"From the fact that in a certain number of cases pneumonia has got well of itself, must one conclude that medical treatment should be expectant? I do not believe it, and for my part I should not know how to remain inactive in the face of this malady. As soon as I am called to an invalid attacked with simple pneumonia, without any complication, I hasten to interfere with the aid of an antiphlogistic plan of treatment." (p. 602.)

XXXIV. The subject of this chapter has been made by M. Trousseau so thoroughly his own, that a brief notice at least must be given to the indications for paracentesis thoracis.

These axioms are put forward as reasons for the performance of the operation, and cases are cited to show their truth;

1. Pleurisy may terminate life merely by the excessive amount of effusion.

2. It may do so more indirectly by becoming the starting-point of accidents which are mortal sooner or later. The effused fluid may become purulent, and hectic fever supervene.

3. The continual irritation of the thoracic viscera may induce tubercular deposit in those persons who have constitutional predisposition.

4. The anatomical changes in the position of the lung, consequent on long duration of a pleurisy uninterfered with, prevent the organ resuming its functions.

Iodine injections have proved of essential service in instances of purulent accumulation.

The direct indications for the performance of the operation are to be drawn, not from the oppression of breathing, but from the conditions made out by auscultation and percussion. This one symptomi.e., the oppression of breathing-is thoroughly variable; its absence must not give rise to feeling of security, nor must its presence be deemed absolute proof of the immediate necessity for practising the operation.

The operation is then described; a preference is expressed for the simpler form of instruments; the puncture into the chest after division of the integuments should be made boldly and cleanly, since then false membranes will be penetrated by, not pushed before the point of the instrument.

The various objections to the operation are considered at the close of the section.

Our limits forbid any more lengthened notice. Enough will, however, we trust, have been adduced to prove the thoroughly practical character of the work, and to show the extreme care with which disease has been observed, and the attention paid to the relative value and interdependence of the accidental phenomena. We have met throughout with very many of the tendencies and opinions of some of our own highest medical writers.

The very aim and object of all sound medical authorship must be the accurate painting of disease, and the recording with all fidelity of the opinions and results of experience. In both these points we would add our humble testimony to the value of these collected lectures.

When so eminent a member of our profession sets forth the paramount importance of acquaintance with the natural history of morbid affections, and avows distinctly that this knowledge is, so to speak, the master-key of medicine, it augurs well for the future of the medical Based on data such as these before us, dependent no longer on the uncertainty of empiricism, content to be the handmaid rather than the fancied controller of nature, medicine may well be proud of the position which it will reach as an art, even though, with M. Trousseau, we allow that it falls short of the dignity of an exact science.

art.

REVIEW X.

Health and Disease as Influenced by the Daily, Seasonal, and other Cyclical Changes in the Human System. By EDWARD SMITH, M.D., LL.B., F.R.S., &c.-London, pp. 409.

AFTER reading the preface to this work, we turned to its pages with more than ordinary interest, inasmuch as the author states in limine that he has undertaken to supply a deficiency "which exists in medical literature, and to offer the results of a series of inquiries in aid of our knowledge of the two functions of the medical practitioner— the preservation of health and the treatment of disease." And we are glad to be able to say that in the perusal, from the beginning to the end, we have not been disappointed, the performance, we think, as a whole, answering the promise.

From the very nature of the work, both its method and matter, it is difficult to review, its method being aphoristical—a series of propositions-its inatter cycle within cycle of human existence, passing in order from the daily to the weekly and seasonal, and from thence to the changes in the ages of man, first giving the results of scientific researches, next their application to health and disease, including in the great argument the progress of the individual and of society, and not omitting those epidemic visitations which from time to time, as far back as history reaches, have been the scourges of mankind.

We are not disposed to find fault with this arrangement, for it has its advantages, especially with a view to development and enlargement, to which we look forward, little doubting that the book will be well received, and that Dr. Smith in successive editions will have it in his power to make emendations and corrections where these are needed, and to introduce without change of plan new facts as these are brought to light.

One, and the chief peculiarity of the work is its scaffolding or frame, this being the original researches of the author on certain physiological points of the first importance in their bearing on the vital economy-such as the rate of pulsation and respiration at different ages and under different circumstances, the quantity of atmospheric air inspired, the quantity of carbonic acid expired, the quantity of urea evolved and of urinary water excreted; comprising researches carried

on for several years, and in part daily, with little interruption, and not neglecting those of other inquirers, chiefly contemporary and most deserving of credit.

Whilst such is the framework, the larger portion of the whole may be considered as deductive: inferences from the scientific premises used in explanation of the registered results and the accredited cyclical changes and events. It is this portion of the work which, if we mistake not, is most open to criticism and most in need of it. Whilst we can agree with the author in a large amount of his deductions. there are some respecting which we cannot but entertain doubt, and some from which we must dissent. However, even when compelled to dissent, we give credit to Dr. Smith for ingenious and plausible, if not always for logical, reasoning. One, and not the least, excellence of the writing is its suggestive character, its very thoughtful mood, prompting to further research and to methods of research such as modern science requires, that science which is founded on weight and measure and is essentially exact.

Instead of attempting a regular analysis, which of such a work could hardly fail of being futile unless unduly lengthened, we shall bring under the notice of our readers certain portions as specimens of the whole, not doubting that those who take an interest in the science and literature of medicine will read the original.

First, of the pulse and respiration: Much new and valuable information is given respecting these, as influenced by age and sex, by position, rest, and exercise, food, fasting, &c., the results of the author's own observations, and conveyed in the form of tables-the conditions in health contrasted with those occurring in disease. This account of these, two of the most important functions-the pulse as the index of the heart's action, the respiration as the index of the state of the lungs variously modified-is deserving of the utmost attention of the medical practitioner. And not less important are the observations made by the author, the results of his own observations, together with those collected from the best original authorities, on the quantity of air respired, the quantity of carbonic acid formed, and the quantity of urea and urinary water excreted. In all these a certain correlation is noticeable; a correlation between the air inspired and carbonic acid formed, the urea and urine voided, the temperature of the body, the power of bodily exertion and of mental activity. We must refer to the work for details; we shall notice only a few of the more striking and least expected results. Speaking of the effects of meals on the pulse and respiration Dr. Smith observed, that not only was there an increase of these witnessed during the act of eating, but also a decrease in the interval of the courses; and that in the instance of children, in whom it was most apparent, the temporary increase was oftentimes twelve and fifteen pulsations per minute. The following passages are an epitome of the general course in the daily cycle of pulsation and respiration, as deduced from actual trials. Whilst they convey curious and valuable information, they also afford an example of the author's method and style:

"21. In the evening, from seven to nine P.M., there is an evident tendency in the rate to decline, and with some slight variations this is continued progressively through the following hours, until from one to three A.M., when the rate is at its minimum. During the next two hours there is a slight tendency to increase, but it is very gradual until the usual hour of rising, when it will have attained an increase of several pulsations per minute. Immediately after the breakfast has been taken there is a rapid and great increase, which attains its maximum in the second hour afterwards, after which it declines greatly in an hour, and loses from ten to fifteen pulsations immediately before the dinner. After the dinner has been taken there is another increase, but the rate is seldom raised so high as that which follows the breakfast, and the highest point is attained in the second or third hour. This again is followed by a decrease which precedes, and a subsequent increase which follows, the tea, when a point as high as that which follows the breakfast is usually found; and lastly, there is the final decrease, which is usually progressive, notwithstanding that supper may be taken at a later hour. When dinner had been taken at a later hour than that above indicated, the rate of the functions followed the same course as that now given, except that there was not any important increase after midday until the dinner hour. The rate remained low, but not uniform, from twelve to one P.M., until the dinner hour.

"22. The extreme difference was sometimes thirty pulsations per minute, and was the greatest in children.

"23. The ratio of the two functions varied with each hour of the day, but was highest during the day, and the lowest during the night.

"24. The ratio is dependent rather upon respiration than pulsation, so that the high ratio of the day is due to the fact, that whilst the rate of both functions is then increased, that of respiration is increased disproportionately. The extremes were as 1 to 29 and as 1 to 5-7, or the larger was double of the smaller ratio; but there was no ratio nor any progression of ratios which was absolutely uniform on consecutive days.

"25. The effect of posture is very different in different persons and at various times, both of the same and different days, so that averages give but a very imperfect view of the result." (pp. 11, 12.)

The quantity of air inspired and of carbonic acid formed appear, from some very accurate experiments recorded, to have varied in the same ratio. In three trials on different individuals, the proportion of carbonic acid produced to the quantity of air inspired at rest was 1 grain to 58 cubic inches in one, to 58.5 in another, and to 54.7 in the third:

There were commonly (Dr. Smith states) 4 minima and 3 maxima in the daily quantities of carbonic evolved, the former found immediately before cach meal (except supper) and during the night, and the latter following each meal. The largest increase commonly followed breakfast and tea, and then the total quantities evolved were nearly identical, whilst there was also a great similarity in the minimum quantities recorded between the intervals of meals. This variation was due to food, but there was a low point below which the quantity did not fall. The highest amount of this variation was from one-third to one-fourth of the whole quantity evolved. There was not any hour of the day in which the evolution of carbonic acid was stationary, except in the hour immediately preceding breakfast." (p. 32.)

The quantity of urea discharged in the daily cycle was ascertained to be as variable as that of any other element of the daily changes; and what is very worthy of note, it was found to be greatly increased

with the increase of urine under the influence of the water drunk, the latter acting, as it were, as a depurator of the blood-if we suppose, as is now very generally received, that the urea is formed in the blood --and is a criterion of organic waste-the débris of the nitrogenous compounds.

The second chapter, on the application of the scientific results to health and disease, is that portion of the work which is likely to be most studied, as laying down rules for the preservation of the one and the correction of the other, enforced by explanatory remarks founded on the results of experiments, using them as principles. The propositions expressing these rules will, for most part, be willingly assented to, more readily, we fear, than adopted and acted on, many of them being in opposition to the ordinary habits of society, such, as in the instance of the easy class, making the early meal the most substantial, when nourishment is most needed, and the vital power is at its maximum, and the late meal the lightest-a meal at which tea and coffee are most appropriate, these beverages promoting respiration and digestion, and thus conducing to the depuration of the blood and the excretion of urea; and in the instance of the working class, the propriety of not beginning labour before breakfast, and limiting it to the interval between the early and late meal-that is, from about six or seven A.M. to five or six P.M., when the system, on physiological data, seems best fitted for muscular exertion.

Whether in these rules the author has made sufficient allowance for the force of habit, as to times of eating and the power man has of conforming to circumstances without material injury of health, is open to question. We rather think he has not, and that consequently his rules are to be accepted for what they are worth; as true, so far as the limited results warrant, but not as universally true; and this remark applies to many other of his deductions.

From the daily cycle of changes to which man is subject, the author proceeds to the discussion of the weekly cycle, which, though not so evident, yet he believes to exist, founding his persuasion chiefly on the variations of functions observed to result from a day of rest, as exhibited in the rate of pulsation and respiration, and the evolution of carbonic acid and urea-all, he thinks, tending to demonstrate that "a periodical day of rest is necessary to the well-being of the body if a suitable amount of exertion be daily made;" and this he holds to be a rule applicable to the industrious of all classes, exempting idlers only, who may be left to the exercise of their own discretion.

Such a conclusion, the result of scientific inquiry, well agrees with the dictum of Sacred Writ, "that the Sabbath was made for man, and not man for the Sabbath;" and let us hope that the labouring man will never be deprived of the blessing of the one day out of the seven for rest, recreation, and the refreshment resulting from these benefits.

The seasonal cycle, the subject of the fourth chapter, is the one which Dr. Smith discusses most at length, prefacing it with a brief account of the opinions of the ancients thereon, and at the same time expressing his