this transmission is more direct than that which is derived from the nurse to the infant, since the milk has no longer any influence here; it is the result either of infection or of contagion.

It is by contact that scabies, favus, thrush, ophthalmia, and hereditary constitutional syphilis may be transferred from the child to the nurse; but it is generally by infection that small-pox, chicken-pox, measles, scarlatina, cholera, diphtheritis, &c., become transmitted from the newly-born to those who are charged with nursing them. There is little difference of opinion in this respect: the only disagreement being as to the number of diseases to be included in the category; the principle of the transmission is everywhere admitted.

Amongst the diseases of the child, which I consider as transmissible to the nurse, there is one upon which all are not agreed; this is constitutional hereditary syphilis. This is a question which as much concerns hygiene and legal medicine, as the medicine of infants: it is necessary to come to a conclusion upon this subject, with reference to the hired nurses who are procured in offices, so as to indemnify them for having been really infected by syphilis through the medium of their nursling.

Our most ancient writers on syphilis have already pointed out the possibility of this mode of infection of the nurse by children, but the question is not resolved in the same manner in the mind of all practitioners; and as I shall treat this subject more fully further on, under the article Syphilis, I shall avoid discussing it in this place.

APHORISMS.

1. Man should be submitted from the cradle to the laws of hygiene, so as to strengthen his constitution if it is good, and in order to improve it if it is bad.

2. Scrofulous, syphilitic, and gouty dispositions hereditarily transmitted should be treated in early infancy.

3. A man of tainted blood should never aspire to the happiness of having children.

4. A woman who becomes pregnant, owes to the world and to God the renunciation of habits, exercises, and hardships which may disturb the conception, if she wishes to give birth to a well formed child.

5. Bleeding is favourable to gestation, but it should be rendered absolutely necessary by symptoms of local or general plethora.

6. The rejection of an unreasonable caprice in a pregnant woman can have no influence over the health of her child.

7. A woman may and should suckle her child when she is in good health, and when she has no relations (direct or collateral) affected with scrofula, phthisis, or cancer.

8. There are women who are of a good constitution and yet who

cannot suckle, for their milk is scanty, imperfectly elaborated, and becomes dried up in consequence of the slightest painful impression.

9. A woman whose mammary secretion is very active before her confinement almost always makes a good nurse.

10. A mother who intends to suckle may commence six or eight hours after her delivery.

11. A woman who nurses should give the breast every two hours at least, every hour at most.

12. Between eleven o'clock in the evening and six in the morning a good nurse only suckles the child once.

13. It is dangerous to take as a hired nurse a primiparous woman, who is necessarily inexperienced.

14. A good nurse should be from twenty to thirty-five years old, and should have brown hair, pink gums, a round figure, the breast well formed, rather hard, and marbled with blue veins.

15. A nurse should have no recent or old blemish of syphilis or scrofula. 16. The milk-yellowish during the first months after delivery, white, or bluish a little later-is an alkaline emulsion, composed of water and of solid constituents in solution or in suspension.

17. The butter is only suspended in the milk.

18. The other principles of the milk are in solution in this liquid. 19. To be profitable the milk should be abundant.

20. The milk should contain numerous globules, rather large and well formed; for small globules, resembling grains of dust, are a sign of its imperfect elaboration and its insufficiency.

21. Too many or too few globules are equally prejudicial.

22. The milk varies in its composition according to idiosyncrasies, temperament, constitution, the time elapsed since delivery, the period of the last repast, the regimen of the nurse, the action of the genital organs, &c.; but the differences are not sufficiently great to establish a law. The child prospers, therefore the milk is good.

23. The milk is altered in its composition by the febrile state, and by acute or chronic diseases.

24. Fever diminishes the quantity of milk, and concentrates its solid constituents in a less proportion of water.

25. The same is the case in different degrees in all acute diseases and in many chronic affections.

26. The milk is sometimes mixed with pus in cases of abscess of the breast.

27. The influence of diseases on the composition of the milk possesses nothing special and specific, for all act in the same manner. The influence of diseases is the same as that of fever.

28. A milk too rich, too much charged with solid elements in a healthy nurse, is indigestible and causes diarrhoea.

G

29. The milk altered, reduced and concentrated by fever or by disease, also causes diarrhoea.

30. A milk altered in its composition by fever or by disease, has not always a prejudicial action on the health of children.

31. Whatever may be the cause of the alteration in the composition of the milk, the result is always the same to the children; the symptoms which become developed are always seated in the alimentary canal, and diarrhoea is always the consequence of it.

32. The milk which does not present any appreciable alteration by chemical analysis, may be altered in an intimate manner in its elaboration, so as to constitute an injurious aliment.

33. Spasm, or instantaneous convulsion, usually result from the perturbation occasioned in the secretion of the milk by moral affections, acute emotions, and the agreeable or painful impressions experienced by the nurse.

34. The moral affections suddenly dry up the secretion of milk, or only modify in a decided manner the proportion of its solid constituents. 35. The happiness which a woman experiences in fulfilling her duties of nurse, is the cause of the internal trepidation which announces the flow of milk at the time she is about to give the breast.

36. The premature reappearance of the menses in a nurse slightly modifies the chemical composition of the milk, and is injurious to its elaboration; but if the child does not appear to suffer from it, which often happens, the nurse should not be discharged.

37. A nurse should abstain from venereal pleasures when she experiences a profound emotion from them.

38. A nurse should abstain from venereal pleasures for fear of a fresh impregnation, which might alter the milk in its quantity and in its qualities, so as to render it injurious to the nursling.

39. The change of nurse has no inconvenience if a bad one can be replaced by a better.

40. The nurse should be changed as often as it is necessary. 41. Lactation by the mother, or by the nurse, may be replaced by means of artificial lactation.

42. Lactation by the feeding bottle is much less successful than maternal lactation.

43. Lactation by the feeding bottle, when well directed, often gives very good results.

44. Artificial lactation should be accomplished in the first months of existence by a feeding bottle filled with tepid cow's milk, diluted with barley water, gruel, or chicken broth; and, later, by means of cow's milk without any admixture.

45. A child only requires milk in the first few months of its

existence.

46. A child should begin to take thin broths when six months old. 47. Fatty food is hardly suitable until towards the end of the first year.

48. It sometimes becomes necessary to wean children before the natural term.

49. The period for weaning should be fixed between twelve and twenty months.

50. In weaning children, one of the periods of repose in dentition should be chosen, and advantage should be taken of that which occurs after the appearance of the twelve first teeth, or after the appearance of the sixteenth.

51. Weaning is commenced by ceasing to give the breast during the night.

52. After several weeks of weaning at night, lactation during the day should be entirely suspended, and the child thus acquires an independent existence.

53. Sleep is so necessary to children that they should be accustomed to a siesta of several hours in the middle of the day.

54. Walking in the open air, the action of the sun, are in all seasons as necessary to the youngest children as to the more aged.

55. A loose wrapper is the best clothing for a few days after birth, for it protects the child from cold without impeding the organic movements.

56. Loose well-made garments are always preferable to large clothes, which leave the skin in different parts of the body uncovered.

57. Young children should be washed every day with tepid water, and, by degrees, with nearly cold water.

58. The head should be washed with the greatest care, and it should be gradually cleansed from the scaly substance which covers it.

END OF PART I.

Part II.

ON THE GENERAL PATHOLOGY OF INFANCY.

SECTION I.

GENERAL CONSIDERATIONS ON THE DISEASES ON THE FIRST
STAGE OF INFANCY AND ON THE MEANS OF

THEIR DIAGNOSIS.

It is impossible to account for the phenomena which accompany disease in the first stage of infancy, without a knowledge of the principles and laws which govern the affections of that tender age; and this 24 knowledge is more especially requisite for the due appreciation of the difference existing between the affections of infancy and the same affections developed in the adult. Nothing is to be compared to the influence of age on the character of disease, without it is the influence which climate exerts on the strength and form of plants and the large animals. When we observe the puny specimens of ricinus of our own country, and then compare them to the superb and gigantic ricini of inter-tropical countries-when we see the pale cacti of our hothouses in juxta position with the brilliant and celebrated cacti of the New World-when we compare animals of the same species born in different latitudes, the Polar bear, for instance, with the bear of the Pyrenees-the lion of the desert with the lion of the forests of Brazil-we shall then comprehend the whole extent of the modifications produced in the development of individuals of the same species according to their place of birth, and consequently be struck with the difference which exists between the disease of a growing infant and the same disease in a well formed man in all the vigour of life.

In this chapter I will consider the general conditions by reason of which the diseases of infants differ from those of adults. I will then point out the most suitable methods for the diagnosis of these diseases; and will treat of the physiognomy of children, of their gestures, attitudes, cry, stature, and of all those external signs furnished by