DISEASES PECULIAR TO CHILDREN—Continued.

(a) Indigestion in very young children is generally accompanied with diarrhoea, because that portion of the child’s food which is not thrown up or digested passes along the intestinal canal and acting as an irritant causes diarrhoea. An indigestion of only a short period of duration excites a catarrhal inflammation of the mucous membrane of the stomach, and this may be so slight that even a change or correction in the diet may be all that is required to relieve it. Children who are suffering from indigestion have stomach ache; this may be continuous or come on half an hour or an hour after nursing. The pain is due to the irritation caused by the nutriment or to the fermentation of the food and the consequent accumulation of gas within the stomach. The stomach becomes distended and sensitive to pressure. When the catarrh is severe the nutriment that the child takes into the stomach is immediately rejected or it may vomit glairy or greenish mucus from an empty stomach. At first the nutrition of the child may not be greatly interfered with, for some of the food is retained and digested in the small intestines, but in the course of time these too become irritated and then diarrhoea complicates the case and the child falls off and becomes rapidly emaciated. Children who are nourished from their mother’s breasts rarely suffer from indigestion, but those who are fed on artificial foods become victims of stomach and bowel troubles. And for this reason it is natural to suppose that the chief reliance for a successful treatment is to regulate and study the diet of the sufferer; the chapter that is especially devoted to this subject should be consulted for further information.

(b) Diarrhoea is a derangement of the stools in which they loose their semi-solid, pap-like consistence and become watery liquid alone, or watery liquid in which indigested particles of food and fecal matter remain suspended. The quantity of alvine matter that is evacuated greatly exceeds that which passes in the normal state. The stools have an alkaline or acrid nature which irritates and often inflames the anus and the surrounding integument. “The normal form of the infantile feces in the first year of life is the pappy; the color is yellow like that of the yolk of egg; the smell is feebly acid, never putrid, and only in children who are fed upon a meat diet as repulsively pungent as in the adult; in later years they are no longer distinguished from the adult.”

The passages of diarrhoea may be simply softer, but yellowish and increased in quantity, or they may be bright yellow and so watery as to squeeze out from the anus as from a syringe and soak through diapers and bedclothes, or the stools may be green, or bilious, and slimy. When children teethe they often have a diarrhoea for several days; this intestinal derangement has no connection with improper feeding, yet it requires to be watched lest it become serious and uncontrollable. There is still another kind of diarrhoea which is foamy and contains large quantities of mucus and little or no coloring matter. For the different varieties one and the same remedy will answer, and that which I here submit has never disappointed my expectation:—

Shake the mixture thoroughly before using, and the dose can be regulated between ten drops for an infant to a teaspoonful for a child three or four years old.

(c) Dysentery or Flux is an inflammation of the mucous membrane of the large intestine, or colon, extending down to the rectum. Children under one year of age are not as liable to this affection as those who are older, and it is during their first dentition that the affection shows itself. In hot summer months, at the season of unripe fruits, the disease often becomes epidemic. The loss of strength and flesh is very rapid, and when children do not perish during the first few days of their sickness, they may succumb later when the disease has assumed a chronic form. Dysentery is extremely liable to become complicated with pneumonia, anÆmia, pyÆmia, perforations and strictures of the intestines, jaundice and abscess of the liver, and in proportion that these complications become developed life becomes seriously threatened. The symptoms of dysentery are striking and can hardly be mistaken for anything else. There is always pain over the abdomen, but on touching the abdomen near the navel and over the course of the colon the pain is greater than elsewhere.

Tenesmus is a characteristic symptom of dysentery. This is a straining sensation as if the bowels wanted to move, yet notwithstanding the violent bearing down, only a little mucus often streaked with pus or blood is discharged. The straining causes the lower folds of the rectum to protrude, and this portion of the bowel presents a livid red color; the sufferer is tormented a great deal by this fruitless bearing down, and the bowels should be anointed with pure zinc ointment and returned. The stools of the child are characteristic of this disease. Every passage contains glairy mucus formed into lumps resembling granules of boiled starch, streaked with blood and associated with a creamy looking substance which is purulent matter. If the disease has progressed to the formation of ulcers the evacuations become grayish red or assume a dirty ashen color, and the odor is putrescent. Portions of the mucous membrane slough off and large quantities of pus are discharged from the ulcerating surfaces so that the stools present sometimes nothing but purulent and bloody matter.

The treatment for this disease must be prompt and directed to the point; reliance must not be placed upon one single remedy, but a combination of expedients must be resorted to.

The greatest annoyance and source of pain is the straining and tenesmus, and to relieve this steps must at once be taken. There is hardly any use to give injections for this purpose for the irritable condition of the rectum makes it impossible for the child to retain them long enough to do any good. Use suppositories instead, and if need be, retain them by holding a soft compress of cloth over the anus, for ten to fifteen minutes until they are dissolved. For example, to a child one year old I employ the following suppository:—

Make into one long suppository and roll in powdered bismuth, dip it first into oil or vaseline and insert into the rectum every three or four hours until the soreness and straining have subsided. If the child is not very sensitive nor very ill an injection of a teaspoonful of boiled liquid starch to which a few drops of laudanum have been added, may be used instead and as often as may be necessary. Cold drinks aggravate the pains, therefore give everything warm.

Cow’s milk should be dispensed with in artificially fed children, and broths substituted to which a portion of a fresh egg is added, previously thoroughly beaten with an egg beater; in very young children the yolk alone should be used. A little whisky is always good for this class of patients, either in their broth, or given as a toddy in teaspoonful doses for the children are generally always thirsty and feverish. When children lose their appetites and refuse nourishment they must be coaxed and even forced to take food at regular intervals, otherwise they cannot rally and will perish from inanition. The medicine that I recommended for diarrhoea is also very useful for dysentery.

(d) Colic is the result of an abnormal accumulation of gas, flatulency, in the small intestine. There is always more or less gas in both stomach and bowels, but usually this passes off and there is no pain felt from it. It is when the quantity increases so as to distend the bowels that the walls of the intestines become the seat of pain. The pain comes on in paroxysms, or fits at short intervals, and increasing in violence. Children suffering from colic have the abdomen swollen or bloated, giving rise to that condition termed meteorismus or tympanites. Those who are under one year old are the most liable to colicky pains, for it is during this period of life that digestive disturbances are the most frequent, and these constitute the chief cause. Whenever the vermicular motion of the intestines becomes lessened or suspended, the gas is not expelled from the anus, and the accumulation causes the characteristic pains under consideration. In perfectly healthy digestion there is always more or less gas developed, and even then there may be colicky pains. The same pains originate with every diarrhoea that is due to improper food or feeding, and in dysentery too they are generally present. Infants who nurse at their mother’s breasts are less liable, but not altogether exempt, for mothers’ milk is very sensitive to impressions of purely physical exertions, or to emotions of fear or fright, thus her milk may become unhealthy for her child; or through her own digestion, suffering from temporary or permanent derangement, her milk may transmit a similar condition to her child; the mother may have eaten green fruit, or too much of a variety, or it may be too highly seasoned, or too fatty. Many mothers and nurses look upon the colic cry as a hunger cry, and hasten to feed the little one, and sometimes a few teaspoonfuls of milk or broth will relieve the cry for a few minutes, then the pain returns severer than ever, and the baby cries louder than ever. I have seen very nervous children thrown into convulsions from severe colicky pains.

My rule has been for years to nurse infants for the first two months not oftener than once in two hours; after that until they are six months old, every three hours, and from six to twelve months every four hours; between times the babies cry, of course, not because they are hungry, but because they have either pain or are thirsty. The old German household remedy for this is fennel seed tea; there is nothing as useful; it expels the gas and it quenches the thirst from which colicky children suffer, at least while they have the colic. This tea should be given regularly between times, and until they are twelve or fifteen months old; it is soothing, and what is of equal importance, it prevents overfeeding, which is the bane of artificially-fed children. The latter, bottle-fed babies, are all more or less colicky, and for these the fennel seed tea, between bottle time is indeed a balm. If the fennel seed tea does not relieve the child at once, or if the pain seems severe, then add a few drops of paregoric to the fennel seed tea, and give an injection of German chamomile tea, rubbing the bowels at the same time with a mixture of turpentine and sweet oil, and I believe that every case will be relieved. Permanent relief must be sought in ferreting out the cause and removing it. This may be due to improper food, or feeding, to indigestible contents in the stomach or bowels, and indeed, very often to constipation. When the stomach is overloaded, a dose of syrup of ipecac may give relief, and if due to constipation, the Femina laxative syrup is the most appropriate remedy.

(e) Convulsions, or spasms in children have long been well known to the laity, and from their frequent occurrence they make an important class of children’s diseases. If there is one thing more frightful to behold than another, to the young and inexperienced mother, it is to see her baby’s eyes unsteadily rolling, or turned up so as to show only the white of the eyeballs, or may be the eyes steadily fixed in a stare while the child becomes completely unconscious. A painful smile may play over its face, or an expression of fear or anger may distort the facial expression, while the muscles of the face twitch convulsively. The jaws are sometimes set, then again there is gnashing of the teeth, alternating with relaxation of muscles and ligaments. The child cannot swallow, and fluids poured into the mouth flow out again. The other muscles of the body also participate in the spasmodic contractions; those of the back contract and relax, and those of the extremities are involved in lively twitchings, or perform acts of thrashing, striking or twisting. The breathing becomes very irregular, and from the spasms of the muscles of the larynx or throat it may become entirely suspended, and if the spasm does not subside in two or three minutes the child may die. The skin becomes livid or congested and loses its sensibility so that blisters or irritants make no painful impression. Sometimes the child bleeds from the nose or mouth; the latter is generally due to the tongue having been caught between the teeth during the paroxysm. Frothy saliva wells up from the mouth and the urine and stools are involuntarily discharged.

All convulsive attacks have not every symptom above enumerated, some of them are usually absent and an attack may be quite mild, and last only a few moments; if convulsions last longer they are not only dangerous, but indicate serious disease, either of the brain or in which the brain or spinal cord is seriously complicated.

The period of the child’s life at which convulsions are most frequent is from the time they are born up to the completion of the first dentition. Nervous children who had convulsions while they were teething are susceptible to violent attacks at the commencement of various diseases or during the developmental stage of the eruptive fevers. Perhaps the most frequent cause of convulsions in children is the eruption of teeth. The irritation which a growing tooth causes in the gums also irritates its nerve and this irritability is reflected on the brain, and this causes the spasm. An overloaded stomach, worms and digestive disturbances that accompany teething irritate the bowels and from this too convulsions ensue. The treatment for convulsions naturally resolves itself into first giving instant relief during the paroxysm, and secondly, finding out the cause of the attack. The latter is not always easy at first sight, and as the cause may be serious a competent physician should be sent for. But instructions that are serviceable while the convulsion is on are of the greatest importance to mother and child. The old and familiar remedy of giving the child a hot bath as soon as possible is certainly the best thing that can be done. The child should be undressed as quickly as possible so as to relieve it from all constriction and so that nothing can interfere with the respiration and circulation.

A towel wrung out of cold water should be placed over the child’s head and its body immersed in hot water that is not so hot as to scald; the hands on which the child is supported while in the water must be well able to stand the heat. When the spasm has subsided, the child should be transferred to a previously warmed woolen blanket in which it is to be wrapped with its head softly elevated. If the bowels are constipated an enema of warm water and a little castile soap should be administered.

(f) Worms of different species infest the human organism; they get into the system from the outside world, with the food we eat and drink. Their abiding place seems to be the mucous membrane of the intestinal canal with the exception of the trichinÆ which penetrate the mucous membrane and make their way to the different muscles throughout the body; the voluntary muscles seem to be their permanent dwelling place. These parasites are peculiar to the meat of the hog and as very young children do not eat this meat, they are so far totally exempt from them.

Tapeworms are rarely found in children under one year of age; it is when they get older and especially when they eat hog’s meat, for this too is the home of the embryo tapeworm, that they become infected.

The roundworm, however, is peculiar to childhood. It is a yellowish or whitish worm resembling the earthworm, from one to twelve inches in length. The body is round, tapering toward each extremity. This worm inhabits the small intestine, but by acts of vomiting they are frequently ejected from the mouth or they may find their way into other cavities. On the Pacific slope these worms are not as frequently met with as on the other side of the Rockies. It is propagated by ova and taken into the system by means of drinking water containing them. The number varies greatly in different cases; sometimes there are only a few and again there may be dozens or hundreds coiled together so as to form balls or masses. They are most common between the ages of three and ten years. I do not believe that they ever exist in early infancy.

The symptoms denoting the presence of these parasites are on the whole obscure and depend somewhat on the temperament of the individual. A nervous child may be thrown into fits or convulsions from them. My first case of these worms in a child seven years old was rather exceptional and remarkable. The child was suddenly taken with a severe attack of spasmodic croup, for which I prescribed remedies without much relief. After the second day the child passed five large roundworms, the croup subsided, and while I claimed no credit that my remedies did not cure the croup it was generally conceded that they killed the worms.

The usual symptoms are colic pains, impaired appetite, diarrhoea, itching of the nose, swollen abdomen, puffy features, offensive odor of breath, dreaming sleep and grinding the teeth during sleep or twitching of the muscles.

The expulsion of the parasite is generally effected with simple remedies. Five to ten drops of spirits of turpentine in half to one tablespoonful of castor oil is a reliable remedy. The oil of wormseed is another convenient remedy in the same dose on a lump of sugar or mixed with oil; a cupful of tansy tea early three or four mornings on an empty stomach serves a useful purpose; pinkroot and senna administered as a tea has also a well-deserved popularity.

The thread, pin, spring or mawworm inhabits the large intestine and chiefly the rectum. It is a thin yellowish-white parasite from one-twelfth to one-third inch in length; the female has a straight, awl-like, pointed tail, the male has a strongly curved tail. It rarely, if ever, enters the small intestines. The worms occur chiefly in young children, but there is no period of life that is exempt from them. They cause pain and an itching sensation at the anus. This is particularly troublesome when the children lie in warm beds. The sexual organs are apt to become excited from the irritation and the habit of masturbation be thus formed. In girls the worms may travel into the vagina and leucorrhoea in children is often accounted for in this way; around the anus there may be pimply redness.

From the loss of appetite and sleep the general health of the child may become impaired; but the only possible evidence of the presence of worms is to examine the stools. If worms of the above description cannot be seen, yet the symptoms make their existence suspected, a dose of some of the remedies above suggested should be given and afterwards the stools again examined. Some children have a peculiar predisposition to pinworms, and although you seem to give them relief for the time being, in a short time afterwards the same symptoms return and the worms are as numerous as ever. In these cases a course of continual treatment becomes necessary to eradicate the morbid habit; for this course I recommend:

Mix and give half to one teaspoonful every night at bedtime.

(g) Constipation is the bane of artificially reared children and if the sagacity of mother or nurse does not correct the evil it often causes serious complications. Sometimes those who are nursed on the breast suffer from constipation, especially when the mothers or wet nurses are troubled with similar derangements. Children under one year of age should have two evacuations, and those from one to three years should have at least one passage a day; when this does not occur the feces become solid and constipation is the result. In most febrile affections constipation is caused by a loss of moisture through the skin and an increased urinary secretion. Certain foods constipate, especially the starchy or farinaceous variety, as soups containing corn starch, rice, sago, etc., and in older children certain dishes consisting of peas, beans, and wheaten bread. A great many medicines are constipating, for instance, most cough mixtures, for they contain opium in some form, also preparations of iron, lead, alum, bismuth, chalk, and vegetable remedies that contain astringents or tannin.

It must be laid down as a RULE never to be violated, that every child must have at least one passage a day from the day it is born, and it is the imperative duty of mother or nurse to see that it is accomplished. The infant of only a few days or weeks old may require only a few drops of olive oil, but if that delays in its effect it may become necessary to give relief at once, and for this purpose we have in a small warm water enema a most decided and effectual remedy. Soapsuds should never be used, except in very urgent cases, for I have known a diarrhoea to ensue from the irritation it caused which was very hard to control. If the feces are not very hard a soap suppository may be used with good advantage, and in the following manner: Take a piece of soap and pare it to a point the thickness of a lead pencil and about an inch long, moisten this and introduce carefully into the rectum; if the straining bring only the soap away it may be well to use the water enema afterward. If the constipation continues to be habitual a slight modification of the diet becomes necessary; starchy foods must not be given as often, and thinner than formerly; the milk too should be more diluted; broth or beef tea substituted once or twice each day will often have a good effect. When children are old enough to eat mixed food the diet can often be so regulated as to materially contribute towards opening the bowels. The children should be encouraged to drink a great deal of water; from the lack of that alone some children become constipated. Graham bread and boiled German prunes are especially to be recommended; so are ripe raw fruits, grapes, strawberries, apples, pears, etc. Children require fresh air and outdoor exercise to be well and robust; they run and jump more when in the open air, all of which gives tone and strength to the general system. If diet and outdoor exercise alone does not remedy the evil, then the Femina laxative syrup should be administered; it is efficient in its action, and pleasant to take, and unlike most laxative or aperient remedies, there is no danger of forming a habit of using purgatives.

(h) Whooping cough is the name of an affection deriving its significance from a characteristic which is peculiar to this cough. It commences like an ordinary bronchitis such as is the result of taking cold; there is the usual hoarseness, tickling in the throat, dry cough, sneezing, running from the nose; the eyes are red and watery, and there is more or less fever. Sometimes the cough is ordinary, but at other times it has a sharp metallic clang from the beginning. Owing to certain marked periods in the course of the affection it has been found convenient to divide it into three stages which may usually be distinguished, although in a certain proportion of cases the first stage (comprising some of the symptoms that have been enumerated above) may be submerged into the second or whooping stage. The first stage may last from four to five days to as many weeks. The second stage is when the peculiar sound or whoop begins; it consists of a great number of violent paroxysms, rapidly-recurring spasmodic coughs, until most of the air in the lungs is expired; there is then a sense of suffocation and the child becomes bluish red over the entire head and face, from which the German designation blue cough has originated. During this spell the face swells and the eyeballs become congested and bulge from their orbits and the nose often begins to bleed, while the urine and feces are often involuntarily ejected and the contents of the stomach thrown up from the violent contraction of the diaphragm. In a few moments the spell is broken by a protracted, whistling croupy inspiration, and this constitutes the whoop.

The whooping generally grows worse the first two or three weeks, after which time in favorable cases the cough gradually becomes milder, but this is not the rule by any means. I have had it in my own family to last, in two instances, six months, and in another eight months before the children had fully recovered.

Laughing or crying, swallowing dry, irritating morsels of food or cold and impure air will bring on a paroxysm of cough. When several children are affected together, the coughing of one will make the others cough.

The third stage is when the cough is wearing off and has lost its severity. The expectoration consists now of a yellowish or green-colored mucus; in otherwise healthy children this lasts only a few weeks, but in weakly or scrofulous ones it may last for several months. This disease is not as yet thoroughly understood. It is an epidemic, contagious bronchial catarrh, involving the nerves of respiration and attacks an individual but once. When complications arise the affection becomes exceedingly dangerous and the most common of these is pneumonia.

There is no specific cure for whooping cough; it has got to run its course, which may be either short or long. I have tried every agent so far known to scientific medicine, and there is none that will give prompt relief in every instance. Whooping cough being a bronchitis plus something else, it seems rational that the same precautions that are observed in a case of bronchitis should be followed here. Children with this affection must not be exposed to drafts or rough winds lest they get cold, which might seriously complicate matters. In summer when the weather is warm, outdoor life is beneficial in hastening recovery. Some children have the cough so light, that no extra precautions seem to be necessary; they have no fever, eat, feel and sleep well. But those who are feverish, who vomit freely, and whose appetite is capricious, require every attention. Their diet should be especially guarded, so that all dry, irritating nutriments are prohibited, and so that the diet consists principally of liquid nourishment. Warm drinks have a favorable influence on the disease; a plentiful supply of warm milk, first thoroughly beaten with an egg beater is the most suitable and convenient. The milk punch is often borne well, and the little whisky that enters into its composition is a needed stimulant to the sufferer; broths may be given for a change, and to these the yolk of an egg can be added with advantage. A great many remedies might be suggested, but the one which has served my purpose the best, is the following:

For a child five years old, give a teaspoonful three or four times a day; older or younger children in proportion. If the cough is hard and dry, ten to twenty drops of syrup of ipecac alone should be given instead of the mixture, and when the cough is loosened, the mixture can be again administered. When in the course of the affection the breathing suddenly becomes labored, and the fever increases, it is fair to presume that the case is complicated with pneumonia.

(i) Eruptive fevers, as their name implies, are characterized by an eruption or exanthema. The most virulent of this class is smallpox. The eruption of this disease is of the nature of vesicles, or pustules, while that of measles, scarlatina, and rose rash is dry, and is properly called a rash. Chickenpox, however, has also vesicles and pustules, and for this reason it is very liable in times of an epidemic of smallpox to be mistaken for a mild form of the latter disease. For obvious reasons it is not proper to consider smallpox in this connection; its gravity and its management require experience, and further, it generally comes under special quarantine regulations of the proper constituted authorities.

The eruptive fevers are all divided into three stages, namely: a stage of invasion or development; a second stage when the eruption appears, and while it lasts; and a third stage, that of desquamation, when the eruption begins to fade or exfoliate in branny scales.

(j) Measles is generally a mild and not serious disease, and only attacks the individual but once in a lifetime; only through gross carelessness the disease becomes complicated, and then it may become a very dangerous affection. It begins with all the symptoms of a common cold. There is frequent sneezing, and an acrid muco-serous discharge from the nostrils. The eyes are irritable, reddened and watery, and there is more or less intolerance of light. The voice becomes hoarse and there is always a bronchitis present which is characterized by a dry, harsh cough. The patient is generally feverish, alternating with chilly sensations or shivering; the appetite is poor or absent and in some cases there is nausea and vomiting. The children feel drowsy; they complain of pain in the head and limbs and want to lounge around. The bowels may be constipated, but diarrhoea supervenes in a certain proportion of cases. In nervous children convulsions may occur; bleeding from the nose and false croup are not infrequently met with in the development of this disease. The duration of the first stage varies greatly in different individuals, and comprises a period extending from one to seven days. The eruption begins generally on the temples and forehead, whence it extends over the head and neck, thence down the back and over the entire body, occupying in its development from thirty-six to forty-eight hours. The eruption bears a resemblance to flea bites at first; it appears as minute red specks which gradually enlarge and become slightly elevated and arrange themselves in circular clusters. The portions of the skin that are free from the eruption retain their white appearance; the face is more or less swollen and the eyelids puffed. In some patients there is considerable annoyance from itching in the skin. The cough and bronchitis continue to be prominent symptoms, and the expectoration, consisting of yellowish sputa becomes abundant. In some children the fever runs very high in this stage and they become delirious and restless, but this is only temporary, for it generally diminishes with the eruption on the third or fourth day.

When the eruption begins to fade the third stage of the affection is inaugurated, and when there exist no complications, the patient may now be considered on the way to recovery which takes from four to eight days longer.

The treatment in measles should consist in good nursing, rather than in medication. Owing to the inflammation of the membranes of the eyes, the patient should be kept in a darkened chamber, and the eyes occasionally bathed with a solution of borax, by dissolving half a teaspoonful in a tumblerful of water. Good judgment forbids that the patient should be sweltered, but that he should be kept comfortably warm and never allowed to cool off suddenly is also very important. When the eruption is slow to develop a good sweat will often bring it out; so will undue exposure, to cold drafts and the transportation out of a warm bed into a cold one or drinking immoderately of cold drinks either delay the development of the eruption or drive it back, and from this undoubtedly dangerous complications arise, like pneumonia, diphtheritic croup, and convulsions. A mouthful of cold water now and then is harmless, but on the whole the drinks should be quite warm; the cough and bronchitis alone would require that.

Warm milk thoroughly beaten is the most suitable form of diet; broths and soups may be given for a change, so can a mixture of equal parts of weak hot tea and milk. The bowels should be moved with a mild laxative and if the fever runs very high, ten to fifteen drops of the sweet spirits of nitre, for a child five years old, in half wineglass of water every few hours will generally reduce the temperature. For the itching, the skin should be rubbed with equal parts of glycerine and warm water. The cough is generally the most troublesome feature, and the only symptom requiring regular medication; for this a good general cough mixture will serve every purpose, such as:

Mix and give to a child four years old a teaspoonful every four hours; older or younger children in proportion.

(k) Rose rash, sometimes called false or German measles is a comparatively trivial affection and of very little importance, for it never has any serious complications and lasts only twenty-four or forty-eight hours in the majority of cases. It is often mistaken for measles, and one attack affords no protection against recurrences. The eruption appears in small rose-colored spots or patches which are not elevated. It does not commence on the head, but appears on different parts of the body. The eruption may be preceded by headache, loss of appetite, occasionally vomiting, and more or less fever or chilly sensations.

The affection of the eyes and air passages, especially the bronchitis which is characteristic of measles, are wanting in rose rash, and when we hear of children having had measles several times it is reasonable to presume that it was rose rash instead. This eruption hardly calls for treatment, but a mild laxative and a regulated diet would fulfill all requirements.

(l) Scarlet fever or scarlatina has received its name from the color of its eruption. This affection presents itself differently in different cases. It may be so mild in its attack that it constitutes a trifling ailment and again it may be so severe that life is seriously threatened, and destroyed in a few days. This has formed the basis of dividing scarlatina into three varieties, namely: simple scarlatina, diphtheritic scarlatina and malignant scarlatina.

The fever, as a rule, is notably higher than in other eruptive fevers. The attack may begin with a chill, nausea and vomiting and headache. There is also bleeding from the nose in a certain proportion of cases. The most constant sign is redness and more or less swelling of the throat, either with or without a sense of soreness and pain in the act of swallowing. The stage of development lasts in the average twenty-four hours, although exceptionally it may appear in a few hours after the first symptoms of the disease have appeared. The eruption often begins on the back first, and from there rapidly spreads over the entire body in twenty-four hours. It greatly differs from the eruption in measles in not allowing any healthy or white skin to intervene between the red specks, but the entire skin has a reddish blush. This has given rise to the expression boiled lobster appearance in scarlatina, and indeed nothing could illustrate the color of the skin better than by comparing the one with the other. The eruption is sometimes accompanied with a great deal of itching and burning and reaches its fullest development on the third day after its first appearance; it lasts from four to six days.

The extent and redness of the eruption varies greatly in different individuals, in some it is very slight and transient while in others there is not a spot as large as a dime which is not covered. Yet a very light attack in one patient when communicated to another individual may develop in that one a most malignant form. One attack secures against a recurrence.

The throat affection seems to modify the eruption of the skin for in some instances in which the throat is very bad, the skin eruption is comparatively slight. There may be simply a little redness over the tonsils, extending more or less over the soft palate, or on the other hand, the disease in the throat may become in every respect equal to if not identical with the worst type of diphtheria. Some writers consider the sore throat of scarlatina and that of diphtheria identical, and from a practical point of view there is certainly no difference, and the very best results are obtained when all severe sore throats of scarlatina are treated precisely as if they were diphtheria; this has always been my practice.

The tongue is quite distinctive of the affection; early in the development of the disease it is generally furred, but later the coating peels off in patches, and these spots present the appearance of a ripe strawberry; sometimes the entire surface of the tongue looks as if cayenne pepper or red sand had been sprinkled on it.

The fever generally increases during the eruptive stage, and the skin becomes very dry and hot. The pulse may run up to 130 to 140 per minute, while the temperature runs up as high as 106° Fahrenheit; this state of affairs places the patient in imminent danger, he now may become restless and even delirious. In a certain proportion of cases the kidneys become involved and albuminuria is a result, but this usually passes off with the improvement and recovery of the patient.

In the third stage the cuticle begins to exfoliate in the form of branny scales. In the absence of serious complications this stage marks the beginning of convalescence; the fever subsides, the appetite returns, and the soreness and redness of the throat disappear.

The treatment of this affection always depends upon the nature of the case. Simple scarlatina requires no medical treatment; the precaution and intelligence which are comprised in good nursing supply everything that is required. There is not the same danger of the eruption striking in with scarlatina as there is with measles, and the patient need not be kept so warmly covered. When the fever runs very high, sponging the surface with cool water is very grateful and reduces the temperature. After the eruption has thoroughly developed, the water for sponging off may be very cold without the least danger, and this may be repeated as often as comfort or the high temperature demands. To relieve the burning and itching of the skin, the entire body should be rubbed over with glycerine night and morning; this relieves the system and makes the skin moist and supple. If the throat is only reddened, a teaspoonful of chlorate of potash dissolved in a cupful of hot water and when cold used as a gargle and a teaspoonful of the solution swallowed at the same time every two hours is all that is necessary. The diphtheritic scarlatina is treated precisely similar to and according to the instructions laid down for diphtheria in another part of this work. Move the bowels freely with the Femina laxative syrup.

(m) Chickenpox has neither distressing symptoms nor is it significant as regards danger. It is an eruptive fever which occasionally affects adults, but for the most part children. The eruption is generally preceded by a slight fever and nausea, and appears first on the body and afterwards on the scalp where it is usually more abundant. There always remains healthy white skin between the vesicles, which at first contain a transparent liquid, hence called by the Germans waterpox, which afterward becomes cloudy or opaline. The eruption begins to dry up from the fifth to the seventh day forming granular crusts that are sometimes followed by pitting. The disease is contagious and develops twelve to seventeen days after the exposure. Chickenpox claims no treatment; its only point of interest is its resemblance to varioloid, but as a successful vaccination guarantees against the latter, and as the vesicles of varioloid have a central depression while those of chickenpox have not, the individuality of the affection is readily established.