diarrhoea and vomiting, which are so rife at this time, are more satisfactorily explained by indigestibility of food than by some occult influence of tooth-cutting. This much, however, may be allowed: that the growth of a child is one of stages; that there are periods during which unusual progress is made; and that the period of dentition is one of these. Increased activity of all the physiological processes at work, necessarily implies greater risks of friction between one organ and another, or even of a regular break-down. Excessive energy, if not properly regulated or adequately expended, is liable to lead to an explosion of some sort or another. Some such general hypothesis as this, must hold good for the instability of working which is common in all the viscera during the first dentition, and to a less extent during the second dentition, and in the years which usher in puberty. In this general sense, the time of dentition is, no doubt, a time of peril. The mortality is high, and disorders of many kinds-convulsions, bronchitis, pneumonia, diarrhoea, etc.-each claims its victims. But this is not as a consequence of the eruption of the teeth, but as part of a general activity of growth and development, to which dentition and morbid phenomena both in a sense respond.

Still there are, no doubt, certain minor evils attending dentition, which require at least a mention. Some children are remarkably susceptible to "colds" under such circumstances--that is to say, as each tooth comes through the gums the child suffers from coryza; the eyes run, the nose also; there is much sneezing, and perhaps a little cough. There may be at the same time pyrexia, and the bowels become irregular-now confined and now relaxed. Some get a sharp attack of fever (temp. 103° or 104°), the lips and tongue becoming a bright red, the child becoming restless and fretful. Others have diarrhoea at these times; others, again, have convulsions, and a still larger number

have threatenings of them in the form of wildness and excitement of manner, more irregularity of muscular movement than usual, temporary carpo-pedal contractions or strabismus. Most children have an excessive dribbling of saliva, are frequently biting anything they can put their hands to, and there may be a little superficial ulceration of the mouth. Indigestion is common. The child suffers from heartburn and offensive eructations, while lichen urticatus (strophulus) appears upon the skin. Convulsions are not a common ailment of dentition, and it is the opinion of West, Henoch, and many other observers, that they are but seldom seen except in association with rickets. Those whose fits commenced with infantile convulsions, form, however, so large a proportion as seven per cent. of the whole number of epileptics.

For the treatment of these varied conditions, to be forewarned is to be forearmed, and the timely management of slight disorders in all probability arrests more serious evils. To control the excess and irregularity of muscular movement, is probably to avert the development of a pronounced convulsion. The "cold" neglected becomes a bronchitis or pneumonia; the indigestion leads to vomiting and diarrhoea; the slight feverishness to severe pyrexia. The treatment may seem somewhat empirical, nevertheless simple means suffice in most cases; carpo-pedal contractions and other threatenings of convulsion, will often speedily subside on the action of some mild aperient―a small dose of calomel, or a couple of grains of hydrarg. c. cretâ with a similar dose of pulvis rhei. The coryza is suitably treated by a little ammonia and ipecacuanha. The fever by a drop of tincture of aconite, or a little salicylate of sodium with acetate of ammonium (F. 2), and so on.

If the pyrexia be severe, and there be any threatening of convulsions, and a tooth seems to be worrying the gum close

beneath the surface, there can be no harm in using the gum lancet to relieve the upward pressure; at the same time bromide of potassium and some saline, such as citrate of potassium, should be given internally, either as a nocturnal draught or twice or three times a day.

The second dentition commences about the seventh year, with the eruption of the first molars; thence onward come the central and lateral incisors, the first bicuspid, the second bicuspid, the canines and second molars, at invervals of a year or so.

[The thirty-two permanent teeth are cut in the following order, the figures representing years:

Molars. Bicuspids. Canine. Incisors. Canine. Bicuspids. Molars.

25-13-6 10-9 | 11 | 8-7-7-8 | II | 9-10 | 6-13-25 | ] Some have thought that this also, is a time of hazard to the child, but there is less evidence of risk now than even during the first dentition; nor is there, indeed, the same reason for the occurrence of any special disorders. There is no change of diet, no special development which begins at this time, at all comparable to that which takes place during the first dentition. It is a time when education begins in earnest, when growth in most cases is proceeding rapidly, and therefore a time when there are many risks, though probably in most cases independent of dentition. Dr. Gowers, from an analysis of a large number of cases of epilepsy, shows that the numbers rise at seven years of age -the commencement of the second dentition-and fall again in the next few years, preparatory to a further rise at puberty. Still it seems not unlikely that this should be referred to the extra calls which, at this time of life, are made in any case, upon brain and body, rather than to the process of dentition; and, apart from epilepsy, chorea, and neurotic diseases generally, there are none which attach themselves peculiarly to this period.

CHAPTER II.

DIET OF CHILDREN IN HEALTH.

THE student often starts in practice with such limited notions on the subject of diet, that many a mother knows more of what is actually required than he does. True, indeed, the fundamental rule upon which all practice is founded, that the mother's milk, and that only, should form the infant's food for the first few months of life, is a choice stock in trade, but we soon find out how very limited, and often at fault is this statement of the matter. Many mothers cannot, many mothers will not, nurse their infants at all, and many more are so situated through the calls of society, or of business, that this, the chief of maternal duties, can only be fulfilled in part. Thus it early becomes a question for all of us, What is to be done under each or any of the circumstances which this enforced neglect entails?

It will be well to attend to the following suggestions:

The infant should be fed from its mother's breast, if not for the full period of lactation, at least as long as possible, and if not entirely, then partially-that is to say, the breast should supply at least one or two meals daily.

If the mother be able to suckle it entirely, no other food is to be given to the infant. It is to be put to the breast every two hours for the first five or six weeks, between the hours of six A.M. and ten P.M., and afterwards the interval between the meals is to be lengthened gradually, till a threehour interval is reached.* It is said that a healthy child

* Should the mother be affected with either syphilis or advanced phthisis, this rule does not hold.-Ed.

will sleep all through the night hours, but in the first five or six weeks of life, it will require food several times during the night. Even when infants are some months old one meal in the middle of the night may be necessary, and to this there is but little objection. The digestion of a healthy infant is rapid, and, while it should not be allowed to have food too often, any lengthened fast is equally to be avoided. The interval between meals is to be strictly enforced for all infants that are healthy. Children are creatures of habit, and soon learn their proper meal-times. They will often, indeed, begin to cry punctually at the time. But they also are easily educated in faulty habits. It is the custom of many mothers to pacify crying at all times with the breast or the bottle and a more pernicious practice it is impossible to conceive. The more the crying the more the feeding, and the more the feeding the more they cry, and what between crying and sucking the day and night are spent in misery. These are the cases which form the great majority of the thin, pining, pitiable mites who are brought to a hospital "for consumption of the bowels," but with bad feeding only to blame. And what wonder; if grown-up persons were to be always eating, who among us would not be dyspeptic, and who would not be quite as miserable, if less demonstrative than the infant! Now let it be remembered that there are many children who in the first week or two of life, when the stomach is, as it were, unfolding to its duties, cry a good deal. They are a source of great discomfort and pain in a household-sucking at something will almost certainly quiet them, and other methods of treatment, food, doctoring, and so forth, often fail. It is very important in such cases to impress upon the mother and nurse that if they quiet a child by this means, they are but sowing the wind to reap an inevitable whirlwind. If they bear with it for a short time the child soon becomes accustomed to the habits enforced; it