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(Dr. Greenhow) could have wished that the gentlemen who hadput them had at the same time stated their own views on thesubject, if they had formed any; for himself, he was unwillingto express any positive opinion on so obscure a question untilfurther observation should have enabled him to verify what hecould now only put forward as conjecture. He could not quiteagree with Dr. Weber in regarding the slowness of pulse,which he had so well described, as one of the most frequentsecondary symptoms of diphtheria. In his (Dr. Greenhow’s)experience it had rarely occurred, and not oftener in the

secondary than in the primary stage of the disease. Wheneverit did occur, it was a serious and too often a fatal symptom,and he was disposed to think with Dr. Weber that it dependedon some affection of the pneumogastric nerve. It was no doubt

true, as Dr. Sanderson had suggested, that many of the pheno-mena of these curious nerve affections were due to a want ofco-ordinating power; but he (Dr. Greenhow) could not, likethat gentleman, regard them as consisting entirely of paralysisof sensation ; for although the loss of motor power only reachedits climax pari passu with the muscular emaciation, theregenerally existed some degree of it from the beginning. Theintense inflammation which had recently affected the super-jacent mucous membrane might perhaps, as Dr. Sibson hadsuggested, partly account for the paralysis of the muscles ofthe fauces, but could scarcely explain the paralysis of thetongue and cheeks which had been sometimes observed, andstill less that of the muscles of the trunk and extremities.

Reviews and Notices of Books.On Diseases of the Chest, including Diseases of the Heart and

great Vessels; tlceir Pathology, Phylsical Diagraosis, Symp-toms, and Treatment. By HENRY WILLIAM FULLER, M.D.Cantab., F.R.C.P.L., Physician to St. George’s Hospital,&c. pp. 703. London : Churchill. 1862.

Peseareczes on the Nature, Pathology, and Treatment of Em-physerna of the Lungs, and its Relation with other Diseasesof the Chest. By A. T. H. WATERS, M.D., M.R.C.P.,Physician to the Northern Hospital, Liverpool, &c. pp. 114.London : Churchill. 1862.

Ucbe,r der Behandlung der Lungenschwindrucht du2-cA dieBrusterweiterung und der Gebrauch der Scrophularianodosa. Von Dr. J. SEILER. ss. 227. Basel and Genf:Georg. 1862.

Ora the Treatment of Consumption by Expansion of the Chestand the Use of Scrophularia nodosa. By Dr. J. SEILFR.WHETHER there was or was not a necessity for another sys-

tematic treatise upon the Diseases of the Chest is a questionadmitting of a twofold answer. There are many who will be-lieve that both the student and practitioner have been alreadysufficiently and well supplied, and might properly be contentedfor some time to come. There are others who may argue thatcontentment is too often but the parent of mediocrity, and thatcompetition is the only satisfactory guarantee that the publicwill be well cared for. Dr. Fuller’s 700 pages will be to theformer a work of supererogation ; to the latter a welcome gift.The physician of St. George’s has come to the conclusion thatas regards the physical diagnosis of diseases of the chest, toomany students yet continue to find themselves bewildered, andready to regard the stethoscope as to them at least a hopelessmystery. He believes that although by extraordinary diligenceand perseverance the more zealous learn to interpret its lan-guage correctly, the less fortunate and less persevering will befound to notoriously fail in mastering its difficulties. Underthese circumstances the author thus writes :-

" My object has been to lessen these difficulties, and to ’,render attainable by men of ordinary capacities and ordinaryopportunities a science which is indispensable to every medical Ipractitioner. I have endeavoured to begin at the beginning—toassume nothing, and to explain every auscultatory sign by re-ference to the morbid condition and consequent aitered me-chanism in which each takes its origin. My wish has been toinculcate the necessity for regarding each physical sign, not asindicative of a certain disease, but rather as the natural con-sequence of a certain physical alteration in the tissues, the

source and true interpretation of which must be determined byconcomitant circumstances.

" I have endeavoured to use the simplest language, so as toobviate the formidable difficulty presented by the confused andvaried phraseology made use of by many writers on the subject,to give a definite meaning to each term which is employed, andto present a classification of the various sounds which shall beintelligible even to a novice at auscultation.....I have pur-posely avoided encumbering my pages with the discussion ofremedies and modes of treatment which experience has provedto be undeserving of confidence, and, whether in respect to dis-eases of the heart or lungs, have contented myself with pointingout the particular methods of treatment which have appearedto me most generally successful, and based upon the soundestphysiological grounds. "-p. vi.

Though dealing with its subject matter from the most ele-mentary phases, Dr. Fuller’s treatise must not be regarded assimply and purely a student’s book; on the contrary, wereit not for its size we should consider it as well adapted to thebusy practitioner, as its true spirit is seen ia its essentiallypractical or clinical character, in spite of its dealing so muchwith the physical and vital causation of symptoms and signs.In some instances, the work before us is even polemical. Theauthor’s explanation of the mechanism and true significance ofaagophony and of sundry other abnormal sounds, is at variancewith that which is more frequently adopted. As relates to

phthisis also, Dr. Fuller has brought together a variety of factsserving to elucidate several points upon which erroneous ideas,it is conceived, are commonly entertained. In these and ana-

logous cases in which the views of others are expressed anddiscussed, concerning which there is considerable difference ofopinion, the grounds upon which the author bases his own con-clusions are stated, so that it is open for future observers and

experimentalists to arrive at an estimation of their real value.But though thus elementary and occasionally polemical, ourreaders, who will remember the character of Dr. Fuller’s well-known work "On Rheumatism," will not hesitate to acceptour judgment that not the least important features of the workare those which spring from its practical and clinical relations.

For some time past there has been considerable discussion asto the determining causes and mechanism, if it may be so

termed, of pulmonary emphysema. Laennec, laying muchstress upon its frequent association with catarrh, consideredthat it must be caused by an over-distension of the air-cellsfrom the accumulation of air in them, arising from the ob-structed condition of the bronchial tubes. But, as Dr. Waterspoints out, the theory advanced by the great French auscul-tator proceeded upon the supposition that the inspiratorypower is greater than the expiratory force. Now, the re-

searches of Hutchinson and others have shown that this theoryis incorrect; and, upon the contrary, that the force of ex-

aggerated expiration considerably surpasses the power of the in-spiratory effort. But with some slight modifications of the Frenchdoctrine, there still remain eminent authorities who regardemphysema as due to the effects of forcible expiration. Opposedto them are those who, influenced by what we have just stated,and by other facts, look upon it as due to forcible inspiratoryefforts. According to Dr. Fuller, neither of these theories isexclusively correct. The pulmonary organs are so efficientlysupported on all sides, that so long as they expand and con-tract freely, it is difficult to conceive how the fullest inspirationor the fullest and most forcible expiration can occasion ruptureof the air-cells. Under these circumstances, and looking tothe various diseased states with which emphysema is associated,Dr. Fuller adopts both the complementary lesion theory ofGairdner and the coughing theory of Jenner as necessary toexplain the causation of this lesion of the air-cells. Dr. Watersaffirms that it is very difficult to account for it by a forcibledistension of the lung as the result of an inspiratory act, espe-cially when we consider the amount of distension which thelungs will bear when in a healthy condition without any rup-ture of the air-sacs taking place-a distension probably far

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greater than they undergo in those cases of disease where onelung or part of one lung takes on increased action to compensatefor the want of action of a disabled portion. To quote Dr.Waters :-

" Although I am disposed to consider that in the majority ofcases of emphysema, such as I have described as partial lobularand lobular, the most frequent cause is the cough, which mayhave existed for a longer or shorter time, yet this view of thedetermining cause is by no means sufficient to satisfy my mindwith reference to that more important and extensive form ofthe disease denominated lobar. Cases of this kind are not un-frequently met with, as I have previously stated, where thedisease has gradually crept on without the existence of anysevere or long-continued cough, and where there has been littleor no bronchitis....... To what mechanical cause, then, are weto attribute the distension of the lungs under the circumstancesjust mentioned ? ...... I am disposed to believe that the disten-sion is brought about by inspiration; that the lung tissue, beingin an unhealthy condition and abnormally weak, gives waybefore the pressure which it would in a state of health resist;that having once yielded, it is unable to recover itself fromhaving lost its elasticity. "-pp. 50-52.Hence, then, it appears that the two latest writers on pul-

monary disease feel obliged to have recourse to both the expi-ratory and inspiratory theories in order to explain the occur-rence of emphysema in its totality. It will be remarked,however, that in advocating his views as regards the inspira-tory theory, Dr. Waters all the while supposes that a primarystep in the disease is a degeneration of the lung tissue, and thatthe mechanical distension is a secondary consequence. Andrecent pathology has, in fact, stated that the great questionfor consideration in connexion with the pathology of emphy-sema is, after all, whether there be any degeneration oftissue either preceding or attending its occurrence-’ whether,in fact, there is any local or general condition which so inter-feres with the normal nutrition of the walls of the air-sacsas to cause their perforation, rupture, and even total destruc-tion." (Waters, op. cit., p. 23.) According to Mr. Rainey andDr. C. J. B. Williams, it is fatty degeneration of the lung tissuewhich aids in bringing about the atrophy and rupture of thecells. On the other hand, Dr. Jenner affirms that the mostfrequent anatomic change in the lung, producing loss of itselasticity, is fibrous degeneration, " the consequence of that

variety of lymph which escapes from the capillaries when theyare the seat of slight but long-continued congestion." Others,again, have endeavoured to show that there is hypertrophy ofthe pulmonary tissue in emphysema. Upon this important andinteresting point, Dr. Waters thus expresses the conclusion towhich he has come :-

" Notwithstanding, however, that my investigations do notenable me to say what is the exact nature of the degenerationwhich leads to the production of emphysema, nor yet whetherit commences as an affection of the capillary bloodvessels or ofthe elastic fibres and basement membrane, I do not entertainthe slightest doubt that the disease, in its severe form, is of aconstitutional nature ; that one of its most important features,and perhaps the primary step in it, is a mal-nutrition of thepulmonary tissue, causing its degeneration, and giving rise toall the structural changes I have previously described."-p. 31.

We are prohibited from carrying this discussion further, butmay observe that Dr. Waters, already well known by his inves-tigations into the anatomy and physiology of the lungs, addsfurther to his repute by his present contribution towards thesolution of an obscure part of the pathology of the same organs.The main arguments of Dr. Seiler’s treatise are, in the first

place, that the chief symptoms of pulmonary phthisis consist ina deficient respiration and a gradually increasing falling-in of thewalls of the chest ; that such thoracic contraction and respi-ratory deficiency exist before the outbreak of the disease astuberculosis in the lungs can be proved; that both symptomsdepend mos probably upon a relatively too weak inspiratorypower, or upon a sort of debility of the muscles engaged in in-spiration ; that when (exceptionally) a natural cure supervenes,

the inspiration will be found to have relatively increased, andthe normal respiratory volume to have become established. It

necessarily follows, then, says Dr. Seiler, that a chief con-sideration in the artificial treatment of consumption must be tostrengthen the tone of the inspiratory muscles, augment thecapacity of the thorax, and re-establish the normal respiratoryvolume. In the second place, these desiderata are to be mostsatisfactorily attained by the use of the galvanic induction-current, induced on a special apparatus constructed by theauthor, applied in a particular manner. The cure is to be

further assisted by the administration of the expressed freshjuice of scrophularia nodosa. When, in spite of such treat-ment, the disease progresses, and the stages of softening andof the formation of vomica are attained, the inhalation of thejuice of the same plant, brought about by means of the " pul-verisator" of Dr. Sales-Giron, is advocated.

SANITARY DEFECTS IN SHIPS OF WAR.

To the Editor of THE LANCET.

SIR,—By giving wide currency to the following observationson this important subject, you may greatly promote the

speedy adoption of a much-needed reform in our men-of-war,by which the health of the navy would be infallibly im-proved.Lord Clarence Paget, the Secretary of the Admiralty, on

moving the Navy Estimates in the House of Commons last year,1862, said :-"Everybody who has been on board ship will know that the

state of the atmosphere in the lower decks is sufficient to pro-voke almost any kind of disease, especially phthisis and fever,as has been shown by the returns from the Mediterranean Fleet.We have had a committee sitting some time, and the result is,that the Admiralty have resolved to make every possible effortto improve the ventilation of the ships."On moving the Estimates for the present year, 23rd of Feb-

ruary, Lord Clarence Paget said:-" We are trying various methods of ventilation, and we be-

lieve that when the ships are properly ventilated, there will bea great decrease in the sick-list."

Sir John Pakington on this occasion remarked :-" To that part of my noble friend’s speech which referred to

the improved ventilation of our men-of-war, I listened withsome regret. I understood him last year to say that a commis-sion had been appointed to consider this subject, and, from thetone of his speech to-night, I am led to infer that that commis-sion has not reported, or that it has not been able to make anysuggestions on which the Admiralty would venture to act. Ihave received a communication lately that four of our ships-of-war on the West India station suffered so severely in 1861 fromyellow fever that fully one-half of their crews were attackedwith the disease, and that a very large number of the casesproved fatal, owing, in a great measure, to the impure atmo-sphere of the between-decks. I hope that the attention of theAdmiralty will be directed to the subject."

Sir J. Elphinstone said :-"Sufficient attention has not been given to the ventilation of

ships which were to be employed in tropical climates. Last

September I went on board one of these vessels. The tempe-rature on the upper deck was 50°. On the lower deck I foundthe thermometer at ’l2°, close to where a man was lying in hishammock ; and I was informed that at night, when the tem-perature was below 50° on the upper deck it was 78° on thelower. "

When such remarks as these are made in Parliament, we maysurely expect that something will be done, and that speedily,to remedy what is acknowledged by all medical officers of the

service, I believe, to be a most fruitful cause of sickness, in-

validing, and death in the navy. I have not heard the namesof the committee to whom the Admiralty have referred theconsideration of the best means to improve the ventilation ofour sbips-of-war. Perhaps one of your numerous naval readerswill be so good as to state the composition of the committee,and what measures may already have been recommended oradopted on the subject.

I am. Sir. vour obedient servant,G. MILROY, M.D.London, lfarcli, 1863.