Imatges de pÓgina
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of treatment for inflammation of the brain. Although the progrosis may be said to be generally unfavourable, yet he maintains that our efforts should not be relaxed ; for that, often in the first st?ge, if early created, the disease yields, like other internal in-flammations, to the remedies employed, and so its consequence (hydrocephalus internus) may be prevented ;' and that, even in the second stage of the disease, it admits of remedy. He was of opinion, that the prospect of relief was greater, when the symptoms of the second stage had taken place without screaming. He had previously mentioned a notion, that the screaming fits occurred with the first and subsequent effusions of water ; but this prognosis he here states as a matter of experience.

Deeming the disease to be, in all cases, in the commencement, pure inflammation of the brain, he considered blood-letting of course as the principal remedy. As in children a large vessel often cannot be found, we are reduced to the choice of cupping or applying lecches; and the author, upon very just grounds, gives a decided preference to the former. We agree entirely with the remarks of the respected anthor upon the necessity of practitioners, especially of those living in the country, learning this most useful and efficacious operation; and we recommend the following very just strictures to the consideration of students.

• In the course of the life of any medical man, in general practice, it is much more important that he should be able to cup and scarify well and effectually, than that he should understand the best mode of applying a trephine, or performing the operation for a strangulated hernia, or aneurism. But it is too common for students to flock to an operation (which they will most probably never have occasion to perform) attended with great difficulty and danger, and requiring the greatest anatomical skill, to the neglect of those things which occur in daily practice, and which are, therefore, of more importance to be well understood by them.' p: 151.

Those who cannot have the opportunity of personal instruction, should procure Mr Mapleson's perspicuous little work on the art of cupping, which will assist them in obtaining some of his great dexterity in that art. The principal caution requisite in taking blood from young children, arises from the circumstance that they bear very well the loss of blood, even to fainting, once or twice, but they ill bear a more frequent repetition of bleeding.' Dr Clarke says,

• From a child of seven or eight months old, two ounces and a half of blood may be taken, and one and a half or two more in sixteen hours afterwards. Three ounces may be taken from a child of a year old, and two and a half or three afterwards, if the symptoms do not yield : at this age two or more may be taken in twelve hours after the

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second bleeding, if it should be necessary, and the patient has not been too much weakened already.

In older children, the external jugular may be opened with advantage, from which the author endeavours to show, at some length, special benefit accrues—but, as it appears to us, by a piece of hypothetical refinement. At four years and upwards, children bear blood- letting from a vein repeatedly, if necessary.

A purging enema immediately, followed forth with by a large dose of calomel, and that by a solution of salts in infusion of senna, at short intervals, daily, is the next step in our author's practice, with the interposition of diaphoretics of ipecac. or antimony. Against the common practice of blistering the scalp, he has a long anatomical objection, which he ascertained, he says, after he had witnessed its entire failure to give relief in all cases. In all other internal inflammations, he believes, the essential value of blisters arises from revulsion ; but the anastomosing branches of the two carotid arteries reciprocally feed each other through the bones of the skull;' and therefore a blister applied to the scalp will rather aggravate the determination of blood to the brain. We are afraid of trusting any man's observation of facts, when he has a specious hypothesis at bis fina gers' ends ; but when the author dwells upon the recovery of a child, who had large blisters applied to the outside of the legs, and still more when he recommends not only rubefacient cataplasms to the lower extremities, but advises us to heat these parts, which in all cases of inflamed brain should be made very warm by additional clothing,' we have no longer any doubt of the paramount infuence of this theory of revulsion. Who that has felt the throbbing headach of a febrile paroxysm, has not also felt the relief from cooling his extremities, and the aggravation excited by flannel and heat ? We believe, indeed, that the stimulus of heat on the extremities, so far from mechanically dilating the vessels, and causing a proportionate distribution of blood into those parts, actually operates as a general excitement to the whole circulation, and aggravates any inflammatory action that may exist in any given organ. The next very judicious remedy, however, tends to counteract any effect of this sort; and we can add our testimony to that of the author in favour of its efficacy in controlling the circulation of the head; we allude to the free application of cold to the shaven scalp. In all cases of determination to the head,-in the violent delirium of common fevers, as well as in the incipient stage of hydrocephalus,--this expedient, if effectually employed, is productive of the most manifest and speedy relief. "Iced water is recommended by the

áuthor ; but as that is only to be procured in a few situations, the application of ether or spirit, much diluted, by the rapid evaporation which ensues, produces a degree of cold adequate to every purpose, and is equally effectual.

Dr.Clarke considered tepid bathing, twice a day for an hour, as a useful auxiliary, by diffusing the circulation.' The food, during the inflammatory stage, should be barely sufficient to sustain life ; but he gives another example of hypothetical refinement, in respect to the restriction of liquids, which he limits to the mere slaking of excessive thirst; ' because when mischief is to be apprehended from pressure on the brain, watery fluids will affect it as certainly as blood, though they may not equally support inflammation.' p. 174. There is too much of mechanism, and too little of the vital excitability, in these speculations, according to our notions of a good pathology, supposing it even proved that the quantity of circulating fluids was much augmented, and vessels were distended by taking diluents, the excretories not maintaining a regular balance, which is altogether gratuitous : yet is it not a matter of experience, that the excitement of perpetual thirst, or any other irritating impression, is a source of considerable aggravation in all febrile states, and much more injurious in its effect upon the circulation, than any imaginary increase of the buik of the blood by dilution ?

The inflammatory stage having passed by, and effusion of water in the cranium having taken place, (the natural cure' of the inflammation), the former treatment must be discontinued; and remedies calculated to effect the absorption of that already thrown out, and to prevent further effusion, must be substituted. This, however, is a matter of no easy accomplishment. Diuretics and purgatives, such as neutral salts, squill, digitalis, and elaterium in very small doses, have not been decidedly beneficial. • Mercury appears to be the only medicine which has been successful in the core of acute hydrocephalus; and with this view it may be used both externally and internally in very considerable quantities.' p. 179. At any age above one year, the author recommends half a drachm of the strong mercurial ointment to be rubbed in on any broad surface every six hours; and this may be increased in two days to two scruples or a drachm. At the same time, to children of a year old and upwards he gave one grain of calomel internally every six, four, or even three hours, unless diarrhea supervened. When it brings on a discharge of green mucous stools, he discontinued the internal use of the mercury, or gave it less frequently. Though not very sanguine in his expectations of success in the second stage of the disease, Dr Clarke had seen several cases of recovery under this mercurial treatment.

The volume is concluded by a very short chapter on · Idiotism, Paralysis, and Epilepsy in children,' which, when they occur as the consequences of inflammation of the brain, are seldom remediable. Some observations follow respecting the means of lengthening the intervals in chronic epilepsy, by regulating the dietand bowels, keeping the head cool, &c. and on the occasional efficacy of the preparations of zinc.

It will be seen that this treatise contains many proofs of an active and vigorous mind, intent upon the investigation of the diseases which an extensive practice presented to the observation of the author; and the treatment adopted implies not less decision than judgment, and is worthy to be studied by all who are occupied in the same pursuit.

IV.

Reports of the Pestilential Disorder of Andalusia, which appear

ed at Cadiz in the Years 1800, 1804, 1810, and 1813; with a detailed Account of that fatal Epidemic, as it prevailed at Gibraltar during the Autumnal Months of 1804; also Observations on the Remitting and Intermitting Fever, made in the Military Hospitals at Colchester, after the Return of the Troops from the Expedition to Zealand in 1809. By Sir JANES FELLOWES, M.D. &c. &c. pp. 484. London, 1815. Longman & Co.

Tus
This work comes from the very highest authority, not only on

account of the professional rank of the author, but much more on account of the zeal with which he availed himself of his opportunities of examining minutely the subject on which he writes. Sir James Fellowes has divided his book into five Re.. ports. The first relates to the fever which prevailed in Cadiz in 1800; the second to that of Gibraltar and Malaga in 1804; the third to the fever of Cadiz in 1810; the fourth to that of 1819 in the same city; and the fifth Report relates to the Walcheren fever, as it appeared in Colchester in 1809. To these are added a Conclusion, and eight Appendixes.

Sir James Fellowes had been with Admiral Christian in the West Indies, and had had only too many opportunities of witnessing the pestilential fever which committed such ravages among our soldiers in St Domingo. He is therefore good authority, when he describes the peninsular fever as' appearing under a similar form of malignity, and showing many of the strongly marked characters of the St Domingo fever.' Upon this point, and indeed upon almost every point, Sir James entertains opinions nearly similar to those of Mr Pym, and, like him, strongly combats the account which Dr Bancroft has given of the origin and mode of propagation of these diseases. Indeed, it is impossible to deny the contagious nature, at least of the peninsular fever, after having perused the documents collected by Sir James Fellowes. Whether he has been successful or not in tracing the introduction of the fever into particular places, we shall not stop to inquire. However satisfactory the proof of such a fact might be, it is almost impossible to ascertain it, so as not to admit of explanation in controversy; and in disputing about circumstances of very secondary importance, we lose sight of the much more conclusive evidence derived from an extended view of the whole. Although we have so lately expressed our sentiments on the subject, we cannot refrain from confirming them by some general arguments derived from the perusal of the instructive volume before us.

The first is the total disproportion between the increased number of deaths, and any supposable increase of any alleged endemic cause. Even if it were ascertained that the weather in these destructive years was somewhat hotter or colder, or drier or moister than usual, we should only expect the endemic diseases to be proportionally more severe and more numerous than usual; at the most we should expect a very unhealthy year; but the change in the peninsular diseases was not in degree,-it was in character. It was not merely that a much greater number of people were attacked, and that of these a much larger proportion died; but we find that, in these pestilential years, few escaped, and of those attacked the mortality was excessive. In Cadiz, in 1800, the population was 57,500; 48,520 were attacked, and 7387 died, while the average deaths in a year did not exceed 2616; in Seville the population was 70,488; 61,718 were attacked, and 16,685 died; and in Gibraltar, in 1804, the garrison consisted of about 4000 men; in the monthly return for August there were 83 sick, in that for October there were 565. The average deaths among the military in a year were 72; during the Duke of Kent's command only 39 in two years; during the epidemic, in four months, 918 died, and 16t of their wives and children ;

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