Perhaps the facts may be rendered more easily appreciable by a different arrangement, as in Table III.

The indications of these tables seem to me tolerably clear. They not only disprove the old notion of the special liability of xanthous persons, but go far towards proving consumption to be more rife among dark-eyed, dark-haired people.

Dark eyes, it will be seen, were more frequently met with among the phthisical than in any one of the five sections of the general population, with which Dr. Beddoe has compared them.

Red hair rose slightly above, and fair hair fell a little below the average. Brown hair (corresponding to the "chatain" and "chatain clair" of the French, and not to their "brun") counted little more than three-fourths of its proportionate number. Dark brown, on the other hand, rose almost as high above the average, and black still higher, showing an excess in the proportion of more than 3 to 2. The frequency of black hair among the non-phthisical Irish does not tell much on the average, as Ireland furnished only 43 cases out of his 500-less than 9 per cent.

Dr. Beddoe could detect only one possible source of fallacy worth mentioning. It is conceivable that the progress of the disease may be in general more rapid, and the duration of sojourn in hospital consequently shorter, in fair than in dark subjects. The result of this would be to diminish unduly the number of xanthous persons present in hospital at any given time. The observations taken in Edinburgh, fully one-half of the whole, are almost free from this objection, having been made while the author was resident in the infirmary, and had the opportunity of examining the cases on or soon after their admission. That consumption may be very frequent among persons of fine skin and delicate complexion, Dr. Beddoe by no means intends to deny; in fact, he believes that a very fair complexion, especially when conjoined with black hair and eyes, is very often associated with proclivity to tubercular disease. But into this question he does not enter, inasmuch as it cannot, like that which has just been discussed, be readily brought to the touchstone of numbers.

ART. 56.-Effect of Local Influence on Spasmodic Asthma. By Dr. HYDE SALTER, Assistant-Physician to the Charing Cross Hospital.

(Edin. Med. Journal, June, 1858.)

The following conclusions appear to be established by several cases related in this paper:—

1. That residence in one locality will cure, radically and permanently cure, asthma resisting all treatment in another locality.

2. That the localities that are the most beneficial to the largest number of cases are large, populous, and smoky cities.

3. That this effect of locality depends probably on the air.

4. That the worse the air for the general health, the better, as a rule, for asthma; thus the worst part of cities are the best, and conversely.

This class includes not only coal-black, which is rare in this country, but certain shades of dark brown, which are not readily discriminated from black unless in a very good light.

5. That this is not always the case, the very reverse being sometimes so-a city-air not being tolerated, and an open pure air effecting a cure.

6. That there is no end of the apparent caprice of asthma in this respect, the most varying and opposite airs unaccountably curing.

7. That, consequently, it is impossible to predict what will be the effect of any given air, but that probably the most opposite to that in which the asthma seems worst will cure.

8. That some of these differences determining the presence of cure of asthma appear to be of the slightest possible kind, arbitrary and inscrutable.

9. That the mere conditions of locality appear to be adequate to the production of asthma, in a person whose disposition to it was never before suspected, and who probably would never have had it had he not gone to such a locality. 10. That, consequently, many healthy persons, who never have had asthma, and never may, probably would be asthmatics if their life had been cast into other localities.

11. That possibly there is no case of asthma that might not be cured if the right air could only be found.

12. That the disposition is not eradicated, merely suspended, and immediately shows itself on a recurrence to the original injurious air.

13. That change of air, as change, is prejudicial.

14. That, from the caprice of asthma, the constancy of the results in any given case is often deranged.

ART. 57.-On Measuring the Capacity of the Chest in Disease. By Dr. J. SCOTT ALISON, Assistant-Physician to the Hospital for Consumption, Brompton.

(Dr. Beale's Archiv. of Med., No. II., 1858.)

While the capacity, the dimensions, and the expansion of the thorax are respectively well gauged by the spirometer, the inch-measure, the callipers, and the stethometers of Quain and Sibson, we have hitherto employed no means for measuring the form of the chest as represented by its curves and the angles at which the planes of its component parts meet. To measure the curves and angles of the chest, the above means are totally void. It frequently happens that the natural curve of a part of the thorax becomes altered in disease, that a curve is replaced by an angle, and that one angle is substituted for another. The eye, it is true, may detect these changes, but by measurement exactitude is obtained, and a record is formed which at another time may serve for a comparison and as a test of reduction or increment. For the measurement of curves and angles the stetho-goniometer has been constructed, and its employment has been found useful. By means of it, important alterations have been gauged. Certain deviations from the natural configuration of the chest, of great extent, as shown by this instrument, have been measured, which elude the operation of all other means. A loss or increase of roundness in the upper and front part of the thorax, so small as to defy the callipers and inch-measure, will be made manifest and be exactly measured by the stetho-goniometer. If, as often happens in phthisis, the articulation of the second costal cartilage with the sternum, or of the second rib with its cartilage, instead of forming part of a curve, has become angular, the deviation is accurately measured.

It has been found that at a very early period of many examples of pulmonary consumption one side of the chest undergoes an alteration in its curves, and differs from the other side; the stetho-goniometer accurately measures this loss of symmetry. The stetho-goniometer may be used not only to measure the angles which the plane of one portion of the chest makes with that of another part, but to measure the angle at which a part of the chest meets the horizontal or the perpendicular line. Thus the first rib may, from contraction of the lungs and pleura, decline as it proceeds from the median line of the body; the amount of this declination may be accurately learned by placing one arm of the stethogoniometer along the plane of the rib and the other in the plane of the horizon. The angle shown on the instrument is the angle of the rib with the horizontal line. The plane of a part may be compared with the median or transverse lines of the body. The sternum may be deflected from its median position

assuming an oblique situation; the angle it forms with the median line is shown by placing one arm of the instrument in the plane of the sternum and the other in the median line. The exact amount of deformity is thus ascertained.

The stetho-goniometer is constructed of ivory. It is composed of two arms, the same as the goniometer employed for the measurement of crystals. The arms are three inches long, and are jointed together. An arc, graduated into degrees, is attached to the arms where they meet and at their revolving point. A vernier is placed upon the arc for the purpose of measuring a part of a degree (1°). This vernier subdivides the degree (1°) into twelve parts, and each of these twelve parts represents 5′ (minutes). The vernier will seldom be required in measuring the chest, as extreme nicety is not commonly desiderated. The arrow upon the vernier-arm is the index of the degree. When both arms of the stetho-goniometer are in the same plane, as upon a level surface, the arrow on the vernier-arm points to 180° upon the arc. The degrees upon the arc range from 20° to 220°, which will include all angles which will usually come under treatment.

When an angular part is to be measured, the centre or junction part of the instrument is applied upon the point of junction of the two planes, and the arms are respectively placed upon them, the edge of the arms being set upon the parts to be measured. The arrow now indicates the degree.

When a curve is to be measured, say the curve of the natural mammary region, or the lateral curve of the dorsal spine, the part of the curve which is its apex is fixed upon, and the centre part of the instrument is placed over it, while the arms are made to touch respectively a point in the middle of the part of the curve on either side of the apex. The arrow on the vernier points on the arc to the degree of the angle to the tangents to the curve. Curves belonging to greater or smaller circles may be thus advantageously compared.

Depressions or hollow parts of the chest may be measured with the stethogoniometer. When angular, the instrument, at its joint, is applied to the point of union of the two planes of the part, and the two arms laid upon the retiring planes respectively. When a curved hollow is to be measured, the centre part of the instrument is placed near the lowest part of the hollow or depression, and, as it were, opposite to the apex of the curve, and the arms are held on either side, parallel with two imaginary tangential lines.

The deviations which most frequently occur and which it is desirable to measure, are chiefly the products of tubercle, of cavities in the lung, pleurisy, and the obliteration of the vesicular structure of the lung which occurs in pneumonia and bronchitis, also of empyema and intra-thoracic tumors.

The stetho-goniometer is light, portable, simple, and exact, and easy of application.

(c) CONCERNING THE CIRCULATORY SYSTEM.

ART. 58.- On the Results of Adherent Pericardium. By Dr. GAIRDNER, Physician to the Edinburgh Infirmary.

(Edinburgh Medical Journal, June, 1858.)

The object of this note is to direct attention to some statements of facts brought forward by M. Henry Kennedy, and which do not harmonize with certain conclusions arrived at by Dr. Gairdner in 1851.

"The only thing in Mr. Kennedy's paper which can be called new," writes Dr. Gairdner, "is a collection of 90 cases of adherent pericardium, 'excluding strictly all where valvular disease was present.' From this large assemblage of cases he hopes to prove the proportion in which hypertrophy, dilatation, and atrophy follow upon adhesion. Unfortunately, he omits to tell us whence the cases are derived; though it seems scarcely too much to infer that they are collected from 'museums and catalogues,' either in Dublin or elsewhere. In a note the author expresses a misgiving, which I believe to be but too well founded, as to the inadequacy of his data to bear the conclusions which he rests upon them.

"These conclusions are as follows (I give them the form of general expressions, in order to compare them with my own): 1st, that in simply adherent pericardium the heart remains healthy till death in not much more than onethird of the cases (34 out of 90); 2dly, that it undergoes hypertrophy, or hypertrophy with dilatation, in considerably more than a half (51 out of 90); 3dly, that it undergoes atrophy in one-eighteenth of the cases.

"It is in reference to this last conclusion that the author chiefly expresses the misgiving referred to above. Can it be,' he says, 'that specimens of this state are not kept in our museums or catalogues; hypertrophy and dilated cavities only being thought worthy of putting up?" I shall not presume to judge absolutely whether this be so; but that some further explanation is required, not only of this, but of the other conclusions above mentioned, I firmly believe; and this on the following grounds, derived from the paper in the Monthly Journal' for February, 1851.

"From a series of 500 miscellaneous post-mortem examinations, performed in the Edinburgh Infirmary, I carefully selected all the cases of adherent pericardium in which the adhesions were so considerable, and so situated, as to restrain the movements of the heart. It is probable that Mr. Kennedy, to obtain a similarly broad basis for his 90 cases of adhesion, would have required to search through the records of 3000 general cases; for my 500 cases only yielded 15 such adhesions. Of these 15, I found 5 in which the condition of the heart was morbid; 10 in which it was not so. Add one, or even two more, as being possibly within the limits of disease; it will still be true, that in more than a half of these cases the heart had suffered no apparent morbid change, although in all of them the adhesions were plainly of very long standing. But as this statement includes two cases of valvular and other disease of the heart, excluded, and rightly excluded, by Mr. Kennedy's plan (though retained by me for reasons specially stated), it would be nearer the truth to say, that in at least two-thirds of my cases of adherent pericardium there was no secondary lesion of the heart fairly attributable to the existence of the adhesions.

The case, therefore, as between Mr. Kennedy's results and my own, in regard to the existence of secondary disease of the heart, stands thus: Mr. Kennedy finds secondary disease in nearly two-thirds of his cases; I find it in about one-third of mine. In his, in other words, the large majority were morbid; in mine, the large majority were either healthy, or not decidedly morbid. Is this the consequence of the selection on his part being from 'museums and catalogues,' instead of from the whole field of nature? I am disposed to think so.

"As regards the question of hypertrophy and atrophy, I am quite sure, from my own observation, that there is a good deal of room for difference between different observers, according to their preconceived ideas of what conditions are entitled to these names. I have very frequently seen very small-sized hearts in connection with adhesions of the pericardium; several such cases, indeed, are alluded to in my paper in the Monthly Journal.' But in all of these the small size of the heart appeared to me, at the time, fully accounted for by the state of the general system. If it really deserved to be called atrophy in these cases, it was part of a general atrophy of the muscular system, and no special cardiac disease. I have, indeed, seen a very few cases which have appeared to justify the opinion of Dr. Chevers and others, that adherent pericardium may lead directly to atrophy, when the adhesions are very dense; and especially, I would say, when they have supervened upon very long-continued effusion. But such cases are, I believe, quite exceptional; and I am fully satisfied that ordinary fibrous adhesions, when not so thick and dense as altogether to prevent expansion mechanically, tend rather in the direction of hypertrophy and dilatation than of atrophy.

"On the whole, I am very willing that the doubtful points in this difficult subject should be reserved for further and more accurate observation; but I can see no reason, in the meantime, to abandon the conclusions which I was led to adopt in 1851. I have little difficulty, on the one hand, in rejecting the opinion of Hope and others as to the invariably and rapidly fatal ten lency of

pericardial adhesions; on the other hand, I regard them as a cause of disturbance very likely to precipitate the course of other diseases leading to embarrassment of the circulation, and not unlikely to be followed, after a longer or shorter time, by hypertrophy and dilatation. For the fuller statement of these opinions I beg to refer to the paper itself; commending the whole subject to the attention of the clinical observer, by whom alone satisfactory data as to the course of this disease can ultimately be furnished. In the meantime, let us not, upon too light grounds, deprive ourselves of the modicum of comfort and satisfaction which we may derive from believing that a certain, not small, proportion of persons affected with pericarditis, and with its sequela of adhesion, may survive the attack for many years, and may live in tolerable comfort, under favorable circumstances, without the inconvenience and the dangers attendant upon a dilated, hypertrophied, or atrophied heart. I believe that I have seen such cases; though from their very nature their diagnosis must be uncertain, as their ultimate issue must remain doubtful."

ART. 59.-Acute fatty degeneration of the Heart as a complication of Pericarditis. By Professor VIRCHOW.

(Archiv. f. Pathol. Anat., t. xiii. 1857; and Archiv. Générales de Méd., Sept. 1858.) M. Virchow has met with two instances of this change, one in a person who had purulent pericarditis and died suddenly; the other, in a person who had been attacked with hemorrhagic pericarditis and died speedily, feebleness of the pulse soon followed by intermittency being the most marked phenomena. In both these cases the superficial muscular layers of the heart were yellowish, opaque, and friable, and so far advanced in the state of fatty degeneration that their proper muscular structure was no longer discernible; and in a lesser degree every part of the heart was affected in the same manner. This form of fatty degeneration differs essentially from the ordinary form, which pursues a chronic course, and affects, first, the muscular fibres subjacent to the endocardium. It is considered by M. Virchow as the direct effect of the pericarditisan effect of the extension of the inflammation of the serous membrane inwards.

ART. 60.-On the relative importance of disease of the Aortic and Mitral Valves. By Dr. WILKS, Assistant-Physician to Guy's Hospital.

(Guy's Hospital Reports, 3d series, vol. iv. 1858.)

"In looking through our cases of heart disease, and observing the histories accompanying them, we think we discern the reason for the difference of opinion entertained respecting the duration and relative importance of the two forms above mentioned. Judging simply from clinical experience, we should incline to second the opinion generally held respecting them, that the mitral is the more severe disease, that is, that when the patient with this form of malady comes before us, he is very often (at least in hospital practice) suffering from dropsy and other symptoms denoting speedy dissolution, whereas the patient with aortic disease speaks of symptoms which have had longer duration and less severity, and he perhaps leaves us again in improved health. Judging then from the duration of illness or loss of health in the two cases, we conclude that the general opinion is correct as to the greater severity of the disease which has its origin in the mitral valve. If, however, we endeavor to discover the time at which the respective maladies commenced, we may readily arrive at an opposite conclusion, but then we are obliged to adopt a different method in the two cases. In the first place, we must inquire what is the origin of the two forms of disease. Our own records most fully corroborate the opinion that disease of the left auriculo-ventricular orifice has its origin in rheumatic endocarditis, and that the disease of the aortic orifice is due generally to a strain on the vessel or valves, and occurs for the most part in men who are accustomed to work hard and use strenuous exertions with their arms. Disease of the aortic valves undoubtedly may arise from endocarditis, but in the majority of instances it appears to arise from the cause named; but whether this be from undue pressure acting on the vessel through the parietes of the chest, or