THE SETON IN CHRONIC PATELLAR BURSITIS.

44 cry, running and taking them toys to soothe them. Right flexion, which, I understand, are the great perpetuators of membrana tympani wrinkled as if sodden; tympanic plexus the mischief in these and similar cases. There is, however, another variety of the certain method, visible; left membrana tympani smooth in most parts, which, though it may be said by some that it is neither so opaque behind malleus; no plexus visible. 5th.—Has been busy making the children in the créche elegant nor convenient as the former, is yet as expeditious say " Poor Bob" after her, and shaking them well if they as any, and certainly cannot be surpassed for its certain and failed. Heard street music to day for the first time. satisfactory results. I. allude to the treatment by the seton. 13th.-Tries to say " sugar," " butter." Has tried to reTo enter into a few details. The seton, composed of a peat the names of the things in the ante-room, and to call double silk thread moistened in weak carbolic oil, is convethe children by their names. niently passed through the same cannula which draws off 25th.-Tries to pronounce the names of the things on the the fluid, and in certain circumstances, where the avoidance alphabet blocks when they are repeated to her; much diffi- of pain is urgently required, the ether spray will be found a culty with "viper." great boon. Too small a trocar is not to be selected, or the Oct. 5th.-Can say 11 spoon "apple," "no more,"pretty apertures will be apt to close up and obstruct the discharges. clearly. Went into a shop and asked for 96 apple,"which To have to enlarge them afterwards would be exceedingly she bought. disagreeable. A pad of lint, moistened also with carbolic llth.-When standing with her back to the fire she heard oil, covered with gutta-percha tissue, and the whole secured a cinder fall out of the grate. by a few turns of a bandage, is both agreeable to the patient 14th.—Tries to repeat words’she hears others mention in and helps to maintain the patency of the apertures. The conversation. Was taught the word "moon"a few’ days seton should be drawn every morning, in order to present a fresh portion of it each time to the suppurating interior, and ago, and repeated it on seeing the moon to-day. Nov. 9th.-Talks better; says " Pick that up" distinctly. the pus encouraged to ooze out by frequent and gentle 30th.-Notices the railway whistle. Repeated the words pressure with the fingers. In five or six days the seton may "Jack Frost" after her mother. Calls her doll "Judy," be withdrawn, and after five or six days more of rest the and says "No, you," on hearing the words uttered. patient may he allowed to walk about. Should any conAfter this date I saw no more of the child, as her parents gestion or weakness be left behind, it is effectually overcome removed to Freshwater in the Isle of Wight; but, writing by the local use of the cold douche. on April 16th last, her mother says: "I feel very much Iodine, blistering, pressure, and even simple tapping, are pleasure in informing you that my little girl has very much very uncertain remedies, and their employment in nearly a source of additional annoyance to improved in her hearing, and wonderfully in her talking. every case is merely She can say distinctly all her alphabet, and count her figures both the patient and the practitioner. Tongue, Lairg, Sutherlandshire. up to 10. She will say,Dadda made that,’Mamma gone out,’ ’Tea, please, mamma,’ but she cannot manage more words in one sentence." From Aug. 2oth to Sept. 13th both Allen’s and Politzer’s nasal bags were employed, but subsequently Allen’s alone, SUCCESSFUL REDUCTION OF A STRANGUin consequence of the child’sresistance to Politzer’s. The LATED CONGENITAL INGUINAL HERNIA only additional local remedy was an iodine embrocation apIN AN INFANT FIVE WEEKS OLD, plied, but irregularly, behind the ears. The treatment was obvious enough. She was unsuccessfully treated a year or IN EXTREMIS. two previously, but only during a short period, I believe; and BY J. T. BURGESS, L.R.C.P., L.R.C.S. EDIN. a friend of her mother’s informed me that she had on former occasions attempted to teach her various words, but being WILLIAM S. G-, born April 10th, was the subject of imperfectly heard they were speedily forgotten. From the above report, in which only new manifestations of speech double congenital inguinal hernia. For a month the child and hearing are detailed, it appears probable that had treat, enjoyed good health, and all its functions were properly per. ment been delayed much longer the child would have be- formed. On May 15th, however, the left hernia showed This case also shows come permanently deaf and dumb. of strangulation. Twenty-four hours after the the desirability of watching patients after scarlet fever, to symptoms was taken child ill, I was sent for, and found the scrotum if is their before note hearing impaired, ceasing to attend them. enlarged and bulging on both sides-the penis being reduced . The pathology was evidently moist catarrh of the middle to a mere tubercle ; the abdomen distended, highly tymear, with occlusion of the Eustachian tube ; and when the panitic, and painful on pressure; the pulse weak and quick; latter was kept permanently .open by means of the nasal the bowels constipated, the tongue furred, stercoraceous bag, the fluid gradually escaped, and the structures regained vomiting occurring every few minutes, and the child crying their normal state, though probably some thickening rein a faint exhausted manner ; in short, presenting every mained. The progress was therefore rapid until the fluid appearance of being in extremis. The right hernia was soft was removed, evidenced by the sound becoming dry on the and easily reduced; the left was firm, lumpy, and bright on use of the nasal bag; afterwards the remaining congestion subsided only slowly, though steadily, the order in which the surface, and refused, after a quarter of an hour’s cautious in the slightest. I then had recourse to sounds became audible being apparently, first, grave tones, taxis, to yield like thunder and the rumbling of vehicles, then sharper enemata of soap and warm water, and succeeded in bringing away some fetid, brown, mucoid substance from the lower ones by degrees, ending with the railway-whistle. the The child suffered from gastro-enteric catarrh, due to im- bowel; still the hernia refused to go up. I next got unfortunate little patient into a hot bath, and fomented the but was well in and other respects, proper food, appeared part well with a soft sponge for a quarter of an hour, when, very quick and intelligent. after a few minutes’ careful manipulation, the bowel graSt. Leonard’s-on-Sea. dually ascended from the scrotum. Keeping my thumbs over each inguinal canal whilst the child was being removed from the bath, I applied pads and a figure-of-eight bandage in the usual manner, the scrotum at this time being quite THE SETON IN CHRONIC PATELLAR small and corrugated. Since then the vomiting has ceased, BURSITIS. the bowels have been regularly moved, the abdomen has diminished in size, food has been regularly taken, and the BY J. A. AUSTIN, M.D. child restored to its usual health. Cases such as this encourage us to work against hope, and THERE are two principal methods of treating the disease persevere in the application of remedies even in an infant known as chronic patellar bursitis, or chronic housemaid’s so young and under circumstances so unpromising. Spilsby. knee-viz., the uncertain and the certain method. Of the latter, one variety, I believe, consists in getting rid of the THE FRENCH HOSPITAL.-The new wing of this effusion in the bursal sac, and, by adopting measures for useful institution in Leicester-street was opened this week keeping the knee-joint extended, to prevent the influence of by the Prince accompanied by the I)uke of pressure, tension, or friction involved in the frequent act of Edinburgh. .

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