DISEASES OF THE CHILD. 577 



as occurred in one case under my own notice, and thus constitute a 

 perpetual cause of disease, particularly of convulsive affections. 



However, in this, as in the preceding cases, art can do nothing, and 

 we are obliged to trust to the powers of nature. 



1233. A more common, and fortunately less serious accident than 

 these, is a sort of subcutaneous effusion, a swelling of the hairy- 

 scalp, which is almost always met with, but in different degrees, 

 when the head has traversed the pelvic canal slowly and with diffi- 

 culty; this tumor is generally found on that part of the cranium which 

 occupied the open space in the pelvis during the labor; or one of the 

 points that was longest and most forcibly pressed against the sacro- 

 vertebral angle or pubis; it is composed in some cases of reddish 

 serum, in some of pure blood, either fluid or coagulated, in others of 

 a mixture of these fluids, and is of various size, from that of a nut up 

 to that of a hen's egg. 



It may be diffused or circumscribed, and it may be fluctuating, 

 though generally elastic and dough-like, and commonly disappears 

 without any assistance; sometimes, however, it suppurates and is 

 converted into a real abscess, which may end in denudation and ne- 

 crosis of the cranial bones. 



Being soft and compressible in the centre, and firmer and more 

 elevated about the edges, it has, on more than one occasion, been 

 mistaken for a fracture or depression of the bones, and excited use- 

 less alarm. But since J. L. Petit, Ledran and Levret have called 

 attention to this sort of mistakes, they have become more and more 

 rare. 



1234. When the tumor is of a small size, it should be left to itself, 

 and disappears in the course of three or four days, leaving behind it 

 only a simple ecchymosis; but its resolution may, and indeed should 

 be facilitated, by keeping it covered with compresses dipped in salt 

 water, red wine, or brandy and water, some eau-bhmche or other me- 

 dicine of the same kind. Should it be fluctuating and not very painful, 

 it should nevertheless be resolved if possible; if the means above in- 

 dicated do not suffice, they might be replaced by a solution of half 

 an ounce of hydro-chlorate of ammonia in a pint of red wine; this 

 liquor, which is recommended by Siebold, and frequently employed 

 by M. Boyer for bloody tumors of the knee, has many times suc- 

 ceeded in dispersing collections which it had seemed indispensably 

 necessary to open. 



However, should it not produce the effect expected from it, and 

 the fluctuation increase, recourse must be had to the bistoury; and in 

 such a case we ought not to wait too long, which would admit of the 

 skin becoming more extensively detached, and much thinner. The 



50* 



