Observations on the Mortality
and Physical Management of Children

by John Roberton

Member of the Royal College of Surgeons, Edinburgh; of the Literary and Philosophical Society of Manchester; and one of the Surgeons to the Manchester Lying-in Hospital

London: Longman, Rees, Orme, Brown and Green. 1827.

The first page of the original Roberton book. Available on microfilm from NLM.

Part First.

Section I. General Remarks on the Mortality of Children. A great proportion of mankind die in youth. Incidental to the species. Some speculators think otherwise. Note on the abuse of the opinions of Malthus. The mortality in question partially under control.

Section II. Of Bills of Mortality. Parochial registers of the dead; their origin and authority. Recent parish act; its imperfections. Mortality bills in various places. Dr. Pervial's opinion of their utility; Scotch and Swedish bills.

Section III. Tables Shewing the Rate of Infantile Mortality in Different Places. Definition of a mortality bill. Table for London; population of that city. Inaccuracy of the London table. Circumstances to be considered in estimating infantile mortality from mortuary registers. The mortality of all ages, in the registers, does not shew exactly the probabilities of life. Table for Glasgow; population of that city. Table for Liverpool. Population and salubrity of Liverpool. Tables for Warrington. Table for Chester. Tables for Northampton and Carlisle. For Holy Cross and Ackworth. For Great Shefford and Spalding. For Eccles and Warwick. Tables for Lymm and Grappenhall. Mortality within the first few days of life; table shewing the proportional mortality at different periods, during the first year. Summary of all the tables. Infantile mortality in foreign countries.

Section IV. Remarks on the Foregoing Tables; and on the Causes of Infantile Mortality in Large Towns. Mortality greatest where the operative class predominates. Great proportion of poor in manufacturing towns; Note on the number of poor women delivered by means of the Manchester Lying-in Charity. Circumstances of the poor, particularly the Irish in this country. Their mode of living. State of the poor in Dublin. Note; a graphic sketch. Children of the poor in a manufacturing community. The same continued. Note; proportion of illegitimate to legitimate births in Manchester, and various places. Immense mortality of the illegitimate. Note, spiritous liquors given to infants at the breast. Infantile mortality increases with the increase of the operative population. Note, Vilerme on the mortality in Paris. Note, the supposed effects of cotton mills on the health of children. Manchester unfavorable to infantile life, causes. Great mortality of large towns. Note, rate of mortality in the Society of Friends in Manchester. Difference between the relative and actual mortality under the age of TEN. Infantile mortality less in country parishes than in towns. Note, on the comparative mortality of England and Wales.

Section V. On the Comparative Mortality of Children Before and Since the Commencement of the Present Century. The idea that vaccination favours the increase of population opposed by Dr. Watt. Data upon which he proceeds. His error. The actual mortality under the age of ten universally less than it was twenty-five years ago. Note, annual mortality for the kingdon, at different periods. Decrease of infantile mortality in France. Note decrease of deaths at the British Lying-in Hospital.

Section VI. On the Question -- "Are Infantile Diseases in General, and Especially Measles, Become More Fatal Since the Cow Pox was Substituted for the Small Pox?" The deaths in the registers, since the vaccine era, fewer under two years, and more numerous between two and ten. Causes of this. Tables shewing the increased mortality from measles. Dr. Watt's sentiments on this question have impeded vaccination. Pernicious effects of the natural small pox on the constitution. Probably greater soundness of health enjoyed, generally, since the cow pox superseded the small pox. Note, conjectures as to the decrease of consumption. More die of measles now than formerly; cause is obvious. Small pox earlier in attack than measles and other infantile complaints; leaves few victims for other diseases. Ravages of the small pox in Warrington and Chester. Note respecting measles. Will measles, in fatality, take the place of small pox? Note, present state of vaccination in Manchester.

Section VII. The Comparative Mortality of the Sexes, Including the Still-Born. The proportion of male to female births, in England and Wales. And in foreign countries. Note, polygamy in warm climates. Note, Causes of deformity at the Hospice de la Maternité. Note, still born, to live, births, in the different European capitals. Disproportionate mortality of males. Note, comparative value of male and female lives above the age of nine years. Comparative mortality of the sexes after birth, illustrated by a table.

Section VIII. On the Rate of Infantile Mortality at Different Seasons of the Year. Celsus' opinion of the influence of the different seasons on the health. Influence of season in this country somewhat uncertain; causes. A popular adage. Effects of intense cold on the rate of infantile mortality. Causes. An open winter in general the most fatal. Influence of season on infantile mortality different to that on the general mortality. Table shewing the mortality at different seasons in London. Table for Glasgow; mortality in the different seasons influenced by the fecundity in each. Table of births for Liverpool. Note, rate of fecundity in the different seasons varies in different countries.

Section IX. The Diseases of Infancy and the Ages at Which They Prove Fatal, Illustrated By a Table. Comparison between the mortality in the civilized and the savage states. More to be learned from the habits of brute animals than the practices of people in a state of nature; reasons. Health and happiness keep pace with the progress of civilization; lower classes improving. Much remains to be done; infantile mortality; coeteris paribus in the ratio of the ignorance and improvidence of the population. Importance of infantile diseases in a medical point of view. Defects in the mortuary registers of this country. Table of diseases producing infantile mortality. Nosological arrangement of children's diseases, difficult or impracticable. Table suggests important considerations. Table of infantile diseases for Chester. For Carlisle.

Part Second.

Section I. Of the Structure, Functions, and Temperament of the Body Peculiar to Infancy and Childhood. The foetus, infant, child, youth, and adult. Infant at birth; changes which take place. Skin and celular substance. Lymphatic glands, muscles, and bones. Predominance of the arterial system; pulse. Note, growth of an infant is inversely as its age. Relative vascularity of different organs. Note, the age of a child, how ascertained. Note, Weight of the brain. Infancy the age of vivid sensations; state of the mouth. Stomach and bowels; liver. The functios of the latter in the foetus, kidneys etc. Symptoms which precede teething. Teething, order in which the teeth cut the gums. Note, deviations from the order in which the teeth usually appear. Definitions of the terms infant and child. Diseases of childhood less fatal than those of infancy. Note, mortality occurring in Cheetham's Blue Coat Hospital; Blue Coat School, Warrington; and in Ackworth School. Infantile temperament.

Section II. On the Duties and Qualifications of a Wet Nurse. She who determines not to suckle ought not to become a mother. Circumstances which disqualify for suckling. Substitutes. Note, advantages of suckling. Suckling by means of brute animals -- hired wet nurse. Wet nurses, their faults and failings. Character of a wet nurse, in prose. In verse. Mortality of the children of wet nurses. Means for preventing it. Qualities of the milk of a wet nurse; sickness incapacitates for suckling. Complaints which disqualify. Note, influence of nervous affections on the milk. At what period the infant is to be put to the breast. State of the milk in phthisical patients. Milk fever and excoriation of the nipple. Infants suckled too often; a nurse should live by rule, -- her foot etc. Effects of spiritous liquors upon a wet nurse. Effects of passion on the milk. Inebriety in nurses a cause of infantile mortality.

Section III. Articles of Aliment Suitable for the Early Periods of Life. The milk of every animal is distinguished by certain properties. Table shewing the richness of different kinds of milk. Milk of the cow, ewe, mare, ass, woman. Peculiar property of woman's milk. Boiling of milk injures its properties. Whey, butter, and cheese. Sugar. Note, experiments of Magendie. Effects of sugar on the teeth; molasses. Different farenacea, esculent vegetables. Potatoes, fruit. Animal food. Methods of cooking it. Infusion of animal food, oyster tea; pickles and spices. Beverages, tea and coffee.

Section IV. On the Dieting of Children, in Health and Sickness. The two maternal breasts secrete only one kind of nutriment; inference. Connexion between the dieting of children and many of their diseases. Division of the subject. Weaning, artificial food. Kinds of artificial food. Dry nursing. Note, mortality of dry-nursed children. Bottle and tea, asses' milk. Over feeding in sickness. Ignorant nursery servants. Diet and regimen in sickness. The same. Age for weaning; season of the year. Diet after weaning. Gluttony, its effects. Animal food, in what period to be commenced. Its effects. False reasoning on the effects of diet. Comparative management in infancy and childhood; animal food during the latter period. Effects of a diet of vegetables; oatmeal. Its effects in producing the itch; a child's breakfast. Dinner. Note, the best sauce. Eating too quickly. Note, over distension of the stomach. Gorging -- beverage for children. Antipathies and idiosyncracies. Different children require different food. Boys, their food at puberty; girls, their habits. Peculiar diet requisite. Note, starvation. Beer. Management at puberty.

Section V. Of Cleanliness, Bathing and the Management of the Skin. Effects of filthiness; skin, its structure, and functions. Danger from accidents affecting the skin. Definition of filthiness; first ablution. Washing the infant. Calls of nature; bathing. Cold bath. Tepid and hot baths. Note, shower and nursery bath. Salt water bath. Rules to be observed in bathing. Friction, flesh brush. Utility of the cold bath; objections. Public baths in large towns. Swimming. Prohibited to the delicate. Skin, cosmetics, pimply face.

Section VI. Of Dress. Properties of a bird's nest. The French baby dress. Rousseau's opinion of it. Note, on the antiquity of swaddling clothes. Monthly dress. Flannel, its qualities. Note, relative warmth of different articles of clothing. Flannel to be used as the inner dress of infants; exceptions. Locke -- his hardening system. Note, his opinion of physic and physicians. Going barefoot. Shoes. Covering for the head. Neck and breast; flannel in summer. Change from warm to light clothing. Light dress. Hinckley collar. Stiff boddices. Curvetures of the spine; causes. Effects of tight stays on the figure and health. A compressed waist; standard of beauty. The dancing girls of Canova; directions for making boddices.

Section VII. Of Air, Temperature, and Exposure. Composition and qualities of the air. Carbonic acid gas -- its dangerous properties. Air in towns. In the country. Temperature. Note, on the heat of the human body in different climates. Effects of cold on the young. Influence of the different seasons; summer, autumn. Winter. Rousseau's hardening system. Softening system. Note, mortality among the children of the poor. Combined effects of moisture and cold. The nursery. Note, nursery garments. Ventilation. Note, on the Manchester Workhouse; -- Note on Foundling Hospitals. Fuel for children's apartments. Gas lights. Note on the properties of carburetted hydrogen.

Section VIII. Sleep. Want of sleep, its effects. Sound sleep. Waking children, Rousseau. Early rising -- cradle -- swing cot -- couch. Abuse of laudanum in nurseries. Note, over-laid children. Irritable bowels. Fidgetting -- sleeping apartments. Bed and bed clothes. Note, concealed beds. Of children sleeping together -- posture in bed, cold feet. Chilblains -- warming pan.

Section IX. Of Exercise and Amusement. Activity characteristic of early life. Effects of activity and inactivity, on the muscles, contrasted. Rationale. Rules for the exercising of infants. Boys -- their games and toys. Variety. Dangerous sports. Different juvenile games. Manchester. Girls -- sedentary. Their employments. Age to being instruction. Note, unhappiness of childhood. Note, infants' schools. Accomplishments. Amusements of girls. Note, restraint. Attempts at improving the figure.

Section X. Derangement of the Alimentary Canal and on the Management of the Bowels. Definition of infantile health. Easily deranged. Note, predisposition to disease. Signs of disorder. Tumidity of the abdomen. Train of symptoms. Consequences. Tabes mesenterica -- worms. Sluggish bowels the curse of large towns. Nature and causes of morbid constipation. Means of remedy. Regimen. Food. Note, constitutional costiveness. Lavements. Note, Dr. Dewee's "Mush." Domestic management. Medicines; contents of the nursery medicine chest. Senna. Castor oil, jalap, aloes, calomel etc.; Tonics, change of air and other restoratives. Friction and bandaging of the abdomen; beneficial effects of the various means.

Section XI. The Hereditary Transmission of Peculiarities of Structure, and the Early Management of Such as are Predisposed to Particular Diseases. Physical history of man. Individual peculiarity -- peculiarity of race etc. Note relative to Dr. Pritchard. Family peculiarity. Varieties of hereditary peculiarity. Laws which govern hereditary transmission. Note respecting the deaf and dumb. The term "hereditary" applied to disease. Note respecting infantile disease. "Hereditary predisposition" defined. Varieties of predisposition. A race may be improved. Note, influence of external circumstances in modifying a race. May the predisposed to disease marry? Effects of diseased families intermarrying. Family disposition to disease. Note, Dr. Adam's definitions. The same. Note respecting critical periods of life. Origin of hereditary predisposition. Causes. Illustrations. Few exempt from hereditary bias to disease. Which increases with civilization; treatment of the predisposed; signs of the scrofulous diathesis. Management. Note, constitutions of children to be studied. Vegetable and animal food. Sea bathing and sea air. Care of the bowels, local situation; morals. Bias to insanity. Religious instruction. Predisposition to gout -- to asthma -- epilepsy etc. Concluding remarks.

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