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that, if portions of lung presenting these characters be dried, the air-cells have a tendency to reappear without having undergone any other change than a well-marked contraction.

I have dwelt long on this pathological condition, though I think not longer than its importance demands; because we shall find that in some form or other it presents itself, modifying the symptoms, determining the prognosis, and influencing the treatment of almost all the affections of the lung in early infancy.

We shall pass to the study of some of these diseases at the next lecture; but, before doing so, may notice an affection about whose nature much controversy has arisen, but to which, thanks to the researches of MM. Bailly and Legendre, we may now assign a place as one of the results of the imperfect expansion or subsequent collapse of the lungs, and of the consequently incomplete performance of the respiratory function. Though very rare in this country, induration of the cellular tissue is extremely common in the foundling hospitals of the Continent, where so many causes contribute to depress the new-born infant's feeble powers. The children in whom it occurs are usually weakly, not seldom premature, and its first symptoms generally appear between the first and fifth day after birth, though occasionally they do not come on till later. In many instances a livid redness of the whole surface is obvious from birth; but the appearance of a circumscribed hard spot on one or other extremity, or on some prominent part of the face, as the end of the chin, or the cheek bone, is the first sign of the commencement of this affection. Other spots of a similar kind are soon discovered on different parts of the surface; and the body generally, and the hardened spots in particular, are found to present a temperature much below the natural warmth of the body. It appears, indeed, from M. Roger's researches, that a general reduction of the temperature precedes the induration, or, at least, exists in a very marked degree, while the induration is still extremely slight. Sometimes, too, the premonitory loss of temperature† may be perceived in weakly children without being succeeded by the appearance of spots of induration. This, however, is exceptional, and in the majority of instances the sinking of the temperature and the extension of the induration advance together, and the warmth of the surface may eventually fall from 100° to 90°, 80°, or even lower. If the induration become very *Op. cit. pp. 124-151.

+ Hervieux, Sur l'Algidité progressive des Nouveaux-Nés, in Arch. Gén, de Méd. Nov. 1855. See also an essay by Dr. Löschner of Prague on the same subject, in the Jahrbruch für Kinderheilkunde, vol. i. p. 91.

extensive, it affects the integuments of the chest and the abdomen, as well as the extremities, and the body feels cold and stiff, as though it were frozen.

This condition is, as might be expected, attended with great impairment of the general health, and with a very remarkable degree of emaciation. Children suffering from it are extremely weak, often too weak to suck: their pulse is very small, their respiration abdominal, and their cry is faint and whimpering, wholly unlike that of a healthy infant. In some of the worst cases, too, a bloody fluid is discharged in considerable quantity from the nose and mouth. If the indurated parts be punctured, a small quantity of reddish serum escapes from them, though generally without much diminution of their previous hardness.

If the induration be at all general, death almost invariably takes place; and so great is the fatality of the affection, that, including even slight cases, five-sixths of those children who are attacked by it in the hospitals of Paris, die. In very slight cases, however, if the infant be at once placed in favourable circumstances, recovery need not be despaired of.

cause.

The hardness of the surface still persists after death, and the absence of any peculiarity in the effused serum, or of any sign of active disease, left writers generally in much perplexity as to its The venous system is usually found gorged with fluid blood, and this congestion is often apparent in the cerebral vessels, as well as in those of the abdominal viscera, particularly the liver. Both the thorax and abdomen also frequently contain a quantity of serum, often tinged with blood-effusions which are evidently of a passive nature, since they are unattended by any trace of inflammation either of the pleura or peritoneum. None of the viscera present any morbid appearances of half so much importance as those which are met with in the lungs, a very great part of which displays those changes to which your attention has already been directed as characteristic of their deficient expansion.† This condition of the lungs

In a paper by M. Elsässer, of Stuttgard, reprinted in the Archives de Médecine for May 1853, from the Archiv. f. physiolog. Heilkunde, are some very interesting facts with reference to the loss of weight in the course of this affection. The average loss of weight in 53 fatal cases, was of a pound; the extremes each way being six ounces and two pounds.

The observations of J. A. Troccon, in his dissertation 'Sur la maladie connue sous le nom d'endurcissement du tissu cellulaire,' 4to. Paris, 1814, are especially remarkable, since he not only described with accuracy the physical condition of the lungs, but even tried the experiment of inflating them, in order to prove that they were not, as had been erroneously supposed, in a state of gangrene. He says 'J'ai insufflé ensuite de l'air dans les poumons par la trachée: aussitôt la couleur noire qui

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had been noticed and most carefully described many years ago, as one of the most striking attendants on induration of the cellular tissue. It was thought by some of those who described it to be the result of pneumonia; while other observers, justly insisting on the absence of the other effects of inflammation of the pulmonary tissue, yet drew the attention of pathologists too much away from the chest, where the clue to the solution of the question as to the cause of the affection was to be found, had they but known how to use it. We, however, are aware that those appearances once thought to be the result of pneumonia, are in reality due to the unexpanded condition of the lung; and we can understand how it may happen, if children be exposed to cold immediately after birth, and then transferred to the ill-ventilated wards of a foundling hospital, and there fed with food far other than that which nature destined for them, that respiration may be but very imperfectly established; that their temperature may consequently fall, and the blood flowing in part through the unclosed fœtal passages may stagnate in its course, may give rise to passive effusions into the great cavities of the body, and to an anasarcous swelling of the surface. There are, it is true, some peculiarities in this form of oedema, but not such as to invalidate the above explanation of the cause to which it is due.

The treatment of this affection implies the removal of every cause likely to induce it. Hence warmth stands foremost both as a curative and as a preventive measure. The warm bath may be resorted to as a means of raising the child's surface to a proper temperature, provided its extreme weakness do not contra-indicate that measure. Gentle friction with warm oil is a means which has been tried for this purpose with advantage. The child should be nourished with breast-milk, even if it be too feeble to suck, and stimulants, of which white-wine whey is a very good one, will in many instances be needed. Defective respiration being the ultimate source of all the symptoms, the main principles of all your treatment must be the same as have already been laid down

était à leur base s'est changée en une couleur rouge claire, laquelle s'est étendue de proche en proche à mesure que je continuais ces insufflations.' After removing a ligature which he had applied around the veins, and allowing the escape of the blood with which the heart and lungs were gorged, he resumed the inflation of the lungs, and 'les organes de la respiration ont été presque de suite dans un état absolument naturel, et aussi beaux que ceux que l'on voit pendus devant nos boucheries.'— pp. 37-8. It seems strange that neither M. Troccon nor subsequent observers perceived the full bearing of these experiments till similar ones were instituted by MM. Bailly and Legendre.

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for your guidance in cases of atelektasis of the lung; and these it can hardly be necessary to recapitulate.

I should have said more about this affection, its nature and treatment, if it were one with which you were likely to meet often; but, in consideration of its extreme rarity in this country, I may perhaps be excused for passing it over with this cursory notice.

LECTURE XIX.

INFLAMMATORY AFFECTIONS OF THE RESPIRATORY MUCOUS MEMBRANE-comparative rarity of catarrh during the first weeks of life-Coryza-simple and pseudo-membranous or malignant- identity of latter with nasal diphtheria.-Catarrh, causes adding to its importance in early life-its treatment danger of bronchitis or pneumonia.

Post-mortem appearances of Bronchitis-redness of the membrane-nature of the contents of the bronchi-dilatation of their cavity.-Extension of the inflammation to the lining of the pulmonary vesicles, producing vesicular bronchitis. State of the lungs in bronchitis-frequency of congestion-carnification of some lobules -possible extension of inflammation to the pulmonary tissue, producing lobular pneumonia-suppuration of these patches producing vomicæ.

ALTHOUGH two lectures have already been devoted to the pathology of the respiratory organs, yet, until to-day, we have not been able to commence the study of their special diseases.

They may be divided into the three grand classes-of the inflammatory, the nervous, and those which result from morbid deposits. We will examine these in the order in which I have enumerated them.

At every age inflammatory affections of the respiratory mucous membrane exceed all others in frequency; and even when the pulmonary substance becomes eventually involved, it is often by the extension to it of mischief which began in the mucous membrane. But in infancy and childhood this is preeminently the case, for the delicate and highly vascular lining of the respiratory organs resists but feebly the influence of noxious impressions from without, while it sympathises most acutely with many morbid processes within.

This extreme susceptibility of the mucous membrane of the respiratory organs in childhood renders its disorders of very frequent occurrence, while we are compelled to study closely the signification of symptoms that may betoken disturbance from such various causes. Something of this sympathy with the affections of other parts exists even in the adult, as we may see exemplified in the cough that attends upon affections of the liver, but in the child the sympathetic disorder of the respiratory mucous membrane is vastly more frequent; and nurses, taught by experience,