vocal appa-
ratus is perfect.   It may be congenital;  very  apt, however, to  follow an
eruptive fever or severe illness.   The  treatment consists chiefly in the  use
of nerve tonics; the general  health should be attended  to; raise  it above
the normal standard ; make the child speak distinctly and slowly.   Let him
fill the chest well before he tries to articulate the first word, and then slowly
enunciate one word after another.   If unable to do  this, let him  beat time
for every word he utters in talking  or reading.   A persistent  course  of
measuring the words until the stammerer can read and talk straight forward
for an hour, will overcome the  habit.  The medical tieatment   must  be
directed to the peculiarities of the case by nux, belladonna, scutellarin.

             HOW ARE  WE TO  HAVE  HEALTHY  CHILDREN?

   At the moment of impregnation, both parents, to a certain extent, trans-
mit their qualities to the offspring: but either may transmit to a greater or
less degree their constitutional peculiarities—thus occasioning  the greater
or less resemblance to one or  the other parent.   But, from the moment of
conception until  birth,  and  even during lactation, the  influences of  the
mother are constant.  Anything that affects her, injuriously or depressingly 
DISEASE.
15
 to some exteflt damages the child.  Let the mother  partake of gross food,
 and in  all probability the child will be scrofulous.  If she is of a sedentary
 habit, it will be weak and flabby;  if she has  been dosed with mercury or
 antimony, it will have a disposition to tuberculosis;  if she  has been dosed
 with certain medicines, each  and all  will modify  the  constitution of  the
 child.  And so with mental influences.  A fit of passion, a misfortune, an
 unhappy home or unkind husband, are each and all causes of abnormal con-
 dition on the part of the mother, and consequent deterioration on the part
 of  the  child.   The rule then is, if we want healthy children, we must keep
 the mother happy and comfortable.
   To have healthy children, the parents should have inherited  or developed
 a good organization; they must be living  healthy lives and observing all
 the conditions of health.
   A most important condition to  our having healthy children, is to give
 them pure air to breathe.   Respiration is the first act of independent life;
 air is a vital necessity.   Shut  a child up in a close room, every breath he
 takes changes the quality of the atmosphere ; it loses oxygen,  and becomes
 loaded  with carbonic acid and excretory emanations from skin and lungs,
 and becomes a deadly poison.   Pure air is absolutely essential to the blood,
 to the whole vital organism.
   Next to air  comes exercise—the activity of  every organ and function.
 There  is not a muscle, nor organ, nor faculty, nor passion, that was  not
 made for use.   Exercise is  necessary to development—an  important con-
 dition of health.  Perfect health  demands  the regular performance of all
 the organic and animal functions, secretions, excretions, and all  muscular,
 nervous, intellectual, moral  and passional  activities.  It demands for  the
 whole skin the cleanliness of daily bathing, without  which its functions  are
 not well performed ; it demands a temperature neither so warm as to debili-
 tate, nor so cold as to chill and stupefy: and for this purpose the clothing
 should  be comfortable, not to impede motion, aeration or perspiration.
   Another requisite to the raising of healthy children is clean, comfortable,
 easy clothing, perfect freedom for exercise.  Rest and sleep are important.
 The whole organism demand rest  and  restoration—absolute repose.   The
 brain must rest; its nutrition demands it.   The child, with its dawning
 intelligence, sleeps nearly all the  time.   Nothing exhausts  and  prostrates
 quicker than the want of sleep.   In  childhood and youth, ten  to twelve
 hours of the twenty-four should be devoted to sleep.   In  maturity^  eight
 hours is sufficient, and in old age  we do with less.

                                DISEASE.
  Disease may be defined as any deviation from health in function or struc-
 ture, a  disorder of any state of a living body, in which the natural  func-
 tions of some organs are interrupted or disturbed;  or, in other words, dis-
 ease is  any deviation from health.   All  disease in a child consists in a lack
 of nervous energy, or the presence of morbid matter in  the  system, or both
 combined.  In either case it may be  hereditary or acquired, general or
 local, acute or chronic, mild or malignant.   The causes of disease are very
 evideut.   But this is a subject we do not mean  to discuss.  But we would
 rather ask what does the Eclectic Medical  Profession possess in the way of
 curative agents ?
  We believe that prevention is better than cure, and that  diseases can be
prevented by keeping the child in all the conditions that are indispensable 
16
DISEASES  OF  CHILDREN.
to health ; by  avoiding  all causes, by avoiding all exces8,*all means of
exhaustion.
  The cure of  disease is not accomplished by medicine—it is  aided by it.
Nature does her own  work.  It is the power of life that builds and moulds
the child: it is the vital  principle that first forms  the body, and  presides
over its processes, which struggles against disease, overcomes it, and throws
it off from the system.  Medicine  cannot accomplish such a work  as this.
We can aid nature; and when the vital force  is sufficient, nature effects a
cure.  If the disease is more than the vital force can overcome, properly
aided with good remedies, the  patient dies.   But the great fault of Allo-
pathic  and Homoeopathic medication is, that  they attack the disease by a
violent or mild  assault upon nature ; they weaken the vital energy, whether
they desire the  primary or secondary action of their  poisons;  they change
the aspect of the scene, and nature sinks under the united attack.
  The Eclectic physician, who regards disease as  a salutary effort, endea-
vors to aid nature in her efforts by a class of  vegetable remedies which are
positive in their action, believing that most diseases are got rid of  by some
sharp crisis.  It is a well attested fact that nearly all cases of disease will
recover if the effort of nature is properly aided.  The mortality of all dis-
eases is increased by Allopathic medication, and the patient is often left to
die  by the imbecility, humbug and do-nothing of Homoeopathy.
  Our readers  will in the present work find allusion  to  our concentrated
vegetable remedies;  and we would say that none are reliable  so  far but
those manufactured by B. Keith & Co., New  York. 
DISEASES   OF   CHILDREN.
               TREATMENT OF  DISEASES OF  CHILDREN.
   Very great attention and long experience are required to treat the dis-
eases of infants judiciously and successfully;  close,  rigid and repeated
observation being the principal means of supplying the want of that kind
of assistance which  the  personal  information of  adult patients usually
affords.  The disorders of early infancy are, however, more obvious than
has been generally supposed;  their number is comparatively small, their
causes are uniform, and the treatment of most of them is simple and pretty
certain.
   Improper food, confined or  unwholesome air, the want of exercise and
cleanliness, difficult  dentition, and unhealthiness of the parents, are the
most general causes  of the diseases of infants.   Others have been enume-
rated by writers, such as  general laxity, the greater  irritability of their
nervous system, and the  delicacy of  their  muscular fibres, which may be
considered as so many predisposing causes.
   The symptoms of  the first diseases of infants are chiefly retention and
excretion,  sour  eructations, sickness,  vomitings,  purgings,  restlessness,
crying, wakefulness, heaviness, loathing of food, contractions  and sharp-
ness of the features, blueness about the mouth, turning up of the  eyes,
sudden startings from sleep, thirst, heat, the manner of breathing and of
crying, retraction of the  limbs, hardness and distension of the abdomen,
and  pustules or eruptions, external or internal.  To these may be added
the openness or firmness of the fontanelles and of the sutures, the strength
and  conformation of  the bones, and  the relaxation or contraction of the
skin in general, and  of the scrotum  in  particular.  As a means of diag-
nosis, the pulse and urine are less certain marks in the greater number of
their complaints than they are in older children.
   Having thus briefly noticed  the causes and  symptoms of infantile  dis-
eases in general, we  shall proceed to consider each  separately.
   As it is  always more desirable, so far as we  are able, to prevent  dis-
eases rather than to cure them, and  to obviate the  causes  rather than to
remove the effects, I beg leave to intrude on the reader's  time for a few
minutes previous to beginning  the  treatment of diseases peculiar to chil-
dren, to offer a few observations  on the diet and  proper management of
young children.
   During the early months of a child's life, the  milk of its mother is
unquestionably to be preferred to every kind of nourishment, and even to
the milk of another woman, provided the parent is in good  health, and
labors under  no constitutional  taint.  As a general rule, it is  bad for the
nursing mother to take food of a liquid  character in order  to create milk.
If a deficiency of  the natural secretion exists, it is usually more conve-
       2 
18
DISEASES  OF CHILDREN'.
 nient, and at times absolutely necessary, to bring up the child partly b>
 feeding it; we should, however, be careful  to regulate the diet both wun
 regard to  quality and quantity, that its stomach may neither be disor-
 dered with what is improper, nor be  oppressed with  excess.   ±ne  ioo
 that is prepared by art, should  be thin and liquid, and made fresh every
 day, unless it be some special article, like  Leibig's food for children,  it
 should be given to  the infant frequently, a little at a  time, and at proper
 intervals, and not  be crammed down  its throat as  often as it awakes
 from  sleep, or cries, as is the custom  with many nurses.   Instead of  a
 spoon, a nursing bottle may  be  used.   This gives occasion to some little
 exertion in nursing, an  imitation of nature, and is,  moreover, attended
 with the advantage that the infant will  not be gorged, or induced to take
 more than it really wants.
   At first it will be sufficient to give infants occasionally, along with the
 breast, a little milk and water, warmed to the temperature of the mothers
 milk, with a very small proportion of sugar ;  or we may substitute Leibig's
food for children, which may be occasionally changed  for their pap made
with bread or  crackers, with a due proportion of fresh  milk ;  but all these
should be passed through a sieve, to insure their being thin and smooth.
   At  the  end of six or  seven months, the diet may be made a little
stronger, consisting of plain chicken or  mutton broth, or beef essence, and
occasionally some light pudding may  be allowed.  About the  ninth  or
tenth month, a small portion of animal food which is  easy of digestion may
be given, particularly if nature has pointed out its  propriety by early
dentition.
   If teething commence soon, and goes on well, the child should be weaned
about the fifteenth  month; but  if dentition  is  late, or accompanied with
much irritation, it  may continue at the breast for eighteen  months, pro-
vided the health of the mother will  admit of it, or  that she is not again
pregnant.  If  such  an event occurs, the child should be instantly weaned ;
and, indeed, no mother  should have  her menses upon  her  during the
period of lactation, being impoverishing to the milk, and a fruitful source
of scrofula and consumption.  When the child is weaned, any kind of light
plain  animal food may be allowed it at least once a day, with a due pro-
portion of vegetables, consisting chiefly of farinaceous articles, rice flour,
sago, &c.  The best drink is plain water.
   The practice of binding infants with  many bandages is judieiously laid
aside; hence deformity, as a consequence of dressing or clothing children
improperly, is  rarely to.be met with.  The rule to be  observed with respect
to certain articles of dress ought to be,  that a child have no more clothes
 than, are  necessary to keep  it warm, that they sit  easy and loose on its
 body, and  that  they be  changed frequently, especially if  wet or  soiled.
 Dirty clothes  not only irritate and  fret the tender skin of infants, but
give them an unpleasant odor, and are apt to produce cutaneous disorders,
if not vermin; whereas cleanliness, assisted by gentle friction  with the
 band  over every part of  the body morning and evening, together  with
proper  ablutions with tepid water, even cold water, tends  greatly  to pre-
 serve the health of the child, and promotes perspiration and comfort.
   In  dressing  the infant, if the mother observes the skin anywhere chafed
 after washing  the parts, and drying  them well, let her apply a little pul-
 verized starch,  in  which  is incorporated some  hydrastin;  but if much
galled, which  sometimes happens at the time of teething, particularly in
/ 
ASPHYXIA.
19
very fat children, from the heat and sharpness of the urine, let her expose
the parts to the air, and occasionally bathe them with  common water im-
pregnated  with a little tincture of hydrastis or tincture of galls.
   A young child should be amused a good deal during  the  day, and not
suffered to sleep during  that  time, so that it may  get the more  rest by
night.  It should be early accustomed to be  in the open air, for  vigor of
body conduces to that of the mind ; and as it is  incapable of exercise of
itself, it should be the special business of the nurse or mother to  see that
it gets sufficient exercise from  time to time.   If it be the summer season,
bathing the child frequently in cold water will tend very much to strengthen
and invigorate  it.  The chamber that is  appropriated for the  nursery
should  be  roomy, and it ought to be  kept  remarkably clean, sweet, and,
above all,  properly ventilated.

                               ASPHYXIA.
   The apparent^cessation of life in a new-born infant may be due to various
causes, such as inherent weakness of the vital powers, peculiar conforma-
tion,  collections of glairy matter  in the vesicles of the lungs, the  intro-
duction of a  quantity of the  amnii into the  trachea, and a congestion of
blood in the lungs, arising either from the neck of the child being tightly
encircled by the os uteri, or vulva, or navel string,  or from its being long
detained in the passage, from pressure on the  cord in breach presentations,
or where the  cord is prolapsed, and various other causes.
   When universal weakness of the vital powers seems to be the cause,
we must  be  cautious not to  suffer any effusion  of blood from the um-
bilical  cord.  The  communication  between  the child and the mother
should  be  kept up as long as possible: for  which reason we should avoid
any violent pulling at the cord, that the  placenta  may not be too soon
detached;  and we should also not be in a hurry to apply a ligature.
   It  not unfrequently happens, after a tedious labor, that the ohild is so
weak and faint as to show little or no signs of life.   In such cases, after
cleansing it thoroughly, and wrapping it in flannel,  we should stimulate it
slightly by rubbing its chest and spine with diluted tincture of capsicum.
If this fails to excite the languid circulation, fwe  should resort to artificial
respiration, by introducing a pipe or catheter into the mouth, and thereby
endeavor to inflate the lungs;  which plan, if tried, ought to be persevered
with for a  considerable length of time, as we have every reason to  suppose
that many  children might be saved were such means actively adopted and
thoroughly applied.   Brisk friction in a wawn room, blowing in the child's
face,  stimulating the intestinal muscles to contraction, by sprinkling  alter-
nately hot  and cold water on the  child's thorax, so that air may rush in
by the glottis, may also be tried.  Besides inflating the lungs and pur-
suing the other steps that have been mentioned, care should be taken that
the child does not lose its heat; for which reason it is  advisable to put it
into a bath of warm water, and while this is preparing, it may be enveloped
in warmed flannel or rubbed with tinct. capsicum and whiskey.  If  there
is an electro-galvanic apparatus  convenient, it should  be  immediately
applied by placing one pole on the  pit of the stomach, the other on  the
spine ; this remedy  proves a  very valuable  auxiliary in many cases  of
asphyxia.  As soon  as the respiration is thoroughly established, I recom-
mend a few drops of brandy, in simple syrup, as the best remedy, repeated
as occasion demands. 
20
DISEASES  OF CHILDREN.
  W
asphyxi
matter, rendering the respiration ~
not only wash out the throat of the child, but also place it in an attitude
which will facilitate the discharge of  the  liquor.  Having done this, we
must endeavor to reanimate the infant by inflating  the  lungs, and then
pressing out the air, imitating in  this way for a considerable  time natural
respiration.
  If a  congestion of blood in the lungs, from the causes before mentioned,
has occasioned the suspension of  life, the  most proper step to be pursued
will be to suffer  a small quantity of blood to be  lost from the end  of  the
divided cord, and  the immersion of the limbs in a warm  mustard bath,
friction to the surface, &c.  The same treatment will be  advisable  after a
tedious labor, where  there is much  stupor present, in order  to lessen  the
determination of blood to the head.
  Medical  practitioners  are often called  upon to give evidence before a
court of justice in cases of supposed infanticide; it seems proper to men-
tion that much careful observation  is required to discriminate between a
child that is still-born and one that has lived only a short space of time
after its birth.  Various appearances  also,  both internal and external,
may be mistaken for marks of violence.  Even the swimming of the lungs
in water, a test on which much reliance is placed, is found on many occa-
sions to be fallacious;  for they will float in consequence of a putrefactive
process having commenced, as well as when filled with air by respiration.
  It may also happen  that an  unmarried woman, on arriving  at the  full
period, and having concealed her condition, may be taken ill  alone, and
be  delivered  of a  live  child;  but  that  either  from  syncope ensuing
speedily, or from her taking a convulsion, or  being deprived of  reason
from a distracted state of mind," or owing  to a sense  of the shame attached
to her condition, may be so  overcome as to be rendered  incapable of
assisting the  infant,  whereby  it may suffer suffocation under the bed-
clothes.  In  other instances it may happen that although the child  is born
alive, still, from some injury in the birth, its universal weakness, or some
other obscure cause, it may soon cease to breathe, without receiving  any
intentional injury from its mother.   No doubt occurrences of this  nature
do  sometimes take place, and they clearly point  out the impropriety of
placing any reliance on  the  floating  of the  lungs in water as a  test of
infanticide.
  Justice undoubtedly requires from every medical  practitioner that his
evidence before a coroner  or jury should be  regulated by  truth;  but
humanity and mercy dictate to them  that  he  ought  to  have  the  fullest
assurances of guilt before he gives an opinion that may deprive a fellow
creature of liberty.   He should always remember  that  it is better that
many guilty  escape punishment than that  one  innocent suffer.

                    RETENTION  OF THE  MECONIUM.

  A dark colored viscid matter,  known by the name of  meconium is
retained in the bowels  of all infants  at their birth, and  is usually  dis-
charged during  the two or three  first days, in consequence of  the milk of
the mother, which is first secreted, being  somewhat of an aperient nature.
  In general  this will be sufficient to bring off the meconium • but if it
fails to do  so in the course of  a day or two, the aid of medicine is neces- 
                          THE YELLOW GUM.                       21

sary, and the best we can  employ is a teaspoouful of castor oil, or a grain
of leptandrin in a little  syrup, or a solution of manna in water, or equal
parts of  oil of almonds and syrup.   If these do not act quickly an enema
of gruel  with leptandrin  and olive oil may be thrown up into the intestines.
   The custom of drenching  children with some drug  or other the very
moment  they are born, whether requisite or not, with the view of carrying
off the meconium, is highly reprehensible, for in  most cases the milk  of
the mother will of itself be amply sufficient.

                          THE YELLOW GUM.

   This is a species of jaundice which affects many children at or soon after
birth, and which usually continues for some days.  It has generally been
supposed to arise from an  obstruction  of the biliary ducts forcing  the bile
back upon  the liver, from the  meconium impacted in  the  intestines, or
from mucus or viscid matter clogging-  the ductus communis.
   The effects  produced by it are languor, indolence, a yellow tinge of the
skin,  bilious  urine, and a tendency to sleep, which is  sometimes fatal,
where  the child is prevented from nursing.
   Treatment.—For the most part the disease is easily removed  by clearing
the intestines  by some mild laxative, such as castor oil, or the neutralizing
cordial,  or a half a grain of leptandrin triturated in liquorice, where  the
mother's milk does not of  itself prove sufficiently aperient.
   In bad cases, it may be  due to viscid matter obstructing the gall ducts
In these  cases a gentle  emetic  of a few drops  of the wine  of lobelia  or
ipec, followed with the leptandrin ; should the  yellowness continue after
these means have been adopted, the emetic as well as the leptandrin might
be repeated, with  the addition of a  half a grain of  euonymin.   Where
these means are  not resorted to, the yellowness may continue  for nearly
a month, accompanied with languor and other symptoms of debility.
   We now and then meet with cases where infants are  affected  with  the
true jaundice, distinguished by the skin being everywhere  discolored, as
well as the white of the  eyes.  In some cases this appearance is of little
importance, scarcely requiring any particular medical aid, and disappearing
spontaneously : but in other cases the infant suffers much. In  these cases
much good  is  derived from the use  of leptandrin and euonymin, three
times daily, besides employing frictions to the abdomen, as well as a bath
twice daily, acidulated  with nitro-muriatic acid.  If the case  does  not
promptly yield  we  should  resort to  stillingin or irisin with euonymin
triturated with bicarbonate of soda.

                   EXCORIATIONS  AND ULCERATIONS.

   From  a neglect of proper cleanliness, children are  very apt to become
chafed in  the  wrinkles  of the neck, behind  the  ears, in the groin, and
around the  arms.  To prevent occurrences of this nature, it is proper to
bathe the excoriated parts,  twice or thrice daily, with a little  warm milk
and water, or an infusion of witch hazel, or hydrastis, or sumach, and
afterwards sprinkle them with pulverized starch, laying  over all a bit of
scorched linen rag.  When the  excoriation is very considerable, a wash,
composed of sulphate of zinc, two to  five grains to an ounce of water, or
borax and hydrastiu, in  solution, may be used.   A little of  the cerate of
baptisin  may be used  as a dressing.   In obviating excoriations,  it should 
22                     DISEASES OF  CHILDREN.

be our aim to dry up all discharges behind  the ears in infants, as no bad
consequence can occur if we attend to the secretions, having them active.
  In children of a scrofulous diathesis, and particularly about the time 01
teething, a species of excoriations, extending from the  ears low down in
the neck, is apt to take  place, which degenerates into  large deep sores,
with a tendency to spread.   In these cases 1 have found a fomentation ot
Peruvian bark, with the same remedy internally, of great value.   1 have
also derived  great benefit from  the muriate  of  hydrastin,  m  solution,
borax and  hamamelin are  excellent.   If these ulcerations are painful,
fomentations of poppy heads, boiled in milk, will be likely to prove  useful.
If they show no disposition to heal after such treatment, then the sulphate
of zinc may be made use of, and this may be laid on, morning and night,
on a bit of soft linen or fine lint.
  If it  seems  intractable,  an alterative  course is highly essential,  nay,
important.  The  administration of such  remedies as our  stillingia  alt.,
a few drops in a little syrup, three or four times daily, or  small doses of
the muriate of platinum, or alnuin, corydalin and irisin.

                            HIC-COUGHS.
  Some infants are much incommoded by hic-coughs, and they arise pro-
bably from acidity in the stomach, or from some nervous irritation.
  If due to acidity, the  neutralizing mixture will prove at once beneficial,
a few drops of lime water in milk, or a grain of the sulphate of soda, in
solution, or some alkali.  If due to nervous  irritation, a drop or two of
the oil of  xanthoxylum  in sugar, or a drop of tinct. aconite  in  water, or
a few drops of the aromatic spirits of ammonia, or a drop or two of pare-
goric, or a teaspoonful of some aromatic  tea, as catnip, caraway, &c.   In
some instances, a little plain vinegar proves an  effectual remedy.  Where
it is severe or returns frequently  it is advisable to apply some stimulating
agent to the stomach, such as soap liniment to which  has been added a
few drops of the  tincture of opium.   I have also found a drop or two of
the wine of lobelia excellent, or a drop of the oil of solidago in syrup.

                        INFANTILE ERYSIPELAS.
  This is a very dangerous  species of erysipelatous inflammation, which
is not often met with in private  practice, but is most frequently to be found
in lying-in hospitals, the ordinary time  of attack being a few days  after
birth, although it has been met with some weeks after  birth.  It  attacks
the most robust as well  as the most delicate children, and in a very sudden
manner ; its progress is very rapid; the skin  becomes of a purplish hue,
and soon becomes much hardened.
   The milder species appears often 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 most violent  and worst species  is when  seated on
the pubes, and  extends upwards on the abdomen, down the thighs  and
legs, and sometimes it begins in  the neck and is equally fatal.   It is less
dangerous when  confined to the extremities, than when  it seizes on, or
spreads  to any other part of the body.   The  swelling is  but moderate,
but after being hard the parts  turn  purple, or livid, and very often mor-
tifies, especially in boys, when it falls on the scrotum;  the penis  swells,
and the prepuce puts on that  kind of emphysematous  appearance which
is common in anasarca of the scrotum. 
CUTANEOUS  ERUPTIONS.                     23
   The disease proves rapidly fatal.   Post-mortem  examinations of such
children as have been destroyed by this disease have discovered the con-
tents of the  abdomen glued together, and  their surface covered with an
inflammatory exudation, exactly like to that found  in  women who  have
died of puerperal fever.  In males, the tunica vaginalis have been some-
times filled with matter, which has evidently made its way from the cavity
of the abdomen, and accounts for the appearances of the organs of gene-
ration just described.  In females, the labia pudendi are  affected in like
manner, the pus having forced a passage through the abdominal ring.
   Treatment.—From a large experience in the treatment of this affection,
ind from the use of various means, we have never employed remedies that
have  so much  therapeutic power locally as the C. tinct. veratrin painted
over  the part three times daily,  or wrapping up the  affected  part with
clothes saturated with a strong solution of the  sulphite of soda and cover-
ing with oiled  silk; the mucilage of slippery  elm seems to check  it, or
potatoes grated and kept constantly applied on the first appearance of the
inflammation, an infusion of  elder blossoms, celandine ointment, and  if
gangrene threatens, a poultice of indigo weed or lotions of the permanga-
nate of potash will be of utility.  The sulphite of  soda applied all over
the affected part has proved eminently successful in checking the inflam-
mation in  several  instances;  at  the  same time sulphate of cinchonine
should be given  internally, or what I have found excellent  is the elixir
cinchonea and iron in half teaspoonful  doses repeatedly.   An infusion of
cinchona should also be thrown  in as an enema.  The disease  is apt to
assume various types, forms or varieties ;  for infants have frequently come
into the world with an incipient erysipelatous disease, but in an advanced
stage of the  same.   In such cases, the cinchona and stimulants must be
liberally and perseveringly given, and the inflamed  or erysipelatous parts
well fomented and dressed with the above agents.

                        CUTANEOUS  ERUPTIONS.
   Children at the breast are very subject to slight eruptions, particularly
about the first month, and these serve, no doubt, to relieve the body of
some   acrimonious  humor.  Of this description is  the red gum, which
consists in  an efflorescence or small red  spots, most usually confined to
the face and neck, but in some cases extending to the hands and legs, and
even  over  the whole body, appearing in large patches, and sometimes
raised considerably above its surface.  It occasionally exhibits itself in the
form  of small pustules, which  are  filled with a limpid, or  sometimes a
purulent or yellow fluid.
   Every species of this  complaint has been attributed to  some derange-
ment  of the  digestive functions in which acidity is generated, or it rather
ought to be regarded as an effort of nature to eliminate or throw off
something deleterious.
  All  that is usually necessary in this complaint is  to give one  or two
drops of the stillingia alt., in simple  syrup, three  or  four  times daily;
give half a grain of leptandrin or euonymin every evening,  according to
the state of the bowels ;  use the alkaline wash morning and night, and
keep the child moderately warm; if  there is the least febrile disturbance,
one or two  drop doses of tinct. of  aconite in water :  if an erroneous mode
of treatment is adopted we may have sickness and purging.  In cases of
nausea at the stomach, or any disposition to convulsions upon the eruption 
24
DISEASES  OF CHILDREN.
        being  repelled, the warm bath, a few drops  of the c. tincture of serpen-
        taria in-warm tea, in alternation with one or two drops of the tincture of
        belladonna every two or three hours.   The state of the skin  and  bowels
        has a  beautiful  harmony—a perfect  equilibrium ;  and, on this  account,
        infants whose early passages have been disordered seem to be benefitted
        by eruptions on the skin.  In such peculiar care is therefore necessary, to
        guard  against their being repelled,  as well as to invite their return.
          Another  species of eruption, which  is frequently  met with in young
        children,  is  that  known as  crusta lactea.  This often  puts on  a very
        unpleasant  appearance,  but is, nevertheless, of a very innocent  nature;
        and it  has been observed that those children who have been much  loaded
        with it have usually been healthy and cut  their teeth easily.  A remark-
        able circumstance attending this eruption is, that however thick and long-
        continued the scabs may be, the crusta lactea never  excoriates nor leaves
        any scars on the parts.
          The crusta lactea appears first on the forehead and sometimes  on the
        scalp,  and then extends half way over the  face in the form of large loose
        scabs,  which, as the disorder increases, appear not very unlike the small-
        pox pustules after they have become dry.   It  begins with white vesicles,
        which  soon  become of a dark  color and then  scab, with an ichorous dis-
        charge and  great itching of the parts affected.
          This affection  generally disappears of itself when the child has cut
        three or four teeth, though it may sometimes continue for several months,
        and in a few instances even for years.  In such cases  the stillingia  alt.,
        irisin,  the muriate of platinum or chloride of gold,  and other alteratives'
        have usually been administered with but poor  success.  The  iodide  of
        sulphur has met with success, so has  the c. tincture  corydalis and citrate
        of potassa.
          Similar diseases, affecting the skin, are not, in  all  constitutions, cured
        by like treatment.   We must mark well the temperament of the patient,
        his diathesis, before we can hope to cure  in a rational, safe  and scientific
        manner.  This is more especially  the  case in  skin diseases, as we  here
        find a greater variety of causes brought  into play, by which  they are
»       continued or excited into action.   Sometimes these  affections are trans-
        mitted, and then our treatment is often palliative.   In some cases we find
        ulcerations, which have no specific  or marked character,  very intractable,
        yield  upon the exhibition of  some of our  concentrated alteratives, the
        vital actions of the body are changed, the  health of the  distant parts are
        restored by the stimulus of an alterative.   In bad cases counter-irritation
        to the neck often proves serviceable.
           Carbolic  acid  has been extensively used,  both  in this  country and
        Europe, and  its  value  as a  remedial agent all have granted.   It is a
        useful agent in skin diseases;  it is an active  local  antiseptic  stimulant.
        Upon  a failure of all the usual applications, I have tried the carbolic
        acid in glycerine, in various proportions, and have  been  much astonished
        at its  effects—at its remarkable power over this disease.   In a few  days
        after  its  first application a decided  improvement takes  place, and, upon
        continuing  it for some little time, the eruption was  entirely removed, and
        the scalp once more restored to its normal state.  The oil  of populous I
        have found a most efficient application.
          • Another favorite remedy of mine in this affection is the ioduret sulphur
        such as R. ioduret  sulphur, grs. xii.; adepis, Ji., ft. ung.   The  strength 
CUTANEOUS ERUPTIONS.
25
 may be increased according as the affected  part will  bear the stimulus,
 until the ioduret  is in the  proportion of half a drachm  to an ounce of
 lard, or what is better, glycerine.  A slight staining of the cuticle attends
  •S.USe;  ,Afe Preparation is easily made, if not accessible to all; it con-
 sists  of  125 parts of iodine and 16 of sulphur gently heated over a spirit
 lamp until they fuse into one mass.   Strict cleanliness of the scalp should
 be rigidly observed, and  it should be washed with a sponge  and Castile
 soap  each time  before the application of either the carbolic  acid or the
 iodide of sulphur.  If the eruption is attended with much heat, and the
 head is tender and inflamed, we should give  alteratives, cooling remedies,
 keeping the head covered with an anodyne lotion prior to the commence-
 ment of either of the above remedies.  In scrofulous constitutions, where
 we have the glands of the neck enlarged, the exhibition of the iodide of
 sodium m the c. syr. stillingia, or c. tinct. corydalis, will materially hasten
 the cure.   The use of the remedies, in cases of long standing, should be
 continued for some  time after  the eruption has disappeared.
    From extensive clinical experience with  these  remedies, I  deem them
 of sterling  utility in the  complaint.   The obstinacy of these  diseases has
 arisen, no doubt,  from their empirical treatment.  It is  good  practice to
 attend to the  constitution—give alterative  remedies.  In  obstinate cases
 use  the remedies alternately: in this way. they are very beneficial.   In-
 ternal remedies, such as  the vegetable alteratives, with some preparation
 of potassa,  as the iodide, the bitter tonics and iron,  will prove beneficial.
    Medicines and medicinal means, which are found adequate  to the  cure
' and removal of disease in the hands of one practitioner, are frequently
 found inefficient  by another ; the virtue  and  efficacy of most remedies
 depending upon the proper  application  of them to  the  existing  state of
 the constitution of the patient.
    Tinea capitis, or  scald head, does  not essentially differ in treatment.
 This is  undoubtedly contagious, and  is  propagated from one child to
 another by contact, hence the necessity of cleanliness;  indeed, this is of
 infinite importance.
    During early dentition a rash, very much resembling measles, is apt to
 make its appearance, and this usually continues very florid for three or
 four  days, but it does not dry off in  the manner  of that disease.  It is
 often preceded by nausea and  vomiting, but is attended with  little or no
 fever.   During the continuance of the  eruption a few drops  of the cone.
 tinct. asclepias and aconite, with a grain of either leptandrin or euonymin
 every night, will be the most proper medicine ; and when it disappears the
 skin, liver, kidneys and bowels, slightly  active,  will  maintain  a cure.
    Other rashes, in  which the  spots  are larger, and often attended with
 some degree of fever, probably occasioned  by the irritation  of teething,
 are frequently to be observed  during  a more advanced stage of dentition,
 particularly while the double and eye teeth  are cutting.  These  require
 only  a proper attention to be paid to  the secretions, unless there  is  con-
 siderable febrile action, when  the exhibition of aconite  or asclepias with
 irisin will be advantageous.
    A  slight species of nettle  rash is another eruptive  disease to which
 infants are  liable ; but this requires  but little  treatment, and often dis-
 appears in a few hours.   When  the  little  patient  is much  covered  by
 eruption, and they remain long out, attention should be paid to their not
 being repelled suddenly by any exposure to  cold, or by any other improper 
26
DISEASES  OF CHILDREN.
 treatment;  but should they happen to strike  in, we  then should  have
 recourse to the tepid bath, asclepias, or tinct. aconite,  or c. tinct. serpen-
 taria, in order to aid their return to the surface of the body, which will
 be of the greatest consequence should the child suffer from the repulsion.
   An eruption of small pustules  is sometimes met with in infants nursing,
 as well as in children who have  cut their first teeth.   It  usually begins
 about the arms and legs,  but almost invariably spreads soon afterwards to
 other parts, and not unfrequently extends from the head to the feet. ^ In
 some places it appears in very small eruptions, like  the points of pins,
 with watery heads, and in others in as large ones "as  peas, and sometimes
 in foul blotches which, after breaking, form  scabs.  These may die  away
 and others show themselves successively in other parts sometimes for two
 or three months,  leaving the skin much stained.  The external application
 of the following R. Oxalic acid,  gr. xx.; creasote, gtt. xv.;  aqua, ^ii. M.;
 or the ointment of the iodide of sulphur is a very efficient remedy, seldom
 failing to remove  the complaint, if assisted, at  the  same  time, with the
 internal exhibition of irisin, gold, c. syr. stillingia or c. tinct. corydalis;
 washing the parts affected with about two drachms of the  liquor potassa,
 mixed with a pint of  water, will  often afford much temporary relief.
   In all the eruptive complaints of infants their taking cold ought to be
 carefully guarded against; the cutaneous surface should be well stimulated
 at least twice daily  by the  alkaline wash, brisk friction with the bare
 hand, and the various secretions  should be stimulated  by such agents as
 the neutralizing mixture,  small doses of leptandrin or euonymin in alter-
 nation,  with full doses of  the pyrophosphate of  iron. Should the eruption
 strike in suddenly, every  means  should be used to reproduce it again on
 the surface.
   In consequence of  some bad quality in the milk of the  nurse, it may
 be a venereal  or  strumous taint; it frequently happens that an eruption
 comes on in different  parts of  the  body.   In  all such cases  the  nurse
 should be changed, or else put upon such a course of medicinal treatment
 as will eradicate or modify the peculiar diathesis : above all, constipation
should be obviated, and such an alterative given as will excite the absor-
bents to action.

                 COLIC, ACIDITIES AND  FLATULENCE.
   Constipation, improper  or too much food, bad  milk, weak digestion, and
that natural tendency there is in  the stomach of all children to generate
 acidity, are the causes which give rise to these affections.   W7hen the food
 becomes acid on the stomach, instead of being properly digested and con-
verted into chyle  and blood, it acts as a deleterious, poisonous  ingredient,
causing great irritation, and thereby crying, restlessness, drawing  up of
the legs forcibly to the body, hiccups, vomiting, diarrhoea, flatulency, sour
 eructations, griping pains, green stools,  and a depression of strength  ;
and where  the  irritation is very  considerable,  convulsions  are  apt to
occur.
   If acidity prevails  in a high  degree, and the  infant is  troubled with
sour eructations, and much irritability at the stomach, it may be advisable
to evacuate its contents by a few drops of the wine of ipec. or lobelia, given
repeatedly in a little tepid  water, until a sufficient effect has been procured  •
after which the neutralizing mixture and leptandrin may be given to carrv
off the remaining offending matter. 
VOMITING.
27
  To prevent  any fresh accumulations  of the  same nature, it  will be
proper to give, as circumstances  may seem  to  demand  it, an occasional
teaspoonful of  the chalk mixture, or a few drops of lime water, or a grain
of frazerin, more particularly if there  is any severe degree of purging
attending.   Together  with these or  other  remedies, exercise, friction  of
the body, but of  the abdomen in particular, should not be forgotten.
 ^ Acidities and  flatulency sometimes prevail in  so  high a degree  as  to
give rise to severe griping pains, perfectly obvious by the infant's scream-
ing, crying, and drawing its knees up  to its belly, with the presence of
abdominal tension.  In such cases it  will  be necessary to dislodge  the
contents of the intestines, should constipation prevail,  by some  gentle
laxative, such  as juglandin and euonymin,  or  leptandrin  and  chelonin ;
after which we may give dioscorein and euonymin, or dioscorein  and fra-
zerin, or a few drops of the cone, tinct. cypriped. pub. and xanthoxylum;
the latter may be given in enema as well  as by the mouth, and where the
pain is very acute, and not relieved, we may add a small proportion  of
lobelia and hyoscyamus; as opium does  not agree well with children, it
should  not be resorted to on trivial  occasions.   Besides adopting these
suggestions, it is good practice to apply warmth externally to the stomach
and bowels by means of heated bran  or chamomile flowers put into a soft
flannel bag, or toasted  salt, which will  probably greatly assist in  abating
the pain.
  Children that are either partly or wholly brought  up independent of a
mother  or  nurse, and who are subject  to  flatulency, should always be
specially attended to  as  regards bathing,  active  secretions and food.
Indeed, acidities, gripes and flatulency,  would seem very frequently  to
originate in some error of  diet, and the proper regulation of this ought to
form a principal part of their cure.   Frequent  changes of diet are abso-
lutely indispensable to  a child as well as an adult.
  Constipation is very  apt to  occasion  flatulency and  griping pains  in
infants.  This  ought, therefore, to be obviated by giving  every other day,
as the case may require, small doses  of juglandin or euonymin, or castor
oil,  or a teaspoonful of the citrate of magnesia, or the white liquid physic,
or leptandrin in  syrup of roses, or  manna, to which a few drops  of the
fluid extract of senna has been  added,  in order to make  it more  active
and  quicken its operation.  Either of these  remedies are to be preferred
to rhubarb or rhein, or the neutralizing  cordial, as this possesses too much
of an astringent property, which is not  easily counteracted even by com-
bining it with other agents.  To promote  the peristaltic motion where
constipation prevails, exercise to the  child, friction to the abdomen, such
as rubbing or kneading the region of the  bowels several  times daily with
the hand warmed, in addition to other remedies.
  Where flatulency is  an  attendant  upon a relaxed state  of the bowels
and  indigestion, its remedy will consist in a removal of these complaints.

                              VOMITING.

  When the food that has been taken is returned  crude  and unaltered, it
may be suspected to arise from over-feeding, and  to require nothing more
than temperance  for its cure.  Vomiting, however, is often an attendant
on other complaints, and sometimes of itself constitutes an original disease.
  Where there is a vomiting of digested food, it will be proper to change
the diet, to open  the bowels by gentle aperients.  If these means do not 
28
DISEASES  OF CHILDREN.
  succeed, and the vomiting is persistent, it is good  practice to cleanse the
  stomach by a gentle emetic, and then give either of the following reme-
  dies : small doses of ipec, or a few drops of tinct. opii in peppermint
  water;  small  doses of lime water in  milk; one grain of leontodin or lep-
  tandrin ; rhein triturated with  xanthoxylum.   We may at the  same time
  apply the spice plaster over the region of the  stomach, or equal parts of
  allspice, cloves  and capsicum, moistened  with alcohol, or, what  I have
  found very serviceable, Peruvian bark and cloves.

                      LOOSENESS OF  THE  BOWELS.
    Various causes may and do occasion a diarrhoea in infants, and perhaps
  in the  greater number of  cases it is brought on  either  by too much or
  unsuitable food;  in which cases a diligent attention must be paid  both to
  the selection as well as the regulation of the diet.
    In some  instances, however, it may be-symptomatic of other diseases,
  or may  arise from an exposure  to cold, or  an  increased secretion of bile.
  In the latter case, it may be advisable, first of all, to cleanse the stomach
  by a gentle  emetic of the wine of ipec. or lobelia :  in  all cases it is pro-
  per to cleanse the intestines by a suitable dose of rhein and leptandrin,
  the operation of which being over, we may give the chalk mixture, or the
  geranin with  a  minute  proportion of  gelsemin or myricin joined with
  some aromatic twice or thrice daily.
    When the stools continue to be more frequent than natural, and  are
  either slimy or tinged with blood, it will be necessary to repeat the rhein,
  geranin, myricin, hydrastin, or to give the neutralizing cordial, with lep-
  tandrin, at proper intervals and in suitable doses, to control the complaint,
  as well  as proper nutriment to recruit and build up the strength.   At the
  same time local applications to  the  abdomen should not be neglected, and
  Peruvian  bark moistened with alcohol, the spice plaster, or hot salt, or
  whiskey.  The diet should be bland ; flour, sago, rice boiled in port wine
  will  be  good articles of diet.  I have also found the sub-nitrate of bismuth,
  &c, of value.   In addition to these means, it is advisable  to envelope the
  child's body in flannel, so as to keep  it of  a proper temperature.
   That form of diarrhoea which  is attended by green  stools and griping
%  may, in general, be removed by leptandrin and  the neutralizing cordial.
  If obstinate, euonymin might be  added, and slight counter-irritation over
  the abdomen will produce a good effect where  the  internal  remedies fail,
  or do not act quickly.
   "When the irritability of the intestines seem to be great, the stools fluid,
  and being passed with  great frequency and force, and the strength seems
  to be rapidly sinking, we  would give  gerauiin, myricin and  populin, and
  an enema of starch with tinct. opii and  tannin; also, the  external  appli-
  cation of opium, by friction or otherwise, is useful.  In such cases I have
  derived great  benefit from  counter-irritation over the abdomen.

                  TETANUS, OR LOCKJAW  OF  INFANTS.
   This  disease is seldom met with in the United States, but is common iu
  Cuba, Jamaica and parts of Northern Europe.  In most cases, the affec-
  tion  seems  confined to the jaw;  but a considerable contraction  of  the
  face, with strabismus and rolling of the eyes, together with subsultus ten-
  dinuhi,  have been observed.
   The cause of  the  disease has been attributed to the improper food of 
INTERMITTENT FEVER.
29
 the  parent, to constipation, and not purging  off the meconium  in  the
 Dowels; to dividing the navel string with a blunt lacerating instrument:
 to not paying attention to its falling  off, and consequent  irritation  from a
 neglect ot the remaining sore; and  to exposures to cold and  currents of
 air.   it is very fatal in almost every instance.
   No effectual means have been discovered for the cure of the disease :
 all that can be done is to avoid, as much as possible, the several causes which
 have been mentioned as being likely to  give rise to  it.  Every lying-in
 woman should have good food and a comfortable abode, which should be
 protected from all inclemencies of the weather.   On the birth of the child
 the  navel string should be divided with a pair of sharp scissors ; after
 which that portion that remains should be wrapped up in a little scorched
 linen.  No force should be used to bring on its separation ; it should come
 away spontaneously, and  if any little ulceration is left behind it should be
 attended to,  and twice  daily dressed with the  black salve, avoiding pres-
 sure upon it by bandages.
   If the divided  navel  string is irritable, a cloth with a watery solution of
 opium  should  be applied.  To  remove  constipation,  and carry off  the
 meconium, which has been assigned as a cause, one or two teaspoonfuls of
 castor oil should be given to the child the day after its birth, which  may
 again  be repeated in  two or three  days, should the mother's milk  not
 prove sufficient.
   On an attack of the  disease, we ought to have recourse to the exhibi-
 tion of the c. tinct. lobelia,  ice to the spine, and  the  general treatment
 of tetanus.

                         INTERMITTENT FEVER.
   Ague is the  common  name for  intermitting  fever,  accompanied by
 paroxysms or fits.  Each fit is composed of three stages;  the cold, the
 hot, and the  sweating stages.  Before a fit, the patient has a sensation of
 debility and  distress about the epigastrium ; feels weak, and  disinclined
 for  exertion; the  surface of the body becomes cold, and  the bloodless
 skin shrivels up into the condition known as goose-skin ;  a cold sensation
 creeps up the back, and spreads over the body ;  the patient shivers, his
 teeth chatter, his knees knock together ;  his face, lips, ears and nails turn
 blue;'he has pain  in  his head, back and loins.  This  condition is suc-
 ceeded  by flushes of heat, the coldness  gives place  to warmth, and  the
 surface regains its natural appearance.  The warmth continues to increase,
 the  face becomes red and turgid, the head aches, the breathing is deep
 and  oppressed, the pulse full and strong.  The third stage now comes on;
 the skin becomes moist and  soft, the pulse resumes its natural force and
 frequency, and a copious perspiration breaks from the whole body.  These
 paroxysms recur at  regular  intervals;  the  interval  between  them  is
 termed  an intermission.   When they  occur  every day, the patient has
 what is termed  quotidian; every second day, tertian; and  when  absent
 for two days, quartan.   All ages, and all conditions in life are liable to
 the disease.
   The exciting causes  of the disease are effluvia, marsh miasma.  A cer-
 tain  degree of temperature is necessary  for the production of this miasma.
 It would seem that the poison is not-generated or developed  below a tem-
perature of 60° Fah.;  at  least the disease does not prevail  in temperate
climates.   It would seem that moisture is  essential to its production, as 
30
DISEASES  OF CHILDREN.
it often disappears when drainage is introduced; still peat, bog or mosa
are most productive of malaria when the climate is moderate.
  Treatment.—On the approach  of the cold stage, a vapor or warm bath,
or the feet in hot mustard and water, and the patient made to drink some
stimulating  tea, such as an infusion  of capsicum.   If possible, put  the
patient to bed, and  apply warmth to the extremities :  and as soon as  the
fever appears, put the patient upon aconite and gelsemin—thirty drops of
each into a half a  tumbler of water, and give a teaspoonful every ten
minutes, till the  pulse is seventy-two, or a profuse perspiration has broken
out.  Sponging  the entire surface  twice daily, with ihe alkaline wash, is
attended with a  most salutary result.  For the purpose of eliminating the
malarial  poison, and interrupting  and preventing a return of the parox-
ysms, various remedies are used.   Among the best, we  may enumerate
the following : quinine, prussiate of iron and gelsemin, equal parts ; com-
mon salt, in an  infusion of boneset, and numerous other agents, as Hux-
han's tincture of bark, Beach's wine bitters, &c.  A good mixture is the
following:
                  R.—Simple syrup, giii;
                       Sulph. quinine, gr. x ;
                       Tanini,  gr. hi—nx.
                   S.—A teaspoonful, thrice daily.

                              APHTHAE.
  Under this head, we may include thursh and follicular  inflammation,
all generally supposed  to arise from acidities or acrimonious  humor lodged
in the stomach  and bowels.  Various causes  of derangement in the  ali-
mentary canal are certainly to be regarded as those which occasion aphthae;
one of  the chief of these is worms, and it appears in this way that these
two complaints are so frequently conjoined.  Another  occasional cause is
bad milk, which may be vitiated by whatever injures the mother's health,
such as anxiety, violent passions, improper diet, &c.
  In some instances aphthae may possibly depend upon the  natural habit
of the infant as  well as upon the mode  of  bringing it up, particularly in
regard to food,  air and the state of the bowels, and want of  proper atten-
tion to the stomach and bowels.
  The  disorder generally appears first in the angles of the lips,  and then
on  the  tongue   and cheeks, in  the form  of little white specks.  These
increasing in number  and in size, run  together, more or less, according
to the degree of malignity y composing a thin white crust, which  at length
lines the whole  inside of the mouth, from the lips even to the oesophagus,
and is sometimes found even to extend into the stomach, and through the
whole of the intestines, producing also a redness about the anus;  when the
crust falls off,  it is frequently  succeeded  by  another of a darker hue;
but this only happens in the worse kind, for  there are frequently cases that
are mild, spread thinly over the lips and  tongue, which return a  great
many times and  is intractable.
  When aphthae is an  idiopathic disease, it is  never or seldom  attended
with any fever at its commencement, although  the mouth is  so very much
heated as to excoriate the nipple of the mother, and becomes so tender
that the child  is often observed to nurse with  reluctance and caution-
but when it arises  in  consequence of a severe  affection of the bowels
or other infantile disorders, it  is  accompanied with fever  and  a severe 
APHTHA.
31
diarrhoea.   Even in the worst grade  there usually is but slight fever at
the commencement of the complaint;  but as it progresses onwards, there
is sure to be slight febrile  disturbance.  In some cases we have distur-
bance of the nervous system, violent hiccough, vomiting, sense of suffoca-
tion,  great prostration of strength, severe diarrhoea, coma;  the  aphthae
being of a brown color, &c, must be  regarded as unfavorable symptoms.
   Treatment.—The disease, when recent, and confined to the  mouth, may
in general be easily removed, but when of long standing, and extending
down to the stomach and intestines, it often proves fatal.
   To evacuate the stomach of acidities, or other acrimonious humors, it
is an  excellent plan to give a gentle emetic ; indeed, this should be done
even  in  slight cases, but when the specks are of a  dark color, and the
inside of  the cheeks  are covered with them, the  emetic  is essentially,
imperatively demanded ;  it empties  the stomach of the crude juices and
acrid matter, and  will, in all  cases,  be of great use.  The  best  emetic
consists of  the C. tinct, or powder of  lobelia.
   After the operation of the emetic, the C. powder of rhubarb and potassa
in infusion, or the neutralizing  cordial, should be administered  until it
acts on the bowels two or three times.  I have succeeded well with small
doses of leptandrin and juglandin for a few days in succession, and then
the rhubarb, to carry down the  scales as  they fall off from the ulcerated
parts.  In  mild  cases, rhein in trituration is the best  remedy; but where
the child is of a  robust habit, and the disease is violent  and has extended
rapidly, it is better to give in addition small doses of gold, or muriate of
platinum, or the stillingia alt., alternately, with' small  doses of the sub-
nitrate of bismuth.
   When a  weakly child  is  attacked  with aphthae, which appears  of a
malignant  nature,  and which, from its dark appearance, threatens to ter-
minate  in  gangrene, we  should give a solution of hydrastin and  baptisin,
or a decoction of cinchonea joined with bydrastis.  To  render  this more
effectual, we may also use borax, say 30 grains  to the ounce of water,
and  direct  that  the  mouth be, carefully washed with it, the  lotion being
applied by means of a soft piece of lint,  or the muriate of hydrastis in
solution.
   In  order to keep the infant's mouth clean and comfortable, and to pre-
vent  injury to the nurse as far as  possible, as  well as  to  dispose the
sloughs  to fall off, and incline the parts underneath  to heal, it is some-
times expedient  to make  use  of gargles, detergent applications,  as the
permanganate or chlorate  of potassea, or  a  solution of the sulphite of
soda,  or dilute sulphuric acid mixed with honey, or gallic acid in solution,
or powdered tannin sprinkled on the  ulcers, or borax and honey, or the
honey of roses, alum and myrrh, gum arabic and myricin.  In the  gan-
grenous  form,  it is best  to wash the parts frequently by means of a
syringe, or a very fine sponge, with  a  strong decoction of cinchona, acidu-
lated  with  nitro-muriatic or aromatic-sulphuric acid; and  if they do not
yield, apply ether the dilute nitric acid or sulphuric  acid, or sulphate of
zinc.  At the same time exhibit sesqui-carbonate of ammonia, or chlorate
of potassea, sometimes a wash of chlorinated soda, or  chloride of lime,
with camphor and myrrh, &c.  If there is any febrile action to any con-
siderable extent, the tinctures of aconite and  veratrum should be given
diluted  in  water.  After  the use of  these remedies, give the iodide of
potassium in an infusion of equal parts of alnus, rumex and quercus rubra,
and the chlorate  of potassea in a weak solution. 
32
DISEASES  OF CHILDREN.
  If the aphthae extend  to  the bowels, enemas  of a  mucilage of slip-
pery elm or flaxseed, and also the same remedies internally.
  If we  have diarrhoea, the  fluid  extract of cranesbill and gelsemin, or
myricin and sub-nitrate of bismuth, &c.
  The skin should be stimulated twice daily ;  a proper perspiration should
be excited, a tepid bath occasionally.
  To remedy the  inconvenience arising from the soreness of the  mouth
and tongue, these  should be washed frequently with some of the remedies
mentioned.   In all forms of the disease, the best results are to be obtained
from a decoction of  cinchona, and the  sulphate of cinchonine  internally
in large doses.
  The diet should be light, nutritious, as milk, mucilaginous drink, jellies,
port wine and water.
  To restore the  lost vigor and tone  of the system, cinchona and iron,
tonics, wine bitters, moderate exercise as the strength will allow.

                           PROLAPSUS  ANI.
  We often  meet with  this  disease  in children of a weak habit, or who
have been much afflicted with diarrhoea, dysentery, and  the like.
  In prolapsus ani a palliative treatment has been very fashionable, and
considerable advantages have been experienced from the course, namely :
the frequent use of astringent  injections, particularly of  an  infusion of
oak bark, solution of kino, hydrastin, tannin, &c, and adding an anodyne
sufficient to allay any irritation  in rectum.   The  same may be used as a
wash to the  protruded parts before  they are replaced.   Should great
soreness be experienced in the reduction, the fingers  or cloth should be
smeared with the black salve, and a pad and T bandage applied.
  For the purpose of effecting a radical cure, I have been in the habit of
using a pretty strong injection of diluted solution of perchloride of iron;
this is a never-failing remedy.  With a view of aiding the treatment, let
it be palliative or  radical; we must  always  recognize  debility as the sole
cause of this disease;  cold hip  baths, and agents calculated to tone and
invigorate  the system,  such as  bark and hydrastis, rhein and sub-nitrate
of bismuth, rhusin, hamamelin and frazerin.

                PURULENT OPHTHALMIA OF  CHILDREN.
   This form  of purulent  ophthalmia  invariably begins a  few days after
birth, generally on the  third or  fourth day.
   It usually shows itself first by the edges of the lids  appearing red  and
glued together; their internal surface  is red  and villous, and the eye is
kept closed.  Then the conjunctiva of the globe becomes intensely  scarlet
and much swollen, often so  much so as to cause eVersion  of the lids;  it
secretes a thick purulent discharge, and the child  is very restless  and
feverish.   If neglected, the disease may occasion opacity, or ulceration
or perhaps sloughing of the  cornea, but it is usually amenable to  proper
treatment.
   Causes.—The presence of a leucorrhoeal  or gonorrhoeal discharge in
the mother is one of the  causes of this affection ;  some of the secretion
finding its way into the eyes during the transit of the child through the
vagina, or upon its first opening them  after  birth.  Neglect in the first
washing of the natural cheesy secretion of  the skin away  from the eyes
or in allowing particles of the same from the  towel to get about the eye! 
PURULENT OPHTHALMIA  OF CHILDREN.
33
The use of irritants, as coarse soap, alcohol and other substances used in
cleansing- the  child, together with exposure to cold,  damp,  light,  bad
nursing, &c.
 ^  Scarcely any disease has a greater tendency to an unfortunate termina-
tion, if neglected, or erroneously treated.  If left to itself, the accumu-
lating secretion seems to soften the cornea, hasten  its destruction, and if
a mild but  efficient  treatment  be adopted, and pursued with  care, it  is
almost certain to  be effectual.  Even if haziness  of the cornea  has
begun  to  show itself, we  need feel  no uneasiness,  provided  the other
symptoms are favorable, as the  transparency will soon be restored.
   Treatment.—The most watchful and constant attention is required from
the  commencement  of this disease.   The eyes should be  kept  clean.
Weak injections of a solution of the chlorate or permanganate  of potash,
or luke-warm water, or a solution of baptisin.   The nozzle  of the syringe
should be carefully insinuated beneath the lid, and then the contents
thrown in with gentle force.  The greatest possible  care should be used
by the nurse, so that there be no squirting into her eye, as this, when it
has occurred, has frequently given rise to conjunctivitis  and loss of vision.
The injections, as a rule, should  be  repeated every two or three  hours,
according  to the  severity of the symptoms, so as  to  keep the eye free
from  any accumulated discharge, and  they should be continued persever-
ingly day and night.  Following the use of the injection, a little glycerine,
or rose-water ointment, should be  applied along the whole edge  of the
lids to prevent them adhering.   Other washes may be  substituted for
those  mentioned if the indications  demand them.   Among  the  best  of
these is the tincture of myrrh, which, if used in a diluted form, should be
freely applied.  It must  be borne in  mind that improvement must be
gradual, and cannot be hastened by many changes of remedies.   If it is
desirable that a different collyrium should be used, then  one  made of a
solution of hydrastin, rhusin, baptisin, hamamelin, sulphate or acetate of
zinc, &c.
   Solutions containing the nitrate of silver, or the bichloride of mercury,
so ignorantly and so strenuously used and recommended  by the  old school,
should never  be  made  use of, as  they  are  irritating  and  essentially
destructive.   If the cornea is implicated, even to a slight  extent,  it  is
best, as  a precaution, to  drop into the eye a drop  of a solution  of the
sulphate of atropia, one or two grains  to  the ounce, or if there is much
irritation, a drop or two of the following:
                 R.—Atropia,  gr. i:
                      Tinct, gelseminum, gtt. xxx.—Misce.
   We thereby diminish  the risk of extensive  adhesion  of  the iris  and
closure of the pupil.  If the child  be feeble when  the disease declares
itself, it is well to  look after  its nutrition, keep it up to a high standard
by cod-liver oil and the syr. of phosphates, friction to the skin, salt water
bathing.                                                .
   All manipulations about the eye should  be performed with the greatest
care and delicacy.   All the emunctories should be free—the bowels should
be acted on  with  leptandrin  and irisin, following with the neutralizing
cordial, and  if there  be  great  tumefaction, the irisin might be repeated
every two or three  hours, or a few drops of  the stillingia  alt., or  the C. syr.
stillingia might be  given every few hours.   As  the  affection begins to  be
controlled, dispense with the frequency of the injections, and use glycerine
        3 
u
DISEASES  OF CHILDREN.
and our concentrated astringents freely, and internally tonics, as the ellx,r
of cinchona and iron.   I have  succeeded  well with small doses of gold as
an alterative.

                              TEETHING.
   Of all the occurrences to which children  are  liable, not one is attended
with such grievous and  distressing symptoms  as difficult dentition.   With
regard to  the time of their cutting  teeth, no fixed  or  exact period can be
laid down, as some cut their first  tooth at three  or four months old, whilst
others again have  not the smallest appearance of a tooth before the ninth
or tenth month.
   Dentition generally commences, in the majority of children, between the
fifth and eighth months, and the process  of  the first teething commonly
continues  to the seventeenth month  at the least, and often much longer.
The  two fore teeth of the  under jaw are those which usually appear first,
and shortly after these are observed two  more come out in the upper jaw
exactly opposite the  two former.  These are succeeded by the four molars,
then the canine, and  the ast of all of an infant's first teeth, their antagonists
or the eye teeth, making in all sixteen.  This  is well known is the ordinary
number of a child'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.
   In  children who are healthy and strong, the process  of dentition goes on
as has just been described, and the  teeth are all cut soon and easily ; but
in unhealthy and weak infants the  process is  both slow  and  uncertain ;
accordingly, children sometimes  cut their teeth irregularly, both by the
teeth appearing first in the upper jaw and  also at some distance, instead of
being contiguous  to each other, which  may be regarded as an indication of
difficult or painful dentition.  It may also  be remarked that  the e  se or
difficulty of circumstances  under which the two first teeth shall happen to
be cut, the succeeding  ones generally making their way in a corresponding
manner.
   At six  or seven years of age all children shed  their  teeth in a gradual
manner, and get a fresh set, and about the age of twenty-one they get one
more in the corner of each jaw, which, from their appearance at  that period
of life, have been named their wisdom teeth.
   Dentition is usually preceded by, or accompanied with, various symptoms :
the child  becomes fretful; nutrition  seems to be impaired ; the gums swell,
spread, and become hot, tender; the child is continually working with its
mouth, desiring to  bite something ;  irritable, fretful, fever, increased heat
in the head, or pallor and dilatation  of the pupils;  there is often a circum-
scribed redness in the cheeks, with eruptions  on the skin, especially on the
face and scalps a looseness ensues,  with griping stools of a  green, pale, or
leaden blue color, sometimes mucus,  and the child is watchful and peevish ;
starts during  sleep, throws its arms, and  seems convulsed in  particular
parts of its body.   In almost all  cases the child shrieks frequently, thrusts
its fingers into its  mouth;  these  symptoms are  sometimes followed  by
cough, difficulty of breathing, emaciation or marasmus, hydrocephalus, and
very frequently by much  febrile  heat, thirst,  convulsions, and  a bad train
of circumstances.
   When, however, the  child's  secretions  and excretions are natural, very
few of the violent symptoms attendant on much irritation occur, and we 
TEETHING.                            35
need not then apprehend any bad consequences from teething.  Infants cut
their  teeth  more readily and more  easily in winter than in summer, and
those of the sanguine temperament more readily than those of the lymphatic,
and children whose secretions are regular the easiest of all.
  The system during dentition being irritable, strong plethoric children
suffer  more  than the apparently weak  and delicate, and it is usually by
acute fever or convulsions  that infants are carried off.  The extremes of
high health and of debility are  both attended with some degree of danger;
the one  being exposed to  acute fever or convulsions, the  other  to slow
hectic or marasmus.  It is  true, that with proper treatment  many of these
symptoms will pass off without danger to the child ;  but very often they
do not, giving rise to a low form of fever, brain disease, convulsions and
derangement of the bowels.
   Treatment.—The irritation  of teething  mostly causes a  determination
of blood, and the gums become swollen and tender to the touch;. there is
fever, irritation of the  nervous system, with occasional convulsions.  In
these cases where the gums appear considerably swollen, and  the child
seems to suffer much from  the stimulus of the tooth in working its way,
and where the tooth is near the surface, that it will be exposed  by the
retraction of the gum,  then it may be advisable to cut down upon it with
a lancet;  where no such appearances present themselves,  and the child
seems nevertheless to be very  restless and uneasy, we can  do little more
than attend to the different symptoms.  In the mildest form of  dentition,
mild sedation is very successful, say thirty drops of the tincture  of aconite
in half a tumbler of water,  and give teaspoonful doses every hour or two :
if there  be strong nervous  symptoms, with a tendency to convulsions, add
a few drops of the tincture  of gelseminum.  If acidity prevails,  it  is to be
obviated by the chalk mixture or the  neutralizing cordial, or  a  little lime
water, with a grain of euonymin triturated in sugar;  if the  flatulency and
griping pains attend, carminatives, such as an infusion of  caraway seeds
and epilobium, or a drop or two of either the oil of xanthoxylum or anise.
If constipation prevail, the  bowels must be opened by some  mild laxative,
such as a grain of juglandin and euonymin, or a grain of leptandrin tritu-
rated with  pulverized liquorice, or the  neutralizing cordial,  or castor oil;
and if violent start ngs, with loud shrieks,  and a disposition  to convulsions
take place, two or three drops of the tincture of lobelia in a little lavender
water, or  the  same amount of the tincture  of belladonna, or cypripedm
must be resorted to.  As an anodyne, l-16th grain-of hyosciamus, or  the
application of a strong counter-irritant between the shoulders,  may also be
advisable.
   In recommending  opiates to be administered to children when  there is
reason to apprehend they will  be attacked with fits in consequence of  the
great irritation occasioned by the teeth working through the  gums, it might
be observed that nurses and mothers are too prone to employ some  prepa-
ration or  other  of opium  in the nursing of children, in  order  that their
own rest may not be disturbed in the night.  This practice  seldom fails to
prove injurious to infants.
   When  a considerable  degree of fever attends  dentition, aconite with
asclepias  should  be  resorted to;  gentle diaphoretics  pirticularly, with
lobelia, in very small doses, together  with diluting drinks, such as catnip
or  sweet marjoram tea.  If we have retention  of  urine,  an infusion of
parsley root, with a few drops of the  sweet spirits of nitre and tincture of 
36
DISEASES  OF CHILDREN.
belladonna, an onion poultice  over the region of the bladder  should be
resorted to.
  A free  action of the bowels during dentition should not be hastily stop-
ped, as this and eruptions on the  skin, when  spontaneous, are the grand
means of  easy and safe dentition.
  The cause  of the  diseases so frequently identified  with dentition, is a
lack of the proper histogenetic  material, thereby causing a drain upon the
other  tissues, which, together with the irritation of  the teeth  upon  the
nerves, produce a  train  of  morbid symptoms, which  are attributed to
anything  but their  true  source.   Supply these materials, give  lime  and
iron,  of  which the  system is   deficient, and  continue  until  dentition is
complete.
  The practice adopted of giving children  ivory and other substances
to suck during  the  period  of  teething  is highly improper, as they have
a tendency to harden tin gums.
  During dentition, children are sometimes troubled with ulcerated gums,
but these may be  readily cured by attention to the bowels, and applying
the muriate of hydrastin  to the part, or some astringent application : borax
and honey may be  used.   Pure air, proper  exercise, wholesome nutritious
diet, regular  bathing, active secretions, and everything that has a tendency
to promote health and guard against  irritation, will greatly contribute to
the safety of  dentition, as well as  the child passing quickly through  this
hazardous period.
                           WEANING  BRASH.
  This affection occurs in children that are weaned too early, or such as
are attempted to be reared  without the breast, and  also where improper
food  is given, with  or without sucking.   It occurs most frequently in
children of a loose  habit, or the scrofulous, those whose constitutions are
liable to strumous disorders.
  It  begins  with  frequent  griping and purging, in which  the  stools are
usually of a  green  color, and  is often  accompanied with bil ous vomiting.
In  the progress of  the disease, the stools  are sometimes ash-colored and
shining, sometimes white; atrophy succeeds these  symptoms,  and convul-
sions  often carry off the  child.   The exciting cause is a too sudden altera-
tion of the diet of the child at an improper season.
  The weaning brash, if attended  to in time, may in general be removed
before the fifth or sixth week.
   Post-mortem examination exhibits the mesenteric glands, either inflamed
or  enlarged, tubercles in the  lungs, the liver enlarged, remarkable  con-
tractions  of the diameter of the intestines, &c.  The treatment  here  con-
sists  in attention to diet as a means of  removal of the  disease,  and above
all, a return  to the  natural food, the  mother's milk, where circumstances
will  admit of it;  where  they  do not, animal food in the form of broth or
jelly  should be principally employed.  Vegetable food should be prohibited,
as well as fruits, acids and compositions in which sugar and indigestible  sub-
stances form a part.   Pure air, exercise, gentle frictions or manipulations,
and frequent washings and  bathing of theJjody, with  tepid salt water or
cold water will be of good service.  Flannel should be worn next the skin,
worsted  stockings, and every  precaution against cold applied, and should
be regularly attended to.  The employment of a warm medicated salt bath
such  as  salt, or nitro-muriatic acid every other day, might  prove advan-
tageous. 
CONVULSIONS.
37
  *or the cure of the disease,  occasional alteratives, such  as stillingia,
leptandrin,  menispermin,  irisin, &c, with absorbents  and tonics, together
with minute doses of  gold seem advisable.

                             CONVULSIONS.
  Violent  spasmodic  affections  sometimes  attack  children  without any
apparent cause ;  but in general they are  produced either by a lodgment of
some  acrid matter in the intestines, or flatulence, or they arise from teething,
worms, the sudden striking in of an eruption, or the infection of small-pox.
Any trifling  matter, capable of irritating the  nervous system, will induce
symptomatic convulsions  in  some children, whilst others will withstand  a
great deal.   The younger and  more irritable the child is, and' especially  if
it be  of the encephalic temperament, or strumous diathesis, the  more liable
will it be to symptomatic convulsions, especially from any slight disturbance
in  the alimentary canal.   Convulsions are always dangerous  as well  as
alarming ;  and a surer indication of danger is to be drawn from the distance
of the paroxysms than from the forcible contractions of the muscles during
the fit.   Where the intervals are short,  alth ugh the fit itself be not long
nor violent, the disease is to be considered as  more dangerous  than where
severe paroxysms are attended with  long  intervals.
  In  the treatment of convulsions in children, the chief object to be attended
to is the removal, if possible, of the cause  which has given rise to them.  If
they  seem to  be occasioned  by improper food  and  indigestion, a gentle
emetic may be  given, and for  this purpose the  wine  of epec, or lobelia,
given in twenty-drop doses every few minutes, until the desired effect  is
produced.   When supposed  to proceed  from  a lodgment of acrid matter
in the bowels, this should  be removed by an  enema of an infusion of the
skull-cap  and  lobelia, or some gentle  remedy giv.en  by the  mouth, as
leptandrin and rhein ;  if from flatulency, then  carminatives, as cypripedin,
xanthoxylin, &c, and  if from teething, whenever the tooth can  be discovered
working a passage through the gum, a slight  scarification should  be made
with  the lancet immediately over it, and this operation  may be repeated
for several successive  days, till either  the tooth  is free or the  convulsions
cease.  If slight  scarifications  are  not found to answer the purpose, we
may boldly cut down  to the tooth, and liberate  it in  every part;  and this
plan we may likewise  adopt with all such as are  making their way.
  Acidity is a very frequent cause, and oue that is generally overlooked.
Acidity gives rise to colicky pains ; hence, in irritable subjects, this griping
gives rise  to reflex  action.   In  these cases  neither the anti-spasmodic
tincture, nor  belladonna, musk, nor any of the anti-spasmodic  remedies
will be effectual in removing the convulsive affection : some alkali, capable of
removing or neutralizing  the  acidity, will alone  be effectual,  such as small
doses of  the super-carbonate of potassa,  or the neutralizing mixture.
  Worms are to be regarded as a frequent cause of recurring convulsions,
and it is proper to have recourse  to  such remedies as santonine, chelonin,
&c.  and  the  remedies recommended  under  that  head, when,  from the
prevailing symptoms, we suspect them  to have been excited by this cause.
  Should convulsions  arise from  the  sudden striking  in of an eruption, or
the drying up of a discharge, warm  baths, the vapcr bath, by means of hot
bricks wrapped  in cloths wet with alcohol placed around the patient; the
perspiration so induced must be maintained by the administration of warm
ufusions of aconite and belladonna. 
38
DISEASES  OF CHILDREN.
    When the disposition  to  convulsions  continues, after  the bowels  and
 stomach have been properly cleansed, we must have recourse to anti-spasmo-
 dics  to  allay irritation ;  the C. tinct, of lobelia  and capsicum  should be
 given until  they cease ;  for the sooner we destroy spasmodic action,  the
 better for the patient;  warm bath and  mustard poultices should  be applied
 to the feet,  enemas of assafcetdia or cannabis indica, counter-irritation to
 the spine, and the  occasional application  of ice, cold to the head ;  rubbing
 the spine, palms of the hands and soles of the feet with oil of lobelia may
 have a  good effect,  Where a  high degree of organic debility prevails,
 stimulants may be added, and nourishing enemas may be persevered with.
   When convulsions are not preceded by any of the usual symptoms, they
 may be regarded as idiopathic.   In  difficult  labors, for example, the brain
 is often  much compressed, and soon after delivery the child is attacked
 with fits.  In  such cases it is  often advisable  to allow a teaspoonful of
 blood to flow from the naval string before it is tied, and in this way oppres-
 sion of  the  brain will  be relieved, and disagreeable consequences will be
 often prevented. But if this is overlooked, and fits have actually come on, we
 must make revulsion by resorting to the hot bath, the application of sinapisms
 to the extremities,  and  the exhibition of  the C. tinct. lobelia, both by the
 mouth and rectum.  Inward fits  are much talked of by ignorant  nurses:
 and, indeed, some authors make mention  of them.  During the first five or
 six weeks infants are liable to them ;  the usual symptoms are, the child, when
 asleep, has  its  eyelids  not  quite closed, thn eyes twinkle, with the  white
 turned up;  there is a kind of tremulous  motion in the muscles of the face
 and lips, which  produces something like a smile, sometimes  the appearance
 of  a  laugh.   As  the  complaint  increases they would seem  to  stop;  the
 nose becomes pinched ;  there is a pale or  blue circle around the mouth  and
 eyes, which  sometimes  becomes  livid, and comes  and goes by  turn ;  the
 child starts,  especially if it is stirred ever so  gently, or if there is the least
 noise.   Thus disturbed, it  sighs  or breaks  wind, which gives  relief  for
 awhile,  but  presently  it  relapses  into  dozing;  sometimes  it  struggles
 hard before it can break wind, and seems  as if falling into convulsions,  but
 a violent burst of wind from  the stomach or  rectum, or vomiting of acid
 matters, or a loud fit of crying, sets all to right again.
   For the relief of these, a few drops of  the C. tinct. lobelia, according to
 the  age of the infant, the  exhibition of some alkali;  and if  the  child
 sleeps too long, and these symptoms  recur, take up the child, tap it gently
 on  the  back, rub its  stomach and  abdomen well before  the fire.  This
 gentle exercise will  probably bring  the wind from  the stomach, the alkali
 will remove  the acidity, the  lobelia will remove any spasmodic  symptoms,
 and the child will then go quietly to sleep; should these simple means  not
 prove sufficient, some carminative may be given,  such as a drop or two of
 the oil of anise, or caraway, on a bit of white sugar.

                                CROUP.

   Croup  is   an inflammatory affection of the mucous membrane of  the
 trachea and  larynx, which, in some  instances, extends,  however, even to
 the bronchiae and ovtr the  surface  of the lungs, to  which children  are
peculiarly subject, producing an  exudation that appears partly in a mem-
braneous  coating, and partly in a fluid resembling pus, and is  attended •
with a peculiar  wheezing, sonorous  inspiration, compared by some to  the
crowing of a  fowl, a similar or stridulous sound in coughing and speaking 
CROUP.
39
great difficulty of breathing, thirst, and other febfile symptoms, as like-
wise by some degree of spasmodic affection.
  Croup has been divided into numerous varieties; idiopathic, where the
disease is primarily and extensively seated in the trachea, bronchia and
surface  of  the lungs;  symptomatic, where it  appears as the consequence
of some  previous  disorder, as measles, scarlatina, &c.   Spasmodic and
inflammatory have been recognized, but not with propriety, as  the disease
is essentially inflammatory.
  Croup is  to  be distinguished from acute asthma by the  following cha-
racteristics : in croup, the  cough is  frequently ringing in our ears ; in
asthma, there is little or  no cough: in croup there  is seldom any remis-
sion, whereas in acute asthma it is one of the most striking  phenomena of
the disease, and  is  attended  with  belching, vomiting, &c.; in croup, the
pulse is strong, rapid, with  great febrile disturbance; the urine is highly
colored,  and the voice shrill and  small; in  acute asthma,  the pulse,
although perhaps equally quick, is less full,  the  urine is limpid, and the
voice is croaking and deep.
  The inflammation of croup  is peculiar, depending  on a plasticity of the
blood.  It is  not contagious, but sometimes  prevails epidemically.  It
is peculiar  to  some families:  and a child being  once attacked with it is
very liable to  its return from any slight exposure to cold.  It  would seem
to prevail most frequently from a few weeks  after birth  to  the eighth or
tenth year of its age: the  plethoric, or robust, are  most obnoxious to its
attacks: it has rarely been  known to attack a person arrived  at the age
of puberty.
  The application  of cold  is an exciting cause, and therefore it occurs
most frequently in  the winter and fall, at those  periods when  the weather
is variable : consequently we have it more prevalent near those locations
where the  air  is loaded with moisture, and where  the changes of the
weather are sensibly experienced.
  A day or two previous to an attack of the disease, the child appears drowsy,
inactive and fretful;  the eyes are somewhat suffused and heavy, and there
is a cough which, from the  first, has a peculiar shrill sound;  this, in the
course of two  days, becomes  more violent and troublesome, and likewise
more shrill.  Every fit of coughing agitates the patient  very much; the
face  is  flushed and swollen,  the  eyes  are protuberant,  a general  tremor
takes place, and there is a kind of convulsive endeavor to renew respira-
tion  at the close of each fit.  As the disease advances, great  difficulty of
breathing prevails,  accompanied with swelling and  inflammation in the
tonsils,  uvula, &c, and the  head is thrown back in the agony of attempting
to escape impending suffocation.   There is  not only an unusual  sound
produced by the cough, but respiration is performed with a hissing noise,
as if  the trachea was closed up by some spongy substance, and resembles
the sound of  a piston forced up a dry pump.   The cough is generally
dry :  but if anything is expectorated, it has either a purulent  appearance,
or seems to consist of films resembling portions of a membrane.   WThere
great nausea and frequent retching prevail, coagulated matter  of the same
nature is brought  up.  W7ith these symptoms there is  much thirst, an
uneasy  sensation of heat over the whole body, great restlessness, and
frequency  of   the pulse.   Frequently the symptoms  suffer considerable
remissions and exacerbations.   In the advanced stage of the  disease res-
piration becomes more stridulous, is performed with still greater difficulty 
40
DISEASES  OF CHILDREN.
and some degree of spasmodic affection, being repeated at longer periods
and with greater exertions, until at last it ceases entirely.
   Prognosis.—Croup must be considered as a very dangerous disease, and
one which  sometimes will destroy the child  quickly by suffocation, and is
induced  either by spasm affecting the glottis, or by a quantity of matter
blocking up the bronchia); but when it terminates in  health, it is by a
resolution  of the inflammation, by a cessation of the spasms, by a relief
to  the dyspnoea, the voice becoming natural, with  a  copious  and  free
expectoration of the plastic matter  exuding from  the  trachea, or of the
membrane formed  thereon.  The unfavorable symptoms are, considerable
difficulty of breathing, great anxiety, violent fever, no  expectoration, the
voice becoming more shrill.
   Croup sometimes terminates rapidly within twenty-four  hours after its
attack ; but more  usually, when it  proves  fatal, it  runs to the  fourth or
fifth day: and where portions of the false membrane, which is  formed on
the surface of the trachea, are thrown off, life is sometimes protracted for
a day or two longer.
   Post-mortem examinations of children who have  died of croup, exhibit
a preternatural membrane of considerable tenacity lining the whole inter-
nal surface of the trachea, which may always be  easily separated from the
proper membrane, and which, in many instances, extends well downwards.
There is also found a great deal  of mucus, with a mixture of pus,  in the
trachea and its ramifications.
   Treatment.—From  these  appearances and the  symptoms, there can be
little doubt but that it is an inflammatory affection of  the mucous mem-
brane  of the  trachea,  larynx, and other  parts immediately  connected
therewith,  attended by  a spasmodic  contraction  of  the  muscles  in conse-
quence thereof; the treatment ought to be managed accordingly.  In the
incipient stage, our efforts should  be  directed  to lessen the increased
action of the heart and  arteries, thereby controlling the increased action
which prevails all over the mucous membrane of the throat, and therefore
arterial sedatives, such  as aconite, veratrum, digitalis, lobelia with coun-
ter-irritation, and warm baths should be promptly resorted to.   As quickly
as possible reduce the pulse to  70, and  thereby prevent exudation.   This
point should never  be  neglected,  and it should be accomplished with
promptness and decision, with aconite, veratrum, lobelia, and the warm or
vapor bath.  Having commenced  this treatment, an  emetic of the C. tinct.
lobelia, or the C. acetated tinct. of  bloodroot should be  given in  doses
sufficient to get a thorough action, to produce sufficient vomiting, by which
a considerable quantity of ropy mucus will be brought off, to the great relief
of the little sufferer;  and so powerful is the effect of  this remedy, that it
sometimes  removes the disease without having recourse to any other
means.   Besides unloading the chest, this remedy will also  produce a
diaphoretic effect.   If the first emetic does not relieve the cough and diffi-
culty of breathing, it ought to  be repeated.  As soon  as possible  after
the operation of the emetic, the throat, neck and chest should be bathed
with a liniment composed of the oil of lobelia and stillingia in alcohol or
a hot fomentation  of  stramonium and lobelia, or capsicum and  vinegar •
the sooner some of these are laid on after the invasion of the disease  the
greater will be the chance of its proving serviceable.
  Throughout the  whole course of the disease,  active  medication  is
demanded: active secretions, leptandrin  and irisin  are  obviously proper 
QUINSY.                            41
enemas. ^
 and their activity hastened by adding jalapin and administering *
 10 assist expectoration and promote a determination to the surface of the
 body, small doses of the wine of lobelia may be given in such doses as to
 excite nausea   To increase the effect  of this remedy, the warm bath  of
 yu  or 100  Fahr., or vapor bath may be  used, the feet  and legs might
 occasionly  be  immersed in jnustard  and  water, the  alkaline sponging
 might be resorted to, and a bandage saturated with mustard and flour, two
 parts of the former to one of the latter, made of the consistency of cream,
 and kept applied from the extremities to the knee.
   In the progress of  the disease, there is always a lodgment of  lymph
 or mucus m the trachea, and it is therefore advisable  to  excite vomiting
 once or twice daily, in order that the effused  fluid, or false  membrane,
 may be brought off.  Much benefit will  be derived from inhaling the
 vapor arising from water or vinegar in which hops have been boiled; and
 the  benefit  is no doubt owing to the fact that the vapor exerts a softening
 influence on the false membrane, which is soluble in vinegar, being changed
 into a different  mass,  thereby lessening the violence of the  spasms, and
 assisting expectoration   If the case  is very  obstinate, and  there are
 morbid accumulations  in the bowels, active purgation may be  necessary;
 the  good effect of this  depends on its operating quickly and powerfully
 on the  circulating  fluids, thereby arresting the rapidity of the inflamma-
 tory symptoms.
   During the day, when  there is a remission of symptoms, the C. tinct. of
 lobelia, or bloodroot, shall be given in small expectorant doses, alternated
 with small  doses of a combination of quinine,  belladonna  and gelsemin,
 and as soon  as the patient is over the critical point,  the  pyrophosphate  of
 iron should  be  given perseveringly until  the  plasticity of the blood  is
 overcome.    After having subdued the inflammatory symptoms, a slight
 form of spasmodic croup may remain, which is usually  relieved by small
 doses of belladonna, or musk, or extract of Indian hemp,  or what is very
 excellent is small doses, of gelsemin and chlorate of potash.  This has a
 salutary effect.  If, at  any time, there is  great difficulty of breathing,
 with a wheezing rattling sound, the emetic should be frequently repeated,
 and the room in which the patient is placed should be kept warm ; that the
 mucous membrane of the throat should not be irritated  by respiring cold
 air, it should be warm and moist.  The treatment of croup is  somewhat
 limited.  We believe that no remedies in the materia medica are so valuable
 &i the acetous tinctures of lobelia  and sanguinaria, controlling the circu-
 lation effectually with  the arterial sedatives.   With these remedies and
 proper  auxiliary treatment, a recovery in almost all cases  is certain, even
 where an extravasation of coagulable lymph within the trachea and bron-
 chial tubes  has  taken place.
                               QUINSY.

   This is an inflammation of the tonsils specially; but the uvula, the soft
palate, the pharynx and  not unfrequently the salivary glands are  impli-
cated.   The disease manifests itself by difficulty in swallowing, and  a
sense of heat and discomfort in the  throat, often  amounting  to considerable
pain.  On  examination,  the throat at first exhibits unnatural redness,
with enlargement  of one or  both  tonsils.   The  uvula is  enlarged  and
elongated;  its end  dropping down  into the  pharynx, and by exciting the
sensation of a foreign body, giving rise to much irritation, or else adhe- 
42
DISEASES  OF CHILDREN.
 ring to one of the tonsils.   The tongue is usually furred, and the pulse
 rapid, and there are the ordinary symptoms of febrile disturbance.   The
 inflammation either terminates in resolution, or suppuration ; in the former,
 if the attack is not severe and yields to treatment, in the latter,  if slight
 rigors are detected with increased softness of the enlarged  tonsil.   The
 matter which is discharged  has a very fetid smell, and the fetor is often
 the first indication of the rupture.  The pain almost entirely ceases with
 the discharge of matter, and the recovery is  very rapid.  The disease  is
 usually at its height in about a week  after the manifestations of  the  first
 symptoms, and it  almost invariably terminates favorably.  The  ordinary
 exciting cause is exposure to cold, especially when the  body is warm and
 is perspiring, and  in persons of a scrofulous diathesis the slightest degree
 of exposure is sure to induce it.
   Treatment.—The  disease may frequently be cut  short, if at  its com-
 mencement an emetic of the C. powder of lobelia be given, following this
 with an active  cathartic of  podophyllin  and jalapin.   It would also be
judicious  to confine  the patient  to  the house, and keep him on  bland
 diet.   A  stimulating liniment, composed of camphor,  extract of phyto-
 lacin  and glycerine, should be applied to the outside of the  throat,  and
 the patient should  be  warmly  covered up.  In mild cases, the  above
 described treatment  I have  found  useful in aborting  it.  But  in more
 severe or  aggravated cases,  the treatment will be somewhat varied for the
 purpose of relaxing  the parts, capsicum  and vinegar  might  be  applied;
 or ammonia,  with  oil  of sassafras, cloves and hemlock; or a fomentation
 of equal  parts  of hops, mullein and  lobelia; or an inhalation of bitter
 herbs ; the warm foot  bath, or  the application of mustard from the
 extremities to the  knee.  The body should be sponged three or four times
 daily  with the alkaline  wash, any undue excitement  of  the circulation by
 aconite, gelsemin and asclepin and  some anodyne sufficient  to  give  the
 patient sleep.  The  vapor of vinegar might be inhaled from some  suit-
 able apparatus.    A  gargle  of chlorate  of potassa,  or  where we  desire
 more active remedies, capsicum, salt and vinegar.   Should it be  tardy  in
 progressing to a termination, and well-marked symptoms of suppuration
 be present, as known by the soft, pliable fluctuation of the  tonsil, much
 suffering  may be prevented, and any  tendency to suffocation obviated, by
 puncturing the parts.   After evacuation, some stimulating and astringent
 gargle composed of  hydrastin, hamamelin, geranin,  &c.  Relapses must
 be guarded against by avoiding  exposures to cold and  damp, protecting
 the body with flannel, sponging the throat and chest with salt water; by
 resorting  to a bland nutritious diet, and a judicious use of alteratives and
 tonics.

                        PAROTITIS, OR  MUMPS.

   This disease chiefly affects children, is often epidemic, and manifestly
 contagious.  It  is distinguished by  an  external  movable swelling  that
 arises commonly on  both sides of the neck, but in  most instances  it is
 confined to one.   These tumors occupy the maxillary and parotid glands ;
 are large, hard, and  somewhat painful:  and sometimes  they attain to  such
 a considerable  size,  as  greatly to impede  the  powers of respiration and
 deglutition.  These  swellings are usually preceded and accompanied  with
 a hot, dry skin, coated tongue, scanty secretions,  general pyrexia.   The
 swelling or enlargement of the gland usually increases until the  fourth 
                         OORYZA—CATARRH.                      *<>

day;  but from that period it declines, and in a few days goes off entirely,
and then the febrile symptoms also subside.   On the disappearance of the
swelling of the parotid, it not unfrequently happens  that  the  disease is
transferred from the glands  of the neck to the breast in the female, and
to the testicle of the male, but this quickly disappears in a few days.  In
a few rare cases, where the  inflammation has been excessive, suppuration
has taken place in the  cellular tissue, and occasioned great deformity, or
by bursting  inwardly  and  discharging its  contents into  the larynx, has
suffocated the patient.
  There is seldom much danger from this disease, except where we have
symptoms of congestion of the brain, or its  membranes  arise.
  The mumps do not require much treatment; if there  is much fever
in the  active stage,  it must be  promptly  controlled by the  use  of
arterial sedatives.  Aconite is specially indicated, sponging the  surface
three times daily with the alkaline wash, open the bowels with the neutra-
lizing mixture  and euonymin, and if a metastasis is threatened, apply a
stimulating liniment of capsicum  and vinegar, or the muriate of ammonia
in solution over the glands.   The case being mild, merely bathing the feet
and taking some diaphoretic  tea, as catnip, may be sufficient.  The C. tinct.
of serpentaria is a valuable agent  in  sufficient  doses  in  treatment.   A
fomentation of stramonium is very valuable.

                               CORYZA.

  This  is a simple, sub-acute inflammation  of the  mucous membrane  of
the nares, the result  of cold.   It  usually  begins with a stuffing  in  the
head, with dull, heavy aching pain, a feeling of debility and fever. In  a
day or two there is a secretion from the  nose ;  the secretions are arrested,
there being usually a dry skin, constipation, scanty urine.
  Treatment.—If the tongue is coated, give  an emetic ;  restore the secre-
tions, give  podophyllin  and colocynthin  and ah  alcoholic  vapor bath.
The  most efficient remedies, aside  from  these  measures, are  the warm
pediluvium and a full  dose  of the essential  tinctures of gelseminum and
asclepias.

                              CATARRH.

  A catarrh consists in an increased excretion of mucus  from the lining
membrane of the  nose, throat  and bronchiae, accompanied with a slight
degree of fever and sometimes great constitutional disturbance.
  It attacks  persons of all  ages and constitutions, but  more particularly
children, and by preference  those of a  strumous  habit; and it may take
place at any time of  the year  when  there  are  sudden changes  of  the
weather.  In numerous  instances cold seems to be  the remote cause of
the disease ;  it sometimes prevails epidemically under the term of influenza.
The  proximate or immediate cause seems to be an increased secretion of
the mucous  membrane of the nose, fauces and bronchiae, in  consequence
of some degree of inflammation in those parts.
  Catarrh usually comes on with a dull aching pain, or sense  of  weight
in the forehead, redness of the eyes, a fullness and heat in the nostrils,
which symptoms  are  soon  followed  by a  discharge from these  parts, 
44
DISEASES  OF CHILDREN.
together with a sense of soreness  in  the  trachea,  hoarseness, frequent
sneezing, some difficulty of breathing, a dry cough, loss of appetite, gene-
ral lassitude over the whole body, and chilliness ;  towards evening, slight
febrile disturbance.
   In the progress of the affection, the cough is attended with ane«w-
tion  of mucus, which at  first is thin, white, and  expectorated with diffi-
culty ; but becoming gradually thicker, of a yellow  color, and is brought
up with greater  ease, and less coughing.
   In cases where the affection would not seem to be severe, it often occurs
that the evening  paroxysm  is  greatly increased; and from  restlessness
and repeated  coughing, the  patient is prevented  from sleeping till the
morning, at which time a crisis takes place for the better, and the patient
may remain tolerably well until the return of the  evening paroxysm.
   When the inflammatory condition subsides, secretion of mucus  ceases,
so that a cure almost invariably arises in this disease.   Catarrh is seldom
fatal,  except when it arises in old persons, or attacks those of a strumous
or tuberculous habit, or has  been much aggravated  by some fresh  appli-
cation  of cold, or by improper  treatment;  and it usually terminates in a
few days, if not neglected,  either  by  an increased expectoration, open
secretions, &c.  In some cases, however, it lays the  foundation of pulmo-
nary consumption, or gives a tendency to asthma, bronchitis, hydrothorax.
In other cases it becomes habitual, and is accompanied with great difficulty
of breathing,  particularly in changeable weather, and is  very apt to clog
up the air vesicles and create other serious inconveniences.
   The inner  membrane of the trachea usually appears, on dissection, in
fatal cases of catarrh, to  be much inflamed, its  cavity filled with a con-
siderable quantity of mucous fluid.  The same morbid condition is also
communicated to the bronchial tubes,  which seem loaded with  matter  of
a like character.
   Treatment.—In mild attacks  of catarrh, it  may not  be  necessary to
have recourse to any medical treatment.   In general it will  be sufficient
to confine the  patient to bed, make him use a little nursing, let him  drink
plentifully of  warm  diluent mucilaginous  liquids, acidulated with  lemon
juice,  open the secretions, more especially the skin; but in violent attacks,
where  there  is  great difficulty of breathing, much febrile disposition, a
full frequent  pulse,  it is proper to administer  arterial  sedatives, in  pro-
portion to the violence of  the  symptoms, age of the patient; aconite and
asclepin.  If  the difficulty of breathing and oppression of the  chest are
not relieved, give  gelsemin and resort to counter-irritation;.  brush on the
cantharidal collodion, then sprinkle on podophyllum  or veratrin.  To pro-
mote expectoration, to give the blood a determination to the  surface, give
small doses of the C. powder of lobelia, and assist its action with an infu-
sion of  capsicum.  Lobelia in catarrh is a powerful  diaphoretic, its action
may be aided with the exhibition of a saline cathartic.   The secretion of
mucus in the lungs and  fauces may be aided by  the admiuistraiion of
senega, sanguinarin,  eupatorium  perfoliatum, <S:c.;  the inhalation  of
medicated vapor by  an appropriate apparatus.
   When the cough is troublesome, and there is a great soreness and raw-
ness in  the fauces, demulcents  may be used with advantage, and after the
active  inflammatory  symptoms  have abated, opiates  will afford relief, and
may with propriety be combined with  the other remedies.  The hyoscia-
min, combined with  the C. tincture of serpentaria will give the patient 
INFLUENZA—OZ^NA.
45
rest at night.   If constipation  prevails,  leptandrin and  juglandin  will
meet the indication.
  It the mucous membrane of the nose is much affected, it might be
smeared, from time to time, with glycerine.  The diet should be cooling,
hygiene should be thorough.
  Such is the treatment resorted to in the  first stage of this disease:  but
it often happens, that after the inflammatory symptoms  have subsided, a
weakness  remains, and there is  an increased  secretion from the  lungs,
which  perhaps  continues for many months.  In  such  cases  the  patient
should* be careful to avoid all fresh exposures to cold, and he should be
warmly and comfortably clad.   If the disease has run on for any  length
of time, and has become chronic, much benefit will be derived by the use
of the warm bath,  more particularly the vapor bath, as by the latter we
have the means of introducing within the  chest, soothing  or  stimulating
vapors, which act on the seat of the disease.  The irritating plaster  over
the region  of the  chest, keeping up constant  irritation tends much to
relieve the  difficulty, and by a  judicious  use of absorbents  and  expec-
torants, to  wit:  lobelia and bromide of potassium  and remedies of  that
class, we not only mitigate the cough, but  remove all consequences of the
disease.   When the secretion from the chest is greatly lessened,  and
debility remains, we should alternate the warm with the cold bath,  give
tonics, such as  iodide of iron, bark, phosphorus, hydrastin, &c.
                              INFLUENZA.

  This affection sometimes  prevails as  an epidemic,  sometimes prevails
idiopathically.    It is generally preceded  by chilliness, shiverings  suc-
ceeded by heat, pains in the head, a discharge from the eyes and nostrils,
severe sneezing, hoarseness, cough.  In  a few hours the headache becomes
intense, as well as the heat, the pulse quick and small, the breathing  diffi-
cult and oppressed, darting  pains in the chest.  Some patients complain
of pains in  the shoulders and limbs.   The  tongue is white;  the thirst is
considerable ; the bowels constipated ; the urine highly colored, and  very
frequently there is a nausea.
  If no treatment is  sought after, about the second or third night the
cough  becomes aggravated, almost incessant, with an expectoration  of thin
mucus.  The fever becomes more severe, being attended with restlessness,
pungent heat, great confusion  in the head  and wanderings.
  Treatment.—In the treatment of influenza or catarrh, the first thing is
to equalize  the circulation, diaphoretics are very useful, an alcoholic vapor
bath  the  feet  in hot mustard and water:  if there are indications  of a
deranged  stomach, a stimulating  emetic.   The  C. tinct. serpentaria in
alternation  with the eupatorium perfoliatum are two of the best remedies
we  possess.   In  some cases, aconite with asclepias  and the ordinary lye
bath are sometimes sufficient.
  As soon as the disease has subsided, and to counteract the languor and
debility which  is an  invariable attendant, during convalescence, have
recourse to  tonics,  such as a decoction of hydrastis, or cinchona, with the
mineral acids, or the  bitter tonics, as gentian, columbo, &o.

                                OZiENA.

  This is  a chronic fetid discharge from the nares, the result of catarrh
or some diathesis as scrofula.  It affects various parts of the cavity of the 
46                     DISEASES OF CHILDREN.
nose, sometimes extending to the frontal sinus, and even to the ethmoidal
and  sphenoidal cells.  It is  confined  in some  cases to  a small surface,
which is ulcerated, and sometimes the bone beneath is diseased.   In this
affection the patient complains of uneasy sensations, with frequent stuffing
up of the nose, nasal voice, constant offensive discharge.   If deep seated,
we have pain in the head, and  excessive fetid discharge.
  Treatment.—For the correct treatment of ozaena, constitutional treat-
ment is of primary importance.   The C. syr.  stillingia, with iodide  of
potassium,  or the mineral acids and bark.  Local medication is of utility,
first commencing with injections of warm water, then following with-injec-
tions of permanganate of potash, or the chlorate of lime, sesqui-carbonate
of potassa, dilute pyroligneous acid, &c.; inhalation of the vapor of crea-
sote, myrrh, balsam tolu  or  Peru.  If  the bones  are  affected,  a good
application  consists of the  sesqui-carbonate  of potassa  and sulphate  of
zinc.  If it seems to depend on scrofula, then  the vegetable alteratives,
cod liver oil, brandy, iron, good diet, &c.
                            PHARYNGITIS.
  In this disease the patient  complains of a frequent sense of  stuffing  in
the back and upper parts of the throat, which gives rise to a hawking and
spitting  of a considerable amount of  mucus.  Occasionally there is mani-
fested a tendency  to cough, which, if the disease lasts long  enough, may
extend to the larynx.  On examination, we perceive the mucous membrane
thickened,  or relaxed and flabby, with the mucous follicles enlarged, and
the color changed from a smooth pink to a dusky red  or bluish appearance.
  Treatment.—We treat this  affection by attending to the secretions, the
liver, intestines, kidneys and skin.  Then following with gargles of muriate
of hydrastin and tincture of myrrh, or tincture of capsicum, rhusin, tannic
acid  and hamamelin, or a decoction  of^oak bark.    If a stimulant, the
sesqui-carbonate of potash, in solution, is the best, applied by means of a
pro  ang.
                              TONSILLITIS.
  The tonsils  in the scrofulous are very apt to take  on inflammation, and
there is a strong predisposition to  return by almost  any change of tempe-
rature.   This  affection  usually manifests itself by stiffness of the throat,
difficulty of deglutition, derangement of the digestive  functions, consider-
able fever.
  Treatment.—The general condition of the patient should be attended to,
the circulation  controlled by aconite and gelsemin, the bowels acted on by
podophyllin and leptandrin, the skin and kidneys by eupatorium and ascle-
pin.   At the same time inhalation would be beneficial, the vapor of vinegar,
or of nitrate of potassa.  The local  application  of  the  con. tindture  of
veratrum to the inflamed part is perhaps the most efficient agent we possess.
In cases that  have suffered from a recurrence, stimulating and astringent
gargles are the best, such as capsicum and myricin, the persulphate of iron,
myrrh and  hydrastin, and locally the application of capsicum and vinegar
to the throat.                                               •
                              LARYNGITIS.
  Laryngitis is not, generally speaking, a common disease, although it  is
very frequently met with among public speakers, or children who  have  to
use their voice freely.  It is almost, however, peculiar to adults ; cold  wet
sudden  exertions  of the voice are exciting  causes.   The symptoms are 
LARYNGITIS.                           47
 usually plain: fever, harsh cough, pain in the throat, difficulty of breathing
 voLV   8wJll0wl°g> great anxiety,  hoarseness, or even  complete loss  of
   ice, and frequent spasmodic exacerbation of these symptoms, causing the
 most distressing  paroxysms  of  threatened  suffocation.   The* inspirations
 are long, and  attended with  a peculiar wheezing  sound,  as if the air were
 drawn  through a reed.   The face is flushed, the eyes protruded, the lips
 swollep, the pulse hard,  and unless relief be afforded promptly the disease
 gets worse  and worse.   The larynx and trachea move with great rapidity
 upwards  and  downwards, and all  the  muscles of respiration are brought
 into action, so that the chest heaves violently, and unless relief be prompt,
  l  g.GiVS VGry  lmminent-   If remedies  fail  to  give relief, tracheotomy
 should be resorted to.
   (Edema of the glottis may arise from other causes besides inflammation,
 and produce the same effects as laryngit s.   It is often due to boiling water,
 the  strong mineral acids, or alkalies taken into the mouth.   The poison  of
 erysipelas may give rise to it.  The larynx may suffer from chronic disease.
 Chronic  inflammation is not  uncommon in  consumption.   The  membrane
 lining the laryngeal cartilages often becomes thickened  and ulcerated  in
 secondary syphilis.   Polypi and warty growths may also arise from different
 parts of this tube, and cause great impediment to the entrance and exit  of
 air.
   Treatment.—The treatment of laryngitis is very simple.   We must have
 thorough secretion and excretion by the usual means, never omitting the
 alcoholic vapor bath daily and hydragogue  cathartic.  For  special  treat-
 ment the C. powder of lobelia, given so as to keep up continuous  nausea;
 general  relaxation is desirable, and if this does not  afford relief, give  it
 sufficiently often  to produce emesis.  For  the purpose  of reducing the ■
 inflammation, and  keeping up relaxation of the  larynx, we would apply
 externally cloths, frequently changed, saturated with the  oils of lobelia,
 stillingia  and capsicum diluted with alcohol.
   Counter- rritation is of great  utility;  dry  cups to the throat,  spine,
 and the back, loins, hips, and the extremities thoroughly rubbed with oil  of
 capsicum  diluted with alcohol.  Inhalation is of the utmost importance.
 Keep on a table opposite  the patient's mouth an inhaler, and let him inhale
 the vapor of vinegar, or  the vapor of water medicated  with belladonna,
 aconite, sanguinarin, myricin, lobelia, &c.
   In some cases, the disease is apt to assume a chronic form; when  this  is
 the case, the treatment must be varied, our remedies must be directed to a
 restoration of the general health, as well as the local disease.  Still special
 attention should be paid to the excretions ; the skin stimulated by the use
 of appropriate  baths; the kidneys by  some  alkaline diuretic;  and  the
 bowels by laxatives.  Cinchona with iron, the hypophosphates, and for the
 relief of  the troublesome  cough the bronchitis drops, or indian hemp  and
 byosciamus.
  Local medication is of much advantage, most any soluble remedy can be
 thus used by inhalation, and  let the patient breathe it direct.   If there is a
great deal of  irritation and  dryness, water  can be made  the  vehicle, and
 lobelia, narcotics and sedatives  to relieve the cough, should be the agents,
 for inhalation.   For  example, such a mode of prosedure as  follows can be
adopted with great advantage :  if we  have little  irritation, the.  vapor of
water may be used, or vinegar, or alcohol  diluted; if we want a tonic,  a
decoction of cinchona, hydrastis, tincture humulus, populus, gold  thread; 
48                     DISEA8ES OF CHILDREN.

if an astringent is demanded, tannic acid, persulphate  of  iron : as  stimu-
lants, sanguinarin, podophyllin, xanthoxylin, myrrh, balsam of Peru, crea-
sote, iodine, and  so on  with other remedies.  Counter-irritation  must  be
active to the sides of  the pharynx, back of the neck.  A course of altera-
tives and  tonics is  attended with  good  results.  Perfect  rest is of the
greatest  importance, and  it is here that we have the greatest difficulty to
contend with in  treatment,  Speaking and singing should  be entirely pro-
hibited, and the larynx  used as little in conversation as possible.  Food of
a bland and nourishing  charac er, milk punch, beef essence, and everything
calculated  to prevent depression.
  The use  of the  nitrate  of silver cannot be too emphatically condemned.
There are more  destruction, more confirmed cases of permanent ulceration,
and  confirmed incurable sore throat and  permanent deafness  result from
the  use  of this agent, as a medicine,  than from  the  use of any  other
remedy.    The treatment of inflammatory sore throat  is  nearly  identical
with the above.
                        PUTRID SORE  THROAT.
  This is to be distinguished from the inflammatory by the soreness and
white specks or aphthal covering ulcers which appear  in the fauces, together
with great  debility of the system, a small fluttering pulse, and it may  be
an erythematous  condition of the skin; whereas in the inflammatory there
is always  great difficulty of breathing, a considerable  degree of  swelling,
with a tendency in the  parts affected  to  suppurate, and a hard full pulse.
In,the one  the  inflammation is seated principally in  the mucous membrane
of the mouth and  throat,  and the type is asthenic or typhoid ; whereas  in
the other, it chiefly occupies the glandular parts, and  the  fever is  of  the
inflammatory type.
  The putrid sore throat often  arises from a peculiar  or  humid state of
the  atmosphere, prevailing as an epidemic, attacking chiefly the  weak,  or
the  debilitated and children, common in the spring and fall    It is produced
by contagion, it would seem to run in famili  s, in infants it is  often  fatil.
In some instances, the symptoms of scarlatina and diphtheria are so blended
together that it is  difficult to say of which disease they  partake most; in a
practical point of  view, this is of little importance as the treatment  is the
same.
  Some authorities consider scarlatina, diphtheria and cynanche as essen-  •
tially distinct; but my experience  induces  me to  believe  that  they  are
merely modifications of  the  same disease ; for I have frequently noticed  it
under all its different forms in  the  same epidemic,  and even in  the same
family from the same contagion.
  Symptoms.—Putrid sore  throat is usually ushered in with cold shiver-
ings, anxiety,  nausea,  vomiting, succeeded  by heat,  restlessness,  thirst,
debility, and oppression at the  chest, the  face is flushed, the eyes  suffused,
stiffness in the neck, hurried respiration,  hoarseness of  voice and  soreness
in the throat;  and upon  examining the  internal  fauces,  there appears a
fiery redness in every part.
  The inflammation  after a while  takes  on a  peculiar termination •  for
upon further inspection of  the  throat,  a number  of  sloughs of a  shade
between  a  light ash  color and  a dark brown are observed  to be on  the
throat and  its appendages:  the  breath is intensely offensive; the tongue
is heav-ly coated  with a brown  fur 5 the  inside .of the  lips is covered with
vesicles,  sordes are on the teeth,  acrid matter comes from the mouth  which 
PUTRID SORE THROAT.
49
occasions excoriations; with these symptoms there is also a coryza, which
pours out a thin acrid matter, excoriating the nostrils.   A diarrhoea often
occurs, especially in infants, and a thin  acrid matter flows from  the  anus,
excoriating this and the adjacent parts.
  From the first  attack there is fever, with a small, frequent, irregular
pulse, an  exacerbation  every  evening,  remission towards  morning,  with
great  loss of strength  and debility.  In some cases the brain is affected,
and we have low muttering delirium, coma, &c.
  About the third day, large  patches  of a  dark  red  color make their
appearance about  the face  and neck, which, by degrees, become dispersed
over the body, even to the extremities  of  the fingers, which feel stiff and
swollen.                                                    -
  The  inflammation, as in  the simple form, sometimes spreads along the
Eustachian tube to the inner ear, occasioning ulceration,  wholly  destroying
its structure, and causing incurable deafness.   In other cases it extends to
the parotid, maxillary, and  other glands of the mouth and throat,  which
become  painful and swollen ;  indeed,  the whole neck sometimes swells, and
assumes a dark red color.
  As the sloughs spread, they generally become of a dark purple color, the
interstices being even darker;  new specks arise, and the  whole internal
fauces are at length covered with thick sloughs, which, when  they fall off,
reveal ulcers  deeply seated.  In severe cases, where  no  medication  has
been  resorted  to, or even  worse, where  that accursed drug, mercury, has
been  administered, we  may have the  fauces  becoming black, the sloughs
corroding deeper and deeper, spreading rapidly and assuming a gangrenous
form, symptoms of irritation  supervening, together  with a diarrhoea and
other indications of decline.
  Prognosis.—If there is a great increase of the evening paroxysm of fever,
with debility, great depression and irregularity of the pulse, early delirium,
coma, vomiting, diarrhoea, or subsultus  tendinum, and these  are accom-
panied with great  swelling of the  throat,  dark-colored  spreading  ulcers,
with  great fetor of the breath,  the prognosis is unfavorable;  but  where
the pulse becomes  more  moderate  and  stronger, the respiration free, the
skin soft and moist, the florid color returning to the fauces, the discharge
less acrimonious, our prognosis is more favorable.  In slight attacks, where
the  fever is of a less putrid nature, the symptoms more moderate, we need
not  apprehend danger.
  Malignant sore throat generally arrives at  its height  about  the fifth or
sixth«day, and in favorable cases  declines in five or six days; as a general
rule, it runs its course more slowly in adults  than in children.   The mild-
ness or  absence  of sore throat in scarlatina  always denotes a favorable
prognosis, and  the  presence of an  eruption,  in  the  shape  of blotches  or
small points, scattered over the  extremities and trunk, of a red, florid, or
a dark purplish hue, affords an unfavorable prognosis.
  Pathology.—From dissections, it would  appear   that the  fauces are
inflamed, suppurated and gangrenous, and that  the trachea and larynx are
likewise in  a  state  of  inflammation, and lined with  a viscid fetid matter.
In numerous  instances, the inflammatory affection  extends to  the  lungs
themselves.  Enormous enlargement  of  the lymphatic glands about the
neck  occasioned by an  absorption of  the acrid  matter poured  out in the
fauces, are now and then to  be found.   We have a state  of  things post-
mortem, analogous  to what  we have in typhus fever.
       4 
50
DISEASES OF CHILDREN.
   Treatment.—As this affection differs essentially from the simple form, its
 treatment is  altogether  different.  Wre  must  abstain from all depleting
 measures, as  they invariably prove  injurious by increasing  the  irritability
 and debility,  which  is  usually extremely great.  The greatest  precaution
 should be used with respect to the  employment of  active purgation.   The
 regular expulsion of the feces must  be promoted by mild  enemas, and even
 these should  only be  had recourse  to  if nature  is insufficient.  Active
 purgation is never admissible, and even where a mild aperient is  demanded,
 one composed of juglandin and leptandrin is the best.
   At the commencement  of all cases an emetic of the C. tincture of lobelia
 is indicated, and even its repetition  is  very  advantageous.  It never fails to
 bring away^i  considerable quantity  of acrid matter, which, by getting into
 the bowels, might induce diarrhoea ; a complication to be avoided by every
 possible  means, as  always adding to  debility and  endangering  the life of
 the patient.   In the early stages an emetic will sometimes cut it short, and
 even  if it does  not, will  break or  mitigate its severity.  At an advanced
 period of the  disease it is often advantageous.
   The grand object to be kept in view in this malignant disease,  is to check
 or counteract  its septic tendency, to wash  off from time to time the acrid
 matter from the fauces, and to overcome debility.   For this purpose capsi-
 cum is  invaluable ;  an infusion of  two  tablespoonsful, with  a teaspoonful
 of salt, a little  vinegar, added to a half a pint of boiling water.  After
 infusing for two hours,  strain through a cloth, and  give two tablespoonsful
 every half hour.   The  speedy and good effect produced by the use of this,
 in every case, points out its utility.  To assist  the  effect  of the above, it
 will be highly advisable to give bark,  sulphate of chinonine in large doses,
 and chlorate of potassae.  Packing  the  throat with cold water, where  the
 case is very active, or painting with equal  parts  of tincture of  iodine  and
 belladonna, is very beneficial.   In children, salicin and baptisin is an excel-
 lent formula, &c.  The mineral acids, more especially nitro-muriatic acid,
 with bark or hydrastis,  are to be  recommended.
   To check the putrid tendency in the parts, as well as to remove the acrid
 matter which  is secreted, it is necessary to wash out the fauces with some
 gargle, as muriate of hydrastis and honey, or a solution of permanganate
 of potash.  After gargling, I have found  it good  practice to  inhale  the
 vapor of pyroligneous acid, or permanganate of potash, or some antiseptic
 agent, by means of an inhaler, which  can  be placed in any position for the
 purpose.
   There can be  no  doubt that the  greater fatality  among children in  this
 disease is to be attributed solely  to  their  swallowing the morbid secretion
 from the  throat.   This no doubt  causes vomiting, griping pains,  purging of
 the worse description, causing  the disease  to  spread along the  alimentary
 canal.   This is sometimes prevented by swabbing the throat with the reme-
 dies'best calculated to promote their healing.
   The circulation must be equalized, the skin must be stimulated, alkaline
 sponging, with aconite and pulsatilla, are the remedies.
   Should a diarrhoea arise in the progress of the disease, immediate recourse
 must be had to opium, gelsemin and myricin, or the fluid extract, cranesbill
 and gelsemin, and stimulants  should  be  given.   The local application of
eapsicum  ancfvinegar to the throat is excellent.   If we have suppression of
 urine, the necessity of pushing, as far  as  possible, the invigorating plan of
 treatment is strongly indicated.   Emollient fomentations over the bladder 
HOOPING-COUGH.
51
are the most advisable means of removing this affection, but if the suppres-
sion continues obstinate, the introduction of the catheter may be necessary.
  In the later stages of this complaint, hemorrhage from the nose, mouth
and ears may occur, and it should be arrested by the perchloride of  iron in
solution, locally arid internally.
  Through  the whole course of the disease, the patient must be supported
by  beet  essence, liquid  nourishment, arrow-root, rice,  milk  punch.  Of
course the quantity of the latter  must  be  in  proportion to the age, the
violence of the febrile symptoms, the tendency to putrescency.  The apart-
ment  should be well ventilated and  of a proper  temperature, bromine or
chlorine should be exposed in the chamber.   The greatest degree of cleanli-
ness is essential.
                           HOOPING-COUGH.
  Hooping-cough is an infectious  disease, rarely occurring more than once
in a life-time ;  manifested by a convulsive cough, interrupted by a full and
sonorous inspiration,  and returning  in fits that are usually terminated by
a vomiting or expectoration, attended by a slight fever,  and that peculiar
cough returning at intervals.   Its duration varies from six to eight weeks.
It is  a disease peculiar  to children.  It is  undoubtedly a disease of the
nervous  system ;  the parts  implicated  being  the pneumo-gastric nerve
and medulla oblongata at its origin.  Like  all other contagious diseases,
it runs a very regular course, and gives immunity against a subsequent
attack.
  Hooping-cough'often prevails epidemically, but does not in this respect
appear to be influenced by any particular season of  the year.   It is much
milder in warm climates than  in cold ones; and it would seem, in con-
formity to  this  law, that the disease  is found to be more severe in  this
country during  autumn and winter than during  spring  and summer.  It
arises generally from contagion, it is  true :  still it must be allowed that
there is  a principle  independent  of  contagion, capable  of producing the
complaint, and that this  principle undoubtedly exists in the atmosphere,
which  it pervades to a certain extent; but what it is, and how formed,
remains  a  subject for physical research.   Usually it is contracted only
when children  are brought into immediate proximity, that the breath or
the exhalations of the diseased is inhaled.  This, however, is not always
the case, as many take it when at a  considerable distance.
  Symptoms.—Hooping-cough, depending upon some poison affecting and
irritating the pneumo-gastric or vagus nerve, exhibits  itself in its inci-
pient stage by a slight febrile  stage of from eight to twenty days, which
is sometimes accompanied, but generally followed, by  violent paroxysms
of coughing.   The little patient is seldom confined to bed, but is restless
from the coryza, oppression of the chest, and  heat  of the skin.   As the
fever abates, the cough assumes its peculiar shrill sound or hoop.   Before
a paroxysm comes on the child instinctively has a sort  of a precognition
of an attack, and runs to its mother for protection.   The series of coughs
or expiratory efforts are so powerful, and expel the air so violently and so
largely from the lungs, that the patient seems  on the point of suffocation,
until a long, protracted inspiratory act follows ;  the rush  of air through the
contracted glottis causing the characteristic crowing or hoop.  As soon as
it is over the child regains his courage, soon appears well, returns to his
play; while  even if it end in an attack of  vomiting, the patient  almost
immediately wants something to  eat.   The frequency of the paroxysms 
52                     DISEASES OF  CHILDREN.

varies very much ; there may be one, two, or three daily, or as many in
an hour.                                                   .
  The duration of the affection is extremely variable ; some being suscep-
tible of cure in  two or three  weeks,  whilst others, with the very  best of
treatment, continue troublesome for months.  It is more obstinate in the
fall and winter than at any other time.
  Complication.—Although the hooping-cough often  proves tedious, and
is liable  to  be aggravated by fresh  cold when not entirely removed, it
nevertheless seldom proves fatal, except to very young  children, who are
likely to  suffer more from it  than those  of a more advanced age.  1 he
danger is in proportion  to the youth of the person, the degree  of fever,
the difficulty of breathing, as also the state of debility which prevails.
  Cases sometimes terminate in apoplexy and suffocation.  It sometimes
coexists or  is complicated with  asthma, bronchitis, pneumonia, disordered
bowels, consumption.   If the  fits end by vomiting, it may be regarded as
a favorable symptom ; so also is a moderately free expectoration,  not being
so apt to cause pneumonia.   An airless condition  of a part of the  lung is
often found  to arise in certain  cases.   It has been designated by various
terms : pulmonary collapse or marginal pneumonia.   The margins of the
lungs, and  the vesicles  most distant from the roots, are the parts which
are  likely to undergo  this change.  It is not at all fatal unless erroneously
treated by depressing agents.   The poison of hooping-cough may  coexist
with other poisons ; as with small-pox, measles.
  Diugnosis.—It is easily recognized by the character of the cough, its
long continuance, and the peculiar hoop, &c. &c.
  Treatment.—In the treatment of hooping-cough, we  are in-its first or
primary stage  to moderate its violence, palliate the urgent symptoms, and
at a more advanced period to arrest its  progress, and put a stop to  it by
suitable remedies, sooner perhaps than it would spontaneously have ceased;
and above all things to  keep it simple—to prevent other  affections  com-
plicating it.   Numerous plans of treatment have been recommended for
this affection, but most of them of an empirical character.  All, however,
agree on the value of emetics;  by all practitioners  they  are found the
most useful in hooping-cough, and they should never be neglected.  The
wine of epec. forms a pleasant agent, and  as it does not depress, seems
to   answer  well;  it affords marked  relief,  and in bad cases it may  be
repeated daily.   In mild cases  very  little management is required; the
patient should be warmly clothed, kept from the vicissitudes of weather,
fed with light nourishing diet, and allowed to drink freely of some nourish-
ing drink.   A very excellent one consists in dropping about eight of ten
drops of strong  muriatic acid into a  pint of cold water; cut into  small
pieces one  pound of lean meat, put into a hair sieve, have a vessel below
it,  and pour on  the  pint of acidulated  water; continue the process of
repouring say over half dozen times.  Then we  l^ave a drink eminently
tonic and nourishing,  and one well calculated to do good in this affection.
  In all  cases I have found it of great utility to use brisk friction to the
spine every night and  morning, with either of the following liniments :
equal parts of chloroform, tinctures of  aconite,  belladonna, and  nucis
vomicae ; or equal parts of tincture belladonna and stramonium ; or apply
a belladonna plaster to  the spine.  I have also found a plaster to the  chest
of  some  advantage, or  rubbing it morning  and night with a  stimulating
liniment  composed  of equal  parts of the oils of lobelia, stillingia, and
alcohol. 
HOOPING-COUGH.
53
  Constipation usually prevails.   It will be necessary to have recourse to
gentle laxatives, such as the  neutralizing cordial, a teaspoonful with one
grain of leptandrin, and two  of  juglandin.   As  a  general thing, diet,
fruit may be given for this purpose.
  With regard to the more severe forms of the disease, the following pre-
scriptions will be found of value :
              R-—Tincture belladonna, gtt. xxx.;
                   Alum, gi.;
                   Syrup senega;
                   Syrup tolu, aa. |ii.—M.
              R.—Huxham's tinct. bark, §v.;
                   Tinct. lytta;
                   Tinct. camphor, aa. £ss.;
                   Tinct. belladonna, gtt. xxx.—M.
              R.—Dilute nitric acid, §iss.:
                   C.  tinct. cardamon, >>iii.;
                   Simple syrup,  ,^iiiss.:
                   "Water, %i.—M.
              R.—Extract conii, gr.  xv.;
                   Alum, gss.;
                   Ether sul., ^ii.;
                   Syr.  simplex, $iv.
  Whichever of the above is resorted to  should be given in teaspoonful
doses, say every two or three hours.
  The various  anti-spasmodics, such as  morphia, henbane, conium, bella-
donna, hydrocyanic acid, ether,  chloroform,  lobelia, sanguinarin,  &c.,
have all been used with  success.   Astringents  combined with these anti-
spasmodics may be used with great advantage :
              R.—Tannin, gr. iii.;
                   Ext.  belladonna, gr. i.:
                   Ext. cicutea, gr.,  iv.;
                   Inf.  senna, gii.;
                   Aq. toenicul,
                   Syr. althea, aa. ^i.—M.
  A teaspoonful every two hours.
  Cochineal  mixture,  clover-hay in infusion, coffee, and  numerous reme-
dies, have been put forth as specifics for this affection.
  For special treatment in bad cases, I  prefer the tincture of the black
cohosh, in  fifteen-drop doses, every four hours, in alternation with one,
two or three  drops of  tincture of  belladonna, according  to the age of the
child ; or combining the  black cohosh with two or more grains of the iodide
of ammonium.  For obviating the fatal tendency of the disease, and putting
it into a safe course, the above remedies can  be relied on.   The tincture
of digitalis, hyoscyamus, stramonium, have been used with seeming advan-
tage   Where there is  great  irritation of the  mucous membrane, I have
found  the oil of skunk-cabbage berries  in three-drops useful; or either
of the following, in suitable doses :
              R.—Muriate of hydrastin,  31.;
                   Cochineal, gr. xx.;
                   Syr. stillingia, 5'u.—M.
              g>.—Sulphate cinchonin ;
                   Muriate hydrastin, aa. 
54
DISEASES OF CHILDREN.
   This combination of cinchonine with the muriate of hydrastin, is excel-
 lent for children ;  being nearly tasteless, it is easily administered.  Where
 the secretion  from the bronchial tubes is excessive, it  can be checked by
 either of the above formulas better than  by such remedies as alum, sul-
 phate of zinc, the mineral acids, infusion of bark.  If the case becomes
 chronic, a cure may be effected with iron, or the elixir of cinchona and iron.
   Experience has taught us that a frequent change of  air is extremely
 serviceable in this disease, and such should never be omitted if attainable.
 Thorough hygiene should  be enforced;  daily bathing, or sponging  the
 surface;  flannel should be worn next the skin, as it promotes absorption,
 and prevents the vicissitudes of the climate taking that effect on the skin
 which is often an exciting cause of coughing.  The diet  should be bland,
 nourishing, and easy of  digestion.
   In sleep, elevate the head and shoulders, and let the patient be care-
 fully placed, that  when  the cough occurs  they may be held  up, so  as to
 stand on their feet, a little  forward.

                             BRONCHITIS.
   Inflammation  of the' bronchial tubes is  an extremely common affection.
 Bronchitis may be acute or chronic, one or both lungs  may be affected, or
 only a portion of them.
   Acute  bronchitis is a dangerous disorder, on account  of the frequency
 with which the inflammatory action spreads to the vesicular texture of  the
 lungs.
   Symptoms.—The chief symptoms are fever, tightness or constriction of
 the  chest, hurried respiration, with wheezing, severe cough and expectora-
 tion ;  at  first of  a glairy mucus,  which subsequently becomes  purulent.
 The pulse is frequent and weak, tongue foul, there is headache, lassitude,
 sickness, and great anxiety.
   Treatment.—Act thoroughly  on all  the secretions by  the appropriate
 remedies, then put the patient  under  the  influence of the C. tincture of
 lobelia and gelseminum, so as to induce expectoration.  If there  is great
 depression, stimulants, milk punch, carbonate of ammonia.   Active counter-
 irritation over the  chest  and back by dry cups, following with turpentine
 stupes, or the  irritating plaster, which should be re-spread every third day,
 or the comp. stillingia liniment.   If the case does not yield quickly, more
 energetic means must  be  used ; we might use the vapor bath, and internally
 the C. tinct. serpentaria  in  an infusion of asclepias and eupatorium.   To
 act powerfully on the kidneys, the acetate of potash, gelsemin  and cannabis
 indica should be resorted to,  or small doses of aconite and veratrum might
 be  given internally.   Where we have fever it is usually of a  remittent
 type:  some preparation of bark  is indicated, the sulphate of cinchonine or
 quinine.   If expectoration is scanty, stimulating  agents  might be given
 such as the syrup of senega, tolu, squills, sanguinarin, &c, or the bromide
 of potassium in some vehicle.  The stimulating expectorant plan of treat-
 ment is often successful; at the  same time  beef essence, the  inhalation of
 the vapor of vinegar,  or  other agents.
   In  the treatment of asthenic cases, the treatment differs not materially •
 the feeble condition of the system, the imperfect circulation, and relaxation
of the bronchial mucous membrane must be taken into account.   Iu mild
 cases, the administration of stimulating expectorants with quinine, couuter-
lrntation to the chest  with dry cups, or Firminch's method, and the veratrin 
ASTHMA.
55
ointment applied.   Inhalation may do good, but  the very best results  are
to be obtained from bromide of potassium in the stillingia alt.  Say,
                   R.—Stillingia alt., Keith, gi.;
                        Bromide potassium, 3SS.—Misce.
t lfteen drops every three hours.  Nourishment  and stimulants  must be
perseveringly given.
   The treatment of chronic bronchitis must  depend very much upon  the
age  and  constitution  of  the patient.   The  most  number  of cases  are
benefited  by stimulating expectorants, by  tonics, by nourishing food, by
stimu.ants.   If  the disease  is due  to the  poison .of syphilis, it is readily
cured  by the C. syr.  stillingia, with the iodide  or bromide of potassium,
and chloride of  gold.   If the patient be gouty or rheumatic, irisin, or the
C. tinct. corydalis, with acetate  of  potash  and iodide  of potassium,  does
well ;  but if we have difficulty in  expectoration, we must resort to such
agents as  C. powder of lobelia, and capsicum in S. syr., or tolu, or scillea.
   But if the case is  one of pure, uncomplicated bronchitis, we must pay
attention  rigidly  to  the skin,  bowels and kidneys.  We must improve
nutrition by every means in  our  power;  cinchona or hydrastin, the bitter
tonics  and  mineral acids, hypophosphites  and nux vomica,  are  all good
curative agents.   Iron and sulphur, in alternation with some of the above,
where  we have a deficient cutaneous  circulation.   To  relieve any morbid
irritation of the  nervous system, belladonna  and hyosciamin should be given
in a trituration of asclepin.  Inhalations  of the vapor of nitrate of potassae,
in an infusion of  hops, or hyosciamus, or stramonium, water and vinegar,
or hydrocyanic acid, with a narcotic or sedative. If no success attend these,
then tar, creasote, myrrb, iodine, chlorine, bromine,  infusions of podophyllum,
sanguinarin, xanthoxylin, and no agent must be used  that  gives rise to
irritation.   As  in the  acute form, when  the  expectoration is too profuse,
we find senega and the balsams valuable.   The oil of lobelia, one drop on
sugar, acts like  a charm; but  the  best agents  to arrest  the  secretion
thoroughly and  positively,  are  the  collinsonia, achillea,  ptelea, trillium,
lycopus, polygonum, euonymus, xanthoxylin, &c,  made into a syrup.  The
balsam  of copaiba, fir, tolu, peru  in  mucilage, with  some  of  the  essential
oils, are employed with advantage.  Judicious  counter-irritation  to  the
chest in all cases where the patient's strength will permit of it;.  Firminch's
instrument, and  the irritating plaster are the best  here.
ASTHMA.
   This disease is a spasmodic affection of the  lungs, which  comes on  by
paroxysms most  generally at night, and is  attended by frequent, difficult
aud short respiration, together with a wheezing noise, tightness across the
chest and a cough, all  of which symptoms  are much  increased when the
patient is in an horizontal position.
   Asthma rarely appears  before  the  age of puberty,  and seems  to attack
men more frequently than  women.  Dyspepsia always prevails, and appears
to be a very prominent feature in the predisposition ;  more prominent among
men than women.
   When the disease is attended with  an accumulation  and  discharge  of
mucus from the lungs, it is called  humid asthma, but when accompanied  by
expectoration, dry or spasmodic asthma, idiopathic  or  spasmodic, sympto-
matic or organic.
   Asthma is essentially a nervous disease, being dependent upon tonic con- 
56
DISEASES OF  CHILDREN.
traction  of  the oircular  muscular  fibres  of the  bronchial  tubes.   The
paroxysm may be induced by direct or reflex mechanism, or in other words,
it may be central in the medulla  oblongata, or it may be in the pulmonary
or gastric portion of the pneumogastric, or some other portion of the nervous
system, being transmitted  to the  medulla oblongata, from thence reflected
by motor filaments.
  Symptoms.—A fit of asthma is either preceded by headache and sleepi-
ness, or by various digestive or other disturbances, or it may occur without
warning.  More generally, however, on the  evening preceding an attack of
asthma, the  spirits are often much depressed, and the  person  experiences a
sense of  fullness about the stomach, with lassitude, drowsiness, and a pain
in the head ; later, a sense of tightness and stricture  across the chest;  the
difficulty of breathing continues to increase, both inspiration and respiraton
are performed  slowly, and with a wheezing  noise ; the speech is difficult
and uneasy;  a  propensity to  coughing succeeds;  the patient can no longer
remain in the  horizontal  position, being as it were threatened with imme-
diate suffocation.  Or it may be that the patient awakes two or three hours
after  midnight, with  a sensation  of suffocation or constriction  about  the
chest; the  dyspnoea  gradually  increasing until  a  painful  and fearful
struggle  for  breath sets in.  Various postures are assumed to facilitate the
attempt at emptying the lungs; the  patient stands erect, or leans his head
forwards on his bands on some  piece of furniture,  or rushes  to the open
window,  at which  he will  remain  almost for hours gasping for air.   The
chest is distended  to its  utmost  limit, inspiration  and expiration are per-
formed  with the  greatest difficulty, and there is evidently some serious
obstruction  to the  entrance and exit of air.
   During the fits the pulse is not usually much affected, but in some cases
there is a frequency of it, with  some  degree of thirst  and   other febrile
symptoms.  In some  persons the face  becomes  turgid and flushed during
the  continuance  of the fits, but  more  commonly  it  is pale  and shrunk.
Urine voided at the beginning of a fit is generally in considerable quantity,
with little color or odor;  but after  the fit is over, what  is voided is in the
ordinary quantity, of a high color, and sometimes deposits a sediment.
   Causes.—It may be hereditary, or due  to  organic disease  of  the chest,
and in other cases no cause can be detected.  It may be due to congestions
of blood, noxious or  irritant air inspired into the air passages, such as dust,
cold air, certain vapors; the influence of particular atmospheres or climatic
conditions;  certain  diathesis, such   as  the scrofulous,  gouty, psoric  and
scorbutic ; dyspepsia, or irritation of the abdominal viscera ;  dyspepsia,  or
eating improper food, or late suppers ; irritation of the bronchial system by
any cause, suppression of long accustomed  evacuations, frequent catarrhal
attacks, debility, water in the chest, aneurisms, polypi, peculiar condition
of the blood.
   Asthma,  once having occurred, is very liable to return periodically, and
more especially when excited by certain causes, such as a sudden change
from cold to warm weather, or from a heavier  to a lighter atmosphere; by
severe exercise of any kind, which quickens the circulation  of the blood •
by an increased bulk of  the stomach ; by exposures  to cold, obstructing
the perspiration, and thereby favoring an accumulation of blood in the  lun^s ■
by disagreeable mental emotion.
   Prognosis.—The proximate or immediate cause of  the disease is a pre-
 ejnatural or spasmodic constriction  of the muscular  fibres of the bronchia 
PLEURISY.                            57
which rarely if ever destroys life, and  many affected with it live to a good
old age.   A complete cure is  often effected; nevertheless the disease is a
serious one, chiefly on account of the cardiac and pulmonary conditions, the
chief of  which are congestion of the lungs, emphysema, hypertrophy and
dilatation of the  right  side of  the  heart, and when  these  conditions  are
established, the patient has a poor time of it indeed.
   Treatment.—In the treatment of asthma, we should endeavor to moderate
the violence of the paroxysms, and* when  they have subsided, prevent their
recurrence.   With the view of preventing  any danger, and removing any
difficulty  that  may exist, we would  give an  emetic of the C. tincture of
lobelia, or the same, per rectum, if it  is thought to arise from irritation from
the alimentary canal.   This may relieve and relax the bronchial spasm ;  if
not sufficient, we  would  keep the patient under the influence of  the lobelia,
either internally in small doses, or the oil cut with alcohol and bathed over
the  throat  and  chest.   I  have succeeded well with lobelia; the  common
tincure, in  twenty-drop doses  every few hours, with five  grains  of  the
bromide  of potassium,  act  like a charm.   Other  sedatives may be used ;
tobacco, to those  not  accustomed to smoking, frequently does good ;  with
the nausea and collapse, the attack  of asthma ceases.  Chloroform, ether,
stramonium, act  in  certain cases like a charm.   The  fumes of  blotting
paper, soaked in a solution of nitrate  of potash and dried, give  relief  in
uncomplicated cases.   Instances now and then occur where relief is  quickest
obtained from  a  stimulant, such as coffee, brandy, ammonia, xanthoxylin;
gelsemin succeeds when all fail.
   The most important part of  treatment  consists in improving the general
health, by tonics, a regular mode of life, and the daily use of the sponge  or
cold shower bath, to prescribe rules as to diet, to obviate attacks of dyspepsia,
to have the  meals so arranged that supper may be digested before bed-time.
The inhalation of oxygen  gas gives relief, since it affords the system an
excess of oxygen.
   It is impossible for me to speak too highly of the value of subcutaneous
injections of a solution  of gelsemin in affording prompt, instantaneous relief
from the paroxysm, and a repetition of them tending to ward off subsequent
attacks.
   As regards counter-irritation  to  the  spine,  galvanism, &c, experience
has clearly proved their utility.   Considering the disease as purely  nervous,
a course  of  treatment calculated to stimulate and  invigorate the brain and
spinal cord is eminently proper, highly consistent and very successful.
                               PLEURISY.

  Pleuritis,  or pleurisy, are terms applied to inflammation of the pleura—
the serous membrane investing  the lungs and  lining the  cavity of the
thorax.   It may run  an acute  or chronic course ; one side  only is  affected,
though we occasionally  have double pleurisy.
  Symptoms.—It is usually ushered  in by chilliness,  or  slight  rigors, fol-
lowed by fever, and  an acute lancinating pain in the side, called a stitch ;
which pain  is commonly seated below tbe nipple, over the anterolateral
attachment  of the diaphragm.   It is aggravated by the  expansion of the
lung in inspiration, by coughing, by lying on the affected side, by pressure.
There is also a short  harsh  cough, the skin is hot and dry, cheeks  flushed,
pulse hard and quick, respiration increased in frequency, anxiety,  restless-
ness urine scanty, high colored.   If we put our  ear to the painful  part, we 
58
DISEASES  OF CHILDREN.
hear the dry inflamed membrane, the pulmonary and costal  pleura rubbing
against each other and  producing a friction sound;  this rubbing can  also
be felt by the hand.  But the sound soon ceases; either the inflammation
terminates in resolution, and  the two surfaces of the pleura  regain  their
natural moisture and smoothness, or the roughened and inflamed  surfaces
get adherent; or they become  separated by the effusion of  serum.  If the
pleurisy has  been severe, the effusion becomes enormous.
   Diagnosis.—The  sharp  lancinating fiain, with  difficult  respiration  and
cough and febrile action, are sufficient to determine the nature of the disease.
The mitigation of the pain, oppression of breathing, dullness on percussion,
diminished respiratory  movement, determine that  effusion has taken place.
   Treatment.—The objects in  the treatment of pleurisy must be  direc'ed
to the removal of the inflammation, to lessen the rapidity and equalize the
circulation by different  means, and prevent the flow  of blood to the pleura.
This  can  be accomplished in various  ways.  It can  be accomplished  by
keeping the  patient thoroughly under the influence  of our arterial seda-
tives, such as veratrum, aconite, gelsemin, lobelia.   From  the well-known
power which these  agents possess over the heart  and arteries, they are
invariably used  with advantage in pleurisy.   To aid these  remedies, we
like profuse diaphoresis; we would use the vapor bath daily, and resort to
the administration  of an active diaphoretic  as  the C. tinct.  serpentariae.
These remedies act promptly, they are powerfully relaxant,  sedative, revul-
sive, and often arrest the disease.
   As strong purgatives are found to determine the flow of  blood to inter-
nal parts, I regard them as improper  agents in pleurisy.  It is well to get
an action of  the bowels with podophyllin and  leptandrin to obviate consti-
pation, and afterwards to relieve them  by mild  measures.   Alkaline diure-
tics are important, as the acetate or citrate of potash.
  To allay the pain in the side, and take off the inflammation  internally, it
is always  advisable the use dry cups freely, and follow with the  irritating
plaster, or  Firminch's method, and follow with veratrin  ointment.   A free
expectoration being  the means that nature adopts to relieve herself of  this
inflammation, it  should be encouraged  by every  possible  means, such as
inhaliug the  vapor of warm water, or administering some expectorant.
   As opiates tend to check perspiration and expectoration, they should as
a general rule be avoided.   It is true the patient must have sleep, but what
will aconite,  gelsemin and the sponging the surface not do in the way of an
anodyne.  Some cases are so mild, so easily controlled, that instead of the
cups and such active measures, fomentations of hops, or stramonium  may
be substituted.  For establishing convalescence, a thorough  tonic course
should be adopted.
  Throughout the whole course of the affection the patient must be care-
fully nursed, his strength supported by the best means.   On  his recovery,
he must guard against any fresh exposure  to cold, as  a return of the com-
plaint is usually attended with very bad consequences.
   Chronic  pleurisy  yields slowly  to  measures that  promote  absorption,
remove  irritation and  restore  the  tone  of the system.  Active counter-
irritation must  be rigidly adopted, then a thorough alterative  course  such
remedies as  menispernin, corydalin,  cornin,  hydrastin, irisin, iodide of
potassium,  &c, are  entitled to our highest confidence.  Great benefit is
derived  from bathing with salt water and bri k friction daily, otherwise the
treatment must be on general principles. 
PNEUMONIA.
59
                              PNEUMONIA.
  Pneumonia, or acute  inflammation  of  the  substance  of the  lungs, is a
serious  disease, commonly ushered in by general febrile disturbance.   At
the end of from one to three  days there are rigors, which are soon followed
by nausea, cough, pain  in the side, distressed breathing, a pulse of  nearly
160 in the minute, burning  heat of skin, thirst, loss of appetite, prostra-
tion, headache, transient delirium.
  Every  case of pneumonia consists  of  three  stages—engorgement, red
hepatization, and gray hepatization.   In  each stage there is fever ; more
or less pain in some part of  the chest more severe  at the commencement;
accelerated and oppressed breathing ; great depression, occasional delirium ;
cough, expectoration  of  viscid, rust-colored sputa, which unite  in a mass
so tenacious, that even inversion of the vessel would not detach them.   If
these sputa  be  minutely examined, they will be found to  consist of  the
debris of  the lungs, mucus,  epithelium, exudation  matter, blood  cells, oil
globules.
  •In  the  stage of engorgement, the substance of the lung becomes  loaded
with  bloody  serum ; in  the second stage, the spongy character of the lung
is quite lost, it is hard  aud solid, and in the third stage we  have diffused
suppuration  of the pulmonary  tissue, parts  of the remaining tense  and
impermeable.  In many instances, we have a true suppuration.
   Chronic pneumonia may be a sequel of  the acute.  Typhoid  pneumonia
where all the symptoms are indicative of feeble vitality, aud where we have
a rapid change in the constituents of the  blood.   Pneumonia  may affect
one lung  or both ;  or techically speaking, may be  double or single.   The
right lung suffers from inflammation nearly twice as  often as the  left; about
once in eight cases both are  affected.   The lower lobes are more obnoxious
to inflammation than the upper.  Average duration  fourteen  days; if com-
plicated, longer.   Pueumonia without  bronchitis is probably  never seen.
   Treatment.—From an.extensive  practice, I am satisfied that  pneumonia
in its early stage can  be arrested, cut short, and all  danger to the structure
of the lungs thus  avoided.   To diminish  the action of the heart and arte-
ries, to effect sedation, establish  secretion, which  being accomplished, an
acute inflammatory condition cannot  go  on.   For this purpose aconite,
veratrum, gelsemin and asclepias combined answer well.   If  the bowels
require evacuation, strong purgatives ought not to be employed, but gentle
aperients  of a  cooling  nature,  mild  purgation is admissible, but never
drastic  ones. •  As  an adjunct, the alkaline  bath  three times daily,  the
mustard foot bath and sufficient doses of  some anodyne to give sleep, and
of citrate of potassea to act upon the kidneys.   Over the affected lung,
counter-irritation, dry cupping, following with the irritating  plaster.   On
the third  or  fourth day the patient  is free from fever and pain, and ready
for the  employment  of  tonics, the  best of which are  bark,  hydrastin, &c.
This is  my plan of treatment of cases  that I get hold of in their incipiency.
I depend  on  the arterial sedatives, keeping the pulse at 70 or so, free skin,
kidneys and bowels aud  toning up the system.  But if the above does not
succeed, I keep on the  same species of sedation, more active counter-irri-
tation, resort to the vapor batb, and large  doses of the C. tinct. serpentaria.
Hot fomentations over  the affected  side are good, but they interfere with
more active treatment.
   In numerous cases of pneumonia the irritation of the respiratory  organs
is so  great, as to keep up  a harassing cough to the great  injury  of  the 
60
DISEASES  OF CHILDREN.
 patient.   To relieve this, free expectoration is the means that nature adopts
. to relieve herself, we ought therefore to promote this as much as  possible,
 by giving such  remedies as are supposed  to have the power of promoting
 a secretion  from the parts, such  as nauseant expectorants, C. powder of
 lobelia.   To assist the effect,  as well as to relax the vessels of the lungs,
 I have found  the inhalation of vapor  of  great  advantage : the vapor  of
 chloroform might occasionally  be used, or. water, or the steam of vinegar,
 making use of a pediluvium every night.   All that is necessary besides is
 a light diet, with a free supply of cold water as  a drink, together with beef
 tea and wine as soon as the symptoms demand them.
   In typhoid pneumonia, when the loss of strength and congestion of the
 lungs  are marked, we must adopt a treatment same as typhoid fever, at the
 same time promoting expectoration and relieving inflammation.  As a rule,
 patients suffering from typhoid pneumonia bear stimulants well, and should
 have them in  sufficient quantities to maintain the integrity of  the  system,
 and nothing must be used  that depresses the vital powers.
   At  the beginning of an  attack of pneumonia opiates  prove injurious .by
 interrupting expectoration, and should not be prescribed in the early stage
 of the disease. In a more advanced stage, where a cough is  the only urgent
 symptom, opiates are useful, and should be given so as  to obtain  sleep for
 the patient.
   During the whole of the complaint the patient should b'e confined to bed,
 lying  with his head and shoulders elevated as much as possible; the  most
 perfect quiet  enjoined;  the, air of  the apartment should  be  kept moist by
 the evaporation  of boiling water, say at a temperature of 60 degrees, and
 the strength well maintained by milk punch, beef essence, &c.  On  recover-
 ing, he should carefully guard against any exposure to cold, or irregularity,
 or excess, which might occasion a relapse ;  for  no form  of  inflammation is
 so  apt to  recur  as  pneumona and a return; a recurrence  often lays the
 foundation of consumption.
   Should the inflammation terminate in gangrene, stimulants and tonics
 will be especially demanded, the general plan of treatment must be  modified
 to meet the pressing indication,  brandy as large as can be borne, quinine freely,
 inhalations of pyroligneous acid, or turpentine, are  often  successful   In
 this stage  of the  disease  everything  that  would derange the alimentary
 canal must be avoided.  This  should be rig'dly attended to, a mild emetic,
 we must avoid purgation, and meet the symptoms by the  appropriate means.
 We must sponge the dry hot skin and give refreshing draughts.   W7e must
 allay pain,  ease the cough, stop diarrhoea  when it arises, and procure sleep
 by the proper means
   To support the vital powers, and resist the tendency to pufrescency, it is
 always right  and highly judicious to give stimulants, and  of all I  prefer
 brandy.  If the fever exhibits a remittent type, we must never  omit that
 sovereign remedy, bark.   If we succeed in removing the  symptoms of putrid
 pneumonia, we must have  recourse to the restorative wine bitters and other
 tonics in  order to strengthen the stomach and system in  general.

                      CONSUMPTION IN CHILDREN.

    Tubercle is the specific product of a peculiar constitutional disease.   It
 is  deposited  in a fluid  state, the  deposit coagulates, aud forms  a foreign
 body; hence it  exists in isolated  masses, or infiltrated into the  tissues of
 many different  organs,  being  most frequently found in  the lungs.  In 
                     CONSUMPTION IN CHILDREN.                   61

children, tuberculosis exists without affecting the lungs, being  more or
less disseminated over the whole viscera.   There is a great deal of specu-
lation as to the  mode of formation, nature and variety of tubercle.   The
best explanation is that it consists of an exudation of the liquor sanguinis,
presenting marked differences from the  simple  or  malignant exudation.
H e can easily understand how meagre diet,  a defect in digestion, in the
elaboration of the blood, will operate  on  or  influence the normal quality
ol that fluid.  In pulmonary phthisis, the tubercular deposit takes place
m the  areolar tissue, between the air  cells,  in the air cells themselves,
and in. the smaller bronchial tubes communicating with them, and wherever
a speck of this matter is deposited from the blood, it continues to increase
by constant addition  or attraction.   When it becomes hard it  is called
tubercle, and  in this condition it  is frequently found;  cavities are rarely
formed m the  lungs in early life.   The tubercles soften, suppurate, and
are expelled through the bronchi, trachea and mouth; their original form
may be a cavity, but more frequently they close  and heal, or  more tuber-
cular matter continues to be deposited on their sides, or in other parts of
the lungs, until  they become  so diseased as  to be incompatible with life.
   The points  of difference  between phthisis  in  the child and adult are
well marked;  the disease usually  comes on gradually, the child is unwell,
listless, it  droops, has  no  appetite, loses  flesh and strength,  a slight dry
cough comes on : but this is never severe, like the cough of the adult: there
is no expectoration, for the child  swallows what the adult  spits up.  In
children  there is  an  absence  of hemoptysis, diarrhoea is not so  common,
and frequently we have no colliquative sweats.
  As the  disease progresses all the symptoms increase; the skin becomes
hot and dry, attacks  of bronchitis* and catarrh recur repeatedly :  the
respriation becomes quickened, attended with wheezing ; the flesh wastes,
the skin  becomes wrinkled, the face assumes  the appearance of old age,
the strength decays, aphthae form about the mouth, bronchitis, exhaustion,
marasmus  terminate the scene.
  Death usually occurs from some of the following causes: bronchitis,
hemorrhage, suppuration  in a bronchial tube  involving a blood vessel, or
from  tubercular peritonitis,  acute  hydrocephalus, exhaustion,  extreme
weakness  or marasmus.
  The usual  physical  signs  derived from percussion  and  auscultation
cannot be relied on, as the deposit of tubercle  in children is much diffused.
Our prognosis  is highly unfavorable, and the most frequent  causes  are
hereditary influence, cold  and damp air, improper nourishment, deranged
nutrition, any depressing agency, the  great  and  sudden changes  of our
climate.
  Treatment.—Experience has taught us that remedies are only  of utility
in the  early stage.  If  there  is any hereditary tendency, great attention
should be paid to prophylactic measures ; the  child should be well nursed,
warmly clothed, kept in the open air in fine weather, kept in well ventilated
rooms, carefully watched at dentition, weaning, &c:  guard  it from  con-
tagious disorders, diarrhoea,  catarrh; no  lowering  measures should be
resorted to, but  everything calculated to  build up and support  are most
appropriate.
   When the disease is present, when tubercular matter is once deposited
in the lungs  or  bronchial  glands, then the  plan of  treatment  which  is
successful  is  to use every possible means to restore and promote the 
62
DISEASES  OF CHILDREN.
general nutrition, to subdue local irritation, and  avoid everything which
deteriorates or induces bronchial irritation
  Nutrition must be improved by attention to the quantity and quality of
the food, by warm clothing, by  pure mild air, by the administration  of
bark, phosphorus, iron, cod liver oil.   Our attempts to  impart strength
are often aborted by a total want of appetite, or by some inability of the
stomach to digest food.   In such cases the elixir cinchona et ferri, or the
wine  bitters, or pepsin should be given ;  these failing, the  juice  of raw
meat  should be tried.  Milk is a valuable remedy in  phthisis, sometimes
invaluable  combined with  brandy.   With the view  of guarding against
any diminution  of cutaneous perspiration, flannel should be  worn  next
the skin.
  In  our climate, tubercles are induced and  accelerated in  winter and
retarded in summer; a free, pure equable  temperature is to  be preferred.
With regard to the use of medicines, as iron, phosphorus, bark, cod  liver
oil, I have great confidence in  them, given  alternately.   If the oil dis-
agrees, it  may be  advantageous to  introduce it into  the  system by
inunction, which is best effected by mixing it with  tincture of  iodine, and
rubbing into the chest morning and night.
  For the  cough, if it is  dry and  harsh, lobelia, sanguinaria, ipecac are
indicated, or the stimulant  expectorants, as  senega, squills, or the syr.
stillingia, tolu and verbascum.   Of all narcotic agents for the purpose of
procuring relief, checking  the cough, I prefer  the cannabis indica.  To
remove inflammation from the  lungs, and prevent the further deposit of
tubercles, or to keep  them from  proceeding  to  suppuration, keep the
irritating plaster constantly applied, and changed from place to place as
it becomes irritable.  Whilst we are pursuing a treatment  calculated to
build up, and giving such remedies as bark, iron, phosphates, and relieving
any symptoms  as  they present  themselves, I  have derived the greatest
possible benefit from the inhalation of oxygen.   This is a remedy of great
power, a powerful  exciter, a gentle stimulus, which  invigorates the vital
fluid, gives firmness  to the solids, energy to the fluids, and obliterates the
cause of the disease.  It is easily prepared from the chlorate of potassea.
  The hectic fever, or night sweats, are best controlled by the  administra-
tion of crawley, or gallic acid, or nitro-muriatic, bathing with salt water,
&c.   If  there be diarrhoea, the  best  remedies are subnitrate  of bismuth
in an infusion of epilobium, aromatic tincture of guiacum with tannic  acid,
nux vomica in the neutralizing cordial.
  Digitalis  is  an  excellent remedy in the  consumption  of children; it
excites the  action of the  absorbents, it lessens the  action  of the heart
and arteries, and  at the same  time it is a powerful  tonic and stimulant
to the  heart;  it is sometimes well to combine it with  the  tincture of
myrrh and balsam copaiba.  To palliate  the  cough, which is  very apt to
prove troublesome, opiates should be  given,  with the C. syr. stillingia,
tolu,  &c. and  some demulcents, as Iceland or  Irish moss, in  a decoction
of milk, may be given.   Pulmonary Consumption is entirely of a scrofulous
character, consequently we want a nutritious  diet, animal food, the white
of egg, the elements of blood, &c, the use of conium, phosphorus, altera-
tives, and a judicious use of counter-irritation.
  Chloride of sodium, used as a bath  and internally is good;   best given
in beef tea, and if there  is thirst, let the patient drink an infusion  of gold
thread.  I am partial  to the use of tannin in phthisis, given in simple 
DISEASES OF THE HEART.
63
 for^L    Clumme-  Mi*k  and yeast is  regarded as a sovereign remedy
 wrcos^   The juice of raw meat? wkh brandyj .g Qot   fi valuaUJ

 acid      *in £Gn    scrofula, anemia and chronic  dysentery.   Carbolic
tnd «reat1^ benefits some  patients, administered partly by the stomach
 7    Paru7 ty  inhalation ;  all patients  to whom this remedy is  given,
 experience the most favorable results.  In my practice, I have found some
 or  our concentrated remedies of  great utility, and their therapeutic power
 much  enhanced when given  in  glycerine—nutrition  is much  improved.
 ihe sulphites are valuable agents;  they arrest the process of the deposit
 of  tubercle, and prevent the disorganization of the blood.

                       DISEASES OF  THE HEART.
   Affections of  the heart, more especially inflammation of the pericardium,
 are very common, not quite so common  in the  young as in  the adult.
   Pericarditis frequently arises  from cold, injuries, contaminated blood,
 produced by disease of the kidneys, the poison of scarlatina, or diphtheria,
 measles  or  rheumatism; its most frequent occurrence is in association
 with rheumatism.   The symptoms are the  same in all ages: pain in the
 region of the heart, increased by inspiration, by pressure, often darting
 to the shoulder  and down the arm :  palpitations,  dry cough, hurried respi-
 ration ;  pain on  lying on the left side, restlessness, anxiety, intermittent
 pulse, ranging about one hundred and twenty;  the motions of the heart
 are tumultuous, perceptible at a distance from the patient;  frequent noises
 in the ears, giddiness and epistaxis.  As the  disease  advances, there  is
 extreme  debility, suffocative paroxysms, tendency to  syncope, and odema
 of the face and extremities.   In the adult these symptoms are seldom
 collectively present in  any individual case; in the young they are often
 marked by many circumstances.
   The physical signs are of great importance,  of these there are three
 prominent ones  that demand our  attention :
   1st. The earliest signs observed are increased intensity of the natural
 sounds, resulting from irritation propagated to the muscular  tissue of the
 heart at the beginning of  inflammation  of its investing  membrane, the
 ventricles contract with  great force, giving us  a  loud systolic bellows-
 murmur, with the  sounds louder, the impulse stronger.
   2d.  Extension of dullness over the heart, resulting from  liquid effusion.
 Dullness  is not  only greater, but greater in  extent beyond the normal
 limit;  as a result, we  have signs  of pressure,  excitement, weakness or
 paralysis, in consequence of the intervening  fluid, and  the impulse  is
 scarcely  perceptible.
   3d.  Friction  signs, attended with, or  preceded by, valvular  murmurs.
 This friction sound is caused by the rubbing of the inflamed and roughened
 surfaces  upon each other.  This sound is only heard early in the disease,
 before the surfaces of  the  pericardium  are separated by the effusion of
 fluid.  When effusion takes place, the surfaces  are either separated  by
 fluid or become  adherent, consequently the sound disappears.
   Prognosis.—Pericarditis  is  always a dangerous  disease, very much so
 when the morbid action is  acute or general, or when it occurs  in the
 scrofulous, or when  it supervenes upon a severe attack of some disease.
The endocarditis, which  frequently accompanies  it, produces mischief to
 the valves of the heart. *  It  may  terminate fatally in a few  days, but
more  frequently it  yields  to  appropriate  treatment, and terminates in 
64
DISEASES OF CHILDREN.
apparent recovery.  Pericardial adhesions occasion other structural changes
in the heart sooner or later to develope themselves.           #
   Endocarditis and carditis give rise to a sense of oppression, uneasiness
at  the  cardiac region, slight fever, small, feeble and intermittent pulse,
great anxiety, cold sweats, cough, great difficulty of breathing, jactitation
aud syncope.   In  either of these  affections  the action  of the heart is
excessively violent; a vibratory thrill is felt by the hand, there is increased
dullness, but the beat  of the heart  is superficial, instead of  remote and
distinct, as in pericarditis.  A bellows-murmur is a constant characteristic
phenomena of endocarditis.   Its  terminations are  usually  permanent
valvular disease, followed by implication of the heart's substance, with a
complete train of consequences, as  anasarca, &c.   •
   Treatment.—In  no  disease are  the arterial  sedatives  used with  such
marked benefit.   Extended experience has demonstrated their utility, so
that  at  the  commencement  of the disease  they should be given, as
veratrum, aconite, digitalis, combined with the tincture of macrotys in  suffi-
cient quantity to  control the action  of the  heart.  Nothing seems  more
certain than the above remedies : they reduce, with great rapidity, the
number of contractions, and, as it were, tone and strengthen ;  they  must
be watched, the medicine discontinued gradually  as  the heart becomes
more regular, the impulse more  normal, the urgent symptoms controlled.
Dry cupping over the  region of the  heart and spine, and then resort to
the hot or vapor bath.   Then I give hyosciamin  and  asclepin, to  give
relief to the patient's sufferings; the dose which will be needed will  vary
with  the severity of the pain  and restlessness, small doses  at first  and
gradually increase.   The bathing  should  be continued.   An effort  then
should be made to  bring the system under  some powerful alterative, as
irisin, menispermin  and iodide of potassium, keeping up the action of the
arterial sedatives.   Counter-irritation over the heart by the cantharidal
collodion,  over which  the  irritating plaster; the  same  on  the  spine
opposite ;  the occasional use of  the mustard foot-bath, keeping up active
sponging of the entire surface every three hours.   If  there be much  fluid
effusion, the following answers a good purpose :

                   R .--Bitartrate  potassea, gr. xxx.;
                        Nitrate potassea, gr.  iii.;
                       Podophyllum, pulv., gr. ii.   Misce.

Every three  hours.  The great  emunctories  must  be  free,  the  heart
relieved by getting  a determination of blood  to other parts of the body,
and keeping down irritation.   Nourishment should be light, mild cooling
drinks, diuretic beverages, and  if  the powers of nature  fag, stimulants
should be perseveringly  given.   There  must  be perfect rest of mind and
body, and all possible causes of  excitement should be carefully excluded.
As a special remedy in  the  stage  of convalescence, the cactus grand, in
alternation with the digitalis, are very appropriate  and highly  useful.
                        DISEASES  OF THE  EAR.

  In children, we have three affections of the ear, which are exceedinglv
common, namely, otalgia, otitis  and  otorrhcea ;. three  pathological condi-
tions, the  treatment of which is exceedingly empirical, and consequently
highly unsuccessful. 
OTALGIA,  OR EARACHE.
65
                        OTALGIA, OR EARACHE.
  This may be symptomatic of inflammation of the ear, or of the presence
of foreign bodies, or of tonsillitis, or disorder of the alimentary canal, or
of malaria, or of rheumatism, &c, or it may be idiopathic, that is to say,
true neuralgia  of the ear.   In the latter it  usually occurs in  paroxysms
of very severe, excruciating, plunging or lancinating pain, of an inter-
mittent character, shooting through the nervous filaments.   Its periodicity,
the total freedom from annoyance  during  the  intervals, are points of its
neuralgic  character.   The symptomatic form  is  due to some functional
derangement acting upon the nerve,  which is the seat of pain, disease of
the brain,  spinal  cord.  Its sympathetic causes  are  debility,  irritation,
wet, cold, eruptions, teething, disorders of the stomach, kc.
   Treatment.—The indications are to remove all sources of irritation, the
primary disease,  and  to amend any  disorder of the constitution that can
be detected,  and to alleviate pain.    The ear should be examined, as well
as the great  secreting organs ;  see that there is no sign of congestion, and
if there is, it should be removed by  counter-irritation, by the warm bath,
or by the application of aconite and  chloroform, or  veratrum ointment.
  The constitution should be well attended to, anemia, emaciation, debility
calls for iron, bark, tonics.  In all cases improve  the  appetite and secre-
tions ; but if no  cause can  be detected, an emetic of the C. tincture of
lobelia, warrri pediluvium, a diaphoretic infusion to aid the action of the
lobelia, as asclepias and serpentaria,  then hyosciamus, leptandrin and scu-
tellarin.   Diuresis must not be overlooked, then follow with this combi-
nation in teaspoonful doses every few hours:  R.—Iodide potassium, ^i;
tincture gelseminum,  macrotys, aa, 5SS;  water,  §iv.—M.   Alternate
with cypripedin and scutellerin.   Gelsemin,  atropia, morphia, nux vomica
are valuable remedies  in solution, as well as guiaicum, colchicum, scutel-
larin, valerianate of zinc, phosphorus, and if malaria be present, prussiate
of iron, quinine  and  gelsemin  in  combination.   Belladonna  internally,
sufficient to  produce dilatation of the  pupil, and locally in the ear.  To
relieve the tinnitis aurium, drop in the ear a few drops of  the following:
R.—Ether, glycerine, aa—M.  To mitigate  the pain, local agents are of
some utility ; electricity, the  vapor of  ether or opium, stramonium.   An
alterative  course and attention to the secretions, small doses of  the chlo-
ride of gold, in alternation with the citrate of bark and iron, are good to
prevent a recurrence.
                                OTITIS.
  Otitis, or inflammation of the ear,  may affect the external and internal
ear at the same time, or it may be confined to either. ^
  Acute otitis is one of the most  painful affections in the catalogue of
disease—it is a disease peculiar to the young, usually induced by  cold.
The pain is of  a most  excruciating character, lancinating in the extreme
and when  it remits, is followed by a dull aching pain  and  soreness,
extending over the whole  side of the head and down the neck, generally
an  aggravation of the  symptoms at  night,  causing sleeplessness, fever,.
and even  delirium.  The  lining of the meatus is swollen, dry, pinkish,
and in a  short  time a muco-purulent or purulent discharge takes place,
and relief is  experienced.   Otitis may be due to  certain causes; we fre-
quently meet it, a3 strumous otitis, exanthematous otitis, &c.
  The treatment  that we  have found most  successful, is  to equalize the
       5 
66
DISEASES  OF CHILDREN.
circulation, reduce  inflammatory action,  subdue  pain,  &c   Aconite,
veratrum and gelsemin combined, given in sufficient  quantities to keep
the pulse at 70 or 75, is good in affording  relief, in mitigating pain, con-
trolling local inflammation ; counter-irritation being useful, followed with
fomentations of an anodyne character, affords instantaneous relief.   The
employment of medicated vapor, if a suitable apparatus can be obtained,
is excellent—the temperature of the apartment should be warm.  If there
is much neuralgic pain, a mixture composed of tinctures belladonna, aco-
nite and  chloroform is very effective, or a mixture of hyosciamus, stramo-
nium and gelsemin.   The condition of the skin should be attended to, it
is hot, dry and demands our attention ; and the asclepin  and C. tincture
serpentaria should be freely given; it should also be frequently sponged
with the  alkaline wash.  The bowels  should be stimulated with podophyl-
lin, leptandrin and hyosciamus.
  Having thus pushed treatment vigorously, if the case does not yield,
give R.—Ext. cannabis indica, gr. ss;  ext. conii, gr. i:  ferro  citrate et
strychnine, gr. ss.—M. Ft.; keep up counter-irritation vigorously.  If the
strumous diathesis seem to be the latent cause, then twenty drops of  the   *
following every four  hours  is attended with advantage:  R.—Con. stil-
lingia  alt.  (Keith's;) iodide of  sodium, aa,  %i.—m.  In all cases  the
treatment should be very prompt, not only by arterial  sedation, but small
alterative doses of gold or irisin should be given.  Convalescence should
be established on iron, bark and stillingia.   If we suspect it to arise from
a rheumatic source, (lactic acid in the  blood,) alkalies must be  given in
addition, and as a local remedy the sulphite or bi-sulphite of soda.

                             OTORRHCEA.

  Otitis  is very apt to terminate in otorrhoea, or purulent discharge from
the ear.  Indeed, all varieties of disease of the ear  are very prone to ter-
minate in otorrhoea.   It is frequently a symptom of certain diseases, and
often  occurs without  any appreciable cause  about the time of dentition.
It is an  affection that is much overlooked, or, if treated at all, in a very
faulty  manner by  dropping certain  obnoxious  ingredients into  the ear;
and in this way an offensive, obstinate discharge  is  established, and in
this way an affection  easily curable  by proper treatment, is  allowed to
become  chronic, which may continue for years, and be very destructive
in its progress.
  Treatment.—If it is acute  and attended  with much fever, it might be
met with arterial  sedatives, and freely unlocking the secretions.   Then
the ear should be well syringed with castile  soap and water, and then an
examination of the ear should be had by speculum; if a granulated or
vascular condition, with a slimy condition  of the lining membrane  exist,
then the brushing over the parts with a solution of  the sesquicarbonate of
potash.   If  the inflammation  is violent, counter-irritaticn should  be
resorted to, and a hot fomentation of stramonium or bran should be con-
stantly applied.   A lotion of  equal parts of  the tinctures of aconite, bel-
ladonna  and hyosciamus should  be applied round the  ear;  or if the pain
be very  intense, the vapor of  opium, stramonium and  lobelia, chloroform.
If all the acute symptoms are  subdued, and the chronic  stage has set in
it must be treated on general principles.  The  general health should be
improved by tonics, alteratives and aperients.
t 
SCROFULA.
67
   Ihe best tonics here are iodide of iron, nitro-muriatic acid, phosphorus,
Huxham's tincture of bark, hydrastis, &e.
   Ihe best alteratives are the  C. syr. stillingia, with iodide potassium,
U syr. celastrus, irisin, gold, phytolacin, menispermin.
   jbor an aperient, podophyllin,  leptandrin.
   Ihe local disease should be  attended to by the  cautious use of stimu-
lating and astringent injections, and  if  the discharge be not severe, and
no cause, as polypus or some constitutional  taint,  a cure may be effected
by syringing with  a solution  of  such  agents  as  zinc, tannin, myricin,
rhusin, lycopin;  and if the discharge is  foetid, a lotion of the permanga-
nate of potash is excellent, being  both an astringent  and antidote to the
disagreeable smell.
   Cleanliness is essential  to  success, syringing the ear twice daily;  the
discharge should never be allowed to accumulate, it is  the principal means
of perpetuating  otorrhoea.  When once the meatus  becomes a secreting
cavity, with  ulceration of its walls, it  resembles a fistula, and the longer
it has existed, the  more  difficult to  deal  ; and this  fistulous character,
especially in a narrow passage, promotes the continuance of a slight thin
discharge, long after the granulations or other producing causes have been
removed.  The action of the external  air upon this secreting surface can
never be too much observed ; hence, the impropriety of using cotton wool.
Counter-irritation  is wonderful in its  effects,  remarkable in its power.
The irritating plaster is the best; next  best the tincture of iodine, made
stronger, and  rendered more soluble by the addition of  the  hydriodate
of potash.
   Most cases of otorrhoea depend upon a constitutional defect, and we have
reason to believe  that the state of the constitutional health  assists in
keeping  up  the  local  disease, and that in all cases we should improve
the general health ;  act upon the absorbents, tonics, change of air, iodine,
cod liver oil; generous diet is invaluable.
   No bad result can follow from curing otorrhoea.  The evils which result
from these  discharges are due to their being neglected ;  for so long as it
does  exist, we can never tell the  result, or what serious  disorganization
may take place.
                               SCROFULA.

   Scrofula, or struma, is a disease  of  constitutional origin, manifested by
certain external signs, as swelling of  the  lymphatic  glands, peculiar con-
formation of body, which give rise to a special diathesis, &c.  Scrofula and
tuberculosis we regard as the same, identical, to wit: an impaired condition
of the vital powers, resulting in the deposit of a peculiar substance in the
lun^s or glands of  the body—a deposit of tubercle.  The local affection in
either case is no  more  than a fragment  of a  great  constitutional blood
maladv-   Phthisis, or scrofula, is  a broken down  condition of the blood
corpuscles—a stat >. where  we have an  excess of white corpuscles, and a
defect in  the  vital  forces, whereby we  have the  elementary ingredients
incapable of assuming a normal  standard.  Taking it for granted, that the
causes of scrofula and tubercular disease  are identical, and that they attack
a  certain class of  persons  whose vital forces  are weak, we find  the blood
in these  cases usually serous, its vitality  is  of a low grade, it is poor—poor
in all the elements of life—nutrition is imperfect, the  blood corpuscles do
not attain their  natural size, consistency and  color; there is abundance of 
68
DISEASES OF  CHILDREN.
white corpuscles, and from these and other causes we have a languid circu-
lation, and such a serous condition of the blood that partial exudations are
apt to occur, more  especially of its albuminous portion : this exudation is
apt to cohere together into  minute spherical masses, destitute of acquiring
an  organized  structure themselves, but grow by attracting to themselves
fresh particles from this white-cell blood.
  Besides  the  hereditary disposition, almost anything that will impair  or
disorder the system, will become an exciting  cause  of tubercular disease.
The hereditary disposition is usually manifested by certain external physical
signs, which  are indicated  by the  hair, skin, delicate  complexion, large
veins, which are seen meandering under the smooth, transparent skin; full
lustrous eyes, the sclerotic of a pearly white color, pouting lips, weak voice,
great sensibility to  external impressions and changes of the  weather, with
a general weakness of organization, &c.   It  is  also  remarkable for  the
peculiarity of  countenance, the teeth, the sour fetid breath, narrow chest,
high shoulders, the flesh soft and flabby.
  Certain diseases predispose to the elaboration of white-cell blood, and
consequently of deposits  from it, as syphilis, diphtheria, &c, certain occu-
pations, unwholsome air, imperfect  ventilation, depressing passions.   The
most prolific cause of this  disease  is insufficient or improper food, diseased
or faulty nutrition, a generation of acid  in  the process  of digestion.  Its
most common  hereditary causes in children  are usually to  be  traced  to
improper marriages of persons  too nearly related by blood or temperament,
where either of the parents are very young or very old, disease, mercury
given to pregnant females, or frequent  copulation, or menses being present
in a woman who  is pregnant, menses during  nursing, &c.   Our  mode  of
living may predispose—our advanced civilization—because we have departed
from the simplicity of nature, by running to excesses and habits prejudicial
to health.  Scrofula or consumption  is but little known among people who
lead simple livesrsubsist upon  plain substantial food, and take abundance
of exercise in  the open air.   Anything that depresses  the vital forces may
be a cause, as  the  allopathic system of medication, with  its mercury and
depleting agents, is a fearful source of this affection, as their chief remedies
diminish the stamina and vitality of the constitution.
  Among the  primary causes of tubercular deposit, no doubt the  principal
one is hereditary disposition, but this disposition explains very little of the
real cause.  Vitality is the  effect of so many conditional causes, each liable
to vary in intensity, and by that variation to influence the degree of vitality,
that it is difficult to tell in  what the ultimate  change  in tuberculosis owes
its origin ;  but there is no doubt, although neither chemistry, nor pathology,
nor physiology have yet demonstrated  it to us, but  that the  blood is less
vital, possesses less red corpuscles, has  essentially less stamina  than the
blood in the normal state.
  Prevention.—There are several  points to be observed in the prevention
of scrofula :                 t
  Well-arranged marriages—the   parties  must  not be  incompatible, nor
related by  blood—they must be in  sound health.   If the disease  is known
to exist in  one or both parents, the greatest possible  care  should be  taken
to keep their health  up to  a normal standard, more especially the mother
during utero-gestation.   She should have good diet, warm clothing, regular
exercise, a freedom from  depressing agents, mentally and physically.  On
the birth of the child, every means should  be  taken to improve its general 
THE ERUPTIVE  FEVERS.
69
health, counteract the hereditary tendency by attention to food, air, clothing,
and in case there is no hereditary predisposition, ill-ventilated apartments,
damp houses, unhealthy localities should be avoided.
   lreatment.—In the treatment of any affection resulting from this diathesis,
we must bear constantly in mind its  constitutional cause; no remedy that
debilitates should  be used.   In all forms of this affection I am partial to
correcting and improving the alimentary tract; for this purpose I resort to
an occasional emetic  of lobelia  and  eupatorium per., this follow  with  the
alcoholic  vapor  batb, letting  the patient drink  freely of cold water, then
give podopbyllin and leptandrin;  there is always a full and hard abdomen,
and a loaded condition of  the bowels, and an excessive quantity of morbid
matter will be discharged—this  should  be repeated every third day.   The
daily use  of the alkaline bath  ; if  there  is  any  leison suspected, then
•counter-irritation with  the irritating  plaster, and getting free  suppuration
is a powerful adjunct in treatment.
   To correct, as much as  possible, the constitutional taint, give the altera-
tive syrup, or the C. syr. celastrus or stillingia^which are  well calculated to
improve nutrition, or the concentrated Kieth's alterative of  stillingia have
succeeded well with me, so has irisin, corydalin, menispermin, rumin, phy-
tolacin ; I have effected more permanent cures with these agents than others.
I always  alternate these alteratives with  some form of cinchonea.  Iron is
an agent  essentially called for;  the  most soluble preparation is  the best,
(pyrophosphate.)   If we have white-cell blood, iron is the antidote,.   These
tonics should be  continued for some time after a cure has been established.
If we do  not succeed, if the  case is chronic, then resort  to  the sulphites;
add them to the  alterative syrups.  Iodine is a remedy of great  value, as
the iodide potassium in moderate doses, iodine baths, iodine,  rendered more
soluble by adding iodide potassium, added  to water  and used in a wooden
bath tub.  Chloride of gold  in small doses, the muriate  of platinum, cod-
liver oil improves nutrition, and so is valuable in the strumous—it requires
to be persevered with.  Diet is of great importance ; an invigorating, easily-
digested,  blood-making diet, avoiding  acids or  all  substances  likely to
become acid on the s omach  ; indigestible substances must be avoWed or
prohibited.  Thorough hygiene should be the rule, daily baths, flannel next
the skin, fresh  air,  exercise, &c.  If  it be  connected  in  any way with
rheumatic diathesis,  alkalies, macrotin,  colchicuin and  cinchonea.  Con-
valescence should be established on general tonics and alteratives;  iodide
of  iron, phosphates, irisin.
   No disease is more apt to recur than  this; it is therefore of  the greatest
importance to keep up treatment  for many months  and if there is the least
indication of a recurrence, to meet  it  promptly and energetically.   Salt
water baths, friction to the surface must not be overlo Aed.
                        THE ERUPTIVE FEVERS.

   The  eruptive  fevers may  be  regarded as  continued fevers, having an
eruption superadded.  The diseases  of this class are  small-pox, measles,
and scarlet fever.  These  diseases have one common character, as follows :
A period  of  incubation, a certain time  elapsing'between the hour of  infec-
tion, and  the establishment of fever ; they  are all accompanied with high
febrile action, which runs a defined course ;  all attended  with an eruption,
which runs a regular series of changes; all  affecting an individual only
once in a life time ; all arising from a specific contagion, and their progress 
70
DISEASES  OF CHILDREN.
  cannot be stayed, but their severity may be  modified with  medicine and
  good nursing.
                         VARIOLA, OR SMALL-POX.

     Variola, or small-pox, may be defined as  a contagious and  infectious
  fever, commencing  with lassitude,  headache, stupor, mental depression,
  rigors, heat of skin, vomiting, pain in the back and loins, and succeeded
  on the third day by an eruption  of pimples, which, in the course of a week,
  inflame and suppurate.   In some cases the mucous membrane of the nose
  and mouth is similarly affected.  W'hen the vomiting and pain in the back
  are violent, it is  indicative of a severe form  of the disease.  It attacks
  persons of all ages, but children are  more liable to it than those of more
  mature years;  it may prevail at all the seasons of the year, but in general
  is most prevalent in the spring and summer.
     Small-pox is distinguished into the distinct and confluent;  in the former
  the eruption is separate, distinct from each  other, in the  latter they run
 . into each other;  the one mild  in its type, the other often accompanied
  with typhoid symptoms.  Both  species are  produced either by breathing
  air impregnated with the  effluvia arising from patients suffering from the
  disease, or from the introduction  of variolous matters from clothes, con-
  tact, &c, and the grade or variety depending altogether on the  amount of
  the poison imbibed, and the state of the constitution of the patient at the
  time, and on  certain contingent circumstances.  The  area of  variolous
•  contagion is limited to a very narrow sphere.
     The time which elapses from the hour of infection to the establishment
  of the fever is twelve days ; but if the disease is received into the system
  by inoculation, only seven days elapse between  the reception of  the virus
  and the appearance of the fever.   There is no contagion so certain, so
  positive, as that of small-pox; the period when the contagion is most
  virulent is during the  suppurative  stage.  The susceptibility of the con-
  stitution to the action of the poison is exhausted by one attack.
     Four different stages are usually observed in small-pox: the febrile,
  eruptive, the maturative, and the declination or scabbing.
     If the disease has arisen naturally, and is of the distinct species, the
  eruption is preceded by redness in the eyes, soreness in the throat, pains
  in the head, back and loins, languor, lassitude, faintness, rigors, alternated
  with heats, thirst, nausea, vomiting, quick pulse, &c.
     In some  instances these symptoms  prevail  in a high degree, and in
  others they are moderate and trifling.  In young children, convulsions are
  apt to occur prior to the appearance  of the eruption, which create great
  alarm.
     About  the  third or fourth  day from the  development  of  the acute
  symptoms, the eruption shows itself in little  red spots  on the face, neck
  and breast; and  these continue to increase  in  number  and size for three
  or four days longer, at  the end of  which  time they are to be  observed
  dispersed over several parts of  the body.
     If the  pustules  are  not very numerous, the febrile symptoms will dis-
  appear on the appearance Of the eruption, or  if not, will become moderate.
  Should the pustules be  perfectly distinct and  separate  from each  other,
  the  suppuration  will probably  be  completed about the eighth or ninth
  day, and they will  then be filled with a thick yellow matter; but should
  they run into  each  other, it will not be completed  until some  days later. 
THE ERUPTIVE FEVERS.
71
  If the pustules are very thick and numerous on the face, it is apt to be
greatly swollen, the eyelids to be closed up;  previous  to  which there
usually arises a hoarseness, difficulty  of swallowing, discharge of viscid
saliva, &c.                        J
  About  the eleventh day the  swelling of the  face  usually subsides,
together with the affection of the fauces  and other  parts.  The severity
of the disease  bears a direct  relation to the  quantity of  the eruption.
Ihe eruption is papular, which ripens into pustules, suppuration being
complete  about the tenth or eleventh day, at  which time  the pustules
break, crusts or scabs form, and  in four or five days  more these begin
falling off.
  In the  confluent  form, the fever which precedes the  eruption is much
more  violent than  in  the  distinct, being usually attended with  greater
anxiety, sickness, more intense pain  in  the back,  greater  heat, thirst,
nausea, vomiting, than in the distinct variety, coma and delirium are not ,
unfrequent, and in  infants convulsions.
  The eruption usually makes  its appearance about the third  day, being
frequently preceded or attended with  a rosy efflorescence, similar to that
which  takes place  in measles; but the fever,  although  it  suffers  some
slight remission on  the striking out of  the eruption, does not go off as in
the distinct variety j on  the contrary, i,t  increases after the fifth or sixth
day, and continues  considerably throughout the remainder of the disease.
As  the eruption advances, the vesicles  on  the face run together, containing
a thin brownish ichor ; the face is pale  and doughy.  On  the parts not
exposed, such  as the  trunk and  extremities, though often  not confluent,
have no areola, and are pale.  The vesicles on the top of the pimples are
seen sooner in the  confluent than in  the distinct; but they never rise to
an eminence, being usually flattened in :  neither do  they arrive at proper
suppuration, as the fluid contained in  them, instead of becoming yellow,
turns to a brown color.
  About  the tenth or eleventh  day  the swelling  of the  face  usually
subsides,  the hands and feet begin to  puff up and  swell, and  about the
same time the vesicles break, and  pour out a liquor  that forms  into brown
or black crusts, which, upon falling off, leave deep  pits behind that con-
tinue  for iife ;  and where the pustules  have run  into each other, they
disfigure  and scar  the face very  considerably.   When to  the foregoing
symptoms malignancy and putresceucy are  added,  the disease  becomes
malignant small-pox.
  In the confluent  small-pox, the  fever which, perhaps, had suffered some
slight remission from the time the eruption made its  appearance to that of
maturation, is often renewed with considerable violence, and this is called
the secondary fever; and this is the most dangerous stage of the disease.
  The only diagnosis that is necessary is between  small-pox and chicken-
pox.   In the latter, the pustules commonly go back, without coming to
suppuration:  their number,  size, appearance and  course  differ  very
essentially.
  Prognosis.—The distinct small-pox  is not  attended with danger, except
when die eruptive fever  is very  violent, or when it attacks pregnant
females, or approaches more nearly to the confluent :  the degree of danger
is in proportion to  the violence and permanence of  the fever, the  amount
of eruption, the vigor of  the vital powers, the  disposition to putrescency
which  prevails.  When there is  a great tendency  this way, the  disease 
72
DISEASES  OF CHILDREN.
    usually proves fatal between the eighth  and eleventh  day, but  a fatal
    termination may be protracted till the fourteenth or sixteenth day.
      The more perfect the maturation, and filling  of the  pustules  by the
    fourth day, the less  the danger.  The more abundant  the eruption, the
    greater the danger;  the pustules eliminate  the morbid poison existing in
    the blood, and their proper filling up or  maturing is essential to  a cure.
    Delirium, suppression of the various secretions, great hoarseness, a  sudden
    suppression  of diarrhoea,  when  present,  are  dangerous  symptoms; the
    sloughing of any part,  the occurrence of convulsions, of erysipelas, will
    increase the probability  of a fatal termination.
      Treatment.—In  the  treatment  of small-pox, and  all  other eruptive
    fevers, there are  three prominent indications to be attended to.   We must
    equalize the circulation  and moderate the fever, when it is violent, by the
    arterial sedatives, aconite and asclepin, by mild  laxatives, as leptandrin
    and juglandin, by  diuretic  drinks, by tepid alkaline sponging;  we must
    support the vital  powers, when  they become  feeble, by  stimulants, by
    nourishing  broths, milk punch, essence of beef; we must combat any
    complication that  may arise with energy and  prudence, bearing in mind
    that no depleting  remedy can  be borne  by a system  aready prostrated
    and overcharged by a debilitating poison.
      Distinct small-pox requires but little medical  treatment, but the most
    thorough hygiene ; and if  the young patient is doing well, little medicine
    need be given.  Consequently, all  that is wanted in addition is  a plain
    unstimulating  diet, a guarded watchfulness  of complications, a 'cool airy
    apartment, bed clothes frequently changed, a regular sponging  every two
    hours, and plenty of water or lemonade to drink.  Supposing the case
*   does not  proceed as  favorably as  could be  desired, then we must attend
    to the prominent symptoms.
      If the  fever run  high,  we  may give aconite and  asclepin :  give  the
    patient plenty of fresh  air;  we would continue  actively  the  sponging.
    As the quantity as well  as  the quality of  the eruption depends much on
    the  violence and  duration of the eruptive  fever, and as by mitigating the
    one  we render  the  other more favorable, and for  effecting  this  desirable
    end, the above remedies I greatly esteem, more  especially the  repeated
    sponging; it mitigates  the headache, the  pain  in the  back, and other
    febrile  symptoms, a slow and  gentle  perspiration  is induced, and  a mild
    eruption is the  result.  If it is early resorted  to, with other appropriate
    treatment, the  febrile symptoms are  controlled, elimination is aided, the
    number of pustules are diminished, the danger of the disease is  lessened.
    The temperature of  the patient's chamber  should be such that he may
    experience no sensation of  cold or heat, comfortable.  He should lie on  a
    mattress covered with a few bed-clothes ;* he should have the apartment
    to himself, and everything  about him should be frequently changed.
     I  have  succeeded well, before beginning any treatment, by giving an
    emetic of the C.  powder of lobelia, and letting the patient drink freely
    of an infusion  of sweet  marjoram and the  pitcher plant.  The pitcher
   plant undoubtedly exercises a  specific action on the virus, and  under its
   exhibition, with proper auxiliary  treatment, many cases  cannot only be
   modified, but effectually  cut short,  Small doses  of the sulphite of soda
    should also be  given all through the case.
     With regard to  the use  of purgatives,  of the very mildest character
   and used for the purpose of diminishing excitement in the  distinct variety 
THE ERUPTIVE FEVERS.
73
they  may prove  serviceable,  if  moderately given, as the  neutralizing
oordial, juglandin, leptandrin, &c.;  but if the case  is aggravated, or of a
typhoid character, they should not be given.  Where constipation prevails,
enemas of tepid water will answer  well.  If convulsions  occur previous
to the appearance  of the eruption,  then the warm  bath, the vapor bath,
the administration of the C. tincture of lobelia, with small doses of bella-
donna, will be appropriate treatment, and if it does not yield, friction to
the surface with dry mustard,  counter-irritation to the spine and extremi-
ties, and  some diaphoretics, as C. tincture of serpentaria with stramonium.
The same remedies, with the addition of carb. ammonia and macrotin, in
an infusion of saffron or sweet marjoram, may be used if the  eruption does
not come out kindly, together with nourishment.
   I have always found it good practice to allay all irritability and rest-
lessness,  either  by Dover's powder or  hyosciamin.   It  is well by this
mode of treatment, to  control the febrile symptoms, lessen the action of
the  heart,  allay thirst  and  every symptom promptly.  If the  febrile
symptoms continue considerable, and  the eruption well developed, the
plan of treatment  must not be  relaxed.  If a great degree of cynanche
is present, gargles and the  inhalation of vapor may be used.
   In those cases where  the pustules contain a thin watery fluid, and are
accompanied with great soreness, uneasiness, loss of strength, prostration,
&c, the C. tincture of cinchona  should be given in large  doses, and per-
severed  with in alternation  with milk  punch.   Even in  the  confluent
variety, where there is a putrid tendency, where  the pustules are filled
with a thin ichorous fluid, bark  and alcoholic stimulants  are our  sheet-
anchor.
   If  the  eruption, after having made its appearance, strike in suddenly,
and is attended with  weak  pulse, a sinking  in  of the  pustules, then a
liberal use of milk punch or wine, with mustard to the  extremities, and
diffusible stimulants, as ammonia, serpentaria, warm bath, &c.
  In  treating  the secondary fever, attend to  the  bowels: administer
sedatives if there is irritability;  and if  suppuration in the  pustules does
not go on kindly,  nourish well with beef tea, milk punch,  eggs, wine or
brandy.   If the,mouth and  throat become implicated, mucilaginous drinks
and  an emetic may be resorted  to.  Any determination  of blood  to the
head or chest, or other viscera, require the foot bath and counter-irritation.
If suppression of urine should occur,  an onion  poultice  over the pubes,
and a few doses  of the  tinctures of gelseminum and cantharides,  and  if
these  and other  means fail,  the catheter should  be used.  Obstinate,
persistent vomiting proves troublesome, and is best relieved by effervescing
salines, or soda  water, or lime water,  or a  few  drops of laudanum and
chloroform ;  locally, counter-irritation over the stomach.
  Profuse, exhausting diarrhoea is a  troublesome and dangerous symptom ;
as it produces rapid debility, the safest  and best plan is  to endeavor to
moderate by such agents  as the  neutralizing cordial  and cranesbill.
There is little secondary fever in  the distinct variety, but a good deal in
the confluent: this of course  must be  carefully treated, chiefly by milk
punch wine, bark, &c.   To relieve the itching that is sometimes intolera-
ble, glycerine with camphor, or  glycerine, rose water, and  subnitrate  of

 * To* prevent pitting, the face should  be masked; it should  be bathed
with tepid inilk and water, and on the sixth  day a mask should be  worn, 
74
DISEASES  OF CHILDREN.
and  the face smeared  over with  sweet oil, or glycerine  and camphor, so
as to exclude  the  external air—a complete  covering.   There are also 'a
numerous class of  remedies  given for  this purpose, as the  pitcher plant,
chlorine, puncturing the pustules, and brushing them over with the nitrate
of silver, &c.   When  the pustules  are  numerous  on the face, the eyes
often become  affected, and a loss  of sight is not unfrequent.  In those
cases some mild astringent wash; glycerine should be used to prevent the
lids from adhering; bathing them with milk  and water.  In all cases the
patient's  strength  should  be  carefully  supported by  food of a  light
character and acidulated drinks; a liberal use of alcoholic stimulants is
always proper.
  In varicella, or chicken-pox, the eruption  generally commences on the
shoulders, breast, but usually spares the face.  There are no constitutional
symptoms of importance: it  is contagious, runs its course in six days, and
requires little treatment aside  from hygienic measures.
  Vaccination should be performed on all children at the sixth month, and
repeated at the age of  puberty; in practising this, the lymph should be
fresh, taken from a vesicle'on the seventh or eighth day, of a healthy
child free from any hereditary taint or disease.

                              MEASLES.

  Measles, a continued contagious fever, accompanied by an eruption, and
frequently attended with inflammation of the  mucous membrane of the
respiratory organs.  The period of incubation varies from ten to fourteen
days, during which there is little disturbance to  the general health;  a
feeling of languor, with slight cough ; symptoms of fever and catarrh begin
to show  themselves, followed by rigors; sneezing,  a diffusion of thin
humors from the eyes and nose, the  eyes are suffused,  the membrane of
the  nose, the  fauces  and the  larynx become affected: the  eyelids are
swollen,  intolerance of  light, dry hollow  cough, hoarseness,  dyspnoea,
drowsiness, a tendency to delirium, great  heat of skin, and frequent and
hard pulse.  The eruption comes out at the end of  the third or beginning
of the  fourth day of the  disease ;  seldom earlier, often later.  It consists
of small circular  spots,  resembling  flea-bites, which  gradually coalesce
into  patches ; these are of a dull dingy red color, present frequently a
crescentic shape, and slightly raised  above the surface of the skin.   The
first  appearance of the rash is  on the forehead  and face, and gradually
extends downwards; it begins to fade in the seventh  day in  the  same
order, and without  producing much marked desquamation.  The diarrhoea,
which sometimes sets in,  is for the most part  beneficial.   The fever does
not abate on the appearance of the eruption.   The contagion of measles
is strong :  most powerful during the eruptive stage.
  Scarlatina  sometimes resembles measle's ;  the  redness of scarlet fever  '
is more diffused, and is not in  distinct spots with  the natural color of the
skin  interposed.   In  measles, the eruption rises  above  the skin, and
occasions a roughness to  the touch, which is hardly observable in scarlet
fever.  In scarlatina  there  is  seldom any cough, the eyes do not water
the eyelids are not red or swollen, all which rarely  fail to attend measles.
The  time of the eruption is also different; for it  appears in scarlet fever
both on the face and arms, about the second day, but in  measles it begins
to be visible about the third  day on the chin and breast, and does not
come on the arms and hands till the fourth or fifth day. 
THE ERUPTIVE FEVERS.
75
 , The measles may prevail at all seasons of the year as an epidemic, but
 the middle of winter is the time they are  usually most  prevalent;  they
 attack all persons of all ages, but children are most liable to them.   Like
 the small-pox, they never affect a person but  once ; their contagion is of
 a specific character.  It is like  all other diseases, worse in the scrofulous.
   Prognosis.—This will depend upon the mildness  or  severity of the
 chest symptoms ; the complications are more to be dreaded, such as severe
 ophthalmia,  laryngeal  and  croup  affections, bronchitis  or pneumonia,
 consumption or hectic fever may arise.  Pneumonia, diarrhoea, and even
 dropsy are sometimes the consequences.  In some cases the measles make
 their attack  in a mild manner, and go through their natural course without
 medical  aid; but in others, the febrile symptoms run high, particularly
 after the appearance of the eruption, and are accompanied with a strong
 pulse, much  coughing, great  difficulty of breathing, and  other symptoms
 of pneumonia.
   Treatment.—During the whole course of the  disease it is proper to
 attend to all the  secretions ; and, therefore, if  constipation  prevails, it
 should be obviated by administering the neutralizing cordial, or leptandrin
 and juglandin, or enemas.  Should the difficulty of breathing and oppres-
 sion of the  chest  be not relieved  by aconite, gelsemin  and asclepin, in
 alternation with pulsatilla, or C. tincture serpentaria and  aconite, then
 counter-irritation  over the chest by capsicum aud vinegar, or mustard,
 often proves  valuable.
   The entire surface  of the patient  must be sponged with the  warm
 alkaline wash every two or three hours ; this gives  great comfort, allays
 restlessness,  promotes convalescence.  Exposure to cold must be carefully
 guarded against.  The patient  should be confined to bed, the apartment
 should be darkened, and kept moderately warm.
   The cough is usually troublesome, and it is usually necessary to give
 mucilaginous drinks, mild diaphoretics, as asclepin, gelsemin and lupulin,
 syrup of poppies, or  simple syrup with cypripedin, and any good acidulated
 drink.  In addition, if the cough proves very troublesome, and  is attended
 with  great   difficulty of breathing, inhaling  the vapor  of vinegar, or
 stramonium,  may prove serviceable.  If the febrile  symptoms run  high,
 the arterial sedatives, together with attention to the great emunctories, is
 essential.
  When  the cough  harasses the patient a great deal at night, then the
 diaphoretic powder at night, or  small and repeated doses of a combination
 of wild.cherry, lupulin, lobelia, and hyosciamus  in  syrup, or  an infusion
 of trillum pendulum, asclepias and hair-cap moss.   Opiates, more especially
 opium, should be administered with great caution, not only in this disease,
 but in all diseases of an inflammatory character, and should not be given
 if  we have a high  grade of fever.  Arterial  sedation  usually affords all
 the  relief  required;  those  valuable  remedies,  aconite, gelsemin  and
asclepin, usually allay the fever, relieve  the respiration, and keep  the
secretions relaxed,  whereas the reverse takes place with opium.
  If the diarrhoea   prove exhausting, geranin, hamamelin  and myricin
should be given, with the neutralizing  cordial; but as an open condition
of the bowels proves serviceable, it should not be  suppressed unless  it is
 violent.
  When the  eruption of measles disappears  before  the proper period, and
 there are  anxiety, delirium, or convulsions  occurring,  the  indication 
76                     DISEASES OF CHILDREN.
evidently is to restore the eruption.   To effect this, immediate  recourse
must be had to the warm  mustard bath, or the vapor bath, the administra-
tion of some of  the following  remedies, either C. tincture serpentaria, or
Pulsatilla and aconite, or ammonia and  the C. powder of lobelia, will be
the  best  remedies;  if there  be debility, or  any  malignant tendency,
nourishing broths, wine, milk punch, cinchona, are pre-eminently indicated.
   Although  we  thus  inculcate  confinement  to bed,  the  avoidance  of
exposure to cold, and a comfortable room, still the patient should not be
loaded with bed clothes.  It is true thorough hygiene should be enforced.
Arterial sedation should  be carefully watched;  we should bear in mind
its tendency; never debilitate in weak habits.
   The  state  of  the three great  cavities  must be  carefully watched,
especially towards the decline of the eruption, and should any indications
arise they should be  met  promptly  on  general  principles.   After  the
disappearance of the eruption, it is proper to give some cooling purgative,
juglandin and leptandrin ;  this is worthy of attention, as many trouble-
some complaints  are thereby prevented.   After the  affection has entirely
subsided, the  patient shoubi be warmly  clad, and not  allowed to go  out
too early, and convalescence established  upon bark, hydrastis and pyro-
phosphate of iron.
                             SCARLATINA.
   Scarlet fever is an  infectious and  contagious febrile  disease, charac-
terized by an extensively-diffused bright scarlet efflorescence of the skin,
and of the mucous membrane of the fauces and tonsils, commencing about
the second  day of the fever, and declining about the fifth ;  it  is  often
accompanied by inflammation of the throat, and sometimes  of the submaxil-
lary glands.  It is  essentially a disease  of  childhood.  The  average
mortality has been great.
   It is divided into  three kinds or grades,  the type depending chiefly on
the amount of the poison absorbed, and  the vital power  of resistance of
the patient; when unaccompanied with an ulceration  of  the  throat, and
the skin only is affected, it is scarlatina simple; when  attended with a
great deal of throat  affection,  as well  as  the skin, it is called scarlatina
anginosa;  and scarlatina maligna when  all  the force of the poison seems
to be expended on the throat, when there are  symptoms of putrescency
present.
   It  has  been disputed whether the  poison  of scarlet fever, malignant
sore, and  diphtheria are  different diseases, or only  varieties of the same
disease.  In my opinion  they  are  the   same,  operating with  different
degrees of  intensity  at peculiar periods and in different constitutions and
temperaments, according to the amount of the poison received.   Scarlatina
does  not always  assume precisely the  same appearance.   This diversity
depends on many contingent causes: the nature of the poison, location,
season of the year,  the temperature of  the atmosphere,  the  mildness or
inclemency of the weather, the circumstances in which  the  patient is
placed, the habit of  body and  constitution, the state  of health at  the time
of the attack, and  their situation with  reference  to  hygiene.   If  the
patient has once had the affection, it is  not liable to recur.  It may attack
persons of all ages, but more particularly children.
   Scarlatina is of a very contagious character:  simple contact,  inocula-
tion  and  inhalation, are  the  channels by which the  infection  may  be 
THE ERUPTIVE FEVERS.
77
introduced into the body.  Undoubtedly the grand avenue of infection is
the respiratory mucous membrane.   The  disorder  to  which scarlatina
bears the greatest resemblance is measles, but from this  affection it may
be distinguished by the following characteristics :
  The efflorescence in  scarlatina generally appears on the  second day of
the fever; in  measles, it is  seldom very evident  until the fourth.  It is
much more full  and spreading  in  the former  disease than in the latter,
and consists of innumerable  points and specks under the  cuticle, inter-
mixed with minute papulae;  in some  cases forming continuous, irregular
patches, in others coalescing into an uniform flush over a considerable
extent of surface.   In measles, the rash is composed of circular dots, partly
distinct, partly set in small clusters or patches, and a little elevated, so as
to give the sensation of roughness when the fingers are pressed over  them.
These patches are seldom confluent, but form a number of crescents, with
large intervening portions of cuticle, which retain their usual appearance.
The color  of the rash is always different in  the two diseases,  being vivid
red in scarlatina, but in measles a dark red.
   During the febrile stage, the measles  are distinguished by an obstinate
harsh cough; by an inflammation of the eyes  and eyelids, with great
sensibility to  light; by an increased discharge from the lachrymal glands,
sneezing, &c.  Scarlatina is frequently attended with cough, redness in
 the eyes;  the cough  in scarlatina is  short, irritating, without expectora-
tion ;  the  redness of the eyes is not attended with intolerance of  light;
the ciliary glands are not affected ; and that, although the eyes are shining
and watery, they never overflow.  In scarlatina  there is  more  anxiety,
depression, weakness, adynamia than  in measles; in the latter the  symp-
 toms are strongly inflammatory.
   The chief  distinctions between the  simple and  the more  aggravated
form consists in  the fever  being great,  but little  difficulty  about the
 throat; the  more  malignant or aggravated, the  greater the fetor of the
 breath ; the fever is  more of a typhoid kind.  In simple scarlet fever, the
 skin  is of a bright scarlet color, smooth, and  always dry and  hot;  in the
 more malignant form it is red, pimply;  the pimples being redder than the
 interstices.
   Scarlet fever begins with  lassitude, debility, confusion of ideas, chills,
 shiverings, alternated by fits of heat; the thirst is great, the skin is dry,
 the  patient  is restless, anxious, nausea,  and  perhaps vomiting.   The
 evacuations  are usually normal, the  pulse feeble but quick,  and in some
 few cases slight affection of the fauces may be perceived.
    About  the second or third day the scarlet efflorescence appea/s  on the
 skin which seldom produces any remission of the fever.   On the departure
 of the efflorescence, which  usually continues  out for about three or four
 days, a mild perspiration comes on, the  fever subsides, the  cuticle falls
 off in small  scales, the patient regains his health  usually rapidly.
    At the same time that the efflorescence  spreads on the body, the mucous
 membrane of the mouth, fauces and  nostrils  also becomes affected.  The
 appearance of the tongue is very characteristic of scarlatina.   At first it
 is covered with a thick white fur, through which the elongated papillea
 projects, but as this fur clears away it becomes clean, preternaturally red,
 of a strawberry appearance.  The affection of the mucous membrane of
 the mouth terminates by resolution, with the  disappearance of the febrile
 symptoms ;  eight or nine days being the  usual period. 
78                    DISEASES OF  CHILDREN.
  In  scarlatina  anginosa,  the  symptoms  are  more violent than  the
preceding; coldness, shivering, languor, debility, sickness, nausea, vomiting
of bilious matter, headache, delirium, pungent heat of skin, marked pros-
tration.  About the second  day stiffness of the neck, uneasiness  of the
throat, hoarseness and  pain  on swallowing.  The fauces, palate, uvula
and tonsils are red, swollen ;  the inflamed surface is  covered with coagu-
lable  lymph.  As this  inflammation goes  on, all  the febrile symptoms
increase ; the skin is very dry and hot.   When  the efflorescence appears,
it brings no relief:  on the contrary, the symptoms are aggravated, fresh
ones arise.   The efflorescence does  not  observe  the same regularity as in
the simple form;  it does not appear so early,  is delayed to the third or
fourth day, comes out in patches on the arms and chest, shows a tendency
to vanish and re-appear.  In the  progress  of the disease, one universal
redness pervades the face, body and  limbs, which  appear somewhat swollen.
The eyes and nostrils  partake more  or less of the redness;  and in propor-
tion as the  former  have an  inflamed appearance, so does the tendency to
delirium prevail.  With the fading of the  eruption, about the fifth or
sixth day, the fever and inflammation of the throat begin to abate, although
the throat often remains sore for a week or  ten days  after the disappear-
ance  of  the  rash.  This variety of fever  sometimes assumes a more
aggravated form ;  being accompanied with  an acrid  discharge from  the
nostrils and  ears,  deafness, inflammation   of  the parotid glands,  and
suppuration sometimes takes place.
  Malignant scarlet fever differs but little from the above in its symptoms;
the fever soon assumes a malignant or  typhoid  character, great cerebral
disturbances  being  superadded to  the  affection  of the fauces and skin,
great irritability, restlessness, delirium of a low muttering character.  The
tongue is dry, brown,  tender  and chapped ;  the  lips,  teeth  and gums are
covered with sordes; the breath is fetid.   The throat is swollen, of a dusky
red hue; the tonsils and other parts are covered with incrustations, con-
sisting of exudations of lymph, or in  some cases gangrene sets in.   The
cervical glands are involved  in  the inflammation.  The rash is irregular
in its  appearance and in its duration: at first it is pale, but soon becomes
changed to a dark livid red;  petechia also often appears upon the skin.
If relief is not prompt, many cases  of this malignant form of scarlet fever
terminate fatally on the  third or fourth day.  It is a  disease of great
danger; great hopes may be  entertained if  the seventh day be passed.
  Prognosis.—Scarlatina  in  its mild form  is not usually attended with
danger, but when the system seems saturated with the poison, and partakes
much of the nature of malignant, or discovers a putrid tendency, it often
proves fatal.  The  discharge of a  highly acrid matter  from the nose,
diarrhoea, the fauces of  a dark red or purple color, without swelling,  ash-
colored or  brown  specks, soon becoming ulcerated, great prostration of
strength, delirium, coma, anxious difficulty of  breathing, petechia, sordes,
&c, are very unfavorable symptoms.
  Treatment.—If called in on the onset of  the  disease, when the skin is
dry and hot, pulse much  accelerated, coated tongue, the  best thing we
can do is to give the patient first an  emetic of  the C. powder of lobelia,
then follow with the alcoholic vapor bath, then put the patient to bed  in a
well-ventilated apartment, have him  sponged the entire surface every  two
hours with  the warm  alkaline wash, open the bowels with an enema of
tepid water.   Then place  the patient upon  aconite and belladonna, suffi- 
THE ERUPTIVE  FEVERS.                     79
cient to keep ihe pulse about seventy-five, and alternate this with chlorate
of potassae in syrup.
  An emetic should never be omitted, and even a repetition of it is often
the means of preventing complications.  After the emetic, it is always
well to  cleanse  the alimentary tract;  purgatives should  be carefully
avoided.^ After the bowels have  been once  unloaded, arterial sedatives
are specially demanded;  the head should be kept cool, and if there are
symptoms of delirium, belladonna and  stramonium are the remedies.  If
symptoms  of depression or collapse appear, wine, ammonia, capsicum,
nourishing food should  be ordered.  Plain  cold  or  tepid water  to the
throat is better than  capsicum and  vinegar.  If the aconite fail in main-
taining moisture on the skin, in promoting elimination of the poison, then
combine it with asclepin, or the C. tincture of  serpentaria, or an infusion
of some diaphoretic tea.
   Throughout the whole course of the disease, if there is either inflammation
or ulceration of the throat, it will be proper to make use of some detergent
gargle.  When the throat is much affected, capsicum and vinegar applied,
and kept on till some degree of irritation is produced.  Wrhen the fauces
are in  a sloughy state, a warm fomentation  of nitric  acid, highly diluted
with  a stimulating gargle of tincture  capsicum and  myrrh, will prove
highly serviceable   To give the patient sleep is all important and essen-
tial ;  for this, hyosciamin in a little  camphor water, or lupulin  with minute
doses of gelsemin  and belladonna.   Opium  is never indicated; it proves
injurious.
   In those cases of scarlet fever which  show a disposition to malignancy
or putrescency, it is always  advisable  to  give cinchona  in substance,
decoction or infusion, with the  mineral acids, or the permanganate  or
chlorate of potassea.  Chlorine  is  often useful, so is pyroligneous acid,
baptisin.  In this  grade, a stimulating plan  of treatment is the best;  the
 vital powers  are  so prostrated  that unless we support them by the free
 administration of  brandy, wine  and bark, agents which* are calculated to
 prevent a metamorphosis, which, if not given, the vital powers would fail.
 I like the carbonate  of ammonia given in alternation with the  above ; it is
 very beneficial in this disease.
   My usual plan of  treatment of this disease is simple, simply eliminative
 and supporting,  meeting the  indications promptly and efficiently.   When
 the fever has abated, cinchona, hydrastin, iron, pyrophosphate, phosphoric
 acid, stimulants, with  nourishing diet, pure  air, and gentle  exercise will
 greatly accelerate the  recovery of the patient.
   Scarlatina being  a very contageous disease, and never failing to  excite
 the greatest consternation and anxiety,  it should be our aim  to annihilate
 the powers of contagion ; we may employ  fumigations of chlorine and
 bromine.
   In regard to prevention, it is obvious that an improvement of the diet
 in those who live  low, moderate  exercise in the open  air, and, in  short,
 they should do everything to promote the building up of the vital powers,
 thorough hygiene, cleanliness and ventilation.  Those in attendance should
 avoid  as much as possible, the inhalation  of the breath or emanations of
 the sick, as scarlatina is most frequently received in this way.
    Sequela.__Children, who suffer  from this fever, are liable to  certain
 consequences, permanent  affections, as ophthalmia, enlargement of the
 cervical glands, &c.;  but  the  most common,  and the  most serious, is an 
80
DISEASES  OF CHILDREN.
affection  of the  kidneys, with anasarca, characterized by cloudy, scanty,
albuminous urine, general serous infiltration of the larger serous cavities.
This sequel is most common after a mild attack, owing to a want of caution
which is observed in such cases.  The patient may expose himself to the
action of the cold; the exposure arrests the functions of the skin ;  the
scarlatinal  poison, which was being eliminated by the cutaneous excretion,
is .thrown back into the circulation ; the kidneys are called upon to do the
work—eliminate that material which the skin has been rendered incapable
of doing—but the contaminated blood is sent to them in larger quantities
than they can bear.   The  same  blood  is intensely serous, white-cell; it
overwhelms them, and hence we have inflammation of the kidneys.
  Acute Desquamative JVephritis is best treated by rest to  the  kidneys,
and purifying the blood  by other channels ; for this purpose, rest in bed
in a  warm room, good diet, consisting of the elements of blood, the vapor
bath daily, the  diaphoretic powder, given with podophyllin, jalapin and
B. tartrate of potassea,  free  purgation,  and a judicious  use  of such
remedies as digitalis, iodide potassea, iron.
  During  the presence  of this  dropsy, children are very apt to suffer
from odema of the lungs; the symptoms in the commencement are those
of bronchitis, but at the end of  two or three days  the breathing becomes
hurried,  dyspnoea, violent action of the heart, feeble pulse.  The only  i
relief consists in free purging, the vapor bath, lobelia emetic, and frequently
repeated doses of the eupurpurin.
                       DISEASES OF  THE SKIN.

  In no department of medical science have we  made such progress as in
the treatment of  cutaneous diseases.   The old school treatment of these
affections has  been very erroneous  and exceedingly mischievous, whereas
in the new  school mode of treatment we have been wonderfully successful,
and the  diagnosis rendered simple and intelligible.   Most of the common
cutaneous affections  are  very irritating and unsightly,  and are generally
merely local manifestations of a constitutional disorder. In speaking of this
subject, we think that the best classification is as follows :  erythematous
eruptions,  hemorrhagic,  vesicular,  bullous, pustular^  parasite^ papular%
squamous, tubercular, maculea.

                           1.—ERYTHEMA.

  Erythema is  a non-contagious,  superficial inflammation  of the skin;
characterized  by red  patches of variable form and extent,  occurring  on
the face, chest, and extremities.   Its duration varies from a week to two
weeks;  it is seldom preceded  by febrile symptoms ;  it causes little heat,
pain, and terminates  by slight exfoliation of the epidermis ; prognosis is
always favorable.
  Treatment.—This is very simple.   The vapor bath, followed with alka-
line  sponging; an emetic, unlock the* secretions  with juglandin, irisin and
podophyllin ; aconite  and belladonna,  then light diet,  tonics, bark,  C.
tincture tamarac, nitro-muriatic acid.
  Roseola  is  a  mild,  non-contagious inflammation of the  skin, charac-
terized  by  rose-colored  spots  or  transient patches  of  redness, small
irregular in  size, distributed  more  or less over the body.   It is  accom-
panied with fever, and lasts from twenty-four hours to a week.
  Treatment.—This is simple; warm  baths, aconite and asclepias, active 
THE ERUPTIVE  FEVERS.
81
secretions, and a slight alterative course by menispermin and  irisin and
tonics.
   Urticaria.—Nettle-rash is a transient, non-contagious exanthematous
eruption, characterized by long,  prominent patches of  irregular shape,
uncertain  in  its duration.   There is heat, burning and  tingling in the
spots, itching aud some gastric disturbance.
   Treatment.—Give  an emetic of the C. tincture of lobelia; follow with
a cathartic, bathe or sponge every three hours with the alkaline wash;
give aconite and the C. tincture  serpentaria, or the C. tincture corydalis,
with a solution of the acetate of potash.
                          2.—HEMORRHAGE*..
   Purpura.—This disease arises from a morbid condition of the  blood.  It
is deficient in fibrinous elements, while the capillary vessels are softened;
there is  a  want  of  tone in all the tissues.   Hence extravasation of blood
from inherent weakness, pressure, or the force of the circulation.
   Symptoms.—The spots or patches vary in color, being red, purple,
livid or  reddish brown,  bearing  a resemblance  to  bruises, ecchymosis;
pressure does not  efface them ; they are sometimes persistent.  Debility
is the type or characteristic ; depression, hectic, faintness, oedema of  the
extremities, prostration.   There  are  several  varieties.   It must not be
confounded with  scurvy, which  is attended  by a  spongy state of  the
gums.
   Treatment.—As purpura is a disease of debility, the treatment must, of
course, consist in the exhibition of the best blood elaborating  diet—beef,
eggs, soups;  give the alt.  stillingin in  glycerine,  alternate  with nitro-
muriatic acid  : attend to  the liver with leptrandrin, the  pyrophosphate of
iron with  the sulphate of cinchonine ; bathing with water medicated with
nitro-muriatic acid, the  sea-side, cod-liver oil. and bark.  Turpentine is
highly esteemed by the old  school.
   Scurvy.—This is a peculiar disease, caused by being deprived of  vege-
table diet,  The blood is deficient in its alkaline elements; and this is  the
cause of the various symptoms ; sallow, dusky countenance : swollen, spongy,
livid-colored gums : they bleed on the slightest touch ; the teeth loose ; breath
offensive; debility as the disease advances;  urgent dyspnoea: the  gums
frequently slough", and hemorrhages from them as well as the mouth, nose,
stomach and  intestines  are not uncommon.   Ecchymosis, or effusions of
blood beneath the skin,  especially on the  lower* extremities, looking like
bruises.    The legs swell, the skin is very dry and rough, urine scanty,
spontaneous salivation, constipation, and latterly general exhaustion.
   Treatment.—As the blood is deficient in its alkaline properties, the sul-
phite of soda, or the tartrate, chlorate, or phosphate of potash are  indi-
cated, then vegetables which possess anti-scorbutic qualities, as oranges,
lemons,  potatoes, and a course of vegetable and mineral tonics.

                             3.--VESICUL.E.
  Sudamina. appear in many acute and chronic diseases;  they are  com-
mon in acute rheumatism, typhoid  fever, &c, and do  not  require  special

 rejjerPes —Herpes, or tetter, is a  non-contagious  affection, consisting of
clusters of globular vesicles upon  inflamed patches of irregular size and
form- run a regular course, not severe, and no constitutional symptoms.
  Treatment.—*Gentle  laxatives, as  juglandin, warm  baths, a  good but 
82
DISEASES  OF CHILDREN.
 unstimulating diet.  The local irritation maybe relieved  by a lotion of
 lime-water or the zinc ointment, lotion of the acetate of lead, of glycerine
 and chlorate of potassas, borax, morphia and glycerine.
   Eczema.   There are various forms and species of eczema, all of a non-
 contagious character, consisting of an eruption of small vesicles on various
 parts  of the skin, closely crowded  together—often  running  mto  each
 other—so as to form, on being ruptured, superficial  moist excoriations.
 Mal-assimilation and faulty secretion of milk  on  the part of the  mother.
 If it once attacks  an infant, it gives rise to the  greatest  trouble.  The
 general health becomes affected, intense itching and burning heat  of skin,
 and the sufferer becomes pale, weak, anemic  and  emaciated.  Sometimes,
 in strumous  cases, the  whole of  the  body becomes covered  with these
 eruptions ; the excoriations are most irritating, and the ichorous discharge
 from them is very disgusting.
   Treatment.—There are three indications to be fulfilled  in the treatment
 of eczema, to wit:  elimination, the  relief of the  local distress,  and the
 restoration of the impaired vital forces.
   For an alterative to fulfill the first indication : irisin, gold, the stillingia
 alt., phytolacin and leptandrin.  It  is sometimes  good to give an emetic
 to stimulate the liver and  obtain a perfect  clearness of the stomach and
 bowels.   As a local  remedy, a solution of the  bi-carbonate of soda, con-
 sisting of  3ss. of  the common carbonate of soda  dissolved in  a  pint of
 water ; cover with oil-silk or gutta  percha sheeting, or the benzoated oxide
 of zinc ointment, a solution of phenol sodique.
   The mal-assimilation must be rectified, the blood  purified and restored
 to its normal condition;  and our best agent for effecting this is  that valu-
 able alterative, stillingia alt. in  glycerine ; gold, muriate of  platinum.
 The sulphites are  useful.  The acetate of potash internally given  with
 colchicum, corydalis, or  an  infusion  of alnus, rumin and  jeff'ersonia, cod-
 liver oil and  iron.   The diet should be wholesome and nutritious ; milk and
 brandy, strong beef tea, white of egg.

                             4.—BULL^.
   Pemphigus.—This affection is characterized by the appearance of large
 bullae, two or three inches in diameter, upon one or more regions of the
 body.   Before the appearance of the eruption, slight indisposition, fever,
 itching of the  skin;  small red circular patches then form,  gradually
 increase in extent, and  become covered with  bullae, which  either  fade
 away on  attaining their full size,  or burst, and are replaced by thin,
 brownish-colored incrustations.  Its duration is  about twenty-one days,
 although it may last for months.
   The class of patients subject to it  are the filthy, squalid  inhabitants of
 ill-ventilated  abodes.  It sometimes affects  children;  it may be  due  to
 over-feeding, to teething, or to some gastric or intestinal irritation.
   Treatment.—C. syr. frostwort or celastrus, alteratives, warm  bathing
 with an alkali, tonics, with  generous diet and fresh air, are  the  remedies.
 Locally the alakine wash.

                            5.—PUSTULEA.
   Impetigo.— Impetigo,  or  running tetter, is a  severe  non-contagious
inflammation of the skin, characterized by an  eruption  of  small hemis-
pherical or flattened pustules in clusters, and forming thick,  rough, yellow
scales  or incrustations.   From  beneath  these incrustations a  discharge 
THE ERUPTIVE  FEVERS.                    83    »   *
SGn'flaCG '  rhe Crusts become thicker and larger, and they fall off, leav-
7LI    ™ surface;   The mode of  distribution has caused a division of the
disease in, several varieties.
oiiroi"*erf'Wmi/i:~"This affecti°n, in all its forms, is best treated by the weak
aiJcaline wash constantly applied  and kept moist.  Alkalies applied from
ume to time only irritate, but when employed continuously they are sooth-
ing   i have  also derived great benefit from the benzoated oxide of zinc
ointment, diluted with  glycerine, applied thrice  daily ;  also olive oil and
lime-water is soothing; elder ointment, or a decoction of phytolacea, or a
lotion  ot  oxalic  acid or creasote wash.  The  constitutional treatment
should consist m attention to diet, the exhibition of  small  doses of irisin,
tonics, hydrastis, cinchona.

                            6.—PARASITICI.
   Tinea Jonsurans is a chronic  contagious disease, caused by a parasite
mucedmous plant—common name, ringworm.  It may occur  in any part
of the body,  but the head is most frequently the  seat of the disease.
   Tinea Favosa commonly  affects the  scalp  in  the form of small crap-
shaped, dry,  bright yellow crusts; each  containing  a hair in its centre,
resembles  a  piece  of honey-comb.   The  scabs increase in size, and  are
highly contagious.   This parasite causes yellow distinct pustules, which
are very itchy and corrosive.
   Tinea Decalvans is  readily recognized by the perfectly smooth  bald
patches, which result from the hair falling off.
   Tinea Sycosis  is  another  species, due to a  parasite, which  creates
inflammation of the hair follicles, eruptions of small acuminated pustules,
occurring most frequently on the chin.
   Treatment.—The treatment is the same in all the varieties.  Cleanli-
ness is very essential.  The disease  can only be  cured by the destruction
of the spores of the parasitic plant.  This can be effected in various ways.
A lotion of the sulphite of soda  or  sulphurous acid, or acetic acid, oil of
cade, pitch ointment; or what I prefer, is the phenol.  In all cases  the
local  treatment should be combined with constitutional treatment, an alte-
rative course, warm clothing,  good diet, tonics, iron, bark.
   Scabies.—Scabies, psora, or the itch, is a contagious disease—conta-
gious  in  the  sense which implies actual  contact—a vesicular eruption,
appearing with watery heads, attended with violent itching.  It may occur
on any part of the body, but it attacks by preference the finer portions of
the skin  inside of the fingers, arms, legs, &c.   The cause is an  insect,
acarus scabiei.
   Treatment.—This  affection is  readily cured by sulphur in a bath or in
ointment, or washing with benzine, oil bergamot, or  the liquid sulphuret
of lime, or an alcoholic solution of stanesacre, a lotion of the sulphate of
copper or iodide potassium.   The patient's  apparel, as well  as the  bed-
clothes, should be thoroughly cleansed.  Phenol sodique acts like a charm ;
it is positive in its effects.
                              7.—PAPULAE.
   Lichen.—This is a popular affection, readily recognized by the minute,
hard,  red elevations of  the  skin which it  presents,  together with  the
annoying pruritius.  There  are several varieties.
   Treatment.—Tepid alkaline baths, mild laxatives, as juglandin, irisin and
drinks of water medicated with nitro-muriatic acid, or a decoction of the 
•   *   84                     DISEASES OF  CHILDREN.

       vegetable alteratives.   The local irritation is quickly relieved by a lotion
       of lead-water and hydrocyanic acid, hydrochlorate of ammonia and vinegar.
          Prurigo.—Prurigo—itching—is a  cutaneous  disease, characterized by
    •   an eruption of small papulea or pimples, of the natural color of the skin-.
       It is a chronic affection, lasting  for years or months.   It is unendurable.
       It must be carefully  diagnosed from insects, as lice, which  are  easily
       destroyed by washing  with an infusion of lobelia.
       •   Treatment.—Alkaline, sulphur and nitro-muriatic acid  baths should be
       used daily.  The  best  local applications are vinegar, lime-water, C. tinc-
       ture of creasote, a lotion of prussic acid, tar ointment, carbolic acid and
       glycerine.   A general alterative course, stillingin, irisin,  gold, &c, nitro-
       muriatic acid, quinine, iron, nux vomica.
                                    8.—SQUAMA.
          Lepra.—This is perhaps the most obstinate and troublesome of all  cuta-
       neous diseases.  It is a non-contagious chronic eruption, consisting of red
       scaly circular  patches, of various sizes, scattered over the different  parts
       of the body, but most abundantly near the joints, as the elbow and knees.
       It may depend on syphilis or other causes of perverted nutrition ; if due
       to the former, the spots are copper: colored.
          Treatment.—In  this  affection of  the  skin we  have  an  excessively
       depraved or broken-down condition  of the  blood, consequently the  diet
       should consist mainly  of .the elements of blood;  all acids or articles of
       diet capable of creating or becoming  acid, must  be positively prohibited.
       Alkalies have  wonderful efficacy here; the sulphite of  soda, liquor potas-
       sea, iodide of  potassium are beneficial.  These remedies should be given,
       and alternately with them the stillingia alt., irisin, decoction of dulcamara
       The best local application is the alkaline wash,  the oil of cade in glycerine.
          Psoriasis.—Psoriasis  is closely allied  to lepra  in its  appearance and
       general pathology.  In psoriasis the patches are irregular, not depressed
       in the  centre ; in  lepra  they are circular, depressed in the  centre, with
       elevated margins.  It is#a chronic,  non-contagious inflammation of  the
       derma, characterized by the development of patches of various extent and
       form, slightly  raised above the level of the skin.  It may be local or dif-
       fused over all the body.   The treatment is the same as lepra.
          Pityriasis.—This disease is a chronic inflammation of the skin, attended
       with itching, and  characterized by the production of minute white scales
       or scurf in great quantity.  Parts covered with  hair are its most common
       seat.
          Treatment.—Tonics, alteratives, active secretions and  alkaline lotions
       to the affected part, the sesqui-carbonate of ammonia.   Phosphorus, either
       internally and locally, is a valuable medicinal  agent.
         Icthyosis.—Icthyosis,  the fish-skin disease,  is  characterized by  the
       development upon one or more  parts of the integuments of thick, hard,
       dry,  imbricated scales, of a dirty gray color, resting  on an uninflamed
       surface,  and unattended by heat, pain or itching.
          Treatment.—Simple warm and alkaline bath, and the use of alteratives
       calculated to augment the action of the capillaries.  Improve  the  secre
       tions by generous  diet, vigorous exercise in the open air.

                                  9.   TUBERCULA.
         There are several skin diseases that are usually classed under this head
       as elephantiasis, molluscum, acne, lupus, framboesia, keloid. 
DISEASES  OF THE NERVOUS SYSTEM.               85
   bkin diseases demand tonic remedies in all cases.   Baths are most essen-
tial remedies, the constant moist application.

                            10.--MACULEA.
   Under this head may be classed all those changes of cole* of the skin
from any cause.

                  DISEASES  OF THE  NERVOUS SYSTEM.       •
   Ihe extreme frequency of diseases of the  nervous system during  the
early period of life in our  country, its great fatality, with its  alarming
symptoms, invest these disorders with great interest and importance.   No
doubt our climate, our advanced civilization, as well as our habits, give a
rapid development to the elaboration of brain, and a great activity  of its
circulation.
   A child  suffering from acute  disease  of  the brain is listless; counte-
nance  anxious, haggard; face flushed, and turned  away from the light;
continually moaning, or uttering piercing cries; hot skin ; frequent irre-
gular pulse ; constantly putting its hand to the head; the scalp is heated,
veins prominent; the fontanelle  tense; the eyes half closed, the pupils
contracted; nausea, vomiting, irregular  respirations, difficulty of breath-
ing, hacking cough, and latterly convulsions.
   Anything that over-excites the nervous  system, or interferes with  the
natural functions of the  nervous centres, will be likely to induce con-
vulsions.   Fits may arise from structural disease of the brain, as tubercle,
phrenitis, apoplexy, &c, incompatibility of temperament of the parents,
or the one  being too old or too young.   They may arise from irritation, as
worms, &c.
   The principles of treatment in all cases are very plain: during the fit
the clothes about the neck and chest should be loosened, elevate the head,
admit plenty of fresh air, sprinkle water on the face ; then the warm bath,
cold being at the same  time  applied  to  the head and  spine by means of
pounded ice and  salt  in a  bladder; give an  emetic of the C. powder of
lobelia, and an enema of the  same ; then act on the bowels with podophyl-
lin, combined with some other agents calculated  to  meet the indications.
If from worms, santonine;  if from  weakness, with serous or white cell-
blood, iron ; if from dentition, lance  the gums, and  give  the elements of
bone ;  and to subdue the restlessness, give lobelia, hyoscyamus and hydro-
gyanic acid; and if these remedies fail, give chloroform by inhalation.

                      CONGESTION OF THE BRAIN.
  This may arise  from any  cause which  disturbs the circulation, as  the
poison of the eruptive fevers, the irritation of teething, and a great variety
of causes.                                   ......    ...    ,   ,  ,
   The symptoms are uneasiness, restlessness, irritability, disturbed sleep,
heat of the head, and pain, which is increased  by noise  or movements,
tension and prominence of the anterior fontanelle, general feverishness,
vomiting, and frequently constipation.  At the end of a few days it may
be that  the disturbance will cease, and  the  symptoms disappear;  or  in
more  serious  cases, we may have  the  congestion  terminating  in  those
formidable maladies, hemorrhage or effusion, or acute hydrocephalus.
   Treatment.__This will be varied to meet the  indications and the cir-
cumstances under which the congestion  occurs.  In all cases the symp-
toms should be controlled, if possible; counter-irritation  to the  extremi- 
86                     DISEASES  OF CHILDREN.
ties, and put the patient thoroughly under the influence of asclepin, aconite
and belladonna.  Apply over the back portion of the head cloths saturated
with the following mixture :

                  R.—Aqua dest., Oss ;
                       Chloride sodium, gi.;
                       Hartshorn, ,^i.;
          •             Spirits camphor, 3vi.—M.

  Change frequently.   If there is not much depression, active purgation,
clean  out the  intestinal tract, and if there is any suspicion of a loaded
condition of the stomach, an  emetic of the  comp.  powder of lobelia.
Sleep should be induced, if possible, by the  inunction of morphia, incor-
porated in glycerine, under  the  axilla.   Quietness, plenty of  fresh  air, a
cool apartment, are essential.
  In  merely  passive  congestion,  occurring during  the paroxysms  of
hooping-cough, or from some abdominal cause, I have found the antispas-
modic tincture  in alternation with hydrocyanic acid, highly useful, attend-
ing to the  secretions, and giving  irisin, gold and phosphorus.   At  the
same time the warm salt water bath, keeping the head cool and the body
warm, and establishing convalescence upon bark, hydrastin, &c, nourish-
ing food, beef tea, and soothing or allaying any  irritability that may
exist.
  But if effusion terminate either in cerebral or meningeal apoplexy, the
principles of treatment do not vary.  A cooling lotion to  the head, sina-
pisms to the extremities, the arterial sedatives, aconite, veratrum;  and if
prostration  supervene, stimulants.   As a general  rule  cerebral diseases
occur most frequently in children of the scrofulous diathesis, and  this con-
stitutional  taint modifies  the disease.  The  treatment of diseases of the
nervous system in children require the nicest discrimination and judgment.
We have tender bodies to deal with; the period of life modifies the  action
of medicines, and an  error  in  prescribing is usually serious.  No child
should  be treated with depressing remedies; they are dangerous, and
many have been sacrified at this altar.  There are several good landmarks.
Arterial sedatives, to lessen  or  reduce vascular action ;  the warm bath, a
powerful agent for relieving the  circulation ; mild purgation, to reduce
the heat, remove obnoxious matter, and encourage a flow of bile ; diuretics,
to promote  a copious  flow  of  urine;  and in the advanced  stages, gold,
irisin and the C. alterative, with iodide potassium,  for  the  purpose of
absorption.
                           HYDROCEPHALUS.
  Fever, pain in the head, particularly across the  brow, stupor, dilatation
of the pupils, suffused  redness of the eye, great sensibility to light, nausea,
vomiting, the pulse quick, then slow, and convulsions, are the usual  symp-
toms  of this  disease.   But these  are liable  to  great variation.   More
generally it begins slowly;  a  slight wasting of the  flesh, a  troublesome
cough, then cerebral congestion, with fever,  which is of a remittent type,
skin harsh and dry, appetite variable, thirst, furred tongue, breath offen-
sive,  nausea,  vomiting; bowels are disordered—usually constipation—
and the evacuations deficient in bile.  If the child can walk, it is easily
fatigued: has attacks  of giddiness, and in walking seems to drag one leg
It is drowsy, but very  restless ; it sleeps badly, moans, or grinds its teeth
screams, and awakes suddenly in alarm,  without any apparent cause
% 
DISEASES OF THE NERVOUS  SYSTEM.               87
   As  the  cases  progress the symptoms  become  established,  the child
^remains in  bed, has  a  most expressive  countenance, indicative of anxiety
•and suffering ; its eyes closed, eyebrows knit, and is annoyed by light and
 sound.  Symptoms aggravated at  night, mind  wanders, delirium, stupor
 or insensibility, picking at the nose and lips; .convulsions, or profound
 coma, usually terminate the scene.
   Prognosis.—This is highly  unfavorable,  even under the best treat-
 ment.   The  average duration of the disease is about  twenty-one days.
 It the patient cannot  be  raised up in bed without  great uneasiness, it
 is a bad symptom ;  so is  deafness, dilatation of the  pupil of either eye,
 or squinting, or both pupils much  dilated, a fatal termination is denoted.
 Stertorous  breathing, coma, with loss of sight, enlargement of the head,
 difficult  respiration, intermitting  pulse, involuntary  evacuations,  are
 unfavorable.
   Prophylactic treatment is most to be  depended on, for if the disease is
 once established  medication is of  little  avail.   If we  have scrofula  or
 tuberculosis as the diathesis of the mother,  she should  be forbid  nursing
 the  child;  it should be reared by a healthy  nurse, warmly clad, have the
 benefit of the cguntry air or  the  sea-side; and it  should be  carefully
 watched at weaning, and shielded as far as possible from the contagion of
 the  eruptive fevers, &c, whilst the diet should  be rich in the elements of
 blood.
   Treatment. —But if  we do not see the patient until the disease has set
 in, then the treatment  to be adopted should  vary according to the symp-
 toms which are present.   If it is marked by an  increased or inflammatory
 action in the  vessels of the brain, then asclepin, aconite and veratrin are
 indicated, and should be given to  lessen congestion, to diminish  arterial
 action ;  and this combination should be given and persevered with as long
 as any marked symptoms of congestion  continues.
   Purgatives and diuretics, by lessening the determination  to  the  head,
 wjll be necessary in all cases.   They are peculiarly indicated by the fetid
 stools ; podophyllin, leptandrin and bi-tartrate of  potassa, in doses suf-
 ficient  to obtain the desired  result.  Judicious counter-irritation  at the
 back of the neck, and  even keeping up a  discharge by  the veratrin oint-
 ment or podophyllin, sprinkled on  the denuded cutis, operates favorably.
   To aid re-absorption, irisin rarely fails  to  produce a good effect.   The
 local employment of cold  is an important remedy early in  the  disease;
 later the evaporating lotion or cloths wet with tepid water.
   My favorite remedy in  hydrocephalus is digitalis, which  I give in all
 stages 6f the disease, with marked benefit.  Whether it relieves by dimin-
 ishing arterial action,  or by its power as a diuretic, I am unable to say;
 certain it is  that good effects attend its use.   The best mode of administer-
 ing it is beginning with moderate doses, and increase till the system  is
 thoroughly  effected.  Give it with asclepin.
   It has been often asked whether vomiting might not be of utility in aid-
 ing in exciting absorption.  In  all  cases of encysted  dropsy little advan-
 tage can be derived from the action of  emetics,  but more  particularly in
 that of the  head.
   After the acute stage of the disease  has  been controlled or subsided,
 every means of supporting the strength should  be  embraced, which is to
 be done by tonics, port wine and water, or port wine and beef-tea.  The
 diet  should be light, but not poor, beef-tea, white of  egg, Liebig's food, 
88
DISEASES  OF CHILDREN.
arrow root; and if sickness causes all food to be rejected, iced champagne
is exceedingly useful.  Should the vital powers become depressed, stimu-
lants must be freely  given.
  If inflammation  of the brain supervene, (which is usually known by the
suddenness  of  the attack, partial or general  convulsions, fever, and  as
the convulsions diminish the child  becomes comatose, vomiting, stupor,
complete abolition  of intelligence, subsultus tendinum, strabismus, squint-
ing, contraction of the pupils, and  perhaps hemiplegia, quick irregular
pulse, open bowels, the motions passed involuntarily, the face pale, and the
expression vacant,) then we must rely upon cold to the  head, the use  of
purgatives, irisin,  iodide of  potassium and counter-irritation,.
  If the case should merge  into one of chronic hydrocephalus, which  is
usually well marked  by the impaired bodily functions, convulsions, twitch-
ing of  the muscles of the mouth, rolling of the eyes, enlargement of the
head, wasting in flesh.  The infant nurses greedily, and yet gets weaker.
  The treatment  which I have  found most  successful, consists  in the
administration of irisin and  gold, giving  diaphoretics  and diuretics, with
counter-irritation,  cathartics ; and convalescence is best established upon
quinine and hydrastin.in small doses, and a general alterative course.

                              EPILEPSY.
  This disease consists in a sudden deprivation of the senses, accompanied
with a violent convulsive motion of the whole body, recurring at intervals.
It is a common disease of infancy; female children are more subject to it
than males.  It attacks by fits, and after  a certain duration, goes off, leav-
ing the patient in  his usual, state of health ; but sometimes a considerable
degree of stupor and weakness remains behind, particularly where the dis-
ease has frequent  recurrences.   Its  returns are periodical, and.its parox-
ysms commence more frequently in the night.
  Epilepsy is properly distinguished into sympathetic and idiopathic, being
considered sympathetic when produced by an affection in some other parttif
the body, such as  acidities in the  stomach, worms, teething, &c. ; and
idiopathic, when it is a primary disease, neither dependent on  nor pro-
ceeding from any  other.
  The causes which  give rise to epilepsy  are blows, wounds, fractures and
injuries  to  the  head, effusion on the brain, tumors, concretions,  polypi,
malformation, violent affections of the nervous system, frights, passion,
great emotion, intoxication, acute pain,  worms, teething, suppression of
some evacuation, poisons.   Sometimes it is hereditary, and at  others it
depends on some predisposition, as plethora, debility.
   An attack of epilepsy is usually preceded by a heavy pain in the head
dimness  of sight, noise in the ears, palpitation, flatulency, languor, stupor,
spectral  illusions,  giddiness,  confusion of thought, and iu a few cases there
prevails  a sense of something like a cold  vapor rising to the  head ; but it
more generally happens that the patient falls down suddenly without much
warning; his eyes  are distorted or inverted, so that the white of them can
be seen , his fingers  are closely clenched : his limbs and  the trunk of  his
body, particularly on one side, are much  agitated ;  he foams at the mouth,
and thrusts out the tongue, which  often  suffers  great  injury  from  the
muscles of the lower jaw being also affected ; he loses all sense of feeling,
and not unfrequently voids both urine and fceces involuntarily.
  After a continuance of the convulsions  for some time they abate gradu 
EPILEPSY.
89
ally, and the patient continues for a short time in a state of insensibility;
but on coming to himself feels very languid and exhausted, and  retains
notthe smallest recollection of what has passed during the fit.
 ,  w uen tbe disease proceeds either from tumors, polypi, malformation of
the  bones of the skull, the case is hopeless.  When it arises from  heredi-
tary disposition, or  comes on after the age of puberty, or where  the fits
recur frequently, or have  become habitual, or of long duration, it  is diffi-
cult to cure.   But when it comes  on  at  an early day, is  occasioned  by
worms, or any accidental  cause, it  is  amenable to  treatment.  It termi-
nates in apoplexy, in mental derangement, impairment of the mental facul-
ties, imbecility.
   Epilepsy has been  perceived  to disappear  suddenly about the  age of
puberty, liable  to increase in parturition, and  by everything  capable of
debilitating the system.
   Treatment.—The  indications of  cure will vary according to the cause
which  occasions the  disease.  If it  is sympathetic, and arises from  worms,
then such remedies as santonin, malefern, pumpkin-seed  oil,  and other
medicines possessed of the power of destroying or dislodging the vermin,
should be used.  If it proceeds  from teething, scarify the gums freely,
stimulate the liver by euonymin and leptandrin; follow with the neutral-
izing cordial, bath, &c.   If it  arises  from  acidity,  an emetic of the C.
powder lobelia, followed with the neutralizing cordial, aqua calcis,  absorb-
ents aud  alkalies.   If the disease  appears to arise  from any suppressed
discharge, appropriate measures should  be adopted to bring it back;  if
from constipation, podophyllin, leptandrin  and nux vomica; if from  any
stimulus which occasions pain or disturbance, this ought to be removed as
quickly as possible; if from  partial division of a nerve, it ought to  be
entirely severed, and communication between the part and the great nerve
centres cut off", &c.
   In the idiopathic epilepsy the cure  consists in avoiding the  occasional
causes, and in removing or correcting  those which  predispose to it.  The
occasional causes which are to be avoided, are over-distension, turgescence,
intoxication, passion, emotional  disturbance ; and as all spasmodic  disease
is  confirmed or impressed  upon the great nerve centres by repetition or
habit, so the avoidance of a recurrence is of the most essential importance.
Indeed, it is a well attested fa,ct, when once the great nerve centres are
thoroughly impressed, that although all causes are  removed, it will con-
tinue ;  aud it should be our effort in all cases to make nature discontinue
the custom or habit  if possible.
   If we can anticipate an  attack, no  medicine, perhaps, under such  cir-
oumstances, is so likely so positively and effectually to prevent an epileptic
fit as  the C. powder of lobelia, given freely  before  an expected  attack.
Change of habits, mode of life, &c, is serviceable in  such cases.   If the
predisposition to the disease has arisen from a plethoric state of the sys-
tem, congestion in any of  the great cavities, then our arterial  sedatives,
with podophyllin and jalapin, are  appropriate  remedies.   To produce  a
permanent effect, they must be  continued; the constitution  must be kept
under their influence.   If the  predisposition is owing to a state of debility,
then tonics, with generous diet, appropriate exercise,  cold  bath, and anti-
spasmodics'generally, from  among our  concentrated remedies.   I like
cypripedin, macrotin, hyoscyamin.           .     ,    .    „
  Hypodermic  injections  of  morphia,,  atropin, gelsemin, &c, may be 
90
DISEASES  OF CHILDREN.
 resorted to with advantage; and, indeed, I am in the habit of resorting to
 these on each side of the spinal column with good success.
   In cases of epilepsy which depend upon some functional organic change,
 a tonic treatment, with small doses of the extract of calabar bean, is often
 successful.  Some are partial to the sulphate of zinc, oxide of zinc, phos-
 phate of zinc and silver, sulphate analine, &c.;  but there is  nothing to
 commend them to the  profession.   The  hydrocyanate of iron is an excel-
 lent remedy, in ten grain doses, in alternation with cypripedin.
   I am very partial to ice to the spine in all  convulsive diseases.  Con-
 vulsions cannot occur  without some affection of the medulla oblongata, or
 spinal cord, direct or indirect.   The sedative agency of cold to the spine ;
 its  effects on the  gray  matter of the cord is positive—controls the irritable
 state of the cerebro-spinal axis.
  Digitalis has produced good effects, the. saturated tincture in large doses
 is very beneficial; so is the cotyledon  umbellicus, belladonna, chloroform ;
 the latter is positive, for just as long as a patient is under the influence of
 chloroform no convulsions can be produced.   Chloroform controls or modi-
 fies  the convulsions of epilepsy.  Strychnine  dissolved in acetic acid,  is
 a most  valuable combination.
  Free purgation is occasionally good, by eliminating the poison from the
 blood, which is the cause of the fit.  The poison is supposed  to depend
 upon an excess of an alkali in the blood, which converts urea  into car-
 bonate of ammonia.   This engenders  noxious  matter, which operates on
 the  brain and spinal cord;  hence the value of nitro-muriatic  acid  inter-
 nally and as  a bath, and other acids in the treatment.
  Our  concentrated vegetable tonics, as hydrastin, scutellarin, cypripe-
 din, macrotin, cinchonin, stramonium, ignatia, cicuta, cocculus, have been
 much used in the  cure of this disease ; and  if it manifests periodicity,
 prussiate of  iron, quinine and gelsemin.  Some of the worst forms of
 epilepsy are  often successfully treated with  electricity.  It is a remedy
 that should be employed more frequently than it is.
  The diet in epilepsy should consist of such as is  light, nutritious, easy
 of digestion,  avoiding  all agents that create flatulency.   Cheerful society,
 placid  mind, guarding against all violent  passions or  other  emotions.
 Relieve every present indication, let it be gastric, enteric or uterine.  Cold
 sponging, friction, fresh air, exercise.   Watch the patient closely when an
 attack is threatened; if the paroxysms approach, dash cold water in the
 face; and if  the fit comes on,  raise the head, expose the face and neck to
 the air, and dash  cold water in the face to excite  a forcible inspiration, by
 which the larynx  may  be opened;  apply  a lotion  to  the head, warmth to
 the feet, and  guard the patient against accident.

                               CHOREA.

  This disease is marked by convulsive  actions, most  generally affecting
one side, and affecting principally the arm and leg.   When any motion is
 attempted to  be made,  various fibres of other muscles act which ought not,
and  thus a contrary effect is produced from what the patient intended.
It is  chiefly  incident  to young persons of both' sexes,  but particularly
females of a weak constitution, whose health  has been impaired by con-
finement, improper food, and makes its attacks between  the ages of  ten
and fifteen ; not very common after puberty.
  The cause  of this disease  is evidently some  want of harmony in  the 
CHOREA.
91
great nerve  centres, the brain and medulla oblongata, or congestion of
tne meninges of the spinal cord, or organic disease of the brain.  It may
De occasioned  by various irritations, as teething, worms, acrid  matter in
the bowels, poisons, pregnancy, falls, injuries, irritation, violent affections
pi the mind, as horror,  fright, anger, &c.   In a  numerous class of cases
it is produced by general weakness and irritability of the nervous system.
  Symptoms.—In the progress of this disease all the voluntary muscles
become affected; the patient cannot keep quiet; there is a constant move-
ment of the hands, arms or legs; the  features are  curiously twisted and
contorted ; articulation is impeded.  If the patient is asked to put out her
tongue, she is  unable to do  so  for some   minutes, but at last suddenly
thrusts it out, and  as suddenly withdraws it.  In walking, she advances
in a jumping manner,  by fits and starts, dragging her leg rather than lift-
ing it, and alternately halting and hopping.  She cannot sit  still; her
shoulders writhe about;  she picks her dress, shuffles  and scrapes the floor
with her feet;  contortion of the facial muscles.   During sleep these irre-
gular actions cease.   The eye loses its lustre and  intelligence, and the
countenance is  pale and  expressive of vacancy; deglutition is  performed
with difficulty ; articulation  is impeded or suspended.  In advanced stages
of the disease, flaccidity and  wasting of the muscles, the consequence of
constant irritation, poor  appetite, impaired digestion, swollen, hard  abdo-
men, constipation.  On auscultation,  an anemic  bellows-murmur  will
frequently be heard, accompanying the first sound of the heart.
   In some instances the mind is affected with some degree of fatuity, and
exhibits itself in causeless emotions, as weeping, crying, &c.   It is seldom
fatal, or even dangerous, unless it merge into organic disease of the nerve
centres.   It may last  an indefinite period, and is often  complicated with
rheumatism, hysteria, &c.
   When it affects children, it usually ceases  at the  age of puberty,  and
when it supervenes  in adults, it usually gives way by a change frOm the
former mode of life, or removal of the  exciting cause.
   Treatment.—The  principal indications in treatment are the  removal of
the exciting causes.   For this purpose, if chorea arises in a  weak, irrita-
ble habit, and  is wholly unconnected with any  species of irritation, as
teething,  worms, we should employ first purgatives, then tonics.  Unload
the bowels, if a torpid condition of the  intestines and liver exist, by podo-
phyllin, leptandrin; and for the purpose of restoring tone, add  strychnine
and iron, and continue  this  excellent  combination ;  and if the tongue is
furred, add the iodide potassium  to the above formulae.   This  purgative
tonic treatment often succeeds.  Purgatives remove the irritation of the
intestinal canal; they prevent the local determination of blood, which is
usually present in excitement of the  nerve centres.  The success of pur-
gation depends a good deal  on the remedies used.   To procure a discharge
of  the indurated  and  fetid faeces, active  and  strong purgatives are
demanded.                                         .
   The most effectual tonics  are macrotin, caulophyllin, iodide of  iron, gold.
In cases arising from ii-ritation, the grand indication is to remove it, and
improve the  blood, amend general nutrition, calm the nervous system, and
infuse tone into the  muscular system.
   Chorea is frequently associated with  pregnancy, and is rarely removed
until delivery takes  place.  Some cases are, however, relieved with macro-
tin valerianate of zinc,  betin, small doses of lobelia, Indian  hemp in full 
92-
DISEASES OF CHILDREN.
 doses, attending to the secretions, and restoring tone to the nervous system.
 In these cases I have a liniment, composed of equal parts of aconite,
 belladonna and chloroform, applied to the spine.  From the first applica-
 tion the violence of the movements have  ceased.   Electricity has a most
 beneficial effect;  so has the cold or shower-bath.  The best tonics are iron
 aud phosphorus,  with a warm sulphur-bath at least once  a day.   This is
 very efficacious.   Some cases are benefitted by  subcutaneous injections of
 gelsemin or atropin ; some by suppositories of the like remedies.  Counter-
 irritation to the spine is generally beneficial.
   The diet must  be nutritious ;  exercise in the open  air should be allowed,
 and mental excitement guarded against.

                              PARALYSIS.
   Infantile paralysis is by no means the same alarming affection as paralysis
 in the  adult:  for though  often obstinate, and it may be incurable, yet it
 is never perilous  to life.   The loss of power often affects but one part,—
 a single limb, or  an arm, or one side of the face, or a single muscle, or
 one side of  the  body may be affected—hemiplegia;  or the lower  half of
 the body—paraplegia.  It often dates from an early period, probably due
 to some defect of  conformation.
   The consequence of persistent paralysis are very great, often leading to
 incurable deformity, atrophy, &c.  Partial or complete loss of power over
 certain limbs or particular muscles is often observed after certain diseases ;
 in other cases the paralysis  comes on during that irritable state of the sys-
 tem which co-exists with teething.
   The treatment  in all cases should vary with the cause.   In all cases the
 general health should be attended to, and the functions kept as nearly nor-
 mal as possible.   Purgatives, followed  by tonics  and nerve stimulants.
 Exercise is of the greatest importance : hence friction should be used, with
 gentle shocks of electricity.  The special remedies will  consist of rhus
 radicans, nux vomica, cantharides, quinine, iron,  hydrastin, scutellarin,
 phosphorus, friction, kneading, &c.

                              DIARRHffiA.
  Diarrhoea consists in frequent and copious discharges of feculent matter
 by stool, accompanied by  griping, and often, at first, with a slight degree
 of vomiting,  but  unattended either by inflammation, fever, or contagion.
 The presence of  these, with tenesmus,  and an'evacuation of blood and
purulent mucus, instead of natural  faeces, which prevail in dysentery, will
always enable one to distinguish the two diseases.   It is readily diagnosed
from cholera  morbus by the discharge not being bilious, and also by  there
being no vomiting of bile.    *
  Diarrhoea is evidently a morbid increase of the peristaltic motion : which
morbid increase is the effect'of a great variety of causes, applied either to
the body in general, or acting solely on the parts affected ; of the former,
cold, check to the perspiration, causing  a determination  to  the internal
parts, mental emotion, disease, dentition, fevers,  &c.; of the latter, articles
taken  into the stomach, as acid fruits, oleaginous  or  putrid substances
articles capable  of causing fermentation, purgatives, irritating matters
thrown into the intestines, causing increased exertion.
  In diarrhoea each discharge  is usually preceded by flatulence in  the
 intestine, with a  murmuring noise, a feeling of  weight and  uneasiness in
the lower part of  the belly, which ceases when  the  discharge takes place. 
                              DIARRHOEA.                          93

tare ofPaeT,ailCe °f thG St00> are various 5  sometimes thin, from the admix-
 he in estinef ^T7 °f ?Uid' Which is P0ured out b? tbe exha«^ of
A  J      ' ^metimes duny or green, or dark brown, and very fetid.
fomitin, 1S^eadvances,thestomach becomes affected; sickness, nausea,
Wth  of t?m,a FeVai^ Wlth dr>'' Parcbed skiQ-   If * conti™e for any
supfrvene.       eiuaci^on, dropsy,  relaxation  and  extreme weakness

c^WrnrS'v7{n-!hiS-affeCti°n We are t0  be determined by the particular
SneWi[.an'e8 ; Whetb6r Wt°matiC °f aDOtL dis°rder' b*

low^fbdta^:'116 trGatment lt WU1 b6 neCeSS^ t0 att6nd t0 the M~
   First.  To obviate or remove the morbid cause.
^Seco/i</. To suspend the increased action which constitutes the disease;

   Third. To restore  the impaired tone of  the parts.
   The value of emetics in not only cleansing  the stomach, but acting upon
the secretions when trie diarrhoea has arisen from excess or  from agents
which have become acrid  on the  stomach, is self-evident.  An'emetic of
the C. powder of lobelia, followed by  the  neutralizing cordial.
   If we have it proceeding from cold, or from an irritable condition of the
bowels, then  small doses  of ipecacuanha  with  asclepin, given  every two
hours, with the vapor-bath.  This latter is invaluable,  excitiug the action
of the superficial capillaries of  the whole  system, determining a greater
flow of blood  to the surface of the body, relieving the irritable state of the
intestines, and removing the disease.   If  we have a species of fermenta-
tion present—a  septic  acid generated in the  intestinal canal, which is
known  by frequent eructations of air, griping pains in  the  bowels, with
dejections of a white chalky appearance,  which, in  passing  off', occasions
a hot, smarting sensation in the lower  bowel.   An  excellent remedy here
is  the C.  syr. rhei et hydrastin, small doses of leptandrin and nux vomica.
   Strong purgative remedies  are injurious :  but where  it  arises from  a
morbid  state of the alimentary tract, such  agents as  leptandrin,  euonymin,
hydrastin, myricin and gelsemin  are invaluable ;  or  the following may be
tried in teaspoonful doses, according to indications :

                     R.—Oleum ricini;
                          Mucil. acacia, aa 3L;
                          Spts. turpentine, 3L:
                          Vino oporto, 3H.—M.

   This could be alternated with fluid extract of cranesbill and gelseminum.
If these fail, give the neutralizing cordial;  after which baptisin, coilin-
soniu, hamamelin, should be given.
   If we have diarrhoea from some repelled eruption or  disease, then the
neutralizing cordial with hot fermentations.   Should it occur from worms,
which may  be known by the  character of the  evacuations, slimy, &c,
mixed with  pieces of the decayed worms, santonin, turpentine.  If it pro-
ceed from malaria, quinine, prussiate of iron and gelsemin ;  if from un-
wholesome water, the impregnation of the  water with lime or other agents ;
if  it proceed from dentition it should not  be  hurriedly checked, unless it
is  excessive, and  the neutralizing cordial with leptandrin, alternated with
the chalk mixture and tincture kino.   These remedies correct the  acidity, 
94
DISEASES  OF CHILDREN.
    and put a stop to the griping stools.  If these fail, then resort to some of
    the remedies mentioned below.  During teething, or upon the striking in
'   of  an eruption, diarrhoea often  occurs, and then  the  irritating plaster
    applied to the back, a plaster of pulverized Peruvian  bark to the  abdo-
    men, or equal parts of allspice, cloves and capsicum, together with the C.
    syrup of rhubarb  and golden  seal.  A diarrhoea which proves salutary
    should not be too  hastily arrested:  but if it tends to exhaust  in  a  great
    degree, then the most powerful remedies should be employed.
      To fulfill the second indication in the cure of diarrhoea, namely, that of
    suspending  the increased action which constitutes the discharge, we must
    employ such remedies as gelsemin, baptisin, myricin, geranin, in simjll but
    repeated doses, so as to keep up a constant effect; or they should be com-
    bined with the remedies we admiuister,  never forgetting to enjoin rest in
    the recumbent posture, with a slight degree of counter-irritation over the
    abdomen.
      The  third indication is to  be effected  by the use of astringents  and
    tonics.   These remedies are especially adapted  to  those  cases where  the
    irritability of the intestines depends on  a loss of tonicity, which may occur
    from debility or from causes acting on the intestines.  The most common
    astringents  are  tannin, kino, erigeron, geranin.  The oil of ergot, ten-
    drop doses every three hours, in mucilage, leptandrin  and epec.  In  the
    green  evacuations of children, tannin,  opium and  cinnamon is excellent.
    Extract logwood, gelsemin and cinchona, subnitrate of bismuth  and  nux
    vomica act well by stimulating the nervous energy of the bowels.   Crea-
    sote or oil of turpentine in mucilage, citrate of  iron and quinine, or prus-
    siate of iron, quinine and gelsemin, or beeberine and hydrastin if of an
    intermittent type.   If to an acidity,  an  alkili and epec, the sulphites.   In
    chronic cases great benefit will be derived  from lime-water and milk, with
    mucilage of gum arabic.
      The tonics which  are  most likely to prove useful, are hydrastin,  cin-
    chona, the various preparations of iron, pepsin, nitro-muriatic  acid.
      The diet  should consist of articles that are easily digested—rice,  arrow
    root, sago,  rare cooked  beef steak, chicken.  An excellent  nourishing
    drink consists of equal parts of port wine  and beef-tea.
      Those who  are  liable  to frequent attacks of this disease, either from
    inherent weakness or  too  great an  irritability of the  bowels, should
    live temperately,  avoiding acids,  unwholesome  diet, indigestible  food.
    Thorough hygiene should be  observed, avoiding cold moisture, or what-
    ever would  interfere with the function of the skin.              '

                                DYSENTERY.

      Dysentery is a disease  of a contagious  nature—a disease in which we
    have an inflammation of the mucous membrane of the intestines, accom-
    panied  with frequent  stools,  severe griping pains, tenesmus, fever: the
    stools frequent, small in quantity,  and without any natural faeces  inter-
    mixed, but consisting principally of mucus, streaked with blood,-and when
    the natural faeces do appear, it is usually under the form of small, compact
    hard substances.  Dysentery is most common in the fall, and is occasioned
    by cold or moisture  succeeding intense heat, whereby the perspiration is
    suddenly checked, and a  determination made to the intestines.   It  mav
    be  produced  by unwholesome, putrid  food, noxious exhalations, vapors
    malaria, certain epidemic influences, &c. 
                             DYSENTERY.                          95

of f/vP^K17*?^ be rea(% distinguished from diarrhoea  by the absence
dvJnt    •       tenesu™s, the appearance  of the  stools.   An  attack  of
slow,   l8 S!   ly Preceded by loss of appetite, constipation, flatulency,
.    ue. s at  the  stomach, and a slight vomiting, succeeded  with  chills,
neat oi  skin frequency of the pulse.   These are usually the precursory
symptoms ot the griping and tenesmus, although in some cases the local
attection is perceived first.  When the  inflammation commences  to occupy
the lower portion of the intestinal tract, the stools become more frequent
ana ie»s abundant,  and in  passing   through  the inflamed parts they
occasion, great pain, so  that  every evacuation is preceded  by a  severe
griping,  rumbling noise, unusual flatulence in the bowels.   The motions
vary  in  color  and  consistence, sometimes being  frothy, streaked with
blood, or of an acrid watery humor, like the washings of meat and very
fetid  sometimes pure blood is voided,  with pieces of coagulated  mucus,
resembling  bits of cheese, and  in  some instances a quantity of purulent
matter is passed.  In other cases mucous  matter  without any appearance
of blood.  From  the violent  efforts which  are made in  discharging  the
irritating matters, a portion of the rectum is sometimes forced beyond the
verge of the anus, which, in the progress of the  disease, proves a source
of great trouble, giving rise to a persistent tenesmus, constant inclination
to  defacate, without  the ability  of voiding anything,  except vitiated
mucus,  or a small quantity < f blood.   More or less fever attend all these
symptoms, which is either of a sthenic or asthenic type.   If the symptoms
run high, and are accompanied with violent irritation of the  whole intes-
tinal ■ tract, great prostration of strength, putrid, fetid  discharges, it is
sometimes fatal.   If  the case  is one of  long standing, if the patient labors
under some  organic  disease, or  if  the  constitution  has become impaired
from any cause or disorder, it is very apt to prove fatal.
  Pathology.—Dysentery consists chiefly  in  inflammation, followed  by
ulceration of the mucous membrane of the  colon  and rectum.   Cases,
however, occur where the whole tract is involved.
  Treatm nt.—In most cases it is good practice  to  begin  treatment with
an emetic of the  C. powder of lobelia, then to follow with  the neutralizing
mixture and  leptandrin, which should  be  continued until  the  symptoms
subside,  then the most active  counter-irritation over the  entire abdomen,
first with a  liniment  of equal parts  of oil  of stillingia,  capsicum  and
solidago, then the irritating plaster.  In order to aid this treatment,  the
vapor or warm bath, then the diaphoretic powders should be given, so as to
keep up  gentle perspiration, without exciting  nausea.   By this  treatment
we often can cut  the disease short.
  A novel method of curing dysentery consists in the use  of  emetics—
ordinary doses  of epec;  its action is speedy, certain, complete, the disease
being quickly  arrested.  If  the  stomach  cannot retain  the remedy, a
sinapism over  the stomach should be  applied.  Should  the vomiting be
persistent, aqua  calcis, gelsemin,  opium, chloroform  and  other remedies
should be tried.
  In  dysentery,  when the  abdomen is hard, tense, and  painful  to the
touch  and  the  gripings are  frequent and  severe, the  application  of
fomentations of stramonium or hops, over the abdomen, afford considerable
relief; but  should these not have the desired  effect, and  afford  relief,
active  counter-irritation  should be  resorted  to.  The foot bath is  an
excellent adjunct in treatment.  To defend  the inner coat  of the intestines 
96
DISEASES  OF CHILDREN.
from the acrimony of  its contents, to counteract attempts at evacuation,
mucilaginous drinks, as solutions of gum acacia in milk, barley, rice, and
enemas of the same, medicated with gelsemin.
  A very excellent mode of treating dysentery consists in giving  leptan-
drin and euonymin, morning and night, with counter-irritation over the
abdomen.  At  the  commencement of an attack, it is improper to  employ
astringents ;  but  in the second  stage, where the  strength is exhausted,
where we have a relaxed condition of the bowels, astringent and  opiate
remedies prove proper  and beneficial, given in the neutralizing cordial.
This is a disease in which the patient should have rest, not only from the
frequency of the motions, but from the  tenesmus.   An admirable remedy
here is "the  hyoscyamin combined with  gelsemin;  a combination well
adapted to the disease, and ought to be tried in preference to opium.   In
chronic  dysentery, I have derived benefit from the following formula :

                       R.—Opii, pulv.,
                            Ext. cinchona,
                            Tannin, aa.—Misce.

Made into three-gram pills.
  When the bowels have been effectually relieved, it  often happens that
there may remain a  tender  state of the rectum, which  gives rise to a
troublesome tenesmus :• under such circumstances, suppositories are very
beneficial.  The remedies  best adapted to  cure dysentery are gelsemin
and cranesbill,  turpentine, nitro-muriatic acid, ergot, bismuth, rhein, &c,
and for  astringents we can  use those that are  specially indicated.  Port
wine and beef-tea for  a drink, lime water  and milk.   A decoction  of log-
wood, with equal  parts of the prickly ash  and witch  hazel,  is a favorite
prescription, and seldom fails to give relief.   In the advanced  and  chronic
stage of the disease  acidity is  apt  to  prevail, then  small doses  of the
sulphite of soda and  chamomile have proved of singular utility in many
instances.  The impaired tone of the intestines should likewise be restored
by tonics, as the wine bitters, hydrastis and nux vomica.
  The fever accompanying this disease sometimesjs intermittent, protracted
and complicated ; in such cases aconite  and  gelsemin,  belladonna, euony-
min, pulsatilla, epec, combined  with  quinine,  are indicated.  In those
eases where a dusky sallow hue  of the  countenance, tenderness over the
region of the liver, clayey appearance of the stools, sulphur, podophyllin,
leptandrin, rhus radicans, epec, &c, and if we have  an obstructed or
diseased state of the liver, the irritating plaster should be kept constantly
applied.   We have derived great  benefit from enemata  of  cold  water,
administered after each evacuation.   In dysentery from cold, dulcamara
and xanthoxylin; in all  dysenteries of a typhoid  character, nux vomica,
rhus, subnitrate  bismuth,  xanthoxylin, myricin, &c;  charcoal, in small
doses, is  of utility.  In the first stage of dysentery, ripe fruits  are proper :
but in a more advanced period, where  acid  prevails,  they should  not be
used, and, indeed, every species of food which tends to putrefaction  should
be carefully avoided throughout the whole course of the  disease,  as well
as all fermented drinks, supporting the patient's strength by juice of raw
meat, rice, arrow root, gelatinous broths, milk, &c  During convalescence,   •
wine, brandy, properly diluted, should,be given:  the  brandy mixed with
milk or arrow root.  When  the  inflammation  is subsiding,  the aromatic
astringents;  gallic  acid,  populin,  erigeron.   Convalescence  is often 
                         CHOLERA INFANTUM.                      97

wh^w?^7 !?n^ ?f aPPetifce5  for meeting this  we would suggest our
wine bitters, the juice of raw meat, pepsin, extract of carnis, &c.
rP^l^;S-re*CuV-ermg,fr0ni dJseQtery should observe the greatest caution,
«hf nU  tJ     T m°de of livinS' should not eat solid food for some time,
should  be warmly clothed, as the  disease  is very liable to relapse from
any tresn exposure  to wet  or cold.   The  importance  of warm clothing,
and the  most thorough hygiene, in the cure of all  bowel  complaints is
very ohvious.  We would observe, that warmth should not be  a secondary
ODject; on  the  contrary, it  should be primary.   Flannel should be worn
next the skin, a flannel bandage should be worn round  the abdomen, and,
it necessary, the spice plaster, or pulverized cinchona, should be quilted
in the bandage, as being the  best means of confining'heat  over that part
ot the  body which  is the sieat of the disease.  Dysentery, being con-
tagious, precautions  should  be always  adopted to prevent its spreading,
by the exposure of bromine,  or permanganate of potash, or phenol sodique
in the apartment.
                         CHOLERA INFANTUM.
   Cholera infantum is a very common affection in this country, and one
very difficult to treat successfully.   It occurs  most commonly about  the
period of dentition,  and in the months of July and August.  A period of
intense heat has much to do  in bringing it on, as well as cool weather has
in checking its course.
   Symptoms.—Cholera infantum is usually preceded by feculent diarrhoea,
which gives little trouble, as  the appetite is  not impaired, sleep is good,
merely a little  emaciation.   Suddenly we  have prostration, frequent dis-
charges from the bowels, nausea, vomiting.  The  thirst is great, the child
desiring water, which, if given, is  immediately rejected by the stomach.
The  skin is harsh, dry and  constricted, and  in some cases seems to be
drawn upon the patient  like  parchment.  As the  disease advances, the
desire for drink becomes  more  craving, the evacuations from the bowels
more frequent,  the little sufferer becomes extremely emaciated;  the dis-
charges vary in character, sometimes  yellowish, with more or less stringy
mucus mixed with them, showing disease of the mucous follicles; at other
times they  are  greenish, have  a sour smell; at others, clayey;  again,
almost white, and rarely of a dark color.   There is  usually great irrita-
bility of the nervous system,  the   patient is  restless,  uneasy, never
satisfied, always changing its position, desiring everything, satisfied with
nothing, very restless and wakeful at night.  The child is invariably worse
at night, and when the disease is well advanced, it is impossible  to keep
it in bed  at night; the heat  seems  to add to its torture,  and  it is only
satisfied when it can freely turn, or when it is carried from place to place.
The brain sympathizes : we  have often congestion, effusion, indicated  by
the continual moving of the head from side to side, sleeping with its eyes
open, rolling^he eyeballs  upwards.   When the  pupils do not contract
upon exposure  to light, there is congestion with  effusion;  we also often
have  a  determination of blood  to  the head, throbbing of the  carotids,
contraction  of the pupil, intense restlessness.   The prognosis is usually
favorable if there is  no brain symptoms; if the latter exist, the mortality
is great.
   Treatment.—In cholera  infantum, our treatment  must be very active,
and should  be  directed to arresting the prominent symptoms.   For the
nausea  and vomiting, small  doses of  lime water in alternation with the
       7 
  98                    DISEASES OF CHILDREN.

  neutralizing cordial, or an  infusion of prickly ash with  subnitrate  of
  bismuth, or minnte doses of aconite, gelsemin and morphia, or external
  applications are of great value; the aromatic plaster  of cloves, allspice
  and capsicum ; hot fomentations give great  relief, so  does more active
  sinapisms.   Once the sickness  of the stomach is arrested, a great deal is
  accomplished :  the  diarrhoea is easily  controlled, either by the C. syr.
  rhubarb, or by leptandrin and geranin, or nitro-muriatic acid and frazerin,
  or hydrastin and hamamelin.  The subnitrate of bismuth may be adminis-
  tered with the  most marked advantage.   If the  skin is harsh and  dry,
  the asclepin should be given  every hour, until the  surface becomes moist,
  and then some preparation of bark,  either Huxham's tincture or quinine.
  If the case is chrrmic, the C. syr. rhubarb and hydrastis,  in alternation
  with epilobium in brandy.  The bismuth and" leptandrin are very valuable
  if there  is  any torpidity- of the liver.   If we have periodicity, quinine
  and hydrastin  are  the most efficient remedies.   In some  cases minute
  doses  of  nux  vomica, with  any of the  other remedies,  act  well  and
  efficiently.   One of my favorite remedies, in all cases, is the juice of raw
  meat, given in  teaspoonful doses every hour, white of egg and brandy.
  The bath is an  important  agency in  the treatment; it may be used cold,
  tepid or warm, according to the indications, and may be medicated by the
  addition of  salt, bicarbonate  of  soda, quassia, cinchona.
   The food will vary in different cases; if the child nurses, it  may be
  restricted to the mother's milk, or if this  disagrees, cow's milk; in other
  cases,  juice  of meat  seems to answer  best, and it  would seem the
  most  gratifying results follow the use  of  the juice of meat, or beef-tea
  and port wine, and even cod-liver oil answers an admirable  purposes if it
  agrees with  the stomach.   Stimulants, as brandy  with  epilobium, given
  every hour.  Quinine and sulphate of hydrastin are excellent remedies;
  they will often  arrest  the diarrhoea after all other remedies have failed.
  Coffee  has a most surprising  effect as a stimulating tonic;  under its use
  vomiting is  arrested, the evacuations become more consistent, and the
 symptoms quickly subside.
                         TUBES MESENTERICA.
   Tabes  mesenterica  is a  tubercular  or  strumous enlargement of the
 mesenteric  glands—abdominal  phthisis.   The mesenteric  glands are so
  small at birth as scarcely to be  observed.   But about the period of denti-
  tion they gradually become  more developed, in common with the other
  glands of the body, and it is  at this period that they are liable to take on
  diseased action, more especially tubercular deposits, and this is very likely
/ to occur if the child is ill nourished.   Children of the scrofulous diathesis
  are exceedingly prone to this disease from the eighth  month to near the
 tenth year.   It may be occasioned  by poor food,  worms, excessive  dfar-
 rhoea, &c;  but whatever the  cause, it is very difficult to cure.
   Symptoms.—The symptoms are very various: pain in theJbowels, more
  or less severe, causing the  child to  keep  his legs  drawn wp towards his
  belly.  The  lips  are  of a  deep red, and the  angles  of the mouth are
  covered with small  ulcers, or the whole  lip  is fissured.   The bowels are
 variable, generally relaxed; the motions are  often  unhealthy, light  clay
  color,  extremely fetid, as is  also the breath; sluggishness, lassitude on
 the slightest exertion, loss of appetite, wasting of  the muscular system
 with bloating, swelling, and great prominence of the abdomen, oedema of
  the lower extremities;  the emaciation is great, and the  debility increases 
PERITONITIS.                          99
rapidly.   The enlarged glands  in  the  mesentery can sometimes even be
felt  through the  attenuated  abdominal parieties.  When  the  disease is
thoroughly established, obstinate diarrhoea often sets in, with hectic fever.
symptoms of pulmonary consumption may set in, or irritation, or conges-
tion of the brain, or  the  child  may  die  worn  out—exhausted by the
disease.   If recovery does occur, convalescence  is  protracted, and the
greatest possible  care is  necessary to shield  the  child from all  other
infantile disorders.
   Treatment.—In all cases of tabes mesenterica, the •patient should make
use  of food that  is  nutritious, easy of digestion, adapted  to  the child's
age and strength; it should be  taken frequently, and in small  quantities.
Thorough hygiene and  change  of  air should be  resorted to.   To  assist
the digestive powers, resort at  once to Beach's wine bitters, an infusion
of  gold  thread or  cinchona, and  with  the food give pepsin.  Proper
evacuations should be strietly attended  to ;  for this we suggest leptandrin,
hydrastin and iron by hydrogen  every night.  This preserves an admirable
action of the liver, as well as a proper action of the bowels, carrying off all
effete matter.   An emetic, say three times a week, acts in a most salutary
manner.  I have  also found  small  doses  of santonin  of intrinsic value;
the pepsin, after meals, I regard as extraordinary in its effects.  The use
of cod-liver oil, when it can  be taken without nausea, or deranging the
bowels, sometimes proves  beneficial, as  also does  the inunction  of the
same.   Friction of the whole surface  of the body, night  and morning,
with glycerine, has a good effect; it is productive  of tranquil sleep;  it
increases  secretion from both  kidneys and liver;  it possesses specific
properties in all diseases of scrofulous  or  tubercular origin.   Morphia in
glycerine, as an  inunction in the axilla and groin, where the  lymphatics
are numerous, is  a good mode of procuring rest.   The abdomen should
be well supported by a flannel bandage.   The  iodide of iron is  often
valuable.   Benefit is also  derived from minute doses  of the  chloride  of
gold, the C. syr. stillingin  and irisin.   If diarrhoea prevail, then the
neutralizing cordial,  the chalk  mixture, with tincture of  kino, change of
air, especially the sea-side, warm or tepid salt water baths, and above all
things animal food, provided it can be  digested, will often work wonders.
The emaciated  state is best overcome  by tonics.  To strengthen the
stomach  and alimentary canal, and  promote a good digestion, the only
and  best  means by which  nutritious chyle can be obtained, and the body
kept in a healthy state by  such  remedies as bark,  sulphate hydrastin.
                             PERITONITIS.
  Inflammation of the peritoneum is usually met with under three forms:
acute peritonitis, puerperal peritonitis, chronic peritonitis.  The various
forms have  certain symptoms in common, usually ushered in  by all the
symptoms of fever, as lassitude, irregular chills, succeeded by flushes  of
heat  headache, frequent pulse, uneasiness or pressure in the region of the
stomach, nausea, loss of appetite.  These symptoms are  speedily succeeded
or accompanied by a pain and tenderness in the abdomen, either confined
to certain portions, or universally diffused over  its whole extent.   The
abdomen  is excessively tender, painful on pressure, even rendering the
weight of the bed  clothes intolerable; but in some cases the pain is slight
from  the  commencement to  the fatal  termination  of  the malady.   The
tongue is moist, and  covered  with a white fur in  the first instance, which
soon becomes dark and  dry in  the centre, with red edges.  The bowels 
100
DISEASES  OF CHILDREN.
are usually constipated.  The pulse is commonly frequent, tense, wiry,
corded.  The countenance  is  contracted, sharp, anxious, indicative  of
acute mental and physical suffering.   The patient lies with his legs drawn
up, his head and shoulders elevated, so as  to relax the abdominal muscles,
and  his  respiration  short, imperfect, performed almost  entirely  by the
muscles of the chest.   In severe cases of peritonitis, the pain is diffused
over the whole abdomen, aggravated by  movement or by pressure; the
abdomen is swollen and inflated with air; the skin is  hot and pungent;
the pulse is frequent  and small:  the  stomach  irritable; the breathing
hurried : the face expressive  of acute suffering.   Puerperal peritonitis is
the form that occurs in females  after confinement, and  is known as puer-
peral fever.  It  does  not differ much from the ordinary form,  only  in
being very violent in its attack, and  having a tendency to run its course
with greater rapidity, rages  as an epidemic, is very fatal if not properly
treated.   The lochia is suppressed as well as the secretion of milk, and
all the other secretions are entirely suspended.
  Causes.—Certain occult conditions of the  atmosphere, undue exposure
to cold, excessive physical exertion, injuries, labor, abortion, over-exertion
when the system is weakened by previous disease, atmospheric vicissitudes,
metastasis of rheumatism, gout, or other diseases.
  Treatment.—In the  treatment of acute peritonitis, I rely chiefly upon
equal  parts  of aconite, gelseminum, belladonna and  bryony; locally, a
fomentation of stramonium over the abdomen, bathing, and acting gently
on the secretions.   If diarrhoea should occur, then epec, rhus, &c;  if
cerebral symptoms, then belladonna.  But the chief remedy that I depend
upon in treatment is the C. tincture  of serpentaria ;  its peculiar properties
are highly important.   The  action  of the C. tincture  of serpentaria on
the cerebro-spinal nervous system is evident, because it renders the  sen-
sorium less impressionable, and  the system less liable to be exhausted by
the  disease.  Its action  on  the sympathetic and vaso-motor nerves  ia
probably similar, as it will relax contracted arteries, and admit  a -freer
transit of blood.  It is also a sedative of  the highest order, a diaphoretic
and  diuretic of  no ordinary kind.   Get  the system quickly  under the
influence of an alterative; podophyllin, irisin and menispermin, the vapor
bath, alkaline sponging, thorough hygiene.   The diet  should consist  of
beef tea and port wine; every symptom quickly controlled.
                         INTESTINAL WORMS*.
  The human body is infested  by several  species of worms, among the
most remarkable are the ascarides,  or small white worm; the teres,  or
round worm; aifcl the  taenia, or tape worm, which is  flat, consisting  of
many joints.  Different situations of the  intestine have  been mentioned
as being occupied by each kind, as  the ascarides in  the rectum, the teres
in the small intestine  and stomach, the taenia the whole of the intestinal
tract.  Worms frequently exist in early life without the slightest indica-
tion  of  disease.   The cause  is usually  unwholesome  food, imperfect
digestion, scrofulous habit, indulgence in unripe fruits, fat, farinaceous
or saccharine articles   of diet, milk, &c.   The  symptoms  are variable;
capricious  appetite, fetid  breath, acid eructations, pain in the stomach,
grinding of the teeth  during sleep, picking  at  the  nose, paleness of the
countenance, hardness  and fullness  of the abdomen, slimy stools,  griping
pains about the umbilicus, heat and itching about the anus, short dry cough,
emaciation, fever, evening exacerbations, irregular pulse, convulsions. 
JAUNDICE,  NEPHRITIS.
101
  In the treatment we must have  in view the destruction and discharge
Of the worms, and preventing their future generations.   The destruction
must be accomplished by remedies whicfc  act  either chemically, mechani-
cally, or by simple evacuation.   Remedies which  act mechanically have
been useful, and more so when combined with those which have a chemical
and purgative effect.  The spirits of turpentine is a remedy that has all
the therapeutic properties indicated, and is well adapted to all the different
varieties.   If this fail, the  pink root may be useful; ten  grains of the
powder to a  child  night  and  morning.  The spigelia  is a poisonous,
narcotic vegetable,#and it is  this property that renders it so beneficial, in
those  cases.
  In tape worm, I have found  the oils of pumpkin seed, male  fern  and
turpentine the most  admirable  combination ever introduced, followed by
an active cathartic of podophyllin and jalapin.  An infusion of kousso or
kameela, or an extract of the same may be used with advantage.  In'the
teres, or round worm, the best therapeutic agents that I have used is the
oil of chenopodii or santonine, or  santonine and podophyllin.   Santonine
is a medicine that is certain  and  satisfactory:  salicin is also good.   In
the ascarides, or seat worms, enemas, are of the greatest utility ;  an injec-
tion of a  solution of common  table  salt, podophyllin, aloes,  lime water,
camphor water.
  For the  complete removal of all kinds of  worms, treatment should be
persevered with for some time, as they are  surprisingly productive.  After
a proper course of vermifuge medicines, accompanied with evacuants, we
should  employ  such remedies as  sulphate hydrastin or bark, or other
remedies which have a tendency to strengthen the stomach and intestines.
                              JAUNDICE.
  Jaundice often depends on  some temporary impediment to the flow of
bile into the duodenum, and the absorptiou  of the retained  bile, or by
defective secretion on the part of the liver from some cause.
  The best mode of treatment  consists in administering  a suitable quan-
tity of a combination of podophyllin, leptandrin and euonymin  to get a
thorough  cholagogue action  ; alternate this with  nitro-muriatic acid in
proper quantities;  a warm  bath morning and night, medicated with the
same acid ; and the whole region of the liver should be painted  over with
the pure acid.   Convalescence  established upon hydrastin, cinchona and
iron.
                             NEPHRITIS.
  This is  often  the result of cold, injuries, the poison of scarlatina,  &c,
&c    It usually commences with rigors, fever, headache, pain  and tender-
ness in the loins, vomiting, effusion of fluid into one or more of the serous
cavities, scanty albuminous urine, &c
  The great point here is perfect rest of the kidneys.  To accomplish this,
keep the patient in bed in a moderately warm room ;  give an  alcoholic
vapor-bath every other day; sponge the  surface with the warm alkaline
wash three times daily; give asclepin combined with all  other remedies;
active  counter-irritation  over the  kidneys, followed with  fomentations;
then all through the case give hydragogue cathartics, as
                   jj,—Podophyllin, grs. i.;
                       Nitrate potass., grs. v.;
                       Bitartrate potass., .^ss;
                       Digitalin, gr. is.—M. 
102
DISEASES  OF CHILDREN.
  Gelsemin, barosmin and eupatorin should be given when the acute symp-
toms are controlled.   The digitalin and sulphate of hydrastin form a good
combination for aiding  convalescence.  The action of the skin  is of the
greatest importance.  Exposure to cold must be guarded against.
                       INCONTINENCE OF  URINE'.
  Various irregularities in the flow of urine occur both  to the adult and
youth.  The functions of the  kidney are  liable to be impaired as well  as
the bladder to retain the secreted  urine.  If the loss of voluntary power
over the muscles concerned is total, the urine  continues  to dribble away
as* fast as secreted—being thus a trouble  and  annoyance.  If  the loss of
power be only partial,  the urine  can usually be  retained until a given
amount is accumulated,  when  the patient is suddenly to yield to the
pressing demand.   In  other  instances  the incontinence is troublesome
only during sleep.
  Complete eneuresis may be  caused  by paralysis of the  sphincter of the
bladder  from  constitutional causes, from external  injuries,  peculiar
deposits, &c  Incontinence is common among children, and is particularly
troublesome in the night during sleep.  It is undoubtedly associated with
debility, or irritation at the neck of tke bladder, originated by acrid urine,
gravel, the irritation of worms.
  Treatment.—The following  remedies are used with success: tinctures
of cannabis indica, cantharides, nux vomica, pulsatilla rhus.
  For the  cure of eneuresis, resulting from lithic acid or gravel, benzoic
acid and alkalies are of great utility.   For the cure of the paralytic form,
recourse should be  had  to phosphorus,  rhus radicans, scutellarin, nux
and iron.   For that intractable form  in children, our best remedies are
tine belladonna, iron, cinchona and the irritating or strengthening plaster
over the lumbar region  of the spine.  When from external injuries or the
irritation  of  calculi, arnica,  pulsatilla, rhus,  gelsemin,  the sulphate  of
hydrastin, the cold sitz-bath.
                              PHYMOSIS.
  This is  a preternatural constriction of the orifice  of the prepuce, too
small to allow of the complete retraction of the foreskin.   It frequently,
from certain causes, forms  an obstacle to the flow of  urine.  Should this
prove to be the case, the preputial orifice  must be cautiously slit up,  or
circumcision should be performed.
  Paraphymosis consists of a  retraction of a tight prepuce over the glans
penis, with swelling, preventing its return.  This swelling is quickly fol-
lowed by inflammation,  which  may run on  to  gangrene of the constricted
glans.
  The  everted prepuce should be replaced as quickly as possible.  I have
alway been able to effect reduction without the knife, or without the use
of relaxing remedies, and in  a few minutes.  My method of treatment is
somewhat peculiar also.   I use a ribbon about an inch and a half wide  ; I
make one complete turn of it round the glans penis, one end I wrap seve-
ral  times round the little finger of the  right and left hand respectively, the
patient standing directly opposite, compressing the glans for a few minutes ;
a diminution in size soon takes place ; the thumb and index fingers of both
hands being free, manipulation by them, such as pressing the glans back-
wards and drawing the prepuce forwards, keeping up traction, firm trac-
tion, on both ends of the ribbon.  I have  never failed to relieve  even  in
the most aggravated cases. 
HYDROCELE,  INFANTILE  LEUCORRHffiA, ETC.
103
   Lobelia, belladonna, ice, cold  water, muriate  of ammonia  dissolved in
water, are often tried to reduce the swelling.   It is  seldom necessary to
divide the foreskin.
                              HYDROCELE.
   This, if attended to early, is very amenable to treatment:  to the appli-
cation of  cold, or a slightly stimulating lotion, as the muriate of ammonia
dissolved  in water; or by painting the scrotum several times with tincture
of iodine.   And if these means fail to procure  absorption, the hydrocele
may be punctured, and the fluid  drained away; and  for the purpose of
establishing a permanent cure, destroying the secreting properties of the
part, injecting tincture of iodine, or leaving a few threads of silk in the
tract of the puncture will excite inflammation  sufficient to do the work.

                       INFANTILE LEUCORRHffiA.
   Children of all  ages are liable to suffer from a discharge from the
mucous glands of the vulva, which, if not checked, spreads up the vaginal
canal, and gives rise to a profuse purulent or  muco-purulent fetid dis-
charge, with heat,  pain in micturition, and excoriation of the surrounding
parts.  The discharge is communicable and  highly contagious; its appli-
cation to  the eye will  give rise to violent ophthalmia.  It is very apt to
occur to the strumous, particularly during dentition ; or if they suffer from
neglect of cleanliness, from the  irritation of ascarides  in the rectum, or
constitutional debility.
   The treatment of infantile  leucorrhoea must  be rigidly carried out, or
the disease will last many months.  It should consist  in perfect cleanli-
ness, frequent sponging with a lotion of the permanganate of potash, grains
three to an ounce of distilled water, injections of the same, or the chloride
or sulphate of fine  The C. syr. stillingia and iodide of potass should be
given ; and the chloride of gold may be  given in alternation.  If due to
seat-worms, enemas of salt and podophyllin, in solution, answer well.  If
to debility, tonics, nourishing food are always  useful; iron and hydrastin
.will cure  the most obstinate cases.
                                BURNS.
   In all accidents of  this nature, it is of the utmost  importance  to apply
a  remedy at once ; for by this means the violent pain  and anguish is
allayed, and vesication prevented.  Of the  remedies most quickly to be
procured  on such occasions,  is cold water,  which  is  of great  service.
Water is  always at hand, and after proper immersions, it may be sufficient
to cover the parts and exclude the atmospheric air.   Other remedies may
be used,  as olive-oil and lime-water, molasses,  gum arabic, common  salt
in solution,  soap,  creasote, vinegar, elm, lard and  flour.   Constitutional
treatment is of great importance ; anodynes, arterial  sedatives, cathartics,
diuretics  and diaphoretics.                                          ,
                              FROST-BITES.
   If a person has exposed his hands and feet to a very severe cold, the
excitability of the parts will  be  so much accumulated that if they are
brought near the fire a violent inflammation, and even  mortification, may
take place from the violent action of the heat upon the  parts;  but if a
patient so affected were to1 put his hands and feet into cold water, or rub
them with snow, the morbid excitability  will be  gradually exhausted, and
no bad consequence will result.   It is therefore an excellent practice, when 
104
DISEASES  OF CHILDREN.
the hands, feet, nose or any other part of the body have suffered  from
frost-bite, to rub them with snow, and afterwards subject them to gradual
warmth.
                             CHILBLAINS.
   This is the result of a suspension of vitality in a limited portion of the
skin from cold.   The treatment must  consist in attempts to restore the
normal circulation and tone to the chilled member,  by frictions with stimu-
lating liniments.   For this purpose, a sponge or piece of flannel saturated
with a concentrated tincture of capsicum, or a combination of thirty parts
of collodion,  twelve parts of Venice turpentine and six parts of castor-oil;
or if they are ulcerated,  the chlorate or permanganate potash lotion ; or a
strong  infusion of galls  or oak-bark, or witch-hazel, or tannic  or  gallic
acid.    Usually  the  constitutional  powers  are low j hence tonics  are
required as well as attention to the digestive  organs.
                        CARBUNCLES  OR BOILS.
   This is an acute inflammation of a circumscribed  portion  of the skin,
extending deeply into the cutaneous tissue, forming a more or less promi-
nent  swelling on  the surface, which is first red,  then  livid, excessively
painful.  The pain, throbbing and burning, &c, &c  It is generally due
to a vitiated  state of  the blood or enfeebled  constitutional  power.  The
nape of the neck is the most favorite situation.  In  treating these cases,
mild  aperients, nourishing food, tonics, with  alteratives will  do  good.
Locally, belladonna  or the aqueous  extract  of opium  will be found  to
afford the greatest relief.   If these are not indicated, paint on ten or more
times the tincture of iodine, which has the effect of  arresting its  progress;
and if it is impossible to obviate them, then apply the caustic potash.  The
morbid action generally terminates with the  application*  It  is seldom
necessary to use the knife ;  its use is frequently followed by erysipelas.

                              BRUISES.
   Bruises are generally accompanied with ecchymosis ; and the best reme-
dies to use locally are arnica or a poultice  of  the bryony-root, pulverized*
and mixed to a proper  consistence, with  Indian-meal,  and  applied in a
muslin bag.   The ecchymosis disappears in about forty-eight hours.  The
muriate of ammonia is a  good substitute.
                              EPISTAXIS.
   Bleeding from the  mucous membrane  of the  nose  may be  produced by
blows, over-exercise,  or  it may arise spontaneously.  If it  occur during
hooping-cough, fever, purpura, it may be serious.   Quietness, cold to the
nose, forehead, cold to the back of the neck, so as  to produce constriction
of the superficial  blood-vessels by reflex action ; mild laxatives and astrin-
gent  injections, as matico, erigeron, per-chloride of iron ; if  the bleeding
continue obstinate, then  the exhibition of the  same  remedies internally, or
inflated  gum elastic  tubes  up the nostril, or plugging with cotton-wool
saturated with a solution of alum. 
ECLECTIC  MEDICAL  COLLEGE  OF  PENNSYLVANIA,
       ff. E. corner of Sixth and Oallowhill Streets, Philadelphia, Pa.
      Only  Cliartered  Eclectic Medical  College in  the State of Pennsylvania.
           HOLDS TWO  SESSIONS ANNUALLY.
Winter Session begins October 8th, 1866, and Spring Session, February 1st, 1867.
      SIXTEENTH ^NJsTXJAL. SESSION, 1866-'6V.
                        TRUSTEES.

     <™Dtt PRESIDEST.                        SECRETARY,
     ZOPHER C. HOWELL, ESQ.               JOHN  FEST, ESQ.

fSwIbI? mS5^C0TT» ESQ"          JOSEPH SITES, M.  D.,
S^J J°*?££TOWN, ESQ.,          HENRY HOLLEMBAEK, M. D.,
StwJaJJ ?£?£'J?SQ'>                 JOSEPH P. FITLER, M.  D.,
tH^^^^J' ESQ"                 J0HN BUCHANAN, M. D.,
THOMAS G.  CHASE, ESQ.,              WILLIAM CLARK,  M. D.
FACTJLT ""ST.
                 THOMAS G. CHASE, M. D.,
    EMERITUS PROFESSOR OP CHEMISTRY AND JURISPRUDENCE.
                   JOSEPH SITES, M. D.,
PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN.
               HENR1T HOLLEMBAEK, M.  D.,
       PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS.
                 JOSEPH P. FITLER, M. D.,
           PROFESSOR OF CHEMISTRY AND  TOXICOLOGY.
                 JOHN BUCHANAN, M. D.,
          PROFESSOR OF THE PRINCIPLES  OF SURGERY.
                 WILLIAM CLARK, M. D.,
PROFESSOR OF THEORY AND PRACTICE OF MEDICINE AND PATHOLOGY.
                     E. DOWN, M.  D.,
        PROFESSOR OF ANATOMY AND OPERATIVE SURGERY.
                 EMIL QUERNER,  M. D.,
     PROFESSOR  OF PHYSIOLOGY AND MICROSCOPICAL ANATOMY.
                  GEORGE H. DAY, M. D.,
            PROFESSOR OF INSTITUTES OF MEDICINE.
                   P.  W. HERON, M. D.,
            PROSECTOR OF ANATOMY AND  SURGERY.
    E. DOWN, M. D.,
DEMONSTRATOR OF ANATOMY.
   The Museum and Clinic of the College will be open every Wednesday and Saturday.  The
reeular course of Lectures will commence on Monday, October 8th, 1866.  The Lectures will be
amply illustrated by the extensive and valuaile collections of Anatomical, Microscopical, Patholo-
gical  Obstetrical, Surgical, Chemical and Philosophical, Botanical, &c, apparatus of the incum-
bents of the various chairs, and every opportunity will be afforded in the Clinic and Hospital for
obtaining a thorough, scientific, and practical knowledge of Medicine in its most advanced state.
                                PEES.

Matriculation Fee, -   -   -   -  $5 00 I Demonstrator's Fee,     -    -    - $5 00
Tickets for the Course,  -   -   -  60 00 | Diploma,......30 00

   For further particulars, address,               JOSEPH SITES,  M. D., Dean,
   tor lurmor t,«                    gixth Md Callowhm gtroet8) Philadelphia, Pa.

ry Twenty deserving Students, unable to pay full fees, will be taken each term for $20. 
ECLECTIC  MATERIA MEDICA,

         BIT HENRY  HOLLSMBAEE,  3MC. D.,
Professor of Materia Medica and Therapeutics in the Eclectic Medical College or Pennsylvania.
   In one large and handsome octavo volume of nearly 700  pages.  127
               illustrations.  Cloth, $3 50.  Leather, $4 00. •

  The gratifying appreciation of his labors, as evinced by the almost exhaustion of
the first edition of this work, has not been lost upon the author, who has endeavored
in every way to  render it worthy of the favor it has received. The opportunity
thus afforded for another revision has been improved, and the work is now presented
as in everyway superior to its predecessors.  Some additions, in the shape of new
remedies, have been made, so as to render it the best standard work on the subject
in the  United States.   The illustrations are more numerous, the typographical
execution of the work is beautiful.  His dissertation on the concentrated organic
remedies is complete,  and entirely absorbs  the whole  class.  It is a work that no
physician can do without.  Practitioners and students desirous of obtaining it with-
out delay will address the author,

                  H.  HOLLEMBAEK, 3VC-  ID.,
             N. E. Corner of Sixth and Callowhill streets, Philadelphia.
            J.   JACOB  TEUFEL,
                    MANUFACTURER OF

Inrgteal   anfo   JenM   Instruments,

       TO.QDS8H8  ASH®  STnBQEKBBS,
No. 103 SOUTH EIGHTH STREET,
                 Third door below Chestnut Street,
                             THE

ECLECTIC  MEDICAL  JOURNAL  OF  PENNSYLVANIA,
   A Journal of Medicine, Surgery, Physiology, Chemistry and Progress,
                          DEVOTED TO

        THE INTERESTS OF THE AMERICAN ECLECTIC PROFESSION.
                          EDITED BY

               JOHN BUCHANAN,, M. D.,
Professor of tht  Principles of Surgery and Institutes of Medicine in the Eclectic
                   Medical College of Pennsylvania,

           ASSISTED BY AN ABLE CORPS OP CONTRIBUTORS.

Its Contents Consist of Original Communications and  Essays, Editorial Articles
    on all Subjects of Importance to the Profession, Keviews and Notices of
       New Books, and Keports of Medical Societies, Selections and
            Abstracts from American and Foreign Journals.
               IE7* Contributions to its pages respectfully solicited.
          Address all Communications to

                  JOHN  BUCHANAN, M.  D.,

                              Sixth  and Callowhill Streets, Philadelphia. 
PURE
          CONCENTRATED   MEDICINES,

OR COMBINED ACTIVE PRINCIPLES OF MEDICINAL PLANTS,
    B. KEITH & CO., Manufacturers,  lew York City.
Put up in bottles of one ounce,
                      from the
     POWDERS.
A.comtin,
Ampelopsin,
Alnuin,
Apocynin,
Atropin,
Asclepin,
Baptisin,
Barosmin,
Caulophyllin,
Cerasein,
Chelonin,
ChimaphiUn,
Collinsonin,
Colocynthin,
Copaivin,
Cornin,
Corydalin,
Cypripedin,
Digitalin,
Bioscorein,
Euonymin,
Euphorbin,
Eupatorin. )
  (Perfo.) \
Eupatorin, )
 (Purpu.) I
Frazerin,
Gelsemin,
Geraniin,
Gossipiin,
Hamamelin,
Helonin,
Hydrastin,
Hyoscyamin,
Iiisin,
Jalapin,
Juglandin,
avoirdupois, and securely
action of the atmosphere,
Leontodin,
Leptandrin,
Lupulin,
Lycopin,
Macrotin,
Menispermin,
Myricin,
Phytolacin,
Podophyllin,
Populin,
Prunin,
Rhein,
Bhusin,
Bumin,
Sanguinarin,
Scutellarin,
Senecin,
Smilacin,
Stillingin,
sealed to protect them


   Strychnin,
   Trilliin,
   Veratrin,
   Viburnin,
   Xanthoxylin.

         PILLS.
   Xanthoxylin in Pills.
   Comp. Podophyllin Pills

          OILS.
   Oil of Capsicum,
    "  Erigeron,
    "  Populous,
    '*  Stillingia,
    ''  Solidago,
    "  Xanthoxylum,
    •'  Lobelia.
   Oleo-Kesin of Lobelia.
CONCENTRATED TINCTURES.
These are much stronger
                 articles
Aconitum Nap.,
Apocynum Cannabinum,
Atropa Bella,
Asclepias Tuberosa,        ,
Baptisia Tinctoria,
Burosma Crenata,
Cannabis Iwlica,
Chelone Glabra,
Cornus Florida,
Corydalis Formosa,
Collinsonia Can.,
Cypripedium Pubescens,
Digitalis Purpurea,
than any other fluid  preparations made from  the  same
  Put up in bottes of 2 ozs. and 1 lb.
  Eunonymus Americanus,
  Eupatorium Purpurum,
  Gossypium Herb.,
  Getseminum Semperv.,
  Humulus Lupulus,
Hyoscyamus Niger,
Hydrastis Canadensis,
Iris Versicolor,
Ipomoea Jalapa,
Luptandria Virginica,
Lycopus Virginica,
Wine, Ti^ Lobelia Inflata,
Macrotys Bacemosa,
Podophyllum Peltatum,
Bhus Glabrura,
Sanguinaria Canadensis,
Scutellaria Lateriflora,
benecio Gracilis.
Smilax Sarsaparilla,
Stillingin Sylvatica,
Strychuos Nux Vomica,
Veratrum Viride,
Xanthoxylum B'rox,
Bronchitis Drops,
Con. Comp. Stillingia Alterative
       CONCENTRATED  ORGANIC  MEDICINES:

BEING A PEACTICAL  EXPOSITION OF THE THERAPEUTIC PROPERTIES AND CLINICAL EM-
        PLOYMENT OF THE COMBINED PROXIMATE MEDICINAL CONSTITUENTS OF

           Indigenous and  Foreign  Medicinal Plants.

  Together with a  brief history of Crude Organic Remedies, Constituents of Plants, Con-
centrated Medicines, Officinal Preparations, <fcc.  By GROVES,  COE, M. D.

Seventh Edition, Octavo, pp. 446.  Price,  $1.25.   Postage 24 cts. extra.

  This is the latest  and most complete work upon the Concentrated Medicines yet issued
from the press.  It  is full, yet terse, concise, and eminently practical.   To all who wish to
lPet> pace with progressive therapeutic science, this work is an available acquisition.
  We will furnish gratis, on application,  a copy of our " Manual of the Active Princi-
ples of Indigenous and Forkion Medical Plants," containing short accounts of each
i    aration, witfa properties, uses, dosos, etc.  Address all communications to

                 B. KEITH & CoM 41 Liberty Street, N.  Y.

  Agent for  Philadelphia, GEO. K RICHARDS, 67 North Second St. 
PHILADELPHIA
                   A LARGE SELECTION OP

             HERBS,   ROOTS,


BOTANICAL  MEDICAL  COMPOUNDS, &c.
                  CONSTANTLY ON HAND.

           Agent for W. S. Merrill & Co.'s

   CONCENTRATED    REMEDIES,

         ESSENTIAL  TINCTURES,  &.C.
Orders addressed to

                                      729 Market sired,
                WILL BE PROMPTLY ATTENDED TO.
                  .A.  TREATISE
                           ON THE

 TREATMENT  OF  THE  VENEREAL  DISEASES,

       BY  JOHN   BUCHANAN,  M.  D.,

Professor of Surgery and Institutes of Medicine in the Eclectic Medical College of
                  Pennsylvania, Philadelphia, Pa.
   This Treatise gives the principles of the treatment of the Venereal Disease with all the
improvements in therapeutics of the Eclectic system of practice.  It is a  reliable and
practical guide, superior to any other work of the kind, and contains a vast amount of
information upon the topics of which it treats. The intrinsic utility of the Concentrated
Remedies, in treatment, occupies a conspicuous place on its pages.
   Price, $2 00.  The work is ready for delivery,

        Address,                    JOHN BUCHANAN,  M. D.,

 __________________________________Sixth and Callowhill streets,  Phila., Pa.

       "Will be ready for Delivery to Subscribers July X, 1866.

  THE ECLECTIC PRACTICE  OF MEDICINE  AND SURGERY.
                BY JOHN  BUCHANAN, M. D.
Professor of Surgery and Institutes of Medicine in the Eclectic Medical College of Pennsylvania.
  The author in publishing this work has the following objects in view:
  To present to the student and practitioner a practical and trustworthy Treatise on Modern
Medicine and Surgery.
  To present all the recent discoveries in Pathology which have led to the vast improve-
ments in Therapeutics of the Eclectic System of Practice, introducing all our new remedies
our improved and successful mode of treatment of all diseases. It will also specially
introduce all the improved methods of treating Surgical Cases, Fractures,  Dislocations
Wounds. Aneurisms, Ac. Ac.                                          '
  It will constitute a complete Practical Work on Eclectic Medicine and Surgery One
large volume, octavo, bound in leather or cloth, and sent free by mail.

              Address                JOHN BUCHANAN,  M. D.,

  4JJ.....,   .            L   Sixth and Callowhill Sts., Philadelphia.
  Additional particulars in subsequent numbers. 
&TJQ-A.TI-GQA.TE2D    FIL3LS  -A.1STID   C3-I?,A.lSrTjriJES3
                                        MANUFACTURED BT

             BULLOCK   &   CRENSHAW,

   WHOLESALE  DRUGGISTS  AND  MANUFACTURING  CHEMISTS,
                    3T. E. comer of A/rch and Sixth Streets, Philadelphia.
  tt^- Those Pills and Granules are accurately compounded of the best materials, and can be confidently relied upon.
FILLS.
Price per. bot.  500
 o/"100 each. each,.
Xgr.l
 Igr.
 Igr
: Torn:  % gr.1
scyain:  % gr. V
;:C.   2gr.J
,,AO_  tt q p  ( Pulv.Aloes Pocot: 2grs. )  ~n .n
Aloes, US.P.J  „  SaponiS)   2|r8P040
  •'   Comp: U. S. P. (Pil: Gent: Comp:)    50
Aloes et AssafcetfU S. P.                  40
              SPulv: Aloes Socot: % gr
                "  Zingib: Jam: 1
              . Ferri Sulph: Exsic
              { Ext: Conii        % gr j
Aloes et "»'astich: (See Pil: Stomachic*)     50
Aloes et Myrrhae, TJ. S. P.              ■   50
Ammon: Bromid: 1 gr.                     75
Anderson's Scot's. (See TJ. S. Dispensatory ) 40
Anti bilious J Pulv: Ext: Coloc:  C. 2# gr.)   75
  (Veg:)    ? Podophyllin, % gr.       \
AntimoniiComp:IT.S.P (See Pil: Cal: Comp:) 40
         .( Ext: Nuc: Vom '
Aperient,  }  " Hyoscyam
          I  <« Coloc  "
Assafuetida, U  S. P
    "      2gr.
    "     < Assafoetida,       1 gr.)
  Comp.   { Ferri Sulph: Exsic: 1 gr J
    .  ...   (Assafoetida.         1 gr. )
Assafoetida J Pulv. Rhei)         j gr  (
  etKnei.  j Ferrum per Hydrog: 1 gr. )
Bismuth: Subnit: 3 gr.
    "    Subcarb: 3 gr.
Calomel: X Kr-
    "     1 gr.
    "     2 gr.
    "     3gr.
    "     5 gr.
 Calomel: Comp: (Plum'rs,) 3 grs.
   "     et Opii,
   "     et Rhei.
 Cathart: Comp: U. S. P.
                       { Pulv: Aloe Soc
Chapman's Dinner Pills. J  "   Rhei Opt
                       ( Gum Mastich.
 Cerii Oxalat:  1 gr.
              SChinoidin:         2 grs
              Ferri Sulph: Exsic:  1 gr
$1 75
 2 25
 1 75
2 25
2 25
R 50
1 75
3 50
1 75
1 75
1 75
3 50

3 50
3 50
1 75
1 75
1 75
1 75
2 25
1 75
4 00
3 50
3 50
PILLS.
Price per bot 1  500
 nf 100 each  each.
$0
1 40
  75

  75

  50
  40
  50
  60
  90
  40
  40
  50
  80
  75

3 50
Chinoidin
  Comp:    ^ piperini,
Cinchon: Sulph: 1% gr
r.)
  60   2 75

1 00   4 T5
1 00  4 75
75  3 50
f Pulv: Aloes Soc: 1 gr.
gr-]
gr- I
gr 1
60
Diuretic
 !
 j
■}
           I   "   Rhei,     1
Cook's 3 gr.]Calomel:       %_
           ( Sapon: Hispan: % gr. J
Coloc: Comp: 3 gr.  (Ext:  Coloc: Comp:
   U.S.P.)
Colocynth: et Hydrarg: et Ipecac:
Copaibse,TJ. S. P.. 3 gr.
Copaiba  et Ext. / Pil: Copaibas, 3 grs. >
  Cubebae,      1 Oleo-res: Cub: 1 gr.
               rPil:Copaib:
                Resin Guaiac
Copaibas, Comp: I Ferri cit.
               [ Oleo-resin: Cubeb: J
           Sapo Hispan^Puly^grs.'


         " "(Pulv: Guaiac:         3 8".
Dupuytren: \ Hydg: Chlor: Corro.: 1-10 gr.
           I Pulv: Opn,            * B
             ( Ox-gall, 2 gr.
Fel: Bovinum, | pow'd Jamaica Ginger, 1 gr
Ferri, (Quevenne's,) 1 gr-
Ferri, (Quevenne's) 2 gr      ,
Ferri Carb: (Valett's) U S. P. ** gr.
Ferri Citrat: 2 gr.
Ferri Comp: U. h• *■
Ferri Ferrocyanid: 5 gr.
Ferri Iodid: 1 gr-
Ferri Lactat: 1 gr -


Fern Valer.  S ^^ Special Recipes made to order when 3,000 Pills are ordered at one time.

             _  .___„____..„«   ,„i«h  nil  thr>  formulrc,  irnt on application.
2 25
3 75
3 50
2 25
3 75
2 25
2 25
2 25
50	2 25
75	3 50
40	1 75
50	2 25
40	1 75
50	2 25
65	3 01)
50	■1 25
40	1 75
40	1 75
1 00	4 75
Ferri et Quass: et Nuc: Vom:
Ferri et Quin: Cit: 1 gr.
         "   "  2gr.
Ferri et Strychniae,
Ferri et Strych: ( Strych: Cif: 1-50 gr. )
  Cit:          \ Ferri Cit: 1 gr.     J
Galbani Comp: U. S P.
Gambogiae Comp: TJ. S. P.
Gent: Comp:
Gonorrhoea,
Hepatica,
Hooper, (Female Pills,) 1% gr. (See TT S.D.)
Hydrargyri, TT. S  P. 3 gr.
Hydrargyri, 5 gr.
           Comp:
      '     lod: et Opii, (Ricord's)
Iodoform < Femum per Hydro: 1 gr "
 et Ferri \ Iodoform, 1 gr.
Ipecac et Opii, 3^ gr. (Pulv:Doveri,'TT.S.P )  50
Leptand: Comp:                         1 (10
Lupulin, 3 gr.                             40
Magnesiaa et Rhei, (1 gr. each,)             40
Morphias Comp:                         1 50
Opii, U *?. P  1 gr.                        80
Opii et Camphorae,                        90
Opii et Camph: et Tannin,                  90
Opii et Plumbi Acet:                      8)
Podophyllin et Hydrarg:                   50
Potass: Bromid: 1 gr.                      75
Potass: Iodid: 2 gr.                        85
Quiniaj Sulph: % gr.                    1 00
   "         1 gr.                     1 60
             2gr.                     3 10
Quiniae Comp:                          1 90
Quinias et Ext: Belladon:                 1 90
Quiniae et Ferri,                        1 90
Quiniae et Ferri et Strychniae,            1 90
Quinias et Ferri et Valer: 2 gr.            3 50
Rhei, U  S. P.                            75
Rhei Comp: TJ. S. P.                      75
Rheumatic:                              90
Santonin, 1 gr.                         1 00
Scillae Comp: TJ. S. P.                     50
Stomachic: (Lady Webster's Dinner Pills)
   3 gr.                                  50
 Zinci Valerian: 1 gr.                    1 00

           GRANULES.

 Acid: Arsenious. 1-2H gr.                  40
         "    ' 1-50 gr.                  40
 Aconitia, 1-60 gr.                         75
 Atropia, 1-60 gr.                          75
 Corrosive Sublimate,  1-12 gr.               40
             "      1-20 gr.               40
 Digitalin. 1-60 gr.                         75
 Elaterium, (Clutterbuck's,) 1-10 gr.       1 00
 Extract Belladonna, (English,) % gr.       40
   "    Cannabis Indica, 3i gr.            60
   '«   Hyoscyaraus, (English,) ^ gr,      40
   '<   Nux Vomica, % gr.                40
 Mercury Iodide, Jtf gr.                    40
     <*     '•    Red, 1-16 gr.              40
 Morphias Acet: % gr.                     85
     '•   Sulphate, l-lo gr.                70
     "       "     }e gr-                  85
     "       "     >6 gr.                1 00
     "    Valerianate, # gr.             1 00
 Podophyllin, % gr.                       40
       "      % gr.                       50
 Potass: Permangan: Cryst: # gr.           50
 Quinia Valerianate, X gr.                2 00
 Silver Nitrate, # gr.                      75
 Strychnia, 1-20 gr.                        40
     '•     1-40 gr.                        4(
     <;     1-60 gr.                        40
 Veratria Sulphate, 1-12 gr.                 W 
         A PRACTICAL  TREATISE
                           ON THE

DISEASES  OF CHILDREN.

               BY JOHN BUCHANAN, HI.  D ,
Professor of Surgery aud Clinical Lecturer on Diseases of Women and Children
            in the Eclectic Medical College of Pennsylvania.
  This is a neat volume, giving the improved mode of treatment adopted by the
Eclectic Medical Profession in all  diseases of children.  In one volume, cloth.
Price $1 j sent free by mail.  Address,

                    JOHN  BUCHANAN,  M. D.,
                                227 North Twelfth  street, Phila-
        JOHN BUCHANAN,  M. D.

ffrotear  of inrgtrtj  anb Sfnstitnte of  J&bmro,

May be consulted daily, from 10, A. M., to 4 o'clock, P. M., and from 6 to 8
o'clock, evening.
  Consultation by mail must contain a fee of $5 to insure an answer.
  All diseases (if amenable to treatment) successfully and promptly cured.

                              JOHN BUCHANAN,  M. D.
 Consultation  Office:

      227 NORTH  TWELFTH STREET,
                                         PHILADELPHIA.
          WM. R. PRINCE, FLUSHING, NEW YORK,

                       WILL TRANSMIT HIS

    "TREATISE ON NATURE'S  SOVEREIGN REMEDIALS FOR DISEASES."

   Extracted from Plants.  Price, 15 cents ; Explanatory Circular, one Stamp.

  It comprises eighty-five specific remedies for all Scrofulous and other inherited
maladies, Mercurial and  Cutaneou3 (Skin) Affections, Consumption, Dropsy,
Catarrh, Asthma, Bronchitis, all Liver and Kidney, and Syphilitic Diseases
Rheumatism of all phases, Spermatorrhoea, Prolapsus Uteri, and other female
maladies.  These remedies are in packages at 83 and §5.   Sent by express. 
          McCLURE  & BROS

                 PHARMACY
                           AND

FAMILY  MEDICINE   STORE,
                   FIRST FLOOR OF THE
   ECLECTIC MEDICAL COLLEGE OF PENNSYLVANIA,
        North-east Corner Sixth and  Callowhill  Streets,
                PHILADELPHIA,
Where all the preparations used by the Eclectic Medical Practitioners, as well as
                     the preparations of the
        U.   S.  PHARMACOPOEIA
can be had.  Furnished to Physicians and Druggists at the lowest wholesale prices.
Physicians' prescriptions  compounded with care and accuracy. We warrant to
give satisfaction to all who deal with us.
  \XFm We can supply all the new and popular remedies, as
Bismuth,
Sulphite of Soda,
Bl-Sulphite of Soda,
Keith's Concentrated Pow-
  ders and Tinctures.
                                 Cactus Grandlflorua,
                                 Phenoel Sodique,
                                 Vaccine Virus,
   Sulphite of Potassa,
   Bl-Sulphlte of Potassa,
 Books, Surgical Instruments, and anything appertaining to the outfit of a
Physician.
   Address all orders to

                McCIAIHE & BEO.,
                     CHEMISTS AND PHARMACEUTISTS,
            N. E. corner Sixth and Callowhill Streets, Philadelphia.
  PENNSYLVANIA ECLECTIC  MEDICAL SOCIETY
Meets at the Pennsylvania Eclectic Medical College last Friday in each month.
Annual meeting last Thursday in January.
  President—HENRY HOLLEMBAEK, xM. D.
  Vice Presidents—WM. CLARK, M. D. and ED. DOWN, M. D.
  Treasurer—JOSEPH SITES, M. D.
  Secretary—JOHN BUCHANAN, M. D.
  Censors—J. P. FITLER, M.D., J. ISAACS, M.D., and J. J. FULLMER, M.D.
  DIPLOMA, $5. .
  Address all communications to
                        J. BUCHANAN, M. D.,  Sec'y,
                       Sixth and Callowhill Streets, Philadelphia. 
eclectic wiiimir pimmacy
 The want of an establishment where Eclectic Physicians could be supplied with
all articles appertaining to their practice, in quantities to suit them, has been long
felt; and to meet this want, the advertiser has been induced to start this establish-
ment, and he feels assured that he will be encouraged in his efforts by a liberal
patronage "of all those favorable to the reform practice.  In his stock will be
found all


ROOTS,  HERBS  AND  BARKS,

            BESIDES A FULL SUPPLY OF


         KEITH'S, MERRILL'S,

                  AND OTHER



   CONCEKETRiTED REMEDES,


     FLUID EXTRACTS  AND TINCTURES

           OF ALL MEDICINAL AGENTS.

        GLASSWARE, &c,

    FURNISHED AT MANUFACTURERS' PRICES.


 KNIGHT'S  CELEBRATED FLAVORING EXTRACTS

          Are also manufactured at this place,

 CONSISTING OF TWENTY DIFFERENT FLAVORS.

Send for Catalogues.  All orders promptly attended to.


              GEORGE K. RICHARDS,

                  PHARMACEUTIST,

     No. 67 North Second Street, Philadelphia. 
 
 
 
 
  PRESSBOARD   *, %
PAMPHLET BINDER  % '. .'&
   Manufactured iai
I ©AYLORD BROS. I«k.
    Syracui*, N. Y.
    Skodrton, Calif.
 
m-
NLC���63329