INFANTS. 



;i Marafmus inckideJ a variety of fymptoms wliicli afled 

 chilJren of both fcxcs. The difeafe ileals on gradually, 

 and the following arc the early fymptoms by which it is 

 characterized : a flug^gifhnefs, and laflitude oji flight exer- 

 tion, <lepravity and lofs of appetite, a flabbinofs and wailing 

 of the mufcular llefh, fuhiefs of the features, and paleiiefs 

 or party colour of the countenance, fwelliiig of the upper 

 Kp, a conilant itchmg of the nofe, foetid breath, with a 

 fwelling of the belly, an irregular and generally coftive Hate 

 of the bowels, and a change in the colour and odour of the 

 fxces. When thefe fymptoms have continued for fome time 

 Other more urgent complaints enfue. There is an alternate 

 palenefs and flufhing of the countenance, followed by heat 

 and drynefs of the ikin, feeble and quick pulfe, thirll:, great 

 frctfulnefs, increafing debility, and difturbed lleep, during 

 which the little patients grind or gnafh their teeth, and 

 are fubjeft to involuntary ftarting, and twitrhing of- the 

 different mufcles, and, when awake, to a conilant picking 

 of the noftrils or lips, or even of the eyes, and to involuntary 

 gclliculations, approaching to convulfions. 



Every cafe of marafmtis does not neceflarily include all 

 thefe fymptoms ; for they occur in different combinations. 

 The difeafe appears moll commonly among weak and in- 

 firm children, whether they are fo froiu delicacy of con- 

 ftitution, or from incidental caufes. It is particularly 

 prevalent in large and populous cities, where children are 

 deprived of ready accefs to exercife in pure air, and ficken 

 and pine in the nurfery ; or when they are confined in 

 crowded and airleis fehool-rooms, whither they are fent, partly 

 for the purpofes of education, and partly, to ufe a com- 

 mon phrafe, with the view of being kept out of harm's way. 

 Children alfo, who are employed in manufaftories, where 

 their occupation and confinement are fuch as to weaken 

 and enervate them, are liable to be attacked with this dif- 

 eafe. Irregularity in diet and improper food alfo give rife 

 to marafmus. It is accordingly obferved to prevail raoft 

 in the fummer and autumn, the feafons which atford an op- 

 portunity of eating unripe fruit and vegetable articles from 

 the garden. 



Marafmus has generally been attributed to the prefence 

 of worms in the alimentary canal. But the afcar'tdcs, which 

 are often pafied in great numbers by children, are not ac- 

 companied, excepc incidentally, by the fymptoms of ma- 

 rafmus ; and the txma, or tape-worm, is altogether un- 

 known in. infancy and childhood. The lumbrkus, or round 

 ■worm,' mufl therefore be the ger.eraliy fuppofed caufe of 

 the lymptoms of marafmus. But the difeafe occurs, in 

 numerous in'lances, and is cured, when no worms are fecn ; 

 and, on the other hand, the prefence of himlrici in the 

 bowels is by no means an uniform caufe of bad health, and 

 has been frequently noticed when marafmus did not occur. 

 Various anthelmintic medicines, however, have been fuc- 

 celTively in vogue for the cure of the difeafe, upon the 

 fuppofition of the exitlence of worms ; but the utihty of 

 fuch of them as have been found to be moft beneficial, 

 pr. Hamilton believes to have been in proportion to the 

 purgative powers which they pofl'efled. He fays, "when 

 I confider the languor and laifitude wh'ch precede this ma- 

 rafmus ; when I recolleft the con.litutional or acquired 

 debility of thofe who are more particularly expofed to be 

 affeded by it ; inftead of adopting ihe common opinion, of 

 its being occafioned by worms, I am more difpofed to 

 tliink, that a torpid Hate, or weakened aftiun of the ali- 

 Bicntary canal, is the immevliate caufe of the difeafe ; 

 whence proceed ccftivenefs, dilleniioii of thi bowels, and a 

 peculiar irritation, the confequcnce of rem(,ra of the faeces. 

 I have accordingly been long in ihe habit of employing 



purgative medicines for the cure of this marafmus ; the 

 object is to remove indurated and fatid fcEces, the accu- 

 mulation perhaps of montlis ; and as this objeft is accom- 

 pliiliing, the- gradual return of appetite and vigour mark 

 the progrefs of recovery." Obf. on Purg. Med. p. 51. 



Since the praftical conclufions are the fame, it is not of 

 material importance by what theoretical views they are fup- 

 ported ; but we accord with the following obfervations of 

 Dr. Hamilton, junior, (profeffor of midwifery at Edin- 

 burgh, whofe excellent " Hints for the Treatment of the 

 principal Difeafes of Infants, &c." we have before quoted.) 

 " There can be little doubt," he fays, " that neither the mere 

 accumulation of the llools, nor the torpor of the bowels, 

 on which that appears to depend, can explain the various 

 fymptoms produced by this condition of the digcftive or- 

 gans. There is every reafon to fuppofe that there is an al- 

 tered aClion, not only in the llomach and intellines, but alfo 

 in the liver and lafteals. perhajis in all the parts concerned 

 in the digeftion of the food. When this has continued for 

 a certain time, the accumulation of acrid matter, which is 

 the confequence, addi greatly to the irritation, and while all 

 this is going on, the circulating juices become depraved.'*' 

 Hints, &c p. 11^. 



In the treatniM of marafmus, then, the leading objefts are,, 

 to remove the accumulating mafs of morbid and irritating 

 fxces from the bowels, to alter the morbid aftions of the 

 digeftive organs, and to palliate the dillreffing fymptoms 

 which occur. The two firll, which arc the curative indica- 

 tions, are both fulfilled by a Heady and perfevering admi-- 

 niflration of purgative medicines. 



In the incipient ilage, while the difeafe is mild, the bow- 

 els are not altogether torpid and inaftive, neither are they 

 overloaded with accumulated fa»ces. Mild purgatives, there- 

 fore, repeated at proper intervals, efFefl a cure. Theypre- 

 ferve the bowels in proper action, carry off fsces which had 

 begun to be offenfive and hurtful, and prevent farther accu- 

 mulation. The difeafe yields- in a few days to this treat- 

 ment, and all that is farther required is fome tonic medi-- 

 cine, which (hall ftrengthen the ftomach and bowels, to- 

 gether with a due regulation of diet, and occafionally a 

 purgative at bed-time, the patient being likewife much in 

 the open air. Preparations of iron are found the bell to- 

 nics in thefe cafes ; and children readily take the w'ine of 

 iron, or the filings covered with fugar. In felefting the. 

 purgatives, it is neceffary to flatter the tafle of our young 

 patients. Powder of jalap is not altogether unpleafant : 

 the mild neutral faits, dilTolved in a fuitable q;:antity of 

 beeftea, are alfo convenient purgatives : but c-alomel will 

 prove, on feveral accounts, the moll certain and ufeful. 

 remedy of this kind. 



When the confirmed ftage of marafmus has been allowed 

 to arrive, m.anifcft danger threatens the young fufferer, whofe ■ 

 remaining flefh and ftrength are rapidly wafted by the fuper- 

 vening fever ; while proilration and depravity of appetite 

 withhold necefiary nouriniment, and at the fame time the 

 more inadive Hate of the bowels, and greater bulk of fecu- 

 Icut matter, throw additional difBculties in the way of a 

 cure. Under thefe circumllances, an aftive.praftice ihould 

 be adopted, with the view of Himulating the inteHines, and 

 of putting the collciled mafs in motion without' d*>lay. 

 Thefe ends are beH obtained by giving fmall dofes of the 

 purgative medicine, and by repeating thefe frequently, fo 

 that the latter dofes may fupport the effefts of the pre- 

 ceding ones. When the bowels are once opened, Hronger 

 purgatives, given at longer intervals, will accomplifh the ■ 

 cure. 



WhiiQ the purgative inedicine& are thus exhibited, it is ; 

 abfolutely. 



