than we yet possess are required in reference to the modifications in the character, progress, phenomena, and results of diseased action produced by the physiological condition of the several tissues and organs during the early periods of life, and the modifications, consequently demanded, in the remedies for its removal.

Neither the physiology nor pathology of childhood has indeed received that attention from the profession generally, which its importance would seem to require, and hence, the gross empiricism which, still to a very great extent, pervades the treatment of many if not the majority of its diseases.

During the past year considerable attention has been paid, by several physicians of Europe, to the investigation of the softening of the stomach observed in certain states of disease occurring in children. The observations recorded in relation to this affection, are not, however, sufficiently accurate or numerous to enable us to establish any important general conclusions as to its true pathology or general treatment.

Neither the particular circumstances under which it is most liable to occur, nor the diagnostic phenomena of its several stages, have, as yet, been determined with any degree of certainty. This is the more to be regretted, as the disease is one of much more frequent occurrence than is generally supposed-there being good reasons for suspecting, that many of the cases of death annually reported under the heads of bowel complaint, cholera infantum, worms, teething, marasmus, convulsions, &c., are in fact, the result of softening of the stomach. The disease was first described with any degree of accuracy, by Dr. Jaeger, of Stuttgard, in 1811; since which period it has been noticed, more or less fully, by Chaussier, Zeller, Laisne, Gairdner, Bernard, Lenhossek, Louis, Camerer, Joerg, Billard, Beck, Rein, Winter, Crusius, Droste, Pommer, Hergt, Barber, and others.

Dr. Iselin, of Mulheim, is the latest writer on this affection, and as he appears to have enjoyed opportunities peculiarly favorable to its study, a brief abstract of his observations may not be considered uninteresting.

The age at which the affection usually occurs is within the first year; it is not, however, necessarily restricted to this period of life.

Previous to the attack, the child is often for several days observed to be unusually restless and fretful-finally, a decided febrile attack occurs, attended with a quick pulse, hot and dry skin, intense thirst, sleeplessness, and constant vomiting, increased upon food of any kind being taken into the stomach. To these symptoms is speedily added a copious diarrhea-the dejections being, at first, of a grayish color, and some degree of consistency, but subsequently of a yellowish or greenish serum, decidedly acid.

The evacuations are usually preceded by contortions of the countenance indicative of pain, which are likewise induced by pressure on the abdomen. The latter is always much, often enormously, distended, and its temperature, especially over the region of the

stomach, is often considerably elevated, while the extremities are cool, or even decidedly cold. The patient exhibits great prostration of strength, and profuse, partial sweats, particularly about the head. The disease varies in its duration-proving fatal, in some cases, within twenty-four hours, and in others not until after a continuance of several days, or even weeks.

In violent cases, its onset is very sudden-and it is attended with frequent fainting, and an irregular and very quick pulse-the eyes and features are sunken-the body bathed in profuse perspirationconvulsions, more or less severe, often attended with strabismus, sooner or later occur-the face becomes of a bluish tint-the diarrhoea or vomiting, or both, soon become suspended, the accessions of fainting and convulsions become more frequent; during one of which, death usually takes place.

The intumescence and augmented heat of the abdominal and epigastric regions, and the coldness of the extremities, are, according to Dr. Iselin, to be considered as among the most constant and characteristic phenomena of the disease.

The agonized expression of countenance and sunken appearance of the eyes are, likewise, almost invariably present, even from its earliest stages.

After death, the whole abdominal cavity, with the stomach and intestines, is found distended with gas, and the cellular tissue of the abdominal parieties is often emphysematous.

The stomach is frequently found perforated in one or more parts, or, at least, so much softened as to yield to the slightest touch; these perforations or softenings, occur especially at the great curvature, and seldom extend, according to Dr. Iselin, beyond the most depending parts; some observers, however, describe the softening as involving the entire stomach. Distinct traces of inflammation are, occasionally, observed surrounding the softened parts. The softening appeared, in all the cases examined by Dr. Iselin, to have extended from the interior to the exterior tissues of the stomach, and to have been the result of an inflammatory action. In the same stomach, there was often present, at different points, mere softening of the mucous coat, softening of the mucous, submucous, and fibrous coats, and complete softening, or perforation of all the tissues of the stomach.

The spleen was, very generally, found softened and discolored at those points which are in contact with the stomach. The intestinal canal presented, most generally, inflamed and softened spots: in one case the duodenum was found completely softened, almost diffluent, as was the case also in numerous spots and patches over the small intestines.

In a large number of cases, more especially when the disease prevailed extensively as an epidemic at Gottengen, softening and perferation occurred simultaneously, in the stomach, intestines, esophagus, lungs and mesentery.

In the brain and its membranes, Dr. Iselin never detected any distinct traces of inflammation, although the blood vessels were often found to be remarkably turgid. Cammerer, however, noticed various organic changes in the substance of the brain, the pons varolii and medula oblongata, which latter were considerably firmer than usual. The lungs were generally found turgid with blood, and exhibiting, in some parts, traces of inflammatory action; similar traces were discovered in the mucous membrane of the bronchi. But in one case was any thing approaching to softening of the tissues observed by Dr. Iselin.

But little is known as to the etiology, and pathological character of this formidable disease. Dr. Iselin refers it to inflammation, and many of its leading phenomena certainly seem to corroborate this opinion. Some of the circumstances, nevertheless, that have been occasionally observed in connection with the disease, appear to be as strongly opposed to such an opinion.

The disease is, under all circumstances, and throughout all its stages difficult to manage, and but little under the control of remedies. In its advanced stages, after convulsions or paralysis has occurred, it is under every plan of treatment very generally fatal.

Dr. Iselin recommends, in its treatment, a strict antiphlogistic course, with leeches to the abdomen and head-blisters and sinapisms were found advantageous. After the bowels were evacuated by castor oil, the only purgative admissible, according to Dr. Iselin, slight astringents and bitters were administered.

The exhibition, in the early stages of the disease, of the carbonate or other preparations of iron, is spoken of, by some of the writers in relation to it, as decidedly advantageous.

The spasmodic affection of the glottis occurring in children-the phenomena resulting from which often simulate closely those of tracheitis or inflammatory croup, and, in all cases, indicate an affection of a very serious character, not unfrequently indeed, terminating fatally-has recently received considerable attention from several of the pathologists of Europe.

By Kopp, Frank, and other medical writers of Germany, the disease, as it is well known, has been referred, in all cases, to an enlarged state of the thymus gland, and numerous observations have been recorded in support of this opinion.

By Dr. Montgomery of Dublin, enlargement of the thymus gland, is supposed to act in the production of the peculiar phenomena of the disease, by causing pressure upon the motor nerves of the larynx, and thus paralyzing the muscles of this part.

Dr. Ley, in a work on this affection, published a few years since, attributes it to a suspended or impeded state of the functions of that portion of the eighth pair of nerves which is distributed to the larynx, caused by pressure from enlarged cervical and bronchial glands. Children of a scrofulous habit, are, according to Dr. Ley, the greatest sufferers--dentition being an exciting cause, from the swelling and inflammation of the glands to which it often

gives rise. The distressing symptom of crowing and prolonged inspiration, is not, according to this author, owing to a "spasmodic closure of the glottis," but rather to an inability of this part to enlarge to its normal size, owing to the want of innervation from the diseased glandulæ concatenata. From the same cause, he conceives, the transverse fibres, behind and connecting the rings of the trachea, lose their contractile power, and allow the sputa to accumulate-hence, the "prodigious rattling in the upper part of the trachea, resembling the sound which attends when there is phlegm that cannot be got up, scarce sensible when the patient is awake, but very great when he is asleep, described by Dr. Molloy, that kind of noise which an increased secretion of the mucus in the air passages would produce, noticed by Dr. North. The approximation of the sides of the glottis, thus produced, Dr. Ley argues, is owing to defective power of the opening muscles, and may be either complete or partial. If complete, the child may be carried off by convulsions, or by asphyxia without convulsion-more commonly, however, the glottis becoming gradually, but partially open, air rushes through the still contracted aperture, producing the sonorous inspirations so characteristic of the disease, and this commonly announces the partial recovery of the child.

Dr. Marsh, of Dublin, considers the disease to consist in all probability, in a lesion seated at the origin of the pneumo-gastric nerves, giving rise to a spasmodic action of the muscles of the glottis. He found the disease usually to occur in children of a strumous diathesis, and frequently to be complicated with painful dentition.

By another and highly respectable class of pathologists, the disease is considered, in very many instances at least, to be symptomatic of cerebral disease-being the forerunner often, of convulsions, and other formidable affections.

Numerous observations of a more recent date, would appear very satisfactorily to prove, that spasm of the glottis is capable of being produced by a variety of very dissimilar causes, and that they who refer it, in all cases, to enlargement of the thymus or other glands in the neighbourhood of the larynx-or to paralysis affecting the laryngeal nerves, have taken a very narrow and inaccurate view of the subject.

That it may often occur in connection with an enlargement or morbid condition of the thymus gland and parts adjacent is proved by a large number of well authenticated cases. Its dependence, also, in numerous instances, upon irritation and other morbid states of the brain, would seem to be equally well established by the result of recent observations.

It is, nevertheless true, that the disease has been frequently observed under circumstances in which it could not be attributed to either hypertrophy of the thymus or any positive affection of the brain.

Professor Porter, of Dublin, has recorded several cases in which spasm of the glottis was evidently induced by an irritation caused by the arrest of some foreign substance in the esophagus-which, nevertheless, could not have produced sufficient pressure upon the larynx, to interfere in the least with the freedom of respirationbut must, according to professer P., have been excited, by some remote, and as yet unexplained, influence, a spasmodic closure of the glottis, which often gives rise to symptoms of such intensity, as to require an operation to preserve life.

A large number of observations have also been recorded within the past year, which establish the fact, that a spasmodic affection of the glottis is liable to be produced by a still more remote irritation, reflected upon the nerves distributed to the laryngeal muscles, and to require for its cure a course of treatment adapted to the removal of the latter. Thus, in many of the cases recently recorded, the disease was evidently brought on by exposure to cold-by the influence of an impure and confined atmosphere-by difficult dentition-by improper food-and by irritating substances in the alimentary canal-and was speedily and effectually subdued by the removal of these morific agents, and by remedies calculated to counteract their immediate effects. We have, ourselves, repeatedly seen the phenomena of the disease very promptly and permanently arrested by the action of an emetic and simple purgative-by the warm bath-scarification of the gums, and a close attention, subsequently, to the diet and regimen of the child: it must not, however, be concealed that, occasionally, it is a much more unmanageable complaint-terminating fatally under the most energetic and well devised plan of treatment.

Much difference of opinion exists among medical writers, as to the source of the purulent opthalmia of new born children. By some, it is referred, invariably, to a specific infection communicated from the mother to the child, during its passage through the vagina―others consider it to depend, in the majority of cases, upon some unknown morbific cause, of an epidemic character, while others refer it, again, to the action of cold, local atmospherical impurities, the stimulus of too much light, &c.

According to Dr. Morrell, who has published, during the past year, some very interesting observations on the disease, purulent opthalmia is a common affection of infants in almshouses, and children's asylums, where the inmates are crowded together, without sufficient attention being paid to cleanliness, and to the securing at all times, a due supply of fresh air-according to Dr. M., contaminated air, with its often associated causes of defective nutriment and exercise, is liable to produce a general tendency to disease of the mucous tissue-the mouth, anus, and vulva, being alike liable to ulcerations of a inalignant character, terminating sometimes in mortification. Dr. M. has seen the vagina, in cases of purulent opthalmia, discharging a purulent matter, precisely similar to that of the conjunctiva.