body, roundness of limb, and firmness of flesh, the existence of some fault in diet or in the digestion and absorption of food must be inferred.

A delay in walking may be due to general feebleness or to paralysis of the muscles of one or both legs, and a limping gait with pain in the knee suggests hip-joint disease.

Closure of the fontanelle is retarded by the disease called rickets, and also by hydrocephalus and constitutional syphilis.

It is well to be cognizant of the fact that girls develop more rapidly than boys, and that the second or later children of the same family, by imitating their elders in the nursery, learn to talk and walk earlier than those who are born first.

4. Position and Gestures.-The complete repose depicted on the countenance of a sleeping child when free from illness is shown also by the posture of the body. The head lies easy on the pillow, the trunk rests on the side, slightly inclined backward, the limbs assume various but always most graceful attitudes, and no movement is observable but the gentle rise and fall of the abdomen in respiration. In the waking state, the child, after early infancy, is rarely still. The movements of the arms, at first awkward, soon become full of purpose as he reaches to handle and examine various objects about him. The legs are idle

longer, though these, too, soon begin to move about with method, feeling the ground, in preparation, as it were, for creeping and walking.

Examples of Variations in Disease.-Restless sleep with a desire to be rocked, fondled or "walked" in the nurse's arms, are common symptoms of acute attacks of illness, especially when attended by pain. Children beyond the age of infancy toss about uneasily in bed or demand a change from the bed to the lap, under similar circumstances. Extreme and long-continued drowsiness and quietness, on the other hand, often precede the onset of such specific fevers as scarlatina or measles.

Sleeping with the head thrown back and the mouth open indicates enlarged tonsils; a tendency to "sleep high," or with the head and shoulders elevated by the pillow, accompanies disease of the heart and lungs, and "sleeping cool," that is, resting only after the bed clothing has been kicked off, is an early symptom of rickets.

Frequent carrying of the hand to the head, ear or mouth shows headache, earache, or the pain of a coming tooth, as the case may be, while constant rubbing of the nose is a feature of irritation of the bowels or stomach.

Should the thumbs be drawn into the palms of the hands, and the fingers tightly clasped over

them, or if the toes be strongly flexed or extended, a convulsion may be expected.

5. The Voice.-Crying is the chief if not the only method that the young infant possesses of making known his displeasure, discomfort or suffering, and affords almost the sole means of determining the characters of the voice at this early age. Again, even long after the powers of speech have been developed, the cry continues to be the main channel of complaint.

One rarely hears a healthy child cry, unless a harsh word, a fall or a blow cause a passing storm of grief, anger or pain. Hence, frequent, peevish crying points to some disturbance of the healthy balance.

The sound of the voice, whether in crying or speaking, should have a clear ring, without either muffling, hoarseness or nasal tone. Weeping should accompany crying, after the establishment of tear secretion. Cough, although not a normal vocal sound, is also worthy of attention.

Examples of Variations in Disease.-Incessant, unappeasable crying is usually due to earache or hunger; it frequently, too, is caused by the constant pricking of a badly-adjusted safety pin or other mechanical irritant.

If crying occur during an attack of coughing it is an indication of some painful affection of the

chest; if just before or after an evacuation of the bowels, of intestinal pain.

When the cry has a nasal tone it should suggest swelling of the lining membrane of the nose, or other obstructing condition. Thickening and indistinctness occur with throat affections. A loud, brazen cry is a precursor of spasmodic croup, and a faint, whispering cry of true or membranous croup. Hoarseness points to disease of the lining membrane of the larynx, either catarrhal or syphilitic in nature.

Finally, a manifest unwillingness to cry can be seen in pneumonia and pleurisy, when the disease is severe enough to interfere materially with breathing.

Tear-secretion having been established, it is a bad omen if the secretion be arrested during the progress of an illness, but an equally good one if there be no suppression, or if there be a reëstablishment after suppression.

The cough, like the voice, may be brazen in spasmodic croup, hoarse in laryngeal catarrh, and suppressed in true croup. The qualities "tightness" and "looseness" are readily appreciated and give a good idea of the progress of lung affections, especially bronchitis, the former being an evidence of the beginning, the latter of the favorable termination of an attack.

Cough is always unproductive, that is, unattended by expectoration, in children under seven years of age.

6. Mode of Drinking and Swallowing.-By watching an infant taking the breast or bottle, some information can be obtained of the condition of the mouth and throat, and of the respiratory organs.

A healthy child drinks continuously without stopping to breathe, and swallows easily.

Examples of Variations in Disease.—If there be any soreness of the mouth the nipple will be held only for a moment and then dropped with a cry of pain. When the throat is affected in infants, swallowing is performed with a gulp and an expression of pain passes over the face, and no more efforts are made than required to satisfy the first cravings of hunger. Older children, under similar circumstances, drink little and refuse solid food.

An infant suffering from the oppressed breathing of pneumonia or severe bronchitis, seizes the nipple with avidity, swallows quickly several times and then pauses for breath. In older children the act of drinking, which should be continuous, is interrupted in the same way.

If the finger be put into the mouth of a healthy baby it will be vigorously sucked for some little time. Diminution of this act of suction during a