[Of nineteen males and fourteen females who died of cyanosis in London in 1849, nineteen males and eleven females died in the first year; of the three remaining

females, one died in the second year, one in the fifth, and one in the twenty-fifth /Y

year.-P.H.B.]

The cyanosis of infants, which thus depends upon the communication

of the cavities of the heart and of the admixture of the two streams of blood, is a disease which time alone can cure, in consequence of the efforts of nature, and if the obliteration of the foetal openings takes place so as to effect this. Consequently there is no motive to make use of any active treatment. It is simply necessary to regulate the test p

regimen of the children, to allow them only to suck every three hours, not to confine them in too warm an apartment, not to toss them about violently, and if they live, not to excite their joy by sudden and fatiguing means. They must not, however, be allowed to get chilled, for it is known that they have a great tendency to chilliness. Moreover the bowels should be kept free by means of slight purgatives administered at frequent intervals.

4TH. ON HYPERTROPHY OF THE HEART.

This lesion is very rare; Billard has reported two examples of it under the name of passive aneurism of the heart. One was observed in a child two days old, which died from pneumonia, with an enormous dilatation of the right ventricle, of the right auricle, and hypertrophy of the left ventricle. The other example took place in a child five days old, which had at the same time an aneurism of the ductusit. arteriosus. A precisely similar case has been observed by Baron. Hypertrophy of the heart has also been remarked by M. Cruveilhier in a child of five days old, born in the eighth month of pregnancy. The disease was congenital. It was an aneurism of the right cavities of the heart with obliteration of the orifice of the pulmonary artery.

The following is a still more curious case which occurred at the Hospital of St. Antoine, and which permitted the child to live until the eighth month; it is an example of hypertrophy of the ventricles with communication of the cavities of the heart and displacement of the aorta, which opened into the ventricles. It has been communicated to me by M. Thieberge.

Case. The patient, Joseph Paihrel, eight months of age, was admitted the 22nd of March, 1851: No. 8, St. Paul's ward, and he died the 13th of the following April.

During the first five months of his existence he enjoyed pretty good health, took the breast well, did not cough, but had occasional attacks of suffocation. Since three months he has often had dyspnoea; the attacks of suffocation have been more frequent, and emaciation has come on.

Since the 22nd of March the digestion is good; the child sucks regularly.
From the 10th to the 13th there was an abundant greenish diarrhoea.

BB

The face is habitually pale, the child is not subject to syncope nor to coldness of the extremities. The pulse is frequent, regular; the beatings of the heart are frequent, tumultuous, they are not accompanied by any abnormal sound; there is no cyanosis.

The emaciation has not increased. Nearly every day, without an appreciable cause, the child is seized with an attack which lasts from some minutes to one hour, and is characterized by great dyspnoea, very violent pulsations of the heart, blue countenance, livid lips.

The child died on the 13th of April, at eleven o'clock in the evening, from an attack of suffocation.

Autopsy. April 15th, 1851, at nine o'clock in the morning.

The heart is very large, three and a half inches from the base to the apex, ten inches in circumference at the base.

The auricles and ventricles are distended by clots. The walls of the auricles are thickened, those of the ventricles are hypertrophied; they are .39 inch in thickness. The septum of the ventricles is 1.17 inch in height and half an inch in thickness at the apex of the heart.

On introducing a probe into the fossa ovalis it penetrates into the auricle of the opposite side, by the orifice of the foramen ovale, which has a diameter of .39 inch. The septum of the ventricle diminishes in thickness from the ventricular cavities to their base; it ceases to exist at about .78 inch from the inferior wall of the auricles, thus interposing between the two ventricles an abnormal orifice of .78 inch in diameter.

The pulmonary artery does not present any alterations in its valves; it has the consistence of an artery.

The aorta at the base of the heart and at its exit from the left ventricle is half an inch in diameter; this artery enters normally into the left ventricle.

In consequence of the incomplete development of the ventricular septum, the aorta is observed across the two ventricles. It corresponds on one side to the left ventricle, and on the other penetrates into the right ventricle by the side of the tricuspid valve.

The sigmoid valves are healthy.

The auriculo-ventricular valves are in a normal state.

The thymus is very small.

The lungs are collapsed, slightly congested, and on insufflation assume their normal volume and appearance.

All the cases of hypertrophy of the heart to which I have just referred are the result of vices of conformation, and have their origin in intra-uterine existence. Here is one of the most curious, and one which probably developed itself after birth. The following is the extract of the case.

A little girl, eight and a half months old, was admitted into the Necker Hospital for a long standing pneumonia; she died at the end of ten days.

Besides the numerous alterations in the pulmonary parenchyma, numerous adhesions of the pleura were observed, and the pericardium was enormously distended in order to contain the heart, the dimensions of which were considerable.

This organ was above times the size of the fist of the subject.

The walls of the ventricle were considerably thickened, and the ventricular cavity very much diminished. The orifices were free.

The right ventricle did not present any thickening of its walls, nor any alteration in the diameters of its cavity. It was then, as may be observed, a concentric hypertrophy of the left ventricle.

The symptoms which would lead to the diagnosis of this disease were, on one part, the enormous projection of the precordial region, and the rhythm of the beatings, which were rather strong but slightly resounding, and rather distant to the ear. They were, besides, difficult to make out, on account of the respiratory bruit and the movements and cries of the child, who was much agitated by the examination to which it was subjected.

5TH. ON PERICARDITIS.

In young children inflammation of the pericardium is more common

than the other inflammations of the heart. It is not less difficult to discover during life. It is scarcely to be recognized except in the dead body.

Billard, who has observed seven well characterized cases of peri- CLA in carditis, considers this disease as the result of the too great activity occurring in the functions of the heart at the time of the establishment of the independent circulation. I have seen one case in a child one'

month old, who died of erysipelas and peritonitis. M. a chore bag one hund has observed another case in very analogous circumstances; the child had old. at the same time a peritonitis and a double pleurisy.

When the pericarditis is exempt from the complications I have just "heesh! pointed out, when it exists alone, the children, according to Billard, appear to experience acute pains, they utter a distressing cry, the le respiration is obstructed and sometimes suffocating; the countenance pinched; the muscles of the face appear to be continually contracting. Sometimes the limbs are agitated by convulsive movements.

Notwithstanding these phenomena, Billard is rightly of opinion, that it is difficult to diagnose the pericarditis of infants. The pulse, percussion, and auscultation do not furnish any special character; and as the children die very rapidly, the diagnosis can only be formed

from the autopsy.

2

In the children who die, a sero-albuminous and sanguinolent effusion, t whitish flakes adherent to the surface of the heart, and very slight adhesions between the two layers of the covering of the organ, are observed in the pericardium.

The pericardium and the surface of the heart are the seat of a more or less considerable injection numerous petechiæ, and of adherent false membranes which are sometimes very compact.

It is a very serious disease, and one which there is reason to believe. is always fatal.

1ST. ADHESION OF THE LIPS. CONTRACTION OF THE MOUTH. Absence of the buccal cavity, astomia, has been observed by M.

Entirely Laroche in cases in which the bones of the face are arrested in their development, and especially when the lower jaw is wanting. It is abs an incurable deformity, and the child which presents it very soon dies. vist ab. A small irregular opening which will scarcely admit the quill of a pen sometimes exists in the place of the mouth. The buccal cavity

Inf. May is regularly formed and the adhesion of the lips is the sole cause of

its occlusion. It is a morbid process accomplished in the mother's womb, a greater or less time previous to birth.

artificial mouth should be made by

a properly directed incision, and the operation is successful if there is no contraction and induration of the lips.

When the mouth is well formed, the lips soft, supple, and only united by slight adhesions, a simple incision by means of scissors will suffice to reestablish the orifice of this cavity.

2ND. MUCOUS TUMOUR OF THE LIP.

A congenital disposition of the lips which is characterized by the presence of a mucous tumour, situated on the internal surface of these cus parts, is especially observed in the upper lip.

This tumour, of oval shape, directed transversely, causing a more Junuz or less considerable projection, only appears at the time the mouth is opened, and has a very unprepossessing appearance. This tumour

increases the size of the lips, exposes them to fissures and ulceration of

under the influence of the winter's cold. It should not be left, and

its removal by a cutting instrument should be recommended to the

parents.

The proceeding for its removal is very simple; we should waiti until the age of six or seven years before it is put in force. The excision of the tumour should be made with curved scissors, while theu Chu an assistant holds the lips apart, and the wound should be dressed with charpie moistened with the hæmostatic water of Tisserand or of Brocchieri.

3RD. ON HARE LIP.

The name of hare lip is given to the congenital division of the lips. It is a defect of conformation. There is, however, an accidental hare lip which results when the edges of the traumatic division of the lips have separately cicatrized each on its own side. I shall not treat of this here, but shall solely confine myself to the congenital hare lip, a very common lesion in infants.

Old

Congenital hare lip is the result of very obscure causes, the action of which is very hypothetical. It may be the consequence of animat acute moral impression. Thus M. Moulin relates that a woman in LE the fifth month of her pregnancy, was much startled by the sight of a hare which her husband skinned in her presence. During the last months of pregnancy, her imagination presented to her this skinned hare, and she did not at all doubt but that her child would be subject to a hare lip. She asserted it to her medical attendant, and the prediction was verified by the event. M. le Professeur Roux has observed a precisely similar fact.

Hare lip is sometimes hereditary; Blaudin and MM. Morel and Demarquay have reported some examples of this.

Whatever may be the nature of these moral or hereditary impres

by