RETENTION OF THE MECONIUM.

THE Meconium is that black, viscid, or tenacious matter, which, it is well known, every infant parts with by stool, for the two or three first days after it is born, or retains it to its manifest injury.

The ordinary source of infantile com­plaints has already been said to originate from something amiss in the first passages, accord­ing to the most ancient opinions^*, and I have long suspected, that a foundation is sometimes laid for them, from not duly attending to an early expulsion of the me­conium; which will sometimes firmly ad­here to the coats of the bowels, and remain for many days, unaffected even by power­ful medicines, as I shall have occasion to re­mark as I go on.—I shall only observe in this [Page 13] place, that though it should not be all re­tained, yet a part will often remain much longer than has been usually imagined, and will come away, perhaps unnoticed, at a late period, where no retention of it has been suspected. Of this I can have no doubt, having been called to visit infants after the month has been expired, who have been unwell through all that period, for want of having been properly purged, and from whom meconium has still been com­ing away. A tea-spoonful of castor-oil, gi­ven once or more, has soon carried off a great quantity; upon which all their com­plaints have disappeared.

The meconium appears to be no longer of use after the child is come into the world, unless it be to keep the bowels from collap­sing, till they be replenished with the aliment the child is soon afterwards to receive. Whereas, if it be not soon carried off, it will not only change the quality of the milk, or other food, as it descends into the bowels, but itself also becomes highly acrid, (as it con­sists chiefly of gall) and cannot fail to produce indigestion, flatulency, pain, purging or costiveness, and other similar evils: And the meconium is farther disposed to this acrid state, on another account, viz. from admixture of atmospheric air. Whilst the infant remains inclosed in the womb, it is secured from all contact of air, and there­fore [Page 14] the alimentary contents remain harmless and bland though increasing for so many months; but it is well known, [...]ow soon every secretion or extravasation will become acrid, upon the admission of air into any cavity where it may be lodged. And it is, doubtless, on these accounts, that provident nature has imparted an opening quality to the first milk of all animals; a certain indi­cation to the rational species, to assist the expulsion of this matter, now no longer re­quired. For though a child should even be suckled by its own mother, (in which case, there is, doubtless, less occasion for other assist­ance) yet we know that nature doth not, in every instance, always fully accomplish her own designs: and it is from some striking instan­ces of the truth of these observations, that I have said so much on this subject, which I have also been the more inclined to, because so many writers have passed it over almost in silence.

I am aware that all those who esteem me­dical people to be officious disturbers of na­ture, have objected to their assistance in this instance, and conclude, that she would do the business much better if left to herself.^* [Page 15] And there are even some physicians of this opinion, amongst whom I find Dr. Buchan, whose abilities and reputation claim particu­lar attention though he, perhaps, may not be so much engaged amongst very young infants, as those whose peculiar province it is to attend them from the birth. But there can be no general rule without without ex­ceptions,^* and as, doubtless, many children would do very well without any such assist­ance, so am I certain, many would not: and I believe, none can be essentially injured by constantly assisting in this work, provided the means first made use of be lenient, as they ought always to be.—It is the province of art to superintend nature, and not only to guard against her excesses, but so to watch [Page 16] over her, as to ensure the accomplishment of her intentions, whenever we perfectly comprehend, and can effect them without the risk of doing harm.^*

For this purpose, amongst others, a new remedy has of late years been recommended as preferable to any purging medicines what­ever.^† Mankind has ever delighted in ex­tremes—no sooner has any thing, formerly judged to be hurtful, or even poisonous, been found in certain cases, to be very use­ful, than it is supposed to be capable of do­ing every thing, and supersedes all that the wisdom of former ages has proved to be sa­lutary. Hence, some advantages experi­enced from the use of wine of antimony, in a variety of children's complaints, as far as they arise from one common cause, has in­duced some people to extol it as an universal remedy. But wherefore give an emetic, calculated to empty the stomach, in order to expel the meconium from the lower bow­els?^‡ It is universally allowed, and by this [Page 17] writer also, that emetics are not to be admi­nistered when the bowels are full, which, in this instance, is precisely the case. It is true, the wine of antimony does not always vomit children, nor will a little matter often­times do this, (as I shall have occasion to take notice very soon); it is sometimes, in­deed, found to act as a purgative: but if this be the intention, why not adhere to the old, and more certain method, and direct at once such things whose proper operation may be depended upon? Not the stomach, but the bowels, are the natural and safe out­let for most complaints of children, and a want of due attention to this circumstance has been productive of some evils, which many practitioners, I think, are not suffici­ently aware of.

It is very evident, that some gentle pur­gative is indicated on this occasion, and that it should be of a kind that will create as lit­tle disturbance as possible, and especially should not be of an offensive, or indigestible nature; though such have been very com­monly advised. In general, indeed, a very [Page 18] little matter will suffice; perhaps a little sy­rup of roses, diluted with some thin gruel, and given occasionally by tea-spoonfuls, will mostly answer the end; will also serve to keep the child quiet, and so prevent the nurse from giving it improper food. But if this should fail to procure stools, a watery infusion of rhubarb, (or a tea-spoonful of the wine, diluted as above) will be found preferable to the indigestible oily mixtures in common use.^* In the country, where the above medicines may not be at hand, a little fresh whey and honey will be an excel­lent substitute.^†

[Page 19] The objection now made to oily medicines is very much increased, from nurses scarcely ever giving the quantity that is directed, in the course of the first twenty-four hours, as it is always designed; and administering the rest long after the child has begun to suck, or to feed. At this period, mixing with the nourishment, it has a direct tendency to produce indigestion, wind, and the very complaints, which the oils, administered in proper time, were designed to prevent. Not to add, that some kind of oily medicine be­ing the usual purgative on this occasion, is an inducement to parents and nurses to pro­cure [Page 20] a repetition of it, and to administer it whenever an infant happens to be costive during [...]he month; and from whence, the above evils may be frequently induced.

But it has been observed, the meconium is not always disposed to come away, even by the assistance of common purgative me­dicines. Having, therefore, begun with such as the above, if the child has no stool for twelve or fourteen hours after birth, and especially if it should seem to be in pain, a clister ought to be thrown up; which may be repeated, if necessary, a few hours af­terwards. And here I would observe, that in the cases where more powerful means are required, scarcely any evacuation will be procured by these gentle means; for, as I have seen, wherever I could procure one copious stool by a clyster, or gentle laxa­tive, the rest of the meconium has come away with little, or no farther assistance. But as it sometimes happens, that neither clysters nor purgatives have any sufficient ef­fect for several days, very powerful means must then be made use of; there being rea­son to suspect a suspension of nervous influ­ence. [Page 21] I shall close this subject therefore, with a recent instance of this kind, (of which, I have seen many) as a proof of what powerful remedies may sometimes be required, and how necessary it is to pay some attention to this first complaint of in­fants.

The child was born of very healthy pa­rents, (not at all of constipated habits) after a quick and comprehensively easy labour, on the 22d. of February.—To avoid prolixity, I shall not state the case in the form of jour­nal; but shall only observe, that the child took a little rhubarb an hour or two after it was born; but having had no stool when I saw it the next day, I ordered a clyster to be thrown up. In the evening, the child be­came drowsy and insensible, and when rouz­ed, it moaned, but seemed unable to cry. It continued pretty much in this state, (and at times, seemingly, in great pain, and evi­dently convulsed) for six days; and was nourished chiefly by a tea-spoon with a little breast-milk, seldom reviving sufficiently to to suck.

It had no stools, but such as made only a few spots on the cloths about the size of a shilling, till the twenty-seventh, and those were very small, hard, and lumpy. On the twenty-eighth it had more of this kind, and it had not till the twenty-ninth any thing like a proper stool, which was also [Page 22] mixed with hard lumps; but on the third of March, they were thinner, and on the fifth came very freely.—In the course of six and thirty hours, I prescribed two ounces of the common infusion of senna, two drams of ro­chelle salts, four grains of jalap, and a grain of calomel; besides purging clysters, and the use of the warm bath. The next day the child took four grains of ipecacuanha at two doses, and forty drops of the new wine of antimony, at four times (in the course of an hour) without any effect; and at another period, six drams of castor-oil, besides seve­ral doses of manna.^* Three days after the child got rid of the meconium, the thrush made its appearance; which was slight, but continued above three weeks.

ICTERITIA, or INFANTILE JAUNDICE.

THE Jaundice of infants seems always to have been improperly conceived of. Those who have written only on children's [Page 23] diseases, have usually passed it over in silence, whilst others have considered it as rather a serious complaint, and have prescribed as for the jaundice of adults. On the other hand, parents and nurses have usually ac­counted the common yellowness that ap­pears about the third day after birth (term­ed by some yellow-gum) as the true jaundice. Neither of these opinions seem to me to be just; for the latter of these appearances re­quires no attention at all, and though infants are not subject to the troublesome jaundice of adults, (unless infected by the breast-milk) they nevertheless are liable to some affections of that kind which claim some at­tention. These are easily distinguished from the common yellowness, mentioned above, by the tunica albuginea, or white of the eyes being always very yellow; but the nails are not tinged, as in the jaundice of adults, though it is probable they usually would be, if the complaint were long neg­lected, and the child suffered to be costive. I have waited some days to see if the yellow­ness would go off of itself, as the usual tinge does; but it has always increased ra­ther than diminished. It arises from viscid matter obstructing the gall-ducts, which open into the duodenum, and therefore re­quires a little emetic. Wine of antimony is a very proper one on this occasion, as it may likewise procure two or three stools; [Page 24] but as children in this complaint are not ea­sily made to vomit, should the wine fail, I would advise three or four grains of the the powder of ipecacuanha, which is more certain in its operation; and the next day give four or five grains of rhubarb. Should the symptoms continue, the emetic ought to be repeated after two or three days, and rhubarb be given about every other day, till the yellowness disappears; which, un­der this treatment, never continues more than ten or twelve days, unless the stools are of a very pale colour; in which [...]ase a little more time, as well as the use of the warm-bath, will be required.

Women long afflicted with jaundice, du­ring any part of their pregnancy, though actually brought to bed in that state, do not infect their children, unless they also suckle them;^* but, from some striking instances, I have found that suckling in that state is capable of communicating the true jaundice to a great degree, and that it will not be cured, but by the recovery of the mother or nurse, or by the infant being weaned, as well as properly treated.

[Page 25] The true jaundice, distinguished by the skin being every where discoloured, as well as the whites of the eyes, seems to be much more common among new-born infants in France, than in this country; as appears by a memoir written by Mr. Baumes, and to which a prize-medal of the Faculty of Me­dicine in Paris has been adjudged.

In this work the various causes and na­ture of the disease are distinguished; and a correspondent treatment pointed out with great accuracy and judgment. Throughout the tract there seems also to be much inge­nious and plausible theory; though I can­not agree with that able physician in suppo­sing the jaundice to be occasioned by the re­tention of the meconium, otherwise than from this viscid matter sometimes obstruct­ing the orifice of the biliary ducts; for in the several instances I have met with of the most obstinate retention of that secretion, there has not been the least disposition to jaundice; nor can I conceive, that any part of the meconium is usually absorbed in icteric cases, as Mr. Baumes has imagined; neither does such an incident appear to be necessary in order to account for the fre­quency of the disease in that kingdom, or elsewhere.

As to the treatment, under the different circumstances there described, I meet with nothing that militates against the more ge­neral account I have given of this disease, or [Page 26] the treatment adapted to it, under the form wherein it appears in this country.

INWARD-FITS.

ANY derangement of the first-passages is capable of giving rise to various complaints, among which, that of inward-fits, has lately been taken notice of by some medical people, but I think scarcely deserves the name of a disease. It demands atten­tion, however, because so much has been said about it as to expose the fond parent to continual apprehensions, left this subtile dis­ease should be insensibly at work, and mak­ing way for more severe and outward con­vulsions.

A constant symptom in this kind of fit, as it is called, is the infant's little mouth being drawn into a smile; which whoever has no­ticed must have beheld it with pleasure. And if the complaint extends no farther than this smiling, which is generally in its sleep, it arises merely from a little wind, and is cer­tainly harmless, because the wind in this case is not really confined; and therefore an immediate recourse to pukes or purges, is more likely to do harm, by straining the stomach, or by relaxing the bowels, than to do any good. Every body is acquainted with the effects of different degrees of irritation of the nerves, from the sensation produced by tickling with a feather, to that of a hard [Page 27] gripe, or a violent stroke. The first may be said to be pleasing; and such, I doubt not, is the stimulus in question on the ner­vous coat of the stomach of little infants, and therefore produces so agreeable a smile, that I could never consider it as an indica­tion of pain. Indeed, I know of no com­plaint that ought to be termed inward fits; and I mention this, because nurses are continu­ally talking to us about them, when children are perfectly well, and often give the fond parent needless distress, as well as many an unpleasant medicine to the child.^* They are at the same time treating the true con­vulsion, whilst slight, in the same way, be­ing led into the error by the ideas of inward fits; a term they are ever using but have no precise ideas of, nor do any two of them mean the same thing by it. It were therefore better, perhaps, the term were altogether abolished; as the child is either evidently convulsed, or has no kind of fit, at least none for which any remedy can be offered.^†—If the child should [Page 28] sleep too long, and this smile should often return, the infant may be taken up, gently tapped on the back, and its stomach and belly be well rubbed by the fire; which is all that can be necessary. This gentle ex­ercise will bring a little wind from its sto­mach, and the child will go to sleep again quietly.

This complaint, however, is largely treat­ed of by some writers, and Dr. Armstrong wishes to give a few drops of the wine of antimony; but it is very apparent, that when he considers it as worthy of more at­tention than I have just now advised, it is either a true convulsion, in which the eyes are distorted, and the mouth is discomposed, instead of putting on a smile, or else he is prescribing for another disease under the name of inward-fits, which former writers have treated under the head of disorders arising from costiveness and wind. But if this little turn of the features should arise from constant over-feeding it, were endless to administer emetics; the cause of the com­plaint [Page 29] is obvious, and upon the removal of it the remedy must rest.

Such has ever been my opinion of this much-talked-of complaint; and indeed I have not to this day, after a good deal of attention to infants, seen any thing myself to induce me alter it; or I would in this edition, have cheerfully retracted the pre­ceding observations. As I wish, however, to afford all the information I can on every complaint, I have to observe, that it is con­ceived by some gentlemen of great respecta­bility and experience, that though the term, inward-fits, has been often misapplied, there is really such a complaint, and that it gene­rally proves fatal. Besides a little blueness of the lips, and slight turning up of the eyes, often noticed by nurses, this complaint is described to me as attended with a peculiar sound of the voice (somewhat like the croup) and a very quick breathing, at intervals; and is supposed to arise from a spasm of the stomach, lungs, or other vital organ; a complaint I have indeed too frequently seen,^* but certainly very different from that usually known by inward-fits.

These symptoms are said frequently to at­tack the child in the sleep; and in their com­mencement will go off upon taking it up [Page 30] from its cradle. They are likewise observ­ed to be induced by sucking or feeding, and to be increased upon any little exertion of body, or transient surprise, and in this man­ner to recur for a length of time, before they become alarming. The remedies pro­posed for the cure of this complaint are an emetic, on the first attack, and afterwards volatiles and fetids; but, as it has been ob­served, not often to good effect.

In regard to costiveness and wind, which have been said to be the parent of what nur­ses commonly term inward-fits, as they do not always arise from one and the same cause, and are productive of other complaints than those above mentioned, I shall consi­der them by themselves; which, it is pre­sumed, will be pursuing a more rational plan, than adhering to a term obscure in itself, and indicative of a disease not well defined, and which therefore may tend to mislead the generality of readers.

DISORDERS arising from COSTIVENESS and WIND.

IT has been usual with ancient writers, when conciseness and accuracy were not so much considered as in the present day, to treat of costiveness and wind as distinct heads of complaint; and for the reasons aforementioned, as well as from this little tract being calculated for general usefulness, and not merely for medical readers, it may not be altogether improper to comply with this custom.

Wind is but a mere symptom of some preceding or attending complaint; nor are its troublesome effects either occasioned or increased by air taken in with the food, as many people have imagined; atmospheric air being essentially different from that pro­duced by indigestion, whether owing to the weakness of the stomach, as it is called, or the improper quality or quantity of the food taken into it. It may, however, prove a source of many complaints, and create watch­fulness, startings, hiccoughs, vomitings, and even convulsions, if not timely attended to, especially if the infant is costive.

Costiveness is either constitutional, or ac­cidental, which ought always to be distin­guished, the former being oftentimes harm­less; and, indeed, children of such a ha­bit [Page 32] of body are frequently the most thriv­ing. If th [...] mother should be very consti­pated, her children generally are so; and such a disposition, (whilst they continue in health) ought not, I believe, to be coun­teracted, though it will be prudent careful­ly to watch it. And this will be especially necessary, in the case of children who are subject to fits; fine lusty infants being often seized with violent convulsions, without a­ny other apparent cause than a natural cos­tive state of the bowels, and as uniformly recovered from the fits, merely by procur­ing stools, and breaking off the wind. And this disposition to fits has taken place long before the ordinary period of teething, and has continued till children have been a twelve-month old; at which time the solids, and especially the nervous system, has ap­peared to get stronger. In such habits, a quarter of an ounce of manna, or the like quantity of the syrup of roses, may be put into any liquid, and as much of it given by tea-spoonsful, as shall open the belly: or a tea-spoonful of castor-oil,^* or from five to ten drops of the compound tincture of aloes, [Page 33] may be taken two or three times a-week. And here it may not be useless to observe, that rhubarb will not be a fit purgative, though it be joined with magnesia, which will not sufficiently counteract its restringen­cy. Another reason for objecting to this compound, is that of its being the almost constant prescription of nurses on every oc­casion, whose indiscriminate use of it is ge­nerally needless, and sometimes prejudicial; rhubarb alone, in ordinary cases, answering all the purpose intended, whilst the magne­sia makes an unnecessary addition to the bulk of the medicine, which should always be a­voided for children. A few grains of mag­nesia in a spoonful of water, and sweetened with a little manna, forms a much neater medicine, and in costive habits, which usu­ally abound with acidity, answers very well in early infancy.

But if the child be otherwise in health, it has been said, it is, in general, inadvise­able to do much to counteract the natural habit of body. I have formerly, even dur­ing the month, directed manna, even to half an ounce at a time, to very little pur­pose, unless it were almost daily repeated, and have at other times given from three to five grains of jalap; till I learned there are some constitutions, even in infants, where the bowels cannot be kept open without a daily exhibition of some purgative medi­cine, [Page 34] and that many such children are as well left to themselves, and require only to be watched. If a stool should be wanted, however, a suppository made of a little slip of paper, twisted up, and well moistened with oil, may be very easily introduced, and will generally answer the purpose: or should this fail, a bit of Castile soap may be intro­duced in like manner.

Should such a costive [...] of the bowels produce griping pains, which may be known by the drawing up of the legs, or of the scrotum, and a certain manner of crying; or should the costiveness be accidental, it must speedily be remedied; and if the oc­casion of it be an improper food, which is very often the case, the food must imme­diately be changed. If the child be not usually costive, rhubarb^* is often the best purgative, as it strengthens the bowels af­terwards, infants being much more subject to an over-purging than to almost any other [Page 35] complaint, especially if brought up by hand. It sometimes happens, however, that much more powerful medicines than rhubarb may be required, whether the child be natural­ly costive, or not; and in such cases, much caution is necessary on the part of parents and nurses: For, where a proper dose of senna-tea has proved ineffectual, it is sur­prising what large doses even of rough pur­ges have been given in vain, or sometimes to the injury of the child. On such occa­sions, I would rather advise a recourse to clysters, and especially those made of suc­cotorine aloes. From five to twenty grains, according to the age of the infant, dissolved in boiled milk, will rarely, if ever fail of procuring two or three stools, especially if preceded by the exhibition of a purge. But even drastic clysters should be administered with caution, and ought not to be very of­ten repeated, especially to very young chil­dren; though less hazardous, in every view, tha [...] [...]he frequent repetition of purges of a similar [...]ind.

It may be necessary here to observe, that purgatives for infants ought generally to be made potentially warm, by the addition of a little ginger, po [...]nded cardamom-seed, car­raway-tea, or dill-water; which is of more consequence than is usually apprehended. I have known a careful attention to this cir­cumstance alone, happily suppress complaints [Page 36] in the bowels, which had long continued obstinate, though, in other respects, pro­perly treated.

As there is usually too much acidity in the first-passages in costive and windy habits, a little magnesia may be given for a few days after the costiveness has been remov­ed; and if the child be suckled, the nurse's diet must be attended to. If any flatulency should still remain, (which will not often be the case if it has arisen merely from consti­pation) a little dill-water is the most harm­less carminative. But should it be an atten­dant upon a lax state of the bowels and in­digestion, its remedy will consist in the re­moval of those complaints, which will be noticed in their place.

I have hitherto spoken chiefly of Costive­ness; wind being, however, likewise some­times a real complaint, though it should not happen to be so confined as to become an occasion of fits. The only instances of this kind, indeed, that I remember having seen, have been in new-born and very lusty infants, whose mothers have also been pecu­liarly distressed by affections of that kind. This is, indeed, a somewhat anile way of speaking, but it states the precise fact; and one instance of an infant suffering in this way was so remarkable, that it may be worth no­ticing in this place.

In this case, the meconium began to pass off soon after birth, but not without repeat­ed [Page 37] clysters, purgatives, and the warm-bath, and was peculiarly viscid, as well as in vast quantity. Nevertheless, the infant appear­ed, for several days, likely to be strangled, and was black in the face, merely through the abundance of wind in the first-passages; though it was continually breaking off both by the mouth and the bowels, and by that peculiar, and very loud noise, when it came upwards, frequently observed in the hyste­rical spasm of adults, and continuing for se­veral hours together, so that the infant was often thought to be dying. The whole face, except the nose, became exceedingly swelled, so that the infant could scarcely open its eyes, though without any disco­louration of the skin; being probably ow­ing to wind diffused through the cellular membrane; the tumor subsiding immedi­ately upon getting rid of the wind from the stomach and bowels.

These symptoms, however, yielded to carminative juleps, and purging medicines; and the infant after the meconium was all come away, was freed from every com­plaint, without any farther semblance of fits, though frequently apprehended.

WATCHING, or WANT of SLEEP.

THIS is frequently a symptom of the fore­going complaints, and is to be remov­ed by opening the belly, and afterwards administering some pleasant and carminative pearl-julep;^* which will then frequently act like an opiate^† by restoring rest. Some­times, indeed, this has succeeded so well, when given in large doses, that I have been suspected of having really given some sleep­ing medicine; which would in these cases prove exceedingly hurtful, as the watchful­ness is generally a mere symptom, and not a disease; though when very obstinate, it [Page 39] is sometimes the harbinger of epilepsy, and then requires purgative medicines. I can­not, therefore, avoid taking notice in this place, of the destructive custom amongst nurses, of giving opiates, in one form or other; which, however useful on proper occasions, are sure to act as a poison, and sometimes not a very slow one, when injudi­ciously administered, and never can be more so, than in a costive state of the bowels.

Watchings may arise from worms, purg­ing, gripings from acrid breast-milk, or other food, and from indigestion, as well as from every thing capable of producing pain; each of which will be considered in their proper place. The seat of this com­plaint is, indeed, usually in the first passa­ges, and in very young infants is frequently owing to costiveness. I shall only observe farther, if watchfulness be confined only to the night, it is probable, the child sleeps too long in the day time, which may be re­medied by keeping it moving, and playing with it throughout the day; of which far­ther notice will be taken, under the head of Management of Children.

The preceding complaints would natural­ly lead me to consider the Thrush, and other disorders connected with the state of the first-passages; but it is necessary first to mention one or two of a very different kind, which either exist at the birth, or [Page 40] appearing very soon afterwards, would o­therwise be much out of place.

IMPERFECT CLOSURE of the FORAMEN OVALE, and CANALIS ARTERIOSUS; with other PRETERNATURAL CONFOR­MATIONS of the HEART.

THESE morbid deviations appearing in different parts,^* have in all the same tendency, viz. in a greater or less degree, to obstruct the passage of the blood through the lungs, which in some instances has con­tinued nearly the same as in the unborn-fe­tus. The peculiarity, is sometimes in the pulmonary artery, which is constricted, or closed, as it rises from the right ventricle; at others, in the septum cordis, which has an unnatural opening, affording a free com­munication between the two ventricles; and sometimes in the imperfect closure of the foramen ovale, or the [...]nalis arteriosus.

These sources of disease are mentioned merely with the view of pointing out the symptoms by which they may be known, and not of attempting a remedy; which is out of our power. The recital, however, may serve to prevent fruitless attempts, and [Page 41] perhaps the aggravation of the symptoms, and consequent distress of the patient, where upon due knowledge of the disease, art has, evidently, nothing to offer. The imper­fections are owing merely to an original malformation of parts, or in the two latter instances, to a deficiency in the powers of the system soon after birth; the only time in which that diversion to the circulation can take place, which nature has intended upon the change made in consequence of respiration.

The precise time when this change should take place, is not attempted to be settled, the passages being open in children of very different ages; nor do both always close at the same time. It is conjectured, however, that this process ought to begin from the birth, as it is found to do in the remains of the vessels of the navel-string;^* so that, although the fatal apertures in the heart should not be actually impervious at the end of some months, it is imagined a con­striction usually takes place, and that, at least, some check is given to the blood's passing from one side of the heart to the other, in the free manner it does in the fe­tus, [Page 42] This, it is natural enough to conceive, and I apprehend, is owing to a greater quan­tity of blood rushing into the lungs, in con­sequence of respiration, (which lessens the difficulty of entering that organ); by which means, a greater quantity flows into the left auricle from the pulmonary veins, which filling the part, prohibits an entry from the right. Upon the like principle, the aorta being more distended by a large quantity of blood from the left ventricle, prevents the pulmonary artery from emptying itself into it by the canalis arteriosus.

Sometimes one of these apertures is found open, and the other closed up, especially the canalis arteriosus, which is of the greater consequence; the foramen ovale having in several instances been found pervious in a­dults; and it is imagined is always so, in those divers, who can remain the better part of an hour under water.

Whether the preternatural aperture be in the vessels, auricles, or ventricles, or wheresoever any morbid stricture may be, whenever it may prove of any consequence, the constant symptoms attending it are a dis­colouration of the face and neck, with a sloe-blue, or leaden colour of the lips, such as is met with in some fits of asthma. These take place soon after birth, and the disco­louration is increased, and attended with [Page 43] difficulty of breathing, as often as the child is any wise agitated; but are not relieved by procuring stools, by the warm-bath, or any other mean made use of as a remedy for fits; nor can be, but by the child being kept as tranquil as possible.

If the aperture be in the canalis arteri­osus, children usually sink very soon under the complaint, of which I have seen one in­stance only a few months since; but if the aperture be in the inferior parts of the heart, infants may survive for months, or even for years. A recent instance of which, with an accurate account of the disease, is re­corded in the third vol. of the Medical Transactions of the College. In such instan­ces, the system having been accustomed to the effects of this derangement, is better able to withstand them; the patient, however, can endure but little motion, the heart be­coming thereby surcharged with blood, and respiration rendered more difficult; hence also the blood is detained in the extremities, and the face, neck, and hands become par­ticularly discoloured. Some time, indeed, before the patient sinks under the disease, the symptoms are aggravated, and almost the least motion endangers suffocation.

ERYSIPELAS INFANTILIS.

IN the former edition it was observed, that this complaint did not appear to have been distinctly noticed by any preceding writer.^* This being now, confessedly, the case (at least in respect to the form in which it now appears) it seems necessary to give a name to the disease, which, it is apprehended, may with propriety be termed Erisipelas In­fantilis.

It is a very dangerous species of the spu­rious, or erisipelatous inflammation, which I have not met with, but in lying-in hospi­tals. The ordinary time of its attack being a few days after birth, it was remarked in [Page 45] the former edition, that it was thought ne­ver to appear later than the mo [...]; but I have since seen it in a child of two months old: and the late Dr. Bromfield informed me, that he had noticed it in a child much older. It seizes the most robust, as w [...]ll as delicate children, and in an instaneous man­ner; the progress is rapid; the skin turns of a purplish hue; and soon becomes ex­ceedingly hard.

The milder species of it 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 more violent kind is almost always seated about the pubis, and extends upwards on the belly, and down the thighs and legs; though I have two or three times seen it begin in the neck. The swelling is but mo­derate, but after becoming hard, the parts turn purple, livid, and very often mortify; especially in boys, when it falls on the scro­tum; the penis swells, and the prepuce puts on that kind of emphysematous, or windy appearance, which it has in children when a stone is sticking in the passage; or in the dropsy of the scrotum.

Upon examining several bodies after death, the contents of the belly have frequently been found glued together, and their sur­face covered with inflammatory exudation, exactly similar to that found in women who [Page 46] have died of puerperal fever. In males, the tunicae vaginales have been sometimes filled with matter, which has evidently made its way from the cavity of the abdomen, and accounts for the appearances of the organs of generation just now described: in fe­males, the labia pudendi are affected in like manner, the pus having forced a passage through the abdominal rings.

Various means were made use of at the British Lying-in Hospital without success, though the progress of the inflammation seemed to be checked for a while by satur­nine fomentations and poultices, applied on the the very first appearance of the inflam­mation; but it soon spread, and a mortifi­cation presently came on; or where matter had been formed, the tender infant sunk un­der the discharge. It is now some years since I proposed making trial of the bark, to which sometimes a little confectio aromatica has been added; from which time several have recovered. My colleague Dr. Garthshore, has for several years past directed the appli­cation of linen compresses wrung out of cam­phorated spirit, in the place of the compound water of acitated litharge which has proved more successful in checking the inflammation in several instances; nevertheless, the greater number of infants attacked with this disor­der, still sink under its violence, and many of them in a very few days.

[Page 47] Since the former edition of this tract, the same disease, as I apprehend, has appeared once in a new form, in the British Lying-in Hospital. In this instance, the infant was not only born with hard, and sublivid in­flammatory patches, and ichorous vesicati­ons, about the belly and thighs, but other spots were already actually in a state of mor­tification. An eschar soon spread to near three inches in length upon the spine of the tibia, and other smaller ones appeared about the legs, and on several of the toes and fin­gers. The parents of the child appeared to enjoy good health, and the mother had plenty of good milk, which her infant was fortunately able to take in great quantity. The child was hereby duly nourished; and taking likewise every day, from the time the mortification began to spread, from four to six ounces of a strong decoction of the bark, it was supported under an excessive discharge of matter, through this tedious disease. The parts affected were at the same time frequently fomented, and were some­times wrapped up in warm cataplasms, and at others, dressed with theriaca, as the sloughs became loose; and were covered with com­presses wrung out of camphorated spirit. The infant, however, lost two joints of one of its fingers, and the first of another; all the other fingers, and the toes, contrary to expectation, throwing off the mortified parts, [Page 48] were recovered entirely, and the child was sent out of the hospital perfectly well; and I had the satisfaction of seeing it in good health, several months afterwards.

APTHAE, or THRUSH.

HAVING considered the above early com­plaints, I return to those which owe their immediate origin to some affection of the first passages, as they are called.

It is amongst the vulgar errors, that the thrush is a very harmless complaint, or is even desirable to a child in the month; for it is said, if it does not then make its ap­pearance, it certainly will at a more advanc­ed age, and will then prove fatal, or will, at least, attend the patient in his last illness. The fact is, it is a disease of debility, and therefore attacks very young, and very old subjects, especially if otherwise weakened. From the above mistake, however, the dis­order is often neglected in the beginning, whereby the acidity in the first passages is suffered to increase, which always aggra­vates the complaint. It is, indeed, a much milder disorder in this island than on most parts of the Continent (through a priori we might perhaps, supose it would be other­wise) particularly in France, where it reigns as a malignant epidemic, especially in the [Page 49] Hotel Dieu, and Foundling Hospitals, known by the names of Muguet and Millet. ^† The thrush, however, is as much a disease, as any other that appears in the month, and is connected with most of the foregoing com­plaints; a proper attention to which may very frequently prevent it.

This disorder is so well known, as scarce­ly to require any description, and generally appears first in the angles of the lips, and then on the tongue and cheeks, in the form [Page 50] of little white specks. These increasing in number and size, run together more or less, according to the degree of malignity, and compose a thin, white crust, which at length lines the whole inside of the mouth, from the lips even to the gullet, and is said to ex­tend into the stomach, and through the length of the bowels; producing also a red­ness about the anus. When the crust falls off, it is frequently succeeded by others, which are usually of a darker colour than the former. But this is true only in the worst kind of thrush; for there is a milder sort, that is spread thinly over the lips and tongue, which returns a great many times, and always lasts for several weeks. I have seen this so very often the case, that when I observe a child to have the complaint very very lightly, and that it does not increase after two or three days, I venture to pro­nounce it will continue a long time, but will be of no consequence. Care, however, ought to be taken that the child be not ex­posed to cold.

The thrush is said to be generally attend­ed with fever, but this is not usually the case where the thrush is an original disease but when consequent to severe bowel com­plaints, erysipelas, and other infantile disor­ders, it is, indeed, often accompanied with fever, and when so, proves either favoura­bly critical, or the infant usually sinks very [Page 51] soon. In ordinary cases, however, I am confident in nine out of ten, there is not the least fever, though the mouth is of­ten so much heated, as to excoriate the niples of the nurse, and becomes so tender, that the child is often observed to suck with reluctance and caution.—It is an old obser­vation amongst nurses, and there is some foundation for it, that very long sleeping, in the course of the first week or two, is often a forerunner of this complaint.

It has long been a received opinion, that the thrush must appear at the anus, and nurses will seldom allow it to be cured if it does not; but the truth is, that its appear­ance there is only a mark of the degree of the disease, and not in the least of its cure, and is not, therefore, generally to be wish­ed for. The redness about this part is oc­casioned by the sharpness of the secretions in the bowels, and consequently of the stools, which lightly inflame and sometimes excoriate the parts about the anus, and in a bad thrush will do so long before the com­plaint is going off; but in the lighter kind, no such effects are produced, or are, at least, very slight. And, indeed, this redness has been so often mentioned to me as an indica­tion that infants must certainly have already had a slight thrush, or be likely to suffer by it very soon, where children have escaped it altogether; that I have ventured to imagine [Page 52] such infants may be least of all liable to it, if otherwise in good health; at least, my experience seems hitherto to support that idea. And I have even conceived, that the acidity of the first passages being in some children more confined, may prove a remote cause of such infants being troubled with the thrush; whilst others by an open belly, and firmer viscera, may escape it, at the expence only of this soreness of the exter­nal parts, which often continues for several days.

The remote cause of this disease, seems to be indigestion, whether occasioned by bad milk, or other unwholesome food, or by the weakness of the stomach.—Perhaps thick victuals, particularly if taken hot, and made very sweet; also covering the face of the child when it sleeps, or its breathing the confined air of the mother's bed, may be amogst these causes, and ought therefore to be avoided.—The proximate cause,^* is [Page 53] the thickness, or acrimony of the juices se­creted from the mouth, fauces, stomach, &c. producing heat and soreness in these parts.—A tea spoonful of cold water given every morning has been a good prophylactic, or preventive.

Much has been said in favor of emetics, especially wine of antimony, as being almost a specific for this disease, but I cannot say it has proved so with me; nor can I see any sufficient cause for departing from the more ancient practice, in the treatment of this very common complaint.

There can be no objection, after having properly opened the bowels, to administer­ing an emetic, and where the thrush is of a dark colour, and the whole inside of the cheeks are lined with it, I believe it will be useful, by emptying the stomach of the crude juices oozing into it from the glands of this part. But, I think it would be almost as endless, as it would generally be prejudicial, to persevere in the use of emetics, for days, and even weeks together, and is both a se­vere, and an unnatural method of treating [Page 54] a tender infant, in which the bowels are al­ways the most natural outlet for its com­plaints; on which, therefore, nature uniform­ly throws the offending matter on almost every occasion, as appears plainly in teeth­ing, in which the first passages cannot be primarily affected.

I believe, therefore, where there is no fever, nor any uncommon symptom, testa­ceous powders are the best and safest reme­dy; which may be joined with a little mag­nesia, if the body be costive; or if in the other extreme, and the child is very weak­ly, two or three grains of the compound powder of contrayerva in its stead. Some such preparation should be administered for three or four days successively, and after­wards something more purgative, to carry down the scales as they fall off from the parts. For this purpose, rhubarb is generally the best; but when the thrush is very violent, is of a dark colour, has come on very rapidly, and the child is lusty and strong, a grain or two of the powder of scammony with calo­mel,^* may be joined with it, agreeably to [Page 55] the idea of HEISTER; but this must be given with caution. After the purgative, the testaceous powders should be repeated for two or three days as before, till the dis­order begins to give way. Afterwards a tea-spoonful of camomile-tea, or a few drops of the compound tincture of gentian, well diluted, may be given two or three times a day with advantage.

The choice of the testaceous powders, on which some writers have said so much, is, I believe, of very little importance; the purest and softest are preferable. The de­sign of these medicines, being to absorb and correct the predominant acidity,^* their effect will be discovered from the kind of stools that succeed, and the dose may therefore be increased or diminished, or they may be al­together discontinued, as circumstances di­rect. In the mean time, if the child is suck­led, the nurse's diet should be attended to, and in general, her usual quantity of porter or ale, (which is almost always more than sufficient) should be diminished.

[Page 56] In regard to applications to the part, it is necessary to observe, that as they have lit­tle to do in curing the complaint, it will be improper to have recourse to them very ear­ly. I know, indeed, it is very common to begin with them, but they serve only to in­crease the soreness of the parts, (especially in the manner they are generally used) and to give a deceitful appearance of amendment. If the inside of the cheeks and tongue are thickly covered with sloughs, it may some­times be convenient to clean the mouth once a day; but it will in general be useless, till the complaint is past the height, the sloughs disposed to fall off, and the parts under­neath inclined to heal. Proper applications will then have their use, both by keeping the mouth clean, and constricting and heal­ing the raw, and open mouths of the excre­tory vessels.

For this purpose, an hundred different lotions and gargles have been invented, which from the earliest times have all been of an astringent nature.—Honey of roses and spirit of vitriol, or of sea-salt, as re­commended by Etmuller and Dr. Shaw, form a very good one; but nothing is pre­ferable to borax, which some advise to be mixed up with sugar, in the proportion of one part of the former to seven of the latter: a pinch of this put upon the child's tongue will be licked to all parts of the mouth. But [Page 57] I prefer a mixture of borax and common honey, (about two scruples or a dram of the former to an ounce of the latter) which hangs about the fauces better than in the form of powder. Either of these may be made use of as often in the day as shall be necessary to keep the parts clean, which they will effectually do, without putting the infant to pain, by being forcibly rubbed on. I must own, I have frequently been distress­ed, at seeing nurses rub the mouth of a lit­tle infant, with a rag-mop, as they term it, till they have made it bleed; and this ope­ration they will often repeat half a dozen times in a day.

It only remains to take notice of the black thrush, as it is called, which is confessedly a very uncommon complaint in the infant state. Dr. Armstrong says he has never met with it. I have seen only two instances of it, which were in strong and healthy chil­dren; but the parts were not perfectly black, and if that be intended by the name, these cases might not be precisely that complaint: they, however, both proved fatal. After the stomach and bowels have been cleansed, I believe, a decoction of the bark, with a little aromatic confection, is the most likely medicine to be of service, and is sometimes necessary in the worst kind of common thrush, when the succeeding sloughs are ve­ry [Page 58] opake, thick, and of a dark colour; which is, however, always a dangerous symptom.

The RED-GUM, or BENIGN-FRUPTION.

THE red-gum is an efflorescence on the skin, appearing usually in small spots, often confined to the face and neck; but at others, it extends to the hands and legs, and even the whole body, appear­ing in very large patches, and some­times raised above the surface. It will like­wise appear in the form of small pustules, filled with a limpid, or sometimes a purulent or yellow liquor; at least, I have never known what name to give this kind of erup­tion, but that of a rank red-gum, as it happens only in the month, or soon after­wards, and never gives any trouble. There is another species as small as pins heads, or even their points; firmer than the former; often of a pearl colour, and opake, which has generally been accounted a kind of red-gum; but it has of late been suggested, might for distinction sake, be termed white-gum. ^* Every species of this eruption is [Page 59] produced by the same cause as the thrush, but can scarcely be termed a complaint, be­ing a kindly effort of nature to throw off some acrimony; consequently an evidence of the strength of the constitution, as the thrush is, usually, of its weakness. In the former, nature throws off the offending matter on the surface more completely than in the lat­ter, and therefore, when the eruption is slight, requires no assistance.

On this account it is, I apprehend, that writers have not usually taken notice of it, though it should seem requisite, if only for the satisfaction of parents, who are some­times distressed on account of it, especially if it be of the more extensive and rank spe­cies. It is necessary only to give a little tes­taceous powder, or magnesia, according to the state of the bowels, and to keep the child moderately warm, otherwise the rash striking in, the acrimony will fall on the first-passages, and be succeeded by sickness, or purging, (till the eruption appears again on the skin) or not unfrequently by the thrush, or a slight return of it, if the child has lately recovered from it.

ERUPTIONS on the SKIN.

IT is, by no means, my intention to enter largely into this extensive subject, but imperfectly understood, perhaps, even to this day. In another part of the work I shall treat of the scall'd-head, and two or three other troublesome affections of the skin, but shall at present confine myself to such eruptions as are peculiar to the state of infancy.

Infants are liable to various anomalous kinds of rash, both in the mouth, and till the period of teething is over. The early ones may be regarded as a sort of red-gum, and children who are most subject to them, generally have their bowels in a better state; the rash carrying off, as has been said, the acidity^* with which they so much abound.

It may be remarked, however, that when infants at the breast are inclined to frequent returns of some eruption on the skin, if the child be always indisposed at such seasons, the rash will often be found owing to some ill quality in the breast of milk, which ought therefore to be examined, and particularly in regard to its taste. On such occasions I [Page 61] have found, that milk which has been above a twelve-month old, has contracted a very unpleasant flavour, and that upon changing the wet nurse, a very ill looking rash has soon afterwards entirely disappeared, toge­ther with the other complaints.

One species of these early rashes often takes place about the time of teething, and not unfrequently at the decline of fevers or severe bowel complaints; insomuch that, upon a sudden appearance of it during a se­rious illness, I have often ventured to prog­nosticate the recovery. This rash very much resembles the itch, both in regard to the little watery heads and foul blotches; and is confined to no particular part of the body, though it appears more frequently about the face and neck. Indeed, I have seen the whole body so covered with it (and mixed with an eruption about the face, of a different appearance, and evidently red-gum) that in a consultation, it has been by some taken to be the true itch. This eruption is certainly salutary, and even critical, requires nothing but to avoid taking cold, and is mentioned only because it is not an uncom­mon appearance, and parents who are un­acquainted with it, are apt to be alarmed at it.

But there is a very common rash that calls for more attention, and to which medical writers have given the name of Crusta lacte [...] [Page 62] (Lactumen, or milk blotches), which has a very unpleasant appearance, but is not­withstanding equally innocent with the for­mer, and even prevents other complaints. I think I never saw an infant much loaded with it, but it has always been healthy, and cut its teeth remarkably well. Indeed, it falls to the lot of the finest children, and such as are well nourished; whence some have imagined it owing only to the richness of the milk.^* And it is remarkable in this eruption, that however thick and long-con­tinued the scabs may be, the crusta lactea never excoriates, nor leaves any scar on the parts.

It appears first on the forehead, and some­times on the scalp, often extends half-way over the face, in the form of large loose scabs, and appears not very unlike the small pox after they are turned. Very little, I believe, is necessary to be done; but in bad cases a perpetual blister may sometimes be of service. It usually disappears of itself when the child has cut three or four teeth, though it may sometimes continue for seve­ral months, and in a very few instances even for years: in such cases, the Harrowgate, or any other sulphureous water will have a good effect; but the medicines commonly prescri­bed do nothing. I have known testaceous [Page 63] powders and various alteratives administered to no purpose, as people of rank are very anxious to have it removed if it be possible. I was lately consulted for a child who had taken a grain of calomel, at short intervals, for several months without any benefit, and fortunately without any injury; which is rarely the case when powerful medicines are administered unnecessarily. This rash will now and then make make its appearance very early, and has then been mistaken by those who are not much accustomed to very young children, for the effects the venereal disease. I not long ago saw such a case, and advised only to keep the body open with a little magnesia; the complaint got no worse, and upon cutting some teeth, disap­peared as usual. I have known it, howe­ver, disappear suddenly, previously to any teeth being cut, and after some weeks be­come more violent than ever; the infant re­maining all the while in perfect health.

It were almost endless to enumerate the various kinds of rash to which infants are liable, but I mean chiefly to confine my re­marks to the more important, or rare ones, and such as may not have been described by preceding writers. Among such is the fol­lowing, whose unusual appearance are apt to alarm parents and others, not accustomed to see them.

[Page 64] The first I shall notice appears chiefly in teething children, very much resembles the measles, and has been sometimes mistaken for it. It is preceded by sickness at the sto­mach, but is it attended with very little fe­ver, though the rash continues very florid for three days, like the measles, but does not dry off in the manner of that disease. It requires nothing more than the shell-pow­ders, or sometimes the addition of a little nitre and compound powder of contrayerva, with a dose or two of rhubarb, or other gentle laxative, on the going off of the rash.

An eruption still less frequently met with appears sometimes after children have cut all their first teeth. I know not what name ought to be given to this kind of eruption, which breaks out in the form of round lumps as large as midling-sized peas, very hard, with a very red base, and white at the top, as if they contained a little lymph.

They come out suddenly without previous sickness at the stomach, are not sore, dis­posed to itch, nor ever give any trouble, and are seldom seen but on parts that are usually uncovered, and are sometimes there in great numbers, resembling the distinct small-pox; but are harder, more inflamed, and less purulent.

Alarming, as well as unusual, as is this appearance, I believe the eruption is always [Page 65] perfectly harmless, if not repelled by cold, or improper treatment; and will dry away in three or four days: nothing more being necessary than the little remedies, directed for the former, and to keep the child with­in doors, if the weather be cold.

An eruption of an appearance equally un­common and analogous to the above, I have met with only in children of at least three or four years of age, and such as have also been affected with slight symptoms of scrofu­la; though I have not seen it frequently enough to ascertain its being, in any de­gree, owing to that specific virus. It breaks out suddenly, covering at once the greater part of the body, but occasioning neither pain nor itching, nor are children sick at the stomach nor otherwise ill with it, though it lasts for two or three weeks.

This eruption, therefore, like some others, [...] taken notice of chiefly for its sin­gular appearance, which, though some­what like the nettle-rash, is of a different figure, but may be pretty exactly conceived of by the little red lumps sometimes left by small-pox, after they are turned, and also rubbed, or picked off; especially after the chrystalline or warty species, and where the pustules have been pretty numerous.

If the first-passages are at all disturbed, my attention is principally directed to them, otherwise to the state of the skin; and in [Page 66] this case, I have usually directed small doses of Dr James's powder, to be taken for a few nights at going to bed, and the poly­chrest salt and rhubarb, occasionally, in the course of the day, with or without the ad­dition of a little of the acitated water of am­monia.

In the course of a few days the eruption puts on a darker colour, is less prominent, and begins to scale off in a branny scurf, somewhat like the measles: but should no such change take place, the vinum antimonii should be taken two or three times a day; to which, if no amendment should soon be perceived, a few drops of the tinctura can­tharidis may be added; a remedy often ve­ry efficacious in disorders of the skin; but should be administered with caution.

Another rash, or rather eruption, takes place both in bowel complaints and in teething, and always appears to be benefi­cial. It consists of vesications or blisters of different sizes, resembling little scalds or burns, and continues for several days. They come out in different parts, but chiefly on the belly, ribs, and thighs; and contain a sharp lymph, which it may be prudent to let out by a puncture with a needle, especi­ally from the larger ones. No medicine is necessary but such as the particular state of the bowels may call for, which usualy abound [Page 67] with acidity whenever there is much erup­tion on the skin.

An eruption, vulgarly termed scorbutic, infesting the face and neck, and discharging a sharp ichor that excoriates wherever it runs, and difficult of cure by chemical alte­ratives, will often yield in a very short time to the expressed juice of the sium aquaticum. From one, to four or five table spoonfuls may be given, mixed with one or more lpoonful of new milk, three times a day, according to the child's age, and the state of its stomach; taking care at the same time, to keep the bowels open by senna-tea or other common laxative.

I shall close this account with a description of an eruption that is singular enough, re­sembling very much the herpes or broad­ring worm, or the adust-coloured spots left on the face after an attack of St. Anthony's fire. I have seen it in various parts, but I think only on such as are more or less liable to be fretted by some part of the infant's dress, especially on the nates and contigu­ous parts covered by the cloths, where the blotches are always the broadest and most [...]ank. Were it to appear no where else, it would seem to be occasioned by some sharp­ness of the urine and stools, as the skin has a very heated appearance, though the erup­tion, I believe, is not at all painful. It fre­quently breaks out before the period of [Page 68] teething, but the bowels are generally some­what disordered, and the stools voided very green, or else become so very soon afterwards. This I take to be one of those eruptions oc­casioned by some bad quality of the breast-milk as I have never met with it but in young infants whose nurse's milk has been old, and has also contracted a very disagreeable taste. If that should not be the case, the rash will probably require nothing but the light ab­sorbent medicines before mentioned, and to guard against constipation. But if these means should not succeed in a short time, the nurse ought to be changed.

In all the eruptive complaints of infants, taking cold ought to be carefully avoided, and great caution be used in regard to all external applications, as well as keeping the belly open. If the child is sick at the sto­mach, a little magnesia, testaceous powders, or the compound powder of contrayerva joined with them, may be given now and then; or should the rash be hastily struck in, and the child be ill, it should be immediately put into a warm-bath and afterwards take five or six grains of the aromatic confection, with, or without a few drops of the wine of antimony, in simple mint water.

Should any scabs become very dry and hard, which the crusta lactea will sometimes be, especially when they extend to the [Page 69] crown of the head, and seem to give pain, they may be touched with a little cream, or with oil of almonds mixed with a few drops of the water of kali; but not a large sur­face at a time. Or should they be very moist, and cause pain by sticking to the cap, they may be dusted with a little common powder, or with flowers of sulphur, and covered with a singed rag, but I should be very cau­tious of doing much more; as the suppres­sion of any considerable eruption on the skin may occasion the worst effects espcially du­ring the time of teething.

SORE EARS.

SLIGHT blisters and ulcerations behind the ears of infants are so very common, that almost every parent is well-acquainted with them, and in general require only to be washed with cold water, or covered with a singed rag, to keep the cap from sticking to them, and thereby giving the child pain. They are, moreover, often very useful, es­pecially during bowel complaints, or the eruption of the teeth. But there is in some children of a gross habit of body, and es­pecially about the time of teething, a spe­cies of ulcer that often requires attention, on account of its extending low down in the neck, occasioning great pain, and spreading [Page 70] into large and deep sores, insomuch that a mortification has sometimes come on, and even the processus mastoideus has become ca­rious. Here fomentations will be necessa­ry, especially those of bark, and its pow­der should be administered internally. Such cases, however, do not often occur; but whenever the sores are large the cure should be begun by a blister on the back, in order to draw off the heated serum that flows to the parts. I have usually given an opening powder of testecea and rhubarb, with a little nutmeg, and sometimes nitre, to which is added either calomel, cinnabar of antimony, or hydrargyrus cum sulphure; the latter of which, I think I have found more service­able in some eruptive complaints in young children, than seem to be generally imagin­ed. But above all, some mercurial should be made use of to the sores, which, though they are often apparently inflamed, never offends them. A very clean and elegant preparation of this kind is the following,

• R. Calomelan. ʒj. ad ʒij.
• Ung. Sambuci ℥j m. ft. inimentum.

A little of this liniment spread on each side of a piece of doubled linen cloth, and applied twice a day, will do more than all the fomentations, or healing ointments, that I have ever seen used; and indeed has al­ways succeeded with me, though I have been [Page 71] told the sores had spread deeper from day to day under various other applications. From such treatment I have never found the least ill effects, but children have preserved their health as well as if the sores had kept open, which, when benign, are certainly design­ed by nature as a preservative from some other complaints, especially those of the sto­mach and bowels, of which I now proceed to take notice.

VOMITING.

VOMITING is certainly not a common complaint of infants, I mean when con­sidered as a disease, unless it be attendant upon some other, of which it is then rather a symptom, or the consequence of such dis­ease improperly treated. Neither are in­fants in health disposed to vomit frequently, unless the stomach is overloaded, the milk is then usually ejected as soon as it is taken, and comes up unchanged. Nor is this to be considered as a disease, or as calling for the discipline recommended by some writers. Wherefore should the residue of the ali­ment be forced off the stomach by an eme­tic, when it has already parted with all the oppressive abundance? This kind of puking is not attended with any violence to the sto­mach: the milk, or other food seems to [Page 72] come up without an sensible action of the stomach, or the child being sick. Nay, it is at once so common to some of the finest children, that it is a saying with some old nurses, (though I am not very partial to many of their proverbs) that a puking child is a thriving child; and when such ejection comes only soon after sucking or feeding, and the aliment is cast up, scarcely changed, matter of fact verifies the obser­vation.^* But if the food remains some time on the stomach, it will then be thrown up in a curdled state, which is an indication to attend to it, if it happens frequently. Not that the milk ought not to curdle on the stomach, which it always must do, in order to a due separation of its component parts, and is the chief, if not the only di­gestion, it undergoes in the stomach. The whey and the rich oil are there separated from the curd and earthy particles, the for­mer being taken up by the lacteal, or milky-vessels in the bowels,^† is converted into blood; whilst the bulk of the latter is carried down and expelled with the other excrementious parts of the food, and gas­tric [Page 73] juices, for which nature has no use. This curdling of the milk, therefore, is the natural course of digestion, though many writers have not been sufficiently attentive to it, and Harris has asserted it is owing to a predominant acid. But when the milk comes up in a curdled state, it proves that the sto­mach having digested what it had received, hath not power to push it forward into the bowels, and therefore throws up a part of it.^* If this be the case, the stomach may perhaps require to be emptied of its whole contents, which may be easily done by giv­ing a little warm water, or camomile tea. The cause of the indigestion was an acci­dental repletion; that removed, together with the consequent foulness, or bad juices of the stomach, the effect also will generally cease, and unless the vomiting returns, from any farther injury the repletion may have occasioned, it requires nothing more. To [Page 74] distress the child, on every such occasion, with a sickening emetic, or drench it with rhubarb and magnesia, is as needless as it would be to awake a patient out of a sound sleep to give him an opiate. Only let the child fast a little after having emptied the stomach of its load, and the nurse be careful not to overfill it for the future, and it will rarely want any other assistance.

If the vomiting, on the other hand, has arisen from acrid diet, a little farther disci­pline may be requisite, because some half-digested food has got into the bowels, per­haps for several days together. In this case, a gentle laxative, and change of food for one of a milder kind, is all that is generally necessary; or if there be a prevailing acidity in the stomach, either the testaceous pow­ders, or magnesia, (according to the state of the bowels) may be mixed with the food, or be otherwise administered for two or three days, as the occasion may require. Or a drop or two of the water of kali, or a little castile, or almond soap, are excellent remedies, especially when the stools are un­usually green, or clayey; not only as they will tend to promote a secretion of the gall, but correct acidity.^* For which purpose [Page 75] also, myrrhe, though an obsolete, seems to be an excellent remedy, when infants are a few months old. Should the vomiting be a symptom attending some other disease, its re­medy will turn on the proper treatment of its cause. If such cause be the sudden disap­pearance of some eruption on the skin, the child may be put into a tepid bath, the limbs be well rubbed as soon as it is taken out of the water, and the infant be then put to bed: and if the vomiting continues, an emetic should be given, and afterwards a blister ap­plied to the pit of the stomach.

Having mentioned emetics, I shall take this occasion to observe, that the choice of them will be always best determined by the na­ture of the complaints for which they are ad­ministered. In those of the first-passages, ipecacuanha is generally the best, but if a fever should attend, or it be wished to pro­mote a gentle perspiration, those of antimo­ny are preferable; or lastly, in disorders of the breast, the oxymel, conserve, or tincture of squills.

But a more troublesome vomiting will sometimes arise in unhealthy children, from too great a sensibility, or too great an irri­tability of the nerves of the stomach. Such [Page 76] medicines are then indicated as will brace, or strengthen that organ, and abate its sen­sibility. For the former, a cold infusion of the bark, or of camomile flowers, with orange peel, and sometimes a little rhubarb. For the latter, a saline mixture with a drop or two of laudanum. And the benefit of these may be increased by aromatic and spi­rituous fomentations to the pit of the sto­mach, or by the labdanum plaister, with a little theriaca added to it.

GRIPES.

THE Gripes is a very common term amongst nurses, and some writers on children's diseases have treated of it under a distinct head; but this serves to perplex mat­ters, instead of explaining them. If a child be not hungry, or hurt by some parts of its dress, there are always symptoms attending, that will account for its crying, and other expressions of pain. The cause is, indeed, very commonly in its bowels, and may be increased by costiveness, which has already been treated of, but more commonly mani­fests itself by a purging, which comes next in order to be considered.

PURGING.

UNDER the article of vomiting it was ob­served, that frequent puking is oftentimes an attendant upon some other complaint, and then demands a peculiar attention, and is to be treated agreeably to the nature of such complaints; and there is, perhaps, none which it more frequently accompanies than a Diarrhoea, or Purging.

Vomiting and Purging very often arise from unwholesome milk or other food, from a moist cold air, or from the sudden disap­pearance of some eruption on the skin. The purging is not then hastily to be stopped, nor even absorbent powders to be given, till the offensive matter be first carried off; and if a vomiting attend, the cure should begin by administering an emetic. But though the purging ought not to be checked with­out previous evacuations, nor to be stopped hastily, yet it is not to be treated with a daily exhibition of rhubarb, which though a common practice with many, serves to keep up a purging after the cause has been remov­ed, by creating a continual irritation in the bowels. The diarrhoea, indeed, is a com­plaint often as difficult to treat as any in the infant state, and is therefore worthy of par­ticular attention. In a general way it may [Page 78] be said, that a sufficient dose or two of rhu­barb should be administered in the beginning, and afterwards absorbents. If the purging should still continue, an emetic will be ne­cessary, as purges do not always lie long enough in the stomach to carry off the offen­sive matter it contains. After this, it is often necessary, the child should be purged again, for it should be always remembered, that many complaints of infants, whether seated only in the first-passages, or attended with fever, will frequently seem to be giving way upon procuring stools freely, but will soon return if the same means be not repeat­ed, till the whole irritating matter be carried down. Should such repetition fail of suc­cess, though the diet has been carefully at­tended to, the use of them at present should be laid aside, and recourse should again be had to absorbents, and if there be no fever, to light cordials, and even to opiates, with­out the latter of which, many bowel com­plaints will not admit of a lasting cure, ow­ing to the great irritability of infants. Such medicines are not indeed very often requir­ed till children are some months old: but when they are found necessary, not only may syrup of white poppies, but even laudanum be given with the most perfect safety;^* [Page 79] though from the time of Galen, (who cau­tions against giving theriaca to children) till of later years, many physicians have been fearful of directing them, (arguing from their abuse against their use) and especially Harris, who in other respects, has written so well on their diseases. I remember being called to see an infant of only two days old, who, through a mistake, had taken some hours before, four drops of laudanum. The parents were greatly alarmed at the child's lying in a stupid, drowsy state, without be­ing able to take the breast or open its eyes, I encouraged them, however, to believe the laudanum would do no kind of harm, if they would frequently get a little breast-milk down with a tea-spoon. Accordingly, though the child lay sleeping above six and thirty hours, it afterwards awoke perfectly well.—This is mentioned, however, only by way of encouragement to such as may be fearful of administering opiates even where they are necessary. They are, nevertheless, very powerful medicines, and should be prescrib­ed with due caution for patients of every age, and especially for infants. A like cau­tion may be necessary in regard to cordials, which are, nevertheless, in many cases equal­ly proper, notwithstanding a modern preju­dice against them. There is a certain cold­ness and langour in infants when they are ill, especially under some bowel complaints; [Page 80] and whenever they may be in that state, that class of medicines will have a very hap­py effect.

Purging in children, it is to be observed, is not always a disease. The bowels are the great natural, and critical outlet in infants, as the pores of the skin, and the kidneys are in adults. Not the mere discharge, there­fore, but the cause of it is, in the first in­stance, to be removed, and the ill effects are to be guarded against by keeping the purg­ing within bounds. For this purpose, the chalk julep, as it is an astringent only by absorbing the acrid, or changing the acid, and irritating matter, is as safe as it is useful, becomes an excellent anodyne, or com­posing medicine, and after the bowels have been well cleased, will usually accomplish the cure.

Dr. Armstrong takes occasion to speak against the use of absorbent powders, and prefers wine of antimony, because modern writers appear to depend so much on the former, from their known property of cor­recting acidity, previous to the exhibition of purges; and says, that in cases of extreme danger, a physician who is called in late, would, according to this practice, often find no opportunity for purging at all. But sure­ly this is scarcely an argument to prove the superiority of his method, since no writer that I know of, ever designed it as a rule [Page 81] without exception; and Harris, who has said as much as any man in commendation of the absorbent powders, does not deny the expediency of sometimes beginning with purgative medicines. But had it been otherwise, the argument goes no farther than to prove, that in cases of great danger, the wine of antimony, being both an emetic and a purge, ought to precede the use of the testaceous powders. Instead of this, Dr Armstrong slides into a general conclusion from premises evidently limited; though he has advanced nothing against an established, and successful method of treatment. And I may add, that whilst he is fearful, that the absorbent powders, (which nobody pre­scribes without some purging medicines) should check the looseness, and thereby in­crease the fever; he ventures, after a repe­tition of the antimony, to administer what he calls a gentle paregoric, or opiate, to ap­pease the pain, consisting of a dram of syrup of white poppies, repeated every three or four hours, till that end be obtained. So that if the pain should continue for nine hours, a child will take half an ounce of the syrup; and this Dr. Armstrong observes is the only medicine he gives, except wine of antimony, which (notwithstanding the opi­ate) he supposes to be the efficient remedy.

It is an improper exhibition of absorb­ents, I apprehend, rather than their dose, [Page 82] that has made some practitioners so averse to them; for they certainly ought, in many cases, to be given in large quantities; but if administered too early, and long continu­ed, the stools may become like plaister of Paris, and be with difficulty excreted. Such an instance is mentioned by Boerhaave, who had, nevertheless, a very favorable opinion of them, as will be noticed hereafter. There is, however, some fallacy in regard to the colour of the stools, as this kind is fre­quently observed in children who have ne­ver taken any of the testacea, if the secre­tion of the bile be obstructed; as in jaun­diced adults.

In his second edition, Dr. Armstrong mentions another method he has fallen upon for curing this disorder, which, however, appears to be recurring to the ancient method of treating bowel com­plaints, and seems, indeed, to overturn the idea he had entertained of the superiority of wine of antimony over every other medi­cine. This method, he tells us, is by cleans­ing the bowels, by means of proper purga­tives, joined with anodynes, or opiates, in­termixed in such a manner as to correct the griping quality of the medicines, and lessen the stimulus occasioned by the acrimony of the stools.—A plan worthy of imitation, it is apprehended, and though not likely to [Page 83] be proper in all cases, must, as an occasi­onal practice, be safe and beneficial.

To return, it is of some consequence to learn what part of the bowels is particular­ly affected, and the degree of pain children may endure; and some indication may be had from undressing the child, and careful­ly examining the belly, and gently pressing in different parts, as well as from the dif­ferent expressions of pain the infant may manifest, either by a forcible contraction of one or both legs, or of the arms, accord­ing as the irritating matter may be higher or lower, or on one, or both sides of the belly; also from the coldness of the feet. Regard is also to be paid to the kind of stools that come away, which in a diarr­hoea are seldom good, and are usually distin­guished into the sour and curdled, slimy, green, clayey, watery, and bloody, some of which are at times also fetid; and in this case, some powerful purgative, such as sen­na-tea, is oftentimes necessary, if the child is not very young. True bloody stools, however, are less common in infants than adult [...], and seldom occur but in the last stage of the disease; but a few streaks of blood may sometimes be mixed with the fe­ces, which arising only from the hemorrhoi­dal veins, is of no consequence. Should purgings return frequently, it will be very useful, (especially in the time of teething, [Page 84] or upon the striking in of some cutaneou eruption), to procure a little discharge be­hind the ears, o [...] [...]o apply a burgundy-pitch plaister to the back. For the former pur­pose, some finely pounded Spanish slies may be rubbed on the [...], till a slight excoria­tion, or rawness, is produced; [...] perhaps a better, though not a common method, is to draw a piece of course doubled worsted, or a bit of narrow tape, through a piece of common blistering-plaister, and lay it close behind the ears where they rise from the head, and repeating it occasionally, which will produce a discharge exactly from the spot where it is wont naturally to arise.

When the stools appear sour or curdled, or the child is much disposed to hiccough, the magnesia, and other absorbent powders are calculated to afford peculiar assistance, and may be warmed by the addition of a little grated nutmeg. When the stools are green, or white and clayey, a drop or two of water of kali may be occasionally put in­to the other medicines, or a little soap be dissolved in the clysters, which are essenti­ally necessary when much griping attends this complaint: the child's belly may like­wise be rubbed with a little warm brandy. The following preparation is highly extoll­ed by Boerhaave,^* as an almost universal [Page 85] medicine in the diseases of infants; and is certainly a good remedy, especially in their bowel complaints:

Take of Venice soap two drams; prepar­ed pearls, one dram; prepared crabs claws, one dram and an half; syrup of marshmal­lows, half an ounce; mint-water and fennel-water, of each three ounces; mix them.—A desert spoonful is directed to be taken once in eight hours.

When purgings have continued a long time without any amendment, a peculiar tightness of the skin will sometimes take place in the last stage of the disease, afford­ing always an unfavourable prognostic; and of which farther notice will be taken under the article of Skin-bound.

The true Watery-gripes, so called, is es­teemed the most dangerous of all purgings, and is usually thought fatal, though perhaps without reason; since if properly treated, children recover from it as well as from ex­cessive purgings of any other kind, unless it happen after some other illness, or to ve­ry small and tender infants during the month. It is not the having a few very thin stools, however, that is an evidence of the true watery-gripes, for in almost every purging of a few days continuance, the stools are very thin as well as numerous. But in this case, they are thin very early in the disease; the child looks wretchedly, and every thing [Page 86] it takes runs almost immediately through it, with very little change, as in the lientery of adults.

The cure should be begun by administer­ing one or more pukes, especially when the stools are of a dark colour and fetid, as they frequently are in the earlier periods of the complaint. And to this end, a pretty strong one should be prepared, which should be given in divided doses, at about a quarter of an hour's distance, till a proper effect is produced; and some hours afterwards a warm purge with rhubarb should be admi­nistered, if the disease be not very far ad­vanced. After the first passages have been cleared, the eighth part of a grain, or less, of ipecacuanha, or a drop or two of wine of antimony, given every three or four hours, with a few grains of the testaceous powders, or the aromatic confection, appear to me amongst the best remedies in the ear­lier periods of the complaint. Indeed, ve­ry small doses of ipecacuanha, especially if duly guarded by some gentle aromatic, is both so useful and safe a remedy, that it should not be hastily laid aside, and when persevered in the use of for some time, will effect wonders, not only in long purgings, but in other chronical complaints.

In the more advanced stages of the watery-gripes, and where the child is not very young, the following old medicine is a ve­ry [Page 87] good one—Of Locatelli's balsam, one ounce, and conserve of red roses, two ounces: from the quantity of an horse-bean to that of nutmeg, may be given three or four times a day, according to the age of the child.—The laudanum plaister likewise, as directed for vomitings, or the following, may be applied to the parts above the navel: Take of Venice treacle, one ounce; ex­pressed oil of mace, two drams; and oil of nutmegs, three drops; mix them into a plaister, to be spread on a piece of soft lea­ther.

Should these means fail, I have known the repetition of a vomit give an immediate check to the complaint, especially where the stools continue to be remarkably sour. So long as this is the case, it would be both vain and hazardous to exhibit opiates, or powerful restringents: the acidity must be first carried off by warm purges, and be corrected by absorbents; the latter of which must be given in large, and repeated doses, and frequently their powers be augmented by the addition of water of kali, or tincture of myrrhe. And an excellent remedy some­times, as an antiacid, is the spir. salis am­mon. succinat. of Bate's dispensatory. The acidity once removed, a starch clyster may be thrown up, two or three times a day, with or without a few drops of laudanum, according to the number of the stools, and [Page 88] weakness of the infant. A drop or two of laudanum may now likewise be given, once or more in the day, (according to the age of the child) either joined with some pur­gative, or in any of the afore-mentioned medicines, or in the chalk-julep, made warm with tincture of cinnamon, or of cardamoms; and in cases of extremity, in the decoction of log-wood, which agrees very well with young children.

If infants ill of watery-gripes, are brought up by hand, the strictest attention must be paid to their food, which must be changed from one kind to another, and especially trial be made of broths, (and to older chil­dren white meats) as long as the food shall be disposed to turn very acid on the sto­mach. In one case, I think I saved a child, by Bates's julepum vitae, lowered with wa­ter, when nothing else would stay on the stomach. This served both for food and medicine; for the former of which, it was still farther diluted. When the watery-gripes, or indeed any violent purging, at­tacks young children at the breast, no other food ought to be given, but the wet nurse be changed, if the acidity and purging con­tinue many days, and medicine does not seem to take a proper effect; which it cannot, if any offensive matter be continually thrown into the stomach.

[Page 89] It has already been hinted, that when there is no fever, purging medicines for children ought to be made potentially warm, and in no case is it more necessary, than in long continued complaints of the bowels, which are so apt to give rise to spasmodic affections. I am not very fond of giving prescriptions, but it may not here be alto­gether amiss for some readers, since the fol­lowing, considered as a general medicine, has been found so frequently useful, and will keep for a great length of time.

Take of rhubarb from fifteen to twenty grains; two scruples of magnesia alba; sweet fennel, and dill-waters, of each one ounce; half an ounce, or six drams of syrup of roses, and fifteen or twenty drops of the compound spirit of ammonia. Of this, one, two, or three tea-spoonsful may be given two or three times a day, and being very plea­sant, infants are never averse to it.

Bowel complaints, it was said, are fre­quently owing to improper food, which on this account, should at all times be peculiar­ly attended to; and when a purging has taken place, ought to be suited to the na­ture of the stools. In the second part of this work, some farther notice will be taken of the article of children's food; at present, I shall only observe, that cow's milk is often found to disagree with them, when their bowels are disposed to be too open, at which [Page 90] times, a little lean mutton broth, or beef-tea is abundantly preferable. On the same account, rusks,^* and biscuit-powder are more suitable than bread; but at other times, I believe, either the common, or the French roll, which is already half digested by a previous fermentation, is more easily dissolved in the stomach, if there be not a predominant acid in the first-passages. But where there is an habitual disposition to a purging, I know of no diet so proper for in­fants who do not suck, or who cannot have enough of the breast, as flour baked a long time in the oven, till it breaks into a soft, greyish-coloured powder,^† and afterwards mixed with boiled cow's milk, the scum be­ing first taken off; the flour and milk should then be boiled a little time together, till the whole appears like a thin custard. This is a very light and soft food, and sufficiently re­stringent; and I have often known more good from it, than from all the absorbent medicines ever devised, and have received more thanks for the prescription, as it proves a permanent remedy. When children who [Page 91] are weaned, are attacked with repeated purgings, and even broth is found to run through them, I have observed no food so generally useful as a bit of the white of chicken, not over-boiled, and afterwards lightly bruised in a mortar with the chicken liquor, and a very little bread, into a kind of light jelly. But this should not be given oftener than twice, or at most, three times a day.

In all bowel complaints, it has been al­ready remarked, that infants are disposed to eruptions on the skin; by which they are so frequently benefited, that if any kind of rash appears during long or severe purgings, a recovery may almost with certainly be prognosticated.

That I may not multiply distinct heads of complaint where little need to be said, I shall briefly notice in this place, that many children who are accustomed at all times to have a very open belly, do not seem to have the faculty of properly retaining their stools, and need a servant continually to attend them, even at two or three years of age; so that some have been suspected of being culpable in the matter. I know of no par­ticular remedy, indeed, on this occasion, but, perhaps, the aqua calcis, and other absorbents may have been of some use; I have, however, observed, that the com­plaint [Page 92] wears off as such children grow up, though oftentimes not entirely for several years.

WORMS.

THIS being a bowel complaint, I have noticed it in this place, especially as worms have sometims been voided by in­fants of only a few weeks old. It is even reported,^* that Lille Van Deoverin has dis­covered them in the still-born fetus. Worms, however, are much oftener suspected to be the cause of children's complaints than po­sitively ascertained; a mere foulness of the bowels often producing all the evils attribu­ted to worms: nor are all children equally affected by them where they are actually met with. Some infants continue very healthy, though they are seldom free from them, whilst others are very ill who have apparently very few.

Worms become hurtful chiefly from their numbers; first, when they obstruct the bowels, or compress the adjacent parts by their bulk. Secondly, by sucking up the chyle designed for the nourishment of the child. Thirdly, by irritation. Fourthly, by actually destroying the parts; though this is certainly a very rare occurrence, and [Page 93] a far less frequent source of injury than those beforementioned. Worms have, however, been said to eat their way through the in­testines; and Lister relates,^* that some re­sembling the Teretes, but of a whiter colour, have been seen coming from an abscess on the ankle. They are likewise said to have occasioned sudden suffocation, by rising up into the throat and lodging there.^†

They are chiefly of four kinds, the large round worm; the very small maw-worm, or ascarides, resembling bits of thread; the short, flat white worm, or cucurbitina, and the jointed, called the tape-worm, or tinaea, which is often many yards long. This is the most hurtful of all, and most difficult of cure, because it will remain long in the bowels even after it is dead, and is then seldom brought away but in pieces, and that by very powerful medicines. But as this kind of worm is certainly not common in children, tho' it may sometimes have been met with, and as it generally occasions a variety of symptoms resembling other com­plaints, for which many different medicines may be required, the bare mention of it here may suffice.^‡

[Page 94] The Symptoms of worms are various, and many of them are very equivocal: I shall name only the more constant, and less un­certain ones. Such are fetid breath, espe­cially in the morning; bad gums; itching of the nose, and of the anus, especially from the ascarides; a very irregular appetite, al­ways in extremes, whether of hunger or of loathing; a large, hard belly; pains at the stomach; sometimes vomiting, oftener cos­tiveness or purging, with slimy stools; ir­regular colicks; thirst; dulness; peculiar unhealthy and bloated countenance, with a dark, hollow circle round the eyes; start­ings in the sleep, and grinding of the teeth. To these symptoms are often added, slow fever, with a small and irregular pulse, pale, or whitish urine, a short and dry cough, (which is an almost constant symptom where the complaint is of long standing, and has injured the health;) sometimes even con­vulsions, epilepsies, and partial palsies of the lower extremities. Children, whose diges­tion is weak, are most liable to be troubled with these vermin, which are sometimes ve­ry easily removed, and at other times very difficult of cure, and subject to return.

[Page 95] The Cause of this troublesome complaint is not perhaps certainly known▪ but the great moisture of young persons is thought to be an occasion of their being more infest­ed with them than older people. Since the doctrine of equivocal generation has been justly exploded, it has been generally ima­gined, that worms are engendered from the eggs of insects, which float in the air, or are swallowed with some part of our food, such as summer fruits, vegetables, cheese, and some kinds of flesh meats. But perhaps this is not altogether so certain as it may ap­pear at first sight, unless we are to imagine that these supposed eggs produce very dif­ferent insects, from being taken into the stomach and bowels, than they would other­wise do; since we do not meet with insects of this kind, especially the tape-worm, any where else.^* It is, however, more than probable, that they were destined by nature to be generated, and to live in the bodies of other animals, as observed by Dr. Black.^† [Page 96] The like, however, are said to be met with in running waters, as well as the bodies of different animals. But as the fact is not generally known, it were desirable to have it established on the authority of several wri­ters: I happen to remember none, indeed, but that of Roseen, whose veracity, how­ever, I do not, in the least disp [...]te.

But whatever be the cause, the general intention of Cure is obvious enough, which is to bring them away in the most easy, and expeditious manner, whether alive or dead; the difficulty chiefly consisting in dislodging them from their firm attachment to the sides of the bowels. To this end, a variety of medicines, pretty much of the same kind, has been devised, and has served the cause of empiricism in every age. Most of them consist either of the bitter purges, or mer­curials, to which are sometimes joined steel, and tin.

Worms existing in the bowels can, in­deed, only be carried away by purging; and very active purges are indicated when the time of life and constitution do not for­bid: on this principle, turn almost all the empyrical medicines prescribed for worms. But when the age and constitution are ten­der, gentle purges given duly for some time, by the constancy of their operation produce, without harm, an effect equally, or per­haps more beneficial and lasting, that the [Page 97] active purges: hence have arisen the family receipts, as worm-seed, tansey, and such like, (given in treacle or honey) rhubarb, senna, &c.

If the child therefore be of a delicate ha­bit, or the complaint not of long standing, a little senna-tea taken every other morning, may be a proper medicine to begin with; but should this, in any instance, prove in­sufficient, a few grains of the powder of scammony with calomel may be given the overnight, once or twice a week, according to the age and strength of the child. If purging much should, on any account, be found improper, the following is very safe, and often effectual.

• R. Limatur: Stanni ℥ij. Hydrargyr: ʒiij.
• Misce, finant amalgama.

About eight or ten grains of this powder, with three or four grains of rhubarb, and as much unwashed calx of antimony, may be taken every morning, in a little honey, for a week together; after which, a clyster of succotorine aloes, dissolved in warm milk, should be thrown up over night, and a pro­per dose of rhubarb, or senna-tea be taken the next morning: which course may be repeated, as the obstinacy of the complaint, or the strength of the child shall direct.—Volatile alkalies also, in some debilitated ha­bits, will prove serviceable.

[Page 98] Amongst other means, especially for such as may be at a distance from medical assist­ance, is a mixture of pewter filings and trea­cle, of which children of four or five years old, may take several tea-spoonfuls in a day, almost at pleasure; which they will also rea­dily do, for the sake of the treacle. At the same time, from five to ten grains of jalap, with as much of the hydrargyrus cum sul­phure should be given twice every week, to carry the worms down, as they die. To answer the last purpose, equal parts of bul­lock's gall, and powdered aloes; may be mixed up with butter, and the parts below the navel be anointed with it, two or three times a week; or succotorine aloes and pow­der of dried rue, made into a plaister with Venice treacle, and applied round the navel, first covering that part with a little cotton.—I mention these things with a view to the country poor, whom the benevolence of their neighbours may incline them to assist, and who may, by these easy means, do it at so little expence to themselves. Amongst such likewise, the decoction of quicksilver, in the proportion of about two ounces to a pint of water, may be made trial of, and and taken as a common drink, of which some people have entertained a very high opini­on. When this shall be drank, the like quantity of water may be added, as often as it may be wanted.

[Page 99] If the complaint, however, has been of long standing, and the child not very young, mercurial purges are a more expeditious, and a safe remedy; though the hydrargyrus cum sulphure taken for a length of time, and occasionally purging with senna, has some­times succeeded, even where there have been the severest convulsions. For which like­wise, or obstinate contractions of the limbs, the warm-bath is often essentially necessary.

Throughout the cure, and indeed after­wards, the diet should be strictly attended to, and all fat and greasy aliments abstained from. The child should live upon milk, broths, and meats of easy digestion, with toasted bread and honey, instead of butter, which is exceedingly pernicious.—To pre­vent a return of the complaint in older children, or grown people, chalybeate-wa­ters and bitters may be made use of.

CONVULSIONS.

CONVULSIONS are of two kinds; the symptomatic, depending upon another disease, and the idiopathic, said to be an original complaint, and arising from a mor­bid affection of the brain, though the dis­tinction be not, perhaps, perfectly philoso­phical, or accurate. It is for want of some such discrimination, however, that writers have had occasion to observe, that children [Page 100] are much oftener supposed to die of con­vulsions than they really do; for though a convulsion frequently closes the scene, it has generally arisen from the great irritabi­ity of their nerves, and violence of the disease under which they have laboured.

Such original Cause may be a rash impro­perly repelled; but is much oftener seated in the gums, in the time of teething; or in the first-passages, where some undigested mat­ter, or sometimes pent-up wind, irritates the coates of the intestines, and produces irre­gular motions throughout the whole nervous system. Such a load, whether from too great a quantity, or bad quality of the food, by occasioning a faulty secretion, must act like a poison; and that the convulsions are ow­ing to this cause may often be known by the complaints that have preceded them, such as loathings, costiveness, purging, pale countenance, large belly, and disturbed sleep. If the child is two or three years old, any load at the stomach may be more readily discovered; the tongue will be foul, the skin hot, and the pulse quick and weak. But should it be granted, that the convulsi­ons of children are generally symptomatic, they may nevertheless be said to die of them more frequently than some authors have al­lowed; for where a disease is disposed to produce violent convulsions, the convulsion, though a mere symptom, may carry off the [Page 101] patient: but as it may sometimes be pre­vented or removed, by its peculiar reme­dies, (the disease which occasioned it being at the same time properly treated) infants may often be recovered, who would other­wise expire in a convulsion fit.

Any little matter capable of irritating the nervous system, will induce the symptoma­tic convulsions in some infants, whilst others will withstand a great deal. For such ha­bits as the former, the cold bath will be found the best preservative. Every young infant is, however, more or less, predispos­ed to this complaint; and the disposition continues throughout childhood, in a pro­portion to the age and delicacy of the ha­bit. The younger and more irritable, therefore, an infant may be, it will be so much the more liable to the symptomatic convulsion, especially from any considerable disturbance in the first passages, as was men­tioned before, particularly the bad quality, or over thickness of the breast-milk, or other food; and from frights of the wet nurse. Of this I remember a remarkable instance in a patient of my own, in whose house a visiter dropped down suddenly dead. The mother of th [...] child, which was six months old, was exceedingly alarmed, but her at­tention being for a moment called off by its crying, she incautiously put it to her breast. It was not an hour afterwards that the in­fant [Page 102] was seized with a sit, and lay either convulsed or drowsy, without so much as taking the breast, for the space of six and thirty hours; though it was at length hap­pily recovered.

The cure of every convulsion will consist, principally, in removing the exciting causes, which must, therefore, be inquired into. If from improper food and indigestion, a gentle emetic should be given. If the ir­ritation be in the bowels, whatever will car­ry down their acrid contents will cure the convulsions, if administered in time; and we ought generally to begin with a clyster. If the stools appear very foul after common purges, (in which case there will frequently be a difficulty of breathing) a few grains of the powder of scammony with calomel may be given with great propriety. But if the disposition to convulsions continues, after the bowels have been properly cleansed, and no new irritation of them may be appre­hended, antispasmodics should be adminis­tered,^* such as tincture of soot or of castor, [Page 103] spirit of hartshorn, or drop or two of lauda­num, or, what I have found remarkably successful, oil of rue; which though an ob­solete medicine, I think I have never admi­nistered, when there was any chance of recovery, where it has not been serviceable. Rubbing the back bone, palms of the hands, and soles of feet with oil of amber, or wa­ter of ammonia, has likewise had a good effect. A very common cause, however, of recurring convulsions is worms, and where no other probable one may appear, ought to be suspected; the cure will then depend on the proper treatment of that complaint.

Should the convulsions arise from the disappearance of a rash; or of a discharge behind the ears, the warm-bath, blisters,^* gentle purges, or a few drops of the com­pound spirit of ammonia joined with the [Page 104] salt of amber, bid the fairest for administer­ing relief. But when the cause is unknown, as the approach of small pox, measles, or other eruptive complaint, bathing the feet in warm water, and throwing up a clyster, are the safest means. If from teething, af­ter gentle evacuations, and other means di­rected under that head, blisters, oil of rue, laudanum, or the compound spirit of vitri­olic aether, and especially lancing the gums, are the grand remedies.

When repeated convulsions connected with some disorder in the first passages, and recurring for several months have withstood all the above means of cure and been sus­pected to arise from some fault in the brain, they will sometimes disappear of themselves as the infant gets older. At other times, the appearance of some other complaint has put an end to the convulsions, and not un­frequently, changing the wet-nurse; and sometimes even weaning children, when six or eight months old, has seemed to remove the complaint. I lately saw a remarkable in­stance of the concurrence of two of these circumstances; the child being seized with the small-pox, and weaned, at, or near the same time. The infant previous to this, for several months together as constantly fell in­to violent convulsions as it chanced to chew a crust of bread, eat a bit of plain pudding, or even take bread and milk, and though [Page 105] when debarred from these, and nourished only at the breast of a healthy nurse, the fits recurred every two or three weeks: but after going through the small-pox in a fa­vourable manner, and being taken wholly from the breast, the fits soon disappeared, and the child was able to take all the light food usually given to infants.

If convulsions come on without any of the preceding symptoms, they have gene­rally been concluded to be a primary dis­ease, and to proceed immediately from the brain. Some derivation is therefore to be made, by bleeding, if the child seems able to bear it, or by leeches behind the ears; by blisters; purging; bathing the feet in warm water; frictions of the legs, and rub­bing the soles of the feet with the water of ammonia. If children of two or three years old are subject to slight and frequent fits, issues or setons should be made between the shoulders, or in the neck, and be kept open for a length of time: chalybeate wa­ters may likewise be useful. But when the idiopathic convulsion attacks very young chil­dren, it generally terminates very soon, sometimes in ten minutes, and is, indeed, often fatal before any means can be made use of. Though, indeed I have often ima­gined, that we are frequently mistaken in regard to such hasty deaths, and that when convulsions prove so suddenly fatal, they are [Page 106] commonly symptomatic, and are occasioned much oftener than is suspected by over-feed­ing.—I have known some of the largest [...]d finest children I have ever seen, die present­ly after the nurse had boasted of their hav­ing eaten three boats-full of victuals.

From this view of the disease, a few words more may not be wholly unnecessary, espe­cially as they will hold out much comfort in regard to this alarming complaint; by which, I am however, assured, many in­fants have perished merely from its not be­ing properly distinguished. For though, in­deed, every convulsion fit is to appearance exceedingly shocking, yet under proper treatment they are much seldomer fatal than is commonly imagined, however often they may recur: neither is the frequency of their returns during infancy, nor the long conti­nuance of such a disposition an indication of future evils, if the fits themselves be of the kind here supposed.^* But though experi­ence warrants my speaking with confidence on this head, and I should account myself exceedingly happy in preventing any unne­cessary distress that parents may endure, yet [Page 107] would I, by no means, put them off their guard; since the recovery depends so en­tirely upon an expeditious use of the reme­dy, that even the time lost in calling in as­sistance from abroad may be fatal to the in­fant.

Fits of this kind are, indeed, pretty ge­nerally known to arise from irritating matter confined in the first passages, as has been already explained, but I believe it is not so generally understood, how often such mat­ters are lodged in the stomach, (perhaps the pylorus itself); or very low down in the rectum. Instances of the latter are not wanting, wherein the hardened feces have lain so low as to dilate the sphincter ani, (or lower opening of the bowels) sufficiently to expose them to view, and yet the infant been dead before a clyster could be procur­ed from a neighbouring apothecary's; where­as such fits cease immediately after a plenti­ful evacuation from the bowels, artificially induced: and I have seen an infant in the month, lying torpid for an hour together, in a kind of fit, and apparently in the very article of death, brought out of it entirely after a large and spontaneous discharge of thick feces. In like manner sudden death has taken place when the load has been in the stomach; whilst other children have been saved by spontaneously throwing it up.

[Page 108] After what has has been said it would be scarcely necessary to point out the remedies in a formal way, but for the sake of direct­ing the most expeditious manner of apply­ing them. In the first instance, doubtless, the obvious means are a soap clyster with two or more tea-spoonsful of salt (such arti­cles being always at hand) and afterwards administering one or other of the purges for­merly directed; which it may often be ne­cessary to repeat for some days, perhaps with an interval between. But when an in­fant falls suddenly into a convulsion very soon after sucking, or feeding, whether on any thing actually improper, or not, and the bowels have been for some days in an orderly state, it may reasonably be presum­ed, that the irritation is in the stomach, es­pecially if there be an unusual paleness of the countenance, indicating sickness; or on the contrary, any considerable blackness, with symptoms of suffocation; which I think do not come on so soon when the obstruction is in the bowels. And it should here be re­marked, that it is not necessary, that the load in the stomach should be considerable in quantity in order to induce such sudden and alarming convulsions; it is sufficient that the stomach be really oppressed by it to a certain degree; nor does i [...] always appear to arise so much from an oppressive abun­dance, as from a small piece of undigested [Page 109] food, irritating, and perhaps sticking in the pylorus, or inferior aperture of the stomach.

In the case here described it would be improper to think of a formal emetic, at least without making trial of some more ex­peditious means, such as irritating the Pharynx, or upper part of the guller, with the finger, or a feather, or forcing in the smoke of tobacco, if that be at hand, which often instantly produce vomit­ing, and put an end to the fit. To this end, the child should be supported by a hand placed under its stomach and belly, whilst the feather or other means are made use of; in which posture the infant will be made to vomit more readily, and with less straining, than in any other position.—It is hoped that the importance of the subject, as well as the very frequent success attend­ing the plans last recommended, under the most alarming appearances, may be thought an apology for the length of this chapter, as well as the sort of repetitions made use of.

It is farther to be noted, that symptoma­tic convulsions are sometimes the effect of a salutary effort of nature, to produce a crisis in some disease the child labours under; in which case, great caution should be used not to be over officious: bathing the feet in warm water, however, as mentioned before, [Page 110] will be perfectly safe, and perhaps useful.—Having spoken of opiates, I shall just ob­serve, that though they are often very ser­viceable, when judiciously prescribed, they become very hurtful if improperly admini­stered. They will, however, always be safe, where convulsions continue after the first exciting cause has been removed; or where they are so violent as to become an obstacle to administering proper remedies; or when the originial complaint is of a spasmodic nature.

When convulsions occur many times in a day, it is of importance to attend to the dis­tance of the paroxysms, or returns; from which a much better indication may be had of their immediate danger, than from the forcible contraction of the muscles during the fit. For where the intervals are short, though the fit itself be not long, nor vio­lent, the disease is more dangerous, than where violent fits are attended with long intervals.

SKIN-BOUND.

IN the preceding edition, this disorder was considered only in a transient way, under the article of Purging; both from its being conceived to appear chiefly in the form of a morbid symptom attending certain [Page 111] bowel complaints, and because I had then neither seen, nor heard enough of the dis­ease to enable me to offer to the public any very distinct account of it. I could indeed wish that this disorder were yet better un­derstood, and that I were able to lay down a more successful method of treatment than has yet been made known: it is however in every view worthy of the most distinct consideration, as well from the observations made in this country, as from the late re­searches by several physicians in Paris, as I shall have occasion to notice very soon.

Having met with no account of this dis­order either amongst the ancients, nor very modern writers when I mentioned it in a former edition, I presumed I was announc­ing a disease, at that time scarcely known, or at least was giving the first public account of it: and this I believe is no uncommon mistake of authors. Perhaps, it may be the wise intention of Providence, that in suc­ceeding ages, many things relating to arts and sciences should be forgotten or over­looked, in order to emulate posterity in the pursuit of knowledge; which men would, probably, be less inquisitive after, if things once known were very rarely lost sight of. However this may be, I continued to con­sult the oldest writers, after having publish­ed my former edition, and was once more led to conclude, that no account of this dis­order [Page 112] had ever before been given to the public. At length, however, I met with a solitary case, which had occurred in the hos­pital at Stockholm, Anno 1718, accurately described by Uzenbesius, and recorded in [...] Scuringii Embrologia (de faetu frigido et [...]ri­gido), ^* but without adverting at all to its treatment. The case, as I since find, is transcribed into the Ephemerid. Academ. Naturae Curiosor. Cent. ix.

The above is related in a manner import­ing it to be an uncommon occurrence, and the disease at that time little, if at all known: and though recorded in two distinct works (the latter of which is rather consulted than regularly perused) the case seems to have been universally overlooked, and conse­quently the true nature of the disease has remained nearly in its original obscurity. It was, indeed, not till a twelve-month af­ter my short account of it appeared, that this disorder began to engage the attention of the French physicians, in consequence of Monsieur Andry being called upon to take the charge of the Hospice des Enf [...]ns trouvès▪ at Paris. The disease indeed had been for many years noticed both in that hospital [Page 113] and the hôtel Dieu, but having always prov­ed fatal, little attention had been for a long time paid to it, till Dr. Andry was elected physician to the first mentioned charity; since which time, no pains seem to have been spared in the investigation of it.

That the present account of the disease may therefore be clearly stated, I shall first consider it as it has appeared in this coun­try, and in the manner I had long ago in­tended, and had actually drawn up before I was favoured with some farther description of it, by Dr. Andry, of Paris.

It has, indeed, been much less common in this kingdom than on the continent, but is equally an hospital disease, and is seldom met with but accompanied with some bowel complaint, and still more rarely appearing at the birth. It was first spoken of in pub­lic, I believe, by my friend Dr. Denman (when physician to the Middlesex hospital, and a teacher in midwifery); as I remarked in the former edition; and it is to him I was indebted for some account of it before I had at all noticed the disorder myself.

The British Lying-in hospital has been very little infested with it, and, possibly, by being solely appropriated to the recep­tion of pregnant women, which the Mid­dlesex hospital was not. I shall therefore first of all lay down the symptoms exactly as they were noticed in that infirmary, by [Page 114] Dr. Denman, whose unwearied attention to it, though not with all the desired effect, does him more honour, than could have been derived from the most successful treat­ment of a disease less fatal than this has proved wherever it as appeared.

The following symptoms may be consi­dered as pathognomonic, or characteristic of the disease.

1st. The skin is always of a yellowish white colour, giving the idea of soft wax.

2d. The feel of the skin and flesh is hard and resisting, but not edematose.

3d. The cellular membrane is fixed in such a manner, that the skin will not slide over the subjacent muscles; not even on the back of the hands, where it is usually very loose and pliable.

4th. This stricture often extends over the whole body; but the skin is peculiarly rigid in the parts about the face, and on the extremities.

5th. The child is always cold.

6th. The infant makes a peculiar kind of moaning noise, which is often very feeble; and never cries like other chirdren.

7th. Whatever number of days such children may survive, they always have the appearance of being dying.

This disease appears at no regular peri­ods; but whenever it takes place it attacks several infants within a short time; and [Page 115] chiefly those, as I have just noticed, who may be in the last stage of obstinate bowel complaints, in which the stools are of a waxey or clayey consistence. It has been also remarked, that it sometimes makes its ap­pearance as an original disease, and even at the birth; in which case, the infant has ne­ver survived many days.

I have seen the rigidity extending beyond the cellular membrane, so as to affect the muscles, but only those of the lower jaw, which became perfectly rigid: but this spasm or tetanus is, by no means, a frequent symp­tom, and does not seize the extremities as it is found to do in France; nor has the dis­ease, in any instance that I have heard of, been attended with the erysipelatous affections constantly noticed in that country.

The Cause of this dreadful complaint, when congenite, or evidently supervenient to disorders of the first-passages, seems to me to be a spasm depending very much upon a certain morbid state of those parts, and with which the skin is well known to have a pe­culiar sympathy. But when, though an original disease, it does not take place till some days after birth, which, I believe, is rarely, if ever the case except in large hospitals, and other crouded apartments; wherever the irritating cause, in such instan­ces, may be seated, the disease seems to be an endemic of certain seasons, arising from [Page 116] that unwholesome air to which such places are peculiarly liable.

The means of Cure in this country have been very different from those that have lately been found successful in France; but instances of recovery have been very few in either. As Dr. Denman did me the kind­ness of giving me the first intimation of such a disease, I very naturally adopted his plan of treatment, which consisted in a strict at­tention to the state of the bowels; and ren­dering the several medicines very warm by means of the compound spirit of ammonia, which was administered every four or six hours; and was the only plan that he ever [...]ound attended with any success. Together with this, I after some time directed the fre­quent use of a warm-bath, and chafing the whole body afterwards with soft flannel; and I think myself happy in having fallen up­on one part of the plan that has since ap­peared to have been attended with the first instances of success in France, as will be no­ticed below.

As the disease raging so much in France seems to differ in many respects from ours, it is very doubtful how far the plan of cure lately adopted there may be applicable in this country, and my own experience has hitherto not gone beyond the means I last mentioned: but I would venture to suggest, that in many cases, trial might be safely and [Page 117] properly made, not only of carminative clysters, but also of a grain of calomel pre­vious to the infant being put into the warm-bath:^* and after a sufficient number of stools shall have been procured by these means, exhibiting other volatile and cordial remedies beside the spirit of ammonia; as well as anti-spasmodics of different kinds.

It was after I had made up my mind about this complaint, in the manner that has been just noticed, that an advertisement appeared from the Royal Society of Medicine in Paris, proposing this disease as the subject for their next prize-medal. About this time also, Mr. TENON published his Mèmoires sur les Hôpitaux de Paris, in which is a brief ac­count of this disease; and very soon after this, Dr. Andry did me the honour of send­ing me his Tract, intitled, Recherches sur L'endurcissement du Tissu cellulaire des En­fans noveaux-nès.

Though these works contain very accu­rate accounts of this disease, and to which Dr. Andry especially has paid an attention that must do him great honour, they at first served only to perplex my own views of it. This obscurity arose from the disorder be­ing combined, or as I then rather conceiv­ed, [Page 118] intirely confounded with another com­plaint first publickly noticed, I believe, in a former edition of this work, under the term anomalous inflammation; and from which Dr. Andry had, on this occasion, made two or three quotations. I therefore took the liberty of writing to that eminent physician, and was soon favoured with a sa­tisfactory answer, by which I hope the pub­lic as well as myself may be obliged; as it must prevent any mistakes arising from the accounts which the above mentioned works afford of this melancholy disease.

After the description given of this disor­der as it appears in London, little more will be necessary, I apprehend, than to select the circumstances in which that in France is found to differ, as related by Dr. Andry in his printed work, as well as the letters with which he was pleased to honour me.

It has already been said, that it is more frequently attended with tetanus, and never occurs without those appearances mention­ed under the article, termed in this edition, Infantile Erysipelas, especially the redness and hardness about the pubes, accompanied farther with tumour and redness of the soles of the feet. But these parts, it seems, tho' of a purple red, are intensely cold, very rarely suppurate, but sometimes mortify.^* [Page 119] In one very late instance, however, the in­fant was not cold, but on the contrary, ex­ceedingly hot. The legs, thighs, and soles of the feet were red and hard; but no men­tion being made of a general tightness of the skin, it is probable this child was affected only with that infantile erysipelas which ap­pears amongst us.

Besides the above variations, the infants are said to swallow with extreme pain; the extremities, especially the legs, are much enlarged, and attended with a serous effu­sion in the cellular membrane, which we have not hitherto noticed: and the disorder is likewise said to rage most in the hotter months.—The infants are observed to die about the third or fourth day, or at farthest, on the seventh from the birth. It is pro­bable, there is another and very material variation, in respect to the degree of stric­ture and immobility of the skin, which are not clearly expressed to be either so consi­derable or extensive, as in the disease I have been describing; but are more confined to those parts which become red and tumid. [Page 120] But in the instance recorded by Scuringius it was clearly otherwise, the infant being said to feel, from head to foot, like a piece of flesh dried in the smoke. The child surviv­ed a compleat day, during which time it took no sort of nourishment; but never cried, nor made any kind of noise.

Upon examining a great number of dead bodies at the Enfans Trouvès, the serous extravasation is constantly met with; is of a deep yellow colour and fluid, but coagu­lates with heat; the fat is peculiarly solid; the glands and lymphatics, especially those of the mesentery, are found stuffed, and the liver uncommonly large, with a great quantity of deep coloured bile in the gall­bladder; and the lungs are said to be load­ed with blood, as well as to contain an unu­sual quantity of air.

The supposed Cause of this disease amongst them, seems to me but ill accounted for; being attributed to the improper diet of the mother or her infant, or to cold it has taken at the birth: whereas, the coldness and ri­gidity of the skin seem to be but mere symp­toms, and not the disease; especially as their children, like ours, are but rarely attacked from the birth. It should rather seem to be a true endemic, arising from foul air, especially as it is found only to attack the poor, and particularly to infest the two large hospitals that are crouded above all others, [Page 121] and receive the lowest and most wretched part of them; of whose new-born children, it is supposed, one out of twenty is visited with this disease.

It has been hinted, that for a long while, little attention was paid to this complaint, on account of its constant fatality, six hun­dred infants sinking under it every year, in a single hospital; four hundred of which are born in the Hôtel-Dieu.

But since Dr. Andry's election, various means have been attempted both by himself and his colleague, Mr. Auvety; and amongst other means, the warm-bath, which appears to have saved the first child that was known to recover.^* Trial has since been made of blisters to the extremities, which succeeded also in the very first instance, as well as since in several others; so that, in the last year, they are reported to have saved five infants out of an hundred, more than in the prece­ding one.

[Page 122] As this disease, more especially in the form it puts on in Paris, is now, by the en­couragement of the Royal Society of Medi­cine, likely to be fully investigated, it may be hoped some farther light will be thrown on it: in the mean time, as it is evidently a complicated disease, the bark and cordials, with proper attention to the state of the bow­els, might possibly be useful.

TETANUS.

THE Tetanus, or Locked-Jaw^* of in­fants, is an equally fatal complaint, and as little known in this country, as the foregoing. In some instances, it has been confined to the jaw only, as in Jamaica; in others, it has been attended with contrac­tion and rigidity of other muscles of the face, and a peculiar fixedness of its features. Some­times, the rigidity has extended to the neck; and in one child I observed it to be spread so completely over the whole body, that the limbs could not be bent so as to place it conveniently in the vessel appropriated to a warm-bath. It has already been observ­ed [Page 123] that it is sometimes joined with the fore­going complaint, but rarely in this country; and even then, the jaw partakes only of that kind of rigidity common to other parts.

In such instances of Tetanus as I have met with, the attack has not been earlier than the sixth, nor later than the ninth day from the birth; and as far as I could learn, the infants had not been costive (as menti­oned by Dr. Evans), nor apparently un­healthy: one, I remember, was a remark­ably strong and lusty child. It seems some­what to differ, therefore, from the disease termed Jaw-fallen, in the West Indies; and in one instance appeared to have some re­semblance to the catalepsy. The rigidity has stolen on in a more gradual way in some in­stances than in others, but has always been very great as far as it extended, from the moment it has been discovered; so that in instances where the mouth has continued sufficiently open to admit my finger, I could not thereby depress the jaw. In some, the eyes have been bloated, and the whole countenance much swollen.

The cause of this complaint, which does not seem to arise from constipation, or ne­glect of purging off the meconium, may, probably, be a certain state of the air, as hath also been suspected in the West Indies; and the more so, as the disease has appear­ed only once in the British Lying-in Hospital [Page 124] during a great number of years and then attacked several infants in a short time.

The remedies made use of at the hospi­tal were, the warm-bath; fomentations to the rigid parts, frictions with oil and cam­phire, and BATES's anodyne balsam; blis­ters behind the ears, and to the nape of the neck; and opium, calomel, the bark, and aromatic confection have been given inter­nally.

One infant, in whom the complaint was confined to the jaw, and who had less rigi­dity than any of the others; never looked ill, and had no convulsions in its limbs, died rather sooner than the rest. Only one sur­vived the third day: this child was not seized till the ninth from its birth, and lived to go out of the hospital with its mother, at the end of the third week, and we hoped was then recovering; but it had never been able to take the breast after the attack, and died three weeks after it left the hospital, though, possibly, not altogether from this complaint.

EPILEPTIC-FITS.

THIS and the following complaint, as well as the two immediately preceding, which relate, some to the more early, and others to the later periods of childhood, are noti­ced [Page 125] together in this place, on account of their falling under the general class of con­vulsions, and it is presumed less improperly, on the whole, than ranking them according to the different periods of time in which they might take place.

Very few words, however, on the Epilep­sy, or falling-sickness, may suffice, as it is either pretty easily cured, or usually conti­nues through life; and is too well known by this popular name to require a particular description: an account of the various pre­current symptoms would be equally useless in this work.—It may just be noticed, that the patient falls suddenly to the ground, and sometimes without any perceptible warning, or at all sufficient to secure him from injury; and is usually much convulsed, but frequent­ly retains his senses during the fit.

I believe it sometimes takes its rise merely from foul bowels, and certainly more com­monly attacks children of a costive habit of body: it should then be treated agreeably to the directions already given in such cases, and especially with active and mercurial purges: after which, the bark, chalybeates, and sea-bathing may be serviceable. In other instances, especially in more advan­ced life, and towards the time of puberty, the epilepsy seems to be owing rather to a more sensible nervous irritation. In such cases, blisters to the back of the head may [Page 126] be useful; and I have experienced much be­nefit from large doses of the powder of va­lerian, and opium; and in one instance, by an infusion of savine, fennel seeds, and juni­per berries; but I never could entirely con­quer the complaint by these means; but the olium succini has, in several instances, perfected a cure in young subjects.

In the worst cases I ever met with, in which the fits were very long and violent, and to the number of twenty or thirty in a day, electricity has very soon rendered them weaker, reduced their number to three or four in a day, and gradually to one in a month; but did not entirely remove them. In such obstinate cases it is generally sup­posed, that the brain is affected by some local and permanent cause, and a perfect cure is consequently despaired of.

When this disease has attacked children of five or six years of age, and where no treatment has been serviceable, the com­plaint has very frequently disappeared sud­denly about the time of puberty, and some­times a year or two sooner. Where it does not, it will probably continue through life, and now and then prove suddenly fatal.

Upon examining the brain after death, I have found a small point of bone standing out from the internal part of the os frontis, as sharp as a needle (of which Boerhaave [Page 127] has recorded several instances) and was, doubtless, the true cause of the disease.

CHOREA SANCTI VITI, or SAINT VI­TUS's DANCE.

I SHALL be equally brief on this untow­ard disorder, which, though not often fatal, is like the former, I believe, rarely cured but in young subjects.

Worms and other foulness of the bowels in children, are likewise frequent causes of this strange convulsion; in which different parts, and especially the extremities are put into continual motion, giving the patient a very awkward appearance, particularly in his walk.

If the first-passages are the seat of irrita­tion, the complaint must be treated in the manner noticed under the preceding article; and, indeed, in most cases, the cure should be begun by administering aloetic, o [...] mer­curial purges. But should the disorder ap­pear to be owing rather to relaxation, as it sometimes is, the bark, chalybeates, and other tonics, especially the vitri [...]lum album, and sea-bathing, are indicated, and are very frequently successful; as I have seen in a late instance, in a child of eleven years of age.

TEETHING.

THE complaints arising during dentition may next be considered, many of the foregoing being blended with it, the first-passages and the nervous system being al­ways more or less affected. The state of dentition is likewise not unfrequently an oc­casion of many complaints afterwards to be mentioned, such as cough, fever, the rick­ets, and even consumption; under each of which heads therefore, occasional references will be made to it.

The time of teething is a most important period of the infant state, and subjects into manifold complaints and dangers. Some writers, indeed, and particularly Dr. Cado­gan^*, and Dr. Armstrong, seem to think otherwise; and that teething is scarcely to be ranked amongst the diseases of infants. They have imagined that children, if other­wise healthy, would cut their teeth with no more danger than adults, who often out their wise-teeth, so called, at an advanced age, without any difficulty, and always with­out hazard. They likewise observe, that many children get their teeth easily. But this argument must suppose the healthiest, [Page 129] and best nurtured children, to be, in all re­spects, in the same circumstances with adults, which is, by no means the case; as they are liable to fever, dangerous purgings, and even convulsions, from causes that would in no wise, affect the latter: nor can they stand under some of those com­plaints so long as adults, nor endure the necessary remedies. For the same reason, the measles and small-pox carry off such numbers of infants, when attacked by them a little more severely than common, whilst young and healthy people often struggle through the most dangerous and complica­ted kinds, when properly treated from the beginning. Not to mention, that very few infants, who are unhappily affected with lues venerea, recover under any treatment, whilst adults are cured in the most advanced stages of the complaint, notwithstanding some parts may be actually mortified. I have, therefore, no doubt, that the time of teething ought to be ranked amongst the most dangerous to infants, and that the greatest attention ought to be paid to it; though it is probable that Dr. Arburthnot greatly over-rates its fatality, when he says that one child in ten may be supposed to sink under it.

Some late writers, and particularly Mr. Le Febure De Villebrune, have conceived this to be a mere dispute about words; but [Page 130] the difference, indeed, extends much far­ther. For though I would, indeed, by no means assert dentition itself to be a disease, and have made use of any such like expressi­on merely in a popular way, yet am I con­fident it induces disease in very many infants of every habit of body, and more especially, however strange it may seem, in the appa­rently healthy and robust. Indeed, weak and even rickety children, more commonly cut their teeth easily, tho' often very late; or if they should be harrasted by a purging, and other complaints, they, nevertheless, escape with their lives oftener than lusty strong children, who are frequently carried off suddenly at this period, unless the teeth happen to find a very easy passage through the gums. The system, during dentition, being disposed to inflammation, such chil­dren must oftener fall into fever than the tender and delicate; like athletic adults, who are more disposed to inflammatory com­plaints, than those who are of a colder, but less healthy temperament: and it is by acute fever, or convulsions, that infants are carried off, who are well known to survive a thou­sand lingering and vexatious complaints, if their viscera be sound.

This period usually commences between the fifth and tenth months, and the process of the first teething continues to the eigh­teenth at the least, and sometimes much lon­ger, [Page 131] The two front teeth in the lower jaw are usually cut the first, and it is commonly a few weeks longer, before the correspond­ing ones in the upper jaw make their ap­pearance. After which, it is frequently a considerable time before the next under­teeth come out; but sometimes, though not often, six or eight are cut in a hasty successi­on. Children sometimes cut their teeth ir­regularly, or cross, as it is called, both by the teeth appearing first in the upper jaw, and also at a distance, instead of being con­tiguous to each other: this is accounted, and with some reason, indication of difficult, or painful dentition.

Teething is usually preceded and accom­panied with various symptoms: the child drivels, or slavers much; the gums swell, spread, and become hot; there is often a circumscribed redness in the cheeks, and eruptions on the skin, especially on the face and scalp; a looseness, gripings, green stools, watchings, startings in the sleep, and spasms of particular parts; a diminution, or increas­ed secretion of the urine, and discharge of matter, with pain in making water, (imita­ting exactly a virulent gonorrhoea) which often mitigates the fever. A less common symptom, appearing only in certain habits, is a swelling of the tops of the feet and hands: it seems, however, of no impor­tance, and goes away upon the appearance [Page 132] of the teeth. I never met with it but in in­fants who cut them painfully; and being seldom accompanied with a purging, it is likely may prevent that fever which is other­wise so apt to attend. In all cases, the child shrieks often, and thrusts its fingers into its mouth: and these symptoms are sometimes followed by a cough, difficult breathing, fits, fever, scrofula and marasmus, or univer­sal decay.

Strong and healthy children cut their teeth both earlier and more easily than the weak and tender. I have known a weak, and rickety child, without a tooth at twen­ty-two months old,^* though it lived to grow up; but at the age of five years became scro­fulous. Therefore air, exercise, wholesome food, an open belly, and every thing that has a tendency to promote general health, will greatly contribute to the safety of den­tition.

Difficult teething is to be treated nearly as other acute diseases with local inflamma­tion. If the body is at all bound, some opening medicine should be administered, and it is to be observed, that even a consi­derable degree of looseness is useful; few children cutting teeth so well as those whose bellies are at this time much more than com­monly [Page 133] open. Diluting drinks are also very necessary, especially if the child does not suck; with a light food, in small quantities, and frequently taken. If much fever at­tends, the loss of a little blood, in some way, will be necessary; though children do not endure bleeding so well as they do other evacuations. If the propriety of bleeding with the lancet be doubted, a leech or two, as Harris advises, may be applied behind the ears, and is generally serviceable. Cly­sters are also very useful, especially if there be retention of urine, which will likewise call for the use of the warm-bath. Gentle diaphoretics are also serviceable, particularly of wine of antimony, or the antimonium tar­tarisatum, which besides opening the belly, often operate in this way: a blister should likewise be applied between the shoulders, especially if there is any disposition to fits. And, indeed, if stools do not afford some considerable relief, there should generally be some discharge from the skin; since a purging, and eruptions on the skin, when spontaneous, are the grand means of easy dentition. A little discharge should there­fore, be kept up behind the ears, by rub­bing the parts with Spanish flies, applying a thread as before directed, or putting on a small blister; which may be kept open. A burgundy-pitch plaister laid on the back will sometimes suffice, which should be re­newed [Page 134] every ten days, till the symptoms disappear, or the teeth come into sight. Even before this period, light scarifications of the gums are very useful, by taking off the tension; or if the teeth are at all to be felt, lancing them, as it is called; the pro­per method of doing which will be noticed below.

I shall close what I have to offer on the general plan of treatment, by observing, that the indications certainly are to assist the eruption of the teeth, and to moderate the inflammatory and other symptoms: which must be treated according to their kind: all parts of the body readily consenting with the gums at the time of teething, but the nerves, the bowels, and the lungs, more particularly and importantly than the rest. It has been observed, that a purging is be­neficial, and it is, indeed, surprising how considerable a diarrhoea children will stand on this occasion, and how very bad the stools will often be for many weeks toge­ther, and a child happily struggle through; though at another time, an equal degree of purging, with such bad stools, and constant fever, would prove infallibly fatal. The diarrhoea is therefore not only to be cauti­ously treated according to the directions al­ready given under the article of purging, but is oftentimes rather to be encouraged than suppressed. Very pale stools are at [Page 135] this time not uncommon, and are sometimes in vast quantity: I have known an infant have fifty in one night, at le [...] by the ac­count of a careful and discreet nursery maid; and from the quantity of feces that I saw the next morning, I had no reason to dis­pute her calculation.

For the fever of dentition, besides bleed­ing the absorbent powders are eminently useful, and are in various respects calculated to afford relief. To these, sometimes a grain or two of Dr. James powder may be added at bed-time, which, if there should be any thing amiss in the stomach or bow­els will either vomit or purge, but other­wise (it has been said) will promote a kindly sweat, which is always beneficial. Nitre is very often useful, joined with the testaceous powders, or a little of the compound powder of contrayerva—Sydenham directs three or four drops of the compound spirit of ammo­nia [...] spoonful of water every four hours, for four or five times, and I have thought it very serviceable after proper evacuations; but this dose may be considerably increased, according to the age of the child. Nor is a drop or two of laudanum to be feared, if the bowels have been previously opened, the pain be very great, and the breathing not difficult.

A principal indication, it has been said, is to assist the eruption of the teeth. This [Page 136] is attempted, by cooling, sedative, and de­mulcent applications made to the gums; by rubbing them with some hard, polished body, such as the coral; or by dividing them with the lancet: which last is the on­ly mean to be depended upon. When it is found necessary to lance the gums, (which is ever, at least, a safe operation) it should always be done effectually, with a proper gum-lancet, and not with a needle, a thin six-pence, or such like instrument, which will not sufficiently divide the gum, or the strong membrane that covers the teeth. The lancet should always be carried quite down to them, and even be drawn across the dou­ble teeth. It is certain, that this litle ope­ration gives scarcely any pain, and the re­lief is at the same time often so considerable that the child appears exceedingly pleased with it, and will immediately squeeze the jaws and grind them together forcibly, which proves the gums are not very sensi­ble.

The most painful part of dentition, and that in which children are most exposed to convulsions, is usually from the teeth cut­ting through the periosteum (or nervous membrane mentioned above) that covers the jaw immediately under the gums. This, I apprehend, in difficult dentition, is often not cut through, but is forced up before the teeth, when they are even in sight under [Page 137] the thin gum; hence it is, that cutting through the gum is so very often useful, and takes off fever and convulsions, which severe symptoms could not arise merely from piercing the gum, which, it has been said, is not a very sensible part. At other times; the pain and fever seem to arise from almost the very first shooting of the teeth within the jaw, and then they will very often not appear for some weeks after the gums have been properly lanced; and parents are therefore apt to conclude, the lancing has been unnecessarily done. I am, however, convinced from experience, that this little operation, though not in the general esteem it ought to be (and by the French physicians even dreaded at this period)^* is often inex­pressibly useful, and appears to have sav­ed many lives, after the most dangerous symptoms had taken place, and every other mean of cure had been made use of. And I cannot here for bear expressing my surprize, at the fears some people entertain of lancing the gums, and their delaying it so long, if not altogether rejecting it, though no evil can possibly arise from the operation. On the other hand, its advantages are so great, that whenever convulsions take place about the usual period of dentition, recourse ought [Page 138] always to be had to it, after an unsuccessful use of other means; though by an exami­nation of the gums there may be no cer­tain evidence of the convulsions being ow­ing to such cause; the irritation from teething, it has been remarked, often tak­ing place in a very early stage of the bu­siness. At any rate, it has been said, the operation can do no harm, even at any period, and should the shooting of teeth be only an aggravation to the true cause of the disease, lancing the gums must be attended with advantage. But should teeth­ing be the proper and sole cause, it is evi­dent how fruitless any other mean of re­lief must frequently be: for should convul­sions, for instance, take place from a thorn run into the finger, or toe, the proper indi­cation of cure, by an immediate extraction of the thorn, and the probable futility of other means, would be equally obvious.

The operation may also be safely repeat­ed, the scars doing no kind of harm. And indeed it will be frequently necessary to lance the gums several times, on account of the extraordinary difficulty with which some infants cut their teeth, especially the double ones, which are furnished with two or more knobs or points. Fever, purging, and even convulsions will sometimes arise from only one point of a large tooth offending the pe­riosteum that covers it, and being nearer the [Page 139] surface than the other points, the lancet sometimes does not completely divide the membrane that lies over the rest; and this part not being injured by the tooth, the symptoms subside on having divided that portion of membrane that was inflamed. But in a little time, another point of the same tooth is found to irritate the periosteum, and calls for the like assistance of the lancet, which again removes all the complaints. This, at least, I have conceived to be the process, when I have found lancing a large tooth immediately remove every terrible symptom, though the fever and other com­plaints have returned, and the tooth not ap­peared till the operation has been three or four times repeated. I have seen the like good effect from it, when children have been cutting a number of teeth in succession, and have bred them all with convulsions. Nothing having relieved or prevented these terrible symptoms but lancing the gums, which has removed them every time it has been done, one or more teeth appearing a day or two after each operation.—In such cases, it will often be proper to draw a lan­cet along a great part of one, or even both the jaws, at the same operation.

Some writers, however, and Dr. [...] particularly, have advised, not to cut quite down to the teeth, but only to scarify the gums, unless the teeth are very near. He [Page 140] suspects that the instrument often injures them, and produces caries, which he thinks will be communicated to the succeeding set of teeth. But this is a needless scruple, and I apprehend arises for want of duly at­tending to the state of the teeth, which are perfect bone, and covered with a strong enamel, long before they get through the gums. The manner of the second teething of children likewise forbids such a fear; for though the first set, which are designed by nature to be only of short duration) should actually be injured by the lancet, the suc­ceeding ones are not at all likely to be af­fected by the carious state of the former. For the first teeth of infants constantly be­come carious at the roots, and are loosened and expelled by that means, when left to nature alone; and though the upper parts of the new teeth are in contact with the ca­rious bottoms of the first set, they never suf­fer from this circumstance. I have dwelt the longer on this head, because writers are not agreed on the subject, and it is a mat­ter oftentimes of no small importance. I have, however, written from experience, and am perfectly satisfied of the propriety and safety of what I have ventured to recom­mend.^*

[Page 141] It has been hinted to be a common prac­tice to touch the gums with oils and mucil­ages, and to rub them with some hard and polished body. To answer the first inten­tion, perhaps a little honey, or syrup of white poppys is as proper as any thing, or the honey may be lightly acidulated with spirit of vitriol. Besides the coral, a crust of bread, or a piece of liquorice root, may be often carried to the mouth, and may sometimes be preferable, as they will yield a little to the pressure of the gums.

It should be a pretty general rule during the time of teething, to abate a little of the usual quantity of food, and the encrease the quantity of drink; unless the child is very weakly, or every thing is going on per­fectly well: or if the child be at the breast, a similar regard ought to be paid to the diet of the nurse.

Children will sometimes have ulcerated gums in teething, and more frequently where they have not been lanced, which are easi­ly cured by keeping the body open, and touching them with astringent applications. As much white vitriol, or roch alum as will give a moderate roughness to a little honey, is usually sufficient for this purpose. But should this fail in any case, it must be treat­ed as directed under the head of Canker.

FEVER.

THOUGH some writers have supposed infants to be as liable to fevers as adults, and from the same causes, I have, by no means, found it so, and I wish parents to take comfort from the consideration; hav­ing observed for many years, as [...]ell in the hospital, as in private practice, that infants do not readily take common fevers, though exposed for a long time to that contagion which has appeared to affect adults around them. Their fevers are also of a short duration if properly treated, unless the few that arise from some more permanent irritating cause.

Young children, however, are disposed to some febrile complaints peculiar to them­selves; which, as I have enlarged this edi­tion considerably, with the design of taking in all their complaints, I shall bestow some pains in specifying, as well as pointing out the treatment most adapted to each.

The more frequent causes of fever, are teething, foul bowels, worms, glandular diseases, some eruptive and very contagious complaint, or taking cold, and are often attended with symptoms peculiar to children. If from the last mentioned cause, and the cold be severe, it will always be attended with a cough, hoarseness, and some difficulty [Page 143] of breathing, and often with running at the nose or eyes, which will distinguish the fe­ver from all others, except it be the mea­sles; which will be attended likewise with violent sneezing, and a peculiar appearance of the eyes not often met with in a common cold.

If a fever from cold be considerable, the cough violent, and the difficulty of breath­ing very great, a blister will always be safe and expedient, and may be applied at the pit of the stomach instead of the back, as be­ing both less painful under any motion of the body, and more readily got at to be dressed, or for the application of fresh cloths, where the discharge happens to be consi­derable. But if the fever and difficulty of breathing should not be very much abated by the blister, children though within the twelve-month, will bear and even be great­ly benefited by the loss of a little blood,^* at least by the application of two or three [Page 144] leeches, as I have frequently seen; and I mention this again, because it has been thought so highly improper for infants. But I can venture to say, they will be much less reduced by it, than by the continuance of the fever, which the loss of a little blood will, in many cases, shorten by two or three days; and which is sometimes absolutely necessary, and in peripneumonic cases, may even be repeated with safety and advantage^*. Oily medicines, likewise, made into a neat emulsion, are often useful, especially if the child be not at the breast; but they should be preceded by an emetic of wine of anti­mony, as there is usually much phlegm on stomach; children never coughing it up. In many cases it is also necessary to repeat the emetic, as often as the phlegm in the throat is collected in such a quantity as seems to impede respiration. But if the cough be dry or convulsive, Bates's spirit. sal. ammoniac. succinat. may be safely and usefully administered, if there be not much fever. The body at the same time should be kept perfectly open, and this purpose is usually well answered by smaller doses of wine of antimony, or of Dr. James's pow­der; but if they should fail to procure stools, as they sometimes will, where there [Page 145] is much fever, they rather do harm than good, unless a little manna, or rhubarb be joined with them.

It is very necessary [...]ere to observe, that though preparations of antimony may per­haps be safely administered under the eye of very attentive parents, they are very pow­erful medicines, and not [...] be prescribed by nurses and ignorant people, or without great caution. And I hope this may be ad­mitted as an apology for the liberty I have taken in saying so much against some prac­tices highly extolled by other writers, and espeially the indiscriminate use of antimonial wine,^* which has induced some people to make free with medicines of this class, who are in no wise competent judges.^† But where such medicines are found to agree, [Page 146] and keep the belly open, children frequently stand in need of no other; though where the fever has been very considerable, I have given nitre to advantage to infants of only a few months old. In the little fevers aris­ing from taking cold, to which some chil­dren are very liable, I often join it with a little of Dr. James's powder, (proportion­ed to the age) and a few grains of the com­pound powder of contrayerva, lowered with testacea; which I find to be a medicine ex­ceedingly useful, when given in time. If the head is much affected, putting the feet into warm water, or applying a milt to them just taken from the animal, are admirable remedies; and I think have sometimes sav­ed a life after all hope had [...] given up. Or a little fresh leaven, or dough, as ad­vised by Mr. Le Febure de Villebrune, may be spread thinly over the soles of the feet. If the fever be accompanied with much cough, and attended with difficulty of breathing, which comes on by fits, both may be greatly relieved by ten or fifteen drops of the spirit of vitriolic aether, given three or four times a-day. But in the ab­sence of fever, the breast-milk is often as good a balsamic as can be had; or if the child be dry-nursed, a little syrup of balsam is both pleasant and useful.

If the fever be not owing to taking cold, to worms, teething, or some eruptive com­plaint, [Page 147] it will generally be found to arise from some foulness in the first-passages, in which case, opening the belly, and after­wards giving a puke and the testaceous pow­ders, usually remove it. But if otherwise, opening medicines must be continued a while longer, especially castor-oil; but if the stools are very fetid, the basilic powder, or small doses of calomel are the fittest purge; though they require to be administered with caution. I have known not only convulsi­ons, but paralytic affections, attended with great pain and continual fever, induced merely, as I apprehend, by a foul state of the bowels; where, after the complaint has been unsuccessfully treated as a fever of a­nother kind, all the symptoms have been removed at once by an active purge. Even infants of only three or four months old will often have very considerable fever, and fits, with so costive a state of the bowels as to require strong purgative medicines to be re­peated for several successive days, with clys­ters and the warm-bath, before the obstruc­tion can be removed, or the fever will at all abate. And I doubt not, it may be mat­ter of surprise to those who may not fre­quently have met with such cases, to find what a quantity of purging medicines have been taken by a tender infant before one proper stool could be procured, and how certainly a relapse will take place, if the [Page 148] opening plan be not persevered in, in the manner recommended. In less urgent cases, and especially in very young subjects, much gentler means will usually succeed; and af­ter the belly has been once or more well opened, many common fevers will nearly subside; after which it will frequently be proper to return to some of the absorbent powders, in one form or other, and that re­commended by Boerhaave^* may be as pro­per as any; though the union of different testacea is of very little importance. Any of them will form an admirable medicine for very young children, as well under little fe­vers, as for almost all their complaints not attended with much costiveness. This, the judicious Harris was so sensible of, that he thinks them alone sufficient to effect almost every thing during the infant state, and has done unspeakable service by abolishing that indiscriminate recourse to cordials, and other heating and rough medicines, such as mer­cury, aurum fulminans, theriaca, &c. to­gether with various anile and superstitious remedies, which the ancient writers fre­quently recommended on occasions peculi­arly improper. And though absorbents will not do every thing he has imagined, yet are there very few medicines of such general use. But should the fever withstand [Page 149] these common remedies, or be found to in­crease, it will be necessary to give some of those before recommended, or, what is sometimes very useful, little draughts with lemon juice and salt of hartshorn, in which the latter is left a little predominant; or three or four drops of the compound spirit of ammonia, in a little water, four or five times a-day. I have, indeed, lately expe­rienced very good effects from persevering in the use of small doses of wine of antimo­ny, given in a saline draught, in the little obscure fevers of infants, where the cause has not been so obvious as it common­ly is.

On the decline of some fevers, especially those arising from fowl bowels, it is not un­common to see an eruption on the skin, re­sembling that called the red-gum, in the month, and sometimes even the thrush will make its appearance, though the infant may have had that complaint already; which are marks of the great disturbance the first passages have suffered, and of the consent they have with the skin; the former, it has been said, is always a favourable indication; but the observation does not hold good in regard to the thrush.

Fevers in children of three or four years old, are sometimes tedious of cure by any of the above means, and like those of adults, require the bark; which should be admi­nistered [Page 150] in a light decoction three or four times a day, in such doses as the symptoms may require.

I have sometimes met with a fever, more remarkable for its being attended with in­flamed and painful tumors, than for any other symptom peculiar to it. These are seated chiefly on the legs, and particularly along the spine of the tibiae; and rise in a day or two to the size of a nutmeg. They are marked with all the appearances of ab­scesses, feeling as if they contained matter, and on this account, they put on a formi­dable aspect to such as may not often have seen the disease; but what is remarkable, they never, I believe, come to suppuration, but disappear again in a few days, though the fever sometimes continues. The like appearances have been met with in adults, and especially females, but perhaps more commonly in children from three to ten years of age; and are not peculiar to scro­fulous habits. As far as my experience has gone, (for I believe it is not a very common complaint) they are conjoined more fre­quently with that fever which attends a foul state of the bowels, than with any other; which therefore requires repeated purging, especially with calomel; and on this ac­count, the pulvis è scammon. cum calomel. becomes a convenient preparation. Saline draughts with the spir. aetheris vitriolici may [Page 151] be given on the intermediate days, and in the end the bark is commonly useful.

MESENTERIC-FEVER.

ANOTHER cause of fever has been hinted at, which is obstructed glands, especially the mesenteric; and is often a fore-runner of the true hectic fever, or fatal marasmus.

It, indeed, frequently arises from scrofu­la, which then discovers itself by other marks; and will require its peculiar treat­ment. But there is an early stage of glan­dular obstruction in the mesentery, and of the fever here alluded to, that is often falsely attributed to worms; but will not yield to mere purgative medicines. It at­tacks children from the age of three or four years, the fever remitting, and sometimes intermitting irregularly; is attended with loss of appetite, swelled belly, and pain in the bowels; the latter more commonly tak­ing place, more or less, every day, or is generally more violent if the child be a day or two free from it. After opening the bowels, half a grain, or a grain of calo­mel may be given to advantage, two or three times a week, and on the intermediate days small doses of the natron ppt. either alone, or neutralized with the juice of lemons, or [Page 152] in some instances partially so. If the belly be very costive, as it often is, an infusion of the burnt sponge and senna is more effec­tual than any thing; and when strained through filtering paper, make a neat pre­paration, and an excellent remedy for many little fevers, in older children, when the primae viae, or first passages are concerned. When the glandular fever, just now men­tioned, has abated, some light bitter, as of camomile flowers, is useful to brace the sto­mach and bowels; and to prevent a relapse, it will often be found necessary to administer some chalybeate, of which the tinct. flor. martialium is usually the most proper for chil­dren.

But as this fever, from its great fatality and frequency, has lately very much enga­ged the attention of writers, it may be pro­per to consider it a little more distinctly in some of its principal stages; in each of which its nature and treatment sometimes materially differ. For before the mesente­ric glands become much enlarged, or the fe­ver continual; whilst the appetite continues, and the first digestion is but little impaired, and no purging has taken place; the open­ing mixture of sponge and senna, with a few doses of calomel, and afterwards bitters and chalybeates, are the only remedies very likely to be called for. In this state, the disorder may still be considered as in its first [Page 153] stage, and of which an unusual costiveness, the hardness and recurring pains in the bel­ly, and an intermitting fever, are the prin­cipal symptoms. The limits of this work, however, will not allow of a particular de­tail of the many others that attend this fever through its various stages; and it is presum­ed, they are so well known to medical peo­ple as to render it unnecessary. But in ge­neral, it may be said, that indigestion, cos­tiveness or purging; irregular appetite; flushed cheeks, or a total loss of colour; impaired strength and spirits; remitting fe­ver; and a hard and tumid belly, with ema­ciated limbs, are amongst the more constant symptoms attending, at one period or other of the disease.

Children are liable to it from their infan­cy to six or eight years of age, it being often a consequence of the long continuance of almost any of the preceding complaints, es­pecially those of the first passages and denti­tion, as well as the measles, and a few o­thers; of which that from teething will be separately considered. Among the poor, it is too frequently owing to a coarse and unwholesome diet; indigestion at the sto­mach, and a consequent vitiated chyle, with infarction, or obstructions in some of the internal glands or lymphatics, being among the primary remote causes of the disease.

[Page 154] As prophylactics, or preventives there­fore, good air, exercise, gentle frictions, an easy dress, frequent washings of the bo­dy of young children with soap and warm water,^* the cold-bath, in older children, and especially a light and nutritious diet, with such mild aromatics as may assist digestion, are some of the principal and most efficacious means.

But when this fever is actually formed, it calls for the most powerful remedies; and such have happily succeeded in several in­stances, wherein formerly little hope had been usually entertained.

As I am constrained to pass over many less important symptoms occurring in the different stages of this long disease, especi­ally such as arise from some peculiarity of habit; so will it be necessary to confine these observations to the more general plan of treatment, without particularly noticing a variety of occasional remedies, which such symptoms might at different periods re­quire.

In a general way, the principal indica­tions are to remove the obstructions in the lymphatic system, and effect a resolution of the indurated glands of the mesentery; to [Page 155] carry off this viscid matter; and lastly, to strengthen the system, and establish a good digestion, as well by means of proper diet as by medicine. To accomplish these inten­tions, attenuants and deobstruents, purges and emetics, and [...]nic, or bracing reme­dies, must be had recourse to, in their turns.

Amongst the first, and as general deob­struents, are mercurial and antimonial re­medies, neutral salts, soap, steel, and, ac­cording to some, the cicuta.

In regard to the efficacy of mercury and steel in this disease, a vast cr [...]ud of testimo­nies appears among writers,^* in almost eve­ry part of Europe. And a very rational idea has been suggested on this head, by Mr. Royer, that of administering mercury clys­ter-wise; inasmuch as the resolution of local and partial obstructions, does not so much require an exertion of the collected force of the system, as deriving all the influence of proper remedies to the seat of the disease: an idea of late years pretty generally re­ceived, and in some instances, successfully adapted to the cure of scrofula, as well as some other chronical disorders.

[Page 156] Calomel is, perhaps, one of the fittest remedies of this class, and may be combin­ed with some purgative medicine, and given for several weeks, till there shall [...] some favourable change in the feel and size of the belly.

The lightest preparations of steel are usu­ally preferable, such as its tinctures, or the salt, or merely some chalybeate water; which will act both as aperitives and tonics; and amongst antimonials, the kermes mineral is found by experience to be more generally useful than any other preparation.

The Evacuants mentioned as proper in this disease, were emetics and purges; to which may be added diaphoretics. The two former are more essentially necessary; but must be adapted and carefully dosed, agreeably to the state of the bowels of the patient. As a purge, rhubarb and salt of tartar are generally the safest and most ef­fectual, and may be persevered in for the greatest length of time; or the composition which, in regard to many cases, has been deservedly extolled by Sir William Fordyce, rhubarb and polychrest salt; which, when­ever mercury may not be preferred, should be exhibited daily for several weeks, and will sometimes restore the patient without recourse to any other means, when the dis­order is not of long standing; being at [Page 157] once both a purge and an efficacious deob­st [...]ent.

As a Diaphoretic, sarsaparilla, or a more compound decoction of the woods; which may be taken together with any of the above mentioned remedies.

The last means recommended were tonic, or bracing medicines, which can very rare­ly be dispensed with; since although the obstructions should actually be removed, the emaciated state to which the patient is ge­nerally reduced, peculiarly calls for bracing remedies, especially with a view to strength­ning the stomach and alimentary canal, and promoting a good digestion; the only means of obtaining a bland and nutritious chyle, by which the body may be conserv­ed in good health. To this end, the bark, steel, the cold-bath, light bitters and aro­matics, are the principal remedies; to one or more of which, recourse may be had, as the degree of remaining fever, and the state of the bowels may point out. To these may be joined daily frictions, especially of the belly and limbs; or the common soap-plaister, or one composed of ointment of marsh-mallows, gum ammoniac, and oil of chamomile, applied over the whole belly: or the body may be covered all over (as di­rected by Mr. Baumes) with sea-salt, reduced to a very fine powder.

[Page 158] It has been already hinted, that the diet ought to be of the lightest and most nutriti­ous kind, and carefully adapted to the age and other circumstances of the child; who, if at a due age, ought in many instances, to partake of light white meats, as well as vegetables, and plain jellies; but always avoiding fat and greasy aliments, pastry, and whatever may not be duly, as well as quickly digested, or will not form a bland and nutritious chyle, however readily they may get out of the stomach.

Though in some instances, merely pur­ging with calomel or rhubarb, for a length of time has been said to succeed, and in others, some one of the above remedies may be more adapted to the patient than the rest; yet in general, each of them will be useful, at one period or other of the com­plaint, and sometimes the union of several: but above all, purging is always the most essential to the cure of this dangerous dis­ease. And though it is oftentimes attend­ed with costiveness and a voracious appetite, it is, at others, accompanied with a loathing of all food, and frequent stools, which do not reduce the belly, but too often deter practitioners from the use of active, or re­peated purges; without which, however, experience proves there can be no prospect of success, after the belly has once become enlarged.—I shall close these observations [Page 159] with offering the following form, which in a general way, may be as suitable as any. It should be continued for a length of time, taking care that the bowels be kept proper­ly open by it, or by other remedies occa­sionally administered.

• R. Calomelan. gr. j. ad. ij.
• Pulv. I pecac. grss. ad. gr. j.
• Zingiber. gr. vj.

Misce, st. Pilulae is, cum quantitat. suffi­cient. vel. Conf. aromaticae, vel Conf. opi­atae, ut alvi status postulet.

HECTIC FEVER, and MARASMUS.

NOT a few, both of the preceding and following complaints, are sometimes found to induce a confirmed hectic fever, and marasmus, or a wasting of the whole body, called by some writers Atrophia Lac­tantium; though it often comes on too late properly to admit of the name. I have no­thing new, indeed, to offer on this disease when it seems to be far advanced, unless it be by way of encouragement to hope for a better issue in the hectic fever, under cer­tain circumstances than we are wont to ex­pect.

This fever, as it is apt to arise from other [Page 160] complaints, is very often owing to their ha­ving been imprudently treated, or imper­fectly cured, especially by suppressing some eruption or discharge from the skin, or in­cautiously stopping a purging during the time of teething. In such cases, and indeed whenever the hectic fever is of some stand­ing, the mesenteric glands become indurated, greatly increased in size, and often suppu­rate, the belly getting large, though the limbs and other parts become emaciated; which state has been treated in the former chapter, and has been shewn to be curable, or otherwise, according to the degree of in­duration, and the length of the time it has existed. But there is sometimes a threaten­ing appearance of hectic fever, where ne­vertheless nature effects a salutary and won­derful change, and will restore the emacia­ted infant as from the very jaws of death. And this, indeed, is often the work only of nature, art doing no more than superin­tending it, and preventing her being coun­teracted by the use of improper medicines, or diet.

Nature alone will, indeed, oftentimes effect wonders for infants, and far beyond any thing to be expected in adults, if she be not officiously counteracted. And the reason is obvious, it being well observed by [Page 161] a great man, and a good physician,^* lately deceased, that "there is, in truth, a great­er luxuriancy of life and health in infancy, than in any other period in life. Infants, it is acknowledged, are more delicately sensi­ble to injury, than those advanced in life; but, to compensate this, their fibres and vessels are more capable of distension, their whole system is more flexible, their fluids are less acrid, and less disposed to put [...]s­cence; they bear all evacuations more easi­ly, except that of blood, and, which is an important circumstance in their favour, they never suffer from the terrors of a distracted imagination. Their spirits are lively and equal; they quickly forget their past suf­ferings, and never anticipate the future. In consequence of these advantages, children recover from diseases, under such unfavor­ble symptoms as are never survived by adults. If they waste more quickly under sickness, their recovery from it is quick in proportion, and generally more compleat than in older people, as diseases seldom leave those baneful effects on their constitutions, so frequent in adults. In short, a physici­an ought scarce ever to dispair of a child's life, while it continues to breathe."—In [Page 162] farther support of this sentiment it may be observed, that their complaints are not often attended with acute fever, like those of adults, which is disposed rather to break up the system, than to rectify the machine.

The above mentioned salutary turns in the true hectic fever, as far as I have obser­ved, are chiefly in that species of it arising from worms or teething; and in which I have known recoveries after hope had long been given up, and all attempts been laid aside. There is, indeed, an atrophy, or uni­versal decay in infants, for want of the breast, or from the unsuitableness of it, or of what­ever else may be the child's ordinary food, (as I shall instance in another place:) but this is not usually attended with fever, and is to be cured merely by making that change, which the nature of the different occasions points out. Harris recounts some remarkable recoveries in what he calls the Atrophia verminosa, (or Worm-hectic) and attributes the cures to the free use of the hydrargyrus cum sulphure, carefully prepa­red; but I have seen none so marvellous as in the Atrophia Dententium, or Tooth-atrophy. In this, I have known children after being reduced by purging, and other complaints, lying for three months together in the cradle, scarcely fit to be moved, with continual fever, flushed cheeks, emaciated countenance and limbs, a large belly, incessant cough, and [Page 163] almost without taking any nourishment, re­cover, as it were in a few days, upon un­expectedly cutting half a dozen teeth.

After what I have said on this fever, it will not be expected I should offer much on the head of medicines; I shall therefore only observe, that after making trial of the mixture recommended by Boerhaave,^* when acidity may prevail in the bowels, or pre­scribing opening medicines, as directed un­der the heads of costiveness and purging, are the chief indications in this advanced stage of the complaint. With this view, Sydenham's rhubarb-beer,^† and purging with mercury, if that has not already been done, should even now be attempted, since children in this state will often bear stronger doses of purging medicines, and more fre­quently repeated, than under any other cir­cumstances.—Some attention, however, should be paid to the diet, which ought [Page 164] chiefly to be of milk, rice, semolina, and such like, with light puddings; but above all, plenty of fresh air, and as much exer­cise as the weak state of the child will bear.

In Dr. Armstrong's second edition, is a pretty long chapter on the hectic fever of teething children, wherein several medicines are prescribed, which the doctor appre­hends may be very serviceable early in the disease. He speaks of it as a very common complaint, beginning like other fevers, and gradually becoming remitting; then a slow continual fever, and terminating in a fatal hectic.

It is very probable, that a fever of this description, may be common among pau­pers, relieved at dispensaries, and may de­serve such a name, but, I believe, it will be rarely met with in higher ranks of life; and if so, perhaps, that ought to have been intimated in a popular work. It seems to me, (and Dr. Armstrong, indeed, says as much) to arise from improper food and nur­sing, joined with a costive state of the bowels, and is therefore, very much the offspring of neglect. When advice is sought for in pro­per time, it, accordingly, appears to be nothing more than the common fever I have described, arising from a foul state of the bowels, and is easily cured by such medicines as are best calculated to clear the first passages. Should this, however, be neglected, it may [Page 165] degenerate into a continual fever; but it is not even then peculiar to the age Dr. Arm­strong has specified, nor, by any means, the common hectic fever of dentition.

FEBRIS SCARLATINA—SCARLET-FEVER, WITH or WITHOUT ULCERATION of the THROAT.

WHENEVER the Scarlet- [...]ver becomes epidemic among adults, children rare­ly fail being attacked by it, in great num­bers, and frequently sink under it. This disease has, indeed, engaged the pen of the most able physicians, and has lately been accurately arranged by Dr. Perkins. It is therefore well understood in this day, at least in the metropolis, and needs only on this occasion, to be adverted to as one incident to ch [...]dren, and its most approved method of treatment to be briefly pointed out.

The scarlet-fever with ulcerated throat, has, perhaps, been distinguished in too re­fined a manner, by some writers, into the scarlet-fever with malignant ulcerated throat, and the malignant fore throat with efflores­cence, or redness, on the skin. But such distinction, it is apprehended, is needless, since the experienced practitioner will al­ways be guided by the degree of tendency in the system either to an inflammatory or [Page 166] putrid diathesis; and the less experienced will only be perplexed by multiplied by dis­tinctions.

The mildest species of scarla [...]ina anginosa should, however, be carefully distinguished from the true inflammatory affection of the tonsils, which the angina maligna will some­times resemble in its first stages: but the genuine marks of the two diseases, and the cast of the epidemics reigning at the time, will direct the attentive practitioner; who will in less certain cases, take a middle course in his method of treatment, till the charac­teristic symptoms of either shall become more evident.

There is, however, a scarlet-fever that is not atended with any affection of the throat, and was long ago described by Sydenham,^* though not much insisted upon by later wri­ters, which is attended with a harder pulse, and other symptoms of an inflammatory disposition, but nevertheless, in every in­stance that I have met with, calls for the same general treatment, only more cauti­ously adapting the necessary cordials and to­nics to the degree of fever, especially in the commencement of the complaint.

The f [...]bris scarlatina of every species be­gins with the common symptoms of fever, often with languor and disposition to faint­ing, [Page 167] sickness, a quick pulse, and pain in the head. The eyes are often inflamed, and where the throat is affected, there is fre­quently a stiffness of the muscles of the neck very early in the disease, which is soon fol­lowed by some difficulty in swallowing. The fever generally increases in the evening, and is often attended with transient fits of deli­rium; but some remission takes place tow­ards morning, with sweating; and on the second, or third day the efflorescence ap­pears on the skin, and generally first on the face, neck, and breast.

The limits of this work allow me only to observe, that the method of cure being di­directed to the two indications of the gene­ral diathesis, and the affection of the throat, the nature and extent of these must ever be kept in view, and the system be duly sup­ported. The throat should be often gar­gled, or rather syringed, with mucilaginous infusions or decoctions, rendered more or less stimulant; such as the compound decoc­tion of barley with honey of roses, warmed with the compound spirit of ammonia, tinc­ture of myrrhe, or a decoction of snake­root; or other such like preparations.

This fever, especially when epidemic, being almost constantly of a low type, the physician must not trust to saline draughts, or other medicines of that class, without the addition of the aromatic confection, [Page 168] snake-root, or the bark, in one form or other; and beside these, should direct a mo­derate quantity of wine to be given with the food, according to the age and other cir­cumstances of the patient.

Should the affection of the throat there­fore to be evidently inflammatory, or should a case occur where the fever may seem to be of that kind, (which may be better ascertain­ed by the hardness of the pulse than any other symptom) it will rarely, if ever, bear bleed­ing, even in the beginning of the disease, as symptoms of debility generally attend in some period of the scarlet-fever, and will al­low only of that middle course of treatment, hinted above.

In a general way, a cordial plan is re­quired throughout the disease, and where the throat is much affected, either with sloughs, or total blackness, the bark is in­dispensably necessary, howesover thick and florid the rash, or however hot and dry the skin may be; the bark, as it were, ex­tinguishing the fever above every other re­medy. Young children take it very well, es­pecially the soft extract, dissolved in a strong decoction. Should it be disposed to purge the child, a little of the spirit of cinnamon, or a drop or two of the tincture of opium should be added to it; or if the child, on the other hand, should be two or three days without a stool, a laxative clyster [Page 169] should be injected.—If there is much exter­nal swelling about the neck, blisters to the part are frequently very useful—Even af­ter the efflorescence has dried off kindly, a gangrene has sometimes seized the whole pa­latum molle.

CARDIALGIA, or INFLAMMATION of the STOMACH.

THIS is a disease very seldom met with, I believe in this country, but is com­mon in France, as it appears by a paper read lately before the Royal Society of Me­dicine, in Paris, by Mr. Saillant; and is said to attack children of four or five years of age.

The pathognomonic, or characteristic symp­toms of this disease are, violent pains in the region of the stomach, sometimes recurring every quarter of an hour; violent contor­tions of the child; and the application of a hand to the seat of the disease. Mr. Sail­lant in the first instance, suspected that these symptoms might be owing to worms, and prescribed accordingly; but that child dy­ing in a few days, the body was afterwards opened, and the presence of genuine inflam­mation of the stomach, and of a part of the intestinal canal was clearly demonstrated.

[Page 170] The treatment of this dreadful disease is, however, represented as very simple, con­sisting only in cooling and laxative remedies, which when administered in good time, are said to be usually successful. For this pur­pose, Mr. Saillant has generally adminis­tered the juice of the lettuce, by spoonsful, every hour; an idea he took up from Bag­livi, who directed the juice of the sow­thistle in the hemitritus, under symptoms analogous to those of the cardialgia. The juice of the lettuce was generally was found to relieve the pains in a short time, and some infants who had been judged to be in a hopeless state, and even at the point of death, were perfectly recovered.

Mr. Andry has done me the kindness of acquainting me, that he has sometimes met with this complaint, in the hospice des en­fans trouvès, especially during the summer, and at such times as infants have been obli­ged to continue there without the breast, for the want of wet nurses; who are usu­ally otherwise engaged in the harvest and vintage seasons, as well as during a hard frost. In the instances Mr. Andry has seen, the infants were found to vomit up every thing that was given them, which it is pro­bable, must generally be the case where the stomach is actually inflamed. In such in­stances, perhaps, fomentations to the sto­mach, and the use of a warm-bath ought to be made trial of.

SMALL-POX, (INOCULATION) and MEASLES.

IT were very foreign to the present inten­tion to treat distinctly of these diseases and their several varieties, being in no re­spect peculiar to childhood, and are noticed only to point out a few principal indicati­ons, and to introduce some observations in regard to the properest time for inocu­lation.

Though the SMALL-POX is a complaint so incident to the early part of life, that comparatively few children living to the age of eight or ten years, are found to escape it, yet it is not so readily communicated, in the state of infancy, as hath been general­ly imagined, unless by immediate infection.^*

[Page 172] The poor furnish frequent instances of the truth of this observation. I have at­tended where children born in an air, satu­rated as it were, with the miasma of this disease, (as well as of the measles) and even lying continually in a cradle in which ano­ther child has died a few days before, have nevertheless escaped the disease, and some­times when they have slept together in the same bed with one loaded with it. Hence it appears that highly tainted air, and even personal contact, are often insufficient to communicate the virus. Yet we know that [Page 173] infants are very easily infected, receiving the small-pox by inoculation as readily as adults; though neither are at all times e­qually susceptible of it. Perhaps this latter circumstance may not always be sufficiently attended to; the mode of inoculation being often blamed, when its failure may be ow­ing to the indisposed habit of the child. Possibly, on this account, it may not be perfectly safe to urge it, at such a time; at least, instances are not wanting, where twice introducing the virus having failed, an in­fant has had the disease very severely, and even fatally, upon its being repeated a third time.

But in whatever way the small-pox or measles may take place, they are to be treated as in adults, with but little other difference than what every practitioner is well acquainted with, that of greater cau­tion and tenderness; as infants cannot bear the powerful antiphlogistic regimen and eva­cuations, often proper for the other.^*

In the treatment of the MEASLES, not only ought children's bellies to be kept open throughout the disease, but unless they are very young, they will bear and even require one or more bleedings, at any period of it when the symptoms indicate its propriety. [Page 174] And, indeed, the cure of the secondary fe­ver, however long it may continue, will turn upon repeated bleedings, laxatives, and a total abstinence from wine, and all animal food.

I have now only to drop a word or two on the subject of Inoculation, because pa­rents are very apt to fall into great mistakes respecting the age, and circumstances most proper for this operation.

It is too common an opinion that a very young infant, sucking at the breast, is the fittest subject for inoculation, and medical people have some difficulty in persuading parents to the contrary. Children are then said to be clear from humors, their blood mild and balsamic, their food innocent, and they are free from all violent passions of the mind. But all these advantages may be counter-balanced by the delicacy of their frame, their disposition to spasm, and their inability to struggle with a severe attack of the disease, if it should chance to fall to their share. And such, indeed, are the facts; infants usually have the small-pox very lightly, whether taken naturally, or from inoculation; though in both there are instances of their expiring in a fit at the time of the eruption; and they seldom get through the disease, if they are full, or it proves of the confluent, or malignant kind. And this furnishes a peculiar objection to [Page 175] inoculating infants at the breast, which arises from their necessarily lying so much on the arm of the mother, or the wet-nurse, espe­cially in the night; the heat exposing them to a much more copious eruption, than children who are weaned. This I have seen clearly exemplified in the instance of a child whose mother could suckle only with the right breast; the consequence was, that the left side of the child was perfectly load­ed with the eruption, (though the pock was of the distinct kind) whilst the other had on­ly a very moderate sprinkling. The child, however, sunk under the secondary fever at the end of five or six weeks, though turned of two years old; the only child I have known to die of inoculation at so ad­vanced an age.

I am aware that many children are inocu­lated very young, and even in the month, and generally with very good success; but the frequency of this practice, among emi­nent surgeons, its owing to the urgent soli­citation of parents, and their fear of conta­gion. I cannot therefore avoid saying, that however few may die under inoculation, un­der any circumstances, the fact is, that the far greater proportion that I happen to have had an account of, is amongst infants under six months old.

From this view of the matter, it is pret­ty evident, I think, that this operation [Page 176] ought, usually, to be postponed to a later period, which is pointed out by the child having cut all its first teeth. To which may be added the observation just made, that infants are not much disposed to take the small-pox naturally, and that fifty chil­dren die under the age of two years, of o­ther complaints, to one that dies of the na­tural small-pox. Should it, however, be in the same house, or prevail in the neigh­bourhood, and the parents find it difficult to remove the child out of the way, it may run a less risk in being immediately inocu­lated, as that operation is now so well un­derstood, and successfully conducted, than by taking the chance of escaping the infec­tion, or of recovering from the disease, if it should happen to take place.

CHICKEN-POX.

FOR the reason given in the former chap­ter, I shall be very brief on this head. The complaint, nevertheless, merits a few words, not only because more incident, per­haps, to children than to adults, but also that parents are often at a loss to distinguish it from the mild small-pox; which it some­times exceeds in violence, and is now and then even attended with danger. This is, indeed, not often the case, and the disease [Page 177] has therefore been very seldom noticed by medical writers; and even Dr. Heberden, who was among the first that obliged the public with a distinct account of it, says he never saw any person with so many as three hundred pustules over the whole body. Phy­sicians, indeed, as he observes, are not of­ten called to visit patients under a complaint usually so trifling, or a gentleman of his long and extensive practice, would have met with instances in which it must have appeared of more consequence, as will pre­sently be noticed.

It is from this disparity, I apprehend, that this disorder is sometimes denominated the swine-pox, which is only a ranker species of the disease, in which the symptoms may run higher, as well as the pustules become much larger. In this case, I have known the head and face as much swollen as I have ever seen them in any distinct small-pox, however full, and the pustules containing a yellow, and seemingly purulent matter, with highly in­flamed bases, and exceedingly sore; and these have formed a complete mask on the face, after the turn, as is often seen in the small-pox. One such patient whom I was called to visit, was about sixteen years of age, of a plethoric habit, but very healthy; and what makes it very certain, that this complaint could not be the small-pox, is, that the young gentleman died of that dis­order [Page 178] a twelvemonth afterwards, and possi­bly owing to its being neglected in the be­ginning, from an idea that the former illness had really been the small-pox. The latter mistake arose from an improper answer hav­ing been then made to my enquiry after the day on which the eruption had first appear­ed (as I was not called in to visit him till the disorder was at the height); a mistake the young gentleman's mother had a perfect recollection of after I was gone, and of which I reminded her upon being called to visit him in the small-pox, only the day be­fore his death.

This case strongly verifies the remark of Dr. Heberden, that this complaint can, in some instances, be distinguished from the small-pox only by its quicker progress to­wards maturation, and the shorter duration of the pustules; a watery vesicle always appearing on the second or third day from the eruption; and the turn, at the farthest, taking place on the fifth.

The treatment of it differs nothing from that of the mild, distinct small-pox; but it more rarely calls for much attention, and only when a patient may have it very full.

AGUE.

THIS is a complaint so well known, that it seems unnecessary here to enter mi­nutely into a description of it. It is suffici­ent to say, that it consists of repeated cold and hot fits regularly succeeding each other, with one or more well-days between them; in which interval the sick passes a high-co­loured urine, that deposits a red sediment.

It, perhaps, partakes more of a nervous affection than other fevers may do, and is known to be endemic in some flat marshy si­tuations, but is most frequent in the spring and fall of the year; in the former of which it is generally easily cured, and is even some­times salutary. Autumnal agues, on the other hand, especially in the country, and amongst the very poor people who feed coarsely, will frequently continue a long time, and return again the next autumn; whereby the constitution becomes consider­ably impaired. In such instances the legs are apt to swell, and more specially the belly, which becomes h [...]d, particularly on the left side, and has been termed the ague-cake. This tumefaction, however, instead of being a bad sign, as might be sus­pected a priori, is a very favourable one, and indicates the recovery of the patient. [Page 180] This circumstance is noticed by Sydenham, and like other observations of that attentive practitioner, is a very just one, and was doubt­less, the result of his experience. The hardness is probably owing to an infarction of the spleen, and usually subsides in the course of a few months, especially upon the use of moderate exercise, and a generous diet. It may be prudent, however, to ad­minister small doses of calomel, and after­wards light bitters, adding likewise chaly­beates, if the habit of the patient seems to require them, and there are no symptoms of morbid affection of the viscera.

It were needless to enter more largely in­to the subject, and it is equally foreign from the present intention, to be more particular in regard to the cure of this oftentimes very troublesome complaint, as it would lead me farther than would be compatible with the design of this work. Some notice of it, however, is taken because, though no more peculiar to children than the last mentioned diseases, yet it may be said, that there are comparatively very few children who have not suffered by it during the years usually passed at school.

The ague, indeed, attacks every age, so that infants even under a year old are very liable to it, whenever it rages among adults. It is with a peculiar view to patients of the former class that the following directions are [Page 181] given, the bark being usually a specific for older children and grown people; to whom, however, it is generally proper first to ad­minister a vomit, and one or more doses of physic.

In a state of infancy, the ague is often ow­ing to, or connected with a foul state of the bowels and obstruction of the gall-ducts, and is frequently accompanied with worms, or such a state of the alimentary canal as affords a proper nidus for them.

The tertian, or more common ague, at this age generally yields to purges of the basilic powder, or calomel and rhubarb, given on the days between the fits, and small doses of Dr. James's powder on the return of the fever. Should this fail, a vo­mit should be administered an hour or two before the next cold fit is expected, if the powder should not already have had that effect. In older children, the common sa­line draught, taken once in six or eight hours, will frequently succeed, as will warm bitters, and medicines that promote and keep up perspiration. A linen waistcoat with fine powder of bark quilted within it, may be worn by infants next their skin.

Amongst popular remedies,^* is a tea-spoonful [Page 182] of white resin in fine powder, mixed with the like quantity of pounded loaf-sugar, taken a little before the cold-fit, and repeat­ed afterwards night and morning. Poor people, [...] such as live in the country at a distance from medical help, may make trial of it with safety, and with as good prospect of success as any other remedy I know of, having found it successful even where large doses of the bark have failed. Such kind of remedies for this disease are numberless; I shall, however, mention another, which, though as anile as any, seems to have been very often successful; and is nothing more than the spider's web, rolled loosely up to the size of a child's marble, and washed down with a little warm wine and water, or camomile tea, before the cold fit is ex­pected: the child should then be put into a warm bed, and perspiration be encoura­ged.

Crude salt ammoniac, in the dose of ten or twelve grains, for children of five or six years of age, has sometimes cured this trou­blesome complaint; but may not be proper for delicate constitutions. Myrrhe is a bet­ter remedy for such, given from four to eight grains, before, or during the cold-fit, and as much cream of tartar, every two or [Page 183] three hours, during the fever. Pepper, and likewise alum, are frequently given with success at this age, the former from five to ten grains; the latter from three to five, joined with the like quantity of nut­meg, three or four times a day in the ab­sence of the fev [...]r. Another good remedy is flowers of brimstone, given in the quan­tity of a table spoonful in a glass of brandy, before or during the cold-fit; this is a pro­per dose for adults, but I have never admi­nistered this medicine to children. I shall close this list of remedies with the following from Dr. Kirkpatrick, which is a very good one for patients no otherwise averse from the bark, than that the stomach will not bear it in large doses.

Take of the fresh sassafras bark, of Vir­ginia snake-root, of roch-allum, of nutmeg, of calcined antimony, and salt of wormwood, of each one dram: to these, well rubbed together into a fine powder, add the weight of the whole of the best Peruvian bark, then add three or four drops of the chemical oil of mint; and with syrup of saffron make all into the consistence of an electuary. This is to be divided into twenty-four doses, one of which may be taken by children of eight or ten years of age, every four or six hours, while the patient is awake.—To make this or any other preparation of the bark sit bet­ter on the stomach, the patient should first [Page 184] eat a bit of bread, or other light food, that the bark may not be received into an empty stomach.

HOOPING-COUGH.

THE Hooping-cough is a disease un­known, probably, to the old writers; the Greek and Arabian physicians make no mention of it, and indeed it has not been well understood in any part of Europe, till of very late years. Even Willis supposed its seat to be in the breast, but Harvey makes it a disease of the stomach, and Astruc an inflammation of the larynx and pharynx, pro­duced by an original affection of the former, from indigestion. He seems to have been one of the first that discarded the use of oily and pectoral medicines, (which indeed some practitioners have been weak enough to re­vive); though he advised bleeding too in­discriminately.^*

This disorder furnishes another proof of the observation made on the impropriety of submitting the complaints of children to im­proper hands—the care of old women, and frequent change of air, being all that this disorder is thought to require: but perhaps the maxim was never worse applied. There [Page 185] is, indeed, a milder sort of hooping-cough, as there is of every disease, that calls for very little medical assistance; and it is al­ways in such cases, that matrons and nurse, acquire their credit. But there is no com­plaint of children with which I am at all acquainted, in which medicine is at times more evidently serviceable, than a bad hoop­ing-cough.

This disease is certainly highly infectious, and one of those that never appears a second time. It often begins as a common cough, and is attended with the usual symptoms of having taken cold, but in its progress soon becomes more [...]: the longer it may be before it plainly discovers itself, by the hoop, the more favorable it is likely to be. The fits of coughing are attended with a peculiar noise, not ill-expressed by the term hoop, and is sufficiently known to every parent who has ever had a [...] severely attacked by it, and to whose feelings, it proves one of the most distressing complaints their children are liable to. A flux of rheum frequently comes from the mouth, nose and eyes, and the food is thrown up, together with a viscid phlegm, (often in great quantities) in the coughing fits; between which the child generally ap­pears to be perfectly well, and eats its food very heartily. These are the more common symptoms, but when the disease is violent, and has continued for some time, they be­come [Page 186] greatly aggravated, especially in the night, and the child will seem almost stran­gled in each fit, and the face and neck be­coming perfectly livid, till by a violent effort, attended by a hoop, it recovers its breath; the blood will likewise sometimes rush from the nose and mouth. When taken in time, and properly treated, it is, however, rarely fatal, and scarcely ever but to young in­fants.

Dr. Armstrong has strongly recommend­ed wine of antimony as the proper and only remedy^* for this, as well as for almost every other complaint of infants, which, however opposite, in this case, the remedy may be, in a general way, is saying no more than that emetics and gentle laxatives are useful, which all modern practitioners are agreed in; and in which view, Dr. James had long before recommended his powder. But the fact is, that many other means are equally useful, and not unfrequently indispensably necessa­ry, unless we should suffer the patient to be strangled in a fit of coughing, or fall into a decline, from the injury which the lungs must endure by a frequent repetition of such violence.

This must be exceedingly apparent from the above history of the disease, the various [Page 187] symptoms of which, certainly demand a con­siderable diversity in the treatment. The more important ones are, the state of in­flammation, sometimes inducing peripneu­mony; the quantity and viscidity of the phlegm; and the spasmodic affection, and danger of suffocation; together with the exhausted state into which the patient may be reduced by the long continuance of the disease. If the breathing therefore be difficult, a blister is indicated, which if the child is not very young, may be kept open for two or three weeks. If the face should be very livid and swollen, during the fits of coughing, if any vessel give way, or the patient be plethoric, and more than two or three years old, or should be hot between the paroxysms, a little blood ought to be taken away, (which is sometimes inexpressi­bly useful) and a saline draught be admini­stered, every six or eight hours, till the fe­ver shall disappear. Otherwise, if none of these symptoms attend, bleeding does not seem, in general, to be indicated, but may rather have a tendency to protract the dis­ease, by increasing the spasmodic disposition, and by weakening the patient.

If there be an inclination to vomit, it ought to be encouraged, unless the phlegm be brought up with great ease in almost eve­ry fit of coughing, in which case, nature seems able to accomplish the business her­self [Page 188] and it will then oftentimes be sufficient to keep the body open by the mildest laxa­tive medicines. But it very rarely happens, unless in infants at the breast, that some kind of emetic is not necessary in the first stage of the complaint. The disease, indeed, ve­ry frequently requires no other medicine, for such usually keep the body open at the same time, which it ought always to be, but not to such a degree as to weaken the pa­tient. For this purpose, perhaps, wine of antimony may be as proper as any thing, when it answers the end, but it is less cer­tain than tartarisated antimony, and is not always, I think, of the same strength. The latter is also rather tasteless, and will there­fore have an advantage over every other medicine, when we are prescribing for chil­dren. Two grains of this in two ounces of water, with the addition of a little sugar, is a medicine to which children will never make any objection. From one to two tea-spoonfuls, given to a child of a year old, (varying the dose according to the age) will in general, act sufficiently; and may be gi­ven upon an empty stomach, every day, or every other morning, according to the strength of the child, and violence of the disease. If the cough should happen to be more violent at any particular time, the emetic should be given a little before the paroxysm is expected. Or perhaps a still [Page 189] better method, at least in some cases, and particularly in very young children, is, to give the tartarisated antimony in smaller do­ses, together with a few grains of magnesia, or prepared oyster-shell powder, (according to the state of the bowels) three or four times a day, so as to keep the stomach in an irritable state, as shall secure a gentle pu­king every time the fits of coughing come on. But in whatever way this medicine be directed, it will prove of no service if it does not vomit, and must therefore be given in a dose suitable to the strength of the stomach, which is exceedingly various, not only at different ages, but in children of the same age, and of the same apparent habit of bo­dy. If the tartarisated antimony has any advantage of the wine, it has much more over every other emetic I have made use of, the ipecacuanha, and oxymel of squills, be­ing exceedingly unpleasant, and the latter likewise uncertain.

Such a plan is all that will be necessary in the common hooping-cough; but it has been said, there are many cases which will require other means, and demand all the skill of the experienced physican. The cough, for instance, will somtimes increase not only for days, but for weeks together, and the strangulation be exceedingly alarm­ing. In this case, the milk of gum ammo­niacum, but especially asa foetida, frequently [Page 190] proves a sovereign remedy, and though ex­ceedingly nauseous, many children will take it tolerably well for the short time it appears to be absolutely required; and when they will not, it may be administered by way of clyster, dissolved in two or three spoonsful of penny-royal, or common water. These medicines, however, will be improper in the very advanced stage of the disease, when attended with hectic heat, hemorrhage, or other phthysical symptoms; a caution equally necessary in regard to the bark, which in the absence of these symptoms, and after the stomach and bowels have been well cleansed, is frequently very useful at the lat­ter stage of the disease, when the patient has been exhausted by its long continuance. Upon the same plan with the afa [...]oetida, camphor and castor are frequently benefici­al, and have the advantage of being less nauseous, but I think are proportionably less powerful. I take no notice of tincture of cantharides, though strongly recommended by some writers, because I have had no ex­perience of it myself, and indeed have never sound any necessity for trying it.

It will sometimes be of no small service, to rub the hands, and the soles of the feet, with the compound spirit of ammonia, se­veral times in the day; or the spine of the back, and the pit of the stomach, with oil of mace, (so called) or oil of amber; but [Page 191] as the smell of the latter is very unpleasant, it may be dispensed with where the spasms are not exceedingly urgent. But when they are so, this oil is sometimes very use­ful, particularly when administered inter­nally, and children of three or four years will often take a few drops of it very well, mixed in a spoon with a little brown sugar; from which I have seen as evident advan­tages, as from any medicine whatever. In a little child of my own, it immediately gave a turn to the complaint in the most violent hooping cough I ever met with, and after almost every other medicine had been tried to no purpose; so that from the hour she took it, the complaint was no longer alarming, nor tedious of cure. But frequently, no antispasmodic is equal to opi­um, in this, as well as in other diseases. With this view, two or three drops of la [...] ­danum, and, to younger children a small tea-spoonful of syrup of white poppies, or to grown people from five to ten grains of the pilula è styrace, taken at bed-time, will not only quiet the cough, and remove the strangulation during its operation, and pro­cure the patient some rest, by which the strength will be recruited, but in many cases, seems to have a kindly operation on the disease itself. It is in this way, I doubt not, that the cicuta once seemed to gain some reputation, but I believe, it is no [Page 192] otherwise a remedy for it than an anodyne. From a mistake, however, in this respect, the strong manner in which this medicine has been recommended by Dr. Butter, has certainly done harm; as I have known ma­ny people depend solely upon it in very bad cases, to the exclusion of other remedies evidently indicated, which would, at least, have shortened the disease.

If obstructions in the lungs be suspected, blisters should be applied, and recourse had to gently deobstruent medicines; but at this period, the cure is chiefly to be accom­plished by a vegetable and milk diet, (espe­cially asses milk) pure air, and gentle exer­cise.

The cough after having disappeared for a week or more, is sometimes found to re­turn with great violence, especially upon taking cold; but a gentle purge or two, a vomit, and abstaining from heavy food, ge­neral remove it in a very short time. If these cautions should be neglected, the cough will often prove extreme tedious.

The only thing that remains to be spoken of, is the proper diet, which for children even of five or six years of age, ought to be little more than milk and broths. These are easily digested, and will afford them much more good nourishment than any kind of meats, and will sit much lighter on the sto­mach than puddings, or pastry, the latter [Page 193] of which is exceedingly injurious. The objection made by old nurses against milk, that it breeds phlegm, is utterly founded in a gross mistake that cannot be too frequent­ly controverted. It has, indeed, been some­times mentioned by a certain class of me­dical people, but the objection is so unphi­losophical and unlike objections of think­ing men, that it scarcely deserves a reply. Should the milk, however, be found to curdle remarkably soon on the stomach, a little common salt, Castile soap, or testace­ous powder, may be added to it occasional­ly; or where it can be afforded, asses milk may be substituted for cow's. These light nourishments soon pass out of the stomach, or if brought up by coughing fifty times in the day, (as I have known them to be) a child of four, or five years old, will immediately take more of them with avidity, and will be better supplied in this way, I mean by taking a tea-cupful at a time, than by making set meals, or taking a large quantity at once. If the child should be thirsty, a little apple-water, toast and water, and other thin drinks, will be pleasant and useful. Patients treated in this way, will get through the complaint, if not severe, in a very short time; and where it proves violent, a child will struggle through this long disease without any considerable loss of strength, or will be very soon re­cruited by a decoction, or cold infusion of [Page 194] the bark, together with gentle exercise, and a little country air, the best restoratives af­ter every kind of disease. Such at least has been my own experience in this tiresome com­plaint, by which I know parents are usually as much alarmed as by any incident to child­hood. But unless it has been long neglect­ed, or taken place in the month, I have ne­ver experienced it to be fatal, and then on­ly in one instance, though I have known eight or nine children in a family labouring under it at a time; and I wish to mention this as an occasion of consolation to those who may have been led to think more for­midably of it.

SPASMODIC-COUGH.

VERY much a-kin to the former com­plaint, is a trouble some cough, proper­ly enough denominated spasmodic, or convul­sive. In a certain state of the air it is sometimes epidemic, and young children, and even infants in the month, are then attacked by it, as well as adults. The irritation seems to be about the larynx, (or superior parts of the throat) or only a very little lower down, and is very distressing, at the time of coughing; but the patient, though an infant, seems imme­diately afterwards to be quiet and comforta­ble. This cough is not usually attended with fever, nor other ordinary symptoms [Page 195] a common cold, nor is it to be relieved by the like means; the cough remaining dry and hoarse under the use of pectoral reme­dies.

Children of four or five years old may be cured by the cicuta, and gentle laxative re­medies; but the former being less adapted to infants in the month, such may take a few drops [...] syrup of white poppies, three or four times a day, and their bowels be carefully kept open; which means seldom fail of removing the complaint in three or four days.—Should the syrup constipate the bowels, or otherwise disagree, Bates's Sp. Sal [...] ammmon. succinat. may be tried in its stead; which is a good medicine in other dry convulsive coughs, where there is no fever.

THE CROUP.

THE Croup, or acute asthma, is a com­plaint somewhat similar to the two for­mer, to which, perhaps, children only are liable, called therefore asthma infantum spas­modicum; also suffocatio stridula. ^* It rare­ly atttacks those who have arrived to the age of ten or twelve years, and chiefly seizes in­fants newly weaned; at which period it is [Page 196] the most severe. Dr. Millar is, perhaps, the first person in this country who has writ­ten particularly on this complaint; but it has been mentioned by some German wri­ters, and well described by them long be­fore it was noticed in Britain.

Remote causes of this disease may possi­bly be the lax fibre of children, the abun­dance of moist humours natural to them, and the vast secretion from the bronchial, or air vessels; and perhaps the change of food from milk, which is easily assimulated, to one requiring more digestion.

The prophylaxis, or mean of prevention, is the same as in most other diseases pecu­liar to children. If this complaint arise from the laxity of their solids, the quality of their food, and the natural weakness of their or­gans of digestion, the general means of pre­vention, as well as of cure, will be readily indicated.—Their food should be such as may be easily digested, and may prove nou­rishing. A due proportion of milk and broth,^* taken separately, whilst children are very young, or light meats when they become older; good air and exercise, and a careful attention to the state of their bow­els.

[Page 197] The proximate cause of this complaint is a morbid secretion of a viscid mucus in the trachea, adhering so firmly to its sides as to impede respiration. The quantity and vis­cid [...]y increasing, gradually lessens the dia­meter of the wind-pipe, and if it effect this to a considerable degree, the disease must necessarily prove fatal.

The Symptoms of this complaint are spas­modic, being such as would be produced by any other matter constantly irritating the trachea, and diminishing its diameter. They will therefore very much resemble those of the nervous asthma, but the complaint dif­fers materially from the common spasmodic asthma of adults, in the peculiar croaking noise made in respiration, (from whence it has its name) and in the violence of the pa­roxysms; which, however, leave no appa­rent indisposition, save a certain dulness, and a sense of fear, in children capable of ex­pressing it. The fits frequently terminate by sneezing, coughing, or vomiting, and return without any regularity. It is attend­ed with a quick pulse, laborious breathing, a sharp, and shrill voice, and a flushed countenance, which grows livid during the paroxysms, or fits.

The disorder is probably inflammatory in the beginning; and though this period seems to be very short, yet should the phy­sician be consulted as soon as the disorder [Page 198] might be ascertained, both emetics and bleeding might be useful; but after the croup, as well as difficult respiration have thoroughly taken place, it would be im­proper to have recourse to any debilitating means.

It does not always seem to be an original disease; being sometimes a consequence of bad fevers, and of some chronical disorders that have reduced the patient's strength. It frequently appears to arise from the same causes as the malignant sore throat, only having its seat lower down, and is therefore more dangerous. And it has, in several instances, accompanied the malignant sore­throat, as may be known in the early stages of that complaint, by the croaking noise pe­culiar to the croup; and, I believe, is in such instances generally fatal.

It is divided into two principal stages; in the latter of which no method of treatment has appeared to be effectual, but medicine is never more efficacious than in the first, if the disorder be not combined with some other, and it be taken in time, though the crouping may be very considerable. This I saw remarkably exemplified in a little boy of my own, who was nearly cured in two days.

The sovereign remedy seems to be asafoe­tida, which ought to be administered both by the mouth and in clysters, according to [Page 199] the exigency of the complaint; and in the first instance, before any marked inflamma­tion has taken place, may be given very freely. Antecedently to this, however, it may often be prudent to apply a leech or two to the throat, especially if there be any per­ceptible fulness of that part, and a blister to the nape of the neck. At the close of the complaint, and to prevent a relapse, the bark proves highly serviceable, and will al­so restore the strength of the patient; re­turning, however, to the asafoetida, if there should be any threatening symptom of the asthmatic affection, which is not un­common. Should a patient suffer two or more relapses, to which a moist air will pe­culiarly expose him, some discharge, by a blister, or issue, ought to be procured, and continued at least for some months.

The French writers depend much upon emetics, and afterwards lenient purges; and to prevent a return, advise aperitives, sto­machics and tonics, particularly prepara­tions of steel, and natural chalybeate wa­ters.

I have examined the trachea after death in only one patient, in which I found the precise appearances described by Dr. Mil­lar; the wind-pipe being lined by a tough viscid coat, so as mechanically to close up the passage.

RICKETS.

THIS is a late disorder in Europe: As­truc observes that England is said to be the part in which it first made its appearance, and that it was then described by Glisson and Mayow; but he thinks it probable, that it appeared at the same season over all Europe, through the coldness of the wea­ther. It was named rachites, from the Greek, implying that the spina dorsi is par­ticularly affected by it;^* though it rarely attacks the spine till the disorder is far ad­vanced.

It was first noticed in the western parts of England,^† about the year 1628,^§ and is [Page 201] said to have taken place upon the increase of manufactures, when people left the vil­lages and husbandry, to settle in large ma­nufacturing towns; where they wanted that exercise, and pure air, which they had enjoyed in their former situation, and em­ployments.

It may therefore frequently arise from un­healthy parents, especially from mothers who pass too sedentary a life in a bad air, and feed upon a weak and watery diet: from children's food being weak, watery, or too viscid to be properly digested; but above all, perhaps, from bad nursing, and the child's being left wet, dirty, or exposed to a cold moist air,^* without sufficient cover­ing; from want of proper exercise, and from close and crouded apartments. Or lastly, from the habit of body being reduc­ed by the long continuance of almost any of the complaints hitherto considered.

The usual symptoms of rickets are soft flesh; bloated, or very florid countenance; weakness; dislike to motion; with enlarge­ment of the belly, head, and joints. The wrists and ankles enlarge first, afterwards the back, and breast-bones; and indeed all the bones swell and become soft, especially [Page 202] the more spongy ones. The pulse is quick, and feeble, and the appetite and digestion usually bad. Teething is commonly late, though not frequently difficult, but the teeth often rot early, and fall out. Great acuteness of mind has been observed, in this, and some other chronical complaints. It seldom attacks children before they are six months old, or above two years.

As it appears to arise from a general weakness and relaxation, the indications of Cure are to brace and strengthen the solids, and to promote digestion, and the formation of good chyle. These ends will be promo­ted by wholesome food, suited to the age; good bread, or biscuit; dry food; and roasted meats, rather than boiled; with a little red Port wine. Should the child be too young to eat flesh meats, its diet ought to be chiefly of rice, millet, pearl-barley, salep, and semolina, with spices, if it be not inclined to be feverish. It must also have good nursing, and especially exercise and air, without being kept too hot or too cold: without a very strict attention to these, medicine can be of but little service. If the child is of a gross habit, the eighth part, or a quarter, of a grain, of ipecacuanha pow­der, taken once or twice a day; gentle pukes, and very brisk purges, especially of the powder of scammony with calomel prove of use. In such habits, all foundation of a [Page 203] cure must be laid in reducing the belly to its proper size, and [...]n strengthening the stomach. If rather delicate, the cold-bath is often of more service than any thing else: but this should not be entered upon in win­ter, nor without previous purging. Fric­tions afterwards with flannel and aromatic powders, or the fumes of frankincense, mastic or amber, especially on the back and belly, will farther tend to strengthen the ha­bit. Besides these, may be given the cold infusion of bark, and other bitters, or small doses of the martial flowers, or the vinum ferri; but a good diet, air, and exercise, especially riding on horse-back, are of the utmost consequence, and if duly persevered in, will often effect wonders. This is one of those chronical or lingering complaints which seem to be gotten the better of by time, and like the following one, wears it­self out, as it were, (if the vital parts do not happen to be affected) and to which the abovementioned means will greatly contri­bute—Saepe Pertinacia Juvantis, Malum Corporis vi [...]it. CELSUS.

SCROFULA, or KING's EVIL.

THIS is primarily a glandular disease, though in its progress it attacks the adipose membrane, the eyes, the muscles, tendons, and even the bones themselves, especially the joints. It seldom makes its appearance before two years of age, nor later than ten or twelve, (except it be in re­gard to affections of the eyes) though there are a few exceptions in regard to the latter period, and it then often proves fatal, by falling on the lungs, or other noble part. It is frequently observed to follow other dis­orders, particularly the small-pox, whether taken naturally or from inoculation, but more especially the former; also the hoop­ing-cough, measles, teething, rickets; and many other disorders already mentioned. Hence, the nature of this disease is better understood, as it so often falls upon weak and tender habits, either originally of a lax fibre, or worn out by previous diseases; or is gradually brought on by a heavy, indiges­tible, and bad diet, or a low, wet, and un­healthy situation. It is, however, some­times found to be hereditary, but will very frequently lie dormant for two or three ge­nerations, and afterwards appear with re­doubled violence. It is often attended, or [Page 205] rather preceded, with a peculiar look about the eyes, which are generally large, and a thickness of the upper lip; and sometimes proves a source of ill-health through life, but is not usually fatal in the first instance. Long before the external glands become af­fected, especially in young subjects, the bel­ly is observed to be hard and enlarged, and after death, the mesenteric glands, and even the pancreas have been found diseased.

Though this is a very unpleasant com­plaint, and one that does not often admit of much relief, yet it frequently disappears at the time of puberty (and sometimes sooner) especially in females; but whether this be owing to the increased strength of the so­lids, or to other changes in the habit, na­turally happening at that period, is not an inquiry proper for this place.

Although I thought it necessary to men­tion this disease amongst others to which the state of childhood is liable, I am sensi­ble how difficult it would be to point out any thing like an adequate remedy. At its first appearance, however, bitter, or mer­curial purges, are sometimes of use, as are also antimonial vomits, and sometimes sapo­naceous medicines. But when the disease is confirmed, lime-water, and decoctions of the woods, together with crude antimony, bark, and steel, with wine, and a generous diet, are, I believe, most to be depended [Page 206] upon as internal remedies; from some of which, I have seen no inconsiderable cures effected. But in this, as in other chronical complaints, good air and exercise are of the greatest importance. Indeed, the ad­vantage of exercise in this disease is so great, that I wish to lay a very great stress on it. But then it must be daily had recourse to, and, by degrees, be so considerable, as to render the patient every night sensibly fa­tigued. Thus, I have known riding behind a carriage, (as I have noticed in another work), almost without the aid of any medi­cine, entirely remove the complaint.

When there are external tumors, I am satisfied that the opinion I have already giv­en to the public, in a larger tract on this complaint, is both rational and safe; and that whenever they are at all disposed to come forward, they ought to be brought to as speedy a suppuration as is possible, and be treated as I have there recommend­ed. The scrofulous virus when thrown on the surface, so far resembles the cancerous, according to the description of the ingenious Mr. Hunter, that it is inclined to spread to a considerable extent; but as tumors of the former class will bear rougher treatment than the latter, I am confident that much benefit may arise from the use of external stimulants, by stopping the progress of the disorder in the neighbouring parts, as well [Page 207] as by invigorating them, and thereby dis­posing the ulcers to heal. Also light fricti­ons with mercury, so as to make it pass free­ly through the lymphatics of the distemper­ed parts, without affecting the system, have in a course of time been beneficial, and de­serve to be brought into a more general practice than they have hitherto been.

I have lately had farther reason to be confirmed in the above opinion respecting stimuli, from observations communicated to me by Mr. Partington, who since the hints I threw out in the afore-mentioned work, has made use of electricity with very good effects, in these, as well as other cold tu­mors and ulcers I had mentioned; which have all healed very kindly, in consequence of this stimulus to the parts. When scro­fulous ulcers have been healed, and only some small tumors remain, I have experi­enced very good effects from the external use of as strong a solution of camphor in oil of almonds as can be made, which has dispersed them very soon; and I have found it the best remedy, and a very successful one, in the cure of the incipient broncho­cele, though enlarged to the size of a tur­key's egg; and requires only to be very well rubbed into the parts, three times a-day. The patient should at the same time take a dram or two of the tartarisated na­tron every morning.—I shall only add, on [Page 208] the head of scrofula, what is very well known, that sea-bathing, alone, sometimes effects a perfect cure. Should the child therefore have several scrofulous tumors, or the habit be conceived to be much af­fected, trial should be made of the sea, in whatever manner it may be determined the tumors shall be treated, if not dispersed by sea-bathing.

HYDROCEPHALUS, or WATERY-HEAD.

THIS complaint is distinguished into the the external, and internal; in the for­mer, the water lies upon the surface of the brain, over the pia mater, but in the latter it is seated much deeper, within the ventri­cles. The external makes its appearance at, or it is said, in some instances, soon after birth. But children with hydrocephalus ex­ternus are more commonly still-born, though I have known one arrive to ten years of age,^* who was then unable to walk, or even to sit upright in a chair. From a very re­cent instance, however, I have learned, that when no symptoms of hydrocephalus ap­pear [Page 209] at the birth, the water is sometimes, at least, contained within the ventricles of the brain: and from the circumstance of no children living long with an internal hydro­cephalus, but such whose heads enlarge within a few months after birth, I should suspect the disorder has, in such instances, taken place in the womb. The foetus, at this time, enjoying only a kind of ve­getative life, may arrive to maturity under such a disease; various instances being met with, in which full grown foetuses have had neither head, nor heart, nor lungs. Accus­tomed to the above-mentioned disease, we may presume such infants more likely to live for a certain time with water in the ven­tricles, than those in whom the disease takes place suddenly, after birth.

In the instance alluded to, the child's head began to be sensibly enlarged when the in­fant was about four months old, and the child lived to the fifth year, unable to walk, or even to support its head. Upon a care­ful examination of the parts after death, the water, to the quantity of three pints, as I am informed by the surgeon, was evi­dently contained within the ventricles: which were so stretched as to compress the brain in such a manner, that it appeared on­ly like a smooth thick membrane within the dura mater; and of all the solid contents of [Page 210] the skull, scarce any thing but the cerebel­lum remained.

The external hydrocephalus, at whatever period it may commence, has always been esteemed a fatal, as well as most distressing complaint; but I have been informed, that where the disorder has not been very mani­fest at the birth, blisters on the head have sensibly diminished its size. These should be applied, successively, to different parts, especially along the top of the head, in the course of the longitudinal sinus, so as to keep up a constant discharge; which from the good effects in two or three cases, when had recourse to in good time, may possibly, in some instances, effect a perfect cure: at least, the advantages already observed are sufficient to justify the attempt, in a disorder hitherto esteemed incurable.

Of the internal watery-head it may be proper to treat more largely, though I have nothing really new to offer in regard to the cure. It usually takes place between the age of two and ten years; is a like melan­choly complaint with the former, and the method of treatment not yet well establish­ed; and as it can hardly be ascertained whe­ther any have recovered from it, (the cer­tainty of its existence scarcely being known but by examination after death,) it is not likely that a very determined, and success­ful treatment will shortly be settled. It may [Page 211] probably arise from falls and blows on the head, or from an original laxity of the brain; from chirrhous tumors and excrescences within the skull; a watery state of the blood, or a lingering illness. It appears, likewise, to be a family complaint in some instances; for I have known six children, born of the same parents, die successively of it at the age of two years, five of whom were afterwards opened.

The attack is sometimes very sudden; but the complaint more commonly begins with the appearances of slow fever, especially in older children, with debility of the arms, and pains in the limbs, especially the upper part of the neck. After a while, the child is suddenly seized with pain in the fore part of the head, and retches: It becomes heavy and dull; can bear no posture but that of lying horizontally; the pulse becomes irre­gular, but usually very slow; in the pro­gress of the disease the faculties and senses are impaired, and the eyes are offended by the light; the patient sees objects double, and becomes delirious. As the disease ad­vances, the pulse grows frequent, the cheeks become flushed, the pupils of the eyes are dilated, the stools and urine come away in­voluntarily, and the patient lies sleeping, or is convulsed.

In the youngest subjects, I have known it begin with a cough, quick pulse, and [Page 212] difficulty of breathing, attended with cir­cumscribed flushed cheeks as in teething, occurring on every little exertion, with con­tinual fever and costiveness; and sometimes a discharge from the nose and eyes.

Symptoms indicative of the disease at this age, are, a hand often put to the head, or lifted upwards, and waving about; vomit­ings; costiveness; expression of anxiety, and dislike to be moved: at other times, an unmeaning look, and marks of insensibi­lity; the fingers often clinched, and hands tumid; drowsiness; the eyes in some cases impatient of light, in others, vision is so imperfect, that the child does not regard any object however close to them. The pupils are often not dilated till near the close of the disease, and patients often hear and comprehend, and take food to the last, and die suddenly upon the decline of the febrile symptoms, when they have been thought to be recovering. These and other symp­toms, however, laid down as indications of water in the brain, are, in some degree, common to other diseases of children, espe­cialy the dilatation of the pupil, and sleepi­ness, in fevers arising from fowl bowels.

For these reasons, it is difficult to say if medicines are so often successful as hath sometimes been imagined; for when a pa­tient recovers, it may be suspected he has not had the true disease. Practitioners seem [Page 213] chiefly to have depended upon repeated bleedings; purges with jalap, or calomel; blisters to the neck or head, and diuretic medicines. A large bleeding early in the disease I have thought very beneficial, espe­cially in children of a robust habit. The use of sternutatories, as powder of asarum, or white hellebore, and electricity, have likewise ben recommended by some experi­enced practitioners; to all which I would add the application of a narrow caustic, the whole length of the head, in the course of the longitudinal sinus, instead of trusting to a small blister on the crown.

Though I have made mention of calomel, I cannot say I have seen any good effects from the use of mercury, either as a purge or an alterative; and on that account shall not enlarge on the different manner of ex­hibiting it with either of these views It has, however, been strongly recommended by Drs. Dobson, John Hunter, Haygarth, Mosely, and Dr. Armstrong; but I am in­formed by other physicians of eminence, that they have not been so successful in the use of it; and some good arguments have lately been advanced against an indiscrimi­nate recourse to it, by Dr. John Warren; who advises trial to be made of emetics.

INCONTINENCE of URINE.

THIS is not a very common complaint, I believe, in children, unless combin­ed with the stone in the bladder, and then is not so constant, nor to the degree that is intended here. It is an involuntary flow of the urine, sometimes by day as well as du­ring the night; arising, I apprehend, from a relaxation or other affection of the Sphinc­ter of the bladder, as in old people, but is not attended with manifest fever, nor symp­toms of decay. An affection of this kind, in which the urine runs away in the sleep only, is perhaps, more common; and I have known it continue to the age of fifteen or sixteen years when not properly treated, and after­wards yield to sea-bathing. The total in­continence generally comes on gradually, and is sometimes attended with excessive gonor­rhae, even in very young children.

Tincture of catechu, or of gum kino; the bark; balsam-copaibae, and white vitriol may be made trial of; but nothing is usually so effectual as repeated blisters applied over the os sacrum, or lower part of the back; and proper doses of the tinctura cantharidis. This may be given in doses of ten or fifteen drops to children from five to ten years of age, and increased to two scruples and a [Page 215] dram; which has general removed the com­plaint if there has been no morbid affection of the spine, as is sometimes the case. If these means should fail, recourse should be had to sea-bathing.

THE SEVEN-DAYS-DISEASE, &c.

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

§ 19. The disease of seven days of new­born infants is common in both quarters of America, and equally dangerous in the high, as in the low parts. A great number of in­fants die of it, without any thing preceding that could occasion it to be suspected. They [Page 216] are, on the contrary, apparently healthy and robust, when the disorder makes its at­tack in the form of epilepsy; and few of those who are visited with it are found to re­cover. Though this complaint is not alto­gether unknown in Europe, it is neither so common, nor so dangerous. It is conceiv­ed, that the best preventative were to guard infants from being exposed to the wind, till the first seven days are over.

§ 20. But infants at Guaneavelica are still liable to another very extraordinary com­plaint. Having escaped the seven-days-dis­ease, they thrive well until the third or fourth month; they are then seized with cough and pulmonic affections, which they call pecheguera. The complaint goes on in­creasing without any sensible relief from the medicines made use of; and a swelling tak­ing place, they presently die. The disor­der attacks only the white people, or chil­dren of the Spaniards; the Indians and the mongrels are not subject to it. The way to escape it, is to remove the infants from the spot, before they are two months old, and to carry them to more favourable climates, into one of the Zuebrades, (or the low grounds between the mountains) that are at a little distance. It is imagined, that the cold and intemperature of the climate is the occasion of infants being so soon seized with this complaint. This may be the case in [Page 217] some degree: but the vitiated habit of bo­dy of their parents, and the sulphureous va­pours continually issuing from the furnaces for the extraction of mercury, may likewise contribute to it. In fact, these vapours are so abundant, that when reunited by means of the cold, they form such a thick cloud in the atmosphere, during the season there called summer, as to cover all the colony. Notic. American. Disc. II. p. 205. L.

TINEA, or SCALD-HEAD.

THE Scald-head is a very troublesome complaint, and is said to be often a scrofulous symptom; but I rather think it is usually communicated by contact, and when lighting on a scrofulous habit may be more difficult of cure. I have never met with it in infants, but it being no uncom­mon complaint in the later periods of child­hood, it may be proper to notice it, as it sometimes proves a very tedious disease. I hope, however, to point out a successful method of cure, the unpleasantness of which has, improperly I think, prevented its be­ing more generally adopted.

From some considerable experience, I may venture [...]o say, that being usually a mere complaint of the skin, it may be most successfully [...]reated by outward applications. This disease is seated in the little glands at the roots of the hair, is sometimes dry, but at others moi [...], and then produces little ul­cers, [Page 223] which being thoroughly cleansed, and made to digest, may be safely healed up, as I have found in many other affections of the skin.

It is not uncommon, I know, to admini­nister a variety of internal remedies, and perhaps they may sometimes be required, though I think I have seldom given any thing more than lime-water, or a decoction of the woods; and a few purges at the de­cline of the disease.

If the complaint be taken early, before it has spread far over the head, and whilst the scabby patches are small and distinct, [...] may be frequently cured by the sulphur ointment, with a small addition of the calx hydrargyri alba. And such a preparation may very safely be made use of, if the pa­tient be kept within doors, and his body be properly open; as it will be necessary to rub in only a small portion, one or twice a day, on the parts immediately affected. But if the disease should spread, or has already extended itself over a great part of the head, the hair must be shaved off, and the head washed twice a day with a strong de­coction of tobacco; repeating this process till the scabs disappear, and the hair grows up from the parts they had occupied. Or, instead of the decoction of tobacco, the head may be well washed with the lotio sa­ponacea, with the addition of a small quan­tity [Page 224] of the aqua kali puri, and the scabs anointed with the unguent▪ hydrargyri nitra­ti in the place of the sulphur ointment and calx of mercury; the former being a very powerful, as well as a safe application, and may be used in any quantity that may be ne­cessary.

But the complaint is sometimes of long standing before medical assistance is asked, and is not only extended over all the head, but the scabs are thick, and rise high above the surface, returning as often as they may fall off. I have, however, never failed to cure the common tinea by a method perhaps well known, but too seldom complied with in time, on account of its apparent severity. It consists only in well washing the head with a piece of flannel, and a strong lather of soap-suds, after it has been close shaved, and then rubbing in very forcibly the com­mon unguentum picae and a good quantity of the pulvis ellebor. alb. or other safe de­pilatory, for near an hour at a time, always using it very warm; and covering the head with a bladder to preserve the ointment on the part, as well as to keep it from sticking to the cap, or other covering made use of. When this has been done three or four times, not only the scabs, but the hairs will also loosen, which must be pulled out, however unpleasant the operation may be; [Page 225] as it will, indeed, prove a kindness in the end: but must be repeated till all the hairs be taken out, after which new hair will rise free from scabs, which is a sufficient indi­cation that the disorder is effectually re­moved.

There is, however, a spurious kind of scald-head, that is sometimes more difficult of cure; but it requires nothing but pati­ence in the use of one or more of the above remedies, or at most, an alterative plan of the flour of sulphur, or of some mild mer­curial preparation, with the common decoc­tion of the woods, or the Lisbon diet-drink. Or, should the difficulty consist in getting out the hair entirely, or destroying the dis­eased glands at its roots, the calx viva may be had recourse to, in one form or other; and is exceedingly preferable to an adhe­sive pitch-plaister. In a few instances, the topical use of the unguent. hydrargyri miti­us has a wonderful efficacy.—In the spuri­ous tinea particularly, it may be proper to open an issue, or fix a seton in the nape of the neck.

HERPES MILIARIS, or SHINGLES; (RINGWORM.)

THE Herpes miliaris, and the Shingles are distinguished by some writers, but I can see no good reason for it; and M. [Page 226] Aurelius Severinus and others, have esteemed them to be the same disorder.

The Herpes, like the foregoing complaint, is a disease of the skin, infesting some chil­dren almost annually, and appearing in dry scurfy blotches, on different parts of the body, and usually of a circular form. It becomes troublesome chiefly from the vio­lent itching that constantly attends it, and would probably get well of itself: it even sometimes has the appearance of being cri­tical, or is, perhaps, rather an indication of some favorable change in valetudinarians, especially in adults, who are sometimes found getting the better of chronical complaints at the time the shingles makes its appearance. It is, however, often a blemish; as it fre­quently attacks the hands and face, and especially the forehead. It is amongst the vulgar errors, I believe, that when it ap­pears on the breast or loins, if it should ex­tend round the whole body, it would prove fatal—This form of the disease is termed Zona herpetica.

The Herpes miliaris is also by many dis­tinguished from the ring-worm, (but per­haps needlessly); the former being always supposed to arise from an affection of the system, and to be preceded by shivering, or sickness at the stomach. They are cer­tainly both very easily cured, and probably would alike disappear of themselves. The [Page 227] Herpes yields very readily to stimulating and astringent remedies. Ink, therefore, as (as it contains an infusion of galls) has been a common, though inelegant application, and may serve very well where better forms are not at hand: it is sometimes made into a paste with the flower of mustard. Spirit of wine; saturnine lotions, with the addi­tion of vinegar, or white vitriol; and oint­ments containing lead, answer very well; or an ointment of calcined zinc and lard: but the ung. hydrarg. nitrati is preferable to most others: The use of a flesh-brush is a good prophylactic, or preventive, in habits accustomed to the complaint.

Should the shingles spread and become sore, it should be treated as directed below.

HERPES EXEDENS, or SERPIGO.

THIS is a malignant species of the above complaint, but is generally local. It is mentioned only as having relation to the former, being rather a sore than an erup­tion, and not very common in children.

Suppurative applications may be made use of in the early stage of the complaint, such as ointments of minium, soap, and Venice turpentine, or a suppurative poultice, in or­der to liberate the diseased glands on the surface, and absorb the acrid discharge. [Page 228] After this, the parts should be washed with saponaceous lotions, and lastly, with strong solutions of vitriol. Should these fail, the ung. hydrarg. nitrati will be proper, and as the last remedy, caustic applications; of which, butter of antimony is the best, with which the little ulcers may be touched light­ly from time to time. The patient may take at the same time of a decoction of burdock-roots, or sarsaparilla.

SCABIES or ITCH.

THIS disorder so commonly known and easy of treatment, is mentioned only to introduce a caution to some readers, against popular washes and girdles; which are generally either useless or hazardous. Such are often had recourse to in order to avoid the unpleasant smell of the brimstone ointment; which, however, rarely fails to cure the genuine itch. There is, indeed, a spurious kind, as of the scald-head, which is far less, or often not at all contagious, but is more difficult of cure than the genu­ine. Should the brimstone ointment there­fore fail, sulphur should be administered in­wardly, and sometimes mercurials; which may likewise be added to the ointment, and in a few weeks, at most, will not fail of re­moving the complaint. It is common to administer at the same time some alterative diet-drink.

OPHTHALMIA, or INFLAMMATION of the EYES.

THE Eyes of new-born infants are very apt to be inflamed during the first three or four days after birth, especially in the winter season. If it be owing to taking cold, it is probable it has been either im­mediately after the child was born, before it has been given away to the nurse, or very soon afterwards; and on this account, a flannel cap becomes a very necessary part of its covering before it can be formally dressed.

This kind of inflammation, however, is usually of very little consequence, and ge­nerally disappears of itself, upon merely keeping the head warm, or by washing the eyes with a little rose-water, to two ounces of which, in some cases, two or three drops of the water of acetated litharge, and a grain or two of white vitriol, may be added. But there is an inflammation to which in­fants are liable, that sometimes continues a long while, and therefore calls for attention. I do not allude to that redness on the eye, known by the name of sugillation, or blood­shot, which will often remain a long time, return, and disappear again, without the least injury to the child; nor to the watery-eye, [Page 230] which will sometimes continue for ma­ny months, and even for years. But that which I here intend, is accompanied with the true appearances of op [...]thalmia, or in­flammation of the white of the eye, attend­ed with a discharge as in the ophthalmia of adults: it will sometimes get a little better by common means, but seldom remains so for many days together, and generally in­creases at the end of the month.—It often seems connected with the state of the bow­els, and the coming on of a purging will fre­quently cur [...] it.

I have nothing out of the common way to recommend for it;^* nor does it need much to be done, unless it be unusually te­dious: in which case, the parts behind the ears should be made sore, in the way I have before described, and be kept so for some time. Previous to this, it is often necessa­ry to apply a blister to the back, and a leech to one or both temples; to keep the body open, and to make use of the cooling eye-water before recommended. If the child be inclined to a frequent return of it for years, as I have known in very healthy children, it will sometimes degenerate into what is termed the watery-eye; an excellent reme­dy for which is a grain of white vitriol, [Page 231] mixed with as much fresh butter as will form it into a liniment, which should be put into the inner angle of the eye every night, at going to bed. In some of these cases, however, the ointment of nitrated quick-sil­ver has proved a more speedy remedy, and is a less painful application.

But there is a far more formidable in­flammation, which has of late years been called the purulent ophthalmy, distinguished from every other, by the vast quantity of thick matter discharged, and great swelling of the lids.

This is so dangerous an inflammation as to require the best advice on its very first appearance. It frequently seizes an infant a few days after birth, without any previous complaint; and sometimes not only destroys the sight, but dissolves the eye itself, in less than a week's time. I have likewise seen it exceedingly violent in children of four or five years old, but rarely without some blow, or other accident.

In this disease, every thing that may re­move inflammation, and unload the vessels of the part, should be immediately had re­course to. The body should, therefore, al­ways, be kept open, and if the child be two or three years of age, leeches should be ap­plied to the temples: scarifications also of the tunica conjunctiva, (which generally falls out upon the opening of the lids); blisters [Page 232] to the back, nape of the neck, and behind the ears, are sometimes essentially necessary. The edges of the eye-lids should be kept constantly greased throughout the day, especially in infants, that the thick matter may find an easy escape. At night, a little of Go [...]lard's cerate may be spread on soft linen, and applied to the eye, and over it a very soft [...], made with the com­pound water of acetated litharge, laid on as lightly as possible; that by its constant moi­sture, the eye-lids may always be kept sup­ple. But if the discharge should seem to be confined, or the eye affected, by the weight of the poultice, this application should be changed for soft linen rage, which should be frequently wetted with cold bran­dy and water, or some yet more astringent lotion.

It should ever be remembered, that in the beginning of the complaint the taking away of blood is often not to be dispensed with, (unless the child be very young, or otherwise weak) nor to be sparingly done. The application of one leech, therefore, to the temple or neck, will have no good effect, though often repeated. Two, three, or even more, according to the age and strength of the child, should be put on at a time, and a blister soon afterwards; which will often do more to conquer the inflammation, than [Page 233] most other means put together, if had re­course to in time.

Throughout the complaint, astringent and stimulating applications are to be made use of, being not only far preferable to other means, but so necessary, that should emolli­ent poultices, and merely cooling collyria be, at any time, depended upon, the event were likely to be fatal. What may be the very best remedy, it may not be very easy to determine, having for some years succeed­ed, and in a reasonable time, by different means. But ever since I have seen Mr. Ware's excellent publication on diseases of the eyes, I have had so frequent recourse to to the aqua camphorata, as recommended by him, in this species of ophthalmy, and have succeeded so well with it, that I am not yet certain to which the decided prefer­ence should be given.

One dram of the aqua camphorata of Bate's dispensatory, to two ounces of water, will be a sufficient strength to begin with. A few drops should be instilled into the eyes, several times in the day, as well as the lids, be frequently washed with it.

The topical remedies alluded to, in the place of the aqua camphorata, are tinct. opii, and the unguentum hydrargyri nitrati, which should be applied every night at going to rest; the former being dropped into the eye after the lids have been touched with [Page 234] the ointment. It is sometimes proper to lower and soften the ointment with a little fresh butter, and to add a little camphor.

It has been said, that where this inflam­mation has not been properly treated from the beginning, the eye is sometimes exceed­ingly injured by it, so that even the eye will burst. At other times, the cornea be­comes much thickened, and the pupil more or less opake by means of one or more specks which the inflammation has occasion­ed. It should be remarked, however, that we sometimes meet with an agreeable sur­prize, at the decline of this formidable complaint, and find the eye much less in­jured than had been suspected at the time we were first able to get a sight of it. And at others, even where the cornea has burst, the aqueous humour has been restored, and being confined by the cicatrice, the patient has recovered his sight. On the other hand, the cornea has sometimes been so greatly in­jured, or the iris contracted, that though the eye has not been sunk, the sight could not be restored by any means.

From what I have known of some per­manent inflammations, I have sometimes been much inclined to the opinion of the late Dr. Hunter and others, who after having tried a variety of means, and assisted in consultation with different physicians, have been induced to think, that many of the very stubborn [Page 235] ophthalmias originate from a venereal taint, and could only be successfully treated by its specific remedy, in one form or other.—Every practitioner will be very careful how he takes up such an opinion in particular instances;^* however, it is right to observe, that if none of the means above recom­mended should produce a favourable change in eight or ten weeks, I believe nothing but that specific species of alteratives will have any lasting effect.

Though it is not my design to treat on this disease, it may not be amiss to observe, that whenever a venereal taint actually ex­ists, it is more safely treated by unction than in any other way; and infants would pro­bably be cured much oftener than they are, if recourse were had to [...] in better time than it commonly is. If internal remedies, how­ever, are for any reason preferred, I have found none so efficacious, convenient, and safe, as the late Mr. WARD's white drop.

LEUCOMA, or SPECK of the EYE.

THIS is often a consequence of long con­tinued ophthalmias, and is mentioned by Dr. Armstrong amongst the diseases of children, in his second edition. He directs a variety of things for the cure of it, which he says are often efficacious if the specks have been recently formed, but when of long standing, he has never seen any me­thod successful. I shall only observe, that in a very great number of cases, a drop or two of the aq. cupri ammon. instilled into the eye, two or three times a day, has re­moved such specks, in the course of a few months, and sometimes much sooner, with­out any other means. Should this fail, however, trial may be made of a solution of the hydrargyr. muriatus, one grain being put into four ounces of water; and the ointment of nitrated litharge be applied in the manner before recommended.

CATARACT and GUTTA SERENA.

ALTHOUGH these disorders are not ve­ry common in young children, they do, nevertheless, sometimes occur, and infants have been born with a cataract in one or [Page 237] both eyes, or totally deprived of [...]ight by the gutta serena. I shall therefore speak of the two diseases together, and the rather because the same remedies are here accom­modated to both.

It would, indeed, ill become a man of the least character and experience to affect to have much to offer in a way of remedy for these dreadful complaints; the oldest and best practitioners never having pretend­ed to be often, or by any means uniformly successful in the treatment of them. From what I have known, however, they are not to be despaired of, and I should think it unpardonable not to hold out every occa­sion of good, or of comfort in my power, however little it may be, in cases wherein art has so generally failed—Valeat quantum va­lere potest.

Where a disposition to cataract and gutta serena have been suspected, I have known very considerable benefit obtained, and even the sight fully restored by an alterative plan of calomel and cicuta, or by the long con­tinued use of an aromatic vapor with spirit. ammon. compos,^* conveyed to the eyes by means of a tube properly adapted; or by [Page 238] brushing the eyes and the adjacent parts, several times a day, with soft and smooth brushes, which are properly constructed by Messrs. Ayliffe and Gee, in Wardour-street. In the gutta serena, electricity also has cer­tainly succeeded in several cases; and in one instance, a lady whilst under such a course, suddenly recovered the perfect use of her eyes, through a blow she accidentally re­ceived on the face, which produced a copi­ous hemorrhage from the nose. In imita­tion of this, the like discharge has been lately artificially procured by wounding the internal vessels of the nostrils; but without apparent good effect. To these brief ob­servations I have only to add, that I have very lately seen a gentleman of near sixy years of age, for whom I had been consult­ed about three years before, who some time after having been let blood in the above mentioned way, and made trial of electrici­ty without apparent advantage, has reco­vered from a gutta serena of near two years standing, under the use only of a common collyrium, which as I cannot conceive to have had any share in the cure, conspires with a few similar instances to hold out ground of encouragement to other sufferers, sufficient to prevent despair, under this me­lancholy disease.

I say nothing in relation to the cure of the cataract by a surgical operation, either by [Page 239] extraction or depression, except it be, that neither of them is advisable for infants un­fortunately born with the disease, till they shall have attained to five or six years of age.

The STITHE, or ST [...]E.

THE stithe is a small inflamed tumor on the edge of the eye-lids, more common­ly on the side towards the nose; but there are sometimes two or more at a-time. It rises suddenly, as if from a cold, or blast, and in the end suppurates, or forms matter, of a thick, or cheesy consistence; often, in­deed, not for several weeks, or even months, but sometimes much sooner. It is occasi­oned by an obstruction in the glands of the eye-lids; and the matter being inclosed in a hard cyst, or bag, the inflammation often returns in the same spot, till the cyst being destroyed by repeated suppurations, the ca­vity is afterwards filled up, and the com­plaint disappears.

All that is necessary to prevent the re­turns of this temporary blemish, which greatly weaken the eye, is to touch the lit­tle abscess, as soon as it breaks, with the caustic called argentum nitratum, cut to a point, (carefully avoiding doing injury to the eye) which by destroying the cyst, at once removes the complaint.

[Page 240] When these stithes are small, or hang by a very narrow base, they may be safely cut off, or be tied very tight with a bit of silk, and afterwards touched with the caustic as before mentioned.

DEAFNESS.

CHILDREN are frequently rendered deaf, in different degrees, in one or both ears, by very slight colds, and at the expi­ration of a few days the hearing returns, without recourse to any means. It is, how­ever, sometimes otherwise, and it becomes necessary to give a little purging physic; to keep the ears warm; and to confine the child to the house: and where this does not succeed, the complaint is not a little dif­ficult of cure. Should it arise from indu­rated wax, it will be proper to syringe the ears with warm water, to which should be added a tea spoonful of lavender or honey-water; and a few drops of warmed oil of almonds may be instilled into the ears at go­ing to bed. If these little means fail, warm­er remedies should be made use of, such as the following, which I have found very fre­quently successful:

℞. Olei amygd. ℥ss Ol. Succini rectific. gtt. xx Sp [...]r. Camphorat. ʒss. Tinct. Castor. ʒj misce et instill. guttas iv vel vj cale­fact. aur. affect. nocte et mane.

[Page 241] Deafness, however, is sometimes owing to the want of a due secretion of wax, and is then much more difficult of cure. To promote this secretion a few drops of the soap-liniment, oil of almonds and aether, and such like warm acoustics should be tri­ed, and continued for some time, if they should not occasion much pain; and in all cases, blisters may be applied behind the ears. The juice of onions, or a clove of garlic, raw, or roasted, put into the ears, has sometimes restored the secretion, and removed the deafness; and in many cases it has been effected by electricity. But it not unfrequently happens, that the cause of deafness lies in the auditory nerve, and in that case, if the last-mentioned remedy fails, very little is to be expected from art. Na­ture, however, sometimes effects the cure, and children after having been deaf for se­veral years, suddenly recover their hear­ing perfectly, especially females.—Medicat­ed snuffs also that invoke gentle sneezing, and discharges from the head, have some­times been found surprisingly efficacious.

CANKER of the MOUTH.

THIS is chiefly a complaint of children, being rarely met with in adults, is often talked of by nurses, and is usually as trifling [Page 242] as any. It has, indeed, been said by some writers to prevail very much in England and Ireland, and to be often a serious complaint. Such a disorder, if it be canker, may be treated as under the next article; but the common canker is rarely troublesome to cure, except it be amongst very poor peo­ple, where a great number of children are crouded together.

It sometimes makes its appearance in the month, at others, about the time of teeth­ing; and frequently at the age of six or seven years, when children are shedding their first teeth, and the second are making their way through the gums, which are co­vered with little foul sores, and will some­times extend to the inside of the lips and the cheeks. It seldom requires more attention than was mentioned under the article of den­tition, any mild astringent application, and keeping the body open, usually effecting a cure; or if it does not, and the complaint makes its appearance at the time of teeth­ing, it will generally go away as soon as the teeth are come through.

The worst species of this complaint that I have happened to see, has been during the second period of dentition, when a child has been shedding a number of teeth together, and the rotten stumps have been neglected to be drawn out. The whole gums will then sometimes be spongy, or dis­solve [Page 243] into foul, spreading sores, and small a­pertures will be formed, communicating from one part to another, accompanied with an oozing of a fetid, and sometimes puru­lent discharge.

If the stumps of the decayed teeth can, in this case, be easily got at, they ought to be extracted; after which some such appli­cation as the following will soon brace the loose gums, and heal up the ulcers.

• R. Bol. Armen. Sang. Draconis,
• Gum. Myrrh. Cort. Peruv. pulv. subtil.
• Cremor. Tartari āā ʒj
• Mel. Rosae q. s. misce, ft. Pasta.
• R. Aq. Calcis ℥vij Tinct. Myrrhae,
• Mel. Rosae āā ℥ss. ft. Mixtura.

The gums should be touched several times in the day, especially after meals, and at going to bed, with the above paste, and the mouth be washed occasionally with the mixture.

If no considerable change for the better should take place, in a week or ten days, a dram of alum may be substituted in the place of one of the drying powders, and instead of the above mixture, one acidulat­ed with as much of the muriatic acid as the parts will endure, occasionally made strong­er, till some amendment be perceived; the belly being, in the mean time, kept pro­perly open. If internal remedies be thought [Page 244] necessary; Peruvian bark, sarsaparilla, and mineral acids are the properest; and the child may be kept on a diet of milk and vegetables.

GANGRENOUS EROSION of the CHEEKS.

THIS complaint resembles the c [...]uker more than any other disorder, though it is much more dangerous, and is not a more local disease. I have seen no clear account of it in any late writer but Mr. Dease of Dublin, who seems to have met with the disorder pretty frequently, and describes it very accurately in his tract on the diseases of Lying-in Women, &c. to which I am very much indebted on this occasion.

It appears to attack children from two, to six or eight years of age; usually unhealthy children, and such as have been subject to worms. The whole body often feels cold on the approach of the disease; af­ter which a black spot appears on one of the cheeks or lips, and spreads fast; but without any appearance of inflammation. Oftentimes the whole side of the face is eaten away, together with the lip, so that the bare jaw-bone and inside of the mouth appear. In the end, the intire lower-jaw falls down on the breast, and the whole side of the face is dissolved into a putrid [Page 245] mass; a colliquative diarrhoea taking place from the offensive matter that is continually swallowed, especially by very young chil­dren.

In the cure, internal as well as external remedies are required, and only such as cor­rect putrescency, and support the strength, appear to be of any use. A few drops of the muriatic acid, therefore, taken inward­ly, in an infusion of red rose leaves, or in the child's drinks; the saline draught in ef­fervescence; and in the end, the bark, in doses suited to the age, with good broths, jellies and wine, are the proper remedies. The parts should be washed, and likewise injected with the muriatic acid in cammo­mile, or sage tea, and afterwards dressed with the acid mixed with honey of roses, and over all a carrot-poultice. The child should in the mean time be gently purged with magnesia or rhubarb, to carry down the putrid matters it may have swallowed. By this treatment Mr. Dease informs us he has recovered every patient except one, since he had recourse to this plan, which the world is much indebted to him for making public; though fortunately this dreadful complaint does not appear to be, by any means, a common one.

PSOAS, or LUMBER-ABSCESS.

FREQUENTLY as this disorder takes place in adults, it is as often met with in younger subjects, and even such as are only four or five years of age; and must therefore be ranked among the diseases of childhood.

It is a true chronic, or slow inflammation, and is often occasioned by bruises, strains, or lying on damp ground; and is not uncom­monly connected with a scrofulous taint of the habit. The inflammatory symptoms be­ing rarely severe, suppuration takes place slowly, and many months elapse before the matter can be felt externally; which some­times points up high about the loins, hip, or groin, and at others, above the middle and on the inside of the thigh: In the most benign, the abscess frequently bursts in the groin. It is, in any case, a very dreadful dis­ease, and is briefly noticed here, only for the sake of warning parents of the danger of so insidious a complaint, and marking the outlines of a practice which seems to have proved the oftenest successful.

The first indication is to procure a reso­lution, if possible, upon the approach of the first symptoms, such as pain in the loins, difficulty of standing upright, and a pain­ful [Page 247] sense of contraction of the limb, and be­fore those of a hectical nature supervene; but unfortunately, the above symptoms are too often over-looked, or mistaken in the be­ginning.

With a view to a resolution of the inflam­mation, recourse should be had to bleed­ing by leeches, and cupping, and by blis­ters applied near the seat of the pain; by purging; a supine posture, and low diet; and sometimes a caustic near the lumbar vertebrae.

Should the [...]e means fail, or advice be sought for too [...]ate to expect any thing from them, of no less consequence is the treat­ment after the matter is formed; which should be evacuated, by an artificial open­ing, as early as possible, and by a very small aperture. Soon after this, the diet should be changed for one more cordial, and nou­rishing; and the bark, steel or vitriol should be administered, and the patient enjoy a pure air, and take such gentle exercise as his situation may admit of without an in­crease of pain.—The abscess should be dressed superficially; and restringent, or other injections be made use of, among which, perhaps, sea-water is one of the best.

A very similar, and equally dangrous dis­ease is the Morbus Coxaris, or abscess of the Hip-joint: the symptoms and treatment [Page 248] of which so much resemble those directed for the Lumbar-abscess, that it were need­less, in a work of this kind, to do more than barely mention the disease.

WHITE SWELLING of the JOINTS.

I SHALL be equally brief also on this ar­ticle, my attention being only to men­tion from experience a few remedies for this dangerous complaint, that have been found successful, in young subjects, if had recourse to in good time, and before any matter has been formed. Such are, the re­peated application of eight or more leeches, and afterwards small blisters to the joint; gentle frictions of the part; two or three vomits a week, with entire rest of the limb; and in the end, sea-bathing, especi­ally if the patient be of a scrofulous habit. In a few instances, electricity has had an immediate, and wonderfully good effect, even where the joint has been considerably enlarged, the pain very great, and the child incapable of straightning the limb.

PALSY of the LOWER EXTREMTIES with CURVATURE of the SPINE.

THIS complaint has been of late years so thoroughly announced, that it should seem unnecessary to enter into a minute de­tail of it after the accurate description given by Mr. Pott, whose early account and judi­cious treatment of this dreadful disease has added lustre to the reputation acquired by his former publications.

It will be proper, however, carefully to distinguish it from the simple curvature of the spine, in which a greater number of ver­tebrae is concerned, and the legs are not pe­culiarly affected; as well as from a com­plaint presently to be noticed, under the name of debility of the lower extremities, in which there is no manifest change of figure in the spine.

The palsy of the lower extremities is cer­tainly confined to no age, and being at first very frequently mistaken in young children for the trifling effect of some fall or strain, is intitled to notice in this work. I have ne­ver met with it, indeed, where it has not been preceded by some fall or violent ex­ertion, though as Mr. Pott has observed, such supposed accidents are seldom much noticed previous to the debility taking place: [Page 250] but this is not universally the case; though it is, indeed, probable, there may be some predisposing cause, without which no com­mon strain would induce so much mischief in a part continually disposed to accidents.

The Curvature is generally in the neck or back, though sometimes in the upper part of the loins, and varies in extent and degree according to the number of the ver­tebrae that may be affected. The first symp­tom noticed by children of an age capable of expressing their feelings, is an increased sensibility, and irregular twitchings in the muscles of the the thighs. This is succeed­ed by a dislike to motion, especially to mov­ing briskly; the patient on such occasions finding himself likely to fall, his legs getting entangled through their weakness, and a disposition to cross each other, in his at­tempts to step forward. Soon after this, perceives himself unable to stand upright long together, and that the legs and thighs have lost much of their natural sensibility. Matters seldom continue long in this state, and weakness increasing, patients lose more and more the use of both the lower extre­mities, till some are unable to move them at all even in bed; and these advances of the disease are said to be more rapid in adults than in infants. In the latter, I have par­ticularly remarked that rigidity of the an­kles noticed by Mr. Pott, by which the [Page 251] toes are pointed downwards, so that the heels cannot be brought to touch the ground.

As my intention is only briefly to point out the disease, and the properest means of relief, it is not of importance to enter into a farther detail of the progress of this dis­order, and of other complaints which are induced by it whenever the original disease has been long neglected.

The obvious remedy is that first happily suggested by Mr. Pott, and consists only of a large issue or seton to be made on each side the curve, at such a distance as may prevent their bursting into one. Where the curva­ture comprehends three or more vertebrae, or joints, the seton may be preferable to an issue, but if the latter be on any account elected, I should advise its being made by the knife rather than a caustic; not only as being less painful, but also for the very ef­fect Mr. Pott has disapproved of, I mean, the consequent inflammation before there has been time for suppuration to take place. It may, indeed, be doubted, whether the be­nefit derived from the issue may not arise rather from the inflammation and stimulus produced on the surface, than from the dis­charge, to which, nevertheless, Mr. Pott solely attributes the cure^*. In a recent [Page 252] case, however, and a very unpromising one, in an infant about ten months old, a very sensible relief was afforded as soon as the inflammation took place, and before any suppuration appeared; and though the child had been many months a cripple, with loss of health and appetite, unable to support its head, and the sternum very much dis­torted, the relief was so great in one week [Page 253] after the incisions were made, as left no room to doubt of a perfect recovery; which accordingly took place very soon, without any deformity remaining. Had Mr. Pott ad­vanced any other reasons for the preference, given to the caustic, or merely affected such pre­ference, I should readily have submitted to the great experience he has had in this dread­ful complaint; but though I may very possi­bly be mistaken in my reasoning, it appear­ed a duty just to state it, as well as to no­tice this instance in point in a disease of so much importance: hoping at the same time, that the desire Mr. Pott has expressed of serving the public, and the satisfaction he has received from the benefit attending the early publication of so valuable a remedy, will induce him to apologize for any attempt to extend, or illustrate its utility.

The issues should be kept open till the pa­tient perfectly recovers the use of his legs, or even a while longer, at least one issue, which ought not to be dried up till the pa­tient can walk firmly alone, and shall have recovered all the height which he may have lost in consequence of that stooping which the disorder had induced.

In addition to the use of these means Mr. Pott has suggested those of cold-bathing, frictions, and the bark, or such like; but I have myself never seen any benefit from any thing where the issues have failed, which I [Page 254] have found efficacious where no other re­medy had been made use of. After the re­covery, however, if the patient be of a scrofulous habit, sea-bathing is peculiarly indicated.

The moxa has been successfully made use of in one instance, by Mr. Gimès,^* after the [...], as directed by Mr. Pott, is said to have [...]. But as the burning was se­veral times repeated, and the recovery ap­pears to have been unusually slow, it is not very certain, but a repetition of the caustic might have proved equally beneficial.

DEBILITY of the LOWER EXTREMITIES.

THE disorder intended here is not noticed by any medical writer within the com­pass of my reading, or is not so described as to ascertain the disease. It is not a com­mon disorder, I believe, and seems to occur seldomer in London than in some other parts. Nor am I enough acquainted with it to be fully satisfied, either in regard to the true cause, or seat of the disease, either from my own observation, or that of others; and I have myself never had opportunity of examining the body of any child who has died of this complaint. I shall therefore [Page 255] only describe its symptoms, and mention the several means attempted for its cure, in or­der to induce other practitioners to pay at­tention to it.

It seems to arise from debility, and usu­ally attacks children previously reduced by fever; seldom those under one, or more than four or five years old. It is a chroni­cal complaint, and not attended with any affection of the urinary bladder, nor with pain, fever, nor any manifest disease; so that the first thing observed is a debility of the lower extremities, which gradually be­come more infirm, and after a few weeks are unable to support the [...]. There are no signs of worms, or other foulness of the bowels; therefore mercurial purges have not been of any use, neither has the bark, nor hot, nor cold-bathing. Blisters, or caustics on the os sacrum, and the great tro­chanter, and volatile and stimulating appli­cations to the legs and thighs, have been chiefly depended upon; though there is no appearance of an enlargement of any of the vertebrae, or joints of the back, nor of sup­puration in the external parts, and therefore no resemblance to the inflammation of the intervertebral cartilages, the psoas abscess, or the morbus coxaris of De Haen.

When only one of the lower extremities has been affected, the above means, in two instances out of five or six, entirely remov­ed [Page 256] the complaint: but when both have been paralytic, nothing has seemed to do any good but irons to the legs, for the support of the limbs, and enabling the patient to walk. At the end of four or five years, some have by this means got better, in pro­portion as they have acquired general strength: but even some of these have been disposed to fall afterwards into pulmonary consumption, where the debility has not been entirely removed. On this account it may be suspected, that the complaint is sometimes owing to scrofula; and I have been very lately informed by a gentleman of character, that he has seen one instance of a paralysis, or debility of this kind, in which, upon opening the body after death, the internal surface of the lower vertebrae lumborum was found carious, though there was no abscess of the ps [...]as muscle, nor ex­ternal tumor on the back, or loins.

I have seen a similar debility seize grown people, especially women, after some ve­ry long illness, and has continued a year, or more; during which time they were utter­ly incapable of walking without the help of crutches. These cases, however, have always been attended with great pain in the commencement of the complaint, though without tumour of the limbs; and have seemed to be benefited by the external use of the waters at Bath.

CURVATURE of the BONES from WEAKNESS.

CROOKEDNESS of the bones, particu­ticularly those of the lower extremities; has been mentioned as a common conse­quence o [...] [...]icke [...]s, and may claim a transi­tory notice [...] this work.

The principal inquiry in the treatment of deformities of this kind, respects the use of irons for the support of the limbs, whene­ver the distortion happens to be considera­ble. The propriety of this assistance has, indeed, been doubted by some practition­ers, as well as their unpleasant appearance been objected to by parents; who have therefore been inclined rather to trust only to cold-bathing. Friend, however, as I am to the latter, I may venture to say from experience, that it is likely to be prejudi­cial at the time it is often had recourse to; for by strengthening the system, it rather serves to confirm the crookedness which the bones have already contracted. It is an ad­vantage, on the other hand, that the bones remain soft and yielding as long as the cur­vature is considerable, if so be the pressure of the superior parts be at the same time duly counteracted. To support the limbs, therefore, with irons, as long as the soft­ness of the bones disposes them to yield un­der [Page 258] the weight of the body, is certainly a rational intention, and has been very bene­ficial in numberless instances. This end ob­tained, the bones being still lengthening as the child grows up, they naturally incline to become straight, and at this time the cold-bath and other tonics are properly in­dicated, and will co-operate to the cure of the complaint. The only care required, is, that the irons be made as light as possible, and be properly adapted, and that they be lengthened as often as may be necessary.

When a curvature takes place in the spine (without any disease of the vertebrae or car­tilages) the like method should be taken. Proper instruments to support the head and upper parts of the body have been contrived by different artists, but those made by Mr. Jones appear to be the best.

Should the bones of the arm be curved, either by accident or disease, in this soft state, rollers and paste board splints properly applied, will be sufficient to support, and restore them to their natural form.

But if the injury extend to the hip and contiguous bones, it will not be manifest at the time, and can be benefited only by the cold-bath, and other general remedies. If this distortion should be considerable, it may, indeed, become a source of manifold evils in females, as will be noticed in another place.

PARONYCHIA, or WHITLOW.

MANY young people are very subject to a mild species of this complaint, which being perfectly superficial, is not im­properly termed the cutaneous ^* whitlow, and will attack the ends of the fingers, se­veral times in a year, without any previous injury of the part. The subject is therefore introduced here only with the design of re­commending a prophylactic, or mean of pre­vention, which I have frequently seen suc­cessful. This consists only in bathing the fingers, several times a day, in the follow­ing mixture, the moment that a sense of any preternatural heat, or pain, may be felt.

• Take of Camphorated spirit, four ounces,
• Water of acetated Litharge, two drams,
• Tincture of opium, half an ounce.
• Mix them.

In the malignant, o [...] deep seated whitlow, doubtless, the best method is to make an early opening down to the bone, which will occasion the patient much less pain than suffering the matter to make its own way [Page 260] to the surface; which is likewise always attended with much mischief to the part.

FURUNCULUS or BOIL.

THE common Boil only is intended here, and is noticed from its frequen­cy in young people towards the time of pu­berty, who are sometimes vexed with a suc­cession of them. They are, however, just­ly accounted salutary, and do harm only when repelled, or hastily dried up. If a poultice of bread and milk, therefore, be applied from the first (if the boil be in a convenient part, otherwise a gum-plaister) and a bit of yellow or black basilicon put every day into the hollow, as soon as the boil breaks, it will be properly digested, and the core, as it is called, be brought out. It is sometimes for the want of this, that another boil forms in the neighbouring parts, or the child is teazed with sore eyes, or some humor, as it is termed, on the skin.

Two or three doses of purging physic should be taken as the boil is healed.

CHILBLAINS.

THIS is a complaint so well known, that it can need no description. It is ge­nerally owing to the circulation of the blood [Page 261] in the minute vessels of the extremities be­ing checked, by a child having been long exposed to cold or wet, and afterwards running to the fire instead of recovering the natural heat by exercise. If the injury be exceedingly great, as it sometimes is when a person has lain for several hours in the snow, the circulation cannot always be re­stored, and some parts actually mortify. To prevent this, if possible, instead of bringing the person near a fire, he should be immediately stripped, and well rubbed all over, especially the parts most af­fected, with snow, and afterwards with salt and water, and be then put into bed. But I speak chiefly of slighter attacks; on the first appearance of which, known by the heat, itching, redness, and swelling of the heels, toes or fingers, country people apply warm wood-ashes between cloths, or rub the parts with mustard and brandy, which if done in time will both prevent their breaking into sores, and entirely remove the complaint. For the like purpose, rub­bing the parts with a soft brush, or soaking them in warm water in which a hot poker has been two or three times quenched, and afterwards rubbing them with soap, or salt and onions, are good remedies; or embro­cating them with the soap liniment, or with camphorated spirit, to two ounces of which may be added a tea-spoonful of the water of [Page 262] acetated litharge. But I have lately experi­enced the good effects of a far simpler means than any of these, and which I have hither­to never found equalled by any of the warm­er remedies; and is nothing more than the ceratum album spread on a large piece of thick, doubled lint to be applied as soon as the extremeties begin to itch, or be painful.

Some children are disposed to have chil­blains every winter; as a preservative a­gainst which, if it be the hands that are lia­ble to affected, warm leather gloves should be worn, (avoiding woollen, which in these cases is unfriendly to the skin) and above all, wearing for a few hours in the day or night, and especially when abroad in the cold, oiled silk gloves, which is the best preventative both of chilblains and of chopped hands, that has been hitherto known. But if the feet are usually the affected parts, the heels only may be covered by a piece of washing-leather, secured round the insteps, and worn day and night during the cold months; and should be taken off only for the pur­pose of rubbing the parts with the brush or liniments, as mentioned above.

When the swellings are broken, it is com­mon to dress the sores only with a little ce­rate, and to wait for the return of warm weather, when they usually heal of them­selves; but by this means, they often re­main [Page 263] bad through all the winter, and when large, are sometimes not well till the summer is very far advanced; and I have even seen them remain very bad in grown people, at the end of September.

After having attended great numbers in this complaint, I am satisfied that this kind of sore requires applications somewhat more invigorating, being a species of mortifica­tion; and though it will not always endure very warm digestives like many other ulcers, yet when the chilblains are pretty large, a portion of some digestive joined with the cerate, is very friendly to them. And I have known some sores, though very small, remain long in a very obstinate and tedious state after the breaking up of a hard frost, whilst they have been dressed only with ce­rate, or other mild, or drying applications, as they are called, and begin to heal imme­diately upon adding a small portion of some warm digestive, and applying a flannel roll­er, without any other alteration in the plan. But if they are spread to any considerable size, nothing contributes so much to their healing, as touching the sores every day with bracing and invigorating lotions, par­ticularly diluted solutions of steel, or tinc­ture of myrrhe; which in a very few days will produce kindly granulations in these, and other cold sores, though of long stand­ing.

[Page 264] When the parts are much swollen, and the sores been long foul, it will be often ne­cessary in severe weather, to make use of poultices, of which, those made of rye-meal and the compound water of acetated litharge are more active, and therefore preferable to mere bread and milk. If these are applied over the above dressing of cerate and diges­tive, and changed twice a day, the sores will heal in much less time than by any of the common applications I have seen used; especially if the parts surrounding the sore be well rubbed with camphorated spirit. If children are not very young, purging them with a little calomel twice a week, will of­ten expedite the healing of the sores: in the worst cases, a decoction of the bark is required.

Since this work has been in hand, I have learned the good effects of electricity in chil­blains, both as a remedy and a prophylactic, or preventative, especially in very old peo­ple, to whom they not unfrequently hap­pen.

BURNS and SCALDS.

BURNS are mentioned by some old wri­ters, and though a misfortune by no means confined to young people, they too often fall to the lot of infants, through the [Page 265] carelessness of their attendants; and for want of being properly treated at the instant, children often suffer exceedingly, when a sit application would have rendered the in­jury trifling.

When such an accident happens, the nearest astringent at hand should be made use of, such as brandy, or other spirit, ink, wine, or even cold water, till something more proper can be procured; into which the injured part should be plunged, or be covered with pieces of cloth dipped in such liquors, which will prevent the blistering of the part; carefully avoiding the use of olive-oil, too frequently had recourse to. As soon as it is possible to send to an apotheca­ry, the following should be procured, and used in like manner.

Lime-water, a pint, brandy, two ounces, water of acetated litharge, half an ounce.

If the injury has been too long received to admit of much relief by these means, and deep sloughs are actually formed, a very proper dressing may be made of equal parts of Turner's cerate, and green ointment of elder; diminishing the proportion of the latter as the sloughs are thrown off, and the sores become disposed to heal. But should the injured surface be large, or the pain, oc­casioned by removing the dressings, be very great, it will be sufficient to cover the parts with pieces of linen dipped in cold-drawn [Page 266] linseed-oil, which should be moistened eve­ry day, and suffered to adhere till the sores are in a state to admit of being dressed in a common way.

A strong solution of soap in water has long been in use with artificers, employed in any business exposing workmen to very bad scalds; and is a very excellent remedy—About three quarters of an ounce of soft soap is a proper quantity for a pint of water. But the soap takes some time in dissolving, and as it requires a certain proportion of boiling water, the lotion cannot be made cool enough for immediate use by the addi­tion of the proper quantity of cold water. A remedy, therefore, more convenient, and perhaps more efficacious, which if not always in the house, may in every large town be speedily procured, may be made of olive-oil, cold water and ley of kali. Six ounces^* of oil to ten of water, with two drams^† of the ley will make a pint.—This quantity may be sufficient for a burn on the hand or foot, which is to be immersed, and kept about half an hour in the liquor, which will remove the injury if had recourse to imme­diately; but must be repeated, as the pain may require, if the scald or burn be of some standing. Should a person be scalded all [Page 267] over, and be immediately put up to the chin in a cold bath of this kind, and the head at the same time, be frequently immerged, or well washed with the liquor, very little injury would ensue.—Whatever sores may be formed, should be treated afterwards accor­ding to the foregoing directions.

LUXATIONS and FRACTURES.

INFANTS are not only liable to these misfortunes by a fall from the lap, but the bones or joints may be sometimes una­voidably injured in the birth. There is in this case, seldom any luxation, I believe, but of the shoulders, which is not difficult to be reduced, and requires nothing afterwards, but that the limb be kept perfectly quiet. Fractures, indeed, are not quite so easily managed, and perhaps happen more fre­quently. The bones are yet but little more than gristle, and if strained beyond a certain degree, are easily bent, or even broken. The former is very readily restored, but I shall be more particular on the latter, as the subject is of some importance.

Fractures in the birth are usually of the collar-bone, the arm, or the leg, the treat­ment of the two former of which, will in­clude all that is necessary to be observed of such as may happen in other parts.

[Page 268] The first, however, requires very little attention, as it will be necessary only to draw the shoulders back, confining them in that posture, by two or three pins in the clothes, and to apply a piece of adhesive, or of the soap-plaister, spread on leather, upon the rising end of the bone, and a larger piece over the first.

A fracture of the arm demands a little more attention, but will always end perfect­ly well. The difficulty consists in keeping the fractured ends of the bones opposed to each other, without rolling up the arm so tight as to occasion pain, or much swelling of the hand, which in a new-born infant, a very small pressure will effect. I have found no method so well adapted as the following, which allowing of a little tumor about the fractured part, without the necessity of loos­ening the roller, preserves the ends of the bones in due contact, without drawing the roller so tight as to prevent the free return of blood from the inferior parts of the limb.

To this end, three little splints, about half an inch in width, and an inch and a half long, may be made of fine linen cloth, five or six times folded together, to the thickness of common pasteboard; and being soaked in a mixture of flour and white of egg, should be placed in the usual manner, along the fractured ends of the bone. Being applied [Page 269] wet, they will accommodate themselves ex­actly to the figure of the limb, and when become dry, will be sufficiently strong to sup­port the bones. They should be applied im­mediately on the skin, without the interven­tion of a roller, by which means, when the parts swell, which they should always do a little, there will be space enough between them to allow of it, notwithstanding the pressure from the roller, which should be applied over them. This ought to be of very fine flannel, and should not be drawn near so tight as for adults, nor will there be occasion for it, as the chief dependance ought to be on fastening the arm down close to the side, by strong pins fixed into the lit­tle gown, in the manner the surgeon may best contrive at the time. The gown, there­fore, ought not to be changed, nor the arm moved but in his presence; and if the hand is not inflamed, nor very much swelled, and the child is easy, the part will no [...] need to be opened under eight or ten days. Till this time, the same gown should be worn, and be preserved clean by such coverings as may easily be removed. The speedy union of the bones will depend upon a strict atten­tion to keeping the limb as still as possible; and if it be so preserved, the accident will af­ford very little trouble after the first ten or twelve days, and at the month's end, the [Page 270] child will move that arm nearly as well as the other.

It is very common for nurses, especially during the month, to support the lower-jaw of an infant whenever it happens to yawn, in the apprehension the jaw might, otherwise, be dislocated. This practice is, at least, an evidence of the nurses attention, and can do no harm, though I have, in­deed, never known the accident happen. Should it, however, take place, either at this age, or in older children through some violence, it will occasion a very awkward appearance, and prove very distressing to the child, who will be disabled from taking any nourishment till the luxation be reduced. Nothing more, however, is required to this end, than to place the thumb of each hand in the back part of the mouth, and the fin­gers on the outside, under the jaw, so as to depress, and at the same time bring it a lit­tle forward, to disengage the head of the condyle, and then force the jaw suddenly back.

On CUTTING the TONGUE.

THE directions on this head, as well as the notice taken of many of the fol­lowing little disorders, proceed rather from a desire that nothing on the subject of chil­dren's [Page 271] complaints should be omitted, than from their real importance. Some of them, indeed, have been entirely overlooked by preceding writers, and though they may seldom require much attention, it may some­times be of advantage to know what has been serviceable in similar cases.—The in­stance under consideration, however, is too trifling a matter to dwell upon.—It will be sufficient to observe that the little opera­tion, performed in order to lengthen the tongue, is very frequently called for where there is no absolute occasion for it, the con­finement being seldom so considerable as to make it really necessary to divide the fraenum, or little bridle, that adheres to the under part of the tongue. The child will suffer so very little, however, in the operation, that when it is carefully done, it will be attend­ed with no inconvenience; and if it can af­ford the mother any satisfaction, it will be very proper to comply with her request. It seems therefore only necessary to add, that some little care and steadiness are re­quired, or the sublingual veins may be wounded, and in consequence an infant may lose its life. To avoid this danger, the bridle may be divided by a small curved bis­toury, instead of scissars. The handle and blade, when open, need not exceed two inches in length; and the point should be a little curved, and the back made broad, [Page 272] whereby the point may be easily forced through the fraenum in the most troublesome case, whilst the back of the instrument will sufficiently press down the veins, so as to be entirely out of the way of being injured. These cautions have been judged by some people to be very trifling; but besides that infants have actually bled to death, the fol­lowing equally fatal accident has arisen from cutting too deep, which I shall therefore no­tice in this edition, as well as describe an instrument contrived for suppressing the bleeding.

SUFFOCATION from SWALLOWING the POINT of the TONGUE.

THE occasion of this accident has been mentioned: it is therefore only neces­sary here to notice the symptoms and reme­dy. The former are those usually attending strangulation, and come on suddenly, and without any probable cause but that of the tongue having been cut; but to which they are seldom attributed by those, who are strangers to the complaint. The infant ap­pears greatly agitated; the face turns black; and unless these symptoms soon disapear, the child goes off in a convulsion. But if they are presently removed, the infant is as sud­denly [Page 273] well; but they generally return again, and have in several instances proved fatal.

Mr. Petit^* has perhaps the credit of disco­vering the true cause of the complaint. The remedy consists in nothing more than bring­ing the tongue into its proper place, and if the infant be suckled, putting it immediately to the the breast, which will give the tongue a natural direction. Should the child be brought up by hand, the tongue should be watched for some time, at least till the bleed­ing shall be stopped; the complaint taking place only in consequence of that being con­siderable, so as to become an inducement to the infant to continue sucking at the part.

When the sublingual veins are actually wounded, the danger, it has been said, is considerable; and it is to Mr. Petit that we are again indebted for the best contrivance for suppressing this hemorrhage. The means consist only of a piece of ivory, in the form of a short fork; the prongs of which should be so placed as to press against the apertures in the veins, and the other end against the inside of the lower jaw, and should therefore be broad and convex in that part, that it may keep its place.

HICCOUGH.

THIS has been ranked among children's diseases, but it is, by no means, a com­plaint of consequence, as it sometimes is in adults. It occurs pretty commonly, in­deed, in infancy, but seldom requires much attention, as it frequently comes on only af­ter over-feeding, or in consequence of the overthickness, or sweetness of the food, and is one of their most harmless consequences. But when it depends on an acid state of the juices of the stomach, or occurs in long bowel complaints, it indicates a necessity for having recourse to the absorbent pow­ders.

SNEEZING.

THIS has likewise been mentioned by some writers as a complaint of young children, for which Rhazes prescribes re­frigerants and anodynes, but it is certainly not a common one, and indeed I have ne­ver met with it, in the form of a disease. It may be occasioned by looking too long a­gainst a strong light, as the fire, and espe­cially the sun, or other very luminous bo­dy. It has already been spoken of as a well [Page 275] known symptom of the measles, and of ma­ny common colds, but in neither, I believe, requires any particular attention. It is men­tioned here, only because I would not pass over a complaint that has been attended to by any writer of reputation, nor leave such readers at a loss, who being unacquainted with the distinction between mere symptoms and diseases, might at any time be needlesly alarmed by it. But knowing nothing far­ther of it myself, and having no idea of its being a complaint of much consequence in this country, I have not chosen under such circumstances, to be a mere copyer from o­thers. It may, however, in conjunction with other causes, give rise to the follow­ing complaint in older children.

BLEEDING of the NOSE.

I MEET with this complaint also amongst old writers, and therefore bestow a few words upon it, though it is not often of much consequence, I believe, before the age of puberty.

If a child be feverish, or otherwise un­well, the hemorrhage is often a mere symp­tom arising from the complaint under which it labours, and will disappear upon that be­ing properly treated. But a bleeding at the nose sometimes takes place in the healthiest [Page 276] children, the vessels of this part being weak­er than those which are covered by the true skin, and often afford a salutary outlet, in case of plethora, or fulness of blood, and therefore usually contract when the inten­tion of nature is answered; after which, a dose or two of cooling physic should be giv­en. But it may be sometimes necessary to draw a little cold water up the nose, to which some vinegar may be added, and to apply some thing cold to the upper part of the back. Should these little remedies fail, the head may be bathed with cold vinegar and water, and the nostrils be stopped up with dossils of lint, which on urgent occasions must be dipped in warmed oil of turpentine, or other styptic liquor, and must extend to the posterior aperture. The last means will almost always succeed; but if otherwise, some blood should be taken from the arm, if the pulse does not forbid, the feet be bathed in warm water, and the body be kept open by manna, and cream of tartar, and the patient should live for a little time pretty much upon whey, vegetables and milk; at least, he should not dine wholly upon animal food—The bark will in some instances be proper.

HEMORRHAGE from the NAVEL.

I HAVE two or three times seen a com­plaint at the navel of new-born infants, which is scarcely worthy of mention, but from its being an uncommon one. This is an oozing of blood from the part, after an unkindly separation of the chord, and is ow­ing to the shooting up of a soft fungus, which prevents the s [...]in from covering the divided vessels in the manner it otherwise does. This hemorrhage has sometimes continued for several months, and in some instances, in such quantity as to prove alarming to the friends of the child, lest it in the end be in­jurious to its health. The little vessel from whence the blood issues, lies always so deep that it cannot be secured by ligature, nor be conveniently cauterized; the latter of which, indeed, would be very disagreeable. I have conveyed the lunar caustic, however, to the part, but the bleeding has always re­turned. Nothing farther is necessary, than to adapt a proper compress, and secure it by a sticking plaister and bandage; which should be continued for two or three weeks.

There is indeed another kind of hemor­rhage of more importance, but this seems to be sympathetic, and is attendant upon in­fants who are in a bad state of health dur­ing [Page 278] the month, and is, perhaps, a bad sign. It takes place where the chord has been ap­parently well healed; but the skin after­wards gives way, and the bleeding is much more considerable than in the former. It re­quires, however, nothing more than the application of common styptics, with pro­per compress and bandage. The bleeding not appearing, in the least, to be critical, ought to be suppressed as soon as may be, and whatever complaint the infant may la­bour under, be treated according to its kind.

HERNIAE, or RUPTURES.

RUPTURES may take place in different parts, but they usually appear at the navel, or the groin. The former is some­times complicated with the ventral hernia near the part, and is occasioned by the se­paration of the recti muscles, the linea alba being there deficient; but it seldom extends far above or below the navel. The simple navel-hernia is a very common complaint, which if immediately attended to, is easily cured, perhaps merely by the use of the cold­bath: but if neglected, may prove trouble­some as the child grows up; especially to females. It will be sooner cured, however, if treated like the former complaint, by a­ [...]apting a pyramidical compress, made of [Page 279] round pieces of good sticking-plaister, spread upon thin leather, with pieces of card plac­ed between them; or what is more easily prepared, and is adapted to poor people, is a piece of bees wax as broad as a shilling, and half an inch thick; the upper part of it may be round, and the other slat, which should be placed on the navel. But if the child be a twelve-month old, these reme­dies will then require a pretty tight bandage round the waste; and such a compression, I have frequently observed nurses afraid of, who often loosen the bandage so much as to render it of very little use. On this ac­count I have for some time past recommend­ed Mr. Squire's elastic bandage, which if this rupture be complicated with the ven­tral, or belly hernia, becomes the more necessary, and sitting quite hollow on the sides, and making no kind of compression but on the part affected, and the opposite point of the back, perfectly answers the end, without the help of a surgeon. The child should be daily put into the cold-bath, for some months, after leaving [...] the ban­dage or truss—I have often observed start­ings of the navel happen to infants, in whom the skin has been found running a certain way upon the navel string; on which ac­count, nurses ought to be particularly care­ful in such instances, and keep the part more than ordinarily confined.

[Page 280] Ruptures at the groin are of more con­sequence, yet may be safely left without a bandage, especially as the cold-bath alone generally cures them when they happen to children before they go alone. In early infancy, there is likewise some difficulty in retaining the truss on the part, and it is continually liable to be wetted. Should a rupture, however, be very large, and the infant usually fretful and crying, recourse may be had to a steel truss; to which it will be necessary to pay some attention, lest it slip out of its place, or the rupture fall down, and be bruised by the pad. After two years of age indeed, when children be­gin to take more exercise, the use of a truss seems to be absolutely necessary, of which those made of steel as improved by Mr. Squire, are incomparably the best.

HYDROCELE, or WATERY RUPTURE.

THIS is a distension of the scrotum of a nature similar to the hydrocele of adults, and when it falls to the share of in­fants, I believe, it usually appears at the birth. It is frequently mistaken by mid­wives and nurses for a common rupture, who therefore advise a linen bandage to be applied in the usual manner. It is, how­ever, easily distinguished from a rupture, by [Page 281] the tumour being transparent; without pain; and from not retiring upon pressure, or not being increased by the crying of the infant.

Though I have said it commonly makes its appearance at the birth, and that the tumor does not retire upon pressure, I think I have lately seen an instance to the contra­ry.^* In this case, I had occasion to examine the parts very attentively at the birth, on account of a little mal-conformation of ano­ther kind, and neither then, nor the next morning saw any appearance of hydrocele; nor was it discovered by the nurse or mo­ther till six weeks afterwards, though the parts, for the reason above mentioned, were frequently examined. About this time I was sent for in haste, on account of the appearance of a large hydrocele, which, however, by the mother's report, was be­fore I got there, greatly diminished. There was, nevertheless, about three tea-spoon­fuls (as I imagine) of water in the scrotum which from this time was distended in dif­ferent degrees, as the water happened to retire, more or less, through the rings of the muscles, which I apprehend must have been preternaturally open; though no por­tion of the caul, or intestine, I believe, ever [Page 282] descended; and the complaint disappeared in a few weeks, by only dashing the parts with cold water, three or four times a day.—This infant was a twin; and it is remar­kable, that the other had likewise an hy­dr [...]ele, which was not discovered for three weeks after the former; but was much smaller and got well by only the like gentle treatment.

The hydrocele is a harmless complaint, and would probably always disappear of it­self in the course of a few months; but may much sooner be dispersed by some astringent lotion. The water of acetated ammonia has succeeded with me perfectly well, and I have sometimes made use of compresses wetted in vinegar and water, with the addi­tion of a little spirit, as the skin has been able to bear it. Perhaps the addition of crude Sal ammoniacus, as lately advised by Mr. Keate, in the treatment of adults, might assist the absorption of the water. The smoke of burning gum benjamin received upon flannel, and applied to the part, is likewise a good remedy. But the speediest method is to puncture the bottom of the tu­mor with the point of a lancet; which, as it may be done with perfect safety, and with little pain to the child, is often preferred by the mother, as it instantly removes a ble­mish which cannot but be unpleasant to her, whenever any other person may chance to [Page 283] be witness to it. In whatever way the wa­ter be got rid of, I never knew it return, nor the child suffer any consequent incon­venience; though the complaint [...] so com­mon that I have seen it in many score in­stances, and cured in different ways.

RETENTION of the TESTES.

THIS is a tumor in one, or both groins, and is another affection resembling the hernia, and is noticed on that account. As the application of a steel truss, or, indeed, any other bandage might here be attended with bad, if not fatal consequences, it is of importance that parents should consult some medical person, whenever they sus­pect a rupture.

This complaint being generally owing to a preternatural stricture of the rings of the abdominal muscles, or to a want of due action in the cremaster or gubernacu­lum, I have nothing to recommend, unless it be in a negative way, to forbid any rude handling of the part, or attempts of the nurse to force the testicles into the scrotum. Should any thing of this kind be necessary, it should be done by another hand. In the course of a few weeks, or months, howe­ver, the obstacle, of whatever kind, usu­ally [Page 284] gives way; though sometimes indeed the part remains confined through li [...], and its unnatural position is certainly attended with some inconveniences, and a greater chance of injury to the testes; of which I have seen more than one instance in adults. Should inflammation take place, in conse­quence of any accident, during infancy, every proper means of counteracting it should be immediately had recourse to, such as gentle laxative medicines, and sedative em­brocations and cooling poultices, made of the compound water of acetated litharge.

TUMEFACTION of the PREPUCE.

THIS little complaint, like the hydrocele, arises from extravasated water, and is a partial anasarsa, or dropsy of the skin, and if it be not attended with inflammation, nor owing to a stone sticking in the passage, as it sometimes is, it never proves of any con­sequence, and is mentioned only because it is always alarming to parents.

It may be washed frequently with the compound water of acetated litharge, or the part be wrapped up in a poultice of that kind, and the body be kept open, which usually removes the complaint in two o [...] three days; but if it should not, the part may be lightly scarified, and afterwards [Page 285] fomented. Should it arise from inflamma­tion, as in the erysipelas infantilis, the in­flammatory cause must be properly treated. If from a stone in the passage, the stone must be extracted, if within reach, or if otherwise, it should be forced back into the bladder.

PROLAPSUS, or PROCIDENTIA ANI.

THIS is a falling down of the internal coat of the lower bowel (this coat be­ing much longer than the others, and full of folds) and is either owing to its laxity, or to irritation. It is no uncommon complaint, nor usually difficult of cure, being general­ly a symptom of some other, such as worms, or other foulness of the bowels, or has been induced by rough purges, diarrhoea, long costiveness, a stone in the bladder, or other irritating cause, and is usually preceded by tenesmus, or needing; to each of which the proper remedy must be applied, or the cure of the prolapsus will be attempted in vain.

But if the complaint should remain, after the irritating cause shall have been removed, it will then depend merely upon a relaxa­tion of the part, arising from the long ha­bit of descending every time the child has gone to stool, and is, in general, easily [Page 286] cured by an astringent lotion. To this end, a compress of cotton, or soft tow, wrung out of the dregs of red wine, to which may be added a few drops of the wa­ter of acetated litharge, should be often ap­plied, and secured by a linen bandage, so as to make a firm compression on the part; the compress may also be sprinkled with fine powder of myrrh, frankincense, and dra­gon's blood, or receive the smoke of tur­pentine cast on burning coals. Or, sup­positories may be made of powder of [...]alau­stines, red rose leaves, and oak bark, in honey, and introduced into the bowel, af­ter going to stool—It may be found expe­dient to have the part supported at such times, by a servant placing a finger on each side the gut: but this caution will not be necessary unless the complaint has been of long standing, or the descent be considera­ble.

When this is the case, astringent fomen­tations and injections will also become ne­cessary. These may be made of a decoction of oak-bark, which must sometimes be ren­dered more powerful by the addition of a little a [...]m; the quantity of which should be increased as the part may be able to bear it. In children of eight or ten years old, who take much exercise, recourse may be had to Mr. Gooch's suspensory, instead [Page 287] of the linen bandage above recommend­ed.

DISCHARGES from the VAGINA.

THESE are either sanguineous, mucous, or purulent.—As I speak professedly only of appearances before the age of pu­berty, I have merely to remark on the first, that female infants have sometimes such a discharge from the vagina a few days after birth, which appears to be of no conse­quence. Should it, however, on any ac­count, be thought necessary to prescribe something, a little testaceous powder, or magnesia, according to the state of the bow­els, will be sufficiently astringent, as the dis­charge always disappears in a few days.

Children of five or six years old, are sub­ject to a mucous discharge, resembling the genuine fluor albus of adults, which will in some instances be in an excessive quantity, so as to run through all their clothes; and is sometimes, though rarely, tinged with blood. If it were suffered to continue, it would probably injure the health, but, I believe, may always be cured, by one or other of the means recommended for the the next, which may be called purulent go­norrhea.

[Page 288] This is no uncommon complaint in chil­dren of three or four years old, and is then, in general, easily removed by a little cool­ing physic, and keeping the parts perfectly clean. I have sometimes made use of a lo­tion of the compound water of acetated li­tharge, which I believe is preferable to most others, if had recourse to in the commence­ment of the complaint; and if there be any excoriations, they should be covered with the unguent. cerussae, spread upon linen or lint.

When the purulent discharge makes its appearance later, which it will do at eight, ten, and even twelve years of age, and is much discoloured and fetid, it gives rise to a suspicion which young practioners cannot be too guarded against. There are, indeed, instances of little girls, not more than six years old, being injured and it is of conse­quence to make a judicial discrimination; but there are on the other hand, instances of a very suspicious appearance, as late as the age of thirteen or fourteen, where no injury could be received without the con­sent of the party, who is generally perfectly innocent, and where, therefore, the least suspicion would be very distressing to her, and might make a whole family miserable.^*

[Page 289] Discharges with the worst appearances, are frequently removed in eight or ten days, merely by the treatment above recommend­ed, but I have seen some cases in the young­est subjects, of a bad habit of body, where mercury, as a deobstruent, has proved use­ful, though I could not have the least suspi­cion of a venereal taint. In such cases, I have found Ward's white drop a more conveni­ent medicine than any other preparation of mercury: it may be given in the dose of half a drop, and may be degrees be increased to two and even three drops, once or twice a day, for two or three weeks. But where this [...], I have only to add, that I have been always able to succeed by giving [Page 290] a decoction of the bark, with balsam. copai­bae ovi vitel. solut. which is also an admira­ble medicine in the fluor albus of adults.

OF the VENOM of INSECTS and of CER­TAIN ANIMALS.

THOUGH the following accidents, like some others before mentioned, are not confined to any age, they are, at least more formidable when they fall to the lot of lit­tle children. It is hoped, therefore, it will not be thought trifling, to recommend some suitable antidote against the bite, or sting of venemous insects, particularly the wasp, gnat, and other flies; especially as they happen frequently to children in the coun­try, at a great distance from medical help, and often alarm parents exceedingly. Indeed, for the most venemous, such help can rarely be had before considerable inflammation has taken place; after which it will take its course, and will continue, if occasioned by a gnat, three days, and by some other insects, for six; though the tormenting itching may be allayed much sooner by the means of proper applications. If the bite should be on the eye-lid, the inside of the lip, or ear, very troublesome symptoms may follow, and the infant will be vexed by it exceedingly.

In the absence of better remedies, the [Page 291] first application may be, of the strongest spi­rit at hand, three parts, two of vinegar, and one of sweet-oil; taking care it do not get into the eyes. But as soon as may be, the following should be applied very frequently; which will check the progress of the venom, and allay the pain and itching immediately,

• Of camphorated spirit, a table-spoonful,
• Of distilled vinegar, and of laudanum, each a tea-spoonful;

to which, if the injury be not too near the mouth, may be added twenty drops of the water of acetated litharge.

The bite of the common bug which in­fests crouded places, not only occasions a tormenting itching in children of a very de­licate skin, and in certain grown people newly come from open villages, but will also sometimes raise blisters as large as pi­geons eggs, and will inflame the parts for several days. The best application, I be­lieve, is vinegar with a small quantity of olive-oil, and a few drops of laudanum: oil alone, would rather increase the size of the blisters.—Whereas, for the highly vene­mous bite of the viper, the immediate appli­cation of olive-oil is the well-known, and certain remedy.

[Page 292] Under the painful impressions of an awful accident that happened in my own family, at the time I was engaged in this part of the work, (though I thank God, the alarm ter­minated happily,) I cannot avoid dropping a few words on the envenomed bite of mor­bidly enraged animals. It is not my inten­tion, however, to advert to the peculiar nature of this most malignant poison, nor to enumerate the many deceitful remedies that have been at different times proposed with an air of infallibility; since dwelling long on this unpleasant subject would ill ac­cord with a tract of this kind. Nor is it my design to propose any new remedy, but ra­ther to lament, that the best preventatives should be so ill attended to, particularly amongst the inferior class of people, to whom this dreadful accident happens oftener than to the rich. And on this account, as well as the subject being rarely treated of, and seldom falling in the way of any but medical people, (who are often consulted too late) it is hoped, the intention will apologize for obtruding a friendly caution in this place. For, after a good deal of experience, and much inquiry and reading on this subject, I am confident, that nothing ought, in any in­stance, to be depended upon, but taking out the injured parts, by the knife or caustic; which if duly and timely effected, cannot fail to prevent every evil apprehended. But [Page 293] whenever the situation of the wound may not admit of going deep enough to insure success, or too much time may already have elapsed, the stronger mercurial ointment ought to be rubbed in very freely, so as to raise a salivation; which has not only been thought to have proved an effectual prophy­lactic, but to have also succeeded even where evident symptoms of infection had taken place.^*

I have only to add, (what it is, indeed, a great satisfaction to be able to say,) that, dreadful as this accident is where the poi­son has taken effect, it is evident, that only a very small proportion of those who are bitten by animals actually enraged, receive any injury from it. Fortunately, the clothes sometimes prove a defence, by wiping off the foam from the animal's teeth; at others, it does not happen to be forced into the wound, or is not yet possessed of a poison­ous quality; or lastly, it is not absorbed, or the system may not be in a state to be in­fected. These assertions are supported by numberless facts, though much less fre­quent, perhaps, in London, than in some other parts, especially on the continent, where such animals are very commonly met [Page 294] with, and often wound great numbers of people.

It is, doubtless, the uncertainty of the ef­fects attending such injuries, that has support­ed the credit of many fallacious remedies on this melancholy occasion. Encouraging, therefore, as the above circumstances certain­ly are, it would indeed, be madness to con­fide in them, where the proper remedy may be made use of in time; and though I should wish to conceal rather than spread these ac­knowledged facts, could I think they would have such an effect, it is on the other hand, no small satisfaction, that such encourage­ment may be justly held out to those who may be under any alarm for themselves or their friends.

There are several other diseases attributed to young children, recorded by Rhazes. Paulus, Oetius, Fabricius ab Aquapendente, Celsus, Primerose, and other less ancient writers; of some of which I know nothing but from their own account of them, or that they are needless distinctions of dis­eases already mentioned, which the ancients were very fond of making, especially in complaints of the skin, but can answer no practical end. Among the diseases mention­ed by these writers are, Lentes, Hispiditas, Achores, Favus. Psorophthalmia, Impetigo, Ranulae or Batrachos, Seriasis, Paristhmia, Parulis, Inflatio, Crinones, Malum Pilare, Phthiriasis, Hydroa, Macies.

[Page 295] The six first are affections of the skin, or the eye-lids. Achores and Favus ^* are a a sort of Crusta-Lactea, or milk-blotches, so called by some, when of a dark colour, or ulcerated, and extending to the head, and Impetigo when it attacks the chin; but by others the term Ach [...]res is applied only to adults. Psorophthalmia is confined to the eye-lids, and is so named by OEIIUS, and others after him.

Ranula is an inflammatory tumor of the parts under the tongue, and according to the ancients, particularly of the veins: it sometimes ulcerates, but often presents a species of soft, and lax oedema. Celsus says the tumor is sometimes included in a cyst, which must be taken out; the operation for which is fully described by AQUAPENDENTE. Although such seemingly different accounts are given of this complaint, the Ranula ap­pears to be no more than an infarction of the sublingual glands, and I believe, is not very common in infants, and indeed is mostly an epedemic complaint. I have seen it how­ever, in this country, in adults, of the size of the largest walnut, and it then be­comes very troublesome, both in speaking [Page 296] and deglutition. When larger it is usually soft, and contains a fluid, and sometimes calcareous concretions, owing to an obstruc­tion of the salivary ducts. In this case, it needs only to be opened, and to be cleared of all the conretions; but if it be hard, the whole tumor must be extirpated▪ Serias, from [...] quia quasi excavatu [...] cernitur—PAULUS (Lib. i.) describes it a [...] an in­flammation about the cerebrum, in which the brain is said often to mortify [...] three days; but if it should not, the child may recover. Paristhmia is an inflammation of the tonsils, or throat, but is certainly not common in this country; it is hinted by Hippocrates in his book de Dentitione. Pa­rulis, a complaint described by Paulus as a painful tumor about the gums; Rhazes calls it a blister in the mouth. Inflatio is a distention of the skin from wind or water after a child has been reduced by long ill­ness. Crinones, or Grubbs, is little known as a disease, I belive, in Europe. It is pro­bably a secretion from the sebaceous glands, and appears on the arms, legs and back of sucking children; and is absurdly enough thought by some to be produced by insects:^* older children are often found to have some appearances of it, but it seldom affords them farther trouble than a little itching, and they [Page 297] amuse themselves by forcing out of the skin what they call worms.—In the instance of infants so affected, rubbing the parts with a coarse cloth, by the fire-side, is all that will usually be necessary in northern cli­mates.

Though this kind of affection is general­ly of little consequence, whether in infants, or young children, I have, nevertheless, known it prove a very troublesome com­plaint in older subjects, especially in females about the time of puperty. In such instan­ces, the whole neck, back and breast will be covered with little black spots, which gradually inflame till the parts become tota­ly covered with heated pimples. These at first itch intolerably, so as frequently to keep the patient from sleep through the greater part of the night; and in consequence of being continually rubbed, turn to little in­flamed and angry boils. When some of these have discharged the sebaceous matter, and are healed up, others will arise, in succes­sion; and at the end of several months, the superior parts of the body are covered with them.

After making trial of common purges and alteratives, to no lasting advantage, I have cured the complaint by washing the parts morning and evening, for a few days, with the lotio saponacea, and afterwards rubbing in a little unguentum hydrargyri ni­trati; [Page 298] and when the soreness has gone off, making use of a proper flesh-brush, for two or three months. The patient may at the same time take a few drops of the aqua kali, two or three times a day, in a cup of sassafras-tea, or milk and water.

A complaint sometimes confounded with the former, is that called Morbum pilare, and is supposed to be spoken of by Hilda­nus, as sadly tormenting one of his children. It is also mentioned by [...] but I have never met with it myself. It is said to be ow­ing to hairs not duly expelled, which stick in the skin, especially the backs of young in­fants, whom it torments by an incessant itching, and sometimes raises small tumors. The cure is said to consist in fomenting the parts, and then pulling out the hairs with a pair of nippers.

Phthiriasis, or Morbus pediculosus, is a complaint I should not have mentioned, were it not sometimes found very troublesome, and the heads even of children who are kept the most cleanly, much pestered with these ugly vermin. It is not therefore intended to treat of it as a disease in other parts, and will be quite sufficient to say, that the cure is, in general, very simple, and requires only the hair to be sprinkled for a few days with the powder of staves-acre; a remedy that is kept a secret by some foreign perfu­mers, who sell it at a great price.

[Page 299] Hydroa, or Sudamina, is a trifling erup­tion from the sudorific glands. Macies, or according to some, atrophia lactantium, is applied to a decay, said to arise either from worms, (and is then called atrophi [...] vermi­nosa ^*) or to the unsuitableness of the breast-milk, which though it may be good in its kind, will not prove alike nourishing to all children. The milk is then properly direct­ed to be changed, upon which it is remark­ed, the child will often recover. This dis­order is, however, a true [...]trophy, or ma­rasmus, from whatever particular cause, and into which an infant may fall in consequence of almost any of the complaints treated of in the forgoing pages, when they may hap­pen to prove of very long continuance.

I have now gone through all that have been usually ranked among the disorders of infants, and have taken sufficient notice, as I apprehend, of every complaint worth men­tioning, that I have met with either in my reading or practice; and may flatter myself this little tract will be found to possess the advantage of compleatness above every work of the kind.^† That nothing may be over­looked, it remains to take notice of some [Page 300] congenite diseases, and other external blem­sh [...]shes; and first of those about the head.

ENCEPHALOCELE, or HERNIA of the BRAIN.

MANY infants come into the world with some parts imperfectly formed, and never more commonly than in the up­per part of the skull. If the deficiency be very great, and accompanied with a like want of brain, such fetuses fall under the class of Monsters, and being never born a­live, are not subjects of this work.

The hernia of the brain, on the other hand, is met with in infants otherwise com­pletely formed, and is generally curable.

The public is indebted to Mons. Ferrand for an accurate description of this complaint, given in the 5th. volume of the Memoirs de L'Academie royale de chirurgie.

The Encephalocele is a soft circumscribed tumor, usually of a round form, and cor­respondent in size with the extent of the deficiency of cranium; to which the com­plaint is owing. It is without fluctuation, [Page 301] or discolouration of the skin, but is attended with a perceptible pulsation of the brain, which synchronizes with the pulse. The tumor retires and disappears upon pressure, and is always situate either on one of the fon­tanelles, or in the course of one of the sutures, and is never larger than a pullet's egg. Where the defect of ossification is very con­siderable, a much larger portion of brain is consequently protruded, which strictly speak­ing, it were less proper to call a disease, than a fatal mal-formation, as it is pertinent­ly remarked by Mons. Ferrand; and no more resembles the true encephalocele, than an eventration resembles the common intes­tinal hernia. It will be very necessary, however, carefully to distinguish this incu­rable evil from other soft tumors of the scalp, presently to be noted, which it very much resembles; the latter having frequently the like precise feel of a bony margin around the tumor, as is common, indeed, in cases of extravasation upon any solid surface. The tumor is also colourless, and often as large as in the fatal mal-formation, but has a con­siderable fluctuation, and is farther distin­guishable by the tumor not retiring upon pressure, nor being attended with any pul­sation.

The Encephalocele is, indeed, easily dis­tinguished from them both, by the brief de­scription above given of it; and fatal as it [Page 302] would be were it left to itself, it requires on­ly to be properly understood, in order to adapt a rational and effectual remedy, which consists only in a careful and due compres­sion of the part. This may be effected by the application of a piece of lead, somewhat larger than the tumor, and pierced with holes, that it may be sewed to the child's cap. The compression should at first be ve­ry moderate, and always such as may not give pain to the infant, nor disturb any or the natural functions; and may gradually be increased as the tumor shall retire. This is all that is required from art, the cure be­ing the business of nature, which if the child continue healthy, will proceed in the work of ossification, and in due time will fill up the vacancy in the skull. The pro­trusion of the brain was before an obstacle to this process, whilst the injury that tender organ must sustain by the pressure from the sides of the bone, exposed it to all the evils which compression never fails to produce; and which it were needless to enumerate in this place.

TUMORS of the SCALP.

THERE are other tumors on the heads of new-born infants, which it were improper intirely to pass over. One kind [Page 303] is occasioned by long compression in the birth, is of different sizes, and the skin is always discoloured, but seldom requires much attention, as these tumors frequently disappear in a few hours. If large, it is common to bathe, or foment them with red wine, brandy and water, or vinegar, and in general they gradually subside, though sometimes not perfectly for several days. Some of them, however, are of more con­sequence, and concerning the treatment of which practitioners have differed; the ab­solute impropriety of opening any tumors arising from compression having been con­ceived of by many. On the other hand, I believe, it may in some cases, be really ne­cessary, in order to prevent a troublesome fungous sore, and even a caries of the skull. The discrimination, however, is sufficiently obvious, such assistance being required only where the above remedies and compression have had no effect, and the tumor is found sensibly to increase day after day, which in some instances has been the case to the end of the month. Such growth is always ow­ing to the extremities of the arteries rup­tured by long compression, being still open, and pouring out an ichorous fluid into the cellular membrane, and thereby keeping up and increasing the original tumor.

Upon opening the integuments, a bloody fluid is led out, and the tumor nearly sub­sides, [Page 304] which afterwards requires nothing but moderately astringent applications and pressure, which should be continued for a little time after the aperture is closed.

Another kind of tumor has been hinted, which has a more unfavourable appearance; and of which it may be proper in this place to take a little farther notice. These tu­mors contain a kind of serum, and are often very large, but without that discolouration of the scalp and bruised appearance, that there constantly is in those last described, nor do they, indeed, seem to arise from compression; I have, at least, seen them extending over a fourth part of the head, and raised a full inch from the skull, after the shortest and most easy labors. To the description before given of them it may be added, that this kind of tumor, I believe, will always subside very kindly, though sometimes not completely, for several weeks. It usually begins to lessen, however, in six or eight days after birth; and as it subsides, more and more of the skull may be felt, from day to day, in proportion as the ab­sorption of the fluid takes place. To assist nature, therefore, in this operation, em­brocations of vinegar, crude sal ammoniac and camphorated spirit should be made use of; with a gentle compression of the part, as well as keeping the bowels properly open.

LVMPHATIC TUMORS on the HEAD and SPINE.

THERE is another kind of tumor ap­pearing sometimes on the head, and at others, on some part of the spine, which is not owing to accidents in the birth, but is of a morbid nature. These tumors con­tain a lymph, and are attended with evident fluctuation, as may be discerned by the touch; and unless they are exceedingly small, ought in no case, I believe, to be punctured, or even removed by ligature, though adhering only by a small pedicle. Those on the spine of the neck, or back, or on the loins, if they do not arise from the dura mater inclosing the medulla spinalis, seem to originate at least from the periosteum of the spine; and the issue having some morbid source, will be kept up after the tu­mors are opened, or even totally extirpated, and preventing the sore from healing, the infant sinks under the discharge, or dies in convulsions.

But there are other tumors of a similar appearance, which being nevertheless of a different kind, may be sometimes safely ex­tirpated, and will be noticed below under the head of Spina Byfida, to which like­wise they bear a considerable resemblance.

SPINA BYFIDA and PARENCHYMATOUS TUMORS.

THE Spina byfida is too well known to require much to be said upon it. It is a fatal mal-formation, and seldom admits even of much temporary relief, though some evils may be prevented by pointing out the most innocent applications.

It is of two kinds, open and occult. They both arise from deficiency of bone in some part of the spine, usually about the loins, or os sacrum. The ulcerated ones are of a deep red colour, and in figure and size resemble the mouth when the lips are drawn together, and the angles brought to­wards the centre. When the spina bysida, is occult, or the skin is yet intire, it is of a scarlet, or sublivid hue, the tumor une­qual, pretty firm in some parts, and in o­thers raised into little vesicles, and often re­sembles a cancer just about to break into a sore. It is well known, that in this state, the skin ought not to be opened, as it would certainly hasten the death of the infant. On the other hand, every mean should be made use of to prevent the skin from giving way, which should therefore be dressed with cool­ing, astringent and drying applications, in the form of lotions and powders, and the [Page 307] part afterwards covered with a saturnine ce­rate; which are likewise the properest ap­plications afterwards, as well as for that which is open from the birth, and will, at least, afford some ease, as well as tend to prolong the life of the child. Such treat­ment is also the more proper, from the hope that the tumor, whilst occult, may possibly be of the more benign kind, now to be noticed.

These I have termed parenchymatous tu­mors; they appear on different parts of the spine, but more commonly near the neck or os sacrum, are accounted marks, and some­times, it has been said, resemble the spin [...] byfida, but are not always of such a morbid nature as to prove certainly fatal, though it is probable, they all might, if left to themselves. As I design, however, to treat only of such as will admit of some remedy, I shall mention only two.

The first is a tumor on some of the verte­brae, usually of the neck, or the first of the back; it is of a sublivid hue, unequal, in­ternally spongy, and very vascular. I saw one of this kind some years ago, in consul­tation with the late Sir Caesar Hawkins, who advised to preserve the skin unbroken, as long as it should be possible, which he feared was all that could be done for it; and to this end, recommend the free use of the compound water of acetated litharge. [Page 308] It was then about the size of a crown-piece, and not raised very much above the level of the surrounding parts. The tumor, how­ever, increased, and the skin not long af­terwards gave way, and the child became ill; in consequence of which the late Dr. Hunter was desired to give his opinion, who advised the tumor to be taken out, as the only chance for preserving the child's life: but the father disapproved of the operation. The part soon began to bleed a good deal at times; in order to suppress which, as well as to lessen the tumor, which was now considerably more prominent, I sprinkled it with the following powder, R. Bol. Armen. pulv. Catechu ā ʒij. Allumin. rup. ℥j. Misce. Over this, compresses wetted as above were applied frequently through the day. These would sometimes adhere for several days owing to the blood and powder forming a sort of paste, till a fresh oozing from the vessels loosened them; at which time the bleeding returned, and the applications were repeated: by the continuance of which, however, for seven or eight weeks, and compression with a piece of thin lead, the vessels gradually shrunk, and the discharge being dried up, the part was happily skin­ned over, and the child recovered its health.

I have lately seen another tumor of this kind, which was treated in a different man­ner. It was seated on the last vertebrae of [Page 309] the back, and was apprehended to be the true Spina byfida: but as no part of the bone could be felt, nor the tumor by pres­sure, be made to recede, I hoped it might be otherwise, and ventured to advise taking it off, as the only chance the infant had for its life. This was accordingly done when the child was about eight days old, and though a good deal of blood was lost in the operation, from a deep seated artery, the sore at the end of the month was per­fectly healed, and the child soon after­wards became as healthy as any other in the family▪

On the HARE-LIP, and other EXTERNAL BLEMISHES, or COMPLAINTS, supposed to be MARKS of the MOTHER.

THOUGH it be somewhat beside my purpose, to treat expressly on surgical operations, I cannot close this part of my subject without taking notice of the hare­lip, and other very common blemishes, if it were only for the sake of adding my testi­mony to that of a sensible modern writer,^* who has in an able manner, though not with equal success, combated the unhappy pre­judices of mothers in relation to marking [Page 310] their children; which they always imagine to be owing to a violent impression from the sight of some disagreeable object, or to a disappointment in something they may have longed for, during their pregnancy.—And I have chosen this place for such observati­ons as I have to offer on this head, because the hare-lip, and a few other of the blemish­es remaining to be noticed, bear that resem­blance to objects around us, which is want­ing in those before mentioned.

The repeated experience of every atten­tive observer, has uniformly militated against the tormenting suspicion alluded to, but still it prevails, though only to the injury of those who ought, for their own sakes, to be persuaded to the contrary. Every man long in business has known many instances of affectionate [...]others, (for this needless dis­tress falls only to the lot of such) who have tormented themselves for six or seven months together, in the painful apprehension of dis­covering some sad blemish in the child, (and on this account have trembled to look on it when it has come into the world) which has afterwards proved to be as perfect as they could have wished, and as the more more dispassionate amongst their friends have all along ventured to foretel. On the other hand, where children have been born with some real blemish, it has never been sus­pected by the mother, unless now and then [Page 311] in a most timid person, (who has always bred in fear on account of some disagreea­ble object or other she has seen), or else the blemish has turned out to be something perfectly irrelative to it.^* And here it ought to be noticed, that where a child has really [Page 312] been marked, and the mother has insisted on her having seen, and been frighted by an object which the blemish has resembled, it has, (to the best of my knowledge, at least) appeared always to be an after­thought, by which the supposed occasion of it has been discovered; and has not been taken notice of before-hand. It is, howe­ver, the farthest from my thoughts to up­braid the sufferer on this painful occasion, or to tax any wilful giving way to suspicions, into which, I am persuaded, their feelings alone insidiously betray them. I wish only to obviate the influence of a sentiment that I take to be without sufficient foundation, and to which nothing but length of time, and prescription, could have given a sanction.

[Page 313] That there are blemishes which bear a resemblance to various objects around us, daily experience has proved; though the true occasion of them is not, perhaps, under­stood. The like deviations from the ordi­nary course is observed, not only in other animals, but also in the vegetable kingdom, fruits being often joined together, and other­wise strangely misshaped, which must arise from the common laws of nature being some-wise diverted from their usual course, by some accidental cause equally unknown to us. But however this may be occasion­ed, there is nothing that we know of in a fright or longing, that can produce such a change in organized matter, nor can ope­rate in the manner that has been supposed, much less at such different periods; but there is, on the other hand, every thing against such an hypothesis; which has ac­cordingly always given way in enlightened ages.

The instance so often adduced from the sa­cred historian, is by no means in point: for without adverting to the very peculiar na­tural circumstances in that transaction, which are wanting in ordinary instances, it is suffi­cient to observe, that there was therein an evident divine interposition. Should any one doubt of this, he has only to make a si­milar experiment, the result of which will, probably, have more weight than ten thou­sand [Page 314] arguments. As matter of fact there­fore, as before observed, does not at all countenance, but directly contradict the hy­pothesis, there is the strongest reason for married women arguing themselves out of such fears, instead of reasoning themselves into them, and suffering a painful conflict for weeks, and months together. It will give me great pleasure if any thing I have advan­ced on the subject, should answer so desira­ble an end; whilst reason, philosophy, ex­perience, and every thing on which we ought to depend, conspire to support such an attempt.

Amongst the various Marks resembling some of the objects around us, that called the Hare-lip is the most common; a ble­mish too well known to require any descrip­tion. It is sufficient to observe, that it is of two kinds; the simple, wherein the upper lip only is divided, either wholly or in part, with some loss of substance; and the com­plex, in which the fissure of the lip is double; and sometimes the palate of the mouth, and even the uvula is divided. It would be be­side my purpose, in this place, to treat of the manner in which this deformity and de­fection is to be remedied; I shall confine myself to speaking only of the time in which it ought to be attempted.

Various considerations contribute to make the distressed parents solicitous to have this [Page 315] blemish removed soon after the infant is born, or at farthest before the month shall be expired. On this account I am convinc­ed, the operation has sometimes been pre­maturely performed, contrary to the better judgment of the operator, and not a few children have thereby fallen a sacrifice; whilst others have received much less bene­fit than they would have done, had the ope­ration been postponed for a reasonable time. Where the blemish is very trifling, indeed, and the operation simple, it may be done with reasonable safety in the course of the month, or a little after; and if the child be able to suck, which is not always the case, there are even some advantages in perform­ing it sooner. For as the child will not be able to take the breast for two days at least after the operation, it will with difficulty be kept tolerably quiet by the spoon after it has been once put to the breast; but as in­fants need but very little nourishment for the first days after birth, and generally sleep a good deal, if the operation be done twenty-four hours after the child is born, it will be in a condition to suck by the time it requires much nourishment, and the mother's breast is prepared to furnish it. But in the com­plex hare-lip the case is exceedingly diffe­rent, and the longer the operation is post­poned, the better it is likely to succeed, and [Page 316] should at least be deferred till the child shall be four or five months old; the good effects of which I have lately seen in a child born at the Lying-in hospital. By this time also, the infant will have got over the period in which it is most liable to some painful and dangerous complaints; will be thoroughly weaned from its hankering after the breast, and have learned to feed contentedly with the spoon; by which children with this kind of hare-lip are obliged to be supported, they being always unable to suck. At this period likewise, the parts will have acquir­ed a degree of firmness necessary to retain the needles, as well as size that will admit of handling them to greater advantage; for the want of which, though the operation may appear to have been favourably per­formed, the needles will sometimes break out, and the deformity be but little remov­ed, or perhaps sometimes be increased.

I have once seen another blemish of the mouth in a child born at the hospital, which required a similar operation. In this infant, the mouth was much wider on one side than on the other, and appeared as if that side had been divided far into the cheek, which gave it a very awkward appearance; but as it was capable of being remedied in the same manner as the hare-lip, I shall only observe, that when I withdrew the pins on the third [Page 317] day, the parts adhered very firmly, and the child left the hospital at the usual time.

A different kind of blemish consists in some superfluous part. Such may sometimes adhere only by a small base, like a thread, and may be removed by only passing a tight ligature round them. But should any even adhere more firmly, and be only a small joint, such as a finger or a toe, it were better to have it cut off on the first days; as the ves­sels will then bleed but little, and the gristle by which such joints are usually connected, are not yet become bony. But should the part be more completely formed, it may be­necessary to delay the operation awhile longer, that by discovering which of the duplicates may take the lead, the more pro­mising one may be preserved; which is not always to be known with certainty, at the birth.

Beside these, there are blemishes of far greater importance, some of which demand an operation as the only chance for pre­serving the life of the infant. Such are im­perforations of the anus and urethra, or the vagina in females.

The Vagina is sometimes imperforate on the external, at others, only in the more internal parts; and is in different degrees. The latter more commonly relates only to the hymen, which requiring an operation to be performed about the age of puberty, [Page 318] I shall do more than barely mention here, especially as it requires only a simple, or crucial incision. Where the imperforation is in the substance of the vagina itself, I have never found an operation to be of any use, though I have known it attempted, in the adult, with great address and resolution.

I have never met with the external parts totally imperforate, but have known the aperture so very small as to require a little operation, which is mighty easily done with the point of a lancet; there being always a raphè, or line, directing the extent nature has seemed originally to intend, which be­ing through, requires only to be kept apart for a few days, by a bit of fine lint.

The imperforate ANUS is a melancholy case, as it seldom allows of an effectual re­medy, the gut often terminating in a cul de sac so high up as not to be reached; it is not, however, always to be despaired of, though no fluctuation of the intestinal con­tents should be felt for two or three days after the infant is born.

I remember only one case of this kind in the Lying-in hospital, and in that I hap­pened to succeed, contrary, indeed, to all expectation, and after the child had puked up a great quantity of meconium; and not only the belly, but also the face was exceed­ingly tumid, and the eyes had not been opened for some time.

[Page 319] The manner of doing this operation must, in different cases, depend so much on the discretion of the operator, that I shall do no more than describe that which I made use of in the instance alluded to.

The operation was not determined upon till the third day. A longitudinal incision was made, of about half an inch, above and below the part where the anus ought to have been, which was marked by a little ex­crescence; a small bistoury was then thrust up in the usual direction of the bowel, for more than an inch. No meconium following this puncture, I examined carefully with my finger, and feeling something like the fluctation meconium would make, I intro­duced a trochar, and withdrawing my finger, I carried up the instrument in such a direction as to avoid injuring the bladder, or forcing it against the os coccygis, for near an inch farther, making allowance, however, for the yielding of the parts, which might be somewhat forced up by the trochar. The in­strument having now passed forwards, with­out that resistance it had hitherto met with, gave me the sensation of having entered a cavity, when withdrawing the trochar, we had the satisfaction of finding the meconium run out at the canula. The child was now put into a warm-bath, up to the waist, and in a few minutes having voided a considera­ble quantity of meconium, it opened its [Page 320] eyes, looked cheerfully about it, and fell into a pleasant sleep before it was taken out of the bath.

A piece of bougie was occasionally intro­duced, and sometimes left in the part, for a few hours, for the first fortnight; after which the child recovered fast, and at the usual time was taken from the hospital in pretty good health, though it had been much reduced by a bad thrush, which un­fortunately made its appearance soon after the operation; but it always voided its stools perfectly well.

The imperforate Penis is not quite so common a case; but is not unfrequently suspected, when the end of the passage is merely stopped up by a little mucus; and should therefore be examined in good time. In this case, washing the part with warm milk and water, or at most, a little assistance with a small probe, or any such blunt pointed instrument, will be sufficient to open the passage. But it is evident, if the urethra be wanting no operation at all can be per­formed: it is, however, more commonly found open a certain way, and often as far as the basis of the glans, and sometimes near to its extremity; in which last in­stance, it is necessary only to make a small aperture with a lancet, or a fine trochar, and to keep the part open by the occasion­al introduction of a bougie. The more [Page 321] common complaint of this part however, is that of the urinary passage terminating by a small aperture at a little distance below the glans, and sometimes on one side of it. In these cases, the precise circumstances must determine the propriety of any opera­tion, which if not carefully managed, may render the case worse than it was. I re­collect two indeed, in which I was able to do considerable service, one of which was in the presence of the late Sir Caesar Haw­kins, and the other of the late Dr. Hunter; in the latter, the urine was discharged from one side of the penis, and pretty low down, which was very happily remedied.

There are other mal-formations of this part, by which it is drawn downwards, or to one side; the peculiar circumstances of which, must point out the nature of the operation most likely to afford relief. This will generally consist in a simple incision of the skin, where it may happen to be too tight or short, and keeping the divided ed­ges at a distance from each other, till the little sore shall be healed.

I have likewise known the Ears to be im­perforate, a case that allows of no re­medy; but the external appearance may sometimes be assisted, when the helix, or outer circle, is turned forwards over the tragus, covering that part which ought to lead to the internal ear; but in these cases, [Page 322] I have always found the concha, and meatus auditorius, totally obliterated.

Another, and a very common blemish, is that called Squinting, which is sometimes contracted by very young infants, and may then frequently be remedied, especially if confined to one eye; but if a child be born with this deformity, it is not so likely to be removed. The means I have to recom­mend are, indeed, very simple, and con­sist only in applying a piece of sticking-plaister spread on some bright coloured silk, in such a position, either on the temple, or the nose, agreeably to the side on which the eye is distorted, as may draw it the con­trary way. In order to keep up this at­traction, the colour of the silk ought to be varied from time to time, as well as its situ­ation, placing it a little higher, or lower, both for the sake of change, as well as to answer any other end, that a due observa­tion on its effects may point out. Besides this, the child ought always to be placed with that side towards the light from which the eye is distorted; and for the like reason, its parents, nurse, play-things, and every other object that can attract its notice, should as constantly as is possible be on the same side, that the child may have every inducement it, age and circumstances will allow, to draw the eye the right way, and [Page 323] by early habit, counteract a muscular action that is not yet become permanent.

Another method more proper for older children, is covering the eyes with ogles, which are glasses fixed in a little case, such as many people wear when they ride on horseback. They must be so placed, that the child can see no object but by turning the eyes to the sides from which they are distorted. It is scarcely necessary to add, that the glasses must be worn constantly, till the bad habit is overcome.

Infants are liable, indeed, to many other blemishes; but as I mean to treat only of such as call for medical attention, and ad­mit of some remedy, I shall mention only one or two more, which are very common, and with them close what I have to say on their Complaints.

VARI and VALGI.

THESE are distortions of the feet, and differ only with respect to the side to which the foot is turned; in the former, the soles of the feet being turned inwards, and in the latter, outwards: the curative intention is therefore alike in both. The complaint is sometimes very trifling, and seems to have been owing only to some cram­ped position of the feet in the womb, and [Page 324] in that case, disappears before the end of the month. In other instances, there is evidently a contraction, if not accurtation of the tendons, which calls for considerable attention. The remedy, is obvious enough, and consists only in the proper application of a roller and paste-board splints, so as gra­dually to bring the foot towards its natural position, and in proportion as it inclines thereto, increasing the force and tightning the roller, every two or three days.

There is also another very common dis­tortion, to which no particular name, I be­lieve, has been given, in which the feet are turned upward towards the instep: but the mode of treatment is alike in them all, and the cure will usually be effected in a reason­able time.—The like easy means, therefore, will generally be sufficient to remedy a con­traction of the joints of the fingers, and va­rious awkward positions of the toes, with which some infants come into the world.

All these complaints may, nevertheless, be sometimes more considerable, and in such case, especially if neglected for many months, or even years, as they sometimes are, re­quire the assistance of some steel instrument, or irons, (as they are called,) which are properly contrived for these and other dis­tortions, as of the knees, &c. by Messrs. Ad­dison, Sheldrake, and other truss-makers; who seldom fail of bringing the parts into a [Page 325] more natural form, even in the worst cases, whenever parents may think the complaint worthy of the time and attention that may be required.