INFANTS. 



emaciation and foflnefs of the flefli, reftlefliiefs, thirft, and 

 fever of a heclic charafter. But the moll cliaraftcriilic 

 fymptom of this difeafe is a conilant peevillinefs, the edeft 

 of unceaiing; griping pain, expieffed by the uhinc oi the 

 child, but t-f!iecially by the fettled difcontent of its features. 

 In the proajrefs of the difcafe, the evacuations from tlie 

 belly fhew very different aflions of the inteftincs, and great 

 changes in the biliary fecretion ; for they arc fometimes of 

 a natural colour, at other times (limy and alh-coloured, and 

 fometimes lienteric. The difeafe feldom proves fatal before 

 the fixth or feventh week ; but fometimes an earlier ter- 

 mination is fuddenly produced by inceffant vomiting and 

 purging, or by convulfions, from the extreme irritation in 

 the bowels. 



By diffettion Dr. Cheyne afcertained the ftate of the 

 vifcera in children who had died of this difeafe. In every 

 cafe the intellinal canal, from the ftomach downward, 

 abounded with fmgular contraftions, and had in its courle 

 one or more intus-fufceptions ; the liver was exceedingly 

 firin, larger than natural, and of a bright red colour; and 

 the gall-bladder, which was enlarged, contained a dark-green 

 bile. In fome diffedions the mefenteric glands were found 

 fwelled and inflamed ; in others, however, they were fcarrely 

 enlarged, and had no appearance of inflammation. It is 

 probable, tlierefore, that this difeafe is owing to an in- 

 creafed fecretion of acrid bile, or rather to the morbid ftate 

 of the liver which occafions this ; and that the extremely 

 irritable ftate of the whole abdominal vifcera, marked by 

 the fpafmodic contraftions and intus-fufceptions, &c. is 

 occafioned by the prefence and paffage of this acrid ex- 

 cretion. 



As the exciting caufe of this iveamug Irnfi is apparently 

 too fudden an alteration of the diet of a child at an unfit 

 feafon, it follows that children ought at all times, but more 

 particularly in the autumn, to be weaned gradually, aiKl 

 well accuftomed to the food on which they are afterwards 

 to fubfift before' they are finally taken from the breaft. 

 At the beginning of the difeafe, or even later, when the 

 sfttack is flight, Dr. Cheyne recommends a dofe or two of 

 rhubarb, to the extent of five or fix grains, at the interval 

 of two days between each dofe ; and that, m th.e mean time, 

 the child (liould take half or a third part of a grain of 

 ipecacuan powder, mixed with fix or eight grains of pre- 

 pared chilk, and a fmall portion of fome aromatic powder, as 

 cafiia, every four or five hours. A Itarch glyfter, with five 

 or fix drops of laudanum in it, may be adminiftered at bed 

 time with advantage, if there be much griping along with 

 the purging. Th<; fnccefs of thcfe remedies, however, will 

 depend upon a ftriil attention to diet. An animal diet pro- 

 duces lefs irritation than one vvhiih is folely compofcd of 

 vegetable matter. Eggs, the finer kind of light fhip-bifcuit, 

 or arrow-root, cuftard, the juice of lean meat, plain ani- 

 maLjellics, broths freed from their oily part, and milk, are 

 proper articles of nourifhment. The breaft milk might 

 perhaps be reftored with advantage. Vegetables of all 

 forts, particularly fruits, acids, and compofitions of which 

 fugar or butter form a part, and- fermented liquors of 

 every kind fhould be ftridly prohibited. The feet fhould 

 Le-4wpt warm by woollen ilockings, and flannel worn next 

 the fidn ; and the warm bath and fomentations may be fre- 

 quently ufed to alleviate the continual fpafms. Dr. Cheyne, 

 however, taught by fubfequent experience, recommends 

 fmall dofes of calomel as the moft effeftual remedy againft 

 tiie weaning brafh, and other chronic forms of bilious 

 diarrhtea. He generally gave half a grain of calomel, morn- 

 ing and evening, or a grain every night, for a week or ten 

 days. After the third or fourth dofe there is generally a 



great change, he fays, in the colour of the alvine difch".rg<> ; 

 it becomes of a dark mrhogany colour, and is in gei, ..I 

 more offenfive. When this change takes place it prod- icc3 

 a favourable chaiige in the diforder. Soon aftCKwardb, il;e 

 children become free from fever, more placid, and in n 

 day or two more their appetite returns, with their fc-n^r 

 complexion, and every otlier demonllralion of health. '. 

 never fovind, he adds, in the many cafes in which he 

 given c.ilomel, that it produced faliva»ion, or any '■ 

 luipleafant effed. Cheyne, Effay ii. On the IJowcl C 

 pi lints more immediately conneiled . with the Bihary 

 cretion. 



Cojlmenffs. — This oppofite condition of the bowels, tlv 

 feldom occurring in young infants, is prodnftive, in chil 

 a li'tle more advanced, of many diftrcfling complaints, fc.^ 

 infants,, indeed, feem to be habitually coftive ; and the-. 

 certainly a confiderable variety, in relpedl to the ftnl,- •; 

 the bov.'els, in different individuals. But what may be p:;^- 

 peily termed coftivenefs is never to be regarded as a ii:\- 

 tural deviation peculiar to any infant: it is always t'..- 

 effcft of difeafe, or of the nurfe's miik, or of the food. If 

 one copious evacuation lake pl.ice every twenty-four hor.i:, 

 and the infant be thriving, there is no occafion for ini i - 

 feivnce ; but if there he any greater torpor of the bov. i ■ 

 than this, fuitable remedies are to be employed. It i.s i - 

 ncrally proper to treat the cafe at tirit as if it were ;,iij 

 confequence of difeafe ; aid on this account a brlft ln-ui- 

 tive may be given every day, for four or five times |i e- 

 cefiively. The beil laxatives for infants are manna, ca'ci-Ad 

 magnefia, calomel, and cold drawn ca(lor-oil ; and Dr. \\:.- 

 railton recommends a laxative fyrup, prepared with treiicle 

 and a ftrong infufion of fenna. 



Where thefe means fail, there is reafon to attribute tie 

 coftivenefs to the nurfe's milk. SoineLimes that peculi;ir 

 ftate of the milk may be altered by regulating the diet, 

 and openiiig freely the bowels of the nurfe. While proper 

 means are tried for this purpofe, the infant's bowels are 

 to be kept clear by fome mild laxative. But if it be found 

 that the milk IHll poU'cfles that injurious quality, the nurfe 

 fhould, if poilible, be changed Where this cannot be done, 

 four or five drops of antimonial wine may be given to the 

 infant every night at bed-time, and inftead of the ordinary 

 food, panada, made with fmall beer and treacle, fhould be 

 fubltituted. 



Temporary coftivenefs may be at any time removed by 

 a fiippofitory, made of a fmall piece of yellow foap, ftiaped 

 like a very large Dutdi vvriting-qnill. This may be ren. 

 dcred more powerful, if neceffary, by being dipped, previous 

 to ufe, into fome powdered fea-falt. Suppofitories are more 

 efficacious in infants, and much more eafily .managed than 

 glyftcrs, though thefe latter means are alio fometimes ufe- 

 ful. In cafes of obftinatecondipation, attended with fymp- 

 toms of great opprefiion, aloes, fufpended in treacle or 

 fyrup, is more powerful than any other laxative ; from four 

 to eight grains may be thus given for a dofe. Many prac- 

 titioners err. Dr. Hamilton affirms, by direfting too fmall 

 dofes of laxative jr.edicines for infants. . 



At a more advanced period of childhood, a morbid ftate 

 of the alimentary canal, of which cojVivfriefs is a confpi- 

 cuous fymptom, frequently occurs, and is the fource of 

 fdveral' varieties of difcafe, both chronic and acute, which 

 conllitute perhaps the moft frequent maladies of the puerile. 

 age. The'firft of thefe, to v/hich we fliall dirett the attention 

 of the reader, has been called, by Dr. Hamilton, fenior, 

 phyfioian to the Royal Infirmary at Edinburgh, marafmus. 

 See his Obfervations on- Purgative Medicines, chap. iii. 

 edit. 2d. 



