MISERABLE indeed is the lot of man in the state of infancy. He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his parents; but alas! this care is not always bestowed upon him; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants.
OF the officious and ill-judged care of midwives, we shall adduce only one instance, viz. the common practice of torturing infants by squeezing their breasts, to draw off the milk, as they call it. Though a small quantity of moisture is generally found in the breasts of infants, yet as they are certainly not intended to give suck, this ought never to be drawn off. I have seen this cruel operation bring on hardness, inflammation, and suppuration of the breasts; but never knew any ill consequences from its being omitted. When the breasts are hard, the only application that we would recommend is a soft poultice, or a little of the diachylon plaster, spread thin upon a bit of soft leather, about the size of half a crown, and applied over each nipple. These may be suffered to continue till the hardness disappears.
IT must be obvious to every attentive person, that the first diseases of infants arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned with indigestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be considered as a poison; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at last convulsions and death.
AS these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to expel it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may be mixed in two table-spoonfuls of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour, till it operates; or, what will more certainly answer the purpose, a grain of emetic tartar may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are not fond of usng the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel.
THESE medicines will not only cleanse the stomach, but will, generally, likewise open the body; should this, however, not happen, and if the child be costive, some gentle purge will be necessary: for this purpose, some manna and pulp of cassia may be dissolved in boiling water, and given in small quantities of it operates, or, what will answer rather better, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and continued till it has the desired effect. If these medicines be properly administered, and the child's belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bowels from which infants suffer so much.
THESE general directions include most of what can be done for relieving the internal disorders of infants. They will likewise go a considerable way in alieviating those which appear externally, as the rash, gum, or fellon, &c. These, as was formerly observed, are principally owing to too hot a regimen, and consequently will be most commonly relieved by gentle evacuations. Indeed, evacuations, of one kind or other, constitute a principal part of the medicine of infants, and will seldom, if administered with prudence, in any of their diseases, fail to give relief.
THE stomach and bowels of a new-born infant are filled with a blackish-coloured matter of the consistence of syrup, commonly called the meconium.This is generally passed soon after the birth, by the mere effort of Nature; in which case it is not necessary to give the infant any kind of medicine. But if it should be retained, or not suffciently carried off, a little manna or magnesia alba may be given, as mentioned above; or, if these fhould not be at hand; a common spoonful of whey, sweetened with a little honey, or raw sugar, will answer the purpose.
The most proper medicine for expelling the meconium is the mother's milk, which is always, at first, of a purgative quality. Were children allowed to suck as soon as they shew an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium; but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats.
THE apthae are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and stomach of infants, sometimes they reach through the the whole intestinal canal; in which case they are very dangerous, and often put an end to the infant's life
IF the apthae are of a pale colour, pellucid, few in number, soft, superficial, and fall easily off, they are not dangerous; but if opake, yellow, brown, black, thick, or running together, they ought to be dreaded.
IT is generally thought that the apthae owe their origin to acid humours; we have reason, however, to believe they are more frequently owing to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with wine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion inflammatory disorders even in adults; is it any wonder then that they should heat and inflame the tender bodies of infants, and set, as it were, the whole constitution on a blaze?
THE most proper medicines for the apthae are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb and half a drachm of magnesia alba may be rubbed together, and divided into six doses, one of which may be given to the infant every four or five hours till they operate. These powders may either be given in the child's food, or a little of the syrup of pale roses, and may be repeated as often as is found necessary to keep the body open. It is common in this case to administer calomel; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution.
MANY things have been recommended for gargling the mouth and throat in this disease; but it is not easy to apply these in very young infants; we would therefore recommend it to the nurse to rub the child's mouth frequently with a little borax and honey; or with the following mixture; Take fine honey an ounce, borax a drachm, burnt alum, half a drachm, rose-water two drachms; mix them together. A very proper application in this case, is a solution of ten or twelve grains of white vitriol in eight ounces of barley-water. These may be applied with the finger, or by means of a bit of soft rag tied to the end of a probe.
THE food of children being, for the most part, of an acescent nature, it readily turns sour upon the stomach, especially if the body be any way disordered. Hence most diseases of chidren are accompanied with evident signs of acidity, as green stools, gripes, &c. These appearances have induced many to believe, that all the diseases of children were owing to an acid abounding in the stomach and bowels; but whoever considers the matter attentively, will find that these symptoms of acidity are oftener the effect than the cause of their diseases.
NATURE evidently intended that the food of children should be acescent; and unless the body be disordered, or the digestion hurt from some other cause, we will venture to say, that the acescent quality of food is seldom injurious to them. Acidity, however, is often a symptom of disorders in children, and, as it is sometimes a troublesome one, we shall point out the method of relieving it.
WHEN green stools, gripes, purgings, sour smells, &c. shew that the bowels abound with an acid, the child should have a little small broth, with light white bread in it; and should have sufficient exercise in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs eyes, and other testaceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove very hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines; as rhubarb, manna, or such like.
THE best medicine which we know, in all cases of acidity, is that fine insipid powder called magnesia alba. It purges, and at the same time corrects the acidity: by which means it not only removes the disease, but carries off its cause. It may be given in any kind of food, or in a mixture, as recommended in the Appendix; See Appendix, Laxative Absorbent Mixture.
WHEN an infant is troubled with gripes, it ought not at first to be dosed with brandy, spiceries, and other hot things, but should have its body opened with an emollient clyster, or the medicine mentioned above; and at the same time a little brandy may be rubbed on its belly with a warm hand before the fire. I have seldom seen this fail to ease the gripes of infants. If it should happen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoonful of it given frequently till the infant be easier. Sometimes a little peppermint-water will answer this purpose very well.
THESE are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine.
AS these complaints are, in a great measure, owing to want of cleanliness, the most effectual means of preventing them are, to wash the parts frequently with cold water, to change the linen often, and, in a word, to keep the child, in all respects, thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders; as burnt hartshorn, tutty, chalk, crabs claws prepared, and the like. When the parts afffected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders; or to anoint the place with the camphorated ointment. If the parts be washed with spring-water, in which a little white vitriol has been dissolved, it will dry and heal them very powerfully. One of the best applications for this purpose, is to dissolve some fuller's earth in a sufficient quantity of hot water; and after it has stood till it is cold, to rub it gently upon the galled parts once or twice a-day.
THE nostrils of infants are often plugged up with a gross mucus, which prevents their breathing freely, and likewise renders it difficult for them to suck or swallow.
SOME, in this case, order, after a suitable purge, two or three grains of white vitriol dissolved in half an ounce of marjoram-water, and filtered, to be applied now and then to the nostrils with a linen rag. Wedelius says, If two grains of white vitriol, and the same quantity of elaterium, be dissolved in half an ounce of marjoram-water, and applied to the nose, as above directed, that it brings away the mucus without sneezing.
IN obstinate cases these things may be tried; but I have never found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free. Some nurses remove this complaint by sucking the child's nose. This is by no means a cleanly operation; but when nurses have the resolution to do it, I am far from discouraging the practice.
FROM the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irritates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood than in the more advanced periods of life. They are seldom, however, dangerous, and ought never to be considered as diseases, unless when they are violent, or continue so long as to exhaust the strength of the patient.
VOMITING may be excited by an over-quantity of food; by food that is of such a nature as to irritate the nerves of the stomach too much; or by the sensibility of the nerves being so much increased as to render them unable to bear the stimulus of even the mildest element.
WHEN vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend upon cleansing the stomach. This may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it is owing to food of an acrid or irritating quality, the diet ought to be changed, and aliment of a milder nature substituted in its stead.
WHEN vomiting proceeds from an increased degree of sensibility, or too great an irritability of the nerves of the stomach, such medicines as have a tendency to brace and strengthen that organ, and to abate its sensibility, must be used. The first of these intentions may be answered by a slight infusion of the Peruvian bark, with the addition of a little rhubarb and orange-peel; and the second by the saline draughts, to which a few drops of liquid laudanum may be occasionally added.
IN obstinate vomitings the operation of internal medicines may be assisted by aromatic fomentations with wine, applied warm to the pit of the stomach; or the use of the stomach-plaster, with the addition of a little Theriaca.
A LOOSENESS may generally be reckoned salutary when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappeared. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours, which would otherwise tend to relax the habit.
AS the principal intention in the cure of a looseness is to evacuate the offending matter, it is custornary to give the patient a gentle vomit of ipecacuanha, and afterwards to exhibit small and frequent doses of rhubarb; interposing absorbent medicines, to mitigate the acrimony of the humours. The best purge however, in this case, is magnesia alba. It is at the same time absorbent and laxative, and operates without exciting gripes.
THE antimonial wine, which acts both as an emetic and purge, is also an excellent rnedicine in this case. By being diluted with water, it may be proportioned to the weakest constitution; and, not being disagreeable to the palate, it may be repeated as often as occasion requires. Even one dose will frequently mitigate the disease, and pave the way for the use of absorbents. If, however, the patient's strength will permit, the medicine ought to be repeated every six or eight hours, till the stools begin to assume a more natural appearance; afterwards a longer space may be allowed to intervene between the doses. When it is necessary to repeat the medicine frequently, the dose ought always to be a little increased, as its efficacy is generally diminished by use.
SOME, upon the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be administered before the acrid humours are discharged, though the disease may appear to be mitigated for a little time, it soon afterwards breaks forth with greater violence, and often proves fatal. After proper evacuations, however, these medicines may be administered with considerable. advantage.
SHOULD any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of poppies may be given in a little simple cinnamon-water, three or four times a-day till these symptoms have ceased.
CHILDREN, while on the breast, are seldom free from eruptions of one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the greatest caution. They tend to free the bodies of infants from hot and acrid humours, which, if retained, might produce fatal disorders.
THE eruptions of children are chiefly owing to improper food, and neglect of cleanliness. If a child be stuffed at all hours with food that its stomach is not able to digest, such food, not being properly assimilated, instead of nourishing the body, fills it with gross humours. These must either break out in form of eruptions upon the skin, or remain in the body, and occasion fevers and other internal disorders. That neglect of cleanliness is a very general cause of eruptive disorders, must be obvious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to swarm with vermin, and are generally covered with the scab, itch, and other eruptions.
WHEN eruptions are the affect of improper food, or want of cleanliness, a proper attention to these alone will generally be sufficient to remove them. If this should not be the case, some drying medicines will be necessary. When they are applied, the body ought at the same time to be kept open, and cold is carefully to be avoided. We know no medicine that is more safe for drying up cutaneous eruptions than sulphur, provided it be prudently used. A little of the flour of sulphur may be mixed with fresh butter, oil or hog's lard, and the parts effected frequently touched with it.
THE most obstinate of all the eruptions incident to children are, the tinea capitis, or scabbed head, and chilblains. The scabbed head is often exceeding difficult to cure, and sometimes indeed the cure proves worse than the disease. I have frequently known children seized with internal disorders, of which they died soon after their scabbed heads had been healed by the application of drying medicines. I sometimes ago saw a very striking instance of the danger of substituting drying medicines in the place of cleanliness and wholesome food, in the Foundling Hospital at Ackworth, where the children were grievously afflicted with scabbed heads and other cutaneous disorders. Upon inquiry it was found, that very little attention was paid either to the propriety or soundness of their provisions, and that cleanliness was totally neglected; accordingly it was advised that they should have more wholesome food, and be kept thoroughly clean. This advice, however, was not followed. It was too troublesome to the servants, superintendants, &c. The bussiness was to be done by medicine; which was accordingly attempted, but had nearly proved fatal to the whole house. Fevers and other internal disorders immediately appeared, and, at length, a putrid dysentary, which proved so infectious, that it carried off a great many of the children, and spread over a considerable part of the neighbouring country.
THE cure ought always first to be attempted by keeping the head very clean, cutting off the hair, combing and brushing away the scabs, &c. If this is not sufficient, let the head be shaved once a-week, washed daily with soap suds, and gently anointed with a liniment made of train oil eight ounces, red precipitate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, sprinkled with a little burnt allum. While these things are doing, the patient must be confined to a regular light diet, the body should be kept gently open; and cold, as far as possible, ought to be avoided. To prevent any bad consequences from stopping this discharge, it will be proper, especially in children of a gross habit, to make an issue in the neck or arm, which may be kept open till the patient becomes more strong, and the constitution be somewhat mended.
CHILBLAINS commonly attack children in cold weather. They are generally occasioned by the feet or hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This occasions a sudden rarefaction of the humours, and an infraction of the vessels; which being often repeated, the vessels are at last over distended, and forced to give way.
TO prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and swell, the patient ought to be purged, and to have the affected parts frequently rubbed with mustard and brandy, or something of a warming nature. They ought likewise to be covered with flannel, and kept warm and dry. Some apply warm ashes betwixt cloths to the swelled parts, which frequently help to reduce them. When there is a sore, it must be dressed with Turner's cerate, the ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are indeed troublesome, but seldom dangerous. They generally heal as soon as the warm weather sets in.
CHILDREN are often seized very suddenly with this disease, which, if not quickly relieved, proves mortal. It is known by various names in different parts of Britain. On the east coast of Scotland it is called the croup. On the west they call it the chock or stuffing. In some parts of England, where I have observed it, the good women call it the rising of the lights. It seems to be a species of asthma, attended with very acute and violent catarrhal symptoms.
THIS disease generally prevails in cold and wet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes known it hereditary. It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet clothes, or any thing that obtructs the perspiration, may occasion the croup.
IT is attended with a frequent pulse, quick and laborious breathing, which is performed with a peculiar kind of croaking noise, that may be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though sometimes it is of a livid colour.
WHEN a child is seized with the above symptoms, his feet should immediately be put into warm water. He ought likewise to be bled, and to have a laxative clyster administered as soon as possible. In this disease bleeding is not always proper; but in very full habits it must certainly be of use. He should be made to breathe over the steams of warm water and vinegar; or an emollient decoction, and emollient cataplasms or fomentations may be applied round his neck. If the symptoms do not abate, a blistering plaster must be applied round the neck or betwixt the shoulders, and the child may take frequently a table-spoonful of the following julep: Take penny-royal water three ounces, syrup of althea and balsamic syrup, each one ounce, mix them together.
ASAFOETIDA is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two drachms of asafoetida may be dissolved in one ounce of Mindererus spirit, and three ounces of penny-royal water. A table-spoonful of this mixture may be given every hour, or oftener if the patient's stomach be able to bear it. If the child cannot be brought to take this medicine, two drachms of the asafoetida may be dissolved in a common clyster, and administered every six or eight hours, till the violence of the disease abates. I was lately favoured with a letter from Dr. William Turnbull in London, a physician of great experience; and who, from his former situation on the north-east coast of England, had many opportunities of observing the symptoms and progress of this dangerous disease. I am sorry the letter came too late to be inserted at length; but as the Doctor's sentiments differ very little from my own, this misfortune is the less to be regretted. The Doctor indeed observes, that he never found blistering of any service; but recommends cataplasms of garlic, camphor, and Venice treacle, to be applied both to the throat and soles of the feet. He likewise recommends boluses of camphor, castor, valerian root, salt of hartshorn, and musk, adapted to the age, strength, &c. of the patient; after which he advises two spoonfuls of following decoction: - Take of garlic and distilled vinegar each an ounce, hysop-water eight ounces; beat up the ingredients together, gradually mixing the water, and adding three ounces of honey. Let the whole be simmered over a gentle fire, and afterwards strained for use.
TO prevent a return of the disorder, all those things which occasion it must be carefully avoided; as wet feet, cold, damp, easterly winds, &c. Children who have had frequent returns of this disease, or whose constitutions seem to dispose them to it, ought to have their diet properly regulated; all food that is viscid or hard of digestion, and all crude, raw, trashy fruits are to be avoided. They ought likewise to have a drain constantly kept open in some part of their body, by means of a seton or issue: I have sometimes known a Burgundy-pitch plaster, worn continually betwixt the shoulders for several years, have a very happy effect in preventing the return of this dreadful disorder.
DR. ARBUTHNOT observes, that above a tenth part of infants die in teething, by symptoms proceeding from the irritation of the tender nervous parts of the jaws, occasioning inflammations, fevers, convulsions, gangrenes, &c. These symptoms are, in a great measure, owing to the great delicacy and exquisite sensibility of the nervous system at this time of life, which is too often increased by an effeminate education. Hence it comes to pass, that children who are delicately brought up, always suffer most in teething, and often fall by convulsive disorders.
ABOUT the sixth or seventh month the teeth generally begin to make their appearance; first the incisores, or fore-teeth; next the canini, or dog-teeth; and, lastly, the molares, or grinders. About the seventh year, there comes a new set; and about the twentieth, the two inner grinders, called dentes sapientiae, the teeth of wisdom.
CHILDREN, about the time of cutting their teeth, slaver much, and have generally a looseness. When the teething is difficult, especially when the dog-teeth begin to make their way through the gums, the child has startings in his sleep, tumours of the gums, watchings, gripes, green stools, the thrush, fever, difficult breathing, and convulsions.
DIFFICULT teething requires nearly the same treatment as an inflammatory disease. If the body be bound, it must be opened either by emollient clysters or gentle purgatives; as manna, magnesia alba, rhubarb, senna, or the like. The food should be light and in small quantity; the drink plentiful, but weak and diluting, as infusions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added.
IF the fever be high, bleeding will be necessary; but this, in very young children, ought always to be sparingly performed. It is an evacuation which they bear the worst of any. Purging, vomiting, or sweating agree much better with them and are generally more beneficial. Harris, however, observes, that when an inflammation appears, the physician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be seized with convulsion fits, a blistering plaster may be applied betwixt the shoulders or one behind each ear.
SYDENHAM says, that in fevers occasioned by teething, he never found any remedy so effectual as two, three, or four drops of spirits of hartshorn in a spoonful of simple water, or other convenient vehicle, given every four hours. The number of doses may be four five, or six. I have often prescribed this medicine with success, but always found a larger dose necessary. It may be given from five drops to fifteen or twenty, according to the age of the child, and, when costiveness does not forbid it, three or four drops of laudanum may be added to each dose.
IN Scotland, it is very common, when children are cutting their teeth, to put a small Burgundy-pitch plaster between their shoulders. This generally eases the tickling cough which attends teething, and is by no means an useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, and ought to be renewed, at least once a fortnight.
SEVERAL things have been recommended for rubbing the gums, as oils, mucilages, &c. but from these much is not to be expected. If any thing of this kind is to be used, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a-day. Children are generally at this time disposed to chew whatever they get into their hands. For this reason they ought never to be without somewhat that will yield a little to the pressure of their gums, as a crust of bread, a wax candle, a bit of liquorice root, or such like.
WITH regard to cutting the gums, we have seldom known it of any great benefit. In obstinate cases, however, it ought to be tried. It may be performed by the finger-nail, the edge of a six-penny piece that is worn thin, or any sharp body which can be with safety introduced into the mouth; but the lancet, in a skilful hand, is certainly the most proper.
IN order to render the teething less difficult, parents ought to take care that their children's food be light and wholesome, and that their nerves be braced by sufficient exercise without doors, the use of the cold bath, &c. Were these things duly regarded, they would have a much better effect than teething necklaces, or other nonsensical amulets worn for that purpose.
THIS disease generally attacks children between the age of nine months and two years. It appeared first in England about the time when manufactures began to flourish, and still prevails most in towns where the inhabitants follow sedentary employments, by which means they neglect either to take proper exercise themselves, or to give it to their children.
CAUSES. - One cause of the rickets is diseased parents. Mothers of a weak relaxed habit, who neglect exercise, and live upon weak watery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them, after they are brought forth. Accordingly we find that the children of such women generally die of the rickets, the scrophula, consumptions, or such like diseases. Children begotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases, or who have been often affected with the venereal disease in their youth, are likewise very liable to the rickets.
ANY disorder that weakens the constitution, or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough, &c. disposes them to this disease. It may likewise be occasioned by improper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it.
BAD nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough of milk to nourish the child, it cannot thrive. But children suffer oftener by want of care in nurses than want of food. Allowing an infant to lie or sit too much, or not keeping it thoroughly clean in its cloths, has the most pernicious effects.
THE want of free air is likewise very hurtful to children in this respect. When a nurse lives in a close, small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should always be in motion, unless when asleep; if it be suffered to lie, or sit, instead of being tossed and dandled about, it will not thrive.
SYMPTOMS. - At the beginning of this disease the child's flesh grows soft and flabby, its strength is diminished; it loses its wanted cheerfulness, looks more grave and composed than is natural for its age, and does not chuse to be moved. The head and belly become too large in proportion to the other parts; the face appears full, and the complexion florid. Afterwards the bones begin to be affected, especially in the more soft and spungy parts. Hence the wrists and ancles become thicker than usual; the spine or back bone puts on an unnatural shape the breast is likewise often deformed; and the bones of the arms and legs grow crooked. All those symptoms vary according to the violence of the disease. The pulse is generally quick, but feeble; the appetite and digestion, for the most part, bad; the teeth come slowly and with difficulty, and they often rot and fall out afterwards. Ricketty children generally have great acuteness of mind, and an understanding above their years. Whether this is owing to their being more in the company of adults than other children, or to the preternatural enlargement of the brain, is not material.
REGIMEN. - As this disease is always attended with evident signs of weakness and relaxation, our chief aim in the cure must be to brace and strengthen the solids, and to promote the digestion and the due preparation of the fluids. These important ends will be best answered by wholesome nourishing diet, suited to the age and strength of the patient; open, dry air, and sufficient exercise. If the child has a bad nurse, who either neglects her duty; or does not understand it, she shouid be changed. If the season be cold, the child ought to be kept warm; and when the weather is hot, it ought to be kept cool; as sweating is apt to weaken it; and too great a degree of cold has the same effect. The limbs should be rubbed frequently with warm hands, and the child kept as cheerful as possible.
THE diet ought to be dry and nourishing, as good bread, roasted flesh, &c. Biscuit is generally reckoned the best bread; and pigeons, pullets, veal, rabbits, or mutton roasted or minced, are the most proper flesh. If the child be too young for flesh-meats, he may have rice, millet, or pearl-barley boiled with raisins, to which may be added a little wine and spice. His drink may be good claret, mixed with an equal quantity of water. Those who cannot afford claret, may give the child now and then a wine-glass of mild ale, or good porter.
MEDICINE. - Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children of a gross habit, gentle vomits and repeated purges of rhubarb may sometimes be of use, but they will seldom carry off the disease; that must depend chiefly upon such things as brace and strengthen the system: for which purpose, besides the regimen mentitioned above, we would recommend the cold bath, especially in the warm season. It must, however, be used with prudence, as some ricketty children cannot bear it. The best time for using the cold bath is in the morning, and the child should be well rubbed with a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath, it must be discontinued.
SOMETMES issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale, would be of service, were it possible to bring children to take it. We might here mention many other medicines which have been recommended for the rickets; but as there is far more danger in trusting to these than in neglecting them altogether, we chuse rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on.
THOUGH more children are said to die of convulsions than of any other disease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves, may occasion convulsions. Hence infants whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimentary canal; likewise by teething; strait clothes; the approach of the small-pox, measles, or other eruptive diseases.
WHEN convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or renders these mild and inoffensive, will generally perform a cure; wherefore, if the child be costive, the best way will be to begin with a clyster, and afterwards to give a gentle vomit, which may be repeated occasionally, and the body in the mean time kept open by gentle doses of magnesia alba, or small quantities of rhubarb mixed with the powder of crabs claws.
CONVULSIONS which precede the eruption of the small-pox or measles, generally go off upon these making their appearance. The principal danger in this case arises from the fears and apprehensions of those who have the care of the patient. Convulsions are very alarming, and something must be done to appease the affrighted parents, nurses, &c. Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to great danger of its life, when a little time, bathing of the feet, and throwing in a mild clyster, would have set all to rights.
WHEN convulsion fits arise from the cutting of teeth, besides gentle evacuations, we would recommend blistering, and the use of antispasmodic medicines, as the tincture of soot, asafoetida, or castor. A few drops of any of these may be mixed in a cup of white-wine whey, and given occasionally.
WHEN convulsions proceed from any external cause, as the pressure occasioned by strait clothes or bandages, &c. These ought immediately to be removed; though in this case taking away the cause will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover, as long as the cause which first gave rise to the disorder continues to act.
WHEN a child is seized with convusions without having any complaint in the bowels, or symptoms of teething; or any rash, or other discharge, which has been suddenly dried up, we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhappy patient. When a disease proceeds from an original fault in the formation or structure of the brain itself, we cannot expect that it should yield to medicine. But, as this is not always the cause, even of convulsions which proceed immediately from the brain, some attempts should be made to remove them. The chief intention to be pursued for this purpose, is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders.
THOUGH water in the head, or a dropsy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly liabile to it, we thought it would be most proper to place it among the diseases of infants.
CAUSES. - A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like; it may likewise proceed from an original laxity or weakness of the brain; from scirrhous tumours or excrescences within the skull; a thin watery state of the blood, a diminished secretion of urine; and lastly, from tedious and lingering diseases, which waste and consume the patient.
SYMPTOMS. - This disease has at first the appearance of a slow fever; the patient complains of a pain in the crown of his head, or over his eyes; he shuns the light; is sick, and sometimes vomits. His pulse is irregular and generally low: though he seems heavy and dull, yet he does not sleep: he is sometimes delirious, and frequently sees objects double; towards the end of this commonly fatal disease, the pulse becomes more frequent, the pupils are generally dilated, the cheeks flushed, the patient becomes comatose; and convulsions ensue.
MEDICINE. - No medicine has hitherto been found sufficient to carry off a dropsy of the brain. It is laudable, however, to make some attempts, as time or chance may bring many things to light, of which at present we have no idea. The medicines generally used are, purges of rhubarb or jalap with calomel, and blistering plasters applied to the neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recommended in the common dropsy. A discharge from the nose ought likewise to be promoted by causing the patient to snuff the powder of asarum, white hellebore or the like. Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any instances of a cure being performed in a confirmed dropsy of the brain; but in so desperate a malady every thing deserves a trial. One reason why this disease is seldom or never cured, may be, that it is seldom known till too far advanced to admit of a cure. Did parents watch the first symptoms, and call a physician in due time, I am inclined to think that something might be done. But these symptoms are not yet sufficiently known, and are often mistaken even by physiclans themselves. Of this I lately saw a striking instance in a patient attended by an eminent practitioner of this city, who had all along mistaken the disease for teething.