of the Hydr. c. Creta, with three of rhubarb, or one of the powdered extract, would be a proper dose for a child a year old. If there be much feverishness and restlessness during the day, you may give a mixture of bicarbonate of potash not quite saturated with citric acid, and containing small doses of ipecacuanha wine, if the stomach be not extremely irritable, and of the tincture of hyoscyamus; the value of which last medicine as a sedative in the diseases of children can scarcely be too highly estimated. The addition of a little syrup of mulberries will render the above mixture extremely palatable.*

You will sometimes meet with cases of cerebral congestion that appear to have been brought on by exposure to the heat of summer, and in them it often happens that the bowels are not constipated, but somewhat relaxed. You must not, however, aim at checking the diarrhoea by direct astringents, but should rather pursue an alterative plan. In most instances there is irregularity of the bowels rather than diarrhea; the child having five or six unhealthy motions, for the most part destitute of bile, in the course of one day, and passing the succeeding twenty-four hours without any evacuation at all. In such cases you will find the treatment I have just indicated very useful. If the bowels be much disturbed, halfgrain or grain doses of Dover's powder may be combined with the mercurial with advantage.

There is not time to enter into more minute details with reference to the management of every variety of active cerebral congestion, but we must briefly notice those cases in which the condition exists in what may, perhaps not improperly, be called the passive state. In the paroxysms of hooping-cough the brain becomes congested by the impediment to the return of the blood from the head: and cerebral congestion is induced in a similar manner when the larynx becomes spasmodically closed in the disease known by the name of Laryngismus Stridulus. But we likewise meet with cases where the passive succeeds to the active form of cerebral congestion, or becomes more or less gradually developed out of some disorder of the abdominal viscera: or, lastly, where it supervenes towards the * (No. 2.)

B Potassa Bicarbonat.

Acidi Citrici, aa. gr. xx.

Vin. Ipecac. mxij.

Træ. Hyosc. mxviij.

Syr. Mori, 3iij.

Aquæ destill. 3ix. M. 3ij. every six hours.

For a child a year old.

E

50

PASSIVE CONGESTION.

close of life in weakly children, whose vital powers have at length become too feeble to propel the blood.

In children who have suffered long and severely from hoopingcough, you often notice a general lividity of the face and lips, a puffed and anxious countenance, and the child makes grievous complaints about its head, while the skin is moist and cool, and the pulse soft, though frequent. Many of these symptoms indicate an overloaded state of the cerebral veins; and if a paroxysm of coughing occur, and the circulation be thus further disturbed, the child may die in a fit, or may sink after some convulsive seizure into a state of coma, which sooner or later proves fatal. In such a case you will find the vessels of the brain and its membranes universally gorged with black blood, the choroid plexuses of a deep purple colour, and more bloody points than natural will present themselves on a section of the brain being made. Both the symptoms during life, and the appearances after death, are only a rather exaggerated illustration of what occurs in all cases of passive congestion of the brain. It is not, however, always easy to explain why this condition comes on. Among the poor you often find it connected with general disorder of the digestive organs, and occurring as one of a long train of ills induced by destitution and neglect. It was so in the case of a little boy four months old, whom I saw some years ago. His parents were young and healthy people, but they had already lost three children, apparently in consequence of their inhabiting one of those narrow courts so numerous in London, into which the sun never shines, and where young children pine and fade like tender plants shut up in a cellar. When ten weeks old, this little boy was taken with pain in his bowels and diarrhoea, and at three months old. he began to suffer from fits, which came on daily, sometimes several times a day. No efficient treatment had been adopted when he was brought to me. He was then as large as most children of his age, and by no means emaciated; but his flesh was flabby, his face unintelligent, puffed, and livid, his head hot, the veins of the scalp and eyelids turgid, the eyes prominent, lustreless, covered by mucus, and the pupils not acting under light. He lay in his mother's lap, uttering a constant hoarse moan; his head thrown rather back, and in incessant rotatory motion; his mouth was open, his tongue red and parched, and the papillæ on its surface were very prominent his abdomen was rather full, and his legs were constantly raw up towards it. He vomited much; his bowels were open three or four times a day, the motions being

green and offensive; his pulse was frequent, but without power. In this, as in many instances of passive congestion of the brain, local depletion was resorted to at first, and, benefit resulting from it, was repeated more than once. It is not, however, every case that will admit of even local depletion, which, whenever employed, must be practised only with the view of affording relief to the gorged cerebral vessels, not with the idea of curing the patient by bleeding. The greatest attention must in every case be paid to diet and to the state of the bowels, and you will find no means of inducing their healthy action better than the employment of small doses of mercury and chalk two or three times a day. If the child be not weaned, you may find it desirable, if there be constant sickness, to take it almost, or entirely, from the breast for a day or two, and to substitute barley-water, sugar and water, or a weak solution of isinglass, with the addition of one third of milk, which should be given in quantities of one or two spoonfuls at a time till the stomach becomes more settled. A stimulating bath, as a hot salt-water bath, or a bath into which a handful of mustard has been put, and in which the child is to be kept for four or five minutes, night and morning, will often be found a valuable auxiliary to the general treatment, as well as very useful, if combined with the application of cold to the head, in cutting short the convulsive seizures.

If the case be associated with much diarrhoea and general impairment of nutrition, the extract of bark, with a few drops of sal volatile, or of the compound tincture of bark, should be given two or three times a day, and you should not let the head symptoms lead you to keep the child on a low diet.* Remember, too, that when nutrition is much impaired, farinaceous food is not usually well digested; you must, therefore, be sparing of arrow-root, and give milk and water, or milk and water with isinglass, or veal-tea. If the broth should purge, as it sometimes does, the white decoction of Sydenham † will form a cheap substitute for isinglass. As the child improves, the ferrocitrate of quinine will be one of the best

For a child a year old.

(No. 3.)

B Extr. Cinchonæ, 3j.

Træ. Cinch. Co. 3ij.

Aquæ Carui, 3x. M. 3j. three times a day in milk.

The taste of the above mixture is best concealed by sweeten

ing it, and mixing it with twice the quantity of milk.

This, the Decoction Blanche of the French Pharmacopoeia, is made by boiling half an ounce of hartshorn shavings, and the inside of one French roll, in three pints of water, till reduced to two; when it may be sweetened, and given either alone or with the addition of one part of milk.

remedies you can give *, and throughout the whole progress of the case you will remember the tonic influence of pure air; and may even find the removal to a healthier spot and a purer atmosphere absolutely necessary to the recovery of your patient.

Lastly, I will just allude to the head symptoms that sometimes for a few days precede death in children who have been long ill. You may in such cases find the vessels of the brain turgid, and be disposed to reproach yourselves for not having adopted active treatment. Such self-reproach would be unmerited; the streams have stagnated, because the vital powers were all too feeble to keep them in motion.

LECTURE V.

CEREBRAL HÆMORRHAGE.-The rupture of any large vessel in childhood very rare. but effusion of blood into arachnoid frequent-reasons for its especial frequency in new-born infants-its symptoms and treatment-Blood sometimes effused external to the skull in new-born infants-Cephalhæmatoma, its characters, changes in the effused blood, and process of cure-its treatment-Hæmorrhage into arachnoid in childhood-changes in the effused blood-obscurity of the symptoms occurs sometimes in very feeble children, or in connection with changes in the blood-illustrative cases-Hæmorrhage into cerebral substance in childhood extremely rare-cases in illustration of its causes and symptomscapillary hæmorrhage in connection with tubercle in the brain.

WHEN we last met, I called your attention to the very important consequences that may result from the vessels of the brain becoming overloaded with blood. I pointed out to you a train of symptoms, rising in severity, from mere pain or heaviness of the head, to convulsions or coma, according to the degree of the cerebral congestion; and told you that death itself might take place, without any mischief being discoverable afterwards, more serious than a general turgescence of the vessels of the brain and its membranes. Simple apoplexy, indeed, is by no means rare in childhood, and the knowledge of this fact may furnish encouragement to us in cases where the symptoms of present danger are most alarming. We may hope, that if the instant peril can be averted, the blood, which has not burst its vessels, will flow again tranquilly through them, and the functions of life once more go on in their wonted course. In the adult we could scarcely indulge such an expectation, for the import of apoplectic symptoms is generally far more serious. If the patient. die, we look for, and seldom fail to find, blood poured out into the brain, compressing its substance, and lacerating the delicate fibres along which the nervous influence travels. Or, even should he survive, it often is to pass through a tedious convalescence, with palsy, and weakened senses, and impaired mental powers,-the sad and standing evidence of the grievous injury which the brain has sustained.