To prevent the milk-fever, the breast ought to be frequently drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to prevent the milk from becoming acrid, and its being absorbed in this state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet.
We shall conclude our observations on child-bed women by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold, of which they never recover. It is pity the poor are not better taken care of in this situation.
But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this conduct must be obvious to every one.
The superstitious custom of obliging women to keep the house till they go to church, is likewise a very common cause of catching cold. All churches are damp, and most of them cold; consequently they are the very word places to which a woman can go to make her first visit, after having been confined in a warm room for a month.
Barrenness may be very properly reckoned among the diseases of females, as few married women who have not children enjoy a good state of health. It may proceed from various causes, as high living, grief, relaxation, &c. but it is chiefly owing to an obstruction or irregularity of the menstrual flux.
It is very certain that high living vitiates the humours, and prevents fecundity. We seldom find a barren woman among the labouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in proportion to their poverty; and it would be an easy matter to adduce many instances of women, who, by being reduced to live entirely upon a milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor vassals and dependants the blessing of a numerous and healthy offspring, while they pine in sorrow for the want of even a single heir to their extensive domains.
Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids; a state, highly unfavourable to procreation. To remove this, we would recommend the following course: First, sufficient exercise in the open air; secondly, a diet consisting chiefly of milk and vegetables[186]; thirdly, the use of astringent medicines, as steel, allum, dragon’s blood, elixir of vitriol, the Spaw or Tunbridge waters, Peruvian bark, &c.; and lastly, above all, the cold bath.
Barrenness is often the consequence of grief, sudden fear, anxiety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of the mind, the person ought to be kept as easy and cheerful as possible; all disagreeable objects are to be avoided, and every method taken to amuse and entertain the fancy.
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[187].
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 unwilling to use the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Small doses of the ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred.
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 till 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 alleviating 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 effectually 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 sufficiently carried off, a little manna or magnesia alba may be given, as mentioned above; or, if these should 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 aphthæ are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal; in which case they are very dangerous, and often put an end to the infant’s life.
If the aphthæ 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 aphthæ 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 aphthæ 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 children 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 oftner 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 their 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[188].
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 affected 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 medicines 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[189].
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 made 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 of the cure of a looseness is to evacuate the offending matter, it is customary 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 medicine 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 offending 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 hurtful 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 effect 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 affected 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[190]. 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 infarction 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 between 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 obstructs 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[191], and to have a laxative clyster administered as soon as possible. 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 between 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.
Asafœtida 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 asafœtida may be dissolved in one ounce of Mindererus’s spirit, and three ounces of penny-royal water. A table-spoonful of this mixture may be given every hour, or oftner, if the patient’s stomach be able to bear it. If the child cannot be brought to take this medicine, two drachms of the asafœtida may be dissolved in a common clyster, and administered every six or eight hours, till the violence of the disease abates[192].
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 between 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 dogteeth; 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 sapientiæ, 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 dogteeth 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 between 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 oftner 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 clothes, 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 wonted 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 backbone puts on an unnatural shape; the breast is likewise often deformed; and the bones of the arms and legs grow crooked. All these 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 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 should 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 a warm hand, 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 mentioned 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.
Sometimes 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 the great danger of its life, when a little time, bathing the feet in warm water, 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, asafœtida, 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 convulsions 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 origial 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 liable 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[193].
To describe all the operations of surgery, and to point out the different diseases in which these operations are necessary, would extend this article far beyond the limits allotted to it: we must therefore confine our observations to such cases as most generally occur, and in which proper assistance is either not asked, or not always to be obtained.
Though an acquaintance with the structure of the human body is indispensably necessary to qualify a man for being an expert surgeon; yet many things may be done to save the lives of their fellow-men in emergencies by those who are no adepts in anatomy. It is amazing with what facility the peasants daily perform operations upon brute animals, which are not of a less difficult nature than many of those performed on the human species; yet they seldom fail of success.
Indeed every man is in some measure a surgeon whether he will or not. He feels an inclination to assist his fellow-men in distress, and accidents happen every hour which give occasion to exercise this feeling. The feelings of the heart, however, when not directed by the judgment, are apt to mislead. Thus one, by a rash attempt to save his friend, may sometimes destroy him; while another, for fear of doing amiss, stands still and sees his bosom-friend expire without so much as attempting to relieve him, even when the means are in his power. As every good man would wish to steer a course different from either of these, it will no doubt be agreeable to him to know what ought to be done upon such emergencies.
No operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It is however an operation of great importance, and must, when seasonably and properly performed, be of singular service to those in distress.
Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonies, &c. It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs, head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After falls, blows, bruises, or any violent hurt received either externally or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul air, the fumes of metal, or the like. In a word, whenever the vital motions have been suddenly stopt from any cause whatever, except in swoonings occasioned by mere weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper.
Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lancet, it is to be preferred to any other method; but where a vein cannot be found, recourse must be had to leeches or cupping.
The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man.
From whatever part of the body blood is to be let, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be applied at least an inch, or an inch and half from the place where the wound is intended to be made.
Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whipcord under the finger.
It was formerly a rule, even among those who had the character of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body; besides, it may often be occasioned or prevented by the manner in which the operation is performed.
Children are generally bled with leeches. This, though sometimes necessary, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practice bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine.
Certain hurtful prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins, heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts from whence they are supposed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will perform wonders. This belief makes them often postpone the operation when necessary, in order to reserve it for some more important occasion, and, when they think themselves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain dated periods or seasons has likewise bad effects.
It is a common notion that bleeding in the feet draws the humours downwards, and consequently cures diseases of the head and other superior parts: but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let.
We shall not spend time in describing the manner of performing this operation: that will be better learned by example than precept. Twenty pages of description would not convey so just an idea of the operation as seeing it once performed by an expert hand. Neither is it necessary to point out the different parts of the body from whence blood may be taken, as the arm, foot, forehead, temples, neck, &c. These will readily occur to every intelligent person, and the foregoing observations will be sufficient for determining which of them is most proper upon any particular occasion. In all cases where the intention is merely to lessen the general mass of blood, the arm is the most commodious part of the body in which the operation can be performed.
From whatever cause an inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is impossible to foretel with certainty in which of these ways any particular inflammation will terminate, yet a probable conjecture may be formed with regard to the event, from a knowledge of the patient’s age and constitution. Inflammations happening in a slight degree upon colds, and without any previous indisposition, will most probably be dispersed; those which follow close upon a fever, or happen to persons of a gross habit of body, will generally suppurate; and those which attack very old people, or persons of a dropsical habit, will have a strong tendency to gangrene.
If the inflammation be slight, and the constitution sound, the dispersion ought always to be attempted. This will be best promoted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embrocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax plaster.
If, notwithstanding these applications, the symptomatic fever increases, and the tumour becomes larger, with violent pain and pulsation, it will be proper to promote the suppuration. The best application for this purpose is a soft poultice, which may be renewed twice a day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, a fluctuation of matter which may be felt under the finger, and, generally speaking, an abatement of the pain, it may be opened either with a lancet or by means of caustic.
The last way in which an inflammation terminates, is in a gangrene or mortification, the approach of which may be known by the following symptoms: the inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby; little bladders filled with ichor of different colours spread all over it; the tumour subsides, and from a duskish complexion becomes black; a quick low pulse, with cold clammy sweats, are the immediate forerunners of death.
When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran. Should the symptoms become worse, the part must be scarified, and afterwards dressed with basilicum softened with oil of turpentine. All the dressings must be applied warm. With regard to internal medicines, the patient must be supported with generous cordials, and the Peruvian bark exhibited in as large doses as the stomach will bear it. If the mortified parts should separate, the wound will become a common ulcer, and must be treated accordingly.
This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, imposthumes, whitloes, &c. They are all abscesses in consequence of a previous inflammation, which, if possible, ought to be discussed; but when this cannot be done, the suppuration should be promoted, and the matter discharged by an incision, if necessary; afterwards the sore may be dressed with yellow basilicum, or some other digestive ointment.
No part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters are possessed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is however a fact, that no external application whatever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the external air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them.
The same observation holds with respect to internal applications. These only promote the cure of wounds as far as they tend to prevent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that Art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature’s efforts.
With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to facilitate their cure.
The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, ought to be extracted, and the wound cleaned, before any dressings be applied. When that cannot be effected with safety, on account of the patient’s weakness, or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it.
When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c. or where any considerable blood-vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the discharge of blood is so great, that if it be not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopt by applying a tight ligature or bandage round the member a little above the wound. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart-rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endanger a gangrene.
In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of styptics, astringents, &c. Cloths dipped in a solution of blue vitriol in water, or the styptic water of the Dispensatories, may be applied to the wound. When these cannot be obtained, strong spirits of wine may be used. Some recommend the agaric[194] of the oak as preferable to any of the other styptics; and indeed it deserves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied so tight as to keep it firmly on.
Though spirits, tinctures, and hot balsams may be used, in order to stop the bleeding when it is excessive, they are improper at other times. They do not promote but retard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouths of the vessels; but, by rendering the parts callous, they obstruct the cure.
In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking-plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, it is not safe to keep its lips quite close: this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It however must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax plaster[195]; and the whole must be kept on by a proper bandage.
We shall not spend time in describing the different bandages that may be proper for wounds in different parts of the body; common sense will generally suggest the most commodious method of applying a bandage; besides, descriptions of this kind are not easily understood or remembered.
The first dressing ought to continue on for at least two days; after which it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be removed with ease or safety to the patient, it may be allowed to continue, and fresh lint dipped in sweet oil laid over it. This will soften it, so as to make it come off easily at next dressing. Afterwards the wound may be dressed twice a-day in the same manner till it be quite healed. Those who are fond of salves or ointments, may, after the wound is become very superficial, dress it with the yellow basilicum[196]; and if fungous, or what is called proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum or red precipitate of mercury.
When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should be changed twice a-day.
If the wound be large, and there is reason to fear an inflammation, the patient should be kept on a very low diet. He must abstain from flesh, strong liquors, and every thing that is of a heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled; and, if the symptoms be urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient’s strength by excessive evacuations.
Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind or moves the passions, as love, anger, fear, excessive joy, &c. are very hurtful. They ought above all things to abstain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegetable diet, as roasted apples, stewed prunes, boiled spinage, and such like.
In slight burns which do not break the skin, it is customary to hold the part near the fire for a competent time, to rub it with salt, or to lay a compress upon it dipped in spirits of wine or brandy. But when the burn has penetrated so deep as to blister or break the skin, it must be dressed with some of the liniment for burns mentioned in the Appendix, or with the emollient and gently drying ointment, commonly called Turner’s cerate[197]. This may be mixed with an equal quantity of fresh olive oil, and spread upon a soft rag, and applied to the part affected. When this ointment cannot be had, an egg may be beat up with about an equal quantity of the sweetest salad-oil. This will serve very well till a proper ointment can be prepared. When the burning is very deep, after the first two or three days, it should be dressed with equal parts of yellow basilicum and Turner’s cerate mixed together.
When the burn is violent, or has occasioned a high degree of inflammation, and there is reason to fear a gangrene or mortification, the same means must be used to prevent it as are recommended in other violent inflammations. The patient, in this case, must live low, and drink freely of weak diluting liquors. He must likewise be bled, and have his body kept open. But if the burnt parts should become livid or black, with other symptoms of mortification, it will be necessary to bathe them frequently with warm camphorated spirits of wine, tincture of myrrh, or other antiseptics, mixed with a decoction of the bark. In this case the bark must likewise be taken internally, and the patient’s diet must be more generous.
As example teaches better than precept, I shall relate the treatment of the most dreadful case of this kind that has occurred in my practice. A middle-aged man, of a good constitution, fell into a large vessel full of boiling water, and miserably scalded about one half of his body. As his clothes were on, the burning in some parts was very deep before they could be got off. For the first two days the scalded parts had been frequently anointed with a mixture of lime-water and oil, which is a very proper application for recent burnings. On the third day, when I first saw him, his fever was high, and his body costive, for which he was bled, and had an emollient clyster administered. Poultices of bread and milk, softened with fresh butter, were likewise applied to the affected parts, to abate the heat and inflammation. His fever still continuing high, he was bled a second time, was kept strictly on the cooling regimen, took the saline mixture with small doses of nitre, and had an emollient clyster administered once a-day. When the inflammation began to abate, the parts were dressed with a digestive composed of brown cerate and yellow basilicum. Where any black spots appeared, they were slightly scarified, and touched with the tincture of myrrh; and, to prevent their spreading, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend his business.