XV.

Hydrocephalus.*

THE celebrated FRANK, of Vienna, has remarked, that "when hydrocephalus is curable, the diagnosis is uncertain-but that when the diagnosis is certain, the case is hopeless." In this country, where the practice in acute diseases is far more efficient than on the Continent, there is every reason to believe that very many cases of hydrocephalus acutus (that is the cerebral excitement which ends in effusion) are annually cured. We do not indeed say, that after effusion, to any extent has taken place in the brain, we can save the patient; but we can often prevent the effusion.

Dr. Fallot has circumstantially detailed a case, which, he thinks, was hydrocephalus successfully treated. The patient was a girl eight years of age, born of sound parents, but herself and two sisters having large heads and delicate constitutions. The girl, M. B. was exposed to severe cold on Christmas-day, 1820, and complained of headach, chilliness, and lassitude in the evening. For several days afterward she continued dull, and complained of pain about the occipital region. On the 1st of January, 1821, she vomited her food, and still continued unwell and irritable. On the 4th the vomiting returned, and being now worse than usual, Dr. Fallot was called in. He found the girl lying on her back, and unwilling to move from that position, having constant inclination to vomit, flushed face, intolerance of light, red dry tongue, burning skin,small hard quick pulse, lancinating pains in the head, especially over the orbits. Six leeches behind the ears-a semicupium. In the evening, there being little melioration, six leeches were applied to the temples, a purgative lavement exhibited, and lemonade ordered for drink. 5th January. The night was passed without sleep, or with short and broken slumbers. A purplish eruption was now visible over the whole surface, without diminution of the fever or gastric irritability. Six leeches to the epigastrium-gum water acidulated with tartaric acid. In the evening the headach, especially of the right orbit and temple, was more violent than ever, causing the child to utter piercing cries. Four leeches to the orbit; mustard pediluvia. 8th. The eruptive disease has run its stages, and dequammation of the cuticle, as in scarlatina, has commenced; but without any mitigation of the constitutional symptoms; the fever having a daily exacerbation or paroxysm at two o'clock, P. M. The patient complains continually of her head, to which she frequently applies her hand. Constipation is obstinate, the clysters producing no effect. Irritability excessive; the little patient not permitting either of her sisters to approach her bed. On the morning of the 9th our author found his patient altered much for the worse. The pulse was be

Journ. Complem. October, 1821. Dr. Fallot.

quick and irregular that he could not count them-the face drawn -the eyes incapable of bearing the least degree of light-continual cries of my head! my head!" even when apparently slumbering. Our author now, for the first time, suspected hydrocephalus acutus, and determined to act vigorously. He proposed a seton in the neck,which was refused. He therefore enveloped the feet in sinapisms, and prescribed a grain of calomel every three hours, changing the lemonade drink for an antimonial solution. The head was covered with ice, which was renewed as fast as it thawed.

12th. There being no sensible amendment yet, the seton was permitted, the girl evincing little sensibility to the pain. When she fell into a slumber of a few minntes, she awoke with a start, and crying out with the pain in her head. One grain of calomel and one of digitalis night and morning. An infusion of arnica montanathe antimonial drink continued.

15th. She this day opened the left eye, and with it viewed the objects around her bed, but kept her hand on the other eye. Had two mucous greenish stools to-day-a cloud in the urine, which has become somewhat more abundant-the pulse a little more regular and better developed-the cries less piercing-no other change of any consequence. The child refused all medicine, and only took beer for drink.

The night between the 16th and 17th was a most severe one; the breathing being oppressed-the anxiety extreme-the patient attempting to raise herself, but wanting the power. When elevated by others, the head fell to one side or other. The heat of skin was burning and unequal-somnolency, interrupted by startings and crying out. About three o'clock in the morning, convulsive movements over the whole body. At daylight, horrible squinting, the right pupil being dilated, and scarcely sensible to a lighted candle. The intellects, however, appeared sound, when the patient was roused from her slumbers. The features were much altered, the skin burning, pulse small and irregular, grindings of the teeth, piercing cries. Cold solutions applied to the head instead of icemustard pediluvia-half a drachm of mercurial ointment to be rubbed on the inside of the thighs, and two grains of calomel with one of antimonial powder every three hours. In the evening the mercurial frictions were repeated on the arms. 18th. Continuation of the same means-antimoniated ptisan for drink.

19th. A remission of the symptoms-cessation of the convulsive movements-inability to move the left arm and leg, which have, however, preserved their temperature. Diarrhoea, at first watery, afterward green and feculent. 21st. The favourable change continues, and the fever abates-the urine lets fall a copious sediment -the stools are abundant and fæcal-some tranquil sleep-an abscess forming at the angle of the lower jaw. Still the patient complains greatly of her head, and feels some ease by the pressure of the hand on the forehead. On the 4th February there was a discharge of purulent matter from both ears; and from this time the cephalalgia gradually abated, and finally ceased in March, the discharge Vol. II. No. 8. 6 A

from the ears continuing till the month of May. Mercury, in small quantities, was continued till the 15th March, the child having taken about 37 grains altogether. The convalescence was very tedious, the bowels remaining long torpid, and requiring lavements-the digestion impaired-and the recovery of strength very slow. The extract of cinchona, with a little Malaga wine, conduced much to the restoration of strength. She is now stouter than any of her sisters.

With all due deference to Dr. Fallot, we do not consider the above case as any other than one of cerebral inflammation-most probably arachnitis, occasioned by cold. We know that all the phenomena exhibited above, even to the strabismus, convulsions, and dilated pupil, may be produced by inflammation of the cerebral investments, without any effusion. The purulent discharge from the ears too, corroborates our observations. We believe, however, that the case would have terminated in effusion, had not Dr. F. taken the measures detailed above, and which were, generally speaking, judicious, with the exception of the neglect of purging-a neglect of which the continental physicians are constantly gnilty, in acute diseases.

XVI.

MEDICAL INTELLIGENCE.

A piece of plate has been presented to Sir Gilbert Blane by several of the senior physicians and surgeons of His Majesty's Navy.

The members of the Medico-Chirurgical Society of London dine together at the Freemason's Tavern, Great Queen-Street, on the fifth of March, at six o'clock, Dr. Cooke in the Chair. It is expected that there will be a numerous attendance of rank and talent at this anniversary meeting of the Society.

DR. WILLIAM BURNETT, formerly Physician to the Mediterranean Fleet, and author of the able work on Mediterranean Fever, has been appointed to the Naval Medical Board, as colleague of Dr. Weir. He has been succeeded in his practice at Chichester by Dr. Forbes, of Penzance, the translator of Laennec on Diseases of the Chest.

DR. MACARTNEY, of Dublin, has for some time employed a solution of alum and nitre for the purpose of preserving anatomical preparations. He finds that it preserves the natural appearances of most parts of the body more completely than spirit or any other fluid hitherto used.-Medical Repository.

The MEDICAL SOCIETY of LONDON has proposed a gold medal, value 20 guineas, for the best dissertation on Dropsy. The conditions are those usually prescribed on such occasions.

A gentleman in London has lately used the concentrated acetic acid in cases of tinea, as an external application, with great sucThe Prussic acid has also been found a powerful application in cutaneous affections, but its price is a great objection.

cess.

Dr. E. Nath. Bancroft, author of the able work on Yellow Fever, who has been dead and buried in the medical journals, is alive and well.

Suicides. It appears by a statistical work of M. Fournier, that in the year 1818, 330 suicidal attempts had been made in Paris, 241 of whith terminated in death. During the year 1821, there were but 32 suicides committed in London, whose population is nearly a third more than that of Paris. '

Jacksonian Prize.-Three of these are proposed by the College of Surgeons this year, viz. Injuries and diseases of Muscle-Diseases of the Skin-and Diseases of the Rectum. Conditions as usual.

Mr. Ring. We have to record this quarter the death of Mr. Ring, well known in the literary and professional world by his different writings. He died of apoplexy.

M. Laennec. We are happy to hear that M. Laennec, now so well and so favourably known to the British Profession, is returned to Paris with renovated health, and with unabated zeal for the promotion of pathological science.

Erysipelas. Mr. Brodie has experimented on the American mode of treating erysipelas by mercurial frictions, as stated some time ago in this Journal. The utility of the application was unquestionable, but it was attended with the inconvenience of producing salivation sometimes. He therefore substituted simple for mercurial ointment, and found that, in several instances, it appeared to enable the patient to go through the various stages of the disease in a more favourable manner than under ordinary circumstances. London Med. and Phys. Journal.

XVII.

CORRESPONDENCE.

The short anonymous article for the Extra-Limiets department is inadmissible. If we have opened a door for authors to defend themselves against what they may conceive to be unfair criticism, in this or any other journal, we cannot permit such papers to become attacks upon individuals, nor to be couched in other than mild (however energetic) language. Such defences would injure us without benefitting them. But we again repeat that every author has free

access to the Extra-Limites department of the Journal, provided he avoids all intemperate language and personal allusions-articles which never can be admitted into our pages. The paper and enclosure will be delivered to any one producing the motto or signature.

Several of our literary friends will see that their hints are attended to; and several others, we are sorry to say, may feel disappointed at not finding the analytical articles, which they have so liberally furnished, inserted in the present number. They, however, and the profession at large, will readily perceive that early reviews of all works are totally incompatible with that careful analytical delineation which is the characteristic feature of this Journal, and to which it mainly owes its success. We could make a tinsel show of 50 or 100 critical articles on each number of this review-and such management might please those Athenians who lounge about the medical booksellers' shops, or dip into periodicals for something to amuse a dull hour. But what would our sober plodding country and colonial readers say to this, who expect articles which they are to peruse slowly and attentively, and preserve for re-perusal and reference in the intervals of their practice? We know well what they would say; and we shall give them no cause for complaint, on this head. They may rely on it, that not even Atalanta's golden apples shall entice us from the firm and straight forward path on which we have so far trodden with safety to ourselves, and advantage to them. We grant, indeed, that it is both necessary and proper for some people to-" chronicle small beer"-because there are appetites for every species of food, and some prefer "soup meagre" or " Bologna sausages," to roast beef and plum pudding. Every literary caterer, therefore, is right in providing for the particular goût of his customers.

XVIII.

EXTRA LIMITES.

Medical Botany,

In our Review for September, 1820, we had occasion to notice the Lectures given on this subject by Dr. Emerson, Member of the Royal College of Physicians, &c.&c. and laid before our readers a general outline of the Course. We are happy to find that the Doctor has continued his labours in this branch of Medical Education; and that he has considerably extended his course, which for the future