ing respiration, interrupted by long pauses, tubercular meningitis. The normal ratio of respiration and pulse is I to 3 or 3.5. Should this be changed to 1 to 2, pneumonia or pulmonary collapse may be suspected.]

The ejecta of children should all be examined, whether they be vomited or passed from the bladder or rectum.

The sleep of a child should be watched if opportunity offer. A child sleeps quite calmly when in health, and for a long time at a stretch when the first few months are passed over and the necessity of frequent suckling has gone by, but it is quickly disturbed in ill-health of all kinds. Slight attacks of fever, gastro-intestinal derangements, dentition, brain disease, etc., all make the sleep uneasy, although not much differentiation of disease can be accomplished by observations of this kind. The manner of deglutition is another feature which often conveys an indication of disease. For in any interference with the freedom of respiration a child will take a few snatches of food and then turn away and splutter, or cough, or cry. If children refuse food without any definite reason, the mouth and throat should always receive a careful examination; stomatitis, tonsillitis, and even more serious troubles, such as post-pharyngeal abscess may otherwise go unrecognized.

By persistently following out the spirit of these preliminary suggestions in the way that seems best suited to the individual examined, it will be but seldom that a very refractory child is met with, or that you fail to make a satisfactory examination.

Treatment. I had purposed to devote a chapter to special points in the treatment of children, but thinking the matter over, the necessity, nay even the wisdom, of so doing may be doubted. For, after all, the dosage for children, the one great dread of students, is a matter which, if stated with precision in a posological table, is never handy for reference,

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and is hardly reliable if it be. [Nevertheless, as a guide to the student, Cowling's rule is serviceable; namely, the proportionate dose for any age under adult life is represented by the number of the following birthday, divided by twentyfour, ie, for one year ; for two years , and so on]. With one or two exceptions, every one must make his own table in his own memory, and must feel his way. Herein is one of the advantages of experience, which can hardly be gained in any other manner. Opium has been a great bugbear in this respect. All powerful drugs must naturally be given with caution to children; but opium is perhaps the only one which requires excessive precaution. It must be given to infants in infinitesimal proportions, and there are some practitioners who evade its use at this time of life as much as possible. Still, combined with castor-oil, it is a useful drug in bad cases of flatulent colic, and perhaps one drop to a two-ounce mixture, of which a drachm may be taken, is an average dose in the first six weeks of life. This quantity may have to be lessened, but it will certainly, in many cases, be necessary to increase it, and after the first two or three months the extreme susceptibility to the drug disappears, and half a drop may then be given for a dose. At two or three years old, two-grain doses of Dover's powder may be given, when requisite, without fear.

Bromide of potassium, a most valuable remedy in many of the diseases of children, must be given to infants with watchfulness. It sometimes, even in small doses, produces severe local inflammation of the skin, and localized patches of soft, warty growths. This is, however, of infrequent occurrence, and cannot be avoided when, as is sometimes the case, the idiosyncrasy is so pronounced that three or four grains suffice to produce the eruption; but, for the reason that there is a risk, the drug should not be continued for any length of time, except under close supervision.

Belladonna and arsenic are illustrations of an opposite tendency, for children are very tolerant of these drugs, particularly of belladonna. A child four or five years old will take fifteen to twenty drops of tincture of belladonna without any inconvenience whatever.* And in such cases as it is necessary to give arsenic, usually in children six years and upwards, a dose of seven drops of the liquor arsenicalis† may be given at the onset three times a day, and a considerable increase on this be attained if necessary. But children do not often require a very energetic treatment with drugs, and probably he will be the best practitioner who lets Nature make for cure without heroic measures. Proper feeding ranks first in all treatment in early life.

It is not unnecessary to add that all drugs should be made as palatable as possible. Castor oil and Gregory may be very good remedies, but, except to babies, they are very disgusting, and there are now at hand numberless substitutes, and methods of disguising nasty remedies, which should be studied. Some may be put into lozenges, some into syrups, some mixed up into a palatable emulsion, and so on.

I must, however, allude to baths for children, because their sphere of usefulness is large. It would probably be difficult to enumerate the variety of diseases in which a bath is useful. As a general rule when a state of pyrexia is recognized, the child is likely to be smothered to keep it warm. For the same reason, the linen which is not actually soiled by the excreta, is not changed for fear of chill. But children of all ages perspire freely, and in the course of a few hours will get exceedingly uncomfortable under these circumstances, fretting and becoming restless, whilst the mother wonders why sleep does not come. Put the child into a

* It must be remembered that Tincture of Belladonna Br. P., is only about half as strong as the same preparation U. S. P.—ED.

Equivalent to liquor potassii arsenitis, U. S. P.-ED.

warm bath for a few minutes, and with fresh linen and a comfortable cot it will probably soon be at rest. Then, too, in most states of fever, sponging is of value-warm, or tepid, or cold, according to the necessities of the case—and a bath, even a warm bath will reduce the temperature if it be very high. Tepid or cold baths may be administered to children in high fever, if requisite, but if cold the bath must be of short duration. A fall of temperature is set going by the immediate shock, not necessarily by prolonged immersion, and the latter is liable to induce a state of collapse and exhaustion, such as is not often seen in adults.

The tender skin of a child should always be a matter of attention. Poultices and hot bottles easily scald, and bandages are very liable to cut or excoriate if not carefully applied, and frequently readjusted. Poultices are in frequent use for cases of thoracic and abdominal disease. They should never be so hot as to be in any degree painful. But I discard them as much as possible. They soon become cold, hard, and uncomfortable, and they are often heavy. A warm fomentation, by means of spongio-piline, well covered in by cotton wool, is in every way preferable, at any rate, for diseases of the thorax.

[A layer of cotton, covered with oiled silk, by condensing the insensible perspiration, and becoming moist, acts in the same manner, and is preferable to a poultice, in both thoracic and abdominal diseases, since it does not require changing, and is always warm.]

CHAPTER I.

DENTITION.

THE milk teeth are cut in the following order: The two lower central incisors from the seventh to the ninth month, often later and sometimes earlier. After a lapse of five or six weeks come the two upper central incisors; next come the two lower lateral incisors, followed by the upper lateral incisors. After an interval, the four front molars appear, followed again by the four canines, and last of all by the four posterior molars, the whole set being cut by about the end of the second year. [The following table shows in months, the usual times of appearance of the twenty milk teeth:

The lower jaw is ordinarily a little in advance of the upper.] But it must not be supposed that there is any strict timekeeping in the appearance of the teeth, for, although there is a pretty definite order of occurrence, the lower central incisors may appear early or late, and the others may follow, sometimes several at once, sometimes with long intervals between them. It often happens that the four central incisors come, then follows an interval, and then steadily onwards come all the rest save the last four molars, the appearance of which may, even in healthy children, be deferred for three or four months over the average age of two years.

Dentition is usually held to be the cause of many ailments, but to what extent it is really so is doubtful. The time of dentition is one of transition. A uniform and bland diet is changing for one of greater variety, and the febrile attacks—