Fleetwood Churchill, M.D.. The diseases of children. Third Edition. Dublin: Fannin and Co. London: Longmans, 1870

We cannot say whether we ever read an earlier edition of this book.  How like a horrid dream it is, to peruse, in this year of grace 1870, one of these manifestos of the bygone ‘blood and iron’ school of therapeutics.

In vain we rub our eyes and try to convince ourselves that it is only a dream; there stand the printed pages before us, embodying every half-forgotten barbarism of the days of our youth; the old bad creed of the men who have learned nothing and forgotten nothing since their pupillage, proclaimed anew as gospel. It is really too much.

That Dr Churchill is a learned man, in the sense of  having read pretty nearly everything by writers on children’s diseases who flourished not later than twenty or twenty-five years ago we do not deny. But of the larger part of recent pathology and therapeutics he is apparently ignorant; and he has thought fit to republish his work as a text-book applicable to the present time. It is certainly the duty of a reviewer to show how little it possesses any claim to be so regarded. We have seldom seen a book more unfit to be taken as a guide for practice.

Pleurisy

We learn, with amazement, that primary pleurisy in strong children (one of the most harmless and spontaneously curable diseases that exists) is to be treated with ‘liberal blood-letting, either from the arm, or by leeches to the side, or both. It may, very likely, be advisable to repeat this if the attack be severe, and the first attempt be only partially successful,’ &c. &c. We are told, moreover, that if there be much fever, with a quick firm pulse, antimony and nitre should be given. And in secondary pleurisy, as it sometimes happens that bleeding and tartar emetic are not well borne, we are to fall back on mercury given to salivation. And all this is but the opening of the ball: further entertainments being provided in the shape of blisters, diuretics, and more calomel for the later stages.

Would anyone believe that all this monstrous armamentarium of treatment is directed against a disease which the best English authorities are in the habit of treating with nothing but warm poultices to the chest and a little opium for the acute stages, iron and cod-liver oil for the later periods, and paracentesis for the removal of fluid which would not be spontaneously absorbed, and that under such treatment the results leave little or nothing to be desired?

Acute meningitis

Take Dr Churchill’s mode of dealing with acute meningitis. Yet here again we find him recommending the most sanguinary practice: bleeding, cupping, or repeated leechings, mercury, purgatives, blisters, &c. &c. He talks, with an assurance that fills us with astonisment, of the ‘derivative’ action of irritant cathartics in this disease; and we begin to ask what possible notion can he have of its pathology?

Convulsions

A still more serious complaint must be urged against Dr Churchill for his teaching on the subject of convulsions in children. Whatever may be thought of the practice of blood-letting in pleurisy or meningitis, we should have supposed that at the present day not a voice would be raised in favour of this practice in convulsions (save in the most rare and special kinds); but to our consternation, we find that here, too, our author looks upon it as the prime remedy in severe cases.

When we read this extraordinary statement and peruse his truly ferocious directions for dividing the gums in case of supposed dental irritation, and then remember the scores of cases which are now every day successfully treated with a mere whiff of chloroform to arrest the convulsions, and with liberal allowances of light nutritious food and a little wine to prevent their recurrence, we must confess that our disapproval of Dr Churchill’s teaching is mingled with indignation.

We are sorry that so much labour as he has expended should be thrown away, but we should still more seriously regret to see his treatise adopted as a text-book by students or practitioners.