Ex tibris I C. K. THE PARENT'S GUIDE. A TREATISE ON THE METHOD OF REARING CHILDREN FEOM THEIK EARLIEST INFANCY ; COMPRISING THE ESSENTIAL BRANCHES OF MOKAL AND PHYSICAL EDUCATION. TO WHICH ARE ATTACHED A FEW SIMPLE REGULATIONS FOR THE HOMOEOPATHIC TREATMENT OF SOME OF THE MORE COMMON AFFECTIONS INCIDENTAL TO CHILDHOOD. BY J. LAURIE, M.D, Licentiate of the Royal College of Surgeons, Edinburgh. LONDON : JAMES LEATH, 9, VERB STREET, OXFORD STREET, AND 5, ST. PAUL'S CHURCHYARD. TURNER, PICCADILLY, MANCHESTER. MACLACHLAN, STEWART, AND CO., EDINBURGH 1849. THE Medicines which the Author is in the habit of using are procured at LEATH'S Homoeopathic Pharmacy, 9, Vere Street, Oxford Street, London, where a practical and pharmaceutical Chemist is in constant attendance. From having tested the efficacy of these remedies in general practice, the Author feels that he can safely recommend them to the highest confidence of the public. N. B. Complete cases or single bottles may also be obtained at the Publisher's, 5, St. Paul's Churchyard (corner of Doctor's Commons). C AND J. ADLARD, PRINTKK8, BAH1 HU1OMKW Cl OSK. PREFACE. THIS work has been suggested, firstly, by the ac- knowledged assistance which may be rendered in the domestic management of young families, by simple directions as to general treatment in all ordinary forms of the more common diseases of childhood ; and, secondly, by the peculiar applicability of the medicines administered according to the Homoeopathic rule to the cases of young children. The reasons of this especial aptitude are obvious, and have been too frequently commented upon elsewhere, by the Author, to require recapitulation. There were already other works in circulation, embracing the same sphere, and emanating from disciples of the old school of medicine, but there was, hitherto, no Homoeopathic publication which was confined exclusively to the treatment of infancy, and in which the medical directions had been combined with those relating to moral and physical education. It is the opinion of the author that these departments in the rearing of children should be sedulously united, in order that they may, invariably, be conducted in conformity to each other, for reasons which he has taken the liberty of explaining in the body of this work. And, prompted by this persuasion, he has essayed to produce a treatise containing regulations by 2015185 IV PREFACE. which all the branches of regimen and tutelage are made conformable. The author feels, likewise, that whilst great service may be rendered by works of this kind, some mischief may also be imputed to them, unless care be taken to warn parents against the error of trusting too much to their own judgment in the treatment of dangerous diseases, lest serious complica- tions be induced, which, by timely professional advice, might, possibly, have easily been averted. He has, accordingly, been careful to announce this caution, and to repeat it constantly, in speaking of particular sym- ptoms and morbid manifestations which are ever to be looked upon with suspicion. Lastly, whilst he has, in some few instances, entered somewhat minutely into the treatment of the various phases of the malady under consideration, he has, at the same time, been at great pains to avoid anything approaching to intricacy and difficulty, by striving to reduce every suggestion and regulation to the simplest form, in so far as it was practicable to do so in con- formity with the Homoeopathic principle. The author therefore trusts that the work may appear to the Public as intelligible and rudimental as he sincerely desired and endeavoured to render it. J. L. LONDON; August, 1849. CONTENTS. PAGK Preliminary Remarks ........ 1 PART I. Of the Nursing of Infants ....... 5 Treatment of Children at the Birth .... 8 Precautions to be taken by the Mother . . .13 Tight lacing injurious to the Nursing Breast . . 18 Of Wet Nurses 20 Of Artificial Feeding and Weaning 26 Of Weaning 35 Of the General Treatment of Children from the Period of Weaning to that of Education, properly so called . . 38 Of Rest . ib. Of Cleanliness 42 Of Air and Exercise 46 Occupation . 50 Of Diet 55 Manners at Table 61 Of Clothing 65 PART. II. Of Physical Education, as tending to Mental and Moral Development. Of Spoilt Children ........ 79 Over-severity Alienated Children . . . . .81 The Duties, and their Inculcation 88 The Six Social Duties . . ... . .90 Duty towards the Parent 92 Of Obedience 93 Of Love . . . . . . . .94 Honour and Reverence . . .96 VI CONTENTS. PAGE The Duties of Consanguinity 97 The Duties of the Younger towards the Elder . . ib. The Duties of the Master towards the Servant, the Superior towards the Inferior, &c. &c. ... 99 The Duties of Wealth towards Poverty, &c. &c. . .102 The Duties to One's Country 103 PART III. Of Mental and Moral Education. Tutelage of Occupation .109 Stages of Youth Ill Languages 124 Mathematics . 126 Geography .128 Of the Distribution of Employment during the Course of Education, and Admonitory Regimen .... 130 Admonitory Regimen ....... 140 Corporal Punishment 141 Close Confinement 142 Rewards . 143 PART IV. Of Temperaments the most common Complaints of Children, and their Treatment in Ordinary Cases. Characteristics of Constitutional Tendency and Temperament 147 Casualties and Disorders concomitant with Birth, or shortly succeeding it 156 Tumours and Contusions ib. Swelling of the Head 157 Ruptures . . . . 158 Jaundice ib. Inflammation of the Eyes 162 Redgum 164 Swelling of the Breasts in Infants . . . ib. CONTENTS, Vll PAGE Diseases of the Digestive Organs 165 Inflammation of the Mouth ib. Ulcerative Inflammation of the Mouth . . .168 Aphthous Ulceration 171 White Thrush 175 Diphtheritic Inflammation 177 Mumps 180 Vomiting of Milk. Intolerance of Milk . . . 183 Infantile Dyspepsia, or Indigestion. Weaning-brash, or Scour 184 Colic. Griping 192 Weaning 193 Bowel Complaints. Diarrhrea 194 Cholera of Infants 204 Inflammation of the Stomach and Bowels . . ' . . 208 Invermination. Worms 212 Mesenteric Disease 219 Derangement of the Stomach 224 Vomiting 230 Constipation 236 Infantile Remittent Fever 241 Diseases of the Respiratory Organs 253 Cold in the Head, or common Catarrh . . . ib. Cold in the Chest. Pulmonary Catarrh. Bronchial Catarrh 257 Inflammation of the Lungs ...... 263 Croup 264 Accidental Obstructions in the Windpipe, &c. . . 273 Spasm of the Opening of the Windpipe . . . 277 Hooping-cough 282 Convulsions 294 Teething 304 Indispositions during Teething 306 Diseases of the Brain, &c 312 Irritation of the Brain ib. Determination of Blood to the Head. Congestion . 316 Vlll CONTENTS. PAGE Inflammation of the Brain. Brain Fever . . . 320 Water in the Brain. Dropsy of the Brain . . .321 Fever. Eruptive Fevers 333 Diet in Fevers ib. Simple Fever 335 Scarlet Fever 336 Measles 349 Roseola. False Measles 361 Smallpox. (Variola.) 362 Chicken-pock ........ 377 Constitutional Affections 378 Scrofula affecting the Glands of the Neck . . . ib. Scrofulous Inflammation of the Eyes . . . . 386 Scrofulous Inflammation of the Ear .... 390 Rickets 396 Cutaneous Diseases 400 Ringworm. (Herpetic or Vesicular) . . . . ib. Scald-head. Ringworm of the Scalp. Pustular Ringworm 402 Milk-Crust 411 Chafing. Scalding. Excoriations .... 414 THE PARENTS' GUIDE. PRELIMINARY REMARKS. INASMUCH as infancy, with its helplessness and delicacy, must necessarily be the first stage of existence, and as the first fostering of a child is that which requires the greatest care and attention, I am led to believe that a work of the nature which I now offer for the direction and assistance of parents may not be found superfluous. It is not but there have been many very useful publications of the kind produced under the auspices of able members of the Faculty, but that I differ most essentially in many important points from the Allopaths,* in our treatment of infants and chil- dren, as well as of adults. I have, therefore, determined to divide my stric- * A term employed to designate the practitioners of the old system of medicine. *1 2 REMARKS. tures on the subject into four branches, and to classify my advice to young mothers in particular, as follows : FIRST I would treat of the infant from its birth to the period of consciousness, or rather of perception, including nursing and its attendants. SECONDLY The development of the physical faculties and functions of the body should be suggested for the careful consideration of my readers. THIRDLY I should have to detain them a con- siderable time on the moral tutelage and mental development of infancy, premising that these should be simultaneous and similar. Thus the second and third portions of my trea- tise would, in fact, include education and training, properly so called, in all their departments. FOURTHLY I shall have to dwell upon tem- peraments ; the susceptibility of children to certain maladies, and the manner in w^hich these maladies should be dealt with. REMARKS. O Thus the fourth portion of my work will be more essentially hygienic than any of the others. It may be urged, that it is no part of a medical man's science to enter into a dissertation on moral or mental training ; but, as I must be my own apologist for the present, I must beg to assert that it is so, and upon this ground, amongst others : The animal or physical portion of human nature being generally the most dominant, especially in infancy, it is only by the anatomical study of the human frame that the organic construction can be justly comprehended or appreciated,and the whole moral and mental superstructure being dependent upon this organic construction, it is most im- portant that no mistake should be made during infancy as to its capabilities and aptitudes. It is in this, indeed, that the fatal errors which, in after life, appear in the character of maturity, are made; for, paradoxical as it may seem, there is barely a human organization which, by proper treatment during the progress of its formation, may not be fashioned to good, as well as left to run to seed for evil. There is another great question in the treatment of infancy which, in my opinion, is not allowed to 4 REMARKS. have sufficient weightier is overbalanced by custom or fasfiion. It is, that the artificial state of society is allowed to distort even the cradle of infancy. A great deal less of Art and a great deal more of Nature might vastly assist the embryo composition which is made a toy of, and, like most toys, spoilt in the playing with. At the same time, it should be remarked that the affectation of letting Nature provide her own appliances may be carried to as pernicious an ex- tent in the other direction. PART I. CHAPTER I. OP THE NURSING OF INFANTS. THE foregoing preliminary remarks have brought me to the first stage of my subject, and I will at once proceed to deal with it methodically. At the birth, and for a very considerable period afterwards, it is palpable that the infant is thoroughly helpless, and entirely at the mercy of those in whose charge it remains. It is obvious also that it has barely any means of making its want or its sufferings understood. It is therefore of paramount importance that at this stage it should be submitted to a regular and methodical course of treatment, and that every precaution should be suggested and taken to prevent pre- judice. During the period of suckling, which averages at from nine to twelve months, but which sometimes extends injuriously to eighteen and twenty-four, there are double precautions to be adopted : first, precautions to guard against a scanty, unwhole- some, or insufficient supply of milk ; and, secondly, with the child, as to the frequency of suckling at various stages of growth. O NURSING. Be it understood, however, that the period of suckling must, in all instances, be regulated by the casual circumstances of the case, under many of which the advice and direction of a medical man will indicate the judicious term. Almost every case has, in truth, its identical circumstances of constitution, of accident, or of situation. But for the more exact and explicit direction of parents, I will divide the care of an infant into two sections, those of external and internal attention- In treating of external precautions, it were impos- sible to lay too much stress upon the observance of proper ventilation and the structure of the apart- ments destined for the purposes of a Nursery, and most especially in towns ; for, be it observed, that too little importance has hitherto been attached to this most essential of requisites. Houses are constructed for what is termed con- venience and accommodation, that is, for the apportionment of as many rooms as possible in the smallest conceivable space ; but, whereas appear- ances must ever be maintained, there is not com- monly any such stint of pitch and space in the receiving portions of the establishment ; thus, whilst the drawing-room must be some fourteen feet in height, the nursery, on the second or third floor, is allowed a scanty eight or nine feet, and often less. NURSING. 7 Added to this, the too solicitous mother or nurse, over careful of herself or her charge, is ever loath to afford a free access of fresh air into the apartment. To avoid the chance of some phantom cold or cough, a fever is sedulously cultivated. Why is there less casualty amongst the brutes in their earliest stage of life than amongst human beings ? If a farmer were to rear his cattle as some matrons do their children, he would have but few to bring to market. The most important of necessaries is air, whose pure chemical properties are essential to sustain vitality, and if that air be foul, or re-inspired after its rejection from the lungs, it does not possess those properties so necessary to life, but others which are more or less fatal to it. This brings me to another portion of the same question, which, after centuries counted by Epidemic and Endemic diseases, is at last beginning to dawn upon the world as something that should be. I allude to proper draining, and the careful prevention or re- moval of fetid odours and rank miasma. These two questions are of almost as much importance to humanity in all its other stages as in infancy, Half a century ago it might have been a matter of great difficulty to provide for the constant cleanli- ness of a house in London. But since the facilities NURSING. for drainage have been so vastly multiplied, and the constant supply of water, great or small, has been rendered so much a part of every house, it is a mere act of wanton carelessness, or perhaps worse, to allow r of anything like a cesspool, or foul pipe, uncleansed by a current of water, in or about any house. It is not unworthy of notice and censure, however, that the humane measure recently proposed for the better removal of all such pollutions of a healthy atmosphere should have met with such chicanery of opposition at every turn. During the period of suckling there is a double evil inflicted upon the infant by mischiefs of this kind, inasmuch as it must not be forgotten that, first of all, the infant is individually affected by them ; and, secondly, it is again affected by the prejudice suffered by the mother. Treatment of Children at the Birth. Immediately upon the delivery, every child should be carefully washed with tepid water, wrapped in its linen, and laid to sleep. In the dressing, some care should be taken not to confine the limbs too much, as the old prejudice still prevails in some places that infants cannot be too closely swaddled. This is a very grievous NURSING. 9 error, as it is one which directly insults at Nature. The free action of the limbs is indispensable to the free circulation of the blood, and, by a parity of reasoning and of reasons, to the free operation of the lungs and of all the vital organs. No sleep can be genuine and really invigorating unless the body be relieved of everything that can oppress and bind it. Why otherwise should not persons of maturer years find as much refreshment from sleeping dressed as undressed ? This allusion will be felt ; it is commonplace, but it is apposite, and there are few who will not have had some occasion to experience its point. The infant should then be left to sleep for some hours, from three to five, according to circum- stances, and if the mother be competent to suckle it herself, should then be put to the breast. In the generality of cases there will not be a sufficiency of breast milk for several days, to afford the infant sustenance, and the want must be supplied by having recourse to the " bottle " as hereinafter described. There are some cases in which women are competent, from the moment of delivery, to afford an ample supply of milk, but they are the minority, and in first confinements they are very rare indeed. Circumstances, and the appe- tite of the child, must indicate its requirements for the period of ten or fifteen days after birth, and 10 NURSING. from that period general directions will be found elsewhere in this chapter. And it should be remarked generally, that pe- culiar circumstances, showing that the course of treatment did not positively agree with the infant, should be the guide of the mother as to any alte- ration in the frequency of feeding. One thing I would very strongly urge upon the attention of every young mother, which is, not to allow her child (unless coerced to do so by ne- cessity) to suckle more from one nipple than from the other. As the being more frequently held in one position when the frame is so easily moulded and fashioned may induce a variety of distortions. I would also entreat mothers generally to hold their children well up to the breast, and not to bend the body down to the mouth of the child, and, for the more natural observance of this rule, I would recommend the breast to be offered always either in an erect or a recumbent position, as in the former in particular it will be more convenient to raise the child. It is the habit, which, if it be not indolent, is careless, of feeding the infant from the lap, which induces the method of bending over it. With respect to the method of affording the proper rest to an infant newly born, it should be remarked, that after the first sleep the inclination of the child will indicate its necessities. For some NURSING. 11 weeks, at least, it -will sleep continually, only waking to be nursed. Although the earlier it is broken of seeking the breast in the night the better. After the lapse of the first few weeks, there will be longer intervals of wakefulness, and less fre- quent but longer durations of sleep. After the first two months it w r ill become imperative to in- duce, if possible, regular periods of sleeping ; at night, in the middle of the day, and, if needful, early in the evening, but for not more than three hours in the course of the day, as a greater indul- gence at that time may be apt to render the nights more restless. The apartment should be dark- ened during the sleep, and a little time allowed to elapse between feeding and sleeping. The mo- ther's observation will become the best index of the proportion of sleep which her child requires, for as with the nursing, &c., this will vary accord- ing to constitution and state of body. A newly-born child has, not sufficient power of generating heat, especially during sleep, to be con- signed to a separate resting-place, and as this deficiency of indigenous caloric must for a certain period be conveyed to it from some other body in order to maintain a sufficient activity of circulation, and, by a complication and combination of pul- monary and hydraulic action, a sufficient oxyge- nation of the blood, it is needful that for a month 12 NURSING. or six weeks after birth every child should either sleep in the same bed with its mother, or with its nurse, or lie in the arms, or in close contiguity to the one or the other. No heat can be imparted to it which will have as beneficial an effect as the animal heat of its species. After the expiration of the term prescribed, however, or otherwise according to peculiar cir- cumstances, the child may be left to sleep in its little bed or cradle separately, provided care be taken that the temperature of the apartment be not too much lowered, (say about what is called temperate,) and that the bed itself be not exposed to a direct current of air of another temperature. I must not be understood to recommend coddling, over-covering, and close apartments ; because, as may have been gathered from my foregoing remarks, I am beyond measure averse to them, and look upon them as the bane and destruc- tion of infancy. I would have a current of air con- stantly passing freshly through the room, if possible, by means of ventilators, open doors, &c., when the weather is too cold to admit of a window con- tinually unclosed ; but I would not have theb ody of the child exposed to the direct action of any such draughts as might be thus occasioned. Above all things, the head and face should be constantly uncovered, in order that the breathing may be free and fresh, and the coverlets should be in plenty to NURSING. 13 encourage proper warmth without being of suffi- cient weight to oppress or confine the limbs, or so closely fastened as to bind them down. I cannot say I agree at all in the common notion that a feather bed is necessary to young children, nor do I imagine anything of the kind to be as wholesome as a good sound French wool mattress. It is far more essential to attend to the thorough sweetness and cleanliness of the bedding, which can be attained by repeated exposure to the air, and being kept very dry, than to its excessive softness. As regards the warmth induced and sustained by a feather bed, I am very much in- clined to the notion that there is something in it which does not thoroughly contribute to whole- some rest. Precautions to be taken by the Mother. There are many personal precautions to be taken by the mother to secure a plentiful and wholesome supply of milk, and amongst these, perhaps the first is to partake of regular exercise as soon as she is able to do so. Never omitting the daily walk, still careful not to exceed her strength and expose herself to suffer from fatigue. The free use of water, also, is amongst the essentials for a nursing mother. The skin cannot be kept too clean and pure. The diet should be as plain as may be, partaking 14 NURSING. of mixed kinds, but very generally nothing in the shape of made dishes, or, more particularly, highly- seasoned viands. She should sedulously avoid fermented liquors, unless deficient in vigour, and even then they should be of as little stimulating a nature as possible, and not taken in greater quan- tities than had been her custom before confine- ment. All surprise or excitement, whether for good or evil, should be avoided. By observing these rules, and paying great at- tention to the general bodily health, a mother of capable constitution (for there are many who should never attempt to nurse), will always find herself able to supply ample nourishment to her child. During the first week or two after delivery, the frequency in offering the breast to the infant must depend almost wholly upon the child's own desire and inclination. But after the expiration of the first stage, the administration of the milk should become as regular as possible at certain stated intervals, say from two to four hours, according to appetite ; and this routine should be most rigidly adhered to during the remainder of the month or six weeks after birth, for the strength- ening and toning of the stomach, and the avoiding of craving and gnawing pain (which renders every infant fretful, and consequently feverish), depend wholly upon the strictest regularity. NURSING. 15 Again, after the brief term pointed out for this course, it becomes most essential to the mother, and, consequently, to the child, to cease offering the breast for some hours during the nights. This, it will be observed, can be effected by giving the last meal when the mother retires to rest, say about 1 1 o'clock at night, and the next about 5 in the morning ; the mother will thus have her noc- turnal rest comparatively undisturbed, and the child will, after a very few days, become perfectly habituated to the change. The greatest mistake which can be made is to forego these rules for the purpose of quieting a child, because irregularity only deranges the stomach, and thereby renders the infant daily more fretful. After from six to eight months the first teeth will have appeared, and then the treatment of the child may begin to be varied, although this should be done as gradually as possible ; because, if the child should hitherto have been healthy and thriving, it might have nothing immediately to gain from the change. But, at the same time, seven or eight months of exclusive nursing may drain a very strong con- stitution, and the mischief of protracting the course any longer may become too serious to be overlooked. It is, moreover, very easy to begin by adminis- tering good cows' milk, a little diluted, and *1 16 NURSING. proceeding to select the lightest and most nourish- ing of farinaceous diets (premising that they should not be the least of a greasy character,) in small but increasing quantities, as the mother's breast is more and more withheld. It should not be out of place at this juncture to add that those who, from circumstances, whether of compulsory employment or pleasure-seeking, are unable or unwilling to perform the duties of a nurse, except by fits and starts, and to observe the simple regulations as to diet, as herein laid down, should, as an obligation, abstain from under- taking these duties at all, in common justice and humanity. Of the expedients, as substitutes for their nurture, I shall have to speak hereafter, and therefore I shall not at this moment detain the reader with them. It will not unfrequently occur, that, although the mother is in other respects in sound health, there will not be a sufficient supply of milk for the sustenance of her child. In such a case as this, rather than submit the infant to a half-artificial and half-natural regimen, it would, generally, be advisable either to intrust it entirely to a wet nurse, selected with great care, or to feed it at once from the bottle. Diluted cows' milk (about f of water to of good milk), with a little sugar, being the best substitute for that of the mother. Most women who do not marry or have children NURSING. 17 before they have attained somewhat ripened years, are apt to be deficient in their supply, either from the first few weeks after delivery, or, at all events, after the lapse of a month or two ; and in such cases they should by no means persist in nursing their children, inasmuch as they are weakening their own constitution on the one hand, and hazarding the health, if not the life, of the child on the other. The ordinary rule with women is, that their MONTHLY INDISPOSITIONS will be entirely sus- pended during the period of their nursing; but cases to the contrary are by no means unfrequent, and when they occur the mother should generally abstain from offering the breast to her child during their continuance. Should the return of this affection only occur after from eight to twelve months, it will not be difficult to understand that a wet nurse, and the hazard attached to the choice of one, may be avoided altogether, inasmuch as the child at that age will be quite sufficiently advanced (if of a healthy frame) to be submitted to artificial feeding, or, in fact, to be weaned ; and if not of a healthy habit, would, in all probability, gain something by the change. It is necessary, however, whilst advising the mother to withhold the breast during the monthly periods, to point out a method of encouraging and preserving a flow of milk, which can be effected 2 18 NURSING. by simply drawing it off at about the stated hours that the child (if nursed) should have been suck- ling. And with relation to the substitute which must be provided for the child in the interim as that will only be of a few days' duration it would be best to resort to the ( ' Bottle," and a mixture of milk, water, and sugar, as directed under the head of " Artificial Feeding," with this reservation that the proportions of milk and water be accommodated to the age of the child as here- after mentioned. Tight Lacing injurious to the Nursing Breast. Whilst engaged upon the subject of nursing, I cannot refrain from calling the attention of all young women, and especially of those who are married or likely to marry, and become mothers, to the extreme injuries which they sustain from the practice of tight lacing. First of all they render themselves subject to danger in delivery, or, if safely acquitted of that operation, still they frequently become unable to afford the natural sustenance to their children. The nipples of the breast become very frequently incapable of affording a sufficient passage for the milk ; and it is in consequence necessary to hand the child over to a wet nurse, and immediately to dry up the milk of the breasts. NURSING. 19 To most women it would no doubt be exceedingly painful to be withheld from performing their maternal offices, and therefore the caution is by no means to be disregarded. There are some women who should never be suffered to take upon themselves the office of nurses to their own children, inasmuch as they are constitutionally incapable of performing this office beneficially. Such, for instance, are those who are afflicted with any hereditary disease, or a tendency to pulmonary or scrofulous complaints ; because not only will their milk be impure, in- sufficient, or inferior in power and quality, but they will be apt to sink under the drain caused by the nursing. Those, also, who are of the most acute sensibility and are alive to every little ex- citement, \vho are startled at trifles, or whose intense anxiety works upon their nerves to the point of constantly suggesting some ill which is accruing, or likely to accrue, to their child, should wholly abstain from attempting to nurse it. The delicate state of mothers for some time after delivery, be it observed, is not unlikely to induce symptoms of this nature if they have had the least tendency to them beforehand ; and as soon as they betray themselves they should become the signal for abandoning the charge. With respect to the former cases of hereditary weakness or complaints, it should not be over- 20 NURSING. looked that children of such parents have already an aptitude for the same disorders engendered with their blood, and that these disorders will almost inevitably be confirmed or superinduced if the mothers should persist in nursing their infants under such circumstances. Without any apparent cause it will sometimes be found that the mother is not sufficiently robust to nurse her own child, a fact which will soon be betrayed by certain symptoms attendant upon her suckling, such as a drawing through the body and from the spine, whilst the child is at the breast, and a dizzy, faint sensation immediately after it. Whenever this should occur there is no safe course but to abandon the attempt, for its con- tinuance will only engender more serious and even dangerous affections. The symptoms which usu- ally follow those recited, are, pains in the head, irregularity and astringency of the bowels, want of spirits, faintness, cough, palpitation, and so on. There are, nevertheless, some cases in which the first symptoms may be allayed and overcome by seasonable advice and judicious employment of medicines. OF WET NURSES. It has frequently occurred in the foregoing suggestions that I have had occasion to appeal NURSING. 21 from the mother to the wet nurse ; it is, therefore, incumbent upon me to give some directions for the selection of persons to fulfil that important office in a household. The first inquiry which should be made, in my opinion, is as to moral character, for no person is adapted as a wet nurse who is not, above all things, cleanly, sober, good tempered, and well conducted. It is also desirable that she should be accustomed to the management of infants, fond of them, and gentle in her treatment. The general state of bodily health is the next point to be considered, for it is paramount in the wet nurse as in the mother, that she should be sufficiently robust and healthy to perform her duties efficiently. The breath, above all things, should be sweet, and the appearance of the mouth wholesome ; the breasts firm, full, and of a good colour; the skin very clean, healthy, and free from any surfeit or humour; and her own child healthy and robust, and bearing all the appearances of thriving upon her nurture. Again, the date of her delivery should, as nearly as possible, tally with that of the mother whose infant she is about to take into nursing, because the breast-milk varies very materially with the age of the child, and becomes more and more heavy as the child advances in age, being then too powerful for a new-born infant, as the milk of a 22 NURSING. woman newly delivered would be too poor in quality for a child of two, three, or four months old. In addition to the external signs of the fitness or unfitness of a nurse, the choice ought to be regulated by the quality of her milk, which point can best be determined by a professional man. The direction of a medical attendant, who has made the treatment of females his exclusive or especial study,* will, moreover, be frequently necessary in the selection of a wet nurse, for many other reasons ; and, therefore, any hints which are afforded in this work should not lead persons to depend entirely upon their own judgment and discrimina- tion in this important matter. Great attention should be paid to the nature of her diet, and a strict inquiry made as to her habitual kind of living, because she cannot but be prejudiced in her capabilities by a change ; and, as it is not unfrequent for wet nurses to make a holiday-time when they go out nursing, and cram themselves to excess because varieties of meats and drinks are within their reach, a careful watch * This is not the author's case ; but, as the well-being of na- turally-reared children, during the first months of their existence, is so inseparably connected with an unexceptionable condition of the mother or wet nurse, he could not avoid making some cursory observations on the above and other subjects, more correctly be- longing to the province of the obstetric practitioner. NURSING. 23 should be kept over them in this respect. They have it ever ready to say that good eating and drinking assist them in their capacity of nurses, and that a considerable quantity of malt liquor is, above all things, needed by them. The excuse is plausible, and, sad to say, is too often successful ; but the practice of humouring them in all their inclinations cannot be too strongly deprecated. The truth is, as has before been stated with respect to the mothers, that the plainer a good sub- stantial diet can be, and the better and the nearer it can be assimilated with the habit of the person, the more likely is it to yield her good milk. As for stimulants and fermented liquors, they are all more or less objectionable, and should, conse- quently (excepting perhaps in the instances analogous to those I referred to when treating of nursing mothers]^ be forbidden. The same precautions should be observed by the wet nurse, as previously indicated for the mother, as to daily and regular walking exercise, careful washing and cleansing of the skin, regular and early hours, and so forth. The latter injunctions also need considerable attention with respect to nurses, inasmuch as there are very few who are too cleanly in their persons, and they are almost invariably indo- lent and lazy. With reference to diet, for those who can afford to keep a kind of separate establishment, I should strongly recommend a table peculiar to the nursery, and great care that nothing should 24 NURSING. be smuggled to it which was not gratuitously allowed. I would also add that it should, where there is a selection, be a sufficient reason to reject a nurse, that she was herself suckling a first child ; for, in the first place, it is not uncommon for a deficiency of milk to attend the first delivery ; and, secondly, a young mother is more in need of advice and assistance over her first child, than she is compe- tent to afford them to others. On the other hand, there is almost as much in- convenience attendant upon having a woman too far advanced in years as a wet nurse, inasmuch as she is very often deficient of an adequate supply for her own child. In cases where the mother is unwilling to intrust her infant to the chances of a wet nurse, and unable to suckle it herself, she must needs have recourse to the bottle, as the best artificial means of affording nourishment to the child, great care being taken not to overload the stomach at one time, but to adopt frequency rather than quantity in feeding. Nothing will sooner derange the stomach of a new-born child than to cram it, or allow it to glut itself. A mixture of about one proportion of good fresh milk to two of water,* sweetened, if possible, with beet-root sugar, or otherwise with the finest * The water added should be boiling ; and the temperature at which the food ought to be given should be the same as that of the mother's milk, viz. at 96 to 98. ARTIFICIAL FEEDING. 25 loaf sugar, will be the best representation of breast milk. The water should have been well boiled, but the mixture should be given lukewarm. On no account should the same be given twice from the bottle, but a fresh supply prepared for every feeding. CHAPTER II. OF ARTIFICIAL FEEDING AND WEANING. I HAVE now arrived at the period in my treatise in which I must call the particular attention of the reader to the question of "ARTIFICIAL FEEDING." And not only shall I dilate upon this topic as the successive course of treatment to breast nursing, but also as its substitute. It has been sufficiently shown in my foregoing remarks, that there are very many instances in which the mother is constitutionally unable to nurse her own child; many also in which she accidentally becomes so from casual debility or sickness ; and many more in which she is so by habit. It is not, therefore, only at the period of wean- ing and subsequently, that artificial feeding is SJO ARTIFICIAL FEEDING. needful in the nursery, but very frequently from the day of birth. It is not unnatural that an anxious mother, finding herself incompetent to perform the duties and offices of her tender capacity, should yet be loath to intrust a child into hireling hands for nurture. There is, and too often with just reason, a secret loathing and uneasiness respecting some possible imperfection in the wet nurse, and when- ever this should chance to be felt with unusual in- tensity, rather than submit the mother to a restless anxiety on this score, it is perhaps better to re- commend recourse to absolutely artificial means. The nearest representative of breast milk has already been detailed,* but it should perhaps be added that the mixture prepared for the bottle should not be persisted in in certain given propor- tions, irrespective of the condition and wants of the infant. After the first fortnight has expired, for instance, the addition of about & of milk may be recommended (which should in all cases be quite fresh, and in hot weather should be carefully guarded from its effect), and after the lapse of a month or six weeks after birth, the proportion of milk to the water may be as 3 to 1, and so on. It should also be understood that cows' milk does not in all cases agree with children, when asses' milk may be tried. * Page 24. ARTIFICIAL FEEDING. 27 Instances are not wanting of the very successful trial of asses' milk for infants who have pined away upon the milk of the cow, and therefore should the latter, after a week's trial, be found to disagree with the child, no time should be lost in procuring the other.* The most common symptoms of an indigestibility in the milk, are gripings, great flatulence, and difficult, though liquid and greenish, or curd-like motions sometimes, also, these last will be hard and dry, a very evident sign of derangement. Some children, from the day of their birth, reject all milk, and equally refuse the breast and the sub- stitutes.f In such cases the use of the farinaceous food may be advised, of which mention is here- after made,f as much liquefied as possible ; in fact, having no consistency. For children of five or six months old and upwards, it may be prepared as follows : Mix, thoroughly, a tablespoonful of the powder with a tablespoonful of pure cold milk, pour thereon half a pint of boiling water, stirring constantly; then boil the mixture for eight minutes, slightly sweeten with a small quantity of loaf sugar, and add a few grains of salt. * The proportions of asses' milk and water should, at first, be equal parts ; after the fifth or sixth month the milk may be given undiluted. f This intolerance of milk may, sometimes, be readily overcome by means of medicine. See page 183. J Page 33. 28 ARTIFICIAL FEEDING. Weak barley-water may also be given, or thin grit gruel, arrow-root, or ground rice, well boiled in water, and seasoned with a very little sugar and salt ; fixing upon that which suits best, and ad- hering to it as long as it appears to agree. An excess in the quantity is, however, a much more frequent source of disturbance than a faultiness in the quality of the food. Milk, when it can be had pure, is always to be preferred to other kinds of food ; it should not, therefore, be discarded with- out sufficient reason. Sometimes it may be made to agree by altering the proportions of the milk and water; and when that fails, the medicinal means, already referred to, should be tried before the milk of the cow or ass is laid aside. Al- though I confess myself opposed to the expedient, weak veal- and beef-tea and snail-broth have been suggested by some.* The last is perhaps the most likely to be beneficial. In using the bottle, it is not unfrequent, as just stated, that the proportions must be changed to suit the stomach, more or less milk and sugar being given. Nevertheless, great care should be taken lest the cause of ailing, if any, be mistaken, and lest the food be varied without sufficient ground. Again, therefore, '* It is only when infants become soft, flabby, and otherwise ill- conditioned, that animal broths may be resorted to, combined, in general, with an equal quantity of thin barley or grit gruel, &c. ARTIFICIAL FEEDING. 29 it may be enjoined as of paramount consequence that the quantity should be moderate at each feeding, and that, if needful, the repetition should be more or less frequent. The worst of all injuries which can be inflicted upon the stomach of an infant respecting its food, is by overloading it. No occasion should be taken to allay peevish- ness by feeding out of regular hours, as this will inevitably increase the cause, and consequently the effect eventually. For, in nine cases out of ten the irritability of an infant arises from de- rangement of the stomach. In general there can be no harm in following the same rules in the use of the bottle as have been before set forth relative to breast feeding, and which it is consequently unnecessary to re- capitulate. But, in particular, the attention of the reader may be recalled to the question of night feeding, and reminded of the strict observance of the same regulation. The sooner a child can be got into the habit of taking from five to six, or even seven or eight hours of unbroken rest the better. It is therefore advisable, after ten or fifteen days from the birth, to train an infant to forego the one or two meals (if I may so call them) which would fall nearest to the middle of the night. Thus, then, would it be advisable to 30 ARTIFICIAL FEEDING. commence and proceed with the application of the "bottle." The same stages and gradations, the same ob- servance of quantity in repetition, should hold as when the mother nurses at the breast, ever pre- mising that care should be taken to accommodate the feeding to the necessities and peculiarities of the child. It may be taken as a general rule, that where an infant is robust and healthy, the flesh being full and sound, and the mouth and gums of a healthy colour, with an absence of peevish irritability, it is thriving upon its food, and changes should not be made except in the regular course prescribed for breast nursing. Before proceeding further with ARTIFICIAL FEEDING, it may be as well, at this place, to caution mothers against the administration of solids to children before the first teeth appear, and indicate that the child is arrived at a proper degree of maturity for their adoption. In fact liquid food should be adhered to exclusively for the same period as the breast would be persevered in under other circumstances. The stomach of a child under six, seven, or sometimes eight months old, is generally incapable of properly digesting solid food, and it is not at all unfrequent that great derangement of the functions is induced by such a method of nourishment. Upon the appearance of the first teeth, which, ARTIFICIAL FEEDING. 31 on the average, occurs about the seventh month, whether the infant has been raised " by hand" or not, the treatment becomes much the same, alter- nating the breast or bottle with some delicate farinaceous food (of which hereafter), gradually increasing the solid, and diminishing the liquid, and thus, by imperceptible steps, weaning the child. Upon the first trial of solid food it should be confined in its administration to once in twenty- four hours, and that in a very small quantity; after the lapse of a week or ten days, repeat it twice, and after a month or six weeks, three times, with the proviso that, in all cases, great attention be paid to the motions, the bodily health, and the temper of the infant, in order to ascertain if in anything the method disagrees with it, and might be altered for the better. There is one thing to which there is not suffi- cient importance attributed in artificial feeding, which is the position of the child. Infants are frequently fed by hand upon the mother's or nurse's knee, with the head hanging backward, and the middle of the body alone sustained by its resting place. Such a method may, on some unlucky occasion, cause suffocation, and will inva- riably impede the regular reception of food. The head of a child, whilst feeding, should always be raised slightly on the arm or pillow, and the posi- 32 ARTIFICIAL FEEDING. tion be as much as possible one of comfort. A short time* after the child has completed its meal, it should be hushed gently to rest, for there is nothing which better facilitates an easy and comfortable course of digestion than the infantine " siesta." In very hot weather the repose may be prolonged. After the lapse of six or seven months from the birth, or, more properly, when the first teeth have appeared, the diet of every child should become of a more solid character, and the addition of a variety of preparations, will become necessary. Still, however, a strict observance of the rules as to frequency, quantity, and posture is enjoined, and still the casual circumstances attendant upon the constitution and bodily health of the child, to which the mother will have become accustomed, and with the peculiarities of which she will doubt- less be intimate, must be her guide. * " It is true, that during the first month, the infant sleeps immediately on leaving the breast, and no evil consequences ensue ; but it must be borne in mind, that it takes but little at a time, and the tenuity of the milk is at that time wisely adapted to its delicate digestion ; but as the secretion becomes richer, and suited to the increasing power of those organs, it is injurious to put the child asleep immediately after a full meal ; his rest is then restless and disturbed, from the process of digestion being interfered with, more particularly when nurses endeavour to force nature, by resorting to the baneful practice of prolonged and violent rocking." Homoeopathic Domestic Medicine, art. SLEEP. ARTIFICIAL FEEDING. 33 Amongst the most valuable of diets for infants, I should reckon baked vvheaten flour, sago, and arrow-root,* but neither should be given without having been carefully prepared for the purpose. It should be remarked that, in most cases of indisposition amongst infants, particularly in those in which they are afflicted with the common ail- ments usually prevalent amongst young children, every mother should be slow to exhibit medicine : it should only be resorted to when strictly required. It is very customary to administer calomel, castor oil, jalap, rhubarb, and magnesia, and other drugs, for every little derangement of stomach and irregularity of motion, and still more, perhaps, to resort to narcotics, to lull the griping so frequent amongst infants. Nothing can be more erroneous, and nothing more likely to set the germ of future disorder than such a course. The flatulence, looseness, or cos- tiveness, so prevalent in the earliest stages of infancy, more frequently arise from diet, want of air, or irregularity, which may produce a derange- ment of stomach, than from any other cause ; and, in almost all such cases, may be cured by a careful attention to these particulars, and by such changes as may be thought necessary. The exhibition of * A farinaceous compound, of a very nutritious and wholesome description, which has been denominated " Alimentary Farina," may be had at the Homoeopathic Pharmacy, 9, Vere street, Oxford street. *3 34 ARTIFICIAL FEEDING. medicine on all occasions induces a morbid state of the stomach, which is not afterwards so easily cor- rected. The ill which it was sought to remove thus becomes more and more aggravated, until it assumes a really serious aspect, and compels the medical man to resort to expedients which he is ever loath to apply in cases where Nature, left alone, is the best of doctors as of nurses. " It is not that, under our principle of medicine, any medical preparation would be used or suffered, which, in its quantity, could affect the constitution prejudici- ally, but that we prefer, when possible, abstaining from medical methods at all in dealing with infants. And now, it might not be irrelevant to observe, that, where Nature is not sufficiently powerful to overcome the obstacle which causes derangement, and medicine becomes absolutely necessary, the Homoeopathic remedies have peculiar advantages for infant organization. The membranes and tissues which line or surround the organs of life, yet tender and susceptible, are far too keenly alive to the action of artificial powers, to sustain uninjured the raking of drugs poured wholesale into the body, and mingled to combat each other w r here they ought, if at all, to operate singly, and in integrity. In more advanced stages of life, a patient may not, perhaps, unfrequently escape unscathed from the effects of the most vio- lent drugs, owing to the maturity of the various WEANING. 35 parts which perform the functions of the body owing to their sturdiness in rejecting and excluding the hurtful impressions of a deleterious foreign power, but in early infancy it is far otherwise, and the use of drugs at all, in their crude or un- attenuated form, too often engenders something which should not be. As I am here treating of the method of dealing with children apart from medical resources, and as I shall hereafter have occasion to give a few details as to the simplest and most useful remedies for some of the more prevalent diseases of infancy and childhood, I shall not here enter further into that department, but content myself w r ith repeat- ing my injunction against the too trivial and constant exhibition of medicine of any kind in the strongest and most unequivocal terms. In most cases, attend closely to the diet, the cleanliness, the ventilation of the nursery and its inhabitants, and do not spare the out-door exer- cise, and you may generally be successful in over- coming the little affections which " Infancy is heir to." OF WEANING. I come now to that important epoch in the life of every human being, designated as the period of WEANING. If WEANING be attempted all of a sudden, it is 36 WEANING. not uncommonly attended with a considerable temporary derangement of the system, but by pursuing the course which I have already indicated, of WEANING, as it were, by degrees, the change may be made so imperceptible as to be without any prejudicial effect, even for a time. The age at which the infant should be finally withheld from the breast will, of course, depend upon circumstances, such as the supply and quality of the milk, and the health and strength both of mother and child. Most mothers are able to nourish their infants satisfactorily from the breast for, at least, five or six weeks ; but if the supply of milk is ample, and its quality unexceptionable, children thrive better if they are fed exclusively from the breast for three or four months. In all cases the change of diet should be effected, if pos- sible, by gradation, and by commencing to discon- tinue the breast at night. The average date of final weaning will be found to be about the ninth or tenth month, after which, in the great majority of cases, if not all, the mother should desist from the tender duty of nursing. Instances are not wanting of suckling being con- tinued until eighteen, or even twenty-four months, but whereas no good is conferred on the child, and very serious mischief may accrue to the mother, nursing should not be persevered in after about the ninth month. After the sixth month a gradual change should, WEANING. 37 in general, be made to farinaceous food ; and when the grinding teeth have made their appearance, but particularly if the child, at the same time, grows rapidly, or if it is of a lymphatic tempera- ment, with soft flabby flesh, the diet may partake yet more of the solid quality ; but so long as the child looks healthy, and presents a satisfactory muscular development when fed on milk, farinaceous food and light soup or broth, there can be no necessity for an alteration. I confess myself opposed to the too early adoption of absolute animal diet ; and as the period of teething is subject to such a variety of ailments amongst infants, and is especially attended with so constant a disposition to fever, I should conceive this to be a sufficient reason for being slo\v and cautious in attempting a change to highly- concentrated diet, requiring considerable powers of digestion, without very strong and sufficient grounds. 38 CHAPTER III. OF THE GENERAL TREATMENT OF CHILDREN FROM THE PERIOD OF WEANING TO THAT OF EDUCATION, PROPERLY SO CALLED. OF REST. THE subject matter of the forthcoming chapter should, to be explicit, be divided into the following sections that of rest, that of cleanliness, that of air, occupation and exercise, in so far as the last two can be applicable, and that of diet and clothing, these being the greatest essentials to the main- tenance of a child's health. Under the head of rest I shall, to avoid further subdivision, include regularity of habits. It will, perhaps, be incumbent upon me to anti- cipate a little of what would properly come within the subsequent department, which has been appropriated to moral training as a part of educa- tion. As there is no question but that, at this early stage of childhood, that is, from the second to about the fifth year, a parent may begin to sow the seeds which shall later germinate in the character. In treating of the method of inducing sound REST. 39 and wholesome sleep, or, in other words, beneficial REST, the subject will be a continuation of the directions which have hitherto been given in my former chapters, and there will perhaps be little to add to those former instructions, for the simple reason that sleep is one of those requirements of humanity of which Nature is ever the best indi- catrix. It must not, however," be lost sight of, that in sickness as in health, in the former for restora- tion and in the latter for preservation, the thorough ventilation of the chamber is one of the first desiderata, which, with cleanliness, may be ranked as amongst the most essential of points. The observance of regular and early hours may also be reckoned in the same class of essentials, for nothing is more prejudicial, both to mind and body, than irregularity in this particular, or a habit of protracting the day through half the night, and carrying the night half through the ensuing day. I have frequently heard children, subjected to this practice, complain of faintness upon rising, and observed a lack of appetite amongst them at the first meal, which entirely originated in the unnatural transposition of the two sections of the twenty-four hours. The use of feather beds and very soft pillows is, also, as unnecessary as I might say it is unnatural, even if it be not very detrimental to the physical 40 REST. vigour of the frame. And after all, these appli- ances of luxury will never be required or sought for in after life if the child has not been constantly accustomed to them. Like many other foibles, it is merely a matter of habit to desire their use. Similarly ought the use of the nightcap to be repre- hended, for what should make the head require more than its natural covering at night than in the day (when unexposed), it is difficult to con- ceive. Even the use of head covering in the open air is acquired by habit. There are many thou- sands who do without it in colder and less genial climates than this. And, moreover, there are some instances extant of children who, from philosophical reasons of the parents, have done very well without it in this country, although brought up to a sphere in which the best of covering was to be obtained, and was considered indispensable. As to the use of a bandage for the head at night, it is worse than useless, it is a great error. Let me add, that where houses are sufficiently roomy, and it is not absolutely necessary to huddle half a dozen children into the same chamber, I look upon the practice as most reprehensible. And also that as without much additional cost the proper conveniences may be erected in every house, it is a sad pity that impure vessels should be suffered in a nursery ; or that any of the con- REST. 41 veniences referred to should be constructed with- out the provision of an ample supply of water on every floor. It should be taken as a general rule with young children, that the absence of sound and healthy sleep and a nightly restlessness, are indications of indisposition, and they should ever be closely attended to as such. Infants, and children even beyond infancy, can but very rarely be subject to a moral or mental uneasiness to predominate over the physical requirements, and, consequently, it may be considered as a symptom of physical de- rangement that these natural pronenesses are in- terrupted. Sleeplessness in children will, apart from denti- tion, generally arise from a febrile affection ori- ginating in the stomach, or in the effects of cold, and it is by dealing with it as such that it will be best overcome. There can never be any harm upon the first manifestation of this affection, in moderating the diet and allowing less of solid in its proportions, and in withholding anything like stimulants, as tea or coffee, and certainly wine and all fermented liquors if at this early age they have been allowed a thing which should not be. Any continuance or aggravation of febrile symptoms had better be checked by recourse to medical aid, because the incipient stages of many 42 CLEANLINESS. of the illnesses to which children are peculiarly subject manifest themselves so similarly that it would be difficult for an unpractised observer to discriminate between them. (See also article DENTITION.) OF CLEANLINESS. I now come to the second section of this chap- ter, in which I have undertaken to give some directions as to the method, not only of keeping children cleanly during the months or years of dependence, but also of habituating and training them to such habits for after life. The first necessity of an infant, at the birth, as has been before shown, is to be thoroughly washed, a necessity which accrues daily during the whole course of existence. It is very requisite that all the orifices of the body should be kept thoroughly clean, being well washed and bathed at least once a day, and, if required, oftener ; and also that the skin should be preserved free from the slightest taint from trans- piration or dirt, which can only be effected by careful washing and immersion. In the first period of infancy the immersion should not be hazarded in quite cold water, but in that of a mo- derate temperature (from 85 to 95 Fahrenheit). If the water be too hot it will create too great a relaxation of the skin, and instead of producing a CLEANLINESS. 43 glow will leave the child chilly and susceptible of taking cold. On the other hand, for some weeks after birth, if the water be too cold, the child, in all probability, will not have an adequate power of generating heat to produce the reaction which should take place in drying. Quite cold water should be used as soon as it safely can be, because the reaction and glow which succeed immersion will be more decided, so that on each successive day the temperature of the water may be lowered until it can be used quite cold, provided always there be no bodily indispo- sition which requires the contrary. But the wash- ing and bathing should, in all instances, be an operation of very short duration, expeditiously completed, and followed by brisk friction with soft towels and flannel, for the purpose of drying, and accompanied also with something of advantage by the gentle use of the flesh-brush. This method of accomplishing the bathing and drying will invariably produce the warm glow on the skin which is so conducive to health, and which is generally so sure an index of the whole- some effect of the bath. Even at a very early age the open air bath may be used with very beneficial effect in fine weather, and it should be a part of the education of every child of robust health (females not even excepted) to learn to swim as soon as the fourth or fifth 44 CLEANLINESS. year is attained. Heterodox as this doctrine may seem, especially as regards girls, in pleading guilty to the apparent want of delicacy in the suggestion, I must insist, that so many remarkable instances of its paramount advantage might be quoted, that they not only overcome, but shame the "mauvaise konte" if not prudery, which affects to blush at the recommendation. To mention no other advantage which can be derived from swimming, it is of no mean import- ance to encourage a strenuous muscular action during the bath, and it greatly facilitates the thorough cleansing of the body. But, apart from this, who \vill pretend to assert, that swimming is anything like a useless accomplishment? Are there any circumstances in life in which it may not become the safeguard against the fatal con- sequences of an accident ? In many parts of Europe, even, not to mention the islands of the Pacific, and elsewhere, it is as common for women as for men to swim. It is just as easy to teach a girl to swim as a boy, and the girl is always as apt a scholar, a proof that it is not inconsistent with the faculties and powers provided by Nature ; and this uni- versal mother made quite as perfect a provision for the female as the male. If this branch of education be commenced, as I have directed, from the earliest years, there will CLEANLINESS. 45 be no difficulty in it. Every child will take to it as naturally as to any other physical exercise. But the same proviso must be made as with respect to everything else in the treatment of young children. Have a care that they are not constitutionally incapacitated, or that the casual derangement of the bodily health does not indicate another kind of treatment. And, above all things, be very careful how you deal with a child of a highly nervous, timid, and susceptible tempera- ment, constitutions which it is impossible to trifle with, with impunity. It is in forcing upon children that which does not simply go against the whim or inclination, but also works upon some moral or physical weakness, that the greatest mischiefs are brought about. Lead, but do not drive; because, by the latter course, you will permanently injure the tone of the temper you will irritate the nerves, and you will induce a per- petual loathing for what might have become congenial after a time, and might have been of the greatest advantage to both the principles of the system in subsequent periods of life. The great art in dealing with children, is to introduce them by habit to what is most conducive to their well-being, and to render everything they have to do or to bear a matter of gratification, and not of repulsive obligation. All the virtues *3 46 AIR AND EXERCISE. of humanity take their rise in these little cares of childhood, and all the vices which afflict society may be traced to the injudicious observance of them or to their omission. The human organism in its worst phases and developments may be modified and subdued for good, and the most perfect construction may be rendered inoperative against the animal propensities, and be overcome by evil. From the first moment that perception dawns upon the infant mind, the child is susceptible of good or evil impressions, and should be dealt with as a creature gifted with superior faculties. From that instant its moral existence has commenced, and from the same moment it should be fashioned after the better models. I would therefore have parents, who for many years are the responsible guardians of the character of their child, beware how they abuse the high responsibility which they have incurred in becoming parents. OF AIR AND EXERCISE. Sufficient has already been said of the require- ments of infancy, as regards fresh air, not to require much recapitulation on that score ; but there are a few things respecting exercise, the times and methods of administering it, and so forth, to which AIR AND EXERCISE. 4? it will be necessary to call the attention of all parents. In the earliest stages of infancy great care must be taken as to the posture of children, when rocked or dandled, and when carried about, as a great deal depends upon this. Until the age of three or four, and sometimes six or seven, months, the spine has not enough of consistency and strength to sustain the frame erect, and, consequently, so long as a child sinks forward when held up, it should not be placed in such an attitude that the principal burthen of the body rests upon the lower vertebrae of the back. The spine and head should invariably be well sustained by the arm of the mother or nurse. With this precaution an infant should always be carried about the apart- ment, if not out of doors, several times in the course of a day, and gently rocked in the arms, or on the knee, but without jolting or rough toss- ing. The mere swinging backwards and forwards in this manner is a species of exercise which is as necessary as it is gratifying to the child, and which is usually as pleasing to the mother. The weather permitting, no day should pass without the regular airing, although it may be advisable to abstain from exposing any child to cold and nipping winds. And on no occasion should the face and mouth be so muffled up as to obstruct a free inspiration of the atmosphere. It 48 AIR AND EXERCISE. is very erroneous to imagine that affections of the lungs arise from a free, habitual access of external air, on the contrary, when they do not arise from constitutional predisposition, they are much more likely to arise from the mistaken attempt to exclude it at all times. Respecting EXERCISE : Besides the appro- priate and beneficial rocking produced by slow lateral movement as the infant reclines in the nurse's lap, it should, when sufficiently strong to roll about by itself (in such a place and position that a fall is impossible), be allowed to indulge freely in its gambols. These little recreations ex- pand the limbs, relieve the joints, and greatly assist in the muscular development of the system. There is no harm either in permitting children to crawl about the room ; they will commence to do so as soon as they can manage to move from place to place in this manner. But any attempt to induce precocious use of the legs and feet is liable to be followed by pernicious results. Far from being beneficial, it is a great disadvantage to children to walk too early; for it conduces much to produce weak and falling ankles, knock - and bow-knees, and other little deformities of con- struction, if not far worse evils, by the mistaken system of hurrying on the capacity and inclination for walking. AIR AND EXERCISE. 49 Eschew all your BABY JUMPERS, and your leading-strings, and such absurdities, if you wish your children to be erect in their carriage, and to walk with ease and grace in after-life. All these artificial contrivances to effect the purpose are mistakes. The injunction which should be observed is brief and simple enough. Let your child learn to walk of its own accord. When this first feat of childhood has been accomplished, allow the child for some time the usual apartment alone in which to indulge in independent exercise; having first taken every precaution that there be no china ornaments, gew- gaws, looking-glasses, knives, or other obnoxious implements, within reach, and no articles of furni- ture which may be easily overturned. When sufficient strength is attained (the weather per- mitting), it were as well to begin the daily walk out of doors, commencing with a quarter of an hour, and increasing the length of time as strength is gained, until the child enjoys open-air exercise for at least one fourth portion of the daylight. Modifications as to time must, of course, be made according to the physical energy and vigour of the child ; because over-fatigue may be as pre- judicial as the lassitude produced by too sedentary and confined a life. So long as there is no abso- lute occupation, it were well if the mind were 4 50 OCCUPATION. engrossed by the little excitements forthcoming from constant exercise abroad in the manner which has been indicated ; and this suggestion may be accepted as the general rule. But, as there will be ample occasion in the ensuing part of my work to dilate further on this topic,, it will not be requi- site that it should be pursued farther into detail at present. OCCUPATION. With reference to the occupations to be provided for early infancy, it may not be improper to pre- mise by stating that they should be as light and little irksome as possible. There is no great ad- vantage, however, in rendering them frivolous and unproductive of any moral or mental effect. There is a common adage, that ft all work and no play makes Jack a dull boy." But as a great philosopher was ever urging, we should define terms before we deduce reasoning from them. What is work ? and what is play ? Does it not appear that this depends more upon the method of providing the employment than upon the nature of the occupation ? Might not building card houses and trundling hoops be made work (in the popular sense of the word) by the manner in which they are recommended, or suggested; whilst some light handicraft, which is popularly OCCUPATION. 51 looked upon as work, might become, with proper management, a constant source of enjoyment. There is no doubt but that for the first three, four, or five years very few children would be competent for, or could be trusted with, imple- ments for any such occupation as is hinted at : and so long as this is the case, their toys may be as useful, if well selected, as any other medium of employment. As a guide for the selection of amisements, it were as well to choose such as partake more of the gym- nastic or athletic, than of the sedentary character. Puzzles and devices of that kind are anything but desirable resources with very young children, as they tend to concentrate the energies too much upon the mental portion of the system ; whereas, the animal powers, being the first in the field, are the first which should be exercised, leaving the mind to ripen by degrees, and to assume its pre- dominance in due course. For the first few years of existence the development of the reflective faculties is exceedingly slow, and should by no means be forced. And for this reason, any occu- pation which racks them, especially with a child of very susceptible and nervous temperament, which is usually accompanied by more acuteness, will have the effect of galling the master- passion, self-love, and thus embittering and irritating the temper. 52 OCCUPATION. Another little hint might be afforded, which will not be found without its good effects if acted upon. And it is this : In those cases in which the parents have leisure hours, they cannot do better than join their children in their trifling amusements, so as mildly, yet firmly, to curb any occasional outbursts of passion or ill-humour, as much as possible without wounding or irritating the child. This, very few nurses have patience to do ; and fewer still feel sufficient of real affection and kindliness towards their charges to trouble themselves to observe. The said method is accompanied by another ad- vantage : that an observant parent can catch every opportunity for inculcating a sound principle out of the most trivial circumstance, without damping the redundant buoyancy of youth. And this rule is more particularly important where there are several young children in the nursery; because the parent will have constant opportunities of detecting in their intercourse the varieties and inconsistencies of character (if they exist), and repeated occasions to enjoin the observance of due decorum and propriety, an affectionate and protecting regard on the part of the elder, a confiding and grateful respect on that of the younger, and a kind and gentle consideration of the boy for the girl all points of paramount moral importance. Great caution is needed in OCCUPATION. 53 reproof; great moderation, mingled with firm- ness, in punishment ; a moderate appreciation of merit; and a calm rejection of the contrary. Above all things, parents should guard them- selves against the loss of their equanimity ; and should preserve, as much as possible, an even un- ruffled tenor of temper towards their children, and avoid betraying uneasiness or irascibility amongst them. The example is the most operative of all means of instruction amongst the young; and, unfortunately, they are too often more quick at the mimickry of a weakness than at the imitation of a sterling quality. Besides the moral to be gathered from these particulars, they have all far more effect upon the physical functions than is usually attributed to them ; for febrile affection is so easily induced in infancy, and is known in all stages of life to exercise so powerful an influence on the frame, that the bodily health may be sapped by ever-recurring irregularities of the above de- scription before the parent dreams of such a consequence. In dealing with children in the respects above mentioned, over-severity is one great mistake, carelessness or inattention is another: the one soon weans the child from due and affectionate regard, and makes it look upon the parent as an object of dread ; the other allows this regard to perish for lack of fostering. The child that never 54 OCCUPATION*. sees its parents but to be chided learns to wish for their absence : the child that rarely sees them at all, or that is rarely noticed by them, seeks the caress, which Nature prompts it to look for at their hands, from others, and loves those who tender it accordingly. The natural attachment between parent and child cannot be too sedulously fostered and stimulated. It is one of the mainsprings of pure moral aspiration ; for inasmuch as affection well directed is the groundwork of all the virtues, it is by encouraging the first and most tender impulse of Nature that the characteris to be moulded aright. Be it observed that this principle of affection, or love, or yearning, or whatever it be termed, must rest somewhere. The human being is a parasite, and cannot subsist alone : his nature is to coil about some other and support himself there, and as this parasitic inclination is well or ill disposed, the determination of the character will be for good or evil. And can art suggest a better prop for the social adhesion of a child than that which Nature so pre-eminently indicates in the parent ? Society is the state of Nature : solitude, though seemingly attractive, plausible, and preferable, in the morbid imagination of the dreamer, is impossible. What if the heart, desolate in the world, looks forth upon the inanimate creation, and associates itself with a tree or a flower, or a cavern, or the bound- ing surface of the endless ocean ? If there be DIET. 55 secret converse between that heart and those inanimate things, it constitutes a society peculiar to itself, from the lack of that which might have been more consistent with its own organism. No : solitude is nowhere in the world but in the withered hopes, the blasted affections, the dis- torted mind, or the churlish and hopeless abstrac- tion of a misguided, and consequently wretched, existence. It is to these, and to the heartburnings and remorse "which cling to ill-regulated conduct, that you expose your children, whose happiness should have been your own, when you foi'ego or pervert the high privilege of conferring upon their infancy a sound principle of conduct, of training them to a good precedent, and of inculcating by practice the purity of an exemplary precept. OF DIET. The diet of young children, as has been shown throughout, should be one of the chief objects of the assiduous attention of all parents. There is no point, perhaps, in which error is likely to arise so easily from mistaken kindness as in this. It is too much the custom with parents, in their treatment of infants, to fancy that feeding is the universal panacea of all their ills. The least sym- ptom of frowardness, peevishness, or irritability is to be allayed by food. And as children advance 56 DIET. a few years in life, there is too little restriction put upon the natural inclination to eat so long as food is before them. Very few children know when they have eaten a sufficiency, especially if the dishes placed before them be gratifying to the palate : as is, unfortunately, the case with too many adults, they very rarely measure the quantity which they swallow by the necessity for susten- ance. But it has already been constantly urged that, of all things which tend to derange the digestive system and to weaken the proper opera- tion of the functions, there is nothing which so seriously produces those effects, as the overload- ing of the stomach of a child, particularly with heavy and solid food. Hitherto the earlier kinds of diet have alone been referred to ; but I shall now proceed to con- tinue this subject during the period of childhood generally, setting no particular limit as to age. Having abandoned the suckling-bottle and the pap-boat, the child emerges from sheer infant feeding to the more mixed and general diet to which it will become accustomed. Broths and light vegetable soups, plain rice-, sago-, or bread- puddings, thick milk, made preferably of baked flour, and so forth, still varying by gradation, and not on a sudden from the liquid to the predominating solid form of diet. It is very essential, however, in this progress of the dietary system, to observe the useful DIET. 57 and invariable rule, that, in the case of children, frequency of feeding is highly preferable to quan- tity. A child should, generally, eat four or perhaps five times a day first, very soon after rising ; and last, a considerable time before rest (say an hour and a half). The long period which elapses be- tween the last meal in the evening and the first in the morning produces a sensation of sinking and exhaustion, and renders it very necessary that, previous to any exertion, the frame should be revived by food. At the morning meal, it were as well, if milk agree with the child, to adhere to that as the best of liquids, toasted bread, or soaked bread, or biscuit being added to supply solidity. Tea, coffee, greasy or spiced chocolate, are anything but desirable articles of food. At the same time, it is not to be understood that feeding entirely upon one thing is peculiarly beneficial, because it is generally by the variety of simple and wholesome diet that the healthy action of the various functions is best pro- moted. Rich dishes and compounds, consisting of numbers of stimulating ingredients, are, however, to be carefully avoided ; for, apart from the ill effects of such a system of diet upon the body, the same demoralization may be attributed to it as to any other course of sensual indulgence. A pampered appetite, whether it be for gluttony or crapulence, is ever the same in its effect. Besides, it were 58 DIET. well if it were ever remembered, that wealth, with her accompaniments of luxury, circumstance, ease and comfort, is not immutable. And it is very essential to inculcate practically, from the earliest age, that fortuitous circumstances may oppress with unforeseen calamities and privations those who seemed most beyond their reach. Want of the attendants of splendour will be no privation where they have not been made habitual; whereas, the want of them may be as great a pri- vation to those who have been accustomed to look for them, as the want of the common necessaries of life to another. Of the varieties of diet peculiarly adapted to the treatment of particular constitutions, there will hereafter be occasion to speak in the Fourth Part of my work ; and therefore, without entering into directions on that score, at present it will be sufficient to refer the reader to the forthcoming chapter on CONSTITUTIONAL TENDENCIES. But there is another injunction with respect to diet, of a more general character, which is of no mean importance to the physical as well as moral powers, the latter being always more or less aifected by the condition of the former. It is not universally known, or, at all events, practically evinced, that diet should vary very materially with the changes of temperature, in the same way that it must vary with climate. DIET. 59 There is a notorious fact in the natural history of every species, which is, that the same frame cannot thrive upon the identical food in a tropical as in a temperate zone ? Why, then, should not the same reasoning be good, of different seasons in the same climate ? But, apart from any ana- logical reasoning of this kind, it is mere matter of experience, that, whereas in the colder seasons the frame requires a greater supply of food, and that of a more generous kind, to aid it in the ge- neration of animal heat alone, than in the warmer periods of the year, when it requires to be relieved of superfluous caloric or to be allowed to radiate faster than it engenders. Amongst adults the inclination to eat is commonly less at such periods, and the lack of inclination may lead them to ob- serve the rule insensibly. But children in the first place, have that inclination more constantly ; and in the next place, do not possess sufficient of reason to moderate it. They eat or cram because things which please them are offered to them. The digestion, as an inevitable consequence, be- comes thereby debilitated, and serious derange- ment of the functions ensues. According to the season, it were always as well to lighten, and to. moderate, as to render more generous and increase the diet. And, as Nature has provided an additional variety of food in 60 DIET. the vegetable kingdom for the warmer season, it is, generally speaking, advisable to adopt the hint, by affording a predominance to vegetable diet at that period of the year, observing certain re- servations as to constitution, hereafter suggested.* Fruit perfectly ripe, in moderation, is wholesome in its proper season, and ought, therefore, likewise to form a portion of the allotted diet. Another mischief, which must carefully be guarded against, is the habit of eating very fast, or of " bolting" the food, as it is called. When once a child is gifted with teeth, it possesses them for some purpose. That purpose is mastication, without which the digestion is either obstructed altogether or rendered too sluggish in its opera- tion to disperse the sustenance derived from food through the frame, and to reject the spurious portions as fast as the body requires it. Some children acquire the trick of swallowing their food without proper mastication from a greedy habit, which has not been checked at its first manifestation. With others, again, it is en- gendered by a constant craving, arising out of an unhealthy condition of the stomach. In the latter case, this habit only increases the ill, and in the former it generally produces it. So that, whether * See Part IV. DIET. 61 the consequence of a weakness of body or of a young vice, it is equally injurious. Another rule, to which more importance should be attached, than at first sight appears, relates to the proper interspersion (if it may be so called) of food. For instance, a child has meat, vegetables and bread placed before it ; and it is not uncommon for the young feeder to attack the meat with vo- racity, leaving the vegetables and bread untouched. This ought to be early corrected; and it is the easiest thing in the world to accustom children to partake of each, mouthful for mouthful as it were a method which greatly contributes to the easy and healthy operation of the digestive organs, and tends, perhaps, as much as anything to sub- due the uneven and craving appetite above alluded to. Again, a sufficiency, though by no means a superfluity, of fluid should be taken at every meal another assistant of digestion which is often not adequately attended to. MANNERS AT TABLE. Without departing from the proper subject- matter of this chapter, it appears that some notice might be taken of the MANNERS OP CHILDREN AT TABLE. It cannot be too often repeated, that out of these insignificant little points arise the 62 DIET. most important consequences; and good-breeding, if it be not a virtue, verges so nearly upon it, that it should be accepted as one ingredient of virtue at the least. There is no reason why, because feeding is entirely the business of the animal part of the system, it should be too much subjected to the disposition of the brute. Intellectuality is rarely of any avail unless it succeed in ruling man, even where it has no participation in his occupation. And intelligence is indeed reduced in its sphere if it cannot attend the human being wheresoever he may range or in whatever he may do. But in this, as in all other matters, the animal inclina- tions will generally predominate unless they be subdued and rendered rather the servants than the tyrants of the mental and moral faculties from the earliest youth. Cleanliness, patience, order, decorum, and the like, should be enjoined at table as soon as the child is accustomed to be placed at it. The habit of scrambling after any favorite service, of screaming spontaneous remarks, or demanding, without propriety, whatever shall chance to appear gratifying, of interrupting con- versation, or of wanting whatever is being served to some one else or is most scanty, and similar vagaries, should be checked at the first onset. It may be a mere suggestion, but somehow or other it seems as if the jealous disposition of a child DIET. 63 might as soon be detected at the board as any- where ; and if so, the suggestion may not prove useless in facilitating the subjugation of this insidious and mischievous passion. Elsewhere there will arise an occasion for me to lay some stress upon the usefulness of training male children to pay deference to the gentler sex. And as in point of moral and social virtue this is amongst the first of vehicles, there can be no need of apology in anticipating a little upon the design of this work, and in impressing this feature of treatment strongly upon the parent whilst deal- ing with a subject with which the first opportu- nities for inculcating the rule will inevitably be connected. The mainspring of civilization is centred in the fairer portion of the creation, and not only do honour, generosity, and propriety, dictate a true regard for the weaker sex, but it is the observance of this regard which the Divinity, for great and good purposes, has implanted in the more ascendant sex that softens down the rugged- ness of the world, cements and polishes society, and renders the intercourse of mankind conducive to the reciprocal benefits and the welfare of every community. Among very young children no better occasion can be taken to impress this pre- ference upon them than when at table, at which time they will usually be brought together, and when they are frequently not over nice in betray- 64 DIET. ing their selfish inclinations. Thus, although it may appear to the rugged philosopher but a mere act of superficial courtesy to pass the services on until all who are entitled to preference at table are served, it will often be found in after-life to have produced a rooted respect for the bienseances of society, and to have been one of the many agents, under tutelage, which have assisted in removing the coarseness of the natural character. It is, doubtless, true, that these remarks apply almost solely to the circumstances of the wealthy ; but there is a similar philosophy, comparative in its degrees and appliances, which is good in all grades ; and as it is as sweet to be heard and appreciated in the cottage as in the palace, and as there is frequently more earnest attention in the former, the suggestion would not be without its use amongst any class in which the repetition of it may introduce the practice. The reason for which many of my remarks are more directly addressed to the rich than to the poor is, that the former are doubly to blame if they overlook ques- tions of importance in the education of their children they have no excuse for the omission ; whereas those whose whole time is employed by toil, relieved only by sufficient time to rest and eat, have barely the leisure to pay minute attention to particulars of the kind. It is not therefore to say, however, that a well-disciplined character CLOTHING. 65 would not be as useful, as productive of happy results, and as commendable amongst the poor as amongst the rich. Goodness, in whatever con- dition of life it be planted, must ever have its sphere. It is only consistent with the eternal principle of justice that it should. OF CLOTHING. The lighter and looser the clothing can be, with- out exposure, the better. The confinement of the limbs, and the restriction of the joints, are highly prejudicial to the free circulation of the blood, and conducive to many deformities (if they may be so called) of the body. Every part of the frame should be left at liberty for the fullest action. Not to digress again, it should be remembered that the use of stays with young girls is apt to become exceedingly injurious. It has frequently been urged, and with great justice, that the adop- tion of this artificial support at all is not only unnecessary, and the use of it induced by habit, but very serious and sometimes fatal in its con- sequences. It is evidently a mere whim of fashion, inasmuch as the many thousands on the face of the globe who support themselves very well without them would be just as subject to the necessity, if it existed, as those who adopt them 5 CLOTHING. from the custom of society. It is by no means true, physiologically or anatomically, that the frame of womankind is too fragile to sustain itself without artificial support. And this excuse so often urged in favour of the fashion, becomes too much the pretext for an excess in the tightness with which this part of female dress is fitted on, until it is suffered to destroy the regularity of the proportions, and actually to impede the operation of most of the vital organs. The heart, the lungs, and the liver, are stripped of the efficacy of those safeguards with which Nature has provided them, when the bones, which constitute the protection, are forced from their proper places, to occupy part of the space assigned to the functions which they were constructed to defend. With respect to texture of dress, the finest descriptions of woollen may, on the whole, be preferable to any. But woollen textures must be very smooth and fine indeed, otherwise they are apt to be too irritating, especially to the tender skins of children. The rivalry between fine cot- ton and fine linen leads, after all, to no very essential distinction. If, on the one hand, the linen be purer, and in many respects cleaner, the cotton, on the other hand, is softer, and better suited to a very young and tender skin ; but neither the one nor the other possess the merit of CLOTHING. 6? the fine woollen,* The last may now be procured with as smooth a surface as any calico, and thus the greatest objection is done away with. Again, the clothing should never be heavier than need be, and particularly the covering of the head. It is very much the custom to invest young children with heavy hats and feathers, and articles of that kind. And whether the costume be in good or bad taste, which it is not my busi- ness to discuss, as a question of utility and advan- tage it is a great mistake. The head especially should be very lightly covered. With respect to under clothing, it is by no means prudent to draw a distinction between the seasons. The difference should consist in the outer covering. For, for example, if flannel be worn next to the skin in the Avinter, and be found necessary or become habitual in that season, it is really far more neces- sary in the summer, when the changes and transi- tions of temperature are greater. And, moreover, far from being productive of inconvenience from heat, it is more likely to lessen it, by facilitating radiation, or, otherwise, because it is a better con- * On this subject of clothing, see the Introductory Remarks to the DOMESTIC MEDICINE. In that work, the author took occa- sion to object strongly to coarse woollens, such as the common flannels, and so forth. The objection does not, however, hold good as regards very fine textures, which, on the whole, are pre- ferable to cotton or linen. 68 CLOTHING. ductor. The difference of colour in the outer clothing is often more essential than the difference of texture, that is to say in bright weather. It has transpired in the course of this work that, in some respects, what is termed the hardening system,* pursued with reason and moderation, (and otherwise nothing can be a greater mistake,) may be extremely beneficial, and that, to say the least of it, it is far better than the method of coddling children. One remark on this point should have place here, which is, that although the skin may be rendered more or less obdurate and insensible to temperature, the blood cannot be altered in quality by any experiments in lessening clothing, and vice versa; a caution as to notion of materi- ally changing the constitution by external means, and by stripping the body of the due amount of clothing which it requires for protection. But, at the same time, the absurd fashion of muffling children in wrapping of every variety of shape and texture, is as likely to be prejudicial as it is ludicrous. The more especially are the wearers likely to be injured by this over care, when the garments are so constructed as to confine the joints, particularly about the shoulders. There should be abundant scope for the expansion of * The author has, in his DOMESTIC MEDICINE, passed severe strictures upon the excess of this method ; but he must not be understood to recommend the other extreme. CLOTHING. 69 the chest and the free motion of the arms. In fact, the limbs should in all respects be left un- restricted by the clothing. There is unfortunately as much indulgence in the fantastical devices of fashion and of seasons amongst the children of the upper classes as amongst the adults, fantastical devices, which too frequently forego the essential for the appear- ance. But it should not be forgotten, that, what may not conduce to injury in an adult, may be very seriously prejudicial to a child. Wherefore the requirements of health, ease, and comfort should have a double preponderance in the treatment of the latter. It were not improper to suggest, as a method for the construction of the clothing of children, that it should be so effected as to afford every facility for active, athletic, and gymnastic exercises to cover, but not to bind. Thus both of the more serious objections of confinement and exposure would be effectually removed. PART II. OF PHYSICAL EDUCATION, AS TENDING TO MENTAL AND MORAL DEVELOPMENT. PART II. OF PHYSICAL EDUCATION, AS TENDING TO MENTAL AND MORAL DEVELOPMENT. IT is in the spirit of humble but well-intentioned recommendation that everyone should embark in a treatise upon the education of childhood ; and it is certainly with some degree of diffidence that the most experienced in the arts of training and tute- lage should claim for their own peculiar method the titular distinction of the best. With these reservations, which are due to the subject, let me, however, intimate at the outset that the reason why, in most instances, a very great portion of the regulative system in such matters should emanate from scientific and professional sources, is that, as has been already repeatedly shown in this work, much of the efficacy of education must depend upon the constitutional aptitude to the system of training. What will suit one frame and one development of faculties will by no means suit another, in the same manner, as the old adage has 74 PHYSICAL EDUCATION. it, that " what is food for one may be poison for another." But, previous to entering into the detail of any system of training, it is necessary to classify the faculties in some method, so as to deal with the subject a little more systematically. Let us premise, therefore, that PERCEPTION is the first amongst the orders of mental and moral powers which is brought into active operation, and that REFLECTION is only of subsequent development. But both these are compound terms, and imply combinations of faculties, in which there are various gradations of progress, and to which appertain various degrees of intensity. These gradations of progress and degrees of intensity are manifested at various stages by the use of the senses, or organs of sense and expres- sion. Again, we must premise that knowledge, or learning, are never intuitive, whereas OBSERVA- TION is so observation being the offspring of a peculiar combination of the perceptive faculties. With PERCEPTION, then, let us begin and, taking it in its simplest state of activity, trace the first period of education to the epoch of its dawn. As far as any agency brought to bear upon it is concerned, the parent must look entirely to its PHYSICAL EDUCATION. 75 manifestation, because if it be unmanifested by any outward sign it is yet dormant. The infant first displays the activity of such faculties in expressions of glee or pain, caused by the appearance of external things. The chuckle, the stare, or the sudden alarm, are, doubtless, expressions of pleasure, wonder, or pain ; and without considering abstrusely whether the effect arises from a simple or complex idea, originating in the external cause, it should be dealt with according to the manifestation of that effect. Thus, that which is unnecessary, and causes evi- dent discomfiture, and conjures disagreeable ideas to the child, should be avoided, as likely to exercise a prejudicial effect upon the temper, where reflec- tion is yet inactive, and, consequently, the powers of judgment and discrimination, and the faculty of reasoning are not present to correct any misimpres- sion to which the child is subject. Never expose what you wish to accustom an infant to, to dread, loathing, or distrust. There will ever afterwards be a predisposition to the same impressions, and almost a horror, quite as causeless, perhaps, but equally powerful in its repulsive agency on the mind. So long as the PERCEPTIVE FACULTIES continue to be the predominant organs in active develop- ment, the tuition must necessarily be one of example almost solely. Precepts will make but little 76 PHYSICAL EDUCATION. impression : they will be heard, and perhaps re- peated from memory, but without much import- ance being attached to them. But whatever of external circumstance, is conveyed by PERCEPTION to the senses and to the intellect, will make a rooted and lasting impression. The eye will catch an attitude, a shape, air, antic, or a feat, which will almost invariably induce an attempt at imita- tion. The ear will listen to forms of expression, and prompt the tongue to repeat them. The manner will be quickly conveyed to the imitative intelligence of the child. The demeanour, the temper, and general habits will grow into general habits with the younger scion. And, in things which gratify the senses whilst they satisfy the demands of a natural instinct, such as feeding and the like, the impression imbibed from observation will be doubly strong. Upon the first appearance of bad habits, a mere sign of disapproval will serve to check them, whilst care in withholding the examples which have suggested them will provide against their reacquisition. But when they have, by long continuance, become part of the habitual conduct there will be the greatest diffi- culty in controverting them. Moreover, children are, by instinct, apt to be very jealous of the attentions and caresses of their parents, so that it is most needful to observe the PHYSICAL EDUCATION. 77 strictest impartiality where there are two or more of an approximate age. Nothing will more rapidly tend to embitter the temper of the neglected child or children, and to alienate their affection, not only from the parent, but from their brothers and sisters also, as any distinction made by the parents between them. It "were as well, too, for the purpose of aiding in subduing the propensities, and elevating the supremacy of the moral sentiments, to inculcate very early, and to continue to instil into the male child a kind of venerative and ideal esteem for the weaker sex : accustom every boy to treat that sex w ? ith tender respect to deal more gently by it than by his own to feel that there is a reverential admira- tion due to it, which will grow upon him with maturer years, and, as a consequence, teach him properly to comprehend and appreciate \voman, and lead him to place her in that high position in the social scale to which she is so justly entitled. Nothing is more degrading to humanity, and nothing more summarily dishonours the purity of the heart, which pollutes itself to pollute, and to be again polluted, than the ascendancy of the animal propensities. And if it be imagined that these propensities only eke out of the character in a more advanced stage of life, it is an error which cannot be too sternly exposed. The first faculties are animal, and partake of 78 PHYSICAL EDUCATION. that character alone, inasmuch as the first faculties are little more than instinctive, and if they be allowed to outweigh the sense of wrong, which is innate in human kind, (perhaps in all kinds,) they will grow great and powerful in the subjugation of the counterbalancing po\ver. It is in the earliest germ that these defects are to be dealt \vith ; in after life they will have become inveterate and indomitable. It may even be suggested that attention might with advantage be paid to the organic develop- ments of the head, whilst closely watching the manifestations of the character, and treating the child as nearly as can be, so as to modify one defect without arousing another, and in general by exciting the sentiments of benevolence, venera- tion, and their like, whilst the PERCEPTIVE FACULTIES are carefully directed upon good models, and the exercise of the reflective (as soon as they shall become active) is encouraged into fruitful operation. The prominent features of virtue and vice are ever easy of distinction to parents who really watch with earnestness over the progress of their child ; and, from the earliest age of percep- tion, they each propound their unalterable evi- dences, and exhibit themselves, at first, under those unsophisticated and undissembled phases natural to the first simplicity of childhood. SPOILT CHILDREN. 79 It is then that the evil should be subdued and the good fostered, before vice has learnt to mask itself in the garb of virtue and to appear like what it should be, and not like what it is. And it is because defects so soon find means to cover their deformity with subtle craft, that the first period of infancy should be marked at every turn. The method of correction in cases of evil pro- pensities should be moderate, insensible, and, if possible, imperceptible to the child itself. The sources of temptation, should, on this account, be removed from reach and contact without remark, and without any apparent design. Because it is dangerous to appear to thwart a hankering, and it is even dangerous to betray that it has attracted attention, inasmuch as what was almost in- nocently done before, will, with some tempers, be perversely and eagerly pursued afterwards. And this pursuit will engender one of the most noxious of vicious tendencies, the desire of concealment an evil which cannot be too carefully guarded against. OF SPOILT CHILDREN. Having thus far treated of children generally, as regards their natural defects, it will be necessary to dwell upon another gradation to wit, what may be termed acquisitive defects. The vicious inclinations to which allusion is 80 SPOILT CHILDREN. made, under this denomination, are those which grow out of errors in management and education, and may be divided into two broad sections, those which accrue from over-indulgence ', and those which are consequent upon over-severity. Those who betray the former propensities are well known by the denomination of spoilt children. It has already transpired that there are two very great errors in the management of children excess either of severity or of indulgence, nor is it easy to determine which of the two produces the most baneful effects upon the character, so equal is the rivalry betwixt them on that score. But the spoilt child is, in one remarkable particular, inferior to the alienated child, which is that whereas the latter has usually learned to cater for himself, and is consequently, as it were, prepared to struggle with the world, the other is incapacitated and helpless, and unadapted to any independent action. When parents, therefore, spoil their children by over- indulgence, they first of all make them the plagues of the household, and the standing nuisances of every- body that is. introduced there ; and, secondly, they leave them, perhaps, to be the playthings and vic- tims of a world which is jealous, cruel, and vin- dictive enough to revel in their torture. They expose all the fine qualities of resolution, determi- nation, courage, and firmness to be relaxed by disuse, or, by never being allowed an occasion for SPOILT CHILDREN. 81 exertion, they suffer the moral convictions of the soul to be subdued by gratified appetites, they expose the temper to be soured by every little cross-purpose which may chance to thwart a whim, and they allow the mental and physical powers to remain so long in disuse, that they cease at last to be capable of development. It should be remembered that of what may be useful to a man, nothing of knowledge is too little for a great mind nothing that is good is too mean. The hands were provided to execute what the brain was devised to conceive. The great lesson, therefore, that is early to be inculcated, is, that nothing can be procured without some self-exertion. Let it appear, as it were, to the child as if he had earned whatever gratifications were conceded, and thus constitute a species of mutual obligation between parent and child, which will become the chief agent in moulding the character. Over-severity Alienated Children. It has already been intimated of over-severity that, far from being productive of good moral effects, it cramps the development of the faculties, damps the buoyant ardour of youth, so essential to manliness and enterprise, embitters the temper and alienates the affection ; and, although it may effect one good, which is to teach the child to 6 82 SPOILT CHILDREN. act and contrive for himself, it teaches him, at the same time, to do so too much irrespective of the parents' wish and judgment, and too much in posi- tive contradiction to both. It induces a habit of harbouring secret designs, of being jealous of the parents' watchfulness, of evading supervision, and of concealing his actions and his motives. More- over, with children who do not possess sufficient determination of character to trust exclusively to their own resources and judgments, the constant habit of finding fault, and of never praising merit, puzzles them, and produces too great a confusion between the faults and the merits. They become at a loss to distinguish when they have really done well, and hence grow careless of well-doing, and reckless of ill-doing. Eulogy properly be- stowed is a powerful preservative of good, and consequently no mean arm against evil. An aifected reserve and austerity towards chil- dren is as dangerous as it is mistaken. There are but few instances in which children have been educated upon the recluse principle, which have not terminated with some very mischievous ten- dencies of character. A proper liberty of thought and action is more likely to induce reflection, and teach the folly of certain habits and certain pur- suits, than the most arbitrary confinement or exclu- sion from them. Under this system they will be invariably sought after, and will possess a peculiar SPOILT CHILDREN. 83 charm ; with a little more freedom in the attain- ment of them, they will generally appear what they are, disgusting or revolting. This remark applies equally to religious, moral, or physical discipline. The disciplinarian who makes his rules rules of iron, will have them broken, when the mind or frame is strong enough to break the chain. The good, and not the ill, becomes hideous and assumes deformity, and the mind and body alike shudder at the injunctions, against which Nature has learnt to revolt. It is barely a matter suited to a work of this kind, to enter into the method of religious education of children, and it is far too delicate and elevated a subject to be lightly handled. Besides, almost every parent has a peculiar religious bias or pre- judice, or conviction, and it is an arrogant as- sumption rashly to impugn and condemn the motives which actuate him : but, without making any direct observation as to method, it may be suggested to parents as advisable, not to force very serious subjects upon children too early, and rather to content themselves with inculcating pure mo- rality, consistent with the maxims of true religion, without troubling the child with the origin of and reasons for belief or conduct. Let reason assume her inquiries on these topics as she grows old enough and strong enough to enter into them. The religious duties should not be made trouble- *6 84 SPOILT CHILDREN. some, but, on the contrary, consoling, comforting, and grateful, and the memory should not be dosed with empty repetitions : they mean nothing, and lead to nothing but to mockery. With reference to mental discipline, have a care that the mind is sufficiently strong and ma- tured to bear it. Begin gently, and do not force on too fast where the occupation is irksome, tedious, and unfruitful. Whenever the mind is glutted, it has not only received the superfluous in vain, but all that it has received is annulled in the same way. It is a profitable recipient only of as much as it can bear and digest, when no more is artificially crammed into it; but, when crammed, it is a profitable recipient of no- t/ting or, possibly, rather worse than nothing, because its powers are impaired without any accession of knowledge. Your systematic and perfect grounding (it should be grinding) of very young children, in the rudi- ments of everything which they are intended to learn perfectly, may be very economical, in as far as it tends to complete a pseudo-education very early, but it is not only far from tending to a per- fect and sound education, but it vastly deteriorates the natural capacities, and lessens greatly the ulti- mate value of what has been taught, besides being seriously prejudicial in many instances to the vitality and organic construction of the frame. SPOILT CHILDREN. 85 Precocious learning is the curse and not the bless- ing of childhood ; and the severe discipline with which it is necessarily accompanied by no means heightens the moral qualities, as is fancied, but renders them obtuse and insensible. Keen sensi- bility will be goaded by this method, till, by goading, it grows callous. Dull apprehension and suscep- tibility will be rendered duller, or acrid and irritable, and will pass from acrimony and irritability to sullen stupidity. For the same reasons, excessive severity in punishment does permanent injury to the character : obstinacy, moroseness, contradiction, and the like, are induced by it, and the wrong doer only becomes hardened in wrong, and not amended. If you inflict too much of mental suffering, you may induce nervous incapacity if you inflict corporal suffering, you may do great injury to the bodily health. The true method of punishing with efficacy, or without prejudice, is to do so as much as possible ly withholding enjoyment, not by inflicting pain. No course of penance, either, should be continued too long no offence, however grievous, allowed to appear unforgiven, if not unforgotten ; because, besides the detrimental state of mental suspense and anxiety, in which a child is kept by such a method, you are infringing one of the first maxims of pure morality, and setting the example of its 86 SPOILT CHILDREN. infringement. By precept and practice inculcate the axiom, "forgive, that it may be forgiven unto you" There is reason for not detaining the reader too long here with the subject, inasmuch as it must necessarily be again introduced under the head of Admonitory Education. Let us, therefore, proceed with Over-severity in physical discipline. This also, in early childhood, does both moral and physical injury. A mere child does not readily understand or appreciate the advantage of, or the necessity for, laborious occupation ; and although in no respect is the excess of severity in discipline, in this parti- cular, likely to become so noxious as in the two former, still there is no particular advantage in inducing a loathing for the employment. More- over, with some constitutions, and with natural debilities, it may become injurious to the bodily health and to the organic construction. For example, let us suppose the occupation to be engraving, or any other which is very trying to the sight, it would barely be judicious to compel its continuance whilst the eyes were becoming daily impaired by it ; the sight might utterly and irretrievably be lost, as has, indeed, been very repeatedly the case, before the parent could be brought to believe that the occupation was not con- genial to the physical construction of the frame. SPOILT CHILDREN. 87 Otherwise, as will hereafter appear, it seems established beyond contradiction that, for the first five or six, or even eight years of life, the occupa- tion should be wholly, or almost wholly, of a physical character: well selected, and enjoined with judgment and precaution, it is the best groundwork of education. Not all the books in Europe combined can afford a young mind one half the useful information, as far as any retentive power is concerned, that can be gathered from mechanical device and mechanical ingenuity. These things speak for themselves in natural facts ; the others reason to show what these exhibit, and sometimes reason more to wards their un show- ing, or, at all events, towards their mystification. A solid in figures and a solid in fact are the same in calculation, but very different to the first appre- hension. Still the pursuit of the more mechanical occupations should be directed with precaution and moderation, and over-fatigue, or the exhaustion of any particular organ of sense or muscular power, avoided as much as possible. 88 THE DUTIES. THE DUTIES, AND THEIR INCULCATIONS Now come we to the great centre upon which the whole of the well-being of individuals as of communities depends as that upon which mo- rality, social, transcendental, and speculative, are and must be founded. Mankind have been so fashioned and disposed by the Creator that there must be a reciprocal communion between them; and this reciprocal communion is manifested in the duties which one man thus owes to another duties whose observ- ance is, therefore, imperative for his own well- being, and upon which communities, polities, laws, societies, and nations must be organized, and by which, and which alone, they can subsist. The justest system of legislation and government, and the most conducive to national happiness and prosperity, is that which as closely as possible assumes and follows the Christian duties as its text. The inculcation of those duties, and of the general principles which enunciate them, is, there- fore, the first office of a parent towards his child ; and whilst it is the first and the best, it is the noblest and greatest: for the goodness of the child cannot but reflect a portion at least of its lustre upon the parent who awoke and fostered it. And, in passing, it may not be amiss to remark, THE DUTIES. 89 whilst genius and learning have so long been toil- ing to produce th e evidences of Christianity, that the best of all evidences is the internal evidence of pure moral and sound social doctrine ; for there is not one iota of the relative duties of man to- wards man, which is not explicitly, clearly, and simply enunciated in the Gospels in that parental spirit of affection, compassion, and remonstrance, which may most surely achieve the happiness of the human race. First and foremost amongst these duties, and indeed embodying the whole code of obligation, is that of doing to another what one would wish to have done to one's self. In early infancy, especially where there are several children of an approximate age and of constant companionship, so many opportunities will occur of inculcating a deferen- tial preference to one another, that it becomes the more easy to root the principle in them; and where the training is well conducted, the practice will so frequently become the source of genuine self-gratification, that its very pleasures will secure adhesion to it: it is the antidote, as it is the reverse, of the worst and darkest passions of human nature vengefulness, malignity, hatred, jealousy, deep selfishness, and the like. It should, moreover, be constantly remembered, in dealing with the human character, that it possesses one dominant, overweening, but necessary passion, 90 SOCIAL DUTIES. self-love, and, therefore, in controverting any mis- chievous tendencies of disposition, (which, too, may not unfrequently have their source in this master passion,) that the surest way of effecting a cure is to endeavour to wean over that very passion from wrong, and to enlist it for good purposes. Thus there should ever be some suppositive reward or punishment for good or evil. Mankind unfortunately require some internal or external incentive to do good, although they know and feel it well; whereas they are prone by weakness to do wrong, although they are rarely deceived by its specious aspect, however they may be willing to close their eyes upon the truth. It is easily conceived how the duty of doing to others as we would be done by involves the whole of the terrestrial obligations of mankind, but yet it involves subordinate branches of duty, of which it is necessary to take some particular and indi- vidual notice. THE SIX SOCIAL DUTIES. First amongst these may be ranked the duty of the child towards the parent j secondly, the duty of a child towards its nearest of kin : which are obli- gations that Nature has rendered incumbent on consanguinity ; thirdly, the duties of the younger SOCIAL DUTIES. 91 towards the elder: reverence for age was ranked high amongst the Spartan virtues ; fourthly, the duties of the master towards the servant, the su- perior towards the inferior, and vice versa; fifthly, the duties of wealth towards poverty, and vice versa; and, lastly, though not least, the duties towards the community the duties to one's country. The early inculcation of these social obligations being alone capable of fashioning a good child, a good brother, a good master or servant, a good proprietor or tenant, a good citizen, and in fact a GOOD MAN, can alone conduce to a happy and prosperous state of society, and consequently to a happy and prosperous existence. It is incumbent upon every father of a family to do his own part towards ameliorating the condition of his race, and assisting in the organization of a better social state. Vice, crime, destitution, and misery, though too sadly and inseparably bound to humanity, are, in great measure, attributable to faulty tutelage in childhood. Legislators and statesmen are too apt to over- look this immense fact, in squeezing out the small instalment for the consummation of a happy com- munity. Let them lay it to their hearts, and remember occasionally that the sweets, the profits, the flattery, and the ascendency of office are not unaccompanied with high and noble moral obliga- tions to the people for whom they act, and to 92 SOCIAL DUTIES. human kind in general obligations indeed, which, overlooked or unheeded, degrade them sadly from their high estate, and make them indirectly guilty of the hideous atrocities which defame and afflict the populace. A vigilant police, an apt, brave, and determined soldiery, or even a flourishing trade, immeasurable wealth, and an ample exche- quer, if these be ever at hand, are not the only appliances which they have to provide for the public safety and the public welfare. It is by no means to the credit of statesmanship that it should have so long delayed to turn its attention to pub- lic education, and perhaps but little more worthy of eulogy that it should have set so erroneously and meanly about it even now. Duty towards the Parent. But, to return, let us proceed with the first of the six duties. The errors of over-indulgence and over-severity which have already been noticed, are, more than anything else in the treatment of chil- dren, likely to lead them to forget, neglect, or despise the obligations which are due to their parents ; and, as there can be no more gnawing affliction than is suffered by the parent from such forgetfulness, neglect, or contempt, no care should be foregone in securing the observance of these SOCIAL DUTIES. 93 duties by the temperate and judicious treatment of childhood. The duties of a child towards his parents may be summed up in the words Love, Honour, Reverence, and Obedience. Of Obedience, But obedience is subject, it must be remembered, to modification, and may, in particular circum- stances, be vice or crime ; abject submission to improper injunctions, is an idolatry, not a genuine ministry or service. In order to inculcate a wholesome, genuine, and virtuous submission, the first care must be with the parent : even the ordinary directions of everyday occurrence should not be given hastily, or without due deliberation. Here, as in all other respects in the tutelage of infancy, the parent must keep strict guard over his own temper, must learn and subdue his own infirmities, and must have a care to under- stand the temperament, moral and physical, of the child with whom he is dealing. 94 SOCIAL DUTIES. Of Love. Love is natural to mankind ; all created beings must love something, and, if nothing else, them- selves, the last direction of love is a vice, and one which can only be provided against by directing the affection elsewhere. But, although love is natural to man, it is not natural to him to love one fellow-creature more than another; he has only a peculiar aptitude and inclination to love his parents, because they are the first on whom his eyes are cast at their earliest awakening, and because they are the first by whom he is loved, cherished, nurtured, and caressed. It is, therefore, an error to suppose that it is the natural right and privilege of parentage to be beloved by its offspring ; but inasmuch as the alienation of the offspring is a great calamity to both relations, and inasmuch, moreover, as there is an inherent predisposition in the child to vest the depth of its affection in the parent, it is the interest of the parent, as it is his duty to encourage, maintain, and cherish that affection ; for, it is through pre- dilection and by attachment that the injunctions of the parent will come with double and sweetened effect upon the child. It is not uncommon for parents to reproach their SOCIAL, DUTIES. 95 children when they betray a coldness and want of duty towards them ; but they should first search their own memory and reflection, and ascertain whether in anything they have foregone the ten- derness which they owed to the age and tempera- ment of their children; and they should, perhaps, also remember that tenderness and care and nur- ture are rather duties incumbent, as duties, upon the parents than the children, inasmuch as the latter are guiltless of their own existence, and the former have incurred these offices as duties, in consenting to become parents. These offices will thereafter become duties, and imperative duties, in the children, by reciprocity, and in gratitude for the gentle observance extended to themselves. Thus the parent must, in some manner, earn the affection of the child, and engross it. The primary duty is in the parent ; the secondaiy, reciprocal and inductive duty, is in the child. Power and ascendency , in all their phases, in human nature, are too apt to assert rights which are not their own, and to forget the obligations which are the foundation of their privileges, and therefore I lay particular emphasis on these distinctions of position. Power and ascendency, in all their phases, have their relative circumstances to learn. 96 SOCIAL DUTIES. Honour and Reverence. The honour of the parent is the honour of the child, and vice versa. A good, just, and tender parent is entitled to honour from the child ; but even this is only an inductive duty in the latter : and yet it is almost an obligation on the child to shield and preserve the honour of the parent when the latter has allowed it to be tarnished. The age, experience, knowledge, and social relation of the parent towards the child entitle the former to honour and reverence in a peculiar degree, from their particular combination in his person ; for as each may claim its share of distinctive respect separately, their combination in one person multi- plies the claim. In the inculcation of these duties, as, indeed, of all others, the example of the parent should be carefully guarded of whatever is obnoxious to either honour or reverence. For, if they be claimed by parentage indiscriminately for good and evil, the principle of morality with which they are asso- ciated is relaxed, and the habit of respecting infirmities would certainly be sufficient to induce them ; but, on the other hand, their due and careful inculcation, by precept and example, will greatly heighten the sense of pure morality, and SOCIAL DUTIES. 97 form one of the keystones of the fairest of social virtues. The Duties of Consanguinity. The duties of consanguinity are affection, pro- tection, and so forth ; or, more properly, they are the general duties to one's neighbour, (to mankind), heightened by peculiar and close relations. It is necessarily reserved that they are in a way duties to merit, and not to demerit: because the latter changes the aspect of all duties, and, to a certain extent, abrogates the vestment of obligations that theymaybecome vested elsewhere. It should also be remarked that there is a very essential point gained by their inculcation, which is, that the broad prin- ciple of the reciprocal duties of mankind is involved in them, is inculcated \vith them, and that this is the first and simplest method of expounding the great social doctrine. The Duties of the Younger towards the Elder. Age, which is supposed to be accompanied by experience, matured reflection, moderated passions, knowledge, and their dependent acquirements, is clearly entitled to respect and veneration on these grounds; and, in teaching children a proper 7 98 SOCIAL DUTIES. decorum towards persons of more advanced years, it must, prima facie, be taken for granted that these merits have been acquired, whereby a respect for the merits is justly inculcated. At all events, a mere child is barely a competent judge on the subject, and it is the duty of the parent to prevent association with those in whom some such merits do not exist. At a little riper age, youth may be allowed to discriminate, and to exercise some dis- cretion and judgment on these matters, as such discretionary exercise of judgment is wholesome; and under such circumstances the rule becomes, like all others, subject to its exceptions. But, on the other hand, the exposition of good examples of age, for the respect and veneration of youth, is calculated to moderate the impetuosity, to calm the excited passions, to form the judgment by reflection, to inculcate self-control, to silence dogmatism (so common amongst precocious chil- dren), to subdue overweening conceit, to abash pride and arrogance, to induce method, industry, application, firmness, resolution, forbearance, and endurance, and to overcome the self-willedness which is so baneful in itself and in its effects. SOCIAL, DUTIES. 99 The Duties of the Master towards the Servant, tht Superior towards the Inferior, fyc. fyc. The remaining of the six social duties, accord- ing to the foregoing subdivision, it is true, ap- pertain rather to maturity than to childhood, but they are, nevertheless, of necessary inculcation in youth, inasmuch as the only method of securing the observance of moral duties is to impress them strongly upon the mind in youth, and to allow them to grow up with the character, so to speak. The duties of superior and inferior, of employer and employed, are not, like the others, of general application, they are offices resulting from circum- stantial and casual relations and intercourse, but they are none the less an essential portion of the moral code ; for the circumstances in which they originate must occur, on the one hand or the other, throughout the existence of all mankind. First, in addressing those who, by circumstances, are placed in a superior condition of life, and in command, it may be suggested that not only should they be careful to impress upon their children the following precepts, but that they should be very guarded of infringing them themselves. As all mankind are liable to error, it is incum- bent upon the superior to bear and to forbear ; for he will hope to obtain such grace of those who, again, are above him. 100 SOCIAL DUTIES. Arbitrary dictation, overbearing arrogance, pride, undue affectation of superiority, and the like, are not only indecorous, but are acts of in- justice. Everyone, however mean his casual position in life, is entitled to the same individual consideration of his merits and his sendees. Leniency, good humour, polite address, and the like, are not so very onerous as duties that any- thing should preclude the title of the inferior to look for them. It is no uncommon thing, in house- holds, for children to be constantly seeing and hearing the dependents treated like so many animals of an inferior caste; and it is no more uncommon for children to be suffered to assume the like tone towards them. Nothing can be more reprehensible in itself. Not only is it unbecoming, but far from asserting a genuine superiority, it is, on the contrary, extremely derogatoryto authority; and, whilst it is thus both reprehensible, unbe- coming, and derogatory, it renders the child, so habituated, incapable of the restraint and control which the usages and the necessities of the \vorld will require of him from some other. To those whose circumstances place them in an inferior position in society, whether menial or not, it might be urged that, although employment with them is necessity, and is therefore (in some shape or other) perhaps the birthright of every dependent person, yet, in engaging in any particular occupa- SOCIAL DUTIES. 101 tion, they assent to a tacit contract, by which they bind themselves to be just and honest towards the employer, and to afford his own views, wishes, or even caprices, every consideration in their power. They are not, therefore, to consider themselves aggrieved by every little trifle, but to offer the same margin to the superior as they themselves expect at his hands. Obedience to every reasonable injunction is part of what they undertake to fulfil ; an industrious and honest performance of the toil which they have assumed as their own ; an un- murmuring and cheerful disposition to yield an obligation when they have the opportunity, with- out waiting to consider whether what they are about to execute can be demanded as a right at their hands. In this country, I must say, these regulations cannot be too strongly impressed upon the young ; for, to refer more particularly to an individual class, who attend upon the households and the luxuries of wealth, there is barely any order of society more pamperedor more fantastical than that of household servants. They are apt to fancy themselves ill-used when Mr. A. does not afford them the comforts oif luxuries conceded to them previously by Mr. B. ; to imagine that nothing can be expected of them but a certain particular occupation, and that if they are simply asked to do something else they are insulted and oppressed j they give themselves ten times more *7 102 SOCIAL DUTIES. airs and graces than their employers ; and, in the midst of it all, they are as obsequious as they are vain and insincere. In these relations a good master is a superior who is not too easily found, and should not be too lightly provoked; and a good servant is an invaluable treasure, which should be preserved and adapted with all reasonable precaution, and with some exercise of self-possession. How im- portant, is it not, to both classes that their infancy should be trained according to their respective capacities ? Teach the child who appears born to com- mand how to forbear, and to obey, if need be ; and teach him who seems less fortunate in his fortuitous position, to obey and endure, that he may be capable of com- manding if called upon to do so. The Duties of Wealth towards Poverty, fyc. fyc. The laws of this country show indeed that the duties of wealth towards poverty are partially appreciated and understood, but no more. Indi- "gence is entitled to a far more valuable free gift than just necessary sustenance at the hands of Property, it is entitled to CONSIDERATION. Labour makes property, and without it property is nothing. It is not my intention to diverge into the SOCIAL DUTIES. 103 economy and relative rights and privileges of property and labour, but merely to hint at the propriety of an early inculcation of the duty which the former owes to the latter. The obligation, on the other hand, of indigence is to guard, protect, and assist in guarding and protecting, the property from which it derives subsistence. These mutual obligations, be it observed, are essentially obligations of interest, involving the well-being of each and of both, as well as of duty ; and therefore each class should be early trained to afford them the consideration which they deserve. The Duties to One's Country. Every citizen owes certain duties to the country, of whose polity he is a subject. He owes it his energies, his influence, his power, and so forth, to defend the rights, privileges, and immunities which it confers upon him and upon his fellow- citizens. In speaking of proper submission to parents, it has before been stated that passive obedience and abject submission are, under special circumstances, vices, and not virtues. It is the same in political as in social and domestic life. But it is due to the country in which any man is a member of the community, either to subscribe to the will and in- 104 SOCIAL DUTIES. clination of the majority of the people ; or, in re- nouncing allegiance to that order of things, to withdraw from it rather than to disturb it. It is due to one's country to use one's talents to the best advantage in endeavouring to ameliorate what is wrong or to preserve what is good : to defend it alike against internal and external violence and oppression, and to treat the community as one vast family, of which one may be a member. Under well-constituted governments the people (majority) have the power of announcing their convictions, and, those once announced, it is the duty of the minority to assent to the declaration ; otherwise society would ever be in turmoil. Where there exists a palpable wrong, it is the duty of the citizen to discover its origin, and, upon conviction, to strive for the conviction of others by all fair and just means. But he is by no means inconsiderately to suppose his own persuasions to be those of the majority, or his proposed remedial measures to be infallible, and to act upon them as such. In inculcating what may be termed political morality (although it is quite as much social) in children, the habit of assuming some hero too near one's own time as a model, is very apt to engender partisanship and other mischievous in- clinations ; it were therefore as well if the examples and illustrations were sought for in antiquity, or SOCIAL DUTIES. 105 in some personage of recognised and universally respected memory. Moreover, some care is necessary in separating what is crime from what bears the glow of virtue, for barbarism was far too much addicted to making crime accessory to the great deeds of heroic and patriotic prowess. Be it further remarked, with reference to abject submission to any established power, whether good or bad, that it may be the very reverse of the obligation due to one's country, inasmuch as the duty is one which is owed to mankind, to our fellow-creatures in general, and to their welfare and the will of the potentate is very frequently that of mere individual gratification and selfish desire. On the other hand, as already intimated, we must not allow ourselves to be beguiled by the glowing term of patriot, into mistaking an atrocity for a good action. Cold-blooded guilt remains guilt, by whatever charming appellation it may be designated. According to my own ideas, and with due sub- mission to the opinions, the prejudices, or the convictions of others, it is upon some such prin- ciple as this, that children should be taught to observe the obligations which they owe to the country of their parentage and their home. PART III. OF MENTAL AND MORAL EDUCATION. PART III. CHAPTER I. OF MENTAL AND MORAL EDUCATION. IT were useless as it were superfluous to enter into the vast and intricate details of the vices and the virtues of humanity ; and, for the purposes of this work, it will be sufficient to indicate generally under this head, that VIRTUE is the observance of the MORAL DUTIES (as herein before detailed), and that VICE is the omission of them, or the adoption of a reverse coufse of conduct. We come now to the period when education may first become physical, and secondly, mental as well as moral. These I will take leave to term the tutelage of occupation, in opposition to the former education of precept and example. TUTELAGE OF OCCUPATION. By way of preamble, it may be remarked, that the two branches of education, comprised under this term, tend as greatly to a perfect moral de- I 10 TUTELAGE OF OCCUPATION. velopment as the others, if, at their own stage, and in the proper periods of life, they be not, indeed, far more powerful agents. Whether the occupation be purely mental or purely physical, it will, to a certain extent, engross the mind ; and, for the efficacy of a moral educa- tion, it is above all things necessary, that the attention of the faculties in activity, whether perceptive or reflective, should be engrossed by something. In IDLENESS may be detected the root of many of the most fatal vices and weaknesses. The mind, running to seed in its own way, without pre- viously perfecting its germination, expansion, and bloom, produces but an imperfect, if not unnatural and cankered fruit. Better far be occupied with innocent (or, more properly, innocuous] pleasures and amusements, than not ba^occupied at all. The lozel, of whatever denomination, is invariably a vicious and bad man. Whilst he gradually grows into the habit of clothing employment in repulsive vestures, he accustoms himself not only to heap vituperation or ridicule, or both, upon industry itself, but what is worse still, upon the virtues which spring from it. He taunts industry with the term of slave, whilst he himself is the abject slave of his own folly : he jeers at sobriety as churlish abstinence ; in fact, he occupies his listless idleness in finding terms of reproach, scorn, and ridicule, to cast upon every- STAGES OF YOUTH. Ill thing which contributes to the goodness and happiness of mankind. Far from being happy himself, \vith fiendish malignity he endeavours to allure others into his own weary existence, by glozing it over with the apparent charms which it possesses; and, in constant ennui, he struggles with his time, as if to choke it, and lives and dies in this weary contest with what he finds, at last, should have been the dearest and most valuable companion to him. Assuming it to be established, that some occu- pation is necessary, as the medium of mental and moral education, it becomes a question as to what that occupation should be. And, for the deter- mination of this question, it might be more explicit to establish a kind of general scale of ages, taking the average of temperaments as a standard (and peculiar constitutions and organizations of course excepted), and to assign to each stage a relative proportion of physical and mental occupation. STAGES OF YOUTH. The first period, then, may extend from three to six years old; the second, from six to ten years ; the third, from ten to twelve ; the fourth, from twelve to fifteen ; and the fifth and last, from fifteen to the termination of the educational courses. 112 STAGES OF YOUTH. During the first stage there is but very little development, physical or mental ; during the se- cond, the physical advancement is rapid, but the mental little more than perceptible ; during the third, the mental faculties begin to ripen, and to gain upon the ascendancy of the physical powers ; during the fourth, they are even capable of taking the lead ; and, during the fifth, they become ma- tured, and may be made highly predominant. In conformity with these gradations of advance- ment, therefore, and in strict unison with the organic developments, the method of training should be, from first to last, conducted. Besides this, there is much reason to suggest that some consideration should be had of the probable sphere of life in which the pupil is likely to move, as to what are to become his probable occupations, and as to the likelihood of a preponderance of mental or physical exercise. It will occur in the course of my remarks upon this subject that there will be occasion for ani- madversion on the system of Public Education, as that is perhaps of the most importance to so- ciety at large. It is a sad fact that the tutelage of the lower orders in public and charitable esta- blishments, now that they are at last somewhat better endowed, should, in the particulars to which I have just referred, be, in my humble opinion, con- ducted upon so erroneous and mischievous a prin- STAGES OF YOUTH. 1 13 ciple as it is. Far from instructing the people in useful arts, and in trades or occupations, which are likely to lead to a comfortable subsistence, all the time is usually lost in drumming vain sectarian dogmas, which, at best, are scarcely understood by the teacher (if by any one else), into the heads of so many ploughboys or reaping girls. Empty col- lections of words and sentences are attempted to be driven into the memory of a hundred parish chil- dren, who attach little or no sense to them, except the idea of punishment, if they are not perfect in their parrot performance. It is, unfortunately, the same with all the places of instruction, whether of one persuasion or another. It is not to be understood that because a ploughboy is a ploughboy, he must always be a ploughboy. There is no intention of closing higher attainments against him, and compelling his mind, of whatever capacity, to remain in per- petual and boorish serfdom. But there are ages, in the first place, in which, as has already been intimated, the occupations should, in all children of whatever grade, be wholly physical; others again, in which the physical employments should certainly predominate ; and in no instance does it appear established by experience that book-work should be adopted at an earlier period than the sixth or seventh year. Secondly, without debarring 8 1 14 STAGES OF YOUTH. the peasant from higher learning, or the artisan from historical, literary, or other attainments, it appears, nevertheless, that the first instruction offered to him should be consistent with his own sphere, and that the discretion of the teacher (if he had any) should guide him in selecting those amongst his pupils who were capable of greater things. For this purpose it is also necessary that the teachers should be well selected and carefully tested as to competency ; but the so-called model seminaries of this country are not the real sources wherein to search for the requisite capacities and the more important qualities. The system now adopted of training teachers to instruct upon one cramped, narrowed, bigoted system, and often upon that alone, is more likely to incapacitate the teacher, and to deprive him of the free exercise of his judgment than otherwise. To continue, however, with the education of children : during the first and second periods, in which their stages of advancement have been divided, they should be accustomed to manual exercises, the use of implements adapted to the trade with which they are most associated, the best methods of husbandry, and the like. Whilst in the higher orders of society, there would be no harm in allow- ing every child to make a selection of some parti- cular occupation, whether carpentering, garden- STAGES OF YOUTH. 1 15 ing, or what not ; and confining him during these two stages to such physical occupations, and to athletic and gymnastic exercises. All those who are likely to become proprietors or holders of land might be most consistently instructed in agricul- ture, horticulture, and the like ; those who are, or may be, designed for a maritime career might, without detriment, turn their hands to ship con- struction in miniature ; those who are likely to be connected with town and house property would not lose by a little practical knowledge of archi- tecture in its various departments. And whilst this course is pursued, the first desi- deratum should never be lost sight of that of rendering the selected occupation at once agree- able and, in so far as is possible, useful. It is a very great encouragement to a child to see that his work is not wasted, that it turns to some- thing; in fact, to believe that he has accomplished something which may obtain consideration. And, moreover, the surest way to discover any latenjt ingenuity, tact, or capability in children, is to offer them the means of developing them, and to gratify them by adopting their work, however trivial. They grow disheartened and disgusted, if what they do, and what seems perfect to their young eyes, either escapes notice altogether, or is cast aside repudiated, or sneered at as imperfect and useless. A sensitive child feels the sting at the STAGES OF \OUTH. heart, turns sick and dejected, and nurses the chagrin till it worms into the character and sours the temper: and, worse than all, in its future moral consequences, till he dreads to undertake anything, lest a gibe, a sneer, or heartless ridicule assail him in his conscious achievements. Fan the little glow of self-complacency with \vhich a child surveys his earliest work. It is an innocent vanity which will perish in his next performance, and so on to infinity, and one, too, which will prompt him to attempt and urge him on to accom- plish. It may be said that there never, yet, was the first sample of mechanism, art, or other undertaking, which, whilst it incipiently flushed the tyro with aspiring triumph, did not disgust him after future attempts, and urge him to accomplish more perfect productions. Thus, vanity, to a certain extent, and well controlled, may not only be harmless and suicidal (as it ever is), but will even be a powerful motive to improvement. The truth of this theory was eminently exem- plified in that most masterly of educational establishments, HOFWYL,* so justly celebrated throughout Europe. The true philosophy of learn- ing to teach and teaching, and the sure method of effecting high moral, physical, and mental deve- iopements, has been practically established by the * Near Berne, in Switzerland. STAGES OF YOUTH. 117 successful experiment there so long continued; and the principle deduced from this experience, and upon which the essay was chiefly founded, is embodied in the regulations which have been offered in the course of these chapters. In brief, it is this : Allow the merits., weaknesses, inclinations, faculties., and so forth, of all children every opportunity of betraying and manifesting them- selves, and then conduct the education accordingly. On the contrary, the method in common prac- tice is briefly this : To establish a certain routine of tuition, which like the code of two ancient nations, is im- mutable; and then to attempt to fashion all the varieties of capacity, temperaments, and character upon this one infallible, unswerving, and unalterable rule. Can anything be more vain, more erroneous, or more absurd ? and can anything be more unjust and cruel ? And yet the very men who sagely propound such a magnificent system, would be the first to ridicule the idea of forming a menagerie contain- ing every animal on the discovered surface of the globe, and adapting them to one uniform system of treatment. NOAH'S ARK is the only instance on record of an approximate success; whilst the HAPPY FAMILY is certainly a case of circum- scribed attempt. Be it observed also, that there is an analogy in 118 STAGES OF YOUTH. the cases, insomuch as there is an endless variety in the organism of the human race, far exceeding that of any other species, and resembling rather the concentration of a variety of creatures. There is but one step from genius to idiotcy. The same parents, even, may engender children of the most contrasted mental, physical, and moral con- struction. Herein it is that the founders of systems, par- ticularly of education, err : they form a beau ideal of their own, founded rather upon themselves than their neighbours, and adapted, no doubt, to all who are of precisely the same temperament, but to no one else. The truth is, that every system upon which education is to be unswervingly con- ducted is false; that Nature must, in each instance, indicate her own system ; and that the soundest of all systems is, therefore, a methodical absence of systematic rule, except in those matters in which all are alike, or nearly so, as, for instance, in the progress of developments before mentioned. Even here there are many exceptions ; and, therefore, it must be carefully taken into consideration that circumstances should modify generalities. There is one particular in which, nevertheless, expli- citness is not inconsistent with the position now asserted, to wit, with respect to the several stages of advancement. The only essential in which they differ GRAMMAR. 119 is in the periods, and of these the parent or teacher will have abundant opportunities of judging. Having attained the third stage of progress, a child may be submitted to mental exercises, beginning, doubtless, by means of the first imple- ments, the ALPHABET and the PEN. The course of study may, for the first year or two, be advan- tageously confined to the simplest material, and to a very short period in each day, beginning with half an hour, and not exceeding two hours within that term. Arithmetic, History, and Natural History should perhaps be the first studies entered into, avoiding everything which savours of abstruseness or per- plexity, and shunning dogmatic teaching. Amongst other things very commonly adopted as the medium of instruction, and very popular with masters, there is one which is anything but commendable or useful, that is, the habit of making children learn by heart. It answers no commendable purpose, and abstracts the mind too much from the matter to vest all the attention in the sounds, rhythms, and words. Grammar also, as it is usually taught, comes under the same category. Grammar is a science which can only be well learnt and understood by habit and by reading, and which is never perfected by dinning a certain set of rules into the ears of very 120 HISTORY. young children. They learn, to be sure, that there are such rules, and that, according to those rules, such and such a construction is right, and such another is wrong, but they very rarely acquire by this means the method of applying the rules correctly, or of turning them to any account. The use of grammatical knowledge is, after all, only to induce a correct, ready, and precise method of writing or speaking, and these are so necessarily induced by habit, and not by grammatical rules, that the grammar rule ought only to be learnt after its practical application is acquired and under- stood. In fact, it is reading and writing which more properly teach good grammar, and not good grammar which teaches the art of reading and writing correctly. In the study of history it is very requisite to avoid confusing the young pupil with a multitude of punctilious dates. Chronology is very important as an accessory to history, but does not the least affect its bearing in moral tuition ; and as the earlier periods of general history, in the popular method of teaching it, ramble over a vast portion of the globe, and, from lack of particulars, crowd a great number of events, each of which identifies an epoch, into a very narrow space, it is of cogent importance that the first studies of general history should only be cursory. Abridgements of historical works are only of HISTORY. 121 real service to one who is more advanced, and is familiar with the particular national details, for the purpose of collating and condensing his reading. It is then, also, that chronological accuracy begins to tell to advantage; before, it only serves to muddle the pupil. Having acquired one summary view of universal history, the pupil might commence reading the particular histories of every nation which has figured in the progress of civilization, and which has exercised an important control over the condi- tion of mankind. Still the doses of study should be few and far between, and, moreover, never of long duration, or ever suffered to weary the pupil. For the great end of all reading is, that it shall be digested : in other words, that the mind, by not being damped in its energies, shall ponder upon the matter which it has gathered, and cast it somewhat into shape. It is very common to place such books as Keightley's Outlines of General History into the hands of beginners, with the'^false idea that, without much labour, they can thus become pretty well acquainted with the general course of events. But, in the first place, as has been urged, the events are necessarily so huddled together, and placed so little in juxtaposition, that- it becomes a labour even to a tolerable historian, much more to a child, who knows nothing what- ever of his subject, to understand them ; and, in 122 HISTORY. the second place, these kinds of historical works are totally destitute of anything like moral instruction they are nothing more than chronological tables. Another thing it were as well to submit to the careful attention of the reader respecting the earlier departments of education, which is the impropriety of the still very general custom of devoting years to the almost exclusive and imperfect teaching of the dead languages. And, independently of the ob- jurgations just offered to this all engrossing study of the Greek and Roman writings, another, and still more palpable, objection is to be found in the cir- cumstance that many of these works (those of Ovid, for instance) are wholly perversive of delicacy of sentiment, and highly obnoxious to pure morality. Much mischief is thus liable to accrue to the pupil with some taste for classic acquirement, by having his propensities flushed and excited by the laxity of ideas which he gathers therein. Besides the mischiefs, then, which thus accrue from early classical study, as it is called, such a course of reading but too generally leads to nothing. We live in an utilitarian age, and education should be consistent with the spirit of the time. The culti- vation of the taste and the elegancies of mental acquirements are the polish which may be sought and acquired, when more essential information has been attained. Moreover, such attainments are only calculated DEAD LANGUAGES. 123 for a very limited proportion of society. The laborious or industrious classes must handle the spade, guide the plough, toil at the loom, serve the counter, labour at the desk, or pursue a hundred other productive avocations ; and the dicta of Cicero or the subtle rules of Aristotle will boot them but little at their work. Children should, before all things, be tutored in the rudiments of the arts and sciences of civiliza- tion, and of every-day application ; and it is still so far inconsistent with this system to pursue the present method of education, that, even in what are called the liberal professions, for the attainment of which classical knowledge is made the scale of ascent, that kind of knowledge has comparatively become quite obsolete, and there remains but little vestige of its use in practice. Be it understood that it is not here intended to contemn learning : learning is doubtless a most noble qualification, but it is not of popular application ; and, noble as it is, if erroneously instilled, it too often warps the understanding. After the utilitarian education is completed, if the pupil has a bent that way, and time, leisure, and opportunity to indulge the inclination, it becomes a w r orthy and beneficial pursuit ; but otherwise, worthy as it may be, it is anything but beneficial. Before instruction in the dead languages, there- fore, if elegant acquirements be the object, the 124 LANGUAGES. course of reading might more profitably be sought amongst the many eminent writers of our own country, or of modern and living tongues. There is a vast fund of pure morality to be gathered from this latter class of English writers, and the taste might well be formed upon worse models. LANGUAGES. With respect to other European languages, we have made some progress of late years, owing to the rapidity and frequency of international com- munication ; and there can be no doubt but that the study of contemporary languages is extremely useful, if not almost necessary, in our time. -It might not, therefore, be unprofitable to place this course of study next in importance to those before recommended. The knowledge of French, Ger- man, Italian, and Spanish in particular, and espe- cially the first two, will be turned to account in every situation of life, in every art or handicraft, and in every science. It is a piece of stupid dogma- tism, and not a worthy national pride, to despise that which owes its discovery to a foreigner, and a dogmatism which is fortunately growing into severe contempt. One nation is, prima facie, as likely to produce an eminently useful discovery as another, and it is LANGUAGES. J25 nothing less than stupid folly to avoid or despise anything which may be turned to account because it is imported, and not indigenous. It is fre- quently by comparing the productions of one nation with those of another that perfection is attained. It is by combining the efforts of genius that art and science are consummated. If less time were devoted in childhood to the study of what is totally obsolete, and can become of no social service, there would be more left to apply to studies such as those from which great social advantages may be gained. Whether the study of contemporary languages be confined to the materials of useful art or science or not, it will inevitably become serviceable, nor do I conceive, if the pupil has an inclination to study Schiller or Corneille, or Tasso or Cervantes, that he should be debarred from access to them ; but still I would not have him crammed against his inclination with the productions of the higher, or imaginative, order of literature. The knowledge of other languages will afford him facilities for the mastery of all the other studies. The study of history, before recommended as so highly essential, will owe more than is readily imagined to the familiar acquaintance with two or three, or more European languages. With respect to the manner of teaching them, it should be borne in mind that, in early years, 126 MATHEMATICS. children have a peculiar aptitude for the accepta- tion of sounds, and that they possess, for that reason amongst others, a ready and intuitive power of learning dialects ; and, in the second place, it may be remarked generally, that far too great stress is laid upon grammatical rules, which, for reasons before recited, are oftentimes quite unavail- ing to the student. Young children must neces- sarily trust more to the senses and the perceptive organs than to those of reflection, and whilst they cannot sufficiently abstract the intellect to dive into the reasons of things, they very readily catch them, such as they are. It is not to say that we need launch into the extremes of a phonetic system, because it seems obvious enough that that rather puzzles than assists, but merely allow the pupil to be rather subject to phonetic than to didactic influence. MATHEMATICS. Having passed from HISTORY to LANGUAGES, we will now turn our attention to another most essential branch of science. Let us consider the study of Mathematics as amongst the useful departments of learning. They may be simple or abstruse they may be compli- cated or wrought in single integrity and may, in MATHEMATICS. 12? a measure, be as usefully adapted to the meanest and most narrow understanding, as to the most commanding and comprehensive intellect. MA- THEMATICS are, therefore, the science of all men: the commodity which can come ill to none, and to none prove unserviceable ; of every-day use and application in the world, down to the most trifling handicraft, they may, at the same time, be the constant toil or recreation of the sage in his closet. A Columbus or a carpenter are equally subject to the laws which they inculcate, and derive their knowledge from them as a common source. The builder who indulges what he calls his taste upon a suburban villa, would be as much puzzled without their aid as Sir Isaac Newton might possibly have found himself in solving the binomial theorem. The study of mathematics, however, should not be too early adopted, inasmuch as it necessarily depends upon a powerful exercise of the reflective faculties. It were as well, in the generality of cases, even, if the rudiments of this science were not taught before the age of from twelve to four- teen years. Mathematics are not, like languages, a study of the senses ; and whereas the latter may be com- menced with the first articulation, the former must be slowly adopted, after the superior mental powers become somewhat developed, and manifest some signs of activity. When, however, this study has 128 GEOGRAPHY. been judiciously commenced, it may, and will, if the capacity exists, be rapidly pursued. The study of mathematics has, of late years, been most abundantly engrossed for engineering purposes. It may be adapted to facilitate any trade or handi- craft, as the accessory to architecture, dynamics, chemistry, and, in fact, all the useful arts; and when in course of study, this science possesses the peculiar recommendation of adapting the mind for the reception of others, whilst, at the same time, it forms a portion of every one of them. GEOGRAPHY. Next in rank to mathematics we might be allowed to suggest Geography. It is never useless to know something of the relative positions of places and countries, nor is it superfluous to pos- sess some knowledge of climate, productions, people, manners, and so forth. Even setting aside all other advantages derivable from this kind of information, he were a bigot, indeed, and an igno- rant one, too, who would aver, in the pride of his semi-ideal civilization, that he could gather nothing worth knowing or having, even from the savage. Apart from such considerations, a know- ledge of geography may become highly useful to any individual at any time. It is an information GEOGRAPHY. 129 of every-day requirement ; and yet how few there are who know anything of their own country, much less of others. It is true that a new social condition, arising out of the mastership of mecha- nical art, has certainly forced this knowledge even upon the most ignorant, by experience, as it were : but this very fact renders the early acquirement of it the more essential to every man. It should, moreover, be observed, as of LANGUAGES, that it is more the acquisition of the perceptive than of the reflective mental powers, and is therefore capable of far earlier inculcation than the former science of mathematics. Geography can best be taught to a child by means of his eyes : a map placed before him shows him at once the relative disposition of lands and zones. But in the teaching of this science, as well as of others, there appears to be a very prevalent and serious error ; it is that of making children learn chapters of a geographical compendium by heart. Humbly conceiving this practice to be prejudicial in all cases and for all purposes, I venture to suggest the propriety of its discontinuance. If the child be left to learn by means of his senses, and not of artificial cramming, he will form a just and accurate idea of his subject, and it will remain in his mind ; if, on the other hand, it be forced into him by sheer repetition, he will remem- ber nothing but the words, and those only for a short time. 9 CHAPTER II. OF THE DISTRIBUTION OF EMPLOYMENT DURING THE COURSE OF EDUCATION, AND ADMONI- TORY REGIMEN. IT has already been mentioned that a great deal depends upon the proper distribution of occupa- tions ; and, for the purpose of drawing a more distinct line between the gradations of advance- ment and capability, a kind of scale of ages had been constructed. A very general and popular method of teaching is to submit children, of three years old, at once to a course of mental tuition. They are taught to read and write, and are crammed with the rudi- ments of everything, before they are capable of understanding the application of any of them ; besides which, no distinction, as to the length of time which is to be devoted to this species of study, is made between the child of three years old and one of twelve. It is too often just as common to confine a mere infant all day over its parrot learning, as it is to require the same application of a child of far more advanced development ; and it is vainly imagined that such confinement and such early application are alone capable of pro- EMPLOYMENT. 131 ducing the finished scholar, and do produce such a prodigy. It could be clearly shown, by example, that far from having gained anything by this system, not only is all that has been superficially and artifi- cially attained lost, but, moreover, it carries with it a great deal of the pristine vigour and energy which the natural intelligence originally possessed. The mind becomes, so to speak, sodden before it is matured, and, instead of being rendered capable of anything, is deprived of all capability. This error, which is one of mistaken zeal, has, however, so thorough a conventional footing in the majority of modern nurseries and schoolrooms, that it is very difficult to persuade parents that it is an error. Most people, now as of old, had rather be u wrong with the world than right with philosophy," even if they go so far as to admit that they are wrong at all. But it is an error which will sooner or later work serious evil in the degeneracy of nations, unless it be counteracted, and which may, perhaps, have to work its own cure in a somewhat inconvenient manner. In the first epoch of mental education, which need not commence before the fifth or sixth year, an hour or two a day is ample time to devote to occupations of that kind, and this course may be most advantageously pursued for two years. 13^ EMPLOYMENT. If the child be placed in such circumstances as to preclude the necessity of manual labour, the rest of its time should be occupied in athletic and gymnastic exercise, and in open-air occupations such as running, leaping, and the like ; but in all circumstances it were as well if the attention were directed to some useful manual occupation, such as gardening or agriculture. Employments of this kind are exceedingly healthy, and tend greatly to invigorate the frame and the mind together, and to render the pupil robust and vigorous ; whilst, at the same time, they heighten the moral aspira- tions, and elevate the understanding.* When the muscular powers have attained sufficient develop- ment, the use of implements of husbandry or of mechanical trades, may conveniently be taught. The Germans have a peculiar fashion of appren- ticing all their children to some trade, with the object of enabling them to produce the little pre- sents which celebrate the advent of a new year from their own handiwork ; and it is not without example that more than one aristocratic student of Heidelberg has before now found the means of subsistence in the trade which he thus learnt as a plaything. This is no mean lesson to the English- man, who piques himself upon his utilitarian sys- * This is the method adopted at the celebrated college of Hofwyl, near Berne, in Switzerland, and which has proved so successful in its issue. EMPLOYMENT. 133 tern of education. The plan might be adopted without derogation to the solemn aspect of learn- ing, and, certainly, without tarnishing the frivolous pursuits of vice, at our own Universities. Apart from the usefulness of such attainments, in cases of need, there is the everlasting moral of " Belisarius begging" which inculcates itself with the acquirements ; a moral which all should learn betimes, that they be not too rudely taught it perforce ; a moral, too, which may serve to subdue the arrogance of pomp and circumstance, and bestow upon our gifted nation one thing, which it sadly wants, a fellow-feeling for misery. The sympathies may be awakened by the simplest incidents and the most trivial occupations, and, as there is no people where egotism and deep selfishness are carried to such excess amongst individuals as in England, it is no work of su- pererogation to suggest some means of arousing them. It should not escape notice that in this country alone, for I believe this could not occur elsewhere in Europe, the sublimest genius might perish in the streets, unfed, unclothed, and unhoused, for lack of the means and the opportunity of making itself known and recognised ; and this may, in a great measure, be attributed to the faulty system of education, whereby the instruction in useful occupations is wholly overlooked. Thus, so many 134 EMPLOYMENT. are left with vast capacity, pre-eminent talent, but without a field for their exercise. We might well forgive ourselves, if we could show that from all this system of book-learning a high order of taste was cultivated, and an elevated cast of intelligence dispersed amongst the population; if we could so much as aver that we had a pure and noble contemporary literature, or that, if there were such, w r e should number any readers ; but as we cannot do or show either of these things, we are unpardonable. Having, therefore, pursued the course above recommended for two years with the pupil in his first stage of education, the time devoted to seden- tary occupations might safely be doubled, the remainder of the day still being employed in invi- gorating exercises or employment. Whilst the proportion of mental occupation is increased, the material may gradually be rendered more scientific, and thus the reflective faculties called into play as they ripen and develope them- selves, without being forced into premature acti- vity. For instance, the geographical study, which commenced with the atlas, may, by degrees, be carried to higher philosophical and literary inquiry, whilst the geometrical problem, at first confined to actual representative figures, may become a matter of numerical calculation. In this stage, however, it would still be prefer- EMPLOYMENT. 135 able to confine the occupations to useful attain- ments, excluding the dead languages, or classical acquirements, from the pale of early education ; for it may be averred that it is not until the combination of perceptive and reflective faculties is sufficiently matured to form a fixed and defined taste, that letters, as letters only, can advantageously be admitted as a portion of every-day study. A thousand circumstances may transpire, even in the early stages of life, to render such acquire- ments useless to the pupil ; whilst the time which has been vainly exhausted in their superficial and repulsive attainment, might have been beneficially devoted to the useful arts or sciences. Emerging from this stage of educational course, the pupil may be submitted to redoubled mental labour, and consequent decrease of physical occu- pation ; that is, where no circumstances transpire to render the completion of a good, elegant educa- tion abortive, or to divert the tutelage into more productive channels at once. Even at this period, however, it is my humble but firm conviction, that the dead languages are not only a superfluous and useless, but also an injurious study. The course of reading may, nevertheless, become more and more abstruse and scientific as the reflective organs ripen and gain the ascendency. We have now ventured to provide for mental 136 EMPLOYMENT. exercise in the proportion of one third of the whole day, or, rather, twenty-four hours, beginning with two hours at the utmost, and doubling that at the second and again at the third stages, thus obtaining a maximum of eight hours a day ; and, supposing that eight hours more be allowed for rest, which is a very fair proportion, we have eight left, or another third for refreshment and active recreation. The rule is of course made for robust and healthy children, because sickness is subject to no rules of the kind, and the state of health must indicate the capability for mental or bodily exertions in such cases. But, admitting that the pupil is robust, healthy, and capable of such regimen, the third of the twenty-four hours thus apportioned for study should be the maximum set apart for such purposes during the whole course of education. It is quite enough for young people, with the best capabilities and the most buoyant energies, to be confined to close mental occupation for one third of their time ; and everything beyond that, if it does no harm, does no good. The only gradations after that consist in the intensity of the application, or, in other words, in the abstruse- ness of the reading. Natural and experimental philosophy, the higher branches of mechanics and dynamics, the grateful and interesting study of analytical and experi- EMPLOYMENT. 137 mental chemistry, astronomy, in so far as it is explanatory of natural phenomena, now come within the sphere of the pupil. The philosophical and jurisprudential readings of history and the particular code which regulates the community of which he is a member, with its origin and progress, should also become subjects of serious considera- tion ; although, during this stage, these sciences should still be confined to their simplest and incipient guise. The historical reading, in par- ticular, should be dilated and particularised, whilst, at the same time, it was being collated and con- densed by the resource before suggested. The mathematical studies may range a little higher, according to the capability and progress of the pupil ; and the study of languages become more scientific and grammatical. At this stage, also, the inculcation of grammatical rules, to which, at a former period, an objection had been raised, may be commenced, as it will materially assist the pupil thus far advanced. At the next stage of advancement, whilst the study of the natural and useful sciences is being actively pursued, the dead languages may become a subordinate portion of the material for com- pleting a polished education. But even now they should only be adopted with a very careful selec- tion of works; and with this reservation, that they be mere accessories to the supererogatory 138 EMPLOYMENT. portion of tuition, rather than be made an essential part of education. Here, again, may the principal burthen of oc- cupation be centred in the higher order of the natural sciences, in which the pupil should by this time have attained some proficiency. A deeper and yet more abstruse study of history and juris- prudence, and the first class of mathematical cal- culations, may also come within his reach. If, indeed, metaphysical study should at any time be admitted within the pale of the educational courses, it might be suffered to commence at this fourth stage; but my impression is, that meta- physical lore is rather an exercise of the imagina- tion, than properly within the region of necessary learning. Sound metaphysical principles certainly exercise a most powerful control over the grosser passions of humanity, and tend greatly to enlarge the understanding and expand the mind. Nevertheless, I am inclined to think, that the less this species of learning is encouraged the better, until, at least, the education has, for some time, been devoted to the physical sciences and their glaring experimental evidences and truths ; since, after such training, the pupil might gather confidence enough to think for himself on meta- physics, and not place a blind reliance on the dogmatic teaching of others. EMPLOYMENT. 139 It hardly needs recapitulation, that the hours of confinement to book study should by no means be forcibly increased, even with those of the most elastic minds, beyond the prescribed limit of eight hours a day ; because, amongst other reasons, the mental and moral faculties are so dependent upon the physical functions of the frame, that, if the latter are disorganized or debilitated by too se- dentary a course of life, or by too close an appli- cation, the former will inevitably suffer. The physical energies should in all cases be carefully sustained by the occupations and exercises hereto- fore indicated. Having thus attained the fifth stage of education, this period may, with an advanced and well- regulated pupil, become one almost of self-teaching; and the higher orders of refined literature may freely be admitted within the pale of materials, whether in the living or dead languages. There are, unfortunately, but comparatively few condi- tions and circumstances in life, in which this stage is not entirely foregone for more productive industrial occupations ; and, consequently, there are but few who are ever able to attain the sphere of elegant and finished scholars. But, as these are, after all, but the gilded ornaments which heighten the splendour of society, we may console ourselves with the reflection, that, as society is con- stituted, we can do without a majority of them. 140 ADMONITORY REGIMEN. ADMONITORY REGIMEN. We now approach another of the essential branches of education, which forms a distinct and important department. I refer to what has been denominated as the ADMONITORY REGIMEN, or, in other words, the regulation of rewards and punishments. The natural frailty of humanity, and the necessity also of working upon and adapting the passions to good purposes, render this a very paramount question. The best of children will sometimes incur punishment, and should suffer it ; and the worst will occasionally earn reward, and should obtain it accordingly. I have already alluded to two very mischievous errors in this branch of treatment over-indulgence and over-severity and have taken it upon me to enunciate as a rule in punishment, that it should consist rather in the privation of enjoyment, than in the infliction of pain. It need only, therefore, be repeated, that, with the youngest as with the eldest of pupils, the incentives to industry and good actions should never be withheld, nor those merits allowed to perish for want of notice ; and that, in punishing generally, we should be most careful to induce no worse failing by the method of dealing with that which incurs present punishment, and also to PUNISHMENT. 141 avoid any physical injury, however momentary. Both errors may have lasting and pernicious consequences CORPORAL PUNISHMENT. Corporal Punishment I therefore conceive to be clearly an error, if it be no worse. Of late years, the application of this resource has, with very good reason, fallen into general disuse ; although it is still resorted to by some. The ROD or CAT can never, I opine, produce more perfect scholars or more obedient and ex- emplary pupils; and it certainly has the effect of counteracting to a great degree the refinement, delicacy, and polish which should and do spring from good education. It is a remnant of bar- barism, and ought to be utterly excluded from every sphere of civilized society. Besides this very great moral objection to the system, we have also another : that, in many cases, corporal punishment has been applied where the pupil was already labouring under a mental or physical incapacity, or both, and thus became a double victim. In such a case, the incapacity, of whatever kind, is only heightened by the remedy. 142 PUNISHMENT. CLOSE CONFINEMENT. Close confinement, though not open to the objection of suscitating the natural harshness and coarseness of the grosser portion of the human character, is none the less subject to the same strictures on other grounds. You may set a robust youth to dig, by way of punishment, if you please, consistently with the power and endurance of his frame, because thereby you are affording him a healthy and useful occu- pation ; but if you condemn him to be closely confined for any length of time, depriving him of the air and exercise which are essential to his physical constitution, you run great risk of in- ducing some serious malady. Another evil, as in the case of the ROD, may arise from close confinement, which is, that, sup- posing the pupil to be of a highly susceptible and nervous temperament, it would inevitably work upon the mind, so as to render that also incapable of regular exertion and application. The same may in general be said of the system of enforcing IMPOSITIONS and the like, by way of punishment ; for if these be really complied with and completed, they may be guilty of the same mischief; and if they are evaded, they are only the agents of a lax morality. REWARDS. 143 Thus, in all cases, it may be held far more safe and preferable to inflict the punishment (which it is not the less expedient should attend every misdeed, in proportion to its magnitude and im- portance), either by subjecting the pupil to a wholesome and useful physical occupation, adapted to his constitution and strength, or to subject him merely to appropriate expostulation and to the process of foregoing all his enjoyments, recrea- tions, and relaxations for a given time. It were, moreover, advisable that a strong dis- tinction were drawn between the mental and physical and the moral wrongs of omission or commission. The latter are ever the most to be dreaded, and should ever be painted in the darker hue, and subjected to the severer regimen. And lastly, the term of punishment should extend only to reasonable limits, in order that the resolutions be not damped, quelled, or made callous ; that the sense of shame be not (as it too often is) converted to one of mere sullen acrimony; and that its compunctions may have occasion to enjoin re- formation, and not its sting, to goad to repetition and inveteracy. REWARDS. The method adopted at the College of HOFWYL, to which allusion has heretofore been made, con- 144 REWARDS. sisted in holding forth rewards for everything that was recommended to the pupil. Learning had its prizes ; art had its prizes ; agriculture and handicrafts had their prizes ; horticulture had its prizes ; and the gymnastic and athletic exercises, such as running, leaping, archery, skating, swim- ming, and military discipline, were encouraged in the same way. Without dwelling very long upon this article, I would humbly suggest some such system for every place of education. It is, perhaps, not too well to over-excite emulation amongst man- kind ; yet it is necessary to call it judiciously into play, for the purpose of improvement, which will and can make no progress without it. Finally, in the sense that it has been contended, no wrong should be allowed to escape some punishment or counteracting power, no me- ritorious trait or act should be suffered to pass unnoticed or unrewarded. PART IV. OF TEMPERAMENTS THE MOST COMMON COMPLAINTS OF CHILDREN, AND THEIR TREATMENT IN ORDI- NARY CASES. *JO PART IV. OF TEMPERAMENTS THE MOST COMMON COMPLAINTS OF CHILDREN, AND THEIR TREATMENT IN ORDINARY CASES. Characteristics of Constitutional Tendency and Temperament. IN treating the indispositions, maladies, and weaknesses of children, as of adults, it is very essential to ascertain distinctly and to be guided by the peculiar caste of constitution and tem- perament of each particular patient, and the degree of virus, or taint, inherent in such temperament ; and not only so, from the various general degrees of susceptibility which accompany these differences and modifications of constitution, but because, amongst the ingredients of our Pharmacopoeia,* we have frequently many, of which the operation would effect the same end, but which are each adapted to some particular phase of temperament, * A book with rules for the compositioa of medicines. 148 CONSTITUTIONAL TENDENCIES. preferably to any other, or perhaps to one only. Thus, then, in giving general directions for the exhibition of medicine, we sometimes appear to confuse the reader with the multiplicity of our prescriptions for the same complaint, unless he happen to be aware of the peculiar applicability of each medicament to some distinct tenor of tem- perament, or unless he happen to cast his eye upon the list of medicines most recommended for each shade of complexion. It is my object in this section to give a general outline of the various phases of constitution, and to attach to the description of each such a list of medicines, in order that the reader may be able to refer back from my subsequent pre- scriptions (amongst which there will necessarily be many remedies for the same malady) to the summary catalogue contained under the head of each particular temperament, to assist in guiding his selection in the case of any particular patient. The varieties of temperament may be generally and briefly included under the following heads: the LYMPHATIC, the SANGUINE, the BILIOUS, the MELANCHOLIC, the NERVOUS, the CHOLERIC (which partakes of the characteristics of the bilious, melancholic, and sanguine), the PHLEG- MATIC (which is the reverse of the former), CONSTITUTIONAL TENDENCIES. 149 and the ADYNAMIC, which is akin to the LYMPHATIC.* The constitution and habit of body peculiar to the lymphatic subject may be generally described as lax. The predominant features are languor and indolence, roundness, bulkiness, softness, want of strong expression, a fair, but dead complexion, and inanimate eye. The circulation is slow and dull, the passions are lethargic, and the brain is in- active; and, with some subordinate distinctions, the same may be said of the phleginatic and adynamic. Those which usually mark the sanguine subject are, rapid and strong circulation, fulness, energy, and strength. The muscular and cerebral systems are vigorous and active, the skin is soft, the complexion fair and florid, the eyes bright and blue, and the hair of a bright auburn yellow or red. The bilious subject is characterised by a strong and frequent pulsation, a dark or swarthy com- plexion, with effective and well-marked lineaments and a countenance expressive of great energy of character; a moderate fulness, but firmness of flesh ; violent passions, and the like. * The above subdivision of temperaments has been adopted for practical purposes. The following are the four primitive and na- tural temperaments, commonly recognised by modern physiologists : the bilious, the lymphatic (or pituitous), the sanguine, and the nervous. These are frequently met with in a mixed form, as, for instance, a combination of the bilious and nervous, the sanguine and lymphatic, and the nervous and lymphatic. 150 CONSTITUTIONAL TENDENCIES. The melancholic temperament is distinguishable by a firmness of fibre, accompanied by a dryness and meagreness of frame ; scanty secretions ; an arid cutaneous system ; a brown complexion ; gloomy, saturnine, meditative look ; obstruction in the digestive operations, of a congestive tendency. It is a modification of the bilious temperament, without its predominant and characteristic energy; the imagination vivid, but all things are seen through a dismal medium ; the pulse is hard, slow, and contracted ; the functions of the nervous system are usually deranged ; and the disposition is sombre, suspicious, and meditative. The peculiar characteristics of the nervous sub- ject are, attenuation of the muscular system ; fine, thin hair and skin ; predominance of the cerebral system, and, in fact, of the whole nervous system ; rapidity of movement, intense susceptibility and excitability, want of decision, and the like. The choleric constitution is marked by a swarthy and yellowish complexion, dark hair, and a firm but arid muscular system ; great susceptibility of the biliary organs, which renders the patient pe- culiarly subject to bilious disorders, and to give a tone of bilious affection to every complaint ; super- abundance of bile; and a tendency to inflammatory complaints. In many essential respects the bilious and choleric temperaments are identical ; but the latter, like the melancholic, is a modification of the CONSTITUTIONAL TENDENCIES. 151 former, with more similarity in some particulars to the last of the three. It possesses, moreover, great affinity, in some respects, to the sanguine temperament. The phlegmatic subject is to be identified by many of the characteristics of the lymphatic, with- out necessarily being so destitute of the impulses to action or of perseverance in action. There is, however, a want of tension in the fibres and mus- cular system, and a tendency to copious lymphatic secretions. The phlegmatic subject is very tardy of excitement. The adynamic constitution, whilst it partakes also of many of the features of the lymphatic, may be characterised by the scantiness of secretions, as well as by their copiousness. It is equally marked by over-elation and over-depression ; and, unlike the lymphatic, is not slow to excitement, but quickly susceptible of it, for good or ill. There is, in this species of constitution, a striking want of strength and endurance, and a weak pulsation. LYMPHATIC TEMPERAMENT. Remedies for se- lection from the prescriptions.* Merc., Sulph., Calc., * As has already been observed, it is to be understood, that the temperament of the patient must only serve as an auxiliary guide in the selection of a remedy. In cases where, from the similarity in the given directions, it is difficult to discriminate between two or more remedies, the temperament will often regulate the choice. 152 CONSTITUTIONAL TENDENCIES. Puls., China, Ars., Bella., Hyos., Phosph., Hell., Dulc., Sep., Ant., Card, v., Arn., Sil., &c. &c. DIET.* Generous and solid ; a predominance of animal food ; little or no vegetable ; very little fluid or liquid : when artificial drinks are necessary, they should be rather of a generous than sti- mulating nature. SANGUINE TEMPERAMENT. Remedies. Aeon., Arn., Bella., Calc., Hep., Merc., Cham., Nux v., Bry., Loch., Phos., Ars., &c. &c. DIET. Plain and simple; no made dishes, unless light ; equal admixture of animal and ve- getable, or even preponderance of the latter; unstimulating liquids ; milk diet. BILIOUS TEMPERAMENT. Remedies.. Aeon., Bry., Nux v., Cham., Ars., Arn., China, SulpA., &c. &c. DIET. Generally low ; small proportion of ani- mal food ; green vegetables only ; small proportion of fruit, and none with kernels ; abstinence from all stimulating liquors, comfits, made dishes, and spices. MELANCHOLIC TEMPERAMENT. Remedies. * The short dietetic rules, given under the head of each tem- perament, are subject to modification in many cases, but particularly in morbid states of the system. CONSTITUTIONAL TENDENCIES. 153 Nux v., Lack., Sulph., Staph., Yeratr., China, Natr., Phosph., Viol, odor., Ars., Bry., Sil., Puls., Sep., &c. &c. DIET. Very similar to that recommended for the bilious temperament ; abstinence in general from strong acids and stimulants ; and precaution against milk diet may be added to the previous regulations. NERVOUS TEMPERAMENT. Remedies. Aeon., Coffea, Bry., Cham., Nux v., Sep., Lach., Ac. nitr., Cocc., Ambra, Ars., China, Cup., Ign., Phosph., &c. &c. DIET. Almost wholly animal, very plain, but very generous, without being stimulating; meat eaten rather underdone ; very small proportion of liquids, and those unstimulating. CHOLERIC TEMPERAMENT. Remedies. When of affinity to the bilious, it is subject to the same regulations as that variety ; and when to the san- guine or nervous, the regimen should be accom- modated to those phases of constitution. DIET. The same remark holds as to diet, as with regard to remedies. PHLEGMATIC TEMPERAMENT. Remedies. Puts., Ac.phos., Sep., Ars., Hell , Bella., Sil., Sulph., Nat. m., Euph., &c. &c. 154 CONSTITUTIONAL TENDENCIES. DIET. Similar to that recommended for the lymphatic subject, with this difference, that fluids need not be so strictly avoided. AD^NAMIC TEMPERAMENT. Remedies. Ars., Sulph., Calc., Phosph., Phosph. v., Garb, v., Nux v., China, Lack., Merc., Natr. m., Staph., Sep., Veratr., Sil., Ant. c., Am., &c. &c. DIET. Similar to that recommended for the nervous subject. The Homoeopathic treatment and remedies are peculiarly well adapted to the management of young children. Amongst other things, one of the most constant inconveniences of Allopathic* remedies is, frequently, their nauseous and bulky character, by which great difficulty occurs in their efficacious administration. Again, the delicate condition of the membranes and fibres of the frame renders them far too susceptible of the action of large doses of powerful drugs to admit of their being uninjured by such means. Both of these objections are wholly set aside by the Homoeopathic method of exhibiting remedies ; for, in the first place, they are without smell or * The medicines employed in the old method of treatment. CONSTITUTIONAL TENDENCIES. 155 taste ; and, in the second, they are of so minute and delicate proportions as to render their judicious employment only operative for good. There are too many ingredients of the com- monest use in the Allopathic pharmacy, by which the most serious consequences are liable to be engendered, either by an over-dose or by their prolonged administration. Moreover, it is by no means an unusual occurrence that the indisposition against which they have been prescribed may indeed be removed, but not unfrequently to be sup- planted by more or less permanent derangement induced by their unduly powerful and pernicious operation. The simple use of aperients alone, and the favorite practice of purging, not to speak of the employment of strong tonics, etc., are only too often quite sufficient, ultimately, to induce obsti- nate derangement of the digestive functions, and the system at large. Our pharmacopoeia* has wholly avoided these shoals. We repudiate not only the large and hurtful doses of the ingredients them- selves, together with the popular, yet often futile, method of attempting to modify their effects, or to correct and mitigate their extreme action, but also the mode of preparation. Previous to giving any directions relative to the peculiar treatment of any complaint, it should be premised that parents must by no means suffer * A book containing rules for the preparation of medicines. 156 TUMOURS AND CONTUSIONS. works of this kind to be the substitute of medical advice for their children, in the graver or more occult kinds of cases, because it is always impera- tive to be prompt in dealing with infants, but to trust to these directions only in the less important instances, in the disorders which have striking and identifying symptoms and manifestations, pending the arrival of a professional practitioner, and in the daily casualties and accidents which may occur, and which cannot be mistaken. CASUALTIES AND DISORDERS CONCOMITANT WITH BIRTH, OR SHORTLY SUCCEEDING IT. When labour has been unusually protracted, and of difficult completion, various mechanical injuries, of more or less importance, are not unfre- quently inflicted on the child. Tumours and Contusions. Tumours are very frequently occasioned about the head and other parts of the body, as also con- tusions from undue pressure. In most instances, these casualties will not be attended with any danger, but they are in the department of the surgeon, and should be dealt with by professional hands alone. Where inflammation is induced, the SWELLING OF THE HEAD. 157 consequences may become serious, unless great care be taken to subdue the irritation. * A lotion composed of about six drops of tincture of ARNICA to a wine-glassful of pure water, together with the internal administration of one globule of the same remedy, is generally the surest and safest of remedies. In default of success with ARNICA, RHUS TOXICODENDRON may be resorted to; or, in some cases, CALENDULA. (See art. WOUNDS.) The features are not uncommonly much distorted on delivery, but they will gene- rally resume their shape spontaneously. Swelling of tJie Head. The head of the infant at the birth is invariably more or less swollen, and this swelling usually subsides of itself. If it should last, one globule of ARNICA, as before, will materially assist the removal ; or, in cases of longer duration, the lotion. Sometimes there is considerable tumour of the fontanel (or larger mould), which is more serious than the former description of swelling, but which is rarely alarming. If it continue more than a day or two, one globule of RHUS TOXICODEN- DRON should be administered ; or, when the fon- tanel is too long in closing, the same quantity of CALCAREA CARBONICA, repeated twice or thrice 158 JAUNDICE. if required, at intervals of a week. SULPHUR and Si LICE A are sometimes requisite in protracted cases. Ruptures. The birth of children is not unfrequently accom- panied by ruptures, in the form of protrusion of the intestines at the navel, and other parts, in the form of a swelling, which, at the first-named and by far the most frequent locality, varies in size from a hazel-nut to a walnut, and is distinguished by its becoming increased in size when the infant coughs or cries, and by its capability of being reduced by gentle pressure. But as these are essentially surgical cases, it is perhaps useless to dilate much upon them here. Suffice it to say that, in cases of protrusion at the navel, stout plasters and light bandages are the only external resources with infants ; there are no trusses of sufficiently delicate pressure to be used with new-born children. The internal employment of Nux v., one globule every four or five days, for three or four times, will materially facilitate the cure in ordinary cases. Jaundice. A yellow discoloration of the skin and eyes is a frequent manifestation in new-born infants ; but, JAUNDICE. 15Q generally speaking, this is of but little import, and will pass off of itself when the secretion of the bile becomes better balanced with the requirements of the digestive organs. In cases in which it lasts more than a few days, one globule ofMercurius may be given, and repeated after an interval of forty-eight hours. The worst of resources in cases of jaundice, whether in new born infants, or children more advanced in age, is the administration of aperients. It is by the too great frequency of exhibiting pur- gatives that confirmed jaundice is very frequently induced, and that its constant return is rendered common. In some instances jaundice, in a very young child, may arise from natural obstructions in the biliary duct, in which cases there is but rarely any successful treatment. In the subsequent period of childhood, the sym- ptoms of jaundice may be described as yellow, of various shades, first appearing in the eyes, and soon extending over the whole surface of the skin. It is attended by hard whitish motions, and deep orange-coloured secretion of water occasionally ; also, a sense of pressure and distension, or other uneasiness, is complained of in the region of the liver ; and there is much irregularity of digestion. Sometimes even the perspiration will tinge the linen of the patient. 160 JAUNDICE. The principal sources from which jaundice may originate are, disordered state of the liver, pro- longed indigestion, poisonous substances, over- fatigue, cold, great mental excitements, the habit of constantly taking drastic purgatives or emetics, obstructions in the biliary ducts (sometimes from worms, gallstones, and the like). Too sedentary or irregular a method of living are amongst the most common exciting causes. This disease is not unfrequently intermittent, and, in many cases, it will recur at stated seasons for some years after it has been once had. With careful treatment jaundice is ordinarily by no means a dangerous complaint, but it may lead to a variety of organic derangements from want of care. The most prominent specific remedy for this disorder is MERCURIUS ; but if, as is not unfre- quently the case, the patient has suffered from the effects of this mineral in large and frequently re- peated doses under the old mode of treatment, or when the affection assumes an intermittent form, or has been excited by over-exertion, accompanied by profuse sweating, CINCHONA is preferable When it originates from mental excitement (such as a fit of passion), or from a chill, CHAMOMILLA maybe looked upon as the most efficacious remedy; or, when attended with costiveness, or alternate costiveness and looseness of the bowels, Nux JAUNDICE. l6l VOMICA is to be preferred. The last remedy is also the first in efficacy in cases where the com- plaint arises from sedentary habits. When the attack has been excited by rich, indi- gestible food, and it is attended with great lassi- tude, chilliness, and restlessness, especially towards evening, we should administer PULSATILLA, or Pulsatllla and Ipecac, alternately every four hours, until improvement results, or some other remedy is called for by a change of symptoms, if vomit- ing ensues. ACONITUM is sometimes required where febrile symptoms supervene. Should the symptoms not yield to the use of one or more of the foregoing, Sulphur may be resorted to, and, if it fail to conquer the affection, professional advice must be sought. ADMINISTRATION OF THE REMEDIES. Four globules, in four dessert-spoonfuls of water, one dessert-spoonful of the solution every four hours,* in the course of the day. Occasionally it may be found necessary to give nearly the whole of the above-named remedies, either successively or otherwise. In such cases an interval of four days may be allowed between each remedy, if the attack is of a mild, though obstinate form. In those of a more urgent character, or when a decided change in the symptoms appears, * See rules for repetition of the dose. 11 162 INFLAMMATION OF THE EYES. with well-marked indications for the employment of a fresh remedy, the alteration may be made with- out delay. The diet should be very plain, light, and unsti- mulating; veal- or chicken-broth, unfermented bread, baked apples, light vegetables, such as stewed lettuce, vegetable marrow, French beans. The drink should be chiefly water, or toast-and- water. (See also Derangement of the Stomach, Mental Emotions, and Bilious Attacks.} Inflammation of the Eyes. Amongst the most common casualties which befall newly-born children, we may include in- flammation of the eyes (purulent ophthalmia). This disorder is by no means to be overlooked or thought too lightly of, inasmuch as, without attention, it may frequently terminate in blindness. Various causes have been assigned as the origin of the complaint, such as cold, exposure to the light or to any kind <5f glare. In some cases, however, it appears to be of epidemic origin ; whilst in others it is attributable to a constitu- tional state of the mother before delivery, or to contact with leucorrhoeal matter, and sometimes from worse manifestations of parental disease. The affection usually displays itself at first by INFLAMMATION OF THE EYES. l63 an inflammatory redness of the inner surface of the eyelids, which speedily extends to the ball of the eye, and is soon afterwards accompanied by a profuse secretion of matter. The eyes are usually quite closed, and are so sensitive to the light, that it is generally impossible to obtain a satisfactory examination of the eye. On separating the lids, a flow of matter ensues, and the inner lining of the lid exhibits a vivid red hue. TREATMENT. Upon the first discovery of inflammation, the better course is to administer one globule of ACONITE, repeating the dose after a lapse of eight hours. In the majority of cases, Sulphur will form the most appropriate remedy after Aconite. One globule of that remedy may, there- fore, be administered twelve hours after the second dose of Aconite, and followed, after an interval of twenty-four hours, by another dose of the last- named medicament ; and then again Sulphur, after the lapse of twelve hours. In other cases, Pul- satilla, Rhus, Belladonna, or Calcarea, &c., may be required ; but, whenever the first-named remedies fail to produce a speedy improvement, professional aid should be sought without delay. Lukewarm water is the only lotion required, and should be dropped or injected between the lids several times a day when the secretion of matter is copious. A poultice is often serviceable when the lids adhere firmly together. 164 SWELLING OF THE BREASTS. Eed Gum. Most children, a few days after delivery, exhibit a reddish eruption or rash, in the form of red pimples, intermingled with a few red patches, about the face, neck, and hands, which is known by the name of RED GUM ; but which in no case is of very serious import, or requires special treat- ment. It is generally esteemed as a symptom of strong health and vigour in the child. If the rash should continue to be thrown out for any length of time, or reappear more than once, which will occasionally occur, we may assist it by administering Arnica montana, one globule in the morning, and again at bedtime. Four or five days afterward, Antimonium crudum may be resorted to, if needful ; and then Sepia, after a like interval. When there is considerable irritation, a globule of Aconitum may be given, and repeated in twelve hours. Swelling of the Breasts in Infants. All children, of either sex, are subject to the manifestation of these symptoms at the birth. The breast of every infant is charged with a kind of secretion, bearing some resemblance to milk ; INFLAMMATION OF THE MOUTH. l65 but it is very erroneous to attribute this to a species of disease, or to treat it as such, as is the common custom. The symptoms will disappear of themselves, if they are left alone; and the practice of pressing the breasts, to produce or to encourage a discharge, is not only useless, but is so far injurious, that it not unfrequently produces inflammation, and sometimes an abscess, which is really serious. Nurses should be strictly pro- hibited from resorting to their favorite expedient. When inflammatory symptoms have been excited by the wanton interference of the nurse or other ignorant persons, a weak lotion of Arnica (three drops of the mother tincture to an ordinary-sized wineglassful of water) may be applied to the part three or four times a day. If matter has formed, one globule of Hepar s. may be given, and the dose repeated after twenty-four hours. DISEASES OF THE DIGESTIVE ORGANS. Inflammation of the Mouth. This disorder almost invariably originates from a derangement of the digestive functions (mucous membrane). It is, consequently, generally a mere symptom of other intestinal disorder. Cold, the use of irritating aperients, a want of care and 166 INFLAMMATION OF THE MOUTH. cleanliness in feeding, or a too stimulating or otherwise unsuitable and indigestible diet, form the most frequent exciting causes. SYMPTOMS. This complaint manifests itself by more or less redness, tumefaction, and heat of the coating (lining or mucous membrane) of the mouth and gums. It is usually accompanied by a parching of the tongue and lips, and not un- commonly by swelling and peeling of the lips. Sometimes, also, an eruption appears externally about the lips. The continuance of this disorder is also accompanied, in some cases, with dribbling, caused by a great accumulation of saliva in the mouth, when the infant is yet but a few months old. When Inflammation of the Mouth takes place at the age of seven or eight months, it is generally accompanied by a good deal of fever; but, in younger infants, this is but very rarely the case. When it is combined with considerable in- ternal derangement, it may be of very serious import ; but, otherwise, it does not indicate any very important evil, nor should it be allowed to give alarm. TREATMENT. In simple cases, MERCURIUS is generally sufficient to effect a speedy cure, par- ticularly when there is an excessive secretion and INFLAMMATION OF THE MOUTH. 16? flow of saliva. To infants of a few weeks old, one globule may be given in the morning or in the evening, and repeated after an interval of twenty- four hours. For those of a more advanced age, three globules may be dissolved in four teaspoon- fuls of water, and a teaspoonful of the solution given every twelve hours. If the symptoms do not improve after the lapse of four or five days, SULPHUR may be administered in the same manner as Mercurius. When there is much acidity and excessive re- gurgitation of milk, Nux v. and PULSATILLA are useful the former particularly in children of bilious, sanguine, or nervous temperament ; the latter more especially in those of lymphatic con- stitution. Nux v. is, moreover, more appropriate when constipation accompanies the irritability of stomach ; whereas Pulsatitta is, generally, to be preferred to that remedy, when the bowels are much relaxed. In administering either of the last-named remedies, one globule may be dissolved in four teaspoonfuls of water, a teaspoonful every twelve hours. The medicine may be repeated in the same way, after an interval of two to four days, if the symptoms continue, although with diminished severity. A globule of ACONITE will act beneficially, either a few hours before or after the employment of any of the above remedies, if considerable febrile disturbance supervene. 168 INFLAMMATION OF THE MOUTH. Ulcerative Inflammation of the Mouth. This disorder is, properly speaking, only an aggravated feature of the last, and is not unat- tended with danger, from the liability of the ulcerations to extend into the intestinal tube, and even the air-passages. The first manifestation of it is almost invariably in its former character, and unattended with ulceration ; but mismanagement, want of care, an acrid state of body, and the con- sequent virulence or duration of simple inflamma- tion, will often, if not generally, produce ulceration. SYMPTOMS. The ulcers are but rarely mul- tiplied, and in most cases there is but one large irregular sore, which is covered with a whitish- yellow slough, generally surrounded by consider- able redness, and accompanied by much irritation in the whole mouth. The roof of the mouth, sometimes the tongue, but more frequently the insides of the cheeks, are the seats in which the ulcers appear. TREATMENT. In mild cases, MERCURIUS is here also the most useful remedy. One globule may be given, and repeated after twelve hours. Two days afterwards, the same medicine may again be administered, if the symptoms remain INFLAMMATION OF THE MOUTH. 169 stationary. In severe cases, with foulness of the breath, swollen, spongy-looking gums, and diar- rhoea, accompanied by much straining, MERCU- RIUS is still the most appropriate remedy ; but if no permanent improvement follow its employment, ACIDUM NITRIC UM may be resorted to, and ad- ministered as recommended for Mercurius. When there is fetor of breath, with frequent efforts to vomit, great debility, and constipation, or scanty, discoloured, offensive stools, give one globule of Nux v., and repeat the dose in twelve hours ; or, particularly with infants of eight or nine months old, dissolve two globules in four teaspoonfuls of water, and give a teaspoonful of the solution every twelve hours. SULPHUR is often required to com- plete the cure after Nux vomica, and sometimes after Mercurius, and Acidum nitricum likewise. It may be exhibited in the same way as Nux v. When fever runs high, and there is, consequently, great restlessness, with heat of skin, and quick, full pulse, one globule of Aconite may be given, and repeated in the space of twelve hours ; or it may be administered in alternation with the remedy otherwise indicated, allowing an interval of from eight to twelve hours between each medicine. In children of two years of age and upwards, the following remedies are frequently required : CARBO v. where the immoderate use of salt or salted diet, or unwholesome food is the cause of 170 INFLAMMATION OF THE MOUTH. derangement, and when the gums swell exces- sively and bleed when touched or moved; also when the mouth is much heated, the teeth are loose, and the tongue very sore. ARSENICUM should follow Carbo, if the ulceration remains unabated, and a burning heat is com- plained of in the gums. Or this remedy should be alternated every twelve hours with CHINA, if the gums appear purple or blackish, and present symptoms resembling gangrene.* Whereas Nux VOMICA is preferable with chil- dren of a bilious temperament and choleric dis- position, and of meagre appearance or dark com- plexion, or with those who lead a very sedentary life. CAPSICUM will commonly be found more effective with those of a plethoric habit and phlegmatic temperament. DULCAMARA will sometimes be found a useful remedy as consequent upon MERCURIUS, when the glands of the throat are enlarged and some- what tender ; and it may be adopted as the sub- stitute of MERCURY where the primary cause is exposure to cold or damp, or the malady is very susceptible of cold or damp weather. When, notwithstanding the employment of the above medicines, the ulcers are slow of healing, and the mouth, lips, and gums remain sore, and show no symptom of cicatrizing, SULPHUR may * Incipient mortification. APHTHOUS ULCERATION. 1?1 be prescribed ; and if this remedy proves insuf- ficient to establish the cure, medical advice should be sought. ADMINISTRATION of the above medicines. Four globules, in six dessert-spoonfuls of water, one every twelve hours. DIET. It is imperative that the food should be of the lightest and most wholesome kind during this disease, and that the patient should be taken into the fresh air daily. To children who have attained the proper age, an adequate proportion of vegetables should be given. Aplithous Ulceration. Aphthous ulceration, or what is commonly de- nominated THRUSH, is more frequently met with in children than the form of ulceration above de- scribed, The affection is characterised by the small, white, and circular appearance of the ulcer, which first presents itself in the form of round, white dots or specks, either widely scattered or occurring in clusters, according to the parts they occupy ; being generally few in number, and isolated, or even single, when occupying the inside of the lips, the gums, or the tongue, but more numerous when situate on the inner surface of the cheeks. When in clusters, they often become confluent, and spread over the entire cavity of 172 APHTHOUS ULCERATIOX. the mouth, and even, in severe cases, extend to the throat and throughout the alimentary canal. In these cases, a thin white crust forms in a con- tinuous coat over the ulcers, and, on being thrown off or detached, the ulcerated spots are exposed to view. Considerable tumefaction of the glands often accompanies the severer varieties of the complaint, and the bowels are commonly more or less de- ranged, being either much confined or relaxed, and the motions unhealthy ; acidity of stomach is also a frequent concomitant. In properly-reared children, the affection is seldom or never malignant or dangerous, although troublesome at times, from its protracted nature, or its tendency to repeated recurrence under favoring circumstances. It is almost exclusively amongst the ill-housed and ill-nourished children of the needy poor that the disease is liable to assume a serious aspect, by extending to the air-passages, or by assuming a malignant or gangrenous character. In the former case, hoarseness, oppressed or otherwise abnormal respiration, and cough are the first indications which excite our alarm : in the latter, the livid hue of the surrounding parts, the soft, lacerated-looking mar- gins, and the brown-coloured coating of the centre are the appearances to be dreaded. Prostration of strength ought always to give rise to apprehen- sion. The greatest inconveniences which arise APHTHOUS ULCERATION. 173 from the ordinary forms of the malady, are firstly, the obstacles offered to the act of sucking or deglutition, and, secondly, the irritation and sore- ness which is generally communicated to the nipple of the mother, by contact with the inflamed and ulcerated mouth of the infant. Want of sufficient attention to the temperature and ventilation of apartments, and to the cleanli- ness of the child itself, and of the bottle (when reared by hand) from which it is fed, combined with irregularity and excess, or want of care in the preparation of food, form the principal exciting causes of thrush (aphthous ulceration). It far more frequently occurs in children reared by hand, wholly or partially, than in those which are en- tirely suckled at the breast. TREATMENT. In slight cases, a dose or two of MERCURIUS are generally sufficient to effect a speedy removal of aphthous ulceration. One globule may be given in the morning or in the evening, and repeated after an interval of twelve hours. Four days afterwards the medicine may again be administered in the same manner. This remedy may be employed with equal advantage, in such cases, as a lotion, by dissolving four or five globules in half a wineglassful of water, and gently applying it, twice a day, by means of a camel's hair brush. In severer forms of the 174 APHTHOUS ULCERAT1ON. affection, with copious flow of saliva, diarrhoea, and straining; also when the ulcers (aphthae) present a yellowish (bilious) appearance, Mercurius is still the most important medicament. If the aphthae present an improved aspect under the use of this remedy, but the disturbance in the bowels continues with unabated vigour, and the secretions become more vitiated and very offensive, Acidum sulpliuricum may be resorted to in the same way as described for the preceding remedy. When the derangement of the digestive functions is chiefly manifested by flatulence, regurgitation of food, and even vomiting of acid or of bilious matter, Nux vomica and Pulsatilla are the most appropriate remedies. The former is, generally speaking, to be preferred when the bowels are constipated ; the latter when they are more or less relaxed and discoloured. The administration of these may be conducted as follows : Dissolve two globules in four teaspoonfuls of water, and give a teaspoonful every twelve hours. If the infant cannot be made to swallow the liquid, a globule may be placed on the tongue in the morning, and again at bedtime, or vice versa. Twenty-four hours afterwards, the medicine may be repeated, and again after an interval of forty-eight hours. And so on, lengthening the intervals as the improve- ment advances, before finally discontinuing the remedy. When the above-mentioned medicaments WHITE THRUSH. 175 are insufficient to accomplish a cure in the forms of the complaint alluded to, SULPHUR will generally be required. And when there is great nocturnal restlessness, sleeplessness, with febrile symptoms, a globule of Aconitum may be given. Should the ulcers display the unhealthy aspect alluded to in the description of the disease, and the prostration of strength be great, Arsenicum, Cinchona, Acidum nitricum, &c., are the most serviceable remedial agents in the hands of the professional adviser. DIET AND REGIMEN. The diet in children who are reared by the hand ought to be light and well prepared. The mouth of the infant should be gently, yet carefully, washed after meals; and if a suckling-bottle is employed, it ought to be thoroughly cleansed after use. Personal cleanli- ness, proper attention to ventilation, and regular exposure of the child to fresh air, must also be observed. White Thrush. It sometimes occurs in young infants, and chiefly anterior to the time of teething, to be afflicted with a peculiar variety of inflammation of the mouth, which, from its peculiar symptomatic hue, is called WHITE THRUSH. This disorder is WHITE THRUSH. by no means so virulent as the former species, nor, perhaps, so painful as the simple ulcerated inflammation. It but very rarely appears in England, but is very commonly prevalent in other parts of Europe. SYMPTOMS. The formation of a cream-like matter, either in patches on the palate or root of the tongue, or over the entire lining membrane of the mouth. On removing this coating, the sub- jacent skin is found to be unbroken, but exhibits a red and shining appearance, as from extreme irritation. It is rarely attended with the general characteristics of fever which accompany the ulcerated variety of sore mouth. The mucous lining close to the fundament frequently presents the same exudation of curd-like matter as the mouth, and this manifestation may extend through- out the alimentary canal, and even to the air-ducts^ as is the case with the common thrush j but there is rarely much, if any danger. TREATMENT. The treatment may be said to be identical with that of the milder varieties of APHTHOUS ULCERATION. The exhibition of re- medies should only be modified according to the comparative virulence of the disorder. DIPHTHERITIC INFLAMMATION. 177 Diphtheritic Inflammation. This is an inflammatory affection of the throat, soft palate, and tonsils, accompanied by mem- branous exudation, but without ulceration. It is common to adults as well as to young children, although far more prevalent amongst the latter. There are two species : the one virulent, gan- grenous, and dangerous, if not fatal; the other comparatively of very little import, excepting from its tendency, in very acute cases, to extend into the air-tubes, a result which constitutes the chief danger to be apprehended in the other form of the complaint. They are distinguished under the de- nominations of the malignant and the acute or highly inflammatory form. The latter species betrays little or no general organic derangement, and is rarely, if ever, accompanied by general fever. Whereas the malignant variety is liable to become one of the most serious and fatal of epidemics. Malignant diphtheritic inflammation is, more- over, often very insidious in its approach, inas- much as at first it causes but little positive pain, and, until the throat becomes much swollen, the operation of swallowing is comparatively easy. SYMPTOMS. The symptoms of diphtheritic in- flammation vary according to the habit of the 12 178 DIPHTHERITIC INFLAMMATION. child. In sickly, squalid children, who are ill-fed, ill-covered, and packed together in ill-ventilated apartments or hovels, the complaint very soon assumes its malignant or gangrenous appearance. In the acute or inflammatory species of the com- plaint, the mucous or lining membrane of the throat first appears highly red, and the palate and tonsils considerably swollen, and very shortly be- comes chequered with spots or patches of a membranous exudation or coating. This tenacious or concrete lymphy secretion, in severe cases, soon assumes the appearance of an uninterrupted, smooth, white covering. In other cases, the exuda- tion forms in soft, easily-detachable, massive patches, of a dirty yellow or grayish colour, which have an uneven surface. In malignant diphtheritic inflammation, the in- novation of the disease is, as already remarked, frequently very stealthy. The difficulty in swallow- ing is generally the first symptom which excites attention ; and this becomes apparent even when, on examining the throat, the redness and swelling appear insufficient to give rise to this circumstance. On the other hand, as the disease may become fully developed before any complaint is made of the throat, and before any attention is drawn to a peculiarity in the act of swallowing, the throat should be carefully examined whenever a child seems indisposed during the prevalence of diph- DIPHTHERITIC INFLAMMATION. 179 theritic inflammation, either in the establishment or in the neighbourhood. In many cases, the pain on swallowing is very early accompanied by swelling and tenderness of the glands under the lower jaw (sub-maxillary). The exudation of lymph, which subsequently takes place, is, in this species of the malady, of a tawny gray colour, of dense structure, and exten- sive surface, often spreading to the back of the nostrils, and sometimes even to the stomach and intestines, or more frequently, and all the more fatally, to the windpipe and its ramifications. An excessively offensive fetor generally attends the worst kinds of the inflammation, and blood not unfrequently extils from the gums and lips. The extension of the complaint to the nostrils is indicated by the foul and acrid discharge there- from ; and the existence of nausea, vomiting, and tenderness of the stomach, or griping and diar- rhoea, denote its transmission to the digestive tube ; whilst the invasion of croup-like symptoms herald its seizure upon the air-passages. Extreme prostration of strength forms an early feature in the train of symptoms ; and a low typhoid fever almost invariably attends, and frequently exhausts the vital energies, even in cases where the lymphy membranous exudation has not extended to the air-passages. 180 MUMPS. TREATMENT. At the commencement of the very acute or inflammatory form of the affection, especially when it occurs in robust, well-fed children, two globules of Aconitum may be given, and repeated after an interval of from six to eight hours. In the majority of cases of this description, however, MERCUBIUS will be found the more appropriate remedy, particularly when there is a tendency to swelling of the glands. Six globules may be dissolved in an ordinary-sized wineglassful of water, and a dessert-spoonful of the solution given every four hours. If, notwithstanding the early use of this remedy, the disease threatens to gain ground, professional aid should be sought, as the disease is often very intractable even in this its milder form. Due attention to cleanliness and ventilation are of the first importance ; and generous, nourishing, but easily digestible diet are essential to sustain the patient's strength in the severer forms of the disease. Healthy children ought to be removed from the vicinity. Mumgs. This is a common and painful complaint amongst children, although not confined to them only. It rages as an epidemy in some seasons, especially amongst the poorer population in low, MUMPS. 181 damp districts. It is usually attributable to cold or to check of perspiration, and the like, and is commonly of more frequent occurrence during the prevalence of keen easterly winds. The affection commences in the form of a small, hard, and rather painful swelling occupying the locality of the gland below the ear (the parotid). It occasionally affects only the gland of one side, but more frequently those of both. The swelling speedily increases in size, and often extends to the gland beneath the angle of the lower jaw (the maxillary). But in its ordinary character it pos- sesses no alarming features, and will generally pursue a course of about four days, and then harm- lessly subside. It is not, however, very unfrequent for the symptoms of the disorder to change their seat from the glands above specified to those of the groin, &c., in males, and to those of the breasts in females. Sometimes, also, the swelling of the parotid gland will, in cases of high inflammation, run on to suppuration, or the formation of matter (abscess), which may, on ripening, discharge in- wardly, and cause suffocation by the entrance of the matter into the windpipe. The glands in other parts of the body sympathetically affected, or affected by a transference of the complaint from the jaws and throat, are also liable to a similar discharge. When the swelling of the glands be- low the ear and jaw becomes suddenly suppressed, 182 MUMPS. and the brain appears affected, or the respiration impeded, danger is to be apprehended. In common cases there is only a mild degree of fever or other signs of constitutional disturbance. TREATMENT. MERCURIUS may be reckoned specific in most cases. One dose of two globules will, in general, suffice to confine the disorder to a regular and harmless course ; but it will sometimes be necessary to repeat the same dose after an interval of twenty-four to forty-eight hours. When there is a very sudden disappearance of the swelling of the glands in the neck, we may look for more serious phases of derangement ; and in these instances we not uncommonly find more heightened fever, accompanied by delirium, and other symptoms indicative of complication of the brain. Such cases are fraught with danger, and ought, therefore, to receive professional aid. Belladonna, Aconitum, Hyoscyamus, &c.., are the remedies usually required. When the swelling of the glands assumes an appearance similar to ery- sipelas, or becomes excessively red and tumefied, Belladonna is the preferable remedy; and in case of its failing to subdue the inflammatory sym- ptoms, Hyoscyamus may be administered. It is necessary to protect children who are suffering from mumps against exposure to sudden chills, or changes of temperature, draughts, and VOMITING OF MILK. 183 the like. The neck and the sides of the face should be bound with flannel or worsted, and the patient should be confined to a well-ventilated, moderately warm apartment. Vomiting of Milk. Intolerance of ' Milk. There are few infants who, in sucking, are not apt to overload the stomach, and, subsequently, to regurgitate a portion of the milk which they have swallowed. This occurrence, in place of being looked upon as a disorder, should be regarded as a healthy effort of nature to prevent that dis- turbance which would otherwise accrue from the retention of a larger quantity of food than is suitable to the digestive powers. When, however, the regurgitation assumes the form of vomiting, and takes place to such an extent, that the greater part of the contents of the stomach are returned after every meal, it can, of course, no longer be. looked upon in the light of a normal circumstance, and will, if unchecked, lead to serious conse- quences. This irritability of stomach, under the stimulus of milk, sometimes comes on suddenly, after the infant has previously appeared to be in a thriving state, and is still more prone to manifest itself in children who are reared by the hand on cow's 184 INFANTILE DYSPEPSIA. milk, than in those who are nourished from the breast. TREATMENT. When the derangement does not proceed from any faultiness in the milk, it may frequently be overcome by the medium of appro- priate medicine. ^ETHUSA CYNAPIUM is deserv- ing of especial notice in such cases. One globule of this remedy may be given morning and evening for the first two days : then daily, or only every other day, according to circumstances; lengthening the intervals as the irritability of stomach di- minishes. Arsenicum, Bryonia, Cuprum, &c., may answer better in some rarer instances. Infantile Dyspepsia, or Indigestion. Weaning- Brask, or Scour. This important and very frequent derangement is more commonly met with in infants who are reared by the hand than in those at the breast. When it occurs in the last-named instance, it almost invariably arises from some unwholesome property of the milk. The infant, in such cases, will take the breast readily enough, and even with avidity; generally, indeed, it never seems satisfied but when sucking, and yet, in lieu of deriving any benefit from these frequent applications to the INFANTILE DYSPEPSIA. 185 breast, it becomes more and more fretful, and at length exhibits marked outward signs of ill-health. The face becomes pale and haggard-like, the body emaciated, and the stomach and bowels so irritable, that the milk is either thrown up soon after it is swallowed, or it is passed by the bowels in an undigested, curdled condition. Flatulency, griping, and obstinate, debilitating diarrhoea su- pervene, and the child, if unrelieved, sinks ex- hausted in a few weeks. Indigestion proceeding from indigestible food, or from over-feeding, is, as already stated, very liable to occur in spoon-fed infants. It is also very fre- quently excited at the period of weaning, and has accordingly received the appellations of "weaning brash" and "weaning scour." This variety of indigestion is generally ushered in by purging ; the stools being commonly of a grass-green or greenish-yellow colour; but, at other times, they are light or clay-coloured, and are fre- quently alternated with constipation. Sooner or later, frequent vomiting of the contents of the stomach, sometimes intermixed with bile, super- venes. The child is continually restless and fret- ful, and ever looks as if in a state of suffering. There is thirst, with aversion to food ; distension of the belly, coldness of the feet and legs ; little or no fever, but a disposition to heat and soreness of the mouth, or formation of small white specks 186 INFANTILE DYSPEPSIA. on the inner surface of the lips, cheeks, &c. (Aphtha, Ajohthom Ulceration], dryness and harshness of skin, feebleness and emaciation. These symptoms go on increasing in intensity until the vital energy is worn out by their depressing influence, or the child is carried off by the development of inflam- matory action and intestinal ulcerations. TREATMENT. In the indigestion of suckling, or that which occurs in infants at the breast, speedy recovery will, in most cases, take place under the substitution of a good nurse of sound constitution, or of appropriate artificial feeding, for the faulty nutriment which has originated the derangement. But when the disturbance produced is already considerable, or if the child does not rally soon after the removal of the exciting cause, the aid of medicine is required, and will materially expedite recovery where such a prospect can be entertained. If the child is much reduced, and there has been much purging, also if symptoms of biliary de- rangement are superadded, one globule of Cinchona should be given morning and evening for the first day, then daily for the next two, and subsequently every other day, until signs of improvement become manifest. If vomiting, acidity, griping, and flatulency threaten to set in with renewed violence after the substitution of artificial food, one globule of Pul- INFANTILE DYSPEPSIA. 187 satilla may be given, and repeated after twelve hours, care being taken that the quantity of food given is not excessive, or its quality unfitted to the weakened digestive powers of the infant. Ipecacuanha and Arsenicum are sometimes required after Pulsatilla; the former when vomiting pre- dominates ; the latter when both vomiting and purging are excessive, and the child much ex- hausted and emaciated. In deranged digestion, induced by improper food indigestion of weaning, if the progress of decay is not too far advanced, or no organic disease has been developed, a cure will, as in the former case, be accomplished by the withdrawal of the main source of all the mischief. The im- proper food ought, therefore, at once to be cor- rected : or the quantity reduced, if that has been too great. At first, asses' milk, or cows' milk, which has been previously boiled, and diluted (one part of water to about three of milk), with chicken- broth, or weak beef-tea or mutton-broth, free from fat, may be substituted for food of a more generous and stimulating or indigestible nature than that with which the infant has been dieted. If there is much thirst, barley-water, rice-water, thin arrow-root, or, still better, pure cold water, may be given in small quantities at a time. The ho- mcEOpathic remedies that are the best adapted to facilitate recovery, and without the aid of which, 188 INFANTILE DYSPEPSIA. indeed, recovery is sometimes hopeless, are prin- cipally Chamomilla, Pulsatilla, Mercurius, Ipeca- cuanha, Arsenicum, Nux vomica, Cinchona, Sulphur, Phosphorus. In the milder forms of the complaint, or when the derangement has only been a few days in existence, Chamomilla, Pulsatilla, Ipecac., and Nux v. are, commonly, the most frequently indicated. CHAMOMILLA is chiefly required where there is hardness and fulness of the belly, severe griping, with drawing up of the legs ; constant crying, great restlessness and peevishness ; acidity, flatulence, frequent purging, the stools being of a deep grass-green or very yellow colour, or whitish- yellow and frothy, sometimes resembling beat-up eggs, and of an offensive odour, often like that of rotten eggs ; occasional sickness, [the matter vo- mited being more or less of a bilious description ; thirst, want of appetite. PULSATILLA is indicated where there is less restlessness and peevishness than in the preceding instance, and little or no thirst, but complete loss of appetite, with acid or otherwise disagreeable risings, or disposition to vomiting of the contents of the stomach, frequent stools of a greenish, bilious description, or watery, slimy, and at times of a light or whitish colour. IPECACUANHA is a most valuable remedy when the affection occurs in the autumnal season, INFANTILE DYSPEPSIA. 189 but is at all times an important medicine when copious vomiting forms a more prominent feature in the case than the purging ; or when there is both vomiting and purging, the substance ejected from the bowels being chiefly of a greenish-yellow colour, and not unfrequently bearing some simi- litude to matter in a state of fermentation. MERCURIUS is required when the alvine dis- charges are very frequent, but generally scanty, and attended with painful straining ; also when small white ulcers (Aphtha., ThrusJi) make their appearance on the inner surface of the lips and cheeks, or on the tongue, &c. ; and when, with less flatulency, most of the symptoms mentioned above under Chamomitta are present. Nux v. The interposition of constipation, or alternate states of costiveness and relaxation, with loss of appetite, regurgitations, or vomiting, flatu- lency, acidity, excessive irritability, great feeble- ness, and soreness of the mouth, or formation of small white ulcerative specks or spots, give occasion for the employment of this remedy. Bryonia is occasionally of service when Nux v. is insufficient to remove the constipation; but Sulphur is generally still more effective here. (See SULPHUR.) After the employment of one or more of these medicines, but sometimes even at the commence- ment of the treatment, when the debility induced 190 INFANTILE DYSPEPSIA* by the protracted purging is very considerable, CINCHONA may be used with advantage. The ^symptoms which, in addition to the consecutive weakness, chiefly point out its applicability, are flatulency and flatulent distension of the belly, thirst, want of appetite ; copious and frequent watery evacuations; the bowels are generally moved immediately or soon after a meal, and usually con- tain particles of undigested food. If Cinchona only partially relieves the aforesaid symptoms, FERRUM may then be administered. In cases of a more ad- vanced or serious description than those for which the medicaments hitherto mentioned are the more applicable, ABSENICUM is, generally speaking, the remedy on which the most reliance is to be placed where there is any prospect of effecting a cure. It is, like Ipecacuanha, more frequently required when the derangement of stomach and bowels occurs during the autumnal season, but may be resorted to under any circumstances, when the affection presents the following features: Extreme emaciation and weakness, sunken cheeks, pallid face, blue-encircled eyes; fulness of stomach, coldness of the extremities ; watery, slimy, green- ish, or dark-coloured stools ; constant whining ; great restlessness and sleeplessness; no appetite, but excessive thirst, with desire for very little liquid of any kind at a time, and increase of the diarrhoea after drinking ; great irritability of stomach and INFANTILE DYSPEPSIA. 1Q1 bowels, the food being often rejected from the stomach soon after it has been swallowed, or passed by the bowels in an undigested state. Cinchona is sometimes required after Arsenicum ; but all depends upon the nature of the symptoms, and any of the other remedies must be selected in preference, if better indicated. SULPHUR is often serviceable in completing the cure, after the pre- vious employment of other medicaments, but especially such as Pulsatilla, Nux v., and Mercurius. In other cases, Calcarea or Phosph. may be required. When there is great tenderness of the belly to the touch, or when the derangement has existed several Aveeks, organic disease is very liable to be induced. Medical aid should be sought in all cases which do not soon yield to the medicines employed, after the removal of the apparent exciting cause of the disease. Gentle friction with the warm hand, or the application of hot flannel or warm fomentations to the belly, are often soothing when there is much flatulence or griping. ADMINISTRATION OF THE MEDICINES. In general cases, three globules may be dissolved in six teaspoonfuls of water, and a teaspoonful given every four hours; and so on, lengthening the intervals, however, as soon as improvement sets in, or changing the remedy, if required by the alteration in the symptoms. 192 COLIC, Colic. Griping. By the above appellations are here meant severe griping pains in the abdomen (belly), not ori- ginating in inflammation. In children, they very generally proceed from indigestion, but may also be induced by exposure to cold, and by mental emotion. TREATMENT. When the derangement has been induced by indigestible food, such as rich animal food, gravy, pastry, fruit, or crude vegetables, and is attended with flatulence and inclination to vomit, or with relaxation of the bowels, Pulsatitta is, commonly, the most effective remedy. (Ipeca- cuanha is sometimes required after, or in alternation with PuUatilla, particularly when indigestible animal food, such as veal or pork, has produced the disorder.) When it has arisen from over-feeding, combined with deficient exercise, and is attended with flatulence, or with inclination to vomit, or vomiting, and obstinate constipation, Nux v. is more appropriate. And when exposure to cold, or a fit of passion, has developed the attack, Chamomilla is generally of speedy efficacy, par- ticularly if there is looseness of the bowels, with flatulent distension, great restlessness and irri- tability of temper. When the affection is associated WEANING. 193 with worms, Cina, Nux v., &c., are the most useful. (See Invermination.) When it occurs in infants at the breast, or in those who have not long been weaned, or who are being reared by the hand. (See Indigestion.) The application of warm flannels or warm fomentations to the stomach often exerts a soothing influence during the attack. The diet should be very light for some days after the disturbance ; and the exciting cause avoided, for the future, as carefully as possible. WEANING. Some particulars which require to be attended to during the process of weaning, have already been alluded to in another part of this work. Temporary derangement of the digestive functions is the disorder which most children are liable to at the epoch in question, and this derangement may easily be confirmed by want of proper pre- cautions. This peculiar susceptibility to indiges- tion, at the juncture of weaning, is attributable to change of diet simply ; and it is by no means to be conceived that the diet will permanently dis- agree with the infant, because, upon first trial, some such symptoms are manifested. It is highly necessary, however, to mark the effects of each particular article of food after the repetition of a 13 194 BOWEL COMPLAINTS. few days ; and in case no improvement be observed with any one species of diet more than another, medicine must be resorted to. Amongst the remedies which will be found the most appro- priate we may in this place simply name Pul- satilla, Nux vomica, Chamomitta, and Ipecacuanha, and refer the reader to the article on Indigestion of Infants for the particular indications which regu- late their selection. When restlessness, or great excitement, sleeplessness, and fretfulness set in immediately after weaning, without any signs of deranged digestion, or before these have become established, a globule of Coffea may be given. In default of improvement, a globule of Belladonna may then be administered, and repeated after a few hours. Bowel Complaints. Diarrhoea. Looseness of the bowels may be occasioned, in children, by disagreement of the food, over-feed- ing, cold, sudden emotions, &c. &c. In infants it is not very rarely occasioned by the mischievous practice of administering aperients, and even powerful purgatives, with the object of clearing the body of the dark-coloured matter, technically known by the name ofmeconium, that collects in the large intestine of the child during the last BOWEL COMPLAINTS. IQ5 month or two of its uterine being. And even in children of a more advanced age, bowel com- plaints are, unquestionably, not unfrequently to be attributed to irritation of the mucous lining by the reiterated employment of aperients. Their active use, or rather abuse, during the existence of the affection, is, moreover, not an uncommon cause of its protraction, not to say its fatal ter- mination. Diarrhoea is a common attendant upon other diseases, and is, consequently, very frequently a mere symptom, the primary malady consisting in some inflammatory affection. In this place, however, it is purposed to treat of this derange- ment as a simple functional disorder originating in various sources, and presenting the variety of features detailed under each of the subjoined me- dicines. It may be, briefly, premised that, in the case of infants at the breast, the motions generally average in number from four to six in the course of twenty-four hours ; but they may be more fre- quent, or, on the other hand, they may be less so in perfectly healthy infants. After the first ten or fourteen days they should present the usual normal colour (not unlike well- mixed mustard, sometimes with a few isolated white specks), and possessing no other than a slightly sour smell. Excessive frequency, foul odour, and unnatural hues and consistence, such as green and watery, or yellow 1Q6 BOWEL COMPLAINTS. and watery, white and frothy as if fermented, brown and frothy, or dark, like pitch, sometimes mixed with slime, or consisting wholly of slime (mucus), accompanied moreover by evident signs of pain and flatulence, must be regarded as unmis- takeable indications of derangement. In children of a more advanced age, but also in infants, the tongue is loaded, either white or yellow, and some- times red at the tip or sides ; the appetite is fas- tidious, fitful, or absent ; thirst generally prevails ; and the abdomen is often more than naturally warm to the touch, and usually either distended or lumpy at the commencement of the attack. TREATMENT. CHAMOMILLA is one of the most invaluable remedies in the treatment of the diseases of children, and particularly in bowel- complaints, whether arising from acidity, irritation caused by indigestible food, excited by a chill, or occurring during teething when the following symptoms are apparent : redness of the face, or of one cheek, hardness and fulness of the belly, attended by severe colic, which is indicated by a state of peevishness, restlessness, constant crying, and drawing up of the legs towards the stomach ; sickness, and risings, which are sometimes so acrid as to excoriate the lips ; yellow furred or red and parched-like tongue; aphthae; thirst; frequent evacuations, of a bilious, watery, slimy, or frothy BOWEL COMPLAINTS. 197 description, of a whitish, yellowish, or greenish* colour, sometimes containing undigested food, or bearing a resemblance to chopped vegetables or to beat-up eggs, and of an offensive odour, occasion- ally similar to that of rotten eggs ; soreness or rawness around the fundament. ADMINISTRATION. See page 202. RHEUM is another remedy of great utility in the treatment of this affection, provided the dis- order has not been actually excited by frequent use of this medicine itself in allopathic doses, in which case it will be necessary to have recourse to Pulsatilla, CAamomilla, or Mercurius, as antidotes, according to the nature of the symptoms. Rheum is particularly appropriate when acidity or bilious derangement has been generated by indigestion, or has arisen from the prolonged use of antacids, such as magnesia, &c., and when there is flatulent distension of the abdomen, colic, crying, restless- ness, straining before and after the evacuations, which are either of the consistence of pap, or watery and somewhat slimy, occasionally of a * Green-coloured stools are, generally, the product of acidity, and they have very commonly a strongly acid smell. Dark, or even black, offensive motions are often connected with deranged liver; and those which are pale, clay-like, or of a very white colour, are frequently to be assigned to deficiency or absence of bile, but sometimes to a more serious cause. Diarrhoea with white evacuations is, indeed, usually very inveterate, if not dangerous. 198 BOWEL COMPLAINTS. grayish or of a brown colour, and when the stools have a very acid odour, and a sour smell is emitted from the body of the infant. It is sometimes necessary to give Chamomilla, after Rheum, to com- plete the cure ; in other cases, and particularly those of an obstinate character, Magnesia c. is more efficacious. PULSATILLA. Diarrhoea arising from indi- gestion, or from a chill, with watery, slimy, whitish, or bilious, greenish, chopped-looking evacuations, occurring chiefly at night; foul tongue, headache, sickness, acidity, want of appe- tite, flatulence, and fretfulness ; chilliness, with shivering or shuddering, or alternate heats and chills. It is, further, often efficacious, under similar conditions, when fright has been the exciting cause, and Opium has not sufficed, or has been administered too late to procure relief. IPECACUANHA is very useful when, from a sudden change of food, which the stomach is unable to digest, the following symptoms result : bilious derangement, with repeated attacks of vomiting ; paleness of the face ; frequent crying ; diarrhoea, with stools of a bilious, slimy, or greenish yellow, sometimes blackish, or streaked with blood, and of a putrid odour ; on other occa- sions, evacuations resembling matter in a state of fermentation, or containing substances like white flocks or flakes, followed by slight straining. BOWEL COMPLAINTS. 1Q9 When this remedy is insufficient to effect a com- plete cure, we should have recourse to Pulsatilla; or to Arsenicum, should the vomiting increase. (See Arsenicum.) MERCURIUS. This medicine will be found very serviceable in cases where the irritation has arisen from a chill, &c., and the following symptoms present themselves : watery and co- pious, or slimy and scanty, or bilious stools (some- times streaked, or mixed with blood), of a blackish, greenish, or whitish-yellow colour: frothy, or having the appearance of beat-up eggs, and of a very sour or fetid smell, attended with severe colic, nocturnal sweats, and frequently also severe straining and protrusion of the last intestine; diarrhoea, with soreness of the fundament, or redness of the whole body, as from general excoriation ; aphthae,* salivation, eructations, sick- ness, shivering, and languor. Nux VOMICA is often useful in cases arising from a chill, or from indigestible food at the period of weaning, or earlier; it is also, like Pulsatitta, useful in some cases in which the disorder has been created by the frequent em- ployment of powerful laxative medicines. Its indications are: very frequent but scanty evacuations of watery, slimy, whitish or greenish * Small white ulcers. 200 BOWEL COMPLAINTS. stools, attended with white or yellow furred, or red- tipped tongue, headache, nausea, risings, sickness, acidity, flatulence, colic, and straining, sometimes followed by protrusion of the intestine ; extreme fretfulness. This medicine is also of great service, in many cases, when the diarrhoea alternates with constipation, and when portions of undigested food are sometimes observable in the stools. BRYONIA is a useful remedy in cases of diarrhoea, with aggravation after a meal, and passing of the food by stool undigested ; or with dark-coloured motions, which recur whenever the weather becomes very warm ; also when looseness is alternated with constipation. (Carlo v. may be found efficacious, when only temporary benefit results from Bryonia, in diarrhoea during the heat of summer.) ABSENICUM. This medicine becomes indis- pensable in neglected cases, or in those at an advanced stage of the disorder, when there is reason to fear that it will terminate inwasting. The following are its characteristic indications : watery or slimy stools, sometimes with portions of undigested food, mostly profuse, of a greenish, whitish, dark-brown or blackish colour, and of a putrid odour, taking place chiefly during the night, or after drinking or partaking of any kind of food, often preceded by crying and restlessness, and fol- BOWEL COMPLAINTS. 201 lowed by exhaustion or tendency to faint in chil- dren of a more advanced age ; great thirst ; foul or vivid red tongue ; sleeplessness ; paleness of the face ; sunken cheeks ; blue circles round the eyes ; enlargement of the abdomen, with extreme weak- ness and excessive emaciation. In diarrhoea with periodical exacerbations, and in that which is attended with vomiting and resembles cholera, Arsenicum is one of the most valuable remedies. LACHESIS is sometimes of much service after Arsenicum or Mercurius, or indeed in preference to these remedies, when, in addition to most of the symptoms thereunder mentioned, the looseness, &c., is invariably worse after sleeping, and the stools are generally of a pale or whitish colour, or tenacious and like pitch ; also when, as with Bryonia and Nux v., constipation alternates with diarrhoea. SULPHUR is an invaluable remedy in some protracted cases, or in those occurring in children who are the offspring of delicate parents, when there is great weakness, emaciation, distension of the abdomen, redness or soreness of the anus, and excoriations between the thighs and neigh- bouring parts, or a sort of miliary eruption over the whole body. (Calcarea is sometimes required to complete the cure after Sulphur. In other cases, Phospk., &c., may be required. See also Indigestion of Infants.} 202 BOWEL COMPLAINTS. CINCHONA is of considerable service against the debility which remains when the diarrhoea is checked ; but it is also useful in the disease itself, particularly when it has been caused by eating fruit or green vegetables, or when the complaint has become inveterate, and is attended with thirst, excessive flatulence, loss of appetite, and great weakness ; also when the alvine discharge is apt to take place immediately after a meal, and con- tains food in an undigested state, or occurs especially during the night, the stools being copious, slimy, frothy, or watery, or of a blackish or dark-brown, or a very yellow colour. When febrile symptoms suddenly make their appearance during diarrhoea, Aconitum should be resorted to. (See Inflammation of Stomach and Bowels.} ADMINISTRATION OF THE MEDICINES. Six globules, of the remedy selected, may be dissolved in an ordinary-sized wineglass of water, and a teaspoonful of the solution given, in severe cases of recent standing, every half hour until three doses have been given : after which the intervals between the doses may be lengthened to every three, and then every six hours, and so on. In less serious cases, as well as in those of long standing (chronic diarrhoea), it will be sufficient to give a teaspoonful thrice a day, or only morning and evening. To very young infants it will be sufficient to introduce a drop or two of the medi- BOWEL COMPLAINTS. 203 cine, in solution, into the mouth, for each dose. Whenever a different remedy becomes clearly indicated, it may at once be resorted to. But it is far from commendable to fly from one remedy to another without sufficient reason, or to change the medicament without allowing a reasonable time for the manifestation of its favorable effects, when no improvement follows the first few doses. (See Rules for the Administration and Repetition of the Dose.} In stupor occurring in children from the de- pleting effects of neglected or protracted diarrhoea, China and Arsenicum in alternation are sometimes of considerable efficacy. Light supplementary nourishment ought at the same time to be given in the case of infants at the breast ; and diet of a nutritive quality to children of more advanced age. But such, and all obstinate cases are beyond the sphere of domestic treatment. DIET AND REGIMEN. As the same dietetic regulations given under the head of Cholera of Infants are equally suitable here, the reader is referred thereto. The diet of children who are subject to diarrhoea ought at all times to be of a somewhat restricted nature. With those who are old enough, mutton is the best animal food ; young meats, particularly veal and lamb, are less digestible; fish is objectionable, being, perhaps, still 204 CHOLERA OF INFANTS. more liable to disagree than the last named. Unripe or acid fruits, and most vegetables, but especially potatoes, should be avoided. The clothing ought to be warm, and a flannel roller or bandage may be worn with advantage round the stomach. Wet feet ought to be guarded against; and fine woollen stockings, with thick shoes, should be worn. During the attack, friction, and the application of warm fomentations to the abdomen (belly) sometimes exert a beneficial influence. Change of air, combined with attention to the above-mentioned precautions, materially aids in warding off returns of the disease. When, notwithstanding the employment of these preven- tive measures, relapses still recur, a course of medical treatment becomes necessary. Cholera of Infants. In the autumnal season, infants are very liable to be affected with a sudden invasion of vomiting and purging, unconnected with teething or wean- ing, and which is sometimes of so violent a character, and so rapid in its course, as to prove speedily fatal if not timely subdued. The majority of cases are not of quite so serious a nature, still it is of importance to give early attention even to those of a milder type. The disease sometimes sets in with purging CHOLERA OF INFANTS. 205 alone, the stools being generally green, but occa- sionally white or yellow. Vomiting, when it does not set in spontaneously with the purging, is early superadded, and frequently exists to such an extent that nothing can be kept on the stomach, the food being constantly rejected from the stomach immediately or soon after it has been swallowed. In some instances, remissions of longer or shorter duration take place; or the purging ceases, but the infant remains, even during these intervals, in a feverish, restless, and otherwise sickly state ; the features look sharp, the face pale, and the eyes sunk, half closed, and surrounded by a livid circle ; fits of drowsiness supervene, but the child is easily roused, and cries much when disturbed. In protracted cases, the child becomes excessively emaciated, the pulse slow and feeble, the limbs cold, and the child gradually sinks exhausted after three or four weeks of suffering, or is rapidly cut off by a sudden exacerbation of the complaint. TREATMENT. In general cases, Ipecacuanha, Veratrum, Secale cornutum, and Arsenicum, are the remedies which are best adapted to arrest the disease. IPECACUANHA is, commonly, the most appro- priate in the milder variety, "or in those cases where the vomiting predominates. VERATRUM corresponds to the more violent 206 CHOLERA OF INFANTS. and dangerous form of the complaint, when the vomiting and purging are equally severe, and when there is insatiable thirst and considerable debility. SEC ALE CORNUTUM if there is predomi- nant diarrhoea, constant crying or whining, with doubling and twisting of the body, great weak- ness, and aphthous* state of the tongue. ARSENICUM is more particularly useful in delicate or scrofulous children. It is chiefly called for when the prostration of strength is extreme, the vomiting and purging incessant, the thirst intense, but the sufferings apparently aggravated by drinking even the smallest quantity ; further, when the evacuations are putrid, and are preceded by severe griping, with piercing cries, and when there is coldness of the extremities and even of the tongue. Veratrum is sometimes required after, or in alternation with Arsenic-urn, when the latter fails to put a speedy check to the vomiting and purging. CHAMOMILLA may be serviceable in slight attacks, when diarrhoea predominates, and the motions are of a deep green colour, but the weak- ness not excessive. ADMINISTRATION OF THESE MEDICAMENTS. Six globules in an ordinary-sized wineglassful of water, a teaspoonful every half-hour, every hour, or only every six hours, according to the urgency * Thrush-like. Ulcerated. CHOLERA OF INFANTS. 20? of the case ; lengthening the intervals as soon as improvement sets in. In protracted cases, inflammation and ulcera- tion are liable to ensue. When the complaint does not promptly yield to the above-named remedies, assistance should be sought. If considerable weakness continues after the subjugation of the vomiting and purging, one globule of Cinchona may be given morning and evening for from two to four days. (See also Diarrhcta.} The little patient should be kept as warm as possible when there is any tendency to coldness of the extremities. Friction, performed under the bed-clothes, or before the fire, often assists in restoring the obstructed circulation. DIET. In the severer forms of the affection, barley- or rice-water, to which a little pure sugar has been added, or thin arrow-root made with water, may be given, in teaspoonfuls at a time, to children who have already been weaned, as soon as the stomach is capable of retaining a little nou- rishment. In the milder varieties, and in the first named, when a favorable change takes place and appetite returns, arrow-root, and then chicken- broth, or well-boiled rice moistened with water or with light gravy, if the digestive powers will allow of this latter addition. For children at the breast, it is sometimes necessary to dilute the milk with 208 INFLAMMATION. a little water, before it can be borne by the highly irritable stomach. Inflammation of the Stomach and Bowels. Inflammatory affections of the stomach and bowels, particularly of the latter, are sometimes so insidious in their invasion and progress as to lead to a fatal result without giving rise to any suspicion of their having been in existence. The following are some of the more striking evidences of their pre- sence. Prostration of strength early in the career of the child's indisposition ; heat of the skin, but especially of that part which is over the seat of the inflammation, with concurrent excessive fulness, tension and tenderness of the stomach and bowels ; sometimes fulness and quickness, but more fre- quently smallness and quickness of pulse ; occa- sionally constipation, but oftener purging, the stools being generally very green, or thin, yellow, and frothy ; vomiting, sometimes of feculent matter; dryness and redness of the tongue or of its tip and margins ; intense thirst, usually accom- panied by an increase of suffering after cold drinks; obstructed or scanty and high-coloured urine ; anxious, sunken countenance ; rapid and impeded respiration; sometimes dry irritating cough, unattended with any signs of inflammation in the chest ; lastly, cr} r ing and starting during INFLAMMATION. 209 sleep, heat of head, intolerance of sound and of light, spasms of the extremities, or convulsions. The child generally lies on its back, with its limbs drawn up, is very restless or uneasy, yet averse to movement. TREATMENT. When the inflammation runs high, or is attended with marked febrile symptoms and obstructed or scanty and high-coloured urine, six globules of Aconitum may be dissolved in an ounce of water (about two tablespoonfuls), and a teaspoonful of the solution given every three to six hours, according to the urgency of the case. As soon, however, as the temperature of the body becomes lowered, or a greater or less degree of moisture appears on the surface, the medicine must be discontinued, and another remedy selected soon afterwards, if required, in accordance with the remaining symptoms. If, in addition to the symptoms above enumerated, there is heat of the head, with congestion or fulness of its vessels ; a wild or fixed look, and intolerance of light; cries and startings during sleep; great acceleration of pulse ; thirst ; vivid red margins and tip of the tongue ; convulsive movements of the limbs ; extreme tenderness and distension of the bowels, causing the child to wince and scream under the pressure of the hand ; w r ith or without vomiting ; and the bowels either confined or relaxed, the 14 210 INFLAMMATION. motions, in the latter case, being greenish or whitish, Belladonna should be administered, in alternation with Aconitum, every two to four hours, or given alone, in the same way as described after Aconite, when the febrile symptoms are less decided.* In slighter cases, or in those where the head is less involved, but the bowels more irritable, the stools being frequent, of a deep green, or watery and very yellow or whitish, the fundament red, or as if excoriated ; the bowels excessively inflated ; with more or less tenderness on pressure; thirst; dryness of the mouth and tongue ; extreme restlessness and peevishness ; startings during sleep, or sudden cries, and some tendency to convulsions, Chamomilla is of much utility. Again, when there is diarrhoea with painful straining, with green or frothy stools sometimes mixed with blood, hardness and fulness of the belly, and the appearance of aphthae (small circular white ulcerations) in the mouth, or around the outlet of the last intestine (funda- ment), Mercurius is of considerable service. Lastly, Nnx v. may be named as a useful remedy, either after the previous employment of Aconite, * When the symptoms are aggravated by cold drinks, or, as is frequently the case, the child will only partake of warm fluids, a drop or two of tepid water may be added to each spoonful of the medicine ; or, particularly when the stomach is very irritable, the medicine may be administered undissolved, one globule being given at each dose. INFLAMMATION. or independently of that remedy, when there is flatulent distension of the stomach and bowels, obstinate constipation, excessive debility, thirst, foulness of the tongue, with redness of the tip and margins ; Lachesis when Belladonna or Mercurius have either failed to relieve, or have effected only partial or temporary improve- ment ; Opium when there is vomiting of feculent matter, provided Belladonna or Nux v. are not better indicated by the other symptoms; and Arsenicum when there is extreme irritability of stomach and bowels, dryness and redness of the tongue, intense thirst, vomiting and purging im- mediately after drinking, coldness or livid colour of the skin, quickness and extreme weakness of the pulse, and entire prostration. But these latter, and indeed most cases of this disease, ought, when possible, to be placed under medical observation, particularly when they do not speedily improve under the action of the medicine administered. Warm fomentations to the abdomen are often soothing. Immersing the child, when not too enfeebled, up to the ribs, in a tepid bath, for half an hour, is also of some service. DIET. When the inflammation is severe, or affects the upper part of the alimentary canal, the stomach is so irritable that almost everything introduced into it is speedily rejected; but as 212 INVERMINATION. soon as these and other acute symptoms have been overcome, the lightest nourishment, such as rice-, barley-, or gum-water, slightly sweetened, may be given, in the quantity of a teaspoonful at a time, and cold in preference to warm, at the com- mencement. Light broths, particularly chicken- broth, may then be essayed, and, subsequently, in the case of children who are old enough, well- boiled rice moistened with broth, or a little gravy, especially that of roast mutton ; and so on, gradually increasing the quantity and altering the quality of the food as improvement advances, taking every possible care never to overtax the weakened digestive powers. Invermination. Worms. It is often difficult to determine the existence of worms in the alimentary canal. The popular idea as to the symptoms which indicate their presence is founded upon evidence which can but be regarded as demonstrative of irritation of the lining membrane of the stomach and bowels. Nothing, indeed, can be received, with certainty, as confirmatory of their existence but their ejec- tion, and ocular testimony of the fact. SYMPTOMS. The symptoms which ought, at INVERMINATION. 213 all events, to excite suspicions as to the existence of worms, are : paleness and emaciation ; pungent wringing, and fitful pain about the navel and pit of the stomach ; irritation and itching, with heat of the posterior passage, and irregular action of the bowels ; fastidious appetite ; irritation of the nose ; excessive faintness, and a sense of hunger without inclination to eat when food is produced; uneasiness ; depression of spirits ; languor ; rest- lessness and anxiety. The brain and lungs are often sympathetically affected ; and dull or pressive aching pains in the head, convulsions, dilated pupils, fixed, wild look, and a dry, hacking cough, often prevail ; or there may be vomiting, hiccup, diarrhoea, straining, suppression of w r ater, diffi- culty in passing water, grinding of the teeth, and starting during sleep. Frequently there is aggra- vation after eating sweets, milk diet, salted meats, raw fruit, &c. ; and often a sudden disappearance of all the symptoms on the voiding of worms. There are three species of worms the thread- worm, the round worm, and the tape-worm. There are two varieties of thread-worms, viz., the long thread-worm and the short thread-worm. The former chiefly inhabits the large intestines, is about two inches long, of a white colour, and resembles a thread. The latter, the ascaris, or ascarides as they are usually denominated, also occupy the large intestines, but are more fre- 214 INVERMINATION. quently located in the last intestine, where they generally create an almost insupportable itching ; and are frequently to be seen, like minute ani- mated fragments of thread, rapidly moving about in the recently passed evacuations ; or they may be observed in congregated numbers around the fundament, and are sometimes even found in the bed in which a child much infested by them has slept. Tape-worm is rarely met with in children. The varieties which give rise to the greatest constitutional disturbance are the round worm and the short thread-worm, particularly the latter. When the symptoms originate from the round worm, they commonly consist in griping about the navel, excessive emaciation, voracious appetite, and a feeling of sickly faintness. Whilst the same indications combined with a nauseating or gnawing pain in the stomach, and more espe- cially, the itching in the nose and in the last intestine, denote the existence of ascarides. CAUSES. Anything which tends to bring about a morbid state of the mucous or lining membrane of the stomach and bowels, such as the constant or frequent use of indigestible or innu- tritions food, a residence in low-lying, damp, ill-ventilated dwellings, &c. &c., favours the gene- ration of worms. Scrofulous or otherwise sickly children are predisposed to be affected with them. INVERMINATION. 215 TREATMENT. In cases of thread-worm, when there are considerable febrile symptoms, with nocturnal restlessness, peevishness, and continual itching and smarting in the last intestine, Aconitum, for infants one, and for a child more advanced two globules may be given in a dessert-spoonful of water, and repeated about every eight hours, until the febrile symptoms subside. IPECACUANHA may be administered in the same manner, twenty-four hours after Aconite, if the bowels are in a relaxed state, and the child complains of a sense of sinking or faintness in the stomach ; also when there is vomiting, oppressed and accelerated breathing, suffocating cough, great listlessness, and aversion to exercise. The employment of Cina and Ipecacuanha in alter- nation for three or four days, is sometimes very beneficial when the symptoms consist of a com- bination of those we have mentioned under both remedies. (See Cina.} Nux v. is preferable to Ipecacuanha, when con- stipation predominates ; or when there are alter- nations of diarrhoea and constipation. ADMINISTRATION. Two globules, at first daily, for three days, and then every other day for a week. IGNATIA should generally be resorted to when Nux v. is ineffectual. Or it may be selected in 216 INVERMINATION. preference to that remedy when convulsive twitchings of the limbs frequently occur. ADMINISTRATION. Same as Nux v. SULPHUR is commonly the best subsequent medicine. ADMINISTRATION. Two globules night and morning, every eight or ten days, for a period of four or five weeks. When only temporary benefit results from the use of Snlpkur, a similar course of Silicea, and then Calcarea, may be given. URTICA URENS (one drop of the tincture in a little water on a lump of loaf sugar) is often a useful palliative against the irritation and itching of the passage, and in default of this remedy, a clyster of one dessert-spoonful of salt dissolved in one pint of water, of which from two to six fluid ounces may be injected. Against Round worm: CINA (for an infant, one globule, dissolved in four teaspoonfuls of water, of which one tea- spoonful should be administered in the morning and evening ; for a child more advanced, three globules, in four dessert-spoonfuls of water, one dessert-spoonful similarly*) when there is great itching and obstruction of the nose; perverseness; fever chills towards evening; restlessness; cries and starlings during sleep ; blackness about the eyes; dilated pupils; hard, quick pulse; rapid * See rules for the administration and repetition of doses. INVERMINATION. 21? changes of colour in the face; fits of delirium; clammy tongue; eructations or vomiting; constant craving for food; distension, heat, and hardness of the stomach; costiveness, or purging; some- times the stools consisting merely of a little mucus, which is passed after much straining ; con- vulsive twitchings of the limbs ; lassitude ; thick, whitish urine; habitual wetting of the bed at night. ACONITUM is sometimes required before Cina; and indeed before, or in alternation with, most of the remedies employed in the early stage against both varieties of worms. It may be given in the manner already described. When Cina produces only partial improvement, some other medicament must be had recourse to. Generally speaking, Mercurius and then Sulphur are the most appro- priate with which to follow up the treatment ; but Nux v. } Ipecacuanha, or Belladonna, &c., are some- times required ; in short, the choice of the remedy must here, as in every other malady, be selected as closely in accordance with the symptoms as possible. Thus MERCURIUS is more espe- cially called for when diarrhosa, with straining and bloody stools, accompanies the presence of worms ; or when the motions are scanty, consisting only of a little slime, and there is an increased flow of saliva, with much hardness and distension of the abdomen, particularly about the navel. Nux VOMICA, when there is considerable de- 218 1NVERMIXATION. rangement of the digestive functions, manifested by foul tongue, inclination to vomit, impaired appetite, thirst, tenderness at the pit of the stomach on pressure; fulness, and sensation of heat in the stomach and bowels ; constipation, sometimes in alternation with diarrhoea ; depres- sion, peevishness, and exacerbation of the sym- ptoms every morning. IPECACUANHA, when vomiting predominates, and when a continued sense of uneasiness and faintness is experienced in the stomach. Pulsa- tilla, when the symptoms nearly resemble those that have been enumerated under Nux vomica, with the distinction that they are more frequently, though not always, increased towards evening, and when there is a more constant tendency to looseness of bowels. ADMINISTRATION. Nux, Ipecac., and Puts., same as Cina, which see. BELLADONNA should be resorted to when there are marked symptoms of symptomatic derangement of the brain, or when the sympa- thetic irritation caused by worms has terminated in inflammatory action. These manifestations are chiefly as follows : starting during sleep, nocturnal delirium, disposition to be frightened or agitated by the most trivial cause ; also when there is heat of the head, headache, excessive thirst, quickness of pulse, heat of skin, wild MESENTEUIC DISEASE. 219 expression of eye and dilated pupils. Lackesis is sometimes required after Belladonna. Sufyphur, as has already been stated, is commonly required after Mercurius. It is, moreover, very frequently of service in -winding up the cure after the pre- vious use of the other medicines here named. ADMINISTRATION (i. e. of Bella.} For an infant, two globules, in four dessert-spoonfuls of water, a teaspoonful of the solution every six to eight hours ; for a child of a more advanced age, four globules, in the same quantity of water, a teaspoonful at the stated intervals. Great attention should, in all cases of worms, be paid to ventilation, exercise, cleanliness, and to the wholesome quality of the diet. Animal food should predominate, plainly roasted or boiled. Salt may be taken somewhat freely at meals; but salt meats and rich made dishes, as also sweetmeats, pastry, and the greater part of vege- tables, especially raw herbs, or roots, or uncooked fruits, are inadmissible. Mesenteric Disease. This affection, of which the immediate seat is in the mesenteric glands, may arise from, or be attendant upon, or be followed by affections of the intestinal lining membrane. Nor is it easy, in the first stage of the complaint, to distinguish when MESENTERIC DISEASE. there actually exists a disease in the mesenteric glands, or to pronounce that certain given sym- ptoms do not simply arise from irritation in the mucous membrane of the stomach and bowels. Mesenteric disease is most prevalent amongst chil- dren of strumous (scrofulous) habit of body, and has been itself classed as a scrofulous complaint. It does not appear in children until the age of seven or eight months, because the glands have not till then become sufficiently developed ; but it is of the more frequent occurrence, amongst those of a par- ticular constitutional tendency, from the third to the sixth or seventh year. Its character is clearly tubercular.* It consists in irritation of the mesen- teric glands, terminating in their enlargement, softening, or suppuration, and is very generally associated with diseased glands in the neck, or with tubercles in the lungs (tubercular consump- tion). This disease is most common amongst the ill- fed and ill-conditioned children of the poor, and especially amongst those of a scrofulous habit. Unwholesome food, combined with impure air, forms, in general, the principal exciting cause of the malady ; but it may, as already stated, follow in the wake of inflammation or ulceration of the * Tubercle a morbid product occurring in various textures of the body, in association with a peculiar and unhealthy state of the system. MESENTERIC DISEASE. 221 lining or mucous membrane of the bowels, or become developed, in children of bad constitution, after measles, or during protracted or renewed attacks of infantile remittent fever. SYMPTOMS. A slow, gradual, but regular pro- cess of emaciation, combined with tenderness on pressure, and the perception of hard and knotty swellings about the centre of the abdomen, cha- racterise the affection in its established form. There is usually a very fastidious appetite, at times exceedingly craving, at others squeamish, and, sometimes, also a strong desire for food which is of the most pernicious kind, but which, when partaken of, does not produce that aggravation of symptoms which accrues therefrom in simple derangements of the digestive organs. Consider- able induration and protuberance of the belly ensue as the limbs become more and more attenuated ; and however well nourished the child may be, he continues to lose flesh ; and marked disorder of the stomach and bowels generally supervenes. Indi- gestion and derangement of the stomach, W 7 ith white chalky stools are often observed ; and occa- sionally the presence of worms in the intestinal canal may be distinguished. When the complaint follows its usual slow and protracted course, hectic fever sets in, and the scene closes with debilitating sweats and diarrhoea ; but in more acute and rapid 222 MESENTEBIC DISEASE. cases, decided symptoms of remittent fever appear, and the child is carried off by acute inflammation of the intestines. During the progress of the ordinary form of mesenteric disease, there is extreme sensibility to cold, and a constant desire to be near the fire ; there is also a lethargic indolence and aversion to any movement, with obtuseness of the faculties, and much peevishness. Sleep is rarely much dis- turbed ; the skin is usually cold, dry, harsh, and corrugated, but becomes heated towards evening. Profuse morning sweats now breakout, particularly about the head and chest, and the pulse becomes hard and accelerated. Continuous purging then attends, and the child sinks exhausted in a state of excessive emaciation. TREATMENT. As this disease is of so serious a character, and, when fairly established, so diffi- cult to arrest, we must be excused from attempt- ing to enter deeply into the details of its treat- ment in a w r ork like the -present. Suffice it, therefore, to remark that, in the first stage of the complaint, if there be some fever, with heat of skin, tenderness of the belly to the touch, and other signs of inflammatory action, the remedies which have been enumerated under the head of Inflammation of the Stomach and Boivels, may be resorted to. DERANGEMENT OF STOMACH. 223 At a more advanced stage of the malady, when the glands in the abdomen are swollen and tender, and those of the neck or in the armpit are likewise enlarged, Belladonna, Mercurius, Sulphur, Calcarea, and Acidum nitricum, are the more generally useful remedies. And Kreosotum, Lachesis, Cinchona, Arsenicum, and Phosphoms, when the diarrhoea, emaciation, and debility are exces- sive. (See art. Diarrhoea, for some of the leading indications for these last-named medicaments.) lodium, Baryta c., Hepar, Cina, &c., are serviceable in some cases, and Phosphorus, Kali c., and Acidum nitricum, are sometimes of considerable utility when the lungs are implicated. Fomentations and abdominal frictions occasionally exert a soothing and otherwise beneficial influence. DIET. The regulation of the diet depends upon various circumstances, such as the state of the digestive functions, the strength of the patient, and so forth. In all cases it should be light, and of easy digestion. Animal broths are required in advanced stages, where there is much debility ; but if there is more or less fever, or if symptoms of some degree of inflammatory action are present, arrow-root, sago, semolina, and the like, will claim a preference. 224 DERANGEMENT OF STOMACH. Derangement of the Stomach. Under this head I intend treating of a dis- order which is of frequent occurrence in impro- perly fed children. The ordinary causes of this derangement are : hurried, imperfect mastication ; overloading the stomach ; fat, greasy, indigestible or tainted food ; flatulent vegetables ; ices ; stimulants, &c. The symptoms are so well known, that it is hardly necessary here to enter upon them, particularly as they will be more specially noted under the different medicines. TREATMENT. We may premise by enumerat- ing the homoeopathic remedies which are more especially called for by the exciting causes of the indisposition : When derangement of stomach, or a fit of indigestion, has been brought on by imperfect mastication, or by overloading the stomach, Ipecacuanha and Pulsatilla are, in general, the most useful medicines. In other cases, though less frequently, Nux v. or Cinchona are more appro- priate. When rich, indigestible food has given rise to the disturbance, Pulsatilla or Ipecac, and Carlo v. DERANGEMENT OF STOMACH. 225 When ices, or cold fruits, have been the exciting cause, Pnlsatilla, Arsenicum, Carbo v. When tainted food (meat or fish), Puhatilla^ Cinchona^ Carbo v. When salt meat, or other salted articles of food, Carbo v. or Arsenicum chiefly. And when it has arisen from vinegar or other acids, Aconitum, Arsenicum, and Carbo v., chiefly. When the symptoms of approaching stomachic derangement declare themselves immediately, or a few hours after a repast which has been too freely partaken of, a cupful of strong coffee, without milk and unsweetened, is frequently a sufficient restorative. When sick headache and inclination to vomit, or actual vomiting, and other symptoms of de- rangement of stomach, as sensation of weight and fulness in the stomach, flatulence, foul tongue, risings of food, or disagreeable and offensive eructations come on immediately, or a few hours after a repast which has been indulged in to excess, we should assist nature by tickling the throat with a feather, and by giving tepid water to drink until the stomach has completely eva- cuated its contents. If, nevertheless, on the following morning, any symptoms of indigestion remain, we may administer ANTIMONIUM CRUDUM and PUL.SATILLA alternately, by dissolving six globules of each remedy separately in an ordinary - 15 DERANGEMENT OF STOMACH. sized wineglassful of water, and giving a dessert- spoonful first of the one, then the other, every three or four hours, until relief is afforded. These medicaments are also calculated to remove the disturbance above indicated when, in addition to the symptoms of disordered stomach, a degree of fever returns every second day. IPECACUANHA is a very effectual remedy when continuous and most distressing nausea forms the most prominent symptom. Its alternate employ- ment with Pulsatilla (in the same way as described for Antim. and Puts.} is preferable in cases which have been brought on by a very hearty and hurried meal, the stomach having consequently been overloaded with imperfectly masticated food ; and also when a rash has been thrown out from the effects of a disordered stomach, attended with anxiety, oppressed breathing, and sickness, but should the difficulty of breathing, and a degree of nausea, or other uneasiness continue, BRYONIA must be resorted to. (Tartarus emeticus is some- times more efficacious than either Ipecac, or Bryonia, when great drowsiness, with constant nausea and frequent vomiting, relaxed, brownish- yellow motions, accompany the oppression.) ADMINISTRATION OF THESE MEDICINES. See the end of the chapter. BRYONIA. In addition to the usefulness of this remedy in the foregoing instance, it is also DERANGEMEN'T OF STOMACH. 22? very serviceable when the following symptoms are present : bitter eructations ; fever, alternately with coldness and shivering; or redness of the face, heat in the head, and thirst with coldness and shivering; also when diarrhoea or constipation and peevishness, or excessive irritability, are present. (In derangement of the stomach arising from dry, or from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief.) PULSATIJLLA, as has already been stated, is of much service, in alternation with Antim. c. or with Ipecac., in recent cases of disordered digestion, when a rash has been thrown out in consequence of the derangement, and when there are risings of food, foul tongue, sometimes covered with mucus ; chilliness and lowness of spirits. It is, moreover, almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastry, or even tainted meat ; or from the effects of ices, cold fruits, or crude vegetables, acid wine, &c., particularly when chilliness and depres- sion of spirits accompany the other symptoms. Arsenicum is generally preferable to Pulsatilla when the derangement has been induced by eating an ice ; but their alternate employment is often attended with great advantage when cold fruits have given rise to the indisposition. ARSENICUM : When there are acrid and bitter 228 DERANGEMENT OF STOMACH. eructations with nausea and vomiting ; also, dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the lower part of the belly, particularly when arising from the effects of an ice which had been partaken of when warm ; or from fruit, stale vegetables, or acids. It may, in many cases, be advantageously followed by Carlo vegetalilis, which see. Nux VOMICA is indicated by offensive or acrid eructations, constipation, and confused headache, particularly when arising from wine or other sti- mulants which children may have been injudi- ciously allowed to partake of; when possible, it should be taken the same night, as taken in the morning, although eventually relieving, it fre- quently causes temporary aggravation in susceptible patients. (In derangement of the stomach with heartburn, flatulence, more or less nausea and headache, &c., in consequence of a chill, or of indulging in mental or corporal exertion imme- diately after a meal, this remedy commonly affords speedy amelioration.) ACONITE : When the affection owes its origin to partaking of sour beer, vinegar, or other acids ; and particularly when there is great heat in the head, anxiety, restlessness, full quick pulse, nausea, or vomiting of mucus. When a fit of passion has produced an attack DERANGEMENT OF STOMACH. 229 of indigestion, Chamomllla rarely fails to relieve. Bryonia is, however, to be preferred when chilli- ness and shivering accompany the symptoms of derangement of stomach. CARBO VEGETABILIS, although last mentioned, is not one of the least useful remedies in this affection, and is often found very serviceable after Pulsatitta, Arsenicum, or Nux vomica, in removing any symptoms that may remain ; it is, moreover, particularly useful where great sus- ceptibility to the influence of the atmosphere, especially to cold, exists at the same time : or in sufferings arising from abuse of wine, ices, or salted meat, &c. Further, in derangement of the stomach arising from having partaken of game or fish which has been too long kept, or meat that has been recooked whilst in a state of fermenta- tion, as is liable to occur in warm weather. In the latter instances, Carbo v. is to be preferred to any other medicine, and will rarely fail to afford relief;* but if any disagreeable symptoms remain, Cinchona may be administered in a little water ; and followed, if required, by Pulsalilla. ADMINISTRATION OF THE REMEDIES. In slight cases, a single dose, consisting of three or * A small quantity of finely-powdered charcoal, in a little good French brandy, will be found an equally efficacious mode of admi- nistering this remedy as a corrective against derangement of the stomach arising from having partaken of tainted meat or fish. 230 VOMITING. four globules, in a dessert-spoonful of water, will be sufficient ; but in those of a severer descrip- tion, it will commonly be requisite to dissolve six or eight globules in two tablespoonfuls of water, and give a dessert-spoonful of the solution every three to four hours, until the symptoms begin to yield, when the intervals between the doses must be lengthened, or the medicine dis- continued. The alternate administration, when called for, has already been alluded to. DIET. A stomach which has been but slightly overtaxed, will generally recover its tone simply after a few hours' abstinence from food ; in cases attended with greater disturbance of the system, it will be necessary, in addition to giving appro- priate medicine, to enjoin a light diet, even for a few days after the removal of the symptoms. Vomiting. This may proceed from a variety of causes, and must therefore be prescribed for in accordance therewith. When it arises from excess in eating or drink- ing, Antimonium, Pulsatilla, Ipecacuanha, and Nux v. are the most useful remedies. (See Derangement of Stomach.} When from foulness of stomach, Pulsa- tilla, Nux v., Bryonia, &c. (See Indigestion of Infants, VOMITING. 231 and Derangement of Stomach.} When from affec- tions of the head, Arnica, Belladonna, Lachesis, etc. (Vid. Inflammation of 'the Brain.} See also Invermina and Colic, as either of these may prove to be the origin of the affection in particular instances. In ordinary cases, when there is uncertainty as to the cause of the vomiting, it should be pro- moted by copious draughts of tepid water when homoeopathic medicines are not at hand. But as the medicines are usually of speedy efficacy, and as they form a much more agreeable mode of giving relief, particularly to children, they should invariably be preferred, when there is no reason \vhatever for concluding that the derangement does not arise from the introduction of poison into the stomach. The medicaments which may generally be resorted to with most benefit are, Antimonium c., Ipecacuanha, and Arsenicum. Of these, Antimonium may be preferred when the tongue is covered with a white or yellow fur, Ipecacuanha when it is clean, Arsenicum when the vomiting is violent and scanty. ADMINISTRATION. Six globules of the remedy selected, in three dessert-spoonfuls, a dessert- spoonful every hour, or only every three or four hours according to the severity of the symptoms. When vomiting proceeds from weakness or debility of stomach (irritable stomach}, Pulsatilla, Nux v. } Bryonia, Cocculus, Arsenicum, Hyoscyamus, 232 VOMITING. Sulpliur, and Calcarea. Pulsatilla, is commonly of great service when the stomach is so delicate and irritable that it is only capable of retaining the smallest possible quantity of food at a time ; a transgression being invariably followed by vo- miting, attended with severe spasms, or vomiting of viscid phlegm, giddiness, diarrhoea, and even fainting. When Pulsatilla produces but partial relief, Coccnlus may be administered. If Cocculus fail to relieve, Bryonia, and then Niix v., may be given, followed in turn, if required, by Cinchona and Ferrum. Sulphur and Calcarea may wind up the cure in all obstinate cases, and Arsenicum and Hyoscyamus may be given as intercurrent remedies when the vomiting is excessively violent. ADMINISTRATION OF THESE REMEDIES. Two globules, morning and evening, in a dessert- spoonful of water, for four consecutive days. An interval of four to eight days to be allowed between the different medicines. In cases of vomiting which come on either periodically or in consequence of errors in diet, exposure to cold, &c., and in which the matter ejected consists chiefly or entirely of bile (bilious vomiting, bilious attacks], accompanied by headache, brownish-yellow tongue, bitter or nauseous taste, sometimes pain in the right side and between the shoulders, disgust at the very thought of food, Nux v,, Pulsatilla, Mercurius, Cinchona, Ipecacuanha, VOMITING. 233 Arsenicum, Veratrum, Sulphur, Calcarea. In a large number of cases, Nux v. is the most appropriate remedy, but particularly those which are liable to be brought on by sedentary habits, severe mental application, or by mental annoyance ; also when errors in diet (especially as regards vinous liquors) invariably bring on an attack. The symptoms which call for Nux v. are closely ana- logous to those above described. A confined state of the bowels is another indication for its employment. ADMINISTRATION. Three globules, at first every two, then every four hours, as the vomiting, &c. subsides. PULSATILLA is called for by a nearly similar train of symptoms, but is generally more effica- cious when the bowels are more or less relaxed, and is better adapted to persons of mild or sensi- tive dispositions ; whereas Nux v. is preferable for those of quick, irascible temper, or who are sub- ject to great depression of spirits, attended with aversion to mental or physical exertion. ADMINISTRATION. Same as Nux v. When either of these fail to afford much relief, Mercurius is often of service. This remedy is moreover called for when the tendency to nausea or vomiting is attended with a distressing feeling of fulness and tension, as if the head were tightly bound. 234 VOMITING. ADMINISTRATION. Six globules, in three dessert-spoonfuls of water, one every three hours. IPECACUANHA generally forms a useful remedy when bilious vomiting is apt to be excited by exposure to cold. It is frequently serviceable in other cases, when there is much nausea, with paroxysms of free and copious vomiting, and pain in the entire head as if it had been severely bruised. ADMINISTRATION. Same as Nux v. ARSENICUM may follow, if the sickness and retching continue to a distressing degree; or it may be selected in preference to Ipecac.., when the evacuation of the contents of the stomach is pain- fully difficult, but the efforts are incessant, or are prone to be renewed on the slightest movement, although the feeling of general uneasiness renders it difficult for the patient to remain quiescent ; also when there is excessive thirst, with aversion to drink, or inclination to drink only small quan- tities at a time, and great debility. Further, when bilious colic and diarrhoea accompany the attack, or when the attacks are invariably preceded or followed by severe nervous headache (megrims), Arsenicum is a most valuable remedy. ADMINISTRATION. Six globules, in two table- spoonfuls of water, a dessert-spoonful at first every hour, then every two to four hours, as the symptoms subside. VOMITING. 235 VERATRUM may sometimes be administered in alternation every hour or every two hours with Arsenicnm, when that remedy brings only partial relief. It is an important remedy in the severest forms of bilious vomiting, attended with distress- ing headache, and preceded or accompanied by co- pious discharge of pale urine ; also when fainting is liable to occur from the violence of the attack. ADMINISTRATION. Same as Arsenicum. When bilious attacks are attended with febrile symptoms, ACONITUM should be given before any other remedy. In such cases, indeed, it will frequently be sufficient to put a speedy stop to the attack. ADMINISTRATION. Six globules, in three dessert-spoonfuls of water, one every three hours. CINCHONA, three globules, repeated after twelve hours, may very generally be given with advan- tage at the termination of every severe bilious attack. It is also of much utility, in some cases, at the commencement particularly when the affection occurs in debilitated children, and in those who have been dosed with calomel or blue pill for this affection. It requires to be followed by Hepar sulp/turis in the latter case. DIET AND REGIMEN. Same as for children who are affected with Derangement of Stomach (which see), as also Jaundice. During the paroxysm 236 CONSTIPATION. ' there is usually such disgust for food of all kinds, that it is better not to torment the patient by coaxing him to take something. As soon as the appetite returns, a cup of weak tea, with some cold toast may be allowed. Constipation. This is a disorder which is generally sympa- thetic with some other derangement of the di- gestive organs, either proceeding from constitu- tional tendency derived from the parents, or from want of air and exercise, combined with too much solid food, especially animal. It is, more- over, often aggravated or confirmed by the fre- quent use of aperients. The affection is far more common amongst infants brought up by hand, than amongst those that are suckled at the breast. TREATMENT. In obstinate cases a lavement of tepid milk and water,* or the introduction, by gentle rotatory movement, of a twisted strip of paper or linen, moistened with oil, may be resorted * An infant at its birth, or soon after, requires about an ounce or so of fluid ; a child between the age of one and five years, from three to six ounces ; and a youth of ten or fifteen, from eight to ten. The tube of the lavement apparatus should be lubricated with oil, and introduced very cautiously. CONSTIPATION. 23? to. If, after the lapse of twenty-four to thirty-six hours or so, no relief ensues, recourse may again be had to the lavement with the addition of a little treacle. Repeated friction of the stomach with the hand will sometimes tend to facilitate operation.' Besides this palliative treatment, and in order to overcome any constitutional predisposition to the disorder, one or more of the following medi- cines maybe administered: Nuxv^Bryonia^Pulsa- tilla, Opium, and Sulphur, according to symptoms. In ordinary cases, Nux v. and SULPHUR are the most useful, particularly when want of air and exercise have chiefly contributed to bring on the symptoms. The immediate indications for Nux v. are flatu- lence, foul tongue, hardness and distension of the stomach and bowels ; obstinate constipation, or costiveness, with offensive, hard and knotty, dark- brown coloured stools ; also when there is languor and debility, great peevishness, sleeplessness, or drowsiness during the day, with disturbed and restless nights. ADMINISTRATION. In cases of recent origin, two globules may be given, and repeated after an interval of twenty-four hours. Four days after the second dose of Nux v., if no material improve- ment has followed, Sulphur may be given in the same way, and then again Nvx v. after five or six 238 CONSTIPATION. days. In cases of long standing, one to three glo- bules may be administered every other day for a week or a fortnight, but as soon as a favorable change ensues the medicine may be discontinued. (See Rules for the Repetition of the Medicines.} When the child seems constantly chilly, or feels cold to the touch, and is almost always dissatisfied and fretful, Bryonia is, generally, pre- ferable to Nuxv. Bryonia is, moreover, commonly better adapted to constipation or sluggishness of the bowels occurring during summer, and when the stools are very dark, and of an unusually large size; or when, with infants at the breast, the motions are more formed than is usually the case. ADMINISTRATION. Same as Nux v. The alternate employment of Bryonia and Nux v. is sometimes productive of the most satisfactory results. OPIUM is well adapted to robust-looking children, who are, in short, in good health in all other respects, but are subject to costive, hard, knotty, dark-brown motions, often with hardness of the belly, or irregularity at the sides, commu- nicating the impression of lumps when felt by the hand. ADMINISTRATION. Same as Nux v. PULSATIL.LA is indicated when the constipated state of the bowels is accompanied by foulness of tongue, flatulence, and other symptoms of im- paired digestion ; or when the evacuations are CONSTIPATION. 23Q scanty, often very offensive, and either of a dark green or pale colour. Pulsatitta is better adapted to children of fair complexion, or who are very sensitive, and easily disposed to shed tears, than Nux v. and Bryonia. LACHESIS is frequently a highly serviceable remedy in obstinate constipation occurring in otherwise healthy children ; but more particularly in inveterate costiveness with hard and difficult motions, the stools being (as noted under Opium and Nux v.} knotty (small, hard, and bullet-like, or resembling the excrements of sheep), or scanty and whitish, like half-baked clay, generally at- tended with hardness and distension of the stomach and bowels, flatulency, and other signs of deranged digestion. ADMINISTRATION. Same as Nux v. SEPIA is sometimes useful after Lackesis ; in other cases Sulphur is more appropriate ; indeed there are few cases of constipation, or habitual costiveness, in which Sulphur is not more or less necessary to complete the cure. In some urgent cases, or in protracted obstipa- tion (i. e. where no evacuation whatever takes place from the bowels for about two days in the case of infants, and for several days in the case of children of a more advanced age), and particu- larly when the employment of mechanical means (injections, &c.) fails to produce the desired effect, 240 CONSTIPATION. the medicines may be administered at shorter intervals than above stated, and in solution ; as, for instance, Nux v. } one to two globules, for an infant, and three to four for a child of from two to six years of age and upwards, in six teaspoonfuls of water, a teaspoonful every six or eight hours. The lavement, or other mechanical means, may again be resorted to if necessary, after the second or third dose of the medicine. In a large number of cases, of recent origin, the bowels will generally act of their own accord after from two to six days. In children who are able to run about, it is, there- fore, only necessary to have recourse to medicine when symptoms of general indisposition super- vene, or when constipation threatens to become habitual. DIET AND REGIMEN. In recent cases, the diet should be very light for some days. In those of longer standing it should be moderate and un- stimulating, and the proportion of animal food small. Perfectly ripe, non-acid fruits, such as grapes, strawberries, and gooseberries ; and some dried fruits, such as the best qualities of plums and figs, as also stewed apples and pears, together with tender, well-boiled vegetables of a wholesome description, may be allowed with advantage, pro- vided they are found to suit the digestive powers, and do not give rise to acidity, flatulence, &c. INFANTILE REMITTENT FEVER. 241 But all vegetables which abound in fibrous or ligneous matter, as, for instance, radishes, turnips, cabbages, &c., as likewise green and acid fruits, raisins, currants, &c., should be prohibited. Too dry a diet is also objectionable ; a sufficiency of pure water should, therefore, be allowed. Half a tumbler of cold water may be drunk with benefit every morning on first waking, and once or twice more in the course of the day, between meals. Daily exercise, but not beyond the child's strength, particularly if of delicate constitution, is of much utility. Infants should be taken regu- larly into the open air. If they are spoon-fed, a change should be made in the diet, and such aliments as highly-baked flour, isinglass, and arrow-root discontinued, in consequence of their somewhat astringent property. Infantile Remittent Fever. By infantile remittent is here chiefly meant that form of fever which arises from morbid irri- tability, inflammation, or even ulceration, in the mucous membrane of the stomach and bowels. The exciting causes of this remittent fever are principally indigestible food, the impression of cold, or the effects of season the malady appear- ing occasionally to extend in an epidemic form. 16 242 INFANTILE REMITTENT FEVER. SYMPTOMS. The affection is usually preceded by languor ; irritability of temper ; drowsiness ; with very restless nights ; want of appetite ; foul tongue ; offensive breath ; nausea, or vomiting ; thirst ; slight heat of skin ; headache ; pain in the stomach; flatulence; constipation, or diarrhoea; and white or turbid urine, which frequently deposits a chalk-like sediment. Ere long these symptoms present themselves in a more aggravated form, to- gether with a further development of morbid phe- nomena, such as hurried and oppressed breathing ; quickness of pulse ; occasional flushes in the face ; vomiting of food or bile ; distension and tender- ness of the belly ; obstinate constipation ; some- times diarrhoea, or frequent desire to go to stool with but little effect ; motions discoloured, fetid, .frequently mixed with mucus, and occasionally with blood. The hands and feet are often cold, while the rest of the body is parched ; the head hot and heavy, or attended with other symptoms resembling water in the head, such as lethargy, &c. The tongue, at first moist, loaded, and occa- sionally very red along the margins, often becomes dry over a triangular spot at the point ; and the lips are sometimes covered with a brown fur. As soon as the fever is regularly established, remark- able aggravations, with consecutive remissions, take place during the twenty-four hours. \Yhen the febrile exacerbation takes place at night, it is INFANTILE REMITTENT FEVER. 243 accompanied by vigilance and tossing; when during the day, there is, on the other hand, drowsiness and stupor. An annoying cough with bronchitic indications,* succeeded by wheezing and expectoration, sometimes appears. Although, as is characteristic of remittent fever, the febrile symptoms never entirely subside, still the patient will frequently appear to be steadily recovering for a time ; and the unwary or inexperienced may consequently be led to pronounce an unduly favor- able opinion, which will too often be contradicted by the occurrence of a relapse, followed perhaps again by another encouraging but deceptive remission, and so on, unless the progress of the disease be checked, until either the mesenterict glands become affected, or dropsical effusion into the cavity of the belly, or unequivocal signs of disease of the brain supervene ; or the little sufferer becomes so emaciated and reduced by protracted disease, that the vital powers give way, and he sinks exhausted. TREATMENT. As already observed, infantile remittent fever is so liable, particularly in scro- * Indications of affection of the tubes of the lungs (the air- passages). f The mesentery is the membrane in the centre of the small intestines, and by means of which they are attached to the spinal column. 244 INFANTILE REMITTENT FEVER. fulous or otherwise inherently delicate children, to terminate in water in the head, inflammation in the chest, mesenteric disease, or in general dropsy, that professional aid should be sought without delay as soon as the febrile exacerbations threaten to increase in severity or become more frequent or almost incessant. Excessive disten- sion of the belly, startings and sudden cries during sleep, flushed face, heated head, dilated pupils, twitchings and jerkings of the limbs, drowsiness and stupor, accelerated and laborious breathing, with increase of cough, indicate that great danger is to be apprehended. In mild attacks, occurring in tolerably healthy children, the disease may, generally, be readily subdued in a few days, by means of one or more of the following remedies : Ipecacuanha, Pul&atilla, China, Nux v., Aconilum, Belladonna, Mercurius, Bryonia, Lachesis, Chamomilla, and Sulphur, com- bined with light farinaceous diet. Solid food, particularly meat and fish, must, in general, be strictly prohibited, even though the appetite should be good, which it occasionally is, and even ravenous at times. (See also the remarks on DIET at the conclusion of the chapter.) With regard to the indications for the remedies quoted, IPECACUANHA may be given if, as is commonly the case, the attack has been excited by over-feeding, or by indigestible food, and par- INFANTILE REMITTENT FEVER. 245 ticularly when the patient has contracted a habit of bolting the food without having previously masticated it properly, and the symptoms en- countered are as follows : general dry heat, or harsh and parched skin, especially towards even- ing ; thirst ; extreme restlessness ; burning heat in the palms of the hands ; perspiration at night ; quick, oppressed breathing ; foul tongue ; nausea, and vomiting; or fastidious appetite, with sickness after eating ; great languor, apathy, and indiffer- ence. Should these symptoms remain unaltered after several doses of fyecae., or should the bowels become very relaxed, the motions fetid, whitish, bilious, or of variable colour at different times, and accompanied with griping and distension of the belly, turbid, reddish, orange-coloured urine, fever towards evening or during the night, PULSATILLA must be prescribed, followed, if required, by CINCHONA, especially if the nausea or vomiting has subsided, but the bowels remain relaxed, and are considerably distended, or tense and drum-like. Nux VOMICA is also a most efficient remedy in mild cases, or in the early stage of any variety of the disorder, when the bowels are confined, or very costive, with frequent inclination to go to stool ; or when there is straining, followed by scanty watery motions, generally mixed with mucus, or occasionally with a little blood ; belly tumid and INFANTILE REMITTENT FEVER. rather painful ; further, when the child is exces- sively peevish and ungovernable ; the tongue foul, or vivid red at the tip and margins ; the appetite impaired ; or there is nausea, with disgust at food ; restlessness ; fever towards morning, but also in some degree during the night. When the patient is of a plethoric habit ; or in all cases in which the febrile action is excessive, the thirst great, the pulse full and greatly ac- celerated, the skin dry and much above the natural temperature, the water scanty and high coloured, ACONITUM is, very generally, of consi- derable value, either alone or in alternation with some other remedy which is more appropriate to the remaining symptoms. CHAMOMILLA is sometimes useful after Nux r. when bilious diarrhoea or vomiting supervenes. It is further indicated if the tongue is red and cracked, or coated yellow; sleep lethargic, or restless and agitated, attended with frequent starts and jerkings of the limbs ; flushes of heat in various parts of the body. Also when the head is hot and heavy, the skin hot or parched, the face flushed, the pulse quick : and when there is thirst, foul tongue, nausea, or bilious vomiting ; no motions ; or frequent and scanty, greenish evacuations with straining; turbid, bright yellow or orange-coloured urine. BELLADONNA may succeed Chamomilla if the INFANTILE REMITTENT FEVER. 247 head continue hot, the pulse excessively quick and full, the tongue loaded, or coated white or yellow in the centre, and very red at the edges ; also thirst, nausea or vomiting ; great heat of the belly, with tenderness on the slightest pressure ; oppressed breathing. If the more active inflam- matory symptoms yield to the action of Belladonna, MERCURIUS will sometimes suffice to complete the cure ; but more particularly when the follow- ing symptoms remain : loaded tongue, nausea or vomiting, with continued tenderness of the belly ; thirst, sometimes with aversion to drinks when offered ; cloudy or milk-like urine ; no motions, or diarrhoea with excessive straining, the stools generally consisting merely of a little slime, some times mixed with blood. If, on the other hand, the head continue hot and heavy; the pulse quick; the tongue foul, or very dry, particularly at the tip ; and other symptoms of stomachic derange- ment are prominent ; together with a tumid and painful state of the belly, constipation, or alternate diarrhoea and costiveness ;* excessive restlessness, and quick, laborious respiration, particularly at night, with drowsiness during the day, BRYONIA is to be preferred. LACHESIS may follow Belladonna or Mercurius, when the signs of intestinal irritation or inflam- * Nux v. and Lachesis also correspond to this symptom. 248 INFANTILE REMITTENT FEVER. mation continue with but little abatement. Or it may precede these remedies, when the tenderness and distension are more marked at one particular spot (the most trivial pressure there being intoler- able) than over the entire belly, when the stools are of a very pale colour, and when the fever is highest at night. SULPHUR may be given with advantage to complete the cure, in many cases, after the previous employment of any of the foregoing medicines. It is, however, when the attack is characterised by the following features, that this remedy is more directly called for : heat, especi- ally towards evening, but also in the morning, or during the day ; flushes, alternately with paleness of the face; dryness of the skin; hurried and laborious breathing ; palpitation of the heart : nocturnal perspiration ; languor and great weak- ness, particularly in the inferior extremities ; tense, tumid, and painful belly; whitish urine; dry, hard, or loose and slimy motions. These, then, are the more generally useful remedies in cases of the above description ; and will materially tend to facilitate recovery, or prevent the disease from assuming a hopeless character. When, however, the malady occurs in children of relaxed and feeble habits, or of a decided scrofulous constitution, it becomes, espe- cially if neglected, and not checked at the com- INFANTILE REMITTENT FEVER. 249 mencement of its course, a most intractable and frequently fatal disease, from the proneness which it then has to terminate in one or other of the serious complications alluded to at the commence- ment. The remedies from which the most benefit is to be anticipated under such unfavorable circum- stances, are, in addition to those previously mentioned, Silicea, Sulphur, Calcarea, Baryta c., Arsenicum, Cocculus, Cina, Sabadilla, &c. Si LICE A, when there is great emaciation, languor and debility, paleness of the face, want of appetite, or craving for dainties ; shortness of breath on movement ; feverish heat in the morn- ing or towards evening. This remedy is also a most important one when the patient is afflicted with worms, and when the disease is m a great measure attributable to that cause. Cina and Sabadilla may likewise be found useful along with Silicea, in the latter instance, the former particu- larly when the urine is milky or deposits a white crust. (See Invermination.} The indications for Sulphur have already been given. CALCAREA. Great debility, with flabbiness of the muscles, dryness of the skin, and excessive emaciation ; frequent flushes, or general heat, followed by shivering towards evening; exhaus- tion, or dejection after speaking ; impaired, fasti- dious, appetite, with weak and slow digestion, or ? 250 INFANTILE REMITTENT FEVER. on the contrary, extreme voracity; perspiration towards morning ; hard, tense, and tumid belly. (Baryta c, is sometimes useful after Calcarea.} ARSENICUM. Extreme prostration of strength and emaciation, with desire to remain constantly in the recumbent posture ; dry, burning heat of the skin, with great thirst, but desire to drink little at a time, or merely to moisten the lips, which are frequently parched ; impaired appetite, and sometimes excessive irritability of the sto- mach, so that very little food can be retained ; hard and tense belly ; restless, unrefreshing sleep, with frequent starts, or twitching of the tendons ; fretful and capricious disposition. COCCULUS. Great weakness, with excessive fatigue, depression, and tremor after the slightest exertion ; heavy expressionless eyes ; flushes of heat in the face ; nausea, or aversion to food, dis- tension of the belly ; constipation ; oppressed re- spiration ; perspiration on attempting any trivial exertion ; lowness of spirits. Belladonna, Lachesis, or Baryta c. will be required when the head becomes much affected. BELLA- DONNA, especially when there is heat, heaviness, violent throbbing of the vessels of the head and neck, flushing, and delirium; or deep and pro- tracted sleep, with twitching of the tendons, coldness of the hands; pale, cold face; small, quick pulse; hot, tumid, and tense abdomen. INFANTILE RKMITTENT FEVER. 251 LACHESIS, either before or after Belladonna, when the patient lies as if in a deep, prolonged sleep ; with grinding of the teeth ; or somnolency alter- nately with sleeplessness ; tremulous, intermittent, or scarcely perceptible pulse. (See WATER IN THE BRAIN.) BARYTA. Lethargy, tossing, or agitation, moan- ing and muttering, feeble and accelerated pulse. Other remedies, such as Antimoninm, Acid.phos- phoricum, Phosphorus,* Hepar s., Rhus, Kali, Acidum nitr., Lycopodium, &c., may be required according as the symptoms happen to vary : we have merely given some of the medicines which have been found of valuable service, when the indications of the disease have corresponded with those above given. It may be added, that when the skin is hot and parched, the sleeplessness and restless- ness are often temporarily removed by sponging the body with tepid water ; this expedient is, how- ever, only to be had recourse to, when the reme- dies fail to afford this relief, and that in a more permanent degree.f ADMINISTRATION OF THE REMEDIES. In general cases, with w r ell-marked exacerbations, it * Phosphorus and Acidum phosphoricum are more especially useful in protracted cases, with debilitating diarrhcea and very white or roilky.looking or turbid urine, which deposits a white coating. f Homoeopathic Practice of Physic. 2,52 INFANTILE REMITTENT FEVER. will be found advantageous to administer the medicine during the period at which the symptoms exist in a more or less subdued form. Six globules of the remedy selected may be dissolved in an ordinary- sized \vineglassful of water, and a dessert-spoonful of the solution given about an hour after each exacerbation. To very young children, of from one to two years of age, a tea- spoonful of the solution may be given at the stated intervals. At the commencement of the attack, before the fever sets in, the above dose may be given every three to six or eight hours, according to the urgency of the symptoms, in the course of the first day. And in milder cases, with less distinctly marked remittent fever, a dose may be given morning and evening.* DIET AND REGIMEN. The utmost possible attention should be paid to diet in the treatment of infantile remittent fever. There is, generally, much aversion to food during the height of the disease, and we should on no account entice the patient to take more than the weakened digestive powers can sustain, even when the appetite is returning. When there is diarrhoea, or symptoms of intestinal inflammatory action,f the dietetic * See rules for the administration and repetition of Ihe dose, t Chiefly characterised by heat of skin, and great tenderness of the belly on pressure with the hand. COLD IX THE HEAD. 253 regulations should be the same as \ve have given under the head of BOWEL COMPLAINTS, and INFLAMMATION OF THE STOMACH AND BOWELS. In which chapters, moreover, some additional indications will be found for some of the remedies enumerated above. In protracted cases, change of air is often of great service. DISEASES OF THE RESPIRATORY ORGANS. Cold in the Head, or Common Catarrh. This common complaint is perhaps more dis- tressing to the infant at the breast than to children more advanced in age ; because, by rendering the nostrils impervious to the air, the operation of suckling is rendered difficult, and is repeatedly interrupted, the child being frequently compelled to relinquish the nipple in order to breathe. These constant and uneasy attempts of the infant at feeding, sometimes, moreover, give rise to irri- tation and excoriation of the nipple SYMPTOMS. The characteristic symptoms of the affection are sneezing, watering at the eyes, and flow of mucus from the nose. With these are sometimes associated : Cough, hoarseness, rattling of phlegm, flushing of the face, and heat of skin. The child sleeps with its mouth open, and snuffles during the act of respiration 254 COLD IN THE HEAD. When the second or secretive stage of cold in the head sets in, the discharge from the nose is at first clear and watery, but soon becomes thick, yellow, or greenish-yellow, and ultimately of the nature of, or resembling the matter of an abscess. TREATMENT. In the first stage of the affection, and when the lining membrane of the nostrils is dry and swollen, a little oil of almonds or cream may be applied to it with a feather, as a palliative to the local irritation. Benefit will also result from placing the infant in a warm bath and sub- sequently keeping it warm and unexposed to great variations of temperature. The homoe- opathic remedies which are most frequently serviceable in arresting or curtailing simple catarrh are : Aconitum, Nux v., Arsenicum, Mer- curius, Chamomilla, Tartarus emeticus, Euphrasia, Pulsatilla, Sepia, Calcarea, Sulphur, Dulcamara, Sambucus, Carbo v., and Graphites. At the commencement of the attack, but espe- cially when there is burning heat of skin, also when a short, dry cough attends, Aconitum is the most useful medicament. One to two globules may be dissolved in three teaspoonfuls of water, and a teaspoonful given every four hours. Twelve hours after the last dose of Aconitum, Nux v. (one to two globules in three teaspoonfuls of water, a teaspoonful every twelve hours,) may be resorted to; if the nose continues obstructed and there is COLD 1,N THE HEAD. 255 no discharge, or if any it is slight and watery, and takes place only during the day.* ARSENICUM is required when there is a copious discharge of acrid, watery mucus, which produces soreness and swelling of the nostrils, and when there is excessive restlessness and agitation. If it fail to relieve these symptoms within twenty-four to thirty-six hours, Lackesis may be employed. MERCUBIUS. Where Arsenicum has been used with some advantage, but there remains a rather scanty, yellowish, or greenish, or a somewhat thick, whitish yellow discharge. Or it may be preferred to Arsenicum if the dischai'ge is of the same de- scription as mentioned under that remedy, but not so acrid, and when it is accompanied by some de- gree of fever, or by copious nocturnal perspiration. Mercurius is, moreover, better adapted to plethoric, lymphatic children than Arsenicum. The admi- nistration of Arsenicum and Mercurius may be con- ducted in the same way as described for Nux v. CHAMOMILLA, which is a remedy of peculiar value in many infantile disorders, is frequently serviceable when the discharge is watery, and is attended with a distressing loose cough, parti- cularly at night ; also when there is some heat of * When, in the case of infants at the breast, the nose remains so much obstructed as to interfere with the act of sucking (notwith- standing the previous use of Nux v.}, a globule of Sambucus may be given every five or six hours until some amendment becomes apparent. 256 COLD IN THE HEAD. skin, and much mucus rattling in the chest. BEL- LADONNA is sometimes of service in alternation with Chamomilla ; and Tartarus emeticus, or Tart, emet. and Ipecacuanha alternately, when the cough and rattling of phlegm do not diminish, or, on the contrary, threaten to increase notwithstanding the administration of Chamomilla. See also PULSA- TILLA. The dose of Chamomilla or of Tartarus em,, may consist of three globules in six teaspoonfuls of water, and a teaspoonful of the solution every six hours. In the alternate administration the same number of globules of each remedy, with the same quantity of water, may be employed, and a tea- spoonful first of the one solution then the other, given at intervals of about twelve hours, or only six in severe cases. If it is found difficult, or almost impossible to administer the medicine in solution, we may give one globule for each dose. EUPHRASIA is generally preferable to Bella- donna, Chamomilla, Arsenicum, or Pulsatilla, when there is considerable redness of the white of the eye, excessive watering of the eyes, with copious discharge of mucus from the nose. ADMINISTRATION same as Nux v. PULSATILLA is best adapted to that stage of nasal catarrh at which the discharge has become thick, green, or yellow, or greenish yellow. It is also well indicated when these symptoms occur in conjunction with a loose cough and mucous rattling in the chest. COLD IN THE CHEST. 257 ADMINISTRATION same as Cliamomilla. SEPIA is often serviceable after the previous employment of Pulsatitta; when the complaint is much mitigated, but threatens to become protracted. CALCAREA is sometimes very effective when the nose continues much stuffed, and the dis- charge puriform, (resembling the fluid formed by the process of suppuration.) When cold in the head assumes the chronic form, the remedies which, in addition to Sepia and Calcarea, are commonly most useful in arresting it are Sulphur t in general cases, Carlo v. when exacerbations always take place towards evening, Dulcamara when the complaint becomes ag- gravated on exposure to cold air, OJT increases or diminishes as the temperature of the atmo- sphere varies, and Graphites where there is great languor and prostration. In such cases, one globule may be given morning and evening, every third day, until improvement ensues. Cold in the Chest. Pulmonary Catarrh. Bronchial Catarrh. This complaint consists in an inflammation of the membrane which lines the various air-tubes and cells of the lungs. 17 258 COLD IN THE CHEST. SYMPTOMS. Chilliness succeeded by fever, with quick pulse and hot skin ; cough, more or less intense, at firsj dry or with scanty expecto- ration of transparent and viscid, or frothy, mucus (phlegm), which subsequently becomes copious, and sometimes streaked with blood. Young children invariably swallow the phlegm which is detached, except when it is ejected during the attack of vomiting which not unfrequently oc- curs after a violent and suffocative fit of cough- ing. The breathing is ever exceedingly quick and laboured, the nostrils are dilated during inspira- tion, and a rattling or wheezing noise is heard on applying the ear to the chest ; the face is generally pale and puffy, and the countenance anxious ; the tongue is usually foul, the appetite gone, and the strength much reduced ; the bowels may be either costive or relaxed, and the secretions vitiated. The symptoms are always exacerbated at night, and the affection is often complicated with inflammation of the substance of the lungs. When a favorable termination is approaching, the fever abates, the respirations become less frequent, and the cough looser and less choking, in four or five days ; but when it takes an unfavor- able turn, the difficulty of breathing increases, the face becomes livid, and the body covered with a clammy SAveat; stupor or convulsions super- vene, and the patient is carried off in a state of COLD IN THE CHEST. 259 suffocation, commonly within eight or ten days from the commencement of the attack. The chances of recovery depend on the extent of the inflammation and the constitution of the patient. Healthy children succumb comparatively rarely when appropriate treatment is resorted to suf- ficiently early. TREATMENT. In the first or inflammatory stage of the affection, particularly if the patient is of a plethoric habit, ACONITUM is an indispensable remedy when the skin is hot and dry, and the pulse full and much accelerated. It is further indicated by the presence of a short, dry, and frequent cough; rapid and laborious respiration, thirst, anxiety, and extreme restlessness. ADMINISTRATION. Three globules, in three dessert-spoonfuls of water, a teaspoonful of the solution every four hours. As soon as improve- ment results the skin becoming moist, and the respiration easier the intervals between the doses may be lengthened, or some other remedy sub- stituted, if indicated by the remaining symptoms. It will sometimes be found necessary to have recourse to Aconitum again, if the heat of skin, the fulness and quickness of pulse, &c., re- turn. When, notwithstanding the employment of Aconitum, the breathing continues to be very rapid and much oppressed, and the temperature 260 COLD IN THE CHEST. of the skin considerably above the natural standard,, which is liable to be the case if the complaint is complicated with inflammation of the lungs, BELLADONNA should be resorted to, particularly if the patient is of a full habit, or of lympha- tic or sanguine-lymphatic temperament. A dry, fatiguing cough, aggravated at night, and fre- quently followed by fits of sneezing, or accom- panied by a rattling noise in the chest, is an additional indication for Belladonna. It may be administered in the same way as Aconitum, or given in alternation with it when the nocturnal fever and restlessness are excessive. BBYONIA and CHAMOMILLA are often required to complete the cure after Aconitum and Belladonna. In many instances, however, either the one or the other will claim a preference to Belladonna. The sym- ptoms which more particularly point out the appropriateness of Bryonia are, quick and difficult breathing ; dry or loose cough, (in the latter case the matter which is expectorated consists of viscid phlegm,) aggravated after taking food or drink; rattling of mucus in the chest; foul tongue; parched mouth and lips ; thirst ; and a constipated state of the bowels. CHAMOMILLA is called for after Aconitum, when the cough is severe, and accompanied by wheezing, thirst, and diarrhoea. ADMINISTRATION of Bella., Bry., and Chamomilla, same as Aconitum. In the second or secretive stage, COLD IN THE CHEST. 26l Pulsatilla is often of service when the acute in- flammatory symptoms have been subdued, and the cough has become looser, the mucus thicker, more copious and more easily detached; the bowels costive or relaxed. ADMINISTRATION. Four globules, in four tea- spoonfuls of water, a teaspoonful morning and even- ing. When the disease has attained an advanced stage, and the secretion of mucus in the tubes and cells of the lungs has accumulated in exces- sive quantity, impeding respiration and threat- ening suffocation, the cough being at the same time very violent, and the paroxysms frequently followed by vomiting, or by rigidity of the limbs, the face livid, and the forehead covered with perspiration, IPECACUANHA is, generally, of considerable service. ADMINISTRATION. Six globules, in an ordinary- sized wineglassful of water, a teaspoonful of the solution every two hours, until a favorable result is effected, or a change of remedy called for. The alternation of Tartartts emeticus with Ipecacuanha is, occasionally, very beneficial. Should these medicines fail to relieve the sym- ptoms above named, and the pulse become very feeble and irregular, the surface cold, and the strength nearly exhausted, Arsenicum will some- times succeed in averting a fatal issue. ADMINISTRATION. Same as Ipecacuanha, or 262 COLD IN THE CHEST. with shorter intervals between the doses, if it seem advisable. Puts., Tart., &c., may be required after Ars. These, then, are a few of the more important medicaments in some of the ordinary forms of inflammation of the bronchial tubes; but there are several other remedies which may be indicated in particular cases, such as Spongia, Hepar sul- phuris (see CROUP), Lachesis, Nux v., and Kali bich., &c. Sulphur is often of service in preventing the affection from assuming the chronic form, when the fever and difficulty of breathing have been overcome by Aconititm, etc. All cases which are attended with much fever and greatly acce- lerated breathing, ought to be held as more or less dangerous, and provided for accordingly. DIET. The thirst being generally excessive in the early stage of the complaint, it is perhaps commendable to withhold the breast from infants, and to give water, or two parts of water to one of the breast-milk or very thin gruel, slightly sweetened in its place, until the active febrile and inflammatory symptoms have yielded. To older children, gum-water, whey, barley-water, and such like, may be given at the commence- ment. But when recovery is steadily setting in, a gradual return may be made to a more nu- tritious diet. INFLAMMATION OF THE LUNGS. 263 Inflammation of the Lungs. Inflammation of the substance of the lungs rarely, if ever, occurs as a primary affection in young children ; being very generally associated with and occurring as secondary to inflammation of the bronchial tubes. It consequently, in chil- dren below six years of age, almost invariably appears in connexion with quick pulse, hot skin, great restlessness, fever, cough, mucous rattling in the chest, accelerated breathing, and con- siderable prostration of strength. Percussion* yields a dull sound. With children who are more advanced in life, the true signs and sym- ptoms of inflammation in the lungs, such as crepitating respiration, dullness on percussion, viscid, rust-coloured expectoration, &c. &c., are usually as well marked as in adults. TREATMENT. Aconitum, Belladonna, and Bryonia are the principal remedies in the early stage. Their leading indications have been given in the preceding chapter, which see. Phosphorus and Tartarus emeticus are the next in most frequent use ; * The act of striking upon the chest with the ohject of pro- ducing sounds, from the nature of which the state of the subjacent parts may be established. 264 CROUP. but it requires professional knowledge and ex- perience to regulate their selection.* Croup. The disease of which I now purpose to treat, has so repeatedly and so strikingly illustrated the sufficiency of the homoeopathic system to cope successfully with the most formidable of acute dis- eases, as to refute most signally the allegations to the contrary which have been so falsely and in- dustriously fostered and propagated. Croup consists of a peculiar inflammation of the mucous membrane that lines the windpipe and its ramifications, generally terminating in the formation of a thick viscid substance, denominated false membrane, which adheres to and takes the form of the parts it covers. The principal exciting causes of the affection are exposure to cold or damp, particularly during the prevalence of north or north-easterly winds; residence in a low, badly- drained locality ; combined with deficient or im- proper food, and consequent derangement of the digestive organs. It frequently appears as an hereditary malady; and when once a child has been attacked by it, he is very liable to a recur- rence. This predisposition is, however, very gene- * Some particulars connected with the treatment of inflam- mation of the lungs in adults, will be found in the ' Homoeopathic Domestic Medicine,' by the Author. CROUP. 265 rally overcome after the patient has been treated homoeopathically during one or more seizures, or has been placed under a constitutional course of treatment on recovering from an attack. From the period of weaning to the eighth or tenth year is the time during which children are most subject to this distressing malady. On the Continent, and especially in Germany, France, and Switzerland, it is more dreaded and more common, as well as more violent, than in England. The duration of the complaint varies : sometimes it runs a fatal course in twenty-four hours ; but in the major number of cases it is pro- longed to the fourth or fifth day before the patient sinks. In some cases again, it assumes a chronic form, and may be protracted over a period of two or three weeks. SYMPTOMS. If croup has precursory symptoms, they will occur for two or three days before the identity of the disease be descried and confirmed, and they generally consist in the manifestation of the symptoms of a common catarrh, usually accompanied by a dry, rough cough, and hoarse- ness. In certain localities, where the complaint is known to be endemic,* and in families pre- disposed by constitution to suffer from it, no attention should be spared in watching and treat- ing any such symptom. When the disease is not foreshadowed by a premonitory stage, the first * Peculiar to a place or country. 266 CROUP. intimation of its presence may be in the charac- teristic sudden, abrupt, shrill, brazen trumpet-like, single cough which the child will emit during the night, and even whilst asleep : the peculiar sharp and stridulous intonation of the voice, the loud and very laboured breathing, and the crowing sound which may often be heard during the act of inspiration. The pulse is accelerated and hard ; the skin is highly hot and feverish ; a sensation of strangulation prevails, and the patient seems to long to swallow something which would remove an apparent obstruction about the gullet. Some children will grasp the throat convulsively, as if to squeeze out some foreign body. There are, frequently, sudden pauses in the malady, when all the symptoms appear to subside ; but these are, commonly, but indications of a worse period of return ; and after them the sense of suffocation is, in general, redoubled ; the head is tossed back con- vulsively, as if to stretch the throat ; the features assume a ghastly pale or livid tint ; the extremities of the body are clammy and cold ; the prostration excessive ; the voice nearly inaudible ; the eye becomes glazed and dull ; and unconsciousness or convulsions supervene. TREATMENT OF THE PREMONITORY ANDFIRST or INFLAMMATORY STAGE. The homoeopathic medicines being of such easy access, and so conve- nient to administer, the treatment of this serious ma- CROUP. 267 lady is thereby, in uncomplicated cases, commonly rendered at once safe, prompt, and effective even in the hands of the most unpractised and unprofes- sional persons, provided the disease is not allowed to attain an advanced stage before the remedies are resorted to. When the attack is preceded by catarrhal symptoms, in the form of a rough, dry, hard cough, accompanied by hoarseness or by wheezing, HEPAB s. will, in the majority of cases, be the means of preventing the development of the affection, by arresting it in this early stage. But when fever and difficulty of breathing become superadded, or when they, together with the cha- racteristic ringing cough, the peculiar faint, sharp voice, and the crowing sound during inspiration, suddenly affect a child, it will be necessary to ad- minister ACONITUM in alternation with Hepar. The immediate employment of these tw r o will, very generally, be speedily followed by an improvement in the breathing, an abatement of the fever, and a loosening of the cough. If, however, some de- gree of oppressed respiration, attended with a loud, grating, and wheezing noise, still remain, SPONGIA must then be had recourse to, or given in alternation with Hejoar s. } as also with Aconitum, if a considerable degree of fever, with quick, full pulse, and, sometimes, hot and flushed face, con- tinues or reappears. ADMINISTRATION OF THESE MEDICINES. When Hepar s. is given in the premonitory ca- 2G8 CROUP. tarrhal stage of the complaint, four or five globules may be dissolved in two tablespoonfuls of water, and a teaspoonful of the solution given every three or four hours. When it is given, in alternation with Aconitum, during the inflammatory stage of developed croup, six or eight globules of each remedy may be separately dissolved in two table- spoonfuls of water, and a teaspoonful, first of the one, then of the other, administered every hour, or only every four hours or so if the symptoms are not very urgent. In giving Hepar s. or Spongia alone in the absence of inflammatory fever, with dry, hot skin, and full, hard, and much acce- lerated pulse the medicine may be prepared in the proportions above stated (or one grain of the second trituration, of either remedy, may be mixed in the two tablespoonfuls of water), and a teaspoonful administered every four hours, until signs of amendment set in, or a change of remedy be re- quired by an alteration in the symptoms. Again, when it seems necessary to employ Aconitum along with Hepar s. and Spongia, in consequence of the continuance of active fever, six globules of each medicine may be separately dissolved in two table- spoonfuls of water, and a teaspoonful, first of the one, then of the next, in rotation, given every hour or two.* As soon as improvement becomes appa- rent, the intervals between the doses may be lengthened. To children under two years of * i. e. A dose of one medicine at a time, every hour or two. CROUP. 269 age, if some difficulty is experienced in exhibiting the medicine in the form of solution, one globule of the remedy may be placed on the tongue at each repetition of the dose. In the worst forms of croup, it is sometimes necessary to administer the medicine every half or even every quarter of an hour. When the disease has reached the second stage or that in which the false membrane is formed, and the difficulty in breathing and the wheezing be- come greatly aggravated sometimes a flapping or valve-like sound accompanies the act of ex- or inspiration, in consequence of a partial detach- ment of a portion of the membrane ; the voice sinks to a whisper, the cough grows hoarser and more suffocative, and the countenance looks blanched or livid. A congested state of the lungs, and, subsequently, of the brain, with the con- comitant symptoms already detailed, then ensues. TREATMENT OF THE SECOND STAGE. The chances of recovery in this stage of the affection are, naturally, materially diminished. Medical aid should, therefore, be sought without further delay, if it has not already been obtained. If the disease has advanced thus far, before remedial measures have been adopted, Hepar s. and Spongia, exhibited alternately in the manner described above, fre- quently succeed in averting a fatal termination. In some cases, viz. where there is much increasedr 270 CROUP. vascular action, with fulness and quickness of pulse, Aconitum must be included in the alternate or rotatory administration. If, on the other hand, as will occasionally happen either from some neglect on the part of the attendants or from the impossibility of preventing the patient from ex- posing himself to a chill during the outbreak of perspiration or from some undetected pecu- liarity in the case, to which the medicaments do not correspond the early employment of Aconitum, Hepar sulphuris, or Spongia fail to subdue the com- plaint, Lachesis, Phosphorus, Belladonna, Arsenicum, and Sambucus, or Tartarus emeticus, are the remedies which, in general cases, may chiefly be relied on. Lachesis and Phosphorus, or, sometimes, Spongia and Phosphorus, commonly in alternation, when there are signs of congestion in the chest, or even of extension of the inflammation to the substance of the lung, or to its enveloping membrane (the pleura), with consequent dullness on percussion ;* Belladonna,? Belladonna &&& Spongia, in alternation, when symptoms of congestion in the brain, with tendency to stupor or to convulsions, supervene; Arsenicum when the patient has become cold, exces- sively debilitated, and seems to be sinking; and Tar- tarus emeticus or Sambucus and Tartarus emeticus, in alternation, when there is much rattling of phlegm in the chest, and sl@w and much-impeded respira- tion. These medicines should be given in rapidly * See note, p. 263. CROUP. 271 repeated doses, and in about the same proportions as Aeon., Hep. s,, and Spong., as long as any gleam of hope remains. When reaction follows the administration of any of the remedies we have recommended for the latter periods of the second stage (viz. Lack., Phosp., Bella., Ars., &c.), or when- ever any signs of a relapse threaten, after all the dangerous symptoms have been overcome, it is advisable to fall back upon Hepar s. and Spongia. There are other remedies, such as Kali bich., Bromium, lodium, Bry., Cham., Sulph., &c. &c., which may be useful in complicated attacks ; but, in the majority of cases, the seasonable employment of Aconitum, Hepar s., and Spongia will be found adequate to conquer the disease in a few hours. When, on the removal of the inflammatory sym* ptoms, the disease becomes subject to remissions, succeeded by sudden exacerbations of a dangerous suffocative, spasmodic character, a rare occurrence in true croup when treated homo3opathically, Arsenicum and Lachesis, in rapid alternation, and, failing these, Samlucus and Moschus may be resorted to. (See also Spasm of the Opening of the Wind- pipe.} But as croup is subject to intervals of comparative ease, followed by exacerbations, the use of Aconitum, Hepar s., and Spongia should not be discontinued without due reason. In the second stage of the complaint, a suddenly fatal issue sometimes results from suffocation, caused 272 CROUP. by a detached portion of the false membrane obstructing the passage of the windpipe. DIET AND REGIMEN. During the existence of croup, a little milk and water may, at the utmost, be given from time to time. Even when every sym. ptom of danger has been surmounted, the greatest possible caution must be observed in the exhibition of food. In the advanced period of the second stage, when Arsenicum, &c., are insufficient to prop the sinking energies, a little burnt brandy may be administered now and then, in the quantity of a few drops. Wine may be preferred in the case of children below three years of age. The child should be kept warm, confined to one apartment ; and every possible precaution taken to guard against a chill throughout, and for some time after the croup seizure. The disease is, as previously remarked, much less liable to return after it has been treated, once or twice, homoeopathically ; but when the home of the child is in a cold, bleak, and much exposed, or a low, damp situation, approxi- mate to large surfaces of water, a change of quarters should, if practicable, be repaired to. In chronic croup, or hoarseness remaining after an attack of croup, Hepar s. } Phosphorus, and Carbo v. are commonly the most serviceable medicines : they form, moreover, useful preventives against recurrences, when administered after a seizure. OBSTRUCTIONS IN THE WINDPIPE. 273 Accidental Obstructions in the Windpipe, etc. Young children are generally in the habit of carrying everything to the mouth, as also of eating quickly and unequally, of talking or laugh- ing whilst feeding, &c. During the course of teething, in particular, every thing which a child can catch hold of is put into its mouth. Any one of these circumstances may lead to the accidental lodgment of some improper material in some part of the windpipe (or throat). As the symptoms which arise from the presence of some foreign substance in the windpipe present a great analogy to those of hooping-cough, spasm of the glottis (opening of the windpipe), and even croup, we should ever at once inquire into the history of the case before resorting to remedial measures. The circumstance of the child having previously been observed to play with some small substance ; or the disappear- ance of a needle, pin, button, &c., which had been in the vicinity of the child; the suddenness of the invasion of the symptoms ; and the absence of constitutional disturbance, such as fever, &c., im- mediately after the seizure, contribute to confirm our suspicion as to the cause of the morbid phenomena. SYMPTOMS. The characteristics of accidents of this kind are usually very similar to those at- 18 274 OBSTRUCTIONS IN THE WINDPIPE. tendant upon the diseases above alluded to. A sudden convulsive and suffocating cough, return- ing at intervals, but sometimes continued for many minutes without intermission (if the obstruction remains) ; hoarse or almost inaudible voice ; im- peded breathing, particularly during expiration ; and sometimes a flapping or other noise from the movement of the body up or down the windpipe, if it happen to be a pea, bead, button, or the like ; the face red, or even purple, and the eyes start- ing and discharging copiously during the fit of coughing. TREATMENT. In cases of a very urgent nature no time should be lost in seeking the assistance of a surgeon ; as an operation, having for its object the admission of air through an artificial opening, made by an incision in a part of the windpipe, frequently offers the only chance of success in such instances. Meanwhile, however, the follow- ing remedies may be resorted to : IPECACUANHA and TARTARUS EMETICUS. Of each, six globules, separately, in a tablespoonful or about half an ounce of water ; a teaspoonful of the solution, first of Ipecac., then of Tart, emet., alter- nately, after every paroxysm of aggravation ; using two teaspoons, one for each medicine. If no relief follows after two or three doses, Belladonna may be substituted for these remedies, and given OBSTRUCTIONS IN THE WINDPIPE. 275 in the same way. But if the patient becomes livid in the face, Opium should be preferred. When the foreign substance is not fixed or firmly impacted in some part of the windpipe, and is known to consist of a bead, pea, or even a small coin, its expulsion may sometimes be accomplished if we encourage the act of coughing or vomiting, by tickling the throat with a feather, or by intro- ducing the handle of a spoon, or the fore-finger into the throat as far as the root of the tongue. Inverting the body suddenly, has also succeeded in some cases. When the extraneous body has been removed, Aconitum and Hepar s. will gene- rally be found the most appropriate remedies against any inflammatory consequences which have been excited by the local irritation. Nearly the same description of symptoms may arise from the stoppage of a large piece of meat in the throat, as those which are occasioned by the entrance of some foreign substance into the windpipe. TREATMENT. If the obstructed substance can be reached with the finger, it should be removed thereby as soon as possible ; but when it is too deeply seated to admit of its extraction in this manner, it should be pushed down the gullet by means of a piece of whalebone, scraped smooth, 76 OBSTRUCTIONS IN THE WINDPIPE. and having a small piece of sponge firmly secured to the end which is introduced into the mouth and throat. A sudden and violent effort to vomit, induced by tickling the throat, by placing snuff on the tongue, or by striking the patient a sharp blow with the flat of the hand between the shoulders, will frequently effect the ejection of a piece of meat or other food which has stuck in the throat. The only chance of saving the patient, in cases of urgency, generally consists in the per- formance of an operation. Fish bones, pieces of glass, pins, &c., may often be removed by means of a piece of sponge fastened to a strip of whale- bone, as above noticed. In this case, however, the sponge should be gently passed downwards by a sort of spiral or rotatory movement, until it is below the object, the exact locality of which the child can frequently indicate by pointing with his finger. A little water should then be given, in order to cause the sponge to swell, whereupon it should be slowly drawn upwards. Swallowing imperfectly masticated bread, &c., will occasionally succeed in removing fish bones. There are various other contrivances for procuring the removal of foreign substances from the throat, but most of them require the skill of the practised surgeon for their successful accomplishment. When a spasmodic contraction of the gullet interferes with SPASM OF THE WINDPIPE. 277 the manipulations, Igimtla will sometimes speedily reduce it ; if not, Lac/iesis or Chamomilla may be resorted to. Spasm of the Opening of the Windpipe. This affection is by some denominated the spasmodic croup, or acute asthma of infants. It bears a considerable resemblance to croup, yet differs from it in many respects, as, for instance, by the extreme suddenness of the attack while that of croup is generally preceded, for one or two days, by hoarseness and a slight cough and by the cessation of suffering the patient enjoys between the attacks, whereas when croup has once set in, the excitement is more or less permanent ; more- over, this disease generally attacks in the evening or at night, whereas croup, in most cases, makes its first appearance during the day. Croup, as we mentioned in the article upon that subject, is an inflammation of the membrane of the windpipe, exciting the formation of a peculiar secretion, which, if not checked, concretes into an abnormal membranous tissue, constituting what is technically called the false membrane of croup ; whereas, in the asthma of Millar, the suffering appears to arise from a spasmodic contraction of the top of the windpipe, impeding the progress of re- spiration. 278 SPASM OF THE WINDPIPE. The attack commences during sleep, from "which the child suddenly awakes as if frightened, and appears as if making ineffectual attempts to fetch breath ; after much effort it succeeds by means of a sudden spasmodic inspiration, attended with a prolonged crowing noise ; if the fit continues, the face becomes purple, and the extremities partake of the same hue, frequently associated with a clenching of the thumbs inside the palm, and spasmodic contraction or extension of the toes. As the complaint advances, the bowels become de- ranged, or the general health impaired; and if proper means are not promptly taken, the spas- modic attacks recur frequently, and at short in- tervals, and occasionally the little patient perishes during one of the paroxysms, or is carried off by a general convulsive fit. The disease rarely occurs except in infants of delicate constitution, when due means should be taken to endeavour to eradicate it by a proper course of treatment; it is frequently associated with dentition, or a deranged state of the digestive organs, engendered by improper food, vitiated air, fever, &c. Although the affection may early prove fatal by suffocation during a paroxysm; it may, on the other hand, be protracted for several months, occurring at intervals from various ex- citing causes, such as fits of passion, vexation, or indigestion. SPASM OF THE WINDPIPE. 279 TREATMENT. The medicines which, in general cases, are the best adapted to the treatment of this affection are : Arsenicum, Ipecacuanha , Lachesis, Sambucus, Chamomilla, Belladonna; and also Aco- nitum, Pwlsatilla, and Nnxv. Of these, IPECACU- ANHA is commonly to be preferred when the attack has been excited by indigestible food, and when the child has been affected with sickness, or with purging, or both, before it was put to rest. ADMINISTRATION. Three globules, in six tea- spoonfuls of water, a teaspoonful of the solution every quarter of an hour until three doses have been given, after which the intervals may be lengthened if improvement has set in ; but if no material alteration for the better has ensued, PULSATILLA may be substituted for Ipecacuanha. When no cause can be assigned for the attack, and the patient is of delicate or exhausted con- stitution, ABSENICUM will usually prove the more suitable remedy; excessive agitation, cold per- spiration, and extreme prostration of strength during and after the paroxysms, with small, irregular, or intermittent pulse, are characteristic indications for Arsenic. It may be administered the same way as the preceding, and if no meliora- tion results after three or four doses, LACHESIS may be resorted to. The last-named remedy may be preferred to Arsenic., or indeed to any other remedy, when the complaint suddenly attacks an 280 SPASM OF THE WINDPIPE. otherwise healthy child, and no exciting cause of the seizure can be determined. ADMIN ISTRATIOX. Same as Ipecacuanha. When the affection is associated with deranged bowels, and acidity of stomach, CHAMOMILLA will be found a useful remedy. It is further indicated when the attacks are prone to come on even during the day, particularly after a fit of passion or vexation ; or when they are connected with the process of teething, and when general convulsions supervene. (See Teething?) BELLADONNA must, however, be had recourse to immediately, if the latter symptoms do not yield to the use of Chamomitta,, but on the contrary, the succeeding paroxysm of convulsions increase in duration or intensity. In all cases that are complicated with symptoms of affection of the brain or its mem- branes, arising from difficult dentition or other causes, and accompanied by a tendency to, or the actual development of, severe general convulsions, Belladonna is an important remedy. ADMINISTRATION. Three globules in six tea- spoonfuls of water, one teaspoonful to be given when the fit is subsiding, or when it has terminated. If an aggravation ensues the result must be awaited. If no change occurs the dose may be repeated, but not until another convulsive fit commences. When an alteration for the better becomes mani- fest, the medicine may be discontinued, and only SPASM OF THE WINDPIPE. 281 resorted to again should threatening signs of a relapse appear. ACONITUM is required when the irritation of teething is evidently the exciting cause of the disease, and there is quickness and fulness of pulse. (See Teething.} Pulsatilla and Nux v. are chiefly indicated in cases dependent upon derange- ment of the digestive organs. Ignatia and Cocculm may also be found serviceable in these cases. When the complaint occurs in highly scrofulous children, with enlargement or fulness in the region of the thymus gland,* Belladonna, Spongia, Baryta, Carlo v., &c., are required. It may sometimes be necessary to have an operation performed, in the hope of preventing suffocation when the malady proceeds from the pressure of the enlarged gland. DIET AND REGIMEN. During the spasmodic seizures, even when somewhat protracted, little or no food beyond a little warm milk and water, will, in general, be necessary in the first instance. In order to aid in the prevention of recurrences, the state of the digestive organs must be carefully attended to, and all nourishment which is of an indigestible nature should be strictly inhibited. If the child be at the breast, supplementary diet * A gland which is of considerable size in the foetus, but which diminishes during youth, and usually disappears entirely in old age. It is situated in the chest, under the upper part of the breast-bone. 282 HOOPING-COUGH. should be withheld, and a healthy nurse, possess- ing a full supply of milk, procured. A change of air is advisable, and every source of annoyance and excitement ought, where practicable, to be removed or avoided. Hooping-cough. This is a malady peculiar to children, in the great majority of cases, although instances are not wanting of its seizing adults. It is very rarely caught more than once. It derives its name from the peculiar whooping, crowing sound, which accom- panies the inspiration after every cough, and which generally becomes lengthened towards the end of the paroxysm. Right or wrong, the affection is commonly looked upon as contagious ; and it most undoubtedly occurs very frequently in an epidemic form. Like Croup, Hooping-cough is most prevalent between the months of January and June, but more especially at the turn of the spring. There is one remarkable feature about hooping-cough, in which it differs from the generality of the acute complaints of the respiratory organs, which is the length of its continuance ; for from the first manifestation of morbid symptoms to the disap- pearance of the malady, there is usually a lapse of from two to three, and sometimes even five or six months. By some this malady is divided HOOPING-COUGH. 283 into two stages, the incipient or febrile, and the congestive and nervous. By others, again, it has been divided into three stages, viz,, the first or febrile, the second or convulsive, and the third or nervous. SYMPTOMS. During the first period, which varies in duration from one to five or six days, we remark the common feverish cold (catarrhal fever), manifested by discharge from the nose, sensibility of the eyes, thirst, heat of skin, quick- ness of pulse, and a hacking, dry, and irritable cough. After the lapse of a few days, in the generality of cases, but in some without any nota- ble premonitory symptoms, the cough assumes the characteristic convulsive form, attended with prolonged inspirations possessing the peculiar noise already alluded to. Occasionally this crowing or whooping noise is absent, or not well marked. During the fits of coughing, which occur in paroxysms at intervals of from half an hour to three or four hours, the face and neck become red, swollen, and livid; the eyes appear as if pro- truding from their sockets, and stream with tears ; the pulse is accelerated ; the vessels of the head are much distended; the patient is excessively agitated, and lays hold of any person or fixed object within his reach for support during the fit. After the seizure has lasted for a longer or 284 HOOPING-COUGH. shorter period, it is terminated by the act of vomiting, and the expectoration of a quantity of phlegm; whereupon the child is usually em- powered to return to his play or previous occu- pation ; but it is often some little time before complete tranquillity is restored. In severe cases, blood is discharged from the nose, eyes, chest, and stomach ; and sometimes the patient falls down insensible from the intensity of the paroxysm. The attacks generally return with some degree of regu- larity, although they are often more frequent or more violent at night, and are liable to be brought on at any time by excitement, too full a meal, or exposure to cold. The straining, during the fits of coughing, occasionally gives rise to involuntary discharges from the bladder and bowels. In mild cases, respiration is free during the intervals, and the child, with exception of some little de- bility, is in every respect apparently healthy. But in more severe cases, or w T hen there has previously been some derangement of the diges- tive organs, the appetite is bad, the bowels disordered, the tongue very foul, and the tem- perature of the skin considerably increased at night. In the worst forms of the complaint, again, fever is never absent, and the respiration is, continuously, more or less laboured and impeded, indicating the existence of some serious internal complication. Such cases sometimes terminate HOOPING-COUGH. 285 fatally in a very sudden manner ; they are, how- ever, only met with in children of unsound constitutions. Other dangerous complications, as for instance, with affections of the brain or its membranes, are liable to occur, particularly in recently weaned infants, or those who are under- going the process of dentition. In favorable cases, occurring in healthy subjects, the disease begins naturally to decline in about three or four weeks, and then continues, gene- rally speaking, for about two months longer in a modified form. The expectoration, which was at first tenacious and scanty, becomes more profuse and less viscid ; the cough loses its harshness ; the paroxysms are not so violent and protracted, and the intervals between them are of longer duration. Young children commonly swallow the phlegm as soon as it is discharged from the air-tubes, except when it is ejected during the act of vomiting. Relapses of the paroxysmal convulsive character of the cough are of frequent occurrence on any exposure to cold ; and the duration of the affection in its second (and third) stage is sometimes con- siderably prolonged by an ungenial state of the atmosphere. TREATMENT, In the incipient, febrile, irritative, or catarrhal stage of the cough, it is not unfre- quently possible to check the further progress of 286 HOOPING-COUGH. the disorder by means of such medicines as Aconitum, Belladonna, Mercurius, Chamomilla, Pulsa- tilla, Nux v., Ipecacuanha, Carlo vegetabilis. ACONITUM is required when there is consider- able fever, with thirst, heat of skin, and quick full pulse ; also when the cough is dry and very frequent, and when there is slight redness and tenderness, or sensibility of the eyes ; or when a feeling of soreness and burning are complained of in the throat and chest. ADMINISTRATION. Six globules in two table- spoonfuls of water : to children of from four to six years of age and upwards, a dessert-spoonful ; and to those under four years, a teaspoonful of the solution every four hours. As soon as the fever lessens, the intervals between the doses must be lengthened, or another remedy resorted to if the remaining catarrhal symptoms indicate the neces- sity for such change. In the second stage of the cough, the alternate use of Aconitum with the other remedy employed is, occasionally, of service when some degree of fever prevails. The great value of Aconitum consists in the circum- stance that whilst it most effectually answers the purpose of arresting general fever and keeping down incipient tendencies to local congestions and inflammations, it accomplishes this desirable end without inducing any consecutive weakness, which so frequently results from the employ- HOOPING-COUGH. 287 ment of aperients and other depleting measures, such as leeches, bleeding, &c., resorted to in the old mode of practice. The importance of this point, not only in this but in many other severe acute diseases, need scarcely be commented upon. BELLADONNA is one of the most important remedies in the catarrhal stage of hooping-cough, particularly when it occurs in plethoric children, when there is heat of skin, dry, hollow, or harsh and barking nocturnal cough, or which becomes materially aggravated at night, and is followed by violent and great sneezing ; incessant crying, and nocturnal restlessness. This medicine is also par- ticularly well adapted to the angina or sore throat, which is not an unfrequent concomitant at the commencement of the affection. ADMINISTRATION. Same as Aconite, only at longer intervals (every six or twelve hours). MERCURIUS. Hoarseness, watery coryza, with soreness of the nostrils; dry fatiguing cough, generally occurring in two successive fits ; profuse night sweats. HEPAR SULPHURIS. Hoarse, dry cough, worse at night, and commonly succeeded by a fit of crying. This medicine is also useful in forward- ing the secretory process. CHAMOMILLA. Dry, hoarse cough, or cough with difficult expectoration of tenacious phlegm, followed by a feeling of soreness at the part from 288 HOOPING-COUGH. which the mucus seems to have been detached ; also when there is thirst, with fever towards even- ing ; exacerbation of cough at night, even during sleep ; great peevishness ; excessive acidity and diarrhoea. The paroxysms of coughing are excited by an almost incessant irritation in the upper part of the windpipe and chest. ADMINISTRATION of Merc., Cham., &c., same as Bella. PULSATILLA. Cough loose, and accompanied with flow of tears, weakness of the eyes, sneezing, thick discoloured discharge from the nostrils, slight hoarseness, and inclination to vomit after coughing; deranged digestion ; occasional diar- rhoea, especially at night. DULCAMARA. When the attack has come on after exposure to a cold, damp atmosphere ; and the cough is loose, with copious and easy expectoration. Nux VOMICA is of great service when the cough approaches the second stage. It is indicated by the following symptoms : dry, fatiguing cough, attended with vomiting, and occurring particu- larly from about midnight until morning, the paroxysms sometimes so protracted and violent as to produce apparent danger of suffocation, with lividness of the face, and, occasionally, bleeding from the mouth and nose. (ARNICA is better adapted to this latter symptom, when the discharge HOOPING-COUGH. 289 of blood is copious.) Foul tongue, loss of appetite, constipation, also indicate the appropriateness of Nux v. IPECACUANHA is, like the former, of great use when the cough is attended with danger of suffo- cation, and each inspiration appears to excite a fresh fit of coughing. It is further indicated when the fits are accompanied by spasmodic stiffness of the body, and blueness of the face, great anxiety, and accumulation of phlegm in the chest. CABBO VEGETABILIS is often of considerable utility when the cough, notwithstanding the employment of one or more of the previously named remedies, assumes more and more of the characteristics of established hooping-cough;, or when it sets in from the first in a convulsive form, and becomes exacerbated towards evening, or in the early part of the night, attended with pains in the chest, redness of the throat, and painful deglutition. The existence of excessive flatulence, and of eruptions about the face, head, and other parts of the body combine to determine the selec- tion of this medicament. ADMINISTRATION of Nux v., Ipecac., and Carbov. same as described for the remedies required in the second or convulsive stage of hooping-cough. (See below. 19 290 HOOPING-COUGH. SECOND OR CONVULSIVE STAGE. TREATMENT. Drosera, Veratrum album, Cuprum acetic-urn, Arnica, Ferrum metallicum, and Conium maculatum. DROSERA is one of the principal remedies in the treatment of the disease when it has reached this stage ; and in cases where it is clearly indi- cated, and the constitution has not been enfeebled by the transmission of hereditary weakness or other causes, it will, very generally, speedily declare its beneficial effects, and materially modify or shorten this trying and painful period of the disorder. The particular indications for the use of this medicine are, violent paroxysms of cough, occurring in such rapid succession as to threaten suffocation, and attended with the characteristic shrill sound during inspiration ; after each fit of coughing, vomiting of food, or of stringy mucus ;* relief on moving about ; no fever, or fever con- sisting in regular attacks of chills and heat, fol- lowed by slight, warm, nocturnal perspiration ; or outbursts of warm perspiration during the pa- roxysms of coughing. VERATRUM ALBUM is very useful either at the very commencement of the convulsive stage, or at a more advanced period, when the child has become reduced in strength and emaciated ; or when it suffers from cold sweats, particularly on the fore- head, with involuntary emission of urine, vomiting, * Phlegm. HOOPING-COUGH. 29 1 spasms, and other symptoms common to this stage ; also pain in the chest and inguinal region ; low fever, with small, weak, and accelerated pulse ; thirst ; aversion to conversation.* When the vomiting, as also the cough, become more distressing at night than at any other time, Conium may follow Veratrum, if the latter fails to relieve this peculiarity. CUPRUM ACETICUM. This remedy is often found strikingly useful in the convulsive or nervous stage, particularly when convulsions, with loss of consciousness, ensue after each paroxysm. Also when we find vomiting after the attacks, together with continuous rattling of mucus in the chest, and wheezing. In almost all such cases, a marked benefit has followed the employment of this remedy; sometimes it has been found sufficient of itself to cut short the disease, or has so far modi- fied it, that other remedies, which had before seemed to fail, have, after its exhibition, acted with the most marked effect, and completed the cure.f * Carbo vegetabilis is frequently useful in bringing this stage of the affection to an early and successful termination, after the pre- vious use of Veratrum or Drosera, or both of these important reme- dies ; particularly when, notwithstanding the decrease of cough, the tendency to vomit still remains. (See also FERRUM.) f Cina is also a useful remedy when there are convulsions, or tetanic rigidity of the whole body during or immediately after the fits of coughing, particularly in children affected with worms. In 292 HOOPING COUGH. ARNICA is useful as an intermedial medicine, when the bleeding from the nose or mouth is considerable ; and also in the affection itself, when each paroxysm is succeeded by crying, (ffepar s. is also useful, when the latter symptom follows a hoarse dry cough.) FERRUM METALLICUM. This medicament will be found very useful as an intermediate remedy, when there is invariably vomiting of food on coughing soon after a meal. When the vomiting occurs only during the night, and when there is much rattling of phlegm in the chest, with diar- rhoea and great prostration of strength, Tartarus emet. is often very useful. KALI CARBONICUM has been found of much efficacy in hooping-cough, when a swelling and puffiness in the form of a little bag appeared between the eyelid and the eyebrows. ADMINISTRATION OF THE REMEDIES IN THE CONVULSIVE OR NERVOUS STAGE. In mild cases, two globules may be given every second day ; but in those of a more severe description, six globules may be dissolved in two tablespoon- fuls of water, and a teaspoonful given every four hours during the first day every six hours the second every twelve the third ; and so on, length- cases which are complicated with the presence of worms in the intestines, Mereurius may be preferred to Cina when there is copious sweating at night. HOOPING-COUGH. 293 enmg the intervals or entirely suspending the medicine, according to the greater or lesser degree of improvement effected. In cases requiring Veratrum or Drosera, it has been found useful to give the first dose immediately after a fit of cough- ing, and only to repeat after the next paroxysm if it proves as severe as that which preceded ; an interval of twenty-four to forty-eight hours should then be permitted to elapse, or longer, if improve- ment becomes manifest, before another dose is given. If the complaint becomes worse in place of improving, after two or three doses of Drosem or Veratrum have been administered, or if new symptoms supervene, not covered by the remedy last employed, another must be selected.* When the cough has lost its convulsive character, recourse may be had to the medicines which have been mentioned as the more appropriate in the catarrhal stage, particularly Pulsatilla, Dulcamara, Chamomilla, Carlo v., but also Nux v. and Ipeca- cuanha, &c., when called for. Bryonia is also serviceable, especially when the cough is always excited or aggravated after eating or drinking. During the progress of the disease, symptoms of local inflammation must be narrowly looked for, and treated accordingly. (See Cold in the Chest, or Inflammation of the Mr-passages ; and also Inflam- mation of the Brain ; Water in the Brain ; Remittent Fever, and Bowel Complaints, when any of these * See rules for the repetition of the dose. 294 CONVULSIONS. complications attend.) When hooping-cough occurs during the process of dentition, Aconitum, Chamomitta, Belladonna, and Mercurins are more or less useful. (See above, and likewise the chapter on Dentition, for indications.) DIET. The diet must be light and of easy digestion; bread-pudding, semolina, and other light puddings of this description, provided the fever be not high, in which case, weak gruel, barley-water, and the like, must alone be allowed ; when the more serious symptoms have been sub- dued, or in all mild cases, we may give a little chicken-broth or beef-tea, and so on, gradually increasing the amount of nutriment as the disease declines. The drinks should consist of water, toast-water or barley-water.* During the first stage the patient should be confined to one, well-ventilated, apartment. When the second stage is unattended with fever, and signs of affection of the chest, change of air is often beneficial. Convulsions. Early childhood is, from various causes, pecu- liarly predisposed to this distressing malady. * Unmedicated jujubes, or gum-arabic and sugar-candy may be allowed, occasionally, for moistening the throat or mouth, when the cough is dry and irritating. CONVULSIONS. 2Q5 Convulsions generally arise from the physical peculiarities of infancy, in the preponderance of the brain, and nervous system in general, over the other parts of the frame hereditary predisposition called into activity by dentition repelled erup- tions irritating substances in the stomach in- testinal worms mechanical injuries fright, and lastly, from some occult cause, frequently a de- rangement of the organic structure, in many in- stances bidding defiance to the powers of medicine. In average cases, they are not quite so dangerous as is popularly supposed, or as might be presumed from appearances. The presence of real danger cannot be correctly drawn from the violence of the manifestations slight convulsive movements frequently proceeding from or denoting, in con- junction with other signs, the presence of more serious mischief than severe convulsions. They generally, as may be concluded, from what has been remarked above, take place in children who have their nervous system in a state of exalted sensibility or irritability, in consequence of an impaired state of health ; but they may occur suddenly in apparently healthy children, without premonitory warning, or without any assignable exciting cause. When harbingers of a convulsive attack are present, they usually display themselves in the form of occasional twitchings of the fingers or toes, clenching of the thumb, downward tor- sion of the hand or foot, and retraction of the toes. 2Q6 CONVULSION'S. The pupils are observed to be suddenly dilating or contracting ; or one is being contracted whilst the other is dilating ; the eyes are either fixed or in constant and rapid motion. An irregularity in the breathing, a livid ap- pearance about the mouth, and frequent changes of colour, are also deserving of notice. SYMPTOMS. During an attack of convulsions of a mild character, the face is sometimes alone affected with slight twitchings, combined with distortion of one or both eyes ; or only one limb, or one half of the body may be convulsed, some- times alternately or successively with the other half. In the severer varieties, all the limbs are more or less affected, and likewise the muscles of the face and those of respiration. The eyes seem about to start from their sockets, and are much distorted, or roll about in various directions ; or the eyelids open and shut in incessant motion ; the tongue is protruded, or alternately elongated and contracted ; the mouth foams ; the breathing is impeded ; the hands are firmly clenched ; the limbs violently jerked or tossed about ; and the face and head, which are often red at the begin- ning of the seizure, assume a dark or purple hue towards the conclusion, as also, at times, the en- tire surface of the body. As the attack declines, the convulsive movements become less violent and of less frequency, the contractions of the muscles CONVULSIONS. 297 relax, and the child, after a fit of crying, recovers his natural appearance. A quiet sleep often ensues, accompanied by a copious perspiration, from which the child awakes calm and refreshed. At other times, the paroxysm is succeeded by a secondary state of great languor, attended with complaints of headache, &c. Convulsions vary in duration as well as in- tensity ; sometimes the paroxysm will last only a few minutes, but occasionally it is protracted for hours, and after a short interval of cessation it may recur with undiminished violence. When very severe or frequently repeated, a fatal issue, or an irrecoverable state of paralysis may be the consequence. Neither fever nor loss of conscious- ness necessarily accompany an attack ; but when they do, or when the pulse is much accelerated, and the skin exceeds the natural temperature, which is more liable to be the case in robust, plethoric children, an inflammatory disease (of the brain or its membranes, for instance) is commonly to be dreaded. TREATMENT, During the attack itself it is rarely necessary, in general cases, to interfere much. It will be sufficient to loosen the child's garments, raise the head, sprinkle the face with cold water, and to give admittance to fresh air. It is only when the paroxysm is of great severity 2Q8 CONVULSIONS. or lasts long, or when the attacks return in rapid succession, with unmitigated or even increased violence, that it is necessary to administer medi- cine before the attack has exhausted itself. The application of cold to the head, by pouring a stream of water upon it from a little distance, is a simple and frequently effectual mode of curtailing a paroxysm. The effect is heightened when the feet and legs are, at the same time, immersed in warm water. If the bowels are much loaded, three to six ounces of tepid w r ater may be injected.* The medicines which are most commonly re- sorted to in Homoeopathic practice, either during or after the paroxysms, are Campfiora, Chamomilla, Ignatla, Coffea. Or Aconitum, Belladonna, Mercurius, Cina, Arsenicum, Ipecacuanha, Sulphur, Opium, etc. CAMPHORA. The application of Camphor to the nostrils of the child, for a few seconds each time, will sometimes succeed in abridging a paroxysm of great severity. CHAMOMILLA is frequently of great service in convulsions, occurring in very young children from the irritation of teething ; but it is also useful at a more advanced age, particularly in children of a nervo-sanguine temperament, who are extremely sensitive, and peevish ; or when the attacks have been excited by fever, colic, a chill, or a fit of passion or vexation. The characteristic indica- * See art. Constipation. CONVULSIONS. 299 tions for its administration are : restlessness, fret- fulness, and disposition to drowsiness when awake ; one cheek red, the other pale ; diarrhoea ; (if this remedy be exhibited at this stage of the disorder, it will frequently prevent the fit from becoming fully developed ;) eyes half-closed; great thirst; quick and loud breathing ; rattling in the throat ; moaning ; twitches of the eyelids and muscles of the face; contortion of the eyeballs; jerks and convulsions of the limbs, with clenched thumbs ; lastly, constant rolling of the head from side to side ; loss of consciousness. (Belladonna may be exhibited after Chamomilla, should the latter fail to do much good.) ADMINISTRATION. We may, for very young children, dissolve one globule in four teaspoonfuls of water, and administer one teaspoonful at the commencement of the attack ; if fresh paroxysms come on some hours after, but decreased in inten- sity, we ought not to repeat the remedy, but allow it to exhaust its action; if the convulsions increase, on a second or third attack, we may give another spoonful unless other symptoms declaring them- selves, intimate that we ought to have recourse to any of the under-mentioned medicaments. (See also the directions given under CINA.) IGNATIA is often very effective in convulsions arising from the irritation of worms ; and is some- times successful during dentition, in cases which 300 CONVULSIONS. withstand the employment of Chamomilla and Belladonna. It is more peculiarly adapted to listless, inanimate children ; or to pale, delicate infants, of peevish dispositions, with alternations of vivacity and sadness, laughing and crying almost in the same breath. The characteristic symptoms are : the infant, while reposing in a light or moaning slumber, becomes suddenly flushed with burning heat, awakes, and springs with a convulsive start, and the utmost soothing scarcely quiets the excitement; there is a tremor of the entire body, attended by violent crying or agonizing shrieks; and the muscles of single limbs seem convulsed. Ignatia is further indicated when the fit returns every day at a regular hour, followed by fever and perspira- tion, or every other day at variable hours. (In some instances Belladonna will be found requisite after Ignatia.} ADMINISTRATION. Same as CJiamomilla. COFFEA is useful when convulsions are liable to be excited in delicate and sickly children by the most trivial cause, but particularly by any mental excitement of a pleasing or joyful descrip- tion. ADMINISTRATION. Same as Chamomilla. ACONITUM. In robust, plethoric children, this remedy is frequently of much service as an auxiliary w r hen the pulse is full and accelerated. CONVULSIONS. 301 It may, under such circumstances, be given either previously to, or in alternation with, the medica- ment otherwise indicated, until the unnatural rapidity of the circulation has been subdued. ADMINISTRATION. As soon as the paroxysm is over, two globules may be dissolved in four tea- spoonfuls of w r ater ; a teaspoonful every four to eight hours when given before any other remedy ; or every four to six hours, in alternation with the other medicine employed. BELLADONNA is one of the most important remedies in all cases which proceed from, or are connected \vith, a more or less serious disturbance in the brain. It is more particularly indicated when the child starts suddenly from sleep, and stares about wildly ; the pupils being much dilated ; the body or individual members rigid ; the head and hands dry and burning ; the blood-vessels much distended. Further, when there is insensibility, with involuntary passing of water after returning to consciousness, and when the slightest touch will sometimes provoke a renewal of the attack. This medicine is also indicated when the paroxysms are preceded by smiles or laughter. ADMINISTRATION. In the same manner as Chamomilla. It is frequently found that Chamomilla and Belladonna answer in alternation ; or, as already 302 CONVULSIONS. remarked, that when one has alleviated the evil, the other will dissipate the remaining symptoms. CINA is useful, particularly during the second teething, for children of a melancholy tempera- ment, and scrofulous constitution, who are troubled with worms, or habitually wet the bed. The characteristic symptoms are, spasms, commenc- ing with constriction of the chest and impeded respiration, and followed by stiffness of the limbs, paleness of the face, with sunken, blue underlined eyes, and rigidity of the whole frame. ADMINISTRATION. Same as Chamomitta. But in some cases it will be found useful to prescribe one globule every four days, for a week or fort- night, in order to remove the susceptibility to the attack. MERCURIUS is useful in spasms which are caused by the presence of worms ; the stomach being swollen and hard before, during, and after the fit ; the child is, at the same time, attacked with painful eructation, and a species of saliva- tion; and the limbs are tossed about and convulsed. After the paroxysms, the patient lies, for a con- siderable time, exhausted and apparently dying. ADMINISTRATION. Same as Ckamomilla. The foregoing are the more generally useful remedies in ordinary cases ; but the subjoined are sometimes called for in the particular instances specified. CONVULSIONS. 303 CICUTA vi ROSA is more or less serviceable when there is a clear indication of the presence of worms ; or when the child is first attacked with severe griping and colic, terminating in convul- sions. The characteristic features of the fit are : tremor of the limbs; jerks like electric shocks, terminated by insensibility. (Nux v., Ignatia, and Mercurius are also useful when convulsions occur in children who are troubled with worms. See Invermination.} ADMINISTRATION. Same as Cina. ARSENICUM has proved very valuable in severe cases of convulsions, during dentition, with the fol- lowing symptoms : a burning heat diffuses itself over the whole body of the child ; the feet are stretched out, and the hands drawn convulsively backwards; the child then throws its hands about, and rolls over with violent shrieks, changes its po- sition, and bends forward with clenched fingers and extended thumbs ; it is irritable, restless, and perverse; evinces insatiable thirst, but drinks little at a time ; is affected with diarrhoea, sometimes of undigested food; frequently vomits immediately after taking food ; the paroxysms recur frequently, and all attempts at soothing seem only to irritate the child. ADMINISTRATION. Same as Cina,. IPECACUANHA is chiefly useful when the attack has been excited by indigestible food ; and when 304 TEETHING. the paroxysms are either preceded, accompanied, or followed by great difficulty of breathing, nausea, or vomiting ; also when the child has a constant inclination to remain in the recumbent posture. Nwx v. or Pulsatitta may likewise be serviceable when improper food has originated the attack. (See Derangement of Stomach.} SULPHUR is particularly indicated in spasms arising from repelled chronic eruptions. In cases of convulsions from FRIGHT, Opium, two globules, may be resorted to, when the follow- ing appearances are present : general trembling ; jactitation* of the limbs; vacant stare; cries; snoring respiration ; insensibility. Change of air is sometimes necessary to aid in overcoming the liability to returns of convulsions in delicate chil- dren. Attention should be paid to the general health ; and every known exciting cause, such as mental emotions, indigestible food, &c., avoided as strictly as possible. (See also the articles on Teething, Invermination, and Derangement of Stomach. Convulsions being frequently merely symptomatic of these disorders.) Teething. With some children the first teeth appear as early as the third or fourth month, but the average period of their first appearance is about * Tossing. TEETHING. 305 the sixth or seventh month. Their protrusion through the gum is often, however, delayed to a later period, owing either to the constitutional condition of the infant, or to some other and unascertainable accidental cause. The first set of teeth amounts to twenty in number, and this set is rarely completed in less than a year and a half, and sometimes remains imperfect until the third year. The front or middle incisors, four in number, two in each jaw, are the first to appear ; next come four more of the same description of teeth, one on each side of the former, then the four an- terior molars or grinders, then the four canine or eye-teeth, and, lastly, the four back grinders. They usually appear in pairs, the lower jaw commonly taking the precedence of the upper in the order of cutting them. Sometimes, though rarely, the canine appear before the front or ante- rior molars. The SECOND SET of teeth, which succeeds the first in the order in which that is shed, date from about the seventh or eighth year on the average, and the process of changing teeth may be said to extend over a period of from five to six years. And this set, which remains permanent, saving accidents or decay, is not completed until the appearance of the wisdom teeth (the last grinders), between the l?th and 20th year on the average. 20 306 TEETHING. The second set of teeth comprises thirty-two in number, i. e. those before described, with the addition of eight additional grinders and four wisdom teeth. Indispositions during Teething. During the progress of TEETHING there are many little inconveniences to which children are apt to be subject, but which indicate no serious consequences, and which, with care as to diet, air, exercise, ventilation, and the like, will usually run their course without prejudice, and subside of themselves. The diet of the mother, or nurse, ought also to be carefully selected ; no precaution should be omitted in providing against any of the inflammatory complications, especially about the mouth and throat, to which children are, during dentition, peculiarly liable, and with this object in view, in order that no extraneous morbid complications should escape early observation, the mouth and gums should be constantly and carefully examined ; pulmonary and cerebral de- rangements,* particularly the latter, are more especially the disorders to which children are subject during teething. But when the process is being favorably carried on, the symptoms will * Affections of the lungs and brain. TEETHING. 30? usually be as follows: in which case the pre- cautions as to diet, before indicated with that of keeping the head cool, will suffice to ward off any more serious affections. SYMPTOMS. Peculiar restlessness, especially at night, sudden paroxysms of crying, alternate flushing and pallor gums swollen, red and hot, especially along the upper edge disposition to gnaw anything difficulty in sucking, arising from the tender state of the gums considerable and constant flow of saliva, and slight diarrhrea, which two last symptoms are to be looked upon as favorable indications, and not as derangements to be counteracted. In these we may detect the salutary effort of nature to afford relief to the system susceptible as it is of inflam- matory and congestive tendencies during denti- tion. The sudden or irregular suspension of these symptoms, with the continuance of the others, in an aggravated form, or the manifes- tation of new ones, such as excessive fretfulness, incessant thirst, with trembling of the lips, con- vulsions, etc., especially with indications of great heat of head and of the body generally, and sup- pressed urine, may be looked upon as a sufficient ground for the exhibition of medicine, for although they may subside of their own accord, and may occur and remit from time to time, until a tooth 308 TEETHING. cuts through, still, a fatal result or some perma- nent injury may be the sequel of neglect. TREATMENT. When there is merely consi- derable excitement, restlessness, want of sleep, starting, &c. COFFEA (one globule) should be administered. In the event of no amelioration after a few hours, ACONITE (similar dose) may be resorted to. If either medicine be attended with good effects, no repetition should take place until a return of the symptoms is threatened. If only partial relief be obtained, they may be followed up with Chamomilla. This remedy should have the priority and pre- ference when indicated by excessive excitability, great thirst, starting at any noise, convulsive and spasmodic twitchings during sleep, dry, hacking, irritative cough; short, quick, and sonorous breathing ; acidity, vomiting, excessive looseness, with green, whitish, and watery motions, (par- ticularly when the nurse is in the habit of drinking coffee.) MERCUBIUS is sometimes required after CJtamomilla, when the excessive looseness conti- nues, and is occasionally followed by protrusion of the last intestine, or is accompanied by glan- dular swellings and a tendency to the formation of aphthae in the mouth or around the funda- ment j or when there is hardness of the belly, TEETHING. 309 and convulsions, followed by great weakness. In the event of only partial or temporary improve- ment from the employment of Merc., Sulphur may be resorted to. Each of these remedies may be administered as follows : one globule, in a teaspoonful of water, at intervals of twelve, twenty-four or forty- eight hours, or oftener if the symptoms are very urgent, until improvement sets in. Nux v. should generally be administered in the same way when constipation prevails, followed or alternated by Aconite, if there be considerable febrile action. ACONITE is at all times indicated by great in- flammation, swelling, and painful tenderness of the gums ; heat of skin ; flushed face ; sup- pressed or scanty, high-coloured urine. Dissolve one globule in three teaspoonfuls of water, and administer one teaspoonful of the solution every six or eight hours. BELLADONNA is indicated by symptoms of determination of blood to the head and cerebral* derangements, manifested by the following : great heat and pulsation about the head; redness and puffiness of the cheeks ; violent throbbing of the vessels of the neck; restlessness and alternate heaviness ; tossing back of the head ; startings and sudden cries during sleep, the child awaking with * Appertaining to the brain. 310 TEETHING. a fixed and terrified look ; dry, nocturnal cough ; increased temperature of the skin and accelerated pulse ; watery and suffused, or red and sparkling eyes, with sensibility to light; dilated pupils; convulsive movements, either confined to the eyes, face, and arms, and consisting of mere twitchings, or of a more violent and general description. ADMINISTRATION OF BELLADONNA. Six globules in a wineglassful of water, a teaspoonful of the solution every three, or six, or twelve hours, being guided by the intensity of the symptoms, and the effect produced. As soon as signs of improvement set in, the medicine must be discon- tinued. (See Rules for the administration and repetition of the Dose.} When the fever is high, Aconitum may be given alternately every three or four hours with Belladonna; or, in not very urgent cases, a teaspoonful of the above-mentioned solu- tion of the last-named medicine maybe given in the morning, and one of Aconitum of the same strength at bedtime ; and so on until relief is afforded. With respect to the extraneous complications to which allusion has slightly been made, and to which, during teething, children are more especially subject, they must necessarily be submitted to the course of treatment recommended under the head of each particular malady. (See Inflammation and Dropsy of the Brain, Inflammation of the Lungs, Constipation, &c. &c.) TEETHING. 311 Various kinds of eruptions, often appear and disappear with the progress of the teeth, but nei- ther these nor a moderate degree of looseness of the bowels ought to be interfered with unnecessarily. DIET AND REGIMEN. Strict attention should be paid to diet, and great care taken not to overload the stomach of the infant ; and the same precau- tion, as already observed, is equally necessary in reference to the nurse. Exposure to a chill should be guarded against; nevertheless, it is essential that the head should be kept cool, and that the infant should be regularly taken into the open air. Whilst the gums are hot, tender, and intolerant of the slightest pressure, the use of ivory rings, a crust of bread, &c. tend but to aggravate matters. The employment of Aconite is, as previously remarked, the most appropriate remedy in such a state of matters, when a remedy seems called for. Its alternation with Arnica is often still more soothing giving one globule of the one and then the other medicament at inter- vals of twelve hours. As dentition advances, pressure appears to relieve the child, and may then be encouraged. Lancing the gums is rarely necessary under homoeopathic treatment; it ought only to be resorted to when the medicines fail to palliate, and there is excessive local irri- tation, combined with attendant symptoms of 312 IRRITATION OF THE BRAIN. extreme nervous disturbance. The incision may, in most cases, be slight, and generally on or towards the outer side of the gum. DISEASES OF THE BRAIN, ETC. Irritation of the Brain. This complaint is perhaps more peculiar to children who have a constitutional predisposition to water on the brain. It is not necessarily in- dicative of organic disease, although it is certainly a species of warning that there is a susceptibility to the suscitation of such derangement; and, moreover, if neglected, it may lead to organic and chronic disease. SYMPTOMS. At the onset of this malady a peculiar susceptibility of the senses prevails. The eye cannot bear to be exposed to too strong a light, and there is great dislike to the slightest noise. The child is, at the same time, peevish, restless, or distressed with wakefulness. A spas- modic closure of the eyelids is not an unusual concomitant symptom ; and there are frequent twitchings or convulsive movements of the limbs the foot or hand being suddenly jerked upwards or the hands are firmly clenched or the thumb is fixed across the palm. The skin is, sometimes, IRRITATION OF THE BRAIN. 313 hot,, and the pulse accelerated ; but more com- monly the temperature of the body and the condition of the pulse are normal. The more frequent exciting causes of irritation of the brain, are the injudicious and culpable use of stimulants ; debility from loss of humours, mental emotions, such as passion, fear, &c. ; or the hurtful effects of low, damp localities, and badly-ventilated dwellings. TREATMENT. Coffea, Aconitum, Lachesis, Bella- donna, Chamomilla, Nux v., Ignatia, Cinchona, and Arsenicum are amongst the more important reme- dies in ordinary cases of morbid irritation of the brain. COFFEA. In simple cases, chiefly characterised by wakefulness, restlessness, sensibility to noise, and great nervous excitement ; two globules of this medicine may be dissolved in three teaspoonfuls of water, and a teaspoonful of the solution given every four hours. If some improvement has followed the use of this remedy, it may be resorted to again as soon as symptoms of a relapse threaten ; but if no melioration has ensued, ARSENICUM may be given in the same way ; and if the latter fails to relieve, LACHESIS may be resorted to, particularly if considerable excitement continues. Due attention must, however, be paid in all cases to the entirety of the symptoms, and 314 IRRITATION OF THE BRAIN. the selection of the remedy made in the strictest possible accordance therewith. ACONITUM is required when there is heat of skin, and acceleration of pulse, combined with sleeplessness and more or less agitation or excite- ment. BELLADONNA. When the case verges closely on acute inflammation of the brain or its mem- branes, the head and face being hot, the face rather flushed, and the vessels distended ; the sensibility to light and noise excessive, and the eye preter- naturally brilliant. The state of wakefulness is apparently accompanied by ineffectual efforts to sleep, and when sleep ensues, it is liable to be broken by the slightest touch or sound the child starting up as if alarmed. Further, an unusual sensitiveness of the skin, spasmodic closure of the eyelids, occasional twitchings of the limbs, a throwing back of the head, and constant crying, are additional indications for Belladonna. (See Inflammation of the Brain and also TEETHING.) ADMINISTRATION of Aconitum and Belladonna same as Coffea. CHAMOMILLA is of service in this affection, when the irritation proceeds from acidity, attended with diarrhoea, colic, and great fretfulness. It is also particularly useful when a fit of passion has given rise to the morbid symptoms. ADMINISTRATION. Two globules in four tea- IRRITATION OF THE BRAIN. 315 spoonfuls of water, one teaspoonful every twelve hours, or oftener if necessary. (See Diarrhoea.} Nux VOMICA is sometimes required in irritation of the brain, but more especially in cases which have been induced by the injudicious employment of stimulants (such as wine, &c.) Some degree of sensibility to light, occasional twitchings of the limbs, sensitiveness of the whole surface of the body, foul tongue, and constipation, are the principal symptoms which denote the appro- priateness of Nuxv. ADMINISTRATION. Same as Chamomilla. IGNATIA is chiefly indicated when twitchings of the limbs or other convulsive movements, some- times of a severe kind, accompany the other symptoms of this derangement. ADMINISTRATION. Same as Ckamomilla. CINCHONA is more especially requisite when debility, arising from protracted diarrhoea, has given rise to the state of morbid, nervous irrita- tion ; or when it has been developed by the injurious consequences of exposure in a low damp situation. Wakefulness, restlessness, emaciation, and extreme sensibility of the entire surface of the body, are the leading indications for the selection of this medicament. ARSENICUM is useful under nearly similar circumstances as Cinchona, but with less striking sensitiveness of the surface. It is well adapted to 316 CONGESTION. children of a scrofulous or otherwise delicate con- stitution. ADMINISTRATION of Cinchona and Arsenicum same as Chamomilla. (See also rules for the repe- tition of the dose.) In cases arising from fright, a globule or two of Opium may be administered with advantage. DIET AND REGIMEN. The diet ought to be of easy digestion and unstimulating, but, when not contraindicated by inflammatory signs, sufficiently nourishing. Exposure to light and noise should be avoided. The apartments ought to be well ventilated ; and when the locality of the dwelling in which the child is kept is unfavorable, a removal will be necessary. The application of warmth to the feet, combined with frequent sponging of the head with cold water, will be found beneficial. Determination of Blood to the Head. Congestion. This affection is not of uncommon occurrence during infancy. SYMPTOMS. A prominent convex state of the open part of the head,* combined with heaviness and want of animation, approximating stupor. Occasionally there is some degree of heat of the * The mould. CONGESTION. 31? head, but the pulse sluggish, or perhaps irregular. The bowels are variable, more especially costive ; the face flabby, full, and of a deep or livid colour; the veins about the forehead and neck prominent and distended ; the eyes present a vacant ex- pression, or they seem difficult to fix on any object, and the pupils are commonly dilated. The sleep is heavy but disturbed, and the breathing is fre- quently thick and oppressed. Congestion is more liable to terminate in ef- fusion (water in the brain), than in inflammation of the brain, although the latter result does occa- sionally ensue. In rapid cases of effusion its occurrence is generally indicated by insensibility, \vith relaxation of the limbs or paralytic weak- ness ; but in those in which the fluid is secreted more slowly, the head gradually enlarges, and the belly becomes retracted, the extremities relaxed and debilitated, and complete stupor or general convulsions supervene. TREATMENT. In the majority of cases OPIUM is one of the most useful medicines in recent congestion, whether arising from a fright, from repulsed scarlatina or measles, or some undis- coverable cause ; and whether occurring in infants iimnediately after birth, or in children of a more advanced age. Its principal indications are : somnolency, or 318 CONGESTION. heaviness and stupor; dark-coloured or livid countenance ; dilated pupils ; convulsed or half- closed eyes; considerable drowsiness; very dis- turbed sleep ; and the child when roused looks vacant or seems incapable of fixing the sight ; prominent state of the mould; full, slow, and rather irregular pulse ; oppressed breathing ; con- stipation. A dose of one or two globules will, when early administered, often cause the above- described symptoms to disappear in a few hours ; but if no perceptible amendment becomes soon apparent, the medicine must be repeated, 'pro- vided some other remedy is not required by a change in the symptoms. Nux v. and BRYONIA are often serviceable after the previous employment of Opium. In slight cases, chiefly marked by extreme drow- siness, and associated with constipation, they may be preferred to that remedy. Nux v. par- ticularly when the stomach has been overloaded with indigestible food, or when wine has been thoughtlessly and culpably given in excess. Pul- satilla is often useful in cases arising from an overloaded or disordered stomach, especially when the patient is of a lymphatic temperament. Bryonia is sometimes useful in completing the cure when Nux v. is insufficient to accomplish it. The administration of these may be conducted in the same way as Opium. (See also art. Derange- CONGESTION. 319 ment of stomach, and administer as there stated if requisite.) BELLADONNA, preceded if needful by Aconitum is to be preferred in congestion with symptoms of approaching inflammation of the brain (see that article, and also the indications given for the selection of this remedy in the preceding chapter) or when drowsiness, heat of the head, puffed, bluish red countenance, dilated pupils, sudden starts on closing the eyes, muscular twitchings or general convulsions, with a projecting condition and violent throbbing of the moulds, form the most striking features of the case. ADMINISTRATION. Three globules in six tea- spoonfuls of water, a teaspooriful of the solution every twelve hours. When convulsions are pre- sent the repetition of the dose may be regulated in accordance with what is stated in the article on that subject. In more advanced cases of con- gestion with symptoms of threatening effusion, or of established effusion, Belladonna, Helleborus, Lachesis, Digitalis,, Arsenicum, and Zincum are the medicines on which the chief reliance is to be placed as long as hope remains. As auxiliaries in the treatment of congestion, the use of the warm bath, and the application of cold to the head and warmth to the feet may be mentioned. Medical aid should be sought in all cases which do not speedily give way to the medicines administered. 320 BRAIN FEVER. Inflammation of the Brain. Brain Fever. Acute* inflammation of the brain or its mem- branes, analogous to that which occurs in adults, is only encountered in children of a robust and plethoric habit of body. It is chiefly characterised by redness and heat of the face, with violent throbbing of the vessels, and intolerance of light and sound. The sleep is restless and much dis- turbed by frequent starting, or by delirium. The pulse is quick and full ; the eye unusually bril- liant, and sometimes inflamed looking ; the expres- sion of countenance peculiar; and the breathing rapid and oppressed. There is commonly, also, great irritability of stomach, constipation, and suppressed or scanty urine. If these symptoms be not speedily arrested, they are very liable to be followed by stupor, with partial or general convul- sions, ending in death. TREATMENT. Aconilum and Belladonna are the principal medicines. When timely resorted to they will rarely, if ever, fail to overcome the af- fection. ADMINISTRATION. Six globules of each medi- cine may be separately dissolved in two table- * Acute is a term applied to diseases which run a short course, but are accompanied by violent symptoms. DROPSY OF THE BRAIN. 321 spoonfuls of water, and a teaspoonful first of Aconitum, and then of Belladonna given, in alterna- tion, every six hours. As soon as the skin becomes moist, and the pulse diminished in force and frequency, the Aconitum must be discontinued, and Belladonna given alone as long as it appears to do good. If improvement does not set in soon after the employment of these remedies, assistance should be sought. (See also WATER IN THE BRAIN.) Water in the Brain. Dropsy of the Brain. This frequent and dangerous affection most commonly occurs in children of scrofulous con- stitution. Its symptoms proceed from a diseased state of the brain or its membranes, which is liable to give rise to a watery effusion, hence the de- nomination water or dropsy of the brain. The less the disease assumes an inflammatory aspect, and the more slow its progress, so much the more surely, generally speaking, will water be thrown out. SYMPTOMS. The malady in its more common form, generally comes on very insidiously, and often creates no alarm for several days the signs of indisposition being attributed to the effects of teething or to peevishness. The first of these 21 322 DROPSY OF THE BRAIN. indications of deranged health consists in great languor and tendency to fatigue from the slightest exertion. The child consequently shuns move- ment ; totters in its walk ; or drags one leg after the other. There is excessive fretfulness, par- ticularly when the head is raised, and pain is frequently complained of in the back of the neck, in the eyes, limbs, and stomach. The stomach is exceedingly irritable, vomiting being generally induced whenever the child sits upright or is placed in the erect posture ; the head is hot ; the eye looks inflamed, or the pupil is contracted, and the countenance \vears a peculiar bold expression. There is some fever, especially at night, with grinding of the teeth during sleep, and starting, or tits of screaming on being awakened. The evacuations are unhealthy, or the bowels are obstinately confined ; the urine scanty or sup- pressed. The child answers correctly when spoken to, but often stutters or hesitates in using a particular word. As the disease progresses, pain is commonly less frequently complained of; the child becomes quiet when allowed to remain in the horizontal posture, but utters a shrill, peevish cry when lifted up. Drowsiness or stupor now prevails; the head sinks upon the pillow; the eyes are half closed ; the pupils dilated or immoveable, or alternately dilated and contracted, and attended with impaired or double vision or with squinting. DROPSY OF THE BRAIN. 323 A diminution or a complete cessation of sickness, sometimes combined with a slight return of appetite, occurs at this stage ; but emaciation proceeds rapidly ; the child moans and frequently lifts its hands to its head with a tremulous motion, and often sighs deeply. This, the second stage, may continue for eight, twelve, or fourteen days ; after which the affection enters upon the third stage, with its convulsions of greater or less intensity. There is constant moaning or raving, but complete loss of consciousness ; the eyes are dim, glazed, and turned upwards ; the pulse may be invariably fast throughout the whole course of the disease : or after having grown slow and weak at the termination of the first stage, it may now become much accelerated for a short period, and then gradually decline. The limbs become relaxed, the belly retracted, and the breathing very unequal. Extreme prostration, with increased stupor, supervene : and the child is carried off in a state of collapse,* or the scene is terminated by a severe convulsive fit. In the acute and less frequent variety of the complaint, the symptoms are much more strongly marked. In robust children it occasionally sets in very suddenly with fever or violent convulsions, the child dying on the third or fourth day. In other cases the child is seized with severe head- * Utter prostration of the vital powers. 324 DROPSY OF THE BRAIN. ache; the face is red, the head hot, and the vessels full and throbbing ; the child starts at the slightest noise; the eye is preternaturally brilliant, and is very sensitive to the light. The pulse is, at first, full and very quick ; and the respiration hurried and laboured. The stomach is excessively irritable ; the tongue white and furred, and perhaps enlarged ; the bowels usually very costive ; or the motions unnatural, generally presenting a singular green colour; the urine scanty, or sometimes altogether suppressed. The countenance is strikingly peculiar, presenting a mixed expression of terror and pain ; the hands are frequently raised to the head ; and the child is extremely fretful, particularly when taken up from the bed ; whilst the screams which occasionally escape from it are piercing and frantic. As the disease advances, the pulse becomes slow, feeble, and unequal or irre- gular any movement has, however, a tendency to accelerate it. The complaint then passes through the stages already described, and terminates in a like manner. Water of the brain occurs very frequently during the progress of other diseases, such as fevers, (infantile remittent,) scarlatina, measles, smallpox, hooping-cough, affections of the chest, bowel complaints, difficult dentition, &c., becoming suddenly apparent on any rapid subsidence of the symptoms, or creeping on insidiously in the course DROPSY OF THE BRAIN. 325 of the primary malady. It is, therefore, incumbent to pay attention to any unaccountable invasion of sickness of stomach, associated with an unusual degree of peevishness, intolerance of light and sound, heat of head, &c. The premonitory sym- ptoms are, however, often absent in these cases ; and stupor, convulsions, or paralysis give the first indications of a secondary disease of the brain or its membranes. Chronic* Water or Dropsy of the Brain. This form of the disease is sometimes a sequel of the preceding variety. But, more commonly, it sets in slowly and insidiously without any antecedent acute stage. The head gradually enlarges, whilst the face retains its natural size ; and if the child affected be of tender age, the bones of the head separate to a considerable extent, the moulds become transparent and prominent, and a sense of fluctuation is detectible on pressure. In some cases the head is unusually large originally, and does not increase in magnitude during the course of the disease. The first general symptoms usually observed are languor, lassitude, and loss of flesh. The physical power is much enfeebled ; and one or the whole of the senses are impaired, or be- come entirely suppressed as the malady advances. * A term applied to diseases of long standing ; it is used in op- position to acute. 326 DROPSY OF THE BRAIN. In some cases, the intellectual faculties are pre- served much longer than could be imagined from the extent of the disease. Occasionally the head attains an enormous size, and is incapable of being kept erect by the debilitated and attenuated frame which supports it. Violent general convulsions sometimes occur, and certain limbs remain con- stantly in a rigid state. At other times the convulsions are only partial, affecting merely the face, the muscles connected with the act of breathing, or those of one' or more extremities. Some degree of giddiness in the erect posture is occasionally complained of; or there may be heat and pain in the head ; vomiting ; nocturnal fever, with great restlessness and movements of the head from side to side, or sinking of the head deep into the pillow ; repeated working of the tongue and lips, or continuous action of the lower jaws as in the process of chewing. Squinting is not an unfrequent attendant. Dissolution is gene- rally preceded by drowsiness, and followed by stupor, convulsions, and relaxation of the limbs ; but the immediate cause of death is often to be found in some other disease, such as ulceration of the bowels, pulmonary consumption, or an inflammatory affection of the chest. TREATMENT. In a malady of this serious and dangerous character, professional aid should be DROPSY OF THE BRAIN* 32? sought without delay. The following remedies may, nevertheless, be named as the most appro- priate to resort to in the majority of cases: Aconitum, Belladonna, Hyoscyamus, Bryonia, Rkus, Helleborus, Mercurius, Sulphur, fyc. In the most acute, but rarer forms of the complaint, occurring in robust, plethoric children, Aconitum is required when the pulse is full and rapid, the head hot, the respiration hurried or oppressed, the stomach more or less irritable, and the urine very scanty or suppressed. ADMINISTRATION. Six globules in two table- spoonfuls of water, to children under two years a teaspoonful, and to those above that age a dessertspoonful of the solution every six hours. As soon as the violence of the fever has been subdued, and the skin has become moist, which will commonly be the case after two or, at most, three doses have been administered BELLADONNA should be had recourse to, par- ticularly when there is great heat in the head, redness of the face, with fulness and violent throbbing of the vessels of the head and neck ; loud complaints of pain in the head ; or frequent clasping of the hands round the head ; increase of suffering from the slightest noise, and extreme sensibility to light ; frequent flushings ; unusual brilliancy of the eye, and bold or wild expression of countenance ; sickness of stomach ; delirium ; 328 DROPSY OF THE BRAIN. frantic screams. This remedy is further indicated when the child buries or sinks its head deep into the pillow, or moves its head from side to side; also when there is drowsiness or stupor; contraction or dilatation of the pupils ; moaning ; partial or general convulsions; grinding of the teeth. ADMINISTRATION. Same as Aconitum. Cold applications to the head are often of considerable assistance, in conjunction with the use of Bella. In the more common, less acute form of the disease, Belladonna is still a very important and most efficient remedy ; and even in the chronic variety it is of considerable service when early resorted to. In both cases, however, it will gene- rally be found advantageous to administer it in al- ternation with HyoscyamuS) or with Helleborus if the mould is full and prominent, at intervals of from six to twelve, or twenty-four hours, according to the urgency of the symptoms. When no improve- ment follows the employment of Belladonna either in the acute form of the complaint, or in the first stage, or the commencement of the second stage of the low and protracted type, BRYONIA may be substituted for it, especially if the bowels are obstinately confined, the urine suppressed, or the act of passing it painful and difficult ; the respira- tion oppressed; and the lower jaw in frequent movement. DROPSY OF THE BRAIN. 32Q ADMINISTRATION. Same as Aconitum. (Hele- borus is often required after Bryonia.} In the second and third stages, the remedies by means of which we may yet entertain some hope of warding off a fatal issue, are chiefly Lackesis, Digitalis, Rkus, Opium, Stramonium, Arsenicum, Sulphur, and Zincum. Without entering minutely into the numerous indications which lead to the selection of these, it may be briefly observed that LACHESIS is better adapted than Belladonna to the low form of the malady, when it occurs in sickly or debilitated children, or when the case under treatment has previously been complicated by the abuse of mercurial preparations; also when there is constipation, with extreme prostration of strength, moaning, drowsiness or stupor, and tremulous, in- termittent, or scarcely perceptible pulse. DIGI- TALIS is sometimes indicated in the second stage of water in the brain, particularly when the pulse is slow, weak, and irregular. RHUS is an important remedy in the low pro- tracted variety of this disease, especially when it has attained the second stage. The following are some of its leading indications : intense headache, giddiness, heaviness, and drooping of the head on the chest or shoulder ; distressing, pressive, aching pains in the back of the head, combined with a sensation of creeping, or as if something were loose and moving about; drowsiness; slow, or quick 330 DROPSY OF THE BRAIN. and weak pulse; convulsive movements of the limbs, attended with complaints of severe pain in the head, and followed by remissions during which the patient lies in a torpid state. In water in the brain occurring in conjunction with general dropsy after scarlet fever, this medicament is often of signal service. Belladonna and Uyoscyamus may, however, be required here, previous to the employ- ment of Rhus, especially if, as is frequently the case, the disease sets in in a very acute form. OPIUM is sometimes serviceable in the second or even the third stage, when there is complete apathy and absence of complaint ; half-closed eyes, contracted, or dilated and immoveable ; drowsi- ness or stupor, and constipation. STRAMONIUM when the convulsions are frequent and severe, and do not yield to the employment of Belladonna and Hyoscyamns, &c. ARSENIC UM, when the face is pale, the emaciation and debility excessive, the pulse quick, weak, and unequal or irregular, and when marked intermissions are observed in the course of the affection. SULPHUR is occasionally useful in winding up the cure after the employ- ment of Bryonia or Arsenicum. And ZINCUM in desperate cases, after the previous use of Bella- donna or any of the other remedies, when there is ice-like coldness of the extremities, or of the whole surface of the body ; blueness of the hands or feet ; impeded breathing ; small, weak, and scarcely per- DROPSY OF THE BRAIN. 331 ceptible pulse. Should any improvement ensue after a few doses of Zincum, Belladonna, or any of the other remedies which may then appear better indicated, should be resorted to. In chronic water or dropsy of the brain, Helle- borus, Arsenicum, Sulphur ; and Pulsatilla, Rhus, Conium, Arnica, together with Belladonna and Hyoscyamus, are amongst the more serviceable remedies. Compression of the head is also of some utility. The more acute the inflammation, the greater are the prospects of cure in general cases of water in the brain. It is in these that the employment of Belladonna and Hyoscyamus, preceded, if neces- sary, by Aconitum, act with striking success a copious outbreak of perspiration, with diminished rapidity and oppression of breathing, and increased flow of urine taking place soon after their timely administration. On the other hand, when the disease comes on gradually and insidiously in the wake of some other malady, and especially if it occurs in a child of scrofulous habit, the chances of recovery are much less ; still, even in these varieties, a cure may often be accomplished when the case seems almost hopeless. Protracted slow- ness and feebleness of pulse, or a sudden fall in the pulse occurring in concomitance with dilated or immoveable pupils, and laborious and irre- gular breathing, are unfavorable signs. 332 DROPSY OF THE BRAI.V. When the chronic form of the complaint follows an acute attack; or when, during its progress, delirium, convulsions, and stupor supervene, a fatal result can with difficulty be warded off. But when this variety is manifested in its more com- mon form, and is regularly confirmed, the child affected with it may live for many years, death being ultimately occasioned, as we have elsewhere observed, by some other disease. DIET. In the first stage of the acute variety, toast-water, or, at the utmost, barley-water, or thin water-gruel, are alone required. In the low form of the complaint, and in the second stage of the acute, the patient's strength may be supported by a sufficiency of nutritious but light, easily- digestible food. In the chronic form of the malady the diet must be nourishing, at the same time care should be taken not to overload the stomach. The practitioner is much more fre- quently called upon to diminish than to increase the amount of food given to the children of parents who are in comfortable circumstances. Habitu- ally overloaded stomachs, and the want of a suf- ficient supply of pure air, form fruitful sources of the derangements of childhood in general. DIET IN FEVERS. 333 FEVER. ERUPTIVE FEVERS. Diet in Fevers. THE great essentials in the treatment of fever are: Perfect rest, mental and bodily. Pure air and a cool apartment ; the temperature of the patient's room should never, when prac- ticable, exceed 55 degrees. Feather-beds should be discarded and mattresses substituted ; and the bed-clothes ought to be light, but sufficient. Nature herself generally prescribes the regimen to be observed, by taking away appetite ; while the thirst present, as an eminent medical writer has well observed, may be considered as her voice calling for fluid. Water is the best diluent ; no solid food, broth, or even gruel and the like, should be permitted in cases where the fever runs exces- sively high; and the utmost caution is to be observed, in allowing gruel or weak broths during the decrease. An error in this respect often causes irreparable mischief, and it is always safer to err a little on the side of abstinence, than on that of indulgence. Toast- water, or weak barley- or rice-water, sweetened with a little sugar or raspberry or straw- 334 DIET IN FEVERS. berry syrup, orangeade, whey, and thin gruel may be allowed, when the fever is somewhat abated. On the approach of convalescence, indicated by the subsidence of thirst and the desire for food, alimentary farina,* semolina, sago, arrow- root, and such like, as also cocoa and beef-tea, may be given, though then we must still carefully avoid incurring the risk of a relapse, by giving any aliment, or any undue amount of nutriment, likely to tax, in however slight a degree, the digestive powers. This is best accomplished by the ad- ministration of very small quantities at a time, and at short intervals, gradually augmenting or diminishing the allowance, according to the effects produced. In all kinds of severe acute diseases, the above rules should be strictly attended to ; but in those of a subacute character, which retain a mild type throughout their course, the diet may, from the first, be of the same description as that we have mentioned as best adapted to the con- valescent stage of the severer forms. Fruits, such as grapes, gooseberries, and the juice of a sweet orange, are often allowable, as the inflammatory symptoms decline, in most forms of fever unat- tended with diarrhoea. * This wholesome preparation may be had pure at the Homoeo- pathic Pharmacy, 9, Vere street, Oxford street. SIMPLE FEVER. 335 Simple Fever. This disease seldom presents any distinct cha- racter, and generally runs its course in twenty- four hours ; as, however, it frequently forms the initiative of other more serious disorders, it deserves attention. Before attacks of scarlatina, measles, smallpox, &c., it is usually present, although occasionally showing itself as a distinct affection. SYMPTOMS. Shivering, followed by general heat, restlessness, thirst, accelerated pulse, great uneasiness and lassitude terminated by profuse perspiration. TREATMENT. Throughout the work, this dis- ease will be found treated of, both when arising from indigestion or cold, and when appearing as the precursor of other affections ; but when it is manifested by the symptoms above detailed, and cannot be traced to any particular exciting cause, and particularly when hot dry skin is present, ACONITE, three globules, may be administered* in a teaspoonful of water, and repeated every six to eight hours, until the febrile symptoms subside, which they will speedily do under the employment of this remedy, sometimes shortly * In all cases where directions for the administration of a me- dicine are given, the attention of the reader is directed to the " Rules for the Administration and Repetition of the Dose." 336 SCARLET FEVER. after the first dose, if the attack be simple fever properly so called ; if, on the other hand, it be the forerunner of any more severe disorder, Aconite will, very commonly, either at once check its further progress, or materially modify its ma- lignancy. The former is more peculiarly the case with purely inflammatory attacks : the latter holds good as far as relates to eruptive diseases, and some other affections, which run a regular course. Scarlet Fever. This appellation is employed to denote an affection, characterised by a bright red erup- tion, which appears in patches upon the skin and lining membrane of the mouth and throat, and which is accompanied by fever, with pain and more or less difficulty in performing the act of deglutition. Scarlet fever generally occurs in an epidemic form towards the end of summer and autumn, particularly in cold, wet seasons, and prevails as such until the opening of spring. It is also capable of being spread by contagion. Different degrees of malignancy may spring from the same fount of infection. The habit of body materially influences the type of the malady ; but when the existing epidemy is of a peculiarly severe or SCARLET FEVER. 33? malignant character, it assumes a more or less serious form in all whom it attacks. When it manifests itself in its simple form, un- complicated with any internal inflammation, the rash coming out freely, remaining its usual time, and presenting its characteristic, boiled-lobster- like, hue, the prospects of recovery are, favorable. SYMPTOMS. General uneasiness and feeling of weakness, nausea, sometimes vomiting, with tran- sient chilliness, or fits of shivering, commonly form the antecedents of the eruption. To these are soon afterwards superadded, headache, thirst, heat of skin, occasionally drowsiness, bleeding at the nose, fever, extreme quickness of pulse, and a feeling of soreness or pain in the throat. In one or more days the face becomes tumefied, and numerous small reddish spots appear on the face, neck, and chest the skin, in the intermediate spaces, retaining its usual colour. In a few hours, this eruption spreads over the whole body, and even extends to the lips, tongue, and throat. About the third day, the small red spots and the majority of the interstices are supplanted by large, indefinitely-marked patches, presenting the vivid hue before described, gradually growing paler to- wards their margins, and often overspreading entire limbs, but especially the groins, hips, and joints, with a uniform scarlet colour. The fever 22 338 SCARLET FEVER. usually diminishes after the evolution of the erup- tion. In five or six days, the efflorescence disap- pears, when the skin scales, and comes off in large pieces. We sometimes find scarlet fever with scarcely any or even no external redness, but, at the same time, marked sore-throat and bright redness of the tongue; in such cases the disease, instead of showing itself on the skin, has fixed upon the mucous mem- brane ; and even the sore-throat and redness of the tongue, present in most cases of this disease, may be considered indicative of an internal scarlatina. Scarlatina was formerly confounded with measles, from the resemblance which the two eruptions bear to each other at their commence- ment ; but they are easily distinguishable, even without taking into consideration the peculiar ap- pearance of the skin above mentioned charac- teristic of the disease, by the eruption, in scarlet fever, generally developing itself in from twenty- four to forty-eight hours after the commencement of the fever, whereas that of measles rarely sets in before the third or fourth day ; the absence of sym- ptoms of cold, such as cough, sneezing, flow of tears the usual precursors of measles consti- tutes another mark of difference. The greatly ac- celerated pulse, which denotes the approach of scarlatina, is also never met with, to the same ex- tent, in any other disease. SCARLET FEVER. 339 TREATMENT. In those cases in which this dis- ease appears in its simple form, BELLADONNA is a specific remedy. Even in cases with symptoms of more or less disturbance of the brain, and in those attended with vomiting and excessive tender- ness of the bowels, or with rapid and laborious breathing and other signs of affection of the chest, it is of the highest importance. It should be administered as soon as the throat becomes sore, or when dryness and burning are complained of in the mouth and throat, accom- panied by much thirst, but almost complete in- ability to swallow even drinks or saliva ; further, when the throat is of a bright-red colour, having its surface excoriated, or covered with white specks, or stringy mucus, or presenting the ap- pearance of thrush ; the tonsils swollen, and the tongue of a Iriglit fiery red hue, or, as is sometimes the case at a more advanced stage of the disease, interspersed with dark red patches. ADMINISTRATION. Six globules in two table- spoonfuls of water, a dessert-spoonful every six hours, until the disease begins to subside, or a change takes place in the symptoms, calling for the employment of some other remedy. To children of from one to six years of age, a tea- spoonful of the solution may be given at the stated intervals. If the disease have taken a favorable turn, we 340 SCARLET FEVER. may allow the Belladonna to continue Us action ; but if after the second or third repetition of Bella- donna, the inflammation and swelling increase in- stead of diminishing, as is frequently the case in scrofulous constitutions; or if we perceive increased secretion of mucus or of saliva, with swelling of the glands and muscles of the neck ; or also soreness of the gums, offensive breath, exacerbation of suffer- ing at night, chills or shivering, sometimes alter- nated with heat, and nocturnal sweating, we must have immediate recourse to MERCURIUS. ADMINISTRATION. Same as Belladonna. If Mercurius produces only partial improvement, or if the throat symptoms are always more complained of after awaking from sleep, and the pain is much increased by the slightest external pressure, La- chesis should be resorted to. When there is little or no glandular enlargement, but a large quantity of viscid mucus is secreted from the inflamed and tumefied lining of the throat, which adheres so tenaciously that it is with difficulty to be expelled, and sometimes even threatens suffocation, Nux v. is of considerable service. (Pulsatilla is also useful in such cases, particularly when the patient is of phlegmatic temperament.) ADMINISTRATION. Same as Belladonna, and $Iercurius. When, at the commencement of the attack, there is violent fever, with dry heat of skin, head- SCARLET FEVER. 341 ache, and hardness of pulse, a dose of Aconite (three globules) should be given six or eight hours before Belladonna is resorted to. In some cases the alternate use of these two is beneficial at in- tervals of four hours, until the fever yields. OPIUM may follow the administration of Bella- donna^ when there is burning heat of the skin, drowsiness, stupor, stertorous breathing, open mouth, eyes half closed, restlessness, with vomiting or convulsions. Again, when violent delirium, accompanied by extreme restlessness, and inces- sant movement of the hands, &c., appears at the commencement of scarlet fever (or, indeed, any of the eruptive fevers), Opium is more serviceable than any other remedy, and will generally prevent a fatal issue from paralysis of the brain, which is so prone to appear under the said circumstances. Zincum may sometimes be required when Opium is insufficient to avert the threatening danger ; or the aid of Belladonna may be needed to complete the recovery, after the favorable change produced by Opium. Such cases, as also those which are com- plicated with putrid ulcerous sore-throat, and a faint or a deep red eruption, interspersed with livid spots, in place of the true vivid red, scarlet rash, should, when possible, be treated by a homoeopathic practitioner. The dose of Opium may consist of six globules, or a drop of the tincture, added to an ounce of 342 SCARLET FEVER. water, a dessert-spoonful every four hours; as soon, however, as a marked improvement sets in, we may discontinue the medicine. When the eruption is very intense, and extends over the entire frame, and particularly when the patient affected is of the scrofulous constitution, Sulphur is often of much service. ADMINISTRATION. Same as Belladonna. Aconitum may be given, in alternation with Sulphur, when there is great restlessness, with dry heat of skin, and fulness and quickness of pulse. If, notwithstanding the employment of these, the throat becomes exceedingly painful and in- flamed, Belladonna must be resorted to. The symptoms of derangement of stomach and bowels, which sometimes come on during scarlet fever, generally give way to the remedies employed against the disease itself. But when they become exceedingly distressing, it is necessary to arrest them by means of Ipecacuanha, Pulsatilla, or Cha- momilla. When nausea and vomiting are the most prominent gastric symptoms, Ipecacuanha is to be preferred ; when there are both vomiting and diarrhoea, but less nausea, together with occasional pains in the bowels and chilliness, Pulsatilla; and when there is diarrhoea alone, Chamomilla. In some instances all three may successively be called for. ADMINISTRATION. Three globules, in three SCARLET FEVER. 343 dessert-spoonfuls of water, a dessert-spoonful every three to six hours, according to the severity of the symptoms. In other cases Mercurius or Arsenicum may be required for diarrhoea occurring during or after scarlet fever. (See DIARRHCEA.) If the bowels are confined, a lavement of tepid water may be employed ; but if they have been properly acted upon at the invasion of the disease, there is no necessity for artificial interference, even though they should remain inactive for several days. When the rash disappears suddenly or prema- turely, Bryonia is commonly the remedy which is most capable of bringing it out again. In other cases, Phosphorus and Sulphur are required. But if the consecutive symptoms resemble those before alluded to under Opium, that remedy must be se- lected in preference. These are the principal remedies employed by Homoeopathists in the treatment of Scarlatina, as it is ordinarily met with. There are, of course, other and more virulent forms in which the dis- ease occasionally appears, but the treatment of such cases ought to be conducted by an experi- enced practitioner, and not by an unprofessional person. We frequently find this affection, in a compli- cated form, distinguishable from pure scarlet fever by the absence of the peculiar hue of the skin, to 344 SCARLET FEVER. which allusion was made at the commencement, and by the pressure of the finger leaving no white imprint. Against this, so widely different type of the disorder, Aconitum is often a specific. ADMINISTRATION. Same as Belladonna. Sometimes it is found necessary to administer a dose of Coffea, a few hours after the first or second dose of Aconite, when the patient complains of severe pain in the head, trunk, or extremities, and is extremely restless, fretful, agitated, and disposed to shed tears, and then again to return to Aconite after an interval of the same length ; and so on, alternately, until the cure is completed; which, under favorable circumstances, is speedily accom- plished by means of these remedies. The accession of any special complication, such as water in the brain, inflammation of the wind- pipe, &c., in the course of scarlet fever, or at its termination, must at once be attended to, and treated in accordance with its peculiar features. In strumous habits, many troublesome conse- quences are frequently left. And it may here be remarked, that even after the desquamatory pro- cess is completed, the whole of the danger is not altogether passed ; any exposure to cold, or in- fringement of dietetic rules, being likely to entail unpleasant and even dangerous consequences. CHAMOMILLA may be employed with advantage, either alone or alternately with Belladonna, against SCARLET FEVER. 345 rawness of the face, &c., occurring after scarlet fever. AURUM. Against an offensive and purulent discharge from the nose, with soreness and swelling of the interior. MERCURIUS vivus is a good remedy against soreness of the nose and face, with swelling of the submaxillary glands ; followed by Hepar sulphuris, Silicea, Sulphur, and Calcarea, if necessary. BELLADONNA. If there is puffiness of the face, with swelling of the hands and feet, lingering fever in the evening, glandular enlargements, chaps about the mouth, severe headaches, stam- mering, &c. ; it may sometimes be advantageously alternated with the medicines just mentioned. Dropsical swelling of the whole body is a very serious and not unfrequent sequel, sometimes re- quiring a most careful and discriminating treat- ment. The extent of the swelling does not always indicate the degree of danger, as children, in whom the external tumefaction is inconsiderable, are often carried off by water in the chest or head. The following remedies will generally be found the best adapted to the successful treatment of the same : Helleborus, Arsenicum, and Rkus. Of these, Helled, is generally the most appropriate when the body has become suddenly swollen (or dropsical) ; Rhus, when the legs or feet are more especially affected; and Arsenicum when Hetteb, 346 SCARLET FEVER. does not soon produce a favorable impression. There are other remedies which may be required under particular circumstances ; but a professional man can alone determine their choice, and the special indications which call for their selection. Against inflammation of, or discharge from, the ears, Belladonna, Hepar sulphwris, or Pulsatitta are the best remedies, in the case of boils, Arnica, which may be followed by Bryonia and Sulphur, where necessary; and for deafness, Belladonna, Pulsatilla, Dulcamara, and Sulphur, are to be chiefly recommended. Belladonna, as Hahnemann discovered upwards of forty years ago, is undoubtedly a most valuable preservative against pure scarlatina when epidemic, whatever may be said to the contrary by those who have either not employed it properly, or who have tried it in an impure or complicated form of the complaint. In those rare instances in which it fails, even when had recourse to at a sufficiently early period, it, at all events, has the power of materially modifying the character of the disease. With very young children, one globule, with those from six to ten years of age two globules (in a teaspoonful of water every second day, or every day when the fever rages extensively), and with adults, or robust children above ten years of age, three globules daily, or night and morning, for from two to three weeks at farthest, will generally SCARLET FEVER. 34? be found sufficient to obviate any risk.* Should the disease continue to rage, this treatment may, in some instances, be renewed. If, however, the ruling epidemy be scarlatina in an unusual or complicated form, the remedies employed as pre- servatives must be such as possess properties which correspond to the peculiar features of the disease. Thus, Aconitum and Belladonna in alter- nation (allowing twenty-four hours to elapse after the administration of Aconitum before Belladonna is given, and from forty-eight to seventy-two hours after Belladonna, before Aconitum is re- peated, and so on) have been employed success- fully in epidemics not possessing the clear scarla- * We have, in common with others, repeatedly proved the truth of Ilahnemaim's discovery of the prophylactic, or preservative powers of Belladonna. Dr. Schneider, of Magdeburg, has recently employed it on a most extensive scale, against the pure, smooth scarlet fever ; he found that, when he gave it to a large proportion of the children of the town or village in which the fever raged, not one of those to whom it was administered sufficiently early, and continued long enough, was seized ; whereas nearly the whole of those to whom Belladonna was not given were more or less seyerely, and often fatally, affected. The prescription he employed was as follows : Five drops of the Tra. fortis to one drachm of spirits of wine. Of this, eight drops to a teacupful of water. Dose. To children up to three years of age, one teaspoonful every morning ; to those between three and five years, one teaspoonful morning and evening ; and to those of a more advanced age, two teaspoonfuls in the morning and one in the evening. Ally. Horn. Zeitung, 1 0, 33. In warm weather the mixture ought not to be kept more than from two to four days. Epitome of Horn. Domes, Med., p. 9. 348 SCARLET FEVER. tina hue, with a smooth and glossy surface. In other epidemics, again, Coffea, Calcarea, &c., might be required. But there are few in which Bella- donna will not be more or less useful. The food must be plain and wholesome, and wine and acids avoided whilst Aconitnm or Belladonna are being taken. We must, in administering preserva- tives, carefully watch their effects ; and if a medicinal action set in, discontinue immediately. DIET AND REGIMEN. During the course of this malady, the greatest possible attention must be paid to this point. Whilst the fever runs high, no other nourishment must be given than toast- water, or weak barley-water ; and even after the fever has abated, every care must be taken, and a return gradually made to a more nourishing diet, as negligence in this respect may be productive of the most serious consequences. Cocoa, milk and water, alimentary farina,* arrowroot, beef-tea, with thin slices of stale or toasted bread, should com- monly form the prelude to the usual mode of living. In mild attacks, the patient may be allowed gruel or weak broths. (See also Diet in Fever.} Stimulants, such as wine, &c., ought never to be given for the purpose of removing debility during convalescence, as they are very liable to give rise to serious and dangerous local inflammations. * Thi preparation may be had pure at the Homoeopathic Pharmacy, 9, Vere Street, Oxford Street. MEASLES. 349 The employment of such medicines as Arsenicum, Veratrum, Pulsatilla, Nux v., and Lachesis, &c., are sometimes, though rarely, required to give tone to this debilitated state of the system, when it threatens to prove tedious. During the course of the disease, the patient should be confined to his bed ; and whilst he is protected from draughts, he should not be oppressed with an excess of clothing, or almost stifled by the close and vitiated air of an ill-ventilated, over-heated apartment. Measles. This eruptive fever is distinguished by its con- nexion with catarrhal symptoms affecting the mucous or lining membrane of the eyes, nose, windpipe and its ramifications. SYMPTOMS. The form of measles which is most generally met with, is ushered in by the usual signs of fever, viz., lassitude or languor; shivering ; heat of skin ; or alternations of heat and chills ; and thirst" Giddiness, headache, and pain in the back are also complained of. As the affection proceeds on its course, the patient is seized with sneezing ; discharge from the nose ; suffused and watery eyes ; hoarse, dry cough ; puffed and feverish face ; vomiting and purging ; or constipation ; or sluggishness of bowels with very offensive evacuations ; scanty secretion of 350 MEASLES. urine ; full, frequent and strong, or quick, small, irregular and oppressed pulse ; sometimes de- lirium ; and commonly an exacerbation of fever towards evening. These symptoms occur in various degrees of intensity. They are often so slight as to attract very little notice, and cannot be determined from common cold or other febrile disease. Exposure to infection, or the prevalence of epidemic measles, being the only means of influencing a decision as to the true character of the premonitory symptoms. In the course of three to four, but sometimes not before the lapse of seven or eight days, the eruption begins to appear on the face and neck, and subsequently on the body and limbs, in the form of small, round, red dots or pimples. These are very slightly elevated, but sufficiently so as to give a sensation of hardness to the hand when passed over the surface of the affected skin. They soon run together into extensive patches of irregular shape, their margins presenting somewhat of a crescentic or semicircular curve. In the average number of well-developed cases, the entire surface is usually bedecked with the eruption about the fifth day. On the sixth day it begins to fade on the face, and generally altogether vanishes with a bran-like exfoliation of the cuticle, about the ninth or tenth day from the invasion of the fever, or the sixth from its own appearance. Deviations from this MEASLES. 351 course are, however, not of unfrequent occurrence. The eruption is sometimes very slight; but the patches which are well marked, and which in healthy measles are of a lightish red colour, ex- hibit a striking contrast with the natural colour of the sound skin in the interstices. The throat, when examined, will be observed, about the fourth or fifth days, to be covered with small red points or patches, which are formed by the extension of the eruption to the mucous membrane, and are occasionally productive of difficulty in swallowing. A greater or less degree of difficulty of breathing, with some pain and tightness of chest, precede the evolution of the eruption ; and, occasionally, violent sickness and vomiting, or even convulsions, supervene. In such cases the rash, when it appears, is frequently combined with an eruption of miliary vesicles. In favorable cases, although the fever does not wholly cease, it nevertheless abates considerably in violence as soon as the eruption is developed. Measles is not so much to be dreaded for itself, as for the deleterious consequences which, in bad constitutions, it frequently entails in the form of consumption, scrofula, diarrhoea, inflammation of the eyes, &c. A complication with other diseases, as inflammation of the lungs or brain ; and an un- healthy, livid-looking, or imperfectly-developed eruption, with concentration of the disease on the 352 MEASLES. windpipe and its ramifications, likewise tend to render the malady of serious import. TREATMENT. In mild epidemic measles, oc- curring in a simple uncomplicated form, a few doses of Pulsatilla, combined with free ventilation, without exposure to currents of air, darkening of the apartment, if the eyes be rather sensitive to light and the use of light, unstimulating food, when the appetite continues unimpaired, are the only remedial means required. Pulsatilla, it may be added, is useful in all the stages of the com- plaint, viz. the catarrhal, the eruptive, and the convalescent, in the latter, when there are con- secutive symptoms, in the form of inflammation of the eyes and eyelids, discharge from the ear or earache, and diarrhoea. Even in the severer varieties of measles, Pulsatilla is more or less useful, but the aid of other medicaments is usu- ally required in such cases, Pulsatilla ought to be given as soon as the slightest catarrhal signs make their appearance during the prevalence of measles ; for, independently of its general ap- propriateness to that stage of the complaint, : particularly when discharge from the nose, fre- quent sneezing, inflamed, watery, and sensitive eyes, headache, hoarseness, and some cough which is aggravated by lying down, and is occasionally accompanied by inclination to vomit, constitute MEASLES. 353 the more prominent symptoms, it appears to assist in bringing out the eruption, and thereby curtails as well as alleviates the catarrhal stage. ADMINISTRATION. Two globules every twelve hours for from two to three days. As soon there- after as the rash makes its appearance, the medicine may be resumed in the same way, unless some other remedy becomes indicated. When the ac- companying fever is severe, the pulse being quick and full, the skin hot and dry, the thirst great, and the secretion of urine scanty, it will be necessary to give Aconitum, two globules every six or eight hours, in alternation with Pulsatitta. And if the intensity of fever persists notwith- standing, Sulp/turmay be substituted for Pulsatilla, and exhibited in alternation with Aconitum, until the febrile symptoms yield. The troublesome itching which usually attends the scaling off of the cuticle or scarf-skin, may be relieved by sponging the body with warm water. When the prevailing epidemy is of a more severe type, although the treatment just mentioned will often suffice to ward off serious complications, and con- duct the patient safely throughout the entire course of the affection, there is, nevertheless, frequently a necessity for resorting to other medicaments, both in the premonitory or catarrhal stage, and during the disease. An inherent delicacy of con- stitution contributes to extend the range of required 23 354 MEASLES. medical treatment, and to entail a variety of consecutive symptoms, some of the more im- portant of which have already been alluded to. As the treatment of the complicated and malig- nant grades of measles ought only to be confided to professional hands, it is not intended, in the following brief observations, to enter into the subject in detail, but merely to point out a few of the medicines which are more frequently indicated in the said cases. It may be remarked, before- hand, that the catarrhal stage even of the mild and simple form of measles may, in particular habits, be attended with symptoms of equal severity as that which precedes the development of the more serious and dangerous species. The medicines which are sometimes called for, soon after or in preference to Pulsatilla, in the catarrhal or premonitory stage of measles, when the sym- ptoms occur with great severity are, Aconitum, Belladonna, Hejoar sulpkuris, Ckamomitta, Ipeca- cuanha, Opium., and Calcarea. ACONITUM is required when the febrile sym- ptoms are the most prominent, the pulse being quick and full, the skin hot and dry, the thirst great, and the urine very scanty and high-coloured. (See Common Cold.} ADMINISTRATION. Six globules in two table- spoonfuls of water ; a dessertspoonful of the solu- tion every eight hours until the skin becomes MEASLES. 355 moist and the pulse reduced. To children under three years of age, the dose may consist of a teaspoonful of the above at the intervals stated. BELLADONNA is more especially adapted to full, plethoric, and scrofulous habits. It is in- dicated when the patient complains of severe pain in the forehead and back; and when the eyes are watery, very sensitive to the light, and much in- flamed ; the head hot ; the pulse quick ; and the skin above the natural temperature. Further, when there is a dry, harsh, or hollow, barking cough, aggravated at night, and sometimes ac- companied by accelerated and oppressed respira- tion, with rattling of phlegm in the chest ; hoarse- ness; frequent fits of sneezing, with discharge from the nose ; thirst ; vomiting ; great restless- ness, sleeplessness, and occasionally delirium, or convulsive twitching of the limbs. ADMINISTRATION. Same as Aconitwm, with which remedy Belladonna may be alternated if the symptoms mentioned under the former are super- added to those just described. IPECACUANHA is chiefly called for when, as is frequently the case about the third or fourth day of the fever, there is distressing tightness of chest, with laborious breathing; extreme restlessness and agitation; deep sighing or moaning; ex- cessive nausea; vomiting, or both vomiting and purging; obstruction of the nostrils ; dry cough. 356 MEASLES. ADMINISTRATION. Same as Aconite. BRYONIA is indicated by nearly the same train of symptoms as Ipecacuanha, but is to be preferred to that remedy when the bowels are in a con- stipated state. ADMINISTRATION. Same as Aconite. The latter may be given alternately with Bryonia when the febrile symptoms run high. HEPAR SULPHURIS is often very useful when a dry hoarse cough, closely resembling that of croup, forms the most prominent feature in the catarrhal stage of measles. ADMINISTRATION. Same as, Aconite, with which it may be taken alternately when the pulse is full and rapid, the skin hot, and the thirst con- siderable. CHAMOMILLA is occasionally of service with very young and delicate children, when the cough is very severe at night, and continues even during sleep ; also when there is difficulty of breathing, colic, diarrhoea, and sometimes vomiting. ADMINISTRATION. Two globules in four tea- spoonfuls of water, a teaspoonful of the solution every six or twelve hours, according to the severity of these symptoms. OPIUM is called for when, antecedent to the appearance of the eruption, the patient is seized with violent delirium, with incessant movement of the hands, &c. MEASLES. 357 ADMINISTRATION. Six globules in two table- spoonfuls of water, a dessertspoonful every four hours. When a marked improvement follows the first dose, the interval must be lengthened before the medicine is repeated, if its repetition seem necessary. CAL.CAREA is sometimes required when con- vulsions occur immediately before the eruption comes out ; and when there is extreme restlessness and anxiety ; obstruction of the nose; hoarseness ; dry cough. ADMINISTRATION. Same as Opium. When the eruption has made its appearance, the following are the more important remedies in measles of a bad or complicated character; Bryonia, Pulsatitta, Sulphur, Phosphorus, Arsenicum, etc. BRYONIA. This remedy is appropriate when the eruption does not come fully out, and the dis- ease concentrates itself upon the chest, with in- cessant cough, pricking pains, quick and oppressed respiration, and acceleration of pulse ; or when there is foulness of tongue, considerable thirst, and severe aching in the limbs, with aggravation of pain from movement : lastly, when the rash presents a deeper hue than usual or is combined with an eruption of miliary vesicles, or livid spots. ADMINISTRATION. Six globules in two table- spoonfuls of water, a dessertspoonful every four 358 MEASLES. hours. If improvement follows, the medicine may be continued with longer intervals between the doses; but if no amendment takes place, and fresh symptoniSj incidental to the prevailing epidemy, supervene, another remedy which cor- responds thereto must be selected. (Aconitum is sometimes useful in alternation with Bryonia, when the affection retains the in- flammatory form, and the shooting or pricking pains in the chest are associated with heat of skin, and rapidity and fulness of pulse.) PHOSPHORUS is indicated in cases somewhat analogous to the preceding medicament ; the chest being chiefly affected, and the eruption imperfectly developed. It is also indicated when there is hoarseness with pain in the windpipe ; great debility; shrunken features; low fever; stupor; and diarrhoea. (Arsenicum is sometimes required after Phosphorus, when the chest has been relieved, but the fever, prostration of strength, and diarrhrea remain.) ADMINISTRATION. Same as Bryonia. PULSATILLA, as already observed, is often useful in measles of a bad type, as well as in the milder form of the disease. A combination of signs of marked disturbance in the digestive organs, as foul tongue, nausea, vomiting or purging, with those detailed under its indications in the catarrhal stage of simple measles, and, some- MEASLES. 359 times, a total absence of thirst, are the principal symptoms which denote its appropriateness. The presence of external or internal inflammation of the ear is, moreover, a marked indication for Pulsatilla. ADMINISTRATION. Same as Bryonia. SULPHUR is often serviceable after the previous employment of Pulsatilla, or indeed any other remedy, when the eyes are much inflamed, and there is earache, with thick discharge and dullness of hearing ; and loose cough, with thick, whitish yellow expectoration. It is also useful when the eruption is faint, or never comes freely out, and there is low fever, with headache, aching in the limbs, and much debility. ADMINISTRATION. Same as Bryonia. Measles sometimes terminates fatally in con- sequence of a retropulsion of the eruption from exposure to cold or change of temperature, or when the sudden and premature recession takes place from unknown causes. In such cases BRY- ONIA, administered as above, is generally found efficacious in re-evolving the eruption, and pre- venting this disaster ; but if diarrhoea with mucous discharge follow the suppression, PULSATILLA is indicated ; if vomiting, with great oppression at the chest, be the more prominent symptom, IPECA- CUANHA should be substituted, and followed in turn by ARSENICUM, if symptoms of improvement 360 MEASLES. do not speedily show themselves : In the case of children, CHAMOMILLA is to be preferred to Ipeca- cuanha, when there is laboured respiration and diarrhoea with colic, vomiting, and tenderness of the abdomen (belly) ; BELLADONNA may follower supersede Chamomilla if the diarrhoea subsides, but the tenderness of the abdomen, the impeded breathing, &c., continue unabated. (See Inflamma- tion of the Stomach and Bowels : as also the other indications already given in this chapter, for the whole of the above remedies.) For the treatment of coughs which sometimes remain after measles, a variety of medicines may be indicated. For the diarrhoea which the disease occasionally leaves behind it Cinchona., Pulsatilla, Mercurius, and Sulphur are, in general, the most appropriate remedies ; for their several indications see Diar- rhoea. For running from the ear Pulsatilla and Sulphur are very serviceable, but other remedies are sometimes required. For inflammation of the glands below, and in front of the ear, Arnica and Dulcamara ; for tenderness of the skin Rhus ; and for a burning, itching, rash, which bleeds after scratching, Arsenicum and Sulphur are severally indicated. When measles rages epidemically, PULSATILLA and ACONITE, administered alternately, for a fortnight, allowing an interval of twenty-four MEASLES. 361 hours after each dose (three or four globules) of Aconitum, and one of forty-eight hours after that of Pulsatilla, will sometimes ward off an attack or give a milder character to the affection if it breaks out. This precautionary treatment may be once more renewed after the lapse of a week if the dis- ease continues to spread. DIET. In this respect the same rules may be followed as given under SCARLET FEVER. The patient ought not to be kept too warm ; but, whilst we ensure free ventilation, care should be taken not to expose him to a current air; or to a very low temperature, lest the eruption should thereby be driven in, or its full development prevented. Roseola. False Measles. This eruption bears a close resemblance to, and, as is the case with Red gum, is often mistaken for measles. It is frequently dependent upon the irritation of teething, or derangement of the digestive organs, and is chiefly discriminated from measles by the absence of catarrhal symptoms. This rash calls for no particular treatment beyond pure air with the avoidance of exposure to cold, unless there is great restlessness and febrile ex- citement, in which case Aconitum or Coffea, &c., 362 SMALLPOX. may be resorted to (see Dentition), or when there is disturbance of stomach and bowels, for which the employment of such remedies as Ipecacuanha, Chamomilla, &c., may be necessary. (See Indigestion of Infants, and also Diarrhoea.} Smallpox. ( Variola.} It is proposed here, to divide this disease into two varieties the distinct, when the pustules on the face are clearly defined, and do not run into one another and the confluent, when they coalesce and form one continuous whole. When the symptoms are less severe than those properly characteristic of the disease, and the eruption on the face slight, it is called the modified smallpox. We generally find this description in such persons as have been properly vaccinated in infancy, a precaution which, although not always a preservative from the attacks of smallpox, greatly lessens its virulence, and gives a milder character to the complaint, when taken. SYMPTOMS. The disease is frequently very sudden in its attacks, commencing with chil- liness and shivering, followed by febrile symptoms, headache, severe pains in the small of the back and loins, languor, weariness, aud faintness ; the SMALLPOX. 363 patient also complains of oppression of the chest, and acute pain in the pit of the stomach, increased by pressure. The eruption generally makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Its establishment is followed by an abatement of fever, in distinct smallpox. Catarrhal symptoms, as sneezing, coughing, wheezing, and sometimes difficulty of breathing, are frequent concomitant symptoms. A convulsive fit is, occasionally, the first decided indication of illness, and has been held to be a favorable sign. The space of time which elapses between the reception of the infection and the invasion of the febrile symptoms is, generally, computed to be about a fortnight. The eruption first displays itself in the shape of small, hard, red pimples, which, in about three days, present a vesicular appearance, surrounded by an inflamed circular margin, and become de- pressed in the centre as they enlarge. About the sixth or eighth day, the lymph in the pustule becomes converted into pus,* and the depression in the centre disappears. This has been deno- minated the process of maturation. When the pustules are very numerous on the face, the features generally become much swollen, and the eyelids are frequently closed up. On the * Matter. 364 SMALLPOX. first day, a small lump, like a millet-seed, may be felt in each of the elevations above noticed, distin- guishing this eruptive fever from almost all others. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course ; thus, those which first appeared are forming into scabs or dying off, while the others are suppurating. The general desiccation com- monly takes place on or about the eighth or four- teenth day, according as the pustules may happen to be distinct or confluent. An extension of the eruption to the mucous membrane of the mouth and throat is a common occurrence. When the pustules have attained their full de- velopment, they generally burst, in mild cases emitting an opaque lymph, which dries into a crust and falls off; whilst, in severe ones, a discharge of puriform matter, forming scabs and sores, which leave, on their healing, permanent marks or pits. Red stains, caused by increased vascular action, always remain for a while after the eruption ; but if no ulceration has taken place, they disappear in process of time. In CONFLUENT SMALLPOX, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease ; the pain in the pit of the stomach and difficulty of breathing are more complained SMALLPOX. 365 of, and in children the eruption is more frequently preceded by convulsions and delirium ; the latter symptom, indeed, is often present with adults during the suppurative or secondary fever, which frequently assumes a typhoid character, and some- times carries off the patient on the eleventh day. All cases in which we have a deeply-rooted morbid constitutional taint to contend against, generally require the utmost skill to ward offa fatal result. An extensive inflammatory blush on the face or trunk almost invariably precedes the con- fluent variety of smallpox. Salivation* (which is more peculiar to adults), and soreness of the throat, with aphthae, or pus- tules on the tongue and pharynx,f frequently occur in both forms of this disease, but particularly in the confluent. In children, diarrhoea is a more common occurrence during the course of the con- fluent variety. When smallpox terminates fatally, the imme- diate cause of death is, for the most part, to be found in some inflammatory affection of the brain or organs of respiration. Complications of the said character, therefore, and a bad type of the dis- ease, must always lessen the prospects of recovery. * Increased secretion of saliva. t The back part of the throat ; the opening into the gullet. 366 SMALLPOX. A species of eruption which never matures properly, but remains flat and looks pale, being unsurrounded by a red areola a large number of confluent eruptions on the face hoarseness, with cough of a croup-like sound the appearance of livid spots on various parts of the surface and lastly, pro- fuse discharges of blood, and symptoms of gan- grene* are all to be considered as unfavorable signs. Before proceeding to the medicines to be ad- ministered in the different stages of the disease, a few words may be said upon the general treat- ment of the patient. Cool and fresh air areo ur best auxiliaries, the variolous virusf being of a nature to react upon the organism, and warmth being calculated to increase its activity. So beneficial is cool air found in this malady, that taking a child to an open window when attacked with convulsions, will generally afford immediate relief. Great cleanliness must also be observed, and the linen frequently changed. TREATMENT. Now that the homoeopathic prin- ciple of vaccination, the discovery of the celebrated * The first stage of mortification. t The matter, product, or poison of smallpox. SMALLPOX. 36? Dr. Jenner, is so universally acted upon, this for- merly so loathsome and fatal disease has in a great measure been deprived of all its virulence. For although it cannot be denied that the process of vaccination is not an effectual preservative against the disease, nevertheless it is comparatively seldom that those who have once or oftener been properly vaccinated, are ever very seriously or dangerously affected, if they do not wholly escape. In ordinary forms of simple, distinct smallpox, Aconitum or Coffea are the most useful in the febrile stage ; Ipecacuanha and Antimonium tartaricum when considerable constitutional disturbance pre- cedes the appearance of the eruption; Antimonium tartaricum or RJms when the eruption has appeared; and Sulphur when the scabs are forming. In cases, either distinct or confluent, which are complicated with affection of the chest (pleurisy in particular), Bryonia, and sometimes Rhus, fol- lowed by Sulphur. For those with affection of the brain, Belladonna or Opium; and those with typhoid fever, Rhm and Arsenicum chiefly, but sometimes also Bryonia and Mercuriux. When cough attends or follows the eruptive or the maturative stage, Chamomilla, Bryonia., Tartarus, orHepars. And when diarrhoea prevails, Chamomilld or Mercurius, &c. To enter somewhat into details, it may be stated, 368 SMALLPOX. that, in the first stage of the affection, the main object to be accomplished is the subjugation of the fever when it exists in a rather intense form. The employment of Aconitum for this purpose, and for the prevention of local congestions and inflamma- tions, is attended with the happiest results ; since, whilst it most effectually and speedily subdues overaction by diminishing the unnatural force and rapidity of the circulation, it does so without, in the slightest degree, depriving the patient of the strength which is required to carry him through this so frequently protracted, exhausting, and ever-loathsome disease. The indications here for Aconitum are those which have already been re- peatedly given in various parts of this work, viz. dry, hot skin, thirst, quickness and fulness of pulse. ADMINISTRATION. Six globules may be dis- solved in two tablespoonfuls of water, and a dessert-spoonful of the solution given every six or eight hours, until the skin becomes moist, and the acceleration of pulse subsides, when the intervals between the doses may be lengthened, or another remedy selected, in accordance with the remaining symptoms. In confluent smallpox, occurring in plethoric children, it is sometimes necessary, in consequence of the continuance of the fever even after the appearance of the rash, to SMALLPOX. 36Q administer Aconltum in alternation with the remedy otherwise indicated; but more frequently it is only necessary to resort to Aconitmn again during the secondary fever, which frequently sets in when the scabs are forming. (See Confluent Small- pox.} In mild cases, with little or no inflammatory fever, but considerable restlessness and excitement, COFFEA is of good service, and appears to exert some influence over the development of the eruption. ADMINISTRATION. Six globules, in two table- spoonfuls of water, a dessert-spoonful every six or eight hours. When considerable tightness and oppression of the chest, sometimes attended with nausea and vomiting, or even purging, are mani- fested before the appearance of the eruption, IPECACUANHA and ANTIMONIUM TARTARICUM may be substituted for Coffea. ADMINISTRATION. Three globules of each remedy, alternately, every six or eight hours, in a dessert-spoonful of water, until signs of improve- ment appear or some other remedy becomes indicated. Antim. tart, is frequently very useful after, as well as before, the evolution of the erup- tion ; the existence of a hollow-sounding cough, with loud mucous rattling in the chest, is an addi- tional indication for its employment. Adminis- tration : Six globules, in two tables poonfuls of 24 370 SMALLPOX. water, a dessert-spoonful every six or eight hours. BBYONIA is also useful in promoting the de- velopment, and assisting the natural course of the eruption ; it is chiefly indicated when symptoms of considerable derangement of the digestive organs are present, such as bitter taste in the mouth, foulness of the tongue ; or, when there is head- ache, with aching pains in the limbs, increased by motion ; constipation, and irritability of disposi- tion; also, when there is complication with in- flammation in the chest, with shooting or pricking pains, especially during inspiration. RHUS is equally serviceable at this stage of the disease, and is to be preferred to Bryonia, when the acute pains in the head, back, and loins are aggravated during a state of rest, and temporarily relieved by movement. It is further indicated when the fever assumes a low typhoid type. ADMINISTRATION. In slight cases, two glo- bules, in a teaspoonful of water, given every twelve hours, as the eruption continues to develope itself; in severe cases, six globules, to an ounce of water, a dessert-spoonful every six hours. Either of these remedies may be preceded or followed by ACONITE, should there be considerable fever, with dry heat of the skin, the medicine being administered as above ordered, until these sym- ptoms abate. SMALLPOX. 371 Should neither Bryonia nor Rhus be indicated, Tartarus emeticus may be administered as above, at longer intervals (every twelve hours), while the disease is running its course, but more particularly during the distension of the pustules (should no other remedies be imperatively called for), and also towards the period of their drying up or bursting. As soon as the latter process has commenced, however, Sulphur may be re- sorted to. ADMINISTRATION. Four globules, in the same number of dessert-spoonfuls of water, a dessert- spoonful of the solution morning and evening. When rheumatic pains, in the back and ex- tremities, which become worse at night, and are somewhat relieved by movement, are complained of at this period, Rhus may be advantageously alternated with Sulphur. ADMINISTRATION. Three globules of Rhus, alternately with three of Sulphur, every twelve hours, until relief is obtained, or a change of sym- ptoms occurs requiring some other remedy. In favorable cases, nothing further is required but frequent and gentle sponging, and light, nou- rishing food, when the scabs are drying up and falling off. When there is much irritation and restlessness, Coffea, and sometimes, though more rarely, Aconitum, may be alternated with Sulphur 372 SMALLPOX. If Antimonium tartaricum and Ipecacuanha do not succeed in allaying the nausea and vomiting, and the patient complains of excessive thirst and dry- ness of the mouth, the tongue being at the same time very foul and dark, and the prostration of strength excessive, we may administer ARSE- NIC UM, two globules, in a teaspoonful of water, and repeat the dose every two or three hours, if re- quired ; but the remedy must be discontinued as soon as decided benefit has resulted from its action. In confluent smallpox, during the filling up of the pocks, which is the most serious period of the disease, a secondary or suppurative fever fre- quently sets in. Should this run high, the em- ployment of ACOXITUM, as already stated, will sometimes be necessary, either alone, or in alter- nation, if needful, with some other remedy which is indicated by coexisting symptoms not embraced- by Aconite. Sulphur,, Mercurius, Chamomilla, Hepar s., Belladonna, Opium, Arsenicum, Rhus, China, Car do vegetabilis, and Acidum muriaticum, are the medi- cines which are more frequently wanted at this stage of confluent smallpox; but as the treat- ment of the forms of disease which call for these remedies is, properly speaking, beyond the pale of domestic treatment, and as some of them are only required among adults, I shall confine myself to a few of the more common indications for each of the remedies just mentioned. SMALLPOX. 373 SULPHUR may be given in alternation with Aconitum, when this latter is insufficient to miti- gate excessive febrile action. MERCURIUS is, principally, indicated when there is inflammation of the eyes, soreness of the throat and nose, fetid breath (salivation), cough, hoarseness, tenderness of the stomach, excessive looseness of bowels, attended with incessant straining, and sometimes bloody stools. CHAMOMILLA is frequently of much use in very young children, when there is predominating looseness of the bowels, with deep green stools, severe colic, tenderness of the belly, and difficult breathing (see art. Diarrhoea, should the looseness become excessive and not yield to Merc, or Cham.}; also when there is much restlessness and whining, and a distressing nocturnal cough. HEPAR SULPHURIS is to be preferred where hoarseness or an incessant, hoarse, croupy cough, with tenderness of the exterior of the throat, and a dry, hot skin, form the most striking symptoms. BELLADONNA is sometimes required after Chamomitta, when that remedy produces only temporary relief; or it is to be preferred thereto, particularly in plethoric children, when the head becomes prominently affected, evidenced by flushed countenance, fulness and throbbing of the vessels, red and inflamed eyes, intolerance of light, headache, delirium, thirst, heat of skin, excessive irritability of stomach, with nausea or vomiting 374 SMALLPOX. on the slightest movement, delirium, prostration of strength, drowsiness, &c. OPIUM may follow, or it may be selected in preference to Belladonna, when there is continuous lethargy, with open mouth, half-closed eyes, and snoring respiration ; but also when there is violent delirium, with incessant movements of the hands, &c. ARSENICUM is sometimes required in an earlier stage of the disease, before the appearance of the eruption, when Ipecac, and Ant. tart, are insufficient to allay the vomiting (or purging), and tightness of chest, which occasionally precede; but it is more especially required when, in confluent small- pox of a bad type, the attack of secondary fever is rapidly followed by extreme prostration, cold- ness of the limbs, great thirst, dryness of the mouth, with foul, brownish, or almost black- looking tongue, livid spots on the surface of the body, and other symptoms of typhus. RHUS is also required in cases which assume a typhoid character, attended with aching pains and paralytic weakness in the extremities, but not quite so much exhaustion as in the foregoing instance. CINCHONA is serviceable when the debility arises from the depleting effects occasioned by diarrhoea or the drain of matter from the pustules. CABBO v. may be resorted to when gangrene SMALLPOX. 375 is apprehended; or when the pustules are thin and unhealthy, and the scabs or incrustations are of a dark brown colour, and have a very fetid smell provided Arsenicum does not correspond better to the other symptoms of the case. The alternate use of these two is sometimes attended with advantage. A number of troublesome and even dangerous consequences often follow attacks of smallpox, such as boils, inflammation of the eyes, glandular swellings, and other scrofulous affections, requiring a more or less prolonged and careful treatment for their removal. Before concluding, it may be added, that THUJA OCCIDENTALIS has very recently been employed on the Continent, with much success, although on a limited scale, in the treatment of smallpox ; no fatal cases having occurred amongst the pa- tients to whom it was administered, and no pock- marks having been left behind ; whilst several fatal cases, and still more disfigurations, occurred at the same time amongst the patients who were treated allopathically.* It has also been recom- mended as a preservative against the disease. Should it prove so, it will form an appreciable improvement upon Jenner's discovery; for, with due deference to the value of vaccination, it cannot * According to the old mode of practice, i.e. by means of blood- letting, aperients, opiates, &c. 376 SMALLPOX. be denied that there appears to be strong pre- sumptive evidence of the fact, that the said pro- cess has, in some measure, contributed to the spread of scrofula. MODIFIED SMALLPOX is merely a mild de- scription of the above, and, as we have before said, is the form the disease generally assumes when it attacks those who have been properly vaccinated. We must regulate our treatment according to the symptoms, being guided in the selection of the remedies by the indications before given. DIET AND REGIMEN. The diet should be regulated by the virulence of the attack; in all instances, the beverages ought to be cold, as a warm regimen, combined with neglect of the precau- tions before mentioned, may convert the mild into the malignant form. While the fever runs high, water or toast-water should alone be allowed ; but when the affection is going off, mildly nutritious food, such as alimentary farina, arrow-root, cocoa, and light animal broths, may be allowed. Stimu- lants are only to be tolerated in rare cases almost never in the case of children ; and it is sometimes necessary that the patient abstain, for a consider- able time, from animal food. (See Diet in Fever.} The pustules may be anointed with oil of almonds, CHICKEN-POCK. 377 or gently sponged with tepid water, when they become hard ; or dusted with pure starch when a thin, acrid, or otherwise unhealthy discharge runs from them. The hair of the head should be clipped, for the sake of the cleanliness and comfort of the patient ; and the hands muffled, to prevent injury to the pustules from scratching. It may be remarked that, after recovery from an attack of malignant smallpox, the patient's constitution often requires a thorough renovation, and that he should, therefore, be put under a course of medicine best calculated to attain that result. Chicken-pock. SYMPTOMS. A disease, bearing a considerable resemblance, in its external character, to smallpox, but differing in its duration, and symptomatically, being considerably milder, and but rarely becoming dangerous, except when it extends itself to the lungs or brain. The fever, however, occasionally runs high. When this affection attacks an individual, and smallpox is epidemic, which is not unfrequently the case, it is often mistaken for that disorder ; but it soon discovers its real character, by the rapidity with which the eruption declares itself: the pustules (in many instances closely resembling 378 SCROFULA. those of the smallpox) being generally fully ma- tured by the third day, and the whole eruption disappearing at the end of the fourth or fifth, without leaving any mark. TREATMENT. Medical treatment is not often required, attention to diet, inhibiting animal food for two or three days, and confinement to bed being generally sufficient. When much fever is present, we should check it by the administration of ACONITE, three globules, in three dessert- spoonfuls of water, one every six hours ; or COFFEA, three globules, in the same way, if there is simply extreme restlessness and anxiety. CONSTITUTIONAL AFFECTIONS. Scrofula affecting the Glands of the Neck. The period at which these glands are most liable to become affected, is that betwixt the fifth year and the age of puberty. The first appearance of the glandular enlargement is often noticed during the existence of eruptions behind the ears or on the scalp, or as a consequence of scarlet fever or measles, the irritation of dentition, or during or- dinary affections of the throat. A deranged state of the mucous membrane of the stomach and bowels, SCROFULA. 379 proceeding from improper food, and conjoined with impure air, forms a fruitful source, or, at all events, gives a powerful stimulus to the develop- ment of the disease, as it does of scrofula in general, particularly amongst the children of the poor. The glands, at the commencement, look like small, oval, or spherical tumours, which are move- able, soft, or possess some elasticity, and are situated upon the sides of the neck below the ears and under the chin. They frequently remain in this state for some time ; but by degrees they become larger, harder, and more fixed ; the skin over them, or over that gland which is furthest advanced acquires a purple redness ; a process of softening then takes place, the tumour at the same time increasing in redness unattended with much pain. Finally, some part of the skin becomes of a paler colour ; and ere long a somewhat thin whitish-yellow fluid escapes through one or more small apertures. As the matter continues to ooze out, it becomes more and more watery, and is intermingled with small white flakes resembling the curd of milk. The swelling now gradually subsides, while the broken skin opens more, extending irregularly, and an ob- stinate ulcer, generally with flat smooth edges, is constituted. New tumours then form, and pursue the course described ; and so the disease proceeds, some of the ulcers healing up wholly or partially 380 SCROFULA. during summer, and breaking open again in spring. Under favorable circumstances the disease is spon- taneously cured in four or five years ; all the ulcers healing up, but leaving some unsightly traces of their previous existence in the form of indelible scars. TREATMENT. In a disease of this description, it may well be supposed that a long course of treatment is very generally required before any permanent benefit can be effected. When early attacked, or when no injudicious and hurtful treatment in the form of large and frequent doses of Mercury, Iodine., Sulphur, &c., has previously been pursued, a favorable impression, if not a radical cure, is often made by homoeopathic medicines in a wonderfully short period. On the other hand, cases repeatedly occur which prove exceedingly obstinate, notwithstanding every advantage in the way of recovery. In all cases, however, there is less risk of the tumour becoming converted into an open sore, or, when that is unavoidable, there is usually much less subsequent disfiguration when the case has been appropriately treated, than when it has been allowed to pass through its different stages unchecked. The medicaments which are most frequently indicated in the homoeopathic treatment of glandular swellings, are Mercurius, Belladonna, Conium, Rhus, Natrum c., Phosphorus 3 SCROFULA. 381 Sulphur, Calcarea, Acidum nitricum, Lycopodium, Hepar sulphuris, Silicea, Dulcamara, Baryta, Thuja, Spongia, Carlo animalis, Clematis, lodium, Bryania, Pulsatilla, Chamomilla, Nux vomica, Lachesis, Arse- nicum, &c. The selections of these must be regulated by a variety of circumstances, to attempt to detail which would materially encroach upon the in- tended limits of this little volume I may, therefore, very briefly observe that in general cases Mercurius, Sulphur, Calcarea, and Hepar sulphuris are the remedies which I am in the habit of resorting to in the early stage of the affection, whilst there is still no change in the colour of the skin, and the glands are free from pain and not sensitive to the touch. In the absence of any special indications for any one of these in par- ticular, they may be given, in the order specified, in the following manner: six globules of MER- CURIUS in six dessert-spoonfuls of water, a dessert-spoonful of the solution morning and evening. When finished, repeat the medicine as before. About a week afterwards proceed with SULPHUR in the same \vay: and so on with the others. If, however, a visible improvement be- comes apparent during the employment of any one remedy in particular, a pause must be made, and no more medicine administered as long as the improvement continues; but if a cessation of 382 SCROFULA. amendment becomes evident, or if threatening signs of relapse supervene, that medicine which had effected the favorable change must again be had recourse to, unless contra-indicated by any fresh symptoms, and administered as above described. In other cases, and particularly when the organs of digestion are in a deranged state, BRYOXIA, Nux v., CHAMOMILLA, and PULSATILLA are required in the early stage. The two former, especially when, amongst other symptoms, there is foulness of tongue, or vivid redness of the tip and margins, with impaired or irregular appetite, and constipation ; and the latter (Cham, and Puls.} when the said symptoms are more frequently associated with a relaxed condition of the bowels. In more advanced cases, somewhat more circumspection is usually required in the selection of the remedies. Considerable impediment is sometimes offered to the cure by a complicated state of matters arising from the injury done to the system at large by over doses of mercurial and other mineral pre- parations (calomel, &c.) If Mercury has evidently been injudiciously administered, ACIDUM NI- TRICUM becomes necessary, succeeded after an interval of a few days by HEPAR s. After whichj CONIUM and AURUM are usually the most ap- propriate. The former when the glands are hard and somewhat sensitive to the touch the latter when there is still more sensibility of the affected SCROFULA. 383 glands, with a good deal of general debility, and a tendency to eruptions on various parts of the body. If Iodine has been given so as to affect the system injuriously, Hepar s., Phosphorus, Spongia, and Sulphur are more or less required. When, on the other hand, the health does not appear to have suffered from injudicious allopathic treatment, Dulcamara,, Rhus, Belladonna, Natrum c., Baryta, Lycopodium, &c., are often of much efficacy at this stage. DULCAMARA is chiefly indicated when the tumour has attained a large size, and has become indurated; exposure to cold during a bleak, moist state of the atmosphere having apparently contributed to develope or aggravate the affection. RHUS is generally preferable to all other remedies when the gland is very hard, and much swollen, and when the skin over it is considerably reddened or inflamed. This remedy is often sufficient to disperse the swelling in a week or two. When it proves inadequate to accomplish this desirable end, Belladonna., Mercurius, Bryonia, Phosphorus, Hepar, &c. become requisite. When the redness is less marked than in the preceding instance, Natrum c. is often an effective remedy ; or Conium, Spongia, Clematis, Carlo v., and Baryta, either in the order named or otherwise, if special indications call for the employment of one more than another. LYCOPODIUM is frequently very serviceable when there is considerable pain and tension in the 384 SCROFULA. glands under the ear, and more especially when the enlargement extends in the direction of the angle of the jaw, and materially interferes with the act of mastication. Dulcamara, lodium, and also Rhus, Hepar s., and Calcarea are useful when a congeries of swollen glands extend under the chin like a chaplet. When the skin over the swelling presents a livid or a purple colour, Lachesis and Carbo v., as also, in a secondary degree, Hepar s. and Aurum, are sometimes the most appropriate. If softening has commenced, Hepar and Silicea, in alternation, should generally be given without delay, as they will either have the effect of promoting absorption even at this stage of the disease, or of forwarding the suppurative process,* if dispersion be im- practicable. No local treatment is necessary; much harm is frequently done by frictions with oily, or greasy and stimulating substances. Warm fomentations are occasionally soothing when there is much pain and tension in the tumour. The employment of the knife is almost always ob- jectionable, even when matter is formed and the tumour large; since absorption may often be accomplished by means of such remedies as Hepar s., Silicea, and even Rhus, &c., after the establishment of suppuration,f as the author has * The ripening of the abscess ; the formation of matter, t The formation of matter. SCROFULA. 385 repeatedly witnessed. When the skin is clearly on the point of giving way, a poultice may be applied, to render its bursting more easy, under the stimulus of the medicine. After the swelling (abscess) has burst, it may be covered with a poultice, if the discharge is copious : subsequently the part may be dressed with dry lint. The healing of the wound is occasionally very difficult and tedious. The homoeopathic medicines, which are commonly the most successful in promoting the closing up of the sore in a favorable manner, are Arsenicum, Sulphur, Silicea, Acid, nitric., Sepia, and Lycopodmm. (See ' Homoeopathic Domestic Medicine' by the Author, art. ULCERS.) DIET. Great attention should be paid to the diet in scrofulous affections of all kinds. The stomach ought on no account to be overloaded, as it so frequently is, with a superfluity of stimu- lating food, not to speak of drinks, such as wine, porter, &c. A sufficiency of light, nutritious food, including that of an animal kind, should be allowed ; but errors in diet, both as to quality and quantity, cannot be too carefully avoided. Daily exercise in the open air, and free ventilation of the apartment occupied by the child, are to be enjoined. A residence on the coast during the summer months is often beneficial. 25 SCROFULA. Scrofulous Inflammation of the Eyes. By the above title is here meant that form of inflammation of the eyes and eyelids which is of frequent occurrence in scrofulous children, and is commonly recognised by the following features : In the first stage of the affection, there is only a slight degree of swelling and inflammation of the edges of the eyelids, and a constant tendency to their agglutination during sleep which induces no little pain and inconvenience, every morning, during the act of removing the secretion which gives rise to the adherence. On turning down the lids, the lining membrane is observed to be redder than natural ; but no other morbid appearance of suf- ficient moment to attract attention is as yet discern- ible. By degrees, however, an aggravated state of the foregoing condition becomes evident ; the eye, at the same time, becomes watery and over sensitive to light, and the blood-vessels of the white part become distended. As the inflammation advances, small pustules form on the edges of the eyelids, and also upon the ball of the eye. These subse- quently terminate in ulceration, and are productive of excessive irritation. When the transparent portion of the ball of the eye (the cornea) is im- plicated in the inflammation, it is generally rendered dull throughout its texture ; and, some- SCROFULA. 387 times, a portion of it becomes permanently opaque; or total blindness results. TREATMENT. In mild cases, or in the first stage of the complaint, Pulsatilla, Mercurius, Sulphur, and, sometimes, Nux v. and Hepar s. are the most useful. PULSATILLAIS, generally, the most appropriate with which to commence, and more especially when the symptoms become aggravated in the afternoon and towards evening ; also when the patient is fretful and very sensitive, being disposed to weep from the most trivial cause. MERCURIUS is usually to be preferred when an exacerbation occurs in the evening and at night in bed. SULPHUR, very commonly, acts beneficially after either of the preceding. When there are no characteristic indications for any one of these medicines in particular, they may be given in rotation in the order named. ADMINISTRATION. Four globules in two dessertspoonfuls of water ; one dessertspoonful to be given in the morning and the other at bed time, or invertedly. Two to four days afterwards, if some improvement has taken place, repeat the remedy ; but if no alteration has occurred, or if the inflammation threatens to increase, select another. 388 SCROFULA. Nux v. is to be preferred to Pulsatilla when the pain, and other symptoms, are worst in the morning; also when the patient is excessively irritable, frequently breaking into fits of passion at the slightest contradiction. (Chamomitta is sometimes useful in the early stage, when Nux v. produces little or no amendment. The existence of diarrhrea is an additional indication for Chamo- mitta.} Pulsatilla and Nux v. are further indi- cated when the digestion is much deranged. HEPAR s. is always more or less useful when the patient has previously taken calomel repeatedly. At a more advanced stage of the complaint, Belladonna, Mercurius corrosivus, Hepar s. } Enphrasia, Conium, Sulphur, and Arsenicum are required. BELLADONNA, when there is considerable red- ness of the ball of the eye, with extreme sensibility to light, and frequent discharge of tears ; or when pustules and small ulcers have commenced to appear on the ball of the eye and on the margins of the lids. MERCURIUS CORROSIVUS is often of much service after, or in alternation with Bella- donna, in some of the worst forms of the complaint, with ulceration of the edges of the eyelids, or of the transparent part of the eye, and incipient dullness of the latter texture. (Hepar s. is to be preferred to Merc. c. } if the patient has formerly suffered from the abuse of calomel or other mercurial preparations.) SCROFULA. 389 EUPHBASIA is indicated under similar circum- stances, as Belladonna, with perhaps a greater degree of pain and irritation, as well as more constant flow of tears and more extensive ulcera- tion. SULPHUR is often useful in windingup the cure in this stage of the complaint also. ARSENIC. is chiefly called for when the pain complained of is described as an intense burning ; and is, more- over, often of much service when given alternately with Euphrasia, in obstinate cases of the complaint. RHUS is serviceable when there is redness and swelling around the affected eye, resembling ery- sipelas ; or when this inflammation is conjoined with scrofulous eruptions (tetters) on the face. STAPHYSAGRIA is also of utility in the latter case. ADMINISTRATION OF THESE REMEDIES. Six globules in four dessertspoonfuls of water; a dessertspoonful of the solution every twelve hours. Two to four days afterwards, the same medicine may be repeated, or another selected according to the effects produced.* Sometimes it is necessary to give all the above remedies in rotation, before a cure can be accomplished. In less active forms of scrofulous inflammation of the eye, or in old and indolent cases, the same medicines as above noted, together with the following, are more or less frequently indicated Conium, Calcarea c,, Graphites, Sepia, fyc. In these cases, it is commonly * See rules for the administration and repetition of the dose. 3QO SCROFULA. necessary to allow an interval of a week or so between each remedy, when a series of medica- ments are found requisite to effect a cure. When the transparent centre of the eye begins to look filmy, Pulsatilla, Sulphur, and Calcarea ; as also Eu- plirasici) Conium, and Cannabis, are the medicaments w r hich are chiefly to be relied on. DIET. The food should be light whilst the inflammation is active, and the pain severe. No local remedy is needful,* beyond a poultice of bread and cold water, contained in a muslin bag, and applied over the eye at night, when there is much irritation and redness, together with the use of a broad, blue silk shade during the day, to protect the eyes from the direct rays of light. Scrofulous Inflammation of the Ear. Children of scrofulous constitution are very liable to inflammation of the lining membrane of the outer passage of the ear, accompanied by the formation of pustules, and discharge of thin,"acrid, or otherwise unhealthy and often offensive matter. The affection is, frequently, conjoined with ulcera- tions of the external ear. In severe attacks, or in * An eyewash, consisting of the same medicine which is ad- ministered internally, seems, occasionally, to facilitate recovery. SCROFULA. 391 neglected cases, the inflammation may extend into the internal ear, implicating and destroying its structure, and consequently giving rise to irre- mediable deafness. More or less dangerous at all times, the disease is particularly so when it spreads to the bones of the skull. The different symptoms which characterise the complaint will be gleaned from those which are mentioned after each remedy. In the acute form or stage, Pulsatilla, Mercurius, Ckamomilla, and Belladonna are the principal reme- dies. PULSATILLA is almost a specific in this com- plaint when early resorted to. Its leading indi- cations are, severe aching, piercing, throbbing, or darting and burning pains in the interior of the ear, combined with heat, redness, and swelling of the external ear, and of the auditory tube ; also when delirium occasionally occurs. CHAMOMILLA. Aching, tearing pains, ex- tending to the lobe, sometimes alternated with a sharp stab as if a knife were thrust into the ear; dryness of the ear; excessive peevishness, and impatience under suffering even when not of the severest description. (Chamomilla is, properly speaking, better adapted to common earache, or rheumatism in the ear, proceeding from a chill ; but it is occasionally useful in this affec- tion when it occurs in very young and delicate children.) 3Q2 SCROFULA. MERCURIUS is chiefly required in less severe cases ; or when the violence of the attack has been subdued by Pulsatilla. The symptoms which more especially denote its appropriateness, are aching, tearing pains extending to the cheeks, and frequently alternated or intermingled with painful jerks or dartings in the ear; aggravation at night, accompanied by profuse perspiration ; slight discharge from the ear ; burning heat and redness externally, with sensation of ice-like coldness internally. BELLADONNA is required in the most serious forms of the complaint, particularly when the brain is involved, and the symptoms are as follow : darting, piercing, squeezing, pressive, aching pains in the ear, exacerbated by movement and from the slightest noise ; extreme agitation ; heat of the head, with distension and violent throbbing of the vessels ; delirium ; vomiting ; coldness of the extremities. (See Inflammation of the Brain.} After the employment of one or more, if called for, of the above medicines, Nux v., or Sulphur, and Calcarea, are sometimes required. Nux v. chiefly in cases where Chamomilla, has been em- ployed. Sulphur and Calcarea, in general cases, against any remaining symptoms. ADMINISTRATION OF THE REMEDIES. Six globules in two tablespoonfuls of water, a dessert- spoonful of the solution every three to six hours, SCROFULA. 393 according to the severity of the symptoms. As soon as improvement sets in, and in less acute cases, the intervals between the doses may be lengthened.* In old standing cases, or in those of recent origin which have begun in a milder and more insidious form than the preceding, and have terminated in running of the ears, Pulsatilla, Mer~ curius, Sulphur, Lycopodium, and Conium are almost always more or less useful ; but Calcarea, Causticum, Hepar sulphuris, Aurum, Carlo v., Silicea, Acid. nitr. QXiAAssafoetida, &c. are also serviceable in protracted cases. When the discharge is fetid, Carlo v., Aurum, Hepar s., and Causticum are generally the more useful. If the discharge is accompanied by sore- ness behind the ear, Conium, Sulphur, Lycopodium, Calcarea, Hepar s., Silicea, Acid, nitr., Petroleum, &c. usually claim a preference. Mercurius and Sulphur, followed, if required, by Belladonna, Lachesis, Silicea, and Calcarea, are chiefly indicated when headache attends. When pain suddenly comes on in old standing cases ; or when, in those of more recent origin, the pain becomes increased, and the patient complains of violent throbbing and buzzing in the ears, headache or tightness around the head, with deafness and some degree of fever, Hepar sulphuris, Lachesis, and Silicea may be given in alternation every four or five * See rules for the administration and repetition of the dose. 3Q4 SCROFULA. hours. A sudden suppression of the discharge is generally attended with serious consequences. If it has been caused by getting the feet wet, Dul- camara should immediately be administered, and succeeded by Belladonna if headache, with heat of skin and other signs of fever supervene. Bryonia may follow Belladonna if the headache continues. If glandular swellings are the result, Mercurius, Belladonna, and Pulsatilla are generally required. The selection of these will frequently be facilitated by the indications already given under these remedies at the commencement of this article. In cases of long standing a succession of medicines at intervals of eight or ten days, is sometimes called for. So long, however, as one remedy appears to do good, it ought not to be changed. It is usually advisable, nevertheless, to discontinue the medicine when some amelioration has been af- fected, and only to return to it w 7 hen further im- provement ceases to be apparent. If, after a re- petition of the medicine which had produced the amendment, the symptoms remain unaltered, another remedy should be administered. In tedious cases, and in those which become associated with affection of the head, medical aid should be sought. In simple earache arising from cold, and oc- curring in otherwise healthy children, Belladonna, Mercurius, Pulsatilla, Chamomilla, are the most SCROFULA. 395 serviceable medicines. They are indicated by nearly the same train of symptoms as mentioned beforehand. When there is fever with fulness and accelera- tion of pulse, one or more doses (two globules) of Aconitum may be given. When the pain increases in intensity, and is attended with, or consists almost exclusively of a continuous and painful throbbing, sometimes accompanied by shivering, Hepar s. should be administered. ADMINISTRATION of these. Six globules in two tablespoonfuls of water, a dessertspoonful every six or eight hours. In slight attacks, a single dose (of two to three globules) will be sufficient. DIET. When the symptoms are severe, and at- tended with considerable fever, toast and water, barley water, or thin gruel, should only be allowed. (See Diet in Fever.) In less violent attacks, although the appetite may be good, the food should be light for the first day or two. Exposure to currents of air, or to sudden changes of temperature, should always be avoided as much as possible when there is any predisposition to complaints of the ear. 396 RICKETS. 'Rickets. This distressing disease, commonly begins to show itself about the tender age of from one to two years. It is generally preceded, for a longer or shorter period, by derangement of the general health, before any of its well-known characteristic features become developed. The following com- prise the more common of these premonitory symptoms: pale and sickly countenance; dry, harsh skin ; soft and flabby flesh ; irregular appe- tite, sometimes with desire for indigestible or un- natural food; constipation or diarrhoea; general febrile excitement, fretfulness, and languor. Sub- sequently, the head is observed to become preter- naturally enlarged, and the forehead unusually prominent. The breast-bone projects ; the ribs appear flattened; the belly is much distended; while the rest of the body, and the limbs in par- ticular, are greatly emaciated : and the debility is extreme. As the disease advances, the muscles become more flaccid ; the wrists and ankles be come swollen; the legs, thighs, and arms distorted ; and the spine partakes in the general deformity, by becoming shorter, and curved in various di- rections. Sometimes the distortion and deformity of the ribs and spine increase to such a degree as to bring on a fatal result, by impeding the performance RICKETS. 397 of the lungs, and other important internal parts. When the disease is early attended to, and the more general exciting causes, such as defective nursing damp, or wet, ill-ventilated dwellings insufficient exercise out of doors improper food and uncleanliness, are capable of being removed, the chances of recovery are much increased; and the deformity is, frequently, materially, if not wholly, diminished as the patient grows up. Otherwise, if life be spared, it is liable to be rendered miserable by a state of almost continuous suffering. TREATMENT. When there is an hereditary pre- disposition to this disease, too great attention cannot be paid to the first manifestations of ill- health. Great care should, at the same time, be taken to avoid undue pressure upon the chest and other parts. From the deficiency of earthy matter in the bones of a rickety child, they are wanting in the natural and requisite strength or firmness to support the weight of the frame. Consequently, when every precaution is not adopted, and the child is allowed, or rather com- pelled, by its heedless and culpable nurse or others, to use muscular exertion, deformity inevitably re- sults. It will, therefore, be necessary to deal gently and cautiously with the child from the first day of its earthly existence. And while every 398 RICKETS. care is observed to escape the mischief alluded to, by giving proper support to the back and loins on all occasions keeping the child habitually on its back; and carrying it about in a little cot or tray constructed for the purpose, particularly if some of the symptoms of the disease have, even in the slightest degree, already become apparent other means, having for their object the improvement of the general health, must be strictly followed. The child should be regularly sent into the open air, when the weather permits ; its apartments ought to be well ventilated ; its personal cleanliness should be constantly ensured ; and wholesome and appropriate nourishment provided. When the health and strength are improving, but the limbs or other parts have become deformed to a greater or less extent, in defiance of every solicitude, or, as more frequently happens, from oft-repeated in- fractions of the rules laid down, considerable benefit may yet be accomplished by judiciously- applied mechanical aid. At the head of the arti- ficial contrivances for counteracting deformity, may be placed the gentle and cautious use of gymnastic exercises, as soon as the child is old enough to undergo them and it is surprising how early they may be advantageously resorted to. Without these, all instruments are often futile not to say hurtful. But in combination with them, the objection to the temporaneous employment of RICKETS. 399 an appropriate apparatus for the purpose of exer- cising compression, is, I opine, in certain cases removed. I allude, more especially, to the in- stance in which the legs have become very much bent, either in consequence of neglect or from its having been found impracticable to prevent a high-spirited child from constantly getting on his feet, before his delicate frame had become suffici- ently invigorated by suitable treatment. I am free to admit, however, that instruments should always be rejected whenever, and wherever, they can possibly be dispensed with. The Homoeopathic treatment, required for the subjugation of the constitutional disturbance which ushers in the local peculiarities of the dis- ease, is so analogous to what has been recom- mended in the chapter on Infantile Remittent Fever, that the reader is referred thereto. If the local manifestations of the disease have supervened, Calcarea is a remedy of primary importance, more particularly when the moulds of the head are in an open condition, and the process of dentition is unduly protracted, or the teeth that are protruded have a tendency to premature decay. Belladonna, Mercurius, Pulsatitta, Sulphur, and Silicea, together with Assafcctida, Phosphorus, or Acidum-phosphoricwn, Acidum-nitricum, Petroleum, and Mezereon, are, however, of equal importance with Calcarea in the established disease. It is some- 400 RINGWORM. times necessary to resort to the whole of these, in rotation, in the order mentioned; giving two globules morning and evening for four or five days, and allowing, under ordinary circumstances, an interval of at least five or six days to elapse between the finishing of one remedy and the commencing of another. But the selection of the remedy ought to be regulated as strictly as can be, by the nature of the symptoms. (See Infantile Remittent Fever, where some of the general indi- cations given for several of the above medicines, will be found equally applicable in this affection.) And if a decided improvement occurs after the administration of any special remedy, it ought not to be exchanged so long as it continues to do good.* CUTANEOUS DISEASES. Ringworm (Hermetic or Vesicular}. This affection is of frequent occurrence in children after the period of infancy. It has been considered contagious from the circumstance of several children of one family, or at the same school, being sometimes attacked at the same time ; but there is every reason to believe that this opinion is erroneous, from the fact of none of * See rules for the administration and repetition of the dose. RINGWORM. 401 the other species of herpes* being communicable by contact. When not complicated with another disease, it is not attended with any general constitutional derangement. The disease is cha- racterised by an eruption of small rings or circular bands, the vesicles only occupying the circum- ference ; these are small, and have a red-coloured base of greater or less intensity. About the third or fifth day the vesicles become turbid, and then discharge, when little brownish scabs form over them. The portions of skin within the circlets are usually healthy at first ; but, for the most part, subsequently become rough, of a reddish hue, and scale off as the vesicular eruption dies away. The duration of the eruption frequently does not extend beyond a week or two ; but when there is a series of consecutive rings on the face, neck, arms, and shoulders, as frequently happens in warm climates (where the affection, moreover, assumes a more serious and obstinate character), or during hot weather in this country, it is necessarily protracted considerably beyond this period. Furthermore, there are some children in whom the affection has a tendency to reappear every spring and summer. TREATMENT. In the majority of cases, the affection yields readily under the action of Sepia, * Herpes. Clustered vesicles, which concrete into scabs. 26 402 RINGWORM. of which from two to three globules may be given in a little water, and the dose repeated on the fourth day, if required by any appearance of tardiness in the subsidence of the eruption, or should there be any indications of the formation of fresh rings. In some obstinate cases, the alternate use otRJms and Sulph. every four or five days is found neces- sary. In others, Calcarea and Natrum are needed. Where there is a liability to annual visitations of the eruption, the employment of Sulphur and Sepia in alternation at intervals of a week, often suf- fices to eradicate the constitutional tendency. All manner of household applications must be avoided. But when the irritation is considerable, before the specific influence of the homoeopathic remedy has begun to tell, lint, moistened with cold water, holding if requisite some of the medicine in solu- tion, and covered over with oiled silk, may be applied to the part. DIET. See that recommended under SCALD HEAD. Scald-Head. Ringworm of the Scalp. Pustular Ringworm. This troublesome disease occurs, most com- monly, about the sixth or seventh year of child- RINGWORM. 4Q3 hood ; but it is liable to take place at an earlier, and also a somewhat later period of life. In short, it may make its appearance any time be- tween the age of about two years to that of puberty. It is not confined to the scalp, but also appears on the neck, trunk, and extremities ; when confined to the trunk, it proves by no means so obstinate and rebellious a disease as when located in the hairy scalp. It is of a highly contagious nature, being readily communicated among children who make use of the same comb and brush, or even towel, and is of long and uncertain continuance, indeed there are few cutaneous affections which have more frequently baffled the unwearied efforts of practitioners than this ; and it would have been well had less been attempted by those of the old school in the way of treatment ; for in but too many instances the so-called cure has proved worse than the disease. SYMPTOMS. The affection is characterised, at the commencement, by the appearance of isolated, red- coloured, irregular, circular patches, on which appear numerous small yellowish points or pus- tules, which do not rise above the level of the skin, and are generally traversed in the centre by a hair. These pustules, which are much more thickly studded in the circumference than 404 RINGWORM. the centre of the circular patches, soon break and form thin scabs, which frequently unite with the adjacent patches, and assume an extensive and irregular appearance, but commonly retain a somewhat circular shape. The incrustations be- come thick and hard by accumulation, and are detached from time to time in small pieces, which bear a close resemblance to crumbling mortar. When the scabs have been removed or torn off, the surface which they had occupied looks red and glossy, but is studded with slightly elevated pimples, in some of which minute globules of matter subsequently become apparent. By these repeated evolutions of the eruption, the incrustations become thicker, the areas of the primary patches extend, and new ones are formed, so that the corresponding edges become blended, and frequently the whole head thus becomes affected. As the patches or clusters extend, the hair covering them usually becomes lighter in colour, and breaks off short ; and as the process of scabbing is repeated, it is thrown out by the roots, and finally there is left only a narrow chaplet of hair round the head. If the hair-follicles are destroyed, the baldness remains permanent. The external characters of scald- head are liable to vary, more or less, from the above description in many cases ; the variation proceeding, conjointly, from the constitution of RINGWORM. 405 the patient and the duration of the disease. Thus we have, firstly, the variety that has been tech- nically denominated the Porrigo lupinosa, which is characterised by small, dry, circular scabs, of a yellowish-white colour, having raised margins, and a central depression like that on the seeds of the lupine. The incrustations are deeply set in the skin, to which their edges are firmly adherent. Secondly, the Porrigo farfurans. This variety commences with the eruption of small pustules, containing a straw-coloured fluid, which soon discharge, dry, and form thin laminated crusts, with scale-like exfoliations. The affection is con- fined to the scalp, and is attended with consi- derable itching and soreness, although there is but slight excoriation; the hair partially falls off, and, occasionally, becomes subsequently somewhat lighter in colour. Thirdly, the Porrigo favosa, distinguished by the eruption of large, soft, straw-coloured pustules, generally somewhat flattened, possessing an irregular margin, and surrounded by a slight in- flammatory redness. They are met with on other parts of the body as well as the scalp, and are accompanied by much itching. On breaking, these pustules discharge a viscid matter, which hardens into semi-transparent, greenish-yellow scales. The disease extends to the face, and 406 RINGWORM. eventually the ulceration spreads over the entire head, and, from the continued discharge, the hair and moist scabs become matted together. Pediculi are generated in large numbers, and aggravate the excessive irritation. The incrustations thicken into irregular masses, bearing some resemblance to a honeycomb. And the acrid exudation, from the ulcerated patches on the scalp, exhales an of- fensive and pungent vapour. Fourthly, and lastly, the Porrigo decalvans, which is chiefly characterised by patches of baldness. Scald-head is very evidently a constitutional, and not a local affection. It is, moreover, in- variably attended with a greater or less degree of constitutional disturbance, such as glandular swell- ings and indurations, deranged digestion, distended abdomen, paleness of the face, emaciation, &c. CAUSES. The disease is chiefly propagated by contagion, but appears to originate sponta- neously in children of scrofulous, flabby, or feeble and emaciated habit, if they be ill-fed, ill-lodged, uncleanly, and deprived of a wholesome degree of exercise. TREATMENT. It cannot be denied that, even under homoeopathic treatment, the disease fre- quently proves extremely obstinate ; but, in many cases, the difficulty experienced in effecting a RINGWORM. 407 cure, arises from the previous treatment which the patient has undergone : or from culpable conduct, on the part of the parents or others, in allowing the disorder to pursue its course, for a lengthened period, unchecked and utterly neg- lected, ere proper assistance is sought. In general cases, while the patches exhibit an irritable and inflammatory aspect, Rhus will usually be found the most appropriate remedy ; the head should at the same time be regularly and gently sponged with tepid water twice a day. Should a dry exfoliation or scaliness and scabbing then ensue, Sulphur may be had recourse to ; but if, on the other hand, an offensive discharge break out, attended by violent itching, without much redness, Staphysagria may be administered, and then again Ehus. The last-named, important remedy, is also useful in cases which are of some standing, and par- ticularly when there is a copious discharge of a greenish colour, accompanied by extensive for- mation of thick scabs ; or when the entire scalp is covered with cup-shaped scabs, presenting a honeycombed appearance, and exhaling a most repulsive odour. If, notwithstanding the admi- nistration of these remedies, very little favorable progress is made; or if, on the contrary, the affection grows rather worse, the exudation 408 RINGWORM. becoming very acrimonious and consequently productive of an extension of the disease, or of the formation of ulcers, Arsenicum should be given ; after the action of which, Rhus will fre- quently produce a satisfactory effect. These remedies may also be occasionally administered externally with good effect, by dissolving a few globules of the remedy selected in a little water, and applying the liquid once or twice a day to the affected parts. When the foregoing means are insufficient to effect a cure, which sometimes happens in inve- terate cases that have previously been subjected to a long course of injudicious allopathic treat- ment, and in neglected cases occurring in scrofulous and debilitated children, the following remedies may be used : Hepar s., when the eruption is not confined to the head, but also appears upon the forehead, face, and neck; when, moreover, the eyes and eyelids become inflamed and weakened, and sore- ness or ulceration breaks out on or behind the ears. In the latter case Baryta c., Graphites, and Oleander are also useful.. Dulcamara, when the glands of the throat and neck are enlarged and indurated (or Bryonia, when there is inflammation and tenderness of the said glands) ; after which, Staphysagria may be admi- RIXGWORM. 409 nistered, and then one or more of the remedies mentioned at the commencement, followed by Baryta c. If these medicines prove ineffectual, Sulphur, Graphites, Calcarea, Lycopodium, Phosphorus, or Oleander, may answer the purpose required, and must be selected according to circumstances. In some cases, the alternate use of two or more medicaments will be found advantageous, such as Sulphur and Calcarea, Sulphur, Rhus, and Graphites, Graphites and Lycopodium, Graphites and Phosphorus, and so on. A dry, inert, and scaly appearance of the eruption, chiefly requires Calcarea, or Sulphur, but also Hepar s., Phosphorus, Rhus, Arsenicum or Oleander. A humid or moist- looking eruption : Lycopodium or Staphysagria, Rhus, Arsenicum, Sulphur, Sepia ; and also Baryta c., Calcarea c., Graphites, Cicuta virosa, and Oleander. In Porrigo decalvans (with patches of baldness), Gra- phites, Phosphorus, Baryta, Lycopodium and Zincum, are, commonly, the more serviceable ; but Sulphur, Calcarea, Silicea, &c. and most of the other afore- said remedies, may be found indicated in particular cases. When the digestive organs are in a deranged state, the intermediate employment of Bryonia, Nux v., Pulsatilla is occasionally required, provided Arsenicum, Sulphur, Calc., etc. are not amply sufficient to cope with this complication. ADMINISTRATION OF THE MEDICINES. With 410 RINGWORM. regard to the administration of the medicines, it may be stated that, at the commencement of the disorder, a dose (three globules) may be given daily, or every second day, until symptoms of improvement make their appearance ; the medicine must then be discontinued, and only renewed when the amelioration ceases, or the disorder threatens to extend itself. When no signs of improvement become perceptible, or when, on the contrary, the malady evidently seems to be getting gradually worse, notwithstanding the exhibition of two or three doses of a particular remedy, another must be selected, according to the in- dications. In cases of old standing, the intervals between the exhibitions of the medicine must generally be lengthened, or a dose may be given daily for a week, and then a period of ten to twelve days, and even upwards, allowed to elapse before the medicine is repeated, or another remedy substituted. DIET AND REGIMEN. The diet should be light and nutritious. Fish and salt meat must be abstained from, and any article of food, even though generally considered wholesome, should, if found to disagree, be strictly avoided. Heating farinaceous food, such as oatmeal (in the form of porridge or stirabout, gruel, and soup) , maize, &c. is, generally, to be objected to. Undeviating MILK-CRUST. 411 attention to cleanliness must be observed through- out the entire course of the complaint, and regular exercise in the open air enjoined. The sleeping chamber should be airy, and not overcrowded. Lastly, a sufficiency of appropriate clothing ought to be worn, and the heat should be pro- tected against damp. The hair ought, generally, to be removed early in the disease. Milk- Crust. This affection usually makes its appearance during the period of the first dentition. It com- mences in the form of numerous small, whitish, more or less confluent pustules, which appear in clusters upon a red ground. These generally show themselves, in the first instance, on the fore- head and cheeks, but sometimes spread over the whole body. The ears rarely escape ; and when the scalp becomes implicated, the glands at the nape of the neck swell, and sometimes end in suppuration. The lymph contained in the pus- tules soon becomes yellow, dark, or even san- guineous, and, on being discharged, forms into thin, greenish yellow crusts ; those on the scalp bearing some similitude to the smeared yolk of a hard-boiled egg. Frequently, there is considerable surrounding 412 MILK-CRUST. redness and swelling, with distressing itching, which renders the little patient excessively restless and fretful, and causes him to keep continually- rubbing the affected parts, by which the discharge and crusts are repeatedly renewed, and increased in thickness, often to such extent that the whole face becomes covered as with a mask, the eyes and nose alone remaining free. The eyes and eyelids, as also the glands beneath the ear, and, in exceptional cases, even those of the mesentery,* occasionally become inflamed, and sometimes emaciation supervenes. TREATMENT. The following medicines have been found serviceable in this affection : Aconitum, Viola, tricolor, Rhus, Sulphur, Calcarea, Lycopodmm, Sarsaparilla, Mezereum, Belladonna, Hepar sulphur is, Euphra-na, Staphysagria, &c. ACONITE should commence our treatment, when we find excessive restlessness and excitability pro- duced by this affection, and when the skin around the parts is red, inflamed, and itching. ADMINISTRATION. Two globules, in four tea- spoonfuls of water, a teaspoonfui every four or five hours. As soon as beneficial effects have resulted from the administration of the above remedy, we may * The membrane in the middle of the intestines, and by means of which they are secured to the spine. MILK-CRUST. 413 follow it up with VIOLA TRICOLOR, which is often sufficient to effect a cure in the simple, uncompli- cated form of the disease, particularly when the accompanying irritation is evidently worse at night, and when the urine has a peculiarly offensive odour. ADMINISTRATION. Three globules, in four teaspoonfuls of water, one night and morning. The prescription to be repeated in four days or another remedy selected, if the affection threatens to extend, or otherwise become worse.* RHUS TOXICODENDRON may succeed or super- sede Viola tricolor, w T hen the scalp is considerably affected and thickly studded with incrustations, or when the surrounding inflammation is still severe, and the itching apparently excessive from the frequency with which the child rubs and scratches the affected parts. ADMINISTRATION. Same as Viola tricolor. When Rhus is insufficient to complete the cure, Calcarea or Lycopodium are generally to be selected in preference to other remedies ; the former more particularly when there is little or no discharge, the latter when there is considerable oozing (sup- puration). In other cases, Sulphur is more appropriate after Rhus, but particularly when the eyelids are severely implicated. The alternate use of Sulphur and Rhus, * See rules for the administration and repetition of the dose. 414 EXCORIATIONS. in chronic cases of the above description, is at- tended with beneficial results. MEZEBEUM is often very efficacious when, from the bursting and discharge of the contents of the pustules, incrustations have formed, from which an acrid exudation flows and gives rise to a fresh eruption of vesicles wherever it comes in contact with the skin. (See also SCALD HEAD.) ADMINISTRATION. Same as Viola tricolor. Every possible attention should be paid to the diet ; and acids or stimulants of every description strictly inhibited. Chafing. Scalding. Excoriations. This affection is of frequent occurrence in in- fants and young children. It displays itself most readily on all parts where opposite surfaces of the skin are in continual contact, or exposed to fric- tion ; consequently the groins, upper part of the thighs, and neighbouring regions; as also the neck, and the space and angle behind the ears, are its usual sites. In severe cases, it sometimes spreads over the greater part of the surface of the body. The more common form in which it appears is in red, irregular, inflammatory patches, occa- sionally attended with excessive itching, and the EXCORIATIONS. 415 discharge, or oozing out, of a watery yellowish fluid. In neglected cases, the skin becomes hard, chapped, and much excoriated. General fever rarely attends ; but the child is rendered extremely peevish and restless when the local inflammation is severe and extensive. TREATMENT. Against this affection, cleanli- ness is the best preventive, and often a sufficient remedy ; however, we frequently find it proceed to such an extent as to require the aid of medicine for its removal. CHAMOMILLA will be found speedily effective in most instances, and particularly in those which proceed from acidity, and are, consequently, at- tended with green-coloured, sour-smelling, eva- cuations. But as the malady is frequently pro- duced, and still more frequently aggravated, by mechanical friction, the alternate employment of Arnica and Chamomitta materially facilitates the cure, in the majority of cases. ADMINISTRATION. Two globules of Arnica in the morning, and again at bed-time. Twenty- four hours afterwards, Chamomitta may be given in the same manner ; and so on for the space of ten or twelve days. For severe or neglected cases, which have spread over the greater part of the body, and are 416 EXCORIATIONS. accompanied by troublesome excoriations, Mer- curius is generally the most effective remedy. ADMINISTRATION. Two globules every other day for a week. Four or five days afterwards, if no amendment has resulted, LYCOPODIUM may be administered in the same way. In all obstinate cases, and in those which have been preceded by, or are associated with, a miliary eruption, SULPHUR should be had recourse to. ADMINISTRATION. Same as Mercurius. Sepia, Calcarea, and Graphites are sometimes re- quired in inveterate cases, which do not yield to the above remedies. Graphites is more especially required when the chafing is chiefly confined to the space behind the ear. DIET. The diet of spoon-fed infants and young children, who are troubled with this affection, ought to be strictly attended to. The stomach should never be overloaded ; and stimulating food, or that which is liable to create acidity, ought to be withheld. When the discharge is considerable, starch powder may be dusted over the parts. Un- deviating care should be bestowed upon the personal cleanliness of the child. The same cau- tion is necessary as regards the cooking and feed- ing utensils used. ADMINISTRATION AND REPETITIONS OF THE MEDICINES. IN the body of the work, special directions have been given for the dose and the mode in which it may be ad- ministered in the different diseases treated of; and although it is almost impossible to give any fixed rule that will serve in all cases, much more depending upon the discrimination of the administrator, and a careful observance of the symptoms than routine, the author, nevertheless, proposes, in this place, to offer a few general observations on the subject of the administration and repetition of the medicines : In severe acute diseases, or such as are attended with violent symptoms, and run a short course, we must carefully watch the symptoms, and, if no perceptible alteration become apparent within a couple of hours or so, we may usually conclude that the remedy ad- ministered is not the appropriate one. In subacute affections a somewhat longer interval must be allowed for the manifestation of medicinal action. Whilst in those of a chronic* description, no alteration of any * Of long continuance. The term is used in opposition to that of acute. 27 418 ADMINISTRATION kind may, generally speaking, be anticipated earlier than two to four days, at the soonest, after the first employ- ment of the medicament ; but these rules are liable to exceptions. Care ought always to be taken not to change the remedy prematurely, particularly when the case under treatment is not of an urgent nature, and too much stress cannot be laid upon the necessity of carefully watching the effects of each dose, as, in ad- dition to the temporary aggravation of the symptoms which sometimes sets in, a development of medicinal ef- fects occasionally takes place, particularly after frequent repetition of different remedies in susceptible patients ; by a want of attention to this important point, we may incur confusion, and may be unconsciously treating a medicinal disturbance of our own creation. Such, unhappily, but too frequently occurs in all allopathic practice, and in a much more serioiis form. We must also guard against falling into the opposite extreme allowing the disease to gain head unchecked. If a medicinal aggravation* take place, followed by * Very marked medicinal aggravations are of comparatively rare occurrence : nevertheless, as they are occasionally very prominently manifested, particularly in highly nervous and susceptible habits, we shall here give the leading and most common distinctive points of difference between the medicinal aggravation (or exacerbation of symptoms produced by the medicine) and that of the disease. The medicinal aggravation comes on suddenly, and without previous amelioration ; the aggravation of the disease more gradually, and frequently following an amelioration. Moreover, in the former, several of the medicinal symptoms, some of which we may find under the indications for the remedy, and not before remarked, declare themselves. The pulse is also a discriminative guide, par- OF THE MEDICINES. 419 amelioration, we must let the medicine continue its action, until the amelioration appears to cease, and the disease again makes head ; if new symptoms set in, we must then have immediate recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but amelioration follow, we may safely await its approach to a termination, ere we again administer. In cases of high inflammatory action, the dose has sometimes to* be repeated every two hours, every hour, or even more frequently. If any symptoms of importance remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine, which seems best fitted to meet them but refrain from changing the remedy as long as benefit results from its employment. In chronic and subacute, as well as in acute forms of disease, when a very striking improvement takes place, it will generally be found advantageous to cease to ad- minister the medicine as long as the improvement con- tinues, and only to repeat as soon as the slightest symptoms of activity in the morbid phenomena reappear. But when a sudden or marked improvement, of com- paratively short duration, follows the first dose of a remedy, and, on repeating the dose, the symptoms of the complaint increase instead of subsiding, as they did ticularly in fevers and inflammations. Thus, when it becomes less frequent, or when, at all events, it does not increase in frequency, on the accession of aggravation, the exacerbation is to be attributed to medicinal influence ; but, when the reverse is the case, the ag- gravation of symptoms must be considered to depend upon the progression of the disease. 420 ADMINISTRATION in the first instance, it is to be understood that the medicine does not answer, and that another must ac- cordingly be had recourse to, in the selection of which it will be necessary to choose one which corresponds in its indications to the remedy first prescribed. Slight diseases are often removed by a single dose of a well-chosen medicine, but more severe and deeply- seated disorders require a frequent repetition. In severe acute affections, we may often repeat the same medicine in the same dose, at regular intervals, as long as it does good ; but this rule has many exceptions, and the directions already given should always be borne in mind. In chronic cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible to its impression ; in such instances if the im- provement remain stationary, or progress slowly, we may give, at suitable intervals, some other remedy or re- medies, of as nearly analogous medicinal properties to that first administered as possible, and then return to the original remedy, if needful; if, on the other hand, decided amelioration follows each administration, we should allow a longer interval to elapse before repeating, by which means the system gradually recovers itself, and the susceptibility of medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases, particularly when the medicine has been frequently repeated, and given in solution; in such instances provided the remedy still appears to be appropriate the medicine should be given dry, and the intervals between the OF THE MEDICINES. 421 exhibition lengthened. When the beneficial effect of a medicine is interrupted by an attack of cold, diarrhoea, &c., some other medicine must be given for the new affection, on the removal of which, the medicine which was previously acting favorably may be recurred to. REMARKS. In the selection of the remedy, it is not necessary that all the symptoms noted in this work should be present ; at the same time care must be taken that there are no symptoms uncovered by the medicine, or more strongly indicating another. When a medicine produces only temporary improvement, or when some degree of improvement has been effected, but on the repetition of the same medicine no farther amendment is brought about, another remedy which corresponds to the first, or which embraces the symptoms if they have become altered in character, ought to be selected. The homoeopathic remedies are best adapted for domestic use in the form of globules of sugar of milk, saturated with the tinctures of the diluted medicaments, for, in addition to the convenience arising from the facility with which they can thus be dispensed, they are, moreover, less readily deteriorated by keeping, and will remain unimpaired for many years if kept in well-stoppled bottles, and not allowed to be constantly handled by the curious. When medicines require to be sent to any distance, or when it is desired to furnish any one with a dose of a particular remedy to be taken only when rendered necessary, it is customary to bruise down the globules 422 ADMINISTRATION in a small quantity of sugar of milk, and thus make up the dose in the form of a small powder. If we wish to give a remedy in divided doses, this is most conveniently fulfilled by dissolving the globules in distilled water, pure cold water, or water which has been previously boiled or filtered. The wineglass, tumbler, or phial in which the medicine is to be mixed, should be scrupulously clean, and whenever a change is made in the medicine, if the same vessel is employed, it ought to be carefully washed, first with scalding, and sub- sequently with cold water, before it is again used. When a phial is preferred, the cork or stopper must also be washed. Hahnernann recommended that the phial should first be rinsed with pure spirits of wine, and then exposed to a rather high temperature by being placed near the fire for some time. If the medicine is retained in an open vessel, it should be covered over with a saucer, or some other utensil of the sort, to prevent evaporation. When two medicaments are to be ad- ministered alternately, there ought to be a clean spoon for each mixture, and care should be taken to keep them separate. DILUTIONS. The terms high, middle, and low, are given to the different dilutions or attenuations. By the first epithet is generally understood the eighteenth, twenty-fourth, and thirtieth (although the attenuations have recently been carried much higher) ; by the second, the ninth, twelfth, and fifteenth ; and by the third, the first, third, and sixth. The strength of these is relative ; for although the low attenuations contain more particles OF THE MEDICINES. 423 of the original medicinal substance, and are commonly found the more effective in acute diseases, they are, upon the whole, less so in those of a chronic nature, and do not maintain their action on the system for so long a period as the higher ones. For domestic purposes, the author would recommend the middle attenuations to those who wish a very small case containing only one attenuation of each medicine, from the circumstance that they are perhaps less liable to cause those temporary medicinal exacerbations which are occasionally mani- fested in extremely susceptible persons ; but as it is frequently of advantage to change the attenuation (by commencing, for instance, with the sixth, and then resorting to the twelfth, on giving a second course of the medicine), a case or box containing both the lower and the middle attenuations, or one number of each of the attenuations, viz. the third or the sixth, the twelfth or fifteenth, and the thirtieth, would be found more extensively useful. Homceopathists prescribe only one remedy at a time ; but, in some complicated cases, con- siderable advantage is occasionally to be derived from the alternate employment of two remedies, viz. either when they seem equally well indicated, and it is difficult to make a selection, or, and more especially, when each remedy possesses certain properties which are wanting in the other, and the sum. of both is required in the case under treatment. It is only in such instances that this procedure is admissible however. When it is requisite to keep a medicine in solution for some days, a few drops of proof spirit may be added to the water, in order to preserve it from decomposition. 424 ADMINISTRATION. In conclusion, it is necessary to state that the medicines should be taken fasting, and food or drink, as also excessive bodily or mental exertion, abstained from for half an hour to an hour afterwards. The homeopathic remedies should be kept, in a clean, dry, dark place, free from odours. Every description of allopathic medicine, patent or domestic, is prohibited ; likewise bleedings, blisters, medicated fomentations, perfumery, and everything containing camphor. INDEX. PAGE Acidity in infants (Indigestion) . 184 Accidental obstructions of the wind- pipe .... 273 Administration of the medicines . 418 Admonitory regimen . . 130,140 Affections, constitutional . . 378 Air and exercise . . 46 Alienated children . . .81 Aphthous ulceration . . . 171 Artificial feeding and weaning . 25 Applicability of homoeopathic treatment to children . . 154 Birth, treatment of children at the 8 casualties, &c. concomitant with . . . .156 Blood, determination of to the head . . . . 316 Bowel complaints . . . 194 Bowels, inflammation of the . . 208 pain in the. See Colic . 192 Breast, tight lacing injurious to the nursing . . .18 Breasts, swelling of the, in infants 164 Bronchial catarrh . . . 257 Brain, diseases of the . . 312 irritation of the . . ib. inflammation of the . 320 fever . . . ib. water in the . . 321 dropsy in the . . ib. Canker of the mouth (ulcerative inflammation) . . . 168 Catarrh, bronchial . . 257 common . . . 253 pulmonary . . . 257 Casualties concomitant with birth 156 Characteristics of constitutional tendency, &c. . . . 147 Chafing ... . . . 414 Children, treatment of, at birth . 8 from the period of wean- ing to that of education 38 PAGE Children, spoilt . . .79 applicability of homoeo- pathic treatment to . 154 alienated . . .81 Chicken pock . . . . 377 Cholera of infants . . . 204 Cleanliness . - . . 42 Close confinement . . . 142 Clothing . . . 65 Colic 192 Cold in the head . . 253 in the chest . . . 257 Complaints, bowel . . . 194 Confinement, close . . . 142 Congestion . . . 316 Consanguinity, duties of . .97 Constipation . . . 236 Constitutional tendency, charac- teristics of . 147 affections . . 378 Convulsions .... 294 Corporal punishment . . . 141 Country, duties to one's . . 103 Croup . . . . 264 Cutaneous diseases . . . 400 Determination of blood to the head 316 Derangement of the stomach . 224 Diarrhoea . . .194 Diet 55 in fevers .... 333 Dilutions of the medicines . . 422 Distribution of employment . 130 Disorders concomitant with birth . 156 Disease, mesenteric . 219 Diseases of the digestive organs . 165 respiratory organs 253 brain, &c. . . 312 cutaneous . . 400 Dose (see Repetition of the Medi- cines) . . . .417 Dropsy of the brain . . . 321 Duties, and their inculcation . 88 the six social . . . 90 28 426 INDEX. PAGE Duties, of consanguinity . . 97 of the younger towards the elder . . . ib. of the master towards the servant, &c. . . 99 of wealth towards poverty . 102 to one's country . . 103 Duty towards the parent . . 92 Dyspepsia, infantile . . 184 Ear, scrofulous inflammation of the 390 Ears, running of the . . . 395 Earache .... 393 Education, physical . . 73 mental and moral . 109 Elder, duty of the younger to wards the . . .97 Employment, distribution of . 130 Eyes, inflammation of the . . 162 scrofulous inflammation of the 386 Exercise, air and . . 46 Excoriations . . . 414 False measles . . . 361 Feeding, artificial . . .25 Fever, simple . . . . 335 scarlet . . .336 brain . . 320 infantile remittent . . 241 Fevers, eruptive . . . 333 diet in ... ib. Flatulency (griping) . . 192 General treatment of children, &c. 38 Geography . . . .128 Glands of the neck, scrofula affect- ing the . . . . 378 Griping . . . .192 Head, cold in the . . 253 swelling of the . . 157 Herpetic or vesicular ringworm . 400 Hooping-cough . . . 282 Homoeopathic treatment, applica- bility to children. . .154 Honour . . . .96 Impartiality, necessity for . 76 Inflammation of the eyes . . 162 scrofulous, of the eyes . 386 of the mouth . . 166 ulcerative, of the mouth 168 PAGE Inflammation, diphtheritic . 177 of the stomach and bowels . . . 208 of the lungs . . 263 of the brain . . . 320 scrofulous, of the ear . 390 Indispositions during teething . 306 Infantile remittent fever . . 241 Invermination . . . 212 Intolerance of milk . . . 183 Inculcation of the duties . . 88 of deference to the female sex 63-77 Infants, of the nursing of . . 5 swelling of the breasts in 164 Injurious tight lacing to the breast 18 Indigestion, infantile . . 184 Irritation of the brain . . . 312 Jaundice . 158 Lacing, tight, injurious to the nursing breast . . . 18 Languages . . . .124 Love . . . . . 94 Lungs, inflammation of the . 263 Master, duties of the . . 99 Manners at table . . .61 Mathematics . . . 126 Medicines, administration of the . 418 dilutions of the . 422 Measles . . . . 349 false . . . ib. Mental and moral development, of physical education as tending to . . 73 Education . . .109 Mesenteric disease . . . 219 Milk-crust . . . .411 vomiting of . 183 intolerance of . . . ib. Mouth, inflammation of the . . 165 canker of the . . 168 ulcerative inflammation of ib. Mother, precautions to be taken by the . . . . 13 Mumps .... 180 Nursing of infants Nurses, wet . Obedience . INDEX. 427 PAGE Obstructions, accidental, in the windpipe . . . 273 Occupation . . . 50 tutelage of . . 109 Organs, diseases of the digestive . 165 of the respiratory . . 253 Opening of the windpipe, spasm at the .... 277 Over-severity . . . 53-81 Pain in the stomach (colic) . 192 Parent, duty towards the . . 92 Partiality, evil effects of . .76 Physical education . . 73 Poverty, duties of wealth towards 102 Precautions to be taken by the mother . .13 to be observed in ad- ministering and changing the re- medies 422, 423, 424 Preliminary remarks . . J Pulmonary catarrh . . . 257 Punishment, corporal . . 141 Pustular ringworm . . . 402 Red gum . . . .164 Regimen, admonitory . . 130, 140 Remarks, preliminary . . . 1 Remittent fever, infantile . . 241 Remarks on the administration of the medicines . . . 421 Rest 38 Respiratory organs, diseases of the 253 Reverence . . . 96 Repetition of the medicines . 417 Rewards . . . . 143 Rickets .... 396 Ringworm, hepatic or vesicular . 400 of the scalp . . 402 pustular . . ib. Roseola, false measles . . 361 Ruptures . . . .158 Scaldhead . . . . 402 Scalp, ringworm of the . . ib. Scalding . . . . . 414 Scrofula affecting the glands of the neck . . .378 Scrofulous inflammation of eyes . 386 ear . 390 Scarlet fever . . 336 PAGE Scour or weaning brash . . 184 Simple fever . . .335 Six social duties . . . 90 Smallpox .... 362 Spasm of the opening of the wind- pipe . . . . 277 Spoiled children . . .79 Stages of youth . . . Ill Stomach-ache. See Colic . 192 Stomach, derangement of the . 224 inflammation of the . 208 Stools of a white or clay co- lour . . .158. 194, 236 of a dark colour ib. ib. Superior, duties of the . . 99 Swelling of the head . . 157 of the breasts in infants . 164 Teething . . . 804 indispositions during . 306 Temperaments . . . 147 Tendency, constitutional charac- teristics of ... ib. Tight lacing . . .18 Thrush . . . . 171 Thrush, white . . .175 Treatment of children at the birth 8 general, of children . 38 applicability of homoeo- pathic, to children . 154 Tumours and contusions . . 156 Tutelage of occupation . . 109 Ulceration, aphthous . . . 171 Ulcerative inflammation of mouth 168 Vesicular ringworm Vomiting of milk . 400 . 230 . 183 Water in the brain . . . 321 Wealth, duties of . . .102 Weaning . . .35,193 artificial feeding and . 26 Weaning brash . . .184 Wet nurses . . . 20 Windpipe, accidental obstruction in 273 spasm of the opening of the . . 277 Worms . . . .212 Youth, stages of Younger, duties of the . Ill 97 C. ANDJ. ADLARD, TRINTEHS, BARTHOLOMEW CLOSE, LONDON WORKS BY DR. LAURIE. Just published, Fifth Edition, 8vo, bound in cloth, price 12s. HOMCEOPATHIC DOMESTIC MEDICINE. Freed of all technicalities, and especially adapted to the use of Clergymen and Private Families. 18mo, bound in cloth, Second Thousand, price 5s. AN EPITOME OF THE ' HOMCEOPATHIC DOMESTIC MEDICINE. Intended to serve as a Guide to those who are desirous of commencing the Homoeopathic Treatment in Family Practice. 8vo, bound in cloth, price 16s. ELEMENTS OF THE HOMCEOPATHIC PRACTICE OF PHYSIC. 8vo, bound in cloth, price 12s. MANUAL ,OF HOMCEOPATHIC THERAPEUTICS, ByC. H. BOENNINGHAUSEN, M.D.. TRANSLATED BY DR. LAURIE. 8vo, Third Thousand, price 3d. PLAIN DIRECTIONS FOR THE TREATMENT OF CHOLERA AND CHOLERINE. THE PARENT'S GUIDE. A 000107360 " o