present, but nothing sufficiently characteristic to make a diagnosis before death.

XX. Winckel's Disease.

Acute hæmoglobinuria with jaundice, cyanosis, and fatty degeneration of all organs caused by a micro-organism.

These two diseases are probably rare and peculiar manifestations of septic infection perhaps due to the reception of a large dose of poison directly into the blood through the umbilical vein.

XXI. Edema Neonatorum.

This affection is always due to kidney insufficiency and is invariably fatal.

XXII. Bloody Discharge from Genitalia of Female Children.

Not very rare. Perhaps analogous to breast changes in the newborn. The condition is not dangerous and requires no treatment. The blood comes from the uterus, like the menstrual discharges. Appears three or four days after birth and lasts only a few days.

XXIII. Sudden Death of Apparently Well Children. Causes. (a) Overlying by mothers, accidentally or intentionally.

(b) Diseases: most commonly pneumonias, apoplexies, more rarely perforation, intussusception, rupture of large viscus, or other diseases, as above.

(c) Occlusion of trachea by enlarged thymus or by curds of milk.

Medication.

The following are some of the drugs and their doses required in the first four weeks of life. Opium, as paregoric 2-5 gtt., laudanum - gtt., mercury, as calomel - gr., castor oil 15 gtt. to 3j, nitrate of silver grain, pepsin gr. j-ij, gallic acid gr. ss.-ij., etc

Pathology of the Puerperal State.

I. Abnormalities of Involution.

These may be anomalies by (A) excess, superinvolution, (B) by defect, subinvolution.

Involution. The old theory was that by fatty degeneration and absorption the uterus was regenerated from the embryonal muscle cells in the outer layer. This has been disproved. The degeneration is chiefly fatty, but there are other degenerative processes at the same time. Regeneration is not absolute, i. e., the whole muscle cell is not destroyed, but loses its redundant tissue. The process is rather an atrophy, and stops after the muscle fibre reaches its original size. This same process affects the mucous membrane, peritoneum, uterine annexa, vagina and vulvæ. Below the contraction ring it is an intermediate process, mainly retraction of overstretched tissue.

(A) Superinvolution.-An exaggeration or abnormal prolongation of that process by which the parturient uterus regains its normal conditions. Is rare. Its diagnosis and treatment belong to Gynecology.

(B) Subinvolution.-A retarded or arrested involution.

Causes. (a) Anything increasing blood supply, as hypertrophy of mucous membrane during pregnancy, fibroids, inflammatory conditions resulting from sepsis, mechanical interference with pelvic circulation, leading to its engorgement, as heart disease, premature getting up, premature resumption of sexual inter

course.

(b) Anything interfering with contraction of uterine muscle, as retained placenta, polypoid tumors, large masses of decidual 'tissue, uterine displacements, distended bladder or rectum, dragging adhesions. The cause is always a local one, i. e., typhoid, pneumonia or other diseases occurring during the puerperium have no influence in retarding involution.

Diagnosis.-Abdominal palpation in the early stages discloses abnormalities in the daily diminution in size of the uterus. Later there is a history of the continuance of the bloody lochia. 1st day, normally, the fundus one finger above umbilicus.