***> •ClL '(' ,*■?- *x ■?SV WK Mi "•> •%*,: ». jfa*^ !C"*4US-v.-i If' '** v*«v. ^; v*. i* ^s w «*i, ■ S^ i:>i %.^-j ^'^v ± ^k.Wl^ .;j;« |?*"«i%^" '#-■ ^ NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service ✓ ) \N ESSAY U****£ 8 O d MANAGEMENT :;» i| FEEDING OF INFANTS. : thes as soon as possible, without allowing them the least respite. No bad consequence in the smallest degree can at- tend a little delay, if the child is kepfwell covered and warm ; and his being settled and composed be- fore he undergoes the hurry and fatigue of dres- sing, must be not only comfortable to him, but also highly proper and necessary, A child, from the sudden effect and impression of the cold air, is very liable to take cold at the time of his birth, from which he does not always readily recover, and which oftentimes is the cause of tedious, troublesome, and dangerous complaints j as a cough and stuffing at the breast, the gripes with looseness, sore eyes, a stoppage in the nose which proves very teazing and troublesome to him in sucking, &c. it is therefore of great consequence !.o take particular care, at this juncture, to avoid , exposing the child to the cold air before he be dres- sed. So liuble are children to take cold before they arc dressed, and in dressing, that I believe 'tis scarce p.o - ible, by any art that can be used, to pre- vent it eiuirrlv, in the colder seasons in this cli- mate. This however has been a circumstance little understood or attended to. Bat were parents, and others concerned, sufficiendy avv.rc oi its im- portance, they would cause more particular r< gard to be paid to it, especially when they are informed that a child's future health, thriving, and even con- stitution may be affected by it; and that the many restiess nights and tedious days, which so many children have after birth, from griping and other causes, may be occasioned by that single unthought of circumstance. During this interval, (viz. the time betwixt the birth and dressing) it is very common to give the child something: the intention of which seems originally to have been with a design of clearing the mouth and throat from phlegm, which some chil- dren have at that time, and which is discovered by a rattling in the throat in taking the breath, and that even sometimes to such a degree as to appear alarming, although it is seldom or never in itself dangerous: for this purpose, butter and sugar, mixed together, is sometimes forced into his mouth, 3 which being a very nauseous mixture, generally oc- casions a sickness, by which the phlegm is brought up : but as sickness at this time, will add to the fa- tigue, and may sometimes hurry a weak child, it is advisable to avoid it: a little sugar, dissolved in water, or molasses and water, given gradually in a tea-spoon, will dislodge and wash down the phlegm ; and as it. does not occasion sickness, must be more pleasant and palatable ; as children, even so early, have the seme of taste more perfect than might be supposed byr a comparison with the other senses, as the sight, hearing, &c. and it seems a piece of wan-' ton cruelty, in our first office to them, to give them so disagreeable a salute, especially when it may more properly be avoided. When, therefore, the breath- ing is tolerably free, it will be advisable not to give any thing ; as what is so given can answer no pur- pose, nor have any use. But when the rattling in the throat is urgent, and the breathing difficult, a little of the sugar or molasses and water may be given, which will generally clear the throat suffi- ciendy. DRESS. New-born children are always (or ought to be) washed before they are dessed ; and which is al- most universally done, in all seasons, with cold water. It has been commonly said, that if cold 9 water is begun with, a child will never take cold af- terward. The application of cold, however, in any shape, will, from what has just now been observed, be improper and certainly injurious, and is the prin- cipal occasion of stuffing at the breast, obstruction of the stomach, and the severe gripings, which new-born children so often experience. But it will not only be an act of tenderness done the delicate, helpless, suffering infant, but also quite proper and necessary to have the water made warm (about the warmth of new milk) at first, increasing its coldness by degrees ; so that in the course of a week or fortnight, according to the season of the year, it may be used quite cold, and continued so afterward ; as the advantages of it will be then con- siderable. The advocates for the washing with cold water at the birth, seem to have derived their practice from the customs of other countries, as South America, Africa, and other warm climates ; where it is not unusual to plunge both child and mother into cold water immediately after delivery. It may in those countries be saiutaiy ; but that is by no means a reason why the practice should ap- ply here, or that it should be any guide to us : we had much better be directed by our own reason and experience ; which appears to be the wish of the present time, as I find the best of the latest writers, who have occasion to name the subject, have con- curred with me in the opinion of using tvarm water 10 on this occasion ; although it is a practice not yet much adopted by nurses ; but whose prejudices will, it is to be hoped, subside in time when they come to be better informed. Every part of the body and limbs ought to be washed, and wiped dry and clean with a towel; and great care should be taken not to leave any of the unctuous, slimy matter which is found sticking commonly very close on many parts of die hodv, particularly in the groins, in the armpits, behind the ears, in the folds of the neck and sides, in the hams, and between the toes, as it is the sole cause of the blisters, sores and troublesome discharge which those parts are so commonly attacked with a few clays or a week after the birth, and v, hich this complete first washing and cleaning only can prevent. This therefore becomes an object .vorthy attending to. I have seen children who have not been at all washed, or imperfectly so, nearly cov- ered with festering sores, from that cause, .vhich have been very troublesome and distressing; for where ever any pr-.t of that matter is left sticking to the skin, a painful sore commonly succeeds there. An obvious advantage in the use of warm weter, is, that it will undoubtedly wash off this slimy matter more readily and perfectly than cold water. In dressing a new-born child, and indeed ever afterwards, simplicity and ease should be consulted li and observed as much as possible: great cart ought to be taken that no part of the body or limbs be tight bound, or closely confined by rollers or any part of the dress ; as tight rolling and confining the limbs, which was formerly practised, must be very injurious, and must greatly impede and pre- vent the growth, strength and activity of the infant. If it should be urged, by some, that the tender frame of an infant requires to be particularly sup- ported by rollers and bandages ; it may be answer- ed ; that however plausible, the argument may, upon a superficial inquiryr, appear in favour of tight rolling ; experience, the most sure guide, convin- ces us, that children thrive much better without it, and are much more likely to be free from defor- mity ; as the body and limbs, when at liberty and un- fettered, are more likely to attain their natural shape and proportion, than by confining them to any par- ticular position ; it being well known that the bones of an infant are so pliant and flexible as to be capa- ble of being moulded into different shapes by rollers and bandages. A flannel roller, about four or six inches broad, is commonly rolled once or twice moderately tight, about the body, next the skin, upon the navel; and was originally and very properly designed to sup- port the navel, to prevent a rupture in it, to which it is subject at that tender age, from causes Loth natural and accidental. A broad flannel roller, 12 over the shirt, loosely folding the body once or twice, is used by some nurses, and is very proper, as it keeps the child more regularly warm than any other form of dress could do, and answers every purpose of support very effectually, besides being easy and comfortable ; but care should be taken, always to let it be put on loose enough. Those who are accustomed to children, will readily know when they are too tightly rolled, or confined in their dress j as they discover a particular kind of uneasiness, with a motion of their arms and bodyr, seeming to struggle as if they wanted to disengage themselves from some incumbrance or oppression., ^attended with a continued restlessness and fretting. I have seen children in great pain and distress from this cause, as they were instantly relieved and per- fectly at ease upon removing or loosening the dress. This caution in dressing is well worth attending to, as any part of the dress, if put on very tight, will prove very painful and distressing to the child, and is what often happens through thoughtlessness and want of care in servants who have the management pf children, and who are very subject to commit this error, if they be not now and then looked af- ter. It does not appear necessary, in this place, to en- ter into a minute detail of the materials and compo- sition of the dress of infants ; they are-much of the •same quality throughout the country, among all 1J ranks and degrees of people. It may be sufficient to observe in general, that they should be light and warm ; and that they ought to be dry and clean ; for which purpose it will be necessary to renew and change them very frequently-----Flannel, very commonly, and properly, composes those parts of the dress which are next to the skin ; the shirt ex- cepted ; and which it is better calculated to do than any thing else. New flannel is generally, and ve- ry justly, preferred, as being warmer and softer than that which has been sometime worn. It is ea- sier, and less liable to give cold when wet by tha child, than any thing else : and the gentle stimu- lus which it affords upon the skin, promotes circu- lation and perspiration there, which at that time are but imperfect. The number of pins used in the dress of a child is sometimes very great; but when tapes or strings can be substituted for them, they are much prefer- able. The foundling dresses; so called from being first invented at the foundling hospital, for the sake, no doubt, of convenience and despatch, are come much into use. They draw and tye with strings, and are otherwise so contrived, that very few pins become needful in putting them on. The advan- tages which attend a dress so contrived and put on, are considerable enough to recommend it. In thq first place, the risque of pricking and wounding the tender bodies of children is avoided, which will B 14 now and then happen, notwithstanding the utmost care and caution, where a great many pins are used: and secondly, the dress sits much easier and plea- ■santer, and is put on with more despatch and less fatigue to the child.—The foundling cap is sim- ple ; and, when put on, has a neatness in it which surpasses all the studied and expensive fineiy that has ever vet been devised for that purpose ; and which perhaps may be accounted for in conformity with the opinion a great many have, that a young child looks the best in its night-cap, which this re- sembles. Quickness and despatch in dressing are proper to be observed, especially at the first, to avoid fatigue, but more particularly cold, and its troublesome and even dangerous consequences. Warmth and rest are invariably requisite, cannot be too strictly enjoined, and ought to be insepara- bly connected during the month, or, more particu- larly, the first fortnight; during which period children should be indulged in them to the utmost, and should seldom or never be moved or disturbed, except to be fed, dressed, or cleaned. The most convincing and satisfactory arguments in favour of uninterrupted and constant warmth and quiet are deducible, and may be gathered from the two following general observations which are to be made upon children: 15 1. A child, who thrives well/is naturally dis- posed to rest and sleep, and is fond of warmth ; as appears by 2. A child, who is much disturbed, or exposed to the cold air, being more fretful and uneasy than when kept still and xvarm. Thus nature dictates ! and we need not a more sure and unerring guide to direct us, in this in-- stance : for if nature or instinct, can, or will dic- tate, direct, or interfere at any period of our exist- ence, it may reasonably be supposed to do it at that time when we are the least capable of direct- ing or assisting ourselves. Children never seem so easy, nor sleep so sound, as when they are close covered up in bed: and it would be no easv matter to suffocate a new-born child, although you wrap him up ever so close in the bed-clothes, so as apparently to exclude the external air from him, provided no violence is done by pressure upon his mouth and nose, or any other part of the body : so natural and desirable i.s ivurmth to an infant at this period. Warmth should be as regularly and constantly supported as may be; 1st, by a moderate warmth of the room ; out of which a child should be carried •m seldom as possible, especially to any •distant part 16 of the house, idlv, by warm clothing; which, as before observed, should be light and sit easy, and changed or removed as often as it is wet or foul. It is scarcely necessary to observe, that a child ought to be always changed or dressed near the fire, during cold or cool weather; and for this purpose, a room immediately adjoining the mother, to pre- vent her being over-heated or disturbed, will be most advisable, when it is convenient to have it so. And 3dly, during the time of rest and sleeping.— Various kinds and forms of beds have been adopted for children to sleep in ; but none of them seem bet- ter, or so well calculated as a common bed; upon which they mav be laid, between the blankets in the day, where they will lie easy, and will he com- fortably warm; and at night, in bed with the mother or nurse. It is not unusual to place a child in a bas- ket before the fire in the day time ; which is not a good practice, as the child is liable to be either starv- ed or over-heated in this situation; whereas a bed affords a regularity of warmth and a just temperature that prove most genial and favourable at this time. Cribs, and other contrivances for children to sleep in, in the night, seem by no means adapted to this climate, at this early age; and cannot, in cold weather or winter, be so comfortable and naturally and regularly warm as a common bed: they seem mere calculated for the ease and convenience of the nurse, tlv.ui the comfort and benefit of the child; tr and very young children will seldom rest so easy and well in them as in bed with the nurse;. as, at that helpless age, they will frequently make surpri- sing efforts and attempts, when in bed with the nurse, to get near her ; and are seldom so easy and contented as when they are so situated: a proof that warmth is agreeable to them; and, as it can be no other than an instinctive requisite, ought to be indulged. The objections which have been made to a ehild*s sleeping with the nurse, are ;. there may be danger of a nurse's overlaying the child. But of this there is little fear, if she has been accustomed to sleep with children j and is an accident that scarcely hap- pens once in an age with those who have not been accustomed to it. Another objection is, that of learning the child a custom it may hereafter be dif- ficult to break him of; but this seems founded more upon surmise than reality; as it may be gen- erally effected, with a little pains taking, at a proper season. Rest or quiet, seems the next essential requisite to warmth; indeed they are, as above observed, inseparably connected; for if a child is not kept still and quiet, he cannot be sufficiently and regu- larly warm. Children, at this age, show evident tokens and marks of dislike to. extraordinary m^u- B 2. 18 tion: they are fretful, and appear feariul and alarmed when they are thrown in the arms or has- tily moved: from which, may it not be inferred, that they are not, even so early, entirely destitute of mental sensations? and that the mind is as sus- ceptible of the impression of fear (in this instance) as the body is of pain ? A child will, upon the lap, often very apparently discover an apprehension of falling by a sudden start, attended with a sinking: as is evidently perceived by the knee of the nurse; throwing out his arms at the same instant, as if to catch and save himself from falling; and which differs greatly from the starting or twitching occa- sioned by gripes, or any other similar cause, as it exactly resembles the sensation and effect a grown- up person has, who when, between sleeping and waking, he fancies himself falling from an emi- nence. This sense of fear in children is discover- ed, with exactly the same appearances, when they are quickly moved or tossed in the arms, awake. As a proof of the impropriety of much motion at this time, instances have occurred where death has been the consequence of hasty tossing in the arms, (without any other external injury) which would, we know, be healthful and grateful at a more ad- vanced period. It has been a doubt with philosophers, whether or not, children at this age have ideas or mental con- 19 ception; and they have been at a loss at what time, and by what token, the first dawning of the intel- lectual faculty is to be discovered: it is a point which perhaps may never be fully elucidated and determined, by positive proof; how far the above circumstance may be one means of leading to a dis- covery, time, and future observation, may deter- mine : there can be little doubt, from it, that children at this period, have mental feelings or sensations, and that the fact itself will, conjunctively with other arguments, serve to point out to us the impropri- ety of much motion and exercise at this very early age.—Very great and sudden changes and transi- tions are never grateful to the human constitution (in a natural or healthy state) at any period: and when material changes are to be made, the more gradually they are introduced, the better; the ne- cessity of which is in no one instance more striking and obvious, than in the case of infants, who would experience so great and sudden a change, from a state of continued warmth and quiet, to the opposite extremes, as would frequently prove fatal, if we did not do all in our power to prevent it. It may seem proper in this place to determine and fix upon the time and manner in which these changes are to take place; and from what has al- ready been observed, the following general rules may be adopted, as far as circumstances will ad- mit. 20 1 In the first week, a child should not be carried' out of the room, except into one immediately ad- joining, and that, for necessary purposes, as dres- sing, &c. but be kept in bed, constantly, or as long as he is disposed to sleep or lie quiet, and never otherwise be disturbed, except to he fed, dressed, or cleaned. During the second week, the same rules are to. be observed, except that, towards the end of it„ the child may be allowed to lie upon the nurse's knee, near the fire, and to be gently moved or dan- dled once or twice a day, for a little time. If about this time the child should, when undressed, seem gratified with having his limbs and body rub- bed with the nurse's hand, it will be proper to do so; at first gently stretching his legs and arms, and gradually continuing to rub his body and limbs, which will be a grateful and salutary ex- ercise. During the third week, the time of the child's being up and out of bed may be lengthened; and he may be gently carried about the room, which will be a means of introducing him gradually to that strange, and, often, alarming sensation, viz. mo- tion. In the fourth week, the motion may be a little increased i but which it should not be to such a de- *3* gree as to shake or agitate the child much. If the weather be warm, he mayT, towards the latter end of the week, be taken into any part of the house which is not cold or damp; but if the season is cold it will be more adviseable to defer it a week or two longer. This seems too early, notwithstanding the season may be favourable, to venture out of doors into the open air. Care should be taken to prevent the child being in any place where wet linen are drying, which is extremely liable to give cold, and I have known more frequent obstruction and oppression of the breast and lungs with severe cough from this than other causes. It may also occasion griping. This becomes a necessary precaution, as servants are very liable to take children into such places, being unconscious of the dangerous consequences; and truly alarming I have often observed them to be. Although all degrees of, what may, by some be termed proper exercise are omitted in the above rules; yet when it is considered, that the dress- ing, washing, shifting, and feeding, are all per- formed daily, and some of them repeatedly each day; they will be found to amount not only to suffi- cient exercise, but even fatigue, for the first or second week. No doubt particular circumstances and situations will very frequently make a devi- ation from the above general rules; in some cases, proper; in others, unavoidable; as theses?-. 22 son of the year, the child's health, family situations and conveniences, &c. for which proper allowances must be made: yet these will seldom happen, to such a degree, as to prevent a compliance with them, in part. It is of late become a practice with some to advise and direct the shaking and tossing of infants, and exposing them to the light and air of the room, repeatedly through the day ; and that, on the day, or a day or two after they are born: also, carrying them out of the room, and into the open air, very soon afterwards. The motives for this practice are (most likely) founded upon the general opinion of air and exercise being conducive to health and strength: so they undoubtedly are; and are found to be highlv expedient, as well, to preserve the hu- man constitution in a state of health, as to restore it when impaired: yet as the best remedies are service- able only as they are judiciously proportioned and administered; so, consistency, upon this occasion, should never be lost sight of. We find nature seeks for, and takes delight in, different kinds and degrees of exercise and air, suited to the different periods and stages of life: and although children, and the young of all animals, are at an early period dispos- ed to be more active and playful than at a future and later; yet it must be considered that, desire, and even ability for motion, do not take place the moment of their birth (a few instances in the who!-; 23 ammal creation excepted) : but that they require an uninterrupted state of warmth and quiet, for some time, to perfect and fit them for motion and the operation and effect of the external air; which, when to excess, in severe seasons, proves very fa- tal to those that, even by nature, are the best pro- vided against them. It ma)- perhaps be said, that exercise, begun so early, will forward a child, and be a means of bring- ing him sooner to the use of his limbs: yet if na- ture, as has been observed, has not then perfected and fitted these limbs for motion, we may do harm by forcing them beyond what they are capable of. It does not appear likely, that a child, who is even more than usually strong and healthy, will have its strength and future activity impaired, or the pro- gress of it sensibly retarded, by a month's confine- ment at his birth: for, notwithstanding the indul- gences we have been speaking of, it will be far from a state of total inaction, as the limbs and every part of the body will be considerably exercised by the washing, dressing, &c. which is daily and regularly practised; and which is as much, when properly performed, as can ever be immedi- ately and essentially necessary for health, at this period. It is remarked, that in Great Britain, a greater proportion of the children of the poor and indigent 24 die in their early infancy, than those of the more opulent; and which is accounted for from a want of warmth, which it is impossible they can have in the cold, uncomfortable, and, frequently, miserable habitations which fall to the lot of the poor and needy, in large towns especially; added to the great defect in the quantity and quality of their clothing: they seldom suffer for want of food, which they ire commonly supplied with, very plentifully, by the mothers ; as poor, laborious women often have a great quantity of suck. Admitting, however, that the number of deaths of the poor and rich are near- ly equal at this period; as the most prevailing causes of death, in the month, may be said to be cold, and improper food (as will be immediately explained); it is obvious, that cold taken at or soon after the birth, must be the most general and prevail- ing cause of death with the poor of large towns; and that, consequently, it becomes a circumstance of very great importance to be duly attended to, by all ranks in every situation. The children of the poor who survive the peri- od of early infancy, generally'appear more hardy and strong than those of the rich; as, those of the latter, although puny and weak at the birth, very often (especially when wet-nursed), by care and indul- gences, survive this period ; but, which very rare- ly is the case with those of the former, from per- haps, a want of these indulgences, will contribute 25 to health, at a later period; although it will, as it very commonly does, prove injurious and fatal, more early. Finally—It is to be observed, that cleanliness, ease and warmth, are essential requisites for a new-born child, should never be lost sight of, and ought at all times to be diligently attended to. FOOD. It cannot be doubted that breast-milk is the most natural, as well as proper food for a child: but it happens, that some mothers are not disposed to suckle their own children; and that others are not capable of doing it for want of milk: and, in large towns, the difficulty that attends getting good wet nurses, and the danger attending bad ones, induce many to prefer bringing up a child with the spoon, which is commonly called dry-nursing, to the risque of getting a bad wet nurse. When a child is heal- thy and strong, this latter mode of dry-nursing, may be adopted with the most propriety, and a prospect of success; but when a child is sickly, weak, or cross-tempered, it will generally be found a perplexing, difficult piece of business. A child does not require food very soon after his birth, nor is the mother capable of giving it imme- c 36 diately: nature therefore has wisely ordered, that the infant's call, and the mother's ability to supply it, shall keep pace with each other. As a child, before birth, has received no nourishment by the mouth; so the mouth, stomach, and other organs of digestion, are not immediately in a proper state and situation to exercise their different offices. The bowels are lined with a mucous thick matter, of a black colour, called meconium; which is dis- charged in the course of the first or second day by stool; and until this is purged off, the child can receive little, or perhaps no nourishment from food of any kind; and which is better omitted. There- fore, in cases where a hired wet nurse is even pro- vided and at hand, it will be better to avoid giving the breast for twenty-four or fortyT-eight hours after the birth, as it may do harm, and can do no good, before that time. It is, by some, thought neces- sary to give the child something to carry off this black matter; but which there is seldom or never any occasion to do, as the child generally has a stool or two the first or second day: and which if he should not, a little manna, a tea-spoonful or two of syrup of rhubarb, or a small tea-spoonful of castor oil, may be given to procure it; but the less such like things are used, the better; as they sometimes occasion troublesome gripings and loosenesses. As it is commonly two, three, or even sometimes four days before the mother has milk for her child, it is usual to give him some kind of food during that 27 interval; but, from what has just now been observ- ed, there can be little or no occasion for it: however, if it did no harm, there would be less occasion to forbid it; but which it certainly does, and that, oftener than is suspected. It is very common for children to be cross the few days before they get the breast, and which is mostly observed to be oc- casioned by griping; which griping is sure to hap- pen, in a greater or less degree, very often con- siderably, if any kind of food, except breast-milk, has been given ; and which is very easily and clear- ly accounted for (and will appear, by observation, to be so), when we consider the quality and com- position of the food that is almost universally given;—namely,—panada or pap; which is com- posed of bread and water boiled and sweetened with brown sugar; to which is, sometimes, added a small quantity of milk: or, oatmeal and water, in the form of thin water gruel, with the same addi- tions. Although these have been intended for, and may seem to be, compositions that are palatable and light, and such as might be easy to the stomach ajt a more advanced age; yet, upon proper exami- nation, they will not be found so well suited to a child, at this age, as might be wished, and as will appear by making a comparison between this kind of food and the mother's milk; which seems the likeliest method of placing the matter in a proper point of view. In doing this, it will be proper 28 to examine distinctly the parts which compose this food ; the principal and most material of which, is Bread; which, in whatever shape or form it is made or given, is a substance, we must acknow- ledge, a child's stomach is not naturally intended, disposed, or prepared to receive; therefore, no wonder, if it should frequently disagree; and which it may reasonably be supposed to do, from its weight, vegetable quality, or some particular anti- pathy, inaptitude, or dislike the stomach has to any thing solid; which last seems one very probable reason; as, when it happens to disagree, all kinds of bread are equally alike disagreeable, and that, commonly, even in the smallest quantity, and which I have frequently observed it to do with chil- dren, in other respects, remarkably strong and healthy,- who could not bear the most trifling quan- tity of bread, of any sort, in their food without giving them apparent uneasiness. Bread may be known to disagree, when the food which contains it is rejected, or thrown up soon after it is taken, unaltered or unchanged in its appearance: or, by a looseness with much griping and green, sour stools; but it most commonly happens that the sickness, and the griping with looseness both occur together. The child upon this occasion is sometimes observed to have a very great dislike to the food when it is made thick with bread, and it is with difficulty he can be got to take it; but which he will take more readily, and with more pleasure, when it is made 29 thin. If the bread should contain alum, or have undergone any other adulteration, the bad effects of it will be increased. Water, that has had a piece of bread boiled in it, when mixed with milk, seems the least exceptionable manner of giving (if it can be called giving) bread.—No wonder bread should disagree now, when we find many grown persons with weak stomachs with whom it disagrees.. Oatmeal, in the form of water gruel, caudle, &c. is liable to the same objections with bread, as it pro- duces much the same effects. Sugar cannot be excepted to, exactly upon the same ground as bread; as, when it is mixed with the food, it dissolves,, and cannot therefore offend the stomach by its weight or substance; yet there is a very powerful objection to it, which is; that as sugar is disposed to turn sour upon the stronger stomach of a grown up person, it certainly, and without any doubt, will do it, in a much greater degree, with an infant; and will have a perpetual tendency to promote griping with, or without looseness; and, when such complaints do exist,, will add to them greatly.* Sugar is almost universally put into the food of children*; and the reasons given for it are; that it; •These objections do not apply to the best double-refined loaf. stigar; which does not readily ferment, or turn sour in the stomach.. c 2 30 makes the food palatable, and which it is supposed, a child will not take, so well without it: and that, as it is rather loosening (when brown sugar is made use of), it will help to keep the body open. With respect to the former of these reasons, it may be observed; that if a child, from the beginning, is not accustomed to sugar, he will undoubtedly take his food just as well without it (a very few, if any exceptions to the contrary). But if he has been used to it for some time, there may be some diffi- culty in weaning him from it; yet that may gene- rally be done by making a proper trial. As habits are not subdued without some difficulty at so early a period ; we cannot be too guarded against such as may have an injurious tendency, even at this tender age. It is no recommendation to the use of sugar that it makes the food palatable, for as children are usually fed as long and as much at a time as they will take their food, they by that means overload their stomachs so much, that, by frequent repeti- tion, the most fatal effects may ensue.----In an- swer to the latter argument in favour of sugar, it may also be observed ; it very seldom happens that children have occasion for any thing opening, as they are at this age, if in health, naturally dispos- ed to be open in their bodies; and when, at any time, they are otherwise, a little manna, castor oil, or magnesia, which may be given safely at any time, will be better for the purpose; as, any thing taken as a medicine constantly, loses, in a great measure, its effect; and, on that account, becomes of very 31 little use when most wanted. It may be said, the mother's milk is sweetish: it is so; and there could be no impropriety in imitating that saccha- rine or sugar-like flavour, provided the means used for that purpose were perfectly, or nearly, consist- ent and unexceptionable on other accounts. Al- though sugar imparts a sweetness to the food that gives it the flavour of the mother's milk; yret it adds, at the same time, other qualities which are foreign to it, and which make it an improper substi- tute. The natural sweetness of the breast-milk, and that which is produced by sugar, although much alike to the taste, may differ as much in qual- ity as any other two sweet things: honey and sugar resemble each other a good deal in flavour, yet dif- fer very materially in quality, and effect, when used as part of the diet or for other purposes: so may and does the natural sweetness of the breast- milk, and that produced by sugar, or any other sweet substitute that has yet been discovered. The third and last article that composes this food, is water ; which, when soft and pure, is not lia- ble to any exception.* Milk, is seldom added the first two or three days; yet, in a small quantity, it would be an useful addition; although it will but very imperfectly counteract or lessen the injurious effects of the bread and sugar. * The Delaware or Schuylkill water, when clear, is to be preferred to the water from the pumps in Philadelphia; as the Utter is extremely impure. 32 Having descanted upon the qualities of the mate- rials of which this food is composed; it may not be amiss further to explain how and in what manner it must constantly disagree, more or less, with an infant; in doing which, it will be necessary to con- sider; that the digestion of the food in the stomach is a process by nature established and supported, in the same regular, uniform manner, and with lit- tle variation, during life ; and that to support this regularity, nature has provided for us, and direct- ed us to the choice of, such kinds of food as are best suited to our support at the different periods of our life; from which if we sensibly deviate, the diges- tion will be interrupted, or go wrong, which must throw the stomach and bowels into disorder, and by which the whole body, if the change be consider- able or continued, must suffer. There can be no doubt that the mother's milk is the only sustenance nature has designed for an infant at the time of his birth; that the stomach and digestive organs are accordingly particularly calculated and prepared to receive it; and that any other kind of food, which is foreign to, or differs very essentially or materially from it, must disagree more sensibly at this tender age, when the digestive organs are weak and im- perfect, and, therefore, less able to overcome an error or irregularity from the diet, than at a future and more advanced period, when they have acquir- ed a degree of strength. .33 The digestion of our food is always accompanied with, and (so far as has been discovered) depends - chiefly upon a fermentation in the stomach; which goes on with great regularity in a state of health, unless interrupted or disturbed by something taken into the stomach which is foreign, unnatural, or un- adapted to it; or which, by its quality, will check, retard, or vary the proper fermentation. From what is here observed, it will be easy to conceive how well suited the stomach is, from its warmth, its natural juices, and the liquors regularly taken into it, to dispose the vegetable and animal food which we daily receive into it, and upon which we subsist, to ferment; and which happens very much in the same manner in, as out of, the body. The human frame and constitution is so disposed by nature, as to require its support and nourishment from a combination of the efforts and effects of these two different fermenting substances (for stones, min- erals, and every thing else in nature that is not ca- pable of fermentation, will afford no nourishment to the body); and therefore the regularity of the diges- tion of the food, and the consequent health of the body, depend very much upon the quality and due assortment and mixture of these different substances or foods in the stomach ; for if either the acid or pu- • The doctrine of digestion depending solely upon fermentation is now obsolete. Solution has a greater agency in this process 34 trid quality prevails too much, and for a continued length of time, the health will suffer by it ; and in either case, the food cannot, for want of a proper and suitable ferment in the stomach, yield and •give out its proper nourishment: hence the sto- mach and bowels are disordered for the present, and must lose their strength and powers in common with the other parts of the body ; and, if the cause is continued, it will lay the foundation for many dis- eases. But when suitable proportions of animal and vegetable food are received into the stomach together, a proper fermentation ensues, by which the digestion goes on briskly, freely and without interruption ; the food affords due nourishment, is grateful to the stomach and bowels, and does not disturb them or occasion any uneasiness in them (for it is necessary to a good digestion that it be quick and hasty ; as whatever lays upon the stomach without digesting readily, does not digest perfectly, and always gives uneasiness) : hence the propriety of, and the natural desire and inclination we have for, a mixture of animal and vegetable food constant- ly and regularly in our diet. The injuries done to the human body by errors in the proportioning of animal and vegetable food, are as follows. First, with respect to animal food, it is to be ob- served ; that from nature's bountiful supply of yegetables and vegetable productions, in the form 35 of fruit, roots, bread, &c. wine, beer, and other fer- mented liquors, throughout the habitable world, in- juries from excess of animal food rarely happen (es- pecially to infants, in this part of the world): however, when from any accidental, occasional cause they do happen, a corruption and destruction of the body, from the effects of an excessive prevalence of the putrid fermentation, must, if the cause be continued, ensue; and which is the case in the sea-scurvy, when in long voyages, the seamen are deprived of, or restrained in, the use of vegetable diet: and if any of the human species were to be confined entirely to the use of animal food, of whatever kind, and wa- ter (pure water partakes of neither an animal nor ve- getable quality, in the smallest degree), they would very soon die in the situation here described. Secondly, with respect to vegetable food it is to be observed ; that an excess of it will not upon all oc- casions be immediately fatal; yet it is, with all, in a natural and healthy state, inadequate to the pur- poses of good health. For it is well known, that the sourness that is produced in the stomach by a prevalence of the acid fermentation there (in conse- quence of the too free use of vegetables), is not on- ly injurious (as acids in all forms are) to the growth and nutrition of the body, but that it is also the cause of indigestion, and severe and painful com- plaints in the stomach and bowels: for when a person, with a weak stomach especially, indulges frequently 36 and freely in greens, fruit, acids, and other vege- table productions, he will almost as certainly be troubled with a sourness rising from his stomach, the heart-burn, or an uneasiness and sense of a weight or load there; all, or each of which, are oc- casioned by an excessive prevalence of the acid fer- mentation in the stomach, which checks and restrains the digestion, by which the food lies as a load upon the stomach, accompanied with a painful sensation and oppression, and which is most com- monly attended with costiveness with grown per- sons ; but with children a sickness frequently, and generally a griping with looseness. As the hand of Providence is admirably display- ed through the whole creation, in connecting and adapting the several parts for the preservation of the whole; so particular care has been taken to adapt food to every animal suitable to its situation. As the human race are not in any parts of the known world so circumstanced as to be under a ne- cessity of confining themselves constantly and en- tirely to the use of animal food, so their nature is not calculated to subsist upon it: but as there are fre- quent occasions in many parts of the world, where, if they could not subsist for long periods and sea- sons upon vegetables alone, they must perish, so na- ture has a provision made for such occasions; and this provision is; a power in the animal constitution to subdue, in part, an excess of the acid fermen- tation and its effects, by a natural disposition in the animal to a putrid tendency, or putrefaction; and the greater the animal powers, that is, the stronger the constitution, the more this disposition prevails; from which, it becomes very consider- able with the strong and healthy of grown persons; and of course but very slight and inconsiderable with infants. Bread, and sugar, together or separately, when mixed with water, in the form of panada, or pap, are, in common with other vegetables, readily dis- posed to turn sour in a certain state of warmth, and with a slight degree of fermentation (as will con- vincingly appear by making the experiment): such a mixture, therefore, taken into the stomach of an infant, where it will meet with nothing that will, in any considerable degree, counteract this acid ten- dency, must inevitably produce an acidity or sour- ness, in a degree proportioned to the quantity taken, and the length of time it is continued. It is from this cause the sour smell and green colour of chil- drens' stools proceed; which are always attended with griping and looseness; sometimes with con- vulsions ; and which frequently prove fatal at this early period. When this food has been given to children, I have constantly observed them to have either a sickness, or sour, green stools with more or less of griping, or both, which have generally in- creased while the food was continued, and which D 38 were mostly troublesome, often alarming: and, on the contrary, when I have been able to prevail with a nurse to avoid giving any thing until the mo- ther's milk was ready, such like appearances and symptoms have rarely occurred, and when they did, it has been in so slight and moderate a degree as not to disturb the child, or be worth notice. It will, no doubt, now and then happen, that children, from causes which we are strangers to, will have complaints in the stomach and bowels that are alarming and dangerous; yet, if nothing in its nature sour, or disposed to turn sour, be taken in at the mouth, the sour smell and green colour of the stools will not happen, except perhaps, in the slightest degree. Cold is a very common cause of griping with looseness; but, in that case, the stools will be nearly of the natural colour, and free from sourness, if nothing in the food conspires to make them otherwise. The sour smell, green colour, and the watery and often frothy appearance of the stools, are uner- ring signs, and the regular consequences of the acid fermentation from improper food. The mother's milk partakes of both the animal and vegetable quality, and therefore is, as nature designs it, perfectly suited to the purposes of di- gestion and nourishment for children. 39 Cows' milk also partakes of both the animal and vegetable quality: and although it differs somewhat from breast-milk, may yet be substituted for the lat- ter, and to advantage when properly directed and managed; as will be presently explained; but it has not sufficient powers and qualities effectually to correct the injurious effects of bread and sugar, when mixed with them, although it will do it in part. From this short and familiar account of the di- gestion of the food, the propriety of attending to the quality of it, with children, is strikingly obvious; as they are ill qualified, from their natural weak- ness and delicacy, to combat the effects of a mate- rial irregularity^ in it. Sir John Pringle, a physician of eminence, has been at great pains in investigating and ascertaining the nature of the digestion of our food ; and most of the arguments here offered are consonant with his reasoning and experiments upon the subject. With respect to vegetables, he in general observes; that when they are taken alone, or even in over proportions, into the stomach, by the acid fermen- tation which they must necessarily undergo, the di- gestion is interrupted, and many complaints of the stomach and bowels produced; all of which are observed to happen the most remarkably with those of weak stomachs and bowels, even of grown per- 40 sons. What effect, therefore, may a diet altogether vegetable, and which differs so much from breast- milk, be expected to have upon the uncommonly weak and delicate stomachs and bowels of infants? certainly a very bad one. Bread must disagree, on two accounts ; as being a vegetable ; and from it£ substance, which (as already observed) the stomach of an infant is not by nature intended, and, of course, prepared to receive.—Sugar will disagree from its disposition, as a vegetable, to turn sour, as well as from its other unfavourable qualities. They who are unacquainted with the properties of sugar, cannot always be readily brought to conceive that one of the sweetest things in nature will so readily and easily be converted into the directly op- posite quality, to the taste of sour; but which they will assent to, and be convinced of, when they re- flect that it happens in the preparation of all sorts of vinegar in which sugar is an ingredient; and that vinegar, for some uses, is made of sugar and water only, by means of fermentation. From what has been observed, there will not be much difficulty in accounting for the prevalence of griping with looseness, he. with infants at this pe- riod ; especially when it is farther considered how few children escape having food of the quality above described forced into them in great quantities with little intermission, frequently from the moment of their birth. It is a very common practice withnurs- 41 es to feed children, at this time, when they are cross, supposing they are hungry and want food; not knowing that they are, by such means, adding fuel to the fire, and promoting the cause, which is no other than griping from the same sort of food which they have before given. For although fretfulness and crying may be signs of hunger, yret they are not always so, as, an uneasy or painful sensation, from griping oc- casioned by cold, improper food, or any other cause, must equally occasion them: and when a child has had as much food as is necessary, how great the absurdity, how great the hardship upon him to be stuffed and gorged night and day with immoderate quantities of what, for the most part is the chief or only occasion of his uneasiness! If children are not fed at all, are kept warm and dry, still and quiet, and are never taken out of bed except to be dressed and cleaned, they will very rarely be cross the first, second, or third day ; and, if they are, it may as reasonably be supposed to proceed from any other cause as hunger. Warmth, and rest answer every intention of nourishment until nature requires the use of food, and prepares the stomach and other organs and instruments of diges- tion to receive it, for that purpose. There is yet one other argument remaining in support of the impropriety of this food at this period, which is ; that a child shall have, while he takes this food, for the first two, three, or four days before he gets the breast, a sickness with or without throwing d2 42 up, or a griping with looseness, &c which will disappear totally, or in a great measure, by quitting this food and being fed entirely from the breast; and this is what happens very often, and in a very sen- sible manner, as may be observed by those who will notice it. To what causes are these sudden and material changes and appearances to be attri- buted, independent of the impropriety of the former food, and the salubrity and propriety of the latter ? Is not this as convincing an argument as can be given, and would there need any other ? It is of the utmost importance to have this subject properly understood and attended to, as the num- ber of children who suffer in their health and lose their lives by the gripes with looseness, at this crit- ical juncture, is very considerable; and as there is no complaint which, at this tender age, they suffer so frequently and so much from, and which is to be more dreaded, especially with those who are dry- nursed, and are of course confined to it for a longer time: for although a child who is intended to be wet-nursed may suffer a good deal by7 impro- per food, yet it is but for a short time, and as he gets the breast in two or three days, the cause is removed, and he generally, sooner or later, over- comes the effect of a short irregularity: yet puny, weak children may, and often do, lose their lives from it, even in that short space of time. But when children are dry-nursed, and confined to such food, 43 no wonder so few should thrive and do well: those, who live, are most commonly teazed with a frequent griping and looseness, which keeps them always weak, puny, and spiritless, and gives them a pallid sickly look; and daily experience but too fully convinces us that numbers are carried off by- it. From what has been observed, it will appear ; that children very seldom can have a real occasion for food, of any kind, before the mother is capable of supplying it; and that, food (especially such as is commonly given upon this occasion) is more likely to do harm than good: therefore, it will be better, in general, to avoid giving any thing as food, till the mother's or another breast be ready. This practice, considered as an innovation in the esta- blished custom or rule of nursing, will, no doubt, meet with opposition from some, merely on that account; it can be founded upon no other pretext, as reason and experience unitedly conspire to confirm the propriety of this practice, and to place it in the most clear and convincing light; and which must have its proper weight and influence with those who prefer the conviction of their own senses to vulgar prejudice: yet if any doubts or objections arise, they will be solved in the best and most satis- factory manner by making the experiment, which, upon most occasions, may be done with the utmost safety. 44 It sometimes happens when a mother intends to nurse her child herself, that it is some time before she can be satisfied whether she will be able to do it or not (especially of the first child), from the state of her breasts, the quantity of her milk, or other causes. It also may happen, that when a wet nurse is intended, she may not be ready or at hand for a like time. In either of these cases it will be necessary to give the child some food, and to con- tinue it until the breast be ready: for which pur- pose, it will be advisable and proper to make choice of such food as appears to resemble and ap- proach the nearest in quality to the mother's milk. Asses' milk comes nearest to the human of any we are acquainted with in use; and therefore, when it can be had, is very desirable and proper: it should be given, alone, without bread, sugar, or any thing else, and always as warm and fresh milked as possible; and the child may be constantly fed with it, nor will any other kind of food be necessary: but, as from the expence which attends it, and the consequent difficulty of getting it, the more opulent only can be indulged with it, it will be necessary to substitute something else that can be more uni- versally' obtained. Cows' milk, as being the only milk in general use, must be had recourse to, and will answer the purpose very well; but as it is a good deal thicker than breast-milk, it will be pro- per to reduce it to the same consistence; and which may be done very well, and with propriety, by di- 45 luting or mixing it with water. As milk is fre- quently mixed with water by those who sell it, it cannot be said, with any degree of exactness, what proportion of water must be added to the milk to reduce it to a suitable consistence: but, if the milk be good, about one part milk, and two parts water, will do very well, to give at the first. In mixing the milk and the water, the follow- ing directions ought to be attended to. The wa- ter that is to be put into the milk must be the softest (if pure) that can be had, must have boiled, and be of such a heat when put into the milk, as, when thus mixed together, they may be as nearly of a proper warmth for the child to take as may be (viz. about the warmth of milk when it comes from the cow). It will be advisable to mix no greater quantity at one time than it may be supposed the child will take at once. The milk ought to be as fresh milked as possible, and, if warm from the cow, the better: but as it can seldom be had warm from the cow oftener than twice a day, it may at other times be prepared from cold milk. It ought not, at any time, to be put upon the fire to warm or boil. It may be better if the milk is obtained from one cow only, and not a number, as is often the case. It is observed that the suck of two different nurses sometimes disagree with children; so, to avoid that 46 risque on this occasion, the precaution may be adopted. The advantages which attend this mode of mix- ing the milk and water, are; that the milk, hy this means, suffers little or no change or alteration, ex- cept being thinned, and is received by the child in a state which must be best suited and most agree- able to his stomach: whereas, on the contrary, when milk is boiled, it suffers a change which makes it harder of digestion, to an infant, and also binding: warming it upon the fire, without boiling, gives it these qualities in a slighter degree: if milk is suffered to stand until it be so cold that the cream separates, its quality is altered: if milk and water, when mixed is suffered to go cold, and is warmed again once or twice, especially7 in warm weather, it is very apt to turn sour. From which consider- ations, it appears how necessary it is to conform, as near as may be, to the rules above-named; all which may readily be complied with, in part, very easily, upon most occasions. There will seldom or never be occasion to put sugar into this food to in- duce children to take it, which they will do equally as well without, if, as has been before observed, they have not been accustomed to it: and if a child is to begin with this food who has been used to sugar, and refuses to take it without, a little may be put in, which may be diminished in so gradual a manner, that, in a little time, he may, perhaps, come 47 to take it without any at all. Sugar is somewhat less injurious than bread; therefore it is the lesser of the two evils. Loaf sugar will alwayrs be prefer- able to brown. This liquor or food, thus prepared, a child may be fed with as often as feeding is necessary, nor will any other kind of food (if this agrees) be needful; and, from what has been observed, the oftener it is fresh made, the better, and which is much preferable to what is warmed over again. Care should be taken that the milk is not adul- terated with any thing that may be hurtful: chalk is said to be put into the milk in London, which must make it very improper food for children, as chalk is powerfully binding. In this town I believe nothing but water is put into the milk, which can do it no other injury than making it poorer and thinner. This is a food which can be easily procured by- all ranks of people, and is prepared much more rea- dily and with less trouble than that made in the usual manner: is palatable and agreeable to children, as they take it readily, and frequendy with avidity and seeming pleasure : and what recommends it still more powerfully, is, its approaching near the qual- ity and consistence of, that natural food, the mo- ther's milk; of which although it should not be sup- posed to be an exact imitation, yet it appears to be 48 nearer than any thing else we are acquainted with that can be generally and easily obtained. It is very nourishing, and agreeable to the stomach and bowels, as appears by its seldom producing, or being accom- panied with, any of the disagreeable symptoms of griping, &c. &c. which the food, prepared with bread and sugar (as has been observed) so very commonly does. When a child is very small or weak at the birth, from any cause, there does not appear to be any ne- cessity for giving food much sooner than if he is lusty and strong; as, if what is given should happen to disagree, by bringing on a looseness, or other- wise, the food may, in his weak state, do much more harm to him, on that account, than it would to a stronger child; and in such a case, it will be more advisable to wait till the breast be ready, and the child able to take it : but if a child is so very weak, that there appears but little prospect of his being able to take the breast, in a reasonable time, it will be proper to give him something; and, upon such an occasion, nothing perhaps is so proper as broth, which must be thin and weak: chicken broth, or chicken tea as it is called, is very well adapted to the purpose. But, veal tea properly- prepared, will be preferable to that of chicken or any thing else. If any other kind of food may be thought necessary, asses1 milk, or the milk and wa- ter, may be given at intervals; perhaps it may be 49 full as well to give the broth and milk and water nlternately and by turns. Asses' milk seems admi- rably calculated to this occasion.—The following case, which fell under my observation, will explain the situation we are treating of. Miss M----, at her birth, was remarkably small, and very weakly, although at her full time: it was intended she should be nursed by her mother: the common food of panada, or pap, with sugar, and without milk, was, as usual, given the first day. On the second day, she had a sickness, which brought up part of what she tfjok, attended with a looseness and griping: a.little milk was now added to the food; the complaints continued, and on the third cl.xy the looseness was increased, with more griping, and watry, sour stools of a greenish colour. The child was now so weak as not to be able to take the breast, which was ready for her, and there seemed to be no probability of her living two or three hours; she was accordingly given up by the nurse and attendants. Seeing the child in this situ- ation, about to expire, I desired a little broth might be given; a little veal broth was very soon pro- cured, and a few tea-spoonsful was, with some difficulty, gotdown^ which staid upon the stomach: in a short time a little more of the broth was given, which went down rather better than the first, and also staid with her. The child, from this time, began apparently to revive, and to show signs of returning E 50 strength: the broth, only, was continued all that day, and the next her complaints were much abated, and she was able to suck a woman who had given suck for some time and was purposely provided, thinking her breasts would, for that reason, be ea- sier to draw than the mother's: the child recovered, was afterwards healthy, and throve well. If the child, in the case before us, had not been fed at all with the panada, she would not, most like- ly, have ailed any thing, nor wanted food: for if she was able to survive, the three days, with such complaints, how mucji better might not she be sup- posed to have been without them, as*the food which she took cannot be supposed to have afforded her any nourishment ? There is little doubt, from the circumstances of this case, but that the panada was the occasion of the sickness, griping, &c. and that the child must have died, as great numbers do in ex- actly the same situation, but for that accidental trifle, the broth. Few periods of infancy are more embarrassing than the short one we have been attending to of a -new-born child before the mother's breast is ready for him. The child's cries, the mother's distress in hearing them, and the nurse's solicitude to still them, frequently form a scene somewhat dis- tressing. The common cause of the child's fret- fulness so commonly attributed to hunger, is L not, cannot, from what has beenobserved, be the 51 general cause. There can be no doubt but that the uneasy sensations a child must experience from a sudden change of situation, exposure to the air, the dress with which he is necessarily encumbered, and the free manner in which he is handled, and the cold which he gets so as to occasion griping and uneasiness in the bowels, are sufficient causes of uneasiness, independent of the two general and premature use of food, and which might very gen- erally be avoided by averting and preventing as much as is in our power, these disposing causes, and which consists in affording ease, warmth and quiet, and avoiding food, especially such as is im- proper. Although I have, at some length, been endea- vouring to point out the most suitable food, and the manner of administering it from the child's birth till the mother's breast is ready for him, if such food should really at any time be wanted; yet in many cases I am, as already observed, convinced it will be inadequate to the purpose. There remains however a method which will be more certainly successful; which is, that whenever food may be necessary at this period, it ought to be supplied from a breast. It can rarely happen but that this may be obtained, either in town or country, from some relative, friend or other healthy woman, who will spare a sufficient supply of suck 'till the mother's be readyr; as the sex, of all ranks, feel much for each other in this situation. It is needless to urge the certainty and propriety of this measure, and the effectual relief which it will afford ; and still less to point out the necessity of it, when all other kinds of food may have particularly disagreed. Before closing this subject, I must repeat; that from the foregoing arguments, confirmed by con- stant experience, I can confidently assert, that in all cases, a child should not receive food of any fcind, not even from a breast, earlier than twenty- four hours after his birth; and that, in a general way, thirty-six or forty-eight hours will still be preferable. OF THE FOOD IN DRY-NURSING. When a child is intended to be dry-nursed, the the milk and water, prepared as directed (page 45) may be begun with and given, towards the end of the second day, and continued; and if the child thrives well, it will be advisable to confine him to it entirely, without giving any other food, except veal tea occasionally, as hereafter advised, for the first, second, or third month, or until his stomach will bear to take it with bread in it: when that will happen, can only be known by making the experi- ment ; as some will bear it much sooner than others. There can however be no occasion, if the child does well, to make trial of the bread for the first or second month; and when, at the end of the second 53 month, if a little bread is put in, and agrees, with- out producing any of the disagreeable, untoward symptoms of sickness, griping, &c. before enume- rated, it may be continued, and increased in pro- portion as it seems to agree. Care is necessary in the choice of the bread: it should by all means be free from alum (which is sometimes put into the flour to make it white), which, from its strong as- tringent or binding quality, will be highly injurious: it should not be too fine, nor too coarse (although the former extreme is less to be avoided) ; the first, may make it binding; the latter, too loosening. The bread should be made with yeast, without but- ter, or any kind of seeds, and very light; so that, when mixed in the food, it may be as smooth and free from lumps as possible ; which will induce most children to take it better, and it will be more likely to sit easy upon the stomach. Hard biscuits, commonly called crackers, are sometimes given; but they are heavy, owing to their being made without yeast, and not fermented. Every sort of bread made with leaven is very improper for chil- dren at any age, as it is difficult of digestion, and is much disposed to turn sour upon the stomach.— When bread, of any kind, is put into the food, it ought to be boiled sufficiently in water first, and the milk put to it afterwards without being boiled. When all sorts of bread have disagreed with the child, I have sometimes found that a piece of upper crust, boiled whole in water, and the wa- e 2 54 ter poured off clear and mixed with the milk, would agree very well. By this method much of the nutritive part of the bread is obtained, and is given to the child in such a manner as must be most acceptable and best suited to his stomach and diges- tion.—Sugar will always, and at every age, be bet- ter omitted; as the bad effects of it will, during the state of childhood, still take place : and although its use may not always be attended with the sensible bad effects of looseness with sour green stools, &C yet it may affect the digestion, and cause an acidity or sourness, in such a degree, without looseness, as to injure the stomach and bowels, and prevent the food from affording the nourishment it other- wise would give. It vitiates the taste; and those children who are accustomed to it in their food, will seldom be brought to take any thing, willing- ly, that is not sweet; which makes them nice and particular in the choice of their food.—It palls the appetite so much, that a great many children who are liberally supplied with it, have weak, bad appe- tites ; which last, united with the other bad effects produced by it, must make them puny, and pre- vent their growth and thriving.----It may be said that many children do well with sugar in their food, and suffer no sensible inconvenience from it: so it may happen: but as it so very frequently happens otherwise, and may do some harm, although not always in the most sensible and perceptible degree, is it not better, and more eligible, to avoid the risque of any, the least bad consequence from it, 55 by entirely omitting it; as no good or advantage can attend its use; and the most that can be said in its favour, is, that it is an indulgence, and that, a needless one. There is a machine made of horn, or tin, in use with many for feeding children: it is so contrived that the child sucks his food from it as from a breast. Some children will not, without difficulty, take their food with a spoon or boat, who will take it more readily with this machine; upon which occa- sions it becomes very useful ; otherwise it has no advantage over the spoon. I have known some chil- dren who took their food very unwillingly, and were much troubled with the gripes and a loose- ness, when fed with a spoon, who took it more readily with this machine, and were more free ftom this complaint; but which I discovered to be owing to their dislike and the disagreement of bread; as those children took it greedily with a spoon, and were well with it when the bread was omitted or less- ened. As a child gets his food from this machine by sucking, he has it thinner than when fed, with the food as it is commonly prepared, with a spoon. If the food and manner of preparing it should in every form disagree with the stomach and bowels, recourse may be had to Naples biscuit; which may be softened down with a little boiled soft water and given with a tea-spoon. The biscuits may be made S6 of the shape of a finger, in which form a child will suck and dissolve them in the mouth, occasionally, without being softened with water.—This is a com- position that is found well adapted to a child's sto- mach and digestion: the proportions of flour, egg and sugar, of which it is composed, are well adapt- ed to form, without the aid of any fermenting lea- ven, a light substance, which like breast-milk, being composed of a mixture of animal and vege- table matter (as explained in the account of the di- gestion of the food), becomes well suited at this time. Here the acid effects of the sugar are coun- teracted by the egg. How far yeast might be sub- stituted altogether or in part for sugar, to make the composition light, I am not yet informed.—-As this food is sweet, a child may be induced to take too much of it at a time if some caution is not observ- ed.—One objection to its use, is the expence : how- ever, there will seldom be occasion for its use for any great length of time, as trials of the other food may any time be made, and repeated or continued as they appear to agree. A child, whatever he is fed with, should never have more food forced upon him at a time than he is disposed to take readily: for if he should happen to overload his stomach, and not bring it up again in a curdled state, it will disorder him, and he may suffer much from it. This stuffing, gorging and overloading of children with food, is an error 57 as great and prevalent as any in nursing. It is done with the laudable intention of promoting their hasty growth and thriving, and also to make them rest better. These are however mistaken designs, as the contrary purposes are produced by them. If a child overloads his stomach at the breast with milk, (as often happens) he is relieved by throwing it up in a curdled state; but this seldom happens with a child who is dry-nursed, especially when he gets bread; therefore, when his stomach is overloaded, he will suffer as much as a grown person in a like situation; and frequent repetitions of the practice will have the worst, and sometimes fatal conse- quences. Nothing is more common than to give and even force food into a child when he is cross, notwith- standing he has been plentifully fed but a short time, perhaps a few minutes before, and when his fret- fulness is owing to the improper quality or undue quantity, or both, of the food already given. As the taking of food is the most necessary and power- fully instinctive act of an infant, he, when in pain from any cause, seems soothed and lulled while employing it: hence while the spoon is in his mouth, he appears appeased, although his stomach is over- loaded with food. When a child, who sucks, is in pain from any cause, he will, if permitted, lay at the breast continually, and is never quiet but when so amused. 58 It is necessary therefore to be very cautious, soon after a child has had a reasonable quantity of food, in giving him more, if cross, although he should appear to receive it greedily ; as such fretfulness may most likely be altogether occasioned by uneasi- ness or pain from what he had before taken : and it will be better always to give a child rather too little at a time than too much, by giving a little and often. There is nothing that relates to the management of a dry-nursed child that requires so careful an inspec- tion, and so nice and judicious a regulation, as the quantity and quality of the food, and nothing that is so generally misconceived and ill-managed ; no wonder therefore the consequence are so often unfavourable ! Many persons have a habit, in feeding a child, of putting the food first into their own mouths, with a design to bring it to a proper warmth. Indepen- dent of indelicacy, it is improper, as the saliva of the person's mouth will be hurtful to the digestion of the food in the child's stomach; the saliva, being a necessary aid in digestion, and can only be properly furnished hy the mouth of the person who is to have the food. I have known many instances of children who have been dry-nursed, whose food was prepared in the usual way, of milk, bread, and sugar, with, and without a proportion of water in it; who, not- withstanding repeated medical assistance, have been 59 brought to death's door by perpetual gripings with looseness and sour, green stools, and who have been restored by confining them entirely to the simple food above mentioned, with which, alone, they have been supported for some months, and have grown remarkably strong and healthy ; and when at any time, during that period, a little bread was, by accident, or otherwise, pvit in the food, the disa- greeable symptoms as certainly recurred, and con- tinued till the bread Was again left out. When bread disagrees with children, I frequently observe them to have a dislike to the food that contains it, which they take very unwillingly, although it be made quite smooth; and bread of every sort, is*equally dis- agreeable : however, although this is commonly the case, yet it may, and does sometimes happen, that a child who has been accustomed to have bread in his food, will not willingly take it without something in it which will thicken it, when it so happens, a little flour may be boiled in water, and the milk add- ed to it after it is boiled ; and as flour is rather binding, it will be an useful addition for the present; and if, hereafter, it should be proper to drop it, it may, most likely, be done by putting in a little less each time the food is made, till, at last, it be entire- ly left out. Children's food is prepared in this man- ner chiefly, with flour instead of bread, in Paris ; and that, very likely, from being found to agree so much better, which in general it certainly does, while they are very young. 60 From finding, in so many cases, that the milk and Wi ter prepared in this manner, had so much the advantage of the food made in the usual way, I have been induced to prefer and advise it upon all occa- sions, when a breast is wanting ; and have repeat- edly found it to answer most desirably. How- ever, I am but too sensible it is imperfect and falls short of an exact imitation of breast-milk, and therefore of course may be expected, and will be found, sometimes, inadequate to the pur- pose ; yet, until something else is discovered that promises, and is found by experience, to be bet- ter suited to the purpose, and that can be easily and universally obtained (for whatever is rare, or diffi- cult to prtpare or come at, will be far from answer- ing a desir.-ble and general intention) it is justly entitled to an attention and preference. I have observed that some children, who take this food, are sometimes costive; and which is the only unfavourable effect I have observed it to pro- duce : but as the effects of costiveness are much less to be feared than tHose from looseness, and as cos- tiveness is always easily, readily and safely re- moved and prevented, it becomes an object of trifling importance ; and if a child, who takes this food, should at any time be inclined to be costive, a little manna, castor oil, magnesia, &c. will always re- lieve it. A little chicken or veal tea will be proper for a child who is dry-nursed and takes this food, and 61 may be given now and then, occasionally and par- ticularly when the food seems to disagree, either by causing a sickness with or without throwing up j or costiveness; both which the broth or tea is, in a particular manner, calculated to relieve; and a lit- tle of this tea added to the milk and water ap- proaches as near to, and produces as close an imi- tation of, the quality of breast-milk (the sweetness excepted) as perhaps is to be obtained by a familiar artificial composition: but as preparing the tea and mixing it with the milk and water constantly, would, in many situations, be attended with trou- ble and difficulty, and as it is not always needful to be done constantly, a very good purpose will be an- swered by giving the tea now and then, when con- venient, alone and by itself, at intervals with milk and water; observing, to be more exact and care- ful in giving it at those times the child happens to be costive, has a looseness (as is equally proper in both) or sickness, or is any way disordered in his stomach or bowels. As the good or bad success of every experiment or trial that is made must, upon all occasions, de- pend very much upon the manner in which it is conducted ; so, in feeding a child with the milk and water, if due care is not observed in the preparation and manner of mixing and giving it, it may disagree, and become as improper as any other kind of food. The proportions of the milk and water above named F 6.2 are, one part milk, and two parts water : for if one part milk, tolerably good, and two parts water, are mixed together, they become of nearly the consist- ence, and look like, breast-milk (and if properly sweetened could scarcely be distinguished from it by the taste) : so that these proportions must, with- out doubt, be the most suitable, and are the most likely to agree with a child at this time. As the quality of milk varies much, it being sometimes to be had very good, and at other times but very poor and thin, the proportioning of it with the water must, in some measure, be left to the discretion of the person who does it. There is a rule, however, in doing it, that ought invariably to be observed; which is; to be careful to make it thin enough, and not exceed the proper proportion of milk, especially at the beginning and in the first month; for if too much milk is put in, it will make the food heavy of digestion, which will clog and cloy the stomach, and maybe attended with indi- gestion, costiveness, with pasty stools; or a griping, with frequent stools, small in quantity, and fre- quently curdled and resembling curds and whey; or a sickness and oppression at the stomach, with, or without throwing up, but most commonly without. Therefore without an exact observance of the rules and precautions, in mixing and giving the milk and water, as here and above described, the proposed ben- efit and advantage from it must not be expected, and 63 cannot be obtained: for, as above observed, it is not the doing a thing, but the manner of doing it, that must ensure success. This caution, in propor- tioning the milk and water, ought to be strictly ob- served, remembering, that it is much safer to be under, rather than exceed the proper quantity of the milk ; for as nurses, or those who feed children, are liable to err in putting in too much milk, by way of making the food, what they suppose good enough; it will happen, that to avoid the risque of starving them, they may literally, and as it is pro- verbially expressed, kill them with kindness. For instance; if a child is fed with milk as it comes from the cow, or with a third part water in it, or perhaps even one half part water, it will very likely disagree, as will appear by some of the unfavour- able symptoms, just mentioned, coming on; and, if constantly continued, may cause the child's death; and from which nothing can rescue him but such an uncommonly strong constitution as falls to the lot of a very few: whereas by reducing it properly with water to such a consistence as may adapt it to the tone, strength, and powers of the sto- mach, and such as it is by nature prepared and dis- posed to receive, it may be expected, and will be found to agree with the major part of those chil- dren to whom it is given. A state of childhood, and a sick bed, are the on- ly situations in life that are denied the refusal of 64 disagreeable and improper things, notwithstanding they may be called good things. The sick man has little better chance of avoiding taking what he dis- likes, and is injurious to him than the infant; for, although the latter can make very little opposition, and is compelled to swallow every thing at the pleasure of his nurse, while his mouth can be forced open; the sick man is in a situation very little bet- ter, as he is as certainly teazed into a compliance with the requests of his friends, by repeated peti- tions and entreaties. By good things, in the diet, is commonly understood, what are the most scarce, costly, rich, and strong, of their kind: and many would suppose themselves negligent in their duty if they did not get all the good things, that their address or pockets could procure for their children or sick friends. I cannot help repeatedly deploring that, upon this, as on other similar occasions, the baneful in- fluence of prejudice and custom is so difficult to overcome, however apparently advantageous the change may be in the result. This difficulty is chiefly supported and increased by nurses, who, it is well known, are not " over fond" of being put out of their way, and who seldom, willingly, submit to be directed, in occasions even of urgent necessity, if they suppose it is in a department which falls un- der their own immediate direction. It appears to be this jealousy of their supposed rights and privi- 65 leges that makes them so tenacious of them, and so zealous in preserving them from infringement: or, it may arise from a mistaken and false concep- tion they form of their own merits in their profes- sion ; in thinking that to have occasion to receive advice from another, will betray a want of know- ledge in themselves. Medical men are seldom al- lowed, or as seldom care to interfere in this, or such other like trivial matters as they have been thought (although they are really of the utmost consequence) ; being deterred from, or despairing of success in, the attempt: or, finding, perhaps, acquiescence and compliance to be more political than an opinion urged: but, as such a deportment becomes a chain thrown across the road to improve- ment, attempts ought to be made to remove it; and which might be done compatible with their own real dignity; which could not fail in the end of be- ing acceptable to the public; and which would be more laudable and candid than suffering an inter- ested servility or false dignity to preponderate against the calls of duty to their friends in par- ticular, and the benefit of the community in general. There will seldom be any occasion to vary or al- ter the proportion of the milk and water, if it agrees with a child, the first month. In the second month however, if a child thrives, and is lusty and strong, the water may be decreased, from two parts, to one half, or nearly so ; which will make the food half 66 milk and half Avater: it will be advisable, at all times, to be careful not to put in too much milk, which may make it heavy of digestion, and may, as has been already observed (page 62), clog and cloy the stomach, which will be attended with disagree- able consequences ; whereas a trifling error in the over proportion of water, can do no harm, and which makes it the safer side to incline to. As it seldom happens that a child is so regular in his body when dry-nursed, as when he gets the breast; it will be needful to attend to that circum- stance : if he be costive, half a tea-spoonful, or more of manna may be given, dissolved in a little warm water, or in the food ; and repeated as often as there is occasion. As manna is one of the gendest pur- gatives we are acquainted with, and pleasant to the taste, it becomes very proper and well suited to this occasion: however, if there ever should be any difficulty in getting a child to take it, a tea-spoonful of castor oil; three or four grains of magnesia; or a little senna stewed with a few prunes, will, any of them, answer the purpose very well, and be very suitable; although the effect of them will not al- ways, perhaps, be so permanent and lasting as that from the manna. Rhubarb, is not so proper upon this occasion: for although it may answer a present purpose, by giving a stool or two ; yet it leaves the body costive and bound afterwards. It is very common to give it upon this occasion; but, for the 67 reason here assigned, it is not a fit or desirable medicine. When a child is too loose in his body, it will be advisable to check the looseness: the means to be taken for that purpose are fully explained hereafter. A child can never be said to have a looseness, or such a one as need be stopped, or even checked, while his stools continue of a proper consistence and are not inclined to be thin and watery; as chil- dren, who have good appetites, and plenty of such kind of food as agrees with them, will commonly have three, four or more stools in the course of twenty-four hours, when in the most perfect health. By a proper attention to the food, &c. children who are dry-nursed will generally do very well: cases will, however, notwithstanding every precau- tion, now and then happen, where they will not thrive so well, or at all, without a breast: but that is never to be discovered until a trial of food has been made; and there seldom or never can be any impropriety or harm in making the experiment. The length of time proper for a trial of food to be made can no way be precisely ascertained or limited in this place, but must depend entirely upon the cir- cumstances of the child's health and strength. When a child is, at his birth, weak, or sickly from any cause, such as, being born before he is at the full 68 time ; from being weak and puny when born, al- though at the full time ; or, from a disease which he may happen to labour under, as a looseness, &c. three or four days or a week may be as long as it will be prudent or advisable to make the trial, if it appears not to agree. But when a child is, at his birth, healthy, and has strength, the trial of food may continue a week, or a fortnight, or even three weeks: a longer delay, in either of these cases, may, if the food does not agree, so far reduce the child as to risque his life ; and may also prevent his tak- ing to the breast afterward. If the food agrees the first, second, third and fourth weeks, it may be rea- sonably expected to do so ever afterward. Before I entirely quit this subject of diet, it may not be amiss to remark, that should it be said, many children do well with dry-nursing upon the usual food, and therefore there is no occasion to alter it: I do not hesitate in acknowledging, that such in- stances are to be met with; yet cannot allow them to be common, or frequent; on the contrary, they are, by daily experience, proved to be very rare. I have no doubt, in declaring, as I do it from expe- rience, that food, prepared in the manner here re- commended, has greatly the advantage of that made in the usual way ; and that many children will do very well, in dry-nursing, with this, who will not do at all with the other; as many, whose lives have been in imminent danger from its effects, have been 69 restored by this, with little, and often no other kind of assistance. Those who, from prejudice, or any other cause may still be inclined to favour the usual mode, may, when that appears not to answer their wishes, be induced to vary it, by adopting and mak- ing trial of this : it has some qualities which will always encourage and promote its use ; which are, that it is simple, and easily tried ; it cannot possibly be attended with the least bad consequence; and, it may be safely declined at any time if it should not answer. There is oftentimes a good deal of difficulty in getting children to take the breast, and which, may happen from different causes ; the most common seems to be, bad nipples ; which, from their small- ness, or unfavourable shape, a child cannot easily take hold of: in which case they must be well and frequently drawn by an older child, or the mouth of a grown person ; or by a glass: but the mouth of an older child particularly, does it most effectu- ally, and is to be preferred. Sometimes the breasts are so swelled and distended as to bury the nipples; and if the nipples are even easy to take hold of, yet the breasts, in that situation, are oftentimes hard and difficult to draw: upon this occasion the breasts must be repeatedly drawn until they be softened. The breasts of some are much easier to draw than those of others ; and it is very usual for one breast 70 to be easier to draw than the other, of the same person. The liking that children sometimes take to one breast more than the other, is not easily accounted for ; as, it often happens, that they repeatedly refuse one, and cannot be even brought to take hold of the nipple by any means or pains that can be taken with them for that purpose. Some refuse attempting to take hold of either of the nipples of one person, who will readily catch at both the nipples of ano- ther : but when this happens, it is commonly the mother's breasts that are refused, and those of ano- ther person, who has been a nurse some time, that will be accepted; by which it may be reasonably concluded, that a child's objection to taking one or both of his mother's breasts may be owing to their not having been drawn before by a child ; and that there is a particular flavour or something in the touch or feel that is communicated to the nipples by the sucking of one child, that induces another so readily to follow him ; as the same dislike and re- fusal will frequendy continue although the breasts have been repeatedly drawn by a grown person. Therefore when the child's refusal of one or both breasts continues some time, it will be advisable to get another child to draw them a few times. This difficulty, which now and then happens, of getting a child to take the breast freely, sometimes 71 becomes a cause of uneasiness to the mother; and her anxiety and pains to accomplish it makes her hurry and fatigue herself more than, at this time, is consistent and advisable, and she needs do: for she may be satisfied that, although he may not at first readily take to the breast, yet there can be little doubt that he will take it in a little time: she may also be assured, that if he will take one breast, he will be brought to take the other, although he re- fuses it for the present; and she must not give it up, but have the breast drawn, two, or three times a day, to preserve the suck in it, which might other- wise go away. And she may likewise be as well assured, that although the child for some time per- sists in refusing both her breasts, yet if he will suck those of another person, he will as certainly be brought to take hers when they have been proper- ly drawn by a grown person, or, particularly, by another child, as above mentioned. These difficul- ties occur most frequently of the first child, and gradually lessen on future occasions. Among the number of causes, that of a want of milk or where there is but little, is not, when it happens, the least frequent; as a child will seldom take much pains when the reward of his labour is tri- fling and unsatisfactory.—If a child is put to the breast the first or second day, he may not, if he is a weak child, have strength enough to suck, especially if the nipples and breasts be unfavourable, and which 72 they very frequently are until they have been oiice or twice drawn.—Some children seem, without any apparent cause, naturally disposed to suck much better than others. It might be supposed, as suck- ing is the most particularly instinctive action of any we are capable of, and so essential at that age, that few or no children would be defective in it; yet some are very shy about beginning, and are never veryr perfect at it. A case fell under my obser- vation of a child, who in every respect was perfectly formed, and was remarkably stout and healthy, who never shewed the least inclination or disposition to suck, notwithstanding every means that could be thought of, to induce him to it, was tried. DIET OF CHILDREN AT MORE ADVANCED PERIODS. When a child is weaned, or dry-nursed, it will be proper to confine hiin chiefly to his milk, or milk and bread, agreeable to the directions given in the former part of this work ; and whatever changes of diet are made afterward, should be, at first, trifling and gradual. There is nothing in general more acceptable and better suited to a child at this time, than a little boiled floury potatoe; just softened with milk; without salt or butter; once or twice a day; and which may be repeated or increased as it is found to agree with the stomach and bowels. 73 A little broth may be given at dinner time occa- sionally. It should be thin and without salt: and the more it resembles the veal tea, (page 48) the better: it should always be made of fresh lean meat, without bones, skin, fat, or any thing that may make it greasy; nor should it have turnips or any fresh vegetables boiled in it. It may be given with or without bread in it, as appears most accept- able to the child. Vegetables in general must be sparingly used in the earlier periods of childhood; and should be confined to potatoes, of which a child may daily partake with freedom in all pe- riods of childhood. The potatoe is light upon the stomach, easy of digestion, and not disposed to promote acidity: and therefore becomes the most acceptable to a weak stomach of any vegetable in common use: being much more so than bread, with which it is nearly equally nutritious. It forms of itself a meal, at once palatable and wholesome; as we observe in many parts of this and a neigh- bouring kingdom, where families, children especi- ally, are chiefly sustained by it in good health, nearly the year about. The quality of the potatoe must be attended to; it must always be of the floury kind, and such as is produced from a light, dry, or sandy soil. The value of this vegetable is yet but partially understood. As an article of food for children, it cannot be surpassed; and it is generally liked by them. G 74 If this mode of feeding is strictly adopted, a child will generally thrive and get forward in a very de- sirable manner, free from those complaints of the stomach and bowels which children are liable to at this period. Care is requisite on the part of the parent or governess to see that nurses or servants do not deviate, which they are very liable to do from negligence or conceitedness. It may be con- tinued for the first twelve, eighteen or twenty-four months, without variation; or even much longer; as I know of no period of childhood that requires any deviation from this plan, that can be attended with any advantage, as herein is contained every thing in a plain simple state, that can be requisite and adapted to the growth, strength, and vigour of the child; and all others are avoided that might retard or diminish them. It is not unusual about the second or third year, to indulge a child with a little of what may be at the table of the parents or servants. This should be permitted, both now and hereafter, with great caution; as it seldom happens any thing there is suited to the child, who is better confined to his nursery and diet. Puddings, of bread, millet and rice, with eggs and milk, without sugar or butter, may be given as they are found to agree with the stomach and bow- els. Sugar, butter, and salt, must form no part of 75 the diet in any shape; and must be completely pro- hibited at all periods of childhood; and the farther the prohibition can be extended to youth, the bet- ter. There may appear a hardship in depriving a child of articles that make food so pleasant and ac- ceptable : there certainly would, were we to draw the conclusion from ourselves: the reverse, however, will be the case, when we make the experiment; as children, who have never been accustomed to these habits, will seldom be gratified by them, but rather show an indifference, which will often continue through youth and even manhood, with evident advantage. All the disadvantages in the use of sugar which have been enumerated in the former part of this work, as applied to infants, (page 54) still continue in childhood; acidity, indigestion, a vitiated appe- tite, and their several consequences, are sure to fol- low, in proportion to its use. Butter, as it is variously used, is proved by re- gular experience to every observer, to be hurtful to children. It is difficult of digestion in any weak stomach, and renders every thing so with which it is taken: it turns rancid, and is very heating; particularly so in toast, baked puddings, pastry; and cakes, or where heat is used; the bad consequences, therefore, arising from sugar and butter, are indi- 76 gestion, obstructions in the stomach and bowels, feverishness, paleness, weakness, want of thriving, delicacy, and depravity of appetite, enlargement of the belly, worms, and other concurring appearances to be observed in delicate and weakly children. It may seem odd, that the two things which chil- dren appear most fond of (sugar and butter) should be of all others, they get, the most injurious: but it must be acknowledged they are not naturally so fond, but become so by habit; for if a child from his birth is not permitted to taste these forbidden fruits, he will be preserved from their deleterious effects without the smallest consciousness of their want, or a desire to have them. Experience, with those, who, out of a due regard to the present and future health and well-being of their offspring, will make it, will be convinced of the justness of the practice here recommended by the comparative benefits attending it. There are, some, however, who from a timorous, mistaken indulgence, cannot assume resolution sufficient to do what even their reason assents to.—Such a want of resolution is oftentimes more to be deplored than assisted.—It is evident, therefore, that every article of the diet, in which sugar or butter form a part, ought to be rejected at all periods of childhood. Dumplings, and hard puddings of all sorts, are better avoided. 77 Salt, as it creates thirst, and vitiates the apptetie, is to be avoided; the more especially as it can be of no advantage, and is seldom relished at this pe- riod. Fresh vegetables should be cautiously used, es- pecially the more flatulent and griping; as cabbage, greens, peas, beans, and sallads; kidney bean, arti- choke, and asparagus, are more proper, occasion- ally; but the place of all these will still be in general best supplied by, that wholesome vegetable, the potatoe ; as abovementioned. Milk, therefore, unboiled, or boiled with bread not too fine, and free from adulteration of alum, or the different preparations of milk in the form of custards and puddings, above described, broth and potatoes, should compose the diet of a child for some of the first years of his life, with as little va- riation as possible; with which he will thrive much better than any other, and is applicable to every constitution, being so well adapted to the sto- mach and bowels, and the nutrition of the body. A child can seldom be thirsty with this diet, when well, and except from exercise in warm wea- ther : if he should, milk, water, or milk and water will be most suitable. New m^* should on all oc- casions, whether as food or drink, be thinned with water in proportion to its richness. g2 78 Regular meals, as far as they can be adopted, are to be preferred: for if a child is suffered to eat at irregular periods, and as his fancy directs, he will be induced to eat too much. He will also get a habit of eating as an amusement, which, if not in- dulged in, will make him fretful. As a child's diet is lighter, and his digestion quicker than those of a grown person, so he ought to have his meals some- what more frequent. He may, in a general way, be al- lowed to eat as much as he will at a meal, supposing he is well, and his food is of a proper quality; as he will seldom be found to suffer any inconvenience from satisfying his appetite, even at night. At the age of three, four, or more years, a child may at dinner have a little flesh meat or fowl, sim- ply roasted or boiled, or fish of any kind, without butter, gravy, or any sauce, with potatoes: the white meats and fish, no doubt, will have the prefer- ence; and will be better boiled than otherwise. Some sorts of shell fish are often acceptable to chil- dren at this or a later period, and are very suitable ; particularly oysters, which are best raw, and coc- kles, shrimps, and prawns ; muscles, lobsters, and crabs, often disagree. As drink will be necessary now, it should invariably be milk, or water; but ra- ther the pure simple element. Beer of any kind should never b* tasted at any period of childhood, as it has an invan^le and powerful tendency to promote acidity and all fo consequences; and can 79 in no wise be necessary, or have any good tendency. It will be evident, therefore, that vinegar, pickles, and acids in all shapes, must undergo a strict pro- hibition. It is very usual to give a glass, or part of a glass of wine, to a child at dinner; being consider- ed as conducive to his strength and thriving : yet as wine, of all sorts, has, at this time, a tendency to promote acidity, its effect must obviously be the reverse of what was intended. If it be given as a cordial, to warm the stomach and cheer the spirits, it is to be considered, that youth requires not such aid : for although " wine is the milk of old age," it is not so of childhood, where the frame, like the mettle of all young animals, requires the rein rather than the spur; and if a child be puny and weak, he will sooner have his health improved by the diet here recommended. Wine, also, vitiates the appe- tite ; and is an indulgence, introduced at much too early a period.—Therefore better totally omitted. Cheese, is an article of food that most children soon get fond of; and when taken moderately, is rarely found to disagree. It seems less suited to form a full meal or part of a full meal, than to be taken in small quantities, with bread, between the regular meals. The newer sorts of cheese appear to agree better than those that are old. 80 Fruit is an article that requires a great deal of caution in its use. If properly selected, and given in moderate quantities, it is a gratification that may be indulged, as a child grows older especially, with- out injury, and perhaps occasionally to some advan- tage. In general, the sweet juicy, or mellow fruits that readily dissolve in the mouth, are the only ones that should be eaten; as the strawberry, ripe goose- berry, and black and white currants without the skins, sweet ripe grapes, and pears ; while the more harsh and solid, as apples, cherries, plumbs, and the generality of stone fruits should be forbidden. The harshness and acidity of fruit lie most in the skin ; the skin of all fruit therefore should be as carefully avoided as may be. The use of fruit may be best determined by its effects ; if it produce no sickness, griping, costiveness or looseness, and the appetite for proper food is not impaired, its guarded use may be continued; otherwise not. Fruits preserved with sugar, are very improper; not only from the sugar which they contain, but as they are generally kept some time before they are used, they acquire a tendency to ferment; and, when eaten, will be apt to produce more acidity than the fruit in its ripe unprepared state would do; and which is still more promoted by the skins, which are commonly preserved with the fruit. Fruit pies, compose no inconsiderable part of chil- dren's diet; however, if any part of this our plan 81 is assented to or adopted, it will be very evident they can form but a very small share now. Baking may seem to meliorate fruit when mixed with sugar, with the addition of buttered crust; yet that is chiefly a delusion of the palate; and sueh a compo- sition certainly makes one of the most unsuitable articles in a child's diet. When pies are made of fresh fruit,, it is often unripe and of the harshest kind. Apples, are in general too harsh for a weak stomach evilvject to aeitlitv, even of a grown person : they are mellowed by keeping ; and such as will bear keeping till after Christmas, may be eaten with the most safety.*—Fruit puddings, are to be objected to much on the same ground with pies. As children in the summer and autumn may be indulged in as much ripe fruit as is proper, there is less occasion for its use in pies or puddings at these or other seasons ; and, in winter, something else may be substituted. Foreign dried fruits, as French plumbs, figs, raisins, and currants, may occasionally be taken, raw or differently prepared. Also grapes. These are better suited to children than our own prepared fruits, as they are mellower and more free from acidity; and when made into puddings or pies, require little or no sugar. If anyr deviation can be made from our general plan, it will be in pies and puddings (chiefly the latter) of foreign dried fruits, * These observations seem chiefly to apply to the fruits and the climate of Great Britain. 82 with little or no sugar, and with as little butter or suet, as may be, in the crusts. Tea is better avoided : for if the tea in itself should possess no noxious quality, yTet from being made sweet, it will vitiate the taste and take off the proper relish of other food ; and if a child is suffer- ed to have it in company, if he does not partake of buttered toast, &c. like the rest, he becomes dis- satisfied nncl fretful. A. little vciy -weak comuiuu tea without sugar, put into a good deal of milk, with a piece of dry bread, is perhaps the only man- ner of taking it that ought to be permitted. Many are committed by servants m this matter ; of whom, errors few can be trusted, even when the strictest orders are given them, as they are universally liable to give the tea very strong and sweet, with great quantities of butter in toast, &C. The commoner teas are to be preferred to the finer. About this time, or even earlier, as it mayrbe pre- sumed to agree, a child may have buttermilk, which commonly proves very acceptable. It may be in- dulged in as a meal, with bread, or as drink at meals or otherwise, as it is found to agree; which it gene- rally does very well with children who are deprived of the other acescent articles of diet abovenamed. It can never disagree, except by producing griping with looseness or costiveness. Some bowels mav 83 be so weak as not to bear it, (yet that is not often the case) and then it should be discontinued. It is considered in some parts of the kingdom as unfit food for the human species; which is a very im- proper prejudice ; as where it agrees, it forms one of the wholesomest articles of a child's diet; and agrees better with children than grown persons. It should always be used as fresh as possible, and never after it is turned sour. The Irish method of mixing it with potatoes, seems very acceptable and proper. As a child grows older and uses more exercise, he may have larger portions of animal food or fish, at dinner only; and may have the daily number of his meals reduced to three : but as from the exer- cise he uses, he will be hungry between the meals, his hunger must be satisfied ; and which is best done by as much dry bread as he will eat. There cannot be a pleasanter sight of the kind, than a child eagerly engaged with a large slice of a loaf; as it is an almost sure test of health, and which all children will do whose appetites are not pampered, depraved, and vitiated by improper diet. If a child takes a liking to a little fat with the meat, it may very properly be given ; as it does not appear from experience to produce grossness of ha- bit more than the lean part of the meat. As puny 84 children, who arc indulged in sweet and improper food, have no great relish for animal food, they have still less for the fat part of it; while those who are not so indulged, often prefer a little of it; and there doing so is one of the best indications of health. The fat of meat does not possess the injurious quali- ties of butter. It is difficult to say when or how this diet is here- after to be varied, as it ought to be continued with as little variation as possible during the whole of childhood ; and the more invariably it is extended to youth, and even mature age, the better; for when innovations are once permitted, it is often a difficult matter to limit their boundaries; and which I do not feel myself disposed to enter upon here, as it would be extending the limits prescribed: confident, however, that a regulation of the diet at the va- rying periods of life, is of the first importance in the establishment and preservation of health. The outline which has been given of a child's diet, must be left to be filled up at discretion, and as cir- cumstances will allow. I am satisfied it is correct for the purpose of health, strength, and vivacity, at this period ; and that it will have a powerful tenden- cy to promote them through life, with both sexes ; the difference of sex requiring no variation at these periods in the quality of their food, although the 85 female will commonly be found to require less in quantity than the male. It is not usual to recommend animal food to children at an early period ; who indeed are not much inclined to it, when they are indulged in but- ter, cakes, and sweet things ; yet when introduced as above-mentioned, may be taken with propriety and advantage, and will be generally well relished. In a former part of this work, (page 32) the diges- tion of the food and its effects are familiarly ex- plained ; whereby it is found, that we are by nature formed to subsist upon a mixture of animal and ve- getable food; and (as there observed) milk, as being a combination of animal and vegetable matter, is properly suited to the first period of infancy ; yet as we become older, we use more exercise, the body becomes stronger, and we require more of the animal quality than milk affords, to support the in- creasing growth and strength; and which cannot be more advantageously obtained, than by a suitable mixture of animal and vegetable food, upon the principle above described. The quantity of animal food to be given, must vary with circumstances, and cannot be here pointed out in every particular case: it is sufficient to observe, that as the animal is the most nutritive part of the food, a lusty gross child must be restrained in proportion to his dispo- sition to become gross, even to limiting him to milk alone; while a child, inclining to be thin and H 86 spare, may have it proportionally increased. It is a very mistaken opinion, that animal food is impro- per for children inclined to be thin, weak, and deli- cate ; and they are accordingly fed with fruit pies, cakes, and sweet things, which, as palling the appe- tite, and not affording sufficient and proper nourish- ment, beside injuring the stomach and bowels, con- tribute to their weakness and delicacy. Vegetables yield very little nourishment in proportion with animal food. A child, as above-mentioned, who has been ac- customed to cakes and sweet things, will not some- times relish animal food, when it may become neces- sary to give it in changing his diet; yet a tolerably strict confinement to milk, bread, and potatoes, for a while, will bring it about. Instances may occur where animal food, in broth or any other shape, may be disliked, or disagree for a very long period; in those cases, the milk, Sec. here mentioned, must be persevered in, while such distaste or disagreement continues. Finally; it is to be observed, that in the fore- going general directions for a child's diet, it is sup- posed the child is not labouring under the effects of any hereditary, constitutional or other particular in- firmity or disease, that may solicit a deviation; and which can rarely happen to any material extent, for any length of time. 87 Note.—In a former part of this essay, the period "for applying the child to the breast, after delivery, is fixed at twenty-four or forty-eight hours ;—but, as a general rule, it is best to put the child to the breast as soon as the mother is refresh- ed, say in twelve hours. C2fc.rv/w INSTRUCTIONS FOR VACCINE INOCULATION, COMMONLY CALLED VACCINATION. 2*^^ ,~~~~~"~~~"*a H 2 VACCINE INOCULATION, Effectually prevents the small pox, is never dan- gerous, requires no particular diet nor medicine, and may be practised at all ages and at every season of the year. TO COLLECT THE VACCINE MATTER. The matter may be taken from a pustule that is making its progress regularly, and which possesses the true vaccine character, by puncturing with a lancet in several points, and charging small square pieces of glass with it, by gently pressing them on the opened puncture, and putting two of them to- gether, with the sides containing the matter in con- tact ; wrap them up in a piece of paper, and pre- serve them from heat and moisture. The best time for taking the vaccine matter is from the seventh to the ninth day, before the efflor- escence or red appearance takes place. An unne- cessary irritation of the pustule is thereby avoided: and it is also advisable not to take a great deal of fluid from one pustule." Or, the internal, central part of the first scab that falls off, which is the true vaccine scab, may be used. 92 The scab of a vigorous pustule should be chosen, and may be kept in a cool dry place for a twelve month: so that vaccination may be performed from it at any time. TO INTRODUCE THE MATTER. The proper place for introducing the matter is on the arm, about midway between the shoulder and the elbow. The mode of doing it is by im- pregnating the point of a clean sharp lancet with the matter, and inserting it by means of a very slight scratch or small puncture, and wiping the point of the lancet on the part where the blood is drawn. Fluid matter taken from a pustule and im- mediately inserted is the most certain. But to use the matter on the glasses, we restore it to a fluid state, by dissolving it in a small portion of cold wa- ter taken upon the point of a lancet; and to use the scab, we scrape off some of the dark, internal, cen- tral part, and mix it with a little cold water on a piece of glass. SIGNS OF TRUE VACCINE INOCULATION* A little red spot will appear on the punctured part on the third day, which, on the fourth or fifth 93 day, becomes a watery or vesicated pimple: ft goes on increasing, with a depression in the middle of the pustule, until the ninth or tenth day, when it is generally surrounded by a rose coloured, circum- scribed appearance or efflorescense, which remains nearly stationary for a day or two. The efflorescence then fades away and the pus- tule, gradually becomes, a bard glossy scab, of a dark mahogany colour. This efflorescence is also • called the areola, and the vaccine ring, from its be- ing circumscribed. It is most commonly in size rather larger than a dollar. These progressive stages of the pustule are com- monly completed in sixteen or seventeen days. One pustule only is produced. On the eighth or ninth day, when the cffiorescence is forming, some fever often occurs in children, and lassitude in adults. SIGNS OF UNSUCCESSFUL VACCINE INOCULATION. The most frequent deviation from the perfect pustule, is that which finishes its progress much within the time limited by the true. Its commencement is marked by a troublesome itching; and it forms a premature efflorescence, 94 sometimes extensive, but seldom circumscribed oi" of so vivid a tint as that which surrounds the com- plete pustule; and it exhibits one peculiar charac- teristic mark of degeneracy, by appearing more like a common festering, produced by any small extraneous body sticking in the skin, than a pustule excited, as before described by the vaccine virus. The successful progress of the vaccine pustule is fre- quently rendered unrrrtain by being rubbed. An attention to the progress of the true vaccine inoculation, impresses On the mind of a practitioner the perfect character of a vaccine pustule. There- fore, when a deviation of any kind arises, common prudence points out the necessity of re-inoculation with vaccine virus of the most active kind, and, if possible, taken fresh from the pustule CAUTIONS RESPECTING THE VACCINATED PART. To preserve the patient from suffering inconve- nience in the vaccinated part, it is necessary that it should not be rubbed; that it should be entirely loose and exposed to the air, and during the time of the efflorescence, should be constantly dusted with rye or buckwheat meal. The arms of adults are often inflamed from their wearing tight clothes, or using too much exercise at the period of the infla- 95 mation's taking place—this might easily be pre- vented by avoiding the cause. If the pustule is rubbed and becomes a sore, the part should be covered with Goulard's cerate, or a salve composed of sweet oil and bees-wax melted together, spread on a piece of clean linen rag, and kept in its place by a piece of soft linen sewed round the arm; the same application should be made if any7 sore remains after the scab has dropped off. SMALL POX DESTROYS, VACCINATION SAVES, THE LIVES OF THOUSANDS. The following facts are chiefly7 extracted from a late work published in London in favour of Vaccina- tion; they are submitted to the serious considera- tion of every person, who may think the preserva- tion of human life an object worthy of attention. The Small Pox we are informed from the best authorities, destroys, annually, in Great Britain alone, between forty and fifty thousand lives; or, throughout the habitable globe, twenty millions of people, exclusive of those who perish from the en- feebled state of the system, produced by this for- midable disease. Some tolerable idea may be formed of the ra- vages committed by the Small Pox, by examining the bills of mortality; for in London, where the climate is temperate, the disease well known, and the treatment of the sick very ably conducted, two or three thousand persons, according to Baron Dims- dale, annually perish. 97 So great was the epidemic rage of the Small Pox at Paris, in 1723, says Voltaire, that upwards of twenty thousand persons perished by it in that city alone. In 1768, the Abbe Chappe informs us, that this same scourge destroyed at Naples sixteen thousand persons in a few weeks. In Russia, the annual de- struction of human beings thereby, is estimated by Baron Dimsdale at two millions. In China, says Dr. Clark, where the population is immense, the number who annually die of the Small Pox, the most loathsome of all diseases next to the leprosy7, is incalculable. The fatality is still more remarkable amongst uncivilized people, who are wholly ignorant of the means of prevention, and of the methods of cure. About fifty years after the discovery of Peru, the Small Pox was carried from Europe to America, by way of Carthagena, when it overran the conti- nent of the New World, and destroyed upwards of one hundred thousand Indians, in the single pro- vince of Quito. This account was found by M. de la Condamine in an ancient manuscript preserved in the cathedral of that city. This author also observes, that in the Portuguese settlements, bordering upon the river of the Ama- 98 20ns, the Small Pox proved fatal to nearly all the natives. Mackenzie in his travels over the continent of North America, gives an affecting account of the destruction occasioned amongst the Indians by the Small Pox. The fatal infection,* says he, spread around with a baneful rapidity, which no flight could escape, and with a fatal effect that nothing could resist. It destroyed with its pestilential breath whole families and tribes, and the horrid scene pre- sented to those who had the melancholy^and afflict- ing opportunity of beholding it, a combination of the dead, the dying, and of such as to avoid the hor- rid fate of their friends around them, prepared to disappoint the plague of its prey, by terminating their own existence". In 1767, as we are informed in Cook's Voyage, a soldier introduced the Small Pox for the first time into Kamtschatka, and twenty thousand persons perished by that disease, leaving whole villages nearly desob.te. Crantz in his history of Greenland says, that the Small Pox was first introduced into that frozen region in 1733, when the mortality of this disease was so great, that it almost depopulated the whole coumrv. 99 Evell sO late as the year 1793, when the Small Pox was conveyed to the Isle of France in the East Indies, by a Dutch ship, five thousand four hun- hundred persons perished there with this distemper in six weeks. From the above statement, it is evident, that ah the wars throughout the whole world, have neve; destroyed so many lives as have been cut off by this awful scourge. To lessen in some degree this destruction of the human race, inoculation was introduced, by which the mortality of the disease was obviated, as far as it respected thpse who submitted to the operation. But as the benefit of inoculation cannot be ex- tended to society, as is observed by a popular wri- ter, by any other means than.by making the practice general: while it is confined to a i'cw it must prove hurtful to the whole. By means of it the contagion is spread and is communicated to mam', who might otherwise have never had the disease. According- ly, it is found that more persons die of the Small Pox now, than before inoculation was introduced: and this important discovery, by which alone more lives might be saved than by all the other endea- vours of the faculty, is in a great measure lost by its benefit not being extended to the whole commu- nity. Dr. Heberden in his observations on the in- 100 crease and decrease of different diseases observes, that he examined carefully the bills of mortality, and comparing the destruction occasioned by the Small Pox in Great Britain before and since inocu- lation, reluctantly was brought to this melancholy conclusion, that at the present period, the propor- tional increase of deaths from this disease was as five to four. Hence it would appear, that inoculation has done a great injury to society at large, and the difficulty of extending it generally so as to convert it truly into a public benefit, is attended with almost insu- perable objections. For to make a law, that inocu- lation shall be general and periodical, appears both cruel and arbitrary, where security of life cannot be given to all; and is what no government, grounded on the basis of general liberty, would venture to adopt. But through the kindness of Divine Providence, the means of obviating all these difficulties and dan- gers, have at length been placed writhin our power, by the invaluable discovery made public by Dr. Ed- ward Jenner, that the Cow Pock which has never been known to prove fatal, effectually secures the constitution from the attacks of either the natural or inoculated Small Pox. The following annual statement of deaths by the Small Pox within the London bills of mortality, in 101 the present century, has lately been published by the Jennerian Society of that city, A. D. 1800.......2409 deaths, 1801.......1461 1802.......1579 1803.......1173 1804....... 622 As the society remarks, it is hoped the know- ledge of these facts will be strongly promotive of the beneficial practice of Vaccine inoculation; it appearing that the fatal disease of Small Pox has progressively declined, as the inestimable discovery of Dr. Jenner has been introduced. Vaccination was introduced into Vienna in 1801. Its effects in decreasing the deaths by Small Pox, are evident, from comparing the deaths since that period with those of the preceding years. In 1800 1801 1802 1803 1804 835 died of Small Pox. 164 61 27 2 only. A Comparative View of the Natural Small Pox, Inoculated Small Pox, and Vaccination, in their Effects on Individuals and Society. NATURAL SMALL POX. For twelve centuries this disorder has been known to continue its ravages, destroying every year an im- mense proportion of the population of the world. It is in some few instances mild, but for the most part violent, painful, loathsome, dangerous to life, and always CONTAGIOUS. One case in three dangerous, one in six dies. At least half of mankind have it, consequently one in twelve of the human race perish by this disease. In London three thousand die annually, forty thousand in Great Britain and Ireland. The eruptions are numerous, painful, and disgust- ing. Confinement, loss of time and expense are cer- tain, and more cr less considerable. Precautions are for the most part unavailing. Medical vreaiment ne- cessary, both during the disease, and afterwards. It occasions pitts, scars, seams, &c. disfiguring the skin, particularly the face. The subsequent diseases are scrophula in its worst forms; diseases of the skin, glands, joints, &c. and loss of sense, sight or hearing frequently follow. It is attempting to cross a large and rapid stream by swimming, when one in six perish. INOCULATED SMALL POX. For the most part mild, but sometimes violent, painful, loathsome and danger- ous to life; always Contagious, and therefore gives rise to the Natural Small Pox, and has actually, by spreading the disease, increased the general mortality seventeen in every thousand. One in forty has a dangerous disease, one in three hundred dies. And in Lon- don, one in an hundred. Eruptions are sometimes very consi- derable, confinement, loss of time, and expense certain, and more or less consi- derable ; preparation by diet and medi- cine necessary, extremes of heat and cold dangerous : during ill health, teeth- ing and pregnancy to be avoided, medi- cal treatment usually necessary. When the disease is severe, deformity proba- ble, and subsequent disorders as in the Natural Small Pox. It is passing the river in a boat sub- ject to accidents, where one in three hun- dred perish, and one in. forty suffer par- tially. VACCINATION Is an infallible preventive of the Small Pox, always mild, free from pain or danger, never fatal, not contagious. No eruption but whereVaccinated. No confinement, loss of time, or expense necessa- ry. No precau- tion, no medicine required, no con- sequent deformi- ty. No subsequent disease. It is passing over a safe bridge 103 Parents and others are earnestly requested to at- tend seriously to the preceding comparison, and to the following certificate and recommendation : Philadelphia, April 12, 1803. We the Subscribers, Physicians of Philadelphia, having carefully considered the nature and effects of the newly discovered means of preventing, by Vac- cination, the fatal consequences of the Small Pox, think it a duty thus publicly to declare our opinion, that inoculation for the Kine or Cow Pock, is a cer- tain preventative of the Small Pox; that it is at- tended with no danger, may be practised at all ages and seasons of the year, and we do therefore'recom- mend it to general use. John Redman, Jno. Porter, Wm. J. Jacobs, W. Shippen, Felix Pascalis, John C. Otto, A. Kuhn, James Stewart, Isaac Ca'thrall, Saml. Duffield, James Dunlap, J. Reynolds, Benj. Rush, James Proudfit, John. Keemle, Thomas Parke, Ts. T. Hewson, J. Church, Benj. Say, James Gallaher, J. C. Rousseau, Philip S. Physick,Charles Caldwell, Arthur Blayney, C. Wistar, jun. Thos. C. James, Rene la Roche, Saml. P. Griffitts, Win. P. Dewees, Monges, John R. Coxe, Benj. S. Barton, Elijah Griffiths, Jas. Woodhouse, Isaac Sermon, William Budd, Sam. F.Conover, George Pfeiffer, Geo. F. Alberti, PI. F.GlentworthJos. P. Minnick, Joseph Pfeiffer, E. Perkins, Wm. Barnwell, Joseph Strong, Wm. Currie, Adam Seybert, Edward Cutbush. M. Leib, James Mease, 104 Philadelphia, May 26, 1806. N. Chapman, Peter Miller, Isaac Cleaver, John S. Dorsey, Jos. Parrish, S. Bleight. Wm. Shaw, PHILADELPHIA DISPENSARY. The attending and consulting Physicians having informed the Managers, " That they had, for these eighteen months past, inoculated for the Cow Pock, and foimd it mild, unattended with danger, and a full security against the Small Pox, and expressing their wishes that the superior advantages of the Cow Pock may be fully experienced by the objects of this charity." Therefore, Resolved, That we do entirely accord with the sentiments of the Physicians; and earnest- ly recommend to the poor of the city, to embrace the means now offered of preserving themselves and families from a dangerous and loathsome disease, by the newly discovered and happy mode of inocu- lation for the Cow Pock; which will be daily per- formed by the Physicians at the Dispensary. Published by Order of the Board of Managers, WIILIAM WHITE, President. April 25,1803. After a mature consideration of the preceding statement of facts and recommendations, we would venture to ask every person of reflection, whether IT IS JUSTIFIABLE TO CONTINUE TO INOCULATE FOR the Small Pox ? FINIS. Met H ist wz.