1847] Laryngismus Stridulus-Worms. 129 so favourably of it as in the erysipelas of adults, where we can bear the strongest testimony to its good effects."-P. 173. Laryngismus Stridulus.-Dr. Davies states that, from considerable experience in the management of the disease, of which he published an account in the 13th volume of the Medical Repository, he considers it to be one of the most treacherous of maladies, and that the child is never safe until it is three years old, or has cut all its teeth-the greater number being first attacked between the 10th and 14th month. A long period may have passed since the paroxysm, and the child appear thriving and well, when any pleasurable or painful excitement may induce the spasm and carry it off suddenly. In most, if not in all, cases, it seems connected with painful dentition, although it may appear before the swollen state of the gums indicates the presence of this. In some families there is a constitutional tendency to the disease, and most of the subjects of it are of the strumous diathesis. In treating the disease we should freely lance the gums over the next expected teeth, and attend carefully to the condition of the bowels. If there is much irritation or fretfulness, the tinct. hyoscy. with a saline will be found a valuable remedy. The pediluvium or general tepid bath has also a very tranquillising effect, the former being often more suitable as causing less disturbance. If the infant sleeps badly, and nothing contra-indicates its use, one grain of the pulv. ipec. co. forms an excellent narcotic. The breast-milk should be exclusively employed for the younger children, and a careful diet observed for the older ones. The head must be kept cool, the child freely exposed to the air, and preserved from all descriptions of excitement. "The fauces should be looked to, and if red or swollen, a solution of nitrate of silver (gr. viij. ad oz.), or, in less urgent cases, an acidulated syrup, as 3j. or more of acid. sulph. dil. to 3 vij. syr. papav. should be freely applied twice a day by means of a hair-pencil. I have no hesitation in stating (in which I am borne out by the observation of others) that I have seen the most decided advantage from these applications, to which my attention was first called by the perusal of Dr. Ley's work." If general convulsions occur, four or six leeches to the occiput may be applied, and supervening cerebral affection, treated by appropriate measures. Enfeebled children require tonics, and, for such, the vinum ferri is the best, which, when there is much languor, may be combined with ammonia, or, in irritable habits, with conium or hyosciamus. The tincture of hop has been recommended as both tonic and sedative. Free exposure to fresh air is however the best tonic, and upon the subsidence of the most formidable symptoms, removal to the country should be strongly recommended. As a prophylactic the application of the acidulated syrup is useful. Worms.-"We prefer, in children, the Spt. Terebinthine in 3 ss. or 3j. doses, in this form:-R. Sp. Tereb., Mellis, Mucil. aa 3, Aq. 3 p. ss. F. ht. One to be given every six hours. Every second day an efficient dose of calomel should be given with P. Scamm. Co., or a dose of Castor-oil; or the Sp. Tereb. may be given in milk. We have never met with Tania in children under eight years old, or known it to resist this treatment. "For Ascarides-an enema of some strong bitter infusion, as wormwood or chamomile flowers, or Semen Sautonici, should be administered moderately warm, No. 107 9 slowly, and in sufficient bulk to distend the rectum, and through a large pipe. It is desirable that it should remain some time up: it is to be repeated twice a week, and, on the intermediate days, a brisk purgative may be given, and generally the administration of three or four enemas, with the intermediate aperients, will be sufficient. "As debility of the organs of digestion, unclean bowels, deficient exercise, improper food and clothing, are the circumstances most favourable to the propagation and continuance of worms, it is in vain to give medicine, unless we endeavour, by appropriate means, to restore the general health. Exercise should be taken in the open air. The strength of the digestive organs should be increased by tonics, for which purpose the bitter vegetable infusions, in combination with soda, and some aromatic, may be given; the chalybeates, where they can be borne, are still better. The abdomen should be rubbed with stimulating embrocations, and when it is large a roller or belt should be applied. The food should be nutritious and somewhat stimulant, and taken in moderate quantities: all unripe fruit and ill-dressed vegetables should be avoided. The child should be sent into the country."-P. 256. Dr. Davies' observations upon Hydrocephalus extend to a length almost amounting to a treatise; but we do not observe that they throw any additional light upon this terrible disease, although they present a very good resumé of the most recent information we have upon the subject. Dr. Davies lays great stress upon the early employment of blood-letting and free purging, and makes the following observation, which we scarcely think a judicious one. "Were it more customary to let blood in these febrile diseases of children commencing with sickness and vomiting, and more especially where there is also a fulness of the hypochondria, one-half the cathartic medicines commonly given would be sufficient to restore the intestinal secretions: the crisis would take place at an earlier date, and fewer cases of hydrocephalus, subsequent to infantile remittent fever, would occur." Our experience is little favourable to the employment of blood-letting in children, save in well-marked acute inflammatory disease, and we have no faith whatever in its preventive efficacy. Of the Hydrocephaloid Disease, Dr. Davies observes : "Although exhausting discharges are for the most part the more frequent cause of hydrocephaloid affection, yet the disease sometimes takes place without any apparent cause of exhaustion, and alterations in the qualities of the blood, or in the nutrition of the brain, sometimes induce the same train of symptoms. Hence, defective nutrition of the body, and an imperfect supply of other vital stimuli, particularly air and light, may, by first inducing a state of irritation, eventually induce congestion, or the symptoms simulating hydrocephalus, and, in accordance with Dr. Bennet's statement, it is in the feeble children of the poor that hydrocephaloid affections are most commonly seen, except in those cases where it follows direct exhaustion."-P. 384. Dr. Davies thus speaks of the employment of Alum in Pertussis : "After a long trial I am disposed to attach more importance to alum, as a remedy in hooping-cough, than to any other form of tonic or antispasmodic. I have often been surprised at the speed with which it arrests the severe spasmodic fits of coughing; it seems equally applicable to all ages, and almost to all conditions of the patient. I was formerly in the habit of taking much pains to select a certain period of the illness for its administration, and of waiting until the cough had existed at least three weeks, taking care that the bowels were open, the patient free from fever, the air-passages perfectly moist, and the disorder free 1847] Treatment of Porrigo. 131 from complication of every kind. A continual observation of the remedy, however, has induced me to be less cautious, and I am disposed to think that a very large amount of collateral annoyances will subside under its use. The fittest state for its administration will be a moist condition of the air-passages, and freedom from cerebral congestion, but an opposite condition would not preclude its use should this state not have yielded to other remedies. It generally keeps the bowels in proper order, no aperient being required during its use. The dose for an infant is two grains three times daily; and, to older children, 4, 5, and up to 10 or 12 grains may be given, mixed with syrup rhead. and water. It is seldom disliked."-P. 432. Treatment of Porrigo.-When it occurs in the form of distinct patches, as is usually the case in the p. scutalata or p. decalvans, the best application is pyroligneous or strong acetic acid. In the first form, the part is to be only slightly touched by means of a piece of rag or sponge; but in the p. decalvans it is to be rubbed with the acid for a minute or two, " until it produces a sort of white vesication, and subsequent redness: it should not be touched again until the redness subsides." Some cases are cured by one application, and most by two or three; and if the acid is too frequently or too freely applied it induces a troublesome irritability on the surface. In the p. favosa the encrustations must be removed by soaking with soap and water and by poultices, and the hair clipped short but not shaved. The parts are then to be washed night and morning with an alkiline wash (Carb. sod. vel Bicarb. pot. 3 ij. adj. Aq. tepid.) and afterwards anointed with pot. bicarb. 3 ij., Axung. 3 ij. M. When the alkaline wash loses its efficacy, a weak solution of chloride of lime or soda, or the following lotion, may be substituted. R. Pot. sulphur. 3 ij., Saponis alb. 3 iiss., Liq. calcis 3 vij., Sp. V. R. 3 ij.M. After this, Dr. Davies has found the following ointment useful. R.Ung. picis, 3 j., Sulphur. 3 ij., Axung. p. p. 3 vj., Acid. sulphuric. viij. M. The most careful attention must be paid to the washing and drying the head and removing the dead hair. The head should be kept uncovered within doors. Attention must, at the same time, be paid to the general health, these cases generally being connected with cachexia. Dr. Davies has added considerably to the descriptions and remarks of former editions, and has thereby usefully filled up several of the lacunæ which existed, and especially so with regard to diseases of the chest. Satisfactorily, however, as he has executed this, the most important portion of his task, we cannot compliment him upon the management of its more mechanical part. Many of his own contributions and those of the former editors, are distinguished by the usual appliances of initials and brackets, but many others are not so, or these are so improperly placed as to be useless. The notes of one writer are run into the text of another, without even the courtesy of a separate paragraph, and undistinguished observations by the editor are inserted amid the current descriptions of the author, so that it often becomes impossible, save by comparing the editions, to ascertain whose property they really are. Persons, strangers to former editions of this work, will doubtless frequently quote passages from it as expressing its author's sentiments which were never printed until long after his death. All portions, contributed by such various and able hands should have been carefully distinguished; for, without such care, the work is deprived of much of its weight and authority. We also think the editor has not acted wisely in omitting several of Dr. Marshall Hall's observations to be found in the former edition. M. Donne's little Treatise, as we have already stated, is an excellent one; and will, we understand, ere long appear in an English dress. OF SCROFULA ; ON THE PATHOLOGY AND TREATMENT being the Fothergillian Prize Essay for 1846. By Robert Mortimer Glover, M.D., &c., Lecturer on Materia Medica in the Newcastle Medical School. 8vo. pp. 315, with 4 Plates. Churchill, London, 1846. WITHIN the last two years we have devoted so much space to the consideration of the very important subject of Scrofula, in reviewing the valuable works of Lugol, Dr. Tyler Smith, Messrs. Rilliet and Barthez, and lastly of Mr. Phillips,* that neither our readers, nor Dr. Glover himself, will expect that we should give an extended analysis of his work. Before proceeding to notice those parts of it which have chiefly attracted our attention, it is but fair to the author to state, that it was in the process of publication when Mr. Phillips' recent treatise was published." The Dr. G. divides his work into two parts, one devoted to the consideration of the pathology, the other to that of the treatment, of Scrofula. former contains eight, the latter two, chapters. Chapter I. is devoted to the "Description of Scrofulous and Tuberculous Matter." From this very expression, it will be at once perceived that our author regards these two forms of morbid deposit as essentially of the same nature; in opposition, therefore, to the opinion of Mr. Phillips on the subject, and in accordance with that which we expressed in our review of his work. The tubercles of the lungs are not to be distinguished from those found in other tissues and organs of the body: "We have," says Dr. Glover, after quoting the sentiments of Barthez and Rilliet, Valleix, and other writers to the same effect, "observed, in granular meningitis, the forms of grey granulation and yellow particles answering very well to the yellow points which appear in the grey granulation of the lungs. The milliary tubercle may exist in all the organs, and it is in the form of a grey infiltrated matter, granular to the microscope, more or less diffused through the substance of a gland that we detect the first appearance of mesenteric tubercle; afterwards we find a more crude or yellow appearance of tubercle matter, as in the lungs. The appearance of infiltrated grey matter is especially marked in effusions organised between the tunics of the intestinal canal. Some of the illustrations which are appended show the tubercular effusion in a mesenteric gland: 1stly, in a diffused form throughout the hypertrophied tissue of the organ; 2ndly, forming striæ and patches, varying in hue from grey to yellow; 3rdly, in cysts filled either * Vide the Numbers of the Medico-Chirurgical Review for January and October, 1845, and July, 1846. 1847] Identity of Scrofulous and Tuberculous Matter. 133 with a tuberculous powder or with a curdy matter; 4thly, in masses of lardaceous consistence implicating either the whole gland, or more or less of its structure. We have specimens of bronchial glands and bronchi sprinkled over, as it were, with a tuberculous powder, and studded with cretaceous fragments. "High authorities, notwithstanding, have spoken of the_grey granulation as a form of tubercle peculiar to the lungs, but we repeat as Barthez and Rilliet observe; it exists in all the organs, not only in the intestines, peritoneum, and pleura, but in the spleen, the liver, the kidneys, the lymphatic glands and the meninges.'"* P. 29. He subsequently remarks :-- "It is exceedingly probable that the grey and gelatiniform infiltration of Laennec are merely early stages of the tubercular effusion. According to this author, the gelatiniform effusion similar to an oedema, formed of a viscous lymph, passes into grey infiltration, as it is probable that this latter, like the grey granulation, passes into the yellow tubercle."-P. 30. In spite of the dissenting opinions of certain writers, we cannot but regard tuberculous deposit as essentially non-vascular in its structure, and altogether as an unorganised product or formation; being destitute of true nucleated cells, and consisting chiefly of molecular, irregularly-shaped granules and corpuscles. Is there any occasion for dwelling upon the Microscopic Characters of Tubercle? We fear not; for, notwithstanding the many elaborate descriptions that have been published, it must be confessed, we fear, that but little satisfactory information has been obtained. In our review of Mr. Phillips' work, will be found an account of the examinations made by Messrs. Dalrymple and Gulliver, two good authorities upon the subject; and, in a preceding number of this Journal, the reader will find M. Lebert's description, which is generally received as one of the most accurate that has yet been published. Dr. Glover has given extracts from the writings of Canstatt, Vogel, Scherer, and some other continental microscopists. For these we must refer the curious reader to his work. His concluding observations are as follows: "Under the microscope, undoubtedly, tubercular masses exhibit evidences of a deficiency of formative power, when compared with the organised deposits of ordinary inflammation on the one hand, and those of a parasitic character on the * According to our author's experience, tuberculous deposits are generally to be found between the investing membranes and the parenchymatous substance of the viscera. "In a specimen of tubercle of the heart, which we recently examined, all the tubercles were in contact with the endocardium or pericardium, although some of them had pushed completely through the muscular substance. In the tubercles of the spleen represented in the illustrations, the morbid formations are connected with the investing membranes of the organ. In all the specimens of tubercle of the kidney which we have seen, the deposit was connected either with the mucous membrane lining the ducts of the organ, or with the external covering. In the same way with the brain, we generally find the tubercles in contact with the external or internal membranes. And so with the bones, the tubercles are in relation with either the periosteum or the medullary ramifications. Not that we should deny the existence of these morbid formations in the parenchyma itself of an organ."-P. 231. |