This is a distemper not very common, but it has been observed by the ancient physicians, and is described by Hippocrates under the name of morbus niger. It shows itself by a vomiting and purging of black tar-like matter, which Hippocrates, Boerhaave, and Van Swieten, supposed to be occasioned by atra bilis. But Dr Home, in his Clinical Experiments, endeavours to shew that it is owing to an effusion of blood from the mesenteric vessels, which, by its stagnation and corruption, assumes that strange appearance. The disease, he says, frequently follows hemorrhage; and those of a scorbutic habit are most subject to it. It is an acute disease, and terminates soon; yet it is not attended with any great degree of fever. In one of Dr Home's patients the crisis happened on the eighth day by diarrhoea; in another, on the 14th, by sweat and urine; and a third had no evident critical evacuation.

As to the cure, Dr Home observes, that bleeding is always necessary where the pulse can bear it; nor are we to be deterred from it by a little weakness of the pulse, more than in the enteritis. Emetics are hurtful, but purgatives are useful. But the most powerful medicine for checking this hemorrhage is the sulphuric acid; and, that this might be given in greater quantity, he mixed it with mucilage of gum arabic; by which means he was enabled to give double the quantity he could otherwise have done. The cold bath was tried in one instance, but he could not determine whether it was of any service or not. The cure was completed by exercise and cinchona.

Of the DISEASES of CHILDREN.

Dr Buchan observes, that from the annual registers of the dead, it appears that about one half of the children born in Great Britain die under twelve years of age; and this very great mortality he attributes in a great measure to wrong management. The particulars of this wrong management enumerated by him are,

1. Mothers not suckling their own children. This, he owns, it is sometimes impossible for them to do; but Appendix.

Diseases but where it can be done, he affirms that it ought Children. never to be omitted. This, he says, would prevent the unnatural custom of mothers leaving their own children to suckle those of others; on which he passes a most severe censure, and indeed scarce any censure can be severe enough upon such inhumanity. Dr Buchan informs us, "He is sure he speaks within bounds, when he says not one in a hundred of these children live who are thus abandoned by their mothers." For this reason he adds, that no mother should be allowed to suckle another's child till her own be fit to be weaned. A regulation of this kind would save many lives among the poorer sort, and would do no harm to the rich; as most women who make good nurses are able to suckle two children in succession upon the same milk.

2. Another source of the diseases of children is the unhealthiness of parents; and our author insists that no person who labours under an incurable malady ought to marry.

3. The manner of clothing children tends to produce diseases. All that is necessary here, he says, is to wrap the child in a soft loose covering; and the softness of every part of the infant's body sufficiently shows the injury which must necessarily ensue by pursuing a contrary method.

4. A new-born infant, instead of being treated with syrups, oils, &c., ought to be allowed to suck the mother's milk almost as soon as it comes into the world. He condemns the practice of giving wines and spirituous liquors along with the food soon after birth; and says, that if the mother or nurse has a sufficient quantity of milk, the child will need little or no other food before the third or fourth month. But to this it may reasonably be objected, not only that the nursing would thus be very severe on the mother; but if the child be left thus long without other food, it will not easily relish that food for some time, and its stomach is apt to be easily hurt by a slight change of diet after it has been long accustomed to one thing. The human species are unquestionably fitted by nature for a mixed aliment, both from the vegetable and animal kingdom. And the analogy of other animals belonging to the class of mammalia for whom milk is equally provided at the earliest periods of life, would lead us to the conclusion, that mixed aliment is well fitted for the human species even in the earliest periods of infancy. The lamb is no sooner dropt than, by natural instinct, it crops the grass as well as it sucks its mother. And the stomach in the human species, immediately after birth, can digest other food as well as milk. Neither can it be shown, that the strongest and most healthy infants are those which get no other food but the mother's milk during the first months of their life. In fact, children are evidently of a weak and lax habit of body, so that many of their diseases must arise from that cause; all directions which indiscriminately advise an antiphilistic regimen for infants as soon as they come into the world, must of necessity be wrong. Many instances in fact might be brought to show, that by the profligaceous method of starving infants, and at the same time treating them with vomits and purges, they are often hurried out of the world. Animal food indeed, particularly under the form of broths, is excessively agreeable to children, and they ought to be indulged with it in moderation. This will prove a much better remedy for those acidities with which children are often troubled, than magnesia alba, crabs eyes, or other absorbents, which have the most pernicious effects on the stomachs of these tender creatures, and pall the appetite to a surprising degree. The natural appetites of children are indeed the best rule by which we can judge of what is proper or improper for them. They must no doubt be regulated as to the quantity; but we may be assured that what a child is very fond of will not hurt it, if taken in moderation. When children are sick, they refuse every thing but the breast; and if their distemper be very severe, they will refuse it also, and in this case they ought not to be precluded to take food of any kind; but when the sickness goes off, their appetite also returns, and they will require the usual quantity of food.

According to Dr Armstrong, inward fits, as they are called, are in general the first complaint that appears in children; and as far as he has observed, most, if not all infants, during the first months, are more or less liable to them. The symptoms are these: The child appears as if it was asleep, only the eyelids are not quite closed; and if you observe them narrowly, you will see the eyes frequently twinkle, with the white of them turned up. There is a kind of tremulous motion in the muscles of the face and lips, which produces something like a frown or a smile, and sometimes almost the appearance of a laugh. As the disorder increases, the infant's breath seems now and then to stop for a little; the nose becomes pinched; there is a pale circle about the eyes and mouth, which sometimes changes to livid, and comes and goes by turns; the child starts, especially if you attempt to stir it though ever so gently, or if you make any noise near it. Thus disturbed, it sighs, or breaks wind, which gives relief for a little, but presently it relapses into the dozing. Sometimes it struggles hard before it can break wind, and seems as if falling into convulsions; but a violent burst of wind from the stomach, or vomiting, or a loud fit of crying, sets all to rights again. As the child increases in strength, these fits are the more apt to go off spontaneously and by degrees; but in case they do not, and if there is nothing done to remove them, they either degenerate into an almost constant drawfiness, (which is succeeded by a fever and the thrush), or else they terminate in vomitings, foul, curdled, or green stools, the watery gripes, and convulsions. The thrush indeed very often terminates in these last symptoms. As these complaints naturally run into one another, or succeed one another, they may be considered, in a manner, as only different stages of the same disease, and which derive their origin from the same cause. Thus, the inward fits may be looked upon as the first stage of the disorder; the fever, and thrush (when it happens), as the second; the vomitings, foul, curdled, green or watery stools, as the third; and convulsions, as the last.

As to the cause of these complaints, he observes, that in infants the glandular secretions, which are all more or less glutinous, are much more copious than in adults. During the time of sucking, the glands of the mouth and fauces being squeezed by the contraction of the muscles, pour forth their contents plentifully; which afterwards mixing with the mucus of the gullet Diseases of and stomach, render the milk of a illthy constilence, by which means it is not so readily absorbed into the lacteals; and as in most infants there is too great an acidity in the stomach, the milk is thereby curdled, which adds to the load; hence sickness and spasms, which, being communicated by sympathy to the nerves of the gullet and fauces, produce the convulsive motions above described, which go commonly by the name of inward fits. The air, likewise, which is drawn in during suction, mixing with the milk, &c. in the stomach, perhaps contributes towards increasing the spasms above mentioned. Dr Armstrong is the more induced to attribute these fits to the causes now assigned, that they always appear immediately after sucking or feeding; especially if the child has been long at the breast, or fed heartily, and has been laid down to sleep without having first broken wind. Another reason is, that nothing relieves them so soon as belching or vomiting; and the milk or food they throw up is generally either curdled, or mixed with a large quantity of heavy phlegm. If they be not relieved by belching or vomiting, the fits sometimes continue a good while, and gradually abate, according as the contents of the stomach are pushed into the intestines; and as soon as the former is pretty well emptied, the child is waked by hunger, cries, and wants the breast; he sucks, and the same process is repeated.—Thus, some children for the first weeks are kept almost always in a dole, or seemingly so; especially if the nurses, either through laziness or want of skill, do not take care to rouse them when they perceive that it is not a right sleep, and keep them awake at proper intervals. This dozing is reckoned a bad sign amongst experienced nurses; who look upon it as a forerunner of the thrush, as indeed it often is; and therefore, when it happens, we ought to be upon our guard to use the necessary precautions for preventing that disorder.

For these disorders, the only remedy recommended by Dr Armstrong is antimonial wine, given in a few drops, according to the age of the infant. By this means the superabundant mucus will no doubt be evacuated; but at the same time we must remember, that this evacuation can only palliate, and not cure the disease. This can only be effected by tonics; and, when from inward fits and other symptoms it appears that the tone of the stomach is very weak, a decoction of cinchona, made into a syrup, will readily be taken by infants, and may be safely exhibited from the very day they come into the world, or as soon as their bowels are emptied of the meconium by the mother’s milk or any other means.

Dr Clarke observes, that fractures of the limbs, and compressions of the brain, often happen in difficult labours; and that the latter are often followed by convulsions soon after delivery. In these cases, he says, it will be advisable to let the navel-string bleed two or three spoonfuls before it be tied. Thus the oppression of the brain will be relieved, and the disagreeable consequences just mentioned will be prevented. But if this has been neglected, and fits have actually come on, we must endeavour to make a revulsion by all the means in our power; as by opening the jugular vein, procuring an immediate discharge of the urine and meconium, and applying small blisters to the back, legs, or behind the ears. The semicuprum, too, would seem to be useful in this case, by driving the offensive load of fluids from the head and upper parts.

It sometimes happens after a tedious labour, that the child is so faint and weak as to discover little or no signs of life. In such a case, after the usual cleansing, the body should be immediately wrapped in warm flannel, and briskly tossed about in the nurse’s arms, in order, if possible, to excite the languid circulation. If this fail, the breast and temples may be rubbed with brandy or other spirits; or the child may be provoked to cry, by whipping, or other stimulating methods, as the application of onion, or salt and spirit of hartshorn, to the mouth and nostrils. But after all these expedients have been tried in vain, and the recovery of the child absolutely despaired of, it has sometimes been happily revived by introducing a short catheter or blowpipe into the mouth, and gently blowing into the lungs at different intervals. Such children, however, are apt to remain weak for a considerable time, so that it is often no easy matter to rear them; and therefore particular care and tenderness will be required in their management, that nothing may be omitted which can contribute either to their preservation or the improvement of their strength and vigour.

All the disorders which arise from a retention of the meconium, such as the red gum, may easily be removed by the use of gentle laxatives; but the great source of mortality among children is the breeding of their teeth. The usual symptoms produced by this are fretting, restlessness; frequent and sudden startings, especially in sleep; coliciveness; and sometimes a violent diarrhoea, fever, or convulsions. In general, those children breed their teeth with the greatest ease, who have a moderate laxity of the bowels, or a plentiful flow of saliva during that time.

In mild cases, we need only, when necessary, endeavour to promote the means by which nature is observed to carry on the business of digestion in the easiest manner. For this purpose, if a coliciveness be threatened, it must be prevented, and the body kept always gently open; the gums should be relaxed by rubbing them frequently with sweet oils, or other softening remedies of that kind, which will greatly diminish the tension and pain. At the same time, as children about this period are generally disposed to chew whatever they get into their hands, they ought never to be without something that will yield a little to the pressure of their gums, as a crust of bread, a wax candle, a bit of licorice root, or such like; for the repeated muscular action, occasioned by the constant biting and gnawing at such a substance, will increase the discharge from the salivary glands, while the gums will be so forcibly pressed against the advancing teeth, as to make them break out much sooner, and with less uneasiness, than would otherwise happen. Some likewise recommend a slice of the rind of fresh bacon, as a proper masticatory for the child, in order to bring moisture into its mouth, and facilitate the eruption of the teeth by exercising the gums. If these means, however, prove ineffectual, and bad symptoms begin to appear, the patient will often be relieved immediately by cutting the inflamed gum down to the tooth, where a small white point shows the latter to be coming forward. When the pulse is quick, the skin hot and dry, and the child of a sufficient age and strength, emptying the vessels by bleeding, Diseases of Children.

Sterling to their patients such medicines as are possessed only of an anthelmintic quality, but to join them with those which are particularly adapted for cleansing the prime vice; as it is uncertain whether a foulness of the bowels may not be the cause of all the complaints. This practice is still the more advisable, on account of viscid humours in the intestines affording lodgement to the ova of worms; which, without the convenience of such a receptacle, would be more speedily discharged from the body.

The difficulty of curing what is called a worm fever, arises, according to Dr Mulgrave, from its being frequently attributed to worms, when the cause of the disorder is of a quite different nature. He does not mean to deny that worms do sometimes abound in the human body, nor that the irritation caused by them does sometimes produce a fever; but he apprehends these cases to be much more uncommon than is generally imagined, and that great mischief is done by treating some of the disorders of children as worm cases, which really are not so. Dr Hunter is of the same opinion on this point. He has, we are told, dissected great numbers of children who have been supposed to die of worm fevers, and whose complaints were of course treated as proceeding from worms, in whom, however, there appeared, upon dissection, to be not only no worms, but evident proofs of the disorder's having been of a very different nature.

The furious worm fever, as Dr Mulgrave terms it, has, in all the instances he has seen of it, arisen evidently from the children having been indulged with too great quantities of fruit. Every sort of fruit eaten in excess will probably produce it; but an immoderate use of cherries seems to be the most common cause of it. The approach of this disorder has a different appearance, according to it arises from a habit of eating fruit in rather too large quantities, or from an excessive quantity eaten at one time. In the former case, the patient gradually grows weak and languid; his colour becomes pale and livid; his belly swells and grows hard; his appetite and digestion are destroyed; his nights grow restless, or at least his sleep is much disturbed with startings, and then the fever soon follows, in the progress of which, the patient grows comatose, and at times convulsed; in which state, when it takes place to a high degree, he often dies. The pulse at the wrist, though quick, is never strong or hard; the carotids, however, beat with great violence, and elevate the skin so as to be distinctly seen at a distance. The heat is at times considerable, especially in the trunk; though at other times, when the brain is much oppressed, it is little more than natural. It is sometimes accompanied by a violent pain of the epigastric region, though more commonly the pain is slight, and terminates in a coma; some degree of pain, however, seems to be inseparable from it, so clearly to distinguish this disorder from other comatose affections.

When a large quantity of fruit has been eaten at once, the attack of the disorder is instantaneous, and its progress rapid; the patient often passing, in the space of a few hours, from apparently perfect health, to a fluid, comatose, and almost dying state. The symptoms of the fever, when formed, are in both cases nearly the same; except that, in this latter fort, a little purulent matter is sometimes discharged, both by vomit mit and stool, from the very first day. The stools, in both cases, exhibit sometimes a kind of curd resembling curdled milk, at other times a floating substance is observed in them; and sometimes a number of little threads and pellicles, and now and then a single worm.

Strong purgatives, or purges frequently repeated, in this disorder, are greatly condemned by Dr Armstrong, as they in general not only aggravate the symptoms already present, but are sometimes the origin of convulsions. Bloodletting is not to be thought of in any stage of the disorder.

Although frequent purging, however, be not recommended, yet a single vomit and purge are advised in the beginning of the disorder, with a view to evacuate such indigested matter and mucus as happens to remain in the stomach and bowels. These having operated properly, there is seldom occasion for repeating them; and it is sufficient, if the body be constipated, to throw up, every second or third day, a clyster composed of some grains of aloes, dissolved in five or six ounces of infusion of chamomile.

The principal part of the cure, however, depends upon external applications to the bowels and stomach; and as the cause of the disorder is of a cold nature, the applications must be warm, cordial, and invigorating; and their action must be promoted by constant actual heat.

When any nervous symptoms come on, or remain after the disorder is abated, they are easily removed by giving a pill with a grain or two of asafoetida once or twice a day.

The diagnostics of worms are very uncertain; but, even in real worm cases, the treatment above recommended would, it is imagined, be much more efficacious than the practice commonly had recourse to. As worms either find the constitution weakly, or very soon make it so, the frequent repetition of purges, particularly mercurials, cannot but have a pernicious effect. Bear's-foot is still more exceptionable, being in truth to be ranked rather among poisons than medicines. Worm seed and bitters are too offensive to the palate and stomach to be long persisted in, though sometimes very useful. The powder of coralline creates disgust by its quantity; and the infusion of pink root is well known to occasion now and then vertiginous complaints and fits.

Fomenting the belly night and morning with a strong decoction of rue and wormwood, is much recommended. It is a perfectly safe remedy, and, by invigorating the bowels, may thereby have some influence in rendering them capable of expelling such worms as they happen to contain. After the fomentation, it is advised to anoint the belly with a liniment, composed of one part of essential oil of rue, and two parts of a decoction of rue in sweet oil. It is, however, a matter of great doubt whether these external applications, in consequence of the articles with which they are impregnated, exert any influence on the worms themselves.

The diet of children disposed to worms should be warm and nourishing, consisting in part at least of animal food, which is not the worse for being a little seasoned. The drink may be any kind of beer that is well hopped, with now and then a small draught of porter or negus. A total abstinence from butter is not so necessary, perhaps, as is generally imagined. Poor cheese must by all means be avoided; but such as is rich and pungent, in a moderate quantity, is particularly serviceable. In the spasmodic worm fever, the patient should be supported occasionally by small quantities of broth; and, at the close of it, when the appetite returns, the first food given should be of the kinds above recommended.

The diet here recommended will, perhaps, be thought extraordinary, as the general idea is at present, that, in the management of children, nothing is so much to be avoided as repletion and rich food. It is no doubt an error to feed children too well, or to indulge them with wine and rich sauces; but it is equally an error to confine them to too strict or too poor a diet, which weakens their digestion, and renders them much more subject to disorders of every kind, but particularly to disorders of the bowels. In regard to the spasmodic worm fever, if it be true that acid fruits too plentifully eaten are the general cause of it, it follows as a consequence, that a warm nutritious diet, moderately used, will most effectually counteract the mischief, and soonest restore the natural powers of the stomach. Besides, if the disorder does not readily yield to the methods here directed, as there are many examples of its terminating by an inflammation and suppuration of the navel, it is highly advisable to keep this probability in view, and, by a moderate allowance of animal food, to support those powers of nature, from which only such a happy crisis is to be expected.

Besides these, many other diseases might here be mentioned, which, if not peculiar to infants, are at least peculiarly modified by the infant state. But into details respecting these we cannot propose to enter. It is sufficient to say, that due regard being paid to age and constitution, the cure is to be conducted on the same general principles as in the adult state.

MEDICAL JURISPRUDENCE.