exert over the composition and quantity of the renal secretion has enabled us not only to make some important and novel therapeutic applications, but also to explain the curative action of many of our most popular remedies. Thus, to take an example :

"A man," says Dr. Golding Bird," labouring under some chronic ailment, which, perhaps, like old rheumatism, is the direct result of unhealthy constituents of the blood, starts for one of the Brunnens or spas, and with fearful devotion swallows the enormous quantity of ten or fourteen beakers of the warm bubbling water. In a few minutes he begins to secrete abundance of urine; and he is engaged alternately drinking and micturating for the greater part of the morning, active exercise, when possible, being enjoined the whole time. By this exercise, the wear of the tissues is increased, and the copious water-bibbing positively aids the metamorphosis of the tissue, and washes its results from the body.

"The same explanation may be given of the success which has attended some cases when submitted to the hydropathic quackery; the patient being actually cleaned out the old and diseased tissues being literally washed away to make room for new structures, deposited under the hygienic influence of exercise, good air, &c." (Lecture vi, p. 228.)

Finding, moreover, that the kidneys can depurate the blood, not only of matters which are generally regarded as the normal constituents of urine, but also of compounds which are generally excreted by other glands, we are enabled to perceive the advantages which result from the use of diuretics in disease of other secreting organs. We have already alluded to this fact, and it may be mentioned that Dr. Golding Bird is especially anxious to point out the benefit which results from the employment of renal alteratives in the cure of hepatic diseases.

Again, as the researches of Krahmer and of Golding Bird show that many of the so-called diuretics act merely by increasing the amount of water excreted by the kidneys, it is evident that such substances can only be of use when we wish to expel any excess of this element from the system. On the other hand, as potash and some of its salts have the power of dissolving the animal structures, and thus of causing the elimination of organic matters, it is clear that the employment of this alkali is indicated whenever we wish to rid the system of the products of a low vitality, &c.

"On theoretical grounds," says Dr. Pereira, "the alkalies have been supposed useful, because their continued use leads to a diminution of the fibrine of the blood, which, in acute inflammations, is augmented in quantity; and also because coagulable lymph, a product of inflammatory action, is soluble in alkaline solutions. The latter observations led Mascagni to propose the use of alkalies in acute inflammatory disease; and in an epidemic pulmonary affection which in 1800 made great ravages in the district of Chiudino, in Tuscany, the practice proved highly successful: as also in dropsy induced by obstruction of the lymphatic vessels and glands, from depositions of coagulable lymph, in consequence of an inflammatory diathesis." (p. 178.)

Dr. Golding Bird, however, speaks with much confidence concerning the use of alkaline remedies in such diseases; and his opinions are not advanced merely upon theoretical grounds, but as we have shown (at p. 316 of our former Article), they are supported upon the basis of actual experiment, and we may also say of actual practice, for

"Before the introduction of iodine into medicine such remedies were more frequently given, and we must either admit their value, or declare the recorded

experience on the subject as a tissue of falsehood or error. As one among many illustrations, I would refer to the results of Mr. Brandish's experience with his solution of potash. In chronic visceral ailments, in cases where albuminous deposits have occurred in glands, as in some forms of struma, and particularly in old rheumatic cases (carefully distinguishing them from mere neuralgic actions), where much of the suffering is kept up by the formation of an undue proportion of acid urates in the system, much good promises to be effected by the remedies in question. The acetate of potash at one time enjoyed a high reputation as a remedy in the treatment of strumous glandular deposit." (Lecture vi, p. 232.)

It having been observed, moreover, that the kidney possesses the power of removing many poisonous matters from the system, it has been proposed by Orfila and by Letheby that diuretics should be given when a poisonous substance has gained access to the body. This proposition has also been sanctioned by Drs. Pereira and Golding Bird. And lastly, concerning the more general treatment of blood-diseases, it has been stated by Dr. Copland that,

"Whenever this fluid becomes more or less changed, it will be requisite to have strict reference to the causes from which the change has arisen. Unwholesome food, vegeto-animal miasms, imperfect secretions and depurations, and deficient nervous and vital power, have been shown to be the chief of these. That the first and second of these should be avoided, need not be stated; and that the secreting and eliminating functions ought to be promoted in order to purify the blood, is equally manifest. The nervous and vital energies must be not only supported, but also promoted and excited, in order that the power of secretion may be afforded to the torpid and weakened viscera, and that the crasis and vital condition of the blood may be thereby restored, and the tonicity of the capillaries and of the tissues generally increased. In addition to these, also, morbid secretions should be frequently evacuated, in order that vital power may not be further reduced by these morbid impressions on the nerves and mucous digestive surfaces, and that the possibility of the absorption of any part of them into the circulation may be thereby avoided." (Dict., vol. i, p. 198.)

In concluding our remarks upon the benefits which have been derived from the application of chemistry to practical medicine, we are compelled to admit that these benefits are not as yet very considerable. In fact, the progress of the chemist into the fields of pathology and therapeutics has been opposed by so many difficulties, that his advances have been slow and erratic; but he has gone far enough to perceive that there is a rich prospect before him, and to know that incalculable good will result from the continuance of his efforts. This may not, perhaps, be evident to the multitude, whose prejudices so often blind them to the light of truth, but,

"The rational physician, who ventures to cast aside the tramels of dogmatism and empiricism, cannot, for an instant, doubt that pathology, therapeutics, and diagnosis are only safely based on chemistry, physiology, and morbid anatomy; he cannot entertain a doubt that the same chemistry with which he scans the changes in crude inorganic matter, will likewise enable him, if not at present, yet surely at some future period, to detect the variations in the composition of the animal fluids and solids, some of which are dependent on physiological, others on pathological causes, and will throw a new light on the normal functions of the organism, as well as on the various processes of disease." (Simon, vol. i, p. xv.)

This was the language of one of the zealous votaries of chemical science, and we are tempted to confirm it with the prophetic words of another : "The time will come, although the present generation will hardly live to see it,

when we shall have obtained a numerical expression, in the shape of chemical formulæ, for all the normal processes or powers of the organism; when we shall measure the variations in the functions of its individual parts by corresponding variations in the composition of the matter of which these parts consist, or of the products which that matter yields; when the effects produced by morbific causes, or by remedies, shall be quantitatively determined; when a better method shall bring us a knowledge of all the conditions of the vital phenomena, and shall introduce clearness and certainty into our explanations. Men will then look upon it as incomprehensible, that there ever was a time when the share which chemistry is destined to take in these conquests of science was contested, or when doubts could be entertained concerning the mode in which her aid was to be given to physiology." (Liebeg, Animal Chemistry, p. 258.)

And let us ask, what is the mode by which we may hope to benefit a science of so much importance? It is, says Liebig, by extending our knowledge beyond the apparatus which serves for the production of animal motion, by seeking into the composition of the organs themselves, by learning the changes to which the food is subject in the living body, as its transformation into portions of organs, and its reconversion into lifeless compounds, and by inquiring into the share which the atmosphere takes in the processes of vitality. A knowledge of all these is required as a foundation for our future conclusions.

So with reference to our mode of improving the science of pathology and therapeutics, we must extend our present knowledge far beyond its present boundaries; for at this time we have only gained an imperfect acquaintance with the grosser changes which occur in the position and general appearance of diseased organs :-we have hardly attempted to make ourselves acquainted with the alterations which take place in their molecular structure and chemical composition, and still less have we sought to be informed concerning the influence which therapeutical agents exert over the structure and composition of these organs, or even of the changes to which the remedies themselves are subject during their pas sage through the living animal body; all of which must be determined, before we can hope to place the science of Therapeutics upon a sure and well-defined basis.

ART. VIII.

1. On Infantile Laryngismus; with Observations on Artificial Feeding, as a frequent Cause of this Complaint, and of other Convulsive Diseases of Infants. By JAMES REID, M.D., &c.-London, 1849. 8vo, pp. 204. 2. Observations on the Pathology of Croup; with Remarks on its Treatment by Topical Medications. By HORACE Green, M.D., M.A., &c.New York, 1849. 12mo, pp. 116.

AFTER a careful perusal of Dr. Reid's volume, we had failed to discover the author's object in publishing it. A medical writer, who appeals to the profession, should, we apprehend, possess one of two qualities to justify his claims to attention. He should either have it in his power to impart new information, or be gifted with the happy faculty of placing facts and observations that are not new in a novel and striking light before his readers, so as to assist either directly or indirectly in elucidating the subject of which he treats. A mere reprint of facts already pretty generally

known is out of place, especially in this age of progress; and, so far as the author is concerned, it is a fruitless expenditure of time and labour. The gist of Dr Reid's 204 pages might be contained in a nutshell. It is as follows; Laryingismus stridulus is a nervous disease, occurring, for the most part, in excitable or irritable children between the ages of ten and fourteen months, and generally caused by spoon feeding, impure air, dentition, and irritation of the stomach and bowels. The etiology of the complaint indicates the treatment. Our readers will perceive that there is nothing new in this epitome, and that precisely the same information may be obtained in Dr. Joys's excellent article on this subject in the 'Cyclopedia of Practical Medicine,' in Dr. Williams's article on Laryngismus in the Library of Medicine,' in Dr. Marshall Hall's Lectures and Essays,' and even in the pages of the different medical periodicals. Hence the question cui bono? was the first that presented itself for our consideration on laying down this volume, after an attentive examination of its contents. With these remarks we should have dismissed the treatise on Laryngismus; but as the subject is one of great interest, we propose to offer a few remarks upon it, and, at the same time, to place before our readers a summary of Dr. Reid's monograph, that they may judge for themselves of its merits.

The author describes four different forms of the disease; which appear to us to be phases and not forms; for there are in reality but two varieties of laryngismus, the mild and the severe, depending on the amount of constriction of the glottis, or, in other words, on whether that constriction be partial or complete during the paroxysm. Dr. Reid takes exception to the name "crowing" being applied to this complaint, because, in his opinion, the sound "more closely resembles the concluding rising note produced by the clucking of a hen," and consequently, as hens never crow, the term is a misnomer. Now it appears to us, although we admit we have not had much experience in the sounds of the henroost, that the noise made during the paroxysm is uncommonly like that of the crowing of a cock, and that the name "crowing disease" is very happily chosen, for it prevents all risk of mistake as to the nature of the complaint, which would not be the case if such vague appellations as Millar's asthma, thymic asthma, spasmodic croup, cerebral croup, all of which have been used, had been still generally adopted. Although the name does not sound very learned, it is as legitimate and correct as that of hooping cough applied to pertussis, and moreover has this great advantage, it prevents the possibility of mistaking a nervous for an inflammatory affection.*

The author having described the premonitory symptoms of the disease, proceeds to the "second form" of his division; and as this embraces the most striking and prominent features of laryngismus, we shall give it in his own words:

"In this variety the area of the glottis is still more diminished by the nearer approximation of its margins, the closure, however, not being perfect, except for a * Dr. Marshall Hall adopts the name "laryngeal asthma" for this complaint, in his work on Diseases of the Nervous System Dr. Hall observes: "The crowing inspiration in children has been aptly designated by Dr. Burgess, laryngeal asthma. There is a pthological truth of much importance involved in this expression. It denotes that the crowing inspiration of infants, taken as a special disease, which it is, is like ordinary or bronchial asthma, a disease of reflex action." For our own part, and for the reasons above stated, we prefer the simple name, crowing disease, or crowing inspiration. 14*

7-1 V.

moment.

There is now a much longer interruption to the respiratory function, and the symptoms of suffocation appear more imminent; there is a violent struggle to inspire through the contracted apperture of the windpipe in order to fill the lungs, the countenance presents the characteristics of great anxiety, with indications of distress, becoming at first red, but soon changing into the purple hue of strangulation; the face becomes turgid and swollen, and the tongue also in some cases. In other instances an ashy paleness of the face is observed. The arms are thrown out, the eyes appear wide open and staring, or more rarely, seem turned up in the sockets, the nostrils dilated, the head thrown back, the limbs become rigid and the abdominal muscles contracted. There is frequently, also, a convulsive and violent action of other muscles, especially of the flexors, causing a peculiar contraction of the fingers and toes, as well as the wrists and ankles, a state which has been called the carpo-pedal spasm. In such cases the thumb is bent in upon the palm, the fingers closing over it, whilst the toes and instep are bent downwards. Occasionally the body itself is bent suddenly backwards, as if by a violent effort, and it appears to the bystanders as if nature could hold out no longer; when at length the attempt at inspiration is partially successful, being attended with a shrill whooping noise termed crowing.'

"This is often an indication that the paroxysm has terminated; but in some cases a succession of incomplete shrill sibilant catches supervene before a sufficient inhalation takes place. When, however, respiration is again properly established, the infant expresses its fright and suffering by a fit of crying, and falls asleep. . . These paroxysms vary much in their frequency, duration, and severity; there is no regularity in the intervals between the attacks, but as the complaint advances they generally become shorter, and in some instances do not continue beyond an hour at a time, or even half that period, the slightest noise or emotion being sufficient to produce a paroxysm. The duration of the paroxysm varies from a few seconds to three or four minutes; but in the latter description of cases it is more a succession of paroxysms, air occasionally gaining admittance into the lungs, during the slight and almost imperceptible intervals between them." (p. 10.)

The "third form" is an aggravation of the preceding symptoms, with the addition of general or cerebral convulsions; and the "fourth" and last division is, "complete infantile spasmodic asphyxia, produced by a sudden and convulsive closure of the glottis, which proves as speedily fatal as if the infant were plunged under water, or strangled by a cord round its neck."

Although spasm of the glottis may occur at any period of life, from accidental or mechanical causes, the growing disease of children, which is a constitutional lesion, is in the great majority of cases confined to the period of dentition. The age at which the complaint is most frequently met with has been variously represented at different periods between three weeks and three or four years; but our own experience coincides with that of the German writers, who state that it most commonly occurs between the fourth and tenth month. Children of a nervous or excitable temperament, or born of parents similarly constituted, being more prone to the disease than others, and those of medical or literary men particularly so.

Dr. Reid devotes a considerable part of his volume to an inquiry into the various causes that have been assigned to this complaint, a great portion of which might have been omitted, without prejudice to the work. For example, it was altogether unnecessary to discuss the merits of the exploded theory of Dr. Hugh Ley, which attributes the disease to pressure from enlarged cervical and bronchial glands on the per vagum,