Volume 1

The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly.

Date:
1833-1835
Catalogue details

Licence: Public Domain Mark

Credit: The Cyclopaedia of practical medicine : comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc. / edited by John Forbes ... Alexander Tweedie ... John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    824/858 page 688
    jiliysical education, and tlie debilitating efiects of various pernicious pnictices pi-oceeding from fa.sliion, luxury, and dissipation, are incapaci- tated for undertaking it. Thus error perpe- tuates itself, and in its natural consequences comes to act in a circle. The dissipated mo- ther neglects her child, and this child, if a female, commences life under disadvantages which, by weakening her frame, tend to unfit her for eventually acting as a mother. Extreme delicacy of constitution, diseased condition of the frame, defective .secretion of milk, may forbid the mother to suckle her child. Unless she can perform the duty with safety to herself and benefit to her infant, she ought not to attemj)t it. In this case a young and healthy wet-nurse is the best substitute. Hut even this resource is not always attainable, and then it is consolatory to reflect that children may be reared without material ])rejudice to health, by what is termed feeding by hand, though ex- treme care is requisite to make the substitution effectual. In this ca.se the process of nature should be emulated its far as possible, and food should be imbibed by suction from a nursing-bottle, rather than swallowed from a spoon. jMiich injury results from giving in- fants food too gross for their digestive j)owers. If nursing by hand, as it is termed, be resorted to, the food, for the early months at least, should ap])roach as nearly as possible to human milk. Alilk and water, with a little sugar, is quite enough for the first two months, after which some farinaceous matter may be com- bined. Thick gruel, jianada, biscuit-food, and such matters, are much too solid, at least in very early infancy. They overload the stomach, causing indigestion, flatulency, and gri])ing. These create a nece.ssity for purgative medicines and carminatives, which again weaken dige.s- tion, and by the unnatural irritation perpetuate the evils which render them necessary. Thus many infants are kept in a continual round of repletion, indigestion, and purging, with the admini.stration of cordials and narcotics, who, if their diet were in quantity and quality suited to their digestive powers, would need no aid from physic or physicians. The frequency with which medical aid is required for infants under gastric and intestinal disturbance, and the numerous infantile ma- ladies which spring from this source, are sulti- cient proof that their ordinary diet is not as rational as it might be rendered. Erom errors of diet are the digestive functions of infants chiefly, if not solely, liable to be impaired, and, when these become so, correction of diet, rather than the exhibition of drugs, should be relied on for remedying the evil. We are far from inculcating that on such occasions medical advice should not be resorted to; on the con- trary, our persuasion is, that, when such di.s- turbance arises, medical counsel is absolutely necessary, as the medical adviser is more likely to see the real nature of the evil, and adopt rational means for its correction, than they whose injudicious proceedings occasioned it. Hut we would strenuously advise the medical attendant to be sparing of his drugs, unless he see ade([uate cause for exhibiting them. W’e are well aware that, even in infancy, the bowels may become loaded, and their lining membrane coated-with redundant mucus, and that purges, even of calomel and antimony, with rhubarb or scammony, may be recpiired to clean.se them, and restore healthy secretion. Hut such reme- dies should not be ])rescril)ed on every trivial occasion, and at all events a succession of such dra.stic jjurges can very rarely be needed. The stools, if rightly understood, will furnish a suf- ficiently certain guide. If there be evidence of redundant and vitiated secretion, and if the removal of this by purgatives relieve j)ain and restore tranquil feelings, no doubt can attach to the means by which these elfects are ob- tained. Hut if .sometimes happens that .some tinge in the fieces, some incidental pain, mis- leads the practitioner, inducing him to believe that more purging is needed, when the pre- vailing distress may be owing to the irritation caused by the purgatives already too freely ad- ministered. In this ca.se he will do w'ell to jiause, and, by abstaining from interference, siiH’er the liowels to recover the tranquillity which his remedies serve but to disturb, it is a valuable jiart of medical science to know when to resolve on doing nothing, and an ex- cellent result of moral courage to dare to act on that resolution. On such occasions it is not true that medical skill is at fault or in abey- ance. It only evinces the sagacity to perceive tliiit nature is competent to her own work, and that she ought not be interrupted in com- pleting it. In judging of the intestinal secretions of infants, there is a source of fallacy which de- serves to be noticed. Mucus accumulates on the lining membrane of the stomach and bowels, and becomes morbid, inducing disease. The irriution of jiurgatives, too freely given, will also cause an increased secretion of mucus manifested in the stools. The matters dis- charged, however, are very different in their nature, and can hardly deceive an experienced eye. In the former case, the mucus is opake, den.se, ropy, or membranous; in the latter, it is limpid and fluid. Purgatives relieve the former condition ; they exasperate the latter. Infants naturally have free bowels, and, if properly fed, they need no medicine. Even in purging off the meconium, art is often superfluously resorted to, or at least prema- turely employed. Tlie first milk of the mo- ther’s breast is the natural purge, and often- times even this is not required. A too early exhibition of castor-oil, as is very generally practised, is unwise. A little manna is le.ss irritating, and will in general suffice. Simple suppositories were formerly much in use, and jjerhaps they have been too much laid aside. When distress, however, arises from distension or flatulency under retention of the meconium, some aperient is needed, and, for certainty of effect, castor-oil is perhaps most to be relied on. With resjiect to the general management of the bowels of infants, the principle is that they should be kept free, and by the mildest and least iiritating means. Tins is all that
    digitised image 1
    digitised image 2
    digitised image 3