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Befides the three places, Vienna, Ratisbon, and Wetzler, where the conftitution of Germany is always confpicuous, it occafionally appears at an election of a King of the Romans, or Emperor, in the deputations of the empire, and particularly the vifitation of the chamber. Separate collegiate meetings may likewise be held, as has been frequently the cafe with the electors and imperial cities, particularly with the ancient fecular princes, prelates, and counts. Befides thefe may be held diets of the circles, especially thofe of Swabia, Franconia, Bavaria, and the circles of the Rhine, as well as the feparate deliberations of each party of religion, which the proteftant body has had the greateft reafon to have recourse to, on account of the majority of votes of their antagonists, and their intolerant principles.

From a full view of this accurate Development, the account of which we are now to conclude, it is evident that the constitution of the Germanic empire is not the moft imperfect, but, in comparison with other countries, has certain advantages in its favour; at least it is not to be attributed to the constitution that the different parts of Germany do not enjoy an equal degree of profperity. The view of the prefent ftate of the population, revenues, &c. of the principal territories in the Germanic empire, is no lefs comprehenfive than well arranged, and appears to be compiled from good authorities. In the tranflation of the whole work, and the notes with which it is accompanied, Dr. Dornford, we think, has acquitted himself with care and ability.

ART. VII. A Treatife on the Dropfy of the Brain; illuftrated by a Variety of Cafes. To which are added, Obfervations on the Ufe and Effects of the Digitalis Purpurea in Dropfies. By Charles William Quin, M. D. Fellows of the King's and Queen's College of Phyficians, Physician-General of his Majesty's Army in Ireland, and of the Royal Hofpital for Invalids, near Dublin. 8vo. 3s. 6d. fewed. pp. 227. Murray. London, 1790.

FEV

EW difeafes incident to mankind have been treated more imperfectly than that of the hydrocephalus. That it has prevailed more or less in all ages, there is not the least reason to doubt; yet the late celebrated Dr. Whyte, profeffor of medidicine in the univerfity of Edinburgh, is the first author who has delivered any accurate account of its hiftory, or even afcertained its diagnoftics. It chiefly prevails among children, and has hitherto been generally reputed a chronic disease; but the author now under confideration adduces feveral cafes to fhew that it feizes, though with fome diverfity in the fymptoms, perfons

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perfons at a more advanced period of life, in whom it proceeds with quick progress to a fatal termination, by means of a hydrocephalic apoplexy.

Dr. Quin remarks, that though we cannot, ftrictly speaking, call the disease hereditary, yet it has been often known to feize feveral children of a family, where no traces could be discovered of any fimilar complaint having ever affected the near relations of either of the parents.

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The author cannot with certainty point out any peculiarity of constitution, temperament, or external appearance, which can properly be deemed a predifpofing caufe. Moft of the patients, however, who have been under his care on account of this complaint, or under that of other physicians who have communicated their obfervations to him, have been, before its appearance, extremely lively, and of acute understanding. În many of them, an unusual transparency of the skin has been obferved, through which the veins were ftrongly marked, particularly about the temples, forehead, and neck. The eyes have been full, prominent, and brilliant; and, in fome few cafes, there has been reason to fufpect the exiftence of a fcrophulous taint. The ufual progrefs of the disease is thus defcribed by our author:

In general, the patient is at first languid and inactive, often drowfy and peevish, but at intervals cheerful, and apparently free from complaint. The appetite is weak, a naufea, and, in many cafes, a vomiting occurs once or twice in the day, and the skin is ob ferved to be hot and dry towards the evenings: foon after these fymptoms have appeared, the patient is affected with a sharp head-ach, chiefly in the fore-part, or if not there, generally in the crown of the head: it is fometimes, however, confined to one fide of the head, and, in that cafe, when the polture of the body is erect, the head often inclines to the fide affected. We frequently find alfo, that the head-ach alternates with the affection of the ftomach; the vomiting being lefs troublesome when the pain is most violent, and vice verfa; other parts of the body are likewife fubject to temporary attacks of pain, viz. the extremities, or the bowels, but more conftantly the back of the neck, and between the fcapulæ; in all fuch cafes the head is more free from uneafiness.

The patient diflikes the light at this period; cries much, fleeps little, and when he does fleep, he grinds his teeth, picks his nofe, appears to be uneafy, and starts often, screaming as if he were ter rified; the bowels are, in the majority of the cafes, very much confined, though it fometimes happens that they are in an opposite state; the pulfe, in this early ftage of the diforder, does not ufually indicate any material derangement.

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When the fymptoms above mentioned have continued for a few days, fubject as they always are in this difeafe to great fluctuation,

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the axis of one eye is generally found to be turned in towards the nofe; the pupil on this fide is rather more dilated than the other; and when both eyes have the axes directed inwards (which fometimes happens), both pupils are larger than they are observed to be in the eyes of healthy perfons: the vomiting becomes more conftant, and the head-ach more excruciating; every symptom of fever then makes its appearance, the pulfe is frequent, and the breathing quick; exacerbations of the fever take place towards the evening, and the face is occafionally flufhed; ufually one cheek is much more affected than the other; temporary perfpirations likewife break forth, which are not followed by any alleviation of distress; a discharge of blood from the nofe, which fometimes appears about this period, is equally inefficacious.

⚫ Delirium, and that of the moft violent kind, particularly if the patient has arrived at the age of puberty, now takes place, and, with all the preceding fymptoms of fever, continues for a while to increase, until about fourteen days, often a much shorter space of time shall have elapfed fince the appearance of the fymptoms, which were first mentioned in the above detail.

The disease then undergoes that remarkable change, which fometimes fuddenly points out the commencement of, what has been called its fecond ftage: the pulfe becomes flow but unequal, both as to its ftrength, and the intervals between the pulfations; the pain of the head, or of whatever part had previously been affected, seems to abate, or at least the patient becomes apparently lefs fenfible of it; the interrupted flumbers, or perpetual reftlefiefs which prevailed during the earlier periods of the diforder, are now fucceeded by an almost lethargic torpor, the ftrabifmus, and dilatation of the pupil increase, the patient lies with one, or both eyes half closed, which, when minutely examined, are often found to be completely infenfible to light; the vomiting ceases; whatever food or medicine is offered is ufually swallowed with apparent voracity; the bowels, at this period, generally remain obftinately coftive.

If every effort made by art fails to excite the finking powers of life, the fymptoms of what has been called the second stage are foon fucceeded by others, which more certainly announce the approach of death. The pulfe again becomes equal, but fo weak and quick, that it is almoft impoffible to count it; a difficulty of breathing, nearly refembling the fertor apoplecticus, is often obferved; fometimes the eyes are fuffused with blood, the flushing of the face is more frequent than before, but of fhorter duration, and followed by a deadly palenefs; red fpots or blotches fometimes appear on the body and limbs; deglutition becomes difficult, and convulfions generally close the fcene."

Such is the history of the apoplexia cephalica, as exactly as our author could compile it from the writings of others, and from his own obfervations; but he defires that it may be confidered only as a general outline; the symptoms, though some of

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them ftrongly marked, being, as we well know, not inseparably connected with the disease.

To guide the judgment of the phyfician in afcertaining, as early as poffible, the diagnofis of this dubious diftemper, Dr. Quin fubjoins to his defcription feveral excellent obfervations, which will prove highly ufeful to the practitioner. He remarks, that when a patient is found to be affected with vomiting, headach, and coftivenefs, the fymptoms which moft ufually appear on the commencement of the apoplexia hydrocephalica, it is difficult, while thefe are the only evident complaints, to determine whether they may not arife from weaknefs of the stomach, or incipient fever (efpecially in young children), from dentition, or worms in the intestines. If, however, they do not, in some degree, yield to an emetic immediately adminiftered, and followed by a few mercurial purgatives judiciously repeated, we fhall commonly find, that fome of the other fymptoms mentioned in the general defcription will very foon present themfelves. Of thefe, averfion to light, pain between the fcapula, and fcreams, fuddenly interrupting fleep, may be confidered as very alarming fignals of an impending difcafe of the brain. But,, though the circumftances laft mentioned fhould not be obferv able, the obftinate continuance of acute head-ach, vomiting, and coftiveness, may afford ftrong reafon for fufpecting the nature of the difeafe, wherever it is known that children of the fame family have been affected with the apoplexia hydrocephalica.

It will be useful alfo, he farther obferves, towards forming an early diagnofis, to recollect that, in cafes of this kind (at leaft in the earlieft ftage), fpafms of the limbs occur much less frequently than where the fymptoms proceed from worms. If, indeed, continues he, during its first approaches, the disease is difregarded, and fuffered to gain ground before proper medical affiftance is called for, ftrabifmus, irregularity of the pulfe, coma, and even blindness, too frequently serve at once to portend death, and to point out its cause.

With refpect to the cause of this difeafe, Dr. Quin endeavours to prove, by deductions drawn from an extensive series of facts, that the diftemper always owes its origin to a morbid accumulation of blood in the veffels of the brain, fometimes proceeding to a degree of inflammation, and generally, but not always, producing an extravafation of watery fluid before death.

In fupport of this doctrine he obferves, that, at the period of the disease in which the head-ach is most acute, every symptom of fever, arifing from an increased action of the vascular system, is evident. The majority, likewife, of patients who are attacked by it exhibit ftrong appearances of plethora in the fuperficial

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veffels of the head; and, in fome inftances, they have been fubject to bleedings at the nofe previous to the attack.

Though thefe obfervations are not of themselves fufficient to eftablish entirely the caufe of the difeafe affigned by our author, yet it must be acknowledged, that, when corroborated by arguments, deduced from phenomena which have been difcovered by diffection, they amount at least to a high degree of probability, which feems to overbalance the theoretical objections to which the doctrine is liable. We are therefore much inclined to coincide with our author's opinion on the fubject; and it certainly derives no fmall degree of authenticity from its having been adopted by Dr. Cullen.

According to the theory which Dr. Quin suggests of the dif ease, the indications of cure are obvious, and confift of the va rious expedients for removing the plethora of the head. These general means our author confiders under feven diftinct articles, in treating of which he makes many judicious and practical obfervations. Some of thefe, as well as other remarks in the course of the work, we should have laid before our readers, did we not think that the treatise must foon come into the hands of every medical practitioner, whofe curiofity we might indeed excite, but could not fufficiently gratify, by a few extracts.

A large appendix contains cafes relative both to the apoplexia hydrocephalica, and the use of the digitalis purpurea in dropfies. Dr. Quin's fituation, as physician to two hofpitals at Dublin, has enabled him to make many trials with respect to the ufe of that remedy; but he has at prefent published only the cafes of eleven patients. Of thefe, we find, three were completely cured; one most unexpectedly indeed. Of the others, fome received temporary relief from the diuretic quality of the fox-glove; though, where the patients fuffered a relapfe, the medicine appeared to have loft its former powers. The remaining hiftories ferve to fhew, that the fame remedy, which in fome cafes has almost performed miracles, does in others, apparently fimilar, either produce no effect at all, or gives rife to fymptoms fo untoward, as to induce a cautious phyfician to defift from the farther use of it.

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