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one side of it, by pointing to the spot; a knitting of the eye-brows, with an expression of the countenance indicative of great distress; for a few minutes there will be a perfect silence and quietism, with a fixed steady stare of the eyes, and a very great dilatation of the pupils, when a sudden start will take place, with a loud screaming and a quick tossing of the arms over the head; frequent moaning; deep sighing; sickness and vomiting; bowels most obstinately costive; the evacuations, when procured, are very scanty and ill-formed, and extremely offensive; and when it happens that by any active means a good mass is brought away, it looks like any thing but fæces, being dark, yeasty, and gelatinous—smelling like a mixture of sour grains with putrid matter; the tongue foul, sometimes brown and dry; much thirst; no appetite; the urine irregularly secreted, both in colour and quantity; the pulse is very irregular, both in the tone of the vibration and in the flow of the blood-sometimes slow, sometimes quick, and intermitting with a tensive feel, until it at last sinks into permanent sluggishness, ushering in its ultimate and fatal celerity; a dewy moisture settles iu drops upon the upper lip and around the nose; a considerable wasting of the flesh bas taken place; the countenance pallid and sunk, with a hollowness of the temples ; blueness of the lips, with their frequent retraction from an attempt, but inability to cry, ending in a whining tone from weakness; the eye-lids half open and motionless; the eyes filmy, and fixed with a peculiar stare, from the extreme dilatation of the pupils; the circulation is extremely hurried; convulsions frequently take place; palsy supervenes, either partially or generally; and death, most commonly in one convulsive struggle, closes the painful scene." (p. 70–73.)
A brief outline of the most efficacious plan of treatment will here be sufficient for our purpose: which is not to encourage domestic quackery, but rather to excite the watchfulness of parents—to inculcate the great importance of arresting the early symptoms of disease--and to enable them, in some degree, to understand, and judge of, the practice recommended by their medical adviser. In the first stage, nothing more will be requisite than a continued exhibition of purgatives, combined with alterative doses of mercury, until the discharges from the bowels shall assume a natural healthy appearance; aided, at the same time, by a proper regulation of the child's diet. In the second stage, purgatives alone are not to be relied on, and those which arė employed ought to be rather of the saline than of the resinous kind : there is now a febrile excitement of the circulation, wbich must be reduced by blood-letting both general and local; but if any circumstance should seem to forbid the general bleeding, the local detraction of blood
Crit. Rev. Vol. IV. Oct. 1816.
from the head, and perhaps from the epigastrium, should by no means be omitted; and in such cases, the effects of digitalis appear to have been particularly beneficial. Mercury should now likewise be administered freely; large blisters have been commonly applied to the head, but the utility of the application is somewhat doubtful, at least before the excitement has been materially diminished; afterwards they may be very properly employed. Such are the means, on the judicious use of which we must depend for the relief of this formidable disease, and free quently with a prospect of complete success : in its more aggravated form, we have recourse to the same measures, but with greatly diminished hopes; nor can we, in these cases, ordinarily look for any other than a fatal termination.
In the course of his remarks upon the effects of general bleeding in the cure of local inflammation, our author observes,
“You may bleed generally till the heart is killed, without destroy. ing the local activity, except by the destruction of the whole sys. tem, as is evident from great congestion of the extreme vessels observable in dissections when patients have died of local inflammation, after large general bleedings. This has occurred very commonly in the brain.”
We admit the fact, and think it of considerable importance, but are inclined to doubt the explanation; it appearing to us, that congestion of blood does not take place in any part, until the veins of that part have either partially or wholly lost the power of propelling their contents; and if the same appearances are observed after profuse hæmorrhage, where no previous inflammation existed, it is in proof of local torpor, rather than of preternatural activity. That this is actually the case, we learn from some experiments made, not long since, by Dr. Sanders and Dr. (ihen Mr.) Seeds, who embodied the results in an inaugural dissertation, published at Edinburgh last year. They destroyed several dogs by opening, in some of them, the larger veins, in others the arteries, and then accurately examined the phænomena discoverable by dissection: the different effects of the two modes of bleeding deserve to be attended to. 'It is remarkable, that in every instance, whether the animal lost arterial or venous blood, the cavities of the brain were distended with lymph, as in those persons who are said to have died of hydrocephalus. It is to be noted, however, that when the bleeding was from an artery, the brain was almost void of blood, at least there was nothing like venous congestion ; but when from a vein, congestion was invari. ably found in the brain. It was also observed, that arterial hæmorrhage neither, so suddenly as venous, interrupted the function of respiration and the action of the heart, nor so speedily enfeeble the animal; and that it was less apt than venous hæmorrhage to be attended with convulsions, These observations indicate the propriety of sometimes preferring artriotomy to phlebotomy, and point out some of the circumstances which ought to influence our choice. Practical writers, indeed, have often insisted upon the preference due, in certain cases, to arteriotomy, without being able to give any other satisfactory reason for it than its su. perior utility in their hands: henceforward we may expect to see the practice guided by something like a rational principle.
It has been said, that hydrocephalus is by many per. sons believed to arise from abdominal irritation; but it may be worth while to carry the notion a little farther, and trace some diseases of adults to the same prevailing source. For a masterly view of the whole subject, we have much pleasure in referring that part of Mr. Abernethy's works which treats of " the constitutional origin and treatinent of local diseases.” The functions of the nervous system will re. main a mystery to physiologists, but enough is known to shew the intimate connection which subsists between the wellbeing of the brain and that of every other organ; no part of the body can be injured, but the brain participates more or less in the injury; and again, the brain cannot suffer without involving the whole system in its disorder, and more particularly the organs of digestion. Thus it is that the injury done to the stomach and liver by a debauch, occasions headach and dullness of intellect; and thus that the sight of a disgusting object, the receipt of afflicting intelligence, or any depressing passion of the mind, will impede the process of digestion, exciting nausea, or even vomiting: the influence of different mental emotions upon the secretions is familiar to every one. The irritation of teething, and the irritation of a worm in the intestines, often occasion convulsions, and may give rise to all the symptoms of water in the brain ; in both cases, there is great disorder of the chylopoietic viscera: the irritation of a painful wound in the extremities, is a cause of tetanus, and here too, the functions of the alimentary canal are greatly de
hot fro peculiar equal to becart of thun,
ranged; in all these instances, we must suppose the irrita. tion to act, in the first place, on the sensoriun, and thence, by a reflected operation, upon that part of the system which, at the time, is most disposed to become disordered. The like causes do not act equally upon all persons ; some constitutions are peculiarly irritable, being more susceptible of impression from all external agents than others : such a constitution is the wretched inheritance of many people, and in others, the habits of civilized life contribute largely to its formation; these are the subjects of that numerous tribe of complaints termed nervous. In such persons ge. nerally, without their being aware of it, there exists a slight degree of disorder in the digestive organs, which, though not productive of any serious present inconvenience, may lay the foundation of a great variety of future ills. They commonly experience a diminution of appetite and digestion, with flatulence, and unnatural colour and fætor of the excretions, which are generally deficient in quantity, though sometimes a lax state of bowels alternates with costiveness. The appetite, however, is sonjetimes moderately good, whilst the digestion is imperfect; in some instances, indeed, the appetite is inordinate. The tongue, in a morning, is dry, whitish, or furred, particularly at the back part; the urine is frequently turbid, and often, especially in the interval between breakfast and dinner, pale-coloured, and copious, like that of hysterical patients; and in many instances a tenderness is felt, when pressure is made in the epigastric region.
They who are affected in the manner now described, usually declare themselves to be in a good state of health; yet, to use the words of Mr. Abernethy, “ they are found, on inquiry, to have all the symptoms which characterize a disordered state of the digestive organs. The mind is also frequently irritable and despondent; anxiety and languor are expressed in the countenance. The pulse is frequent, or feeble; and slight exercise produces considerable per: spiration and fatigue. The patients are sometimes restless at night; but when they sleep soundly, they awaken unrefreshed, with lassitude, and sometimes a sensation as if they were incapable of moving. Slight noises generally cause them to start, and they are, to use their own expression, very nervous.” It is possible that patients of this description may continue many years to live without any material improvement or deterioration of their general state of
health; but it is more likely, unless the morbid condition be early corrected, and its causes avoided, that the symp. toms should in time be aggravated by the continued reac. tion of the disordered brain and digestive organs upon each other, until they terminate in. habitual headachs, apoplexy, palsy, hypochondriasis, madness, or some other equally terrible disease. The difference between the severe headaches of adults, and the disease which forms the principal subject of this article, is not very great; Mr. John Bell says, it 66 is but a slower hydrocephalus ;” and again, habitual and very violent headachs, attended with bilious vomitings and severe sickness, 6 are as surely attended with effusion of serum as rheumatism is with swelling of the inflamed joint: we see such headachs depressing the spirits, hurting the memory, extenuating the body, and destroying the health ; causing grey hairs, and a broken constitution early in life.” Even that familiar and tormenting pain the toothach, may most frequently be traced to irritation in some of the abdominal viscera: let any one disposed to be incredulous on this point, consult his own feelings, and say, whether, during a paroxysm of toothach, he does not experience a flatulence of the stomach, some uneasiness or tenderness upon pressure there, or in the right hypochondrium, and some. times a dull pain in the right shoulder, symptomatic of inflamed liver.' Is not the paroxysm apt to be excited too by indigestible food, by depressing passions, and by causes in general that act particularly on the stomach? Finally, if the pain shall be removed by the operation of an emetic, or, still better, by an opiate combined with a brisk mercurial cathartic, it must be admitted that the cause of the complaint was some disorder in the organs of digestion, and that its return may be best prevented by guarding against all the causes of such disorder.
It is sufficient at present thus briefly to have touched upon this subject, to point out the very moderate beginnings of fatal diseases, to hint at the common origin of many of these; and we conclude with once more urging the great importance of what has justly been called preventive medicine.