when this indisposition is met with in a healthy and robust condition of body, it will most probably last through life. Happily, however, experience has further shown that in most of these instances the individual is equally insusceptible of the small-pox disease.

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CHAPTER XII.

MANAGEMENT DURING TEETHING.

THE infant at birth has no teeth visible; the mouth is toothless. It possesses, however, hidden in the jaw, the rudiments of two sets; the first of these to make their appearance are called the temporary or milkteeth; the second, the permanent or adult-teeth, and these come up as the former fall out, and so gradually replace them.

Sect. 1.-Management of the Infant during

Teething.

The first set of teeth, or milk-teeth, as they are called, are twenty in number: they usually appear in pairs, and those of the lower jaw generally precede the corresponding ones of the upper. The first of the milk-teeth is generally cut about the sixth or seventh month, and the last of the set at various periods, from the twentieth to the thirtieth month. Thus the whole period occupied by the first dentition may be estimated at from a year and a half to two years. The process varies, however, in different individuals, both as to its whole duration and as to the periods and order in which the teeth make their appearance. It may be as

well to state that, as a rule, the teeth appear in the following order :-7th month, the central incisors; 7th to 10th month, the anterior molars; 11th to 20th month, the canine (eye) teeth; and last of all, the posterior molars; the lower teeth being generally a short time in advance of the upper ones. It is unnecessary, how

ever, to add more upon this point.

Their development is a natural process. It is too frequently, however, rendered a painful and difficult one, by errors in the management of the regimen and health of the infant, previously to the coming of the teeth, and during the process itself. Thus, chiefly in consequence of injudicious management, it is made the most critical period of childhood. Not that I believe the extent of mortality fairly traceable to it is by any means so great as has been stated; for it is rated as high as one-sixth of all the children who undergo it. Still, no one doubts that first dentition is frequently a period of great danger to the infant. It therefore becomes very important for the mother to know how the dangers and difficulties of teething can in any degree be diminished, or, if possible, altogether prevented. I shall consider, first, the management of the infant when teething is accomplished without difficulty; and, secondly, the management of the infant when it is attended with difficulty.

1. The Management of the Infant when Teething is without Difficulty.—In the child of a healthy constitution, which has been properly, that is, naturally, fed, upon the milk of its mother alone, the symptoms attending teething will be of the mildest kind, and the management of the infant most simple and easy. There will be an increased flow of saliva, with swelling and heat of the gums, and occasionally flushing of the

cheeks. The child frequently thrusts its fingers, or anything within its grasp, into its mouth. Its thirst is increased, and it takes the breast more frequently, though, from the tender state of the gums, for shorter periods than usual. It is fretful and restless; and sudden fits of crying and occasional starting from sleep, with a slight tendency to vomiting, and even looseness of the bowels, are not uncommon. Many of these symptoms often precede the appearance of the tooth by several weeks, and indicate that what is called 'breeding the teeth' is going on. In such cases the symptoms disappear in a few days, to recur again when the tooth approaches the gum.

The treatment of the infant in this case is very simple, and seldom calls for the interference of the medical attendant. The child ought to be much in the open air, and well exercised; the bowels should be kept freely open with castor-oil, and be always gently relaxed at this time. Cold sponging should be employed daily, and the surface of the body rubbed dry with as rough a flannel as the delicate skin of the child will bear, friction being very useful. The breast should be given often, but not for long at a time; the thirst will thus be allayed, the gums kept moist and relaxed, and their irritation soothed without the stomach being overloaded. The mother must also carefully attend, at this time, to her own health and diet, and avoid all stimulant food or drinks.

From the moment dentition begins, pressure on the gums will be found to be agreeable to the child, by numbing the sensibility and dulling the pain. For this purpose coral is usually employed, or a piece of orris-root, or scraped liquorice-root; a flat ivory ring, however, is far safer and better, for there is no danger

Gentle

of its being thrust into the eyes and nose. friction of the gums, also, by the finger of the nurse, is pleasing to the infant; and, as it seems to have some effect in allaying irritation, may be frequently resorted to. In France, and in this country also, it is very much the practice to dip the liquorice-root, and other substances, into honey or powdered sugar-candy; and in Germany a small bag, containing a mixture of sugar and spices, is given to the infant to suck whenever it is fretful and uneasy during teething. The constant use, however, of sweet and stimulating ingredients, must do injury to the stomach, and renders their employment very objectionable.

3. The Management of the Infant in difficult Teething. In the child which has been partly or altogether brought up by hand, or who is of a feeble and delicate constitution, or imbued with any hereditary taint, the process of dentition will be attended with more or less difficulty, and not unfrequently with danger.

The symptoms of difficult dentition are of much more aggravated description than those which attend the former case; and it is right that a mother should, to a certain extent, be acquainted with their character, that she may early request that medical aid which, if judiciously applied, will mitigate, and generally quickly remove them. There will be painful inflammation and swelling of the gum, which is hotter, of a deeper red than natural, and intolerant of the slightest pressure. There is often great determination of blood to the head, which a mother may recognise by the cheeks being red, hot, and swollen; the eyes red, irritable, and watery; and the saliva running from the mouth profusely. The fever is great, and the thirst extreme. The child is at one time restless and irritable, and at