Klinische BeitrÄge zur Erkentniss und Behandlung schwerer KrankheitsfÄlle. Von Dr. Adolf Hermann. Primararzt in Pest. Wien: W. Baumler, 1868. Gr. 8vo. pp. 282.

(Clinical Contributions to the Diagnosis and Treatment of severe Cases of Disease. By Dr. A. Hermann.)

The preface to this work explains that the author enjoys, at the “Israelitenspital” of Pesth, a considerable field of experience, but is less overburdened with cases than are many physicians of hospitals where people of all creeds are received, and thus has time to study them individually with the greater care. We gather that this volume, which is the fruit of official labours during two years, is the first of a series which it is intended to publish, and it fairly enough fulfils the promise which the preface holds out. One of the most interesting parts of the book is the observations on “tuberculous” affections of the larynx. We must say, however, that the general treatment of the subject of tuberculosis disappoints us, and certainly does not come up to the standard of accurate and careful work which the author has set up for himself. It shows few traces of that wide acquaintance with modern pathological researches on its subject which is more than ever essential to the clinical observer who would throw any light, even by means of the most diligent labours, upon those matters which are really the quÆstiones vexatÆ in regard to the nature and treatment of the various diseases commonly confounded under the name of tubercle. The last chapter in the book contains an interesting account of the author’s experience of the hypodermic injection of remedies. We observe with surprise that he comes to conclusions very unfavourable to the subcutaneous use of atropine, which he almost totally condemns. We entirely agree with him in the statement that doses as high as half a grain, or even less, will at times produce some cerebral and vaso-motor symptoms, but the persistent use of much smaller quantities does, we believe, meet with quite a different and a much higher measure of success. On the other hand, the author speaks with the warmest praise of the efficacy of hypodermic injection of morphia in all kinds of neuralgias; for these diseases he declares that there is no remedy comparable to it.

Annuaire de ThÉrapeutique, de MatiÈre MÉdicale, de Pharmacie et de Toxicologie, pour 1869. Par A. Bouchardat.

M. Bouchardat’s well-known compact little yearly volumes are always welcome, and always useful; and this year the rÉsumÉ includes a rather unusual number of interesting matters. The first thing which deserves notice is the recent researches on the therapeutic action of arsenic in phthisis; a subject which we have for some time past desired to discuss in this journal, but have been prevented by want of space and time. The very able paper of M. Moutard-Martin, read before the Academy in November last, called forth a report from M. HÉrard, which speaks in such strong eulogy of the remedy as used in the manner and under the conditions laid down by M. Moutard-Martin, that we are considerably surprised to observe the small amount of notice which has been given to the subject in England. Arsenic has of course been long known as a tonic more or less applicable to phthisis, as to other states of debility. But the points so sharply brought out by the French author—the limitation of the therapeutic action of arsenic to the non-febrile periods and cases, and (on the other hand) its extraordinary efficacy within these limits, in restoring flesh and strength and general health, and wonderfully amending the state of the lungs themselves—are so important that they demand the serious and immediate attention of English physicians. M. Moutard-Martin employs the remedy in pills, as being more convenient than the liquid form; each of these pills (granules de dioscoride) contains a milligramme (·00156 of a grain) of arsenious acid, with manna and honey.

Another matter which deserves notice, and had escaped ours, is the experience of M. de Beaufort as to the efficacy of iodide of potassium in diseases of the lachrymal apparatus. This observer began by applying the treatment to comparatively recent and slight cases of obstruction of the sac and nasal duct, the result of coryza, chronic conjunctivitis, &c. Obtaining a speedy cure in several such cases, he proceeded to try it even in instances where a tough fibrous stricture had existed for a long time. Even in such apparently unlikely circumstances, he has twice obtained success by the treatment. Where there is lachrymal fistula, following an abscess of the sac, the iodide is also very useful, but its employment should be accompanied by applications of tincture of iodine.

A matter of some consequence is the opinion of M. Regnault respecting the comparative activity of various preparations of digitaline. In his preface to the seventh edition of Soubeiran’s TraitÉ de Pharmacie, this author remarks on the serious difference which exists between various samples of so-called digitaline. He declares that he finds himself driven to employ exclusively the granules of Hornolle and Quevenne. Under the head of digitalis also we may notice the employment, by MM. Dumesnil and Lailler, of a combination of opium (in the form of extrait gommeux) with tincture of digitalis. This appears, according to the authors, to have a calming effect upon the excitement and sleeplessness of insane patients, with less tendency, at the same time, to congestive effects than is the case when opium is given alone. They say that not merely does it produce better immediate effects, but that it can be more harmlessly continued after the original excitement has calmed down than other narcotics. But they remark that as digitalis, in therapeutic doses at least, has a well-known tendency to wear out the susceptibility of the organism for it, it is best to suspend its use as soon as may be. Two formulas are employed by the author:—

According to circumstances, the stronger or the weaker of these two prescriptions is the allotted potion for twenty-four hours. We have recounted all this gravely, but must not be expected to preserve our gravity to the last. Not even the respected name of M. Dumesnil can keep down an irresistible tendency to laugh when we are seriously told that 7½ minims of tincture of digitalis, taken in two separate doses in the course of twenty-four hours, will avert the mischievous excitement which might otherwise be caused by ? grain of extract of opium similarly distributed! That neither potion No. 1 nor potion No. 2 can be considered a dangerous narcotic we quite allow; but we fancy that must be because there is so little opium in either of them, not because there is so much digitalis. In fact, if we might be allowed to make a delicate suggestion to our therapeutical brethren of Outre-mer, it is, that just now they are going the least bit in the world crazy over digitalis and its wonderful properties. However, we have nothing but praise for such researches as those of MM. Oulmont and Hirtz, already noticed in these pages.

A small matter worth noting is the suggestion of M. Hager as to the bad effects of impure glycerine which are occasionally met with. It appears that certain glycerines, which are locally irritant when applied to the skin, prove to contain formic and oxalic acid; the latter is more especially the irritating agent.

Some interest attaches to a comparison instituted by M. Rabuteau between the action of sulphate of soda and that of sulphate of lithia. The former diminishes or removes thirst and produces constipation; the latter increases thirst considerably, and causes copious liquid stools and watery vomiting. The soda salt dries the alimentary canal, the other thickens the blood and pours out its watery element in abundant intestinal secretions.

The chlorides of sodium and lithium present analogous differences. The former does not purge when introduced into the veins, though it does purge when given internally in similarly large doses. Its ormolic effects are like those of sulphate of soda. Iodide of sodium has similar differences of effect, according as it is given by the veins or the alimentary canal. In short, the purgative effects of salines would appear to depend on the metallic and not on the metalloid element which they contain.

We must finish this hasty notice with a rÉsumÉ of M. Rabuteau’s ingenious theory as to the cause of the constipation which so often succeeds saline purgation. According to him, if the dose of the saline be large almost the whole is directly eliminated by the alimentary canal; if it be medium, a part passes into the blood; if it be small, nearly the whole of it is absorbed into the blood. In the first case, purgation is violent; in the second it is slight; in the third it is nil, and there is even constipation. But as a certain quantity of the medicine may have been absorbed, even when there has been powerful purgation, there may be consecutive constipation from the presence in the organism of the purgative salt, which slowly eliminates itself from the intestinal surface. Rabuteau inclines to think, though it is impossible to affirm, that not merely saline, but other purgatives, show analogous differences of action.

In concluding our notice of this Annuaire, useful and interesting as it is, we cannot but repeat the complaint we made last year. It is astonishing to what an extent the accomplished editor has ignored some of the most valuable therapeutic work done both in Germany and in England. We venture to say that he would have done better to attend to these matters, than to fill so many pages as he has done with a reproduction of his own papers on the etiology of saccharine urine, which is clearly beyond the proper work of his Annuaire.

De la MÉdication AntipyrÉtique. ThÈse de Concours. Par le Dr. A. Ferrand, Ancien Interne LaurÉat des Concours des HÔpitaux, &c. &c. Paris: F. Savy, 1869. 8vo. pp. 90.

(On Antifebrile Medication. By Dr. A. Ferrand.)

The author of this treatise is a really distinguished man in the jeune mÉdecine of France; and it is with a natural interest that we turn somewhat eagerly to the pages of his thesis to discover what are his ideas as to the part which treatment can play in pyrexia. One can hardly do better, in reviewing his work, than select the chapter on the “Indications in Fever,” as a kind of test object, to judge the quality of his work. Judged by this test, it must be pronounced very good. In a quiet and thoughtful manner, M. Ferrand inquires into some of the deepest problems of the physiology and chemistry of fever, and really hits, as it seems to us, most if not all of the principal difficulties which are troubling the minds of the most advanced pathologists and clinical observers in Europe. That he does not pretend to solve all these mysteries is no dispraise to him, but the reverse: at any rate it may be fairly said that he has carefully considered all the doubtful points by the light of the best observations in nearly every European country. If we were inclined to make any exception to his accuracy and completeness of information, it would be on the score of what he says, or rather omits to say, respecting the rÔle played by hydro-carbonaceous foods in alimentation. He seems to us to greatly undervalue, if not to ignore, the incalculably important results of recent researches in deciding the rank of non-azotised aliments in feeding, and consequently in great part disarming, the destructive force of pyrexial combustion. He assigns, as it appears to us, an altogether exaggerated importance to the secondary effects of pyrexia upon the nervous system: while at the same time he appears inadequately impressed with the enormous destructive incidence of febrile action upon the tissues. Upon this point M. Ferrand would surely do well to consult the description of what passes in the organism in pyrexia which was given by Professor Haughton in his admirable address before the British Medical Association at Oxford. He seems to forget, what Professor Haughton therein so ably showed, that a typhus fever or pneumonia patient lying still on his back, and with scarcely anything moving except the organs of vegetative life, and the deep chemistry of the tissues, does in fact a heavier day’s work than any healthy labourer!—heavier, that is, as regards the inevitable destruction of tissue that must go to the maintenance of the most elementary and necessary acts of life, in the absence of the power to assimilate ordinary nutriment. It is this defect (as we think it) in his physiology which makes M. Ferrand’s practical remarks on alcohol so very inferior to those which he makes, in the practical therapeutic portion of his work, upon other agents which he thinks appropriate to the treatment of the febrile state. His account of Todd’s doctrine and school is indeed extremely inadequate, and proves, for the hundredth time, how much that remarkable teacher has been misunderstood by the majority of those who have criticised his opinions, or supposed opinions. Here is a sentence, for instance, of M. Ferrand’s, which is nearly as incorrect as it is possible for a sentence to be—“Alcohol, for instance, is ... stimulant and resolvent in small doses; but in larger and more continued doses it becomes antipyretic.” That is precisely what alcohol does not do. Given in large doses (relatively to the needs of the organism), it becomes eminently pyretic. It need not always raise the temperature of those parts to which we apply the thermometer; but, assuredly, given in such doses as produce phenomena of intoxication, it does most directly increase and give a mischievous impulse to the destructive processes going on in the organism.

We have no wish, however, to leave an unfavourable impression of M. Ferrand’s very able pamphlet on our readers’ minds. On the contrary, we refer them with confidence to the work as a repository of a large amount of accurate and careful thought and observation on the nature and the remedies of the pyrexial state.

A Practical Treatise on Perimetritis and Parametritis. By J. Matthews Duncan. Edinburgh: Adam and Charles Black. 1869.

Though we have nothing to do with the pathology of this work, it may be as well to explain the meaning of the terms employed in the title, so that the value of the author’s therapeutics may be the better understood. Objecting to such expressions as pelvic cellulitis and inflammation of the uterine appendages, Dr. Duncan adopts in part the phraseology of Virchow, and employs the words perimetritis and parametritis, the former to signify inflammation of the uterine peritoneum, and the latter to imply inflammation of the cellular tissue in connexion with the uterus. With the justification of such a terminology we need not concern ourselves, but we may express a regret that so much of the author’s observations are confined to the natural history of these affections, and so little to the all-important problem of treatment. In a work extending over nearly 250 pages, one expects to find therapeutics represented by a greater space than that included in about a sheet of printed matter. Our disappointment, too, is enhanced when we find the author, in many instances, limiting himself to the vaguest of generalities, and, while sceptical as to opinions which do not coincide with his own ideas, credulous to a high degree on some points of traditional medicine. The only methods of treatment on which Dr. Duncan at all dwells are those of leeching and poulticing—save that, in a few words on internal remedies, he urges the use of mercury to produce slight salivation, and rejects, what many think so valuable, the employment of opium. He is strong on the subject of poulticing, and his statements are in accordance both with practical experience and À priori reasoning. He impresses seriously on his readers the importance, during the acute stage, of keeping up the poultices constantly night and day. As to blood-letting, his practice is definite, though his arguments from physiology in support of it are, we must confess, insufficient for us. Local leeching is, in his opinion, vastly superior in its effects to more distant venesection; and doubtless there is much good in the practice of applying a few leeches over the groin or to the perineum. But the following argument in favour of the former plan of distant blood-letting strikes us as being of that painfully unprecise character which unhappily is so much associated with medical research:—

“The profession in this country at least has lost all faith in this treatment, as well as in the corresponding doctrine regarding venesection of special veins of the upper extremity in disorders of the head. But enough remains in the well-known and, it appears to me, well-founded belief in the value and efficacy of the pediluvium in menstrual affections to prevent us from regarding these therapeutics as absurd; and, although not dreamt of in our modern and too self-sufficient medical philosophy, yet laws of sympathy between distant parts may be discovered which will explain and inculcate some such remedial measure, which now appears to be unreasonable.”

How, in the name of all that is “positive” in medical science, is therapeutics to advance an inch while philosophers reason to truth in this fashion? It would not be more absurd for a chemist to support a gratuitous speculation on the faith of a future recognition of phlogiston, than for an intelligent practitioner to establish a therapeutical fact by argument such as that which Dr. Duncan employs. When the author confines himself to telling us under what circumstances blood-letting should be adopted, he gives us the result of a valuable and wide clinical experience; but his hypotheses are, we confess, too much for us. We cannot understand why Dr. Duncan completely overlooks the subject of restoratives and tonics in perimetritis and parametritis; and we should be glad to hear his reason for ignoring such very important agents in the treatment of these affections.

The Atlas of Venereal Diseases. By M. A. Cullerier. Translated from the French, by F. J. Bumstead, M.D. Philadelphia: Henry C. Lea, 1868.

We wish for once that our province was not restricted to methods of treatment, in order that we might say something of the exquisite coloured plates in this fine volume; for the work is essentially one to aid in diagnosis rather than to detail means of cure. The Atlas, which Dr. Bumstead has not only translated, but very materially added to from his own stores of knowledge, is in every respect a most useful work for the practitioner, who is often called on to diagnose an affection which in the absence of a truthful history may appear either syphilitic or not in nature. With the aid of these handsome plates, there need be little difficulty in the identification of a syphilide. It must not be supposed, however, that therapeutics are neglected, or sacrificed to etiology. Both author and editor give us a very full account of the remedies now in vogue, and of their own clinical observations. We have not seen anything on the subject of the hypodermic employment of mercury, but the internal administration of the salts of mercury and iodide of potassium is of course enjoined. Indeed, the chapters on the treatment of syphilis are not the best. The section devoted to the remedial measures to be attempted in gonorrhoea strikes us as being copious and well arranged, and contains some sound, practical commentaries by the editor, who disapproves of the porte-caustique and other heroic modes, and recommends the use of an extremely weak injection of nitrate of silver (gr. ? to the ?j.) every three or four hours. His suggestions as to general treatment are equally judicious. In every respect this Atlas will be found most useful for reference by the busy practitioner.

The Medical Formulary, &c. By B. Ellis. Twelfth Edition, revised by Albert H. Smith, M.D. Philadelphia: Lea, 1868.

The aim of this work is to supply the young physician with the means of writing “elegant and judicious” prescriptions; and if we may judge by its success, the book must be one which meets a want. But we cannot help saying that the habit of writing “elegant and judicious” prescriptions is one of the barbarisms of the practice of ancient times which we should gladly see consigned to oblivion. It fosters charlatanism, and utterly retards all efforts to found a rational system of therapeutics. How can any logical induction, or any generalization of the slightest value be drawn as to the remedial effect of drugs administered after the mode laid down in such books as the “Formulary?” Without pausing to consider a recipe for pills which are “elegantly” and alliteratively styled “Chapman’s peristaltic persuader,” let us ask what can be the judiciousness of the following marvellous concoction of substances?—

Elixir of Cinchona.

?

QuiniÆ sulphatis, gr. xxv.

QuinidiÆ sulphatis,

CinchoniÆ sulphatis, aa gr. x.

Sacchari, ?xx.

Olei anisi,

Olei foeniculi, aa gtt. ij.

Olei cinnamonii Zeylandici, gtt. vj.

Olei cari, gtt. j.

Olei aurantii, ??xl.

Spiritus CuraÇoÆ, f. ?vj.

Alcoholis deodorati,

AquÆ rosÆ,

AquÆ, aa Oj.

Caramel, Ziij.

Misce secundem artem!

Conservative Surgery, with Reports of Cases. By Albert G. Walter, M.D. Pittsburg: Johnston.

This is a very verbose treatise on the mode of dealing with lacerated wounds, &c. The author recommends free incisions along the whole length of the limb, and the subsequent application of poultices and fomentations, assisted by general and local supporting measures. As is usual in such cases, he cites a vast series of cases, which, as is equally usual, might be cited in evidence of a very large number of different and conflicting propositions. There is some sense in the author’s practice, but a terrible deal of nonsense in certain of his physiological speculations.