spirations, leucorrhoea, and other maladies, in the treatment of which, the writer is at the present time, extensively testing its efficacy." 75. The thanks of the profession are due to Sir James Eyre for this plain and succinct detail of important cases treated by a safe and easy remedy. which is only just coming into use. 1. TRAITÉ CLINIQUE ET PRATIQUE DES MALADIES DES ENFANS. Par MM. Rilliet et Barthez. Tom. 3. 8vo. pp. 2370. Paris, 1843. A Clinical and Practical Treatise on the Diseases of Children. By MM. Rilliet and Barthez. II. MANUEL PRATIQUE DES MALADIES DES NOUVEAUX-NéS ET DES A Practical Manual of the Diseases of New-Born Infants and III. PRACTICAL OBSERVATIONS ON THE DISEASES MOST FATAL TO We have long intended to present our readers with a succinct analysis of the contents of the important work placed first upon the above list, but have been prevented undertaking the somewhat laborious task by the pressure of other matters. The contributions of the French press to this branch of medical literature have been of late years numerous and valuable, but have chiefly related, as in the works of Billard and Valleix, to the diseases of new-born infants. It is the object of MM. Rilliet and Barthez to present a detailed account of the maladies affecting children aged fifteen months and upwards, and the complete manner in which they have carried it out must render their work a high authority for a long pe riod to come. Paris offers in her large Foundling and Children's Hospitals opportunities for the pursuit of these investigations, which do not exist in this country. The absence of such establishments is not, however, a subject of unmingled regret; for there can be no doubt, as we observed in our notice of M. Billard's treatise, (Med. Chir. Rev. Vol. 32,) that much of the disease found within their walls, is generated by the assembling together of such large numbers of these little creatures; and the modifications produced in the nature and signs of the various affections by the operation of this circumstance, must prevent our too rigorously applying the conclusions derived from such a source to the exigencies of private practice. The authors have for several years laboriously cultivated this ample field of research with a view to the publication of the results. Besides the minute pathological statements and able diagnostic descriptions, so characteristic of the French school, we find a better acquaintance with the writings of others, and a more accurate statement of therapeuti cal indications than are usually displayed by our continental brethren. M. Bouchut's Manual relates to younger children, and is evidently the work of a judicious observer, qualifying as it does, in some instances, the hasty conclusions arrived at by preceding writers. It is the result of a two-years' study in the wards of Professor Trousseau. Mr. Hood's work is about as unfit a one to put into the hands of a young practitioner as those above-mentioned are suitable for this purpose. The confidence of the tone assumed and the error of the doctrine taught, alike render it dangerous. Fortunately, adducing neither fact nor argument worthy of the name, its authority is not likely to become very great. A complete hæmatophobia has seized the author, and he sees in the child but a bloodless, sensitive, irritable little creature, whose maladies must ever be aggravated by depletion, however guardedly employed. He does not admit of the possibility of the use of the lancet, or the application of a single leech being admissible; and most of the few cases he alludes to are examples of his rescuing the victims from the consequence of more active procedures. The diseases of children ordinarily considered as inflammatory, and treated by depletion, such as bronchitis, pneumonia, croup, convulsions, hydrocephalus, &c., depend upon, according to Mr. Hood, the presence of a state of "irritation," in which blood-letting is worse than useless. The readers of this Journal need not be told how often we have protested against indiscriminate and excessive depletion at any age, much more that of childhood; and the attention of the medical observer has been forcibly called of late years, by several talented men, to the existence of conditions of the infantile economy which forbid debilitating measures of any kind. But the proscription of bleeding, local or general, under all circumstances, and the rash recommendation of opiates, tonics, and stimuli, in conditions of the system ill-fitted to endure them, were reserved for Mr. Hood; who does not find it requisite to embarrass himself with diagnostic minutiæ, and consequent variety in therapeutical indications; but having determined that children's diseases arise from and consist only in "irritation," simplifies his practice accordingly. This book should at least bring consolation to those practitioners who, observing the latter stages and postmortem appearances of some of these affections, have felt poignant regret that more active measures were not instituted at an early period! Our attention will be chiefly directed to the work of MM. Rilliet and Barthez, adding any illustrative particulars that may offer themselves in that of M. Bouchut. Both works contain some introductory observations, a few of which it may be as well to glance at. 1. The Physiological Condition of Children.-In children the lymphatic temperament especially prevails, which disenables them from offering strong resistance to injurious agencies, such as errors of diet, cold, impure air, &c.; but as they advance in age their susceptibility diminishes, their flesh becomes more firm, and the diffusion of heat is more uniform. The pulse being in children so rapid, their susceptibility to cold must depend upon some imperfection of hæmatosis. M. Trousseau found the numbers vary in children aged less than 21 months from 96 to 160, the mean number being 137 in the 1st and 2nd months, 128 from the 2nd to the 6th month, 120 from 6 months to a year, and 118 from 12 to 21, months. After the third month the pulse of girls commences to be more frequent than that of boys. Sleep has a remarkable effect, the number then diminishing 15 or 20 beats. Fear and other causes produce great acceleration, and the mere rapidity of pulse is therefore seldom an indication of treatment in the child, unless accompanied with fever. The inspirations vary from 20 to 32 in children from 2 to 5; from 20 to 28 in those from 6 to 10 years of age. They are regular, full, and noiseless, and during sleep in young children are often so deep as to amount to sighing. In these young subjects, too, the respiratory movements are often irregular or intermitting without any derangement of health. The normal form of the thorax and abdomen must be borne in mind. A depression which extends from the xyphoid cartilage around the lateral portions of the chest (the false ribs being at the same time expanded,) owing to these yielding more readily to the attachments of the diaphragm, and the small capacity of the pelvis, cause a remarkable projection forward of the abdomen, which in very young children may be mistaken for disease. After some years the pelvis becomes enlarged, the margins of the ribs more resisting, and the liver diminished in size--so that the superior and inferior abdominal organs making no projection, the marked boundary between the two cavities ceases to appear. Auscultation.The chest is more sonorous in the child than in the adult, and the vesicular murmur, which is also more intense, is only heard during inspiration. MM. R. and B. prefer mediate percussion by means of the finger and immediate auscultation, as the stethoscope frightens some children and pains others. In ricketty children, and others, in whom the chest is deformed, the examination is made more easily by having the child held to the ear horizontally in the arms of the nurse. The maximum of sound is perceived from just below the clavicle to near the nipple anteriorly, and in the intra-scapular region behind. M. Bouchut observes that, however true it is that the respiration is louder [puerile] in children more than two years of age, such is not the case in children at the breast. On the contrary, probably from the air not completely dilating the vesicles, there very little sound indeed. So too in a healthy infant percussion is dull, being however sonorous if the child is very thin. The sound elicited even from the same child is liable to great change and variety, and is not to be relied upon. is 2. On the Examination of Sick Children.--MM. Rilliet and Barthez give detailed explanations of the plans they followed in collecting the particulars of the various cases which came before them. They justly observe, without some mechanical aid of this kind, it is impossible for the medical officers of large institutions to record these with the requisite accuracy and minuteness. For each patient four sheets of paper are provided, one of which is dedicated to his history and state on admission, the second is a record of his progress and symptoms from day to day, and the third is a register of the results of the autopsy. The fourth forms a cover for the others, having written upon it a resumé of the particulars they detail. the margin of each of these sheets every particular concerning which in quiry has to be made is printed, thus saving valuable time to the narrator, and preventing his overlooking any important point. One can judge upon a small scale how convenient this plan must be, by comparing the much less trouble it takes to reply to the medical queries of an insurance office, than it would do if the statement had to be made unaided by these. Examples of the tables are given, to which we refer those of our readers who are connected with large institutions. 3. On the administration of Medicinal Substances to Children.—The authors observe that, although in the course of their work they frequently recommend active medicines, yet that they agree with Henke, that if ever expectant medicine is justifiable, it is so in some of the diseases of children. Many of the functional disturbances do not require active drugs, and in others the diagnosis is but imperfect. Practitioners should remember too that, owing to the carelessness of attendants and the obstinacy of children, all they send is never administered. But we may ask, does not this often arise from the even yet continued practice of sending far more medicine than is required-a dangerous practice, for the parent quite unable to give all, is as unable to determine which and what portion is essential. The obstinacy on the part of children is chiefly manifested in their slighter affections. MM. Rilliet and Barthez also deservedly condemn the routine practice which always treats the same disease in the same manner, without due consideration of the actual condition of the patient, the stage of his disease, or the hygienic circumstances which surround him. In almost all diseases, a period arrives in which the consideration of the general condition of the patient should predominate over that of the organ specifically affected. Modes of Administering Medicine.-Giving children medicine by the mouth is not always practicable, and when other means suffice, they should not be irritated by the attempt. Where it is essential, the nose should be pinched with one hand, and the spoon introduced completely into the mouth with the other. Is sufficient pains usually taken to disguise the nauseous flavour of medicines? Injections are much used in France, for the conveyance of other substances besides laxatives. The dose required is often less than when given by the mouth. The substance is more readily absorbed if the bowel is first emptied and the mucous membrane cleansed by means of an emollient glyster thrown up just before. So too the action of an injected substance is often extended by following it with an abundant watery enema. The authors much approve of administering medicines by rubbing them into the skin, believing this very preferable to the endermic method. The skin should be well cleaned with warm water before the frictions are employed, which require repetition several times in the twenty-four hours. The inner part of the thigh is a very eligible site for absorption, or a piece of wool smeared with ointment may be retained in the armpit by means of a handkerchief. M. Prevost says, the facility with which any ointment is absorbed is much increased by adding 1 part of ung. hydr. to every 32 parts. Baths, simple or medicated, are highly useful, the authors usually employing them at from 26 to 23 Reaumur. A child may frequently be retained in a simple warm bath for one or two hours, but in a medicated one not longer than from 15 to 45 minutes. Foot-baths are seldom used, and Hufeland says that steeping the feet with cloths dipped in hot milk forms a good substitute-inducing copious transpiration. Hand-baths are frequently used, and are very convenient, as the child need not be removed from its bed. Cataplasms and fomentations, so frequently used for children, require still more frequent renewal than they do in adults, to prevent chilling. Blisters are seldom used by MM. R and B. in consequence of the irritation they so often give rise to; and are especially to be avoided in very thin children, during the course of convalescence and chronic or enfeebling diseases, and during epidemics. Notwithstanding the observations of M. Bouchut relate to much younger children, he is a warm advocate of the utility of blisters applied for a brief period. Although the authors are more bold than their predecessors in this respect, they still have a very unfounded dread of purgatives in many of the diseases of children. In their preliminary remarks MM. Rilliet and Barthez remark, that the diseases of children seldom pass through their various stages without becoming complicated with, or followed by, other morbid affections. On this account they might be classed in three categories; diseases which almost always appear during the existence of good health; those which are nearly constantly the consequence of a prior morbid state; and those which sometimes occur spontaneously and at others succeed another affection. In fact, the due consideration of the primary or secondary nature of the child's disease is of vital importance. The more diseases resemble each other the greater is their tendency to complication. Thus, if the primary affection be a phlegmasia, secondary or tertiary phlegmasiæ easily follow. The presence of dropsy or tubercle in one organ is usually accompanied by its existence in others. When the secondary disease is different in nature from the primary one, the latter has acted as a stimulus to its production. Thus tubercle may give rise to an inflammation of the organ in which it is deposited, and pertussis may develop a bronchitis or pneumonia. Although the severity of diseases is usually augmented by complication, they occasionally, when of a different nature, produce a contrary effect. Thus, scarlatina or small-pox occasionally cure tubercle; and some of the phlegmasiæ relieve some of the neuroses. If the affections are of a similar nature, the primary one will only be relieved when no diathesis prevails, in which case pneumonia, e. g. may cause the disappearance of diseases of the hairy scalp. of The distinction of diseases into acute and chronic, is not always so easily made or so fundamentally important as in the adult. The diseases of children often assume an intermediate form-frequently in consequence a continued succession of morbid conditions. The disease may be acute as regards its duration and the nature of the lesions it gives rise to, but chronic in the sympathetic disturbance which it excites. When an acute disease attacks a feeble infant and vigorous re-action is impossible, it may be termed cachectic. The various affections are treated of under eight separate divisions, viz. Inflammations, Dropsies, Hæmorrhages, Gangrenes, Neuroses, Continued Fevers, Tuberculizations, and Entozoaires. This is a very faulty classification, giving rise to the separation of diseases possessing strong affinities |