cases of acute phthisis have been observed which have presented here and there a speck on the abdomen, having many of the characters of the typhoïd rash. Now, the diagnosis between this form of rapid pulmonary tuberculization and typhoid fever has been discussed with considerable minuteness by several writers, amongst whom are Walshe and Louis; and on careful comparison of the symptoms and postmortem appearances detailed by Dr. Copland, and those observed by the above-named authors, we fail to find any ground for specific distinction. The author insists particularly upon the trifling character of the cough and the scantiness of expectoration, in the cases which have come under his notice; but the absence of expectoration in some instances, in others its clear or opalescent character, and the rarity of viscid sputa, have been noticed by Walshe, who also observes that cough may only follow the fever in the order of development. Again, in three of the cases of acute phthisis detailed by Louis, the amount of expectoration was trifling, and in one instance the entire absence of both cough and expectoration in the initial stage is especially noticed by him. In every other essential indication, as well as in the postmortem appearances, the form of phthisis simulating low fever described by Dr. Copland is the same with that which has been for years fully recognised.

The sections on etiology and treatment embody the results of an extended acquaintance with ancient and comparatively recent medical literature, together with the fruits of the author's personal observation and experience. The consideration of treatment is prefaced by an historical introduction which fully upholds the reputation for erudition which Dr. Copland enjoys. We doubt, however, whether many readers will agree with the conclusion at which he arrives as to the relative position of past and present methods of treating phthisis. He is of opinion that, with the single exception of the introduction and use of cod-liver oil, the treatment of pulmonary consumption in the present day is nearly the same as that advised by the best medical writers of the seventeenth and eighteenth centuries, and more particularly by Bennet and Rush. The following is a sketch of the treatment recommended by the former physician

"For hæmoptysis leading to phthisis, he advises bleeding, warmth to the extremities, and bleeding from the feet in females, if the catamenia be scanty or suppressed. He recommends milk and milk diet, but prefers medicated whey, and reprobates the use of saccharine substances, as productive of an injurious fermentation. He considers the best expectorants to be those which contain resin and turpentine. Bennet also has recourse to frictions and fomentations, and to balsamic fumigations. These last should consist, in his opinion, of frankincense, turpentine, and styrax, with cinnamon, coltsfoot, and other articles, made into a powder or troche, and burnt on coals. He prescribes also mixtures of herbs, on which boiling water is poured, and the vapour to be inhaled by holding the head over the vessel containing them. Issues are much praised, and, according to my experience, with great justice. He directs them in various situations, according to the symptoms, and he considers that they may be kept sweet by using peas of orris root, and when the discharge should be promoted, he advises equal parts of hermodactyls and He recommends Welsh flannel to be worn next to the skin, and not

wax.

to be too frequently changed. Animal food, neither very fat nor lean, is allowed, and a gentle emetic is given when the stomach is loaded; and a decoction of sarsaparilla and other woods, with ginseng, is recommended for drink. If we except the recent employment of cod-liver oil in phthisis, in what, it may be asked, has the treatment of this disease been advanced since the appearance of the work of Bennet, by the voluminous writings of specialists and stethoscopists in recent times ?"-pp. 191, 192.

To the question thus triumphantly put, it may be answered, first, that bleeding for hæmoptysis is not a practice which meets with much favour in the present day. Most living physicians with whose opinions we are conversant, would as soon think of drawing blood to arrest uterine hæmorrhage, or to stop a wounded artery; and, secondly, that the main improvement depends on the universal acceptation of the doctrine, that phthisis is essentially a disease of imperfect nutrition and assimilation, and that efforts in treatment must therefore be mainly directed, not to the pulmonary, but to the digestive systems. The principal treatment of phthisis now-a-days consists in the free administration of nourishing animalized diet, containing a large proportion of the fatty elements of nutrition; in exercise, with unrestricted exposure to the invigorating influences of sun and air; and in the substitution of a few simple but effective tonic medicines for the effete polypharmacy of our predecessors. Doubtless an analeptic method was occasionally advocated by physicians of a past age, although its supporters have been in the minority; but even their advocacy was imperfect, because founded on no clear view of the pathology of tuberculization.

Constantly haunted by a dread of the supervention of inflammatory action, they were ever and anon recurring to small bleedings or other antiphlogistic measures; whilst the principal part of their ordinary treatment consisted in the exhibition of expectorants, sedatives, counter-irritants, and derivatives. We by no means deny the use of the latter-named classes of remedies in relieving symptoms, but every country apothecary is now aware that such remedies are mere palliatives, and that they do far more harm than good when they are permitted to interfere with true reparative measures. Were it needful to say one word respecting the fumigations recommended by the physician. thus eulogized, and as used in olden times, we might stop to prove that some advance has been effected in medicine by the progress of chemistry and physiology. We now know that a man deprived of a portion of his lungs is virtually in the position of one whose supply of oxygen has been in part cut off; and that, were there no other objection to burning a farrago of drugs constantly in his apartment, by the very combustion itself his supply of the life-giving element would be still further diminished.

On turning to the treatment recommended by the author, we have certainly been surprised to find local and in some instances general bloodletting still advised in the first stage of phthisis; but the advice is surrounded with so many cautions and exceptions, that we feel convinced the cases in which he in practice would prescribe it must be very few and far between. In most other respects his treatment is of a reparative character, although occasionally allowing too great deviation, as it appears to us, in an opposite direction. The following are

An inland

amongst the results of Dr. Copland's personal observation. locality is to be preferred to a residence by the sea, provided the former offers equal advantages as to dryness of air, annual, monthly, and daily changes of temperature and vicissitudes of weather, together with facilities for out-door exercise. During the early stages and in the winter months, sea voyages, especially in the Mediterranean, Pacific, and Atlantic Oceans, between latitudes 10° and 30°, are recommended. Under the head of residence, the value of a dry atmosphere and of elevation above the level of the sea, is insisted on, although the assertion that inhabitants of marshy districts, where ague is endemic, are singularly free from pulmonary tuberculosis, is to a certain extent confirmed by the author's experience. The influence of various localities, both in this country and abroad, is discussed at considerable length, and the chapter on this subject will afford a valuable fund of useful information to the practitioner. In respect of purely medical treatment, great stress is laid on external medication, especially on the employment of issues and setons in the earlier stages, and on the continued application of terebinthinate liniments, the good effects of which Dr. Copland believes to depend partly upon inhalation of the vapour. The internal administration of turpentine is spoken of as a most valuable remedy in hæmoptysis; in this we most fully concur, although we cannot assent to the propriety of even the small bloodlettings" to arrest hæmorrhage and remove local congestion," which are also recommended. Cod-liver oil is stated to be the remedy on which most reliance may be placed to diminish the excessive perspirations which accompany the softening stage, and the administration for the same purpose of Griffiths's mixture, or of the muriated tincture of iron in twenty-minim doses, as recommended by Dr. Watson, is spoken of with approbation. Amongst the older medicines which have fallen into comparative disuse, sulphur has appeared to the author to be occasionally productive of benefit; he does not, however, particularize the conditions under which its exhibition is likely to prove advantageous. The sulphureous waters of Harrowgate are recommended in scrofula, glandular affections, and the earlier stages of phthisis, the curative influence of the waters being favoured by what are considered the advantages of a high, dry, temperate, and inland locality.

The latter portions of the work are allotted to phthisical affections of the larynx and trachea, and to a treatise on the various forms of bronchitis. Our space, however, is already exhausted. It only remains to observe that the expectations with which we commenced our review of Dr. Copland's labours have been in most respects fulfilled. Although we have ventured to disagree with many of the opinions advanced, and however we may regret the tone in which some of those opinions are enunciated, whilst, moreover, we are fully aware of omissions, some of which-as, for instance, the neglect of all reference to the influence of pregnancy on phthisis-constitute serious defects, we must yet allow to the treatise a certain value as a learned and laborious compilation, and as at the same time embodying the individual experience of the author.

PART SECOND.

Bibliographical Record.

ART. I.-An Introduction to Practical Chemistry, including Analysis. By J. E. BOWMAN, F.C.S., late Professor of Practical Chemistry in King's College, London. Edited by C. L. BLOXAM, Professor of Practical Chemistry in King's College, London; Lecturer on Chemistry in the Royal Military Academy, Woolwich. Fourth Edition.-London, 1861.

A NEW issue of this well-planned and well-written book has lately appeared; the subjects treated of are explained in such simple yet elegant language, that the work has deservedly become a general favourite. Having pointed out the chief features of the author's plan in noticing former editions, we may now conteut ourselves with a few words as to the difference between the present and the last (1858) edition.

The editor announces in the new preface several alterations and improvements, especially in the course of qualitative analysis, the use of the blowpipe, and the examples of volumetric analysis.

Chapters I. to IV. of Part I. remain almost unaltered, and in the early part of Chapter V. we find no change. But at the end of Chapter VI. an excellent "Systematic Examination of Unknown Substances with the Blowpipe," is detailed; it proves, however, on closer inspection, to be nothing more than a part of what is generally termed the "Preliminary Examination." Section 147, p. 52, now seems obsolete in great measure, owing to the improved photo-chemical methods of Cartmell and Bunsen, a simple and brief notice of which might very well be here introduced.

One or two additions have been made to the chapter on alkalimetry and acidimetry, including the determination of iron by means of permanganate of potash. Might not an example of quantitative gasanalysis have been given here? such, for instance, as Pettenkofer's beautiful and accurate process for estimating carbonic acid in the air -a process which any student taking moderate care can perform successfully.

In Part II. the reactions of the bases are described under the metals, and the reactions of the acids under the non-metallic bodies, Although beyond this we do not see any very striking alteration in the course of qualitative analysis, yet it is evident that this part of the volume has been very carefully revised. Most of the changes

57-XXIX.

11

made are decidedly for the better, and tend to facilitate the progress of the student. Among these improvements, a place might advantageously have been found for the following special tests of tried excellence, most of which are now in common use in the laboratory: Binoxide of lead with nitric acid, as a test for manganese.

Binoxide of lead with hydrate of potassium, as a test for chromium in the state of sesquioxide.

Nitrite of potassium, as a test for cobalt.

Sulphate of strontium, to discriminate between barium and strontium.

Disulphate of copper as a test for iodine.

Potassio-iodide of mercury as a test for minute traces of ammonia. In the case, too, of molybdate of ammonium, a meagre foot-note on p. 122 is all the information given, and does not describe the way of applying the test for the detection of phosphoric acid. Chloride of palladium as a test for iodine is referred to with similar brevity on p. 126. In the examination for acids, the further analysis of the precipitate produced by nitrate of silver is not given with a fulness sufficient to ensure satisfactory results.

In the table of the more important elements given on page 2, we think that lithium, cadmium, molybdenum, and tungsten might be added with benefit, since several compounds of these metals are now manufactured, and have become comparatively common.

We note a few additions in the remainder of the volume: for instance, some fresh examples of quantitative analyses are given. One or two of the more modern and more perfect forms of gas-burners and gas-blowpipes devised by Griffin and others might have been substituted for those represented on pp. 214 and 215; Bunsen's burner, in some of its numerous forms the most useful of all, is dismissed in a foot-note of one line.

But the merits of the book are so conspicuous, and the faults so trivial, that we may be excused for pointing out the defects which seem to us to mar, though slightly, the general perfection of this sound and useful work.

Von

ART. 11.-Die Formen des Beckens, insbesondere des engen weiblichen Beckens, nebst einem Anhange über die Osteomalacie. Dr. CARL CONRAD Th. LitzMANN.—Berlin, 1861. The Forms of Pelvis, especially of the Narrow Female Pelvis; with an Appendix on Osteomalacia. By Dr. C. C. TH. LITZMANN. PROFESSOR LITZMANN, the distinguished Professor of Medicine and Midwifery, and Director of the Lying-in Institution of the University of Kiel, has contributed in this work an elaborate and most useful account of the varieties of that formidable obstetric difficulty, the narrow pelvis. His descriptions are based upon extensive personal inquiries, and undoubtedly constitute the most systematic and accurate account of the subject hitherto published. Inverting somewhat the order followed in the book, we find a most interesting historical