Roberts's Handbook of Medicine. In the presence of so many admirable works on medicine, its theory and practice, that have in recent years issued from the press of this country, including works of home-growth, such as Sir T. Watson's, Dr. Aitken's, and Dr. Tanner's, and treatises of foreign production that have commended themselves by their intrinsic merits for translation, such as Trousseau's and Niemeyer's, it would seem a bold and ambitious venture on the part of a young physician to bring out yet another book on that subject, and something by way of justification or apology for the course taken might fairly be demanded, for "of making many books there is no end." However, the author makes no serious attempt to explain the production of his work, excepting so far as stating that it is addressed especially to students preparing for their examinations, and that he has desired to condense the information needed for this end into book of moderate dimensions. Its speciality is therefore its being a student's handbook of medicine in one volume, and as such it can be confidently recommended. It is essentially a compilation, and in the matter brought together very completely reflects the present state of medical science, particularly in the departments of symptomatology and pathology. Treatment is dealt with in that general way which suffices the student at a theoretical examination, but which will be found very inadequate to the emergencies of practice. Dr. Roberts's experience as a clinical teacher has suggested to him two "innovations on the method usually adopted in manuals of medicine," to which he particularly calls attention as special features of his treatise. "First, before describing the individual diseases of the several organs or systems, an outline has been given of the clinical phenomena which indicate a morbid condition of each, and of any modes of physical examination' employed in their investigation, while the principal symptoms are considered in detail...Secondly, an endeavour has been made to generalise the remarks on diagnosis, prognosis, and treatment, so far as was practicable." These innovations will be, we believe, highly appreciated by students, particularly in carrying on clinical work. The information presented is concisely and clearly given, and the subdivision of subject well conceived. We have to confess to delay in noticing this volume, a delay caused by press of subjects and of books calling for review, but albeit entailing the advantage of affording more opportunity to make ourselves acquainted with the character and merits of the treatise, an opportunity we have used, and which enables us to A Handbook of the Theory and Practice of Medicine. By F. T. ROBERTS, M.D., &c. London, 1873. Pp. 1043. speak in terms of praise of its value to students in acquiring the theory of medicine in a manner and to an extent calculated to satisfy the most rigid examiners. Shapter on Heart and Lung Disease. With the exception of a short chapter of fifteen pages, the whole of this work is devoted to what is evidently supposed to be a tolerably exhaustive review of the symptoms and signs of cardiac disease, with a few hints as to treatment. Dr. Shapter is an excellent and most estimable physician of nearly fifty years' standing, one, therefore, who was educated long before anything like precision was attained in the estimation of cardiac phenomena, whether healthy or diseased; it is, consequently, a bold step in him to come forward, not with a mere record of experience, which certain parts of this work show him to be admirably qualified to give, but with what, under the modest title of "Notes and Observations," is actually a statement of what he conceives to be the present stand-point of cardiac physiology and diagnosis, and it is from this point of view that, in the interests of medical science, this work must be judged. Dr. Shapter is one who has evidently had a wide field of experience, and who possesses a self-reliant, independent mind; unfortunately, mere amount of experience is no efficient guarantee of accuracy, and mere independence of thought, unless tempered by accuracy of judgment, is more apt to lead astray than to conduce to material progress. It is now certain that by a careful determination of the rhythm of a murmur—that is, the relation it bears to the several acts which constitute a cardiac pulsation-and by also ascertaining that part of the cardiac area at which it is heard loudest, we can infer with absolute certainty at which of the four cardiac openings a murmur originates, and whether it is a murmur of obstruction or regurgitation. Dr. Shapter will, probably, be surprised to learn that, though he has devoted a whole chapter to a consideration of the errors in the rhythmical action of the heart, he has very vague ideas himself as to the succession of those acts the continued repetition of which constitutes what we call the rhythmic action of the heart. But how else can we account for his speaking as he does at p. 24 of a systolic murmur which may be so greatly protracted as to interfere with the audibility of the second sound, or, as at p. 48, of an aortic regurgitant murmur which " may so mask and overpower a constrictive (and therefore systolic) aortic murmur as to render it not always easy to decide on the presence of the latter." Systole and diastole, however, are successive and not simultaneous acts of a cardiac pulsation, and a murmur or sound occurring during the one cannot be 1 Notes and Observations on Diseases of the nexion therewith. By THOMAS SHAPTER, M.D. Heart and of the Lungs in con- masked or obscured by a murmur or sound occurring during the other. Very many other examples might be quoted of our author's vague ideas as to cardiac rhythm; for instance, the way in which he speaks at pp. 45, 183, &c., of diastolic and presystolic or auriculosystolic as signifying the same thing, when we all know they do not, and that there may be an auriculo-diastolic murmur as well as an auriculo-systolic, and that while the latter, from its character and rhythm, is readily enough distinguished from an aortic diastolic as well as contrary to what our author supposes, vide p. 184 &c. -from a mitral systolic murmur, the former (the auriculo-diastolic) is mainly to be distinguished by its position of maximum intensity, a means of recognising the place of origin of murmurs to which Dr. Shapter has not once referred. Contrary to the experience of all authors who have written on the subject, and are, without exception, agreed upon the fact, that a presystolic murmur is invariably associated with disease of the mitral valves, Dr. Shapter says (p. 189), that whatever the suspicions the existence of this murinur may originate," it does not absolutely imply vital unsoundness." He has, probably, been led to make this statement by the indefinite results which have followed his own attempts at the diagnosis of a presystolic murmur, but he is as unquestionably wrong in this as in another statement he has made at p. 186, that a mitral murmur is only due to statical causes, "morbid conditions of the blood not appearing adequate to produce it," because the condition of the blood alone is a very frequent cause of mitral murmur even in rheumatism, and still more in erysipelas, chlorosis, anæmia, &c., while a very large number, if not all, of those cases to which Dr. Shapter has referred as instances of an anæmic murmur audible in the pulmonary artery are actually mitral murmurs propagated into the auricle, as Naunyn has pointed out, and having their position of maximum intensity, not in the pulmonary area, but an inch and a half to the left of it, over the appendix of the left auricle. Dr. Shapter is independent enough to accept as correct the dogma that the diastole of the heart is active, and consequently that muscle elongates as well as contracts; in this he errs, if even it be with many good men both of past and present times; we doubt, however, if there be many either in the past or the present who agree with him in basing the circulation of the blood entirely on ventricular action, to the ignoring of the contractile force of the auricle as well as of those other forces which are in themselves sufficient to produce this end. This, however, is a mere error in physiology, of little importance either in the diagnosis or in the treatment of cardiac disease. But when he argues, as at p. 177, that hypertrophy is not "the statical or mechanical result of valvular disease, but that it has an independent, though probably coexisting, vital origin," he opposes himself to facts with which every observer of any experience is well acquainted, facts which form the basis of all our treatment of cardiac disease, and upon which much of our diagnosis is founded, because the consecutive changes in the chambers of the heart resulting from valvular lesions are more permanent and therefore more important than the murmurs to which these lesions give rise, which, as Dr. Shapter well knows, frequently vary and occasionally disappear. Almost every page of our copy of Dr. Shapter's work is covered with marks of exclamation and interrogation, showing how frequently we have felt compelled to differ from him. We regret to have so often to dissent from the views of a man so estimable and of such large experience as Dr. Shapter, but in the interests of truth and of medical science, which are one, it is impossible to do otherwise. The diagnosis of cardiac disease is not based upon mere opinions or on probabilities; it is founded upon immutable and easily learned physical and physiological laws which leave no room for doubt. There is no disease of any organ in the diagnosis of which certainty is more attainable than in valvular cardiac disease; there is none, therefore, in which it is of more importance for us to set our face against those puerile plausibilities which passed current in the early days of our science, and to inculcate the necessity of every would-be teacher, basing his teachings, not on those subjective ideas which he terms his experience and believes he has gathered from nature, but upon objective phenomena, which are capable of proof and which every one can verify for himself. Brown's Manual of Botany.The author of this Manual of Botany,' who bears the highly honoured name of the most distinguished and philosophic botanist England has produced, has given to students a work which may compare favorably with any of the like kind that have issued from the press. He has evidently sought out from almost every available source, and has brought together within this volume, every opinion and fact deserving attention or admitted within the domain of positive knowledge, and has largely illustrated them by excellent woodcuts. And although, as he rightly admits, such a treatise must of necessity partake very largely of the character of a compilation, yet Mr. Brown is enabled by his long and varied acquaintance with botany, gained as well by home study as by explorations in many distant parts of the earth's surface in the capacity of botanist attached to expeditions, to critically weigh the statements and opinions of others, to confirm or reject, and also to add. We have consequently much satisfaction in recommending this manual to botanical students, and, likewise also, in view of the 1 A Manual of Botany, Anatomical and Physiological, for the use of Students. By ROBERT BROWN, M.A., &c. Edinburgh and London, 1874. Pp. 614. botanical knowledge at present required of them, to medical students. We however, sympathise with these last in the necessity they are submitted to of "getting up" even so excellent a manual as the one before us for the purpose of obtaining a licence to practice physic and surgery. It is, indeed, a captivating and, except for its terminology, withal an easy science for the learner. Yet, considering the extent of the medical student's curriculum and the exactness and width of knowledge now required of him in every subject, botany should, in our opinion, be only slightly insisted upon either as a matter of study or of examination. Its bearings on practical medicine are few, and vastly few are those who acquire such a knowledge of the science as to turn it to practical account. With the great majority the learning of botany is a "cram," and the amount. crammed is beyond utilisation. If the knowledge of the subject is to be insisted on for medical men, that knowledge should be chiefly acquired previously to the course of medical study, for to interpose it in that course and demand the serious study of such a manual as Mr. Brown's, which, by the way, is not so formidable a “manual" some we are acquainted with, is to intrude upon time and energies that should be occupied in studies more distinctly necessary and professional. These remarks are merely incidental to the subjectmatter of the treatise under notice, but are not out of place in a medical periodical. "as Nursing the Sick.1-People may be said to have first been aroused to the importance of nursing by the appearance of Miss Nightingale's most able little treatise on the subject, which happily may be appealed to still as an authority on almost every detail. Several medical men have since written on nursing the sick, but their productions have not distinctly advanced the knowledge of the matter, being too brief and superficial, and consequently ephemeral in existence. Dr. Munro has now come forward as an instructor in "the science and art of nursing the sick," and has produced a treatise of the sufficient length of 331 pages. The title of his book elevates nursing to the grade of a science; but this position might be readily contested, and most people would be contented with regarding nursing as simply an art. As a matter of course various smaller details in the management of the sick not alluded to in Miss Nightingale's volume were at the disposal of Dr. Munro for observation, and are not neglected by him, but he sadly wants the incisive and aphoristic style of the lady writer, and, unfortunately, writes in an involved, diffuse, and often ungrammatical manner. Likewise exception might be taken here and there to some of his statements-for instance, to his remarks 1 The Science and Art of Nursing the Sick. By ENEAS MUNRO, M.D. Glasgow, 1873. |