A Treatise on the Diseases and Physical Education of Children.
By John Eberle, M. D., &c. &c. Fourth edition with cuts,
and large additions, by Thomas D. Mitchell, M. D., &c. &c.
Philadelphia, Lippincott & Grambo : 1850.
Professor Meigs has not been idle during the last few years, as
his recent publications testify. Cognizant of the vast experience a
large practice among children must have afforded him, we were
rather disappointed in finding that he confined himself to “ some of
the diseases of children,” and in limine we must beg leave to differ
from the general custom of the day, to disclaim in the preface
“ any intention to make a systematic work on the subject, seeing
that the place is already occupied with numerous valuable books,
presenting a complete body of doctrines on children’s diseases.”
Such an announcement cannot excuse any author, nor free him
from the necessity of unfolding to his fellow laborers all the results
which his abilities and opportunities have enabled him to attain.
The work before us is undoubtedly a valuable addition to the
fund of information which has already been treasured up on the
subjects in question. It is practical, and therefore eminently
adapted to the general practitioner. We regret to find occasionally
the same style pervading it, for which our esteemed author has
hitherto been censured. He now and then takes liberties with his
mother tongue, coining words where he chooses, and anastomosing
them wTith those of other languages whenever it suits his fancy.
We regret this careless style the more as he designs his publications
chiefly for students; if he be desirous of impressing them with the
importance and gravity of the subject he is treating, and with the utility
of his instructions, let him recall the advice of the Roman satirist:
“ Si vis me Here primo tibi flendum est;” if he desire to secure the
attention of his readers, he must treat his subject with the serious-
ness and dignity it demands.
Nor any the less objectionable are the theoretical flights in which
our author now and then indulges, the more dangerous because
they are so happily expressed.
In attaching a great deal of importance to the physiognomy of
the sick child, we consider that Prof. Meigs is calling the attention
of medical men to a point too often neglected, and from which
they might derive great advantages in their prognosis of the diseases
of children, thus confirming Mr. Jadelot’s researches on this subject,
to whom the profession is deeply indebted for information which
had previously remained latent, but we cannot yield our implicit
confidence to the author’s views upon the voice of the child in
crying, although we know that in this opinion he is also sustained
by others. It has been beautifully said in reference to the undulatory
theory of light, that the eye listens for light as the ear does for
sound, but those who give the different aches a voice have
certainly the advantage in originality.
Prof. Meigs is down stairs, hears a child cry, and by a species of
mysteiious knockings upon his own tympanum, instantly recognises
from the peculiar tones of the child that it has the earache. He
proves the correctness of his views by entering the room, and pres-
sing upon the right ear; the infant only evinces surprise at his
rudeness; he repeats the same movement upon the left, when
lo! the same dulcet notes are poured forth hence it is the cry of the
earache. Here is the key to all aches, so that every organ
has its peculiar key, and when all become affected, all the stops
are pulled out, a glorious diapason is formed, and we have a
chorus of aches—“ spectatum admissi risum teneatis amici.” We
prefer the views of Bouchut on this point, who in his recent work,
“Surles maladies desnouveaux nes,” in the chapter headed “Du Cri”
thus expresses himself: “11 n’y a gu&re qu’ une maladie dans laquelle
le cri presente des modifications importantes et caracteristiques, je
veux parler du croup.” Again, still further on, “la duree du cri des
enfants n’ indique pas autre chose qu’une douleur tres vive, sans
aucune rapport avec l’affection de tel ou tel autre organe,” &c.
The first chapter is taken up with some very able remarks in
reference to the diagnosis of the diseases of early infancy, the
importance of which is forcibly dwelt upon ; some of the diseases
of uterine life, the non-viability of the child, the causes of children
being born in an asphyxiated condition, and the treatment to be
pursued under such circumstances, the formation of the navel, and
lastly the retention of the meconium from inertia of the bowels or
imperforate anus. Although these points are in the main well
treated, still we regret their conciseness, and we would have wished
our author to have drawn more upon his vast fund of experience
and observation, and given us some chapters upon the physical
training, and hygienic treatment of new born children.
We skip over the chapters on bloody tumors of the scalp, and
inflammation of the eyes and mouth, as they require no particular
remark.
Chapter 4th has for its subject Coryza. Dr. Meigs holds the
opinion “ that the nares are the orifices through which the vital air
has access to the lungs, and that an instinctive sense teaches the
new-born children to use them alone.” He attributes the disease
entirely to the nares becoming obstructed with a thick inspissated
mucus ; respiration being thus interfered with, the vitality of all the
tissues becomes impaired from want of proper seration of the blood,
the functions are interfered with, and emaciation takes place. The
author has omitted to state that rapid emaciation very often ensues
from the child’s inability to suck, the mouth being constantly em-
ployed in keeping up the oxygenation of the blood ; it is therefore
requisite that the child should be fed with the mother’s milk, by
means of a spoon, since the fruitless efforts to suck aggravate its
sufferings, and yet the want of nourishment, tending to augment
the vitiation of the tissues, the child may die from inanition.
Dr. Meigs concludes his admirable chapter on this subject by
recommending a constant lubrication of the nostrils with some ani-
mal oil to prevent the hardening of the mucus viscosities.
He also dwells with much earnestness upon the treatment
suggested by himself. We copy his own words. “ In a very con-
siderable number of cases. I have found the warmth of a flannel
cap, worn upon the head, sufficient speedily to cure the malady, and
I beg leave to assure the reader that, for the most part, little else is to
be done, beyond giving very clear directions as to this method.”—
We have tried this eureka, and regret that we cannot confirm the
author’s views, having found that it has no advantages superior to
those derived from keeping the child in a room of equal temperature,
the disease in the majority of cases running its course.
We would call particular attention to the chapter on bowel com-
plaints and early feeding, as containing most valuable suggestions.
It is unfortunately too common a practice to cram the newborn infant
with gruel, or molasses and water, the physicians carelessly entrus-
ting their delicate charges to the whims and freaks of officious nurses,
whom neither time nor experience can teach, that in this, as in all
similar circumstances, we should attend to the indications
of nature. The peculiar secretion called colostrum, which is-
sues from the mother’s breast, is the repast which nature
has destined for the child, and which from its very composition is
peculiarly adapted to lubricating the internal surface of the diges-
tive tube, to stimulate its contractions, to dilute the meconium, and
consequently to facilitate its expulsion ; properties which our learned
author does not appear to recognize, judging from the following
remarks :—u I know not and believe it is not knowrn, whether any
peculiar function or power is connected with the early ingestion of
the early milk of the mother, a fluid known to be characterised by
the presence of a large quantity of colostrum.”
The following chapters treat of infantile jaundice, and of the child’s
dress. We recommend the attentive perusal of the last named chapter
to those practioners who as servile panderers to the morbid tendencies
of the age would trammel the young and delicate infant by the bonds
of fashion, regardless of the varieties of climate orthe peculiar diathe-
sis of the child.
We have now7 reached the chapter on Cyanosis Neonatorum, and
in approaching this subject we would inform our readers, that we
have reached our author’s hobby-horse, and as, in the language of
Sterne, “ a man’s hobby-horse is as tender a part as he has about
him,” we shall carefully endeavor to make no unprovoked strokes.
The first part of this chapter is taken up in considering the foetal cir-
culation; the author then proceeds to prove that, 1st, the nervous
mass is the generator and conductor of biotic force, and 2dly, that
oxygeniferous blood is indispensable to the evolution of life force.
Professor Meigs’ remarks on these points are fraught with informa-
tion of the most practical kind, but we are at a loss to understand
how7 he can consider them as consequent upon his own theory alone
of the causes, inasmuch as they can be predicated of that of his op-
ponents. Professor Meigs still maintains his former theory of this
disease, viz., “ its being entirely due to a persistent opening in the
foramen ovale after birth, and an admixture of arterial and venous
blood.” He also persists in the treatment suggested by himself, of
placing the child upon the right side and thus causing the valve of
Botalli to close.
It seems to us that if the discoloration of the skin depends entirely
upon the admixture of arterial and venous blood, we should always
find in cases where discoloration existed the communication above
named. Many cases, however, have been cited in which neither
the foramen ovale nor the ventricular septum, was open, nor
did there exist any other passage by which the arterial and venous
blood could commingle, yet in all these there was the discoloration
which is characteristic of cyanosis.
We could go on to prove, 1st, that cyanosis may exist without the
admixture of blood ; 2d, that there is no proportion between cyano-
sis and the degree to which the blood is mixed; and 3d, that com-
plete mixture of the blood may take place without cyanosis. We
might thus step by step sap the foundation of his whole theory of
cyanosis. While upon this point, we would refer our readers to the
excellent inaugural essay written on this subject by Moreton Stille,
M. D., of this city, and published in the American Journal of Medi-
cal Sciences for 1844, whose views have been entirely overlooked
by Professor Meigs in all his writings on cyanosis; and yet Dr. Stille
examines the subject so ably and dispassionately, and presents such
an array of facts to support his opinions, that we should have sup-
posed they would have commanded the attention of so philosophical
a mind as our author’s. The result of the observations of Dr. Stille
prove, we think, most conclusively that congestion of the venous
system, resulting from some obstruction in the right side of the heart,
or in the pulmonary artery, impeding the return of the blood to the
lungs, affords the best method of explaining cyanosis; and that if
contraction of the pulmonary artery be taken as the type of all the
lesions which may produce cyanosis, we are entitled to state, 1st,
That it is present in every case of cyanosis. 2d. That it never
exists without the concurrence of cyanosis. 3d. That it is an ade-
quate explanation of the most important phenomena of the disease.
As for Dr. Meigs’ proposed plan of treatment, and the great suc-
cess which he says has attended it, we think that we cannot do
better than copy the remarks of Mr. Norman Chevis upon this
point, who, in an able article, published in the London Medical Ga-
zette of March, 1847, after having announced that his own investi-
gations are almost confirmatory of Dr. Stille’s inferences, uses the
following language in respect to Dr. Meigs’ plan of treatment.
“ Successful as this application of Dr. Meigs’ theory may have
proved, it is certain that his explanation of the fact is by no means
demonstrative. So far from the patency of the foramen ovale being
an essential concomitant of blue disease, it is well known that in a
very considerable proportion of instances of cyanosis, the auricular
septum is perfectly closed.”..........Further on he adds, “ The
position of the body recommended by Dr. Meigs, is, however, well
calculated to relieve the paroxysms from which subjects of congenital
heart disease suffer, as it places nearly the whole of the voluntary
muscles in a state of relaxation, thereby rendering the circulation
through the extreme vessels as free as possible, and, (what is of
more importance) as it facilitates the supply of arterial blood to the
lungs, and to the brain.” It is not, therefore, essential to the suc-
cess of Dr. Meigs’ treatment, that his views of the cause of the dis-
ease should be correct.
The chapter on Croup is an able exposition of the most recent
views of the disease; and the great success which the author has
had in this disease, should secure the greatest confidence in his state-
ments.
The opinion that croup, though an inflammatory disease, is not
without a very evident spasmodic element, is, we think, a most judi-
cious one; and many practitioners in treating this disease shipwreck on
this point, some entirely excluding the inflammatory, others the spas-
modic. The following paragraph will, therefore, be read with in-
terest :
“It is quite true that in spasmodic croup, or spasmodic laryngitis,
it often happens that although the patient may have been suddenly
attacked, and almost as suddenly relieved, he is notwithstanding left
for some time after the relief, affected with signs of an altered
condition of the windpipe ; that is to say, he will be a little hoarse ;
and upon any attempts at rapid, or sudden aspiration, he will find
that the croup sound is still there ; as is the case also in the act of
coughing, and this though, in any ordinary state of breathing, not
the least sign of difficulty can be perceived. This seems to me to
show, that what is called spasmodic croup, is not merely spasm, but
there is a substratum of congestive, or inflammatory, disorder, which
ought not to be lost sight of by the medical attendant,” &c.
Dr. Meigs is a strong advocate for the lancet in this disease, and
very justly observes, “ a vast number of cases yield readily to a
treatment without venesection. I advocate the precept to remember,
always, that the lancet affords the surest guaranty of success and
safety.” Our own experience confirms the author’s views, and
we could relate numerous instances in which the attack was cut
short by a prompt application of the lancet.
Dr. Meigs extols the use of the alum emetic, and we think with
great propriety, for in our hands it has proved one of the most useful
remedies in removing the inspissated mucus from the fauces and
larynx, and at the same time it is so much more harmless than the
domestic remedy, Coxe’s hive syrup, a preparation, from the indis-
criminate use of which, we have seen many untoward symptoms
arise. We have for some time entertained the opinion that this
was entirely too powerful a remedy to be entrusted in the hands of
a mother or nurse, and administered at their discretion. It is
undoubtedly accumulative in its effects, and we have the records
of several cases in which inflammation of the gastro-intestinal
mucous membrane supervened upon its use. We therefore deem
it a duty to enter a caveat against our author’s recommendation of
it as a domestic remedy ; the alum has in our hand’s been quite as
efficient.
The observations upon tracheotomy as an ultima ratio in croup,
are sound and liberal, and contrast well with the croakings and
anathemas of some of our medical men against this brilliant triumph
of surgery.
We ourselves could add the authority of a recent case of tracheo-
tomy performed by the same eminent surgeon, Prof. Pancoast, in
which the result was as gratifying as that of young Repplier’s;
there is one point, however, in the treatment of tracheotomy which
our author seems to have overlooked, and yet one we deem of vital
interest, we refer to the introducing into the trachea, after the
operation, a solution of nitrate of silver, sixty grs. to the ounce of
water. This solution should be dropped by means of a quill used
as a fate liqueur, having found in our experience that the impetus
with which the stream issues from the syringe, causes the trachea
immediately to reject the fluid, whereas, by gradual instillation a
great deal oozes down.
The chapter on pertussis is extremely interesting and practical;
the origin of the disease is attributed entirely to a morbid condition
of the medulla oblongata, unattended with any disease of the lungs
or pharynx. The following is very much to the point:]
“I have already said that I look upon ordinary whooping cough,
as a mere fit of coughing, which is peculiar not only by the long
inspirations and the succession of incomplete expirations, and by
the whoop, but also by the periodicity. And I repeat that if the
patient have only the whooping cough, I generally leave him to
nature for the cure, preferring to entrust him rather to her power
than to the questionable conservatism of any therapeutics what-
ever.”
The following remarks upon the condition of the stomach are of
great utility.
“ It is expedient in cases of pertussis to regulate the diet of the
patient. An over rich and stimulating diet tends to develope the
the gastric and circulatory complications of the malady in a positive
manner,” &c.
The chapter on laryingismus stridulus is in our opinion one of the
most interesting in the book. The origin of this affection is seated
by the author in the brain and diaphragm, especially the latter,
and hence he proposes the name Phrenismus, as more properly
indicating the real seat of the disease. Considering that the attacks
by suspending the seration of the blood, vitiate the blood so as to
render it either unfit for the nervous mass or even poisonous to it,
Prof. Meigs very properly recommends us to cut short the attack,
especially the primary attack, as rapidly as possible, “ by applying
a lump of ice wrapped in a handkerchief or napkin, to be applied
to the epigastrium, and moved over the arch of the hypogastrium.”
The author finishes his judicious treatment of the disease by the
following recapitulations which on account of their soundness and
usefulness we will give in full.
“ In fine I believe our duty in the case consists—
1st. In making a correct diagnosis.
2d. In presenting proper explanations to the friends as to the
prognosis, which is often unfavorable.
3d. In obviating the provoking causes, as swollen and distend-
ed gums, which are to be relieved by cutting them.
4th. In directions as to diet, dress, exposure, and all that concerns
the hygiene of the case.
5th. In the use of counter-irritants and anti-spasmodics in the
exhibition of tonics, and in attempts to defeat the demonstration of
the attack by great quietude, and by applying cold to the region
of the diaphragm; and lastly, in conducting the paroxysm, - when
formed, to the earliest and least mischievous possible conclusion,
by the warm bath, and other measures.”
We have now reached the last chapter in the book, in which
the author treats of scarlet fever.
He first sets out with the announcement of his opinion “ that
scarlet fever is a non-contagious disease, whose cause is to be
sought for in some intemperies of the air, or epidemic principle, of
whose intimate nature I am wholly ignorant.” The next question
discussed is the nature of scarlet fever, which our author considers
an inflammation of the true blood vessels or endangium, the inflam-
mation being observable chiefly in the capillaries of the skin,
mouth, throat and nostrils. In some cases the inflammatory affec-
tion seizes upon the capillaries of the brain, and more rarely
upon those of the stomach and bowels. The author says :
“ Seeing that the skin is an organ of vast extent, exceedingly
vascular, and possessing important relations -with the rest of the
economy, we feel no surprise to observe the constitutional disorder
produced by so extensive an inflammation as that of the whole
derm. As the crasis of the blood depends upon the healthful force
of the endangium, it is to be expected that extensive and violent
disorders of the endangium shall produce great changes in the
blood, and that these influences will exercise a pernicious influ-
ence throughout the economy. The nervous force, dependent as
it is on the power of the blood to be charged with oxygen,
fails under such conditions of the vital fluid, and the organs and
functions in succession become overthrown.”
Dr. Meigs considers that the different varieties of scarlet fever,
result entirely from the peculiar set of capillaries affected: thus
in scarlatina simplex, the capillaries of the skin are solely affected,
in scarlatina anginosa those of the skin and of the mucous mem-
brane of the fauces; in scarlatina maligna, the capillary endan-
gium of the skin, fauces, Schneiderian membrane, tongue, parotids,
heart, lungs, stomach or encephalon are all involved.
The author’s pathology, however ingenious and interesting it
may be, lacks certain links, without which his deductions are im-
perfect. In the first place it is by no means conceded that the
endangium either makes the blood by transmitting to its elements
the nervous force, or maintains the blood in a living state, by its
presence and contact. 2d. Proofs are still wanting, that positive
inflammation of any part of the lining membrane of the capillaries
exists in this disease. The morbid appearances upon dissection
of fatal cases of scarlet fever are by no means uniform, and Dr.
Tweedie states that he has frequently been surprised on examin-
ing rapidly fatal cases, to find no morbid appearances that could
explain the cause of death.
Dr. Meigs’ remarks upon the treatment of the disease, are fraught
with practical instruction. In treating the sick, says the author,
we ought always conscientiously to avoid the administration of
drugs and medicines, in the cases where we have no call for them.”
The practice of the present day, is unfortunately sadly at variance
with this salutary caveat. “ Melius anceps remedium quam
nullum,” is the cry which assails us on all sides. Masterly inactiv-
ty is as sedulously eschewed in the sick room as in the legislative
halls, and the progressiveness of the age requires all the thunders of
the materia medica to be hurled against the aggression of the dis-
ease, in whose ruins the mangled remains of the vis medicatrix
naturoe may sometimes be discovered.
Dr. Meigs’ experience is in favor of venesection in strong and
plethoric subjects, where the fever is high. Affusion of the
body with cold water is highly extolled by him, but we think
that the sponging of the body is preferable to the method pointed
out by the author. We were anxious to discover what views
Dr. Meigs entertained, as regards the administration in this dis-
ease of any of the mercurial preparations. We have invariably
found their employment attended with ill results, and have for
some time sedulously avoided them. We should be glad to have the
opinion of such experienced men as our author, upon this subject.
Too much stress cannot be laid upon the author’s instructions to
keep the fauces and nostrils clear, not only in reference to the
comfort of the child, but also with the view of preventing a viti-
ation of the blood from partial asphyxia.
We regret that our limits will not allow us to follow Professor
Meigs any further, for although there is much in the pathology of
this work which is fanciful and at variance with recent investiga-
tions, and we have not hesitated to designate those points in which
wye deemed the author to err, still we would remind our readers
that stones are only thrown at those trees which are laden with
fruit; the spots in the sun must be carefully mapped out and num-
bered, to be known ; but the light and heat of the great luminary
require no herald and no chronicler. Dr. Meigs’ works have the
same fascination which belongs to himself; his style is bold, fanci-
ful and ingenious ; he writes curent e calamo, his thoughts trickling
down from his brain to his pen ; and though he sometimes forgets
the sage precept, “ saepe stylum vertas,” still, considering his con-
stant occupation, and the immense toils which he undergoes, we
are amazed that he can accomplish all that he does. Long may
he be spared to grace the profession with his rare abilities.
We shall look forward for another volume from him, when,
having retired from the toils and anxieties of one of the largest
practices ever enjoyed by a medical man, in the shade of a mellow
age, he can reveal to us more calmly, more dispassionately, and
■with more justice to himself, those mysteries which the labors of
years have disclosed to him, years spent in unceasingly ministering
to the sufferer, and in the practice of the most ennobling virtues.
We regret that the space occupied in noticing Professor Meigs’
work, prevents us from dwelling at length upon the second which
heads our remarks.
Dr. Mitchell’s work is a reprint of Dr. Eberle’s upon children,
to which he has added a large appendix. We refrain from making
any comments upon Dr. Eberle’s part, inasmuch as it belongs to
the past, and the profession have already pronounced judgment
upon it.
We differ from Dr. Mitchell in our views, as regards the utility
of bringing out another edition of Eberle, at a moment when we
are flush in works in all languages upon the diseases of children,
works combining in them all the experience of the past with the
results of modern investigation. We admit that the importance of
this branch of medical science demands the deepest attention, and
exacts from us a most intimate acquaintance with every author
that can shed any light upon so obscure a subject ; and yet we
think that the profusion which now exists is disadvantageous to the
student and practitioner, placing them in the same category with the
child cited by J. G. Rousseau, who, gathering shells by the seaside,
begins at once by picking up an ample supply, and then desirous
of securing all those which strike his eye as he moves onward, he
alternately selects and rejects, until finally weary, overwhelmed by
the number and hesitating which to choose, he ends by throwing
all away, and returns home empty handed.
Dr. Mitchell’s sequel contains a fair and concise exposition of
some of the diseases of childhood. As we have not noticed anything
original in the author’s views, and finding that they are generally
a fair summary of the opinions of the majority of writers upon the
same points, we shall not pause to make any remarks. We would
merely call particular attention to the chapters on “ Infantile Mor-
tality,” and “ Diseases acquired and inherited;” they are very in-
teresting, and are entitled to serious consideration.
The author has a queer fancy for commingling Latin and En-
glish in his prescriptions, as we observed before in our notice of
his work on Therapeutics ; it would be far preferable to adopt
one or the other. A hasty examination of Dr. Mitchell’s work has
led us to believe that it embodies all that is important and useful
on the subject, and may therefore be safely consulted as a text
book ; but as it has not added materially to our previous informa-
tion on the subject, we are forced to exclaim cui bono ! If an au-
thor is not going to add to our previous store, if he cannot give us
the results of his own daily observations and midnight watchings,
in fine, if he have no original communication to offer, as we are
strong in books, we beg “ in mercy spare.”