of appetite; his temples throbbed; his face was alternately pale and flushed; the heat of the forehead, often bedewed with perspiration, was intense; the bowels were confined, and the urine was high-coloured; there was restlessness, sighing and moaning; the pupils were dilated, and very sensible to the application of light; the eyes were suffused, and the countenance was expressive of pain and distress; the pulse varied in strength and regularity, and in frequency from about 120 to 130.

"This state of excitement had existed six or eight days, and was preceded by a fortnight's indisposition, which was ascribed to cold and indigestion. Six ounces of blood were immediately taken from the arm; three grains of calomel, mixed with eight of jalap, were given every fourth hour until they operated, and in the evening twelve leeches were applied to the temples. On the mornings of the three successive days the same quantity of blood was taken from the arm, and every evening the same number of leeches was ap plied to the temples; a cathartic was daily exhibited, and the tepid bath was employed morning and evening.

"By these means a considerable remission of the urgent symptoms was produced, and for four days the parents of the little patient supposed the danger to be past; the com. plaint, however, then recurred with violence, and it became necessary twice again to have recourse to general and local blood-letting, and to repeat the cathartic and the tepid bath. Three grains of calomel, combined with a small quantity of the watery extract of opium, were given every sixth hour until the gums became affected, and ipecacuanha was added in order to determine to the surface; the fæces varied in colour and consistence, being dark, hardened, greenish, yellow and slimy; and while the cathartic was operating considerable uneasiness was felt in the abdomen, augmented by pressure, and always mitigated by fomentations or the tepid bath. As this child was subject to eruptions of the head and a watery discharge from behind the ears, a drain was establised in the vertex by means of lunar caustic, and kept open for nearly seven months. A fit regimen and country air were recommended, and these have prevented a return of the complaint,”*

433.

Seeing that hydrocephalus often flows by an hereditary prerogative from father to son, and taints the constitutions of entire families; that it is so insidious in its approach, and so rapid in its progress; so perverse in its management, and so destructive in its issue; every caution should be observed that would tend, either to diminish the frequency of its occurrence, or lessen the violence of its action. The children of families predisposed to it should be preserved in the best state of general health; their intestinal secretions should be daily noticed; and, immediately that either languor, anorexia, vacancy of aspect, head-ach, or aversion to exercise betrays itself, every moment ought to be one of watchfulness, and such treatment should be instituted as will be best calculated to meet whatever event may occur. Much mischief may result in doubtful cases from delay, but little can arise from alertness; and, although the issue may occasionally prove the groundlessness of our fears, it is much better to be guilty of an error which may reflect upon our judgment, than of one which may destroy a valuable life.

"Our great objects are, to maintain the equilibrium of the circulation, and preserve the viscera in a healthy condition; this is to be done by supporting the actions of the cutaneous vessels, and preserving a healthy state of the secretions by the establishment of issues, the use of cold and tepid baths, exercise, warm clothing, proper diet and medicines, and living in a pure air." 458.

Issues and setons are especially useful when, from any suppressed erup

* "Eight additional cases of recovery from supposed Hydrocephalus were submitted to the Association by Dr. Mills, which the Committee of Publication, for want of space, are reluctantly obliged to withhold." 433.

tion or discharge, the balance of the circulation is lost, and the head becomes encumbered with blood. A caustic issue formed on the vertex has been very highly recommended; but there is a serious inconvenience attached to all such remedies; when once established, we often run the greatest hazard in removing them. If they be not persevered in, until the constitution have so gained upon the predisposition to disease, that little fear remains of its approach; to dry them up, would in nine cases out of ten, either immediately produce what we had been endeavouring to prevent, or so increase the predisposition to it that our prophylaxis would be rendered much more troublesome.

After speaking highly of the cold bath as a preventive, he adds:

"In delicate habits, where the cold bath is not admissible, recourse may be had to the tepid sea-water bath, which often produces all the good expected from the cold. This bath may be used every second or third day, and the patient may remain in it from fifteen to thirty minutes; meanwhile the body and extremities should be constantly rubbed with the flesh-brush; in situations remote from the sea, fresh-water, strongly impregnated with rock-salt, will answer instead of seawater. In a variety of instances the shower-bath, cold or tepid, according to circumstances, will prove highly efficacious." 460.

The diet should be light and easily digested, and neither repletion nor abstinence allowed; the bowels should be carefully observed, as a very slight derangement in the cerebral functions will generally produce in them palpable disorder; the temperature of the body should be preserved moderate and equable; the head should be kept elevated during sleep, and no solid food taken immediately before it; nothing should be permitted as dress, which might obstruct any part of the circulation, especially that devoted to the head; the purest air should be inhaled; regulated exercise should be taken, and every passion and emotion of the mind should be kept within proper limits.

Our extracts have been hitherto selected for the sake of our readers; let our author participate in the oject of the last. While the citation of the following passage is only justice to the one, it will enable the other to appreciate the value of patient research and successful labor, when contrasted with the chamber-spun fineries of library-makers, and the indigested fancies of Esculapian poets :

“When the reader examines the nature of the present undertaking, and is informed that every case was taken from my own private practice, and that I was present at every dissection, one excepted, he will readily appreciate the labour and anxiety attendant on such a pursuit, the difficulties I had to encounter, and the prejudices and feelings to combat and appease. In truth I should have shrunk from an inquiry, at once painful and laborious, had I not been impressed with a conviction that through this channel alone I could become acquainted with the seat and nature of the disease, and a just and rational mode of treatment.

"For the benefit of those who may be desirous to pursue the same path, with regard to Hydrocephalus, or any other complaint, I shall beg leave to state, in a few words, the plan I pursued. During my attendance on each patient I took notes daily of the case; if death followed I noted, assisted by the surgeon, the morbid appearances; on my return home, while the subject was fresh in my memory, I made a fair copy of the case and dissection, wrote the observations to which these gave rise, and the names of the surgeons by whom the bodies were examined." 467.

We have now done with Dr. Mills, and we feel refreshed after our review of his very valuable Essay. It presents no parade of learning, nor display of theory. Truth comes forward to you in her native and most becoming garb of unostentatious modesty, aware that the more she is examined, the

more she will please; and that, although the naiveté of her exterior may repel the vain, the substantial materiel of her internal qualities, will constitute a sufficient attraction to the honest inquirer after knowledge. If Dr. Mills can, with justice to his health and circumstances, persevere in his synthetic labours, by every such contribution as the present, he will lay the profession under a fresh obligation, and insert a new leaf into his wreath of laurel.

IV.

DEAFNESS; ITS CAUSES, PREVENTION AND CURE. By John
Stevenson, Esq. 8vo.

No one will dispute the importance of the organ of hearing to the welfare as well as the pleasure of man-and as the disorders of this organ are very common, and all ranks of society are now dabbling in physic and surgery, we do not much wonder that Mr. Stevenson should have given his Treatise a popular form. There was no occasion, however, to tell his readers so in the introduction. The general reader prefers hard words, because he does not understand them-the professional reader prefers them because he does; and the latter is usually prejudiced against all ostensible attempts to enlighten the non-professional public on medical matters. That popular medical works do harm, there can be little doubt-but the question is, do they not, also, some good? We believe they do. If the non-professional public did not acquire a smattering of medical science, many practitioners would have a temptation to rest satisfied with a smattering also. They are now forced to keep their distance before the general reader, in order to avoid unpleasant collisions, and maintain their superiority.

But a medical writer, when he expressly tells us that he addresses himself to the general as well as to the professional public, has no claim on any extended notice of his work in a purely medical review. This Mr. Stevenson must bear in mind.

We shall pass over the first half of the volume, which treats of the anatomy and physiology of the ear, addressed (and improperly addressed) to the general reader. In the fourth chapter Mr. S. takes up the DISEASES Of the organ; but here again we are met by a damper.

"Persuaded, as I am, that if a little learning is a dangerous thing' in reference to subjects of literature, it is tenfold more so when applied to the healing art, I shall studiously avoid the error into which writers on popular medicine are too frequently betrayed; namely, that of detailing histories which cannot be understood, and of prescrib. ing formula for powerful remedies which cannot be used with impunity by unprofessional readers. Instead of adopting a plan calculated to mislead or injure rather than benefit those who seek to be instructed, by arming them with a two-edged sword, which they cannot wield without hazard of wounding themselves, I propose to detail the symptoms which indicate danger, or require for their treatment the band of experience to point out the various and often unsuspected causes of local derangement ;

to show how far the patient, may, without risk, be guided by his own acquired knowledge and lastly, to caution him against the employment of useless or dangerous domestic nostrums, suggested by persons alike ignorant of the nature and character of disease, and of the action and effects of those remedies which they so fearlessly recommend." 117.

It is curious that wounds, tumours, and ulcers, which partially destroy the texture, do not materially impair the function of the AURICLE. Even its entire removal only occasions a temporary confusion of hearing. The most troublesome and distressing ailment to which the auricle is liable, is an herpetic eruption, consisting of numerous small watery pimples, or vesicles, surrounded by an inflamed base.

"These little vesicles bursting spontaneously, or being more frequently ruptured by the fingers of the patient-who is almost irresistibly impelled to rub or scratch them, with a view to allay the accompanying almost intolerable smarting and itching-they pour out a copious discharge, which soon becoming fœtid and acrimonious, occasions irritation, excoriation, and often ulceration of the affected surface

"If the progress of this disease be not speedily arrested, the skin and subjacent cellular texture begin to thicken and enlarge to such a degree, as to render the auricle, already inflamed, disgustingly frightful and deformed. Nor is this the termination of the mischief. In consequence of the tumefaction extending to the soft parts of the auditory canal, and of the inspissation of the discharge, the area of this tube becomes so much narrowed, and in some instances so completely obliterated, as to offer a considerable barrier or total obstruction to the ingress of sound, causing, while the disorder continues, either partial or total deafness." 126.

What will the professional reader think when he is told that the adaptation of local and general remedies is much too difficult and complicated “to be confided to any but the most experienced persons"—and consequently it is kept back from the profession, as well as from the public!! Can Mr. Stevenson justly complain, if we condemn this mode of procedure ?—the very mode which DOCTOR, alias SURGEON HARRISON has adopted in his work on Crooked Spines.*

As a compensation for surgical information respecting HERPES AURICULA, Mr. Stevenson favours us with an anathema against hair-dressers, who "strip us of the pendent SIDE-LOCKS-the real ornaments and guardians of the ear"-also against flannel night-caps, evening parties in hot rooms, long dances, and exposure to currents of cold air, &c. We hope the ladies will fend an ear to these admonitions.

Speaking of otitis externa, Mr. S. observes, that frequent repetitions of the inflammation tend to render the membrane reflected over the tympanum, thick, dry, and opaque, as may be distinctly seen in a strong light :—

The Doctor has addressed a long letter to Dr. Johnson in the LANCET, complaining of the review of his book of Demi-Quackery. The complainant also rips up an old grievance about a picture in the Exhibition at Somerset House; but he states no par ticulars. We shall help him on this occasion. The Doctor got his picture perched up in the exhibition, with a long crooked spine on one side, and his intended big book of CHARLATANNERIE, on the other! This we satirised as an advertisement-and the crooked spine has proved to be sufficiently emblematical of the Doctor's subsequent crooked policy.-ED.

"In this state of the affected part, a sense of cracking (crepitus) is sometimes experi enced, accompanied with defective hearing-symptoms generally, but I suspect improperly, attributed to a want of wax, a privation which should be considered as operating secondarily, and injurious only by depriving the passage of its protecting secretion." 146.

Mr. S. properly condemns the application of stimulating and irritating substances in these cases-and enjoins the strictly antiphlogistic treatment. In the reduction of otitis, Mr. S. recommends " cupping behind the auricle, or the local application of from two to six leeches behind, or on the concave surface of the ear*-fumigating the passage with the vapour of poppy-head tea with a little hot vinegar, and afterwards applying to the opening of the meatus a dossil of lint imbued with warm sallad oil." Purgation is necessary, and the depletion should be repeated pro re nata. But otitis will sometimes baffle the most rigid antiphlogistics, and suppuration ensues. Fomentations, poultices, and generous diet, are then necessary. In these cases, spongy excresences not unfrequently protrude into the meatus, and by plugging up the passage, keep up much irritation, in consequence of the retained matter.

Polypi grow on the lining membrane of the ear, in the same way as on the Schneiderian membrane. They may be extracted by the forceps-removed by scissors or ligature-and the part from which they are torn, touched with the nitrate of silver.

An adventitious membranous septum sometimes is found, external to the membrana tympani, and closing up the foramen. It may be congenital -or it may occur after long continued otorrhoea. It is ascertained by inspection in a strong light. Mr. S. met with a case where it was situated about a quarter of an inch outward from the membrana tympani. He punctured it, and hearing was immediately restored. This is the only method of cure.

REDUNDANCY OR DEFICIENCY OF CERUMEN.

Numerous causes concur to derange the secretion of the cerumenamong which Mr. S. enumerates, as a very frequent agent, "the use of earpickers, made of gold, silver, ivory, or some other hard substance." Sir

"In the case of a son of an eminent physician, a leech having been applied in front of the auricle for acute external inflammation of the ear, the temporal artery was penetrated, and required to be divided and tied, to suppress the dangerous hemorrhage that ensued." 147.

It is curious that neither Sir Astley Cooper, nor Mr. Stevenson, has stated this case correctly. Sir A. in his Lectures, says, the hemorrhage was suppressed by pressure, though he himself was obliged to cut down and divide the artery, after which, pressure was sufficient. Mr. Stevenson is in error respecting ligature of the vessel. The accident, however, should render a surgeon cautious in the application of leeches in the direction of the temporal artery before the ear. The young gentleman alluded to, would have been destroyed in a few minutes more, had not Šir Astley cut down upon the artery.