of the humerus and the under surface of the acromion; secondly, in soft, oily, and caseous bones, in which there is a deficiency of phosphatic deposit, a change takes place in the head of the bone, the anatomical neck slides slightly downwards (chiefly in old people), and assumes a rather more lateral aspect than normal, while the inner shell of the bone passes upwards and inwards, and penetrates the cancelli. This, I think there can be no doubt, is the result of the upward pressure against the ac romion process. In Sir A. Cooper's case, the tendon is said to have united. With every possible submission to so high an authority, I think he must have meant, that it had become united to the capsule of the joint. The deltoid muscle is not so much affected by the change in the joint as would be expected; occasionally it is slightly atrophied, but the muscle soon again recovers its proper size and tone. Should there appear to be much wasting of it, the surgeon would then have to decide upon the probability of its dependence upon some injury to the posterior circumflex nerve. In this case, sensation over the posterior fold of the axilla and over the insertion of the deltoid would be much impaired." (pp. 150-1.)

In dislocation of the tendon, it may be thrown inwards to the lower part of the joint, or may be lodged either in the greater or lesser tuberosity of the humerus; and it is to be regarded as a more serious accident than rupture.

The treatment of both these accidents is the same, and altogether negative. Entire rest to the joint at first, taking care to bring the elbow forward; and subsequently passive motion, when all chance of inflammation has subsided, constitute all that it is in our power to do.

Fractures of the head of the humerus. This, the last chapter in the book, though sensibly and well written, does not call for much comment. The usual division into fracture of the anatomical and surgical neck, and their occasional complication with dislocation, is adopted by the author. He also adds a third, of fractures implicating either or both of the tubercles, or in any way comminuting the head of the bone; of which accident two examples are recorded.

Mr. Callaway concludes his modestly-written and instructive essay, by some sensible remarks on the deficiency of an accurate system of hospital reports; and expresses the regret in which all will join at the immense mass of knowledge that is daily running to waste in our hospitals, from the want of some one to collect it.

ART. XVII.

The Treatment of Rheumatic Diseases by Lemon-Juice; with illustrative Cases from Hospital Practice. By G. OWEN REES, M. D., F. R. S., &c. -London, 1849. 8vo, pp. 38.

In this little pamphlet Dr. Rees has brought before the notice of the profession the beneficial effects of lemon-juice in acute rheumatic affections. Dr. Rees states that in these cases, lemon-juice in doses of one ounce four or five times a day, appears to be equally efficacious with colchicum, or even more so; it produces an equally rapid reduction in the force and frequency of the pulse, and ensures an earlier relief from pain. In support of these assertions, eight cases of rheumstism are related; and subsequently Dr. Rees proceeds to explain the mode in which the lemon-juice. may be supposed to act. The cases seem to have been of moderate severity; in one case only does there appear to have been any cardiac affection, and in that case (vii) there was only a slight systolic murmur at the base. 8-iv.

45

The relief to the urgent symptoms seems to have been rapid; although, on adding up the number of days in hospital, we find the average duration of the malady to have been about the same as under other modes of treatment, viz. rather more than twenty-four days; the longest time was fortyseven, and the shortest twelve days. The most marked effects were on the pulse, which often was lowered six, eight, or ten beats in twenty-four hours. The influence on the urine was not so decided; the solids excreted in twenty-four hours were in one case augmented during its use, in another diminished; the urine was generally acid, and in one case became acid under the use of lemon-juice, although it had previously been alkaline. The acid perspirations do not seem to have been affected. No examination of the blood, or analyses of urine, appear to have been made; and the cases are so briefly detailed, that we do not learn much more from them except the main fact that the patients got well while taking lemon-juice. We cannot help remarking, that we are sorry Dr. Rees should not have been a little more minute in his chemical observations; for in regard to the pathology of rheumatism, the examination of the blood, the urine, and the sweat is the great subject for inquiry; and probably there is no man in London who is more competent to undertake this investigation than Dr. Rees. We must confess to no little disappointment when we found these important topics so briefly treated in the pamphlet before us.

Dr. Rees's theory of the action of lemon juice appears to be founded on the notion of Liebig, that urea may be formed from the oxidation of uric acid. Dr. Rees seems to consider retained uric acid as the materies morbi in rheumatism; and thinks that the citric acid (C,, H2, O,,) of the lemon-juice yields oxygen, which, with the elements of water, converts uric acid into urea and carbonic acid. Nothing, however, is more doubtful than this Liebigian hypothesis; and one of Dr. Rees's own colleagues has pointed out its probable fallacies. We would suggest to Dr. Rees an accurate determination of the absolute quantity of urea and uric acid excreted in acute rheumatism; it is evidently a condition of his hypothesis that the quantity of urea shall be relatively much below that of the uric acid, since the mode in which the uric acid comes to be in excess, is by reason of the failure in the process by which, according to Liebig, it is converted into urea. But we shall not be surprised to find analyses proving the urea to be even in excess in rheumatism, either in the blood or the urine. Again, to prove his position Dr. Rees should have brought forward evidence to show an increase in the quantity of urea after the use of 'emon-juice; but this has not been done.-We should, however, say that our author expressly states that he considers his hypothesis extremely doubtful, and attaches no importance to it; while he earnestly calls the attention of the profession to the practical fact of the utility of lemon-juice in rheumatism, from whatever cause this good effect may arise. We also attach much more importance to this fact than to its interpretation; and from some little experience of lemon-juice in rheumatism, we are inclined to gree with Dr. Rees in believing it to be of some efficacy, although the amount of this has not been so great in our cases as in those of Dr. Rees. But with the strong opinion which has been given in favour of lemon-juice by Dr. Rees, we have not the slightest hesitation in urging our professional brethren to give it a fair trial in rheumatism, in the belief that it will be found at any rate a useful auxiliary, if not an absolute and certain spceific.

PART SECOND.

Bibliographical Notices.

ART. I.-An Essay on the Diseases of Young Women. By WALTER JOHNSON, M.B., Medical Tutor, Guy's Hospital.-London, 1849. Port 8vo, pp. 256.

THE title of this work affords by no means a sufficient indication of the nature of its contents; for among all the disorders to which young wome. are peculiarly liable, it only treats of two, namely, Chlorosis and Hysteria. The author gives us, in his preface, as a reason for the production of this Essay, that although the peculiarities manifested by young females, ast class, have been frequently dwelt upon by medical authorities, yet that these peculiarities have always been discussed as isolated problems, and never brought together nor systematized;" in consideration of which he has "thought it not unprofitable to collect a variety of cases, illustrative of each affection that presented itself, to form a basis upon which, at some future period, a comprehensive theory may be constructed." We infer from the first part of this statement, that Dr. Johnson is unacquainted with Dr. Laycock's valuable treatise on the 'Nervous diseases of Females,' which embraces both a practical and a philosophical view of the whole subject; not to mention other works of inferior merit. But even supposing that no monograph of this kind existed, it is scarcely to be expected that a mere collection of cases, brought together from the writings of dif ferent authors, could be of much service to the professional reader; either in aiding him in that very difficult task of discriminating between the proteiform manifestations of the hysterical diathesis and the indications of serious disease, which often baffles the most experienced practitioner; or in throwing any new light upon the real nature of the disordered condition of the system whence these manifestations proceed. It might be all very well for Dr. Johnson to form such a collection of cases as a basis for his own study of the subject; but we cannot but regret that he should have been so ill-advised as to put them forth to the world in their present shape, which is such as more resembles a "bait for practice" than a scientific essay. In fact, the whole book has the air of being addressed to the public much more than to the profession. Thus, for example, the description of chlorosis is almost entirely confined to the changes in the external appearance and habits of the patient. To illustrate the perversion of appetite, which is a frequent, though by no means a constant, symptom of this complaint, Dr. Johnson has recourse to the letter wherein "Sabina Green, now Sabina Rentfree," described to the "Spectator" her succession of cravings, which occupies no less than three pages of his book; whilst all that he tells us about the state of the blood is, that it is "poor and watery." Not a word is said of the results of exact analysis; nor do we find any

more specific directions in regard to the treatment,-which is noticed, in combination with that of hysteria, at the conclusion of the work, these two diseases being regarded by the author as "varieties of one disease,"than that "if the patient exhibit marked pallor of countenance, indicative of the absence of iron from the blood, it may not be imprudent to administer a supply of that metal."

The collection of cases of hysteria, which forms the chief part of the work, has not even the merit of completeness or discrimination; and several of those strange aberrations, on which, from the author's preface, we should have expected him more especially to dwell, are altogether unnoticed. In his original matter he frequently displays a singular mixture of bad taste and good judgment; the former being displayed in his manner, the latter in his meaning. As a sample of both we shall quote the following passages, of which the first, relating to the causes of hysteria, is written in a style on which we should hope that none of our readers will look with any favour :

Why

"But the grand cause of hysteria-that which puts out the eyes and lames the limbs, and distorts the features of the young and beautiful; that which prompts the canine bark, obstructs the breath, and wrings the brow with anguish that which melts the women of England into powerless babes, lulls them into months of slumber, deforms the moral beauty of their souls, and shatters their intellect; that which stretches them moaning and struggling on the ground, or petrifies them into living statues; that which will sometimes freeze every faculty of soul and sense, and, by destroying reason, level them with those that chew the cud-this grand traitor and foe to humanity is Polite Education. First, the boarding-school, then the saloon, the theatre, the opera-these are the focus of infection, the very den of hysteria. At school, the unhealthy confined life, the premature tasking of the mental powers, that excessive application to music, lays a foundation which is consolidated upon the young lady's entrée into society. What occurs then? a constant round of toilsome pleasure, liko a squirrel in its wiry box, the maiden maloo much utton, though but little progress. The waltz, the polka, a flood of music, enrapturing every faculty, a concourse of people with mirth in their faces, brilliant dresses, rapid vivacious conversation, the thus and frankincense of flattery -oh! it is delightful, ecstatic, divine! Yes, little bewildered one, it is divine, if Jupiter still sits upon Olympus, and pagan deities breathe impurities into our hearts, and receive adoration. Listen to the heart in thy bosom, how it throbs; question thy conscience, how it trembles. Hope, fear, joy, ambition, self-adulation, rebellion against authority, and a thousand conflicting emotions, disturb the serenity of thy mind. He is my slave,' says Vanity. He is a Croesus,' adds Avarice. He is odious to me,' whispers Truth, and I cannot forget another.' 'Can I forego a coronet?' asks Ambition. How they will envy me!' sighs Pride. Alas! upon no sybarite-bed lies she whose body is enfeebled by nights of dissipation, and whose mind is polluted by the mercenary schemes and lax morality of the gay world." (pp. 232-4.)

We could quote many pages equally inflated in manner, and commonplace in matter with the preceding. But, in mercy to Dr. Johnson, we shall forbear, and shall substitute a passage which will show how much better he can write, when he is thinking of his subject, instead of the attractiveness of the garb in which he desires to present it.

"Perhaps the most important feature in the treatment of the maladies of young females is that which I fear is most frequently overlooked or neglected, viz. the gentle consideration and tender sympathy of those about the patient. I do not wish to have it inferred that a patient is absolutely to domineer unrestrainedly over

a whole family, nor to display unchecked the wild caprices of her malady. The observance of a due mediuin between stern coercion and unlimited indulgence constitutes, perhaps, the great difficulty which we have to encounter. It would be as injurious to the patient to allow an hysterical female complete license, as it would be oppressive to her friends. What we have to do is to restrain her from indulging in the weakness or violence of her malady, by a certain moral influence. Remembering that almost ever the disease originates in a preponderance of the impulsive over the reflective faculties, our task appears to be to restore this lost equilibrium. This, in fact is an arduous enterprise; it involves the attempt to re-educate an illeducated mind; to weed from it that false philosophy in which it has been entangled; to implant clear and just ideas of life and of duty; to elevate and purify the soul. Now, to effect this grand object, it is needless to point out, that a mere series of moral admonitions, come they from whom they may, or abstract disquisitions on the whole duty of woman,' are quite unserviceable, and even calculated to disgust those whom they are intended to benefit. It is evident also that, the first point which must be gained by any one who imposes on himself the task of healing the afflicted mind-the first point, and the most difficult-is to acquire the esteem and affection of the patient. Unless this first step be satisfactorily made, all is hopeless; but this step once made, the onward path becomes less thorny. The benevolent Mentor has then to study the mental peculiarities of his scholar, and shape his course accordingly. He will probably, by various means, according to various circumstances, endeavour to fill his pupil's mind, to present to it some object or objects which may worthily employ the idle faculties. He will, perhaps, engage them in the contemplation of the wonders of Nature. Thus ennobling her mind, and raising it above the pettinesses by which it was once agitated, he will infuse serenity into her bosom, impart vigour to her intellect, and enable her gradually to master the turbulent passions to which she was lately a prey. However, not to all dispositions are such lofty thoughts adapted; the discerning instructor will regulate his course in accordance with individual temperament. He will seek to occupy the mind in some steady pursuit, and to inspire the soul with an ambition to excel in some province, however lowly. For nothing is more pernicious than to wrap one's self in one's own feelings, to luxuriate without reserve in happiness, or to meditate uninterruptedly on misfortunes. It is this self-involution which constitutes the hysterical mind-it is this Hindoo paradise from which we would liberate the captive. Hence, therefore, we should endeavour to tear the patient from herself, and to absorb her thoughts, were it even by Berlin wool." (pp. 252-55.)

We would earnestly counsel Dr. Johnson to write no more books, until he has acquired, by observation and study, some knowledge which may be communicated to the profession with real advantage.

ART. II.-Confessions of a Hypochondriac, or the Adventures of a Hyp. in Search of Health. By M. R. C. S.-London, 1849. Post 8vo. pp. 310.

THE Conception of this book, which will be readily understood from its title, is excellent. The supposed "Hyp." is a merchant who has acquired an ample fortune by forty years of hard labour, and who then retires from business," intending to give his spirit a life-long holiday," but without any objects of interest, domestic or social, scientific, literary, or æsthetic. He found the ordinary pleasures of life unattractive as soon as their novelty had worn off; and like the hero of that admirable comedy, 'Used Up' whether he looked up the dome of St. Peter's, or looked down the crater of Vesuvius, he always found "nothing in it." He consequently falls a victim to ennui, and first has recourse to the "regulars," who send him to 8-IV. 45*