1873-4. TRANSACTIONS OF THE HOMŒOP. MED. Soc. OF THE STATE OF NEW ORTHOPEDIA. By James Knight, M.D. MEDICAL ESSAYS. Austin Flint, M.D. London: Kent & Co. New York: G. P. Putnam Philadelphia: H. C. Lea. INFLAMMATION OF THE LUNGS. By Dr. Ludwig Buhl. Trans. by Matthew S. Bauer, M.D., and Sam'l B. St. John, M.D. G. P. Putnam & Sons. CLINICAL LECTURES. Sayre. Hip Disease. CYCLOPEDIA OF PURE MATERIA MEDICA. York. G. P. Putnam & Sons. By T. F. Allen. New CLINICAL LECTURES ON VARIOUS IMPORTANT DISEASES, delivered in the medical wards of Mercy Hospital, Chicago, by Nathan Davis, A.M., M.D. 2d ed. Philadelphia: Henry C. Lea. Among all the evidences of progress and enlightenment in this progressive and enlightened country, none can speak more eloquently for the healthy development of the American nationality under the freedom of republican institutions than the rapidity with which the new towns and cities everywhere springing up, almost as if by a sudden act of creation, assume the aspect of high culture and become centres of radiation for the best knowledge of the day. And nothing shows more plainly the practical as well as the ethical character of this advancing civilization than the number of excellently appointed hospitals which, with the school-houses, even as far west as Denver City, lift up their testimony to the soundness of the basis upon which our progress rests, and stand as answers to the sneers at the crudeness of our customs and manners, with which, in older countries, it is the fashion to discuss our development. Already these hospitals are the centres for the diffusion of scientific medical knowledge, more especially for clinical instruction, the most essential part of all medical study; so that nowhere, even in the most distant parts, need the medical student of the present generation suffer from that lack of practical acquirements which made the beginning of professional life, especially in remote regions, so trying to the majority of newly-fledged doctors of but one generation ago. Of the character of this clinical instruction we have evidence before us in the little volume which embodies the substance of Dr. Davis's clinical lectures. It already presents itself in the second edition, apparently within a very short time; and as we have reason to infer from this fact, among others, that it has found favor in the eyes of the medical public, it demands more than a mere passing notice at our hands, more especially as there probably has never been a time when the clinical teaching of eminent American physicians, in all departments of practice, has made itself so widely felt as it is to-day in this country. On first opening the volume, we confess that the prej udice which not unnaturally possesses the critic's mind in these days of making many books, in approaching a work from a distant source, led us to look for scarcely anything of sufficient weight to claim an extended review; but on closer examination we are forced to declare that the book has merits of its own which constitute it a fair and able representative of the ruling theory and practice of the day. Dr. Davis is unquestionably a gifted teacher, possessing, in a high degree, the faculty of seizing at once upon the salient features of a case, and of illustrating these in terms as precise and clear as the nature of the subject—or, we should say more correctly, as the phraseology of his school - will admit. It is his aim to be thoroughly practical, and there can be no more proper aim on the part of a clinical teacher in the presence of his class. But unfortunately all medical teaching must of necessity become hopelessly dogmatic as soon as it attempts to construct plain and easy rules of practice upon the unstable data afforded by physiological and pathological speculations. This lays it open to the most serious objections which can be urged against any teaching claiming to be scientific, as such rules can only be based upon attempted explanations of what is, in its very nature, inexplicable. In order to have a starting-point, therefore, the rational school finds it necessary to take many things for granted in medicine and science generally, thus burdening itself in the outset with a whole host of illdefined and contradictory dogmas in its efforts to escape from the thraldom of a single "exclusive" one. To prop up these assumptions, then, and give them plausibility, an amount of ill-bestowed ingenuity is exercised, which, among the young or unreflecting, will always go for erudition and comprehensive reasoning, while it is actually nothing more than a perpetuating, in a new form, of all the ancient fallacies which, from a time even before the advent of Galen, have been the curse of the healing art. It is after this fashion that Dr. Davis too often assumes a vague and baseless theory, or a mere phrase, to be a substantial fact. From this he then infers certain rules of treatment, and having declared these infallible he again reasons from them to the correctness of the premises, thus establishing one of those fallacies of generalization which so possess the "regular" mind as to make it incapable of recognizing the existence of any law governing the action of drugs on the system in health and disease. In order to show the method of establishing clinical rules adopted by Dr. Davis and the school to which he belongs, we quote one or two passages which, being selected from a large number of similar ones, may stand as the representatives of the principle underlying "regular" practice as commonly taught at the foremost seats of medical learning in this country to-day. Speaking of intestinal inflammation and its treatment, he says (p. 136, et seq.): "The consequences of peritoneal inflammation, when uncontrolled, are thickening of the membrane, plastic exudations, and serous effusion. The second often leads to adhesions, the third to ascites or abdominal dropsy. Most pathologists, in treating of the nature of inflammation, have restricted their attention too exclusively to the condition and movements of the blood or fluids in the parts affected. Thus, Dr. Williams makes inflammation consist, essentially, of a determination of blood to the structure involved, with the circulation through it partly increased and partly diminished. We regard every inflammation as involving three primary elements or morbid conditions, namely: an accumulation of blood in the part, an exaltation of the elementary property of the tissue, which we call susceptibility, and an alteration of the vital affinity. If the accumulation of blood in the part is accompanied by an active determination to it, with increase of both the susceptibility and affinity, it constitutes what is familiarly known as active, sthenic, or phlegmonous inflammation. If on the other hand the accumulation of blood in the part results not from increased determination, but from an impaired action of the capillaries themselves, with diminution of vital affinity while susceptibility alone is increased, it constitutes asthenic or plastic inflammation. We thus claim that the movements of fluids and the properties of the solids are both necessarily involved in every true inflammatory process. Hence, we have two uniform and rational indications for treatment, namely, to allay the morbid susceptibility, and to diminish the fulness of blood in the part. Anodynes and the local application of cold constitute the principal means for accomplishing the first, while the means of accomplishing the second will depend upon the immediate cause of accumulation. Thus, where active determination of blood to the part inflamed exists, depletion and arterial sedatives will be required; but if the cause of the accumulation is an impaired condition of the capillaries of the part, then, instead of sedatives, such stimulants or excitants as are capable of giving increased tone and contractibility to the capillary system will be most promptly efficient. These observations relate to inflammation in its first or elementary stage. If it has existed long enough to produce secondary effects, - such as infiltration of texture, effusions either serous or sanguine, softening, suppuration, etc., - these will afford other indications for remedial agencies. In the case before us, there is not that fulness of pulse, or force in the action of the heart, which would call for either depletion or sedatives, neither are there any signs of effusion. Hence, the only clear indications are to subdue the extreme morbid susceptibility of the inflamed membrane and overcome the irritability of the stomach. "The most efficient means we possess for this purpose are narcotic fomentations and full doses of opium, with alterative doses of calomel. To be effectual in such cases, the opuim must be given in doses sufficient not only to allay pain but to induce more or less sleep. In inflammation of the serous membrane, this can be done with impunity," etc. It will be seen at once that the whole passage is made up largely of "glittering generalities," which, however they may impress the youthful mind with confidence in rational treatment, will be proved, on a moment's reflection, to be nothing but empty phrases. Irrespective of the fact that the definition here given of inflammation is wholly at variance with the known sequence of phenomena in this process, and the accepted idea of it as established by careful experiment and observation, it makes use of the terms "susceptibility," "vital affinity," "sthenic" and "asthenic," "impaired action of the capillaries," etc., as if they expressed some demonstrable states of which the variations in kind and degree could be readily determined, while, in fact, they are admitted, on all hands, to stand merely as convenient expressions for certain doubtful theories, but conveying no definite meaning, at all events, describing no observable state of the tissues. To say, for instance, that inflammation depends upon increased susceptibility, is merely stating a proposition, without offering anything like an explanation from which it would be justifiable to infer a rule of practice or a remedial measure. But upon the subject of susceptibility it will be necessary to say a word more when we shall meet with a definition of this phenomenon. 66 The expressions sthenic and "asthenic," like "constriction" and "relaxation," are among those vague and fallacious generalizations, which from the time of Themison, some hundred years B.C., to that of John Brown, and from his to our own day, have sat like an incubus upon medicine, obstructing all progress from the fact that they are looked upon as descriptions of actual conditions of organs or tissues, when in reality they are only admissible as suggestions of certain indefinite states of the system generally. The same holds good of " vital affinity," a more modern term, and undoubtedly a property of the tissues, but not one which is measurable except by its simple increase in hypertrophy, or its simple diminution in atrophy, unattended by other morbid processes. Whether it is increased or diminished in inflammation is as yet a matter of doubt: hence any rule of practice deduced from it must of necessity be of an exceedingly uncertain character. It is upon such baseless fabrics that the two uniform and rational indications for treatment - namely, to allay morbid susceptibility and to diminish the fulness of blood in the part — are founded, i. e. depletion and arterial sedatives in active or sthenic inflammation, and full doses of opium and alterative doses of calomel in asthenic." It will be seen that Dr. Davis is of the old school indeed, and that the modern affectation of doubt in the efficacy of drugs finds no favor in the wards of Mercy Hospital. Again, in speaking of the causes of summer complaints, he says, p. 148, "While we attribute to the extremes of the seasons, confinement to the nursery, dampness of the atmosphere, malaria and other impurities, a predisposing influence, I am fully satisfied that the immediate exciting or efficient cause is a high atmospheric temperature." After enumerating many instances of cholera-epidemics and endemic intestinal fluxes occurring during the hot season, he continues, p. 149, "To understand the modus operandi of caloric, or a high temperature, in producing disease, we must have a clear con Dr. Hugh Bennett, of Edinburgh, whose authority may be safely accepted on this point, describes inflammation as consisting essentially of exudation of liquor sanguinis following upon active congestion. The experiments of his, Samuel, Techaussos, and others, not only confirm this description fully, but also proves the active congestion to be, not "accumulation of blood in the part," but a contraction and dilatation of arteries succeeded by similar phenomena in the veins with increased flow of blood through them. ception of the normal properties of living, organized matter, and the manner in which those properties may be modified by exterior agents. A careful analysis of the phenomena connected with organization and life shows that every organized living structure, whether vegetable or animal, is possessed of two properties, elementary and essential to the existence of matter in an organized and living state. The first is an affinity by which the organic atoms are made to assume a definite arrangement, constituting the primary structures and types of organization; this property, for convenience, we call vital affinity. The second is a susceptibility to impressions from exterior influences, or a capability of being acted upon; this susceptibility must not be confounded with nervous sensibility, which is merely one of the functions of nerve-structure, and not an elementary property of organized mat ter. The two elementary properties here alluded to will be most clearly appreciated by reference to the simpler types of organization, such as the germinal cells of the ovarium, the egg, or the acorn. You examine the latter, for instance, and you find the organic atoms of which it is composed arranged in a certain definite and uniform manner, in strict obedience to a special affinity. That the particles thus arranged possess a special susceptibility is easily demonstrated by the action of certain exterior agents upon them." The author then instances the effect of heat and moisture on an acorn and a piece of chalk, by which the former is made to produce a miniature oak, while the latter remains unchanged, "thus demonstrating that the acorn possessed a susceptibility, though passive or dormant, peculiar to organized matter." "If you see thus clearly what we mean by vital affinity and susceptibility, as the elementary properties of all organized living matter, you are prepared to understand the effects of a high temperature, both as a predisposing and exciting cause of disease. Caloric is one of those imponderable agents capable of prevading all matter, whether organic or inorganic; and its effect is to expand all bodies by causing the atoms of which they are composed to be separated farther from each other. Hence, it is the great antagonistic power to affinity, whether simple, elective, or vital. Its direct effects upon the living tissues of the human system constitute no exception to the general law of its operation upon other matter; every successive addition of caloric or increase of temperature, increases the expansion of the tissues, and, of course, lessens in the same proportion the vital affinity between the atoms of which the tissues are composed." In illustration of this the phenomenon is mentioned that of a finger held in water allowing a closely-fitting ring to be slipped on to it, while the ring is immovably fixed if the finger be afterwards held in warm water, in consequence of its increased size. "But caloric not only expands living tissues, thereby diminishing vital atlinity, but it also increases their susceptibility. It is chiefly by its power thus to diminish the tonicity or compactness of the tissues, while it increases their irritability or susceptibility, that caloric, or a high temperature, becomes an efficient predisposing or exciting cause of disease. Acting more directly on the cutaneous surface, and, both by continuity of structure and close |