changes have taken place, we have first to restore the healthy action of the kidney--and, secondly, to guard against those dangerous secondary consequences which may destroy the patient at any period of the disease. Inflammatory affections, especially of the serous membranes, and serous or sanguineous effusions on the brain, are the two principal sources of danger. Thus, out of seventeen dissections, they found ten or eleven betraying pleural inflammation, ancient or recent--five of pericardial phlogosis, (three recent, two old,) and only one where peritoneal inflammation was well marked. In respect to cerebral affections supervening on renal disease, the cases recorded by our author present both apoplexy and epilepsy. The treatment must, therefore, bear on the prevention of these impending dangers, and active depletion, in the early stages, is indispensably necessary. When symptoms indicative of the presence of these inflammatory affections appear, there can no longer be a doubt as to the free abstraction of blood. Practitioners should bear in mind that, in these complaints, the thoracic inflammations are extremely insidious, and are often masked by the hydropic phenomena. "And we are led to ascribe many of the symptoms--such as the slight cough, the dyspnoea, and the difficulty of lying down--to effusion rather than inflammation." We are sorry to hear such observations from Dr. Bright, at a period when effusion in the chest may be very readily distinguished from inflammation of the lungs or pleura, by even tyros in auscultation.

When the inflammatory attack comes on early in the disease, it is often overcome by free depletion; but in the more advanced stages, the patient bears depletion so ill as to check the depletory measures. But bleeding is also an important remedy for the restoration of healthy action in the kidneys themselves. The foundation of future disorganization is probably laid in a previous state of slow inflammation or congestion. General blood-letting was useful in many cases-in others, local depletion from the loins had a better effect.

Purgatives, especially the saline laxatives combining diuretic powers, are decidedly beneficial. The supertartrate of potash was found very useful in our author's hands. He gave it in a fully saturated solution-a large draught early in the morning. The next diuretic which Dr. B. has been in the habit of employing, was squill, in its various preparations, especially when combined with hyosciamus or opium. Digitalis, where the pulse was sharp, seemed adapted to the complaint. When the inflammatory stage had subsided, Dr. B. thought he saw advantage derived from turpentine and Peruvian balsam.

In respect to the employment of mercury in this class of diseases, Dr. Bright seemes to be of opinion that it is injurious, rather than advantageous; although it is consistent with good and successful practice in most other inflammations to avail ourselves of the valuable combination of calomel and opium. Still Dr. B. appears to be in doubt upon this subject. He observes, however, that the sphere of mercurial practice, in these diseases, is very much limited, on account of the rapidity with which ptyalism comes on, and the difficulty of restraining it afterwards. When the cellular membrane is anasarcous, from renal disorganization, the gums and cheeks are not capable of supporting the process of ulceration, and often pass into a state of gangrene.

Where, as in a case to which I have only referred, we have a flaccid, watery and dissolved state of the kidney, I can point out no diagnostic symptoms by which it can be discovered, except such as show general debility of circulation and feebleness in the structure of the heart; for probably the feeble condition of the two organs may often be found co-existent. If this be the case, it is not improbable that Tonics will be the most appropriate remedies. In one or two cases of anasarca which I have lately had under my care, where from the feeble but extensive beat of the heart I was led to suppose that a feeble state of that organ existed, a combination of Sulphate of Quinine with Squill, effectually restored the patient. And occasionally we find anasarca even with coagulable urine so marked by debility, that tonics and steel give decided relief; probably it is as a tonic that the Uva Ursi is sometimes useful." 74.

II. CHEMICAL PROPERTIES OF THE URINE.

Dr. Bostock has favoured the author with a letter on this subject, from which we shall extract some particulars. In the greater number of specimens of urine examined by Dr. Bostock, as passed by the patients whose cases are narrated, the quantity of matter dissolved or suspended was below the average of healthy urine. Dr. B.'s experiments induce him to conclude that these specimens of urine were not only deficient in some of the natural constituents, but contained a quantity of extraneous matters. The coagulability of the dropsical urine, Dr. Bostock attributes to the presence of albumen; but thinks that this proximate principle is modified or altered, in some cases of the disease under consideration.

Here Dr. B. trenches a little on the pathological physician's province. He observes that the presence of albumen is commonly considered a morbid phenomenon, and a pathognomonic symptom of a certain state of the constitution, or, indeed, of a

specific disease. If the albumen be in a state coagulable by heat, the first position may be true; "but it must be admitted, on the other hand, that an albuminous state of the urine is produced by such a variety of circumstances, and many of them of so trifling a nature, as to render it almost a constant occurrence." In his own person, he has hardly ever found the urine entirely free from albumen, and he observed it to be increased to a considerable amount by the slightest causes.

This brings our analysis of the first part of Dr. Bright's work, occupying 88 quarto pages, to a close. In our next number, we shall pursue our analysis, so as to make our readers as well acquainted with the work as can be done through the medium of a journal, and without the assistance of the plates. We strenuously recommend again this very meritorious production to the patronage of the affluent members of our profession, and think that no medical society or association should be without it.

IX.

Traité de l'Auscultation Mediate, &c. A Treatise on the Diseases of the Chest, and on Mediate Auscultation. Translated from the French of R. T. H. Laennec, M.D. with copious Notes, and a Memoir on the Life of the Author, by JOHN FORBES, M.D. senior Physician to the Chichester Infirmary, &c. Second Edition. One volume, 8vo. pp. 722, with Plates, and a Head of the Author. London, 1827.

EIGHT years have now elapsed, since we first called the atten tion of the profession, in this country, to the treatise of M. Laennec, which we characterised as one of the most valuable productions that had appeared in the present age. In doing this, we rested our opinion chiefly on its pathological merits, having then had but little personal experience of the application of the author's discovery to the diagnosis of thoracic diseases. Since that period, however, we have had abundant opportunities of verifying the truth, and of appreciating the value, of mediate auscultation; and we can now as confidently bear testimony to the value of the diagnostic part of M. Laennec's work, as we then did to its pathological merits.

As, on the occasion alluded to, we entered very fully into

*

the pathological views of the author, and again took up the subject in noticing Dr. Forbes's translation of the first edition, we do not now mean to give any thing like a formal analytical review of the work before us. And we the more readily come to this determination, seeing that, in its present improved form, it must soon be in the possession of every medical man, who is really desirous of making himself acquainted with a class of diseases, which he is called upon to treat more frequently, perhaps, than any other; and his successful treatment of which must of course, depend no less on his knowledge of their nature than on his powers of distinguishing them from each other. Our principal object, in this notice, will be to point out to our readers the very material improvements and additions with which the present edition has been enriched by the distinguished author and able translator.

The work has now attained all the perfection which it ever can receive from the hand of M. Laennec, whose premature death we had lately the melancholy task of recording. He just lived to see the present edition published, the completion of which, with his other arduous professional avocations, seems clearly to have hastened his end. The death of M. Laennec has deprived the profession of one of its most talented and most zealous members, and the medical school of Paris of one of its brightest ornaments; and this, too, at a period of life, when, judging from his past labours, so much might still have been expected from him.t

The present edition possesses many and great advantages over the former. It is much enlarged and improved in every respect. The arrangement is infinitely superior, the pathological descriptions more complete, the diagnostic signs are more correctly stated, and the limits and practical utility of

* See vol. II. of this Journal, Jan, 1820, when we occupied upwards of thirty closely-printed pages, in giving a condensed analysis of the first edition.

N. B. We were a good deal surprised at a singular mis-statement in Dr. Forbes's dedication, wherein he gives Dr. Clark the credit of being the first to promulgate the work of Laennec in this country. Our analysis of it came out several months before Dr. Clark's notes were printed.

+ Dr. Forbes has prefixed to his translation an interesting sketch of the author's life, containing a history of his studies, an accurate list of his numerous writings, and an estimate of his private and professional character. He was only in his 45th year when he died. It is singular that none of Laennec's biographers have noticed his genius for, and even practical knowledge of, mechanics; though it was, in all probability, this turn of mind which led to the discovery of the stethoscope.

mediate auscultation more clearly defined. The treatment of the different diseases is also added in the present edition; and the work must now be considered as a very complete treatise on the pathology, diagnosis, and method of cure, of the diseases of the thoracic viscera:

"The original treatise," says Dr. Forbes, and in this sentiment we entirely accord, "will remain an imperishable monument of the genius and industry of the author; and the discovery of which it treats, will entitle him to a distinguished rank among the benefactors of mankind. As a standard work on the pathology and diagnosis of diseases of the chest, it is not only without an equal, but may be considered as almost perfect in its kind. Much, no doubt, will hereafter be discovered that will modify and improve the delineations of disease which he has left us, but their great outlines must remain unalterable as nature itself."*

Besides the treatment and general improvements which we have noticed, numerous additions have been made to the original materials of this work, which we shall rapidly glance at. In the very important chapter on "Inflammatory Affections of the Mucous Membrane of the Bronchia," the sections on pituitous, dry, latent, suffocative, and symptomatic catarrh, and also on hooping-cough, are either altogether new or greatly enlarged. The chapter on Dilatation of the Bronchia is also much augmented, that on Croup is entirely new. The subsequent chapters on Bronchial Hemorrhage, Bronchial Polypus, Ulcers of the Bronchia, &c. are materially enlarged. The dissertation on the structure of the lungs, introductory to the diseases of these organs, contains much new matter. The chapters on Atrophy and Hypertrophy of the lungs are new; that on Emphysema of the Lungs is much enlarged, and one of the most interesting in the treatise. The chapter on Peripneumony is materially improved, and really constitutes a complete and elaborate monography of pulmonic inflammation. The article Phthisis is greatly enlarged and also materially improved; and, like many others in the work, constitutes a beautiful specimen of accurate pathological research. Before the publication of the work of Luis, this monography of consumption was unrivalled; even now, with the aid of the translator's copious annotations, derived from the work of Luis and many others, it is probably still the best memoir on the subject; certainly it is, beyond all question, the best in the English language. The chapters on Diseases of the Pulmonary Vessels, and on Nervous Affections of the Lungs, are mostly new.

To the second grand division of the work, which treats of