telligent part of the community have lost faith in drugging, and medical men should not continue to countenance or encourage superstition as to

drugs. When a placebo seems indicated, a few drops of hydrochloric acid in sugar water or in essence of pepsin are rational and will do no harm. Infants do not require a placebo, and young and inexperienced mothers should be gently but firmly enlightened on such matters. Drugs may be administered by the stomach, by the rectum, by inunction, or by hypodermic injection, with reference to the local or general therapeutic activity sought.

Dose Determination.-Regarding dose determination, it is well to remember the rule advanced by Dr. V. C. Pedersen, of New York: A full

FIG. 33.-BED GRAPPLE FOR THE COMFORT OF PATIENTS.

(From the Medical Council, 1904.)

therapeutic dose will be tolerated by a subject twenty years of age and upwards; the proportionate dose for any age, twenty years or less, is found

by taking of the full dose and multiplying the result by the age in years or fractions of years.

The Metric System in Prescription Writing has made but little progress in the United States.

To facilitate the conversion of apothecary's weights and measures into the metric system the following tables and rules are not too cumbersome and tedious for practical use:

To convert ounces into grammes, multiply by 30.

To convert grammes into ounces, divide by 30.

To convert troy grains into centigrammes, multiply by 6.
To convert centigrammes into troy grains, divide by 6.
To convert troy grains into milligrammes, multiply by 60.
To convert milligrammes into troy grains, divide by 60.

To convert troy grains into grammes, or minims into fluid grammes, divide by 15.

To convert grammes into grains, or fluid grammes into minims, multiply by 15.

To convert drachms into grammes, or fluid drachms into fluid grammes, multiply by 4.

To convert grammes into drachms, or fluid grammes into fluid drachms, divide by 4.

PRACTICAL APPROXIMATE GRAMME VALUES

Invalid Bed. In severe or protracted illness a properly constructed invalid bed or bed grapple is a great convenience for patient and nurse. (See Illustrations.)

CHAPTER III

PEDIATRICS

SYNOPSIS: Care of the New-Born.-Diseases of the New-Born.-Deformities.-Malformations.-Infant Feeding.-Facts about Milk.—Maternal Nursing.-Cow's Milk for Infant Feeding-Diet for Children after Weaning.-Ailments of the Mouth in Infants and Children. - Mumps.- Indigestion and Diarrhoeal Disorders.-Malnutrition.— Rickets. -Marasmus.-Scurvy. -- Worms in Children. — Tuberculous Peritonitis in Children.-Diseases of the Respiratory Tract in Children.-Colds, Bronchitis, Pneumonia, Pleurisy, Empyema, Whooping Cough.-Pyothorax.-Thymus Gland.-Bronchial Lymph Nodes.-The Nasopharynx.-Diphtheria and Croup.-Intubation and Tracheotomy.-The Nasopharyngeal Toilet.-Tonsillitis.-Peritonsillitis.-Quinsy.-Enlarged Tonsils.-Adenoid Growths.-Retropharyngeal Lymphadenitis and Abscess. -Eruptive and Other Fevers in Children.—Measles, Rubeola, Scarlet Fever, Malaria, Typhoid Fever.-Glandular Fever. — Vulvovaginitis and Masturbation.-Familiar Forms of Nervous Derangements Peculiar to Early Life.

INTRODUCTORY REMARKS

In this section the author presents in a clinical garb the diseases which are peculiar to early life or show marked peculiarities in infancy or childhood. In order to avoid unnecessary repetition, no attempt has been made to enumerate and discuss all diseases occurring in children, and when an apparent omission is noticed, particularly as regards skin lesions, urogenital and circulatory disturbances, etc., which present no marked difference in childhood, the reader will find the matter discussed elsewhere.

CARE OF THE NEW-BORN

The Cord.-Express the excess of gelatine from the cord, dust with subnitrate of bismuth, and wrap in aseptic gauze or absorbent cotton, after which the flannel binder around the abdomen may be applied. The dressing is not to be unnecessarily disturbed, and may be removed at the time the cord separates from the body, about the fifth or seventh day. The stump may then be dusted with mild aseptic powder and a small pad placed in situ. The cord stump is practically healed about the tenth day.

Asphyxia. This condition when present will call for prompt relief. The infant is cyanotic, livid, or frequently, when the asphyxia is deep, the child presents a pale, deathlike appearance. This condition is due to many and various causes, prominent among which are inherent weakness of the child, pressure of the cord about the neck, prolonged labor, undue pressure exerted on the head by forceps, aspiration of mucus, blood, or

amniotic fluid, or illness of the mother (convulsions during labor, anesthesia, etc.). In attempting to reestablish the respiration, there are many methods of resort. First, clear the mouth and pharynx with a swab of cotton to disengage accumulated mucus. If mucus or fluid obstructs the trachea, aspiration by the rubber catheter is indicated. Applications of alternate. hot and cold water and spanking are mechanical means of favoring better respiratory efforts and assisting the flagging circulation. Mouth to mouth inflation, with the infant's head thrown back, may be tried. Sylvester's and Schultze's methods of inducing artificial respiration are commendable, also, rhythmical traction of the tongue. After the reestablishment of respiration, the infant should be observed for some hours, and one or more of the combined methods above indicated resorted to in instances demanding repetition. Asphyxia may result in cerebral congestion, effusion, thrombosis, extravasation, and destruction of nerve tissue with secondary inflammation and cystic degeneration. Prolonged asphyxia of the newborn may result in idiocy; about 40 per cent of the idiots who were first born children have a history of asphyxia. The longer the duration of asphyxia, the greater the danger. The immediate treatment of asphyxia is therefore very important.

Mouth. The maintenance of cleanliness of the mouth is important. It may be wiped out with soft lint or cotton moistened with 2 per cent boric acid solution, but we must avoid washing out the mouth directly after a nursing, to prevent vomiting of recently ingested milk. The mouth of infants is exquisitely tender, and cleansing with the finger, unless carefully done, is apt to injure the epithelial surface and result in ulceration. The same injury occasionally results from the pressure of too large a rubber nipple. Ulcerative stomatitis in the new-born is observed over the hamular process of the sphenoid, and is due to irritation in cleansing the mouth or may be due to the irritation of epithelial pearls in the roof of the mouth. It shows as a superficial ulcer, covered with a yellow film and bounded by a red line, and may occupy the larger part of the soft palate. Such a child appears in good health and has no fever. The epithelial pearls are a physiological formation and require no treatment, as they disappear in time. The stomatitis yields to the usual local antiseptic treatment.

The Eyes. Avoid the use of a sponge to the eyes. Fresh tufts of absorbent cotton are cleanlier and less irritating. To prevent the occurrence of ophthalmia neonatorum, instil a to 2 per cent nitrate of silver solution into the eye and neutralize after a few minutes with mild sodium chloride solution (table salt).

The Temperature at birth is about 100° F. This soon falls, and varies from a fraction to a degree under the action of the bath, clothing, and skin radiation. The average rectal temperature of the healthy infant is

about 99°.

Respiration in infants is diaphragmatic, and the rhythm is easily disturbed. At birth we observe 35 to 40 respirations a minute.

Pulse. -At birth it is quite rapid, more so in the female than in the male infant. In infancy, too, the slightest disturbance in activity from rest to motion profoundly influences the pulse rate and its force. The average frequency of the pulse is about 120 to 150.