increased activity, but diminished power of the ventricular contractions; these are the characteristics which indicate supporting measures, of which alcoholic stimulants form an essential part.

*

*

*

*

Whenever the question arises, whether alcoholic stimulants be advisable or not, it should be borne in mind that to begin earlier than they are required is far preferable to subsequent delay; for with proper care they can be suspended without injuring, whereas the time lost in beginning too late cannot be regained."

On the treatment of Acute Bronchitis, Professor Flint says that "in some instances it may be prevented by a full opiate and diaphoretic. A quarter of a grain of sulphate of morphia, half a grain of codeia, a proportionate dose of any of the preparations of opium, may be given at bedtime, accompanied by a hot pediluvium, and some warm stimulating drink, such as weak punch or toddy, followed in the morning by a saline purge." We make this extract, for it is a plan we have often followed with much success. Again he says::- Opium is thought by many to be contraindicated in the first stage. It is supposed to interfere in the free secretion of mucus, and renders expectoration difficult. This is an inference from the effect of opium on the secretions in health; but so far from these results being produced, opium appears to hasten the second stage. The free secretion of mucus is not the cause, but the consequence of an abatement of the inflammation, and by contributing to the latter, opium virtually acts as an expectorant. Opium, therefore, is indicated in the first stage of bronchitis, as it is in most acute inflammations. In the second stage it is only indicated, when the cough is out of proportion to the expectoration; that is, when the amount of cough existing is not needed to effect the removal of morbid products in the bronchial tubes. Opium is contraindicated, if owing to the feebleness of the patient, the efforts of expectoration are inadequate to prevent accumulation in the bronchial tubes."

When treating of the subject of delerium tremens,—our author thus gives expression to his opinion regarding the cause of the disease. "In a large proportion of cases its development is evidently owing to the use of alcohol being suspended or much diminished. Thus it occurs in persons who voluntarily undertake to abandon intemperate habits, or who are unable to obtain liquor, or who are prevented from drinking by the occurrence of some disease or accident. It is notoriously common among inebriates who are thrown into prison, and among those admitted into hospital. It is apt to follow paroxysms of intemperance in periodical drinkers when the stomach refuses further alcoholic libations," Dr. Flint has tried the method of treating this disease by large doses of

tincture of digitalis, and says:- "In one case it acted like a charm, but in the others no curative effect was apparent. He recommends tartar emetic in nauseating doses, and opium as advised by Professor Stille, of Philadelphia-that is, commencing with a quarter of a grain, and hourly increase the dose, till sleep is produced. He thus speaks of the continuance of the stimulus :-"In general it is injudicious to discontinue entirely the use of stimulants so long as the affection continues. The time for breaking off the habitual use is after sleep has taken place and the patient is convalescent. Stimulants are to be given freely, in cases in which the symptoms denote failure of the vital powers."

When writing of the various means that have been suggested to prevent pitting in small pox, Professor Flint does justice the late Dr. Crawford, Professor of Clinical Medicine in McGill University, by stating "The application of tincture of iodine, once or twice daily, by means of a brush, was a plan introduced by Dr. Crawford of Montreal." Dr. Flint has evidently devoted great care in the compilation of his work, which has the advantage of being brief, and yet containing almost everything really essential. It has faults, and what work is free from them? But we feel that, with justice, we can cordially recommend it to the practitioner—although we must admit there are works from other pens, that we would sooner have in the hands of students. It is neatly produced from the publishing house of Henry C. Lea, late Blanchard & Lea, Philadelphia.

Phila

The Practice of Medicine. By THOMAS HAUKES TANNER, M.D., F.L.S., Member of the Royal College of Physicians, London. From the fifth London edition, enlarged and improved. delphia Linsay & Blakston. Montreal: Dawson Bros. Tanner's Manual of the Practice of Medicine has, for a number of years, been the standard one in use among practitioners and students, but we think they will hardly recognise their old friend, in the large volume of almost a thousand pages, into which it has been transformed, and which bears the title at the head of this article. In his preface Dr. Tanner tells us that all the time that he could spare from his onerous duties have been devoted to the revision of his work, which has almost unconsciously attained its present size. His style of writing is pleasant, and, without being at all wearied, several hours can be passed in its perusal; but we cannot avoid stating that this work has one of the faults, which we complained of in the review of Dr. Austin Flint's Practice of Medicine, viz., the dogmatic tone to be observed throughout the entire

volume. Dr. Tanner has, in his preface, attempted an apology for this in the following words-" I trust it may not be thought that too dogmatic a tone has been adopted. But twenty years of daily observation have given me great confidence in the strength of the general principles which I have tried to inculcate in the following pages; and being thus zealously impressed, it is difficult (even were it advisable) to do otherwise than speak positively." We can fully appreciate the difficulty to which Dr. Tanner alludes, yet believe that it might have been overcome, and upon the advisability of his having overcome it we do not entertain a doubt. With this exception we believe Dr. Tanner's work to be a most admirable compendium upon the treatment of disease-one from which much useful information may be derived. Upon the subject of obesity our author gives a good deal of credit to Mr. Banting, for his system. Speaking of the power which physicians have to cure obesity, he says—" Now I believe that we possess this power, and that we are indebted for it to the light which has been shed by physiological chemistry on the production of fat in the body, and the influence of respiration of removing carbon from the blood ***. But it is only fair to allow, that some credit is due to Mr. Banting, whose pamphlet appears to me a very sensible production. In August 1862, this gentleman was 66 years of age 5 feet 5 inches in stature, and 202 lbs. in weight. He could not stoop to tie his shoe, was compelled to go down stairs backward to avoid the jar of increased weight on the knee and ankle joint, and was made to puff and blow, with every slight exertion. After trying many remedies, including fifty Turkish baths with gallons of physic, without the slightest benefit, he consulted Mr. William Harvey, who cut off the supply of bread, butter, milk, sugar, beer, soup, potatoes and beans, and ordered the following diet.—(We give this table, as it may be of interest to many of our readers who may have been unable to obtain Mr. Banting's phamplet.-ED. Journal.)

*

Breakfast.-Four or five ounces of beef, mutton, kidney, broiled fish, bacon or cold meat (except pork), a large cup of tea, without milk and sugar; a little biscuit or one ounce of dry toast.

Dinner.-Five or six ounces of any fish except salmon, (it would have been as well to have forbidden herrings and eels,) any meat except pork, any vegetable except potatoe, one ounce of dry toast, fruit out of a pudding, any kind of poultry or game, and two or three glasses of good claret, sherry or madeira; champagne and beer forbidden.

Tea.-Two or three ounces of fruit, a rusk or two, and a cup of tea without milk or sugar-(coffee might have been allowed).

Supper.-Three or four ounces of meat or fish or a glass or two of

claret. For nightcap, if required, a tumblerful of grog (gin, whisky or brandy without sugar or a glass or two of claret or sherry.)

"At the same time a draught of a drachm of the aromatic spirit of ammonia, with ten grains of carbonate of magnesia, was given twice daily on an empty stomach. The result of this treatment was a deduction of 45 lbs. in weight, with better health than had been enjoyed for the previous twenty years."

When writing of the treatment of gonorrhoea, a disease which is unfortunately but too prevalent, he advises great caution with regard to two drugs, copaiba and cubeb pepper. He says "Without saying that these agents are never to be prescribed, yet I would guard their administration with so many 'ifs' as almost to amount to a prohibition. Such has been our experience; and for a number of years we have never made use of either of the drugs named, and yet have seldom met with much difficulty in curing the disease." This assertion we most cordially endorse. Within the last seven years we have treated several hundred cases of this disease, and with one or two exceptions, never made usa of the last drugs named. In the only cases in which we used it, we found the nausea produced so great, that we then abandoned their administra tion in the disease, and never have had occasion to regret it.

As we gave Dr. Flint's views of the cause of delirium tremens, we quote Dr. Tanner's, with a view of shewing what entirely opposite opinions, are held by these two eminent authors. Dr. Tanner says"According to some authors, the symptoms of delirium tremens, may set in after a protracted debauch of six or eight days, or upon the sudden withdrawal of the accustomed potations. The latter observation has been repeated so frequently that at last it has almost become a sort of recognised law; but for all that it is probably thoroughly untrue. Evidence derived from hospital practice, and from the reports of convict prisons, seems directly to negative it; and it may now be said to be at least highly probable, that a person accustomed to the very free use of stimulants may at once give them up without any danger whatever; in fact, as with other persons, the only risk to be feared is from continuing their employment." Our experience has tended to prove directly the opposite, and so great a benefit have we seen derived from the administration of stimulants, in this disease, when the patient has been cut off from it for several days previous to the attack, that we would feel, we would not be doing our duty to our patient, if, in the majority of cases, we did not continue the stimulants until sleep had supervened. Looking upon the disease as alcoholic toxæmia, our author says"It is as absurd as it is injurious to treat this disease by continued doses of the

poison that has caused all the mischief." Dr. Tanner says his experience tends to confirm that of Dr. Jones, of Jersey, of the benefits to be derived from the employment of digitalis in large doses.

We have no doubt that all who patronised the Manual of Dr. Tanner will be anxious to obtain the work in its enlarged and improved edition; to others we can especially commend it as being replete with the most valuable practical information. It is neatly got up, and substantially bound, by the publishing house, whose imprint the book bears, that of Lindsay & Blackston, of Philadelphia.

PERISCOPIC DEPARTMENT.

Midwifery and Diseases of Women and Children.

ILLUSTRATIVE OF THE DISEASES OF CHILDREN.

By G. STEVENSON SMITH, L.R.C.S.E, Fellow of the Obstetrical Society, and formerly resident Medical Officer, Royal Edinburgh Hospital for sick children.

ACUTE HYDROCEPHALUS.

The following cases are intended to illustrate the chief symptoms of Acute Hydrocephalus, which is one of the most frequent and most fatal affections of early life. The insidious manner of its approach, the extremely painful nature of its course and termination, as well as the resistance it usually offers to all treatment, cause this disease to be regarded both by parents and practitioners with feelings of anxiety and alarm.

cure.

It is one of that class of ailments for which unfortunately medicine can do but little; for although in recent years, mainly through the researches of French pathologists, we have become intimate with the structural changes and appearances which generally accompany an attack of hydrocephalus, we are still ignorant of any remedy on which we can rely as a And consequently the annals of medicine record very few instances indeed of recovery having taken place, after any well-marked symptoms of water on the brain had manifested themselves. It is no uncommon thing for patients labouring under the chronic form of the disease to survive for many years, but in them the senses and the intellect are often impaired; in acute cases, however, a fatal result is almost invariable. Case 1.-E. W., aged 6, had enjoyed tolerably good health up till the month of October, 1865; but about that time she began to fall off, her