ART. II.-Essays on Medical Science.-1. On the Nature of Inflammation. 2. On the Encephalic Circulation and its Relation to the Physiology of the Brain. By JAMES CAPPIE, M.D.-Edinburgh, 1859. pp. 103.

THIS little book is the production of an earnest and logical mind, and well merits, not only perusal, but careful study. The first essay, on inflammation especially, is calculated to attract attention, and we regret much that it had not reached us in time to examine it conjointly with the doctrines of Professor Virchow on Cellular Pathology,* as both authors have, by different paths, arrived at similar conclusions on some important points in pathology. We are quite unable to do justice to Dr. Cappie's views at present, and we only trust that the brief jottings we can offer our readers may induce them to examine his arguments for themselves and in detail.

Dr. Cappie makes healthy nutrition his starting-point, and finds it to consist of three series of phenomena; first, the changes in the tissueelements; secondly, the circulation in the adjoining capillaries; thirdly, the interchange of fluids between these vessels and the extravascular spaces. In the changes that take place in the tissues, we have to deal with the removal of effete matters, and with the supply of fresh material; and these two processes, which are mutually subservient to each other, are accomplished by endosmosis and exosmosis between the fluid within, and the fluid external to, the capillaries. The capillary circulation itself depends not only upon the heart, but in a great measure upon the tissue changes; the more actively these are carried on, the more active will be the capillary circulation—

"In physical science," Dr. Cappie remarks, by way of illustration, "the phenomena of capillary attraction and those of combustion afford instances of a current of fluid being produced, independently of the influence of gravitation, or any obvious mechanical arrangement. The conditions in which nutrition is carried on, may be regarded as involving a combination of the causes that operate in these two instances."

After having analysed the phenomena of nutrition, the author proceeds to examine in what way the successive symptoms of inflammation may be referred to a disturbance of the normal sequence of nutritive changes. The increased amount of blood in the capillaries, and the greater rapidity in the local circulation of an inflamed part, are the first steps of inflammation, and are attributable to excitement in the capillary circulation; the next step is the increased production of fibrine, which Dr. Cappie regards, with Zimmermann, Bennett, and Simon, as excrementitious. The disintegration of tissue leads to the formation of fibrine, which is introduced into the circulation, and is there subjected to further reduction. The author assumes the larger quantity of fibrine found in the blood in inflammation to be due to a larger quantity being primarily formed, and not to an arrest in its removal from the blood.

* British and Foreign Medico-Chirurgical Review, Oct. 1859.

"We are led, then, to suppose, that some excitement must exist in the process by which fibrine is usually produced, and a more particular inference at once forces itself on our judgment. As inflammation is essentially a local disease-as it is constituted by changes occurring in a circumscribed portion of the system, and the increased production of fibrine, therefore, must depend on local causes the fibrine itself must be elaborated in greater quantity at the seat of inflammatory action. It is naturally derived from the intervascular spaces; these, where inflammation exists, must furnish more than their usual amount. Its increase in the circulation will be the natural and necessary result of its increased local production."

These remarks will prepare our readers for Dr. Cappie's objection to the prevailing views on exudation. He holds, that the fibrine is the product of an excessive metamorphosis of the tissues, resulting from a modification of the nutritive process; that this is accompanied by all the evidences of greater activity, and that the increase of heat, tension, and vascular excitement of inflammation, are the necessary accompaniments or sequels of the process.

In applying his theory to the treatment of inflammation, Dr. Cappie observes, that debilitating influences disturb the balance of the circulation, and thus favour a determination of blood to the seat of inflammatory action.

"A constant antagonism is exerted between all parts of the body in relation to the circulation. If A and B are supplied with blood from one vessel, the amount which A will receive will not altogether depend upon the amount of stimulus applied to it, but also on the intensity of the attractive force operating at B, and on the facility, therefore, with which the latter will permit itself to be deprived of a portion of its supply. And so in the general system, it is not only the amount of stimulus applied to an organ or texture which determines the amount of blood it shall receive, and consequently the effect that will be produced upon nutrition: the result will greatly depend on the degree of force required to derive that fluid from other parts of the body.”

The more vigorously the general process of nutrition is carried on, the greater will be the difficulty with which the blood will be drawn to a diseased part; while a languid state of the nutrition will allow the blood to be more readily determined to a part upon which morbid influences have been brought to play. We will not examine in detail the author's application of this doctrine, because we have not room for the controversy which it suggests, nor can we follow him in his discussion of the views held by various writers of high authority, in regard to the intimate nature of inflammation. We will only add, that the paper on Inflammation is interesting and suggestive; and that the same may be said of the essay on the Encephalic Circulation, though it is not of that heretical character which gives a peculiar pungency of flavour to its predecessor.

ART. III.-Notes on Nursing. What it is and what it is not.
By FLORENCE NIGHTINGALE.-London.

pp. 79.

THIS is a small and unpretending volume, but one nevertheless, in our opinion, destined to exercise a wide influence. The principles it incul

cates have in various forms often been offered to the public, but the public has never thought it necessary to imbibe and, generally, at least, to act upon those principles. Miss Nightingale's book is a code of sanitary ethics, which comes with all the more force from her, that we know her to have had larger opportunities than any woman ever had before of testing the correctness of the advice she gives, and of the system she advocates. We might exhaust ourselves in the commonplaces of praise, without conveying to our readers our exact sense of the qualities of the little volume. But this is the less necessary, as it is certain of a large circulation, and we would specially urge the members of the profession to promote its diffusion, because they will find no better friends and assistants than among those of the laity who are duly imbued with correct hygienic principles. Let it be distinctly understood, that Miss Nightingale does not supply us with a manual of nursing such as Dr. Thomson's Management of the Sick Room,' or Mr. Barwell's 'Care of the Sick.' Her volume gives rather the sanitary than the sanatory directions which should guide the attendant upon the sick.

Ventilation and Warming, Health of Houses, Petty Management, Noise, Variety, Taking Food, What Food?, Bed and Bedding, Light, Cleanliness of Rooms and Walls, Personal Cleanliness, Chattering, Hopes and Advices, Observation of the Sick, are the successive headings of different sections, and will suffice to give our readers an idea of the scope of the work. That such a book had been long wanted appears evident from the avidity with which it is caught up. There is a reality and truthfulness about all the suggestions it contains, which appeal to the heart as well as to the understanding, and although we might object to one or two slight exaggerations, we most heartily wish the book God-speed, feeling, as we have already hinted, most fully assured that it is destined to produce a more permanently salutary effect in all homes where English women reign, than the whole array of excellent physiological treatises that have been compiled for their benefit.

ART. IV.-On Chronic Alcoholic Intoxication, or Alcoholic Stimulants in Connexion with the Nervous System; with a Synoptical Table of Cases. By W. MARCET, M.D., F.R.S., Fellow of the Royal College of Physicians, Assistant-Physician to the Westminster Hospital, &c. &c.-London, 1860. pp. 172.

THIS little book is not an inquiry into the general question of alcoholic poisoning, social, moral, and pathological, nor does it even embrace more than a small portion of the morbid effects traceable to the abuse of fermented beverages. It is devoted to the consideration of the assemblage of symptoms manifested, especially in the nervous system of the individuals who have been the victims of intemperance, and to which the term "chronic alcoholism" has been applied. The prominent symptoms upon which our author dwells, are want of sleep, tremors, vertigo, headache, hallucinations, such as musce volitantes, spectres,

imaginary noises, great debility, and dyspnea; the state of the chylopoietic and other viscera in this affection is not or but very cursorily alluded to.

The author's main object is to direct the attention of the profession to the value of oxide of zinc as a remedy in the cases in which the above-mentioned complex of morbid phenomena presents itself. He gives the remedy in doses of from two to six grains two or three times a day, and he finds that it induces improved sleep, arrest of the hallucinations and tremors, and a restoration of vigour of body and mind.

ART. V.-1. Transactions of the Medical Society of the State of New York for the Year 1859.-Albany. 8vo, pp. 454.

2. Extracts from the Records of the Boston Society for Medical Improvement, published in the Boston Medical and Surgical Journal. By FITCH EDWARD OLIVER, M.D., 1856-9. Vol. III. With Supplement, pp. 202.-Boston, 1859. 8vo, pp. 312.

MORE than one-half of the former volume is taken up with an Annual Address, and with accounts of the private business of the Society from the year 1807 down to the present time, subjects of a purely local interest, if deserving publication at all. The rest of the volume is made up of twenty-four communications by members of the Society. The more important of these are:-1. A Paper on the Prognosis in cases of Fracture of the Neck of the Femur within the Capsule, by Dr. Hamilton, of Buffalo, in which the author has collected a number of instances in which ossific union appears to have taken place. 2. An Account, by Dr. C. E. Isaacs, of a large Encephaloid Tumour originating from the under surface of the Dura Mater, and projecting from the upper and back part of the Cranium, and where an attempt at removal had been made during life with a fatal result! 3. Two cases of Ectopia Cordis, by Dr. Alden March, in both of which the infants were born with their hearts projecting through an opening between the ensiform cartilage and the lower end of the sternum proper, and lying quite naked and exposed. In both cases the heart continued to beat for about two hours after birth; but in neither were any observations made as to the phenomena of the cardiac motions. 4. An Account of an Epidemic of Diphtheritis in Albany, accompanied by great prevalence of cynanche tonsillans.

The volume of Records of the Boston Society is of a far more valuable and practical character. This, indeed, promises to be one of the most important periodical publications issued by the American Medical Press. The first part of the work is made up of brief abstracts of papers read at the Society between May, 1856, and December, 1858, having reference for the most part to interesting cases and questions in practice. Among these we may mention particularly: A Case of Aneurism of the Ascending Aorta, opening into the Pulmonary Artery. (p. 17.) A Case of Impacted Fracture of the Neck of the Femur. (p. 29.) An Account of a

Breech of a Gun extracted from the Superior Maxilla, after a lodg ment of eight years. (p. 32.) Four cases are recorded in which ovariotomy was performed, pp. 40, 44, 84, 78, and 262. In all of these the operation proved unsuccessful; as also in two other cases alluded to in a discussion upon the subject. Six cases of tubular pregnancy are recorded (pp. 103, 183); but in none is any reference made as to whether or not the ovum was enveloped in a decidual membrane. Case of adhesion of the gall-bladder to the duodenum, followed by ulceration, the passage of a gall-stone into the intestine, obstruction, and death. (p. 106.) Three cases of bronzed skin (pp. 114, 185, 186); in one of which the supra-renal capsules were diseased (tubercle); in a second they were normal; and in a third they were atrophied, although "it could not be said that they were diseased." Case of typhoid fever, with perforation of the gallbladder, and escape of the contents into the peritoneal cavity. (p. 120.). Case of typhoid fever, with perforation of the intestine about the twelfth day, and death forty-eight hours after the perforation. (p. 308.) Here, as is very frequently the case, the perforation occurred while the symptoms of the disease were by no means severe. A collection of 104 cases of imperforate anus, with absence of the rectum. (p. 156.) Case of cancer of the stomach, followed by adhesion to the abdominal parietes, and the formation of an abscess in the latter. An account of cases which were thought to prove the inoculability of secondary syphilis. (pp. 199 and 283.) A very interesting discussion upon this subject is recorded, which merits the attention of those interested in the subject. A case of ovarian dropsy, in which tapping was performed thirty-one times between April, 1847, and December, 1858, and 2002 pounds of fluid drawn off. (p. 305.)

The Supplement is made up of twenty-five original papers, of which the more important are the following:-On Inflammation and Abscesses of the Lung caused by Closure of the Primary Bronchus, by Calvin Ellis, M.D. On the Use of Stramonium in Puerperal Convulsions, by R. H. Salter, M.D. Account of a Case in which numerous Lumbrici were ejected from the Mouth, and of another in which 365 Lumbrici were found in the Small Intestine, besides 8 or 10 in the Large Intestine, by William Morland, M.D. An Account of a Pustular Eruption on the Skin, in which the pustules contained the larvæ of a species of fly, by Dr. Mitchell. Four Cases of Croup, which recovered after Tracheotomy, by George H. Gay, M.D. On the Influence of the Placenta upon the Development of the Uterus during Pregnancy, by William Read, M.D. Two successful Cases of Excision of the Knee-joint, by Drs. Warren and Cabot.

Altogether, the volume is one which contains a great fund of useful information, and is highly creditable to the medical profession of Boston.

50-XXV.

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