growth progresses and the child develops into the lithe, active youth or maiden.

The shape of the head varies greatly between the round, bullet form and the elongated oval one. When it has been subjected to much pressure, instrumental or otherwise, during delivery, it is often so distorted as to shock the expectant mother. Little fear of permanent disfigurement need be entertained, however, as the deformed head usually assumes a natural shape in time. The same is true of less noticeable depressions, prominences and irregularities. But it should be remembered that restoration to symmetry must be left entirely to nature, as any attempt to mould the skull by pressure rarely fails to injure the delicate brain beneath.

The anterior fontanelle, or, as it is called by nurses, "the opening of the head," is readily seen and felt in infants under a year old. In the normal state it is level with, or very slightly depressed below, the surrounding bones of the skull, and may be observed to pulsate, or rise and fall, rhythmically. It is soft to the touch and yields readily to pressure.

Examples of Variations in Disease.-Lividity of the eyelids and lips is a sign of imperfect oxidization of the blood, and points to disease of the heart or lungs. A decided yellow color of the skin and whites of the eyes is seen in jaundice; an

2

earthy tinge of the face, in long-standing disease of the bowels; a waxy pallor in kidney disease, and paleness in any acute or chronic affection attended by exhaustion.

Marked squareness of the head with projection of the forehead, a widely-open fontanelle, and a

FIG. 1.

b

DIAGRAM SHOWING SHAPE OF HEADS.

a, Normal head; b, Hydrocephalic head; c, Rickety head.

relatively small face indicate rickets. A very large. globular head is characteristic of hydrocephalus or "water on the brain;" bulging of the fontanelle is also a symptom of this disease. In this connection it must be observed, however, that certain children are born with relatively large, globe-shaped heads,

though in every respect healthy. The peculiarity is especially apt to be observed when one of the parents-notably the father-has the same characteristic. In order to indicate disease, the deformity must be marked and combined with a widely open, bulging fontanelle, or with indications of impaired brain activity. Depression of the fontanelle shows general debility and the need of food or stimulants. The accompanying diagram, Fig. 1, will aid in explaining this subject.

Great distention of the abdomen is usually due to an accumulation of gas in the intestines, and indicates disease of this portion of the digestive tract; marked depression, on the other hand, is encountered in serious brain affections, in cholera infantum, inflammation of the intestines and dysentery.

3. Development.-To be robust the newly-born infant must have a certain average length and weight. The length varies between sixteen and twenty-two inches, and the weight between six and eight pounds.

From the first day, growth or increase in length and weight, steadily progresses, according to certain definitely fixed rules.

Length increases most rapidly during the first week of life; afterward the progress is almost uniform up to the fifth month, and then it becomes less

rapid, though still uniform, until the end of the twelfth month.

These facts may be seen in the following table :

During the second year the increase is from three to five inches; in the third from two to three and a half inches; in the fourth from two to three inches, and from this age up to the sixteenth year the average annual gain is from one and two-thirds to two inches.

In the first three days of life there is always a

loss of weight, but by the seventh day the babe should have regained weight and be as heavy as at birth. The period of most rapid gain in this respect is during the first five months of life. The maximum is attained during the second month, when the increase is from four to seven ounces each week. Throughout the next three months the increase amounts to about five ounces per week, and in the remaining months of the first year, from two to five ounces.

The subjoined table shows the average rate of gain :