A Practical Treatise on the Diseases of Children. By D. Fran-
cis Condie, M. D., Secretary of the College of Physicians,
etc., etc. Fourth Edition, revised and augmented. Philadel-
phia, Blanchard and Lea, 1853. pp. 732.
Dr. Condie’s excellent treatise on the Diseases of Children is
so familiar to the American profession as a standard work, and
it has on previous occasions been so fully noticed in our columns,
that we need only now announce the recent appearance of a
/ouriA edition. The author’s great experience, extensive read-
ing, and familiarity with foreign languages, peculiarly fit him for
the execution of such a work ; and its value is abundantly proved
by the numerous editions which it has reached in a very short
period. It is characterized by great clearness and lucidity of
style and arrangement, sound pathological views, and precise
and plain therapeutical directions. The author claims “ to pre-
sent only those remedies and plan of treatment which he has
found from actual observation, made at the bedside of the patient,
to be best adapted to relieve or remove the several forms of dis-
ease of which he treats. *	*	* lie has not failed, however,
o notice every remedy and plan of treatment which comes to us
with the recommendation of practitioners of unquestionable au-
thority, even although he may not have had an opportunity of
testing its efficacy.”
Dr. Condie’s remarks on re-vaccination appear to us to present
very sound views on this subject. He believes that the system,
once fully infected with the vaccine disease, enjoys a “ protec-
tion against the occurrence of small pox, which is unimpaired
with the lapse of time.” But he admits and advocates the ne-
cessity of re-vaccination, “ as a test whether the susceptibility of
the individuals to the variolous disease has been fully extin-
guished.” Whatever theoretical view may be adopted on this sub-
ject, whether with Dr. Condie, we assume that in a certain number
of persons there exists “ a greater or less degree of susceptibility
to variolous infection, [which is] left unextinguished, and which
susceptibility augments in time,” or whether we adopt the opin-
ion, “that the protective powers of the vaccine infection become
gradually impaired, as the individuals who have been subjected
to its influence advance in age,” we think the question of the
practical value of re-vaccination is abundantly settled. Our own
experience in re-vaccinations, in a large Institution of children,
has resulted in about 11 per cent, of cases, in which the genuine
vesicle was reproduced in individuals who were supposed to have
been vaccinated, and had good scars. And our first experiments
with re-vaccination in this Institution, led we think, to very stri-
king evidence of its prophylactic virtues. Two cases of modified
small pox occurred in the Institution, during the epidemic which
prevailed in this city in 1851. Immediately on the appearance
of the eruption, we re-vaccinated all the inmates (over a hundred
and thirty.) In twelve, the re-vaccination was successful, a large
number had sore arms, with more or less approximation to the
genuine vesicle; but no other cases of varioloid or small pox oc-
curred in the Institution,
A Treatise on Diseases of the Heart. By O’B. Bellingham,
M. D. F. R. C. S. Member of the Court of Examiners of the
Royal College of Surgeons in Ireland, etc., etc. Part 1. Dub-
lin : Fannin and Co. pp. 252.
This work is a republication, with revisions and: additions, of
Clinical Lectures delivered by the author at St. Vincent’s Hos-
pital, Dublin. They appeared originally in the Dublin Medical
Press, and London Medical Gazette ; and, having attracted con-
siderable attention, have been appropriately re-issued in a distinct
form.
“ The work consists of two Parts : the first contains a description of
the healthy heart, its size, weight, and the measurement of its cham-
bers and orifices ; followed by sufficiently full details respecting its mo-
tions and sounds. The examination of the heart in disease is then en-
tered upon, commencing with the physical signs; the general signs, and
the secondary or remote symptoms of cardiac disease are described in suc-
cession. The second part is devoted to the individual diseases of the heart,
which are arranged according as their seat is the investing membrane,
the lining membrane, or the muscular tissue of the heart, followed by a
description of the functional or inorganic affections of the heart.”—Pre-
face, p. 8.
Part second only ha3 been issued. It will be found to present
a clear, concise, and accurate account of the heart, with original
and novel views of its motions and sounds in health and disease.
The author rejects both valvular action and muscular contraction
as influencing the normal sounds of the heart, and accounts for
both the first and second sound as the result of friction between
the blood and the parietes of the-orifices of the heart. We extract
his explanation of the sounds at length.
a First sound.—The first sound of the heart we know is synchronous
with the ventricular systole : in this act, the blood, compressed by the
contraction of the powerful muscular walls of the ventricles, is propelled
with considerable force into the aorta and pulmonary artery, the sigmoid
and semilunar valves of which are suddenly elevated. In the rapid
passage of the blood from a wider to a narrower area, there must be
considerable friction between this fluid and the parietes of the arterial
orifices ; quite sufficient, in my mind, to produce the prolonged first
sound of the heart. This sound necessarily has a distinct character
from the second sound of the heart, because the resistance to be over-
come is so much greater, and the passage of the blood through these
orifices is more gradual; it is likewise more prolonged, because sound
must be developed during the entire period that the blood is passing
from the ventricles into the large arteries : and the slower the action of
the heart, the more prolonged will this sound be.
Second sound.—The second sound of the heart we know is synchro-
nous with the ventricular diastole : during this act the muscular fibres
of the ventricles are relaxed, the cavity of the ventricles enlarges, and
the walls of the ventricles re-expand j the curtains of the auriculo-ven-
tricular valves open, and there is a sudden influx of blood from the
auricles through the auriculo-ventricular orifices. It is scarcely neces-
sary to say, that it is not the contraction of the auricles which propels
the blood into the ventricles at this period of the heart’s action ; nor is
the dilatation of the cavities of the ventricles the result of the entrance
of the blood from the auricles, as some have supposed. It is not, either,
necessary for the production of this sound that the diastole of the ven-
tricles should be an active process like the systole ; the ventricles being
hollow muscles, the state of relaxation of their muscular fibres is a state
of dilatation of their cavities : hence a vacuum would be created in
them if the auricles were not at this period full of blood ready to supply
them, but, as the latter had been filling during the whole period of the
ventricular systole, this cannot happen, and the blood passes through
the auriculo-ventricular orifices in a full and rapid stream, and with suf-
ficient force to generate sound.
That the blood enters the ventricles with considerable force, would
appear from what has been observed in experiments upon animals, as
well as in the human subject. Cruveilhier says that, in a case of ectopia
of the heart in an infant, when the organ was grasped with the hand
during the ventricular diastole, it was violently and forcibly opened,-—
so much so, that he was at first under the impression that the diastole
was the active state of the ventricles.
The second sound of the heart is much shorter than the first sound
because the relaxation of the muscular fibres of the ventricles in the
diastole is rapid, and the motion is sudden and instantaneous. It has a
different character from the first sound, because the blood has no im-
pediment to overcome in entering the ventricles from the auricles.’’
That friction between the blood and parietes of the orifices of
the heart must be an important element in producing the first
sound of the heart, we have long believed, and, with the author,
we have regarded it as an inconsistency “ to reject this element
as incapable of producing the normal sounds, while it is set down
as the one which almost exclusively gives rise to the abnormal
sounds of the heart. We cannot, however, subscribe to the opinion,
that friction is the only element in causing the first sound of the
heart, for we believe it to be produced by several elements. And
we cannot at all understand, how the short, sharp second sound
is to be referred to the same cause as the first. Dr. Bellingham
dwells pointedly upon its “different character from the first sound,”
which he attempts to explain by the fact “ that the blood has no
impediment to overcome in entering the ventricles from the auri-
cles.”
We have been for sometime disposed to lean to the opinion,
that both the sounds and impulse of the heart are best explained
by adopting the account of its actions which has been deduced
from the observations of Dr. Robinson, of Virginia, and Mr.
Beau, of France. According to the cases of these observers
(new born infants in whom the breast-bone was wanting) the ac-
tion of the heart begins with an active diastole or dilatation of
the organ in all directions, during which its apex is projected up-
ward and forward, and the impulse is produced. This active di-
astole is followed, without observable interval, by the contraction
or systole. And the first sound is probably the result, 1, of the
friction between the blood and the auriculo-ventricular orifices
during the active diastole ; 2, of the subsequent closure of the
mitral and tricuspid valves; and 3, of the friction between the
blood and the orifices of the aorta and pulmonary artery, during
the systole ; while, 4, the impulse, and also 5, the muscular con-
traction in the systole may contribute to this sound. The se-
cond sound, according to this view, is produced by the closure of
the semilunar and sigmoid valves, after the systole.
These opinions have been urged with much ability by Dr. A.
Stills, in a work on General Pathology, and are now adopted by
Prof. Wood in his lectures at the University of Pennsylvania.
They are certainly plausible ; and, although they require the con-
firmation of further observations, before they can be positively
admitted, they appear to us to offer the best explanation of all
the phenomena of the heart’s action that has been presented.
Dr. Bellingham’s chapters on the Examination of the Heart in
Disease, and on the Signs of Cardiac Disease, present a faithful
and graphic picture of what is known on these subjects, and on
many points his views are striking and original. We shall look
with anxiety for the speedy appearance of Part Second.
Proceedings of the American Pharmaceutical Association, at the
Annual Meeting held in Boston, August, 1853. pp. 48.
We have read these proceedings with much interest, and we
feel confident that the action of this Association is destined to
accomplish great good. It has taken the highest ground on the
subject of quack medicines, as will be seen both from the reso-
lutions adopted, and negatived.	y
Those adopted were—
“ Resolved,—That the American Pharmaceutical Association believe
that the use and sale of secret or quack medieines is wrong in principle,
and is in practice attended with injurious effects to both the profession
and the public at large, and believe it to be the duty of every conscien-
tious druggist to discourage their use.
“ Resolved,—That this Association earnestly recommend to our phar-
maceutical brethren to discourage by every honorable means the use of
these nostrums; to refrain from recommending them to their customers ;
not to use any means of bringing them into public notice; not to manu-
facture or to have manufactured any medicine the composition of which
is not made public ; and to use every opportunity of exposing the evils
attending their use, and the false means which are employed to induce
their consumption.”
The resolution lost carries a no less pregnant negative.
(l The following resolution, [embodying an opinion of the Committee
on the Inspection of Drugs,] was offered, and after much discussion de-
cided negatively :
il Resolved, That we believe the Drug Law was never designed to
exclude foreign secret or quack medicines through the Custom House,
nor do we believe this justifiable however desir able.'’