Concerning the means of removing the causes of mortality among children. If it is to the interest of every city to have the largest possible number of its inhabitants in good condition, it is also indispensable that the officers of the public health, whose duty it is to watch over all that concerns the health and cleanliness of their districts, should prevent the development of all these morbific causes; especially those which deteriorate the air in all places where a large number of persons congregate, such as factories, hospitals, asylums for children, churches, schools, &c.

This public officer ought to be invested with more extended power to show up as much as possible the causes which affect a great number of persons, and by the application of sanatory rules nip in the bud the propagation of epidemic diseases.

In families where these deleterious causes act upon only a small number of persons, individual surveillance devolves upon the mother of the family, who ought to be the officer of health in her household. But how can we hope that women will fulfil these duties while they are obliged to absent themselves, or while those who remain at home (I speak not only of work-people, but of women of a higher and better educated class) are entirely ignorant of the most simple hygienic laws, and of the rational treatment of their infants?

To diminish the consequences of this ignorance — the perennial source of sickness and death among children—I established some ten years ago, with the aid of some philanthropic ladies, a society named the "Ladies' Sanatory Association," with a view to propagate and popularise the laws of health.

[Here follows an account of the objects and mode of working of this admirable society, with which our readers are, or ought to be, familiar.]*

As to the group of hereditary causes, we can only diminish its evils by improving the health of the parents, especially the mothers; by giving the children plenty of pure air; by

*For further information apply to the Secretary of the Association, 14a, Princess Street, Cavendish Square, London, W.

rearing them as well as possible in respect of nourishment and care, and, when they are older, by developing well their physical powers by means of proper gymnastic exercises previous to allowing them to work in manufactories. The hours of children's work ought to be considerably lessened, and interrupted by various games and other recreation; and the quantity of their food ought to be proportioned to their growth, and to their amount of work.

To obtain the minimum of mortality among children, those mothers who are obliged to work ought to do so at home, at any rate for the greater part of the day. During their pregnancy they should take especial care of themselves. They should be taught to put in practice the laws of health in all that concerns their house and family. In cases where it is absolutely impossible that the mother should take care of the children, those who replace her, whether in the house or at the crèche (infant-home) during the day (which themselves need entire remodelling), ought to show themselves conscientious, and not evade the sacred duties imposed upon them, concealing the grossest negligence under hypocritical pretences.

It may be said, that it is Utopian to expect to save more than half the children who die under the age of ten. But my conviction, that more may be done, grows ever firmer. On the other hand, I am no less convinced that it is only by combating ignorance-that general enemy of all progressthat one can hope to arrive at this end, and save a still greater number of children from the maladies and deformities which afflict them.

The French Government have spent during the last two years about half a million of francs on several institutions where foals and colts are brought up and trained under scientific superintendence, with the object of developing all their faculties and powers. All the attendants, grooms, stablemen, &c., obtain certificates after having passed a scientific course. I ask for babies, infants, and young children only as much as has been done for young horses, and hope that those who share my views will exert themselves in establishing similar sanitary associations.

TWO CASES OF BRIGHT'S DISEASE.

BY GEORGE MOORE, M.D.

CASE 1.-Acute Bright's disease; hæmaturia at first, attended with amaurosis, and followed by pleuro-pneumonia and great dropsy; patient pregnant; dropsy rapidly removed by Apocynum.

Mrs. H―, æt. 35, miner's wife, came under treatment on April 5th, 1865.

Family history.-Father died in early life of consumption; mother alive and well; two brothers have "cough and spitting" at the present time; her only sister I found to be badly marked in the neck with strumous cicatrices.

Personal history.-Until her marriage, a few months since, patient has been a domestic servant. Her health has been good, with the exception that for some years she has been troubled with pain after eating, sourness at the stomach, and occasional vomiting of dark-coloured bitter fluid. She has never had any serious illness, and there is no history of scarlatina, or of rheumatism, or of exposure to cold. She is in the eighth month of her first pregnancy. No morning sickness.

History of illness.-About a fortnight before the above date, the patient first noticed that the urine was scantier than usual, and that she had to get up several times at night to discharge it. She cannot say whether it was dark-coloured or not. She had no shivering, no pain in the back, and no pain or difficulty in relieving the bladder. A few days later her sight became dim, and strange bodies seemed to float before her eyes. In addition, swelling appeared in the feet and ankles, and has gradually extended to the thighs, hands, and face; the whites of her eyes, she says, "rose and swoll." She has been under treatment (allopathic) without benefit. Her medical man has looked at the urine, but has never taken any of it away with him. Four days since (April 1st), VOL. XXIII, NO. XCIV.-OCTOBER, 1865.

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she was suddenly seized with sharp stabbing pain in the right side of the chest, behind and on a level with the nipple; the pain "shot" through the chest. Cough; quick breathing; and expectoration, at first white, and subsequently rustcoloured, speedily followed. Her doctor neither percussed nor auscultated her chest, but he applied leeches and sent some physic.

Present symptoms.-Patient, propped up in bed, is restless and uneasy, and out of breath when talking; face pale, puffed, and anxious; lower eyelids much swollen; conjunctivæ raised and watery; pupils widely dilated and fixed; patient cannot see my hand held before her eyes; says she sees large painted ships, &c. Has had no sleep for several nights. No headache, no delirium, no defect of hearing. Tongue covered with white fur; appetite fair; bowels relieved two days since; skin cool and dry. Pulse 120 and soft. Still complains of the "stitch," but the pain is not so severe as at first. Cough frequent; expectoration gummy and colourless; breathing quick and oppressed. The feet, legs, thighs, buttocks, backs of hands and arms up to elbow, are swollen, shiny, pale, and pit on pressure; the swelling is not very tense. On examining the abdomen, I found the enlargement of the gravid uterus; the foetal heart was heard beating at a point midway between the umbilicus and the anterior superior spinous process of ilium on right side; no tenderness; no appreciable fluctuation. The patient connects a distressing sensation of suffocation with fulness at the epigastrium where there is tympanitic sound on percussion. On examining the chest, I found four leech marks at the inferior angle of the right scapula; dull, flat sound on percussing over the lower two inches of right lung; no creaking; no murmur; bronchial voice distinct but not tremulous; and above this point, small crepitation. Area of heart's dulness natural, as well as the heart's rhythm and sounds. The urine passed during the last twenty-four hours is porter-coloured and thick, and measures twelve and a half ounces. Some of it was brought away for examination. The only medicine at hand, or that could be conveniently obtained,

was Merc. sol. 3rd trituration, of which four grains were placed in a teacupful of water, and a teaspoonful of the solution prescribed every two hours.

Examination of urine.-Sp. gr. 1010; acid reaction; a dark-brown, dense deposit occupies the lower fourth of the vessel, the supernatant fluid being turbid; copious precipitate with NO, and heat. The deposit was found to consist-(1) of abundance of blood-corpuscles; (2) of numerous bloodcasts; (3) of a few casts entangling healthy renal epithelium; (4) of three or four casts containing both epithelial cells and blood-discs; (5) of scattered masses of exudation, stained orange-red by hæmatin; (6) of free and healthy renal epithelium. There were no crystals.

April 7th.-Feels generally easier and better; has slept several hours during the past night; cough not so frequent and expectoration less abundant. Pulse 110; respiration 45. To the naked eye the urine is unaltered. Arsen. 1, six drops in four ounces of water, and Terebinthina 1, six drops in the same quantity of water, prescribed in teaspoonful doses alternately every hour.

8th.-Pulse and respiration same as yesterday; lungs not so dull on percussion; some creaking and bronchial breathing at the base of the right lung; the œdema is perceptibly less everywhere, especially in the face. During the last twenty-four hours forty-three ounces of urine have been passed; a sample of the urine gives sp. gr. 1015; the deposit is less and not so dark; the fluid over the deposit is of the natural colour; the flaky albuminous precipitate from the reaction of nitric acid and heat settles in the lower third of the test-tube. The microscope reveals a change in the constituents of the deposit; the blood-corpuscles are much less numerous, and there are now no true blood-casts; there are coarsely granular casts, some of which contain epithelial cells of the kidney of a healthy character; several large oval epithelial cells isolated and joined together in groups; two or three flakes of amorphous, colourless fibrin, and a few scattered large granular (inflammatory) corpuscles. Continue medicines.