CHAP. I.
Of the DIET and REGIMEN of the Puerperial or Child-Bed-Woman.
THE Good Woman being now delivered, and laid in Child-Bed, may rightly be compared to a Ship, which, after a dangerous nine or ten Months Voyage, rides at Anchor in her Port; where, tho’ arriv’d with great Security, yet if not well moor’d against sudden Winds and Storms, she may perhaps at last drive from her Anchors and suffer Shipwreck: So in like manner if both the Mother and the Child be not duly taken Care of after the BIRTH, Both may be still expos’d to the Danger of DEATH. Wherefore, to prevent all such melancholy Accidents, I shall first point out the proper REGIMEN of the One, and then successively direct That of the Other, in the following Manner; viz.——
I. THEN, immediately after the BIRTH, a soft gentle Closure may be apply’d to the Womb for repelling of the cold Air; of which we must be now very cautious, if we will avert the fatal Consequences that may thereby happen: As also a small Plaister of Galbanum with a little Civet in its Center, may be applied to the NAVEL for attracting, or rather retaining the Womb in its proper Place, where the MIDWIFE’s careful Hand has fixed it after the DELIVERY.
II. THE Patient having her Body wrap’d about with a warm Cloth, and her Hips girt round with the same, is to be placed conveniently in a warm Bed; that is, directly upon her Back-Bone, with her Head and Body a little elevated, for her breathing and cleansing the Better; as her Thighs and Legs also are to be stretched down close together: Whereupon now, if not before, she ought to have a little good Chicken or Pullet-Broth for her Refreshment; which being done, all Doors and Windows are to be shut, and the Bed-Curtains drawn close, that she may rest and sleep quietly.
III. IN the next place, the Closures are to be remov’d, and the clotted Blood taken away; which being diligently done, the BELLY, LOINS, and PRIVITIES are to be anointed with the Oil of sweet Almonds, or white Lillies, mixed with a little warm Wine, which may be repeated at pleasure, for allaying the PAINS of these Parts: And as the Woman is to be carefully kept always very warm, as well as disposed to Rest and Sleep; so every now and then, she is to be comforted with some small Matter of any convenient Food; abstaining however chiefly from strong Meats, as well as from all hot or strong Liquors.
IV. A Decoction of Barley, Linseed, and Chervil, or Marsh-Mallows and Violet-Leaves, with a little Honey of Roses, may be afterwards used Milk-warm three or four times a Day, by way of Fomentation for the first five or six Days of CHILD-BED: Or, instead of these Things, fresh warm Milk, or Barley-Water only may be properly used; always remembring that the Parts be duly cleansed from the clotted Blood, &c.
V. IN the mean time, the Woman’s Breasts are all along to be kept very close and warm-cover’d with soft Cloaths, that the MILK may not curdle; which however is no ways yet in the beginning fit for the CHILD’s Nourishment, until the Conflux of the MILK and the Humours is over; which, upon the first days after DELIVERY, run in abundance to the Breasts.
VI. SPECIAL Care also must be taken, when the Woman is resolv’d not to Nurse the CHILD herself, that the Lochia or Child-Bed-Evacuations flow-off plentifully, in order that thereby the Shock of the BLOOD may be averted from the BREASTS; which if not sufficient to prevent that Inconveniency, they may be properly anointed with the Oil of ROSES and a little Vinegar beat-up together; or a CATAPLASM of the Meal of Beans and Vetches mixed with Oxymel may be applied to the BREASTS; or they may be fomented with a Decoction of the Leaves of Mint, Dill, or Parsley.
VII. IN the time of Cleansing, all Noise and Clamour about the Woman ought to be suppressed; and as she herself ought not to talk much, or aloud, neither ought any Person about her to be obstreperous: Because her Repose is not only thereby disturb’d, but also her Spirits exagitated; which violent Commotion of Humours may readily stop the natural Course. And as for the same Reason, all Passions of the Mind are to be suppressed; so the Woman is to keep herself as much as she conveniently can upon her Back, carefully avoiding frequent TURNINGS to either Side.
VIII. AFTER ten or twelve Days, proper Measures may be taken to fortify and strengthen the Members; and after she has fully done cleansing (which may be about the 20th Day, sooner or later after DELIVERY, according to the Patient’s Constitution, or her way of Living) some proper Astringent Medicines may be discreetly made use of, for corroborating and reconsolidating the Parts.
IX. AS to her DIET, during this Time, she ought to be very regular, and live abstemiously (especially the first Days) as if she had a Fever, using only good Broths, Jellies, fresh-laid Eggs, Ale-soup made with fresh Butter, or the like; after which, she may begin by degrees to eat a little Chicken, Pullet, Capon, Veal, Mutton, or any thing else of good Nutrition and easy Concoction.
AS to her DRINK, if she has no Fever, she may use besides her Cawdles, small White-Wine and Water for Variety’s sake; but in case of a Fever, Water boil’d with a little Cinnamon, or Coriander-Seed; or a Ptisan of Liquorish, Figs, and Aniseeds boil’d in Water; or small Ale a little butter’d, as the Woman pleases, are far more convenient; observing always carefully that her DRINK, of whatsoever sort, be at all times a little warmed.
X. FINALLY, as the Child-Bed-Woman’s Body is always to be kept open, if not otherways naturally so, by a proper gentle CLYSTER, repeated as often as Necessity requires, until the Course of the Lochia is quite over; so afterwards she ought to take one or more proper gentle Purges, for cleansing the Stomach and the Bowels of such vitious Humours, as Nature could not otherways evacuate: Upon which, a repeated Strengthening BATH may be most pertinently used, as also, in order that she may again the more successfully begin upon a new Score, other proper Measures may be prudently taken.
THUS we suppose that all things have succeeded well with our Puerperial Woman; in which Condition the above-mention’d is her only requisite REGIMEN: But in Case of any Preternatural Accident, we must come to her Assistance, according as the Nature of Circumstances does require: Of all which in their Order, as they most commonly happen to the Woman in her present Condition; and FIRST——
THESE Pains, which usually accompany or follow after the BIRTH, are common to all Child-Bed-Women; and in that Natural Sense, as they proceed only from the quantity of BLOOD abounding in the relaxed Womb, distending its MEMBRANES, or arise from its Acrimony; so they gradually cease, and in two or three days quite vanish: Wherefore I am not to insist upon Those, which only affect the debilitated Womb.
BUT it often and too commonly also happens, that another Sort, justly call’d Preternatural AFTER-PAINS, afflict the Woman; which she sometimes feels about her Loins and her Groins, sometimes about the Navel, sometimes all over the Belly, and sometimes in the Womb only, and that sometimes with a little, and sometimes without any Intermission.
THE most common Cause of which PAINS is generally one of the Five following; Viz. 1. The External AIR, especially the more frigid, which easily penetrates into the Womb, if not carefully prevented: 2. Clotted BLOOD, or some other foreign Body left behind in the Womb: 3. Some Acrid, and Mordacious Blood adhering to the Womb, which excites and stimulates Excretion: 4. The SERUM vellicating or twitching the excoriated part of the Womb: Or, 5. WINDS elevated from the Humours fermenting in its Substance; which, together with those turgent Humours, tear its tender TUNICKS.
NOW because these Pains often excruciate the Woman as much as the real Labour-Pains do, and since they are not always without Danger, Necessity demands that they should be either cured, or at least mitigated: Which may be most properly done, by convenient relaxing and attenuating Medicines outwardly applied, as well as inwardly taken, when the Case does not require the Hand-Cure, or manual Operation.
HOWEVER, yet more particularly, in respect of the Pains, from what Cause soever they may proceed, CLYSTERS of Milk with the Yolks of Eggs are proper; as are also emollient Fomentations mix’d with attenuating and Uterine Medicines; a Fumigation of BRANDY; a Decoction of the Recrements of the Regulus of Antimony; such things being of a sulphurous Nature: And moreover, in fine, all AFTER-PAINS are eased by Aromatick and Carminative Remedies; such as Seeds of Anise, Carway, Cummin, Fennel, Penny-Royal, Roman-Camomil, &c. infus’d or boil’d in Wine or Water, adding thereto a very little Mace and Saffron.
THE LOCHIA are nothing else, but the ignobler part of the Blood and congested Humours, which after the BIRTH Nature evacuates and discharges out of the Uterine Vessels, in consequence of the Divulsion and Separation of the Placenta from the Womb. Which LOCHIA however differ always according to the Constitution and Disposition of the Woman, and that not only in Quantity, but also in Quality: For if the PATIENT be otherways Healthy, and Well-disposed, these are at first of a florid rosy Colour, degenerating day by day into a Pale-dye; Whereas if otherways, they are sometimes Aqueous, and sometimes Bilous, Melancholick, &c. And, according also to the usual Habit of Body, and Way of Living, some Women flood more plentifully, others more sparingly; some a longer, and others a shorter Time: as for Instance——
A Woman given to Ease, and high Living, being delivered of a Male, may cleanse from twenty to thirty Days; and if of a Female, from thirty to forty-two Days at most, however still declining in Quantity from Day to Day: Whereas another given to Exercise, may flood only from eight to fifteen Days; and that also perhaps more sparingly, or by Intervals of one or two Days. But it oftentimes happens, that this Evacuation is either suppressed in Whole, or in Part; of which Suppression or Preternatural Retention, I am now about to speak.——
FIRST then, the Cause of this Evil, proceeds either from an Obstruction of the Uterine Vessels, occasion’d by thick BLOOD stopping the Passages: Or, Secondly, from a Constriction or Compression of the same Vessels, occasioned by an oblique Situation of the Womb, or by cold Air, cold Drink, or the like, which readily constrict their Orifices, as well as contract the Womb itself: Or, Thirdly and lastly, the Cause may proceed from the BLOOD’s being retracted and converted to some other Part of the Body; which is most commonly occasion’d by some Passion or Perturbation of Mind, that may not only turn the Shock of the BLOOD to the Breasts, but also retard the Motion, and thicken the Mass of the same BLOOD.
THE DIAGNOSTICKS however of this Distemper are manifest; for either no BLOOD is voided at all, or too small a Quantity, in respect to the Size, Temperament, and Constitution of the PATIENT: But besides, it may be also known by the following Symptoms; viz. a SWELLING of the BELLY, upon the Retention of the Humours that ought to be evacuated; a Difficulty of Breathing arises; Pains seize the Abdomen, as also the Loins and the Groins; a Fever and Tremblings follow; as Faintings do upon a weak, quick and unequal Pulse; something fuliginous appears in the Urine; and a livid, black, grumous, or nauseous Matter is excreted.
HENCE proceed various PROGNOSTICKS; viz. Fevers, Spitting or Vomiting of Blood, Melancholy, Inflammations of the Liver, Quincy, Pleurisy, Frenzy, Dropsy, Apoplexy, and Madness itself: The least of which may prove of fatal Consequence, wherefore Delays in this Condition are most dangerous; because when any of these heavy Symptoms has befallen the Woman, there is scarce any Hope left for her Recovery; whereas before, they may be artfully prevented, and the Cure duly perfected by convenient DIET, VenÆsections, Revulsive Medicines, &c.
BUT more particularly the Cure ought to vary, according to the difference of the co-incident Symptoms: For since continual Fevers and Inflammatory Diseases most commonly follow upon this Suppression or Diminution of the Lochia, we must take great Care that, endeavouring to promote the FLUX, and to open the Uterine Vessels, we do not augment the FEVER and Inflammation; which will certainly happen, (if without distinction) we use the hot Medicines prescribed by many Authors.
WHEREFORE in this Case repeated VenÆsections sometimes in the Ancle, and sometimes in the Arm; and cupping Glasses applied to the Thighs and Shins; as also Rubbing of the Legs and Thighs well, are generally sufficient Remedies; especially if followed with one or more Cleansing, or partly opening, partly cooling, and Emollient CLYSTERS, of a Decoction of Mallows, Pellitory, or the like; in which strain’d Liquor, the Pulp of CASSIA with a Dram of Nitre, and Sugar, and Honey may be dissolved: As also Fomentations and Fumigations of Emollient and Aperient Medicines that are not sharp, may be very pertinently used. Finally, the Infusion of Jesuits-Bark in Water, may be properly given three or four Times a day; and purging PTISANS, after the first days, are of good Service in the present Case.
THE too copious and long lasting, or immoderate Flux of the Child-Bed Purgations, is no less Preternatural, than the former Case of their being altogether suppressed, or in part diminished. Tho’ it is however to be observ’d, that there can be no certain Quantity of flowing Blood, nor any certain Time of Duration of this Flux prefix’d or determined to the Puerperial Woman, as aforesaid: Wherefore the Excess of this Evacuation is best known by the Loss of Strength, sinking of the Spirits, and the great Uneasiness of the Patient.
THE Cause of this Distemper is, either 1st, a too great Plenty of the abounding Blood; or 2dly, its Tenuity and Acrimony stimulating Nature to Excretion; or 3dly, too great an Apertion of the Uterine Vessels; or 4thly and lastly, a violent Extraction of the AFTER-BIRTH: For the Flux of the LOCHIA proceeding meerly from the Separation of the Placenta from the Womb, the more strong and violent this Separation or Divulsion is, the more the Vessels in the Concave Part of the Womb are torn or dilacerated; and so being either too much opened, or too difficult to reconsolidate, they discharge Blood immoderately.
HENCE, I say, this immoderate FLOODING, is not only known by the great Quantities of BLOOD voided, by its Continuance, or by coming away in Clods, and much at a time; but also by the Loss of Strength, and a Defect of SPIRITS; upon which follows a low, debilitated and frequent PULSE; Loathing of VICTUALS; PAINS in the Hypochondriacks, with a Twisting of the GUTS, and Griping of the BELLY; a Dimness of SIGHT; a Hissing of the EARS; and at last Swoonings or Convulsions, proceeding from the Depauperation of the BLOOD: Which after an immoderate FLUX always disorders the SPIRITS, because when the Mass of it is much lessened, it cannot keep its due Mixture and Disposition.
IN this Case the true Prognostick is, that, if all immoderate HÆmorrhagies are dangerous; because by them, the Treasure of LIFE (the natural Heat) is exhausted: Then, without Controversy, the immoderate Flux of the Lochia, whether after Labour, or after a MISCARRIAGE, is full of Danger; as coming upon the PATIENT at a most unseasonable time, when her Strength is already spent.
THE Cure of this Distemper ought to be well-weigh’d, and very cautiously perform’d, because the definite Quantity of BLOOD to be evacuated cannot be well or certainly known: And because if any Part of That be stopped, which ought to be ejected, it of course flows to some other Part, and excites Inflammations or other heavy SYMPTOMS. Wherefore this is only, in the Beginning, to be corrected by proper DIET, and some other convenient light Means: But afterwards by repeated VenÆ-Sections in the Arms, if Strength will permit; and proper Astringents inwardly taken, as well as outwardly applied; continuing always a Thickening, Cooling, and Astringent DIET: But farther yet, as the Patient grows weaker, she ought also to have some corroborative Remedies, to enable her to stand out the Cure. Fomentations for the lower Belly of Oxycrat, or an astringent Decoction; Fumigations of the same Decoction, or of hot Oxycrat, are very convenient and helpful on this Occasion, as are also astringent Injections.
BUT however sometimes, and not seldom, it happens, that this Case proceeds from the negligent or ignorant MIDWIFE, by her not duly cleansing the Womb; by which Means, some part (how small soever) of the SECUNDINE or Membrane, or some clotted BLOOD, or perhaps a MOLE, miscall’d a false Conception, may be left behind in the Womb; which distending that Body, occasions not only an immoderate Flux, but also stirs up violent Pains, not unlike to those of Labour: In this pitiful Condition, all possible Diligence must be prudently used to fetch away and remove this Cause, which is only most effectually to be done by the Hand-Cure, in the manner already abundantly set forth.
AFTER which, the PATIENT is to be treated as before, laying her equally flat upon her Back, and keeping her very still and quiet in Bed; which Bed may however in this Case be kept a little Cool, as well as her Chamber, lest Heat should provoke and continue the Course of the Flux.
MOREOVER, in fine, it also sometimes happens, that immoderate Purgations proceed from some gross Excrements contain’d in the Rectum antecedent to the Time of Labour; which, as they puff up the Belly, so they also commonly occasion severe Cholicks; but these being discreetly evacuated by a pretty strong emollient Clyster, the Flooding immediately ceases.
WE are in this place only to consider the Acute Distempers of the Puerperial Woman, because the Time of lying-in is not of such a long Continuance as to admit of Chronick Diseases: And these Acute Ones, in short, which they are most commonly subject to, are continual Fevers, (Either, 1. Essential, that is, Fevers proceeding first from the Blood; or, 2. Symptomatick Fevers, that is, such as follow upon the internal Inflammations, which often attend the Child-Bed-Woman;) as also Frenzies, Watchings, Lethargies, Convulsions, Epilepsies, &c.—
BUT more especially there is one particular kind of Fever, which invades almost all labouring Women the third or fourth Day after the BIRTH, and is commonly call’d the MILK-FEVER; because about that time, the MILK begins to generate more plentifully in the Breasts, taking its Rise from the Motion and Agitation of the Blood, which converts it from the Womb to the Breasts. This Distemper, resolving itself about the ninth Day by Sweat, is of no dangerous Consequence; provided the PATIENT observes a good and proper Diet, and duly prevents all Cold, that might readily stop the Sweat, and carefully preserves the Milk from coagulating or putrefying in her Breasts, whence the Symptomatick FEVERS commonly arise: Wherefore, I say, this MILK-FEVER, being of the extended Ephemerick Sort, and ceasing of itself, requires no great Cure.
ONLY in this Case, it is a vulgar Error among the good Women, that because this FEVER lasts only four or five Days at most, coming on about the fourth, and ending about the ninth Day after the BIRTH, they take all Fevers in this time, for the MILK-FEVER; and consequently thro’ this Mistake, neglecting, or not regarding duly the true Condition, the Patient is very often endanger’d: Which Mistake, that they may for the future diligently avoid, I shall subjoin here some certain Signs of Distinction in due Course. But previously——
THE Causes of all FEVERS incident to the Child-Bed-Woman, are either the Suppression of the Lochia in whole or in part; or the vitious Quality of the Humours accumulated in Gestation, and exasperated in the Birth; or a vitious irregular DIET in the time of lying-in; or the cold Air, or any such Accident by bad Management, may readily convert the MILK-FEVER into a putrid and dangerous one; as a latent CACOCHYMY may also easily dispose it to Corruption.
THE true DIAGNOSTICKS, in my Opinion, are as follow, viz. First, the MILK-FEVER is known from hence, that it always begins about the Fourth Day, when the BREASTS begin to fill with MILK; and then the LOCHIA flowing regularly, the Woman finds a certain Gravity or Weight in her Back and Shoulders.
BUT, Secondly, when the LOCHIA are suppressed, whether in whole, or in part, ’tis then certain that the present FEVER proceeds from thence; the BELLY thereby swells and is puffed up, as also it is pained when touched; and the Humours, at last, putrefying in the WOMB, it ejects a certain foetid or corrupt Matter.
WHEREAS, Thirdly, if the FEVER neither proceeds from the MILK, nor from any Irregularity of the LOCHIA, why then it must necessarily either proceed from the vitious Quality and Preparation of the Humours; or from a Cacochymical Habit of Body; or from an irregular Way of Living in time of GESTATION.
THE most certain PROGNOSTICKS are as follow, viz. First, All Acute Diseases in Child-bed Women, whose Strength is impaired by their LABOUR, are much more dangerous than in any Others. Secondly, These which proceed from the Suppression of the LOCHIA are most dangerous; because the Humours putrefying in the WOMB, occasion most severe SYMPTOMS, yea and too commonly DEATH itself, unless a lucky DiarrhÆa, or a timely Ejection of the corrupted Matter, prevents the Misfortune. Thirdly, The self-same is the unfortunate Consequence, when the Distemper proceeds from the vitious HUMOURS; for Nature then not being able to expurgate their abounding Superfluity by the LOCHIA, the PATIENT must needs be greatly endanger’d, if not overwhelm’d.
THE most adviseable Cure, First, as to the MILK-FEVER, is only to be committed to Nature, the Woman using always a proper DIET, and carefully animadverting, that the SWEAT, in which it commonly terminates, be no ways checked, impeded, or obstructed.
SECONDLY, As to the Watchings, Deliria’s, Epilepsies, &c. which the PATIENT is subject to in this Condition; as they proceed only from Vapours of the BLOOD and Humours, ascending to the Head, when the LOCHIA do not flow regularly, or when the Woman is Feverish: So the Cure of these distemper’d Cases depends (at first) chiefly upon retracting the HUMOURS from the Head to the inferiour Parts, and correcting the Course of the LOCHIA: Because, if these flow orderly, and the vitious Humours, from which such depraved Vapours as affect the Head, be removed and evacuated, all such SYMPTOMS quickly cease and vanish of their own Accord.
THIRDLY, in the other above-mentioned Cases, the PATIENT ought always to be treated according to the various Circumstances of her Condition; I mean, according to the attending SYMPTOMS, conformable also to which the ingenious Physician will always judiciously take his prudent Measures: Since the Cure does not always depend upon the same Method; especially when a symptomatick, or concomitant FEVER, joins the first, as it very often happens, by an Inflammation of some particular Part, proceeding from something of the vitious HUMOURS enforcing itself upon the same very Part.
NOW, in short, tho’ such Inflammations may affect any Part of the Body, yet (I think) the most common Case is, that which affects the PLEURA; and from hence (the Pleurisy joining the FEVER) the Woman labours under both these complicated Acute Diseases at once. The Cure of which difficult and dangerous Condition belongs only to the ablest Physician, to whom I should be justly censured, in impertinently offering any Instruction upon this Subject. Finally, in a word, from what has been said in the Chapter of the Acute Diseases of Women with CHILD[181], we may more fully gather what is to be prudently done to Women in CHILD-BED, afflicted with the like Distempers.
FIRST then, Because these accidental Distempers are very many and numerous, as well as various and different in Kind: SECONDLY, Because some of them have been already treated, or occasionally discoursed upon at large: And, THIRDLY, because others are only to be named in this Place; I shall take leave to include and comprehend them all, for Brevity’s sake, in this present Chapter.
IN order to which, I may first observe, that most (if not All) of these unfortunate Accidents, depend entirely upon the indiscreet Conduct of the MIDWIFE in time of LABOUR, or the ill Management of the Woman after the BIRTH: Since by the prudent and judicious Means of the expert MIDWIFE, many Accidents may be prevented, which otherways must necessarily happen, especially in difficult or preternatural BIRTHS; as also, on the other hand, by treating the Woman orderly, and guiding her carefully, many Distempers may be totally averted, which otherways will inevitably seize the PATIENT. As for Instance——
IT sometimes happens, that she is troubled with a Prolapse, or bearing down of the WOMB, or Vagina, or Both; as also sometimes with a Falling out of the FUNDAMENT: In all which unhappy Conditions the industrious MIDWIFE will find her Instructions, not only with respect to the Cure, but also with respect to the Prevention (which concerns her most) particularly set down and accounted for in SECT. V. Chap. 10, and 11. as she will also, upon Perusal, find the Method of preventing that deplorable Accident, of making a Rupture in, or renting the PerinÆum, in Chap. 9.
BUT in case of Contusions, or Smaller Rents in the VULVA, or Vagina, which sometimes cannot be well prevented, especially in the First BIRTHS; such are by no means to be neglected, lest they degenerate into malignant ULCERS: Wherefore they ought to be cured, as soon as possible, after the Woman’s DELIVERY; which Cure is easily performed, when taken in hand betimes, by proper Fomentations, and convenient CATAPLASMS.
SOMETIMES again, the WOMB, the Belly, and the Feet swell much after the BIRTH; which SYMPTOMS commonly proceed from some Cold, or from drinking too much, or from either a Suppression or Diminution of the LOCHIA, or from any irregular way of Living during the time of GESTATION: By which means the vitious HUMOURS, resolving themselves into Flatulencies, swell and puff up both the WOMB and the ABDOMEN; and these Winds descending, have the same Effect upon the Legs. But the Cure, however, of all such SYMPTOMS, is readily accomplished by convenient DIET, proper Fomentations, and discutient Medicines.
HENCE I might orderly descend to an Indefinity of Particulars, deriving from the following general Heads, which I Shall only name at this time; viz. the various Diseases of the PUDENDUM and Vagina, as well as of the MATRIX itself, together with their co-incident SYMPTOMS; as also the divers Distempers, and different SYMPTOMS of the Woman’s BREASTS. But These Subjects being as different as numerous (which I have already hinted) I must refer them to another Opportunity; being resolved to keep the present Work, for the common Good, within the Purchase of all sorts of People as far as possible; and until such time as something on these Heads appears more judicious or elaborate, either from my own, or some more capable Hand, I hope English Women can be at no great Loss for good Instruction, or ready Assistance; especially not in this famous City of London, which is, by the Divine Mercy, abundantly well-stock’d, and singularly well provided, with some of the most excellent Physicians of the Age, as well as with some very ingenious Practisers in the Art of MIDWIFERY.
AND, thus, in fine, having piloted the good Woman (as it were) thro’ the three Gulphs of GESTATION; BIRTH, and CHILD-BED, and at last brought her into safe Harbour; we may now (I hope) securely leave her there, to refit for the same prosperous Voyage again; whilst we, in the next Place, undertake to provide for the Safety of her CARGO, or direct the Regimen and Nursing of the CHILD. And FIRST—
IF after the Torrents of Difficulties and Oceans of Danger that the Mother has painfully gone through, and narrowly evaded, the Child should at last be lost; the Comfort of her Burden would be but small, and the Reward of her Sufferings but very little: Wherefore special Care ought to be taken to prevent such melancholy Events; in order to which, we are not only to remedy such Indispositions as it (too often) brings with it into the World, but also to defend it from the many periculous Contingencies, to which the Tenderness of its Body, and the Debility of its Age expose it.
THE first Duty then, that the INFANT requires of us after BIRTH, whether born by the Head, or extracted by the Feet, is the tying and cutting of the Umbilical Vein, or NAVEL-STRING; which being a thing generally well known, I shall have no Occasion to insist upon it, especially since tho’ the common Gossips may differ in the Performance, yet they always agree in the Fact.
HOWEVER, that we may not pass this essential Point by in Silence, in case a notable Word may drop by the By, I would,——
I. OBSERVE, that, until the STRING be cut, the Child is to be carefully laid on one Side, not on its Back, for fear that the HUMOURS, running to its Mouth or Nose, may choke it, for want of free Evacuation.
II. I would take notice, that, if need require, while the MIDWIFE is busy about the Mother, in extracting the AFTER-BIRTH, cleansing the WOMB, &c. the most capable of the Gossips should tie and cut the STRING, especially if the INFANT is weak or ill; otherways it may be deferred until the Woman be entirely delivered, and fairly laid. Then,——
III. AS to the Performance of this Matter, it may be tied with a good strong Thread, laid four or five-fold, according to its Strength; and the Knot tied close within two Inches of the CHILD’s Body: Tho’, I say, that the Knot is to be tied close, yet it must not be so strictly tied as to cut asunder the STRING; which might easily happen, especially to the INFANTS of a tenderer Constitution. And the Reason that I would have the Constriction made two Inches from the Body, is this, That in case any Blood should happen to drop out afterwards (as it often happens) there may be room enough to tie it again nearer the NAVEL.
IV. THE STRING is not to be cut off close to the Knot, but also two or three Inches from it; so that, if it happens to swell with Wind (as is very common) after being tied, it may be loosed again, the Wind discharged, and itself conveniently retied. But the far better and preferable way is, to tie this Vein in two Places, and cut it asunder betwixt the Ligatures; being thereby secure from losing Blood. Some (I know) will not have the Vein to be tied before the CHILD cries or makes Water; but, however, long Delays in this Case are no ways convenient, nor without Danger.
V. THIS Vein or String being cut, must be wrapped up in a three or fourfold Rag, to defend the BABE from Cold or Pains of the Belly; which otherways might ensue from the naked Vein’s lying upon its Body: Which being done, this Part of the String is to be laid on the upper Part of the Belly, with a small Boulster on the Top of it; and then swathed with a Linnen Swath of about four Inches broad, to keep it firm and steady.
VI. THE first time that the CHILD is unswathed, a new Knot ought to be made or tied, and that to prevent all Danger by Loss of BLOOD, which may readily happen by the first Knot’s relaxing, as the STRING begins to wither away or contract.
THIS being so duly taken care of, it remains only in general, that the Infant be presently washed, cleansed, and examined all over, and at last orderly swaddled. All which if the MIDWIFE does not perform with her own Hands, she ought at least to see it carefully accomplished: Upon which she may then say, she has faithfully discharged her Duty to both the MOTHER and the CHILD.
VII. BUT more particularly, in the seventh Place, I must take notice, that as soon as the NAVEL-STRING is thus duly handled and provided for, the INFANT is to be tenderly cleansed of the adhering Excrements, and washed all over in a little warm Wine, Milk, or Ale; especially its Head, Arm-Pits, Groins, Cods, or Privities, &c. are to be softly cleansed and gently bathed with a soft Spunge or Rag, dipt in the same Liquors: But if the viscous Matter sticks too fast or close to the tender Body, a little Oil of sweet Almonds, or fresh Butter, may be added to either of the foresaid Liquors. As also the Ears and Nostrils ought to be well cleansed and unstopped with small Tents of fine Rags wet therein; and the Eyes wiped with a soft dry Cloth; as the Mouth, Tongue, and Jaws may be cleans’d by the Finger.
VIII. THESE things being all very carefully and tenderly performed, every Part of the Body ought to be diligently searched, in case of a Dislocation, or any other Accident, happened by Violence in the BIRTH, or otherways; that present Remedies may be used, according to the Nature of the Circumstances: And especially the two Conduits of the URINE and ORDURE are to be examined; since it sometimes falls out that these are not perforated, and consequently that the Meconium cannot be voided, which inevitably proves fatal, unless timely Care be taken.
IX. AS to the URINE, all Children discharge it as soon as born, at least as soon as they feel the Heat of the Fire; when if the Excrements, properly called MECONIUM, tho’ improperly COLLOSTRO by the Italians, do not follow a little after; I mean within an Hour or two; then a small Suppository may be used, such as a sugar’d Almond anointed with a little boiled Honey; or a Piece of Venice-Soap anointed with fresh Butter; as also a little Syrup of Roses or Violets, mixed with the Oil of sweet Almonds by Expression, that is, drawn without Fire, may be given in the Mouth, anointing the Belly with the same Oil, or with fresh Butter; in like manner as a small Clyster (upon occasion) may be discreetly used and managed to purpose.
X. THE INFANT being in these respects provided for, it is now to be duly dressed and swaddled in its Swathing-Cloathes; and beginning with the HEAD, a Compress of a three or fourfold fine Linnen Rag, about four Inches broad, is to be applied to the MOULD, for defending the (yet open) BRAIN from Cold, &c. which Compress is to be carefully covered with, and pinned to the ordinary CAPS made on purpose. Next then, some small soft RAGS are to be laid behind the Ears, upon the Breast, in the Arm-Pits, and the Groins; after which the BABE is to be wrapped softly up in warm Blankets, and discreetly swathed; not too strait, especially not about the Breast and Stomach, that it may breathe the freer, and the better retain the MILK it sucks. The ARMS are to be stretched along the Sides, and the LEGS equally streight, with a little of the Bed betwixt them; and the HEAD is always to be kept steady, as the whole CHILD is to be preserved thus warmly wrapped up, and judiciously appointed. But now because the INFANT is commonly committed to the Nurse’s Care, I shall, in the next Place, enter upon the Description of the proper Person for that purpose.
THO’ the BABE may be brought up by the Hand only, without Suckling, as many Instances of very thriving Children testify; yet because the most natural, common, and commendable way is to suckle it, I come now to touch upon the proper NURSE, her Milk, and Diet. Upon which I first observe, that the prime and chief Quality of a good NURSE is, that she be the Mother of the Fosterling INFANT herself; and that because her MILK, being generated of the same Blood, of which the CHILD is formed, and has hitherto been nourished, is of a nearer Affinity with the Nature of her BABE, than the MILK of any other strange Woman whatsoever; which can differ no less from the Maternal Milk, than the own Mother, and the other differ in Constitution and Temperament of Body, Regimen, and Method of Living, &c. All which affect the INFANT in no small Degree; for as the Blood is generated of the Chyle, and the Spirits of the Blood, so the CHILD imbibes the very Manners and Disposition, as well as the gross Humours and Qualities of the NURSE with her Milk.
AS a Lamb sucking a Goat, changes not only its Nature, but even its Skin and Wool into the Goat-Kind; so it is also among the rational Creatures: From hence we have justly the old Proverb, touching an ill-natured Person, that some Brute or other has been his NURSE. And hence it is that Romulus and Remus, the Sons of Mars (without any Reality) are said to have been nursed by a Wolf[182]; Pelias, the Son of Neptune, by a Mare; Telephus, the Son of Hercules, by a Hind, &c. Not that they ever actually sucked such Creatures, only their NURSES were of such Tempers and Natures, which they were thus supposed to have by the Breast infused into them.
AND, in short, daily Experience, as well as many Learned Authorities, may sufficiently convince us, that Children really suck in the several vitious Inclinations and depraved Passions of their NURSES; such as Anger, Malice, Fear, Melancholy, &c. Agreeable to which Opinion, Diodorus says[183], that Nero the Emperor’s NURSE was very much addicted to Drinking; which Habit Nero imbibed from her, to such a Degree, that the People took notice of it, and from thence instead of Claudius Tiberius Nero, call’d him Caldius Biberius Mero. The same Author relates of Caligula, that his NURSE used frequently to moisten her Nipples with Blood, that he might take the better hold of them; which (says the same Diodorus) was the Cause of his being so cruel and Blood-thirsty all the Days of his Life; that he not only committed frequent Murders by his own Hand, but even wished that all humane Race was but one Neck, that he might have the pleasure to cut it off.
IN short, honest Parents perceiving their Children to incline variously, one to Thieving, another to Drinking; one to Stupidity, another to Barbarity; are amazed at such Degeneracies of Mankind, not knowing after whom the Child can take those Propensions. But abstracting from this, how many fine Children do we daily see thrown into Fits, Rickets, Consumptions, &c. merely by sucking their imprudent NURSES, when enraged, or otherways in a Passion? If then the Case stands thus, that every Disorder of the NURSE is a real Detriment to the INFANT, surely, upon this Account, all Parents ought to know Her well, to whom they entrust these Dear Pledges of their sacred and natural Desires.
MOREOVER yet, besides all these Things, the tender Care, as well as the Love and Affection of the Mother to her own Child, by far surpasses that of any mercenary NURSE whatsoever. Wherefore the Mother, tho’ perhaps not the best NURSE in other respects, is always preferable to a STRANGER: Which if People of Probity and Honour would more observe, I sincerely believe that there would not be so many graceless, disobedient, and undutiful CHILDREN of our Age. I do not think what I have read of Scipio Africanus to be any singular Instance; namely, that He esteemed Her more for his Mother, who nursed him two Years after his Birth, than Her who brought him forth, and then forsook him in the World. Agreeable to which, and most À propos, was the Answer of the Philosopher, Favorinus[184], to the Mother of a certain Noble-woman in CHILD-BED, who was dissuading her Daughter to nurse the CHILD she had born; viz. I entreat thee Woman (says he) suffer her to be the whole and entire Mother of her own Son. And verily, She only can be properly so called, who carefully nurses as well as brings forth her own CHILDREN. Hence it is that the Earth is called the Mother of all Things, not so much because she produces all Things, as because she maintains and nurses what she produces.
ALL which, notwithstanding, there is sometimes a Necessity (on account of sundry Reasons) to provide another NURSE for the CHILD; wherefore I come now briefly to describe the most proper Person for this TRUST, and to set forth the Qualities of the most convenient MILK, for the wholesome Nourishment of the Infant.
FIRST then, the NURSE ought to be a Woman between the 20th and 35th Year of her Age, perfectly graced with the Blessings and Ornaments of Nature; and a Person of Probity and Reputation in her Rank, endued with Love, Pity, and Tender-heartedness: As she also ought to be sound and healthy, of a good Habit and Disposition of Body and Mind, of a sanguine Complexion, and rosy Colour; of a middle Stature, having black or brown Hair, a lively Eye, sweet Breath, sound and white Teeth, with an agreeable chearful Countenance. In short, she ought also to be a well-mannered, modest, and sober Person, having middle-sized, well shaped, not flabby nor hanging down, but solid fleshy Breasts, with elegant, firm, and well perforated Nipples.
SECONDLY, As to her MILK, it ought neither to be too new, nor too old; but at any time from the Puerperial Flux, until the 6th or 8th Month thereafter, it is not to be rejected; especially if it be of a good Consistence, neither too thick nor too thin, of a pure white Colour, an agreeable pleasant Smell, and a perfect sweet Taste.
BUT it sometimes however happens, that the Milk of a NURSE, otherways a very proper Person, degenerates from some of the abovesaid Qualities: In which Case it is no ways convenient to change the NURSE, especially if it so happen to the Mother; only the MILK is to be corrected according to Art, which may be easily performed by proper Medicinal Means, and that as well with respect to its Quality as Quantity: However, as this Case belongs to the SYMPTOMS of the Breasts, which I have already declined speaking to, as in the foregoing Chapter, so I shall no ways enter upon it in this Place. But again——
THIRDLY as to her Regimen, such a Nurse is to make use of, and enjoy a good and convenient Diet; abstaining carefully from all salt and sharp Victuals, as well as from high-spiced Meats, and strong or spirituous Liquors. In short, as she ought to avoid all Sorts of intemperate Air, and keep herself clean both in Person and Cloaths; so she ought always to exercise herself by some light Labour, and keep herself in a moderate active Motion; prudently suppressing, at all Times and upon all Occasions, the various Passions of the Mind: By which means, any Woman as above described, may make a very good NURSE, and that even without abstaining altogether either from the moderate Use of Wine, or of Conjugal Conversation; notwithstanding the contrary Opinion of most Authors, provided only that she does not give the CHILD suck for an Hour or two after Copulation.
BESIDES the external and internal Excrements mention’d in the foregoing Chapter, the Infant in a few days after BIRTH, pukes up a certain Sort of viscid Phlegm; for which Reason it ought to have no SUCK until this Humour be evacuated, lest the Milk incorporating with that Matter, both should corrupt: To prevent which Inconveniency, some order a little Oil of sweet Almonds by Expression, and a small Quantity of Sugar-Candy, or a little fresh Butter and Honey mixed.
INSTEAD of which, however, I have seen some Jewish Matrons give also the new-born Child for the first Thing, a little Salt dissolv’d and mix’d in a Spoonful of Hysop, or Saxifrage-Water; which (tho’ no improper Prescription in itself) yet I conceive their chief Reason for it to proceed from Ezek. 16. 4. where the Lord summing up the Duty of the MIDWIFE, says, Thou wast not salted at all, &c. Again farther——
THE Learned Arnoldus de Villa Nova, advises us to give the CHILD, for the first Thing, half a Scruple of fine pulverized Coral in a little of the Woman’s MILK; and that (says he) to prevent FITS, to which new-born Children are very subject.
ALL which may be indifferently us’d, according to Pleasure, tho’ I take a small Spoonful of Sugar’d Wine, given twice or thrice a day, for the first four or five days running, to be the most preferable Remedy for Prevention: By reason that the Wine cuts and loosens the Acid Humour, preparing afterwards by Concoction and Digestion what remains, as the Sugar temperates and helps to expurge the Acrimony: Which being duly done, I would order the Infant always to rest, laying it not on its Back, but on its Side, that this morbifick Matter may be the more commodiously voided by the Mouth, as already precautioned in Chap. 7.——
THIS Humour being then thus prepared and discharg’d, the Breast of some other clean and sound Woman may be given the CHILD, until the Mother’s Milk be purified for its proper Use; which it can scarce be supposed to be, before the Dissolution of the MILK-FEVER, that is before the ninth day after DELIVERY: From which time, it is to be maintain’d and nourish’d for the first three or four Months by BREAST-MILK only; augmenting however its Allowance from day to day, in proportion to its Age and Strength, that the weak Stomach may never be overloaded, so as to occasion Vomiting, or (which is worse) a DIARRHÆA: To prevent which Inconveniency, let the INFANT rather suck often, and a little at a Time, than too much at once.
AFTER these first Months are over, a little thin PAP may be given it every Morning, and in time twice a day; which is commonly made of Flower and Milk, or Ale, with a little Sugar and Butter: But because FLOWER is of itself humid and viscid, and may not only occasion Pains and Obstructions, but also, engender Gravel and Worms, it ought to be first well dryed in a new or clean earthen Pot in an Oven; or, what is better, the Pap may be made of the Crumb of a Loaf: Which Diet is properly observ’d, until the time of Teething, laying it still, a little after its Meal, to rest upon its Side, or now and then upon its Back, with the Head a little rais’d; however not in the Bed with the Nurse, for fear of overlaying it, but in a Cradle close by her Bed-side; always very carefully covering the Child’s Face, that the Light may not offend its tender Eyes, and render them any ways distorted or goggled: And as the Infant may be brought up by the Hand without Suckling, so it may easily be accustomed to Sleep without Rocking. But be that as it will, as soon as the CHILD is furnish’d with Teeth, it is proper by degrees to use it to a little more solid Food, such as Bread and tender Meats or Fleshes, however, a little chewed by the NURSE: In the mean time no Crude, or Meats of hard Digestion, are to be allow’d it, because such Things produce a Corruption of Humours, whence Worms engender, and other various, grievous, and irregular Symptoms arise.
BUT before I proceed farther, I ought to observe, that the Duty of the Nurse does not consist entirely in the abovesaid Conditions; for the BABE must be as duly washed and shifted, unswaddled and reswaddled as Fed: Wherefore from the Birth, until the third or fourth Month, it ought to be loosed and washed all over in warm Water twice or thrice a day, before the warm Fire; as also in the night time if necessary, that the Acrimony of the Excrements may not offend it: Upon which at every singular Occasion, the Nurse may also rub its tender Body gently, not only for the better Concoction of its Aliment, but also for strengthening and consolidating its Members; which Offices being all carefully and affectionately done, the Infant is to be shifted toties quoties, and orderly reswaddled in clean, dry and warm Clouts and Blankets. However yet, from the third Month until the Teething-Time, the Body needs only be washed once a day, or (if you please) every other day; as from thence forward it may only be twice a Week.
MOREOVER, when the CHILD begins to use its Hands and Feet, if it moves briskly from place to place, it is a good Sign of a strong and lively Constitution; as it is the Reverse, when it sits torpidly or drowsily still and unactive. Which notwithstanding, these brisk INFANTS are not to be allow’d such Motions too soon, I mean not to use their Feet prematurely or too fast, as many ignorant Nurses commonly encourage them to do: Because by these means, their tender Legs may be easily distorted or become crooked. Whereas when they are more firm and well-grown, they may be learned to walk by the help of the Nurse’s Hand, or of a Leading-String; as afterwards they may be inur’d to walk of themselves, by the means of a small Vehicle or Chariot, as is generally well known in populous Places.
AS to the time of Ablactation, or weaning the CHILD from the Breast, it is not always the same; some being more robust and lively than others, and consequently may be sooner wean’d; but others are more weak and tender, and accordingly require longer time of the Breast. However this be, the Infant ought not to be wean’d before it has its compleat Sett of Teeth; because if sooner, it can no ways duly prepare its VICTUALS by the Mouth, for Concoction in the STOMACH, which may be of very bad Consequence; Besides, in the time of Teething, especially about the Eruption of those call’d the Dog-Teeth, the Child is subject to Fevers, Pains of the Gums, and various other Symptoms, which would certainly be of more Danger by far, if it was at that Juncture to be deprived of the Breast.
OTHERWAYS, I take the due and proper Time for Weaning the Infant, to be about the 18th or 24th Month, rather longer than shorter; because it surely finds the Benefit of this proper and benign Aliment all the Days of its Life. Yet at what time soever it happens to be done, the Child is not on a sudden to be accustomed to different sorts of Victuals, but rather, while it yet Sucks, to be gradually brought to the Use of what is most convenient for its Nutrition, such as Hen or Chicken-Broth, or the Soup of other Meats, mix’d with a little Crumb of Bread; or a Soup made of Ale, and Crumbs, with a little Fresh-Butter, which is of excellent Nourishment: As before, or about the Time that the Infant is to be Wean’d, a little half chew’d Meat of any Sort, provided sweet and fresh, may be given it for a good weaning Repast.
UPON this Head, I shall only farther observe, that the Ablactation, or Weaning, always happens more conveniently in the Spring or Autumn, than in the Summer or Winter, and that more auspiciously with the encreasing than with the decreasing Moon: And this, because otherways, besides the Alteration which happens to the Child from the Change of its Diet and Aliment, another may easily affect it from the Calidity or Frigidity of the Ambient Air.
BUT besides, in short, that the Infant may be the better and the more readily Wean’d, the Nurse’s Nipples may be anointed with the fresh Juice of Wormwood; or with a Liniment of the same Juice, Honey and Aloes; or any other proper Ingredients, discreetly us’d, that its tender Lips or Gums may not be inflam’d, nor the weak Stomach hurt or offended. However, the better way is, that the Nurse withdraw herself from the Child’s Presence; upon which it is to be plentifully fed, as already advis’d, allowing it a little Ale, but no Wine, for its Drink.
NOW as to the Diet and Regimen of Children from Ablactation to the first Seventh Year of their Age, I would farther observe, that it differs yet altogether from that of more adult Persons, since their infirm Habits and tender Bodies can no way tolerate, or withstand the consequential Effects of an irregular Diet, or an Erroneous Regimen: Besides this Age requires Victuals frequently, and that not only what is sufficient for Nutriment, but also for Growth: And moreover they ought still to be now and then bathed or washed at Times.
BUT touching the Affections and Passions of their Minds, great Care must be taken, that they be not provoked to Wrath or Anger, nor frighted with fearful Notions or Phantasms; since such Things make strong Impressions upon their soft Bodies, and frequently give Origin to Convulsions, Epilepsies, &c. However, as Children are naturally more prone to Evil than to Good, and to Vice rather than to Virtue, they are not to be too much indulged; but from their Infancy upwards, all such perverse Faculties and Passions of Mind are to be so curbed and moderated, that they may become subservient and obedient to Reason; and that because this very Age is the proper Time to lay the Foundation of their future good Qualities and Disposition, agreeable to the Rules and PrÆscripts of a right rational Oeconomy.
I know This is sometimes accounted a hard Task, but if we consider that the Whelps of Savage Bears and Lions may be so tamed, as to obey the Motions of their Keeper, how much more easily may the Sons of Men be inur’d to follow the Laws of right Reason? Their Passion first discover themselves most commonly by Crying and Tears, tho’ sometimes also otherways; wherefore such Fits of Anger or Passion ought to be prudently reprehended in them; and when neither Admonitions nor Commands may prevail, then Threats ought to take place, that all Frowardness and Obstinacy may be stifled in the Bud; for the Mind of Youth may be justly compar’d to a Mass of Wax or Clay, on which we may readily stamp what Impression we please to make.
FOR these Reasons, their Attendants, or such other Persons as may be occasionally about Children, ought carefully to avoid doing or saying any mean, base or vile Thing, especially in their Presence or to their Knowledge; since here the old Proverb holds most true, that, we are drawn by Precept, but led by Example. Wherefore to moderate and mitigate their Passions, Children ought to be allowed proper Diversions, and such Exercises of Body as their Age and Constitution will permit; and that also, because if they were to be brought up lazily or sluggishly, without Motion or Exercise, their Victuals which is now commonly given them both plentifully and frequently, could not possibly disperse itself nor digest, upon which the innate Heat would infallibly suffer a sensible Decay.
THESE Things being duly observed, it now only farther remains, that the Child be well train’d up, and carefully educated; instilling all along into its Mind the Principles of Humanity and Morality, and instructing it gradually in the Knowledge of Arts and Sciences; which it will even at this tender Age be found capable of Conceiving: For the Human Mind being naturally adapted to attain to the Cognition of all sublunary Things, may be thus endued and furnished with the most laudable Arts, before it can distinguish the Use of them; since according to the Philosopher’s wise saying[185], Nostrum scire nihil aliud est, quam Reminsisci. Because (I say) the Mind of Man perceives and comprehends the Notion and Knowledge of all temporal Things in it self, notwithstanding that it cannot easily display it self, by reason of the burthensome Oppression of the Body and its gross Humours: Like as a Fire, overlaid with Ashes, must be raised up and fomented, before its engender’d or retain’d Sparkles can exert themselves with any Lustre; so it is even with us, before the Light and Instinct of our Natures can shine forth: For as some Roots cast no Smell, or breathe no Fragrancy of themselves, unless they be softly touched or squeezed with the Hand; so neither do our Natural Powers and Faculties exert or show themselves, unless they be diligently exercised and cultivated.
THUS we have now guided and conducted the Child from its Birth, to the Seventh Year of his Age; which being only meant by the Infant, that was safely Born, and continued all along in Health; I come now in the next place, to hint upon what is farther Requisite towards the rearing of such Children, whole Misfortune it may be, either to come into the World with Infirmities, or to be afterwards subjected to them in their Cradles. And First,
SINCE some only, not all Children, happen to bring Infirmities with them into the World; and because such Indispositions as are chiefly meant here, discover themselves presently at the Time of Birth, and require immediate Cure; I shall concisely enter upon, and briefly comprehend them All here, as they most commonly fall out, in this present Chapter.
IN order to which, I shall previously observe, that such Inconveniencies happening to the Infant, may have a double Origin, and proceed either from a Defect in Nature, or the Effect of a difficult Birth: The First may take Rise from various Causes, such as of the Parental Seed, the Forming Faculty, the Maternal or Uterine Constitution, an illegitimate Time of Birth, and the like; as the Latter may also arrive, not only from a Difficult, or Preternatural Labour, &c. but also from the ignorant, rough Usage, or barbarous Treatment of the Midwife. However, not to insist too long on these Things, it very often, and too commonly happens.
I. THAT, The Child suffers so much in the Birth, that (when born) it is hard to know, whether it be dead or alive, not one part of the Body being perceiv’d to move; which however may be thus well known, viz. by laying my Hand upon its Breast, I shall feel the Motion of the Heart, if alive, tho’ never so weak; as I shall also perceive a small Pulsation of the Arteries, by touching the Navel-String near the Belly.
IN which Case, I would immediately order the Infant to be laid in a Warm Bed or Blanket, and quickly carried to the Fire; where its Mouth is to be open’d, as its Nose is to be clean’d and unstopp’d with small Tents dipp’d in warm White-Wine, and Linnen wet with the same applied to its Breast and Belly; spurting always in the mean time, a little of the same Wine into its Mouth and Nose, until it begin to stir: Or then I would distil a drop of Aqua-VitÆ, from time to time upon its Tongue, bathing its Pulses and Nostrils with the same, while I anointed its Mouth with Honey.
II. IT sometimes only happens, that the tender Face is bruised Black or Blew, Pale or Livid; which may also as well proceed from the Bones of the Pelvis, or from the Child’s being Born Face-upwards, as from the Midwife’s hard Usage. In this Condition, I would only order it to be frequently anointed with the Oil of Sweet Almonds, drawn without Fire, that is, by Expression; upon which it soon recovers its Natural Colour.
III. AGAIN sometimes the Infant is born with a Knob or Tumour on the Crown of its Head, occasion’d by its hard Pressure against the Orifice, or by its strict Compression in the same: In which Condition, I would immediately foment it with warm Wine or Aqua-VitÆ, and apply a Compress to it, either wet in the same, or in the Oil of Roses and Wine beat together; and the same Fomentation and Compress may serve for any other Part of the Body, which may be swell’d by rough Usage, or otherways, in a difficult Birth. But in Case of Suppuration, it must be open’d in a proper place with a Lancet, applying afterwards a Plaister of Betony. As also in Case of a Fracture, or any sort of Dislocation, the Parts must be join’d and reunited, and duly retain’d in their Natural Position by convenient Boulsters or Splinters, until they be firmly closed and reconjoin’d. Moreover
IV. IN Difficult Births, it very commonly falls out that the Head is pressed into an oblong Form by the Bones of the Pelvis, because the Scull not being made of one piece, is not equally hard or firm; the Sutures being only surrounded with Membranes, especially the Top of the Head is so Membranous and soft, that the Bones forming the Scull may be easily pressed one upon another; from whence we have this oblong Figure of the Head. However, in short, this may be corrected and reduced to its Natural Shape, by frequent, but cautious and skilful, Handling.
V. WEAK Children, and such as come prÆmaturely, or before their Time, into the World, have the Mould and Sutures very open, and the Bones far distant: In which Condition they are only to be softly bound about with a small Cross-Cloth, committing the rest to Nature; which in time, and by degrees, will close up and consolidate these Sutures; and sooner or later, according to the innate Heat and Moisture of the Infant, unite and join the Bones of the Head.
VI. SOMETIMES also it happens that the Child is Tongue-ty’d, by the too strait Astriction of its Bridle; so that this Member cannot freely extend or move itself, thro’ the Capacity of the Mouth; which in the Infancy impedes or hinders its Sucking, as in riper Years it does the Faculty of Speaking: In this Case, the Tongue, being supported or held up, on each side of the String, by a small forked Instrument, ought to be cut a-cross by sharp Scissors as much as is needful; which however must be done with Caution, not to hurt the Veins under the Tongue.
VII. THE Infant is also sometimes troubled with a small round Tumour under the Tongue, fill’d with vitious Blood, or pituitous Matter; which AËtius and Paulus Ægineta call’d Ranula LinguÆ; Which Case may be managed, and the Tumour dissolved by a little Ammoniac Salt, or such other proper Remedies; but if Occasion require, the same may be open’d by a Lancet.
VIII. IT also happens, tho’ but seldom, that the Child is born with a close Fundament; and that sometimes shut up by the single Skin, and sometimes by a fleshy Substance: In the first Condition, there appear some livid Marks of the Meconium thro’ the Skin, which feels soft to the Touch. Upon which occasion, an Apertion must be made with a small Incision-Knife, a-cross, not long-ways, that it may the better receive a round Form, and not so easily grow again together; which however must be done with great Caution, that the Sphincter of the Rectum may not be hurt: And the Meconium being afterwards voided, whether by a Suppository, Clyster, or otherways; the Orifice is to be stopp’d up with a Linnen-Tent, anointed at the beginning with Rose-Honey, but afterwards with some drying and cicatrizing Ointment, such as Unguentum-Aleum, Pompholyx, &c. Dressing it always as often, and as soon, as the Excrements are evacuated, lest the Apertion should turn to an Ulcer.
BUT in the other Case, where the Fundament is stopped up with Flesh, that neither any Mark nor Appearance of the Rectum is seen or felt, whereby its true Situation may be known, or the proper place where the Aperture ought to be made; The Operation is much more difficult, and the Infant but seldom escapes the fatal Consequence of this Misfortune: Which Difficulty notwithstanding, we are diligently to do our Best upon such Occasions; to which End, an Apertion must be made within half an Inch of the Child’s Rump, being the certain place of the Rectum; which in the interim must be perform’d with the greatest Care and Judgment by a small Incision-Knife with one Edge, turning the Back upwards, and thrusting it so forward, until the Aperture be made big enough for the Excrements to pass thro’, always prudently regarding the Sphincter as above; upon which the Wound, &c. are to be dressed and order’d, as in the preceding Case.
IX. IN like manner, it also may happen that the Infant is born with its Urinary Passage shut up; upon which Occasion, a convenient Apertion must also be made with a proper Lancet: Which Operation must likewise be perform’d with great Prudence and Ingenuity.
X. MOREOVER, It also sometimes falls out, that the Child is infected with the Venereal Lues, from the Predominancy of that Distemper in the Mother; which Case easily discovers itself by many Pustules and Ulcers appearing at the Birth in diverse Parts of its Body, especially about the Head, Belly, Thighs and Clunes: Upon which the Cure may be pertinently protracted to a more advanced Age, tho’ prudent Measures may be taken, to keep the Distemper under, but if the Condition be Malignant, the Remedy is commonly prevented by Death.
XI. FINALLY as to the small or puny Faults of Nature, such as a distorted or wry Mouth, crooked or flat Nose, thick or flabby Lips, rough or ugly Visage, or the like Blemishes,——
THE Child’s Body being tractable like a piece of Wax, or the Potter’s Clay, These may be Judiciously corrected and Ingeniously amended, and a more Delectable and Amiable Form given to[186] every Part; as in Case of any Blemish of the Eyes, whether they be Discoloured, or Sparkling, Dim or Short-sighted, Squint or Goggle, Rolling or Goat-eyed; a Lovely black Colour, and a graceful Beauty, may be also artfully given them[187].
NOW (I think) These are all the most common Symptoms or Indispositions which the Child brings with it into the World; which being thus briefly discuss’d, I come at length to——
NOTWITHSTANDING that the Child may be born free from all apparent Symptoms of any Indisposition, and however careful the Honest Nurse may be of its Diet and Regimen; yet it seldom happens, but it undergoes some one or more of the following subitaneous Inconveniencies, viz.——
I. Gripes or Pains of the Belly, which may proceed either from the Meconium, its not being timely, or not fully evacuated; or from the Nurse’s Milk, its generating Wind and acid Humours, either by her using improper flatulent Food, or from the Babe’s sucking more Milk than its Stomach can digest: Or the same Pains and Gripes may also proceed from the Effects of cold Air, or from Worms in the Intestines, or from the unseasonable use of Pap, &c.
THIS Affection in general is known by the Inquietude and Crying of the Infant, which is now (in a manner) averse to the Breast, continually turning itself here and there, without Rest or Intermission of Pain; But more particularly, This proceeding from the Meconium, may be distinguished and known by the Colour of the Excrements, since the Meconium is always black, and as soon as it is altogether voided, the Stool becomes pale; and that may be readily cured by the means already prescribed[188]. If this Affection proceeds from Wind, it may be known by the Child’s frequently belching and the Belly’s swelling, if from Cold, the use of Pap, or from any pituitous viscid Humour, the Belly is most commonly bound, and the Cure differs but little from the preceeding Case. If from corrupted Milk or acid Humours, the Condition is most commonly attended with a DiarrhÆa, and the Excrements are of a greenish or Saffron Colour: The Cure of which, depends upon proper Abstergents and Evacuations. If at last from Worms, their proper Diagnosticks shew it, of which in their Place.
II. SOMETIMES an Extension or shooting forth of the Navel happens to the Child, and that frequently to the Bigness of an Egg, more or less; which Case is properly call’d an Exomphalon, and proceeds either from the continual Cries, or violent Coughs of the Infant, or from a Laxation or Rupture of the PeritonÆum, or sometimes from an Exulceration of the Navel.
IN this Condition, whatever the Cause may be, the sooner that the Cure is undertaken, the more easily it is perform’d; for which End, after removing the Causes of Crying or Coughing, the relaxed PeritonÆum may be strengthened and astringed; as when bursten, it may be reunited and consolidated by proper Cataplasms and Swaths; after replacing the Intestines (if fallen down) keeping the Child for the most part in Bed, with its Belly always loose, and never too full.
III. AND the same is the Method of Cure, in Case of an Intestinal Rupture, otherwise call’d Enterocele, i. e. Hernia; only, That a Truss is now more convenient than a Swath: However in this Place I would observe that all Tumours of the Scrotum, are not to be mistaken for the present Bursten Case; because the same may also happen from a Watry Humour collected in that Part, which is more properly call’d an Hydrocele, and is easily distinguish’d from the Enterocele: Insomuch, that, in this Condition the Tumour is most commonly, in one part of the Scrotum, I mean in its Right or Left Side; when also the fallen Intestines may be perceiv’d by the Touch; as the Rupture or Hole through which the Intestines are fallen, may be by the Finger: Whereas in the Case of an Hydrocele, the Tumour is commonly in both Sides, and the Scrotum is more puffed up, neither is there any Hole of a Rupture to be found in the PeritonÆum. The Cure of which Case depends entirely upon proper Absorbents, or Discutients, for resolving and drying up the Water, or dissipating the Wind, and afterwards upon Corroboratives for confirming the Parts. But after All, in the mean Time this Tumour is also sometimes, upon occasion, properly open’d by a LANCET to evacuate its preternatural Contents.
IV. AN Inflammation or Exulceration of the Navel may happen to the Child, by the String’s falling off too soon, or before it be fully clos’d and cicatriz’d; which may proceed from any violent Agitation of the Belly, by continual Crying, vehement Coughing, &c. as it also may from an unskilful Ligature of the String, or from cold Air; upon which sometimes follows a great loss of Blood, and even Death itself, if not timely prevented.
THIS Inflammation is known by the Navel’s swelling-up, being red and hard with Heat and Pulsation; In which Case after appeasing the Infant’s Coughs, or Cries, &c.—I would apply to it the Unguentum refrigerans Galeni & Populeon, each one half mix’d; or a small Bolster dip’d in the Oil of Roses with a little Vinegar.
BUT, and if the Navel continues Ulcer’d after the falling of the String from it; in that Case proper Desiccative and Astringent Medicines are to be apply’d, such as small Rags dipp’d in Lime-Water, but not too strong; or in Plantane-Water, wherein a little Alum has been dissolved. If the Ulcer be but small, a Pledget of Dry Lint will be sufficient; observing always to keep a good Linnen Compress on the Top of whatsoever Remedy is us’d, with a Swath to keep all fast, until the Navel be perfectly heal’d and cicatriz’d; lest at the same time it should also force itself outwards, as in the ’foregoing Case.
V. THE Child is also very frequently troubled with the AphthÆ, or Ulcers of the Mouth; commonly call’d the Thrush: Proceeding either from vitious Milk, or from its Corruption, in the Stomach; emitting sharp Vapours, which readily affect the tender Skin and Superfice of the Infant’s Mouth, and that the more easily, because the same Tunick, or Skin, which invests the Mouth, is common to the Gullet, which naturally communicates the Affections of the Ventricle to the Jaws. Hence it is that the Nice Taste of the delicate Tongue so readily distinguishes all Relishes; and hence it is that the Ingenious Physician, by looking upon the Tongue only, is able to judge of the prevailing Intemperament of the whole Body.
THE Cure of these Thrushes, proceeding as aforesaid from the acid Vapours of bad Milk, or from its ill Digestion, depends properly and entirely upon defeating and obtunding the Acrimony, by proper Absorbents, and gentle Purgatives.
VI. ANOTHER Symptom not only familiar, but even Natural, to all Children, is their Teething; which tho’ This be the mere Work of Nature, yet because of the various Distempers and Symptoms, which commonly attend and conjoin this Dentition, it is not improperly reckon’d in the Category of the Diseases of Infants: Which however is to be understood, not of the Simple Dentition, but of the difficult Breeding of Teeth; Not but that the Child is furnished with Teeth even before Birth, tho’ they lurk so long in their proper Sockets, being cover’d with the Gums, until their due Time of Eruption[189]. Tho’ in the Interim, it has been observed that some Children have brought eminent Teeth with them into the World[190], as it is also for Instance, particularly reported of Lewis the XIV of France.
BUT however the Teeth most commonly break out about the Seventh Month, and first those call’d Dentes Incisores, or the four fore-Teeth; which after a short Interval, are followed by the two Dog-Teeth, commonly call’d the Eye-Teeth; and at last succeeded by the eight Cheek-Teeth or Grinders, in each Jaw; the two last of the Molares, properly called Dentes SapientiÆ, springing only out about, or after the one and twentieth Year. Now as this Eruption, particularly that of the Dog-Teeth, because of their very deep Root and small Nerve, cannot happen without an exquisite Sense, and intense Pain to the Infant; so, from the continual Solution of the Gums, many prÆternatural Affections seize the Child, according to Hippocrates’s Catalogue[191]; to which, in short, I must only refer: Because if I was to enter upon the particular Detail of all These, I should extend the Limits of this Work beyond all measure; wherefore I shall endeavour to comprehend them all under the one following general Head; viz.——
THE very tender Nature and infirm Constitution of Children, subject them to many various and grievous Symptoms, besides those to which they are expos’d by a vast variety of Procatarctick Causes. But as I am not in this place to enter upon the Detail of these particular Symptoms, neither shall I enumerate their respective Causes: Which however is the less requisite, considering the Regimen and Nursement of the Child already prescribed in the foregoing Chapters; since the least step, degenerating from what is there inculcated, may prove an effectual mediate Cause; for all that indeed, according to the most Learned and Excellent Dr. Harris, the only immediate Cause of all Children’s Diseases is, an Active and prevailing Acid[192].
THIS Doctrine, in as much as the Constitution of Infants is undeniably most Humid, appears also evident from Hippocrates’s his own Words, saying, the Rise of all Diseases is one and the same, the Place only makes the Difference[193]. Hence we may justly conclude, First, That, however the Symptoms may differ in degree, the Diseases of the Infant-State are but very few: Secondly, That the Cure of these is far more Safe and Easy, than those of full grown Persons: Thirdly, That the Younger the Sick Child is, the more easy still is the Cure: Because its tender Body, abounding with Natural and acquired Moisture, is soft and flexile, and consequently apt to receive any Alteration: And Fourthly, I observe that the Infant easily falls into Sickness, or may be suddenly taken Ill, and as readily restored to Health, if but carefully and ingenuously treated: Because any Impression whatsoever, good or bad, is sooner received by a Soft, than by a Hard Body; tho’, I confess, the same is more Lasting, if once strongly impressed upon the Hard adult Constitution.
NOW as to the Diagnosticks of Children’s Diseases, These depend chiefly upon the Relation of the Nurses; since all Sentiments taken from their unruly Pulses, or their (naturally) thick Urines, prove most Uncertain. However, as the Stomach is always affected with an Acid Distemper, (whatever the reigning Disease may be, or howsoever it may be intitled by ingenious Authors) so it most commonly produces Fastidy or Loathing of Victuals, Vomiting of a thick Gelly, or a viscid and coagulated Phlegm, sour Belchings, and Excrements of a sourish Smell, and a greenish Colour, especially in the Beginning. As afterwards——
IF the Distemper continues, the Patient turns gradually Pale, and its discoloured Face is tinged a little Green or Yellowish; The Belly swells with Wind, which breaks frequently upwards; one or more red Pustules (a certain sign of Acidity) commonly rise in the Face, or upon some other upper Part of the Body; and the Infant growing daily worse, breathes high, and smells sour or Acid.
Again, As to the Prognosticks of these Distempers, of what kind soever they be, which afflict the Infant; I cannot in short, but readily agree with the most Ingenious Doctor before-mentioned, who plainly tells us, that These depend chiefly upon the Method of Cure, and the Conduct of the Nurse; Wherefore I proceed to the Cure.
AS to this point then of the Cure of Children’s Diseases, I shall First observe that, how many soever these Distempers are accounted, according to the Registers of Polite Authors, by what Name soever they are denominated, and how learnedly soever defin’d, as they all proceed from one immediate efficient Cause, (which has been already hinted at) so the Cure of them all is the same, and depends, in like manner, upon One only regular Method.
SECONDLY, I observe that as this Cause is nothing else than an Acid Humour, abounding in the Stomach, and coagulating the imbib’d Nourishment of the Infant, (as is evident from all the given Diagnosticks) so the proper Method of Cure, depends entirely upon obtunding that Acidity, dissolving those Coagulations, and eliminating the peccant Matter. But more particularly,
HAVING always a great and due regard to the natural Debility, and tender Constitution of the Young Patient, the Acid ought first to be prepared by prudent means, and then to be carried off by proper Medicines. I say prepared by prudent Means, because this is no indifferent Matter; For if we should take the same Method with these tender Creatures in this Case, that we do with more adult Persons we would certainly miscarry in our Attempts; or if we should attempt this Preparation, by Alexipharmacks, Cordials, (improperly so call’d) Causticks, or Sudorificks; these Things being most prejudicial to the Nature of young Ones, would rather promote the Crudity, than the Concoction of the Humours.
THEREFORE the ingenious Doctrine of the Excellent Doctor Harris, must certainly take place here, namely[194],that the most temperate Things most securely absorb the prevailing Acidity, and that the more Simple and Gentle the Remedies are, the more Safe and Certain the Cure is.
HENCE the simple Testaceous Medicines mentioned by him, are not to be paralleled in the present Case; since they effectually mitigate all Ebullitions, and gradually become the most safe and powerful Anodines: Insomuch, that they, in a word, as certainly asswage all the Pains, Gripes, Disquiets, Watchings, &c. of Children; as Narcoticks, or Opiats, do allay those of older People.
THE Body being then alter’d by these means, and the Humours duly prepared, they are to be forthwith ejected, or timely purged off, even from the youngest Infants, as well as from those of riper Years: The Doses and Quantities of all sorts, being discreetly adapted to the Age and Strength of the Child, under what Form soever they may be given.
UPON this Head, I might indeed pretend to expatiate, but because, whatever I, or any other ingenuous Person, understanding the Matter in Hand, may attempt to offer, will only terminate in, and be consentaneous to, what my last quoted Author has plainly laid down, and concisely comprehended in a few emphatick Words; I shall here also, for Brevity’s-sake, set Bounds to my Progress. And thus, in short, having at large, and in every particular Respect, faithfully discharged my Duty, both as Physician and Midwife, to the Child as well as to the Mother; I now take leave of both the one and the other, and in the next place, come briefly to touch upon the Reverse Cases.
