which he returned through the wound, his hand following them into the cavity of the abdomen. Mr. Thorne made a similar examination, and his report corresponds with that of Mr. Birch. We shall not pursue the details of the after-treatment. Inflammation came on, of course, and the proper means were employed to reduce it, including leeches, fomentations, and calomel and opium, carried to ptyalism. At the end of three weeks she had a relapse, which again required the same measures. But she ultimately recovered.

REMARKS. We cannot for a moment doubt, after the above statements, that either the uterus or vagina was ruptured. Mr. Birch acknowledges that his examination of the wound was not so minute as to enable him positively to say whether it was the one or the other. He thinks that the circumstance of the bladder remaining uninjured, is a certain proof that it was the uterus which was torn. What strikes us as somewhat remarkable, was the examination of the wound by Mr. Thorne, after Mr. Birch had pushed the intestines through it, and even carried his hand into the abdomen. We confess that we should not have liked to exercise this second trial, even to secure a witness of the interesting event.

Mr. Birch has appended some practical conclusions, drawn, not from these cases alone, but from a general consideration of the subject of laceration of the uterus. Some of these conclusions we shall notice in a summary way. The first is, that women die of these lacerations either speedily, or more slowly--secondly, that they sometimes recover, where the rent has been in the cervix uteri or the vagina, the reason, he thinks, being, that the intestines or bladder, coming in contact with the wound, prevent a further effusion of air or blood into the abdominal cavity," and form a kind of temporary bond of union-thirdly, that the instances of recovery after the escape of the child into the abdomen, if left there, are very few, whilst they are much more numerous, where delivery by turning or gastrotomy has been performed. The corollaries are, 1st, That delivery should always be accomplished-2dly, If the child remain in utero, it shold be extracted by forceps or lever, if possible--if not, by the perforater, by turning or other means-3dly, If the fœtus have partially escaped, it is to be brought back, if practicable, without much violence-if not, it is to be delivered through an opening in the parietes of the abdomen-4thly, If the child have entirely escaped into the abdomen, it is to be brought back through the uterine laceration, if practicable, without great force--5thly, Where this is not practicable, gastrotomy is to be had recourse to-6tly, That whatever is done, should be done quickly-bis dat quo dat cito.

For the construction of these rules, and for the drawing of these conclusions, the author claims no originality. They may, nevertheless, be useful in their present condensed form. We are not aware that any material objection lies against any of the precepts delivered by the learned lecturer on this occasion.

Medico-Chirurgical Review,

No. XVI.

[FASCICULUS III]

FEBRUARY 9, 1828.

ART. VII.

Pathological and Practical Researches on Diseases of the Brain and the Spinal Cord. By JOHN ABERCROMBIE, M. D. Fellow of the Royal College of Physicians of Edinburgh. Octavo, pp. 444. Edinburgh and London Dec. 1827.

THERE are, or rather there ought to be, but two species of purely,

medical writings-the record of facts, and the deduction of principles from those facts. How is it, then, that medical science is so over-run with error? The reasons are but too obvious-more than half the facts are false-and nine-tenths of the deductions are illegitimate! We do not say that half our facts have been wilfully falsified; but, if the observation of a fact be incorrect, or the record of it distorted, it is the same for science whether the motive be good or bad which led to the error. Little did Cullen dream that, ere his bones were mouldered into dust, there would be a regularly organized school for the manufacture of false facts in medicine! As for illegitimate deductions from facts, (such as these facts are) they meet us at every step. It was easier, indeed, in all ages, to sit in the closet or library, spinning out theories, than to plod in the dissecting room among the dead, or watch the phenomena of disease at the bedside of sickness. But the bad effects of theorising have now been so long conspicuous, that the medical profession is running into the opposite extreme, and by shutting the door against all doctrine, has opened an immense and somewhat lucrative market for the sale of facts. It behooves the public to narrowly scrutinize these articles, now so plentiful and cheap; for assuredly there is no small proportion of counterfeit wares afloat.

Dr. Abercrombie has long distinguished himself by a careful observance of facts, the record of which has, from time to time, enriched our esteemed northern contemporary, through the medium of which journal, the major part of the volume before us was originally promulgated. That the papers published in the Ed. Journal have here assumed a much more systematic shape, and that the deductions from them are rendered far more useful, we are ready to grant-and, there, we think Dr. Abercrombie has done a service to the profession, and credit to himself, by this publication.

The volume is divided into four parts-the first three of which embrace diseases of the brain-the fourth, those of the spinal marrow. The cerebral affections are arranged under three classes—the INFLAMMATORY, the APOPLECTIC, and the ORGANIC. The inflammatory class will occupy our attention in the present article.

INFLAMMATORY AFFECTIONS OF THE BRAIN.

This part of Dr. A's work is divided into seven sections, with an appendix. The author observes, with reason, that peculiar difficulties attend the investigation of this subject. The rapid effects which acute diseases of the sensorium produce on all the functions of this organ, render the patient unable to express his feelings correctly—and, hence, the proper symptoms of the disease are masked, or disguised, by that suspension of faculties, to which we give the name of oppression of the brain. This state has been naturally associated in the mind with PRESSURE on the organand inquiries have accordingly been directed towards the compressing cause. Effused fluid having, in many cases, been found, this fluid has been generally considered as explanatory of the symptoms, and there investigation has too often ended. This is exemplified in the case of acute hydrocephalus; but more accurate observation has taught us, that the condition which we denominate coma, with its usual symptoms, is not characteristic of any one state of brain, but may appear in states and diseases widely, if not diametrically, opposite in their nature. At all events, it is proved to have no necessary connection with an effused fluid, and that it may show itself in simple inflammatory affections of the organ. Following the light thus obtained, the phenomena of cerebral inflammation are subjects of important investigation, especially as regards acute hydrocephalus, so called, since we are now pretty well authorised to conclude, that this disease is not a mere dropsical affection of the brain, but an inflammatory disease, terminating by effusion. This phlogosis varies in character, according as it is seated in the membranes, or the brain itself—and, also, according to its degree of activity, and the mode of its termination. Thus the dura mater, pia mater, or substance of the brain, may be the seats of inflammation-while the intensity may vary, from the most acute to the most chronic-its terminations being by serous effusion, deposition of false membrane, suppuration, or softening of the cerebral mass. The variety of phenomena, resulting from these several seats and terminations, open a wide field for observation, both in the sick chamber and dissecting-room.

SECT. I.--GENERAL VIEW OF THE SYMPTOMS INDICATIVE OF INFLAMMATION WITHIN THE HEAD.

Dr. A. acknowledges, in the outset, that he is incapable of distinguishing

inflammation of the brain from that of its membranes--and this is the general opinion of the English Profession. The French pathologists, however, have lately endeavoured, and they say with success, to discriminate between the seats of phlogosis, even by the symptoms. Dr. A. considers the diagnosis as "not of much practical importance"-and hence his attention is directed to the phenomena which indicate the actual existence of inflammation, whether membranous or encephaloid.

1. The FIRST FORM-the phrentis of systematic writers-is characterised by fever, insomnium, acute head-ache, intolerance of light, suffusion of eyes, maniacal delirium. Such a pure case, however, is rarely met with, except from the abuse of spirituous liquors, insolation, or as a supervention on fever or mania; still more rarely after injuries of the head. It is probable that this form is the result of primary membranous inflammation. When fatal, the vital powers are rapidly exhausted by the high excitement, without much disorganization of the parts affected: hence the dissections of such cases are unsatisfactory-if not deceptive. By the following passage, we should be induced to suppose Dr. A. is describing delirium tremens, though he does not say so.

"There is an affection of frequent occurrence, which perhaps may be referred to this head. It is characterised by a peculiar aberration of mind without any complaint of pain. There is a remarkable restlessness, quickness and impatience of manner, obstinate watchfulness, and incessant rapid talking, the patient rambling from one subject to another, with little connection, but often without any actual hallucination; he knows those about him, and generally answers distinctly questions that are put to him. There is a rapid pulse, but without the other symptoms of fever; and the disease is apt to be mistaken by a superficial observer for mania, and consequently to be considered as not being attended with danger. But it is an affection of very great danger,and is often very rapidly fatal. The nature of it is obscure, and the appearance on dissection is rather unsatisfactory; it consists chiefly of a highly vascular state of the Pia Mater, without any actual result of inflammation."

2. In the SECOND FORM, a sudden attack of convulsions, preceded or not by indisposition, is the first symptom that excites alarm. The convulsion is generally long and severe-in some cases followed by coma, proving fatal in a few days-in others, the paroxysm recurs frequently at short intervals, the patient being sensible in the intermediate periods, and complaining of headach, till, after twelve or twenty four-hours coma supervenes. From this coma there is occasionally a complete recovery for several days, when, without any warning, the convulsion returns, and ends in fatal coma.

"In a very interesting modification of this form of the disease, the convulsion is confined to one side of the body, or to one limb, and is usually followed by paralysis of the part affected; and in some cases, the first symptom is a sudden attack of paralysis without the preceding convulsion. These cases are remarkable from their resemblance to the ordinary attack of hemiplegia. It will appear in the sequel, that they are often connected with inflammation of a small defined part of the cerebral substance; that the attack may be so sudden as precisely to resemble the paralytic attack from other causes; and that the disease in the brain may not have advanced beyond the state of

simple inflammation, while the symptoms have gone through the usual course, and have terminated in fatal coma. In general, however, the disease in such cases will be found to have advanced to suppuration, or to the ramollissement or peculiar softening of the cerebral substance, to be afterwards more particularly referred to; while, on the other hand, in some very interesting cases of this class, the inflammation will be found to have been entirely seated in the membranes."

3. THIRD FORM. This is most commonly seen in children, though occasionally in adults. It is generally preceded by a day or two of languor and peevishness, and followed by fever. The patient is oppressed, and unwilling to be disturbed-complains of acute pain in some part of the head, with flushing of the face and impatience of light. In many, there is sickness of stomach--in some not. Sometimes the pain is in the neck-or even in the arms or other parts of the body. The pupil is usually contracted-the eye morbidly sensible, and sometimes suffused-tongue white but moist; sometimes clean-sleep disturbed-grinding of the teeth-bowels generally obstinate, though often natural. After some days, slight delirium appears, at first transient, or only at night-sometimes amounting to coma. In some cases, their appears a peculiar forgetfulness, the patient using one, word for another, or misnaming persons or things, bearing no resemblance to delirium. These symptoms are followed by tendency to sleep, ending soon in coma. While this scene is passing, the pulse, at first frequent, usually falls to the natural standard or below it--the pain becomes less violent--eye loses its sensibility, becoming dull and vacant, often with squinting and double vision. The pulse from this depressed state, often rises in a few days or hours, to extreme frequency. Indeed, throughout the whole course of the disease it is very variable--so remarkable an inquality not being observable in other diseases. It is a symptom of serious import in all affections of the head. The patient is now in a state of perfect coma, sometimes with partial paralysis, and in a few days death closes the scene. The duration of the malady is very various-from five or six days to three weeks. At some period of its progress, there is generally a signal remission, giving sanguine but deceitful hopes of recovery. In very young children, who cannot describe their feelings, this form of the disease is characterized by fever, flushing, restlessness, screaming, and sometimes vomiting, succeeded, in a few days, by stupor and squinting, the pulse coming down as the stupor appears.

4. The FOURTH FORM of cerebral inflammation has been most frequently observed in young persons towards the age of puberty and upwards.

"It begins like a slight feverish disorder, and for a considerable time excites no alarm; there is slight headach, with general uneasiness of the limbs, impaired appetite, and disturbed sleep; the tongue is foul, and the pulse slightly frequent, probably from 96 to 100. After a few days the complaint appears to be going off; but, at our next visit, we are disappointed to find the patient complaining as much as at first. More active treatment is then adopted, and there is again an appearance of amendment; the tongue perhaps becomes clean, there is some appetite, and better sleep; but there is