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deeply sunken as to be only visible on a square front view, and then only part of the corner, on account of the preternaturally small rima palpebrae; neck perfectly concealed by the high, heavy stock of the last generation; long, gaunt, bony fingers, seldom, or never, used in gesture; no delivery, a voice almost whining, disposition exceedingly irritatable, unattractive in personelle, he still draws a larger crowd than any professor in the University, simply by the power of superior knowledge. To any particular dignity he makes no pretention whatever; out of the clinic room he drops down among the students, is their referee and adviser, presides over many of their societies, visits them in sickness, his life is with them and among them, he is one of them indeed, and you may easily fancy what a real reverence and affection they entertain for him. His will be a sad and irreparable loss.

Though perfectly at home on whatever subject, the old man still has his favorite themes, and above all others he loves to dwell on the heart. Start him on a case of cardiac affection and he will run on two straight hours by the clock, only ceasing, like the time piece, when the force is all exhausted; and with a few notes on this subject we will bring this already too long letter to a close.

The normal cardiac percussion dullness is a triangular area enclosed on the right by the right border of the sternum, below by a line intersecting this and the point of apex beat, and outward by a curved line with the convexity outwards, whose center fulls just inside of the nipple, and whose extremities, of course, touch the perpendicular and base, the former at the cartilage of the fourth rib, the latter at the cartilage of the sixth. The normal apex lies in the parasternal line. which is the line exactly half way between the sternal and the mammillary, and in the fifth intercostal space. The real limits of the heart extend a full inch further downward and outward. Dilatation, or hypertrophy, of the left ventricle lengthens the horn-shaped hypothenuse, leaving the angle of the base in the same position, while the same conditions of the right ventricle carry the angle of the base over to the right side of the sternum. Diseases of the mitral value broaden the heart, diseases of the semilunar lengthen it. A valvular disease is of no evil effect until the texture of the muscular walls has been altered. A strong clear sound is evidence of good muscular contraction. so, also, the thrill of the pulmonary which may often be felt. Hypertrophies are generally due to valvular diseases and are most marked in insufficiencies of the semilunars, because the walls here must sustain

the whole column of blood which otherwise falls on the valves. Stenosis never presents such hypertrophies as insufficiencies. An endocarditis in the foetus attacks preferably the tricuspid valves, because the right heart is the most active; generally in the adult insufficiency of the right valves is due to dilatation of the ostium, and hence the insufficiency is only relative. Insufficiency of the tricuspid leads to hypertrophy of the right ventricle, because of the increased pressure on its walls, then follows dialatation of the right auricle, and even of the venæ cavæ, but will not give rise to jugular pulsation unless the jugular valve be insufficient. Stenosis of the tricuspid, which is exceedingly rare, leads to comparative atrophy of the right ventricle, because its walls are freed from pressure. This pressure of gravity explains hypertrophies much more satisfactorily than the theory of compensatorily increased activity, as on this latter view stenoses should present in this state the more marked.

Insufficiency of the pulmonary valves is always, without exception, attended with tuberculosis. Experiments have proven that, in defective closure of the foramen ovale, it is not the mixture of arterial and venous blood which induces cyanosis, but the congestion which ensues therefrom. It may be necessary to establish a perfect diagnosis of any heart disease to render the heart active by exercise, a murmur may then often be elicited, which is inaudible when the patient is at rest.

We possess no positive cvidence or symptoms of adhesions of the two surfaces in pericarditis. Should the pericardium be united with the walls of the chest, and the two layers with each other, then the intercostal space will be drawn in with every systole. Rapid filling and emptying of the jugular veins are evidence that the right auricle is interfered with by a too narrow pericardium, the veins are then filled in systole and emptied in diastole. An adhesion between the costal and cardiac layers may induce hypertrophy of the left ventricle, fatty degeneration and cyanosis. These are a few isolated points, selected from many different lectures which may explain their want of connection; they are transmitted more to show the character of his investigations than for any particular value.

He prefers the direct to the diagnosis by exclusion whenever possible; although we are occasionally compelled to take refuge in exclusion, it is always faulty on account of our present defective knowledge. This he illustrates by presenting a blind man fruit for description. “It is not a pear, it is not a peach, therefore it must be an apple.”




BY BERKELEY HILL, M. B., LONDON, F. R. C. S., Assistant Surgeon Union College Hospital; Surgeon to Out-Patients at Lock Hospital, &c. Phil.

adelphia: H. C. Loa. 1869.

During the past year, our English brethren have given us two new works on Syphilis, one by Barton, of Dublin, the other by Berkeley Hill, of London, works by no means as valuable to us as “ Bumstead" or “Durkee,” yet welcome additions to our authorities on venereal diseases. In a four hundred and fifty page volume, Mr. Hill has presented to the student and general practitioner, a very acceptable work on "Syphilis and Local Contagious Disorders.

Evidently well read in the literature of his subject, his connection with the London Lock Hospital has afforded him ample opportunity for studying the various forms of specific affections. His descriptions of these forms, their origin, delvelopment and termination, are clear and satisfactory; his treatment judicious. To the majority of his American readers familiar with the terms "chancre" and "chancroid," Mr. Hill's application of the term “chancre” to the non-infecting local disease will seem strange and improper. Having tried opinions by cases, and knowing the difficulties in the way of squaring all observed facts with any proposed theory, our author is, on certain points, quite guarded in his expressions. A decided dualist, he says, "while admitting the truth of Bassereau's conclusions, (if the infected person has constitutional syphilis, the infecting person is similarly affected; and conversely if the infected person escape general disease, the infecting person is also free from any but local disorders incapable of affecting the constitution), it must be observed that at present we do not know the whole of the connection between venereal ulcers and constitutional syphilis. But, when acknowledging this incompleteness, it is not necessary to refuse to believe in this essentially distinct nature of the principle exciting chancres, from that of the virus of general syphilis." Again, with reference to the “occasional sources for multiplying syphilis,” he declares "gonorrhæal discharges in syphilitic persons prob

ably also impart syphilis to healthy individuals, leading to the belief in former times that gonorrhea and syphilis were the same disease.” Yet he is at times sufficiently positive in his statements. For example, with reference to the diagnosis of gonorrhæa he says: “Constitutional syphilis has been in very rare and exceptional cases known to succeed discharge without induration. This apparent anomaly is caused by both affections having been contracted at the same time, for we know persons can suffer from the two disease at once, and the mucous membrane when swollen and inflamed by gonorrhæa, is an excellent hot-bed for the absorbtion of syphilitic poison. Bating this exception, syphilis has no connection with gonorrhea.”

It is interesting, with reference to this connection, to remember certain cases reported by Hammond and his conclusions drawn from their observation, that, First—"The virus of an infecting chancre, when deposited on a secreting mucous surface upon which there is no solution of continuity, may give rise to gonorrhæa unattended by chancre, but which is syphilitic in its character and capable of producing constitutional disease ;” and Second—“That the matter of such a gonorrhea is capable of causing an infecting chancre, either by natural or artificial inoculation, which chancre is followed by constitutional syphilis."

As a plain, well written statement of the symptomatology and treatment of syphilitic affections, Mr. Hill's work will be a useful addition to the library of the general practitioner, and the author may rest assured that he has well succeeded in his expressed endeavor * to render the work complete, while keeping it concise and suitable for the student as well as the practitioner."


Professor University of Berlin. Translated by Rufus Browne, M. D.

The above is a title of a neat pamphlet of forty-seven pages that comes to us without containing either date or place of publication. We suppose that Rufus King Browne, M. D., who presents, in an English dress, this valuable brochure of the celebrated Berlin Professor, is an American, yet no information on the subject can be obtained

from his work as here quoted. Professor Virchow presents, in a succinct manner, the principal facts now known in relation to the history of trichina, gives directions how to recognize them in meat, describes the dangers to the human body the trichoiæ cause, what remedies there are for the disease they produce, and what preventive measures against the spread of the trichinæ are necessary. Under the latter head is included the "infection of pigs," the "investigation of the preparation of meat.”

It is desirable that more knowledge, in relation to the subjects considered by Professor Virchow in this paper, be diffused among the profession; therefore it is unfortunate that this translation is not likely to become widely known, owing to the failure to give place of publication or sale.

J. R. W.


WE HAVE been required to devote so much space to the proceedings of the American Medical Association, that comments upon the action of the meeting must be postponed, as well as all notice of the last meeting of the Indiana State Medical Society.

There is one subject upon which we wish to say a few words, viz: the organization of an Association of Editors of Medical Journals. It will be remembered that, in our April number, we proposed such organization; upon arriving at New Orleans we found our brother editors, who were present at the Association, had considered the proposition, and were quite prepared for its execution. We give below the articles of agreement, etc., as reported in the New Orleans Times, pertaining to this new medical body.

Quite appropriately, Dr. N. S. Davis, a veteran in the ranks, a man of indomitable energy, and of national reputation, one who has been contributing to the press probably thirty years, was elected President When the Association meets in Washington next May, we anticipate, from Dr. Davis, a most interesting address upon the History of American Medical Journalism.

One of the purposes of this organization, as our readers observe, is to secure the names of all of the regular physicians in the United States—to make a complete register of all American practitioners. Difficult as this task is, yet its accomplishment can be effected by none

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