were due to aortic obstruction, aortic regurgitation, or a combination of the two-the sphygmographic trace would settle the point at once. Lesions of the pulmonary valves are comparatively rare, and the influence which they exert on the pulsation of the radial is, of course, slight. As yet no characteristic of the trace obtained in these diseases has been noted; if, therefore, we were in doubt, in a given case, whether an existing lesion were one affecting the aortic or the pulmonary orifice, the trace might be of great service in deciding. The most noticeable points in the trace of mitral insufficiency are, that the breadth of the trace is diminished (Fig. 17), that the traces of successive pulsations differ from each other, and that the heart beats irregularly. Dichrotism is almost always present, and is in many cases more marked than normal. The principal points in the trace of mitral obstruction are that the breadth is somewhat diminished (Fig. 18), that there is more or less irregularity in the curves, and that respiration has a marked effect on the trace taken as a whole. The character of the pulse in affections of the mitral orifice appears most important because the trace differs so entirely from that obtained in affections of the aortic valves, while these lesions are precisely those which give rise to sounds occurring at the same time. It never would be possible for an instant to confound the trace of aortic obstruction with that of mitral insufficiency, or that of aortic regurgitation with that of mitral obstruction. Insufficiency of the tricuspid valve (Fig. 19) is usually accompanied by a venous pulse; and the sphygmograph gives evidence of this even when the finger and eye fail to detect it, or when we cannot be sure whether the pulsation which is seen or felt is in the vein itself or is only transmitted from an underlying artery. Fig. 20 is the trace of a patient suffering with insufficiency of both the mitral and aortic orifices, and the characteristics of each lesion are sufficiently evident. We have now pointed out some of the most simple uses of the sphygmograph. There is a large class of diseases, however, namely fevers, in which it is probable that experience may prove that the sphygmograph will render valuable aid both in prognosis and in indicating treatment. It certainly gives us a better indication than can be obtained in any other way of the degree of arterial tension; and as this is controlled in a great measure by the contracted or relaxed condition of the capillaries, we have a very good index of the state of these last-named vessels. Enough observations have not yet been made to enable us to decide how great is the importance of this point; but as the capillaries offer the greatest part of the resistance experienced by the heart, their condition as to contraction or relaxation cannot be without importance. Dr. Grimshaw, as has been already said, has shown the importance of the return of dichrotism; and it is probable that further experience in this subject, which is still in its infancy, will bring to light many other important points. 206 WEST 42nd street. ILLUMINATION BY THE MAGNESIUM LIGHT ECLIPSED BY ZIRCON.-M. Caron employs zircon, which is infusible, and burns with brilliancy in the oxy-hydrogen flame. Only the portion of crayon exposed to the flame need be made of zircon, the body can be formed of magnesium, which will be a saving in expense. M. Caron, after employing the same piece of zircon for an entire month, could not detect the slightest trace of wear or tear. La France Médicale. A NEW METHOD OF TREATING HYDROCELE, VARICOCELE, AND VARICOSE VEINS. By G. P. HACHENBERG, M.D., U.S.A., POST SURGEON, FT. RANDALL, DACOTAH TERRITORY. To reduce a surgical operation to its most simple form, and to lessen its tendency to danger, should be the surgeon's highest aim. Influenced by these motives, I present the following operations for hydrocele, varicocele, and varicose veins. The practice suggested itself to me from the manner in which a seton was disposed of in the case of a patient some years ago. He was a professional gentleman, and labored under amaurosis. When inserting the seton in the nape of the neck, I pinched up a large mass of the integuments, through the base of which I inserted the seton, in order to retain it for many months. Notwithstanding every precaution to keep it intact, the seton sloughed away in about four or five months. I. In 1855, B. N. B., aged 76, had had hydrocele of the left scrotum two years. The case was unhappily complicated with an organic disease of the portal system. He was highly cachectic. I did not consider it safe to attempt the treatment by exciting inflammation of the tunica vaginalis by the injection of stimulating fluids. Without resorting to paracentesis, I inserted a seton of saddler's silk through the lower anterior part of the scrotum, embracing nearly two inches of the tunica vaginalis. I left the seton for months, until it sloughed away, when the patient was permanently cured of his trouble. The seton at no time seriously incommoded the patient. I did not repeat this operation, as I adopted a still less painful and simpler method, referred to in a recent number of the Transactions of the American Medical Association. This consisted in letting out the fluid by paracentesis, after which a gum elastic bag, or rather scrotal compress, was adjusted to the scrotuin, which the patient wore, without the least inconvenience, for weeks, or until the cure was effected. At no time is the patient confined to bed. These scrotal compresses are made of pure caoutchouc, thin, light, and elastic; are of different sizes, are self-adjusting, and need no bandage to keep them in place. They do not, in my opinion, cure by exciting adhesive inflammation, but by restoring the enfeebled tone of the secretions of the tunica vaginalis. II. In 1864, while surgeon of the Veteran Reserve Corps at Nashville, Tenn., a soldier presented himself with varicocele on the left side. The spermatic veins were most prominently involved. In operating, by careful manipulation, I isolated them from the cord, and with the fingers secured them to the side of the scrotum, in as small a compass as possible. I then secured them within the loop of a seton. After the operation the scrotum was treated with ice-water applications occasionally through the day, in order to maintain an astringent effect as well as to counteract active inflammation, and at one time phlebitis in particular. The treatment we had in view was to graduate the inflammation-slowly to bring about such infiltration of serum and fibrous deposit as would so compress the veins as to cut off their circulation long before they were severed by the seton. The scrotum was well supported by the ordinary suspensory bag, and after we had a certain degree of induration and tolerance from the seton, by the aid of a frail elastic band fixed over the left inguinal region by adhesive strips, a gentle tension was kept on the loop of the seton. This, and, at a later period, the use of the savine ointment applied to the seton, greatly facilitated the sloughing, until the seton finally dropped out, leaving the patient relieved of his disease. Certain cases of varicocele I have relieved by the use of the caoutchouc scrotal compress, and found it an invaluable article for the treatment of sarcocele, hematocele, and in the latter stages of orchitis. III. Last spring, on taking charge of the U. S. Post Hospital at Ft. Randall, D. T., the wife of one of the sergeants of the 22d U. S. I. came under my treatment for varicose veins. The saphenous of the right leg was very much distended, so that its bursting was apprehended by the patient. I began by a system of laxatives, the cold douche, and having her maintain a recumbent position, the leg being kept higher than the body. By this course the heat and venous congestion of the leg soon subsided. We now environed the vein, about four inches above the ankle, with a seton of silver wire, taking care not to transfix it with the needle. For a few days the parts were dressed with cold water application, and the patient kept in bed. After the parts became somewhat inured to the presence of the seton, at least when there was less tendency to an active inflammatory action, she was permitted at times to go about, and even to attend to her household affairs, still keeping up the cold water dressing. A month after the insertion of the seton a gentle elastic tension on the wire was instituted, which was kept up until it sloughed out. This tension was varied according to circumstances; when it aggravated the inflammation and pain too much, it was suspended for a day or two. In about two months the wire worked itself out, and left the circulation of the leg so altered as to give great relief to the patient. The seton might have been disposed of in less than a month, but only by incurring more inflammation, pain, and perhaps danger. This procedure does not cause, comparatively, a very active inflammatory action if judiciously managed, and therefore is not attended with any unhappy consequences. A seton, after a certain stage, maintains strictly a reparative process. Nature struggles to get rid of it, and therefore all the soft integuments must give way to it. On the principle of disintegration, the seton is thus disposed of. As the advance tissues are broken down by the influences of its presence, it leaves behind its course the works of reparation. As we progress outwards with the seton, slow as it may be, we have all the time only a small perforated ulcerative wound to contend with, so trivial as to cause, usually, little or no constitutional reaction. A I would ask attention to one point of this paper. slow, morbid action, artificially induced, is never so formidable as one suddenly brought about. A NEW METHOD OF APPLYING BY FRANK P. FOSTER, M.D. LATE RESIDENT SURGEON TO THE NEW YORK HOSPITAL. tibia, with a tendency of the soft parts to fall backwards en masse, leaving three or four inches of the tibia exposed, I placed the stump in a fracture-box, sustaining it by a broad strip of adhesive plaster passing under it, and thence upwards on either side over the edge and down the outside of the side-board of the box; and finally attached a weight to the end of the box, by a cord running over the foot of the bed. I have recently met in private practice a case in which, from the tender age and great restlessness of the patient, a child sixteen months old, some modification of the appliance was called for. This I effected in the following manner: A U-shaped piece of stiff iron wire, wound with adhesive plaster, was applied so that an arm of the wire passed up on either side of the stump. The counter extending straps were fastened to rings at the free ends of the wire, and the ordinary extending stirrup was fastened to the cross-bar by means of a strip of elastic webbing. A large bag of bran was then placed under the ham, and secured to the limb by means of strips of muslin passing around the leg and thigh. This branbag was made so large that any ordinary amount of tossing about on the part of the patient would neither disarrange the appliance nor injure the face of the stump. The flaps soon came into apposition, and the patient made a good recovery, the cicatrix being no larger than if primary union had taken place. 83 E. 28th st., New York, Oct. 5, 1868. Original Lectures. THE HYGIENE OF INFANCY : DELIVERED AT THE BELLEVUE HOSPITAL MEDICAL COLLEGE, PROF. OF OBSTETRICS AND THE DISEASES OF WOMEN AND CHILDREN. GENTLEMEN:-The subject to which I shall call your attention, in the four lectures of this preliminary course, is of the first importance to the rational study and treatment of the diseases of infancy; for many of these owe their existence to infraction of the laws of hygiene. To diminish the terrible-though to a certain extent inevitable-mortality of infancy, to avert evil influences, to develop the good, to diminish the necessity for drugs, and so to carry these helpless little ones through the perils of infancy that they may reach the less dangerous years of childhood with well developed constitutions, are tasks which demand both the knowledge and the application of the best hygienic laws. In the treatment of stumps it often becomes an object to make the most of what remains, in the way of If time would permit our thorough study of the subflaps, after sloughing has taken place. For this pur-ject, we should commence with those hereditary prepose Dr. R. F. Weir employed elastic extension in the dispositions and influences which affect for good or ill hospital under his charge at Frederick, Md., during the foetus and the man, and those conditions of the the early part of the late war, and at about the same mother's health and hygiene which are liable to affect time I observed excellent results from its use in the gestation; but, passing over these interesting ques New York Hospital during my pupilage at that insti- tions, we come at once to a broad division of the subject. tution. In some of those cases I applied the weight and pulley in the same manner as they are used for I. DUTIES OF THE PHYSICIAN TO THE NEW-BORN CHILD. fracture of the thigh, and in others (leg stumps), where Establishment of Respiration.--Hitherto in the womb there was extensive ulceration over the crest of the it has drawn its supply of oxygen from the mother, While it will be impossible for me to attempt to exEX-haust the subject, I shall avoid at least useless details, and endeavor to fix your minds only on what may be direct and practical; nor shall I hesitate to set the hygienic indications in a clearer light by illustrating as well as those which may forbid success. pathological conditions which may follow their neglect, through the placental circulation; now it is obliged to obtain this vitalizing agent from the outer world, through organs whose functions have rested in abeyance. Hence our first duty is to see that the function of respiration is fully established. Fully, I say, because it not unfrequently happens that unless this be thoroughly done, portions of the lungs are left unexpanded, collapsed as they were in the womb before respiration was necessary; and thus, sufficient machinery not being set in action, after a while oxygenation is not thoroughly accomplished; the respiration labors; the vital power fails; more lung tissue ceases to work, perhaps collapses; the surface becomes blue, the nerve tissue poisoned by black blood, the senses benumbed, the vital warmth displaced by the advancing coldness of death. This unexpanded condition of the air-cells, which may obtain from the failure to establish respiration, and to which the lungs of infants are liable to revert in conditions of debility and catarrh, is known under the name of atelectasis. Prevent these dangers by insuring such full and continued respirations as may make you morally certain that all the cells have been distended. Hearty and continued cries from the child generally attest this result. Now children are often born in natural labor, and in labors attended by special dangers, in a condition of apparent death. A broad distinction is drawn by authors between those apparently dead or apparently dying, with a congested or a pallid surface of the body. Treatment has been formulated in accordance with these obvious signs. I do not dwell upon them. No greater congestion of the internal organs has ever come under my observation, in the autopsy of these children, than in cases where the surface has been pallid. Congestion of the skin does not kill, it is congestion and extravasation within that we dread. Skin congestion accompanies internal congestions, but these latter may exist without the former. Signs of strength and vigor may permit treatment contraindicated in premature and puny children. Do not believe that the liver and brain must be pallid, because the skin is white. Do not assume that, because a child is born and shortly dies with a thoroughly congested and blue surface, it died from "the blue disease," or cyanosis. Cyanosis, to constitute a disease, must be recurrent; or if believed to have caused the death under the circumstances we are considering, something more than a patent foramen ovale must be shown by the autopsy. The foramen ovale would be patulous, as a matter of course. How could it have closed in so short a time, even if its persistent patency were assigned as the cause of cyanosis? When, therefore, children are born and do not respire, is blood to be let? Is the indication to be based on the color of the skin? What method is to be preferred? Shall we allow blood to flow from the cord, or take it by leeches? I mention the latter advice only for condemnation. If you allow blood to flow from the cord, hold it well, as you would a cut axillary artery, so that you can control it at once. A teaspoonful is a limit beyond which I would very rarely go. But I very seldom allow any blood to flow, and still more rarely until I have rapidly tried the measures to which I now invite your attention. Establish respiration thoroughly, and the sluggish circulation becomes active, the ruddy glow of health colors the skin. Free the mouth and nose from mucus and vaginal discharges. Note that there be no malformation. It has been noticed that a simple band of skin over both nostrils, easily divided with a bistoury, has powerfully affected the respiration of a new-born child. Women relatively breathe more with the thorax, men with the abdomen; perhaps the new-born child, destined in lactation to rely so much on the nostrils, may physiologically need them more than we. Free the nostrils and the mouth thoroughly, both in order to admit air, and because in the first inspirations these materials may be drawn into the air-passages and occlude the bronchi. Such conditions may have obtained in utero from premature inspiratory efforts. Liquor amnii and meconium may be demonstrated in the air-passages by the microscope. The child yet contained within the unbroken amniotic pouch, compelled to respire prematurely by reflex irritations, or by that respiratory need awakened by interference with the placental circulation, may thus be drowned in the womb of its mother, and the cause of death demonstrated at the autopsy. Try to prevent this accident to the respiratory passages when the child is born, and in your hands. When the child is separated from the placenta, if the stimulus of the respiratory need, and the transition to the cool air of the room are not sufficient, spank it over the buttocks with the tips of your fingers, and rapidly use Marshall Hall's or Sylvester's method for the resuscitation of those who have been drawn from the water. If not promptly successful, plunge the body of the child in warm water (which should be ready in advance), and then into cold water. You thus keep up the warmth, draw blood to the surface, and increase the shock of the cold application. Spur the diaphragm and intercostals by brisk sprinkling of water; a lump of ice or a column of water to the epigastrium; then back again to the warm water, so as to diminish internal congestion and the benumbing influence of continued cold. From the warm water place the child on a blanket, on the floor or bed, and thoroughly try Hall's or Sylvester's method. I prefer Hall's, but use both, and have seen children saved exclusively by each. It is not necessary to draw the tongue forward. It is important to keep the chin in line with the sternum, and to keep the trachea somewhat prominent. Remember to prevent the child from getting too cold. Hot and cold water again. Slap, sprinkle, blow on the surface of the body, aid the slow and struggling expiration by gentle pressure on the chest. Have a battery on hand. Place the poles on the sides of the neck (third and fourth cervical), and over the diaphragm. The theory is to stimulate the phrenic nerve. The battery, however, under my observation, has proved less valuable than the other methods detailed, and I therefore only indicate the most important application. During this time abstraction of blood will have been considered. Do not let the water be too hot; you may scald the insensible child, Too hot water has been asserted to have caused trismus. Shall you inflate the lungs with your own breath? If so, be sure that the air enters the larynx. With skilful manipulation a catheter makes this certain. Generally the stomach is blown up, unless precautions be taken. Do not blow into the lungs so as to produce emphysema. I have seen emphysema, however, in new-born children, whose lungs had not been thus inflated. If you inflate the lungs, do not blow when the child is making a respiratory effort. In one word, my personal experience makes me rank this method of inflation as secondary to alternations of heat and cold, stimuli, and the methods of Hall and Sylvester. Persist in these trials as long as the heart can be felt or heard, and a little longer than it can be heard. The quickest way to feel the heart is to put the pulp of your finger under the ribs and lift up the diaphragm. Pulsation can be felt thus when it cannot be touched through the thorax. Persist a while after the heart has apparently ceased to beat. A life for which you are responsible hangs upon the effort. There is nothing more surprising than the tenacity with which some infants cling to life, except the facility with which others lose it. But, gentlemen, all your endeavors will often fail. For your satisfaction, and for the satisfaction of the family, obtain an autopsy. The pathology of foetal life and of the still-born yields to none other in interest or value. It is a microcosm but too little explored. It is melancholy to see the neglect of the subject in practice and in the records of great hospitals. A still-born child one would suppose to be a child still-born from some unexplained and sufficient general cause. Start clear from such apathy, such delusions. The autopsy may show that you struggled against hope, that the establishment of respiration was hopeless, or its continuance impossible. Gather this consolation when you can. Search at least for truth. The respiratory passages may be proved by the autopsy to be absent in whole or in part. Trachea or bronchi may be replaced by impervious cords. Cysts, peritoneal effusions, pleuritic effusions, may have developed themselves in foetal life, may not have killed the child, but may prevent air from reaching the lungs, the diaphragm from descending, the lungs from expanding. The pulmonary artery may be absent or barely pervious. The heart may be in front of the neck, within the abdomen, outside of the thorax; it may be unfitted for the strain of the altered circulation from malformation and from intra-uterine disease. The diaphragm may be open, and the intestines have crowded into the thorax and stopped the lungs from expanding. Extravasations on the brain and into its tissue may have caused the death. These extravasations may have occurred before the labor commenced. I have said enough to show that you may have the consolation of knowing and proving that your responsibility has been discharged, that the cause of death bore no relation to your management of the labor, or to your choice and use of means to establish respiration, when respiration was impossible. Ligation of the Cord.-In ligating the cord, always examine the umbilicus thoroughly for hernial protrusion. Cut far enough away from the body to leave space for a second ligature, in case it become necessary to apply it after the occurrence of hæmorrhage. The gelatinous material composing the envelope of the cord is very apt to make the first ligature slip. clothes, by the mother or nurse, either accidentally or intentionally, overlaying it. The mother or nurse is also very apt to nurse the child too often at night, and thus institute a bad habit both for herself and for the infant. Moreover, the air of the mother's bed is more or less impure from the lochia. I now wish to advise you particularly to see that there is constantly in the nursery a sufficient supply of fresh air. No observations illustrate my remark better than those made in the Dublin Lying-in Asylum, where for twenty-five years the mortality was 1 in 6. On the introduction of proper ventilation, the mortality fell to 1 in 19, and subsequently to 1 in 58. A thousand cubic feet of space are ordinarily regarded as desirable for an adult; a young child requires no less than an adult. Apart from the respiratory troubles overcrowding produces, it increases the liability to epidemics, to ophthalmia, and depraved nutrition. Residence.-Very frequently it will be found that a change of residence will prove of decided benefit to the infant, especially when some depressing or contagious atmospheric influence exists in the neighborhood where the child is residing. A change from one part of the city to another may be sufficient. Often, however, the sea-side or the mountain may offer special claims, especially for escape from heat. Urination. It is of great consequence to see that the infant passes its water. Urine is secreted and passed in utero, and may be passed during and just after birth. In some children the urine has been retained, and the distension of the bladder has been so great as to prove a cause of delayed labor. Cystic kidneys have done the same. In one case the bladder was found capable of containing two quarts of urine; in other cases it has ruptured before birth. After birth, almost before the child draws its first breath, it often passes its urine. Should it not do so within the first twentyfour hours, we should learn why not. It may happen that the bladder was emptied immediately after or during labor. It may be that so little milk has been taken that the kidneys have not been called upon to act freely. Babies urinate in direct proportion to the amount of milk or liquid nourishment they receive, in a ratio five or six times as great in proportion to bulk as in the case of the adult. Hence, whenever we learn that the infant is passing but a scanty amount of urine daily, it is always safe to ask whether it is receiving milk enough from its mother or the wet-nurse. Knots in the cord may be found, but they rarely produce death. Their occurrence has been explained by Obstruction to the passage of the urine may occur supposing that the head of the child passed down from deformity or the partial or total absence of the orthrough a loop in the cord. The cord is often twisted gans necessary to the function of urination; such as partial about the neck; and it is sometimes necessary to use or complete absence of the urethra, absence of the bladder forceps to effect delivery in these cases; I have never, with compensatory openings, or of the kidneys, or imperhowever, had to cut the cord before delivery. A cord vious ureters. Perhaps the bladder may be very capashortened from this or other reasons may produce de- cious or atonic. A cause of obstruction to the flow of layed labor; and, if the forceps be used, the resistance urine shortly after birth, in boys, is dependent upon due to the cord may he felt upon attempting traction simple agglutination of the urethral walls. (I have more in increasing ratio to the advance. It is difficult or im- frequently found urine in the bladders of still-born possible to diagnosticate these cases, until the head is boys than in those of still-born girls. It is natural that well down in the vagina, or until the head is delivered. it should be so.) This condition is easily remedied by Warmth and Ventilation. After having secured the the introduction of a silver probe curved into the form establishment of respiration, it is of the first importance of a catheter; the urine generally trickles out along its to see that the infant be kept warm. Of all the young sides, and then flows freely. The reflex irritation thus mammals the human probably requires the most care produced is often all that is necessary. Whenever you in this respect. Yet exceptional instances may be cited are told that the water does not pass by the natural indicative of the opposite condition. Children exposed outlet, always examine thoroughly for some abnormal in the streets and taken to foundling hospitals often die opening through which it may be passing unperceived, from cold. The competent monthly nurse takes the especially for vesico-vaginal fistula, cloaca, and hermagreatest care of the warmth of the child. Sleeping with phroditism. Sometimes, but not very frequently, a con, its mother is the natural means for warming the child, a dition occurs, known as hydronephrosis, in which the species of incubation, but is attended with liability to bladder and ureters may be immensely dilated, so as to accidents; the child may be smothered beneath the bed-resemble the factal intestines, and the kidneys affected In children born without an anus, there may be a connection of the rectum with the vagina or the bladder. In the former case, we should make an incision in the median line, establish an anus in its usual situation, and later in life heal the recto-vaginal fistula by the usual procedures. In the latter wait developments, or if possible follow the same course. by the pressure of the retained urine. In one case under my observation, in which this condition was found, my explanation was that, owing to the shallowness of the pelvis and the obliquity of its brim, the bladder had fallen forwards, after dilatation had commenced, thus producing an angular flexure of the urethra or neck of the bladder, preventing the discharge of the urine, for the urethra was normal in size; accumulation Simple closure of the raphe or lower part of the rechad then occurred, and by the "back-water" action tum is the easiest malformation to detect and treat. produced the changes in the urinary tract, distending When the question arises as to the advisability of gropthe ureters, calices, pelves, and causing absorption of ing one's way with bistoury, scissors, and fingers, where the cortical structure. Retention of urine may also the rectum ought to have been, and then of plunging a occur from pressure upon the ureter, as by the passage trocar into something above that we believe to be across it of a supernumerary branch of the renal artery. intestine, or when we select the alternative of an arI have never seen a case in which puncture of the blad-tificial anus, our duty is clear, to represent fully the under was demanded in the new-born child for retention, certainties and dangers to the family, with the limited but if necessary, I should prefer the supra-pubic method. chance of success in the last contingency. If the Cleanliness.-The education of the infant should begin parents refuse, a painful and unsatisfactory operation with the first days of its extra-uterine life, and a point need not be performed. If they assent, or saddle you of no little importance is to see that it does not lie in with the whole responsibility of the decision, you must wet or soiled diapers. Let these be removed immedi-even make the artificial anus, for it has saved life in the ately after it has soiled them, and soon it will learn to history of the operation, though you will probably fail. indicate by its cries its disapproval of damp diapers. The alacrity to be felt in the operation is in direct See that the napkins are not dried in crowded rooms ratio to the expectation of speedily reaching the intesbefore the registers. Moreover, if a child is allowed tine from below. Before performing it, wait for the to lie almost constantly in its own excretions col-intestine to be distended, if you cannot feel it, but not lected in the napkins, erythematous eruptions or even too long. ulcerations will be formed upon its nates, and these may sometimes have a very suspicious appearance. Now, gentlemen, do not be in a hurry to diagnosticate all ulcerations you find upon the buttocks of an infant as necessarily syphilitic in character. Appearances should not always be interpreted against the infant. Uncleanliness, and neglect to apply other clean, dry napkins as soon as the first are soiled, is a very common source of sores about the infant's buttocks, simulating syphilitic cachectic ulcers. By removing the cause of the trouble, applying a mild lead wash or other lotion, and seeing that the child is well nourished, we can generally heal up these ulcerations without difficulty, and dissipate the mistaken diagnosis. In diarrhoea redouble precautions: cleanliness, lead water, calamine powder, disinfectants. tus. Clinical Department. BELLEVUE HOSPITAL. CASE OF FACE PRESENTATION-POWERLESS LABOR-AT- BY THE FORCEPS. SERVICE OF DR. ISAAC E. TAYLOR. Reported by Chas. S. Bull, M.D., House Physician. ELLEN MCDERMOTT, aged 24, a native of Ireland, and by occupation a domestic, was admitted to Bellevue Hospital in August, in apparently perfect health, and pregnant with her first child. Her last menstrual period was about November 20th, 1867. Passage of Faces.-The liquor amnii does not as a rule contain meconium. When the finger, introduced Labor pains first came on about 2 o'clock on the into the vagina, encounters this, its presence is com- morning of August 31st, 1868, though she had had premonly supposed to indicate the death of the foetus, or monitory pains for several days previously. A vaginal a breech presentation. But even when there is no examination was made, but owing to the thickness or breech presentation, we should not lay too much stress the membranes, the position could not with certainty upon this symptom in making our prognosis, except be made out, though it was plain that the head was in so far as it is indicative of great danger to the foe-presenting. The foetal heart was heard in the right There are very few positive signs of death of the foetus. Inability to recognize the foetal heart-beat is not sufficient evidence that the child is dead. There are few very strong evidences of its death. No pulsation distinguishable after a long lapse of time in the cord; second, the perception by the finger that the parietal and occipital bones collapse and move about on pressure, while the skin peels off on friction. If you do not recognize by the touch that the child is putrid, try to deliver promptly and revive it if possible. iliac fossa. The pains came on at unusually long intervals, and were very slight. At 8 A.M. of same day the membranes ruptured, and a second examination revealed the fact that the child was presenting by the face, the occiput being to the right sacro-iliac synchondrosis. In about two hours the pains had almost entirely ceased, and the head could still be pushed up above the superior strait. The bowels were moved by an enema, and whiskey was administered at intervals of two hours. Early on the morning of the first of September the pains returned more forcibly, and the head soon became firmly jammed in the superior strait. The patient now stated that she had not been able to Always inquire the first day after birth if the infant has had a passage from its bowels. If it has not, examine it carefully. An examination of the external orifice alone is not sufficient. Introduce a probe into the rec-pass her water for nearly twenty-four hours. On tum, and see whether it does not end in a cul-de-sac. It may be that parts of the intestines which you cannot reach consist only of fibrous bands, and in these various contingencies the question will arise as to the formation of an artificial anus. Obstruction of the intestinal canal may occur from infarction by an accumulation of epithelial scales. attempting to introduce the catheter, it was at first found impossible, as the head of the child was pressed firmly against the bladder, completely blocking up the orifice of the neck. At length, by directing the point of the catheter obliquely to the right side and using firm pressure, it entered the bladder, and about twenty ounces of urine were drawn off. The head made very little |