appetite was poor, and she had frequent headaches. On the 1st day of January, 1866, she was seized with a violent attack of vomiting and retching, which continued for several days. On the 6th she was so exhausted that she had to go to bed, and there was severe pain in the head and back of the neck. On the 21st she had what the friends described as nervous fits, during which the hands were spasmodically clenched, the eyes rolled wildly, and the teeth were ground together. The bowels had been all along confined, and when first seen by me on January 24th she was in the following condition :-Face pale and dingy, eyes sunken and glassy, the pupil of the right eye widely dilated, left pupil natural, conjunctivæ red and injected. She was greatly emaciated, skin dry, pulse feeble, rapid but regular; breathing was gurgling; tongue coated, small and sharp-pointed, fiery-looking at the tip. Though extremely exhausted she was quite sensible, and answered questions correctly. The belly was sunken but the bladder was distended, and about fourteen ounces of urine were drawn off. It was of specific gravity 1007, faintly acid in its reaction, and free from albumen. As the patient was so feeble, ammonia, strong beef-tea, and wine were ordered. On the morning of the 25th the breathing was slow, pulse fluttering, and irregular. She kept constantly pushing the bedclothes down, clutching at imaginary objects, and grinding the teeth all day, and died without any convulsion at eight o'clock the same evening.

Sectio Cadaveris thirty hours after death.-Rigor mortis feebly marked. Hypostatic congestion considerable. On examining the head some adhesions of the membranes to the brain posteriorly were found. Both ventricles were distended with clear fluid. Around the optic nerves the membranes were roughened, and in the fissure of Sylvius that appearance of the textures which has been described as resembling sago was found to exist. The brain substance was not at all softened, but of a natural firm

ness.

In the abdomen the mesenteric glands were enlarged.

The left lung was firmly adherent to the thoracic wall anteriorly, but no trace of tubercle could be found in either of the lungs.

Remarks. In this case the approach of the disease was heralded by symptoms which are extremely common, falling off in general health, retching and vomiting, and pain in the head and neck. The headache is generally confined to one side, and according to my experience, pain or stiffness in the neck is almost a constant symptom in cases of inflammatory affections of the head. The roughening of the membrane about the optic nerves was no doubt caused by the deposit of minute masses of tubercular matter.

The urine

Case 2.-T. J., aged 6, was first seen by me on the 28th of January, 1866. He had been ill for about a week with feverish symptoms. He was restless, cried aloud every now and again, and complained of pain in the forehead. The pulse was 80 and intermittent. Tongue red at the point; pupils natural. Body emaciated, belly sunken, skin dry and dingy, There were some purpura-like spots on the arms and trunk. was acid, slightly albuminous, and of specific gravity 1033. Under the microscope numerous amorphous masses of urate of ammonia were seen. The iodide of potassium, three grains every four hours, was prescribed, and as there was some tenderness on pressure over the stomach, a mustard poultice was applied. Wine, beef-tea, and milk were also ordered to be given frequently.

On the 29th the pulse was 132, and irregular. The breathing was gasping and shallow, eyes sunken, but natural. He complained of pain over the spine in the dorsal region, when pressure was made there. He was quite sensible, but tossed about in bed, and coughed a good deal. As the bowels had not opened, an enema was ordered, and blistering fluid was. painted on behind both ears.

On the 30th patient still continued conscious, but had some difficulty in speaking. The breathing was laboured, pulse 120-140, and very feeble and irregular; pupils unaffected.

On the day following-viz., the 31st January-the bowels became very loose, the pulse fell to 96 beats in the minute, and he vomited some black bad-smelling matter. Towards evening his motions were very foetid, and passed involuntarily in bed. At midnight he was seized with violent convulsions, which affected chiefly the left side. During the attacks the pupils, which hitherto had remained unaltered, became dilated, and the arms were pronated forcibly. The pulse at this time could hardly be felt, and patient moaned much. He died on the 1st of February, having retained his consciousness till near the close. No examination of the body could be obtained.

Remarks. In this, as in the preceding case, the patient retained possession of his faculties till the close; but it differs from Case 1, in being accompanied by convulsions. The boy was evidently of a strumous constitution, and had previously suffered from pneumonia,

The iodide of potassium has been greatly extolled of late in the treatment of the head affections of children, but like all other remedies, it is too generally found to be of little service. There is one case, however, recorded in the books of the Edinburgh Children's Hospital, in which, after the manifestation of the usual symptoms of hydrocephalus, including convulsions, recovery took place under frequent and full doses of this drug.

B

VOL. III.

In Case 2, I made a daily observation of the state of the temperature of the body, and found that in the axilla the mercury of the thermometer stood as follows:

January 29th, Morning, temp. 97 2-5th degrees.

It will be noticed that during the convulsions there was a rise in the temperature, and just at the moment of dissolution the thermometer stood at the same figure-namely, 99 1-5th degrees.

Had there been any doubt as to the nature of the case, any uncertainty as to whether it was hydrocephalus or typhoid fever, the state of the temperature would have been of invaluable service in aiding us to form a correct opinion.

Case 3.-J. M., aged 9, had never been a very healthly boy, and some time ago suffered from an an attack of inflammation of the lung. He had been pretty well, however, and running about as usual, till one day in the end of the month of September, 1865, when, after eating a raw turnip, he was seized with a violent headache. Two days afterwards retching and vomiting came on, and continued for five days, when he fell into a state of stupor, and had a violent convulsion. When seen by me he was partially insensible, screamed with pain in the head, tossed restlessly in bed, and had a good deal of gurgling in the throat. The skin was hot, and so was the head, pulse small and quick, tongue red and parched. There was also an occasional short cough. The iodide of potassium in frequent doses was prescribed, and patient was to have milk and beef-tea. Cold was also applied to the scalp. The following day, October 6th, he seemed to be rather more sensible, but still complained of pain in the forehead and face. A small fly blister was applied to the nape of the neck.

October 7th: Patient worse to-day. Eyes very much congested. At times he lies quietly in a semi-comatose state, and then gets restless again and cries out most piteously. An enema was administered, and the bowels were freely moved. The gurgling in the throat continues, and he seems to lack the power to cough up the mucus.

The urine is free from albumen.

October 8th: Patient died quietly, without any convulsion, this after

noon.

Sectio-cadaveris twenty hours after death.—The veins of the head were quite full of dark clotted blood. The ventricles contained a small quantity of greenish-coloured fluid. The cerebellum was adherent to the membranes at several points. The substance of the brain appeared to be healthy.

An examination of the chest revealed an old pleurisy of the right side, which had resulted in extensive adhesions. The pericardium contained about two drachms of fluid. The mesenteric glands were slightly enlarged; liver large but healthy; spleen very dark and shrivelled.

All these cases were regarded as hopeless by the time they came under my care; but they may be looked upon as good illustrations of hydrocephalus in its acute form. It is worthy of remark that in all of them there was distinct evidence of previous inflammation of the chest; while in two of them the mesenteric glands were found to be enlarged. These facts lead us to infer that the patients were of a weakly constitution, and that in cases I. and III. at least, there was a tubercular diathesis. Paralysis was not observed in any of these cases; but it ought to be remembered that frequently loss of muscular power in the arm or leg is the first recognizable symptom of approaching disease of the head. Cases have come under my notice in which a slight dragging of one leg, or a failure in the prehensile power of the hand, was the precursor of a fatal attack of hydrocephalus, and this symptom occurring in a child who has been previously healthy should always be regarded with suspicion. Squinting is another sign of grave importance in all intracranial affections; but in the three cases recorded above it was not present, although in Case 1 the pupils were unequally dilated.

TYPHOID FEVER IN CHILDREN.

In his "Clinical Records illustrative of the Diseases of Children," published in the Dublin Press and Circular, Dr. G. STEVENSON SMITH makes the following remarks on diet and treatment of typhoid fever in children:

With regard to the very important subject of diet we have merely to say that the patients are allowed sweet milk ad libitum, with small quantities of beef-tea occasionally, and this is all the food that is necessary. During convalescence, however, eggs are sometimes given, generally beat up in the form of flip. Solid food, such as beef, etc., is often productive of much evil, by being given too soon, and is a frequent cause of diar

rhoea and feverishness. As to the use of wine and brandy, that is a subject which has caused a great deal of discussion, and concerning which much diversity of opinion still prevails. Experience leads us to take up no extreme position on one side or the other, for while we hold that stimulants are often used much too freely, and to the injury of the patient, we must at the same time admit that we have seen typhoid patients saved by the continuous and judicious administration of brandy. The fact is, that many cases will do well without a single drop of wine, while others need to be stimulated from the very first. There are some physicians who in every case of fever pour into the patient so great a quantity of wine or brandy, that the symptoms are rendered most complex and confused; while others again, even when the patient's powers are flagging, when the tongue is black, and the teeth are covered with sordes, refuse to allow the administration of any stimulant whatever. The exercise of a wise discrimination on the part of the practitioner is therefore required to prevent his falling into error. If the diarrhoea is troublesome, sound port wine is the most suitable. When there is much nervous prostration, indicated by tremor of the tongue and hands, brandy ought to be given.

As to medication, the patients in the Children's Hospital, Edinburgh, generally are given the following;

Aquæ,

f. 3 iij.

M.

S. A dessert spoonful every four hours. Occasionally, if a stimulant is indicated, a drachm of the sp. æth. nit. is added. pleasant to the taste, and possesses tonic and

This mixture is very refringent properties; besides it is eagerly taken, and indeed often greedily demanded by very young children.

If diarrhoea exists, a few grains of DOVER's powder are generally most useful. When the looseness is very persistent, a grain or half a grain of plumb. acet. should be added. When hæmorrhage occurs, enemeta of starch and laudanum will be found of much benefit, but occasionally more active remedies are required. Nitrate of silver in or grain doses, along with some preparation of opium, is often attended with much benefit. When the breath and evacuations smell badly, the chlorate of potass., dissolved in milk or water, and given as a drink, acts very beneficially.

If there is much tenderness of the belly, warm light poultices of linseed meal, or turpentine stupes are useful in allaying the pain, while an enema of castor oil, and a few drops of the tincture of asafoetida, will be of use in removing the tympanitis, which is frequently troublesome and distressing.