No, 759,

LONDON, SATURDAY, MARCH 17, 1838. [1837-38.

LECTURESON THE

THEORY AND PRACTICEOF MEDICINE;

NOW IN COURSE OF DELIVERY AT THE

THEATRE OF ANATOMY AND MEDICINE,WEBB-STREET, SOUTHWARK.

BY

MARSHALL HALL, M.D.,F.R.S. L.& E.&c., &c.

THE CROUP-LIKE DISEASE. - Disputes re-"garding- the nervous system; Mr. New-

port and Professor Grant; parallel l)as-stages, Causes Qf the croitp-like convul-sion; analysis of its symptoms. D1’, J.

Clarke’s description of the disease. Is the. origin of the disease cerebral? -Rcmo!!’/Mof Dr. llTeroitnazz. Reasons for not adopt-ing Ð1’, Hu6 h Ley’s opinion. Probabletheory of the disease. Treatment. Para-

lysis from dentrll îrritation; remarkablecase. Paralysis from intoxication. Suc-cessful performance of tracheotomy by Mr.Sampson.

GENTLEMEN :-Befoi°e I proceed to theproper subject of this lecture, I must brieflyallude to the exception tliat has been takenio § 15 and 16 of Lecture.!. The former,I find, by the concurrent testimony of two ofProfessor Grant’s pupils, of 1832, to be per-fectly correct ; and the latter, by inference,from the admission of all parties. Thepoints in question are four:-1. The exist-ence, and, 2, the ftenctiou, of the third columnof nerves in the articulata; 3. The dates ofthe publication of these discoveries ; 4. Theiubrutitude of a pupil who attempts to de-prive his teacher of the merit of havingtaught both, and made one, of them.

503. Now the notes of the two pupils ofDr, Grant, state, that he showed and ex-ptained, in 1832, the plate of Prof. Müller,published in 1828, portraying the thirdcolumn in the scorpion, and taught that thiscolumn was aganglionic in its structure, andmotor in its function.

504. After this, the individual alluded to,

a gratuitous pupil of Dr. Grant, and, throughhis means, of the other medical professorsat the University, pretended to have madethis discovery in the lobster, at the sugges-tion of Sir C. Bell, in 1833, and publishedit as such in the " Philosophical Transac-tions " for 1834. See particularly pp. 406,408. The most complete refutation of thepretensions of this individual is afforded byDr. Baly’s notes, and those two paragraphs.I therefore subjoin them here :-Extract from Dr. Baly’s Notes of Professor

Grant’s Lectures in 1832.1832.

" Muller has found in the scorpion, onthe side of the knotted chord, a nerve pass-ing down, having no connection, taperingtowards the last ganglion, where it is re-moved with more difficulty." &c.

Dr. Baly gives a sketch of MiiIIer’s plate,made with the pen, during the lecture." We have seen nerves apparently cor-

responding to the nerves of sensation, withganglia ; and to the nerves of motion, withoutganglia. Also, nerves of vegetative life,thought to supply the office of the nervusvagus and sympathetic."N.B. Mr. Storrar’s Notes are to the same

effect.-See LANCET, p. 748.Extract from Ttff. Ne2cton’s Paper in the" Philosophical Transactions" fur 1834,p. 406.

1834.« It was during the early part of the sum-

mer of 1833, that I first had an opportunityof conversing with Sir C. Bell, respectingthe nervous system of insects, when he sug-gested a closer examination of the chordsthan I had then made, to ascertain whethera double nervous column, one portion forsensation and the other for motion, exists inthe invertebrata, as in the higher animals.He at the same time pointed out one of thecrustacea, the ’lobster, as perhaps the mosteligible for the inquiry. At that time Ihad no hopes of succeeding in demonstrat-ing the parts by dissection, although I be-lieved they really did exist. In the monthof August, after many dissections and ex-aminationsof the animal in its recent state,I began first to hope for success ; and in the

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beginning of September completed a prepa- mach, or constipation or loaded bowels. Theration of the nervous system of the lobster, effect of this irritation is conducted to thethat appeared to show the two motor and II. True Spinal Marrow.sensitive columns." &c.-p. 406. It is then reflected uponSecond Extract from lllr. Newport’s Paper in III. 1. The Superior Laryngeals,

the " Philosophical Transactions " for 1834, 2. The Diaphragmatic, ,

p. 408. 3. The Intercostals,1834. 4. The Abdominal Nerres.

« The detection of a double spinal column 508. This disease might be portrayed byin the lobster has since led me to examine a sketch, as has been already done.more closely the nervous system of the scor- All spasmodic diseases might be repre.pion, one of the arachnida. Upon showing sented in a similar manner, and thus a view

my dissection of the lobster to Professor of these affections will be given, at once

Grant, he directed my attention to a structure novel and distinct.observed in the scorpion by Prof. Milller of 509. The general question of convulsionsBonn, which has been thought to be the motor is one of the greatest interest. That thetract. This structure I had not at that time whole class of convulsive diseases consists

observed."-p. 408. of affections of the true spinal system, thereWhen we remember that these two pupils is no longer any doubt. But these diseases

of Dr. Grant sat beside each other, we cannot do not all originate in this system. Somebut perceive that one of them has been of them originate in the cerebrum; theyguilty of " statements not in stnict accord- then ariseance with facts:’ 1. From counter-pressure in diseases, or

505. These, then, are the facts of the 2. From confre-cozcp in injuries of the en.case. They do not concern me individually, cephalon;except as being the truth. Much mystifica- 3. From irritation in diseases of the me-tion and subterfuge have been employed in ninges, or at the base of the brain;a recent discussion, but you have only to 4. From exhaustion.

keep steadily in mind the subject of that dis- 510. In this manner we solve the difficult

cussion, viz., the third abdominal nervous question of convulsions arising from affec-column in the articulata,-its discovery, and tions of parts not endowed with the excito.the discovery of its function. (See § 15.) motory property. Allow me to refer you to

506. But I proceed to the proper subject the observations formerly made upon theof this lecture,—The symptoms of hydro- subject, 272, and § 273.cephalus, and of the hydrocephaloid:disease, 511. It is in this manner that we explainare affections of the cerebral functions in the the occurrence of convulsions in encephalitisfirst instance, and of the true spinal in the and hydrocephalus, in meningeal or othersecond. In the crotip-like convulsion this affections of the base of the brain, or of theorder is reversed, and the true spinal system spinal marrow, and the effects of extremeis first affected, and the cerebral subse. exhaustion. In a word, convulsions belongquently. This is an interesting and impor- to the later period, and the close of all thetant view of the subject. It teaches us the diseases of the nervous system, as, on theorder, not only of the symptoms, but of the otherhand, repeated convulsions eventuallyremedies to be employed. affect the encephalon.

512. But of convulsions originating inTHE CROUP-LIKE CONVULSION. the true spinal system, some are centric,

507. In introducin- to your notice the others eccentric. The former consist of dis-

ease of the true spinal marrow itself, thecraup-like disease of children, I must advert ease of actions spinal the incident nerves, to a subject which I shall notice more fully latter of affections of the incident nerves,hereafter, viz., the division of the diseases and, through case is the centre of the sys.of the true spinal system ; 1. Into those ori- tem,. Such a case is the croup-like con-

vulsion.gmally seated in the incident, excitor nerves, 513. In treating of this affection, I pro.of which the type is given in the figure in pose to include eccentric convulsions in§ 49 ; 2. Into those having their seat in the children generally, for they are parts of thecentre of this system, of which the type is same whole.given, § 34; and 3. Into those affecting the same whole. causes of convulsions incourse of the motor nerves, and represented 33. children, in a practical point of view, are,The croup-like convulsion belongs to the 1. Dental Irritation.

first of these divisions. It arises from the 2. Gastric Irritation.3. hatestinal Irritation.arritation of

, , And here I must make the important, the

I. 1. The Trifacial, all-important, practical remark, that I have2. The Pneumogastric, or never seen the measures suggested by this3. The S’pinal Nerves, view of the causes, when early and effectually

during dentition, indigestion or loaded sto- enforced, fail in remedying this disease.

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514. Besides these especial causes, there " This convulsive affection occurs byare others which act upon the nervous cen- paroxysms, with longer or shorter intervalstres. Passion, vexation, and certain odours, between them, and of longer or shorter’dura-are of this class ; and, singular as it may tion in different cases, and in the same case

appear, the state of sleep predisposes, at at different times.

least, to attacks of convulsions. " It consists in a peculiar mode of inspi-

515. It is interesting to observe how the ration, which it is difficult accurately to

series of symptoms in the convulsions of in- describe.fants are affections of the excito-motory 521. ° The child having had no apparentfunctions. warning, is suddenly seized with a spasmo-

516. Amongst the most frequent of the dic inspiration, consisting of distinct at-

symptoms is strabismus ; in a second case we tempts to fill the chest, between each ofmay have contractions of the thumb and which a squeaking noise is often made ; thefingers, of the wrists, and of the toes and eyes stare, and the child is evidently infeet ; next comes that affection of the larynx great distress ; the face and extremities, ifand of the muscles of inspiration, which has the paroxysm continues long, become pur-been so well described by the late Dr. John ple, the head is thrown backwards, and theClarke, as a "peculiar species of convul- spine is often bent, as in opisthotonos ; atsion ;" in other cases the larynx is actually length a strong expiration takes place, a fitclosed, and there are an expression of fright, of crying generally succeeds, and the child,and, sometimes, retraction of the head, and evidently much exhausted, often fallsviolent convulsive expiratory efforts ; in a asleep.fifth case there is an affection of the sphinc- "In one of these attacks a child some-ters of the bladder and intestine, even lead- times, but not frequently, dies.ing to the idea of calculus. Compare " They usually occur many times in the38, &c. course of the day, and are often brought on517. One or more of these symptoms, or by straining, by exercise, and by fretting;

a sardonic smile, lead to a general con- and sometimes they come on from no appa-vulsion. rent cause.Strabismus is the first of the symptoms 522. ‘ They very commonly take place

which I have enumerated. Like the rest, it after a full meal, and they often occur im-is sometimes acute, sometimes chronic in its mediately upon waking from sleep, though,character. The eye is turned inwards,most before the time of waking, the child hadfrequently, sometimes obliquely. The stra- been lying in a most tranquil state. As thebismus is variable, obviously augmented by breathing is affected by these paroxysmsteething, improper food, constipation or fret the complaint is generally referred to theof the bowels, &c., and it is relieved by re- organs of respiration, and it has been some-lieving these states of irritation. It is times called chronic croup ; but is very dif-

equally obviously increased by nervous agi- ferent from croup, and is altogether of atation, by calling the muscles into greater convulsive character, arising from the sameaction than usual, &c. causes, and is relieved by the same remedies

518. Very similar to the undue action of as other convulsive affections.the muscles of the eye, inducing strabismus, 523. " Accompanying these symptoms, ais that of the muscles of the fingers and toes, bending of the toes downwards, clenchinginducing clenched hands and contraction of of the fists, and the insertion of the thumbsthe feet. This affection is noticed by into the palm of the hands, and bending theUnderwood and Clarke, and particularly fingers upon them, is sometimes found, notby the late Dr. Kellie of Leith; the last only during the paroxysms, but at othernamed writer published a paper expressly times.on it. It is augmented by causes similar to " Clenching the fist with the thumb in-those which augment strabismus. It is, like serted into the palm of the hand, often ex-strabismus, apt to assume a chronic charac- ists for a long time in children without beingter, and it always constitutes a symptom much observed, yet it is always to be con-portentous of other forms of spasmodic and sidered as an unfavourable symptom, andconvulsive affection. frequently is a forerunner of convulsive dis-

519. The peculiar convulsion described orders, being itself a spasmodic affection.by Dr. Underwood, and especially by Dr. 524. " It rarely happens that a child re-John Clarke, must next be noticed. Dr, covers from an attack of this sort, unlessUnderwood describes it as combining a little the progress of the disorder has been inter-blueness of the lips, slight turning up of the rupted by a timely application of propereyes, a peculiar sound of the voice (somewhat remedies, without a general convulsion.like croup), and a very quick breathing at Then the friends become alarmed, and a dis-intervals, frequently coming on during sleep, ease which had existed for two or threeor any exertion of the body, or transient months, is, for the first time, considered tosurprise. be important enough to require medical

520. Dr. J. Clarke’s description of this assistance, after all the farrago of populardisease is highly interesting. He observes:- medicines, such as fit-drops, soot-drops,

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assafoetida, &c. have been ineffectually ap-plied.

525. 11 Convulsions of this descriptionseldom, if ever, occur after the expirationof the third year of a child’s life, and notoften in children which have lived by suck-ing till they have teeth, and have nevertaken animal food till the dentes cuspidatihave come through the gums; this, however,is liable to some exceptions."

526. The next question is that of thenatunc of this affection ; and, in discussingthis question, I must particularly notice theopinion of the late Dr. J. Clarke, that it iscerebral in its origin; and of the late Dr.Hugh Ley, that it arises from the compre-sion of enlarged glands upon the pneumo-gastric nerve.

527. In reference to the opinion of thecerebral origin of this disease, I may ob-serve :-

1. That the changes in the symptoms,whether for better, or for worse, are far toosudden to be dependent on disease withinthe head.

2. That the effects of its causes and ofremedies are of a character totally ditferentfrom what would be seen in such disease.

3. Hydrocephalus,—I mean tubercularhydrocephalus, - does not produce thecroup-like convulsion. This statement

must, however, be received with caution,and be submitted to new observation. I

528. Meantime I may add the followingremark with which I have been favoured byDr. P. Hennis Green. This gentleman ob-serves :-

’

I have looked over 66 cases of acuteand chronic meningitis occurring in chil-dren, which I possess in manuscript, and donot find a single example of the coexistenceof crowing inspiration.’ Most of the caseswere examples of the tubercular’ form.It should, however, be remarked that allwere cases of the disease occurring in chil-dren above twelve months of age, and lar-yngismus stridtiltis,’ I believe, generallyattacks children under that age."

In reference to the opinion of the croup-like convulsion being dependent upon com-pression of the pneumogastric nerves, Imust cail your attention to the followingobservations :-

529. Dr. Merriman observes :.-« It is byno means anuncommon affection of children,arising generally from improper feeding, andclose and confined apartments. If timelyattended to, the complaint commonly yieldsto daily aperients, so as to produce at leasttwo copious motions, and continued dosesof soda, a strong infusion of burnt sponge,with proper attention to diet and regimen.When the head is manifestly affected, cup-ping-glasses behind the ears are required:but when the patient has cold, pale, flabbycheeks2 as have not unfrequently observed

in this disease, abstraction of blood is ratherinjurious than beneficial.

530. " In two cases of this kind, whichwere under my care nearly at the same time,the cleildren died in fits. They were bothopened by Mr. Sweatman, a very skilfulanatomist, but not the slightest aypeurance ojcerebral affection could be discovered ineither of them. The principal derangedstructure discovered, was a collection ofsmall glandular swellings in the neck, press.ing upon the par vagum."

531. It has been recently attempted, byDr. Hugh Ley, to found the pathology ofthis interesting disease upon observations,such as that adduced by Dr. Merriman, butI think unsuccessfully.

532. In the first place, as far as my me.mory and judgment serve me, the cases ad-duced to support this view, are not cases inpoint, but, in reality, cases of other dis-eases.

533. Secondly, supposing pressure uponthe pneumogastric to exist, it would inducetotally different phenomena from those actu-ally observed in this disease ; and it wouldnot explain the series of phenomena whichactually occur in it ; for,

534. Firstly, such pressure would inducesimple paralysis.This would, in the first place, affect the

recurrent nerves, and the dilator muscles ofthe larynx; it would induce a partial butconstant closure of that orifice,-a perma-nent state of dyspnoea, such as occurred inthe experiments of Legallois, or such as isobserved to be excited in horses affected with" cornage" or roaring, as described by M.Dupuy in his treatise " De la Fluxion Pe-riodiqne," 1829, p. 117, &c.

535. Secondly. It would induce paralysisof the inferior portion of the pneumogastric,with congestion in the lung or lungs, and thewell-known effects upon the stomach of thedivision of this nerve, with paralysis of thecardia.The disease in question, on the contrary,

variously designated, " peculiar coamulsion,"spasm of the glottis," &c., is obviously apart of a more general spasmodic affection,and frequently, indeed most frequently,comes on in the midst of the first sleep, inthe most stiddett manner; receding equallysuddenly, to return, perhaps, as before, aftervarious intervals of days, weeks, or evenmonths. Very unlike paralysis from anycause. Nay, the convulsive efforts in themuscles about the larynx are frequentlyquite obvious. There is even opisthotonos,or conprosthotonos, in some cases.

536. Thirdly. It not unfrequentlyinvolvesor accompanies, as I have said, other affec-tions irxdishaclulay spasmodic, as distortion ofthe face, strabismus, contractions of thethumbs tote palms of the hands,-of thewrists; feet, toes, general convulsions, sud-

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den dissolution,—a series of phenomena to-tally unallied to paralysis.

537. I’ozcrthly. Indeed the larynx is some-times absolutely closecl,-ati etlect which

paralysis of the recurrent nerve, and of thedilator muscles cannot produce.

538. Fifthly. Paralysis from the pressureof diseased glands would be a far less cur-able disease, a far less variable disease, a farless suddenly fatal disease than the croup-like convulsion.

539. Sixthly. Almost all recent cases areat once relieved by attention to three or fourthings, viz.: the state, 1, of the teeth; 2, ofthe diet 3, of the bowels ; and 4, by changeof air ; they are as obviously produced orreproduced by the agency of errors in oneor more of these.

540. Seventhly. In fact, the croup-likeconvulsion is a spasmodic disease, excited bycauses situated in the nervous centres, oreccentrically from them ; in a case of spinabifida already mentioned, a croupy and con-vnlsive inspiration was induced by gentlepressure on the spinal tumour; in cases

from teething the attack has been inducedand removed many times by teething, andby freely lancing the teeth, by crudities, andby emetics and purgatives, by change ofair, &c.

511. Eighthly. There is a series of factswhich prove the connection of this diseasewith other forms of convulsions in chil-dren, and with epilepsy in the adult subject.

542. Nintkly. In protracted cases, con-gestion and eil’tision within the head occuras effects of this disease.

543. Lastly. Innumerable cases of un-doubted croup-like convulsion have occur-red, in which no enlarged glands could bedetected in any part of the course of thepneumogastric nerve.

544. But if the contiguity of enlargedglands with the pneumogastric have any COD-cern, in any case, in causing this disease, Ibelieve the action is one totally different fromthat assigned, and not suspected by the au-thor of this opinion. It is obviously an ac-tion upon this nerve, as an incident excitornerve, and not as a mere niotoi, or muscularnerve.

-

545. I must here detail an experimentupon the pneumogastric, made by Mr.Broughton, but hitherto unapplied to anyquestion in physiology or pathology. Thepneumogastric was laid bare in a donkey,and pinched continuously by the forcepsthe animal made a sudden act of inspirationand of deglutition. The nerve was divid-

ed ; the Uppel’, or incident portion of thenerve, was pinched with the same effect asbefore; the lotvei- extremity of the nervewas pinched without any effect.

I may here, also, refer once more to theinteresting experiments by M. Dupuy, p.130, &c. for a similar fact. ,

546. In this manner, I conceive1 irritation

of the pneumogastric in the neck may haveinduced the croup-like convulsion. Pres-sure upon this nerve, inducing paralysis ofits rernote extremity, could not possibly in-duce the phenomena in question.

547. It would be difficult to adduce amore convincing proof of the pathologicaland practical importance of the views of thenervous system, which I am laying beforeyou.

548. I venture to suggest another view ofthis matter as nearer the truth, viz., that thisdisease is induced through thefiftft pair ofnerves in teething, the pneumogastric in in-digestion, and spinal nerves in constipation,as parts of the excito-motory system. Theview itself points to the most useful andefficient remedies, and this is highly import-ant ; it points to the teeth, indigestion, andconstipation, as causes, and to the well-known means of removing them; it pointsto the important objects involved in changeof air, mental quiet, &c.

549. If, instead of the popular remedy,(the warm bath), the gum-lancet, and fullwarm water enema, were instantly adminis-tered, many little patients would be savedfrom the effects of this terrible disease.The diet should be barley-water only.

550. The respiration is actually arrestedby closure of the larynx; there are forcibleexpiratory efforts only, or principally, in theactual convulsion. This need scarcely bedescribed ; the eyes are distorted from theiraxes; the face is drawn into horrible forms;the mouth is filled with foam ; the body andthe limbs are variously and shockingly con-vulsed. The countenance is livid withvenous blood, affording an index to the con.dition of the brain. There is perfect coma,sometimes long-continued, or there may besudden dissolution.

551. Sometimes a more transient and par-tial convulsive movement occurs, like anelectric shock. In one deeply interestingcase, such a convulsive affection was some-times ushered in by a sardonic smile. Inother moments the little boy was obviouslyexpecting the shock in alarm.

552. In another very interesting case therewere strangury and tenesmus, symptomsleading to the suspicion of calculus. The

lancing of the gums afforded immediaterelief.

553. As in the affection noticed in my lastlecture, cerebral disease wa described asfrequently leading to convulsion; so, inthose which I have just mentioned, the con-vulsion frequently leads eventually to cere-bral disease, especially congestion and effu-sion. The due relation of the disease of thecerebral and true spinal subdivisions of thenervous system is plainly seen. Hithertothere has been little but confusion in our

views, both of the pathology and treatmentof these several diseases.

554. We may now discern that, whilst in

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the cerebral diseases our remedies were warm salt and water is also a valuable

chiefly directed to relieve the morbid con- auxiliary remedy.dition of the arterial or capillary circula- 562. It is impossible to misconceive thetion within the head, in the diseases of the vast importance of this subject. If anythingtrue spinal system, our efforts must be could add to this importance, it is the factmade to remove the cause, or causes, of that the convulsions of infancy frequentlythese diseases, whilst we guard against their lay the foundation of epileptic attacks in

effects, viz., undue venous congestion of the youth, or adult age. Sometimes the tran-cerebrum, and of effusion. sition is so gradual and continuous, that the

555. I need scarcely advert to the errone- two affections are proved to be obviouslyous views, and, consequently, erroneous the same.mode of treatment of this affection, of those The subject of dentition has not even yetauthors who have considered it as origi- been fully investigated, in reference to con-ally an affection of the encephalon. Cause vulsion. Is the temperature augmented?has been mistaken for effect, and effect for This point should be determined by a ther.cause. The effusion, for example, which is mometer. Is there a state of sub-inflamma-the effect of the previous convulsive tory action? And may not this be subduedstruggles, has been considered as their ex- by scarification of the gums, on the same

citing cause. The whole confusion upon principle as inflammation of the conjunc-this point has arisen from not observing to tiva? Does this view afford us a new andwhat subdivision of the nervous system important motive for a more frequent andthe first symptoms belong. I quite agree extensive use of the gum-lancet? laywith Dr. Merriman in condemning, as use- the excitation of the trifacial nerve be thusless, or rather as injurious, the indiscrimi- removed, and its effect subdued? Withnate and lavish detraction of blood. these objects the gums should be fully di-

556. The proper mode of treatment com- vided, not once, or occasionally, but twice,prises the remedies- or even thrice, daily. Anything rather than

1. Against the attcecks. repeated attacks, which may lead to con.2. In the attacks, and in the threatening vulsion, and eventually to cerebral disease

of the attack. and enfeebled intellect, or crippled limbs.3. Against their effects. With the same objects, the diet and the

557. The remedies against the attacks, or condition of the bowels must be attended tothe prevention, consists in avoiding all the with equal energy. All irritation must beexciting causes: dental, gastric, intestinal avoided, and amongst these drastic medi-irritation ; passion ; vexation; disturbance; cines must be arranged. A young nurse’sinterrupted sleep, &c. or asses’ milk should constitute the former.

558. The remedies in the threatening of Enemata of warm water may be used eflec-attacks consist in the watchful and prompt tually to relieve the bowels, night and

repetition of the same treatment; lancing morning.the gums, relieving the stomach and the The tinctura hyoscyamis, and the hydro.bowels. The sleep especially should be cyanic acid, are important auxiliaries, butwatched, and if there be a sardonic smile, especially change of air.or starting, or other symptoms, the little A cold lotion, the ice-cap, perhapspatient must be gcntly awoke, and the re- leeches, must be used to guard the head;medics just enumerated should be adminis- the feet must be fomented, and kept care.tered. fully warm.

559. After the gum-lancet I would advise 5g3, I shall conclude this lecture by call-a copious enema of warm water. ing your attention to a case not hitherto

If there be great threatening of an attack, well known to the profession, viz., paralysisI would tickle the fauces, dash cold water from dental irritation.on the face, and irritate the nostrils, having A little girl, aged twenty months, wasthe patient placed, as speedily as may be, in taken, when sufferidg from dentition, withthe warm bath, loss of the power of elevating the right arm560. To guard against the effects of the -that of closing the hand remaining; thereattacks, we may deplete the blood vessels was no other symptom of cerebral affection.about the head with cupping, or leeches, was nor symptom of cerebral aaect.on.apply an alcoholic lotion constantly all The suffering from dentition was undoubted,over the head, or, if the case be urgent, the

I therefore concluded that the case was one

ice-cap. ’ ’ ’ of paralysis from teething.

561. In addition to these measures, the 564. The gums were freely lanced, thesecretions must be corrected, mild mercu- bowels well moved, the diet strictly regu-rials being given, perhaps, to affect the sys- lated ; and, for fear of hidden disease withintem ; afterwards change of air is of un- the head, two leeches were applied. Andoubted efficacy; and a very mild tonic embrocation was prescribed for the arm.plan may be added with advantage, as A few days after the attack of paralysis,minute doses of the sulphate of quinine, of this little girl was seized, in the early partthe carbonate of iron, &c. Sponging with of the night, with a fit of crowing inspi-

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ration. This event confirmed me in mydiagnosis.The event justified the view I had taken.

The child recovered perfectly, without anyenergetic remedy being used for cerebralaffection, by continued attention to the stateof the gums, the stomach, and the bowels;an event which could scarcely have occur-red, from such simple measures, had therebeen such decided affections, arising fromcerebral disease.

565. This case was watched with pecu-liar interest, from the circumstance of itsoccurring in the family of a medical friend,Mr. Grant, of Thayer-street.

566. But I will give this interesting casein Mr. Grant’s own words :-

11 M. A. G-, at twenty months, has beensuffering for some time from dentition, being fretful, and having a cough during the

night. This morning, April 30th, 1835, hermother observed that she was incapable of

raising the right arm ; she retained thepower of swinging the arm backwards andforwards, and bending the forearm on thearm, but had not the least power to raisethe arm itself, as if the deltoid muscle onlywas paralysed. On examining the arm thechild suffers no pain, and there is not theleast reason to believe that any accidentcould have occasioned this loss of power.The general health of the child, with theexception above mentioned, is excellent;appetite good; bowels are every day re"

lieved.11 Dr. Marshall Hall, on seeing the child,

recommended a gentle emetic, followed by adose of castor-oil; the gums, over the foureye teeth, which are all coming forwards, tobe carefully lanced every second day ; and,alternately, an embrocation to the arm, anda light unirritating diet." May 7th. Little alteration in the state of

the arm, which the child is perfectly unableto raise in the smallest degree. The castor-oil is given every morning, which producesfree and healthy evacuations; the gumshave been repeatedly lanced, but the teethdo not advance; she still coughs during thenight, but last night she had several fits ofcoughing, resembling the convulsive crow-ing of croup ; but, as there was no heat ofsurface, or quickening of pulse, nothing wasdone. To-day it was considered prudent toapply two leeches to the back of the ear,and have the hair removed from the backpart of the head, and the same plan of treat-ment as before was pursued." 1-ltb. There has been no return of the

crowing cough, and the child’s generalhealth continues very good. She now evi-dently has regained some power in raising ,,the arm ; continue the mild diet; occasional i,doses of oleum ricini, lancing the gums, and’the embrocation to the arm. ’

" 21st. She daily.acquires more the use of

her arm. One of the teeth hats come up tothe surface, and the others are advancing." June 10th. She has nearly regained the

complete power of her arm ; her nightcough is almost gone, and general health

improving. The other teeth are not quitethrough yet; regularity of diet and attentionto the bowels enjoined.

11 August 20th, The child has been forsome time in the country, and has perfectlyrecovered the use of her arm. The fourteeth are quite through. Up to the presenttime she has never changed her diet in anyway, taking bread and milk for breakfastand supper, and bread-pudding, with a

single egg in it, for dinner. Her bowels areso regular that she has required no medicinefor some time.—August 20th, 1835."

567. Before I conclude this subject, andthat of diseases of the nervous system ininfants and children, must very briefly noticea paralysis of a different kind.

568. We frequently observe a hemiplegicparalysis from defective development of theopposite hemisphere of the cerebrum. (See§ 150.) In this case both arm and leg, butchiefly the arm, are involved in the para-lysis. But it occasionally happens that oneleg only is affected with a partial paralysis;the limb does not grow as the other leg does,but remains thinner and shorter; yet it doesgrow, so that the paralysis is not complete,and it is moved, only with somewhat lesspower than the other leg. What is the na-ture of this partial paralysis ? Is it of den-tal origin ? Is it an affection of the spinalmarrow, or of its nerves, equally partial?Cases, and careful examinations, are entirelywanting to determine these questions. Ithink this subject might be illustrated bythe experiment of dividing the posterior, organglionic nerves of the spine, which pro-ceed to the lower extremity in a very younganimal. Sensation with nutrition would belost, or impaired, whilst the muscular powerwould remain.

569. But sometimes the muscular poweris entirely paralysed. You may comparethe following interesting case of the son ofmy friend, Dr. Webster, of Dulwich, withone taken from Dr. Abercrombie’s ablework :-° When my boy was about twentymonths old (he is now nine years) he had a.

fit of illness, connected with dentition, whichthreatened the brain, and for which I openedthe jugular vein and purged him. Thistook him off his feet, and, very soon after,he had a fall from a rather high crib-bed ; ;but this was not attended or followed byany apparent bad consequences. The childrecovered his health ; but for some weekshe seemed to have almost entirely lost theuse of his legs, and, being uneasy abouthim, several of my medical friends saw him,among others, I think, yourself. He gra-dually, however began to walk. again, but

880

not so steadily as before, as he tottered !,much in his steps, and was constantly fall-ing over every little object that happened tobe in his way, and he had much less com-mand over the left limb than the right. Heseemed to walk on his toes. It was not atfirst ascertained that one leg was more af-fected than the other; but as he grew upand was breeched, the matter became moreapparent; he plainly walked more firmly onthe healthy limb, and less so on the lameone, and he threw’it about more in walkingand playing, and rarely set down the heel,except when walking slowly ; never whenrunning. He now runs on the toes of thatfoot, and with a sort of lurch; the limbis less firm ; the muscular power is evidentlyless, but the sensibility seems equal to theother. I have only to add, that the affectedlimb is about an inch shorter than the other,which is the reason (of his walking on thetoes."

570. « It is now upwards of twenty yearssince I first saw a girl, aged, at that time,about eighteen months, and previously en-joying excellent health. She had been leftfor some time sitting upon damp grass, andwas immediately seized with fever, accom-panied by such a degree of oppression asled to an apprehension of an affection of thebrain. These symptoms, however, passedoll’ in a few days, and upon her recoveryfrom them it was found that she was en-tirely paralytic in the right lower extremity..She has from that time enjoyed uninterrupt-ed health, and is now a tall and strongyoung woman ; but the right lower extre-mity has continued entirely paralytic ; it isalso a great deal smaller than the oppositeextremity, and several inches shorter. Allthe joints are remarkably relaxed, and themuscles flaccid ; but there is no other ap-.pearance of disease in any part of it, or inthe spine."In concluding this, I wish to advert once

more to the subject noticed § 533.There is such a case as paralysis of the

pneumogastric nerve, and of the dilatormuscles of the larynx ; it occurs in [deep-intoxication, and probably in other cases ofcoma, as in that of apoplexy, of epilepsyfrom opium, &c.A patient affected with such paralysis

from deep intoxication was rescued from

impending death by tracheotomy, at the sug-gestion of Mr. Sampson of Salisbury. Thecase is published in the " Medico-Chirurgi-cal Transactions," vol. xx. p. 45, and formsone of the most splendid achierements ojmodern Surgery. I shall revert to it hereafter.

This interesting case contrasts painfullywith a case of spasmodic contraction of thelarynx, from a portion of food arrested inthe upper part of the oesophagus, published.by Mr. Kirby, in the " Dublin HospitalReports," vol. ii., p. 225. Tracheotomy washere, also, performed, but it was too late.

LECTURESON

MATERIA MEDICA AND

THERAPEUTICS;NOW IN COURSE OF DELIVERY

AT THE

WINDMILL-STREET SCHOOL OF MEDICINE.BY

GEORGE G. SIGMOND, M.D.

ZINC—ZINCUM.ZINC—BISMUTH—TIN.—Natural history of

zinc; SltltS of zinc ; the oxide ; its me-dical properties ; the carbonate ; formulafor preparing the sulphate of zinc; action ofthe sulphate in epilepsy and in chorea; ne-cessity of distinguishing these affectionsfrom hysteria. BISMUTH.—The pure metal;its nitrates. Poisonous effects of the ti-isizi.trate ; practice of the German physicians;its value in certain affections of the stomach;the pearl-potcder. TIN: Remedial powersof the metal. H7id?,ochlorate of tin. Laboursof the German and French chemists.GENTLEMEN :-The salts of zinc have been

introduced into medicine, and possess someuseful properties. Paracelsus gave thismetal the name by which it is known to us;he mentions this and bismuth as substancesapproaching to metals, but not really metal-lic, as they wanted two properties, whichhe believed to be the essential characteristicsof metals, fluidity and ductility; he statesthat zinc is a spurious offspring of copper,and bismuth of tin. Agricola called it con-tre-feyne, and Boyle, speltrum.

Zinc is found in great abundance in mostof the mining countries of Europe, and like-wise in India, from whence it is brought tous under the name of tutenague; pure zincis of a brilliant white colour, with a bluishtint, and has a very distinct lamellated tex-ture ; it weighs 7.190 ; it fuses as soon asit becomes red-hot at 773 ; if heat be con-tinued after this fusion in close vessels, itrises into vapour, sublimes, and forms abrilliant metallic substance, on the upperpart of the vessel. If the metal be acted onin a crucible by fire, until it becomes of a

bright-red colour, on exposure to the atmo-spheric air, and, if it be at all agitated, itsuddenly takes fire ; it emits a flame whichis very striking, tinging every object with a

slight greenish hue, but shedding around amost brilliant lustre ; an oxide of zinc isformed, which appears floating in the airlike a white flocculent substance, and a

thick smoke having some odour, and atfect.ing the throat and fauces ; this oxide, formedin the air, has been called philosopher’swool, pompholyx, nihil album, and flowersof zinc.