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18 people who brought him say he complained of shivering ant headach, and that for the last two nights he has raved inces -santly. Of his previous history nothing is known, but he ap pears very thin and emaciated. He lies on his back in bed looking earnestly at some imaginary object, and talking indis tinctly to himself; by speaking sharply to him his attention i: fixed for a moment, and he will answer that lie is suffering -greatly from headach, but is otherwise well. His skin i hot, and covered with maculao of a light rose-colour; pulse] 100 rather sharp; the tongue clean, inclined to be dry, but not preternaturally red; some thirst; abdomen full,- but not tym- panitic, and quite tolerant of pressure; respiratory murrnui heard through both lungs, though weak and indistinct. To have cold lotion to the head; five grains cf mercury-with- chalk, directly. An acetate-of-ammonia draught every three hours. Fever diet. Seventh day.-He obtained no sleep, but was talking to -himself the whole of the night. When questioned, he replies that he is quite well. There is much heat of scalp; eyes blood- shot ; pulse 110, sharp and vibratory; bowels opened twice. To have a blister-1>laster behind each ear. A quarter of a grain of tartarized antimony every two hours. Eighth day.-He continued sleepless and talking all night; the aspect is stern, though he uses no threatening language; - sealp less hot; eyes still bloodshot; pulse 110, sharp and con- tracted ; tongue dry; thirst remaining. He is now taking the tartarized antimony every hour, with five minims of sedative solution of opium. Ninth day.-After taking five doses of the fresh medicine yesterday, he fell asleep, and slept for nearly six hours; on aevaking he still wandered slightly, so the antimony was con- tinued without the opium; he again fell asleep, and is now quite rational ; early this morning he had a shivering fit, and complains at present of feeling sore all over. Pulse 106, fuller and softer; skin less hot than yesterday. Towards evening, he began again to mutter to himself; convulsive twitchings oc- curred in the extremities; pulse 130; respiration very quick; - small crepitation very distinct in the lower lobes of both lungs. He died in the night. Aufops, fourteen hours after deatlt.-Cranium.o Great en. gorgement of the vessels of the pia mater, not, however, pro- .ceeding to minute capillary injection. Much sub-arachnoid effusion, especially seen in the interstices between the convolu- tions ; the arachnoid membrane itself thickened in patches, and of a pearl-white colour; no minute injection, however, or other mark of recent inflammatory action in the vicinity of the patches; convolutions not flattened; substance of brain healthy; no effusion in the ventricles.—Thorax: Throughout both sides, the lungs were completely bound to the walls of the chest by old and very firm adhesions; in no part did the adhesions appear as of recent formation. The anterior and upper margin of the left lung was slightly emphysematous. The lower lobe of the left lung, and the whole of the lung on the right side, were intensely congested, dark brown-red >coloured, and when cut into giving exit to a large quantity of - frothy and deeply tinged sanguineous fluid, a piece submitted to the action of water not recovering its natural colour; and ;-the mucous membrane of the bronchial ramifications of a dark colour, and covered with a tenacious rust-coloured rfiuid. The simultaneous occurrence of these two cases, the simi- larity in’their mode of attack, in their progress, in the reme- dies required, and in their termination, was very remarkable. In both there was sleepless delirium, benefited by the exhi- bition of opium and antimony, but this amelioration was fol- lowed by the occurrence of pneumonia in each; this naturally leads to the inquiry as to what circumstances were present to ,determine the latter phenomena. We know, or at least be- lieve, that for the production of metastasis there must be an :alteration of the nervous sensibility of the part, in the state of the capillaries, and perhaps some changes in the blood itself; the capillaries especially are thought to be concerned in the translation of disease. Now, in the first case, (B-,) the order of circumstances seems pretty evident; the poison of typhus, being present in the system, had especially attacked he head; dislodged, at length, and become floating in the mass of the blood, .it was ready to seize on any organ which it ound predisposed to its reception; just previous to this, ex- posure to cold had taken place, which was more likely to affect the capillaries of the lung than of any other organ, thus laying t open to the full force of the disease, the whole mass of the blood, in its most deleterious condition, having to pass through 4 and undergo the necessary vitalizing changes in its texture. I In the second case, (C-,) we cannot fix the cause of the metastasis quite so clearly, but, most probably, cold had been in operation previously; his mode of life and circumstances warrant the supposition; he was evidently of a broken consti- tution, as the emaciation, theproducts of old inflammation in the pleurae, and the existence of previous disease in the arachnoid, fully proved. It was evidently a case of metastasis, and not primary inflammation of the lungs, masked by the head affec- tion, for the lungs were free at the commencement, and ÍInme- diately before they were observed to be attacked he had a shivering fit, and those general flying pains which are so fre- quently observed immediately before the translation of disease from one part to another. One question with respect to the state of the capillaries may arise from the treatment: Had the opium any effect in causing congestion? It will be seen that they had neither taken more than half a drachm of Battley’s solution. We are certainly cautioned against the use of opium in inflammation of parenchymatous structures, and, above all, of the lungs; but then its combination, in the above cases, with antimony, should have tended effectually to prevent congestion from that cause; and we have, moreover, the posi- tive or presumed effects of cold, quite sufficient to account for the determination. These cases are good examples of the comparative rapidity of the progress and termination of pneumonia, in typhoid over idiopathic cases; one of them also, of the preference which exists in these cases to run on to purulent infiltration, rather than to throw out lymph, and thus form red hepatization. Revíems and Notíces. first Medical Report of the Hospital for Cm;s1lmption and Diseases ojihe Chest. By the Physicians of the Institution. ; London: Churchill. 1849. 8vo, pp. 42. l IT has been a constant object of THE LANCET to stimulate the medical officers of hospitals to a due discharge of those re- sponsibilities which their opportunities for advancing profes- sional knowledge so obviously entail, and we hail with satis- faction the example presented by this Report, of the faithful and efficient discharge of such responsibilities. A Report, the result of the united action of the medical officers of au hospital, exhibits a cheering specimen of pro- fessional harmony, whilst it is calculated to ensure accurate conclusions by excluding any bias to partial opinion or one- sided observation. The statements in the Report are deduced, it appears, from an analysis of more than four thousand cases of consumption, and are arranged under three heads-the first contains obser- vations on the influence of sex, age, social condition, occupa- tion, and hereditary predisposition, upon the development of the disease; the second treats of some of its symptoms; and the third, of the results of treatment-the whole being illus- trated by a number of well-arranged tables. The conclusions upon the influence of sex show the in- correctness of the general opinion, assigning to females a greater liability to phthisis than males, the tables proving that the number of men attending the hospital was about sixty- one per cent., whilst that of the women amounted only to thirty- eight per cent. That this could not have resulted from a greater number of males being in the habit of attending hos- pitals generally is shown by a comparison with two metro- tan hospitals, in both of which the very converse takes place. It is interesting to observe, that the tables published by the registrar-general agree upon this point with those furnished by this Report. It is shown that the period of life most prone to consumption is between the ages of twenty-five and thirty-five; that females are much more frequently attacked than males before they reach twenty-five, but that, after this age, and increasingly so in more advanced life, the liability is considerably greater on the side of males. No age seems to be exempt from phthisis, the years of infancy and the " threescore years and ten" alike contributing to the tables.
Transcript
Page 1: Revíems and Notíces

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people who brought him say he complained of shivering antheadach, and that for the last two nights he has raved inces-santly. Of his previous history nothing is known, but he appears very thin and emaciated. He lies on his back in bed

looking earnestly at some imaginary object, and talking indistinctly to himself; by speaking sharply to him his attention i:fixed for a moment, and he will answer that lie is suffering-greatly from headach, but is otherwise well. His skin ihot, and covered with maculao of a light rose-colour; pulse] 100rather sharp; the tongue clean, inclined to be dry, but notpreternaturally red; some thirst; abdomen full,- but not tym-panitic, and quite tolerant of pressure; respiratory murrnuiheard through both lungs, though weak and indistinct. Tohave cold lotion to the head; five grains cf mercury-with-chalk, directly. An acetate-of-ammonia draught every threehours. Fever diet.

-

Seventh day.-He obtained no sleep, but was talking to-himself the whole of the night. When questioned, he repliesthat he is quite well. There is much heat of scalp; eyes blood-shot ; pulse 110, sharp and vibratory; bowels opened twice.To have a blister-1>laster behind each ear. A quarter of agrain of tartarized antimony every two hours.Eighth day.-He continued sleepless and talking all night;

the aspect is stern, though he uses no threatening language;- sealp less hot; eyes still bloodshot; pulse 110, sharp and con-tracted ; tongue dry; thirst remaining. He is now taking thetartarized antimony every hour, with five minims of sedativesolution of opium.Ninth day.-After taking five doses of the fresh medicine

yesterday, he fell asleep, and slept for nearly six hours; onaevaking he still wandered slightly, so the antimony was con-tinued without the opium; he again fell asleep, and is nowquite rational ; early this morning he had a shivering fit, andcomplains at present of feeling sore all over. Pulse 106, fullerand softer; skin less hot than yesterday. Towards evening, hebegan again to mutter to himself; convulsive twitchings oc-curred in the extremities; pulse 130; respiration very quick;- small crepitation very distinct in the lower lobes of bothlungs. He died in the night.

Aufops, fourteen hours after deatlt.-Cranium.o Great en.gorgement of the vessels of the pia mater, not, however, pro-.ceeding to minute capillary injection. Much sub-arachnoideffusion, especially seen in the interstices between the convolu-tions ; the arachnoid membrane itself thickened in patches,and of a pearl-white colour; no minute injection, however, orother mark of recent inflammatory action in the vicinity ofthe patches; convolutions not flattened; substance of brainhealthy; no effusion in the ventricles.—Thorax: Throughoutboth sides, the lungs were completely bound to the wallsof the chest by old and very firm adhesions; in no part did theadhesions appear as of recent formation. The anterior andupper margin of the left lung was slightly emphysematous.The lower lobe of the left lung, and the whole of the lung onthe right side, were intensely congested, dark brown-red>coloured, and when cut into giving exit to a large quantity of- frothy and deeply tinged sanguineous fluid, a piece submittedto the action of water not recovering its natural colour; and;-the mucous membrane of the bronchial ramifications of adark colour, and covered with a tenacious rust-colouredrfiuid.

The simultaneous occurrence of these two cases, the simi-larity in’their mode of attack, in their progress, in the reme-dies required, and in their termination, was very remarkable.In both there was sleepless delirium, benefited by the exhi-bition of opium and antimony, but this amelioration was fol-lowed by the occurrence of pneumonia in each; this naturallyleads to the inquiry as to what circumstances were present to,determine the latter phenomena. We know, or at least be-lieve, that for the production of metastasis there must be an:alteration of the nervous sensibility of the part, in the state ofthe capillaries, and perhaps some changes in the blood itself;the capillaries especially are thought to be concerned in thetranslation of disease. Now, in the first case, (B-,) theorder of circumstances seems pretty evident; the poison oftyphus, being present in the system, had especially attackedhe head; dislodged, at length, and become floating in themass of the blood, .it was ready to seize on any organ which itound predisposed to its reception; just previous to this, ex-posure to cold had taken place, which was more likely to affectthe capillaries of the lung than of any other organ, thus layingt open to the full force of the disease, the whole mass of theblood, in its most deleterious condition, having to pass through4 and undergo the necessary vitalizing changes in its texture. I

In the second case, (C-,) we cannot fix the cause of themetastasis quite so clearly, but, most probably, cold had beenin operation previously; his mode of life and circumstanceswarrant the supposition; he was evidently of a broken consti-tution, as the emaciation, theproducts of old inflammation in thepleurae, and the existence of previous disease in the arachnoid,fully proved. It was evidently a case of metastasis, and notprimary inflammation of the lungs, masked by the head affec-tion, for the lungs were free at the commencement, and ÍInme-diately before they were observed to be attacked he had ashivering fit, and those general flying pains which are so fre-quently observed immediately before the translation of diseasefrom one part to another. One question with respect to thestate of the capillaries may arise from the treatment: Hadthe opium any effect in causing congestion? It will be seenthat they had neither taken more than half a drachm ofBattley’s solution. We are certainly cautioned against the useof opium in inflammation of parenchymatous structures, and,above all, of the lungs; but then its combination, in the abovecases, with antimony, should have tended effectually to preventcongestion from that cause; and we have, moreover, the posi-tive or presumed effects of cold, quite sufficient to account forthe determination.These cases are good examples of the comparative rapidity

of the progress and termination of pneumonia, in typhoid overidiopathic cases; one of them also, of the preference whichexists in these cases to run on to purulent infiltration, ratherthan to throw out lymph, and thus form red hepatization.

Revíems and Notíces.

first Medical Report of the Hospital for Cm;s1lmption andDiseases ojihe Chest. By the Physicians of the Institution.

; London: Churchill. 1849. 8vo, pp. 42.l IT has been a constant object of THE LANCET to stimulate the

medical officers of hospitals to a due discharge of those re-sponsibilities which their opportunities for advancing profes-sional knowledge so obviously entail, and we hail with satis-faction the example presented by this Report, of the faithfuland efficient discharge of such responsibilities.A Report, the result of the united action of the medical

officers of au hospital, exhibits a cheering specimen of pro-fessional harmony, whilst it is calculated to ensure accurateconclusions by excluding any bias to partial opinion or one-sided observation.The statements in the Report are deduced, it appears, from

an analysis of more than four thousand cases of consumption,and are arranged under three heads-the first contains obser-vations on the influence of sex, age, social condition, occupa-tion, and hereditary predisposition, upon the development ofthe disease; the second treats of some of its symptoms; andthe third, of the results of treatment-the whole being illus-trated by a number of well-arranged tables.The conclusions upon the influence of sex show the in-

correctness of the general opinion, assigning to females agreater liability to phthisis than males, the tables provingthat the number of men attending the hospital was about sixty-one per cent., whilst that of the women amounted only to thirty-eight per cent. That this could not have resulted from a

greater number of males being in the habit of attending hos-pitals generally is shown by a comparison with two metro-tan hospitals, in both of which the very converse takes place.It is interesting to observe, that the tables published by theregistrar-general agree upon this point with those furnishedby this Report.

It is shown that the period of life most prone to consumptionis between the ages of twenty-five and thirty-five; that femalesare much more frequently attacked than males before theyreach twenty-five, but that, after this age, and increasingly soin more advanced life, the liability is considerably greater onthe side of males. No age seems to be exempt from phthisis,the years of infancy and the " threescore years and ten" alikecontributing to the tables.

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The remarks upon social condition are of much interest, anda comparison is made with similar records furnished by ageneral hospital; they show, amongst other things, that mar-riages, especially at an early age, are more frequent amongstconsumptive than non-consumptive persons, and that thisis particularly observable in males. Such a subject, how-ever, is obviously open to many sources of inaccuracy, and wecommend the remarks of the reporters, which show a prefer-ence rather to an expression of facts than to risk an attemptat incorrect generalizations.The section upon trades and occupations is worthy of con-

sultation, and includes some excellent tables made from therecords of a general hospital for the sake of comparison. Wequote the following, to show the points discussed, and the care-fulness exhibited by the authors." Recollecting that the numbers of persons pursuing different

occupations vary very greatly, and that this difference must ofcourse affect the number of persons in each occupation liableto disease, no accurate conclusion can be drawn from numbersonly; we avail ourselves, therefore, of the means at our dis-posal of comparing the numbers which represent the occupa-tions of the consumptive at this hospital, with those which re-present similar occupations at one of the London hospitals fordisease in general:’The result is, that printers and compositors are found to be

more liable to consumption than to all other diseases collec-tively, in the proportion of nearly four to one; that amongstclerks and shopmen the proportions are nearly the same. It

is shown, also that in-door servants are twice as numerous atthe consumption as at a general hospital. Milliners, andpersons similarly engaged, are very numerous at both institu-tions, but they form nearly one fifth of the total number offemale patients at the hospital for consumption-a fact con-firming the truth of the sad but too long neglected plea forthe "poor needlewomen:’In explanation of the preceding, we find, after some judi-

cious remarks upon the modifying tendency of hereditary in-fluence, the following observations :—

"There are certain pursuits which exercise a directly in-jurious influence on the health of those engaged in them, par-ticularly those which compel persons to work in close, ill-ven-tilated, and over-heated rooms, sitting for many hours eachday in a posture unfavourable to the free action of the musclesof respiration, breathing an impure atmosphere, and restrictedfrom taking exercise in the open air." .

The first part concludes with some deeply-interesting ob-servations upon hereditary predisposition, showing that aboutone-fourth at least of all cases of consumption may be tracedto family transmission. It is probable, however, that this issomewhat under-rated, since the inquiries have not on thepresent occasion been carried farther back than to the condi-tion of the parents, no mention being made of grand-parentsor collateral relations: and we know that phthisis, like otherdiseases, may remain latent for one or more generations. Wethink it will be nearer the truth to suppose that one half the

consumptive derive the disease from hereditary taint. The

subject becomes still more interesting when we find it statedthat the father transmits consumption to the sons more fre-quently than to the daughters, whilst the latter derive itfrom the mother much oftener than the sons do; and that thedifference in this respect is about the same, numerically, inboth cases. Some tables derived from statistics on insanity,are inserted to show the great similarity existing in this respectbetween consumption and the 11 mind diseased." We havebeen tempted to analyze, with somewhat unusual regularitythe subjects treated of in the first division, from the interestattached to them, and the honest manner in which the facts arehandled. Our remarks upon the remainder must be necessarilyless extended.The second division comprises observations upon the spiro-

meter and the occurrence of haemoptysis. The tables uponthe former are numerous and worthy the attention of those

who use this very ingenious appliance: we shall contentourselves by saying, that whilst they show the careful industryof the physicians, they give additional testimony to the trust-worthiness of the instrument.

It appears that sex has but little influence upon hsemoptysis;as, contrary to what might have been anticipated, it was foundto occur with equal frequency in the two sexes. But if dis-tinction be made in regard to age, it seems that whilst maleshave an equal tendency to spitting of blood at all periods oflife, females are far more prone to it during their earlier years.Haemoptysis was about three times as frequent during themiliary and crude state of the tubercles, as after softeninghad commenced: a very rational explanation of this fact is

given.The duration of the disease, and the effects of remedies, oc-

cupy the third division. Although many cases were found torun through their whole course, within a period of from threeto six months, and others extended over a period of four years,the more usual duration was found to be from six to eighteenmonths.The results of treatment, spolien of with modesty, are en-

couraging, since it is stated that about one half of the patientswho applied during the earlier stages of the disease werematerially relieved; that the disease was arrested in about

twelve per cent. of the males, and seven per cent. of thefemales.

The claims of naphtha, as a remedial agent, are dispassion-ately considered, that medicine being found sometimes usefulin cases of bronchitis, but possessed of no power to subdue orameliorate tubercular disease. One of the most instructive

parts of the Report relates to the administration of cod-liveroil, which is described as "deserving especial notice, havingbeen productive of more good in the treatment of phthisisthan any other agent yet employed." The facts adduced am-

ply sustain this opinion, for, placing all stages of the diseasetogether; it appears to have been arrested in eighteen percent. In 219 cases the weights were recorded, and it appearsthat, taking both stages of the disease and the sexes collec-tively, a gain of weight occurred in seventy per cent., a loss ofweight In only twenty-one per cent., and in about eight and ahalf per cent. the weight remained stationary. Several re-markable instances are specified, of patients gaining nearly apound in weight daily, for several days, under the use of thisremedy.We will not prolong our analysis, but refer our readers

to the Report itself, the reader of which may, to a certainextent, judge of the manner in which the materials foran essay like this are arranged and presented, but hecan scarcely form a conception, except lie has himself

laboured, of the patient, close attention, and the dailytoil, requisite for collecting and recording so great a varietyof medical facts. We therefore feel that such labouris the more to be commended, when it brings no return of per-sonal gain, and is a labour of love in the cause of science. Mostheartily, therefore, do we promise the authors our cordialsympathy and encouragement in carrying out the work theyhave begun so creditably. They have shown what may beeffected by print, when it is not the object to manufacture abook, but to state facts and add to our store of useful know-ledge. Some volumes on medical subjects, consisting of fivehundred pages, do not contain, in their entire bulk, so muchpositive information as is to be found in a single page of thisadmirable and matchless Report. It ought, in truth, to beadopted as a model by every medical institution in the king-dom. The authors of this Report, by one laborious andsplendid effort, have succeeded in placing the " Hospital forConsumption" in the first rank anlOngst the useful medicalcharities of England.

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Eruptions of the Frcce, Head, and Hands; or the Regional Pa-thology of’the S’kin, with the Latest Improvements in the Treat-ment of Cutaneous Diseases. 13 y THOMAS BURGESS, M.D., Trans-lator of Cazenav0’s Manual of Diseases of the Skin, &c. Illus-trated with coloured plates. London: Renshaw. 8vo,1849. pp. 254.

WITHOUT entertaining very limited or restricted views, onemight have supposed the field of cutaneous pathology fully oc-cupied in this country. The admirable works of Mr. Erasmus

Wilson, and others, and the magnificent plates of the gentle-man just named, have not left much to be desired. Yet it can-not be denied, that Dr. Burgess’s idea of dividing the cutaneoussurface into regions, and describing the diseases which occurin each division, separately and in groups, possesses both

novelty and usefulness. It materially simplifies the study ofa subject that has proverbially been intricate and perplexing,and is equally legitimate with the anatomical division of thehuman frame into parts or regions, the practical advantage ofwhich is thoroughly familiar to medical students, and tf’acherson anatomy. Although most of the diseases to which theskin is subject may appear on any part of the body, there are,undoubtedly, certain eruptions which show a predilection forcertain regions; and the character of the disease will varyoften, so as to give an idea of a totally different complaint, ac-cording to the surface on which it is developed. As Dr. Bur-

gess observes, the itch never attacks the face, nor lupus thehands, and eczema or impetigo has an appearance on the headvery different from that which it presents when developed onparts not covered by hair. Modifications in the structure ofthe skin will cause those variations.

The main object of the author, as lie says in his Preface, is"practical utility," and in pursuit of this object he has sacri-ficed all descriptive and historical detail. He has succeedediri accomplishing his object, for the whole book is virtually aclinical report, founded on the broad principles of rational me-dicine, rather than a recondite treatise on an obscure subject,or an empirical flourish about the virtues of some idle specific ’,for the cure of " skin diseases and all other affections."

Dr.Burgess,in explaining his views on cutaneous pathology, IIvery widely manifests a decided inclination towards the doc-trine of the humoral pathologists. _

In the first group, or Diseases of the Face, the chapters onacne, lupus, and the syphilides, are deserving attention. The

disease first mentioned is one of the commonest, as well as themost obstinate, of all cutaneous maladies, and, from the ex-posed situation in which it occurs, is most annoying to bothpatient and practitioner. The second, although by no meansso frequent, is comparatively formidable; it is one of the fewmortal diseases to which the skin is subject; and the thirdforms, perhaps, the most interesting group of cutaneous

diseases, as well as a striking illustration of their constitutionalorigin. The author has availed himself, as he informs us inthe Preface, of the friendship of M. Cazenave, to whom thisbook is dedicated, and of the practical experience affordedhim in the wards of the Hospital of St. Louis, while engagedin the composition of these chapters, the latter being the ex-pression of the views of Biett and Cazenave, the result oftwenty years’ experience In the same hospital, modified by Dr.Burgess, and " adapted to English practice."In the second group, or Eruptions of the Head, the prac-

tical advantage of Dr. Burgess’s method of dividing the cuti-cular surface into regions is clearly demonstrated. Every oneis familiar with the quackery and confusion associated withthat most disagreeableof allsubjects to practitioners-diseasesof the scalp. Few medical men enter upon the treatment of

any of those eruptions with hearty good will. The practi-tioner feels, that if he is not finally discomfited, he will in allprobability retire from the field with little credit to medicine;

and so between the proverbially obstinate character of thesecqmplaints and the thousand-and-one conflicting opinions as totheir name, nature, and treatment, he is glad to be relieved

from such troublesome cases.’ Hence it is that diseases of the

scalp have from time immemorial formed one of the principalstrongholds of charlatanism. The vague and stupid term"porrigo" has materially assisted In promoting this confusion.Even amongst medical men of the present day, intelligentand well-informed in all other branches of the profession, itis by no means uncommon to hear the remark, " I have got atedious case of affection of the scalp;" or, " I have a trouble.some case of porrigo,"-vesicles, pustules, scales, the degene-rations of favus and ringworm,—one or all being embraced inthat comprehensive and elastic term, " porrigo."The medical practitioner engaged in the active pursuits of

his profession, and anxious to economize his studies, will findgrouped together in this volume,within a small compass, thosediseases which he is constantly liable to witness in practice,and may at a glance ascertain the nature and treatment ofany given eruption of the particular group referred to; andso with regard to the diseases of other regions.The diseases most interesting to the practitioner, in the

second group, are ringworm and favus, (the porrigo lupinosaand porrigo favosa of Willan.) The former is pre-eminentlydistinguished, even amongst diseases of the scalp, for theobscurity and confusion which to this hour prevail respectingits elementary nature. It is, in truth, the questio vexata ofdermatologists. Dr. Burgess considers ringworm to be " theresult of vitiated or abnormal nutrition in the organs whichsecrete the hair, analogous to scrofulous degenerations whichoccur in other parts of the body." This view nearly coincideswith that of Mr. Erasmus Wilson; but Mr. Wilson places theseat of the disease in the hair, and not, as Dr. Burgess allegesit to be, in the organs which secrete it." Moreover, Mr.Wilson says the disease is not contagious. Dr. Burgess regardsboth favus and ringworm as highly contagious. Our own expe-rience corresponds with that of Mr. Wilson as regards favus. Theauthor passes in review the vegetable theory of these diseasesadvanced by Gruby, Shoenlein, Remak, and others; and whileadmitting the existence of the vegetable parasite in both

eruptions, denies that it is the origin of either complaint,-affirming, in short, that it is merely a secondary product or,

epi-phenomenon. The chapter on " Loss of Hair," whichconcludes this section, is likely to be read with interest.

In the third group, on " Diseases of the Hands," the arti-cles Pellagra, or Italian leprosy-a disease which Dr. Burgessappears to have personally observed in Italy-and Scabies-particularly the latter-are deserving of perusal. The historyof the acarus scabiei, and its exact relations with the associateddisease, are discussed at length. The work concludes with auseful formulary.In terminating these remarks, we shall simply add, that

Dr. Burgess has here well supported the reputation which hehad acquired by his successful translation of M. Cazenave’svolume on " Diseases of the Skin."We confidently predict that the work itself will be regarded

by the profession as one of sterling merit and much practicalvalue.

ne Druggists’ General Receipt Book. By HENRY BEASLEY.London: Churchill. 12mo, pp. 424.

THIS little volume contains a vast deal of information in a

very condensed form-it must prove of the greatest assistanceto all vendors of medicines.

Surgical Anatomy of the Arteries and Descriptive Anatomy ofthe Heart. By the late VALENTINE FLOOD, M.D. NewEdition. By J. H. PowER, M.D. Dublin : Fannin & Co.12mo, pp. 189.

DR. FLOOD’S work on Surgical Anatomy obtained a well-merited reputation. That accurate and laborious anatomistsucceeded in producing a really standard book, and we areglad to see this edition carefully edited and enlarged by Dr.Power. We perceive that some alterations have been made

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by the Editor, as also some additions of great importance-amongst others, the anatomy of the heart, and of the largevessels near, which may become the subject of operation foraneurisni-the operations on the brachial artery, and the cureof aneurism of that vessel by pressure : the circulation of

blood in the liver and kidneys, &c. &c., may be mentioned.The work is concise, clear, and simple.

Observations on Asiatic C7aolexa, and Facts regarding the ltlodeof its Diffusion. By T. SIMPSON, M.D. London : Churchill.’York: Sunter. Small 8vo, pp. 168.

DR. SIMPSON has arranged a great number of facts to provethat cholera is a " contagious disease, depending for itsexistence on an animal poison." We think it was, scarcelyuecessary to expend so much time and labour in the proof ofthat which we believe now to be generally acknowledged bythe profession; for however much practitioners may differ onsome of the minor points regarding the question, we believethat it will be found that generally the whole question is onei6f degree rather than of nature: for even the opponents ofContagion admit, that under some circumstances cholera is

propagated by communication with the infected person. Thedebates in all our societies, and the facts constantly broughtbefore us, show this to be the case. However, Dr. Simpson haswritten a readable book, and has collected many curious andinstructive facts.

A Few Suggestions on Consumptaon. By- ROBERT HULL, M.D.’London : Churchill. Norwich: Stevenson & Matchett.

,

12mo, pp. 138. ,

IF Dr. Hull advances no new facts respecting either the.cause or cure of consumption, he is original enough in the-way in which he puts his experience and reflections uponrecord. If Dominie Sampson had been a physician, the style,of this little work would have served him.for a model in.writing. The pedantry and the common sense, the dogma-tism and the good humour, though they " blend in exceptionto all general rules," are, however, indicative of a thoughtful’and observant physician.

Rational Medicine: a Vindication. An Address delivered onthe Opening of the New School of Medicine, Surgeon’s- ’

Hall, Edinburgh, Nov. 6, 1849. By A. WOOD, M.D. Edin-burgh : Maclachlan & Stewart. 8vo, pp. 88.

GOOD service will be rendered to the practice of Rational Me-sdicine by the very able lecture of Dr. Wood. Though more.particularly addressed to students, it can be read with advan-tage by all the members of our profession. Among the morevaluable contents of the Appendix is a very clear and able ex-position of the case of Miss Martineau, who was alleged tohave been cured by mesmerism.

The Retrospect of Medicine. Vol. XX. July-December,1847. Edited by W. BRAITHWAITE. London: Simpkin,

Marshall, & Co. Small 8vo, pp. 504.MR. BRAITHWAITE without the journals would be somethinglike a general without soldiers, but even aided by the hebdo-madal and monthly press, he can then scarcely be said to be ageneral with an army. At all events, he plays a very insigni-ficant part in the campaign. If the whole duty of an editor.consisted in a certain amount of picking and stealing of

" other men’s stuff," then Mr. Braithwaite might claim somepraise; but if the duty of that functionary embraces a carefulselect,ion, a personal revision, and the making of elucidatoryremarks, then, we fear, no meed of approbation can be awarded;’to the Editor of the Retrospect.. ** A single comment on a thousand lines" is scarcely suffi-cient even for an editor, whose whole store is contraband. It

. may be said of this book as of many others, that what " is goodis not new, and what is new is not good."One grave fault, however, deserves especial mention, and

!more particularly as it exposes, in a curious manner, the wayin which literary piracy always does an injustice to some one:numerous articles are quoted from journals which first stolethem from THE LANCET, without acknowledgment; they arepilfered again by ilir. Braithwaite, the pirate, apparently, notbeing aware that they had been previously stolen.

MR. GUTHRIE AND REFORM. -

To the Editor of THE LANCET. _._

SIR,—I am sure you will allow me space for a few words ofself-justification in reply to your remarks on my previousletter. I have not the slightest wish to misrepresent Mr-Guthrie; but I am not singular in my opinion of the partialand limited nature of his efforts in the question of the CollegeCharter. In the report published last year by the council ofthe National Institute,-parties likely at that time to be wellinformed,—I find mention of " some such power as that soughtfor by Mr. Guthrie to be given to the council of the Collegeof Surgeons, enabling them to make another selection fromthe members, .of a limited number of individuals to be createdfellows," &c.; and the notion formed of the proposal by thosewho drew up the report is evident from a subsequent clause,:" Of the 138 gentlemen who have appended their names to theShropshire Petition, if half a dozen were created fellows to-morrow, and the cause of the others delayed or abandoned,would the remaining 132 be satisfied 1 and amongst the gentle-men who attended the meeting at the Freemasons’ Tavern, if £one or two of the more active were made fellows, would thisadvance one i6ta the cause of medical reform ?"

:. But perhaps the writers, like myself, were in error." Theymight have misunderstood Mr. Guthrie’s views. Let him thenspeak for himself. On the 29th February, 1848, he said tothe Registration committee-" I am not desirous of enteringany further into this question" (of the fellowship) " thansimply to say, that I have nothing to do with, and do not intendtofight, the battle of the community at large, who are quite able

, to contend for themselves." * ’ * * " Tli6 questioa with regard

.

to the officers of the public service, which alone I undertake tobring before the committee, is one which requires, I am afraid; alittle explanation:

These are his words, and as a cut direct to the members orthe College, they seem, like the question he alludes to, to" require a little explanation," and this explanation you havenow furnished to us. You tell us that the officers of thepublic service had called upon Mr. Guthrie.to protect them,but that, as the members generally had not done so, he con-sidered it would have been presumptuous in him to take up‘

their cause, without such confidence having been placed inhim by them. You tell us that his language was prompted

- by delicacy, and a fear of appearing presumptuous ; but if youwill call to your recollection that the requisition to Mr.

_ Guthrie to take the leading part on the side of the membersin this quarrel received in a few days no less than 1200 signa-

’ tures from fifty of the principal towns in England, and that’

(although from the withdrawal of Sir James Graham’s thirdbill in 1845, and the controversy therefore taking a new tura,the meeting did not, if I recollect right, take place) Mr.Guthrie could not be ignorant of this requisition, I think youwill agree with me that his great anxiety to separate himselffrom the cause of the members was not very happy, to say the

’ least of it, and not very likely to make them look withoutsuspicion upon any proposals said to emanate from him. Ifdelicacy is to be taken as an apology, we may still have a

,. feeling allied to regret that Mr. Guthrie’s delicacy should beof so over-scrupulous a sort.

If, however, it should turn out that his deeds are fairer thanhis words, so much the better. I cannot regret my error,

r since it has been the means of eliciting the welcome statement,f contained in your article. And my mistake, if it shall proveto be so, was not, I think you will admit, without a very

colourable foundation.In conclusion I must, Sir, convict you of an error in your

y turn. You have attributed to me a hint that the College

d would be none the worse for the retirement of the threesenior members of the council. It was not my letter which

i_ contained this hint, but that of another correspondent, a mis-take I am the more desirous to correct, because upon - the

d point in question my opinion is opposed to his, and entirely,

in accordance with your own. -

. ’ I am, Sir, your obedient servant,

d THE WRITER OF A FEW WORDS ON THE FELLOWSHIP.


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