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John Roberton, Observations on the Mortality
and Physical Management of Children

Part I, Section IX

The Diseases of Infancy, and the Ages at which they Prove Fatal, Illustrated by a Table

In a former section, we have seen how large a proportion of the deaths in this country, and in some parts of the Continent, happens, under the age of 10 years. A mortality so great must have many causes, some of which we may presume will depend on circumstances peculiar to civilized society. Granting this, we do not thence infer that the probability of life in the savage state, although its maladies are fewer, is greater than with us. On the contrary, it is certainly less for adults, if not for children. Wars, hardships, alternate famine and surfeit, unwholesome food, gross licentiousness, infanticide, and other barbarous and unnatural practices, as well as great liability to pestilential complaints, check the increase of population in such a condition of society more than even the luxuries and numerous diseases of civilized life.

It is true, perhaps, that we may learn something with respect to the physical management of the young, from the usages of people in a state of nature. Yet to represent such a state as more conducive to health and happiness than that which is the result of civilization, as some philosophers have done, shews an amusing fondness for hypothesis, joined to a convenient forgetfulness of facts.

I am inclined to think we might even learn more than is really useful from an attentive study of the habits of brute animals. Mankind, in whatever state of society, the rude or the polished, are continually straying from truth and nature, by an inherent tendency to pervert their faculties and appetites to their own injury. With the inferior animals it is different. Instinct, unless when blunted by domestication, is in them almost unerring for the ends it was intended to serve; the principal of which are the selection of proper food, and the preservation of life generally. Hence they are liable to fewer diseases, and especially, are less subject to premature death, than the human species. Indeed with a little exaggeration brute creatures might be held up as in several respects well worthy of our imitation; with full as much propriety, at least, as those filthy tribes of human beings which some have dignified with the name of "unsophisticated children of nature."

It is pleasing to reflect that health and happiness keep pace with the progress of knowledge and civilization, even in a degree greater than, unless when we carefully compare the present and the past, we should imagine possible. Reverting to a period as yet little more than a century removed, we find many fatal diseases prevailed then, depending chiefly on circumstances in the condition and habits of the people, the state of the soil, and want of medical knowledge, which now are unknown, or so modified as to excite comparatively little attention. Such were the plague, the milliary fever, scurvy, rickets, dysentery, spotted and intermittent fevers; and it is our own disgrace if we cannot add, small pox.

Within the last seventy years, the habits of the lower classes especially, have been rapidly improving; and as there can be no question that the moral more than the physical condition of human beings, influences the rate of mortality, we may hope for yet greater improvement in the healthiness and comfort of our population.

Indeed much remains to be done. There are many hurtful prejudices to be eradicated, especially in the domestic management of children, and of the sick. There is great room for advancement in the knowledge and treatment of disease, but particularly in the cultivation of infantile medicine. Our medical police too, if it be worthy of the name, is singularly defective; in this respect we are behind every other European state; a circumstance too well attested, among other proofs, by the continued prevalence of the small pox in all our large towns, when it has for some time been wholly, or nearly extinguished, in most civilized countries. To these might be added grave defects of an economic kind, particularly in the parochial management of the poor, the administration of many of our public charities, and in the want of a general efficient system of education; what has been done in this latter respect, being, in a very great degree, inadequate, at least in populous districts. We should hardly err in affirming, that the rate of infantile mortality will be found to be, coeteris paribus, in the ratio of the ignorance and improvidence of the population; a consideration which gives no little weight to the defects above mentioned.

It is consoling to reflect that, where so much remains to be done in the great cause of human improvement and happiness, every one may do something. Whoever, in his own particular sphere, assiduously inculcates sobriety, cleanliness, industry, and forethought; and is on the watch to correct hurtful prejudices and practices, especially in all that concerns the moral and physical education of the young, performs duties which are not the less important because they are humble and unobtrusive. It certainly does not thence follow that their effects will be limited. The most effective virtues are those which operate at first in small circles: for, as he that is guilty of a moral injury to even a single human being, can never calculate what may be the extent and duration of the evil to which he has given the impulse; so he that is instrumental in improving one individual, however lowly that individual's condition, can as little estimate either the extent or duration of the benefit.

The importance of infantile diseases, in a medical point of view, must be obvious, when we reflect that, under 10 years of age, nearly five times as many human beings die as in any after period of life of the same duration: and moreover, that perhaps two-thirds of all the cases confided to the care of the general practitioner are children's complaints. That these complaints have not hitherto, in this country, received that share of attention which they merit, is evident from the comparatively small number of works in our language which treat of them. When a department of any science is zealously studied, publications relating to it will be sure to appear as the fruits of such study.

The following table has been extracted with great care, and I hope accuracy, from the valuable register at the Rusholme Road Cemetery. It will assist us in estimating the comparative danger from different infantile diseases, as well as the age, at which the attack of each is most to be dreaded. It strikes me that many other important corollaries may likewise be drawn from it. In regard to the value of the register referred to, as a record of diseases which cause death, I am inclined to believe, from the character and habits of the present respected registrar, that it is kept with great discrimination and accuracy, and that it is on many accounts incomparably more worthy of reliance than the London mortality bills. It is certainly a considerable, but in this country unavoidable, defect in the mode of registration, that the name of the disease is entered from the mere viva voce report of the friends of the diseased, and not as in some parts of the continent, in Berlin, for example, from the certificate of a medical practitioner. Until there is some legal provision to enforce the latter practice in England as respects the keeping of the parochial and other mortuary registers, we must be contented to remain, as we are now, far behind every other country in the important and fascinating study of medical statistics.

Diseases

Under 1 Month

Between 1 and 2 Months

2 and 3 Months

3 and 6 Months

6 and 9 Months

9 and 12 Months

1 and 2 Years

2 and 3 Years

3 and 5 Years

5 and 10 Years

Total

Measles

0

1

1

5

8

25

117

72

50

20

299

Scarlet Fever

0

0

0

0

1

0

0

1

4

2

8

Small Pox

0

1

2

5

25

17

49

30

44

14

187

Quinsey

0

0

0

0

0

0

0

0

0

1

1

Erysipelas

0

0

0

1

0

0

0

0

0

0

1

Swine Pox

0

0

0

0

0

0

0

0

1

0

1

Chin-Cough

0

2

3

17

17

16

48

24

17

6

150

Croup

0

0

0

3

2

3

9

10

12

2

41

Inflammation of the Lungs

0

1

3

14

36

17

42

12

21

9

155

Do. of the Bowels

4

2

0

4

8

3

7

6

1

3

38

Do. of the Brain

0

0

0

1

0

1

0

0

0

1

3

Inflammatory Fever

0

0

0

0

0

0

1

0

0

2

3

Inflammation of the Liver

0

0

0

0

0

0

2

0

0

0

2

Do. of the Kidneys

0

0

0

0

0

0

1

0

0

0

1

Ulcerated Throat

0

0

0

0

0

0

0

0

0

1

1

Mortification

0

0

0

0

0

0

0

0

0

1

1

Water in the Brain

1

0

1

14

16

8

39

18

10

18

125

Convulsions

121

85

42

49

14

9

9

1

1

1

332

Fits

0

2

0

4

2

1

1

4

4

0

18

Asthma

0

0

0

0

0

0

0

0

1

1

2

Water in the Chest

0

0

1

0

0

0

0

0

1

0

2

Disorder of the Nerves

0

0

0

0

1

0

0

0

0

0

1

Dropsy

0

0

0

0

0

0

0

0

0

3

3

Brain Fever

0

0

0

0

0

0

1

1

0

5

7

Continued Do.

1

0

0

0

1

1

2

3

1

0

9

Typhus Do.

0

0

0

0

0

0

1

1

0

6

8

Worm Do.

0

0

0

0

0

0

2

7

1

1

11

Tooth Do. and Teething

0

0

0

12

34

47

78

9

1

0

181

Remittent Do.

0

0

0

0

0

0

0

1

0

0

1

Rheumatic Do.

0

0

0

0

0

0

0

0

0

1

1

Putrid Do.

0

0

0

0

0

0

1

1

0

0

2

Cholera Morbus

1

1

2

6

1

4

4

1

0

1

21

Bowel Complaints

5

11

7

17

15

12

10

4

2

2

85

Black Thrush

0

0

0

2

0

1

1

0

0

0

4

Bilious Complaints

0

0

0

1

1

0

0

0

0

0

2

Jaundice

0

0

1

0

0

0

0

0

0

0

1

Violent Vomiting

0

0

0

0

0

0

1

0

0

0

1

Stoppage in the Bowels

1

0

0

1

0

1

0

0

1

0

4

Infantile Decline

7

10

9

39

34

22

66

30

20

23

260

Consumption

0

0

0

0

0

0

0

0

6

12

18

Decline after Measles

0

0

0

0

0

0

3

1

1

0

5

Stricture of the Bowels

0

0

0

2

0

0

1

0

1

0

4

Defect in the Internal Organization

0

0

0

0

0

0

0

1

0

0

1

Inflammation of the Head

0

0

2

0

0

0

0

1

0

1

4

Tumour on the Hip

0

0

0

0

1

0

0

0

0

0

1

Inflammation in the Groin

0

0

0

1

0

0

0

0

0

0

1

Inflammation in the Neck

0

0

0

1

0

0

0

0

0

0

1

White Swelling

0

0

0

0

1

0

0

0

0

0

1

Burned to Death

1

0

0

0

0

0

1

1

5

7

15

Scalded to Death

0

0

0

0

0

0

1

2

1

1

5

Swallowed Vitriol

0

0

0

1

0

0

0

0

0

0

1

Took Too Much Gamboge

0

0

0

0

0

0

1

0

0

0

1

Hunger and Cold

0

0

0

0

0

0

0

1

0

0

1

Killed by a Fall

0

0

0

0

0

1

1

0

0

1

3

Do. by the Kick of a Horse

0

0

0

0

0

0

0

1

0

0

1

Do. by a Blow

0

0

0

0

0

0

0

1

0

0

1

Concussion of the Brain

0

0

0

0

0

0

0

0

1

0

1

Drowned

0

0

0

0

0

0

0

0

0

4

4

Unknown and Lingering Compts.

4

0

0

1

0

4

1

1

2

1

14

Total

146

116

74

201

218

193

501

246

210

151

2056

In the Table, under the heads of "Infantile Decline," "Convulsions," "Worm Fever," &c. are no doubt included many distinct diseases to which these popular appellations are indiscriminately assigned; but in other instances, as "Chin-cough," "Measles," "Scarlet Fever," "Croup," there can hardly be mistake. As an internal evidence of the accuracy of the register, "Tooth Fever" and "Teething" may be instanced. It will be seen in the Table that the deaths under this head, are all at ages, when the effects of teething are usually experienced. Moreover it is also to be considered that the name of a disease, as reported by the friends of the dead, is in general that which they have learned from the professional attendant.

After repeated attempts to class the diseases in this table, in nosological order, I find it to be impracticable. No arrangement of children's complaints has yet appeared which, in my opinion, is likely to answer any scientific purpose. [1] Indeed it would seem that writers on nosology in general have exerted their talents in a thankless task; -- talents too of a high order, as the perseverence, learning, and ingenuity of several abundantly shew. Certainly we may doubt how far their labours have been useful, or whether they have not retarded rather than advanced the science of medicine. Unwilling should I be, and the attempt would be absurd, to undervalue the productions of men such as Cullen, and Mason Good; the fame of the former as a nosologist is still unequalled, as will ever be some of his definitions of diseases; yet there is little doubt his reputation will rest upon his Materia Medica and Practice of Physic, when his work on nosology remains only as a curious document to illustrate the history of the healing art.

Whether a nosological arrangement, the fruit of modern pathology, is a hopeless expectation, remains yet to be seen. The degree to which diseases are modified by constitution, season, climate, and an infinite variety of accidental circumstances, renders it at least doubtful; and if doubtful, as respects diseases in general, it is still more so with reference to infantile complaints.

The foregoing Table suggests many important considerations. Of the 2056 deaths from various diseases which it exhibits, 994 alone, and most of them within the first year of life, are from Convulsions, Infantile Decline, Water in the Brain, Tooth Fever and Teething, Worm Fever, and Bowel Complaints. Such terms are no doubt somewhat indefinite, and probably, as has been already observed, comprise a variety of diseases which they do not express; yet into how many varieties soever they may be distinguishable, most, if not all of them originate in disorder of the first passages. When to these we add Remittent, Typhoid, Continued, and Inflammatory Fevers, which are to be traced, perhaps, in every instance to a similar origin, we cannot fail being struck with the comparatively small number of deaths resulting from what are called regular diseases. No facts can shew more forcibly the importance which ought to be attached to the physical management of children. Upon it chiefly depends, under all circumstances, the healthy condition of the digestive organs; and when it is neglected or conducted in error, the foundation is laid for many definite as well as anomalous ailments which either ruin the health or speedily prove fatal.

I have only met with Tables on a similar plan in the writings of two authors. In three successive volumes of the Philosophical Transactions, those for the years 1772, 73, and 74, tabular arrangements of the diseases of Chester are published by Dr. Haygarth of that city. The following is extracted from these documents.

Diseases

Under 1 Year

Between 1 and 2 Years

2 and 3 Years

3 and 5 Years

5 & 10 Years

Total

Fevers

5

1

2

6

10

24

Teething

6

3

0

0

0

9

St. Anthony's Fire

1

0

0

0

0

1

Small Pox

55

40

46

54

24

219

Measles

0

2

0

0

0

2

Consumption

4

4

6

2

4

20

Convulsions

139

35

8

12

1

195

Chin-Cough

15

8

5

3

2

33

Weakness of Infancy

20

13

7

7

2

49

Rickets

3

0

1

1

0

7

Water in the Brain

0

0

0

1

2

3

Quinsey

1

0

0

0

0

1

Thrush

1

0

0

0

0

1

Looseness

1

0

0

0

0

1

Cancer

0

0

0

0

1

1

Cholic

1

0

0

0

0

1

Mortification

0

0

0

0

1

1

Sore Throat

0

1

0

3

0

4

Casualties

0

0

0

3

2

5

Unknown Complaints

2

1

0

1

1

5

Total

254

110

75

93

50

582

There is a Table of the diseases of Carlisle, for eight years, viz. from 1779 to 1789, (excepting the year 1780, which was lost) the production of Dr. Heysham, and to be found in Milne's work on Annuities. The following is that part of the Table which includes the deaths under the age of ten years.

Diseases &c.

From Birth to 5 years of age.

Between 5 & 10 years.

Total

Nervous Fever

2

3

5

Putrid Fever

5

4

9

Jail Fever

4

2

6

Sore Throat

3

0

3

Pleurisy

3

2

5

Small Pox

225

8

233

Measles

28

2

30

Scarlet Fever

31

4

35

Thrush

63

2

65

Consumption

34

15

49

Infantile Remittent Fever

19

8

27

Teathing

3

0

3

Fainting

0

1

1

Convulsions

10

0

10

Asthma

1

0

1

Chin-cough

18

1

19

Diarrhoea

7

1

8

Dropsy

1

1

2

Weakness of Infancy

204

0

204

Costiveness

1

0

1

Dropsy of the Brain

2

2

4

Scrofula

0

2

2

Jaundice

3

0

3

Unknown Diseases

32

11

43

Accidents

7

5

12

Total

707

74

781

 

Footnotes

[1] The only attempts of this kind, which the writer has seen, are contained in Dr. B. Davis' Annals of the London Dispensary for Children; and in M. Eusebe de Salle's recent edition of Underwood, both highly respectable, but in his opinion, unsatisfactory.


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