Page images

heart. Those malformations only are spoken of which are compatible with extra-uterine life, whether of long or brief duration.

The first class of malformations comprises cases in which the heart consisted respectively of two cavities, of three cavities, and of four cavities, with one or both septa imperfect; the presence of a supernumerary septum, to which the author attributes "the majority of cases of apparent duplicity" of the cavities of the heart which are on record, is discussed under the same head. It appears that the right ventricle is the part most liable to this malformation, and that its morphology is explained by reference to the hearts of the higher reptiles. We here find the heart consisting

"Of three imperfectly-separated ventricles; the right and left systemic ventricles, from which the two aorta arise, and a small anterior ventricle, which gives rise to the pulmonary artery. The latter is entirely separated from the left, but communicates with the right aortic ventricle. The sinus and infundibular portion of the right ventricle are in man the analogues of the right systemic and pulmonic ventricles of the turtle; the right ventricle in the wellformed human heart always shows, at the point at which the two portions unite, some indications of division by the muscular columns to which the folds of the tricuspid valves are attached; and in cases of malformation this is still more marked. When also a supernumerary septum is developed, it is at the point of union of the sinus and infundibular portion that it occurs."

The malformations of the second class comprise premature closure of the foetal passages, and patency of the foramen ovale and ductus arteriosus. The third subdivision is devoted to irregularities of the valves, such as excess or deficiency.

The fourth division of the book presents us with an historical analysis of the malformations consisting in the irregular development of the primary vessels, together with Dr. Peacock's personal experience in these deviations from the normal state.

The work concludes with a valuable inquiry into the development of the malformations previously spoken of, and with remarks on the diagnosis and treatment of these affections. The whole deserves a careful study, and while we regret our inability to give a more detailed account of the information it contains, we cannot refrain from extracting the following remarks on some of the diagnostic features presented in the young child:

"Where an infant suffers from great difficulty of breathing and palpitation, and is intensely and constantly cyanosed at or immediately after birth, it may be inferred that it labours under some serious malformation, occasioning great obstruction to the circulation of the blood-as obliteration or contraction of the pulmonic orifice, or transposition of the aorta and pulmonary artery. On the contrary, when the symptoms do not manifest themselves at so early a period, and are less constant and intense, there is probably only some slight malformation, as a moderate amount of contraction at the pulmonary orifice. Of 153 cases of various forms of decided and important malformations of which I have collected notes, in 74 there existed more or less contraction of the orifice of the pulmonary artery, or other sources of obstruction to the exit of the blood from the right ventricle; and in 25 others the orifice or trunk of the vessel was obliterated. In those patients who survived the age of twelve, the entrance of the blood into the pulmonary artery was interfered with in a much larger proportion of cases, or in 32 out of 39; so that, in any given case of malformation, especially after the age of fifteen, the probability is that the pulmonary artery is contracted. If this be the case, a loud systolic murmur will be heard in the præcordial region, and most intensely at the level of the nipple, and between that body and the sternum."

Obstruction of the pulmonic orifice almost necessitates deficiency in the septum of the ventricles or patent foramen ovale; but Dr. Peacock considers it doubtful whether we possess diagnostic characters by which these can themselves be recognised. Collateral evidence may sometimes aid in the diagnosis.

Of the treatment recommended to be pursued, it suffices to say, that it aims at meeting the physiological requirements of the case, and is perfectly rational.

In concluding our observations on Dr. Peacock's book, we would only add, that it is one which must take a high rank in medical literature, and cannot fail to serve as an important aid to all students of cardiac disease.

ART. II.-The Diseases of Children. By FLEETWOOD CHURCHILL, M.D. T.C.D., M.R.I.A., Fellow of the King and Queen's College of Physicians; Professor of Midwifery, with Diseases of Women and Children, in the King and Queen's College of Physicians; Honorary Member of the Philadelphia Medical Society, &c. Second Edition. -Dublin, 1858. pp. 782.

Ir is now eight years since we had occasion to present to our readers an analysis of the first edition of Dr. Churchill's work 'On the Diseases of Children,' in which we were compelled to point out certain deficiencies. It affords us pleasure in stating that he has consulted his own distinguished reputation in the additions and improvements which he has made to the second edition, and that many of the subjects which were not adverted to in its predecessor now receive ample attention. Mesenteric disease, phthisis, paralysis, scleroma, atelectasis, syphilis, which were passed over in the former work, now form the subjects of so many new chapters, while throughout the volume we discover evidences that the author has watched the progress of science, and gathered its fruits for the benefit of his readers. The additional matter introduced in the present volume amounts to a hundred and twenty-six pages. It may appear almost ungracious, where so much labour has been expended, to ask for more, yet we cannot but think that when a third edition is required, by the condensation of some parts, space may be obtained without further enlargement of the volume, for the introduction of some further matter which we are of opinion ought not to have been omitted; thus, a chapter on scrofula would be very acceptable; rachitis, purpura, diabetes, nephritis, are also among the topics which, in a volume like the one before us, deserve a prominent place, and of which we have found no notice.

ART. III.-Evil Results of Overfeeding Cattle. A New Inquiry, fully Illustrated by Coloured Engravings of the Heart, Lungs, &c., of the Diseased Prize Cattle lately exhibited by the Smithfield Cattle Club, 1857. By FREDERICK JAMES GANT, M.R.C.S., Surgeon and Pathological Anatomist to the Royal Free Hospital.-London, 1858. pp. 39.

ANXIOUS to demonstrate that the system which is at present pursued by persons ambitious of obtaining prizes at cattle-shows for their farm produce is a vicious one, Mr. Gant has applied the test of pathological anatomy. He has been at some pains to follow the prize oxen, prize sheep, and prize pigs, from their pens in Baker-street, to the slaughterhouse in Hampstead, and the result of his researches is, that these animals, without exception, suffer from fatty degeneration of the muscular tissue, and that this disorganization is particularly perceptible in the heart. The delineations are truthfully and artistically executed, and entirely confirm the author's descriptions. Mr. Gant argues justly, that meat so got up cannot possess the nutritive qualities of muscle in which the fibre is not degenerated, and that it is more to the interest of breeders and of the public to follow a system of training cattle which shall preserve the animals in health, while it produces the maximum of food that they are capable of yielding.

We recommend the supporters of the Smithfield cattle-shows to pay attention to the facts ably and clearly put before them by Mr. Gant; and a little reflection will show them that there is an error in pursuing the system of fattening animals intended for human food, to the extent to which it is now carried; they are perpetuating an error alike disadvantageous to the producer as to the consumer.

ART. IV.-Rheumatism; its Nature, Causes, and Cure. Gout; its Nature, Causes, Cure, and Prevention. By JAMES ALEXANDER, M.D., Member of the Royal College of Physicians, Fellow of the Royal College of Surgeons, &c.-London, 1858. pp. 266.

THAT there is an analogy between gout and rheumatism nobody would be disposed to deny; that there are forms of the two diseases which so closely resemble one another as to render the diagnosis difficult, is also indubitable; but we can scarcely admit that diseases, which in their typical manifestations present such characteristic distinctions, are due to a retention of the same poison in the blood. This is essentially the doctrine advocated by Dr. Alexander in the book before us. He regards urate of soda as the materies morbi in both these diseases, the difference in form and degree between them depending

"Partly on the difference in the chain of events which has preceded and led to the formation of the morbific matter, and which has at the same time exercised an important influence on the character of the vital fluid itself, and partly to the different effect which this animal irritant exercises on two opposite conditions of the blood."

The urate of soda is raised to a pinnacle of importance which it has not hitherto enjoyed, and if we adopt Dr. Alexander's version, we shall be compelled to return to the mechanical theories of Asclepiades, or to the analogous doctrines of the iatro-mathematical school of later days. The pain of rheumatism and gout is attributed to the irritation caused by the entanglement of the particles of urate of soda in the fibrous structures which are the chief seats of the local phenomena of the disease; at the same time, owing to its being "a very powerful animal irritant," it stimulates the lining membrane of the heart, causing increased action of the heart, and consequently a quick bounding pulse. That we may not be supposed to misrepresent the author, we quote his own words. In speaking of the fibrous structures which are the seat of rheumatism, he says: "The particles of urate of soda become mechanically arrested between the fibrilla of which these dense structures are composed." And again :

"The pain of rheumatism in the acute fibrous form of the disease is dependent on the particles of urate of soda which accumulate in the myolemma and sarcolemma of the muscles pressing on the nervous fibrille which traverse these structures, and temporarily paralysing them by the pressure occasioned by their accumulation."

Although a great deal of the book is purely theoretical, and calculated to excite controversy rather than to convince the reader, we have no objections to raise to Dr. Alexander's method of treatment, which is rational and judicious, inasmuch as his chemical and mechanical theories regarding the diseases in question fortunately lead to conclusions which are in harmony with the therapeutic proceedings adopted by the most enlightened practitioners of the day.

ART. V.-On Medicine and Medical Education. Three Lectures, with Notes and an Appendix. By W. T. GAIRDNER, M. D., Fellow of the Royal College of Physicians, and Lecturer on the Practice of Physic, Edinburgh.-Edinburgh, 1858. pp. 130.

Nor long ago, we introduced to our readers an ethico-medical trilogy, by Dr. Simpson, of Edinburgh; we have now to recommend to them-and we do so heartily-another similar production by Dr. Gairdner of the same town. There is necessarily a great resemblance between essays of this kind if the different authors stand on the same ground of science and morality; and yet we are glad to see them multiplied so that each successive generation of students may at least have an opportunity of becoming imbued with the high and able principles that animate their teachers. Dr. Gairdner's little book is not, however, intended for students of medicine only. His second lecture was addressed to the members of the Scottish Educational Institute, and places before them, in suitable terms, the fallacies which prevail among the general public regarding medicine and its professors. Not the least interesting part of the collection is contained in the notes to the last lecture, where we find succinct accounts of the lives and teachings of Paracelsus,

Brown, and Hahnemann. An appendix concludes the book, in which Dr. Gairdner strongly advocates a system which we, too, with many other teachers, would gladly see carried out -viz., the institution of examinations by the medical corporations at the end of every session, or, as he terms them, sessional examinations. To be of any service, they would necessarily be compulsory; and that they would exercise a beneficial influence upon the student, by insuring continuous instead of spasmodic study, who can doubt that knows students and student life? The only question with us is, whether it would not, for various reasons, be better that the examinations should be instituted by the teachers themselves than by the Halls and Colleges. The prize system, as it now prevails, is acknowledged to be vicious-the chief objection to it would fall to the ground if all students were required to enter for competition, and by that means a uniform emulation in all the classes maintained.

ART. VI.-Transactions of the National Association for the Promotion of Social Science, 1857. Inaugural Addresses and Select Papers. London, 1858. pp. 608.

OUR readers will probably remember that in the month of October of the past year, a meeting was held at Birmingham, presided over by Lord Brougham, to which all were invited who had worked, or were supposed to be interested, in the cause of social science. As set forth in the introduction to the Transactions by Mr. Hastings, with whom the idea appears to have originated, the object was to form "an association for affording those engaged in all the various efforts now happily begun for the improvement of the people an opportunity of considering social economics as a great whole." The plan was most successfully realized, and the various phases of social science were represented in five departments, each separately organized, but working together to the one great object of the advancement and growth of Christian society and civilization. The first department, devoted to Jurisprudence and Amendment of the Law, was presided over by Lord John Russell; the second, for Education, was under the chairmanship of Sir John Pakington; the third, under the presidency of the Bishop of London, investigated the questions connected with Punishment and Reformation; Public Health was the topic to which the fourth department turned its attention, with Lord Stanley at its head; while the fifth department, under Sir Benjamin Brodie's leadership, was devoted specially to Social Economy.

No man could be more suitably selected to head such an undertaking than Lord Brougham; second to none in zeal for the advancement of man in all his social relations, superior to most of the living in profound acquaintance with the intellectual produce of mankind. In the opening address delivered by this great man we receive the strongest evidence in favour of such combinations as that of the Association for the Advancement of Social Science. No one has had greater experience than he of the beneficial effects of combined action in the advancement of civilization; and few could, from personal knowledge of his contemporaries, or from appreciation of the labours of the past, speak with greater authority on all the topics which this Association proposed to inquire into. It was well done, then, to request Lord Brougham to preside, and to tell the assembly, and the country at large, both what the Association was called upon to undertake, and what it had in its power to achieve.

The present volume is a proof how earnestly men of all denominations and professions are working at the different problems of modern times. It contains valuable papers read at the meetings of the different departments, besides the very interesting addresses of the respective chairmen; and no small credit attaches both to the originators of the movement and to those who thus far have brought it to a successful issue.

ART. VII.-Lehrbuch der Allgemeinen Chirurgie. Von C. F. LOHMEYER, Dr. Med.' &c.-Lahr, 1858. 8vo, pp. 253.

A Compendium of General Surgery. By Dr. LоHMEYER.

THIS Volume is one of a circle of the medicinal sciences of which Dr. C. H. Schauenburg

is editor. The plan which the author follows in treating the subject may be deduced from his introductory remarks:

"General surgery," he observes, "takes cognizance, generally, of those disorders which admit of mechanical aid; it has to investigate the laws of their origin, development, and changes, and to furnish means for their cure. If a comprehensive view be taken of those maladies which are regarded as objects of surgical treatment, it will be found that they naturally divide into three leading groups, according to their more prominent appearances, but of which it is not possible accurately to define the limits. Thus we observe, on one hand, a great series of changes, which we must regard as signs of irregular nutrition, as, for instance, inflammatory processes, mortification, hypertrophy, the formation of pathological tissues, &c. On the other hand, we meet with anomalies of coherence-partly as abnormal separations, partly as faulty unions-conditions which are often the sequel of disordered nutrition, but frequently originate in other causes, such as direct mechanical injuries, spasmodic affections of muscular structures, and the like. Thirdly, we encounter abnorinal relations which depend on the irregular form or situation of individual parts of the body-curvatures, luxations, hernias, prolapsus, pathological phenomena, again, which may result from very different causes."

A considerable portion of the work is devoted to surgical pathology. A number of woodcuts are interspersed throughout the text, mostly illustrative of morbid changes of structure; and two lithographic plates, containing figures taken from the writings of Paget, Förster, and others, are inserted at the end of the volume. On the whole, we consider the author has produced a useful compendium, and one likely to prove acceptable to the junior practitioners of his country.

ART. VIII. Das Wesen und die Entstehung der Spondylolisthesis. Von Dr. WILHELM LAMBL, Docent an der Universität in Prag.- Würzburg, 1857. pp. 79.

The Nature and Origin of Spondylolisthesis. By Dr. WILLIAM LAMBL, Teacher in the University of Prague. (A Reprint from Scanzoni's 'Beiträge,' Band iii.)Würzburg, 1857.

THE purpose contemplated in Dr. Lambl's work is the anatomical examination of all the hitherto known cases of pelvis with a dislocation of the fifth lumbar vertebra forwards, with consecutive lordosis of the loins, so as to contract the pelvic space, and increase the danger of childbirth. Dr. Lambl's researches show that the anomaly, though rare, is very important. The recorded cases of this remarkable pelvic deformity are the following. We repeat the list here in order to multiply the opportunities to our readers of inspecting a preparation of the deformity for themselves: 1, The Prague case, the preparation of which is in the collection of the Lying-in Institution at Würzburg; 2, A preparation in the Anatomical Museum at Munich; 3, A gigantic pelvis, and 4, A small pelvis, with this deformity, both in the Pathologico-Anatomical Museum of Vienna; 5, A pelvis in the possession of the director of the Midwives' School of Dr. Everken, of Paderborn. To these are added descriptions of other pelves presenting analogous or illustrative features met with by the author in his travels. His theory of the origin of the deformity may be briefly summed up as follows: Lumbo-sacral hydrorachis, traces of which disease were discovered in all the preparations, is the primitive causal condition of a deformation of the fifth lumbar vertebra, which leads, through dilatation of the canal, to thinning and lengthening of the vertebral arch. With this elongation of the vertebral arch and dilatation of the canal, a real displacement of the articular processes is observed. Together with this divergence of articular processes, which is produced by the elongation of the interarticular substance, the inferior oblique processes suffer a twisting of their articular surfaces, so that these last, deviating from their oblique normal direction, obtain an abnormal parallel direction. Under these circumstances the weight of the body brings about the further deviation of the vertebral column. The size and compressibility which the intervertebral cartilage of the lumbo-sacral joint possesses in so high a

« PreviousContinue »