Dr. Christison's experience has led him to conclusions somewhat at variance with the foregoing propositions; thus he has found the proportion of albumen in the urine to correspond, in a great measure, with the intercurrent inflammation of granular degeneration, being in greatest quantity in the commencement, and diminishing as the disease advances, so as frequently to disappear, nearly, or entirely, either for a time, or altogether, unless recalled by the supervention of a new reaction. But he, in common with M. Rayer, disowns the opinion, "that the presence of granular disorganization of the kidnies may be known by the condition of the urine alone;" and he further declares:

"In respect of the pathological characters of the urine as diagnostic of the disease, it seems necessary to add, that although I feel confident of their great value in a practical point of view in all cases, and of their being generally sufficient to direct the physician's opinion,-it would nevertheless be very wrong to rely on such a test alone, when he has it in his power to take also into account a variety of other important symptoms, among which the secondary or collateral affections are often most conclusive, and seldom entirely wanting."

We need not apologise to our readers for referring to the opinion of Dr. Bright. That distinguished physician, to whom is due the discovery of this important lesion, fully demonstrates in a letter to Dr. Graves, (dated December 27, 1838,) which is now before us, that in his published works, he has always been careful to state, "That functional disease, in this as in most other cases, precedes the structural change." (Vide Reports of Medical Cases, 1827, page 3, and vol. ii., 1831; and Guy's Hospital Reports, 2nd No., 1836.) Thus we find in the first work cited, page 70:-

"In the treatment of the disease as it occurs in sudden attacks of anasarca, from intemperance, and exposure in its early stages, and before organic changes have taken place, we have two distinct indications to fulfil," &c.

The following passage from the letter above referred to, Dr. Bright will excuse us for extracting, as we are unwilling to deprive our readers of a pleasure similar to what we felt in its perusal.

"Thus it seems to me, that, upon the whole, I ought to be pretty free from the imputation of stating, that albuminous urine never proceeds but from a kidney in which structural change has taken place; having indeed never written upon the subject, as you here see, without declaring the contrary to be my opinion. In truth, however, I am sorry that such a notion

should have been spread abroad, for I have no doubt it has given unnecessary uneasiness to many. I cannot, however, accuse myself of any thing, except that I have ever been unwilling to enter into long explanations respecting opinions which may be right or wrong.'

The opinions we have quoted from the foregoing eminent physicians, will be found very nearly to approach that uttered by Dr. Graves in his published lectures. (Am. ed. page 378.) "When albuminous urine in chronic dropsy is found to occur along with Bright's kidney, I consider this particular state of urine and kidney as depending upon different causes, which often co-exist in chronic dropsy, and consequently I regard albuminous urine as a sign of Bright's kidney, but not as its result."

We have been the more particular in comparing the sentiments of these different writers, because it is commonly thought among members of the profession, that their opinions are utterly opposed: such, however, is not the case; and even if it were, their common goal being truth, to that point its sincere pursuit must sooner or later have led them.

We must now conclude this very long article. Our high opinion of the works to which it is devoted, may be gleaned from the numerous and lengthy extracts we have quoted. We have displayed for the present use of our readers, a few specimens of the ore, but there remains in the rich mine much that will reward an attentive perusal. This, however, is now scarcely a matter of choice; for ere many years have elapsed, a knowledge of the signs derivable from the urine will be as necessary to the physician as an acquaintance with the use of the stethoscope is at present. JOHN ALDRidge.

Die Lehre von der Erkenntniss und Behandlung der Lungenund Herzkrankheiten. Mit vorzüglicher Hinsicht auf die Auscultation, Percussion und die anderen physicalischen Explorationsmethoden. Von Dr. P. J. PHILIPP. Zweite, gänzlich umgearbeitete Auflage. Berlin, 1838.

Doctrines for the Recognition and Treatment of Diseases of the Lungs and Heart, with particular Reference to the Methods of Exploration by Percussion, Auscultation, &c. By Dr. P. J. PHILIPP, Berlin. Second Edition, thoroughly revised.

THOSE Who have perused the former edition of this work, will hardly recognize it in is present form, it is so much enlarged and improved.

VOL. XV. NO. 43.

T

Throughout the whole, the object of the author appears to have been rather to collect the views of those who have written with most clearness on the various subjects of which he treats, than to put forward his own opinions in a prominent manner. Unambitious of distinguishing himself as the author of original subjects, he seems satisfied with introducing to his countrymen, in their own language, a collection of all the valuable facts, which have been confirmed, to be found in the works of Corvisart Laennec, Louis, Andral, Bouillaud, Magendie, Forbes, Hope, Stokes, Williams, &c.

Dr. Philipp complains, and we must say with justice, of the want of zeal which the German practitioners have shown in the study of auscultation, whilst it has been so assiduously cultivated in France and England; and this he conceives is the more to be wondered at, as Germany gave birth to Anenbrugger, who, after the discovery of succussion by Hippocrates, may fairly be considered as having developed the second step to the more perfect art.

This work is well worthy of being translated into English, forming, as it does, a concise epitome of all that is known with regard to diseases of the chest, with their physical signs; in the former the greatest confidence is reposed, in the descriptions given by Stokes; in the latter on those by Laennec; whilst the theory of Williams and Hope with regard to the sounds of the heart, is that to which he appears to be most favourable.

A Synopsis of the various Kinds of difficult Parturition, with practical Remarks on the Management of Labours. By SAMUEL MERRIMAN, M. D., F.L.S., &c. &c.

THE merits of the greater part of this work are already too well known, and too highly appreciated by the profession, to require that we should express, at any great length, the high opinion we entertain of what is universally regarded as one of the very best practical books of reference in our language: to the author's reputation we could add nothing.

The present edition, while it retains all the valuable information embodied in former ones, is enriched by the addition (in the form of introduction) of two chapters, one on "the Symptoms of Pregnancy," and the other on "the Period of Parturition in Women": the former contains many valuable remarks in a condensed form, and brief space, the author having relinquished his original intention of writing at large upon the

subject, for a reason which we notice with much satisfaction.

"It was once my wish," he says, "to enter into an elaborate discussion of the symptoms of pregnancy; but various occurrences interfered to prevent me, and I can hardly say that the work was begun. Dr. Montgomery has now published an exposition of the signs and symptoms of pregnancy, so complete and satisfactory, as to render any other publication on the subject unnecessary."—p. xi.

Obstruction of the menses, Dr. Merriman appears to think almost a necessary consequence of pregnancy; to this position our experience will not allow us to subscribe; menstruation during several months of gestation, we concur in thinking a rare circumstance; and during the whole period, excessively rare; but its occurrence during the first two or three months we have too often known, to consider it as very uncommon.

The author attaches great value to the areola, and considers the drawings of it, in Dr. Montgomery's work, as admirably representing it at different periods of pregnancy.

"I am disposed," he observes," to consider the formation of an areola round the nipple, connected with a suppression of the menses, as the most conclusive evidence we can possess, in the early part of a first pregnancy. But after a woman has borne children, the evidence of the areola is not so perfect; and I once watched, with great care, a case of first pregnancy, in which the areola was not developed till the commencement of the seventh month; I believe this is a solitary instance, within my practice."-p. xiii.

The formation of milk, also, he thinks, carries with it great weight in a first pregnancy, but afterwards, is by no means conclusive, as, when the secretion has been once established, it may continue for a very long time: thus, he says:—

"A woman became pregnant at nineteen years of age; she was not pregnant again for nearly twenty years, yet during this time, she could always produce milk, by gently squeezing the breasts; the milk was in small quantity, it is true, but it was pure milk."

Our author's next section is on the period of parturition in women; a subject to which, our readers must be already aware, he has paid great attention, both before and since he gave his evidence in the House of Lords, in 1825, in the Gardner peerage case; on which occasion, he maintained, as he still does, that the period of human gestation was not absolutely limited in all cases to 280 days, but might be extended somewhat beyond that length of time.

He gives us, p. xviii. "A table of the births of 150 mature children, calculated from, but not including, the day on which the catamenia were last distinguishable;" from which it appears, that

In the 37th week there were born

5

16

21

46

28

18

11

5

From this table he infers, and we agree with him, "that conception is effected more commonly soon after the catamenial period has intermitted, than immediately before the recurrence of that discharge."

The remainder of the volume is occupied with observations on the different kinds of difficult labour; and does not contain any thing except what has already appeared in former editions, with which our readers are already familiar. This is one of the best class books in our language.

Principles of General and Comparative Physiology, intended as an Introduction to the Study of Human Physiology, and as a Guide to the Philosophical Pursuit of Natural History. By WILLIAM B. CARPENTER, Member of the Royal College of Surgeons, London, Lecturer on Forensic Medicine in the Bristol Medical School, &c.-London, Churchill, 1839.

THE following extract from the author's preface will serve to explain the peculiar objects of his work:

"However trite may be the reason so commonly assigned by writers on any subject for presenting themselves to the public, the author is not disposed to omit its mention as regards himself. During the course of his physiological studies, he has felt, in common with many others, the want of a treatise which should give a comprehensive view of the science, embracing whatever general principles may be regarded as firmly established, and illustrating them as fully as could be done within moderate limits, yet without distracting the attention by profuseness of detail. He has long, therefore, kept in view the production of such a work as the present, should it not be anticipated by some other on the same plan; and in now deciding upon its publication, he has been influenced by the opinions of individuals of high eminence as teachers of physiology, as well as