lochial discharge is suppressed, or becomes altered in

character; the secretion of milk ceases. It is often complicated with peritonitis or metritis-inflammation of the uterus. The symptoms and severity are variable, but it is always dangerous and highly infectious. The treatment is like that of pyæmia, which it much resembles.

Another disease of the puerperal state, though not entirely confined to it, is phlegmasia dolens, or milk-leg, caused by obstruction of the femoral vein by a bloodclot. It results most commonly from exposure or overexertion. The leg swells, and becomes intensely painful, the skin white and tense. There is often fever accompanying it, and sometimes chills. It is treated by absolute rest; support the limb comfortably, keep it warm by enveloping it in cotton wool, and the condition may be expected to gradually disappear, though it does not always terminate so happily.

Puerperal convulsions sometimes occur, resembling those of epilepsy. These are usually of a uræmic type, resulting from deficient action of the kidneys, and are very dangerous.

A form of insanity may follow labor, known as puerperal mania. It usually takes a melancholy form, often with a disposition to injure the child. It is acute while it lasts, but rarely permanent.

CHAPTER XXI.

Sick children-Early symptoms of disorder--Tact required in nursing them-Feeding infants-Dentition, and its accompanying disorders-Thrush-Ophthalmia-Colic - - Diarrhoea

- Constipation — Descent of the bowel-Worms-Incontinence-Cholera infantum Convulsions-Croup-Whooping-cough-Mumps-Chicken-pox

-Measles-Meningitis.

A VERY high degree of development of those qualities desirable in any nurse is requisite in the care of sick children. This calls for infinite tact, patience, and judgment, and especially is the habit of critical observation essential, for, with children too young to speak, the involuntary revelations of signs and gestures give often the only clew to the seat and kind of distress. The objective symptoms are, fortunately, very marked in children, and they respond to treatment with a readiness which makes them very interesting subjects. A good deal may be learned from the character of a baby's cry. With abdominal pain the cry will be long, loud, and tearful, subsiding, as the pain is relieved, into longdrawn sobs. The legs will be drawn up, to relax the strain on the abdominal muscles. If there is inflammation of the chest, there will be less profusion of tears and less noise, the cry begun after each deeper breath or cough will be sharp and suppressed, evidently augmenting the pain. Sharp screams, alternating with low moans or stupor, suggests some affection of the brain.

Waking suddenly with a cry, grinding the teeth, or starting nervously in the sleep, and boring the head into the pillow, are all noteworthy symptoms in children. No departure from the usual habits of the child is unimportant. Note whether it is unusually stupid, restless, or irritable, in what position it seems most easy, whether the light occasions distress, and whether the general symptoms of disorder increase in severity toward night. The temperature should be taken by rectum. If a child complains of pain anywhere, and has a rise of temperature, it is safe to examine the throat. The pulse of an infant can only be taken with any approach to accuracy during sleep. A very slow pulse is more ominous in a child than a rapid one. Children gain and lose flesh with great rapidity, showing it first on the inner side of the thighs, where two or three days' illness will have a marked effect.

In dealing with sick children the utmost gentleness is necessary. They ought never to be frightened or startled. It is a bad time to introduce a stranger to a shy baby when it is sick, and the first thing to be done -often a very difficult thing to do-is to acquire the child's confidence. Until it has grown used to your presence, it may be best to allow everything to be done for it by the mother or usual attendant, while you merely give directions. A child accustomed to unlimited indulgence, afraid of strangers, and fretful from pain, is not an easy patient to manage; it will require very winning tact and a genuine sympathy for the little one, to get even the possibility of caring for it helpfully. Whatever excites or alarms does the child harm, making it nervous and feverish. Do not give too many toys in the effort to divert, one at a time is better than a dozen; and, above all, do not let the child see any that it can

not have. Children may be attacked by many of the same diseases as older people; there are also some which are peculiar to them, and others which appear most frequently in early life. When a child first exhibits indisposition, it is always safe, and often soothing, to put it in a warm bath. This will tend to bring out any latent rash, for which the whole body should be carefully examined. The room should be warm and free from draughts, the temperature of the bath 100° Fahr., and the child allowed to remain in it about five minutes. the baby is afraid of the water, prepare the bath out of sight, and cover it with a blanket. The child can then be gradually let down into the water, blanket and all, without any shock. When taken out, it should be wrapped in a soft dry blanket for a few moments, and then dried with soft towels. Guard against exposure, keep as quiet as possible, on the simplest diet, and watch carefully for further signs of disorder.

If

The only suitable food for a baby is its mother's milk; or, failing that, the nearest approach to it that can be made. If it is necessary to bring up a child by hand, milk properly diluted is still the one thing to be given. Jacobi recommends the following: Boil an ounce of barley, ground in a coffee-mill, in a gill of water for fifteen minutes; strain, add half as much boiled milk, and a lump of white sugar. When there is a decided tendency to constipation, oatmeal may be substituted for the ground barley. The use of cow's milk necessitates the addition of salt, and, if it has to stand for any length of time, a teaspoonful of lime-water should be put in each pint. The milk should be given at a temperature of 90°. The baby's bottle and mouthpiece should be well washed, and kept in water when not in use. If the food is rejected, either the child is

overfed-a common source of trouble-or the food is unsuitable. If the mother's milk is, as sometimes happens, too rich to agree with the child, it may be diluted by giving first a little sugar and water, or barley water. Vomiting by an infant is rarely attended with much constitutional disturbance. If the milk is thrown up unchanged, the matter is more serious than if it is returned coagulated and sour. A child is often rendered restless by thirst, and will be quieted and relieved by a little clear cold water. After eight or ten months, the daily meals should not exceed six in number. An allowance of bread and milk, or beef-tea, may be given, but it should not come to depend upon solid food until all the teeth are cut. Contrary to the common impression, thick food is less nutritious than thin. The first teeth may be looked for at about the sixth or eighth month, and the others at intervals, until the first set of twenty is complete, at about the age of two years. The process of dentition is accompanied by various functional disorders. It unsettles the healthy balance of the system, and predisposes to, if it does not exactly cause, disease. The child will be restless and feverish; diarrhoea is common; sometimes even croup and convulsions occur. These need medical advice, as at other times, and great attention must be paid to general nursing and dieting. Keep the little one in the open air as much as possible, suitably clothed. If the gums are very painful and swollen, it will be necessary to have them lanced.

Thrush is a sort of fungoid growth appearing in the form of white spots on the tongue and inside of the mouth. It may result from improper food, or from neglect to wash out the child's mouth after eating. Particles of milk remaining in the mouth decompose, and,