or other respects. Further, would the use of chalybeates, or other means, ever so invigorate the child as to prevent those placental diseases-such as fatty degeneration-which may possibly be connected with want of power in the fœtal economy and circulation? Could any variety of diet or drug render the maternal blood a more nutritious medium for the child, where the placental disease tended to produce intra-uterine death by marasmus or inanition? The subject is quite open for inquiry, and one in regard to which I know not any very accurate existing data. In all the series of cases which I have adverted to, that is to say, in cases where children of the same mother have died successively from the effects of different diseased states of the placenta, I believe that the induction of premature labor about the seventh or eighth month ought to be a principle of treatment prominently held in view, and frequently had recourse to. This remark especially holds good with regard to all cases and causes of recurrent placental disease; and I think that obstetric authors must add, what no one of them, so far as I know, mentions, the diseased states of the placenta to which I have alluded, as indications for the induction of premature labor, both when they have recurred several times in the same mother, and produced death of the child but a few days or weeks previous to its birth, or even in a first pregnancy, when very distinct symptoms of placental hemorrhage and inflammation have occurred after exposure to injury, and, in addition, the stethoscope shows a state of impending danger to the life of the child. Out of three cases of diseased placenta which have been under my care since the commencement of the present year (1845), in two I induced premature labor successfully, as regards both mother and child, one of the patients having previously lost six, and the other three children. I had thoughts of allowing the third to go on to the full period, but fortunately, natural premature labor came on about the eighth month, and a living child was born. The placenta was so destroyed by inflammatory induration in this last case, that I am sure it could not have served the purpose of a lung to the child for a much longer period. Nature here pointed out strongly, and effected by her own efforts, what ought to be done by art in similar instances. Allow me to add, that the necessity for the immediate induction of premature labor is sometimes shown in these cases by the supervention of lowness and depression, more rarely by the occurrence of irregularity and intermittence, in the action of the fœtal heart as heard by the stethoscope. Hence, in watching and treating these cases, auscultation should be constantly used to ascertain the first advent of this sign of danger to the life of the child. PART VI. PATHOLOGY OF INFANCY AND CHILDHOOD. CASES OF DOUBLE CEPHALEMATOMA.1 THEIR TREATMENT. (From Edinburgh Monthly Journal of Medical Science, April, 1848, p. 764.) DR. SIMPSON showed a child two weeks old, with a well-marked large and defined cephalæmatomatous swelling on each parietal bone, with the hard rim distinct at different points. He had never seen it on both sides except in this case. In this, as in most other cases, the tumors had not been observed till the first washing of the child, having come on, or at least grown greatly, for some hours after birth. The effused blood was already becoming absorbed, and, by leaving the case entirely to nature, a cure would soon be effected. The effusion was between the skull and pericranium. He had watched various cases of cephalæmatoma during the process of a natural cure; and he several times found that a layer of bone is formed on the inner surface of the separated pericranium, which can sometimes be felt distinctly to crackle under the finger like parchment-and, as the fluid gets absorbed, the two plates of bone gradually approximate and come together. Dr. S. believed that these tumors were often mistaken and maltreated, by too active measures being employed. He had now had an opportunity of seeing a considerable number of cases of cephalæmatoma, and he had never seen any treatment required except time and patience. The difficulty in their management generally consisted in keeping the friends and others from doing something or other to them, when nothing in reality was required. 1 Extracted from Proceedings of Edinburgh Obstetric Society, January 12, 1848. DISEASED STATES OF THE UMBILICUS AFTER BIRTH.1 (From Edinburgh Monthly Journal of Medical Science, July, 1847, p. 70.) 1. Fungating Excrescences of the Umbilicus in Infants.-In infants, after the umbilical cord has mortified and dropped off, by a kind of natural "dry gangrene," instead of the resulting raw surface contracting and cicatrizing, I have several times seen large granulations appear, and a red, elevated, fungus-like excrescence, resembling the "fungous testis" of surgeons, form at the bottom of the umbilical depression. These umbilical excrescences in general shrink and slough after a time; or they do so on being touched with alum or other astringents, or with nitrate of silver. In one case, which I lately attended with Dr. Finlay of Newhaven, this simple treatment had little or no effect. The excrescence enlarged to the size of a cherry, which it likewise resembled in color. It was apparently insensible to touch; but blood oozed from its red surface under slight handling. It was cauterized several times with nitrate of silver; but this treatment did not cause it to shrink. At last, after several weeks, a ligature was passed round its base, and in a few days it had dropped off. It did not in any degree offer to return. 2. Secondary Hemorrhage from the Umbilicus.-Occasionally secondary hemorrhage occurs from the ulcerated mouths of the umbilical vessels, at the site of their natural separation, either before the cord is entirely thrown off, or far more frequently some days after this. The blood wells slowly up, fills the umbilical pit, recurs perseveringly, and often leads ultimately to a fatal termination. I have heard of several instances in which this secondary umbilical hemorrhage occurred in more than one member of the same family. It is frequently found combined constitutionally with jaundice, or with purpura; and locally with deposits and disease in the walls of the umbilical vessels. In the way of treatment all internal medication has failed, and local styptics, caustics, cauteries, and compresses, have proved of little, or indeed of no avail. I have known, however, two cases in which the transfixure of the bleeding part with a needle and including ligature-as in harelip-perfectly succeeded; and it seems to be the only plan of treatment on which any dependence can be placed. 1 Extracted from Proceedings of Edinburgh Obstetric Society, April 13, 1847. ON THE TREATMENT OF ERECTILE NÆVI. I HAVE seen many different plans tried for the obliteration and removal of the small erectile tumors constituting the usual form of nævi materni. Latterly, in my own practice, I have been led to place most reliance upon the two following methods, as being at once the most certain as well as the most expeditious: 1. The application of a pointed stick of potassa fusa to the surface and tissue of the tumor, carefully limiting, at the same time, the effects of the alkali by the free use of vinegar. With the potassa fixed in a common caustic-holder, one can easily and satisfactorily destroy the diseased tissue to the required extent and depth in the course of two or three minutes; and the free application of vinegar immediately afterwards, both at once arrests any further destructive action of the caustic, and annuls the sensation of pain and irritation on the part operated on. I have seen a number of both large and small nævi most successfully removed by this plan. But— 2. The galvanic cautery, as ingeniously proposed by Mr. Marshall for various purposes in surgery, has appeared to me a valuable means of effectually destroying some nævi when they occupied such positions upon the eyelids, lips, &c., and could not be very readily or safely treated by the potassa. In some cases where the erectile tissue ran deep, I have sometimes passed the platinum wire obliquely under the skin of the nævus, so as to break up and obliterate its interior structure without destroying much of its cutaneous covering; in other more superficial nævi its direct application to the cutaneous surface is sufficient. In using either the potassa fusa or galvanic cautery, the little patients should be previously anesthetized. PROPOSITIONS REGARDING LOCAL PARALYSIS (From Edinburgh Monthly Journal of Medical Science, January, 1851, p. 92.) 1. INFANTILE paralysis most frequently seems to affect a single limb-as one leg, or more rarely one arm;-sometimes a few fingers only. Occasionally it appears in the form of hemiplegia affecting one whole side; sometimes in the form of paraplegia. I have watched one case in which the paralysis occurred in early infancy, 1 Extracted from Proceedings of Edinburgh Obstetric Society, Dec. 11, 1850. and now permanently affects both lower extremities, the left upper extremity, and the left side of the face. The child, now several years old, is very acute and intelligent. 2. The side of the face, but more particularly the upper and lower extremities, when paralysed in infancy, do not grow in relative proportion with the corresponding healthy parts; so that when the individuals affected reach adult life, the paralysed extremity appears small, blighted, diminutive, and shorter than natural. 3. The paralysed limb does not appear to want sensation, and its motory muscular power, although greatly diminished, is not entirely abolished. When the local paralysis is seated in the leg—the part most frequently attacked-the person usually walks awkwardly and imperfectly, throwing out the foot at each step with a flap-like motion, and often with the toes or external surface of the foot somewhat drawn inwards, as the leg is each time extended. 4. The disease generally comes on during the first three years of life, and especially during the occurrence of that morbidly irritable state of the nervous system which coexists with teething. I have seen an instance in which two children of the same family were affected within a week of each other. 5. Infantile paralysis generally supervenes very suddenly, sometimes in the course of a single night; and it is often, at the time of the attack, accompanied with little or no constitutional derangement; but occasionally it comes on with a fit of convulsions, or other symptoms of temporary cerebral derangement. Sometimes it supervenes after exposure to cold, and with rheumatic pains in the affected limb. Intestinal irritation in some cases appears to be the exciting cause. 6. The affection is frequently first noticed immediately after fever, especially after the eruptive fevers; and occasionally it comes on during the period of convalescence from them. In one case paraplegia came on in a child three years old, during the convalescence from scarlatina-the patient going to bed apparently well, and waking paraplegic, and astonished at her own want of power of movement in both her legs. This patient has now reached puberty, and is so paraplegic as to be unable to stand. 7. When the patients do not recover from the paralysis within a few days or weeks after the attack, under antiphlogistic measures, blisters and careful correction of the condition of the intestinal canal and other functions, the paralytic affection almost always proves chronic, and, indeed, permanent. I have seen counter-irritation to the spine, galvanism, &c. &c., perseveringly employed in the chronic forms, but without much or any success. Small and long-continued doses, however, of nux vomica have appeared to |