REGIMEN.—Cooling drinks, as plain water, toast and water, barley water flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may all be resorted to in their turn. The child may also be allowed oranges, grapes, or lemons sweetened with sugar, particularly when the mouth is foul and dry; but care must be taken that neither the pulp nor the stones are swallowed. These will both refresh and feed the patient as much as is necessary until the decline of the disease. The parent must strictly forbid the attendants in the sick chamber giving, at this period, any heating or stimulating fluid, as also animal food; and this injunction must be strictly regarded, even in the mildest form of the disease.

When the child is convalescent, mild nourishment will be required, such as arrow-root, tapioca, chicken or mutton broth, beef tea, jellies, and roasted apples; and by and by a mutton chop. Wine is seldom necessary, except under circumstances of unusual debility after a protracted illness, when its moderate use tends much to assist the convalescence; but, if given unadvisedly, there will be great hazard of exciting internal inflammatory disease.

Relapses are sometimes caused by the child getting about too soon, and by indulgence of the appetite, particularly for food: a proper degree of restraint, therefore, must be placed upon the child by the parent, who cannot too strictly carry out the directions of the medical attendant upon the diet and regimen during this period.

Great attention must still be paid to the state of the bowels, and, indeed, to all the secretions and excretions.

PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.—To promote the more easy separation of the cuticle from the surface of the body, a warm or tepid bath may be usefully employed at the close of the disease. It will, moreover, greatly contribute to the comfort of the child, and induce a more healthy condition of the skin. Occasionally the cuticle of the whole hand and fingers will peel off unbroken, when it will resemble precisely a glove in shape.

As is the case in all fevers, more or less, so particularly after scarlet fever, there is a great tendency to the falling off of the hair. It will be always well, therefore, to shave the head at this time, and exhibit daily a tepid shower bath, as early as the strength of the child will permit.

CAUTIONS, ETC.—The contagious character of this disease requires the separation of the invalid from the rest of the family; and, when it is practicable, the children should be removed to a distance. This measure is imperatively called for, when the form of the disease is very severe in its character.

Great caution must also be exercised, after the convalescence of the patient, that the other children are not brought into too early contact with him: for infection may be thus produced, though several weeks may have elapsed from the period of the peeling off of the skin.

The period at which the disease shows itself after the exposure of an individual to sources of contagion, is exceedingly various. One child will be seized within a few hours; another, not for some days; and now and then (though rarely), five or six weeks have intervened between the period of exposure and the manifestation of the disease.

When this disease is rife in a family, it will frequently affect the individuals composing it very differently. Some escape altogether;— others have the mild form of the complaint;—others the severe;—and, again, the attendant in the sick room may be attacked with the sore throat and fever only, both of which may subside without any appearance of a rash.

In conclusion, this disease is a complaint of infancy and childhood, rather than of adult age; generally affects the same individual but once during his life; and, though examples of a second attack have occurred, such a circumstance is extremely rare.



Sect. VI.—MEASLES.



Measles consists of a fever, in which the mucous lining of the air- passages is principally affected, and which, after about three days' duration, results in an eruption of a red rash over the surface.

It depends upon a specific contagion;—occurs most frequently during childhood and adolescence, though no age is exempt from it;—and affects the system but once; a peculiarity to which an exception is very rare, proved by the few instances of the kind which have been recorded.

The period at which the disease manifests itself after infection is various,—generally about the ninth day; it has, however, been delayed until the sixteenth.

DESCRIPTION OF THE DISEASE.—The child infected will be observed not to be as well as usual, less active, and out of spirits; his appetite will fail, and his sleep be restless and disturbed. It will soon be evident that he has apparently taken a cold in his head, and that this is accompanied by fever. His voice will be hoarse; there will be frequent cough, headach, sneezing, running from the nose and eyes,—the eyelids being somewhat swollen, and the eyes inflamed;—the skin will be hot and dry, and he will complain of occasional chilliness. In the course of the next two or three days, these symptoms will increase in severity, and perhaps be accompanied by oppression at the chest and hurried breathing, and towards evening by slight delirium.

On the fourth day, the rash will appear, but the symptoms will be little, if at all, mitigated; indeed, they will sometimes increase in severity. The eruption will first be perceived about the head and face, in the form of small red spots, at first distinct from each other, but soon coalescing, and forming patches of an irregular crescent-like or semilunar figure, of a dull red colour, and slightly elevated (giving a sensation of hardness to the finger), while portions of the skin intervening between them will retain their natural appearance. At this time the eruption will also be found on the inside of the mouth and throat, and the hoarseness will consequently increase.

On the fifth day, the rash usually covers the whole surface of the body, with the exception of the legs and feet; and is now very vivid on the face, which is not unfrequently so much swelled, especially the eyelids, that the eyes are quite closed up, as in small-pox. On the sixth day, it is fully out on the extremities, and is beginning to fade on the face. On the eighth, it is fading from all parts; on the ninth, it is hardly perceptible; and has entirely disappeared on the tenth day from the commencement of the fever, or the sixth from its own first appearance. As the fading proceeds, the spots drop off in the form of little branny scales, which are sometimes, from their minuteness, scarcely perceptible. They leave a slight discolouration on the skin, with considerable itching.

Such is the ordinary course of this disease; occasionally, however, deviations are met with.

CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.—Under the description given of Scarlet Fever, are noticed several signs by which that disease may be distinguished from measles: to these may be added the absence of cough, of water flowing from the eyes, and of redness and swelling of the eyelids as in measles. Again, in measles, the eruption is more pointed, of a crimson instead of a scarlet hue, and does not appear until two days later than in scarlet fever.

In small-pox, the fever abates as soon as the eruption makes its appearance. In scarlet fever, this is by no means the case; and as little so in measles: the vomiting, indeed, subsides; but the cough, fever, and headach grow more violent; and the difficulty of breathing, weakness of the eyes, and, indeed, all the catarrhal symptoms, remain without any abatement till the eruption has all but completed its course.

MATERNAL MANAGEMENT.—Measles, in its ordinary and simple form, is a mild, and by no means dangerous, disease: it is sometimes, however, accompanied or immediately followed by symptoms of a very serious character, and which, it is to be feared, in many instances, owe their origin to the carelessness of the attendants in the sick chamber. A mother's superintendence, therefore, is much required at this time to insure a careful attention to the medical directions, as also to those general points of management upon which the well-doing of her child much depend, of which the following are the most important:—

VENTILATION OF THE BED-ROOM, ETC.—The child must be kept in bed from the onset of the attack. He must have so much clothing only as will secure his comfort, avoiding equally too much heat or exposure to cold. To these points the parent's attention must be particularly directed. It is the practice with some nurses, in the belief that a breath of cool air is most pernicious, to keep the child constantly enveloped in a smothering heap of bed-clothes, with curtains closely drawn, and the room well heated by fire, by which means the fever and all its concomitant dangers are greatly augmented. It is equally a popular error (and yet by many it is still held and acted upon) to suppose that because in small-pox exposure to cold is useful, that therefore it must be of equal advantage in measles. It cannot be too generally known that the nature of the fevers accompanying the two diseases are widely different, and that the adoption of this error is productive of the most serious consequences; for it would most likely produce in measles inflammation of the lungs, which, in truth, is commonly the result of carelessness upon this point.

The bed-room should be large and airy; free from currents of cold, but well ventilated, and not hot. The room, also, must be darkened, on account of the tenderness of the eyes; all noise excluded, and mental excitement or irritation carefully avoided.

REGIMEN.—Little or no food must be allowed, and whatever is taken must be of the simplest kind, and in a liquid form. Mild mucilaginous drinks, and warm, may be given liberally; as barley-water, or thin gruel, etc.

SPONGING, ETC.—The face, chest, arms, and hands should be sponged occasionally with vinegar and warm water (one fourth and three fourths). This will be productive of great comfort to the little patient; it removes the heat, dryness, and itching of the skin, which are often very distressing; and is especially useful at night in relieving wakefulness. If the cough be troublesome, it will be useful for the child to breathe the steam of warm water; not through an inhaler, but over a large basin, with the head covered with flannel large enough to hang over its edges. By this means the tender and inflamed eyes will at the same time derive advantage from the soothing effect of the vapour.

CAUTIONS.—Whenever the measles is known to be prevalent in a neighbourhood, and a child manifests symptoms of cold in the head and fever, it should at once be a reason for carefulness on the part of the parent. The diet should be light, cooling, and scanty; and the child should be carefully kept in doors.

It has been before remarked, that in its ordinary course measles is a disease unaccompanied with danger, but that the mildest form may be speedily converted into the most dangerous. That is to say, a sudden change may lake place in the symptoms, arising out of circumstances which could not have been foreseen, and therefore unavoidable; or may be produced by improper management on the part of the nurse, such as the giving of stimulants, by too much heat, or by exposure to cold. Now it is for the parent early to notice any change which may occur from the first source, and by her watchfulness to guard against the possibility of its arising from either of the second.

In reference to the first, if the child should complain at any period of the disease of severe headach, with piercing pain through the temples, and if this is accompanied by wandering of mind, great increase of suffusion of the eyes, as also intolerance of light, the immediate attention of the medical man is demanded. So, if towards the dose of the eruption, that is, from the seventh to the ninth day, the breathing should again become hurried (this symptom is very generally present during the height of the eruption, and is not necessarily connected with disease of the lungs), with pain and oppression felt at the chest, the cough becoming hacking and incessant, etc. (all symptoms cognizable by the mother, and indicative of inflammation of the lungs), no time must be lost in seeking medical aid.

With regard to the last cause (improper management), it may be well, in reference to it, to observe, that it sometimes happens that the rash comes out imperfectly, or, having appeared properly, suddenly retrocedes and disappears; and that under such circumstances the nurse will almost certainly, if not well watched, give the child "a good dose of sulphur in diluted spirit, or a glass of punch containing saffron," which are considered specifics for bringing out the eruption. Nothing can be more injurious than such remedies, for generally the disappearance of the rash will be dependent upon the existence of some internal inflammation, or of too high a fever; for the removal of which the medical man ought to be instantly applied to. Sometimes, however, it may be fairly traced to a careless exposure to cold: under such circumstances the child should be instantly, and without hesitation, put into the warm bath.

Measles are frequently followed by cough, and deranged bowels; and there is always great susceptibility about the child for some time. On this account he should be carefully screened from a cold or damp atmosphere; the diet should be carefully regulated; and flannel worn next to the skin. If the cough should continue, it must not be neglected on the supposition that it will wear off; for it demands the skilful and careful attention of the medical man.

In conclusion, it may be remarked that very frequently during infancy and childhood, and particularly during the period of teething, eruptions very similar in appearance to this disease occur; unless, however, they are accompanied by the specific fever, and run the regular course, they may at once be decided upon as not being the measles.



Sect. VII.—SMALL-POX.



This disease, the most dreaded of all eruptive fevers, is not so commonly met with in the present day as formerly; thanks to that Providence which led to the discovery of Jenner. But although its occurrence is not so frequent, it still does occasionally present itself; when it will assume either a mild or severe form. If it attack a child that has not previously been vaccinated, it is called natural small-pox; and the chances are that the disorder will be severe in character;—if, on the other hand, it occur in the vaccinated, the disease will generally be much modified in its symptoms; the attack will be mild, and without danger.

NATURAL SMALL-POX.—The infection of small-pox having been received into the system of a child that has not been vaccinated, fourteen days (on an average) will transpire before the commencement of the febrile symptoms, or eruptive fever. A distinct rigor or shivering fit then takes place, accompanied by pain in the back or in the stomach, with sickness, giddiness, or headach; as also great drowsiness. And if an infant be the subject of the disease, a convulsive fit will sometimes take place, or several in succession.

At the end of eight-and-forty hours from the occurrence of the rigor (in the majority of cases), the eruption comes out; and shows itself first on the face and neck in minute flea-bite spots. In the course of the next four-and-twenty hours in some cases, and in others not until the expiration of two or three days, it completely covers the body; not being confined exclusively to the skin, but frequently extending to the mouth and throat, and even to the external membrane of the eye.

In the course of two or three days from their first appearance the little pimples, increasing in size, will be found to contain a thin transparent fluid, to pit or become depressed in their centre, and the skin in the spaces between them will be found red. On the seventh or eighth day from the commencement of the fever, the fluid contained in the pimples will be no longer transparent, but opaque; and they will consequently appear white, or of a light straw colour. Each pimple or pock will be no longer depressed in its centre, but will become raised and pointed, being more fully distended by the increased quantity of fluid within; and the skin around each pock will now be of a bright crimson. The head, face, hands, and wherever else the eruption shows itself, gradually swell; and the eyelids are often so much distended as to close the eyes and produce temporary blindness. There will always at this time be some degree of fever present, and its amount will vary with the circumstances of each individual ease. The skin too will be very tender, so much so sometimes as greatly to harass and distress the child.

On the eleventh day the swelling and inflam of the skin of the body and face subside; the pimples upon these parts dry up and form scabs, which fall off about the fourteenth or fifteenth day. Those on the hands, as they come out later, commonly continue a short time longer. The eruption leaves behind, in some cases, the peculiar marks of the disease; and in others merely discoloured spots, which disappear in the progress of a short time.

The natural small-pox is sometimes much more severe in its character than the foregoing, and what is called confluent small-pox is said to exist. This form will be marked by great constitutional disturbance, and the eruption coming out earlier than in the milder form; instead of being distinct, that is, each pimple standing distinct and separate one from the other, they will coalesce, and appear flat and doughy, not prominent: they will more particularly run into each other on the face, where they will form one continuous bag, which soon becoming a sore, will discharge copiously.

SMALL-POX IN THE VACCINATED.—When small-pox occurs to those that have been formerly vaccinated, the disease, in almost every instance, is much altered or modified in its character. Indeed in children, in whom of course vaccination has been but comparatively lately performed, small-pox when it occurs will, in the majority of cases, be so mild that the real nature of the disease will be with difficulty determined: so mild, that again and again has a parent been heard to exclaim, "Surely these few scattered pimples cannot be the small-pox!" If, however, as the pimples progress, they are narrowly watched, and are seen to become depressed in their centre; if there has been the precursory rigor, etc.; and if the source of the disorder can be traced to some case of undoubted small-pox, the child in fact having been exposed to contagion, no doubt ought to exist in reference to the nature of such a case, however slight may be the character of the disease.

The usual progress, however, of small-pox modified by vaccination is as follows. The first stage is the same usually as in the natural form of the disease. As soon, however, as the eruption appears, the modifying power of the vaccination becomes apparent. The eruption will be found to be generally both less in quantity and more limited in its extent; or if even it should come out profusely, and cover a large extent of the surface of the body, still the controuling power of the vaccination will immediately show itself after its appearance,—first, in the complete subsidence of all the febrile symptoms which will now take place; and, secondly, in reference to the eruption, part of which will die away at once, and the remainder will by the fifth day be filled with the opaque yellowish fluid, then dry up, becoming hard and horny, and falling off will leave a mottled red appearance of the skin, and now and then slight pitting.

Such is the usual progress of the disease: subsequent to vaccination, it is a mild and tractable disorder. It is right, however, to mention that small-pox has occurred even to the vaccinated in almost as severe a form as the confluent natural small-pox, and running its regular course unaltered or unmodified. Such instances, however, are extremely rare, and form the exceptions to the general rule; for "no reasonable doubt can be entertained, from the abundance of facts now before the world, that such modification is the law of the animal economy, and that the regular or natural progress is the exception."

MATERNAL MANAGEMENT.—The grand principle in the treatment of small-pox is to moderate and keep under the fever; and however the plans adopted by different medical men may vary in particular points to accomplish this purpose, they uniformly make this principle their chief aim and object. To carry out this intention, however, the medical adviser is greatly dependent upon the aid and assistance of a judicious parent, and without this it is impossible to hope for a successful issue to the case. A clear knowledge, therefore, of those points of general management in which in fact a great part of the above principle consists (few and simple as these directions are), it must be all-important for the mother to be acquainted with: for the rest, she must and ought to look to the medical man.

In the more rare and severe form of this disease, viz. the confluent small-pox, although in some instances it runs the same course as the milder form, the distinct or natural small-pox, still, usually, the constitutional symptoms are much more aggravated, and the medical and general treatment required will so much depend upon the character of the individual case, that we do not think it well to notice it here.

BED AND BED-ROOM.—It will not be necessary at first for the child to be confined to his bed, but generally about the third or fourth day he will gladly resort to it; and if he does not, it will be prudent to keep him there. He must not, however, be loaded with bed-clothes, but lightly covered; and the bed and body linen should be changed daily, if possible.

The bed-room should be capacious and well ventilated; fresh air frequently admitted; and if the season of the year permit, and there is no dampness of atmosphere, a window should be constantly open during the day: it is also desirable to keep the chamber darkened in all cases, as there is always a tendency to inflammation of the eyes.

If these directions are not regarded, and a great heat of the apartment is permitted, with abundance of bed-clothes heaped upon the child, the hot bath is used, and hot and stimulating regimen given (upon the old and erroneous notion of bringing out the eruption), the mildest case will inevitably be converted into one of the most severe and dangerous. Facts have abundantly shown that such measures invariably prove the most effectual means of exasperating the disease, and endangering life.

REGIMEN.—This must be most sparing. Cold water may be given whenever the child asks for it. Lemonade should form the common drink during the fever; and gruel, barley-water, and roasted apples are all else that is required during this period, and not until the disease is going off must any change be made in the diet.

The above period having arrived, mildly nutritious food should be given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or sago; to be followed in a few days by the wing of a chicken or a mutton chop; remembering always, that solid animal food must at first be given cautiously and sparingly. Wine or stimulants must be positively forbidden; unless, indeed, ordered by the medical man, for circumstances may arise which render them advisable.

The state of the bowels must be carefully attended to at this time.

THE ERUPTION.—In the natural and mild form of this disorder the pustules generally break from the sixth to the eighth day; dry scabs succeed; and in about nine or ten days the parts heal perfectly, requiring no treatment. In the more aggravated cases, however, in which the pustules are very numerous, running one into the other, and, bursting, discharge greatly, the whole surface of the body should be frequently and liberally dusted over with dried flour, or, what is better, starch powder. The sores in this instance are always tedious in healing, and followed by the well-known pits or marks: these arise from a loss of substance in the true skin, and occur more particularly on the face, from the great vascularity of this part causing the pustules to be more numerous here than elsewhere. It is a popular error to suppose that by wearing masks of fine linen or cambric illined with particular ointments, these scars or pits may be prevented: it is impossible to prevent them; and any local application, except a little cold cream or oil of almonds applied to the scabs when they harden, will prove more injurious than useful. The child's hands, however, should always be muffled to prevent its scratching or breaking the sores, for otherwise he will not be kept from thus attempting to allay the excessive itching which they occasion.

The hair should be closely cut at an early period of the disease, and so kept throughout its continuance. This will contribute very much to the comfort of the child, by preventing the hair becoming matted together with the discharge from the pustules when they break, which gives rise to great pain and irritation. In the confluent and worst forms of this disease, this measure it is particularly necessary to attend to, as also to the application of cold lotions to the head when hot and dry (with other remedial means), as there is always a tendency in these cases to the formation of abscesses, the healing of which is troublesome and attended with difficulty.

CAUTIONS, ETC.—It has already been stated that a free ventilation of the bed-room is necessary to the well-doing of the patient. This measure, however, must not be confined to the chamber of the sick, but acted upon through the whole house.

In conjunction with ventilation, fumigations by means of aromatic substances kept slowly burning should be resorted to. A solution of the chloride of lime too, a most powerful disinfectant, should be used to purify the different apartments. This is best accomplished by steeping in the solution pieces of linen, and hanging them about the rooms, as also frequently and freely sprinkling the walls themselves; and as soon as the invalid is removed, the chamber should be white-washed, the various articles of furniture well scoured with soap and water, and the room be well and freely ventilated prior to its being again occupied.

The clothes of the patient and the bed linen should be frequently removed, and when taken away immediately immersed in boiling water, and whilst hung up in the open air sprinkled occasionally with a weak solution of the chloride of lime. If these directions are not observed, and the clothes are closely wrapped up, they will retain and give out the disease to others at a great distance of time.

Again: as the contagious property of smallpox hangs about the child as long as any scabs remain (which indeed may be said to retain the poison in its concentrated form), a parent must be most careful that the invalid is not too early brought in contact with the healthy members of the family.

An observance of these precautions is imperatively demanded; they not only protect the healthy, but aid the infected.



Sect. VIII.—HOOPING-COUGH.



My chief inducement to notice the above disorder arises out of the well-known fact, that there is no complaint of childhood more frequently subjected to quackery and mismanagement than is this. Indeed, there are few maladies against which a greater array and variety of means have been recommended, than against hooping-cough.

I suppose from the circumstance of the simple and mild form of the complaint being so tractable (provided it remain such) that the simplest and mildest measures effect its cure, parents are tempted to undertake its management in the more severe and complicated forms; and the result is but too often the establishment of disease dangerous to life, and sometimes fatal to it.

But although most imprudent for a parent to assume the office of the physician, her aid is essentially necessary in carrying out the measures prescribed. By her watchfulness and care the duration of the disease may not only be abridged, but, what is of much greater importance, a more serious and aggravated form of disease prevented; for although hooping-cough in itself is not a dangerous disorder, still the most simple and slight case, if neglected or mismanaged, may quickly be converted into one both complicated and dangerous.

DESCRIPTION OF THE DISEASE.—Hooping-cough commences with the symptoms of a common cold, which is more or less frequent. These symptoms continue from five days to fifteen; at the end of which time the cough changes its character, and assumes the convulsive form, which distinguishes the disorder. It occurs in paroxysms, varying with the severity of the disease from five to six in the twenty-four hours to one every ten or fifteen minutes; being generally more severe and frequent during the night than in the day.

During a paroxysm the expirations are made with such violence, and repeated in such quick succession, that the child cannot breathe, and seems in danger of suffocation. The face and neck become swollen and purple from suffusion; and the eyes prominent, injected, arid full of tears. The little one, with a forewarning of the attack, which it dreads, falls on his knees, or clings closely to any thing near him. The paroxysm terminates with one or two long inspirations, attended with that peculiar noise, or "whoop," from which the disease has derived its designation.

Sometimes the fit of coughing is interrupted for a minute or two, so that a little rest is obtained; and is then succeeded by another fit of coughing and another hoop, until after a succession of these actions the paroxysm terminates by vomiting, or a discharge of mucus from the lungs, or both.

The disease having continued at its height for two or three weeks, it begins naturally to decline; the paroxysms become less frequent and violent; the expectoration increases; the cough loses its characteristic hoop, and gradually wears away altogether; until at length, in two or three months from the first onset of the disease, the child is restored to perfect health. Sometimes, however, particularly in the autumn, and at other seasons on the occurrence of easterly winds, the paroxysms of cough will return,—it will assume its spasmodic character, and be accompanied with the "whoop," after a month, or even two or three months, of perfect and apparent recovery. Errors in diet will sometimes alone have a similar effect.

It is a disease which usually occurs during childhood, rarely affects the same individual twice, and is seldom seen in the very young infant.

In reference to the probable result of the disease, when it occurs in its mild and simple form in a healthy child, the termination is usually favourable; but it may at first assume this form, and afterwards become complicated, and consequently more or less dangerous, owing to injudicious management, or to various influences over which the mother has no control.

It generally appears as an epidemic, and at those seasons when catarrhal complaints are most prevalent, and affects many or several at the same time. Isolated cases, however, frequently occur, which seem to prove the disease to be infectious. Some persons deny that it is so. Mothers and nurses, however, who have not had the disease, will often contract it from the child under such circumstances, and thus it will be quickly propagated through the family. The nursing mother will occasionally take it from the infant at her breast. The child who has caught it from others whilst at school, and brought home in consequence, will communicate it readily to his brothers and sisters, although the disease did not exist previously in the family or neighbourhood, and was brought from a distant part of the country. All these instances are surely proofs of its infectious character, and point out the necessity of caution whenever hooping-cough may present itself in a family, and the necessity which exists for an early removal of the unaffected children from the sphere of its contagious influence. The infectious property diminishes as the disease declines.

MATERNAL MANAGEMENT.—In the mild and simple form of this disease the medical treatment is one rather of prevention than cure, and the maternal management consists in assisting, by watchfulness and care, the fulfilment of this design.

In these slighter cases little more is required of the mother during the Jirst stage of the disorder (that is, before the cough becomes spasmodic) than attention to diet, regimen, and the excretions. The diet should be farinaceous, with milk, or as may be otherwise directed. The child must be confined to a mild equable temperature; in fact, to his apartment. It is a popular error to suppose that at this time change of air is beneficial to the disease: at a later period it certainly is so, but now injurious, and attended with great risk. Should the weather be cold, the little patient must be warmly clad, and flannel worn next the skin; this latter precaution should always be taken in the winter, spring, and autumn. Purgatives and other medicines will be required, and ordered by the medical attendant; the chief attention, however, of the parent must be directed to any change she may observe in the symptoms, breathing, etc.; she must be all on the alert to notice the first signs of local inflammation. Of this, however, we shall speak presently.

During the early part of the second stage, that is, when the cough becomes spasmodic, assuming its peculiar sound, the same diet and regimen must be continued, and the same watchfulness observed, lest any inflammatory symptoms manifest themselves.

Under the foregoing treatment the disease generally runs its course without any untoward event, and the child recovers perfectly. Sometimes, however, although the patient is quite well, and the disease on the decline, the cough still continues. In these cases, and at this time, it is that change of air often proves so very serviceable. The sea-side is preferable, if the season of the year permit; and salt- water bathing, commencing with the warm or tepid bath, and passing gradually to the cold-bath (if no complication forbid it), will also prove certainly and rapidly remedial.

Crying, mental irritation, or opposition, frequently bring on a fit; and even the sight of another in a paroxysm will induce it in those affected by the disease. Running or other active exercise will generally cause the fits to be more severe. Young children, too, must be carefully watched at night, and be raised up by the nurse as soon as the fit is threatened. These hints the mother should bear in mind.

So much for the simple form of the disease, and that in which it most frequently and commonly presents itself to our notice: a mild disease; and, if carefully managed and watched over, certainly not a dangerous one.

Of what, then, is a parent to be afraid, or against what is she to guard? Lest other disease insidiously come on, and advance to an irremediable degree, masked by the cough, without attracting her attention. This is the great source of danger in hooping-cough. The physician, in a case of simple hooping-cough, is not in daily attendance upon his patient, and therefore not present to notice the commencement or first symptoms of those diseases which so frequently occur at this time, and the successful treatment of which will mainly depend upon their early detection, and the decision with which they are treated. When you hear of a child or several children in a family dying of hooping-cough, it is not this disease which proves fatal; but death is caused by some disease of lungs or brain, which has been super-added to the hooping-cough. The progress of hooping-cough, then, must be closely attended to by the parent, even in the most favourable cases.

The most frequent complication with hooping-cough is inflammation of the air-tubes of the lungs. This is extremely frequent during spring and winter, especially in the months of February, March, and April, owing to the prevalence of easterly winds at this season. It is not my intention to detail the symptoms of this affection, only to point out those which will enable a parent to recognise its approach. A parent then may take warning, and fear the approach of mischief, when she observes the fits of coughing become more frequent and more distressing to the child, and the breathing hurried in the intervals of the paroxysm; when any exertion or speaking causes increased difficulty of breathing or panting; when the expectoration becomes less abundant, and difficult to get up; when there is no longer, or at all events less frequent, vomiting after the cough, and more or less febrile symptoms present.

If the lungs themselves are attacked by inflammation, most of the symptoms already pointed out will occur; the cough will be frequent, in short paroxysms; the vomiting will not take place; the breathing will be very quick and hurried; and as the disease advances the hoop will cease.

If hooping-cough attack a child whilst teething, or from six months to two or three years of age, it is very common for the brain to suffer, and convulsions and water on the head to occur, particularly if the latter disease prevails in the family. Whenever the paroxysm of cough is increased in violence, the characteristic hoop disappearing, and the face becomes very livid; the hands clenched, and the thumbs drawn into the palms; the head hot, and marked fits of drowsiness and languor; and the child, during sleep, screaming out, or grinding its teeth,— something wrong about the head ought to be anticipated. Of the treatment we have here nothing to say, except that the gums must be carefully examined, and scarified if they require it, and the temperature of the head reduced by cold sponging, or the application of a bag of ice when necessary. The chief duty, however, of the parent is to be alive to these symptoms, and early to detect the incipient mischief, that by a prompt application of efficient means the accession of so formidable a malady may be prevented.

To specific remedies for this disease it is scarcely necessary to allude, after what has been advanced, except by way of warning. In the simple form of the complaint such medicines are superfluous, or rather some of them, from their violent properties, most dangerous; in the complicated forms of the disease they are inadmissible.

The indiscriminate use of purgatives, also, a parent should avoid. Bowel affections are not an infrequent attendant upon hooping-cough, and always aggravate the primary disorder.

Of external applications all that need be said is this, that if they are not violently stimulating they do no harm; if, however, they contain tartar emetic, in addition to their doing no good to the disease, they cause unnecessary suffering to the patient, and are sometimes productive of dangerous and even fatal sores.



Sect. IX.—CROUP.



This disease is one of the most formidable of childhood; sudden (generally) in its attacks, most active in its progress, and if not met by a prompt and decided treatment, fatal in its termination. Hence the paramount importance of parents being acquainted with the signs which indicate its approach, that medical aid may be secured at the very onset of the disease. Upon this early application of suitable remedies every thing depends.

SIGNS OF ITS APPROACH.—Croup may appear in one of two ways: either preceded for two or three days by the symptoms of a common cold, accompanied with hoarseness and a rough cough; or it may attack with the most alarming suddenness, during the night for instance, although the child had been merry and well the previous evening.

Hoarseness, however, is the premonitory and important symptom of croup; for although it is not every hoarseness that is followed by this formidable malady, still this symptom rarely attends a common cold in young children, and therefore always deserves when present the serious attention of the mother, particularly if accompanied by a rough cough.

The symptoms or signs of the approach of this disease have been ably and graphically depicted by the late Dr. Cheyne,

"In the approach of an attack of croup, which almost always takes place in the evening, probably of a day during which the child has been exposed to the weather, and often after catarrhal symptoms have existed for several days, he may be observed to be excited; in variable spirits; more ready than usual to laugh or to cry; a little flushed; occasionally coughing, the sound of the cough being rough, like that which attends the catarrhal stage of the measles. More generally, however, the patient has been for some time in bed and asleep before the nature of the disease with which he is threatened is apparent; then, perhaps without awaking, he gives a very unusual cough, well known to any one who has witnessed an attack of the croup: it rings as if the child had coughed through a brazen trumpet; it is truly a tussis clangosa; it penetrates the walls and floors of the apartment, and startles the experienced mother—'Oh, I am afraid our child is taking the croup!' She runs to the nursery, finds her child sleeping softly, and hopes she may be mistaken. But remaining to tend him, before long the ringing cough, a single cough, is repeated again and again. The patient is roused, and then a new symptom is remarked: the sound of his voice is changed; puling, and as if the throat were swelled, it corresponds with the cough; the cough is succeeded by a sonorous inspiration, not unlike the kink in hooping-cough—a crowing noise, not so shrill, but similar to the sound emitted by a chicken in the pip (which in some parts of Scotland is called the roup, hence probably the word croup); the breathing, hitherto inaudible and natural, now becomes audible, and a little slower than common, as if the breath were forced through a narrow tube; and this is more remarkable as the disease advances," etc. etc.

It is unnecessary for me to add to the foregoing picture.

MATERNAL MANAGEMENT.—Having early obtained medical assistance attend with the strictest obedience to the directions given. And in this disease, more than any other, it is particularly important that the mother should give her personal superintendence; for the activity of the progress of the disease leaves no time to retrieve errors or atone for neglect. The practitioner may be prompt and decided in the measures he prescribes, but they will avail little, unless they are as promptly and decidedly acted upon.

The parent will have her reward; for, if timely aid has been afforded, and adequate means used, the event will be almost invariably favourable.

ITS PREVENTION.—Croup, when it has once attacked a child, is very liable to recur at any period before the thirteenth or fourteenth year of age. It may even do so several times, and after intervals of various duration. It is very desirable, therefore, that a parent should be acquainted with the means of prevention.

They consist simply in the following measures:—The careful protection of the child from cold or damp weather, particularly the north-east winds of spring following heavy rains. Croup is most prevalent in those seasons which are cold and moist, or when the alternations of temperature are sudden and remarkable. If the residence of the child is favourable to the production of croup, (for instance, near a large body of water, or in low damp spots,) he should, if possible, be removed to a healthier situation. Sponging or the shower-bath, with cold water and bay-salt, with considerable friction in drying the body, should be commenced in summer, and employed every morning upon the child's rising from bed. The clothing should be warm in the winter and spring, the neck always covered, and flannel worn next the skin throughout the year; but hot rooms, and much clothing when in bed, must be avoided. The diet must be light and nourishing; no beer or stimulant given; and the state of the bowels must be carefully watched.

The above precautions are of course particularly necessary to enforce immediately after a recovery from an attack, for there is a great tendency to relapse. If the attack takes place during the winter or spring months, the invalid must be kept, until milder weather, in the house, and in a room of an equable and moderately warm temperature. If in the summer, change of air, as soon as it can be safely effected, will be found very useful.



Sect. X.—WATER IN THE HEAD.



Water in the head is a formidable disease, and not unfrequent in its occurrence. It is often destructive to life, and the instances are numerous in which it has appeared again and again in the same family, carrying off one child after another, as they have successively arrived at the same age.

But notwithstanding its frequency and fearful character, a mother may do much to overcome a constitutional predisposition to this disease, and thus prevent its appearance; as also she may assist greatly in promoting its cure, when it does occur. Hence it is most important that a mother should be acquainted with the measures of prevention; and also, when it does manifest itself, that clear and accurate information should be possessed, upon what may be said to constitute the maternal management of the disorder.

ITS PREVENTION.—Whenever there is found to exist in a family a predisposition to this malady, one or more children having suffered from it, a mother must make up her mind, and in the strictest sense of the word, to be the guardian of the health of any child she may subsequently give birth to. And not only during the period of infancy, but during that of childhood also, must she continue the same careful and vigilant superintendence.

The infant must be brought up on the breast, and if the mother is not of a decidedly healthy and robust constitution, she must obtain a wet-nurse possessing such qualifications. The breast-milk, and nothing beside, must form the nutriment of the child for at least nine months; and if the infant is delicate or strumous, it will be prudent to continue it even six months longer. When the period arrives for the substitution of artificial food, it must be carefully selected; it must be appropriate to the advancing age of the child; nutritious and unirritating. Good air and daily exercise, and the bath or sponging, are of much importance; in short, all those general measures which have a tendency to promote and maintain the tone and general health of the system, and thus induce a vigorous and healthy constitution, and to which reference has been so fully made in the first chapter of this work, must be strictly regarded and followed out by the parent.

The condition of the digestive organs must be the mother's especial care. Costiveness must be guarded against; and if at any time the secretions from the bowels indicate the presence of derangement, the medical attendant must be applied to, that appropriate remedies may without delay be exhibited. Their disordered condition is frequently productive of head-disease. Again and again have I clearly traced the origin of the complaint, of which I am now writing, as more immediately resulting from disorder of the digestive apparatus. To a child thus predisposed to water in the head, the healthy state of these organs is not only of first consequence, but any deviation from health to be dreaded, to be immediately attended to, and guarded against in future; and, as there is a great liability to these attacks at the time of weaning, the above remarks especially apply to that period, when due attention must be particularly paid to the plan of diet adopted.

During teething the mother must be especially watchful, for it is at this time that the disease so commonly appears; the irritation produced by this process being a frequent exciting cause. Every thing, therefore, that will tend to allay excitement of the system, must be strictly enforced, as well as all causes avoided, which would produce derangement of the stomach and bowels. The head should be kept cool. For this purpose it must be sponged night and morning throughout the whole period of teething; a horse-hair pillow used in the cot; and nothing but a light straw hat should be worn, except in winter, The diet should be moderate, and carefully regulated after leaving the breast, and the child should be as much as possible in the open air. The mouth must be occasionally examined, and if the gums become hot or distended, they must be scarified or lanced, as may be advised. If the parent finds at any time an unusual heat about the head, the medical man must be at once consulted; or if there is watchfulness or indisposition to sleep at the proper periods, or frequent startings in the sleep, irritability of temper, and much crying, danger should be apprehended, and prompt and judicious means employed.

Eruptions about the head, or sores behind the ears, discharging more or less, will sometimes make their appearance just before the cutting of a tooth, and disappear after it is cut; or it will sometimes happen that, if not interfered with, they will continue throughout the whole period of dentition. Great caution should always be exercised in reference to these eruptions in all children; and when there is a predisposition to water in the head, it is dangerous to interfere with them at all, except they run to such an extent as to become very troublesome. The sudden healing of these cutaneous affections has again and again been followed by head-disease. They are unsightly in the eyes of a parent, but it must be recollected that they render the situation of such children much more safe; and when teething is completed they will generally disappear spontaneously; or, if they should not, they will readily do so by proper medical treatment. I have no doubt that many a child's life has been saved by the appearance and continuance of these eruptions; and so sensible are medical men of the benefit derived from them, that in individuals in whom they do not appear, and in whose family there exists a predisposition to the disease now under our consideration, an issue or seton, in the arm or neck, has sometimes been made, and had a remarkable influence in warding off this affection. Dr. Cheyne refers to the circumstance of ten children in one family having died of this disease; the eleventh, for whom this measure was employed, having been preserved.

Stimulants, throughout the whole period of infancy and childhood, and of every description, must be prohibited. Children nursed by drunken parents, and who have indulged in the use of spirituous liquors during suckling, are never healthy; are the frequent subjects of convulsions, and many of them die eventually of water in the head. The practice of administering spirits to the child itself; a habit unfortunately not very uncommon among the lower classes; produces a similar result. Narcotics may operate in a like manner: they derange the whole system when persevered in, particularly affecting the brain; promote disease; and sometimes give rise to the one in question. This remark should be borne in mind by the mother, as Godfrey's Cordial and other preparations of opium are too often kept in the nursery, and secretly given by unprincipled nurses to quiet a restless and sick child.

All causes of mental excitement should be carefully avoided, and particularly the too early or excessive exercise of the intellectual faculties. If the child be endowed with a precocious intellect, the parent must restrain rather than encourage its exercise. Nothing is more likely to light up this disease in a constitution predisposed to it, than a premature exertion of the brain itself.

MATERNAL MANAGEMENT OF THE DISEASE.—The early detection of this disease is of great importance. The chances that the medical treatment will terminate successfully much depend upon the early and prompt application of remedial means. The reason why these cases have so often terminated fatally has arisen from the physician being consulted when irremediable mischief had already taken place. It would be difficult, however, to point out the signs of its approach in all its forms (for this disease does not always commence in the same way, sometimes with fever, etc.), still it most frequently occurs preceded by certain striking and well-marked symptoms; and whenever the following are noticed by the parent apprehensive of mischief, she should at once send for her medical adviser:—watchfulness, or starting from sleep with a cry of alarm; prolonged screaming without any obvious cause; moaning and drowsiness; rolling the head from side to side on the nurse's arm, or thrusting it back against the pillow; knitting the brows and aversion from light, with heat of head, and constant carrying the little hand up to it; half closing the eyelids, and frequent vomiting.

The chief and principal point in the maternal management (for it includes every other) is promptly and faithfully to administer the remedies prescribed by the medical attendant. A vigilant maternal superintendence is more necessary in this than almost any other disease; and it is highly desirable, therefore, that the mother should have a day and night nurse—individuals upon whom she can depend. A careful notice of symptoms and changes in the patient, in the intervals of the medical man's visits, and a true and faithful report to him upon his return, are of essential importance. A sleepy nurse will neglect the application of the most important remedies, and necessarily give an unfaithful report of symptoms; hours the most valuable to the child's well-doing are thus lost, and the chances of saving its life worse than problematical.

The temperature of the room should be kept rather cool than warm, and the bed-clothes only sufficient to preserve the natural heat of the body. Strong light must be excluded. Great quiet should be observed. Freedom from all excitement of the senses, and irritation of the temper, should be carefully avoided: this is particularly necessary where the child is naturally of a quick and sensitive disposition.

All the excretions must be put aside for the inspection of the physician, but not kept in the sick chamber, which must be well aired, and perfectly free from closeness. The regimen must be only such as is ordered, and any departure therefrom will be attended with mischievous consequences. During the early periods of the disease, all that is required are cooling diluents, given frequently, and in small quantities at a time; and upon approaching convalescence great carefulness must be paid to the amount of nourishment allowed, lest the disease be rekindled: strict compliance, therefore, to medical directions must be given.

A very useful and indeed powerful remedy prescribed in this disease, is sometimes rendered utterly useless from a want of a persevering and also proper mode of applying it, viz. cold applications to the head. It is to be effected either by means of cloths kept constantly wet with cold water, or evaporating lotions; or by means of a bladder containing pounded ice mixed with water. If the two former are employed they require frequent renewal, or they become dry, hot, and more injurious than useful; and whichever is used, it must be kept in constant contact with the forehead, temples, and upper part of the head. Here is another error; they are seldom used large enough, and only partially cover these parts. With the further view of keeping the head cool, and preventing the accumulation of heat, a flat horse-hair pillow should be employed, and the head and shoulders somewhat raised.

Perseverance in the measures prescribed, even when the case appears beyond all hope, must ever be the rule of conduct. Recovery, even in the most advanced periods of the disease, in cases apparently desperate, occasionally takes place. There is great reason to fear that many a child has been lost from a want of proper energy and perseverance on the part of the attendants in the sick room. They fancy the case is hopeless, and, to use their own expression, "they will not torment the child with medicine or remedies any longer."

"Whilst there is life, there is hope," is a sentiment which may with great truth be applied to all the diseases of infancy and childhood. Striking, indeed, are the recoveries which occasionally present themselves to the notice of medical men; and those individuals may with great justice be charged with unpardonable neglect who do not persevere in the employment of the remedies prescribed, even up to the last hours of the child's existence.



INDEX.



Ablution, or sponging, 125.

Abstinence, its good effect, in flatulence and griping in the infant, 50. 226.

Accidents and diseases which may occur to the infant at birth or soon after, 187.

Acids, injurious to the teeth, 159.

Air and exercise, in infancy, 83. —, in childhood, 89. —, its importance to the mother whilst a nurse, 33.

Animal food, in childhood, 55. —, its injurious effects upon the young and delicate child, 58.

Aperient liniment, 107. —, medicine, 97. —, poultice, 104.

Artificial feeding; the causes rendering it necessary, 34.

Artificial food; the proper kind for the child before the sixth month, 35. —; the mode of administering it, 39. —; the quantity to be given at each meal, 42. —; the frequency of giving it, 43. —; the posture of the child when fed, 43. —; the proper kind for the child after the sixth month, to the completion of first dentition, 44. —; the kind most suitable under the different complaints to which infants are liable, 48.

Bath, the cold-water, plunge-bath, 118. —, the shower, 123. —, the warm, 128. —, rules for the use of the warm bath, 131.

Bathing, sea, 120. —, and cleanliness, during infancy, 72. —, during childhood, 75.

Bleeding, from leech-bites, how controlled, 113. —, from the navel string, 201. —, navel, 203.

Blisters, mode of application, 114.

Bottle, nursing, 40.

Bowels, disorder of, in the infant, 208.

Breasts of the infant, swelling of, 195.

Breathing, how affected by disease, 175.

Calomel, danger in its use, 167. —, injurious to the teeth, 160.

Carminative, Dalby's, 111.

Carriage, "a good carriage;" how best obtained, 95. —; the sad results of the mode frequently adopted, 91.

Castor oil, 99.

Choice of a wet-nurse, rules for, 28.

Cleanliness and bathing, 72.

Clothing, in infancy, 78. —, in childhood, 81.

Clysters, what kind best for children, 105. —, mode of application, 106.

Cold, infants very susceptible of, 78.

Convulsions, 112, 167.

Cork-nipple teat, 41.

Costiveness, in infancy, 50. 229. —, in childhood, 231.

Cough, as a sign of disease, 175.

Countenance, in health, 165.

Countenance, in disease, 165.

Croup, 176. 286.

Dalby's Carminative, 111.

Damp, induces disease in the infant, 85.

Dentition, easy, 136. —, difficult, 139.

Diarrhoea, in the infant, 50. 227.

Dietetics of infancy, 2. —, of childhood, 54. —, general directions upon, and of animal food, 55. —, sugar, 60. —, salt, 61. —, fruits, 62. —, water, 63. —, wine, beer, spirits, 63.

Diet, under the different complaints to which infants are liable, 48. —, and regimen of a wet-nurse, 31.

Digestion, in the infant; time requisite for its performance, 42.

Discharge, from the eyes of the infant, 196.

Disease, the importance of its early detection, and hints upon, 162.

Dress, in infancy, 78. —, in childhood, 81.

Enema. See Clysters.

Eruptions on the skin in infancy; how best prevented, 74. —, about the head, and sores behind the ears, 295. —, during teething, 147.

Exercise and air, in infancy, 85. —, in childhood, 89. —, horse-exercise; its importance to delicate children, 89.

Eyes, of the infant, discharge from, after birth, 196.

Fever, scarlet, 239.

Flannel clothing, 80.

Flatulence and griping in the infant, 50. 208. 226.

Food, for infants. See Artificial Feeding. —, for children. See Dietetics of Childhood. —, and regimen, for nurses, 31.

Fruits, 62.

Gestures, of the infant, in health and disease, 169.

Godfrey's cordial, 111.

Grief, its effects upon the mother's milk, 34.

Gums, of the infant in difficult dentition, the importance of their being lanced, 140.

Hare-lip, how the infant may be nourished with this defect, 199.

Head, of the infant, swellings upon, when born, 193.

Hereditary transmission of scrofula and consumption; the best antidote to, 20.

Hooping-cough, 275.

Horse-exercise, its importance to delicate children, 89.

Hunter's, Dr., experiments on the effects of wine upon children, 64.

Jaundice, in the infant after birth, 204.

Ice, how to be applied to the head, 127.

Indigestion, in the infant, 208.

Infant, food for. See Artificial Feeding. —; when still-born, how to be managed, 187. —; of injuries received during its birth, 193. —; retention of its urine after its birth, 194. —; swelling of the breasts after birth, 195. —; discharge from the eyes, 196. —; hare-lip, 199. —; bleeding from the navel string, 201. —; ulceration, or imperfect healing of the navel, 202.

Infant; bleeding from the navel, 203. —, jaundice in, 204. —, tongue-tied, 205. —, moles and marks on the skin, 206.

Inflation of the lungs of the infant, the mode, 190.

Lavement, the proper kind for infants and children, 105.

Leech-bites; the mode of controlling the bleeding of, 113

Liniment, aperient, 107.

Looseness, 208.

Lungs of the infant, inflation of, 190.

Magnesia, 102.

Manna, 101.

Maternal nursing, 3. —, management of the diseases of children, 184.

Measles, 258. —, how distinguished from scarlet fever and small-pox, 255.

Medicine, aperient, 97.

Mercury, 107.

Milk, the mother's; how to be preserved healthy during suckling, 3. —; deficiency of, 11. —; drying up of, 54. —, cow's; for infant's food, 35. —, ass's; for infant's food, 37. —, all kinds of, sometimes disagrees with the infant, 39.

Mind, anxiety of; effects upon the parent's milk, 24.

Moles and marks on the skin, 206.

Mothers, their duty in relation to suckling, 3. —; those who ought never to suckle their children, 20. 24. 26.

Motions of the infant; what the appearance of, and how frequent, in health, 99. 172. —; their deranged condition, a sign of disease, 173.

Napkins, the infant's, 74.

Navel, bleeding from, 203. —, ulceration or imperfect healing of, 202.

Navel-string, bleeding from, 201.

Naevi, or moles, 206.

Nurses, wet, rules for the choice of, 28. —, diet and management of, 31.

Nursery medicines, 97.

Nursing, maternal, 3. —; the plan to be adopted for the first six months, 7. —; the plan to be followed after the sixth month to the time of weaning, 9. —; the injurious effects to the mother of undue and protracted suckling, 15. —; the injurious effects of undue and protracted suckling to the infant, 18.

Opiates, 110. 297. —, in teething, dangerous, 145.

Passion, its effect upon the breast-milk, 33.

Porter, of its use, by the mother during suckling, 1 —, when mischievous, 4.

Poultice, bread-and-water, how made, 116. —, mustard, how made and applied, 115.

Purgative medicine, 97.

Retention of urine in the infant, 194.

Rhubarb, 103.

Rules for nursing, 3. —, for the use of the warm bath, 181.

Salt, as a condiment, 61.

Scarlet fever, 239. —, how distinguished from measles, 245.

Scrofulous constitution, 180.

Sea-bathing, 120.

Seasons (the), their influence in producing particular forms of disorder, 178.

Shower-bath, 123.

Signs of health in the infant, what, 168. —, of disease in the infant, what, 169.

Skin of the infant, importance of its perfect cleanliness, 72. —, friction and sponging of, beneficial, 73.

Sleep, during infancy, 66. —, childhood, 69. —, how affected when the child is ill, 171.

Small-pox, 262.

Spirituous liquors, their pernicious effects to children, 63. 296.

Sponging, 125.

Spoon-feeding, 39.

Still-born, 187.

Stomach and bowels, their derangement, a fruitful source of disease, 208. —, disorders of, in the infant at the breast, 210. —, disorders of, at the period of weaning, 217. —, disorders of, in the infant brought up by hand, 221. —, their treatment, 222.

Stools of the infant, what the appearance of, and how frequent, in health, 99. 172. —, their deranged condition, a sign of disease, 173.

Suckling, plan of, 3. —, by a wet-nurse, 27.

Sugar, 60.

Swelling of the breasts in the infant, 195.

Teat of the cow—the artificial—the cork, 41.

Teeth, of the permanent or adult teeth, 148. —, the manner in which they appear, 148. —, their value and importance, 152. —, their management and preservation, 154.

Teething, easy; management of the child, 136. —, difficult; hints upon, 139.

Tight-lacing, evils of, 92.

Tongue-tied, 205.

Ulceration or imperfect healing of the navel, 201.

Urine, retention of it in the infant after birth, 194.

Ventilation of the sleeping-rooms of children, 84. —, its importance in sickness, 246.

Walking, the best mode of teaching a child, 87.

Warm bath, 128. —, rules for the use of, 131. —, directions for the use of, when the infant is stillborn, 192.

Water, as a beverage for children, 63. —, in the head, 291.

Weaning, the time when to take place, 51. —, the mode of effecting it, 52. —; drying up the mother's milk, 53.

Wet-nurse suckling, 27. —, rules for the choice of, 28. —, diet and management of, 31.

Wine, its pernicious effects in childhood, 63.

Worms, 234.



THE END.



Also by Dr. Bull,



HINTS TO MOTHERS

FOR THE

MANAGEMENT OF THEIR HEALTH.

Second Edit, greatly enlarged, foolscap 8vo. 7s. cloth lettered.



Opinions of the Press.

"A very valuable compendium for all who expect to become mothers.—In the short preface prefixed to this little work, Dr. Bull judiciously remarks, that feelings of delicacy often prevent many young married females from making to their medical attendant, a full disclosure of the circumstances connected with their state, and which render medical assistance necessary. The object of the work is to meet this difficulty, by furnishing a species of information for which married women are often very unwilling to ask, although they readily search for it in books. The matter of Dr. Bull's treatise is arranged completely in a popular form—in one that is best calculated to be understood by the fair readers to whom it is addressed; and contains a variety of useful information, so clearly conveyed as to render it a very valuable compendium for all women who expect to become mothers."—Lancet.

"A valuable monitor to the fair sex. It contains so much useful advice for every woman likely to become a mother, that married men would do well to provide it for their partners."—Spectator.

"This little volume is the benevolent contribution of good sense and professional skill, to the well-being of those who have the strongest claims on our sympathy. Unfortunately a vast mass of erroneous notions exists in the class to whom it is addressed; to which, and to the concealment prompted by delicacy, until the time for medical aid is gone by, we are indebted for very much of the danger and suffering incident to the periods they are destined to pass through. Dr. Bull, in the true spirit of a physician and a gentleman, has by his perspicuous statements removed the first, and by his judicious and simple directions, anticipated the last of these fruitful sources of evil. There is no mother that will not be heartily thankful that this book ever fell into her hands; and no husband who should not present it to his wife. We cannot urge its value too strongly on all whom it concerns."—Eclectic Review.

"We recommend it to our readers; and they will confer a benefit on their new-married patients by recommending it to them."—British and Foreign Medical Review.

"Dr. Bull has performed a very kind and important office in the publication before us."—Patriot.

"We never read any popular treatise, or directions rather, that bear more strongly the stamp of scientific and expert mental knowledge. The mere reading of our Author's book will do more good in the way of encouraging the fearful, and banishing nervous anxiety, than a whole conclave of the wisest and most sanguine matrons that society can anywhere bring together."—Monthly Review.

"This little manual will prove useful exactly in proportion to the extent of its circulation."—Medical Gazette.

THE END