terminating in a fatal marasmus. 'It is not to be removed by emetics, purgatives, or the warm bath, the usual remedies for obstructions in the ducts; and hence it is conceived by the author to arise from

-atrophia ablactatorum; in the first place it will be found superabundant, and eventually it will appear to be possessed of unusual acrimony. In the icterus infantum there is often a complete obstruction to the passage of the bile.

66

Taking these diseases in the order of time in which they occur, I shall first mention that species of jaundice which attacks infants a few days after birth. This is always an alarming disease, for when infants do recover it is with great difficulty. It generally comes on about the third day after birth; for it is necessary that this time should elapse before the complete absorption and subsequent deposition of the bile into the blood can take place. It is attended with languor, flatulence, and bilious urine, and continues many days or even weeks. Sometimes it goes gradually away, but generally ends in a fatal ma

rasmus.

"When this disease is fatal, it in all probability is so from an original malconformation in the liver; for we do not find, upon dissection, that it is a disease of the hepatic or of the common ducts, which, though somewhat contracted, from the thickening of their coats, are always pervious. The malconformation is probably an impermeable thickening of the beginnings of the hepatic duct, or, as they are called, the pori biliarii."

Gentle laxatives, frictions of the abdomen, and emetics, are the only medicines which promise advantage.

Another derangement of the function to which the liver is subject in early infancy, is a discharge of bile by vomiting or purging, which is often accompanied with convulsions, fever, gripings, &c. The complaint originates from improper food or cold, and is cured by vomits and cathartics,

—especially cathartic glysters; and should the disease, or any symptom of it denoting great irritation, continue after the full operation of these medicines, we must have recourse to opiates and testaceous powders; but we must be cautions in giving opiates until the purgative medicines have operated." When there is merely a purging, it is called by nurses the green scour.

The principal object of this essay is the description of a disease, which is known in Scotland by the name of weaning brash, and which the author thinks may properly be designated atrophia ab.

lactatorum. The purging which accompanies this complaint has generally, by practitioners, been supposed to originate from teething, or from a mesenteric enlargement in scrophulous children; and for some time the author was himself induced to adopt the latter opinion. The indispositions which sometimes accompany teething may occasionally meet in the same child with the weaning brash, but that there is no necessary connexion between them, he considers as proved, by the latter frequently existing where no affection of the gums, or appearance of pain in the mouth, are to be observed, and where the teeth have frequently been cut easily; but more particularly by its frequently coming on in children long before the teething period.

The weaning brash is an atrophy, says the author,

"-the consequence of weaning children too suddenly at an unfavourable season of the

year.

"This disease sometimes comes on two or three days after weaning; frequently not for three or four weeks; sometimes not before five or six weeks have elapsed.

"The first symptom is a purging, with griping pain, in which the dejections are usually of a green colour. When this purging is neglected, and after continuing for some time, there is added a retching, with or without vomiting; when accompanied by vomiting, the matter brought up is frequently covered with bile.

These increased and painful actions of the alimentary canal produce a loathing of every kind of food, and naturally are attended with emaciation and softness of the flesh, with restlessness, thirst, and fever.

"After some weeks I have often observed a hectic blush on the cheek; but the most constant peevishness, the effect of unceasing characteristic symptom of this disease is a griping pain, expressed by the whine of the child, but especially by the settled discontent of his features; and this expression of discontent is strengthened towards the conclusion of the disease, when the countenance

has shared in the emaciation of the body.

"In the progress of the disease, the evacuations from the belly show very different actions of the intestines, and great changes in the biliary secretion; for they are sometimes of a natural colour, at other times slimy and ash-coloured, and sometimes lienteric.

"Towards the end of the disease the extremities swell, and the child becomes exceedingly drowsy; but these I rather con

ceive to arise from debility than to be pathognomic (pathognomonic) symptoms. It is remarkable, in the advanced stages of the disease, that the purging sometimes ceases for a day or two, but without any amelioration of

the bad symptoms; nay, I think that children decay even faster than when the purging is most violent.

"The disease seldom proves fatal before the sixth or seventh week; and in this short time I have seen the finest children miserably

wasted. I have seen, though rarely, a child recovered after the disease had continued three or four months; and again, I have seen the disease cut short by death in the second, third, or fourth week, before it had reached the acme; the sudden termination having been occasioned by an incessant vomiting and purging, or by convulsions from the

immense irritation in the bowels.

"The discase is more frequent in children who have been weaned before the eighth or ninth month, and in particular in those who, in consequence of some accident happening to the nurse, have been weaned abruptly.”

It is a disease of the autumnal months, and is most likely to occur in delicate constitutions, such as might be supposed to be, in future, liable to scrophula.

The peculiar nature of this disease the author thinks he has detected by dissection, which, instead of confirming his first opinion, has given him reason to conclude, that it originates in an increased secretion of acrid bile, or rather in the morbid state of the liver, which occasions it. He observed,

"-in every instance, that the intestinal canal, from the stomach downward, abounded with singular contractions, and had in its course one or more intus-susceptions; that the liver was exceedingly firm, larger than natural, and of a bright red colour, and that the enlarged gall bladder contained a dark green bile. In some dissections the mesenteric glands were swelled and inflamed; in others, however, they were scarcely enlarged, and had no appearance of inflammation.

"These contractions and intus-susceptions were entirely of a spasmodic nature, as in the latter the contained part of the gut was easily disengaged from that which formed its sac; and in no part of the entanglement was there adhesion, or even the mark of inflammation; and the contracted portions of the intestine were again permanently dilated by pushing the finger into them."

The connexion which the author presumes to exist between these appearances, and an increased secretion of acrid bile, he infers from some positions which may be regarded as rather hypothetical. When a child is weaned abruptly, and at an improper period, the food on which it is put becomes too violent a stimulus to the intestines. The liver is connected with the intestines by a very close sympathy, and is hence excited to unusual action, which produces a large and vi

tiated secretion of bile, to which the long-continued purging, and the various phænomena observed by dissection, are which are observed at an early period of supposed to be owing. The green stools, this complaint, discover an increased se cretion from the liver; and though, at some stages of it, the faces are clay-coloured, and therefore seem to indicate a defect of bile, yet this circumstance seems to the author accountable, upon the sup position that when the gall bladder is distended with bile, it presses so much upon the cystic duct, and so much increases its natural curvature, as to prevent it from flowing out freely; hence it becomes concentrated and more acrid, and when by some action of the stomach and duodenum the enlarged gall bladder is compressed, the intestines are inundated with bile. This supposition, however, requires the necessity of an interruption to the passage of the secreted bile, which could be poured into the intestine by the hepatic and common ducts, notwithstanding any obstacle to its flow from the gall bladder.

With regard to the cure of this complaint, the author, after trying without success various means of relief, was at last induced to employ calomel, and from the use of this medicine has had many very satisfactory results. He gives it generally in doses of half a grain every morning and evening, and until its operation on the liver has taken place, moderates the griping, purging, or vomiting, by opiate glysters. The same plan has been found efficacious in the diarrhocas of children. Whatever opinion may be formed of the author's theory of this disease, the practice which he recom mends, of giving calomel for its removal, is

certainly a very proper one, but at the same time it is too general to admit of its being received as a new idea. The author annexes several cases to exemplify the effects of his practice, and to illus trate the appearance observable on dissection. Two well executed and coloured plates exhibit the morbid appear. ances in two cases which terminated fatally.

He

A few pages at the conclusion of this essay, which are intended to be placed with that part of his work to which they refer, are devoted to the defence of some of the author's ideas on croup. entertains an extreme aversion to the operation of bronchotomy, which he is of opinion no circumstances can ever justify, and now gives some observations

with a view to strengthen his former arguments. He does not, however, appear to have placed the question in a new light, or to make it necessary to add any thing to what we have remarked upon this subject in our last volume.

We approve of the author's plan in

thus publishing, in separate parts, the results of his experience in a numerous and important class of diseases; but at the same time we cannot forbear observing, that the style of publication is very unnecessarily expensive.

THE author informs us, that the work which we are now to notice is the result of an extensive practice and long experience in medicine and surgery. Whatever, therefore, may be the opinions entertained of its merit, the medical world must feel itself obliged to an individual, who, at a late period of life, conquers his disinclination to appear before the public, from the hope of rendering some

degree of service to his profession. We are sorry that we have not been able to discover, either in the theoretical or practical discussions of this work, much that is likely to improve the medical practitioner, and likewise regret that we are obliged to notice the very great inaccuracy of the composition, which is every where apparent.

Gout.

THE annunciation, by an anonymous writer, of a concealed remedy for a disease which has hitherto been an opprobrium to the regular practitioner, and has long afforded numberless opportunities to the empiric, of imposing upon credulity, comes with so suspicious an aspect, as to require all the care and precautions of the author, to give it any claim to professional consideration. Various circumstances, we are informed, prevent it from being thought proper, either to publish the name of the author, or of the medicine here recommended; but in order to ascertain fully its particular effects, before an ultimate decision is made upon the best means of communicating it to the world, it has been placed at the disposal of Drs. Beddoes and Bradley, whose reports, contained in the present work, afford a confirmation of its efficacy, and a sanction to its employment. If the trials of this medicine still continue, we may soon expect to have additional evidence on the subject from various professional quarters; but we cannot help expressing our fears, that, as has been by no means unusual in similar cases, experience will not be found to warrant the flattering expectations at present formed of it. It is hardly necessary to give any particulars of its success from the cases given, either by the author or his friends. It will be sufANN. REV. VOL. II.

cient to state the circumstances which led to its employment. The author informs us, that he had a very early aptitude at determining by the eye the qualities of vegetable substances, as whether such or such a tree bore sweet or sour apples by the configuration of the leaf or the twig. Hence he frequently felt a very urgent desire to taste the fruit, the leaf, or the bark, of any new untried plant that he chanced to meet with. About fourteen years ago, during the affliction of an acute rheumatism, he first tasted the fruit, whose juice affords the medicine afterwards applied to the use of gout. He found relief by it, and was induced to repeat it until a cure was effected. Some time afterwards, on a return of the same complaint, the same medicine was resorted to, and with similar good effects. The author has been for some years subject to the gout, but in 1798 he had a fit of extreme severity, which recalled to his mind the good effects which he experienced by the use of the fruit abovementioned when affected with rheumatism. He was hence induced to try it, and was agreeably sur prised to find the first dose followed by the production of sleep, and the permanent removal of pain. The use of the medicine produced a gradual recession of the swelling, in a few days enabled him to ride and walk, and in 3C

THE author of this publication deserves great credit for his strenuous endeavours to remove the prejudices which so much tend to affect the health of females and their offspring; and which it is to be lamented still too generally prevail. The care ful observation of a long life has pointed out in strong terms the various disadvantages which arise from the common mode of managing children, and the facility with which those disadvantages might be avoided, by attending more closely to the plan which nature and common sense dictate in so important an object. The physician and the philosopher seem to consider it as beneath them to turn their attention to the cares which are proper in the nursery, and thus unfortunately leave to the management of ignorance and self-conceit, a very important period in the life of the rising generation.

The circumstances to which it is necessary to attend, for the purpose of procuring to females that permanent state of robust health, which is necessary to fit them for the proper performance of the maternal office, is the first object of consideration with the author in the present work. He possesses an elevated idea of the dignity of the maternal character, which he justly considers as capable of materially influencing the future destiny of the offspring, and he

view's with a well merited veneration the

exertions of a female who faithfully discharges her parental duties.

The education and conduct of females of the present day, are justly considered as worthy of severe reprehension, and the author strenuously endeavours to bring them back to the mode of life which nature has intended them to pursue, as that which is best fitted for mak ing them good wives and good mothers. .A weak, languid, nervous, or deformed woman may become a wife, but she is wholly unfit to become a mother.

"She risks her own life-she disappoints the natural wishes of a husband-and should

she have children, her puny, sickly offspring, as I before observed, will have little cause to thank her for their wretched existence. The evil is not confined to her own family; society at large is materially injured; its wellthat compose it; and universal experience being depends on the vigour of the members has fully proved, that the frame of a husbandman or a hero is not to be moulded or cherished in the womb of debility, and that the bold eagle will never be brought forth by the timid dove."

The observations made in the chapters which relate to the conduct proper to be observed during pregnancy and child-birth, are very judicious and worthy of attention, but we should hope that the author has deviated far from accuracy, when he represents it as no uncommon thing for a married woman to endeavour prehension of a large family, or to avoid to procure abortion, merely from an apchildren. the trouble of bearing and bringing up

The second and greater part of this treatise relates to the nursing and rearing of children. Very little medicine the author considers as necessary for infants, and this he had an opportunity of determining, upon a large scale, many years ago, at an extensive establishment at Ackworth, in Yorkshire where the consumption of drugs was by his means greatly diminished, and the health of the children materially increased. The indiscriminate use of cold water, for the purpose of daily washing infants, he is and is at best a very unnecessary seveof opinion does a great deal of harm, rity, which ought to be laid aside. When the mother is able to suckle her child, nothing more than her milk need be given for some months, but this may then be gradually diminished, and other food substituted, that the change in weaning may

not be sudden.

work, the observations are in general In this as in the other parts of the creditable to the author's good sense, knowledge of the world, and philanthropy; and if attended to, will, we have no