The Ears should always be carefully ex amined. A boil in the ear is very common in young children, and may occasion days of feverishness, restlessness, and crying, the cause of which remains undiscovered till discharge from the ear reveals it. Gentle pressUre with the finger on the part of the cheek that pro jects over the canal of the ear will provoke evidence of pain, if there is any irritation in the interior.
The Throat must always be examined, the child being held on the lap of one person in front of a well-lighted window, while the observer gets a view of the throat with the help of a spoon-handle to depress the tongue.
Gesture and here the movements of the hands and arms. Children, like grown-up people, often try to aid obstructed breathing by grasping with the hands and rais ing the arms to help expansion of the chest. In severe fevers the rigid bend of the fingers with the thumb doubled in on the palm is very no ticeable. In irritation of the bowels the thighs are bent up on the belly while the pain lasts. The involuntary movements and twitches of St. Vitus' dance (p. 182) are well known.
Movements of the and jerky movements, with constriction at the sides, and accompanied by heaving of the belly, and depression at the collar-bones, indicate serious lung mischief. Breathing that is accompanied by a pleuritic stitch is manifested by the sudden convulsive stop in the middle of the inspiration, the pain being also shown by the movements of the face and the cry. Disease of the belly also affects the movements of the chest, for if move ment of the belly causes pain it will be kept quiet, and all the breathing will be performed by chest movements, which will be short and quick, incomplete, that is to say, prevented from going so far as to exert downward pres sure on the belly.
Movement of the indicated above, the movements of the belly may be ex aggerated, when the disease is in the chest, to relieve the chest of the work it is unable to perform, or the movements of the belly may be entirely restrained when it is itself the seat of disease. In the latter case it will be tense, the muscles firmly contracted to guard against movement, and the thighs will be bent up on it to relieve it of strain. When the belly is the
seat of pain, specially colicky pain due to flatu lence, the contracted muscles make the belly feel tight and firm, and the child usually kicks and twists itself about, crying lustily while the pain lasts. But as soon as the spasm of pain has passed, the child speedily quiets down, giving vent only to a final sob or two, unless another attack rouses it to the same crying and kicking. On the other hand, if the pain is inflammatory the child lies moving as little as possible, for movement increases this pain, and there is moaning rather than crying out.
The General State and Warmth of the Body may be gathered from noticing the plumpness or wasted appearance, firmness or softness, of the .child. The way in which the child holds itself together, also, should be ob served, whether bright and buoyant, or languid and drooping. The heat of the body is roughly ascertained by laying the hand on the skin or on the head; but the most reliable means is by using the thermometer (p. 38). It will indicate a rise of temperature amounting to fever when feeling with the hand would give no hint of anything wrong. A mother who learned how to use it, and it is very easy learning its use, would find it of inestimable value. It would not only tell her whether her child was really ill, but also, within an hour or two of the employment of her simple method of treatment, she would be able to tell by means of it whether any good had been done.
The Cry of the child is often peculiar. The feeble, plaintive cry is itself sufficiently sugges tive. Au acute cry, very shrill and intermittent, is not infrequent in " water - in - the - head" (p. 155), while a hoarse, muffled cry is heard in croup (p. 538). If a child, apparently healthy, takes suddenly to a constant crying, which movement and dandling seem only to aggra vate, thorough search should immediately be made to see that it is not due to some wayward pin, or some uncomfortable fastening or knot ting of the dress.