THE BOSTON MEDICAL AND SURGICAL JOURNAL.

Vou. LI. Wepnespay, Ocroper 25, 1854. No. 13.

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CASES OF POISONING BY THE EXTERNAL APPLICATION OF COR- ROSIVE SUBLIMATE.

BY H. R. DE RICCI, MEDICAL OFFICER OF THE BALLYMAHON UNION WORKHOUSE,

Cases of poisoning by mercurial preparations are of so rare occurrence, that 1 am induced to lay before the profession the following account, in which death was the result of the outward application of corrosive subli- mate for the treatment of porrigo of the scalp.

P. and W. B., brothers, one aged 11, and the other 7 years, had been suffering from tinea favosa, or porrigo, for a very long period. As well as I could discover, the eldest had labored under it for about six years, and the youngest for about three.

They first came under my notice about a year ago, when they applied © for relief at my dispensary ; but finding, I suppose, that the cure was not proceeding sufficiently quick, and that I was not torturing their heads with painful applications, they soon gave up attending ; and eventually, in April last, they applied to one Corny Mack, a shoemaker by trade, but well known through the country as a skilful man,” and he engaged to cure them in a week.

Iam induced to believe that they were displeased with my mode of treatment, because on several occasions they complained that the oint- ment | gave them caused no pain, and they several times asked me for pitch plasters, which I always refused ; for I have found by experience, inmy workhouse hospital, that Dr. Neligan’s mode of treatment is de- cidedly the only one I know of, which offers a chance of cure. I speak thus decidedly upon this matter, because when 1 began the profession I started with the generally-received idea that porrigo is incurable ; but having had my hospital at one time filled with paupers drafted from three other workhouses, and among them having chanced to get a large pro- portion of children affected with porrigo, every one of whom had been under some kind of treatment or other; I instituted a series of experi- ments in order to test Dr. Neligan’s mode of treatment, and satisfy my own mind. ‘The result was as follows :—Of the children treated consti- lutionally, as he recommends, some recovered ; whereas of those. who Were treated by local applications of the most varied kind, very few were even improved. But to return to my cases.

The father of these unfortunate children having made a bargain with

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250 On Poisoning by Corrosive Sublimate.

the quack, sent them to his house on or about the 15th of April last, and whilst there, Mack rubbed into their heads a white ointment (which | subsequently learned from himself was made with two drachins of cor- rosive sublimate, and one ounce of tallow). If my applications had been painless, this made ample atonement for all my deficiencies ; pain most agonizing at once set in, and before the doctor shoemaker had done rubbing an the second, the first was in torture, screaming that his head was on fire.

The operation being completed on both the children’s heads, they re- turned home, and by the time they reached there, their sufferings were so intense that they could be heard screaming from every part of the village where they lived, and, in about forty minutes from the application of the ointment, they were completely delirious. Vomiting of green matter, to a large amount, also set in, together with pains in their bowels, diarrhoea and bloody stools, all in less than three quarters of an hour from the application of the ointment. ‘Thus they continued from bad to worse, till death put an end to their sufferings, the youngest on the seventh day, and the eldest on the ninth day of their illness. During the whole of this time they had not one intermission, and from the mo- ment they returned from Mack’s to the hour of their death the scream- ing, the vomiting and the purging never once ceased.

The youngest child having died, an inquest was held, and I was di- rected by the coroner to make a dissection of the body, which I did thirty-eight hours after death, and gave in my written opinion that de- ceased had died from the effects of a mineral poison, probably a_prepa- ration of mercury or of arsenic.”

These were the appearances | found :—Body well formed, and not at all emaciated ; cadaveric rigidity well marked. On examining the head I found the scalp studded with small, depressed, circular ulcers of about one inch to an inch and a half in diameter, with fragments of dock leaves adhering to them; these being scraped off, the bottom of the ul- cer presented a peculiar yellow tint, and on making an incision into it perpendicularly to the surface of the cranium, this yellow appearance was seen to penetrate the entire substance of the scalp ; it was of firmer consistence than the adjoining sound pieces of skin, and felt under the knife like cutting through a piece of brawn. I removed the calvarium, and found nothing’ worthy to note except a peculiar dryness of the entire surface of the brain, which was also present in the ventricles and the spinal canal. The substance of the brain itself was firm and white, sprinkled with minute red points, but not in great number. On opening the abdomen I was again struck by the extreme dryness of all the pe- ritoneal surface. The liver was large, but not extremely so, and its sub- stance on section appeared normal ; the gall-bladder was distended with bile, contrary, I believe, to what has been generally stated to be the case mM poisoning by corrosive sublimate. The intestines, as they lay in situ, appeared blotched with pink, purple and brown spots, and a_ perfect mass of intus-susceptions—I counted twenty-three. On opening the stomach, which was moderately distended, [ found the mucous mem- brane injected with red blood throughout, presenting the most beautiful

On Poisoning by Corrosive Sublimate. 251

arborescent appearance, but not the smallest ulceration or softening. The duodenum was healthy, but the jejunum, ‘ileum, colon and rectum, were all in the highest state of inflammation, especially the lower third of the ileum, and the commencement of the colon, about the ileo-ceecal valve, which was not only inflamed, but studded with some small patches of ulceration, about the size of a pea.

The pancreas, kidneys and spleen, were all healthy ; the bladder empty, and contracted to the size of a chestnut.

While this examination was going on, the elder brother died. On the following day, sixteen hours after death, I made an examination of his body also, the details of which | need not give. as the appearances were exactly similar to those just described, with the following excep- tions :—The gall-bladder was empty and highly contracted ; the urinary bladder quite full; the ulcerations of the intestines were also more ex- tensive, and the stomach presented, in addition to the beautiful pink arbo- rescence above described, some few black spots of extravasated blood.

| had seen this last child alive about two hours before he expired ; his countenance was then expressive of extreme anxiety and pain ; round his mouth, for the space of about an inch and a half, there was a rash, such as appears often in poisoning by arsenic; he was quite delirious, and died shortly after in convulsions.

The principal points of interest which appear to me worth noticing in the two foregoing cases are, first, the extreme rapidity with which all the severe symptoms set in. So far as I have been able to learn, from the very few cases of external poisoning by corrosive sublimate which are on record, pain has set in immediately in some of the cases ; but vomit- ing and bloody stools have not commenced for hours and days. Now in the foregoing, although, for the sake of greater certainty, | have said that forty-five minutes elapsed between the inunction and the commence- ment of the bloody stools, yet | believe that I could reduce that interval to thirty or thirty-five minutes, as the children were attacked at once on reaching home, and the distance is easily walked in half an hour or less.

Another interesting feature was the total absence of ptyalism in both cases, and the appearance of cancrum oris in the youngest ; whilst a rash very similar to that which occurs after arsenical poisoning appeared round the mouth of the eldest.

The eldest child passed water throughout his illness, although in di- minished quantity, and his bladder was found full on dissection.

The youngest had complete suppression of urine from the commence- ment; and in him I found the urmary bladder empty and contracted, whilst the gall-bladder was distended with bile, contrasting with the elder brother, in whom these conditions were reversed.

The following is the verdict, which was unanimously agreed to by twenty-three highly-intelligent jurymen at the inquest ; and before giv- ing it | must premise that, in addition to the other evidence, the quack admitted that he had applied an ointment to these children’s heads on the day they were taken ill :—** That deceased came by his death from the effects of a poisonous substance applied to his head for the cure of a disease of the scalp by a person or persons unknown to us.”—-Dublin

Quarterly Journal of Medical Science.

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SMALLPOX OCCURRING TO THE FCTUS IN UTERO. BY R, AULSEBROOK, ESQ., M.R.C.S.E. AND L.S.A.

I am desirous of placing upon record the following case of smallpox oc- curring to the foetus in utero, which came under my observation in the year 1834, the entire particulars of which | have not been able, from circumstances, to gather together until the present time.

Variola existed in Bierton, near Aylesbury, Bucks, in November, 1833, contiguous to the residence of Jacob W————, a baker in that village, His son, who had never been vaccinated, caught the disease, as it was supposed, from the family of a neighbor, and the eruption was observed in him on Saturday, November 30th. On Sunday, December Ist, Mrs, W— and all her other children were vaccinated, for the first time, by Mr. W. Hayward, surgeon, of Aylesbury, with whom 1 was then resi- dent as visiting assistant. ‘The vaccination was successful in all, except. ing one daughter, who, however, was successfully re-vaccinated by me at the end of a week. Mrs. W———— had but one vesicle ; but there is now (June, 1854) a tolerable scar visible. Fourteen days before her confinement, Mrs. W———— states that she remembers most distinctly on that day that a most nauseating and depressing effect was produced in her by the odor of one of the stools from her variolous son, whom she was nursing; and on the 4th of January, 1834, a fortnight from the Above sensation produced in her, and five weeks, minus one day, after her vaccination. she was delivered of the child the subject of this notice. On examining the infant almost immediately after its birth, 1 observed on the abdomen some spots, differing in size and appearance ; others were discovered on the loins and back, and on the face and neck, those - on the latter parts being most numerous. At the inner angle of one of the eyes was a pustule, nearly maturated, of the size of a common smallpox pustule, and others of the same size were found on the hands, On the following day the eruption was considerably more out ; each pus- tule had a distinct red inflamed base, was depressed in the centre, and had unequivocally the true variolous character ; a cluster of them existed at the left side of the tongue near the apex, and one on the dorsum of that organ towards the root.

The child was feeble, did not suck, nor take scarcely anything by the mouth, and early on the third day expired. Mrs. W—— had herself no illness, nor any manifestation of the disease apart from the nausea arise ing from the effluvium before mentioned, which she perceived on the four- teenth day prior to her confinement, and at which time it is perhaps scarcely questionable the taint was communicated to the foetus in the womb.

Having had the honor of an acquaintance for many years with Mr. Robert Ceely, of Aylesbury, and knowing how extensive the labors of that gentleman have been on this general subject, constituting him, in- deed, by common consent, the greatest living authority upon it, | men- tioned this case to him, and he has pointed my attention to two exam- ples recorded by Dr. Jenner in the Medico-Chirurgical Transactions for 1809, page 269, in which the fcetus in utero became affected, the

Effects of Medicines on the Healthy Human System. 253

mother escaping any external manifestation of the disease. Dr. Jenner adduces those cases to show the continued susceptibility to variola through life ; but as the cases differ as to particulars, I shall briefly state them.

In one of those cases the mother had had smallpox herself many years before, but had never been vaccinated ; and on meeting in the street, very shortly before her confinement, a child covered with the disease, and loathsome in appearance, she was very sensibly affected. The sen- sations passed off, and she had no outward manifestations of the disease ; but five days after her delivery, pustules appeared on the infant, and the diseased went through its usual stages, though in a mild form.

In the other case related, smallpox had been introduced into the house by the parish surgeon (1808) inoculating three of the sons of the family, but the mother was vaccinated by another surgeon. The vaccination was successful, and in five weeks after its performance (during four weeks

; of which time she had been exposed to the variolous infection of her | three sons) she was delivered of a female child, which on its birth was ' found affected with the smallpox eruption. The surgeon (Mr. Gervis, 4 of Ashburton, Devonshire), whose case the above was, distinctly states that at no period after the exposure of the mother to the variola in the | house, did she evince any sign of being affected by the effluvium ; yet i the disease was transmitted through her system to the constitution of the infant, herself clearly escaping any kind of manifestation. 4 In the case 1 have related, and which came under my own notice, f the mother, it will be borne in mind, had been vaccinated, and success- 4 fully ; but, notwithstanding, had, fourteen days prior to the birth of the : child, and three weeks after her vaccination, “a most nauseating and q depressing effect produced on her by the odor of one of the stools from f her variolous son.” ‘| This strong perception of the variolous infection was not, however, suf- of ficient against the protective influence of the vaccine matter which had been introduced into her system, to produce any development in her of " the smallpox, and the infection passed to the foetus in the womb.— if _ The value of this case, in so far as it may be considered to possess nm interest, Consists, it may perhaps be said, in this, that it sets forth, at one nf and the same time, and in a more palpable way than any previously re- ps corded, the continued susceptibility to variola after vaccination ; and yet a the protective influence of the vaccine lymph in operation, guarding the system so far in this instance as to prevent any eruption appearing, or 4 any other than a transitory affection of the health.—London Lancet. of in- ne EFFECTS OF MEDICINES ON THE HEALTHY HUMAN SYSTEM. m-

BY. E, C, ATKINSON, M.D., DOVER, IOWA.

Tue science of therapeutics has now attained a degree of perfection at least equal to that of any other. The prescriptions of the physician, who merits the name, are no longer influenced by magical incantations, and visionary notions of relations and affinities which never existed. His

254 Effects of Medicines on the Healthy Human System.

opportunities enable him to acquire a comprehension of the relations of medicines to each other, and to diseased action, so that he can rest his judgment on the legitimate basis of sound philosophy. After determining the pathology of the case before him. the experienced practitioner may generally prescribe with singular confidence as to the effect which will follow, often eradicating disease in its incipiency, controlling it in its cul- mination and decline, and alleviating what it cannot cure.

With the physiological effects of medicines, however, we are not so well acquainted. The science of toxicology is yet in its infancy. This arises not only from the fact that it is a subject of comparatively modern inquiry, but from the limited field of observation to which the student of this department of science is necessarily restricted.

While he may have daily opportunities of witnessing the effect of cu- rative agents in disease, he is indebted chiefly to the occasional circum. stance of accident, or criminal design, for testing their effects in health. Nor is this the only difficulty he has to encounter ; under the same modi- fying influences, the action of medicine is less uniform in the healthy than in the diseased state.

When disease invades the system, it levels to a great extent its pecu- liar sympathies and idiosyncrasies, and establishes a tolerance of the agents necessary for its cure. In health, on the other hand, with all its sympathies in full play, each system is acted on differently. Thus we might give a certain quantity of tinct. opii to a number of individuals of the same nativity, and apparently of the same condition ; but while we should find the lives of some destroyed by-its effect, others would hardly be in the least affected; a fact not referable to their muscular strength, but to a different susceptibility of their nervous systems to its action.

Again, medicines sometimes exh ibit a specific effect on the healthy system, to a knowledge of which their effect on the same system in dis- ease furnishes us no precedent. An interesting illustration of this princi- ple recently came under my notice.

An old lady of much experience as a nurse, asked me for a mild Jaxa- tive, cautioning me at the same time not to give her rhubarb, for said she, “it always gives me violent strangury.”” A few weeks subsequently she called on me again for a similar prescription. I gave her rhubarb con- cealed in pills ; a severe strangury was the result, which, however, was soon relieved. A few months after she suffered from a severe attack of erysipelas, during the course of which she was troubled by a persistent watery diarrhoea, for which I gave her rhubarb at several different times, with no other than the best effects. Since her recovery, I have been informed of another case on whom rhubarb produced the same bad re- sult. With these facts before us, it is obvious that some time must elapse before toxicology can be considered a matured science resting on a firm foundation. The task, however, by the energy of the medical profession, will doubtless in due time be accomplished.

Without further preliminary, I submit the following record of cases for publication, without attempting a philosophical analysis of the facts which they contain.

Effects of Medicines on the Healthy Human System. 255

Effects of Opium. Case 1.—Mrs. C., aged 69, never had much sickness ; intellectual faculties but little impaired; was advised by a friend to take tinct. opii for a slight diarrhoea; accordingly took 30 gtts. on going to bed. About fifteen minutes after retiring, her moanings awakened her daughter, who found her in great distress, though suffi- ciently rational to inform her what she had taken. Her daughter at once sent for medical aid, but before I arrived she was dead. I ascertain- ed that about fifteen minutes after the toxical effects were first exhibited, she sank into a perfect coma, and in about two hours died.

Case I1.—Mr. B., aged 18 years, on account of some difficulty with his lady-love, attempted suicide by taking of tinct. opii 20 gtts. This small quantity, however, produced an extreme impression. After taking it, he retired to his room. One hour after, when found, the following symptoms were presented : pulse moderately full, beating but 40 per minute, stertorous respiration, countenance livid and suffused, skin moist and cool, extreme stupor, total insensibility to external impressions, and powers of life sinking. After trying a variety of means for his relief, with no apparent good effect, we resorted to showering his head with cold water, under the influence of which he gradually recovered, though after he revived there was for some hours a great tendency to relapse, requir- ing the most vigilant care and repeated applications of the water.

Case [1].—G., a child of one week old, strong and healthy—during the night its mother gave it 8 gtts. of landanum to keep it quiet. It sank into.a stupor, in which state it remained for a space of nearly ten hours, after which, by the use of energetic means, it was aroused, and slowly recovered. During convalescence it had several severe convulsions, from which it was completely restored.

Case 1V.—C., a child seven days old, large and healthy ; its mother gave it 7 gtts. tinct. opii in the night to keep it quiet; in.about an hour itsank into a stupor. At the end of about two hours I was called in. It then presented all the symptoms of extreme narcotism. Notwithstand- ing our utmost efforts, it died in about eight hours; it revived several limes, and we fondly hoped the worst was over, but the nervous system had received an impression incompatible with life. The closing symp- toms were severe convulsions. I shall ever regret that I did not make use of artificial respiration, the only remedy which L think might have been of benefit. ‘The practice of giving laudanum to very young infants, either in health or disease, cannot be too severely reprobated. I have met with several cases of convulsions in infants, under 1 year old, caused, | have reason to suppose, by the secondary effects of some form of opium.

Casz V.—Mr. A., a young man, aged 20 years, of nervous tempera- ment, good habits and good constitution, while suffering from toothache, was advised by a careless physician to take laudanum. He accordingly purchased an ounce, and being ignorant of its nature took three eighths of it, After taking it he started for his home, five miles distant, and with great effort reached it, retired immediately to his room, and slept ten hours. At the end of this time I saw him ; all the symptoms of nar- Cotism were passing off, and in two days he was well.

I once heard a physician of reputation and experience testify that three

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256 Observations on Epilepsy.

drachms of laudanum retained on the stomach of an adult, would * in all cases as a general rule produce death.” Had he been well acquainted with the different works on toxicology, he would have known that this rule has too many exceptions to be depended on. Equally as intelli- gent testimony is frequently given by physicians in medico-legal cases, to the great disgrace of our profession.

Effects of Morphia. Case 1.—C.,a boy 2 years old, took one sixth of a grain of sulph. morphia, through mistake for calomel. In about one hour he was seized with opisthotonos, which continued about five hours, when the life powers suddenly yielded. Some little stupor was present prior to the attack coming on.

1 have never known this effect to follow a narcotic in any other instance, In this case it must have been produced by morphia, as there was no other cause for it.

Effect of Camphor. Case I.—L., a man aged 45, an inveterate drunkard, during a debauch drank about one and a half ounce of satu- rated tinct. of camphor ; was seized with convulsions one hour afterwards, and died in forty minutes.

Case II].—M. A.,a young man aged 21 years, while walking the street with a friend, accidentally swallowed one drachm of gum camphor, Nothing more was thought of it, until one hour after, when he suddenly fell to the ground while talking, and remained in a complete stupor for about half an hour. He then revived and resumed conversation as if nothing had happened—no medication was resorted to.

I have on record three other similar cases ; complete anesthesia was the result in each, and no bad consequences ensued.

Case II].—Mrs. K., aged 34. Five powders of camphor of three grains each, pulverized by addition of a few drops of spts. nit. dulc., were left her for after-pains; after taking the third, convulsions supervened, though mild, and soon passed off; on the next day the other two were given with like effect. Some authors state that camphor produces con- vulsions only when taken in solution, a rule which evidently has ex- ceptions.

Sulphate of Zinc. Case 1.—D., a young man aged 28, took one tablespoonful of sulphate of zinc, supposing it to be Epsom salts ; violent vomiting, and subsequently violent purging, ensued. ‘These effects soon terminated spontaneously, and on the next day he resumed business. I examined the sulphate of zinc, and found it a good article, slightly dam- aged by contact with the atmosphere.—Jowa Medical Journal.

OBSERVATIONS ON EPILEPSY.

[Continued from page 242.]

Precocity an Exciting Cause of Epilepsy.—Precocity of intellect—or, rather, undue stimulus applied to the minds of children—is another fruit- ful source of epilepsy. ‘That system of mental education which attempts to make men and women, scholars and philosophers, of little children, should be discountenanced by every parent, guardian, teacher, and, es-

Observations on Epilepsy. 257

pecially, by every physician. You, Mr. Editor, some time since pub- lished an article in your Journal, upon “too much study in our public schools.” Never was oracle more true than those remarks. I wish every committee man, teacher, and the superintendent of these schools, and his honor the mayor, would not only read, but heed those statements.

The day of infant schools for study has passed. Thanks to a kind Providence that it has: its death will be the life of many a child. If one half the study now required of pupils in our public schools were re- linquished, and the children compelled to practise some athletic exercise instead, they would be great gainers, both as it respects mind and body.

Urge a child prematurely forward, and he soon becomes jaded ; his intellect loses its balance. Nervous disease supervenes, and the little bright and sprightly child, the idol of its fond parents, their little pride,” soon becomes the object of their solicitude and painful anxiety. The precocious intellect was quite too active for the body—* the sword too sharp for the scabbard.” With the pressing studies, the ner- vous itritation increased, and bodily health began to fail. The bright flashes of thought, the sparkling witticisms of the pale little thing, burst- ing from the overtasked mind, called forth loud applause from incon- siderate friends and ignorant admirers. Next followed nervous spasms ; and, as the nervous system continued to give way, and the bodily energy to decline, more food was claimed ; and the more food that was taken, the worse for the child. ‘The twitchings and spasms increased, tll by some extra mental effort, or sudden fright, or overloaded stomach, the spasm became the convulsion, and epilepsy, with all its horrors, was apparent ; and under the ordinary treatment, in all probability, irretrievable zdiocy lies in the future before the child.

Such has been, and is now, the course pursued by many a parent ; and such a physiological and hygienic perversion of nature, and of all her laws of action, can never fail to be visited by a sad retribution of an exhausted system of both mind and body. Here is another proof that epilepsy springs up in an exhausted state of bodily and mental energy ; and, 1 may add, when the usual depleting course of treatment is super- added to this already jagged and worn-down child, he stands but a small chance of ever seeing good days in the land of the living.” But, as | shall speak of the treatment hereafter, I forbear at present.

Let me here warn parents and teachers, and ask physicians to warn them, against such a hot-bed course of education as 1 have portrayed above, and is too often pursued. Beware of wishing to see your son or your pupil a genius. You will be quite as likely, in the end, to see him an idiet, or be called to follow him to an untimely grave. If you are a parent, by pursuing such a course, instead of planting a tree which will furnish you with refreshing shade and comfort in your old age, you will throw the dark mantle of the most bitter reflection over the meridian of your life, and be compelled to drain to the dregs the chalice you have poisoned, in the blighted body and unstrung mind of your child. Such precocious children need holding in, rather than spur mg on, in intellectnal culture. Better, far better, would it be for them, and the parent, if, like Rousseau, in the training of his Emilius, they

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258 Observations on Epilepsy.

should not be allowed to learn a word till they numbered a dozen winters, Such an early development of the mental powers is altogether unnecessary, even if the child is designed for a scholar, Almost all our scholars gra- duate from college too early. ‘Their bodies are injured by too much study in early life, and their education is not half as thorough, or as valuable to them, as it would be if they were half a dozen years older than they usually are. They verify the old adage, soon ripe, soon rot- ten.” Men of the brightest parts, and the most brilliant scholars and philosophers, have been considered almost dunces and blundering logger- heads when children, But they have endured and studied for a long life, while the hot-house plants have put forth their butterfly-brilliancies, have shone for a day, and withered, like the angry prophet’s gourd,” the first night. Sir Isaac Newton, Walter Scott, and Andrew Fuller, were all dull scholars in childhood ; and yet, who have been more emi- nent than they in the field which each chose for himself? Each of them accomplished more in philosophy, or literature, or polemics, than all the men who were ever reared from precocious children. Our whole educational system is in a wrong direction. Jt commences wrong, and is carried on and ends in the same way. It is opposed to physiological laws. ‘They demand the education of the physical powers first ; this commences with the mental.

The treatment of epilepsy laid down in medical works generally, it is believed, has augmented, rather than relieved, epileptics. From the re- marks already made by the authors quoted, it is evident that the use of the lancet is in no way serviceable in epilepsy. 1 am not now speaking of epilepsy complicated with apoplexy or with any other disease ; but of epilepsy alone. Bleeding is not necessary to remove congestion be- fore the fit, for that does not take place till the fit has come on. It is not necessary to cut the fit short, for both Drs. Radcliffe and Copland have shown that it not only does not do that, but that it induces a new attack more violent than the preceding. For what, then, can it be necessary? Its effect is to debilitate the already too much debilitated system.

The same may be said of the administration of purgatives in general, in cases of epilepsy. I would not say but that in a person of robust habit, not predisposed to be nervous, who had induced an_ epileptic seizure by eating enormous quantities of indigestible food, a cathartic might do less mischief than the retention of such materials in the system.

Under such treatment as is above referred to, for epileptics, it is not strange that both patients and physicians should become discouraged and settle down into the belief that these were incurable cases, and as “sic tolvere Parcas,” they must bear the calamity as well as possible, upon the principle of the old adage—that “what can’t be cured must be en- dured.”

Far be it from the writer to intimate that all cases of epilepsy are cu rable, and quite as far be it from him to deny that the course of treat- ment usually pursued has not oftener rendered such cases incurable, than the original disease did. In this opinion I am happily borne out by the remarks of Drs. Radcliffe and Davey. in the London Lancet. Dr. R. showed that the condition of the patient was itself an insuperable

Observations on Epilepsy. 259

objection to bleeding and purging in this malady, and an argument for the necessity of stimulants and tonics, and all means which could cor- roborate the system.” Dr. Davey said, Epileptics were best treated by tonics, and a judicious and discriminating diet. In the treatment of all nervous disorders, practitioners had gone too far generally, on the anti- phlogistic system, by which he was sure many cases had been rendered incurable.”

‘Tbe idea that epilepsy has its origin in the blood may not be new, as it has already been shadowed forth in the remark quoted from Dr. Car- penter’s Physiology. But we feel full well assured it is the correct idea. Long since, it was declared by the Jewish Lawgiver, Moses, that the life of the flesh is the blood ;” and though this idea has been contro- verted and re-asserted, rejected and re-revived, many times since the days of Moses, it is now generally conceded by physiologists that he was right, and that “the blood ts the life.’ Every intelligent physi- cian knows that almost all (perhaps quite) the chronic local diseases which invade and ultimately destroy the human body, originate in the blood. ‘This is confessedly the case with cancer, scrofula, syphilis and consumption. Do what you will of a local nature ; apply what remedies you please directly to the diseased organ ; extirpate, burn, cauterize, scarify, inhale, bleed, blister, cup—all is to little purpose, unless you ean eradicate the poison, and change, invigorate, purify and build up the system. In this respect no small share of medical practice, in by- gone days, has been carried on upon a wrong principle ; and, happily for the good of the patient and the credit of the doctor, many eminent practitioners have recently seen the error and changed their practice. Twenty-five or thirty years ago almost every physician believed, for in- stance, that scrofula was to be purged away by drastic cathartics, and bled away by the effusion of the crimson fluid ;” and many a patient has been catharticised and exsanguinated till he found refuge only in the grave. But such practice at the present day would not be tolerated, and the doctor who should advise such practice in this disease would be considered half a century behind the age.

What is true, in this respect, of scrofula, is equally true of cancer, secondary syphilis and consumption. Not one of them can be cured, or was ever cured, by drastic cathartics, extirpation, or the shedding of blood. In cancer, for instance, it is now the expressed opinion of some of the best surgeons abroad, that, while the life of the patient may have been prolonged by the use of the knife in some few cases, on the whole, taking into account all the operations, it has been of no benefit, if not positively injurious, The same may be said of the other diseases above named ; and it may be emphatically and truthfully said of epilepsy. Some remarks in the Boston Medical and Surgical Journal eae these articles were commenced, Vol. LI., p. 151), from the pen of Dr. Cart- wright, fully harmonize with the views here expressed. “The best definition,” says Dr. C., “ever given of pulmonary consumption, was given by Dr. Benjamin Rush, when he called it an all-overness. He viewed it as a disease of the whole system, and not of any particular part.

260 Mortality among Children.

It is an all-overness, because it is a disease of blood origin.” This js undoubtedly correct, as it respects consumption, and the remarks may as truly be applied to epilepsy.

[To be continued. ]

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MORTALITY AMONG CHILDREN —NO. III. BY W. A. ALCOTT, M.D.

One fruitful source of infantile mortality is medicine. Let not my medi- cal friends accuse me of heterodoxy, in making this statement. I have reasons for my belief,

When I speak of medicine as a cause of infantile mortality, I have no reference—not the remotest—to that small amount of it which is given at the prescription of the family physician. ‘There may have been error here ; there certainly has been, in all time and countries, un- less it is our own. But 1 waive all this. Nor do I refer in particular to the enormous quantity of drugs and medicines taken without the pre- scription of any person duly qualified for the purpose beyond the pale of the family—a hundred times greater than the quantity given by all our regular physicians of every school.

But | would aim, chiefly, in these paragraphs, at what I have been accustomed to call maternal dosing and drugging. Bad as the world is, in other departments of drugging, this is more prolific of infantile disease and premature death than all else, except bad cookery ; of which, by the way, | have said something in a former number.

Mothers assume to understand the constitution of their own children ; and almost deem it an insult to be told of their mistake. Yet they are mistaken, Reasoning a priori, it is impossible, or at least next to m- possible, for those who are situated as mothers generally are, to under- stand enough of the laws of hereditary descent, temperament, &Xc., to be able to understand what is almost impossible to the wisest physiolo- gists and physicians. And then, as regards the plain matter of fact, their mistake is still more obvious, They almost every day, for example, treat their scrofulous children—amounting to one third or one fourth of the whole—in a manner diametrically opposite to what they would have done had they understood the nature of the case and how the first symptoms of Jatent scrofula manifest themselves.

And yet it is almost as much as one’s reputation is worth, whether in the profession or out of it, to run the risk of giving to our mothers this little piece of information, And the hazard is great in exact propor- tion to their ignorance. An ignorant mother is, next to the Pope of Rome, the most infallible of all human beings! I mean, of course, in her own estimation. You may reason, sometimes, with an intelligent mother —seldom with an ignorant one.

But whether ignorant or somewhat enlightened, the vast majority of our mothers doctor, more or less, their own children. At least, if they refuse to call it doctoring, they give thema vast amount of small elixirs, cordials,&c. The closets of not a few house-keepers are a complete

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apothecary’s shop. ‘They may, it is true, have smaller parcels than the regular apothecary ; but they have almost as great an assortment. And they not only keep it; they administer it. ‘They may not intend it; they do not mean to give much ; sometimes they really think they do not give much. But it comes to pass, in the course of the year, that much is given by somebody ; and | greatly fear that the-mother must be held responsible for it.

True it is, that no mother confesses to this crime of dosing and drug- ging. As it used to be with tight lacing of the chest, that no one was guilty herself, but almost everybody else was, so in this matter of drug- ging and dosing children. Yet how often have I seen these very mo- thers with their bottles or phials on the steamboats and railroads of our country—hardly willing to wait for the arrival of the cars at a sta- tion,” before they administered the needful elixir, but actually adminis- tering it on the road!

But now for the consequences of this maternal dosing; for this it is with which medical men have chiefly to do. Next to bad food and wretched cookery, as I have before intimated, this error is productive of more sickness and premature death than any other. No physician knows what to do with a sick child, who has been thus tampered with. He may indeed guess a little better than others ; but even he will often guess wrong. ‘Their first- passages are irritated, and perhaps inflamed ; and if it were possible to make the right appliances either internally or ex- ternally, it would still puzzle the wisest head to know how to apportion the quantity so as to be more likely to do good than harm. Diseases, in these circumstances, as you know, are more apt to be severe and com- plicated, and the termination more likely to be fatal, especially if much medicine is used.

The worst remains to be told. As it is not always easy to trace the cause of severe, protracted or fatal infantile disease to maternal error, we not only contrive to kill, from generation to generation, by thousands and tens of thousands ; but we partly kill by millions. If all the mischief that is done could be concentrated, as it were, in a few, and were to kill them outright, so that everybody might see that they fairly died of vio- lence, there might be hope. But no; we seem to be left to grope on in