PRACTICAL URINE TESTING.

A Guide to Office and Bedside Urine Analysis, for Physicians and Students. By Charles Godwin Jennings, M. D., Professor of Chemistry and of Diseases of Children, Detroit College of Medicine, Etc. Detroit: D. O. Haynes & Co. Price, $1.00. For sale in St. Louis by MEDICAL BRIEF.

As a means of testing the urine in a convenient and accurate manner, this little work recommends itself to the practitioner and student as having the latest advances in the most convenient form, and imparts valuable information as to cleanliness, ease of application and simplicity of apparatus used. It is certainly a valuable little work..

WARNER'S THERAPEUTIC REFERENCE Book. Philadelphia: William R. Warner & Co., Publishers. Price, $1.00.

With the commendable push that characterizes this house in the manufacture of staple drugs, we would expect just such a valuable work as is before us. The greater part of this brochure is taken up with a carefully selected and alphabetically arranged formulary. The prescriptions are the studied selection from home and abroad. The different diseases arranged alphabetically with formulæ of the most successful practitioners. In addition there are so many good and valuable things included that we are sorry we can not find space to enumerate them in full. CYCLOPEDIA OF THE DISEASES OF CHILDREN. Medical and Surgical. By American, British and Canadian Authors. Edited by John M. Keating, M. D. Illustrated. Volume I. Philadelphia: J. B. Lippincott Company. Price, Cloth, $5.00; Full Sheep, $6.00; Half Russia, $6.50 per volume.

This exhaustive work will be complete in four handsome imperial octavo volumes of about 800 pages each. Volume one, which is before us, contains 992 pages. The publishers say they have spared no expense in presenting the cyclopædia in a manner becoming a work of so great importance, and an examination of the first volume fully bears out the statement. The articles have been written especially for this work, and the amount of valuable material collected is so extensive that it has not been practicable to present the work in less than about 3200 pages, bound in four volumes. Each volume will be carefully indexed, and the final volume will contain a general index to the entire work. Every practitioner who possesses

a copy will find it a safe counsellor in the daily responsibilities of practice. The volumes will follow each other at intervals of about three months. The work is sold by subscription, and in order to secure it you should make up your minds as early as possible, as it is the most complete work of the kind ever undertaken, and deserves success.

DIABETES; Its Cause and Permanent Cure. From the Standpoint of Experience and Scientific Investigation. By Emil Schnee, M. D., Consulting Physician at Carlsbad,and Physician of the Imperial and Royal Consulate of Austria and Hungary for the Riviera, at Monaco. Translated from the German by R. L. Tafel, A. M., Ph. D. English Edition Revised and Enlarged by the Author. Philadelphia: P. Blakiston, Son & Co. Sold by MEDICAL BRIEF. Price, $2.00.

Dr. Schnee's discovery of the real cause of diabetes and the experience he has gained in conquering this dread disease, which for a long time had been considered incurable, must necessarily be a valuable work and make this disease more tractable in the hands of the physician than it has been heretofore. The observation and experience of the literature of this subject from Celsus to Frerichs and respectively to the present work demonstrates to the satisfaction of everyone that diabetes not simply "glycosuria" is curable. All physicians are interested in this subject, and should secure a copy of this work.

YELLOW FEVER EPIDEMIC 1888. Report of the Jacksonville Auxiliary Sanitary Association, of Jacksonville, Fla., covering the work of the Association during the Yellow Fever Epidemic, 1888. Edited by Charles S. Adams. Published under the supervision of the Executive Committee of the Association.

This report is intended to be a plain, matter-of-fact history of facts. The financial report indicates the boundless generosity of the American people. The editor says: "If it is difficult to express grief, it is quite as hard to indicate the feeling of gratitude on the part of each member of the Association to the men, women and children, all over our common country, who gave freely, gladly, munificently, from their treasures, not merely of money, but of sympathy, of pity, and of cheer, to our assistance." The report covers 350 pages and is thorough and complete, reflecting great credit on the editor, Chas. S. Adams, Jacksonville, Fla.

ST. LOUIS OFFICE:-9th and Olive Sts.

Terms-$1.00 a year, in advance.

VOL. XVII.

Single Copies, 10 Cents.

Definition, Etiology, Morbid Anatomy, Symptoms, Diagnosis, Prognosis, and Treatment of Pulmonary Phthisis.

DEFINITION.-Pulmonary phthisis is the term used to designate a chronic disease of the lungs, the characteristic features of which are progressive wasting of the tissue of the entire body. Cough with abundant expectoration of matter of a puriform character, and the expectorated matter is sometimes mixed with blood. There is always more or less hectic fever, which is accompanied by night sweats and diarrhea.

ETIOLOGY.-There are various pathological conditions which are connected with the causation of pulmonary phthisis, and the most important of all is the tubercular diathesis which is transmitted from parent to offspring. The above statement is based on the family history of a goodly number of phthisical cases which have come under the writer's cognizance. The writer's researches show clearly that at least three-fourths or more of all cases of consumption show a family taint-though some writers put the per cent very much below this. In regard to family history, the following is based on personal observation as well as statistics: Females are more apt to inherit a predisposition to consumption than

No. 8.

males. It is also a fact that fathers more readily transmit the disease to sons, and mothers to daughters. Mothers transmit the disease to offspring more readily than fathers.

In subjects who are predisposed to consumption the disease is liable to develop from numerous causes, such as acute and chronic affections of the respiratory organs, etc. Anything that has a tendency to impair the general health, in those that are predisposed to pulmonary phthisis, is liable to light up the disease. In sections where the soil is damp and the atmosphere is heavy at all seasons of the year, the death rates from consumption are usually very high. Pulmonary phthisis is generally associated with a morbid state of the lymphatic glands and defective nutrition. In many cases it is impossible to assign a cause, and we are bound to admit that we are ignorant, in a large measure, of the exact cause of pulmonary phthisis. There are a great many things that are thought to cause consumption, namely, the influences of certain climates, living in illventilated apartments, occupations that cause confinement in an atmosphere

loaded with particles of matter, such as iron, coal, flint dust, and the emanations from cotton factories, etc. Some observers claim that in phthisis pulmonalis

paired, gradually becomes less and less, dyspnoea is most always a prominent symptom. The circulation is always disturbed, though this disturbance of the circulation varies very much in different cases at the same stage of the disease. In the first stage the pulse is somewhat accelerated, and if the acceleration is great, as a rule, the disease runs a rapid course to a fatal termination.

The nervous system is not much affected in the first stage, and, as a usual thing, there is very little pain complained of, only in the act of coughing, and the pain is generally complained of over the site of the lung mostly involved in the pathological process, though in exceptional cases the pain is referred to other regions of the chest from that which the morbid process is going on. Acute lancinating pain is rarely ever complained of but a dull heavy aching and uneasy feeling is common during the first stage.

The digestive organs are most always disturbed to some degree. The tongue becomes white, the bowels constipated, the appetite impaired, and usually there is a repugnance to fatty food.

The physical signs in the first stage of pulmonary phthisis depend in a large measure in the amount of damage the lung tissue has sustained, and also in the number of tubercular masses that have formed, and whether there is an aggregration or isolation of these tubercular masses. By close inspection you will notice that respiration is increased in frequency, and the upper part of the chest does not expand, as in health, during the act of inspiration, and there is lack of infra-clavicular retraction. Palpation shows loss of motion in the region of the affected lung, and it is well to remember that tubercular deposit as a rule commences at the apices of the lung. On percussion there will be found dull

ness

over the site where the morbid changes are taking place.

Auscultation in the first stage shows that expiration is prolonged, and a dry friction sound is heard. Mucus rales are most always present and crepitation over the affected region will be heard.

The Second Stage.-The symptoms in the second stage of pulmonary phthisis show signs of softening of the tubercular masses and formation of cavities within

the lungs. In the second stage the cough is commonly paroxysmal and the paroxysms come on at any hour during the twenty-four. In some cases it occurs in the early morning, and in other cases it may occur about one or two o'clock in the afternoon, or late in the evening, though there is no fixed rule; in some cases the cough is not paroxysmal, but almost a constant thing. In this stage of the disease the expectoration is of a yellowish color, and is sometimes streaked with blood, and not infrequently the sputa is composed largely of pus.

Respiration depends on the amount of lung-surface involved in the morbid process. If the air-cells are largely obstructed, respiration is usually quick and somewhat painful, and on the other hand if the lung-surface is small, that is involved in a pathological state, there is not much alteration in the function of respiration.

The pulse in this stage of consumption ranges from 90 to 130 per minute, and is generally weak, but regular.

The temperature is both pyrexial and subnormal, and its height depends on the amount of inflammation going on in the lung substance. The febrile temperature commonly ranges from 100 to 105°F., and the subnormal temperature ranges from 92 to 98°F. The high temperature is generally in the evening, and the low in the morning, though the reverse may happen.

Physical Signs.-The physical signs in this stage differs very much in different cases. On percussion, there is an increase of dullness which is caused by the lung becoming solidified, and this solidification is thought, by some, to be caused mostly from pneumonia of adjacent lobules. It sometimes happens that cavities have formed deep in the substance of lung tissue, and are very obscure in regard to physical signs.

Upon auscultation in the second stage where bronchophony existed, and fine crepitating rales were heard, crepitation of a very different character is heard, which is first a click sound that gradually develops into a croak, and when this last note has been reached we hear the tubular sound in coughing, and soon the sound which is characteristic of a cavity is audible.

Third Stage.-In this stage there is generally profuse diarrhea and the night