A PRACTICAL TREATISE ON THE DISEASES

OF INFANCY AND CHILDHOOD.

PART I.

ON THE PHYSIOLOGY AND PATHOLOGY OF CHILDHOOD.

CHAPTER I.

INTRODUCTORY REMARKS.

THE trite maxim, that—a large and healthy population is the life and strength of a nation, and the source of its success in science, art, agriculture, and commerce, can hardly be quoted too often but though none probably will deny its truth, there are very many who will not act upon its precepts that such an observation ought to inculcate. It would indeed be well if our political economists could be led to believe, that in London and most of our large towns and cities, there are numerous gold mines, that only require working with energy and perseverance to yield a more satisfactory return even than the auriferous veins of Australia. Were the filthy streets and courts at present inhabited by so large a portion of the population swept away, and replaced by thoroughfares into which light and fresh air could freely penetrate, the Registrar-General's returns of deaths would be certainly lessened: while, with model lodginghouses and other healthy dwellings, many of the indigent would become useful and respectable members of society, instead ofas now-incumbrances upon the industrious. The facilis descensus has been tested by many a poor man, who driven from his miserable, ill-ventilated and badly drained home, has been led to seek a solace at the gin-palace; whence drink, idleness, and poverty have soon conducted him to the hospital, workhouse, or prison. The very usefulness of the poorer classes, as instru

ments for the creation of wealth and all the luxuries it procures, ought to be sufficient to make us mindful of their claims; and the most urgent of these claims is that they be saved from all preventible disease. At present to take only one example from many-scrofula, in one or other of its numerous forms or complications, runs riot; and by it the children of the poor are either prematurely cut off, or the seeds of future disease are sown, to bear subsequently an abundant harvest.

A lengthy statistical inquiry into the amount of mortality which occurs in infancy might be considered out of place in a treatise like this: at the same time, as the object of this work is to furnish information which, it is hoped, may be the means of saving life, some reference to this branch of our subject may be advantageously made. It may suffice to mention, that there is distinct evidence to prove that in the present day more than one-fourth in the unhealthy districts of some large manufacturing towns, not less than one-third, and even a greater proportion of all the children ushered into the world and born to endure for threescore years and ten, are cut off within the first five years after birth: and if we may argue from past experience, there is little room to doubt that much of this mortality is due to the unhealthiness of the majority of the homes of the working classes; the unjustifiable use of stimulants, drugs, and quack medicines containing opium, &c.; the prejudices, neglect, and ignorance of nurses and parents; and to other preventible causes. So directly is infant life influenced by good or bad management, that less than a century ago the London workhouses presented the almost incredible result of twentythree deaths in every twenty-four infants under one year of age! this frightful devastation being allowed to go on for a long time almost unnoticed, as it was deemed beyond the reach of remedy. But when, in consequence of a Parliamentary inquiry, an improved system of management was adopted, and the parish officers of London and Westminster were obliged to send their infant poor to be nursed in the country, at proper distances from town, the proportion of deaths was speedily reduced from 2600 to 450 a year.

Mr. McCulloch, in his Statistical Account of the British Empire, quotes a table from the Lancet of 1835-36, showing the births and deaths under five years of age, according to the London Bills of Mortality, for 100 years, in five periods of twenty years each, and also the number dying under five years of age out of 100 born; the results of which demonstrate that the mortality of children in London has been constantly on the decline. The table runs thus::

Total births. Total deaths under five years

1730-49 1750-69 1770-89 1790-1809 1810-29 315,156 307,395 319,477 386,393 477,910 235,087 195,094 180,058 159,571 151,794

Here it appears that in the 20 years, 1730-49, out of 100 born, 74.5 died under the age of five years; while during the 20 years, 1810-29, only 31-8 died out of the same number. If, then, half the children formerly cut off at an early age in England be now reared, it will appear-argues Mr. McCulloch, rather illogically-that a vast number of weakly children are annually introduced into the English population; and that unless we take proper means to fortify the constitution in manhood, the relative vigour will not increase in the same ratio as the population.

As late as 1838, Mr. Maclean, in his visit to St. Kilda, found that the population of that island was decreasing rather than increasing, owing to the excessive mortality at all times going on in infancy; "eight out of every ten children," he says, "die between the eighth and twelfth day of their existence.' The principal cause of this terrible destruction of life, was the filth amidst which the inhabitants lived, and the noxious effluvia which pervaded their houses, owing to their being used during the winter months as stores for manure. The air of the island was good, the water excellent, and the clergyman, who lived exactly as his neighbours did, except as regarded the condition of his house, had a family of four children, all strong and healthy.

From the twenty-ninth Annual Report of the RegistrarGeneral, for the year 1866, it appears that while the population of England numbered 20,066,224, the total number of births was 753,870, there being 384,955 males, and 368,915 females; the total number of deaths was 500,689, of which 256,402 were males, and 244,287 females. Of these deaths, 203,019 occurred under the age of five years, in the proportion of 108,424 males to 94,595 females. These totals were made up of the following numbers at the several ages specified :

:

TABLE OF DEATHS IN ENGLAND AT DIFFERENT AGES UNDER FIVE YEARS.

Thus, more than half the deaths under the age of five years occur before the completion of the first year, and nearly onefourth of all the deaths in England is made up of children under one year. Further it appears that scarcely more than three-fourths of all the children born survive the end of their fifth year, and nearly one-sixth succumb from various causes before the completion of their first year.

Again, if we limit the calculation to London we find that during the same year, 1866, the total population was 2,803,989; the births amounted to 108,665, of which 55,249 were males, and 53,416 females. The deaths at all ages amounted to 80,453, in the proportion of 41,092 males, and 39,361 females; 34,565 of these deaths occurred under the age of five years, and so on with the other ages under five, as shown in this table:

TABLE OF DEATHS IN LONDON AT DIFFERENT AGES UNDER FIVE YEARS.

Hence again more than half the children who die under five years succumb before the end of the first year. Less than onethird of all the children born reach their fifth year, and considerably more than one-sixth never see the end of their first

year.

But the most striking proof, probably, that can be given to show that infant mortality may be diminished by ordinary care, is to be found in the records of the Dublin Lying-in Hospital. It appears that, from the foundation of this hospital in 1757 up to 1783, the number of infants born alive in its wards amounted to 17,650, of which number 2944 had died of convulsions, or what is commonly termed nine-day fits; so that,