1885. ] 175 REVIEWS. Arr. XVI.— Recent Works on Practice. 1. Lectures on the Principles and Practice of Medicine, delivered in Chicago Medical College. By Naruan Smuitu Davis, A.M., M.D., LL.D., Dean of the Faculty, and Professor of Principles and Practice of Medicine. 8vo. pp. 896. Chicago: Jansen, McClurg & Co., 1884. 2, A Text-book of Practical Medicine, designed for the use of Students and Practitioners of Medicine. By Auyrep L. Loomis, M.D., LL.D., Professor of Pathology and Practical Medicine in the Medical Department of the University of the City of New York. 8vo. pp. 1102. 211 IHustrations. New York: Wm. Wood & Co., 1884. 3. A Treatise on the Theory and Practice of Medicine. By Joun Syer Bristowr, M.D., LL.D., F.R.S., Fellow of the Royal Col- lege of Physicians; Senior Physician and Lecturer on Medicine at St. Thomas’s Hospital, London. 8vo. pp. 1240. Fifth edition. London: Smith, Elder & Co., 1884. In a review, written in 1881, we remarked upon the paucity of Ame- rican text-books of medicine, and upon the modesty of the sixty-five professors of “ Theory and Practice,” who for nearly twenty years had left the field in possession of foreign authors, with whom Wood and Flint alone competed. ‘The example set by Dr. Bartholow, in 1881, was soon followed by Dr. Palmer, of Michigan; and now we have placed at the head of the list two new candidates for professional favor, which we pro- pose to introduce to our readers. 1. One of the motives, and we may suppose the chief one, which has induced Dr. Davis, towards the close of his professional life, to give to the world this bulky volume, “was,” as he says, ‘a desire to place on record those views and modes of practice developed in my own mind as a result of fifty years’ constant devotion to the study and practice of the healing art.” Another motive, which he mentions, will be less appre- ciated, viz., “to place within reach of medical students a work on practice which embodies in its text the metric system of weights and measures.” Fortunately, to prevent embarrassment, the equivalents in the old system are given. The work consists of ninety-two lectures, embracing substantially the course which Dr. Davis has been in the habit of giving in the Chicago Medical College, and prepared for publication, from stenographic reports, but in part rewritten, and all fully revised. The first five lectures, upon the general principles of medicine, illus- trate the difficulty a teacher has in escaping from the bonds in which a routine course, delivered year after year, tends to inclose him. They bear the impress. of the thoughts and professional opinions of thirty years ago—at which time, very possibly, the framework was put together— 176 REVIEWS. . (Jan. and though modernized in many respects, one is constantly reminded, in their perusal of those fine old works on Principles by Billings, Williams, and Simon. In Lecture VI., under classification, we are given a truly extraordinary arrangement of diseases. The two great divisions are made into General and Local affections, and the latter are divided into four sub- classes, Inflammation, Fluxes, Neuroses, and Miscellaneous. The term “fluxes” is stated to be not free from criticism; but it is made to do good service, and under it we find the motley group of diaphoresis (cutaneous flux), serous diarrhoea, epidemic and sporadic cholera, dropsies, and hemorrhages. The miscellaneous sub-class is an olla podrida of spas- modic asthma, aphonia, diabetes, angina pectoris, parasites, ete. And yet Dr. Davis naively enough remarks, in objecting to etiological or ana- tomical methods of classification, that they ‘lead to the grouping together of diseases the most dissimilar in their nature !” To understand Dr. Davis’s views on fever we must observe that he “ recognizes two inherent elementary properties of living matter, one which gives it the capacity to receive impressions, susceptibility, the other, vital affinity, causes the atomic changes, which result from the impression, to follow certain laws. Fever is not caused primarily by alteration of the blood or a depression of the nervous or other processes, but ‘ consists in the action of some cause capable of disturbing the general elementary properties common to all the organized structures,” ¢. e., the susceptibility and vital affinity. Thus in the fever of pure excitement, febricula, both of these primary endowments of the living tissues are increased, whereas, in the typhoid group they are‘diminished; on the other hand, in the periodical group, sensibility is increased, and vital affinity impaired ; and again, in the eruptive group of fevers, the sensibility is increased, and the vital affinity perverted. The subject of typhoid fever is very fully discussed, and the author is strongly in favor of the view that it may arise spontaneously, holding that it may originate, first, in any dwellings in which, from over-crowd- ing or ill-ventilation, the air, furniture, and walls of the rooms become impregnated with organic emenations; second, from the percolation through the soil, from drains or privies, of fecal and urinary matters ; and, third, it may even occur in an individual without communication with other cases or sources of infection, originating from causes ‘such as protracted mental depression and anxiety, excessive mental and physi- cal work, and abrupt changes from out-door to passive in-door work.” Under such circumstances it is possible that there may be modifications in the processes of disintegration of living structures, evolving septic or other poisonous material, which, returned into the blood, produce febrile disturbance of the same character as when an organic poison is received from without. That the evidence for a specific typhoid germ has uo existence except in the human imagination is the burden of the lecture on etiology, and a great many interesting facts are adduced against the more popular and prevalent theory. Dr. Davis has been very successful in his treatment of the disease. Of 520 cases treated by him in the Mercy Hospital, from 1850 to 1880, only 1 in 16, or 6.2 per cent. died—a very low mortality for a general hospital. He attaches less importance to the temperature than other writers, and believes that the conditions of the kidneys, abdominal viscera, and lungs offer more reliable guides in prognosis. In his remarks upon treatment there is much of interest. In cachectic and depressed conditigns of the | i 177 1885.] Recent Works on Practice. system he has found more benefit from the use of small S88 on code ride of mercury with cinchona than from all the prepara eS ted im oa liver oil, and alcoholic stimulants. In typhoid its us a aa ‘of calomel for its specific curative effect in typhoid, revived or late in Germany, he has seen in many cases, and it yn Pear and found wanting by the physicians of the South an tt in the 1850. Dr. Davis is an unsparing opponent of the use of une disease, believing that it increases the impairment o dthoveby pane ens the ae the carbonic ci eee nes and the “fatty degeneration of stion in the lungs and o gans, and fatty de " ° the heart, Several very interesting real aeectratio oe ating a. change inion on these questions. In the stration and low Co wilee upon careful feeding and the use of stryehnia and me acid a The lecture on yellow fever gives a full an 7 car Be me en ate knowledge of this affection, and the labors of the Sou P ledged and utilized. ; . ; . ten speaking of the history of epidemics of erysipelas in the country Oe Davis is able to confirm, from personal observation, the of the ment. that the epidemic of 1841-46 was true erysipe as, and on acute infectious disease closely allied to diphtheria,” as supposed by $ ie cmpactant subject of the periodical fevers is discussed in three lee. tures. In the severe, congestive types the author strongly urges he nse of the cold douche for the purpose Oe vomale Oa ioe pat ne eon does not think that there 1s a distin O- er eee dvelling i inghi : sand pathological changes in patie Aone O hich the causes of both continued and intermittent fevers onder vocal affections, inflammation is first considered, mae the authors two elementary propery of thee forms steno, astheni and is of the phenomena. Jn ; onic, ame are fethe susceptibility of structure 1s exalted, and te eae a blood increased. In sthenic the vital affinity 1s inerea 7 and tne te ib of the blood plastic; in the asthenic form it 18 jus a s 7 oad the specific the vital affinity is perverted, and the ane ity ue by toxemic. The process is thus explained in a ime ner ne told making very free use of properties, upon the nature ° ype romp with it would be a waste of time to speculate. _We pre Bee nor which everything shall be made clear and bright, but w vive camed with interest to the lectures on pneumonia to a ihings ‘new and old, which Dr. Davis has brought out of ie ome or naively edge. He shows pretty clearly that the disease preva S more ox eld De ‘in the Middle and Northern States than in the son re ms Sneed Drake.and some recent writers. ‘The disease is regar 7 Ne of a inflammation, not a general febrile disease, ane there ne ee euences specific poison, organic or inorganic. Typhoida Bee ae tic pneumonia as modifying the type are considered. A oe ye rt a eeh is is also described, but on very insufficient grounds. cae tent uoted in illustration, the man had during the irene Men , be oe pain in the chest, endocarditis developed, and he die in a ut OW eel The presence of these symptoms, and the fact that the pa No. CLXXVII.—Jan. 1885. 12 178 Revizws. [Jan. occasional attacks of articular rheumatism, led to the opinion that he had “subacute rheumatic inflammation of the parenchyma of ihe lung; in other words, genuine rheumatic pneumonia.” Gouty and syphilitic forms of the disease might readily be described on equally good grounds. The author’s experience in the treatment is instructive. When he began practice in a country district in 1837 he bled and gave tartar emetic, and found that the sthenic cases did well on this plan. In his early days in Chicago, when malaria was prevalent, quinine was most useful, and bleeding, except in rare cases, of no utility. In the heart failure, which he does not look upon as induced so much by the fever as by the defective oxygenation, he finds the stimulating effects of quinine, digitalis, and chlorate of potash, with coffee, the most valuable remedies which have sueceeded in his hands when alcohol has failed. Three forms of phthisis are recognized: tuberculous, pneumonic, and fibroid. The question of the contagiousness is not discussed, and the bacillus is believed to be only an accompaniment of the degenerative changes in the tubercular masses and without causative influence. its diagnostic value is doubted. The lectures on the nervous system suffer from the system of classifi- cation which the author has adopted. Meningitis, cerebral and spinal sclerosis, come, early in the work, under local inflammations; while apo- plexy, bemiplegia, paraplegia, chorea, ete. come late in the sub-class neuroses. The large amount of good work which has been done of late in this department, and which has rendered the study of nervous diseases so much more simple, has not been utilized to a sufficient extent. Lectures 82 and 83 on insanity, while pleasant reading, are too dis- cursive, and do not show an’acquaintance with modern psychological medi- cine. They should be dropped from a subsequent edition, and the pages allotted to a specialist. It is difficult to understand the omission of the subject of general paresis, so important to the ordinary practitioner. Dr. Davis’s therapeutics are most consoling in these days of general scepticism. Art with him is everything ; Nature as understood by Holmes and others “‘ not merely a fanciful goddess, but a positive hindrance to the advancement of practical medicine.” We have already given some illustration, but will briefly refer to one or two others. Mercury holds a high place in his estimation, if one may judge from the number of times its use is advised in various diseases. The index contains eighty-three references to its employment. In hard cancer some very remarkable statements are made of the power of the bichloride to arrest the growth when combined with a simple milk and vegetable diet. xcept in cases of cancer of the stomach he has never seen this treatment fail to relieve the pain and check the growth. On the question of the use of alcohol Dr. Davis is clear and emphatic, and if his opinions prevail with the staff of the Mercy Hospital, the item of “wine and spirits’ in the annual account must be very small. He holds that from first to Jast it acts as a paralyzant and anesthetic, and is in no sense a stimulant. As a result of thirty-five years’ clinical study of the effects of alcohol in all forms of low febrile diseases, he has never yet found an instance in which it in- creased the cardiac force or the efficiency of the circulation. Place this negative statement against the very positive assertions of so many other observers, and we have an illustration of how difficult it is to get at thera- peutical trath, and how much must be allowed for the « personal equation” in the observer. Even 1885. ] Recent Works on Practice. 179 The work asa whole is strongly conservative in its tendencies 3 the younger men “ whose apprehensive senses all but new things isdain wi call it old-fashioned, but they will find in its pages the ripe wis aie 0 a keen and conscientious observer who has arrived at conclusions after stu y and deliberation, conclusions from which ai times we may differ, but which sve our consideration and respect. . ; oon one ‘matter the work is the most distinctively American practice which we have. From his long connection with the American Medical Association and with American journalism, Dr. Davis has becom thoroughly familiar with the good work done year after year by men w 10, far from the great centres, have placed their contributions in local Journa ‘ and the Transactions of State Societies, from the quiet solitudes 0 which he has in many instances gleaned most useful information, and the work abounds with references to the communications of men in every i f the country. eet has been said that the climate of Chicago is unfavorable to careful proof-reading. We do not wish to be too critical, but there are a few errors which spoil one’s pleasure in reading. The proper names, partenlary ° foreigners, need revising. At p. 28 the average temperature 0 ‘ne ony is given as 55° C. (78.6° F.). One of the most curious errors 1s at p. ; where the words “ frematotd or fluted worms” are used instead of trema- id worms or flukes. . to rhe index is a striking example of how such a valuable adjunct to a book should not be prepared. It is largely an index of authors saad and therapeutic means. Thus, under the letter B, of fifty-three re er ences, only three are to diseases, and under brain, only one reference is. given, inflammation of. The fevers are all grouped under the word fever, without any other references to special forms. 2. The work of Dr. Loomis is in many respects a great contrast. It, t00, isa revision and elaboration of the lectures on Medicine | given sn ° University of New York, but we miss in Jt the special features a make Dr. Davis’s lectures so valuable. We do not feel the author 8 personality so strongly, which is of course not to be expected 3 an i the work is more like the general run of text-books on the subjects an Q so being has more than compensating advantages as a manua or Bt a It is systematic; the fecture form has been obliterated; 1t i , ‘arranged and fully illustrated. . ee neintroduction of eight pages, on Inflammation, opens the work, and the diseases of the respiratory system are at once considered. erouP is regarded as a distinct disease, aaa er ene Tree differences which are i rtainly serve to distinguish it from diphtheria. or The prevalence of pneu monia is stated to increase from the pole to the equator, and is more common in the Southern than in the Nort ace ta ey an opinion which, as we noted, is upposed to Dr. Davis’s 0 servation a 7 research. In the compass of a page a very strong case 1s put in von 0 the view that it is an acute specific disease. In its treatment Dr. oomis recommends, as the result of the past five years experien that the patient be brought under the full influence of opium, and he ; ina sta of comparative comfort by repeated hypodermic injections. ne vs way the primary shock is well sustained, and the chance of heart failure is lessened. The relief and comfort which it gives are sufficient to commen its use. The drug should be stopped as soon as the infiltration is com- 180 REVIEWS. [Jan. pleted. For cardiac failure, alcohol is given the first place, and to reduce high temperature, quinine in doses from grs. x to xv is preferred to cold. In his treatment of the disease Dr. Loomis occupies a mid-position between Dr. Davis with his poly-pharmacy and Dr. Bristowe with “nature and nurse.” It is most instructive to read the sections on/the treatment of this disease in these three works. Dr. Bristowe, in a little more than a page full of qualifying phrases, such as, “may possibly,” “« probably,” ‘ perhaps,” as regards drugs, gives most rational advice, and, while treating ordinary cases expectantly, he is in many quite prepared to supplement this plan by other measures. Alcohol he also regards as indispensable in certain cases. In the treatment of empyema Dr. Loomis gives very clear warning against washing outthe cavity, and his recent experience is very posi- tively against it, having on three occasions had reason to believe that death followed the injection of weak carbolic acid solutions. The author’s position on the relation of the bacillus to tuberele is putas follows: ‘The presence of a distinct bacillus in connection with tubercle, and its absence in all other morbid conditions, are generally confirmed by the most competent observers. The etiological relation of this bacillus to phthisis rests solely on the demonstration of Koch. Observers are not want- ing who deny entirely, not only the etiological relation, but even that this bacillus is confined to the tubercular tissues—but they fail to present satis- factory proof of such statements.” ‘The question of the contagiousness he holds is one to which clinical observation bas given no conclusive answer. In the treatment of pnthisis the author places great confidence in quinine, believing that no drug has equal power of arresting phthisical processes in the early stage. In the section on Diseases of the Digestive System and Diseases of the Heart, we notice nothing for special comment; they are carefully pre- pared and well illustrated. . In the treatment of uremia the use of morphia is strongly recommended to arrest the spasms, induce sweating, and facilitate the action of cathar- tics and diuretics. The arterio-capillary fibrosis of Gull and Sutton is recognized as a tolerably well-defined disease, characterized by hyaline- fibroid changes in the arterioles and atrophy of the adjacent tissues, and clinically by a state of high arterial tension. The vascular changes are primary, the renal and cardiac secondary. Typhoid fever is regarded as a miasmatic contagious disease, the specific poison of which is in the fecal discharges, but is not active when these are fresh, requiring to undergo a development outside of the body, either in the excrement itself, or in soil saturated with it. In the treatment of the fever the cold bath is favorably spoken of, when employed with care and judgment. In the majority of cases the temperature can be kept below 103° by quinine, but there are some which require the cold bath as well. In such cases Dr. Loomis’s rule is: after reducing the temperature to 101° or 102° FF. by a cold bath, to administer an antipyrectic dose of quinine, and thus delay the recurring rise. The whole subject of the treatment of this important disease and its complications is most carefully and judicially considered. In typhus fever the author speaks most strongly of the value of fresh air in neutralizing the poison, and advises the use of tents in every epi- demic. He urges caution in the employment of alcohol, and gives an exceedingly interesting account of the fever tents of Blackwell’s Island i 181 1885.] Recent Works on Practice. duced to a minimum, and yet in 1864, where the use of stimulants was re see pellevue Hospital. the death-rate was only 1 in 16 against 1 in ' nt Under the term ceoutinued malarial fever,” there is Oe ae ee te of the much-discussed ‘typho-malarial fever. It is i He oe eed in result of the presence in the body of malaria ana sept i 2 i 7 ane an its morbid anatomy and symptomatology is 2 combina ty enich dhe eases. In cities where malaria prevails sewer-gases neem puacuea ion septic element which is so essential for its developmen *snatl gat or hoid Dr. Loomis does not believe that the septic element jis ac na y ae eat poison, although the intestinal lesions which he describes identical with those of enteric fever. ; i "The article on acute rheumatism is very brief 3 i ecpntinting. are i referr’ tion on the whole is di . simply referred to, and the sec a Soi ne ause i ates, believing tha y author has given up the use of the salicy. , that ef and i rt, incr lity to endocardial mischiei, .pression of the heart, increase the liability it é aeenote relapses. He now gives carbonate of soda to neutralize the urine, i rmi relieve the pain. . and morphia hypodermically to re | The concluding section on Diseases of the pene System contains 4 i ° important affections. brief, but good summary of all the more imp _ The author has produced a clear, practical, and useful text-book, me which can be recommended to the student as a good companion nis hospital work, and to the busy practitioner as a safe gute i ling oss i rati re for the great part original, a nd treatment. The illustrations are 4 na excented the execution of some of the cuts is very good, of a others indi i ry free from typographi . rather indifferent. The work is very m ty pros. i i i bt toa slip of the pen, and it re There is one little mistake, due no dou i : minds us of the remark of a student who had just come An, a cline of Sir William’s, at University College Hospital, ran caein y ae i ter all. hous he, “Jenner is not such an old fellow a L h Ee en ia i . is hag written Sir William Jenner, scovered years ago.” Dr. Loomis bh en re of Edward, e "The Gloucestershire physician had tardy public and professional, never court recognition, and his reputation is how, merit was then, above titular distinction. 3. Dr. Bristowe’s work needs no words of commana from a The profession in Great Britain has endorsed its ree cal ng tor diti ithi The present differs 1 t five editions within seven years. 1 n f L ein i i j rati , t views on infective organisms, chiefly in the incorporation of recent. \ hile toman i i i diseases of the heart. rile t y a new introduction to the section on : vet there 46 jecti i is i scanty details of treatment, y an objection to this work is in the scan yet | s much force in what the author says in the preface, that a man siapting likely to make a thoughtful physician and benef his patienilowing P ng i i ses, than g drugs and methods to the exigencies of cases, tha ue stereotyped procedure of some predecessor.” He hesitates—many do Dad to force his **own routine and trivialities of practice upon ve ents ne contents himself with inculcating general principles, ‘‘and pol wee . : a? the specific virtues of certain drugs.