alimentary canal, or with some affection of the liver, in consequence of which the serum of the blood becomes surcharged with the coloring matter of the bile; in this case, the adnata of the eye exhibits the same yellow hue as the surface of the body.

In very young infants, however, yellowness of skin is occasionally produced by an unusually yellow color of the serum, and in such cases is seldom a symptom of much importance.

In protracted diseases of the alimentary canal-chronic diarrhoea, cholera infantum, &c.—the skin assumes a sallow, dirty yellow or brownish hue.

The fulness and tension of the surface are increased from hyperemia of the cutis and subcutaneous tissues, in eruptive fevers, and in local cuticular inflammations. In hyperæmia and inflammation of the brain, the integuments of the face are very generally increased in fulness and tension. Tension of the integuments of one cheek, accompanied, at first, with increased redness, and subsequently with a shining whiteness, is an indication of one of the most common forms of gangrene of the mouth.

Tension of the abdominal integuments, when accompanied by tenderness, is an indication of inflammation of the abdominal viscera, particularly of the alimentary canal. When unaccompanied by tenderness, it may be produced by the formation of gas within the intestines, or by effusion within the peritoneum.

General or local tension of the surface of the body may be produced by the effusion of serum within the cellular membrane generally, as in anasarca, or in some particular portion of it, as in oedema. It is then distinguished by the diminished temperature and paleness of the parts where the effusion occurs, and by the pitting upon pressure.

A reduction of the fulness and tension of the skin may be produced by the action of cold, or by deficient food, or it may result from emaciation, resulting from protracted disease. In serous diarrhoea, and the cholera of infants, it often occurs with great rapidity. Perspiration is readily excited in children. During, or immediately succeeding a violent attack of coughing, of convulsive paroxysms, and of intense pain of the bowels, it is a common occurrence for a copious perspiration to break out about the head and face. A general moisture of the surface, occurring in acute diseases, with an abatement of their respective symptoms, is, in general, a favorable indication; but when the perspiration is local, and confined to the head and face, or to the extremities, it is, in general, an unfavorable symptom. A cold, profuse perspiration, with sunken eyes, a livid hue of the countenance, and short, slow, imperfect respiration, is a sign of great prostration, and is always an unfavorable occurrence. The natural odor of the sweat in young children is acid; in the miliary eruption, the acidity is very decided. In particular forms of cutaneous eruption, the sweat presents a very peculiar and characteristic odor.

Many of the cutaneous eruptions are indicative of disease of the alimentary canal, and other organs, or they may depend on simple

derangement of the digestive process. Thus the several species of strophulus, prurigo, urticaria, and erythema, result, in general, from improper, or too much food, an unwholesome condition of the mother's or nurse's milk, acid food or drinks; from certain articles of food eaten at improper seasons, as fish; from food of too stimu lating a character; and, in certain constitutions, or in particular conditions of the stomach, from articles of food not generally esteemed unwholesome, as strawberries, honey, &c. Many of these eruptions are attendant upon the process of dentition.

Herpetic and erythematous eruptions, and pemphigus, are very generally connected with disease, either acute or chronic, of the digestive organs. The occurrence of ecthyma is often favorable in the acute affections of the intestinal canal; as is, also, herpes labialis in all febrile and acute diseases. Minute vesicular eruptions often occur in chronic diarrhoea and in protracted cases of cholera infantum. Petechiæ are common in many of the intestinal diseases of children; they are usually an unfavorable symptom.

Roseola may arise from irritation of the digestive tube, or it may occur in the course of catarrhal and other complaints.

Itching and pricking of the skin are produced by gastric derangements or intestinal irritation. Itching of the nose is a common symptom of intestinal worms, and itching at the orifice of the rectum of the presence of oxyures. An itching and tingling of the skin often precede the occurrence of exanthematous diseases.

8. The Breath.

The breath of a young infant has often the smell of the breastmilk; occasionally its smell is slightly sour. It is generally, however, during the entire period of infancy and childhood, destitute of any peculiar or very decided odor.

Every marked change in the odor of the breath is the indication of disease of the mouth, nostrils, or digestive apparatus; or of disturbance of the digestive function.

When the breath of an infant is decidedly acid, it is usually in consequence of imperfect digestion of the food, and hence the occurrence of an acid breath is generally accompanied, sooner or later, with diarrhoea or colic.

In the diseases of the alimentary canal, and in the febrile affections of children generally, the breath has a peculiar smell, difficult to describe, but when once observed, always readily recognized.

A fetid state of the breath may arise from indigestion, from disease of the alimentary canal, from ulcerations of the nose, mouth, and throat, and from gangrene of the gums or cheek. It is present, also, in smallpox, and the latter stages of the more violent forms of scarlatina anginosa, diphtheria, etc.

A rancid smell of the breath is, ordinarily, the result of indigestion from overloading the stomach with animal food.

9.-Discharges by Vomiting and Stool.

Infants at the breast often vomit from mere repletion of the stomach with milk; a greater amount being sucked than the stomach can digest. The vomiting, in this case, is beneficial, and is favored by the peculiar position and structure of the stomach during the first months of existence. The milk thrown up is unchanged, or partially coagulated.

Vomiting, however, may be induced by some disturbance of the digestive process; the milk discharged, in this case, being decidedly acid. Repeated vomiting is, in general, however, an indication of disease of the alimentary canal, and is often accompanied with purging. In certain cases the caseous portion of the milk is retained in the stomach, undigested, in the form of a hard, tenacious coagulum; and gives rise, often, to gastrodynia, colic, and even convulsions. When discharged by vomiting, an almost immediate relief of all the unpleasant symptoms induced by its presence in the stomach is experienced.

Almost incessant vomiting, increased upon anything being taken into the stomach, the discharges being decidedly acid, and often of a green color, is a symptom of gastro-malacia, or that form of stomachic disease of children, terminating in a gelatiniform softening of the

coats of the stomach.

Vomiting occasionally attends the process of dentition. It very generally ushers in an attack of scarlatina, and not unfrequently terminates the violent paroxysms of spasmodic cough, in severe cases of pertussis.

Vomiting, attended with increased bilious discharges from the bowels, is common in infants during the heat of summer, particularly at the period of weaning, or during dentition. When violent and protracted, and accompanied by repeated-almost constant-discharges of a yellowish or colorless fluid from the bowels, it constitutes the cholera infantum.

Frequent vomiting, attended with gradual, sometimes rapid, emaciation, is common in infants who are deprived at an early period of the breast-milk, and attempted to be reared upon other food.

Vomiting is occasionally symptomatic of diseases of the brain, and is often one of the indications of incipient hydrocephalus.

In early infancy, repeated evacuations from the bowels occur in the course of the day. During the whole period of infancy and childhood, the evacuations from the bowels are much more frequent than in after life. Increased evacuations are then also, in general, much more readily produced from trifling errors in diet, and slight degrees of irritation of the intestinal mucous membrane. The period of teething is very generally accompanied by increased discharges by stool, of a thin mucous character.

Diarrhoea in children may arise from improper or too much food, the irritation of teething, irritation or inflammation of the intestinal canal, the action of cold, and from increased acid secretions in the stomach, the effect of functional derangement or disease of that

organ. When profuse or long-continued, it often proves fatal by the great exhaustion produced.

Immediately after birth, the discharges from the bowels are of a very dark green or black color-the meconium. During the early period of infancy, the discharges are of a soft, curdy consistence and appearance, occasionally tinged with bile, and without fetor. During the remainder of infancy and childhood, they are more or less soft, and of a yellow or light brownish hue.

Frothy, acid discharges from the bowels, of a light yellow or slightly green color, indicate a disturbance of the digestive function; generally from over-feeding or improper food.

Discharges of slimy mucus occur in irritations of the bowels, from worms or teething; or they are the consequence of an increase of the mucous exhalation from the follicles of the intestines, caused by the impression of cold upon the surface.

Repeated discharges of viscid mucus, occasionally streaked with blood; or of a greenish fluid, mixed with small masses resembling the curd of milk, are frequent in most of the inflammatory affections of the bowels.

Profuse and frequent discharges of thin or frothy fluid, nearly colorless, and devoid of fetor, mark the occurrence of cholera infantum.

A deep green color of the stools, the discharges resembling chopped grass or spinage, is generally a symptom of serious disease of the stomach or intestines, and is a striking feature in gastromalacia, and the more acute grades of gastro-intestinal inflammation. In chronic diarrhoea the stools are thin, dark-brown, and often intolerably fetid.

In certain cases of intestinal irritation, whether from worms or other causes, the discharges from the bowels consist occasionally of a slimy fluid of a whitish color, resembling milk.

Light brown or clay-colored stools are, in general, the indication of hepatic disease, attended with a diminished secretion of bile. Worms are occasionally passed with the stools, during the latter period of infancy, and in childhood, without any symptoms having been present to indicate their existence.

A diminution in the number of stools, when diarrhoea occurs as a symptom of the diseases of children, with a return to the ordinary healthy condition in the color and consistence of the discharges, is a favorable symptom.

The appearance of natural feces in cases of dysentery, and of bile in the discharges in infantile cholera, is a favorable indication.

Blood is occasionally observed in the discharges of children, in hyperæmia, irritation, and inflammation of the mucous membrane. It is generally mixed with mucus or with fecal matter, and never occurs in any great quantity.

The passage from the bowels of the substances taken as food entirely unchanged, or but little altered, is an indication of excessive irritability of the alimentary canal. It occurs occasionally in inflam

mations of the stomach and bowels, but more frequently in protracted cases of cholera infantum, and chronic diarrhoea.

Constipation is not unfrequent in the early stages of infancy, and in many cases appears to be constitutional, and in others to depend upon the quality of the mother's milk. We have frequently known, in a young infant, several days to pass, and no evacuation by stool to take place without, apparently, any inconvenience resulting, but when, finally, the desire to discharge the contents of the bowels occurred, the violent straining, and the pain attendant upon the passage of dry, hardened masses of feces, were particularly distressing to the little patient. Constipation should, therefore, never be overlooked, as it may be the means of inducing violent colic, invagination or inflammation of the intestines.

Constipation often exists in the early period of many of the acute affections of infancy, particularly of the head and chest. It may arise, in some cases, from functional derangement or disease of the liver, preventing the free secretion of bile. Constipation is, not unfrequently, induced in infants and young children, by the imprudent use of opiates.

In very young infants, the retention of the meconium occasionally gives rise to a deep comatose condition, terminating, if not speedily relieved, in asphyxia and death; in other cases partial or general convulsions have been known to arise from this cause.

10. The Urinary Discharge.

The condition of the urine, during infancy and childhood, affords but little important aid in the diagnosis of the seat or character of morbid action. In most of the acute febrile affections the urine is high-colored and scanty, and its passage often attended with some degree of pain. It is often white in intestinal irritation from the presence of worms, and in hydrocephalus.

In irritation of the gastro-intestinal mucous membrane, it is frequently of a bright yellow or deep orange hue.

Incontinence of urine is frequent in children at all ages. It may simply depend upon the extreme irritability of the mucous membrane of the bladder during infancy; from an augmented secretion of serous urine, in consequence of a derangement of the renal function, or from neglect on the part of the child of the sensations incident to the natural call to urinate, in consequence of which, the command of the will over the action of the bladder and its sphincter is lost. It occasionally results from irritations seated in the lower portion of the intestinal canal; and in some cases, from disease of the brain or spinal marrow.

An excessive amount of limpid watery urine is often voided by infants and children, and is indicative of a disordered state of the digestive function from improper food. It often occurs at the period of weaning, and is occasionally attendant upon dentition. The increased flow of urine in children is said to be, occasionally, saccha

rine.