deficiency in these walls. The deficiency usually occurs near the umbilicus, and on the median line. The integuments are sometimes wanting around the umbilicus, and the sac, inclosing a portion of intestine, is formed by the base of the cord alone: the covering is sometimes so thin that the intestine may be seen through it. In a case of this kind, a permanent occlusion of the umbilical opening was produced by reducing the intestines, their return being prevented by an assistant compressing the cord close to the abdomen, placing a compress, formed of circular pieces of leather spread with adhesive plaster, laid one upon another in a conical form, upon the navel; when the skin upon each side of the aperture was brought into contact, one lip slightly overlapping the other, and the whole secured by a linen belt. with a thick quilted pad, circular in form, applied over the navel. The bandage was renewed occasionally. At the expiration of a fortnight after the separation of the funis, the aperture at the navel was so far contracted, that not the least protrusion was occasioned even by the crying of the child.

This case will sufficiently indicate the general plan upon which the irregular hernia, occurring during infancy, are to be managed: of course, slight modifications will be required in particular cases, which the good sense of the practitioner will readily suggest. Early and judiciously treated, nearly all of these hernia may be permanently removed; whereas, if neglected or improperly managed, they may entail a serious infirmity that will last as long as the individual lives. Arrest of the Testicle.-As closely connected with the subject of congenital inguinal hernia, a few words will be proper in this place, in relation to a not unfrequent occurrence, from which we have repeatedly seen a very considerable amount of suffering result; we allude to the arrest of the testicle at the abdominal ring, or in the groin, in its passage from the abdomen. In this situation, it frequently becomes inflamed, causing severe pain, sometimes of several days' continuance, attended with considerable febrile reaction, and occasionally with tension and tenderness of the abdomen, nausea, or vomiting, obstinate constipation, and the other symptoms of peritoneal inflammation, producing, sooner or later, in the groin, or at the ring, a small, intensely red tumor, exquisitely painful to the touch, and upon every motion of the patient's body; in this, suppuration, sooner or later, occurs, forming an abscess of considerable size. The inflammation is often attended with complete disorganization of the testicle.

The treatment consists in leeching, warm bathing, and emollient poultices to the groin, laxatives by the mouth, and gentle purgative enemata. The child should be kept as much as possible at rest, and as soon as an abscess forms it should be opened.

12. Vaginal Hemorrhage.

In many cases, a discharge of red fluid blood takes place from the vulva of the new-born female infant, and continues, without interruption, for several days or even weeks, after birth. This sanguineous discharge is unattended by redness, swelling, or any other indication of the existence of the least degree of irritation in the vagina, or

external parts of generation; nor do the functions and general health of the child appear to suffer any derangement.

Billard has twice observed effusion of blood in the form of clots into the cavity of the uterus in female infants who have died soon after birth. Mallat mentions the case of a child who had, some days after birth, vulvar hemorrhage, followed by the formation of a vaginal clot, which was drawn out by the mother at the end of two weeks. It was attended by intumescence of both mammary glands; all disappeared by the end of ten days. Dr. Camerer has observed a similar case, four days after birth, at the full term. Some drops of blood escaped from the vulva, and the flow did not reappear: five days afterwards, the breasts become for a short period swollen; otherwise the child remained in good health. Barrier cites a precisely similar case. Lastly, Ollivier, of Angers, has observed this hemorrhage in a number of infants at the breast. He states that the blood is red and fluid, escapes for one or two weeks or longer, and then ceases spontaneously without the health of the child suffering. (Bouchut.)

It is very difficult to understand the cause of this discharge. The whole of the mucous surfaces are, it is true, during the early period of infancy, in a state of extreme vascularity, amounting often to perfect hyperæmia; nevertheless we can trace the excretion of blood by the vaginal membrane of the infant to no very evident exciting cause. It has been attributed by Ollivier, of Angers, to the same physiological cause which, in after life, produces the catamenial dischargenature appearing to anticipate, in some degree, the establishment of a function which is fully developed and regulated, only, at a much later period of life. This suggestion would be more plausible were the discharge in the infant, instead of appearing once for a few days, to recur repeatedly at regular or nearly regular periods.

The hemorrhage always ceases of itself, and requires no particular treatment. The preservation of perfect cleanliness by repeated ablutions of the vulva will, of course, be necessary.

The alarm and anxiety which it almost invariably excites in the mother, and those about the child, should be quieted by an assurance that it is unattended with danger. In no instance, so far as we are aware, certainly in none that has fallen under our notice, has any inconvenience resulted from it; nor has it ever continued beyond the first few weeks after birth.

13. Edema of the Prepuce.

The cellular structure of the prepuce, in the male infant, is occasionally the seat of serous effusion, by which this part becomes sometimes enormously distended, and very hard to the feel: in a few instances, we have found the whole of the integuments of the penis to be similarly affected. When the prepuce is at the same time retracted behind the glans penis, a species of paraphimosis is produced, and we have known considerable difficulty to be experienced in the passage of the urine, from the stricture upon the urethra which is thus occasioned. A similar difficulty may also result, when the tumefied parts envelop the glans, from the closure of the prepuce. Ordinarily, how

ever, the intumescence gives little or no trouble, and is unattended with pain or suffering, and generally disappears spontaneously. We have known it, however, to continue for a long time, with little or no abatement.

Although we have arranged oedema of the prepuce among the dis eases occurring within the month, it is by no means confined to this period; we have met with it frequently in children from one to six years of age.

The causes of this affection it is, in many cases, somewhat difficult to trace. It would appear to be occasionally produced by an irritation seated within the urethra, as a stone sticking in the canal, or a small splinter of wood or fragment of straw, introduced by the child. In one case, we saw it produced by a portion of thread that the child had wound round the end of the penis. It is occasionally connected with an erysipelatous affection of the integuments of the penis and scrotum, and not unfrequently we have found it accompanied with an herpetic eruption around the external skin of the prepuce at the point of duplicature.

In some cases it is attended by a discharge from within the prepuce, resembling a strong lather of soap, or the froth of milk. This is evidently caused by the retention of the natural discharges of the part, rendered perhaps more copious from the irritation of the urine, which often fills the cavity of the prepuce before it is discharged externally. The discharge almost invariably disappears as soon as the tumefaction subsides.

In the treatment of this affection, if the tumefaction be not very extensive, and it presents no difficulty or impediment to the discharge of the urine, little else is required than to wash the part frequently with camphorated spirits, and an equal quantity of water, or with two parts of aqua camphorata and vinegar, or to envelop the prepuce in crumb of bread moistened with a weak solution of the acetate of lead. In all cases it will be proper to examine the urethra, and if a stone or other foreign substance be found in the passage, to extract it. If the oedema be very extensive, and the free discharge of the urine is interfered with, the best plan is to slightly scarify the skin at the most depending portion of the tumor, and foment it freely with tepid,

water.

When connected with an erysipelatous inflammation, this should be treated by its appropriate remedies; and in cases in which an herpetic eruption is present, the application to this, night and morning, of a little of the unguentum nitratis hydrargyri, diluted with an equal quantity of fresh lard, we have found to be generally sufficient for its for its speedy removal.

14.-Cohesion of the Labia and Nymphæ.

In female infants, there is, occasionally, an adhesion of either the labia or nymphæ; but much more frequently of the latter. This cohesion may be congenital, or occur some time after birth.

The cohesion of the labia, when present, is easily detected. In some cases it is so slight as to give way upon the mere separation of the

labia; in others, it is produced by a very firm but delicate and transparent membrane, extending across from the inner surface of one labium to that of the other, for the division of which the aid of the knife will become necessary; in other cases, again, the adhesion of the labia is more intimate and extensive, and requires a cautious use of the knife for its removal: finally, there may occur a complete occlusion of the external orifice of the vagina, which is usually connected with a deficiency of some one or all of the internal sexual organs.

In all these cases of cohesion of the labia, excepting the last, the sooner it is removed the better. When there is a complete closure of the vagina from a congenital and perfect fusion of the two labia, nothing should be attempted previously to puberty, unless we are able to determine with certainty that the vagina or uterus is not wanting, inasmuch as the child might otherwise be subjected to a severe and fruitless operation. At the period of puberty, we shall be able to decide with tolerable accuracy, as to the existence or non-existence of the internal organs, and consequently, as to the propriety or nonnecessity of an operation.

Adhesion of the nymphæ is much more common than cohesion of the labia, and requires for its detection a much closer inspection. When the nymphæ cohere, upon the separation of the labia, they are extended in such a manner as to form a flat, continuous covering to the origin of the vagina. By the blood being pressed out of their tissues when they are thus put upon the stretch, they become pale, and scarcely to be distinguished from the surrounding surface; at first view, therefore, it appears as though the nymphæ were wanting, and there existed no vagina. By gradually approximating the labia, however, the nymphæ will assume their usual form and situation; a probe may also be passed behind them, and if the cohesion was not congenital, we may learn from the nurse, that the opening into the vagina was the same, at first, as it is in other infants.

Cohesion of the nymphæ may often be destroyed by the mere separation of the labia; or by a probe being passed behind the coherent nymphæ, and made to bear upon the line of juncture. In some cases, however, the adhesion is so intimate and firm as to require the aid of the knife. Care must always be taken by the interposition of a portion of soft linen, moistened with sweet-oil or fresh lard, to prevent the divided surfaces from again adhering.

Simple cohesion of the nymphæ should be remedied at an early period. The longer it is allowed to continue, the more difficult, in general, does its removal become.

15. Hare-Lip.

It is not our province to enter into a description of the several forms of hare-lip, nor of the surgical operations by which they are to be remedied. The only question in relation to them we propose to notice, is, at what period should an operation be performed. The question will be often put to the physician, and it is important that he should be able to answer it understandingly.

As the deformity is always considerable, a natural feeling on the part of the parents urges them to desire its early removal, and, in many cases, an immediate operation is absolutely necessary, in order to preserve the life of the little patient-the abnormal division of the lip, complicated, perhaps, with a division or deficiency of the bony palate, preventing the child from sucking. Here, whatever may be the risk attendant upon an early operation, it must be encountered, as the removal of the deformity is the only means we have of saving the infant from a lingering death from inanition. If the deformity, however, does not interfere with sucking, we believe it will be better, in all cases, to defer the operation until the child has attained an age when there will be less danger of its inducing convulsions, or other dangerous results, and when also there is a greater chance of its proving successful.

The question, nevertheless, still presents itself, how long is it proper to wait before performing the operation, or, in other words, what is the earliest period at which it may be undertaken, without danger to the child, or of its failure in the removal of the deformity. The end of the first or second year is the time usually adopted for the operation. A much earlier period, however, has been recommended by Dr. Houston, and several cases are adduced by him to prove the resi lience of a young infant, under the operation, and the strength of its reparative powers. The age which the gentleman just referred to considers the best for undertaking it is about the third month. He has never seen convulsions follow its performance at this age, and he knows of no other evil consequences that are liable then to occur, to which an infant a year or two older would not be equally liable.

Dr. Hullihen, of Virginia, is decidedly in favor of operating early. He states that he has operated on thirteen cases before dentition had commenced; three of the patients were only four weeks old. He has, he declares, yet to witness the first untoward event, or the slightest unfavorable indication resulting from the operation when thus early performed. Paul Dubois, in a paper read before the French Academy of Medicine, in May, 1845, adduces his experience in favor of an early operation. He details a number of cases operated on by himself or his friends, at intervals varying from a few minutes to several days or weeks after birth, all of which had proved completely successful. Dr. Dawson, in a paper in the Dublin Medical Press, for 1842, advocates the same practice, and relates two cases, one of a child four days old, and the other of a child seven hours old, in which he operated successfully. Dr. Mason Warren (Amer. Journ. Med. Sciences) has frequently resorted to the operation twenty-four hours after birth, and with better success than in older children. Dr. Anselon (Union Médicale) has been convinced by a long experience, that the practice of early operating is the best. Guersent, the younger, agrees with Dubois in believing that the best time for the operation is immediately after birth; but if this favorable opportunity is allowed to pass by, it is better, he thinks, to wait until the eighth, tenth, or twelfth year. Malgaigne has operated nine hours after birth, on a child with harelip, complicated with a wide fissure of the palate, and of the alveolar