bled freely until three o'clock, at which time he had the first motion, a black fætid mass.

I

Third, nine o'clock, A. M.-Urgent symptoms much abated: the boy answered incoherently, Yes and No; when questioned, complains of his head, and puts his hand to the back part of his head as the seat of pain; pulse 80, fuller and regular, but not soft. As he had had four copious motions, I ordered a free supply of gruel to assist the operation of the medicine. This morning the pupils contracted and dilated freely, and in unison. Twelve o'clock, repeated the powder; the blister ordered last night could not be applied, in consequence of his resistance and screams. I directed the attempt to be repeated at nine o'clock, and I learnt that it was again frustrated. Supposing a disposition existed in the mother and attendants not to apply it, I endeavoured to place it between the shoulders; but, although a child, three of us could not get him in a position to accomplish it he writhed about, determined not to have it on; indeed, had it been applied, he would soon have rubbed it off. This attempt gaye me an opportunity of observing, that it was not altogether disease, but a great deal of temper, that appeared in his resistance. have often experienced the disadvantage of such a circumstance, when, in defiance of threats or entreaty, children of this description have borne out their resistance to the exhibition of a medicine the most essential to their recovery; and, if coercive measures be adopted, the resistance they put in force, combined with temper, if obstinate, produces sometimes a fit: thus I never advise parents to force their children to take medicine. I trust this will not be considered a digression, because it is not irrelevant to the case in point: among the poor, especially, this fact is conspicuous; and in the instance here stated I feel its force severely. The boy who is the subject of this case, is of poor parents, and, like the "wild ass's colt," unmanageable; for whilst he was insensible, the powders were fortunately got into the stomach, but after he became conscious of sur rounding objects, neither the threats of his father, nor the entreaties of his mother, could prevail on him to swallow another mouthful, even of gruel, fearful lest it might be "physic." I had, therefore, no other dependence for success, than the lancet and the powders he had taken, which fortunately proved efficacious, for he gradually recovered, and at the end of five days from the occurrence of the accident, he called for more food than his parents could supply. At the end of a fortnight he became convalescent; and in three days after, that is, on the 18th of July, he was out of doors. I have seen him since, and there appears a degree of idiocy about him, which I understand has been noticed by others: whether he will recover this, remains to be proved.

It appears from this circumstance, that the brain sustained a severe shock, and that, had not the approach of inflammatory symptoms been detected, and their progress arrested, the boy would have been lost.

Upon comparing this case with the symptoms which some authors point out as distinguishing concussion from compression of the brain, it appears to me impossible to draw a correct inference in even the

generality of affections of the brain. In concussion, say the teachers of surgery, you have vomiting, dilated pupil, and sensibility to local, stimuli; in compression there exists vomiting (but this is not always a concomitant symptom), dilated pupil, and insensibility to local stimuli; whereas in a case which has occurred in my practice, which was demonstrably compression, there existed vomiting, immoveably contracted pupils, with strong susceptibility of local stimuli. In. the case of the boy, William Parish, the pupil was decidedly not dilated, and the susceptibility to local stimuli was highly conspicuous; so that it appears we are not warranted, in affections of the brain, to adopt decisive diagnoses from any particular symptom, or set of symptoms, as they may, and do exist, in each particular disease reciprocally, where there is no visible injury of the head: we should therefore, collect, arrange, and compare the appearances and symptoms as they arise at the bedside of the patient, to assist our judgment in forming a prognosis. To quote the words of a very able writer in support of my position, he says:

"To distinguish between a commotion and an extravasation (of the brain) by the symptoms only, is frequently a very difficult matter, sometimes an impossible one; the similarity of the effects in some cases, and the very small space of time which may intervene between the going off of the one and the accession of the other, render this a, very nice exercise of the judgment. The first stunning, or deprivation of sense, whether total or partial, may be either, and no man can tell from which; but when these first symptoms have been removed, or have spontaneously disappeared, if such patient is again oppressed with drowsiness, or stupidity, or total or partial loss of sense, it becomes most probable, that the first symptoms were from commotion, and the latter from extravasation; and the greater the distance of time between the two, the greater is the probability, not only that an extravasation is the cause, but that the extravasation is of the limpid kind, made gradatim, and within the brain. Whoever seriously reflects on the nature of these two causes of evil within the head, and considers them as liable to frequent combination in the same subject, and at the same time considers that in many instances no degree of information can be obtained from the only person capable of giving it (the patient), he will immediately be sensible, how very difficult a part a practitioner has to act in many of those cases, and how very unjust it must be to call that ignorance which is only a proper diffidence, arising from the obscurity of the subject, and the impossibility of obtaining materials to form a clear judgment. Hence, how invaluable are the opportunities of examinations after death, and how culpable the negligence of that practitioner, not only to himself, but the community at large, who neglects to seize them when offered, nay, to ask it as a favour wherever there may be the slightest shadow of evidence wanting in the general symptoms to warrant any important conclusion! Let us, in this important point of our professional career, viz. the searching out for facts to guide our judgments, imitate the great John Hunter, not inded in transgressing the laws of propriety, but in that ardour which he evinced for inquiry; that thirst after knowledge which led him to seek for patho

logical truths, where alone it is to be acquired, viz. on the ground of morbid anatomy."

REPORT OF DISEASES IN BERLIN.--Professor Hufeland has CASES published two annual reports of the Royal Polyclinical Institution, of Berlin, which, in a practical point of view, are highly valuable. In the years 1817 and 1818, two thousand nine hundred and seven patients were treated in this institution. Of these, one thousand nine hundred and seventy-two were cured; twenty-six died; five hundred and thirty-seven were unrelieved or sent to other hospitals; one hundred and eighty-six remained under treatment. In this number, there were seven hundred and twelve children under twelve years of age; and among these, two hundred and ninety from one to two. The professor, after various details as to the funds and administration of the institution, presents a statement of the different diseases during the two years.

Acute Fevers.-One hundred and fifty-six patients were treated for acute fevers. Of these, ninety-one recovered, and three died; they were for the most part rheumatic, very few nervous. The rare occurrence of intermittents during these years is remarkable ; eleven cases only were observed: there were seventy cases of inflammation of the lungs and of pleurisy, of which fifty-nine were discharged cured.

Pulmonary Consumption.-Of one hundred and five consumptive patients, twenty-five were discharged cured, or rather relieved for the Professor adds, "which indeed is not always, in this disease, to be considered as a radical cure. There were, however, in the number of the convalescent, several cases of chronic inflammation of the mucous membrane of the windpipe, &c. which may be regarded as completely cured. In these, the decoction of the Iceland moss, with the bitter-sweet, and pearl barley, in milk; acetate of lead, and issues, were the principal remedies. In tubercular and catarrho-rheumatic consumption, the excellent effects of a strong decoction of the bitter-sweet (half an ounce daily; boiled from sixteen ounces of water to eight) combined with either the seeds of the water fennel, or rattle-snake milkwort, or Iceland moss, were very evident.

Rheumatism and Gout.-There were one hundred and eighteen patients afflicted with rheumatism and gout. Of these, seventyseven were cured. Besides the ordinary remedies, decoction of the woods, guaiac gum, &c., the great utility of repeated blistering and cupping, were in several cases remarkable.

Nervous Diseases.-Out of ninety patients suffering from nervous diseases, forty-nine were cured. In epilepsy and Saint Vitus's dance, the oxyde of zinc was invariably found most serviceable. It was administered in gradually increasing doses, to the extent of half a scruple; and when the patient had become habituated to its employment, the sulphate of zinc was substituted for it.

Spasms in the Stomach.-Seventy-one individuals, mostly females, were admitted with spasms in the stomach, and fifty-three cured. Exposure to cold air, employment in damp situations, and hysteria, were its principal causes. Bismuth, henbane, magnesia,

winter's bark, cajiput oil, tonic and sedative plaisters over the stomach, and blisters, when the disease was of rheumatic origin, constituted the chief remedies. In some cases, where organic disease of the stomach evidently existed, the most conspicuous benefit was derived from the internal employment of the prussic acid, hemlock, and mercury, conjoined with mercurial friction.

:

Cutaneous Diseases.-One hundred and seventy-three patients were affected with chronic diseases of the skin of these, one hundred and fifteen recovered. In obstinate herpes, the carburet of iron, given daily to the amount of a drachm, was sometimes successful. Crude antimony, also, given from two to three drachms a day, proved beneficial. In young children, magnesia and chalk, with rhubarb, were found to be adequate to a cure; hence proving the presence of acidity in the stomach to be the principal cause. The important influence exercised by the digestive system in the cure of cutaneous diseases was evinced in a case of erysipelatous ulceration of the foot, which, in three days, was cured by emetics and the mere external application of the wax plaster.

The extent of the city of Berlin affords an opportunity of observing many rare cases. The Professor notices seven cases of diabetes, of which the urine was analysed by Mr. Hermbstaedt; six of organic diseases of the heart; nine of watery head; two of dropsy of the pericardium; and several remarkable ones of morbid structure, which are uninteresting.

RHATANY ROOT.-Professor Hufeland, physician to the King of Prussia, has pulished, in his "Journal of Practical Medicine, "observations on the rhatany root, confirmatory of its very beneficial effects in cases of debility. The first is, chronic or passive hæmorrhage of the uterus. The patient was only twenty-five years of age. The second is a similar case in a person aged forty-five years; the third, painful menstruation, at the age of twenty-eight; the fourth, fluor albus; the fifth, gout and fluor albus in a subject aged thirty-eight; the sixth, fluor albus of long standing; and the seventh in a case of local debility in a young man. In all these cases, the Professor states, the Peruvian bark and the ordinary medicines had failed. Dr. Ruiz, of Madrid, in his "Treatise on the Virtues of the Rhatany Root," particularly notices its beneficial effects in similar affections of the uterus and vagina, dependent on relaxation or want of tone; and our countrymen, Sir Henry Halford, Dr. Maton, and Dr. Cheston, speak highly of its tonic power in cases of hæmorrhage and mucous dis charges from debility. The foreign extract being made by solar heat, contains all the medicinal virtues of the root, whilst that made in the usual way in this country is as free from any medicinal pro perty as the powder of rotten wood. The tincture made by dissolving an ounce of the foreign extract in a pint of brandy, in the dose of two tea-spoonsful with one tea-spoonful of the saturated tincture of cubebs, in a glass of water, two or three times a day, is an excellent remedy for the indigestion of gouty subjects, fluor albus, and gleet.

Since the foreign extract of rhatany has been scarce, many

wholesale druggists have sold a foreign extract of bark for it; and with it, we are credibly informed, most of the retail shops in the country are supplied. The foreign extract of rhatany, which is decidedly the best preparation of the root is brittle, and imparts a red- › dish hue to water; it is also transparent, very slightly bitter, and powerfully astringent. The article which is now very generally substituted for it, is soft, produces a muddy mixture when dissolved in water is very bitter, and slightly astringent. A translation of Ruiz's "Treatise on the Rhatany Root," has lately been published in London, by Messrs. Sherwood and Co.

MUCOUS MEMBRANE.-Dr. Hastings, Physician to the Worcester Infirmary, fancying that he has accumulated many facts calculated to throw additional light on acute and chronic inflammation of the mucous membrane of the lungs, has lately made a book, of the value of half-a-guinea, with the very benevolent and most laudable view of communicating the same to his brethren, for the benefit of suffering humanity. Before Dr. Badham's Essay on Inflammation of this membrane, technically termed bronchitis, Dr. Hastings supposes no work existed, in our own language at least, on this disease. By way of introduction, this learned physician devotes no less than sixty-six pages to the consideration of the opinions of dreamers, on the "kind and degree of contractility or irritability possessed by the blood vessels."-To have these determined, the doctor supposes "to be most important, because opposite opinions respecting them are held by men whose distinguished talents claim the greatest respect." To settle the opposite opinions of men of distinguished talents, is certainly a very modest undertaking for a physician on the commencement of practice.-It is really laughable to hear physicians contending respecting contractility of arteries, a point, which a surgeon's pupil, who has seen one operation, must be capable of settling. If the late Dr. Parry, of Bath, or his son, Dr. C. H. Parry, had been educated in a school of surgery, would they have ever disgraced the science of medicine, by publishing such ridiculous nonsense respecting the momentum of the blood, and the irritability of arteries? The action of the heart, Doctor H. is satisfied, does not depend on nervous influence, because Dr. Philip says so; and again, the circulation of blood in arteries, does not depend on the propelling power of the heart, because the said Dr. Philip "saw the circulation of blood continue with regularity in the mesentery of a rabbit for half an hour after the excision of the heart." Now the fact is, the muscular coats of arteries remain excitable a much longer time after the death of a rabbit; and their motion the doctor fancied to be produced by the transmission of blood through them: so much for pre-conceived theories. If the circulation really continued for the space of half an hour after the heart was removed, from whence came the blood? Again, we would ask the learned doctor, if the action of the heart is not frequently influenced by passions of the mind; and if so, is it not through the medium of the nerves? This long introduction is followed by a chapter, on the "general nature of inflammation," to which no less than eightytwo pages are sacrificed. In this most desultory dissertation, he