MEDICAL INTELLIGENCER.

“NON EST VIvere, sed vALERE VITA."

VOL. IV.

MAY 16, 1826.

NO. 1.

CASE OF HYDROCEPHALUS.

Communicated for the Boston Medical Intelligencer;

BY JOHN WALLACE, JUN, ESQ.

In

March 29th, 1826, i was called to a child aged 8 months. It Lat for several weeks. The attending physician had been dismissed. Learm De loving history of the case from the mother, an intelligent woman. The child had enjoyed good health until the beginning of winter, when it took the boopingcough, which it bore very well, and had almost recovered. the beginning of March, it was attacked with the prevailing influenza, with considerable affections of the lungs. After the febrile symptoms had in some measure abated, the child gave evident symptoms of an affection of the head, with occasional convulsions, which symptoms had gradually increased to this time. The principal medicine for the last three weeks was Fowler's Mineral Solution, six drops twice a day;—it had taken about one third of an ounce. I found it with a sallow and somewhat bloated countenance, the head voluntarily drawn backwards, impatient in an erect posture, the right arm frequently raised to the head, the left still by its side, and apparently paralytic-the head constantly rolling on the pillow (which had been the case for at least three weeks). The right side of the head was much distorted, the sutures between the temporal and parietal bones considerably separated, and the bones protruded outwards, the integuments at the fontanel raised to the thickness of a man's thumb, and as tense as a drumhead. There was constant retching and vomiting when any thing was taken into the stomach; the bowels constipated, nothing had passed for forty-eight hours, and very little urine voided; great heat in the head and bowels, pulse quick and fluttering, the tongue red and parched, and apparently great thirst; respiration quick, with occasionally a moaning kind of groan. The stomach seemed in a state of violent inflammation, probably in consequence of the arsenical solution. I could have no doubt that there was water in the head, and considered the case a hopeless one. Palliatives only were at this time thought of. Directed to discontinue the arsenical solution-to apply sinapisms to the feet -cloths, wet with cold vinegar and spirit to be applied to the head and region of the stomach and bowels, and changed as often as they became dry; internally, small and repeated doses of su per tartrite potass, and linseed tea.

1

March 30th, had bad a restless night; coma alternated with restlessness and partial convulsions; the general appearance mach as yesterday, except that the eyes were drawn toward the nose, and the pupils much contracted, with a slight convulsive motion or twitching; the medicine was retained on the stomach; has had one thick green stool, and voided urine once. Medicine to be continued, with the addition of an infusion of senna and anise seed, to assist the cathartic effect of the sup. tart. potass.

March 31st, had passed several copious watery stools; voided urine freely; less heat in the head and bowels, but considerable difficulty of breathing. Directed solution tarterized antimony, short of emetic doses, to alternate with the former cathartic medicine.

April 1st, heat and difficulty of breathing greatly abated; fre quent watery discharges from the bowels continued, but somewhat green; has taken the breast, several times, moderately; pulse weak, and great debility; head less crowded; the tumor at the fontanel less tense. Suspend the cathartic medicine till ever.ing; meantime directed an infusion Rad. Serpentaria flos. Melissa and flos. Cracus, together with a few grains calcined magnesia.

April 2d, the cathartic medicine had been repeated in the evening, followed with several more watery stools, less green; great debility remains, yet the general appearance better; took the breast several times, and rested comfortably through last night.Directed the cordial infusion through the day and night, to be followed next morning with Ol. Ricini, continuing the Magnesia.

In

April 4th. Did not see the patient yesterday, but learnt that it was comfortable through the day; the oil operated but once. the evening the difficulty of breathing greatly increased, with partial convulsions. An emetic dose of the solution of T. Antimony was given; operated once upward, and many times powerfully by the bowels, which greatly relieved the symptoms; the child extremely weak and exhausted from the powerful operation of the medicine. Directed to continue the cordial infusion, with wine, and to give the former cathartic medicine so as to produce two or three stools in twenty-four hours.

April 6th. Debility less, breathing more free, the distortion of the cranium diminishing; takes the breast freely; directions the same as on the fourth.

April 9th. Continues to mend; the bowels opened every day; the eyes appear natural; the fontenal quite flaccid: the sutures between the temporal and parietal bones gradually regaining their natural position; takes the breast freely. Medicine the same.

April 13th. Gradually mending. Medicine the same.

April 17th. The head scarcely distorted; appetite good; discharges from the bowels natural, without cathartic medicine; eyes lively; is playful; appetite sufficient.

April 20th. The child apparently restored to health in every respect, except remaining debility, which is every day diminishing.

REMARKS.

The recovery in this case was wholly unexpected. In the course of twenty-four years' practice, I had not seen so distinctly a marked case of hydrocephalus that recovered. That there was a large collection of water in the head there can be no doubt. That it was within the dura mater, seems not less evident. That it was diffused in the ventricles of the brain, may be perhaps doubted, although my impression is that it was, because many of the symptoms corresponded with those in several fatal cases where on examination I have found water in the substance of the brain. The relief to the head was evidently in consequence of the fluid discharges from the bowels; and that relief appeared to be exactly in proportion to those discharges. In what manner

the water was transferred from the head to the bowels, I shall leave for physiologists to determine, as well as whether the cathartic medicines made use of were the best calculated to produce that effect.

Milford, N. H. May 4, 1826.

For the Medical Intelligencer.

BIOGRAPHY.

The Rev. PHINEHAS FISK was the son of Dr John Fisk, and was born at Milford, Con., 1683. His father appears to have been the son of the Rev. John Fisk, of Chelmsford, Mass., [see Elliott's Biography,] who, as is frequently the case in the early history of New England, was both a clergyman and a physician. While the infant seminary of Yale College remained at Killingworth, under the immediate charge of the Rev. Abraham Pierson, the first president or rector, PHINEHAS FISK, in company with Jared Elliott. who was subsequently distinguished as a clergyman and a physician, Jonathan Dickenson, who was afterwards president of the College of Nassau-Hall, with several others, pursued their academical studies in that town. He was graduated in 1704. In 1706, the College being removed to Saybrook, he was appointed tutor, and continued in that station till 1713. During these seven years, he was the principal instructor, and had almost the sole superintendence of the institution; since, after the decease of Mr Pierson, in 1707, the Rev. Samuel Andrew, of Milford, the temporary rector, did not reside at Saybrook, and consequently could have only a nominal presidency. Under his tuition about forty studenta received their education, and the school first assumed the form and regularity of a College. Dr Stiles used to mention him as a very able instructor, and considered the institution as much indebted to his abilities and exertions. Among his most distinguished pupils, was the Rev. Samuel Johnson, D. D., first president of the College of New York. In 1714 he was settled as the minister of Haddam, where he died Oct. 17th, 1738.

Mr Fisk was possessed of quite a philosophical turn of mind, was a good mathematician, and an excellent linguist. He spoke Latin very fluently, and, as was the custom of that day, when he met with professed scholars who introduced any philosophical or literary subjects for discussion, he always preferred conversing in that language, which upon such topics was the most familiar to him. Judging from the remains of his library, his reading must have been very extensive; and from the various opposite tenets of the different authors, he was in the habit of reading both sides upon controversial questions. He was a very modest man, and had a great aversion to appearing before the public as an author. He left a valuable common-place book, which contained many curious extracts with original remarks of his own, and several manuscripts; but it is not known that he ever published any thing, except a sermon preached before the legislature at the General Election at Hartford.

He was descended from medical ancestors, and in company with many of his clerical brethren of his day, practised medicine himself, and was distinguished as a physician, more particularly for his skill in treating insanity and epilepsy. The attention of his family had been especially turned to the latter disease, from the circumstance of one of his brothers being subject to it; and both his father and himself, though the case of his brother proved to be incurable, made themselves better acquainted with the complaint, and treated it with greater success, than any of their cotemporary physicians. It does not appear, that either his father or he made any mystery of their treatment; yet one of his recipes was long employed as a nostrum by some of his descendents. His general treatment of epilepsy, consisted in making a strong impression upon the stomach and alimentary canal, by a preparation of antimony; this, he afterwards followed by a free use of castor, asafoetida, and other anti-spasmodics; and he completed the cure by a persevering course of iron. [See the Catalogue of Yale College, and Field's Statistical account of the county of Middlesex, Connecticut.]

DR HOSACK'S OBSERVATIONS ON MEDICAL CHARACTER.

We have perused with considerable pleasure a pamphlet entitled "Observations on the Medical Character, addressed to the graduates of the College of Physicians and Surgeons of N. York, at the commencement held on the 4th of April, 1826, by David Hosack, M. D." It presents a just view of the duties and responsibility attached to the profession of medicine, with much sound and judicious advice to its younger members. The Professor writes like one who values his art above every thing else, which sometimes gives his style a degree of freedom which may possibly detract a little from its effect with those who estimate things by the sober standard of common sense. As it was, however, addressed to young men, this very quality was

probably well adapted to give it its proper effect; and is therefore to be considered not as a blemish, but as an evidence of the judgment and address of the author. On a subject of is kind much novelty of course is not to be expected, and the merit of such papers must chiefly depend on the power of the writer to enforce and illustrate maxims and truths that are already well known. In this view Dr Hosack's “Observations" are valuable, and may be confidently recommended to the younger members of the profession. His remarks on the mischief of intemperance, are particularly worthy of attention, as observation seems to have established the truth, which, however mortifying, it were worse than useless to attempt to disguise, that too many of our profession have fallen into this degrading and beastly vice. The remarks on the professional jealousy of physicians, and its consequences, are also worthy of some consideration, as they point to the source of that base and contemptible conduct which we sometimes witness among certain medical characters who are determined per fas et nefas to work their way into business. We would also recommend, especially to our younger brethren, the advice of Dr Hosack on the subject of the apportionment and diligent employment of time. The importance of this subject, in reference to professional improvement, it is impossible to overrate. Habits of patient industry should be formed early, while the mind is flexible; and they will not fail richly to reward the subjects of them, not only in the rapid increase, but in the accelerated ratio of increase of their medical knowledge. On one point we cannot, to the full extent, agree with the author, We refer to his remarks on the duty of physicians of devoting themselves solely and exclusively to their own profession. In a country of free institutions, and enjoying a state of society like ours, we think it neither possible nor desirable that medical men should be so wholly engrossed by their profession as to feel no interest, and to take no part in the political concerns of their country. As citizens enjoying all the benefits of our political system, they owe a duty to their country which no professional consideration can wholly supersede. Our country has eminently a right to some small portion at least of the time, the talents, and the exertions of all its children and a special claim upon those whose education has qualified them above the great mass of their fellow-citizens, to reason and judge correctly. Further, we are aware of no solid reason why physicians, whose taste and leisure qualify them for literary pursuits, should be wholly interdicted from the cultivation of them. One great means of dignifying medicine, is to make it, in every proper sense, a liberal profession. And this can in no way be more effectually accomplished, than by adorning its literature with the solid graces of a correct and enlightened taste. The classical author bas surely not forgotten that the god of Poetry and Eloquence was the eminent patron of physic. In expressing these opinions, however, we do not wish to be understood as dissenting from the general spirit of the author's remarks, on this subject. In the main, we agree with him, and with the gratification which we have desired to express, we cordially recom