Infant diseases

every where furnish a vast supply to the gloomy realms of Pluto; and this calamity is infinitely aggravated by the noxious atmosphere of cities and towns. At birth, an infant is not only ushered into a new world, but every function of its frail body undergoes new and sudden changes. From the human oven of 96 degrees of heat, it is launched into a variable climate of heat and cold. A new element of many thousand pounds weight then presses upon the surface of its body. This atmospherick fluid, adulterated in cities with innumerable impurities and feculencies is drawn into its lungs: its diaphragm and muscles of respiration then begin to act, the lungs expand, and the respiration commences. The passage between the auricles of its heart and arterial duct are gradually closed up; the sphere of the circulation is extended; the whole current of blood in its frequent revolution hourly, passes through the lungs; the circulation through the navel-string, and through which it had till then drawn its principal nourishment, instantly ceases: food, for the first time, begins to be taken in by its mouth; the digestive, with all the numerous secretory and excretory organs, then begin to perform their different offices; the tender creature is exposed to sounds, in a few days to light; the bones at the superior part of its head gape, and the brain is there defended by skin only; its head, belly, liver, and lymphatic glands, are large, and its extremities slender; the fetal brain is destitute of ideas; its bones are little more than gristles and cartilages; its muscles are soft, flabby, and without swell or expression; the greatest part of its time is spent in a state of inactive vegetation; it is unable for several months to support its own weight, or to take nourishment, and is then the most feeble and helpless of all the animal creation. With such delicate machinery, it has soon to encounter pain and disease; the assaults of internal and external enemies; when its crazy beams and bolts are easily shook asunder in the first storm.

The acute diseases of early infancy; that is, under two years of age (small pox, measles, and a few others excepted) are in the London registers, principally accumulated into two aggregate heaps, Convulsions and Teething: the former of which forms a dreary catalogue of astonishing magnitude in London funerals; amounting to nearly one third of the whole mortality in the metropolis. But convulsions and teething are terms too indefinite. Every infant disease, not immediately obvious to the senses, is thrust into these two articles by the ignorant reporters. If we consider the term scientifically, convulsions, in multitudes of cases, convey no more intelligence of the nature of the disease, than if they had said the child died from want of breath. Let us therefore examine, whether the collected observations of medical authors will not illuminate many dark and defective parts of the publick registers, respecting infant mortality. Infants are exempt from a multitude of the acute and chronic diseases of adults: they rarely suffer so early in life from hereditary diseases, cares, passions of mind, painful impulses of retentive memory, severe study, intemperance, hard labour, the inclemency and vicissitudes of the seasons, and so on. The principal diseases of infancy may be comprehended under the following: convulsions, inward spasms and tetanus, colick, vomiting, acidity, indigestion, flatulence, diarrhœa and gripes, thrush, dentition, hectic fever and atrophy, rickets, scald head, rash, dropsy of the head and spine, inguinal ruptures; together with small pox, measles, hooping cough, worms, and a few others already described.

As infants cannot by speech express their pain, we are too often under the necessity to guess at their complaints by physiognomy, gestures, and dumb signs: these are principally manifested by nausea, indigestion, vomiting, flatulence, refusal of food, or the breast, diarrhœa and its different colour and consistence, restlessness, cries, shrieks, agitation and contraction of the lower extremities, disturbed sleep, injured respiration, cuticular eruptions, pustules, and ulcers. In infancy the pulse and urine are precarious symptoms: their arterial pulsations in fevers are sometimes so rapid, that the most minute divisions of time in horological instruments, cannot keep pace with them.

The general causes of Infant Diseases

and mortality may be referred to the sudden and violent changes after birth in its tender machinery; to weakness and injuries from tedious and laborious parturition; delivery before the end of the ninth month; hereditary debility; diseased parents; foul air of cities; improper food and drink; scarcity of food and milk; ill formed nipples; the tongue tied or retracted; errors in quantity or quality of nutriment; too long continuance of vegetable and acescent food; foul stomach and intestines; acidity in its stomach; errors of the mother or nurse in food, drink, rest, exercise, excretions, passions of mind, ill temper, passionate, hysterical, addicted to raw spirituous liquors and drunkenness; diseased; fasting too long before the infant sucks; unwholesome milk; adulterated milk and bread; neglect of cleanliness, and suffering the infant to lay too long in wet cloaths; insufficient exercise, and also too violent agitation of the infant; the ligatures, bandages, and pins too tight, and tormenting the infant; improper positions and postures; cold cloathing and habitations, beds, and scarcity of fuel, especially in northern regions, and in winter; infants excretions, and especially by the anus, defective or excessive; improper treatment and quackery of old women and nurses, and other such medicasters, during its illness. It is but candid also to confess, that, in numerous instances, the causes of infantile maladies are not yet sufficiently established nor explained.

Convulsions, Inward Spasms, and Tetanus.

From the exquisite tenderness and irritability of its frame, most diseases of infants, when fatal, seem to terminate in spasms, epilepsy, and convulsions; with which they are infinitely more afflicted than adults, and often endure better. Inward spasms are amongst the first of infantile maladies: it appears as if slumbering; the eyelids are not perfectly closed, and the white bulb of the eye is partly turned upwards, and exposed to view; the eye-lashes twinkle; there is a tremulous motion of the muscles of the face and lips, sometimes resembling a smile or laugh: as the disease increases, the breath seems frequently to stop; the tip of the nose is then contracted, with a pale, sometimes ghastly and livid circle around the eyes and mouth; it starts on any motion or noise; sometimes it seems falling into convulsions, but on discharging flatulent air upwards and downwards, it recovers, and relapses again into a lethargic state. By continuance, these spasms often terminate in some of the following diseases; hectic fever, thrush, vomiting, diarrhœa and green feces, watery gripes, convulsions. Infants also are sometimes subject to a locked jaw; which we have already noticed under Tetanus.

The predisposing and occasional causes of convulsions and inward spasms are, acrid stimulus of food, acidity, or bile, or inflammation in its stomach or intestines; general debility; the brain compressed during parturition, hence mould shot, horseshoe head; water in the brain; teeth cutting the gums; passions and frights of the nurse affecting her milk, or drinking raw spirituous liquors; improper food of the nurse or infant; scald head, excretion behind its ears, and cutaneous rash repelled; they are usually imputed to fulness and foulness of the stomach and intestines. Lastly, Derangements in its yet crude machinery.

Some adult mortality, but in all probability a very inconsiderable portion, is included in convulsions: infants are the principal victims. The convulsive list diminishes during the latter half of the present century: but to unravel the problem respecting convulsive increase or decrease, requires more elaborate investigation than preceding calculators and criticks seem to have suspected. It is necessary to contrast the deaths by convulsions and teething with the christenings; for if more are born, more should be expected to die in infancy. We must also take cognizance of some other titles of London diseases, particularly stoppage of the stomach, colick and gripes of the guts; both which have already been under review. Besides, chrysoms and infants, an obsolete term, denoting the deaths in the first month after birth, is long exploded from the bills, and probably ingulfed in convulsions.

Dentition.

It is probable that the mortality under this head is exaggerated enormously in the London registers, amounting to one fifteenth part of the annual burials. Dentition usually commences about six or seven months after birth; sometimes not before ten, twelve, or eighteen months, and, in some extraordinary instances, not before two years of age. These sharp bones, in piercing the tender gums, often excite exquisite pain, restlessness, fever, flow of saliva; the infant’s hand is frequently thrust into its mouth; it bites the nipple; sometimes the gum is swelled at the jutting of the tooth, and a pale spot appears at the part where it endeavours to protrude. When dentition is out of the natural order, it is generally painful: in the natural progress, the two foreteeth of the lower, then those of the upper jaw; next, the two adjacent of the upper, and afterwards of the lower jaw, cut their way. After the eye-teeth, or canine, in the upper, and those two opposite to them in the lower jaw are protruded, the danger of teething is generally escaped. It is only in the first dentition, that is, under two years of age, that mortality ensues from this source: the fatal and most frequent transition is into convulsions. About two years of age, infants are generally provided with twenty teeth for the purposes of mastication: and this number remains stationary until after seven years from birth, when all the first set are gradually and successively thrust out by others deeper seated in the jaw bones; about the age of fourteen all are excluded; and in adults the number is increased to thirty-two.

Rickets.

Notwithstanding the omission of ancient authors to discriminate this disease, we cannot believe but that, in this instance, the same causes would in all ages have produced the same effects. Rickets would seem by the London registers to decrease; for in our last group of fifteen years they shrink to 104; whereas in the thirty last years of the preceding century, ricketty deaths are numbered at 11,415. To what cause is this decrease to be ascribed? Does it indicate more maternal attention, and also more propriety in suckling and rearing of infants? Is implicit faith to be placed in the London registers, and crimination of diseases?

Rickets, one of the chronic diseases, seldom commence before three, six, or nine months after birth, generally between nine months and two or three years of age, and seldom or ever after five. The progressive symptoms are aversion to motion, and to put the feet to the ground, decrease of strength, paleness and flaccidity of the muscles, wasting of flesh, although in many the appetite is voracious; enlarged belly, liver, spleen, head, and joints; tumid and tympanitick abdomen; laborious respiration; dentition later or slower than usual; carious teeth; fetid breath; premature acuteness of genius and reason than is natural to the years; the countenance serious and ancient; the infant waddles in its gait, the spine and bones of the lower extremities become crooked and deformed, the breast prominent. The earlier rickets commence, they are more contumacious; and when chronic or fatal, are frequently accompanied with hectic fever: they may continue several years, and at length terminate in general bad health, atrophy, dropsy. Should they not be checked before the fifth, or at the utmost, the eighth year, irremediable deformity must ensue, which in females is often the cause of distorted pelvis, and difficult labours. The predisponent and occasional causes are hereditary; weak diseased parents or nurses; negligent nursing; not sufficient exercise nor cleanliness; improper diet and gross food; worms; foul stomach and intestines; scrophulous obstructed mesenteric and lymphatic glands; diseased liver; general bad health, with hectic fever; various causes of atrophy; difficult dentition; faulty state of ossification; deficiency in the ossious rudiments; faults in the organs of nutrition.

Thrush.

In the preceding century, Canker was often joined together in the London registers with Thrush; but whether it should be coupled with this or with gangrene, or with both, I cannot determine. Thrush is principally a disease of early infancy: it is likewise often a concomitant symptom of some febrile and acute diseases of adults. It infests not the young alone, but also aged persons, especially in cold northern and moist climates, in damp situations, and in warm rainy seasons. As an idiopathic disease of adults, it is rare in this island. The disease generally appears first on the tongue and roof of the mouth, in small superficial red specks, and ash-coloured ulcers, spreading gradually over the palate, fauces, cheeks and lips; with anxiety, restlessness, pain, difficulty of suction and deglutition, fever, nausea, vomiting. After some time, the ulcers form thick, tenacious incrustations, shining like lard, ash-coloured, brown, rarely black: these crustaceous layers scale off, but, not unfrequently, after the interval of a few days, are again renewed: the oftener the worse: and in such cases they may be protracted weeks. When the raw skin appears dry under the crusts after desquamation, they are reproduced; moisture there indicates a speedy and favourable termination: diarrhœa frequently supervenes.

In order to prevent the superfluous multiplication of symptoms and diseases, and which are common to all ages, I have, under the respective titles of Vomiting and Acidity, Colick, Diarrhœa and Watery Gripes, diseases so frequent and harassing in infancy, added the discriminating marks and peculiarities in those early years. Small pox, measles, hooping cough, croup, dropsy of the head and spine, phthisis, hectic and atrophy, scald head, rash, worms, have each been the subjects of preceding investigation: ruptures make a part of our subsequent inquiry.