A Compendium of Medical Practice, illustrated by ... cases and ... observations

Front matter

A COMPENDIUM OF MfiJitnl practice. A Compendium OF MEDICAL, PRACTICE, ILLUSTRATED BY INTERESTING AND INSTRUCTIVE CASES, AND BY PRACTICAL, PATHOLOGICAL, AND PHYSIOLOGICAL OBSERVATIONS; b\ JAMES BEDINGFIELD, Surgeon; Late Apothecary to the Bristol Infirmary. " By a union of experience and reasoning, are the great and valuable objects of Medical Science to be attained." LONDON MEDICAL BEPOSITORY, NO. 19, P. 2. LONDON. PRINTED FOR HIGHLEY AND SON, MEDICAL BOOKSELLERS, //Zf ttBMBBI fleet-street; ASD SOLD BTNOItTOS AX» SONS, BARRY AND SON, AND W. SHEPPARD BRISTOL; AND ALL OTIIER BOOKSELLERS. enttrEB at gitatfowrs* Ball. Printed by Maby BrYAs (City Prioting-Office) 61 , Con-Street, Bristol. TO EDW. L. FOX, M. D. W. K. CRAUFU1RD, M. D. AND. CARRICK, M. D. JOHN E. STOCK, M. D. PHYSICIANS TO THE BRISTOL INFIRMARY; WITH THE HIGHEST ESTEEM FOR THEIR TALENTS; A DEEP SENSE OF THE ADVANTAGES WHICH HE HAS DERIVED FROM BEING A SPECTATOR OF THEIR SUCCESSFUL PRACTICE; AND THE WARMEST GRATITUDE FOR THAT KINDNESS WHICH HAS ENCOURAGED HIS ATTEMPTS, AND CHEERED HIS LABOURS ; THIS VOLUME IS RESPECTFULLY INSCRIBED, BY THEIR FAITHFUL FRIEND AND SERVANT, JAMES BEDINGFIELD.

Preface

. This volume forms an epitome of the medical prac tice of the Bristol Infirmary during the last five years. The object which its author has had principally in view, is the recommendation of that practice in the different diseases treated of, -which he has seen, upon the whole, to be the most successful. He trusts that to the junior members of the medical profession, and to those whose conversation has been rather with books than actual disease, his endeavours to promote a know ledge of the most efficient remedies will not prove unacceptable. In the schools of physic, and in books, such a multi plicity of remedies for diseases is sometimes enumerated,

PREFACE.

. that the inexperienced practitioner is bewildered in his choice of them. In this volume he will find that an allusion to medicines of doubtful or of but little efficacy, is very rarely made. The authenticity of the cases related may be relied upon. Well aware of the difficulty of engaging the attention to the perusal of long cayes, the author has compressed his, as much as possible. It is to be regretted that this indifference to cases prevails, for they form a species of reading more beneficial than any other: nothing can exceed its utility but actual attend ance upon the diseased. So numerous a selection of unsuccessful cases as the author has made for the illustration of disease, seldom appears in one volume. This selection will, he trusts, be attended with its advantages. It will tend to prove that the grand object to be kept in view in

PREFACE.

. IX the practice of medicine, is the prevention of a derangement of structure ; and that no means will be found so effectual for that purpose as copious venesection, and a strictly antiphlogistic regimen. The observations which the author has occasionally introduced, were made by the bedside of the patient. The practical and the speculative parts of the work are carefully separated from each other. One advantage which the author hopes that his physiological con jectures will be found to possess, over many daily obtruded upon the Public, is, that, however defectively supported by argument and experiment they may be, they will lead to a successful practice. The author is aware that in some parts ofhis volume he has been betrayed into the adoption of an ego tistic, in other parts of a dictatorial style. For this he

PREFACE.

. X craves the indulgence of the reader. Almost every thing here recorded has passed under his immediate ob servation. Ardently and deeply interested in all that he has described, he so completely identified self with subject, that he found it impossible to separate them. Where he assumes a dictatorial language, it must be remembered that he is not insisting upon the efficacy of his individual practice, but upon that of Physicians who have long distinguished themselves by an eminent display of talent, and who now most deservedly enjoy the public confidence. CONTENTS.

Section I

On Diseases of the Brain, See. Page. Chapter 1 — Painful Affections of the Scalp - 1 2 — Tinea Capitis 4 3 — Hydrocephalus Externus - - 7 4 — Hydrocephalus Internus 8 CaseI 9 2 - - - 13 3 - - - 15 4 - - - 16 5 - - - - 18 5 — Apoplexia 29 6 — Hemiplegia - - 31 Case 6 ... 34 7— Phrenitis CONTENTS. Fag., Chaptkr8— Inflammation of the Pia Mater - 39 Case 7 - - 39 8 — Cerebri Abscessus ... 43 CaseS - 43 9 — Epilepsia - - - 47 10— Chorea Sancti Vitl 51 1 1 — Tetanus 53 Case 9 - - 54 12 — Tic Douloureux 58 Case 10 ... 58 13 — The Functions of the Brain 61

Section II

On Diseases of the Fauces, Trachea, Sec. Chapter 1 — Ophthalmia 72 2 — Dentitio 74 3 — Odontalgia - - - - 77 4 — Cynanche 79 5 — Pharyngis Ulceratio 79 Case 11 - - - 81 6 — Laryngis Ulceratio 85 Case 12 - _ gg 7 — Laryngis et Tracheae Ulceratio. - 89 Case 13 - ... 89 8 — Bronchitis 94 Case 14 CONTENTS. XIII Pa?e. Chapter 9 — Haemoptysis - - - 99 Case 15 ... 100 16 - 101 10— Phthisis Pulmonali- - . - 106 11 — Pneumonia - - - - 109 Pleuritis - - - - 112 12 — Empyema - - - - 113 Case 17 - - 113 13— Hydrothorax - - - 123

Section III

On Diseases of the Heart, Sec. Chapter 1 — Carditis - 128 Case 18 - - - 128 2 — Hydrops Pericardii - 134 Case 19 ... 135 3 — Ventriculorum Cordis Iuflammatio - 140 Casb20 - - -141 4 — On the Velocity and Inequality of the Ac tion of the Heart - 146 Case 21 - 146 5 — Polypi of the Heart - 152 6 — Aneurism of the Aorta - - 155 Case 22 155 7 — The Functions of the Pulmonary Artery CONTENTS.

Section IV

On the Diseases of the Stomach, Sjc. Pag, Chapter 1 — Dyspepsia - 172 Case 23 - - ... 175 Pyrosis - - 176 2 — Hæmatemesis - * - - 177 3 — Ulceration of the Stomach - - 179 Case 24 179 4— Gastritis - - - .182 Case 25 - - 183 5 — On the Effects of Ardent Spirits upon the Stomach - - - 187 6 — On the Effects of Arsenic on the Stomach 191 Case 26 - - 191 7— On the Structure of the Pylorus - 193 8— Splenitis - - - - 195 9 — Induration of the Pancreas - - 197 10 — Biliary Calculi - - - 200 11 — Icterus - 202 12 — Hepatitis .-•_'>_ 203 Case 27 ... 204 Chronic Hepatitis - 206 13 — On the Function of the Liver - 207 14 — Peritonitis - - - - 209 Case 28 - 209 29 210 30 - 212 15 — Peritonitis Chronica - - - CONTENTS. XV 16— Enteritis - - - 218 17 — Ascites - - 219 Case 31 - 223 18 — Tabes Mesenterica - 225 19— Diarrhœa - - - 226 20 — Tympanites - 227 21 — On Worms ... - 229 Tænia - - 229 Lumbrici - ■- - - 230 22 — Aorfæ Descendentis Ulceratio - - 231 23— Nephritis - - - - 237 24 — Diabetes .... 239 Case 32 - 239 25— On the Function of the Kidneys - 242

Section V

On Diseases of the Pelvic Viscera. Chapter 1 — Affections of the Bladder . - 245 2 — Affections of the Rectam - - 250 3 — Affections of the Uterus - - 254 Hysteria - 254 Emansio Mensium - - . 256 4 — Amenorrhœa - . , - 257 5 — Leucorrhœa ... 258 6 — Menorrhagia - CONTENTS.

Section VI

On Affections of the Spine, S;c. PaKe. Chapter 1 — Diseased Spine ... 261 Psoas Abscess - 262 2 — Fracture of the Spine - - 264 Case 33 ... 264

Section VII

Chapter 1 — Theory of Fever - 269 2— Typhus - - - - 272 3 — Febres Intermittentes - - 278 4— Scarlatina - - - - 281 Case 34 ... 282 5— Rubeola - 285 6— Pertussis - - - 288 7— Variola - - - - 290 8— Variola Vaccina - - 292 9— Syphilis - - - 293 10— Erysipelas .... 296

Section VIII

General Affections. Chapter 1 — Diseases of the Skin - - 300 2 — Anasarca .... 302 3— Sphacelus - - - - 303 4— Scrophula - - - - 305 5 — Rheumatismus Acutus - - 807 Rheumatismus Chronicus - - A COMPENDIUM OF MEDICAL PRACTICE, $c.

Chapter I

Painful Affections of the Scalp. THE scalp is liable to painful affections, the causes of which it is frequently very difficult, and even im possible, to ascertain. Sometimes, they may be traced to an injury inflicted upon the part at a distant period ; at others, they appear to arise spontaneously. Derangement in the functions of the digestive organs often precedes the local affection, and they are uni formly aggravated by it. It not uncommonly happens that a partial or universal puffiness may be discovered upon examination ; the scalp however is sometimes excessively tender to the touch without exhibiting any visible marks of disease. b Painfid Affections of the Scalp. 2 Mr. Abernethy has described these cases with great minuteness, perspicuity and elegance; to his works* I must therefore refer all those who are desirous of obtaining full information relative to them.

Some complicated and violent affections of this kind have fallen under my observation. Although, from their commencement to their termination they were highly interesting; they were of such long duration that I fear I could not describe them in detail without ap pearing tedious. For their relief 1 have seen extensive incisions of the scalp resorted to, but without any durable advantage. In one case the trephine was applied upon the left parietal bone ; but little good resulted from the operation. Treatment. A judicious regulation of the digestive organs will be found more beneficial than any local application or surgical aid. The blue pill unquestionably will, if properly administered, establish a more healthy action in the liver and alimentary canal than any other * See Abernethy on the Constitutional Origin and Treatment of Local Injuries.

Painful Affections of the Scalp. 3 remedy. In these affections it will be found peculiarly serviceable. Fowler's solution of arsenic ought to accompany its exhibition. In what manner this medicine affords relief in these and other diseases it is impossible to explain. Five grains of the mercurial mass taken once, twice, or thrice a week, as circum stances may indicate, and eight drops of the solution three times a day, will, in these complaints, afford more speedy and permanent benefit than any other means that I have been able to observe.

Chapter II

Tinea Capitis. In cute capillata ad radices capillorum, ulcuscula humorem in erusfam albam friabilem abeuntem fundentia. — Cl. iv. O. vii. G. txxx. Culleni. Tinea Capitis is a very prevalent disease amongst the lower classes of society in this City ; it appeai-s to have its origin in a want of cleanliness ; it is however extremely probable that animalculæ have a considerable share in its production. The same remedies which prove so efficacious for the cure of psora, are equally so in this malady. Treatment. Sulphur in combination with tar seldom fails to remove it; when however it has been allowed to acquire a considerable degree of malignity, it will be necessary to vary the applications as well as the mode of applying them. If the head be very scaly, or covered with thick and indurated crusts, the Tinea Capitis. 5 practice pursued at this hospital, is to invest the whole scalp with a poultice of linseed meal.

Some tar ointment with sulphur may be advantageously com bined with the poultice. After this plan has been put in force, the hair is to be completely removed with a razor and the parts anointed with the ointment night and morning. Previously to rubbing on the ointment it will be extremely proper to wash the head with soft soap and watej". There is a species of Tinea or Porrigo much more difficult of removal, although less disgusting to the eye. It is in the highest degree contagious, and when ever it gets admission into a seminary of education, or other large establishment, it is not easily eradicated. The hair falls from the head either partially or entirely. The denuded places look as if they had been stripped of their covering by a razor or a pair of scissars. Whitish furfuraceous scales, which sometimes adhere with great pertinacity, form upon the bared parts.

Treatment. With this species of the complaint mercurial preparations succeed more speedily than sulphurous. Tinea Capitis. If the scalp be not entirely free from hair, what remains should be removed with a razor. A blister should then be applied, and dressed with mercurial ointment. Should a morbid skin be reproduced, anoint the scalp with an ointment composed of equal parts of tar and mercurial ointment. For this pre paration diluted nitrated ointment of quicksilver may sometimes be advantageously substituted. Frequent washing is in this species of the disease highly desirable.

Chapter III

Hydrocephalus Externus. Capitis intumescentia mollis, inelastica, hiantibus cranii suturis. — Cl. iii. O. ii. G. lxxii. Cli.iem. This disease uniformly and inevitably proves sooner or later fatal. Its appearances are so univer sally known, that it would be superfluous in me to dwell upon them. It probably is the consequence of original defective organization in the brain.* Before it manifests itself by any enlargement or other symptom, its existence may be sometimes recognised by the veins of the scalp becoming varicose. The most beautiful appearance I ever saw those vessels assume was upon the integuments investing the head of a hydrocephaiic patient, f The cranium was large, but had not acquired an immoderate size. In the cases I have witnessed there has been but a scanty growth of hair. * Dr. Spurzheim has, I think, very satisfactorily shewn, that the deposition of fluid takes place within the ventricles, and not between the membranes of the brain, as generally supposed.

If it be so, the disease must no longer be designated — external. t The superficial veins upon the abdomen often present the same appearance before any great accumulation of water has taken place within its cavity.

Chapter IV

Hydrocephalus* Iniernus. It is perhaps to be lamented, that professional men sacrifice so much of their time in searching after specifics for diseases which have been proved by the experience of ages, utterly incurable. Would they but employ it in devising measures for their prevention; and zealously insist upon the necessity of their being rigorously adopted ; from what a series of sufferings and miseries would they deliver mankind! When once Hydrocephalus Internus is fully deve loped, medicine can achieve but little. I will relate several cases of this formidable disease ; detail the appearances which presented themselves upon dissec tion ; investigate its nature ; point out that which I conceive to be the most judicious mode of treating it; and finally give such directions as will, I hope, if steadily pursued, preserve many from becoming its victims. * More properly, Hydrencephalus.

Hydrocephalus Internus. 9 CASE I. On the 21st of January, 1811, a Boy, aged 15, by the name of Jesse Clissold, applied for relief as an out-patient to the Bristol Infirmary, His mother stated, " that he had been in an indifferent state of health for a considerable length of time ; that three or four days previous to his application he had been unmercifully beaten by some boys, and that he had scarcely held his head up since. His appearance was by no means unhealthy. His countenance was florid, his complexion clear. He complained of slight headach and a sore throat. His pulse was full and rather frequent, the tongue white, the tonsils slightly inflamed, the parotid glands were very much enlarged, the bowels were confined, and there was a little oppression about the chest. The enlargement of the glands principally attracted attention, and the disease was considered to be Cynanche Parotidœa, attended with a more than usual degree of inflammatory diathesis.

An emetic was ordered to be taken in the evening, a purgative on the following morning, and afterwards four grains of the antimonial powder every six hours. On the 24th, he appeared to be nearly in the same state. A blister was ordered to the chest, and a saline mixture to be taken in lieu of the powders. On the Slst, he was admitted into the Infirmary. Ten ounces of blood were drawn from the arm and fifteen grains of the cathartic powder of the House* were taken on the following morning. February 1st. Pulse soft and rather frequent, throat sore, tongue white, parotids not much enlarged, skin rather dry. 2nd. Delirium with loud and frequent moaning came on during the night, pulse strong and frequent, bowels costive. Ordered a stimulating enema. Eight ounces of blood were abstracted from the external jugular vein.

A blister was applied between the shoulders. Three grains of calomel were taken at ten o'clock at night, and repeated on the following morning at four o'clock. * This powder is formed of five grains of calomel, and fifteen of jalap. 3rd. Has some lucid intervals. Pulse full, tongue moist. The bleeding was ordered to be re peated, and three grains of calomel to be administered every three hours till copious evacuations should be procured. The blood exhibited no inflammatory appearance. 4th. Bowels open, pulse 100 in the minute and soft, tongue clean and moist. Passed a more comfortable night, delirium continues, stools fetid and black, picks his nose and lips. Ordered three grains of calomel to be taken every six hours. 5th. Delirium unabated, picking of the bed clothes, involuntary discharge of fæces, pupils dilated ; Strabismus. 6th.

Continued in the same state till seven o'clock this morning, at which hour he expired. Examination. The vessels of the pia mater were very much distended with blood, and a large quantity of the same fluid escaped from the lateral sinuses through an accidental opening made into it, while sawing the occipital bone. The texture of the hemispheres appeared to be natural. Upon making an incision by the side of the raphe into the lateral ventricle, a large quantity of water was discharged ; the right lateral ventricle was very much distendetl and appeared to have contained more than two ounces of the fluid, the left ventricle was filled with about an ounce and a half; the clioroid plexuses were remarkably pale. They in all probability were rendered so by the water in which they floated, having after death deprived them of the red particles of the blood ; in other words, they had a sodden appearance.

The foramen of Monro Was remarkably distinct, a small quantity of water was situated between the folds of the septum lucid um, the third ventricle contained nearly half an ounce of the serous fluid, the pineal gland was destitute of gritty particles, the fourth ventricle was in a healthy state, the prominences of the basis of the brain were remark ably distinct. Appearances in the thoracic cavity. The surfaces of the lungs had a tuberculated appearance, but no tubercles existed within the substance of those organs ; there were slight adhe sions between the pleura and its reflected portion ; a mass of coagulable lymph was found in the right ventricle of the heart. Appearances in the abdominal cavity. All the abdominal viscera were perfectly healthy, but the stomach was very much contracted, and its internal surface beautifully corrugated.

I have seen a similar appearance in the stomachs of two executed patients. These stomachs are preserved in the Museum at St. Thomas's hospital. There were slight marks of external violence on the sides and back. CASE II. A boy, 17 years of age, was admitted into the Infir mary on April the 4th, 1811. Some months previous to his admission he received a blow upon his knee ; inflammation and suppuration were the consequence ; the ligaments covering the joint became very much thickened; pus was continually passing out of the joint; there was great constitutional irritation ; and as there was but little chance of saving the limb, it was deemed advisable to remove it. It was considered a favorable case to operate upon. About four days after the operation the boy began to complain of headach and the stump assumed an unfavorable aspect.

The former symptom was unregarded, and stimulants were freely exhibited, with a view of bettering the condition of the stump. The affection of the head daily increased in violence. The patient screamed with vehemence in the day time, and disturbed the whole ward by his moanings at night. He at length became delirious ; his eyes looked glassy, but the pupils were but slightly dilated. On the following day the patient became comatose. The stimulating plan was laid aside, and the antiphlogistic regimen adopted. Blood was twice taken from the temporal artery ; once from the jugular vein ; and once from the arm ; in all about forty ounces. A blister was applied to the scalp, and three grains of calomel were given every six hours. This practice was however adopted too late, to afford any reasonable ground to hope that it would be attended with success.

The patient died on the 6th of May. The brain exhibited the same appearances as those related in the former case, except that there was a larger quantity of water contained in the lateral ventricles. There was throughout the whole of this case but a very slight dilatation of the pupil. I do not recollect that its diameter ever measured more than one line. The application of the strongest light would not however stimulate the iris to a further contraction. In Jesse Clissold's case the dilatation was considerably greater, but there was throughout its whole progress a tendency to contract, whenever a strong light was suffered to fall upon the eye. The lad whose case is above narrated was of a scrophnlous habit of body. CASE III. Mary Ann Nelson, aged three years, a sickly child, and of a very diminutive size, was admitted into the Infirmary on May the 1st, 1815, in order to be operated on for a hare lip.

The head was large, the skin delicate, and there were other marks of a scrophulous disposition about the patient. The operation was performed, and the lip at the end of three or four days began to unite. At this time she was attacked with severe pain in the head, screamed violently, and refused all nutriment. A cathartic powder was administered, and afterwards a grain of calomel every six hours. On the following day the child became comatose ; and there was con siderable dilatation of the pupils. A blister was applied to the head. The calomel was persisted in, and a scruple of mercurial ointment was rubbed upon the abdomen every night. This practice was unat tended with the slightest diminution in the violence of the symptoms ; and on the 4th of June, the patient died. No opportunity occurred of ascertaining the state of the brain, but little doubt can exist of there having been considerable effusion into the ventricles.

I should have observed that the mouth was affected by the mercury. CASE IV. A sickly child, 4 years of age, with deformed rickety limbs, was placed under the care of the Surgeon of the week. A few days after her admission she was attacked with all the symptoms commonly attendant upon hydrocephalus internus. There was also great acceleration of the pulse and a hot skin. She screamed at intervals and refused all kinds of food. Two grains of calomel combined with eight of jalap were given to her, and afterwards a grain of calomel every six hours. On the following morning she appeared somewhat better; her pulse was slower and her skin more cool. The body was directed to be sponged and the cathartic and calomel to be repeated. The next day she appeared much better ; she had voided with her fæces two lumbrici, about four inches in length each ; she took a little nutriment and did not complain of her head ; the pupils were less dilated ; the powder and calomel were repeated.

She passed on the following day another worm, and from this time gradually recovered. One grain of calomel combined with ten grains of tin filings were administered every morning for about a week, and the child left the house free from any hydrocephalic symptoms. That this was a genuine case of Hydrocephalus Internus may be disputed. I can only say, that I never saw a case in which the symptoms of the disease were more decidedly marked. c CASE V. A boy, sixteen years of age, was admitted into the Infirmary for a tumor in the thigh. This tumor, upon more minute investigation, was ascertained to form the most dependent part of a psoas abscess. The lad complained of universal indisposition, and there was a slight acceleration of his pulse. On the 23rd of July he became feverish ; skin hot, tongue dry, great pain in the head.

A purgative was prescribed, and he was desired to be kept cool. On the 25th, his pulse was hard and rapid, his face flushed, his skin hot; there was but a slight dilatation of the pupils, but he complained of excessive pain in the head. It was evident that the disease had made very considerable progress, and that no time was to be lost. Ten ounces of blood were directed to be taken from the temporal artery, and the following medicines were prescribed. i?. Calom. ppt. gr. iij. 6ta. quaq. hor, Mist. Salin. unc. viii. Iuf. Digit, dr. vi. M. Capt. cochl. iij. 6ta. quaq. hor. His body was likewise sponged with vinegar and water. 26th. Pulse rather slower, skin cooler, pupils more dilated, delirium during the night, cannot be made to answer questions, bowels open. The temporal artery was again opened, and twelve ounces of blood drawn from it ; a large blister was applied to the head ; the calomel and mixture were continued with an addition of two drachms of the infusion to the latter ; a drachm and a half of strong mercurial ointment was rubbed upon each thigh at bedtime. 27th.

Pulse 130, but softer, pupil very much dilated, but contracts upon being exposed to a strong light, his stools pass involuntarily. Friction with the mercurial ointment was directed night and morning ; the calomel pill was omitted at bedtime, and a grain of opium with three grains of antimonial powder substituted. 28th. Salivary glands slightly affected ; the patient could be roused, and replied readily to questions proposed. He swallowed a little food, tongue soul, pulse very frequent, pupils less dilated, fæces dis charged involuntarily. In the afternoon he began to pick the bedclothes, became insensible to all external objects, and died on the following morning. Examination. The brain exhibited evident marks of active vascular action having existed. Upon cutting off the hemi spheres numerous minute spots of blood exuded from the divided vessels.

The texture of the brain itself was firm, and rather more glutinous than is usually met with. The ventricles did not contain so large a quantity of water as was expected to be found within them ; only two ounces were collected, and about half an ounce escaped. I am inclined to believe, that a partial absorption had taken place previous to the death of the patient. The abdominal viscera were all in a healthy state. The psoas muscle had been formed into a funnel, for the reception of about three quarts of cream-coloured pus. Solid flakes of con siderable magnitude were deposited at the bottom of the abscess ; and wpuld have effectually prevented the matter from passing through the canula of a trocar, bad one been introduced into the tumor for the purpose of evacuating it. The lumbar vertebræ were all in a diseased state, and large pieces were easily chipped from them with a common scalpel.

There had like wise been Considerable absorption of the bones of the sacrum. There was no projection of the spinous processes externally, nor did they deviate from the the straight line. When pressure was firmly made upon them, the boy, at his first admission into the hospital, said it gave him considerable pain. Observations. The unfortunate termination of four out of five cases, although what have been generally conceived to be active remedies were employed, naturally leads to an enquiry into the cause of their failure. Are the medicines themselves improper, or does the nature of the disease for the most part preclude the possibility of relief? I much fear that we must attribute its fatality to the latter circumstance. It is well worthy of remark that all the patients whose cases I have related were highly tainted with scrophula, and it is in scrophulous habits that I have uniformly observed the disease to occur.

In scrophulous patients, a peculiar sensibility or irritability of mind is very observable, and to this irritability of mind, I am inclined to attribute the susceptibility of these patients to the disease. It may perhaps be considered the predisposing cause. Parts predisposed to disease, are more easily excited into sympathetic action with diseased parts, however remote they may be from them, than healthy parts although placed in their immediate vicinity. It is on this account, that local irritation, proves so frequently the cause of Hydrocephalus Internus. Hydrocephalus Internus is rarely an idiopathic disease. I have been induced to relate so many cases with a view of establishing this fact ; they form however but a small proportion of those which have fallen under my observation. The deposition of the serous fluid I conceive to be the consequence of sympathetic inflammation of the brain; the predisposing cause to this sympathetic inflammation, an irritability of mind ; and this irritability of mindis most frequently met within scrophulous habits.