the child; but in general from fifteen to twenty minutes will be found amply sufficient. This application must at all times be carefully watched for if it remain on too long, ulceration and even death of the part might ensue; therefore, directly the skin is found tolerably red, the poultice should be removed. After its removal a soft piece of linen is to be put over the part, and if very painful it may be dressed with spermaceti-oint

ment.

Sect. 12.-The Warm Bath.

The warm bath, judiciously prescribed, is one of the most valuable remedial agents we possess, and the means for promptly administering it should always be at hand. For infants with active inflammatory affections of the respiratory organs, it is a remedy of the first importance. Again, when a child is attacked with convulsions, there is no safer or surer remedy than a hot bath. In the early stage of croup also, hot baths are of the greatest service; their use has saved many a child's life.

As a preventive, where there is a tendency to disease, the warm bath may be employed without scruple, and will be found most serviceable. Its value in this point of view is very great, and it is to be regretted that it is not sufficiently appreciated and used. For example, a severe cold has been taken and inflammation of the air-tubes is threatened; only put the child into a warm bath, and, with the common domestic remedies, a very serious attack may be warded off. Again, in the commencement of a diarrhoea, a warm bath, and discontinuing the cause of the attack, will alone suffice to cure; and, moreover, in the protracted diarrhoea attendant upon teething, where, after various

Σ

remedies have been tried in vain, the child has lost flesh and strength to an apparently hopeless degree, recovery has been brought about by the simple use of the warm bath.

The opinion that warm baths generally relax is erroneous; they are, no doubt, debilitating when used by persons of a weak and relaxed constitution, or when continued too long; but, on the contrary, they invariably give tone when employed in the cases to which they are properly applicable.

There are certain rules for the use of the warm bath, which should be invariably acted up to. Their neglect might be followed by serious consequences.

Temperature of the Water.-When the warm bath is used as a measure of hygiene, as a general rule, any degree of temperature may be chosen between 92° and 98° which appears to be the most agreeable to the child; but on no account must 98° be exceeded. When ordered as a remedial measure, the temperature will of course be fixed by the medical attendant. The same degree of temperature must be kept up during the whole period of immersion. For this purpose the thermometer must be kept in the bath, and additions of warm water made as the temperature is found to decrease. These additions of warm water, however, must be regulated by the thermometer, and not by the feelings of the child or of the nurse.

Period of remaining in the Bath.-This must depend on circumstances. It must be varied according to the age of the child. For the first four or five weeks the infant should not be kept in beyond three or four minutes'; and the duration must be gradually prolonged as the child advances in age, until it extends to a quarter of an hour-a 'period which may be allowed

after it has attained the age of four years. If the bath is employed as a remedial agent, the time of immersion must be prolonged; this will be determined by the medical adviser. Speaking generally, a quarter of an hour may be said to be the shortest period, an hour the longest, and half an hour the medium.

When in the bath, care must be taken that the child's body is immersed up to the shoulders or neck, otherwise that part of the body which is out of the bath (the shoulders, arms, and chest), being exposed to the cooler temperature of the air, will be chilled. And the instant the infant is taken out of the bath, the general surface, especially the feet, must be carefully rubbed dry with towels previously warmed; and when one of the objects of the bath is to excite much perspiration, the child should be immediately wrapped in flannel and put to bed. If, however, the object is not to excite perspiration, the child may be dressed in his ordinary clothing, but should not be allowed to expose himself to the open air for at least an hour.

Time of using the Bath.-When resorted to for sudden illness, the bath must of course be employed at any time needed. For any complaint of long standing, or as a general rule, it should be taken between breakfast and dinner, about two hours after the former, or an hour and a half before the latter. This implies that an infant should never be put into the bath after having been freely nourished at the breast. Neither should it ever be used when the child is in a state of free perspiration from exercise, or on awakening from sleep.

Foot-bath.-A partial warm bath, such as the foot-bath, is one of the safest and most frequently employed in the nursery. It is frequently ordered during

teething, and in affections of the head. In these cases the intention is not merely to produce a gentle and general perspiration, but it is more particularly used to draw the blood from the head and body to the feet. The temperature of the water should be raised as high as can be borne, and it must be kept up by the occasional addition of fresh hot water. The vessel employed should be deep enough to permit the water to reach the knees, and a blanket must be thrown round the little patient and the bath. After the child has remained in from ten minutes to a quarter of an hour, the feet and legs must be rubbed perfectly dry, woollen stockings drawn on, and the child put into a warm bed.

A mustard foot-bath is made by the addition of a table-spoonful of mustard-flour to every gallon of water. In convulsions excited by difficult teething, this bath is most useful, and may always be resorted to without fear by the mother. Its good effects will be much enhanced if, at the same time, a piece of flannel wet with cold water is applied over the head and temples, or cold water may be sprinkled on the face.

309

CHAPTER XI.

OF VACCINATION.

In the year 1876, I think it is scarcely necessary to point out the immense advantages of vaccination. One hears, it is true, every now and then of weakminded individuals, who resist the evidences of facts and of their senses, and oppose it, but they form an exception which proves the rule. We need only refer to the Registrar-General's annual reports, if we require any further proofs of the efficacy of this measure. The deaths from small-pox now are but a tithe of what they were formerly; and if we remember that a large proportion of those who did not actually die only recovered-with shattered health and broken-down constitutions, and that all were horribly disfigured, and many of them blind, I think you will agree with me in saying that Dr. Jenner's discovery is one of the greatest advances of modern science.

There are several circumstances connected with vaccination-namely, the age and condition of the child upon whom it is to be performed, the progress and appearance of the vaccine vesicle, and the maternal management of the child during the process—with which a parent ought to be more or less acquainted.

The Age and Condition of the Child.-The most favourable time for vaccinating an infant is between