quickly covered with thin, dark crusts, and surrounded with a darkred or purplish margin. It has been doubted whether the venereal disease is ever communicated to the infant during birth; the vernix caseosa affording it is supposed a sufficient protection to the skin against infection. It is certainly not very common to find the disease communicated in this manner; when such is the case, it will present itself most generally, we believe, under the form of purulent ophthalmia. Transmission by the nipple of a diseased nurse is a very frequent mode in which infants are infected with syphilis. Ulcers, in this case, are generally formed in the mouth of the child, which are often entirely overlooked; or, when first noticed, are liable to be mistaken, even by the physician, for the ordinary eruption so common in infants during lactation. Thus, the true character of the disease is not recognized in its first stage, and it seldom comes under treatment until blotches and ulcerations make their appearance upon the skin, when its characters are the same precisely as those described above. It is very common for syphilitic eruptions in infants to entirely disappear under an appropriate treatment, but again to return, sooner or later, after the treatment is suspended, and thus to recur repeatedly until every vestige of the disease is eradicated. This should serve as a caution to the young practitioner not to pronounce the child entirely cured, until several months have elapsed without any symptoms of the disease reappearing. The diagnosis of syphilitic eruptions in infants is not always very easy. They, in many cases, resemble very closely psoriasis or lepra, or some of the more inveterate forms of scabies. The physician who has seen a good deal of the disease will, however, seldom be deceived; the young practitioner must depend altogether upon a cautious investigation of the history of every suspected case, without, if possible, exciting suspicion in the minds of those interested. An incautious hint, or imprudent question, might have the effect of destroying domestic peace, or, at least, of deeply wounding the feelings of a mother, in cases where neither parent is in the slightest degree concerned in the production of the infant's malady. In every instance, indeed, the expression of opinion should be very guarded. The treatment of infantile syphilis is extremely simple, and, when judiciously carried into effect at an early stage of the complaint, is, very generally, successful in its eradication. One or two grains of hydrargyrum cum creta, two, three, or four times a day, according to the age of the child; or a third or fourth of a grain of calomel, combined with chalk, ipecacuanha, and extract of hyoscyamus;' with the external application of the black wash, or dilute citrine ointment, to the crusts, ulcers, or condylomæ, twice or thrice a day, should be directed, and continued until the eruption and the discharge from the nostrils disappear; and subsequently at longer intervals, for one, two, or three weeks more. 1 R.-Calomel. gr. iij.—iv. Ipecacuanhæ. gr. ij.-iij. 2 R.-Ungt. hyd. nit. Ziij. Cretæ ppt. 3ss. Ext. hyoscyami, gr. iij.—iv.-M. f. One to be given twice a day, or every 3 or 4 hours, according to the age of the In recent cases, we have generally succeeded, by this plan of treatment, in the removal of the disease in one month. In cases which have been neglected in their earlier stages, it will seldom, however, effect a cure under two, three, or even four months. We are to recollect, also, the liability of the eruption to recur, after, to all appearance, it has been entirely eradicated; when the same treatment is to be again resumed. Should the mercury, when given by the mouth, produce griping and purging—which, however, we have seldom found it to do when combined with the chalk, ipecacuanha, and hyoscyamus-a small portion of Dover's powder may be added to each dose; carefully, however, watching the effects of the opiate, which, in infants, often gives rise, even in the smallest doses, to very serious effects. When the gastrointestinal irritation produced by the calomel cannot be controlled by such doses of opium as it would be prudent or safe to administer to an infant, it has been advised to omit its use, and resort to the external application of mercury, in the form of ointment. Fifteen grains of the unguentum hydrargyri mitis may be rubbed upon the inner surface of the thighs alternately, once in two days, until the mouth becomes hot, when it is to be intermitted, and again resumed after a proper interval, should it be necessary. In children under two years of age, salivation is rarely if ever produced; it is necessary, nevertheless, to watch the effects of the mercury upon the gums, and if these become hot, slightly swollen, or livid, its use should be at once suspended, as in some cases gangrene has been known to result from its continuance under these circumstances. This result, however, is seldom witnessed excepting in very feeble children. When the external sores are very indolent, they may be washed with a weak solution of the sulphate of copper, or of the nitrate of silver. If we have reason to suppose that the mother or nurse is laboring under disease of a syphilitic character (and we must recollect that, for very obvious reasons, it would be imprudent either to wean the infant or to suckle it at the breast of a healthy nurse), we should administer to her the ioduret of mercury, with the decoction of syrup of sarsaparilla. It is true, that the milk may be thus rendered less adapted for the nourishment of the child, but it seems, nevertheless, absolutely necessary for the effectual eradication of the disease in the infant. We would remark, however, that we recommend this course only in the case of the mother being actually syphilitic. We are opposed to the plan of attempting the cure of the infant by giving mercury to the nurse, as was formerly practised. During the course of treatment, both mother and child should enjoy the benefit of a pure, fresh atmosphere. The diet of the former should be plain, mild, and sufficiently nourishing, and her drink, water alone. It is important, also, that she take sufficient daily exercise in the open air, and observe regularity in her hours of repose. SECTION V. DISEASES OF THE NUTRITIVE FUNCTION. SCROFULA. SCROFULA is a very common affection of infancy and childhood, and is itself often the cause of various morbid phenomena. More frequently, however, it acts as a predisposing cause of disease, or it imparts to the several affections, common to the earlier stages of life, a peculiar character, as well in reference to their symptoms as to their progress and termination. It is very difficult to give a correct, and at the same time concise and comprehensive definition of scrofula, hence the somewhat vague term scrofulous or strumous diathesis, has been very generally adopted by physicians; the various manifestations of this morbid condition being usually described as individual diseases. This plan, while it is productive of no little confusion, is but illy calculated to lead to correct views in regard to either the pathology, prophylaxis, or therapeutical management of that particular morbid condition of the organism in which scrofula consists. In children in whom the scrofulous predisposition is strongly marked, there is a deficiency of fibrine in the blood; there is a predominance of the white fluids and tissues over the red; the several organs are pale, small in size, loose in texture, and perform languidly their respective functions. There is usually a peculiar fragility of the whole frame. The skin is, in most cases, thin and delicate, and by allowing the vessels beneath to be distinctly seen, gives to the complexion an appearance of great delicacy and beauty. The limbs are often small, soft and rounded, but with large joints; the fingers are long and slender, but commonly broad and flat at the extremities; the chest is contracted; the head is usually large, and the hair fine, silky, and often light-colored; the eyelashes are long, the eyes prominent, though languid in expression, and the pupils large; the lips are ordinarily thick and prominent. The whole frame exhibits an appearance of languor and debility. Exercise of every kind quickly tires. Notwithstanding there is generally a want of muscular development, yet in many cases, the body and limbs have an appearance of plumpness, resulting from the infiltrated state of the cellular tissue. The action of the heart, though usually languid and feeble, is easily excited, and a degree of febrile excitement will be apt to result from slight causes. The feelings are quick, warm and ardent. In many cases there is very decided quickness and precocity of intellect. Not unfrequently the countenance is swollen, and of a sallow hue; the cheeks full, tumid, and flaccid; the hair coarse and dark-colored; the lips thick, coarse, and liable to chap; the skin thick, harsh, and subject to eruptions; the eyes dull and watery; the eyelids full and drooping, and the general expression dull, heavy, and stupid. Digestion is ordinarily slow and imperfect, and liable to frequent derangement. The bowels are torpid or irregular. Cold and heat are alike borne with difficulty. It must be evident that the effects of any of the usual morbific causes are more certain to be experienced by an organization such as we have described, than by one of greater health and vigor; evinced, however, in the production rather of chronic than of acute disease. Inflammation occurring in scrofulous habits is slow in its progress, and often unattended by very manifest symptoms, unless when it is externally seated. When adhesions occur, the adhesive matter, instead of being firm, is of a curd-like consistence and appearance; very soft and easily broken, and with few, if any, blood vessels penetrating it. Suppuration is attended with the formation, instead of genuine pus, of a thin, puruloid fluid, containing curd-like matter. Ulceration is slow in its progress; granulations are tedious in forming, and unequal; and cicatrization, which is very tardy in taking place, leaves an uneven, deep, and unsightly scar. Softening of the internal tissues is very common, as well as tumefaction, suppuration, or disorganization of the lymphatic glands. Throughout almost every tissue of the body there is a tendency to tuberculous depositions, varying somewhat in their character, progress, and termination, according to the different tissues in which they occur; whilst in the bony structure we have a disposition to softening from the defect of the ossific process, and in the skin a predisposition to various chronic eruptions. It is evident from the foregoing general sketches of the characteristics of the scrofulous diathesis that they are all dependent on an abnormal condition of the organic functions, giving rise to imperfect sanguification and nutrition, and, consequently, a defective organization of the several tissues. Children are often born with this defective organization, or with so decided a tendency to it as to render its development certain, if they be subjected to influences calculated to impede or render imperfect the functions of digestion, assimilation, and sanguification. Under such circumstances, tubercular depositions take place early, and a decided and very peculiar modification is manifested in the phenomena, progress, and tendency of the ordinary diseases of that period of life. Under opposite circumstances, or by a judicious course of hygienic treatment, the organic functions may be roused into greater activity, and the organization of the tissues so far improved as to destroy their tendency to disease, or to allow the individual to pass through life with a delicate constitution, but without the occurrence of any morbid phe nomena calculated to produce suffering, or materially to impair his comfort. The question has been long discussed as to the hereditary character of scrofula. Upon a cautious review of all the facts that have been adduced, and a reference to the recorded experience of every observing physician, it appears to us to be a question very easy of solution. There cannot be a doubt that the children of parents who have labored under the disease are more peculiarly liable to its occurrence, all other things being the same, than those born of individuals who were free from it. In the foetus in utero, scrofulous affections have not unfrequently been developed, when one or other of the parents has been diseased; but, ordinarily, all that the child inherits is that particular organization, which predisposes it subsequently to birth to affections of this character. This diathesis or predisposition may be derived not only from scrofulous parents, but from such as have never manifested, during their whole lives, any trace of the disease. Thus, it may result from a morbid condition of the parents, produced either by disordered digestion, chronic disease, intemperance of various kinds, a luxurious and indolent life, too late or premature marriage, or the habitual indulgence of any of the depressing passions. Repeated intermarriages between near blood relations have probably, also, a very powerful tendency to produce a predisposition to scrofula in the offspring. While it is true that children, born with the organization, and consequent predisposition above alluded to, are such as, under all circumstances, are the most liable to the occurrence of scrofulous disease, it is, nevertheless, not the less true that the scrofulous tendency may be developed subsequent to birth, even in children exhibiting no traces of a lymphatic temperament, and born of perfectly healthy parents. The causes which produce this development are various. The most important are improper or deficient food-impure and confined airdefect of exercise-cold and dampness-imperfect clothing-neglect of personal cleanliness-over-fatigue and the depressing passions generally. Improper or deficient food is probably of itself sufficient to produce that particular condition of the organic functions upon which the development of scrofulous disease depends. The origin of scrofula in disorder of the digestive organs is indeed of so frequent occurrence, that many pathologists have considered this to be its invariable cause. Improper or deficient food must necessarily give rise to imperfect digestion, defective assimilation, and incomplete sanguification. The blood in consequence becomes deficient in fibrine, and the nutrition of all the tissues suffers. The child becomes pale and loses flesh, its strength sinks, and a general unhealthy condition of the whole organism quickly ensues. This may occur to the infant at the breast, from the bad quality or insufficient quantity of the mother's milk. It is more likely, however, to take place when the deficiency is attempted to be supplied by rearing the child, partly or entirely, by the hand, and still more so, after weaning, by the unappropriate character, the insufficient amount, the indigestibility, or the unnutritious properties |