The Mother's Manual of Children's Diseases Part 10

=Inflammation of the Heart.=--The above remarks do not comprise all that is to be said about heart-affection in early life. _Inflammation_ may attack the investing or the lining membrane of the heart at all ages, may produce in the child the same suffering as in the grown person, and may tend to destroy life in a similar manner. The causes, indeed, which produce heart disease, are far more frequent in the grown person than in the child, and advancing age brings with it changes which, wholly apart from active inflammation, produce grave forms of disease unknown in early life. There is, however, one cause of heart disease which is far more frequent in childhood and early youth than in later life, namely, rheumatism. Eight out of ten of all cases of heart disease under the age of fifteen are of rheumatic origin, and in eighteen out of twenty cases of acute rheumatism under that age, whether slight or severe, the heart becomes more or less involved. Now and then, though rarely, the heart becomes affected in the course of scarlatina, and still more seldom in the course of the other fevers, and every now and then affection of the heart is a.s.sociated with some other form of inflammation of the chest.

Pain is by no means a constant attendant on it, but fever, more or less considerable, a quickened pulse, and hurried breathing are all but invariable, and one great reason for seeking the immediate help of the doctor is, that his skilled ear may at once detect by the altered sounds the heart-affection at its very outset, and employ the measures calculated to arrest its progress.

Death in the acute stage of a first attack of inflammation of the heart is of extreme rarity, but the damaged heart is liable to returns of acute mischief, any one of which may prove fatal. Independently of this, life with diseased heart is one of suffering, attended as it is by symptoms similar in kind, though not identical with those which I have already mentioned as attendant on malformation of the organ.

The hopeful element, however, to which I have already referred as present in cases of malformed heart, exists here in even a greater degree; since repair of injury is possible, while the reconst.i.tution of an organ faulty from birth is obviously beyond nature's power.

I can but repeat the directions already given as to the importance of allowing the heart as much rest, and giving it as little work, as is possible with a never-resting organ; and this with the added motive for perseverance furnished by the happy issue which may be hoped for as its reward.

One word I must add about the occasional occurrence of _irregular action of the heart_ during the years of growth, especially from the age of ten to fourteen. This is often quite independent of any disease, and ceases when with added strength the nervous system becomes less impressionable.

CHAPTER VIII.

DISEASES OF THE ORGANS OF DIGESTION.

=Manner of Performance of Digestion.=--The organs situated in what is called in medical language the abdomen, have in the child no other duty to perform than such as subserve the processes of digestion and nutrition. The saliva secreted by the appropriate glands in the mouth, mixing with the food, facilitates the further changes which take place in the stomach. In the stomach the food is acted on and dissolved by the gastric juice or pepsin, which is poured out by an almost infinity of minute tubes, or follicles as they are termed. When the stomach has done its work, its contents in a semi-fluid state pa.s.s into the small intestine, and mix there with the bile, the secretions from the intestines themselves, and with those of the large gland, the pancreas (in culinary language known as the sweetbread), which seems to have the special power of dissolving fatty matters. As the food, thus acted on, travels along the intestines, whose constant movement facilitates the pa.s.sage of their contents from above downwards, its elements are taken up, partly by the blood-vessels, partly by innumerable small vessels, called absorbents from their power of imbibing fluids, and lacteals, from the milky hue of the fluid within them when first absorbed. The fluid taken up by the blood-vessels is conveyed to the liver; that taken up by the absorbents to the mesenteric glands, and in these organs further changes take place in it, which fit it to be received into the ma.s.s of the circulating fluid. With this it is carried to the right side of the heart, and thence to the lungs and, lastly, from them to the left side of the heart, whence it is distributed, the great life and health giver, to the rest of the body. The useless inconvertible material, leaving every available element behind, is got rid of, either in a solid form by the bowels, or in a fluid form by the kidneys; and thus as long as life lasts there goes on more or less perfectly the wonderful process of constant change, of constant renewal, and during childhood and youth, of constant increase of size and stature.

Incomplete as this sketch is, it may yet suggest how readily one part of this complex machinery may be thrown out of gear, and further how not one part can suffer without all being disordered. Solid food given to the child before it has cut its teeth, enters the stomach unreduced to pulp by the grinders, and unmixed with the saliva, which should help its solution, and which the undeveloped salivary glands do not yet furnish.

Too large a quant.i.ty of food, or food of an unsuitable character, on which the gastric juice cannot act readily, may pa.s.s into a state of fermentation; vomiting, flatulence, sour and offensive breath will be the result, and the food will pa.s.s into the intestine unprepared to be acted on by the bile. Exposure to cold, or the opposite condition of excessive heat, may disturb the action of the liver, and interfere with the secretion of bile; and the food will then pa.s.s along the intestine in a state unsuitable for absorption. Or, again, the mesenteric glands may be irritated by long-continued imperfect performance of the earlier stages of digestion, or their structure may be altered, and mesenteric disease, or consumption of the bowels, as it has been termed, may result. From want of muscular power, or from want of care on their part who have charge of the child, the bowels may become habitually constipated. Health will then suffer, if the child carries about with it for days together matters which can serve no useful purpose, but which are to the body what an ill-kept dustbin is to the rest of the house.

Lastly, if the kidneys perform their duties imperfectly in consequence of exposure to cold, or of the changes which some diseases, such as scarlatina, sometimes bring about in their structure, the blood will be imperfectly purified; dropsy and various forms of inflammation may result; or the brain and nervous system may be disordered, and death in convulsions may attest the dangerous nature of this blood-poisoning.

It would take too long to go in detail through all the phases of disordered digestion in early life. Much has been already antic.i.p.ated in a former part of this book, especially with reference to the troubles of digestion in infancy and early childhood. There is, indeed, but one form of indigestion whose characters are so special as to require that I should enter into any detail with reference to it.

=Dyspepsia of Weakly Children.=--Children from the age of about three to ten years, whose health has been impaired by an attack of typhoid, or, as it is commonly called, infantile remittent fever, or who belong to a weakly family, or to one, some of whose members have shown a disposition to consumptive disease, are sometimes martyrs to indigestion. It does not need with them any special error of diet, or any casual exposure to cold to disorder their digestion; but every two or three weeks, even under the most scrupulous care, they lose their appet.i.te, their tongue becomes thickly coated with yellow fur, their breath offensive, their bowels constipated, the evacuations being either very white or very dark, and frequently lumpy, and coated with a thin layer of mucus from the bowel, which also appears in shreds at the bottom of the utensil.

With this condition, too, there is some, though not considerable, feverishness, and the urine becomes turbid on cooling, and throws down a reddish-white deposit, which disappears if heated. At the end of two or three days of rest in bed, of a diet of beef-tea and milk, with no solid food, with simple saline medicines, mild aperients, and perhaps a single small dose of calomel, the symptoms pa.s.s off; but return again and again at uncertain intervals, and without any obvious cause.

In these cases, the children almost always, when in their ordinary health, have a peculiar patchy condition of the tongue, one part of it being covered with a thin white coating, through which little red points project, while another part is of a vivid red, and looks raw and shining, as though it had been scalded, while the red points, or the papillae, as they are termed, project above its surface like so many pins' heads. Children in whom this condition exists, require much watching and much care. I have dwelt upon it in order to impress on parents the conviction that it is not a state to be cured, once for all, even by the most skilful doctor, but that years are needed to eradicate a bad habit of the body, as much as to cure a bad habit of the mind.

=Jaundice.=--I have already spoken of the jaundice of new-born infants; but a sluggish condition of the liver, accompanied by very white or pale evacuations, constipation, and loss of appet.i.te, with a sallow tint of the skin, and sometimes even with actual _jaundice_, are by no means uncommon during the first ten years of childhood. Neither condition is serious; that of actual jaundice occurs mostly in the summer, and is then connected with the sudden onset of hot weather. When severe, it may be a.s.sociated with some degree of feverishness, with dizziness, and complaint of headache, and occasionally with vomiting, while the child rests ill at night, or awakes in a state of alarm, and these symptoms sometimes give rise to the fear that the child is about to be attacked by water on the brain. But the following consideration may serve to calm anxiety on that score. The attack is not preceded, as water on the brain is almost invariably, by several days or even weeks of failing health.

It is not attended by heat of head, nor by intolerance of light, nor by constant nausea; and the belly is full rather than shrunken. When to these symptoms are added tenderness on the right side, high-coloured urine and white evacuations, you may set your mind at rest, even before the yellow colour of the skin, which appears in a day or two, stamps the case unmistakably as one of jaundice.

My business is, as I have said more than once, the endeavour to describe the symptoms of disease, to explain their nature, to indicate the principles to be observed in attempting their cure, and not to lay down definite rules for their treatment, with the idle expectation that I could thus enable every mother to be her children's doctor.

=Diarrh[oe]a.=--I have, therefore, comparatively little to say about _diarrh[oe]a_ in children, important though it is, for its symptoms force themselves on the notice even of the least observant. There are, however, a few points concerning it worth bearing in mind. Before the commencement of teething, diarrh[oe]a is almost always the result of premature weaning, or of a diet in some respect or other unsuitable. As soon as teething begins, the liability to diarrh[oe]a increases greatly, and cases of it are more than twice as frequent, and twice as fatal, between the ages of six and eighteen months as they were in the first six months of life; while, as soon as teething is over, their number immediately declines again to the half of what it was during the continuance of that process. The practical conclusions to be drawn from these facts are that looseness of the bowels during teething is not a desirable occurrence to be promoted, as some mistakenly imagine, but a risk to be by all means avoided, and I may add, when it does take place, far less easy to control than constipation is to remedy. And next, that in order to prevent its occurrence, care should be taken to make changes in the diet of a child, not during the time when a fresh eruption of teeth is taking place, but during one of the pauses in that process.

There are certain seasons of the year when diarrh[oe]a is specially prevalent, independent of any change in diet, or alteration, in any respect, of the circ.u.mstances in which the child is placed. Thus, in May, June, and July, diarrh[oe]a is twice as prevalent among children at all ages as in November, December, and January; and in August, September, and October, its prevalence is three times as great as during the winter months. The high mortality of children in the summer months is due almost entirely to diarrh[oe]a, and even the bitter Northern winter of a city like Berlin is a third less fatal to infants and young children than the heat of its short summer.

The next point to remember is that mere looseness of the bowels is never to be regarded during the first three years of life as of no importance; for I have seen infants die exhausted from its continuance, even though the examination of the body after death showed almost no sign of disease. Doctors distinguish two forms of diarrh[oe]a: the simple, or, as it is technically called, catarrhal diarrh[oe]a; and inflammatory diarrh[oe]a, or dysentery. The one may pa.s.s into the other, just as a common cold, or catarrh, may pa.s.s, if unattended to, into a dangerous bronchitis.

_Simple diarrh[oe]a_ usually comes on gradually, and is some days before it grows severe, or pa.s.ses into the more dangerous dysentery.

Simple precautions will often arrest its progress, and, among them, rest in bed is one of the most important. Over and over again I have known a diarrh[oe]a which had continued in spite of all sorts of medicines so long as the child was running about, cease at once when the child was kept for a couple of days in bed. The reason of this is obvious; constant movement of the intestines themselves, which serves so important a part in maintaining due action of the bowels, is increased by the upright position and by movement, and is reduced to a minimum by the horizontal position. A second precaution concerns the diet; solid food and animal broths should for a time be discontinued, and arrowroot, milk and water, and rice subst.i.tuted for it, for a day or two, with isingla.s.s jelly, and the white decoction of which I have already spoken.

It is not always that astringents are suitable at the beginning of an attack, and the sending to the neighbouring chemist for diarrh[oe]a medicine, which often contains an unknown quant.i.ty of opium, is always risky, frequently mischievous. In a first attack of diarrh[oe]a, the doctor should always be consulted, for when it is a.s.sociated with disorder of the liver a mercurial may in the first instance be needed, or possibly very small doses of a saline medicine, such as Epsom salts, with the addition of a few drops of the tincture of rhubarb; or, again, if the diarrh[oe]a sets in with profuse watery discharges, sulphuric acid for the first few hours is often of extreme service. It is at a later time that direct astringents commonly have their use; and the mother, who in her child's first attack of diarrh[oe]a has had the advice of a judicious doctor, will often be helped by him to manage for herself slight returns of the ailment.

_Inflammatory diarrh[oe]a_, or dysentery, not only follows the continuance of the simpler forms of the disease, but sometimes in the hot months of summer or autumn sets in suddenly with violence. It then frequently commences with vomiting, and the stomach may continue so irritable for twenty-four hours as not to retain even a teaspoonful of cold water. At the same time the over-action of the bowels sets in, and twenty or thirty evacuations may be pa.s.sed in twenty-four hours. The motions soon lose their natural character, and become watery, slimy, and mixed with blood. They are at first expelled with violence, afterwards with much pain, effort, and often fruitless straining. With these local symptoms, the child, as might be expected, is very ill, feverish, and stupid, though without sound sleep, much exhausted, and its nervous system so disturbed as to occasion frequent twitchings of the fingers and of the corners of the mouth, while sometimes actual convulsions take place. The thirst is intense, the child calling constantly for cold water, and crying out for more the moment the cup is taken away from its lips; while the loss of flesh and the exhaustion are more rapid than in any other disease with which I am acquainted. The fat happy babe of four and twenty hours before is scarcely to be recognised in the miserable little being, with sunken l.u.s.treless eyes, and wizened features, and miserable countenance, lying in a state of half-stupor, sensible only to pain, which yet rouses it but to utter a moan, and then sinks again into silent suffering. I can well believe what we are told, that in some countries this, the so-called Summer Complaint of many of the American cities, sometimes carries off children in a few hours.

If a fatal termination does not take place speedily, the disease pa.s.ses into the chronic stage, the diarrh[oe]a diminishing in frequency, but the pain and straining, and the unhealthy character of the evacuations persisting. Ulceration of the bowels has taken place, emaciation becomes extreme, and the child often sinks at the end of several weeks, worn out by suffering; while recovery, doubtful at the best, is always very slow.

But I need not pursue this subject further: enough has already been said to show how little infantile diarrh[oe]a is a disorder for domestic management.

=Peritonitis=, or inflammation of the membrane covering the bowels and lining the cavity of the belly, is of excessive rarity in its acute form; and is attended by such general illness and such severe local suffering, that it is impossible to overlook it or to misapprehend its gravity. Severe pain in the belly is sometimes complained of by children, and is due to what is termed colic, a spasm of the bowels which is generally a.s.sociated with constipation. The great test of the cause of the pain is furnished by the presence or absence of tenderness on pressure. The pain of colic is relieved by gentle pressure and gentle rubbing. The pain of inflammation in any degree and of any kind is aggravated by them. This applies also to cases, not indeed very common, in which inflammation is set up by some small body, such as a cherry-stone getting fixed in a little offshoot or appendage of about the size and length of the little finger, connected with the commencement of the large bowel, and producing ulceration. In these circ.u.mstances the bowels are confined, there are nausea and sickness, together with pain and tenderness of the belly, especially on the right side. The disease is a very dangerous one, and often proves fatal in the course of a few days. I refer to it because I have often seen it overlooked both by parents and doctors at its outset, since the pain then is often not severe nor the tenderness intense, and because I have seen the patient's condition rendered hopeless by strong aperients being given to overcome the constipation which was supposed to be all that ailed the child. I repeat then the caution, never to overlook the existence of tenderness, never to attempt to treat a case in which it is present; but always to call in medical advice, and above all always to abstain, unless ordered by a medical man, in every such case from the use of aperients.

=Large Abdomen.=--I must not leave the subject of disorder of the digestive organs without some reference to a condition which often excites much needless anxiety among mothers, namely, the large size of a child's belly. This is sometimes supposed to be a certain evidence of the presence of worms, at other times to be a positive proof of the existence of grave disease, especially of disease of the mesenteric glands, or glands of the bowels as they are popularly termed. It is evidence of neither the one nor the other.

If you go into a gallery of the old masters, and look at any of the pictures of angels which are generally to be seen there in such abundance, you will probably be struck in the case of all the child angels by what will seem to you the undue size of their abdomen. You will notice this even in the works of painters who, like Raphael, most idealise their subjects, while in those of others who, like Rubens, interpret nature more literally, the apparent disproportion becomes grotesque; or, in the coa.r.s.er hands of Jordaens, even repulsive.

These painters were, after all, true interpreters of nature. In infancy and early childhood the abdomen is much larger comparatively than in the grown person. For this there is a twofold cause; the larger size of the liver on the one hand, and the smaller development of the hips on the other. In a weakly child this appearance is exaggerated by its want of muscular power, which allows the intestines to become much distended with air. If the child is not merely weakly but also ricketty, the contracted chest will leave less room than natural for the lungs, while at the same time the ordinary development of the hips being arrested by the rickets, the disproportion is further increased both by that and by the flatulence due to the imperfect digestion with which the condition is almost always a.s.sociated.

In no case need the mere size of the abdomen occasion grave anxiety, so long as when the child lies upon its back the abdomen is uniformly soft, nor so long as even if tense it is not tender, and as it everywhere gives out a hollow sound like a drum when tapped with the finger.

It is not for a moment meant that no notice is to be taken, nor opinion asked, as to the cause of excessive size of the abdomen, for its distension may be due to real disease; but it is yet worth while to remember that its mere size is not of itself evidence of disease, nor cause of grave anxiety.

=Worms.=--There is no mistaking or overlooking the existence of _worms_ when they are really present. Their presence, however, is often suspected without any sufficient reason. Ravenous or uncertain appet.i.te, indigestion, flatulence, undue size of the abdomen, a dark circle round the eyes, itching of the nose and of the entrance of the bowel, a coated tongue, and offensive breath are no real proof of the presence of worms, and do not justify the frequent repet.i.tion of violent purgatives or of so-called worm medicines. The only real proof of the presence of worms is their being seen in the evacuations.

The worms commonly found in children are either the round-worm, which resembles the earth-worm, the thread-worm, or the tape-worm; the appearance of each of which is clearly indicated by its name. None of them are spontaneously generated in the body, but they are all introduced from without; their eggs, or, as they are technically called, their ova, being swallowed unperceived in some article of food, or drink. A proof of this is afforded by the fact that an infant, so long as it is nourished exclusively at the breast, never has worms.

The _round-worm_ occasions the fewest symptoms, and is rather an object of disgust than of grave importance, at least in this country, where it seldom happens that more than two or three are present. In other countries, as some parts of Italy, for instance, where the drinking water is bad and stagnant, they are sometimes found in great numbers, as thirty or forty, and it is then not easy to determine whether the symptoms which accompany them are produced by the worms, or by the unwholesome character of the water in other respects.

They appear to live on the contents of the intestines, and do not adhere to them, as the tape-worm does, and hence their comparative harmlessness, and they have no power, as has sometimes been mistakenly imagined, of perforating the bowels, and of thus producing grave mischief.

The _thread-worm_ is the commonest variety of these creatures, and has the peculiarity of inhabiting the lowest twelve inches of the bowel, where it produces much irritation and causes very distressing itching.

It is often present in great numbers, and is so rapidly reproduced, that in a week or two after it has been apparently got rid of, it may again be found as numerous as before. Certain articles of food seem to favour its development, such as pastry, sugar, sweets, beer, fruit, and anything which is apt to undergo fermentation, and thereby to impart to the evacuations a specially acid character. These worms are often accompanied with more or less marked symptoms of indigestion, but otherwise the local irritation is usually the only indication of their presence. They produce, indeed, such disturbance of the nervous system as may attend indigestion in any of its forms, but I have never but once known convulsions occur apparently due to their presence in great numbers, and ceasing on their expulsion; and this was in a child between eighteen months and two years old.

The _tape-worm_ is developed in the human body from a minute germ or ovum; one form of which exists in the flesh of the bullock, the other in that of the pig; and which seems to require for its growth the favouring conditions of warmth and moisture which are found in the intestines. It fixes itself to the lining of the bowels by means of its mouth, which is furnished with minute tentacles, and it thus derives its support from the juices which it imbibes. The head is so small as not to be seen distinctly without a magnifying gla.s.s; and immediately beyond it the jointed body begins; at first, scarcely bigger than a thread of worsted, but gradually enlarging, till at the distance of three inches it is an eighth of an inch wide, and thence rapidly widens till each joint is half an inch wide, and from a third to half an inch apart. It does not exceed these dimensions, even though it may grow to the length of four or six yards. Portions of it, sometimes a yard or two in length, are thrown off from its lower end occasionally, and this occurrence often gives the first indication of its presence, the worm continuing to grow as before, and fresh portions being detached from time to time. It does not appear that the worm has the power of reproducing itself; hence its French name of _ver solitaire_, and the occasional presence of two or three would seem to be due to the development of two or three distinct ova within the intestine.

Deriving as it does its support from the system of the child, and not as the other worms do from the contents of the bowel, the tape-worm often produces graver inconveniences. It sometimes causes uncomfortable colicky sensations, which may even be very distressing, and the disorders of digestion which accompany it are often very considerable; certainly more so than in the case of the other varieties of worms; but I have seen no instance of convulsions which could be attributed to them, notwithstanding the generally received opinion to the contrary.

When the existence of worms is suspected, one or two doses of a simple aperient, such as castor oil, repeated two days successively, seldom fail to produce evidence of their presence; which in the case of tape-worm is also furnished by the spontaneous detachment of some of the joints. It must be remembered, however, that until the head has been detached from its connection with the bowel, nothing has been gained, and the tape-worm will in a short time grow again. To obtain the detachment of the head it is necessary that any worm medicine should be given when the intestines are empty. I am, therefore, always accustomed to give a dose of castor oil about two hours after the child's mid-day meal; and to send the child to bed as soon as the aperient begins to act, and to give it no more food except a biscuit and a little milk and water during the rest of the day. In the early morning, the special worm medicine is given, and over and over again I have known the worm to be brought away completely after many previous failures. When the smallness of the joints shows that the greater part of the worm has been thrown off, and that little more than the head remains, it is necessary to have recourse to the unpleasant proceeding of mixing the evacuations with water, and then straining them through muslin, in order that the doctor may by means of the microscope make out whether or no the head has been really detached. This is no question of mere curiosity, but a matter of the gravest moment, since nothing has been really gained so long as the head of the worm remains adherent to the bowel.

Precautions such as these are not needed in the case of the other kinds of worms. Thread-worms, however, are best attacked in their habitation; that is to say, in the lower bowel, by means of lavements. It is, therefore, desirable before they are administered that the bowels should be emptied by a dose of castor oil.

The only other caution which remains for me to give refers to the peculiar effect which salicine, a very valuable medicine, especially in the case of thread-worms, has upon the urine. It sometimes turns the urine of a greenish-yellow, often of a red colour, as though it were mixed with blood. The appearance, however, has no grave meaning, but is due simply to a chemical action of the medicine on the colouring matter and salts of the urine.

There still remain some local ailments of parts connected with the process of digestion, concerning which a few words must be said.

=Ulcerated Mouth.=--First, with reference to the _sore-mouth_ of children. I have already noticed a form of inflammation and ulceration of the gums sometimes met with during teething, but the sore-mouth of which I am now about to speak is often quite independent of that process; though it may sometimes be found a.s.sociated with it, and is indeed rarely met with after five years of age. In almost all instances it is preceded and attended with symptoms of indigestion, during the course of which the mouth becomes inflamed, hot and red, and small very painful shallow ulcers with sharp-cut edges, and a little yellowish deposit on their surface, appear at the edge of the tongue, on the inside of the mouth, and especially on the inside of the lower lip, and the adjacent surface of the gum. Successive crops of these little ulcerations not unfrequently appear, so that for many weeks the child may be kept by them in a state of extreme discomfort; swallowing, and even speaking being the occasions of considerable suffering.

It is seldom that nursery remedies, and the so-called cooling medicines, though often of some service, suffice to get rid of the ailment, which for the most part needs judicious medical treatment, and local as well as const.i.tutional measures. Now and then this condition comes on in the course of measles, and is then sometimes of serious importance.

In the other form, the disease is usually limited to the gums, and affects especially those of the front of the lower jaw, which become swollen, ulcerated at their edges, where a very ill-smelling deposit takes place of a dirty white or greyish colour, the surface beneath being spongy, swollen, raw, and bleeding. The ulceration sometimes extends so as to lay bare a large part of the sockets of the teeth; but though loosened they seldom drop out. Coupled with this, the glands at the angle of the jaw are swollen, and the child dribbles constantly a large quant.i.ty of horribly offensive saliva. In the children of the well-to-do cla.s.ses the condition is seldom seen except in a slight degree; but even when severe it is rarely accompanied by any grave disorder of the general health. It seems to tend, whether treated or left to itself, slowly to get well; but its progress to a natural cure is extremely tedious, and the gums are left by it for a long time spongy, bleeding easily, and only very imperfectly covering the teeth.

Anxiety is sometimes excited by this condition; it being supposed that the white deposit on the edge of the gum implies some relation between it and diphtheria. This is not so, for though this peculiar ulceration of the gums has now and then been found a.s.sociated with diphtheria, the nature of the two diseases is essentially different. It is, however, always wise to call in medical advice in order to settle this important question, and the more so, since there is one remedy, the chlorate of pota.s.s, which, in appropriate doses, acts upon the condition almost as a charm.

I say nothing about a dreadful form of inflammation of the mouth which ends in mortification, because it is of infinite rarity except among the dest.i.tute poor, and even among them it is very seldom seen except as a consequence of measles, or of some kind of fever. It is only among the very poor that I have seen it, and even among them it has come under my notice only ten times in the whole course of my life.

There is a very common but inaccurate opinion that sore-mouth in childhood is often produced by the employment of mercury. I never yet saw a sore mouth due to the administration of mercury in any child before the first set of teeth were entirely cut; and never but once out of 70,000 cases which have come under my notice in hospital or dispensary practice, have I seen in children of any age under twelve any affection of the mouth from mercury sufficiently severe to cause me a moment's anxiety.