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The case of spontaneous pneumothorax reported here is presented not only because of the rarity of the condition but because it is the only instance that I have been able to find in which roentgen evidence of the mechanism has been available.When one reviews the literature it soon becomes evident that there is a tremendous amount of confusion as to the limitations that should be applied to the descriptive term spontaneous pneumothorax in the newborn. It would seem that the term could be better applied if it were not extended so as to include the entire neonatal period, ordinarily reckoned at about one month, but were limited to the period between birth and the establishment of the normal vital processes. This period then would be limited to the first four or five days of life, and lesions that made their first appearance after this time might better be considered as disturbances having a separate cause.The reason for this differentiation is that there is a group of symptom complexes that arise at the onset of respiration and are characteristically different from disturbances arising at a later date. In this group are congenital deformity, congenital atelectasis and mechanical interference with respiration.The group which consists of the cases of congenital malformation of the respiratory tract, of course, requires separate treatment. Atelec¬ tasis may be due either to mechanical interference with respiration or to intrinsic factors which prevent proper aeration of the lung. Mechanical interference with respiration may give rise either to atelectasis or, occa¬ sionally, to emphysema, followed by rupture of the lung and pneumo¬ thorax. The term spontaneous also has particular significance in this group because the lesion, as it occurs, is a part of the primary mechanism and is not due to the intervention of any other factor, particularly the factor of infection.From the Beth Israel Hospital.

Within the last few years there has been an intense interest in otologic infections in early infancy due, in a great degree, to the work of Marriott on mastoiditis in young athreptic infants. There has been a general feeling, however, that the association of vomiting and diarrhea, on which so much emphasis has been placed, was possibly not an essential part of the picture. Also in some quarters it was felt that even the existence of a definite clinical and pathologic mastoiditis at so early an age was open to question. About a year ago, I reported 1 a case of mastoiditis in an infant, aged 10 weeks, as a postmortem observation without any of the usual signs or symptoms. I now wish to report the case of a patient with mastoiditis who was operated on at the age of 8 weeks; undoubtedly, the condition was of even earlier origin. It was the work of Marriott that gave me courage to make the diagnosis and submit the child to operation. The clinical history in this case is the typical history of an acute mastoiditis, and the operative observations are definite. The slight variations from the course of the disease in older children are only those dependent on the difficulties of accurate observa¬ tion of the ear at this age.It is worthy of note that the severe and persistent vomiting in this case was of an origin completely and demonstrably separated from the otologie complication, and the occurrence and subsidence of this com¬ plication had absolutely no effect on the underlying condition. At no time was there any tendency to diarrhea, and there were no symptoms referable to the mastoid except the temperature and the local observa¬ tions. The anatomic possibilities of a mastoiditis in the infant. I believe, are now generally fairly well conceded, and although the antrum is small. it is sufficiently differentiated to give rise to the classic picture.REPORT OF CASE D. O., a white boy, born on Dec. 12, 1928, after a normal full-term pregnancy, weighed 8 pounds (3.6 Kg.) ; the delivery was normal, without instrumentation. He left the hospital on the tenth day, weighing 7 pounds and 13 ounces (3.5 Kg.). He was a first child, and there had been no miscarriages. He was breast-fed for two weeks, and then was given a milk, water and sugar mixture, about 50 calories per pound. He was brought to the office at the age of 6 weeks because of per-