"Properly used, emetics are of the first importance in symptomatic mania; and, fortunately, their administration is easy, without having recourse to the objectionable custom of giving them in food. Where the general health is good, and where no other cause for treatment is apparent, than mere noise or violence, the use of so powerful and painful a remedy is seldom justifiable. It is not because a patient is out of temper, or because he may be a little more extravagant than usual, that we are justified in giving an emetic; on the contrary, we ought to witness the existence of symptoms pointing out the propriety of its exhibition, independent of maniacal affection; we ought to have a flushed countenance, a rapid pulse, a high temperature, a furred tongue, and cold extremities; or at least we ought to suspect constipation, or an over-loaded stomach. To sum up our duty in a few words, we are bound to entertain a definite and sufficient object, in the use of this, or any other remedy, before we employ it."

SOME OBSERVATIONS ON ORGANIC ALTERATIONS OF THE HEART, and particularly on the beneficial Employment of Iron in the Treatment of such Cases. By S. Scott Alison, M.D. &c. 12mo. pp. 62. London, 1845. Longman and Co.

THE object of this little work is to recommend the more general exhibition of Steel medicines, and consequently to avoid the use of all lowering means, in various organic diseases of the heart, which are unaccompanied with any symptoms of inflammation or sanguineous plethora. That chalybeates are often useful in those cases of cardiac disease, in which we have reason to believe that there is either an atony in the muscular parietes of the heart, or an impoverished condition of the blood-provided always the secretion of the liver and other chylopoietic viscera be duly attended to—has very generally been admitted by all the best writers on this branch of pathology. Dr. Elliotson strongly recommended them in his clinical lectures at St. Thomas's Hospital, a good many years ago; and Dr. Copland also alludes in a forcible manner to the benefit to be derived from their use. Still however, many medical practitioners are too apt to have recourse to antiphlogistic and lowering remedies, more especially of digitalis, in almost all cases of supposed hypertrophe of the heart; seeming to forget that there may be a positive deficiency of proper muscular power, with an inordinate thickness of its muscular parietes. Dr. Alison's remarks are very well calculated to remove this error, and to lead the reader to adopt a more rational and successful treatment. We have repeatedly had occasion to observe the good effects of a regulated course of chalybeate medicines-none is better than the common sesqui-oxyde, taken in any bitter infusion: Dr. A. seems to prefer the Mist. ferri comp., and the Ferri iodidum-in cases of atonic disease of the heart. Much of the benefit is unquestionably owing to their invigorating action upon the stomach, the comfort of the patient always depending very materially upon the state of his digestive organs. Hence the great and often immediate benefit that is obtained, in such cases, from the use of alkalis, bitters, hydrocyanic acid, and mild opiates. We have already-vide the review of the works of Drs. Latham and Furnival in the present number of this Journal-spoken

of the paramount importance of a seton or issue in the cardiac region, in almost all cases of hypertrophic enlargement. Dr. Alison makes no men. tion of the remedy.

A FEW REMARKS ON HYDROPATHY, &c. By William F. Soltau, M. B. è Coll. Ball. Oxon. Octavo, pp. 72. London and Plymouth. 1845.

THIS brochure ought surely to have made its appearance a year or two ago; as the cold water cure has been evidently on the wane for some time past-witness the frequent advertisements of late for the sale of (once flourishing) Hydropathic Establishments. We need scarcely say that

Dr. Soltau, like every other sensible man, ridicules and condemns this and all such attempts to impose on the credulity of the public, to the sacrifice of their health as well as of their substance.

How comes it that our Oxonian author has allowed a very obvious error to creep into the very first sentence of his work? The well-known aphorism of Hippocrates is surely " Ο βίος βραχὺς, ἡ δὲ τέχνη μακρὴ”—not μαχρή.

THE LOST SENSES: DEAFNESS. By John Kitto, D.D. 12mo, pp. 206. London, 1845. Knight.

A LITTLE Volume that will well repay perusal. It is written by the editor of the Pictorial Bible, and contains a truly interesting account of his deafness, which is complete and absolute, and is the result of an injury of the head when he was only 12 years of age. The heaviest clap of thunder is perfectly inaudible by him; and indeed no sound, however loud, unless it induces a vibration perceptible by the general sense of touch, makes any impression upon him. The effect produced by a piece of ordnance, fired off near him, is compared to the sensation of a heavy blow upon the head from a fist covered with a boxing-glove: it is tactual rather than acoustic. So sensitive, however, is the body to the impressions arising from the gentlest tangible percussions, that, when any small article, as a thimble, pencil, or even a more minute object, falls from the table upon the floor, Dr. K. is often aware of it, even when other persons sitting at the same table have not been apprised of it by the ear. He adds,

"I am subject to a painful infliction from the same cause, during the hour in which my little ones are admitted to the run of my study. It often happens that the smallest of them, in making their way behind my chair, strike their heads against it: and the concussion is, to my sensation, so severe, that I invariably wheel hastily round in great trepidation, expecting to see the little creature seriously injured by the blow; and am as often relieved and delighted to Lee it moving merrily on, as if nothing in the world had happened."

We could gladly extend our extracts from this interesting and beautifully written work; but this will not be necessary, if our readers take our advice of reading it for themselves.

OBSERVATIONS UPON THE EMPLOYMENT OF COMPRESSION IN ANEURISM. By O'B. Bellingham, M.D., F.R.C.S.I. Octavo, pp. 14. Dublin, 1845.

SINCE the re-introduction of compression in the treatment of popliteal and femoral aneurism by Dr. Hutton, in 1842, there have occurred eleven other cases in which it has been successfully employed. Dr. Bellingham, under whose care two of these were, has, in two numbers of the Dublin Journal, detailed the progress of this vast improvement in surgery. Compression, as now exercised, differs from that heretofore essayed in its lesser degree and shorter duration. The object now is not to altogether obstruct the flow of blood through the artery, but only to diminish it: partial current through the sac enables the fibrine to be readily entangled in the parietes of the sac in the first instance, and this goes on increasing, until it becomes filled; the collateral branches having been previously enlarged, the circulation is readily carried on through them.” Instead of one compressing instrument, two or three are employed if necessary, so that when the pressure of one becomes painful it may be relaxed, another having been previously tightened. The patient can even regulate this himself, and no suspension of treatment in consequence of the irritation produced is necessary. The Dublin surgeons employ an instrument invented by a patient, and consisting of a modification of a carpenter's clamp, and which, Dr. Bellingham believes causes far less pain than that employed in the London hospitals.

Thus

The advantages of compression over the ligature are-1. That it is not attended with the slightest risk. 2. It is applicable to certain cases to which the ligature is not, as well as to some in which the employment of the ligature might be attended with unfavourable circumstances. in very large aneurisms, the pressure so long continued acts injuriously upon the collateral circulation, and the application of the ligature may be followed by gangrene of the limb. So, too, in large aneurisms, inflammation and suppuration of the sac very commonly follow the ligature. The vessel, again, between the tumour and the heart, may be in too diseased a state to admit of the safe application of the ligature. "Pressure is applicable to cases of the aneurismal diathesis, and when more than one aneurism exists at the same time; cases in which the operation by ligature is likewise contra-indicated; as well as to cases of spontaneous aneurism, occurring in individuals of intemperate habits, or of broken-down constitution, in which the surgeon with great reluctance would perform any operation. A few cases have been related, in which the operation by ligature failed in consequence of some irregular distribution of the artery above the aneurism." 3. If pressure fail to cure the aneurism, it does not preclude, but favours, the successful performance of the operation.

The objections which have been offered to this plan are so frivolous— so purely, in some instances, objections for objection's sake, that we have neither patience or space for allusion to them. Hunter's procedure was a vast improvement upon the methods of his predecessors; but all must rejoice at the probability of even his painful and sometimes dangerous operation being speedily superseded by a new bloodless achievement in surgery.

OBSERVATIONS ON THE MECHANISM AND DIAGNOSTIC VALUE OF THE FRICTION VIBRATIONS PERCEIVED BY THE EAR, AND BY THE TOUCH, IN PERITONITIS. By Robert Spittal, M.D., F.R.S.E. Pp. 19. [Reprinted from London and Edinburgh Monthly Medical Journal, May 1845.]

M. PIORRY states that although Laennec has not alluded to the subject in his work, he directed the attention of those who attended his clinique to the fact that the peritoneal surfaces, when inflamed, give rise to the production of certain audible sounds. M. Désprez, in 1834, stated to the Anatomical Society of Paris, that, in the early stages of peritonitis, a leather creaking or friction sound, analogous to that of pericarditis, could be heard. Since that period, Drs. Beatty, Bright, Stokes, Corrigan, and M. Désprez, have communicated additional observations: and Dr. Spittal details the particulars of two other cases in the present communication.

A tabular view is presented of the results observed in 15 cases, as recorded by the various authors. In the majority of these cases there was either a tumour of the abdomen present, or the peritoneal surface of one of the solid organs, as the liver or spleen, was affected; but the vibrations existed in other cases where these conditions did not prevail. Of the 15 cases, 4 recovered and the particulars of one are not stated. In 7 of the remaining cases, adhesions were discovered; but the post-mortems were in some instances made years or months after the first perception of the sounds, whose presence cannot be considered as diagnostic of the existence of adhesions.

"From the sixth column of the table it appears that almost every author who has made original observations upon this subject, has recorded the peculiar vibratory indications perceived by the sense of touch over the part affected; and this, no doubt, has arisen from the necessity of manual examination of the abdomen leading so directly to their detection. The character of the sensations has been very differently described, even in the same case, at different periods of the inflammation; so much so, indeed, as to render it more than probable that the various physical conditions of the serous surfaces had given rise to corresponding modifications of this peculiar sensation. The sounds

perceived either along with the tactile vibrations, or unaccompanied by them, are by no means so numerous as could have been wished for. Few as they are, however, they exhibit, as their identity of origin would have led us to expect, the same variations in character as the tactile vibrations, and so exact is the resemblance, and so much does the one indication suggest the other, that, in most instances, the same terms have been employed to describe them.

From the terms used to describe the vibrations perceived

by the touch, it appears, that these sensations varied in intensity from a soft creeping, or gentle vibration under the hand; or a sensation like that of the finger rubbed over a damp pane of glass, to those of a more intense kind, described by the terms creaking, crepitus, and grating. The accompanying sounds varied in the same manner from a gentle rustling, to a hard friction, and sound of creaking." The rubbing together of the peritoneal surfaces physically altered by the inflammatory process is the immediate cause of the vibrations. They are produced in three ways: by the respiratory movements, especially the descent of the diaphragm; by pressure with the hand; and by the peristaltic action. It is highly probable that in the early stages of peritonitis, when the membrane is drier than natural, friction vibrations occur as well as after the effusion of lymph. When the surfaces are separated by fluid effusion the vibrations cease, unless this be made to gravitate to some other part of the cavity than that under examination.

The author thus estimates the value of this sign.

"Of the value of the facts connected with the friction vibrations, it may be remarked, in conclusion, that they appear to have placed within our power an additional method of detecting the existence of an important and frequently fatal disease, often obscure by the ordinary modes of investigation, whether from peculiarity of idiosyncrasy, or from the co-existence of cerebral complication, by which pain and its characteristic results, with reference to the position of the patient, and to the respiratory movements, may have ceased to guide the physician in his diagnosis. In cases of peritoneal inflammation in the upper portions of the abdomen, simulating pleuritis, the presence of any degree of the peristaltic friction vibration might very much assist us in the diag

nosis."

A PENTAGLOT DICTIONARY OF THE TERMS EMPLOYED IN ANATOMY, PHYSIOLOGY, PATHOLOGY, &c. &c. &c. In Two Parts.-Part Second and last. By Shirley Palmer, M.D., of Tamworth and Birmingham. Octavo, pp. 656. Longman

and Co. 1845.

In our number for April, 1842, we spoke in high but just terms, of the first part of this gigantic-not in size but labour-production of Dr. Palmer. From some unaccounted cause, its appearance has been delayed four years after its completion. It is at length published, and will stand a memorial of its author's erudition and labour as long as any of the languages in which it is written. The love of fame, present and posthumous, must be very strong in the author of this Dictionary, who, amid the distractions of extensive private practice, must have devoted so much of his time and talents to its construction as scarcely to leave him a scanty opportunity for food and sleep during many years past! The "auri sacra fames" could not have entered into Dr. Palmer's calculation or ambition, since profit was totally out of the question. The constantly extending curricula of, medical education, and, what is more, the daily increasing thirst for knowledge, render such a work as this indispensible to the student of our own days.