tervene before repeating its introduction; and it is not desirable to allow it to remain within the urethra more than a few minutes on each occasion. Stricture is most commonly met with about 51⁄2 inches from the orifice, or at the point nearly corresponding with the arch of the symphysis. It occurs less frequently at about 3 inches near the root of the penis, being much more commonly cartilaginous in this situation. It is here, too, more tedious in cure, more liable to relapse, and oftener attended with incontinence of urine. Straight catgut bougies are often advantageously employed in its management here; but the cure is much expedited by the use of the wedge-shaped wire sound already described.

We may conclude our notice of this work by extracting a few observations upon the management of retention of urine from stricture. After observing that retention usually occurs from inflammatory or spasmodic action being superadded to the mechanical obstruction requiring general measures, as bleeding, warm-bath, opiates, and large doses of calomel for its relief, Mr. Briggs continues :

"In old and confirmed strictures the part is generally so much contracted as to render the introduction of a catheter even of the smallest size rarely practicable. The only means which seem to promise success are that of passing a fine bougie down to the contracted part, and endeavouring to force the point of it within the aperture. If this can be effected, and the instrument suffered to remain for some time, on its removal the urine will sometimes be discharged in a very small stream, or by drops; but at each successive effort a small quantity will be voided sufficient to relieve the most distressing symptoms, and by a perseverance in the same measures, the stricture may be gradually enlarged, and the necessity of puncturing the bladder avoided. Where the opening of the stricture deviates, as is often the case, from the line of the urethra, a fine bougie possesses an advantage over every other instrument, in adapting itself to the irregularity but in proportion to its fineness it becomes more liable to bend on the slightest resistance, and when the point has entered the contracted part, the waxy coating is ruffled up so as to prevent its advancing further. The instrument proposed (the fine steel sound) is not only free from the latter disadvantage, but, by uniting the two qualities of firmness and tenuity, gives the operator a command over it which he cannot have upon soft or flexible instruments. On this account the two kinds of instruments will be often found subsidiary to each other, and more useful than when employed separately. In cases where the stricture has been so narrow as not even to admit these instruments, I have more than once succeeded with a fine curved whalebone bougie, so tapered that the point has scarcely exceeded the size of a bristle.

"The notion of the absolute necessity of introducing a catheter into the bladder in these cases, leads often to ineffectual attempts to perform what is impracticable, and thereby to render the use of other means more difficult and uncertain. The simple introduction of an instrument, however small, through the obstructed part, when the retention arises from this cause, will, I believe, be found sufficient to procure a flow of urine, and to relieve the dilatation of the bladder, and thereby allow time for the dilatation of the stricture. And it is worthy of observation, that, however small the quantity may be which is voided, it will, pro tanto, take off the distension of the bladder, and consequently the straining and spasmodic pain, almost as effectually as if the bladder had been emptied by drawing off the whole of its contents by means of the catheter."

Mr. Briggs does not of course intend his little work for a complete treatise on stricture, and hence there are many points he entirely passes over which would have yet furnished interesting subjects for comment.

1846.]

CLUTTERBUCK ON INFLAMMATION.

251

His object is merely to state the means of relieving stricture which he has found most successful, and his observations seem to us useful and judicious. We cannot however agree with him in the entire proscription of caustic, and believe that the rapid cure he describes following dilatation by metallic sounds will seldom be found permanent. Moreover, we regard these fine wire sounds as dangerous instruments in the hands of any one who is not constantly exercised in their employment.

A SERIES OF ESSAYS ON INFLAMMATION AND ITS VARIETIES. Essay 1. The Natural History of the Disease. By H. Clutterbuck, M.D. Octavo, pp 67. London, 1846.

Or all that falls within the province of the practice of medicine, Inflammation always has obtained, and seems destined always to demand, the greatest share of attention. Its external and more obvious characters have long been minutely described, and are now well known, but its intimate nature, even with the aid of the microscope, is a matter of keen dispute, and affords a field for investigation that promises fertile results. Independently of this, the observation of disease has long taught most men the vast influence which it exerts in the production, course, and management of the various phenomena of morbid manifestations; and although the time has gone by when these were regarded as mere varieties of expression of the same essential and identical fact, yet many will yet agree with our author in affirming the proposition these Essays are intended to establish-"That most diseases either consist in inflammation, or are consequences of it, more or less remote." Few have advocated this doctrine more boldly or more successfully than he has heretofore done in respect to a class of affections, for the explanation of which it would to most seem defective or faulty; and we are glad to find so veteran a writer again in the field, armed, we hope, with additional facts and arguments. Whether this is the case or not, however, we shall not yet have an opportunity of judging, as the present part of the work treats only of the natural history of the disease. The characters and causes of inflammation are lucidly stated, but we will confine ourselves to the section upon its nature. Dr. Clutterbuck maintains that the humoral pathology is in no wise competent to the explanation of the production of the phenomena of inflammation, and makes the somewhat obscure statement, that a vitiated state of the fluids, when it does occur, is for the most part the effect of disordered action of the solids; and to be viewed rather in the light of an exciting cause, than as constituting the disease itself." It does not seem very clear how it can be both of these. In searching for the proximate cause in the solids, we must not limit our attention to the inspection of the effects of the disease on the dead, but likewise interrogate the phenomena in the living. Mr. Hunter and his followers maintain that the blood-vessels are more active in this state, and transmit the blood with greater force and velocity. They appeal to the comparative rapidity with which it flows

from an inflamed part, and to the enlarged condition of the veins issuing from it-increased redness and augmented temperature being the natural consequences of these conditions. The sensibility and irritability of the part are increased, its movements more energetic, and its bulk augmented by increased secretion or new growth.

"Notwithstanding these strong, and, one would think, conclusive proofs of increased activity of the blood-vessels in inflammation, and incompatible as they seem to be with the notion of debility, there are, nevertheless, not a few who still maintain the opposite opinion-namely, that, in inflammation, the action of the vessels is weakened, instead of being increased, and the circulation in the part carried on more slowly and feebly than in health. The chief argument adduced on this occasion, seems to be derived from the enlargement of the vessels of the part; distension being considered as necessarily implying weakness. Thus, Dr. Billing observes, that the natural action of the arteries is contraction. Now, as the arteries in an inflamed part are larger than before, they must have contracted less, and consequently have acted with less force.' Another distinguished teacher and writer of the present day, (Dr. C. Williams,) expresses himself to much the same effect. Speaking of determination of blood to a part, he denies that this is caused by increased action of the arteries, because,' he says, 'the only active property we know these vessels to possess is that of slow or tonic contrac tion; and this would diminish instead of increasing the motion and quantity of blood proceeding to the part.' 'The enlargement of vessels,' it is further said, 'where a determination of blood takes place, is effected by arterial distension from behind, acting on a tube that has already lost some of its contractile power. The arteries, thus enlarged, become channels for the conveyance of more blood, and with more force, into the capillaries and veins leading from them; these will become, in like manner, enlarged, and share the increase of force and motion thus supplied to them.' But if, as here alleged, the distended arteries of the part are in a weakened state, and the only active property of arteries is that of slow or tonic contraction,-whence, it might be asked, is derived that arterial distension from behind' which is said to produce the enlargement of the vessels of the inflamed part, seeing that the action of the heart is not at all increased in these cases? It is, besides, not easy to understand, how an enlarged tube, that has already lost some of its contractile power' in what is called determination of blood, should thereby become a channel for the conveyance of more blood,' and with more force, the capillaries and veins leading from it, the contrary rather should be the case, according to ordinary hydraulic principles.

6

“The notion, that the only active property possessed by arteries is that of slow or tonic contraction,' leads to a denial of thefr having any share in the general circulation of the blood, this office being supposed to be performed by the heart alone; as, indeed, has been of late contended for also by Dr. Marshall Hall and a few other physiologists. The fallacy of this, however, was so clearly pointed out by Mr. Hunter, that one wonders so unfounded a supposition-one so inconsistent with striking facts-should still be held."

After adducing proofs that the arteries really possess an oscillatory action, i. e., a condition of alternate contraction and relaxation, Dr. Clutterbuck continues :

"Such are the chief grounds that may be adduced in favour of the opinion entertained by Mr. Hunter and his numerous supporters, with regard to the intrinsic nature of inflammation considered as a vital process; viz., that it is a state of increased activity, chiefly observable in the blood-vessels of the part, these being the principal agents in effecting the various physical changes that are taking place. But while it is contended, that in every inflammation there is an increase

1846.]

WILL ON QUALITATIVE ANALYSES.

253

of vital activity in the part affected, it is of great importance to bear in mind, that it is not simply a state of increased action, but an action of a preternatural and morbid kind, and subject to new laws, widely differing from those of health; as is proved by the results above stated. Of the intrinsic nature of this, however, we are, and probably ever shall remain, ignorant. We know it by observation alone, and by comparison with the healthy state. In proper management, likewise as a matter of practice, is only to be learned in the same way, namely, by observation and experience. And even these are but uncertain and insufficient guides; because the disease is subject to be influenced by a variety of circumstances, many of which are unknown to us, and many beyond our ability to control. This acknowledgment of the imperfection of our art should inspire caution in the application of remedies; more especially, in the present day, when the Materia Medica consists, to so great an extent, of the most deleterious articles."

In his section on the varieties of inflammation, Dr. Clutterbuck characterizes many diseases as inflammatory not usually considered such, among which may be reckoned tic douloureux, ague, phthisis, &c., &c.; but we must reserve our objections to this summary procedure until we are in possession of the defence of his views in the future parts of the work. The present part is a very able one, and fully maintains the reputation of its author.

OUTLINES OF THE COURSE OF QUALITATIVE ANALYSES FOLLOWED IN THE GIESSEN LABORATORY. By Henry Will, Ph. D., Professor Extraordinary of Chemistry in the University of Giessen. With a Preface by Baron Liebig. London, 1846.

TRANSLATIONS of the works of German chemists into English have lately been abundant, and it would be unfair to deny that they have been useful to the student; and the present work, though somewhat wanting in details, forms no exception to the general character of the class. As a translation we have no doubt that it is a correct one, but this is not all that is wanted or expected by the pupil; the original should have been accompanied with notes by the translator to have rendered it extensively useful; there are besides other deficiencies-for example, though we have abundant formulæ, there is no list of equivalents appended, to the book, so that we have to guess at their value. Baron Liebig, in the Preface, has stated that "the present work is designed for the use of the laboratory; consequently everything, which does not immediately refer to the processes of analysis, is very properly excluded." Let us admit the accuracy of this statement, and yet the praise is of a truly negative description. It would have been more to the purpose, if the Baron could have assured us that it does contain all or even a large portion of what does immediately refer to the subject treated of.

We shall offer a few observations on parts of this work taken entirely at random, and, if the translation be faithful, the original contains statements which surprise us as coming from so well known and justly appreciated an authority as Dr. Will. For example it is men

tioned with respect to oxide of manganese, that "most of the salts of this oxide dissolve in water, yielding pale rose-coloured solutions, and all of them are soluble in hydrochloric acid." Now, though we have seen slightly reddish-coloured solutions of manganesian salts, we believe the colour to have arisen entirely from some of the metal being in the state of acid. Of this we are at any rate perfectly sure, that we possess solutions of protosalts of manganese which are perfectly colourless, and therefore to state that a pale rose-colour is characteristic of them is utterly fallacious.

Under the head of "Acids of Nitrogen," we have first nitric acid represented by HO, NO, and it is stated that "pure hydrate of nitric acid is a colourless liquid, diffusing white fumes of a pungent odour, when in con tact with the atmosphere. Now the strongest nitric acid obtainable is sesqui-hydrate, and ought therefore to be represented by 3HO, 2NO3.

It is moreover stated that, " with the exception of binoxide of tin, peroxide of antimony, (tellurous and tungstic acid,) all oxides are soluble in an excess of nitric acid ;" this is surely a mis-statement, for binoxide of manganese requires the presence of a deoxidizing agent, as sugar, to become soluble in nitric acid; and binoxide of lead is also insoluble in it, and red oxide of lead is decomposed by its action. It would surely, therefore, disappoint and surprise the student to find no action whatever occurring in the two first cases, and that, in the third, he obtained a brown powder insoluble in the acid.

The author states that, "when ignited, carbonates lose their carbonic acid, with the exception of the carbonates of the alkalies and some alkaline earths (baryta and strontia.)" Now carbonate of baryta we know, and that of strontia we believe, to be decomposed by heat.

Some other statements have struck us as requiring correction, and these, we have no doubt, that the translator will discover to be erroneous; and by the time that a new edition of the work is required, we trust that the requisite attention will be paid to the alterations requisite to render it perfectly worthy of the confidence of the chemical student.

A TREATISE ON MEDIATE AUSCULTATION AND ON DISEASES OF THE LUNGS AND HEART. By R. T. H. Laennec. Translated by a Member of the College of Physicians. Edited by Theophilus Herbert, M.D. With Practical Notes, condensed from the Lectures of F. H. Ramadge, M.D. Octavo, pp. 862. London, 1846.

We felt somewhat surprised at perceiving the announcement of a new translation of Laennec's immortal work, inasmuch as the profession is already in possession of one by an accomplished physician, well qualified to do justice to the task. Upon examining the book, however, we have been still more so, for we could not have believed that any man would have had the hardihood to dedicate a translation of the work of this great and scientific physician to a person of the calibre of Dr. RAMADGE-yet