neglected until irreparable damage is done to the organ of hearing, because of the absurd belief that it will get well itself when the child has cut all his teeth, and that it would be unsafe to check it before that time. We have yet to see an inflamed eye or a discharging ear the real cause of which was the eruption of the teeth.

Bowel Troubles.

Diarrhoea is notably the most common ailment for which the teeth are held accounta

ble. On the supposition that it is a salutary accompaniment of teething-a sort of a safety valve-it is often allowed to go unchecked until the supervention of alarming symptoms. In consequence, many infants are sacrificed every year. Now, if teething caused diarrhoea, it should be as prevalent in the winter as during the hot weather, for the teeth erupt at all seasons. As such is not the case, it is evident there must be, and there is, some other cause. The occurrence of an attack of diarrhoea with the eruption of a tooth is a pure coincidence, and the two are in no way related. Infants that are fed exclusively at the breast, at proper intervals, and whose hygiene receives careful attention, seldom suffer with this derangement of the bowels prior to the period of weaning.

The causes of diarrhoea are improper feeding, bad hygiene, the heated atmosphere of a city and sudden and great changes in temperature. Babies at the breast are generally nursed too often. Bottle-fed infants, in addition to being fed too frequently, labor under the disadvantage of not being provided with a suitable substitute for their natural aliment. Too commonly undue importance is attached to the appearance of the first tooth. Its presence is hailed as the advent of a new era in the child's existence, and no opportunity is lost in putting the anxiously watchedfor organ to a legitimate use. Consequently, at meal time Baby may be found in his place at the table, wrestling with a piece of tough meat, or indulging in viands that would stagger many a mature stomach. Then, when a retributive diarrhoea overtakes the little gourmand, the mother awaits, with complacent

The so-called tooth cough is another fallacy of which the parental mind should be disabused. If there were such a thing, it is strange that it should be so infrequent during the summer, as compared with the other three seasons.

Coughs are generally dependent on congestion or inflammation of some part of the respiratory tract, and not on the cutting of the teeth. After a child has commenced to creep and walk, he is more exposed to atmospheric changes than earlier in life, and hence the greater frequency of attacks of bronchitis during the second year. Some children, owing to a delicate constitutioneither inherited, as in the case of descendants of consumptive parents, or acquired, as in rickets-catch cold more readily than others. In cool weather, improper clothing is a prolific source of colds. A bronchitis may result from the chilling of the chest by clothing that has become saturated with the fluid that flows from the mouth in drooling.

Convulsions.

Muscular twitchings and convulsions are said to be expressions of the difficulty a tooth is experiencing in making itself visible. Even at the present day there are some physicians who believe teething may produce convulsions, but we have never seen a case of convulsions that we could satisfy ourselves was due to this cause. The vast majority of children who suffer with convulsions are rickety. This seems to be a predisposing factor, and it requires but the accession of some trifling disturbance that would have no perceptible effect on a healthy child, to excite a fit in one belonging to this class. Even in a perfectly healthy infant, the nervous system is so delicately balanced that its equilibrium is liable to be seriously disturbed by apparently most trival causes. The most common exciting cause of a convulsion

is the presence of some irritating substance in the stomach or bowels, as undigested food. A convulsion not infrequently marks the beginning of some acute illness, as pneumonia, scarlet fever or meningitis. Among other causes may be mentioned constipation, fright, violent temper, severe pain. Sometimes the real cause of a convulsion cannot be discovered.

Eruptions on the Skin.

There are numerous other maladies that are incorrectly supposed to originate in teething, but we will allude to but one group, namely, skin eruptions. The delicate and sensitive nature of an infant's skin renders

more

it quite susceptible to disorders from slight irritation. Derangement of the digestive organs seems to be a very common cause of eruptions of the skin, as eczema (salt rheum), or urticaria (hives). Lack of cleanliness, the use of irritating soaps, or impure toilet powder, rough handling in washing, drying or dressing the baby, irritation from the clothing, either because of its improper arrangement or rough quality, but not teething, are among the causes of eczematous skin eruptions in children. So that, when a patch of eczema appears on a baby's face or behind his ear, it should be attended to at once instead of being allowed to spread until the whole face and scalp are involved, simply because the teeth are developing.

Well-Meaning but Misdirected Efforts. The majority of mothers, whether their babies are ailing or not, seem to be imbued with an almost uncontrollable desire to do something to facilitate the evolution of the teeth and lessen the alleged dangers incident to this process. The numerous expedients, all of them the outgrowth of ignorance and superstition, that have been resorted to in different countries at various periods, were as amusing as they were absurd and nonsensical. Many were indeed disgusting. Even in our own country at the present day there are not wanting those who have an unshaken faith in the occult influence of phylacteries, and the different forms of witchcraft on the teething baby. The string of amber beads |

may still be found adorning the infant neck, a barrier to all the evils that lurk in the air, and the silly dame still survives who rubs a piece of stolen meat on the baby's gums and then buries it-the meat. Among the more common measures in vogue among parents for alleviating the sufferings supposed to arise from teething, are the rubbing of the gums with medicaments, as laudanum, and hard substances, as thimbles, spoon handles, etc.; the use of a teething ring-perhaps a family heirloom with which Baby's ancestors for several generations back lured their milk teeth through the gum-and the administration of teething cordials, elixirs, paregoric or some other preparation of opium. Not infrequently the baby is conveyed to the doctor's to have the gum lanced.

Now these different measures are not only unavailing and unnecessary, but are, most of them, positively harmful. The development of the teeth is a natural and slow process, beginning about seven months before birth. As a tooth advances toward the surface of the gum, the superimposed soft parts are very gradually absorbed to make way for it, so that it is not forced through the gum as a nail is pushed through a piece of leatherthe impression many parents have of teething. We have no means of facilitating the eruption of the teeth other than proper attention to the child's general health, and, indeed, further than this none are necessary. When coincident derangements of the health occur, the cause should be looked for in some other direction than "the teeth." The gums must not be irritated with thimbles, finger-nails, and the like. A smooth, clean ivory ring for the baby's manipulation is usually harmless and will amuse him, and at the same time set the mother's mind at ease on the score of something being done. The use of the disgusting sugar-teat should be tabooed. Teething cordials, soothing syrups and such nostrums are most of them concoctions of opium, and should never be given to babies. Lancing of the gums, although quite extensively practiced by physicians some years ago, is but seldom resorted to at the present day.

M

ASSAGE has its origin probably with the mother who first "rubbed the place to make it well." Professor Billroth says that massage is as old as surgery. Another writer says "It would be more correct

an old treatment systematized and provided with a new name. It is useful for

Bruises or Contusions.-We have here, first, pain; later, swelling and some increase in the local temperature. The "bump" feels hot to the hand. At the same time we have redness; or later, a purplish, greenish or yellowish discoloration. The first pain of a bruise is produced from the direct violence done by the blow to the nerve-ends. It is not due to any change in the part struck. This pain, while referred to the part injured, is not really felt there, but in the brain, to which the nerve has carried its message. By gentle friction over the bruised part we can send other messages or impulses up to the same nerve-center which will attract its attention away from the first painful impression. This is exactly what we try to do when we run so quickly in response to the cry which announces the injury. Many times a little gentle friction is all that will be required to bring healing and peace. At other times, however, even under our fingers a "bump" rises, and we have a distinct swelling which is itself painful to the touch. This

to state that it is as old as mankind." All primitive peoples practice massage. Strabo tells us that the Indians contemporary with Alexander esteemed friction very highly. In the Sandwich Islands and the islands of Oceanica, massage has been found under strange local names. The Turks, Egyptians and Africans use similar procedures. They rub, press with the fingers, and knead all parts of the body. The Japanese and Chinese have very effective methods of massage. Among the Greeks and Romans, massage was extensively used. Hippocrates, the Father of Medicine, recommended rubbing to the consideration of the physician.

Massage is, then, no new treatment. It is

FIG. 2.-EFFLEURAGE OF THE NECK.

second variety of pain is directly connected. with the swelling, and is due to the pressure which it exerts upon the nerve-filaments of the part.

FIG. 3.-EFFLEURAGE

OF

For Children and Persons

Necks. From "Mas

A question worth consideration just here is the composition of the bump. Manifestly, material has been added to the part since the injury; its circumference is greater, it is more bulky than before the injury. Whence did this increased bulk come, and of what is it composed? It is composed first of enlarged blood - vessels and an increased bloodsupply. If you could have seen the part before injury with a magnifying glass, you would have observed upon one side, perhaps, a great river, crowded with what appeared to be little round boats, which passed slowly but steadily on; THE NECK.-upon the other side of WEISS. the field under inspection with Long, Delicate you would have seen, sage in Nervous Dis. perhaps, another and eases," by George W. smaller stream, carrying Jacoby, M.D. the same queer-looking disks, but moving in jerks, as though forced by a pump. Great waves would appear in this stream, and yet the countless fleet would be whirled onward without any evidence of shipwreck. Crossing the field and intersecting in all directions, there would be seen smaller streams or rivulets, only wide enough to receive a single vessel, which proceeded with difficulty, stopping now and again as though to unload or to determine its bearings; yet its course, however crooked, always away from the jerking current and toward the slower stream which it finally entered. The same arrangement would be repeated wherever you shifted your glass. The broad, slow streams are veins; the turbulent, pulsating currents, arteries; the smaller streams, capillaries; their contents are blood, and the countless fleet are corpuscles, or blood-disks. The arteries carry blood from the heart; the capillaries distribute this blood to the tissues, and the veins collect and return it to the heart.

Now, look again after the injury, when swelling and redness have commenced to appear. The artery is dilated to twice its former diameter and is filled to distention. The capillaries are crowded. Where before one or two corpuscles pursued their winding way the canal is now choked by a throng of corpuscles so that forward motion is impossible.

This is what has happened: The artery is guarded by little circular muscle-fibers which narrow its diameter. These, under ordinary circumstances, act as sluice-gates and prevent an extraordinary afflux of blood. By their rhythmic vermicular contraction, too, they aid in the propulsion of the current. These muscle-fibers, however, are under the control of sentries in the shape of little gray nervecells, situated in the vessel-walls, which sen

relaxed and blood continued to pour in upon the already over-supplied part until stagnation resulted.

Following stagnation we may have the escape of the fluid part of the blood through the walls of the capillaries, giving us oedema; or capillaries may rupture, when we shall have hemorrhage or extravasation of blood, with the purplish or greenish discoloration with which all are familiar.

The Stroking Motion (Effleurage)

is capable of averting this history. Applied during the period of congestion, it mechanically empties the veins. On account of certain valves in the veins no backward flow can take place, and the empty lumen draws upon the contents behind it. If the vein be again and again emptied the capillary current will be re-established; swelling will be lessened, and, when relieved from tension, the arteries may recover their usual caliber, or, in other words, recover their tone.

Where effusion with oedema has already occurred, the stroking motion of massage is further capable of reducing the swelling by hastening the absorption of the effused matters. It does this by accelerating the current in the lymphatic system or the drainage system of the body. Surrounding the elements of the tissues are spaces which contain the so-called juices of the tissues. It is into these spaces that the nutritive portions of the blood pass, and it is from these spaces or eating-troughs that each little element takes up its portion of food. It is in these spaces, too, that the water of oedema and other pathological products are found. Lymphatic capillaries proceed from these spaces; these capillaries coalesce and form larger lymphatic vessels, which intersect with lymphatic glands, making many a way-station, but finally terminating in the great veins. The flow in the lymphatics is still slower than that in the veins, because it is not in any direct way aided by the heart. The lymphatics also have valves, and, as in the case of the veins, we can, by the stroking movement of massage, mechanically displace their contents toward the heart.

The tissues may be clogged with excrementitious material, not only in local inflammatory processes, but also in conditions of malaise, where, with a sluggish circulation, the general health is impaired, and in obstructive diseases of the liver, kidneys and other organs. In these cases also the stroking motion of massage will be of service.

Effleurage, or the stroking motion of massage, consists in passes of the hands from the extremities toward the heart. Effleurage should be applied with a firm, deep pressure, the hand being well oiled. Where oil or

vaseline is objectionable, talcum powder will be found to answer the purpose. Unless some lubricant be used sufficient force cannot be applied without giving pain. Upon a large part, such as the thigh, both hands may be used simultaneously; upon smaller parts only one hand can be used, the other being required to steady the part.

In using effleurage for congestion we do not work so much upon the congested part as upon that above or internal to it—that is, the part nearer the heart.

For contusions or other local injuries