Ill-tasting medicine when mixed up in food and administered to little children is a source of future trouble since the child will distrust foods offered, imposing additional difficulties in feeding. It is better to give the fluid, or a powder floated upon water, by force if necessary. The spoon is not to be placed upon the lips, hut carried far into the mouth; a certain amount of pressure is to be exerted on the back of the tongue, and the medicine is to be introduced slowly, drop by drop, until a swallow has been taken, this being repeated until the spoon is emp tied. In older children it is possible to administer the whole dose at once by pinching the nostrils until the mouth is opened, pouring in the entire dose, and not withdrawing the spoon until after the medicine has been swallowed.
The regulation of the dose of medicine to be employed is not diffi cult, when rapidly repeated small doses are to be employed for an easily recognized effect. If, for instance, it becomes necessary to coat the gastric mucous membrane with bismuth, or the intestinal mucous mem brane with an almost insoluble preparation of tannic acid, large doses of these harmless remedies may be administered without interfering with the desired action. One may give as much as one-half to 1 Gm. (seven and one-half to fifteen gr.) of a tannic acid preparation every hour, for 1 doses. When, however, as in the various digitalis prepara tions, the action is cumulative and continues after the effecf of the drug can he recognized, it is necessary to use small doses carefully, so that the amount of the drug ingested •w'ill not produce more than the desired effect. It is necessary, however, not only to administer drugs in such a manner as to obtain the maximum chemical and therapeutic results, but also, by proper closing, to limit the collateral effects. For instance, ipecac may produce intestinal irritation before its action as an expec torant is thoroughly manifested. The collateral action, however, may usually be prevented by observing proper precautions at the right time; e.g., in using mercury, the mouth should be kept clean and the action of the bowels be regulated, and in the use of iodides or bromides, table salt in the food should be restricted to a minimum. When idiosyncrasies exist, as against antipyrin or opium, it is necessary to desist from its use in even the smallest doses. Only in rare instances is a case met with in which a patient is oversensitive to an entire group of remedies.
Certain drugs may have opposite actions even when used within the normal limits of clinical therapeutics, as when calomel, castor oil, rhubarb, or Glauher's salt used in small doses produce constipation, and in larger doses act as cathartics. Glauber's salt is present (only 0.230 per cent.) in Karlbad Milhlbrunnen water, which constipates when ad ministered to children in quantities of 20 to 100 Gm. (five to twenty
five drains) for gastric and intestinal catarrh, whereas only one-half to one dram is required for a laxative effect.
When adult doses are taken as a standard, it is not sufficient to use the age or weight in arithmetical comparison. Still, the latter gives a very important clue for graduating the doses of various remedies (e.g., the alkaloids and nerve poisons of all kinds); while such remedies as astringents, expectorants. cathartics, etc., whose principal action is local upon the internal mucous membranes, must be used in relatively larger (loses for children. In childhood, especially during the first and second years, the size of the (lose of medicine must be carefully consid ered. The dose is to be gradually increased during the following years (without assigning any particular close to each year, however) until, between the ages of ten and fourteen years, the size of the close is about one-half that of the adult. The physical development, however, must in a measure he taken into consideration. For the first six or eight weeks of life, all internal medication should be avoided, as a rule, ex cepting in such conditions as congenital syphilis, or spasms. During the remainder of the first year, great care is necessary in the adminis tration of drugs, especially opiates (one minim of the tincture of opium may be fatal); whereas sedatives are well borne, -c.g., chloral hydrate (up to 0.5 Gin. (seven and one-half gr.) once daily internally or by rec tum) and bromides (up to one Gm. (fifteen gr.) per day). An uncer tainty in the amount administered arises through the poor method of ordering a "teaspoonful," "as much as may he held on the point of a penknife," etc. Even though the capacity of a teaspoon is in general between 3 and .5 Gin. (forty-five and seventy-five gr.), a dessertspoon between S and 10 Gm. (two and two and a half drams), a soup spoon between 12 and 15 Gm. (three and four drams). the point of a penknife between 0.5 and 1 Gm. (seven and a half and fifteen gr.), the specific gravity of the remedy and the degree of care with which it is dispensed may increase these variations considerably. Because of the simplicity with which they may he figured, it is customary to consider a teaspoon ful as 5 Gm. (75 gr.), a dessertspoonful as 10 Gm. (two and a half drams), a tablespoonful as 15 Gm. (one-half and in so doing the close actually given is somewhat less than the calculated dose. The measuring of fluid medicines in medicine glasses, and the dispensing of dry drugs in exactly weighed powders is to be preferred for certain drugs. If medicines are ordered in drop doses, one should figure twenty drops to one gram (which is sometimes very inexact).