65. These deposits are not critical evacuations, but are products of organic decomposition.

66. They are induced artificially by bloodletting.

67. Patients treated by bleeding become much more emaciated than those treated dietetically.

68. In expectant practice, the instant that exudation is completed the sensation of weakness vanishes, and the patient very quickly recovers; when bleeding is practised the patient is certainly easier after exudation is complete, but he then becomes affected with a degree of weakness difficult to combat.

69. The length of convalescence is comparatively far shorter in expectant practice.

70. There is no such disease as chronic pneumonia.

71. Primary croupal pneumonia is a well-marked, distinct, and acute process, in its course bearing most resemblance to the acute exanthemata, especially to small-pox.

72. Hepatisation, whether extensive or limited, requires for its completion, in most cases five, in rarer instances, seven days.

73. Most cases of quickly-cured, or suppressed pneumonia, are instances of hepatisation of the lungs, hastened by venesection.

74. Clinical and physiological facts tend to prove, that venesection cannot prevent the development of the pneumonic exudation.

75. In cases treated by bleeding, the most extensive hepatisations, and largest fibrinous coagula in the cavities of the heart and great vessels, are met with. 76. Bleeding promotes the extension of hepatisation.

77. Many intense and extensive pneumonic cases originate and run their course in patients while under antiphlogistic treatment (unter der Lanzette). 78. Bleeding cannot stay the course of hepatisation once commenced. 79. Rapid resorption is observed after both forms of treatment, but the most rapid instances occur in those treated on the expectant plan.

80. Resorption seldom proceeds rapidly in patients considerably debilitated by blood-letting.

81. Resorption of pneumonic exudation commences when appetite is first restored no appetite, no resorption.

82. Absence of the so-called critical evacuations is a sure sign of rapidly-proceeding resorption.

83. A first attack of pneumonia, if left to nature, is usually quickly resolved by resorption, without critical evacuation.

84. In many cases venesection does not hinder resorption at all.

85. Venesection favours the suppurative softening of hepatisation, and indirectly impedes resorption.

86. Abscess of the lung is a rare metamorphosis of hepatisation, and is not induced by either mode of treatment.

87. Induration, or partial destruction (verödung), of the inflamed pulmonary parenchyma, seems to be favoured by the expectant treatment.

88. Gangrene is not a consequence of an exquisite degree of pneumonia, and may occur indifferently after any form of treatment.

89. Tuberculosis is developed independently of any particular form of treat

ment.

90. Venesection decidedly favours the complication of pneumonia with other acute exudative processes, such as meningitis and pericarditis.

91. Venesection seems to favour the complication of pneumonia with oedema pulmonum and pleuritis.

92. Uncomplicated pneumonia, if left to nature, is very seldom fatal.

93. Uncomplicated pneumonia, treated by blood-letting, is often fatal.

94. The expectant treatment affords a far more favourable proportionate mortality.

95. Venesection is a certain, and by no means trifling, cause of the great mortality of cases of pneumonia.

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96. Pneumonia treated by bleeding proves fatal for the most part, by an increase in the morbid condition of the blood.

97. Bloodletting is never necessary for the restoration of health, and is, therefore, never indicated.

98. Bloodletting is in many cases decidedly pernicious.

99. No remedy procures the patient such remarkable and prompt relief as bloodletting.

100. Bloodletting, as a means of combating symptoms, cannot be replaced by any known remedy.

101. The indications for bloodletting cannot be scientifically established.

102. The application of bloodletting to the treatment of pneumonia should be extremely limited; or, what is safer, it should be altogether dispensed with.

Now, all this is written in sober earnest. Dr Dietl is a public medical officer, in one of the district hospitals of the suburbs of Vienna, and his work bears intrinsic evidence of being the production of one who thinks much, and is anxious for the investigation of truth. We fear, however, that this object is not likely to be much promoted by the promulgation of the above given creed. Our readers will, we presume, gladly be spared the infliction of the statistical part of the work. Suffice it to say, that it includes 85 cases of pneumonia treated by bleeding alone; 106 by heroic or contra-stimulant doses of tartar emetic alone; and 189 by dietetic means, or on the purely expectant plan;-the respective mortalities being 20-4, 20-7, and 7·4, per cent. In vain we look for any details as to the age, or sex, or occupation, or social position, of the patients, or for precise information as to the epidemic constitution of the seasons during which the three different plans of treatment were in operation.

The pneumonia of Dr Dietl is a disease of the blood, with a tendency to exudation into the tissue of the lungs, characterised by certain physical signs, such as crepitation, bronchial respiration, and modifications of the sound of the chest on percussion-signs unknown to the older physicians. They indeed recommended bloodletting as the most important remedy in what they termed "inflammation of the lungs," and under this head would no doubt have included many cases of modern pneumonia, with probably an equal number of the morbid process now termed pleurisy. But very many cases of the pneumonia of our more accurate modern pathology, many examples of what has been termed stethoscopic pneumonia, they would either not have recognised at all, or if recognised, would not have treated as they were wont to treat the exquisite cases. Pathologically, they must undoubtedly have made many inevitable mistakes; but whether their treatment was not as rational and successful as that now adopted by the most learned of foreign pathologists, may admit of question. What we here contend for is, that, as the pneumonias of our forefathers and those of modern pathology are not identical, no just conclusions can be drawn from contrasting the results of their treatment

by phlebotomy, say in the days of Sydenham, with the statistics furnished by the experience of a physician of the present day.

Let any man, whose conscience will permit him to do so, apply an active and exclusive system of phlebotomy to the first hundred cases, with physical signs of pneumonia, which present themselves to him in hospital practice-the result may be predicted. Some will recover in spite of him, many will die in consequence of his ill-directed energy. The list of victims will include many examples of typhoid pneumonia, and a few unhappy patients, whose slighter ailments would, if less actively treated, have probably undergone spontaneous cure, instead of passing into tuberculosis, becoming chronic, or recurring in more aggravated and less manageable shape. So far, we bow to the statistics of Dr Dietl. The mortality of 20-4 per cent. might easily be obtained by such a course of proceeding.

But even if the practitioner, convinced of the inutility of the lancet, should feel justified in testing the powers of human endurance, by instituting a perfectly similar and parallel set of experiments with nothing but heroic or contra-stimulant doses of tartarised antimony, we should still expect to hear of very considerable execution done. He would poison a few children, would equally dispose of adults, whose typhoid symptoms indicated the use of stimulants rather than of sedatives, and might by perseverance easily contrive to lose 20.7 per cent. of his patients.

If now he should turn in disgust to homœopathy, or, what is the same thing, to the expectant do-nothing plan, with low diet, and should again make one hundred trials on all comers afflicted with pneumonia, we might anticipate results far more encouraging. All his trifling cases would recover; a proportion of mild ones would recover imperfectly; some of the severe ones might recover too; some would die whose lives no treatment could have saved; others, whose lives should have been saved, would die, victims of neglect. The ratio of mortality would be increased, directly as the proportion of the severe to that of the slighter cases. It is very possible that this expectant plan might, as Dr Dietl asserts, be found the least destructive of the three, and that the 7-4 per cent. might represent its mortality; for, by systematically abusing remedies, powerful for good or evil, more harm may be done than by neglecting their use altogether.

But it may be objected, "that in the view of these trials above laid down, we do not use Dr Dietl fairly,-that we assume that he practised bloodletting indiscriminately and largely, instead of resorting to it only in well marked cases, such as seemed absolutely to require it." Let us accept the author's own explanation of his practice. "Bloodletting was uniformly had recourse to, when there was a certain degree of fever and dyspnea, and no extreme degree of exhaustion to counter-indicate it. In several cases a single copious bleeding sufficed to still the storm; in most instances two or three; and

in a small number five or six were required," (p. 126, l. 12-17). After this avowal, what becomes of the "Numerische Ergebnisse ;' where are now the statistics, where the superstructure of practical aphorisms? We are asked to compare results drawn from 85 cases of extreme gravity, treated, perhaps ill treated, by bloodletting, with 175 applications of expectant practice to cases, most of which (all comers being included) probably required no active treatment at all, and in which no intelligent physician would have used the lancet. And a grave table of comparative mortality is drawn up, wherein the same precious facts are presented in divers approved fashions, and the eyes of the weak-minded are blinded when the great statistical mesmerist shuts his own-and this is an example of statistical inquiry and the power of numbers!

Whether the 85 cases of pneumonia treated by bloodletting include all the cases which Dr Dietl met with, while still imbued with the heresy of his early preceptors; or whether (as seems tolerably certain) they consisted of the more exquisite examples of the disease, culled from the practice of one wavering between prejudice and scepticism, we must equally protest against conclusions drawn from comparison of this experience, with the results of his subsequent expectant practice. On the first supposition, he must have performed blood-letting unnecessarily, and did wrong to trust to it exclusively; on the second, he omits all notice of the slighter cases which occurred in his early practice, while he has included all, slight and severe, in his account of his expectant eccentricities. The great and fundamental condition necessary for a satisfactory experiment the precise similarity of the cases-is obviously wanting; its results, and theories thereon based, are consequently worthless, and calculated to mislead.

We should not have devoted so much space to the exposure of the chief fallacy which pervades and vitiates this statistical inquiry, had it not been presented to the profession in a simple unassuming form, wearing the mask of truth, and recommended by the authority which favourable notice in various foreign journals confers.

On the fanciful nature of much of the physiology and bloodpathology by which Dr Dietl attempts to account for the whole phenomena of pneumonia, we need make no remark: the reader who endeavours to tread the misty maze of the author's own epitome of his doctrines, will hardly need to be informed where he may break his shins.

But ere we dismiss Dr Dietl from our thoughts, a word of admonition suggests itself, directed to all about to undertake the cure of disease. The responsibilities of the medical man are very awful; and the practitioner who cannot recognise them is, in the true sense of the term, a moral maniac. An honest and God-fearing man dares not to make rash experiments upon those confiding in his skill: nothing new or paradoxical will he attempt in dealing

with life and health, unless the indications for departure from established rules seem so clear as to carry conviction to his mind. We trust that Dr Dietl, and other foreign members of the same pathological school, who have made wholesale experiments upon their fellow-beings, changing from system to system, till further metamorphosis is hardly possible, could offer some moral justification for their course of error. But what shall we say for those who, repudiating the faith professed by their forefathers (men wiser than themselves) are, in fact, medical sceptics, practising a profession which their conscience assures them is superfluous and mischievous ? We say that no species of imposture can be more detestable, and that cretinism were preferable to the degree of moral degradation which such conduct implies.

Pathology of the Human Eye. By JOHN DALRYMPLE, F.R.C.S. London, 1850. Fasciculi 5 and 6. Imp. 4to. 8 Plates.

Surgical Anatomy. By JOSEPH MACLISE, F.R.C.S. London, 1850. Fasciculi 6 and 7. Folio. 8 Plates.

THESE beautifully illustrated works, of which the first Fasciculi were issued in 1849, are now approaching their completion. The fifth number of Mr Dalrymple's work embraces delineations of the appearances and effects of inflammation in the anterior chamber of the eye, in the iris, and in the sclerotic. The sixth fasciculus is devoted to congestion and inflammation of the choroid and retina, glaucoma, hydrophthalmia, and partial staphyloma of the sclerotic. The drawing and colouring of these plates are alike admirable.

Mr Maclise's fasciculi include demonstrations of the nature of congenital and infantile inguinal hernia, of the surgical anatomy of hernia inguinal and femoral, of the blood-vessels of the groin and thigh, of the position and relations of the pelvic organs of the male subject, and of the male perineum. There is much originality in these demonstrations: Mr Maclise does not always content himself with reproducing the ideas of other anatomists, but depicts and describes the regions in his own way. We need hardly renew the praises which were in this Journal bestowed upon the earlier fasciculi of the work: the later numbers fully maintain the character which these secured for it.

We should not omit to mention, in justice to Mr Churchill, the publisher of both works, that the numbers have hitherto succeeded each other with a most praise-worthy regularity, and that a speedy completion of both series may be confidently expected.