18 DISEASES OF CHILDREN. 



are confined, a mild alterative purgative (rhubarb, soda, and grey powder) may 

 be given, and the motions should be carefully watched for any signs of worms or 

 other cause of irritation. 



Next look to the teeth. It used to be almost a matter of routine to lance the 

 gums in every case of laryiigismus, but some discrimination is necessary before this 

 measure is taken. Look to the mouth, and ascertain if the child has the proper 

 number of teeth for its age (see Dentition), and if it has not, proceed to ascertain 

 whether the gums are being pressed upon and irritated by the teeth coming up 

 beneath. If this is the case the gums are generally reddened and swollen, and so 

 tender that the child will cry out when they are touched. It is not uncommon 

 to find the glands under the jaw enlarged and tender. If these signs be present, 

 then there need be no hesitation about lancing the gums; but if they are not 

 present, such a proceeding is unnecessary, and is merely a useless infliction of 

 pain. 



Examine carefully into the child's constitutional state, and examine its head, 

 bones, joints, and back, for any sign of rickets, and in nine cases out of ten we have 

 no hesitation in saying that such signs will be present. This being the case, we 

 must look to the diet, which should be as nourishing as possible, and great benefit 

 will be derived from the administration of cod liver oil and steel wine (a tea- 

 spoonful of each twice daily after meals). It is important, too, that these children 

 should get as much as possible into the open air. It is a mistake to suppose that 

 their throats are delicate and that they need coddling : such is not the case. They 

 should be warmly wrapped up with a thick veil over the face to keep off the cold 

 wind, and they should be taken out regularly, and, if old enough, encouraged to 

 run about. Sometimes the child, instead of being rickety, is scrofulous, and in 

 such cases the administration of iodine (half a tea-spoonful of the syrup of the 

 iodide of iron once or twice a day) is advisable. Sea air in scrofulous cases is 

 a most valuable adjunct to treatment, and the child should, if possible, have the 

 benefit of it. 



Dentition. The cutting of the teeth is a natural process, and we have no right to 

 class it among the diseases of childhood ; but, nevertheless, the process is often a cause 

 of so much difficulty and trouble to delicate children, and the period during which 

 the process is going on is one which is often so critical, that we may be excused for 

 offering a few remarks on the subject. The " first set " of teeth, or the milk teeth, 

 as they are more properly called, are twenty in number. The first to appear are the 

 central incisors, or the thin cutting teeth, in the middle of the jaws, in the very 

 front of the mouth. These should be cut by the seventh month of life, so that at the 

 end of the seventh month a child should have four teeth two in each jaw. The 

 lateral incisors are the next to appear. These are two in number in each jaw, and 

 immediately adjoin the central incisors. They should be cut by the end of the ninth 

 month, so that a child of nine months old ought to have eight teeth. At the end of 

 the first year the anterior molars, or front grinding teeth, ought to have appeared : 

 and at a year and a half the canines, or dog teeth, should be cut. Lastly, by the 

 completion of the second year, the posterior molars, or back grinding teeth, make up 



