in a child over a year old
the risk is almost negligible.

Fortunately in all save the rarest possible instances the apnoea
yields and a deep inspiratory movement follows. As the air rushes past
the glottis, which is still partially closed, a sound recalling the
whoop of pertussis is heard. Often this recurs throughout all the
burst of crying which follows, and each inspiration is accompanied by
a shrill stridulous sound. With the re-establishment of respiration
the cyanosis rapidly fades, to be succeeded in some cases by pallor
and perspiration.

It need hardly be said that we should do all in our power to prevent
these alarming and distressing attacks. Each seizure predisposes to a
repetition. In some children we notice that months and even years
after an attack of whooping-cough, a slight bronchial catarrh may be
sufficient to bring back the characteristic cough. In laryngismus in
the same way we may suppose that the reflex path is made easy and the
resistance lowered by constant use. Fortunately the spasms are not
usually difficult to control. Calcium bromide, in doses of from two to
four grains, according to age, three times daily, is generally
successful with or without the addition of chloral hydrate in small
doses. At the same time we must endeavour in every way possible to
keep the child calm, by paying close attention to nursery management.
The child with spasmophilia is as a rule excitable and easily upset,
and although calcium bromide is a drug which offers powerful aid it is
not able to achieve its effect unless we are able at the same time to
guarantee a reasonable immunity from emotional upsets. It is for this
reason that I have included some description of laryngismus, although
its origin is undoubtedly very different from that of the other
disorders of conduct which we have examined.

MIGRAINE AND CYCLIC VOMITING

The aetiology of cyclic or periodic vomiting in childhood is not yet
completely understood. We do not know how far it is dependent upon
disturbance of the liver, and it is still disputed whether the
acidosis which accompanies it is the cause or the result of the
profuse vomiting. Into these difficult questions we need not at the
moment enter. It is enough in the present connection to recognise that
the great majority of children who suffer from cyclic vomiting are
sensitive, excitable, and nervous, and that every one is agreed that
the nervous system is intimately concerned in its causa