2500. Baked flour, when cooked into a pale brown mass, and finely powdered, makes a far superior food to the others, and may be considered as a very useful diet, especially for a change. Prepared groats may be classed with arrowroot and raw flour, as being innutritious. The articles that now follow in our list are all good, and such as we could, with conscience and safety, trust to for the health and development of any child whatever.

2501. We may observe in this place, that an occasional change in the character of the food is highly desirable, both as regards the health and benefit of the child; and though the interruption should only last for a day, the change will be advantageous.

2502. The packets sold as farinaceous food are unquestionably the best aliment that can be given from the first to a baby, and may be continued, with the exception of an occasional change, without alteration of the material, till the child is able to take its regular meals of animal and vegetable food. Some infants are so constituted as to require a frequent and total change in their system of living, seeming to thrive for a certain time on any food given to them, but if persevered in too long, declining in bulk and appearance as rapidly as they had previously progressed. In such cases the food should be immediately changed, and when that which appeared to agree best with the child is resumed, it should be altered in its quality, and perhaps in its consistency.

2503. For the farinaceous food there are directions with each packet, containing instructions for the making; but, whatever the food employed is, enough should be made at once to last the day and night; at first, about a pint basinful, but, as the child advances, a quart will hardly be too much. In all cases, let the food boil a sufficient time, constantly stirring, and taking every precaution that it does not get burnt, in which case it is on no account to be used.

2504. The food should always be made with water, the whole sweetened at once, and of such a consistency that, when poured out, and it has had time to cool, it will cut with the firmness of a pudding or custard. One or two spoonfuls are to be put into the pap saucepan and stood on the hob till the heat has softened it, when enough milk is to be added, and carefully mixed with the food, till the whole has the consistency of ordinary cream; it is then to be poured into the nursing-bottle, and the food having been drawn through to warm the nipple, it is to be placed in the child's mouth. For the first month or more, half a bottleful will be quite enough to give the infant at one time; but, as the child grows, it will be necessary not only to increase the quantity given at each time, but also gradually to make its food more consistent, and, after the third month, to add an egg to every pint basin of food made. At night the mother puts the food into the covered pan of her lamp, instead of the saucepan—that is, enough for one supply, and, having lighted the rush, she will find, on the waking of her child, the food sufficiently hot to bear the cooling addition of the milk. But, whether night or day, the same food should never be heated twice, and what the child leaves should be thrown away.

2505. The biscuit powder is used in the same manner as the farinaceous food, and both prepared much after the fashion of making starch. But when tops-and-bottoms, or the whole biscuit, are employed, they require soaking in cold water for some time previous to boiling. The biscuit or biscuits are then to be slowly boiled in as much water as will, when thoroughly soft, allow of their being beaten by a three-pronged fork into a fine, smooth, and even pulp, and which, when poured into a basin and become cold, will cut out like a custard. If two large biscuits have been so treated, and the child is six or seven months old, beat up two eggs, sufficient sugar to properly sweeten it, and about a pint of skim milk. Pour this on the beaten biscuit in the saucepan, stirring constantly; boil for about five minutes, pour into a basin, and use, when cold, in the same manner as the other.

2506. This makes an admirable food, at once nutritious and strengthening. When tops-and-bottoms or rusks are used, the quantity of the egg may be reduced, or altogether omitted.

2507. Semolina, or manna croup, being in little hard grains, like a fine millet-seed, must be boiled for some time, and the milk, sugar, and egg added to it on the fire, and boiled for a few minutes longer, and, when cold, used as the other preparations.

2508. Many persons entertain a belief that cow's milk is hurtful to infants, and, consequently, refrain from giving it; but this is a very great mistake, for both sugar and milk should form a large portion of every meal an infant takes.

TEETHING AND CONVULSIONS.

Fits, &c., the consequence of Dentition, and how to be treated.—The number and order of the Teeth, and manner in which they are cut.—First and Second Set.

2509. About three months after birth, the infant's troubles may be said to begin; teeth commence forming in the gums, causing pain and irritation in the mouth, and which, but for the saliva it causes to flow so abundantly, would be attended with very serious consequences. At the same time the mother frequently relaxes in the punctuality of the regimen imposed on her, and, taking some unusual or different food, excites diarrhoea or irritation in her child's stomach, which not unfrequently results in a rash on the skin, or slight febrile symptoms, which, if not subdued in their outset, superinduce some more serious form of infantine disease. But, as a general rule, the teeth are the primary cause of much of the child's sufferings, in consequence of the state of nervous and functional irritation into which the system is thrown by their formation and progress out of the jaw and through the gums. We propose beginning this branch of our subject with that most fertile source of an infant's suffering—

Teething.

2510. That this subject may he better understood by the nurse and mother, and the reason of the constitutional disturbance that, to a greater or less degree, is experienced by all infants, may be made intelligible to those who have the care of children, we shall commence by giving a brief account of the formation of the teeth, the age at which they appear in the mouth, and the order in which they pierce the gums. The organs of mastication in the adult consist of 32 distinct teeth, 16 in either jaw; being, in fact, a double set. The teeth are divided into 4 incisors, 2 canine, 4 first and second grinders, and 6 molars; but in childhood the complement or first set consists of only twenty, and these only make their appearance as the development of the frame indicates the requirement of a different kind of food for the support of the system. At birth some of the first-cut teeth are found in the cavities of the jaw, in a very small and rudimentary form; but this is by no means universal. About the third month, the jaws, which are hollow and divided into separate cells, begin to expand, making room for the slowly developing teeth, which, arranged for beauty and economy of space lengthwise, gradually turn their tops upwards, piercing the gum by their edges, which, being sharp, assist in cutting a passage through the soft parts. There is no particular period at which children cut their teeth, some being remarkably early, and others equally late. The earliest age that we have ever ourselves known as a reliable fact was, six weeks. Such peculiarities are generally hereditary, and, as in this case, common to a whole family. The two extremes are probably represented by six and sixteen months. Pain and drivelling are the usual, but by no means the general, indications of teething.

2511. About the sixth month the gums become tense and swollen, presenting a red, shiny appearance, while the salivary glands pour out an unusual quantity of saliva. After a time, a white line or round spot is observed on the top of one part of the gums, and the sharp edge of the tooth may be felt beneath if the finger is gently pressed on the part. Through these white spots the teeth burst their way in the following order:—

2512. Two incisors in the lower jaw are first cut, though, in general, some weeks elapse between the appearance of the first and the advent of the second. The next teeth cut are the four incisors of the upper jaw. The next in order are the remaining two incisors of the bottom, one on each side, then two top and two bottom on each side, but not joining the incisors; and lastly, about the eighteenth or twentieth month, the four eye teeth, filling up the space left between the side teeth and the incisors; thus completing the infant's set of sixteen. Sometimes at the same period, but more frequently some months later, four more double teeth slowly make their appearance, one on each side of each jaw, completing the entire series of the child's first set of twenty teeth. It is asserted that a child, while cutting its teeth, should either dribble excessively, vomit after every meal, or be greatly relaxed. Though one or other, or all of these at once, may attend a case of teething, it by no means follows that any one of them should accompany this process of nature, though there can be no doubt that where the pain consequent on the unyielding state of the gums, and the firmness of the skin that covers the tooth, is severe, a copious discharge of saliva acts beneficially in saving the head, and also in guarding the child from those dangerous attacks of fits to which many children in their teething are liable.

2513. The Symptoms that generally indicate the cutting of teeth, in addition to the inflamed and swollen state of the gums, and increased flow of saliva, are the restless and peevish state of the child, the hands being thrust into the mouth, and the evident pleasure imparted by rubbing the finger or nail gently along the gum; the lips are often excoriated, and the functions of the stomach or bowels are out of order. In severe cases, occurring in unhealthy or scrofulous children, there are, from the first, considerable fever, disturbed sleep, fretfulness, diarrhoea, rolling of the eyes, convulsive startings, laborious breathing, coma, or unnatural sleep, ending, unless the head is quickly relieved, in death.

2514. The Treatment in all cases of painful teething is remarkably simple, and consists in keeping the body cool by mild aperient medicines, allaying the irritation in the gums by friction with a rough ivory ring or a stale crust of broad, and when the head, lungs, or any organ is overloaded or unduly excited, to use the hot bath, and by throwing the body into a perspiration, equalize the circulation, and relieve the system from the danger of a fatal termination.

2515. Besides these, there is another means, but that must be employed by a medical man; namely, scarifying the gums—an operation always safe, and which, when judiciously performed, and at a critical opportunity, will often snatch the child from the grasp of death.

2516. There are few subjects on which mothers have often formed such strong and mistaken opinions as on that of lancing an infant's gums, some rather seeing their child go into fits—and by the unrelieved irritation endangering inflammation of the brain, water on the head, rickets, and other lingering affections—than permit the surgeon to afford instant relief by cutting through the hard skin, which, like a bladder over the stopper of a bottle, effectually confines the tooth to the socket, and prevents it piercing the soft, spongy substance of the gum. This prejudice is a great error, as we shall presently show; for, so far from hurting the child, there is nothing that will so soon convert an infant's tears into smiles as scarifying the gums in painful teething; that is, if effectually done, and the skin of the tooth be divided.

2517. Though teething is a natural function, and to an infant in perfect health should be unproductive of pain, yet in general it is not only a fertile cause of suffering, but often a source of alarm and danger; the former, from irritation in the stomach and bowels, deranging the whole economy of the system, and the latter, from coma and fits, that may excite alarm in severe cases; and the danger, that eventuates in some instances, from organic disease of the head or spinal marrow.

2518. We shall say nothing in this place of "rickets," or "water on the head," which are frequent results of dental irritation, but proceed to finish our remarks on the treatment of teething. Though strongly advocating the lancing of the gums in teething, and when there are any severe head-symptoms, yet it should never be needlessly done, or before being satisfied that the tooth is fully formed, and is out of the socket, and under the gum. When assured on these points, the gum should be cut lengthwise, and from the top of the gum downwards to the tooth, in an horizontal direction, thus——, and for about half an inch in length. The operation is then to be repeated in a transverse direction, cutting across the gum, in the centre of the first incision, and forming a cross, thus +. The object of this double incision is to insure a retraction of the cut parts, and leave an open way for the tooth to start from—an advantage not to be obtained when only one incision is made; for unless the tooth immediately follows the lancing, the opening reunites, and the operation has to be repeated. That this operation is very little or not at all painful, is evidenced by the suddenness with which the infant falls asleep after the lancing, and awakes in apparently perfect health, though immediately before the use of the gum-lancet, the child may have been shrieking or in convulsions.

Convulsions, or Infantine Fits.

2519. From their birth till after teething, infants are more or less subject or liable to sudden fits, which often, without any assignable cause, will attack the child in a moment, and while in the mother's arms; and which, according to their frequency, and the age and strength of the infant, are either slight or dangerous.

2520. Whatever may have been the remote cause, the immediate one is some irritation of the nervous system, causing convulsions, or an effusion to the head, inducing coma. In the first instance, the infant cries out with a quick, short scream, rolls up its eyes, arches its body backwards, its arms become bent and fixed, and the fingers parted; the lips and eyelids assume a dusky leaden colour, while the face remains pale, and the eyes open, glassy, or staring. This condition may or may not be attended with muscular twitchings of the mouth, and convulsive plunges of the arms. The fit generally lasts from one to three minutes, when the child recovers with a sigh, and the relaxation of the body. In the other case, the infant is attacked at once with total insensibility and relaxation of the limbs, coldness of the body and suppressed breathing; the eyes, when open, being dilated, and presenting a dim glistening appearance; the infant appearing, for the moment, to be dead.

2521. Treatment.-The first step in either case is, to immerse the child in a hot bath up to the chin; or if sufficient hot water cannot be procured to cover the body, make a hip-bath of what can be obtained; and, while the left hand supports the child in a sitting or recumbent position, with the right scoop up the water, and run it over the chest of the patient. When sufficient water can be obtained, the spine should be briskly rubbed while in the bath; when this cannot be done, lay the child on the knees, and with the fingers dipped in brandy, rub the whole length of the spine vigorously for two or three minutes, and when restored to consciousness, give occasionally a teaspoonful of weak brandy and water or wine and water.

2522. An hour after the bath, it may be necessary to give an aperient powder, possibly also to repeat the dose for once or twice every three hours; in which case the following prescription is to be employed. Take of

Powdered scammony 6 grains. Grey powder 6 grains. Antimonial powder 4 grains. Lump sugar 20 grains.

Mix thoroughly, and divide into three powders, which are to be taken as advised for an infant one year old; for younger or weakly infants, divide into four powders, and give as the other. For thirst and febrile symptoms, give drinks of barley-water, or cold water, and every three hours put ten to fifteen drops of spirits of sweet nitre in a dessert-spoonful of either beverage.

THRUSH, AND ITS TREATMENT.

2523. This is a disease to which infants are peculiarly subject, and in whom alone it may be said to be a disease; for when thrush shows itself in adult or advanced life, it is not as a disease proper, but only as a symptom, or accessory, of some other ailment, generally of a chronic character, and should no more be classed as a separate affection than the petechae, or dark-coloured spots that appear in malignant measles, may be considered a distinct affection.

2524. Thrush is a disease of the follicles of the mucous membrane of the alimentary canal, whereby there are formed small vesicles, or bladders, filled with a thick mucous secretion, which, bursting, discharge their contents, and form minute ulcers in the centre of each vessel. To make this formal but unavoidable description intelligible, we must beg the reader's patience while we briefly explain terms that may appear to many so unmeaning, and make the pathology of thrush fully familiar.

2525. The whole digestive canal, of which the stomach and bowels are only a part, is covered, from the lips, eyes, and ears downwards, with a thin glairy tissue, like the skin that lines the inside of an egg, called the mucous membrane; this membrane is dotted all over, in a state of health, by imperceptible points, called follicles, through which the saliva, or mucous secreted by the membrane, is poured out.

2526. These follicles, or little glands, then, becoming enlarged, and filled with a congealed fluid, constitute thrush in its first stage; and when the child's lips and mouth appear a mass of small pearls, then, as these break and discharge, the second stage, or that of ulceration, sets in.

2527. Symptoms.—Thrush is generally preceded by considerable irritation, by the child crying and fretting, showing more than ordinary redness of the lips and nostrils, hot fetid breath, with relaxed bowels, and dark feculent evacuations; the water is scanty and high-coloured; whilst considerable difficulty in swallowing, and much thirst, are the other symptoms, which a careful observation of the little patient makes manifest.

2528. The situation and character of thrush show at once that the cause is some irritation of the mucous membrane, and can proceed only from the nature and quality of the food. Before weaning, this must be looked for in the mother, and the condition of the milk; after that time, in the crude and indigestible nature of the food given. In either case, this exciting cause of the disease must be at once stopped. When it proceeds from the mother, it is always best to begin by physicking the infant through the parent; that is to say, let the parent first take the medicine, which will sufficiently affect the child through the milk: this plan has the double object of benefiting the patient and, at the same time, correcting the state of the mother, and improving the condition of her milk. In the other case, when the child is being fed by hand, then proceed by totally altering the style of aliment given, and substituting farinaceous food, custards, blanc-mange, and ground-rice puddings.

2529. As an aperient medicine for the mother, the best thing she can take is a dessert-spoonful of carbonate of magnesia once or twice a day, in a cup of cold water; and every second day, for two or three times, an aperient pill.

2530. As the thrush extends all over the mouth, throat, stomach, and bowels, the irritation to the child from such an extent of diseased surface is proportionately great, and before attempting to act on such a tender surface by opening medicine, the better plan is to soothe by an emollient mixture; and, for that purpose, let the following be prepared. Take of

Castor oil 2 drachms. Sugar 1 drachm. Mucilage, or powdered gum Arabic half a drachm.

Triturate till the oil is incorporated, then add slowly—

Mint-water One ounce and a half Laudanum Ten drops

Half a teaspoonful three times a day, to an infant from one to two years old; a teaspoonful from two to three years old; and a dessertspoonful at any age over that time. After two days' use of the mixture, one of the following powders should be given twice a day, accompanied with one dose daily of the mixture:—

Grey powder 20 grains. Powdered rhubarb 15 grains. Scammony 10 grains. Mix.

Divide into twelve powders, for one year; eight powders, from one to two; and six powders, from two to six years old. After that age, double the strength, by giving the quantity of two powders at once.

2531. It is sometimes customary to apply borax and honey to the mouth for thrush; but it is always better to treat the disease constitutionally rather than locally. The first steps, therefore, to be adopted are, to remove or correct the exciting cause—the mother's milk or food; allay irritation by a warm bath and the castor-oil mixture, followed by and conjoined with the powders.

2532. To those, however, who wish to try the honey process, the best preparation to use is the following:-Rub down one ounce of honey with two drachms of tincture of myrrh, and apply it to the lips and mouth every four or six hours.

2533. It is a popular belief, and one most devoutly cherished by many nurses and elderly persons, that everybody must, at some time of their life, between birth and death, have an attack of thrush, and if not in infancy, or prime of life, it will surely attack them on their death-bed, in a form more malignant than if the patient had been affected with the malady earlier; the black thrush with which they are then reported to be affected being, in all probability, the petechae or purple spots that characterize the worst form, and often the last stage, of typhoid fever.

2534. In general, very little medicine is needed in this disease of the thrush—an alterative powder, or a little magnesia, given once or twice, being all, with the warm bath, that, in the great majority of cases, is needed to restore the mucous membrane to health. As thrush is caused by an excess of heat, or over-action in the lining membrane of the stomach and bowels, whatever will counteract this state, by throwing the heat on the surface, must materially benefit, if not cure, the disease: and that means every mother has at hand, in the form of a warm bath. After the application of this, a little magnesia to correct the acidity existing along the surface of the mucous membrane, is often all that is needed to throw the system into such a state as will effect its own cure. This favourable state is indicated by an excessive flow of saliva, or what is called "dribbling," and by a considerable amount of relaxation of the bowels-a condition that must not be mistaken for diarrhoea, and checked as if a disease, but rather, for the day or two it continues, encouraged as a critical evacuant.

2535. Should there be much debility in the convalescence, half a teaspoonful of stee wine, given twice a day in a little barley-water, will be found sufficient for all the purposes of a tonic. This, with the precaution of changing the child's food, or, when it lives on the mother, of correcting the quality of the milk by changing her own diet, and, by means of an antacid or aperient, improving the state of the secretion. Such is all the treatment that this disease in general requires.

2536. The class of diseases we are now approaching are the most important, both in their pathological features and in their consequences on the constitution, of any group or individual disease that assails the human body; and though more frequently attacking the undeveloped frame of childhood, are yet by no means confined to that period. These are called Eruptive Fevers, and embrace chicken-pox, cow-pox, small-pox, scarlet fever, measles, milary fever, and erysipelas, or St. Anthony's fire.

2537. The general character of all these is, that they are contagious, and, as a general rule, attack a person only once in his lifetime; that their chain of diseased actions always begins with fever, and that, after an interval of from one to four days, the fever is followed by an eruption of the skin.

CHICKEN-POX, OR GLASS-POX; AND COW-POX, OR VACCINATION.

2538. CHICKEN-POX, or GLASS-POX, may, in strict propriety, be classed as a mild variety of small-pox, presenting all the mitigated symptoms of that formidable disease. Among many physicians it is, indeed, classed as small-pox, and not a separate disease; but as this is not the place to discuss such questions, and as we profess to give only facts, the result of our own practical experience, we shall treat this affection of glass-pox or chicken-pox, as we ourselves have found it, as a distinct and separate disease.

2539. Chicken-pox is marked by all the febrile symptoms presented by small-pox, with this difference, that, in the case of chicken-pox, each symptom is particularly slight. The heat of body is much less acute, and the principal symptoms are difficulty of breathing, headache, coated tongue, and nausea, which sometimes amounts to vomiting. After a term of general irritability, heat, and restlessness, about the fourth day, or between the third and fourth, an eruption makes its appearance over the face, neck, and body, in its first two stages closely resembling small-pox, with this especial difference, that whereas the pustules in small-pox have flat and depressed centres—an infallible characteristic of small-pox—the pustules in chicken-pox remain globular, while the fluid in them changes from a transparent white to a straw-coloured liquid, which begins to exude and disappear about the eighth or ninth day, and, in mild cases, by the twelfth desquamates, or peels off entirely.

2540. There can be no doubt that chicken-pox, like small-pox, is contagious, and under certain states of the atmosphere becomes endemic. Parents should, therefore, avoid exposing young children to the danger of infection by taking them where it is known to exist, as chicken-pox, in weakly constitutions, or in very young children, may superinduce small-pox, the one disease either running concurrently with the other, or discovering itself as the other declines. This, of course, is a condition that renders the case very hazardous, as the child has to struggle against two diseases at once, or before it has recruited strength from the attack of the first.

2541. Treatment.—In all ordinary cases of chicken-pox—and it is very seldom it assumes any complexity—the whole treatment resolves itself into the use of the warm bath, and a course of gentle aperients. The bath should be used when the oppression of the lungs renders the breathing difficult, or the heat and dryness of the skin, with the undeveloped rash beneath the surface, shows the necessity for its use.

2542. As the pustules in chicken-pox very rarely run to the state of suppuration, as in the other disease, there is no fear of pitting or disfigurement, except in very severe forms, which, however, happen so seldom as not to merit apprehension. When the eruption subsides, however, the face may be washed with elder-flower water, and the routine followed which is prescribed in the convalescent state of small-pox.

2543. COW-POX, properly speaking, is an artificial disease, established in a healthy body as a prophylactic, or preventive agent, against the more serious attack of small-pox, and is merely that chain of slight febrile symptoms and local irritation, consequent on the specific action of the lymph of the vaccination, in its action on the circulating system of the body. This is not the place to speak of the benefits conferred on mankind by the discovery of vaccination, not only as the preserver of the human features from a most loathsome disfigurement, but as a sanitary agent in the prolongation of life.

2544. Fortunately the State has now made it imperative on all parents to have their children vaccinated before, or by the end of, the twelfth week; thus doing away, as far as possible, with the danger to public health proceeding from the ignorance or prejudice of those parents whose want of information on the subject makes them object to the employment of this specific preventive; for though vaccination has been proved not to be always an infallible guard against small-pox, the attack is always much lighter, should it occur, and is seldom, if indeed ever, fatal after the precaution of vaccination. The best time to vaccinate a child is after the sixth and before the twelfth week, if it is in perfect health, but still earlier if small-pox is prevalent, and any danger exists of the infant taking the disease. It is customary, and always advisable, to give the child a mild aperient powder one or two days before inserting the lymph in the arm; and should measles, scarlet fever, or any other disease arise during the progress of the pustule, the child, when recovered, should be re-vaccinated, and the lymph taken from its arm on no account used for vaccinating purposes.

2545. The disease of cow-pox generally takes twenty days to complete its course; in other words, the maturity and declension of the pustule takes that time to fulfil its several changes. The mode of vaccination is either to insert the matter, or lymph, taken from a healthy child, under the cuticle in several places on both arms, or, which is still better, to make three slight scratches, or abrasions, with a lancet on one arm in this manner, ,,",, and work into the irritated parts the lymph, allowing the arm to dry thoroughly before putting down the infant's sleeve; by this means absorption is insured, and the unnecessary pain of several pustules on both arms avoided. No apparent change is observable by the eye for several days; indeed, not till the fourth, in many cases, is there any evidence of a vesicle; about the fifth day, however, a pink areola, or circle, is observed round one or all of the places, surrounding a small pearly vesicle or bladder. This goes on deepening in hue till the seventh or eighth day, when the vesicle is about an inch in diameter, with a depressed centre; on the ninth the edges are elevated, and the surrounding part hard and inflamed. The disease is now at its height, and the pustule should be opened, if not for the purpose of vaccinating other children, to allow the escape of the lymph, and subdue the inflammatory action. After the twelfth day the centre is covered by a brown scab, and the colour of the swelling becomes darker, gradually declining in hardness and colour till the twentieth, when the scab falls, off, leaving a small pit, or cicatrix, to mark the seat of the disease, and for life prove a certificate of successful vaccination.

2546. In some children the inflammation and swelling of the arm is excessive, and extremely painful, and the fever, about the ninth or tenth day, very high; the pustule, therefore, at that time, should sometimes be opened, the arm fomented every two hours with a warm bread poultice, and an aperient powder given to the infant.

MEASLES AND SCARLET FEVER, WITH THE TREATMENT OF BOTH.

Measles.

2547. This much-dreaded disease, which forms the next subject in our series of infantine diseases, and which entails more evils on the health of childhood than any other description of physical suffering to which that age of life is subject, may be considered more an affection of the venous circulation, tending to general and local congestion, attended with a diseased condition of the blood, than either as a fever or an inflammation; and though generally classed before or after scarlet fever, is, in its pathology and treatment, irrespective of its after-consequences, as distinct and opposite as one disease can well be from another.

4548. As we have already observed, measles are always characterized by the running at the nose and eyes, and great oppression of breathing; so, in the mode of treatment, two objects are to be held especially in view; first, to unload the congested state of the lungs,—the cause of the oppressed breathing; and, secondly, to act vigorously, both during the disease and afterwards, on the bowels. At the same time it cannot be too strongly borne in mind, that though the patient in measles should on no account be kept unduly hot, more care than in most infantine complaints should be taken to guard the body from cold, or any abrupt changes of temperature. With these special observations, we shall proceed to give a description of the disease, as recognized by its usual—

2549. Symptoms, which commence with cold chills and flushes, lassitude, heaviness, pain in the head, and drowsiness, cough, hoarseness, and extreme difficulty of breathing, frequent sneezing, deduction or running at the eyes and nose, nausea, sometimes vomiting, thirst, a furred tongue; the pulse throughout is quick, and sometimes full and soft, at others hard and small, with other indications of an inflammatory nature.

2550. On the third day, small red points make their appearance, first on the face and neck, gradually extending over the upper and lower part of the body. On the fifth day, the vivid red of the eruption changes into a brownish hue; and, in two or three days more, the rash entirely disappears, leaving a loose powdery desquamation on the skin, which rubs off like dandriff. At this stage of the disease a diarrhoea frequently comes on, which, being what is called "critical," should never be checked, unless seriously severe. Measles sometimes assume a typhoid or malignant character, in which form the symptoms are all greatly exaggerated, and the case from the first becomes both doubtful and dangerous. In this condition the eruption comes out sooner, and only in patches; and often, after showing for a few hours, suddenly recedes, presenting, instead of the usual florid red, a dark purple or blackish hue; a dark brown fur forms on the gums and mouth, the breathing becomes laborious, delirium supervenes, and, if unrelieved, is followed by coma; a fetid diarrhoea takes place, and the patient sinks under the congested state of the lungs and the oppressed functions of the brain.

2551. The unfavourable symptoms in measles are a high degree of fever, the excessive heat and dryness of the skin, hurried and short breathing, and a particularly hard pulse. The sequels, or after-consequences, of measles are, croup, bronchitis, mesenteric disease, abscesses behind the ear, ophthalmia, and glandular swellings in other parts of the body.

2552. Treatment.—In the first place, the patient should be kept in a cool room, the temperature of which must be regulated to suit the child's feelings of comfort, and the diet adapted to the strictest principles of abstinence. When the inflammatory symptoms are severe, bleeding, in some form, is often necessary, though, when adopted, it must be in the first stage of the disease; and, if the lungs are the apprehended seat of the inflammation, two or more leeches, according to the age and strength of the patient, must be applied to the upper part of the chest, followed by a small blister; or the blister may be substituted for the leeches, the attendant bearing in mind, that the benefit effected by the blister can always be considerably augmented by plunging the feet into very hot water about a couple of hours after applying the blister, and kept in the water for about two minutes. And let it further be remembered, that this immersion of the feet in hot water may be adopted at any time or stage of the disease; and that, whenever the head or lungs are oppressed, relief will always accrue from its sudden and brief employment. When the symptoms commence with much shivering, and the skin early assumes a hot, dry character, the appearance of the rash will be facilitated, and all the other symptoms rendered milder, if the patient is put into a warm bath, and kept in the water for about three minutes. Or, where that is not convenient, the following process, which will answer quite as well, can be substituted:—Stand the child, naked, in a tub, and, having first prepared several jugs of sufficiently warm water, empty them, in quick succession, over the patient's shoulders and body; immediately wrap in a hot blanket, and put the child to bed till it rouses from the sleep that always follows the effusion or bath. This agent, by lowering the temperature of the skin, and opening the pores, producing a natural perspiration, and unloading the congested state of the lungs, in most cases does away entirely with the necessity both for leeches and a blister. Whether any of these external means have been employed or not, the first internal remedies should commence with a series of aperient powders and a saline mixture, as prescribed in the following formularies; at the same time, as a beverage to quench the thirst, let a quantity of barley-water be made, slightly acidulated by the juice of an orange, and partially sweetened by some sugar-candy; and of which, when properly made and cold, let the patient drink as often as thirst, or the dryness of the mouth, renders necessary.

2553. Aperient Powders.—Take of scammony and jalap, each 24 grains; grey powder and powdered antimony, each 18 grains. Mix and divide into 12 powders, if for a child between two and four years of age; into 8 powders, if for a child between four and eight years of ago; and into 6 powders for between eight and twelve years. One powder to be given, in a little jelly or sugar-and-water, every three or four hours, according to the severity of the symptoms.

2554. Saline Mixture.—Take of mint-water, 6 ounces; powdered nitre, 20 grains; antimonial wine, 3 drachms; spirits of nitre, 2 drachms; syrup of saffron, 2 drachms. Mix. To children under three years, give a teaspoonful every two hours; from that age to six, a dessertspoonful at the same times; and a tablespoonful every three or four hours to children between six and twelve.

2555. The object of these aperient powders is to keep up a steady but gentle action on the bowels; but, whenever it seems necessary to administer a stronger dose, and effect a brisk action on the digestive organs,—a course particularly imperative towards the close of the disease,—two of these powders given at once, according to the age, will be found to produce that effect; that is, two of the twelve for a child under four years, and two of the eight, and two of the six, according to the age of the patient.

2556. When the difficulty of breathing becomes oppressive, as it generally does towards night, a hot bran poultice, laid on the chest, will be always found highly beneficial. The diet throughout must be light, and consist of farinaceous food, such as rice and sago puddings, beef-tea and toast; and not till convalescence sets in should hard or animal food be given.

2557. When measles assume the malignant form, the advice just given must be broken through; food of a nutritious and stimulating character should be at once substituted, and administered in conjunction with wine, and even spirits, and the disease regarded and treated as a case of typhus. But, as this form of measles is not frequent, and, if occurring, hardly likely to be treated without assistance, it is unnecessary to enter on the minutiae of its practice here. What we have prescribed, in almost all cases, will be found sufficient to meet every emergency, without resorting to a multiplicity of agents.

2558. The great point to remember in measles is, not to give up the treatment with the apparent subsidence of the disease, as the after-consequences of measles are too often more serious, and to be more dreaded, than the measles themselves. To guard against this danger, and thoroughly purify the system, after the subsidence of all the symptoms of the disease, a corrective course of medicine, and a regimen of exercise, should be adopted for some weeks after the cure of the disease. To effect this, an active aperient powder should be given every three or four clays, with a daily dose of the subjoined tonic mixture, with as much exercise, by walking, running after a hoop, or other bodily exertion, as the strength of the child and the state of the atmosphere will admit, the patient being, wherever possible, removed to a purer air as soon as convalescence warrants the change.

2559. Tonic Mixture.—Take of infusion of rose-leaves, 6 ounces; quinine, 8 grains; diluted sulphuric acid, 15 drops. Mix. Dose, from half a teaspoonful up to a dessertspoonful, once a day, according to the ago of the patient.

Scarlatina, or Scarlet Fever.

2560. Though professional accuracy has divided this disease into several forms, we shall keep to the one disease most generally mot with, the common or simple scarlet fever, which, in all cases, is characterized by an excessive heat on the skin, sore throat, and a peculiar speckled appearance of the tongue.

2561. Symptoms.—Cold chills, shivering, nausea, thirst, hot skin, quick pulse, with difficulty of swallowing; the tongue is coated, presenting through its fur innumerable specks, the elevated papillae of the tongue, which gives it the speckled character, that, if not the invariable sign of scarlet fever, is only met with in cases closely analogous to that disease. Between the second and third day, but most frequently on the third, a bright red efflorescence breaks out in patches on the face, neck, and back, from which it extends over the trunk and extremities, always showing thicker and deeper in colour wherever there is any pressure, such as the elbows, back, and hips; when the eruption is well out, the skin presents the appearance of a boiled lobster-shell. At first, the skin is smooth, but, as the disease advances, perceptible roughness is apparent, from the elevation of the rash, or, more properly, the pores of the skin. On the fifth and sixth days the eruption begins to decline, and by the eighth has generally entirely disappeared. During the whole of this period, there is, more or less, constant sore throat.

2562. The Treatment of scarlet fever is, in general, very simple. Where the heat is great, and the eruption comes out with difficulty, or recedes as soon as it appears, the body should be sponged with cold vinegar-and-water, or tepid water, as in measles, poured over the chest and body, the patient being, as in that disease, wrapped in a blanket and put to bed, and the same powders and mixture ordered in measles administered, with the addition of a constant hot bran poultice round the throat, which should be continued from the first symptom till a day or two after the declension of the rash. The same low diet and cooling drink, with the same general instructions, are to be obeyed in this as in the former disease.

2563. When the fever runs high in the first stage, and there is much nausea, before employing the effusions of water, give the patient an emetic, of equal, parts of ipecacuanha and antimonial wine, in doses of from a teaspoonful to a tablespoonful, according to age. By these means, nine out of every ten cases of scarlatina may be safely and expeditiously cured, especially if the temperature of the patient's room is kept at an even standard of about sixty degrees.

HOOPING-COUGH, CROUP, AND DIARRHOEA, WITH THEIR MODE OF TREATMENT.

Hooping-Cough.

2564. THIS is purely a spasmodic disease, and is only infectious through the faculty of imitation, a habit that all children are remarkably apt to fall into; and even where adults have contracted hooping-cough, it has been from the same cause, and is as readily accounted for, on the principle of imitation, as that the gaping of one person will excite or predispose a whole party to follow the same spasmodic example. If any one associates for a few days with a person who stammers badly, he will find, when released from his company, that the sequence of his articulation and the fluency of his speech are, for a time, gone; and it will be a matter of constant vigilance, and some difficulty, to overcome the evil of so short an association. The manner in which a number of school-girls will, one after another, fall into a fit on beholding one of their number attacked with epilepsy, must be familiar to many. These several facts lead us to a juster notion of how to treat this spasmodic disease. Every effort should, therefore, be directed, mentally and physically, to break the chain of nervous action, on which the continuance of the cough depends.

2565. Symptoms.—Hooping-cough comes on with a slight oppression of breathing, thirst, quick pulse, hoarseness, and a hard, dry cough. This state may exist without any change from one to two or three weeks before the peculiar feature of the disease-the hoop-sets in. As the characteristics of this cough are known to all, it is unnecessary to enter here, physiologically, on the subject. We shall, therefore, merely remark that the frequent vomiting and bleeding at the mouth or nose are favourable signs, and proceed to the

2566. Treatment, which should consist in keeping up a state of nausea and vomiting. For this purpose, give the child doses of ipecacuanha and antimonial wines, in equal parts, and quantities varying from half to one and a half teaspoonful once a day, or, when the expectoration is hard and difficult of expulsion, giving the following cough mixture every four hours. Take of

Syrup of squills 1/2 ounce. Antimonial wine 1 ounce. Laudanum 15 drops. Syrup of Toulou 2 drachms. Water 1-1/2 ounce.

Mix. The dose is from half a spoonful to a dessertspoonful. When the cough is urgent, the warm bath is to be used, and either one or two leeches applied over the breastbone, or else a small blister laid on the lower part of the throat.

2567. Such is the medical treatment of hooping-cough; but there is a moral regimen, based on the nature of the disease, which should never be omitted. And, on the principle that a sudden start or diversion of the mind will arrest a person in the act of sneezing or gaping, so the like means should be adopted with the hooping-cough patient; and, in the first stage, before the hooping has been added, the parent should endeavour to break the paroxysm of the cough by abruptly attracting the patient's attention, and thus, if possible, preventing the cough from reaching that height when the ingulp of air gives the hoop or crow that marks the disease; but when once that symptom has set in, it becomes still more necessary to endeavour, by even measures of intimidation, to break the spasmodic chain of the cough. Exercise in the open air, when dry, is also requisite, and charge of scene and air in all cases is of absolute necessity, and may be adopted at any stage of the disease.

Croup.

2568. This is by far the most formidable and fatal of all the diseases to which infancy and childhood are liable, and is purely an inflammatory affection, attacking that portion of the mucous membrane lining the windpipe and bronchial tubes, and from the effect of which a false or loose membrane is formed along the windpipe, resembling in appearance the finger of a glove suspended in the passage, and, consequently, terminating the life of the patient by suffocation; for, as the lower end grows together and becomes closed, no air can enter the lungs, and the child dies choked. All dull, fat, and heavy children are peculiarly predisposed to this disease, and those with short necks and who make a wheezing noise in their natural breathing. Croup is always sudden in its attack, and rapid in its career, usually proving fatal within three days; most frequently commences in the night, and generally attacking children between the ages of three and ten years. Mothers should, therefore, be on their guard who have children predisposed to this disease, and immediately resort to the means hereafter advised.

2569. Symptoms.—Languor and restlessness, hoarseness, wheezing, and short, dry cough, with occasional rattling in the throat during sleep, the child often plucking at its throat with its fingers; difficulty of breathing, which quickly becomes hard and laboured, causing great anxiety of the countenance, and the veins of the neck to swell and become knotted; the voice in speaking acquires a sharp, crowing, or croupy sound, while the inspirations have a harsh, metallic intonation. After a few hours, a quantity of thick, ropy mucus is thrown out, hanging about the mouth, and causing suffocating fits of coughing to expel.

2570. Treatment.—Place the child immediately in a hot bath up to the throat; and, on removal from the water, give an emetic of the antimonial or ipecacuanha wine, and, when the vomiting has subsided, lay a long blister down the front of the throat, and administer one of the following powders every twenty minutes to a child from three to six years of age.

2571. Take of calomel, 12 grains; tartar emetic, 2 grains; lump sugar, 30 grains. Mix accurately, and divide into 12 powders. For a child from six to twelve years, divide into 6 powders, and give one every half-hour.

2572. Should the symptoms remain unabated after a few hours, apply one or two leeches to the throat, and put mustard poultices to the foot and thighs, retaining them about eight minutes; and, in extreme cases, a mustard poultice to the spine between the shoulders, and at the same time rub mercurial ointment into the armpits and the angles of the jaws.

2573. Such is a vigorous and reliable system of treatment in severe cases of croup; but, in the milder and more general form, the following abridgment will, in all probability, be all that will be required:—First, the hot bath; second, the emetic; third, a mustard plaster round the throat for five minutes; fourth, the powders; fifth, another emetic in six hours, if needed, and the powders continued without intermission while the urgency of the symptoms continues. When relief has been obtained, these are to be discontinued, and a dose of senna tea given to act on the bowels.

Diarrhoea.

2574. The diarrhoea with which children are so frequently affected, especially in infancy, should demand the nurse's immediate attention, and when the secretion, from its clayey colour, indicates an absence of bile, a powder composed of 3 grains of grey powder and 1 grain of rhubarb, should be given twice, with an interval of four hours between each dose, to a child from one to two years, and, a day or two afterwards, an aperient powder containing the same ingredients and quantities, with the addition of 2 or 3 grains of scammony. For the relaxation consequent on an overloaded stomach, or acidity in the bowels, a little magnesia dissolved in milk should be employed two or three times a day.

2575. When much griping and pain attend the diarrhoea, half a teaspoonful of Dalby's Carminative (the best of all patent medicines) should be given, either with or without a small quantity of castor oil to carry off the exciting cause.

2576. For any form of diarrhoea that, by excessive action, demands a speedy correction, the most efficacious remedy that can be employed in all ages and conditions of childhood is the tincture of Kino, of which from 10 to 30 drops, mixed with a little sugar and water in a spoon, are to be given every two or three hours till the undue action has been checked. Often the change of diet to rice, milk, eggs, or the substitution of animal for vegetable food, or vice versa, will correct an unpleasant and almost chronic state of diarrhoea.

2577. A very excellent carminative powder for flatulent infants may be kept in the house, and employed with advantage, whenever the child is in pain or griped, by dropping 5 grains of oil of aniseed and 2 of peppermint on half an ounce of lump sugar, and rubbing it in a mortar, with a drachm of magnesia, into a fine powder. A small quantity of this may be given in a little water at any time, and always with benefit.



THE DOCTOR.

CHAPTER XLIII.

2578. "Time," according to the old proverb, "is money;" and it may also, in many cases, and with equal truthfulness, be said to be life; for a few moments, in great emergencies, often turn the balance between recovery and death. This applies more especially to all kinds of poisoning, fits, submersion in water, or exposure to noxious gases; and many accidents. If people knew how to act during the interval that must necessarily elapse from the moment that a medical man is sent for until he arrives, many lives might be saved, which now, unhappily, are lost. Generally speaking, however, nothing is done—all is confusion and fright; and the surgeon, on his arrival, finds that death has already seized its victim, who, had his friends but known a few rough rules for their guidance, might have been rescued. We shall, therefore, in a series of papers, give such information as to the means to be employed in event of accidents, injuries, &c., as, by the aid of a gentleman of large professional experience, we are warranted in recommending.

List of Drugs, &c., necessary to carry out all Instructions.

2579. We append at once A LIST OF DRUGS, &c., and a few PRESCRIPTIONS necessary to carry out all the instructions given in this series of articles. It will be seen that they are few—they are not expensive; and by laying in a little stock of them, our instructions will be of instant value in all cases of accident, &c.—The drugs are—Antimonial Wine. Antimonial Powder. Blister Compound. Blue Pill. Calomel. Carbonate of Potash. Compound Iron Pills. Compound Extract of Colocynth. Compound Tincture of Camphor. Epsom Salts. Goulard's Extract. Jalap in Powder. Linseed Oil. Myrrh and Aloes Pills. Nitre. Oil of Turpentine. Opium, powdered, and Laudanum. Sal Ammoniac. Senna Leaves. Soap Liniment, Opodeldoc. Sweet Spirits of Nitre. Turner's Cerate.—To which should be added: Common Adhesive Plaster. Isinglass Plaster. Lint. A pair of small Scales with Weights. An ounce and a drachm Measure-glass. A Lancet. A Probe. A pair of Forceps, and some curved Needles.

2580. The following PRESCRIPTIONS may be made up for a few shillings; and, by keeping them properly labelled, and by referring to the remarks on the treatment of any particular case, much suffering, and, perhaps, some lives, may be saved.

2581. Draught.—Twenty grains of sulphate of zinc in an ounce and a half of water. This draught is to be repeated in a quarter of an hour if vomiting does not take place.

2582. Clyster.—Two tablespoonfuls of oil of turpentine in a pint of warm gruel.

2583. Liniments.—1. Equal parts of lime-water and linseed-oil well mixed together. [Lime-water is made thus: Pour 6 pints of boiling water upon 1/4 lb. of lime; mix well together, and when cool, strain the liquid from off the lime which has fallen to the bottom, taking care to get it as clear as possible.] 2. Compound camphor liniment.

2584. Lotions.—1. Mix a dessert-spoonful of Goulard's extract and 2 tablespoonfuls of vinegar in a pint of water.—2. Mix 1/2 oz. of sal-ammoniac, 2 tablespoonfuls of vinegar, and the same quantity of gin or whisky, in half a pint of water.

2585. Goulard Lotion.—1 drachm of sugar of lead, 2 pints of rain-water, 2 teaspoonfuls of spirits of wine. For inflammation of the eyes or elsewhere:—The better way of making Goulard Lotion, if for the eyes, is to add to 6 oz. of distilled water, or water that has been well boiled, 1 drachm of the extract of lead.

2586. Opodeldoc.—This lotion being a valuable application for sprains, lumbago, weakness of joints, &c., and it being difficult to procure either pure or freshly made, we give a recipe for its preparation. Dissolve 1 oz. of camphor in a pint of rectified spirits of wine; then dissolve 4 oz. of hard white Spanish soap, scraped thin, in 4 oz. of oil of rosemary, and mix them together.

2587. The Common Black Draught.—Infusion of senna 10 drachms; Epsom salts 10 drachms; tincture of senna, compound tincture of cardamums, compound spirit of lavender, of each 1 drachm. Families who make black draught in quantity, and wish to preserve it for some time without spoiling, should add about 2 drachms of spirits of hartshorn to each pint of the strained mixture, the use of this drug being to prevent its becoming mouldy or decomposed. A simpler and equally efficacious form of black draught is made by infusing 1/2 oz. of Alexandrian senna, 3 oz. of Epsom salts, and 2 drachms of bruised ginger and coriander-seeds, for several hours in a pint of boiling water, straining the liquor, and adding either 2 drachms of sal-volatile or spirits of hartshorn to the whole, and giving 3 tablespoonfuls for a dose to an adult.

2588. Mixtures—1. Aperient.—Dissolve an ounce of Epsom salts in half a pint of senna tea: take a quarter of the mixture as a dose, and repeat it in three or four hours if necessary.

2589. 2. Fever Mixture.—Mix a drachm of powdered nitre, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitre, in half a pint of water.

2590. 3. Myrrh and Aloes Pills.—Ten grains made into two pills are the dose for a full-grown person.

2591. 4. Compound Iron Pills.—Dose for a full-grown person: 10 grains made into two pills.

2592. Pills.—1. Mix 5 grains of calomel and the same quantity of antimonial powder with a little bread-crumb, and make into two pills. Dose for a full-grown person: two pills.—2. Mix 5 grains of blue pill and the same quantity of compound extract of colocynth together, and make into two pills, the dose for a full-grown person.

2593. Powders.—Mix a grain of calomel and 4 grains of powdered jalap together.

2594. In all cases, the dose of medicines given is to be regulated by the age of the patient.

2595. Abernethy's Plan for making a Bread-and-Water Poultice.—First scald out a basin; then having put in some boiling water, throw in coarsely-crumbled bread, and cover it with a plate. When the bread has soaked up as much water as it will imbibe, drain off the remaining water, and there will be left a light pulp. Spread it a third of an inch thick on folded linen, and apply it when of the temperature of a warm bath. To preserve it moist, occasionally drop warm water on it.

2596. Linseed-Meal Poultice.—"Scald your basin, by pouring a little hot water into it; then put a small quantity of finely-ground linseed-meal into the basin, pour a little hot water on it, and stir it round briskly until you have well incorporated them; add a little more meal and a little more water; then stir it again. Do not let any lumps remain in the basin, but stir the poultice well, and do not be sparing of your trouble. What you do next, is to take as much of it out of the basin as you may require, lay it on a piece of soft linen, and let it be about a quarter of an inch thick."—Abernethy.

2597. Mustard Poultice.—Mix equal parts of dry mustard and linseed-meal in warm vinegar. When the poultice is wanted weak, warm water may be used for the vinegar; and when it is required very strong, mustard alone, without any linseed-meal, is to be mixed with warm vinegar.

2598. An ordinary Blister.—Spread a little blister compound on a piece of common adhesive plaster with the right thumb. It should be put on just thickly enough to conceal the appearance of the plaster beneath. The part from which a blister has been taken should be covered till it heals over with soft linen rags smeared with lard.

Baths and Fomentations.

2599. All fluid applications to the body are exhibited either in a hot or cold form; and the object for which they are administered is to produce a stimulating effect over the entire, or a part, of the system; for the effect, though differently obtained, and varying in degree, is the same in principle, whether procured by hot or cold water.

2600. Heat.—There are three forms in which heat is universally applied to the body,—that of the tepid, warm, and vapour bath; but as the first is too inert to be worth notice, and the last dangerous and inapplicable, except in public institutions, we shall confine our remarks to the really efficacious and always attainable one—the

2601. Warm and Hot Bath.—These baths are used whenever there is congestion, or accumulation of blood in the internal organs, causing pain, difficulty of breathing, or stupor, and are employed, by their stimulating property, to cause a rush of blood to the surface, and, by unloading the great organs, produce a temporary inflammation in the skin, and so equalize the circulation. The effect of the hot bath is to increase the fulness of the pulse, accelerate respiration, and excite perspiration. In all inflammations of the stomach and bowels, the hot bath is of the utmost consequence; the temperature of the warm bath varies from 92 deg. to 100 deg., and may be obtained by those who have no thermometer to test the exact heat, by mixing one measure of boiling with two of cold water.

2602. Fomentations are generally used to effect, in a part, the benefit produced on the whole body by the bath; to which a sedative action is occasionally given by the use of roots, herbs, or other ingredients; the object being to relieve the internal organ, as the throat, or muscles round a joint, by exciting a greater flow of blood to the skin over the affected part. As the real agent of relief is heat, the fomentation should always be as hot as it can comfortably be borne, and, to insure effect, should be repeated every half-hour. Warm fluids are applied in order to render the swelling which accompanies inflammation less painful, by the greater readiness with which the skin yields, than when it is harsh and dry. They are of various kinds; but the most simple, and oftentimes the most useful, that can be employed, is "Warm Water." Another kind of fomentation is composed of dried poppyheads, 4 oz. Break them to pieces, empty out the seeds, put them into 4 pints of water, boil for a quarter of an hour, then strain through a cloth or sieve, and keep the water for use. Or, chamomile flowers, hemlock, and many other plants, may be boiled, and the part fomented with the hot liquor, by means of flannels wetted with the decoction.

2603. Cold, when applied in excess to the body, drives the blood from the surface to the centre, reduces the pulse, makes the breathing hard and difficult, produces coma, and, if long continued, death. But when medicinally used, it excites a reaction on the surface equivalent to a stimulating effect; as in some cases of fever, when the body has been sponged with cold water, it excites, by reaction, increased circulation on the skin. Cold is sometimes used to keep up a repellent action, as, when local inflammation takes place, a remedy is applied, which, by its benumbing and astringent effect, causes the blood, or the excess of it in the part, to recede, and, by contracting the vessels, prevents the return of any undue quantity, till the affected part recovers its tone. Such remedies are called Lotions, and should, when used, be applied with the same persistency as the fomentation; for, as the latter should be renewed as often as the heat passes off, so the former should be applied as often as the heat from the skin deprives the application of its cold.

2604. Poultices are only another form of fomentation, though chiefly used for abscesses. The ingredient best suited for a poultice is that which retains heat the longest; of these ingredients, the best are linseed—meal, bran, and bread. Bran sewed into a bag, as it can be reheated, will be found the cleanest and most useful; especially for sore throats.

How to Bleed.

2605. In cases of great emergency, such as the strong kind of apoplexy, and when a surgeon cannot possibly be obtained for some considerable time, the life of the patient depends almost entirely upon the fact of his being bled or not. We therefore give instructions how the operation of bleeding is to be performed, but caution the reader only to attempt it in cases of the greatest emergency. Place a handkerchief or piece of tape rather but not too tightly round the arm, about three or four inches above the elbow. This will cause the veins below to swell and become very evident. If this is not sufficient, the hand should be constantly and quickly opened and shut for the same purpose. There will now be seen, passing up the middle of the fore-arm, a vein which, just below the bend of the elbow, sends a branch inwards and outwards, each branch shortly joining another large vein. It is from the outer branch—that the person is to be bled. The right arm is the one mostly operated on. The operator should take the lancet in his right hand, between the thumb and first finger, place the thumb of his left hand on the vein below the part where he is going to bleed from, and then gently thrust the tip of the lancet into the vein, and, taking care not to push it too deeply, cut in a gently curved direction, thus and bring it out, point upwards, at about half an inch from the part of the vein into which he had thrust it. The vein must be cut lengthways, and not across. When sufficient blood has been taken away, remove the bandage from above the elbow, and place the thumb of the left hand firmly over the cut, until all the bleeding ceases. A small pad of lint is then to be put over the cut, with a larger pad over it, and the two kept in their places by means of a handkerchief or linen roller bound pretty tightly over them and round the arm.

2606. When a person is bled, he should always be in the standing, or at any rate in the sitting, position; for if, as is often the case, he should happen to faint, he can, in, most eases at least, easily be brought to again by the operator placing him flat on his back, and stopping the bleeding. This is of the greatest importance. It has been recommended, for what supposed advantages we don't know, to bleed people when they are lying down. Should a person, under these circumstances, faint, what could be done to bring him to again? The great treatment of lowering the body of the patient to the flat position cannot be followed here. It is in that position already, and cannot be placed lower than it at present is—except, as is most likely to be the case, under the ground.

2607. BLEEDING FROM THE NOSE.—Many children, especially those of a sanguineous temperament, are subject to sudden discharges of blood from some part of the body; and as all such fluxes are in general the result of an effort of nature to relieve the system from some overload or pressure, such discharges, unless in excess, and when likely to produce debility, should not be rashly or too abruptly checked. In general, these discharges are confined to the summer or spring months of the year, and follow pains in the head, a sense of drowsiness, languor, or oppression; and, as such symptoms are relieved by the loss of blood, the hemorrhage should, to a certain extent, be encouraged. When, however, the bleeding is excessive, or returns too frequently, it becomes necessary to apply means to subdue or mitigate the amount. For this purpose the sudden and unexpected application of cold is itself sufficient, in most cases, to arrest the most active hemorrhage. A wet towel laid suddenly on the back, between the shoulders, and placing the child in a recumbent posture, is often sufficient to effect the object; where, however, the effusion resists such simple means, napkins wrung out of cold water must be laid across the forehead and nose, the hands dipped in cold water, and a bottle of hot water applied to the feet. If, in spite of these means, the bleeding continues, a little fine wool or a few folds of lint, tied together by a piece of thread, must be pushed up the nostril from which the blood flows, to act as a plug and pressure on the bleeding vessel. When the discharge has entirely ceased, the plug is to be pulled out by means of the thread. To prevent a repetition of the hemorrhage, the body should be sponged every morning with cold water, and the child put under a course of steel wine, have open-air exercise, and, if possible, salt-water bathing. For children, a key suddenly dropped down the back between the skin and clothes, will often immediately arrest a copious bleeding.

2608. SPITTING OF BLOOD, or hemorrhage from the lungs, is generally known from blood from the stomach by its being of a brighter colour, and in less quantities than that, which is always grumous and mixed with the half-digested food. In either case, rest should be immediately enjoined, total abstinence from stimulants, and a low, poor diet, accompanied with the horizontal position, and bottles of boiling water to the feet. At the same time the patient should suck through a quill, every hour, half a wine-glass of water in which 10 or 15 drops of the elixir of vitriol has been mixed, and, till further advice has been procured, keep a towel wrung out of cold water on the chest or stomach, according to the seat of the hemorrhage.

Bites and Stings.

2609. BITES AND STINGS may be divided into three kinds:—1. Those of Insects. 2. Those of Snakes. 3. Those of Dogs and other Animals.

2610. 1. The Bites or Stings of Insects, such as gnats, bees, wasps, &c., need cause very little alarm, and are, generally speaking, easily cured. They are very serious, however, when they take place on some delicate part of the body, such as near the eye, or in the throat. The treatment is very simple in most cases; and consists in taking out the sting, if it is left behind, with a needle, and applying to the part a liniment made of finely-scraped chalk and olive-oil, mixed together to about the thickness of cream.

2611. Bathing the part bitten with warm turpentine or warm vinegar is also of great use. If the person feels faint, he should lie quietly on his back, and take a little brandy-and-water, or sal-volatile and water. When the inside of the throat is the part stung, there is great danger of violent inflammation taking place. In this case, from eight to twelve leeches should be immediately put to the outside of the throat, and when they drop off, the part to which they had been applied should be well fomented with warm water. The inside of the throat is to be constantly gargled with salt and water. Bits of ice are to be sucked. Rubbing the face and hands well over with plain olive-oil, before going to bed, will often keep gnats and musquitoes from biting during the night. Strong scent, such as eau-de-Cologne, will have the same effect.

2612. 2. Bites of Snakes.—These are much more dangerous than the preceding, and require more powerful remedies. The bites of the different kinds of snakes do not all act alike, but affect people in different ways.—Treatment of the part bitten. The great thing is to prevent the poison getting into the blood; and, if possible, to remove the whole of it at once from the body. A pocket-handkerchief, a piece of tape or cord, or, in fact, of anything that is at hand, should be tied tightly round the part of the body bitten; if it be the leg or arm, immediately above the bite, and between it and the heart. The bite should then be sucked several times by any one who is near. There is no danger in this, provided the person who does it has not got the skin taken off any part of his mouth. What has been sucked into the mouth should be immediately spit out again. But if those who are near have sufficient nerve for the operation, and a suitable instrument, they should cut out the central part bitten, and then bathe the wound for some time with warm water, to make it bleed freely. The wound should afterwards be rubbed with a stick of lunar caustic, or, what is better, a solution of this—60 grains of lunar caustic dissolved in an ounce of water—should be dropped into it. The band should be kept on the part during the whole of the time that these means are being adopted. The wound should afterwards be covered with lint dipped in cold water. The best plan, however, to be adopted, if it can be managed, is the following:—take a common wine-glass, and, holding it upside down, put a lighted candle or a spirit-lamp into it for a minute or two. This will take out the air. Then clap the glass suddenly over the bitten part, and it will become attached, and hold on to the flesh. The glass being nearly empty, the blood containing the poison will, in consequence, flow into it from the wound of its own accord. This process should be repeated three or four times, and the wound sucked, or washed with warm water, before each application of the glass. As a matter of course, when the glass is removed, all the blood should be washed out of it before it is applied again.—Constitutional Treatment. There is mostly at first great depression of strength in these cases, and it is therefore requisite to give some stimulant; a glass of hot brandy-and-water, or twenty drops of sal-volatile, is the best that can be given. When the strength has returned, and if the patient has not already been sick, a little mustard in hot water should be given, to make him so. If, on the other hand, as is often the case, the vomiting is excessive, a large mustard poultice should be placed over the stomach, and a grain of solid opium swallowed in the form of a pill, for the purpose of stopping it. Only one of these pills should be given by a non-professional person. In all cases of bites from snakes, send for a surgeon as quickly as possible, and act according to the above directions until he arrives. If he is within any reasonable distance, content yourself by putting on the band, sucking the wound, applying the glass, and, if necessary, giving a little brandy-and-water.

2613. 3. Bites of Dogs.—For obvious reasons, these kinds of bites are more frequently met with than those of snakes. The treatment is the same as that for snake-bites, more especially that of the bitten part. The majority of writers on the subject are in favour of keeping the wound open as long as possible. This may be done by putting a few beans on it, and then by applying a large linseed-meal poultice over them.

Injuries and Accidents to Bones.

2614. Dislocation of Bones.—When the end of a bone is pushed out of its natural position, it is said to be dislocated. This may be caused by violence, disease, or natural weakness of the parts about a joint.—Symptoms. Deformity about the joint, with unnatural prominence at one part, and depression at another. The limb may be shorter or longer than usual, and is stiff and unable to be moved, differing in these last two respects from a broken limb, which is mostly shorter, never longer, than usual, and which is always more movable.—Treatment. So much practical science and tact are requisite in order to bring a dislocated bone into its proper position again, that we strongly advise the reader never to interfere in these cases; unless, indeed, it is altogether impossible to obtain the services of a surgeon. But because any one of us may very possibly be placed in that emergency, we give a few rough rules for the reader's guidance. In the first place make the joint, from which the bone has been displaced, perfectly steady, either by fixing it to some firm object or else by holding it with the hands; then pull the dislocated bone in a direction towards the place from which it has been thrust, so that, if it moves at all from its unnatural position, it may have the best chance of returning to its proper place. Do not, however, pull or press against the parts too violently, as you may, perhaps, by doing so, rupture blood-vessels, and produce most serious consequences. When you do attempt to reduce a dislocated bone, do it as quickly as possible after the accident has taken place, every hour making the operation more difficult. When the patient is very strong, he may be put into a warm bath until he feels faint, or have sixty drops of antimonial wine given him every ten minutes until he feels sickish. These two means are of great use in relaxing the muscles. If the bone has been brought back again to its proper place, keep it there by means of bandages; and if there is much pain about the joint, apply a cold lotion to it, and keep it perfectly at rest. The lotion should be, a dessert-spoonful of Goulard's extract, and two tablespoonfuls of vinegar, mixed in a pint of water. Leeches are sometimes necessary. Unless the local pain, or general feverish symptoms, are great, the patient's diet should be the same as usual. Dislocations may be reduced a week, or even a fortnight, after they have taken place. As, therefore, although the sooner a bone is reduced the better, there is no very great emergency, and as the most serious consequences may follow improper or too violent treatment, it is always better for people in these cases to do too little than too much; inasmuch as the good which has not yet may still be done, whereas the evil that has been done cannot so easily be undone.

2615. FRACTURES OF BONES.—Symptoms. 1. Deformity of the part. 2. Unnatural looseness. 3. A grating sound when the two ends of the broken bone are rubbed together. 4. Loss of natural motion and power. In some cases there is also shortening of the limb.—Fracture takes place from several causes, as a fall, a blow, a squeeze, and sometimes from the violent action of muscles.—Treatment. In cases where a surgeon cannot be procured immediately after the accident, the following general rules are offered for the reader's guidance:—The broken limb should be placed and kept as nearly as possible in its natural position. This is to be done by first pulling the two portions of the bone in opposite directions, until the limb becomes as long as the opposite one, and then by applying a splint, and binding it to the part by means of a roller. When there is no deformity, the pulling is of course unnecessary. If there is much swelling about the broken part, a cold lotion is to be applied. This lotion (which we will call Lotion No. 1) may be thus made:—Mix a dessert-spoonful of Goulard's extract and two tablespoonfuls of vinegar in a pint of water. When the leg or arm is broken, always, if possible, get it to the same length and form as the opposite limb. The broken part should be kept perfectly quiet. When a broken limb is deformed, and a particular muscle is on the stretch, place the limb in such a position as will relax it. This will in most cases cure the deformity. Brandy-and-water, or sal-volatile and water, are to be given when the patient is faint. Surgical aid should, of course, be procured as soon as possible.

2616. JOINTS, INJURIES TO.—All kinds of injuries to joints, of whatever description, require particular attention, in consequence of the violent inflammations which are so liable to take place in these parts of the body, and which do so much mischief in a little time. The joint injured should always be kept perfectly at rest; and when it is very painful, and the skin about it red, swollen, hot, and shining, at the same time that the patient has general feverish symptoms, such as great thirst and headache—leeches, and when they drop off, warm poppy fomentations, are to be applied; the No. 1 pills above-mentioned are to be given (two are a dose for a grown person) with a black draught three hours afterwards. Give also two tablespoonfuls of the fever-mixture every four hours, and keep the patient on low diet. When the injury and swelling are not very great, warm applications, with rest, low diet, and a dose of aperient medicine, will be sufficient. When a joint has received a penetrating wound, it will require the most powerful treatment, and can only be properly attended to by a surgeon. The patient's friends will have to use their own judgment to a great extent in these and in many other cases, as to when leeches, fever-mixture, &c., are necessary. A universal rule, however, without a single exception, is always to rest a joint well after it has been injured in any way whatever, to purge the patient, and to keep him on low diet, without beer, unless he has been a very great drinker indeed, in which case he may still be allowed to take a little; for if the stimulant that a person has been accustomed to in excess be all taken away at once, he is very likely to have an attack of delirium tremens. The quantity given should not, however, be much—say a pint, or, at the most, a pint and a half a day. Rubbing the joint with opodeldoc, or the application of a blister to it, is of great service in taking away the thickenings, which often remain after all heat, pain, and redness have left an injured joint. Great care should be observed in not using a joint too quickly after it has been injured. When the shoulder-joint is the one injured, the arm should be bound tightly to the body by means of a linen or flannel roller, and the elbow raised; when the elbow, it should be kept raised in the straight position, on a pillow; when the wrist, it should be raised on the chest, and suspended in a sling; when the knee, it should be kept in the straight position; and, lastly, when the ankle, it should be a little raised on a pillow.

2617. BRUISES, LACERATIONS, AND CUTS.—Wherever the bruise may be, or however swollen or discoloured the skin may become, two or three applications of the extract of lead, kept to the part by means of lint, will, in an hour or little more, remove all pain, swelling, and tenderness. Simple or clean cuts only require the edges of the wound to be placed in their exact situation, drawn close together, and secured there by one or two slips of adhesive plaster. When the wound, however, is jagged, or the flesh or cuticle lacerated, the parts are to be laid as smooth and regular as possible, and a piece of lint, wetted in the extract of lead, laid upon the wound, and a piece of greased lint placed above it to prevent the dressing sticking; the whole covered over to protect from injury, and the part dressed in the same manner once a day till the cure is effected.

2618. BRUISES AND THEIR TREATMENT.—The best application for a bruise, be it large or small, is moist warmth; therefore, a warm bread-and-water poultice in hot moist flannels should be put on, as they supple the skin. If the bruise be very severe, and in the neighbourhood of a joint, it will be well to apply ten or a dozen leeches over the whole bruised part, and afterwards a poultice. But leeches should not be put on young children. If the bruised part be the knee or the ankle, walking should not be attempted till it can be performed without pain. Inattention to this point often lays the foundation for serious mischief in these joints, especially in the case of scrofulous persons. In all conditions of bruises occurring in children, whether swellings or abrasions, no remedy is so quick or certain of effecting a cure as the pure extract of lead applied to the part.

Burns and Scalds.

2619. BURNS AND SCALDS being essentially the same in all particulars, and differing only in the manner of their production, may be spoken of together. As a general rule, scalds are less severe than burns, because the heat of water, by which scalds are mostly produced, is not, even when it is boiling, so intense as that of flame; oil, however, and other liquids, whose boiling-point is high, produce scalds of a very severe nature. Burns and scalds have been divided into three classes. The first class comprises those where the burn is altogether superficial, and merely reddens the skin; the second, where the injury is greater, and we get little bladders containing a fluid (called serum) dotted over the affected part; in the third class we get, in the case of burns, a charring, and in that of scalds, a softening or pulpiness, perhaps a complete and immediate separation of the part. This may occur at once, or in the course of a little time. The pain from the second kind of burns is much more severe than that in the other two, although the danger, as a general rule, is less than it is in the third class. These injuries are much more dangerous when they take place on the trunk than when they happen on the arms or legs. The danger arises more from the extent of surface that is burnt than from the depth to which the burn goes. This rule, of course, has certain exceptions; because a small burn on the chest or belly penetrating deeply is more dangerous than a more extensive but superficial one on the arm or leg. When a person's clothes are in flames, the best way of extinguishing them is to wind a rug, or some thick material, tightly round the whole of the body.

2620. Treatment of the First Class of Burns and Scalds.—Of the part affected.—Cover it immediately with a good coating of common flour, or cotton-wool with flour dredged well into it. The great thing is to keep the affected surface of the skin from the contact of the air. The part will shortly get well, and the skin may or may not peel off.—Constitutional Treatment. If the burn or scald is not extensive, and there is no prostration of strength, this is very simple, and consists in simply giving a little aperient medicine—pills (No. 2), as follows:—Mix 5 grains of blue pill and the same quantity of compound extract of colocynth, and make into two pills—the dose for a full-grown person. Three hours after the pills give a black draught. If there are general symptoms of fever, such as hot skin, thirst, headache, &c. &c., two tablespoonfuls of fever-mixture are to be given every four hours. The fever-mixture, we remind our readers, is made thus:-Mix a drachm of powdered nitro, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitro, in half a pint of water.

2621. Second Class. Local Treatment.—As the symptoms of these kinds of burns are more severe than those of the first class, so the remedies appropriate to them are more powerful. Having, as carefully as possible, removed the clothes from the burnt surface, and taking care not to break the bladders, spread the following liniment (No. 1) on a piece of linen or lint—not the fluffy side—and apply it to the part: the liniment should be equal parts of lime-water and linseed-oil, well mixed. If the burn is on the trunk of the body, it is better to use a warm linseed-meal poultice. After a few days dress the wound with Turner's cerate. If the burn is at the bend of the elbow, place the arm in the straight position; for if it is bent, the skin, when healed, will be contracted, and the arm, in all probability, always remain in the same un natural position. This, indeed, applies to all parts of the body; therefore, always place the part affected in the most stretched position possible.—Constitutional Treatment. The same kind of treatment is to be used as for the first class, only it must be more powerful. Stimulants are move often necessary, but must be given with great caution. If, as is often the case, there is great irritability and restlessness, a dose of opium (paregoric, in doses of from sixty to a hundred drops, according to age, is best) is of great service. The feverish symptoms will require aperient medicines and the fever mixture. A drink made of about a tablespoonful of cream of tartar and a little lemon-juice, in a quart of warm water, allowed to cool, is a very nice one in these cases. The diet throughout should not be too low, especially if there is much discharge from the wound. After a few days it is often necessary to give wine, ammonia, and strong beef-tea. These should be had recourse to when the tongue gets dry and dark, and the pulse weak and frequent. If there should be, after the lapse of a week or two, pain over one particular part of the belly, a blister should be put on it, and a powder of mercury and chalk-grey powder, and Dover's powder (two grains of the former and five of the latter) given three times a day. Affections of the head and chest also frequently occur as a consequence of these kinds of burns, but no one who is not a medical man can treat them.

2622. Third Class.—These are so severe as to make it impossible for a non-professional person to be of much service in attending to them. When they occur, a surgeon should always be sent for. Until he arrives, however, the following treatment should be adopted:—Place the patient full-length on his back, and keep him warm. Apply fomentations of flannels wrung out of boiling water and sprinkled with spirits of turpentine to the part, and give wine and sal-volatile in such quantities as the prostration of strength requires; always bearing in mind the great fact that you have to steer between two quicksands—death from present prostration and death from future excitement, which will always be increased in proportion to the amount of stimulants given. Give, therefore, only just as much as is absolutely necessary to keep life in the body.