118 PHYSICAL EXPRESSION. 



appetite is often variable, voracious or entirely lost ; 

 there may be considerable emaciation with a good 

 appetite, and without any accompanying signs of 

 organic disease ; often there is considerable nausea 

 or retching with the attacks of headache. Hacking 

 cough, without physical signs to account for it, is- 

 often met with, and usually the child is excessively 

 fidgety. 



In studying this group of nervous excitable 

 children in whom recurrent headache was a main 

 symptom, it was first necessary to look out for 

 certain objective signs by which they might be 

 indentified ; and these were principally found in the 

 condition of the nerve-muscular system, the teeth, 

 and the urine, but chiefly in the muscular system. 



The nerve-muscular condition was carefully 

 observed in this group of cases. Usually, the child 

 was made to stand with the heels together, looking 

 straight before him, the hands being down by his 

 side. The general steadiness of the body, trunk, 

 and limbs was then observed, as well as the condi- 

 tion of the face and eyes. He was next directed to 

 put out his tongue, and, finally, to hold out both 

 arms straight before him, on a level with the 

 shoulder, at the same time separating the fingers. 

 Observations were then made as to the muscles of 

 these parts. The state of the heart, lungs, teeth, and 

 urine was examined, and the patient's weight was. 

 recorded. As the result of these examinations, it 

 was observed that frequently there was marked 

 fidgetiness, and irregular movement of the trunk 

 and limbs ; the trunk was often swayed about 



