Having attended to the diet, attention should next be directed to the clothing of the child. These patients, especially if they show any signs of rickets, are very sensitive to changes of temperature, and it is of extreme importance that they should be thoroughly protected from chills. The belly should be covered with a broad flannel belt. This must be applied carefully, so as to cover the whole of the abdomen, from the hips to the waist, and should fit closely to the skin. In cold or changeable weather the child's legs and thighs should be protected by long woollen stockings, and all his underclothing should be of flannel or wool. So protected, the patient must be taken out of doors as much as possible, and in suitable weather should pass the greater part of the day out of the house. Before he leaves home, his feet should be examined to see that they are perfectly warm ; and in cold weather it is best to pack the child in a perambulator, so that his back and sides may be properly supported. His feet can then rest upon a hot-water bottle. If the patient be sent to a good seaside air, the effect of these measures is often very marked.
For medicine, unless there are positive signs of syphilis, mercurials and other lowering drugs should not be employ-ed. The best treatment consists in the use of iron in full doses and cod-liver oil ; but this treat ment must not be begun until the bowels have been put into a healthy state by appropriate remedies. For a child of eighteen months of age
two or three grains of the exsiccated sulphate of iron may be given in gly cerine ; or ten drops of the tincture of perchloricle of iron may be adminis tered, freely diluted with water and sweetened with glycerine, three times a day after meals. Quinine is also of service, and may be given in con junction with the iron. The value of alcohol must not be forgotten. A teaspoonful of the St. Raphael tannin wine, given two or three times a day, diluted with an equal quantity of water, is an important addition to the treatment.
I have employed frictions with mercurial salves to the splenic region, and seen them used by others, but have never noticed any special benefit from this proceeding. As a rule, it has seemed to me that the anaemia has been intensified by this means, and that the size of the spleen has in creased rather than diminished under the use of the drug. Unless the employment of the remedy is distinctly indicated by clear evidence of the presence of syphilis in the child, this method of treatment seems likely to be attended with a bad rather than a good result.