(WITH THE COMPLIMENTS OF THE AUTHOR.) 
THE THERAPEUTICS 
O F 
HIGH TEMPERATURES 
IN 
YOUNG CHILDREN. 
BY 
WILLIAM PERRY WATSON, A.M., M.D., 
JERSEY CITY, N. J. 
Assistant to the Chair of Diseases of Children in the New York Polyclinic. 
Reprinted from the “Archives of Pediatrics,” September, 1884. 
\ 
PHILADELPHIA: 
JOHN E. POTTER & CO., Publishers, 
617 Sansom Street. 
1885. THE THERAPEUTICS OF HIGH TEMPERATURES 
IN YOUNG CHILDREN. 
A Clinical Lecture Delivered at the New York Polyclinic. 
WILLIAM TERRY WATSON, A.M., M.D., JERSEY CITY, N, J. 
[.Reported by j. d. patterson, m.d.] 
Gentlemen,—During this session we have seen many 
cases where the high temperature had an important 
bearing on the course of the disease under consideration ; 
and you will find in private practice that this element is 
not an exception, but rather the rule in a large majority 
of cases; and even more than this, you have probably 
heard, and will undoubtedly hear physicians say, “ the 
high fever went to the head and killed the child.” As I 
have but casually called your attention to the treatment 
of this condition in the several cases already examined— 
purposely leaving the discussion of so important a subject 
until you had seen its varied effects in different cases—I 
think we can spend this hour profitably in reviewing 
some of the means applicable in reducing a high temper- 
ature. 
In the first place, let me impress upon you the necessity 
of taking the temperature of every infant or young child 
(unless a recent injury), before you prescribe any treat- 
ment. Don’t be guided by the sense of touch ; you have 
seen here how deceptive that is. You have seen cases 
where apparently the temperature was not elevated, and 
yet the thermometer showed a rise of two or three degrees, 
and vice versa. Even if the extremities are cold, don’t 
imagine that the temperature is low, for you have seen 
cases in this clinic with cold extremities and yet the tem- 
perature was 104°F. You may approximately estimate 
the degree of fever, in the absence of a thermometer, by 2 
Watson: Therapeutics of High Temperature. 
the general development of the child, whether well- 
nourished or emaciated ; the condition of the extremities 
as compared with the body, whether uniform, or the one 
cold and the other hot; the condition of the anterior fon- 
tanelle (if open), whether bulging or depressed, and the 
mental condition, whether drowsy or restless as compared 
with intelligence and quiet. Usuall}’, however, your best 
guide will be the sense of touch of the abdominal wall. 
Always take the temperature of your little patients in 
the rectum ; this way may not be so neat as others, but 
you are looking for absolute facts, and you should always 
use every legitimate and reasonable means to obtain them. 
As a rule, most young children bear a high temperature 
better than adults; thus, a temperature of 10I°F. will 
usually produce far more serious effects in the adult than 
in the infant. 
A good general rule in the management of all cases 
with a high temperature, i. e., over 102°F. in the young, 
is to keep them off of feathers and flannel. During the 
existence of the fever have them clothed in cotton flannel 
or muslin, and keep them on a smooth even surface made 
with a hair or straw mattress, simply covered with an 
ordinary quilt or several folds of a sheet. Keep the 
temperature of the sick-room, if possible, at about 75°F., 
and have it well ventilated and with plenty of sunlight. 
Remember that as with adults so with young children, 
“ fever patients ” are not liable to “ take cold.” 
Again, in all these cases give the child all the wrater it 
will drink, and that, too, notwithstanding it is immedi- 
ately vomited. In some cases, where the vomiting is 
obstinate, an enema of luke-warm water, a gill at a time, 
frequently repeated, will be beneficial in quenching the 
thirst. 
Our limited time will allow me to speak of only a few 
of the valuable febrifuges. These we may arbitrarily 
classify in two divisions, Internal and External Remedies. 
I. Internal Remedies.—While I do not intend to speak 
of the causes of high temperature to-day (as wre daily go 
over that ground with each case appearing before us), yet Watson : Therapeutics of High Temperature. 
3 
you must remember that in some cases your treatment 
must be directed toward the removal of an existing 
exciting cause. Thus, you may have a high fever from 
an acute attack of indigestion, and obviously you should 
relieve that. This, then, leads me to say that it is good 
practice in nearly all your cases with high fever to precede 
your regular febrile treatment by cleaning out the gastro- 
intestinal canal. You can do this with castor oil, rhu- 
barb, and frequently combined with soda, or with calomel 
and soda, as in this prescription, 
—Ilydrarg. chi. mitis, gr. i to iij; 
Sodii bicarbonatis, gr. ij to xv. 
followed by a seidlitz powder in milk, in three or four 
hours. The most available, and, at the same time, valuable 
internal remedies are aconite, quinine, and antipyrine. 
1. Aconite.—The best preparation of this drug to use is 
the tincture of the root, and is given in plain water, or it 
may be combined with other febrifuges. 
On account of its comparative tastelessness, it is 
readily taken by young children, and as I have told you 
about all tasteless and non-irritant medicines, it is best to 
give it in small and frequently repeated doses. 
On account of its frequent prostrating effects, you 
should see the child taking it every two or three hours. 
When this is impossible, I have found the following plan 
to answer very well, viz: For a child under two years of 
age, I prescribe one-twelfth of a drop every fifteen min- 
utes for the first hour, and then every half-hour for two 
hours, and subsequently every hour, until my next visit. 
You will, however, get better results from it if you give 
it every ten or fifteen minutes, and see the child at least 
every second hour. A precaution that I always give the 
mother is to stop giving it when the child begins to per- 
spire. This is usually, though not always, a reliable 
guide. 
The indications for its use are a hot, dry skin, full and 
frequent pulse, and a temperature over 102° F. Hence, 
its value is most marked in the pneumonias, in the erup- 4 
Watson : Therapeutics of High Temperature. 
tive and desquamative stages of the exanthemata, and in 
the acute inflammations of the serous membranes. 
While you will find this drug one of the most valuable 
anti-febrifuges, yet it will fail in some cases, and if you 
have produced a marked effect on the quality and fre- 
quency of the pulse, without any fall in the temperature, 
then you must abandon its use for another remedy wThich 
I will shortly tell you about. In some cases you will get 
excellent results with the following combination, viz:— 
—Tr. aconitii rad. gtt. ij; 
Sp. seth. nitrosi, 5ij; 
Glycerin®, 5ij; 
Liq. ammon.acet. q. s. ad. §ij; 
M. S. 5ss, q. h. 
If the child has more or less delirium, it will be well to 
add five or ten drops of paregoric to each dose as given. 
As I have frequently told you, it is always better to pre- 
scribe your preparation of opium separately, so that you 
can increase or diminish its quantity as desired. 
2. Quinine.—For those of you who live in districts 
where malaria is either the primary or a complicating 
factor in nearly all diseases, quinine wfill be your sheet- 
anchor. You can use it in any of the following ways, 
viz:— 
Per Orem 
Powder • 
Milk, 
Coffee, 
Cocoa, 
Liquorice. 
Quinine 
Per Rectum 
Liquid 
r Suppository, 
L Enema. 
Hypodermically, or by Inunction. 
In nearly all cases it will be advisable to precede the 
use of quinine by the mouth by a cathartic. One of the 
best ways to give quinine by the mouth to young chil- 
dren is in the form of a powder in one of the menstrua 
mentioned. When given this way have the quinine Watson: Therapeutics of High Temperature. 
5 
dispensed in one-grain powders, and add one or more, as 
desired, to a teaspoonful of the milk, coffee, chocolate, or 
liquorice, at the time of its administration. 
Sometimes I add ten or fifteen drops of the fluid extract 
of liquorice-root to the teaspoonful of milk, in which the 
bitter taste of the quinine is very well disguised. Again, 
you will find cases which will take the quinine in powder 
alone. 
The Elix. Taraxaci Comp, is also a very good vehicle 
for the administration of quinine, and there are also sev- 
eral other compounds upon the market for a similar 
object, but I don’t think you will require them, especially 
with children. As with adults, so with children, the most 
reliable effects will be obtained from the use of an acid 
solution of the quinine, but its very bitter taste would be 
objectionable in most cases. 
I have frequently used quinine in suppositories 
with very satisfactory results. I think it well, without 
some marked indication to the contranq to combine 
with it a minute dose of opium, to allay, in some 
degree, the local tenesmus of the gut. When used 
in this way, I prescribe double the quantity that I 
would by the mouth. The best menstruum is cocoa 
butter, and after the introduction of the suppository 
within the sphincter, the buttocks should be pressed 
firmly together for several minutes. 
It will be well for you to remember that these supposi- 
tories may so irritate the lower bowels as to simulate 
dysentery. 
Keating recently related to me a case where this con- 
dition had existed, and been treated as an attack of dys- 
entery for several weeks, which, on coming under his care, 
was quickly relieved by a suppository of cocoa butter. 
But you will find cases where quinine is not tolerated 
by the stomach, which will be effectually relieved by the 
same in suppository. I always use the ordinary sulphate. 
I have never had occasion to use quinine in an enema. 
It is, however, recommended by several writers. The dose 
should be the same as in a suppository, and the least irri- 
tant preparation should be used. 6 
Watson : Therapeutics of High Temperature. 
You will frequently have occasion to use quinine hypo- 
dermically, and usually with good results. The best loca- 
tion for the injection is the buttocks. The dose should be 
from a half to two-thirds of that for the stomach. I have 
always used the bisulphate, which, with the addition of a 
little heat, is soluble in eight parts of water. 
Quinine has also been used by inunction, with somte 
oleate as a menstruum, but rather in chronic than acute 
cases. 
I have thus hurriedly called your attention to this drug 
and, at the same time, do not advise you to use it as an 
antipyretic unless there are malarial elements to the 
case. 
When you have a temperature of 10G°F. of undoubted 
malarial origin, and there are no immediate complications 
apparent, use quinine hypodermically, and repeat i-t in 
an hour if required. 
3. Antipyrine.—The last of the internal remedies I 
shall call your attention to is antipyrine. During the 
past year, or two, it has been used quite extensively in this 
country, and for sometime previously in Germany. There 
seems to be no special indications for its use, excepting a 
high temperature regardless of its cause. It may be given 
by the stomach, by the rectum, or hypodermically. The 
best way to give it is in three successive doses at hourly 
intervals, which can be repeated in six hours if necessary, 
and for a child under seven years of age the dose, to begin 
with, is one grain for every one and a half years of the 
child’s age. This dose should bedoubled in the second series 
of these doses. Usually, however, the temperature remains 
down several degrees for about eighteen hours after the 
first series of these doses, and then does not reach its pre- 
vious height. If given in an enema, double the quantity 
should be administered at the same intervals. If given 
hypodermically, half the quantity dissolved in warm 
water can be used. 
I have used it in several cases with good results, and 
its administration was accompanied by no vomiting, pros- 
tration, etc. I have also used it in cases where it had no Watson: Therapeutics of High Temperature. 
7 
appreciable effect on the temperature. However, if more 
extended and extensive trials shall confirm results already 
obtained, antipyrine will be one of our most valuable 
antipyretics. When you have a temperature of 104° F., 
and over, and where there are no signs of immediately 
impending danger, use antipyrine. It seems to do no 
harm. 
These, then, are the three principal antipyretics 
used internally. There are many others, it is true, but I 
think you will find these most applicable, and when they 
fail you, the others would also, and you would have to 
resort to the external remedy, water, finally. 
To summarize the indications for the use of each of these 
three internal remedies, I would advise you to use aconite, 
in small and frequently repeated doses, when you have a 
hot dry skin with full and rapid pulse; to use quinine 
when there is any suspicion that malaria is an exciting 
element; and to use antipyrine when these have failed or 
are contra-indicated. 
But, gentlemen, you will see cases before you have been 
in practice very long, where you will be unable to reduce 
the high temperature with either of the internal remedies 
just mentioned, or with any other internal remedy you 
may employ. 
You will see cases dying from a high temperature before 
the effect of any internal remedy could be obtained. You 
will remember that Professor Ripley, during the past 
winter, has taught you that an excessively high tempera- 
ture produces such changes in the gastric juice as to de- 
stroy its digestive properties. 
You will see cases where convulsions will follow the 
high temperature to sudden death. And just here let me 
remind you of the importance of taking the temperature 
in every case of convulsions you may be called upon to 
attend. 
You can reduce any temperature, and that, too, with a 
remedy which you will always have at hand wherever 
you may practice medicine—i. e., water. Furthermore 
you can reduce the temperature safely and prolong, if not 8 
Watson: Therapeutics of High Temperature. 
save, the life of the little patient; at least you will not 
have done your duty until you have made every effort to 
reduce the high temperature which is killing the child. 
You can use the water in any one of the following ways, 
viz.: 
Sponging. 
Douche. 
Bath. 
Pack. 
Enema. 
r Directly 
Water* 
Cranial. 
Cervical. 
Thoracic. 
Abdominal. 
Spinal. 
Rubber Coil 
Indirectly 
Rubber Cot. 
I. Direct Application.—In this way the water is 
applied to the surface of the little patient’s body. And 
here Jet me say to you that, in all these different modes of 
application, the water is applied to the head, thorax, and 
abdomen, and sometimes to the neck, and you are always 
to remember to keep the extremities warm, and that, too, by 
the use of artificial heat. It frequently is necessary to 
wrap the extremities, especially the lower ones, in flannel 
or cotton wadding, and have them surrounded with bags 
or bottles of hot water. This point is of the greatest im- 
portance and should never be overlooked. 
1. Sponging.—This is the easiest and frequently a very 
efficacious way of using the water. If you have a tem- 
perature of 105° F.,with no serious complication impend- 
ing, you can have the child’s clothes removed, and [dace 
it on the smooth surface previously mentioned (with a 
rubber sheet beneath the cotton sheet), and with water at 
90°, commence to sponge the thorax and abdomen, and, 
at the same time, have the water gradually cooled down 
to 70°, turning the child first on one side and then on the 
other, so that the back can be frequently sponged. Do 
this for thirty minutes, and you will probably find the 
rectal temperature down to 102° or 101°; if so, I usually Watson : Therapeutics of High Temperature. 
9 
wring out a piece of muslin, long enough to reach from 
the shoulders to the hips, in equal parts of whiskey and 
water, to which a little ground mustard has been added, 
and wrap tins around the child’s body; then covering 
the child with an ordinary sheet, allow it to remain in 
this way for one or two hours. If, at this time, the tem- 
perature remains down, the child can be removed to a 
dry surface, but not dressed for at least three hours more, 
when, if the temperature still remains down, it can be 
lightly dressed. During all this time, cloths dipped in 
iced water should be repeatedly applied to the head, and 
if the child is comatose, a hot flaxseed poultice sprinkled 
with mustard, is kept applied to the nape of the neck. 
If the heart’s action is feeble or irregular, I usually take 
a small sponge moistened in hot whiskey and water, 
sprinkled with mustard, and apply it over the peri- 
cardium for ten or fifteen minutes. During all this time 
the extremities have been kept warm, as previously de- 
scribed. In the meantime, the child has taken whatever 
nourishment it desired. Now, if malaria was the cause 
of the high temperature, primarily, you should admin- 
ister quinine in some one of the ways I have already de- 
scribed; or you can keep the child in this way—i.e., un- 
dressed, and when the temperature goes above 103°, either 
sponge it again or apply the whiskey-water sheet. How- 
ever, if the temperature repeatedly goes up, after being 
thus reduced, it will be better to put the child either on 
a rubber coil or a rubber cot, which I will soon describe 
to you. ' I think this one of the most practical and 
feasible ways of reducing a high temperature in ordinary 
practice; the parents and friends, however skeptical, 
cannot object to it, for they see you commence with warm 
water, which you have gradually cooled, under the pre- 
tence that “the body is so hot that you must add ice to 
keep the water the same as when }mu commenced.” 
2. Douche.—When you have a temperature of 10G° or 
107°, wuth the child either in convulsions or profoundly 
comatose, more rapid work than the preceding must be 
done. In three cases of this kind, I have improvised a 10 
Watson : Therapeutics of High Temperature. 
Kibbe cot, with two chairs, a blanket, and a sheet. The 
chairs, with square-top backs, are placed back to hack, 
about thirty inches apart, and over the tops the blanket 
is tightly stretched, and fastened with large safety pins to 
the centre cross-piece, in the back of each chair, respec- 
tively; then on this blanket the sheet is placed, and the 
undressed child on the sheet; beneath the blanket, and 
between the chairs, there is a small bath-tub. It is well 
to place a thin sheet over the thorax and abdomen of the 
child, so that the shock of the water will not be so great. 
When everything is in readiness, and you can do it all in 
the time I have been describing it to you, take water at 
a temperature of 90°, and pour it over the thorax and 
abdomen for three or four minutes, gradually having the 
water cooled down to 75° in the meantime, and there will 
be signs of returning consciousness within a few minutes. 
Within five minutes, the thermometer in the rectum will 
show a fall of four or five degrees in the body temper- 
ature; and here again keep the extremities warm. You 
can protect the legs from the water by a sheet tightly 
rolled up and placed under the thighs. If you put your 
hand underneath the blanket, over the middle of the 
back, you will be surprised to filid the amount of heat 
there. Leave the child on this cot for several hours. 
Perhaps, after several hours the temperature will go up 
again, if so, then again apply the douche, but only for 
two or three minutes. One advantage in using the water 
in this way, is that you have it under your complete con; 
trol, so that if there are any appearances of shock, you 
can apply warm or hot water instantly, and that, too, 
without moving the child. Of course you are to use this 
method only in desperate cases, and in families of intelli- 
gence, and with their full consent, after you have ex- 
plained to them the gravity of the case. 
3. Bath.—The cold bath has been used a great deal, but 
there is more or less (and I think most decidedly more) 
danger in its use. I have used it, and even on an infant 
only three weeks old, and with good results, but I do not 
advise you to use it now, for you have so many safer and Watson : Therapeutics of High Temperature. 
11 
even more effectual ways~of reducing a high temperature. 
4. Pack.—The wet, or cold pack, consists simply in 
wrapping the body, from the shoulders to the hips, in a 
sheet wrung out of cool, cold, or iced water. It is usually 
a very effectual way of reducing a high temperature, and 
is used by a large number of practitioners. I have used 
it frequently, and in some cases the temperature kept on 
going up, notwithstanding the fact that the sheet was 
changed every ten minutes. 
You must remember one thing about a cold pack, and 
that is that it must be changed every five or ten minutes, 
and thus constantly disturbing the patient, or else it be- 
comes hot, and will act simply as any other moist appli- 
cation—i. e., like a poultice. 
5. Enema.—In cases where you must reduce the tem- 
perature very rapidly, enemata of cold water, a gill at a 
time, repeated every ten minutes, will do well in some 
cases. I have used it in one case with a temperature of 
107°, caused by malaria. The infant was in convulsions 
when I was called in, and a syringe being at hand, I im- 
mediately gave it an enema of cold water, and repeated it 
in five minutes, after which the convulsion ceased; the 
enemata were repeated every ten or fifteen minutes for an 
hour, at which time I had obtained a solution of the bi- 
sulphate of quinine, which I gave hypodermically, and 
the high temperature or convulsions have not since re- 
occurred. I should advise you to use it only in similar 
desperate cases. 
II. Indirect Application.—This method of .using 
water in reducing high temperatures in young children 
consists in the use of tubing of rubber (lead or copper 
might be used) through which water is passed either from 
the hydrant or a syphon. The most convenient way of 
using it is to attach one end of the tube—i. e., the receiving 
tube—to the water faucet of the hydrant, while the other 
end, or the discharging tube, is placed in the basin of the 
hydrant. The temperature, or degrees of cold, applied to 
the skin of the patient can be regulated in four ways, viz.: 
1. By the temperature of the water used; 2. By the force 12 
Watson: Therapeutics of High Temperature. 
applied to the stream in passing through the tube; 3, 
By the thickness of, and covering over (as sheet or blanket) 
the tube; and 4. By the amount of clothing on the patient. 
1. Rubber Coil.—Different varieties or shapes of tubing 
have been made applicable to most any portion of the 
body. The following are most applicable to children : 
a. Cranial.—The size of tube ordinarily used for these 
different styles is that of a drainage-tube. 
You will remember that I have told you to alwa}Ts 
keep the baby’s feet warm and its head cool. Now, in 
these cases of high temperature, this injunction is especially 
imperative. I have already told you how to do the former, 
and while the latter can be done by the frequent applica- 
tion of ice-cold cloths, which is, perhaps, better in many 
cases on account of the rapid evaporation, yet there may be 
times when everything should be dry around the head 
and neck, and in all such instances the rubber coil for 
the head will answer every indication. 
b. Cervical.—A very effectual mode of reducing a high 
temperature, and especially when there is any inflamma- 
tory action in or around the throat, or when a moderately 
high temperature threatens convulsions, is to use the 
rubber coil passing from ear to ear beneath the chin. Never 
Let it pass entirely around the neck, for, as I have just 
told you, there are instances where a hot application to 
the nape of the neck is of special value. 
c. Thoracic.—The coil for the chest may be either double 
or single—i. e., for the back and front, either together or 
separately. In cases where there is more or less weakening 
of the heart’s action, the coil should not be placed over 
the front of the chest. 
d. Abdominal.—This form of coil, made so as to just 
cover the abdomen, is very valuable in the reduction of 
a high temperature. 
The objection to all these forms of coils is that the con- 
stant moving about of the child gets them displaced, and 
while it might seem that bandaging them in position 
would answer, yet it does not. 
e. Spinal.—The spinal can be so arranged as to over- Watson: Therapeutics of High Temperature. 
13 
come this difficulty, and next to the abdominal form is 
the most valuable in these cases. 
2. Rubber Cot.—I have now in use a cot made by the 
attachment of successive coils of tubing to sheet-lead, 
which I have found very serviceable in reducing any 
temperature to any desired point, and keeping it there as 
long as necessary. The child lies directly on the tubing, 
and the principle of regulating the degree of cold is the 
same as that in the rubber coils already described to you. 
I am now having made a rubber cot, shaped like a 
pillow, with spiral springs inside so as to be comfortable 
for the little patient to lie upon. 
I have thus, gentlemen, at considerable detail, described 
to you the different ways by which you can reduce any 
temperature; for I should regret to have any one of you 
go out into private practice from this clinic, and let any 
of your little patients die from a high temperature. True 
it is, that a high temperature is not always the cause of 
death, but what I wish to impress upon you is the fact, 
that when you have a high temperature you can surely 
and safely reduce it. No matter what the cause thereof, 
or what the existing conditions are, if the child is dying 
from the high temperature, it is your duty to reduce it; 
and if, after you have done that intelligently, the child 
dies, you have done your duty. CONTENTS OF “ARCHIVES OF PEDIATRICS” 
For August, 1885. 
FAGB. 
Cholera Infantum. By William Perry Watson, A.M., M.D., Jersey City, N. J. 
Assistant to the Chair of Diseases of Children in the New York Polyclinic . 449 
On the Operative Procedures in Cases of Cleft Palate and their Effects upon the 
Voice. By John H. Morgan, M.A., Oxon., F.R.C.S., Assistant Surgeon to the 
Hospital for Sick Children, London 467 
Diphtheria (concluded). By William T. Plant, M.D., Professor of Diseases of 
Children in Syracuse University, Syracuse, New York ..... 474 
The Surgical Diseases of the Intestine in Children (continued). By Charles B. 
Kelsey, M.D., New York 482 
Tape-worm in a Young Infant ........... 488 
% (jfMcjiixaX (JTcrroramxicalicrtts. 
11. ©xxvvetxi ICttcvatnvjc. 
1. Hygiene and Therapeutics. 
Therapeutic Uses of Antipyrine 489 
The Deterioration of Vision in School Children 490 
Observations on the Clinical Features and Treatment of Phimosis in Infancy and 
Childhood 491 
Absolute Loss of Hearing Power in both Ears Accompanying an Attack of Mumps. 492 
The Present State of Knowledge Regarding Chorea ....... 493 
A Case of Vaso-Motor Neurosis of a Rare Form Occurring in a Child . . . 493 
Nystagmus: the Pathological and Clinical Significance of the Symptom . . . 494 
The Treatment of the Intestinal Diseases of Infancy 495 
2. Medicine. 
The Causation and Treatment of Scarlatina . 496 
A Case of Scarlet Fever, with Extensive Sloughing of the Triangle of the Neck, and 
Exposure of the Vessels . 498 
Concerning the Occurrence of the Phenomena of Chronic Epilepsy after Scarlet 
Fever 498 
Epidemic Roseola in Calcutta 499 
Diarrhea and Dysentery in Children 500 
Points in the Etiology and Pathology of Diphtheria....... 502 
Observations Concerning Diphtheria 503 
Mumps as a Cause of Ear Disease * 503 
Carbolic Acid in the Treatment of Acute Earache 504 
Congenital Infiltrating Growth in Liver and Adrenals 504 
Nocturnal Incontinence of Urine and its Treatment ....... 505 
3. Surgery. 
Circumcision a Cause of Reflex Irritation of the Genito-Urinary Organs. . . 506 
Paracentesis with Incision of the Pericardium after Resection of a Rib in a Child 
Thirteen Years of Age 507 
Congenital Fissure of the Sternum 507 
A Case of Infantile Mollifies Ossium. ,*«»08 
Congenital Tumors of 'Testis . ., 
A Case of Traumatic Tetanus . *^.•'508 
The High Lithotomy Operation in Children; Inaugural Dissertation, Berlin,509 
Congenital Caudal Growth; Removal; Death 510 
Accessory Kidneys in the Newly Born ......... 510 
A Rare Case of Spina-Bifida 511 
Treatment of Empyema 512 
Ligature of Common Carotid Artery for Hemorrhage during Scarlatina . . . 512