Practical observations on the diseases most fatal to children; with reference to the propriety of treating them as proceeding from irritation and not from inflammation

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PRACTICAL OBSERVATIONS

DISEASES MOST FATAL TO CHILDREN

WITH REFERENCE TO

THE PROPRIETY OF TREATING THEM

PROCEEDING FROM IRRITATION,

NOT FROM INFLAMMATION.

BY P. HOOD,

CIENERAL PRACTITIONER IN MEDICINE AND SURGERY.

MDCCCXLV.

LONDON : 'i. J. PALMER, PRINTER, SAVOY STREET, STRAND.

TO HIS FRIEND, B. 11. PENNINGTON, ESQ.,

A MEDICAL PRACTITIONER

NO LESS

EMINENT IN HIS PROFESSIONAL

THAN

ESTIMABLE IN HIS PRIVATE CHARACTER,

THIS WORK

IS, WITH SENTIMENTS OF SINCERE REGARD, INSCRIBED BY

THE AUTHOR.

Preface

The chief object of this work is to call the attention not only of medical men, but of all persons who may be interested in the matter, to the investigation of the mode of treatment which may be most appropriate in the more serious diseases of children. The treatment generally adopted in most of those diseases, when they are severe, and more especially in such of them as affect the organs of respiration, is founded on the opinion that they either proceed from, or resolve themselves into, inflammation ; and that this so-called inflammation, if not promptly checked by bleeding and the administration of active antiphlogistic medicines, speedily causes death.

Now, without entering here into any pathological discussion respecting the symptoms and con-

a 3

PREFACE.

sequences of inflammation, but supposing that it exists, or is to be apprehended, in the diseases referred to, it may yet be confidently affirmed, on evidence furnished by the Reports of the Registrar- General, that the mode of treatment above men tioned is improper. If, in answer to tins, it be asserted that the great mortality of children, as shown in those Reports, is the result of a law of nature, which declares that, out of a given number born, so very many must die in early childhood, the question then is, of what use is " the Doctor ?" Does he assist nature in carrying out the law, or has he any power to suspend it ? Is he called in to remedy " medicable ills," or to lull with delusive hope the anxiety of the parents, till death steps in and reveals the distressing truth ? This so-called law of nature, however, will, on examination, be found to be nothing more than an ex-postfacto gloss, interpolated by a commentator, who has erroneously inferred the operation of a general principle from a partial result. The " law" has many exceptions, — valet nee ubique nee semper. — it varies according to times, and seasons, and localities, and circumstances ; and many of those, whom nature is supposed to doom to an early death, may be saved by a right interpretation of her authentic laws relating to health and disease.

But to come to facts, as recorded in figures, by the Registrar-General of Births, Deaths, and Mar-

PREFACE. vii

riages, in his Eeport for 1841. Here the very great mortality in children is ascertained hy the simple process of counting, which leaves no room for doubt, and supersedes the necessity for estimating or guessing: " Men guess before they learn to count," says Dr. Johnson, " and they usually guess wrong." Between the 1st of July, 1840, and the 30th of June, 1841, the number of Births registered in England and Wales were, males, 257,129 ; Females, 244,460; total, 501,589. In the same year the deaths, of all ages, were, males, 177,926 ; females, 172,175; total, 850,101. Of this number, 76,328 were children, of both sexes, under one year; and 65,419 children between one and five years old, making together 141,747, which is at the rate of rather more than forty out of every hundred deaths. The comparative mortality at different periods from birth till the age of five will appear from the following statement.

DEATHS.

Age. Males. Females. Total.

PREFACE.

Age. Males.

Females.

Total.

1 Year and under 2 ... 15,304 .

.. 14,538 ..

.. 29,842

.. 7,827 ..

,. 15,952

. 5,737 ..

. 11,403

. 4,093 ..

. 8,222

The much greater mortality of males than females under a month old, as shown in the ahove tables, is remarkable. After the first year, the deaths of males and females become more proportionate to the relative number of each sex. Between the 15th and 25th years, the mortality is greater in females, as will be seen in the following table, which is here given for the purpose of calling the attention of medical men to this fact.

Age. Males. Females. Total.

The following table, transcribed from an abstract of the causes of death registered in 1839, will serve to show the mortality in some of the diseases most fatal to children.

PREFACE.

Diseases.

Males.

Females.

Total.

Small-pox . . .

4,824 .

■ .. 4,307 ..

. . 9,131

Measles . . . .

5,536 .

. . 5,401 . .

• 10,937

Scarlatina . .

5,095 .

.. 5,230 ..

. 10,325

3,683 .

. . 4,482 . .

. 8,165

2,223 .

.. 1,969 ..

. 4,192

Hydrocephalus

4,313 .

. . 3,436 . .

. 7,749

Convulsions . .

14,245 .

.. 11,163 ..

. 25,408

Pneumonia . .

10,000 .

.. 8,151 ..

. 18,151

Teething . . ; .

2,614 .

. . 2,402' . .

. 5,016

IX

In the Appendix to the Report of 1841, it is observed that the ' diseases incidental to childhood are twice as fatal in the town districts as they axe in the country," and in illustration of this the following comparative table is given.

Disease.

Hydrocephalus, Cephalitis Convulsions, Teething . .

Pneumonia

Small-pox, Measles, Scarlatina, Hooping-cough, Croup .

Deaths in 1,000,000 persons living in the

Country. Towns.

419 1,071

942 2,586

905 2,028

1,999 4,014

In a paper on the Pressure and Progress of the Causes of Mortality, by Mr. E. Chadwick, printed in the Journal of the Statistical Society, vol. vii., 1844, the following proportion of deaths in each class, is given from the District Returns of the Metropolis, 1839.

X

PREFACE.

Adults.

Under 10.

Ratio of Deaths of Children to Total Deaths.

Gentlemen 1,724 .

Tradesmen 3,979 . .

3,703 . .

Labourers . 12,045 . .

13,885 ..

1 in 1 T V

Paupers . . 3,u62 . .

Undescribed 2,996 .

. 2,761 ..

With reference to the different ratio of the deaths of children to those of adults perceived in the different classes, Mr. Chadwick observes : " It has been shown in the Sanatory Keport that in the same districts where one-fourth of the children of the gentry died, more than one-half of the children of the working classes have died ; and this excess of deaths among the poorer classes was traced to preventible causes."

From the following table, it appears that the difference of temperature, in the different seasons, has considerable influence in some diseases ; and that in others it has had but little effect. Of diseases of the epidemic class, it has been observed that influenza and hooping-cough followed the same law as the pulmonary : cholera, dysentery,

* It must not be inferred from this item that the mortality of children of " paupers" is less than that of the children of the other classes. The naked fact, as it stands here, may be taken as evidence that in the class of paupers there is not so large a proportion of young children as in the others. Comparatively few children are born of parents in a state of legal pauperism. Women are not prolific in union workhouses. — P. H.

PREFACE. XI

diarrhoea, and thrush, the same as the abdominal affections.

Causes of death.

Winter.

Spring.

Summer.

Autumn

Hooping-cough .

.. 1674 .

.. 1208 .,

. 644 ..

• 787

Thrush ... .

.. 156 .

.. 166 .

.. 339 ..

. 145

Pneumonia ...

.. 3326 .

.. 2454 .

.. 1827 ••

. 3600

Hydrocephalus .

.. 1370 .

.. 1330 .

.. 1348 ..

. 1231

Convulsions

.. 2414 .

.. 2298 .

.. 2532 ..

. 2119

Consumption

.. 5600 .

.. 5778 .

.. 5501 ..

. 5748

Scrofula ... .

.. 72 .

.. 64 .

.. 72 ..

Cancer

.. 276 .

.. 230 .

.. 264 ..

. 262

The preceding statistic details, — which scarcely differ in their proportionate results from those furnished by subsequent reports, — afford not only precise information respecting the great mortality of children, but also display its comparative amount in the diseases to which they are more peculiarly liable. Frorn one of the tables we learn that the mortality occasioned by many of those diseases is twice as great in the town as it is in the country districts ; and from another, furnished by the District Eeturns of the Metropolis, we learn that the mortality of children is proportionably greater in the class of labourers than in the class of tradesmen ; and greater in the latter than in the class of gentlemen. It is thus evident; from the excess of deaths in the children of the poorer classes, that the diseases which are most fatal to children generally, have not in themselves, — that is, when considered, nosologically, as something distinct

Xll PREFACE.

from the living subjects, the patients, in which they subsist — a character essentially mortal ; but that their life-destroying energy is owing, in a considerable degree, to circumstances over which man has control.

Among the principal " preventible causes," either inducing disease, or lending power to its malignity, are, impure air, unwholesome or insufficient food, want of proper clothing, too great fatigue, or too little exercise. Any of these, by disturbing the functions of respiration, or of nutrition, either directly or indirectly, may occasion debility in the system, and thus render it less able to resist or sustain the attacks of specific disease. The remedy in those circumstances, before specific disease has manifested itself, is obvious; and may be safely applied by any one who possesses the means, without the necessity of consulting a physician.

The great irritation which usually accompanies teething, and the derangement of the stomach which frequently results from the change of diet at the time of weaning, may be regarded as the two grand internal agents or promoters of disease in infants. When specific disease manifests itself during the prevalence of either of those states, and more especially when they are combined, as is frequently the case, all the symptoms are aggravated. From certain peculiarities in the structure and constitution of young children, such as the preface.. xiii

small size of the chest, the imperfect development of the lungs, and the rapidity of the circulation, the organs of respiration appear to be extremely liable to derangement of function, either in consequence of derangement in other vital functions quickening the circulation, or from external causes directly affecting them, such as cold, or damp air, noxious exhalations, &c. When those organs appear much oppressed, when the breathing is hurried and the pulse rapid, it is but too frequently concluded that either inflammation already exists, or that it will speedily set in. Antiquated authority prescribes what is to be done in these cases : a vigorous attack is to be made uj)on the phantom inflammation, as if it were something real, and independent of the living being in which it subsists ; bleeding, leeching, and active lowering medicines are directed against the disease, and whether they hit or not, the already enfeebled patient is sure to feel their effects : " S'ils n'emportent pas le mal, ils emportent au moins le malade," as Dr. James Gregory, in a letter subsequently quoted, observes of the " abominable remedies" sometimes administered in the hooping-cough.

The mode of treatment developed in the following pages is founded on the principle that the diseases of children, and of adults also, proceed from irritation, considered in a general sense, as distinct from inflammation, and indicating an opposite

b

XIV TREFACE.

course of treatment. Having so frequently witnessed the beneficial effects of this mode of treatment, not only in the diseases of children expressly mentioned in the following pages, hut in others also, whether occurring in children or adults, I have ventured to publish the present work, with, the view of calling the attention of both medical practitioners and parents more expressly to the subject. It would have been easy to have enlarged the book by the insertion of numerous cases, of persons of all ages, successfully treated on the principle advocated ; but my object is to direct attention to the principle, and treatment dependent on it, and not to advertise my own practice.

In concluding this preface, however, I will briefly relate two cases of puerperal fever, which are strikingly illustrative of the different results of the two different modes of treatment as applied to the cure of the same disease. A lady, aged thirty, of healthy constitution, was seized, three days after being put to bed, with a violent pain over the abdomen, which became swelled and tense. She was feverish, thirsty, and restless. Her medical attendant, impressed with the idea of inflammation, bled her ; and for a short time the violence of the symptoms appeared to abate. At the end of twelve hours, however, she became worse, and the alarming symptoms returned. Her medical attendant now called in a surgeon of great repute, who coin- 5

PREFACE. XV

cided in the propriety of what had been done, and recommended a further abstraction of blood, and the administration of active purgatives. She was accordingly leeched and purged ; and died on the third day from the first attack of the malady. The body was opened by the desire of the husband, who thought his wife had not been properly treated, and, at his request, I attended the examination. The external appearances were extreme pallor of the face, and blueness about the mouth ; the body looked bloodless, and like that of a person who had died of cholera. Upon opening the abdomen and puncturing Jhe intestines, large quantities of gas escaped : the intestines, which were enormously distended, appeared pale and bloodless. The uterus was uncontracted, and contained a small quantity of dark-coloured grumous blood.

A lady, aged thirty-four, remarkable for her excellent health, and her quick recovery after child-birth, was seized, on the evening of the third day of her confinement, in precisely the same manner as the lady whose case has just been given. I was called in next morning, — she had not previously had any medical aid, — and I found her much exhausted, restless, and in great pain. I immediately ordered hot bran to be applied to the abdomen, which was extremely painful, and as greatly distended as before she was put to bed. I gave her the following medicine.

XVI PREFACE.

B. Hydrarg. submuriat gr. ij.

Extract, hyoscyami gr. iij.

colocynth. c. gr. v.

Olei carui gutt. i. — Fiant pilulse dure. To be taken directly, — and the following draught in four hours time :

R. Iufusi senna? comp. 3i*' Tincturae ejusdem 5ij- Mannse opt. 5ij- Magnesiae sulphatis 5ij- Tinct. zingiber. 3j. — -Fiat haustus.

This medicine operated favourably, and afforded relief. — She now took one of the following draughts every four hours.

$>. Liquor, ammon. acetatis 3iij. Tinct. opii. inxv.

Spirit, myristicse 3j.

aether, nitrici 3ss.

Aq. mentha? pulegii gj. — Fiat haustus.

These draughts had the effect of producing sleep ; and next morning she said she felt greatly relieved. She looked much more composed, but was extremely languid. As I considered that the bowels were not sufficiently evacuated by the medicine which I had given, and as I thought it improper to repeat it in the state she was in, — more especially as the stomach appeared to be irritated, — I ordered an enema composed as follows. R. Confect. ruta3 3iij. ; Decoct, avense Jxvj. — Fiat enema.

PEEFACE. xvii

The operation of this was favourable, and was attended with a great discharge of wind. The abatement of pain in the abdomen, and the subsidence of the swelling, were from this time distinctly marked. She continued to take the draughts for four days, and at the end of that time she no longer required medical attendance. She continued weak for a longer period than was usual with her on the occasion of her confinement, but suffered no subsequent inconvenience in consequence of the disease. The attack, I have reason to believe, originated in a. disordered stomach, caused by some improper food given by the nurse.

P. H.

Chapter I. Inflammation

The theory of Inflammation, and the belief in its frequent occurrence in the diseases of infants, have taken deep root in the minds of many practitioners, and have naturally influenced the treatment which they employ for subduing many of the severe complaints to which children are subject. Thus antiphlogistic remedies, comprising blood-letting, general and local, calomel, drastic purges, &c, have been looked upon as the " sheet anchor" of successful practice. It has also been asserted that " the inflammatory affections of children are very common ;" and " that children bear blood-letting better than adults." These dogmas have extensively prevailed, and most fatal have been the results of the confidence reposed in them.

B

Theory, however erroneous, is harmless when confined within the boundaries of abstract science ; but as soon as it passes those limits and assumes to direct a practice, without experience, and without regard to facts and consequences, it becomes a positive evil ; and more particularly so in the practice of medicine, where the fallacy of a theory is demonstrated by the death of those on whom it is tested.

The following is the definition of inflammation given in Dr. Copland's Dictionary of Practical Medicine. " Alteration of the vital actions of a part, manifested by morbid sensibility or pain, by redness, increased temperature, and swelling, generally with more or less febrile commotion of the system."

That these symptoms of inflammation are constantly found to occur in the adult is certain ; and that they render the diagnosis of the disease comparatively easy, and thus impart decision in the treatment of it, there can be no question ; but there are the strongest possible grounds for doubting that a mere knowledge of these symptoms only is of much service in detecting an analogous state in the infant.