c/ Vid¥iM£ o^ lG[>rof{&>[dEj %£1$ of ^krly I, cry, skin, temperature of the body, breath, circula- tion, discharge by vomiting and stool. In order that the importance of these may be better understood, they will be considered separately, and somewhat in detail. . THE COUNTENANCE. It is not uncommon for infants to have a yel- low, jaundiced condition or color of the skin for some weeks after birth, and it is said to be owing to the effect produced on the circulation of the blood through the liver, by the tieing of the umbilical cord ; but from whatever cause, it soon passes away, in most cases, without much trouble. The face also presents a livid appearance awhile after birth, owing sometimes to the mode of de- livery ; but when the lividity of the counte- nance comes on after exercise, in a child other- wise healthy, it indicates malformation, or im- perfection of the valves of the heart. Temporary lividity sometimes comes on in connection with diseases of the lungs, which shows that the blood is not sufficiently acted upon by the air entering the lungs. 4* THE SKIN AND FEATURES. The skin, being very vascular and delicate, is liable to irritating, and unsightly diseases of various kinds. Many disorders of the skin are owing to an unhealthy state of the stomach and bowels, while others, like the eruptive diseases, are -owing to specific poisons in the blood. The cheeks of children are red and congested, in fevers and in inflammatory diseases. When this congestion of the face, ears and forehead, is circumscribed and changeable, it indicates disor- ders of the brain, or spinal cord, and so does cross-eyes coming on in connection with febrile derangements, with rolling of the eye-balls, pu- pils of the eyes of unequal size, drooping of the upper eye lids, &c. When there is severe inflammation of the lungs, there is often dilatation, or expansion of the nos- trils, with contraction of the eye brows, and THE SKIN" AND FEATUKES. 43 flushed cheeks. Absence of tears during the act of crying, when the child is three or four months of age, is said to indicate a severe and probably fatal form of disease. When an infant loses flesh rapidly, cheeks become hollow, and bones prominent, there is doubtless derangement of the stomach and bowels, with diarrhea, so that the nutrition of the body is interfered with or arrested. Where there is great emaciation of features, which has been gradual in its progress, it surely indicates a chronic disease, of a severe charac- ter, as hydrocephalous, or dropsy of the brain, consumption of the lungs, or bowels, or chronic inflammation of the same. Where the eyes are continuously directed downwards, with expansion of the head, dropsy of the brain no doubt exists. All the eruptive diseases, and febrile disor- ders of children, are ushered in by changes in the appearances of the skin. CRYING, GESTURES, ATTITUDE. Where there is a sharp, shrill, piercing cry, head bent backward, limbs bent and stiff, spasm of the muscles, irregular movements of one or more limbs, with imperfect consciousness, there is almost certainly disease of the brain, or spinal cord, or both. Chorea, or St. Vitus dance, is characterized by irregular movements of the muscles, while in a state of perfect conscious- ness, and the muscular movements partly under control of the will. Turning the face from the light, contracting the eyebrows, a dislike of noise, shows that head- ache, sensitiveness of the eyes, or both, exists. When a child has severe ear-ache, it will every little while carry its hand to the ear, and press its ear against the breast of the mother, or nurse. In disease of the throat, children are restless, and move from side to side, while there is at the CRYING, GESTURES, ATTITUDE. 45 same time, more or less trouble in swallowing, and difficulty in breathing. In pleurisy, the cry will be short and be sud- denly stopped, as the movements of the chest in breathing, cause sudden and sharp pain. When the child lies perfectly quiet, with sunken fea- tures, without smiling or crying, some severe and exhausting disease is present, like dysentery or chronic diarrhea. THE BREATHING. Breathixg, in the young infant is not regular as in older people, but, on the contrary, is very irregular, spasmodic, and the infant frequently sighs, has hiccoughs, often holds its breath while laughing, or moving suddenly about, or when its attention is fixed in any direction, or upon any object. The rapidity of breathing, or number of respirations per minute, is very variable at different periods of infancy, and in health and disease. Dr. J. L. Smith, from observations in the Children's Hospital of New York, has made a tabular statement of infantile breathing, as follows, the extremes of slowness and rapidity of breathing, being given. O " DO During the first week, 32 to 64 times per minute ; from the end of the first week to the end of the first month, 40 to 96 per minute ; from the close of the first month to the end of the third month, 32 to 68 per minute ; from the THE BREATHING. 47 close of the third to the close of the sixth month, 36 to 88 per minute ; from the close of the sixth month to the close of the first year, 28 to 64 per minute. As the child advances beyond the age of one year, the frequency of breathing diminishes, but the breathing through the whole period of child- hood, is more rapid than in middle, or adult life. These figures represent the frequency of breathing in health, while in disease, it is ren- dered very irregular and variable. The character of the breathing in disease dif- fers very much, according to the nature and lo- cation of the disease. In diseases of the brain, or its membranes, the breathing is often slow, and intermittent, with sighing, particularly if there is more or less drowsiness. In diseases of the larynx and wind- pipe, with obstruction of the same, the breath- ing is much changed in character, the inspira- tion, or drawing in of the breath being much lengthened and difficult. The breathing is rapid in bronchitis, and especially so in capillary bronchitis, and when the drawing in of the breath stops short, the child at the same time uttering a moan, pleurisy, or lung fever, or both, probably exist. THE CHARACTER OF THE COUGH. The cough is an important symptom of dis- ease. In spasmodic croup, it is loud and sono- rous, and in true membraneous croup it is hoarse and harsh. In bronchitis it is clear and sharp ; low, suppressed, and painful, in lung fever and pleurisy, in whooping cough, it is convulsive, with inspirations, then expirations ; and in measles, the cough is dry, and irritating, es- pecially the cough that comes on prior to the appearance of the eruption. Derangements of the digestive organs, and the irritation of them produced by the presence of worms, often are attended with a cough of an irritating character. In all organic diseases of the lunsrs, the char- acter of the cough varies greatly with the pe- culiar kind of disease and its extent, and at dif- ferent stages of the same disease. THE CIRCULATION. The pulse is very variable in infants, and is much more rapid than in childhood, and in mid- dle and adult life. Any mental or physical excitement increases its frequency from twenty to thirty beats per minute. The average pulse of the healthy in- fant, is, according to Trousseau, 137 per minute, during the first and second months, 128 per minute from the third to the sixth month, and 120 per minute from the sixth to the twelfth month. If the pulse of infants intermits, dis- ease of the brain, spinal cord, or their mem- branes, may be suspected. 5 THE DIGESTIVE SYSTEM. The examination of the mouth, will reveal the condition and diseases of the stomach and bowels, in children, and this is almost the only means of detecting these disorders in infancy. In health, the mouth is moist and pale, tongue smooth, gums red, and the breath free from offensive odors. These conditions, or appearances, become altered from slight causes, the mouth becoming hot and dry, the tongue coated with a white cheesy matter, the breath hot and sour. This is especially the case in fevers, and in inflamma- tion of the stomach and bowels. In severe cases of scarlet fever, measles and croup, the tongue often swells, and becomes coated, the color being of a dark brown. In scarlet fever, after the thick coating has disap- peared from the tongue, the follicles, or points of the mucous membrane, show through, and THE DIGESTIVE SYSTEM. 51 give to the tongue a strawberry appearance, from its redness and roughness. The apthous sore mouth of infants, is often due to improper food, irritation of teething, impure air, using unclean nursing bottles, and to an unhealthy condition of the stomach and bowels. Vomiting is very frequent in infancy, and is common in brain affections, and it is also one of the first symptoms of scarlet fever and small- pox. Vomiting also attends indigestion, diarrhea, chol- era infantum and inflammation of the bowels. Flatulence, or the accumulation of gases in the stomach and bowels, is a source of great pain and uneasiness to infants, and this is particu- larly the case in scrofulous and weakly infants. Much is to be learned concerning the diseases of the stomach and bowels by the color, and character, of the discharges from them. Stools of bloody mucus, with fever, indicate inflamma- tion of the bowels. The discharges from the bowels are very often of a dark-greenish color, which color may arise from a variety of causes. It may be due to over feeding, to the action of cold, to irritating articles of food, and to inflam- mation. It may speedily disappear, and again, it may continue for several days. It often comes on in attacks of diarrhea and dysentery. It 52 THE DIGESTIVE SYSTEM. sometimes manifests itself in children who are apparently in perfect health, and who seem to suffer no inconvenience from it, and it soon passes away without any treatment. The discharges from the bowels are frequently acid, having a sour smell, and so require alkalies to remedy the trouble. When the presence of worms are suspected in the bowels, the stools should be examined, when the truth of the mat- ter can be ascertained. Bloody discharges from the bowels may be owing to piles, polypus, or ulceration of the bowels. Sometimes the stools are white, clay colored, and of the consistence of putty, which is gener- ally owing to the absence of bile in the stools. All these changes in color, consistence and na- ture, have their peculiar and special significance, and call for special treatment, all of which will be found to be treated of under their appropri- ate heads, in the succeeding chapters. SLEEP. New-born infants sleep a greater portion of the time, occasionally awaking when they are eager to nurse, and soon as their appetite is ap- peased, fall asleep again. The sleep of the infant is quiet, sound, and long continued, in health, with breathing slow, and occasional sighing. In disease, the sleep is irregular, disturbed, breath- ing often loud and difficult, the eye brows are often contracted, mouth drawn one way or the other, there is grating of the teeth, sudden start- ings, and the infant may awake, cross, fretful, and not unfrequently will shriek out as if fright- ened. There is sometimes rigidity, or stiffness of the muscles, during sleep, with turning in of the fingers and toes, which indicates brain trouble and approaching convulsions. Care should be taken not to suddenly arouse infants from slumber, and as a general thing, 54 SLEEP. the infant should be allowed to sleep until it awakens of its own accord. If the infant shows signs of convulsive disorders, it may be wise to terminate its sleep, in order to give it the neces- sary attention. Having treated of the peculiar symptoms of various diseases, and the methods of diagnosis, we will pass to the consideration of special diseases. JAUNDICE. Doubtless almost every one is familiar with the fact, that the color of the infant's skin is very changeable, during the first few days after birth. At first, being of a vivid reel, it gradu- ally changes into the light rose hue of the skin of a healthy baby. But the skin often takes on a different hue, of a deep yellowish tinge, usually showing itself on the third or fourth day after birth, growing more and more yellow for a few days, and gradually subsiding, or continuing for weeks and months, as the case may be, and especially is it apt to be prolonged if there be any organic disease. Sometimes the jaundiced hue is owing to changes taking place in the blood, in the over-congested skin, in which cases the color will soon disappear. In cases of this character, the white of the eye will not be yel- low, while in cases where there is functional or 56 JAUNDICE. organic disease, the eyes will almost always be of a yellowish hue. Children in whom this jaundiced appearance is noticed are generally immature and feeble ; and offspring of unhealthy parents. In all these cases, the functions of the skin are inactive, breathing is but imperfectly per- formed, and the blood often circulates through channels which ought to have been closed at birth, and oftentimes, troublesome bleeding from the navel and other parts of the body, are liable to ensue. In many cases the whole difficulty will disappear if nothing is done, while in others, remedial measures are demanded. Great pains must be taken, while the yellow color of skin remains, to avoid all exposure of the infant to cold, and no other nourishment but the mother's milk should be allowed. Some- times a powder of chalk mixture, containing equal parts of chalk and magnesia, followed by a teaspoonful of castor oil, will hasten recovery, especially if the bowels have been, or are, inac- tive. When the yellow color of the skin is owing to inflammation of the bowels, or liver, or when owing to the want of bile ducts, or obstruction of them, when existing, the disease is very fatal. In these cases, bleeding oftentimes sets in from JAUNDICE. 57 the navel, and other places, and no time should be lost in summoning medical aid, for it is diffi- cult, and sometimes impossible, to control it. In rare instances, a child will live on for several months, without any apparent improvement, the skin being of a dark yellow hue, body very much emaciated, the tongue and mouth, dry and red, and covered with white spots, and yet ultimately recover. The author has in mind, one case, where the infant continued to look exceedingly yellow for six months ; but afterward, taking the child from the breast, (the mother being consumptive,) and giving it-Liebig's food for infants, mutton broth, beef tea, &c, it grew better rapidly, and in a few months afterward, it was the perfect picture of health. In all cases of this kind, the bowels should not be allowed to go confined, but be kept regular and active, by the use of mild laxatives, like rhubarb, magnesia, &c. The greatest benefit is often derived from change of air, and location, by removal from the city to the country, or to the sea side, provided it be in the warm season. ERYSIPELAS. This is a disease that frequently affects infants soon after birth, and during childhood. In chil- dren thus affected, the skin will be found to be of a deep red color, hot, painful, and swollen. The places most usually affected, are the face and head, neck, about the navel, small of the back, and the buttocks. It usually begins by a small spot, which increases in size, and rapidly extends, and is attended with swelling and more or less chills and fever ; the child being restless on account of the burning and prickling sensa- tion of the skin. The ' infant sleeps but little, suddenly starts, and convulsions not unfrequently occur. When the disease affects the face, the lips swell, cheeks enlarge, the eyes are closed by the puffy lids, the features can hardly be rec- ognised, and the disease rapidly proves fatal, if it extends to the membranes of the brain. In EETSIPELAS. 69 some cases the skin vesicates, or blisters, absces- ses form, and the parts slough. The treatment required in erysipelas, depends much upon the nature and severity of the case. It is generally the case that infants troubled with this disease are children of unhealthy parents ; ill-fed, living in dark, damp, unhealthy localities, so that one of the first things to be done in order to arrest the progress of the disease, is to admit fresh, pure air to the body of the patient, and have the room well ventilated. Many people are afraid to admit cool, fresh air into the sick room, for fear the disease will " strike in," but no fears need be apprehended on this score, and it is well for every one to remember, that nearly all of the infectious, and contagious diseases-, originate in, and are propagated by, filth and impure air. If the bowels are inactive, it is best to relieve them by the use of a little of the solution of the citrate of magnesia, teaspoonful doses of fluid extract of magnesia and rhubarb, or castor oil, if nothing else is handy. The patient's strength must be well supported, and when the mother's milk is deficient, a good wet nurse should be obtained, and cordials, wine whey, beef tea, mutton and chicken broth, and small doses of wine, either sherry or port, may be given to a 60 ERYSIPELAS. child a year old, or more. The remedy most used and seemingly of the most benefit in erysipelas, is the tincture of the chloride of iron. To a child from one to two years old, it may be given in two or three drop closes every three hours, in sweetened water, and the dose may be increased to ten drops every four hours, for a child five or more years old. Local applications relieve the fever and burn- ing heat of the skin, and a solution made by steeping poppy heads in water, and applied by means of flannels wrung out of the solution, will be useful. Flour may be sprinkled on the in- flamed surfaces, and sugar of lead, twenty grains to a pint of water, may be used as a lotion. Tincture of iodine, and nitrate of silver, are sometimes applied to arrest the progress, or pre- vent the extension of the disease upon the skin, but these should only be used by physicians or those accustomed to their use. Pure air, sunlight, frequent bathing, general cleanliness, good and sufficient nourishment, are the best preventives of the disease. THRUSH. This disease is most apt to appear in those infants who are constitutionally feeble, or who are children of poor and unhealthy parents, sur- rounded by unhealthy, or unfavorable hygienic conditions. It is common among the poor of cities, and among foundlings in public institu- tions ; it also prevails among infants brought up on the bottle, and all who are ill-clad, ill-fed and ill-nourished. It depends upon derangement of the digestive organs, which afterwards produces inflammation of the mouth. On examining the mouth of an infant afflicted with this disease, you will observe that the mucous membrane is covered with small white spots, looking like curdled milk, but they will be found to adhere firmly to the lining of the mouth. These spots appear upon the inside of the lips, near the corners of the mouth, upon the inside 6 62 THRUSH. of the cheeks, and upon the tongue, being thick- est upon its tip and edges, and sometimes the disease affects the gums, causing a great deal of swelling and an abundant flow of saliva. When these spots first appear they are small, circular in shape, about the size of a pin head, and after- ward increase in size, sometimes running to- gether. When they disappear the mucous mem- brane or lining of the mouth, looks very red, and then gradually returns to its natural color. The disease oftentimes extends to the stomach and bowels, and occasionally proves fatal, if neg- lected, by preventing the nutrition of the body, so that death results from insufficient nourish- ment and exhaustion. In most cases, infants with this disease, grow thin in flesh, have colic pains, diarrhea, the discharge from the stomach at the same time, being sour and offensive, and the mouth being sore, the infant has but little disposition to nurse. The duration of the disease depends upon its intensity, and the favorable, or unfavorable, con- ditions of the child. If the child is otherwise healthy, and the disease slight, two or three days will suffice to effect a cure ; but if the contrary is true, it may take as many weeks to remove the difficulty. THKUSH. 63 Soon as the spots show themselves, means should at once be employed to prevent the dis- ease extending. In mild cases, local applica- tions will often prove sufficient, while in the severer grades of the disease, both local and internal treatment will be required. One-half a drachm of borax, and one-half a drachm of chlorate of potash, dissolved in one ounce of glycerine, makes a very good local application, and it should be applied with a soft camel hair brush, taking care in the first place, to thoroughly rinse the mouth with warm water. It should be applied several times during the day, and if it does not soon remove the spots, the mouth may be washed with a weak solution of sulphate of zinc, after the following formula : Sulphate of zinc, two grains, to two ounces of rose water, or with a solution of nitrate of sil- ver, as follows : Nitrate of silver, two grains, to two ounces of rose water. Chlorate of potash, in two or three grain doses, may be given inter- nally, dissolved in water, three or four times a day ; or tea-spoonful doses of the following mix- ture : Chlorate of potash, one-half a drachm ; muriatic acid, ten drops; water, four ounces. There is often diarrhea, with green passages from the bowels, which needs attention. Some mild 64 THKUSH. laxative, as rhubarb, and chalk mixture, or cal- cined magnesia, or solution of the citrate of magnesia may be given, and lime water and milk, if the stomach and the secretions are sour. In infants who are brought up by hand, the dis- ease is often found to be owing to the fact that the nursing bottles have not been kept clean and sweet, and therefore, strict attention should be paid to perfect cleanliness of the articles used in feeding the infant. They should be thor- oughly scalded, rinsed with pure cold water, and milk should not be allowed to stand in them for any length of time, when not in use. The person of the infant should be kept scru- pulously clean, and the clothes, especially the diapers, should be changed often. For diet, the infant should be confined to its mother's milk, or if the mother is not healthy, a wet nurse should be secured. FLATULENCE, OR WIND COLIC. It is very commonly the case, that infants are troubled with this affection for several days, or weeks, after birth. The bowels are distended, full, and hard, and the attacks of pain are fre- quent, and often severe, so that the infant is con- stantly restless and fretful. Infants of feeble constitutions, offspring of unhealthy parents, are the most liable to the affection, and though the mother furnishes abundant milk, and the child nurses well, yet it does not thrive. It may attack children of healthy parents, but in such cases it often appears that the mother does not furnish the infant sufficient nourishment, and the trouble is aggravated by feeding with im- proper food, which does not nourish the infant, but turns sour upon the stomach, and diarrhea and indigestion follow. If the stomach is sour, a few grains of bicarbonate of soda, magnesia, G* 66 FLATULENCE, OR WIND COLIC. or a little chalk mixture, may be given. If the trouble is caused by the mother's milk, her diet should be so changed, and regulated, as to over- come the difficulty. When these simple measures fail, various remedies are resorted to, among the best of which are the following : A few drops of the tincture of assafcetida, and tincture of cinna- mon, in half a tea cup of warm milk and water, injected into the bowels once or twice a day, will afford prompt relief. The following mixture, taken internally, is very good. Carbonate or calcined magnesia, one scruple ; tincture of assafcetida, one drachm ; laudanum, ten drops ; water, one ounce. When the child is in pain, give twenty drops, in a lit- tle sweetened water, and if not relieved in an hour, give ten drops more. These doses are for an infant two or three weeks old, but if the child be much older a few drops more may be given, but it need not be repeated often, and must be stopped as soon as the pain is relieved. The aromatic remedies are much used, as an- nise, coriander, spearmint, cinnamon, catnep, etc. These are usually prepared in the form of a warm tea, and freely given. In some cases, the colic is periodical in kind, FLATULENCE, OR WIND COLIC. 67 coming on every morning, or during the latter part of the afternoon, and children thus affected often look fat and healthy. Children with this periodical colic are often constipated, and if ha- bitually so, should be regulated in this respect, by the use of some mild laxative. In all these cases, the diet of both mother and child, should be carefully looked after. DISEASES ATTENDING TEETHING. Although teething is not a disease, but a natural process, it is nevertheless a time of great peril and fatality, to the infant, owing to the many derangements and diseases that set in during this period. It is the time when the infant is most rapidly developing, and is most likely to be affected by any, and every, source of irritation and disturbance of the system. Some of the most common disorders have been alluded to in the chapter upon teething, while some of the more special diseases attending teething, will be treated of here. MILKY SCALL. This is an eruptive disease of the skin, most always confined to infants teething. The disease appears sometimes earlier, sometimes later, in the period of teething. It often begins on the cheek or forehead, and is recognized first by a small collection of white pustules upon a red surface, the pustules gradually fading to a brown, or yellowish brown color, which finally breaks, forming a crust of variable thickness, from beneath which, there proceeds a thick, dirty, discharge. New eruptions constantly appear, which unite with the old, and so extend over the face, head, and various parts of the body, and sometimes the whole face and scalp will be entirely covered. This disease is troublesome and offensive, but not often dangerous, or serious in its results, although death has been known to take place, 70 MILKY SCALL. owing to the constant itching, fever and diarrhea, attending the severer cases. It is the popular opinion in domestic circles, that it is dangerous to cure these affections of the skin, on account of giving rise to some internal trouble, but such fears need not be entertained. Although the eruption will disappear in time if left to itself, on account of the loathsome appearance, and uncomfortable feeling, treatment is called for to hasten its removal. The bowels should be acted upon by mild doses of magnesia, confection of senna, oil, or any other laxative that is suitable, and if the child be at the breast, the mother should gener- ally resort to a milk and vegetable diet, using but little animal food. If the child be weaned, then arrowroot, wine whey, milk, &c, should be given. The warm bath should be had recourse to every, or every other day, and the face, head, and other parts affected, should be washed often with castile soap and water, after which, the ointment of benzoated oxide of zinc, should be applied twice daily, morning and night. These simple measures will be found all suffi- cient in most cases, but there may be cases where some tonic will be needed, in order to build up, and strengthen the system, and remedies to improve the condition of the blood. TOOTH RASHES. The sympathy between the gums and skin, is abundantly shown by the number and variety of eruptions which the skin is liable to, during the teething process. The tooth rash, is an eruption of numerous small papillae, or pustules, appearing on different parts of the body, and is so called because it appears at no other period excepting that of teething. At about the fourth or fifth month, this erup- tion appears on most infants, and is noticed most frequently on the cheeks, side of the nose, fore- head and arms, and sometimes extends over the whole body. The disease usually lasts but a few weeks, and requires but little treatment, beyond regulation of the bowels, if constipated, keeping the skin clean, by frequent washing with warm water, and using nothing but linen next to the skin. The pimples will soon fade out, cast off their scales, and finally disappear. RED GUM. This is an eruptive disease, that affects the great majority of children during the first month of their existence. Many nurses look for its appearance with pleasure, and if it fails to put in an appearance will dose the infant with saffron, catmint, sage, &c, after which they will often be rewarded with a generous eruption. The eruption is generally owing to disorders of digestion, caused by an acid condition of the stomach, taking too much milk, or by some im- proper quality of the mother's milk. The com- plaint is often preceded by nausea and vomiting, or diarrhea. It is sometimes caused by the infant being too warmly clad, its head being covered with clothing, so that it is compelled to breathe over and over again, the same air, causing profuse perspiration. The eruption is most commonly situated on KED GUM. 73 the face, arms, hands, chest, and occasionally on the whole surface of the body. In all ordinary cases, the disease requires no medical treatment. It is well to pay proper attention to cleanliness, diet, and digestion, and the infant should not be exposed to changes of temperature, from hot to cold, for it may cause the eruption to suddenly disappear, and result in difficulty of breathing, drowsiness and spasms. In such cases the in- fant turns pale and purple around the mouth, refuses to nurse, stretches itself out stiff, and suddenly becomes relaxed, with cold skin. The warm bath should be immediately resorted to, until the child's body is warm, when it should be rubbed dry, and clothed in warm flannel, and have some warm tea, or stimulating drink ad- ministered, as saffron, sage, sweet marjoram, etc. 7 WHITE GUM. This eruption is characterized by small, hard, white, specks, but little elevated from the sur- face of the skin, somewhat resembling warts in shape and structure. They are most frequently observed on the face, neck and chest, and they last for some time. No treatment is necessary, beyond the regulation of diet, attention to clean- liness, and the general health. SORE EARS. Children, during the teething process, fre- quently have sores form behind the ears, which soon spread and take on an ulcerative character, often involving the whole ear. A large quan- tity of pus, or matter, issues from the ulcerated surface, forming thick, dirty, scabs, or crusts. In treating this affection, the diet must be well regulated, no improper or indigestible food being given ; the bowels must be acted upon by some gentle laxative ; the sores must be thoroughly cleansed with soap and water, or what is better with a weak solution of carbolic acid and water. After thoroughly cleansing the ulcerated sur-' faces, an ointment of the benzoated oxide of zinc, should be applied night and morning. If the child is pale, bloodless and feeble, a few drops of the ferrated wine cordial may be given three or four times a day, or small doses of wine whey, 76 SORE EARS. blackberry, or native grape wine. The disease will usually yield promptly to the remedies mentioned ; but in some cases of long duration, some general, or constitutional treatment may be required. OTTORRHEA, OR INFLAMMATION OF THE EARS. Attacks of ear ache, or inflammation of the internal ear, are the most common after the com- pletion of the first teething, yet they occur in young infants, who are wholly unable to point out the seat of pain. Sometimes the attacks suddenly manifest themselves, but more fre- quently, the child is nervous, fretful, uneasy, or languid, ranging from several hours, to several days, before the severe pain follows. The child will cry, if tossed about, noise seems unpleasant, it notices nothing with interest, and if at the breast manifests no desire to nurse. The infant keeps moving its head about, striving to place it in a comfortable position, and on watching closely, it will be seen that it is always the same side of the head, (when one ear alone is affected,) that it buries in the pillow, or rests on its mother's arm, and no other position seems to afford much 7* 78 OTTOEEHEA. relief. The pain is often followed, after a time, by a profuse discharge of matter from the ear, which affords great relief, and the trouble appar- ently disappears for a time. Other cases assume a chronic form, with a continued discharge, which is very offensive, and which goes on to the injury or destruction, of the internal ear, resulting in deafness, or inflammation of the membranes of the brain and death. In treating this painful affection of children, warm applications should be made to the ear, such as poultices of bran, hops, chamomile flower, or roasted onions, or a little sweet oil, to which a few drops of laudanum has" been added, may be put in the ear occasionally. If the discharge from the ear is profuse and persistent, the sur- face of the canal should first be cleansed by in- jecting in a little warm water, after which, the canal of the ear, should be painted, or brushed over with a solution of nitrate of silver, of the strength of from six to ten, and even twenty grains, to the ounce of water ; but this applica- tion should be entrusted alone to the physician. If the ear ache and discharge continues, it becomes necessary sometimes, to apply a blister, or leeches, behind the ear. Proper attention should be paid to the general health of the infant, OTTOEEHEA. 79 for it is true, that most children troubled with this affection, are children of feeble, scrofulous constitutions, and require tonics, such as syrup of the iodide of iron, wine of iron and calisaya bark ; they also want good nutritious diet, pure air, out of door exercise in favorable weather, and sunlight. It is highly important that these inflammatory diseases of the internal ear, should not be neg- lected, for they not only often leave behind per- manent disorganization of the ear, and conse- quent deafness, but the disease is always liable to extend, and involve the membranes of the brain, producing inflammation thereof, and sub- sequent death, and the verdict should be rendered in all such cases, death from neglect. INCONTINENCE, OR INABILITY TO RETAIN THE URINE. This trouble is exceedingly common in early life, and although it is frequently caused by force of habit rather than by any special derange- ment, it often proves a serious infirmity, and one not easily overcome. It usually affects children more during the night, than the daytime, though both forms of the disease are met with in chil- dren. The causes of this difficulty are various, the principal ones being as follows : In the first place, it is often caused by bad habits, as letting the child drink freely during the evening, and on going to bed, and that too without seeing that the child empties its bladder before retiring. Lying on the back at night, is a position that favors the involuntary flow of urine, and should be avoided. Again it may be, and often is, owing to the urine becoming a source of irrita- tion, by an excess of lithic acid in the secretion. Sometimes it is caused by the irritation produced INCOXTIXENCE 81 by the presence of the small round, or pin worm, in the lower bowel or rectum. It is not an un- common thing for infants to suffer from gravel, or stone in the bladder, in which case there will be more or less incontinence of urine. In seeking to remedy this difficulty, a little genuine authority will prove beneficial, provided it is rightly exercised, such as making the child abstain from drinks of all kinds, two or three hours before going to bed, and if possible making the child empty its bladder before retiring, and two or three times during the night, and taking care that the child lies on one side or the other, and not on its back. The remedial measures, so far as medicine is concerned, will depend upon its cause. If there is an abundant deposit in the urine, or if the urine is very acid, attention must be directed to the diet, which must be simple, nutritious, and regular. Magnesia, bicarbonate of soda, acetate of potash, either one of them may be given to neutralize the acidity of the urine. If worms infest the rectum, an injection occasionally given, consisting of a strong solution of salt and water, will kill them. If they infest the other portion of the intestines, fluid extract of pink root and senna may be given, three times a day, on an 82 INCONTINENCE. empty stomach, followed the next day by some cathartic. Santonine is also a valuable vermi- fuge, and may be given in two or three grain doses, three times a day. Tonic remedies are demanded in children of feeble constitutions, and in this peculiar affection, the tincture of the chloride of iron is good, and may be given in doses of five to ten drops, three times a day, in a wine glass of sweetened water. Cold sponging to the back and thighs, is useful, and in the long continued cases, blisters applied to the small of the back and thighs, afford relief, though they are not desirable things to use on children. Nux vomica and belladonna, are two valuable remedies in this 'disease, and in fact, the great majority of cases will yield either to one or the other of these two, or the tincture of iron spoken of above. The tincture of nux vomica and belladonna, may be given in four or five drop doses, repeated three or four times daily, to young children, the dose being increased for those above four or five years of age. The presence of stone or calculi, in the bladder, or the presence of tumors about the neck of the bladder, or its appendages, will only be detected by the physician, and of course will call for his interference. DIABETES. An abundant flow of urine occurs at all ages, as a primary and temporary symptom of various diseases, but in diabetes, the increased flow of urine is associated with certain changes in the chemical composition of the urine itself, the presence of sugar sometimes being detected in considerable quantity. The disease is attended with great thirst, there being a constant desire to drink in large quantities, and the appetite is often ravenous, yet the child will become very much emaciated, pale and feeble. The disease is not common in very young children, yet they are not exempt. The primary cause of diabetes, is derangement of the processes of assimilation, and nutrition, the processes by which food imparts its virtues to maintain the health, vigor and growth of the body. There seems to be no effectual remedy 84 DIABETES. for the disease, but much can be done to modify it, and relieve the patient. Alkaline medicines have, been useful, among which are bicarbonate of soda, a few grains to be given three or four times daily, in water, occasionally omitting it for a few days. The carbonate of ammonia, or citrate of ammonia, have been found very bene- ficial in this disease, and they can be given three or four times daily, in five grain doses, dissolved in water or syrup. Food containing much sugar or starch should be avoided, but meat of all kinds may be allowed, with " butter, cream, curd, cheese, eggs, and all vegetables deficient in starch and sugar, such as lettuce, cabbage, chicory, tops of beets, spinach, celery and water cresses." Vegetables which abound in starch and sugar, such as rice, potatoes, beets, turnips and beans, are not to be allowed ; neither is wheat or rye bread, corn or oat meal. Tea and coffee, claret and sherry wine, are useful. The skin should be thoroughly protected from cold, and frequent bathing in warm water should be practiced. Children suffering from this affection should not be sent to school, but should be allowed complete freedom from mental taxation, and should exercise in the open air freely. CONSTIPATION. By constipation is meant an inactive state of the bowels, in which there may be no passages from the bowels for two days or two weeks. Constipation may be considered a symptom of various diseases and derangements, rather than a disease itself, although it may become one. This may be a constitutional trouble, or may be acquired by habit, or by improper diet, and use of drugs. Dosing children continually with laudanum, soothing syrup, paregoric, &c, is a fruitful source of the complaint. The disease is sometimes owing to malformation of the bowel, in which the size of the bowel is diminished, or completely obstructed, a trouble that children are often born with. Constipation is often owing to simple torpidity of the bowels, in which case, the difficulty can be removed by gentle laxative remedies, such as manna,rhubarb, magnesia, the 8G CONSTIPATION". confections of senna, &c. Pepsine is useful in many cases, given in doses of from three to six grains dissolved in milk, the dose to be repeated three or four times daily. Injections of simple cold water, molasses and water, or salt and water, into the bowel, is an effectual remedy, affording prompt relief. At least, from a gill to a pint of liquid should be injected at once, in order to insure success. Small closes of tincture of bella- donna, with aloes, or colocynth, is a prompt remedy, but is best adapted to children above five years, or older. As the disorder is acquired by the force of habit, the habit being that of protracted neglect of the necessity, whenever it arises, so can a cure be accomplished by the force of habit, if the individual will make daily, and regular effort to secure action of the bowels, whether the necessity seems to exist or not. In order to keep the system in good condition, one movement of the bowels should be secured every day. VOMITING. This is one of the most common affections of infancy and childhood, and also a prominent symptom of various diseases, such as pneumonia, scarlet fever, measles, chicken and small-pox, brain fever, and the various disorders of the stomach and bowels. Infants frequently vomit from mere repletion, the stomach having been overloaded by too fre- quent nursing. In these cases the vomiting will sometimes be frequent and violent, yet the infant does not seem to suffer much from it, as there seems to be almost no debility, or constitutional disturbance produced by it, and it is nothing but the simple effort of nature to relieve the overfed organ. The infant may have a good appetite and nurse freely, but the stomach being in an irritable condition, it immediately rejects the milk, either in its natural state or curdled. This 88 VOMITING. state of things is often produced by some act of impropriety of the mother, or nurse, such as allowing a too long interval before nursing the child ; giving the child the breast immediately after a fatiguing walk or other exercise ; or arousing the infant suddenly from sleep, before the usual time. It may be due to over excite- ment, fatigue, and exposure of the infant. In treating a child in whom vomiting has come on in this way, take it at once from the breast, and allow it nothing for two or three hours, then give it simply a teaspoonfiil or two of cold water, and if that is retained in the stomach, repeat it in half an hour. Should the last be retained, then dissolve a little isinglass in water, and give it in two teaspoonful doses, oft repeated. Cold barley water, rice water, flax seed tea, may be given in like manner. After a few hours have elapsed, the mother's milk, or diluted cow's milk, may be allowed in small quantities. If milk disagrees with the child, weak lamb or chicken broth may be sub- stituted. After twenty-four, or forty-eight hours, if the vomiting ceases, the infant may be allowed the breast regularly, care being taken not to nurse the infant too long, and too often. Although the trouble is usually overcome by VOMITING. oy proper attention to diet, it sometimes calls for medical treatment. Where the milk is thrown off curdled, showing the existence of acidity of the stomach, lime water, in teaspoonful doses, should be given three or four times daily. Ox- alate of cerium, in one or two grain doses, given in a teaspoonful of cold water, and repeated every three or four hours, will often prove very effectual. If there be vomiting, with much diarrhea, a grain of the mild chloride of mercury may be placed upon the child's tongue, at the same time forbidding the infant to nurse. In two hours the following mixture, recommended by Dr. J. Lewis Smith of New York, may be given : bicarbonate of potash, twenty-four grains ; citric acid, seventeen grains ; bitter almond water, one ounce ; water, two ounces ; mix and give the child a teaspoonful occasionally, until vomiting ceases. The following mixture has also been found useful in the Childs' Hospital, of New York : creasote, two drops ; lime water, two ounces ; mix and give one teaspoonful with a teaspoonful of milk. Vomiting is not always a solitary symptom, nor a disease by itself, but is frequently associa- ted with general disturbances, impairment of the digestive organs, by which nutrition is 90 VOMITING. arrested, the child wastes away, and pulmonary consumption is the final result. Often in these cases, the infant has no appetite at all, either for the breast or anything else, grows pale, languid, nurses occasionally, often vomiting as it ceases to nurse. This trouble may also be caused by too close confinement of the infant, in hot, ill-ventilated rooms, and it often follows attacks of diarrhea and inflammation of the bowels. There may be a craving and unnatural appetite, and soon as the child takes any nourishment, it will cry with pain until relieved by vomiting. In other cases, the infant has frequent belching of wind, of a sour, nauseous odor, with attendant diarrhea, or constipation, as the case may be. If the infant is fed upon the breast entirely, the stools will generally be liquid, of a pale yellow color, often curdled, while at other times they will look like putty, or pipe clay, of a greyish white appearance, and at other times they will present a dirty, slimy, green color, frequently tinged with blood, and very offensive. In all cases of vomiting, diarrhea, or general disturbance of the digestive organs, hygienic and sanitary measures are the first to be looked after, and enforced. The nursery, or where the child remains most VOMITING. 91 of the time, should be kept well ventilated, and at a moderate temperature, and not hot as an oven, as is too often the case. The room should be on the sunny side of the house, well exposed to the sun's rays, for there is health imparting power in sunlight, not generally attributed to it. Change of air from one location to another, will often effect a cure, especially if it be to some elevated and thinly populated place. Care must be taken not to overload the stomach, for too little is better than too much for a weak stomach. Tonic remedies are often required to build up and strengthen the feeble vital powers. The following is recommended by Dr. J. Lewis Smith of New York: Dilute sulphuric acid, sixteen minims ; tincture of orange peel, one drachm ; cinnamon water two drachms ; simple syrup, one drachm ; the whole to be mixed and given in teaspoonful doses three times a day to an infant a year old. Citrated kali, bismuth, calcined magnesia, oxalate of cerium, are all useful. If the bowels are inactive, castor oil, decoction of aloes, and glycerine, confection of senna, will any of them relieve. A formula recommended is as follows : Com- pound decoction of aloes, six drachms ; extract of liquorice root, one scruple ; ansise water, two 92 VOMITING. drachms ; mix and give it in one or two tea- spoonful doses, when needed. Where the trouble with the stomach has been long continued, digestion being but imperfectly performed, attention to diet, combined with various medicinal remedies, will usually establish a cure. If the child has been brought up on cow's milk, benefit is often derived by diluting the milk, or by changing it for asses' milk, or goat's milk, or Avhey. Small quantities of car- bonate of soda, or potash, chalk, magnesia, or lime water, should be added to the milk, and if the stomach be very irritable, small closes of laudanum may be added. Sometimes it is well to combine the alkali, as soda, potash, &c, with a vegetable tonic, as an infusion of columba, gentian, and quassia. In cases where the breath is offensive, with frequent belching of the gases of the stomach, the following formula may be used: Dilute hydrochloric acid, twenty drops ; syrup of orange peel, one drachm ; tincture of orange peel, one drachm ; infusion of cascarilla, ten drachms ; mix and give a teaspoonful three times daily. The wine of pepsine, given in ten or fifteen drop doses, three or four times daily, is useful. The diarrhea associated with these cases, so often VOMITING. 93 seen with pale yellow, or dark green stools, is relieved by moderate diet, and small doses of sulphate of magnesia, and tincture of rhubarb, say five grains of magnesia, and twenty drops of rhubarb, given three or four times a day, to a child a year old. When the passages from the bowels are white, or clay colored, the mercury and chalk powder, may be given morning and night, in small doses, or if the vomiting contin- ues, small doses of the mild chloride of mercury combined with a grain of Dover's powder, will afford the most prompt relief. While vomiting is a symptom of, and attends so many disorders, such as inflammation of the brain, bowels and stomach, scarlet fever, measles, cholera infantum, &c, it is highly important that the cause should be sought out, that the proper remedies may be applied. The causes, especially where they originate in the brain, are often obscure, and all the skill and foresight of the best medical men is requisite in such cases, and they should be entrusted to them alone. DIARRHEA. This, like vomiting, is one of the most fre- quent of infantile disorders, and during the first two years of life, it is constantly manifesting itself in some one of the various forms, and from a great variety of causes. The following are among the more common causes of simple diarrhea. Improper diet, the milk, or food, being given in too great quantities, or of a poor, unhealthy quality; feeding too frequently, so as to overtax the digestive organs, arresting the process of digestion, so that the food acts as an irritant, and excites frequent discharges. At other times, some property of the mother's or cow's milk, disagrees with the infant, producing the diarrhea. Fright, or any- thing unduly exciting the nervous system of the mother or child, is a sufficient cause. Sudden changes of temperature, exposure to cold, or to DIARKHEA. 95 excessive warmth will induce it. The eruption of the teeth, and the irritation produced by their pressure upon the gums, is a common cause. Worms in the rectum, or lower part of the bowel, not unfrequently excite diarrhea, and children who are kept in dark, damp, close apartments, without ventilation, are almost always subjects of this disease. The simple form of diarrhea, which is not attended by inflammation or much pain, usually comes on without much warning. In diarrhea caused by fright, exposure to cold, or improper diet, the attack usually comes on directly after the exposure. If caused by teething, symptoms which are referred to the mouth, will be noticed. The symptoms generally preceding an attack of diarrhea, are more or less heat of skin, rest- lessness, disturbed sleep, an expression of pain, with more or less nausea, and vomiting, if the attack is to be at all severe. The most frequent color of the stools in young infants afflicted with diarrhea, is a dirty, slimy, greenish color. This arises from the most trivial causes, and need excite no alarm, if properly attended to. When the infant is suffer- ing from indigestion, the stool will often present the appearance of curdled milk, and in fact, they 96 DIARRHEA. often consist of but little else. The face of the infant is pale, and the flesh flabby, but there is no great loss of flesh, or prostration, unless the diarrhea has continued for some length of time. There is but comparatively little danger in the common diarrhea of children, unless the disease is allowed to continue so as to undermine the general health, and constitution, and till it be- comes complicated with some organic disease of the bowels or brain. In order to relieve the diarrhea, the cause of the difficulty must, in all cases, be sought for, and removed if possible, when the trouble will in most cases soon end. In those cases where the passages from the bowels are acid, and frequent, it is well to give some alkali, with a laxative, such as teaspoonful doses of the fluid extract of rhubarb and mag- nesia, or a little of the Rochelle salts, given with the syrup of rhubarb, or a teaspoonful of castor oil, with five grains of the bicarbonate of soda, given in a little sweetened water, or five grains of bismuth, with a teaspoonful of the citrated kali, given in a little water. The following is a useful mixture where there are loose, watery discharges, without much pain or straining : Sul- phate of magnesia, three drachms ; tincture of DIARKHEA. 97 rhubarb, two drachms ; tincture krameria, two drachms ; syrup of ginger, half an ounce ; com- pound tincture of cardamons, half an ounce ; mix and give one teaspoonful three or four times daily, to an infant one year old, increasing the dose according to the age. In cases where there is a sour stomach, with acid discharges from the bowels, the following remedy may be used : Pulverized ipecac, one grain ; pulverized rhubarb, two grains ; bicar- bonate of soda, and subnitrate of bismuth, each five grains ; mix and make twelve powders, one to be given every four hours. If the diarrhea should continue three or four days, astringent remedies will be called for. The following is a good formula, recommended by Dr. West : Ex- tract of logwood, one drachm ; tincture of cat- echu, two drachms ; simple syrup, one drachm ; caraway water, nine drachms ; mix and give one teaspoonful three times a clay. In diarrhea, attended with great straining, or spasmodic action of the lower bowel, with fre- quent painful discharges, injections into the bowel of the following mixture, will afford prompt relief: Prepare a teacupful of starch water as thick as can be used in a syringe, the starch to be boiled, to which add ten or twelve drops of laudanum, 9 98 DIARRHEA. and give the injection two or three times a day till relief follows. In the severer cases, attended with discharges of blood and matter from the bowel, two or three grains of nitrate of silver should be added to each injection. The compound powder of chalk and opium is a very good preparation for infantile diarrhea, and may be given in doses of from one to three grains, to a child one year of age. When there is great irritability of the stomach, so that everything is thrown up soon as taken, Dr. West advises a small mustard poultice applied to the stomach, the child to be taken from the breast if nursing, and fed on cold barley water, or something as simple in its nature, and then a powder containing a third of a grain of the mild chloride of mercury, and a twelfth of a grain of opium, to be placed upon the tongue every three hours. Where the nervous system is irritable, and there is evidence of any tendency to disturbance of the brain, and con- vulsions, the warm bath should be resorted to, and cold applications be made to the head, as cloths wrung out in ice water, and frequently changed. In cases attended with great debility, feeble pulse, coldness of the skin, &c, stimulants, such DIAKKHEA. 99 as blackberry wine, small doses of brandy, will be required, and rubbing the body thoroughly with strong mustard water, and placing hot drafts to the feet, or bottles of warm water, will be very useful, and afford much relief by the reaction they excite. In cases where the disease has involved the brain, the child will be exceedingly restless, will sleep but a few moments, and suddenly awake, and cry out with a shrill piercing cry, and throw its arms about and above its head, oftentimes its hands will be closed and stiff, face pale, eyes presenting a glassy appearance, and rolling around uneasily. Serious, and too often fatal, consequences follow these symptoms, and the very best possible attention from the nurse and medical attendant, is required, for relief must be obtained soon, if at all. The warm bath should be employed, and small doses of Dover's powder should be given, with free use of stimulants, particularly if there is great paleness and cold- ness of the skin. CHOLERA INFANTUM. Cholera infantum, is so called, on account of its close resemblance to Asiatic cholera, in its general symptoms. It is a disease occurring only in warm weather, and the causes are various, as follows : Improper diet, too thin clothing, teeth- ing, worms, premature weaning, or weaning during the hot months, living in ill-ventilated apartments, the air being loaded with foul, nox- ious vapors, such as arise from animal and vegetable decomposition, or from over crowded rooms, and also from want of general and per- sonal cleanliness. For these reasons, the cases are most frequent among the poorer classes, who dwell in large tenement houses, and in low, damp, unhealthy localities. There are but a few cases, comparatively speaking, in well appointed houses, where diet, dress, exercise and cleanliness receive their due attention. The intense heat of summer, CHOLERA INFANTUM. 101 is, no doubt, the primary cause in most cases, and infants fed on the bottle, are much more liable to it than children at the breast. The disease usually attacks children who are under two years of age. Cholera infantum sometimes comes on as a simple diarrhea, with some disturbance of the stomach, at the same time the trouble increases, until the disease assumes a violent form. In the most severe forms of the disease, there are vomiting and purgings, with violent cramps of the limbs, and at times of the whole body. The passages increase in frequency from the bowels, are thin and watery, and the child sinks rapidly. Sometimes a diarrhea for several days precedes an attack, while at other times, it will appear almost without warning of any kind. Whatever is swallowed, is at once rejected, on account of the great irritability of the stomach, and there is a total loss of appetite, with great thirst. The loss of flesh and strength is exceedingly rapid, and the whole appearance of the child is so much changed, often in a single day, that it looks like another person, or not at all like itself. The eyes are sunken, lips and eyelids often perma- nently open, because the muscles are so much relaxed, and the skin will be found in folds, or 102 CHOLERA INFANTUM. puckered up, on account of the great loss of the fluids of the body. The disease often proves fatal in twenty-four, or forty-eight hours, and in the severer attacks, the infant will often lie in a state of stupor, and can with difficulty be aroused, the head and limbs become cool, eyes bleared, and glassy, pupils contracted, the eye balls roll about during the paroxysms of pain, and there is often profuse perspiration. When the child passes into a state of stupor, death is apt to follow in a few hours. The dis- charges from the bowels are so frequent, thin and watery, and the sinking of the infant is so rapid, that the most prompt and decisive meas- ures are demanded in the treatment of this disease. If the child has taken any unusual article of food, or anything in the shape of fruit, or vege- tables, which is often the case, and this acts as an irritant to the stomach, and bowels, something should be given that will act as a laxative, or purgative, in order to expel the offending mate- rial from the bowels. Small doses of ipecac, three or four grains of the powder, may be given in a little water, to clear the stomach, provided the efforts of nature have not been sufficient. To clear the bowels, small doses of castor oil, CHOLERA INFANTUM. 103 rhubarb, magnesia, may be given, but the best of all remedies is calomel, given in one grain doses, combined with a grain of the camphorated Dover's powder, both to be rubbed together with a little sugar of milk, and placed upon the tongue. If the first dose is rejected, immediately repeat the dose, and so on till the powder is retained. This settles the stomach better than most any- thing else, and whatever objections older people may have to its use,, it certainly is harmless to children, properly administered, and no question should be raised against its use in a disease which might prove fatal in a few hours without it. But where any one has any objection to its use, syrup of rhubarb, or fluid extract of rhubarb and magnesia, may be given, provided the stomach can be made to retain it long enough to have the desired effect. If the calomel is used, it should be in one grain doses, and not be repeated more than three or four times, before some other laxative is given. Purgative medicines need not be given at all, unless there is evidence that there is some irri- tating and indigestible substance in the bowels, that needs to be removed. Treatment should then be given to improve the general character of the discharges, and to lessen their frequency, 104 CHOLERA INFANTUM. without delay. Our main reliance is upon opium, in some of its various forms. Laudanum may be given in one drop doses, to a child one year old, and repeated every half hour or hour, its effects being watched, so that the child may 'receive no unfavorable effect therefrom. Some- times sudden stupor comes on, the discharges from the bowels suddenly cease, in which condi- tion opium would increase the difficulty, and hasten the fatal result. Other preparations of o'pium, besides lauda- num, often used in this disease, are paregoric, compound powder of chalk and opium, and Do- ver's powder. To check the discharges, an alkali and an astringent may be used together, such as the following : laudanum, twelve drops ; chalk mixture, one ounce and a half ; tincture of catechu, two drachms. Mix, and give tea- spoonful doses, every two hours, to an infant a year old. Another useful mixture is as follows : laudanum, twelve drops ; tincture of krameria, three drachms ; bismuth, one half a drachm ; cinnamon water, an ounce and a half. Mix, and give in teaspoonful doses, every two or three hours. Some eminent authorities, as Billet and Barthez, prefer nitrate of silver, dissolved in distilled water, as an astringent, in cholera in- CHOLERA INFANTUM. 105 fantum. It is certainly effectual, given with starch water and laudanum, as an injection into the bowel. I have often seen prompt relief from an injec- tion of the following mixture, repeated three or four times in the course of twenty-four hours : One cupful of boiled starch water, the water to be as much thickened with starch as its use in a syringe will permit, to which add two grains of the nitrate of silver, and five drops of laudanum. The disease so rapidly prostrates the vital pow- ers, that alcoholic stimulants, in some form, are generally demanded, the best of which is, good Bourbon whiskey and French brandy, which should be used early in the disease. They not only sustain the strength, but relieve the irrita- bility of the stomach as well. The diet, during an attack of cholera infan- tum, must be very simple, the infant to be con- fined to the breast, if not weaned, otherwise, it may be fed on cold barley water, rice water, milk, or wine whey, with brandy or whiskey, and later in the disease, as convalescence begins, mutton, chicken, and beef broth may be given. The great gravity of the disease, its frequent fatal termination in a few hours, the rapid sink- ing of the vital powers, from the profuse and 106 CHOLERA INFANTUM. frequent discharges, the necessity for the most prompt and decided measures of relief, all call for skillful attention, and it need hardly be said, that no time should be wasted in trifling or ex- perimenting, or adopting the theory of this friend, or that old woman, or such and such a one, who used this and that. If you know just what to do, do it, if not, send for some good physician, and do as he directs you. PNEUMONIA, OR INFLAMMATION OF THE LUNGS. Pneumonia, inflammation of the lungs, or lung fever, as it is variously called, may occur at any period of life, yet it is not so common in early infantile life, as it is in children a few years of age. It often comes on independent of any other disease, and at other times it is consequent upon some other affection. The disease may develop gradually, especially when it depends upon some other disease as the exciting cause ; or it may come on suddenly, with cough, hurried and difficult breathing, and great heat of skin. More frequently, hoAvever, it is preceded for a short time, by symptoms of a common cold. There is no well marked chill, as in grown people, but a sense of chilliness, and sometimes convulsions. The general appearance of ihc child, is that of one out of health ; fretful, restless, feverish, thirsty, pulse rapid, face flushed 108 PNEUMONIA. breathing frequent, with a moaning sound on expiration of the air from the lungs, and the countenance indicating suffering. Soon after the disease sets in, cough comes on, which at first, is usually a dry, irritating, painful cough, and sometimes attending with vomiting. Bowels are apt to be constipated, tongue coated white, the infant breathes with the mouth open, and if at the breast, will not nurse more than a moment before it will stop to get a full breath. In the first stage of the disease, the general array of the symptoms, is as follows : Child is dull, sleepy, fretful, if aroused, the body is hot, the extremi- ties cold, the face pale, with a dark hue around the mouth often, pulse very rapid, the nostrils dilated, owing to the difficulty of breathing. The rapidity of breathing often reaches thirty or forty times per minute, and in severer cases, has been known to reach sixty. The red colored sputa, so generally noticed in the lung fever of older persons, is absent in children, simply because they are unable to raise it, and swallow it instead, or occasionally throw it up in the act of vomiting. The onset and progress of the disease, can readily be detected by the sounds in the lungs, but only by the educated ear of the physician, who has accustomed himself to such PNEUMONIA. 109 examinations, so that the description of these sounds would be of no value in domestic practice. In the mild, and more favorable cases, a gen- eral improvement takes place in the first week, or ten days. The pulse and breathing are less rapid, the cough is much looser, and less irrita- ting, the countenance presents a more natural appearance, there is increased appetite, and the child manifests a desire for his accustomed play- things. The convalescence is generally gradual, and a cough more or less severe, will often re- main for several weeks. In fatal cases, the pulse grows more frequent, and weaker, the breathing more and more diffi- cult, and as death approaches, the face and extremities become quite cool, with profuse cold perspiration. In the last stages of the dis- ease, abscesses not unfrequently form in the lungs, the matter from them escaping into the pleural cavity, or between the membranes that envelop the lungs and the walls of the chest, gives rise to pleurisy. The disease in children, is quite apt to attack both lungs, while in people of middle and adult life, it seldom attacks but one. Pneumonia in itself, is a serious disease, and is rendered much more so, by the various complications with other affections to which it 10 110 PNEUMONIA. is liable, such as bronchitis, pleurisy, abscesses, &c, and the best of care, close watching, constant attention, on the part of the nurse, as well as the best resources of the medical attendant, is demanded in these cases. The following general course of treatment may be pursued, and in all the milder class of cases, will doubtless suffice : In the primary form of the disease, where it comes on independent of any other affection, and there is difficulty of breathing, with threat- ened suffocation, emetics may be given, to expel the mucus from the throat and air passages. The following emetic will answer ; Syrup of ipecac, one ounce ; pulverized ipecac, seven grains ; mix and give the child a teaspoonful or two, frequently, until vomiting ensues. At the same time a mustard paste should be applied to the chest, and after it is removed envelop the whole chest with thick dry flannel, or what is better, make an oil silk waist, or jacket, and have the child wear it next to the skin. It keeps the heat and moisture of the body from escaping rapidly, and protects the body from cold and sudden changes of temperature. When the skin is hot and dry, tincture of digitalis, or tincture of aconite, may be given PNEUMONIA. Ill after the following formula : Tincture of aconite or tincture of digitalis, five drops ; wine of ipecac, thirty drops ; syrup of squills, one drachm ; simple syrup, an ounce and a half; mix and give one teaspoonful every three or four hours, to a child a year old. Tincture of veratrum viride, in doses of one drop every three hours, to a child five years of age, will be very useful, but the remedy is too powerful for use, except its effects are to be watched by a medical man who knows its effects and how to regulate them. When there are violent fits of coughing, espec- ially at night, Dover's powders may be given as follows : Dover's powder, four grains ; white sugar, two teaspoonfuls ; mix thoroughly, and give the infant what can be placed upon the point of a pocket-knife, every two or three hours. The following mixture may be used instead : Laudanum, six drops ; syrup of squills, one drachm ; simple syrup, two drachms ; water, two ounces ; mix and give in teaspoonful doses every two hours. The solution of the acetate of ammonia, or spirit of mindererus, as usually prepared in drug stores, is a useful remedy for allaying the fever heat of the skin, and it may be given in doses of half a teaspoonful in a little water, every four 112 PNEUMONIA. hours, to a child one year old. The bowels should be acted upon by some laxative, if con- stipated, and warm baths, or stimulating lini- ments applied to the chest, with friction, will be beneficial. Children of five years of age and older, often require more powerful and active remedies, to produce the same effect. For instance, if a child five years of age, with lung fever, has a trouble- some cough, with difficult breathing, the follow- ing formula of Dr. J. Lewis Smith's of New York, will be found to answer an excellent pur- pose : Sulphate of morphia, one grain; tartrate of antimony, one grain ; syrup of tolu, four ounces ; mix and give in teaspoonful doses, every three or four hours. If there is great difficulty of breathing, owing to the intensity of the fever, the following mixture may be given : Tincture digitalis, sixteen drops; tincture veratrum viride, three drops ; wine of ipecac, one teaspoonful ; syrup of tolu, two ounces ; mix and give one teaspoonful every three or four hours. Chil- dren of a weakly, scrofulous constitution, thin, pale-faced, require a tonic course of treatment, and to such may be given the following prepar- ations : Quinine, eight grains ; white sugar, half a drachm ; mix and make six powders, giving PNEUMONIA. 113 one twice a clay; or, carbonate of iron, eight grains ; white sugar, one drachm ; mix, and make eight powders, and give one morning and night. One or two teaspoonful doses of wine may be given several times during the twenty- four hours, and a nourishing diet, that is easily digested, should be employed, such as beef tea, chicken, mutton and oyster broth, milk, wine whey, etc. The temperature of the room should be mod- erately warm, air moist and fresh, while extremes of either heat or cold, are to be avoided, by keeping the temperature of the sick room as even as possible. Sometimes the breathing becomes slow and labored, the circulation torpid, when the child turns bluish or purple in the face, in which event, stimulants, like brandy, camphor, carbonate of ammonia, lavender, etc., are useful. The following mixture will answer : Tincture camphor, one drachm ; simple syrup, two ounces ; tincture lavender, one drachm ; mix and give teaspoonful doses every hour. Or the following mixture : Carbonate of ammo- nia, with syrup of senega, in the proportion of one-half drachm of the former, to two ounces of the latter ; mix and give teaspoonful doses every two hours. Another formula is as follows : 10* 114 PNEUMONIA. Carbonate of ammonia, twenty-four grains ; tinc- ture bloodroot, twenty-four drops ; syrup senega, two drachms ; extract liquorice, one -half drachm; water, two ounces ; mix and give a teaspoonful every three or four hours, to a child two or three years old. Dr. Jackson of Boston, recommends the fol- lowing mixture to allay the troublesome cough in this disease : Olive oil, one-half ounce ; syrup of squills, half an ounce ; mucilage gum acacia, half an ounce ; paregoric, one drachm ; mix and give in teaspoonful doses every three or four hours, to a child two or three years of age. Children in disease, especially any disease involv- ing the lungs, should have their position changed often ; and infants should be taken up often and carried about, and not be left to lie on their backs for a great length of time. The foregoing is the general course of treatment to be pursued in perhaps the generality of cases. Where com- plications arise, a change, or modification of treatment, will be required. As it is impossible, or improbable, that these should be detected by any one but the physician, the treatment neces- sary in such instances, will no doubt be left for him to suggest. WHOOPING COUGH. Whooping cough is emphatically a disease of children, and one of the most frequent of infan- tile disorders. It is a contagious disease, due to specific causes, yet the real nature thereof is not clearly understood. The disease is marked by three stages, viz : catarrhal, with symptoms of common cold ; second, stage of convulsive cough ; third, the stage of decline. The appearance of a child coming down with whooping cough, is that of a person with a severe cold in the head. The eyes will often be injec- ted, or blood shot, there is frequent disposition to sneeze, discharges from the nose, and more or' less cough. At this stage, there is nothing unusual about the cough, but the pulse and breathing are more rapid than in health. These" symptoms of cold in the head gradually improve, and no trouble or sign of disease remains, except 116 WHOOPING COUGH. a continual cough. The cough increases in CD D severity after a while, and the peculiarities of the disease begin to show themselves; the cough now comes on in spasms, and during each attack the child will turn red, almost purple in the face, and the whole body is convulsed with the vio- lence of the coughing. Each attack of the cough is made up of several short expirations of air from the lungs, continuing till the lungs are almost emptied of air, when a loud, long inspir- ation, or influx of air into the lungs takes place, which causes the peculiar sound or whoop. The whoop is quickly followed by cessation of the cough, and a feeling of great relief. Sometimes one spasm of coughing will be followed by several others in quick succession, until the child vomits, and throws up some thick mucus. Not unfrequently the spasm will amount almost to suffocation, and it seems almost impos- sible for the child to regain its breath. The veins about the head and neck become much congested and swollen, and the eyes almost seem to start from their sockets, the nose often bleeds, and the contents of the bladder and bowels are sometimes forcibly expelled. The spasms of coughing may come on every fifteen or twenty minutes, but sometimes there WHOOPING COUGH. 117 will be an interval of an hour or more. Infants often manifest great dread of the approaching spasm, wearing an expression of anxiety upon the countenance, often look up to their mother, holding fast to her, or, if old enough to be about the house, will throw away their playthings and make preparations for the attack by holding on to a chair, or anything offering support. The spasms last from a quarter to a whole minute, and during this time there is often as many as fifteen or twenty forcible expirations, or succes- sive fits of coughing, and Trousseau, a French author, has observed as many as fifty per minute. At the close of the spasm, if the cough is not complicated with any other derangement, the symptoms improve, the temperature of the body is lowered, the pulse is less frequent, and the breathing becomes quite natural. The cough in the second stage, is much more frequent in one case, than in another, there being no regularity about it, and the cough is apt to be more severe and violent where there are long intervals between the attacks. During the height of the disease, it is estimated, that there is, on the average, about one spasm of coughing every hour, although the attacks may recur at longer or shorter intervals. 118 WHOOPING COUGH. The general course of the disease is about as follows : The cough increases in violence till about the third week of the second stage of the disease, or the thirtieth, or thirty-fifth, day from the onset of the disease, and then continues with almost no change, for some time. The cough is usually more troublesome by night than during the day, and it is readily excited by any mental excitement, or bodily exertion. The ordinary duration of the second stage of the disease, is from thirty to sixty days, though it may be longer or shorter, and it is followed by the third stage, that of the decline of the disease, which contin- ues two or three weeks, or much longer if there is any complication with other diseases. The most frequent complications which take place in this disease are as follows : In the younger children attacked, especially if the cough comes on while teething, convulsions, spasms of the mus- cles of the throat are common, the spasm begin- ing during, or directly after the spasm of cough- ing. The convulsions are owing to congestion, or fullness of the blood vessels of the brain, the congestion being caused by the determination of blood to the brain during the act of coughing. The severity of the convulsion can be determined by noticing the readiness with which conscious- WHOOPING COUGH. 119 ness is restored. If full consciousness is promptly restored, it is safe to say that there exists no very serious congestion of the brain ; but if stupor, drowsiness, or a semi-conscious state con- tinues, serious disturbance of the brain may be suspected, and death anticipated. Dr. Copeland says, that in all cases of whoop- ing cough, where there are chills, followed by burning heat of skin, pain in the head, with unusual redness, or paleness of the face, redness of the eyes, with a fixed, brilliant, peculiar ap- pearance of them ; torpid bowels, irritability of the stomach ; an aversion to light and noise ; drowsiness or languor, grinding of the teeth, sudden twitchings or shocks of the body while asleep ; rolling or tossing of the head, with piercing screams, irritation of the brain exists, which will soon pass into organic disease, followed by stupor, insensibility and death. Another frequent complication associated with whooping cough, is that of bronchitis, and pneu- monia, especially if the disease comes on in cold weather. Bronchitis is attended with in- creased frequency of the pulse and breathing, the heat of the skin is much greater, and the danger from this complication is in proportion to the difficulty of breathing. In infants the 120 WHOOPIXG COUGH. smaller bronchial tubes may become involved, producing capillary bronchitis, which is a very dangerous disease. Dr. Tanner saj^s, that unless the bronchitis is severe, it will only be noticed in the commencement that the child is feverish, and that the breathing is increased in frequency, especially during the intervals between the spasms of coughing ; but as the disease increases, the disturbance of the general health becomes well marked, the breathing difficult and rapid, pulse quick, with high fever, and the general symptoms of bronchitis, become fully and clearly developed. Dr. Alderson, and Dr. Grailly Hewitt, declare, that when whooping cough proves fatal, it in- duces catarrhal inflammation of the bronchial tubes, attended with collapse of a portion of the lungs, by which air is excluded therefrom. Pneumonia is not so frequent a complication as bronchitis, but is said to attend whooping cough more than any other disease, except measles. Whatever complications arise, whether they be lung fever, bronchitis, or any other of an inflam- matory nature, they seem to lessen the violence of the spasms of coughing, and as the inflammation subsides, the cough increases in severity. The disease may also be complicated with derange- WHOOPING COUGH. 121 ment of the stomach and bowels, as shown by a heavily coated tongue, offensive breath, swollen belly, and unnatural passages from the bowels. If these symptoms continue for any length of time, fever follows, the cough becomes more frequent, the breathing more rapid and difficult, the child wears a peculiar expression of counte- nance, and is constantly picking at the bed- clothes, there is greater loss of flesh, and if the disease progresses, effusion into the cavities of the brain is apt to result. In considering the treatment of whooping cough space will not allow mention of the long catalogue of remedies that have had special and peculiar virtues accorded to them, and their cer- tain curative influences, for there have been about as many different remedies extolled for this disease as there have been individuals afflicted with it. As the disease is essentially nervous in its character, remedies designed to act upon the sympathetic nervous system, through the nerve centers, will be found most effectual in affording relief, except it be in the first stage of the dis- ease, when other remedies will be required. In recommending the course to be pursued in the treatment of whooping cough, 1 shall exclude as comparatively useless, the thousand and one 11 122 WHOOPING COUGH. drugs that have been more or less extolled for their virtues, and give the general plan of treatment which has been adopted, and carried out, by the best and most experienced medical men of the past and present. The great object of treatment is to prevent any other disease setting in, to allay the violence of the spasms, and to maintain the patient's general health and strength ; therefore, all rem- edies of a weakening or depressing nature, should be studiously avoided. In the first stage of the disease, should there be much bronchitis, or difficulty of breathing, counter irritation to the chest, such as friction, with camphorated oil, aqua ammonia, spirits of camphor, equal parts, the chest to be completely wrapped in oil silk afterward. Gentle laxative medicines to operate upon the bowels, as citrate of magnesia in solu- tion, castor oil, or rhubarb and magnesia, should be given. Remedies to promote expectoration are also required, and the following formula of Dr. West's will be found useful for this purpose : Wine of ipecac, ten minims ; wine of the tartrate of antimony and potassa, thirty minims ; com- pound tincture of camphor, twenty minims; almond mixture, seven drachms ; the whole to be mixed and given in two teaspoonful doses WHOOPING COUGH. 123 every four hours, to a child a year old. Should there be much wheezing, owing to the air pas- sages being obstructed with mucus, an emetic of ipecac once or twice a day will relieve the diffi- culty, although it must be borne in mind, that too much emesis is very prostrating, and injuri- ous effects might follow. Later in the disease, when the cough assumes its spasmodic character, Dr. West has great faith in hydrochloric acid, the following formula being the one used by him : Dilute hydrochloric acid, four minims ; sim- ple syrup and distilled water, each seven drachms ; mix and give teaspoonful doses every six hours, to a child nine months old. The effects of this remedy need to be watched, to see that it be not continued too long, nor any injurious effects follow its use. Sometimes the child will be quite comfortable during the clay, but when night comes on, the cough grows very troublesome by its frequency, in which case, small doses of Dover's powder with extract of hemlock, is recommended by Dr. West ; the following is his formula : Dover's powder, one-half a grain ; pulverized extract of hemlock, one grain ; powdered cinnamon, two grains; white sugar, four grains; mix and make one powder, and give it at bed-time, to a child 124 WHOOPING COUGH. two years old, and in smaller doses to younger children. The most effectual remedies, and those most in use at the present day, are, bro- mide of potassium, bromide of ammonium, hy- drochloric acid and belladonna. Trousseau and Guersant, celebrated authors, physicians of large experience in the treatment of children's dis- eases, speak of belladonna properly administered, as being very effectual, so also does Schaeffer, and Goelis, who are men of great ability and wide reputation. Trousseau prepared pills con- taining one-fifth of a grain of the extract and one-fifth of a grain of the powder, and gave one in the morning, on an empty stomach. If the attacks of coughing improved, and were less severe, the same dose was given each day ; but if no improvement was noticed two pills were given on the following morning, then the next, and so on, till a noticeable effect was produced. The dose which he found to relieve the symptoms, he directed to be continued for six or eight days, and then, if improvement continued, he directed the dose to be lessened by one pill daily, thus giving only one pill a day. Dr. J. L. Smith of New York, prepares the extract of belladonna in one grain pills, and if the patient be an infant a year or so old, one WHOOPING COUGH. 125 pill is dissolved in eight teaspoonfuls of water, and if three years old, in four teaspoonfuls of water, and the mixture is to be given in tea- spoonful doses once a day, or even two or three times daily if needed in order to produce an effect, and as in case of the pills, the dose which affords relief, is to be continued for a week or more. Trousseau sometimes used atropia, instead of belladonna, and Brown Sequard stated before the United States Medical Association, that the duration of whooping cough, or the spasmodic character of it, might be reduced to a few days, by using atropia in sufficient quantities to pro- duce its peculiar poisonous effects, even produc- ing delirium for two or three days. It is, how- ever, a medicine to be given only by the physician, and belladonna, though used much in domestic practice, should not be given to chil- dren by any one not familiar with its use, and the effects produced, and who can not tell by the symptoms manifested, when the patient is under the full influence of the drug. Dr. Gibbs and Professor Harley of London, use the bromide of ammonium. Professor Harley gives one grain of the bromide of ammonium three times a day, to a child one year old, and 11* 126 WHOOPING- COUGH. increases the close one grain, for every additional year of the child's age. Dr. Ritchie, physician to the Royal Edinburg Hospital for sick children, says, that in his opinion, the remedy appears most effectual when the child is over two years of age. He gives from three to twelve grains, in divided doses, every eight hours. Belladonna is considered the best in the early stage of the disease, and bro- mide of potassium, with bromide of ammonium, or iodide of potassium, in the advanced stages. Bromide of potassium, is believed to have more control over the spasms of coughing, than any other remedy. It may be given in doses of one grain every three or six hours, to a child one year old. The following formula is a convenient one for use : Bromide of potassium, sixteen grains ; simple syrup, one-half an ounce ; cara- way water, two ounces ; mix and give one tea- spoonful every three or six hours, to a child one year old. Dr. J. Lewis Smith of New York, mentions a case where a child had twenty convulsions within forty-eight hours, who recovered by the use of the bromide and iodide of potassium, two grains of each being given every two or three hours. WHOOPING COUGH. 127 Dr. Dillnberger of the Vienna Medical school recommends the following formula, where there is much congestion of the brain in whooping cough, and tendency to convulsions : Extract of belladonna, two grains ; oxide of zinc, two grains ; white sugar, one drachm ; mix and divide into eight powders, and give one, two or three times a day, to children from six to ten years of age, the dose to be reduced for younger children according to age. Where the child raises a purulent, profuse secre- tion, an astringent remedy may be required, and for this purpose, alum, tannin, or sugar of lead may be given. If tannin is used, the following formula will answer : tannin, seven grains ; white sugar one drachm ; mix and make eight powders, and give one every three or four hours in a little water. Sugar of lead may be given as follows : Sugar of lead one grain ; white sugar, one drachm ; mix and make eight powders, and give one powder every four hours, the dose answering for children at the breast. Where the paroxysm of coughing is very severe and prolonged, some physicians make the child inhale chloroform soon as there are any indica- tions of the attack, and so prevent, or shorten the spasm. During the paroxysm of coughing, 128 WHOOPING COUGH. the infant must be held, and the mucus which is coughed up must be removed from its mouth. Dr. Dillnberger of Vienna, says that severe paroxysms of whooping cough may be relieved by laying a cold dressing on the lower part of the breast bone, and cold water frequently applied has the same effect. When convulsions occur, cold applications to the head, warm foot- baths, and laxatives, if the bowels are inactive, will be required. Many are the remedies that are highly valued in domestic practice, among which is the follow- ing mixture : Cochineal, one-half a scruple, carbonate of potassa, one scruple ; white sugar one drachm ; water, four ounces. The dose of the mixture for a child one year old, is a dessert- spoonful three times a day. Change of air is often beneficial, and in cases of whooping cough, where no other trouble is associated with it, and the weather is warm and pleasant, benefit will be derived by "taking the child out into the open air daily; but if the weather be cold or damp, it should not be allowed. The diet should be well regulated and should be such as is easily digested and nutritious. Everything tending to excite the child must be avoided, and the child's head, whether it be asleep, or awake, should always be WHOOPING COUGH. 129 elevated, for if it lies with its head low, it will aggravate the cough. Although the great majority of the children affected with whooping cough recover, any case is liable to become complicated with some other disease which may render it fatal ; it is therefore very important that every case should be care- fully watched, to notice the first signs of approaching danger, and so be prepared to resist it. CROUP. Few children escape this, one of the most prevalent, as well as the most serious, and fatal diseases of early life. Croup consists of an acute inflammation of the larynx and trachea, or wind pipe,, which rapidly increases in severity, termi- nating in the formation of a false membrane upon the inflamed surfaces, which fills the wind pipe, and renders breathing difficult, or impossi- ble, according to the extent of the membranous deposit. It is most frequent in the first two or three years of life, and decreases in frequency as age advances. The most frequent causes of the disease are, exposure to sudden changes of temperature, as from a warm to a cold room, or taking a child from a warm room into the street on a cold day, or being exposed to currents of air, or change of dress, the child being dressed much warmer at CROUP. 131 one time than at another. Location has much to do with it; low, damp places, situated near ponds and rivers, always favoring the progress of the disease. Swallowing substances of any kind that irritate the throat, give rise to it in children very susceptible to the disease. Croup usually manifests itself in one of the following ways : By a hoarseness, or huskiness of the voice, which is noticed in coughing, and which continues for several clays, or until some fresh exciting cause, as sudden change of tem- perature, kindles up the inflammation. Exposure to cold, or damp, at such times, which checks perspiration, is sure to give rise to alarming symptoms, as greater or less difficulty of breath- ing, troublesome cough, fever, etc. The other way in which the disease often shows itself, is by a sudden and violent attack, with almost no warning of the approaching difficulty. Life is in danger from the beginning of the disease, and if its rapid progress be not arrested death will soon follow. But in whatever way the disease comes on, its most frequent time for showing itself is in the latter part of the evening, or towards morning, doubtless owing to the cold and damp atmosphere of the night, and the greater relaxation of the system. Now, what 132 croup. are the symptoms of this disease ? So well marked and prominent are they that it would seem to be no difficult task to detect the disease, and yet many cases are called croup, which lack the essential characteristics of the malady. One of the first and surest signs that croup is coming on, is a peculiar, hollow, sonorous sound, or hoarseness,- when the child attempts to cough, but which at this time does not affect the voice. This state of things may continue for a longer or shorter period, and at the beginning of the attack, the circulation, breathing, and the appe- tite, are not much affected, the child usually appearing comfortable and cheerful. The hands are frequently noticed to be cold, the face paler than usual, and the skin often presents a cold appearance during the premonitory stage. The cough is short, dry, hollow, and if anything is raised, it is thin, whitish, and in small quantities. After these symptoms have continued for a time, a sadden change often takes place, which may prove fatal in a few hours, or continue on for a longer or shorter time, with final recovery. We now notice increased hoarseness, which affects the voice, the cough is more frequent, with longer attacks, and each effort is attended with greater exhaustion and difficulty of breathing ; the face ceoup. 133 becomes flushed during the attacks of coughing, the circulation rapid, child is often drowsy, and falls into frequent, but disturbed sleep, from which it is awakened by a violent cough and distress in breathing. If the child is old enough, it raises itself, or elevates its head, in order that it may breath easier. At this stage of the disease, -the cough is attended with more or less secretion of mucus in the throat and air passages, and attempts to raise it become more frequent and prolonged, so much so at times, as to threaten strangulation. The child becomes more and more exhausted in its efforts to get relief, and throws itself back as if in despair, but instantly springs up again as if avoiding suffocation. The child can not lie down, it throws its head forwards and backwards, trying to gain some position which will afford some relief from the painful efforts at breathing. At this period of the disease, the face instead of being red, flushed, is of a dark, livid, bluish color, the lips present the same appearance, the gums are pale, and the tongue is of a dark color, the skin is covered with cold perspiration, the pulse is frequent, fluttering and contracted, the heart pulsates violently, and the muscles of the neck and chest are called into play, to carry on 12 134 croup. breathing;. The couedi now becomes more fre- quent, there is loss of voice, thirst is torment- ing, the countenance presents an anxious ap- pearance, the eyes are shining with peculiar brilliancy, and the little sufferer soon expires, unless relief is jn'ocured, by means of medica- tion, or surgical operation, the latter sometimes rescuing the patient from death, even at- the eleventh hour. The symptoms, which are here given in detail, are those that usually attend true mem- braneous croup, that is to say, where there is a deposit of false membrane on the mucous surface of the air passages, obstructing them so that tlie ingress 'and egress of air is much im- peded. There are other forms of the disease, like common croup, without the deposit of false membrane, which is known as false, or spas- modic croup, the trouble being caused by the spasm of the glottis, preventing the entrance of air into the lungs. In these cases, the symp- toms are very much modified, the disease is less severe, and the treatment required of a different nature ; which will be alluded to after consider- ing the treatment of true membraneous croup. In a disease so sudden in its development, so croup. 135 rapid in its progress, so fatal in its consequences, no time should be lost in. obtaining relief, and the most reliable and prompt means should be employed for this purpose. The treatment of croup must be energetic, for relief must be obtained soon, or it may be too late. Before the disease is fully developed, the child, having simply a moderate, ringing cough, should be carefully watched, placed in a warm bath for ten or fifteen minutes, and then be con- fined to the bed, the air of the room at the same time being kept warm and moist by the genera- tion of steam. Afterward, if any difficulty of breathing manifests itself, and the cough still being rough and hoarse, an emetic should be given, for which purpose the following mixture will suffice : Wine of antimony, one-half an ounce ; wine of ipecac, two drachms ; water, one ounce ; mix and give one teaspoonful every ten minutes, until the desired effect is produced. Another convenient formula is as follows : Pul- verized ipecac, ten grains ; white sugar, one drachm; mix and divide into twelve powders, giving one every fifteen minutes, till vomiting ensues. Emetics are useful. in the premonitory stages of croup, because they promote the secre- tion of mucus, and are attended by more or less 136 croup. vomiting of this substance. They remove from the larynx, by the forced expiration caused by their action, any albuminous, or fibrinous sub- stance, which, till now, is in a soft semi-liquid state, but which is likely to become organized into false membrane. The depressing effect of emetics in the earlier stages of the disease, is not injurious, but care must be exercised to see that too much prostration does not attend their use. Where a very prompt emetic is desired, tartar emetic may be given as follows : Tartar emetic, one grain; compound syrup of squills, one ounce; mix and give one teaspoonful every ten minutes, till emesis follows. Ipecac is the best emetic for children at the breast, or under two years of age. Early in the disease, before much inflam- mation exists, hot water, persistently applied by means of a sponge, or flannels, to the throat and chest, will frequently relieve the severity of the symptoms. The cloths should be re-appliecl every few minutes, in order to keep up the temperature, the practice to be continued for twenty minutes or half an hour, when a general perspiration often sets in, the cough is relieved, as well as the difficulty of breathing and hoarse- ness, and frequently a quiet sleep follows. After ceoup. 137 an emetic has had its effects it is often desirable to maintain a feeling of nausea for some time, for which purpose, use this mixture : Chlorate of potash, one drachm ; wine of tartrate of anti- mony and potassa, one drachm ; wine of ipecac, half a drachm ; syrup of lemon, three drachms ; water, three ounces ; of this mixture give a des- sert-spoonful every three hours, to a child two years old. Dr. Smith of New York, and many other physicians of large experience in the treat- ment of children's diseases, speak highly of the chlorate of potassa, or soda, and muriate of ammonia, as a remedy for this disease. The following is Dr. J. Lewis Smith's formula for their use : Chlorate of potash, one drachm • muriate of ammonia, two scruples ; simple syrup, one ounce ; water, two ounces ; mix and give one teaspoonful every twenty minutes or half an hour in severe cases, and once in an hour or two in mild cases. Inhalation of steam, is a valuable adjuvant, in the treatment of croup, the moist air coming in contact with the inflamed surfaces, promotes expectoration, and renders the cough looser. Steam may be readily produced by put- ing hot irons or bricks in a shallow dish of water, or by pouring water on heated surfaces, or by keeping two or three kettles continually 12* 138 croup. boiling on the stove. The addition of a little unslacked lime to the water, has been found to be beneficial. The temperature of the room should be kept uniform, but not too high, and all exposure to cold or currents of air, must be avoided. Allusion has been made to emetics, and those were mentioned that operate mildly, without much depressing effect ; but in the most serious forms of the disease, where the air passages are filled with membraneous deposit, the most prompt and powerful emetics are demanded, and those should be selected that are the least depressing in their effects. Sulphate of copper will best answer these indications, and it may be used as follows: Give a dose of one grain, dissolved in a little water, and repeat it every twenty min- utes, till vomiting results. If there are any signs of exhaustion, and the membrane has been re- noved so that the child can swallow, beef tea, milk, wine whey and alcoholic stimulants should be given, in order to keep the patient's strength up as well as possible. Local treatment, both ex- ternal and internal, should be resorted to, for much relief is obtained by these means. Some of the best authorities speak highly of cold water as an external application in croup, among whom are croup. 139 Professor Peaslee of New York, Dr. Dillnberger of Vienna, and others. It may be applied by wringing out flannels in cold water, or by pieces of ice, or finely powdered ice, in oil silk bags, placed around the neck. These cloths, or bags, need to be continually applied, changing as often as they grow warm, for if reaction is allowed to take place, and warmth ensues, the inflammation will increase rather than diminish. Cold appli- cations agree best with robust, full-blooded chil- dren, but in all cases where these applications render the child more uneasy, restless and un- comfortable, hot applications must be substituted, and these may consist of heated bags of fine salt, boiled potatoes, well mashed, or poultice of flax- seed and mustard, equal parts. Oil silk should be placed over these poultices, to keep the heat and steam from escaping, and at the same time protect the patient's clothing from dampness. It is a very common practice, in domestic circles, to bathe the throat and chest with olive oil, or to bind a piece of salt pork on the throat, and it frequently answers a good purpose. In- stead of the latter, equal parts of aqua ammonia, camphorated oil, and chloroform liniment, mayjje frequently and thoroughly applied with flannel, the neck to be well protected with oil silk after 140 CROUP. each application. Internal applications to the throat are demanded, in order to soften and remove the membraneous deposit from the throat, and many are the remedies which have been used for this purpose. Among the most common are, nitrate of silver, dilute hydrochloric acid, dilute nitric acid, chlorate of potassa, muriate of iron, or a mixture of the two last; but other remedies have been found that are more effectual. Professor Smith of Bellevue Hospital, New York, says : " Of late years, three other remedies have been used for topical treat- ment of the throat, which appear to be more effectual in removing the false membrane, and controlling the inflammation. One is liquor of the subsulphate of iron, the other carbolic acid, and the third, bromine. The sulphate of iron is best employed with glycerine, in the proportion of one part to four, as follows : Liquor of the subsulphate of iron, one drachm ; glycerine, half an ounce. Carbolic acid should be used diluted with water, the following formula answering the purpose : Carbolic acid, one drachm ; water, six ounces. Bromine is used in combination with bromide of potassium, a solution of which may be made after this formula : Bromine, two drachms ; bromide of potassium, sixteen grains ; CKOUP. 141 water, one ounce. From twenty-four to forty drops of this solution, should be added to an ounce of water, for application to the throat. " Although it is a confession of weakness, it is, nevertheless, too true, that all these remedies, and remedial measures frequently prove unavail- ing, the disease progresses, there are violent paroxysms of choking, with great difficulty of breathing, signs of exhaustion, or fainting, and coma, or lethargic state, appears, the bodily strength is not sufficient to remove the collected secretions and false membrane with the cough- ing, or even perhaps with the vomiting, and death soon closes the painful struggle for life, unless the last weapon of defense, the knife, proves successful. The operation of tracheotomy, or opening the wind pipe, has its advocates and opponents, but as all cases must inevitably die without it, where all other means have failed, they can no more than die if the operation is performed. It is looked upon by parents as a cruel procedure, but the fact is, the operation is a great source of relief to the child, while it does live, and it is a question whether the operation should not be performed for this purpose alone, in cases where 142 croup. recovery is utterly hopeless. M. Trousseau, the great advocate for tracheotomy in the last stage of croup, states that in four years time, he operated twenty-four times in private practice, with fourteen cures, and two hundred and six- teen times at the Children's Hospital, with forty- seven recoveries. Professor Jacobi of New York, in a statement published in the American Journal of Obstetrics, for May, 1868, says, that out of 166 cases oper- ated on by himself and Drs. Krackowizer and Voss of New York, 39 recovered and 127 died. Other statistics could be furnished, but these are enough to convince any one of the prac- tical utility of the operation as a means of sav- ing life. The details of the operation are not called for in a work of this kind, for no one but the physician could perforin it. In all cases of croup, after recovery has taken place, the utmost precaution must be taken to guard the child against cold, currents of air, and excitement of any kind, for it takes but little exposure to cause a relapse of the disease, which is more apt to prove fatal than the first attack. croup. 143 In spasmodic, or false croup, anodynes and antispasmodic remedies will be the most service- able, such as belladonna, valerian, musk, assa- foetida, camphor, bromide of potassium, chloro- form, and other remedies of like nature. SCARLET FEVER. Scarlet Fever, is also called scarlet rash and scarlatina. It is called scarlet fever, on account of the peculiar red, or scarlet color of the skin. The disease is both contagious and infectious, and is attended with fever, inflammation of the mucous membrane of the mouth and throat, and an eruption which appears upon the skin about the second day of the fever, and continues till about the fifth day. The disease often affects the glands about the neck and throat, which increase in size, and occasionally sivppurate, discharging matter freely. Scarlet fever is much more prevalent in Winter and Spring, than in Summer and Autumn. Most authors classify the disease into three varieties, according to the kind, and severity of the symp- toms, as follows : Simple scarlet fever, or the regular form of the disease ; scarlatina anginosa, SCARLET FEVER. 145 or irregular form of the disease, where the throat and glands of the neck become involved in the course of the disease ; and malignant scarlet fever. Like most other fevers, the simple form of this disease is generally ushered in by a dis- tinct chill, or feeling of chilliness, fullness of head, and headache, high fever, vomiting, prostration and sometimes delirium. The pulse is often from one hundred and ten to one hundred and twenty per minute ; the skin is hot, face flushed, and in many cases there is twitching of the muscles, and more or less stupor. Vomiting usually takes place during the first twenty-four hours, or before the appearance of the rash, and when it continues for a longer time than usual, or with unusual violence, it indicates a severe attack of the disease, and one attended with more than common danger. After these symptoms have continued for twelve or twenty-four hours, the rash begins to appear, showing itself first about the ears, upon the face, neck and shoulders, in indistinct patches, which gradually fade. These patches unite , rapidly, extend, and in a few hours the whole body is covered. About this time a degree of redness and swelling appear in the throat, the same appearance extending to the tongue. The 13 146 SCARLET FEVER. skin is now excessively hot, there is great thirst, the pulse is very rapid, and the rash gives rise to an itching, or burning sensation, which adds much to the discomfort of the patient. Cough frequently attends the disease, though usually slight. In the common form of the disease, the symptoms as here detailed, continue without much change for five or six days, when the fever begins to decline, the heat of the body to dimin- ish, and the rash fades away, so that convalescence begins at the first of the second week, or before. During the second week the rash becomes very indistinct, the redness and swelling about the throat disappear, the tongue regains its natural appearance, the appetite returns, and a general look of health manifests itself. During convalescence the skin desquamates, or peels oft*, commencing on the face and neck, and so on over the whole body, the process last- ing for several days. Such is the general course of scarlet fever in its most common form ; while in scarlatina anginosa, or the form of the disease which affects seriously the glands of the neck and throat, the symptoms are more violent. , There is more headache, with delirium, intoler- ance of light, greater heat of skin, and more prostration. In a day or two there is stiffness SCAKLET FEVER. 147 of the neck, uneasy sensation in the throat, with hoarseness and difficulty of breathing, caused by the swelling of the tonsils and palate. As the inflammation extends, the fever increases, the skin grows hot and dry. The eruption does not come on with its usual regularity, not appearing as early as usual, and instead of extending over the whole body, it comes out in patches here and there, which soon disappear, and partially reappear after uncertain intervals. As the eruption fades away about the fifth or sixth day, the fever and inflammation of the throat abate, but the soreness of the throat often continues for several days after the rash and fever disappear. Sometimes this variety of the fever assumes a still more serious form, when there is an acrid discharge from the nose and ears, with deafness, and the glands of the neck often swell up, and suppurate, discharging freely. In the third variety spoken of, viz., malignant scarlet fever, the symptoms are much more vio- lent than in the other varieties. The fever is of a typhoid character, and attended with much greater prostration ; there is great disturbance of the brain, followed by irritability, restlessness, and delirium, which is sometimes violent, and at other times a low muttering kind, the patient 148 SCARLET FEVER. constantly talking in a low voice, picking at the bed-clothes, or imaginary objects; the tongue is of a dark color, the teeth are covered with sordes, the pulse is very rapid and everything indicates the gravity of the disease. The erup- tion is very irregular in its appearance, disappears in a few hours, and reappears the second time, in the course of the disease, and it is at first of a pale color, but is soon changed to a dark, livid hue. Scarlet fever is very apt to leave the health permanently impaired, therefore the greatest care and watchfulness is necessary, both during the course of the fever, and for sometime after con- valescence has taken place. Among the many disorders caused by scarlet fever, are a variety of scrofulous affections, as scrofulous ulcers, disease of the eyes, enlarge- ment and suppuration of the glands of the neck, disease of the scalp, inflammation of the inter- nal ear, with profuse discharges therefrom, often terminating in the destruction of the in- ternal ear, and consequent deafness. But the most serious difficulty resulting from scarlet fever, is inflammation of the kidneys, resulting in dropsy. The dropsical trouble usually comes on between twent}' or thirty days after the commencement SCARLET FEVER. 149 of the fever, and it is much the most common after the mild form of the disease. This fact is at- tributed to the greater carelessness of the patient in mild cases, exposure to cold, the exposure checking the action of the skin, so that the poison, instead of passing off through the perspi- ration, is thrown back into the blood, and is eliminated by the kidneys, which causes the inflammatory trouble, and attendant dropsy. Sometimes serious disturbances of the lungs and digestive organs, result from this disease. In the mild form of the disease, but little treatment is required beyond attention to diet, and general hygienic measures. Some mild remedy to promote perspiration, is useful, and for this purpose the following mixture may be given : Sweet spirits nitre, three drachms ; wine of ipecac, two drachms ; syrup of ginger, one ounce and a half; mix and give one teaspoonful every three hours, to a child from four to six years of age. This formula will also anwer the purpose well: Liquor of the acetate of ammonia, two ounces ; two teaspoonfuls to be given every four hours in a swallow or two of water. If the bowels are constipated, some gentle laxative will be useful, as the solution of the citrate of magnesia, given in wine glass doses, oft repeated. 13* 150 SCARLET FEVER. To relieve the restlessness, a warm foot bath is good, or sponging the whole body with tepid water, and bathing the head with cool water, bay rum, and the like. The sick room should be well ventilated, allowing no currents of air to reach the patient, but allow plenty of cooling drinks, and light, but nutritious diet. Where the disease is more violent in its be- ginning, with high fever, delirium, and great prostration, more vigorous treatment will be demanded. The application of cold w r ater, by putting the patient in a bath tub, pouring on cold water, immediately afterward placing the patient in bed, warmly wrapped in flannels, thereby inducing copious perspiration, is highly recommended by good authorities. The wet sheet, or packing, as it is called, is a convenient method of applying cold water ; after the patient has remained in the wet sheet for an hour or so, free perspiration is produced, and then the patient is to be wiped thoroughly dry, placed in bed, the wet clothes at the same time being exchanged for dry. If called for, the process may be repeated, until the great heat of the body, and the dryness of the skin, is overcome. In very young children, while the cool applications would be equally useful, the shock which they SCARLET FEVEE. 151 cause, would not be so well tolerated, therefore, tepid water should be used instead. Where there is much debility and prostration, small doses of wine frequently repeated, or occasional doses of brandy, should be given to support the strength, together with beef tea, and broths. Medicines should be given internally, to allay the fever, and to promote the removal of the fever poison from the blood, and for this purpose various remedies are useful, and among them, perhaps there are none better than a mixture of chlorate of potash and hydrochloric acid, in the following proportions : Chlorate of potash, four grains ; hydrochloric acid, half a drachm ; water, half a pint. A tablespoonful of this mixture may be given several times during the day. When the patient is constantly drowsy, delirious, the circulation torpid, skin of a dark, dusky hue, stimulants must be given freely. Wine whey, egg-nog, milk punch, are convenient methods, or mixtures, for administering stimulants to chil- dren. Carbonate of ammonia, is a quick, volatile stimulant, and is a remedy much used, and very effectual in sustaining the strength of the patient. Dr. Smith of Bellevue Hospital, of New York, recommends its use with iron, in the following formula : Carbonate of ammonia, half a drachm ; 152 SCARLET FEYER. citrate of iron and ammonia, half a drachm; simple syrup, two ounces ; mix and give a tea- spoonful every three hours, to a child five years of a^e. Often there is great itching of the skin, so as to greatly annoy the patient, which is best relieved by rubbing fresh lard into the skin, olive oil, or what is much more agreeable, glyc- erine. In cases where the rash appears but im- perfectly, the patient should be placed in a warm bath, to which a little mustard may be added, and in cases with much delirium, wake- fulness, picking at the bed-clothes, anodynes will be required. Bromide of potassium may be given in five grain closes, to a child five years of age, the dose to be repeated every hour, till quiet is restored. I have seen the happiest results from the use of bromide of potassium, in combination with the compound spirits of ether, in cases of extreme wakefulness and restlessness. Ten drops of the spirits of ether may be given, with five grains of the bromide of potassium, the dose to be repeated every hour or two, as the case demands, until sleep is secured. I have known this to succeed, when opium in its various forms failed altogether, and it has the advantage of being comparatively harmless. The throat SCARLET FEVER. 153 trouble often proves serious, therefore the throat should be carefully watched from the outset of the disease. The glands of the neck not only swell and suppurate, but the inflammation is at times so severe, that gangrene, or mortification and sloughing of the parts, takes place, which is apt to result fatally. If the throat is found to be much inflamed and swollen, gargles should be used, and if the child is too young to use gargles, then local applica- tions should be made with a brush. A gargle like the following will suffice in mild cases : Solution of the chloride of soda, one ounce ; glycerine, one ounce ; water, one ounce ; mix, when it is ready for use, without dilution. One of the best preparations for applications to the throat is, however, a mixture of the tincture of the chloride of iron and chlorate of potash, after the following formula : Tincture of the chloride of iron, two drachms ; chlorate of potash, two drachms ; glycerine, one ounce ; rose water, three ounces ; mix and apply to the throat thoroughly every two hours. Often in young infants the throat becomes so much stopped up with mucus that breathing is rendered difficult, when the throat must be well swabbed out, and whatever is used for a swab, should be dipped 154 SCARLET FEVER. into a mixture of chloride of soda, yeast, or hydrochloric acid and honey. For the ulcera- tions of the throat, nitrate of silver, twenty grains to the ounce of water, is serviceable. Liniments, lotions and poultices, are all more or less useful in relieving the soreness of the throat, applied externally. A poultice of hops and powdered flaxseed, or a liniment like the following may be used : Camphorated oil, chloro- form liniment, aqua ammonia, each an ounce, mix and rub the throat well with the mixture three or four times daily. The common domes- tic practice of applying slices of salt pork, with mustard sprinkled upon the surface that is ap- plied to the throat, is by no means a bad or useless one, but on the contrary, it is a very good as well as a convenient one, and when used, should be kept constantly applied. When the glands of the neck are much swollen, with tendency to suppuration, tincture of iodine should be applied, or painted on the parts twice daily, the applica- tion to be made with a camel-hair brush. In the malignant forms of the disease, every means must be resorted to to support the patient's strength, for this type of the fever is always attended with marked and severe prostration from its commencement. Beef tea, egg-nog, SCAELET FEVER. 155 wine or brandy, either with or without carbonate of ammonia, as the exigencies of the case de- mand, should be given at short intervals, night and day, for convulsions and stupor, or coma, are much less liable to occur, if the strength of the patient is well supported. After the child has recovered from the fever it should be kept in doors, and not be exposed to currents of air for some weeks afterwards, for as has been before stated, this exposure to cold and getting chilled, is the frequent cause of the kidney disease, that so often attends the fever, and the dropsy that succeeds it. When there is any evidence that the kidneys are involved, and dropsy is resulting, profuse perspiration should be excited, and diuretics should be given to in- crease the flow of urine. These effects may be accomplished by placing the patient in a warm bath for a few minutes, after which, put the patient to bed, and surround him with bottles of hot water, or generate steam under the bed clothes, by placing underneath them a pan of water, into which drop heated stones, bricks, flat-irons, or anything that comes handy. Diu- retics and diaphoretics must be given to increase the action of the skin and kidneys, for which purpose small doses of Dover's powder may be 156 SCARLET FEVER. given, together with teaspoonful doses of spirits mindereri, or solution of the acetate of ammonia, the close to be repeated every three or four hours. Sweet spirits of nitre and solution of acetate of ammonia may be given in combination, as follows : Solution of acetate of ammonia, two ounces ; sweet spirits of nitre, one ounce ; jnix and give one teaspoonful in a wine glass of water every four hours, to a child five years of age. The acetate of potash is a remedy much in use, and is very good as a diuretic. It may be given in five grain doses, dissolved in a little simple syrup and water, the dose to be repeated every four hours. The dropsical effusion is rapidly diminished by the use of cathartics, which produce copious and watery stools, such as citrate of magnesia, colocynth and Rochelle salts. Elaterium is a prompt and powerful cathartic, producing abundant watery stools, and may be used in this manner : Dissolve one grain of the powder in two ounces of glycerine, and give teaspoonful doses once in four hours, until the desired effect is produced. The remedies mentioned above are generally successful in lessening, if not entirely removing the dropsical trouble in its acute stage, but where the difficulty assumes a chronic form, other SCAELET FEVEE. 157 remedies of a different nature will be more effectual. Many drugs have had peculiar virtues ascribed to them ; but among the most service- able in dropsy following scarlet fever, may be 'mentioned, tincture of the chloride of iron, iodide of potassium, syrup of the iodide of iron, and the compound solution of the iodide of potassium, of the London Pharmacopoeia. The latter remedy has been found highly useful by Dr. E. Copeman of Norwich, England, given in one-half, or one drachm doses, as the case demands, repeated every four hours. The com- pound liquor of iodine, of the United States Pharmacopoeia, (Lugol's solution,) is to be used in much smaller closes, viz., two drop doses, gradually increased to five, and repeated every five hours, each dose to be given in a wine glass of water. If the tincture of the chloride, or syrup of the iodide of iron are used, they may be given in doses of ten drops in a wine glass of water, repeated every five hours. The syrup of the iodide of iron may be given in combination, as follows : Syrup iodide of iron, one ounce ; iodide of potassium one scruple ; mix and give ten drops in a wine gla^s of water every four or six hours. The great majority of d ropsical cases, will yield to the course of treatment here marked 14 158 SCARLET FEVER. out, if all due precautions are taken, and the remedies judiciously applied. Belladonna is a remedy which has been much used, and highly extolled, both as a remedy, and a preventive, but the results have not at all satisfied the expectations of its advocates. The discharges from the nose and ears often caused by this fever, have been treated of in the chapter on inflammation of the ears, and so need not be enlarged upon here, more than to say that they should be attended to at once, in order to prevent disastrous consequences, and whatever complication arises during the progress of the fever, it should receive "prompt attention. In a word, there is no disease where so many ill effects follow ; and it requires great care, and constant watching, to guard against changes of temperature, improper exposure, injurious diet, and these precautions should be heeded long after the patient has left the bed. MEASLES. This is an eruptive disease, prevailing princi- pally in infancy, and childhood, although it may attack people of any age. It usually occurs but. once in a life time, yet there are well authenti- cated cases of a second attack. The disease prevails to its greatest extent in the winter and spring, the cold weather seeming to favor the spread of the disease, which is true of most of the eruptive disorders of a contagious nature. The disease usually manifests itself from seven to fourteen days after exposure, and it is ushered in by a sense of chilliness, debility, heat of skin, thirst, especially the first day. The fever is quite high from the first, and especially about the time the eruption appears, ' which is the third or fourth clay from the begin- ing of the attack, and there is most always a dry hollow cough, more or less hoarseness, sore throat, pain in the chest, and difficulty of breath- ing. The eyes are red, watery, lids swollen, 160 MEASLES. there is sneezing, free discharge from the nostrils, and a general appearance of a cold in the head. The eruption most always appears first, on the face and neck, and spreads from thence over the whole body. Sometimes the eruption instead of coming on in this regular form, appears in large red spots of irregular size and shape. The color of the eruption is usually very red for the first three or four days, after which it assumes a brownish color, and then gradually disappears. After the eruption fades away the cough often increases in severity, attended with expectoration, and not unfrequently, lung fever attends the disease, which is an unfavorable complication. The shape of the eruption in measles, is cres- ent, a half-moon shape, and is raised but a little above the surface of the skin. Occasionally the eruption shows itself but imperfectly, disappears, then comes out again, in which case internal troubles are more likely to result, and whenever the eruption is dark, or black in color, the disease is called malignant, or black measles, and is generally fatal. Bronchitis and pneumonia are often caused by measles, and diarrhea usually comes on during the course of the disease and is sometimes quite MEASLES. 161 severe. Sore eyes, inflammation of the ears, with discharges therefrom, very frequently result from measles. The disease in the great majority of cases, is not attended with much danger, yet, as in scarlet fever, a variety of secondary disor- ders are apt to follow, and constant watch and care is necessary, until all traces of the disorder have disappeared. In deciding whether the eruptive disease is that of measles, there need be no doubt, when the characteristic odor of the disease is noticed, which is a strong, mousy, musty smell, unlike that attending any other disease. In mild cases little or almost no treatment is demanded, beyond keeping the patient in a warm room, and giving warm drinks to excite perspiration, and confin- ing the patient to light, nutritious diet. To promote the appearance of the eruption, various drinks and medicines have been used, among which are saffron, sage, catmint, and pennyroyal tea. Dover's powder in from two to ten grain doses, according to age, will answer the same purpose. Spirits of mindereri may be given in teaspoonful closes, with twenty drops of the sweet spirits of nitre in a little water, every three or four hours. When there is much debility, with a weak constitution, the eruption 14* 162 MEASLES. is often tardy and imperfect in its appearance, which calls for stimulants, as small doses of wine or brandy, and in cases assuming the malignant type of the disease, with a dark purplish erup- tion, both alcoholic stimulants, and the most nutritious animal broths will be required to support the patient's strength. The cough which always accompanies the disease sometimes is severe and persistent, and care needs to be taken to see that pneumonia or lung fever does not result, as is frequently the case if neglected. Small doses of the camphorated Dover's powder, say two or three grains every four hours, to a child from three to fi ve years of age, or small doses of the wine of antimony, or w r ine of ipecac, with tincture of opium, or elixir paregoric. The following mixture will be found useful for the cough : Elixir paragoric, syrup of squills, syrup of ipecac, each one-half an ounce; compound spirits of ether, two drachms ; tincture of vera- trum viride, ten drops; mix and give one tea- spoonful every four or five hours, to a child of five years, lessening or increasing the dose according to age. If difficulty of breathing manifests itself, and the symptoms indicate disturbance of the lungs, the chest should be covered with a bag filled with fine salt, or meal, heated, so as to keep the MEASLES. 163 chest warm, or a liniment containing an ounce each of spirits camphor, olive oil, water of ammonia, and chloroform lininent should be applied. A good sized mustard paste of good strength, will answer the same purpose. The chest needs to be well protected from cold, by means of an oil silk covering, and the cough mixtures, with alcoholic stimulants, good nu- tritious diet, all need to be continued until the croup and lung trouble entirely disappears. The same precautions are necessary for some time after measles, that are so important after cases of scarlet fever. MUMPS. Mumps consist in inflammation and congestion of the parotid gland, situated in front of, and below the ear. The disease commences with tenderness and swelling of the gland, the swelling gradually increasing until it fills the hollow space below the ear, or behind the angle of the jaw, and extends forwards upon the cheek, and downwards upon the neck, to a greater or less degree, involving often the gland, situated beneath the chin. Sometimes only one, at other times both sides will be affected, and in some cases, there will be but little swelling, while in others, the whole face and neck will be swollen to a considerable size, and attended with so much soreness and stiffness that it becomes almost impossible to open the jaws, so that the patient has to be confined to liquid nourishment. There MUMPS. 165 is more or less fever present, which lasts for three or four days. When the swelling has reached its full height it remains stationary for two or three days, then declines, and gradually disappears in the course of a week or ten days. Occasionally the swelling suddenly disappears from the face, when it will be found to have attacked the private organs, in the male, and the breasts in the female, and on account of this peculiarity of the disease, great precautions must be taken to guard against cold. The disease, like most others of its class, is contagious, and makes its appearance in ten or twelve days after exposure. But very little treatment is required in this affection. The swollen parts may be rubbed with warm camphorated oil, or chloroform lini- ment, and cotton wool bound on to protect from cold. Small doses of Tully's powder may be given to promote rest, and perspiration. Mild laxative medicines may be given, such as citrate of magnesia, teaspoonful doses of the citrated kali, seidlitz powders, and the mineral waters. If the swelling goes to the private organs in the male, or the breasts in the female, warm poultices or fomentations, should be applied to the parts, when the trouble will soon dis- 166 MUMPS. appear, in most cases. Sometimes the swelling can be made to return to the face, by applying warm poultices to the face, and stimulating liniments. VARIOLOID. Varioloid is simply small-pox modified by vaccination, and presents the same class of symptoms, though of course, less severe. The disease commences with chills, followed by fever, more or less headache, pain in the back and groins, usually quite severe, vomiting, a sense of dizziness, while in some cases there is more or less delirium. About the third or fourth day after these symptoms first appear, the erup- tion shows itself in shape of little red points, that feel quite hard underneath the skin. The erup- tion may be quite thick, but frequently there are no more than twenty or thirty on the entire body. The eruption runs through its natural course much sooner than in genuine small-pox, and there is not generally any great amount of constitutional disturbance, unless it be during the premonitory stages. 168 VARIOLOID. But little treatment is required in varioloid, beyond keeping the patient in doors, and giving light, nourishing diet, cooling drinks, and a mild laxative. SMALL POX. Small-pox is both contagious and infections, and is accompanied with high fever, pustular eruption, and is one of the most loathsome dis- eases that flesh is heir to. The symptoms indicating the approach of small-pox, are, a decided chill, followed by high fever, vomiting, pain in the back and groins, loss of appetite and strength, a feeling of general lassitude, with free perspiration, pain in the head and vomiting, followed the second or third day by the eruption, which appears first on the face, forehead, hands, and rapidly extends over the whole body. Where the eruption is slow in making its appearance, it is claimed that the disease will be of a mild form, and severe if the eruption comes out early and rapidly. The eruption first shows itself in minute red points, feeling hard and like small shot beneath 170 SMALL POX. the skin, which gradually increase in size, be- coming vesicular on the second or third day, and at the eighth day, the vesicle will have reached its full height, or size, often nearly a fourth of an inch in diameter. The base of the vesicle is circular, hard, and there is quite a circle of red and inflamed skin around it. As the pock matures it changes its form, or shape, and becomes hollow, or depressed in the center, with its outer edge or rim considerably elevated. When the eruption appears, the fever, headache, pain in the back, and thirst, cease, the appetite improves, unless it be in the confluent form, in which the fever continues to a greater or less extent. At the same time the eruption appears upon the skin it may appear upon the eyes, in the throat, and upon all the mucous surfaces, which may terminate in severe and dangerous ulcera- tions of the throat and larynx, and ulcerations of the cornea, destroying vision. During the time the pustules are filling, or during the suppurative stage, the fever reappears, and in the confluent variety, is very severe, with fre- quent pulse, loss of appetite, wakefulness and violent delirium, and there is so much swelling of the face that the individual could hardly be SMALL POX. 171 recognized by his friends, and the odor from the patient at this time is peculiar, and decidedly unpleasant. As time advances the liquid contents of the pustules dries up, and a hard, dry, brown crust remains, the pustules drying up first on the face, and so on in the order of their appear- ance. The crusts begin to be thrown off about the fifteenth day of the eruption, and should be gone in about three weeks. As the crusts dis- appear, the cough, hoarseness, fever, delirium, all disappear, patient sleeps better, appetite is good, and health is restored. The symptoms vary much in severity in dif- ferent cases, but the symptoms as they gener- ally manifest themselves, are here protrayed. Various disorders are liable to be developed during an attack of small pox, among which are the following : Inflammation and ulceration of the eyes, with loss of vision, abscesses, swelling and suppuration of the joints, inflammation of the private organs in the male, and of the ovaries in the female, bronchitis, pneumonia, and some- times mortification and sloughing of different parts of the body, and inflammation of the brain, or its enveloping membranes. This disease, like most eruptive and febrile diseases, is self limited, 172 SMALL POX. running a definite course, and in considering its treatment, we are to watch the progress of the disease, meet the emergencies as they arise, and guard against complications as much as possible, therefore, the treatment must be pallia- tive and expectant. If the disease is uncompli- cated and pursuing its natural course, but little treatment will be needed, except a laxative to begin with, and an occasional sponging with tepid water, to allay the fever and heat of skin, with an anodyne now and then to procure sleep, and supporting the patient's strength with beef tea, egg-nog, milk and wine, or brandy if needed. The patient may be allowed cooling drinks, like lemonade, champagne cider, carbonic acid water, or tamarind water. The sick room should be kept cool, thoroughly ventilated, and moder- ately dark ; the bed clothing should be light, and changed as often as circumstances will allow. In the. confluent variety, or where the sores or pustules run together, there is greater prostra- tion of the system, complications are much more liable to arise, and there is much more danger of a fatal result. If there is troublesome constipa- tion, something to act upon the bowels should be given. The vital powers of the patient are here sorely taxed, and great pains must be taken SMALL POX. 173 to properly support the patient's strength, by means of the best and most nutritious animal broths, alcoholic stimulants, either with or without carbonate of ammonia, as the case may demand. The heat and itching of the skin is at times almost intolerable, and some relief may be ob- tained by frequent sponging with tepid water, or a weak solution of chloride of soda and water. It is desirable as far as possible to prevent pitting, and a great variety of means have been resorted to for this purpose. Eayer, and others, advise breaking up the vesicle by means of a fine needle or some pointed instrument. Rillet and Barthez speak highly of cauterizing the pustules with a stick of nitrate of silver, and in order to be successful, it must be done early in the disease, as early as the second or third day of the eruption. The appli- cation of the tincture of iodine is recommended by some, and though not preventing it, is said to diminish pitting. Another method is by excluding light and air, by means of plaster, or by applying oil and dusting on some fine dry powder. Dr. Smith of Bellevue College, New York, uses a powder made of equal parts of sub- nitrate of bismuth and prepared chalk, and where 15* 174 small rox. there are cracks or fissures, he uses nitrate of silver, or oxide of zinc in glycerine, in the pro- portion of one drachm of silver, or zinc, to the ounce of glycerine. Collodion, or a solution of gutta percha, is sometimes painted on the ex- posed surfaces, which forms a complete coating when dry, and quite effectually excludes the air. It is the duty of every individual, both for their own interest and that of the public, to use all consistent and lawful means for preventing the spread of this malady, and while I would fully endorse all precautionary measures I would at the same time urge people not to be influenced, or at least, governed, by the wholly unwarrantable fears that are often manifested during the prevalence of the disease. The enervating influence upon the system which fear exerts, places the individual in one of the best conditions to take the disease, and sometimes, it really seems as though all con- tagious disorders, like small-pox, cholera and yellow fever, thrived best on timid victims, and pursued them in hot haste. A case illustrating this point, lately occurred on an ocean steamer plying between New York and San Francisco, Cal. One of the cabin passengers was taken down with the disease soon after leaving New SMALL POX. 1 i O York, and died a few days before reaching his destination. As there was a clergyman aboard they called upon him to make a prayer, before casting the body overboard ; but he could not be prevailed upon to appear on deck, and so remained in a remote corner of the ship, the subject of much scorn and ridicule from the passengers and crew. The first person that was stricken down with the disease, was this same divine, in his secluded retreat, and the passengers and crew said it was a judgment sent upon him ; but did not fear execute the judgment ? There is then wholesome fear, that serves as a protec- tion, and unwholesome fear, that invites the disease to take hold of you. Keeping the body thoroughly cleansed, well nourished, apartments you live in w T ell ventila- ted, securing your usual rest and perfect digestion, are all important protective measures. Vacci- nation is, however, the most perfect preventive that has yet been discovered, or in all probabil- ity ever will be, and this will be fully treated of in the succeeding chapter. VACCINATION. Much has been said both for and against vaccination, but there is no denying the fact, that it is a great protection against small-pox. Statistics collected by Simon and Marson, show that of those who contract varioloid, the larger the number of vaccine cicatrices, or scars, the milder the disease, and the less the proportionate number of deaths. In Simon's statistics, of those claiming to have been vaccinated, but who had no scar, 21 3-4 per cent, died ; of those who had one scar, 7 1-2 per cent, died ; of those who had two scars, 4 1-8 per cent, died ; of those who had three scars, 1 3-4 per cent, died ; while those who had four scars, only 3-4 per cent. died. These facts so fir as they go indicate the pro- priety of vaccinating in several places, and things being equal, the system must thereby be brought more thoroughly under the influence of the virus, VACCINATION. 177 and consequently be the better protected. The common practice is, however, to vaccinate only in one or two places, and there are various methods of performing the operation, viz., by cutting the skin with a point of a lancet, and inserting beneath the cuticle a small particle of the vaccine crust well softened, so as to be readily absorbed ; by use of an instrument made for the purpose, the needle or pipe of which is inserted beneath the skin, and the liquid virus forced suddenly in ; by simply scarifying the skin, which consists in making several slight incisions or scratches, and rubbing the virus in ; and lastly, by scraping the skin with the point of a lancet till the blood just shows through, and then applying the virus in a state of solution. The last two methods are the simplest, safest, and most desirable. The patent vaccinators, or instruments, which suddenly force the virus in, often place the virus deep into the cellular tissue, exciting erysipelas and causing a hard painful swelling of the arm, with large ulcerative sores, that are not only very disagreable but difficult to heal readily. Every time an instrument is used to vaccinate with, it should be well cleansed before repeating the operation on another individual. The pop- 178 VACCINATION. ular prejudice against vaccination is, that humors and blood diseases are introduced into the system by this mean?, and while this may be true, in a certain sense, it is not true to the extent gen- erally supposed. It is true, that if any person has erysipelas, scrofula, or other humors, vacci- nation will kindle them up to renewed activity, especially while the virus is operating throughout the system. Erysipelas and syphilis are the most liable of any disorders to be introduced into the blood by vaccination, therefore, virus should never be taken from any person who has ever been subject to either of these disorders, nor should virus be taken from any but those who have always been healthy, and free from blood disorders and hereditary disease. It is safe to say, that if the virus is thus selected and prop- erly used, no trouble will arise from vaccination. In selecting virus for use, the lymph, or matter, taken directly from the arm, from the fifth to the eighth day of the eruption, is the surest and safest. The lymph is often prepared for use by inserting quill points into the vaccine sore, or pustule, until they are well covered with the virus, in which condition they can be kept for use for two or three weeks in cold weather. The vacine crusts, in order to be good must be of a VACCINATION. 179 dark brown or mahogany color, circular in form, with a depression in the center. In preserving them for use, they should be wrapped in cotton wool and tin foil, then placed in a vial tightly corked, so as to exclude the air as much as pos- sible. Vaccination should be performed the first year of life, and it can with propriety be performed any time after the child is two or three months old, or even much earlier if necessity demands it. It was the opinion formerly that one vac- cination would suffice for a life time, but the fact is established beyond all question of doubt, that the protective power of vaccination does grad- ually die out, and needs to be repeated, every five or seven years. The course of genuine vaccination is as follows : No effect is noticed, except it be slight inflammation, till the end of the third day, when the specific inflammation should begin. At this time there will be noticed a small red point, at first scarcely visible, hard, slightly elevated above the skin, as noticed by the touch. This increases, and on the fifth day, the skin over the inflamed part begins to be raised by a transparent, and thin, watery liquid. The vesicle increases in size, and by the sixth day, presents a depression in the center, with 180 VACCINATION. considerable swelling around it. On the ninth day, the red areola around the sore becomes more distinct, and its diameter increases ; the color thereof is deep red, there is quite a good deal of swelling, the parts being hard, and tender to the touch. On the tenth day, when the pustule is mature, the inflammation around the sore reaches its height, and the heat, tenderness, and itching, are such that the child will often be fretful, feverish and restless. About the eleventh day the inflammation begins to subside, and gradually disappears, and the crust falls off about the twentieth day. If, as is sometimes the case, the vesicle leaves an unhealthy and persistent ulcer, a mild healing ointment should be applied, as ointment of oxide of zinc, or an ointment composed of benzoic acid and oxide of zinc. CONVULSIONS. Convulsions occur in a great variety of diseases, beginning at birth, and prevailing to a greater or less extent during the first six or eight years of childhood, and they depend upon a variety of causes. The exciting cause may be located in the brain or spinal cord, as congestion, inflammation, or some organic disease, and tem- porary derangement of the digestive organs, is a fruitful source of the difficulty. They are not unfrequently traced to the operation of fear, or some other mental emotion. In nurslings, convulsions are often caused by changing the milk with which it is nourished, or if confined to the breast, by changes wrought in the milk of the mother, due to violent emotion of the mother, as anger, fright, or grief. If the mother chances to have her courses while nursing, it is apt to produce convulsions in 16 182 CONVULSIONS. the infant at the breast. Constipation, worms, dysentery, scarlet fever, teething, brain fever, all are frequently attended with convulsions, more or less severe. The causes being so numer- ous, it is highly important in any and every case, to ascertain what the particular cause is, where it is located, and treat it accordingly. Sometimes the convulsions come on suddenly without any warning, then again there will be premonitory symptoms for some time before the disease becomes fully developed, and in the latter case the symptoms indicating the approach of an attack, are as follows : there is more or less drowsiness, and if the child be disturbed it appears very fretful ; the eyes generally have a wild, unnatural appearance, sometimes fixed for a time on some given object, apparently without noticing it ; the sleep is unsound, there is unusual heat of the head, the features present a variety of expressions, and there seems to be actual delirium. Just as the convulsion is to come on, the child's thumbs are often drawn into and across the palm of the hands, and the child usually lies quiet, with its eyes open and fixed, and if spoken to takes no notice of anything. The face is sometimes pale, at other times flushed, and when the cause of the convulsion lies in the CONVULSIONS. 183 brain, the face is marked by streaks, or patches, of a flushed appearance, while around them the natural color remains. Before the spasmodic movements set in, the child often utters a pierc- ing scream, which is generally involuntary. The convulsive attacks are indefinite in their duration, lasting from a few minutes to several hours, and even days, and they may be partial, affecting only certain muscles or portions of the body, while at other times they will be general, involving in one convulsive attack the whole body. When the whole body is thus involved, the muscles of the face and eyelids, the arms and legs, are in a state of frequent involuntary contractions, followed by relaxation of the spasm. The features are much changed in appearance, and contorted, the mouth is drawn out of shape, often to one side, by the violent contractions of the muscles ; the teeth are closed together like a vise, the tongue often being bitten severely. If the attack continues for any length of time, froth pours out of the mouth, not unfrequently being tinged with blood, the head is forcibly drawn backward, or to one side, the thumbs and fingers are forcibly brought together, the fingers covering the thumbs. Consciousness is usually lost, the head is hot, and the face flushed, though 184 CONVULSIONS as before stated, in some cases, the head will be cool and the face pale, owing to different exciting causes. The pulse is increased in frequency, and the breathing- is also hurried and irregular. The contents of the bladder and bowels are frequently passed involuntarily during the attack. The partial form of the disease affects only cer- tain muscles, as those of the face, neck and throat. Convulsions last for an uncertain length of time, and while they may last for hours, the average duration is said to be from five to twenty minutes. Unless there is organic disease of the brain, or some other important organ, prompt relief is usually afforded, and the most violent attack will generally prove of short duration. As the convulsive attack ceases, the child takes a long breath, fills the lungs, lies quiet and breathes quite naturally. Some recover in a few moments, and seem to suffer no great incon- venience afterwards, while others soon recover their consciousness, the temperature of the body, breathing and the circulation become natural, but remain dull and listless for a time, not noticing things, and are unable, or not inclined to speak, some hours elapsing before all effects of the spasms disappear. In many cases, especially where the convulsions are caused by some inter- CONVULSIONS. 185 nal derangement, there will be only one con- vulsion if suitable treatment is promptly given, while in other cases there may be several con- vulsions in 24 or 48 hours, or during a longer or shorter time. The treatment for this disease must of course depend greatly upon the particular cause, which should be ascertained as soon as possible. As soon as a child is seized with convulsions it should at once be put into a warm bath, to which mustard may be added, in order to produce some irritation of the skin, and at the same time cold water should be applied to the head, either by cloths clipped in ice cold water, or by placing bags of finely powdered ice on the forehead for a few minutes at a time. This process quiets the nervous system, and tends to relieve the congestion of the brain and spinal cord. The bath should be continued for fifteen or twenty minutes, after which thorough friction, with the hand or towel, would be beneficial in equalizing the circulation. Constipation is quite apt to exist, in which case some laxative should be given at once, but if the stomach is irritable, so that medicine is not well retained, an injection into the bowels may be substituted. Soap and water, salt and 16* 186 CONVULSIONS. water, or water well sweetened with molasses, will serve the purpose of an injection, and about half a pint should be injected at once, as smaller quantities are generally ineffectual, or are apt to be. Whatever objections may be raised against the use of calomel, it certainly is a most valuable remedy in convulsions depending upon derange- ments of the digestive organs. It may be given in doses of one grain of the powder once in five or six hours, and followed with fluid extract of rhubarb and senna, citrate of magnesia, citrated kali, or castor oil, sufficient to act upon the bowels. If there is much irritability of the stomach, with vomiting, lime w r ater and bismuth, or oxalate of cerium may be given. The lime water and bismuth may be given after the fol- lowing formula : Lime water, two ounces ; bis- muth, twenty grains ; mix and give two tea- spoonfuls every hour or two, in a wine glass of water or milk. Warm external applications over the stomach, of flannels, poultices, bags of hops, or poppy leaves, steeped, will serve a good purpose. In cases where the whole trouble is caused by eating some indigestible food, or fruit, an emetic should be given, in order that the offending substance CONVULSIONS. 187 may be thrown off. Where the convulsive attacks come on frequently and severely, it is necessary, or at least best, to control them by the inhalation of chloroform. Bromide of potassium is a remedy highly valued, and much used for this affection. It may be given in doses of one grain every three hours, to a child a year old, and the dose may be increased by one grain, for every additional year of the child's age. The following formula is a convenient one to adopt in using this drug : Bromide of potassium, twenty-four grains ; simple syrup, one ounce ; peppermint water, two ounces ; mix and give teaspoonful doses every three hours, to a child a year old. In the severer cases, where drowsi- ness, and symptoms of congestion of the brain continue for some time after the convulsion, it sometimes becomes necessary to apply irritating substances to the back of the neck, as mustard pastes, blisters, or chloroform, applied with the hand, as long as it can be borne. Soaking the feet in warm water, and applying drafts of mustard, or roasted onions, are sometimes ser- viceable. INFLAMMATION AND CONGESTION OF THE BRAIN. Inflammation of the brain and its membranes, is a frequent disease of infancy and childhood, and one of the most fatal in its consequences. It often comes on as an independent disease, while at other times it is a sympathetic, or secondary disease. The symptoms are well marked, and about as follows : At first there is a general restlessness, more or less fever, which is irregular in its character, the child looks sober, is peevish, is slow and languid in its movements, and takes but little notice of things which usually please. Sometimes it will stop suddenly in the midst of its play, and put its hand to its head, or place its head in some one's lap, at the same time complaining of pain in the head, and of being tired and sleepy. There is often a sudden look of fear, the child utters a sudden cry, and looks strangely, as if not knowing what to do or think. INFLAMMATION OF THE BKALNT. 189 If old enough to walk, the child will often pre- sent a peculiar gait, as halting, or dragging of one leg. The appetite is variable, generally poor, while at other times, or in other cases, it will be good, so that the patient will cry for food. The stomach is frequently affected through sym- pathy, as evidenced by vomiting, and the bowels are generally constipated ; the tongue is red on its side and tip, and is covered with a white coating in the center. The pulse is generally quite rapid, often 120 or 130 per minute, the child is drowsy but restless, grinds its teeth in its sleep, lies with eyes partially open, and starts up at every little noise ; the eyes are often sen- sitive to light, and in some cases it cannot be tolerated at all. As the disease progresses the symptoms increase in severity, the face assumes an expression of anxiety, or of pain, showing great suffering, the head is hot, face flushed, the child cannot bear to be disturbed, and lies in a dull, sleepy state, and is not inclined to say anything when aroused. As the disease reaches its third stage, the child passes into a state of stupor, picks its nose, lips, or at the bed clothes. The head is now hot, the face flushed ; the next moment the head may be cool, and the face pale j at one time the skin 190 INFLAMMATION AND may be dry and hot, and in a few moments be covered with a profuse perspiration. The pulse grows small and very rapid, the eye lids but partially close, eye balls roll around, and the child makes irregular motions with its mouth. A sudden attack of convulsions may end the scene, or the child may live on for some time and waste away, dying from exhaustion. These are the general symptoms which attend brain fever, or inflammation of the brain, though all of the symptoms are not present in any individual case, the symptoms varying greatly in different cases ; but there are enough of them present in most cases, and so characteristic as to leave but little doubt regarding the nature and location of the disease. The disease is a dangerous one, rapid im*its progress, and calls for prompt and vigorous measures of relief, with constant watching, and careful, faithful nursing. As soon as the child manifests the first symp- toms of uneasiness, or fretfulness, and complains of its head, precautionary measures should at once be adopted. Everything which tends to excite or irritate the child, should be strictly avoided. If the bowels are constipated, they should be acted upon by injections, or laxative CONGESTION OF THE BKAIN. 191 medicines, for it will not do to let the constipa- tion continue. A warm mustard bath with thorough friction of the skin, will be useful to equalize the circulation, and relieve the head by its derivative effect. If the patient be teething, the gums badly swollen, hot and painful, it may be advisable to lance the gums, and relieve the pressure of the teeth. Benefit may be derived thus early in the disease by applying small blisters behind the ears, or on the back of the neck, or by producing counter irritation by means of croton oil painted on the skin with a small hair brush. Children of a weakly scrofulous condition, are especially liable to this disease, and such persons require a tonic, sustaining course of treatment, in Order to render them less liable to the disease. The diet in such cases should be simple, easily digested and nutritious. Cod liver oil should be given in teaspoonful doses, with syrup of the iodide of iron, in doses of five or ten drops, before each meal. Anodynes are needed after, to quiet the irritability and restlessness, and for this pur- pose, Dover's powder, syrup of poppies, bromide of potassium, laudanum, elixir paregoric, or Hoffman's Anodyne, may be given. If the symptoms increase in severity, and inflamma- 192 INFLAMMATION AND tion of the brain becomes fully developed, more active and vigorous treatment will be demanded. The internal remedies recommended are numer- ous, but the best effect is obtained from the use of iodide of potassium, given in two or three grain doses, every two hours, to a child a year or two old, the dose to be increased according to the age of the patient. When the vomiting is severe, it is best to try to relieve it, though it is quite apt to prove persistent, as long as the irritation of the brain continues. A mixture of lime water and bismuth given after the following formula, will often be effectual in relieving the vomiting : Lime water, four ounces ; sub-nitrate of bismuth, two drachms ; mix, and to a half a cup of milk, add one-third of the mixture, and give a table-spoonful hourly, at the same time use warm applications to the pit of the stomach. The room should be kept dark and quiet as possible ; ice cold cloths should be applied to the head, or bags of finely powdered ice, which will relieve the head symptoms, and in the most serious cases, blisters to the back of the neck, may be of much benefit. Alcoholic stimulants late in the disease, when there is evidence of failing strength and great prostration, will be re- quired, but they should be avoided early in the CONGESTION OF THE BRAIN. 193 disease. During the attack, the strength must be supported by beef tea, mutton or oyster broth, milk, &c. The general course of treatment required is here given, but what would be serviceable in one case, might be ill-adapted to another, and as the disease is so grave in its character, so fatal in its consequences, no time should be lost in summoning the best medical aid to be procured, and constant care, with the best possible nursing, are equally important. HYDROCEPHALUS, OR DROPSY OF THE BRAIN. This disease consists in an excess of fluid in the cranial cavity, which may be external to the brain, or in its interior. Children are sometimes born with the disease, and in other cases it is acquired. It may be acute, running a rapid course, or chronic, the child suffering for a long time, gradually wasting away to a skeleton, and dying at last of exhaustion. Children who are born with the disease, do not always have it plainly developed at birth, and nothing unusual will be noticed for some time, after which, the head and features begin to present the striking appearance so characteristic of the disease. As the dropsical fluid increases within the skull, the bones are expanded and are rendered thin, by the process of absorption, caused by the pressure of the contained fluid ; the scalp is stretched, grows tight and thin, and is scantily covered with hair ; the veins of the face and head are HYDROCEPIIALOUS. 195 quite prominent, and their whole course can be traced in the colorless skin, and the whole head is quite elastic from the amount of water within. Not long since, the writer was in attendance at the birth of a child with hydrocephalus, where the skull, or cranial cavity must have contained a quart of water, and the bones of the skull were so thin and widely separated, that they could be moulded into any shape desired. Owing to the pressure of the fluid upon the bones of the forehead, the eye balls are turned downwards, the downward direction increasing with the increase of the dropsical effusion. The face and features look diminutive in size, on account of the disproportionate size of the head. During the early stages of the disease the child has a fair appetite, nurses well, and digestion is quite well performed ; but as time advances, evidences of imperfect nutrition of the body be- gin to show themselves ; the head increases in size, while the rest of the body instead of grow- ing, shows signs of wasting and rapid emaciation, especially the neck, arms and chest. In the last stages of the disease, digestion is very much impaired, the stomach becomes very irritable, vomiting being a constant symptom, frequently attended with diarrhea, and the senses of sight, 196 HYDROCEPHALOUS. smell, and taste, are all affected. If the child is old enough to walk, it does so with an unsteady gait, and if the fluid accumulates in sufficient quantity to compress the brain, the child becomes dull, drowsy, and takes but little notice of any- " thing, there are frequent spasmodic movements of the limbs, the pupils of the eyes act feebly and irregular, one often being much more dilated than the other. Sometimes there is strabismus, or cross-eyes, and as the end draws near, con- vulsions set in, followed by a state of stupor, soon terminating in death. Such is the general course of this disease when it goes on to a fatal termination. Not every case proves fatal, but the vast majority are hopeless cases, nothing whatever having any control over them. All that science can do in these cases, is to place obstacles in the way of the progress of the disease, and prolong life as much as possible, and so treatment can be only palliative. Any means that will tend to lessen the quantity of liquid in the brain, will relieve to a certain extent. Medicines to act upon the kidneys, increasing the secretion of urine, are beneficial, among which are the acetate and nitrate of potash, syrup of squills, tincture of digitalis, iodide of potassium, and other drugs of HTDEOCEPHALOUS. 197 this class. The nitrate and acetate of potash may be given as follows : Dissolve half an ounce of potash in eight ounces of water, and give a teaspoonful three or four times daily, in a little sweetened water. Iodide of potassium may be given in one or two grain doses every two hours, to a child a year old, and it should be given in a little sweetened water. If the bowels are inactive, some laxative should be given, and a regular action thereof secured daily. Some recommend strapping the bones of the skull together with adhesive plaster, in order to prevent their separation, but such a measure could hardly afford relief, for as the spreading of the bones is prevented, so much greater must be the compression of the brain within. As a last resort, puncturing the head and drawing off the dropsical fluid, is sometimes performed, which of course, would have to be entrusted to the medical adviser. Every child presenting evidences of impaired health, feeble constitution, with unusual promi- nence and blueness of the veins, should have the full benefit of pure air, sunlight, bathing, good nourishment, and every hygienic, and san- itary measure available. 17* TETANUS AND LOCK JAW OF NEW- BORN CHILDREN. This is a peculiar malady which manifests itself during the first few days after birth, gen- erally between the fifth and tenth day, or about the time of the separation of the umbilical cord. In some countries, and in certain localities, cases are very rare, while in hot climates, and in un- healthy localities, one-fourth of all children born are carried off with the disease, and in certain places half the infants have died with it. The disease develops very rapidly, and comes on wholly unexpected, for a child now healthy, is lifeless in a few hours from the time the disease first makes its appearance. There have been various opinions as to the real exciting cause of this disease, but it seems to be pretty well established, that it is owing to uncleanliness, impure air, atmospheric changes, inflammation of the umbilical cord and its mem- TETANUS AND LOCK JAW. 199 branes, and to injuries to the spinal cord, received during labor, or after birth. Where the disease comes on gradually, it may be often noticed that the child is fretful, frequently moans or cries, its sleep is unsound, and while asleep, there are efforts at smiling. While awake the child is restless, throws its limbs about, there is a livid circle around the eyes, the discharges from the bowels are of a greenish color, and there is a great desire for the breast. One of the first alarming symptoms noticed by the parents, which shows the real nature of the trouble about to develop itself, is, that the infant is unable to nurse, or manifests much pain and hesitation in nursing. The muscles that first become contracted and rigid, are those of the face, especially the muscles used in the jaws, and as the disease extends, involves the muscles of the back and limbs. In the early part of the disease, the limbs can be bent, the jaws opened, but as the disease progresses it becomes difficult, or impossible. The jaws become fixed together, the tongue presses against the teeth, and froth issues from the mouth; the muscles of the neck are stiff, contracted, and the head is drawn backward and held there ; the fore-arms are bent, the thumbs are placed across the palm of the 200 TETANUS AND LOCK JAW. hands, and are held tightly by the fingers, and the thighs are drawn up toward the body. Sometimes the head and feet are both drawn backward, and so stiff is the whole body at times, that the child can be lifted by the head and feet without the body bending at all. During the spasms the features present a very unnatural appearance, often much contorted ; the eye lids are forcibly shut together, and the lips may be either drawn in, or pouting, and the forehead and cheeks, are drawn into folds, or wrinkles, by muscular contractions, there is at times trembling of the limbs, and in cases most fatal the spasms come on more and more frequently, until death ends the struggle. During the attack, the breathing is imperfect, the circulation of the blood is much impeded, and the skin becomes deep red, almost livid, and in fatal cases death usually takes place within twenty-four or forty-eight hours. Treatment amounts to but little in this disease, when it has made any progress. Some recom- mend that the cord be dressed, and a clean cloth applied daily, with frequent bathing. Others advise the application around the cord, of the spirits of turpentine, or tincture of opium and spirits of wine. Glycerine and solution of car- TETANUS AND LOCK JAW. 201 bolic acid, or per manganate of potash, may also be used as an application to the cord. These are to be used as means of prevention, rather than curatives, for if anything is to be accom- plished, it must be before the disease is actually developed. In administering medicines during the attack, but little can be given by the mouth, on account of the jaws being fixed, and if medicine is placed in the mouth it is forced back by the muscular contractions of the mouth and throat. The remedies used for this malady are numerous, among which are the following, by different physicians : Dr. John Furlonge of St. Johns, in a favorable case, gave one drop doses of lauda- num, alternately with two grains of Dover's powder every three hours. Dr. Woodworth also gave one drop doses of laudanum every three hours, and Dr. Eberle, one-sixth of a drop hourly. Dr. Furlonge, in giving Dover's powder, com- bined with it five grains of sulphate of zinc. Dr. Eberle, gave with his one-sixth of a drop doses of laudanum, six drops of the tincture of assa- foetida. Chloroform has been much used, the child inhaling it till the spasm is relieved, and its iipplication renewed with each succeeding spasm. 202 TETANUS AND LOCK JAW. The loss of flesh and strength is very rapid, and wine, whiskey, or brandy, is needed to keep up the strength of the patient ; but instead of giving by the mouth, it will frequently have to be given by injection. If the navel presents evidences of inflammation, it is advisable to apply poultices, and blisters applied to the navel sometimes afford relief. A warm foot bath, and friction of the spine with some stimulating lini- ment will be beneficial. Dr. Beclnor advises the application of bags of ice to the spine, or a douche of cold water. The blowing of ether spray upon the spine is sometimes substituted for the ice, which has the advantage of being more easily and conveniently applied. In the great majority of cases medicines do no good, and the disease when once developed, rapidly progresses to a fatal issue. EPILEPSY. Epilepsy is a frequent disease of childhood, the attacks of which come on suddenly, with loss of consciousness and sensibility, with spasms, followed with more or less stupor. Sometimes the patients, instead of falling suddenly down, have some warning of the approaching attack, such as a peculiar sensation of the body, as of a stream of cold water running on them, or currents of warm air blowing on them, and of insects creeping upon the skin, these sensations com- mencing at the extremities of the limbs and ascending upward till they reach the head, when the spasm comes on. Some have spectral illusions, and imagine they see strange and curious objects. There is headache, dizziness, imperfect vision, and confusion of .thought, and as the attack begins, the child often utters a loud piercing shriek, and immediately falls senseless to the 204 EPILEPSY. floor, in violent convulsions. The muscles are contracted, the hands are firmly shut together ; there is grating of the teeth and frothing at the mouth ; the eyes are fixed and partly open ; the breathing is loud and difficult ; the face is flushed, and for a moment it seems as though the child would suffocate, when the spasm suddenly yields, and the patient often lies for some time insensible, seemingly in a quiet sleep. The fit lasts for an indefinite time, sometimes for half an hour or more, though it is usually of short duration, con- tinuing for only five or ten minutes, and fre- quently, the subjects of epilepsy are able to get up and walk in a few moments afterward. The fits recur at variable intervals, it may be for months, and again, they may come on almost daily. The causes of this disease are somewhat obscure. It is said to be owing in some cases to malforma- tion of the bones of the head, and it is true that attacks frequently follow blows, or falls, upon the head. The diet, exercise and mental pursuits have their influence in causing the disease, and it sometimes depends upon the irritation of the nervous system, produced by teething, especially while getting the second set. In seeking to remedy this affection, the first EPILEPSY. 205 step should be to ascertain the cause, and en- deavor to remove it. The medicines which have been highly extolled for their peculiar effects upon this malady, are almost numberless, but there are comparatively few that are effectual in curing, or relieving the disease. The latest medical authorities point to bella- donna and bromide of potassium, as the most effectual remedies. The latter may be given as follows : Bromide of potassium, one scruple ; white sugar, half an ounce ; annise water, two ounces ; mix and give teaspoonful doses, every three hours, to a child a year old, increasing the do?e to twice or three times the amount if the child is six or seven years old. If belladonna is used, one-eighth of a grain of the extract, may be dissolved in an ounce of water and given in teaspoonful doses every three or four hours. During the attack, throwing cold water upon the face, will often arouse the patient, or a bottle of ammonia, held to the nostrils will sometimes do it. The diet of patients subject to epilepsy, should be light and nourishing, but little meat should be taken, arrti everything that unduly excites the child, or fatigues it bodily or mentally, should be guarded against. 18 CHOREA, OR ST. VITUS DANCE. This disease is not common in children at a very early age, but it is quite frequent from five to fifteen years of age. It consists in loss of power of the will, to control the movements of the muscles of voluntary motion, giving rise to irregular, tremulous, and often ludicrous mo- tions, on account of which the disease has been called " Insanity of the Muscles." The disease may develop suddenly, particularly when it results from injuries to the head, or elsewhere, but it generally comes on gradually. The first thing observable, which indicates the approach of the disease, is that there are awk- ward, uneasy movements, which the child can- not control, and these movements are seen to be confined to one side, generally to the arm. In a few days the trouble extends, and involves the legs, and they present the same irregularity of CHOREA, OR ST. VITUS DA:N T CE. 207 motion, so that the child in attempting to walk, finds that it has not full control of its limbs, and falls. Now, it may be, that the muscles of the face have become involved, and the strange movements of the features begin, the child making peculiar faces, and absurd grimaces. The difficulty may now extend, and the whole body be affected at once, so that the legs, arms and features, are sometimes in almost constant motion. Anything that excites or embarrasses the patient, increases the difficulty, while if his attention is diverted, and fixed upon any object, the muscular movements are lessened, and dur- ing sleep the muscular movements usually cease, though there are cases where they do not. Frequently the disease is of a mild form, and inability to hold anything in the hand steadily, to keep the arms from twitching, slight distortion .of the muscles of the face, and ah occasional spasmodic movement of the head is all the trouble noticeable. In cases more severe, both sides of the body are usually affected, when the child is unable to seize any object, or if it succeeds in grnsping it, soon lets it drop, being wholly un- able to hold ifc The gait of the patient is very unsteady, and awkward, and in attempting to walk, the child 208 CHOREA, OR ST. VITUS DANCE. is very apt to fall at any moment. The face is constantly out of shape, and if the patient attempts to show its tongue, it does so in a hurried, imperfect manner, with much difficulty ; the speech is stammering and almost unintelli- ble, and even swallowing becomes difficult. In the severest cases, the intellect of the child is impaired, and it presents an idiotic appearance. In some instances the child presents a pitiable, and distressing appearance ; the following is one which Dr. West mentions in his book on children's diseases. Speaking of a little girl he saw in the Children's Hospital in Paris, he says : " All the muscles of the body were affected ; her spine was often bent backward to an extreme degree, and her movements were so violent, and inces- sant, that it was necessary to place a board three feet high around her bed, to keep her from throwing herself over its edge, and by the violent grating of her teeth, she had forced almost all her teeth from their sockets." It has been noticed that there is more or less irresfularitv of the heart's action during; this clis- ease, probably owing to the fact that the mus- cles of the heart, in common with the general muscular system, are affected, and in acting spasmodically, greatly interfere with the circu- CHOREA, OR ST. VITUS DAKCE. 209 lation. Like most all convulsive, spasmodic af- fections, St. Vitus dance is thought to be due to some irritation of the spinal cord, or other nerve centers, and there are good proofs that such is the real exciting cause. The disease may prove fatal, though it is very rarely the case. It is generally slow in devel- opment, and in disappearing, lasting for one month, and it may be several. One writer speaks of one hundred and seventeen cases, whose average duration was sixty-nine days. The treatment of this disease must depend in a great degree upon the general condition of the patient, and the severity of the disease. There is usually a tendency to torpidity of the bowels, therefore medicines to act moderately on the bowels will be required. The subjects of this disease are generally weak, pale, bloodless, in appearance, and require tonics. The various preparations of iron, and zinc, have been much used, and with more or less success in many cases. The carbonate of iron is a favorite prep- aration with some, and may be given in one or two grain doses, three times daily, to a child seven years old. Sulphate and valerianate of zinc in small doses, is useful in some cases. Dr. Flint of New York, speaks highly of mix vomica 18* 210 CHOREA, OR ST. VITUS DANCE. and strychnia, especially in those cases where there is a great lack of muscular power. Fow- ler's solution, which is an arsenical preparation, is also a useful remedy, but it should be given with care, and its effects watched closely. To children from five to ten years of age, it may be given in closes of one or two drops three times daily, in a little w T ater, occasionally omitting it for two or three days at a time. The oxide of zinc, tincture of Indian hemp, assafcetida and camphor, are all valuable remedies for use in this disease. Cold shower bath, particularly to the spine, with friction afterwards, is recommended, as well as the warm sulphur bath, and the following method of Dr. West's for preparing it, will be found convenient : Add six and one-half ounces of sulphuret of potassium to a common bath, heated pretty warm, or to 90 degrees Fahrenheit, and let the patient remain in the bath an hour daily. Belladonna given in small doses every few hours, is valuable in some cases, and when used should be continued for several days. Dr. Douglas, Vice-President of the Medico Surgical Society of Edinburg, speaks highly of Indian hemp as a remedy. Dr. Fraser of Edinburg, and Dr. Ashdown, highly recommend calabar CHOREA, OR ST. VITUS DANCE. 211 bean in the treatment of this disease. In some cases electricity is useful, while in others, gym- nastic exercises have had a good effect, by divert- ing the mind from the diseased condition, and regulating the muscular movements by well directed and systematic efforts. The diet of the patient should be easily digestible, yet nutritious ; the patient should be allowed exercise in the open air, and should be kept free as possible from any excitement, or anything calling forth much physical or mental exercise. The general tendency of the disease is to recovery if left to itself, but it usually lasts for weeks or months unless cut short by remedial measures. The treatment that suits one individual case, may be ill-adapted to another, therefore care and dis- cretion is required in directing the treatment. INFANTILE PARALYSIS. Paralysis is generally considered a very seri- ous disease, in older people, and it is in fact fre- quently fatal, while in children it is not usually attended with serious results, the trouble as a rule proving to be but temporary. Paralysis occasionally manifests itself soon after birth, and seems to depend upon some original bodily defect, in which case the child seems to have but little control over the extremities on one side of the body, and the limbs on that side are smaller and poorly nourished. In these cases treatment can be of little service, beyond mechan- ical appliances to properly support the limbs, and guard against deformities. Infantile paralysis can often be traced in its commencement to some disturbance, or conges- tion of the brain, which was attended by a single convulsion perhaps, or by a sense of heaviness INFAXTILE PAEALYSIS. 213 of the head which lasted for a short period. It is always best to examine a child after any con- vulsive attack, to see if it is followed by any signs of paralysis or difficulty in moving the limbs. Again, paralysis may come on independent of any disease of the brain or nerve centers, and may be owing to the irritation of teething; to long continued inactivity of the bowels ; or it may follow a febrile attack, and not infrequently results from general debility and prostration of the system. The affection seems to be most common from two to eight years of age, the period of teething, and there is no doubt that this process gives rise to the irritation of the nervous system, which results in paralysis. The disease may attack one arm or leg, or may attack both together, and it may affect the whole of one side of the body at once. Some- times it attacks one side of the head, face and neck, and occasionally the lower half of the body. If the paralysis comes on suddenly, involving both limbs on one side at once, and there is no evidence of brain s}nnptoms, it is pretty safe to say that there is no organic disease of the brain, while on the other hand, if the disease comes on gradually, and only one limb is affected, if there 214 INFANTILE PARALYSIS. is involuntary twitching of the muscles, with contractions of the fingers and toes, it is prob- able that serious organic disease of the brain or spinal cord exists. In the majority of cases of simple paralysis, the palsy comes on after a single fit, but if it depends upon some disturbance of the brain, it usually manifests itself after several convulsive seizures, during each of which, the limb that is afterwards paralyzed, is in a peculiar and fre- quent motion. If paralysis is lasting in a child, it creates greater deformity than in a grown person ; the growth of the limbs is arrested, the muscles of the limbs waste away, and the limb involved is shorter than the sound one. The muscles act involuntarily, and the limbs are often drawn out of shape, so that an operation is required to remedy the deformity afterwards. To guard against the liability of these deformities result- ing from paralysis, children should be constantly and carefully watched, until entire recovery has taken place. Soon as palsy is discovered in chil- dren, its cause should be sought for at once, and removed if possible, and the treatment must depend largely upon the cause of the trouble. Nux vomica is highly spoken of by Dr. West, as INFANTILE PAEALYSIS. 215 an internal remedy, given in doses of one-eighth of a grain of the alcoholic extract, three times daily, to a child four years of age. The prepa- rations of nux vomica and strychnia, operate to increase the power and tonicity, or strength of the paralyzed muscles. If the legs be affected, the child should have its limbs well rubbed three or four times daily, the palsied limbs should be moved frequently with the hands ; the child should be supported by the parents, and efforts be made to make the patient move or swing the limbs to and fro, the passive motion to be kept up in this way until the use of the muscles is regained. Splints are often required for a long time after the patient begins to use the limb, in order to guard against deformity, as the muscles being weak will yield readily in the direction of the greatest weight, or pressure. The digestive organs should be kept in a healthy condition, and regular in their action. The cold shower bath to the limb or part affected, followed by thorough friction, is of great use to restore the warmth of the part, and to regulate the circulation therein. Electricity proves of good service in many cases, while in others it is of no account whatever. The author has in mind one case of a little boy about three years 216 INFANTILE PARALYSIS. of age, who had both legs completely palsied, who speedily recovered, under the following treatment : The upper portion of the spine was painted with croton oil, until the skin was thickly covered with small pustules or blisters, and the child was ordered to take internally small doses of tincture of mix vomica and iodide of potassium three or four times daily ; his limbs were bathed in strong mustard water, once or twice daily, and thoroughly rubbed, and a good generous diet was allowed. The child was able to walk nearly as well as ever, in four weeks from the commencement of the treatment. Dr. J. R. Reynolds, Physician to University College Hospital, in speaking of the use of elec- tricity in infantile paralysis, says : " The most efficacious application is that of the interrupted battery current, and a curious fact is commonly elicited by its continued use. You find, for example, a group of wasted, palsied muscles, inactive to faradization, but responding readily to galvanism. You apply galvanism on several occasions, and observe that gradually some vol- untary power returns, and with this a diminution of response to the agent you are employing. The same muscles were unaffected by faradiza- tion at first, but now as their voluntary power INFANTILE PAKALYSIS. 217 returns, and their contractility to the battery- current diminishes, they act readily when the induced current is applied. When, after six or eight applications of both faradic and battery electricity, there has been no appearance of electric irritability, I have seen no good result from its continued use." It appears from this that it is important to change from frictional to galvanic electricity, and vice versa. There are many children suffering from palsied and deformed limbs, past hope, that might have been remedied, had proper attention been paid to moving the limbs often, with the help of an assistant, rubbing the limbs frequently, and thoroughly, and exercising the muscles of the diseased limbs in every possible way, and by giving the limbs in this weak condition, proper support, by means of mechanical appliances. While there are cases hopelessly incurable, owing to some early malformation of the body, or congenital disease, as organic disease of the brain and spinal cord, it is true that the major- ity of children with paralysis recover the sound- ness and use of their limbs. 19 NIGHT TERRORS. This is an affection dependent upon some irri- tation of the brain, caused frequently by some disturbance of the digestive organs. A child subject to them, may go to bed seemingly per- fectly well, but two or three hours after it has been asleep, or during the night, it awakes sud- denly in great alarm, and utters a loud cry, while its attention seems absorbed by some fearful dream, and its attention is fixed upon some imaginary object of its alarm. At first the child does not recognize its friends, but after being quieted and soothed, it weeps, sobs, and gradually falls asleep. The attack seldom returns the same night, and may not for two or three nights afterward. Children subject to this trouble should not be frightened by sleeping alone in a room without a light, for it is under these circumstances that NIGHT TERRORS. 219 they are most troubled with visions of their imaginary foes. In treating a patient subject to night terrors, the constipation that usually exists, should be relieved by mild laxatives, such as confection of senna, or fluid extract of rhubarb and senna, and the digestive organs should be kept in a healthy condition. A tonic and laxative mix- ture recommended by Dr. Tanner, after the fol- lowing formula, will be found useful : Bi-tartrate of potash, two drachms ; aromatic spirits of am- monia, twenty minims; compound tincture of cardamons, one drachm; extract of liquorice, one scruple ; compound decoction of aloes, two ounces ; mix and give one teaspooniul every hour or two. WASTING DISEASES OF CHILDREN. It has been almost the universal custom, as Dr. Eustace Smith of London says, to apply the vague terms of tabes mesenterica, marasmus and atrophy, to the slow, wasting, fatal disorders of children, the origin, or real nature of the disease not being clearly understood or expressed. It is safe to say that in all cases of wasting, loss of flesh in infantile life, that there is some change, or defect, in the nutritive processes, whereby the growth and health of the body is maintained. The waste of the body is unnatural, or far greater than the supply of new material. It is true that every deviation from health, will to a greater or less degree impair the nutri- tion of the body, as is the case in diarrhea, and inflammations in children, but there are cases where the primary disease, the disease per se, seems to be that of imperfect assimilation and WASTING DISEASES OF CHILDREN. 221 nutrition. Those cases of slow impairment of nutrition, with gradual loss of flesh, where the wasting cannot be traced to any acute disease, are the ones to be specially considered under this head. The cause of this arrest, or impairment of the process of nutrition, is often the use of improper food, the child almost starving from inability to digest and assimilate the food with which it is supplied. There may be some unhealthy con- dition of the digestive organs themselves, or some constitutional taint, as the existence of tuberculosis, or the inheritance of syphilitic poison in the blood, which interferes with the proper nourishment of the tissues. Whenever wasting of the body is manifest in children, not associated with any acute disease, it is plainly evident that the vital processes which sustain the strength and growth of the body, are failing, and therefore it is highly important to detect the first evidences or symptoms of defec- tive nutrition. Wasting is not always one of the first signs, and it may be absent if the interfer- ence with nutrition is not excessive. A child may be plump, and appear to be in perfect health, and at the same time be suffering from the slow, but sure approach of rickets, and if 19* 222 WASTING DISEASES OF CHILDREN. the cause operating to produce the disease be inherited, it will develop itself unmistakably, in a short time. It is true that acute disease is often the start- ing point of these wasting diseases of the body ; either by kindling up some peculiar constitu- tional tendencies to disease, by leaving behind some chronic derangement of the digestive or- gans, or by some mysterious influence over nerve power. Thus, measles often excite mani- festations of some latent, or hitherto hidden tendency to tubercle or consumption. Scarlet fever and measles, as is well known, are apt to be followed by obstinate diarrhea, and dipthe- ria is frequently followed by loss of nervous power, and paralysis. Therefore, in all diseases, especially in children, there are two sources of danger to guard against, viz., those immediate, and those that succeed, or are remote. Acute diseases are generally marked by prom- inent symptoms, which call for and secure prompt attention, but the contrary is true in the slow, insidious chronic diseases, the progress of which is measured by the gradual undermining of the constitution, thereby lessening nutrition, and causing emaciation. In fact, this class of disorders are apt to be WASTIXG DISEASES OF CHILDREN. 223 overlooked, or disregarded, until the wasting of the body is so rapid or so noticeable as to cause alarm in itself. Of course the infant cannot communicate its feelings by speech, therefore the eye must be educated to gather from the ex- pressions and gestures of the infant, the desired information, for by these we can certainly detect the presence of pain, and readily locate it. Thus, pain in the head is attended by contraction of the eye brows ; pain in the chest, by sharpness or contraction of the nostrils ; and pain in the belly, by a drawing of the upper lip, and of the lower extremities. The color of the face is to be carefully noticed. Blueness of the lips and eyes show that the blood is imperfectly aerated, and its circulation interfered with. A waxy, yellowish color is said to indicate inherited syphilitic disease, and there is apt to be an earthy, sallow hue of skin, in chronic disease of the intestinal canal. Exhaustion is indicated by coldness and pale- ness of the face ; by blueness of the eye-balls and mouth, with half closure of the eyelids and mouth, and by depression of the fontanelles or openings between the bones of the skull. The character of the breathing is another important symptom. For instance, if rapid, with much 224 WASTING DISEASES OF CHILDREN. movement of the nostrils, probably bronchitis or lung fever exists. Unequal movements of the two sides of the chest, indicate serious de- rangement of one side. The cry of the child is varied, and itself is an important symptom of disease. When it is short, sharp, and shrill, or sudden, it shows that the brain is the seat of the disease. When there is pain in the bowels, the cry is generally pro- longed ; in inherited syphilitic disease, it is hoarse, and high pitched ; in disease of the throat, it is hoarse or whispering. In inflamma- tion of the lungs, and severe rickets, children do not cry much on account of the pain produced in so doing. Weakly children often have large bellies, w T hich excites alarm in the minds of most parents, and it may be owing to various disorders or diseases, but most usually is caused by the col- lection of large quantities of gas. This gaseous accumulation is frequently a source of great annoyance during the first two or three months of infantile life. It is generally the case that children with tubercular disease of the bowels, or consumption of the bowels, as it is sometimes called, have swollen or enlarged bellies, but this unnat- WASTING DISEASES OF CHILDKEN. 225 ural largeness may be caused by enlargement of the liver, spleen, or various organs within the abdomen. In the treatment of chronic wasting in a young child, the first object should be, to remove any derangement of the stomach and bowels that may exist, and a strict regulation of the bowels is demanded. Frequently the whole trouble can be traced to improper feeding, therefore the diet should be carefully attended to, after which some special treatment may be resorted to, if required. External applications are useful in restoring healthy action of the skin, and for this purpose friction, counter irritation, and hot or cold baths may be used. Friction may be produced with the hand alone, with stimulating liniments, or with either olive or camphorated oil. By these means the circulation of the blood is improved, and the action of the skin increased, and made more healthy. The feebleness of the constitution in infancy is shown by coldness of the extremities, and in chronic diseases attended with cold feet, prompt beneficial results will be noticed after the appli- cation of warmth. The infant will generally cease crying, pain will cease, and sleep result. 226 WASTING DISEASES OF CHILDKEN. Friction of the whole body should be resorted to, unless there is tenderness, which is usually the case in children suffering from rickets, or spinal difficulties. Rubbing cod-liver or sweet oil into the skin is highly recommended by the highest authorities, as a means of introducing nourish- ment into the system in chronic disorders, espe- cially where there is great irritability of the stom- ach and bowels, and certainly some remarkable results have followed this practice. These oily applications have another purpose than that of introducing or affording nutriment. When the oil, slightly warmed, is rubbed over the whole body with a sponge, and the child is wrapped in flannel, and placed in bed, one of the first effects noticed is a general perspiration, while at the same time the irritability of the nervous system is allayed, and the infant rests quietly and soundly. Another effect noticed is an increase of all the secretions; the urine is more abun- dant, the liver is. more active, and the bowels are more natural in their action. A warm bath before the application of the oil, increases its usefulness by promoting the healthy action of the skin, and the absorption of the oils. Warm friction baths in which mustard has been put WASTING DISEASES OF CHILDREN. 227 in sufficient quantities to produce slight irrita- tion and redness of the skin, are beneficial. Cold baths should never be used for weakly children, as the shock to the nervous system would be more injurious than the bath would be beneficial. As to internal remedies, they will be spoken of more fully when we consider the treat- ment of the several wasting diseases separately. Tonics are called for soon as the digestive organs are brought into a healthy state. Cod-liver oil is a nutritive tonic much used, but it needs to be given in small quantities to children, for if given in larger quantities than can be digested it will be seen to pass off with the stools unchanged. For a child under two years of age, ten or fifteen drops is enough for a dose to begin with, repeated two or three times a day, and if well borne, the dose can be gradually increased from day to day. If the fontanelles, or openings between the bones of the skull, are depressed or sunken, stimulants are required, and pale brandy may be given in ten or fifteen drop doses, and repeated as often, as the case demands. The dose is al- ways to be increased in proportion to the age of the child. The following diseases which give rise to wasting and innutrition of the body will 228 WASTING DISEASES OF CHILDREN. be treated of separately, viz. : simple wasting from insufficient nourishment, chronic diarrhea, chronic vomiting, chronic tuberculosis or con- sumption, and disease of the glands. SIMPLE ATROPHY FROM INSUFFICIENT NOURISHMENT. This is the most common form of wasting disease in children, especially in the larger cities, and thousands of children die annually for the simple reason that they are persistently fed upon food they cannot digest, and so long as the children of the poor remain uninstructed regard- ing the duties which they are to fulfill in after life, so long will this one evil continue to increase the table of infantile mortality. The causes of insufficient nourishment are various. The supply of food may be inadequate to afford the necessary nutriment ; which is often the case where the infant is nourished entirely at the breast, and the mother's milk is poor and watery ; or in those cases where the breast has afforded the only nutriment long after the child should have been fed with other food. When the mother is weak, pale, thin in flesh, her milk 20 230 SIMPLE ATROPHY. is thereby rendered poor, and affords but little real nourishment to the infant. Women of strong constitution, in good flesh and strength, do not always give milk of a healthy quality, the sugar and casein frequently being deficient in quantity. The best test of the goodness of the milk is well said to be de- rived from observing the child. It should be watched while at the breast, and if it sucks vig- orously, ending its meal with the milk running over its lips, and requires to nurse but a few times daily, it may be inferred that the milk is sufficient in quantity, and of good quality. Besides those cases where the quantity of food is at fault, there is another class of cases where nutrition is equally unsatisfactory, although the quantity of food is liberal enough. These cases occur where weaning is premature, or where the child has been brought up by hand, and the kind of food selected to replace the natural food, is improperly chosen, proving too much for the limited digestive powers of the infant, so that it is not converted into nutritive material for assim- ilation. It is therefore seen that a child is not nourished by the quantity of food introduced into the stomach, but only by the amount cf food it can digest and assimilate. A child may SIMPLE ATROPHY. 231 take large quantities of food into its stomach, and from weakness of the organs of digestion, or from the indigestible nature of the food, receive no nourishment from it whatever, but on the contrary, it may cause great irritation and pain, with more or less fever, which tends to still farther reduce the child. The natural tendency of the mother is to over feed the infant, mistaking every cry for the cry of hunger, and so as the fretfulness of the in- fant increases with the increase of pain, the food is made more nourishing, or more frequently given, until a violent attack of vomiting, or con- vulsions, warns the parent of the excess, and that it is time to stop. Cases of constant and steady loss of flesh are often due to this cause alone, especially in infants brought up by hand. The children of the poor are often fed with starchy food, which affords but little nourish- ment, and in consequence thereof they rapidly dwindle and die, or if of a natural robust con- stitution, linger for a long time weak, rickety, and are finally carried off with a bowel com- plaint, or some secondary affection. For perfect nutrition, four classes of food are required, viz. : albuminates, or those containing albumen, fatty substances, carbo-hydrates, or those containing 232 SIMPLE ATROPHY. carbon and hydrogen, and salts. These are all found in the most digestible forms, and perfect proportions for the young child, in the casein, butter, sugar and salts of the human milk, pro- vided always that the quality of the milk is what it should be in the normal standard. The casein supplies the waste of the muscles, brain and nerves, and by its oxidation when it has formed a part of these tissues, contributes to animal heat, thereby keeping up the temperature of the body. The butter, or fatty substances, are necessary to the formation of muscular and nerve tissue, and also aids by its oxidation or combustion in the production of heat. The sugar is principally heat giving, while the salts form the necessary constituents of all tissues. For perfect nutrition it is necessary that change of tissue should be rapid, and this is es- pecially true in infants, where growth and de- velopment are so rapid. This change is pro- duced by the oxidation, or destruction of old material, which is removed, and gradually re- placed by new; so for rapid change of tissue it is important that no impediment should exist to the free oxidation thereof. Now the starches, and sugars into which the starches are converted by the process of diges- SIMPLE ATROPHY. 233 tion, have a greater affinity for oxygen than the albuminates, so that they tend to appropriate the oxygen which is required for the removal of waste material, and thus prevent the proper changes taking place. For this reason alone, without any reference to their indigestible prop- erties, they form a very improper diet for chil- dren. Infants that are fed entirely on cow's milk are not entirely free from clanger, for the specific gravity of cow's milk is higher than that of human milk, and it contains a larger quantity of solid matter, owing to an increase of the amount of casein. The proportion of sugar is less than in human milk, therefore in substituting it for the natural food of the infant, these differences should be remedied by diluting the milk with water, and the addition of sugar. There is another difference between human and cow's milk, which it is important should be noticed. On the addition of rennet, human milk coagulates into loose clots, or flakes, while cow's milk coagulates into heavy, compact lumps, and the same result takes place in the stomach of the infant. It will readily be seen that there is a wide difference between the digestibility of these two products, one being readily assimilated, 20* 234 SIMPLE ATROPHY. without any undue demands upon the digestive organs of the infant, while the other frequently tasks the digestive powers to their utmost ; and unless a small quantity is taken, it Avill often undergo fermentation, giving rise to flatulence, colic, and diarrhea. Some children thrive upon this kind of diet, while others, and by far the largest part, do not, for it is impossible for them to digest and assim- ilate this mass of curd, and unless it is rejected by vomiting, it passes off through the bowels unchanged; their wants are not supplied, and they starve for lack of nourishment, although swallowing every day a quantity of milk, which would afford an ample support for a much stronger and healthier child. Children suffering in this way from improper diet, are irritable and restless, crying day and night, at one time from pain in the bowels — at another from hunger, which their diet has failed to relieve. In all cases where the food of the infant is said by the nurses to be insufficient, the stools should be carefully examined, and if they are found to consist of pale, hard, round lumps, exhibiting in their interior the cheesy appearance so charac- teristic of a mess of curd, we may safely say that not too little but too mack has been given. SIMPLE ATROPHY. 235 There are often constant attacks of vomiting and diarrhea resulting from this surplus of food, which add greatly to the debility of the infant, and the impairment of the digestive powers; The symptoms of simple wasting may be divided into two classes, according to the nature and quantity of food taken, to wit : food suitable but insuf- ficient ; food unsuitable. In the first of these two classes there are no very prominent symp- toms, especially early in the disease ; the infant gradually loses its plumpness, its fat slowly dis- appears, and the muscles get soft and flaccid. The child does not seem to grow, its skin is moist, it perspires freely, the face and lips are pale and thin ; is feverish on account of hunger, takes the breast ravenously at first, and if the secretion of milk is scanty, stops at intervals, and cries as if vexed at its inability to obtain food sufficient to supply its wants. At night the child is irritable and restless, but in the day-time is drowsy, sleeping a greater part of the time. The bowels are usually confined, and the stools solid, and in this class of cases, nutrition is deficient on account of the inferior quality, and small quantity of the mother's milk, noth- ing being added to supply the deficiency. When the required nourishment is given, the wasting 236 SIMPLE ATPOPHY. or loss of flesh ceases, the child is no longer fret- ful, and regains flesh and strength rapidly. In the second class of cases, where the food is bad in quality, we find the symptoms of imper- fect nutrition, combined with other symptoms produced by the irritation of the digestive organs, which the indigestible food gives rise to. The child is dull, languid, flesh becomes flabby and it begins to waste ; the skin is moist at first, though it is apt to become dry, except about the head ; the face and body generally are pale, and sometimes the complexion turns yellowish, as- suming a jaundiced appearance, which remains for hours, days, or weeks, as the case may be. The tongue is clear and moist, and remains so unless there are symptoms of acute digestive disturbance. The bowels are irregular in their action, generally constipated, sometimes, how- ever, they are open three or four times daily, the stools being green, liquid, slimy, and very offensive, and in either case the food which the child has taken passes through the bowels with- out being digested. Flatulence, or wind colic, is a source of great annoyance to the infant, often causing frequent paroxysms of pain, in which the face becomes pale, the upper lip livid, and the belly tense ; the child utters piercing SIMPLE ATEOPHT. 237 cries, and draws its legs suddenly upon the belly. During sleep frequent startings and moanings, elevation of the corners of the mouth, and con- traction of the eye-brows, show that the child is suffering from abdominal pain. The pain and uneasiness from which these children suffer, and which is constantly renewed at every additional meal, makes them so noisy as to be almost intol- erable, and well may the mothers say that " they wear one's life out." At this time they are apt to be feverish, and are seized with fits of scream- ing which they persist in until too much fatigued for further action. Notwithstanding all this disturbance, the ap- petite of the child is ravenous, owing to the acidity, and flatulent condition of the stomach. Eruptions upon the skin are very common in connection with deranged digestion of the infant. Attacks of nettle-rash, and the eruptions known as red and white gum are frequent, appearing on the face, neck, and arms, occasionally over the whole body. Thrush, or disease of the mouth, is another consequence of unsuitable diet, and is most prevalent in warm weather. The mucous membrane of the mouth becomes red, the little pearly white eruptions appear upon the inflamed surface, run together and form 238 SIMPLE ATROPHY. patches, sometimes extending so as to cover the whole of the inside of the mouth. There is usually little fever, with more or less thirst, and sometimes a thin, watery diarrhea. Another symptom of the irritation excited by improper food is that trouble knows as inward fits. The phenomena which attend this condition of things are blueness or lividity of the upper lip, which is more or less everted, and inclined to twitch. A slight squint or rotation of the eye, with con- traction of the fingers, and turning the thumbs inward. These symptoms should never be allowed to pass unnoticed, as they are the almost sure indication of convulsions. When there has been a great accumulation of food in the stomach of an indigestible nature, the symptoms are often quite severe, the skin gets hot, face flushed, and violent vomitings of sour smelling food take place, with great straining. At the same time the bowels are loose, and large, dark green or putty-like stools are passed with great effort. The belly is full, hard, and irregular to the feel. The child refuses all food, is thirsty, but usually vomits the fluid as soon as taken. Sometimes a convulsion ushers in the attack, and frequently the convulsions recur so often that death follows from exhaustion. SIMPLE ATEOPHY. 239 When the attack subsides the infant goes on wasting in flesh and strength as before, unless some new measures are adopted for its general improvement. The attacks coming on one after the other leave the infant weaker, its face wrinkled and old looking ; its eyes dull and hazy ; it expression languid and weary, and as the debility increases, the griping pains to which it is subject, do not excite a cry, but simply a pitiful moan, or it may be a simple contraction or movement of the features, without any sound from its lips. Any acute disease attacking a child in this condition, readily proves fatal, for the reason that all power of resistance has been starved out of it. The least cold or catarrh leads on to pneumo- nia, or bronchitis ; a chill is followed by a pro- fuse diarrhea, which now and then assumes a chronic form, and terminates the existence of the sufferer. The treatment of simple wasting from want of nourishment, consists mainly in so selecting the diet of the infant with proper regard for age, that it may be able to digest, and there- fore be nourished by all food taken. The weaker the child the nearer does its condition resemble that of the new-born infant in its power 240 SIMPLE ATROPHY. of assimilating different articles of food, and therefore the earlier in the scale must we look for nutriment suited to its wants. In properly considering this subject of wast- ing and its treatment in the early life of the infant, it is perhaps necessary to repeat some things that have been alluded to in the chapter on nursing, as the rules there laid down need to be enforced here. The child should be nursed by its mother, or at least mothers ought to try to do it, partly for their own sakes, as it causes uterine con- tractions and prevents diseases of the breast ; partly for the child's sake, as the mother's milk is as a rule, better adapted to the child than that of a stranger. Where the mother is unable to nurse the child a wet nurse should be substituted, in the choosing of which great care should be exercised, and two points especially considered, to wit : the state of her health and age of her milk. With regard to her health she should be examined for signs of consumption, scrofula and syphilis ; her breasts and milk should be examined, and her child should be looked at to see if it is well nourished and healthy in appearance, for if it is healthy and robust, it is the best evidence that SIMPLE ATROPHY. 241 her milk is not faulty. The diet of the mother or nurse should be liberal, and a certain amount of wine, ale or porter may be allowed, and fresh vegetables and fruits may be included in her meals. When the child gets to be six or eight months old its meals need not be so frequent, and the nurse will be able to tell when the child cries from hunger, and can meet the requirements of the case as she sees the necessity. If the babe rouses itself and seems pleased, at the same time clutching at the breast, you may know it is hun- gry, but if it be indifferent and remains quiet, it is safe to say it has no appetite, and if it cries, is fretful, throws its limbs about, it has no doubt got pain in the stomach or bowels, so that more milk taken would simply add to its misery. Up to six months of age the child may derive its entire nourishment from the breast, provided it does well, grows, and gives evidence of good nourishment. When children are brought up on the bottle, cow's milk is used, which needs dilu- tion and additions to render it proper to use. For the first six weeks the milk may be diluted with an equal part of lime w^ater, and a tea- spoonful of sugar should be added to every six ounces of the mixture. Some physicians advise 21 242 SIMPLE ATEOPIIY. the addition of two teaspoonfuls of cream to half a pint of the diluted milk. After six weeks, the proportion of lime water may be reduced to one-third, and after four or five months, cow's milk may be given clear. The child must be fed at regular intervals, from three to four ounces being given every two or three hours during the first six weeks. The milk should be put into a feeding bottle, and the child be allowed to suck till it is gone, but never should it be allowed to suck an empty bottle, as it swallows air in so doing, which becomes a source of trouble to it afterwards. The bottle should be thoroughly cleansed after each time using, and then be placed in a basin of cold water until wanted again. When the child is six months old, something beside milk may be given, and among the many simple articles of diet spoken of is one advised by many eminent physicians, prepared for use as follows : a pound of wheat flour tied up tightly in a bag, is placed in a sauce-pan of boiling water, and is allowed to boil continually for ten hours. At the end of this time, after removing the cloth, a yellowish white ball is seen, feeling soft and elastic to the touch, like India rubber. When cold, the soft outer coat is cut away, and the inside, which is hard, is reduced to a fine SIMPLE ATROPHY. 243 powder. For a child six months old, two tea- spoonfuls of this may be added to its milk every day. It is to be rubbed up and gradually dis- solved in boiling milk, and so made ready for use. Should this flour not agree with the infant, there are several preparations of infant's food, which come already prepared, which may be used instead. After the eighth month a little oyster, mutton, chicken or beef broth, may be given as an extra meal, but not in addition to their ordinary meal. Some children in using cow's milk are con- stantly vomiting up curds, even if lime water has been added, and in such cases, one tea- spoonful of isinglass, or gelatine, dissolved in four ounces of milk and water, will prevent the running together of the curds. It is in such cases as these that Liebig's food for infants is so valuable, for this can be digested in most cases where no other food can be borne. The time of weaning is very important to con- sider. Too early weaning may be more or less dangerous, and too long continued nursing is a) 1 ended with much evil. In ordinary cases, where the child is healthy, twelve months should be allowed to pass before weaning takes place. To nurse the child longer would make too great 244 SIMPLE ATROPHY. a demand upon the mother, and would be of no advantage to the child. ■ Human milk generally is the best food for infants, bat when it becomes so poor as to be no longer nutritious, it ceases to be food, but the child's stomach is filled with a fluid worse than useless, affording no nourishment itself, and destroying the appetite for other food. Although it is best to nurse a child one year, circumstances may arise which render it necessary to wean the child much sooner, among which the follow- ing may be mentioned. If the mother's health is suffering ; if from some cause, as pregnancy or acute disease, the mother's milk is rendered unwholesome ; if the child is not sufficiently nourished by the breast, and yet refuses to take other food ; or if the monthly courses come on; these all are good reasons for weaning. The time for weaning should be chosen when the child is free from any disorder, and it should not take place during the summer months, if it can be avoided. It is best to wean the child gradually, lessening the frequency of its meals for a week, when it may stop nursing altogether. When the child has become used to doing without breast milk, it may begin to take the food which is to form its ordinary diet. Pota- SIMPLE ATROPHY. 245 toes thoroughly mashed, light puddings, soft boiled eggs, or a bone to suck may be allowed. No meat should be given until the sixteenth or eighteenth month, when a small quantity may be given once a day. In changing the diet of children it is well to watch its effects upon the digestive organs of the child, to see that no ill effects follow. It is highly important that perfect cleanliness should be maintained. The whole body should be well washed with warm water and soap every morning, and after each bath the skin should be rubbed with the hand, or flannel, until a healthy glow of the skin is excited. The napkins should be frequently changed, and the nates sponged with warm water, and thoroughly dried. The child should sleep alone on a cot, instead of with the mother or nurse. The nursery should be large, well ventilated, not too warm, and should face the south, where it is exposed to sunlight. ' The child should be taken out fre- quently in favorable weather, and should be dressed warm, so as to be well protected against cold and currents of air. Any and every de- rangement of the organs of digestion should be immediately attended to. Constipation, which is a common result of improper food, often con- 21* 246 SIMPLE ATROPHY. iinues after the diet has heen changed, and calls for remedial measures. In cases where the infant at the breast is troubled with constipation, the mother should occasionally take some saline aperient, as Seidlitz powder, Rochelle powder, or something of the sort, and should use more vegetables in her diet. Should this plan not relieve the child, a teaspoonful of castor oil, fluid extract of rhubarb and magnesia, or rhu- barb and senna may be given. Daily friction of the belly with the hand, and with some stim- ulating lotion is useful. Dr. Morrison recom- mends the following : Compound tincture of aloes one-half an ounce, compound soap liniment one- half an ounce ; to be mixed and applied to the belly every morning with thorough friction. For a child a year old, with constipation, Dr. Dunglison advises a drachm of Socotrine aloes to be dissolved in an ounce of simple syrup, and given in teaspoonful closes until the bowels are relieved. Injections of water, with either soap, salt or molasses, into the bowel, will often an- swer the purpose. At least a gill should be in- jected at once, and should be used about luke- warm. Should there be diarrhea, instead of constipation, with dark, offensive, slimy stools, a dose of powdered magnesia and rhubarb, five SIMPLE ATEOPHY. 247 grains of each, may be given, and followed by this mixture : Laudanum twelve drops, castor oil one drachm, syrup of ginger half an ounce, mucilage gum acacia two ounces ; one teaspoon- ful is to be given three times daily. If there should be a sour smell to the breath, a few grains of prepared chalk may be given. The feet should always be kept warm, for cold feet alone will give rise to pain and uneasiness in the bowels of the infant. Sometimes the flatu- lence, or wind colic is severe, when the belly should be rubbed with some warm, stimulating liniment, and the following mixture be given: Infusion of rhubarb one ounce, syrup of ginger half an ounce, tincture of myrrh half a drachm, peppermint water three ounces ; give in doses of two teaspoonfuls three or four times daily. If sickness attends the colic, one teaspoonful of the syrup or wine of ipecac may be given to relieve the stomach, after which this mixture may be given : Subnitrate of bismuth half a drachm, carbonate of magnesia two scruples, syrup of ginger half an ounce, mucilage acacia half an ounce, water two ounces. Give one teaspoon- ful four or five times daily. When the colic is severe, the parents may be alarmed by the state of collapse into which the infant is thrown. In 248 SIMPLE ATROPHY. such cases the child should be placed in a warm bath, the bowels relieved by an injection of warm water, and a few drops of brandy be given in milk or water. On removing the child from the bath it should be well dried, a hot meal poultice be applied to the belly, and then be well wrap- ped up in flannel. If the openings between the bones of the skull are sunken, brandy with aro- matic spirits of ammonia, or a few grains of the carbonate of ammonia should be given. Con- vulsions may arise from the above causes, and if they should not yield to the ordinary treatment, Dr. Graves recommends the following: Oil of turpentine one drachm, castor oil half an ounce, mixture acacia and cinnamon water each three ounces ; mix and give one teaspoonful every four hours. This acts upon the bowels, and also produces free discharge of urine. To prevent thrush the mouth should be thor- oughly washed after each meal, and when the disease has appeared in the mouth some mild cathartic should be given, and the mouth should be swabbed with the following wash : Chlorate of potash half a drachm, borax one drachm, glyc- erine one ounce; mix and apply several times daily. At the same time this mixture may be given internally : Borax one drachm, chlorate SIMPLE ATROPHY. 249 of potash one drachm, simple syrup three ounces ; mix and give one or two teaspoonfuls three or four times daily. When attacks of acute indigestion come on, with hot skin, thirst, furred tongue, vomiting and diarrhea, with grip- ing pain in the bowels, all food must be stopped, and nothing allowed but barley water, or some simple gruel. The stomach may be relieved by a simple emetic of ipecac, after which rhubarb and magnesia may be given to regulate the action of the bowels. If the diarrhea continues after the tongue has become clean, the following mixture will be found serviceable : Aromatic sulphuric acid, half a drachm, laudanum five drops, syrup of ginger half an ounce, caraway water three ounces ; mix and give two teaspoonfuls three times daily. Milk and lime water may be given when the stomach has become less irrita- ble, but great care needs to be exercised regard- ing the diet for some time afterwards. CHRONIC DIARRHEA. This disease is a sequel of a large number of diseases, but it also conies on as an independent affection. When it comes on after some acute disease, it is usually attended with more or less fever, pain in the belly, a sense of debility, loss of appetite, and not infrequently, vomiting. The trouble comes and goes irregularly, until finally it merges into a chronic affection. When the disease assumes the chronic form to begin with, there is usually little or no fever. The frequency of discharge from the bowels varies greatly in different cases, amounting to three or four daily in some, while in others there may be many more. The stools frequently present an appearance as if undigested material was passing from the bowels in shape of curds mixed with liquid, slimy feces; sometimes with blood if there is much straining. The children afflicted CHRONIC DIARRHEA. 251 with this trouble look pale, dull, but yet are somewhat active, and partake of food with a seeming relish. The disease continues for an indefinite period, varying from a few weeks to as many mcnths. During the continuance of the disease, the child grows paler, thinner and weaker, and after a time the discharges grow more frequent and liquid, and change their appearance often. One day they may be watery with a brown color ; at another time, thicker and clay colored ; while at other times they will consist of slimy mucus and blood. Again they present a green color, with an exceedingly offen- sive odor, which indicates additional irritation of the intestines. The disease is very changeable in its character, the changes being influenced by diet, changes of temperature, and conditions of the atmosphere, as from warm, to cold, and vice versa, and from dry to wet. The child wastes away, the skin takes on a dirty, yellowish appearance, which is quite a constant character- istic of the disease, especially after it has been of long continuance. The .skin is dry and rough, lips pale and thin, strength diminishes, so that the child is unable to move about, and lies down with no disposi- tion to exercise. If the diarrhea still continues 252 CHRONIC DIAEKHEA. it is with greater frequency of discharges, as many as fifteen or twenty a day, which are thin, watery, of a dirty color, and very offensive. The child grows exceedingly weak, the bones become prominent, eyes hollow, skin wrinkled, and the disease, unless soon controlled, runs to a fatal termination. As a result of this disease various other disorders are liable to arise, such as dropsical affections, congestion of the lungs from imperfect circulation, various eruptive diseases, convulsions, and disorders of the brain from closure of its blood vessels ; and when a child dies with chronic diarrhea it is commonly from some one of these secondary disorders, as a complication. In cases where recovery takes place, the first improvement noticed is in the character and fre- quency of the discharges, the stools becoming more solid, and containing more bile. The gen- eral bearing of the child is more animated, eyes look more brilliant, grows more fretful, cries with more strength, and the increase of the secretion of tears, usually so scanty in the severer stage of the disease, is said to be an exceedingly encouraging symptom. The child begins to gain in flesh slowly, the stools lose their unhealthy character, and the diarrhea ceases. CHRONIC DIAEEHEA. 253 Chronic diarrhea is caused principally by unhealthy surroundings, bad sanitary conditions, exposure to cold, malarious atmosphere, and liv- ing in crowded, ill ventilated rooms, also the use of improper, indigestible articles of diet. Not infrequently it follows measles, scarlet fever, and other acute diseases. Children brought up on the bottle are often subject to it from birth, and another period when the diarrhea is apt to set in is when after nursing a few months other food is given which proves a source of irritation because the food chosen is of an unsuitable nature. The disease is very apt to develop itself after weaning, particularly if it take place during the summer months. Bad air, want of sunlight, and uncleanliness, cause the disease quite as often as all other things put together. It is amongst the low lived, ill fed, ill housed, of our foreign population, that the disease com- mits its greatest ravages, and carries off a large percentage of their children before they arc two years old. Chronic diarrhea is also caused by the irritation of the bowels produced by the presence of worms ; and where it depends upon tubercular disease of the bowels it is exceed- ingly fatal. Prevention is cheaper, and worth much more, 22 254 CHRONIC DIARRHEA. than any amount of cure, and here lies our great duty, and parents should understand not only what causes the disease, but what its preventives are. A great deal is accomplished in this direc- tion by attention to the diet, and general man- agement of the child. As is well known, any and all indigestible articles of food as they pass through the bowels cause more or less irritation, which increases the flow of watery fluid from the vessels of the bowels, which induces the diarrhea. The rules for feeding children have been alluded to at length in the foregoing pages, and no gen- eral reference to them is needed here. Stuffing children with sweet cake, nuts, fruit and candy, between meals, or any other time, is a miserable practice, and very injurious. Often is it the case that physicians are called to children in con- vulsions because they have swallowed green apples, pieces of pine apple, or other substances better suited to the stomach of an ostrich. Exposure to cold, chilling of the blood being a fruitful source of the disease, children should be dressed warmly, and so dressed that the legs, arms and chest, should not be exposed to the winds, as is so generally the case. The cloth- ing should be changed and made warmer or cooler according to changes of the temperature, CHRONIC DIARRTIEA. 255 and flannel should be worn next to the skin of infants the year round. Fresh air is the best medicine for infants, and they should have the full benefit of it by being taken out of doors in all suitable weather, and that may be said to be in all but damp, wet days. Additional care is requisite in guarding against chronic diarrhea during the teething period, for it is apt to come on at this time in spite of all precautions. Exposure to cold, sudden changes of temperature, errors in diet, must more than ever be avoided. Variations of temperature exercise such a notable influence in cases of chronic diarrhea in children, that it is highly important to maintain an equable temperature in the rooms occupied by such patients, which should not be too warm, nor too cold, but should range from 60 to 70 degrees Fahrenheit. The rooms should be well ventilated by night and day, except it be in damp weather when it might be injurious. The utmost cleanliness should be exercised by thorough sponging and drying after each stool, and in infants where there is redness, soreness and excoriations of the skin caused by the frequent discharges, the parts should be sprinkled with equal parts of powdered lycopodium and oxide of zinc or tannin. The 256 CHRONIC DIARRHEA. napkins, soon as soiled, should be removed, and the child's bed and bedding thoroughly aired. Chronic diarrhea is kept up and aggravated by chills, as is the case in catarrh and colds. The feet and legs should be well protected by woolen socks and leggins, for cold extremities, particu- larly cold feet, have the effect to greatly increase the pain and disturbance of the bowels. One of the most important items in the management of this disease is the proper regulation of the diet. Children though suffering severely from this affection, often have a vigorous appetite, even when the food taken cannot be digested ; the child they say * will eat anything," and so they give it anything to eat. Infants at the breast should be confined to the mother's milk, and children brought up by hand, who are under six months old, should be allowed nothing but equal parts of lime water and milk, wine whey, cream or milk and water, thickened with isinglass, in the proportion of one teaspoonful to four ounces of the milk and w r ater. When milk cannot be tolerated, chemi- cal food as prepared by Liebig, is especially nutritious and answers the purpose admirably. Children thrive upon this when almost every- thing else in the shape of nutriment is useless. CHRONIC DIARRHEA. 257 The frequency of the meals should be regulated according to the necessities and severity of the case. The more frequent the discharges from the bowels the smaller should be the meals, and more frequently given. Where the discharges are thin, watery, not more than one or two table- spoonfuls of liquid should be given at one time. If the child is from six months to a year old, heartier food may be given, such as beef tea, oyster, mutton and chicken broth. Extract of beef, with iron and wine, may be useful when the diarrhea is checked, to impart tone and strength to the system. Where the patient is a year old, boiled flour cooked in milk, canna farina, arrowroot, tapioca and sago, are useful, but small quantities should be given at a time. The nutrition of the body must be sustained with as little demand upon the powers of diges- tion as possible, in order to avoid irritating those organs in their peculiarly sensitive condition. Where the discharges from the bowels present a putty, or clay colored appearance, milk should be avoided, and the following diet, recommended by Eustace Smith of the London Hospital, may be used, and will be found of great usefulness : First meal, one teaspoonful of Liebig's food for infants dissolved in four ounces of milk and 22* 258 CHRONIC DIARRHEA. water, equal parts. Second meal, four ounces of* beef tea, of the strength of four ounces of the fillet of beef to a pint of water. Third meal, four ounces of whey, to which is added a teaspoonful of cream. Fourth meal, yolk of one egg, beaten up with a tablespoonful of cin- nanon water, a little white sugar, and ten drops of pale brandy. Fifth meal, the same as the first. It is always better that the child should go a little hungry, than that its appetite should be entirely satiated. The skin in chronic diarrhea is inactive, and therefore external applications are serviceable. The warm bath may be used every night, after which the whole body should be anointed with warm olive, or camphorated oil, the child wrap- ped in flannels and placed in bed, and in cases where there is much prostration, the mustard bath should be used. When there is danger of ulceration of the bowels, it is advisable to envelop the . bowels in a good sized poultice, applied warm, which may be prepared with equal parts of flaxseed meal and mustard. The poultices should be changed often, care being taken not to chill the patient, or dampen the clothing, while using them. The internal remedies used for this disease CHRONIC DIARRHEA. 259 have differed greatly with different physicians, one strongly advocating one plan of treatment, another equally enthusiastic over a different course, and so on, perhaps the one plan proving quite as successful as the other. If the child is seen early in the disease, before the diarrhea is fully developed, and there is pale- ness, loss of flesh, straining and pain, with sour smelling stools, a small dose of powdered rhu- barb and carbonate of soda may be given, and after this has acted upon the bowels, the follow- ing mixture will be found useful : Laudanum ten drops; bicarbonate of soda, two scruples; simple syrup and caraway water, each one ounce ; a teaspoonful of the mixture to be given three times a day. Laudanum with castor oil is useful in many esses, especially if the tongue is coated, and may be used as follows : Laudanum, sixteen drops; castor oil, two drachms; syrup of ginger, half an ounce ; mucilage acacia, an ounce and a half. Mix and give one teaspoonful four or five times daily. When the diarrhea sets in with green, slimy, watery stools, with a sour odor, this mixture may be given ; subnitratc of bismuth, one scru- ple ; pulverized chalk, two scruples ; simple syrup and cinnanon water, each an ounce and a half; 260 CHRONIC DIARRHEA. one teaspoonful to be given every three or four hours. If there is much straining at stool, a drop of laudanum, or three or four drops of the syrup of ipecac, may be added to each dose, the doses always to be increased in proportion to the age of the child. Should the tensemus or straining be severe, a mixture of a teacupful of starch water and five or six drops of laudanum may be injected into the bowels, and the opera- tion repeated three or four times daily. If the diarrhea continues after the tongue is clean, stringent remedies are called for, and this strin- gent compound will be found effectual in many cases : Tincture krameria, and tincture of cate- chu, each two drachms, laudanum ten drops, simple syrup two ounces ; mix and give one tea- spoonful every three or four hours. Another mixture is as follows : Sugar of lead ten grains, dilute acetic acid twenty drops, laudanum twelve drops, tincture of kino two drachms, syrup of ginger two ounces; mix, and give one teaspoon- ful every six hours. The following astringent mixtures, used and recommended by Dr. Eustace Smith of the Lon- don Hospital for sick children, will be found of special service in the chronic diarrhea of chil- dren : Gallic acid one scruple, aromatic sulphuric CHRONIC DIARRHEA. 261 acid half a drachm, laudanum ten drops, spirits of nitre half a drachm, simple syrup one ounce, water two ounces ; mix, and give one teaspoon- ful every four or six hours. Another mixture is : Tincture of capsicum six drops, simple syrup half an ounce, decoction of logwood one ounce and a half; mix, and give one teaspoonful every four hours. In many obstinate cases of chronic diarrhea, nitrate of silver is useful after all other means have failed, and it may be given by the mouth, or by injection into the bowels, or both. It may be given internally in this form : nitrate of sil- ver one grain, dilute nitric acid five drops, mu- cilage and simple syrup each six drachms ; mix, and give one teaspoonful every four or six hours. When given as an injection add five grains of the nitrate of silver, and five drops of laudanum, to a teacupful of starch water, and inject the whole at once, repeating the process three times a day if needed. The above mixture for inter- nal use is very useful in cases where there is great loss of flesh, frequent stools, which contain mucus and blood. In cases where the stools are slimy, with lumps of bloody mucus, resembling lumps of flesh, the bichloride of mercury given after the following formula, will be beneficial : 262 CHRONIC DIARRHEA. Bichloride of mercury, one grain ; water, half a pint ; mix and give one teaspoonful every hour or two. When the child continues to grow worse and the prostration is very great, stimulants will be demanded. From five to ten drops of pale brandy, or twice the quantity of sherry wine, way be given in milk several times a day, the dose to be increased according to the neces- sities of the case. In some cases the diarrhea continues in spite of all treatment, in which cases all common food must be stopped, and the child be nourished by the use of raw beef pre- pared in the following manner : A piece of beef steak, free from fat, should be finely cut, and pounded to a jelly, season with salt, and give one or two teaspoonfuls of it three or four times a day, increasing the amount each day, until it is borne in considerable quantity, allowing no other food whatever while using it, except it be barley water, or something of that nature for drink. Bismuth and lime water, or chalk with a drop or two of laudanum, may be given before each meal while using the meat diet. After the diarrhea is arrested by this treatment, tonic remedies will be found useful in giving strength and tone to the debilitated organs. Among the most useful may be mentioned the various prep- CHRONIC DIARRHEA. 263 arations of iron, quinine, cod liver oil and calis- aya bark with wine. The pernitrate of iron is highly spoken of, given after this formula : solu- tion of the pernitrate of iron half a drachm, dilute nitric acid half a drachm, syrup of gin- ger one ounce, cinnamon water three ounces ; mix and give one teaspoonful every four or six hours. In giving cod liver oil, begin with small doses, say ten drops in a tablespoonful of milk, three times daily, but if the oil can be detected in the passages from the bowels, by odor or oth- erwise, then omit it for a day or two, or give smaller doses. CHRONIC VOMITING. Vomiting, more or less severe, is exceedingly common in infancy and childhood. Nearly all infants while at the breast are subject to slight attacks of vomiting, which last from one to sev- eral days as the case may be. The matters thrown up are the food, mucus and bile. There is with the vomiting heat of skin, furred tongue, and either constipation or diarrhea, the latter being more frequent. These simple attacks re- quire but little attention, beyond relieving the stomach with an emetic of the wine or syrup of ipecac, followed by some mild cathartic, and proper attention to diet afterward. When the disease becomes chronic, attended with loss of flesh, and great prostration, it be- comes a serious matter, requiring close watch- ing and constant care. The symptoms of chronic vomiting are as follows : there is little or no CHRONIC VOMITING. 265 fever, the child vomits at irregular intervals, throwing up curdled milk with a sour, sickening odor, tinged green or yellow with bile. Soon the bile disappears from the matters rejected by the stomach, and a clear, watery fluid takes its place. Tenderness over the pit of the stomach is noticed by pressing the hand upon this local- ity. The stomach is often distended with gas, and rumbles when pressed upon ; the gases are raised from the stomach in considerable quanti- ties. The bowels are apt to be constipated in the severer cases ; the tongue is heavily coated ; the breath has a sour smell ; the lips are dry and red ; the mouth dry and parched ; the child nurses eagerly, but soon vomits all the milk taken. Cases may continue on for some time in this way without any great change for the bet- ter or worse, but finally the vomiting grows more frequent, occurring not only after taking food, but during the intervals, and the milk taken is thrown up without being curdled. The child now loses flesh very rapidly ; the skin is dry ; flesh is loose and flabby ; eyes are dark and sunken ; nose sharp ; cheeks hollow; child lies with its legs drawn up, occasionally moving them as if in pain ; is very fretful ; cries out suddenly, and is wakeful night and day. The tongue now 266 CHRONIC VOMITING. becomes dry, coated, rough, presenting a granu- lar appearance. The vomiting still continuing, the child becomes terribly reduced in flesh ; body is cold and pale ; hands and feet purple ; vomiting occurs if the patient is simply moved about. The child lies in a dull, stupid state, with eyes half closed, and breathing is the only evidence of remaining life. Thrush now appears in the mouth, which is a pretty sure indication that the disease will soon end in death. Trouble with the head often results from these long continued cases of vomiting, death fre- quently resulting from some secondary disease of the brain. When children recover from this disease, the vomiting gradually grows less and less frequent, until it ceases altogether, and it is necessary to be very careful about giving much food for some time after the trouble has disappeared. There are various causes for this troublesome affection, such as, premature weaning, giving indigestible food ; crowding children into ill ventilated rooms, where there are several per- sons, as is so often the case in the apartments of the poor ; and overfeeding by too frequent nurs- ing. In the management of this disease certain rules and precautions need to be enforced. In CHRONIC VOMITING. 267 the vomiting of infants at the breast, the qual- ity of the milk should be examined, the quantity taken must be so regulated that a child shall get but a comparatively small allowance at a time, and for a while after nursing, the infant must not be subjected to any violent movements, like swing- ing or rocking, as these movements are often sufficient to excite nausea, and vomiting, when the stomach is full. If the infant has been pre- maturely weaned, it is sometimes advisable to procure a wet nurse, if one can be obtained with good milk, suitable to the necessities of the child, but if the milk should fail to agree with the patient, the nurse should be changed. Where children are greatly reduced and prostrated, the mere act of nursing seems to excite vomiting, in which case the milk of the nurse should be drawn, and fed to the infant with a spoon. If a wet nurse is not to be had, equal parts of milk and lime water is to be substituted. Liebig's food for infants, prepared in milk and water, a teaspoonful to four ounces, is an excel- lent substitute for milk in many of these cases, an 1 is well borne when milk is not tolerated. All food should be given hot or cold, as luke- warm articles are more apt to prove nauseous. The 'infant should be warmly clad, a flannel 268 CHEONIC VOMITING. bandage should be applied around the belly, and the patient kept in a room comfortably warm. Warm applications should be made over the stom- ach, and they may consist of flaxseed or poppy leaf poultices ; fine salt thoroughly warmed, placed in a bag and laid on ; or a liniment of equal parts of camphorated oil and chloroform liniment, or a liniment made of equal parts of compound camphor and soap liniment. Warm mustard baths followed by thorough friction are beneficial. For the vomiting which often attacks infants from irritability of the stomach, without any special exciting cause, Dr. Bednor advises relieving the stomach with teaspoonful doses of the wine of ipecac. After the stomach has been emptied of its acid secretions, it is best to give some alkaline and sedative mixture, like the fol- lowing : Lime water, two ounces ; white sugar, a tablespoonful ; mix and give one or two tea- spoonfuls three or four times daily ; or carbon- ate of soda, ten grains ; bismuth, twenty grains ; white sugar, two tablespoonfuls ; water, two ounces ; mix and give a dessert-spoonful every three hours. The following is sometimes very useful : Subnitrate of bismuth, one scruple ; car- bonate of magnesia, half a drachm ; oxalate of cerium, ten grains ; tincture capsicum, ten drops ; CHRONIC DIARRHEA. 269 simple syrup and mucilage tragacanth, each half an ounce, water two ounces ; mix and give one teaspoonful every hour or two. In chronic vomiting the bowels are almost always constipated, and should be relieved by some simple laxative medicines, or by stimulat- ing injections. A gill of warm salt and water may be injected into the bowels once or twice a day, or ten grains of powdered aloes in a tea- cupful of boiled milk. Ten or twelve drops of the tincture of aloes may be given once or twice a day in a little syrup, if it can be retained upon the stomach long enough to take effect. Small doses of the mild chloride of mercury, from one- eighth to one-sixth of a grain, placed upon the tongue every four hours, afford frequent relief. Dr. Eustace Smith of the London Hospital rec- ommends the following mixture : Dilute hydro- cyanic acid, six minims ; nitrate of potash, one drachm ; simple syrup, half an ounce ; water, an ounce and a half; mix and give one teaspoon- ful three times daily. A drop of laudanum may be added to each dose, if the vomiting is obsti- nate. One drop doses of the wine of ipecac, or of Fowler's solution, given in a teaspoonful of water every five or six hours is said to cure vom- iting not relieved by other remedies. 23* 270 CHRONIC VOMITING. In some of the cases where vomiting contin- ues after the tongue presents a healthy appear- ance, stimulants should be given, for in these cases the vomiting is often the result of debility of the stomach. The following formula for their use will answer : Aromatic spirits of ammonia and spirits of chloroform, each half a drachm ; syrup of tolu, half an ounce ; decoction cinchona bark, two ounces ; mix and give one teaspoonful three times daily. Or, dilute nitric acid and spirits of nitre, each half a drachm ; tincture capsicum, ten drops ; syrup of ginger, half an ounce ; caraway water two ounces ; mix and give a teaspoonful every four or six hours. These remedies should be used for some little time after vomiting ceases. EICKETS. This disease results from want of proper assimilation of the food taken into the system, and the consequent imperfect nutrition of the body. Its commencement is hardly noticeable, the simple symptoms of impaired nutrition being all that marks the onset of the affection. There is a gradual diminution of strength, and reduc- tion of all the vital forces, resulting in the gen- eral innutrition of the whole system, so that any disease thus operating to derange the func- tion of nutrition may lead on to rickets, in which the bony structures become softened, so that their natural shape is very much changed by the action of the muscles attached to them, or by the limbs bending, being unable to support the weight of the body. It is emphatically a disease of childhood, and most generally develops itself during the second and third years of life, when 272 RICKETS. children are beginning to walk. Among the early symptoms indicating the approach of rick- ets are the following : The temperature of the body is exalted, there is a general feverish con- dition of the body ; often a profuse perspiration of the head, neck and chest, which continues by day as well as night ; and if the child falls asleep the sweating is increased so as to wet the pillow, and while awake the least exertion in- creases the difficulty. * The superficial veins of the face and forehead are large, full and prominent, and while this portion of the body is covered with sweat, the abdomen and lower limbs may be dry and hot. The child, in trying to keep cool at night, will kick the clothing off as often as it is put on. These general symptoms of weakness and relaxation come on prior to the malformation of the bones. Before much deformity takes place there is usually discernable a general tenderness upon the surface of the body, the child mani- festing discomfort when it is tossed up and down in the arms of its mother, becomes cross and fretful on being touched ; and is comparatively easy when sitting or lying down, as all move- ments seem to give rise to pain and general uneasiness. The bowels are more or less in- KICKETS. 273 volved in the general derangement, constipation generally existing, though at times there is swelling of the abdomen and diarrhea. The food taken passes through the bowels with but little change. The appetite is often voracious, children being hungry soon after eating a hearty meal. The child soon loses its power of walk- ing, and either sits or lies down most of the time, grows dull, stupid, and loses flesh. The long bones, such as the spine and bones of the legs, are apt to bend under the weight of the body, head increases in size, face looks small, features less prominent, breathing becomes more frequent, and the pulse small and more rapid. The bones also become soft, the earthy matter being diminished while the animal matter is in excess. The lower extremities are the first involved in distortion, owing to the weight of the body, so that the child as a consequence becomes bow legged. Later in the disease there is deformity of the spine and chest, producing curvature of the spine and pigeon breast. Sir William Jenner in his lecture on rickets men- tions the following as the most constant changes that take place in this disease : Enlargement of the ends of the long bones, where the bones and cartilage are in contact, viz., when the cartilage 274 RICKETS. is read} 7 for ossification, and when bony harden- ing is taking place in the cartilage ; softening of all the bones ; thickening of the flat bones, as the bones of the skull, shoulder blades, and pel- vis. Deformities which follow from mechanical causes acting upon the softened bones, thus giv- ing rise to deformities of the chest, pelvis, spine, and all the long bones, as those of the arms and legs. All these deformities may be present in a single case, but it would be the exception and not the general rule, for the degree of deformity is very variable in different cases. The changes that take place in the different bones are about as follows : The skull is much increased in size, and its general shape altered, being longer from before backward than natural. The openings between the bones of the skull are open much wider than usual, and they remain open for a much longer time than is usually the case. The top of the skull is flattened, and the sut- ures, or lines of union between the bones, are expanded and separated. The forehead is high, square, projecting, and out of proportion to the face. The bones of the face are arrested in their growth, so that while the forehead is larger the face is smaller than usual. The head presents much the same appearance RICKETS. 275 as in dropsy of the brain, or hydrocephalus, but there are distinguishing symptoms, which can be detected by physicians familiar with the two affections, which could not or would not be readily observed by any non-professional ob- server. A curious condition of the skull known as cranio tabes, sometimes exists, which was first detected by Elsasser, and is well described by Dr. Alford Vogel of Munich. On resorting to gentle pressure upon all of the posterior surface of the head, spots can be found where the bone is much thinner than nat- ural, and is soft and elastic to the touch, and there is a depression, which varies according to the size or extent of the thinning. The usual size of these spots is said to be from that of a flaxseed to a bean, though they have been found much larger, and the most frequent seat of them is on the occipital bone. The portion of the bones not involved is much thicker than in the natural, healthy skull. A case of this peculiar affection of the skull in a man of thirty or more years of age, has occurred during the past year in the practice of one of our resident physicians. When occurring in infants the disease arrests the process of teething, so that if some teeth have 276 EICKETS. appeared, further progress is stopped, and teeth that have protruded turn black and fall out. The curvature of the spine is much greater in some cases than in others, the deformity being dependent upon the extent of the muscular debility. The direction of the curvature of the spine varies according to whether the child can walk or not. If the child cannot walk, the anterior curvature of the cervical, or upper portion of the spine is increased, and there is a posterior curvature in the small of the back. If the child is able to walk, the dorsal portion of the spine is curved backwards, the lumbar portion for- wards. In other cases the spine curves laterally, though this curvature is the least common. The chest is gradually deformed, being thrown sharply forward. The angles of the ribs and their curvatures are very much altered. The ends of the ribs are enlarged so that the chest presents a rough, uneven appearence, and there is recession of the chest in one portion, and bulging in another, producing ridges and fur- rows, leaving almost no regularity of surface. The collar bone, or clavicle, and the bones of the arm, are bent by the action of the muscles attached to them. The shoulder blade is said to RICKETS. 277 be often so much thickened as to interfere with the motions of the shoulder. The bones of the pelvis are very much distorted. The thigh bones are curved forward, if the child is unable to walk, but if walking they are curved forward and outward. The bones of the leg below the knee, are bent outward, so that when a child is lifted up, the limbs will be widely separated. The deformity of all these bones is very varia- ble in different cases. The older the child is when attacked with the disease, the less liable is it to much deformity, and the earlier in life, the greater the deformity will be as a rule. There is not only deformity of the bones in rickets, but they cease to grow and develop, so that the whole body is stunted in its growth. While these changes are going on, the symp- toms spoken of in the fore-part of this chapter, are still manifest. There is loss of appetite, ten- derness, weakness, perspiration, sickness at the stomach, diarrhea, loss of flesh, and the muscles still grow thin and flabby. The belly seems to be much distended, but it is rather thrown for- ward by the deformity of the spine. The face looks old, eyes are large and sunken, breathing is difficult, the child appears stupid, and mani- 24 278 EICKETS. fests no disposition to play or exert itself in any way, grows pale, and often presents a waxy, green, or yellowish appearance. Owing to the great debility of the system, secondary diseases are apt to accompany, or fol- low rickets, and often with a fatal result, such as catarrhal troubles, bronchitis, pleurisy, diar- rhea, convulsions, and dropsy of the brain, all of which are much more likely to prove fatal, than when occurring as independent affections. In the treatment of this disease, our first aim must be to remove the cause which created the disease, and is maintaining it in force. The houses occupied should be in dry, healthy local- ities, where there is plenty of sunlight, pure air, and the rooms in which the child lives and sleeps should always be thoroughly ventilated. One of the first and most important things to accom- plish is healthy nutrition, which is brought about by due attention to diet, and sanitary and hygienic measures, taking care to correct any derange- ment of the digestive organs which may inter- fere with the digestion, and assimilation of food. Often the bowels are relaxed, there being three or four stools a day, the discharges being like putty mixed with mucus and blood, and very offensive. It is advisable to commence treat- EICKETS. 279 merit by giving some gentle laxative, as a tea- spoonful of oil, rhubarb and soda, or magnesia, and after the bowels have been thus acted upon alkaline remedies may be administered as fol- lows : Laudanum, twelve minims ; bicarbonate of soda, one drachm and a half; aromatic spirits of ammonia, one drachm ; syrup of ginger, half an ounce ; cinnamon water, three ounces ; mix and give two teaspoonfuls three times daily. Under this treatment the motions of the bowels will become much more healthy, and the griping pains will cease. The diet must be regulated according to the digestive powers of the patient ; plenty of fresh air is indispensable, and rickety patients should be taken out into the open air as often as the weather will permit. Great attention must be paid to clothing and cleanliness. The whole body should be well washed night and morning, or at least once a day, with warm salt and water. The bedding used, and room occupied, should be thoroughly aired every day. As the functions of digestion become regulated, and restored to healthy activ- ity, tonic remedies are called for, among the most useful of which are cod liver oil, iodine, iron, and the salts of soda, potash and lime. To infants cod liver oil may be given after the 280 RICKETS. following formula : Cod liver oil and syrup of tola, each two drachms ; syrup of ipecac, one drachm ; mucilage gum arabic, half an ounce ; water, three ounces ; mix and give a teaspoon- ful every three hours. Iron may be given in either of the following forms : Lactate of iron, one scruple ; precipitated carbonate of lime, one drachm ; white sugar, two drachms ; mix and give as much as can be placed upon the point of a pocket knife, three or four times daily to infants. For older children, the following may be used : Solution of the pernitrate of iron and dilute nitric acid, each half a drachm ; syrup of ginger, one ounce ; infusion of columba, three ounces ; mix and give two teaspoonfuls three times daily. Other preparations of iron are useful, such as the syrup of the iodine of iron, syrup of the phosphate of iron, and reduced iron, or iron in powder. Quinine and iron given together are valuable, and may be given in the form of citrate of iron and quinine, of which three or four grains may be dissolved in a little glycerine, and given three or four times daily. When cod liver oil is given separately, not more than ten or twenty drops should constitute a dose. Should there be troublesome diarrhea, the following mixture may be given : Carbonate of iron and EICKETS. 281 sugar, eight grains ; extract of logwood ten grains, white sugar one drachm ; mix and make eight powders, and give one every four hours. Should there be constipation of the bowels, the following laxative may be used : Carbonate of iron and sugar, ten grains ; extract of aloes fif- teen grains ; extract of gentian, ten grains ; mix and make twenty pills, and give one or two pills twice a day. For young children the pills might be dissolved in a spoonful of syrup. All the salts of iron, lime, soda, potash and iodine, are useful in restoring the earthy matter of the bones. The following mixture is highly recom- mended by Dr. Tanner, in his work on children's diseases : Phosphate of lime, two drachms ; car- bonate of lime, one drachm • lactate of iron, twelve grains ; sugar of milk, three drachms ; mix and make twelve powders, and give two powders a day. The first symptoms of catarrhal trouble in rickety children should receive prompt atten- tion. The whole chest should be painted with tincture of iodine, or be thoroughly rubbed with some stimulating liniment, and then be enveloped in oil silk. For an internal remedy, Dr. Smith of the London Hospital advises the following : 24* 282 RICKETS. Iodide of potassium, five grains ; nitrate of pot- ash, one drachm; liquor acetate of ammonia, three drachms, simple syrup, one ounce ; cinna- mon water, three ounces ; mix and give two tea- spoonfuls every four hours. The object is to pro- duce as soon as possible a free secretion from the bronchial tubes, in order to clear them from the tough mucus that is apt to clog them up, caus- ing difficulty of breathing. When the cough has become loose, a little of the wine of ipecac and syrup of tolu, or squills, may be added to the mixture. If the patient is weak, a few drops of brandy may be given frequently. If there is much rattling of mucus in the throat and bronchial tubes, when breathing, a tea- spoonful of the wine or syrup of ipecac, may be given occasionally until vomiting ensues. When diarrhea occurs it must be checked as soon as possible, on account of the great exhaustion it produces. The following rules will serve as a guide to treatment in the diarrheal affections. If the tongue is coated white or yellow, the skin hot, the belly hard, and the passages from the bowels are green and slimy, attended with strain- ing and griping pains, give the following mix- ture : Magnesia, one drachm ; syrup of ginger RICKETS. 283 and mucilage acacia, each half an ounce ; cara- way water, three ounces ; mix and give one or two teaspoonfuls three times daily. If the tongue is coated white or yellow, skin hot, belly soft, passages from the bowels pale and frothy, and sour smelling, attended with no straining, give a mixture of chalk, catechu and aromatic confection. If the tongue is clear, smooth, motions of the bowels dark, watery and offensive, Avith straining, give opium ; and if diarrhea continues, lead may be added as follows : Sugar of lead, eight grains ; dilute acetic acid, twenty minims ; laudanum, six minims ; simple syrup, half an ounce ; water, one ounce and a half; mix and give one teaspoonful three times daily. Should the diarrhea still continue it must be treated the same as chronic diarrhea. The diet in these secondary affections, must be well regulated, and the utmost caution exercised. MUCOUS DISEASE. This disease is characterized by an increased secretion of mucus from the mucous membrane, which lines the whole alimentary canal. This abundant secretion of mucus deranges the whole digestive and nutritive processes. This trouble is exceedingly common in the earlier ages of life, between two and ten years of age. The symptoms of this affection vary much in degree of severity ; at first usually slight, but becoming more aggravated as the difficulty con- tinues. The child grows dull, stupid, is little inclined to amusement, or exercise ; grows pale, and loses flesh. There is oftentimes drowsiness during the day, and wakefulness during the night ; the child grinds its teeth, and is disturbed by dreams which terrify it. Often the child will awake out of sleep uttering loud cries, and appear to be in a state of partial unconscious- MUCOUS DISEASE. 285 ness, like those persons who walk and talk in a state of somnambulism. The urine is often passed involuntarily ; the appetite becomes much impaired ; tongue is flabby, with a glossy, slimy look ; the bowels are either costive, or there are frequent, scanty stools, consisting principally of mucus, and attended with straining, and some- times diarrhea alternates with constipation. The skin is apt to be remarkably sallow, and there is generally a jaundiced condition of the system. The skin is also inactive, and presents a rough, harsh appearance, and the glands about the neck are frequently enlarged. There is but little regularity about the symptoms, as the disease is very changeable ; children one week will be feeling comfortably well ; the next, suf- fering from pain, diarrhea, vomiting and general prostration. It is not unusual to find that chil- dren thus affected have an enormous appetite, which results from the want of nourishment felt in the system, and partly from a morbid craving excited by the stimulating effect of the mucus, which is present in unusual quantities. Many infantile diseases leave behind this condition of the mucous secretions. Whooping cough is a prominent example of this, the mucous mem- brane lining the bronchial tubes secreting a 286 MUCOUS DISEASE. tough, stringy mucus, in large quantities, and at the same time there is a free mucus flux from the stomach and bowels. The tough mucus that is vomited up after a fit of coughing, comes principally from the stomach. As the severity of the cough diminishes, the symptoms of mucous derangement subside. The period of second teething is frequently attended with this mucous disease, the irritation of teething exciting a sympathetic irritation of the digestive organs. In order to cure this, as well as other disorders of the digestive system, the utmost care must be taken regarding the diet. Every article of diet which undergoes fermentation in the acids of the stomach, or bowels, must be discarded. All farinaceous arti- cles of food, except stale bread, must be forbid- den, and vegetables of all kinds must not be used. The child must be kept on meat, milk, eggs, &c. ; but a small quantity only must be given at once, and the allowance be oft repeated. The following is a scale of diet adopted by Dr. Smith of the London Hospital for Sick Children. First meal : fresh milk diluted with a third part of lime w T ater, and a small slice of dry toast, or stale bread. Second meal : a small mutton chop, or slice of roast mutton, with dry toast, or stale MUCOUS "DISEASE. 287 bread. Third meal : a cup of beef tea, or mut- ton broth, or the yolk of a soft boiled egg, with dry toast. Fourth meal : same as the first. This scale of diet is for a child two or three years of age or more. This kind of diet should be continued so long as the tongue presents the characteristic slimy appearance, or so long as there is mucus vomiting, or diarrhea. Where the strength has been much reduced, stimulants will be useful in improving the strength, and the digestive powers. Half a wine-glass of pale sherry wine diluted with water, may be taken at dinner. Every effort should be made to restore healthy .action of the skin by frequent bathing, and thorough friction. The child should be warmly clad, and exercised in the open air. Medicines are useful in checking the secretion of mucus, and to correct any acidity of the secretions that may exist. The bicarbonate of soda in some bitter infusion, is beneficial, and may be used after this formula : Bicarbonate of soda, one drachm ; infusion of Colombo, two ounces ; mix and give one-half a teaspoonful to a child two years old, three times daily. The com- pound decoction of aloes may be given in one tea- spoonful doses, two or three times a day, which 288 MUCOUS DISEASE. acts as a tonic to the bowels, and checks exces- sive secretion. Sometimes it is well to combine a tonic with the decoction of aloes. The citrate of iron and cinnamon may be given in the alka- line mixture, or a teaspoonful of the wine of iron may be added to each dose of the decoc- tion of aloes. Another useful mixture is as fol- lows : Tartrate of iron and potash, one drachm and a half; compound decoction of aloes two ounces ; water, six ounces ; mix, and give a table spoonful two or three times daily. After the treatment has been continued for some time, it will be noticed that the improvement is less rapid than at first, and it becomes oftentimes necessary to change from alkaline to acid reme- dies, in which case the following mixture may be used: Powdered alum, two scruples; sul- phate of potash, two drachms ; aromatic sul- phuric acid, one drachm ; syrup, one ounce ; water, four ounces ; mix, and give one table- spoonful three times daily. Where there is great loss of flesh, cod liver oil, given in small doses before or after each meal, is useful, and change of air, and location, results in great good. WORMS. The presence of worms in the intestines of children, if not an actual disease, is certainly a very frequent source of irritation, which seri- ously disturbs the digestive organs and the ner- vous system. The varieties of the parasitic worms found infesting the stomach and bowels of children are as follows : the small thread worm, the long round worm, the long thread worm, the common tape, and the broad tape worm. The small thread worm, or pin worm, commonly so called, and the long round worm, are the most common species found in children. The tape worm is very rarely found in young children, and the broad tape worm, though sel- dom infesting children in this country, is said to be common in other countries. The small thread worm varies in length from one-sixth to one-third, or one-half an inch, 25 290 WORMS. These worms inhabit the large intestine, but they do not usually trouble children at the breast unless artificial food is given besides the breast milk, but they are very common in older children. The long round worm is much larger than the foregoing species, and varies in length from four to fourteen inches. This worm lives in the small intestine, but often passes into the stomach, and is vomited up. This worm is most common in children between the ages of three and ten years. The long thread worm is from an inch and a half to two inches in length, with a long, slender neck. This worm also inhabits some portion of the large intestine. The common tape worm is often of great length, ranging anywhere from twenty-five to fifty feet and upwards. It is about a third of an inch wide in its widest part ; is flat, white in color, and the whole worm is made up of a series of joints or segments. The broad tape worm is the largest one that inhabits the human body, being about an inch in width, and many feet in length. The origin of, or the way in which these various worms get into the human body is not satisfactorily under- stood, but it is believed that the round worms come from drinking impure water, and there is good proof that the tape worm is derived from WORMS. 291 eating meat containing the ova, or eggs, which produce the worm. People who eat raw bacon, Bologna sausage, rabbits, etc., are especially lia- ble to contract the disease. The presence of worms in children is usually attended by an unhealthy condition of the bowels, which comes on after the worms make their appearance, and continues even after they have disappeared. There is quite a variety of symptoms which indicate the presence of worms in children. As a general rule the nutrition of the body becomes impaired, so that the child loses flesh ; the face is pale, and presents often- times a puffy appearance ; the lower eye-lids are dark and sometimes leaden colored, and the pupils are frequently dilated. There is more or less itching about the nose and anus, and bleed- ing at the nose is not infrequent. The sense of smell may be dulled ; the upper lip often swells ; the breath is offensive, and in many cases there is salivation, the saliva flowing freely from the mouth. The child suffering from worms grows exceed- ingly restless as night approaches ; during sleej3 it suddenly starts, twitches, grinds its teeth, and frequently awakes out of sleep crying and talk- ing wildly. There is often a dry, hacking, 292 worms. troublesome cough, together with sighing, sob- bing, and hiccough. The belly is more or less swollen, sometimes quite hard, and there is more or less pain complained of. The appetite is very fluctuating, the child at one time having a rav- enous appetite, while at another time it will not touch food. Sometimes sudden attacks of nausea and vomiting come on, during which worms may be expelled from the stomach. Diarrhea may be present, but the bowels are most usually con- stipated. The passage of urine is often difficult and painful, and the urine is frequently of a white, milky color, owing to the presence of mucus. The pulse is small, quick, or slow, as the case may be, and irregular ; the temper of the child is fretful, and there may be attacks of fainting, delirium, or complete stupor. Some- times there is loss of voice, cross eyes, or general convulsions. According to Dr. Underwood, an attack of convulsions, accompanied by small pulse and hiccough, is an almost sure sign of the presence of worms. The presence of the different varieties of worms is indicated by certain special symptoms. The small thread worm usually causes severe itching at the anus, which is most troublesome at night, or towards evening, the irritation not woems. 293 only preventing sleep, but causing a great deal of discomfort. Another frequent symptom indi- cating the presence of pin worms, is tensemus, or straining, the desire to go to stool being frequent and ineffectual, and the trouble continuing often gives rise to a diarrhea. These worms not only inhabit the lower bowels, but migrate to other organs, and are found to infest the vagina, uterus, urethra, throat and stomach. The long round worm gives rise to more or less pain, which is often located about the navel. This worm often passes into the stomach from the bowels, causing sudden vomiting, by which it is ejected from the stomach. The presence of this worm in the intestine is very apt to be fol- lowed by unusual nervous derangements, such as dizziness, St. Vitus dance, and convulsions. The irritation caused by the round worm may give rise to diarrhea, and cases are on record, where children have had a diarrhea for six or eight months, which ceased soon as the worms were expelled. Tape worms produce sensations of weight and gnawing in the belly ; pain, sometimes amount- ing to severe attacks of colic, with swelling of the belly. Sometimes there is vomiting, diar- rhea, headache and lassitude. The presence of 25* 294 worms. these worms in the bowels is detected by the passage of fragments of them in the stools. The presence of worms in the passages from the bowels is the only satisfactory and positive proof of their existence. The great majority of the symptoms which are associated with the presence of worms may be due to derangements of the stomach and bowels, independent of the worms themselves. The thread worms and the round worms give rise to considerable local irritation, but do not produce any general disturbance of nutrition, as is the case with tape worms, as they cause very much emaciation, notwithstanding the patient may all the time have a voracious appetite. In treating children for worms there are two objects to accomplish, viz. : to expel the worms, and to restore the bowels to a healthy condition. The small thread worms which inhabit the lower bowel, or large intestine, are within reach of injections, and they afford the most prompt relief. Various mixtures may be employed for this purpose, such as a strong solution of com- mon salt, one tablespoonful to a gill of water ; or four or five ounces of the infusion of quassia, with twenty drops of the tincture of the muriate of iron. worms. 295 An English author recommends for. an injec- tion, two scruples of aloes, rubbed up with a half a pint of lime water. The injections should always be given luke-warm, and at bed-time. The diarrhea caused by the thread worms may be checked by a simple laxative medicine, as follows : pulverized aloes, one grain ; pulverized jalap, five grains; pulverized scammony, five grains ; syrup of ginger, one ounce. Rub them together, and give a tablespoonful to a child four years old. A dose of castor oil, or the fluid extract of senna and magnesia, will answer the same purpose. Where there is great irritation of the lower bowel or rectum, a cup of thin starch water, to which a few drops of laudanum have been added, may be injected before going to bed. For the long thread, and the long round worm, santonine is a useful, and one of the best reme- dies, either given alone, or in combination with some purgative. It may be given in- powder, spread on bread and butter, or syrup, being almost tasteless ; or it may be given in form of a lozenge ; or after any of the various formulas for its use, among which are the following from an English author: Santonine, fifteen grains; pulverized ginger, five grains ; pulverized jalap, 296 worms. half a clraclim ; sulphur, one drachm and a half; confection of senna, one ounce ; mix, make a confection, and give a teaspoonful two or three times a day. Santonine, half a drachm ; mucilage gum acacia, one ounce ; compound decoction of aloes, six ounces ; mix and give one or two teaspoon- fuls two or three times a day. In giving santonine alone a good way to admin- ister it is to give it in one or two grain doses, sprinkled on a piece of bread and syrup, repeat- ing the dose two or three times daily, occasion- ally giving a laxative to carry off the dead worms. The use of this drug often causes a free flow of urine, and affects the vision, so that objects looked at appear green or yellow. Pink root and senna is another remedy much in use, and may be given combined w T ith santonine as follows : Fluid extract of pink root and senna, one ounce ; santonine, eight grains ; mix and give from a half to a whole teaspoonful three times daily. Some cathartic should be given to operate upon the bowels after using any of these worm medicines internally to destroy them. For the round worm this formula has been found effectual : Rectified spirits of turpentine, two drachms ; oil of lemon, five drops ; mucilage worms. 297 gum acacia and syrup of ginger each, six drachms, annise water one ounce ; mix and give one teaspoonful every six hours. In young children suffering from tape worm, cowhage may be given, followed by some mild laxative. For children over eight years of age, Dr. Davis of London, recommends turpentine given as follows : Oil turpentine, honey, muci- lage gum arabic, each one-half a drachm ; water half an ounce ; mix and give a teaspoonful every two hours. Every second day, give a dose of castor oil, magnesia, or rhubarb. When children are old enough to fast suffi- ciently long, tape worms can be effectually dis- posed of in the following way. In the evening give the child a cathartic to free the bowels, and the next morning after the cathartic has taken effect give this mixture : Oil of male fern one drachm, simple syrup and mucilage gum acacia each half an ounce, cinnamon water one ounce ; mix and drink at once. After three hours have passed give some laxative to again act upon the bowels. A very important part of the treat- ment consists in the fact that from before the first dose of the mixture given above until after the worm is expelled, no food must be taken, and but a little drink of any kind allowed. 298 worms. After the worm has been expelled, the diet of the patient must be regulated so as to pre- vent unhealthy secretions in the bowels, and for this purpose alkalies, aloes, and some bitter tonics may be given for some time. The bow- els should not be allowed to go constipated. TUBERCULAR AND SCROFULOUS DISEASES. The tubercular disease, which consists in the deposit of a hard, or soft, cheesy matter in the lungs, or the glands of the system, which de- velops, and goes on to the destruction of the lungs, is very common in children. This disease is indicated by certain general symptoms. The lungs continually suffer, but not alone, for the membranes of the brain, the bronchial and mesenteric glands, the external membrane of the lungs, the liver, spleen, and in fact almost every organ of the body may be involved, or affected by the disease. The disease may run a rapid course, or may become chronic, and many changes are apt to take place during its progress. Children who are subjects of tubercle present the following peculiarities to a greater or less extent : They are often tall for their age, and of slight build ; 300 TUBERCULAR AND the skin is delicate, and looks transparent, so that the superficial veins of the face, neck and hands, are seen plainly through it. The face is apt to be oval, and features usually irregular ; the complexion is generally clear, though such is not always the case, for the face is sometimes covered with freckles. Children with this diseased condition of the system are often remarkably brilliant, precocious, good looking, with large, prominent, intelligent looking eyes, long eye-lashes, and soft, silken hair. The limbs are straight ; wrists and ankles small; the nervous system is developed to a high degree, and the general organization is very delicate. Where the constitutional derangement is owing to scrofulous, instead of tubercular disease, a different appearance of the patient is manifest. In these cases the face is generally more rounded than oval ; the complexion is dull and pasty looking ; the skin is thick, and opaque ; the face is not so attractive ; the features are large, lips full, and the nostrils expanded. The tongue is often large ; the fingers are clubbed or blunt ; the belly is large and prominent. In these cases the hair and nails grow rapidly ; the skin is rough and scaly ; there is a constant secretion SCROFULOUS DISEASES. 301 from the nose ; the skin about the lips cracks, and becomes quite sore, and the eyes look weak, though they may not be inflamed. This disease most always runs a chronic course, and is at- tended with the following symptoms : One of the earliest symptoms noticed is a want of a healthy color of the face, which soon becomes quite pale ; the child is dull and listless, but still continues to play, though with but little anima- tion, and soon tires ; its flesh becomes flabby and wastes away. It complains of no pain, but often says it is tired ; the appetite appears to be good, and so does digestion. Where the disease is well marked in children the chest often presents a peculiar appearance or shape. The lungs being small in proportion to the walls of the chest, they adapt themselves to the size of the contents. The chest is lengthened, and the direction of the ribs much changed. Sometimes the chest is long and circular, then again it is flattened from before backward. Another shape, known as pigeon breast, is said to be owing to repeated diseased conditions, or catarrhal affec- tions of the lower portion of the lungs, which interfere with the proper performance of breath- ing. The symptoms here spoken of continue for a longer or shorter time • the loss of flesh 26 302 TUBEKCULAR AND gradually increases ; the cheeks become hollow looking ; the eyes sunken ; the bony projections more prominent; the skin remains thin and transparent, or becomes dry, rough, and yellow- ish. The child grows more listless ; is dull and inactive ; is inclined to lie down a good portion of the time, and complains of its limbs aching. The pulse becomes more frequent, and there is more or less fever. The appetite may continue to be quite good, though very changeable ; there is thirst ; the tongue is clear and red, or slightly coated. The bowels at one time may be consti- pated, while at another time diarrhea may be present, the motions being light colored and offensive. The wasting and loss of flesh con- tinues, and after a time the weakness becomes so great that the child keeps its bed, and even dislikes to sit up to take its food. The appetite now often fails altogether, spots appear upon the tongue, gums, inside of the cheeks, and lips. The lower limbs become swollen, as well as the body, owing to dropsical effusion, which is caused by the poor state of the blood. In this disease the temperature of the body always rises towards evening, as indicated by the thermome- ter placed under the arms or tongue. The exciting causes which usually determine SCROFULOUS DISEASES. 303 the development of this disease, or the general tendencies thereto, consist of anything which interferes with the nutrition of the body, whether by preventing the introduction of nutriment into the system, or by hindering the escape of waste material from the body, the removal of which is necessary to the proper working of the different functions. Such causes are impure air, insufficient, or improper food ; cold or damp apartments ; want of sunlight, and healthy exercise. A combination of these causes will in almost any case awaken the dormant tendencies to tubercular and scrofulous disease, and if these causes continue to operate, will produce rapid development of the disease in one or other of its several forms. Certain diseases of an acute character are often the starting point of the chronic constitu- tional disorders, as for instance, pneumonia, may cause the formation of tubercle in the lung, and measles, and whooping cough, may also cause the disease to develop in various organs of the body. In these instances it is especially the lungs and bronchial glands that become involved. The tendencies to tubercular and scrofulous disease in childhood are so common, that all means of prevention should be strictly resorted 304 TUBEKCULAR AND to, and carried out, and certainly there is much that can be done to prevent the disease, or at least, to retard its progress. In all cases where the mother is consumptive, she should not allow herself to nurse the child longer than the first month, when a healthy wet nurse should be provided, unless she decides to bring it up by hand, in which case she must follow the rules for infant feeding laid down in one of the foregoing chapters. The diet of older children should be carefully regulated, so that no more food should be taken than can be readily and thoroughly digested. After the child is two years of age it should have four meals a clay ; of these, two may be of bread and milk ; a third of meat finely cut, or mashed ; the fourth of pudding, or an egg softly boiled. The milk used should be fresh from the cow, and if not, a teaspoonful of cream should be added. The skin must be kept clean and active, by sponging the whole body with warm water once or twice daily. The clothing should be warm and loose, with nothing to interfere with the free play of the lungs and chest. In selecting a house in w T hich to live, a high, dry, airy location should be chosen. In the treatment of tubercu- losis certain things are important. As before SCEOFULOUS DISEASES. 305 mentioned, a free supply of fresh air is one of the first requisites. Moderate exercise, not amounting to fatigue, and plenty of nutriment, are necessary. The child should pass as much time out of doors as possible, during the day, but should not be out of the house after sun- down. Cold is less injurious than dampness, therefore due caution should be exercised in this respect. The child should be dressed warm enough so as not to be chilled on going out, and flannels should be worn next to the skin the year round. The condition of the bowels needs to be looked after, and constipation overcome whenever it exists. The most common condi- tion of the bowels in these diseases is one where the bowels are relaxed, with three or four light colored, offensive stools a day. In the latter case the following mixture may be given : Tinc- ture of opium, twenty-four minims ; aromatic sulphuric acid, one drachm ; tincture of myrrh, one and a half drachms ; syrup of orange peel, one ounce ; infusion of orange peel, six ounces; mix and give one teaspoonful three times a day. Or the following : laudanum, twenty-four drops; castor oil, three drachms ; syrup and mucilage gum arabic, each one ounce ; peppermint water, six ounces ; mix and give two teaspoonfuls three 26* 306 TUBERCULAR DISEASES. times a day. Tonics, as iron, quinine, cod liver oil and iodine, are very beneficial. In giving cod liver oil, one or two teaspoonfuls may be given before or after each meal, unless some of it passes off through the bowels in an undigested state, in which case the dose must be diminished. In the scrofulous affections of the glands, with swelling and softening, iodide of iron, iodide of potassium, preparations of bark, quinine and wine are highly beneficial. FOLLIES OF DRESS, AND EVILS PER- TAINING TO THE SEXES. "When we consider that a great proportion of children's diseases result from exposure in one way and another, it is not at all to be wondered at, that the mortality of children between the ages of one and fifteen years is so great. While in infantile life being unable to walk, and con- fined as they are most of the time in the house, like hot house plants, it matters not so much if children have but little covering over their neck, chest and limbs, but the way children are dressed, especially girls, between the ages of five and twelve years, who are out upon the street every day in cold winter weather, is productive of physical evils, that often result in serious con- stitutional diseases. Girls between the ages mentioned above may be seen any day upon the street, during the coldest weather in winter, with dresses so short 308 FOLLIES OF DRESS, AND EVILS that the skirts only come down to their knees, with nothing on the limbs below, but a pair of woolen or cotton hose, and not unfrequently children are seen where the hose and other clothing do not meet into two or three inches, leaving a portion of the limbs actually uncov- ered and unprotected. Let an adult man, or woman, travel around the streets on a cold wintry day, with pants or dress cut off at the knees, with no protection for the limbs but a thin pair of hose, and how do you suppose they would look, and do you suppose they would feel very warm and com- fortable ? Would there not rather be an unpre- cedented lot of swollen, stiff, rheumatic joints, aching bones, restless nights, and many cases of people made prematurely decrepid and useless, or helpless ? Equally absurd, and as much to be denounced, is the practice of wearing low neck dresses, exposing the upper part of the chest to wind and storm. Within a year or two past girls have approximated the primitive style of wear- ing no clothing at all, as near as the rules of decency and propriety would permit, but either the climate was fatal to the fashion, or its un- popularity caused it to become extinct. PEETAINIXG TO THE SEXES. 309 The practice so extensive of bundling up the neck with furs, scarfs, or comfortors, is injurious for the following reason : Where a person has once become habituated to their use, it will never do to leave it off on going out of doors, for in this event a " cold " will almost surely result, and all persons who thus keep their necks wrapped up, and in more or less perspiration, are much more subject to diseases of the throat and lungs, than those who never wear them. Persons who have been in the habit of keeping their necks thus bundled up, but who have after- wards accustomed themselves to do without the extra covering, have often remarked that since discarding the scarfs and fur collars, they have been freer from coughs, colds, and throat diseases, than ever before. There is a golden mean between wearing noth- ing at all upon the chest and about the neck, and the superabundant covering sometimes put on, which should be appreciated and adopted. These evils of dress, it would seem, might be easily overcome, and in one sense they are, and in another they are not. It would be an easy thing to do to cut the dress skirts longer, and to cover the limbs with leggins of cloth or worsted, which would be an easy remedy. But to remedy 310 FOLLIES OF DRESS, AND EVILS this evil of dress, you have much to contend with, for fashion is one of the hardest things to overcome. There is almost no independence in dress, and whatever fashion dictates, however absurd it may be, its votaries attentively and obediently worship at her shrine. It is to be hoped however, that the day will ere long dawn when a little more sense, and far less nonsense, will be displayed in matters of dress, so that the young will be not only covered, but well pro- tected against cold, and sudden changes of tem- perature. Another source of evil is the want of proper parental instruction while young, regarding the functions, proprieties and improprieties of the sexes. It seems to have been the idea of the popular mind that young girls and boys should not be spoken to about sexual evils, or fore- warned of any abuses and pernicious habits that they might Ml victims to for want of a little wholesome instruction, for fear that by so doing the subject would be prematurely brought to their attention, and so do more harm than good. The same rule of action has kept mothers from giving their daughters timely advice con- cerning the menstrual function, when it is to be expected, what it is, and what precautions are PEETAINING TO THE SEXES. 311 requisite at such periods. Now the idea that it is too delicate a question to bring to the atten- tion of boys and girls of eight or ten years of age, is perfectly absurd, for if parents do avoid any allusion to the subject, and fail to give them proper instruction, they need not flatter them- selves that the younger members of the family are kept in ignorance of the subject. The great majority of the youths that attend the common schools are thoroughly posted about the evil practices, the very things that they should be early instructed about by their parents, that they may be taught to avoid them. It is often the case that people allow false modesty to run away with their health. It is well for parents to remember that the girls and boys are exceedingly precocious as regards these questions of the procreative functions, and that if they do not receive proper enlightenment from their parents, they certainly will receive improper information from people and older chil- dren with whom they are brought in contact daily. For the physical and moral well-being of their children, every parent should thoroughly instruct them about the proprieties and improprieties, the uses and abuses, of the sexual relations and 312 FOLLIES OF DRESS. functions ; and instead of resulting in evil by any premature knowledge of the subject, it would result in great good, by warning the young, none too soon, of the dangers that lay in their pathway in life. If every father will early enlighten his sons upon everything bearing upon this subject, using plain, outspoken language, telling them what to do, and what not to do, we venture to say that a more vigorous, robust and moral set of men will be the result. If every mother will do the same by her daughters, there will be a far less number of young ladies who are physical wrecks before they are twenty years of age, pale, bloodless, suffering from weakness, palpitation, neuralgia, hysteria, and all manner of nervous and uterine disorders. Let this plain and healthy advice be given then, without fear of evil, with the full assurance that the moral and physical well-being of your children demand it. SURGICAL DISEASES AND DEFORMITIES OF CHILDREN. The deformities to which children are subject are various, and are both congenital and ac- quired, among which may be mentioned, club- foot, hare-lip, cleft palate, rupture of the bowels, or navel, bow-legs, knock knees, tongue tie, and a great variety of mal-formations. Many deformities of this class are allowed to continue, without any efforts being made to remedy the evil, and so the person is afflicted for life. Whether this neglect arises from the belief that nothing can be done for the child, or from some other reason, I know not ; but one thing is certain, viz., that the neglect to remedy these several deformities of infancy is unpar- donable. The various surgical diseases and deformities will be treated of separately, the operations required will be explained, and the different mechanical appliances resorted to to overcome the malformations will be described. 27 TONGUE TIE. It is very frequently the case that children are born with the tongue attached by nearly all of its under surface to the floor of the mouth, so that sucking, and many other movements are prevented. The fraenum, or narrow tendinous band that is attached to the bottom of the tongue, frequently extends almost to the tip of the organ, whfch is the malformation usually designated tongue tie. The trouble is easily remedied by raising the tongue, and dividing the fraenum for an eighth of an inch or so, with a pair of blunt pointed scissors. Care must be taken to cut close to the floor of the mouth, so as to avoid wounding the artery. CLEFT PALATE. This deformity of the mouth and palate is very variable in its extent ; sometimes the uvula only may be divided, while in other cases the hard palate, or roof of the mouth, will be divided also, and occasionally the deformity will extend to the face, producing hare-lip. The most fre- quent cases are .those where the soft palate and uvula are cleft, without the hard palate being involved. The inconveniences arising from a fissured palate are, difficulty in swallowing, the fluids often being forced up the posterior nos- trils, producing more or less strangulation ; and talking, which is rendered imperfect, indistinct, the voice, or speech, being nasal. The deformity is readily overcome by means of an operation, the only question regarding the propriety of the operation being as to the best time of life to perform it. As the success of 316 CLEFT PALATE. the operation depends upon the quiet and tran- quility of the patient during its performance, and also during the healing process, some sur- geons advise postponing the operation until the child is old enough to comprehend what is re- quired of it, in order that it be taught to take the needful precautions against movements of the throat and palate. The operation consists in the first place of dividing the various muscles of the palate, which are concerned in its movements ; and secondly, in paring the edges of the fissure. After the bleeding is arrested, the edges of the palate which have been pared, are brought together, and kept so by means of stitches properly intro- duced. After the operation, the patient must be put to bed, and every possible care used to prevent movement of the palate. Nothing but liquid food is to be allowed, which should be swallowed with little effort, and coughing, spit- ting, sneezing must be prevented as much as possible. The stitches have to remain in ten or twelve days, more or less, as the case demands. The voice does not regain its natural tone and clearness for some time after the operation, and the child has to be instructed in the use and movements of the palate and tongue, for some CLEFT PALATE. 317 time. Where the hard palate, or roof of the mouth, is fissured, the trouble is sometimes rem- edied by putting in plates of silver, gold, -ivory, or rubber. It can be remedied also by dissect- ing the tissues from about the arches of the palate and uniting them, the same as in fissured soft palate. There are various operations and methods of procedure for overcoming this de- formity, though not varying much in their essential points, and suffice it to say that they all generally result in perfect relief. Frequently the uvula, or that portion of the palate which is seen hanging from the roof of the mouth, is much larger than usual, requiring to be snipped off a little, for by dragging upon the tongue it keeps up a continual irritation, or tickling of the throat, provoking a troublesome, hacking cough. The tonsils also become fre- quently diseased and enlarged, which renders it necessary to remove the diseased portion, either by local applications of caustic preparations, or by the knife. The operation for their removal is simple, quickly performed, and gives rise to but little pain or inconvenience, if care is taken not to wound any blood vessels, so that hem- orrhage shall be avoided. 27* HARE LIP. This deformity consists in a cleft or fissure, either single or double, under one or both nos- trils. The most common form is the single fissure, which extends through the upper lip, not infrequently exposing one or two teeth and the gum. Where the hare lip is double, there is generally deformity of the palate at the same time. It is recommended that this operation be performed very early in life, any time after two or three months old, and even earlier if the necessity for its performance exists. The essential points in the treatment of hare lip are as follows : 1st — To procure union by the direct adhesion of the cut edges of the fissure. 2nd — That the union should be attended by as little deformity as possible. 3rd — the avoid- ance of all strain or traction on the fissure after it has been fastened together by pins or stitches. HARE LIP. 319 These objects of treatment are secured by paring the edges of the fissure freely, bringing them together by means of twisted sutures, and re- moving the strain upon them by means of proper appliances. The operation is simple in its nature, readily performed, and causes but com- paratively little pain and inconvenience, and the cure of the deformity is complete. The full details of all the various methods of overcoming the deformity are not called for, and the rules to be enforced would always be laid clown after any and every operation, best suited to the indi- vidual case. People in middle life are frequently seen with this deformity, for which there can be no reasonable or pardonable excuse, and for their own sakes, as well as those with whom they are brought in contact, they should see to it that the unsightly malformation is corrected. CLOSURE OF THE LIPS, EYE-LIDS AND VULV.E. Although rare, yet it does occur, that the lips, eye-lids, and vulvas, or vaginal lips are grown together, and where these several adhe- sions exist, the trouble is overcome by thoroughly dividing the adherent surfaces, and keeping them well separated until the healing process is per- fected. Care needs to be exercised to see that the division is carried to a sufficient extent so that no deformity or contractions may remain afterwards. Frequently the adhesion of the vaginal lips is not discovered until menstruation takes place, when trouble arises, and on investi- gation it is ascertained that the menstrual fluids are retained in the womb and vagina, producing more or less pain, and distention of the organ. When such is the case the membrane has to be divided, the accumulated fluids drawn off, and healing, cleansing applications have to be made CLOSUKE OF THE LIPS, ETC. 321 afterward. Parents should early look to it and see that no such deformities exist without their knowledge, and they are certainly remiss in duty if they allow them to go unremedied. IMPEDIMENTS OF SPEECH. The defects of speech known as stammering, or stuttering, have been ascribed to various causes, and various operations have been resorted to for the purpose of remedying the evil. It seems, however, the impediments of speech are largely owing to nervous causes, and the force of example. Children have often acquired the habit by going with another child in the habit of stammering, bringing on the trouble by fre- quent imitation. The impediment may also be congenital, and may result from nervous affections of various kinds. The several operations performed for the cure of these defects have been of little or no avail, and all that is accomplished generally is by a systematic course of instruction, and careful training, in which the child is made to talk slow, without being fretted or excited, . IMPEDIMENTS OF SPEECH. 323 enunciating every word clearly, and not allowed to speak or talk when excited. All threats of punishment or disgrace, and everything tending to excite the emotions, and nervous system of the child, must be strictly guarded against. Children should not be sent to school who are thus afflicted, for they are so much embarrrassed that it is continual torture to them. A stam- mering pupil may understand his lesson as well as the best of scholars, but cannot give utter- ance to it, and so is ranked as a fool almost, and treated as such by the rest of the pupils, if not by the teacher. For these reasons the child should be instructed by those who have some natural sympathy for him, and will show him all due consideration and respect. STRABISMUS— CROSS EYES. Strabismus, or squint, according to the defi- nition of Mr. Holthouse, consists in a mal-direc- tion of one or both eyes, or a want of power to move them harmoniously, so that their axes shall always be directed at the same time to the same place. There are two kinds of strabismus ; one where the eye is drawn inward, and the other where it is drawn outward, but the variety in which the eye turns inward is the most common. Let any child with cross eye be directed to look upon an object placed a little distance be- fore him, the squinting eye will be found to turn inwards towards the nose, while the sound eye is directed to the object ; and it makes no dif- ference in whatever way the position of the object may be changed, the effect will be the same, the sound eye gazes at the object, while STKABISMUS CROSS EYES. 325 the affected eye does not. Should the patient close the sound eye, he can then direct the other upon any object desired. Where the eye is turned outward, there is also want of harmony in the movements of the eyes, one being everted while the other is directed upon the object. Sometimes there is both divergent and converg- ent cross eyes, and also double convergent strabismus, in which case both eyes are habitu- ally turned inwards towards the nose. In most cases of cross eyes, vision is impaired to a greater or less degree, and frequently there is double vision. The distorted eye is, as a rule, more or less prominent, and the pupil of the cross eye does not respond naturally to the action of light. This deformity arises from a variety of causes. Sometimes it comes on after an attack of scarlet fever, measles, and the several eruptive diseases. At other times, or in other cases, it may be due to some weakness of the muscles, or paralysis of the nerves which control the movements of the eye-ball. Again it may arise from disease of the brain, or nervous centers ; from worms in the intestines, and from imitation children have acquired the deformity. Defective vision, con- vulsions in children, difficult teething, whooping 28 326 STRABISMUS — CROSS EYES. cough, epilepsy, injuries to the head, all are said to frequently give rise to cross eyes. The de- formity almost always develops quite early in life, and sometimes proves to be temporary, and owing to some simple functional disorder, while in the great majority of cases it continues until remedied by an operation. In cases where the deformity is due to some local inflammation of the eye, or to some func- tional derangement, sometimes the difficulty is overcome by proper attention to the general health, and relieving the local inflammation. The operation for the cure of cross eye con- sists in properly dividing the tendons of the muscles that produce the deformity. Thus : if the eye is drawn outward, the outer, or external rectus muscle must be divided ; and if the eye be drawn inward, the inner or internal rectus muscle is to be cut, and so on. The operation is quickly performed, causes little or no pain, the wound promptly heals, and the deformity is fully overcome. The real cause must first be ascertained, before seeking to remedy the de- formity, and this duty, together with deciding as to the propriety of an operation, and the proper time for its performance, you must leave for STRABISMUS CROSS EYES. 327 your medical adviser to discharge. Your duty as parents is to see that the deformity is removed, for the sake of the future welfare of your children. CONGENITAL CATARACT. Cataract consists of an opacity of the crys- taline lens of the eye, or its capsule. Infants are frequently born with the disease, in which case both eyes are usually involved. Infants are very liable to attacks of inflammation of the eyes soon after birth, and it is after the subsid- ence of these inflammatory seizures, that the opacity, or cataract, is first discovered. Where the disease is congenital, it is said to be due to an original imperfect formation of the crystaline lens. When the opacity involves the entire lens the eye should be operated on before teething commences. Dr. W. Jones says : As the infant cannot see, its eyes are not fixed upon any object, but roll about in a heedless manner. This being allowed to go on the infant loses command over the eyes, or rather does not CONGENITAL CATARACT. 329 acquire command over them ; and even if sight be afterward restored by an operation, the power of directing the eyes properly and steadily towards objects may never be fully gained. As a rule good sight is more likely to result from an early operation. There are many things to be taken into con- sideration in the management of all cases of cataract, as all operations should be performed under the most favorable conditions of the eye, and of the general health. There are different kinds of cataract, which call for different opera- tive procedures, which can only be determined by the oculist, or medical attendant. As there is no other remedy for the disease, parents should show no hesitancy in having an operation performed, for they are conferring the greatest possible favor to the child by thus restoring, or rather securing vision. The oper- ation is short, causes little suffering, and in the majority of cases renders vision very good if not perfect, after sufficient time has elapsed after the operation, wherein the child has acquired control and use of its eyes. Never let your children go blind five or six years with cataract, when relief is so promptly and surely to be 28* 330 CONGENITAL CATARACT. obtained. The particulars of the proceedings in case of an operation for cataract, if detailed here would not be well understood, or compre- hended, therefore they will be omitted. STYES AND TUMORS OF THE EYE-LIDS. The eye-lids are subject to a variety of dis- eases, among which styes and tumors are fre- quent. A stye is a small swelling at or near the edge of the lid, which develops rapidly, and either soon disappears, or suppurates and dis- charges. If painful or troublesome they may be frequently bathed with a little lead and opium wash, or with a weak solution of acetic acid and tincture camphor. Tumors that so frequently grow in the substance of the eye-lids, consist of a small sack filled with a thick, waxy-like matter of the consistence of candied honey, or congealed lard. They continue to grow, though slowly, as long as they are allowed to remain. The oper- ation necessary for their removal consists in simply dividing the skin on the outside, or the mucous membrane on the inside of the eye-lid, and dissecting out the tumor and its enveloping 332 STYES AND TUMORS OF THE EYE-LIDS. sack. It is not enough to simply empty the contents of the tumor, for if the sack is left it will fill again, and so the tumor or growth will reform. The operation is so simple, and at- tended with so little pain, that young children will sit still until the operation is completed and the trouble removed. There is nothing at all alarming about these simple, non-malignant growths in the eye-lids, but they somewhat dis- figure the child, and when of considerable size, they act as an irritant upon the surface of the eye, giving rise to more or less inflammation and disordered vision. They are usually seen in children whose digestive organs are debilitated, with feeble constitution, and general health more or less impaired, therefore a tonic strengthening course of treatment is called for after an opera- tion. Bark, wine and iron, together with a good nourishing diet, should be given, for some little time, in order to guard against future attacks. NEVUS, OR MOTHER'S MARK. There is a variety of malformations known as mother's mark, such as erectile tumors, vascular growth, and special deformities of one kind and another. That the foetus in utero is susceptible to impressions communicated through the ner- vous system of the mother, is well proven, and as a result of these nervous impressions the de- velopment of the child may become arrested, limbs spontaneously amputated, and various unsightly growths appear upon the surface of the body. Tumors of the veins are the most common mark that is noticed. At birth they are simple small red, or purplish spots, which continue to grow and spread, until they' acquire a considerable size, unless early attended to. Their removal is accomplished by tieing the tumor, strangulating it ; by passing needles through them or beneath them and then ligating, 334 NEVUS, or mother's mark. or by the applications of caustics, as nitric acid, lunar caustic, &c. Oftentimes the trouble will disappear without any treatment, but where the blood tumor is of any considerable size it should receive early at- tention. Most of the malformations known as mother's marks are attributable to fright, imagi- nation, injuries, or some shock to the nervous system of the mother, received while carrying the child ; therefore pregnant women should guard against all undue excitement, physical and mental. Whatever the mark or deformity may be, if it is curable, let it be remedied as soon as possible and not wait ten or a dozen years. ATRESIA ANI, OR CLOSURE OF THE BOWEL. Not unfrequently infants are born with the anus, or opening into the bowels, completely closed, so that no movement of the bowels can be accomplished. The bowel usually terminates in a blind pouch a short distance from the natu- ral outlet. The difficulty is overcome by an operation, which consists in puncturing, or thoroughly dividing the intervening tissues, and thus establish communication with the intestine. The opening must be well kept open, by means of lint and proper appliances, until the parts are healed, and the artificial opening, or anus, has become permanent. If the attending physician fails to discover any trouble of this kind, the nurse should always carefully examine the infant, and promptly report the discovery of anything and everything that is unnatural, either in the anatomy, or general appearance of the infant, that it may receive early attention. UMBILICAL HERNIA, OR TUMOR OF THE NAVEL. This consists of a small tumor formed by the expansion of the umbilical cicatrix, the swelling or tumor being formed by the protrusion of a portion of the intestine, or the omentum, or layer of fatty tissue which covers it. The cause of the formation of this hernia, or navel tumor, may be either external or internal. It is some- times caused by the continual crying of the child in cases where the bowels are flatulent, or dis- tended with gas, and at other times it is caused by too tight bandaging, thus squeezing the con- tents of the abdomen up into too small a com- pass, and thereby forcing them into the umbili- cal cord. When infants are born with it, it is apt to be more extensive and serious in its nature. As a rule, the trouble is easily remedied by putting on a compress of rubber, steel, silver, or any UMBILICAL HERNIA. 337 hard substance, so shaped that it can be nicely fitted, and when applied will keep the tumor pressed back into the abdomen. Too much pressure should not be applied, for it would add to the trouble by producing irritation, and sub- sequent inflammation. In the great majority of cases, these simple mechanical appliances will suffice, while there may be exceptional cases where some opera- tive procedure may be called for. Where there is ulceration of the cord, or navel, an ointment of zinc, or of benzoic acid and zinc with lard, or a little red precipitate ointment, should be applied once or twice daily, at the same time frequently cleanse the ulcerated surface with soap and water. 29 INGUINAL AND SCROTAL HERNIA, OR RUPTURE. It is generally the case, that the opening in the abdomen through which the testis, or pri- vate organs pass, closes soon after their passage down, but where the canal remains open, the bowel, or a portion of the intestine, passes down into it, causing rupture, or inguinal hernia, as it is called, and when the bowel passes down into the scrotum, or sack, enveloping the private organs, it is called scrotal hernia. This is a very frequent deformity of infancy, and should re- ceive prompt attention, for in early life a cure is much more easily effected, than in later life. The method of treatment is as follows : When there is positive evidence that the testicle has descended into the scrotal sack, the protruding portion of the bowel is to be returned into the belly, and retained therein by means of a prop- erly adjusted truss, the pressure of which causes INGUINAL AND SCROTAL HERNIA. 339 slight inflammatory action, and closes the open- ing. At times there may be adhesions which render it impossible to reduce the rupture, and an operation in rare instances may be demanded. There are other varieties of rupture, all however, requiring about the same kind of treatment. All of these deformities or malformations of the intestinal region, urethra, or water passage, and of the rectum, should receive early and skillful attention, in order to avoid a life long burden and deformity, which renders existence a misery. PHYMOSIS. This malformation consists in an unnatural constriction of the prepuce, or fore-skin, cover- ing the glans penis, the constriction sometimes being so great as to interfere with the passage of the urine. Generally speaking, these narrow- ings of the preputial orifice, correct themselves as children grow older, but there are times when immediate relief is called for, which is best secured by means of the operation of circum- cision, which consists in slitting up the fore-skin sufficiently to let it back of the glans, and re- move thus all constriction of the organ ; or by means of a circular incision, removing a portion of the prepuce, and afterward stitching the cut edges of the skin and mucous membrane to- gether. The operation is simple, quickly per- formed, and affords immediate and permanent relief. CONTRACTION OF FINGERS. It sometimes happens that contraction of the muscles of the fingers and palm of the hand will become so severe as to give rise to what is known as club-hand, being similar to the deformity called club-foot. The muscles as they contract forcibly draw and flex the fingers into the palm of the hand, so that all efforts to extend, or straighten them are futile. The remedy consists in dividing, one after another, the tendons and muscles, and keeping them properly extended until the divided ten- dons and muscles become properly healed and attached. Contraction of the muscles of the neck often draws the head to one side, causing the deformity known as wry neck. 29* CLUB FOOT. There are several varieties of this peculiar deformity, caused alike by rigidity and contrac- tion of various tendons and muscles. Children may be born with the deformity, or it may develop itself soon after birth, or at any other period of life. The following are the several Before Treatment. After Treatment. varieties noticed : Talipes equinus, in which the heel is elevated so that the patient walks on the ball of the foot ; talipes calcaneus, in which the front part of the foot is elevated, and the heel CLUB FOOT. 345 depressed, so that the latter receives the weight of the body ; talipes varus, in which the foot is Before Treatment. After Treatment. inverted, so that the patient walks on the outer edge of the foot ; talipes valgus, in which the 346 CLUB FOOT. foot is everted, so that the patient walks on the inner ankle. Sometimes there are distortions Before Treatment. After Treatment. wherein two of these deformities are united in one. The exciting causes of this deformity CLUB FOOT. 347 when it comes on after birth is said to be any- thing that prevents the proper nutrition of the Before Treatment. After Treatment. muscles, or that interferes with their nervous influence. It also arises from wounds, inflam- liefore Treatment. After Treatment. mation, rheumatism, burns, paralysis, &c. It is also attributed by some to disease and irritation of the internal organs, and nervous centres. 348 CLUB FOOT. When the deformity is seen early, before the muscles and tendons have become firmly and rigidly contracted, it may at times be overcome Before Treatment. After Treatment. by the proper applications of gutta percha splints, bandages, &c, but as a general rule, the muscles and tendons that are contracted must Before Treatment. After Treatment. be divided, and afterward the foot be brought into its proper position by gradual, forcible extension and manipulation, the mechanical ap- pliances at the same time being so adjusted as to exert a continual force in the required direction. CLUB FOOT. 349 As there is much better chance of completely overcoming the deformity when attended to early, parents should consult their medical ad- viser, or surgeon, as soon as the deformity is noticed. It is unnecessary to mention in detail Before Treatment. After Treatment. here the various steps of the operations required in the several varieties of club foot, as they do not vary much in kind, but suffice it to say, that they generally result in a removal of the un- sightly and ungainly deformity. 30 BOW LEGS AND KNOCK KNEE. These deformities are very common in infancy, and although unsightly enough then, they make people in maturer years to present a much more awkward appearance. Before Treatment. After Treatment. The malformation, or deformity, is generally caused by the infant being allowed to walk at too early an age, before the bones and muscles have acquired adequate strength for the support of the body. The weight of the upper extrem- GENU-VALGUM, OR BOW KNEE. Before Treatment. Page 350. GENU-VALGUM, OR BOW KNEE. After Treatment. Page 860. BOW LEGS AND KNOCK KNEE. 351 ities being too great, the ligaments yield, the bones being flexible, bend either outward or inward as the case may be, and either bow leg or knock knee results. Before Treatment. After Treatment. Parents are very apt to let these deformities go unremedied, either thinking them of little importance, or incurable. Any parent who thus neglects a child, and allows it to grow up the object of pity, as well as an eye-sore to the public, never ought to be pardoned, as he will never be by his offspring. 352 BOW LEGS AND KNOCK KNEE. As soon as the tendency to this deformity is known to exist, proper mechanical supports should at once be applied to the limbs, and suf- ficient tension maintained to keep them in their proper and natural position. By early attention to these rules the limbs, although sadly distorted, can generally be restored to their normal con- dition. Before Treatment. After Treatment. KNOCK KNEE. Page 352. HIP DISEASE. We come now to consider one of the most serious, and not uncommon, surgical diseases of childhood. It frequently comes on from very trivial causes, such as over exertion in too active exercise, taking too long walks, a sprain received in falling or jumping, getting wet and taking cold when in a state of perspiration. Hip disease may assume an acute, subacute, or chronic inflammatory character, and differ widely in its severity in different cases. Children of a scrofulous or strumous habit of body are much more liable to the affection than others. There is usually much pain in the diseased joint, sometimes suppuration, or discharge of matter, which continuing, disorganizes the joint, so that it becomes liable to dislocation, in which event the limb or joint becomes stiff and im- movable oftentimes. 30* 354 HIP DISEASE. The pain in hip disease varies according to the nature and extent of the inflammatory af- fection. In the chronic form of the disease it is at first comparatively slight, and often felt more at the knee than at the hip. In cases where the structure of the joint and socket are at once involved, the pain is quite severe, and every movement greatly aggravates it, on account of the inflamed condition of the mem- brane entering into the formation of the joint. Suppuration does not take place in all cases, but most frequently is seen in scrofulous patients. As the disease advances, and the socket and head of the thigh bone become diseased, and par- tially destroyed, the head of the bone becomes dislocated and thrown backward, so that the limb is shortened several inches. Abscesses often form in and around the joint before dislo- cation takes place, which cause a good deal of pain and constitutional disturbance. As the internal structures of the joint become involved the pain is intense, attended with spasms and twitchings of the limb. So great is the suffer- ing that the patient cannot bear the slightest movement, and cannot even tolerate the weight of the bed clothes, and the jar caused by a per- Before Treatment. After Treatment. HIP DISEASE. HIP DISEASE. 355 son leaning against the bed, or walking across the room, will often cause great pain. The terminations of acute hip disease depend largely upon the constitution of the patient, and the methods of treatment resorted to. Some- times under exceedingly favorable circumstances a gradual recovery may take place with but little distortion and shortening of the limb, with but little stiffness and wasting of the limb. In other cases the patient may become completely exhausted by the continual and profuse dis- charges, and die from exhaustion. The deformities produced by the disease are contractions of the hip and knee, dislocation of the hip, with more or less shortening of the limb, and flattening of the buttocks, &c. A disease so severe in its nature, so rapid in development, so disastrous in its consequences, requires prompt and vigorous treatment. The strength of the patient is to be kept up by means of the most nutritious diet possible, this being rendered doubly important from the fact that it is usually weakly, strumous children that fall victims to this malady. External applications, either soothing or irri- tating as the case demands, are of more or less utility, and the internal administration of tonics 356 HIP DISEASE. like iron, quinine, brandy, ammonia, bark, iodine, and kindred medicines are called for. The greatest benefit seems to be derived, however, by proper extension and counter extension of the limb, so as to separate the joint so that the inflamed surfaces of the socket, and head of the bone will not rub or press together. Various mechanical appliances have been arranged for this purpose, some of which are well adapted to the use intended, and afford great relief. All abscesses should be opened so as to allow free exit of pus, and absolute rest should be strictly enjoined. Where other means fail the operation of removing the head and a portion of the shaft of the thigh bone, is performed, and the dead or diseased portion of bone being thus removed, suppuration ceases, the wounds heal, and re- covery takes place, though with a limb compar- atively useless. The more prominent outlines of the disease have been here given, and some of the methods of treatment cited, but it is not required to go into full details in a work like this. Whenever a child manifests pain or uneasiness in walking, an examination should be made to see where and what the trouble is, and so be on the guard against the approach of this serious Before Treatment. After Treatment. DISLOCATION OF HIP JOINT FROM PARALYSIS. Page 356. HIP DISEASE. 357 affection, and if not clearly and readily under- stood by the parents and friends, a medical adviser should be summoned without much delay, for true it is that time is precious in these cases. BONE DISEASES. The bony structures, like soft tissues, are subject to ulcerative and destructive diseases. Disease attacking the outer surface of the bone causes it to scale off, giving rise to ulceration of the soft tissues, and thus the way is prepared for the discharge of the scales of bone thrown off. When the bone becomes diseased on its inner surface, the whole bone is apt to die, and when it does it causes profuse suppuration, and discharge of offensive matter until the diseased bone is destroyed. During the inflammatory and suppurative stage of bone disease, new bone gradually forms around the dead bone, so that the strength and contour of the limb is maintained. The diseased limb is often consid- erably increased in size, by the extensive de- posit of new bone around the old. Diseases of bone are very common in chil- BONE DISEASES. 359 dren, and while suppuration is going on greatly reduces and exhausts the flesh and strength of the patient. The weaker the constitution of the child, and especially if the child be of a strumous or scrofulous habit of body, the greater the liability to this class of diseases. To remedy the bone affections the first duty is to look after the general health of the patient, see that proper nutrition of the body is secured, digestion is properly carried on, and the general sanitary conditions are what they should be. Where there is carious disease of the bones, or disease of the external surface, a cure can be promptly effected by cutting down to the diseased surface, and thoroughly and completely removing all unsound portions of bone. When the disease attacks the inner surface of bone, and the bone dies, then a cure is only accom- plished by entirely removing the section of dead bone. After this is done, granulation takes place, new bone is gradually formed, discharges soon cease, and the bone and limb regain their former health and strength. When the bones become thus diseased the trouble should not be allowed to continue with the expectation that a spontaneous cure will 360 BONE DISEASES. take place, but it should receive immediate and careful attention, in order that the difficulty may be removed before there is a possibility of its becoming incurable. DISEASE OF GLANDS. Children who inhabit houses situated in low, damp places, and are poorly fed, ill nourished, exposed but little to pure air and sunlight, are above all others subject to glandular diseases. The glands most frequently involved in disease are the glands about the throat, under the arm and in the groins. They often swell up to a great size, and finally ulcerate and give rise to profuse suppuration, and ultimate destruction of the glands. Children thus affected are apt to be of a scrof- ulous habit of constitution, skin pale, flesh flabby, and the countenance wears a look of weariness and impaired vitality. To remedy these evils of constitution, or what is better, prevent them, give children the full benefit of abundant airing and exercise out of doors, in places exposed to the full rays of the 31 362 DISEASES OF GLANDS. sun ; see that abundant and proper nutriment is furnished, and if they chance to be predisposed to scrofulous affections, or other vices of consti- tution, administer iron, iodine, and vegetable tonics ; pay proper attention to clothing, and regulate it according to the temperature, and bathe frequently in acid, salt, or mustard baths, in order to secure healthy and active cutaneous circulation. It must be remembered that these glandular affections, if not early attended to, lead on to other diseases that are more serious and fatal in their consequences. POLYPI. These growths are pendulous, usually pear- shaped masses, growing from the mucous sur- faces, especially from the nose, ear, throat, uterus and anus. In children they most fre- quently affect the nose, throat and ears. Any- thing that irritates and inflames the mucous membranes may give rise to them, such as long continued catarrhal troubles, inflam- mation and suppuration following measles and scarlet fever. They generally are attached by a small root, and hang down into the ante- rior or posterior nostrils, interfering with breath- ing, and when seated in the canal of the ear so obstruct it as to cause more or less deafness. The only remedy for these growths is the re- moval of them With the knife or forceps, and caustic applications to kill the roots of the tu- mor, so as to prevent their recurrence. ENLARGEMENT OF THE TONSILS. The tonsils frequently become considerably- enlarged, as a result of inflammation, or the dif- ficulty may arise without any assignable cause. Where the enlargement is extensive the glands obstruct the posterior nares, render the voice thick, cause deafness, cough, and more or less difficulty in breathing. Strong solutions of nitrate of silver, say one drachm to the ounce, applied with a brush to the tonsils, or tincture of iodine, will gradually bring down the swelling. External applications of tincture of iodine, and stimulating liniments, will be useful adjuncts to the internal treatment. In cases where these local and external appli- cations do not remove the trouble, the knife must be had recourse to, and a portion of the tonsils be removed. RANULA, OR TUMOR UNDER THE TONGUE. This consists of a tumor, globular in form, and is said to be owing to obstruction of one of the salivary ducts, and becomes filled with a semi-transparent fluid like saliva. It sometimes grows to considerable size, pushes up the base or roots of the tongue, and interferes with the act of swallowing. Sometimes the growth is of the form of an encysted tumor, which attains to the size of an orange. Generally, however, the growth is small, but might grow to a greater size if allowed to progress. The tumor is to be removed either by caustic applications, by passing a seton through it, or by the knife. The affection we are glad to say is rare, but when it is noticed, it should not be neglected, though the child be ever so young. 31* FOREIGN BODIES IN THE EARS AND AIR PASSAGES. Children as soon as they can creep, and es- pecially walk about, are continually picking up substances that come within their grasp, and forcing them into the ears, nose and mouth, fre- quently swallowing them, producing violent choking and coughing. The substances most frequently disposed of in this way are buttons, peas, beans, stones, pins, marbles, beads, bits of slate pencils and nails. Children will often force things up the nose and into the ears, out of sight, and any attempt of the parents or friends to remove them generally is unsuccessful, and only serves to irritate the parts, and push the substance further into the opening. Often- times they become firmly impacted in the pas- sages, the mucous membrane becomes swollen around them, when it is no easy task to remove them, especially if the substance happens to be FOREIGN BODIES IN THE EAR, ETC. 367 a bean, smooth button, or anything with a smooth, hard surface. When the foreign substance is pushed high up into the nostrils, and cannot be readily got hold of, it is sometimes advisable to push it backward into the throat, taking care that the child does not swallow it, and get choked. Gen- erally, the substance can be reached and grasped with forceps, and removed without much diffi- culty, provided the patient can be kept in one position long enough to accomplish the object. Sometimes the articles can be syringed out of the nose and ears, if they , are not pressed tightly in. As a rule, it is unwise for parents or friends to attempt to remove substances from the ears and nostrils, for they will be liable to produce a good deal of irritation by the force used, and they being sensitive organs cannot tolerate too much manipulation without serious injury. If it is decided to call a physician, do not wait until the object you wished removed becomes obscured by inflammation and swelling of the tissues around it. Where the foreign body gets into the throat, and is choking the child, give a prompt emetic, and force it up if possible. Sometimes it can be forced downward, by means 368 FOREIGN BODIES IN THE EAR, ETC. of tubes introduced into the throat. If the substance is small, drinking freely will some- times remove it, or swallowing oil, or glycerine, being heavier and of more consistence, will be more likely to accomplish relief. There are various instruments designed for physicians' use, with which various foreign bodies can be easily removed, but which would not be safe to use in domestic practice, by un- educated hands. BURNS AND SCALDS. These are among the most frequent accidents that befall children, hence they should receive more than a passing notice. The general and constitutional effects of a burn or scald depend upon their extent and location, and the vital strength of the patient. If the burn is exten- sive the shock to the nervous system is propor- tionally great. In ordinary burns the skin and superficial tissues are only involved, producing vesication, and a discharge of serum, while in the more extensive burns the deeper tissues are involved, ulceration and sloughing takes place, and profuse suppuration follows, and when the parts heals cicatrices form, producing unsightly contractions and deformities. Where the burn is severe the patient may die from the shock to the nervous system, but if the patient survives this, the pain may give rise to 370 BURNS AND SCALDS. dangerous congestion of the vital organs, by exciting the heart, brain, and spinal cord. After the patient rallies from the nervous shock, and reaction takes place, there is more or less fever, which continues to a greater or less degree, through the stage of reaction and sup- puration. The first object to be accomplished in the treatment of a burn is, to relieve the intense pain and depression, and for this purpose opium in some one of its forms may be given, and chloroform has been used where the pain is severe. A thousand local applications have been extolled, such as flour, starch, cotton wad- ding, solution of India rubber, and the like, but it matters not so much what the article is that is used, provided it protects the parts from the air. A common domestic remedy is flour sprinkled evenly on the burned surface, so as to protect from the air, and it answers the purpose very well for all ordinary burns. Solutions of gun cotton, or collodion, and gutta percha, also answer the same purpose, though they cause some smarting when first applied. Carron oil, composed of equal parts of lime water and lin- seed oil, is a useful application, and should be applied by means of lint, or cloths thoroughly BURNS AND SCALDS. 371 saturated with the compound. . A solution of carbolic acid in glycerine is an excellent appli- cation, and a solution of opium, tannin and glycerine also affords relief. Deep ulcerations and exuberant granulations frequently form, which require the application of ointments, such as the red precipitate, lead, and citrine, and strong solutions of nitrate of silver, or tincture of iodine. Care must be exercised to see that sympathetic inflammation and congestion of the internal organs does not take place, as they are very liable to in severe burns and scalds. Great care must also be taken to guard against mus- cular and tendinous contractions; as the injured parts are healing. WEAK ANKLES. It is frequently the case that children who are old enough, cannot walk on account of weak ankles. The muscles and tendons are relaxed, and are not tense enough to give strength and solidity to the joint, so that if the child attempts to walk the feet turn over to one side or the other, generally outwards. Sometimes the trouble is quite persistent, and even in some cases permanent, if not properly treated. No child thus affected should be al- lowed to bear its weight upon its limbs unless some mechanical appliances have been fitted to the parts so as to furnish the needed support. There are splints made of steel plates extend- ing clown, and bands of the same encircling the limbs, which if nicely adjusted, and worn for a sufficient length of time, will entirely remedy the difficulty. Occasionally more or less of the WEAK ANKLES. 373 trouble arises from paralysis of the muscles, when means for strengthening them, and over- coming the paralysis will be required, such as frequent bathing in mustard water, and thorough frictions, applications of electricity, and stimu- lating lotions. All splints and mechanical appliances required for this and other surgical diseases, can be obtained at instrument makers, by forwarding the necessary measurements of the limb. As a rule it will be best to leave these important matters with the medical attendant, as he alone can attend to the case properly. 32 DIET IN HEALTH. PROM BIRTH TO SIX MONTHS OLD DIET 1. If the child be nursed and the breast milk be found in all respects suitable, no other food will be required. The child should take the breast alternately every two hours for the first six weeks, after- wards every three hours, except between 11 P. M. and 5 or 6 A. M. In cases where the secre- tion of breast milk is tardy, and insufficient in quantity, the following food in addition to the breast milk may be given : one tablespoonful of fresh cream, two tablespoonfuls of whey, two tablespoonfuls of hot water. This mixture is to be taken from a feeding bottle. The whey is made fresh in the house by adding one teaspoon- DIET IN HEALTH. 375 ful of prepared rennet to a pint of new milk. After the milk is coagulated it is to be strained through muslin. DIET 2. If the infant be brought up b}>- hand, new milk and lime water in equal proportions, may be given. Three to four ounces, sweetened with a teaspoonful of sugar of milk, are to be given at first, every two hours, from a feeding bottle. The proportions of milk and lime water are to be varied according to the age of the infant. From six weeks to three months, one-third lime water may be used ; and from three to five months, this quantity should be reduced to one- fourth. DIET 3. If the infant be partially nursed, the breast milk being poor and scanty, the breast must not be given but twice daily. For the other meals, the child must be fed upon milk and lime water as directed in diet table No. 2. Up to the age of six months the milk should be warmed by dipping the bottle containing it into hot water. After the age of six months it may be boiled if convenient. New unskimmed milk should always 376 DIET IN HEALTH. be used. In all cases where children are arti- ficially fed, great attention must be paid to the cleanliness of the feeding bottle. DIET 4. FEOM SIX TO TWELVE MONTHS OLD. FIVE MEALS IN THE DAY. First meal, 7 A. M. — One teaspoonful of baked or boiled flour carefully prepared with a teacupful of milk. Second meal, 10.30, A. M. Third meal, 2 P. M. — A cupful of milk ren- dered alkaline by half a teaspoonful or more of lime water. Fourth meal, 5.30 P. M. — Same as the first. Fifth meal, 11 P. M. — Alkaline milk as before. For the second meal a yolk of an egg, beaten up with a cup of milk, may occasionally be given. DIET 5. FOR A CHILD TEN MONTHS OLD. First meal, 7 A. M. — A tablespoonful of pearl barley jelly, dissolved in a cup of milk, and sweetened with loaf sugar. Second meal, 10.30 A. M. — A breakfast cup of milk and lime water. DIET IN HEALTH. 377 Third meal, 2 P. M.— The yolk of one egg beaten up in a teacupful of milk. Fourth meal, 5.30 P. M. — Same as the first. Fifth meal, 11 P. M. — Same as the second. Pearl barley boiled for six hours forms, on cooling, after the water is strained off, a jelly which dissolves readily in warm milk. DIET 6. (To alternate with the preceding.) First meal, 7 A. M. — Half a teaspoonful of cocoa essence, boiled for one or two minutes in a cupful of milk. Second meal, 10.30 A. M. — A cupful of milk and lime water. Third meal, 2 P. M.— A cupful of beef tea, (half a pound of meat to a pint of water.) Fourth meal, 5.30 P. M. — A spoonful of pearl barley jelly, dissolved in a cupful of milk, and sweetened. Fifth meal, 11 P. M. — Same as the second. If the child requires food before 7 A. M., on waking from sleep, a little milk may be given. A healthy child, between ten and twelve months old, will require from a pint and a half to a quart of milk in the twenty-four hours 32* 378 DIET IN HEALTH. DIET 7. FROM TWELVE TO EIGHTEEN MONTHS OLD. First meal, 7.30 A. M. — A slice of stale bread well soaked in a cupful of milk. Second meal, 11 A. M. — A drink of milk, a plain biscuit, or slice of thin bread and butter. Third meal, 1.30 P. M.— A cupful of beef tea, (a pound of meat to the pint,) a spoonful of some light pudding. Fourth meal, 6 P. M. — Same as the first. Fifth meal, 11 P. M. (if required.)— A drink of milk. DIET 8. (To alternate with the preceding.) First meal, 7.30 A. M.— The yolk of a soft boiled egg, a slice of bread and butter, a cupful of new milk. Second meal, 11 A. M. — A drink of milk, a slice of bread and butter. Third meal, 1.30 P. M. — A potato well mashed, moistened with two tablespoonfuls of good beef essence, or gravy, a cupful of new milk. Fourth meal, 6 P. M. — A slice of stale bread, well soaked in a cupful of milk. Many children between twelve and eighteen months old, will be DIET IN HEALTH. 379 found to do well upon only three meals a day, as follows : DIET 9. First meal, 8 A. M. — One teaspoonful of baked or boiled flour, one teaspoonful of fine oat meal, one-half to three-quarters of a pint of fresh milk, a little white sugar. Second meal, 1 P. M. — The same with the addition of a yolk of one egg. Third meal, 5 P. M. — Same as the first. In this diet the flour and oat meal are first beaten up till smooth with four tablespoonfuls of cold water, and are then boiled. The milk and sugar are then added, and the mixture is boiled till it thickens. For the second meal the yolk is stirred up in the saucepan and boiled with the rest. DIET 10. FROM EIGHTEEN MONTHS TO TWO TEARS OLD. First meal, 7.30 A. M.— A cupful of milk, a little rice, or a slice of stale bread. Second meal, 11 A. M. — A cup of milk. Third meal 1.30 P. M.— Roast mutton or beef, done rare, pounded, or cut fine, a tablespoonful, 380 DIET IN HEALTH. one well mashed potato moistened with beef essence. For drink, milk, or toast water, crust coffee. Fourth meal, 6 P. M. — A cup of milk, bread and butter. After the age of eighteen months old it is well to omit the meal at 11 P. M., for a healthy child of that age should sleep from 6 P. M. to 6 A. M. without waking. DIET 11. (For a child of the same age.) First meal, 7.30 A. M. — A cup of new milk, soft boiled yolk of one egg, a slice of bread and butter. Second meal, 11 A. M. — A cup of milk. Third meal, 1.30 P. M.— A cup of beef tea, a cup of plain custard pudding. Fourth meal, 6 P. M. — A cup of milk, bread and butter. These diets can be given on alter- nate da}'s. Between the ages of two and three years the same diets may be continued. Meat can, however, be given every day, and a little stewed fruit may be added. DIET IN DISEASE. For a child of two or three months old, brought up by hand, weakly and emaciated, in whom milk with lime water excites griping and flatu- lent colic, with occasional attacks of vomiting and purging. In these cases we can often succeed in render- ing the milk and lime water digestible by adding an aromatic. Thus, to half a pint of cold milk, add a teaspoonful of caraway seeds, or chopped cinnamon enclosed in a small muslin bag, and boil for five minutes. The bag is then with- drawn, and the lime water and sugar are after- wards added as usual. If this do not succeed, one of the diets given below can be tried. 382 DIET IN DISEASE DIET 12. The child is to be fed every three hours from a feeding bottle, with the following, in alternate meals : 1st. One teacupful of Liebig's food for infants dissolved in a cupful of new milk and water, (equal parts,) with the addition of atablespoon- ful of cinnamon, or caraway water. 2nd. A cup of fresh whey, containing a tea- spoonful of cream. If the amount of milk given above cannot be digested, as is often the case, the proportion of water used to dilute the milk may be increased to two-thirds ; or in some of the meals the milk may be entirely omitted, using instead barley water, or equal parts of barley water and weak chicken broth in which Liebig's food can be dissolved. DIET IN CHRONIC DIARRHEA. For a child of twelve months old, who can hear milk, 'purging not severe. DIET 14. A teaspoonful of Liebig's food for infants, every three hours, dissolved alternately in milk and water (equal parts,) and in equal parts of mutton broth and barley water. If no milk at all can be digested, a good diet is the following : DIET 15. First meal, 7 A M. — One teaspoonful of Lie- big's food for infants, dissolved in a teacupful of mutton broth and barley water (equal parts.) Second meal, 11 A. M. — One tablespoonful of cream in a cupful of fresh whey. Third meal, 2 P. M. — Yolk of one egg beaten up with fifteen drops of brandy, a tablespoonful of cinnamon water, and a little white sugar. 384 DIET IN CHRONIC DIARRHEA. Fourth meal, 5 P. M. — Six ounces of beef tea (a pound to the pint.) Fifth meal, 11 P. M.— Same as the first. DIET 16. FOR A WEAKLY CHILD OF TWELVE MONTHS OLD. First meal, 7 A. M. — Four ounces of whey, with a teaspoonful of cream. Second meal, 9.30 A. M. — Four ounces of veal or mutton broth, (half a pound to the pint.) Third meal, at noon. — A teaspoonful of pearl barley jelly, dissolved in four ounces of whey. Fourth meal, 2.30 P. M. — Four ounces of milk and lime water, (equal parts), with a table- spoonful of cinnamon water. Fifth meal, 5 P. M. — One teaspoonful of Lie- beg's food for infants, dissolved in four ounces of barley water. Sixth meal, 9 P. M. — Same as the second. During the night, whey or barley water may be given. If the purging be very severe, all regular meals should be discontinued, and the child be supplied with any of the above foods in quanti- ties of one tablespoonful every quarter of an hour. Diet 13 will often succeed in these cases. DIET IN CHRONIC VOMITING. Ik this disorder the food must be given in minute quantities, one teaspoonful in many cases being all that can be retained at one time. This may be repeated every ten minutes. Choice may be made from the following : Di- luted whey with cream as in diet 1 ; milk and lime water with cinnamon water ; one teaspoon- ful of Liebig's food for infants dissolved in four ounces of milk and water (equal parts,) or in equal parts of weak mutton broth and barley water. Whatever food is given it should be given cold or hot, not tepid. 33 DIET IN RICKETS. Here the kind of diet will depend in a great measure upon the condition of the alimentary canal. In almost all cases it will be found that farinaceous food has been supplied in excessive quantities, and the amount will have to be con- siderably reduced. If the bowels are relaxed, with loose, slimy, offensive motions, diets 1 5 and 16 will be suitable. If the motions are healthy, diets 5, 6, 7, 8, 10, 11, may be made use of, according to the age of the child. DIET IN MUCOUS DISEASE. FOR A CHILD SEVEN OR MORE TEARS OF AGE. DIET 19. Breakfast, 8 A. M. — Three-quarters of a pint of milk rendered alkaline by the addition of lime water, a thin slice of toasted bread. Dinner at 12. — A small mutton chop broiled, a little well boiled spinach, or beans, according to season, a thin slice of toasted bread, a wine glass of sherry diluted with twice its bulk of water. Tea, 4 P. M.— Same as breakfast. Supper, 7 P. M.— A cupful of beef tea. Two of the meals should consist of milk. For the other meals selection should be made from the following : Meats : Roast beef, roast or boiled mutton, roast or boiled fowl. No spiced or salted or pre- served meats can be allowed. Fish : boiled cod, 388 diet m MUCOUS DISEASE. turbot, mackerel, raw oysters. Eggs : Boiled or poached. Soup : Clear turtle, beef or veal tea. Vegetables : Cauliflower, spinach, turnip greens, asparagus, lettuce or celery (stewed.) For drink : Sherry or claret diluted with water, light bitter ale, toast water, milk and water. DIET IN TUBERCULAR DISEASE, AND IN CONSUMPTION. In these cases all fat forming material is of value, but as digestion is more or less impaired, in regulating the diet attention must be naid to this fact. FOR A CHILD SEVEN TEARS OF AGE. DIET 20. Breakfast, 8 A. M. — Half a pint of new milk to which lime water is added, a soft boiled egg, thin bread and butter. Dinner, 12 or 1 P. M. — A slice of roast beef or mutton with dressing, a mealy potato well mashed, milky farinaceous pudding. For drink, half a wine glass of sherry, diluted with twice its bulk of water. Tea, 4 or 5 P. M. — A teaspoonful of chocolate 33* 390 DIET IN" TUBERCULAR DISEASE. or cocoa boiled with half a pint of milk, bread and butter. Supper, 7 or 8 P. M. — Half a dozen raw oys- ters, or cooked if preferred, bread and butter. DIET 21. (For same age.) Breakfast, 8 A. M. — Bread and milk. Dinner, at 12 or 1 P. M. — Roast, or boiled fowl, a mealy potato, sherry and water ; for des- sert a bunch of sweet grapes. Tea, 4 or 5 P. M. — A soft boiled egg, bread and butter, half a pint of milk, or an egg may be beaten up raw with the milk. Supper, 7 or 8 P. M. — A cup of strong beef tea. HOW TO PREPARE BEEF TEA. Put half a pound or a pound of beef (accord- ing to strength required,) cut up into small pieces, into a covered sauce-pan, or into a bottle, with one pint of water. Let this stand by the side of the fire for four or five hours, and let it then simmer gently for two hours, season with salt, skim well, and serve. The meat should be used as fresh as possible, and should be cleared beforehand of all fat or gristle. If this precaution be neglected, a greasy taste is given to the beef tea, which can- not be removed afterwards by skimming. The sauce-pan should be made of copper or tin. Iron sauce-pans should not be used unless enam- elled. In re warming beef tea which has been left to cool, care must be taken to warm the tea up to the point at which it is to be served, and no higher. It should on no account be allowed to boil. CHEMICAL AND VEGETABLE DIET. Liebig's prepared food for infants, and Liebig's extract of beef, can be obtained at nearly all drug stores, and full directions for their use ac- company each package. Boiled rice, canna farina, pearl tapioca, sago, oat meal, and articles of this kind are suitable diet for children when in usual health. Many of the ripe fruits, in their proper season, may be allowed in the diet of children, but all unripe fruit and vegetables should be discarded, especially during the hot months. Note. — The photographs of club feet were kindly furnished by Buckminster Brown, M. D., of Boston, from cases occurring in his practice. SPLINTS AND MECHANICAL APPLIANCES. [For the benefit of all those who may have occasion to procure mechanical supports and various splints to use in overcoming de- formities, the following description of the more important and use- ful ones is giren, so that their use may be the better understood. They are manufactured by Messrs. Leach & Greene, of Boston, where they can always be obtained, or where one can get them made to order, in the highest style of the art.] No. 1 is a support for weak ankles. It consists of a steel foot piece riv- eted to the sole of the shoe with steel uprights, jointed at the ankle to correspond with the natural artic- ulation, and extending up each side of the leg to the calf, around which >they are buckled by a softly padded band. A cushioned pad inside the upright, be- low the ankle joint, supports the ankle on the side to which it is inclined to yield. A loose strap passing around the ankle and buckling to the opposite standard relieves the foot from undue pressure upon the pad. 394 SPLINTS AND MECHANICAL APPLIANCES No. 2 is the Apparatus for bow legs. It con- sists of two steel uprights riveted to the sole of a strong laced boot, jointed at ankle and knee, with padded bands encircling thigh and calf. Cushioned pads inside the inner upright at knee and ankle joints afford points of resis- tance at either end of the curved bone. From the center of the inner upright an elastic strap passes around the leg over the arc of curva- ture, and when tightly drawn necessarily re- duces the curve. SPLINTS AKD MECIIAXICAL APPLIANCES. 395 No. 3 represents the modification of Scarpas Shoe commonly used in the treatment of Club Foot. It consists of jointed uprights, similar to those in the Bow Leg Apparatus, which are at- tached to a padded metal shoe, jointed at the medio-tarsal articulation, so as to admit of lat- eral motion. Midway between the ankle and sole a strong steel is attached to the outer standard, and projects forward as far as the little toe joint. At the end of this spring is a strap, which passing around the shoe everts the foot on being tightened. The heel is kept down by a strap over the instep, which passes through two holes in the heel of the shoe, and ties be- hind. A strap passing from the toe of the shoe to the band below the knee raises the toe and stretches the heel cord. 396 SPLINTS AND MECHANICAL APPLIANCES. No. 4 is Sayres' Club Foot Shoe, which has the same perpendicular supports as the others. The shoe is made like an ordinary laced boot with a metal inner sole, but is cut into at the Medio-tarsal articulation, and joined together by a ball and socket joint, which admits of free motion in every direction. On either side the shoe opposite the toe joints are metal hooks, to which are attached two elastic cords of rubber tubing, the shorter of which attaches to a knob on the heel of the shoe and moves the foot lat- erally, the longer attaches to the standard just below the knee and Ilexes and rotates the foot. The advantage of this form of apparatus over other styles is, first, greater control over the foot; second, the artificial rubber muscles allow the exercise of the weakened muscles of the leg, by which their power is increased rather than weakened. SPLINTS AND MECHANICAL APPLIANCES. 397 No. 5 is an Apparatus for Knock Knees, con- sisting of two steel uprights attached to the sole of the shoe, and passing up the outer aspect of the leg — jointed at ankle, knee and hip, and at- taching tj a hand encircling the pelvis. Elastic hands are brought around the knee, crossing each other from below and above. By tightening those bands the knees are drawn outward, thus correcting the deformity. 398 SPLINTS AND MECHANICAL APPLIANCES. No. 6 is Sayres' short splint for Disease of the Hip Joint. The lower portion of the Splint is attached to the thigh by adhesive plaster. The upper part, which plays in a ball and socket joint on a pad resting over the outer surface of the hip, is kept in place by a well stuffed perineal strap. Extension is effected by a ratchet move- ment, which is operated by a key. SPLINTS AND MECHANICAL APPLIANCES. 399 No. 7 is a modification of Sayre's Long Splint, and obviates the necessity of using adhesive plaster. The foot piece of the splint is riveted to the sole of a laced boot. The uprights, which extend up either side of the leg, are retained in place by stuffed bands encircling the calf and thigh. The outer upright ends in a pad with ball and socket joint, like that on the short splint, and is held securely in place by a belt encircling the pelvis, and a perineal strap. Extension is effected by means of a nut and screw — the laced boot and the perineal strap affording the points of counter-extension. 400 SPLIXTS AXD MECIIAXICAL APPLIAXCES. No- 8 represents Dr. Taylor's apparatus for angular curvature of the spine. It consists ot a metal band passing across the hips. From the center of this band two steel uprights extend up each side of the spine, and are connected at the top by a steel cross-piece at either end of which is an arm resting on the shoulder blade. A knob at each end of these arms affords attach- ment for padded straps, which pass over the shoulders and around the arms. The steel up- rights have a joint opposite the point of curva- ture, which opens backward, allowing of motion in that direction, but no other. Softly stuffed pads fitted so as to press evenly on the trans- SPLIXTS AXD MECHANICAL APPLIANCES. 401 verse processes of the diseased vertebrae are placed under the jointed uprights, and by means of set screws the pressure can be increased either above or below as may be desired. A broad apron of firm drilling, covering the front of the body and buckling to the pelvic band and uprights, holds the apparatus in place, and with the shoulder straps keeps the spine erect, and has the effect of a splint upon a broken limb. This, like all spinal apparatus, requires very accu- rate adjustment to render it effective. No. 9 represents Leach & Greene's apparatus for Angular Curvature of the spine. It has the 34* 402 SPLINTS AND MECHANICAL APPLIANCES. pelvic band, apron, and steel uprights, the same as the Taylor apparatus, but the uprights are not jointed, but padded their whole length, and capable of being moulded so as to bring the pressure wherever it is required. It also has crutches which relieve the diseased vertebrae from sudden jars, and obviate the tendency to lateral distortion which often accompanies cases of angular curvature. The same apparatus, with the addition of lateral bands passing from the crutch supports over the arc of curvature, affords an excellent support for lateral curvature of the spine. INDEX. A Atrophy. Simple 229 Attitudes and Gestures 44 Atresia ani 335 Ankles,' weak 372 B Brain, dropsy of. 144 Breathing, the 44 Bowels, closure of 335 Bone diseases 358 Burns 369 Beef Tea, how to prepare 391 C Crying', gesture and attitude 44 Constipation 85 Cholera Infantum 100 Croup 130 Convulsions 1S1 Chorea, or St. Vitus Dance 206 Children, still horn 11 Child, dressing the 20 Congestion of the brain 188 Children, wasting disease of 220 Cough, character of. 48 Constitution the 49 Colic, wind 65 Countenance, the 41 Child, washing the 18 Circulation 49 Cough, whooping 115 Cataract, congenital 328 • D Diagnosis of infantile diseases 40 Digestive svstem 50 Diabetes. . ." 83 Diarrhea 94 Diarrhea, chronic 250 Dress, follies of. 307 Deformities of children 313 Disease, hip 353 Diseases, bone 358 Disease of glands 361 Diet in health 374 Diet in disease 381 Diet in diarrhea 883 Diet in vomiting 885 Diet iii rickets 386 Diet in mucous disease 887 Diet in consumption 889 Diet, vegetable 892 Erysipelas 58 Epilepsey 203 Ears, sore 75 Ear, inflammation of. 77 Eve lids, closure of 320 Eves, cross 324 Eye lid, tumors of. 331 Ears, foreign bodies in 306 F Food after first teething 37 Fever, scarlet 144 Fingers, contraction of. 341 Feet, club 344 G Gums, red 72 Gums, white 74 Gestures and attitudes 44 Gland disease 361 H Hernia, umbilical 336 Hernia, scrotal 338 Hip disease 353 J Jaundice 55 K Knee, knock 350 L. Lungs, inflammation of. 107 Lock iaw 198 Lip, Hare 318 Lips, closure of. 320 Legs, bow 350 M Mortality, infantile 7 Milky scald 69 Measles 159 Mumps 104 Mucous disease 284 Mark, mothers' 333 N Nursing 25 Nursery 81 Night terrors 218 Nourishment insufficient 229 Nevus, or mothers' mark 333 Navel] tumor of 336 404 INDEX. O Ottorrhea 77 P Paralysis, infantile 212 Pox. small 169 Palate-, cleft 315 Phimosis 340 Polypi 363 R Rashes, tooth 71 Rickets 271 Rupture 333 Ranula, or tumor under the tongue. 365 S Still horn children 11 Skin and features 42 Sleep 53 Scrofula 299 Sexes, evils pertaining to 307 Surgical diseases 313 Speech, impediments of 322 Strabismus, cross eves 324 Stves and tumors of the eve 33: Scalds " 369 Splints and mechanical appliances. 393 T Tooth rushes 71 Teething 33 Thrush 61 Tetanus, or lock jaw 198 Tubercular diseases 2j9 Tongue tie 314 Tonsils, enlargement of 364 Tongue, tumor under 365 U Urine, inability to retain 80 V Vomiting 87 Varioloid 167 Vaccination 176 Vomiting, chronic 264 Vulvae 320 W Weaning 23 Whooping cough 115 Worms. 289 f). % fl&K&'CO ENEBQETW AQESTS WASTED in all sections of the country, to canvass for FIRST CLASS ILLUSTRATED WORKS. Experienced Agents have found, after dealing with us for years, that they can get better commissions and terms for themselves, and furnish better books to their patrons than elsewhere. "We prefer those of Experience and Energy ; or those who iutcnd to make canvassing a business for life. OT No One should fail to send for our Descriptive and Illustrated Circulars, before engaging with other Publishers. Please read the following pages, and call the attention of any one on whom you wish to confer a favor. [105] [It is worth the effort of a lifetime to be able to die well.'] THE GUIDE BOARD TO Health, Peace and Competence: OR THE ROAD TO HAPPY OLD AGE. A HAND BOOK, adapted to all classes, in all Darts of Hie Country. BY W. W. HALL, M. D., New York, Author of " Health by Good Living," " Fun Better than Physic," "Journal of Health," &c. 1 VOL., KOYAL OCTAVO, 730 PAGES. Pine Heavy White Paper, Small Pica Type, English Muslin, Bev- eled Boards, Gilt Back and Side Stamp, Library Style, and Half Calf, with Fine Steel Plate Engraving of the Author, and Thirty-Three Elegant Full Page Illustrations on Fine Heavy Tinted Paper. EXCLUSIVELY A SUBSCRIPTION BOOK, Agents Wanted for this and other Popular "Works, in all sections of the Country, and the best inducements offered. D. E. FISK & CO., Publishers, SPRINGFIELD, MASS. We will present a copy of The Guide Board to any one sending us a good Agent. [406] The First and Immediate Aim of the Great and Good Physician Is to restore his patients to health in the shortest time, with the smallest amount of medicine, and with the least discom- fort practicable. When this is accomplished, he has a more elevated ambition ; an object nobler and still more humane presses upon his attention — The Prevention of all Dis- ease. It is hard enough to get along in this world when a man is well ; but to have to make a living under the de- pressing influence of sickness, and pain, and suffering, is worse than having to climb a steep clay bank in wet weather. Old age is comfortless enough of itself; but to be old, and full of aches and pains, and gout and rheumatism, is dread- ful to think of. To prevent the young from getting sick, to enable all to grow old gracefully, with the heart full of the milk of human kindness, a genial smile and a pleasant word for everybody, and to go down to the grave " like as a shock of corn fully ripe in his season," — these are the main objects of Tiie Guide Board. W. W. HALL, M. D. [407] WE PRESENT THE GUIDE BOARD To the public, believing that the writings of no one will be more .acceptable and beneficial to all classes of readers, than those of the Author. His style is plain, fascinating, free from technicalities, full of Philosophy, Science and Common Sense, combining Med- ical and Moral Advice ; showing how health may be pre- served, and disease cured, by the proper adaptation of food and exercise, in quantity and quality, to the condition of the system, rather than turning the stomach into a drug shop. But while he battles the indiscriminate use of medicine, he by no means discards it when prescribed by intelligent phy- sicians. He writes for ALL, — Men, "Women and Children, — to in- struct, to amuse, and-to enable them to preserve health and morality. The Professional Men who have experienced his advice and treatment will welcome his further counselliugs, ripened by nearly forty years' practical experience. The Farmer and Mechanic here find an earnest advocate for their economy, as his firm belief in the remedial power of nature prompts him first to give nature a fair chance, and assist her by obeying her dictates. The Young will here find a pleasurable entertainment for mind and body, as by it their attention may be efficiently turned to the maintenance of a good constitution, resulting in a HApry, uealtiiy, and useful old age. PUBLISHERS. [408] Oaa?a§iitff Asentt "We offer an opportunity seldom if ever equaled. "We give you a book of peculiar interest and value, issued in the very best style, faultless in its character and beautiful in its adornments, both externally and internally, receiving the commendations of all who examine it, and meriting the ap- probation and praise of a;l good people. It is a work with which you can enter the dwelling of the Farmer, the Re- fixed and Intelligent, the office of the Merchant and Professional Man, and the shop of the Industrious Me- chanic, and meet encouragement and aid ; not only making the business profitable but pleasant. As the author is more widely known and quoted from than any other, agents often take orders as soon as the Title and Author are named, without an examination of the Book. To better enable au applicant for an Agency for this work to be convinced that he is getting a good bargain, in hulk as well as in reading matter, we give dimensions : Length, 9^ inches ; width, 6 £ inches ; thickness, 2 £ inches ; with nearly full page letter press — the muslin bound (the lightest) weigh- ing 3£ pounds. The Prospectus contains 50 pages of read- ing matter, Steel Portrait of the Author and full page Illus- trations, Price, Terms, &c, with ruled pages for nearly 1,000 subscribers, and specimens of Binding. PRICE OF THE GUIDE BOARD : Bound in English Muslin, Gilt Back and Side $4.00 Fine Leather, Library Style, 4. .00 Half Calf, Gilt Back, Sprinkled Edge 5.00 Balf Calf, Gilt Back and Marble Edge 5.50 As Agents sometimes have calls for Extra Styles, we have the Half Calf (iilt Back and Edge.... ti.00 Turkey Morocco, Full (iilt 7.00 [409] As this is a First Class, Standard Work, \Ye employ none but good, experienced Agents to canvass for it, or those of good address, energy and good character, and would prefer corresponding recommendations, with ap- plication. Applicants should state experience, territory de- sired, &c. Agents can engage in no more humane or philanthropic work, than in circulating this good book, for it not only shows how to prevent disease, but thfc folly and danger of Self Medication* by following the prescriptions of many of the " Medical "Works" throughout the country ; at the same time not understanding the nature of the complaint. No family should be without it, for they can save thrice the cost each year, if its injunctions are heeded. "We are often in receipt of orders where we have no Agents, as follows : " Office of the Thomas Clock Co., Thomaston, Ct. Gentlemen : — Enclosed find §12, for two copies Hall's 'Guide Board.' Send by express. Yours truly, A. THOMAS." Anchor Works, Camden, lie. Gentlemen : — Enclosed find $4, for which please send us the ' Guide Board.' H. E. & W. G. ALDEN." Lasalle, III. Gentlemen : — I enclose you P. 0. money order for $6. Please send to my address, as good a bound volume of the -Guide Board ' as the money will pay for. Yours respectfully, II. B. CHAPMAN. [410] TMSTIMQMTAItB, Dr. Hall possesses many claims to the notice and respect of an intelligent, moral and virtuous community. He is handsome, learned, wise, industrious, practical, zealous in well doing, and has BUILT A WORK WORTHY THE STUDY AND ADMIRATION of the WOrld. City Items, Philadelphia. The " Guide Board " is Dr. Hall's largest work, and is thoroughly characteristic of the man. It treats of almost every subject liable to arise for consideration in the home, bearing upon the well-being and happiness of all. We commend the book to the careful study of all parents. — Rural New Yorker. "We can imagine it popular with the great mass of readers, who like to have, in bulk as well as in quality, the worth of their money. Every one may learn something from this volume about themselves — for there are few subjects pertaining to the human system which are not alluded to in it. — Evening Journal, Albany. A very useful and excellent book. — New York Independent. •We are certain that this work, if carefully read and its sugges- tions followed, would prevent at least one half of the pain and dis- ease suffered, or greatly ameliorate it. As friends of humanity, we call upon parents to place this book in the hands of their children, and to read it carefully themselves. The work contains over 750 pages, and every page will add a week to every person's life, and a year to his happiness, if their injunctions are heeded. No work of the kind has sold as this is selling, and we believe that no similar work has the merit that this has. — Westfield Times. This is a royal octavo volume of 750 pages, and next to the Bible, is the most useful book that any family can possess. The author, eminent as the editor of that widely popular publication, "Hall's Journal of Health," is universally known as one of the best physi- cians in the country, and of no one are the writings and opinions on health so extensively quoted by the newspapers at large, and so conscientiously relied upon by the whole people as are those of Dr. Hall. "The Guide Board to Health " is his largest work, and is the most complete and searching of its kind that for family use ever issued from the press of any country. It is so plain that all can understand it, being free from medical terms; it exposes humbugs, condemns quackery, and is a book that is endorsed by the best and most learned men of the country. As a medical friend and adviser it is invaluable, saving its cost many times during the year by giv- ing information that otherwise would necessitate the expense of calling a physician. — Daily Union, Springfield, Mass. [411] TESTIMOmAm, The " Guide Board " is beautifully bound and printed. The sub- ject is treated in an instructive, practical and entertaining manner, and we predict for the work a wide circulation. — Herkimer County News. There is no doubt but that Dr Hall is, in his way, a benefactor to his kind, and that his books have helped many people to get into a simple, regular, healthy way of living, which has prolonged their lives and made them happier. We take pleasure in directing the attention of our readers to his largest work, which we have this moment received from the enterprising publishers. The " Guide Board " is just the book to take up at brief periods of leisure, and the writer's ideas are so directly and pertinently expressed, that they will leave an impression on the reader's mind. It has a wide scope, and embodies much information, aside from the expressed opinions of the author. It is copiously indexed, so that, as a fa- miliar hand-book, its suggestions are readily available. — Evening Gazette, Worcester, Mass. The "Guide Board " will be of great service to every household. — Watchman and Reflector. The " Guide Board " is for the benefit of the world, and adapted to every class. We have not space to do justice to the work. It is destined to have an extensive circulation. — Taunton Gazette. The man or woman who reads this volume and abides by the re- quirements cited as necessary to the conditions of a normal exist- ence, may feel certain of possessing the inestimable boon of health. Northampton Press. The " Guide Board" ought to be circulated far and wide. — New York Observer. Seven of the Best Physicians in Saginaw City, Michigan, sub- scribed for this work and cordially recommended "all to read, know and practice the teachings of this most excellent book." Dr. Hempel, of Michigan, says: "I feel justified in recom- mending ' The Guide Board to Health ' to my friends and all families who feel interested in the welfare of the rising generation. It will be found an admirable, convenient and useful acquisition to every family." It is a finely executed and valuable work, containing a vast amount of common sense. — Western New Yorker. [412] A FEW WORDS Frem Soma of ©if Bsperie&ced Ag©it§ B I have read the Guide Board with much benefit to myself, and was induced to apply to the Publishers to be constituted Agent for its sale in Boston. Among my patrons are the State and City Officials, Members of Congress, Bank Presidents, and other leading citizens, having sold to the Shoe and Leather Dealers alone, 130 copies. B. H. SKINNER, Boston. Gentlemen : — I am meeting with very good success in my can- vass for the " Guide Board," and feel that I am engaged in a very good work, as I frequently hear from my patrons remarks which are very encouraging, such as — "You are not only benefiting yourself, but the community in general by circulating such a valuable Book." " Every wife and mother who neglects reading it, does herself and family injustice." "Although we see Agents every day, we have never had a work of equal value offered us." Next to the Bible, I value the Guide Board above all other books. Respectfully, F. J. GARDNER, Gloucester, Mass. S. E. Goodwin, our Agent in New Haven, Conn., writes : "My list is rapidly increasing. I am often told that, ' though your list is not as large as some we have seen in this place, yet it embraces more of our best and most noted citizens, than any we have ever helped to increase.' I have canvassed for many books, but none have given my patrons and myself so much satisfaction as the 'Guide Board.'" (From the Rev. L. W. Ham, Agent for Bristol County, Mass.) Gentlemen: — I find "Dr. Hall's Guide Board" the best sell- ing Book I ever sold, and I have had six years' experience in sell- ing many other works. In a short time I sold 15(5 copies in New Bedford ; thirteen physicians subscribed, paid for, and recommend the work ; six of the clergymen, and many other of the leading citi- zens, were among my patrons. I find Dr Hall so popular and widely known, that I often take orders as soon as the title page and name of the Author are mentioned, without an examination of the work. Patrons often have remarked to me, " I would not part with it at any price " — " I am only glad to get that book" — " It is worth dollars to any family" — "Dr. Hall is sensible" — " He believes in common sense." It is gratifying to me to be able to present so val- uable a work to the public, and I hope to be able to continue in well doing. [413] WORDS FROM AGENTS. —Continued. Gentlemen : — I have already delivered several hundred copies of the " Guide Board," and many of my patrons are enthusiastic in its praise. One says, "It is worth its -weight in gold ; " another, " There is more sense on one leaf than in any other book I ever saw ; " and still another, who owns one of the largest libraries in the State, says, " I would not exchange it for any book I have in my whole library." I find very few among the more educated who are not more or less familiar with the writings of Dr. Hall, and this makes it much easier for the Agent to sell this, his largest work. F. L. CHILDS, Agent, Grand Rapids, Mich. (From Dr. S. C. "Whitney, Agent for Tioga County, N. Y.) "I have sold and delivered a large number of the "Guide Board," and still selling. Those to whom I have delivered are more than satisfied, and would not be deprived of the Avork for sev- eral times its cost." Alleghant River, Pa. Gentlemen : — I am selling Dr. Hall's Guide Board in Oil Terri- tory, where they have flowing wells, but as a general thing have to pump the oil ; so I expected to have to apply the pumping appara- tus, to obtain a subscriber; but I find I have struck a, flowing well. I have only to inform patrons who the author is, and men have run out bare-headed, stopping me in the street, to inquire if I was the Agent that was selling Dr. Hall's work on health; if so, they wanted a copy. I have had ladies say to me, that their husbands, who scarcely ever read much in a book, would take up this work, and " hang on to it," until late bed time. I have been engaged in this business for many years, and I find it the best selling book I ever canvassed for. E. DRAPER, Agent for Oil Creek and Alleghany River. Rockport, Howard Co., Mo. Gentlemen : — This is written to state that I have been canvassing in this section for the " Guide Board," and shall continue as long as I can make it profitable. I wish for 40 copies. Please send by whatever conveyance you deem most safe and convenient. En- closed find draft. Truly Yours. A. STEVENSON. Newburgh, N. Y. Gentlemen : I have sold a great many books, but have never had any to take as well as the " Guide Board." My patrons, who are among the most influential in all professions and avocations, are much delighted with it, and I have delivered nearly 200 copies al- ready. Next to the Bible, it is the lest book ever published. CHARLES SMITH. (414) WORDS FROM AGENTS.— Continued. Lowell, Massachusetts. Gentlemen: — I know of no work akin to the " Guide Board," held in so general and high estimation for practical worth, by its readers. My list of over 700, obtained in a portion of the business Bection of this city, includes prominent and influential men, in all professions and avocations. Seventeen of the practicing Physi- cians have purchased it, and all agree that it cannot fail to be of great practical good to all who read and study it. Yours Respectfully, J. F. DODGE. Westboro', Massachusetts. Gentlemen : — Yours of the 27th came duly at hand, and contents noted. I must say I like your style of correspondence. There is not so much of the " puff and blow " about it as a great many of the publishers of the present day choose to use. I have been watching for a long time for a work that I thought a man need not be ashamed to offer to the public, and I think your " Guide Board " is the one — coming, as it does, from an Author of experience and well known. I often receive letters from publishers offering " Splendid Inducements," but many of the works do not come up to what the people wish. After five years' experience, I find most of them want something practical, substantial and useful. Enclosed find P. O. money order for the Prospectus and one copy of the Library Binding. I can devote the whole of my time to this business. Yours Respectfully, L. M. ELLIS. Mr. J. T. French, our Agent at Madison, Wis., says : " Those who have become familiar with subscription lists inform me they have never seen a better list, with one exception. I like the 'GdlDE Board,' as it is appreciated by a class of people with whom I like to do business. Your proposed allowance for damage on books is quite satisfactory, for which please accept thanks." There is no town in the West, however small, that the reputation of Dr. Hall has not reached. And when the "Guide Board" is mentioned, I often hear the expression, " That is the hook of all others I most want. I have not subscribed for 'a book for years, but Dr. Hall's Works are not to he resisted." I have never seen a subscriber dissatisfied with his investment. The superior manner of Binding elevates it at once above all ordinary subscription hookR, which is a source of pride to the Agents and satisfaction to the buyer. [415] liw Illustrated Edition. IPBOIAL HOTIOT. HAVING EXPENDED NEARLY FIFTEEN HUNDRED DOLLARS in procuring Electrotype Plates to illustrate TME QWIBE B&ABB, we shall now consider all territory as unCdflVClSSed, or the same as for a new work. Besides the Steel Plate Portrait of the Author, there are TUIFLTY-THREB ELEGANT FULL PAGE ILLUSTRATIONS, by the best Artists ?> on Fine Heavy Tinted Paper, adding much to the beauty and value of the book, and making it the most desirable, cheapest and best work ever published in this country. Though each copy, independent of the ex- pense of the electrotype plates, will cost 20 per cent, more than the former editions, we do not intend to raise the price of either style of binding, being satisfied that the illustra- tions will rapidly increase the sales. As the Guide Board has given universal satisfaction to all patrons, who are often recommending it to their neigh- bors, we think Agents can re-canvass some of their terri- tory and double their list of subscribers. [416] FAQTB FQE TME PWBM@, "We wish to call the attention of the Public to this Fact. "We use the very best material in all respects, and our books are bound in the most tasteful and substantial manner. We use the same paper in the Book, we do in the Prospectus ; some Publishers do not, thereby saving several hundred dollars in each edition. In the Gilt Edge, and in Lettering on Covers, we use the Pure Gold, " 18 karats," while many use the Light Metal, which has a sil- very look, costing nothing, comparatively. With this Book we secure the services of First Class Agents and those of long experience, who well know and understand that a Good Standard Work has a long, steady sale, securing the class of patrons who always have funds on call, thereby losing no Subscribers. Agents who have sold our works exclusively for nearly six years, and are still selling, is a proof of the above, and an indication of their satisfaction with our dealings. One of the most noted men of this Republic says : " The Guide Board is, without doubt, far ahead of any subscription book yet published, and worth its weight in gold. The country is flooded with cheap, trashy subscription books, but this one, I am happy to state, is an exception. It is a solid book, full of choice, valuable information, and will save hundreds of dollars to the purchaser, and the Agent will reap a ricii Harvest." The 3Iilwaukee Sentinel says : " "We have seldom chroni- cled our opinion of a new book with more pleasure to our- selves, or with a greater certainty that we are doing the world at large a favor, than Ave do now in calling the atten- tion of our readers to the new and complete work of the celebrated Dr. Hall of New York. Every family would be healthier and happier for having read it. We believe its Sale will be Immense. [417] LIST 0F &LS3TEATI0IS IN THE O-TTIIDIE BOABD Page. 1. Portrait of the Author. (Steel Plate) 2. Health, Peace and Competence. Frontispiece . . 3. Genius and Science 9 4. The Most Efficient Exercise 22 5. The Joking Clergyman 40 6. The Little Courtesies of Life 70 7. The Quaker and Thief 74 8. Salt Lake Mail Party 109 9. Effects of Imagination on Health 115 10. Our Clergy Feasted too much 131 11. The Knickerbocker and Yankee 165 12. Prosperity the best Pill 183 13. How to be Happy 186 14. Mr. Income and Litte Tommy 199 15. The Two Donkeys 213 16. Martin Luther and his Three Frogs 214 17. Queen Victoria and the Butcher's Daughter. .254 18. Sowing Seed for a Harvest of Woe 275 19. The Bulletin Board 297 20. The Doctors who Attended Lazarus 314 21 . Tomboys 331 22. How to Make Home Happy 344 23. Cold Water Mania 353 24. Jack Tar and the Newspapers 391 25. Riches and Poverty 437 26. The Best Gymnasium 462 27. Babies 489 28. Farmers' Wives Overtaxed 525 29. A Mother's Responsibility 533 30. Poetry, Music and Health 540 3 1 . Playing Cook 595 32. Dirty Children 622 33. Piazzas 681 34. Growing Old Happily 747 [418] A Hearty Laugh Elevates the Spirit and En- livens the Circulation." In Better thai Physic I EVEETBQBT-B MWM BME&EMYEMi W. W. HALL, M. D., ' Health by Good Living," " Gi to Health, &c." I Vol. l2mo. pp.333. Price $1.50. Author of " Health by Good Living," " Guide Board to Health, &c." This Hook contains TWELVE HUNDRED MAXIMS in regard to HEALTH, MORALS, and HUMAN HAPPINESS. Is the Most Rapidly Selling Work on tie Continent. There is more sense, wit and fun in this book than any work published, and it is the best daily companion for the fireside and the traveler. D. E. FISK & CO., Publishers, Springfield, Mass. The American Bookseller's Guide says : " It is brimful of wis- dom, sportively disguised." " Let it circulate far and wide." — N. 0. Picayune. " In • Fun Better than Physic,' Dr. Hall has outdone himself." Springfield Telegram. " If the maxims in this hook were made rules of living, there would he 'Fun' in 'throwing Physic to the dogs." — Detroit Tribune. "We advise every family to send for it." — State Register, Iowa. "Excellent Hints." — Louisville Courier. "The world would he healthier and happier by following the maxims in this book." — X. }'. Tribune. For Sale in the Cars and by Canvassing Agents. Sent to any address, by Mail, post paid, on receipt of Price, where we have no Agent. [419] PlQTUBES FEQH THE PQETS, FROM THE BRUSH OF LOUIS A. ROBERTS : — AND— §g@rt im Brief Qh&pt@rsz FROM THE QUILL OP IKABOB IZAX. 1 Vol., JJCedium Octavo, Fine Heavy Tinted Taper, Elegant Type, English STuslin, Bevel Boards, Gilt Back and Side Stamp. With 56 Elegant Full- Page Illustrations. This book contains some of the Finest Quotations from the most noted Poets, which are illustrated in a -unique and mirth- provoking manner. The Spicy, Sarcastic Chapters of Ikabod Izax show up the follies and foibles of everyday life, in a pleasing and agreeable manner, yet containing good solid advice to old and young of both sexes, in all classes of society. The chapters on "Ancient Marry-ners," "A "Woman Moved," "Tale Bearers," " Human Shoddy," and "Hogs," and the Amus- ing Illustrations of "Angelina Turning the Grindstone," the " Poor but Eespectable Parents," Whittier's " Maud Muller," (Raking Hay with a Mule,) and the Antediluvian Monkey recog- nizing "Darwin as his own Son," are worth double the price of the Book. ggp" As a Traveling and daily cheerful Fireside Companion it has no equal. PRICE, $1.50. Sold by Canvassing Agents, and all News Boys on the Trains, or sent to any address, post paid, (where we have no Agents) on receipt of price. D. E. FISK & CO., Publishers, SPRIXGFIELD, MASS. AGENTS WANTED. [420] 9V \k\ LIBRARY OF CONGRESS 022 169 372 3