writers on pædiatrics, Dr. Meigs recognises the distinction between non-expansion and collapse. He, however, discusses separately "collapse in the early weeks of life," because the symptoms which it gives rise to resemble much more those of congenital atelectasis than those of collapse at later periods.

"They are, in fact, those of cyanosis, and in some instances are as strongly marked as those observed in the worst cases of that condition caused by malformation of the heart or great vessels. . . . . . In this form of atelectasis the child may have been born perfectly healthy, or only weaker than usual, or it may have had some difficulty in establishing the respiration, which, however, has afterwards been effected in the most complete manner. Some days or even weeks after birth, from a cause disturbing the function of respiration, portions of the lung may collapse, and give rise to the different symptoms of that condition in the manner above described. The most important of these symptoms are difficulty of breathing, consisting either in an increased or diminished rate of that function, diminution of the muscular power, cyanotic hue of the skin, and slight or severe spasmodic phenomena." (p 123.)

The histories of four cases are related and a fifth referred to; in three, recovery took place in spite of the most dangerous and alarming symptoms, while in two death occurred in a period of about twenty-four hours. We have no account of the post-mortem appearances in the latter. This is much to be regretted. Dr. Meigs is inclined to think that the great difference between the symptoms of this form of the disorder and "post-natal collapse" of later periods, may be explained, in part at least, by the fact that the foetal openings are still patulous, or in such a condition that they may be re-opened under pressure, and so allow a portion of the contents of the over-loaded and congested right side of the heart to pass into the left auricle and aorta, and so to the whole body. The subject of pneumonia has received fresh consideration; but upon the litigated question, as to whether the so-called "lobular pneumonia" of children in its different forms is or is not pulmonary congestion, or bronchitis with collapse of the air-cells, Dr. Meigs has nothing of his own to offer us. He remarks, however,

"I have been led to the belief that the former method of dividing the pneumonia of children into the two forms of lobular and lobar is incorrect, and I have determined to substitute for the term lobular that of partial, which is the one employed by M. Legendre, and very lately also by Dr. Alois Bednar, while I shall describe the form of the disease under the usual title of lobar." (p. 146.)

In reference to the more frequent seat of pneumonic inflammation, the author's experience is in unison with that of MM. Rilliet and Barthez, Rufz, Berrier, and opposed to Dr. West's, in so far as its greater frequency in one lung alone is concerned. But it differs from the former as to the relative frequency with which the two lungs are attacked. In our author's practice, the inflammation occurred with equal frequency in the two lungs; whilst of 129 cases of unilateral pneumonia observed by the above authors, 84 were seated in the right, and 45 in the left lung. Whilst the author agrees in the general doctrine that pneumonia of the lower lobe is more common than that of the upper lobe, he observes:

"As it seems to be a general opinion in the profession that inflammation of the summit of the lung is rare in comparison with that of the base, I wish to call attention again to the fact stated above that of 33 cases in which I ascertained accurately the seat of the disease, it was in the upper lobe in 13, and in the lower in 20." (p. 151.)

"We quote the following as bearing upon one of the questions of the day:

"I know that the opinion has been advanced and vigorously maintained by several more recent writers of extensive observation and experience, that pneumonia recovers as well, or almost as well, without as with bloodletting. I freely acknowledge, moreover, that of late years I have used this means more rarely and more sparingly than formerly; but I cannot doubt the evidence of my senses, and I have too often witnessed a great and immediate miti

gation of the symptoms, both general and local, of the disease, from a bleeding, leeching, or capping, to be willing to abandon the use of these means, and trust the case entirely to its natural course." (p. 170.)

The subject of bronchitis has received from the author an equal revision to pneumonia; but we do not find anything that needs particular comment.

The article on scarlet fever has been almost entirely rewritten, and the results of more than a hundred fresh cases have been added to those contained in the first edition. The disease is very fully considered, it having been so rife and so fatal in America in latter years, as to have become of much greater importance than formerly. Nearly seventy pages are hence devoted to its consideration. The chief points worthy of notice are as follows. The division of the disease into the simple, anginose, and malignant forms constitutes, according to Dr. Meigs, a faulty arrangement, and one not consonant with the nature of the malady.

"The simple form of the English writers, or that in which there is no anginose affection, has no existence whatever. So far as I have been able to discover, I believe that inflammation of the mucous membrane of the fauces constitutes an essential element of this disease; for I have never yet seen a case of scarlatina in which it was not present to a greater or less extent. It is often very slight-so slight, indeed, as to be unaccompanied by any evidence of pain in the part; but in all that I have examined it has been decided and obvious. This supposed form of the disease does not, therefore, in my opinion, exist. The two other forms usually described, the anginose and malignant, are also of little value practically, since I have found that in all severe or grave cases in which the patient did not die with violent nervous symptoms under the first shock of the scarlatinous poison, there has been developed a severe and dangerous anginose inflammation about the third or fourth day; so that it is fair to say that I cannot imagine any malignant case lasting over the third or fourth day which is not anginose, nor any severe anginose case which might not also be styled, from its dangerous character, malignant." (p. 498.)

We admit that Bateman does differentiate scarlatina simplex, as consisting "merely of the rash with a moderate degree of fever," and that Rilliet and Barthez do also maintain that in it "les amygdales et le voile du palais ne sont pas tuméfiés et à peine rouges." We ourselves believe we have also seen occasionally the throat so normal looking, that if the patient had not the cutaneous efflorescence, we should have had some misgivings about the matter, more particularly when bearing in mind the very variable condition of the tonsils and adjacent parts in children. However, be this as it may, very many English writers allude to the fact, that, to use the words of Dr. West, "in most instances, even when the disease is mild, a slight degree of soreness of the throat comes on on the second or third day, the palate and tonsils appear red, and the latter are generally somewhat swollen, and deglutition is slightly impeded." Dr. Meigs settles down at last into a division of mild and grave cases, since the only real difference between the cases is a difference in the degree of severity they exhibit." Now to our mind, the qualifying terms, "simple," "anginose," and "malignant," serve to express this degree of severity very well. The author seems to regard "cold" as the exciting cause of the subsequent dropsy, but does not appear to have made up his mind in regard to what he calls the "exact pathologic cause" of it.

"The form which the dropsy takes varies greatly in different cases, and seems to depend on inappreciable causes. Of the 29 cases that I have met with, anasarca alone was present in 22. In 5 hydrocephalus was present, and in 4 of these anasarca also existed. In 1 there were some symptoms which indicated the probable existence of a small amount of effusion in the brain; but they were not at all violent. Lastly, in 1 there was extensive anasarca, hydrothorax of the right side, hydropericardium, and ascites.

"The degree of danger to be apprehended from this complication depends upon the form which it assumes. M. Cazenave says that there is no danger from it so long as it remains confined to the subcutaneous cellular tissue; and this is probably true. When, however, it attacks the brain or lungs, it becomes exceedingly dangerous. Dr. Wood says that he has seen but one fatal case from dropsy, and in that the heart was diseased. Of the 29 cases that

I have had under charge, 6 were fatal. Of the 22 cases in which the effusion was anasarcous alone, but 1 was fatal." (p. 528.)

About ten years back, Dr. C. Schneemann published an essay* upon the great value of treating scarlatina by rubbing the body all over with the fat of bacon. By a reference to Meissner's Grundlage der Literatur der Pädiatrik,' we find, however, that in 1810, Dähne proposed general infriction with oil for the same purpose. According to Schneemann, as soon as we are certain as to the nature of the disease, the patient must be rubbed, morning and evening, over the whole body with a piece of bacon, so that a superficial covering of fat everywhere exists. In order to render this infriction easy, it is advisable to take a piece of bacon fat of the size of the hand, choosing a part still armed with the rind, that we may have a firmer grasp. On the soft side of this piece slits are to be made in various directions, that the fat may ooze out, and which may be still further promoted by previously warming the bacon. From this procedure, Dr. Schneemann affirms that the most happy results accrue. The dry brittleness and itching of the skin are, for the most part, fully put a stop to; the oxidation of the blood promoted; the affection of the throat modified; the period of desquamation is shortened; and the patient protected against the sequelae of the disease. Finally,

"Owing to the fatty covering, the skin is kept moist, and the cuticle prevented from being driven about the room by currents of air, and thus one fertile source of infection is kept closed up; it being well known that infection is most easily communicated at the period of desquamation."

The proposer admits that complications may demand a modification of the practice; that ordinary therapeutic agents may be employed at the same time; and that the rubbing in is to be kept up twice a day for three weeks, and once a day during the fourth. Soon after this mode of treatment was proposed, no less an authority than Professor Mauthner, of Vienna, put it in force there at the hospital for children. He stated his opinion of it in high terms, and affirmed that he would, without hesitation, thus treat his own children if they were attacked by the disease. He had not long to wait for this latter opportunity, as the following extract will show :

"Infriction with bacon still increases in repute. I have treated my daughter (fifteen years old) by it alone, and carried her through a bad attack of scarlatina. I employ it now in measles (which is just commencing to rage in an epidemic form).”‡

The next information we can obtain is from Dr. Ilisch, a Russian physician at Ssergiewfsk-Bad, in Orenburg. As he was passing through the village of Dmitrewka, on a journey, he learned that in twelve days fifteen children had been attacked by scarlatina, and that all had died. He advised that other children affected should undergo "infriction," which being done, the happiest effects ensued. Acting upon this, he has employed it more extensively, and has arrived at a judgment highly in its favour (op. cit). A third time Professor V. Mauthner offers us evidence of the value of the method in question; and again a fourth time (in the paper whose title is given at the head of this article), when he likewise administers a little quiet bantering castigation to the illustrious proposer of the plan-viz., Der Herr Medizinalrath Doctor Carl Schneemann. The latter, it appears, issued a new manifesto on the 'Heilwirkungen,' &c., in which Professor

Die sichere Heilung der Scharlachkrankheit durch eine neue, völlig gefahrlose Heilmethode nach zahlreichen Erfahrungen mitgetheilt. Hannover, 1848. 8vo. + Beiträge zur Aetiologie und Kur des Scharlachfiebers nebst Empfehlung der Einriebung von Oel gegen dasselbe, Leipzig, 1810, 8vo. Zweite Auflage, 1821.-See also Ranking's Abstract of the Medical Sciences, vol. xii. p. 18; and the Journal für Kinderkrankheiten, subsequent to vol. ix. passim.

Jahresbericht &c. des St. Annen-Kinderspitales in Wien während des Jahres 1849.

Ueber Speckeinriebung bei Scharlachkranken: Journal für Kinderkrankheiten, Band xvii. p. 128. 1851.
Aus Briefen des Herrn Prof. V. Mauthner, in Wien: Ibid., p. 220.

V. Mauthner's support is strongly boasted of. But although the latter continues willingly to afford this support up to a certain point, he will not go beyond it, and sarcastically jokes Dr. Schneemann upon the daring peculiarities he has otherwise introduced into his treatment for scarlet fever. For what these consist in, we must refer to V. Mauthner's 'Observations.' In 1850-51, no less than 77 children were treated by "infriction," in the hospital for children at St. Petersburg. The Report says:

"It was certainly found agreeable to the children, as it cooled the burning, hot skin, and lessened its tension. But we were not able to preceive that the course of the disease was specially altered; and in 25 cases desquamation by large scales followed. It was unable, also, to avert death in some bad instances of the malady."

We heard of the importance of "infriction" in diminishing the febrile state accompanying pneumonia as referred to by a physician at a late meeting of one of the medical societies of this metropolis: let us now upon this treatment hear Dr. Meigs :

"Within the last few years inunction has been highly recommended in the treatment of scarlet fever. . . . . For my own part, I have never made use of the bacon fat for the purpose of inunction, except in two instances, being deterred by its disagreeable character. I have, however, employed inunction with other unctuous substances very frequently. Indeed, for the last eight years I have made use of it habitually in all my cases. The ointment I prefer is the following. I have tried others, but find this one the most agreeable and most convenient:-B Glycerinæ, 3j; ungt. aq. rosæ, 3j. M.

"There can be no doubt at the present time that the employment of inunction in scarlet fever has proved a most useful addition to our former means of treatment. In my hands it has had the effect of allaying, in all cases, the violent irritation caused by the intense heat and inflammation of the skin. In nearly all cases it sensibly diminishes the frequency of the pulse, and in many this effect is very strongly marked. It removes, of course, the dryness and harshness of the skin, keeping it instead soft and moist. It lessens or even removes the burning irritation and itching caused by the eruption. By these effects to wit, lowering of the pulse, and alleviation of the external heat, dryness, itching, and irritation, it cannot but, and evidently does, modify and diminish most happily the injurious effects of the disease upon the constitu tion at large; so great is the comfort it gives to the patient, that I have several times had young children, still untaught to speak, make signs and motions at shorter or longer intervals, showing their desire to have the application renewed. The frequency of the application must depend upon the case. Where the eruption is intense, the skin very hot, and the febrile symptoms marked, they should be made every two or four hours, or even oftener. In milder cases they need to be repeated only three or four times in the twenty-four hours." (p. 539.)

Of this particular application of an ancient therapeutic measuret we ourselves have no experience. We have for some time felt the necessity of caution in paying attention to out-of-the-way recommendations in therapeutics, as made by our German brethren. We remember with what excited interest and curiosity we began a paper a few years back, in the German Journal for Diseases of Children,' entitled "A Strange Remedy in the Eklampsia of Children." It was, risum teneatis, to hold the rump of a pigeon against the anus of the little patient during the paroxysm (so stirbt das Thier schnell und der Anfall hört rasch auf). The remedy was too good to be forgotten. So, when we received our next number of the Journal,' behold in it "An Addition to Dr. Blik's Communication on the 'Pigeon's Rump-cure' in the Eklampsia of Children, by Dr. J. F. Weisse, of St. Petersburg." He had tried it in two cases, and it had been successful; "the bird, soon after its application, several times gasped for breath, and closed its eyes from time to time; it then convulsively twitched its feet, and finally vomited;" the convulsions in the child then lessened materially, but the bird was done for, and it soon died. Finally, the learned author calls upon his medical brethren to

Berichte über das Kinderhospital zu St. Petersburgh die Jahre 1846-1851 umfassend von Dr. 8. F. Weisse. + Ungi enim leniterque pertractari corpus, etiam in acutis et recentibus morbis oportet."-Celsus, Lib. II. cap. xiv. Vol. xvi. pp. 159, 881.

institute investigations respecting this method of treatment, as, if really to be depended upon, "it will be such a great gain to children's practice, particularly amongst the lowest orders." We mentally offered (such as were so disposed to act in conformity with Dr. Blik's request) the advice of an old French physician, who, on being asked his opinion of a new remedy that was highly praised for its extraordinary virtues in a certain disease, very gravely replied, "Dépêchez-vous de vous en servir pendant qu'il guérit."

Dr. Meigs is shy of the "cold affusion" over the whole body, according to Currie's plan, preferring "the use of the tepid affusion bath, immersion baths, and of lotions with tepid or cold water." The whole of the author's discussion of this subject merits perusal. In a clinical lecture lately published (Gaz.-Hebdomad.) by M. Trousseau, occur some interesting observations upon this topic, and likewise upon the scarlatina of puerperal women. In the month of May, a girl, twenty years of age, who had been ill two days with a violent attack of the disease, entered the "clinic" of M. Rostan. The latter requested M. Trousseau to see her, or to take her into his department, asking his opinion at the same time as to the propriety of a lowering treatment. M. Rostan was inclined to enforce venesection, whilst M. Trousseau proposed cold affusion. The pulse was 144, the heat of skin considerable, and delirium with violent excitement present. Cold affusion (with water at a temperature of 59° Fah.) was successfully employed. But, says M. Trousseau,

"I must observe, that my ordinary treatment of scarlatina does not consist in the use of this agent; it must only be employed against violent ataxic nervous symptoms; nor must its value be considered as equivalent with that of a bath. Cold affusion, lasting only for a few seconds, is alone of any effect." (op. cit.)

Dr. Corson, of Pennsylvania, a strong advocate among the American practitioners for "cold affusion," has also advised the local application of cold to the throat. In cases attended with great heat of skin and fully-developed pulse, Dr. Meigs has satisfactorily employed "pieces of ice wrapped in flannel, and applied behind the angles of the jaws." Of the prophylactic virtue of belladonna he has received "an impression decidedly favourable," but his experience of its employment appears very limited. More than a hundred pages of new matter upon the "Diseases of the Skin" have been added since the first edition of Dr. Meigs's treatise. We should greatly have preferred if the author had sought to make the preceding portion of his work more complete, than to have touched upon (and necessarily very imperfectly) what most prefer to see treated as a distinct speciality. Nothing is said concerning diseases of the heart or of the urinary organs; fever, scrofula, with tuberculosis and rachitis, remain untouched, along with all their important relations to the lungs, peritoneum, &c. Even the subjects of rubeola, as distinct from morbilli, and scarlatina rheumatica, as it has been called, in its relations to rheumatism and scarlet fever, are unnoticed, notwithstanding stress is laid by the author upon the elaboration of his chapters upon the two typical affections. We have missed also any reference to the cardiac relations of chorea. In his next edition let Dr. Meigs cancel all that he says about the non-febrile cutaneous affections, and give us something in reference to the above and other important topics connected with pædiatrics that he has hitherto let slip.

There are few diseases in connexion with which those who pay particular attention to pædiatrics would express themselves with more caution than in respect to the fevers of children. In this country, for years past, the terms "remittent fever," "infantile remittent," as also "gastric remittent" and "gastric fever," have been usually employed to designate a general febrile condition, with more or less disturbance of the alimentary canal. The designation "infantile remittent" has been the chief favourite, intended to express the "fever" par excel lence of early life. But few who know much about our present subject would deny that this expression has been most loosely employed, and been made to