J. K. Walter

“ We know that as the infant advances in age, the liver diminishes in size, and instead of extending into the abdomen, retires behind the ribs, below which it does not extend, except when in a state of disease. In some cases, it is true, the child retains this natural hypertrophy, and in some children it is greater than in others. In those in whom this disproportion is the greatest, it is consistent with analogy to suppose, that its influence must more or less be felt in the digestive functions, on the lungs, and on the brain ”

“ It is a subject not unbecoming the highest attainments, to increase the stock of medical knowledge in that branch of our art. So important, indeed, to society, is the successful treatment of infantile diseases, that happy shall I be, if any effort of mine shall awaken attention to this hitherto neglected department of medicine. ”

“ There is no brighter reward, that is in the power of this world to bestow, than to be made the instrument of relief to these helpless little ones, and of saving the lives of these engaging beings, to be a blessing to their parents, and, perhaps, the future ornaments of society. ”

“ If, for instance, the system has been reduced by long disease, or if the child has been suckled too long, or where (from the ill health of the mother,) the quality of the milk is bad, and a gradual wasting of the body of the infant takes place; is a tendency to coma in such a child, to be treated as an indication of oppressed brain? We know that, when debility exists, the irritability of the system is often increased by it, and convulsions take place as the consequence of extreme exhaustion. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ When the state of the poor is such as to enable the mother, who is suckling an infant, to partake of a more liberal diet than she had previously been accustomed to, what a change will often take place in the health of the babe. The habit too frequent among the poor, of deferring the time of weaning beyond the proper period, is often followed by the most mischievous consequences to the health of the child. ”

“ Take the teeth as an illustration, which are formed within the gums, and there stop, as their further development would incommode the process of sucking, by which the infant is for some time to be nourished. The milk itself too. It is secreted just at the moment it is wanted, and, above all, is found to contain those ingredients that are best adapted for infantile aliment. No substitute is equal to a healthy mother's milk. Its properties seem to undergo some alteration with the age of the child; any irregularity of diet, or ill health of the mother, affects its salubrity. ”

“ How often, among the symptoms of that disease, do we see it ourselves, and find it confirmed by others, that the bile is unnatural, either in quantity or quality? Green bile is often found in the gall bladder and ducts, and the action of a brisk purgative, especially of calomel, will often dislodge morbid secretions from the liver, and from the bowels, and the consequence of such free evacuations, is seen in the restoration of the healthy functions of the liver, and along with it a frequent disappearance of that formidable array of symptoms which so closely simulate hydrocephalus. ”

“ The idiosyncrasy of the mother may affect the mammary secretion; and diseases, we know, exercise a direct influence, in proportion to their intensity, on the fluid secreted, and the effects are not slow to show themselves on the health of the child. Even a slight derangement of the digestive organs of the mother is apt to become transmissible by the milk, and the stools of the infant, from being of a natural appearance, suddenly assume a green or darkish tinge. ”

“ But, as the highest rate of infant mortality has usually been in large towns, so has the diminution of deaths been the greatest there. It is the object of the following paper to take a cursory view of those causes which tend to cut short the career of human beings in the very threshold of existence. Nor can I conceive any subject of higher importance than the study of medical statistics, and especially of that branch of it, which leads to a more correct estimate of the sources of infant mortality. ”

“ In other instances I have observed a less degree of cerebral irritation to follow the disappearance of the cutaneous symptoms; other viscera, the lungs, liver, and alimentary canal, become the seat of disordered action, even in children, who appeared, previously, free from disease in this respect. Take, for instance, one of the earliest of the infantile eruptions, the strophulus intertinctus, which is not always accompanied or preceded by any disorder of the constitution, but appears, occasionally, in the strongest and most healthy children. Even this cannot always be suppressed with impunity. ”

“ Wherever it mingles with any accidental or local complaint, it makes all the symptoms worse, and there is no structure nor organ of the body which is not obnoxious to its ravages. It is not merely in the tumid abdomen and the enlarged joint, but in the lungs, heart, liver, kidneys and intestines, in the eyes and brain, that its destructive effects unfold themselves. ”

“ Though many of the symptoms, indicative of the latter disease, present themselves; such as prominence of the belly, and wasting of the muscular flesh, with a chylous aspect of the stools, yet, if we find all of them yielding, in a reasonable time, to ordinary treatment, we must surely conclude that no very serious disease exists in the mesenteric glands. It is true that hypertrophy of the liver, in children of a scrofulous habit, may give rise to mesenteric affections ”

“ Here we have experimental proof of the tendency of the mammary secretion in animals to vary with the nature of the aliment, nor can it be doubted that the same tendency obtains in the milk of the human female. Neither should it be forgotten that other causes as well as diet, exercise a material agency in modifying the human milk. We know that intemperance of any kind will influence its nature, so will grief, anger, fear or joy. ”

“ Every thing indicates a special provision for a special contingency. We all know how readily cow's milk coagulates on the addition of acids, but healthy human milk will not do so. No coagulation is effected either by acids, alcohol, rennet, or by infusion of the stomach of the foetus, at least for some days. Neither has it the same tendency to run into acescency that cows' milk exhibits. In speaking of this phenomenon, I am aware that it applies only to the milk of such mothers as are supported by a generous diet ”

“ Every one's own experience will point out to him the substances most likely to be absorbed, and to answer a specific purpose. It only remains for me to observe, that it is the duty of every practitioner to acquaint himself with the causes which cut off so many of the human race, at so early a period of their existence, and, as far as possible, also, with the best means of remedying the evil. ”

“ Though this cause of emaciation among children is rarely mentioned by pathological writers, yet there is reason to believe that many children fall victims to this inordinate secretion of urine, who have been treated for mesenteric disease or hydrocephalus; for it should seem that a tumid prominent abdomen, as well as a comatose state, are the frequent accompaniments of the more fatal form of this disease. Cases occur, where the brain, lungs, heart, liver, and other digestive organs, are implicated in the affection ”

“ This tendency to spasmodic constriction of the larynx, if neglected, is capable of superinducing other affections, such as convulsions; and, in these cases, when they terminate fatally, the brain is often found highly vascular. Nay, in some instances, it seems that these paroxysms of spasm, and croupy respiration, may recur for several weeks, and terminate fatally, and yet, on dissection, no other mark of disease is discovered than effusion into the ventricles, or between the membranes of the brain. ”

“ In delicate and feeble children, and particularly among the poor, when the milk of the mother is impoverished by scanty nutriment, and a tabid state of the infant is the consequence, do we not find that a careful exhibition of tonic remedies will often succeed in removing that tendency to drowsiness, better than a system of depletion? ”

“ Nor is the disease confined to the bowels, but the mesentery and peritoneum, lining the parietes of the abdomen, share in the affection, and the belly is tumefied and tense. The surface of the abdomen is often tender to the touch, and there is frequent deep-seated lancinating pain within its cavity. Should these symptoms not subside under proper treatment, a rapid increase of the emaciation ensues, and the evening accession of fever is more severe, and in some instances, towards the conclusion, the little patient becomes comatose. ”

“ Such contrivance would be in perfect unison with the many merciful provisions made by unerring wisdom, to meet the special wants of helpless infancy; for every part of the human frame, at man's entrance into the world, is full of prospective contrivances. ”

“ It is a fact of some importance to know, that cerebral hypertrophy may present symptoms indicative of effusion, and may even terminate fatally, yet without any other morbid appearance than extraordinary development of the brainular mass, and with only very little fluid in the ventricles. Instead of effusion, the convolutions of the brain appear flattened from previous pressure, exhibiting increased density of structure. ”

“ Liniments, ointments, fomentations and poultices, may be made the vehicle of medicines, which cannot always be introduced by the mouth. It is quite manifest, as has been observed by an able writer on the diseases of infants, from the innumerable ramifications of the capillary vessels which penetrate the cutaneous texture, and the multitude of nervous filaments which give them sensibility, that poultices, in their simple or medicated forms, can be made remarkably efficient in counteracting the impressions of disease in many of the living structures. ”

“ At other times the mesenteric glands are in a tubercular condition. The bones, too, do not escape the ravages of scrofula, which affects the softer and more spongy structure at the heads of cylindrical bones, the bones of the carpi, tarsi, and vertebræ. In its early development, so insidious and imperceptible is the change, that it is most frequently overlooked. Perhaps a sense of slight weakness is all that attracts attention, until the disease is more advanced, and a dull pain is felt in the hip, knee, or ankle joint, which is aggravated by pressure or long exercise. ”

“ Every practitioner who has had much experience in the treatment of children, must have remarked the closest sympathy betwixt the chylopoietic viscera and the brain, insomuch that a morbid condition of one will influence the functions of the other ”

“ If the mother's milk is not efficacious enough to counteract a tendency to sluggishness in the bowels of her infant, and the aid of medicine is required, some aperient powder, sprinkled, or, in some instances, a little castor oil, rubbed, on the abdomen, and the subsequent application of a warm poultice, will often suffice. ”

“ The brain, the liver, and the intestines, seem among the first to feel the effect of this change, and cerebral excitement is not slow to shew itself, especially if other circumstances combine to favour such determination. Where repulsion takes place, before all the deciduous teeth have made their appearance, the danger is greater, as the nervous as well as vascular system, seems endowed with singular susceptibility during dentition. ”

“ In a family residing in this neighbourhood, where, out of fourteen children, eight have died; it appears that, of these eight deaths, three were cases of hydrocephalus, two of disease of the mesenteric glands, and two of phthisis pulmonalis. In other families we find the osseous fabric the seat of strumous disorganization, and one child will have a rickety affection, or a deformity of the chest, such as in after life may evoke some phthisical tendency, another a caries of the bones, and a third spinal distortion. ”

“ Very lately I saw a child, Mary Calverly, æt. two years, who lay in a comatose state, the pupils dilated and insensible to light; the respiration interrupted by sighs; pulse weak and irregular; bowels costive. On enquiry, I found that the child for several months had been troubled with an eruption which the mother called the itch, which had occupied not only the arms and thighs, but other parts of the body. The eruption not giving way to the internal exhibition of alternatives, the external application of an ointment, consisting of the unguentum sulphuris, with a little of the ung. ”

“ This is a form of disease that has doubtless occurred to every practitioner. But in some instances, along with many of the above symptoms, there is cough, with chronic diarrhoea, followed by a febrile and marcescent state; and some structural derangement of the lungs is superadded to the abdominal mischief. From the appearances on dissection, of some such cases, one might suppose that the germs of tubercles are sometimes born with us, for in one such dissection of a child, I find it recorded, that both lungs were completely studded with tubercles. ”

“ Another peculiarity may be found in the size of the brain, which is usually so much larger, in proportion in infants than in adults; and we are told by M. Jadelot, that in many children who had died with symptoms of hydrocephalus, dissection presented no other pathological condition than morbid hypertrophy of the brain. ”