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RULES FOR PRESCRIBING

apartment; and nothing beyond these simple measures is needed to remove many of the minor ailments of the young child. Many medicines, too, can be given without any trouble either to the child or to its attendants. A few drops of ipecacuanha wine will be unperceived in its drink, a little James's powder may be concealed in some arrow-root or on a bit of bread-and-butter, or a dose of scammony may pass unnoticed in a little hot and sweetened milk; while, if tonics are needed, the saccharine carbonate of iron or the steel wine will seldom be refused by the most spoilt and most wilful inhabitant of the nursery. Your own ingenuity will suggest many other remedies which may be given without exciting suspicion, or at any rate without causing disgust; and, believe me, the doctor who brings smiles rather than tears into the nursery, he whom the children love most, the parents will trust most, and that love and trust will stand him much in stead when he has to combat serious illness.

As far as may be, then, it is well to avoid formal prescriptions in treating the ailments of early life. Often, however, this is not possible; but something may still be done to make physic at any rate supportable. Let its bulk be small; two tea-spoonfuls will be swallowed readily by many a child whom no persuasion could induce to take two table-spoonfuls. For the same reason, powders, except when very small, are often worse than useless; and yet one sees powdered bark or powdered calumba, or large doses of rhubarb and soda, prescribed for little children of two or three years old; and they must have been educated with far more than average wisdom, or be possessed of more than average docility, who will be prevailed on to take the nauseous compound.

In the heat and fretfulness of fever, when the child would gladly drink any moderately palatable medicine, the solution of acetate of ammonia is not seldom prescribed, and the return of the time for giving each dose of medicine is but the signal for a fresh combat between the child and its attendant, in which, whoever gains the victory, the patient is sure to suffer. A few moments' thoughtfulness would avoid the trial both to the child and its parents, for nothing would be easier than to prescribe a mixture such as it would take eagerly. A solution of carbonate of potash saturated with citric acid and flavoured with syrup of mulberries, or a few grains of nitre dissolved in water and rendered palatable with syrup of lemons, forms a febrifuge mixture to which very few children would object. If it is desirable to give antimony, a watery solution of tartar emetic may be substituted for the wine, the unaccus

FOR YOUNG CHILDREN.

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tomed taste of which might be disagreeable. If a stimulant is needed, milk well sweetened conceals to a great extent the pungency of ammonia; while the chloric ether, on account of its sweet taste, is almost always taken readily.

Of course it is not possible to make all medicines palatable, and then you must confine yourselves to giving that which is unpleasant in as small a bulk as possible. Still, if you keep this object in view, it is remarkable to how large an extent it is attainable. The compound jalap powder is almost the only aperient powder which children do not very much object to, and the small bulk of the jalapine enables us to dispense even with that in the greater number of instances. Scammony, and especially its extract, can be concealed in milk; and even castor-oil shaken up in a bottle with hot sweetened milk, in which a piece of cinnamon has been boiled, is so disguised as scarcely to be suspected. The addition of a little chloric ether to the infusion of senna covers its nauseous taste almost completely, and an extra quantity of liquorice makes even the decoction of aloes palatable, while powdered aloes, occupying a small space, can often be given in brown sugar. Rhubarb is the one medicine which nothing effectually disguises, though a little spirit of nutmeg mitigates the nauseous flavour of the infusion. Even the difficulty of administering rhubarb may often be surmounted, if we employ the extract, which is thrice as strong as the powder. Each grain of the extract may be divided into four or six tiny pills, and then, if silvered, may be given unsuspected, or at any rate quite untasted, in a little arrowroot or currant jelly. We seldom, however, need be at a loss in selecting some of the milder laxatives; for the senna electuary, the various syrups and essences of senna, the nursery infusion of senna and prunes, fluid magnesia, and the saccharine carbonate of magnesia, may each in turn be employed.

It is not in general difficult to prescribe a tonic which shall both be suitable for a child, and at the same time not very unpalatable. The ordinary bitter infusions, as gentian, cascarilla, and calumba, are out of the question with young children; but the mineral acids can always be made tolerable, and the infusions of roses, cloves, and orange-peel, though perhaps of little value except as vehicles for some other remedy, are by no means unpleasant. The decoction. of logwood is very valuable as a tonic and astringent, and a little sugar and a tea-spoonful of port wine generally render the dose popular. In spite of its bitter flavour, the small bulk of quinine generally enables us to give it without much difficulty; while fortu

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RULES FOR PRESCRIBING FOR YOUNG CHILDREN.

nately the cod-liver oil, disgusting as it seems to be, is comparatively seldom objected to, and orange syrup or orange wine usually conceals its taste very effectually. The steel wine and the saccharine carbonate of iron have been already referred to as the best chalybeates for children; but if iron is needed in stronger forms, the syrup of orange-peel covers the taste of the muriated tincture of iron, and even the compound iron mixture of the London Pharmacopoeia is taken readily if sufficiently diluted with almond emulsion.

But enough has probably been said on these preliminary subjects. Your own experience will every year deepen the conviction that in dealing with the diseases of early life nothing can be considered trivial. The object of my first lecture was to show you how it is only by attention to little things that you will learn rightly to discriminate their nature; the purpose of this has been to teach you how necessary the same attention is to their successful treatment.

LECTURE III.

DISEASES OF THE BRAIN AND NERVOUS SYSTEM.-Their extreme frequency in early life favoured by the rapid development of the brain, and the wide variations in the cerebral circulation during childhood.-Peculiar difficulties of their study.Symptoms of cerebral disease in the child.—Convulsions, their symptomatic value very various—their frequency in great measure due to the predominance of the spinal system in childhood-may be excited by many causes-hence attention should always be paid to the precursors of an attack.-Description of a fit of convulsions.

Ir can scarcely be necessary to assign many reasons for beginning this course of lectures with the study of the diseases of the nervous system. The subject, although beset with many difficulties, has always engaged much attention; partly, no doubt, from the natural tendency of the human mind to enquire most curiously into those truths that seem most hidden; but still more from the alarming nature of many of the symptoms that betoken disturbance of the nervous system, and from the frequently fatal issue of its diseases. But besides the general interest and importance of these affections, at whatever age they may occur, their extreme frequency in early life gives them an additional claim on our notice.

It appears from the Reports of the Registrar-General, that 16,258 out of 91,225 persons who died in the metropolis during the years 1842 and 1845, of ascertained causes, were destroyed by the various diseases of the nervous system. But 9,350 of these 16,258 deaths took place during the first five years of existence; or, in other words, 57 per cent. of the fatal disorders of the nervous system occurred within that period. Even after making a very large allowance for the possible errors of statistical data, this predominance of the diseases of the nervous system in early life is far

* These numbers, which yield results differing but very little from those given in the first edition, are deduced from the returns furnished in the Fifth and Eighth Reports. The returns for 1846, which are also given in the Eighth Report, are not included, since, owing to the epidemic prevalence of diarrhoea in the autumn of 1846, they would not yield average results.

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FREQUENCY OF THE DISEASES OF THE NERVOUS SYSTEM.

too remarkable to be overlooked; though some persons, not being able to account for the fact, have affected to doubt its reality.

The fact is one which cannot be gainsaid; and though we do not pretend thoroughly to account for it, yet two considerations may help in some degree to explain it.

The first is derived from our knowledge of the circumstance, that in an organ whose development is rapidly advancing, many diseased processes also, if once set up, will go on with proportionate activity. Now there is no organ in the body, with the exception of the pregnant womb, which undergoes such rapid development as the brain in early childhood. It doubles its weight during the first two years of life, and reaches nearly, if not quite, its maximum by the end of the seventh year. This same active state of the nutritive or vegetative processes in the brain of the child renders the organ liable to have disease set up in it by causes which would produce little or no injurious effect on the brain of the adult.

In the second place, the brain in infancy is much more exposed to disorder than that of the adult, owing to the far wider variations. of which the cerebral circulation is susceptible in early life than subsequently. Nor is the cause of this difficult to discover. The cranium of the adult is a complete bony case, and the firm substance of the brain affords a comparatively unyielding support to the vessels by which it is nourished. It has been proved, indeed, by Dr. Burrows,* that the quantity of blood which these vessels contain is not always the same, as some have erroneously supposed: still its variations must needs be circumscribed within far narrower limits than in the child, whose cranium, with its membranous fontanelles and unossified sutures, opposes no such obstacle to the admission of an increased quantity of blood, while the soft brain keeps up a much slighter counter-pressure on the vessels than is exerted by the comparatively firm parenchyma of the organ in the adult. If the circulation in the child be disturbed, whether from difficulty in the return of venous blood as during a paroxysm of hooping-cough, or from increased arterial action as at the onset of

* In his Lumleian Lectures, published in the Medical Gazette, April 28 and May 6, 1842, and subsequently in his work on Disorders of the Cerebral Circulation, &c. 8vo, Lond. 1846. The general accuracy of Dr. Burrows's conclusions, though called in question by the late Dr. John Reid, in the London and Edinburgh Monthly Journal for Aug. 1846, and more recently by Dr. Hamernjk, of Prague, in the Vierteljahrschrift für die praktische Heilkunde, Vol. xvii. p. 38, seems to be placed beyond doubt by the very careful experiments of Dr. Berlin, published in the Nederlandsche Lancet, Feb. 1850, and in Schmidt's Jahrbücher for 1851, No. 1, p. 14–16.