Chemical Physiology and Pathology-Vaughan.*

This little work claims only to be the lecture notes of a teacher of chemical physiology and pathology. These notes have been made from a study of the eminent workers in this field. In their passage through the writer's brain they are more or less modified, and with occasional additions or subtractions as would be natural to any independent thinker and worker. We doubt not that the work is of great value to the author's students, and to such other students as have teachers pursuing similar methods. Generally, chemical physiology is taught in connection with experimental physiology, and physiological anatomy and histology. Altogether these are concerned in what we call vital processes. But it may be that, as many think, it is better to teach the various parts separately. In accordance with his plan, the author has made an excellent work, accurate and readable. We have read it with much interest, and can commend to all desiring a clear statement of our knowledge on these subjects.

Tellor on Diseases of Live Stock.t

This is intended to be a plain description of the diseases to which horses, cattle, sheep and swine are subject, and the best treatment for the same. The author was brought up on a farm, and has practised medicine in a rural locality. In this way, being often consulted respecting diseases of these animals, he secured the best works on the subject. Combining these with his experience, he has prepared this volume in the hope that it may be of service to those having the care of these animals, and particularly to those situated as he was. From our examination we can say that the volume is carefully prepared and admirably adapted for the purpose designed. It is well printed, on good paper, reflecting credit on its publisher.

*LECTURE NOTES ON CHEMICAL PHYSIOLOGY AND PATHOLOGY: By Victor C. Vaughan, M. D., Ph. D., Lecturer on Medical Chemistry, University of Michigan. Second edition, revised and enlarged. Cloth; pages 315.

1879. Ann Arbor: Ann Arbor Printing Co.

THE DISEASES OF LIVE STOCK AND THEIR MOST EFFICIENT REMEDIES: By Lloyd V. Tellor, M. D. Cloth; pages 469. 1879. D G. Brinton, 115 South Seventh street, Philadelphia. Price, $2.50.

Clinical Diagnosis.*

The diagnosis of disease at the bedside is a subject of perennial interest. Undoubtedly more medical men fail in this than in all other points. So vast are the fields of research connected with the normal structure and function of every portion of the body, and with the various degrees by which this structure and function become abnormal, that the student, and too often the practitioner, is unable to so sift it as to bring to bear upon any particular case just that knowledge that shall unravel its perplexities.

Here perception, memory, reasoning and judgment, all have opportunity for their fullest activity. The work before us is designed "to give some assistance in the clinical study of the signs and symptoms of disease by supplying carefully selected data in a condensed form, by submitting accurate methods of investigation, by pointing out probable fallacies and by directing attention to collateral inquiries or issues which might otherwise be readily overlooked by the inexperienced." Its several chapters are prepared by different authors especially familiar with the clinical diagnosis of the disorders discussed. Thus Dr. W. T. Gardiner contributes the article on "Physiognomy of Disease;" Dr. James Finlayson on "Case-taking, Family History and Symptoms of Disorder in various Diseases;" Dr. Wm. Stephenson on "Disorders of the Female Organs;" Dr. Alexander Robertson on "Insanity;" Dr. Samson Gemmell on “The Sphygmograph and the Physical Examination of the Chest and Abdomen;" Dr. Joseph Coats on "The Examination of the Fauces, Larynx and Nares, and on the Method of Performing Post Mortem Examinations." We have read the various chapters with interest, and hesitate not to affirm that there are few practitioners, and no medical students, who would not be greatly profited by their careful study. Largely the scope of the work is unique, in that it occupies a medium position between those

*CLINICAL DIAGNOSIS-A Hand-book for Students and Practitioners of Medicine. Edited by James Finlayson, M. D., with eighty-five illustrations. Cloth; pages, 546; 1878. Henry C. Lea, Philadelphia. Price,

works that give the merest skeleton and those that are extremely elaborate. The opening chapter on the physiognomy of disease is concise and yet graphic. Generally, we are inclined to the belief that too little is made of this topic by students, and even practitioners. Speaking of diathesis, Dr. Gardiner remarks that the proof of its existence is a proof of disease, though it may be in its earlier manifestations and least notable forms. Every teacher will assent to this. "What has chiefly to be rooted out of the mind of the ill-informed or imperfectly trained clinical student is the impression that such conclusions are to be safely reached through mere phrases, appealing largely to the imagination, without minute and careful study of details. The popular, and to a certain extent, the half-educated medical mind is always looking for a pathognomonic sign, or a broad, striking, easy generalization from a few facts; whereas it is only by ripened experience that we come to know gradually the real value of common and obvious, still more of uncommon and not obvious, facts, when seen in combination, so as to form conjointly a basis for large inferences. Such a diagnosis, however, is often the result of the careful study of the physiognomic characteristics of individual patients."

In considering the physiognomy of corpulence, "it is to be remarked that the experience of years, and the critical appreciation of the human form under a great variety of conditions, normal or abnormal, gives to the physician, in many cases, a power akin to that of the artist, incommunicable by words-an instinct of divination, so to speak, by which the true character and the history of the organism may be read in the external features and physical characteristics; and this not only as to health and disease, but as to all the leading elements of character." He does not regard any amount of external fat beyond a fair average as advantageous to its possessor.

As senile decay begins, the embarrassment caused by an excess of rotundity is most apt to tell upon the constitution. Speaking generally, a moderate accumulation of fat up to the age of 40, or even 45, is wholesome rather than otherwise, and

if associated with a broad chest, well developed and active muscles, an energetic character and a healthy respiration and circulation, will tend to long life, even if the digestion should be, as often happens, rather feeble. But increase of fat to a notable degree beyond the middle term of life, is always to be regarded with suspicion as implying a probability of vital and dynamic conditions of nutrition tending to precipitate the process of the senile decay. In persons of spare habit the following points require notice: The presence of "clubbing" of the finger-ends, or of undue curvature of the nails, the red line on the gums, said to be more or less characteristic of tubercular disease; the peculiar momentary starting and elevation of the skin produced by a tap of the finger point over the costal cartileges, and described as "myoidema;" any undue, and especially any unilateral flattening below the clavicles, or deformity elsewhere of the chest, and any inequality or want of symmetry in the respiratory movements; any rapid and too easy flushing of the face, and especially that limited flush of the cheek with pallid complexion generally which denotes fever in an exhausted constitution; any or all of these may, in particular cases, be valuable indications of truly morbid emaciation. In almost every serious disease of infancy and childhood, it is possible, by studying carefully the relation of the spontaneous movements to each other, and to the attitude and expression of the child, its cries, smiles, inarticulate noises, its color, state of general nutrition, behavior in sleep and in waking, to arrive at a reasonable and often a perfectly just conclusion as to the general nature and locality of the disease. The various other chapters are prepared with equal care and felicity. It is an admirable book in design and execution. Every student that is in attendance upon clinics or hospitals would act wisely in making it his constant companion until its contents are mastered.

INDEX TO VOLUME II.

PAGE

Atropia, Action of on Salivary Secretions. 155 Ergot, Precautions in Administration of.
Auscultation of Arteries..

154, 225 Eserine in Glaucoma.

150 Ether in Short Operations.

413 Ethidene Di-Chloride as an Anæsthetic.

Editorial.297, 374 Exercise in Prevention of Disease.