Imatges de pÓgina

gainst which, the author affirms, there is a prohibitory by-law of the College of Physicians, excluding the fellows from the practice of it; whence the ignorant and empirical use, which is not altogether exploded, of opiates, carminatives, emetics, &c.; many which have been seen by the author to prove speedily fatal. He concludes this chapter, by showing that the diseases of children, though not elucidated by the descriptions of the patients, are nevertheless very distinctly cognizable from visible symptoms. It might be added, indeed, that, generally speaking, they are much less complicated and obscure than many of the diseases of adults, and much more certainly under the influence of well-directed remedies, on account of the greater mobility of the infantine system.



Chapter II. professes to treat of the structure of the mouth and organs of digestion of children, and the diet proper for them at different ages dependent upon it; and contains many forcible arguments in proof of the great importance of the proper management of the ingesta, and in favour of the practice of suckling on the part of mothers. He depicts in strong colours the physical and moral evils which arise from the employment of wet nurses in the families of these poor women, and deprecates the practice on the score of humanity, as well as of the frequent inaptitude of the milk to the age of the child. He shows how numerous and important are the maladies which may be indirectly traced to mal-administration of the aliments, and consequent derangement of the digestive process; such as 'the disorders attendant upon dentition, scrofula, incurvation of the spine, rickets, enlargement of the absorbent glands of the mesentery and other parts of the body, many eruptions on the skin, phthisis, inflammation of the brain, the remitting infantile fever, marasmus,' &c. (p. 37.) And he dwells especially on the impropriety of using stimulating food and drink, and full diet, which necessarily induce a predisposition to inflammatory disease, and aggravate the difficulties of dentition, catarrhal, pulmonary, cerebral, and intestinal complaints. He argues, from the manifest adaptation of the organs to the natural aliment in all classes of animals, against the practice of giving solid food, whether animal or vegetable, to young children, and considers that every mode of feeding them, in which the action of sucking is not excited, by which means a proper quantity of saliva will be mixed with the aliment, is injurious. His expressions on this topic are very strong,

'Nothing can be more contrary to this,' he says, than to stuff a child's mouth and stomach with solid (perhaps animal) food, or even to pour down its throat, with a spoon, milk and bread, or any

other solid matter, without sucking, mastication, or the secretion of saliva. To give an infant the best chance of health, it should live exclusively upon the milk of a healthy woman, and that woman should be its mother, if she is healthy and capable of nursing it. Scarcely any thing will compensate for the want of this natural support. Multitudes of children die, literally starved, under the eye of persons who would shudder at infanticide, and the exposure of children as it is practised in China; as if a speedy death were not preferable to a life cruelly protracted, in distress, pain, disease, and agony, and at last miserably terminated.' p. 48.

He concludes, therefore, that, when a child is brought up by the hand, its food should be entirely fluid, and taken by suction, till it has teeth. As soon as the incisores are protruded,

solid farinaceous matter, boiled in water, beaten through a sieve, and mixed with a small quantity of milk, may be employed; and then, for the first time, the child should be fed by hand.' When the molares have appeared, the same food is recommended; but the bread need not be beaten; and solid animal food should not be given, till the child has all the cuspidati, and then in small quantity, once in a day. They require no other beverage than water, or rennet whey; and the practice of giving wine is not to be justified in any instance, where the child is healthy. He apologizes for the stress laid upon this part of the subject, which some may deem trivial, from a conviction of its essential importance as a preventive of disease.

Much novelty is not to be expected on the subject of the disorders attendant on dentition, which occupies the third chapter. Dr Clarke ascribed much of these evils to overfeeding, which produces plethora, or to improper feeding, which excites irritation, and also to the error of keeping the heads of children too hot. He asserts, from experience, that coolness of the head and daily washing with cold water, render them less liable to serious complaints at the time of teething; and that weakly children often suffer little or nothing, because less liable to inflammation and fever. Spontaneous salivation or diarrhoea lessen the irritation of teething, which indicates the propriety of laxative medicines: and these he deemed especially necessary, if, from neglect of diet, &c. plethora had occurred, cutaneous eruptions had appeared, and local remedies were applied to the latter, which, however, if not very important, he advises us to leave unassisted, especially if extensive. He recommends very free scarification of the gums, when they are tumid, especially in full habits; and cautions us against the use of opiates, adding a philippic against the immorality of the government, in bartering the lives and health of its subjects, and virtually sang

tioning murder, for the sake of a stamp duty on quack medicines. They will hang the vender, he says, if he forge the stamp; but if he pays for it, he may deal death and destruction around him with impunity.

The three following chapters treat of convulsions. In Chapter IV. we have a brief account of the symptoms which precede, accompany, and follow the ordinary attacks of convulsions. The principal observation, which may not be familiar to practitioners, is contained in the following paragraph. The author believes that, under the vague use of the term convulsions, in the bills of mortality, the deaths of blue children, arising from the disturbed state of the circulation in malformations of the heart, are included.

But,' he adds, " every case in which a livid appearance of the face, &c. occurs, is not one of malformation. If from any accidental cause, such as flatulency, the diaphragm is prevented from descending in the act of inspiration, the lungs cannot be sufficiently expanded to admit a proper quantity of air into them. A paroxysm of this kind will then be produced, which commonly yields either to a strong spontaneous contraction of the stomach, expelling the air which had over-distended it, or to some medicine, stimulating the stomach to contraction, such as ammonia or æther, in aqua anethi, aqua pimentæ, aqua menthæ, or any other mild stimulating medicine, occasionally given, so as to produce the muscular contraction of the stomach. P. 80.

In Chapter IV. (for we have two Chapters IV.) the author describes a peculiar species of convulsion in infant children,' which is often mistaken, even by medical men. This affection has been denominated by some practitioners, chronic or spasmodic croup, an appellation calculated in some degree to mislead us as to the nature of the affection. It occurs by paroxysms; and, to use the author's words,

It consists in a peculiar mode of inspiration, which it is difficult accurately to describe. The child, having had no apparent warning, is suddenly seized with a spasmodic inspiration, consisting of distinct attempts to fill the chest, between each of which a squeaking noise is often made; the eyes stare, and the child is evidently in great distress; the face and the extremities, if the paroxysm continues long, become purple, the head is thrown backward, and the spine is often bent, as in opisthotonos; at length a strong expiration takes place; a fit of crying generally succeeds; and the child, evidently much exhausted, often falls asleep. p. 87.

These paroxysms occur several times in the day, from the slightest irritations, and often immediately on waking from a tranquil sleep; and may go on for two or three months, if not properly treated, until a general convulsion produces alarm.

The complaint seldom occurs after the third year, or in children which have lived by sucking till they have got teeth. This and all other convulsive diseases the author ascribes to some actual affection of the brain, and he takes some pains to show how this affection may be produced directly and indirectly, from overfeeding, keeping the head hot, the sudden cure of ophthalmia, and of discharging eruptions, the occurrence of fevers, &c.

The treatment of convulsions' is the subject of a separate chapter, which is numbered V., though in fact the sixth. After remarking upon various organic causes of convulsion in the brain, and stating several circumstances connected with congenital or chronic hydrocephalus, all of which are beyond the reach of medical agency, and upon the temporary irritations, connected with the approach of some eruptive fever, which cease on the equable distribution of blood which follows the eruption, Dr Clarke has detailed the principal remedies on which any dependence is to be placed in the cure of convulsions; beginning with very free scarification when the gums are fuil; an immediate glyster under all circumstances, followed speedily by an active purgative; and the warm bath at 92° or 94°. In most cases, considering that the head is usually overloaded with blood, he deemed it right to produce an evacuation of that fluid by leeches, cupping, or from the external jugular vein. Respecting the particular preference of one or the other mode of operation, he refers to a future part of these commentaries. If these means have failed, blisters may be applied to the lower extremities, and cold fluids or ice to the shaven scalp. The use of opiates, he affirms, requires the greatest circumspection, and should never be resorted to until the bowels have been completely unloaded, and there is obviously no inflammation or danger from pressure in the brain. An individual paroxysm may be shortened by dashing cold water over the face, in a horizontal position, and by the inhalation of volatile alkali. The author had never been fortunate enough to witness any good effects from the tribe of internal antispasmodics, the preparations of æther and ammonia excepted; which never appeared to him to derive any additional efficacy from an admixture with assafoetida, valerian, castor, musk, tinctura fuliginis, amber, and other fetid substances. These medicines, which seem to possess no property in common, save their offensiveness to the smell and taste, have, he believed, been greatly overrated, and are continued to be employed, rather from a deference to authority, than from any decided proof of their efficacy; an observation in which we are disposed to coincide.

The longest chapter in the volume, marked VI., treats of

' phrenitis, or inflammation of the brain in children,' under which appellation it is manifest that the author describes hydrocephalus, which he considers as the consequence and natural cure of the former. Inflammation of the brain, he affirms, is a far more common disease of children than it has been suspected to be, and has probably been the cause of death, in numbers who have been said to be cut off by idiopathic convulsions. But convulsions are seldom, if ever, idiopathic. He states many reasons why children should be more subject to this inflammation than adults; and affirms that simple fever, independent of a local cause, never occurs at the early periods of life. He endeavours to show that the febrile affection accompanying the commencement of inflammation of the brain, may be distinguished from others, chiefly by the increased acuteness of the senses of feeling, hearing, and sight. Impatience of light, particularly, he deems a striking diagnostic at a very early stage of the disease, which occasions a violent contraction of the iris even in a moderate light, so as almost to obliterate the pupil. This circumstance, though overlooked by modern writers, he found was noticed by Aretæus. The author might have found the observation in Dr Cheyne's valuable essay on Hydrocephalus, among the early symptoms so well detailed by that judicious writer. He then describes the change from this state of irritability of the sensorium to the opposite condition, resulting from oppression; observing that when the patient is cut off in the first stage of the disease (which he says, often happens), it is always by convulsions. When these are partial, the side affected not uncommonly becomes permanently paralytic, remaining so through life. The observations resulting from dissection are very brief. When patients die in the first stage, there is high vascularity of the membranes, especially at the basis of the cranium, but no decided alteration in the substance of cerebrum or cerebellum; and the author had seen the optic nerves entirely imbedded in a sheath of coagulating lymph.' After death in the second stage, there is always more or less of water effused between the membranes, or in the ventricles, or in both situations. But the author adds, that the derangement of structure is not always found to be commensurate with the violence of the symp



After some discussion respecting the predisposing and exciting causes, among the latter of which, he strenuously insists upon the sudden healing of cutaneous eruptions and discharges about the head and ears, and the cure of ophthalmia, without a simultaneous diminution of nourishment, purges, setons or issues at the nucha, or blisters to the lower extremities, he lays down his plan

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