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Michael Underwood, 1819, Treatise on the Diseases of Children

Volume III.


Whatever splendour the actual treatment of Diseases may reflect on the science of Medicine, it by no means comprehends the whole of its province; for prevention being in every case preferable to remedies, the medical art would be more imperfect than other sciences, were it devoted only to the latter. In the management of infants more especially, such a variety of other articles occurs subject to medical direction, that this work would be peculiarly incomplete if confined merely to the cure of disorders. In a view, therefore, to such miscellaneous matters, and certain recurring affections, too trifling to be ranked as diseases, this volume is annexed; and it is hoped, may contain every thing on which the most inexperienced can wish for information, without being tedious by enlarging upon trifles. In all matters of importance a becoming firmness has been adopted; but I have not equally insisted upon others, wherein the manners of a refined age cannot comply, nor have urged any peculiar modes with the generality may not adopt. Should any opinion be more obstinately maintained, it is probably in relation to the aliment most adapted to new-born infants; an article frequently alluded to in the following pages: and which, a greater attention to the poor since I left London, has, practically, assured me is of the utmost importance to the health and life of the rising generation.

In a view to this, an Introduction is given on the Nature and Properties of Human Milk, as more especially connected with the subject of this volume: which, it is hoped, will exhibit a plan as rational in design, as the author is led to conceive has been successful in its application.

Experience having so fully confirmed every argument of the ablest theorists on the peculiar attentions due to the state of infancy and childhood, and the fatal effects of mismanagement in regard to the non-naturals, so called; the author has reason to hope, that the subsequent revised pages on the head of Management, as well as the two revised volumes on their diseases, will still meet with the sanction of a candid public. He has, indeed, paid no inconsiderable attention on each of them, by perusing the several treatises on the Diseases of Children that have appeared since his retirement from London; esteeming it his duty to present his own readers with everything he might judge worthy of notice in those publications, in this, most probably, his last revise. And the author presumes he cannot better introduce this volume than by making certain extracts from Dr. Hamilton and Dr. Buchan; the Treatise of the former containing the most judicious abridgement of the Diseases of Children for domestic use that has fallen in his way; whose accurate representation of the state of infants in utero, and at the time of their birth, from which useful practical inferences may be drawn, he shall here beg leave to transcribe.

"The infant, when in the womb, surrounded by a fluid which defends it from external accidents, and supplies it with an equable degree of heat, nourished by a somewhat which its own organs do not prepare, and furnished with the vivifying principle of air, by a beautiful and wonderful machinery, may be said to vegetate only.

"But, when separated from the mother by the process of delivery, it undergoes a great and important revolution; the supply of heat, and protection from injury, must depend on the attention of others; nourishment must be prepared by the digestion of food received into his own stomach; and the benefits of air can be obtained by the operation of breathing only.

"Did not experience prove, that nature has most bountifully provided for these changes, an examination of the structure of the infant would lead to the supposition, that it is ill-calculated to sustain so wonderful a revolution.

"Thus its bones are soft, spongy, and imperfect. Those which are afterwards single are generally divided into several portions, and almost all of them have their extremities or edges in the state of gristle.

"The different parts cannot therefore be well supported, nor steadily moved, while the organs lodged within the cavities cannot be properly defended.

"The fleshy fibres are soft and tender, and the cellular substance which connects them is of a lax texture, and in a large proportion, so that the several limbs have not that accuracy of shape which takes place at a subsequent period of life.

"All the vessels are extremely numerous, and their actions are very frequently repeated, which accounts for the pulse of infants being twice as quick as that of grown persons, and for all the secretions and excretions being performed rapidly and abundantly.

"The nerves too are not only in large proportion, but extremely susceptible of excitement, so that many circumstances, as degrees of heat and cold, which do not affect grown persons, occasion pain and serious derangements in the systems of infants.

"The skin is of the most delicate texture; it is influenced by the most trifling external expressions, and it shews and immediate and an extensive sympathy with all the other parts. Hence the slightest attractions of heat and cold produce and almost instantaneous effect upon, and often disturb rapidly the functions of, the skin or bowels.

"All the fluids are mild and watery, and furnished in great quantity. The chyle is more nutricious, and the blood is less acrid than in grown persons. The slimy and gelatinous fluids are bland; and the bile and urine have very little acrimony.

"The head is large in proportion to the body; as its bones are not indented into each other, but connected by membranous layers, the brain, which is very soft, may be readily compressed and injured.

"The face has not the expression which it afterwards assumes. The eyes at first have no power of distinguishing objects. They, and their appendages, being remarkably delicate, suffer from the slightest accidents, the nose, from the state of its bones, is also much more exposed to injuries, and the sensibility of its nerves renders it highly irritable, but the bad effects which would oten be the consequences of this structure, are probably counteracted by the mucus with which its inside is constantly lubricated. The ears for some time, like the eyes, do not appear to possess much power. The mouth is not usually supplied with teeth for some months after birth; for, although formed, they remain under the gums till that time. The lower jaw is divided by a portion of gristle into two pieces.

"The trunk of the body is not so firm as to support properly the superincumbent parts, nor to defent the organs contained in it: for a great part of the spine is gristly, and the breast is entirely so. The ribs indeed are more perfect than many of the other bones; but they can be easily made to yield from the state of the breast; and the fleshy parts, &c. which surround the belly, being soft and delicate, cannot afford resistance to any circumstance that may injure the bowels.

"The lungs, hitherto small, collapsed, and supplied with little blood, immediately after birth begin to perform the operation of breathing, and to receive the whole blood of the body; which functions continue during life. These organs are at first weak and irritable. The heart acts with considerable force and quickness.

"The liver is of a remarkably large size in proportion to the other parts, and is not so well defended as afterwards. The gall bladder is nearly in the same proportions. The stomach differs only in size, and in delicacy of structure: and the same may be said of the intestinal canal. But in the great guts a substance different from what is observed in grown persons is lodged: it is a black, viscid, tenacious matter, called in medical language the meconium. The kidneys are lobulated; and the renal glands are larger in proportion. The urinary bladder, and the other organs in the bason, are differently placed, as that cavity is very imperfect, from the gristly state of the bones of which it is composed.

"The extremities are weak, and the condition of the articulations, and quantity of gristle on the superior and inferior extremities, render them incapable of performing their proper functions for a considerable time.

"The changes by which the size and strength of every part of the body are increased, and the perfection of the several organs is completed, proceed gradually, and are not fully accomplished till the period of puberty.

"Childhood (the Doctor adds in another place) extends from the time at which all the milk-teeth are protruded above the gums, to the age of puberty. During all that time, the growth of every part of the body is progressively advancing, the several limbs are acquiring increased activity and strength; the various secretions and excretions are gradually altering in their appearance and nature, and the organs of the senses and the faculties of the mind are improving in power and energy."

"While those important changes are going on, the bones acquire additional strength and size, the ligaments and muscles become firm, the cellular membranes and skin more dense, the action of the heart and arteries less frequent, the respiration more slow, the nervous system less susceptible of impression, and the sympathy between the skin and the internal parts less considerable."

I shall close this Preface with the philanthropic observations of Dr. Buchan on the late Dispensary for the Relief of the Infant Poor, with which he has closed his revised edition of Dr. Armstrong on the Diseases of Children; and I most cordially wish that this further circulation of the Doctor's statement might tend to promote his laudable design, by anywise conducing to the re-establishment of the Dispensary. His statement and benevolent proffer are as follows:--

"A persual of this plain but interesting account of the Dispensary for the Relief of the Infant Poor, will probably impress the minds of many readers, as it has done that of the Editor, with surprise and regret, that an institution of such evident public utility should have been discontinued, for want of the very moderate pecuniary aid requisite for its support; and in a day (to the honour of this country) abounding in charitable institutions. Among no people, either in ancient or modern times was there ever so much money set apart for the relief of the poor and distressed, as in England; and at no former period were charitable institutions more numerous in this country, than at present. Whatever may be the political effects of these charities, it is impossible to cavil at the motives of those who support them. Distress is always an object of compassion. But whether that pecuniary assistance, to which the natural decay of friendless old age has the most indisputed claim, should be equally extended to those premature infirmities which originate in intemperance, or that the money which would be well bestowed in the relief of suffering virtue, is with the same propriety expended in affording an asylum to the voluntary profligate, may, perhaps, be questioned. The utility of administering medical relief to the children of persons in the inferior ranks of society admits of no such doubt. When the children of the poor are afflicted with sickness, to which those who live in the close unventilated habitations of great towns are peculiarly liable, natural affection, which knows no distinction of ranks, renders the mother anxious to obtain medical assistance. The expense of such as lies within their reach quickly exhausts their slender means; while the small quantity of medicine that can be consumed by an infant, is not sufficient to induce the practitioner, who has no other means of being remunerated for his time and trouble, to pay the requisite attention to his patient. The complaints of children are not in general of such a nature as to be exasperated by being brought into the air under the care of their parents. They may in general be alleviated by a small quantity of appropriate medicine, and their recurrence may frequently be prevented by suggesting some rules concerning diet and general treatment, to which I have observed that young mothers especially, are commonly attentive, and willing to put in practice. These circumstances render children peculiarly fit objects of dispensary relief; and it will hardly be denied that this, or any other plan which enables parents to rear their children at home, is preferable to the best system of education in a public institution, by which they are necessarily separated from each other. That the labouring class of people in the metropolis are sensible of the benefits of such an institution, and ready to avail themselves of the best medical advice they can obtain for their offspring, is abundantly proved by the numbers who applied to Dr. Armstrong's Dispensary when it became generally known. -- For several years past, I have dedicated a part of the morning to the purpose of giving gratuitous advice to the children of poor persons. Even in this narrow sphere of observation, I have seen enough to convince me that such assistance is thankfully received, and often productive of beneficial consequences. -- Should any well-disposed persons be influenced by these remarks, to establish a Dispensary for the exclusive purpose of relieving the children of the poor, my humble services shall not be wanting to further their benevolent intentions."

It is not unlikely that it is owing to this and other institutions, of affording proper advice and medicines to the poor, as well as to the great attention that has been paid to the improved management of infants, and to the treatment of their diseases, amongs the superior orders of society, by writers and practitioners of late years, that so sensible a decline in the fatality of infants has been observed; comparatively great as it still is with that of advanced childhood, and may perhaps still remain. I shall close this Preface with a proof of this happy abatement, stronly marked in Dr. William Heberden's comparative view of mortality occasioned by two diseases the most destructive to the Infant race, at the beginning, middle, and the close of the eighteenth century.













May future ages mark the like progressive diminution in every other infantile complaint, arising from mismanagement.

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