not dwell on it, but simply state that there appeared little doubt concerning the nature of the disease.

M. Demarquay thought that success had been due to the absence, in the tumour, of the nervous element, formed, in most cases of hydrorachis, by hernia of the spinal marrow.

M. Larrey related that M. Laborie, in a work published in 1845,* has alluded to hydrorachis, and has pointed out the indications which may allow us to have recourse to surgical treatment; he has also pointed out the mobility of the tumour, its transparency, and the natural structure of the skin as favourable circumstances; and it may be remarked, that in M. Chassaignac's patient, all these characters were met with.

The following, moreover, is the table, as it has been published by M. Laborie:

To resume-all operations put in force, in case of hydrorachis, present great danger and great difficulties. They generally induce acute inflammation of the sac, and soon afterwards rachidian meningitis. It is the latter disease which causes death.

[A case of spontaneous cure of spina bifida by rupture of the sac is related by Dr. Nance. A girl about thirteen, in whom a tumour, situated at the juncture of the lumbar vertebræ and the sacrum, had increased from the size of the end of the thumb to that of a quart measure. All whom the mother consulted in the child's * Annales de la chirurgie fraise; Paris, 1845; t. xiv, p. 272.

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Book II, Chap. VII.] ON FACIAL HEMIPLEGIA.

Spontane

infancy refused to meddle with it, believing that doing so would hasten a death they” regarded inevitable. However, the child, though rather delicate, continued to grow, ous curi with the use of all its limbs; the prominence of the tumour being visible, externally, through all her clothing.

After an attack of measles, the skin over the tumour became inflamed, and eventually sloughed, and an immense quantity of straw-coloured fluid came gradually and constantly away, the patient being exceedingly exhausted, as if from hæmorrhage. External and internal stimuli were freely administered; and after the slough had entirely given way, the whole of the matter had been discharged, and a healthy purulent secretion had replaced the gangrenous one, she recovered. The remains of the sac gradually contracted, and there is only left a semi-cartilaginous lump, the size of a walnut, acting as a protective covering where the bone is deficient. Two years have elapsed, and the girl has become a healthy and active young woman.— American Journal of Medical Science, vol. xl, p. 552.-P.H.B.]

CHAPTER VII.

FACIAL HEMIPLEGIA.

The facial paralysis of infants is a disease of the seventh pair, caused by the compressive action of the forceps, or by a contusion of the face against a projecting part of the bones of the pelvis.

M.M. Vernois, Smellie, Paul Dubois, Danyau, Landouzy, and Jacquemier have met numerous instances of it.

It is not always easy to discover the facial paralysis of infants, for it causes little deformity. During repose, the symmetry of the face is scarcely altered, and the half-closed eye seems to be the only characteristic of this disease. But the same is not the case at the time of

the child's crying. The features are distorted, the commissure of the lips drawn towards the healthy side, and suction is very difficult.

However, the paralysis is soon removed, and usually disappears at Causes

the end of a period varying from two days to six weeks.

The uvula and the tongue are not affected by the paralysis Comp

(Landouzy), and their sensibility is preserved.

This paralysis has as yet only been observed on one side of the divul1: face; perhaps it may one day be seen to occupy both sides; this is not impossible, since Smellie has already seen it extend to the upper limbs. M. Danyau has also seen a very curious case in which, with paralysis of the face, he observed paralysis of the arm of the same side. A young primiparous woman, with albuminuria, was seized at the end of gestation with violent attacks of convulsion. After the t third attack it was discovered that the os uteri was sufficiently dilatable to allow the introduction of forceps. The child presented itself by the head in the right posterior occipito illiac position, the movement of rotation not being performed. With much difficulty the blades of the

While

forceps were applied laterally, and by means of rather forcible tractions the child was removed face forwards.

It did not breathe, but it was reanimated by insufflations; paralysis The Same of the left facial nerve was discovered, and paralysis of the left arm besides; the paralysis was nearly complete in the whole limb, motion was only involved, sensation being left intact.

In examining the child, it was discovered that the extremity of the right blade of the forceps had extended beyond the base of the jaw, and had left an impression in the subclavicular triangle, exercising a rather powerful pressure on the course of the brachial plexus, so that a small eschar formed and afterwards became detached.

The child died several days after birth. On the post-mortem examination, there was discovered an effusion of blood near the origin of the brachial plexus. From this point to the external edge of the scaleni, the branches which joined to form the plexus presented a sanguinolent tint which did not disappear on friction.

Beyond the scaleni, at the axilla, the nerves were without colour as in the natural state. The nervous tissue otherwise presented its normal constitution throughout.

The facial nerve also presented an extravasation of blood at its exit from the stylo mastoid foramen.*

In this case the paralysis was evidently caused by the compression of the blades of the forceps, as is elsewhere observed in all the cases of this kind.

[Dr. Weber remarks, that occasionally children live for some time with more or less complete paralysis of one half of the face, or they may entirely recover from it. The cause of it is an extravasation of blood, which his dissections have revealed to be situated between the arachnoid and the dura mater.-Op. Cit., p. 35.

Dr. West observes that the facial hemiplegia is quite independent of any injury of the brain, and is the result of injury to the nerve from application of the midwifery forceps, or as has in one or two cases been observed, from injury received during the passage of the head through the pelvis, without any instruments having been employed. In the only case of the kind which came under his observation, the distortion of the face, though very great at birth-one eye being wide open, and the corresponding side of the face powerless, so that the child was unable to suck— had already greatly diminished within forty-eight hours, and had quite disappeared within a week.

A child having been recently admitted with facial paralysis from exposure to a current of air, occasioned Professor Romberg to remark, that paralysis of the facial nerve does not manifest itself by exactly the same character as the adult ; for while, in the latter, the constant play of the features exhibits continuously the want of symmetry in the two sides of the face, this is only observable in the infant when it screams, or its emotions are otherwise excited. In the adult the forehead is more or less wrinkled, but its smooth state in the child prevents its two sides being so remarkably contrasted as they are in the adult. If the child be examined during a state of calm, nothing remarkable is observable in his * Union Medicale, 1851.

countenance; but if we make it cry, the deformity of the lineaments is seen, since the mouth is drawn to the left and upwards, while the right eye is not closed. The parents state, that in sleep this eye is almost entirely closed, which is an important point, signifying that the nervous directing power is not completely abolished, as in complete paralysis the eye remains open during sleep. The collapsed condition of the alæ nasi is not observed as in adults, and it is only when the child sneezes that we can remark it, as upon the palsied side the peculiar motion which this action calls forth is wanting. M. Romberg has sometimes seen such paralysis spontaneously cured, after he has abandoned the use of remedial means for weeks. Still we must not rely on this, since, as a rule, the hope of cure diminishes with the prolonged duration of the case. When general symptoms, calling for treatment, are not present, a blister should be applied to the angle of the jaw, and from one twelfth to one third of a grain of strychnine applied endermically daily, the palsied parts being treated by friction with flannel and "nervine" ointment.—Journ. fur. Kinderkrank; xv, p. 125.-P.H.B.]

Facial hemiplegia usually terminates quickly in complete recovery. The child should simply be laid on the non-paralysed side, the light kept from that eye which does not close, and the feeding bottle should be used if the child does not readily take the breast.

When the paralysis is prolonged, the skin should be rubbed with stimulating liniments, small flying blisters should be applied on the face, over the situation of the facial nerve, and galvanism employed.

CHAPTER VIII.

PARALYSIS OF THE DELTOID.

Paralysis of the deltoid is a rather rare accidental disease, which M. Jacquemier has observed, and of which he has related an instance in his work on midwifery.

Besuch

&covery

A strong and well constituted child, born after a rather long and Caus difficult labour, presented to the persons charged to take care of it, a difference between the two upper extremities. M. Jacquemier ressu examined it. The two arms were equally well developed, but the right was as if pendant, and kept itself close to the trunk; the shoulder appeared a little flattened and less rounded. The arm, when raised, fell back inert, contrasting with the opposite limb. The movements of the hand and of the fore arm were freely exercised, but the arm itself could only be moved a little backwards and forwards. M. Jacquemier at first thought this paralysis of the deltoid a abini congenital disease, but he soon changed his opinion from the progress of the disorder, which disappeared completely at the end of twenty o days. He considered this accident as fortuitous, and attributed it to the compression of the axillary nerve against the humerus, at the spot where it is applied to the deep surface of the deltoid muscle.

CHAPTER IX.

ON PHRENO-GLOTTISM-SPASM OF THE GLOTTIS.

Phreno-glottism is a convulsive and intermittent disease of the glottis and diaphragm, characterized by short attacks of suffocation, returning at very variable intervals.

This disease has been sometimes incorrectly called goitre of infants;* thymie asthma or asthma of Kopp, from the name of its first observer; lanyngeal asthma, infantile asthma, cerebral croup, spasm of the glottis, &c.

Although this last name has been adopted by M. Hérard, as the title of his excellent work, it is objectionable, because it has the * Goitre in new-born children. The goitre of infants is a rather frequent but not generally known disorder. The children who are attacked by it are strong and of good constitution, so that the enlargement of the gland is often regarded as a fold of the skin charged with fat; at other times the neck merely presents a slight enlargement, and in some cases the goitre is not at all visible.

This disease may occasion disturbance of the respiratory functions capable of causing death in some hours, or two or three days after birth.

These children appear to have great difficulty in respiration. The respirations are deep, noisy, and jerking; expiration is also sometimes very difficult, often accompanied with tears. Sometimes the respiration appears to become arrested, and the child is seized with suffocation, when a fresh inspiration, followed by a cry, restores it to existence. These symptoms reappear at variable intervals.

Moreover, the bluish colouration of the skin and of the lips, as well as of the mucous membranes, coldness of the extremities, anguish of the countenance evinced by great agitation of the ala nasi are constantly present.

Suction is difficult or impossible, the child can neither suck nor drink, its mouth becomes filled with saliva and mucus, and it soon dies asphyxiated.

The goitre of new-born children is the result of hypertrophy of the thyroid body without change of texture; the gland is only more vascular than natural. The hypertrophy sometimes affects the entire gland, which then assumes a half moon form; sometimes the two lobes are united by an isthmus, and then the neck is enlarged; or, lastly, it only exists on one lobe alone. It is especially when the two lobes are hypertrophied that compression of the trachea and of the oesophagus results, which prevents the entrance of air and of liquid.

Goitre is hereditary, a circumstance which has also been assigned to lanyngeal asthma. Moreover, the knowledge of the organic alteration which determines the symptoms just related may throw some light on lanyngeal asthma, spasm of the glottis, thoracic asthma, &c., diseases which produce analogous effects.

The author had recourse to leeches and emetics, and recommends the use of iodine internally and externally when the symptoms are less violent, and when the progress of the disease leads to the hope that medicine may have time to act.Fred. de Betz. (de Tubingue) Gazette des Hôpitaux; Juin 21, 1851.