360

objectionable, and capable of doing muchmtscliief, especially in infants ; such arethe more drastic purgatives, and calomelamong the rest.

It’ worms are actually discharged, andwe have sufficient evidence to believethat they are the occasion of the disorderpresent, it be proper to attempt theirremoval. This is accomplished In two

ways ; first, by administering medicin s

which, as is sopposed, will destroy the

worms, and which are called anthelmin-tics; secondly, by forcibly dislodgingthem, by exciting a violent action of tileintestinal canal by purgatives.The efficacy of many or most of the an-

thelmintics that have been proposed, is

vory questionable. This is shown by thefact, that none of them retain long theirreputation; wnich they might be expectedto do, if they wete really as efficacions asalleged. I may nrentiun the powder of’tin, the fern-root, the anthelmia, or In-dian pink root. and the cow-itch: these,with many others, are liable to the obser-vation I have just made. Purgatives, audthose of the most active kind, are in

reality the only unequivocal means wepossess for removing worms from the in-teslines. The oil of turpentine deservesto be distinguished hel e, tor its superiorefficacy ; and it is particularly ser vice-able in removing the tape-worm), whichit commonly does entire, while other pur-gatives bring the worm away piece.meal.It requires to be exhibited it) a large do.e,as all ounce, or an ounce and a half; inwhich quantity it operates much moremildly than could have been expected.It commonly purges very quickly and ac-tive.y, but still without violence. Some-times it occasions vomiting, and a kindof intoxication, which lasts a few hours,but is of no importance. It is remark-able, that although in small doses the oilof turpentine is apt to irritate consider-ably the urinary organs, it seldom hasthis effect when largely administered,probably, because its quick operation as

a purgative, leaves no time for its beingabsorbed Im the lacteals.Where ascarides are lodged in great

numbers in the rectum, as is often the

case, they may be removed by an injec-tion of the oil ot tnrpentine.

It is not to be forgotten, that wormsare rarely fonud, where the naturalfunctions of the stomach and bowels arewell performed. Hencf it is an object ofthe first importance to restore the healthyaction ot’ these parts by bitters and othertonics, and by attention to the patient’sdiet. Now it is evident, that the frequentemployment of drastic purgatives wouldcounteract this object.

REVIEW.

A Practical Dissertation on the means ofobviating and trealing the varieties ofCostiveness, which occur ut differentperiods of life, and in cases of predispo-sitions to various Constitutional Mula-

dies, in peculiar temperaments of body,in disorders of the lungs, stomach, liver,rectum, &c., and during Pregnancy, byMedicine, Diet, &c. By RICHARD REECE,M. D. Member of the Roy,tl College ofSurgeons. 8vo. pp.351. Longmanand Co. 1826.

Dr. Reece is pretty generally known to

the public as the author of’ " The Medi-

cal Gtude for the use of the heads of

Famines, the Clergy, &c.," and as Edi.

tor of a periodical work, called " The

Uazetteof Health," both of them devotedto what may be called popular or domes-tic medicine. We look upon the presentvolume as a continuation of the series,but are by no means prepared to assert

rnat, as well as its prodecessors it does

not contain many things to interest the pro-fession. Costiveness, one of the most

common " ills that Hesh is heir to," the

ertile, and probably the most ancient,*rarent of disease, has perhaps addednore thin any thing else to the vocabu,

of medicine. Barely to enumeratehe various orders of catharties which

have swelled the materia medicasofeveryand conntry, would be no easy task;

or is it less (Jifficult to explain all the

causes of costiveness, or why it assumes- nch a variety of forms. Cullen has no.

iced three species of costiveness,—1.Ob-

* The Ibis is said to have tanght theEgyptians to obviate costiveness bv thense of ciysters ; and according to Hero.dotus and Pausanias, Melampus learnedthe use of hellebore by observiug thathis goats were purged after browsingupon it.

361

Itipatio debilium ; in persons of a lax,weak, and, in general, dyspeptic habit.2. Obstipatio rigidoruin in persons of arigid, often hypochondriac cemperament,but these, as Dr. Young observes, are

scarcely vaiieties; and his third species,obstipatio obstructorum, is a symptom of

colic. Good makes only two species,’ constipation and obstipation ; the first,’

" in persons of a compact and robust

bahit, with hearty appetite and strongdigestive powers," arising, he thinks,from the " intestinal absorbents occa-

sionally evincing an excess of action,the fæces, while they become harden-ed in consequence of such action, assnm-

ing, from their copiousness, the figureof the rectum." The second species, ob-

stipation, is the consequence of debility,or diminntion of the irritability of the

muscularfibres of the intestines, occurr inggenerally in elderly subjects, or personsot infirm or delicate health. In old peo-

ple, it is often necessary to remove the

freces impacted in the rectum by a mar-row spoon, a practice first recommended

by the late Dr. Warren. On the second

species we need not dwell at present.Vhetherthefirst arises from an excessive

activity of the absorbents we are nncer-

taiu, hot we have often met with it in

persons of great gastric capacity, and ot

thetfmperament he describes. It is pro-bable that the peristaltic motion of theintestines is in the inverse ratio to the

contents, and that this may have some

effect in producing costiventss. To hastenthe descent of the fæces, he recommendsthe milder eccropotics, such as the ex-

pressed oils of the olive and almond ;

oily farina of the cocoa nnt, in the forn,

of chocolate ; pulp of cassia, either

alone or in the form of lenitive elec-

tnary, &e. Dr. Arbuthnot advised tht

use of butter, marrow, and fat, appa-rently on the authority of Celsus. Cul-

len tells as that he found fonr ounces of

fresh butter, taken in the morning, pro-duce a stool or two more than tistial in

the day. We shall merely add horse-radish, mustard seed, cloves of garlic,salads, and undressed vegetables of allkinds, to the list ; and conclude this partof the subject, not deeming it necessaryto proceed from the dieratical to what

especially belongs to the medical treat-

ment of costiveness, upon which proba-bly weshould throw no new light. After

making some useful remarks on diet,Dr. Reece recommends the patient " to

attempt to exercise his mind on the

bowels," and observes, that the-

" Influence of the stimutating and de-pressing passions of the mind on the sto-mach and intestines, and also on some ot

the viscera of the abdomen and pelvis, iswell known; the sudden action of stimu-lating ones, as anger and joy, soon aftera menl, interrupting digestion, and some-times exciting vomiting ; and the suddenaction of grief occasioning violent purg-ing. By frequently ditecting the mindto the intestinal canal, and making aneffort to bring it into action, by excitingthe diaphragm, and the abdominal mus-cles, we think a person might, by perse-vefanct’, bdng the muscular coat of theintestines, in some degree, under the in-fluence of the mind, the peristaltic motionbeing evidenlv easily retarded or in-creased through its medium. Dr. Hunterhas noticed a case of a prolapsed uterus,which the female had, by frequent erlorts,brought so tar under the action of themind. as to move the protruding partbackwards and forwards; and we haveno doubt, those who have established re-gular bowels, by making frequently, forsome time, a kind of mental effort, havebrought the muscular coat of the lowerintestines, in some degree, under the tn-fluence of the mind. We know a m..dicalgentleman who cannot remain ten mi-nntes in the shop ot a bookseller in Fleet-strett, without experiencing an urgentnecessity ofvisitiug his water-cioset, al,dthat too after having had his regulardaity evacuation. This effect he attri-butes to the noleful countenance of thebookseller. The fact shows how easilythe bowels are disturbed through themedium of the mind."

If the " doleful countenance ot a book.

seller" has such a magical influence on

362

the sphincter ani, we are sure there willbe no need of purgatives in the Row forthe next twelve months at least, for cer-

tainly the place is filled with doleful faces,luctus ubique et ptivor ; but we trust thatthe sun of misfortune has set, and that

a brighter and more prosperous morrowis at hand. Grief and fear are said to

occasion sudden and violent purging ; wedo not, therefore, deny the practicabilityof " exercising the mind on the bowels;"on the contrary, we regret that our an-thor has given no precise directions forattempting it. We ourselves know an

apothecary who cannot mix, what ourfriend Johnson calls, " a black draught,"without feeling a disposition to evacuate,but in his case there is an obvious asso-

ciation of ideas, as in Themison’s, who,as Cœlius tells us, relapsed into hydro-phobia whenever he attempted to writeupon it; * but we do not see that a

bookseller of " a doleful countenance" is

more likely to send his customers to the

temple of Cloacina than another, who is

ever jocund and ever gay.

To proceed : the purgative which theauthor has found most useful in cases of

constitutional costiveness, is an alcaline

extract of jalap, which is made by gentlyevaporating (balneo aquœ) an infasion ofthe root in proof spirit, a small quantityof subcarbonate of’ potash being added" to prevent a separation of the resin,"upon the evaporation of the menstruum.Fiom three to ten grains of this extract,made into pills, with a few drops of ol-carni, may be taken every other night.The anthor makes a few observations onthe colon and kidneys as " depurators ofthe blood," and concludes his chapter on" constitutional costiveness," by quotingtwo cases by Dr. Borthwick, which arerelated in the Ed. Med. Journal for Jan.

* De morbis acutis. Lib. iii. cap. xvi.

1825, and noticed in THE LANCET, vol.

v. p. 209.

In his next chapter (costiveness of thesedentary and studions) the doctor makesthe following, as we think, judicious ob.servations :-" On the dinner meal of merchants

who lead sedentary lives, and of clerkswho are much confined to theconnting.house. Dr. Paris, in a late publication,makes the following remarks :-

In all cases of feeble or imperfectdigestion, the valetudinarian ought neverto take his principal meal in a state offatigue, and yet, (says the doctor,) letme a,k, whether there is a habit more

generally pnrsued, or more tenacionslydefended ? Aye, (proceeds the observantDoctor,) and defended too upon principle!The invalid merchant, the backer, theattorney, the government clerk, (says he,)are all impressed with the same belief,that after the sedentary occupatious ofthe day, to walk several miles to theirvillas, or to fatigue themselves with ex.ercise before their dinner, or rather earlysupper, will sharpen their- tardy stomachsand invigorate their feeble organs of di-gestion. The consequence is obvious—instead of cnring, such a practice is cal-cnlated to perpetuate, and even aggra-vate the malady under which they suffer,by calling upon the powers of digestionat a period when the body is in a stateof exhaustion from fatigue. Often haver, in the course of my practice in thistown, cnred the dyspeptic invalid, bymel ely inducing him to abandon so mis.chievous a habit.’

If a merchant, or a clerk, either of abanker, attorney, or of a governmentoffice, were capable of walking severalmiles before dinner, we should snpposehe could not be much of an invalid. Ifan invalid were so imprudent as to walkseveral miles before dinner, i.e. we pre-some ten or fifteen miles, he must expectto experience all the bad conseqnencesof fatigue. The villas of those gentlenienare generally within the distance of fonrmiles, and such a walk after confinementto a connting house for five or six hours,must not only relieve the fatigned mind,but even invigorate the stomach, by ex-ercising the muscles which had been in astate of indolence during the 11 sedentaryoccupation," and greatly tend to pro-mote the peristaltic motion of theintes-tinal canal. The whole body, by a " se-dentary occupation," is unquestionablyenfeebled ; and walking, by amusing themind, exercising the muscular system, and

363

promoting the circulation in the extre.

mities, will bring the stomach into ac-tion ; and as to the refreshing effects ofa dinner and a little wine, we presume" invalid merchants, &c." are as compe-tent to form as accurate tn opinion ofthem from experience, as Dr. Paris is fromtheory. Certain it is, if they were not tdtake such exercise, their systems wouldbecome plethoric; and if some organicdisease should not take place either inthe lungs. liver, or some internal viscus,apoplexy wonld probably terminate theirlives. lf invalids who are accustomed toexerrise their minds in a sedentary statefor five or six hours every day, or for sixdays ont of seven, were not to take awalk hefore dinner, they would not onlyeat without an appetite, but that whichthey had forced into their stomachs wouldproduce a sense of oppression, and pro-bablyreqaire three or four hours longerto pass through the process of digestion,than if the invalid had previously re-laxed his mind, and exercised his muscu-larsystem even by a fatiguing walk ; fortlie;ense of fatigue from a long walk isspeedily removed by a good meal, witha small proportion of wine."

In like manner, and under npwards oftwenty distinct heads, the author treatsof the costiveness " of elderly people,"offemales at the age of puberty ; of scro-

fulous, hysterical, gouty, theumatic, epi-leptic, rnptured, and plethoric subjects ;of " costiveness attendant on palsy,"jaundice, diseased liver, and Devonshirecolic, (costiveness attendant on the colic,a pleonasm, at least ;) of the costivenessof infants, and of the various tempera-ments, leucophlegmatic, nervous, melau-

cholic, and erysipelatous of retention offæces from mechanical causes, &c. &c.

&c. Several formulas for clysters, withremarks on that class of remedies, con-dude the work. Without stopping to

inquire if this arrangement be philosophi-cal and just, or overstretched, too rami-fied, tedions, and after all, insufficient,we shall merely observe, that it precludesns from giving any thing like a generalanalysis of the work, and pass on to theanthor’s 16th chapter " on the costive-ness of invalids subject to constitutional

or winter cough," where he notices aDaffection of the larynx (sometimes calledphthisis laryngea,) which has not alwaysbeen judiciously treated. He says,- There is a variety of cough attend-

ant on thickening of the part at the topot the windpipe, termed the larynx, withchronic inflammation of the internal mem-brane of the windpipe. This is a verycommon disease in this country, especiallyamong elderly men who have freely in-dnlged in the clieering glass, and in sing-ing, spouting, or preaching. Being at-tended with wheezing, short congh, pa-roxysms of difficulty of breathing, ex-

pectoration, &c., it is often mistaken forasthma, constitutional cough, and con-

snmption, by inexperienced practitioners.The disease may he easily ascertained byexternal examination, the enlargement ofthe larynx being evident to the touch.It is also panf’u: when compressed ormoved. The irritative inflammation ex-tends to the fauces, and there is generallyan acnte pain on swallowiug : indeed, theinflammation sometimes extends two orthree inches down the gullet, when thepatient is very much troubled by an ac-cumulation of phlegm in the pharynx, andsometimes such a quantity gravitates intothe stomach, as to interrupt digestionand produce nausea."

To illustrate this affection, and the me-thod of treating it (salivation,) the Doc-tor quotes the case of Sarah Phtfett fromVol. IX., pate 303, of THE LANCET, andanother of an elderly gentleman, who ex-pectorated a good deal, and had thicken-ing of the larynx, inflammation of thefauces, distressing cough, and severe pa-roxysms of dyspnoea during the night.The Doctor ordered hirud. x. et posteaemp. canth. ad pomum adami, and a me-dicine of which the basis or efficient in-

gredient was the blue pill. In a fortnightthe patient was nearly salivated, andafterwards rapidly recovered. The sequelof the case is as follows:

" The patient afterwards enjoyed healthfor five years. During a residence a fewmiles from London, he experienced a re-turn ot the thickening, with all the it-rita-tive attendants. He applied to a medicalgentleman in his neighbourhood, who pro-nounced his complaint " pulmonary con-sumption." Pruisic acid in the almond

364

emnlsion, the oxymel of squills, Icelandmoss, and the common routine practicein pulmonary consumption, had a fairtrial ; but failing to make any good im-pression on the disease, and a very badone on his general health, the assistanceof a high bred Cambridge physician, withwhom the apothecary wasconnectad, wasrequested. The Doctor, lookillg most

wisely. examined the pulse with his goldwatch, splendid chain and seals, and aftermaking a few inquiries, coincided withthe apothecary. The patient’s strengthcontinning to decline, and his distressfrom difficiilty of breathing, cough, &c.

increasing, he requested our advice. Wefound him in a most emaciated and debi-litated state. The larynx was much en-larged, and the fauces inflamed and ulce-rated. The time had evidently passed,when all alterative medicine would havecured him. The case being hopeless, hiscountenance, wandering state of his mind,small quick pnlse, coldness of’ extremi-

ties, &c. indicating approaching dissolution, we merely ordered a medicine todiminish his sufferings. The fJllowingday he discharged his debt to nature: ’-pp. 206, 207.

Dr. Reece likes a hit at his brother

practitioners, and we have here, at least,allowed him to have his fling in the pagesof THE LANCET. Nor shall we not bestow

on Dr. Reece all the praises that are dueto him as a writer on popular medicine.but we do utterly disapprove of such

treatises being made the vehicles of cast-

ing obloquy and slander on a body ofmen who are, perhaps, as useful in their

sphere, as he can be in his. He moves in

an atmosphere purely his own, and scat-ters his missiles where there is no one to

pick them up. He sometimes tells us, thatsuch things did occur, and then shews byhis narrative, that they did not.

Upon Sarah Parfett’s case, which the

Doctorhas taken without acknowledgmentfrom THE 1,ANCET, we may remark thatwe have cured many worse ones, in

48 hours, by scruple doses of ctlotiiel

guarded by a grain or two of opium. Ot

the other case which the Doctorquoteswedo not think much. Occurring as he tellsus it did ten years ago," we should cer-

tainty have heard of it if he had any idethow or npon what principle the cllre waseffected. Until now, however, althoughhe has a mighty organ to propagate his

discoveries, he has been perfectly silent;and when we look at his formula, we areinclined to believe that his success was

accidental, and that he could not have

relied much upon the blue pill, holdingas it did so in.,ignificant a relation to thedrugs which were mixed with it.* We

do no not like any man to make overt

acts his own.

We shall quote the author’s 19th chap.ter, (on costiveness attendant on the De.vonshire colic,) since it is short, and willserve as a specimen of the general con.duct of the work." On the first attack of the Devonshire

colic, the bowels are generally most ob.stinately constipated. Some practitionersof eminence recommend opium to he ad.ministered, by the month and clysterwise,wth the view of allaying spasms andmorbid irritation of the intestines, pre.viously to the employment of an aperientmedicine ; whilst others contend that,when the opium is intimately mixed with apurgative medicine, the latter does notexcite nausea or vomiting, and operatesmore easily and expeditionsly, iu conse.

qnence of the opium removiug the spas.modic construction of the muscular coatof the intestines ; and this latter practiceunder the direction of the late Mr. Cam,of Hereford, and Dr. Blount, at theHereford Infirmary, (a county in whichthis disease prevails,) we have known to

prove most beneficial.The following is the composition ofthes6

eminent practitioners :: Take of opium powder, two grains ; cathartic

extract, twelve grains; prepared calomel, tbreegrains.A cathartic clyster of infitsion of senna,

Epsom salt, and tincture af opinm, wasalso administered, and the bowels wet.fomented, till an evacuation was produ-ced.

* The forrnula was as follows:Px Pit. hydarg. ss. Pulv. ipecac. gr.x.

Ammoniac, gu. ij. Ext. gratrolœ (hedgehyssop) ss. sur. simp. quantùm satis

sit. Frat pil. xxx. We ask any one ifthese pills could have been prescribed forthe purpose ot’ bringing the system underthe influence of mercnry ?

365

A stlmnlating purgative is necessary inthis species of constipation, although thetension and tenderness of the bowels, onpressure, and the state of the blood-vessels,may render bleeding and blistering neces-sary; for when the disease has been re-moved by it. the patalytic affection of theupper extremities is always much less thanwhen a solution of the Epsom salt, in aninfusion of senna, was exhibited under thedirection of another physician of the sameinstitution. Althongh the constipation isnot occasioned bv a mechanical obstruc-tion, a, in the disease tertned introsuscep-tion, when it proves obstinate, it will re-

quire the same decisive treattnent to re-move it as recommended for introsuscep-tion, In one obstinate case, the followingcomposition, taken at once, produced thedesired effect:Take ofcroton oil, two drops ; Castile soap,

four grains; extract of henbane, five grains; colo-cynth powder, four grains; oil of cloves, t o drops.Tube mixed and divided into middle-sized pills.

In another case, the croton oil excitedvomiting. It appears by an account of!the croton oil, by an Indian practitioner,that when rubbed round the navel, it hassncceeded in prodncing- a vine evacua-

tions. in cases when the stomach was intoo irritable a state to admit of the exhi-

bit’on of any aperient medicine. Wehave knom this active article excite

purging in a case of apoplexy, whenrubbed over the tongue; an effect whichwe are disposed to attribute to a peculiarcontinuous action, and not to sympathy,absorption, or to its getting into the sto-mach."—pp. 211-213.

The heading of this chapter (on cos-

siveness attendant on Devonshire colic)lets the secret out, that the author under

the title of "a dissertation on costive

ness," meant to survey and describe and

give general directions for treating everyafection that he has mentioned in his

book, which is therefore not so much " a

treatise on costiveness," as on the natureand treatment of a great number of dis-eases incident to the human frame. In

this light we look upon the work as an

appendix to the "Medical Guide," anddomt hesitate to say that it is a valuableaddition to popular medicine. We have

stated our opinions freely on some parts,bnt we are not on that account to over.

look the excellence of others. As we

have already observed, Dr. Reece is too

fond of criticism, and often wastes his

ingenuity upon a very trifling point, for in-stance he blames poor Dr. Good for call-

ing carbonate of soda an alcali !-Vanityof vanities !-of’ this we bid him beware.

Practical Observations on the Convulsion,

of Infants.—By JOHN NORTH, Surgeon-accoucheur, Member of the Royal Col-

lege of Surgeons, 8vo. pp. 282, London,1826. Burgess and Hill.

HAVING had " several opportunities of

witnessing the injurious effects of’ the in-

judicious application of the doctrine pro-mulgated by the late Dr. J. ( larke, (viz.that in every case of convulsion the brain

is organically affected, either directly or

indirectly,") Mr. North has been in-

duced to direct a goodly-sized octavo

against the abuse of calomel and the lan-cet. Ctarke’s language certain’y is notso expli<it as it might have been, but wethink the right meaning can hardly bemistaken. The adverb printed in italics

alrpears to have been thrown in more for

the sake of euphony, than to give p’e-cision to the sentence, or refers rather to

functionul derangement than to disease ofthe brain, for it would be idle to supposethat a person of his experience could se-riously have maintained the manifest ab-surdity conveyed by the literal reading.Convulsion, like every other symptom,is an effect, and generally ceases with itscause, although it is sometimes continuedfor a while by debility or the force of ha-bit. Almost any irritant will disturb the

nervous system of a child, and workinginsidiously, non vi sed ssepe cadendo, ul-timately accomplish disease of the brain.This we apprehend is Clarke’.s meaning,and we think he is right. "The originalcause of convulsions," says Underwood," may be a rash improperly repelled ; but

the source of fits is much oftener seated inthe gums, in the time of teething ; or in

366

the first passages, where some undigestedmatter, or merely pent up wind, irritatesthe coats of the intestines, and producesirregular motions throughout the whole

nervous system." To these may be added

as predisposing canses, foul air, want ofcleanliness in the dress and other accom-

modations of infants, &c., as noticed in

the Dublin Lying-in hospital, and pub-lished by Dr. Clarke in the transactions ofthe Royal Irish Academy for the year1789. Though not inclined to advocate

the opinion of Rousseau, who consideredreading to be the scourge of infancy, Mr.North thinks the moderns are apt &deg;&deg; tostimulate the infant intellect to prematureand therefore prejudicial exertion ;" that11 the practitioner cannot too forcibly re-probate the pernicious enforcement of pre-cocious studies," " and says that the inju-

rious effects arising from the jolly and falsevanity of parents, who are ambitious of

holding forth their children as specimensof extraordinary talent," are ever beforehim. Further, a robust child "may be-come by the negligence or want of judg-ment of those to whose care he is en-

trusted, sickly, (we thought we shouldnever have come to the word) and proneto various derangements of health and

more especially to convulsive affections."He next tells us that " a child delicate bynature" may do well ‘&deg; with proper ma-

nagement," and that it is not "ridiculousto deprecate the too early employment ofthe infant mind." Moreover "children

are sometimes born in a state of asphyxia,and the spasmodic colic is at all times to

be regarded with apprehension." Finally," too little care is taken to avoid those

sudden moral emotions, which althoughnot immediately productive of bad effects,may, and often do, very frequently act

upon their iri-itable and sensitive power.in a very injurious manner," thus, "Tissolrelates the case of a child who was at.

tacked with epilepsy, from the repetition

of which disease he was reduced to a

state of idiotism, from the sudden firingof a pistol close to his ear," &c. He

seems to think (pp. 98, 173,175,) thatchildren who are suckled by irrascible

nurses are very obnoxious to convulsions.

Boerrhaave, Banmes, and others, have af-f’ected to observe some such instances, but

probably they overlooked some other

more ostensible cause. Disease of a nnrse

may certainly alter the constituents of

her milk, but we much doubt whether

mental emotions can. We liave often

thought that the breasts of the woman

who suckled Sir Wm. Blizard secretlynothing short of bile, thns instilling thoseelements of fretfulness, which like yeasthave at length levened the whole lump,and rendered him now that he is in the" yellow leaf the sport of nature and of

men, that we see him, and damned him to

eternal tame.

B Mr. North’s work is divided into sixchapters, 1st and 2d, on the canses,

symptoms, prognosis, and treatment of

convulsions ; 3d and 4th, on infantile

epilepsy, : 5 th and tith, on a spasmodic af-fection of the chest and larynx in young

children, accompanied by general or par-tial convulsions, and on its treatment.

After the extracts we have made from

the first and second chapters, we neednot dwell much longer on the subject of

the convulsions of infants. We have

shown that Mr. North set. out by ob-jecting to a passage in Clarke, which asfar as we have seen, has not been mis-

taken, and then substitutes "irritation"

for "organic affection" of the brain insome cases, without denying the ex.

istence of the latter pathological condi-tion in others. Convulsions, he says, may: be induced and continued by the irrita.

i tion of teething, and shall subside on

lancing the gnms, therefore the braincannot in these cases be organically affec-

t ted. So of the irritations of cruditea

367

in the prim&aelig; vi&aelig;&mdash;of watchfulness, and

many others,&mdash;a do&ecirc;trine which has in-

fluenced practice in all ages. Again,Clarke’s doctrine has caused " free and

repeated bleedings, frequent purgation,and large doses of calomel," to be pre-scribed " in the slightest convnlsive affec-tions of children," a statement which our

experience does not enable us to con-

firm. He tells us that no Englishmanhas written " particularly upon the con-vulsive diseases of children," and it wouldhave been as well perhaps, if he had notessayed to do it. Underwood and

others have written sufficiently and wellupon the subject, and that is enough.We pass over onr author’s treatment,

(merely remarking, that it appears to be

judicious,) as also the chapters on the

epilepsy of infants, and conclude by de-scribing as briefly as we can, an affec-

tion which he has denominated "chroniccroap," or " spasmodic affection of the

chest and larynx in young children,"with general or partial convutsion. It

somewhat resembles the " acute asthma"

of Millar and Chalmers, but differs bothin its mode of attack in its symptoms andtermination.

"The premonitory symptoms occur atan uncertain period ; generally betweenthe third and seventh month. At firstthey may not be sufficiently striking to at-tractthe particular attention of the friends,although the practitioner, who has metwith similar cases, may with much con-tidence predict from them the series ofsymptoms which is subsequently to be de-leloped. When the child wakes from itssleep, the breathing is for some momentsunusually accelerated, and is accom-

panied by that kind of noise which an in-creased secretion ot mucus ill the air

passagesuonld produce."* t

On examining the body of a childwhich had died from this or some othercanse, the author and his friend Mr. Stonefonnd " the vascnlar system of the brain"highly furgid, a small qnantity of bloodunder the dura mater, and in the ventrictas i"a small quantity of fluid." A few spotswere found on the liver. Strange tosay, they did not examine the thorax !

" If the little patient has previously en-joyed a good state of health, the charac-teristic rotundity of feature observable ininfants qnickly undergoes a remarkablechange; the countenance becomes anx-ious; the sides of the nose are drawn in ;the face is pallid and emaciated; thechild frowns almost constantly ; when

put to the breast, it sucks greedily for amoment, but suddenly ceases to do so,throwing back the head with violence.Whatever may have been the previouscondition of the bowels, they now becomeconstipated. A considerable time mayelapse before any remarkable changetakes place in these symptoms. A con-vu,sive affection ot the hand is nsnally thenext morbid sign which excites attention.The child’s thumb will be found con st,ntly and firmly pressed upon the palmof the hand ; the wrist and ancle joints arebent rigidly inward’’; the head is almostconstantly thrown backwards, by whichthe anterior muscles of the neck are

kept painfully upon the stretch. Theinconvenience at the moment of wakingis not now a mere acceleration of thebreathing. This symptom still continuesin an aggravated degree, but the noise

accompanying the respiration, has gra-dually assumed a very ditferellt charac-ter from that which at first marked it.

I Each illspiration is now attended by afond crouping noise, which may be heardin an adjoining apartment; the chest andlarynx appear to be painfully constricted;the heart palpitates violently; the chitdsobs, but never cries in its natural mannerduring the paroxysms of suffering. So

great is the difficulty of breathing, that itsometimes appears to he almost totallysuspended for a few seconds. The coun.tenance is then unusually pale a in a stateof syncope. Sometimes, but more rarely,it is dark, and the vessels of the faceturgid, as in apoplexy. The child hasfrequent attacks of convulsions, duringwhich the features are much distortedThe whole body is sometimes, but more

rarely, implicated in the convulsive move-ments. The paroxysms vary in duratiouand violence."-pp. 254-257.

The affection is not usually accom-

panied by fever or cerebral disturbance,but Mr. North has lately seen two casesin which these, and an evident determi-nation of blood to the brain were present.The symptoms usually subside with the

appearance of the teeth, and rarely be.fore. According to Mr. North, some

practitioners contend that " if a chiid

368

makes this crouping noise in breathing,’’hydrocephalus will ensue unless largedoses of calomel, and frequent bleedingsare employed. This brings ns back to

what has been said of Clarke’s doctrines,and of convulsions ; and as we need notdwell upon the treatment, we take our

leave.

A Catechism of Anatomy, with Plates.

18vo. pp. 72. Whittaker: London.

IN no country in Europe has the mode of

publishing in the form of dialogue, andof question and answer, been carried tosuch an extent as in England, and noworks of this description have become so

popular ab those known under the nameof " Pinnock’s Catechisms." The most

abstruse subjects have been illustrated inan easy and familiar manner. The onlyrecommendation of this, as well as manyother works of the same kind, is the ex-treme cheapness at which they are pub-

lished. To persons in the profession, the

catechism before us can scarcely be of

any use ; and those out of the profes.I sion, who are desirous of becoming ac-

quainted with the elements of anatomicalknowledge, will not find it capable ofaffording tlietn much instruction.The Surgeon - Dentist’s Anatomical and

Physiological Manual. By G. WAITE,Esq., M.R.C.S. 12mo. pp. 214. Cal-low and Wilson. 1826.

THIS book is a compilation from variousanatomical works, and contains a con.

densed account of what is known on the

anatomy and physiology of the teeth. Themost interesting part of the work, and

perhaps that but least known, is what re.lates to the teeth in the different classes

of animals; and the following Tables,showing the number of teeth in several

of the mammalia; are worthy of a pe.rusal:&mdash;

TABLE I.

Upper I Lower Upper Lower

Names. Upper Lower Canines Canines Molares Molares Total.Incisors Incisors on one on one on one on one

side side side sideonly. only. only. only.

-

The first Molaris is veryBears.... 6 6 1 1 5 5 36} small, separated from the6 1 5 others, and near the Ca-

..

’ nine Tooth.Badger.. 6 6 1 1 4 5 36

Glutton.. 6 6 1 1 5 6 34

Coati . 6 6 1 1 6 6 40Coati. ... 6 (; 1 1 6 40

Dog.)Wolf,}.. 6 6 1 1 6 7 42

;Fox, ;

Hy&aelig;na.. 6 6 1 1 5 4 34

Cat..... 6 6 1 1 3 or 4 3 28 or 30