ART. X.-The Cure of Clubfoot without Cutting Tendons; and on certain New Methods of Treating other Deformities. By RICHARD Barwell, F.R.C.S., &c. PAGE 471 ART. XI.-Dairy Stock: its Selection, Diseases, and Produce: with a Description of the Brittany Breed. By JOHN GAMGEE, Professor in the New Veterinary College, Edinburgh, &c. With Plates and Woodcuts 473 ART. XII.-1. Further Observations on the Distribution of Nerves to the Elementary Fibres of Striped Muscle. By LIONEL S. BEALE, M.B., &c. (Philosophical Transactions,' 1862) 2. On the Anatomy of Nerve-fibres and Cells, and the ultimate Distribution of Nerve-fibres. Abstract of Dr. Beale's Demonstrations. By G. V. CIACCIO, M.D., of Naples. (Reprinted from the 'Microscopic ib. ib. 474 ART. XIII.-The Causes and Treatment of Imperfect Digestion. By ARTHUR LEARED, M.D., &c. Third Edition Original Communications. ART. I-On the Geographical and Chronological Distribution of some Epidemic ART. II.-Statistical Analysis of Cases of Chorea. 475 ART. III.-Contributions to Therapeutical Statistics. By THOMAS K. CHAMBERS, M.D., &c. ART. IV.-Examination of the Spinal Cord in a Case of "Wasting Palsy," with Remarks. By J. LOCKHART CLARKE, F.R.S., &c. ART. V.-On Tumours in Voluntary Muscles; with an Analysis of Sixty-two Cases, and Remarks on the Treatment. By W. F. TEEVAN, B.A., &c. 504 ART. VI.-Notes on "Historical Researches on the Use of Forceps in Extraction of Cataract." By Q. E. D. . 517 Chronicle of Medical Science. (CHIEFLY FOREIGN AND CONTEMPORARY.) Half-Yearly Report on Micrology. By J. F. STREATFEILD, F.R.C.S., &c. Half-Yearly Report on Toxicology, Forensic Medicine, and Hygiene. By B. W. RICHARDSON, M.D., &c. Quarterly Report on Surgery. By JOHN CHATTO, Esq., M.R.C.S. E. THE BRITISH AND FOREIGN MEDICO-CHIRURGICAL REVIEW. OCTOBER, 1863. PART FIRST. Analytical and Critical Reviews. REVIEW I. 1. Beiträge zur Kinderheilkunde. Von Dr. E. HENNOCH, Professor der Medicin an der Königl. Universität zu Berlin und Dirigenten einer Poliklinik für Kinderkrankheiten.-Berlin, 1861. SS. 213. Contributions to Paediatrics. By Dr. E. HENNOCH, Professor of Medicine at the University of Berlin, &c. 2. Familiar Letters on the Diseases of Children, addressed to a Young Practitioner. By JAMES BOWER HARRISON, M.D., Fellow of the Royal College of Surgeons, &c.-London, 1862. pp. 197. 3. Infant Mortality and its Causes. By ARTHUR LEARED, M.D., M.R.S.A., &c.-London, 1862. pp. 13. 4. Excessive Infant Mortality: how can it be Stayed? To which is added a short Paper on Infant Alimentation.. By M. A. BAINES. -London. pp. 20. 5. Observations on some of the Causes of Infanticide. By GEORGE GREAVES, M.R.C.S., Lecturer on Midwifery and the Diseases of Women and Children, Manchester Royal School of Medicine, &c.-— Manchester, 1863. pp. 26. 6. The Practice of Hiring Wet Nurses (especially from the "fallen") considered as it affects Public Health and Public Morals. By M. A. BAINES.-London. pp. 16. A NATURAL inclination towards the study of the diseases of early life, strengthened by a clinical assistantship of seven years' duration in the service of M. Romberg, prompted Dr. Hennoch to found for himself a dispensary for the diseases of children, by which he could continue to foster his early bias. Notwithstanding the useful establishments connected with pædiatrics already existing in Berlin, the new founder received an ample share of patronage, six hundred cases being treated 64-XXXII, •1 by him and his assistant, Dr. Aron, during the course of the first year's trial. As materials for generalization collected in the casebooks, Dr. Hennoch conceived the idea that the results he might arrive at should not be altogether devoid of interest to his professional brethren. He therefore decided on placing his inferences before them; and hence is explained the origin of these "contributions," which are based upon the experience of between four and five hundred cases. Had our author been either a tyro in his art, or a novice in the "speciality" he was dealing with, it would have been preferable that he should have permitted more than one year to have passed over ere he favoured us with the experience drawn from his establishment. But, as it happens, Dr. Hennoch is well known as an able and experienced clinical teacher; hence the work before us may be consulted with advantage by such as desire either to refresh or strengthen their knowledge of the pathology of childhood and infancy. It may be said that the chief purport of it is to show how far the author's own cases bear out the usually accepted histories of the particular maladies referred to, and to what extent and wherein they fail to do so. This renders the account the author gives more fitted for one already tolerably acquainted with the general subject, than for the commencing student of the pathology of childhood. Diseases of the nervous system are first discussed: amongst them we may refer to the examples given of tubercular meningitis, as illustrating that variety of the malady in which the initiatory vomiting lasts for a very long period, and where this, combined with its isolation as a symptom, may give rise to the formation of a wrong diagnosis. A child not presenting any other trouble than vomiting pretty continuously for a whole week, may readily lead the inexperienced away from the suspicion of cerebral mischief. But Piet's instance of 9 days' initiatory gastric regurgitation exceeds the 7 and 8 days of Hennoch and Romberg. When the disease quickly passes into the second stage, the emesis may continue 12, 15, or even 25 days, ceasing, in fact, only with death, (Rilliet and Barthez.) The author discusses the question as to whether (as many maintain) there are any signs by which the vomiting from insidious brain diseases may be distinguished from that attendant upon indigestion, "febrile gastric catarrh," &c., in cases where the emesis is the only symptom present. Certainly, considerable trouble has been taken to demonstrate such, but with little satisfaction, as Dr. Hennoch considers. It is true that the influence of the upright position in exciting cerebral vomiting is very frequently observed, but it is not always so; and in one of Hennoch's cases, the child could repeatedly sit erect in its mother's lap without the slightest emesis following, whilst in another very frequent vomition ensued when the little patient was kept in the recumbent posture. On the other hand also, dyspeptic vomiting may frequently be induced by the sudden removal from the lying into the upright position. Even the constipated state of the bowels, which forms so general an accompaniment to the vomiting of brain mischief, may not only be wanting, but actually diarrhoea may be present. The want of a feeling of nausea, as preparatory to the gastric regurgitation in brain disease, is a point upon which we may very readily go astray in the case of children. The remembrance of these and analogous facts will show that over-much dependence should not be placed upon any single symptom in the earlier stages of brain disease in infancy. Under diseases of the respiratory organs we meet with the following case-Gustav C, eleven weeks old, was attacked by cough upon the 23rd of February. On the 25th, he exhibited all the signs of a highly acute pulmonary affection. There was frequent cough, extreme dyspnoea, moaning expiration, high temperature, a pulse of 196, and very small, and the breathing was frequent and irregular. Percussion was everywhere duller than normal; the respiratory murmur was universally very sharp or acute, with a bronchial "timbre" anteriorly and laterally upon the left side of the thorax; there was, here and there, slight moist rattling. At eleven the same night the child died. At the necroscopy several small patches of atelectasic lung were found upon the posterior surfaces of the lower lobes; these patches were readily inflated; the small bronchial twigs alone traversing them were filled with muco-purulent matter. Not a trace of pneumonia existed; the bronchial tubes, with the exception of those just mentioned, were universally void of secretion; whilst the mucous membrane, from the bifurcation of the trachea to the smallest ramifications of the bronchial tree, was deeply reddened, and by so permanent a colour, that it remained when the mucous membrane of the small transparent bronchia was removed from the pulmonary parenchyma. We give some of the author's comments in his own words: "What is particularly striking in this case-running its course within fortyeight hours-is the want of secretion observed almost throughout in so intense and diffused a form of bronchitis. A very small portion only of the smaller bronchi closely connected with the atelectasic portions of the lungs was filled with muco-purulent matter, and which, in fact, was the cause of the atelectasis. In by far the greater number of the air-tubes not a drop of fluid was met with, in spite of the intense redness present. With these conditions, too, the physical signs existing during life agreed. Scarcely any other view remains to be taken than to regard the case as one of a rapidly supervening and progressing hyperæmia with subsequent tumefaction of the bronchial mucous membrane, which, through diminishing the calibre of the air-tubes, obstructing the entrance of air, and hindering the oxydation of the blood, put an end to life before the stage of secretion was attained. Since Rilliet and Barthez, in reference to this point, observe (loc. cit. 454)- Il est vrai que la preuve anatomique manque, car l'autopsie n'est jamais faite avant la secrétion des mucosités; et le fut-elle, elle ne donnerait probablement aucun résultat, le gonflement ayant disparu après la mort.' I may add that, so far as the fatter statement only is concerned, is the present case a testimony. The writers in question draw attention to analogous circumstances connected with other mucous membranes, e. g., of the nose, of the larynx, of the trachea, in which, in consequence of a suddenly supervening catarrh with swelling of the mucous membrane, a partial obstruction of the affected tubes with corresponding symptoms may be developed, and by which, for example, in the latter case, the phenomena of pseudo-croup may be produced. Such congestive states pass, it is true, not infrequently into the stage of secretion (nasal and tracheal catarrh); but they can also, as daily experience teaches, subside without having reached the latter. Rilliet and Barthez believe the same to hold good as regards the bronchi, and remark-Nous avons vu des cas dans lesquels un accés de dyspnée avec râle sibilant disparaisait sans qu'il eut à la suite ni rejet de mucosités, ni râles bullaires; mais nous le répétons c'est seulement par analogie et d'après des preuves symptomatiques qu'on peut admettre ces congestions subites avec gonflement de la muqueuse bronchique.' As it is, then, I believe that actual proof of the position is afforded by the above case." (p. 35.) Under this division may be found some good remarks upon pulmonary tuberculosis. (p. 61.) Of the latter, a case is detailed in a child only four months old, in whom a considerable cavity existed in the lung, the smooth parieties of the vomica leading to the belief that the latter was not of recent formation. "Gastric catarrh," remittent fever, and "abdominal typhus" are critically discussed by Dr. Hennoch; but we cannot say that we have received much enlightenment from the author's endeavours to explain the nature of all cases of so-called "remittent fever." No one at present doubts that a pyrexial state of a remitting character is common in early life as the constitutional reaction of many different local maladies, nor that this state so related has been often looked upon as a primary or idiopathic fever, and described as "infantile remittent." But the question still remains unanswered-viz., what is the exact nature of the remitting febrile condition in children, which, so far as we can see, is neither typhoïd, nor the secondary, nor symptomatic fever of a local lesion. In reference to this we do not receive any help from Dr. Hennoch. To pass to the digestive, &c., organs, we may observe that the extract of nux-vomica-first recommended by Schwartzhas been found by the author highly serviceable in the treatment of prolapsus aui. Duchaussoy and Foucher have likewise praised this agent as increasing the tonic and contractile power of the sphincter. The former applies strychnia epidermically (as it were) upon a small blistered surface near the anus, whilst the latter injects a small quantity of a solution of strychnia into the anal subcutaneous cellular tissue, by means of Pravaz's syringe. A subject to which Dr. Hennoch has devoted considerable attention is that of Rachitism. We have ourselves upon two previous occasions (vol. xviii. p. 6, vol. xxvii. p. 371) discussed this morbid state with some minuteness. We must perforce refer to it again, however; for when dealing with the work of a German author, the latter will assuredly expect to awaken our curiosity when he touches upon a malady known to Continental medicine as Der Englische Krankheit.' But we deny the "soft impeachment" here involved, though we may listen to Dr. Hennoch. The experience of our author tends to prove that rachitism is not more common in one sex than it is in another, and it negatives the doctrine of Friedleben, that its maximum of frequency occurs just before and after the completion of the first year of life. By far the greater number of the Berlin cases occurred between the ages of fifteen months and two years and a half. It is well-known that Friedleben strongly opposes Elsässer's teaching, that in cases of |