attended by convulsions, caused, we may suppose, by a passive congestion of

the brain.

If you practice in malarial districts you will observe that in infants the cold stage is often marked by a convulsion rather than a chill.

It is not unusual for the exanthematous diseases to begin in this way. Both scarlet fever and small-pox are sometimes introduced by fits of so violent a character that life is destroyed before any eruption appears. In some of these cases our knowledge of the cause is conjectural rather than certain; in others it is made certain by the appearance of a characteristic eruption after death. I have also known diphtheria to herald its coming by convulsions. There is no doubt that in such cases the poison of the disease shares with the cerebral hyperemia in producing the result, for in other instances spasms ensue from deleterious substances circulating in the blood, as after large doses of opium, veratrum-viride, aconite or belladonna.

You may note it as an interesting fact, that cerebral anaemia as well as hyperæmia may be a cause, opposite conditions giving rise to the same symptoms. Large losses of blood and exhausting diarrhoeas, that rapidly render the brain anæmic, not seldom lead to convulsions.

Furthermore, you may very often find the cause in an overloaded stomach. One day I was hurriedly called to the Fifth Ward to see a suckling whose father had fed it, in the mother's absence, with hard-boiled eggs. Two terrific fits were the result, but after a vomit it was as well as ever.

Worms, especially the lumbricoid and ascarides, sometimes excite eclamptic spasms, but not nearly so often as the laity think. "Worm fits" is an old phrase that is still used much more frequently than there is any actual warrant for.

Strong emotion is an occasional cause. Many a child has been "scared into fits." Outbursts of passion have had the same effect; sudden injuries also, partly through pain as well as fright.

There have been many instances of nurslings being thrown into spasms through disturbances of the maternal system by anger and inebriety, and the onset of acute diseases as also by the return of the menses.

I must not forget to mention the fact that all serious disorders in children are in their latter stages liable to this symptom. The physician learns to dread late convulsions. They show that the disease has made a profound impression upon the nervous system, and they are very apt to precurse a fatal termination.

I could mention other causes, but I have said enough to convince you that almost any disease or accident may in some children lead to convulsions. And you will be more fortunate than I have been if, on some occasions, with your best efforts you do not fail to ascertain the cause.

The liability to eclampsia-for such is the name often employed to designate convulsions--is not the same at all ages or in all children. I think you will find it most frequent during the second and third years, though many older children are not strangers to it. Many escape altogether, though exposed to the causes that produce it in others. Some children I have known to have a convulsion with the onset of every trifling ailment. A highly sensitive and nervous temperament is favorable to their appearance, and temperaments are inherited; so

that eclamptic seizures are common among the children of some families; rare in others.

You will naturally ask if there are any prodromal symptoms-symptoms that herald an approaching attack. Occasionally there are appearances that may give an inkling of what is to happen. Such are twitching of the facial muscles and grinding of the teeth in sleep; waking suddenly in fright; strong flexion of thumbs and fingers; drowsiness in the day and unusual petulance on being disturbed. The smiles or "angel whispers" of sleeping infants are but the contractions of certain facial muscles in response to some irritation of the nervous system. Timely attention to these phenomena may ward off an attack of general convulsions.

But many times there are no premonitory symptoms whatever, and the child leaps at one bound from full health into a terrific fit.

Not all cases are so severe and frightful as the one I have described. The seizure may be so light as to seem scarcely more than a transient nervous perturbation. Sometines only one side of the body is affected; and, indeed, when it is bilateral, one-half is usually more convulsed than the other. Grinding of the teeth, rolling of the eyes and flexion of the digits are but convulsions in miniature.

The fits are variable in number and duration. Often there is but one; sometimes there are many following hard on one another. A single one does not last more than three, or five, or ten minutes as a usual thing; exceptionally for half an hour. In one case that occurred in my practice some years ago, a lusty boy was taken suddenly in the morning and was in strong convulsions, with an occasional remission but no intermissions, for twenty-one hours, when he died. This was one of the cases in which I was entirely unable to ascertain the cause.

Whether light or severe, a convulsion is but a symptom, and your prognosis will always depend on your conviction as to the nature of the cause. If there is progressive cerebral disease there is small ground for hope. If the cause is trivial and transient, as teething or indigestion, the outlook is hopeful however severe the spasms may be. Occurring at the outset of acute febrile diseases, they are not to be regarded as of unfavorable omen, though some rare cases of variola and scarlatina must be excepted; but occurring in the course of and especially near the natural termination of these disorders, the outlook is serious, and experience will teach you to be chary of strongly encouraging words under such circumstances.

There are remote as well as immediate dangers from eclamptic fits. Paralyses of various parts may remain, though these are not usually, I think, permanent. In such cases we may presume that some lesion of the brain, as hæmorrhage, occurs as the result of the convulsion. Some children are left in a lasting condition of semi-idiocy. In my own practice a promising girl was taken in strong convulsions in the middle of the night. For some time after, they were often repeated, leaving her in a giddy and unbalanced mental state, which time has not improved. In another case, in which the fits were equally without forewarning or apparent cause, the power of

speech was for a long time nearly gone. In that respect the patient has improved, but she is still of a spiteful temper, and given to fits of ungovernable passion.

Regarding treatment, I have some things to add to what I told you at the outset. "Forewarned is forearmed." When your attention is asked to an infant that has premonitory symptoms-jerking tendons, fixed thumbs and fingers, half-open eyes, grating teeth, etc., that is your opportunity for forestalling trouble. Give a cathartic as a grain or two of calomel with magnesia, or three grains of hydrargyrum cum creta with castor oil; give a hot mustard foot-bath, and a dose of bromide or valerian at bedtime, repeating as there may be occasion. If the bromide alone will not control these symptoms, I would combine chloral with it in quantities of from two to five grains.

If you find hot and swelling gums over advancing teeth, use the gum lancet as I shall direct when I talk to you of dentition. I have known great apparent relief from this little operation.

Fits so often result from disturbances of digestion that you will naturally inquire if the child has eaten of improper articles. But whether you find a cause in dietetic errors or not, if the abdomen is tumid, the tongue coated and the breath offensive, you are justified in resorting to purgatives. I know of none better for this condition than those above recommended. One grain, or even a half grain, of calomel well rubbed with sugar frequently acts very happily.

Bearing in mind the possibility of worms as a cause, I am much in the habit of combining santonine in a suitable dose with the above laxative, or giving it with castor oil.

Though not appropriate in most cases, though even harmful in some, there are occasions when opiates are of the utmost service in warding off convulsions. I refer to cases of cerebral anæmia from loss of blood, or profuse diarrhoea, attended with pale features, and, if the child is under one year, with a depressed fontanelle. Severe pain also affords an indication for their use. In a drop of laudanum or its equivalent of paregoric with brandy or bourbon and the hot bath, you will find, I think, your best safeguards.

The diet of children subject to fit should be carefully attended to. It ought to be nourishing, but plain. Milk, bread, oatmeal and potatoes, with lean meat now and then, should be the staples. Occasions of excitement, anger and fright should be avoided. There should be daily exercise out of doors, and a daily cool bath. Attendance on school had better be deferred until the health is completely re-established.-Archives of Pediatrics.

RECENT METHODS OF TREATING COLD ABSCESSES.-Professor Billroth, of Vienna, writing on the above subject (Medical Press and Circular, January 16, 1884) says: When we turn our thoughts to a cold abscess we must first of all place before ourselves the questions, Why is not the contained fluid absorbed ? and why are we compelled either to await its opening or open it ourselves?

Exudations that arise in the course of acute inflammations, or transitory disturbances of circulation, are indeed usually absorbed; if the general condition of the body is in other ways normal, the absorption of the fluid is the ordinary

process. If you have a clear conception of the arrangement of the lymphatic vascular system you will comprehend this, for the lymphatic vascular system sucks up all these exudation products like a sponge, and carries them all back into the blood channels. Under what conditions, then, does this resorption fail to take place? 1. You may say first that absence of open lymph vessels is a very important cause, and that is just the case with the capsule that in the course of time forms around these abscesses. The walls of the veins can, it is true, take up some of the fluid, but it is the open lymph vessels that are most concerned in such absorption. But even when such open lymph courses are present, that may become closed under certain circumstances, as by an exudation that becomes clotted, in which fibrine forms quickly, and in which the clotting may be continued into the lymph vessels, or into the interstitial structural interspaces. This is the case to a great extent in croupous and diphtheritic exudations. 2. The resorption is dependent on the degree of concentration of the fluid. If the fluid is to be resorbed, its concentration must be less than that of the blood. That is not the case in cold abscesses. Moreover, the various regions of the body show great differences in their power of resorption; the pelvis is the most favorable for resorption; the most unfavorable is the pleural cavity. How can we overcome these difficulties therapeutically? 1. The first method would be by the removal of the fluid, but experience teaches that the fluid may be removed for the moment, but that the exudative property of the structure does not cease; on the contrary, the cavity refills with uncommon rapidity with pus, this refilling being principally caused by the fact that by the removal of the fluid the vessels in the abscess walls are subjected to a greatly reduced pressure. 2. Is it possible by certain irritating agents to excite a greater vascularity in the walls of the abscess? With this object in view tincture of iodine has been injected, for the purpose of exciting an inflammation, whereby an exudation is certainly set up, but which, in consequence of the higher vascularity thus induced, is readily absorbed, with the result that the cavity shrinks up. 3. This method was succeeded by the opening of the abscess under strict antiseptic precautions. Not only is the pus evacuated, but the abscess cavity is carefully scraped with the sharp spoon, after which an antiseptic dressing is applied. In this way the walls of the abscess, which consist of a mass of soft granulations, are removed as far as the healthy tissues, whereby, by means of a light compress, healing by first intention has been achieved. Indeed, by this method good results have been obtained in many cases, but it is one that requires to be carried out with great accuracy. Since the introduction of iodoform we have strewn the scraped-out cavity with iodoform in powder, and brought the edges together with the exception of the openings left for drainage. By means of iodoform, sepsis is to a great extent avoided, and under certain circumstances granulations may spring up under which healing rapidly takes place. 4. Quite recently we have attempted another method, namely, puncture of the abscess, and subsequent injection of an emulsion of iodoform, consisting of ten parts of iodoform to one hundred parts of glycerine. The emulsion must be well shaken up before using, and then, according to the size of the abscess, twenty to thirty

grammes are to be injected. In most of the cases in which this method has been attempted the course has been free from reaction, only moderate swelling has taken place, and but little pain has been present. This, however, would only indicate that the treatment has done no harm; it is also desirable that it should bring about the shrinking of the abscess, and that the fluid remaining in the cavity should be absorbed. As a matter of fact, the results in some cases were exceedingly favorable, but further experience is necessary to show whether the iodoform emulsion is still to be continued. Generally speaking, I should advise you, unless there should be some reason for it, not to open the cold abscess, but to allow it to open spontaneously, especially if you cannot watch over your patients closely. You can then calculate with certainty that the pus will escape without fever and without further reaction, whilst at the same time the entrance of air is completely avoided. In such cases the mechanical relations are extremely favorable, even wonderfully so, without our being able to give an explanation of them; for it happens, for example, that an abscess bursts into the bladder or rectum, and in such cases I have never seen urine or intestinal gases enter the abscess cavity. Under strict antiseptic precautions, and under your constant supervision, you may open the abscess, especially if you suspect with some certainty that you can easily reach the bone from which the abscess springs, or if it causes by its great expansion compression of the neighboring structures, and in consequence of this gives rise to various difficulties.

ORIGINAL CORRESPONDENCE.

To the Editor of Gaillard's Medical Journal:

15 RUE CAUMARTIN, PARIS, May 31, 1884. DEAR DOCTOR: The oldest of the physicians of Paris is Ricord, with whose name and works the medical world has so long been familiar. He has already passed his eightieth year, and yet he devotes himself persistently to professional labor, with a heart as buoyant and a brain as clear as in the prime of manhood.

Although still wedded to his specialty, he is emphatically a great physician, and as a consultant he has few equals and no superiors. Having frequently had occasion to avail myself of his counsel and assistance, I have invariably been impressed by his skill as a diagnostician, his profound and comprehensive knowledge of medicine, and the richness and variety of his supply of remedial agents, together with the urbanity of his manner and the kindness of his heart.

He is, as you know, a native of Maryland, and his attachment to the country of his birth, and his regard for his compatriots, have undergone no abatement during the long and eventful years which have elapsed