modern system of education, to stimulate the infant intellect to premature, and therefore prejudicial exertion. The recommendations enforced by Struve, should never be forgotten; and if they are forgotten by the parents, it is the imperative duty of the medical practitioner to point out the necessity of complying with them. We should operate on the tender intellect of a child by the gentlest progression. It must surely be much more judicious to complete the instrument previous to its use, than to employ it in an imperfect state. It is the same with children as adults. In the cultivation of the mental powers, we are always to bear in mind the capability of the individual to answer the demands which are made on him for exertion. It is not only irrational, but it is frequently destructive, to impose either on the mind or body, but particularly on the former, a load which it is incapable of supporting. It may be a source of consolation to those parents who are too apt to lament any apparent loss of time in the very early periods of life, to remember that early acquirements are not to be gained without destruction of health, and that the future progress and powers of the individual depend on the foundation which is laid in infancy, by judiciously adapting the studies of the child to its age and constitution." By premature efforts at mental improvement the organ is exhausted, and the injurious effects thus created by a false ambition in patients, present themselves in a train of nervous symptoms, which often pave the way to decided symptoms of convulsions. We should constantly bear in mind that our means of affording relief when convulsions have actually occurred, are limited and uncertain, and therefore our grand object must be to prevent their formation, by paying assiduous attention to the slightest disturbance of health, and by a judicious and timely recurrence to appropriate remedies. In accordance with the views of our author, we think the brain is directly or indirectly irritated in most cases of convulsions; yet this irritation may last but for a moment, and be so trifling as to produce no serious derangement of the cerebral functions, much less any organic alteration; still, he adds, it may be kept up by a repetition of the exciting cause, and produce irremediable mischief. At the same time our author cannot admit irritation of the brain to be the proximate cause of all convulsive affections; for, in some cases of local injury, they must arise independent of the mediation of the brain; since, also, if a nerve which is separated from the nervous centre is irritated, convulsions take place in the mus cles to which it is distributed. Neither can he conceive how the convulsive affections which arise in plethoric habits where we are called on to abstract blood, and those which occur from the accidental loss of blood, can alike arise from cerebral irritation. We can readily assent to the following proposition, which manifestly leads to a sound and judicious practice, p. 47: "The effects of any given irritation will depend on the particular constitution and temperament of the individual. In one, local pain unconnected with general disturbance may ensue; in a second, an attack of fever may arise ; and in a third, are excited by their constant and long continued irritation, but likewise a formidable list of other diseases, such as chorea, tetanus, consumption, dysentery, &c. It is to be regretted, that our limits entirely preclude us from following Mr. North in his copious observations on the premonitory symptoms of convulsions, and the convulsions with or without pain or febrile movement." But though convulsions may arise from some serious cerebral disease, our author adds, "we should not hastily determine that the brain is organically or even functionally affected, because a paroxysm of convulsions occurs; or prognosticate the speedy effusion of water in the ventricles, unless enormous various morbid affections in which doses of calomel are prescribed, convulsions may appear; from p. and repeated bleedings are rad 80 we make the following exrecourse to." tract. "In the remittent fever of infants, convulsive paroxysms are common; and it will require much experience, and a careful consideration of the progress of the disease, to avoid diagnosis in such cases. It is very any erroneous likely to be mistaken for hydrocephalus. "Unless they arise from mechanical violence or intense moral impressions, idiopathic affections of the brain are, I conceive, very rare in children." "And it appears to me, when a paroxysm of simple convulsions is once excited, whatever may have been the cause of it, that it is essentially the same, though it may differ much in its degree of violence and duration." His observations on the various forms of convulsive disease, and more particularly on the pathology of convulsions connected with cutaneous eruptions, we consider valuable, being an evidence of the extent of his information aud practical experience; our limits only admit of this cursory notice. Mr. N. appears unwilling to admit intestinal worms as a frequent cause of convulsions in children. "For," says he, "many worm cases' have fallen under my care, and I do not remember a single instance where convulsions appeared to depend on the presence of worms in the intestines, or to be relieved by their being discharged. In this instance we are disposed to differ from our author, as we feel confident in stating as the result of our experience, that not only convulsions impossible, to determine the naIn many cases, it is ture of the disease, till many days have elapsed, and it has assumed a decided form." us Mr. N. very justly observes, that a plethoric state of the bloodvessels may predispose to convulsive attacks, and cautions against committing an error in practice, by resorting to indiscriminate depletion; as, on the other hand, he considers pure debility or a state of nervous irritability, likewise, a frequent concomitant of convulsion. worthy of remark, that every aniHe adds, "it is mal which dies from loss of blood, is attacked with violent convulsions, during the last moment of its existence. This fact is daily exemplified in slaughterhouses. Puerperal women, who suffer considerable hemorrhage from the uterus, are almost invariably convulsed. augmented energy of the vital There can surely be no force' in these cases; for it must be observed that convulsions oc cur before any reaction takes place in the system weakened by excessive bleeding." the temples. The indiscriminate employment of the lancet in every case of convulsions, without reHe adds, the younger the child, ferring to the cause of attack, or the less is the danger to be appre- the condition of the patient, is hended; and he thinks the prog- frequently attended with irremenosis favorable, when the attacks diable mischief, or even the imare slight, and of short duration, mediate destruction of life. Noand succeeded by the natural thing can be more fallacious than cheerfulness of the child. But, to determine the propriety of this on the contrary, exceedingly omi- measure, by the violence of the nous of danger, when they are of paroxysm; as Mr. North remarks, long continuance, and gradually the most violent form of this disincrease in severity and violence, ease he ever encountered, occurand leave the child dull and heavy. red in a weak female, who was In all cases which he has witness- exhausted by uterine hemorrhage. ed, where the child was suddenly In opposition to the experience destroyed, the dark livid color of of Dr. Currie, who asserts, that the face, and the almost sterto- the cold bath is very efficacious rous respiration, indicated a state in all cases; that it arrests the approaching to apoplexy. Indeed, fit, and affords time for the emno one that has met with this dis- ployment of other means, our auease, would attempt to deny the thor states, that he would be ununiform existence of extensive willing to plunge a child of a very cerebral engorgement. delicate and enfeebled constitution, into a cold bath, during the paroxysm, as it would appear to him a hazardous experiment. Treatment of Convulsions.-Mr. North commences with observing that, as the causes of convulsions are innumerable, the treatment must consequently be ever varying, and for this reason only attempts to lay down general principles of practice. He believes the severity of the attack is frequently relieved by a few drops of the spirit of ammonia, fœtid or aromatic, and the warm bath, and the latter is more particularly indicated if the disease is associated with repelled eruptions, or spasmodic colic. He thinks the paroxysm is greatly aggravated by repeated attempts to exhibit medicine internally during the fit; and prefers opiate frictions to the chest and abdomen, and the administration of a purgative enema; and if there are evident marks of cerebral determination, to open the jugular vein, or apply cups to He recommends local or general depletion, according to the intensity of the symptoms, and the constitution of the patient; the application of a few leeches to the temples, he considers as totally inefficient; and gives a decided preference to opening the jugular vein, or cupping. He directs active purging with calomel and jalap; and condemns the practice of administering large and repeated doses of calomel every two or three hours. At p. 156, Mr. North enters into a free discussion of the benefit to be derived from the proper and assiduous application of cold to the head, where symptoms of determination to this organ are present. He advises that the whole head should be wetted with a large sponge, soaked in spring water, to be frequently changed; or the application of pounded ice in a large bladder. If the child becomes pale, and the head cool, it should be omitted, and renewed when the flushing of the cheeks, and heat of the head, indicate a return of vascular excitement. At the same time we endeavor to preserve the natural heat of other parts of the body. He recommends a diet of milk and water, thin gruel, or arrowroot, and the stimulus of light, and exercise to be carefully avoided, At p. 165, Mr. North discusses the propriety of employing opiates in diseases of children, and very justly observes, that "we are not to deprive ourselves of a powerful weapon, because in the hands of the unskilful it may have proved the means of destruction, rather than of defence." To manage and control their action, when we wish to subdue nervous irritability, he confesses to be no easy task, as their effects depend greatly on the state of the system, and the dose exhibited. He states, on the authority of Dr. Brachet, the good effects of oxyde of zinc, combined with extract of hyoscyamus, which, when long continued, entirely prevented the repetition of convulsive paroxysms. Mr. N., however, is induced to prefer the sulphate of quinine as a more elegant and efficient tonic. In derangements of the prima viæ, which appear to threaten convulsions, our author prefers the judicious use of purgatives to emetics. At p. 202, Mr. N. alludes again to the use of blisters in infantile diseases; his observations appear to us sound and judicious. If, says he, convulsions occur during fever, we are advised by many authorities to apply blisters freely; but confesses he is ignorant of the principle that leads to their adoption. In many cases he has seen much distress and aggravation of symptoms attending their employment. He has twice known infants destroyed by the consequent sloughing, which could not be arrested, From repeated observation, he is induced to believe, that if blisters were never to be applied to children in any case whatever, much less evil would arise from the want of them, than is in common practice daily, or perhaps hourly, inflicted by this popular and painful remedy; unless the child is in a comatose state, and our object is to rouse the nearly extinguished powers of life, he considers them injurious, as excitants. He adds, at p. 216-"It may be worthy of observation, that Mr. Husson, in his researches on the vaccine disease, has recorded two cases in which the appearance of the vaccine vesicle entirely freed the patients from convulsive paroxysms to which they had been subject several months, and which had resisted all the ordinary methods of treatment." On Infantile Epilepsy.-- Mr. North states, that in children, epilepsy is an extremely common disease; to which both sexes are equally subject, during the first four or five years of life; but after the age of seven or eight, it occurs more frequently in females. It is sometimes hereditary, but is much oftener acquired after birth. He thinks that every cause capable of producing even a slight convulsive affection, may, from a predisposition, give rise to a well marked paroxysm of epilepsy. From what Mr. N. has observed, he is disposed to doubt that epilepsy and simple convulsions are reciprocally convertible into each other. In the opinion of Dr. Parry, epilepsy usually depends on excessive impetus of blood in the vessels of the brain, whatever may be its primary causes. But we often have, observes Mr. N., no evidence of such increased action in the cerebral vessels; besides, depletive measures, he adds, would rather aggravate the severity, and increase the frequency of attacks. Epilepsy may be divided into idiopathic and symptomatic; when the cause is presumed to reside in the brain, it is termed idiopathic; the latter designates that variety in which the cause is situated at some distance from the brain. In children, derangement of the primæ viæ may be considered as the most prolific source of symptomatic epilepsy. And this, as Mr. North observes, is mainly dependent on the important and extensive nervous sympathies of the stomach. In every case of epilepsy, he adds, the brain is affected either primarily or secondarily. The danger is certainly in proportion to the frequency of the paroxysms. The severity of the paroxysm will depend more on the natural irritability of the child, than the nature of the exciting cause. Cases are recorded where patients have been attacked with epilepsy from the influence of certain odors, sounds, or the sight of particular colors; in one instance, a paroxysm was always induced by the sight of any red object. Mr. North's description of the symptoms of a strongly marked epileptic paroxysm, appears to be faithfully copied from nature, of which we select the following. P. 230.The eyes appear to project unnaturally, and are fixed; the eyelids tremble; the ball of the eye is thrown upwards, so that only the conjunctiva or white of the eye can be seen; the face is swelled, becomes red, livid, or black, and is sometimes apparently in a state of ecchymosis; the features are horribly distorted by the powerful and irregular action of the muscles of the face; the lower jaw is sometimes firmly closed; at others it is forcibly separated from the upper jaw, and luxation of it is to be feared; the tongue is frequently thrust from the mouth, from which is discharged a frothy saliva; and if proper precautions are not adopted, the tongue may be severely injured when thus protruded, from the alternate contraction and relaxation of the lower jaw; the bloodvessels of the head and neck are excessively turgid; the head is thrown about in various directions, and sometimes becomes suddenly fixed; the whole body is agitated by the most violent convulsions, which may subside for a moment or two, to be again renewed with undiminished force. During this cessation, the child either lies motionless and totally insensible, or rolls its eyes about with a wandering and unfixed gaze, without being attracted by the look of the mother or the nurse, and without the appearance of any degree of consciousness. The limbs of one side are commonly more affected than those on the other. In most cases, the child when attacked staggers and falls instantly to the ground. Oc |