the toes are bent down to the plantar aspect of the foot. Along with the thumb, the carpus also is, in some cases, drawn thenard by a spastic contraction of its flexors, which much increases in appearance the prominence and sphericity of the metacarpal tumour. The child labouring under this state of disease is unhappy and restless, but does not appear to suffer much, if any, pain, in the parts affected, unless an attempt be made to force them from their situation; and even this forcing of the thumb or toes from their unnatural position, does not always make the child cry. Though peevish, fretful, and evidently suffering from irritation, he cannot be said to labour under pyrexia at all times. In some cases, indeed, the pulse is more frequent than in health, and towards evening there is an increase of heat, and perhaps flushing of one or both cheeks, with coldness of the feet. The bowels are commonly torpid, and the stools obtained by laxatives are, as Dr Underwood has described them, fetid and clayey, or green, sour, and slimy. This spasmodic affection, though on some days it may appear more relaxed than on others, is, upon the whole, wonderfully persistent. I have known it continue, with little abatement, for many weeks. In others, it has yielded within a shorter period; in a few days, in a week or a fortnight. In one child, who at length died of supervening marasmus, the contracted state of the thumbs continued, with little occasional relaxations, for three months. The greater number of cases which I have seen have terminated favourably. I have sometimes known eclampsia to supervene to this tonic spasm of the thumbs and toes. One child had repeated fits of convulsion, on three successive days, and eventually recovered. Two others have died after supervening eclampsia. In another case of this disease, in which the thumbs and toes had been contracted for three or four weeks, fever supervened, and the child died after passing through all the symptoms of hydrencephalus acutus. Two other children, affected with the disease in question, have tardily sunk under that train of symptoms which Dr Armstrong distinguished as the hectic of teething. These are the only instances I have met with, in which this disease has had a fatal termination; and that termination, it may be observed, has been by a sort of conversion, or gradation, by the supervention of eclampsia, hydrencephalus, or abdominal fever.

With regard to the connexion of the disease which I have now described with the process of dentition, I am not prepared to speak with perfect confidence. Dr Underwood says expressly, that the swelling of the tops of the feet and hands is the consequence of painful teething, and that it goes away upon the ap

pearance of the teeth. Now, although I have seen the swelling of the hands and feet, without the spasm of the thumbs and toes, I have found them very commonly conjoined, and seldom, if ever, have met with the spasm, without some degree of the swelling. Since, also, my attention has been more particularly directed to this disease, I have detected the spasm of the thumbs in cases of the swelling, where it might have escaped the observation of another physician. In these slighter cases, the thumb. is pressed close to the metacarpal bone of the fore-finger, instead of being completely deflected upon the palm, as in the more severe and more obvious cases of the disease. I cannot therefore doubt, that the swelling and spasm acknowledge one common cause, and constitute the symptoms of one disease. I must also admit, that it is a disease of the epoch of dentition. All the cases of which I have made any memoranda, have occurred, in general, at the teething period of life, and in children who had yet teeth to cut. Not one of these has been under six months, or above two years of age. But I cannot say with Dr Underwood, that the symptoms always have disappeared on the cutting of the expected teeth, though they certainly have, in some instances. A disease does not necessarily give way on the removal of its exciting cause. Although, therefore, I have known the disease now under consideration to continue unsubdued after the teeth suspected as the exciting cause had made their appearance, and yet yield before others in succession had come forward, I do not consider this observation as invalidating the opinion, that the irritation of painful dentition is the chief of its remote causes. The same uncertainty, and the same apparent looseness of connexion, can be alleged of all the diseases of the epoch of dentition; for example, of diarrhoea, fever, and eclampsia. On this subject, I have on another occasion remarked, that it was an error to expect that a disease, once formed, should cease the moment the tooth is liberated, whether by the natural process of dentition, or by the scarification of the surgeon. It is a common and a wise indication of cure, to remove the remote causes when they are in our power; but we do not expect that the disease shall instantly cease; we know that we have other indications to fulfil;-that we must restore the disordered functions to their natural and healthy actions ;-that we must combat symptom after symptom, till the system returns to the same state in which it was before the remote causes deranged the play of its organs; for the powers of the machine have been weakened, and its wheels deranged. *

* Inquirer, No. VIII. Edinburgh Med. & Surg. Journal, vol. III.

In this disease, therefore, I have generally judged it expedi ent to liberate, by the scarificator, the teeth which are in the course of cutting; and I think, in some cases, with that marked and almost immediate benefit which sometimes follows that operation in eclampsia, in vomiting, and in the diarrhoea of teething, when not inveterate. The general treatment must be grounded on the pathological character of the disease itself, and a knowledge of its tendencies and conversions. The disease is spasmodic, and its most formidable conversions are eclampsia, abdominal fever, and hydrencephalus. The indications, therefore, are, to remove plethora when it exists, to obviate or restrain vascular excitement,-to correct local determinations,and to regulate the alvine secretions and discharges.

There is a disease of early infancy called skin-bound, a disease which I have never had an opportunity of seeing, and with which, therefore, I am acquainted by description only; in which, as in the one I have now described, it is remarkable that there exist together an affection of the cutaneous structure, and a tonic spasm of the muscular. The disease called skin-bound appears soon after birth, and very speedily proves fatal. The skin over the whole body is said to acquire a pale waxen colour, to be cold, hard, resistant, and immoveable, as if fixed to the flesh below; and, in the French hospitals, where this disease destroyed thousands of infants, it was accompanied with tetanus. Dr Underwood, too, in describing the appearances of skin-bound children, as observed by himself, says, he has seen the rigidity extending beyond the cellular membrane, so as to affect the muscles of the lower jaw, which become perfectly rigid. I do not mean to insinuate, by this observation, that I conceive any specific affinity to exist between this most fatal disease which occurs in infants soon after birth, and the comparatively trifling disease of teething children which forms the subject of these notes, but merely to remark this one point of coincidence, that the cutaneous and muscular structures are simultaneously affected in both.

My principal object has been simply to record the more striking features of a tonic spasm affecting the thumbs and toes of children about the period of teething; an affection not of very rare occurrence, but which seems to me to have been passed unnoticed by writers on the diseases of children.

Leith, 10th September 1816.

1

X.

Severe Case of Chorea Sancti Viti. By DAVID LITHGOW, M. D. Coleraine, Ireland.

THE following case of Chorea is communicated, neither on account of its singularity, severity, nor for the introduction of any new plan of treatment; but, through the medium of this widely circulating Journal, to make known, in the more remote parts of the sister kingdom, the treatment of Dr Hamilton in this curious disorder, as he has made it known in his valuable work on Purgative Medicines; a work which, I am sorry to say, in many places has not been read, if even heard of.

MARY ANN MACLAMMON, ætatis 8, is affected with involuntary movements throughout her whole body; her fingers, especially those of the right hand, are in constant motion; the mouth is contracted, twitches of the eyes, and other involuntary actions of the muscles of the face. The right side was first and most severely affected; her limbs were affected with the same movements; but latterly, they have become paralyzed. She frequently loses all power of speech; but, at intervals, it returns. Sleeps well and quietly; but, on awaking, is not conscious of surrounding objects. She is much emaciated. Abdomen, at the beginning of her illness, was a little swelled; but, by the use of gentle laxatives, this was taken away. Belly natural; occasional flushes of the face, and frequent pains in the head. Pulse 107, small and weak.

About two months ago, began to complain of an inability, with the right hand, to perform ber usual exercises, since which time she has been gradually getting worse. Has frequently taken medicine, with the nature of which her friends are unacquainted. About a fortnight ago, after having taken a little senna, she passed two worms, without any alleviation of the symptoms.

Small doses of calomel were now frequently exhibited, which produced many copious stools, of a colour nearly natural. The quantity was increased, and the more violent the action of the purge, the blacker and more unnatural was the appearance of the stools. For a considerable time, appearances were unfavourable; no change for the better being effected. She still continued, however, to receive, three or four times a week, a dose of jalap and calomel; the stools continued black and unnatural; and so obstinate was the complaint, that it was only

after a perseverance of three weeks, in the purgative plan alone, that symptoms of amendment began to present themselves. The progress of cure was rapid, after the first symptoms of alleviation began to appear. The motions of the muscles gradually ceased, and strength was gained by the useless limbs. A weakness remained for a considerable time in the right side, but it gradually acquired strength.

Tonic remedies were for a short time exhibited, after the diseased actions had entirely ceased, with the occasional use of a cathartic. Six weeks elapsed from the commencement of the above plan, till a cure was perfected, during which time a single worm only was passed, and that when the patient was in a state

of convalescence.

January 27, 1815.

XI.

An Apology for a Fact and an Hypothesis; with Remarks on some few Passages in Mr LAWRENCE's Introduction to Comparative Anatomy and Physiology.' By JAMES WOODHAM, Surgeon, London.

T

Ir is doubtless to be lamented, that philosophers of every age should have been so prone to hypothesize. With few exceptions, there is not a philosopher of eminence, either in intellectual or mechanical, in physiological or chemical science, but what has had his hypothesis. Locke had his ideas or pictures, Sir Isaac Newton his subtle æther, Cullen his oscillations, and Sir Humphrey Davy has his vibrations and revolutions. Genius and hypothesis would thus seem to be inseparable. If hypotheses, then, offer no impediment to the progress of science, however futile we may regard them, they need not vehemently excite our indignation or displeasure, A late writer, an anatomist and surgeon of distinguished talents, thinks otherwise; and in his second introductory lecture to comparative anatomy and physiology, has dealt out his censures with an unsparing hand. The majority of hypotheses being gone, as he informs us, to the tomb of the Capulets, I have no wish to disturb their ashes;-requiescant in pace. But having had the honour to be a pupil and dresser to John Hunter, and received great information from the