Domestic Medicine - Chapters 48-49



CHAPTER XLVIII.
DISEASES OF WOMEN.

WOMEN, in all civilized nations, have the management of domestic affairs, 
and it is very proper they should, as Nature has made them less fit for 
the more active and laborious employments. This indulgence, however, is 
generally carried too far; and females, instead of being benefited by it, 
are greatly injured, from the want of exercise and free air. To be 
satisfied of this, one need only compare the fresh and ruddy looks of a 
milk-maid with the pale complexion of those females whose whole time is 
spent within doors. Though Nature has made an evident distinction between 
the male and female with regard to bodily strength and vigour, yet she 
certainly never meant, either that the one should be always without, or 
the other always within doors.

THE confinement of females, besides hurting their figure and complexion, 
relaxes their solids, weakens their minds, and disorders the functions of 
the body. Hence proceed obstructions, indigestion, flatulence, abortions, 
and the whole train of nervous disorders. These not only unfit women for 
being mothers and nurses, but often render them whimsical and ridiculous. 
A sound mind depends so much upon a healthy body, that where the latter is 
wanting, the former is rarely to be found.

I HAVE always observed, that women who were chiefly employed without 
doors, in the different branches of husbandry, gardening, and the like, 
were almost as hardy as their husbands, and that their children were 
llkewise strong and healthy. But as the bad effects of confinement and 
inactivity upon both sexes have been already shewn, we shall proceed to 
point out these circumstances in the structure and design of females, 
which subject them to peculiar diseases; the chief of which are, their 
monthly evacuations, pregnancy, and child-bearing. These indeed cannot 
property be called diseases, but from the delicacy of the sex, and their 
being often improperly managed in such situations, they become the source 
of numerous calamities.


OF THE MENSTRUAL DISCHARGE.

FEMALES generally begin to menstruate about the age of fifteen and leave 
it off about fifty, which renders these two periods the most critical of 
their lives. About the first appearance of this discharge, the 
constitution undergoes a very considerable change, generally indeed for 
the better, though sometimes for the worse. The greatest care is now 
necessary, as the future health and happiness of the female depends, in a 
great measure, upon her conduct at this period. It is the duty of mothers, 
and those who are intrusted with the education of girls, to instruct them 
early in the conduct and management of themseles at this critical period 
of their lives. False modesty, inattention, and ignorance of what is 
beneficial or hurtful at this time, are the sources of many diseases and 
misfortunes in life, which a few sensible lessons from an experienced 
matron might have prevented. Nor is care less necessary in the subsequent 
returns of this discharge. Taking improper food, violent affections of the 
mind, or catching cold at this period, is often sufficient to ruin the 
health, or to render the female ever after incapable of procreation.

IF a girl about this time of life be confined to the house, kept 
constantly sitting, and neither allowed to romp about, nor employed in any 
active business, which gives exercise to the whole body, she becomes weak, 
relaxed, and puny; her blood not being duly prepared, she looks pale and 
wan; her health, spirits, and vigour decline, and she sinks into a 
valetudinary for life. Such is the fate of numbers of those unhappy 
females, who, either from too much indulgence, or their own narrow 
circumstances, are, at this critical period, denied the benefit of 
exercise and free air.

A LAZY indolent disposition proves likewise very hurtful to girls at this 
period. One seldom meets with complaints from obstructions amongst the 
more active and industrious part of the sex; whereas the indolent and lazy 
are seldom free from them. These are, in a manner, eat up by the 
chlorosis, or green-sickness, and other diseases of this nature. We would 
therefore recommend it to all who wish to escape these calamities, to 
avoid indolence and inactivity, as their greatest enemies, and to be as 
much abroad in the open air as possible.

ANOTHER thing which proves very hurtful to girls about this period of 
life, is unwholesome food. Fond of all manner of trash, they often indulge 
in it, till their whole humours are quite vitiated. Hence ensue 
indigestions, want of appetite, and a numerous train of evils. If the 
fluids be not duly prepared, it is utterly impossible that the secretions 
should go properly on: Accordingly we find, that such girls as lead an 
indolent life, and eat great quantities of trash, are not only subject to 
obstructions of the menses, but likewise glandular obstructions; as the 
scrophula or king's evil, &c.

A DULL disposition is also very hurtful to girls at this period. It is a 
rare thing to see a sprightly girl who does not enjoy good health, while 
the grave, moping, melancholy creature, proves the very prey of vapours 
and hysterics. Youth is the season for mirth and cheerfulness. Let it 
therefore be indulged. It is an absolute duty. To lay in a stock of health 
in time of youth, is as necessary a piece of prudence as to make provision 
against the decays of old age. While therefore wise Nature prompts the 
happy youth to join in sprightly amusements, let not the severe dictates 
of hoary age forbid the useful impulse, nor damp, with serious gloom, the 
season destined to mirth and innocent festivity.

ANOTHER thing very hurtful to females about this period of life is strait 
clothes. They are fond of a fine shape, and foolishly imagine that this 
can be acquired by lacing themselves tight. Hence, by squeezing the 
stomach and bowels, they hurt the digestion, and occasion many incurable 
maladies. This error is not indeed so common as it has been; but, as 
fashions change, it may come about again. we therefore think it not 
improper to mention it. I know many females who, to this day, feel the 
direful effects of that wretched custom, which prevailed some years ago, 
of squeezing every girl into as small a size in the middle as possible. 
Human invention could not possibly have devised a practice more 
destructive to health.

AFTER a female has arrived at that period of life when the menses usually 
begin to flow, and they do not appear, but, on the contrary, her health 
and spirits begin to decline we would advise, instead of shutting the poor 
girl up in the house, and dosing her with steel asafoetida, and other 
nauseous drugs, to place her in a situation where she can enjoy the 
benefit of free air and agreeable company. There let her eat wholesome 
food, take sufficient exercise, and amuse herself in the most agreeable 
manner; and we have little reason to fear, but Nature, thus assisted, will 
do her proper work. Indeed she seldom fails, unless where the fault is on 
our side.

THIS discharge in the beginning is seldom so instantaneous as to surprise 
females unawares. It is generally preceded by symptoms which foretel its 
approach; as a sense of heat, weight, and dull pain in the loins; 
distenflon and hardness of the breasts; head-ach; loss of appetite; 
lassitude; paleness of the countenance; and sometimes a slight degree of 
fever. When these symptoms appear about the age at which the menstrual 
flux usually begins, every thing should be carefully avoided which may 
obstruct that necessary and salutary evacuation; and all means used to 
promote it; as sitting frequently over the steams of warm water, drinking 
warm diluting liquors, &c.

AFTER the menses have once begun to flow, the greatest care should be 
taken to avoid every thing that may tend to obstruct them. Females ought 
to be exceeding cautious of what they eat or drink at the time they are 
out of order. Every thing that is cold, or apt to sour on the stomach 
ought to be avoided; as fruit, butter-milk, and such like. Fish, and all 
kinds of food that are hard of digestion, are also to be avoided. As it is 
impossible to mention every thing that may disagree with individuals at 
this time we would recommend it to every female to be very attentive to 
what disagrees with herself, and carefully to avoid it.

COLD is extremely hurtful at this particular period. More of the sex date 
their disorders from colds, caught while they are out of order, than from 
all other causes. This ought surely to put them upon their guard, and to 
make them very circumspect in their conduct at such times. A degree of 
cold that will not in the least hurt them at another time, will, at this 
period, be sufficient entirely to ruin their health and constitution.

THE greatest attention ought likewise to be paid to the mind, which should 
be kept as easy and cheerful as possible. Every part of the animal 
oeconomy is influenced by the passions, but none more so than this. Anger, 
fear, grief, and other affections of the mind often occasion obstructions 
of the menstrual flux, which prove absolutely incurable.

FROM whatever cause this flux is obstructed, except in the state of 
pregnancy, proper means should be used to restore it. For this purpose we 
would recommend sufficient exercise, in a dry, open, and rather cool air; 
wholesome diet, and, if the body be weak and languid, generous liquors; 
also cheerful company, and all manner of amusements. If these fail, 
recourse must be had to medicine.

WHEN obstructions proceed from a weak relaxed state of the solids, such 
medicines as tend to promote digestion, to brace the solids, and assist 
the body in preparing good blood, ought to be used. The principal of these 
are iron and the Peruvian bark, with other bitter and astringent 
medicines. Filings of iron may be infused in wine or ale, two or three 
ounces to an English quart, and after it has stood for two or three weeks 
it may be filtered, and about half a wine glass of it taken twice a-day: 
or prepared steel may be taken in the dose of half a drachm, mixed with a 
little honey or treacle, three or four times a-day. The bark and other 
bitters may either be taken in substance or infusion, as is most agreeable 
to the patient.

WHEN obstructions proceed from a viscid state of the blood; or for women 
of a gross or full habit, evacuations, and such medicines as attenuate the 
humours, are necessary. The patient in this case ought to be bled, to 
bathe her feet frequently in warm water, to take now and then a cooling 
purge, and to live upon a spare thin diet. Her drink should be whey, 
water, or small beer, and she ought to take sufficient exercise. A tea-
spoonful of the tincture of black hellebore may also be taken twice a-day 
in a cup of warm water.

WHEN obstructions proceed from affections of the mind, as grief, fear, 
anger, &c. every method should be taken to amuse and divert the patient. 
And that she may the more readily forget the cause of her affliction, she 
ought, if possible, to be removed from the place where it happened. A 
change of place, by presenting the mind with a variety of new objects, has 
often a very happy influence in relieving it from the deepest distress. A 
soothing, kind, and affable behaviour to females in this situation is also 
of the last importance.

AN obstruction of the menses is often the effect of other maladies. When 
this is the case, instead of giving medicines to force that discharge, 
which might be dangerous, we ought, by all means, to endeavour to restore 
the patient's health and strength. When that is effected, the other will 
return of course.

BUT the menstrual flux may be too great as well as too small. When this 
happens, the patient becomes weak, the colour pale, the appetite and 
digestion are bad, and oedematous swellings of the feet, dropsies, and 
consumptions often ensue. This frequently happens to women about the age 
of forty-five or fifty, and is very difficult to cure. It may proceed from 
a sedentary life; a full diet, consisting chiefly of salted, high-
seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; 
relaxation; a dissolved state of the blood; violent passions of the mind, 
&c.

THE treatment of this disease must be varied according to its cause. When 
it is occasioned by any error in the patient's regimen, an opposite course 
to that which induced the disorder must be pursued, and such medicines 
taken as have a tendency to restrain the flux, and counteract the morbid 
affections of the system from whence it proceeds,

TO restrain the flux, the patient should be kept quiet and easy both in 
body and mind. If it be very violent, she ought to lie in bed with her 
head low, to live upon a cool and slender diet, as veal or chicken broths 
with bread; and to drink decoctions of nettle-roots, or the greater 
comfrey. If these be not sufficient to stop the flux, stronger astringents 
may be used, as Japan earth, allum, elixir of vitriol, the Peruvian bark, 
&c. Two drachms of allum and one of Japan earth may be pounded together, 
and divided into eight or nine doses, one of which may be taken three 
times a-day. Persons whose stomachs cannot bear the allum, may take two 
table-spoonfuls of the tincture of roses three or four times a-day, to 
each dose of which ten drops of laudanum may be added. If these should 
fail, half a drachm of the Peruvian bark, in powder, with ten drops of the 
elixir of vitriol, may be taken, in a glass of red wine, four times a-day.

THE uterine flux may offend in quality as well is in quantity. What is 
usually called the fluor albus, or whites, is a very common disease, and 
proves extremely hurtful to delicate women. This discharge, however, is 
not always white, but sometimes pale, yellow, green, or of a blackish 
colour; sometimes it is sharp and corrosive, sometimes foul and foetid, 
&c. It is attended with a pale complexion, pain in the back, loss of 
appetite, swelling of the feet, and other signs of debility. It generally 
proceeds from a relaxed state of the body, arising from indolence, the 
excessive use of tea, coffee, or other weak and watery diet.

TO remove this disease, the patient must take as much exercise at she can 
bear without fatigue. Her food should be solid and nourishing, but of easy 
digestion; and her drink rather generous, as red port or claret, mixed 
with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I 
have often known strong broths have an exceeding good effect; and 
sometimes a milk diet alone will perform a cure. The patient ought not to 
lie too long a-bed. When medicine is necessary, we know none preferable to 
the Peruvian bark, which, in this case ought always to be taken in 
substance. In warm weather, the cold bath will be of considerable service.

THAT period of life at which the menses cease to flow, is likewise very 
critical to the sex. The stoppage of any customary evacuation, however 
small, is sufficient to disorder the whole frame, and often to destroy 
life itself. Hence it comes to pass, that so many women either fall into 
chronic disorders, or die about this time. Such of them, however, as 
survive it, without contracting any chronic disease, often become more 
healthy and hardy than they were before, and enjoy strength and vigour to 
a very great age.

IF the menses cease all of a sudden, in women of a full habit, they ought 
to abate somewhat of their usual quantity of food, especially of the more 
nourishing kind, as flesh, eggs, &c. They ought likewise to take 
sufficient exercise, and to keep the body open. This may be done by 
taking, once or twice a-week, a little rhubarb, or an infusion of hiera 
picra in wine or brandy.

IT often happens that women of a gross habit, at this period of life, have 
ulcerous sores break out about their ancles, or in other parts of the 
body. Such ulcers ought to be considered as critical, and should either be 
suffered to continue open, or have artificial drains substituted in their 
stead. Women who will have such sores dried up, are often soon after 
carried off by acute diseases, or fall into those of a chronic nature.


OF PREGNANCY.

THOUGH pregnancy is not a disease, yet that state is often attended with a 
variety of complaints which merit attention, and which sometimes require 
the assistance of medicine. Some women indeed are more healthy during 
their pregnancy than at any other time; but this is by no means the 
general case: most of them breed in sorrow, and are frequently indisposed 
during the whole time of pregnancy. Few fatal diseases, however, happen 
during that period; and hardly any, except abortion, that can be called 
dangerous. We shall therefore pay particular attention, to it, as it 
proves generally fatal to the child, and sometimes so to the mother.

PREGNANT women are often afflicted with the heart-burn. The method of 
treating this complaint has been already pointed out. They are likewise, 
in the more early periods of pregnancy, often harassed with sickness and 
vomiting, especially in the morning. The method of relieving these 
complaints has also been shewn. Both the head-ach and toothach are very 
troublesome symptoms of pregnancy. The former may generally be removed by 
keeping the body gently open, by the use of prunes, figs, roasted apples, 
and such like. When the pain is very violent, bleeding may be necessary. 
For the treatment of the latter, we must refer to that article. Several 
other complaints incident to pregnant women might be mentioned, as a cough 
and difficulty of breathing, suppression and incontinency of urine, &c. 
but as all of these have been taken notice of before, it is needless to 
repeat them.

EVERY pregnant woman is more or less in danger of abortion. This should be 
guarded against with the greatest care, as it not only weakens the 
constitution, but renders the woman liable to the same misfortune 
afterwards. Abortion may happen at any period of pregnancy, but it is most 
common in the second or third month. Sometimes, however, it happens in the 
fourth or fifth. If it happens within the first month, it is usually 
called a false conception; if after the seventh month, the child may often 
be kept alive by proper care. Every mother who procures an abortion does 
it at the hazard of her life; yet there are not a few who run this risk 
merely to prevent the trouble of bearing and bringing up children. It is 
surely a most unnatural crime, and cannot, even in the most abandoned, be 
viewed without horror; but in the decent matron, it is still more 
unpardonable. - Those wretches who daily advertise their assistance to 
women in this business, deserve, in my opinion, the most severe of all 
human punishments.

THE common causes of abortion are, the death of the child; weakness or 
relaxation of the mother; great evacuations; violent exercise; raising 
great weights; reaching too high; jumping, or stepping from an eminence; 
vomiting; coughing; convulsion fits; strokes on the belly; falls; fevers; 
disagreeable smells; excess of blood; indolence; high living; or the 
contrary; violent passions or affections of the mind, as fear, grief, &c.

THE signs of approaching abortion are, pain in the loins, or about the 
bottom of the belly; a dull heavy pain in the inside of the thighs; a 
slight degree of coldness, or shivering; sickness; palpitation of the 
heart; the breasts become flat and soft; the belly falls; and there is a 
discharge of blood or watery humours from the womb.

To prevent abortion, we would advise women of a weak or relaxed habit to 
use solid food, avoiding great quantities of tea, and other weak and 
watery liquors; to rise early, and go soon to bed; to shun damp houses; to 
take frequent exercise in the open air, but to avoid fatigue; and never to 
go abroad in damp foggy weather, if they can shun it.

WOMEN of a full habit ought to use a spare diet, avoiding strong liquors, 
and every thing that may tend to heat the body, or increase the quantity 
of blood. Their diet should be of an opening nature, consisting 
principally of vegetable substances. Every woman with child ought to be 
kept cheerful and easy in her mind. Her appetites, even though depraved, 
ought to be indulged as far as prudence will permit.

WHEN any signs of abortion appear, the woman ought to be laid in bed on a 
matrass, with her head low. She should be kept quiet, and her mind soothed 
and comforted. She ought not to be kept too hot, nor to take any thing of 
a heating nature. Her food should consist of broths, rice, and milk, 
jellies, gruels made of oat-meal, and the like, all of which ought to be 
taken cold.

IF she be able to bear it, she should lose, at least, half a pound of 
blood from the arm. Her drink ought to be barley-water sharpened with 
juice of lemon; or she may take half a drachm of powdered nitre, in a cup 
of water-gruel, every five or six hours. If the woman be seized with a 
violent looseness, she ought to drink the decoction of calcined hartshorn 
prepared. If she be affected with vomiting, let her take frequently two 
table-spoonfuls of the saline mixture. In general, opiates are of service 
but they should always be given with caution.

SANGUINE robust women, who are liable to miscarry at a certain time of 
pregnancy, ought always to be bled a few days before that period arrives. 
By this means and observing the regimen above prescribed, they might often 
escape that misfortune.

THOUGH we recommend due care for preventing abortion, we would not be 
understood as restraining pregnant women from their usual exercises. This 
would generally operate the quite contrary way. Want of exercise not only 
relaxes the body, but induces a plethora, or too great a fulness of the 
vessels, which are the two principal causes of abortion. There are, 
however, some women of so delicate a texture, that it is necessary for 
them to avoid almost every kind of exercise during the whole period of 
pregnancy


OF CHILDBIRTH

MANY diseases proceed from the want of due care in child-bed; and the more 
hardy part of the sex are most apt to despise the necessary precautions in 
this state. This is peculiarly the case with young wives. They think, when 
the labour-pains are ended, the danger is over; but in truth it may only 
then be said to be begun. Nature, if left to herself, will seldom fail to 
expel the foetus; but proper care and management are certainly necessary 
for the recovery of the mother. No doubt mischief may be done by too much 
as well as by too little care. Hence females who have the greatest number 
of attendants in childbed generally recover worst. But this is not 
peculiar to the state of child-bed. Excessive care always defeats its own 
intention, and is generally more dangerous than none at all. Though the 
management of women in child-bed has been practiced as an employment since 
the earliest accounts of time; yet it is still, in most countries, on a 
very bad footing. Few women think of following this employment till they 
be reduced to the necessity of doing it for bread. Hence not one in a 
hundred of them have any education, or proper knowledge of their business. 
It is true, that Nature, if left to herself, will generally expel the 
foetus; but it is equally true that most women in child-bed require to be 
managed with skill and attention, and that they are often hurt by the 
superstitious prejudices of ignorant and officious midwives. The mischief 
done in this way is much greater than is generally imagined; most of which 
might be prevented by allowing no women to practice midwifery but such as 
are properly qualified. Were due attention paid to this, it would not only 
be the means of saving many lives, but would prevent the necessity of 
employing men in this indelicate and disagreeable branch of medlcine, 
which is, on many accounts, more proper for the other sex.

DURING actual labour, nothing of a heating nature must be given. The woman 
may, now and then, take a little panado, and her drink ought to be toast 
and water, or thin groat gruel. Spirits, wines, cordial-waters, and other 
things which are given with a view to strengthen the mother, and promote 
the birth, for the most part tend only to increase the fever, inflame the 
womb, and retard the labour. Besides, they endanger the woman afterwards, 
as they often occasion violent and mortal haemorrhages, or dispose her to 
eruptive and other fevers.

WHEN the labour proves tedious and difficult, to prevent inflammations, it 
will be proper to bleed. An emollient clyster ought likewise frequently to 
be administered; and the patient should sit over the steams of warm water. 
The passage ought to be gently rubbed with a little soft pomatum or fresh 
butter, and cloths wrung out of warm water applied over the belly. If 
nature seems to sink, and the woman is greatly exhausted with fatigue, a 
draught of generous wine, or some other cordial, may be given, but not 
otherwise. These directions are sufficient in natural labours; and in all 
preternatural cases, a skilful surgeon, or man-midwife, ought to be called 
as soon as possible.

AFTER delivery, the woman ought to be kept as quiet and easy as possible. 
We cannot help taking notice of that ridiculous custom which still 
prevails in some parts of the country, of collecting a number of women 
together upon such occasions. These, instead of being useful, serve only 
to crowd the house, and obstruct the necessary attendants. Besides, they 
hurt the patient with their noise and often, by their untimely and 
impertinent advice, do much mischief. Her food should be light and thin, 
as gruel, panado, &c. and her drink weak and diluting. To this rule, 
however, there are many exceptions. I have known several women, whose 
spirits could not be supported in child-bed without solid food and 
generous liquors; to such, a glass of wine and a bit of chicken must be 
allowed.

SOMETIMES an excessive haemorrhage or flooding happens after delivery. In 
this case, the patient should be laid with her head low, kept cool, and be 
in all respects treated as for an excessive flux of the menses. If the 
flooding proves violent, linen cloths, which have been wrung out of a 
mixture of equal parts of vinegar and water, or red wine, should be 
applied to the belly, the loins, and the thighs. These must be changed as 
they grow dry; and may be discontinued as soon as the flooding abates. In 
a violent flooding after delivery, I have seen very good effects from the 
following mixture: Take of penny-royal water, simple cinnamon-water, and 
syrup of poppies, each two ounces, acid elixir of vitriol a drachm. Mix, 
and take two table-spoonfuls every two hours, or oftener, if necessary.

IF there be violent pains after delivery, the patient ought to drink 
plentifully of warm diluting liquors, as groat-gruel, or tea with a little 
saffron in it; and to take small broths, with carraway seeds, or a bit of 
orange-peel in them; an ounce of the oil of sweet almonds may likewise be 
frequently taken in a cup of any of the above liquors; and if the patient 
be restless, a spoonful of the syrup of poppies may now and then be mixed 
with a cup of her drink. If she be hot or feverish, one of the following 
powders may be taken in a cup of her usual drink, every five or six hours. 
Take of crabs claws prepared half an ounce, purified nitre two drachms, 
saffron powdered half a drachm; rub them together in a mortar, and divide 
the whole into eight or nine doses. When the patient is low-spirited, or 
troubled with hysterical complaints, she ought to take frequently twelve 
or fifteen drops of the tincture of asafoetida in a cup of penny-royal tea.

AN inflammation of the womb is a dangerous and not unfrequent disease 
after delivery. It is known by pains in the lower part of the belly, which 
are greatly increased upon touching; by the tension or tightness of the 
parts; great weakness; change of countenance; a constant fever, with a 
weak and hard pulse; a slight delirium or raving; sometimes incessant 
vomiting; a hiccup; a discharge of reddish, stinking, sharp water from the 
womb; an inclination to go frequently to stool; a heat, and sometimes 
total suppression of urine.

THIS must be treated like other inflammatory disorders, by bleeding and 
plentiful dilution. The drink may be thin gruel or barley-water; in a cup 
of which half a drachm of nitre may be dissolved, and taken three or four 
times a-day. Clysters of warm milk and water must be frequently 
administered; and the belly should be fomented by cloths wrung out of warm 
water, or by applying bladders filled with warm milk and water to it.

A suppression of the lochia, or usual discharges after delivery, and the 
milk-fever, must be treated nearly in the same manner as an inflammation 
of the womb. In all these cases, the safest course is plentiful dilution, 
gentle evacuations, and fomentations of the parts affected. In the milk-
fever, the breasts may be embrocated with a little warm linseed-oil, or 
the leaves of red cabbage may be applied to them. The child should be 
often put to the breast, or it should be drawn by some other person.

NOTHING would tend more to prevent the milk-fever, than putting the child 
early to the breast. The custom of not allowing children to suck for the 
first two or three days, is contrary to Nature and common sense, and is 
very hurtful to the mother and child.

EVERY mother who has milk in her breasts, ought either to suckle her own 
child, or to have her breasts frequently drawn, at least for the first 
month. This would prevent many of the diseases which prove fatal to women 
in child-bed.

WHEN an inflammation happens in the breast, attended with redness, 
hardness, and other symptoms of suppuration, the safest application is a 
poultice of bread and milk, softened with oil or fresh butter. This may be 
renewed twice a-day, till the tumour be either discussed or brought to 
suppuration. The use of repellents, in this case, is very dangerous; they 
often occasion fevers, and sometimes cancers; whereas a suppuration is 
seldom attended with any danger, and has often the most salutary effects.

WHEN the nipples are fretted or chapt, they may be anointed with a mixture 
of oil and bees-wax, or a little powdered gum-arabic may be sprinkled on 
them. I have seen Hungary water applied to the nipples have a very good 
effect. Should the complaint prove obstinate, a cooling purge may be 
given, which generally removes it.

THE miliary fever is a disease incident to women in child-bed: but as it 
has been treated of already, we shall take no further notice of it. The 
celebrated Huffman observes, That this is fever of child-bed women might 
generally be prevented, if they, during their pregnancy, were regular in 
their diet, used moderate exercise, took now and then a gentle laxative of 
manna, rhubarb, or cream of tartar, not forgetting to bleed in the first 
months, and avoid all sharp air. When the labour is coming on, it is not 
to be hastened with forcing medicines, which inflame the blood and 
humours, or put them into unnatural commotions. Care should be taken, 
after the birth, that the the natural excretions proceed regularly; and if 
the pulse be quick, a little nitrous powder, or some other cooling 
medicines, should be administered.

THE most fatal disoder consequent upon delivery is the puerperal, or child-
bed fever. It generally makes its attack upon the second or third day 
after delivery. Sometimes indeed it comes on sooner, and at other times, 
though rarely, it does not appear before the fifth or sixth day.

IT begins, like most other fevers, with a cold or shivering fit, which is 
succeeded by restlessness, pain of the head, great sickness at stomach, 
and bilious vomiting. The pulse is generally quick, the tongue dry, and 
there is a remarkable depression of spirits and loss of strength. A great 
pain is usually felt in the back, hips, and region of the womb; a sudden 
change in the quantity or quality of the lochia also takes place; and the 
patient is frequently troubled with a tenesmus, or constant inclination to 
go to stool. The urine, which is very high-coloured, is discharged in 
small quantity, and generally with pain. The belly sometimes swells to a 
considerable bulk, and becomes susceptible of pain from the slightest 
touch. When the fever has continued for a few days, the symptoms of 
inflammation usually subside, and the disease acquires a more putrid form. 
At this period, if not sooner, a bilious or putrid looseness, of an 
obstinate and dangerous nature, comes on, and accompanies the disease 
through all its future progress.

THERE is not any disease that requires to be treated with more skill and 
attention than this; consequently the best assistance ought always to be 
obtained as soon as possible. In women of plethoric constitutions, 
bleeding will generally be proper at the beginning. It ought however to be 
used with caution, and not to be repeated unless where the signs of 
inflammation rise high; in which case it will also be necessary to apply a 
blistering plaster to the region of the womb.

DURING the rigour, or cold fit, proper means should be used to abate its 
violence, and shorten its duration. For this purpose the patient may drink 
freely of warm diluting liquors, and, if low, may take now and then a cup 
of wine-whey; warm applications to the extremities, as heated bricks, 
bottles or bladders filled with warm water, and such like, may also be 
used with advantage.

EMOLLIENT clysters of milk and water, or chicken water, ought to be 
frequently administered through the course of the disease. These prove 
beneficial by promoting a discharge from the intestines, and also by 
acting as a kindly fomentation to the womb and parts adjacent. Great care 
however is requisite in giving them, on account of the tenderness of the 
parts in the pelvis at this time.

TO evacuate the offending bile from the stomach, a vomit is generally 
given. But as this is apt to increase the irritability of the stomach, 
already too great, it will be safer to omit it, and to give in its stead a 
gentle laxative, which will both tend to cool the body, and to procure a 
free discharge of the bile. Midwives ought to be very cautious in 
administering vomits or purges to women in child-bed. I have known a 
woman, who was recovering extremely well, thrown into the most danger, by 
a strong purge which was given her by an officious midwife.

THE medicine which I have always found to succeed best in this disease is 
the saline draught. This, if frequently repeated, will often put a stop to 
the vomiting, and at the same time lessen the violence of the fever, If it 
runs off by stool, or if the patient be restless, a few drops of laudanum, 
or some syrup of poppies, may occasionally be added.

IF the stools should prove so frequent as to weaken and exhaust the 
patient, a starch clyster, with thirty or forty drops of laudanum in it, 
may be administered as occasion shall require; and the drink may be rice-
water, in every English pint of which half an ounce of gum-arabic has been 
dissolved. Should these fail, recourse must be had to Columbo-root, or 
some other strong astringent.

THOUGH in general the food ought to be light, and the drink diluting, yet 
when the disease has been long protracted, and the patient is greatly 
spent by evacuations, it will be necessary to support her with nourishing 
diet and generous cordials.

IT was observed that this fever, after continuing for some time, often 
acquires a putrid form. In this case the Peruvian bark must be given, 
either by itself, or joined with cordials, as circumstances may require. 
As the bark in substance will be apt to purge, it may be given in 
decoction or infusion, mixed with the tincture of roses, or other gentle 
astringents: or, a scruple of the extract of bark with half an ounce of 
spirituous cinnamon-water, two ounces of common water, and ten drops of 
laudanum, may be made into a draught, and given every second, third, or 
fourth hour, as shall be found necessary.

WHEN the stomach will not bear any kind of nourishment, the patient may be 
supported for some time by clysters of beef-tea, or chicken-water.

TO avoid this fever, every woman in child-bed ought to be kept perfectly 
easy; her food should be light, and simple, and her bed-chamber cool, and 
properly ventilated. There is not any thing hurtful to a woman in this 
situation than being kept too warm. She ought not to have her body bound 
too tight, nor to rise too soon from bed, after delivery; catching cold is 
also to be avoided; and a proper attention should be paid to cleanliness.

TO prevent the milk-fever, the breasts ought to be frequently drawn; and 
if they are filled previous to the onset of a fever, they should, upon its 
first appearance, be drawn, to prevent the milk from becoming acrid, and 
its being absorbed in this state. Costiveness is likewise to be avoided. 
This will be best effected by the use of mild clysters and a laxative diet.

WE shall conclude our observations of child-bed women by recommending it 
to them, above all things, to beware of cold. Poor women, whose 
circumstances oblige them to quit their bed too soon, often contract 
diseases from cold, of which they never recover. It is pity the the poor 
are not better taken care of in this situation.

BUT the better sort of women run the greatest hazard from too much heat. 
They are generally kept in a sort of a bagnio for the first eight or ten 
days, and then dressed out to see company. The danger of this conduct must 
be obvious to every one.

THE superstitious custom of obliging women to keep the house till they go 
to church, is likewise a very common cause of catching cold. All churches 
are damp, and most of them cold; consequently they are the very worst 
places to which a woman can go to make her first visit, after having been 
confined in a warm room for a month.


OF BARRENNESS.

BARRENNESS may be very properly reckoned among the diseases of females, as 
few married women who have not children enjoy a good state of health. It 
may proceed from various causes, as high living, grief, relaxation, &c. 
but it is chiefly owing to an obstruction or irregularity of the menstrual 
flux.

IT is very certain that high living vitiates the humours, and prevents 
fecundity. We seldom find a barren woman among the labouring poor, while 
nothing is more common among the rich and affluent. The inhabitants of 
every country are prolific in proportion to their poverty; and it would be 
an easy matter to adduce many instances of women, who, by being reduced to 
live entirely upon a milk and vegetable diet, have conceived and brought 
forth children, though they never had any before. Would the rich use the 
same sort of food and exercise as the better sort of peasants, they would 
seldom have cause to envy their poor vassals and dependants the blessing 
of numerous and healthy offspring, while they pine in sorrow for the want 
of even a single heir to their extensive domains.

AFFLUENCE begets indolence, which not only vitiates the humours, but 
induces a general relaxation of the solids; a state highly unfavourable to 
procreation. To remove this, we would recommend the following course: 
First, sufficent exercise in the open air; secondly, a diet consisting 
chiefly of milk and vegetables; thirdly, the use of astringent medicines, 
as steel, allum, dragon's blood, elixir of vitriol, the Spaw or Tunbridge 
waters, Peruvian bark, &c. and Iastly, above all, the cold bath. Dr. 
Cheyne avers, that want of children is oftener the fault of the male than 
of the female, and strongly recommends a milk and vegetable diet to the 
former as well as the latter; adding, that his friend Dr. Taylor, whom he 
calls the Milk-doctor of Croydon, had brought sundry opulent families in 
his neighbourhood, who had continued some years after marriage without 
progeny, to have several fine children, by keeping both parents, for a 
considerable time, to a milk and vegetable diet.

BARRENNESS is often the consequence of grief, sudden fear, anxiety, or any 
of the passions which tend to obstruct the menstrual flux. When barrenness 
is suspected to proceed from affections of the mind, the person ought to 
be kept as easy and cheerful as possible; all disagreeable objects are to 
be avoided, and every method taken to amuse and entertain the fancy.



CHAPTER XLIX.
DISEASES OF CHILDREN.

MISERABLE indeed is the lot of man in the state of infancy. He comes into 
the world more helpless than any other animal, and stands much longer in 
need of the protection and care of his parents; but alas! this care is not 
always bestowed upon him; and when it is, he often suffers as much from 
improper management as he would have done from neglect. Hence the 
officious care of parents, nurses, and midwives, becomes one of the most 
fruitful sources of the disorders of infants.

OF the officious and ill-judged care of midwives, we shall adduce only one 
instance, viz. the common practice of torturing infants by squeezing their 
breasts, to draw off the milk, as they call it. Though a small quantity of 
moisture is generally found in the breasts of infants, yet as they are 
certainly not intended to give suck, this ought never to be drawn off. I 
have seen this cruel operation bring on hardness, inflammation, and 
suppuration of the breasts; but never knew any ill consequences from its 
being omitted. When the breasts are hard, the only application that we 
would recommend is a soft poultice, or a little of the diachylon plaster, 
spread thin upon a bit of soft leather, about the size of half a crown, 
and applied over each nipple. These may be suffered to continue till the 
hardness disappears.

IT must be obvious to every attentive person, that the first diseases of 
infants arise chiefly from their bowels. Nor is this in the least to be 
wondered at, as they are in a manner poisoned with indigestible drugs and 
improper diet as soon as they come into the world. Every thing that the 
stomach cannot digest may be considered as a poison; and unless it can be 
thrown up, or voided by stool, it must occasion sickness, gripes, 
spasmodic affections of the bowels, or what the good women call inward 
fits, and at last convulsions and death.

AS these symptoms evidently arise from somewhat that irritates the 
intestines, doubtless the proper method of cure must be to expel it as 
soon as possible. The most safe and effectual method of doing this is by 
gentle vomits. Five or six grains of the powder of ipecacuanha may be 
mixed in two table-spoonfuls of water, and sweetened with a little sugar. 
A tea-spoonful of this may be given to the infant every quarter of an 
hour, till it operates; or, what will more certainly answer the purpose, a 
grain of emetic tartar may be dissolved in three ounces of water, 
sweetened with a little syrup, and given as above. Those who are not fond 
of usng the emetic tartar, may give six or seven drops of the antimonial 
wine, in a tea-spoonful of water or thin gruel.

THESE medicines will not only cleanse the stomach, but will, generally, 
likewise open the body; should this, however, not happen, and if the child 
be costive, some gentle purge will be necessary: for this purpose, some 
manna and pulp of cassia may be dissolved in boiling water, and given in 
small quantities of it operates, or, what will answer rather better, a few 
grains of magnesia alba may be mixed in any kind of food that is given to 
the child, and continued till it has the desired effect. If these 
medicines be properly administered, and the child's belly and limbs 
frequently rubbed with a warm hand before the fire, they will seldom fail 
to relieve those affections of the stomach and bowels from which infants 
suffer so much.

THESE general directions include most of what can be done for relieving 
the internal disorders of infants. They will likewise go a considerable 
way in alieviating those which appear externally, as the rash, gum, or 
fellon, &c. These, as was formerly observed, are principally owing to too 
hot a regimen, and consequently will be most commonly relieved by gentle 
evacuations. Indeed, evacuations, of one kind or other, constitute a 
principal part of the medicine of infants, and will seldom, if 
administered with prudence, in any of their diseases, fail to give relief.


OF THE MECONIUM.

THE stomach and bowels of a new-born infant are filled with a blackish-
coloured matter of the consistence of syrup, commonly called the meconium. 
This is generally passed soon after the birth, by the mere effort of 
Nature; in which case it is not necessary to give the infant any kind of 
medicine. But if it should be retained, or not suffciently carried off, a 
little manna or magnesia alba may be given, as mentioned above; or, if 
these fhould not be at hand; a common spoonful of whey, sweetened with a 
little honey, or raw sugar, will answer the purpose.

The most proper medicine for expelling the meconium is the mother's milk, 
which is always, at first, of a purgative quality. Were children allowed 
to suck as soon as they shew an inclination for the breast, they would 
seldom have occasion for medicines to discharge the meconium; but even 
where this is not allowed, they ought never to have daubs of syrup, oils, 
and other indigestible stuff, crammed down their throats.


THE APHTHAE OR THRUSH.

THE apthae are little whitish ulcers affecting the whole inside of the 
mouth, tongue, throat, and stomach of infants, sometimes they reach 
through the the whole intestinal canal; in which case they are very 
dangerous, and often put an end to the infant's life

IF the apthae are of a pale colour, pellucid, few in number, soft, 
superficial, and fall easily off, they are not dangerous; but if opake, 
yellow, brown, black, thick, or running together, they ought to be dreaded.

IT is generally thought that the apthae owe their origin to acid humours; 
we have reason, however, to believe they are more frequently owing to too 
hot a regimen both of the mother and child. It is a rare thing to find a 
child who is not dosed with wine, punch, cinnamon-waters, or some other 
hot and inflaming liquors, almost as soon as it is born. It is well known 
that these will occasion inflammatory disorders even in adults; is it any 
wonder then that they should heat and inflame the tender bodies of 
infants, and set, as it were, the whole constitution on a blaze?

THE most proper medicines for the apthae are vomits, such as have been 
already recommended, and gentle laxatives. Five grains of rhubarb and half 
a drachm of magnesia alba may be rubbed together, and divided into six 
doses, one of which may be given to the infant every four or five hours 
till they operate. These powders may either be given in the child's food, 
or a little of the syrup of pale roses, and may be repeated as often as is 
found necessary to keep the body open. It is common in this case to 
administer calomel; but as that medicine sometimes occasions gripes, it 
ought always to be given to infants with caution.

MANY things have been recommended for gargling the mouth and throat in 
this disease; but it is not easy to apply these in very young infants; we 
would therefore recommend it to the nurse to rub the child's mouth 
frequently with a little borax and honey; or with the following mixture; 
Take fine honey an ounce, borax a drachm, burnt alum, half a drachm, rose-
water two drachms; mix them together. A very proper application in this 
case, is a solution of ten or twelve grains of white vitriol in eight 
ounces of barley-water. These may be applied with the finger, or by means 
of a bit of soft rag tied to the end of a probe.


OF ACIDITIES.

THE food of children being, for the most part, of an acescent nature, it 
readily turns sour upon the stomach, especially if the body be any way 
disordered. Hence most diseases of chidren are accompanied with evident 
signs of acidity, as green stools, gripes, &c. These appearances have 
induced many to believe, that all the diseases of children were owing to 
an acid abounding in the stomach and bowels; but whoever considers the 
matter attentively, will find that these symptoms of acidity are oftener 
the effect than the cause of their diseases.

NATURE evidently intended that the food of children should be acescent; 
and unless the body be disordered, or the digestion hurt from some other 
cause, we will venture to say, that the acescent quality of food is seldom 
injurious to them. Acidity, however, is often a symptom of disorders in 
children, and, as it is sometimes a troublesome one, we shall point out 
the method of relieving it.

WHEN green stools, gripes, purgings, sour smells, &c. shew that the bowels 
abound with an acid, the child should have a little small broth, with 
light white bread in it; and should have sufficient exercise in order to 
promote the digestion. It has been customary in this case to give the 
pearl-julep, chalk, crabs eyes, and other testaceous powders. These, 
indeed, by their absorbent quality, may correct the acidity; but they are 
attended with this inconvenience, that they are apt to lodge in the 
bowels, and occasion costiveness, which may prove very hurtful to the 
infant. For this reason they should never be given unless mixed with 
purgative medicines; as rhubarb, manna, or such like.

THE best medicine which we know, in all cases of acidity, is that fine 
insipid powder called magnesia alba. It purges, and at the same time 
corrects the acidity: by which means it not only removes the disease, but 
carries off its cause. It may be given in any kind of food, or in a 
mixture, as recommended in the Appendix; See Appendix, Laxative Absorbent 
Mixture.

WHEN an infant is troubled with gripes, it ought not at first to be dosed 
with brandy, spiceries, and other hot things, but should have its body 
opened with an emollient clyster, or the medicine mentioned above; and at 
the same time a little brandy may be rubbed on its belly with a warm hand 
before the fire. I have seldom seen this fail to ease the gripes of 
infants. If it should happen, however, not to succeed, a little brandy or 
other spirits may be mixed with thrice the quantity of warm water, and a 
tea-spoonful of it given frequently till the infant be easier. Sometimes a 
little peppermint-water will answer this purpose very well.


GALLING AND EXCORIATION.

THESE are very troublesome to children. They happen chiefly about the 
groin and wrinkles of the neck, under the arms, behind the ears, and in 
other parts that are moistened by the sweat or urine.

AS these complaints are, in a great measure, owing to want of cleanliness, 
the most effectual means of preventing them are, to wash the parts 
frequently with cold water, to change the linen often, and, in a word, to 
keep the child, in all respects, thoroughly clean. When this is not 
sufficient, the excoriated parts may be sprinkled with absorbent or drying 
powders; as burnt hartshorn, tutty, chalk, crabs claws prepared, and the 
like. When the parts afffected are very sore, and tend to a real 
ulceration, it will be proper to add a little sugar of lead to the 
powders; or to anoint the place with the camphorated ointment. If the 
parts be washed with spring-water, in which a little white vitriol has 
been dissolved, it will dry and heal them very powerfully. One of the best 
applications for this purpose, is to dissolve some fuller's earth in a 
sufficient quantity of hot water; and after it has stood till it is cold, 
to rub it gently upon the galled parts once or twice a-day.


STOPPAGE OF THE NOSE.

THE nostrils of infants are often plugged up with a gross mucus, which 
prevents their breathing freely, and likewise renders it difficult for 
them to suck or swallow.

SOME, in this case, order, after a suitable purge, two or three grains of 
white vitriol dissolved in half an ounce of marjoram-water, and filtered, 
to be applied now and then to the nostrils with a linen rag. Wedelius 
says, If two grains of white vitriol, and the same quantity of elaterium, 
be dissolved in half an ounce of marjoram-water, and applied to the nose, 
as above directed, that it brings away the mucus without sneezing.

IN obstinate cases these things may be tried; but I have never found any 
thing necessary, besides rubbing the nose at bed-time with a little sweet 
oil, or fresh butter. This resolves the filth, and renders the breathing 
more free. Some nurses remove this complaint by sucking the child's nose. 
This is by no means a cleanly operation; but when nurses have the 
resolution to do it, I am far from discouraging the practice.


OF VOMITING.

FROM the delicate state of children, and the great sensibility of their 
organs, a vomiting or looseness may be induced by any thing that irritates 
the nerves of the stomach or intestines. Hence these disorders are much 
more common in childhood than in the more advanced periods of life. They 
are seldom, however, dangerous, and ought never to be considered as 
diseases, unless when they are violent, or continue so long as to exhaust 
the strength of the patient.

VOMITING may be excited by an over-quantity of food; by food that is of 
such a nature as to irritate the nerves of the stomach too much; or by the 
sensibility of the nerves being so much increased as to render them unable 
to bear the stimulus of even the mildest element.

WHEN vomiting is occasioned by too much food, it ought to be promoted, as 
the cure will depend upon cleansing the stomach. This may be done either 
by a few grains of ipecacuanha, or a weak solution of emetic tartar, as 
mentioned before. When it is owing to food of an acrid or irritating 
quality, the diet ought to be changed, and aliment of a milder nature 
substituted in its stead.

WHEN vomiting proceeds from an increased degree of sensibility, or too 
great an irritability of the nerves of the stomach, such medicines as have 
a tendency to brace and strengthen that organ, and to abate its 
sensibility, must be used. The first of these intentions may be answered 
by a slight infusion of the Peruvian bark, with the addition of a little 
rhubarb and orange-peel; and the second by the saline draughts, to which a 
few drops of liquid laudanum may be occasionally added.

IN obstinate vomitings the operation of internal medicines may be assisted 
by aromatic fomentations with wine, applied warm to the pit of the 
stomach; or the use of the stomach-plaster, with the addition of a little 
Theriaca.


OF A LOOSENESS.

A LOOSENESS may generally be reckoned salutary when the stools are sour, 
slimy, green, or curdled. It is not the discharge, but the production of 
such stools, which ought to be remedied. Even where the purging is thin 
and watery, it ought not to be checked too suddenly, as it often proves 
critical, especially when the child has caught cold, or an eruption on the 
skin has disappeared. Sometimes an evacuation of this kind succeeds a 
humid state of the atmosphere, in which case it may also prove of 
advantage, by carrying off a quantity of watery humours, which would 
otherwise tend to relax the habit.

AS the principal intention in the cure of a looseness is to evacuate the 
offending matter, it is custornary to give the patient a gentle vomit of 
ipecacuanha, and afterwards to exhibit small and frequent doses of 
rhubarb; interposing absorbent medicines, to mitigate the acrimony of the 
humours. The best purge however, in this case, is magnesia alba. It is at 
the same time absorbent and laxative, and operates without exciting gripes.

THE antimonial wine, which acts both as an emetic and purge, is also an 
excellent rnedicine in this case. By being diluted with water, it may be 
proportioned to the weakest constitution; and, not being disagreeable to 
the palate, it may be repeated as often as occasion requires. Even one 
dose will frequently mitigate the disease, and pave the way for the use of 
absorbents. If, however, the patient's strength will permit, the medicine 
ought to be repeated every six or eight hours, till the stools begin to 
assume a more natural appearance; afterwards a longer space may be allowed 
to intervene between the doses. When it is necessary to repeat the 
medicine frequently, the dose ought always to be a little increased, as 
its efficacy is generally diminished by use.

SOME, upon the first appearance of a looseness, fly immediately to the use 
of absorbent medicines and astringents. If these be administered before 
the acrid humours are discharged, though the disease may appear to be 
mitigated for a little time, it soon afterwards breaks forth with greater 
violence, and often proves fatal. After proper evacuations, however, these 
medicines may be administered with considerable. advantage.

SHOULD any gripings or restlessness remain after the stomach and bowels 
have been cleansed, a tea-spoonful of the syrup of poppies may be given in 
a little simple cinnamon-water, three or four times a-day till these 
symptoms have ceased.


OF ERUPTIONS.

CHILDREN, while on the breast, are seldom free from eruptions of one kind 
or other. These, however, are not often dangerous, and ought never to be 
dried up but with the greatest caution. They tend to free the bodies of 
infants from hot and acrid humours, which, if retained, might produce 
fatal disorders.

THE eruptions of children are chiefly owing to improper food, and neglect 
of cleanliness. If a child be stuffed at all hours with food that its 
stomach is not able to digest, such food, not being properly assimilated, 
instead of nourishing the body, fills it with gross humours. These must 
either break out in form of eruptions upon the skin, or remain in the 
body, and occasion fevers and other internal disorders. That neglect of 
cleanliness is a very general cause of eruptive disorders, must be obvious 
to every one. The children of the poor, and of all who despise 
cleanliness, are almost constantly found to swarm with vermin, and are 
generally covered with the scab, itch, and other eruptions.

WHEN eruptions are the affect of improper food, or want of cleanliness, a 
proper attention to these alone will generally be sufficient to remove 
them. If this should not be the case, some drying medicines will be 
necessary. When they are applied, the body ought at the same time to be 
kept open, and cold is carefully to be avoided. We know no medicine that 
is more safe for drying up cutaneous eruptions than sulphur, provided it 
be prudently used. A little of the flour of sulphur may be mixed with 
fresh butter, oil or hog's lard, and the parts effected frequently touched 
with it.

THE most obstinate of all the eruptions incident to children are, the 
tinea capitis, or scabbed head, and chilblains. The scabbed head is often 
exceeding difficult to cure, and sometimes indeed the cure proves worse 
than the disease. I have frequently known children seized with internal 
disorders, of which they died soon after their scabbed heads had been 
healed by the application of drying medicines. I sometimes ago saw a very 
striking instance of the danger of substituting drying medicines in the 
place of cleanliness and wholesome food, in the Foundling Hospital at 
Ackworth, where the children were grievously afflicted with scabbed heads 
and other cutaneous disorders. Upon inquiry it was found, that very little 
attention was paid either to the propriety or soundness of their 
provisions, and that cleanliness was totally neglected; accordingly it was 
advised that they should have more wholesome food, and be kept thoroughly 
clean. This advice, however, was not followed. It was too troublesome to 
the servants, superintendants, &c. The bussiness was to be done by 
medicine; which was accordingly attempted, but had nearly proved fatal to 
the whole house. Fevers and other internal disorders immediately appeared, 
and, at length, a putrid dysentary, which proved so infectious, that it 
carried off a great many of the children, and spread over a considerable 
part of the neighbouring country.

THE cure ought always first to be attempted by keeping the head very 
clean, cutting off the hair, combing and brushing away the scabs, &c. If 
this is not sufficient, let the head be shaved once a-week, washed daily 
with soap suds, and gently anointed with a liniment made of train oil 
eight ounces, red precipitate, in fine powder, one drachm. And if there be 
proud flesh, it should be touched with a bit of blue vitriol, sprinkled 
with a little burnt allum. While these things are doing, the patient must 
be confined to a regular light diet, the body should be kept gently open; 
and cold, as far as possible, ought to be avoided. To prevent any bad 
consequences from stopping this discharge, it will be proper, especially 
in children of a gross habit, to make an issue in the neck or arm, which 
may be kept open till the patient becomes more strong, and the 
constitution be somewhat mended.

CHILBLAINS commonly attack children in cold weather. They are generally 
occasioned by the feet or hands being kept long wet or cold, and 
afterwards suddenly heated. When children are cold, instead of taking 
exercise to warm themselves gradually, they run to the fire. This 
occasions a sudden rarefaction of the humours, and an infraction of the 
vessels; which being often repeated, the vessels are at last over 
distended, and forced to give way.

TO prevent it, violent cold and sudden heat must be equally avoided. When 
the parts begin to look red and swell, the patient ought to be purged, and 
to have the affected parts frequently rubbed with mustard and brandy, or 
something of a warming nature. They ought likewise to be covered with 
flannel, and kept warm and dry. Some apply warm ashes betwixt cloths to 
the swelled parts, which frequently help to reduce them. When there is a 
sore, it must be dressed with Turner's cerate, the ointment of tutty, the 
plaster of cerus, or some other drying ointment. These sores are indeed 
troublesome, but seldom dangerous. They generally heal as soon as the warm 
weather sets in.


OF THE CROUP.

CHILDREN are often seized very suddenly with this disease, which, if not 
quickly relieved, proves mortal. It is known by various names in different 
parts of Britain. On the east coast of Scotland it is called the croup. On 
the west they call it the chock or stuffing. In some parts of England, 
where I have observed it, the good women call it the rising of the lights. 
It seems to be a species of asthma, attended with very acute and violent 
catarrhal symptoms.

THIS disease generally prevails in cold and wet seasons. It is most common 
upon the sea-coast, and in low marshy countries. Children of a gross and 
lax habit are most liable to it. I have sometimes known it hereditary. It 
generally attacks children in the night, after having been much exposed to 
damp cold easterly winds through the day. Damp houses, wet feet, thin 
shoes, wet clothes, or any thing that obtructs the perspiration, may 
occasion the croup.

IT is attended with a frequent pulse, quick and laborious breathing, which 
is performed with a peculiar kind of croaking noise, that may be heard at 
a considerable distance. The voice is sharp and shrill, and the face is 
generally much flushed, though sometimes it is of a livid colour.

WHEN a child is seized with the above symptoms, his feet should 
immediately be put into warm water. He ought likewise to be bled, and to 
have a laxative clyster administered as soon as possible. In this disease 
bleeding is not always proper; but in very full habits it must certainly 
be of use. He should be made to breathe over the steams of warm water and 
vinegar; or an emollient decoction, and emollient cataplasms or 
fomentations may be applied round his neck. If the symptoms do not abate, 
a blistering plaster must be applied round the neck or betwixt the 
shoulders, and the child may take frequently a table-spoonful of the 
following julep: Take penny-royal water three ounces, syrup of althea and 
balsamic syrup, each one ounce, mix them together.

ASAFOETIDA is found to have a good effect in this case. It may be both 
given in form of clyster, and taken by the mouth. Two drachms of 
asafoetida may be dissolved in one ounce of Mindererus spirit, and three 
ounces of penny-royal water. A table-spoonful of this mixture may be given 
every hour, or oftener if the patient's stomach be able to bear it. If the 
child cannot be brought to take this medicine, two drachms of the 
asafoetida may be dissolved in a common clyster, and administered every 
six or eight hours, till the violence of the disease abates. I was lately 
favoured with a letter from Dr. William Turnbull in London, a physician of 
great experience; and who, from his former situation on the north-east 
coast of England, had many opportunities of observing the symptoms and 
progress of this dangerous disease. I am sorry the letter came too late to 
be inserted at length; but as the Doctor's sentiments differ very little 
from my own, this misfortune is the less to be regretted. The Doctor 
indeed observes, that he never found blistering of any service; but 
recommends cataplasms of garlic, camphor, and Venice treacle, to be 
applied both to the throat and soles of the feet. He likewise recommends 
boluses of camphor, castor, valerian root, salt of hartshorn, and musk, 
adapted to the age, strength, &c. of the patient; after which he advises 
two spoonfuls of following decoction: - Take of garlic and distilled 
vinegar each an ounce, hysop-water eight ounces; beat up the ingredients 
together, gradually mixing the water, and adding three ounces of honey. 
Let the whole be simmered over a gentle fire, and afterwards strained for 
use.

TO prevent a return of the disorder, all those things which occasion it 
must be carefully avoided; as wet feet, cold, damp, easterly winds, &c. 
Children who have had frequent returns of this disease, or whose 
constitutions seem to dispose them to it, ought to have their diet 
properly regulated; all food that is viscid or hard of digestion, and all 
crude, raw, trashy fruits are to be avoided. They ought likewise to have a 
drain constantly kept open in some part of their body, by means of a seton 
or issue: I have sometimes known a Burgundy-pitch plaster, worn 
continually betwixt the shoulders for several years, have a very happy 
effect in preventing the return of this dreadful disorder.


OF TEETHING.

DR. ARBUTHNOT observes, that above a tenth part of infants die in 
teething, by symptoms proceeding from the irritation of the tender nervous 
parts of the jaws, occasioning inflammations, fevers, convulsions, 
gangrenes, &c. These symptoms are, in a great measure, owing to the great 
delicacy and exquisite sensibility of the nervous system at this time of 
life, which is too often increased by an effeminate education. Hence it 
comes to pass, that children who are delicately brought up, always suffer 
most in teething, and often fall by convulsive disorders.

ABOUT the sixth or seventh month the teeth generally begin to make their 
appearance; first the incisores, or fore-teeth; next the canini, or dog-
teeth; and, lastly, the molares, or grinders. About the seventh year, 
there comes a new set; and about the twentieth, the two inner grinders, 
called dentes sapientiae, the teeth of wisdom.

CHILDREN, about the time of cutting their teeth, slaver much, and have 
generally a looseness. When the teething is difficult, especially when the 
dog-teeth begin to make their way through the gums, the child has 
startings in his sleep, tumours of the gums, watchings, gripes, green 
stools, the thrush, fever, difficult breathing, and convulsions.

DIFFICULT teething requires nearly the same treatment as an inflammatory 
disease. If the body be bound, it must be opened either by emollient 
clysters or gentle purgatives; as manna, magnesia alba, rhubarb, senna, or 
the like. The food should be light and in small quantity; the drink 
plentiful, but weak and diluting, as infusions of balm, or of the lime-
tree flowers; to which about a third or fourth part of milk may be added.

IF the fever be high, bleeding will be necessary; but this, in very young 
children, ought always to be sparingly performed. It is an evacuation 
which they bear the worst of any. Purging, vomiting, or sweating agree 
much better with them and are generally more beneficial. Harris, however, 
observes, that when an inflammation appears, the physician will labour in 
vain, if the cure be not begun with applying a leech under each ear. If 
the child be seized with convulsion fits, a blistering plaster may be 
applied betwixt the shoulders or one behind each ear.

SYDENHAM says, that in fevers occasioned by teething, he never found any 
remedy so effectual as two, three, or four drops of spirits of hartshorn 
in a spoonful of simple water, or other convenient vehicle, given every 
four hours. The number of doses may be four five, or six. I have often 
prescribed this medicine with success, but always found a larger dose 
necessary. It may be given from five drops to fifteen or twenty, according 
to the age of the child, and, when costiveness does not forbid it, three 
or four drops of laudanum may be added to each dose.

IN Scotland, it is very common, when children are cutting their teeth, to 
put a small Burgundy-pitch plaster between their shoulders. This generally 
eases the tickling cough which attends teething, and is by no means an 
useless application. When the teeth are cut with difficulty, it ought to 
be kept on during the whole time of teething. It may be enlarged as 
occasion requires, and ought to be renewed, at least once a fortnight.

SEVERAL things have been recommended for rubbing the gums, as oils, 
mucilages, &c. but from these much is not to be expected. If any thing of 
this kind is to be used, we would recommend a little fine honey, which may 
be rubbed on with the finger three or four times a-day. Children are 
generally at this time disposed to chew whatever they get into their 
hands. For this reason they ought never to be without somewhat that will 
yield a little to the pressure of their gums, as a crust of bread, a wax 
candle, a bit of liquorice root, or such like.

WITH regard to cutting the gums, we have seldom known it of any great 
benefit. In obstinate cases, however, it ought to be tried. It may be 
performed by the finger-nail, the edge of a six-penny piece that is worn 
thin, or any sharp body which can be with safety introduced into the 
mouth; but the lancet, in a skilful hand, is certainly the most proper.

IN order to render the teething less difficult, parents ought to take care 
that their children's food be light and wholesome, and that their nerves 
be braced by sufficient exercise without doors, the use of the cold bath, 
&c. Were these things duly regarded, they would have a much better effect 
than teething necklaces, or other nonsensical amulets worn for that 
purpose.


OF THE RICKETS.

THIS disease generally attacks children between the age of nine months and 
two years. It appeared first in England about the time when manufactures 
began to flourish, and still prevails most in towns where the inhabitants 
follow sedentary employments, by which means they neglect either to take 
proper exercise themselves, or to give it to their children.

CAUSES. - One cause of the rickets is diseased parents. Mothers of a weak 
relaxed habit, who neglect exercise, and live upon weak watery diet, can 
neither be expected to bring forth strong and healthy children, or to be 
able to nurse them, after they are brought forth. Accordingly we find that 
the children of such women generally die of the rickets, the scrophula, 
consumptions, or such like diseases. Children begotten by men in the 
decline of life, who are subject to the gout, the gravel, or other chronic 
diseases, or who have been often affected with the venereal disease in 
their youth, are likewise very liable to the rickets.

ANY disorder that weakens the constitution, or relaxes the habit of 
children, as the small-pox, measles, teething, the hooping-cough, &c. 
disposes them to this disease. It may likewise be occasioned by improper 
diet, as food that is either too weak and watery, or so viscid that the 
stomach cannot digest it.

BAD nursing is the chief cause of this disease. When the nurse is either 
diseased, or has not enough of milk to nourish the child, it cannot 
thrive. But children suffer oftener by want of care in nurses than want of 
food. Allowing an infant to lie or sit too much, or not keeping it 
thoroughly clean in its cloths, has the most pernicious effects.

THE want of free air is likewise very hurtful to children in this respect. 
When a nurse lives in a close, small house, where the air is damp and 
confined, and is too indolent to carry her child abroad into the open air, 
it will hardly escape this disease. A healthy child should always be in 
motion, unless when asleep; if it be suffered to lie, or sit, instead of 
being tossed and dandled about, it will not thrive.

SYMPTOMS. - At the beginning of this disease the child's flesh grows soft 
and flabby, its strength is diminished; it loses its wanted cheerfulness, 
looks more grave and composed than is natural for its age, and does not 
chuse to be moved. The head and belly become too large in proportion to 
the other parts; the face appears full, and the complexion florid. 
Afterwards the bones begin to be affected, especially in the more soft and 
spungy parts. Hence the wrists and ancles become thicker than usual; the 
spine or back bone puts on an unnatural shape the breast is likewise often 
deformed; and the bones of the arms and legs grow crooked. All those 
symptoms vary according to the violence of the disease. The pulse is 
generally quick, but feeble; the appetite and digestion, for the most 
part, bad; the teeth come slowly and with difficulty, and they often rot 
and fall out afterwards. Ricketty children generally have great acuteness 
of mind, and an understanding above their years. Whether this is owing to 
their being more in the company of adults than other children, or to the 
preternatural enlargement of the brain, is not material.

REGIMEN. - As this disease is always attended with evident signs of 
weakness and relaxation, our chief aim in the cure must be to brace and 
strengthen the solids, and to promote the digestion and the due 
preparation of the fluids. These important ends will be best answered by 
wholesome nourishing diet, suited to the age and strength of the patient; 
open, dry air, and sufficient exercise. If the child has a bad nurse, who 
either neglects her duty; or does not understand it, she shouid be 
changed. If the season be cold, the child ought to be kept warm; and when 
the weather is hot, it ought to be kept cool; as sweating is apt to weaken 
it; and too great a degree of cold has the same effect. The limbs should 
be rubbed frequently with warm hands, and the child kept as cheerful as 
possible.

THE diet ought to be dry and nourishing, as good bread, roasted flesh, &c. 
Biscuit is generally reckoned the best bread; and pigeons, pullets, veal, 
rabbits, or mutton roasted or minced, are the most proper flesh. If the 
child be too young for flesh-meats, he may have rice, millet, or pearl-
barley boiled with raisins, to which may be added a little wine and spice. 
His drink may be good claret, mixed with an equal quantity of water. Those 
who cannot afford claret, may give the child now and then a wine-glass of 
mild ale, or good porter.

MEDICINE. - Medicines are here of little avail. The disease may often be 
cured by the nurse, but seldom by the physician. In children of a gross 
habit, gentle vomits and repeated purges of rhubarb may sometimes be of 
use, but they will seldom carry off the disease; that must depend chiefly 
upon such things as brace and strengthen the system: for which purpose, 
besides the regimen mentitioned above, we would recommend the cold bath, 
especially in the warm season. It must, however, be used with prudence, as 
some ricketty children cannot bear it. The best time for using the cold 
bath is in the morning, and the child should be well rubbed with a dry 
cloth immediately after he comes out of it. If the child should be 
weakened by the cold bath, it must be discontinued.

SOMETMES issues have been found beneficial in this disease. They are 
peculiarly necessary for children who abound with gross humours. An 
infusion of the Peruvian bark in wine or ale, would be of service, were it 
possible to bring children to take it. We might here mention many other 
medicines which have been recommended for the rickets; but as there is far 
more danger in trusting to these than in neglecting them altogether, we 
chuse rather to pass them over, and to recommend a proper regimen as the 
thing chiefly to be depended on.


OF CONVULSIONS.

THOUGH more children are said to die of convulsions than of any other 
disease, yet they are for the most part only a symptom of some other 
malady. Whatever greatly irritates or stimulates the nerves, may occasion 
convulsions. Hence infants whose nerves are easily affected, are often 
thrown into convulsions by any thing that irritates the alimentary canal; 
likewise by teething; strait clothes; the approach of the small-pox, 
measles, or other eruptive diseases.

WHEN convulsions proceed from an irritation of the stomach or bowels, 
whatever clears them of their acrid contents, or renders these mild and 
inoffensive, will generally perform a cure; wherefore, if the child be 
costive, the best way will be to begin with a clyster, and afterwards to 
give a gentle vomit, which may be repeated occasionally, and the body in 
the mean time kept open by gentle doses of magnesia alba, or small 
quantities of rhubarb mixed with the powder of crabs claws.

CONVULSIONS which precede the eruption of the small-pox or measles, 
generally go off upon these making their appearance. The principal danger 
in this case arises from the fears and apprehensions of those who have the 
care of the patient. Convulsions are very alarming, and something must be 
done to appease the affrighted parents, nurses, &c. Hence the unhappy 
infant often undergoes bleeding, blistering, and several other operations, 
to great danger of its life, when a little time, bathing of the feet, and 
throwing in a mild clyster, would have set all to rights.

WHEN convulsion fits arise from the cutting of teeth, besides gentle 
evacuations, we would recommend blistering, and the use of antispasmodic 
medicines, as the tincture of soot, asafoetida, or castor. A few drops of 
any of these may be mixed in a cup of white-wine whey, and given 
occasionally.

WHEN convulsions proceed from any external cause, as the pressure 
occasioned by strait clothes or bandages, &c. These ought immediately to 
be removed; though in this case taking away the cause will not always 
remove the effect, yet it ought to be done. It is not likely that the 
patient will recover, as long as the cause which first gave rise to the 
disorder continues to act.

WHEN a child is seized with convusions without having any complaint in the 
bowels, or symptoms of teething; or any rash, or other discharge, which 
has been suddenly dried up, we have reason to conclude that it is a 
primary disease, and proceeds immediately from the brain. Cases of this 
kind, however, happen but seldom, which is very fortunate, as little can 
be done to relieve the unhappy patient. When a disease proceeds from an 
original fault in the formation or structure of the brain itself, we 
cannot expect that it should yield to medicine. But, as this is not always 
the cause, even of convulsions which proceed immediately from the brain, 
some attempts should be made to remove them. The chief intention to be 
pursued for this purpose, is to make some derivation from the head, by 
blistering, purging, and the like. Should these fail, issues or setons may 
be put in the neck, or between the shoulders.


OF WATER IN THE HEAD.

THOUGH water in the head, or a dropsy of the brain, may affect adults as 
well as children, yet, as the latter are more peculiarly liabile to it, we 
thought it would be most proper to place it among the diseases of infants.

CAUSES. - A dropsy of the brain may proceed from injuries done to the 
brain itself by falls, blows, or the like; it may likewise proceed from an 
original laxity or weakness of the brain; from scirrhous tumours or 
excrescences within the skull; a thin watery state of the blood, a 
diminished secretion of urine; and lastly, from tedious and lingering 
diseases, which waste and consume the patient.

SYMPTOMS. - This disease has at first the appearance of a slow fever; the 
patient complains of a pain in the crown of his head, or over his eyes; he 
shuns the light; is sick, and sometimes vomits. His pulse is irregular and 
generally low: though he seems heavy and dull, yet he does not sleep: he 
is sometimes delirious, and frequently sees objects double; towards the 
end of this commonly fatal disease, the pulse becomes more frequent, the 
pupils are generally dilated, the cheeks flushed, the patient becomes 
comatose; and convulsions ensue.

MEDICINE. - No medicine has hitherto been found sufficient to carry off a 
dropsy of the brain. It is laudable, however, to make some attempts, as 
time or chance may bring many things to light, of which at present we have 
no idea. The medicines generally used are, purges of rhubarb or jalap with 
calomel, and blistering plasters applied to the neck or back part of the 
head. To which we would beg leave to add diuretics, or medicines which 
promote the secretion of urine, such as are recommended in the common 
dropsy. A discharge from the nose ought likewise to be promoted by causing 
the patient to snuff the powder of asarum, white hellebore or the like. 
Some practitioners have of late pretended to cure this disease by the use 
of mercury. I have not been so happy as to see any instances of a cure 
being performed in a confirmed dropsy of the brain; but in so desperate a 
malady every thing deserves a trial. One reason why this disease is seldom 
or never cured, may be, that it is seldom known till too far advanced to 
admit of a cure. Did parents watch the first symptoms, and call a 
physician in due time, I am inclined to think that something might be 
done. But these symptoms are not yet sufficiently known, and are often 
mistaken even by physiclans themselves. Of this I lately saw a striking 
instance in a patient attended by an eminent practitioner of this city, 
who had all along mistaken the disease for teething.