philosophy, might have been spared to the world had this principle been recognized! Progress is, however, being made. Psychology is beginning to be understood as a science, the principles of which rest upon the structure of the brain and nervous system. Metaphysics has gone as far as it can, and henceforth the philosophy of the mind must be studied from a new stand-point. To all who desire to enlighten themselves, and to push forward the cause of exactness in science, we commend Fichte's admirable little volume. As a manual of practical anatomy, Holden's' work on the subject takes high rank; indeed it is doubtful if there is a better in the English language. The American edition is well printed, and will certainly become a favorite with medical students. The illustrations are good and well executed, and cannot fail to be of assistance to the young dissector. Of course there is nothing particularly novel in any work issued at the present time on human anatomy. Clearness, exactness, conciseness, and good arrangement are all that can be expected. These, we are happy to say, Mr. Holden's book possesses in an eminent degree. Toothache is one of those miseries of life which is only of minor importance, because ordinarily it can easily be got rid of. A scientific treatise on the subject has long been a desideratum, and Mr. Shaw2 has done good service in preparing one. The author appears to be a dentist of Manchester, England, but in the construction of his treatise has drawn largely 1 A Manual of the Dissection of the Human Body. By Luther Holden, F.R.C.S., etc. With Notes and Additions by Erskine Mason, M.D., Demonstrator of Anatomy at the College of Physicians and Surgeons, etc. New York: R. M. De Witt. 1868. 8vo., pp. 588. 2 Odontalgia, commonly called Toothache; its Causes, Prevention, and Cure. By S. Parsons Shaw. Philadelphia: J. B. Lippincott & Co. 1868. 16mo., pp. 258. on American writers. Relative to the cause of toothache we extract the following: "When the pulp has become exposed and the tooth aches, it sometimes happens that it had better be at once extracted. But if undesirable to remove the tooth, this pain may be relieved by the application of a local anodyne; oil of cloves, carbolic acid, and many similar preparations will act as anodynes to the pain in question; but the application of creasote will be found the most efficacious, and it will almost instantly relieve the pain of odontitis." The author's remarks upon neuralgia of the face and its relations with decayed teeth are practical. Of course when such a cause exists, nothing but its removal can prove effectual in removing the consequence. 1 Dr. Thomas W. Evans, the celebrated American dentist of Paris, has interested himself greatly in the work of alleviating the miseries of war. During our own domestic troubles he translated into French several of the medical memoirs published by the United States Sanitary Commission. The present volume relates to the sanitary institutions of the recent Austro-Prussian-Italian conflict, and is printed for private distribution only. Undoubtedly the volume will be the cause of attracting increased attention to the objects the author has in view. 1 Sanitary Institutions during the Austro-Prussian-Italian Conflict, etc. By Thomas W. Evans, M.D. Third edition. Paris. 1868. 8vo., pp. 257. 593 CHRONICLE. PHYSIOLOGY AND PATHOLOGY OF THE BRAIN AND The following report of a Clinical Lecture relates to a subject which is at present attracting considerable attention. On Paralysis with wasting of Muscles, especially in Children. By J. Russell Reynolds, M.D., F.R.C.P. THERE are many cases of paralysis met with in the adult, with regard to the commencement and past history of which the only ascertained fact is that the symptoms had their origin in infancy. Such cases commonly present wasting and shortness of the affected limbs, and not unfrequently deformity. The causes of infantile paralysis are numerous, and some of them are well understood, inasmuch as they differ in no special manner from those which are encountered in after-life; but there are some forms of paralysis, of which young children furnish the examples, that we cannot refer to the commonly recognized conditions of hæmorrhage, softening, tubercle, syphilis, and the like. So peculiar have these cases appeared that they have sometimes been called "essential paralysis," and this, it would seem, from the fact that nothing beyond or besides the paralysis has been observed. When such cases fall under observation it often happens that the physician sees before him an apparently healthy child, in whom the only morbid condition that can be recognized is a weak and ill-nourished, or a paralyzed and withered limb. It is to the clinical history, pathology, and treatment of such cases that I wish to direct your attention. You have you have lately seen two such cases in Wards 3 and 4, and witnessed the marked improvement-I may say almost complete restoration-which followed treatment; but you had no opportunity of observing the earlier history of these cases, and I will therefore supplement the account of their symptoms by giving you the result of my experience of some other examples, the minute history of which at their onset I have been able to observe or learn. 1. Commencement of symptoms.-A. B—, a healthy girl, the youngest of three, born of healthy parents, without any premonition of disease of any kind, at the age of nine months took cold in the head," was feverish, and heavy in manner, for nearly a week, but improved toward the end of that time, 66 VOL. II. 41 and tried to get up. It was seen, however, that she "could not put either foot to the ground," although both of the hands were moved quite freely, and there was no pain nor spasm in the lower extremities. In a very short time she moved and used the left leg as freely and firmly as before the attack of "cold," but the right leg was paralyzed, and in the course of a few weeks was observed to be cooler, softer, and smaller than the other. C. D, a fine boy, the fifth of six healthy children, at the age of four years suffered from some "stomach complaint, was "poorly" for about a week, complained of his legs being "sore, " and was found, after keeping his bed for five or six days, unable to stand. At the end of a month he could walk, but, in doing so, dragged his left leg, which was then thinner, softer, and cooler than the right. E. F-, a boy who had never had a day's illness," the youngest of eleven healthy children, when two years old became fretful, restless, sore all over, and lay on his back; "seemed to lose the use of all his limbs," and could not sit up; was distinctly feverish for a day, but for one day only: he moaned at night; but after a few days he seemed well. At the end of a fortnight he walked, but did so like a much younger child, and it was noticed that he made no use of his right arm, that the arm was thin, and especially so about the shoulder. These three cases are sufficient to illustrate the ordinary manner in which the paralysis I am describing makes its appearance. The febrile symptoms were slight, and of only short duration; the constitution was good; there was no recognized cause of disturbance; no fall, no blow, no exposure to cold, no obvious external influence nor internal derangement which could account for the phenomena. The age, at the onset of symptoms, ranged from nine months to four years, and dentition did not appear to have exercised any influence in the production of the malady. In some cases that have come under my notice, after several years' duration, it has been affirmed that there were no febrile symptoms at the commencement, but that the child was suddenly, or accidentally, found to be unable to move any of its limbs, or even to sit up; but it must be remembered that slight accessions of fever are sometimes disregarded at the time, and are wholly forgotten afterward. The child is put to bed because it is not well, and when it is "better" the paralysis is recognized. Laborde (in an excellent treatise entitled "De la Paralysie dit Essentielle de l'Enfance") states that fever was present in Your out of five cases that came under his observation; and where I have been able to learn accurately the previous history, there has invariably been some period of distinct but slight and transient illness. I therefore beg you to remember this febrile mode of onset; the fever being of only one or two days' duration, being feebly marked, but continuous in type so long as it lasts, and unaccompanied by the vomiting and marked nervous disturbances which, under other circumstances, so frequently characterize its presence in early life. Sometimes, but not more frequently than once in five cases (Laborde,) convulsions mark the onset of infantile paralysis; and there is occasionally nothing in their actual phenomena which will enable you to distinguish between them and the fits which may arise from dentition, from worms, and from organic disease of the brain. But usually there is an absence of those symptoms which pertain to organic disease of the brain there is no vomiting, no headache, no strabismus, and no spasm of the face. Commonly, the limbs are found rigid after the fit has passed away; sometimes there is but one fit, but more frequently there are two, three, or four. When convulsions are present, there is no fever; and vice versa, when febrile symptoms constitute the commencement of the malady, there are no convulsions. 2. General paralytic symptoms.--When first observed the paralysis is usually at its maximum, both of intensity and extent. It is often general-not only the muscles of all the limbs, but even those of the trunk are affected; the child can neither stand or sit up, nor use its arms. The lower limbs are more distinctly and more frequently affected than the upper, and it is very rare to find paralysis of the sphincters. Paraplegia is the most common form observed at an early period, and this form of paralysis may become persistent; but more frequently the "clearing up," if I may use the expression, of the paralytic state extends beyond the arms, and in a very short time, namely, from three to fifteen days, only one extremity remains affected. One of the lower limbs is more often paralyzed than one of the upper; sometimes the right arm and the left leg are weakened; sometimes, but very rarely, there is hemiplegia. The electric irritability of the muscles is distinctly diminished at the onset, and coolness and wasting of the limbs set in almost immediately. There is no constant change in the sensibility of the skin, or of the organs of special sense; but reflex movements are sometimes, though not always, abolished in the affected limb. |