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Paediatrics at a Glance
This book is dedicated to our children

Charlie, Mollie, Rosie

Aaron, Rebecca
Alysa, Katie, Ilana, Hannah, David
and all those children who enlightened and enlivened us during our working lives.
Paediatrics at a Glance

LAWRENCE MIALL
MB BS, BSc, MMedSc, MRCP, FRCPCH
Consultant Neonatologist and Honorary Senior Lecturer
Neonatal Intensive Care Unit
St James’s University Hospital
Leeds

MARY RUDOLF
MB BS BSc DCH FRCPCH FAAP
Consultant Paeditrician in Community Child Health
Leeds Community Children’s Services
Belmont House
Leeds

MALCOLM LEVENE
MD FRCP FRCPCH FMedSc
Professor of Paediatrics
School of Medicine
Leeds General Infirmary
Leeds

Blackwell
Science
© 2003 by Blackwell Science Ltd
a Blackwell Publishing company
Blackwell Science, Inc., 350 Main Street, Malden, Massachusetts 02148-5018, USA
Blackwell Science Ltd, Osney Mead, Oxford OX2 0EL, UK
Blackwell Science Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia
Blackwell Wissenschafts Verlag, Kurfürstendamm 57, 10707 Berlin, Germany

The right of the Authors to be identified as the Authors of this Work has been asserted in accordance
with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior
permission of the publisher.

First published 2003

Library of Congress Cataloging-in-Publication Data

Miall, Lawrence.
Paediatrics at a glance/Lawrence Miall, Mary Rudolf, Malcolm Levene.
p. ; cm.—(At a glance)
Includes index.
ISBN 0-632-05643-6
1. Pediatrics—Handbooks, manuals, etc.
[DNLM: 1. Pediatrics—Handbooks. WS 39 M618p 2002] I. Rudolf, Mary. II. Levene, Malcolm I.
III. Title. IV. At a glance series (Oxford, England)
RJ48 .M535 2002
618 .92—dc21
2002009515

ISBN 0-632-05643-6

A catalogue record for this title is available from the British Library

Set in 9/11.5 Times by SNP Best-set Typesetter Ltd., Hong Kong

Printed and bound in United Kingdom by Ashford Colour Press, Gosport

Commissioning Editor: Fiona Goodgame

Managing Editor: Geraldine Jeffers
Production Editor: Karen Moore
Production Controller: Kate Charman

For further information on Blackwell Science, visit our website:

www.blackwell-science.com
Contents

Preface 6 32 Swollen joints 77

List of Abbreviations 7 33 Swellings in the neck 78
34 Swellings in the groin and scrotum 79
Part 1 Evaluation of the child 35 Pyrexia of unknown origin and serious
1 The paediatric consultation 10 recurrent infections 80
2 Systems examination 12 36 Rashes—types of skin lesions 82
3 Understanding investigations I 18 37 Rashes—acute rashes 83
4 Understanding investigations II 20 38 Rashes—chronic skin problems 86
39 Rashes—discrete skin lesions 88
40 Rashes—nappy rashes and itchy lesions 89
Part 2 The developing child
5 Growth and puberty 22
Part 6 Problems presenting through child
6 Development and developmental assessment 25
health surveillance
7 Infant nutrition 28
41 Short stature and poor growth 90
8 Common problems for parents 30
42 Failure to thrive (weight faltering) 92
9 Adolescent issues 32
43 Heart murmurs 94
44 Anaemia and pallor 96
Part 3 The child in the community
45 Neglect and abuse 98
10 The child health service 34
46 The child with developmental delay 100
11 Child care and school 36
12 Immunization and the diseases they protect against 38
Part 7 The newborn infant
13 Screening and surveillance tests 39
47 The newborn baby 102
48 Congenital abnormalities 104
Part 4 The acutely ill child 49 Prematurity 106
14 The acutely ill child 40 50 Neonatal jaundice 108
15 The unconscious child 44 51 Congenital heart disease 110
16 The fitting child 46
17 The febrile child 48 Part 8 Chronic illness in childhood
18 Acute diarrhoea and dehydration 50 52 Asthma 112
19 Vomiting 52 53 Diabetes 114
20 The chesty child 54 54 Cystic fibrosis 116
21 Stridor 56 55 Juvenile chronic arthritis 117
22 Acute abdominal pain 58 56 Childhood cancer 118
23 Accidents and burns 60
24 Poisoning 61 Part 9 The child with a disability
57 The child with a disability 120
Part 5 Common symptoms 58 The child with visual and hearing impairment 121
25 Chronic diarrhoea 62 59 The child with cerebral palsy 122
26 Recurrent abdominal pain 64 60 Epilepsy 124
27 Constipation 66 61 Learning disability 126
28 Urinary symptoms 68
29 Headache 72 Index 129
30 Fits, faints and funny turns 74
31 Leg pain and limp 76 A colour plate section follows at the end of the book.

5
Preface

He knew the cause of every maladye, to paediatric problems and child health as they present in primary, com-
Were it of hoot or cold or moiste or drye, munity and secondary care. We have now taken the familiar At a Glance
And where engendred and of what humour: format and have visually presented each common symptom and led the
He was a verray parfit praktisour. student through the causes and key components of the evaluation so that
Geoffrey Chaucer c.1340–1400 a competent diagnosis can be made. Chapters are also devoted to pro-
A Doctor of Medicine, From Prologue to The Canterbury viding the reader with an understanding of children’s development and
Tales their place in society with additional chapters on nutrition, childcare,
Chaucer outlined with some clarity the qualities that a doctor of medi- education and community services.
cine requires, and emphasized that knowledge about the causes of mal- Although this book is principally intended for medical students, it
adies was required to come to competent diagnosis. We have structured may well provide appropriate reading for nurses and other allied pro-
Paediatrics at a Glance around children’s common symptoms and mal- fessionals who would like to deepen their understanding of children and
adies, and the likely causes for them. We have also attempted to distil paediatric management. It is particularly likely to appeal to those who
for the student not only the knowledge base they require but in addition take a visual approach to learning.
the competencies they must acquire in order to become ‘verray parfit Hippocrates wrote in his Aphorisms for Physicians, ‘Life is
praktisours’ when working with children and their parents. short, science is long, opportunity is elusive, experience is dangerous,
The world has changed since Chaucer’s time, and it is now widely judgement is difficult’. We have produced this concise volume in the
acknowledged that the medical curriculum suffers from ‘information hope that it will help students cope with these hurdles to medical train-
overload’. We have made great efforts to adhere to the General Medical ing, and facilitate the development of clinical acumen in their work with
Council’s recommendations in Tomorrow’s Doctors, and have only children.
included the core knowledge that we consider is required by doctors in
training. We have in addition placed great emphasis on the evaluation of Lawrence Miall
the child as he or she presents. Mary Rudolf
The focus of the book is similar to its parent book Paediatrics and Malcolm Levene
Child Health. In both we have attempted to provide a working approach July 2002

Acknowledgements 37 Acute rashes

Various Figures are taken from: Rudolf, M.C.J. & Levene, M.I. (1999) Figure 37 (chicken pox): Bannister, B.A., Begg, N.T. & Gillespie, S.H.
Paediatrics and Child Health. Blackwell Science, Oxford. (2000) Infectious Disease, p. 236. Blackwell Science, Oxford.

5 Growth and puberty 51 Congenital heart disease

Figure 5.1: Child Growth Foundation. Figure 51: British Heart Foundation.
Figure 5.3: Heffner, L.J. (2001) Human Reproduction at a Glance, pp.
32 & 34. Blackwell Science, Oxford.

36 Rashes; types of skin lesions

Figure 36 (papules): Courtesy of Dr Katherine Thompson.
Figure 36 (macule): Courtesy of Mollie Miall.

6
List of abbreviations

ACTH adrenocorticotrophic hormone IDDM insulin-dependent diabetes mellitus

ADD attention deficit disorder Ig immunoglobulin
AIDS acquired immunodeficiency syndrome IM intramuscular
ALL acute lymphoblastic leukaemia INR international normalized ratio
ALTE acute life-threatening event IRT immunoreactive trypsin
AML acute myeloid leukaemia ITP idiopathic thrombocytopenic purpura
ANA antinuclear antibody IUGR intrauterine growth retardation
APTT activated partial thromboplatin time IV intravenous
ASD atrial septal defect IVC inferior vena cava
ASO antistreptolysin O titre IVF in vitro fertilization
A-V ateriovenous IVH intraventricular haemorrhage
AVPU alert, verbal, painful, unresponsive IVU intravenous urogram
AVSD atrioventricular septal defect JCA juvenile chronic arthritis
AXR abdominal X-ray JVP jugular venous pulse
AZT zidovudine (azidothymidine) LMN lower motor neurone
BCG bacille Calmette–Guérin LP lumbar puncture
BP blood pressure MCH mean cell haemoglobin
BSER brainstem evoked responses MCUG micturating cystourethrogram
CDH congenital dislocation of the hip MCV mean cell volume
CFTR cystic fibrosis transmembrane regulator MDI metered dose inhaler
CHD congenital heart disease MLD mild learning difficulty
CMV cytomegalovirus MRI magnetic resonance imaging
CNS central nervous system NEC necrotizing enterocolitis
CPAP continuous positive airway pressure NHL non-Hodgkin’s lymphoma
CPR cardiopulmonary resuscitation NICU Neonatal Intensive Care Unit
CRP C reactive protein NPA nasopharyngeal aspirate
CSF cerebrospinal fluid NSAID non-steroidal anti-inflammatory drug
CT computerized tomography OAE otoautistic emissions
CXR chest X-ray OFC occipito frontal circumference
DIC disseminated intravascular coagulation PCO2 partial pressure of carbon dioxide
DKA diabetic ketoacidocis PCP Pneumocystis carinii pneumonia
DMD Duchenne muscular dystrophy PCR polymerase chain reaction
DMSA dimercaptosuccinic acid PCV packed cell volume
DTPA diethylenetriamine penta-acetate PDA patent ductus arteriosus
EB Epstein–Barr PEFR peak expiratory flow rate
ECG electrocardiogram PMH past medical history
EEG electroencephalogram PT prothrombin time
ENT ear, nose and throat PTT partial thromboplastin time
ESR erythrocyte sedimentation rate PUO pyrexia of unknown origin
FBC full blood count PVL periventricular leucomalacia
FDP fibrin degradation product RAST radioallergosorbent test
FTT failure to thrive RDS respiratory distress syndrome
GCS Glasgow coma scale RNIB Royal National Institute for the Blind
GOR gastro-oesophageal reflux ROP retinopathy of prematurity
GP General Practitioner RSV respiratory syncitial virus
G6PD glucose-6-phosphate dehydrogenase SCBU Special Care Baby Unit
HbF fetal haemoglobin SGA small for gestational age
HbS sickle-cell haemoglobin SIADH syndrome of inappropriate antidiuretic hormone
HIV human immunodeficiency virus secretion
HSP Henoch–Schönlein purpura SIDS sudden infant death syndrome
HUS haemolytic uraemic syndrome SLD severe learning difficulty
IBD inflammatory bowel disease SSPE subacute sclerosing encephalitis
ICP intracranial pressure STD sexually transmitted disease
7
T4 thyroxine UTI urinary tract infection
TB tuberculosis VACTERL Vertebral anomalies, Anal atresia, Cardiac anomalies,
TGA transposition of the great arteries Tracheo-oEsophageal fistula, Renal anomalies, Limb
TSH thyroid stimulating hormone defects
U&E urea and electrolytes VER visual evoked response
UMN upper motor neurone VSD ventricular septal defect
URTI upper respiratory tract infection WCC white cell count

8
1 The paediatric consultation

The doctor–patient relationship

The consultation Observations
• Introduce yourself to the child and their parents. • While taking the history, try to
They may be anxious so try to put them at ease observe the child and parents
• Use the child's name and talk in an age- • How do they relate to each other?
appropriate manner • Do the parents seem anxious or
• Explain what is going to happen depressed?
• Use a child-friendly atmosphere, with toys • Will the child separate from the
available parent?
• Arrange the seating in a non-threatening • Does the child play and interact
way that makes you seem approachable normally?
• At the end, thank the child and parents • Is the child distractible or
and explain what will happen next excessively hyperactive?

Ethical issues
A number of difficult ethical issues arise in treating infants and children.
These include:
• Deciding whether to provide intensive care to infants born so premature that they are
at the threshold of viability (i.e. <24 weeks gestation)
• Deciding whether to continue intensive therapy in an infant or child who has sustained
an irreversible severe brain injury and who would be expected to have an extremely poor Consent
quality of life • Children have rights as individuals
• Deciding whether to use bone marrow cells from one sibling to treat another sibling • Consent for the consultation and examination is
• Making a judgement as to when children are in such danger that they should be usually obtained from the parents
removed from the parents and taken into care for protection • Older children who are competent may consent
• Deciding whether to give life-saving treatment, such as a heart transplant, against to examination and treatment without their
the apparent wishes of a young child who may not understand all the implications of parents, but cannot refuse treatment against
refusing such treatment their parents' wishes
• Respecting the confidentiality of a competent teenager who does not want her • A child is defined in law as anyone under the age
parents to know that she is being prescribed the oral contraceptive pill of 18 years

Paediatric medicine is unique in that the way in which we interact with diagnosing and treating childhood diseases, but also about maintaining
our patients is very dependent on their age and level of understanding. normal health and development and preventing illness. This requires an
When seeing a child over a period of time this interaction will evolve understanding and appreciation of child health and normal develop-
gradually from a relationship predominantly with the parents to one ment so that we can put the illness into context, and treat both the illness
with the child as an individual making their own decisions. and the child.
Paediatrics covers all aspects of medicine relating to children. As the The relationship in a paediatric consultation needs to be with both the
children grow, so the nature of their medical needs changes, until they child and the carers, usually the parents. Whilst obtaining information
match those of an adult. The younger the child the greater the difference from the carer it is vitally important to establish and build a relationship
in physiology and anatomy from an adult, and so the greater the range with the child. This relationship changes rapidly with age—a newborn
of health-related issues to be considered. Paediatrics is not just about baby will be totally reliant on the parent to represent them, whilst a
10 Evaluation of the child
young child will have their own views and opinions, which need to be • Try to get down to the child’s level—kneel on the floor or sit on the
recognized. The older child needs to start taking responsibility for their bed. Look at the child as you examine them. Use a style and language
health, and should be fully involved in the consultation. This ability that is appropriate to their age—‘I’m going to feel your tummy’ is good
to interact with children as individuals, and with their parents and for a small child but not an adolescent!
families at the same time, is one of the great skills and challenges of • Explain what you are going to do, but be careful of saying ‘can I
child health. listen to your chest’ as they may refuse!
• Babies are best examined on a couch with the parent nearby; toddlers
History taking may need to be examined on the parent’s lap. Older children and
Taking a good history is a vital skill. The history can often lead to the adolescents should always be examined with a chaperone—usually a
diagnosis without needing to perform extensive examination or parent but if the child prefers, a nurse. Allow as much privacy as
investigations. The history can be taken from a parent, a carer or from possible when dressing and undressing the child.
the child. Record who gave the history and in what context. A typical • Sometimes you may need to be opportunistic and perform what
history should include: examination you can, when you can. Always leave unpleasant things
• Presenting complaint—record the main problems in the family’s until the end—for example, looking in the throat and ears can often
own words as they describe them. cause distress.
• History of presenting complaint—try to get an exact chronology • In order to perform a proper examination the child will need to be
from the time the child was last completely well. undressed but this is often best done by the parent and only the region
Allow the family to describe events themselves; use questions to that is being examined needs to be undressed at any one time. Allow
direct them and probe for specific information. Try to use open ques- them to get dressed before moving on to the next region.
tions—‘tell me about the cough’ rather than ‘is the cough worse in the • Hygiene is important, both for the patient and to prevent the spread of
mornings?’ Use direct questions to try to confirm or refute possible infection to yourself and other patients. Always sterilize or dispose of
diagnoses. equipment, such as tongue depressors or auroscope tips, that has been in
• Past medical history—in young children and infants this should start contact with secretions.
from the pregnancy, and include details of the delivery and neonatal • Much information can be gained by careful observation of the
period, including any feeding or breathing problems. Ask about all ill- child—this can be done whilst talking to the parents or taking the
nesses and hospital attendances, including accidents. history. Does the child look well, ill, or severely unwell? Is the child
• Ask about immunizations and foreign travel. well nourished? Are behaviour and responsiveness normal—is the child
• Developmental history—ask about milestones and school perfor- bright and alert, irritable or lethargic? Is the child clean and well cared
mance. Are there any areas of concern? for?
• Family and social history—who is in the family and who lives at • Is there any evidence of cyanosis or pallor? Does the child look
home? Ask about consanguinity as first-cousin marriages increase the shocked (mottled skin, cool peripheries) or dehydrated (sunken eyes,
risk of genetic disorders. Ask if there are any illnesses that run in the dry mouth)? Is there evidence of respiratory distress? What is the level
family. Does anyone have special needs and have there been any deaths of consciousness?
in childhood? • Assess the child’s growth—height and weight should be plotted on
• Take a social history—which school or nursery does the child centile charts. Head circumference should be measured in infants and in
attend? Ask about jobs, smoking, pets and try to get a feel for the finan- those where there is neuro-developmental concern.
cial situation at home. The social context of illness is very important in The examination of individual systems is discussed in detail on the
paediatrics. following pages.
• What drugs is the child taking and are there any allergies?
• Complete the systems enquiry—screening questions for symptoms
within systems other than the presenting system.
• Ask if there is anything else that the family thinks should be
KEY POINTS
discussed.
• The consultation is with the child and the carers and both must be involved.
• At the end, try to come up with a problem list, which allows further
• History taking is a crucial skill.
management to be planned and targeted.
• Language and approach need to be adapted to the age of the child and the
understanding of the family.
Approaching the examination
• Consent should be obtained for examination, which must be conducted in a
• Make friends with the child to gain their cooperation. Try to be con- child-friendly manner.
fident yet non-threatening. It may be best to examine a non-threatening
• Observation is often more important than hands-on examination when
part of the body first before undressing the child, or to do a mock
assessing a child.
examination on their teddy bear.

The paediatric consultation 11

2 Systems examination

Respiratory system

Observation Ear, nose and throat

• Is there respiratory distress? • Examine eardrums using an auroscope
-nasal flaring, recession -grey and shiny: normal
-use of accessory muscles -red and bulging: suggests otitis media
• Count the respiratory rate -dull and retracted: chronic secretory
• Is there wheeze, stridor or grunting? otitis media (glue-ear)
• Is the child restless or drowsy? • Examine nostrils for inflammation,
• Is there cyanosis or pallor? obstruction and polyps
• Is there finger clubbing? • Examine pharynx using tongue
- cystic fibrosis, bronchiectasis depressor (leave this until last!)
-Are the tonsils acutely inflamed
(red +/- pustules or ulcers) or
Chest wall palpation chronically hypertrophied (enlarged but
• Assess expansion not red)
• Check trachea is central • Feel for cervical lymphadenopathy
• Feel apex beat
• Is there chest deformity?
-Harrison's sulcus: asthma
-barrel chest: air-trapping
-pectus excavatum: normal Auscultation
-pigeon chest: congenital • Use an appropriately sized stethoscope!
heart disease • Listen in all areas for air entry, breath
• May 'feel' crackles sounds and added sounds
• Absent breath sounds in one area suggests pleural
effusion, pneumothorax or dense consolidation
• With consolidation (e.g. pneumonia) there is
Percussion often bronchial breathing with crackles
• Resonant: normal heard just above the consolidated lung
• Hyper-resonant: pneumothorax or • In asthma and bronchiolitis expiratory wheeze is
air-trapping heard throughout the lung fields
• Dull: consolidation (or normal liver in • In young children upper airway sounds are often
right lower zone) transmitted over the whole chest. Asking the child
• Stony dull: pleural effusions to cough may clear them

KEY QUESTIONS FROM THE HISTORY

• Is there a history of cough? Nocturnal cough may suggest asthma. • Has the child travelled abroad or been in contact with relatives who might
• Is the child short of breath or wheezy? have TB?
• Are the symptoms related to exercise, cold air or any other triggers? • Is there any possibility the child may have inhaled a foreign body?
• Has there been a fever, which would suggest infection? • How limiting is the respiratory problem—how far can the child run, how
• Has the child coughed up (or vomited) any sputum? much school has been missed because of the illness?
• Is there a family history of respiratory problems (e.g. asthma, cystic • Has the child been pulling at his ears (suggesting an ear infection) or
fibrosis)? showing difficulty swallowing (tonsillitis or epiglottitis)?

12 Evaluation of the child

 Cardiovascular system

Observation Palpation
• Is there central cyanosis? Peripheral • Feel apex beat (position and character), reflects
cyanosis can be normal in young babies left ventricular function
and those with cold peripheries • Feel for right ventricular heave over sternum
• If the child is breathless, pale or sweating • Feel for thrills (palpable murmurs)
this may indicate heart failure • Hepatomegaly suggests heart failure. Peripheral
• Is there finger clubbing? - cyanotic heart oedema and raised JVP are rarely seen in children
disease
• Is there failure to thrive? -suggests heart
failure
Auscultation
• On the basis of the child's age, pulse, colour and
signs of failure try to think what heart lesion
may be likely, then confirm this by auscultation
• Listen for murmurs over the valve areas and
the back (see p. 94). Diastolic murmurs are
always pathological
• Listen to the heart sounds: are they normal,
increased (pulmonary hypertension), fixed and split
(ASD) or are there added sounds (gallop rhythm
in heart failure or ejection click in aortic stenosis)?
1 2 1

Systolic murmur

Pulse
• Rate: fast, slow or normal? • Rhythm: regular or irregular? Occasional ventricular
ectopic beats are normal in children
Age Normal pulse
Circulation • Volume: full or thready (shock)
(years) (beats/min)
• Measure blood pressure with age- • Character: collapsing pulse is most commonly due to
appropriate cuff, which should cover <1 110–160 patent arterial duct. Slow rising pulse suggests left
2/3 of the upper arm 2-5 95–140 ventricular outflow tract obstruction
• Check capillary refill time; if more 5-12 80–120 • Always check femoral pulses in infants—coarctation
than 2 s, consider shock >12 60–100 of the aorta leads to reduced or delayed femoral pulses

KEY QUESTIONS FROM THE HISTORY

• Has the child ever been cyanosed? • Has the child ever complained of palpitations or of their heart racing?
• Has the child been breathless or tired (may suggest cardiac failure)? • Has anyone ever noticed a heart murmur in the past? (Physiological flow
• Has the child been pale and sweaty (may suggest cardiac failure)? murmurs may only be present at times of illness or after exercise.)
• Ask about the pattern of feeding in babies, as breathlessness may inhibit • Is there a family history of congenital heart disease?
feeding. • If the child has a heart defect, have they been taking prophylactic antibiotics
• Review the child’s growth—is there evidence of failure to thrive? for dental or other invasive treatment? (Consider particularly for valve dis-
• Has there been any unexplained collapse, such as fainting? orders and ventricular septal defects.)

Systems examination 13
 Abdominal system and nutritional status
(See also Chapters 3 and 22)
Palpation Percussion Auscultation
• Use warm hands and ask whether the • Percuss for ascites (shifting dullness) • Listen for normal bowel sounds.
abdomen is tender before you begin and to check for gaseous distension 'Tinkling' suggests obstruction
• Is there distension, ascites or tenderness?
• Palpate the liver: 1–2 cm is normal in infants.
Is it smooth and soft or hard and craggy?
• Feel for the spleen, using bimanual palpation.
Turning the child onto the right side may help
• Feel for renal enlargement Observation
• Palpate for other masses and check for • Make sure the child is relaxed—small children
constipation (usually a mass in the left can be examined on a parent's lap; older
iliac fossa) children should lie on a couch
• Jaundice: look at the sclerae and observe
the urine and stool colour (dark urine and
pale stools suggests obstructive jaundice)
• Check conjunctivae for anaemia
• Oedema: check over tibia and sacrum. Peri-
orbital oedema may be the first thing noticed
by parents
• Skin: look for spider naevi—suggests liver
disease
• Wasted buttocks: suggests weight loss and
is characteristic of coeliac disease
• Measure the mid upper arm circumference

Rectal examination Genitalia

• This is very rarely indicated, but examine • Check for undescended testes, hydroceles and hernias. Retractile testes are normal
the anus for fissures or trauma • In girls examine the external genitalia if there are urinary symptoms

KEY QUESTIONS FROM THE HISTORY

• Review the child’s diet. Ask in detail what the child eats. ‘Take me through • Has there been any diarrhoea? Always assess what the parents mean by
everything you ate yesterday.’ diarrhoea—frequent or loose stools or both?
• Is the quantity of calories sufficient and is the diet well balanced and • Has the child been constipated? Straining, pain on defaecation, poor
appropriate for the child’s age? appetite and a bloated feeling may suggest this is a problem.
• Ask about the pattern of weight gain. The parent-held record (red book) • Have there been any urinary symptoms such as frequency, dysuria or enure-
can provide invaluable information about previous height and weight sis?
measurements. • Has the child got any abdominal pain? Ask about the site and nature of the
• Does the child have a good appetite? pain.
• Has there been any vomiting? • Is there a relevant family history (e.g. coeliac disease, inflammatory bowel
• In babies ask about posseting (small vomits of milk) and regurgitation of disease, constipation)?
milk into the mouth, which may suggest gastro-oesophageal reflux.

14 Evaluation of the child

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to the liquidation of the national debt.

It is, however, apparent that Congressmen will never surrender the

patent-office report; and if this is admitted, it seems to me that the
man who succeeds in infusing into those volumes such an amount of
interest that people will be induced to read them will have a right to
be regarded as a great public benefactor. I suppose no human being
ever did read one of them. It is tolerably certain that any man who
would deliberately undertake to peruse one from beginning to end
would be regarded as a person who ought not to be at large. His
friends would be justified in placing him in an asylum. I think I can
suggest a method by which a reform can be effected. It is to take
the material that comes to hand each year and to work it up into a
continuous story, which may be filled in with tragedy and sentiment
and humor.
For instance, if a man came prowling around the patent-
office with an improvement in hayrakes, I should name that
man Alphonso and start him off in the story as the
abandoned villain; Alphonso lying in wait, as it were, behind
a dark corner, for the purpose of scooping his rival with that
improved hay-rake. And then the hero would be a man,
suppose we say, who desired an extension of a patent on
accordeons. I should call such a person Lucullus, and plant
him, with a working model of the accordeon, under the window of
the boarding-house where the heroine, Amelia, who would be a
woman who had applied for a patent on a new kind of red flannel
frills, lay sleeping under the soothing influence of the tunes
squeezed from the accordeon of Lucullus.

In the midst of the serenade, let us suppose, in

comes a man who has just got out some
extraordinary kind of a fowling-piece about which
he wants to interview the head of the department.
I should make this being Amelia's father and call
him Smith, because that name is full of poetry and
sweetness and wild, unearthly music. Then, while Lucullus
was mashing out delicious strains, I might make Alphonso
rush on Smith with his hay-rake, thinking he was Lucullus,
and in the fight which would perhaps ensue Smith might
blow out Alphonso's brains somehow on the spot by a
single discharge, we might assume, of Smith's extraordinary fowling-
piece, while Lucullus could be arrested upon the suit of the
composer who had a copyright on the tune with which he solaced
Amelia.

If any ingenious undertaker should haunt the patent-office at this

crisis of the story with a species of metallic coffin, I might lay
Alphonso away comfortably in one of them and have a funeral, or I
might add a thrill of interest to the narrative by resuscitating him
with vegetable pills, in case any benefactor of the race should call to
secure his rights as the sole manufacturer of such articles. In the
mean time, Lucullus, languishing in jail, could very readily burst his
fetters and regain his liberty, provided some man of inventive talent
called on the commissioner to take out searches, say, on some kind
of a revertible crowbar.

Then the interest of the story would be sustained, and a few more
machines of various kinds could be worked in, if, for instance, I
should cause this escaped convict of mine to ascertain that the
musical composer had won the heart of Amelia, in the absence of
her lover, by offering to bring her flannel frills into market, and to
allow her a royalty, we will assume, of ten cents a frill. When
Lucullus hears of this, I should induce him to try to obtain the
influence of Amelia's parents in his behalf by propitiating old Mr.
Smith with the latest variety of bunion plaster for which a patent
was wanted, while Mrs. Smith could be appeased either with a
gingham umbrella with an improvement of six or seven extra ribs, or
else a lot of galvanized gum rings, if any inventor brought such
things around, for her grandchildren.
Then, for the sake of breaking the monotony of these intrigues, we
could have a little more of the revivified Alphonso. I could very
readily fill the heart of that reanimated corpse with baffled rage, and
cause him to sell to old Smith one of McBride's improved hydraulic
rams. Smith could be depicted as an infatuated being who placed
that ram down in the meadow and caused it to force water up to his
house. And Alphonso, of course, with malignant hatred in his soul,
would meddle with the machine, and fumble around until he spoiled
it, so that Smith could not stop it, and it would continue to pump
until the Smiths had a cascade flowing from their attic window. Mrs.
Smith, in her despair, might impale herself on a variety of reversible
toasting-fork, and die mingling the inventor's name with
maledictions and groans, while Smith, in the anguish of his soul,
could live in the barn, from whence he could use an ingenious kind
of breech-loading gun—patent applied for—to perforate artists who
came around to sketch the falls.

In the mean time, Lucullus might come to the rescue with a suction
pump and save the Smith mansion, only to find that Amelia had
flown with the composer, and had gone to sea in a ship with a
patent copper bottom, and a kind of a binnacle for which an
extension had been granted by Congress on the 26th of February. It
would then be well, perhaps, to have that copper-bottomed ship
attacked by pirates, and after a bloody hand-to-hand contest, in
which the composer could sink the pirate craft with the model of a
gunpowder pile-driver which he has in the cabin, the enraged
corsairs should swarm upon the deck of the other ship for the
purpose of putting the whole party to the sword. And, of course, at
this painful crisis it would be singularly happy to cause it to turn out
that the chief pirate is our old friend Alphonso, who had sold out his
interest in his hay-rake, discontinued his speculations in hydraulic
rams and become a rover upon the seas.

The composer, it would seem,

would then be in a particularly
tight place; and if the
commissioner of patents had
any romance in his soul, he
would permit me to cause that
pirate to toss the musician
overboard. Amelia would then
tear herself from the pirate's
loathsome embrace and plunge
in after him. The two would float
ashore on a liferaft, if any applications of that kind happened to be
presented to the department. When they got to land, Amelia would
shiver with cold until her jaws rattled, and the painful truth would be
disclosed to her lover that she wore teeth which were attached to
one of the gutta-percha plates about which there was a controversy
in the courts.
Then, if we seemed to be approaching the end of
the report, I think I would cause the composer to
shriek "False! false!" or to use some exciting
language of that kind, and to tear out his hair
and wring his nose and fly off with a broken
heart and a blasted life to join the pirates and to play melancholy
airs in a minor key, expressive of delusive dreams, for ever and for
ever, upon some kind of a double-barreled flute with a copyright on
it.

Thus even the prosaic material of which the patent-office reports are
constructed could be made to yield entertainment and instruction,
and afford a basis of succulent and suggestive fact for a
superstructure of pathetic and blood-curdling fiction. The advantages
of adopting such a method in constructing these documents would
be especially marked in the case of Congressmen. The member who
now sends a patent-office report to one of his constituents is
regarded by that man as a kind of moral ruin who ought to be put in
some place where it would be impossible for him to destroy the
happiness and poison the peace of unoffending families. But when a
competent novelist prepares those reports, when he throws over
them the glamour of his fancy, when he adorns them with his
graceful rhetoric, and gives a certain intense human interest to all
the hay-rakes and gum rings and suction pumps which now fill the
leaden pages, these reports will be sought after; their tone will be
changed; children will cry for them; Sunday-schools will offer them
as rewards, and the intelligent American voter whose mind craves
healthy literature will elect to Congress the man who will promise to
send him the greatest number of copies.

Here is the story of a tragical event of which I was a witness, and

which has created a profound impression upon the people of this
community.
 An aunt of Bessie Magruder's
lives at Salem; and as she had
never seen Bob, she invited him
and his betrothed to visit her
one day last week, coupling the
invitation with a request that we
and the elder Magruders would
come at the same time and take
dinner with her. When the boat
from up the river arrived at New
Castle, the entire party of us
went aboard. As the steamer
shot across the water to
Delaware City, Bob and Bessie
wandered away by themselves,
while the rest of us passed the
time pleasantly in conversation.
At Delaware City we came out of
the cabin to watch the people as
they passed over the gangway.
To our surprise and vexation, Lieutenant Smiley appeared among
them. As he pressed forward in the throng some one jostled him
roughly, when he uttered a fierce oath and aimed a blow at the
offender. It missed the mark, and he plunged forward heavily. He
would have fallen had not one of the boat's crew caught him in his
arms. We saw then that he was intoxicated.

I watched Bob as he looked at the wretched man. His face flushed

with indignation as he recalled the injury done to him by Smiley, and
he looked as if he would have found intense satisfaction in an
attempt to give the lieutenant a thrashing on the spot. But he did
not contemplate such a performance, and Bessie clung tightly to his
arm, half afraid that he might have a sudden and irresistible impulse
to revenge, and half afraid lest Smiley might make some shocking
demonstration against the party in that public place. As he staggered
past us he recognized us; and, brutalized as he was with liquor, he
seemed to feel the shame of his condition and the infamy of his past
conduct. He went away to the other side of the boat and concealed
himself from view.

When the vessel left the wharf and proceeded down the bay, past
the fort, we walked about the lower deck, looking at the scenery and
at the shipping which thronged the water. No one of us perceived
Smiley or knew that he was near us. We had, indeed, suffered
ourselves to forget the scene we had just witnessed, and we were
speaking of other matters. As I stood by the railing with my wife and
the Magruders, Bob and Bessie came out from the cabin, and Bob
had just spoken one word, when a man came with a hurried and
uneven step to the gangway. It was Smiley. He had been sitting in
the corner behind one of the beams of the boat, with his hat pulled
over his eyes. The rail at the gangway swings aside to admit of
passage to and from the wharf. Now it opened out upon the water.
Smiley paused for one moment, with his fingers clenched upon it;
then he flung it wide open, and leaped forward into the sea.

A cry of horror came from the lips of those who saw him make the
plunge, and instantly the steamer resounded with screams for help.
Before any of us could recover from the paralysis of terror
occasioned by the act, Smiley rose to the surface far away from the
boat, and with a shriek so awful, so full of agony and despair, that it
chilled the blood of those who heard it, he threw up his arms and
sank. In a second Bob tossed off his coat, and before I could restrain
him he leaped into the water. He rose instantly, and struck out boldly
in the direction in which Smiley had been seen.
Bessie almost fainted in her father's arms, and Mrs. Adeler was white
with fear. The next moment the steamer stopped, and an attempt
was made to lower the boat. The operation required time; and
meanwhile, Bob, who is a good swimmer, gallantly cleft his way
through the waves. I think Smiley never rose again. For as I entered
the lifeboat I could see Bob turning about and endeavoring to swim
toward the steamer. He was a long way from us, for the vessel had
gone far before her headway could be overcome. Our boatmen
pulled with desperate energy lest the brave fellow should be unable
to sustain himself; and as I stood in the stern and watched him with
eager eyes, I could see that he gave signs of being in distress. It
was heavy work in the water, with his clothing on, and the sea was
rough. We were within a hundred yards of him when he sank, and I
felt my heart grow sick as I saw him dragged beneath the waves.
But as we reached the spot one of the men, who was leaning over
the side, uttered an exclamation; and extending his arms, he pulled
the lad's head and shoulders above the surface. A moment later he
was in the boat, but insensible. As we turned about to seek the
steamer, we rubbed his hands and his temples and strove to bring
him back to life, and we seemed to have partial success.

But when we reached the vessel

and placed him upon the
cushions in the cabin, we
committed him to better hands
than ours. Mrs. Magruder's
medical skill then was of the
highest service. She cared for
the poor lad with a motherly
tenderness which was as
admirable as her art. In a brief
while he revived; and though
suffering greatly, he seemed
sure of life. It would have made
him blush, even in his weakness,
to have heard the praises
heaped upon him for his
splendid courage; we rejoiced at
them, but we rejoiced more to
think how he had avenged
himself upon his enemy by an act of sublime self-sacrifice.
And so, as he came back to consciousness, we neared our journey's
end; and while we carried Bob from the boat to the carriage and
placed him among his loving friends, we shuddered to think how the
wretched man who had wrought so much evil was even now
sweeping past us in the embrace of that swift current to burial
beneath the rolling billows of the sea.
 CHAPTER XXIII.
Pitman as a Politician—He is Nominated for the Legislature—How he
was Serenaded, and what the Result was—I take a Hand at Politics—
The Story of my First Political Speech—My Reception at Dover—
Misery of a Man with Only One Speech—The Scene at the Mass
Meeting—A Frightful Discomfiture.

Some of the friends of Judge Pitman induced

him, just before the last election, to permit
himself to be nominated for the State Legislature,
and accordingly he was presented to the people
of this community as a candidate. Of course he
was not selected because of his fitness for the
position. The party managers knew him to be a
very popular man; and as the success of the
party is the only thing they care for, they chose
Pitman as the person most likely to secure that
result. I cannot say that I disapproved of the
selection. For some reason, it appears to be entirely impossible for
American citizens who live in any of the Middle States to find
educated and intelligent men who are willing to represent them in
the Legislatures. Those bodies are composed for the most part of
men whose solitary purpose is plunder. They are legislators simply
because it pays better to blackmail railroad companies and to accept
bribes from people who want votes for rascally measures than it
does to pick pockets. They have the instincts and the principles of a
pickpocket, but their ambition is greater. They do not steal
handkerchiefs and watches, because they can filch fabulous sums of
money from the public treasury and from villains who want to do
dirty work under the color of the law. They know enough to enable
them, with the assistance of party rings, to have themselves counted
in at election-time, and to devise new and dexterous schemes of
dishonesty; but in other and rather more desirable of the
qualifications of law-makers they are deficient. They occupy the
most important place in republican governments without knowing
what republicanism means, and they create laws for the
communities without having any knowledge of the science of law or
the slightest acquaintance with the needs and requirements of the
people for whom they act. The average American legislator is both
ignorant and dishonest. Judge Pitman is ignorant, but he is honest;
and as his election would secure at least a very important half of a
fitting legislator, I supported him.

My other neighbor, Cooley, was the chairman of the committee to

whose care was consigned the management of the campaign in
which Judge Pitman played so prominent a part; and Cooley
conducted the business with even an excess of enthusiasm. Just
after the nomination of Pitman, Cooley called on him to say that a
number of his friends had declared their intention to offer him a
serenade. Cooley informed the judge that some refreshment must
be given to the serenaders, but he, as the chairman of the
committee, would attend to that; the judge need not make
preparations of any kind. Accordingly, on the following evening a
brass band, accompanied by a score or two politicians, entered
Pitman's front yard, and for half an hour there was some very good
music. Then the judge came out upon the porch and made a better
speech than I had expected to hear from him. He concluded by
asking the company to enter his house. Cooley was there with a
wagon-load of meat and drink, including, of course, a large quantity
of rum of the most impressive kinds. The judge, with the fear of the
temperance society present in his mind, protested against the liquor;
but Cooley demonstrated to him that he would be defeated and the
party ruined if it was excluded, and so Pitman reluctantly permitted
it to be placed upon his table. Besides, as Cooley had been so very
liberal in undertaking to make this provision at his own cost, the
judge disliked to hurt his feelings by refusing to permit the use of
that which Cooley evidently considered the most important portion
of it.

The guests remained at the banquet until four o'clock the next
morning, the politicians meanwhile making speeches and the band
playing occasionally in the dining-room in a most uproarious manner.
We could hear the noise at my house during the night, and sleep
was possible only with the windows closed.

At four o'clock my door-bell rang violently; and upon descending to

ascertain the cause of a visit at such an unseemly hour, I
encountered Judge Pitman. He was nearly frantic with indignation.

"Adeler," he said, "them fellers is a-carryin' on scand'lus over yer at

my house. They're all drunk as owls; an' when I want 'em to go
home, they laugh an' swear an' cheer an' smash the furniture an'
bu'st things generally. Mrs. Pitman's 'bout skeered to death. Can't
you come over an' help me clear them out?"

"Why don't you call a couple of policemen? You hunt up two or three
officers while I dress myself, and we will see if we can't adjourn the
meeting."
By the time I was ready Pitman arrived with one policeman, and we
proceeded to his house. As we entered, the leader of the band was
sitting upon the stairs, infamously drunk, with the handle of his
umbrella in his mouth, vainly endeavoring to play a tune by fumbling
his fingers among the ribs. Mr. Cooley was in a corner of the parlor
supporting himself by the wall while he endeavored to discuss the
question of the tariff with Pitman's plaster bust of Daniel Webster,
and to correct Daniel's view of the local option law. Another
politician was sitting upon the carpet crying because, so he informed
us, his wife's maiden name was McCarthy, and just as the policeman
was removing him a combat occurred between the bass drummer
and a man from Wilmington, during which the drummer was hurled
against the pier glass and then dragged out to bleed upon the rug.
The house was finally cleared of the company just as the church
clock struck six, and then Pitman went to bed with sentiments of
complete disgust for politics and politicians.

But he remained a candidate of the party. He had promised

to run, and he determined to go through with the business.

"That serenade was rough enough without anythin' wuss,"

said the judge to me a day or two afterward; "but I did
think Cooley was a-rubbin' it in 'most too hard when he come over
yesterday with a bill for the refreshments which he wanted me to
pay."

"Why, I thought he agreed to supply the supper?"

"So he did. But now he says that of course he was only actin' for
me. 'The candidate,' he says, 'always foots all the bills.' I'll foot this
one, an' then I'll foot Cooley if he ever brings them ruffians to my
house agin. I expect nothin' else but the temperance society will
shut down on me for that riot we had t'other night."

"I hope not; but I should think that affair would have made you
sorry that you ever undertook this business."

"So it does," replied the judge, "but I never back down when I go
into a thing. I'm goin' to run for the Legislatur'; and if I'm elected,
I'm goin' to serve my country honestly until my time's up. Then I'm
comin' home, an' goin' to stay home. And what's more, I'll stir up
that Legislatur' while I'm in it. You mind me!"

The result of the contest was that the judge was elected by a large
majority, and he will sit in the next Assembly.

I played a peculiar part in the campaign; and although the narrative

of my experience as an amateur politician is not a particularly
grateful one to me, it might as well be given, if for no other reason,
because it will serve to warn others against the fate that befel me.
I had for some time entertained a strong conviction that nature
designed me for an orator. I was assured that I possessed the gift of
eloquence which enables great speakers to sway the passions of the
multitude, and I felt that I needed but the opportunity to reveal this
fact to the world. Accordingly, at the beginning of the political
campaign of which I speak I sent my name to one of the executive
committees of the State, in Wilmington, with the request that it
might be written down with the names of the speakers who could be
called upon whenever important meetings were held. I waited
impatiently all through the campaign for a summons to appear and
electrify the people. It did not come, and I was almost in despair.
But on the day before the election I received from the chairman a
brief note, saying that I had been announced to speak at Dover that
evening before a great mass meeting, and requesting me to take the
early afternoon train, so that I might report to the local chairman in
Dover before nightfall. The pleasure with which this summons was
received was in some measure marred by the fact that I had not a
speech ready, and the time was so short that elaborate preparation
was impossible. But I determined to throw into some sort of shape
the ideas and arguments which would readily occur to the mind of a
man familiar with the ordinary political questions of the day and with
the merits of the candidates, and to trust to the inspiration of the
occasion for the power to present them forcibly and eloquently.

Of course it was plain that anything like an attempt at gorgeousness

in such a speech would be foolish, so I concluded to speak plainly
and directly to the point, and to enliven my argument with some
amusing campaign stories. In order to fix my points firmly in my
mind and to ensure their presentation in their proper order, they
were numbered and committed to memory, each argument and its
accompanying anecdote being associated with a particular
arithmetical figure. The synopsis, if it may be called by that name,
presented an appearance something like the following, excepting
that it contained a specification of the points of the speech which
need not be reproduced here.
 The Speech.
1. Exordium, concluding with Scott's famous lines, "Breathes
there a man with soul so dead," etc.

2. Arguments, introducing a narrative of the facts in the case of

Hotchkiss, who was locked out upon the roof of his house all
night. (See particulars farther on.) The design of the story is to
give a striking picture of the manner in which the opposition
party will be left out in the cold by the election. (Make this
strong, and pause for cheers.)

3. Arguments, followed by the story of the Kickapoo Indian who

saw a locomotive approaching upon the plains, and thinking it
was a superior breed of buffalo, determined to capture it, so
that he could take the first prize at the Kickapoo agricultural fair.
He tied his lasso to his waist and threw the other end over the
smoke-stack. The locomotive did not stop; but when the
engineer arrived at the next station, he went out and cut the
string by which a small bit of copper-colored meat was tied to
his smoke-stack. This is to illustrate the folly of the attempt of
conservatism to check the onward career of pure and
enlightened liberalism toward perfect civilization, etc., etc.
 4. Arguments, and then the anecdote of that
Dutchman in Berks county, Pa., who on the
10th of October, 1866, was observed to go
out into his yard and raise the American flag;
then he got his gun and fired a salute
seventeen or eighteen times, after which he
consumed six packs of fire-crackers and gave
three cheers for the Union. He enjoyed
himself in this manner nearly all day, while his
neighbors gathered around outside and
placed their elbows upon the fence, watching
him and wondering what on earth he meant. A peddler who
came along stopped and had an interview with him. To his
surprise, he found that the German agriculturist was celebrating
the Fourth of July, 1859. He did not know that it was any later
in the century, for he had been keeping his time on a notched
stick; and having been sick a great deal, he had gotten the
thing in a dreadful tangle. When he learned that he was seven
Fourths in arrears, he was depressed; but he sent out and
bought a box of fire-crackers and a barrel of gunpowder, and
spent a week catching up.

(Tell this vivaciously, and make the point that

none but a member of the other party could
forget the glorious anniversary of our
country's birth, and say that the whole party
will have to do up a lot of back patriotism
some day, if it desires to catch up with the
people whose devotion to the country is
encouraged and kept active by our side.)

5. Arguments, supplemented with the

narrative of a confiding man who had such
child-like faith in a patent fire-extinguisher which he had
purchased that he set fire to his house merely to have the fun
of putting it out. The fire burned furiously, but the extinguisher
gave only two or three imbecile squirts and then collapsed, and
in two hours his residence was in ashes. Go on to say that our
enemies have applied the torch of anarchy to the edifice of this
government, but that there is an extinguisher which will not
only not collapse, but will subdue the flames and quench the
incendiary organization, and that extinguisher is our party.
(Allow time for applause here.)

6. Arguments, introducing the story of the Sussex county farmer

who was discouraged because his wife was perfidious. Before
he was married she vowed over and over again that she could
chop four cords of wood a day, but after the ceremony the
farmer found he was deceived. The treacherous woman could
not chop more than two cords and a half, and so the dream of
the husband was dissipated, and he demanded a divorce as the
only balm for the wounds which lacerated his heart. Let this
serve to illustrate the point that our political enemies have
deceived us with promises to reduce the debt, to institute
 reforms, etc., etc., none of which they have kept, and now we
must have the government separated from them by such a
divorce as will be decreed to-morrow, etc., etc.

7. Peroration, working in if possible the story of Commodore

Scudder's dog, which, while out with its master one day, pointed
at some partridges. The commodore was about to fire, but he
suddenly received orders to go off on a three years' cruise, so
he dropped his gun, left the dog standing there and went right
to sea. When he returned, three years later, he went back to the
field, and there was his gun, there was the skeleton of the dog
still standing and pointing just as he had left it, and a little
farther on were the skeletons of the partridges. Show how our
adversaries in their relations to the negro question resemble
that dog. We came away years ago and left them pointing at
the negro question, and we come back now to find that they are
at it yet. Work this in carefully, and conclude in such a manner
as to excite frantic applause.

It was not much of a speech, I know. Some of the arguments were

weak, and several of the stories failed to fit into their places
comfortably. But mass meetings do not criticise closely, and I was
persuaded I should make a good impression, provoking laughter and
perhaps exciting enthusiasm. The only time that could be procured
for study of the speech was that consumed by the journey. So when
the train started I took my notes from my pocket and learned them
by heart. Then came the task of enlarging them, in my mind, into a
speech. This was accomplished satisfactorily. I suppose that speech
was repeated at least ten times between New Castle and Dover until
at last I had it at my tongue's end. In the cars the seat next to mine
was occupied by a colored gentleman, who seemed to be a little
nervous when he perceived that I was muttering something
continually; and he was actually alarmed once or twice when in
exciting passages I would forget myself and gesticulate violently in
his direction. Finally, when I came to the conclusion and was
repeating to myself the exhortation, "Strike for your altars and your
fires," etc., etc., I emphasized the language by striking fiercely at the
floor with the ferule of my umbrella. It hit something soft. I think it
was the corn of my colored friend, for he leaped up hurriedly, and
ejaculating "Gosh!" went up and stood by the water-cooler during
the rest of the journey, looking at me as if he thought it was
dangerous for such a maniac to be at large.

When the train arrived at Dover, I was gratified to find the chairman
of the local committee and eighteen of his fellow-citizens waiting for
me with carriages and a brass band. As I stepped from the car the
band played "See, the Conquering Hero comes!" I marched into the
waiting-room of the dépôt, followed by the committee and the band.
The chairman and his friends formed a semi-circle and stared at me.
I learned afterward that they had received information from
Wilmington that I was one of the most remarkable orators in the
State. It was impossible not to perceive that they regarded me
already with enthusiastic admiration; and my heart sank a little as I
reflected upon the possibility of failure.

Then the music ceased, and the chairman proposed "three cheers
for our eloquent visitor." The devoted beings around him cheered
lustily. The chairman thereupon came forward and welcomed me in
the following terms:

"My dear sir, it is with unfeigned satisfaction that I have—may I say

the exalted honor?—of welcoming you to the city of Dover. You
come, sir, at a moment when the heart of every true patriot beats
high with hope for a glorious triumph over the enemies of our
cherished institutions; you come, sir, at a time when our great party,
the true representative of American principles and the guardian of
our liberties, bends to grapple with the deadly foe of our country; at
a time, sir, when the American eagle—proud bird, which soars, as we
would, to the sun—screams forth its defiance of treason, and when
the banner of the free, the glorious emblem of our nationality, waves
us onward to victory; you come, sir, to animate with your eloquence
the hearts of our fellow-citizens; to inspire with your glowing
language the souls of those who shrink from performing their duty in
this contest; to depict in words of burning, scathing power the
shame, the disgrace, the irretrievable ruin, which will befall our land
if its enemies are victorious, and to hold up those enemies, as you
well know how, to the scorn and contempt of all honest men. We
give you a hearty welcome, then, and assure you that Dover will
respond nobly to your appeal, giving to-morrow such a vote for
justice, truth and the rights of man that the conservative wolf will
shrink back in dismay to his lair. Welcome, sir, thrice welcome, to our
city!"

I stood looking at this man throughout his speech with a conviction,

constantly growing stronger, that I should be obliged to reply to him
at some length. The contemplation of such a thing, I need hardly
say, filled me with horror. I had never made a speech of the kind
that would be required in my life, and I felt positively certain that I
could not accomplish the task now. I had half a mind to hurl at the
heads of this chairman and his attendant fiends the entire oration
prepared for the evening; but that seemed so dreadfully
inappropriate that the idea was abandoned. And besides, what
would I say at the mass meeting? The comfort of the situation was
not, by any means, improved by the fact that these persons
entertained the belief that I was an experienced speaker who would
probably throw off a dozen brilliant things in as many sentences. It
was exceedingly embarrassing; and when the chairman concluded
his remarks, the cold perspiration stood upon my forehead and my
knees trembled.
Happily, the leader of the band desired to make himself conspicuous,
so he embraced the opportunity afforded by the pause to give us
some startling variations of "The Star-Spangled Banner."

As we stood there listening to the music, I observed that

the energetic gentleman who played upon the drum and
cymbals was looking at me with what seemed to be a
scornful smile. He had a peculiarly cold eye, and as he fixed
it upon me I felt that the frigid optic pierced through and
through my assumption of ease and perceived what a
miserable sham it was for me to stand there pretending to be an
orator. I quailed before that eye. Its glance humiliated me; and I did
not feel more pleasantly when, as the band dashed into the final
quavers which bring up suggestions of "the land of the free and the
home of the brave," I saw the scorn which erst flashed from that eye
change to a look of wild exultation. The cymbal man knew that my
hour had come. He gave a final clash with his brasses and paused. I
had to begin. Bowing to the chairman, I said,

"Mr. Chairman and fellow-citizens, there are times—times—there are

times, fellow-citizens, when—times when—when the heart—there
are times, I say, Mr. Chairman and fellow-citizens, when the heart—
the heart of—of—" It wouldn't do. I stuck fast, and could not get out
another word.

The cold-eyed man seemed ready to play triumphal strains upon his
drum and to smash out a pæan upon his cymbals. In the frenzy and
desperation of the moment, I determined to take the poetry from
my exordium and to jam it into the present speech, whether it was
appropriate or not. I began again:

"There are times, I say, fellow-citizens and Mr. Chairman, when the
heart inquires if there breathes a man with soul so dead, who never
to himself hath said, 'This is my own, my native land'—whose heart
has ne'er within him burned as home his footsteps he hath turned
from wanderings on a foreign shore? If such there breathe, go, mark
 him well!" (Here I pointed to the street, and one
of the committee, who seemed not to
comprehend the thing exactly, rushed to the
window and looked out, as if he intended to call
a policeman to arrest the wretch referred to.)
"For him no minstrel raptures swell." (Here the
leader of the band bowed, as if he had a vague
idea that this was a compliment ingeniously
worked into the speech for his benefit; but the
cold-eyed man had a sneering smile which
seemed to say, "It won't do, my man, it won't do.
I can't be bought off in that manner.") "High though his titles, proud
his name, boundless his wealth as wish can claim; despite these
titles, power and pelf, the wretch, concentred all in self, living, shall
forfeit fair renown, and doubly dying shall go down to the vile dust
from whence he sprung, unwept, unhonored and unsung."

I stopped. There was embarrassing silence for a moment, as if

everybody thought I had something more to say. But I put on my
hat and shouldered my umbrella to assure them that the affair was
ended. Then it began to be apparent that the company failed to
grasp the purpose of my remarks. One man evidently thought I was
complaining of something that happened to me while I was upon the
train, for he took me aside and asked me in a confidential whisper if
it wouldn't be better for him to see the conductor about it.

Another man inquired if the governor was the man referred to.

I said, "No; the remarks were of a poetical nature; they were

quoted."

The man seemed surprised, and asked where I got them from.

"From Marmion."

He considered a moment, and then said,

"Don't know him. Philadelphia man, I reckon?"

The occasion was too sad for words. I took the chairman's arm and
we marched out to the carriages, the cold-eyed man thumping his
drum as if his feeling of animosity for me would kill him if it did not
find vigorous expression of that kind.

We entered the carriages and formed a procession, the band, on

foot, leading the way and playing "Hail to the Chief." I rode with the
chairman, who insisted that I should carry the American flag in my
hand. As we passed up the street the crowd cheered us vehemently
several times, and the chairman said he thought it would be better if
I would rise occasionally and bow in response. I did so, remarking,
at the last, that it was rather singular such a reception should be
given to a complete stranger.

The chairman said he had been thinking of that, and it had occurred
to him just at that moment that perhaps the populace had mistaken
the character of the parade.

"You see," said he, "there is a circus in town, and I am a little bit
afraid the people are impressed with the idea that this is the
showman's procession, and that you are the Aërial King. That
monarch is a man of about your build, and he wears whiskers."

The Aërial King achieved distinction and a throne by leaping into the
air and turning two backward somersaults before alighting, and also
by standing poised upon one toe on a wire while he balanced a pole
upon his nose. I had no desire to share the sceptre with that man,
or to rob him of any of his renown, so I furled the flag of my beloved
country, pulled my hat over my eyes and refused to bow again.

It was supper-time when we reached the hotel, and as soon as we

entered, the chairman invited us into one of the parlors, where an
elaborate repast had been prepared for the whole party. We went
into the room, keeping step with a march played by the band, which
was placed in the corner. When supper was over, it was with dismay
that I saw the irrepressible chairman rise and propose a toast, to
which he called upon one of the company to respond. I knew my
turn would come presently, and there seemed to be no choice
between the sacrifice of my great speech to this paltry occasion and
utter ruin and disgrace. It appeared to me that the chairman must
have guessed that I had but one speech, and that he had
determined to force me to deliver it prematurely, so that I might be
overwhelmed with mortification at the mass meeting. But I made up
my mind to cling desperately to the solitary oration, no matter how
much pressure was brought to bear to deprive me of it. So I
resolved that if the chairman called upon me I would tell my number
two story, giving the arguments, and omitting all of it from my
speech in the evening.

He did call. When two or three men had spoken, the chairman
offered the toast, "The orator of the evening," and it was received
with applause. The chairman said: "It is with peculiar pleasure that I
offer this sentiment. It gives to my eloquent young friend an
opportunity which could not be obtained amid the embarrassments
of the dépôt to offer, without restraint, such an exhibition of his
powers as would prove to the company that the art which enabled
Webster and Clay to win the admiration of an entranced world was
not lost—that it found a master interpreter in the gentleman who sits
before me."

This was severe. The cold-eyed child of the Muses sitting with the
band looked as if he felt really and thoroughly glad in the inmost
recesses of his soul for the first time in his life.

I rose, and said: "Mr. Chairman and gentlemen, I am too much

fatigued to make a speech, and I wish to save my voice for to-night;
so I will tell you a story of a man I used to know whose name was
Hotchkiss. He lived up at New Castle, and one night he thought he
would have a little innocent fun scaring his wife by dropping a loose
brick or two down the chimney into the fireplace in her room. So he
slipped softly out of bed; and dressed in his night-shirt, he stole up
stairs and crept out upon the
roof. Mr. Hotchkiss dropped
nineteen bricks down that
chimney, Mr. Chairman and
gentlemen, each one with an
emphatic slam, but his wife
didn't scream once."

Everybody seemed to think this

was the end of the story; so
there was a roar of laughter,
although I had not reached the
humorous part or the real point
of the anecdote, which describes
how Hotchkiss gave it up and
tried to go down stairs, but was
surprised to find that Mrs.
Hotchkiss, who had been
watching all the time, had retreated fastening the trap-door, so that
he spent the next four hours upon the comb of the roof with his
trailing garments of the night fluttering in the evening breeze. But
they all laughed and began to talk; and the leader of the band,
considering that his turn must have come, struck out into "Hail
Columbia," while the man with the cymbals seemed animated with
fiendish glee.

I tried to explain to the chairman that it was all wrong, that the
affair was terribly mixed.

He said he thought himself that it seemed so somehow, and he

offered to explain the matter to the company and to give me a
chance to tell the story over again properly.

I intimated, gloomily, that if he undertook such a thing I would blow

out his brains with the very first horse-pistol I could lay my hands
upon.
He said perhaps, then, it would be better not to do.

The proceedings at the mass meeting were to begin at eight o'clock.

At half-past seven I went to the telegraph office, and sent the
following despatch to the Wilmington papers, fearing the office
might be closed when the meeting adjourned:

"Dover, —— —, 18—: A tremendous mass meeting was held here to-

night. The utmost enthusiasm was displayed by the crowd. Effective
speeches were made by several prominent gentlemen, among them
the eloquent young orator Mr. Max Adeler, whose spirited remarks,
interspersed with sparkling anecdote, provoked uproarious applause.
Dover is good for five hundred majority, and perhaps a thousand."

At eight o'clock a very large crowd really did assemble in front of the
porch of one of the hotels. The speakers were placed upon the
balcony, which was but a few feet above the pavement, and there
was also a number of persons connected with the various political
clubs of the town. I felt somewhat nervous; but I was tolerably
certain I could speak my piece acceptably, even with the poetry torn
out of the introduction and the number two story sacrificed. I took a
seat upon the porch and waited while the band played a spirited air
or two. It grieved me to perceive that the band stood directly in
front of us upon the pavement, the cold-eyed drummer occupying a
favorable position for staring at me.

The chairman began with a short speech in which he went over

almost precisely the ground covered by my introduction; and as that
portion of my oration was already reduced to a fragment by the use
of the verses, I quietly resolved to begin, when my turn came, with
point number two.
The chairman introduced to the crowd Mr. Keyser, who was
received with cheers. He was a ready speaker, and he
began, to my deep regret, by telling in capital style my
story number three, after which he used up some of my
number six arguments, and concluded with the remark that
it was not his purpose to occupy the attention of the
meeting for any length of time, because the executive committee in
Wilmington had sent an eloquent orator who was now upon the
platform and would present the cause of the party in a manner
which he could not hope to approach.

Mr. Keyser then sat down, and Mr. Schwartz was introduced. Mr.
Schwartz observed that it was hardly worth while for him to attempt
to make anything like a speech, because the gentleman from New
Castle had come down on purpose to discuss the issues of the
campaign, and the audience, of course, was anxious to hear him. Mr.
Schwartz would only tell a little story which seemed to illustrate a
point he wished to make, and he thereupon related my anecdote
number seven, making it appear that he was the bosom friend of
Commodore Scudder and an acquaintance of the man who made the
gun. The point illustrated I was shocked to find was almost precisely
that which I had attached to my story number seven. The situation
began to have a serious appearance. Here, at one fell swoop, two of
my best stories and three of my sets of arguments were swept off
into utter uselessness.

When Schwartz withdrew, a man named Krumbauer was brought

forward. Krumbauer was a German, and the chairman announced
that he would speak in that language for the benefit of those
persons in the audience to whom the tongue was pleasantly familiar.
Krumbauer went ahead, and the crowd received his remarks with
roars of laughter. After one particularly exuberant outburst of
merriment, I asked the man who sat next to me, and who seemed
deeply interested in the story,
"What was that little joke of Krumbauer's? It must have been first
rate."

"So it was," he said. "It was about a Dutchman up in Berks county,

Penna., who got mixed up in his dates."

"What dates?" I gasped, in awful apprehension.

"Why, his Fourths of July, you know. Got seven or eight years in
arrears and tried to make them all up at once. Good, wasn't it?"

"Good? I should think so; ha! ha! My very best story, as I'm a
sinner!"

It was awfully bad. I could have strangled Krumbauer and then

chopped him into bits. The ground seemed slipping away beneath
me; there was the merest skeleton of a speech left. But I
determined to take that and do my best, trusting to luck for a happy
result.

But my turn had not yet come. Mr. Wilson was dragged out next,
and I thought I perceived a demoniac smile steal over the
countenance of the cymbal player as Wilson said he was too hoarse
to say much; he would leave the heavy work for the brilliant young
orator who was here from New Castle. He would skim rapidly over
the ground and then retire. He did. Wilson rapidly skimmed all the
cream off of my arguments numbers two, five and six, and wound
up by offering the whole of my number four argument. My hair fairly
stood on end when Wilson bowed and left the stand. What on earth
was I to do now? Not an argument left to stand upon; all my
anecdotes gone but two, and my mind in such a condition of
frenzied bewilderment that it seemed as if there was not another
available argument or suggestion or hint or anecdote remaining in
the entire universe. In an agony of despair, I turned to the man next
to me and asked him if I would have to follow Wilson.

He said it was his turn now.

"And what are you going to say?" I demanded, suspiciously.

"Oh, nothing," he replied—"nothing at all. I want to leave room for

you. I'll just tell a little story or so, to amuse them, and then sit
down."

"What story, for instance?" I asked.

"Oh, nothing, nothing; only a little yarn I happen to remember about

a farmer who married a woman who said she could cut four cords of
wood, when she couldn't."

My worst fears were realized. I turned to the man next to me, and
said, with suppressed emotion,

"May I ask your name, my friend?"

He said his name was Gumbs.

"May I inquire what your Christian name is?"

He said it was William Henry.

"Well, William Henry Gumbs," I exclaimed, "gaze at me! Do I look

like a man who would slay a human being in cold blood?"

"Hm-m-m, n-no; you don't," he replied, with an air of critical

consideration.

"But I AM!" said I, fiercely—"I AM; and I tell you now that if you
undertake to relate that anecdote about the farmer's wife I will blow
you into eternity without a moment's warning; I will, by George!"

Mr. Gumbs instantly jumped up, placed his hand on the railing of the
porch, and got over suddenly into the crowd. He stood there
pointing me out to the bystanders, and doubtless advancing the
theory that I was an original kind of a lunatic, who might be
expected to have at any moment a fit which would be interesting
when studied from a distance.

The chairman looked around, intending to call upon my friend Mr.

Gumbs; but not perceiving him, he came to me and said:

"Now is your chance, sir; splendid opportunity; crowd worked up to

just the proper pitch. We have paved the way for you; go in and do
your best."

"Oh yes; but hold on for a few moments, will you? I can't speak
now; the fact is I am not quite ready. Run out some other man."

"Haven't got another man. Kept you for the last purposely, and the
crowd is waiting. Come ahead and pitch in, and give it to 'em hot
and heavy."

It was very easy for him to say "give it to them," but I had nothing
to give. Beautifully they paved the way for me! Nicely they had
worked up the crowd to the proper pitch! Here I was in a condition
of frantic despair, with a crowd of one thousand people expecting a
brilliant oration from me who had not a thing in my mind but a
beggarly story about a fire-extinguisher and a worse one about a
farmer's wife. I groaned in spirit and wished I had been born far
away in some distant clime among savages who knew not of mass
meetings, and whose language contained such a small number of
words that speech-making was impossible.

But the chairman was determined. He seized me by the arm and

fairly dragged me to the front. He introduced me to the crowd in
flattering, and I may say outrageously ridiculous, terms, and then
whispering in my ear, "Hit 'em hard, old fellow, hit 'em hard," he sat
down.

The crowd received me with three hearty cheers. As I heard them I

began to feel dizzy. The audience seemed to swim around and to
increase tenfold in size. By a resolute effort I recovered my self-
possession partially, and determined to begin. I could not think of
anything but the two stories, and I resolved to tell them as well as I
could. I said,

"Fellow-citizens: It is so late now that I will not attempt to make a

speech to you." (Cries of "Yes!" "Go ahead!" "Never mind the time!"
etc., etc.) Elevating my voice, I repeated: "I say it is so late now that
I can't make a speech as I intended on account of its being so late
that the speech which I intended to make would keep you here too
late if I made it as I intended to. So I will tell you a story about a
man who bought a patent fire-extinguisher which was warranted to
split four cords of wood a day; so he set fire to his house to try her,
and— No, it was his wife who was warranted to split four cords of
wood—I got it wrong; and when the flames obtained full headway,
he found she could only split two cords and a half, and it made him
— What I mean is that the farmer, when he bought the exting—and
courted her, that is, she said she could set fire to the house, when
he tried her, she collapsed the first time—the extinguisher did, and
he wanted a divorce because his hous—h, hang it, fellow-citizens,
you understand that this man, or farmer, rather, bought a—I should
say courted a—that is, a fire-ex—" (Desperately.) "Fellow-citizens! If
any man shoots the American flag, pull him down upon the spot; but as for
me, give me liberty or give me death!"

As I shouted this out at the top of my voice, in an ecstasy of

confusion, a wild, tumultuous yell of laughter came up from the
crowd. I paused for a second beneath the spell of that cold eye in
the band, and then, dashing through the throng at the back of the
porch, I rushed down the street to the dépôt, with the shouts of the
crowd and the uproarious music of the band ringing in my ears. I
got upon a freight train, gave the engineer five dollars to take me
along on the locomotive, and spent the night riding to New Castle.
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