lous, was arrested, so that now the case promises to be cured; but the joint will for ever be stiff, and the limb shorter than the other.

G. B., the brother of the above, a handsome boy, with light hair, fine blue eyes, when six years old, had enlargements of the glands in his neck, which were relieved by the treatment resorted to. Two years later he was observed by his mother to limp slightly in walking, but complained of little or no pain. From the caution, however, which had been given to the parent at the time I was consulted about the previous case, to notice at an early period any symptom of this nature in her children, the fact was immediately attended to. The affection was evidently in the hip; there was imperfection in the gait, and pain upon pressing over the hip-joint. A blister was applied, perfect rest to the limb enjoined, and steel medicines ordered; and in a fortnight the motions of the joint were restrained more effectually by the application of strips of soap plaster and a bandage. In three months the child was ordered to the seaside, and eventually was able to walk without the slightest limp or pain, and may be said to be quite well.

I would not say that in the first case, if the disease had been discovered early, and at that time met by judicious medical treatment, a stiff knee and shortened limb would have been prevented, although this is my belief; but as to the latter case, I have no hesitation in saying that, if the disease had not been detected as soon as it was, the remedial measures might have failed, certainly the result would not have been so highly satisfactory as it was.

206

CHAPTER XI.

ACCIDENTS AND DISEASES WHICH MAY OCCUR AT BIRTH OR SOON AFTER.

THERE are many circumstances of more or less frequent occurrence, involving the happiness of the parents, and the present and future welfare of the child, immediately connected with its birth, or arising soon after, of which the attendants in the lying-in room ought not to be ignorant. Thus the child may be born apparently dead (still-born as it is termed), and, unless the most active exertions are made, will be lost. The superintendence of the means used devolves upon the medical man, but it would be often well if his assistants were already acquainted with the measures to be pursued, that they might be carried into effect with more promptitude and success than they now frequently are. It must be remembered that in a rapid labour the child is not unfrequently born before it is possible for medical assistance to be procured, and it may happen in such a case that it is still-born. Again, deformities occur, happily not very often; still, when the event does arise, it is most important it should not be discovered to the mother immediately upon the birth of the child by a sudden exclamation of surprise on the part of the attendants, which undoubtedly will be the

case, unless a hint of this kind is given, and they are put upon their guard; but a fit and proper opportunity must be chosen when the communication may be made tenderly and cautiously, and with the least danger of causing distress or producing excitement. It may be a defect in the bowel or urinary passage, which the nurse only discovers, after a few hours, by the fact of nothing passing through these passages. Now, she is not at once to make the circumstance known to her mistress, but should do so quietly to the medical man, who having given what professional aid the case demands, will exercise his own judgment in revealing it or not to the parent at this time or hereafter. And so at a later period, about the second or third day after the child's birth, an inflammation sometimes attacks the eye, which is of considerable consequence, and the more so from its commencing in a way not calculated to excite alarm. The child cannot express its sensations, and the swelling of the eye conceals the progress of the disease, so that serious mischief is frequently done before the medical man sees the patient. The inflammation is not immediately noticed, and the measures employed are frequently insufficient to check its progress. This causes more blindness (I refer to the lower classes of society more particularly) than any other inflammatory disorder that happens to the eye; and the number of children is very considerable whose sight is partially or completely destroyed by it. The parent or nurse is apt to suppose, when this inflammation first appears, that it is merely a cold in the eye, which will go off; and the consequences which I have just mentioned take place, in many cases, before they are aware of the danger, and before the medical man is resorted to for assistance. These, then, and many

other morbid conditions connected with the infant, will occasionally be met with in the lying-in room, and although one and all will demand the professional attendant's care and management, enough has been said, I think, to prove, that the unprofessional attendants ought to be aware of their existence and possible occurrence, that they may act discreetly as circumstances arise, early call his attention to them, and subsequently carry out his directions with promptitude and exactness.

Sect. 1.- Still-born.

This condition may exist in a greater or less degree: the infant may be completely still-born, with no indication of life, except, perhaps, the pulsation of the cord, or a feeble action of the heart ;-or it may make ineffectual efforts at breathing, or even cry faintly, and yet subsequently perish for want of strength to establish perfectly the process of respira tion. Under all these circumstances, a good deal can often be effected by art. In every instance, therefore, in which we have not positive evidence of the child being dead, in the existence of putrefaction, or of such malformation as is incompatible with life, it is our duty to give a fair trial to the means for restoring suspended animation; and as long as the slightest attempt at motion of the respiratory organs is evinced, or the least pulsation of the heart continues, we have good grounds for persevering and hoping for ultimate

success.

The measures to be employed to restore a still-born child will be a little modified by the circumstances present.

If there is no pulsation - no beating in the cord,

when the child comes into the world, it may at once be separated from the mother. This is to be effected by first tying the navel-string with common sewing thread (three or four times doubled), about two inches from the body of the child, and again two inches from the former ligature, and then dividing the cord with a pair of scissors between the two. And now the means for its restoration are to be made use of, which are detailed below, viz., inflation of the lungs, and perhaps the warm bath. If, with the above circumstances, the child's face be livid and swollen, some drops of blood should previously be allowed to escape before the ligature is applied to that part of the navel-string which is now only attached to the child.

If there is pulsation in the cord, but respiration is not fully established, it must not be divided: and as long as pulsation continues, and the child does not breathe perfectly and regularly, no ligature should be applied. The first thing to be done here, is to pass the finger, covered with the fold of a handkerchief or soft napkin, to the back of the child's mouth, to remove any mucus which might obstruct the passage of air into the lungs, and at the same time to tickle those parts, and thereby excite respiratory movements. Then at short intervals suddenly and forcibly blow on its face and chest. Everyone knows the convulsive gasping which the shock of sudden cold produces. Rub the chest with the hand, and give a gentle shock to the body by slapping the back. A little perseverance in the employment of these means will often establish respiration, and save the necessity of further If, however, they fail, the chest and soles of the feet must next be rubbed with spirits, the nostrils and back of the throat irritated with a feather

measures.

P