,,the ,,maternal ,,management ,,of ,,children1 ,,in ,,health ,,and ,,disease4 ,by ,thomas ,bull1 ,m4,d4 ,physician ,accoucheur ,to ,the ,finsbury ,midwifery ,institution1 ,and ,lecturer ,on ,midwifery1 ,and ,on ,the ,diseases ,of ,women ,and ,children2 ,author ,of ,hints ,to ,mothers ,on ,the ,management ,of ,their ,health4 #ahdj4 ,,preface4 ,this little book has been written for the young and inexperienced mother4 ,it is intended to furnish her with that information which the experience and observation of some years convince the author1 young mothers1 almost without any exception1 do not possess2 and yet1 from ignorance of which1 the constitution of many an infant has received irretrievable injury1 and life itself but too frequently fallen a sacrifice4 ,in the first chapters1 devoted to the general management of the child in health1 the author has endeavoured to teach the young mother1 that the prevention of disease is her province1 not its cure2 that to this object all her best efforts must be directed2 and1 moreover1 that to tamper with medicine1 when disease has actually commenced1 is to hazard the life of her offspring4 ,in the fourth chapter it has been attempted to point out1 how the first symptoms of disease may be early detected by the parent4 ,the subject has been felt to be a difficult one1 and to give particular directions quite out of the question2 but it is hoped that the suggestions thrown out will1 in some measure1 answer the purpose intended4 ,on the advantage of an early and prompt application of remedies in the diseases of childhood1 generally so active in their progress and severe in their character1 it is unnecessary to offer any observation4 ,the latter part of the work1 consisting of the maternal management of disease1 the author regards as a subject of high and serious moment4 ,small as is the attention which has been hitherto paid to it1 yet1 in the diseases of infancy and childhood1 how invaluable is a careful and judicious maternal superintendence to give effect to the measures prescribed by the physician4 ,the author has endeavoured to arrange the contents of the work in a manner which shall be most easily understood and readily available2 and he now publishes it with the desire to supply1 in some degree1 a deficiency in this important department of knowledge4 ,finsbury ,place1 ,june1 #ahdj4 ,,contents4 ,chapter ,i4 ,,on ,,the ,,general ,,management ,,of ,,infancy ,,and ,,childhood4 ,sect4 - ,page ,i4 ,on the ,dietetics of ,infancy - #b #a4 ,maternal ,nursing - #c ,plan of ,suckling - #c ,deficiency of ,milk - #aa ,the injurious ,effects to ,mother and ,infant of undue and protracted ,suckling - #ae ,mothers who ought never to suckle - #bj #b4 ,wet-nurse ,suckling - #bg ,choice of a ,wet-nurse - #bh ,diet and ,regimen of a ,wet-nurse - #ca #c4 ,artificial ,feeding1 7bringing up by hand7 - #cd ,the ,kind of artificial ,food before the sixth ,month - #ce ,the ,kind of artificial ,food after the sixth ,month to the completion of first ,dentition - #dd ,the ,kind of artificial ,food most suitable under the different ,complaints to which ,infants are liable - #dh ,,ii4 ,weaning - #ea ,the ,time when - #ea ,the ,mode - #eb ,the drying up of the ,mother's ,milk - #ed ,,iii4 ,on the ,dietetics of ,childhood - #ed ,general ,directions1 and of animal ,food - #ee ,sugar - #fj ,salt - #fa ,fruits - #fb ,water - #fc ,wine1 ,beer1 and ,spirits - #fc ,,iv4 ,sleep - #ff ,during ,infancy - #ff ,during ,childhood - #fi ,v4 ,bathing and ,cleanliness - #gb ,during ,infancy - #gb ,during ,childhood - #ge ,,vi4 ,clothing - #gh ,during ,infancy - #gh ,during ,childhood - #ha ,,vii4 ,air and ,exercise - #hc ,in ,infancy - #hc ,in ,childhood - #hi ,chap4 ,,ii4 ,,on ,,the ,,use ,,and ,,abuse ,,of ,,certain ,,remedies4 ,i4 ,aperient ,medicine - #ig ,castor ,oil - #ii ,manna - #aja ,magnesia and ,rhubarb - #ajb ,the ,lavement - #aje ,the ,aperient ,liniment - #ajg ,,ii4 ,calomel - #ajg ,,iii4 ,opiates - #aaj ,,iv4 ,leeching - #aac ,v4 ,blisters and ,poultices - #aad ,,vi4 ,baths - #aag ,the ,cold-water ,plunge ,bath - #aah ,sea ,bathing - #abj ,the ,shower ,bath - #abc ,ablution1 or ,sponging - #abe ,the ,warm ,bath - #ahh ,chap4 ,,iii4 ,,on ,,teething1 ,,and ,,hints ,,upon ,,the ,,permanent ,,teeth4 ,i4 ,on ,teething4 - #acd ,the ,manner in which the temporary or milk ,teeth appear - #acd ,the ,management of the ,infant when ,teething is without difficulty - #acf ,the ,management of the ,infant in difficult ,teething - #aci ,,ii4 ,hints on the permanent or adult ,teeth - #adh ,the ,manner in which they appear - #bdh ,their ,value and ,importance - #aeb ,their ,management and ,preservation - #aed ,chap4 ,,iv4 ,,hints ,,for ,,the ,,early ,,detection ,,op ,,disease ,,in ,,the ,,child ,,by ,,the ,,mother4 ,i4 ,signs of ,health - #afc ,,ii4 ,signs of ,disease - #afd ,of the ,countenance - #afe ,of the ,gestures - #afi ,of the ,sleep - #aga ,of the ,stools - #agb ,of the ,breathing and ,cough - #age ,,iii4 ,other ,circumstances which will assist in the early ,detection of ,disease - #agh ,the ,influence of the ,seasons in producing particular ,forms of ,disorder - #agh ,the ,influence of an hereditary ,predisposition to certain ,diseases - #agi ,chap4 ,v4 ,,on ,,what ,,constitutes ,,the ,,maternal ,,management ,,of ,,the ,,diseases ,,of ,,children4 ,i4 ,accidents and ,diseases which may occur to the ,infant at ,birth1 or soon after - #ahg #a4 ,still-born - #ahg #b4 ,injuries received during ,birth - #aic #c4 ,retention of ,urine - #aid #d4 ,swelling of the ,breasts - #aie #e4 ,inflammation of the ,eyes - #aif #f4 ,hare-lip - #aii #g4 ,bleeding from the ,navel-string - #bja #h4 ,ulceration or imperfect ,healing of the ,navel - #bjl #i4 ,bleeding from the ,navel - #bjc #aj4 ,jaundice - #bjd #aa4 ,tongue-tied - #bje #ab4 ,moles and ,marks on the ,skin1 etc4 - #bjf ,,ii4 ,disorders of the ,stomach and ,bowels2 viz41 ,indigestion - ,flatulence - ,vomiting - ,griping and ,looseness - #bjh #a4 ,in the ,infant at the ,breast - #ba,o #b4 ,at the period of ,weaning - #bag #c4 ,in the child brought up by ,hand - #bba ,maternal ,treatment - #bbb ,,iii4 ,costiveness - #bbi ,in ,infancy - #bbi ,in ,childhood - #bca ,,iv4 ,worms - #bcd ,not so frequent as popularly supposed2 an error productive of mischief - #bcd ,how produced and how best prevented - #bcg ,v4 ,scarlet ,fever - #bci ,mild ,form - #bci ,with ,sore ,throat - #bdb ,scarlet ,fever compared with ,measles - #bde ,maternal ,management - #bdf ,,vi4 ,measles - #bec ,description - #bec ,compared with ,scarlet ,fever and ,small ,pox - #bee ,maternal ,management - #bef ,,vii4 ,small-,pox - #bfb ,natural ,small-,pox - #bfc ,small-,pox in the ,vaccinated - #bff ,maternal ,management - #bfh ,,viii4 ,hooping ,cough - #bge ,description - #bgf ,maternal ,management - #bgi ,,ix4 ,croup - #bhf ,signs of its ,approach - #bhf ,maternal ,management - #bhi ,its prevention - #bhi ,x4 ,water in the ,head - #bia ,its ,prevention - #bib ,maternal ,management - #bih ,,the ,,maternal ,,management ,,of ,,children4 ,chapter ,i4 ,,on ,,the ,,general ,,management ,,of ,,infancy ,,and ,,childhood4 ,the line of demarcation made between infancy and childhood1 both by ancient and modern writers1 has always been arbitrary4 ,i would draw the line between the two1 at a period of time which appears to me to be the most natural1 the most simple1 and least likely to lead the reader into the danger of misapplying any part of the practical directions of this1 or any future chapter of the work4 ,we will consider1 then1 that-- ,infancy1 commencing with birth1 extends to about the end of the second year1 when the first dentition is completed4 ,childhood extends from about the second1 to the seventh or eighth year1 when the second dentition is commenced4 ,sect4 ,i4 ,,dietetics ,,of ,,infancy4 ,in the early months of infancy the organs of digestion are unsuited to any other food than that derived from the breast of the mother4 ,so little capable are they1 indeed1 to digest any other1 even of the blandest and most digestible kind1 that probably not more than one infant in six or seven ever arrives at the more advanced periods of life when deprived of the kind of nourishment nature intended for this epoch4 ,it is not every parent1 however1 who is able to become a nurse2 and with many this office would not only be highly injurious to their own health1 but materially so to that of their offspring4 ,this may arise from various causes1 hereafter to be noticed1 but whenever they exist a wet-nurse is demanded4 ,again1 the latter resource is not always attainable1 so that the hazardous experiment of an artificial diet1 or bringing up by hand1 as it is then termed1 is obliged to be resorted to4 ,thus1 infantile dietetics naturally divides itself into ,maternal ,nursing1 ,wet-,nurse ,suckling1 ,and ,artificial ,feeding4 #a4 ,,maternal ,,nursing4 ,,plan ,,of ,,suckling4 ,from the first moment the infant is applied to the breast1 it must be nursed upon a certain plan4 ,this is necessary to the well-doing of the child1 and will contribute essentially to preserve the health of the parent1 who will thus be rendered a good nurse1 and her duty at the same time will become a pleasure4 ,this implies1 however1 a careful attention on the part of the mother to her own health2 for that of her child is essentially dependent upon it4 ,healthy1 nourishing1 and digestible milk can be procured only from a healthy parent2 and it is against common sense to expect that1 if a mother impairs her health and digestion by improper diet1 neglect of exercise1 and impure air1 she can1 nevertheless1 provide as wholesome and uncontaminated a fluid for her child1 as if she were diligently attentive to these important points4 ,every instance of indisposition in the nurse is liable to affect the infant4 ,and this leads me to observe1 that it is a common mistake to suppose that1 because a woman is nursing1 she ought therefore to live very fully1 and to add an allowance of wine1 porter1 or other fermented liquor1 to her usual diet4 ,the only result of this plan is1 to cause an unnatural degree of fulness in the system1 which places the nurse on the brink of disease1 and which of itself frequently puts a stop to the secretion of the milk1 instead of increasing it4 ,the right plan of proceeding is plain enough2 only let attention be paid to the ordinary laws of health1 and the mother1 if she have a sound constitution1 will make a better nurse than by any foolish deviation founded on ignorance and caprice4 ,the following case proves the correctness of this statement3-- ,a young married lady1 confined with her first child1 left the lying-in- room at the expiration of the third week1 a good nurse1 and in perfect health4 ,she had had some slight trouble with her nipples1 but this was soon overcome4 ,the porter system was now commenced1 and from a pint to a pint and a half of this beverage was taken in the four and twenty hours4 ,this was resorted to1 not because there was any deficiency in the supply of milk1 for it was ample1 and the infant thriving upon it2 but because1 having become a nurse1 she was told that it was usual and necessary1 and that without it her milk and strength would ere long fail4 ,after this plan had been followed for a few days1 the mother became drowsy and disposed to sleep in the daytime2 and headach1 thirst1 a hot skin1 in fact1 fever supervened2 the milk diminished in quantity1 and1 for the first time1 the stomach and bowels of the infant became disordered4 ,the porter was ordered to be left off2 remedial measures were prescribed2 and all symptoms1 both in parent and child1 were after a while removed1 and health restored4 ,having been accustomed1 prior to becoming a mother1 to take a glass or two of wine1 and occasionally a tumbler of table beer1 she was advised to follow precisely her former dietetic plan1 but with the addition of half a pint of barley-milk morning and night4 ,both parent and child continued in excellent health during the remaining period of suckling1 and the latter did not taste artificial food until the ninth month1 the parent's milk being all-sufficient for its wants4 ,no one can doubt that the porter was in this case the source of the mischief4 ,the patient had gone into the lying-in-room in full health1 had had a good time1 and came out from her chamber 7comparatively7 as strong as she entered it4 ,her constitution had not been previously worn down by repeated child-bearing and nursing1 she had an ample supply of milk1 and was fully capable1 therefore1 of performing the duties which now devolved upon her1 without resorting to any unusual stimulant or support4 ,her previous habits were totally at variance with the plan which was adopted2 her system became too full1 disease was produced1 and the result experienced was nothing more than what might be expected4 ,the plan to be followed for the first six months4-,until the breast- milk is fully established1 which may not be until the second or third day subsequent to delivery 7almost invariably so in a first confinement71 the infant must be fed upon a little thin gruel1 or upon one third water and two thirds milk1 sweetened with loaf sugar4 ,after this time it must obtain its nourishment from the breast alone1 and for a week or ten days the appetite of the infant must be the mother's guide1 as to the frequency in offering the breast4 ,the stomach at birth is feeble1 and as yet unaccustomed to food2 its wants1 therefore1 are easily satisfied1 but they are frequently renewed4 ,an interval1 however1 sufficient for digesting the little swallowed1 is obtained before the appetite again revives1 and a fresh supply is demanded4 ,at the expiration of a week or so it is essentially necessary1 and with some children this may be done with safety from the first day of suckling1 to nurse the infant at regular intervals of three or four hours1 day and night4 ,this allows sufficient time for each meal to be digested1 and tends to keep the bowels of the child in order4 ,such regularity1 moreover1 will do much to obviate fretfulness1 and that constant cry1 which seems as if it could be allayed only by constantly putting the child to the breast4 ,a young mother very frequently runs into a serious error in this particular1 considering every expression of uneasiness as an indication of appetite1 and whenever the infant cries offering it the breast1 although ten minutes may not have elapsed since its last meal4 ,this is an injurious and even dangerous practice1 for1 by overloading the stomach1 the food remains undigested1 the child's bowels are always out of order1 it soon becomes restless and feverish1 and is1 perhaps1 eventually lost2 when1 by simply attending to the above rules of nursing1 the infant might have become healthy and vigorous4 ,for the same reason1 the infant that sleeps with its parent must not be allowed to have the nipple remaining in its mouth all night4 ,if nursed as suggested1 it will be found to awaken1 as the hour for its meal approaches1 with great regularity4 ,in reference to night-nursing1 ,i would suggest suckling the babe as late as ten o'clock p4 m41 and not putting it to the breast again until five o'clock the next morning4 ,many mothers have adopted this hint1 with great advantage to their own health1 and without the slightest detriment to that of the child4 ,with the latter it soon becomes a habit2 to induce it1 however1 it must be taught early4 ,the foregoing plan1 and without variation1 must be pursued to the sixth month4 ,,after ,,the ,,sixth ,,month ,,to ,,the ,,time ,,of ,,weaning4--,if the parent has a large supply of good and nourishing milk1 and her child is healthy and evidently flourishing upon it1 no change in its diet ought to be made4 ,if otherwise1 however1 7and this will but too frequently be the case1 even before the sixth month,,fn#a17 the child may be fed twice in the course of the day1 and that kind of food chosen which1 after a little trial1 is found to agree best4 ,,fn#a ,see ,deficiency of ,milk1 p4 #aa4 ,leman's tops and bottoms1 steeped in hot water1 with the addition of a little fresh milk1 and sweetened or not with loaf sugar1 is one of the best description4 ,if the stomach reject this1 farinaceous food boiled in water1 and mixed with a small quantity of milk1 may be employed4 ,or weak mutton or veal broth1 or beef tea1 clear and free from fat1 and mixed with an equal quantity of farinaceous food4 ,if this artificial diet is used before the sixth month1 it must be given through the sucking-bottle2 after this period with a spoon3 in either case it must be previously passed through a sieve4 ,when the large or grinding teeth have appeared1 the same food is still to be continued1 but need not any longer be expressed through the sieve4 ,such is the plan of nursing to be followed by the mother until she wean her infant altogether from the breast4 ,the period when this ought to take place1 as also the manner of accomplishing it1 are detailed in the section on ,weaning4,,fn#b ,,fn#b ,see page #ea4 ,the diet from weaning to the termination of infancy is pointed out under ,artificial ,feeding4,,fn#c ,,fn#c ,see page #cd4 ,,deficiency ,,of ,,milk4 ,if this deficiency exist from the earliest weeks after delivery1 and it is not quickly remedied by the means presently to be pointed out1 a wet-nurse must be obtained4 ,it will be of no avail partially to nurse1 and partially to feed the infant at this period and under such circumstances1 for if it is not soon lost1 it will only live for a few months1 or a year at most1 and be an object of the greatest anxiety and grief to its parent4 ,this condition arises from the unwholesomeness of the mother's milk1 united with the artificial food2 for when the milk is deficient from the first1 and continues so notwithstanding the means used for its increase1 it is invariably unhealthy in its quality4 ,this deficiency1 however1 may exist1 and even at a very early period after delivery1 and yet be removed4 ,this1 however1 is not to be accomplished by the means too frequently resorted to2 for it is the custom with many1 two or three weeks after their confinement1 if the supply of nourishment for the infant is scanty1 to partake largely of malt liquor for its increase4 ,sooner or later this will be found injurious to the constitution of the mother3 but how1 then1 is this deficiency to be obviated8 ,let the nurse keep but in good health1 and this point gained1 the milk1 both as to quantity and quality1 will be as ample1 nutritious1 and good1 as can be produced by the individual4 ,i would recommend a plain1 generous1 and nutritious diet2 not one description of food exclusively1 but1 as is natural1 a wholesome1 mixed1 animal1 and vegetable diet1 with or without wine or malt liquor1 according to former habit2 and1 occasionally1 where malt liquor has never been previously taken1 a pint of good sound ale may be taken daily with advantage1 if it agree with the stomach4 ,regular exercise in the open air is of the greatest importance1 as it has an extraordinary influence in promoting the secretion of healthy milk4 ,early after leaving the lying-in room1 carriage exercise1 where it can be obtained1 is to be preferred1 to be exchanged1 in a week or so1 for horse exercise1 or the daily walk4 ,the tepid1 or cold salt-water shower bath1 should be used every morning2 but if it cannot be borne1 sponging the body withsalt-water must be substituted4 ,by adopting with perseverance the foregoing plan1 a breast of milk will be obtained as ample in quantity1 and good in quality1 as the constitution of the parent can produce1 as the following case proves3 ,on the #agth ,september1 #ahci1 ,i attended a lady twenty-four years of age1 a delicate1 but healthy woman1 in her first confinement4 ,the labour was good4 ,every thing went on well for the first week1 except that1 although the breasts became enlarged1 and promised a good supply of nourishment for the infant1 at its close there was merely a little oozing from the nipple4 ,during the next fortnight a slight1 but very gradual increase in quantity took place1 so that a dessert spoonful only was obtained about the middle of this period1 and perhaps double this quantity at its expiration4 ,in the mean time the child was necessarily fed upon an artificial diet1 and as a consequence its bowels became deranged1 and a severe diarrhoea followed4 ,a wet-nurse was advised for the child as the only means of saving its life1 and change of air for the mother as the most likely expedient 7in connection with the general treatment pointed out above7 for obtaining a good breast of milk4 ,accordingly1 on the #eth ,october1 the patient1 taking with her the infant and a wet-nurse1 went a few miles from town4 ,for three or four days it was a question whether the little one would live1 for so greatly had it been reduced by the looseness of the bowels that it had not strength to grasp the nipple of its nurse2 the milk1 therefore1 was obliged to be drawn1 and the child fed with it from a spoon4 ,after the lapse of a few days1 however1 it could obtain the breast-milk for itself2 and1 to make short of the case1 on the #beth of the same month1 the mother and child returned home1 the former having a very fair proportion of healthy milk in her bosom1 and the child perfectly recovered and evidently thriving fast upon it4 ,where1 however1 there has been an early deficiency in the supply of nourishment1 it will most frequently happen that1 before the sixth or seventh month1 the infant's demands will be greater than the mother can meet4 ,the deficiency must be made up by artificial food1 which must be of a kind generally employed before the sixth month1 and given through the bottle4 ,if1 however1 this plan of dieting should disagree1 the child must1 even at this period1 have a wet-nurse4 ,women who marry comparatively late in life1 and bear children1 generally have a deficiency of milk after the second or third month3 artificial feeding must in part be here resorted to4 ,,the ,,injurious ,,effects ,,to ,,the ,,mother ,,and ,,infant ,,of ,,undue ,,and ,,protracted ,,suckling4 ,,upon ,,the ,,mother4--,the period of suckling is generally one of the most healthy of a woman's life4 ,but there are exceptions to this as a general rule2 and nursing1 instead of being accompanied by health1 may be the cause of its being materially1 and even fatally1 impaired4 ,this may arise out of one of two causes1 either1 a parent continuing to suckle too long2 or1 from the original powers or strength not being equal to the continued drain on the system4 ,examples of the first class ,i am meeting with daily4 ,i refer to poor married women1 who1 having nursed their infants eighteen months1 two years1 or even longer than this1 from the belief that by so doing they will prevent pregnancy1 call to consult me with an exhausted frame and disordered general health1 arising solely from protracted nursing1 pursued from the above mistaken notion4 ,i most frequently meet with examples of the second class in the delicate woman1 who1 having had two or three children in quick succession1 her health has given way1 so that she has all the symptoms arising from undue suckling1 when perhaps the infant at her breast is not more than two or three months old4 ,since the health of the mother1 then1 will suffer materially from this circumstance1 she ought not to be ignorant of the fact2 so that1 when the first symptoms manifest themselves1 she may be able to recognise their insidious approach2 and tracing them to their real cause1 obtain medical advice before her health be seriously impaired4 ,,symptoms4--,the earliest symptom is a dragging sensation in the back when the child is in the act of sucking1 and an exhausted feeling of sinking and emptiness at the pit of the stomach afterwards4 ,this is soon followed by loss of appetite1 costive bowels1 and pain on the left side2 then1 the head will be more or less affected1 sometimes with much throbbing1 singing in the ears1 and always some degree of giddiness1 with great depression of spirits4 ,soon the chest becomes affected1 and the breathing is short1 accompanied by a dry cough and palpitation of the heart upon the slightest exertion4 ,as the disease advances1 the countenance becomes very pale1 and the flesh wastes1 and profuse night perspirations1 great debility1 swelling of the ankles1 and nervousness ensue4 ,it is unnecessary1 however1 to enter into a more full detail of symptoms4 ,,treatment4--,all that it will be useful to say in reference to treatment1 is this2 that1 although much may be done in the first instance by medicine1 change of air1 cold and sea bathing1 yet the quickest and most effectual remedy is to wean the child1 and thus remove the cause4 ,,the ,,ill ,,effects ,,upon ,,the ,,infant4--,there is another and equally powerful reason why the child should be weaned1 or rather1 have a young and healthy wet-nurse1 if practicable4 ,the effects upon the infant1 suckled under such circumstances1 will be most serious4 ,born in perfect health1 it will now begin to fall off in its appearance1 for the mother's milk will be no longer competent to afford it due nourishment2 it will be inadequate in quantity and quality4 ,its countenance1 therefore1 will become pale2 its look sickly and aged2 the flesh soft and flabby2 the limbs emaciated2 the belly1 in some cases1 large1 in others1 shrunk2 and the evacuations fetid and unnatural2 and in a very few weeks1 the blooming healthy child will be changed into the pale1 sickly1 peevish1 wasted creature1 whose life appears hardly desirable4 ,the only measure that can save the life1 and recover an infant from this state1 is that which would previously have prevented it a healthy wet-nurse4 ,if the effects upon the infant should not be so aggravated as those just described1 and it subsequently live and thrive1 there will be a tendency in such a constitution to scrofula and consumption1 to manifest itself at some future period of life1 undoubtedly acquired from the parent1 and dependent upon the impaired state of her health at the time of its suckling4 ,a wet-nurse early resorted to1 will prevent this4 ,it will be naturally asked1 for how long a period a mother ought to perform the office of a nurse8 ,no specific time can be mentioned1 and the only way in which the question can be met is this3 no woman1 with advantage to her own health1 can suckle her infant beyond twelve or eighteen months2 and at various periods between the third and twelfth month1 many women will be obliged partially or entirely to resign the office4,,fn#d ,,fn#d ,see ,weaning1 p4 #ea4 ,the monthly periods generally reappear from the twelfth to the fourteenth month from delivery2 and when established1 as the milk is found invariably to diminish in quantity1 and also to deteriorate in quality1 and the child is but imperfectly nourished1 it is positively necessary in such instances at once to wean it4 ,,of ,,mothers ,,who ,,ought ,,never ,,to ,,suckle4 ,there are some females who ought never to undertake the office of suckling1 both on account of their own health1 and also that of their offspring4 ,,the ,,woman ,,of ,a ,,consumptive ,,and ,,strumous ,,constitution ,,ought ,,not4--,in the infant born of such a parent there will be a constitutional predisposition to the same disease2 and1 if it is nourished from her system1 this hereditary predisposition will be confirmed4 ,no fact in medicine is better established than that which proves the hereditary transmission from parents to children of a constitutional liability to pulmonary disease1 and especially to consumption2 yet no condition is less attended to in forming matrimonial engagements4 ,the children of scrofulous and consumptive parents are generally precocious1 and their minds being early matured1 they engage early in the business of life1 and often enter the married state before their bodily frame has had time to consolidate4 ,for a few years every thing seems to go on prosperously1 and a numerous family gathers around them4 ,all at once1 however1 even while youth remains1 their physical powers begin to give way1 and they drop prematurely into the grave1 exhausted by consumption1 and leaving children behind them1 destined1 in all probability1 either to be cut off as they approach maturity1 or to run through the same delusive but fatal career as that of the parents from whom they derived their existence4,,fn#e ,there is scarcely an individual who reads these facts1 to whom memory will not furnish some sad and mournful example of their truth2 though they perhaps may have hitherto been in ignorance of the exciting cause4 ,,fn#e ,combe's ,principles of ,physiology applied to the ,preservation of ,health1 etc4 ,it is1 however1 with the mother as a nurse that ,i have now to do1 and ,i would earnestly advise every one of a consumptive or strumous habit 7and if there is any doubt upon this point1 the opinion of a medical adviser will at once decide it7 never to suckle her offspring2 her constitution renders her unfit for the task4 ,and1 however painful it may be to her mind at every confinement to debar herself this delightful duty1 she must recollect that it will be far better for her own health1 and infinitely more so for that of the child1 that she should not even attempt it2 that her own health would be injured1 and her infant's1 sooner or later1 destroyed by it4 ,the infant of a consumptive parent1 however1 must not be brought up by hand4 ,it must have a young1 healthy1 and vigorous wet-nurse2 and in selecting a woman for this important duty very great care must be observed4,,fn#f ,the child should be nursed until it is twelve or fifteen months old4 ,in some cases it will be right to continue it until the first set of teeth have appeared1 when it will be desirable that a fresh wet-nurse should be obtained for the last six months4,,fn#g ,if the child is partially fed during the latter months 7from necessity or any other cause71 the food should be of the lightest quality1 and constitute but a small proportion of its nutriment4 ,,fn#f ,see ,choice of a ,wet-nurse1 p4 #bh4 ,,fn#g ,one that has been confined about six weeks or two months4 ,but not only must the nourishment of such a child be regarded1 but the air it breathes1 and the exercise that is given to it2 as also1 the careful removal of all functional derangements as they occur1 by a timely application to the medical attendant1 and maintaining1 especially1 a healthy condition of the digestive organs4 ,all these points must be strictly followed out1 if any good is to be effected4 ,by a rigid attention to these measures the mother adopts the surest antidote1 indirectly1 to overcome the constitutional predisposition to that disease1 the seeds of which1 if not inherited from the parent1 are but too frequently developed in the infant during the period of nursing2 and1 at the same time1 she takes the best means to engender a sound and healthy constitution in her child4 ,this1 surely1 is worth any sacrifice4 ,if the infant derives the disposition to a strumous constitution entirely from the father1 and the mother's health be unexceptionable1 then ,i would strongly advise her to suckle her own child4 ,,the ,,mother ,,of ,a ,,highly ,,susceptible ,,nervous ,,temperament ,,ought ,,not4--,there are other women who ought never to become nurses4 ,the mother of a highly nervous temperament1 who is alarmed at any accidental change she may happen to notice in her infant's countenance1 who is excited and agitated by the ordinary occurrences of the day2 such a parent will do her offspring more harm than good by attempting to suckle it4 ,her milk will be totally unfit for its nourishment3 at one time it will be deficient in quantity1 at another1 so depraved in its quality1 that serious disturbance to the infant's health1 will ensue4 ,the young and inexperienced mother1 who is a parent for the first time1 and altogether ignorant of the duties of her office1 and at the same time most anxious to fulfil them faithfully1 is but too frequently an instance in point2 although at a future period she will generally make a good nurse4 ,the following is an illustration3-- ,in ,december1 #ahch1 ,i attended a young married lady in her first confinement1 and in excellent health4 ,she gave birth to a fine1 plump1 healthy boy4 ,every thing went on well for three weeks1 the mother having an abundant supply of milk1 and the infant evidently thriving upon it4 ,about this time1 however1 the child had frequent fits of crying2 the bowels became obstinately costive2--the motions being lumpy1 of a mixed colour1 quite dry1 and passed with great pain4 ,it became rapidly thin1 and after a while its flesh so wasted1 and became so flabby1 that it might be said literally to hang on the bones4 ,the fits of crying now increased in frequency and violence1 coming on every time after the little one left the breast1 when it would commence screaming violently1 beat the air with its hands and feet1 and nothing that was done could appease it4 ,having lasted for half an hour or more1 it would fall asleep quite exhausted2 the fit recurring again1 when again it had been to the breast4 ,it was very evident that the infant's hunger was not satisfied1 as it was also but too evident its body was not nourished by the parent's milk1 which1 although abundant in quantity 7the breast being large and full of milk71 was at this time seriously deteriorated in its nutritive quality4 ,this was caused1 ,i believe1 from great anxiety of mind4 ,her nurse became suddenly deranged1 and the whole responsibility and care of the child thus devolved upon the mother1 of the duties connected with which she was entirely ignorant4 ,a wet-nurse was obtained4 ,in a very few hours after this change was effected1 the screaming ceased1 the child had quiet and refreshing sleep1 and in twelve hours a healthy motion was passed4 ,the child gained flesh almost as quickly as it had previously lost it1 and is now as fine and healthy an infant as it promised to be when born4 ,whenever there has existed previously any nervous or mental affection in the parent1 wet-nurse suckling is always advisable2 this1 with judicious management of childhood1 will do much to counteract the hereditary predisposition4 ,,the ,,mother ,,who ,,only ,,nurses ,,her ,,infant ,,when ,,it ,,suits ,,her ,,convenience ,,ought ,,not4--,the mother who cannot make up her mind exclusively to devote herself to the duties of a nurse1 and give up all engagements that would interfere with her health1 and so with the formation of healthy milk1 and with the regular and stated periods of nursing her infant1 ought never to suckle4 ,it is unnecessary to say why2 but ,i think it right1 for the child's sake1 to add1 that if it does not sicken1 pine1 and die1 disease will be generated in its constitution1 to manifest itself at some future period4 ,the child1 then1 under all the foregoing circumstances1 must be provided with its support from another source1 and a wet-nurse is the best4 #b4 ,,wet-,,nurse ,,suckling4 ,ill health and many other circumstances may prevent a parent from suckling her child1 and render a wet-nurse necessary4 ,now1 although she will do wisely to leave the choice of one to her medical attendant1 still1 as some difficulty may attend this1 and as most certainly the mother herself ought to be acquainted with the principal points to which his attention is directed in the selection of a good nurse1 it will be well to point out in what they consist4 ,,choice ,,of ,a ,,wet-,,nurse4 ,the first thing to which a medical man looks1 is the general health of the woman2 next1 the condition of her breast1 the quality of her milk its age and her own2 whether she is ever unwell while nursing2 and1 last of all1 the condition and health of the child4 ,,is ,,the ,,woman ,,in ,,good ,,health8--,her general appearance ought to bear the marks of a sound constitution1 and ought to be free from all suspicion of a strumous character2 her tongue clean1 and digestion good2 her teeth and gums sound and perfect2 her skin free from eruption1 and her breath sweet4 ,,what ,,is ,,the ,,condition ,,of ,,the ,,breast8--,a good breast should be firm and well formed2 its size not dependent upon a large quantity of fat1 which will generally take away from its firmness1 giving it a flabby appearance1 but upon its glandular structure1 which conveys to the touch a knotted1 irregular1 and hard feel2 and the nipple must be perfect1 of moderate size1 but well developed4 ,,what ,,is ,,the ,,quality ,,of ,,the ,,milk8--,it should be thin1 and of a bluish- white colour2 sweet to the taste2 and when allowed to stand1 should throw up a considerable quantity of cream4 ,,what ,,is ,,its ,,age8--,if the lying-in month of the patient has scarcely expired1 the wet-nurse to be hired ought certainly not to have reached her second month4 ,at this time1 the nearer the birth of the child1 and the delivery of its foster-parent1 the better3 the reason for which is1 that during the first few weeks the milk is thinner and more watery than it afterwards becomes4 ,if1 consequently1 a new-born infant be provided with a nurse1 who has been delivered three or four months1 the natural relation between its stomach and the quality of the milk is destroyed1 and the infant suffers from the oppression of food too heavy for its digestive power4 ,on the other hand1 if you are seeking a wet-nurse for an infant of four or five months old1 it would be very prejudicial to transfer the child to a woman recently delivered2 the milk would be too watery for its support1 and its health in consequence would give way4 ,,the ,,nurse ,,herself ,,should ,,not ,,be ,,too ,,old6--,a vigorous young woman from twenty-one to thirty admits of no question4 ,and the woman who has had one or two children before is always to be preferred1 as she will be likely to have more milk1 and may also be supposed to have acquired some experience in the management of infants4 ,,inquire ,,whether ,,she ,,is ,,ever ,,unwell ,,while ,,nursing8--,if so1 reject her at once4 ,you will have no difficulty in ascertaining this point2 for this class of persons have an idea that their milk is renewed1 as they term it1 by this circumstance1 monthly2 and1 therefore1 that it is a recommendation1 rendering their milk fitter for younger children than it would otherwise have been4 ,it produces1 however1 quite a contrary effect2 it much impairs the milk1 which will be found to disagree with the child1 rendering it at first fretful1--after a time being vomited up1 and productive of frequent watery dark green motions4 ,last of all1 ,,what ,,is ,,the ,,condition ,,of ,,the ,,child8--,it ought to have the sprightly appearance of health1 to bear the marks of being well nourished1 its flesh firm1 its skin clean and free from eruptions4 ,it should be examined in this respect1 particularly about the head1 neck1 and gums4 ,if a medical man finds that both mother and child answer to the above description1 he has no hesitation in recommending the former as likely to prove a good wet-nurse4 ,,diet ,,and ,,regimen ,,of ,a ,,wet-,,nurse4 ,the regimen of a wet-nurse should not differ much from that to which she has been accustomed2 and any change which it may be necessary to make in it should be gradual4 ,it is erroneous to suppose that women when nursing require to be much more highly fed than at other times3 a good nurse does not need this1 and a bad one will not be the better for it4 ,the quantity which many nurses eat and drink1 and the indolent life which they too often lead1 have the effect of deranging their digestive organs1 and frequently induce a state of febrile excitement1 which always diminishes1 and even sometimes altogether disperses1 the milk4 ,it will be necessary then to guard against the nurse overloading her stomach with a mass of indigestible food and drink4 ,she should live as much as possible in the manner to which she has been accustomed2 she should have a wholesome1 mixed1 animal and vegetable diet1 and a moderate and somewhat extra quantity of malt liquor1 provided it agree with her system4 ,a very prevailing notion exists that porter tends to produce a great flow of milk1 and in consequence the wet-nurse is allowed as much as she likes2 a large quantity is in this way taken1 and after a short time so much febrile action excited in the system1 that instead of increasing the flow of milk1 it diminishes it greatly4 ,some parents1 however1 aware of this fact1 will go into an opposite extreme1 and refuse the nurse even that which is necessary4 ,either excess is of course wrong4 ,it is difficult in general terms to say what ought to be considered a proper daily allowance1 but some is in general necessary2 and whenever a woman has been used to drink malt-liquor1 she will rarely make a good wet-nurse if she is denied a reasonable quantity of that beverage4 ,good sound ale sometimes agrees better than porter4 ,it may be well here to remark1 that in ,london1 ,i frequently meet with severe cases of diarrhoea in infants at the breast1 fairly traceable to bad porter1 which vitiating the quality of the milk1 no medical treatment cures the disease1 until this beverage is left off or changed1 when it at once disappears4 ,the nurse should take exercise daily in the open air4 ,nothing tends more directly to maintain a good supply of healthy milk1 than air and exercise2 and the best wet-nurse would soon lose her milk1 if constantly kept within doors4 ,sponging the whole body also with cold water with bay-salt in it every morning1 should be insisted upon1 if possible3 it preserves cleanliness1 and greatly invigorates the health4 ,united with this1 the nurse should rise early1 and also be regularly employed during the day in some little portion of duty in the family1 an attendance upon the wants of the child not being alone sufficient4 ,an amiable disposition and good temper are very desirable4 ,a violent fit of passion may exert so peculiar an influence in changing the natural properties of the milk1 that a child has been known to be attacked with a fit of convulsions after being suckled by a nurse while labouring under the effects of a fit of anger4 ,the depressing passions frequently drive the milk away altogether4 ,it is hence of no small moment1 that a wet-nurse be of a quiet and even temper1 and not disposed to mental disturbance4 #c4 ,,artificial1 ,,feeding1 ,,or ,,bringing ,,up ,,by ,,hand4 ,extreme delicacy of constitution1 diseased condition of the frame1 defective secretion of milk1 and other causes1 may forbid the mother suckling her child2 and unless she can perform this office with safety to herself1 and benefit to her infant1 she ought not to attempt it4 ,in this case a young and healthy wet-nurse is the best substitute2 but even this resource is not always attainable4 ,under these circumstances1 the child must be brought up on an artificial diet by hand1--as it is popularly called4 ,to accomplish this with success requires the most careful attention on the part of the parent1 and at all times is attended with risk to the life of the child2 for although some children1 thus reared1 live and have sound health1 these are exceptions to the general rule1 artificial feeding being in most instances unsuccessful4 ,,the ,,kind ,,of ,,artificial ,,food ,,before ,,the ,,sixth ,,month4 ,it should be as like the breast-milk as possible4 ,this is obtained by a mixture of cow's milk1 water1 and sugar1 in the following proportions3-- ,fresh cow's milk1 two thirds2 ,boiling water1 or thin barley water1 one third2 ,loaf sugar1 a sufficient quantity to sweeten4 ,this is the best diet that can be used for the first six months1 after which some farinaceous food may be combined4 ,in early infancy1 mothers are too much in the habit of giving thick gruel1 panada1 biscuit-powder1 and such matters1 thinking that a diet of a lighter kind will not nourish4 ,this is a mistake2 for these preparations are much too solid2 they overload the stomach1 and cause indigestion1 flatulence1 and griping4 ,these create a necessity for purgative medicines and carminatives1 which again weaken digestion1 and1 by unnatural irritation1 perpetuate the evils which render them necessary4 ,thus many infants are kept in a continual round of repletion1 indigestion1 and purging1 with the administration of cordials and narcotics1 who1 if their diet were in quantity and quality suited to their digestive powers1 would need no aid from physic or physicians4 ,in preparing this diet1 it is highly important to obtain pure milk1 not previously skimmed1 or mixed with water2 and in warm weather just taken from the cow4 ,it should not be mixed with the water or sugar until wanted1 and not more made than will be taken by the child at the time1 for it must be prepared fresh at every meal4 ,it is best not to heat the milk over the fire1 but let the water be in a boiling state when mixed with it1 and thus given to the infant tepid or lukewarm4 ,as the infant advances in age1 the proportion of milk may be gradually increased2 this is necessary after the second month1 when three parts of milk to one of water may be allowed4 ,but there must be no change in the kind of diet if the health of the child is good1 and its appearance perceptibly improving4 ,nothing is more absurd than the notion1 that in early life children require a variety of food2 only one kind of food is prepared by nature1 and it is impossible to transgress this law without marked injury4 ,if cow's milk disagree with an infant--and this is sometimes unfortunately the case1 even from its birth ass's milk1--diluted with one third its quantity of water1 may be given as a substitute4 ,i am now attending a lady in her fourth confinement1 who is unable1 from defect in her nipples1 to suckle her children4 ,the first child had a healthy wet-nurse1 and has grown a fine healthy lad4 ,the second1 a girl1 was unfortunate in her nurse1 she being of a strumous and unhealthy constitution1 although to a casual observer bearing the appearance of health4 ,the child lived only three months1 and the nurse died of a rapid consumption shortly after4 ,this discouraged the mother from adopting wet-nurse suckling for the third child 7a great error72 and an artificial diet of cow's milk was resorted to4 ,the third day from commencing this plan1 flatulence1 griping1 purging1 and vomiting came on1 one symptom quickly following the other2 the child wasted1 and on the sixth day had several convulsive fits4 ,the diet was immediately changed for ass's milk1 and in less than twelve hours the sickness and purging ceased2 the flatulence was relieved2 the motions1 from being green1 watery1 and passed with great violence and pain1 became of a healthy consistence and colour1 and the screaming ceased4 ,the symptoms did not return1 the child thrived1 very soon consuming regularly one quart of the ass's milk daily1 and is now a fine healthy girl two years old4 ,a fortnight since the parent was confined with a fourth child4 ,cow's milk was given to it for two or three days 7from the difficulty of obtaining that of the ass71 the same train of symptoms1 precisely1 came on with which the third child had been affected1 which again gave way upon following up the same plan of diet--the substitution of the ass's milk for that of the cow4 ,the evident conclusion from this is1 that the breast-milk of a healthy woman is incomparably the most suitable diet for the infant2 but that1 if she be not of a healthy constitution1 it may be destructive to the child2 and that where this cannot be obtained1 and cow's milk is found to disagree1 ass's milk may sometimes be resorted to with the happiest results4,,fn#h ,,fn#h ,an infant will generally consume a quart1 or a little more1 of ass's milk in the four and twenty hours2 and as this quantity is nearly as much as the animal will give1 it is best to purchase an ass for the express purpose4 ,the foal must be separated from the mother1 and the forage of the latter carefully attended to1 or the milk will disagree with the child4 ,sometimes the mother's breast1 and every description of milk1 is rejected by the child2 in which case recourse must be had to veal or weak mutton broth1 or beef tea1 clear and free from fat1 mixed with a very small quantity of farinaceous food1 carefully passed through a sieve before it is poured into the sucking-bottle4 ,,the ,,mode ,,of ,,administering ,,it4--,there are two ways--by the spoon1 and by the nursing-bottle4 ,the first ought never to be employed at this period1 inasmuch as the power of digestion in infants is very weak1 and their food is designed by nature to be taken very slowly into the stomach1 being procured from the breast by the act of sucking1 in which act a great quantity of saliva is secreted1 and being poured into the mouth1 mixes with the milk1 and is swallowed with it4 ,this process of nature1 then1 should be emulated as far as possible2 and food 7for this purpose7 should be imbibed by suction from a nursing-bottle3 it is thus obtained slowly1 and the suction employed secures the mixture of a due quantity of saliva1 which has a highly important influence on digestion4 ,too much care cannot be taken to keep the bottle perfectly sweet4 ,for this purpose there should always be two in the nursery1 to be used alternately2 and1 if any food remain after a meal1 it must be emptied out4 ,the bottle must always be scalded out after use4 ,the flat glass nursing-bottle itself is too well known to need description2 it may be well1 however1 to say a word about the teat that covers its narrow neck1 and through which the infant sucks the food4 ,if the artificial or prepared cow's teat is made use of1 it should be so attached to the bottle that its extremity does not extend beyond its apex more than half or three quarters of an inch2 for if it projects more than this1 the child will get the sides of the teat so firmly pressed together between its gums1 that there will be no channel for the milk to flow through4 ,this remark applies equally to the teat made of soft wash- leather1 which many ladies prefer to that of the cow1 and it is a good substitute2 but then a fresh piece of leather must be made use of daily1 otherwise the food will be tainted1 and the child's bowels deranged4 ,it is also necessary that both of these1 when used1 should have a small conical piece of sponge inclosed4 ,the most cleanly and convenient apparatus is a cork nipple1 upon the plan of ,m4 ,darbo1 of ,paris1 fixed in the sucking-bottle4,,fn#i ,the cork1 being of a particularly fine texture1 is supple and elastic1 yielding to the infant's lips while sucking1 and is much more durable than the teats ordinarily used4 ,,fn#i ,sold by ,weiss et ,son1 #fb4 ,strand1 ,whatever kind of bottle or teat is used1 however1 it must never be forgotten that cleanliness is absolutely essential to the success of this plan of rearing children4 ,,the ,,quantity ,,of ,,food ,,to ,,be ,,given ,,at ,,each ,,meal4--,this must be regulated by the age of the child1 and its digestive power4 ,a little experience will soon enable a careful and observing mother to determine this point4--,as the child grows older the quantity of course must be increased4 ,the chief error in rearing the young is overfeeding2 and a most serious one it is2 but which may be easily avoided by the parent pursuing a systematic plan with regard to the hours of feeding1 and then only yielding to the indications of appetite1 and administering the food slowly1 in small quantities at a time4 ,this is the only way effectually to prevent indigestion1 and bowel complaints1 and the irritable condition of the nervous system1 so common in infancy1 and secure to the infant healthy nutrition1 and consequent strength of constitution4 ,as has been well observed1 ,nature never intended the infant's stomach to be converted into a receptacle for laxatives1 carminatives1 antacids1 stimulants1 and astringents2 and when these become necessary1 we may rest assured that there is something faulty in our management1 however perfect it may seem to ourselves4 ,,the ,,frequency ,,of ,,giving ,,food4--,this must be determined1 as a general rule1 by allowing such an interval between each meal as will insure the digestion of the previous quantity2 and this may be fixed at about every three or four hours4 ,if this rule be departed from1 and the child receives a fresh supply of food every hour or so1 time will not be given for the digestion of the previous quantity1 and as a consequence of this process being interrupted1 the food passing on into the bowel undigested1 will there ferment and become sour1 will inevitably produce cholic and purging1 and in no way contribute to the nourishment of the child4 ,,the ,,posture ,,of ,,the ,,child ,,when ,,fed4--,it is important to attend to this4 ,it must not receive its meals lying2 the head should be raised on the nurse's arm1 the most natural position1 and one in which there will be no danger of the food going the wrong way1 as it is called4 ,after each meal the little one should be put into its cot1 or repose on its mother's knee1 for at least half an hour4 ,this is essential for the process of digestion1 as exercise is important at other times for the promotion of health4 ,,the ,,kind ,,of ,,artificial ,,food ,,after ,,the ,,sixth ,,month1 ,,to ,,the ,,completion ,,of ,,first ,,dentition4 ,as soon as the child has got any teeth1--and about this period one or two will make their appearance1--solid farinaceous matter boiled in water1 beaten through a sieve1 and mixed with a small quantity of milk1 may be employed4 ,or tops and bottoms1 steeped in hot water1 with the addition of fresh milk and loaf sugar to sweeten4 ,and the child may now1 for the first time1 be fed with a spoon4 ,when one or two of the large grinding teeth have appeared1 the same food may be continued1 but need not be passed through a sieve4 ,beef tea and chicken broth may occasionally be added2 and1 as an introduction to the use of a more completely animal diet1 a portion1 now and then1 of a soft boiled egg2 by and by a small bread pudding1 made with one egg in it1 may be taken as the dinner meal4 ,nothing is more common than for parents during this period to give their children animal food4 ,this is a great error4 ,to feed an infant with animal food before it has teeth proper for masticating it1 shows a total disregard to the plain indications of nature1 in withholding such teeth till the system requires their assistance to masticate solid food4 ,and the method of grating and pounding meat1 as a substitute for chewing1 may be well suited to the toothless octogenarian1 whose stomach is capable of digesting it2 but the stomach of a young child is not adapted to the digestion of such food1 and will be disordered by it4,,fn#aj ,,fn#aj ,sir ,james ,clarke on ,consumption4 ,if the principles already laid down be true1 it cannot reasonably be maintained that a child's mouth without teeth1 and that of an adult1 furnished with the teeth of carnivorous and graminivorous animals1 are designed by the ,creator for the same sort of food4 ,if the mastication of solid food1 whether animal or vegetable1 and a due admixture of saliva1 be necessary for digestion1 then solid food cannot be proper1 when there is no power of mastication4 ,if it is swallowed in large masses it cannot be masticated at all1 and will have but a small chance of being digested2 and in an undigested state it will prove injurious to the stomach and to the other organs concerned in digestion1 by forming unnatural compounds4 ,the practice of giving solid food to a toothless child1 is not less absurd1 than to expect corn to be ground where there is no apparatus for grinding it4 ,that which would be considered as an evidence of idiotism or insanity in the last instance1 is defended and practised in the former4 ,if1 on the other hand1 to obviate this evil1 the solid matter1 whether animal or vegetable1 be previously broken into small masses1 the infant will instantly swallow it1 but it will be unmixed with saliva4 ,yet in every day's observation it will be seen1 that children are so fed in their most tender age2 and it is not wonderful that present evils are by this means produced1 and the foundation laid for future disease4,,fn#aa ,,fn#aa ,dr4 ,john ,clarke's ,commentaries4 ,the diet pointed out1 then1 is to be continued until the second year4 ,great care1 however1 is necessary in its management2 for this period of infancy is ushered in by the process of teething1 which is commonly connected with more or less of disorder of the system4 ,any error1 therefore1 in diet or regimen is now to be most carefully avoided4 ',tis true that the infant1 who is of a sound and healthy constitution1 in whom1 therefore1 the powers of life are energetic1 and who up to this time has been nursed upon the breast of its parent1 and now commences an artificial diet for the first time1 disorder is scarcely perceptible1 unless from the operation of very efficient causes4 ,not so1 however1 with the child who from the first hour of its birth has been nourished upon artificial food4 ,teething under such circumstances is always attended with more or less of disturbance of the frame1 and disease of the most dangerous character but too frequently ensues4 ,it is at this age1 too1 that all infectious and eruptive fevers are most prevalent2 worms often begin to form1 and diarrhoea1 thrush1 rickets1 cutaneous eruptions1 etc4 manifest themselves1 and the foundation of strumous disease is originated or developed4 ,a judicious management of diet will prevent some of these complaints1 and mitigate the violence of others when they occur4 ,,the ,,kind ,,of ,,artificial ,,diet ,,most ,,suitable ,,under ,,the ,,different ,,complaints ,,to ,,which ,,infants ,,are ,,liable4 ,artificial food1 from mismanagement and other causes1 will now and then disagree with the infant4 ,the stomach and bowels are thus deranged1 and medicine is resorted to1 and again and again the same thing occurs4 ,this is wrong1 and but too frequently productive of serious and lasting mischief4 ,alteration of diet1 rather than the exhibition of medicine1 should1 under these circumstances1 be relied on for remedying the evil4 ,calomel1 and such like remedies1 the little powders of the nursery1 ought not to be given on every trivial occasion4 ,more mischief has been effected1 and more positive disease produced1 by the indiscriminate use of the above powerful drug1 either alone or in combination with other drastic purgatives1 than would be credited4 ,purgative medicines ought at all times to be exhibited with caution to an infant1 for so delicate and susceptible is the structure of its alimentary canal1 that disease is but too frequently caused by that which was resorted to in the first instance as a remedy4 ,the bowels should always be kept free2 but then it must be by the mildest and least irritating means4 ,it is a very desirable thing1 then1 to correct the disordered conditions of the digestive organs of an infant1 if possible1 without medicine2 and much may be done by changing the nature1 and sometimes by simply diminishing the quantity1 of food4 ,a diarrhoea1 or looseness of the bowels1 may frequently be checked by giving1 as the diet1 sago thoroughly boiled in very weak beef-tea1 with the addition of a little milk4 ,the same purpose is frequently to be answered by two thirds of arrow-root with one third of milk1 or simply thin arrow-root made with water only2 or1 if these fail1 baked flour1 mixed with boiled milk4 ,costiveness of the bowels may frequently be removed by changing the food to tops and bottoms steeped in hot water1 and a small quantity of milk added1 or prepared barley1--mixed in warm water and unboiled milk4 ,flatulence and griping generally arise from an undue quantity of food1 which passing undigested into the bowels1 they are thus irritated and disturbed4 ,this may be cured by abstinence alone4 ,the same state of things may be caused by the food not being prepared fresh at every meal1 or even from the nursing-bottle or vessel in which the food is given not having been perfectly clean4 ,in this case weak chicken-broth1 or beef-tea freed from fat1 and thickened with soft boiled rice or arrow-root1 may be given4 ,sect4 ,,ii4 ,,weaning4 ,,the ,,time ,,when ,,to ,,take ,,place4--,the time when weaning is to take place must ever depend upon a variety of circumstances1 which will regulate this matter1 independently of any general rule that might be laid down4 ,the mother's health may1 in one case1 oblige her to resort to weaning before the sixth month1 and1 in another instance1 the delicacy of the infant's health1 to delay it beyond the twelfth4 ,nevertheless1 as a general rule1 both child and parent being in good health1 weaning ought never to take place earlier than the ninth 7the most usual date71 and never delayed beyond the twelfth month4 ,i should say further1 that if child and parent are both in vigorous health1 if the infant has cut several of its teeth1 and been already accustomed to be partially fed1 weaning ought to be gradually accomplished at the ninth month4 ,on the other hand1 that if the child is feeble in constitution1 the teeth late in appearing1 and the mother is healthy1 and has a sufficient supply of good milk1 especially if it be the autumnal season1 it will be far better to prolong the nursing for a few months4 ,in such a case1 the fact of the on-appearance of the teeth indicates an unfitness of the system for any other than the natural food from the maternal breast4 ,and again1 if the infant is born of a consumptive parent1 and a healthy and vigorous wet-nurse has been provided1 weaning should most certainly be deferred beyond the usual time1 carefully watching1 however1 that neither nurse nor child suffer from its continuance4 ,,the ,,mode4--,it should be effected gradually4 ,from the sixth month most children are fed twice or oftener in the four-and-twenty hours2 the infant is in fact1 therefore1 from this time in the progress of weaning2 that is to say1 its natural diet is partly changed for an artificial one1 so that when the time for complete weaning arrives1 it will be easily accomplished1 without suffering to the mother1 or much denial to the child4 ,it is1 however1 of the greatest importance to regulate the quantity and quality of the food at this time4 ,if too much food is given 7and this is the great danger7 the stomach will be overloaded1 the digestive powers destroyed1 and if the child is not carried off suddenly by convulsions1 its bowels will become obstinately disordered2 it will fall away from not being nourished1 and perhaps eventually become a sacrifice to the overanxious desire of the parent and its friends to promote its welfare4 ,the kind of food proper for this period1 and the mode of administering it1 is detailed in the previous section1 on ,artificial ,feeding4,,fn#ab ,,fn#ab ,the kind of food after the sixth month to the completion of first dentition1 p4 #dd4 ,much exercise in the open air 7whenever there is no dampness of atmosphere7 is highly necessary and beneficial at this time2 it tends to invigorate the system1 and strengthens the digestive organs1 and thus enables the latter to bear without injury the alteration in diet4 ,,the ,,drying ,,up ,,of ,,the ,,mother',s ,,milk4--,this will generally be attended with no difficulty4 ,when the weaning is effected gradually1 the milk will usually go away of itself without any measures being resorted to4 ,if1 however1 the breasts should continue loaded1 or indeed painfully distended1 a gentle aperient should be taken every morning1 so that the bowels are kept slightly relaxed2 the diet must be diminished in quantity1 and solid nourishment only taken4 ,the breast1 if painfully distended1 must be occasionally drawn1 but only just sufficiently to relieve the distention4 ,in either case they must be rubbed for five or ten minutes1 every four or five hours1 with the following liniment1 previously warmed3-- ,compound soap liniment1 one ounce and a half2 ,laudanum1 three drachms4 ,sect4 ,,iii4 ,,dietetics ,,of ,,childhood4 ,childhood1 as has been before intimated1 extends from about the second to the seventh or eighth year1 when the second dentition is commenced4 ,no precise rules of diet can be laid down for this period1 as this requires to be adapted in every case to the particular constitution concerned4 ,there are1 however1 certain general principles which must be acted upon1 and which can be easily modified by a judicious and observant parent1 as circumstances and constitution may require4 ,,general ,,directions1 ,,and ,,of ,,animal ,,food4--,the diet of the latter months of infancy is still to be continued1 but with the important addition of animal food1 which the child has now got teeth to masticate4 ,this must be given in small quantity2 it should be of the lightest quality1 only allowed on alternate days1 and even then its effects must be carefully watched1 as all changes in the regimen of children should be gradual4 ,a child at this age1 then1 should have its meals at intervals of about four hours3--thus its breakfast between seven and eight o'clock1 to consist of tops and bottoms1 steeped in hot water1 a little milk added1 and the whole sweetened with sugar2 or bread may be softened in hot water1 the latter drained off1 and fresh milk and sugar added to the bread4 ,its dinner about twelve o'clock1 to consist1 every other day1 of a small quantity of animal food 7chicken1 fresh mutton1 or beef1 being the only meats allowed7 with a little bread and water2 on the alternate days1 well boiled rice and milk1 a plain bread1 sago1 tapioca1 or arrow- root pudding1 containing one egg2 or farinaceous food1 with beef-tea4 ,its afternoon mealy about four o'clock1 the same diet as formed the breakfast4 ,at seven1 a little arrow-root1 made with a very small proportion of milk1 or a biscuit1 or crust of bread1 after which the child should be put to bed4 ,the child must be taught to take its food slowly1 retain it in it's mouth long1 and swallow it tardily4 ,nothing must be given in the intervals of the meals4 ,the stomach requires a period of repose after the labour of digestion2 and if the child is entertained by its nurse1 and its mind occupied1 there will be no difficulty in following out this important direction4 ,as the child grows older1 the quantity at each meal should be increased2 the tops and bottoms changed for bread and pure milk1 boiled or not2 meat may be taken daily1 except circumstances forbid it2 and a small quantity of vegetable also4 ,if a child1 then1 be of a sound constitution1 with healthy bowels1 a cool skin1 and clean tongue1 the diet may be liberal1 and provided it is sufficiently advanced in age1 animal food may be taken daily4 ,too low a diet would stint the growth of such a child1 and induce a state of body deficient in vigour1 and unfit for maintaining full health3 scrofula and other diseases would be induced4 ,at the same time let the mother guard against pampering1 for this would lead to evils no less formidable1 though of a different character4 ,and as long as the general health of this child is unimpaired1 the body and mind active1 and no evidence present to mark excess of nutriment1 this diet may be continued4 ,but if languor at any time ensue1 fever become manifested1 the skin hotter than natural1 the tongue white and furred1 and the bowels irregular1 then1 though these symptoms should bebonly in slight degree1 and unattended with any specific derangement amounting to what is considered disease1 not only should the parent lower the diet1 and for a time withdraw the animal part1 but the medical adviser should be consulted1 that measures may be taken to correct the state of repletion which has been suffered to arise4 ,for some time after its removal1 care should also be taken to keep the diet under that1 which occasioned the constitutional disturbance4 ,but if the child be of a delicate and weakly constitution 7and this is unfortunately the more common case71 it will not bear so generous a diet as the foregoing4 ,during the three or four earliest years1 it should be restricted chiefly to a mild farinaceous diet1 with a small allowance only of meat on alternate days4 ,the constant endeavour of the parent now should be1 to seek to increase the digestive power and bodily vigour of her child by frequent exercise in the open air1 and by attention to those general points of management detailed in the after- part of this chapter4 ,this accomplished1 a greater proportion of animal food may be given1 and1 in fact1 will become necessary for the growth of the system1 while at the same time there will be a corresponding power for its assimilation and digestion4 ,a great error in the dietetic management of such children is but too frequently committed by parents4 ,they suppose that because their child is weakly and delicate1 that the more animal food it takes the more it will be strengthened1 and they therefore give animal food too early1 and in too great quantity4 ,it only adds to its debility4 ,the system1 as a consequence1 becomes excited1 nutrition is impeded1 and disease produced1 ultimately manifesting itself in scrofula1 disease in the abdomen1 head1 or chest4 ,the first seeds of consumption are but too frequently originated in this way4 ,a child so indulged will eat heartily enough1 but he remains thin notwithstanding4 ,after a time he will have frequent fever1 will appear heated and flushed towards evening1 when he will drink greedily1 and more than is usual in children of the same age2 there will be deranged condition of the bowels1 and headach1--the child will soon become peevish1 irritable1 and impatient2 it will entirely lose the good humour so natural to childhood1 and that there is something wrong will be evident enough1 the parent1 however1 little suspecting the real cause and occasion of all the evil4 ,in such a child1 too1 it will be found that the ordinary diseases of infancy1 scarlet fever1 measles1 small pox1 etc41 will be attended with an unusual degree of constitutional disturbance2 that it will not bear such active treatment as other children1 or so quickly rally from the illness4 ,strength is to be obtained not from the kind of food which contains most nourishment in itself1 but from that which is best adapted to the condition of the digestive organs at the time when it is taken4 ,,sugar4--,this is a necessary condiment for the food of children1 and it is nutritious1 and does not injure the teeth1 as is generally imagined4 ,during the sugar season1 observes ,dr4 ,dunglison1 the negroes of the ,west ,india islands drink copiously of the juice of the cane1 yet their teeth are not injured2 on the contrary1 they have been praised by writers for their beauty and soundness2 and the rounded form of the body1 whilst they can indulge in the juice1 sufficiently testifies to the nutrient qualities of the saccharine beverage4,,fn#ac ,sweetmeats1 on the other hand1 are most indigestible1 and seriously injurious4 ,,fn#ac ,elements of ,hygiem4 ,philadephia1 #ahce4 ,,salt4--,this is necessary for the health of a child2 it acts as a stimulant to the digestive organs1 and if not allowed in sufficient quantity with the food1 worms will result4,,fn#ad ,it may1 therefore1 be added in small quantity1 and with advantage1 even to the farinaceous food of infants4 ,salted meats1 however1 should never be permitted to the child2 for by the process of salting the fibre of the meat is so changed1 that it is less nutritive1 as well as less digestible4 ,,fn#ad ,lord ,sommerville1 in his ,address to the ,board of ,agriculture1 gave an interesting account of the effects of a punishment which formerly existed in ,holland4 ,the ancient laws of the country ordained men to be kept on bread alone1 un-mixed with salt1 as the severest punishment that could be inflicted upon them in their moist climate4 ,the effect was horrible3 these wretched criminals are said to have been devoured by worms engendered in their own stomachs4 ,the wholesomeness and digestibility of our bread are undoubtedly much promoted by the addition of the salt which it so universally receives4 ,a pound of salt is generally added to each bushel of flour4 ,hence it may be presumed1 that every adult consumes two ounces of salt per week1 or six pounds and a half per annum1 in bread alone4 ,dr4 ,paris on ,diet4 ,,fruits4--,these1 and of all kinds whether fresh or dried1 a delicate child is better without2 except the orange1 which when perfectly ripe may be allowed to any child1 but the white or inner skin should be scrupulously rejected1 as it is most indigestible4 ,a healthy child may be permitted to partake of most fresh fruits4 ,of the stone-fruits1 the ripe peach1 the apricot1 and nectarine1 are the most wholesome2 but cherries1 from the stones being but too frequently swallowed1 had better not be allowed4 ,apples and pears1 when ripe and well masticated1 are not unwholesome2 and the apple when baked affords a pleasant repast1 and where there is a costive habit1 it is useful as a laxative4 ,the small-seeded fruits1 however1 are by far the most wholesome4 ,of these1 the ripe strawberry and raspberry deserve the first rank4 ,the grape is also cooling and antiseptic1 but the husks and seeds should be rejected4 ,the gooseberry is less wholesome on account of the indigestibility of the skin1 which is too frequently swallowed4 ,dried fruits a child should never be permitted to eat4 ,,water4--,this should be the only beverage throughout childhood4 ,toast- and-water1 if the child prefer it1 which is rendered slightly more nutritive than the more simple fluid4 ,the water employed in its preparation1 however1 must be at a boiling temperature1 and it ought to be drunk as soon as it has sufficiently cooled2 for by being kept1 it acquires a mawkish and unpleasant flavour4 ,,wine1 ,,beer1 etc4--,the practice of giving wine1 or1 indeed1 any stimulant1 to a healthy child1 is highly reprehensible2 it ought never to be given but medicinally4 ,the circulation in infancy and childhood is not only more rapid than in the adult1 but easily excited to greater vehemence of action2 the nervous system1 too1 is so susceptible1 that the slightest causes of irritation produce strong and powerful impressions3 the result in either case is diseased action in the frame1 productive of fever1 convulsions1 etc42 wine1 accordingly1 is detrimental to children4 ,an experiment made by ,dr4 ,hunter upon two of his children illustrates1 in a striking manner1 the pernicious effects of even a small portion of intoxicating liquors in persons of this tender age4 ,to one of the children he gave1 every day after dinner1 a full glass of sherry3 the child was five years of age1 and unaccustomed to the use of wine4 ,to the other child1 of nearly the same age1 and equally unused to wine1 he gave an orange4 ,in the course of a week1 a very marked difference was perceptible in the pulse1 urine1 and evacuations from the bowels of the two children4 ,the pulse of the first was raised1 the urine high coloured1 and the evacuations destitute of their usual quantity of bile4 ,in the other child1 no change whatever was produced4 ,he then reversed the experiment1 giving to the first the orange1 and to the second the wine1 and the results corresponded3 the child who had the orange continued well1 and the system of the other got straightway into disorder1 as in the first experiment4,,fn#ae ,,fn#ae ,marcellin relates an instance of seven children in a family whose bowels became infested with worms1 from the use of stimulants4 ,they were cured by substituting water for the pernicious beverage4 ,in this town1 spirits1 particularly gin1 are given to infants and children to a frightful extent4 ,i have seen an old ,irish woman give diluted spirits to the infant just born4 ,a short time since one of those dram-drinking children1 about eight years of age1 was brought into one of our hospitals4 ,the attendants1 from its emaciated appearance1 considered the child was dying from mere starvation2 which was true enough in a certain sense4 ,food was accordingly offered and pressed upon it1 but the boy would not even put it to his lips4 ,the next day it was discovered that the mother brought the child very nearly a pint of gin1 every drop of which before night he had consumed4 ,it is easy to discover when children have been fed upon spirits3 they are always emaciated2 have a lean1 yellow1 haggard look3 the eyes sunk1 the lips pale1 and the teeth discoloured1 the cadaverous aspect of the countenance being most fearful4 ,they are continually suffering from bowel complaints and convulsive disorders2 which1 under these circumstances1 terminate invariably in an early death4 ,sect4 ,,iv4 ,,sleep4 ,,during ,,infancy4--,for three or four weeks after birth the infant sleeps more or less1 day and night1 only waking to satisfy the demands of hunger2 at the expiration of this time1 however1 each interval of wakefulness grows longer1 so that it sleeps less frequently1 but for longer periods at a time4 ,this disposition to repose in the early weeks of the infant's life must not be interfered with2 but this period having expired1 great care is necessary to induce regularity in its hours of sleep1 otherwise too much will be taken in the day-time1 and restless and disturbed nights will follow4 ,the child should be brought into the habit of sleeping in the middle of the day1 before its dinner1 and for about two hours1 more or less4 ,if put to rest at a later period of the day1 it will invariably cause a bad night4 ,at first the infant should sleep with its parent4 ,the low temperature of its body1 and its small power of generating heat1 render this necessary4 ,if it should happen1 however1 that the child has disturbed and restless nights1 it must immediately be removed to the bed and care of another female1 to be brought to its mother at an early hour in the morning1 for the purpose of being nursed4 ,this is necessary for the preservation of the mother's health1 which through sleepless nights would of course be soon deranged1 and the infant would also suffer from the influence which such deranged health would have upon the milk4 ,when a month or six weeks has elapsed1 the child1 if healthy1 may sleep alone in a cradle or cot1 care being taken that it has a sufficiency of clothing1 that the room in which it is placed is sufficiently warm1 viz4 #fj degrees1 and the position of the cot itself is not such as to be exposed to currents of cold air4 ,it is essentially necessary to attend to these points1 since the faculty of producing heat1 and consequently the power of maintaining the temperature1 is less during sleep than at any other time1 and therefore exposure to cold is especially injurious4 ,it is but too frequently the case that inflammation of some internal organ will occur under such circumstances1 without the true source of the disease ever being suspected4 ,here1 however1 a frequent error must be guarded against1-- that of covering up the infant in its cot with too much clothing throwing over its face the muslin handkerchief--and1 last of all1 drawing the drapery of the bed closely together4 ,the object is to keep the infant sufficiently warm with pure air2 it therefore ought to have free access to its mouth1 and the atmosphere of the whole room should be kept sufficiently warm to allow the child to breathe it freely3 in winter1 therefore1 there must always be a fire in the nursery4 ,the child up to two years old1 at least1 should sleep upon a feather bed1 for the reasons referred to above4 ,the pillow1 however1 after the sixth month1 should be made of horsehair2 for at this time teething commences1 and it is highly important that the head should be kept cool4 ,,during ,,childhood4--,up to the third or fourth year the child should be permitted to sleep for an hour or so before its dinner4 ,after this time it may gradually be discontinued2 but it must be recollected1 that during the whole period of childhood more sleep is required than in adult age4 ,the child1 therefore1 should be put to rest every evening between seven and eight2 and if it be in health it will sleep soundly until the following morning4 ,no definite rule1 however1 can be laid down in reference to the number of hours of sleep to be allowed2 for one will require more or less than another4,,fn#af ,regularity as to the time of going to rest is the chief point to attend to2 permit nothing to interfere with it1 and then only let the child sleep without disturbance1 until it awakes of its own accord on the following morning1 and it will have had sufficient rest4 ,,fn#af ,the amount of sleep necessary to preserve health varies according to the state of the body1 and the habits of the individual4 ,as already observed1 infants pass much the greater portion of their time in sleep4 ,children sleep twelve or fourteen hours4 ,the schoolboy generally ten4 ,in youth1 a third part of the twenty-four hours is spent in sleep4 ,whilst1 in advanced age1 many do not spend more than four1 five1 or six hours in sleep4 ,it is a cruel thing for a mother to sacrifice her child's health that she may indulge her own vanity1 and yet how often is this done in reference to sleep4 ,an evening party is to assemble1 and the little child is kept up for hours beyond its stated time for retiring to rest1 that it may be exhibited1 fondled1 and admired4 ,its usual portion of sleep is thus abridged1 and1 from the previous excitement1 what little he does obtain1 is broken and unrefreshing1 and he rises on the morrow wearied and exhausted4 ,once awake1 it should not be permitted to lie longer in bed1 but should be encouraged to arise immediately4 ,this is the way to bring about the habit of early rising1 which prevents many serious evils to which parents are not sufficiently alive1 promotes both mental and corporeal health1 and of all habits is said to be the most conducive to longevity4 ,a child should never be suddenly aroused from sleep2 it excites the brain1 quickens the action of the heart1 and1 if often repeated1 serious consequences would result4 ,the change of sleeping to waking should always be gradual4 ,the bed on which the child now sleeps should be a mattress3 at this age a feather bed is always injurious to children2 for the body1 sinking deep into the bed1 is completely buried in feathers1 and the unnatural degree of warmth thus produced relaxes and weakens the system1 particularly the skin1 and renders the child unusually susceptible to the impressions of cold4 ,then1 instead of the bed being made up in the morning as soon as vacated1 and while still saturated with the nocturnal exhalations from the body1 the bed-clothes should be thrown over the backs of chairs1 the mattress shaken well up1 and the window thrown open for several hours1 so that the apartment shall be thoroughly ventilated4 ,it is also indispensably requisite not to allow the child to sleep with persons in bad health1 or who are far advanced in life2 if possible1 it should sleep alone4 ,sect4 ,v4 ,,bathing ,,and ,,cleanliness4 ,,during ,,infancy4--,too much attention cannot be paid to cleanliness2 it is essential to the infant's health4 ,the principal points to which especial attention must be paid by the parent for this purpose are the following3-- ,,temperature ,,of ,,the ,,water4--,at first the infant should be washed daily with warm water2 and a bath every night1 for the purpose of thoroughly cleaning the body1 is highly necessary4 ,to bathe a delicate infant of a few days or even weeks old in cold water with a view to harden the constitution 7as it is called71 is the most effectual way to undermine its health and entail future disease4 ,by degrees1 however1 the water with which it is sponged in the morning should be made tepid1 the evening bath being continued warm enough to be grateful to the feelings4 ,a few months having passed by1 the temperature of the water may be gradually lowered until cold is employed1 with which it may be either sponged or even plunged into it1 every morning during summer4 ,if plunged into cold water1 however1 it must be kept in but a minute2 for at this period1 especially1 the impression of cold continued for any considerable time depresses the vital energies1 and prevents that healthy glow on the surface which usually follows the momentary and brief action of cold1 and upon which its usefulness depends4 ,with some children1 indeed1 there is such extreme delicacy and deficient reaction as to render the cold bath hazardous2 no warm glow over the surface takes place when its use inevitably does harm3 its effects1 therefore1 must be carefully watched4 ,,drying ,,the ,,skin4--,the surface of the skin should always be carefully and thoroughly rubbed dry with flannel1--indeed1 more than dry1 for the skin should be warmed and stimulated by the assiduous gentle friction made use of4 ,for this process of washing and drying must not be done languidly1 but briskly and expeditiously2 and will then be found to be one of the most effectual means of strengthening the infant4 ,it is especially necessary carefully to dry the arm-pits1 groins1 and nates2 and if the child is very fat1 it will be well to dust over these parts with hair-powder or starch3 this prevents excoriations and sores1 which are frequently very troublesome4 ,soap is only required to those parts of the body which are exposed to the reception of dirt4 ,,napkins4--,the frequency of the discharges from the bowels and bladder requires a frequent change of napkins4 ,a nurse cannot be too careful of this duty from the first1 so that she may be enabled to discover the periods when those discharges are about to take place1 that she may not only anticipate them1 but teach the child1 at a very early age1 to give intelligent warning of its necessities4 ,thus a habit of regularity with regard to those functions will be established1 which will continue through life1 and tend greatly to the promotion of health4 ,as the child grows older1 the system of cleanliness must in no particular be relaxed1 and it will be found the best preservative against those eruptive disorders which are so frequent and troublesome during the period of infancy4 ,,during ,,childhood4--,when this period arrives1 or shortly after1 bathing is but too frequently left off2 the hands and face of the child are kept clean1 and with this the nurse is satisfied2 the daily ablution of the whole body1 however1 is still necessary1 not only for the preservation of cleanliness1 but because it promotes in a high degree the health of the child4 ,,plan ,,to ,,be ,,pursued ,,with ,,the ,,vigorous ,,and ,,healthy4--,a child of a vigorous constitution and robust health1 as he rises from his bed refreshed and active by his night's repose1 should be put into the shower-bath1 or1 if this excites and alarms him too much1 must be sponged from head to foot with salt water4 ,if the weather be very cold1 the water may be made slightly tepid1 but if his constitution will bear it1 the water should be cold throughout the year4 ,then the body should be speedily dried1 and hastily but well rubbed with a somewhat coarse towel1 and the clothes put on without any unnecessary delay4 ,this should be done every morning of the child's life4 ,if such a child is at the sea-side1 advantage should be taken of this circumstance1 and seabathing should be substituted4 ,the best time is two or three hours after breakfast2 but he must not be fatigued beforehand1 for if so1 the cold bath cannot be used without danger4 ,care must be taken that he does not remain in too long1 as the animal heat will be lowered below the proper degree1 which would be most injurious4 ,in boys of a feeble constitution1 great mischief is often produced in this way4 ,it is a matter also of great consequence in bathing children that they should not be terrified by the immersion1 and every precaution should be taken to prevent this4 ,the healthy and robust boy1 too1 should early be taught to swim1 whenever this is practicable1 for it is attended with the most beneficial effects2 it is a most invigorating exercise1 and the cold bath thus becomes doubly serviceable4 ,,plan ,,to ,,be ,,pursued ,,with ,,the ,,delicate ,,and ,,strumous4--,if a child is of a delicate and strumous constitution1 the cold bath during the summer is one of the best tonics that can be employed2 and if living on the coast1 sea-bathing will be found of singular benefit4 ,the effects1 however1 of sea-bathing upon such a constitution must be particularly watched1 for unless it is succeeded by a glow1--a feeling of increased strength1--and a keen appetite1 it will do no good1 and ought at once to be abandoned for the warm or tepid bath4 ,the opinion that warm baths generally relax and weaken1 is erroneous2 for in this case1 as in all cases when properly employed1 they would give tone and vigour to the whole system2 in fact1 the tepid bath is to this child what the cold bath is to the more robust4 ,in conclusion3 if the bath in any shape cannot from circumstances be obtained1 then cold saltwater sponging must be used daily1 and all the year round1 so long as the proper reaction or glow follows its use2 but when this is not the case1 and this will generally occur1 if the child is delicate and the weather cold1 tepid vinegar and water1 or tepid salt water1 must be substituted4 ,sect4 ,,vi4 ,,clothing4 ,,in ,,infancy4--,infants are very susceptible of the impressions of cold2 a proper regard1 therefore1 to a suitable clothing of the body1 is imperative to their enjoyment of health4 ,unfortunately1 an opinion is prevalent in society1 that the tender child has naturally a great power of generating heat and resisting cold2 and from this popular error has arisen the most fatal results4 ,this opinion has been much strengthened by the insidious manner in which cold operates on the frame1 the injurious effects not being always manifest during or immediately after its application1 so that but too frequently the fatal result is traced to a wrong source1 or the infant sinks under the action of an unknown cause4 ,the power of generating heat in warm-blooded animals is at its minimum at birth1 and increases successively to adult age2 young animals1 instead of being warmer than adults1 are generally a degree or two colder1 and part with their heat more readily2 facts which cannot be too generally known4 ,they show how absurd must be the folly of that system of hardening the constitution 7to which reference has been before made71 which induces the parent to plunge the tender and delicate child into the cold bath at all seasons of the year1 and freely expose it to the cold1 cutting currents of an easterly wind1 with the lightest clothing4 ,the principles which ought to guide a parent in clothing her infant are as follows3-- ,the material and quantity of the clothes should be such as to preserve a sufficient proportion of warmth to the body1 regulated therefore by the season of the year1 and the delicacy or strength of the infant's constitution4 ,in effecting this1 however1 the parent must guard against the too common practice of enveloping the child in innumerable folds of warm clothing1 and keeping it constantly confined to very hot and close rooms2 thus running into the opposite extreme to that to which ,i have just alluded3 for nothing tends so much to enfeeble the constitution1 to induce disease1 and render the skin highly susceptible to the impression of cold2 and thus to produce those very ailments which it is the chief intention to guard against4 ,in their make they should be so arranged as to put no restrictions to the free movements of all parts of the child's body2 and so loose and easy as to permit the insensible perspiration to have a free exit1 instead of being confined to and absorbed by the clothes1 and held in contact with the skin1 till it gives rise to irritation4 ,in their quality they should be such as not to irritate the delicate skin of the child4 ,in infancy1 therefore1 flannel is rather too rough1 but is desirable as the child grows older1 as it gives a gentle stimulus to the skin1 and maintains health4 ,in its construction the dress should be so simple as to admit of being quickly put on1 since dressing is irksome to the infant1 causing it to cry1 and exciting as much mental irritation as it is capable of feeling4 ,pins should be wholly dispensed with1 their use being hazardous through the carelessness of nurses1 and even through the ordinary movements of the infant itself4 ,the clothing must be changed daily4--,it is eminently conducive to good health that a complete change of dress should be made every day4 ,if this is not done1 washing will1 in a great measure1 fail in its object1 especially in insuring freedom from skin diseases4 ,,in ,,childhood4--,the clothing of the child should possess the same properties as that of infancy4 ,it should afford due warmth1 be of such materials as do not irritate the skin1 and so made as to occasion no unnatural constriction4 ,in reference to due warmth1 it may be well again to repeat1 that too little clothing 7that state of semi-nudity which the vanity of some parents encourage7 is frequently productive of the most sudden attacks of active disease2 and that children who are thus exposed with naked breasts and thin clothing in a climate so variable as ours are the frequent subjects of croup1 and other dangerous affections of the air- passages and lungs4 ,on the other hand1 it must not be forgotten1 that too warm clothing is a source of disease1--sometimes even of the same diseases which originate in exposure to cold1--and often renders the frame more susceptible of the impressions of cold1 especially of cold air taken into the lungs4 ,regulate the clothing1 then1 according to the season2 resume the winter dress early2 lay it aside late2 for it is in spring and autumn that the vicissitudes in our climate are greatest1 and congestive and inflammatory complaints most common4 ,with regard to material 7as was before observed71 the skin will at this age bear flannel next to it2 and it is now not only proper1 but necessary4 ,it may be put off with advantage during the night1 and cotton maybe substituted during the summer1 the flannel being resumed early in the autumn4 ,if from very great delicacy of constitution it proves too irritating to the skin1 fine fleecy hosiery will in general be easily endured1 and will greatly conduce to the preservation of health4 ,it is highly important that the clothes of the boy should be so made that no restraints shall be put on the movements of the body or limbs1 nor injurious pressure made on his waist or chest4 ,all his muscles ought to have full liberty to act1 as their free exercise promotes both their growth and activity1 and thus insures the regularity and efficiency of the several functions to which these muscles are subservient4 ,the same remarks apply with equal force to the dress of the girl2 and happily1 during childhood1 at least1 no distinction is made in this matter between the sexes4 ,not so1 however1 when the girl is about to emerge from this period of life2 a system of dress is then adopted which has the most pernicious effects upon her health1 and the development of the body1 the employment of tight stays1 which impede the free and full action of the respiratory organs1 being only one of the many restrictions and injurious practices from which in latter years they are thus doomed to suffer so severely4 ,sect4 ,,vii4 ,,air ,,and ,,exercise4 ,,in ,,infancy4--,the respiration of a pure air is at all times1 and under all circumstances1 indispensable to the health of the infant4 ,the nursery therefore should be large1 well ventilated1 in an elevated part of the house1 and so situated as to admit a free supply both of air and light4 ,for the same reasons1 the room in which the infant sleeps should be large1 and the air frequently renewed2 for nothing is so prejudicial to its health as sleeping in an impure and heated atmosphere4 ,the practice1 therefore1 of drawing thick curtains closely round the bed is highly pernicious2 they only answer a useful purpose when they defend the infant from any draught of cold air4 ,the proper time for taking the infant into the open air must1 of course1 be determined by the season of the year1 and the state of the weather4 ,a delicate infant born late in the autumn will not generally derive advantage from being carried into the open air1 in this climate1 till the succeeding spring2 and if the rooms in which he is kept are large1 often changed1 and well ventilated1 he will not suffer from the confinement1 while he will1 most probably1 escape catarrhal affections1 which are so often the consequence of the injudicious exposure of infants to a cold and humid atmosphere4,,fn#ag ,if1 however1 the child is strong and healthy1 no opportunity should be lost of taking it into the open air at stated periods1 experience daily proving that it has the most invigorating and vivifying influence upon the system4 ,regard1 however1 must always be had to the state of the weather2 and to a damp condition of the atmosphere the infant should never be exposed1 as it is one of the most powerful exciting causes of consumptive disease4 ,the nurse-maid1 too1 should not be allowed to loiter and linger about1 thus exposing the infant unnecessarily1 and for an undue length of time2 this is generally the source of all the evils which accrue from taking the babe into the open air4 ,,fn#ag ,sir ,james ,clark on ,consumption4 ,exercise1 also1 like air1 is essentially important to the health of the infant4 ,its first exercise1 of course1 will be in the nurse's arms4 ,after a month or two1 when it begins to sleep less during the day1 it will delight to roll and kick about on the sofa3 it will thus use its limbs freely2 and this1 with carrying out into the open air1 is all the exercise it requires at this period4 ,by and by1 however1 the child will make its first attempts to walk4 ,now it is important that none of the many plans which have been devised to teach a child to walk1 should be adopted--the go-cart1 leading-strings1 etc42 their tendency is mischievous2 and flatness of the chest1 confined lungs1 distorted spine1 and deformed legs1 are so many evils which often originate in such practices4 ,this is explained by the fact of the bones in infancy being comparatively soft and pliable1 and if prematurely subjected by these contrivances to carry the weight of the body1 they yield just like an elastic stick bending under a weight1 and as a natural consequence become curved and distorted4 ,it is highly necessary that the young and experienced mother should recollect this fact1 for the early efforts of the little one to walk are naturally viewed by her with so much delight1 that she will be apt to encourage and prolong its attempts1 without any thought of the mischief which they may occasion2 thus many a parent has had to mourn over the deformity which she has herself created4 ,it may be as well here to remark1 that if such distortion is timely noticed1 it is capable of correction1 even after evident curvature has taken place4 ,it is to be remedied by using those means that shall invigorate the frame1 and promote the child's general health 7a daily plunge into the cold bath1 or sponging with cold salt water1 will be found signally efficacious71 and by avoiding the original cause of the distortion--never allowing the child to get upon his feet4 ,the only way to accomplish the latter intention1 is to put both the legs into a large stocking2 this will effectually answer this purpose1 while1 at the same time1 it does not prevent the free and full exercise of the muscles of the legs4 ,after some months pursuing this plan1 the limbs will be found no longer deformed1 the bones to have acquired firmness and the muscles strength2 and the child may be permitted to get upon his feet again without any hazard of perpetuating or renewing the evil4 ,the best mode of teaching a child to walk1 is to let it teach itself1 and this it will do readily enough4 ,it will first crawl about3 this exercises every muscle in the body1 does not fatigue the child1 throws no weight upon the bones1 but imparts vigour and strength1 and is thus highly useful4 ,after a while1 having the power1 it will wish to do more3 it will endeavour to lift itself upon its feet by the aid of a chair1 and though it fail again and again in its attempts1 it will still persevere until it accomplish it4 ,by this it learns1 first1 to raise itself from the floor2 and secondly1 to stand1 but not without keeping hold of the object on which it has seized4 ,next it will balance itself without holding1 and will proudly and laughingly show that it can stand alone4 ,fearful1 however1 as yet of moving its limbs without support1 it will seize a chair or anything else near it1 when it will dare to advance as far as the limits of its support will permit4 ,this little adventure will be repeated day after day with increased exultation2 when1 after numerous trials1 he will feel confident of his power to balance himself1 and he will run alone4 ,now time is required for this gradual self-teaching1 during which the muscles and bones become strengthened2 and when at last called upon to sustain the weight of the body1 are fully capable of doing so4 ,,in ,,childhood4--,when the child has acquired sufficient strength to take active exercise1 he can scarcely be too much in the open air2 the more he is habituated to this1 the more capable will he be of bearing the vicissitudes of the climate4 ,children1 too1 should always be allowed to amuse themselves at pleasure1 for they will generally take that kind and degree of exercise which is best calculated to promote the growth and development of the body4 ,in the unrestrained indulgence of their youthful sports1 every muscle of the body comes in for its share of active exercise2 and free growth1 vigour1 and health are the result4 ,if1 however1 a child is delicate and strumous1 and too feeble to take sufficient exercise on foot1--and to such a constitution the respiration of a pure air and exercise are indispensable for the improvement of health1 and without them all other efforts will fail1--riding on a donkey or pony forms the best substitute4 ,this kind of exercise will always be found of infinite service to delicate children2 it amuses the mind1 and exercises the muscles of the whole body1 and yet in so gentle a manner as to induce little fatigue4 ,the exercises of horseback1 however1 are most particularly useful where there is a tendency in the constitution to pulmonary consumption1 either from hereditary or accidental causes4 ,it is here beneficial1 as well through its influence on the general health1 as more directly on the lungs themselves4 ,there can be no doubt that the lungs1 like the muscles of the body1 acquire power and health of function by exercise4 ,now during a ride this is obtained1 and without much fatigue to the body4 ,the free and equable expansion of the lungs by full inspiration1 necessarily takes place2 this maintains their healthy structure1 by keeping all the air-passages open and pervious2 it prevents congestion in the pulmonary circulation1 and at the same time provides more completely for the necessary chemical action on the blood1 by changing1 at each act of respiration1 a sufficient proportion of the whole air contained in the lungs1--all objects of great importance1 and all capable of being promoted1 more or less1 by the means in question4 ,and be it remembered that these remarks apply with equal force to the girl as to the boy4 ,she should be allowed1 and even encouraged1 to take the same active exercise4 ,fortunately1 this course is followed during childhood2 not so1 unfortunately 7in the majority of cases1 at least71 after this period4 ,young females are then subjected to those unnatural restraints1 both in exercise and dress1 which fashion and vanity impose1 to be followed by effects which1 though not immediately obvious1 are capable of laying the foundation of evils that cannot afterwards be remedied4 ,a good carriage is the point aimed at 7and to which ,i particularly refer71 and the means adopted for its cultivation fail1 after all1 in their end1 just in proportion to their rigid employment4 ,for this purpose the head is kept erect1 and the shoulders drawn back1 and they are to be kept in this position not for an hour or so1 but continually4 ,to preserve1 however1 this unnatural and constrained position1 requires considerable muscular powers1 such as no girl can exercise without long1 painful1 and injurious training2 nor even by this1 unless other measures be resorted to in aid of her direct endeavours4 ,for instead of the muscles obtaining increased power and strength by these efforts 7to enforce a good carriage71 they are enfeebled1 and soon become more and more incapable of performing what is required of them4 ,this fact soon becomes perceptible2 weakness is noticed2 but instead of correcting this by the only rational mode1 that of invigorating the weakened muscles1 mechanical aid is called in to support them1 and laced waistcoats are resorted to4 ,these undoubtedly give support--nay1 they may be so used as almost wholly to supersede the muscular efforts1 with the advantage of not tiring1 however long or continuously employed4 ,improvement of carriage is manifested1 the child is sensible of relief from a painful exertion1 the mother is pleased with the success of her management1 and this success appears to superficial observation fully to confirm the judgment which superintends it4 ,yet what are the consequences to which her measures tend1 and which such measures are daily and hourly producing8 ,the muscles of the back and chest1 restrained in their natural and healthful exercise by the waistcoat called in to aid them1 and more signally1 in after-life1 by the tightly- laced stays or corsets1 become attenuated1 and still further enfeebled1 until at length they are wholly dependent on the mechanical aid1 being quite incapable of dispensing with it for any continuance4 ,by and by a taper waist becomes an object of ambition1 and the stays are laced more closely than ever4 ,this is still done gradually1 and1 at first1 imperceptibly to the parties4 ,the effect1 however1 though slow1 is sure2 and the powers of endurance thus exercised come in time to bear1 almost unconsciously1 what1 if suddenly or quickly attempted1 no heroism could possibly sustain4 ,this increased pressure impedes the motion of the ribs4 ,for perfect respiration these motions should be free and unrestrained1 and perfect respiration is necessary to those changes in the blood which fit it for nutrition1 and the other purposes of the animal frame4 ,in proportion as respiration is impeded1 is the blood imperfectly vitalised1 and in the same ratio are the nutrient and other functions dependent on the blood inadequately performed4 ,here1 then1 is one source of debility1 which affects the whole frame1 reducing every part below the standard of healthful vigour4 ,quickened respiration soon ensues1 the heart becomes excited1 the pulse accelerated1 and palpitation is in time superadded4 ,there are still further evils produced by tight lacing4 ,for the pressure being chiefly made on the lower part of the chest1 the stomach and liver are necessarily compressed1 to the great disturbance of their functions2 and being pressed downwards too1 these trespass on that space which the other abdominal viscera require1 superinducing still further derangements4 ,thus almost every function of the body becomes more or less impeded4 ,and again1 the girl not being able always to have her body cased in the tight-laced stays1 some relaxation must take place4 ,under it the muscles of the back1 deprived of their accustomed support1 and incapable of themselves to sustain the incumbent weight1 yield1 and the column of the spine bends1 at first anteriorly1 causing round shoulders and an arched back2 but eventually inclines to one or other side1 giving rise to the well-known and too frequently occurring state of lateral curvature4 ,this last change most frequently commences in the sitting posture1 such females being1 through general debility1 much disposed to sedentary habits4 ,such1 though but very slightly sketched1 are a few of the evils attending this baneful practice4 ,but how1 then1 is a good carriage to be obtained2 which is not only pleasing to the eye1 but is1 when natural1 absolutely conducive itself to health8 ,to insure a good carriage1 the only rational way is to give the necessary power1 especially to the muscles chiefly concerned2 and this is to be done1 not by wearying those muscles by continual and unrelieved exertion1 but by invigorating the frame generally1 and more especially by strengthening the particular muscles through varied exercise alternated with due repose4 ,attention to general health1 suitable diet1 regular bowels1 moderate but regular exercise1 not of particular muscles only1 but of the whole frame1 cold-bathing or sponging1 and other such measures1 will maintain a good carriage1 by giving that power which the more direct means so generally practised serve but to exhaust4,,fn#ah ,,fn#ah ,the above remarks on good carriage are almost wholly taken from a valuable article of ,dr4 ,barlow's1 in the ,cyclopaedia of ,practical ,medicine4 ,chap4 ,,ii4 ,,on ,,the ,,use ,,and ,,abuse ,,of ,,certain ,,remedies4 ,sect4 ,i4--,,aperient ,,medicine4 ,one of the greatest errors of the nursery is the too frequent and indiscriminate exhibition by the mother or nurse of purgative medicine to the infant4 ,various are the forms in which it is given2 perhaps the little powders obtained from the chemist is the most frequent1 as it is certainly the most injurious1 form1 their chief ingredient being calomel4 ,the choice of the aperient1 or the dose1 or the exact condition of the health of the infant1 or whether it is an aperient at all that is required1 are points entirely overlooked3 a little medicine is thought necessary1 because the child appears unwell1 and a purgative1 or a little white powder1 is forthwith given4 ,the great art of medicine is the proper application of the proper medicine1 in the proper dose1 at the proper time2 points never considered in the nursery4 ,for example1 ,i have known a large dose of magnesia given by a nurse to an infant1 that had been suffering from a diarrhoea of some days' standing1 and very quickly cause death4 ,now1 magnesia is one of the most useful and harmless medicines that can be given to an infant when indicated2 when prescribed in a dose suited to its age1 and when the proper time is fixed upon for its exhibition2 in the foregoing case1 however1 every thing forbad its use1 but none of these points were considered4 ,aperient medicine1 too1 is sometimes unwittingly repeated to remove those symptoms which it has itself produced4 ,some incidental pain and uneasiness1 some slightly greenish appearance of the motions1 leads the mother to believe that more purging is necessary1 when1 in fact1 both circumstances have probably been induced by the irritation caused by the purgatives already too freely administered4 ,how frequently is this the case1 during the first week or ten days of the infant's life1 when the nurse doses the child with tea-spoonful after tea-spoonful of castor oil1 for the relief of pain1 which her repeated doses of medicine have alone created4 ,the bowels of an infant in health should be relieved two1 three1 or four times in the twenty-four hours4 ,the stools should be of the consistence of thin mustard1 and of a lightish yellow colour1 having little smell1 free from lumps or white curdy matter1 and passed without pain1 or any considerable quantity of wind4 ,and a parent is only justified in giving aperient medicine1 when any deviation from these conditions exists2 and only then1 when what may be called healthy costiveness is present1 viz4 either the stools less frequent than they ought to be1 or lumpy and partially solid4 ,then1 the only purgative medicines that can be given with safely to an infant1 without medical sanction1 are1 castor oil1 manna1 rhubarb1 and magnesia2 the application of the lavement1 and the aperient liniment4 ,,castor ,,oil ,this is one of the mildest aperients1 prompt in its action1 and effective in clearing out the contents of the bowels2 it is a medicine1 therefore1 particularly applicable to infants4 ,during teething there is generally much torpor of the bowels2 here1 then1 castor oil is a very appropriate and useful artificial means of increasing the frequency of the alvine discharges4 ,then1 again1 no purgative can be so much relied on for overcoming habitual costiveness as castor oil2 it may for this purpose be given daily for some weeks1 gradually reducing the dose until only a few drops be taken2 after which the bowels generally continue to act without further artificial assistance4 ,even its occasional administration leaves the bowels in a relaxed state2 a great advantage over other purgatives1 which generally cause1 after their action is passed off1 a confined state4 ,the proper dose will depend upon the age1 and the known effect of aperient medicine upon the childsome requiring more1 others less3 ,under one year1 one small tea-spoonful4 ,under three years1 two ditto4 ,under six years1 three ditto4 ,under ten years and upwards1 a table spoonful4 ,the quantity being more or less according to the facility with which the bowels are purged4 ,it may be given in various ways2 poured upon a little mint water1 or blended with a little moist sugar2--or1 if the stomach is unusually delicate1 the oil may be made into an emulsion with some aromatic water1 by the intervention of the yolk of an egg and a little syrup of roses or sugar combined with it4 ,the following proportions make an elegant and not at all a disagreeable mixture1 of which a desert- spoonful 7or more1 according to the age17 may be repeated every hour until it operate3 ,castor oil1 six drachms2 ,the yolk of an egg2 ,mix well together1 and add ,dill water1 two ounces1 ,syrup of roses1 two drachms4 ,,manna4 ,this also may be given with impunity to the youngest infant2 it is sweet to the taste1 and mild in its operation4 ,it should be exhibited in doses of one to two drachms in a little warm milk2 or if it cause flatulence in this form1 in some aromatic water1 a desert spoonful of carraway-seed or dill water4 ,for children above two years1 it must always be given with some other aperient3 thus1 it may be combined with castor oil by the medium of mucilage or the yolk of an egg2 in fact1 it might be substituted for the syrup of roses in the previous prescription for castor oil4 ,,magnesia ,,and ,,rhubarb4 ,magnesia1 besides being a laxative1 allays irritability of the stomach2 it is consequently useful during dentition1 at which period there is both much irritability and a prevailing acescency of the stomach4 ,the dose is from five grains to ten for an infant1 increasing the quantity to fifteen grains or twenty to children of nine or ten years of age4 ,when taken alone the best vehicle is hot milk1 which greatly quickens its aperient operation4 ,and whenever the bowels are distended with wind1 the pure magnesia is preferable to the carbonate4 ,it is well to mention here1 that when the infant throws up the nurse's milk it is generally curdled2 a fact which leads the inexperienced mother to infer that the child is suffering from acidity2 and to counteract the supposed evil magnesia is given again and again4 ,this is a useless and pernicious practice1 for curdling or coagulation of the milk always takes place in the stomach1 and is produced by the gastric juice1 and is so far from being a morbid process1 that milk cannot be properly digested without it4 ,rhubarb1 it should always be recollected1 has an astringent as well as purgative property1 according to the extent of the dose in which it is administered2 the former of which never opposes or interferes with the energy of the latter1 since it only takes effect when the substance is administered in small doses1 or1 if given in larger ones1 not until it has ceased to operate as a cathartic4 ,this latter circumstance renders it particularly eligible in cases of diarrhoea1 as it evacuates the offending matter before it operates as an astringent upon the bowels4 ,as a purgative it operates mildly1 and may be given to the youngest infant2 if from two to twelve months old1 from three to six grains2 for children above that age1 the dose may range from ten grains to twenty4 ,its operation1 however1 is much quickened by the addition of magnesia2 both of which are more effective when thus united than when given separately4 ,the following form1 in a costive and flatulent state of the bowels1 will be found useful,,fn#ai2 a tea-spoonful or more may be given every three or four hours until the desired effect is obtained3-- ,powdered rhubarb1 half a drachm2 ,magnesia1 two scruples2 ,compound spirits of ammonia1 twenty drops2 ,dill water1 two ounces2 ,simple syrup1 two drachms4 ,,fn#ai ,this may be made up and kept in the nursery for a long time without spoiling4 ,rhubarb1 mixed with flour and warm water1 may be made into a poultice1 and applied to the abdomen of a child that obstinately refuses to swallow medicine1 and it will be found to produce the same effect as if the medicine had been taken into the stomach2 it will purge briskly4 ,,the ,,lavement4 ,this is an excellent nursery remedy when the bowels are obstinately costive4 ,it may then be employed as a substitute for medicine1 a protracted and frequent use of which 7even of the mildest aperients7 is apt to injure the digestive functions1 and to give rise to some degree of intestinal irritation4 ,lavements1 however1 like aperient medicine1 must not be resorted to for a long time together2 for whilst the latter irritate1 the former most certainly tend1 after a long continued use1 to debilitate the bowels1 and thus render them less than ever disposed to act for themselves4 ,they are an excellent occasional remedy4 ,the simplest form of an aperient enema1 is warm water2 but barley- water1 or thin gruel1 or even milk and water1 are to be preferred at all times1 as they are of a more bland and less irritating nature4 ,if it be desirable to increase the strength of the injection1 castor oil may be added4 ,the proportions of fluid which are necessary for the different stages of life1 under ordinary circumstances1 maybe stated as follows3--,an infant at its birth requires about one fluid ounce2 a child between the age of one and five years1 from three to four fluid ounces2 and a youth of ten or fifteen1 from six to eight fluid ounces4 ,the mode of administering an injection to an infant deserves particular attention1 as injury might be caused by its being performed in a careless or unskilful manner4 ,a gum elastic pipe should be always used instead of the hard ivory tube4 ,having smeared this over with lard1 and placed the infant on its left side1 with its knees bent up in the lap of the nurse1 it is to be passed a couple of inches into the bowel1 in a direction not parallel to the axis of the body1 but rather inclined to the left4 ,the latter circumstance should never be neglected1 for if not attended to1 there will be difficulty in administering the injection4 ,the fluid must then be propelled very gradually1 or it will be instantly rejected2 on the whole being thrown up 7the pipe carefully and slowly withdrawn71 the child must be kept quietly reposing on its nurse's lap1 and in the same posture for some little time4 ,,the ,,aperient ,,liniment4 ,a liniment to be rubbed on the stomach is another resource in cases of habitual costiveness1 and will frequently be attended with great success when repeated purgatives have been resisted4 ,olive or castor oil may be used for this purpose2 they must be warmed and rubbed over the abdomen night and morning1 for five or ten minutes4 ,perhaps the best form of liniment that can be made use of is the following3-- ,compound soap liniment1 one ounce2 ,compound tincture of aloes1 half an ounce4 ,sect4 ,,ii4--,,calomel4 ,calomel is one of the most useful medicines we possess2 but though powerful for good1 it is by no means powerless for mischief1 and pages might be written upon the evil effects which have resulted from its indiscriminate use in the nursery2 medical men are daily and hourly witnessing this fact4 ,it is particularly eligible in the diseases of children2 but then it is quite impossible for unprofessional persons to judge when it may be appropriately exhibited4 ,and it cannot be too generally known1 that the effect of this medicine upon the evacuations is always to make them appear unnatural4 ,from ignorance of this fact1 calomel is often repeated again and again to relieve that very condition which it has itself produced1 causing1 but too frequently1 a degree of irritation in the delicate lining membrane of the bowel1 which it may be very difficult for a medical man to remove1 and perhaps a source of misery to the child as long as it lives4 ,its frequent exhibition has also another evil attending it1 for the immoderate use of mercury in early infancy produces more1 perhaps1 than any other similar cause1 that universal tendency to decay1 which1 in many instances1 destroys almost every tooth at an early age4,,fn#bj ,,fn#bj ,bell on the ,teeth4 ,in the diseases of childhood it is often administered by the mother or nurse with a degree of careless excess which ultimately1 if not immediately1 produces severe and irremediable injury4 ,i have met with such cases2 but ,mr4 ,bell details a remarkable instance in point3 ,a child1 about three years of age1 was brought to me1 having a most extensive ulceration in the gum of the lower jaw1 by which the alveolar process 7that portion of the jaw which forms the sockets of the teeth7 was partially denuded4 ,the account given by the mother was1 that the child had some time previously been the subject of measles1 for which a chemist1 whom she consulted1 gave her white powders1 one of which was ordered to be taken every four hours4 ,it appears by the result1 that this must have been calomel2 for1 after taking it for two or three days1 profuse salivation was produced1 with swollen tongue1 inflamed gums1 etc41 followed by ulceration of the gum1 lips1 and cheek4 ,on examining the denuded alveolar process1 ,i found that a considerable necrosis 7death of the bone7 had taken place1 including the whole anterior arch of the jaw from the first double tooth on the left side to the eye-tooth on the right4 ,by degrees the dead portion of bone was raised1 and became loose1 when ,i found that the mischief was not confined to the alveolar process1 but comprised the whole substance of the bone within the space just mentioned1 etc4 ,surely the knowledge of such a case as this would induce every prudent mother to exclude calomel from her list of domestic nursery medicines4 ,sect4 ,,iii4--,,opiates4 ,this class of medicine is often kept in the nursery1 in the forms of laudanum1 syrup of white poppies1 ,dalby's carminative1 and ,godfrey's cordial4 ,the object with which they are generally given is to allay pain by producing sleep2 they are1 therefore1 remedies of great convenience to the nurse2 and ,i am sorry to be obliged to add1 that1 so exhibited1 they are but too often fatal to the little patient4 ,the fact is1 that in the hands of the physician1 there is no medicine the administration of which requires greater caution and judgment than opiates1 both from the susceptibility of infants to their narcotic influence1 and their varying capability of bearing it2 the danger1 therefore1 with which their use is fraught in the hands of a nurse should for ever exclude them from the list of domestic nursery medicines4 ,dalby's carminative and ,godfrey's cordial are1 perhaps1 more frequently used than any other forms2 and some striking cases1 illustrative of the fatal results of exhibiting them indiscriminately1 and without medical sanction1 are on record4,,fn#ba ,the late ,dr4 ,clark1 in his ,commentaries1 mentions a case which he saw1 where forty drops of ,dolly's carminative destroyed an infant4 ,dr4 ,merriman gives the following in a note in ,underwood1 ,on the ,diseases of ,children3-- ,,fn#ba ,two or three fatal cases1 and upon which coroners' inquests were held1 have occurred within the last two years4 ,a woman1 living near ,fitzroy ,square1 thinking her child not quite well1 gave it a dose of ,godfrey's cordial1 which she purchased at a chemist's in the neighbourhood4 ,in a very short time after taking it the child fell into convulsions1 and soon died4 ,in less than a month the child of another woman in the same house was found to be ill with disordered bowels4 ,the first woman1 not at all suspecting that the ,godfrey's cordial had produced the convulsions in her infant1 persuaded her friend to give the same medicine to her child4 ,a dose from the same bottle was given1 and this child was likewise attacked almost immediately with convulsions1 and also died4 ,convulsions and epilepsy1 without such fatal results as the foregoing1 are not uncommon as the effect of a single dose of an opiate given unadvisedly2 and by their continued and habitual use 7and the form of syrup of poppies is but too often administered by an indiscreet and lazy nurse1 unknown by the parent71 a low1 irritative1 febrile state is produced1 gradually followed by loss of flesh1 the countenance becoming pallid1 sallow1 and sunken1 the eyes red and swollen1 and the expression stupid and heavy1 and the powers of the constitution at last becoming completely undermined4 ,such an object is to be seen daily among the poorer classes1--the miniature of a sickly aged person3 death soon follows here4 ,sect4 ,,iv4--,,leeching4 ,difficulty sometimes arises in putting a stop to the bleeding from leech-bites2 a matter of considerable importance in the case of a delicate infant4 ,the following measures may be resorted to for this purpose3-- #a4 ,expose the surface of the part to the external air1 so that a coagulum of blood may form at the orifice3 this simple mode will frequently arrest it4 #b4 ,if this fail1 make compression upon the part3 this is one of the most effectual means of restraining haemorrhage4 ,it is to be effected by taking a piece of lint folded three or four thicknesses1 and the size of the finger-nail1 to be steadily pressed upon the open orifice with the point of the finger until the blood has ceased to flow4 ,the pledget of lint1 however1 must not be removed for some hours afterwards1 or the bleeding will break out afresh4 #c4 ,if the compression fails in stopping the bleeding1 or from the situation of the leech-bites it cannot be adopted1 because there is no firm point of resistance upon which to make pressure1 the part may be dusted with starch or gum arabic powder1 or1 if this is of no avail1 the wound may be touched with lunar caustic4 ,if none of these measures are successful1 the assistance of the medical attendant must be obtained2 and if firm pressure be made upon the part1 no serious loss of blood can ensue before his arrival4 ,leeches should never be resorted to by a parent for any of the diseases of infancy1 without medical direction4 ,sect4 ,v4--,,blisters ,,and ,,poultices4 ,a blister should never be applied for any infantile disease1 except when ordered by a medical man1 as its injudicious use might greatly aggravate the complaint4 ,there are also one or two precautions in reference to the mode of the application of a blister1 which it is always right for a parent to attend to4 ,from the great irritability of the skin1 it should never be allowed to remain on longer than from two to four hours4 ,at the expiration of this time1 the surface will usually become red and inflamed2 and1 if the blister is removed1 and the part dressed with fresh spermaceti ointment spread on lint1 or with a soft bread and water poultice1 a full blister will soon be raised3 the little patient is thus saved much suffering1 and a very troublesome sore prevented4 ,a piece of tissue or silver paper1 interposed between the blister and the skin1 will answer the same purpose2 the blister will act well1 and the evils before alluded to will be prevented4 ,after a blister has been two or three hours applied1 its edge should be carefully raised1 to ascertain the effect produced2 and if the surface be much inflamed1 more particularly if little points of vesication 7watery bladders7 are present1 it should be removed1 and the above directions attended to4 ,mustard poultices are invaluable in some of the diseases of infancy and childhood1 and therefore frequently ordered4 ,a mustard poultice is made by mixing two thirds of mustard flour and one third of wheaten flour with warm water or vinegar1 in sufficient quantity to render the powder of the consistence of paste4 ,it is then spread on linen from the size of a half-crown to that of the palm of the hand1 according to the effect intended1 and placed on the skin4 ,how long it is to be kept on will depend upon the individual sensibility of the skin of the child2 but1 in general1 from fifteen to twenty minutes will be found amply sufficient4 ,the application1 however1 must at all times be carefully watched2 for if it remain on too long1 ulceration1 and death of the part1 might ensue2 therefore1 directly the skin is found tolerably red1 the poultice should be removed4 ,after its removal1 the part may be exposed1 or1 if very painful1 smeared over with fresh cream or common cerate4 ,a bread and water poultice1 although one of the commonest applications in use1 is rarely well made or properly applied4 ,it thus becomes injurious rather than useful2 adding to the inflammation or irritation of the part1 instead of soothing and allaying it4 ,nothing1 however1 is more simple than the mode of its preparation4 ,cut slices of stale bread of sufficient quantity1 scald out a bason1 put the bread into it1 pour upon it boiling water1 cover it over1 and let it stand for ten minutes2 next strain the water oft1 gently squeeze the saturated bread in a thin cloth1 so that the poultice shall not be too moist1 and then spread it upon a cloth so that it shall be in thickness half an inch1 and of a size large enough to cover the whole of the inflamed part1 and a little more4 ,apply it just warm enough to be borne1 and cover it well with oiled silk4 ,a poultice thus made1 will act as a local tepid bath to the inflamed part2 and the oiled silk preventing evaporation1 it will be found1 when taken off1 as moist as the first moment that it was put on4 ,sect4 ,,vi4--,,baths4 ,baths are much resorted to during infancy and childhood1 both in health and in disease4 ,in the former state1 they constitute an important measure of hygeiene 7this has been briefly alluded to under the section ,bathing71 and in the latter1 a valuable remedial agent4 ,their indiscriminate use1 however1 might be followed by serious consequences2 it is therefore important to point out a few rules for their judicious employment4 ,,the ,,cold ,,water ,,plunge ,,bath4 ,it consists of water in its natural degree of heat2 its temperature varying1 according to the season of the year or other circumstances1 from #cj degrees to #fj degrees4 ,the phenomena produced upon a strong and healthy boy plunging into this bath will be as follows3--,he will first experience a sensation of cold1 followed by slight shuddering1 and1 if the immersion has been sudden1 a peculiar impression in the nervous system1 called a shock4 ,almost immediately after the shock1 the feeling of cold will vanish1 and give place to a sensation of warmth1 speedily diffusing itself over the whole frame4 ,if the boy leaves the bath at this time1 or1 at all events1 before the warmth of the body goes off1 and quickly dresses himself1 a renewal of the reaction which had followed the shock of immersion will be experienced2 he will be in a most delightful glow1-- there will be a general feeling of enjoyment1 accompanied by a sensible increase of animal power1 and invigoration of the whole system4 ,but1 on the other hand1 if the boy greatly prolong his stay in the water1 no reaction will ensue1 and he will become chilly1 which will gradually increase to a strong and general shivering2--his feet and legs will become benumbed1 and the whole body will soon be languid1 exhausted1 and powerless4 ,the same result will happen to the young and delicate infant1 if plunged into this bath2 the same sensations will be produced2 except that here the shock is scarcely followed by any reaction1 and therefore from the first moment of the immersion1 the shivering and consequent train of sensations occur4 ,this arises from the infant at birth having less power of producing heat than when further advanced in age4 ,from the foregoing remarks1 then1 it will be seen1 that1 in early infancy1 the cold bath is inadmissible1 and water of a higher temperature than that which feels cool to the hand of the nurse should always be used at this age4 ,but that1 as the child grows older1--if of a healthy and vigorous constitution1--the cold bath is unquestionably most desirable2 and1 if used in a proper manner1 will be found to act as a most powerful tonic to the system4 ,the summer is of course the only period of the year when the cold plunging bath can be resorted to for the child4 ,,sea ,,bathing4 ,when sea bathing can be obtained1 it is even more conducive to the health of the child than the fresh water plunge bath2 for the sea water is more tonic1 stimulant1 and bracing1 than fresh4 ,the period of the year best adapted for sea bathing is the summer and autumn4 ,the best time of the day for bathing is two or three hours after breakfast2 except in very hot weather1 when an earlier hour must be chosen4 ,exercise is always useful previously to the bath2 but it must be gentle1 so as not to induce fatigue or much perspiration1 ,then the bath must be entered suddenly1 with a plunge1 inasmuch as an instantaneous immersion produces a greater reaction than a gradual immersion4,,fn#bb ,the length of time of remaining in will depend upon circumstances4 ,one dip only is enough at the first bath4 ,subsequently the time of remaining in the water may be prolonged1 but this must be increased gradually2 the positive necessity of leaving the bath while there still remains sufficient power of reaction being always kept in mind4 ,exercise in the water1 particularly that of swimming1 is highly useful4 ,the body should be speedily and well dried1 immediately upon coming out2 a rough jack towel is an excellent means of accomplishing this purpose1 while at the same time it insures considerable friction of the surface of the skin4 ,if the boy is in sound health1 he may bathe daily4 ,,fn#bb ,it is a matter of importance in bathing children1 that they should not be terrified by the immersion1 and every precaution should be taken to prevent this4 ,as a remedy1 sea bathing is highly serviceable4 ,its employment1 however1 requires much caution1 and great mischief is sometimes committed by its indiscriminate use4 ,the child of a strumous habit may be greatly benefited by sea bathing1 united with a few years' residence on the coast4 ,indeed1 by carefully following up a course of sea bathing1 a suitable diet1 and a judicious mode of living1 the very temperament of the individual may be all but changed1 and a power and activity imparted to the system1 productive eventually of comparatively strong and robust health4 ,a parent will do wisely1 therefore1 to send a child of such a habit to a school on the coast4 ,great caution1 however1 must be observed when bathing is commenced1 lest the shock be too powerful for the energies of the system1 and be not followed by the necessary degree of reaction4 ,it will be prudent to begin with the tepid bath 7#he degrees to #ib degrees71 and gradually reduce the temperature until the open sea can be resorted to without fear4 ,the measures already mentioned for promoting reaction--exercise previous to immersion2 the immersion at first only momentary1 and followed by strong friction--must be diligently regarded in such a case4 ,in the child of a delicate and feeble habit1 much out of health1 whose general debility is dependent on some organic disease1 sea bathing is not only improper1 but dangerous4 ,instead of being strengthened1 such a child will be rendered more weak and debilitated4 ,on the other hand1 when the child is of a weak and relaxed habit1 but free from organic disease1 the cold bath will be highly useful1 provided sufficient power of reaction exist in the system4 ,in this case the skin and flesh of the child is relaxed and flabby2 there is a great tendency to warm perspirations in bed1 capricious appetite1 confined or relaxed bowels1 indisposition to exertion1 and weariness from the slightest effort4 ,,the ,,shower ,,bath4 ,the effects of the shower bath are1 on the whole1 similar to those of the plunge bath of the same degree of temperature1 except that the immediate shock of the shower bath is in general felt to be greater than that from simple immersion4 ,this1 however1 may be met by putting warm water into the bottom of the bath in sufficient quantity to cover the ankles of the individual taking the bath1 which tends at once to lessen the shock1 and to increase the reaction4 ,the apprehension and alarm experienced by young children in entering this kind of bath is easily overcome1 by using at first a modification of it1 lately brought into use4 ,it consists of a tin vessel in the form of a large bottle1 pierced at the bottom like a colander1 and terminating in the upper part in a narrow tube1 with an open mouth4 ,when put into water it becomes filled1 which is retained by closing the mouth of the tube with the finger2 on removing which the water flows gradually out of the sieve-like bottom in a gentle shower4 ,this may be used to the youngest child4 ,at first the quantity of water employed should be small1 and its temperature warm2 as1 however1 the child grows older and accustomed to the bath1 the former may be increased1 and the latter lowered4 ,its tonic effect may be augmented by the addition ofbay salt1 and by much active rubbing4 ,as the child gets older the common form of shower bath may be used1 and throughout the year1 if he enjoy robust health2 during the winter season1 however1 the water should be made tepid4 ,this bath should be taken immediately upon rising from bed4 ,,ablution1 ,,or ,,sponging4 ,by ablution is meant the process of applying water to the surface of the body by means of a sponge or towel4 ,it is one of the best substitutes for the cold bath2 and if done quickly and thoroughly1 produces a glow and invigoration of frame almost equal to the former4 ,it is also the surest preventive against catching cold4 ,every child in health ought to be obliged1 every morning of its life 7when other means of bathing cannot be obtained71 upon rising1 and while the body still retains all the warmth of the bed1 to sponge the whole body4 ,if too young to do it for himself1 it must be done for him4 ,salt or vinegar should be added to the water2 and if the boy be robust1 cold water may be used throughout the year2 if not1 in the winter season it must be made tepid4 ,as a remedy1 cold water sponging1 and the application of ice and iced water1 are often ordered under certain states of disease by the medical attendant1 and frequently followed by delightful results4 ,but it is necessary that they should be properly applied to do good4 ,cold water sponging is a convenient and grateful method of moderating febrile heat of the surface1 provided undoubted powers of reaction be present in the system4 ,it is frequently ordered1 therefore1 to be employed in eruptive fevers1 as measles1 scarlet fever1 smallpox1 and other fevers2 and also in some local inflammations1 particularly of the brain4 ,vinegar may be added to the water under these circumstances with advantage4 ,it should at first be used tepid or cool1 but afterwards cold4 ,as a general rule1 the more dry and parched the heat of the surface1 the more urgent the necessity for the application of the cold1 and the more frequently and fearlessly ought it to be renewed1--every hour or half-hour not being too often4 ,should the child fall asleep during the process1 and begin to perspire1 it must be intermitted1 but resumed again on a recurrence of the parching heat4 ,ice and iced water are most frequently employed in affections of the brain4 ,the former is most conveniently applied in a well-cleaned pig's bladder1 which should be half filled with broken fragments of the ice4 ,the bladder prevents moisture about the clothes1 and1 from its smooth and pliant nature1 readily accommodates itself to every part of the child's head4 ,if iced water is used1 care must be taken that the cloths are sufficiently large to cover the whole of the head1 and they should be doubled to prevent their getting rapidly warm4 ,indeed1 in applying cold locally1 as in inflammation of the brain1 one rule it is of the utmost importance to observe1 viz4 that the application of the cold shall be continuous2 therefore a second set of cold cloths or bags of ice should be applied before the former has become warm4 ,this plan1 especially pursued during the night1 along with judicious internal treatment1 will save many children from perishing under the most insidious and fatal disease of childhood--water on the brain4 ,if neither water of a sufficiently low temperature1 nor ice1 can be procured1 then recourse may be had to refrigerating mixtures1 of which the following is a good form3-- ,common water1 five pints2 ,vinegar1 two pints2 ,nitre1 eight ounces2 ,sal ammoniac1 four ounces4 ,,the ,,warm ,,bath4 ,the warm bath judiciously prescribed is one of the most valuable remedial agents we possess2 but although powerful for good1 when misapplied1 it is equally powerful for mischief4 ,for instance1 in active inflammatory affections1 before the loss of blood1 the use of the warm bath would greatly aggravate the disease2 and yet1 for an infant with active inflammation of the respiratory organs1 it is continually resorted to4 ,again1 nothing is more common than for a child1 when attacked with convulsions1 to be put immediately in the warm bath2 and1 generally speaking1 it is extremely beneficial in this class of diseases2 but it is sometimes no less prejudicial1 when applied without due examination of the peculiarities of individual cases4 ,for1 in plethoric and gross children1 the local abstraction of blood from the head1 and the complete unloading of the alimentary canal1 are often necessary to render such a measure beneficial1 or even free from danger4 ,in convulsions1 however1 and particularly when arising from teething1 a parent may1 without hesitation1 at any time immerse the feet of the infant in water as warm as can be borne1 at the same time that cloths wet with cold water are applied to the head and temples4 ,as a preventive1 where there is a tendency to disease1 the warm bath may be employed without scruple1 and will be found most serviceable4 ,its value in this point of view is very great1 and it is to be regretted that it is not sufficiently appreciated and used4 ,for example1 a severe cold has been taken1 and inflammation of the air- tubes is threatened3 only put the child into a warm bath1 and1 with the common domestic remedies1 a very serious attack may be warded off4 ,again1 in the commencement of a diarrhoea1 a warm bath1 and discontinuing the cause of the attack1 will alone suffice to cure2 and1 more-over1 in the protracted diarrhoea attendant upon teething1 where1 after various remedies have been tried in vain1 the child has lost flesh and strength to an apparently hopeless degree1 ,recovery has been brought about by the simple use of the warm bath4 ,in the treatment of scrofulous children1 warm and tepid bathing is of great value4 ,in such cases1 a course of warm sea bathing1 with active friction over the whole surface after each bath1 will at once relieve that abdominal fulness which is generally present1 improve the functions of the skin1 and give tone and vigour to the whole system4 ,towards the termination of such a course of baths1 their temperature must be gradually reduced till they become tepid 7#he degrees to #ib degrees74 ,the opinion that warm baths generally relax is erroneous3 they are1 no doubt1 debilitating when used by persons of a weak and relaxed constitution1 or when continued too long2 but1 on the contrary1 they invariably give tone when employed in the cases to which they are properly applicable4 ,a partial warm bath1 such as the foot-bath1 is of much service in warding off many complaints4 ,if a child get the feet wet1 plunging them into warm water will often prevent any ill consequences2 and even when the first chill and slight shiverings which usher in colds1 fevers1 and other inflammatory complaints1 have been complained of1 the disease may be cut short by the use of a foot-bath1 continued till free perspiration occurs4 ,,rules ,,for ,,the ,,use ,,of ,,the ,,warm ,,bath4 ,,temperature ,,of ,,the ,,water4--,when the warm bath is used as a measure of hygeiene1 as a general rule1 any degree of temperature may be chosen between #ib degrees and #ih degrees1 which appears to be most agreeable to the child2 but on no account must #ih degrees be exceeded4 ,when ordered as a remedial measure1 the temperature will of course be fixed by the medical attendant4 ,the same degree of temperature must be kept up during the whole period of immersion4 ,for this purpose the thermometer must be kept in the bath1 and additions of warm water made as the temperature is found to decrease4 ,these additions of warm water1 however1 must be regulated by the indications of the thermometer1 and not by the feelings of the child4 ,,period ,,of ,,remaining ,,in ,,the ,,bath4--,this must depend upon circumstances4 ,as a measure of hygeiene1 it must be varied according to the age of the child4 ,for the first four or five weeks1 the infant should not be kept in beyond three or four minutes2 and the duration must afterwards be gradually prolonged as the child advances in age1 until it extends to a quarter of an hour1 a period which may be allowed after it has attained the age of four years4 ,when the bath is employed as a remedial agent1 the time of immersion must be prolonged2 this will be determined by the medical adviser4 ,speaking generally1 a quarter of an hour may be said to be the shortest period1 an hour the longest1 and half an hour the medium4 ,when in the bath1 care must be taken that the child's body is immersed up to the shoulders or neck1 otherwise that part of the body which is out of the bath 7the shoulders1 arms1 and chest71 being exposed to the cooler temperature of the air1 will be chilled4 ,when the infant or child is taken out of the bath1 the general surface1 especially the feet1 must be carefully rubbed dry with towels previously warmed2 and when one of the objects of the bath is to excite much perspiration1 the child should be immediately wrapped in flannel and put to bed4 ,when1 however1 the object is not to excite perspiration1 the child may be dressed in his ordinary clothing1 but should not be allowed to expose himself to the open air for at least an hour4 ,,time ,,of ,,using ,,the ,,bath4--,when resorted to for sudden illness1 the bath must of course be employed at any time needed4 ,when used for any complaint of long standing1 or a measure of hygeiene1 as a general rule1 it should be taken between breakfast and dinner1 about two hours after the former1 or an hour and a half before the latter4 ,this implies that the infant should never be put into the bath after having been freely nourished at the breast4 ,neither should it ever be used when the child is in a state of free perspiration from exercise1 or on awaking from sleep4 ,chap4 ,,iii4 ,,of ,,teething1 ,,and ,,hints ,,on ,,the ,,permanent ,,or ,,adult ,,teeth4 ,the infant at birth has no teeth visible3 the mouth is toothless4 ,it possesses1 however1 hidden in the jaw1 the rudiments of two sets4 ,the first of these which makes its appearance1 are called the ,temporary or ,milk ,teeth2 the second1 the ,permanent or ,adult ,teeth1 and these come up as the former fall out1 and so gradually replace them4 ,sect4 ,i4--,,on ,,teething4 ,,the ,,manner ,,in ,,which ,,the ,,temporary ,,or ,,milk-,,teeth ,,appear4--,the first set of teeth1 or milk-teeth as they are called1 are twenty in number2 they usually appear in pairs1 and those of the lower jaw generally precede the corresponding ones of the upper4 ,the first of the milk-teeth is generally cut about the sixth or seventh month1 and the last of the set at various periods from the twentieth to the thirtieth months4 ,thus the whole period occupied by the first dentition may be estimated at from a year and a half to two years4 ,the process varies1 however1 in different individuals1 both as to its whole duration1 and as to the periods and order in which the teeth make their appearance4 ,it is unnecessary1 however1 to add more upon this point4 ,their developement is a natural process4 ,it is too frequently1 however1 rendered a painful and difficult one1 by errors in the management of the regimen and health of the infant1 previously to the coming of the teeth1 and during the process itself4 ,thus1 chiefly in consequence of injudicious management1 it is made the most critical period of childhood4 ,not that ,i believe the extent of mortality fairly traceable to it1 is by any means so great as has been stated2 for it is rated as high as one sixth of all the children who undergo it4 ,still1 no one doubts that first dentition is frequently a period of great danger to the infant4 ,it therefore becomes a very important question to an anxious and affectionate mother1 how the dangers and difficulties of teething can in any degree be diminished1 or1 if possible1 altogether prevented4 ,a few hints upon this subject1 then1 may be useful4 ,i shall consider1 first1 the management of the infant1 when teething is accomplished without difficulty2--and1 secondly1 the management of the infant when it is attended with difficulty4 ,,management ,,of ,,the ,,infant ,,when ,,teething ,,is ,,without ,,difficulty4 ,in the child of a healthy constitution1 which has been properly1 that is1 naturally1 fed1 upon the milk of its mother alone1 the symptoms attending teething will be of the mildest kind1 and the management of the infant most simple and easy4 ,,symptoms4--,the symptoms of natural dentition 7which this may be fairly called7 are1 an increased flow of saliva1 with swelling and heat of the gums1 and occasionally flushing of the cheeks4 ,the child frequently thrusts its fingers1 or any thing within its grasp1 into its mouth4 ,its thirst is increased1 and it takes the breast more frequently1 though1 from the tender state of the gums1 for shorter periods than usual4 ,it is fretful and restless2 and sudden fits of crying and occasional starting from sleep1 with a slight tendency to vomiting1 and even looseness of the bowels1 are not uncommon4 ,many of these symptoms often precede the appearance of the tooth by several weeks1 and indicate that what is called breeding the teeth is going on4 ,in such cases1 the symptoms disappear in a few days1 to recur again when the tooth approaches the surface of the gum4 ,,treatment4--,the management of the infant in this case is very simple1 and seldom calls for the interference of the medical attendant4 ,the child ought to be much in the open air1 and well exercised3 the bowels should be kept freely open with castor oil2 and be always gently relaxed at this time4 ,cold sponging employed daily1 and the surface of the body rubbed dry with as rough a flannel as the delicate skin of the child will bear2 friction being very useful4 ,the breast should be given often1 but not for long at a time2 the thirst will thus be allayed1 the gums kept moist and relaxed1 and their irritation soothed1 without the stomach being overloaded4 ,the mother must also carefully attend1 at this time1 to her own health and diet1 and avoid all stimulant food or drinks4 ,from the moment dentition begins1 pressure on the gums will be found to be agreeable to the child1 by numbing the sensibility and dulling the pain4 ,for this purpose coral is usually employed1 or a piece of orris-root1 or scraped liquorice root2 a flat ivory ring1 however1 is far safer and better1 for there is no danger of its being thrust into the eyes or nose4 ,gentle friction of the gums1 also1 by the finger of the nurse1 is pleasing to the infant2 and1 as it seems to have some effect in allaying irritation1 may be frequently resorted to4 ,in ,france1 and in this country also1 it is very much the practice to dip the liquorice-root1 and other substances1 into honey1 or powdered sugar-candy2 and in ,germany1 a small bag1 containing a mixture of sugar and spices1 is given to the infant to suck1 whenever it is fretful and uneasy during teething4 ,the constant use1 however1 of sweet and stimulating ingredients must do injury to the stomach1 and renders their employment very objectionable4 ,,the ,,management ,,of ,,the ,,infant ,,in ,,difficult ,,teething4 ,in the child which has been partly or altogether brought up by hand1 or who is of a feeble and delicate constitution1 or imbued with any hereditary taint1 the process of dentition will be attended with more or less difficulty1 and not unfrequendy with danger4 ,,symptoms4--,the symptoms of difficult dentition are of a much more aggravated description than those which attend the former case2 and it is right that a mother should1 to a certain extent1 be acquainted with their character1 that she may early request that medical aid1 which1 if judiciously applied1 will mitigate1 and generally quickly remove them4 ,difficult dentition will be attended with painful inflammation and swelling of the gum1 which is hotter1 of a deeper red1 than natural1 and intolerant of the slightest pressure4 ,there is often great determination of blood to the head1 which a mother may recognise by the cheeks being red1 hot1 and swollen2 the eyes red1 irritable1 and watery2 and the saliva running from the mouth profusely4 ,the fever is great1 and the thirst extreme4 ,the child is at one time restless and irritable1 and at another heavy and oppressed3 the sleep will be broken1 and the infant frequently awake suddenly and in alarm from its short slumbers4 ,such are the chief symptoms of difficult teething1 and which will be present to a greater or less degree4 ,,treatment4--,as most of the above symptoms are induced by the painful tension of the gum1 it would seem that the most rational mode of attempting their relief is by freely lancing the swollen part4 ,great prejudices1 however1 still exist in the minds of some parents against this operation4 ,they think it gives great pain1 and1 if the tooth is not very near1 makes its coming through the gum subsequently the more difficult4 ,with regard to the first objection1 the lancet is carried through the gum so quickly1 that this is hardly possible2 and the fact that the infant will often smile in your face after it is done1 although previously crying from pain1 is sufficient evidence that it is not a very painful operation4 ,in reference to the second1 that the scar which ensues1 opposes1 by its hardness1 the subsequent progress of the tooth1 it is quite groundless2 for cicatrices1 like all other new-formed parts1 are much more easily absorbed than the original structure4 ,of the practical utility and perfect safety of this operation we have ample proof in its daily performance with impunity1 and in the instant relief which it often affords to all the symptoms4 ,mere scarifying the gums is sometimes all that is required1 and will afford great relief4 ,this operation1 therefore1 should not be opposed by the mother4 ,she1 at the same time1 should be acquainted with its precise object1 lest the speedy return of the symptoms1 and the non- appearance of the expected tooth1 might tend to bring the operation of lancing the gums into disrepute4 ,the parental management of the infant1 then1 and by which much of the pain and difficulty of teething may be removed or alleviated1 consists in attending to the following directions3-- ,,first1 ,,to ,,the ,,state ,,of ,,the ,,mouth4--,to this it is an important part of the mother's duty to pay especial attention2 and1 by so doing1 she will save her child much suffering4 ,the condition of the mouth should be carefully inspected from time to time2 and should a swollen gum be discovered1 it should immediately be attended to1 not waiting till constitutional symptoms appear before she employs proper aid for her child4 ,for this purpose the mother should make herself familiar with the appearances of the gum under distention and inflammation2 a matter of no difficulty1 accompanied1 as this condition usually is1 by a profuse secretion of saliva1 heat of mouth1 and at a time when the age of the child justifies the supposition that it is about to cut its first tooth1 or1 if it have some teeth1 that others are about to appear4 ,,secondly1 ,,to ,,the ,,food4--,if a child is teething with difficulty1 it should always have its quantity of nourishment diminished4 ,if it is being fed1 as well as nursed at the breast1 at the time1 the former should be immediately withheld3 if it is being fed alone1 the only kind of food that should be allowed is milk and water4 ,these cases are much aggravated by the not uncommon habit of parents giving the infant food whenever it cries from the irritation attending upon the process2 and thus a slightly difficult dentition is converted into serious disease4 ,,thirdly1 ,,to ,,the ,,state ,,of ,,the ,,bowels4--,these must be carefully watched1 that they may not become confined2 it being necessary that they should be gently relaxed at this time4 ,if a slight diarrhoea is present1 it must not be checked2 if it pass beyond this1 however1 medicine must be had recourse to1 and great benefit will also arise from putting the child into a warm hip-bath1 and warmly clothing the body1 but keeping the head cool4 ,,fourthly1 ,,to ,,the ,,head4--,the infant's head should be washed with cold water night and morning1 and no other covering than that which nature has provided should be put upon it when within doors or asleep2 and on no occasion should warm felt or velvet hats be worn during mild or warm weather1 straw or white hats being much lighter and cooler4 ,the child should be much in the open air4 ,the sponging of the infant's body daily1 either with cold or tepid water1 must depend upon the season of the year and constitution of the child1 as well as upon other circumstances4 ,sponging the head with cold water night and morning is almost invariably atttended with great benefit1 and may be resorted to in every case without fear2 and now and then the use of the warm hip-bath1 for several days together1 will be ordered by the physician1 which1 by acting upon the skin1 diminishes the determination of blood to the head1 and thus forms an important source of relief4 ,,fifthly1 ,,of ,,convulsions4--,if they should occur1 and they are not unfrequently excited by difficult teething1 and then give great alarm to the parent1 relief will be afforded by immersing the hips1 legs1 and feet of the infant in water as warm as can be borne1 and at the same time applying over the head and temples a piece of flannel wet with cold water4 ,i have also often cut the fit short by sprinkling cold water in the child's face while in the bath4 ,the gums should always be looked to1 and if they appear swollen1 and painful1 at once lanced4 ,i have known the most formidable convulsions to cease immediately after this operation4 ,,sixthly1 ,,of ,,the ,,use ,,of ,,opiates4--,it is the practice with some nurses to administer narcotics to quiet infants while teething4 ,it is not only objectionable1 but1 from the uncertain effects of sedatives upon infants1 a very dangerous practice1 and they ought never to be given1 except at the suggestion of a medical man4 ,it is far better1 if the child is restless at night1 to have it frequently taken out of its cot1 and carried about in an airy room2 for the cool air1 and change of posture1 will do much to allay the feverishness and restlessness of the child4 ,from these few hints1 it must have been seen how much the sufferings from teething may be mitigated by judicious management4 ,that1 if the parent is able to support her infant upon the breast alone1 teething will be found comparatively an easy process1 and unattended with danger2 the mother thus reaping a delightful reward for all the anxieties and privations nursing necessarily involves4 ,that the child brought up partially1 or entirely1 by hand will always pass through dentition with more or less of pain and difficulty2 but that even here1 if the diet has been properly regulated1 much less suffering and inconvenience will arise than when less attention has been paid to it4 ,and1 lastly1 that1 when teething is difficult1 how highly important it is to call in proper aid at an early period1 and to carry out fully the directions of the medical attendant1 allowing no foolish prejudices to interfere with his prescriptions and management4 ,if ,i stood in need of any argument to impress upon the mind of a parent the importance of attending to the last injunction1 ,i would simply state1 that its neglect is but too frequently the cause of disease of the brain1 terminating in death1 or a state of idiotcy far worse than death1 of which ,i know more than one living instance4 ,it may be as well to add1 that eruptions about the ears1 head1 face1 and various parts of the body1 very frequently appear during the process of the first teething4,,fn#bc ,if they are slight1 they should be left alone1 being rather useful than otherwise2 if they are troublesome1 they must receive that kind of attention from the parent which will be pointed out under the chapter on diseases4 ,the same remark applies to enlargements of the glands of the neck1 which frequently appear at this time4 ,,fn#bc ,in some infants a rash always precedes the cutting a tooth4 ,sometimes it appears in the form of hard elevated pimples as large as peas2 in other instances in the form of red patches1 of the size of a shilling1 upon the arms1 shoulders1 and back of the neck4 ,they are always harmless1 require no particular attention1 and prevent1 ,i doubt not1 more serious complaints4 ,,sect4 ,,ii4 ,,hints ,,upon ,,the ,,permanent ,,or ,,adult ,,teeth4 ,parents are not sufficiently alive to the importance of attending to the condition of the mouth of their children at the period of changing the first for the second set of teeth2 they do not seem to be aware how much the comfort1 appearance1 and future health of the child depends upon it4 ,nor do they subsequently impress upon the minds of their children how necessary1 on their part1 is the observance of certain rules for the preservation of the teeth1 and how distressing are the effects which result from their neglect4 ,it is proposed1 here1 to say a few words for the information and guidance of the parent upon this subject4 ,,the ,,manner ,,in ,,which ,,they ,,appear4 ,the change of the temporary for the permanent or adult teeth commences1 in the majority of instances1 at about seven years of age2 occasionally it occurs as early as five1 and as late as eight years and a half4 ,the necessity which exists for this change1 and the mode by which it is effected1 are striking and beautiful2 it is1 however1 not our object to enter fully upon its consideration here4 ,it has already been observed1 that the infant is born with the rudiments of two sets of teeth in the jaw1 although neither make their appearance till long after birth4 ,the time when1 and the manner in which the first set appear has been pointed out4 ,now although these admirably answer the purposes for which they were given up to the seventh year1 after this period they fail to do so3 they are not sufficiently numerous1--in their structure they are not strong or durable1--nor is their power of mastication sufficiently great4 ,they are not sufficiently large or numerous4 ,if the mouth of a child at this age is examined1 it will be seen1 that a considerable interval has taken place between the teeth in consequence of the growth and expansion of the face2 hence a larger set has become necessary to fill the arch4 ,but it may be asked1 do not the teeth grow with the growth of the body8 and if not1 why is it so8 ,they do not1 and for this reason3 the important office which these organs are destined to perform requires that they should be composed of a substance too dense and of too low an organization to allow of any subsequent growth and enlargement4 ,thus the size of the teeth is determined and acquired before they make their appearance through the gums4 ,this being the case1 it will be readily seen1 that the teeth which would be of appropriate size in the mouth of the infant1 would be quite inadequate to the enlarged dimensions of the adult2 hence the necessity of a second set1 exceeding in number1 and size the teeth of the first4 ,that a necessity also exists at this age1 that the weak and delicate teeth of childhood should be exchanged for a set stronger and more durable in their structure1 more robust and more powerful1 will be sufficiently apparent1 if we only recollect the great change which has gradually been taking place in the nature of the food of the two epochs of childhood and adult age4 ,the second set1 or permanent teeth1 then1 lying under the milk-teeth and hidden in the jaw1 undergo in this situation their full developement1 before they appear above the gum4 ,this occurrence commences about seven years of age1 at which period the first set begin to fall out from their roots becoming absorbed1 and no longer retaining their hold of the jaw2 to be entirely replaced in the course of a few years by the permanent set1 which thus succeeds them4 ,the first teeth of this set which make their appearance are the large double teeth1 which emerge from the gum immediately behind the last of the temporary set4 ,next the two front teeth of the lower jaw fall out1 and are succeeded by two others of similar character and form1 but of larger size2 then the two corresponding teeth of the upper row are cast off1 and their place supplied2 shortly after the teeth immediately adjoining these2 then the double teeth of the first set are exchanged for their smaller successors of the second4 ,the eye-teeth after a time begin to make their appearance2 and then more double teeth2 making in all twenty-eight teeth1 and occupying in their developement from the seventh to the fourteenth year of age4 ,they are not1 however1 yet complete2 for between the latter date and the twenty-first year four more teeth appear1 called the wisdom teeth1 making the adult set or permanent teeth to amount in all to thirty-two teeth4 ,it should be observed1 that whilst this is the most usual course in which this set appear1 the line of succession is sometimes different4 ,,their ,,value ,,and ,,importance4 ,it would seem almost unnecessary to say a word upon so self-evident a truth1 and yet perhaps the full extent of this statement is not generally appreciated4 ,it has not1 perhaps1 occurred to the minds of all1 that upon the right position and arrangement of the teeth the beauty and expression of the countenance much depends4 ,but so it is2 for however regular and perfect the general features1 if the teeth are irregular or deficient1 an unpleasing expression1 proportionate to the extent of the displacement1 is inevitably produced4 ,now every mother should be alive to this fact1 that she may early apply to the dentist to have any error of the above nature rectified1 before it is too late4 ,on their complete and entire state also depends the perfection of utterance and articulation4 ,the child1 for instance1 makes no attempt at articulation until it has acquired several teeth2 this faculty becomes also exceedingly imperfect during the process of changing them2 from this time it continues to improve1 until again it is permanently impaired in old age1 when they are finally lost4 ,and so again1 if a child lose merely a single tooth from the front of its mouth1 lisping will result2 or if a supernumerary or irregular tooth be present1 the articulation will be abrupt and imperfect3--the former plainly showing the importance of the entireness of the series1 and the latter1 the necessity of regularity in their arrangement and position4 ,the teeth1 however1 are chiefly important in relation to the part they sustain in connection with digestion1 viz4 the mastication of the food4 ,by this act the food1 after being received into the mouth1 is mixed with the saliva and broken down1 till it becomes of an uniform pulpy consistence1 fit for being easily swallowed1 and acted upon by the gastric juice on its arrival in the stomach4 ,that due mastication of the food is essential to healthy digestion1 which will be promoted or retarded in exact proportion as it approaches or falls short of this point1 is a fact so generally known as scarcely to need comment4 ,suffice it to add1 that1 if food be introduced into the stomach unmasticated1 the gastric juice will only act upon its surface2 and after a number of hours it will be either rejected by vomiting1 or pass on into the intestine1 to give rise to cholic1 bowel complaints1 or flatulence1 and very frequently in children to a serious attack of convulsions4 ,,their ,,management ,,and ,,preservation4 ,,irregularity ,,of ,,arrangement ,,and ,,position4--,every parent ought to have the mouth of her child inspected occasionally1 during the advance of the permanent teeth1 that any irregularity in their position or arrangement may be prevented4 ,and it is equally her duty to see to it1 that she choose a competent person to do this1 since great mistakes are not unfrequently made in this matter1 and which themselves become the source of evils far more serious than those they are intended to obviate4 ,i have known1 says ,mr4 ,bell1 no less than eight or even ten firm teeth forcibly removed from the jaws of a child at once1 when there was not the slightest reason to apprehend any evil result from their being left alone4 ,here there was a most cruel1 because unnecessary1 infliction of pain1 as well as great hazard incurred of seriously injuring the permanent teeth by interfering with the secretion of their enamel4 ,and besides all this there is another and yet greater evil1 for1 if the temporary teeth be removed1 before the permanent ones are so advanced as to be ready to occupy their situation1 the arch of the jaw will assuredly contract1 and when1 subsequently1 the permanent teeth are fully formed1 there will not be room for them to range in their proper situation4 ,thus the operation which was intended to prevent irregularity becomes the cause of its occurrence1 and that in its very worst form1 producing a want of accordance between the size of the teeth and that of the jaw4 ,the eye-teeth generally occasion most anxiety to a parent1 from the prominent position in which they present themselves2 but in the majority of cases nothing but time is required to reduce them to their proper station4 ,but1 whatever may be the peculiarities of each individual case1 the dentist will decide what may be required2 only1 ,i would again repeat1 do not neglect the occasional inspection of the mouth at this age1 if you regard the future comfort and appearance of your child4 ,,their ,,preservation4--,the preservation of the teeth requires attention to several points2 the first and principal of which is1 to enforce the habit in the child of thoroughly cleaning the teeth by means of water and a brush night and morning1 and rinsing out the mouth after each meal4 ,the brush should not be very hard1 as it will not only be more difficult to clean the interstices between the teeth1 the part in which the tartar,,fn#bd is most likely to be deposited1 but by its friction1 will occasion the gradual absorption of the gum and the exposure of the neck of the teeth4 ,the hair of the brush should be firm and elastic1 and not too closely set4 ,,fn#bd ,a sort of calcareous substance1 which becomes deposited at the roots of the teeth1 from a want of proper attention to cleanliness2 and1 if allowed to remain1 will destroy first their beauty1 and then the organ itself4 ,,tartar4--,if there is a tendency to the formation of tartar1 then it will be necessary to have recourse to some tooth-powder4 ,tooth-powders1 however1 must be chosen with care1 as many of them are composed of substances highly injurious to the teeth4 ,many of the tooth-powders which are offered for sale1 with the promise of rendering the teeth beautifully white1 perform1 for a time1 all that is promised1 at the expense of permanent and irremediable injury to the teeth2 for they often contain a quantity of tartaric or other acid1 which effects a gradual decomposition of the enamel4,,fn#be ,prepared chalk is one of the simplest and best tooth-powders4 ,,fn#be ,bell on the ,teeth4 ,the following form1 also1 may be used with advantage3-- ,prepared chalk1 three ounces2 ,orris root1 powdered1 half an ounce2 ,powdered myrrh1 half an ounce2 ,cuttle fish1 powdered1 one ounce2 ,essential oil of cinnamon1 four drops4--,mix4 ,the best preservative1 then1 against the formation of tartar1 is to see that the child cleans his teeth thoroughly night and morning with the brush1 powder1 and water1 and also 7if possible7 that he rinses out the mouth after each meal4 ,if the gums should be tender1 irritable1 and bleed 7as is frequently the case when an individual gets out of health1 or the tartar accumulates7 the mouth may be washed night and morning with a tumbler of tepid water1 containing from ten to twenty drops of the tincture of myrrh1 and the same quantity of spirits of camphor2 or the following form may be used3-- ,alum1 one drachm and a half2 ,tincture of myrrh1 two drachms2 ,camphor mixture1 five ounces and a half4--,mix4 ,,acids4--,the use of acids to the teeth cannot be too strongly deprecated3 they decompose their substance1 and lead to their rapid decay4 ,hence the whiteness produced by acid tooth-powders and washes is not less deceitful than ruinous in its consequences4 ,as has been just observed1 they perform all that their vendors promise1 causing the teeth1 for a little while1 to become very white and beautiful in their appearance1 but1 at the same time1 injuring them irremediably3 the enamel becomes gradually decomposed1 the bone of the tooth exposed1 and its death is the inevitable consequence4 ,it is therefore of great importance when acid medicines are ordered for children that they should be taken through a glass tube1 to prevent their coming in contact with the teeth4 ,from a want of this precaution1 ,i know a lady 7and there are many such instances7 who once had as sound and fine a set of teeth as any one could boast of1 but from this cause has had nearly the whole of the upper row destroyed4 ,she was in delicate health3 it was judged requisite that she should take for a considerable time 7with other medicines7 sulphuric acid2 but the glass tube was not thought of1 and the consequences followed which have been described4 ,,calomel4--,this medicine1 as it is frequently given1 alone1 or in the little white powders1 in infancy and childhood1 by mothers and nurses1 is productive of serious and indeed irremediable injury to the teeth4 ,the immoderate use of mercury in early infancy produces1 more perhaps than any other similar cause1 that universal tendency to decay1 which1 in many instances1 destroys almost every tooth at an early age4 ,it is certainly not unimportant to bear this fact in mind1 in the administration of this sovereign remedy1 this panacea1 as many appear to consider it1 in infantile diseases4,,fn#bf ,,fn#bf ,bell on the ,teeth4 ,,heat ,,and ,,cold4--,the teeth are exceedingly apt to suffer from sudden variations of temperature4 ,fluids1 therefore1 should never be taken into the mouth so hot or so cold as to produce the slightest pain2 and1 for the same reason1 the water with which the mouth is cleansed should in winter be always warm or tepid4 ,when ices are taken1 the precaution of placing them in the centre of the mouth1 so as to prevent contact with the teeth1 should be carefully observed4 ,there are many other causes which might be mentioned as tending to induce decay of the teeth1 but their consideration here is purposely avoided4 ,it is hoped that enough has been said to draw the parent's attention to the subject of the teeth1 to prevent their neglect1 and yet at the same time to induce a cautious management4 ,,chap4 ,,iv4 ,,hints ,,for ,,the ,,early ,,detection ,,of ,,disease ,,in ,,the ,,child ,,by ,,the ,,mother4 ,life is soon extinguished in infancy4 ,at this epoch any disease is formidable1 and must be met most promptly4 ,it is either sudden and active in its assaults1 or comes with slow and insidious approach4 ,the first signs of its coming on are not always visible to an unpractised eye3 it may have made dangerous advances before the mother's mind is awakened to its presence2 and medical aid may be solicited when remedies and advice are no longer of any avail4 ,it is therefore highly important that a mother should possess such information as will enable her to detect disease at its first appearance1 and thus insure for her child timely medical assistance4 ,this knowledge it will not be difficult for her to obtain4 ,she has only to bear in mind what are the indications which constitute health1 and she will at once see that all deviations from it must denote the presence of disorder1 if not of actual disease4 ,with these changes she must to a certain extent make herself acquainted4 ,sect4 ,i4--,,signs ,,of ,,health4 ,the signs of health are to be found1 first1 in the healthy performance of the various functions of the body2 the regular demands made for its supply1 neither in excess or deficiency2 and a similar regularity in its excretions both in quantity and appearance4 ,if the figure of the healthy infant is observed1 something may be learnt from this4 ,there will be perceived such an universal roundness in all parts of the child's body1 that there is no such thing as an angle to be found in the whole figure2 whether the limbs are bent or straight1 every line forms a portion of a circle4 ,the limbs will feel firm and solid1 and unless they are bent1 the joints cannot be discovered4 ,the tongue1 even in health1 is always white1 but it will be free from sores1--the skin cool1--the eye bright1--the complexion clear1--the head cool1--and the abdomen not projecting too far1--the breathing regular1 and without effort4 ,when awake1 the infant will be cheerful and sprightly1 and1 loving to be played with1 will often break out into its merry1 happy1 laugh2 whilst1 on the other hand1 when asleep1 it will appear calm1 every feature composed1 its countenance displaying an expression of happiness1 and frequently1 perhaps1 lit up with a smile4 ,sect4 ,,ii4 ,,signs ,,of ,,disease4 ,just in proportion as the above appearances are present and entire1 health may be said to exist2 and just in proportion to their partial or total absence disease will have usurped its place4 ,we will1 however1 for the sake of clearness examine the signs of disease as they are manifested separately by the countenance1--the gestures1--in sleep1--in the stools1--and by the breathing and cough4 ,,of ,,the ,,countenance4 ,in health the countenance of a thild is expressive of serenity in mind and body2 but if the child be unwell1 this expression will be changed1 and in a manner which1 to a certain extent1 will indicate what part of the system is at fault4 ,the brows will be contracted1 if there is pain1 and its seat is in the head4 ,this is frequently the very first outward sign of any thing being wrong1 and will occur at the very onset of disease2 if therefore remarked at an early period1 and proper remedies used1 its notice may prevent one of the most fearful of infantile complaints--,water in the ,head4 ,if this sign is passed by unheeded1 and the above disease be threatened1 soon the eyes will become fixed and staring1--the head hot1 and moved uneasily from side to side upon the pillow1 or lie heavily upon the nurse's arm1--the child will start in its sleep1 grinding its teeth1 and awake alarmed and screaming1--its face will be flushed1 particularly the cheeks 7as if rouged71--its hands hot1--but feet cold1 its bowels obstinately costive1 or its motions scanty1 dark-coloured1 and foul4 ,if the lips are drawn apart1 so as to show the teeth or gums1 the seat of the pain is in the belly4 ,this sign1 however1 will only be present during the actual existence of suffering2 if1 therefore1 there be any doubt whether it exist1 press upon the stomach1 and watch the eifect on the expression of the countenance4 ,if the pain arise simply from irritation of the bowels excited from indigestion1 it will be temporary1 and the sign will go and come just as the spasm may occur1 and slight remedial measures will give relief4 ,if1 however1 the disease be more serious1 and inflammation ensue1 this sign will be more constantly present1 and soon the countenance will become pale1 or sallow and sunken1--the child will dread motion1 and lie upon its back with the knees bent up to the belly1--the tongue will be loaded1--and in breathing1 while the chest will be seen to heave with more than usual effort1 the muscles of the belly will remain perfectly quiescent4 ,if the nostrils are drawn upwards and in quick motion1 pain exists in the chest4 ,this sign1 however1 will generally be the accompaniment of inflammation of the chest1 in which case the countenance will be discoloured1--the eyes more or less staring1 and the breathing will be difficult and hurried2 and if the child's mode of respiring be watched1 the chest will be observed to be unmoved1 while the belly quickly heaves with every inspiration4 ,convulsions are generally preceded by some changes in the countenance4 ,the upper lip will be drawn up1 and is occasionally bluish or livid4 ,then there may be slight squinting1 or a singular rotation of the eye upon its own axis2 alternate flushing or paleness of the face2 and sudden animation followed by languor4 ,these signs will sometimes manifest themselves many hours1 nay days1 before the attack occurs2 may be looked upon as premonitory2 and if timely noticed1 and suitable medical aid resorted to1 the occurrence of a fit may be altogether prevented4 ,the state of the eyes should always be attended to4 ,in health they are clear and bright1 but in disease they become dull1 and give a heavy appearance to the countenance2 though after long continued irritation they will assume a degree of quickness which is very remarkable1 and a sort of pearly brightness which is better known from observation than it can be from description4 ,the direction of the eyes1 too1 should be regarded1 for from this we may learn something4 ,when the infant is first brought to the light1 both eyes are scarcely ever directed to the same object3 this occurs without any tendency to disease1 and merely proves1 that regarding one object with both eyes is only an acquired habit4 ,but when the child has come to that age when the eyes are by habit directed to the same object1 and afterwards it loses that power1 this circumstance alone may be looked upon as a frequent prelude to disease affecting the head4 ,,of ,,the ,,gestures4 ,the gestures of a healthy child are all easy and natural2 but in sickness those deviations occur1 which alone will often denote the nature of the disease4 ,suppose an infant to have acquired the power to support itself1 to hold its head erect2 let sickness come1 its head will droop immediately1 and this power will be lost1 only to be regained with the return of health2 and during the interval every posture and movement will be that of languor4 ,the little one that has just taught itself to run alone from chair to chair1 having two or three teeth pressing upon and irritating the gums1 will for a time be completely taken off its feet1 and perhaps lie languidly in its cot1 or on its nurse's arm4 ,the legs being drawn up to the belly1 and accompanied by crying1 are proofs of disorder and pain in the bowels4 ,press upon this part1 and your pressure will increase the pain4 ,look to the secretions from the bowels themselves1 and by their unhealthy character your suspicions1 in reference to the seat of the disorder1 are at once confirmed4 ,the hands of a child in health are rarely carried above its mouth2 but let there be any thing wrong about the head and pain present1 and the little one's hands will be constantly raised to the head and face4 ,sudden starting when awake1 as also during sleep1 though it occur from trifling causes1 should never be disregarded4 ,it is frequently connected with approaching disorder of the brain4 ,it may forebode a convulsive fit1 and such suspicion is confirmed1 if you find the thumb of the child drawn in and firmly pressed upon the palm1 with the fingers so compressed upon it1 that the hand cannot be forced open without difficulty4 ,the same condition will exist in the toes1 but not to so great a degree2 there may also be a puffy state of the back of the hands and feet1 and both foot and wrist bent downwards4 ,there are other and milder signs threatening convulsions and connected with gesture1 which should be regarded3--the head being drawn rigidly backwards1--an arm fixed firmly to the side1 or near to it1--as also one of the legs drawn stifly upwards4 ,these signs1 as also those enumerated above1 are confirmed beyond all doubt1 if there be present certain alterations in the usual habits of the child3--if the sleep is disturbed1--if there be frequent fits of crying1--great peevishness of temper1--the countenance alternately flushed and pale1--sudden animation followed by as sudden a fit of languor1--catchings of the breath followed by a long and deep inspiration1--all so many premonitory symptoms of an approaching attack4 ,,of ,,the ,,sleep4 ,the sleep of the infant in health is quiet1 composed1 and refreshing4 ,in very early infancy1 when not at the breast1 it is for the most part asleep in its cot2 and although as the months advance it sleeps less1 yet when the hour for repose arrives1 the child is no sooner laid down to rest1 than it drops off into a quiet1 peaceful slumber4 ,not so1 if ill4 ,frequently it will be unwilling to be put into its cot at all1 and the nurse will be obliged to take the infant in her arms2 it will then sleep but for a short time1 and in a restless and disturbed manner4 ,if it suffer pain1 however slight1 the countenance will indicate it2 and1 as when awake1 so now1 if there is any thing wrong about the head1 the contraction of the eye-brow and grinding of the teeth will appear2 if any thing wrong about the belly1 the lips will be drawn apart1 showing the teeth or gums1--and in both instances there will be great restlessness and frequent startings4 ,,of ,,the ,,stools4 ,in the new-born infant the motions are dark coloured1 very much like pitch both in consistence and appearance4 ,the first milk1 however1 secreted in the mother's breast1 acts as an aperient upon the infant's bowels1 and thus in about four-and-twenty hours it is cleansed away2 or if it should not1 a tea-spoonful of castor oil accomplishes this purpose4 ,from this time1 and through the whole of infancy1 the stools will be of a lightish yellow colour1 the consistence of thin mustard1 having little smell1 smooth in appearance1 and therefore free from lumps or white curded matter1 and passed without pain or any considerable quantity of wind4 ,and as long as the child is in health1 it will have daily two or three1 or even four1 of these evacuations4 ,but as it grows older1 they will not be quite so frequent2 they will become darker in colour1 and more solid1 though not so much so as in the adult4 ,any deviation1 then1 from the above characters1 is of course a sign of something wrong2 and as a deranged condition of the bowels is frequently the first indication we have of coming disease1 the nurse should daily be directed to watch the evacuations4 ,their appearance1 colour1 and the manner in which discharged1 are the points principally to be looked to4 ,if the stools have a very curdy appearance1 or are too liquid1 or green1 or dark-coloured1 or smell badly1 they are unnatural4 ,and in reference to the manner in which they are discharged1 it should be borne in mind1 that1 in a healthy child1 the motion is passed with but little wind1 and as if squeezed out1 but in disease1 it will be thrown out with considerable force1 which is a sign of great irritation4 ,the number1 too1 of stools passed within the four-and- twenty hours it is important to note1 so that if the child does not have its accustomed relief1 7and it must not be forgotten that children1 although in perfect health1 differ as to the precise number17 a little castor oil may be at once exhibited1 and thus mischief be prevented4 ,this1 however1 is not the place to discuss the question of disordered bowels1 but simply to point out how this circumstance may be known4,,fn#bg ,,fn#bg ,see section on ,disorders of the ,stomach and ,bowels1 p4 #bjh4 ,,of ,,the ,,breathing ,,and ,,cough4 ,the breathing of a child in health is formed of equal inspirations and expirations1 and it breathes quietly1 regularly1 inaudibly1 and without effort4 ,but let inflammation of the air-tubes or lungs take place1 and the inspiration will become in a few hours so quickened and hurried1 and perhaps audible1 that the attention has only to be directed to the circumstance to be at once perceived4 ,now all changes which occur in the breathing from its healthy standard1 however slight the shades of difference may be1 it is most important should be noticed early4 ,for many of the complaints in the chest1 although very formidable in their character1 if only seen early by the medical man1 may be arrested in their progress2 but otherwise1 may be beyond the control of art4 ,a parent1 therefore1 should make herself familiar with the breathing of her child in health1 and she will readily mark any change which may arise4 ,of cough ,i should not have said any thing in this chapter1 as it can never fail to be noticed1 except that it is highly necessary to throw out one caution4 ,whenever a child has the symptoms of a common cold1 attended by hoarseness and a rough cough1 always look upon it with suspicion1 and never neglect seeking a medical opinion4 ,hoarseness does not usually attend a common cold in the child1 and these symptoms may be premonitory of an attack of croup2 a disease excessively rapid in its progress1 and which1 from the importance of the parts affected1 carrying on1 as they do1 a function indispensably necessary to life1 requires the most prompt and decided treatment4 ,the following observations of ,dr4 ,cheyne are so strikingly illustrative1 and so pertinent to my present purpose1 that ,i cannot refrain inserting them3--,in the approach of an attack of croup1 which almost always takes place in the evening1 probably of a day during which the child has been exposed to the weather1 and often after catarrhal symptoms have existed for several days1 he may be observed to be excited1 in variable spirits1 more ready than usual to laugh than to cry1 a little flushed1 occasionally coughing1 the sound of the cough being rough1 like that which attends the catarrhal stage of the measles4 ,more generally1 however1 the patient has been for some time in bed and asleep1 before the nature of the disease with which he is threatened is apparent2 then1 perhaps1 without waking1 he gives a very unusual cough1 well known to any one who has witnessed an attack of the croup2 it rings as if the child had coughed through a brazen trumpet2 it is truly a tussis clangosa2 it penetrates the walls and floor of the apartment1 and startles the experienced mother1--',oh6 ,i am afraid our child is taking the croup6' ,she runs to the nursery1 finds her child sleeping softly1 and hopes she may be mistaken4 ,but remaining to tend him1 before long the ringing cough1 a single cough1 is repeated again and again2 the patient is roused1 and then a new symptom is remarked2 the sound of his voice is changed2 puling1 and as if the throat were swelled1 it corresponds with the cough1 etc4 ,how important that a mother should be acquainted with the above signs of one of the most terrific complaints to which childhood is subject2 for1 if she only send for medical assistance during its first stage1 the treatment will be almost invariably successful2 whereas1 if this golden opportunity is lost1 this disease will seldom yield to the influence of measures1 however wisely chosen or perseveringly employed4 ,,sect4 ,,iii4--,,other ,,circumstances ,,which ,,will ,,assist ,,in ,,the ,,early ,,detection ,,of ,,disease4 #a4 ,,the ,,influence ,,of ,,the ,,seasons ,,in ,,producing ,,particular ,,forms ,,of ,,disorder4--,the recollection of the fact1 that at the different seasons of the year some diseases are more prevalent than at other periods1 will greatly aid a judicious parent in the early detection of the presence of disorder1 and its kind1 in her child4 ,thus1 in the early part of the winter1 what is called catarrh1 viz4 an increased secretion of mucus from the membranes of the nose1 fauces1 and air-tubes1 with fever1 and attended with sneezing and cough1 thirst1 lassitude1 and want of appetite1 is generally prevalent4 ,as the winter advances1 the air-tubes of the lungs1 and the lungs themselves1 are liable to become the seat of disorder2 and those signs will present themselves1 which have been pointed out in the previous section as characteristic of such attacks4 ,in the spring1 we have still the same diseases prevalent1 and in addition1 measles1 scarlet fever1 small-pox1 and chicken pox1 which increase in liability towards the close of this season1 and with the first weeks of summer4 ,in the summer1 disease is less prevalent than at any other period of the year2 but towards its middle and close1 and through the whole of the autumnal months1 bowel complaints may be expected1 in the forms of diarrhoea1 cholera1 and dysentery4 #b4 ,,the ,,influence ,,of ,a ,,hereditary ,,predisposition ,,to ,,certain ,,diseases4-- ,without entering into this subject at large1 still it may be useful to remark1 that in some families there is a predisposition to some diseases1 which1 occurring in the first child1 will1 as each succeeding child is born1 attack at the same age4 ,amongst other diseases of this class are1 croup1 hooping-cough1 and water in the head4 ,this observation should not only lead a mother to be alive to the possibility of the successional occurrence of these diseases in her family1 and so early note their appearance1 and seek medical advice1 but should at the same time make her most anxious1 on the one hand1 to shield her child from all their exciting causes1 and on the other1 to adopt those measures which may contribute indirectly to overcome the constitutional predisposition to them4 ,of the scrofulous constitution1 ,i will merely mention here1 that it is of the greatest importance1 where a predisposition to this disease exists in a family1 that a mother should immediately attend to any alteration in the gait or contour of her child1 and give prompt attention also to any complaint made of swelling about a joint1 although it may be unattended with pain4 ,the importance of this remark will be seen by contrasting the result of the following cases which occurred in children of the same family4 ,case ,i4 ,a4 ,b41 a female child1 having blue eyes1 light hair1 and a fair complexion1 in the early part of the year #ahch1 being then two years of age1 had an enlargement of the left knee joint4 ,for some weeks previous to this time1 there had been a degree of heat about the part2 but as no pain apparently existed1 it was not regarded as of any consequence1 and nothing was done4 ,the child1 living in the neighbourhood of ,london1 was afterwards placed under medical treatment4 ,two or three months having elapsed1 it was brought to town1 and shown to me1 in consequence of a slight tumefaction over the lower part of the spine4 ,this soon disappeared under the measures employed1 and eventually the disease of the knee 7evidently scrofulous7 was arrested1 so that now the case promises to be cured2 but the joint will for ever be stiff1 and the limb thus affected shorter than the other4 ,case ,,ii4 ,g4 ,b41 the brother of the above1 a handsome boy1 with light hair1 fine blue eyes1--indeed1 very much like his little sister1--in the year #ahcf1 had enlargements of the glands in his neck1 which were relieved by the treatment resorted to4 ,in ,april1 #ahci1 being then eight years old1 he was observed by his mother to limp slightly in walking1 but complained of little or no pain4 ,from the caution1 however1 which had been given to the parent at the time ,i was consulted about the previous case1 to notice at an early period any symptom of this nature in her children1 the fact was immediately attended to4 ,the affection was evidently in the hip2 there was imperfection in the gait1 and pain upon pressing over the joint4 ,a blister was applied1 perfect rest to the limb enjoined1 and steel medicines ordered2 and in a fortnight the motions of the joint were restrained more effectually by the application of strips of soap plaster and a bandage4 ,in three months the child was ordered to the sea- side1 and eventually was able to walk without the slightest limp or pain1 and may be said to be quite well4 ,i would not say that in the first case1 if the disease had been discovered early1 and at that time met by judicious medical treatment1 a stiff knee and shortened limb would have been prevented1 although this is my belief2 but in reference to the latter case1 ,i have no hesitation in saying1 that without the disease had been early detected by the mother1 and as promptly attended to by her1 the remedial measures might have failed1--certainly the result would not have been so highly satisfactory as it was4 ,chap4 ,v4 ,,on ,,what ,,constitutes ,,the ,,maternal ,,management ,,of ,,the ,,diseases ,,of ,,children4 ,the especial province of the mother is the prevention of disease1 not its cure4 ,to the establishment and carrying out of this principle1 every word contained in the preceding pages has directly or indirectly tended4 ,this1 however1 is not all4 ,when disease attacks the child1 the mother has then a part to perform1 which it is especially important during the epochs of infancy and childhood should be done well4 ,i refer to those duties which constitute the maternal part of the management of disease4 ,medical treatment1 for its successful issue1 is greatly dependent upon a careful1 pains-taking1 and judicious maternal superintendence4 ,no medical treatment can avail at any time1 if directions be only partially carried out1 or be negligently attended to2 and will most assuredly fail altogether1 if counteracted by the erroneous prejudices of ignorant attendants4 ,but to the affections of infancy and childhood1 this remark applies with great force2 since1 at this period1 disease is generally so sudden in its assaults1 and rapid in its progress1 that unless the measures prescribed are rigidly and promptly administered1 their exhibition is soon rendered altogether fruitless4 ,the amount of suffering1 too1 may be greatly lessened by the thoughtful and discerning attentions of the mother4 ,the wants and necessities of the young child must be anticipated2 the fretfulness produced by disease1 soothed by kind and affectionate persuasion2 and the possibility of the sick and sensitive child being exposed to harsh and ungentle conduct1 carefully provided against4 ,again1 not only is a firm and strict compliance with medical directions in the administration of remedies1 of regimen1 and general measures1 necessary1 but an unbiased1 faithful1 and full report of symptoms to the physician1 when he visits his little patient1 is of the first importance4 ,an ignorant servant or nurse1 unless great caution be exercised by the medical attendant1 may1 by an unintentional but erroneous report of symptoms1 produce a very wrong impression upon his mind1 as to the actual state of the disease4 ,his judgment may1 as a consequence1 be biased in a wrong direction1 and the result prove seriously injurious to the welldoing of the patient4 ,the medical man cannot sit hour after hour watching symptoms2 hence the great importance of their being faithfully reported4 ,this can alone be done by the mother1 or some person equally competent4 ,there are other weighty considerations which might be adduced here1 proving how much depends upon efficient maternal management in the time of sickness2 but they will be severally dwelt upon1 when the diseases with which they are more particularly connected are spoken of4 ,sect4 #a4--;,,accidents ,,and ,,diseases ,,which ,,may ,,occur ,,to ,,the ,,infant ,,at ,,birth1 ,,or ,,soon ,,after4 ,,still-,,born4 ,sometimes the child comes into the world apparently dead1 and1 unless the most active exertions are made by the attendants1 is lost4 ,the superintendence of the means used devolves upon the medical man2 but it would be often well if his assistants were already acquainted with the measures pursued under these circumstances1 for they would be more likely to be carried into effect with promptitude and success1 than they now frequently are4 ,and again1 the still-born child is frequently in this state from having been born very rapidly1 and before the medical man can have arrived1 it will be more especially useful in such a case1 that the attendants in the lying-in-room should know how to proceed4 ,the various causes producing this condition it is unnecessary to mention4 ,the condition itself may exist in a greater or less degree3 the infant may be completely stillborn1 with no indication of life1 except1 perhaps1 the pulsation of the cord1 or a feeble action of the heart2--or it may make ineffectual efforts at breathing1 or even cry faintly1 and yet subsequently perish for want of strength to establish perfectly the process of respiration4 ,under all these circumstances1 a good deal can often be effected by art4 ,in every instance1 therefore1 in which we have not positive evidence of the child being dead1 in the existence of putrefaction1 or of such malformation as is incompatible with life1 it is our duty to give a fair trial to the means for restoring suspended animation2 and as long as the slightest attempt at motion of the respiratory organs is evinced1 or the least pulsation of the heart continues1 we have good grounds for persevering and hoping for ultimate success4 ,the measures to be employed to restore a still-born child will be a little modified by the circumstances present4 ,,if ,,there ,,is ,,no ,,pulsation--,,no ,,beating ,,in ,,the ,,cord1 when the child comes into the world1 it may at once be separated from the mother4 ,this is to be effected by first tying the navel-string with common sewing thread 7three or four times doubled71 about two inches from the body of the child1 and again two inches from the former ligature1 and then dividing the cord with a pair of scissors between the two4 ,and now the means for its restoration are to be made use of1 which are detailed below1 viz4 inflation of the lungs1 and perhaps the warm bath4 ,if1 with the above circumstances1 the child's face be livid and swollen1 some drops of blood should previously be allowed to escape before the ligature is applied to that part of the navel-string which is now only attached to the child4 ,,if ,,there ,,is ,,pulsation ,,in ,,the ,,cord1 ,,but ,,respiration ,,is ,,not ,,fully ,,established1 it must not be divided2 and as long as pulsation continues1 and the child does not breathe perfectly and regularly1 no ligature should be applied4 ,the first thing to be done here1 is to pass the finger1 covered with the fold of a handkerchief or soft napkin1 to the back of the child's mouth1 to remove any mucus which might obstruct the passage of air into the lungs1 and at the same time to tickle those parts1 and thereby excite respiratory movements4 ,the chest should then be rubbed by the hand1 and a gentle shock given to the body by slapping the back4 ,if these means fail1 the chest and soles of the feet must next be rubbed with spirits1 the nostrils and back of the throat irritated with a feather previously dipped in spirits of wine1 and ammonia or hartshorn may be held to the nose4 ,,inflation ,,of ,,the ,,lungs4--,these means not having been successful1 and the pulsation in the cord having ceased1 the infant must be separated1 and inflation of the lungs resorted to4 ,this is to be effected gently and cautiously as follows3-- ,the child1 wrapped in flannel1 is to be laid on its back upon a table placed near the fire4 ,its head is to be slightly extended1 and the nostrils held between the fingers and thumb of one hand1 whilst with the fingers of the other slight pressure is to be made upon the pit of the stomach1 so as to prevent the air from passing into that organ4 ,the lungs of the child are now to be filled with air1 by the operator applying his own lips--with a fold of silk or muslin intervening1 for the sake of cleanliness--to those of the child1 and then simply blowing in its mouth1 he is to propel the air from his own chest into that of the infant4 ,previously1 however1 to his doing this1 he should make several deep and rapid inspirations1 and1 finally1 a full inspiration1 in order to obtain greater purity of air in his own lungs4 ,when the chest of the child has been thus distended1 it is to be compressed gently with the hand1 so as to empty the lungs2 and then the inflation1 with the alternately compressing the chest1 must be repeated again and again1 until either the commencement of natural respiration is announced by a sneeze or deep sigh1 or until after long-continued1 steady1 persevering1 but unavailing1 efforts to effect this object shall have removed all ground of hope for a successful issue4 ,whilst these efforts are being made1 some other individual must endeavour to maintain or restore the warmth of the infant's body1 by gently but constantly pressing and rubbing its limbs between his warm hands4 ,and after respiration is established1 the face must still be freely exposed to the air1 whilst the warmth of the limbs and body is carefully sustained4 ,it will sometimes happen--and to this circumstance the operator should be fully alive--that when the child begins to manifest symptoms of returning animation1 its tongue will be drawn backwards and upwards against the roof of the mouth1 filling up the passage to the throat1 and preventing further inflation of the lungs4 ,this is to be remedied by the introduction of the fore-finger to the upper and back part of the child's tongue1 and gently pressing it downwards and forwards1 by which the difficulty will be removed1 and the air again passes4 ,,the ,,warm ,,bath4--,more reliance may be placed upon the above measure to restore animation1 than upon the warm bath4 ,still this is sometimes useful1 and therefore must not be neglected4 ,whilst inflation is going on1 the bath may be got ready1 then resorted to1 and if unsuccessful1 inflation may and ought again to be followed up4,,fn#bh ,if the bath is useful at all1 it will be so immediately upon putting the infant into it2 respiration will be excited1 followed by a cry2 and if this does not occur at once1 it would be wrong to keep the child longer in the bath1 as it would be only losing valuable time which ought to be devoted to other efforts4 ,the temperature of the bath should be about #ajj degrees2 and if1 upon plunging the infant into it1 it fortunately excite the respiratory effort1 it should then be taken out1 rubbed with dry but hot flannels1 and1 when breathing is fully established1 laid in a warm bed1 or1 what is still better1 in its mother's bosom2 letting it1 however1 have plenty of air4 ,,fn#bh ,we should not relinquish our endeavours at resuscitation under two or three hours1 or even longer2 and if ultimately successful1 the state of the infant should be carefully watched for two or three days4 ,,injuries ,,received ,,during ,,birth4 ,if a labour be long and tedious1 the head and body of the child may be bruised and disfigured4 ,the shape of the head is frequently altered by the compression it has undergone1 so that it may be elongated1 and measure from the chin to the back of the head as much as six or seven inches4 ,this always excites surprise1 sometimes apprehension1 in the minds of the attendants3 there is no ground for it4 ,it must be allowed to regain its natural shape without interference4 ,tumours or swellings upon the head are very common4 ,they arise from pressure upon the part during the labour4 ,the only treatment that is required1 or safe1 is1 freedom from all pressure1 and the application of cold lotions composed of brandy or vinegar and water4 ,the swelling will gradually subside4 ,it will be right to direct the attention of the medical man to this circumstance4 ,the face may be frightfully disfigured from the above cause1 exceedingly black1 and the features distorted4 ,nothing is necessary here2 in a few days the face will recover its proper appearance4 ,,retention ,,of ,,urine4 ,occasionally an infant will not pass any urine for many hours after its birth4 ,this most frequently arises from the fact of none being secreted4 ,in the last case of this kind that ,i was called to1 three days had elapsed since birth1 and no urine had been passed2 it proved that none had been secreted4 ,sometimes1 however1 it is the effect of another cause1 which the use of the warm bath will be found to remove1 which should always therefore be employed four and twenty hours after the birth of the infant1 if it has not by that time passed any water4 ,it now and then happens1 but fortunately very rarely1 that some physical obstruction exists4 ,it is always important1 therefore1 for the nurse to pay attention to the above point2 and it is her duty to direct the attention of the medical man to the subject1 if anything unusual or unnatural be present4 ,the same observation applies to the bowel also2 and if twelve hours pass without any motion1 the parts should be examined4 ,,swelling ,,of ,,the ,,breasts4 ,at birth1 or two or three days subsequently1 the breasts of the infant will frequently be found swollen1 hard1 and painful1 containing a fluid much resembling milk4 ,nurses generally endeavour to squeeze this out1 and thus do great mischief2 for by this means inflammation is excited in the part1 and sometimes abscess is the result4 ,if the breasts are simply slightly enlarged1 it is unnecessary to do any thing more than rub them occasionally and very gently with warm almond oil1 and a little time will restore them to their proper size4 ,if1 however1 they are inflamed1 hot1 painful1 with a red surface1 and unusually large1 a bread and water poultice must be applied every three or four hours1 which will generally prevent either the formation of matter1 or any other unpleasant consequence4 ,in a few days1 under this treatment1 they will usually subside1 and be quite well4 ,,inflammation ,,of ,,the ,,eyes4 ,,its ,,importance4--,about the second or third day after the child's birth1 an inflammation sometimes attacks the eye1 which is of considerable consequence4 ,the more so1 from its commencing in a way not calculated to excite the attention1 or alarm the fears1 of the mother or nurse4 ,the child cannot express its sensations1 and the swelling of the eye conceals the progress of the disease1 so that serious mischief is frequently done before the medical man sees the patient4 ,in the first place1 the inflammation is not immediately noticed2 and1 in the second1 the measures employed are frequently insufficient to check its progress3 hence it causes more blindness 7,i refer to the lower classes of society more particularly7 than any other inflammatory disorder that happens to the eye2 and the number of children is very considerable1 whose sight is partially or completely destroyed by it4 ,the parent or nurse is apt to suppose1 when this inflammation first appears1 that it is merely a cold in the eye1 which will go off2 and the consequences which ,i have just mentioned take place1 in many cases1 before they are aware of the danger1 and before the medical man is resorted to for assistance4 ,i only desire1 in mentioning this complaint1 to inform the attendants of the lying-in-room of its great importance1 that it may not be trifled with1 that upon its first approach the physician may be informed of it1 and that the treatment he directs for its cure may be sedulously and rigidly followed4 ,,symptoms4--,the inflammation commonly comes on about three days after birth1 but it may take place at a later period4 ,it may be known by its commencing thus3--,when the child wakes from sleep1 the eyelids will be observed to stick together a little2 their edges will be redder than natural1 and especially at the corners2 the child experiences pain from the access of light1 and therefore shuts the eye against it4 ,a little white matter will also be observed lying on the inside of the lower lid4 ,after a short time1 the lids swell1 become red on their external surface1 and a large quantity of matter is secreted1 and constantly poured from the eye2 the quantity of discharge increasing until it becomes very great4 ,but enough has been said to point out the importance of the disease1 and the signs by which it may be recognised at its first approach4 ,,treatment4--,keeping the eye free from discharge1 by the constant removal of the matter secreted1 is what the medical attendant will chiefly insist upon2 and without this is done1 any treatment he may adopt will be useless2 with it1 there is no doubt of a successful issue of the case1 provided his attention has only been called to it at a sufficiently early period4 ,,hare-,,lip4 ,this is a blemish too well known to require a formal description4 ,the questions most interesting to a mother in relation to it1 are1--,how is her child to be nourished1 that is born with it8 and when ought an operation to be performed for its removal8 ,,the ,,mode ,,of ,,feeding ,,the ,,infant4--,if the defect is but trifling1 the infant will be able to suck1 provided the mother's nipple is large1 and the milk flows freely from it4 ,if this is not the case1 the difficulty may be obviated by using the cork nipple shield4,,fn#bi ,i have known this to answer the purpose admirably1 when the mother had previously despaired of nursing her infant1 the nipple being too small for it to grasp4 ,,fn#bi ,see p4 #da4 ,if1 however1 the defect exists in a still greater degree1 feeding by means of the spoon must be resorted to2 the greatest care being necessary as to the quantity1 quality1 and preparation of the food4,,fn#cj ,,fn#cj ,see ,artificial ,feeding1 p4 #cd4 ,,caution ,,in ,,reference ,,to ,,the ,,operation4--,with regard to the operation for the removal of this deformity1 ,i would strongly warn parents against desiring its too early performance4 ,various considerations contribute to make the distressed parents anxious for this4 ,but very seldom indeed--except the deformity be very great1 and implicating other parts beside the lip--will the operation be required1 or ought it to be resorted to1 before the second year and a half of the infant's life2 and for this very cogent reasons exist4 ,for instance1 convulsions may thus be induced1 which often terminate fatally4 ,the most proper age for removing this deformity by operation1 is from that of two years and a half to four years4 ,,bleeding ,,from ,,the ,,navel-,,string4 ,bleeding from the navel-string will sometime take place hours after it has been supposed to be carefully secured4 ,this will arise1 either from the cord being carelessly tied1 or from its being unusually large at birth1 and in a few hours shrinking so much that the ligature no longer sufficiently presses on the vessels4 ,in either case1 it is of importance that the attendants in the lying-in-room should understand how to manage this accident when it occurs1 that it may not prove injurious or fatal to the child4 ,,the ,,mode ,,of ,,arresting ,,the ,,bleeding4--,the clothes of the child and the flannel roller must be taken off2--the whole cord without delay must be unwrapped1 and then a second ligature be applied below the original one1 7viz4 nearer to the body of the infant17 taking great care that it shall not cut through the cord when drawn very tight1 but at the same time drawing it sufficiently tight to compress the vessels4 ,the ligature should be composed of fine linen threads1 three or four thicknesses1 and not of tape or bobbin1 or any substance of this nature1 as it cannot be relied on for this purpose4 ,,ulceration ,,or ,,imperfect ,,healing ,,of ,,the ,,navel4 ,the cord separates from the navel generally some time between the fifth and fifteenth day from delivery1 and the part usually heals without giving the slightest trouble4 ,this1 however1 is not always the case1 for sometimes a thin discharge will take place1 which1 if the part be examined1 will be found to proceed from a small growth about the size1 perhaps1 of a pea1 or even less4 ,this must be removed by applying a little powdered alum1--or1 if this fail1 it should be once or twice slightly touched with blue-stone1 and afterwards dressed with calamine cerate4 ,at other times1 though fortunately very rarely1 excoriation of the navel and the parts around takes place1 which quickly spreads1 and assumes an angry and threatening character4 ,if1 however1 the attention of the medical man is called to it early1 it will always do well3 until his directions are given1 apply a nicely made bread and water poultice4 ,,bleeding ,,from ,,the ,,navel4 ,sometimes1 a day or two after the cord separates1 or at the time of separation1 bleeding takes place from the navel3 fortunately1 this very seldom occurs2 indeed1 it is very rarely met with2 and ,i only mention it1 to observe that1 upon its occurrence1 the point of the finger should be placed over the part1 and pressure steadily applied until medical assistance is obtained4 ,now and then1 in these cases1 a growth sprouts up and bleeds4 ,let this be touched with lunar caustic1 or any other astringent application1 or let pressure be employed1 still it will bleed1--not freely or in a stream1 but there will be a constant drain from the part1 and the infant1 as a consequence1 will waste1 and be brought to death's door4 ,excise it1 it will only make matters worse4 ,the treatment in this case consists in simply winding a piece of very narrow tape round the growth1 and then leaving it untouched4 ,the bleeding will soon cease2 the fungus will sprout over the upper margin of the tape2 in a very short time it will1 as it were1 strangle the disease1 which subsequently falling off1 a complete cure is accomplished4 ,,jaundice4 ,it frequently happens1 during the first or second week after birth1 that the skin of the child becomes very yellow1 and it has all the appearance of having the jaundice4 ,this gives rise to great distress to the parent when she perceives it1 and she becomes very anxious for the medical man's next visit4 ,now1 ordinarily1 it is of no consequence2 commonly disappearing spontaneously1 and requiring no medical treatment4 ,if1 however1 it does not go off in two or three days1 a tea-spoonful of castor oil should be given once1 or oftener1 if necessary4 ,it is1 of course1 possible for an attack of real jaundice to occur at this early period1 and a disease of a very serious nature will then have to be dealt with2 but1 except as a consequence of malformation 7a very infrequent occurrence71 it is not likely to arise2 and therefore jaundice during the first and second week after delivery need not create alarm4 ,tongue-tied4 ,,from ,,what ,,it ,,arises4--,this arises from the bridle under the tongue being so short1 or its attachment to the tongue extended so near the tip1 as to interfere with the motions of the organ in sucking1 and1 in after years1 in speaking4 ,it is a rare occurrence1 although nothing is more common than for medical men to have infants brought to them supposed to be labouring under the above defect4 ,,how ,,its ,,existence ,,may ,,be ,,determined4--,the best guide for a parent to determine whether it exist or not1 is for her to watch whether the infant can protrude the tip of the tongue beyond the lips3 if so1 it will be able to suck a good nipple readily1 and nothing need or ought to be done4 ,no mother will unnecessarily expose her infant to an operation1 which1 unless very carefully performed1 is not altogether unattended with danger2 and1 if she suspects any defect of this kind to exist1 she has only to observe the circumstance mentioned above1 to satisfy her mind upon the subject4 ,,moles ,,and ,,marks ,,on ,,the ,,skin1 ,,etc4 ,the supposed influence of the imagination of the mother1 in the production of the above appearances in the texture of the skin of her infant1 has been fully discussed in the author's work ,hints to ,mothers1 etc4 ,this part of the subject is1 however1 foreign to the present inquiry1 which chiefly has reference to the probable effect of their presence upon the health of the child4 ,they may be divided into two classes3 the brownish mole1 and claret- stain2 and small but somewhat elevated tumours1 either of a dark blue1 livid colour1 or of a bright vermilion hue4 ,,moles ,,and ,,stains4--,they are of no importance1 as far as the health of the infant is concerned4 ,if situated in the face1 however1 they frequently cause great disfigurement1 as the claret-stain1 which may be seen sometimes to occupy nearly half the face4 ,but they happily do not increase in size1 remaining stationary through life2 and as any operation that might be proposed for their removal1 would only cause an equal1 if not greater1 deformity1 they ought to be left alone4 ,,coloured ,,spots ,,or ,,tumours4--,these vary in their number1 size1 and situation4 ,the same child is sometimes born with many of them4 ,they may be as small as a pea1 or as large as a crown piece4 ,they are not only found on the skin1 but on the lips1 in the mouth1 etc4 etc4 ,these1 also1 sometimes remain stationary in their size1 having no tendency to enlarge1 unless1 indeed1 they are subjected to friction or pressure4 ,but as they frequently require surgical aid1 in which case1 the earlier the application of remedial measures1 the less severe in their kind1 and the greater the probability of a speedy and successful result1--so is it always important for the mother early to obtain a medical opinion1 that the measure of interference or non-interference may be decided4 ,sect4 ,,ii4 ,,disorders ,,of ,,the ,,stomach ,,and ,,bowels ,,of ,,the ,,infant4 ,,indigestion1 ,,flatulence1 ,,vomiting1 ,,griping1 ,,and ,,looseness4 ,disorder of the stomach and bowels is one of the most fruitful sources of the diseases of infancy4 ,only prevent their derangement1 and1 all things being equal1 the infant will be healthy and flourish1 and need not the aid of physic or physicians4 ,experience daily proves1 that a large proportion of the children who die in infancy are lost from derangement of these organs1 as the primary cause4 ,there are many causes which may give rise to these affections2 many of them appertain to the mother's system1 some to that of the infant4 ,all are capable1 to a great extent1 of being prevented or remedied4 ,it is1 therefore1 most important that a mother should not be ignorant or misinformed upon this subject4 ,it is the prevention of these affections1 however1 that will be principally dwelt upon in this chapter2 for let the mother ever bear in mind1 and act upon the principle1 that the prevention of disease alone belongs to her2 the cure to the physician4 ,for the sake of clearness and reference1 these disorders will be spoken of as they occur3-- ,to the infant at the breast4 ,at the period of weaning4 ,and to the infant brought up by hand4 #a4 ,,to ,,the ,,infant ,,at ,,the ,,breast4 ,,unhealthy ,,milk4--,the infant's stomach and bowels may become deranged from the breast-milk becoming unwholesome4 ,this may arise from the parent getting out of health1 a circumstance which will be so manifest to herself1 and to those more immediately interested in her welfare1 that it is only necessary just to allude to it here4 ,suffice it to say1 that there are many causes of a general kind to which it may owe its origin2 but that the most frequent is undue lactation1 a subject to which reference has already been made1 and the effects both upon mother and child fully dwelt upon4,,fn#ca ,to cure derangement of the bowels from this cause1 a wet-nurse is the only remedy4 ,,fn#ca ,see page #ae4 ,anxiety of mind in the mother will cause her milk to be unhealthy in its character1 and deficient in quantity1 giving rise to flatulence1 griping1 and sometimes even convulsions in the infant4,,fn#cb ,a fit of passion in the nurse will frequently be followed by a fit of bowel complain in the child4,,fn#cc ,these causes of course are temporary1 and when removed the milk becomes a healthy and sufficient for the child as before4 ,,fn#cb ,see page #be4 ,,fn#cc ,see page #cc4 ,sudden and great mental disturbance1 however1 will occasionally drive away the milk altogether1 and in a few hours4 ,a ,mrs4 ,s41 aet4 #ba1 a fine healthy woman1 of a blonde complexion1 was confined of a boy in ,october1 #ahcf4 ,she had a good time1 and a plentiful supply of milk for the child1 which she continued to suckle till the following ,january1 a period of three months1 when her milk suddenly disappeared4 ,this circumstance puzzled the medical attendant1 for he could not trace it to any physical ailment2 but the milk never returned1 and a wet-nurse became necessary4 ,in the following spring the husband of this lady failed1 an adversity which had been impending since the date when the breast-milk disappeared1 upon which day the deranged state of the husband's affairs was made known to the wife1--a fact which at once explained the mysterious disappearance of the milk4 ,unwholesome articles of diet will affect the mother's milk1 and derange the infant's bowels4 ,on the #beth ,may1 #ahcf1 ,i was called to see an infant at the breast with diarrhoea4 ,the remedial measures had but little effect so long as the infant was allowed the breast-milk2 but this being discontinued1 and arrow-root made with water only allowed1 the complaint was quickly put a stop to4 ,believing that the mother's milk was impaired from some accidental cause which might now be passed1 the infant was again allowed the breast4 ,in less than four-and-twenty hours1 however1 the diarrhoea returned4 ,the mother being a very healthy woman1 it was suspected that some unwholesome article in her diet might be the cause4 ,the regimen was accordingly carefully inquired into1 when it appeared that porter from a neighbouring publican's had been substituted for their own for some little time past4 ,this proved to be bad1 throwing down1 when left to stand a few hours1 a considerable sediment2 it was discontinued2 good sound ale taken instead2 the infant again put to the breast1 upon the milk of which it flourished1 and never had another attack4 ,in the same way aperient medicine1 taken by the mother1 will act on the child's bowels1 through the effect which it produces upon her milk4 ,this1 however1 is not the case with all kinds of purgative medicine1 nor does the same purgative produce a like effect upon all children4 ,it is well1 therefore1 for a parent to notice what aperient acts thus through her system upon that of her child1 and what does not1 and when an aperient becomes necessary for herself1 unless she desire that the infant's bowels be moved1 to avoid the latter2 if otherwise1 she may take the former with good effect4 ,again2 the return of the monthly periods whilst the mother is a nurse always affects the properties of the milk1 more or less1 deranging the stomach and bowels of the infant4 ,it will thus frequently happen1 that a few days before the mother is going to be unwell1 the infant will become fretful and uneasy2 its stomach will throw up the milk1 and its motions will be frequent1 watery1 and greenish4 ,and then1 when the period is fully over1 the milk will cease to purge4 ,it is principally in the early months1 however1 that the infant seems to be affected by this circumstance2 for it will be generally found that although the milk is certainly impaired by it1 being less abundant and nutritious1 still1 after the third or fourth month it ceases to affect the infant4 ,is then a mother1 because her monthly periods return after her delivery1 to give up nursing8 ,certainly not1 unless the infant's health is seriously affected by it2 for she will generally find that1 as the periods come round1 by keeping the infant pretty much from the breast1 during its continuance1 and feeding him upon artificial food1 she will prevent disorder of the child's health1 and be able in the intervals to nurse her infant with advantage4 ,it must be added1 however1 that a wet- nurse is to be resorted to rather than any risk incurred of injuring the child's health2 and that1 in every case1 partial feeding will be necessary at a much earlier period than when a mother is not thus affected4 ,the milk may also be rendered less nutritive1 and diminished in quantity1 by the mother again becoming pregnant4 ,in this case1 however1 the parent's health will chiefly suffer1 if she persevere in nursing2 this1 however1 will again act prejudicially to the child4 ,it will be wise1 therefore1 if pregnancy should occur1 and the milk disagree with the infant1 to resign the duties of a nurse1 and to put the child upon a suitable artificial diet2--if1 however1 pregnancy should take place before the infant is six month's old1 a wet-nurse ought to be procured4 ,,from ,,irregular ,,nursing4--,this is one of the most frequent sources of derangement of the stomach and bowels of the child4 ,the infant that is constantly at the breast will always be suffering1 more or less1 from flatulence1 griping1 looseness of the bowels1 and vomiting4 ,this is caused by a sufficient interval not being allowed between the meals for digestion4 ,the milk1 therefore1 passes on from the stomach into the bowels undigested1 and the effects just alluded to follow4 ,time must not only be given for the proper digestion of the milk1 but the stomach itself must be allowed a season of repose4 ,this evil1 then1 must be avoided most carefully by the mother strictly adhering to those rules for nursing which have been already laid down4,,fn#cd ,,fn#cd ,see page #e4 ,,from ,,teething4--,the bowels of the infant at the breast1 as well as after it is weaned1 are generally affected by teething4 ,and it is fortunate that this is the case1 for it prevents more serious affections4 ,indeed1 the diarrhoea that occurs during dentition1 except it be violent1 must not be subdued2 if1 however1 this is the case1 attention must be paid to it4 ,it will generally be found to be accompanied by a swollen gum2 the freely lancing of which will sometimes alone put a stop to the looseness3 further medical aid may1 however1 be necessary4 ,,from ,,cold ,,and ,,damp1 ,,etc4--,of course there are other causes besides these already alluded to1 giving rise to bowel complaints1 during this epoch1--causes not cognisable by the mother1 however1 and not mentioned therefore here4 ,it is right1 however1 that she should be aware that these affections are sometimes the result simply of impressions of cold or damp1 particularly at certain seasons of the year2 in the autumn1 for instance1 when1 as is well known1 bowel complaints are very frequent4 ,when thus produced1 it is important early to seek medical aid1 as inflammation is generally the result4 #b4 ,,at ,,the ,,period ,,of ,,weaning4 ,there is great susceptibility to derangements of the stomach and bowels of the child at the period when weaning ordinarily takes place1 so that great care and judgment must be exercised in effecting this object4 ,usually1 however1 the bowels are deranged during this process from one of these causes2 from weaning too early1 from effecting it too suddenly and abruptly1 or from over-feeding and the use of improper and unsuitable food4 ,there is another cause which also may give rise to diarrhoea at this time1 independently of weaning1 viz4 the irritation of difficult teething4 ,,weaning ,,too ,,early4--,the substitution of artificial food for the breast- milk of the mother1 at a period when the digestive organs of the infant are too delicate for this change1 is a frequent source of the affections now under consideration4 ,the attempt to wean a delicate child1 for instance1 when only six months old1 will inevitably be followed by disorder of the stomach and bowels4 ,unless1 therefore1 a mother is obliged to resort to this measure1 from becoming pregnant1 or any other unavoidable cause1 if she consult the welfare of her child1 she will not give up nursing at this early period4 ,but if she should be no longer competent to suckle1 and her infant be delicate1 a wet-nurse must be obtained2 for1 the infant's bowels becoming disordered1 medicine or remedies will avail little without healthy breast milk4 ,the age at which weaning ought to take place must ever depend upon circumstances2 the ninth month would not be too early for some1 the twelfth would be for others4,,fn#ce ,,fn#ce ,see page #ea4 ,,for ,,sudden ,,and ,,abrupt ,,alteration ,,of ,,diet4--,depriving the child at once of the breast1 and substituting artificial food1 however proper under due regulations such food may be1 will invariably cause bowel complaints4 ,certain rules and regulations must be adopted to effect weaning safely1 the details of which are given elsewhere4,,fn#cf ,,fn#cf ,see page #eb4 ,,overfeeding1 ,,and ,,the ,,use ,,of ,,improper ,,and ,,unwholesome ,,food4--,these causes are more productive of disorder of the stomach and bowels at the time of weaning than any yet referred to4 ,if too large a quantity of food is given at each meal1 or the meals are too frequently repeated1 in both instances the stomach will become oppressed1 wearied1 and deranged2 part of the food1 perhaps1 thrown up by vomiting1 whilst the remainder1 not having undergone the digestive process1 will pass on into the bowels1 irritate its delicate lining membrane1 and produce flatulence1 with griping1 purging1 and perhaps convulsions4 ,then1 again1 improper and unsuitable food will be followed by precisely the same effects2 and unless a judicious alteration be quickly made1 remedies will not only have no influence over the disease1 but the cause being continued1 the disease will become most seriously aggravated4 ,it is1 therefore1 of the first importance to the well-doing of the child1 that at this period1 when the mother is about to substitute an artificial food for that of her own breast1 she should first ascertain what kind of food suits the child best1 and then the precise quantity which nature demands4 ,many cases might be cited1 where children have never had a prescription written for them1 simply because1 these points having been attended to1 their diet has been managed with judgment and care2 whilst1 on the other hand1 others might be referred to1 whose life has been hazarded1 and all but lost1 simply from injudicious dietetic management4 ,over-feeding1 and improper articles of food1 are more frequently productive1 in their result1 of anxious hours and distressing scenes to the parent1 and of danger and loss of life to the child1 than almost any other causes4 ,,teething4--,the irritation caused by difficult teething may give rise to diarrhoea at the period when the infant is weaned1 independently of the weaning itself4 ,such disorder of the bowels1 if it manifestly occur from this cause1 is a favourable circumstance1 and should not be interfered with1 unless indeed the attack be severe and aggravated1 when medical aid becomes necessary4 ,slight diarrhoea then1 during weaning1 when it is fairly traceable to the cutting of a tooth 7the heated and inflamed state of the gum will at once point to this as the source of the derangement71 is of no consequence1 but it must not be mistaken for disorder arising from other causes4 ,lancing the gum will at once1 then1 remove the cause1 and generally cure the bowel complaint4 #c4 ,,to ,,the ,,child ,,brought ,,up ,,by ,,hand4 ,children brought up on an artificial diet are very liable to indigestion and bowel complaints2 indeed none more so3 and it is from these affections that so many of these infants perish4 ,when1 then1 it is absolutely necessary from untoward circumstances to have recourse to this mode of nourishing the child1 the rules and regulations laid down in the section on ,artificial ,feeding must be most strictly followed out1 if the parent would hope to avoid disease and rear her child4,,fn#cg ,and if these affections should at any time unfortunately manifest themselves1 the mother ought carefully and diligently to examine whether the plan of feeding pursued is in every particular correct1 particularly bearing in mind that the two causes most frequently productive of disorder in the child are overfeeding and the exhibition of unsuitable food--the two grand errors of the nursery4 ,these results1 however1 have already been sufficiently dwelt upon as likely to take place at weaning1 and they may of course occur to a child who is brought up on an artificial diet at any period4 ,,fn#cg ,see page #cd4 ,,maternal ,,treatment ,,of ,,the ,,disorders ,,of ,,the ,,stomach ,,and ,,bowels4 ,as must have been already seen1 the maternal treatment chiefly consists in the removal of the cause of the disorder2 medicine may occasionally be exhibited by the mother1 but its use in her hands must be very limited indeed4 ,unfortunately the general resource and only remedy of most mothers in affections of the stomach and bowels is an aperient1 and a combination containing calomel is the one too frequently selected4 ,the primary cause of the disorder is undetected1 and consequently no measures taken for its removal1 but purgative powder after purgative powder is given1 the evil being supposed to rest in the bowels alone1 and that such means must eventually get rid of it4 ,the mother is not aware all this time that the real source of the derangement is probably in the diet itself2 that there is some error here1 and that unless this is corrected1 the remedies must be worse than useless4 ,the consequence of such a plan of proceeding is usually very sad2 a confirmed and obstinate diarrhoea but too commonly ensues1 and the infant is sometimes reduced to the last extremity4 ,the removal of the cause of the disorder1 then1 in a large number of instances of derangement of the stomach and bowels1 if effected early1 will cure the disease1 and without further remedy4 ,but it will be asked1 by what method is this cause to be detected8 ,in this way4 ,in all human probability the primary cause of the disorder is connected with the diet2 this is the case in ninety-nine instances out of a hundred4 ,well1 then1 is the sick child at the breast8 ,if so1 ascertain whether the breast-milk is healthy and wholesome1 or whether any circumstances exist which have rendered it otherwise8 ,if nothing faulty is found here1 the next question would naturally be1 whether the rules and regulations laid down for suckling have been strictly adhered to8 ,or1 whether the infant is sufficiently old to render it at all probable that a tooth may be irritating the gum8 ,perhaps the child is being weaned2 well1 is there any error here8 ,is the change being attempted too early8 or too suddenly and abruptly8 ,if this is not the case1 then1 has the child been overfed1 or is the food given of the proper description8 ,is the child being brought up by hand8 ,then1 there is every reason to suspect1 either that the quality of the food given is not the most suitable1 or1 that the quantity exhibited is too great2 in fact1 that the rules laid down for artificial feeding have not been strictly acted upon4 ,by a mode of investigation like this1 any defect or error in the dietetic management of the infant producing the disorder will be easily detected by a careful mother2 and its correction alone will1 in very many instances1 be all that is necessary to remove the symptoms4 ,for example1 if flatulence and griping1 followed by diarrhoea1 occur to an infant at the breast2 if at the same time it becomes pale1 its flesh flabby1 its disposition fretful1 always crying until it is put to the breast1 the nipple of which it grasps eagerly1 sucking eagerly1 yet never satisfied1 for its hunger continues1 it is not nourished2 if1 too1 the more it sucks1 the more the stomach and bowels are deranged1 the more it vomits and is purged2 depend upon it the cause of all the evil will be found to be unwholesome milk4 ,no medicine will avail any thing here2 the cause must be removed2 the best medicine1 and the only remedy1 is a breast of healthy milk4 ,and if this is not procured early1 there will be great danger of a diarrhoea setting in1 which may probably prove fatal to the child4 ,again2 if there is simply vomiting of the breast-milk almost immediately after the child has been suckled1 the milk coming up pure and unchanged1 and discharged without any apparent effort1 and the moment after the child is cheerful and happy1 this will be found to depend upon repletion1 and not upon unwholesome milk2 in fact1 the stomach has received too much4 ,this must be prevented in future1 not by giving medicine1 but simply by removing the infant from the nipple immediately it ceases to draw strongly1 the moment it begins to dally with the breast4 ,again2 if flatulence and griping occur to the child brought up by handy this derangement will generally be found to result from overfeeding3 abstinence and diminution of the quantity of the food will generally be all that is necessary here4 ,it will be well1 however1 for the mother in this case1 and she may do it with the utmost safety1 to unload the bowels of their indigestible contents by the exhibition of a tea-spoonful of castor oil4 ,a dose or two of this medicine will effectually clear them out1 without increasing the irritation1 or weakening the child1 whilst it will in most instances altogether remove the symptoms4 ,if the flatulence1 however1 should continue1 four or five grains of magnesia may be mixed with the last meal at night1 and a little warm water thrown up into the bowel as an injection the next morning4 ,diarrhoea occurring in a child brought up by hand1 if it be not the result of overfeeding1 will very frequently be found to arise from unsuitable diet1 the food given not being of a kind suited to the infant's stomach2 for what will agree with one child often disagrees with another4 ,alteration of diet will sometimes alone suffice in these cases to cure1 if this alteration is only made early enough1 before any considerable irritation of the stomach and bowels has been induced4 ,thin arrow-root made with water 7prepared very carefully1 or the child will refuse it17 should be given for five or six days2 the warm bath used every night for the same period1 a new flannel bandage rolled round the body1 and the child cautiously protected from a damp atmosphere4 ,the arrow-root1 upon the cessation of the diarrhoea1 may have cows' milk added to it1 if milk is not found to disagree3 when this is the case1 chicken or weak mutton broth1 free from fat1 or beef- tea1 thickened with farinaceous food1 with a little salt added1 are the best substitutes4 ,should not the diarrhoea yield to the foregoing measures1 and that readily1 medical aid ought to be sought4 ,diarrhoea is very frequent from the time of weaning to the third year of age1 and certainly in its effects forms so important a disease1 that1 unless in the slight form noticed above1 a mother is not justified in attempting its relief4 ,in conclusion1 ,i would observe1 that ,i do not think a mother justified in attempting more than what has been laid down here for her guidance4 ,it is believed that the few and plain common-sense directions given1 if followed1 will do much to prevent disease1 and even to relieve it in its milder forms2 they will not1 however1 cure disease itself when really established3 and again ,i would repeat1 let the mother recollect that to prevent disease is her province--to cure it1 is the physician's4 ,sect4 ,,iii4--,,costiveness4 #a4 ,,in ,,infancy4 ,the principle to act upon in the management of the infant's bowels is this1--that they should be kept free1 and by the mildest and least irritating means4 ,if therefore they become accidentally confined 7less than two stools in the four-and-twenty hours71 and the infant is suckled1 the mother may ascertain whether an aperient taken by herself will render her milk of a sufficiently purgative quality to act upon the bowels of her child4 ,this is the mildest mode of all4 ,if1 however1 this does not answer1 or is not practicable from the child being fed artificially1 then the mildest aperient medicines must be chosen to accomplish this purpose4 ,the kind of medicine to be selected1 and the doses in which to be adminstered1 will be found in the section on ,aperient ,medicine4,,fn#ci ,,fn#ci ,see page #ig4 ,if1 however1 the bowels of the infant are disposed to be habitually confined1 it should be ascertained whether this may not be dependent upon its diet4 ,the same food that agrees perfectly well with one child will frequently cause costiveness in another4 ,an intelligent and observing mother will soon discover whether this is the source of the mischief1 or not4 ,boiled milk1 for instance1 will invariably cause confined bowels in some children2 the same result will follow sago boiled in beef tea1 with others2 whilst1 on the other hand1 the bowels may frequently be brought into regular order1 and their confined state overcome1 by changing the food to ,leman's tops and bottoms steeped in hot water1 and a small quantity of unboiled milk added2 or prepared barley1 mixed in warm water and unboiled milk1 will have the same effect4 ,sometimes children are constitutionally costive1 that is1 the bowels are relieved every third or fourth day1 not oftener1 and yet perfect health is enjoyed4 ,this occasionally will happen in large families1 all the children1 though perfectly healthy and robust1 being similarly affected4 ,when such is found by a mother to be really the habit of her child1 it would be very unwise1 because injurious to its health1 to attempt by purgatives to obtain more frequent relief4 ,at the same time it will be prudent and necessary for her to watch that the regular time is not exceeded4 ,this condition seldom occurs to the very young infant4 #b4 ,,in ,,childhood4 ,children of sound health1 who are judiciously fed1 and have sufficient exercise1 very seldom need aperient medicine4 ,errors in diet1 a want of proper attention to the state of the skin1 insufficiency of air and exercise1 in fine1 a neglect of those general principles which have been laid down for the management of health1 and upon the observance of which the due and healthy performance of every function of the body depends1 are the sources of bowel derangements1 and particularly1 at this age1 of costiveness4 ,i feel assured1 however1 that some children are more troubled with costiveness than others1 from the simple but important circumstance of their not being early taught the habit of relieving the bowels daily1 and at a certain hour4 ,there is a natural tendency to this periodical relief of the system1 and it exists at the earliest age4 ,and if the mother only cause this habit to be fairly established in infancy1 she will do much towards promoting regularity of her child's bowels throughout life4 ,the recollection of this fact1 and the mother's acting upon it1 is of the greatest importance to the future health and comfort of her children4 ,if the bowels are accidentally confined at this age1 castor oil is certainly the best aperient that can be given3 it acts mildly but efficiently1 clearing out the bowels without irritating them4 ,the dose must be regulated by the age1 as also by the effect that aperients generally have upon the individual4 ,great care must in future be taken to avoid the cause or accidental circumstance which produced the irregularity4 ,when the bowels are habitually costive1 much care and judgment is necessary for their relief and future management4 ,fortunately this condition is very rare in youth4 ,the activity and exposure to the air1 usual at this period of life1 render purgatives unnecessary1 unless1 indeed 7as just mentioned71 some error in diet1 or some unusual circumstance1 render them accidentally confined4 ,should1 however1 the foregoing state exist1 medicine alone will avail little2 there are certain general measures which must also be acted up to1 and most strictly1 if the end is to be accomplished4 ,they consist1 principally1 in an observance of great regularity with respect to the time of taking food1 its quality1 quantity1 and due mastication2 regular and sufficient exercise1 horse exercise being particularly serviceable2 the shower-bath1 or daily ablution2 early rising 7the indulgence in the habit of lying in bed always predisposing to constipation72 and1 lastly1 the patient habituating himself to evacuate the bowels at a certain hour of the day4 ,after breakfast appears to be the time when the bowels are more disposed to act than at any other part of the day2 this is the time1 then1 that should be chosen4 ,all these points must be sedulously observed1 and upon the principles laid down in the various chapters upon these subjects1 if habitual costiveness is expected to be overcome4 ,,sect4 ,,iv4--,,worms4 ,,not ,,so ,,frequent ,,as ,,popularly ,,supposed2 ,,an ,,error ,,productive ,,of ,,mischief4--,almost all diseases have been1 at one time or other1 attributed to the generation of worms in the intestines4 ,and at the present day it is not at all an uncommon occurrence for medical men to be called in to prescribe for children1 to whom the strongest purgative quack medicines have been previously exhibited by parents1 for the removal of symptoms which1 upon investigation1 are found in no way connected with or produced by worms4 ,the results of such errors are always1 more or less1 mischievous1 and sometimes of so serious a nature as to lay the foundation of disease which ultimately proves fatal4 ,this observation1 moreover1 it behoves a mother carefully to regard1 since the symptoms1 popularly supposed to indicate the existence of worms1 are so deceptive1 7and none more so than that which is usually so much depended upon--the picking of the nose17 that it may be positively asserted to be impossible for an unprofessional person to form a correct and sound opinion in any of these cases4 ,it was at one time imagined1 and the idea is still popularly current1 that worms were the occasion of a troublesome and lingering species of fever1 which was therefore designated worm-fever4 ,this notion is now entirely exploded2 for if worms be present under such circumstances1 it is a mere accidental complication2 the fever referred to being generally of a remitting character1 and neither caused by or causing the generation of worms4 ,the symptoms of this fever1 however1 have led and continue to lead very many astray4 ,this is not surprising1 since they so closely resemble those which characterise the presence of worms1 that an unprofessional person is almost sure to be misled by them4 ,amongst other symptoms1 there is the picking of the nose and lips1 offensive breath1 occasional vomiting1 deranged bowels1 pain in the head and belly1 with a tumid and swollen condition of the latter1 a short dry cough1 wasting of the flesh1 etc42 symptoms continually attendant upon the disorder now under consideration4 ,these cases have hitherto been perpetually looked upon by mothers as worm-cases1 and after having been treated by them as such1 by the use of the popular worm-powders of the day1 have1 as perpetually1 presented themselves to the physician greatly and grievously aggravated by such injudicious treatment4 ,it is folly1 at any time1 for an unprofessional person to prescribe for a case where worms are actually known to exist3 surely where there is any doubt upon the latter point it must be greater folly still4 ,the infant at the breast is seldom1 if ever1 the subject of this disorder1 whilst an artificial diet1 or bringing up by hand1 predisposes to it4 ,worms most frequently occur1 however1 during childhood2 much more so at this epoch than in adult age4 ,they do not invariably occasion indisposition1 for they are now and then passed without pain or distress by children who are in the enjoyment of perfect health1 and in whom previously there was not the slightest suspicion of their existence4 ,the idea1 formerly so prevalent1 of their being attended with danger1 is without foundation2 for unless the case be mismanaged1 they rarely give rise to serious consequences4 ,,how ,,produced1 ,,and ,,how ,,best ,,prevented4--,the causes of worms it is not very easy to explain2 at the same time it is very certain that some known circumstances favour their production4 ,if the general health of a child be enfeebled1 particularly if the child be strumous1 such a condition will favour the generation of these animals4 ,the protracted use of unwholesome and innutritious articles of food1 or a deficient supply of salt 7the most necessary stimulant to the digestive organs71 or other condiments1 predisposes to worms4 ,this observation is strikingly illustrated by an occurrence which formerly took place in ,holland1 where an ancient law existed forbidding salt in the bread of certain criminals2 they were in consequence horribly infested with worms1 and quickly died4 ,sugar1 too1 whilst a necessary condiment for the food of children1 if given in the form of sweetmeats1 and their indulgence1 long persisted in1 may so enfeeble the organs of digestion as to cause worms4 ,and1 lastly1 7though many other causes might be referred to7 the injudicious means occasionally employed to effect the removal of these animals1 by the debility produced in the intestinal canal1 favours not only their re-appearance but their increase4 ,these1 then1 are so many causes which may occasion worms in the child1 and of course the best and most effectual method to prevent their production is their avoidance4 ,a mother1 therefore1 should at all times be careful in the regulation of the diet and general management of her child's habits and health1 even if no stronger obligations existed than the dread of this disorder2 and she must be more than ordinarily vigilant on this head1 when the slightest disposition to such disorder is manifested4 ,again2 she must not forget that the symptoms so commonly ascribed as characteristic of worms are much more frequently caused by other diseases2 that at no time1 therefore1 is she justified in giving worm powders1 or strong doses of medicine for such symptoms2 for if they do exist1 their use is always attended with risk1 and if they do not1 the debility which they occasion in the stomach and bowels may itself become the source of their production4 ,sect4 ,v4 ,,scarlet ,,fever4 ,there are several varieties of this disease2 it will be more perspicuous1 however1 for our purpose to speak of it under the two following forms3-- ,mild scarlet fever2 ,scarlet fever1 with sore throat4 ,,mild ,,scarlet ,,fever4--,in this form of the disease there is only the rash with fever4 ,,symptoms4--,the anticipating symptoms are those of fever3 they precede the eruption4 ,the degree of fever1 however1 is variable2 for the symptoms are sometimes so moderate as scarcely to attract attention1 slight and irregular shivering1 nausea1 perhaps vomiting1 thirst1 and heat of skin2 whilst1 at others1 there is considerable constitutional disturbance1 indicated by pungent heat of skin1 flushing of the face1 suffusion of the eyes1 pain in the head1 great anxiety and restlessness1 and occasionally slight delirium4 ,these symptoms are followed on the second day 7in the majority of instances7 by the rash4 ,this first appears in numerous specks or minute patches of a vivid red colour on the face1 neck1 and chest4 ,in about four-and-twenty hours it becomes gradually diffused over the whole trunk4 ,on the following day 7the third7 it extends to the upper and lower extremities1 so that at this period the whole surface of the body is of a bright red colour1 hot and dry4 ,the efflorescence1 too1 is not always confined to the skin1 but occasionally tinges the inside of the lips1 cheeks1 palate1 throat1 nostrils1 and even the internal surface of the eyelids4 ,sometimes the efflorescence is continuous and universal2 but more generally on the trunk of the body there are intervals of a natural hue between the patches1 with papulous dots scattered over them1 the colour being most deep on the loins and neighbouring parts1 at the flexure of the joints1 and upon those parts of the body which are subjected to pressure4 ,it is also generally most vivid in the evening1 gradually becoming paler towards morning4 ,the eruption is at its height on the fourth day2--it begins to decline on the fifth1 when the interstices widen1 and the florid hue fades2--on the sixth1 the rash is very indistinct2 and on the eighth day it is wholly gone4 ,the various symptoms with which the eruption is accompanied1 gradually disappear with the efflorescence2 but the tongue still remains morbidly red and clean4 ,the peeling off of the cuticle 7the outer layer of the skin71 which begins about the end of the fifth day on the parts on which the eruption first appeared1 proceeds2 so that about the eighth or ninth1 portions of the cuticle are thrown off1 the thickest and largest being those detached from the skin of the hands and feet4 ,,scarlet ,,fever1 ,,with ,,sore ,,throat4--,in this form of the disease1 the fever and rash are accompanied with inflammation of the throat4 ,,symptoms4--,the symptoms are more severe than in the mild form of this disease1 and1 in the majority of instances1 the inflammation of the throat appears with the eruption1 and goes through its progress of increase and decline with the cutaneous eruption4 ,sometimes1 however1 it precedes the fever2 whilst at others it does not appear until the rash is at its height4 ,it is generally in the course of the second day that the child complains of considerable stiffness in the muscles of the neck1 extending to the lower jaw1 and under the ears2--of a roughness of the throat1 and difficulty in swallowing2--and some degree of hoarseness will be noticed3 all so many indications that the throat is affected4 ,very shortly1 an increased secretion of the mucus of these parts occurs1 and1 collecting about the tonsils1 aggravates the child's sufferings1 from the frequent and ineffectual efforts made to expel it4 ,if the inflammatory action be more severe1 exudations of lymph will also be poured out1 and intermingling with the mucus1 greatly augment the difficulty of swallowing4 ,at this time the lining membrane of the mouth1 as also the tongue1 assume a florid red colour2 the red points of the latter becoming much elongated4 ,the febrile symptoms are severe from the first2 amongst others1 there will be headach1 sometimes accompanied by slight delirium1 nausea1 intense heat of skin1 languor1 and considerable inquietude and anxiety3 and as the inflammation approaches its height1 the fever increases1 the pulse rises1 the breathing becomes oppressed1 the skin becomes more pungently hot and dry1 and the thirst urgent4 ,all these symptoms being increased towards evening1 when the febrile restlessness is often succeeded by delirium4 ,the rash is seldom perceptible before the third day1 and then comes out in irregular patches on various parts of the body1 particularly about the elbows and wrists2 thus differing as to the time and mode of its appearance1 from the mild form of the disease4 ,it frequently recedes1 or entirely vanishes1 the day after it first comes out1 and then reappears partially1 and at uncertain times4 ,this generally protracts the duration of the disorder1 without1 however1 producing any perceptible change in the other symptoms4 ,on the fifth or sixth day of the disease1 the fever and inflammation of the throat begin to abate2 at the same time the rash declines1 and the peeling off of the cuticle soon follows4 ,this is the ordinary course of scarlet fever with sore throat2 but in many cases the symptoms run still higher1 and the disease is alarmingly dangerous from its commencement4 ,in some instances1 there is an acrid discharge from the nostrils or ears1 often accompanied with deafness2 as also enlargements of the glands in the neck1 followed by the formation of abscesses in their immediate neighbourhood4 ,it is unnecessary1 however1 to follow out the symptoms of scarlet fever more fully2 as all that has been attempted here1 has been so to sketch out the more prominent symptoms of this disease1 that the directions upon the parental management may be readily comprehended3 they will be very brief1 but a strict attention thereto will be found all-important to the well-doing and comfort of the child4 ,,character ,,of ,,scarlet ,,fever ,,compared ,,with ,,that ,,of ,,measles4--,it will be seldom difficult to distinguish this disease from other acute eruptive disorders4 ,the one to which it bears the greatest resemblance is the measles2 but from this it is readily distinguished by the absence of the cough1 the inflamed and watery eye1 running at the nose and sneezing1 which are the predominant symptoms in the early stage of the measles2 but which do not usually attend on scarlet fever--at least1 in any high degree4 ,in measles1 also1 there is an absence of that restlessness1 anxiety1 and depression of spirits1 by which scarlet fever is peculiarly distinguished4--,the rash1 too1 in measles1 does not appear till two or three days later than that of scarlet fever4 ,it also differs in its characters4 ,in scarlet fever1 the eruption consists of innumerable minute dots or points1 diffused in patches with uneven edges of various sizes and forms2 and gives to those portions of the skin on which it appears1 a diffused bright red colour4 ,in measles1 the rash comes out in irregular semi-lunar or crescentic shaped patches1 distinctly elevated2 the spots being of a deeper red in the centre than in the circumference1 and leaving intervening spaces in which the skin retains its natural pale colour4 ,,maternal ,,management4--,the chief points to which the parent's attention must be directed1 irrespective of a strict attention to the more immediate medical treatment directed by the physician1 are the following3-- ,,ventilation ,,of ,,the ,,bed-,,room4--,even in the mildest cases1 the child must be kept in bed from the first accession of the fever4 ,he must not be loaded1 however1 as was formerly the practice1 with a quantity of bed-clothes1 in order to encourage the fever and increase the quantity of eruption4 ,a moderate quantity of clothing is all that is required1 adapted to the heat of skin and feelings of the patient4 ,the bed-room must be kept cool and well ventilated4 ,this is of importance in the mildest cases2 but in the more severe forms of this disease1 in which the throat is much affected1 the constant and free admission of pure air will have a most decided and marked good effect upon the symptoms4 ,the air should be renewed1 therefore1 from time to time4 ,the linen1 both of the bed and the patient1 should also be frequently changed daily1--if practicable4 ,however mild the symptoms of this disease may be at the commencement1 the child must always be carefully and vigilantly watched by the parent1 as inflammation of some internal organ may suddenly arise 7which is generally indicated by symptoms sufficiently obvious71 and thus change an apparently mild form of this disease into one of an alarming character4 ,,cold ,,sponging4--,whenever the skin is pungently hot and dry1 the whole surface of the body should be sponged with cold water1 or with vinegar and water4 ,the heat is by this means rapidly abstracted1 and the child refreshed2 and this may again and again be resorted to1 as the heat again returns4 ,by this application alone1 the pulse has been diminished in frequency1 the thirst has abated1 the tongue has become moist1 a general free per spiration has broken forth1 the skin has become soft and cool1 and the eyes have brightened2 and these indications of relief have been speedily followed by a calm and refreshing sleep4 ,in all these respects1 the condition of the patient presented a complete contrast to that which preceded the cold washing2 and his languor was exchanged for a considerable share of vigour4 ,the morbid heat1 it is true1 when thus removed1 is liable to return1 and with it the distressing symptoms2 but a repetition of the remedy is followed by the same beneficial effects as at first4,,fn#dj ,,fn#dj ,bateman's ,practical ,synopsis of ,cutaneous ,diseases4 ,,gargles ,,and ,,the ,,inhalation ,,of ,,warm ,,water4--,when the throat is affected1 gargles are sometimes ordered2 but the pain and inconvenience which their employment gives rise to1 frequently precludes their use3 and children seldom understand how to employ them1 even if the state of the throat permitted it4 ,under these circumstances1 the inhalation of the steam of hot water1 or hot vinegar and water1 may be substituted1 and with decided benefit4 ,mudge's inhaler is a good contrivance to effect this4 ,when the throat is found by the mother to be early affected1 an immediate application to the medical adviser is especially important4 ,for1 if he be called upon to treat this form of scarlet fever at its very commencement1 by judicious treatment1 the duration and violence of the disease may be both shortened and greatly mitigated4 ,,regimen4--,cooling drinks1 as plain water1 toast and water1 barley water flavoured with lemon peel1 fresh whey1 lemonade1 and thin gruel1 may all be resorted to in their turn4 ,the child may also be allowed oranges1 grapes1 or lemons sweetened with sugar1 particularly when the mouth is foul and dry2 but care must be taken that neither the pulp nor the stones are swallowed4 ,these will both refresh and feed the patient as much as is necessary until the decline of the disease4 ,the parent must strictly forbid the attendants in the sick chamber giving1 at this period1 any heating or stimulating fluid1 as also animal food2 and this injunction must be strictly regarded1 even in the mildest form of the disease4 ,when the child is convalescent1 mild nourishment will be required1 such as arrow-root1 tapioca1 chicken or mutton broth1 beef tea1 jellies1 and roasted apples2 and by and by a mutton chop4 ,wine is seldom necessary1 except under circumstances of unusual debility after a protracted illness1 when its moderate use tends much to assist the convalescence2 but1 if given unadvisedly1 there will be great hazard of exciting internal inflammatory disease4 ,relapses are sometimes caused by the child getting about too soon1 and by indulgence of the appetite1 particularly for food3 a proper degree of restraint1 therefore1 must be placed upon the child by the parent1 who cannot too strictly carry out the directions of the medical attendant upon the diet and regimen during this period4 ,great attention must still be paid to the state of the bowels1 and1 indeed1 to all the secretions and excretions4 ,,peeling ,,off ,,of ,,the ,,cuticle1 ,,and ,,falling ,,off ,,of ,,the ,,hair4--,to promote the more easy separation of the cuticle from the surface of the body1 a warm or tepid bath may be usefully employed at the close of the disease4 ,it will1 moreover1 greatly contribute to the comfort of the child1 and induce a more healthy condition of the skin4 ,occasionally the cuticle of the whole hand and fingers will peel off unbroken1 when it will resemble precisely a glove in shape4 ,as is the case in all fevers1 more or less1 so particularly after scarlet fever1 there is a great tendency to the falling off of the hair4 ,it will be always well1 therefore1 to shave the head at this time1 and exhibit daily a tepid shower bath1 as early as the strength of the child will permit4 ,,cautions1 ,,etc4--,the contagious character of this disease requires the separation of the invalid from the rest of the family2 and1 when it is practicable1 the children should be removed to a distance4 ,this measure is imperatively called for1 when the form of the disease is very severe in its character4 ,great caution must also be exercised1 after the convalescence of the patient1 that the other children are not brought into too early contact with him3 for infection may be thus produced1 though several weeks may have elapsed from the period of the peeling off of the skin4 ,the period at which the disease shows itself after the exposure of an individual to sources of contagion1 is exceedingly various4 ,one child will be seized within a few hours2 another1 not for some days2 and now and then 7though rarely71 five or six weeks have intervened between the period of exposure and the manifestation of the disease4 ,when this disease is rife in a family1 it will frequently affect the individuals composing it very differently4 ,some escape altogether2-- others have the mild form of the complaint2--others the severe2--and1 again1 the attendant in the sick room may be attacked with the sore throat and fever only1 both of which may subside without any appearance of a rash4 ,in conclusion1 this disease is a complaint of infancy and childhood1 rather than of adult age2 generally affects the same individual but once during his life2 and1 though examples of a second attack have occurred1 such a circumstance is extremely rare4 ,sect4 ,,vi4--,,measles4 ,measles consists of a fever1 in which the mucous lining of the air- passages is principally affected1 and which1 after about three days' duration1 results in an eruption of a red rash over the surface4 ,it depends upon a specific contagion2--occurs most frequently during childhood and adolescence1 though no age is exempt from it2--and affects the system but once2 a peculiarity to which an exception is very rare1 proved by the few instances of the kind which have been recorded4 ,the period at which the disease manifests itself after infection is various1--generally about the ninth day2 it has1 however1 been delayed until the sixteenth4 ,,description ,,of ,,the ,,disease4--,the child infected will be observed not to be as well as usual1 less active1 and out of spirits2 his appetite will fail1 and his sleep be restless and disturbed4 ,it will soon be evident that he has apparently taken a cold in his head1 and that this is accompanied by fever4 ,his voice will be hoarse2 there will be frequent cough1 headach1 sneezing1 running from the nose and eyes1--the eyelids being somewhat swollen1 and the eyes inflamed2--the skin will be hot and dry1 and he will complain of occasional chilliness4 ,in the course of the next two or three days1 these symptoms will increase in severity1 and perhaps be accompanied by oppression at the chest and hurried breathing1 and towards evening by slight delirium4 ,on the fourth day1 the rash will appear1 but the symptoms will be little1 if at all1 mitigated2 indeed1 they will sometimes increase in severity4 ,the eruption will first be perceived about the head and face1 in the form of small red spots1 at first distinct from each other1 but soon coalescing1 and forming patches of an irregular crescent-like or semilunar figure1 of a dull red colour1 and slightly elevated 7giving a sensation of hardness to the finger71 while portions of the skin intervening between them will retain their natural appearance4 ,at this time the eruption will also be found on the inside of the mouth and throat1 and the hoarseness will consequently increase4 ,on the fifth day1 the rash usually covers the whole surface of the body1 with the exception of the legs and feet2 and is now very vivid on the face1 which is not unfrequently so much swelled1 especially the eyelids1 that the eyes are quite closed up1 as in small-pox4 ,on the sixth day1 it is fully out on the extremities1 and is beginning to fade on the face4 ,on the eighth1 it is fading from all parts2 on the ninth1 it is hardly perceptible2 and has entirely disappeared on the tenth day from the commencement of the fever1 or the sixth from its own first appearance4 ,as the fading proceeds1 the spots drop off in the form of little branny scales1 which are sometimes1 from their minuteness1 scarcely perceptible4 ,they leave a slight discolouration on the skin1 with considerable itching4 ,such is the ordinary course of this disease2 occasionally1 however1 deviations are met with4 ,,character ,,of ,,measles ,,compared ,,with ,,scarlet ,,fever ,,and ,,small-,,pox4--,under the description given of ,scarlet ,fever1 are noticed several signs by which that disease may be distinguished from measles3 to these may be added the absence of cough1 of water flowing from the eyes1 and of redness and swelling of the eyelids as in measles4 ,again1 in measles1 the eruption is more pointed1 of a crimson instead of a scarlet hue1 and does not appear until two days later than in scarlet fever4 ,in small-pox1 the fever abates as soon as the eruption makes its appearance4 ,in scarlet fever1 this is by no means the case2 and as little so in measles3 the vomiting1 indeed1 subsides2 but the cough1 fever1 and headach grow more violent2 and the difficulty of breathing1 weakness of the eyes1 and1 indeed1 all the catarrhal symptoms1 remain without any abatement till the eruption has all but completed its course4 ,,maternal ,,management4--,measles1 in its ordinary and simple form1 is a mild1 and by no means dangerous1 disease3 it is sometimes1 however1 accompanied or immediately followed by symptoms of a very serious character1 and which1 it is to be feared1 in many instances1 owe their origin to the carelessness of the attendants in the sick chamber4 ,a mother's superintendence1 therefore1 is much required at this time to insure a careful attention to the medical directions1 as also to those general points of management upon which the well-doing of her child much depend1 of which the following are the most important3-- ,,ventilation ,,of ,,the ,,bed-,,room1 ,,etc4--,the child must be kept in bed from the onset of the attack4 ,he must have so much clothing only as will secure his comfort1 avoiding equally too much heat or exposure to cold4 ,to these points the parent's attention must be particularly directed4 ,it is the practice with some nurses1 in the belief that a breath of cool air is most pernicious1 to keep the child constantly enveloped in a smothering heap of bed-clothes1 with curtains closely drawn1 and the room well heated by fire1 by which means the fever and all its concomitant dangers are greatly augmented4 ,it is equally a popular error 7and yet by many it is still held and acted upon7 to suppose that because in small-pox exposure to cold is useful1 that therefore it must be of equal advantage in measles4 ,it cannot be too generally known that the nature of the fevers accompanying the two diseases are widely different1 and that the adoption of this error is productive of the most serious consequences2 for it would most likely produce in measles inflammation of the lungs1 which1 in truth1 is commonly the result of carelessness upon this point4 ,the bed-room should be large and airy2 free from currents of cold1 but well ventilated1 and not hot4 ,the room1 also1 must be darkened1 on account of the tenderness of the eyes2 all noise excluded1 and mental excitement or irritation carefully avoided4 ,,regimen4--,little or no food must be allowed1 and whatever is taken must be of the simplest kind1 and in a liquid form4 ,mild mucilaginous drinks1 and warm1 may be given liberally2 as barley-water1 or thin gruel1 etc4 ,,sponging1 ,,etc4--,the face1 chest1 arms1 and hands should be sponged occasionally with vinegar and warm water 7one fourth and three fourths74 ,this will be productive of great comfort to the little patient2 it removes the heat1 dryness1 and itching of the skin1 which are often very distressing2 and is especially useful at night in relieving wakefulness4 ,if the cough be troublesome1 it will be useful for the child to breathe the steam of warm water2 not through an inhaler1 but over a large basin1 with the head covered with flannel large enough to hang over its edges4 ,by this means the tender and inflamed eyes will at the same time derive advantage from the soothing effect of the vapour4 ,,cautions4--,whenever the measles is known to be prevalent in a neighbourhood1 and a child manifests symptoms of cold in the head and fever1 it should at once be a reason for carefulness on the part of the parent4 ,the diet should be light1 cooling1 and scanty2 and the child should be carefully kept in doors4 ,it has been before remarked1 that in its ordinary course measles is a disease unaccompanied with danger1 but that the mildest form may be speedily converted into the most dangerous4 ,that is to say1 a sudden change may lake place in the symptoms1 arising out of circumstances which could not have been foreseen1 and therefore unavoidable2 or may be produced by improper management on the part of the nurse1 such as the giving of stimulants1 by too much heat1 or by exposure to cold4 ,now it is for the parent early to notice any change which may occur from the first source1 and by her watchfulness to guard against the possibility of its arising from either of the second4 ,in reference to the first1 if the child should complain at any period of the disease of severe headach1 with piercing pain through the temples1 and if this is accompanied by wandering of mind1 great increase of suffusion of the eyes1 as also intolerance of light1 the immediate attention of the medical man is demanded4 ,so1 if towards the dose of the eruption1 that is1 from the seventh to the ninth day1 the breathing should again become hurried 7this symptom is very generally present during the height of the eruption1 and is not necessarily connected with disease of the lungs71 with pain and oppression felt at the chest1 the cough becoming hacking and incessant1 etc4 7all symptoms cognizable by the mother1 and indicative of inflammation of the lungs71 no time must be lost in seeking medical aid4 ,with regard to the last cause 7improper management71 it may be well1 in reference to it1 to observe1 that it sometimes happens that the rash comes out imperfectly1 or1 having appeared properly1 suddenly retrocedes and disappears2 and that under such circumstances the nurse will almost certainly1 if not well watched1 give the child a good dose of sulphur in diluted spirit1 or a glass of punch containing saffron1 which are considered specifics for bringing out the eruption4 ,nothing can be more injurious than such remedies1 for generally the disappearance of the rash will be dependent upon the existence of some internal inflammation1 or of too high a fever2 for the removal of which the medical man ought to be instantly applied to4 ,sometimes1 however1 it may be fairly traced to a careless exposure to cold3 under such circumstances the child should be instantly1 and without hesitation1 put into the warm bath4 ,measles are frequently followed by cough1 and deranged bowels2 and there is always great susceptibility about the child for some time4 ,on this account he should be carefully screened from a cold or damp atmosphere2 the diet should be carefully regulated2 and flannel worn next to the skin4 ,if the cough should continue1 it must not be neglected on the supposition that it will wear off2 for it demands the skilful and careful attention of the medical man4 ,in conclusion1 it may be remarked that very frequently during infancy and childhood1 and particularly during the period of teething1 eruptions very similar in appearance to this disease occur2 unless1 however1 they are accompanied by the specific fever1 and run the regular course1 they may at once be decided upon as not being the measles4 ,sect4 ,,vii4--,,small-,,pox4 ,this disease1 the most dreaded of all eruptive fevers1 is not so commonly met with in the present day as formerly2 thanks to that ,providence which led to the discovery of ,jenner4 ,but although its occurrence is not so frequent1 it still does occasionally present itself2 when it will assume either a mild or severe form4 ,if it attack a child that has not previously been vaccinated1 it is called natural small-pox2 and the chances are that the disorder will be severe in character2--if1 on the other hand1 it occur in the vaccinated1 the disease will generally be much modified in its symptoms2 the attack will be mild1 and without danger4 ,,natural ,,small-,,pox4--,the infection of small-pox having been received into the system of a child that has not been vaccinated1 fourteen days 7on an average7 will transpire before the commencement of the febrile symptoms1 or eruptive fever4 ,a distinct rigor or shivering fit then takes place1 accompanied by pain in the back or in the stomach1 with sickness1 giddiness1 or headach2 as also great drowsiness4 ,and if an infant be the subject of the disease1 a convulsive fit will sometimes take place1 or several in succession4 ,at the end of eight-and-forty hours from the occurrence of the rigor 7in the majority of cases71 the eruption comes out2 and shows itself first on the face and neck in minute flea-bite spots4 ,in the course of the next four-and-twenty hours in some cases1 and in others not until the expiration of two or three days1 it completely covers the body2 not being confined exclusively to the skin1 but frequently extending to the mouth and throat1 and even to the external membrane of the eye4 ,in the course of two or three days from their first appearance the little pimples1 increasing in size1 will be found to contain a thin transparent fluid1 to pit or become depressed in their centre1 and the skin in the spaces between them will be found red4 ,on the seventh or eighth day from the commencement of the fever1 the fluid contained in the pimples will be no longer transparent1 but opaque2 and they will consequently appear white1 or of a light straw colour4 ,each pimple or pock will be no longer depressed in its centre1 but will become raised and pointed1 being more fully distended by the increased quantity of fluid within2 and the skin around each pock will now be of a bright crimson4 ,the head1 face1 hands1 and wherever else the eruption shows itself1 gradually swell2 and the eyelids are often so much distended as to close the eyes and produce temporary blindness4 ,there will always at this time be some degree of fever present1 and its amount will vary with the circumstances of each individual ease4 ,the skin too will be very tender1 so much so sometimes as greatly to harass and distress the child4 ,on the eleventh day the swelling and inflam of the skin of the body and face subside2 the pimples upon these parts dry up and form scabs1 which fall off about the fourteenth or fifteenth day4 ,those on the hands1 as they come out later1 commonly continue a short time longer4 ,the eruption leaves behind1 in some cases1 the peculiar marks of the disease2 and in others merely discoloured spots1 which disappear in the progress of a short time4 ,the natural small-pox is sometimes much more severe in its character than the foregoing1 and what is called confluent small-pox is said to exist4 ,this form will be marked by great constitutional disturbance1 and the eruption coming out earlier than in the milder form2 instead of being distinct1 that is1 each pimple standing distinct and separate one from the other1 they will coalesce1 and appear flat and doughy1 not prominent3 they will more particularly run into each other on the face1 where they will form one continuous bag1 which soon becoming a sore1 will discharge copiously4 ,,small-,,pox ,,in ,,the ,,vaccinated4--,when small-pox occurs to those that have been formerly vaccinated1 the disease1 in almost every instance1 is much altered or modified in its character4 ,indeed in children1 in whom of course vaccination has been but comparatively lately performed1 small-pox when it occurs will1 in the majority of cases1 be so mild that the real nature of the disease will be with difficulty determined3 so mild1 that again and again has a parent been heard to exclaim1 ,surely these few scattered pimples cannot be the small-pox6 ,if1 however1 as the pimples progress1 they are narrowly watched1 and are seen to become depressed in their centre2 if there has been the precursory rigor1 etc42 and if the source of the disorder can be traced to some case of undoubted small-pox1 the child in fact having been exposed to contagion1 no doubt ought to exist in reference to the nature of such a case1 however slight may be the character of the disease4 ,the usual progress1 however1 of small-pox modified by vaccination is as follows4 ,the first stage is the same usually as in the natural form of the disease4 ,as soon1 however1 as the eruption appears1 the modifying power of the vaccination becomes apparent4 ,the eruption will be found to be generally both less in quantity and more limited in its extent2 or if even it should come out profusely1 and cover a large extent of the surface of the body1 still the controuling power of the vaccination will immediately show itself after its appearance1--first1 in the complete subsidence of all the febrile symptoms which will now take place2 and1 secondly1 in reference to the eruption1 part of which will die away at once1 and the remainder will by the fifth day be filled with the opaque yellowish fluid1 then dry up1 becoming hard and horny1 and falling off will leave a mottled red appearance of the skin1 and now and then slight pitting4 ,such is the usual progress of the disease3 subsequent to vaccination1 it is a mild and tractable disorder4 ,it is right1 however1 to mention that small-pox has occurred even to the vaccinated in almost as severe a form as the confluent natural small-pox1 and running its regular course unaltered or unmodified4 ,such instances1 however1 are extremely rare1 and form the exceptions to the general rule2 for no reasonable doubt can be entertained1 from the abundance of facts now before the world1 that such modification is the law of the animal economy1 and that the regular or natural progress is the exception4 ,,maternal ,,management4--,the grand principle in the treatment of small-pox is to moderate and keep under the fever2 and however the plans adopted by different medical men may vary in particular points to accomplish this purpose1 they uniformly make this principle their chief aim and object4 ,to carry out this intention1 however1 the medical adviser is greatly dependent upon the aid and assistance of a judicious parent1 and without this it is impossible to hope for a successful issue to the case4 ,a clear knowledge1 therefore1 of those points of general management in which in fact a great part of the above principle consists 7few and simple as these directions are71 it must be all-important for the mother to be acquainted with3 for the rest1 she must and ought to look to the medical man4 ,in the more rare and severe form of this disease1 viz4 the confluent small-pox1 although in some instances it runs the same course as the milder form1 the distinct or natural small-pox1 still1 usually1 the constitutional symptoms are much more aggravated1 and the medical and general treatment required will so much depend upon the character of the individual case1 that we do not think it well to notice it here4 ,,bed ,,and ,,bed-,,room4--,it will not be necessary at first for the child to be confined to his bed1 but generally about the third or fourth day he will gladly resort to it2 and if he does not1 it will be prudent to keep him there4 ,he must not1 however1 be loaded with bed-clothes1 but lightly covered2 and the bed and body linen should be changed daily1 if possible4 ,the bed-room should be capacious and well ventilated2 fresh air frequently admitted2 and if the season of the year permit1 and there is no dampness of atmosphere1 a window should be constantly open during the day3 it is also desirable to keep the chamber darkened in all cases1 as there is always a tendency to inflammation of the eyes4 ,if these directions are not regarded1 and a great heat of the apartment is permitted1 with abundance of bed-clothes heaped upon the child1 the hot bath is used1 and hot and stimulating regimen given 7upon the old and erroneous notion of bringing out the eruption71 the mildest case will inevitably be converted into one of the most severe and dangerous4 ,facts have abundantly shown that such measures invariably prove the most effectual means of exasperating the disease1 and endangering life4 ,,regimen4--,this must be most sparing4 ,cold water may be given whenever the child asks for it4 ,lemonade should form the common drink during the fever2 and gruel1 barley-water1 and roasted apples are all else that is required during this period1 and not until the disease is going off must any change be made in the diet4 ,the above period having arrived1 mildly nutritious food should be given1 as chicken or mutton broth1 beef-tea1 arrow-root1 tapioca1 or sago2 to be followed in a few days by the wing of a chicken or a mutton chop2 remembering always1 that solid animal food must at first be given cautiously and sparingly4 ,wine or stimulants must be positively forbidden2 unless1 indeed1 ordered by the medical man1 for circumstances may arise which render them advisable4 ,the state of the bowels must be carefully attended to at this time4 ,,the ,,eruption4--,in the natural and mild form of this disorder the pustules generally break from the sixth to the eighth day2 dry scabs succeed2 and in about nine or ten days the parts heal perfectly1 requiring no treatment4 ,in the more aggravated cases1 however1 in which the pustules are very numerous1 running one into the other1 and1 bursting1 discharge greatly1 the whole surface of the body should be frequently and liberally dusted over with dried flour1 or1 what is better1 starch powder4 ,the sores in this instance are always tedious in healing1 and followed by the well-known pits or marks3 these arise from a loss of substance in the true skin1 and occur more particularly on the face1 from the great vascularity of this part causing the pustules to be more numerous here than elsewhere4 ,it is a popular error to suppose that by wearing masks of fine linen or cambric illined with particular ointments1 these scars or pits may be prevented3 it is impossible to prevent them2 and any local application1 except a little cold cream or oil of almonds applied to the scabs when they harden1 will prove more injurious than useful4 ,the child's hands1 however1 should always be muffled to prevent its scratching or breaking the sores1 for otherwise he will not be kept from thus attempting to allay the excessive itching which they occasion4 ,the hair should be closely cut at an early period of the disease1 and so kept throughout its continuance4 ,this will contribute very much to the comfort of the child1 by preventing the hair becoming matted together with the discharge from the pustules when they break1 which gives rise to great pain and irritation4 ,in the confluent and worst forms of this disease1 this measure it is particularly necessary to attend to1 as also to the application of cold lotions to the head when hot and dry 7with other remedial means71 as there is always a tendency in these cases to the formation of abscesses1 the healing of which is troublesome and attended with difficulty4 ,,cautions1 ,,etc4--,it has already been stated that a free ventilation of the bed-room is necessary to the well-doing of the patient4 ,this measure1 however1 must not be confined to the chamber of the sick1 but acted upon through the whole house4 ,in conjunction with ventilation1 fumigations by means of aromatic substances kept slowly burning should be resorted to4 ,a solution of the chloride of lime too1 a most powerful disinfectant1 should be used to purify the different apartments4 ,this is best accomplished by steeping in the solution pieces of linen1 and hanging them about the rooms1 as also frequently and freely sprinkling the walls themselves2 and as soon as the invalid is removed1 the chamber should be white-washed1 the various articles of furniture well scoured with soap and water1 and the room be well and freely ventilated prior to its being again occupied4 ,the clothes of the patient and the bed linen should be frequently removed1 and when taken away immediately immersed in boiling water1 and whilst hung up in the open air sprinkled occasionally with a weak solution of the chloride of lime4 ,if these directions are not observed1 and the clothes are closely wrapped up1 they will retain and give out the disease to others at a great distance of time4 ,again3 as the contagious property of smallpox hangs about the child as long as any scabs remain 7which indeed may be said to retain the poison in its concentrated form71 a parent must be most careful that the invalid is not too early brought in contact with the healthy members of the family4 ,an observance of these precautions is imperatively demanded2 they not only protect the healthy1 but aid the infected4 ,sect4 ,,viii4--,,hooping-,,cough4 ,my chief inducement to notice the above disorder arises out of the well-known fact1 that there is no complaint of childhood more frequently subjected to quackery and mismanagement than is this4 ,indeed1 there are few maladies against which a greater array and variety of means have been recommended1 than against hooping-cough4 ,i suppose from the circumstance of the simple and mild form of the complaint being so tractable 7provided it remain such7 that the simplest and mildest measures effect its cure1 parents are tempted to undertake its management in the more severe and complicated forms2 and the result is but too often the establishment of disease dangerous to life1 and sometimes fatal to it4 ,but although most imprudent for a parent to assume the office of the physician1 her aid is essentially necessary in carrying out the measures prescribed4 ,by her watchfulness and care the duration of the disease may not only be abridged1 but1 what is of much greater importance1 a more serious and aggravated form of disease prevented2 for although hooping-cough in itself is not a dangerous disorder1 still the most simple and slight case1 if neglected or mismanaged1 may quickly be converted into one both complicated and dangerous4 ,,description ,,of ,,the ,,disease4--,hooping-cough commences with the symptoms of a common cold1 which is more or less frequent4 ,these symptoms continue from five days to fifteen2 at the end of which time the cough changes its character1 and assumes the convulsive form1 which distinguishes the disorder4 ,it occurs in paroxysms1 varying with the severity of the disease from five to six in the twenty-four hours to one every ten or fifteen minutes2 being generally more severe and frequent during the night than in the day4 ,during a paroxysm the expirations are made with such violence1 and repeated in such quick succession1 that the child cannot breathe1 and seems in danger of suffocation4 ,the face and neck become swollen and purple from suffusion2 and the eyes prominent1 injected1 arid full of tears4 ,the little one1 with a forewarning of the attack1 which it dreads1 falls on his knees1 or clings closely to any thing near him4 ,the paroxysm terminates with one or two long inspirations1 attended with that peculiar noise1 or whoop1 from which the disease has derived its designation4 ,sometimes the fit of coughing is interrupted for a minute or two1 so that a little rest is obtained2 and is then succeeded by another fit of coughing and another hoop1 until after a succession of these actions the paroxysm terminates by vomiting1 or a discharge of mucus from the lungs1 or both4 ,the disease having continued at its height for two or three weeks1 it begins naturally to decline2 the paroxysms become less frequent and violent2 the expectoration increases2 the cough loses its characteristic hoop1 and gradually wears away altogether2 until at length1 in two or three months from the first onset of the disease1 the child is restored to perfect health4 ,sometimes1 however1 particularly in the autumn1 and at other seasons on the occurrence of easterly winds1 the paroxysms of cough will return1--it will assume its spasmodic character1 and be accompanied with the whoop1 after a month1 or even two or three months1 of perfect and apparent recovery4 ,errors in diet will sometimes alone have a similar effect4 ,it is a disease which usually occurs during childhood1 rarely affects the same individual twice1 and is seldom seen in the very young infant4 ,in reference to the probable result of the disease1 when it occurs in its mild and simple form in a healthy child1 the termination is usually favourable2 but it may at first assume this form1 and afterwards become complicated1 and consequently more or less dangerous1 owing to injudicious management1 or to various influences over which the mother has no control4 ,it generally appears as an epidemic1 and at those seasons when catarrhal complaints are most prevalent1 and affects many or several at the same time4 ,isolated cases1 however1 frequently occur1 which seem to prove the disease to be infectious4 ,some persons deny that it is so4 ,mothers and nurses1 however1 who have not had the disease1 will often contract it from the child under such circumstances1 and thus it will be quickly propagated through the family4 ,the nursing mother will occasionally take it from the infant at her breast4 ,the child who has caught it from others whilst at school1 and brought home in consequence1 will communicate it readily to his brothers and sisters1 although the disease did not exist previously in the family or neighbourhood1 and was brought from a distant part of the country4 ,all these instances are surely proofs of its infectious character1 and point out the necessity of caution whenever hooping-cough may present itself in a family1 and the necessity which exists for an early removal of the unaffected children from the sphere of its contagious influence4 ,the infectious property diminishes as the disease declines4 ,,maternal ,,management4--,in the mild and simple form of this disease the medical treatment is one rather of prevention than cure1 and the maternal management consists in assisting1 by watchfulness and care1 the fulfilment of this design4 ,in these slighter cases little more is required of the mother during the ,jirst stage of the disorder 7that is1 before the cough becomes spasmodic7 than attention to diet1 regimen1 and the excretions4 ,the diet should be farinaceous1 with milk1 or as may be otherwise directed4 ,the child must be confined to a mild equable temperature2 in fact1 to his apartment4 ,it is a popular error to suppose that at this time change of air is beneficial to the disease3 at a later period it certainly is so1 but now injurious1 and attended with great risk4 ,should the weather be cold1 the little patient must be warmly clad1 and flannel worn next the skin2 this latter precaution should always be taken in the winter1 spring1 and autumn4 ,purgatives and other medicines will be required1 and ordered by the medical attendant2 the chief attention1 however1 of the parent must be directed to any change she may observe in the symptoms1 breathing1 etc42 she must be all on the alert to notice the first signs of local inflammation4 ,of this1 however1 we shall speak presently4 ,during the early part of the second stage1 that is1 when the cough becomes spasmodic1 assuming its peculiar sound1 the same diet and regimen must be continued1 and the same watchfulness observed1 lest any inflammatory symptoms manifest themselves4 ,under the foregoing treatment the disease generally runs its course without any untoward event1 and the child recovers perfectly4 ,sometimes1 however1 although the patient is quite well1 and the disease on the decline1 the cough still continues4 ,in these cases1 and at this time1 it is that change of air often proves so very serviceable4 ,the sea-side is preferable1 if the season of the year permit2 and salt- water bathing1 commencing with the warm or tepid bath1 and passing gradually to the cold-bath 7if no complication forbid it71 will also prove certainly and rapidly remedial4 ,crying1 mental irritation1 or opposition1 frequently bring on a fit2 and even the sight of another in a paroxysm will induce it in those affected by the disease4 ,running or other active exercise will generally cause the fits to be more severe4 ,young children1 too1 must be carefully watched at night1 and be raised up by the nurse as soon as the fit is threatened4 ,these hints the mother should bear in mind4 ,so much for the simple form of the disease1 and that in which it most frequently and commonly presents itself to our notice3 a mild disease2 and1 if carefully managed and watched over1 certainly not a dangerous one4 ,of what1 then1 is a parent to be afraid1 or against what is she to guard8 ,lest other disease insidiously come on1 and advance to an irremediable degree1 masked by the cough1 without attracting her attention4 ,this is the great source of danger in hooping-cough4 ,the physician1 in a case of simple hooping-cough1 is not in daily attendance upon his patient1 and therefore not present to notice the commencement or first symptoms of those diseases which so frequently occur at this time1 and the successful treatment of which will mainly depend upon their early detection1 and the decision with which they are treated4 ,when you hear of a child or several children in a family dying of hooping-cough1 it is not this disease which proves fatal2 but death is caused by some disease of lungs or brain1 which has been super-added to the hooping-cough4 ,the progress of hooping-cough1 then1 must be closely attended to by the parent1 even in the most favourable cases4 ,the most frequent complication with hooping-cough is inflammation of the air-tubes of the lungs4 ,this is extremely frequent during spring and winter1 especially in the months of ,february1 ,march1 and ,april1 owing to the prevalence of easterly winds at this season4 ,it is not my intention to detail the symptoms of this affection1 only to point out those which will enable a parent to recognise its approach4 ,a parent then may take warning1 and fear the approach of mischief1 when she observes the fits of coughing become more frequent and more distressing to the child1 and the breathing hurried in the intervals of the paroxysm2 when any exertion or speaking causes increased difficulty of breathing or panting2 when the expectoration becomes less abundant1 and difficult to get up2 when there is no longer1 or at all events less frequent1 vomiting after the cough1 and more or less febrile symptoms present4 ,if the lungs themselves are attacked by inflammation1 most of the symptoms already pointed out will occur2 the cough will be frequent1 in short paroxysms2 the vomiting will not take place2 the breathing will be very quick and hurried2 and as the disease advances the hoop will cease4 ,if hooping-cough attack a child whilst teething1 or from six months to two or three years of age1 it is very common for the brain to suffer1 and convulsions and water on the head to occur1 particularly if the latter disease prevails in the family4 ,whenever the paroxysm of cough is increased in violence1 the characteristic hoop disappearing1 and the face becomes very livid2 the hands clenched1 and the thumbs drawn into the palms2 the head hot1 and marked fits of drowsiness and languor2 and the child1 during sleep1 screaming out1 or grinding its teeth1-- something wrong about the head ought to be anticipated4 ,of the treatment we have here nothing to say1 except that the gums must be carefully examined1 and scarified if they require it1 and the temperature of the head reduced by cold sponging1 or the application of a bag of ice when necessary4 ,the chief duty1 however1 of the parent is to be alive to these symptoms1 and early to detect the incipient mischief1 that by a prompt application of efficient means the accession of so formidable a malady may be prevented4 ,to specific remedies for this disease it is scarcely necessary to allude1 after what has been advanced1 except by way of warning4 ,in the simple form of the complaint such medicines are superfluous1 or rather some of them1 from their violent properties1 most dangerous2 in the complicated forms of the disease they are inadmissible4 ,the indiscriminate use of purgatives1 also1 a parent should avoid4 ,bowel affections are not an infrequent attendant upon hooping-cough1 and always aggravate the primary disorder4 ,of external applications all that need be said is this1 that if they are not violently stimulating they do no harm2 if1 however1 they contain tartar emetic1 in addition to their doing no good to the disease1 they cause unnecessary suffering to the patient1 and are sometimes productive of dangerous and even fatal sores4 ,sect4 ,,ix4--,,croup4 ,this disease is one of the most formidable of childhood2 sudden 7generally7 in its attacks1 most active in its progress1 and if not met by a prompt and decided treatment1 fatal in its termination4 ,hence the paramount importance of parents being acquainted with the signs which indicate its approach1 that medical aid may be secured at the very onset of the disease4 ,upon this early application of suitable remedies every thing depends4 ,,signs ,,of ,,its ,,approach4--,croup may appear in one of two ways3 either preceded for two or three days by the symptoms of a common cold1 accompanied with hoarseness and a rough cough2 or it may attack with the most alarming suddenness1 during the night for instance1 although the child had been merry and well the previous evening4 ,hoarseness1 however1 is the premonitory and important symptom of croup2 for although it is not every hoarseness that is followed by this formidable malady1 still this symptom rarely attends a common cold in young children1 and therefore always deserves when present the serious attention of the mother1 particularly if accompanied by a rough cough4 ,the symptoms or signs of the approach of this disease have been ably and graphically depicted by the late ,dr4 ,cheyne1 ,in the approach of an attack of croup1 which almost always takes place in the evening1 probably of a day during which the child has been exposed to the weather1 and often after catarrhal symptoms have existed for several days1 he may be observed to be excited2 in variable spirits2 more ready than usual to laugh or to cry2 a little flushed2 occasionally coughing1 the sound of the cough being rough1 like that which attends the catarrhal stage of the measles4 ,more generally1 however1 the patient has been for some time in bed and asleep before the nature of the disease with which he is threatened is apparent2 then1 perhaps without awaking1 he gives a very unusual cough1 well known to any one who has witnessed an attack of the croup3 it rings as if the child had coughed through a brazen trumpet2 it is truly a tussis clangosa2 it penetrates the walls and floors of the apartment1 and startles the experienced mother--',oh1 ,i am afraid our child is taking the croup6' ,she runs to the nursery1 finds her child sleeping softly1 and hopes she may be mistaken4 ,but remaining to tend him1 before long the ringing cough1 a single cough1 is repeated again and again4 ,the patient is roused1 and then a new symptom is remarked3 the sound of his voice is changed2 puling1 and as if the throat were swelled1 it corresponds with the cough2 the cough is succeeded by a sonorous inspiration1 not unlike the kink in hooping-cough--a crowing noise1 not so shrill1 but similar to the sound emitted by a chicken in the pip 7which in some parts of ,scotland is called the roup1 hence probably the word croup72 the breathing1 hitherto inaudible and natural1 now becomes audible1 and a little slower than common1 as if the breath were forced through a narrow tube2 and this is more remarkable as the disease advances1 etc4 etc4 ,it is unnecessary for me to add to the foregoing picture4 ,,maternal ,,management4--,having early obtained medical assistance attend with the strictest obedience to the directions given4 ,and in this disease1 more than any other1 it is particularly important that the mother should give her personal superintendence2 for the activity of the progress of the disease leaves no time to retrieve errors or atone for neglect4 ,the practitioner may be prompt and decided in the measures he prescribes1 but they will avail little1 unless they are as promptly and decidedly acted upon4 ,the parent will have her reward2 for1 if timely aid has been afforded1 and adequate means used1 the event will be almost invariably favourable4 ,,its ,,prevention4--,croup1 when it has once attacked a child1 is very liable to recur at any period before the thirteenth or fourteenth year of age4 ,it may even do so several times1 and after intervals of various duration4 ,it is very desirable1 therefore1 that a parent should be acquainted with the means of prevention4 ,they consist simply in the following measures3--,the careful protection of the child from cold or damp weather1 particularly the north-east winds of spring following heavy rains4 ,croup is most prevalent in those seasons which are cold and moist1 or when the alternations of temperature are sudden and remarkable4 ,if the residence of the child is favourable to the production of croup1 7for instance1 near a large body of water1 or in low damp spots17 he should1 if possible1 be removed to a healthier situation4 ,sponging or the shower-bath1 with cold water and bay-salt1 with considerable friction in drying the body1 should be commenced in summer1 and employed every morning upon the child's rising from bed4 ,the clothing should be warm in the winter and spring1 the neck always covered1 and flannel worn next the skin throughout the year2 but hot rooms1 and much clothing when in bed1 must be avoided4 ,the diet must be light and nourishing2 no beer or stimulant given2 and the state of the bowels must be carefully watched4 ,the above precautions are of course particularly necessary to enforce immediately after a recovery from an attack1 for there is a great tendency to relapse4 ,if the attack takes place during the winter or spring months1 the invalid must be kept1 until milder weather1 in the house1 and in a room of an equable and moderately warm temperature4 ,if in the summer1 change of air1 as soon as it can be safely effected1 will be found very useful4 ,sect4 ,x4--,,water ,,in ,,the ,,head4 ,water in the head is a formidable disease1 and not unfrequent in its occurrence4 ,it is often destructive to life1 and the instances are numerous in which it has appeared again and again in the same family1 carrying off one child after another1 as they have successively arrived at the same age4 ,but notwithstanding its frequency and fearful character1 a mother may do much to overcome a constitutional predisposition to this disease1 and thus prevent its appearance2 as also she may assist greatly in promoting its cure1 when it does occur4 ,hence it is most important that a mother should be acquainted with the measures of prevention2 and also1 when it does manifest itself1 that clear and accurate information should be possessed1 upon what may be said to constitute the maternal management of the disorder4 ,,its ,,prevention4--,whenever there is found to exist in a family a predisposition to this malady1 one or more children having suffered from it1 a mother must make up her mind1 and in the strictest sense of the word1 to be the guardian of the health of any child she may subsequently give birth to4 ,and not only during the period of infancy1 but during that of childhood also1 must she continue the same careful and vigilant superintendence4 ,the infant must be brought up on the breast1 and if the mother is not of a decidedly healthy and robust constitution1 she must obtain a wet-nurse possessing such qualifications4 ,the breast-milk1 and nothing beside1 must form the nutriment of the child for at least nine months2 and if the infant is delicate or strumous1 it will be prudent to continue it even six months longer4 ,when the period arrives for the substitution of artificial food1 it must be carefully selected2 it must be appropriate to the advancing age of the child2 nutritious and unirritating4 ,good air and daily exercise1 and the bath or sponging1 are of much importance2 in short1 all those general measures which have a tendency to promote and maintain the tone and general health of the system1 and thus induce a vigorous and healthy constitution1 and to which reference has been so fully made in the first chapter of this work1 must be strictly regarded and followed out by the parent4 ,the condition of the digestive organs must be the mother's especial care4 ,costiveness must be guarded against2 and if at any time the secretions from the bowels indicate the presence of derangement1 the medical attendant must be applied to1 that appropriate remedies may without delay be exhibited4 ,their disordered condition is frequently productive of head-disease4 ,again and again have ,i clearly traced the origin of the complaint1 of which ,i am now writing1 as more immediately resulting from disorder of the digestive apparatus4 ,to a child thus predisposed to water in the head1 the healthy state of these organs is not only of first consequence1 but any deviation from health to be dreaded1 to be immediately attended to1 and guarded against in future2 and1 as there is a great liability to these attacks at the time of weaning1 the above remarks especially apply to that period1 when due attention must be particularly paid to the plan of diet adopted4 ,during teething the mother must be especially watchful1 for it is at this time that the disease so commonly appears2 the irritation produced by this process being a frequent exciting cause4 ,every thing1 therefore1 that will tend to allay excitement of the system1 must be strictly enforced1 as well as all causes avoided1 which would produce derangement of the stomach and bowels4 ,the head should be kept cool4 ,for this purpose it must be sponged night and morning throughout the whole period of teething2 a horse-hair pillow used in the cot2 and nothing but a light straw hat should be worn1 except in winter1 ,the diet should be moderate1 and carefully regulated after leaving the breast1 and the child should be as much as possible in the open air4 ,the mouth must be occasionally examined1 and if the gums become hot or distended1 they must be scarified or lanced1 as may be advised4 ,if the parent finds at any time an unusual heat about the head1 the medical man must be at once consulted2 or if there is watchfulness or indisposition to sleep at the proper periods1 or frequent startings in the sleep1 irritability of temper1 and much crying1 danger should be apprehended1 and prompt and judicious means employed4 ,eruptions about the head1 or sores behind the ears1 discharging more or less1 will sometimes make their appearance just before the cutting of a tooth1 and disappear after it is cut2 or it will sometimes happen that1 if not interfered with1 they will continue throughout the whole period of dentition4 ,great caution should always be exercised in reference to these eruptions in all children2 and when there is a predisposition to water in the head1 it is dangerous to interfere with them at all1 except they run to such an extent as to become very troublesome4 ,the sudden healing of these cutaneous affections has again and again been followed by head-disease4 ,they are unsightly in the eyes of a parent1 but it must be recollected that they render the situation of such children much more safe2 and when teething is completed they will generally disappear spontaneously2 or1 if they should not1 they will readily do so by proper medical treatment4 ,i have no doubt that many a child's life has been saved by the appearance and continuance of these eruptions2 and so sensible are medical men of the benefit derived from them1 that in individuals in whom they do not appear1 and in whose family there exists a predisposition to the disease now under our consideration1 an issue or seton1 in the arm or neck1 has sometimes been made1 and had a remarkable influence in warding off this affection4 ,dr4 ,cheyne refers to the circumstance of ten children in one family having died of this disease2 the eleventh1 for whom this measure was employed1 having been preserved4 ,stimulants1 throughout the whole period of infancy and childhood1 and of every description1 must be prohibited4 ,children nursed by drunken parents1 and who have indulged in the use of spirituous liquors during suckling1 are never healthy2 are the frequent subjects of convulsions1 and many of them die eventually of water in the head4 ,the practice of administering spirits to the child itself2 a habit unfortunately not very uncommon among the lower classes2 produces a similar result4 ,narcotics may operate in a like manner3 they derange the whole system when persevered in1 particularly affecting the brain2 promote disease2 and sometimes give rise to the one in question4 ,this remark should be borne in mind by the mother1 as ,godfrey's ,cordial and other preparations of opium are too often kept in the nursery1 and secretly given by unprincipled nurses to quiet a restless and sick child4 ,all causes of mental excitement should be carefully avoided1 and particularly the too early or excessive exercise of the intellectual faculties4 ,if the child be endowed with a precocious intellect1 the parent must restrain rather than encourage its exercise4 ,nothing is more likely to light up this disease in a constitution predisposed to it1 than a premature exertion of the brain itself4 ,,maternal ,,management ,,of ,,the ,,disease4--,the early detection of this disease is of great importance4 ,the chances that the medical treatment will terminate successfully much depend upon the early and prompt application of remedial means4 ,the reason why these cases have so often terminated fatally has arisen from the physician being consulted when irremediable mischief had already taken place4 ,it would be difficult1 however1 to point out the signs of its approach in all its forms 7for this disease does not always commence in the same way1 sometimes with fever1 etc471 still it most frequently occurs preceded by certain striking and well-marked symptoms2 and whenever the following are noticed by the parent apprehensive of mischief1 she should at once send for her medical adviser3--watchfulness1 or starting from sleep with a cry of alarm2 prolonged screaming without any obvious cause2 moaning and drowsiness2 rolling the head from side to side on the nurse's arm1 or thrusting it back against the pillow2 knitting the brows and aversion from light1 with heat of head1 and constant carrying the little hand up to it2 half closing the eyelids1 and frequent vomiting4 ,the chief and principal point in the maternal management 7for it includes every other7 is promptly and faithfully to administer the remedies prescribed by the medical attendant4 ,a vigilant maternal superintendence is more necessary in this than almost any other disease2 and it is highly desirable1 therefore1 that the mother should have a day and night nurse--individuals upon whom she can depend4 ,a careful notice of symptoms and changes in the patient1 in the intervals of the medical man's visits1 and a true and faithful report to him upon his return1 are of essential importance4 ,a sleepy nurse will neglect the application of the most important remedies1 and necessarily give an unfaithful report of symptoms2 hours the most valuable to the child's well-doing are thus lost1 and the chances of saving its life worse than problematical4 ,the temperature of the room should be kept rather cool than warm1 and the bed-clothes only sufficient to preserve the natural heat of the body4 ,strong light must be excluded4 ,great quiet should be observed4 ,freedom from all excitement of the senses1 and irritation of the temper1 should be carefully avoided3 this is particularly necessary where the child is naturally of a quick and sensitive disposition4 ,all the excretions must be put aside for the inspection of the physician1 but not kept in the sick chamber1 which must be well aired1 and perfectly free from closeness4 ,the regimen must be only such as is ordered1 and any departure therefrom will be attended with mischievous consequences4 ,during the early periods of the disease1 all that is required are cooling diluents1 given frequently1 and in small quantities at a time2 and upon approaching convalescence great carefulness must be paid to the amount of nourishment allowed1 lest the disease be rekindled3 strict compliance1 therefore1 to medical directions must be given4 ,a very useful and indeed powerful remedy prescribed in this disease1 is sometimes rendered utterly useless from a want of a persevering and also proper mode of applying it1 viz4 cold applications to the head4 ,it is to be effected either by means of cloths kept constantly wet with cold water1 or evaporating lotions2 or by means of a bladder containing pounded ice mixed with water4 ,if the two former are employed they require frequent renewal1 or they become dry1 hot1 and more injurious than useful2 and whichever is used1 it must be kept in constant contact with the forehead1 temples1 and upper part of the head4 ,here is another error2 they are seldom used large enough1 and only partially cover these parts4 ,with the further view of keeping the head cool1 and preventing the accumulation of heat1 a flat horse-hair pillow should be employed1 and the head and shoulders somewhat raised4 ,perseverance in the measures prescribed1 even when the case appears beyond all hope1 must ever be the rule of conduct4 ,recovery1 even in the most advanced periods of the disease1 in cases apparently desperate1 occasionally takes place4 ,there is great reason to fear that many a child has been lost from a want of proper energy and perseverance on the part of the attendants in the sick room4 ,they fancy the case is hopeless1 and1 to use their own expression1 they will not torment the child with medicine or remedies any longer4 ,whilst there is life1 there is hope1 is a sentiment which may with great truth be applied to all the diseases of infancy and childhood4 ,striking1 indeed1 are the recoveries which occasionally present themselves to the notice of medical men2 and those individuals may with great justice be charged with unpardonable neglect who do not persevere in the employment of the remedies prescribed1 even up to the last hours of the child's existence4 ,,index4 ,ablution1 or sponging1 #abe4 ,abstinence1 its good effect1 in flatulence and griping in the infant1 #ej4 #bbf4 ,accidents and diseases which may occur to the infant at birth or soon after1 #ahg4 ,acids1 injurious to the teeth1 #aei4 ,air and exercise1 in infancy1 #hc4 --1 in childhood1 #hi4 --1 its importance to the mother whilst a nurse1 #cc4 ,animal food1 in childhood1 #ee4 --1 its injurious effects upon the young and delicate child1 #eh4 ,aperient liniment1 #ajg4 --1 medicine1 #ig4 --1 poultice1 #ajd4 ,artificial feeding2 the causes rendering it necessary1 #cd4 ,artificial food2 the proper kind for the child before the sixth month1 #ce4 --2 the mode of administering it1 #ci4 --2 the quantity to be given at each meal1 #db4 --2 the frequency of giving it1 #dc4 --2 the posture of the child when fed1 #dc4 --2 the proper kind for the child after the sixth month1 to the completion of first dentition1 #dd4 --2 the kind most suitable under the different complaints to which infants are liable1 #dh4 ,bath1 the cold-water1 plunge-bath1 #aah4 --1 the shower1 #abc4 --1 the warm1 #abh4 --1 rules for the use of the warm bath1 #aca4 ,bathing1 sea1 #abj4 --1 and cleanliness1 during infancy1 #gb4 --1 during childhood1 #ge4 ,bleeding1 from leech-bites1 how controlled1 #aac4 --1 from the navel string1 #bja4 --1 navel1 #bjc4 ,blisters1 mode of application1 #aad4 ,bottle1 nursing1 #dj4 ,bowels1 disorder of1 in the infant1 #bjh4 ,breasts of the infant1 swelling of1 #aie4 ,breathing1 how affected by disease1 #age4 ,calomel1 danger in its use1 #afg4 --1 injurious to the teeth1 #afj4 ,carminative1 ,dalby's1 #aaa4 ,carriage1 a good carriage2 how best obtained1 #ie4 --2 the sad results of the mode frequently adopted1 #ia4 ,castor oil1 #ii4 ,choice of a wet-nurse1 rules for1 #bh4 ,cleanliness and bathing1 #gb4 ,clothing1 in infancy1 #gh4 --1 in childhood1 #ha4 ,clysters1 what kind best for children1 #aje4 --1 mode of application1 #ajf4 ,cold1 infants very susceptible of1 #gh4 ,convulsions1 #aab1 #afg4 ,cork-nipple teat1 #da4 ,costiveness1 in infancy1 #ej4 #bbi4 --1 in childhood1 #bca4 ,cough1 as a sign of disease1 #age4 ,countenance1 in health1 #afe4 ,countenance1 in disease1 #afe4 ,croup1 #agf4 #bhf4 ,dalby's ,carminative1 #aaa4 ,damp1 induces disease in the infant1 #he4 ,dentition1 easy1 #acf4 --1 difficult1 #aci4 ,diarrhoea1 in the infant1 #ej4 #bbg4 ,dietetics of infancy1 #b4 --1 of childhood1 #ed4 --1 general directions upon1 and of animal food1 #ee4 --1 sugar1 #fj4 --1 salt1 #fa4 --1 fruits1 #fb4 --1 water1 #fc4 --1 wine1 beer1 spirits1 #fc4 ,diet1 under the different complaints to which infants are liable1 #dh4 --1 and regimen of a wet-nurse1 #ca4 ,digestion1 in the infant2 time requisite for its performance1 #db4 ,discharge1 from the eyes of the infant1 #aif4 ,disease1 the importance of its early detection1 and hints upon1 #afb4 ,dress1 in infancy1 #gh4 --1 in childhood1 #ha4 ,enema4 ,see ,clysters4 ,eruptions on the skin in infancy2 how best prevented1 #gd4 --1 about the head1 and sores behind the ears1 #bie4 --1 during teething1 #adg4 ,exercise and air1 in infancy1 #he4 --1 in childhood1 #hi4 --1 horse-exercise2 its importance to delicate children1 #hi4 ,eyes1 of the infant1 discharge from1 after birth1 #aif4 ,fever1 scarlet1 #bci4 ,flannel clothing1 #hj4 ,flatulence and griping in the infant1 #ej4 #bjh4 #bbf4 ,food1 for infants4 ,see ,artificial ,feeding4 --1 for children4 ,see ,dietetics of ,childhood4 --1 and regimen1 for nurses1 #ca4 ,fruits1 #fb4 ,gestures1 of the infant1 in health and disease1 #afi4 ,godfrey's cordial1 #aaa4 ,grief1 its effects upon the mother's milk1 #cd4 ,gums1 of the infant in difficult dentition1 the importance of their being lanced1 #adj4 ,hare-lip1 how the infant may be nourished with this defect1 #aii4 ,head1 of the infant1 swellings upon1 when born1 #aic4 ,hereditary transmission of scrofula and consumption2 the best antidote to1 #bj4 ,hooping-cough1 #bge4 ,horse-exercise1 its importance to delicate children1 #hi4 ,hunter's1 ,dr41 experiments on the effects of wine upon children1 #fd4 ,jaundice1 in the infant after birth1 #bjd4 ,ice1 how to be applied to the head1 #abg4 ,indigestion1 in the infant1 #bjh4 ,infant1 food for4 ,see ,artificial ,feeding4 --2 when still-born1 how to be managed1 #ahg4 --2 of injuries received during its birth1 #aic4 --2 retention of its urine after its birth1 #aid4 --2 swelling of the breasts after birth1 #aie4 --2 discharge from the eyes1 #aif4 --2 hare-lip1 #aii4 --2 bleeding from the navel string1 #bja4 --2 ulceration1 or imperfect healing of the navel1 #bjb4 ,infant2 bleeding from the navel1 #bjc4 --1 jaundice in1 #bjd4 --1 tongue-tied1 #bje4 --1 moles and marks on the skin1 #bjf4 ,inflation of the lungs of the infant1 the mode1 #aij4 ,lavement1 the proper kind for infants and children1 #aje4 ,leech-bites2 the mode of controlling the bleeding of1 #aac ,liniment1 aperient1 #ajg4 ,looseness1 #bjh4 ,lungs of the infant1 inflation of1 #aij4 ,magnesia1 #ajb4 ,manna1 #aja4 ,maternal nursing1 #c4 --1 management of the diseases of children1 #ahd4 ,measles1 #beh4 --1 how distinguished from scarlet fever and small-pox1 #bee4 ,medicine1 aperient1 #ig4 ,mercury1 #ajg4 ,milk1 the mother's2 how to be preserved healthy during suckling1 #c4 --2 deficiency of1 #aa4 --2 drying up of1 #ed4 --1 cow's2 for infant's food1 #ce4 --1 ass's2 for infant's food1 #cg4 --1 all kinds of1 sometimes disagrees with the infant1 #ci4 ,mind1 anxiety of2 effects upon the parent's milk1 #bd4 ,moles and marks on the skin1 #bjf4 ,mothers1 their duty in relation to suckling1 #c4 --2 those who ought never to suckle their children1 #bj4 #bd4 #bf4 ,motions of the infant2 what the appearance of1 and how frequent1 in health1 #ii4 #agb4 --2 their deranged condition1 a sign of disease1 #agc4 ,napkins1 the infant's1 #gd4 ,navel1 bleeding from1 #bjc4 --1 ulceration or imperfect healing of1 #bjb4 ,navel-string1 bleeding from1 #bja4 ,naevi1 or moles1 #bjf4 ,nurses1 wet1 rules for the choice of1 #bh4 --1 diet and management of1 #ca4 ,nursery medicines1 #ig4 ,nursing1 maternal1 #c4 --2 the plan to be adopted for the first six months1 #g4 --2 the plan to be followed after the sixth month to the time of weaning1 #i4 --2 the injurious effects to the mother of undue and protracted suckling1 #ae4 --2 the injurious effects of undue and protracted suckling to the infant1 #ah4 ,opiates1 #aaj4 #big4 --1 in teething1 dangerous1 #ade4 ,passion1 its effect upon the breast-milk1 #cc4 ,porter1 of its use1 by the mother during suckling1 #a --1 when mischievous1 #d4 ,poultice1 bread-and-water1 how made1 #aaf4 --1 mustard1 how made and applied1 #aae4 ,purgative medicine1 #ig4 ,retention of urine in the infant1 #aid4 ,rhubarb1 #ajc4 ,rules for nursing1 #c4 --1 for the use of the warm bath1 #aha4 ,salt1 as a condiment1 #fa4 ,scarlet fever1 #bci4 --1 how distinguished from measles1 #bde4 ,scrofulous constitution1 #ahj4 ,sea-bathing1 #abj4 ,seasons 7the71 their influence in producing particular forms of disorder1 #agh4 ,shower-bath1 #abc4 ,signs of health in the infant1 what1 #afh4 --1 of disease in the infant1 what1 #afi4 ,skin of the infant1 importance of its perfect cleanliness1 #gb4 --1 friction and sponging of1 beneficial1 #gc4 ,sleep1 during infancy1 #ff4 --1 childhood1 #fi4 --1 how affected when the child is ill1 #aga4 ,small-pox1 #bfb4 ,spirituous liquors1 their pernicious effects to children1 #fc4 #bif4 ,sponging1 #abe4 ,spoon-feeding1 #ci4 ,still-born1 #ahg4 ,stomach and bowels1 their derangement1 a fruitful source of disease1 #bjh4 --1 disorders of1 in the infant at the breast1 #baj4 --1 disorders of1 at the period of weaning1 #bag4 --1 disorders of1 in the infant brought up by hand1 #bba4 --1 their treatment1 #bbb4 ,stools of the infant1 what the appearance of1 and how frequent1 in health1 #ii4 #agb4 --1 their deranged condition1 a sign of disease1 #agc4 ,suckling1 plan of1 #c4 --1 by a wet-nurse1 #bg4 ,sugar1 #fj4 ,swelling of the breasts in the infant1 #aie4 ,teat of the cow--the artificial--the cork1 #da4 ,teeth1 of the permanent or adult teeth1 #adh4 --1 the manner in which they appear1 #adh4 --1 their value and importance1 #aeb4 --1 their management and preservation1 #aed4 ,teething1 easy2 management of the child1 #acf4 --1 difficult2 hints upon1 #aci4 ,tight-lacing1 evils of1 #ib4 ,tongue-tied1 #bje4 ,ulceration or imperfect healing of the navel1 #bja4 ,urine1 retention of it in the infant after birth1 #aid4 ,ventilation of the sleeping-rooms of children1 #hd4 --1 its importance in sickness1 #bdf4 ,walking1 the best mode of teaching a child1 #hg4 ,warm bath1 #abh4 --1 rules for the use of1 #aca4 --1 directions for the use of1 when the infant is stillborn1 #aib4 ,water1 as a beverage for children1 #fc4 --1 in the head1 #bia4 ,weaning1 the time when to take place1 #ea4 --1 the mode of effecting it1 #eb4 --2 drying up the mother's milk1 #ec4 ,wet-nurse suckling1 #bg4 --1 rules for the choice of1 #bh4 --1 diet and management of1 #ca4 ,wine1 its pernicious effects in childhood1 #fc4 ,worms1 #bcd4 ,,the ,,end4 ,also by ,dr4 ,bull1 ,,hints ,,to ,,mothers ,,for ,,the ,,management ,,of ,,their ,,health4 ,second ,edit1 greatly enlarged1 foolscap #hvo4 #gs4 cloth lettered4 ,opinions of the ,press4 ,a very valuable compendium for all who expect to become mothers4--,in the short preface prefixed to this little work1 ,dr4 ,bull judiciously remarks1 that feelings of delicacy often prevent many young married females from making to their medical attendant1 a full disclosure of the circumstances connected with their state1 and which render medical assistance necessary4 ,the object of the work is to meet this difficulty1 by furnishing a species of information for which married women are often very unwilling to ask1 although they readily search for it in books4 ,the matter of ,dr4 ,bull's treatise is arranged completely in a popular form--in one that is best calculated to be understood by the fair readers to whom it is addressed2 and contains a variety of useful information1 so clearly conveyed as to render it a very valuable compendium for all women who expect to become mothers4--,lancet4 ,a valuable monitor to the fair sex4 ,it contains so much useful advice for every woman likely to become a mother1 that married men would do well to provide it for their partners4--,spectator4 ,this little volume is the benevolent contribution of good sense and professional skill1 to the well-being of those who have the strongest claims on our sympathy4 ,unfortunately a vast mass of erroneous notions exists in the class to whom it is addressed2 to which1 and to the concealment prompted by delicacy1 until the time for medical aid is gone by1 we are indebted for very much of the danger and suffering incident to the periods they are destined to pass through4 ,dr4 ,bull1 in the true spirit of a physician and a gentleman1 has by his perspicuous statements removed the first1 and by his judicious and simple directions1 anticipated the last of these fruitful sources of evil4 ,there is no mother that will not be heartily thankful that this book ever fell into her hands2 and no husband who should not present it to his wife4 ,we cannot urge its value too strongly on all whom it concerns4--,eclectic ,review4 ,we recommend it to our readers2 and they will confer a benefit on their new-married patients by recommending it to them4--,british and ,foreign ,medical ,review4 ,dr4 ,bull has performed a very kind and important office in the publication before us4--,patriot4 ,we never read any popular treatise1 or directions rather1 that bear more strongly the stamp of scientific and expert mental knowledge4 ,the mere reading of our ,author's book will do more good in the way of encouraging the fearful1 and banishing nervous anxiety1 than a whole conclave of the wisest and most sanguine matrons that society can anywhere bring together4--,monthly ,review4 ,this little manual will prove useful exactly in proportion to the extent of its circulation4--,medical ,gazette4