the heart and its appendages, the additions are less important, though this part is also much enlarged and improved. The new sections on nervous affections of the heart and arteries are interesting, and conclude the work.*

Thus much for the original: with respect to Dr. Forbes' translation, it has our most unqualified praise. He has not only given a complete version of the present edition, but has enriched the original matter with copious and valuable notes; partly from the stores of his own observation, and partly selected from the older authors, both foreign and English, whose works Laennec had overlooked. He has also been enabled to supply much valuable matter from the works of Andral, Luis, &c. which have appeared since Laennec's work was printed. Dr. Forbes's acquaintance with the German and Italian languages has also enabled him to draw upon the medical literature of these countries on many occasions. And it may be stated generally, that where Laennec's account of any disease is incomplete, Dr. Forbes has either added what was wanting, or has indicated the sources whence more full information may be obtained. On the treatment, which certainly is not equal to the other parts of the work, though still containing many practical remarks, well deserving the attention of the English physician, the notes supply much valuable information. They are evidently the produce of a mind well stored with knowledge, and possessing a sound judgment to direct its practical application. Dr. Forbes, with talents of no ordinary stamp, evinces in all his writings the highest degree of candour and liberality: attached to no sect, and free from prejudice and bias of every kind, he willingly grants to each man the merit that is his due, to whatever age or nation he may belong, Though fully impressed, we observe, with the value of the great improvements introduced into medicine by modern pathologists, and more especially by the French, we are happy to see that he does not on that account, overlook the stores of sound practical knowledge to be found in the writings of the older authors, particularly those of our own country, and which are too much neglected in the present day. The notes, in truth, contain a vast mass of important information, which renders the translation a much more valuable work than the original. The whole treatise deserves the careful perusal of every medical man, but we would particularly call the attention of the younger members of the profession to the chapters on bronchial diseases,

*In comparing the translation with the original, we perceive that Dr. Forbes has made several transpositions of chapters and sections which appear judicious.

which are treated in a masterly manner. The dry and latent forms of catarrh demand especial attention, as being little at tended to-we had almost said, entirely overlooked, in this country; though the neglect of them often leads to the most distressing and even fatal consequeuces. They very frequently lay the foundation of those interminable coughs, dyspnoeas, asthmas, &c. which embitter the remaining period of thousands of lives, which they eventually shorten. They also complicate many other diseases, and render them much more difficult of cure, for instance, fever, pneumonia, pleurisy, &c. The complication of these, and indeed of all the forms of chronic catarrh, with an irritated condition of the mucous membrane of the gastric system, forms one of the most important subjects, in a therapeutical point of view, with which we are acquainted. The following excellent practical remark shows that the morbid connexion in question has not escaped Dr. Forbes's observations. After noticing the use of copaiva and similar medicines recom. mended by authors for the cure of catarrhal affections, he observes

"A circumstance not much noticed by these writers, and which renders all such plans of treatment nugatory, is the frequent coexistence, especially in old persons, of a similar condition of the mucous membrane, of the upper portion of the alimentary canal. In this complication, every thing stimulating, whether as food or medicine, is decidedly injurious: while the most marked benefit is derived from such mild regimen as the obvious condition of the membrane indicates."*

The article on pleurisy is altogether excellent, and the treatment good. In one point of practice, in which we find Dr. Forbes differs from the author, (who prefers cupping to the application of leeches,) we decidedly agree with M. Laennec. In cupping the operation is much less tedious and harrassing to the patient, the quantity of blood abstracted can be accurately regulated, and the exposure of the chest, which we hold to be of great consequence to guard against, is much more easily avoided.

In the treatment of peripneumony our views do not accord so fully with those of M. Laennec. He carried the use of tartar emetic to a great extent, and we must say, in our opinion, without much judgment or discrimination. The following is the author's own account of his practice:

*P. 76-note.

"As soon as I recognize the existence of pneumonia, if the patient is in a state to bear venesection, I direct from eight to sixteen ounces of blood to be taken from the arm. I very rarely repeat the bleeding, except in the case of patients affected with disease of the heart, or threatened with apoplexy, or some other internal congestion. More than once I have even effected very rapid cures of intense peripneumonies without bleeding at all; but, in common, I do not think it right to deprive myself of a means so powerful as venesection, except in cachectic or debilitated subjects. In this respect M. Rasori does the same. I regard blood-letting as a means of allaying, for a time, the violence of the inflammatory action, and giving time for the emetic tartar to act. Immediately after bleeding I give one grain of the tartar emetic, dissolved in two ounces and a half of cold weak infusion of orange-leaf, sweetened with half an ounce of syrup of marshmallows or orange-flowers; and this I repeat every second hour for six times; after which I leave the patient quiet for seven or eight hours, if the symptoms are not urgent, or if he experiences any inclination to sleep. But if the pneumonia has already made progress, or if the oppression is great, or the head affected, or if both lungs, or one whole lung, is attacked, I continue the medicine uninterruptedly, in the same dose and after the same intervals, until there is an amendment, not only in the symptoms, but indicated also by the stethoscopic signs. Sometimes even, particularly when most of the above unfavourable symptoms are combined, I increase the dose of tartar emetic to a grain and a half, two grains, or even two grains and a half, without increasing the quantity of the vehicle. Many patients bear the medicine without being either vomited or purged. Others, and indeed the greater number, vomit twice or thrice, and have five or six stools the first day; on the following day they have only slight evacuations, and often indeed have none at all."

The

We have no doubt of the powers of antimony in subduing pulmonary inflammation; but we are equally satisfied that it requires to be exhibited with circumspection, and with due regard to the peculiar character of each individual case. general use of it, however, in large doses, and in the indiscriminate manner in which M. Laennec and the followers of Rasori employ it, we regard as both injudicious and dangerous; we, therefore, perfectly coincide in the judicious comments which Dr. Forbes has made on this subject, and to which we beg to refer the reader. Pneumonia is often complicated with irritation and congestion of the abdominal viscera, and requires a corresponding modification of treatment. In this combination will in truth be found a key to the very contradictory statements regarding the utility of emetics, purgatives, &c. in

The report which M. Laennec gives of the success of this treatment appears great, though certainly some of the most observant pupils who attended his clinic were not equally satisfied on this point with the professor himself; and we confess the result of our inquiries on this subject ineline us to the opinion of those, who think that M. Laennec deceived himself in estimating the extent of the success obtained by his tartre stibié, and underrated, perhaps, the effects of the venesection which was premised in those cases in which the antimony appeared to be most successful.-P. 250, Translation.

+ See notes on the treatment of peripneumony, by the translator.

pneumonia. Every physician of observation must have remarked the comparative facility of curing simple pulmonary inflammation, and the great difficulty of managing it when complicated with the pathological state to which we allude. When all is sound below the midriff, things turn out well, often under the most unpromising circumstances; while the reverse too frequently obtains when the abdominal viscera are in an unhealthy state. The translator has some long, and rather learned notes on the employment of antimony-we make one selection for our present purpose.

"In respect to the administration of the emetic tartar in pneumonia complicated with gastric disorder, I should say that it requires the utmost caution generally, and the greatest attention to each particular case, in order to guard against producing great mischief by it. In many of those cases of gastric complication recorded by Stoll, Reviere, Hellis, and others, where the affection consists rather in a loaded condition of the stomach, duodenum, and liver, and a vitiated state of their respective secretions, than in inflammation or high irritation of the mucous membranes, no doubt the emetic tartar may be valuable, at all events, as an emetic: but when evident signs of the other condition of parts exists, we cannot administer this remedy without imminent danger of augmenting the evils we are attempting to alleviate. That ever in these latter cases, the emetic tartar is sometimes useful, I do not deny; but I believe Broussais' opinion on this point will be found to be generally correct: he says, speaking of emetic tartar in simple inflammatory affections of the stomach, 'leur effet est incertain dans les cas légers; et dan les graves, ils sont toujours dangereux, parcequ' ils ne manquent jamais d'augmenter l'inflammation qu'ils n'ont pas réussi à enlever.' (Prop. de Med.) But my principal object at present is, to call the attention of practitioners to the frequent co-existence of gastric affections with pneumonia in this country, and to point out the absolute necessity, in such cases, of treating both diseases at the same time. In the simple disease we shall generally find our bleedings from the arm, and our tartar emetic, according to the French phrase, heroic; while, in the complicated affection, we shall find these means, if not injurious, at least inefficacious, if we fail to attack the gastric affection with leeches to the epigastrium, saline refrigerants, mucilaginous diluents, &c. and if we do not forbid the ingestion of purgatives and other irritants, at least for a season."

Dr.

In the truth of these remarks we perfectly accord. Forbes, in another note, gives the results of his own experience of tartar emetic, which are, upon the whole, favourable, and will be so, we doubt not, in the hands of those who use the same judgment and discrimination in the employment of it that Dr. Forbes does.

pre

On asthma, in its various forms, we find much most valuable matter in this edition; and, taken in conjunction with the ceding accounts of dry catarrh and emphysema of the lungs, affords more precise information respecting the pathology of asthma than is to be met with in the writings of all preceding authors. Indeed after a careful study of this part of the work, we are disposed to believe, with the translator, "that we have

such additional light thrown upon this disease, (asthma,) that it may henceforth, in a great measure, be considered as raised from the obscurity of hypothesis into the light of rational pathology." In the following remarks by Dr. Forbes, on the treatment of asthma, we perfectly concur.

"Among the remedies that best deserve notice in asthma, I would mention a mild and spare diet, residence in a more temperate climate, and warm bathing. The first of these measures will be found very beneficial in cases compli cated with gastric irritation; the two last are especially indicated in that class of cases which date from the disappearance of cutaneous eruptions under the use of powerful external applications. This method of cure is, I am convinced, the fruitful source of many internal irritations and inflammations, and, among others, of bronchitis and asthma. Although the doctrine of repulsion may be deemed by some theorists somewhat absolute, I feel assured that its truth will be assented to by most observant practitioners of experience. I therefore consider it my duty to caution the student against a practice, which accords too well with the energetic empiricism so much in favour in this country, not to be readily adopted from analogy, even if not inculcated by positive precept." -(Note, p. 418.)

But to notice all the valuable articles in the volume before us would be to go over the table of contents. In no other work is the same accurate and comprehensive information, on the various subjects of which our author treats, to be found, It is truly a classical production, not only to be read but studied; a work of reference, in short, which almost every practitioner might advantageously recur to while the disease is under his observation. By comparing the descriptions of Laennec with nature, the clinical student more especially, to whom the work is invaluable, will learn to estimate the graphic delineations of the author, while he will greatly increase his knowledge of disease, and improve his powers of observation at the same time.

The second division of the work, which treats of diseases of the circulating system, is less perfect than the other; but Dr. Forbes's notes and references go far to supply its deficiencies. We make a single extract from one of the former, because it contains a practical admonition of great importance.

"I would therefore lay it down as a valuable practical rule in chronic affections of the heart, that previously to having recourse to any remedies intended to act directly on it, we ought to be assured that the digestive organs are in a healthy state-that their mucous surfaces are free from irritation-their vascular system not morbidly distended, and that the liver is performing its secretory function freely and regularly."

*

Note, p. 687. We recommend the careful perusal of the whole of this note to every medical man. In the concluding part of it, as on many other occasions, the translator bears testimony to the benefits derived by the profes sion from the labours of Broussais.