his opinion in relation to a case of cyanosis, accompanied by perfect clearness of intellect, related by Dr. Richardson, remarking that this seemed to have been due to absence of interference with the functions of the lungs, and that the influence of cyanosis on the intellectual powers is always in strict proportion to the quantity of oxidized blood which reaches the brain. But to this there are marked exceptions; in one remarkable case, in which the patient ultimately succumbed to apnoea after having been purple for years from interference with respiration, and with entire absence of cardiac disease except hypertrophy of the right side, there was in our own cognizance perfect intelligence, clear and undisturbed up to the moment of death.

The next paper, on the use of ether in the treatment of phthisis, is a purely practical one, and seems a valuable contribution to therapeutics.

In the following paper, on the use of digitalis in heart disease, Dr. Foster has given a most admirable summary of the action of digitalis in cardiac complaints, and the indications for its use, marred, unfortunately, by what we cannot help, regarding as two most important blunders-he objects to the use of digitalis in aortic insufficiency with deficient compensation, and he praises its usefulness in similar cases with over-compensation. In this view of the action of digitalis we know that Dr. Foster errs with many good men, but we are astonished to find this error homologated by a man of so much intelligence and so large an amount of practical experience. He appeals, it is true, to the sphygmograph, but there is no sphygmograph yet invented of any value in relation to practical therapeutics; it counts the pulse, perhaps, more accurately than the finger, it graphically exhibits irregularities in the duration of each pulsation which might otherwise escape notice, but it can do no more, and perhaps the best proof of this is to be found in the fact that, while Foster finds arterial tension increased by digitalis when it produces diuresis, Lauder Brunton appeals also to the sphygmograph in proof that diuresis produced by digitalis is accompanied by a fall in the arterial tension. In short, the sphygmograph makes pretty pictures, which when they agree with our theories we accept as important, but when they disagree we reject as erroneous, but we cannot rely upon it to teach us anything of value. On the other hand, we know from experiment that digitalis kills with the heart in systole, while the danger in uncompensated aortic insufficiency is death from asystole; does common sense not teach us that a drug with such an action must be invaluable in combating this proclivity, and that any tendency to over-dilatation of the

ventricles is likely to be more than counteracted by the semicontracted condition in which the walls of the ventricle is permanently kept, a condition which is proved to exist by the increased firmness and force of the heart's impulse, and which occasionally can be measured by the alteration in the position of the apex beat. But to produce these good effects digitalis must be given with no niggard hand; there is no disease of the heart in which digitalis requires to be more freely given, and there is none in which better results are obtained than in inefficiently compensated aortic insufficiency. On the other hand, digitalis is not called for when the lesion is over-compensated; as a rule, it does harm in such cases by increasing the force of the systole, already excessive; when it appears to be beneficial it can be so only by producing so great a persistent contraction of the over-hypertrophied ventricle as to threaten death in systole from tonic spasm of the heart. Foster himself has very accurately pointed out at p. 99 that the state of matters thus produced is most dangerous, and that the drug has very speedily to be withdrawn in such cases. A longer experience and a more enlightened consideration of the mode in which digitalis acts will by and by enable Dr. Foster to correct this error which is, indeed, a grave one. Following this is an admirable lecture on rupture of the aortic valves, and the only objection to any part of this is to the statement at p. 139, that when sufficiently compensated aortic insufficiency has existed for years without inconvenience the original regurgitation must have been slight. This is unquestionably a mistake, as many such cases have been observed in which there was from the first very considerable regurgitation.

The article on the synthesis of acute rheumatism is interesting, but there is a hitch in the reasoning, as the same patient in whom lactic acid produced rheumatism at first was afterwards able to take even larger doses without any untoward result. There is no doubt that in exceptional cases the use of lactic acid is followed by rheumatic affections; in some of these cases the rheumatism is recovered from without pretermitting the use of the acid, and it still remains to be proved that in any of these the lactic acid qua lactic acid—and not simply as an accidentally introduced disturbing element, which might have been anything else was really the active morbific agent.

The paper on Duchenne's paralysis (pseudo-hypertrophic paralysis) contains a very instructive clinical history of three cases of this extraordinary disease, with remarks and a postscript on pathology, referring its origin to lesion of the spinal cord. The next paper is an excellent one on that bete noir of the medical profession, the treatment of diabetes mellitus,

which is replete with information and well worthy of careful consideration. In it Foster apparently proves that, in some cases at least, the injection of large quantities of cold water has an appreciable influence in lowering the temperature of diabetics. Following this is an essay illustrating the use of the sphygmograph and cardiograph in the study of diseases of the heart and great vessels. We have already said that no faith is to be put in the sphygmograph, and we fear the cardiograph is not much more trustworthy as a means of diagnosis, and it certainly never gives us any information adequate to repay the trouble and time its application involves. Such instruments can never form part of the armamentarium of an ordinary practitioner; their only profitable use would be to enable us to correct and confirm the meaning of phenomena otherwise ascertained. We fear that the use of such instruments is still wanting in precision enough to enable us even to do this usefully, and is not comparable to the results obtained by longcontinued observation followed by a dissection. Given a tracing of a certain form, we can interpet it readily enough by an appeal to a pattern by Marey or some other; but if we procure a tracing of a different pattern, has any of us sufficient confidence in the instrument to base a diagnosis upon it alone? And if not, why waste our time poring over pictures which are fully more likely in the hands of average men to give us wrong ideas as right ones? Let us rather wait till physiologists shall place in our hands instruments which can be used with more precision, and, while so waiting, perfect our own means of diagnosis from palpation, percussion, and auscultation. There is not a single case related by Foster in the diagnosis of which the cardiograph was either required or in which it gave important assistance. The last lecture is a very interesting one on pulmonary embolism following thoracentesis by aspiration, which calls for no remark, as we all well know how often this fatal occurrence follows the most trifling operations.

We conclude as we commenced, with the expression of our qualified approbation of Dr. Foster's work; we have differed from him on certain points of practice and of teaching, but we suppose that even if the angel Gabriel were to publish a work a reviewer would find something to find fault with, and, besides, Dr. Foster is a man of so great ability that it is a pleasure to point out to him where we think he has erred, because we feel sure he will take it in good part, regarding us as merely co-workers with him for the good of mankind, a good to be attained, not so much by the perfecting of ourselves, as by the careful tuition of those who are to come after us, and in this respect there is no higher or more responsible position than that of a teacher of clinical medicine.

Bibliographical Record.

Clowes's Practical Chemistry. This work is marked out by certain meritorious characteristics from the crowd of recent chemical handbooks. It does not, indeed, contain much new matter, nor are the special features to which the author refers as distinguishing it really novel, but, after all, it derives great value from the intimate practical acquaintance with actual analysis which every page illustrates. If the list of errata had been less formidable, and if the literary style of the work had been more refined, our commendation would have been stronger.

This "Practical Chemistry" is made up of a judicious selection from the text-books of Fresenius, Rose, Valentin, and other writers on the subject, the analytical tables following those of Valentin very closely. Still, the author's experience in teaching has given a special impress and character to his description of experiments and processes.

Mr. Clowes divides his book into seven parts or sections, the first three of which are devoted to the simplest cases of chemical manipulation, such as the preparation of gases, the fitting of apparatus, and the use of the blowpipe. He has certainly succeeded. in explaining, with the aid of illustrations, the construction and use of the commoner forms and arrangements of apparatus in so clear a manner that the dullest of students cannot fail to understand his descriptions. The fourth and two succeeding sections discuss the reactions and separations of metals or bases and of acids. One of these sections, the fifth, has been rather spun out, for it simply treats of the analysis of salts containing one metal and one acid, and yet the greater portion of its contents is recapitulated in Section VI. The tables of differences given at the end of each of the five metallic groups will prove very serviceable to students, showing, as they do at a glance, the reactions of the metals with the various reagents employed in each group, as well as the behaviour during the Preliminary Examination. These tables ought to be very useful to pupils whose memories are not retentive of chemical facts, to pupils

1 An Elementary Treatise on Practical Chemistry. By F. CLOWES. London, 1874. Pp. xviii & 327.

in fact, who belong to the not uncommon doliocephalic race-the "sieve-heads" (Latin, dolium, a sieve).

The seventh and last section of the work before us contains a list of apparatus and reagents required for the course of analysis; it also gives a series of substances suitable for analysis. Much care has been taken in the preparation of this part of Mr. Clowes's book, and it will be found to afford the means of saving time and trouble to those who have the charge of the working arrangements of a laboratory.

Although it is difficult to give much space to theoretical explanations in a practical treatise, some readers of Mr. Clowes's book may object to his somewhat abrupt introduction of chemical formulæ on page 61, without any preliminary explanation of symbols, equations, and the language of chemical change. But those who raise this objection to books on practical chemistry should remember that the authors of such of these works as are good for anything beyond cramming do not assume that they are to be used alone, but with the aid of lectures and of the intelligent study of chemical theory.

Flint's Practice of Medicine.1-This excellent treatise on medicine has acquired for itself in the United States a reputation similar to that enjoyed in England by the admirable lectures on physic by Sir T. Watson. It may not possess the same charm of style, but it has like solidity, the fruit of long and patient observation, and presents kindred moderation and eclecticism.

We have referred to many of the most important chapters and find that the revision spoken of in the preface is a genuine one, and that the author has very fairly brought up his matter to the level of the knowledge of the present day.

Dr. Flint is no believer in the doctrine of change of type in diseases, and has steadfastly upheld the value of bloodletting in some acute inflammations, as, for example, in pleuritis and pneumonia, or, as he prefers to call it, "pneumonitis." Looking to his instructions for treatment, we find a close agreement with those of the best teachers of the British school of medicine, and few illustrations of special American therapeutics.

The work has this great recommendation, that it is in one volume, and therefore will not be so terrifying to the student as the bulky volumes several of our English text-books of medicine have developed into. Moreover, although the pages are closely set, the typography is very good and clear.

A Treatise on the Principles and Practice of Medicine, designed for the Use of Practitioners and Students of Medicine. By AUSTIN FLINT, M.D., &c. Fourth edition, carefully revised. 1873. Philadelphia and London.