be a low continued cry which is almost a moan; but this cry occurs too late to be of any special value. Short violent cry may be due to several factors: in the apparatus used in nursing) or that nursing caused pain. The cry of acute gastro-enteric infection is of a restless type, with intervals during which the infant sleeps quietly, but these last only a few minutes. In pneumonia the cry is apt to be short and catchy. In meningitis we may encounter a sharp, piercing, nocturnal cry, but this is true also of chronic bone disease. In marasmus there is a continual (a) Increased upon pulling at the ear or by movements which affect the head suggests the probability of inflammation of the ear. In the presence of an acute inflammation of the ear the mere act of sucking will cause pain and this type of crying. whine; the child is seldom at ease. There is usually some elevation of temperature. (b) With a shrill character and following or associated with the act of coughing or sneezing, it points to acute pleurisy. (c) When very piercing in character, very sudden in its onset, and almost simultaneous with the act of vomiting and associated with marked prostration quickly following, it should lead to an examination. for intussusception. (d) While in a somnolent condition it is evidence of hydrocephalus or hydrocephaloid. (e) Occurring during defecation (due to actual pain) or just previous to the act (dread of pain), and associated with persistent constipation, it is almost certainly due to fissure of the anus. The same thing happening during the act of urination indicates that there is a spasm of the bladder, the passing of some fine calculi, or it is occasioned by phimosis. The administration of appropriate treatment quickly clears up the first, the examination of the diaper shows evidence of the second, and examination of the penis clears up doubt as to the latter. Crying which occurs only when food is offered would indicate that the child was unable to nurse (and this might be due to causes in the nose or mouth or to faults If the infant cries when it is handled and at other times seems to be comfortable, it is indicative of infantile scurvy. Any vigorous crying, no matter what its type, would immediately exclude such dis eases as atelectasis, advanced peritonitis, pleuro-pneumonia, or croup. And so if I had time, I might go on and mention many things which are great aids to the examiner who is alive to the eloquence of the infant. And when we come to consider those indicators of the pathological condition; indicators which are not subject to the infant's will or choice, their name is legion. Even though the eloquence of the infant moves the mind to a clearer appreciation of the disease present or impending, and observation seems to indicate that a certain pathological process is present, the attitude of the physician should be two-fold. First, for the infant's welfare, the deductions drawn from observation must be confirmed by the most careful examination. And, second, having drawn a conclusion, the physician for his own good, should question himself as to why he arrived at such conclusions. This double examination must surely act as a stimulant to personal endeavor and the finer appreciation of disease in the infant. As physicians living in an age when scientific achievement and activity seem to be at their height and when the whole medical world is alive with the stimulating expectancy of impending discovery, we are prone to be negligent of the smaller things. And yet this may be said to be one of the great dangers of a medical career; the trusting in special occasions. We are apt to think that conspicuous occasions, unusual experiences with disease and the wrestling with big problems have most to do with the advancement of our profession. In this we are wrong. The commonplace day, the doing of the ordinary things, the regard for everyday experience; these are the things which try out and prove the man. The real test comes during the commonplace experience with disease and it is this experience that fits one for the mountain-top attainment. 42 Gates Ave., Brooklyn, N. Y. SOME POINTS OF IMPORTANCE IN THE PERFORMANCE OF VA GINAL FIXATION. BY SAMUEL WYLLIS BANDLER, M. D., Adjunct Professor of Diseases of Women in the New York Post-Graduate Medical School and Hospital. New York City. Vaginal fixation of the uterus attaches the fundus uteri to the anterior vaginal wall and places the bladder on the posterior wall of the uterus. In order to perform this operation to the greatest advantage to the patient, it is necessary that the fundus should be well up behind the symphysis and that the cervix should be thrown high up and as far back as possible toward the hollow of the sacrum. The cervix takes this position when vaginal fixation is done to correct retroversions or retroflexions which are not complicated by elongatio colli, by cystocele, by descent of the uterus or by descent of the vaginal walls. Then the simple operation of vaginal fixation usually suffices except in those cases where the anterior vaginal wall is congenitally a short one, in which cases vaginal fixation is contra-indicated. If in the above mentioned class of cases of retroversions or retroflexions complicated by elongatio colli, by cystocele, by descent of the uterus, etc., the simple operation of vaginal fixation is done the operation fails of its best results as can be seen from Figures 1 and 2. Figure 1 shows the fixation sutures which. are to unite the anterior wall of the uterus to the anterior vaginal wall in the simple operation of vaginal fixation. Fig. 2 shows the sutures tied and the longitudinal and transverse incisions in the act of being closed by running catgut su ture. Figure 2 shows, in an exaggerated form, the lack of tautness in the anterior vaginal wall in the case of simple vaginal fixation done for cystocele with descent. The important point to be noted however, is the faulty position of the cervix. (The cervix is shown for purposes of demonstration further out beyond the vulva than is actually the case). This demonstrates that the lack of tautness in the anterior vaginal wall is not alone responsible for the position which the cervix has assumed. The trouble is that the uterus is too long, hence the simple operation does not throw the cervix high up and far back when, as is depicted in this drawing, we are dealing with an enlarged or elongated uterus, a uterus which has descended. It is necessary to overcome this obstacle when dealing with ptoses of the uterus, when the uterus is enlarged and |