The Diseases of the Lungs. By J. K. Fowler, M.A., m.d., f.r.c.p. ; and R. J. Godlee, m.s., f.r.c.s.

Longmans, Green (j- Co., 1898, London. Pp. 715, with 160 Illustrations. Price ?1.55.

The names of the authors suffice to indicate that one of the objects of this work must be ail attempt to combine the medical with the sur-

gical aspects of pulmonary diseases, and thus to present a comprehensive and continuous dis- sertation on the subject. The work of each is, however, easily recognisable, because the differ- ent chapters bear the initials of the writers. The first chapter contains an elaborate de-

scription of the anatomy, surgical and medical, of the thorax. In it are collected many useful facts culled from a wide range of text-books and

monographs. It is magnificently illustrated, no fewer than 43 of the 160 fine diagrams and plates are devoted' to this initial chapter. The anatomical relations o{ the lungs and pleurae are given with great clearness and attention to

detail, and new material of interest has been introduced regarding the subdivision of the bron- chial tubes.

Aeby, supported by others, has shown that the classical description of the right bronchus, com-

August 1898.] DISEASES OF THE LUNGS. 307

ing off more abruptly from the trachea than

the left, is a mistake, arising from the fact that

the eparterial bronchus on the right side has been ignored. As a matter of fact, the right bronchus usually follows the course of the tra- chea more nearly than the left. It is also noted

that the old dichotomous subdivision of the

bronchi is erroneous. As in other animals, there is really one main stem starting from the

bifurcation of the trachea and running down the lung; from this main stem lateral branches

are ?iven off. There is a useful hint given con- ? ? l

cerning the position of the internal mammary

artery, and the extent of the pleural sac, with

reference to paracentesis pericardii, and there is a luminous suggestion to explain the predilection of tubercle for the apex of the lung in a plithi- noid chest. The second chapter, on physical diagnosis, is

not quite so full and thorough as it might be. No mention is made of the value of the feeling of resistance obtainable in palpation, which is almost as useful as the feeling of resistance in

percussion. The subject of auscultatory per- cussion is dismissed in a few lines, and only absolute dulness of the liver is referred to, the

significance of deep or relative hepatic dulness being ignored. In discussing the theory of

percussion, more attention might have been

paid to the intensity, pitch and quality of a percussion sound. There is, however, a very useful table given on the auscultatory phenom- ena of the five ordinarily recognised forms of breathing. The best part of this chapter is at the end, where the author ably describes the various cardiopulmonary sounds, which

simulate valvular murmurs, but which really originate outside the heart.

Most of the diseases of the lungs are fully discussed in the following chapters, which

number over sixty; but diphtheria receives

merely a passing notice in the chapter on

diseases of the trachea, and 110 mentioni s made of the antidiphtheritic serum treatment. The section dealing with the surgical treat-

ment of pulmonary cavities is a valuable contri- bution containing excellent advice. Operative interference at an early stage is strongly advo- cated in gangrene or abcess of the lung, and also

prompt treatment when there is reason to sus-

pect the presence of a foreign body in a bron- chus, or an abcess resulting therefrom. Good "reasons are given for discouraging surgical interference in cases of bronchiectasis ; but the author is slightly more hopeful than the general consensus of opinion concerning the opening of tubercular cavities, especially if they are

basal. He puts no faith in intralaryngeal or intrapulmonary injections for tubercular cavi- ties. There is a noteworthy omission in the chap-

ter on haemoptysis, as regards treatment. No

reference is made to the value of chloride of

calcium in arresting haemorrhage, or preventing its recurrence in those cases where it is due to the erosion of a vessel wall or of an aneu-

rysm ; to those cases, in fact, where increased coagulability of the blood is most desirable. Nor is any mention made of the prompt use of digitalin hypodermicalty when the haemorrhage has a capillary origin. The book, however, contains a great amount

of valuable information, the collective experi- ence of a physician and a surgeon who are

specialists, and it is a volume to which the medical practitioner may confidently turn for

j good counsel and sound advice.