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Michael Underwood, 1819, Treatise on the Diseases of Children

Volume III.

A Treatise,

&c. &c.

Directions for the Management of Infants from the Birth.

 

Amongst the multifarious matter brought forward in the following pages, the aliment most adapted to infancy has been said to be one of the first importance. Previously, therefore, to treating of Diet more extensively, and the General Management of Children, I shall enter into a candid discussion of that particular, by considering the case of infants intended to be reared without the breast; or brought up as it is termed by hand. -- An article esteemed to be of the first importance by writers and practitioners in every age.

On Dry Nursing.

An attempt to set forth all the improprieties of this mode of training up infants from the birth, would carry me altogether beyond the limits I have assigned to the work. And I am glad to find by some recent examples among persons of rank, that there is less occasion for it than there appeared to be some years ago: and, indeed, the mistake has generally originated with parents, rather than with medical men. It would be unpardonable, however, in a work of this sort, not to insist how inadequate every substitute for the breast has been universally found; and therefore how proper it is, that every child should have it, and even be suckled by its own mother, where her health can safely admit of it. -- Reason, instinct, experience, all conspire to support this opinion; and whoever will determine to attend only to matters of fact, may soon be convinced of it. [1] Nature herself points it out: all the nobler part of the irrational creation is qualified for it, and by instinct it obeys -- the human race alone, possessed of nobler powers, and rational discernment, perverts those faculties to evade its dictates, and to invent excuses for refusing its claims. But puerile, indeed, are all the common arguments against it, in the greater number of instances; and herein Dr. Armstrong seems to have egregiously erred; for though, apparently, an advocate for suckling, he has laboured for arguments to apologize for the spoon and boat, in too many instances. -- It were easy, perhaps, to produce as sound arguments against eating more than once a day, because so many people become diseased from excess. On the other hand a new and very rational argument in favour of breast-milk, is advanced by Mr. Moss, who observes, that the gastric juices of every animal may be supposed to be the best suited to act upon its respective milks.

But not only is the breast-milk the only natural, [2] and most proper food for infants, (experience demonstrating, no artificial one to be equally easy of digestion, and nutricious,) but suckling conduces likewise to the easy recovery of the mother; though she should not be able wholly to support her child by the breast, nor to continue suckling so long as the infant may require it. But though from much experience I venture to give this opinion, I do, by no means, intend to assert that every mother is able to suckle her child, even for the month, or would do well to attempt it; but I am, nevertheless, equally satisfied, that many are very well able who do not; and that several who have only through fear been discouraged from doing it, in two or three lyings-in, having afterwards been prevailed upon to make the attempt, have gone on with it for several months; enjoyed better health when they suckled than at any other part of their lives, and their children have thriven perfectly well. Art and management will likewise afford some assistance, when the natural constitution, alone, may not be fully equal to the task. In this view, besides a suitable diet, exercise and a regular manner of living; I will venture to recommend cold-bathing, especially in the sea, if the season of the year should permit; and this not only from my own experience but that of the writer just quoted, who asserts, that it is often found particularly useful in restoring the strength, and increasing the milk in nurses of a weak constitution; adding, that it can never do any harm to a woman merely as a nurse, where no other reason independent of the situation, forbids it. The principal caution necessary, being, not to bathe too frequently; more than twice or at most three times a week being often injurious to delicate habits.

Thus, besides the advantages derived to infants, it appears that are others resulting to the suckling mother, and by some deserving a further notice. For by this means, where due care is taken, painful inflammations and suppurations in the breast may often be prevented, as may be fairly concluded, not only from the rarity of such complaints in the British Lying-in Hospital, where almost every mother suckles her infant, but from the like authority of Dr. Nelson, who reports, that "out of 4,400 women who suckled their children, only four had milk-sores, and that these had either no nipples or former sore breasts." It has likewise long been suspected, and of late years more generally imagined, that some of the worst fevers, and more rare ill effects of child-bearing may, generally, be prevented, by suffering the milk to flow duly to the breasts, and be freely drawn from them, though only for the month. These advantages, one should hope, might tend to induce ladies of rank to set a general example, by performing this kindest and most pleasant office, at least during the month. [3] But it would be unjust not to add, that whenever they may purpose to assume it for a much longer time, they should determine to do it effectually, or they will but injure their children, as well as forfeit many of the advantages and comforts, which in a due execution of it, they would have a right to expect.

For a long time, however, writers have successively complained, that, notwithstanding the many encouragements often brought to the ears, and urged upon parents, that tyrant Fashion has prevailed over the good sense and natural feelings of many, whose maternal affection can be, in no other instance, suspected. There are honourable exceptions, however; and it is with great pleasure, that I have been able to observe, in the later editions of this work, that ladies of rank are every year becoming converts to this maternal duty, and are proud of supplying their offspring with that new nourishment, wherewith nature hath purposely endowed them.

Another important, and affecting consideration might be brought forward on this head, which I shall, indeed, only touch upon, as it call s rather for the pen of the moral philosopher rather than of a physician; I mean the sacrifice which poor women make in going out to suckle other people's children; the sad consequences of which are often severely felt by their own, through neglect or mismanagement, and especially for want of the breast. Indeed, no attention of the nurse can duly compensate this loss; and only the most common substitutes for it can, in their forlorn circumstances, be allowed them. This hath become a source of evil that I fear has not been sufficiently thought of, and has led to the sacrifice of many infants every year; a matter of serious importance, indeed, to the public, as well as to the families immediately concerned.

It gives me real concern to find occasion for the least unpleasant reflections upon any part of the sex I so much honour, and upon any of my fair and sensible countrywomen, in particular; nevertheless, I cannot help suspecting, that wherever any neglect of parental duties may exist, whether in regard to suckling, or superintending the management of their children, [4] that does not arise from want of health, or some equally warrantable excuse, it can be charged only on the depravity of the age, which insensibly corrupts the taste and perverts the judgment of many who wish to do well; and depravity of manners, when once become general, has ever been considered as the leading symptom of a falling empire, and ought to be pointed out, as far as it extends, by every friend to the community, at whatever hazard of giving offence, in every conspicuous instance of it. Tacitus complains of the degeneracy of Rome in his days, though by no means its most degenerate era, lamenting that, while in former times grave matrons attended to their children, as their first family concern, they now, says he, intrust them to the care of some Grecian girl, or other inferior domestic. -- It is no small satisfaction to me, however, to observe, that in this country there has been no ground for much complaint on this head, and that the evil is annually diminishing; there are also examples of the first magnitude of a nobler conduct; and one at the head of all which, were it copied without exception in domestic life, would prove the glory of the present day, and a blessing to the rising generation. -- May the time hasten when it shall be universally followed by her inferiors; whilst I attempt to point out, as far as my observation has extended, the most prudent means of executing this important branch of female duty.

It may not be amiss, at the opening of the ensuing observations, to remark, that the demand for the multifarious directions here offered, as well as all those given by other writers on the management of children, arises from the false reasoning of those to whose care the infant-state is frequently entrusted; who, instead of being guided by the sober dictates of nature, have adopted the rules of art, falsely so called, or have followed the wild fancies of anile superstition.

On the other hand, the various tribes of the irrational species act in a thousand instances more prudently than we do; and being uniformly guided by instinct, are led implicitly and safely through all their operations. Many quadrupeds, fish, fowls and even reptiles, seem to know what is proper for them as soon as they come into existence, and have strength sufficient to reach after it. In other instances, they are guided by the parent, who seems to adjoin some degree of knowledge acquired by experience, to the instinct with which it is endowed; and gradually leads on its young to imitation, whether it be to eat, to swim, or to fly. Man, on the contrary, designed to be the pupil of observation has scarce any innate discernment; and consequently his infant race pass through a long period utterly helpless, alike divested of ideas to guide, and of strength to manage for themselves; but to the parent is imparted both; whose province it is to judge for them, and actually to put into their hands or mouths whatsoever they may stand in need of. When the parent, therefore, forsakes the paths of simplicity, and lays down arbitrary rules, the result of false science, instead of patient experience, or mistakes the clamour of fashion for or prefers it to the voice of nature, confusion and disease must be the unavoidable consequences. -- Awakened by these, man is loudly called upon to return to the simplicity of nature, and the result of dispassionate observation. To lead to this, will be a principle intention of this work, wherever danger and deviation are connected; assured that the experience of the most judicious and successful practitioners will applaud the design and confirm the generality of the following observations on:

The General Management of Infants.

To this end let us imagine an infant just born, who, doubtless, at this moment, calls for our best attentions. And first, it may be observed, that it ought not to be exposed to any thing that may violently or too suddenly affect the senses: on which account, Moschion and Albinus have well advised, that it should not be exposed either to great heat or cold; not to a strong light, nor odours of any kind, however grateful to adults; the unpleasant effects of which are sufficiently manifested by the infant itself. [6] It is hoped I may be allowed in this place to introduce a caution on the too early attention to mental improvement; which is more frequently, than seems to have been imagined essentially injurious both to the bodily health, and future progress of the mental powers; and I have myself known one or more decided proofs of its inducing a confirmed fatuity.

The attention will next be called to washing and dressing it, together with other little offices suited to the occasion; and this first washing is of more importance than is usually imagined, being amongst the little things which are often overlooked by writers and others, and by some thought of no consequence; [7] but it is not every little thing that may be safely neglected, or carelessly done. In regard to poor people especially, and infants born in hospitals, and other crowded apartments, the importance of proper washing is greatly increased; the foulness left upon the skin being a remote cause of some dangerous epidemic complaints. [8] Some infants also are covered much more than others with a thick, viscid matter, which cleaves so firmly to the skin, that it is not easily washed off; which there is, however, another reason for doing, as it would obstruct perspiration; which can never be duly performed where the skin is left anywise foul. On this account nurses should be directed to be very attentive to this first concern of their infant charge; and, whatever wash they may make use of, it should always have soap in it, and the child be well rubbed, especially under the arms, in the hams, and groins, where this mucus is apt to adhere: and to this end it would be better that no pomatum should be made use of, or other grease, which tends to stop up the pores, and prevent perspiration; or that nurses be, at least, very careful the grease be afterwards well wiped off. In the same view it were well if it were a common practice to repeat the washing for two or three days, with light friction of the skin; which it is not improbably might tend to prevent the redgum, and other similar affections of the skin, which such other complaints as may arise from the suppression of insensible perspiration.

After a little time, and sometimes on the next day, most nurses wash a child all over with cold water; a practice highly extolled by Dr. Armstrong, as well as many other practitioners; but, though no one can be a greater advocate for every thing that is bracing than I am, I cannot approve of this substitute for cold bathing, as it is called; at least, as a too indiscriminate practice. The cold bath acts on a quite different principle, and is so very beneficial, that I could wish almost every child, especially those born in London were bathed at three or four months old, (provided they be not costive, nor feverish at the time, have no internal obstructions, nor the season of the year be improper;) which I am certain would remove, or perhaps prevent, many of their complaints. [9] But to see a little infant of a few days old, the offspring perhaps of a delicate mother, who has not even strength to suckle it, washed up to the loins and breast in cold water, exposed for several minutes, perhaps in the midst of winter, (when children or more liable to disease than those born in summer;) itself in one continued scream, and the fond mother covering her ears under the bed-clothes, that she may not be distressed by its cries, has ever struck me as a piece of unnecessary severity, and savours as little of kindness as plunging an infant a second or third time into a tub of water, with its mouth open and gasping for breath, in the old-fashioned mode of cold bathing: both of which often induce cramps and pains in the bowels, and weakness of the lower extremities; but rarely an increase of the strength. It surely cannot be amiss, in winter time at least, to take the cold off the water for the first few days, which, it has been observed, will be useful in other respects; and, whenever cold water is made use of, it will be quite sufficient to wash the child, as far as a regard to cleanliness may require, which will always be the parts exposed to the worst kinds of galling and excoriation; on which I shall here drop a few hints.

On the Intertrigo, or Chafings.

To obviate these troublesome affections, washing with cold water is certainly useful; but can never call for an infant being plunged with its feet or nates into a pan-full of cold water, and be afterwards dashed all over with it, to its daily discomfort and terror. Cleanliness and bracing the skin are the proper intentions; and with this view therefore, beside the nates and groins, the arm-pits, folds of the neck, and parts behind the ears, being also disposed to slight chafings, may be occasionally washed with cold water; and, if the discharge be not checked by it, they should be dusted with a little hair-powder, the powder of lapis calaminaris, or of ceruse, or a little white vitriol may be added to the water; which, if the excoriations are not very considerable, will generally heal them very soon: should these fail, they may be dressed with the red drying ointment of Bate's Dispensary, which is an excellent remedy in a thousand instances, and has very undeservedly fallen into disuse. But these drying remedies should rarely be applied to the ears. In a very acid state of the stomach, during the month, particularly where there is a purging with very green stools, the parts covered by the cloths are moreover infested with a still more troublesome excoriation, called Intertrigo, and whilst that state continues, will not be healed by any drying applications. I have found nothing so pleasant and useful in this case as covering the parts with the thin skin found upon the veal kidney, which softens and cools them, till the cause of the complaint may be removed by the use of proper absorbents. There is a mixed affection of this kind, however, in which these parts are not actually excoriated, but are very hard and swollen, as well as painful and inflamed; and the affection seems to be kept up by the acrid nature of the excretions, though not originally caused by it. In this case, instead of daubing the parts with wetted fuller's earth, gruel, or greasy mixtures, an embrocation of elder-flower-water, with as much boiling milk as will render it moderately warm has been immediately efficacious. By the use of these means, the worst cases I have met with have been successfully treated; having never seen any thing like mortification, or need of administering bark, as recommended by Dr. Armstrong. But one grand mean of keeping children from chafing is to preserve them very dry and clean; articles of so much importance, that I might have insisted much longer upon them if I had not already far exceeded the bounds I had intended, as well as presumed it unnecessary for the generality of readers. A vulgar error, however, may be noticed, which is still too common -- that of wearing a pilch, as it is called; an old fashion still too much in use, and contributes not a little to make children weak; it being originally designed to be worn only for the few first weeks after birth, but is often continued for as many months. It can answer no possible end but that of saving a little trouble, since, instead of keeping children dry and clean, it has the directly contrary effect; for, if it has received any wet through the usual cloth laid under it, it ought itself to be changed as often as the other, or must certainly be damp and uncleanly; whilst, by heating the loins and lower limbs, it has a manifest tendency to relax, and dispose infants to become ricketty. It may be proper, however, to drop a word more, with a view to counteract a vulgar notion, familiar only to common people, that a frequent change of linen has a tendency to weaken new-born children; an absurd idea that has not the smallest foundation in reason or fact. It is, on the other hand, next to impossible that a child should thrive or be healthy, if the strictest attention be not paid to cleanliness, which is one of the principle articles in which the children of poor people are at a great disadvantage, and which becomes a constant source of rickets and distortions among them. But indeed, little infants, if healthy, may oftentimes be so managed as to be much more cleanly, than even people of great delicacy have been wont to imagine; so as even to supersede altogether the use of clothes, either by night or day. [11]

Tumid Breasts of Infants.

Another imprudent, and certainly useless operation, practised by nurses, is that of forcing out the milk from the little breasts of new-born infants. Some children, a day or two after they are born, have the breasts exceedingly tumid, hard, and painful, containing something like milk; and nurses imagine it to be a great kindness to milk it out, as it is called; but I have often been grieved to see a nurse rudely rubbing, and even squeezing the breasts already in a state of inflammation, and continuing it even for some minutes, though the child's cries might convince her she is putting it to pain. In the case of inflammation, a bit of bread-and-milk poultice is the properest application; but, if the part be not inflamed, it can want nothing at all; or should it be conceived that something ought to be done, a little oil with a few drops of brandy may be gently rubbed in, or small pieces of the litharge-plaster may be applied, and lie on the parts till they fall off of themselves. I have, indeed, had sufficient evidence of such considerable tumefaction and hardness, as to satisfy me, that, when no violence is applied to the parts, the application of a bread-and-milk poultice will always prevent either suppuration or other unpleasant consequence. I have met with instances in which the tumour has been much larger and harder than I could have suspected on such an occasion, and yet after continuing for more than a week without any sensible diminution or amendment, has soon afterwards subsided entirely.

Having considered the necessary preparations, I proceed to offer a few remarks on the prevailing errors in Dress.

On the First Clothing of Infants.

Upon the first sight of a new-born infant every one is struck with the idea of its weakness and helplessness; and we often take very improper methods of strengthening it. It is designed to be weak and tender in this infant-state, as is every other object around us. [12] Take a survey of nature, from the first opening leaves of the vernal flower, or the more delicate foliage of the sensitive-plant to the young lion or the elephant; they are all, in their several orders, proportionally weak, and cannot exist without some exterior support. But they stand in need of nothing but what nature has prepared for them. If seed be cast into a proper soil, it wants only the surrounding elements to ensure vigour and maturity. So, if the tender infant be born of healthy parents, and at its full time, it is usually sufficiently strong; proper food and nursing (with ordinary attentions to screen it from the extremes of heat and cold) are the elements whose fostering influence it requires -- if it have these, it will need nothing more.

It is true it is very weak; but is it therefore to be tight rolled, under the idea of supporting it, and giving it strength? It is a bundle of tender vessels, though which a fluid is to pass, uninterrupted, to be equally distributed through the body, and which are therefore surrounded by a soft medium predisposed to yield to the impetus of their contents. Hence we cannot but conceive, how injurious any great pressure must be to so delicate a frame, which before birth swam in a soft fluid. But besides this, the infant requires freedom and liberty on other accounts: the state of infancy and childhood (as Dr. Gregory observers) is impatient of restraint in this respect through

"...the restless activity incident to youth, which makes it delight to be in perpetual motion, and to see every thing in motion around it."

Let us again advert to irrational species, whose more sagacious conduct so often disgraces our own. There is no occasion on which they do not seem to consult propriety; and, having a right end in view, they as certainly accomplish it, and always in proper time. -- Doth a little bird design to prepare a lodging for her young, it is sure to make choice of the fittest situation, whether to defend them from dangers, or obtain the most convenient supply of their wants; if to this end it is necessary to construct the nest of rough and strong clay it is still lined with down; the young lie warm and secure, but they lie at their ease.

"In this view of nature" (says a good writer, [13] about fifty years ago) we shall find the birds not only provide nests for their young, but cover them with their wings, to guard them from the chilly Air till time has increased their feathers. The beasts, with amazing tenderness, cherish their young till nature has lengthened the hair, the wool, or whatever covers them; or time has given them the power of action. Further, we shall find, that insects, and all the vegetable creation, shoot out into life, and receive vigour, comfort, and support, from that glorious body the Sun, so indispensably necessary is warmth, and so essential to the arising and preserving of all."

But, necessary as warmth and support most indubitably are, they must not be obtained at the expense of liberty and ease; which, during the fragile state of infancy especially, are of peculiar importance.

I am not ignorant, indeed, that for many years past, the very ancient tight mode of dressing infants has been discontinued; and for which we were probably first indebted to Dr. Cadogan. It is certain also, that for the last forty years the fashion recommended by him has been improving; but there is yet room to go forward; and were every tender parent in this country thoroughly sensible of its advantages, it would soon become fashionable to see children as much at their ease on a christening-day, as they are when laid at night in their beds. And I may be permitted to add here, what every modern practitioner has adverted to, that were strings, almost in every instance, substituted for pins, physicians would seldom be at a loss to account for the sudden cries, and complaints of infants, which are too often produced by this needless part of their dress [14] -- a practice, it is to be hoped, which may in time be laid aside, sine some of the first families in the kingdom have already set the example.

Nature knows no other use of clothing but to defend from the cold; all that is necessary therefore for this purpose, is to wrap the child up in a soft loose covering, and not too great a weight of it; to which ornaments enough might be added without doing mischief. And had this matter always been left to the most ordinary discretion of parents, this is probably all that would have been done; but the business of dressing an infant is become a secret, which none but adepts must pretend to understand. The child itself, however, discovers to us the propriety of such clothing, by the happiness and delight it expresses every time its light day-dress is removed, and its night-clothes put on; which should always be looser, and less thick than those worn through the day, and the lower limbs be less confined than they sometimes are. Whereas, the art of dressing has laid the foundation of many a bad shape; and, what is worse, of very bad health through the greater part of life. Instead therefore of a scrupulous and hurtful attention to such formalities, nurses would be much better employed in carefully examining new-born infants, in order to discover any malformation of parts, especially those concerned in the excretions necessary to life, which, it has been said, is sometimes overlooked.

The tender infant being dressed, and having undergone such other little discipline as has been mentioned, is usually so far fatigued by it, as soon afterwards to fall into a sound sleep; we shall consider it as in this state, and leave it a while to be refreshed, whilst I indeavour to conduct my reader through the various other duties which the infant calls for, from day to day, till it happily arrives at an age free from the peculiar hazards of infancy.

In the pursuit of such a plan we meet with a variety of miscellaneous articles, and, though many of them are not of apparent magnitude in themselves, are in their consequences highly worthy of notice; which, that they may be thrown into some kind of order, may all be very well classed under the several heads of the Non-naturals, as they have absurdly been called. [15] Such are air; meat and drink; sleep and watching; motion and rest; retention and secretion; and the passions of the mind; a due attention to which, may prevent many of the evils incident to the tender age. -- To being with the first of these: --

On Air.

The great importance of this has been set forth when speaking of the Diseases of infants: I shall here in a more particular way observe, that the age, constitution, and circumstances of the child, and the season of the year, ought always to be taken into consideration, that being highly proper on one occasion, which would be very detrimental at another. In general, it has been said, that warmth is friendly to very young infants; but they should, nevertheless, be inured gradually to endure the cold air, which is absolutely essential to their health, I cannot therefore agree with Dr. Armstrong, who thinks that the reason of the rich losing fewer children than the poor, is from their being kept warmer. On the other hand, it was aptly said by one, that "a warm nursery fills a cold church-yard." In fact, it is not a mere cold, but damp and confined air, that is so injurious to children, and to which the poor are peculiarly exposed, especially during sleep. Much caution, indeed, is necessary on this head in this unsettled climate, and evinces the necessity of parents superintending those to whose care they entrust infant-children, since nurserymaids are often indiscreet in keeping them too long in the air at a time, which is a frequent occasion of their taking cold, and deters many parents from sending them abroad as often as they could. Another, and a worse, as well as common fault of nurses and servants, is, that of standing still with children in their arms in a current of air, or even sitting down with other servants, and suffering children who can run about, to play at a little distance by themselves, sit down on the grass, and such like irregularities; the consequences of which are often a long confinement to a warm room, and either a prohibition against going out so much as they ought, or a fresh cold, owing to some of the like irregularities.

But if children be properly clothed and attended to, they will not only endure a great deal of very cold, but of other inclement weather; though it has been observed, that caution and prudence are required in training up infants to withstand and profit from being abroad when the air is very cold or moist. Notwithstanding, it certainly may be accomplished; and it is a known fact, both amongst the higher as well as inferior ranks of people, that those children are the healthiest, and suffer the least from colds, who are accustomed to be abroad in almost all kinds of weather. But, to render children thus strong and healthy, it is not sufficient that they be abroad daily in a coach; they should be carried on the arm, and be put on their feet, at a proper age, and partake of such exercise, for a reasonable time, as shall keep them moderately warm, and bring them home in a glow, instead of wishing to rush towards a fire the moment they return; such transitions being always improper, and only render children more liable to taking cold.

Kruger has some such pertinent remarks on this head as it will scarce be thought a digression to transcribe:

"The important step," says he, "a man takes into this world imparts to him all the privileges thereof, of which this is one -- the ability to bear the effects of the air. Why then debar him from this privilege? as he is all his life to be encompassed with this air, at one time cold, at another warm, now moist, again dry. For the cold of the air so anxiously avoided brings along with it the means that secure against its own inclemency; the great strength of fibres imparted by it to the child, procuring, by means of a brisker circulation, a greater degree of heat, and consequently the reverse of its violent impression. This, indeed, may seem unintelligible to those who imagine the human body to be only an hydraulic machine, consisting of innumerable tubes, in which the wheel is moved, without a proper power, consequently without a sufficient reason; not to those who can distinguish between the effects of nature and art; who are apprised of the power that moves the animal body, and that the sensations are such a power, which arise without our knowledge and our will. To such only it will be intelligible, in what manner an increased resistance, produced by the cold in the solids and fluids, is capable of bracing the heart, the source of life. From a slight knowledge of mechanics we come to understand that the resistance diminishes that power which in animal bodies is increased; come to see, that the most ingenious constructions produce no manner of motion; that all mechanical laws are, indeed, perfectly just, but more accurately to be determined, in order to a proper application of them to the human body, in which the will, imagination, and sensations, are the springs of motion, without which all motion would cease, and only leave a machine resembling a water-work, to be carried about by wind. -- We need only appeal to experience, which will teach us, that, in order to a healthful state, we need not be brought up like those who are indulged with a bed of down, and a warm room, but those, of whom no other extraordinary care being taken, are greatly left to their own disposal."

I cannot better close these remarks on the benefit of a pure air, than by quoting the remarks of the Rev. John Howlett; who observers, that, in consequence of the humane suggestions of Mr. Jonas Hanway, about fifty years ago, an Act of Parliament was passed, obliging the parish-officers of London and Westminster, to send their infant poor to be nursed in the country, at proper distances from town. Before this time not above one in twenty-four of the poor children received into the workhouses lived to be a year old; so that, out of two thousand eight hundred, the average annual number admitted, two thousand six hundred and ninety died; whereas, since this measure was adopted, only four hundred and fifty out of the whole number; and the greater part of these deaths happen during the three weeks that the children are kept in the workhouses.

It is, indeed, generally owing to sudden transitions only that some infants so readily take cold. This sometimes happens as soon as they are born, and repeatedly during the month: the slightest symptom of which is a stoppage, or stuffing of the nose, which may be here briefly considered.

On the Snuffles.

The stoppage, so termed, is indeed only a trifling complaint, and seldom requires more than a little pomade-divine or other unctuous aromatic to be put to the nostrils when the child is laid in the cradle; or if this fail a little white vitriol may be dissolved in rose-water, and the ossa nasi often wetted with it. -- A matter of much more importance, however, under this head, is to remind the reader of a much more serious complaint, which this resembles only in the kind of noise which the stuffing of the nostrils occasions and has been termed Coryza maligna, or the morbid snuffles, and been already largely considered.

On Short-coating.

It will be adviseable, in order to inure infants to the air, that this change in their dress be made as early as the season of the year will permit; but their dress should still be loose and easy, and many children may continue without stockings even for two or three years, and boys till they are breeched. As to the latter change, I think it would with more propriety be made in the beginning of winter than in summer, as the dress upon the whole is warmer, especially about the chest, which, from having been open for three or four years, it seems rather strange to cover all at once, at the beginning of hot weather. [16]

But though I have said many children would be as well without stockings for a considerable time, I must remark that circumstances are always to be taken into consideration. Mutatis mutandi should not only be the motto of physicians, but of common life, and we should be guided by it in regard to all general rules. For want of this caution in the present instance tender children suffer exceedingly in severe winters, and are distressed with chilblains merely for want of proper covering to their tender limbs. I have seen a child of four years old, the daughter of people of fashion, whose legs were covered with these sores quite up to the knee, and yet her mother could not be prevailed upon in time to suffer stockings to be put on, because strong and healthy children are thought to be better without them. And there is, indeed, of late years an additional reason for such cautions, from a fashionable mistake of this day, of habiting young children indiscriminately too thinly; the feet, legs, and arms, being more uncovered than the hands, which, when children are abroad, are ornamented with gloves: a mode of dress howsoever appropriate to the athletic, must be hazardous to those of delicate habit.

We proceed now to the second article under the head of the Non-naturals: --

Meat and Drink.

This is, indeed, worthy of ample discussion; having as yet been considered only in relation to the expediency of breast-milk, where that may anywise be procured.

In the first place it may be remarked, that, although an infant be suckled by its own mother, it certainly can stand in no real need of any food till the time nature will bring milk into her breast, supposing the child be laid to it in proper time; which, doubtless, ought to be as soon as the mother, may, by sleep or otherwise, be sufficiently refreshed to undergo the little fatigue that an attempt to suckle may occasion. This method, however unusual with some, is the most agreeable to nature, and to observations on the irrational species, who in many things are the very best guides we can follow. [17] And herein I am constrained to differ from a late writer, [18] whom I have more than once quoted with approbation; for, by means of putting the child early to the breast, especially the first time of suckling, the nipple will be formed, and the milk be gradually brought on. Hence much pain and its consequences will be prevented, as well as the frequency of sore nipples, [19] which in a first lying-in have been wont to occasion no inconsiderable trouble. But should this, or even an abcess take place, they are both far less distressing under proper management than has been usually imagined: [20] and, what is of great importance, the latter is attended with a negative good; no woman, I believe, having been seized with puerperal fever who had a milk access. -- However, should the mother be unable to suckle, and a wet-nurse be engaged, there can be no harm in putting the child to the breast after it has taken a dose or two of the opening medicine; or should it be brought up by hand, and not easily kept quiet, a spoonful or two of water gruel, sweetened with a little Lisbon-sugar or honey, may be given for this purpose, which will usually set it asleep; after which it will be ready for whatever culinary food shall be thought proper for it.

And on this article, a vast crowd of absurdities open upon us at once; and many of them with the sanction of custom and authority. I shall first advert to the thickness of the food: and it has, indeed, been matter of wonder, how the custom of stuffing new-born infants with bread could become so universal, or the idea first enter the mind of a parent, that such heavy food could be fit for its nourishment. It would be well, that all who are intrusted with the management of children should have more just ideas of the manner in which we are nourished; and especially, that is not from the great quantity, nor from the nutricious quality of the food, abstractly considered, since the inhabitants of different parts of the globe are equally healthy and long-lived, who feed on the most opposite diets. Every one, one should think, may be led to conceive, that our nourishment arises from the use the stomach makes of the food it receives, which is to pass through such a change in digestion as renders it balsamic, and fit to renew the mass of blood which is daily wasted and consumed. An improper kind, or too great a quantity taken at a time, or too hastily, before the stomach has duly disposed of its former contents, prevents this work of digestion, and, by making bad juices, weakens instead of strengthens the habit; and in the end produces Worms, Convulsions, Rickets, Scrofula, Slow Fevers, Purging, and a Fatal Marasmus.

Nature, it, should be considered, has provided only milk for every animal adapted to draw it from the breast; and that of women is certainly amongst the thinnest of them, but at the same time far more nutritive than bread, and probably than any other milk, as it contains a greater proportion of saccharine matter; [21] which is thought to be that quality in all our food which renders it nutricious. It is true, bread, as it requires more digestion, will lie longer on the stomach both in infants and adults; and hence probably, because it satisfies the present cravings, it has been conceived to afford a greater proportion of nourishment, though mixed up only with water, as it too frequently is, it is far less nutritive than has been imagined. Children ought to be frequently hungry, and as often supplied with light food, of which milk is really the most nourishing that we are acquainted with. This could never be doubted but from its passing so quickly out of the stomach; on which account, indeed, though not the properest food for adults, employed at hard labour, and many hours from home, it is the fittest of all for the sedentary life of a tender infant, who cannot get the whole of that nutriture contained in bread, or other solid food which the stomach of the adult is able to extract. It must have been for want of attending to this consideration that Dr. Armstrong has said so much in favour of bread and other thick victuals: which, by the bye, he began to make use of for his own children, (from its success in whom he ventured to recommend it,) at the age of six or seven months; a matter very different from cramming an infant with it almost as soon as it is born: for every thing the stomach cannot digest, it has been said, may be justly considered as a poison; which, if not puked up, or very soon voided by stool, may occasion sickness, gripes, what are called inward-fits, and all the train of bowel-complaints which may terminate in one or the other of the evils just mentioned. And this I see almost daily exemplified; a new-born infants after being so fed, and seemingly thriving for a short time, suddenly falling into a purging, or being carried off by fits.

Milk itself (like all the other animal juices) is produced from food taken in by the mother; and is the richest part of it. It is in her stomach that the aliment is digested, which, by a combination of powers in the chylopoëtic viscera, is so far animalized as to be converted into a kind of white blood; from whence it has been observed, every animal body is daily recruited. Hence it is very apparent, that, previous to an infant having acquired strength enough to convert solid food into this wholesome chyle, the parent, by this wise substitution in nature, previously accomplished this work for the infant she is to nourish. During infancy, therefore, both nature and reason most clearly points out the expediency of a milk-diet; [22] but how long it ought to be perservered in, or infants totally confined to it, is not easily ascertained, and will be further considered in its place, with a latitude that the question demands. There is a period in life, indeed, to which this nutriment is more particularly adapted, both experience and theory demonstrating it to be more suitable to young people than adults, as Arbuthnot has remarked; and it has been observed, that it does not appear that the gastric juice of the cow will produce the same change upon milk, as that of the calf does, which is, therefore, constantly made use of in dairies, for separating the curd from the whey.

It can scarcely be improper, before I entirely quit the article of suckling, to relate a recent instance, and a remarkable one out of many, as a proof of the degrees to which infants may pine for the breast, even to the great hazard of perishing for the want of it, where the real cause of the disease is not suspected. This little history will likewise further serve to illustrate the preference of human milk which has been so strongly insisted upon.

The little infant alluded to was very healthy when it was three months old, and was then weaned on account of the illness of the wet-nurse; but soon afterwards ceased to thrive and had continual bowel-complaints. At the age of nine months I was desired to visit it, and was informed that it slept very little, was almost incessantly crying, and had for many days brought up nearly all its food; was become very ricketty, and had all the appearance of an infant almost starved. Trial had been made of every kind of food, except the breast, and the child been many weeks under the care of an experienced apothecary; was constantly in a state of purging, and seemed to have been just kept alive by art.

On the first sight of the child, and upon the face of this account, it was very evident that this infant was not nourished by the food it had received, and that the complaint lay wholly in the first passages; but reduced as it was, I had little expectation from medicines, and therefore gave as my opinion that either the child still pined for the breast, in which case, I doubted not, it would take it, though it had now been weaned six months; or, that it ought to be carried immediately into the country, and be supported for some time only upon asses' milk, or perhaps be fed now and then with a little good broth.

My advice being taken, a good breast was procured, which the infant seized the moment it was put to it; and after suckling sufficiently, soon fell asleep for several hours, waked without screaming, and took the breast again. It is sufficient to add, that the child ceased to puke or be purged, and recovered from that hour; and, after sucking eight or nine months longer, became in the end a fine healthy child.

Although this instance has something extraordinary in it, in respect to the length of time the child had been taken from the breast; and though infants are generally completely weaned in six or seven days at the furthest; yet are similar occurrences met with, differing only in degree, it being no uncommon thing for children, when ill, to take the breast again, after seeming to be thoroughly weaned for three or four weeks. And this circumstance is the more worthy of notice, as it sometimes is a very fortunate one; and should lead to making the trial whenever infants newly weaned may be seized with any complaint, under which a return to the breast may be useful. Such particularly is the hooping-cough; under which I have known a child of more than a year old, and apparently thoroughly weaned for a month, take to the breast of a stranger very cheerfully, in the presence of its former nurse, with the precaution only of leading it to make the first attempts during the night. Such children for the few first days turn away from the new wet-nurse to the former one, as soon as they have satisfied themselves at the breast, and go back to the nurse again very readily whenever they find an inclination to suck.

To return; I am free then to lay it down as an axiom, that milk ought to be the chief part of the diet of infants for a certain time, whether it be breast-milk or any other; [23] and that it will prove sufficiently nourishing for nineteen out of twenty; I might perhaps say ninety-nine out of a hundred: exceptions, I believe, there may be; but much fewer children would perish if no exception were to be made, than by absurdly rushing into the contrary extreme. But, supposing a very strong child, at the end of the month, really not satisfied with milk only, and always craving the moment it has been thus fed, it, doubtless, may have a little boiled bread added to it two or three times in the day; but I should be very cautious of extending it further. [24] In the case, however, of an infant at the breast, if it be always craving as soon as it is taken from it, the occasion of its craving will generally be found to be in the nurse's milk; previously therefore to allowing a more solid food, the quality of the milk, as well as the state of the nurse's health should be inquired into, and the milk be changed if its goodness be suspected; and, should its quantity be found deficient, its quality is always proportionately inferior. Perhaps, where bread and milk is allowed, whether at a very early or later period, it would be an advantage to boil a piece of roll, together with the upper-crust, in a good deal of water, till it is very soft, by which means the bread will part with some of its acescent quality; the water should then be strained off, and the bread be mixed up with the milk, which ought to be boiled if the child is very young, or inclined to a purging. [25]

It would, I perceive, lead me beyond all bounds to enter further into this matter; I shall therefore only add, that infants certainly ought not to be fed lying on their backs, but sitting upright, howsoever contrary to long established usage, as they will in this position swallow their food more readily, as well as more readily perceive when they have had enough. So also children nourished at the breast ought to be withdrawn from it for a short time, especially just after waking from a long sleep; whereby, besides other advantages, much undue labour to the stomach may be prevented, as well as enabling it to retain what it has received, a part of which is otherwise very frequently thrown up.

If milk be the proper food for infants brought up by hand, the next inquiry will naturally be, what milk is the best? and what is the fittest instrument for feeding with? And it is from long experience, as well as from reason and analogy, that I venture again to recommend the ingenious contrivance of the late Dr. Hugh Smith, which I shall presently describe. The milk he likewise advises, is cow's milk in preference to all others, as being the most nourishing, and therefore, in general, the most proper; and I wish to refer the inquisitive reader to such other reasons as the Doctor has given, [26] to which I can add nothing but my own experience of their validity. To the milk should be added a little thin gruel, or barley-water, which forms a very smooth and pleasant nourishment; the latter being more proper if the bowels are too open. A few weeks after birth, (and I think in general the sooner the better,) there should be mixed with the milk a small quantity of a light jelly made from hartshorn shavings, boiled in water to the consistence that veal broth acquires when it has stood to be cold. [27] The design of the jelly is obvious and rational, at once calculated to render the food more nutritive, as well as to correct in some measure the acescency of the milk; this quality being thought to abound in the milk of different animals, in proportion to the quality of vegetables on which they feed. [28] And the milk of quadrupeds we know is produced from vegetable juices only, whilst breast-milk is formed by a mixture of animal and vegetable food. A little Lisbon-sugar may be added to this compound of jelly and milk, if the child be not inclined to a purging; or in that case a little loaf sugar; but the less of either the better. It will be proper to have the milk and jelly warmed separately, and no more at a time than may be wanted; when it should be put into the pot, which must be very carefully cleansed and scalded, at least once every day, and the spout be thoroughly rinsed, lest any sour curds should stick about it; and to this end it may be convenient to be provided with two. [29] At first the milk ought to be boiled, to render it less opening; but, when the child is several months old, or may chance to be costive, the milk need only be warmed. If it be fresh from the cow and very rich, a portion of water may be added to it, whilst the infant is very young. Indeed, it ought to be as new as possible, since milk, as an animal juice, probably contains some fine subtle particles, which evaporate upon its being long out of the body.

Though I have said cow's milk is usually preferable to any other, it will be conceived, that I mean for infants who are strong and healthy. Asses' milk, on the other hand, being more suitable for many tender infants during the first three or four weeks, or perhaps for a longer time, as well as for children who are much purged; as it is thinner and having far less curd than any other milk, it sits much lighter on the stomach, both of tender infants and adults; although in a few instances it is found to be too opening. And perhaps it may be inferred, from the very different proportion of cream and of cheesy principles, that the milks of different animals contain, that Providence has rather considered the benefit of man than the young of various quadrupeds; though, doubtless, the milk is likewise properly adapted to them.

In regard to the mode of feeding infants, I can say from experience, that for the delicate and tender at least, the boat, the spoon, and the horn, are in no wise comparable to the pot; which is so contrived, not only as to please the child by its resemblance to the nipple, and the milk coming slowly into its mouth; but also to afford the infant some little degree of labour, in order to acquire the quantity it needs, which the horn does not; by which means the food is also duly mixed with saliva. The like little fatigue takes place in children nourished at the breast, and by this means it is, that infants, especially when very young, are not so apt to oversuck, as they are to be over-fed by the boat or the spoon; the food of which being sweet and pleasant, and requiring only the trouble, or rather the pleasure of swallowing it, the child is tempted to take too much at a time; whilst the nurse often forces down a second or third boatful, in order to put a stop to the cries, which indigestion from the former may have occasioned.

The writer just now alluded to, as well as Mr. Le Febure de Villebrune detracts from the advantage of this mode of feeding, by observing that infants may be fed as slowly and cautiously by the spoon: but the fact is, that this is, indeed, one of the things in which servants cannot be depended upon, whilst there are such temptations to the contrary, (at least I have not met with many who could;) [30] nor will children, indeed, oftentimes endure slow feeding, but will be screaming all the while, instead of being kept quiet by their food: though the hope of quieting them, it has been observed, is frequently the nurse's sole motive for giving it. But, when an infant can get it only slowly from the pot, and yet is itself all the while employed in the business, it will be agreeably diverted while it is acquiring its nourishment in the same manner that it is amused at the breast.

The pot is formed in the shape of an Argyle, or gravy-pot, with a long spout rising from the bottom, an pierced only with a few small holes at the end, which is to be covered with a piece of vellum, washing-leather, or parchment.

This covering should be left loose a little way over the spout, which will render it soft and pleasing to the infant's mouth; and it has been said, is nearly as acceptable to many children as the breast; as I have often been a witness.

This manner of feeding is not only pleasant to the child but very convenient to the nurse, and the food equally at hand in the night as the day, being easily kept warm by a lamp, or even in the bed. The only objection I have ever known made made by those who have made trial of it, is that which I esteem one its highest recommendations; which is, that children thus fed are frequently hungry; that is, they are what nature designed them to e; this food sitting light on the stomach, and being easily digested, like the breast-milk, children often need a supply of it.

I shall just mention another popular objection to the plan here recommended: this is taken from some fine children we meet with, who have been brought up by hand from the birth, and fed with thick bread victuals all the day long, whilst we every now and then see some of those who have been debarred that sort of diet, weak and tender till they become a year or two old. Not to stop long to observe, that this objection militates equally against children living on the breast, though that is the food nature has designed for them; it will be sufficient to say, that it is only strong children, who may be bred up almost anywise, that can at all digest thick victuals; that there are others who cannot endure the least thickening in their food, nor any kind of bread; and that weakly infants, who are scarcely preserved by the most careful attention to their food, would be soon hurried out of the world if that attention were withheld. And this reminds me of an observation of a very judicious friend in the north of England, which greatly surprised me at the time, as I had never met with any observation from him before, the propriety of which was not exceedingly obvious and convincing. Upon seeing one day a number of fine children, he with some shrewdness observed, that we did not seem to have so many weakly have-starved children in the streets of London, as he met with in the country, and that he had often before made the like observation in his journies to town. It appeared to me that my friend must lie under some mistake, and I accordingly mentioned my surprise at such a remark coming from him; when he removed my astonishment by insisting on the fact, with the following obvious solution of it: -- I apprehend, says he, that there are scarcely any but fine and strong children in London, who live to be two or three years old, the weaker ones for want of good air and exercise, sinking under their infirmities; whilst the tenderest children in the country, by being turned out to crawl in the wholesome open air, or by sitting at the door almost all the day, escape the fatality of your gross air and hot nurseries, and survive the trying periods of infancy, though some of them remain weak and ricketty till they become old enough to endure severe exercise; which can alone strengthen them effectually.

I have no doubt of there being certain exceptions to the mode of feeding I have recommended, that are worthy of more attention; although very few have actually come to my knowledge; and though I am persuaded, that, as a general plan, it is both a natural and salutary one. Instances may be met with, however, of some very athletic children who may require a more nourishing and perhaps somewhat more solid diet; and the state of bowels in others, will call for a greater variety of food, and of a kind not calculated to be administered in the mode here recommended, as hath been already noticed under the head of purging. On these accounts, I would offer another observation or two in regard to the thicker kind of victuals; and first, that in families accustomed to bring up their children by the spoon, I think I have found a greater number of infants well nourished by the French or the Uxbridge roll boiled in water to a jelly, and afterwards diluted with milk, than on any other kind of pap. From such families I have likewise learned, that some change in the food is, however, frequently necessary; and will be indicated by the degree of relish which the infant may discover towards different kinds of food, as well as by their effects on the bowels; though the child be not supposed to be at such times really unwell. Such changes principally respect the different kinds of bread, or other farinaceous substance usually mixed with milk; and sometimes the substitution of broth, for a few days, in the place of the latter.

When children brought up by hand become four or five months old, especially if strong and healthy, they may, doubtless, be allowed a thicker kind of victuals, because their digestive powers being by this time become stronger, they are able to extract good nourishment from it; though this change is not equally necessary for children brought up at the breast, at least, such do not require it so early; breast-milk, it has been said, being more nourishing than any other. The first addition of this kind, however, whenever it becomes necessary, I am persuaded, ought to be beef-tea or good broth, [31] which, with a little bread beat up in it in the form of thin panada, will be at once an agreeable and wholesome change, and prepare them for further advances in this way. But, as this cannot well be given oftener than two or three times a day, (unless where other food is found to turn acrid on the stomach,) a little bread and milk may also be allowed them every morning and evening, as their strength and circumstances may require. A crust of bread likewise, as soon as the child has a couple of teeth, will amuse and nourish it, whilst it will assist the cutting of the rest, as well as carry down a certain quantity of the saliva; a secretion too precious to be lost, when the digestive powers are to be further employed. As the child grows older, to broth may be added light puddings, made of bread, semolina, tapioca, [32] or rice; salep boiled in milk, and such like. But to feed a child with veal, chicken, or other animal food, before nature hath given it teeth enough to chew it, however small it may be minced in the kitchen, is altogether unnatural, [33] and can prove nourishing only to such children, as from the great strength of their natural constitution, need least of all the assistance of art. It is by degrees only, that children ought to be brought to such food; which at a certain period, indeed, is as necessary as a light diet at an earlier age. For it is certain, that the error of some parents runs the contrary way, and their children are kept too long upon a fluid, or too slender diet; whence their bellies and joints become enlarged, and the bones of the lower extremities too weak to support them, at an age when they want more exercise than their nurses can give them. For when they go alone, not only is a little light meat and certain vegetables to be allowed them once a day, or alternately, with broths, puddings, or blamange, whitepot, custards, and such like kitchen preparations of milk; [35] but even a little red wine is beneficial to many constitutions. This will not only promote digestion, and obviate in a great measure a disposition to worms, but, by strengthening the habit, will also render children less liable to become ricketty, at the very period they are very much disposed to it. Such a plan is the rather insisted upon, because some parents, the most desirous of doing right, fall into a like mistake, even in regard to older children, whom they keep too low, allowing animal food only every other day to those of four and five years of age; which, unless in very peculiar habits, is surely an error, at least in this damp climate: and disposes our children to scrofula. But so many little infants, on the other hand, fall a sacrifice to the use of indigestible food under the age of six months, being carried off by vomiting, purging, or fits, that whoever would preserve them over the most dangerous period of infancy, cannot too cautiously attend to their diet at this time. [36]

It is a common direction in works of this kind, to point out the properest times for feeding an infant brought up by hand, and to direct how often it may safely be fed. I shall just observe therefore, that no adequate rules can be laid down on the occasion; and on that account none ought to be attempted; since none can be sufficiently comprehensive; and I am happy in not being at all at a loss in this instance wherein writers have differed so widely. For infants, not usually taking too much at a time in the manner of feeding that has been recommended, on account of the little fatigue which it was observed they undergo in acquiring their nourishment, may generally be permitted to partake of it as often as they might of the breast. [37] This is, however, by no means the case, when children are allowed to eat thick victuals, and are fed by the spoon, by which it has been said, they are always in danger of taking too much; an evil that cannot be too often pointed out.

Before I close this head of the Management of Children, perhaps the most important of all, I shall point out the most suitable diet under the different complaints to which they are most liable. But, after the hints that have been thrown out through the former part of this work, the directions need not to be very ample and precise; I shall, therefore, only observe, that as light a diet as is possible is usually called for when a child is unwell, let the disorder be almost whatever it may. If a fever should accompany it, the child will require still less food than in any other complaint, but plenty of drinks; which may also be so calculated as to furnish nearly as much nourishment as the infant will require, and may in summer-time be given cold. Such are barly-water, water in which a crust of bread has been boiled, and thin tapioca; or, if purging attends, rice, or arrow-root-water; and a drink made of hartshorn shavings, with a little baked flower in it. In this complaint, wherein more nourishment is required to support the child than under most others, (if not attended with fever,) baked flour mixed up with boiled milk, (as mentioned under the article of purging) is admirably calculated both as a proper diet and medicine. For the like complaint, arrowroot, or the food directed by Dr. Smith is very well adapted, and will afford a little variety. He orders a table-spoonful of ground rice to be boiled with a little cinnamon, in half a pint of water, till the water is nearly consumed; a pint of milk is then to be added to it, and the whole to simmer for five minutes: it is afterwards to be strained through a lawn sieve, and made palatable with a little sugar. In this way, or joined with arrow-root, milk may generally be made to agree perfectly well, even when the bowels are purged; and when it does so, proves exceedingly nourishing. Should it chance to disagree, owing to the great acidity of the first passages, good beef-broth ought to be made trial of, which may be thickened with baked flour, instead of bread, or mixed with an equal quantity of thick gruel, and makes a very pleasant, as well as anti-acescent diet. Likewise the patent sago, properly boiled, adding to every half-pint a large tea spoonful of red Port wine, for the use of infants of a week old; cautiously increasing the quantity of wine, as they grow older. A large family of children whose bowels had been continually disordered by various other food, has been brought up by this, which was persevered in till they had four, or more teeth, and were able to partake of pudding and other common food. Young children in this country so seldom tasting wine, it may seem strange to advise it for infants in the month; but it will be recollected by some readers, that the practice is very different in wine-countries, where it is often exhibited as well for food as medicine; and is one of the best cordials for infants, as I have experienced in various instances.

Perhaps much more has been said on the subject of acidity, by some writers, than really ought to have been, or it may at least be suspected, that a proper attention has not been paid to the peculiar circumstances of infants, who are all much disposed to it. Acidity, when injurious, is probably, oftentimes rather an effect than the first cause of the disorders of infants. It seems, indeed, to be natural to them, arising alike from the weakness of their organs of digestion, and the nature of their food; though there is no doubt, that their complaints are afterwards aggravated by an abounding acid, or rather, probably, from this natural acid becoming morbidly acrid, through over-feeding, and other errors in their diet, or from it being accidentally confined in the first passages. Nature, however, seems to have designed the food of infants to be acescent; and till the body be disordered, and digestion impaired from one cause or the other, [38] this quality of their food is not likely to be very injurious to them; and probably, is far less so, in a general way, than food of a very alkaline nature would be, with a like weak digestion. It is true, indeed, that as many similar complaints in adults, who feed on different diets, will, caeteris paribus, have their varieties, and each have some relation to the different qualities of their food; so it is not to be wondered at, that the complaints of infants should be attended with wind and other marks of acidity, which in adults are usually the least hurtful of all; and are, indeed, for the most part, pretty easily corrected in children, while that is the only complaint. When they are much troubled with wind therefore it cannot be wrong to mix some carminative seeds, or the waters distilled from them, now and then, with their food; such as sweet fennel, or cardamom seeds, bruised very fine; but the aq. anaethi is that I have generally recommended, and, being a liquid, is always ready to be added to the food, without loss of time. But though such an occasional addition to their food is often exceedingly useful, I cannot help speaking against its being made a constant practice; by which children not only suffer when by accident, or absence from home, it has been neglected, but it destroys the very end for which it was used, by the stomach becoming accustomed to it.

Children, however, become less subject to wind and hurtful acidities as they grow older, and the stomach gets stronger, as it is called. But should these complaints, notwithstanding, continue obstinate, a little fine powder of camomile flowers, or a few drops of tinctura columbo, mixed in water, and warmed with a little ginger, will prove exceedingly bracing to the stomach and bowels, and render them less disposed to acidity. Exercise also, according to the age and strength, is a grant preventative and remedy; and especially making infants break wind after sucking or feeding. And this may generally be effected, as every one knows, by raising the infant up, and gently tapping it on the back, or rubbing its stomach before it be laid in the cradle to sleep.

I have only to add, that, when through an abundant acid, milk is frequently thrown up curdled, a little prepared oyster-shell powder may be added to it, or a very small quantity of almond soap, or of common salt, which will not at all injure the flavour, and will prevent this change happening too soon in the stomach.

It will be proper to include under this head, some observations relating to wet-nurses, and to weaning.

On the Choice of Wet-nurses.

The first and essential point in a wet-nurse is, doubtless, that her milk be good; to which end it is necessary she be healthy and young; not of weak nurses, nor disposed to menstruate while she gives such; and that her bowels be rather costive than otherwise. Her nipples should be small, but not short, and the breast prominent, and rather oblong than flat; such distension being rather from fat, than from milk. The chief marks of a good milk, are its being thin, of a bluish colour, rather sweet, and in great quantity; and if under four months old, it is, doubtless, and advantage; and certainly ought not to exceed six. And this is of more consequence, than it seems of late years to be thought; for after this time it generally becomes too thick for a new-born infant, unless very robust; and is not easily digested. On this account, though an infant may not be really ill, I have frequently observed it not to thrive, though it take great plenty of such milk. When the milk is of this age, there is also a greater change of its failing before the infant be of a proper age to be weaned. A wet-nurse ought furthermore to have good teeth, at least, her gums should be sound, and of a florid colour. She must be perfectly sober, and rather averse from strong liquors; which young and healthy people seldom need in order to their having plenty of milk. She should be cleanly in her person, good-tempered, careful, fond of children, and watchful in the night, or at least, not liable to suffer in her health from being robbed of her sleep.

The diet proper for wet-nurses is likewise worthy of notice. And here, an invariable attention should be paid to natural constitution and habit. Due allowance being made for these, it may be said, that milk, broth, and plain white soups, plain puddings, flesh meats of easy digestion, and a due mixture of vegetables, with plenty of diluting drinks, and such proportion of more generous liquors, (spirits excepted) as the variety of circumstances shall direct, will be a proper diet for suckling women. -- Respecting vegetables, particularly, the strictest regard should be had to constitution and habit. Wherever vegetables, or even acids, uniformly agree with the suckling parent or nurse, I believe healthy children will rarely suffer by her partaking of them; but, on the contrary, the milk being thereby rendered thin and cooling, will prove more nourishing and salutary, in consequence of being easier of digestion. To these regulations should be added an attention to exercise, and frequent walks in the open air: to these, hired wet-nurses have been previously accustomed, and are therefore sure to suffer by confinement to warm rooms, equally to the injury of their own health, and of the infants they suckle.

I shall close these general directions with the following from Struve, in a view rather to suckling parents of a delicate constitution, than hired wet-nurses.

"Let two parts of milk rise over a gentle fire; and add one part of well fermented beer, previously boiled. This beverage is to be taken cold; and has been attended with the greatest advantage by women who were already so exhausted, that they thought it impossible to continue suckling their children; they became replenished in a short time, and recovered their strength with a continued increase of milk." Tract on the Education and Treatment of Children, &c. -- Hanover.

On Weaning of Infants.

A principal article under this head, is the age at which it should take place; and this will depend greatly upon attending circumstances. A child ought to be in good health, especially in regard to its bowels; and, doubtless, ought first to have cut, at least, four of its teeth; unless that process should commence very unusually late. This seldom takes place till it is near a twelve-month old; and it may be observed, that healthy women who suckle their own children, and take proper exercise, do not usually become pregnant again in less time, and which I have conceived may be considered as one intimation of the properest period. We shall not be very wide, therefore, of the order of nature, if we say that children in general ought not to be weaned much earlier than this; making proper allowances, however, for all just exceptions to general rules, [39] and especially as far as teething may be concerned. -- Small and weakly infants, if rather feeble than ill, are oftentimes benefited by being weaned; they should therefore, about this age, be taken from the breast, instead of being, on account of weakness, nourished much longer in that way: a trial of such a change should, at least, in most instances be made.

Any preparation for weaning is generally needless, and especially that of feeding children before-hand, though made a common excuse for stuffing them whilst at the breast with indigestible food. I have seen many mothers needlessly torturing themselves with the fear of their children being weaned with difficulty, because they could not get them to feed when eight or ten months old, and still at the breast; but I have always found such children wean, and feed just as well as others, when once taken wholly from it. I, therefore, never have any fear in that respect, and therefore wish to counteract, if possible, a sentiment encouraged by several writers, which has, I believe, no real foundation in fact, but has too often been productive both of much inconvenience and mischief. But I do not by this intend to say, that a child of eight or ten months old would be injured, or oftentimes not benefited, by a little food, once a day, of a more solid nature than the breast milk, as, indeed, I have intimated before; but when children happen to be weaned much earlier, and are fed almost from the birth merely with that view, (which is often the case) they may be essentially injured by it.

Objections to immediate weaning, which has of late years been brought forward, have arisen, I am persuaded, from fallacious reasonings, and not from facts and experience; having myself lived, as it were, in the nursery for many years, and never found any ill effects from the sudden transition from breast-milk to artificial food when properly chosen; [40] and as long as I shall continue the pupil of nature, I shall hearken to no argument in favour of adding a less adapted nutriment to that which nature has provided, in order to obviate possible injurious consequences, the existence of which I do not think have been confirmed by facts.

It has been remarked, that infants who are indisposed to feed at all while at the breast, are nevertheless weaned, and feed just as well as others, when once taken wholly from it. There is, however, in a few children a little difficulty for the first two or three days under any circumstances; but it is remarkable, that the instance attended with the greatest aversion to common food, that I have ever witnessed, was in an infant who had been allowed a little chicken broth once a day for two months before the weaning was entered upon. This child was very healthy, slept well, and scarcely cried at all upon its being deprived of the breast, and yet would not receive even the food it had been accustomed to; so that for six and thirty hours, it continued averse from every thing that was offered to it, even though it appeared in very good humor. After the second day, however, it took a moderate breakfast, and in a little time it fed as readily as other weaned children.

Under such circumstances, if the weaning has been committed to the wet-nurse, or she be still in the house, it will be proper that strict inquiry be made and the nurse be watched; there being instances of such hankering after the breast being kept up, by her occasionally indulging the child in that way. It may be further observed, that if the infant be in the least degree costive, a little magnesia and rhubarb should be administered, which besides opening the bowels, will tend to create an appetite. Such infants also, where there are more young children in the family, should sit at the table with them while taking their meals; as they will thereby, through mere imitation, be disposed to take food.

When the weaning is once entered upon, a great part of their food ought still to be of milk, with puddings, broths, and but little meat, supposing the infant to be of a fit age to admit of any; and every kind of food, and even drink should be prohibited in the night, even from the first, supposing them to be weaned at a proper age. The mere giving them drink, even only for a few nights, creates the pain and trouble of two weanings instead of one, and if it be continued much longer, it not only breaks the rest, but the child will acquire a habit of being fond of drinking; the consequence of which very often is a large belly, weak bowels, general debility, lax joints, and all the symptoms of rickets. The only need is, that the last feeding be just before the nurse goes to bed, which may generally be done without waking it; and whilst the child seems to enjoy this sleepy meal, it becomes a most pleasant employment to the mother, or nurse, from observing how greedily the child takes its food, and how satisfied it will lie for many hours on the strength of this meal; -- the mention of which naturally leads to the consideration of the next Article proposed, viz.

Sleep and Watching.

After what has been already advanced on this article, under the head of their Complaints, only a few observations will be necessary in this place; and first, that healthy children sleep a great deal for the first three or four days after they are born, probably from having been previously accustomed to it. They ought not, however, to be suffered to continue this habit in the day-time to the degree some children are permitted, but should be gradually broken of it; and indeed of not indulged, they will not be so much disposed to sleep as is generally imagined, and will therefore take more rest in the night; which is mutually beneficial to the child and the mother, if she be in the same room, who, especially if she suckles, will be less disturbed, at a time when she particularly requires this refreshment.

Therefore, when infants are sleepless in the night, they should be kept more awake, and have as much exercise as possible in the day time, which, though they be ever so young may be pretty considerable, (as will be directed more at large in its place,) by playing with them, or dandling on the knee, and otherwise amusing them; and, when older, by every kind of exercise they can bear. The child, if healthy, will soon contract a habit of being very much awake while it is light, through that lively and restless spirit peculiar to infancy; and by this means another evil will be very much avoided, that of often laying a child down to sleep in the day time for hours altogether, loaded with a thick dress, and covered besides with heavy clothes in a soft cradle, or bed.

But though I am confident these cautions will have their use, I am equally satisfied that many children have much less sleep than they require; but then this deficiency is chiefly in the night, and is often the consequence of some complaint which the child labours under. Upon these, however, sufficient has already been said in the former volumes, to which therefore the reader is referred.

Before I quit this article, it may be remarked, that the custom of constantly placing infants on the back, whether in the cradle or bed, is very improper; for by this means, the superfluous humour secreted in the mouth, which, in the time of teething especially, is very considerable, cannot be freely discharged, and must fall down into the stomach, where its abundance occasions various disorders. [41] Infants should therefore be frequently laid on one side, particulary the right, as favourable to the stomach getting easily rid of its contents; to which side also children, when strong enough, will instinctively turn, if not prevented by the weight or confinement of their own clothes, or those of the cradle or bed. The chief apology for all which, is a fear of the infant's falling, or turning on its face; but this is rather an apology for the neglect of that necessary attention to infants, which, whenever it can be commanded, should never be spared them.

It only remains, under this article, to say something of the Cradle, which most writers have spoken against. I believe there is no doubt but the custom of laying children down awake, and rocking them in a cradle in the day-time, or at seven or eight o'clock in the evening, when they are to go into their night's sleep, as it is called, may be an occasion of making them more wakeful in the night; or at least may cause them to expect that kind of motion whenever they awake. But yet I cannot help thinking, there is something so truly natural, as well as pleasant, in the way motion of a cradle, (when made use of at the proper times) and so like what all children are used to before they are born, (being then suspended and accustomed to ride, as it were, or be gently swung in a soft fluid, upon every motion of the mother, and even during her sleep, from the effects of respiration) that, always wishing to follow nature as I do, I cannot, on the whole, but give an opinion rather in favour of the cradle. It is, at least, among the little things in which we may harmlessly err, and in which every mother may therefore be safely guided by her own opinion, or even by her feelings. And if the child, in consequence of being sometimes rocked to sleep in the day-time, shall expect it when it awakes in the night, it will not be very difficult to find a substitute for it; and indeed, parents seem, as it were instinctively and mechanically, to pat and gently move a child, whether lying on the lap or the arm, whenever it appears to awaken prematurely. The objections to the cradle made by some late writers, militate only against the abuse of it, from any violent rocking; as though infants must necessarily be jumbled in a cradle like travellers in a mail-coach. For I cannot easily persuade myself, that we are in everything become so much wiser than our fore-fathers, with hom for some ages, and in distant countries, amongst rich and poor, the cradle has been judged to be a necessary part of family furniture.

Since the last edition of this work, some new, and stern objections have been offered to the arguments I had advanced, and from very respectable authority; but I conceive, not the result of actual experience of any ill consequences attached to the practice I had ventured to espouse. It is objected, however, that infants, after birth, pass into a very different state to that they had been accustomed to in utero. True; but I have not advised children to be rocked all the time they sleep, like the unborn infant; but have merely said, that, as some new-born infants certainly do not sleep so much, nor so long at a time as they ought, and are often with difficulty got into that state, through illness and other causes, I conceive they cannot be injured by gentle rocking, when they are first laid down in the cradle, nor from being gently, and to themselves pleasantly moved, when they may be disposed to awake prematurely. -- More than this I never intended; whilst my argument, from the infant having been accustomed to this waving motion in utero, was calculated only to combat the frivolous objection, as I conceived it to be, against this very ancient practice, and not as being a reason in itself for its continuance. But the writer observes, that "no prudent person would recommend any unnecessary expedient, which may, through inattention be improperly used." As this argument stands, it must carry conviction with it; but if by unnecessary, be meant useless expedient, I beg leave to deny the supposition; and, in return, to inquire, what actual evils have resulted from the practice? For, if these be neither frequent or great, I would ask again, what good thing is there that has not been abused? or what is there of more importance to children than sleep; every innoxious inducement to which, it should seem, ought to be encouraged; and if so, the cradle, or some similar mean of grateful motion does not appear to be wholly unnecessary. In regard to watchfulness, however, as was observed in another place, it is usually a mere symptom, and should be treated according to its cause; but in a general way it may be said, that nothing can so safely and effectually contribute to procure natural rest as that exercise to be further considered under the next head.

Motion and Rest.

It is chiefly the former of these that will claim our attention, as infants ought scarcely to be ever in a quiescent posture, except when asleep; and happy for them, that active principle with which nature hath endowed them, is so vigorous and overflowing, that they reluctantly submit to it. Exercise, like air, is, indeed, of such universal importance, that neither children nor adults can possibly be truly healthy without it; whilst for the former, particularly, care should be taken that it be properly suited to their age.

The first kind of exercise, it has been said, consists in dandling, as it is called, patting the back after feeding, and gently raising the child up and down in the arms; taking care at first not to toss it very high, infants being very early susceptible of fear, and even capable of being thrown into fits by it. Another exercise adapted to this tender age, and of the utmost advantage, is rubbing them with the hand. This should be done all over, at least twice a day, when they are dressed and undressed, and especially, as noticed before, along the whole course of the spine; and ought to be continued for some time, being peculiarly agreeable to the child, as it constantly testifies by stretching out its little limbs, and pushing them against the hand, with a smile expressive of the satisfaction it receives from it. Such gentle exercise may be partially repeated every time the child's clothes are changed, by rubbing the lower limbs, and every other part within reach. -- Likewise dashing the face with cold water, in the manner recommended for the rickets, [42] but more lightly, will produce the effects of exercise well adapted to this age.

When children are older, their exercise should be proportionately increased, and, as has been observed, they ought never to be carried in a quiescent posture, but the arm that supports them should be continually in such motion as the nurse may be able to continue. -- For children, it has been noticed, delight to be in constant motion; and this exuberant activity is given them for the wisest purposes, and ought by no means to be counteracted. And I notice the mode of carrying them, because I have seen children slung carelessly over the arm in such a manner, as neither affords them any exercise, nor allows them to give any motion to themselves; which lively children will always endeavour to do. And, indeed, the manner of carrying an infant is of more consequence than is generally imagined, for, from it, the child will contract a habit, good or bad, that it will not readily give up, and may be as much disposed to become ricketty, by improper management in the arms, as if it were lying wet in the cradle; the ill effects of which have been pointed out already.

It may be a proper inquiry in this place, at what age children should be put on their feet; a point on which people have differed considerably; but I apprehend nothing more is required than to follow nature, whose progress is always gradual, as our imitations of her should be, and we shall then seldom run very wide of her intentions. If we take notice of a healthy child, it has been said, we shall observe it to be always in motion, and as soon as it gets strength, it will be supporting itself by the help of its hands and feet, and be crawling around wherever it is permitted. From this exercise, it will soon acquire an increase of strength; and, whenever it is upheld by the arms, and disentangled from the weight of its clothes at the time of dressing and undressing, it will naturally walk up the waist of its mother, or nurse; [43] and, by the manner of moving its limbs, and its bearing more or less on the arms, will shew what advances it has made. Whenever it is strong enough, it will have attained sufficient knowledge to walk by itself, and will never attempt it till it is fully equal to the task. It will then be perfectly safe to permit it to follow its inclination, at least as far as the straitness of its limbs is concerned; and I think I may defy any one to produce a single instance of a child getting crooked legs, from being suffered to walk as soon as it has been disposed to make the attempt. But in no wise ought nature to be forced; a maxim applicable to every other occasion; "aware, (as a writer before quoted, [44] finely observes) that whatever forms may, by artifice, be intruded upon her, and she compelled to assume, to enlarge or contract her bias and inclination, she can never be made, eventually, to deviate without manifest injury to herself, from the station and bounds unalterably impressed upon her by the unerring Power, which first created and gave her laws." But the mischief is, we lead on children prematurely to the trial, by back-strings, and goe-carts, and other contrivances, calculated only to spare idle nursery-maids, or what is really pitiable, to allow poor people time to attend to other concerns, who are obliged to work for their bread. But where this is not the case, such contrivances are unpardonable, and are the consequences of ignorance, or idleness, which are productive of great evils; and then by way of excuse it is asked, at what age a child may be put on its feet -- a question, I apprehend, that ought to be replied to only in the manner I have done [45] -- leave children to themselves, and they will afford a satisfactory answer in good time.

It is said, however by a sensible writer, [46] that children's legs do not become crooked by putting them too early on their feet, and he asks if any other animal has crooked legs, though they stand on them almost as soon as they are born. But this is running to the contrary extreme; the cases, I apprehend, being widely different; quadrupeds and fowls are designed by nature to be early on their legs: and it is necessary that they should be so. They are accordingly calculated for it, their bones being strongly ossified from the birth; but this is, by no means, the case with the human species, and therefore no argument can be founded upon it without considerable latitude, and making such allowances for the different circumstances of children as have been pointed out. But if it be meant only to suffer children to feel their way, if I may so speak, for themselves, they will never deceive us, nor do I think their limbs ever become crooked, but by urging them to it by contrivances of their own; for which poverty is the only apology that can possibly be offered.

A note of Dr. Buchan on the subject of giving exercise to children, which some people from their straitened circumstances cannot spare time to afford them, charmed me exceedingly. The good sense and philanthropy manifested in it, as well as a desire of extending its useful contents, will, I hope, be apology sufficient for transcribing it, especially as it is at present so apposite to my purpose; and though I cannot flatter myself that government, however benevolently disposed, will, or perhaps can, at this time, adopt such a plan, either from his recommendation or mine, it is, nevertheless, in the power of people of large fortune, both in town and country, to give it very considerable effect, especially if the premium were made double for such children as should be produced in good health. The Doctor's words are:--

"If it were made the interest of the poor to keep their children alive, we should loose very few of them. A small premium given every year to each poor family, for every child they have alive at the year's end, would save more infant's lives than if the whole revenue of the crown were expended on hospitals for that purpose. This would make the poor esteem fertility a blessing; whereas many of them think it the greatest curse that can befall them;"

and I may add, I have known them express great thankfulness when any of their children have died.

The advice contained in this chapter is further worthy of serious attention, from late discoveries of much greater fatality amongst the children of the poor of this metropolis than I ever suspected.

To ascertain the fact, an enquiry has for some time set on foot, at the British Lying-in Hospital, at the suggestion of my then colleague, Dr. Combe. Inquiries have likewise been making ever since in different ways; and I have no reason to suspect that the statement made out from the report of the women offering themselves at the Hospital, is at all beyond the fatality in other poor families in London, but, indeed, rather under it, in regard to still poorer people.

The following is a brief statement of the result of the investigation at the Hospital, during the first year:--

Several women who had borne

3 Children, had lost as many as

2

4

3

5

4

6

5

7

6

8

7

9

8

10

9

11

8 and 10

12

10 and 11

14

11

and several of the mothers of different numbers had lost them all.

During another long period, only one woman having borne as many as five children, had reared them all; and one having had twelve, had eight living. -- But some having had four, had lost three; and five, had lost four; and six, five; and seven, six; and eight, six and seven; and ten, seven and nine; and women having borne eleven and twelve, had lost eight, nine, and ten; and fourteen eight;: with many who had borne four, five, and six, one twelve, and another twenty-one, had buried them all. In addition to this, may be remarked the sad and ricketty state of many of the surviving children.

The above, indeed, contains the most formidable view of this matter, but the most favourable is, by no means, such as to counterbalance it; there being, during a year and a half, no more than three women, I think, who having borne only three children; and one woman, lately come from the country, having four children, who had lost none of them. Only one having had as many as six, had them all living; and another, who had preserved eight children out of ten. Amongst the surviving ones, however, it was frequently observed, was the last born; therefore, one less likely to be reared than an older child.

From these different degrees of fatality further contrasted with the small number of deaths in the hospital, within the month, [47] we may suspect the different care and attention bestowed upon young children, as well as the want of certain accomodations; and may fairly argue on their effects, there being no such fatality amongst the opulent: a singular corroboration of this remark, I had the opportunity of noticing only a few days ago; where a lady who had borne fifteen children, and no more, had them all sitting around her table at dinner; and in two other families, there were twenty-one children at table; and a lady visited a few months ago, told me that the number of her children and grand-children amounted to forty-seven.

It would be unpardonable not to add a few words in this place with a peculiar reference to females; upon whom, beside every infirmity common to the other sex, is imposed the painful task of child-bearing. It is the benefit of the lower class of people, indeed, that I have here principally in view; though the caution is not utterly unnecessary elsewhere. The many distressing, and sometimes fatal labours I have been witness to, have led me to regard with a kind of horror a ricketty distorted female infant; whose parent's or nurse's neglect, or ignorance, is heaping up for it additional sufferings and dangers, to those which are great enough under every advantage that art and good health can contribute.

From the age of two years therefore, or rather earlier, this care is especially called for; and besides every caution already pointed out, lays a strict prohibition on girls being suffered to sit, for hours together, on a low seat; whereby the pelvis is pressed between the lower extremities and the spine, and is made to grow out of its natural form. The consequences of this change of figure, if it be anywise considerable, cannot fail to be productive of increased pain and dangers in parturition, frequently equally fatal to both the parent and her offspring.

I am aware, that many poor people are not in circumstances to give their children all the exercise they require: they may, however, suffer them to afford as much as possible to themselves, by allowing them to crawl about on the floor, near an open window or door, instead of compelling them to lie on their backs, or to sit upright, pinned in a chair; the ill consequences of which are so exceedingly evident.

It is hoped, no apology may be thought necessary for these obvious remarks; since no pains should be thought too great if they may prevent the evils here pointed out, nor can too much be said to inculcate good nursing, (and especially exercise) which is alone adequate thereto. [48]

A very few words may suffice on the head of Rest; the irregularities therein being far less numerous and important than in the former. In a general way, it will be sufficient to notice them in regard to the improper inducement of young children to continue in action after they feel themselves wearied, and in keeping them out of bed beyond a proper hour. Children in health never wish to sit still when they do not actually feel it to be necessary, much less to go to bed over early. But it is to be remembered, that young people require more sleep, and to be longer in a recumbent posture than adults; for though they usually rise very early, they get to rest more than proportionally soon, being disposed to fall asleep almost the moment they are still; and this is natural to them, and is a demonstration of the advantage of exercise.

On some slight Natural Deformities.

Prolix as these articles may already have appeared, it may, nevertheless, add a completeness acceptable to the younger part of the profession, to comprehend under them other particulars of no small importance, that relate equally to both. These will respect the different modes of motion and rest, in order to point out several improprieties that have a natural tendency to induce, or increase, various corresponding deformities.

Such will relate to the manner of children's standing, walking, sitting, and lying; and will particularly respect the position of the head and feet, and the form of the back, shoulders, and hips. It may not, therefore, be improper in this place, nor, it is hoped, be thought going out of the true line of my profession to advert a little to each of these. Indeed, to propose regulations of any kind, merely with a view to a graceful manner of standing or walking, would be highly incompatible with the intention of the work; but, since this part of it is appropriate to the general management of children, it is hoped the reader may not deem it altogether impertinent that he is invited to pay attention to certain things, which, for want of correction whilst children are young, and frequently under the eye of medical people, may, by the neglect of their ordinary, and less intelligent attendants, grow up to real evils. For it is very certain, that, from an improper manner of resting upon any of the extremities, whether in sitting or otherwise, different parts may take an ill-form; and what is worse than an awkward appearance, (to which their parents are apt to confine their attention) children often grow up weak; whereby the poor become unfit for those labours and exercises for which they are designed, and the necessities of their situation frequently demand.

And I here beg leave to remark, that the very means frequently made use of by people of rank to prevent some of these deformities, may, on the contrary, occasion them.Such are the use of steel-collars, various sorts of stiff stays, and other tight bandages. For I am confident, nor am I singular in the opinion, that, when recourse is had to these things, before any parts have taken a wrong turn, they are very likely to occasion it. Not that such contrivances are afterwards improper; for when the bones have, by any means, been thrown out of their natural direction, Art can frequently rectify it, and point out where to apply, or to take off pressure; and has been fully considered in the account of diseases. But before this, and while the bones are growing, compression, however properly applied, is in effect oftentimes ill-directed, owing to the continual and irregular action of children, especially when they feel any parts unpleasantly confined.

I come now to the circumstances immediately hinted at, and first those which regard the head or neck.

Many infants come into the world either with the neck drawn a little to one side, or an awkward turn of the head appears to take place afterwards. In the latter instance, it may be the effect of habit, and amongst other causes may be owing to children being placed in the cradle, or carried improperly, so that the light, and other objects that forcibly attract their notice, are too frequently on the same side. The remedy in either case, as far as it may become such, is obvious, differing nothing from the intentions already noticed in the chapter on squinting; every thing should be so contrived as may tend to draw the head to the other side, and especially such things as may have a sudden and forcible operation on the muscles, by producing strong voluntary motions. It may not, perhaps, occur to every one, how much may be effected by such means: several striking instances of it, however, have been met with; [49] and we daily observe similar effects of a certain position in flowers and shrubs, which, without any help from the hand, turn about, obedient to the air and sun operating upon their internal structure.

The next observations respect the back and shoulders. -- Some young children, naturally well-formed, acquire after a while what is termed round-shoulders; the vertebrae of the neck and back projecting too much, and forming an unsightly curve.

The morbid affection of this part has been mentioned already; I have only to notice here a change arising merely from some bad habit or custom, through an improper manner of sitting or standing. In regard to the former, it may be observed, that the soft concave-bottom chairs, in which young children usually sit, are on many accounts improper for their years, who should always make use of a flat and hard seat, and generally without arms, as directed for the prolapsus ani; which complaint it would have a tendency to prevent. But in the hollow-bottomed chairs children find themselves obliged to recline in one way or other, or to be making certain exertions for keeping themselves upright, and preserving an equilibrium of the body; and it is obvious, that either a bending posture, or the efforts necessary to avoid it, often repeated, may become hurtful to weakly children.

An improper manner of standing, though less frequently a source of this kind of mischief, on account of the position being more frequently varied than in sitting, is, nevertheless, capable of giving an awkward turn to the back and shoulders, as well as to the feet. We are creatures of habit, both in respect to our bodies and minds, so that to whatever we may have for a little while accustomed ourselves, we have an increasing propensity; and when the habit is once formed it is with difficulty broken. Children should therefore be early accustomed to stand very upright, instead of being suffered to lean upon whatever may happen to be near them, as they are frequently disposed to do.

Should one of the shoulder-blades project more than the other, the child should lie as much as may be on the contrary side; as the shoulder upon which one lies always projects beyond the plane of the back. When the shoulders themselves happen to be too high, a child so disposed should never be suffered to sit in an elbow-chair; nor should any child sit before a table, that is either much too high or too low for the seat in which he may be placed, especially if it be for the purpose of reading, writing, or any other employment that may engage him for any length of time. But, if one of the shoulders is higher than the other, the child should be frequently be directed to stand only upon the foot of that side, at least to bear his weight chiefly upon it; by which means the shoulder that is too high must necessarily fall lower, and the other be raised: or a small weight may be put upon the shoulder that is too low, which will incline the child to raise it up. Or he may be caused frequently to carry a light chair, or such like, as a play-thing, in the hand of that side, which will have the same effect. The like means should be used when one hip is higher than the other, which is both a very common and peculiarly unfortunate complaint, especially to females.

Another easy and efficacious method of rectifying the shoulders, is to make the child support himself with a very short cane on the side where the shoulder is too high, which will oblige him to lower it; and at other times, to put one that is too long for him into the other hand, which will raise the shoulder on that side. He may likewise often sit in a chair with two arms, one of them being made a little higher than the other.

These and other similar means may be very easily complied with; and several of them so managed as to be made a sort of play or amusement to the child; and if properly perservered in, will correct many deformities that have originated merely from bad habits, as well as conspire with other contrivances to remedy such as may depend upon a slight malformation.

The feet of children, it has been said, are likewise liable to receive an improper turn; and this may arise from habit, as well as from original mal-formation; which has already been noticed. Children, when conversing with those with whom they are familiar, seldom stand firmly upon their feet, but are apt to lean upon one side of them, so as to bear almost upon the ankle, instead of the soles of the feet. By degrees, this habit is not only increased, but the tendons themselves are disposed to contract, or those on the opposite side become weakened. In the like manner, by standing upon the toes, the tendon of the heel, in time, becomes shorter, as was formerly very manifest in women who wore very high-heeled shoes. To obviate the former, little more is required than to correct the child's manner of standing, by teaching him to bear firmly on the bottom of his feet: or if a foot be turned very much to either side, the sole of the shoe may be thickened upon the side on which the child bears. If, by treading upon the toes, the heel is become contracted, the heel-piece should be taken off from that shoe, instead of its being raised, as hath sometimes been very improperly done. Beside this, such children should be frequently caused to walk up steep ascents, by which they will be obliged to raise up the fore-part of the foot, whereby the tendon of the leg will be stretched, and the heel must fall lower.

Most of the remedies proposed for these little disorders, will have another advantage, as they necessarily inculcate exercise; in favour of which so much has been said; the great neglect of it, especially among the younger children of the poor, is daily lamented by every man of observation and feeling, and the more so, as it is a good they cannot always command.

If I had not already far exceeded the bounds I had intended, I should be induced to say something on the manner in which exercise becomes so beneficial to children. -- Let it suffice, however, to extract a few of the pertinent and elegant remarks of Desessartz [51] on this head, whilst I more briefly observe, that exercise tends to push forward the blood through the small vessels, and to unfold them in the manner nature has designed them to be extended, in order to promote the growth of the infant, whilst it preserves the blood in a proper state of fluidity, and promotes both the secretions and excretions; which are the next things it was proposed to consider.

Retention and Excretion.

Every medical reader will be sensible, how greatly health depends upon a due proportion between the daily supplies and the various discharges of the body; the latter will vary according to the diet, age, and particular mode of life of each individual. The excretions of infants, however, insensible perspiration excepted, are chiefly from the bowels and bladder; but the latter is not very liable to disorders; as it sometimes takes place, however, it ought not to be entirely passed over.

Retention of Urine in New-born Infants.

After what has been already advanced under the head of Diseases, it will be sufficient to say, that the retention of urine during early infancy is chiefly from the birth, and is usually removed by applying a bladder of hot water to the belly, and gently rubbing with a little warm brandy, with oil of juniper, and oil of almonds, or an onion; and throwing up a clyster: or should these fail, the infant may be put up to the breast in a pan of warm water, and take a spoonful of marsh-mallow, or parsley, or wild carrot-tea, sweetened with honey, with the addition of two or three drops of the spirit. aether nitrosi. This, if there be no malformation of parts, will generally produce the desired effect in the course of a few hours; though cases have occurred in which infants have voided no urine for the space of four days, and have suffered very little inconvenience: I have even known one instance of the suppression continuing for five; and it is remarkable, that two former infants in this family voided no urine for three days. Should the suppression, however, continue for two complete days, the following cataplasm may be applied warm to the region of the pubis.

Take of parsley and mallow-roots, leaves of cresses, and juniper-berries, of each a handful, and of the roots of garlic one ounce; boil them slowly in water, or in wine, to the proper consistence for a poultice. On the other hand, the sudden application of cold to the regio pubis has sometimes produced an immediate good effect. Where all these means have failed, and the infant been in much pain, I have directed a clyster with a few drops of laudanum, which has presently removed both the pain and suppression.

As in adults a suppression of a very distressing kind sometimes occurs merely from a spasmodic stricture of the urethra, and not only resists for a length of time the ordinary means of cure, but is found to recur again after a temporary removal, it may not be amiss just to notice it here, as the complaint may, possibly, be met with in robust youths, although I have never yet seen it. The remedy for it is also very simple, and I believe newly discovered, and first announced by Mr. Cline, [52] consisting only in the tinctura ferri murati, which he advises in the dose of gtt. x, to adult persons every ten minutes, till some relaxation shall take place; which generally does in the course of an hour.

Some of the old writers have spoken also of incontinence of urine, arising from weakness of the sphincter of the bladder; but I have never met with it in early infancy. They prescribe agrimony and myrrh, and a direct astringent fermentations of red wine to the belly, perinaeum, and loins: for adults, (it being no uncommon complaint, in old people) three grains of camphire in a pill, and fifteen or twenty drops of laudanum in a dose of camphire julep, twice a day, has speedily removed the complaint.

The present observations are therefore chiefly confined to the bowels, which would call for a scrupulous attention in this place, if so many particulars relative to them had not been discussed in a former part of this work. It were needless, therefore, to say more, than that (generally speaking) infants are rarely healthy long together, who have not two or three stools every day; or should they be more, for the first three months, if the child be brought up at the breast, and the nurse have a sufficiency of milk, it will generally thrive the better. The stools likewise ought to be loose, of a yellow colour, free from lumps, or curdy matter, neither of a very acid nor fetid smell; and should come away without griping. When children are about a year old, or perhaps earlier, pains should be taken to procure one stool at least every day, as well periodically as constantly; and for this the morning is most adapted, and after their breakfast, by which the stomach and bowels will be stimulated. To this end they should be set on the chair, and not be suffered to play until they have had an opening, for which they should strain, till at length it becomes customary, which may be easily effected; by which we shall gain a point, with respect to the health of children. On the other hand, if an infant be dry-nursed, the danger generally lies in the other extreme, such children being disposed to be purged, and to have griping and sour stools, from the acescent, and often indigestible nature of their food, especially if fed by the spoon; and therefore require an early attention when their bowels are disposed to open, or, on the other hand, the feces are too stiff and clayey; and their food be changed, in the manner directed under the article of Purging.

The Passions of the Mind.

This is the last Article mentioned as included in the Non-naturals, and on which I shall be very brief, it being the happiness of infants to be very little affected by them. This article can, therefore, relate to them merely in regard to their mode of expressing such passions, and principally respects Laughter and Crying. The former, if long kept up, or very violent, may not only induce the hiccough, but it is said, may even throw an infant into fits. The latter is, indeed, much oftener suspected of being mischievous, and chiefly by occasioning fits, or a rupture; the excess of both these affections should, therefore, be guarded against. Moderate, and not too frequent crying, however, ought not to be alarming; and, indeed, a variety of considerations induce me to think, that this expression of the passions in infants is not only much more harmless in itself than is generally imagined, but is also, in some respects, salutary. The first cries it makes we know to be so, and that children recover from the paroxysms of some complaints (as was mentioned in regard to the Croup) by an effort of this time. It is evident likewise, how very much health depends on a free circulation of blood through the lungs, and on their free expansion from the dilatation of the bronchial vessels. But as new-born infants are incapable of giving themselves any exercise, and, indeed, of receiving that kind which tends to promote such an effect, I have conceived crying to be an effort which Nature may have wisely substituted in its stead. [53] Whatever is truly natural I always conceive to be right, though every thing is capable of being abused; and the most beneficial dictates of nature may be exceeded. I am satisfied, however, that the pacifying of children by improper means, and especially cramming them with food when they are not hungry, against which so much has been said, occasions far greater evils in thousands of instances than ever were produced by the irritation from Crying.

The cries of infants, however, it must be confessed, are, very commonly, plaintive; and, as they seem to argue distress, cannot but create it in every person of sensibility around them, and merit a strict inquiry into the particular occasion of them. The Nurse, therefore, who can with calmness hear an infant cry, without attempting to pacify it by every proper means, is a monster in human shape, unfit to be trusted with the care of rational beings, much less, with a tender, helpless creature, whose only language by which it can express its wants or sufferings is its tears.

I cannot take my leave of the reader without offering one apology more for having dwelt so long on this and some other heads less important than the rest; my motive has been the desire of instructing, though in some instances at the risk of tiring, or otherwise displeasing; but practitioners, who feel as parents, will endeavour by every other means to lessen a mother's fears as far as they may appear to be needless, wherever no other remedy can be offered.

I shall conclude by observing, that, though the Passions of the Mind refer so little to infants, they relate very materially to the wet-nurse; who, besides endeavouring to keep her spirits as calm as possible, ought to be exceedingly careful not to put a child to her breast, when under the influence of undue passion, of whatever kind it may be, the bad effects of which have already been instanced under the head of diseases. -- And I shall think myself well recompensed for the trouble I have had, if the counsel I have been able to offer, may prove the means of lessening the dangers of the infant state, and the consequent sad fatality that attends it; as well as of abating the anxiety of the fond mother, who, after having brought her tender charge into the world with sorrow, is pierced with double pangs at its leaving it; an event which, as experience warrants me to say, may by art and good management, be often prevented, and the author ardently hopes, that both parents and practitioners may have fewer occasions to lament.

The End.

Printed by Benjamin Bensley,
24, Nelson Square.

Footnotes

[1] The duty of suckling has the sanction of almost every writer, as well as of many persons of rank, and is distinctly noticed in the remote times of Pliny. Ann Van Swieten remarks, that one of the Queens of France suckled her own son, and continued it even during a fever. One of her ladies, however, having, on some occasion, given the child her breast, the Queen was so much disgusted at it, that she forced her finger into her son's mouth to excite vomiting; unwilling that it should receive any nourishment but from herself.

[2] In some very northern parts of the world, as those of Greenland, and the neighboring country of the Esquimaux, the breast appears to be, in the strictest propriety of speech, the only food that nature has provided for infants; insomuch that, whenever a suckling-mother happens to die, her infant is buried with her; experience (one would hope) having demonstrated the inefficacy of the hard and coarse diet which nature has there so sparingly dealt out, it is esteemed an act of compassion to put an end to an infant's sufferings by plunging it into the sea.

[3] The present day is peculiarly favourable to ladies determined upon this laudable attempt, through the admirable discovery of Mrs. Relf's nipple case, sold at No. 12, Bell's Buildings, Salisbury Square, Fleet Street, or at Mr. Savigny's, Surgeon's Instrument-maker, in St. James's Street. Though a most simple, it is an efficacious contrivance, especially with the late improvement of the plate being made of glass instead of silver, equally calculated to assist the infant to draw out the milk without trouble to itself, or pain to the parent, howsoever unfavourably formed, or tender the part may be.

[4] This has long been the case among the lower class of people in France; and that, nation therefore has been very much indebted to the goodness of the late monarch, who to the last was making solicitous enquiries through Europe to discover the best substitute for the breast. [5] Should the method recommended in the subsequent pages, be, amongst others, adopted, its claim will soon be determined; and I venture to hope, will yet be to the advantage of the rising generation in that kingdom, and elsewhere.

[5] See Questions proposed to the Royal Society of Medicine in Paris, October, 1789, by the late King's authority.

[6] Perhaps the extraordinary convulsion case mentioned, vol. 1, page 163, may illustrate the propriety of Moschion's observation. I having lately learned, that the infant there alluded to, after its health was fully restored, and thriving well, was seized with a kind of spasm on the chest, and was dead in two or three seconds of time in the bar-room of the liquor-house, where its parents resided, and to which the infant was brought back; but I was not informed of the event in time to solicit the examination fo the body.

[7] Dr. Hamilton.

[8] See Mon. Baumes on the Jaundice and Mesenteric fever.

[9] Mons. Le Fébure de Villebrune, in his translation of this work into French, has added a chapter upon baths; in which he highly extols the warm bath, and as strongly controverts the idea of the probable good effects of cold bathing, and even makes use of a long chain of arguments against it, deduced, indeed, from an ingenious theory, and supported by quotations from the ancients; who practiced, however, in a very different climate. -- The shortest and perhaps the best reply to this specious reasoning might be given in the well-known mode of Diogenes to Zeno, whose metaphysical arguments against the possibility of motion, Dioegenes laconically refuted, by hastily getting up, and walking across the school. We have, in like manner, only to point to the numbers of children and young people, who, from very weakly infants, have been rendered strong and healthy, merely from a prudent use of the cold bath; and may defy any man to produce the like instances of its opposite effects, when made use of with the cautions which every powerful remedy requires. The Spartan women likewise afford us sufficient evidence of the salutary effects of cold bathing, notwithstanding the comments made upon the women themselves, by Aristotle, as quoted by our author.

So great, and often times surprising, indeed, are the good effects of cold baths, that I do not wonder the priests, in times of ignorance, have been known to account them holy, and dedicate them to some saint; to whose influence certain cures were attributed.

The salutary operations of the cold bath are, however, easily accounted for, from its promoting insensible perspiration, and rendering that excretion less readily affected by the impression of external air.

It may be known to agree with children, when they come out of it warm and lively; and their strength increase on the use of it. On the other hand, if they continue cold, are dispirited, and seem rather to lose strength, it will be as certainly prejudicial.

As a mean, however, of acquiring that re-action and glow, which bathing is designed to affect, a loose flannel chemise may be thrown over the child the instant it is taken out of the bath. This will not only secure from the unpleasant shock arising from the cold air, but allow time for friction, along the course of the spine, which should be continued all the while that an assistant is employed in wiping the lower extremities, and putting on their usual covering. If this were duly attended to, I am persuaded that both many infants and adult persons would be benefited by cold-bathing, who, for want of that kindly glow, are unable to bear even bathing in the sea.

But I must observe, that the above-mentioned unpleasant effects are frequently owing to an improper use of bathing, and for want of making a very obvious discrimination in the habit of body of different children. -- For the tender and delicate, not only should a good quantity of salt be put into the bath, but the water may also at first be a little warmed, and children be brought only by degrees to endure it quite cold, which they will not by this means be the less likely to do: or, should the water never be perfectly so, (but merely below the heat of the skin) the advantages of such bathing will neverthless, be considerable; [10] though the late Dr. Hunter and others have thought differently. For it is not, indeed, merely from the coldness of the water that the benefit arises, but is rather from the subject being suddenly immersed into a very different medium (if so be, that medium be not actually warm;) in which the contact of the external air is taken off during the immersion, and is as suddenly restored upon his being taken out. By this means, the blood is alternately pushed forward into the extreme vessels, and suddenly repelled to the heart, (in proportion to the coldness of the water and the powers of the system) and suffers an advantageous attrition against the sides of the vessels. The small passages are rendered pervious, and the contractile power of the heart is increased, as well as the muscular fibres proportionally strengthened. -- The salt added to the water pretty certainly prevents taking cold, whilst it adds to the stimulus on the skin, and has therefore a more salutary operation on the pores.

The infant having been put quite under water, should be taken out as soon as it is possible. It should be received in a blanket, and wiped dry with a cloth in the most expeditious manner; and, as soon as it can be dressed, should partake of such exercise as may be best suited to its age. There will need no great attention to it being made perfectly dry, as a child will be less liable to take cold from a few drops of salt-water being left upon it, than by being long uncovered in some parts of its body, in an over caution to wiping it dry.

[10] Hippocrates, speaking of bathing, cautions against the two extremes of heat and cold. -- De Liquid. Usa.

[11] I have, indeed, known only four or five instances of it, (though there may be many that I have not been made acquainted with;) the first of which was in the family of a lady of rank, whom I was some years ago attending. I was there myself a witness to the good effect of holding a little pan under an infant of only four months old, as it lay across the nurse's lap; which I was assured had been her practice from the month, and that the lady had obliged her nursery-maids to do the like with her two former children.

[12] Nous naissons foibles, nous avons besoin de forces; nous naissons dépourvous de tout, nous avons besoin d'assistance; nous naissons stupides, nous avons besoin de jugement? tout ce que nouis n'avons pas à notre naissance, et dont nous avons besoin etant grands, nous est donnè par l'education. -- Rousseau

[13] Nelson; whose Treatise on Health I have perused with more satisfaction than most of the modern productions that I have examined, because he has taken Nature for his guide.

[14] A gentlewoman many years ago informed me, that one of her children, after long and incessant crying, fell into strong convulsions, which her physician was at a loss to account for, nor was the cause discovered till after death; when, on the cap being taken off, which had not been changed on account of its illness, a small pin was discovered, sticking up to the head, in the large fontanelle.

[15] The observation of the late Dr. James Mackenzie on this term may not be unacceptable to some readers:--

"The very sound of the epithet non-natural, when applied to aliment, air, sleep, &c. so essential to the substance of mankind, is extremely shocking; nor is the long continuance of this ill-fancied appellation, which arose merely from the jargon of the peripatetic schools, less surprising. The origin of it appears in a passage where Galen divides things relating to the human body into three classes: Things which are natural to it; things which are non-natural; and things which are extra-natural. I shall subjoin his own words from the vulgar Latin version, class vii. lib. de ocul. partic. tertia, cap. 2. 'Qui sanitatem vult restituere decenter debet investigare septem res naturales, quae sunt elementa, complexiones, humores, membra, virtutes, spiritus, et operationes -- Et res non-naturales, quae sunt sex, aer, cibus potus, inanitio et repletio, mosta et quies, somnus et vigilia, et accidentia animi. -- Et res extra-naturam, quae sunt tres, morbus, causa morbi, et accidentia morbum comitantia.' From this fanciful distinction the epithet non-natural first arose, and has been retained in common use to this day, though it cannot be understood without a commentary, by which physicians seem to make an apology for the impropriety of it. Hoffman, for instance, and some others, when they apply the appellation non-natural to air and aliment, are obliged to subjoin the following explanation: "A veteribus hae res non-naturales appelantur, quoniam extra corporis essentiam constitutae sunt." Dissertatio 3, Decadis 2.

[16] The propriety of this remark was more striking at the time the former editions of this work appeared, when the dress of young children was different from what it is at present, and to which it may possibly revert.

[17] This subject is largely and elegantly treated by Dr. Gregory, in his Comparative View, before quoted.

[18] Mr. Moss.

[19] It may be proper to notice in this place, the colour sometimes given to an infant's stools, from a little blood it has repeatedly swallowed, when the nipples of the suckling mother have continued to be very sore; a circumstance, indeed, that does not often occur, but has been alarming for want of the true cause being understood. The stools in this case will be of a strange blackish color, such as have been noticed under the head of a fever, and very similar to the first stools of new-born infants.

[20] See the author's Surgical Tracts before-mentioned, in which the milk-abscess, and sore nipples are fully considered, and a successful and easy method of treatment pointed out.

From motives of benevolence, I beg leave to mention here a new contrivance, which has succeeded so far byond every former device, for defending the nipples, and enabling women to nourish their own children, that I cannot but wish to extend its advantages, by this public recommendatation of the Nipple-shield. It may be had of the ingenious contriver, Mrs. Relf, No. 12, Bell's-Buildings, Salisbury-Square, Fleet-street; or for families at a distance from London, by application to Mr. Savigny, Surgeon's Instrument-maker, in St. James's-Street.

In Struve's Education and Treatment of Children, published in Hanover, some apparently similar contrivance is mentioned, called the wendelstoedtian; by which it is said suckling may be accomplished, although the nipples should be very deficient in their formation; but the writer has given no description of this useful invention.

[21] The sugar, or salt of human-milk is one-third more in quantity, and its extract, or solid contents, is double as much as in cows. See the Table at the end of the Introduction.

[22] Whether the parent be able to suckle her own child, or that office be performed by a hired nurse, is not here particularly considered. The design is only to prove that milk is in general the most proper food for an infant. Whether that, indeed, be prepared by its own mother, a nurse, or by such animals as the cow, or the ass, is equally to the purpose: where the former cannot be had, the best, and most natural substitute should be provided.

[23] See Dr. Parsons, who has some judicious observations on this head.

[24] "In Italy, Holland, Turkey, and through the whole Levant, children are rarely allowed any other food than the breast-milk, during the first year:" -- (Buffon) And the Savages in Canada suckle for four or five, and often six or seven years. -- In some extreme northern climates (as hath been already remarked) we know they can have no other food, for a long time; and yet, there, the death of an infant is as rare an event as that of a suckling mother.

[25] For infants subject to acidity and indigestion, it will be found very advantageous to boil the milk two or three times, waiting after each till the milk shall cool sufficiently to allow the curd, or cheesey parts to rise to the surface, which should be carefully taken off; whereby a much smaller proportion of the less easily digestible part of the milk will remain to offend such irritable stomachs.

[26] See his Treatise on the Management of Children, in a Series of Letters addressed to Married Women.

[27] There is sometimes a difficulty in making this jelly, on account of the hartshorn being bad; those who shave it, often mixing with it the shavings of trotters, which may, however, be distinguished by their brittleness. If the shavings are good, two ounces of them boiled very slowly in a quart of water to a pint, will make the jelly of the proper consistence.

[28] See Dr. Young, De Natura et Usu Lactis, in diversis Animalibus.

[29] The objection to this mode of feeding, made by a writer at Dover, that the pot may often, be left foul, and therefore the food become sour appears to me to be very far-fetched; since if nurses are not to be depended upon in matters of cleanliness, and the sweetness of the food, they are to administer, we can trust them in nothing, and infants must be continually suffering; there being a hundred particulars essential to children's health, in which servants cannot be always superintended, but must be entirely confided in.

Having been often sent to for a direction to the shops where the infant feeding-pot may be met with, I notice in this place that it is always kept at Philips's in Oxford-street, near Cavendish-square; and at Neale's Staffordshire Warehouse in St. Paul's Churchyard.

[30] Amongst the exceptions I have met with, I was lately greatly pleased with a nurse, who said, "I always let my children ask for their food:" which she pertinently explained by saying, "I do not feed infants because they cry; but if, after fasting a reasonable time, they begin to moan, I endeavour to amuse them till they anxiously hunt about them, and repeatedly form their lips in a certain way, that assures me it is a want of food only that makes them complain."

[31] "I cannot help remarking here, that the gravy of beef or mutton, not over roasted, and without fat, properly diluted with water, is the wholesomest and most natural as well as nourishing broth that can be made." -- Dr. Hugh Smith.

[32] The best tapioca, I believe, comes from the French West-India Islands, and is called by the general term, farine. It is in very common use also in our West-India Islands, where it is made into thin cakes, and is called cassada: [34] in this form, therefore, it is most likely to be genuine, and may be preserved for a very long time. Two ounces of tapioca should be boiled slowly in three pints of water to a quart, and be then passed through a sieve: a little milk being added, or not, as circumstances may direct.

[33] Ante dentium eruptionem non conveniunt cibi solidiores. Ideo natura quae nihil frustra fecit, et non deficit in necessariis, dentes ipsis denegavit, sed lac concessit, quod masticatione non eget. -- Primros.

[34] The Straopha Manibot of Linnaeus.

[35] "Infancy and childhood demand thin, copious, nourishing aliment." Arbuthnot On Aliments.

[36] From a note in Dr. Smith's letters it appears, that the average of births annually, within the bills of mortality, for ten successive years, was 16,283; out of which were buried, under five years of age, 10,145, and from amongst these 7,987 were under two years. So that almost two-thirds of the children born in London and its environs, become lost to society, and more than three-fourths of these die under two years of age. This proves how hazardous a period that of infancy is in this country; and I am sorry there is so much reason to be persuaded, that the want of air, exercise, and a proper diet, has added, unnecessarily to its dangers; there being no such mortality in barbarous nations, whose inhabitants live in a state of nature; nor in any part of the known world, amongst other young animals. Although these, and other calculations I have seen, should be found ever so accurate, it is a pleasant reflection, (to whatsoever the circumstances may be owing), that, since the time they were taken, the proportion of deaths at the early period above alluded to, has been very considerably decreasing; and the writer has noticed, that for some years the average of deaths, according to these bills, has not been more than six in sixteen: which is little more than one-third.

[37] Optimum vero medicamentum est opportune cibus datus. Celsus. De Med.

[38] Such cause, it has been observed, may be an over quantity, or too sweet a food, or heavy and indigestible diet; which indeed, prove more frequent occasion of a distempered acidity, than any thing else.

[39] Astruc advises children to be suckled until they are two years old; but without giving any sufficient reasons.

[40] Were weaned infants to be immediately crammed with animal food; it might, indeed, bear some analogy to adult persons with dyspepsy, "being all at once forced to live upon Cheshire-cheese."

[41] See vol. 1, page 6.

[42] Vol. 1, page 343.

[43] I cannot avoid taking notice here of an imprudence on this occasion, which it is well if it have not been prejudicial oftener than has been suspected; I mean, that of suffering a child to crawl so high up the neck, as to render the mother, or nurse, incapable of raising the arms high enough to support it: for not only may a child be suffered to slip out of the hands, but the mother may be injured. I have felt much on this occasion, from seeing tender and delicate ladies with their arms on a stretch, suffering a heavy child, perhaps with its shoes on, to crawl over the breasts, distended with milk, and squeezing them so forcibly against the edge of the stays, that parents have sometimes cried out from the pain, and yet not been able at the moment, to bring the infant down into the lap. But the dgree of evil attached to this, depends not a little on the fashion which the dress may assume at the time. This note was calculated for an abridged edition of this work, for domestic use; but as every medical gentleman may not have noticed this injurious custom, by not being often present when ladies are suckling their children; it is thought the caution might not be wholly improper here.

[44] Mr. Moss

[45] I have seen two children walking alone before they were nine months old, and at ten months, carrying a heavy play-thing in their hands; whilst other children, rendered weak and ricketty by mismanagement, have been able to do half as much at two years of age. -- I have even seen a child walking fairly alone, for a few steps, the day before it was eight months old.

[46] Dr. Hugh Smith, Letters to married women.

[47] See the Introduction to this volume.

[48] A proper attention to this, and may of the preceding articles has been conceived to be of so much importance, that the benevolent Governors of the British Lying-in Hospital, some years ago gave orders, that suitable Directions on these heads should be drawn up, and given to every mother, on her leaving that Charity.

[49] An Embassador from Morocco, being at Paris, went to see the Charity-Hospital, where passing the ward for the wounded, six of them who had not stirred for several months before, rose up and came to the Ambassador, to the great surprise of the whole hospital; [50] curiousity or surprise effecting that which the most powerful medicines could not, in so short a time. -- The like circumstance, is reported to have taken place very lately from a fire happening in the house where an elderly lady had long lain bed-ridden; who, perceiving the fire, suddenly rose up from her bed, without any assistance, and ran into the street.

[50] Histoire de l'Ambassadeur de Moroc, Envoye au Roi de France, en 1682.

[51] "La liaison et la dépendance que l'auteur suprême de la nature a établies entre toutes les parties de ce composé merveilleux, sont si intimes, que le Prince de la Médicine nous a répresenté le corps animé et jouissant de ses fonctions, comme un cercle dans lequel on ne peut reconnoître ni commencement, ni fin. En effect, les instrumens destinés à la chylification tirent toute leur force des organes de la sanguification, ceux ci des nerfs et du fluide qu'ils contiennent: et ce fluide (si nous en croyons le systême le plus universellement adopté, et auquel il manque peu de chose peur être démontré: ce fluide) tire son origine du sang, et la sang des alimens que nous prenons tous le jours. -- De la constance et de la régularité de fonctions aussi différentes et aussi multipliées dépendent notre santé et notre vie. Il ne suffit pas de prendre des nourritures, il faut qu'elles soient bien digérées, changées en sang, et ce sang doit être assez travaillé pour fournir non seulement la nymphe nourriciere de tout le corps, mais encore un flude très-subtil qu'on apelle fluido animal. Chaque liqueur doit être separée dans ses glandes, et celles que la nature rejette comme inutiles et dangereuses, doivent être poussés au dehors.

"Or, rien n'est plus propre à faciliter et a perfectionner toutes ces opérations, que l'Exercise. Si nous jettons les yeux sur notre corps, nons y appercevrons une multitude de vaisseaux qui sont entrelassés les uns dans let autres, serpentans entre les fibres musculaires, à la pression successive desquelles ils doivent une grande partie de leur movement et de leur actions sur les fluides. A mesure que les muscles entreat en jeu, ils produisent des secousses reiterées sur les vaisseaux sanguins, qui se communiquent dans tout le systême artériel et veineux. Ces secousses non seulement procurent aux fibres la force, et la souplesse, qui caracterissent leur bonne constitution, mais elle broyent, atténuent et subtilisent les liquides contenus dans les vaisseux, ache, vent la transmutation du chyle en sang, en lymphe, et en fluide animal; la circulation est plus libre, les sécretions fse ont mieux, et plus uniformément, et la digestion en devient plus parfaite." -- Traité de l'education corporelle des Enfans en bas Age.

[52] Medical Records and Researches.

[53] Fletus moderatus pueris non obest -- pectus dilatat et calefacit. Primeros. See also Aristot. Politic. Lib. vii. C. 17, where the idea is supported more at large.


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