days together, the child's head probably growing
heavier, and its headache more severe. The bowels during this time are
disordered, generally constipated from the very first, though their
condition in this respect sometimes varies at the commencement of the
disease. The evacuations are usually scanty, sometimes pale, often of
different colours, almost always deficient in bile, frequently
mud-coloured and very offensive. The tongue is not dry, generally rather
red at the tip and edges, coated with white fur in the centre and
yellowish towards the root, but occasionally very moist, and uniformly
coated with white fur. The skin is harsh, but not very hot, the
temperature seldom above 100 deg. Fahr., varying causelessly, but usually
higher towards evening than in the daytime. The nostrils are dry, the
eyes lustreless, and _the child sheds no tears_. It is drowsy, and will
sometimes want to be put to bed two or three times in a day; but it is
restless, sleeps ill, grinds its teeth in sleep, lies with its eyes
partially open, awakes with the slightest noise, or even starts up in
alarm without any apparent cause. At night, too, the existence of
intolerance of light is often first noticed in consequence of the
child's complaints about the presence of the candle in the room.

I have purposely dwelt long on this preliminary stage because it is only
in it that treatment is likely to be of any service, while the very
indefiniteness of the symptoms constantly leads to their being
overlooked, or referred to teething, or thought at any rate to be a mere
temporary ailment for which it is not worth while to call in the doctor.

After four or five days, however, the illness of the child becomes too
marked to escape notice. All cheerfulness has fled, the eyes are closed
to shut out the light, the child lies apparently dozing, but answers
questions rationally, in a short quick manner in as few words as
possible, and from time to time complains of its head, or utters a
short, sharp lamentable cry. The night brings with it no other change
than an increase of restlessness, attended sometimes with noisy cries,
or with the wandering talk of delirium. Sickness often diminishes, but
the bowels continue constipated, and it is to be noted that whereas in
fevers the bowels are distended with wind, here all wind has disappeared
and the belly is sunken to a striking degree.

Next comes the last stage. Each stage is distinguished by peculiarities
of